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The aim of this prospective study was to use direct matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) to rapidly diagnose periprosthetic joint infections (PJIs). Synovial fluid was taken from 77 patients (80 joints, 41 hips and 39 knees) who met the International Consensus Meeting criteria for PJI, and inoculated into blood culture bottles (BCBs) and onto conventional swabs. Positive blood cultures were analyzed using either direct or routine MALDI-TOF MS. Pathogen identification and the time to identification was recorded. Differences between groups were analyzed using the Kruskal-Wallis test and Bonferroni's post-hoc test. Direct and routine MALDI-TOF MS both detected 64 positive results (80%), compared to 47 (59%) by conventional swabs (p = 0.002). Direct MALDI-TOF MS identified 85.3% of the gram-positive organisms and 92.3% of the gram-negative organisms. No fungi were identified by direct MALDI-TOF MS. In 17 BCBs that were flagged positive, identification by direct MALDI-TOF MS failed. Among the positive results in the direct MALDI-TOF MS group, Staphylococcus aureus accounted for 47%, followed by Staphylococcus epidermidis (17%), Escherichia coli (9%) and Klebsiella pneumoniae (9%). The median time to microorganism identification was significantly shorter with direct MALDI-TOF MS (12.7 h, IQR: 8.9-19.6 h) than with routine MALDI-TOF MS (39.5 h, IQR: 22.8-46.0 h) or swabs (44.4 h, IQR: 27.2-72.6 h) (p < 0.0001). In pairwise comparisons, there were significant differences in the time of microorganism identification between direct MALDI-TOF MS and routine MALDI-TOF MS (p < 0.0001) or swab culture (p < 0.0001). There was no significant difference between routine MALDI-TOF MS and swab culture (p = 0.0268). Compared with current laboratory practice, direct MALDI-TOF MS shortened the time to microorganism identification and had superior results compared to conventional swabs, except for fungi. Further studies should investigate whether the earlier administration of appropriate antimicrobial agents can improve the treatment outcomes of PJIs.

Background The optimal timing for reimplantation for periprosthetic joint infection (PJI) has not been established and varies from a few weeks to several months. The aim of this study was to assess the commendable time between implant removal and reimplantation in patients who underwent two-stage exchange arthroplasty for PJI. Methods We retrospectively reviewed 361 patients who were treated with two-stage exchange arthroplasty for hip and knee chronic PJI at our institution between January 2000 and December 2018. Patient characteristics, comorbidities, surgical variables, microbiology data, and time to reimplantation were recorded. All patients were followed for a minimum of one year. Treatment failure was defined by Delphi criteria. Logistic regression analyses were used to calculate survival rates and adjusted odds ratios (ORs) of treatment failure. Results In final analysis, 27 (7.5%) had treatment failure. Factors related to treatment failure including interim spacer exchange (OR, 3.13; confidence interval (CI), 1.04–9.09, p = 0.036), higher ESR level at reimplantation (OR, 1.85; CI, 1.05–3.57; p = 0.04), and time to reimplantation (OR, 1.00; CI, 1.003–1.005, p = 0.04). Performing revision arthroplasty surgery from 16 to 20 weeks had highest successful rate. The reimplantation over 24 weeks had a lower successful rate. However, no statistical significance in comparing each interval group. Conclusion Our study emphasized the importance of timely reimplantation in achieving successful outcomes. Factors such as ESR levels, spacer exchange, and the duration of time to reimplantation influenced the likelihood of treatment failure in two-stage exchange arthroplasty for hip and knee PJI.

In this work, an ultra-thin silver film-coated grating as a split silver nanotube array exhibits not only high TE polarized reflectance as a conventional subwavelength grating but also high TM polarized reflectance that is close to or higher than TE reflectance at certain wavelength range. The TM reflectance peak shifts with the morphology of the silver covering. The near-field analysis reveals that the silver nanotube array is an ultra-thin optical double negative metamaterial. The negative permeability associated magnetic field reversal is induced within the grating that is surrounded by a split current loop at the TM reflectance peak wavelength. The near field simulation is used to retrieve the equivalent electromagnetic parameters and optical constants that cause the anomalous TM high reflection. It is demonstrated that the TM impedances have a low magnitude and high magnitude with respect to unity for light incident onto the top and bottom of the grating at the peak wavelength, respectively.

Solitary fibrous tumor (SFT) is characterized by the inv12(q13q13)-derived NAB2–STAT6 fusion, which exhibits variable breakpoints and drives STAT6 nuclear expression. The implications of NAB2–STAT6 fusion variants in pathological features and clinical behavior remain to be characterized in a large cohort of SFTs. We investigated the clinicopathological correlates of this genetic hallmark and analyzed STAT6 immunoexpression in 28 intrathoracic, 37 extrathoracic, and 23 meningeal SFTs. These 88 tumors were designated as histologically nonmalignant in 75 cases and malignant in 13, including 1 dedifferentiated SFT. Eighty cases had formalin-fixed and/or fresh samples to extract assessable RNAs for RT-PCR assay, which revealed NAB2–STAT6 fusion variants comprising 12 types of junction breakpoints in 73 fusion-positive cases, with 65 (89%) falling into 3 major types. The predominant NAB2ex4–STAT6ex2 ( n =33) showed constant breakpoints at the ends of involved exons, whereas the NAB2ex6–STAT6ex16 ( n =16) and NAB2ex6 – STAT6ex17 ( n =16) might exhibit variable breakpoints and incorporate NAB2 or STAT6 intronic sequence. Including 73 fusion-positive and 7 CD34-negative SFTs, STAT6 distinctively labeled 87 (99%) SFTs in nuclei, exhibited diffuse reactivity in 73, but did not decorate 98 mimics tested. In seven fusion-negative cases, 6 were STAT6-positive, suggesting rare fusion variants not covered by RT-PCR assay. Regardless of histological subtypes, intrathoracic SFTs affected older patients ( P =0.035) and tended to be larger in size ( P =0.073). Compared with other variants, NAB2ex4–STAT6ex2/4 fusions were significantly predominant in the SFTs characterised by intrathoracic location ( P <0.001), older age ( P =0.005), decreased mitoses ( P =0.0028), and multifocal or diffuse STAT6 staining ( P =0.013), but not found to correlate with disease-free survival. Conclusively, STAT6 nuclear expression was distinctive in the vast majority of SFTs, including all fusion-positive tumors, and exploitable as a robust diagnostics of CD34-negative cases. Despite the associations of NAB2–STAT6 fusion variants with several clincopathological factors, their prognostic relevance should be further validated in large-scale prospective studies of SFTs.

The transmittance, reflectance, and extinctance that correspond to the localized plasmonic resonance within TiN nanorods were investigated. The obliquely deposited TiN nanorod array shows polarization-independent admittance matching to air. Unlike noble metal nanorods, the near-field localized longitudinal and transverse plasmonic resonance of TiN nanorod arrays present polarization-dependent light extinction in the far field. The longitudinal plasmonic mode presents stronger extinction than transverse plasmonic mode. In order to have high efficient light absorption, an ultra-thin two-layered TiN nanorod array was fabricated with orthogonal deposition planes for upper layer and bottom layer to absorb different polarized light energy. The measured spectrum shows broadband and wide-angle light extinction.

Background This study aimed to conduct a systematic review and meta-analysis to assess the impact of extended postoperative oral antibiotic prophylaxis (EPOAP) on the risk of reinfection following two-stage exchange arthroplasty for hip and knee periprosthetic joint infection (PJI). Methods A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted on January 11, 2025. Studies reporting reinfection rates in patients receiving EPOAP after two-stage exchange arthroplasty, compared to those who did not, were included. A random-effects model was used to calculate pooled risk ratios (RRs) and subgroup analyses were performed based on the duration of EPOAP use (> 2 weeks vs. ≤2 weeks) and the joint site (hip or knee). Results Five studies, including four retrospective cohort studies and one randomized controlled trial, with a total of 486 knees and 444 hips, were included. The meta-analysis demonstrated that EPOAP significantly reduced the risk of reinfection following two-stage exchange arthroplasty (pooled RR: 0.52; 95% confidence interval [CI]: 0.35, 0.75; p  = 0.0006). Subgroup analyses yielded similar findings, with significant reductions in reinfection risk for EPOAP duration > 2 weeks (pooled RR: 0.51; 95% CI: 0.34, 0.78; p  = 0.002), hip arthroplasty (pooled RR: 0.37; 95% CI: 0.20, 0.70; p  = 0.002), while knee arthroplasty showed a borderline nonsignificant reduction (pooled RR: 0.64; 95% CI: 0.39, 1.04; p  = 0.07). Only one cohort study reported a decreased risk of reinfection with EPOAP use ≤ 2 weeks. Two studies assessed adverse events related to EPOAP. No complications were observed among 22 patients in one cohort study, whereas 6 of 22 patients (27%) in an RCT experienced mild gastrointestinal or dermatologic reactions that led to treatment discontinuation. Additionally, another cohort study reported that 16 of 24 reinfection cases (67%) involved organisms resistant to EPOAP. Conclusions This meta-analysis suggests that EPOAP is associated with a reduced risk of reinfection following two-stage exchange arthroplasty for hip arthroplasty, while further research is warranted for knee cases. This approach may improve patient outcomes and help optimize post-operative antibiotic management.

This study investigated variations in strain concentration factors (Kε) within the full deformation range of self-reinforced poly(ethylene terephthalate) composites (srPETs) with double-edge semicircular holes (DESH) using digital image correlation (DIC) at different width-to-diameter (W/D) ratios. The value of Kε agrees with the theoretical concentration factor (Kt) within the elastic deformation range; then, it increases rapidly to a peak because of plastic deformation. Therefore, the change in Kε was divided into different stages based on the spread of the yield extent (beginning from the hole edge). These results will help improve the understanding of the yielding phenomenon of open-hole materials and provide early warnings before final material damage. Kε decreased in both the elastic and plastic regions with a decrease in W/D; however, there was an exception when the W/D ratio = 1.5. Therefore, the geometric configuration W/D > 1.5 was recommended for designing secure structural ductile composites. The Kε of DESH is lower than that of circular holes (CH) in both the elastic and plastic regions for the hole effect. Thus, composites with DESH should be preferred as an alternative for structural applications.

Coal-based thermal power generation has long been the main source of power generation in the mainland of China. The efficiency of power generation is an important factor that determines the energy conservation and emission reduction as well as the sustainable development of the power industry in China. By comparing the regional differences of 30 provinces in the mainland from 2013 to 2017, this study uses the Super-DDF model and the TFEE to comprehensively evaluate the energy efficiency of thermal power generation. Empirical results: Overall efficiency: eastern efficiency (1.181) is the highest, followed by western (0.956), central (0.951) and northeastern (0.926). Total factor energy efficiency: eastern efficiency (0.923) is the highest, followed by western (0.754), central (0.742) and northeastern (0.710). The government and power industry managers should fully consider the regional differences in the field of thermal power generation when formulating policies so as to improve the power efficiency and promote the green development of power industry in China. Based on the analysis results, although the coal-fired power industry is more mature than other alternative energy industries, the expansion of thermal power generation cannot be considered if CO2 emissions are to be reduced. Additionally, the market share and competitiveness of the local power industry can be increased based on the different conditions of the resource endowments of each region.

Massive perioperative blood loss in complex revision total joint arthroplasty (TJA) often requires blood transfusions. Tranexamic acid (TXA) has been used in elective primary TJA to minimize blood loss and transfusions. The purpose of this meta-analysis was to evaluate the safety and efficacy of intravenous TXA in revision TJA. A literature search of PubMed, Scopus, and the Cochrane Controlled Trials Register was performed to identify studies published between January 2000 and May 2017. All randomized controlled trials (RCTs) and retrospective cohort observational studies evaluating the efficacy of intravenous TXA during revision total knee arthroplasty (TKA) and total hip arthroplasty (THA) were included. The mean differences (MDs) of blood loss, hemoglobin (Hb) change, and red blood cell (RBC) units transfused were compiled, and ORs of transfusion and venous thromboembolism (VTE) events in TXA and control groups were calculated. Seven studies involving 930 patients were included (501 TXA vs 429 control). Intravenous TXA use had a significantly less blood transfusion (OR=0.20, 95% CI=0.11-0.34, <0.001), lower Hb drop (MD=-0.88, 95% CI=-1.31 to -0.44, <0.001), and less number of RBC units transfused (MD=-0.44, 95% CI=-0.65 to -0.24, <0.001) compared to control in the postoperative period. No significant difference was seen in blood loss (MD=-245, 95% CI=-556 to 66, =0.12) and VTE events (OR=0.57, 95% CI=0.13-2.42, =0.45) between groups. Our meta-analysis suggests that intravenous administration of TXA can significantly reduce blood transfusion requirements following revision TJA, without increasing the risk of VTE. However, due to the variation in included studies, larger RCTs are required to draw firm conclusions.

Background Computer-assisted surgical navigation has been used in total knee arthroplasty (TKA) procedures for years trying to the accuracy of prosthesis placement. We conducted this prospective randomized clinical trial to compare the accuracy of the radiographic parameters of the prosthesis, total blood loss (TBL), and related complications, between a new pinless navigation system (Stryker OrthoMap Express Knee Navigation) and conventional method in patients undergoing minimally invasive (MIS) TKA procedures. Patient and methods A consecutive series of 100 patients underwent unilateral primary TKA were randomly assigned into two groups: navigation group and convention group. The radiographic parameters of the knee implant and the alignment of lower limb were measured at 3 months after surgery. TBL was calculated according to Nadler’s method. The duplex ultrasonography of both lower limbs was performed in all patients to detect the presence of deep-vein thrombosis (DVT). Results Totally, 94 patients have completed the radiographic measures. Only the coronal femoral component angle in the navigation group (89.12° ± 1.83°) had significant differences from that in the convention group (90.09° ± 2.18°) ( p  = 0.022). There were no differences in the rate of outliers. The mean TBL in the navigation group was 841 ± 267 mL, which was similar to that in the convention group at 860 ± 266 mL ( p  = 0.721). Postoperative DVT risk did not differ between the two groups (2% vs. 0%, p  = 0.315). Conclusion This pinless navigation TKA showed a comparable acceptable alignment compared with conventional MIS-TKA. There were no differences regarding postoperative TBL between the two groups.