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Background: The diagnosis of periprosthetic joint infection (PJI) remains a challenge in clinical practice. Many novel serum and joint fluid biomarkers have important implications for the diagnosis of PJI. The presented study evaluated the value of joint fluid interleukin-6 (IL-6) combined with the neutral polymorphonuclear leukocyte (PMN%) ratio for chronic PJI diagnosis after arthroplasty. Materials and methods: Sixty patients with chronic PJI or aseptic failure who underwent hip or knee revision from January 2018 to January 2020 in our department were included in this retrospective study. According to the 2013 MSIS diagnostic criteria, the 60 patients were divided into a PJI group and a non-PJI group (30 patients per group). We collected the joint fluid before surgery and determined the level of IL-6 and the PMN% by ELISA, and the differences between the two groups were compared. The diagnostic efficacy of joint fluid IL-6 combined with PMN% in chronic PJI was analyzed using a receiver operating characteristic curve (ROC curve). Results: The diagnosis of PJI using joint fluid IL-6 combined with PMN% presented an area under the curve of 0.983, which was more accurate than the areas under the curve for diagnosis using IL-6 and PMN% individually (0.901 and 0.914, respectively). The optimal threshold values for IL-6 and PMN% were 662.50 pg/ml and 51.09%, respectively. Their sensitivity and specificity were 96.67% and 93.33%, respectively. The accuracy of the diagnosis of PJI was 95.00%. Conclusions: Joint fluid IL-6 combined with PMN% can be used as an auxiliary method to detect chronic infection around the prosthesis after hip/knee arthroplasty. Level of evidence: Patients who underwent hip/knee revision at the First Hospital of Chongqing Medical University for periprosthetic infection or aseptic failure of the prosthesis after hip/knee arthroplasty from January 2018 to January 2020 were included. Trial registration This study was approved by the ethics committee of the First Hospital of Chongqing Medical University on September 26, 2018 (local ethics committee number: 20187101) and registered with the China Clinical Trials Registry (registration number: ChiCTR1800020440) with an approval date of December 29, 2018. [ABSTRACT FROM AUTHOR]

The diagnosis of prosthetic joint infection (PJI) is still a challenge, the ratio of interleukin-6 (IL-6) to IL-4 in the joint fluid of knee or hip was used to analyze whether the diagnostic accuracy of PJI can be improved. Between January 2017 and May 2022, 180 patients who developed pain after revision total hip or knee arthroplasty were enrolled retrospectively. 92 patients of PJI and 88 of aseptic failure were included. PJI was as defined by the Musculoskeletal Infection Society (MSIS). The content of IL-6 and IL-4 in synovial fluid of knee or hip were measured, and the areas under the receiver operating characteristic curve (ROC) and IL-6/IL-4 curve were analyzed to obtain a better diagnostic effect. The area under the curve of IL-6/IL-4 in synovial fluid of knee or hip was 0.9623, which was more accurate than ESR 0.5994 and C-reactive protein 0.6720. The optimal threshold of IL-6/IL-4 ratio was 382.10. Its sensitivity and specificity were 81.32% and 98.86%, respectively. The positive predictive value for the diagnosis of PJI was 98.91%. This study showed that the level of IL-6/IL-4 in synovial fluid of knee or hip could further improve the diagnostic accuracy for PJI. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of periprosthetic joint infection (PJI), especially chronic PJI, is very confusing and challenging. The value of C-reactive protein (CRP) in infectious diseases has been recognized, but the diagnostic value of CRP in chronic PJI is unknown. Our aim was to investigate the diagnostic value of synovial CRP in chronic PJI and to explore the role of combined serum and synovial CRP in distinguishing chronic PJI from aseptic failure after knee and hip arthroplasties.Methods: We prospectively enrolled patients scheduled to have a revision surgery for chronic PJI or aseptic loosening from January 2019 to December 2020, in which synovial CRP was additionally measured along with routine preoperative diagnostic serum ((ESR, CRP) and synovial (PMN%) biomarkers. The receiver operating characteristic (ROC) curves and area under the curve (AUC) were analyzed for each biomarker to determine diagnostic efficacy.Results: There were no statistically significant differences between the infection (n = 39) and aseptic (n = 58) groups, including 61 hips and 36 knees. The synovial CRP levels were significantly higher in the infection group than in the aseptic group (median: 9.93 mg/l vs 3.58 mg/l; p < .001). The optimal cut-off value for detecting chronic PJI of Synovial fluid (SF) CRP was of 7.26 mg/l with a sensitivity of 84.62%, a specificity of 93.10%. The combined model I (Serum CRP > 10.2 mg/l OR SF CRP > 7.26 mg/l) had a negative predictive value (NPV) of 96.67%, and a sensitivity of 97.44%. The combined model II (Serum CRP > 10.2 mg/l AND Synovial CRP > 7.26 mg/l) led to a specificity of 1, and a positive predictive value (PPV) of 1.Conclusions: The present study demonstrated that the combination of serum and synovial CRP can be used as an adjunct to the diagnosis of chronic PJI. [ABSTRACT FROM AUTHOR]

The rising incidence of ectopic pregnancy (EP) in China underscores the critical need for early and accurate diagnosis to achieve optimal patient outcomes. Colour Doppler ultrasound, β-hCG, and progesterone testing are essential tools in the detection of EP, with transvaginal ultrasound offering precise visualization of EP lesions. Lower levels of β-hCG and progesterone in EP cases compared to normal pregnancies serve as key diagnostic markers. Awareness of atypical symptoms is crucial to prevent missed or misdiagnosed cases, underscoring the importance of timely intervention to mitigate severe complications.To investigate the differences in colour Doppler ultrasound findings, serum β-hCG levels, and progesterone levels between normal and ectopic pregnancies, in order to provide insights into the clinical diagnosis and treatment of EP.Sixty patients who showed no gestational sac in the uterus during early pregnancy and were either highly suspected or pathologically confirmed to have EP were selected for this study. As controls, fifty women with normal pregnancies during the same period were also included. Colour Doppler ultrasound findings (endometrial thickness, pelvic effusion, uterine effusion, and adnexal mass), serum β-hCG levels, and progesterone levels were recorded and compared between the two groups.Colour Doppler ultrasound showed that the EP group had significantly greater incidences of pelvic effusion, uterine effusion, and an adnexal mass than did the control group. Moreover, the EP patients had significantly thinner endometria (8.3 ± 3.37 mm vs. 16.12 ± 3.09 mm; P < 0.05), lower serum β-hCG levels (846.18-1444.09 vs. 2429.24–3020.56; P < 0.05), and lower progesterone levels (9.1 ± 7.19 vs. 17.66 ± 5.63; P < 0.05) than did the controls. Receiver operating characteristic (ROC) analysis revealed that endometrial thickness, serum β-hCG concentration, and progesterone concentration had considerably high area under the curve (AUC), sensitivity, and specificity for the diagnosis of EP.Colour Doppler ultrasound, serum β-hCG concentration, and progesterone concentration have high diagnostic value for EP. [ABSTRACT FROM AUTHOR]