Mid-term clinical outcomes of the uncemented Robert Mathys pressfit cup

BACKGROUND The use of uncemented cups during total hip arthroplasty(THA)has gained popularity in recent years.The Robert Mathys(RM)pressfit cup,an uncemented monoblock implant is expected to preserve bone density due to its composition and external surface,while reducing backside wear with its monoblock construction.These factors should lead to a high survival rate of the implant.AIM To evaluate the mid-term survival and functional outcome of the RM Pressfit cup in a large study population.METHODS Between 2011 and 2020,we included 1324 patients receiving a primary THA using the RM pressfit cup.Final clinical follow-up was performed at 2 years postoperatively with the Dutch arthroplasty register used to assess implant status thereafter.Revision for acetabular failure and reason for revision were reported to evaluate implant survival,while the hip disability and osteoarthritis outcome score(HOOS)scores were used to assess functional outcome.RESULTS The mean age at surgery was 64.9 years.The mean follow-up was 4.6 years.Of the 1324 THAs performed,13 needed cup revisions within 5 years after index THA:5 due to aseptic loosening,6 due to infection,2 due to dislocation and 2 due to other causes.This resulted in a 5-year cup survival of 98.8%(95%CI:98.1-99.5).Nine of the cup revisions occurred within the first year after index THA.HOOS scores increased significantly in all domains during the first year and levelled out during the second year.CONCLUSION In the present study,the RM pressfit cup demonstrated excellent clinical outcomes at mid-term follow-up;however,future studies are needed to assess the long-term outcomes of this acetabular implant.

Appearance of aseptic vascular grafts after endovascular aortic repair on[(18)F]fluorodeoxyglucose positron emission tomography/computed tomography

BACKGROUND Diagnosis of prosthetic vascular graft infection with[(18)F]fluorodeoxyglucose positron emission tomography/computed tomography(18F-FDG PET/CT)allows for early detection of functional changes associated with infection,based on increased glucose utilization by activated macrophages and granulocytes.Aseptic vascular grafts,like all foreign bodies,can stimulate an inflammatory response,which can present as increased activity on 18F-FDG PET/CT.Consequently,distinguishing aseptic inflammation from graft infection,though important,can be difficult.In the case of endovascular aneurysm repair(EVAR),a minimally invasive procedure involving the transfemoral insertion of an endoprosthetic stent graft,the normal postoperative appearance of these grafts on 18F-FDG PET/CT can vary over time,potentially confounding study interpretation.AIM To investigate the visual,semiquantitative,and temporal characteristics of aseptic vascular grafts in patients status post EVAR.METHODS In this observational retrospective cohort study,patients with history of EVAR who underwent 18F-FDG PET/CT for indications other than infection were identified retrospectively.All patients were asymptomatic for graft infection-no abdominal pain,fever of unknown origin,sepsis,or leukocytosis-at the time of imaging and for≥2 mo after each PET/CT.Imaging studies such as CT for each patient were also reviewed,and any patients with suspected or confirmed vascular graft infection were excluded.One hundred two scans performed on 43 patients(34 males;9 females;age=77±8 years at the time of the final PET/CT)were retrospectively reviewed.All 43 patients had an abdominal aortic(AA)vascular graft,40 patients had a right iliac(RI)limb graft,and 41 patients had a left iliac(LI)limb graft.Twentytwo patients had 1 PET/CT and 21 patients had from 2 to 9 PET/CTs.Grafts were imaged between 2 mo to 168 mo(about 14 years)post placement.Eight grafts were imaged within 6 mo of placement,including three that were imaged within three months of placement.The mean interval between graft placement and PET/CT for all 102 scans was 51±39 mo.PET/CT data was reconstructed with region-of-interest analysis of proximal,mid and distal portions of the grafts and background ascending aorta.Maximum standardized uptake value(SUVmax)was recorded for each region.SUVmax-to-background uptake ratios(URs)were calculated.Visual assessment was performed using a 2-pattern grading scale:Diffuse(homogeneous uptake less than liver uptake)and focal(one or more areas of focal uptake in any part of the graft).Statistical analysis was performed.RESULTS In total,there were 306 AA grafts,285 LI grafts,282 RI grafts,and 306 ascending aorta background SUVmax measurements.For all 102 scans,mean SUVmax values for AA grafts were 2.8-3.0 along proximal,mid,and distal segments.Mean SUVmax values for LI grafts and RI grafts were 2.7-2.8.Mean SUVmax values for background were 2.5±0.5.Mean URs were 1.1-1.2.Visual analysis of the scans reflected results of quantitative analysis.On visual inspection,98%revealed diffuse,homogeneous 18F-FDG uptake less than liver.Graft URs and visual pattern categories were significantly associated for AA graft URs(F-ratio=21.5,P<0.001),LI graft URs(F-ratio=20.4,P<0.001),and RI graft URs(F-ratio=30.4,P<0.001).Thus,visual patterns of 18F-FDG uptake corresponded statistically significantly to semiquantitative URs.The age of grafts showing focal patterns was greater than grafts showing diffuse patterns,87±89 vs 50±37 mo,respectively(P=0.02).URs were significantly associated with graft age for AA grafts(r=0.19,P=0.001).URs were also significantly associated with graft age for LI grafts(r=0.25,P<0.0001),and RI grafts(r=0.31,P<0.001).Quartiles of similar numbers of graft(n=25-27)grouped by graft age indicated that URs were significantly higher for 4th quartile vs 2nd quartile URs(F-ratio=19.5,P<0.001).When evaluating URs,graft SUVmax values within 10%-20%of the ascending aorta SUVmax is evident in aseptic grafts,except for grafts in the oldest quartiles.In this study,grafts in the oldest quartiles(>7 years post EVAR)showed SUVmax up to 30%higher than the ascending aorta SUVmax.CONCLUSION Characteristics of an aseptic vascular stent graft in the aorta and iliac vessels on 18F-FDG PET/CT include graft SUVmax values within 10%-20%of the ascending aorta background SUVmax.The SUVmax of older aseptic grafts can be as much as 30%above background.The visual uptake pattern of diffuse,homogeneous uptake less than liver was seen in 98%of aseptic vascular grafts,making this pattern particularly reassuring for clinicians.

Analysis of the Role of Nursing Intervention in Operating Room in the Prevention of Incision Infection in Orthopedic Aseptic Surgery

Objective:To explore and analyze the role of nursing in the operating room in the prevention of incision infection in aseptic orthopedic surgery.Methods:68 patients that underwent aseptic orthopedic surgery in our hospital from January 2021 to December 2022.They were divided into a research group(n=34)and a control group(n=34)by the random number table method.The patients in the control group received conventional nursing intervention in the operating room,and the patients in the study group received the optimized and modified nursing intervention in the operating room;then,the related indicators of nursing intervention of the two groups were compared.Results:The incidence of incision infection in the study group was lower than that of the control group(P<0.05);the average duration of surgery and length of stay the study group were lower than those in the control group(P<0.05);the stress response indexes of patients in the study group were lower than those in the control group 24 hours after operation(P<0.05);the degree of satisfaction of the patients in the study group to the services provided by the nursing staff was significantly higher than that of the control group(P<0.05).Conclusion:High-quality nursing intervention in the operating room for aseptic orthopedic surgery patients can significantly reduce the incidence of incision infection,reduce the stress response caused by surgery,shorten the duration of surgery and length of stay,and improve nursing satisfaction,which makes it worthy of popularization.

Effects of Exogenous Hormones on Subculture Multiplication and Root Induction of Tissuecultured Seedlings of Mulberry

Objective The purpose of this experiment was to investigate the effects of exogenous hormone factors on subculture multiplication and root induction of tis-suecultured seedlings in mulberry. [Method] The aseptic seedlings of Guisangyou 12 were used as the materials and the comparative experiment on subculture multi-plication and root induction used different kinds,concentrations and combinations of exogenous hormones. [Result] The hormone combination of 0.1 mg/L IBA＋1.5 mg/L 6-BA＋0.03 mg/L TDZ showed the best effects to bud multiplication, and the multiple of bud multiplication was 5.28. The effects of NAA was better than IBA and IAA on root induction. The hormone combination of 2.0 mg/L NAA＋1.0 mg/L PP333 was most suitable to the root induction, in which the rooting rate arrived to 100%, the root number was 7.01 and the root length was 1.38 cm on average. [Conclusion] The results wil provide some technical reference for large-scale propagation of mul-berry seedlings in vitro.

Preliminary Studies on the Tissue Culture of Cannabis sativa L.(Industrial hemp)

The internodes of the new cultivar Long-ma No.1 of Cannabis sativa L.（Industrial hemp） were used as explants for tissue culture. The paper studied the key factors of industrial hemp tissue culture, such as the physiological state of aseptic seedlings, the selection and concentration of plant growth regulators and so on.Hemp seed disinfection used 75% alcohol for 2 min and sterilized in 1‰ Hg Cl2 for 5min. The best combinations of plant growth regulators were 1.0 mg/L 6-BA and 0.5mg/L NAA for the induction of callus, and the best combinations of hormones were1.0 mg/L KT and 0.5 mg/L NAA for differentiation rate of adventitious bud.

Aseptic Seedling and Rapid Propagation of Ludisia discolor

[Objective] This study was conducted to establish a system for aseptic seeding and rapid propagation of a wild Chinese herbal medicine Ludisia discolor. [Method] The seeds of L. discolor were germinated in four different culture media MS, 1/2MS, Hyponex No.1 （3.0 g/L）, and 1/2 Hyponex No.1 （1.5 g/L）, and the ger- mination rate was calculated 80 d later to select the optimal medium for seed ger- mination of L. discolor. Then, by culturing the protocorms and buds of L. discolor in the media supplemented with different hormone combinations （6-BA and NAA） or organic substrates （potato juice, banana juice and coconut milk）, the optimal medi- um compositions for multiplication and .differentiation, seedling hardening and rooting of L. discolor were respectively determined. [Result] After 80 d of dark culture, 86.67% of the seeds inoculated into the medium 1/2 Hyponex No.1 germinated and developed into protocorms, proving 1/2 Hyponex No.1 was most suitable for seed germination of L. discolor among the four basic media, while MS medium had the worst effects. In culture medium of 1/2 Hyponex No.1＋2.0 mg/L 6-BA＋100 ml/L co- conut milk supplemented with 0.4 or 0.6 mg/L NAA, a mixed body of protocorms and small buds were induced after being cultured for 45 d, and the multiplication rate was 6.11, which was higher than that in the medium supplied with 0.2 or 0.8 mg/L NAA. By adding 10% potato juice, 10% banana juice or 100 ml/L coconut milk into Hyponex No.1＋1.0 mg/L NAA, it was found that 10% banana juice had better effects in hardening and rooting of L. discolor planlets than 10% potato juice and 100 ml/L coconut milk. The small buds grew into plantlets about 80 d later in the medium with banana juice, the rooting rate was 93.33%, and the plantlet height was 7.19 cm. After hardening-culture for 10 d in a greenhouse, the L. discolor plantlets were transplanted into the mixed matrix of peat soil and lava （at a ratio of 3：1）, and 91.7% of them survived 60 d later. [Conclusion] A relatively perfect propa- gation system of L. discolor was established by using aseptic seeds as explants in this study, which can be used for the protection of L. discolor germplasm resources, seedling propagation and industrial development.

Role of polyethylene particles in peri-prosthetic osteolysis:A review

There is convincing evidence that particles produced by the wear of joint prostheses are causal in the periprosthetic loss of bone,or osteolysis,which,if it progresses,leads to the phenomenon of aseptic loosening.It is important to fully understand the biology of this bone loss because it threatens prosthesis survival,and loosened implants can result in peri-prosthetic fracture,which is disastrous for the patient and presents a difficult surgical scenario.The focus of this review is the bioactivity of polyethylene(PE)particles,since there is evidence that these are major players in the development and progression of osteolysis around prostheses which use PE as the bearing surface.The review describes the biological consequences of interaction of PE particles with macrophages,osteoclasts and cells of the osteoblast lineage,including osteocytes.It explores the possible cellular mechanisms of action of PE and seeks to use the findings to date to propose potential nonsurgical treatments for osteolysis.In particular,a nonsurgical approach is likely to be applicable to implants containing newer,highly cross-linked PEs(HXLPEs),for which osteolysis seems to occur with much reduced PE wear compared with conventional PEs.The caveat here is that we know little as yet about the bioactivity of HXLPE particles and addressing this constitutes our next challenge.

Beh et's disease complicated by multiple aseptic abscesses of the liver and spleen

Aseptic abscesses are an emergent entity and have been described in inflammatory bowel disease,especially in Crohn's disease,and in other diseases.However,aseptic abscesses associated with Beh et's disease are extremely rare.We report a Japanese male diagnosed with an incomplete type of Beh et's disease who developed multiple aseptic abscesses of the spleen and liver.In 2002,the spleen abscesses were accompanied by paroxysmal oral aphthous ulcers and erythema nodosum.As the patient's response to antibiotic treatment was inadequate,a splenectomy was performed.Severe inflammatory cell infiltration,largely of polymorphonuclear neutrophils,was observed without evidence of bacterial or fungal growth.Although the patient had no history of ocular symptoms or genital ulcers,a diagnosis of incomplete Beh et's disease was made according to the Japanese diagnostic criteria because of the presence of paroxysmal arthritis and epididymitis since 2002.In 2005,multiple liver abscesses developed with right hypochondrial pain and seemed to be attributed to Beh et's disease because the abscesses yielded negative results during a microbiologic investigation and failed to go into remission under antibiotic therapy.Oral prednisone(15 mg/d) was started in May 2006,and the abscesses dramatically disappeared 4 wk after treatment.Although the patient had a relapse of the liver abscesses in association with the tapering of prednisone,the augmentation of prednisone dosage yielded a response.The abscesses of the liver and spleen were strongly suggested to be attributed to Beh et's disease.Clinician should be aware of the existence of aseptic abscesses as uncommon manifestations of Beh et's disease.

Why total knees fail-A modern perspective review

Historically, the most common mechanism of total kneearthroplasty(TKA) failures included aseptic loosening, instability and malalignment. As polyethylene production improved, modes of failure from polyethylene wear and subsequent osteolysis became less prevalent. Newer longitudinal studies report that infection has become the primary acute cause of failure with loosening and instability remaining as the overall greatest reasons for revision. Clinical database and worldwide national registries confirm these reports. With an increasing amount of TKA operations performed in the United States, and with focus on value-based healthcare, it is imperative to understand why total knees fail.

RANK-ligand and osteoprotegerin as biomarkers in the differentiation between periprosthetic joint infection and aseptic prosthesis loosening

AIM To assess serum levels of RANK-ligand(RANKL) and osteoprotegerin(OPG) as biomarkers for periprosthetic joint infection(PJI) and compare their accuracy with standard tests.METHODS One hundred and twenty patients presenting with a painful total knee or hip arthroplasty with indication for surgical revision were included in this prospective clinical trial. Based on standard diagnostics(joint aspirate, microbiological, and histological samples) and Musculoskeletal Infection Society consensus classification,patients were categorized into PJI, aseptic loosening,and control groups. Implant loosening was assessed radiographically and intraoperatively. Preoperative serum samples were collected and analyzed for RANKL, OPG, calcium, phosphate, alkaline phosphatase(AP), and the bone-specific subform of AP(b AP). Statistical analysis was carried out, testing for significant differences between the three groups and between stable and loose implants. RESULTS All three groups were identical in regards to age, gender, and joint distribution. No statistically significant differences in the serum concentration of RANKL(P = 0.16) and OPG(P = 0.45) were found between aseptic loosening and PJI, with a trend towards lower RANKL concentrations and higher OPG concentrations in the PJI group. The RANKL/OPG ratio was significant for the comparison between PJI and non-PJI(P = 0.005). A ratio > 60 ruled out PJI in all cases(specificity: 100%, 95%CI: 89, 11% to 100.0%) but only 30% of non-PJI patients crossed this threshold. The positive predictive value remained poor at any cut-off. In the differentiation between stable and loose implants, none of the parameters measured(calcium, phosphate, AP, and b AP) showed a significant difference, and only AP and b AP measurements showed a tendency towards higher values in the loosened group(with P = 0.09 for AP and P = 0.19 for b AP). CONCLUSION Lower RANKL and higher OPG concentrations could be detected in PJI, without statistical significance.

An improvised in vitro vegetative propagation technique for Bambusa tulda： influence of season, sterilization and hormones

Season and concentration of sterilizing agents play a significant role for establishment of aseptic in vitro shoot cultures and sprouting of nodal explants from field growing culms of bamboo species. In the present investigation the nodal segment explants of Bambusa tulda Roxb collected in different seasons and treated with various concentrations of HgC12 showed significant variation in aseptic culture establishment and bud break. The rainy season （July-August） recorded with highest of 78% aseptic culture establishment whereas autumn recorded with lowest 46%. Summer and winter seasons emerged to be the best period, registering 〉 60% in vitro bud break. On the other hand, the autumn season had the lowest value for bud break, i.e. 42%. Among different doses of sterilizing agent tried, HgC12 0.1% found to be suitable for maximum aseptic culture establishment （66%） as well as bud break （59%）. However, among the interactions, summer season and the dose of 0.1% HgC12 exhibited maximum of 73% response for both aseptic culture establishment and bud break. MS medium （liquid） enriched with 5.0 μM BA ＋5.0 μM Kn [Kinetin （N6-Furfuryladenine）] with additional supplementation of 100 μM glutamine ＋ 0.1 μM IAA supported a maximum in vitro shoot multiplication of 4.75 fold. The proliferated shoots were successfully rooted on MS medium （liquid） supplemented 40 μM coumarin. The plantlets transferred to the polythene bags showed 98% survival.

Research on protoplast preparation and culture in Gladiolus hybridus Hort

Protoplasts prepared from the aseptic leaves of Rose Supreme in Gladiolus hybridus Hort. were cultured. The yield of protoplasts with vigour was the highest under the following conditions： 1.5% cellulase Onzuka RS, 0.5% pectinase Y-23, 0.6 mol· L^-1 mannitol, pH 5.8, digestion time 2 h, and temperature 27℃. After isolation and purification, protoplasts were cultured in solid and liquid combined medium, which included KM8P, 0.6 mol· L^-1 mannitol, 1.0 mg· L^-1 2, 4-D, 0.2 mg· L^-1 NAA and 0.2 mg· L^-1 KT. The division of the protoplasts first emerged in medium after cultured 4 days, and emerged only a few times.

Management of failed metal-on-metal total hip arthroplasty

The theoretical advantages of metal-on-metal(MOM)bearing couples in total hip arthroplasty(THA) have been recently balanced by concerns regarding adverse local and systemic effects. Higher than anticipated early revision rates have been reported by several joint registries. Failed MOM hips present with a spectrum of symptoms and findings and traditional methods of failure must be considered in addition to the failure modes that appear to be unique to the MOM bearing couple. Metal hypersensitivity and soft tissue immune reactions remain incompletely understood and require careful ongoing study. The tools available to evaluate MOM THAs and the indications for revision surgery remain to be defined. Outcomes following revision of MOM hips appear to depend on appropriate evaluation, early identification, and appropriate surgical management.

Medical errors, infection-control breaches and the use of adulterated and misbranded medical devices

Several well-publicized cases of improper cleaning,disinfection or sterilization of contaminated reusable medical equipment that posed an increased risk of patientto-patient disease transmission were reported within the past few years,resulting in the notification of approximately 20 000 patients.These medical errors,the specific infection-control standards they breached,and assessments of the risk of infection associated with each are discussed.Other topics discussed include the Food and Drug Administration’s(FDA)regulation of medical devices and infection-control products;the use of adulterated,misbranded,and investigational devices;consent decrees and associated Certificates of Medical Necessity;and informed patient consent.Focus is placed on liquid chemical sterilization,its history,and the FDA’s recent censure and discontinuation of a medical device labeled with this claim,namely,the STERIS System 1 processor.Recommendations are provided for healthcare facilities,regulatory agencies,manufacturers of reusable medical devices,and professional healthcare organizations and administrations to improve public health and prevent healthcareassociated infections.

Early Screening of Rice Varieties with High Essential Amino Acids by Aseptic Seedling Method

With 5 rice varieties( Yifeng 3321,Yifeng 3315,Yifeng 3317,Yifeng 45,Yifeng 14-24) as the experimental objects,the aseptic seedling method was used to culture the rice seeds,and the HPLC was used to determine the content of amino acids in aseptic rice seedlings as well as the total content of 8 kinds of essential amino acids and the content of protein. And the content of protein and amino acids in the polished rice of 5 varieties was detected,and the analysis of variance was performed for screening of the varieties containing high essential amino acids. The rice with high essential amino acids could be produced to meet people's rice quality requirements. The analysis of variance indicated that there were significant differences( F = 39. 262,p = 0. 01) in the content of essential amino acids among 5 kinds of rice varieties. By the Duncan's multiple comparison,the differences among rice varieties were calculated to obtain screening results. The aseptic seedlings:Yifeng 3321(7. 268),Yifeng 3315(6. 395),Yifeng 3317(5. 698),Yifeng 45(5. 567),Yifeng 14-24(5. 190). Rice: Yifeng 3321(2.998),Yifeng 14-24(2. 627),Yifeng 3317(2. 611),Yifeng 3315(2. 503),Yifeng 45(2. 281). Based on the estimated human daily requirement of essential amino acids and amino acids requirement pattern,it was found that the polished rice of 5 varieties was up to standard.The variety with the highest content of essential amino acids was Yifeng 3317(3830 mg/100g),followed by Yifeng 3321(3770 mg/100 g).The results showed that the high quality rice variety in this experiment was Yifeng 3321.

A Study on the Aseptic Germination Method for <i>Rosa rugose</i>Seeds

In order to find a method to break dormancy of Rosa rugose seeds and interspecific hybrid seeds between Rosa rugose and Rosa hybrid quickly, and accelerate the breeding process of interspecific hybridization between Rosa rugose and Rosa hybrid, the influence of concentrated acid, seed maturity, GA3 (gibberellin) and low temperature (4°C) on seed germination of Rosa rugose from Muping was researched under aseptic condition. The results showed that aseptic germination can significantly shorten the germination time of Rosa rugose seeds and raise its germination ratio. Before inoculation, concentrated acid treatment greatly increased the germination rate and reduced the contamination rate of the seeds. The higher the degree of maturity of seeds is, the lower the germination rate would be, and the best time for seed to aseptic germination is 60 d after pollination. The addition of GA3 in 1/2MS medium could promote seeds germination better, and when the concentration of GA3 was 0.15 mg/L, the seed germination ratio was the highest;the germination time decreased and the seed germination ratio increased gradually as the treatment time at 4°C lasted longer.

Experimental studying of the drug efficiency Prostamax in the therapy of chronic aseptic prostatitis and its complications

The treatment of one of the most common urological diseases, a chronic aseptic prostatitis, is an exigeant problem. Used methods of pharmacotherapy are insufficiently effective and after treatment, as a rule, there comes a recrudescence. The efficiency of new prostatotropic agent Prostamax is studied in the present work, this drug is related to bioregulator peptides at experimental chronic aseptic inflammation of prostate gland. It is established that Prostamax reduces intensity of signs of a chronic inflammation (swelling, hyperemia of vessels, lymphoid infiltration), prevents development of sclerotic and atrophic processes. It is shown that the agent intensifies sexual activity of animals. Efficiency of the preparation Prostamax surpasses that among widespread prostatotropic agents derived from the extract of Serenoa repens and prostate of animals.

Dual infection with hepatitis A and E virus presenting with aseptic meningitis:A case report

We report the case of a young male who presented with features of aseptic meningitis and elevated serum liver enzymes,hut no symptoms or signs suggestive of an acute hepatitis. Subsequently,he was diagnosed with dual infection with hepatitis A and E viruses,and recovered completely with symptomatic therapy.Isolated aseptic meningitis,unaccompanied by hepatitic features is an unusual presentation of a hepatotrophic viral infection,and is yet to be reported with hepatitis A and E virus co-infection.

Correlation analysis between the interface membrane and loose hip prosthesis

Objective To analyze the cause of prosthesis loosening by observing the interface membranes harvested during the hip restoration operation. Methods A total of 28 specimens of interface membrane around the loose prosthesis were harvested from 28 patients undergoing the restoration of total hip replacement. All the specimens underwent the observation of appearance, light microscopy and scanning electronic microscopy(SEM). Results All the gaps around the loose prosthesis were filled with interface membrane of different thickness. The color of the most interface membrane was madder red, and the other one third of membrane was black. The comparatively thicker membrane was similar to scar connective tissue while the thinner was similar to fiber membrane. A large number of wear debris, macrophages and foreign-body giant cells were found under light microscope. With SEM observation a large number of different diameter collagen fibra structures that looked like scar tissues were arranged disorderly in a great mass, foreign particles and bone debris of different size were distributed unevenly, and the fibroblast was distributed in the collagen fiber. Conclusion Wear debris is related to inflammatory cell response around the interface membrane of the loose prosthesis. The wear debris engulfed by macrophage stimulates the interface membrane to release bone resorption factors (such as TNF) which lead to osteolysis, and this is one of the most important causes of the prosthesis loosening.

Fabry Disease with Aseptic Meningitis:A Case Series and Literature Review of an Underestimated Clinical Presentation

Objective Fabry disease(FD)is an X-linked lysosomal storage disease caused by the mutation in theα-galactosidase A gene that leads to a consequently decreasedα-galactosidase A enzyme activity and a series of clinical presentations.However,FD accompanied with aseptic meningitis can be relatively scarce and rarely reported,which leads to significant clinical misdiagnosis of this disease.Methods Sixteen patients diagnosed with FD based on a decreased activity ofα-galactosidase A enzyme and/or genetic screening were identified through a 6-year retrospective chart review of a tertiary hospital.Clinical presentations,brain magnetic resonance imaging,cerebrospinal fluid analysis,treatment and outcome data were analyzed in cases of aseptic meningitis associated with FD.Results Three out of 16 cases exhibited aseptic meningitis associated with FD.There was one female and two male patients with a mean age of 33.3 years.A family history of renal failure or hypertrophic cardiomyopathy was found in 3 cases.All cases presented with a persistent or intermittent headache and recurrent ischemic stroke.The cerebrospinal fluid analyses showed mild pleocytosis in 2 patients and an elevated level of protein in all patients.Cerebrospinal fluid cytology revealed activated lymphocytes,suggesting the existence of aseptic meningitis.In the literature review,up to 9 cases presenting with FD and aseptic meningitis were found,which bore a resemblance to our patients in demographic and clinical characteristics.Conclusion Our cases suggested that aseptic meningitis in FD might be under-detected and easily misdiagnosed,and should be more thoroughly examined in further cases.