Objective: To investigate the correlation between magnetic resonance imaging (MRI) lamellated hyperintense synovitis and periprosthetic infection of hip arthroplasty and estimate its value in the diagnosis of infection after hip replacement. Methods: A retrospective analysis of 50 patients who underwent MRI from January 2016 to June 2019 after hip replacement was performed. The MRI scanning was performed with a 1.5T clinical imaging unit using SEMAC protocols. A total of 25 patients (cohort 1) showed infected total hip arthroplasty, and 25 patients had non-infected arthroplasty as controls (cohort 2). Two musculoskeletal radiologists, blinded to the clinical diagnosis, reviewed all the images for the presence of lamellated hyperintense synovitis independently. The cases were rereviewed by each reader after 2 weeks. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated using the first reads. The Kappa statistic was used to assess inter-observer and intra-observer reliability. Results: The incidence of lamellated hyperintense synovitis was 76%-88% in the experimental group and 8%-16% in the control group. The sensitivity of lamellated hyperintense synovitis for infection was 0.80-0.88 (95% confidence interval [CI]:0.59-0.97), the specificity was 0.840.92 (95% CI: 0.64-0.99), the positive predictive value 0.83-0.92 (95% CI: 0.67-0.98), the negative predictive value 0.81-0.88 (95% CI: 0.65-0.96). The agreement between two readers was substantial (Kappa = 0.76, 95% CI: 0.58-0.94, P < 0.05). There were moderate inter-observer agreements for both readers, reader 1 (Kappa = 0.48, 95%CI: 0.23-0.72, P < 0.05) and reader 2 (Kappa = 0.44, 95% CI: 0.19-0.69, P < 0.05). Conclusion: In this cohort, the presence of lamellated hyperintense synovitis in the MRI of hip arthroplasty showed high sensitivity and specificity for infection. This sign had substantial intra-observer reliability and moderate interobserver reliability in the classification of the synovial pattern.
Isoschaftoside is a C-glycosyl flavonoid extracted from the root exudates of Desmodium uncinatum and Abrus cantoniensis. Previous studies suggested that C-glycosyl flavonoid has neuroprotective effects with the property of reducing oxidative stress and inflammatory markers. Microglia are key cellular mediators of neuroinflammation in the central nervous system. The aim of this study was to investigate the effect of isoschaftoside on lipopolysaccharide-induced activation of BV-2 microglial cells. The BV-2 cells were exposed to 10 ng/ml lipopolysaccharide and isoschaftoside (0–1000 μM). Isoschaftoside effectively inhibited lipopolysaccharide-induced nitric oxide production and proinflammatory cytokines including iNOS, TNF-α, IL-1β, and COX2 expression. Isoschaftoside also significantly reduced lipopolysaccharide-induced HIF-1α, HK2, and PFKFB3 protein expression. Induction of HIF-1α accumulation by CoCl2 was inhibited by isoschaftoside, while the HIF-1α specific inhibitor Kc7f2 mitigated the metabolic reprogramming and anti-inflammatory effect of isoschaftoside. Furthermore, isoschaftoside attenuated lipopolysaccharide-induced phosphorylation of ERK1/2 and mTOR. These results suggest that isoschaftoside can suppress inflammatory responses in lipopolysaccharide-activated microglia, and the mechanism was partly due to inhibition of the HIF-1α-mediated metabolic reprogramming pathway.
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