Authors: Shulin Li, Huayao Sun, Jiahao Zhang, Huiling Guo, Laipeng Yan and Faqiang Tang
Objective To investigate the application value of arthroscopic channel modification in meniscal injury repair.
Methods We retrospectively analyzed the data of 100 patients with meniscus injuries treated with knee arthroscopy from December 2022 to December 2023 and divided them into a control group and a modified group according to the application of “arthroscopic access modification technology”. We compared the operation time, postoperative hospitalization time, VAS score, Lysholm knee function score, postoperative complications, and postoperative images of the patients in these two groups. We compared the operation time, postoperative hospitalization time, pre- and postoperative VAS scores, Lysholm knee function scores, postoperative complications and postoperative imaging indices of the patients in the two groups.
Results All patients successfully underwent surgery and were followed up without intraoperative vascular or nerve injury or postoperative complications such as infection, wound necrosis or thrombosis. The average follow-up time was 16.03 ± 3.69 months; the average operation time and postoperative hospitalization time of the modified group were significantly better than those of the control group were (P < 0.05); the pain and knee function of the two groups significantly improved over time (P < 0.05); and, compared with those of the control group, the modified group could obtain a more satisfactory score at an early stage of the postoperative period (P < 0.05), and the comparison of the intermediate and long-term scores of the two groups was not statistically significant (P > 0.05). There was no statistically significant difference (P > 0.05).
Conclusion The improved arthroscopic access technique can make the entry and exit of instruments into and out of the joint cavity smoother, improve the surgical field of view, significantly shorten the operation time, reduce the occurrence of intraoperative complications, improve the function of patients’ knee joints earlier, and increase their satisfaction with the operation.
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Authors: Meichun Han, Weibin Du, Lei Zhang, Zhenwei Wang, Shengqiang Fang, Yang Zheng and Renfu Quan
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Objective Osteoporosis is a systemic disease with high morbidity and significant adverse effects. Increasing evidence supports the close relationship between oxidative stress and osteoporosis, suggesting.....
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Authors: Meichun Han, Weibin Du, Lei Zhang, Zhenwei Wang, Shengqiang Fang, Yang Zheng and Renfu Quan
Objective Osteoporosis is a systemic disease with high morbidity and significant adverse effects. Increasing evidence supports the close relationship between oxidative stress and osteoporosis, suggesting that treatment with antioxidants may be a viable approach. This study evaluated the antioxidant properties of dichotomitin (DH) and its potential protective effects against osteoporosis.
Methods SD rats were divided into three groups: Sham, OVX, and OVX + DH (5 mg/kg, intraperitoneal injection twice weekly). After three months, blood samples, femurs, and tibiae were collected for analysis. Micro-CT evaluated the femoral, while histological examination assessed tibial tissues. Serum osteogenic biochemical markers were measured. In vitro, osteogenic differentiation was induced with varying concentrations of DH, followed by ALP and ARS staining. RT-qPCR and western blot were used to assess the expression of osteogenesis-related genes and proteins. Additionally, an oxidative stress cell model was established, dividing cells into control, H2O2-treated, and H2O2 + DH-treated groups. Expression of oxidative stress-related genes and proteins was assessed using real-time quantitative PCR and western blotting.
Results Micro-CT and histological staining revealed decreased and disrupted bone trabeculae in the OVX group, whereas the DH-treated group exhibited enhanced bone trabecular area and structure compared to the OVX group. In vitro studies showed that DH enhanced ALP activity and elevated expression of RUNX2, OPN, OCN, SOD1, and SOD2.
Conclusion DH has the potential to enhance osteoblast differentiation and alleviate osteoporosis through the attenuation of oxidative stress.
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Authors: Weijie He, Jie Zhao, Jiafei Liu, Fangxing Wang and Zhenyu Xu
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Background There is currently no definitive treatment for osteoarthritis. We examined the therapeutic effects and underlying mechanisms of platelet-rich plasma (PRP) and adipose-derived mesenchymal stem.....
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Authors: Weijie He, Jie Zhao, Jiafei Liu, Fangxing Wang and Zhenyu Xu
Background There is currently no definitive treatment for osteoarthritis. We examined the therapeutic effects and underlying mechanisms of platelet-rich plasma (PRP) and adipose-derived mesenchymal stem cells (ADSCs), individually or in combination, in a rat model of anterior cruciate ligament-induced degenerative osteoarthritis (OA) of the knee. This study seeks to advance clinical approaches to OA treatment.
Methods Eight- to nine-week-old male Sprague-Dawley (SD) rats were randomly assigned to two groups: (1) a normal control group (Group A) and (2) a model group. The control group received no treatment. The model group underwent treatment and was further subdivided into six groups: Group B (an injury control group), Group C (highdose ADSCs), Group D (PRP combined with high-dose ADSCs), Group E (low-dose ADSCs), Group F (PRP combined with low-dose ADSCs), and Group G (PRP alone). PRP and/or ADSCs were administered via intra-articular injection on Days 7, 37, and 67 post-surgery. Daily observations recorded activity levels and behavior, while weight changes were monitored weekly. Digital radiography (DR) was conducted on Days 30, 60, and 90 post-surgery to assess joint surface and contour alterations. Histopathological examination and inflammatory factor analysis were performed on cartilage and synovial tissue.
Results No abnormal reactions were observed in any rats, and body weights increased as expected (P > 0.05). Significant differences in knee swelling rates and Wakitani scores were observed between Groups A and B (P < 0.01). Knee swelling rates also differed significantly between Group B and Groups C–G (P < 0.01). Wakitani scores decreased on Days 60 and 90 in Groups C–G. TNF-α and IL-1β expression levels were significantly higher in Group B compared to Group A (P < 0.05). Expression levels of these genes were significantly lower in Groups C–G than in Group B (P < 0.05).
Conclusions Repeated intra-articular injections of PRP and ADSCs alleviated inflammation and pain, promoted tissuerepair, and modulated immune responses in rats with surgically induced OA. The combination of PRP and ADSCs demonstrated enhanced therapeutic efficacy, suggesting its potential as a treatment option for OA.
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Background Finite element analysis (FEA) could advance the understanding of fracture fixation and guide the choice of surgical treatment. This study aimed to compare two.....
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Background Finite element analysis (FEA) could advance the understanding of fracture fixation and guide the choice of surgical treatment. This study aimed to compare two internal fixation methods in the treatment of displaced proximal humeral fracture (PHF) through FEA.
Methods Three-dimensional FEA model based on the left shoulder joint of a 67-year-old female patient with PHFs and osteoporosis was adopted, in order to analyze the fixation effect and load stress distribution of internal fixation plates with open reduction and intramedullary nails without opening the fracture in the treatment of Neer III-VI PHF.
Results The displacement of the distal humerus with intramedullary nail fixation was more obvious than that of the distal humerus with bone plate fixation, and the resistance of intramedullary nail fixation was less than that of bone plate fixation under the same stress load. Maximum stress on the screw when adopting the intramedullary nail fixation was smaller than that when adopting the internal fixation with the internal fixation plates. The strain data indicate that the strain of both the fixation device and the bone when adopting the internal fixation with the intramedullary nails is less than that when adopting the internal fixation with the internal fixation plates.
Conclusions Biomechanical analysis demonstrated that for complex fracture types with osteoporosis intramedullary nail system without opening the fracture had better stress dispersion than internal fixation plates with open reduction, and the risk of failure of central fixation was lower.
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Authors: Xunhao Wang, Linyi Zhu, Jingyi Mi and Fei Xiong
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Background Wrist synovitis often leads to persistent pain, swelling, and limited mobility, causing significant functional impairment and psychological distress, including anxiety. Although arthroscopic synovectomy can.....
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Authors: Xunhao Wang, Linyi Zhu, Jingyi Mi and Fei Xiong
Background Wrist synovitis often leads to persistent pain, swelling, and limited mobility, causing significant functional impairment and psychological distress, including anxiety. Although arthroscopic synovectomy can alleviate physical symptoms, whether it also improves anxiety and the causal relationship between synovitis and anxiety remains unclear.
Methods A prospective study was conducted on 44 patients diagnosed with wrist synovitis who underwent arthroscopic synovectomy. Patients were assessed preoperatively and at 2 and 4 weeks postoperatively using the Visual Analog Scale (VAS), Mayo Wrist Score, and Self-Rating Anxiety Scale (SAS). MR analysis was employed to investigate the causal relationship between wrist synovitis and anxiety using genome-wide association studies (GWAS) summary data.
Results Significant reductions in SAS and VAS scores were observed at 2 and 4 weeks postoperatively, along with improvements in wrist function as measured by the Mayo Wrist Score. MR analysis did not find statistically significant evidence of a direct causal relationship between wrist synovitis and anxiety, though a positive trend suggests that wrist synovitis may be a risk factor for anxiety.
Conclusions Arthroscopic synovectomy may alleviate anxiety symptoms and may improve wrist function in patients with wrist synovitis. While a direct causal link between wrist synovitis and anxiety was not conclusively established, the observed associations highlight the need for integrated management of physical and psychological health in these patients.
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Authors: Thomas Ibounig, Lasse Rämö, Romi Haas, Mark Jones, Teppo L. N. Järvinen
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Objectives To determine the prevalence of acromioclavicular (AC) joint and subacromial space imaging abnormalities in asymptomatic adults, with a secondary objective of comparing findings between.....
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Authors: Thomas Ibounig, Lasse Rämö, Romi Haas, Mark Jones, Teppo L. N. Järvinen
Objectives To determine the prevalence of acromioclavicular (AC) joint and subacromial space imaging abnormalities in asymptomatic adults, with a secondary objective of comparing findings between asymptomatic and symptomatic shoulders within the same study populations.
Methods We conducted a systematic review of studies examining shoulder imaging abnormalities detected by X-ray, ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) in asymptomatic adults (PROSPERO registration CRD42018090041). This report focuses on AC joint and subacromial space abnormalities. Databases searched included Ovid MEDLINE, Embase, CINAHL and Web of Science from inception to June 2023. Our primary analysis used data from population-based studies, and risk of bias and certainty of evidence were evaluated with tools for prognostic studies.
Results Thirty-one studies (4 X-ray, 11 US, 15 MRI, 1 both X-ray and MRI) provided useable prevalence data. One study was population-based (20 shoulders), 16 included miscellaneous study populations (2436 shoulders) and 14 focused on athletes (708 shoulders). The certainty of evidence was very low mainly due to high risk of bias, imprecision, and indirectness across studies. Clinical diversity precluded pooling. Population-based prevalence of acromioclavicular osteoarthritis (AC OA) ranged from 85% on MRI to 95% on X-ray. In other study populations, AC OA prevalence in asymptomatic shoulders varied from 6 to 47% on X-ray, 1 to 65% on US, and 0 to 82% on MRI. Among eight studies that included both asymptomatic and symptomatic shoulders, AC OA prevalence ranged from 13 to 95% in asymptomatic shoulders and from 20 to 100% in symptomatic shoulders.
Conclusion The prevalence of AC joint and subacromial space abnormalities in asymptomatic shoulders is highly variable, and often comparable to that in symptomatic shoulders. Due to the low certainty of evidence and significant variation among study populations, further research is needed to clarify these prevalence estimates and to guide evidence-based management of shoulder abnormalities.
Key message
• Structural abnormalities in shoulder imaging are frequently observed in asymptomatic adults, raising concerns about their clinical significance
• Careful interpretation of imaging results is crucial to avoid unnecessary interventions based solely on imaging findings.
• More accurate prevalence data are essential for developing evidence-based approaches to managing shoulderpain in clinical practice.
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Background The interbody fusion apparatus is a key component of the operation and plays a key role in the postoperative efficacy. Cage subsidence is one.....
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Background The interbody fusion apparatus is a key component of the operation and plays a key role in the postoperative efficacy. Cage subsidence is one of the common complications after lumbar fusion and internal fixation. Clinical studies on the risk factors of cage subsidence are incomplete and inaccurate, especially paravertebral muscle atrophy and intervertebral bone fusion time.
Methods Among the patients who underwent PLIF surgery in our hospital from January 2016 to January 2019, 30 patients with cage subsidence and 30 patients without cage subsidence were randomly selected to be included in this study. The differences between the two groups were compared, and the relevant factors of cage subsidence were explored by single factor comparison and multiple logistic regression analysis.
Results Bone mineral density (T) of the subsidence group [(− 1.84 ± 1.81) g/cm2 vs (− 0.87 ± 1.63) g/cm2, P = 0.018] was significantly lower than that of the normal group. There were 4 patients with end plate injury in the subsidence group (P = 0.038). Preoperative end plate Modic changes [I/II/III, (7/2/2) vs (2/5/8), P = 0.043] were significantly different between the two groups. In the subsidence group, preoperative rCSA of psoas major muscle [(1.43 ± 0.40) vs (1.64 ± 0.41), P = 0.043], CSA of paravertebral muscle [(4530.25 ± 776.55) mm2 vs (4964.75 ± 888.48) mm2, P = 0.047], paravertebral muscle rCSA [(3.03 ± 0.72) vs (3.84 ± 0.73), P < 0.001] and paravertebral muscle rFCSA [(2.29 ± 0.60) vs (2.89 ± 0.66), P < 0.001] were significantly lower than those in normal group. In the subsidence group, the vertebral body area [(1547.81 ± 309.89) mm2 vs (1326.48 ± 297.21) mm2, P = 0.004], the height of the immediately corrected vertebral space [(2.86 ± 1.10) mm vs (1.65 ± 1.02) mm, P = 0.020], immediately SL corrective Angle [(5.81 + 4.71)° vs (3.24 + 3.57) °, P = 0.009), postoperative PI—LL [(11.69 + 6.99)° vs (6.66 + 9.62) °, P = 0.029] and intervertebral fusion time [(5.38 ± 1.85) months vs (4.30 ± 1.49) months, P = 0.023] were significantly higher than those in the normal group. Multivariate logistic regression analysis showed that the time of intervertebral fusion (OR = 1.158, P = 0.045), the height of immediate intervertebral space correction (OR = 1.438, P = 0.038), and the Angle of immediate SL correction (OR = 1.101, P = 0.019) were the risk factors for cage subsidence. Bone mineral density (OR = 0.544, P = 0.016) and preoperative paravertebral muscle rFCSA (OR = 0.525, P = 0.048) were protective factors.
Conclusion Intervertebral fusion time, correctable height of intervertebral space, excessive Angle of immediate SLcorrection, bone mineral density and preoperative paravertebral muscle rFCSA are risk factors for cage subsidence after PLIF.
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Authors: Shuai‑Kang Wang, Peng Wang, Zhong‑En Li, Xiang‑Yu Li, Chao Kong and Shi‑Bao Lu
Abstract:
Background The burden of lumbar degenerative diseases (LDD) has increased substantially with the unprecedented aging population. Identifying elderly patients with high risk of postoperative adverse.....
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Authors: Shuai‑Kang Wang, Peng Wang, Zhong‑En Li, Xiang‑Yu Li, Chao Kong and Shi‑Bao Lu
Background The burden of lumbar degenerative diseases (LDD) has increased substantially with the unprecedented aging population. Identifying elderly patients with high risk of postoperative adverse events (AEs) and establishing individualized perioperative management is critical to mitigate added costs and optimize cost-effectiveness to the healthcare system. We aimed to develop a predictive tool for AEs in elderly patients with transforaminal lumbar interbody fusion (TLIF), utilizing multivariate logistic regression, single classification and regression tree (hereafter, “classification tree”), and random forest machine learning algorithms.
Methods This study was a retrospective review of a prospective Geriatric Lumbar Disease Database (age ≥ 65). Our outcome measure was postoperative AEs, including prolonged hospital stays, postoperative complications, readmission, and reoperation within 90 days. Patients were grouped as either having at least one adverse event (AEs group) or not (No-AEs group). Three models for predicting postoperative AEs were developed using training dataset and internal validation using testing dataset. Finally, online tool was developed to assess its validity in the clinical setting (external validation).
Results The development set included 1025 patients (mean [SD] age, 72.8 [5.6] years; 632 [61.7%] female), and the external validation set included 175 patients (73.2 [5.9] years; 97 [55.4%] female). The predictive ability of our three models was comparable, with no significant differences in AUC (0.73 vs. 0.72 vs. 0.70, respectively). The logistic regression model had a higher net benefit for clinical intervention than the other models. A nomogram based on logistic regression was developed, and the C-index of external validation for AEs was 0.69 (95% CI 0.65–0.76).
Conclusion The predictive ability of our three models was comparable. Logistic regression model had a higher net benefit for clinical intervention than the other models. Our nomogram and online tool (https:// xuanw umodel. shiny apps. io/ Model_ for_ AEs/) could inform physicians about elderly patients with a high risk of AEs within the 90 daysafter TLIF surgery.
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Authors: Zheng.Ji Wang, Qian Du, Shu.Fa Wang, Heng Su, Wen He, Wen.Bo Liao, Zhi.Jun Xin and Wei.Jun Kong
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Objective Full endoscopic techniques are being gradually introduced from single-segment cervical disc herniation surgery to two-segment cervical disc herniation surgery. However, there is no suitable.....
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Authors: Zheng.Ji Wang, Qian Du, Shu.Fa Wang, Heng Su, Wen He, Wen.Bo Liao, Zhi.Jun Xin and Wei.Jun Kong
Objective Full endoscopic techniques are being gradually introduced from single-segment cervical disc herniation surgery to two-segment cervical disc herniation surgery. However, there is no suitable full endoscopic treatment for mixed-type two-segment cervical disc herniation (MTCDH) in which one segment herniates in front of the spinal cord and the other segment herniates behind the spinal cord. Therefore, we introduce a new full endoscopic technique by combining an anterior transcorporeal approach and a posterior translaminar approach. In addition, we provide a brief description of its safety, efficacy, feasibility, and surgical points.
Methods Thirty patients with MTCDH were given full endoscopic surgical treatment by a combined transcorporeal and transforaminal approach and were followed up for at least 12 months.
Results Clinical assessment scales showed that the patient’s symptoms and pain were significantly reduced postoperatively. Imaging results showed bony repair of the surgically induced bone defect and the cervical Cobb angle was increased. No serious complications occurred.
Conclusion This technique enables minimally invasive surgery to relieve the compression of the spinal cord by MTCDH. It avoids the fusion of the vertebral body for internal fixation, preserves the vertebral motion segments, avoids medical destruction of the cervical disc to the greatest extent possible, and expands the scope of adaptationof full endoscopic technology in cervical surgery.
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Authors: Yu‑Chuan Lin, Yu‑Jen Chen, Tsang‑Yu Fan, Pei‑Hsi Chou and Cheng‑Chang Lu
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Background The effect of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) combination in enhancing graft maturation and tendon–bone tunnel interfacial healing after anterior.....
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Authors: Yu‑Chuan Lin, Yu‑Jen Chen, Tsang‑Yu Fan, Pei‑Hsi Chou and Cheng‑Chang Lu
Background The effect of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) combination in enhancing graft maturation and tendon–bone tunnel interfacial healing after anterior cruciate ligament (ACL) reconstruction remains unclear. We hypothesised that BMAC and PRP combination could lead to better clinical results and better graft maturation/interface healing than PRP alone or conventional ACL reconstruction without any other biologic augmentation.
Methods In this randomised double-blind prospective study, patients undergoing ACL reconstruction surgery were randomly assigned into three groups: (1) control group (without any biologic augmentation), (2) PRP treatment group, and (3) combined BMAC and PRP (BMAC + PRP) group. Moreover, they were evaluated using the clinical functional score, laxity examination, and magnetic resonance imaging (MRI) analysis.
Results No significant difference was observed in the improvement of functional scores among groups. However, laxity improvement at 24 weeks showed a significant difference with the BMAC + PRP group having the lowest laxity. MRI analysis showed no significant change in whole graft maturation among groups. In particular, the BMAC + PRP group showed delayed signal peak and higher graft signal at 24 weeks compared with the other two groups; however, the difference was not significant. With regard to tendon–bone interfacial healing, the BMAC + PRP group showed significantly wider tendon–bone interface in the femoral bone tunnel at 24 weeks compared with the other two groups. Moreover, the BMAC + PRP group showed significantly higher peri-tunnel edema signal in the femoral bone tunnel at 12 weeks compared with the other two groups.
Conclusion PRP alone and BMAC and PRP combination showed limited enhancing effect in clinical function, graft maturation and tendon–bone interfacial healing compared with control (no additional treatment). When BMAC is used in ACL reconstruction, the possibility of greater inflammation in the early stage to graft maturation and bonetunnel healing should be considered.
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Authors: Shuai Cheng, Jian Yu, Meiling Cui, Hongmin Su and Yang Cao
Abstract:
Purpose Lower back pain (LBP), mainly caused by intervertebral disc (IVD) degeneration (IDD), is widely prevalent worldwide and is a serious socioeconomic burden. Numerous factors.....
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Authors: Shuai Cheng, Jian Yu, Meiling Cui, Hongmin Su and Yang Cao
Purpose Lower back pain (LBP), mainly caused by intervertebral disc (IVD) degeneration (IDD), is widely prevalent worldwide and is a serious socioeconomic burden. Numerous factors may trigger this degenerative process, and microbial dysbiosis has recently been implicated as one of the likely causes. However, the exact relationship between IDD and the microbiome remains obscure. In this study, we investigated the gut microbiota composition and fecal metabolic phenotype and discussed the possible influences of microbiome dysbiosis on IDD.
Methods Fecal DNA was extracted from 16 fecal samples (8 rabbit models with IDD and 8 sex- and age-matched healthy controls) and analyzed by high-throughput 16S rDNA sequencing. The fecal samples were also analyzed by liquid chromatography–mass spectrometry-based metabolomics. Multivariate analyses were conducted for the relationship between the omics data and IDD, linear discriminant analysis effect size was employed for biomarker discovery. Moreover, the Kyoto Encyclopedia of Genes and Genomes (KEGG) database was used to annotate the differential metabolites. The potential correlation between differential gut microbiota and metabolites was then assessed.
Results The 16S rDNA sequencing results showed that the β-diversity of the gut microbiota was significantly different between the IDD and control groups, with distinct abundance levels of dominant genera. Moreover, 59 metabolites were significantly upregulated and 91 were downregulated in IDD rabbits versus the controls. The KEGG enrichment analysis revealed that the top pathways remarkably impacted by IDD were tyrosine metabolism, amino sugar and nucleotide sugar metabolism, benzoate degradation, ABC transporters, ascorbate and aldarate metabolism, pantothenate and CoA biosynthesis, and pyrimidine metabolism. The correlation analysis revealed that DLtyrosine and N-acetylmuramic acid were associated with multiple differential bacterial genera, including Helicobacter and Vibrio, which may play important roles in the process of IVD degeneration.
Conclusion Our findings revealed that IDD altered gut microbiota and fecal metabolites in a rabbit model. The correlation analysis of microbiota and metabolome provides a deeper understanding of IDD and its possible etiopathogenesis. These results also provide a direction and theoretical basis for the clinical application of fecal transplantation,probiotics, and other methods to regulate gut microbiota in the treatment of LBP caused by IDD.
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Authors: Yawen Jiang, Yaping Xu, Xiangrui Kong, En Zhao, Chunxia Ma, Yihang Lv, Hongqi Xu, He Sun and Xiaojuan Gao
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Objective To tackle non-specific low back pain (NSLBP) among patients and find the most effective solutionand to quantitatively synthesize the overall effect of motor control.....
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Authors: Yawen Jiang, Yaping Xu, Xiangrui Kong, En Zhao, Chunxia Ma, Yihang Lv, Hongqi Xu, He Sun and Xiaojuan Gao
Objective To tackle non-specific low back pain (NSLBP) among patients and find the most effective solutionand to quantitatively synthesize the overall effect of motor control training (MCT) compared with Pilates, McKenzie method, and physical therapy (PT) in pain and physical function.
Methods Randomized controlled trials (RCTs) of four types of intervention (MCT, Pilates, McKenzie method, and PT) for LBP were collected by searching PubMed, Web of Science, EBSCOhost (Cochrane Central Register of Controlled Trials), and Scopus databases from the establishment of the database to September 30, 2023. The risk of bias was evaluated for included studies using the Revised Cochrane Risk of Bias tool for randomized trials (RoB 2.0). Taking pain and physical function in the experimental and control groups as outcome indicators, subgroup analysis was performed according to the intervention method to calculate the standardized mean difference (SMD) and 95% confidence interval (CI).
Results A total of 25 RCTs, including 1253 patients, were included. Meta-analysis showed that MCT effectively relieved pain [SMD = −0.65, 95% CI (− 1.00, − 0.29), p < 0.01] and improved physical function [SMD = −0.76, 95% CI (− 1.22, − 0.31), p < 0.01] comparing with other 3 types of intervention. Subgroup analysis suggested that MCT could alleviate pain [SMD = −0.92, 95% CI (− 1.34, − 0.50), p < 0.01] and improve physical function [SMD = −1.15, 95% CI (− 1.72, − 0.57), p < 0.01] compared with PT, but it had no statistical significance compared with Pilates [pain: SMD = 0.13, 95% CI (− 0.56, 0.83), p = 0.71; physical function: SMD = 0.10, 95% CI (− 0.72, 0.91), p = 0.81] and the McKenzie
method [pain: SMD = −0.03, 95% CI (− 0.75, 0.68), p = 0.93; physical function: SMD = −0.03, 95% CI (− 1.00, 0.94), p = 0.95].
Conclusions MCT can effectively relieve pain and improve physical function in patients with NSLBP. It is more effective compared with PT for LBP, while no differences were detected between MCT and Pilates, as well as McKenzie method. Therefore, MCT, Pilates, and the McKenzie method should be encouraged as exercise interventions for NSLBP rehabilitation.
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Authors: Wietse P.R. Melman, Harmen B. Ettema, Mireille A. Edens and Cees C.P.M. Verheyen
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Background Reports show a high complication rate when starting with the Direct Anterior Approach (DAA) in a supine position for hip arthroplasty. The DAA with.....
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Authors: Wietse P.R. Melman, Harmen B. Ettema, Mireille A. Edens and Cees C.P.M. Verheyen
Background Reports show a high complication rate when starting with the Direct Anterior Approach (DAA) in a supine position for hip arthroplasty. The DAA with the patient in lateral decubitus position may avoid this problem because it supposedly provides better visibility, especially on the femoral side. However, this approach did show a rather high complication rate during the adoption of the approach at 1 year follow up in our previous report. We were interested what the overall 7 year survival estimate would be and whether improvement could be seen with growing experience.
Methods A cohort of patients undergoing total hip arthroplasty right from the start of applying the DAA in lateral decubitus position was analysed.
Results In total 175 hip prostheses (162 patients) were evaluated. The 7-year survival estimate was 95.1%, 95 CI: 91.8–98.4%. In 6 of 8 revisions there was aseptic loosening of the stem. By dividing the cohort into 3 consecutive groups in time we did not see a significantly improving revision rate.
Conclusions In our experience, the adoption of the direct anterior approach in lateral decubitus position caused arelatively low 7-year survival estimate without an apparent decrease with growing experience, however given the low number of cases further research is needed to investigate the long-term risk of adopting a new approach.
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Authors: Marco Daghero, Simone Borrelli, Taian M. Vieira, Francesco Cannito, Alessandro Aprato, Andrea Audisio, Cristina Bignardi and Mara Terzini
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Background The application of lower limb traction during hip arthroscopy and femur fractures osteosynthesis is commonplace in orthopaedic surgeries. Traditional methods utilize a perineal post.....
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Authors: Marco Daghero, Simone Borrelli, Taian M. Vieira, Francesco Cannito, Alessandro Aprato, Andrea Audisio, Cristina Bignardi and Mara Terzini
Background The application of lower limb traction during hip arthroscopy and femur fractures osteosynthesis is commonplace in orthopaedic surgeries. Traditional methods utilize a perineal post on a traction table, leading to soft tissue damage and nerve neuropraxia. A postless technique, using high-friction pads, has been considered as a potential damage-free alternative. However, whether these pads sufficiently prevent patient displacement remains unknown. Thus, this study systematically assesses the efficacy of commercial high-friction pads (PinkPad and CarePad) in restraining subject displacement, for progressively increasing traction loads and different Trendelenburg angles.
Methods Three healthy male subjects were recruited and tested in supine and Trendelenburg positions (5° and 10°), using a customized boot-pulley system. Ten load disks (5 kg) were dropped at 15s intervals, increasing gradually the traction load up to 50 kg. Pelvis displacement along the traction direction was measured with a motion capture system. The displacement at 50 kg of traction load was analyzed and compared across various pads and bed inclinations. Response to varying traction loads was statistically assessed with a quadratic function model.
Results Pelvis displacement at 50 kg traction load was below 60 mm for all conditions. Comparing PinkPad and CarePad, no significant differences in displacement were observed. Finally, similar displacements were observed for the supine and Trendelenburg positions.
Conclusions Both PinkPad and CarePad exhibited nearly linear behavior under increasing traction loads, limiting displacement to 60 mm at most for 50 kg loads. Contrary to expectations, placing subjects in the Trendelenburgposition did not increase adhesion.
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Background Although short-segment posterior spinal fixation (SSPSF) has shown promising clinical outcomes in thoracolumbar burst fractures, the treatment may be prone to a relatively high.....
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Background Although short-segment posterior spinal fixation (SSPSF) has shown promising clinical outcomes in thoracolumbar burst fractures, the treatment may be prone to a relatively high failure rate. This study aimed to assess the effectiveness of machine learning models (MLMs) in predicting factors associated with treatment failure in thoracolumbar burst fractures treated with SSPSF.
Methods A retrospective review of 332 consecutive patients with traumatic thoracolumbar burst fractures who underwent SSPSF at our institution between May 2016 and May 2023 was conducted. Patients were categorized into two groups based on treatment outcome (failure or non-failure). Potential risk factors for treatment failure were compared between the groups. Four MLMs, including random forest (RF), logistic regression (LR), support vector machine (SVM), and k-nearest neighborhood (k-NN), were employed to predict treatment failure. Additionally, LR and RF models were used to assess factors associated with treatment failure.
Results Of the 332 included patients, 61.4% were male (n = 204), and treatment failure was observed in 44 patients (13.3%). Logistic regression analysis identified Load Sharing Classification (LSC) score, lack of index level instrumentation, and interpedicular distance (IPD) as factors associated with treatment failure (P < 0.05). All models demonstrated satisfactory performance. RF exhibited the highest accuracy in predicting treatment failure (accuracy = 0.948), followed by SVM (0.933), k-NN (0.927), and LR (0.917). Moreover, the RF model outperformed other models in terms of sensitivity and specificity (sensitivity = 0.863, specificity = 0.959). The area under the curve (AUC) for RF, LR, SVM, and k-NN was 0.911, 0.823, 0.844, and 0.877, respectively.
Conclusions This study demonstrated the utility of machine learning models in predicting treatment failure in thoracolumbar burst fractures treated with SSPSF. The findings support the potential of MLMs to predict treatmentfailure in this patient population, offering valuable prognostic information for early intervention and cost savings.
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Authors: Zhuangzhuang Li, Yi Luo, Minxun Lu, Yitian Wang, Taojun Gong, Xuanhong He, Xin Hu, Jingjunjiao Long, Yong Zhou, Li Min and Chongqi Tu
Abstract:
Objective This study aims to biomimetic design a new 3D-printed lattice hemipelvis prosthesis and evaluate its clinical efficiency for pelvic reconstruction following tumor resection, focusing.....
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Authors: Zhuangzhuang Li, Yi Luo, Minxun Lu, Yitian Wang, Taojun Gong, Xuanhong He, Xin Hu, Jingjunjiao Long, Yong Zhou, Li Min and Chongqi Tu
Objective This study aims to biomimetic design a new 3D-printed lattice hemipelvis prosthesis and evaluate its clinical efficiency for pelvic reconstruction following tumor resection, focusing on feasibility, osseointegration, and patient outcomes.
Methods From May 2020 to October 2021, twelve patients with pelvic tumors underwent tumor resection and subsequently received 3D-printed lattice hemipelvis prostheses for pelvic reconstruction. The prosthesis was strategically incorporated with lattice structures and solid to optimize mechanical performance and osseointegration. The pore size and porosity were analyzed. Patient outcomes were assessed through a combination of clinical and radiological evaluations.
Results Multiple pore sizes were observed in irregular porous structures, with a wide distribution range (approximately 300–900 μm). The average follow-up of 34.7 months, ranging 26 from to 43 months. One patient with Ewing sarcoma died of pulmonary metastasis 33 months after surgery while others were alive at the last follow-up. Postoperative radiographs showed that the prosthesis’s position was consistent with the preoperative planning. T-SMART images showed that the host bone was in close and tight contact with the prosthesis with no gaps at the interface. The average MSTS score was 21 at the last follow-up, ranging from 18 to 24. There was no complication requiring revision surgery or removal of the 3D-printed hemipelvis prosthesis, such as infection, screw breakage, and prosthesis loosening.
Conclusion The newly designed 3D-printed lattice hemipelvis prosthesis created multiple pore sizes with a widedistribution range and resulted in good osteointegration and favorable limb function.
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Authors: Abdallah Mohamed kamel, Karim Ghuiba, Dina S Abd Allah, Nadia Abdelazem Fayaz and Nasr Awad Abdelkader
Abstract:
Background Patellofemoral pain syndrome is considered a common cause of anterior knee pain that could disturb
function and limit daily activities. The purpose of the study.....
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Authors: Abdallah Mohamed kamel, Karim Ghuiba, Dina S Abd Allah, Nadia Abdelazem Fayaz and Nasr Awad Abdelkader
Background Patellofemoral pain syndrome is considered a common cause of anterior knee pain that could disturb
function and limit daily activities. The purpose of the study was to investigate the effect of adding short foot exercise
on pain, function, balance, and hip abductors, and quadriceps muscles strength in the treatment of patients with
patellofemoral pain syndrome.
Methods Twenty-eight male and female patients with patellofemoral pain syndrome with age ranged from 18 to 35
years old participated in this study. They were equally and randomly assigned into two groups; the study group which
received short foot exercise in addition to hip and knee exercises (n = 14) and thecontrol group which received hip
and knee exercises only (n = 14). Participants received their interventions during 6 consecutive weeks (12 sessions).
Pain intensity, function, abductors quadriceps muscle strength, and balance were assessed using the Visual Analog
Scale, anterior knee pain scale (AKPS), hand-held dynamometer, and the Biodex Balance System respectively. All
measurements were taken before and after 6 weeks of intervention in both groups. Multivariate analysis of variance
was performed to compare the within and between groups effects for measured variables.
Results The within-group comparison showed significant improvement in pain severity, function, balance, and hip
abductors, and quadriceps muscles strength in both groups post-treatment compared with pre-treatment. Between
groups analysis, however, showed no significant statistical difference between both groups in all variables, except in
pain, function, and mediolateral stability which showed better improvement compared to the control group.
Conclusions Adding short foot exercise to hip and knee exercises improved pain, function, and mediolateral stability
in patients with patellofemoral pain syndrome.
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Authors: Ana‑Marija Hristovska, Louise B. Andersen, Bodil Uldall‑Hansen, Henrik Kehlet, Anders Troelsen, Kirill Gromov and Nicolai B. Foss
Abstract:
Background Early postoperative mobilization is essential for early functional recovery but can be inhibited by postoperative orthostatic intolerance (OI). Postoperative OI is common after major.....
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Authors: Ana‑Marija Hristovska, Louise B. Andersen, Bodil Uldall‑Hansen, Henrik Kehlet, Anders Troelsen, Kirill Gromov and Nicolai B. Foss
Background Early postoperative mobilization is essential for early functional recovery but can be inhibited by postoperative orthostatic intolerance (OI). Postoperative OI is common after major surgery, such as total knee arthroplasty (TKA). However, limited data are available after less extensive surgery, such as unicompartmental knee arthroplasty (UKA). We, therefore, investigated the incidence of OI as well as cardiovascular and tissue oxygenation responses during early mobilization after UKA.
Methods This prospective single-centre observational study included 32 patients undergoing primary UKA. Incidence of OI and cardiovascular and tissue oxygenation responses during mobilization were evaluated preoperatively, at 6 and 24 h after surgery. Perioperative fluid balance, bleeding, surgery duration, postoperative hemoglobin, pain during mobilization and opioid usage were recorded.
Results During mobilization at 6 h after surgery, 4 (14%, 95%CI 4–33%) patients experienced OI; however, no patients terminated the mobilization procedure prematurely. Dizziness and feeling of heat were the most common symptoms. OI was associated with attenuated systolic and mean arterial blood pressure responses in the sitting position (all p < 0.05). At 24 h after surgery, 24 (75%) patients had already been discharged, including three of the four patients with early OI. Only five patients were available for measurements, two of whom experienced OI; one terminated the mobilization procedure due to intolerable symptoms. We observed no statistically significant differences in perioperative fluid balance, bleeding, surgery duration, postoperative hemoglobin, pain, or opioid usage between orthostatic intolerant and tolerant patients.
Conclusions The incidence of orthostatic intolerance after fast-track unicompartmental knee arthroplasty is low (~ 15%) and is associated with decreased orthostatic pressure responses. Compared to the previously described orthostatic intolerance incidence of ~ 40% following total knee arthroplasty, early orthostatic intolerance is uncommonafter unicompartmental knee arthroplasty, suggesting a procedure-specific component.
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Authors: Renfeng Liu, Tao He, Xin Wu, Wei Tan, Zuyun Yan and Youwen Deng
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Background Previous studies have demonstrated the clinical efficacy of decompression alone in lower-grade spondylolisthesis. A higher rate of surgical revision and a lower rate of.....
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Authors: Renfeng Liu, Tao He, Xin Wu, Wei Tan, Zuyun Yan and Youwen Deng
Background Previous studies have demonstrated the clinical efficacy of decompression alone in lower-grade spondylolisthesis. A higher rate of surgical revision and a lower rate of back pain relief was also observed. However, there is a lack of relevant biomechanical evidence after decompression alone for lower-grade spondylolisthesis. Purpose Evaluating the biomechanical characteristics of total laminectomy, hemilaminectomy, and facetectomy for lower-grade spondylolisthesis by analyzing the range of motion (ROM), intradiscal pressure (IDP), annulus fibrosus stress (AFS), facet joints contact force (FJCF), and isthmus stress (IS).
Methods Firstly, we utilized finite element tools to develop a normal lumbar model and subsequently constructed a spondylolisthesis model based on the normal model. We then performed total laminectomy, hemilaminectomy, and one-third facetectomy in the normal model and spondylolisthesis model, respectively. Finally, we analyzed parameters, such as ROM, IDP, AFS, FJCF, and IS, for all the models under the same concentrate force and moment.
Results The intact spondylolisthesis model showed a significant increase in the relative parameters, including ROM, AFS, FJCF, and IS, compared to the intact normal lumbar model. Hemilaminectomy and one-third facetectomy in both spondylolisthesis and normal lumbar models did not result in an obvious change in ROM, IDP, AFS, FJCF, and IS compared to the pre-operative state. Moreover, there was no significant difference in the degree of parameter changes between the spondylolisthesis and normal lumbar models after undergoing the same surgical procedures. However, total laminectomy significantly increased ROM, AFS, and IS and decreased the FJCF in both normal lumbar models and spondylolisthesis models.
Conclusion Hemilaminectomy and one-third facetectomy did not have a significant impact on the segment stability of lower-grade spondylolisthesis; however, patients with LDS undergoing hemilaminectomy and one-third facetectomy may experience higher isthmus stress on the surgical side during rotation. In addition, total laminectomychanges the biomechanics in both normal lumbar models and spondylolisthesis models.
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Authors: Guiyong Jiang, Yu Cai, Duo Cheng, Hao Wang, Geyang Deng and Dayong Xiang
Abstract:
Background Osteoporosis (OP) is the result of bone mass reduction and bone structure disorder. Bone marrow mesenchymal stem cells (BMSCs) are the main source of.....
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Authors: Guiyong Jiang, Yu Cai, Duo Cheng, Hao Wang, Geyang Deng and Dayong Xiang
Background Osteoporosis (OP) is the result of bone mass reduction and bone structure disorder. Bone marrow mesenchymal stem cells (BMSCs) are the main source of osteogenic precursor cells involved in adult bone remodeling. The involvement of the deubiquitinating enzyme CYLD in OP has recently been discovered. However, the detailed role and mechanism of CYLD remain unknown.
Methods The OP mouse model was established by performing ovariectomy (OVX) on mice. Hematoxylin and eosin staining, Masson and Immunohistochemical staining were used to assess pathologic changes. Real-time quantitative PCR, Western blot, and immunofluorescence were employed to assess the expression levels of CYLD, WNK1, NLRP3 and osteogenesis-related molecules. The binding relationship between CYLD and WNK1 was validated through a co-immunoprecipitation assay. The osteogenic capacity of BMSCs was determined using Alkaline phosphatase (ALP) and alizarin red staining (ARS). Protein ubiquitination was evaluated by a ubiquitination assay.
Results The levels of both CYLD and WNK1 were decreased in bone tissues and BMSCs of OVX mice. Overexpressionof CYLD or WNK1 induced osteogenic differentiation in BMSCs. Additionally, NLRP3 inflammation was activated in OVX mice, but its activation was attenuated upon overexpression of CYLD or WNK1. CYLD was observed to reduce the ubiquitination of WNK1, thereby enhancing its protein stability and leading to the inactivation of NLRP3 inflammation. However, the protective effects of CYLD on osteogenic differentiation and NLRP3 inflammation inactivation were diminished upon silencing of WNK1.
Conclusion CYLD mitigates NLRP3 inflammasome-triggered pyroptosis in osteoporosis through its deubiquitination of WNK1.
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Authors: Hui Zhang, John C. Elfar, C. Kent Kwoh and Zong-Ming Li
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Background Elevation of carpal tunnel pressure is known to be associated with carpal tunnel syndrome. This study aimed to correlate the shear wave elastography in.....
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Authors: Hui Zhang, John C. Elfar, C. Kent Kwoh and Zong-Ming Li
Background Elevation of carpal tunnel pressure is known to be associated with carpal tunnel syndrome. This study aimed to correlate the shear wave elastography in the transverse carpal ligament (TCL) with carpal tunnel pressures using a cadaveric model.
Methods Eight human cadaveric hands were dissected to evacuate the tunnels. A medical balloon was inserted into each tunnel and connected to a pressure regulator to simulate tunnel pressure in the range of 0-210 mmHg with an increment of 30 mmHg. Shear wave velocity and modulus was measure in the middle of TCL.
Results SWV and SWE were significantly dependent on the pressure levels (p < 0.001), and positively correlated to the tunnel pressure (SWV: R = 0.997, p < 0.001; SWE: R = 0.996, p < 0.001). Regression analyses showed linear relationship SWV and pressure (SWV = 4.359 + 0.0263 * Pressure, R2 = 0.994) and between SWE and pressure (SWE = 48.927 + 1.248 * Pressure, R2 = 0.996).
Conclusion The study indicated that SWV and SWE in the TCL increased linearly as the tunnel pressure increased within the current pressure range. The findings suggested that SWV/SWE in the TCL has the potential for prediction oftunnel pressure and diagnosis of carpal tunnel syndrome.
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Authors: Haitao Lu, Wei Zhang, Zihao Chai, Xiubo Ge and Haiyang Yu
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Background Poor neurological recovery in patients after anterior cervical discectomy and fusion has been frequently reported; however, no study has analyzed the preoperative imaging characteristics.....
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Authors: Haitao Lu, Wei Zhang, Zihao Chai, Xiubo Ge and Haiyang Yu
Background Poor neurological recovery in patients after anterior cervical discectomy and fusion has been frequently reported; however, no study has analyzed the preoperative imaging characteristics of patients to investigate the factors affecting surgical prognosis. The purpose of this study was to investigate the factors that affect the preoperative imaging characteristics of patients and their influence on poor neurologic recovery after anterior cervical discectomy and fusion.
Methods We retrospectively analyzed the clinical data of 89 patients who met the criteria for anterior cervical discectomy and fusion for the treatment of single-level cervical spondylotic myelopathy and evaluated the patients’ neurological recovery based on the recovery rate of the Japanese Orthopaedic Association (JOA) scores at the time of the final follow-up visit. Patients were categorized into the “good” and “poor” groups based on the JOA recovery rates of ≥ 50% and < 50%, respectively. Clinical information (age, gender, body mass index, duration of symptoms, preoperative JOA score, and JOA score at the final follow-up) and imaging characteristics (cervical kyphosis, cervical instability, ossification of the posterior longitudinal ligament (OPLL), calcification of herniated intervertebral discs, increased signal intensity (ISI) of the spinal cord on T2-weighted imaging (T2WI), and degree of degeneration of the discs adjacent to the fused levels (cranial and caudal) were collected from the patients. Univariate and binary logistic regression analyses were performed to identify risk factors for poor neurologic recovery.
Results The mean age of the patients was 52.56 ± 11.18 years, and the mean follow-up was 26.89 ± 11.14 months. Twenty patients (22.5%) had poor neurological recovery. Univariate analysis showed that significant predictors of poor neurological recovery were age (p = 0.019), concomitant OPLL (p = 0.019), concomitant calcification of herniated intervertebral discs (p = 0.019), ISI of the spinal cord on T2WI (p <0.05), a high grade of degeneration of the discs of the cranial neighboring levels (p <0.05), and a high grade of discs of the caudal neighboring levels (p <0.05). Binary logistic regression analysis showed that ISI of the spinal cord on T2WI (p = 0.001 OR = 24.947) and high degree of degeneration of adjacent discs on the cranial side (p = 0.040 OR = 6.260) were independent risk factors for poorneurological prognosis.
Conclusion ISI of the spinal cord on T2WI and high degree of cranial adjacent disc degeneration are independent risk factors for poor neurological recovery after anterior cervical discectomy and fusion. A comprehensive analysis of the patients’ preoperative imaging characteristics can help in the development of surgical protocols and the management of patients’ surgical expectations.
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Authors: Maria Anna Smolle, Lukas Jud, Fabrice André Scheurer, Armando Hoch, Jakob Ackermann, Benjamin Fritz and Daniel Andreas Müller
Abstract:
Background This experimental study aimed at directly comparing conventional and endoscopic-assisted curettage towards (1) amount of residual tumour tissue (RTT) and (2) differences between techniques.....
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Authors: Maria Anna Smolle, Lukas Jud, Fabrice André Scheurer, Armando Hoch, Jakob Ackermann, Benjamin Fritz and Daniel Andreas Müller
Background This experimental study aimed at directly comparing conventional and endoscopic-assisted curettage towards (1) amount of residual tumour tissue (RTT) and (2) differences between techniques regarding surgical time and surgeons’ experience level.
Methods Three orthopaedic surgeons (trainee, consultant, senior consultant) performed both conventional (4x each) and endoscopic-assisted curettages (4x each) on specifically prepared cortical-soft cancellous femur and tibia sawbone models. “Tumours” consisted of radio-opaque polyurethane-based foam injected into prepared holes. Preand postinterventional CT-scans were carried out and RTT assessed on CT-scans. For statistical analyses, percentage of RTT in relation to total lesion’s volume was used. T-tests, Wilcoxon rank-sum tests, and Kruskal-Wallis tests were applied to assess differences between surgeons and surgical techniques regarding RTT and timing.
Results Median overall RTT was 1% (IQR 1 – 4%). Endoscopic-assisted curettage was associated with lower amount of RTT (median, 1%, IQR 0 − 5%) compared to conventional curettage (median, 4%, IQR 0 − 15%, p = 0.024). Mean surgical time was prolonged with endoscopic-assisted (9.2 ± 2.9 min) versus conventional curettage (5.9 ± 2.0 min; p = 0.004). No significant difference in RTT amount (p = 0.571) or curetting time (p = 0.251) depending on surgeons’ experience level was found.
Conclusions Endoscopic-assisted curettage appears superior to conventional curettage regarding complete tissue removal, yet at expenses of prolonged curetting time. In clinical practice, this procedure may be reserved for cases athigh risk of recurrence (e.g. anatomy, histology).
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Background In recent years, the use of tapered-wedge short stems has increased due to their ability to preserve bones and tendons. Surgical techniques occasionally result.....
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Background In recent years, the use of tapered-wedge short stems has increased due to their ability to preserve bones and tendons. Surgical techniques occasionally result in a varus position of the stem, which is particularly pronounced in short stems. Although the varus position is not clinically problematic, there are reports of an increased incidence of stress shielding and cortical hypertrophy. Thus, we evaluated and examined the acceptable range of varus angles using finite element analysis.
Methods Patients diagnosed with osteoarthritis of the hip joint who had undergone arthroplasty were selected and classified into three types [champagne-flute (type A), intermediate (type B), and stovepipe (type C)]. Finite element analysis was performed using Mechanical Finder. The model was created using a Taperloc microplasty stem with the varus angle increased by 1° from 0° to 5° from the bone axis and classified into seven zones based on Gruen’s zone classification under loading conditions in a one-leg standing position. The volume of interest was set, the mean equivalent stress for each zone was calculated.
Results A significant decrease in stress was observed in zone 2, and increased stress was observed in zones 3 and 4, suggesting the emergence of a distal periosteal reaction, similar to the results of previous studies. In zone 2, there was a significant decrease in stress in all groups at a varus angle ≥ 3°. In zone 3, stress increased from ≥ 3° in type B and ≥ 4° in type C. In zone 4, there was a significant increase in stress at varus angles of ≥ 2° in types A and B and at ≥ 3° in type C.
Conclusion In zone 2, the varus angle at which stress shielding above Engh classification grade 3 may appear is expected to be ≥ 3°. Distal cortical hypertrophy may appear in zones 3 and 4; the narrower the medullary cavity shape, the smaller the allowable angle of internal recession, and the wider the medullary cavity shape, the wider theallowable range. Long-term follow-up is required in patients with varus angles > 3°.
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Authors: Lechi Zhang, Zhihang Xiao, Zelin Su, Xinlong Wang, Huifang Tian and Min Su
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Spinal cord injury (SCI) is a severe condition with an extremely high disability rate. It is mainly manifested as the loss of motor, sensory and autonomic nerve.....
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Authors: Lechi Zhang, Zhihang Xiao, Zelin Su, Xinlong Wang, Huifang Tian and Min Su
Spinal cord injury (SCI) is a severe condition with an extremely high disability rate. It is mainly manifested as the loss of motor, sensory and autonomic nerve functions below the injury site. High-frequency transcranial magnetic stimulation, a recently developed neuromodulation method, can increase motor function in mice with spinal cord injury. This study aimed to explore the possible mechanism by which transcranial magnetic stimulation (TMS) restores motor function after SCI. A complete T8 transection model of the spinal cord was established in mice, and the mice were treated daily with 15 Hz high-frequency transcranial magnetic stimulation. The BMS was used to evaluate the motor function of the mice after SCI. Western blotting and immunofluorescence were used to detect the expression of Connexin43 (CX43) and autophagy-related proteins in vivo and in vitro, and correlation analysis was performed to study the relationships among autophagy, CX43 and motor function recovery after SCI in mice. Western blotting was used to observe the effect of magnetic stimulation on the expression of mTOR pathway members. In the control group, the expression of CX43 was significantly decreased, and the expression of microtubule-associated protein 1 A/1b light chain 3 (LC3II) and P62 was significantly increased after 4 weeks of spinal cord transection. After high-frequency magnetic stimulation, the level of CX43 decreased, and the levels of LC3II and P62 increased in primary astrocytes. The BMS of the magnetic stimulation group was greater than that of the control group. High-frequency magnetic stimulation can inhibit the expression of CX43, which negatively regulates autophagic flux. HF-rTMS increased the expression levels of mTOR, p-mTOR and p-S6. Our experiments showed that rTMS can restore hindlimb motor function in mice after spinal cord injury via regulation of the Cx43-autophagy loop and activation of the mTOR signalling pathway.
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Background In patients undergoing total joint arthroplasty (TJA), the administration of dexamethasone may contribute to perioperative blood glucose (BG) disturbances, potentially resulting in complications, even.....
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Background In patients undergoing total joint arthroplasty (TJA), the administration of dexamethasone may contribute to perioperative blood glucose (BG) disturbances, potentially resulting in complications, even in patients without diabetes. This study aimed to demonstrate the impact of different administration regimens of dexamethasone in postoperative BG levels.
Methods In this randomized, controlled, double-blind trial, 136 patients without diabetes scheduled for TJA were randomly assigned to three groups: two perioperative saline injections (Group A, placebo); a single preoperative injection of 20 mg dexamethasone and a postoperative saline injection (Group B), and two perioperative injections of 10 mg dexamethasone (Group C). Primary outcomes were the postoperative fasting blood glucose (FBG) levels. Secondary outcome parameters were the postoperative postprandial blood glucose (PBG) levels. Postoperative complications within 90 days were also recorded. Risk factors for FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl were investigated.
Results Compared to Group A, there were transient increases in FBG and PBG on postoperative days (PODs) 0 and 1 in Groups B and C. Statistical differences in FBG and PBG among the three groups were nearly absent from POD 1 onward. Both dexamethasone regimens did not increase the risk for postoperative FBG ≥ 140 mg/dl or PBG ≥ 180 mg/ dl. Elevated preoperative HbA1c levels may increase the risk of postoperative FBG ≥ 140 mg/dl or PBG ≥ 180 mg/dl, respectively.
Conclusion Perioperative intravenous high-dose dexamethasone to patients without diabetes has transient effects on increasing BG levels after TJA. However, no differences were found between the split-dose and single high-dose regimens. The elevated preoperative HbA1c, but not the dexamethasone regimens were the risk factorfor FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl.
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Background Bone defects, resulting from substantial bone loss that exceeds the natural self-healing capacity, pose significant challenges to current therapeutic approaches due to various limitations......
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Background Bone defects, resulting from substantial bone loss that exceeds the natural self-healing capacity, pose significant challenges to current therapeutic approaches due to various limitations. In the quest for alternative therapeutic strategies, bone tissue engineering has emerged as a promising avenue. Notably, excretory proteins from Toxoplasma gondii (TgEP), recognized for their immunogenicity and broad spectrum of biological activities secreted or excreted during the parasite’s lifecycle, have been identified as potential facilitators of osteogenic differentiation in human bone marrow mesenchymal stem cells (hBMSCs). Building on our previous findings that TgEP can enhance osteogenic differentiation, this study investigated the molecular mechanisms underlying this effect and assessed itstherapeutic potential in vivo.
Methods We determined the optimum concentration of TgEP through cell cytotoxicity and cell proliferation assays. Subsequently, hBMSCs were treated with the appropriate concentration of TgEP. We assessed osteogenic protein markers, including alkaline phosphatase (ALP), Runx2, and Osx, as well as components of the BMP/Smad signaling pathway using quantitative real-time PCR (qRT-PCR), siRNA interference of hBMSCs, Western blot analysis, and other methods. Furthermore, we created a bone defect model in Sprague-Dawley (SD) male rats and filled the defect areas with the GelMa hydrogel, with or without TgEP. Microcomputed tomography (micro-CT) was employed to analyze the bone parameters of defect sites. H&E, Masson and immunohistochemical staining were used to assess the repair conditions of the defect area.
Results Our results indicate that TgEP promotes the expression of key osteogenic markers, including ALP, Runx2, and Osx, as well as the activation of Smad1, BMP2, and phosphorylated Smad1/5—crucial elements of the BMP/Smad signaling pathway. Furthermore, in vivo experiments using a bone defect model in rats demonstrated that TgEP markedly promoted bone defect repair.
Conclusion Our results provide compelling evidence that TgEP facilitates hBMSC osteogenic differentiation through the BMP/Smad signaling pathway, highlighting its potential as a therapeutic approach for bone tissue engineering for bone defect healing.
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Authors: Dillon C. O’Neill, Eleanor H. Sato, Tyler J. Thorne, Makoa Mau, Joshua M. Klonoski, Aaron L. Olsen and Justin M. Haller
Abstract:
Background Most existing animal models of acute compartment syndrome (ACS) rely on exogenous manipulation of intra-compartmental pressures to model ACS. The purpose of the current.....
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Authors: Dillon C. O’Neill, Eleanor H. Sato, Tyler J. Thorne, Makoa Mau, Joshua M. Klonoski, Aaron L. Olsen and Justin M. Haller
Background Most existing animal models of acute compartment syndrome (ACS) rely on exogenous manipulation of intra-compartmental pressures to model ACS. The purpose of the current study was to evaluate the endogenous effect of a blast injury on porcine lower leg intra-compartmental pressures (ICP).
Methods The hindlimb of juvenile Landrace pigs was fractured at the diaphyseal tibia and subjected to blasts of compressed air to mimic a blast injury. Injured and control legs underwent pre-operative continuous ICP monitoring. At 4.5 h post injury, the fracture was stabilized followed by closure of the anterior compartment fascia (continued compartment pressure model, CCPM) or four compartment fasciotomy. Pressure measurements were made after operative fixation. Select pigs in CCPM were harvested between 48 and 72 h post-injury to evaluate the duration of ICP elevation.
Results Post-injury, the model created significantly elevated ICP compared to control limbs (54.5 ± 18.2 vs. 18.2 ± 4.9 mmHg; p < 0.001). Operative fixation and anterior compartment fascial closure further increased the ICP (Mean: 87.4 ± 42.5 mmHg) relative to the pre-operative state (p = 0.037). Fasciotomy returned baseline compartment pressures (Mean: 13.7 ± 10.2 mmHg) which were equivalent to control limbs (p = 0.117). Pressure measurements at the time of delayed harvest (48–72 h) demonstrated that elevated ICP persisted following injury (69.7 ± 55.12 mmHg).
Conclusion The current study demonstrates that a pilot porcine blast model elevates ICP comparable to existinganimal models of compartment syndrome without exogenous ICP manipulation. ICP remained elevated at 48–72 h in the absence of fasciotomy.
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Authors: Ying-Jin Sun, Ning Liu, Long Huang, Xiang-Yang Chen, Ju-Tai Wu and Shuo Feng
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Objective The aim of this study was to investigate the effect of patellar denervation (PD) on pain, function and ability to kneel after unicompartmental knee.....
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Authors: Ying-Jin Sun, Ning Liu, Long Huang, Xiang-Yang Chen, Ju-Tai Wu and Shuo Feng
Objective The aim of this study was to investigate the effect of patellar denervation (PD) on pain, function and ability to kneel after unicompartmental knee arthroplasty (UKA).
Methods Patients with medial knee osteoarthritis who underwent UKA were prospectively selected. Patients were randomly divided into PD and non-PD groups based on whether patellar denervation was performed. Clinical assessment was performed using the Hospital for Special Surgery (HSS) knee score, Kujiala score, visual analogue scale (VAS) and forgotten joint score (FJS-12), as well as postoperative complications were recorded. The patients’ postoperative self-perception and actual ability to perform different kneeling positions were assessed in the two groups.
Results UKA patients treated with PD achieved better Kujiala scores and FJS-12 scores, reduced anterior knee pain and improved kneeling ability postoperatively, validating the effectiveness of PD in UKA. Perception and actual performance of kneeling remained mismatched in PD patients, but performance during different kneeling activities was generally better than in non-PD patients.
Conclusion Patellar denervation can safely and effectively improve patellofemoral joint function, pain and kneeling ability in the early postoperative period after UKA.
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Authors: Yanzhao Dong, Junfang Xu, Feipeng Wang, Yunheng Jia, GuoMing Feng, Yu Liu and Han Xue
Purpose To observe the effect of the forearm rotation function reconstruction with an external fixator in treating congenital radioulnar synostosis.
Methods From July 2017 to July 2023, 6 patients (9 sides) with congenital radioulnar synostosis who underwent reconstruction of the forearm rotation with the external fixator were retrospectively analyzed. The extent of flexion and rotation, the Modified An and Morrey functional rating index, and the grade according to the classification system proposed by Failla et al. were compared before and after the operation.
Results All patients were followed up for an average of 12.00 (8.00, 38.50) months. The average range of rotation, the Modified An and Morrey functional rating index increased from 0°, 64.56 ± 1.33 points to 85.00° ± 25.86°, 83.71 ± 5.50 points, respectively. The differences were statistically significant (t = 9.86, P < 0.01, t = 11.20, P < 0.01). There was no significant difference in forearm flexion before and after the operation (Z = 1.34, P = 0.18). According to the Failla classification system, 2 forearms were classified as poor preoperatively, 6 as fair and 1 as good. 2 forearms were assessed as excellent, 6 as good and 1 as fair during the last follow-up.
Conclusion Reconstruction of the forearm rotation function with an external fixator is safe and effective for treatingcongenital radioulnar synostosis. This technique can restore the partial rotational function of the forearm.
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Purpose The difference of Hounsfield Unit (HU) value in different regions of L3 vertebra in middle-aged and elderly patients with lumbar degeneration diseases (LDD) was.....
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Purpose The difference of Hounsfield Unit (HU) value in different regions of L3 vertebra in middle-aged and elderly patients with lumbar degeneration diseases (LDD) was analyzed. To investigate the influence of proliferative tissue on HU value of cancellous bone and its correlation with bone mineral density (BMD).
Methods The medical records of middle-aged and elderly patients with LDD in our hospital from December 2020 to December 2023 were retrospectively analyzed. The patients were divided into osteophyte group and no-osteophyte group according to the presence or absence of osteophyte formation on lumbar spine X-ray. In osteophyte group, cancellous bone HU value, containing cortical bone overall HU value and containing osteophyte overall HU value in L3 vertebra were measured on the lumbar CT cross-section. In no-osteophyte group, only the cancellous bone HU value and the containing cortical bone overall HU value were measured. Differences in HU value in different regions of the L3 vertebral body were compared within and between groups of middle-aged and elderly patients with LDD, respectively. To investigate its effect on cancellous bone HU measurements and to do a correlation analysis with patients’ BMD.
Results A total of 115 patients with LDD were included in this study, including 65 males and 50 females, with an average age of 67.83 ± 6.59 years. The results of the study showed no statistical differences in age (P = 0.15), gender (P = 0.57), smoking (P = 0.88), drinking history (P = 0.76), medical history (P > 0.05) and BMI(P = 0.29) between the two groups. In osteophyte group, the mean cancellous bone HU value was 98.00 ± 25.50 HU, the containing cortical bone overall HU value was 189.02 ± 46.18 HU, and the containing osteophyte overall HU value was 232.69 ± 56.01 HU. The overall HU values containing cortical bone and containing osteophyte were significantly higher than cancellous one HU value (P < 0.001). In no-osteophyte group, the mean cancellous bone HU value was 102.04 ± 19.64 HU, and the containing cortical bone overall HU value was 175.00 ± 28.97 HU, which was statistically significantly different (P < 0.001). There was no significant difference in cancellous bone HU value and the containing cortical bone overall HU value between the two groups (P > 0.05). The results of the Pearson correlation analysis showed a significant correlation between the cancellous bone HU value of the L3 vertebrae and the QCT BMD value of the patients (r = 0.95, P < 0.001). However, there was no significant correlation between containing cortical bone overall HU value and containing osteophyte overall HU value and the patient’s QCT BMD value (P > 0.05).
Conclusions Vertebral HU value is an alternative measurement that effectively reflects the patient’s BMD. In middle aged and elderly LDD patients, HU values in different areas of L3 vertebra are significantly different, and hyperplastic tissues such as cortical bone and osteophytes may exponentially lead to higher HU value in patients. Compared withother
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Authors: Liang Qiao, Yao Yao, Xiaokang You, Dengxian Wu, Hungkang Tsai, Guanjie Zhou, Zhihong Xu and Qing Jiang
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Background Caprini score and D-dimer are well-recognized markers in deep vein thrombosis (DVT) assessment. However, their utility in guiding post-arthroplasty DVT risk is hampered by.....
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Authors: Liang Qiao, Yao Yao, Xiaokang You, Dengxian Wu, Hungkang Tsai, Guanjie Zhou, Zhihong Xu and Qing Jiang
Background Caprini score and D-dimer are well-recognized markers in deep vein thrombosis (DVT) assessment. However, their utility in guiding post-arthroplasty DVT risk is hampered by susceptibility to various post-operative factors, limiting their effectiveness as reminders. Conversely, these markers exhibit greater stability in the preoperative setting. Despite this, research on the pre-operative predictive value of Caprini score and D-dimer for DVT following primary total knee arthroplasty (TKA) remains scarce.
Methods In a retrospective study, we analyzed data from patients who underwent primary TKA, between August 2015 and December 2022. Upon admission, Caprini scores were assessed, and comprehensive blood panels were obtained from fasting blood samples. For all patients, lower limb vascular Doppler ultrasonography was performed pre-operatively to exclude those with pre-existing DVT, and all patients underwent DVT examination again post-operatively.
Results Our study included 2,873 patients, averaging 67.98 ± 7.54years, including 676 men and 2,197 women. In this study, 303 (10.55%) patients developed postoperative DVT, and 57 (1.98%) cases presented with lower limb symptoms. DVT incidence in patients with pre-operative Caprini scores of 1–2 (6.50%), 3 (10.28%), and ≥ 4 (18.05%) showed significant differences (P < 0.05). DVT rates were 14.80% in patients with pre-operative D-dimer levels of ≥ 1 mg/L, higher than the 8.98% in those with levels of < 0.5 mg/L, and 10.61% in those with levels 0.5-1 mg/L (P < 0.05). In patients with Caprini scores of 1–2 and D-dimer levels ≤ 0.5 mg/L, the occurrence rate of postoperative DVT was only 5.84%. For patients with Caprini scores ≥ 4 and D-dimer levels ≥ 1.0 mg/L, the postoperative DVT occurrence rate soared to 24.81%, with the OR(odds ratio) was 4.744 compared to the former group.
Conclusion Patients with preoperative higher Caprini scores and D-dimer are more likely to develop DVT after TKA. Additionally, those with a preoperative Caprini score ≥ 4 and D-dimer level ≥ 1.0 mg/L have a significantly increased risk (24.81%) of developing DVT, identifying them as a high-risk group for DVT following TKA. These findings hold significant value for DVT risk stratification in primary TKA patients and the formulation of preoperative interventions tomitigate the risk of DVT.
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Authors: Yunfei Zhang, Hu Wang, Jiangpu Yi, Hongtao Zhang, Chuan Dong, Guoliang Wang, Zhengfeng Zhu, Wei Liu and Wen Luo
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Background Medical education related to bone fracture must address numerous challenges including complex anatomical characteristics, diverse injury mechanisms, fracture typing, and treatment modalities. Our newly.....
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Authors: Yunfei Zhang, Hu Wang, Jiangpu Yi, Hongtao Zhang, Chuan Dong, Guoliang Wang, Zhengfeng Zhu, Wei Liu and Wen Luo
Background Medical education related to bone fracture must address numerous challenges including complex anatomical characteristics, diverse injury mechanisms, fracture typing, and treatment modalities. Our newly developed 3D printed model comprises components that may be combined or split to simulate various anatomical features, fracture types, and treatment modalities. This study aims to analyze the teaching utility of the new 3D-printed model compared with the traditional solid model.
Methods This prospective study included 112 students randomly assigned to fracture-related education with a conventional model or the newly developed 3D-printed model. All students received 40 min of lecture, 20 min for femoral neck and 20 min for tibiofibular fractures, and a post-class quiz (10 min each) immediately followed. Scores on tests of fracture-related knowledge and user satisfaction were measured pre and post education for comparison.
Results The 3D printing group had an advantage in retention of anatomic knowledge, fracture typing and choice of treatment for the femoral neck fracture (P < 0.05). For the tibiofibular fracture the 3D printing group had an advantage in retention of anatomic knowledge and fracture complications (P < 0.05).Scores on the questionnaire survey also showed increased satisfaction in the 3D-printed model group(P < 0.05).
Conclusions The proposed 3D-printed model can enhance the teaching effect significantly and has potential forwidespread use in medical student education.
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Authors: You-li Tan, Shao-hua Ju, Qiang Wang, Rui Zhong, Ji-hai Gao, Ming-jian Wang, Ya-lan Kang and Meng-zhang Xu
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This study aimed to investigate the effects of Shuanglongjiegu pill (SLJGP) on the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) and explore its mechanism based.....
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Authors: You-li Tan, Shao-hua Ju, Qiang Wang, Rui Zhong, Ji-hai Gao, Ming-jian Wang, Ya-lan Kang and Meng-zhang Xu
This study aimed to investigate the effects of Shuanglongjiegu pill (SLJGP) on the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) and explore its mechanism based on miR-217/RUNX2 axis.Results found that drug-containing serum of SLJGP promoted BMSCs viability with a dose-dependent effect. Under osteogenic differentiation conditions, SLJGP promoted the expression of ALP, OPN, BMP2, RUNX2, and the osteogenic differentiation ability of BMSCs. In addition, SLJGP significantly reduced miR-217 expression, and miR- 217 directly targeted RUNX2. After treatment with miR-217 mimic, the promoting effects of SLJGP on proliferation and osteogenic differentiation of BMSCs were significantly inhibited. MiR-217 mimic co-treated with pcDNA-RUNX2 further confirmed that the miR-217/RUNX2 axis was involved in SLJGP to promote osteogenic differentiation of BMSCs. In addition, analysis of Wnt/β-catenin pathway protein expression showed that SLJGP activated the Wnt/β- catenin pathway through miR-217/RUNX2. In conclusion, SLJGP promoted osteogenic differentiation of BMSCs by regulating miR-217/RUNX2 axis and activating Wnt/β-catenin pathway.
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Background Muscle atrophy is a typical affliction in patients affected by knee Osteoarthritis (KOA). This study aimed to examine the potential pathogenesis and biomarkers that.....
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Background Muscle atrophy is a typical affliction in patients affected by knee Osteoarthritis (KOA). This study aimed to examine the potential pathogenesis and biomarkers that coalesce to induce muscle atrophy, primarily through the utilization of bioinformatics analysis.
Methods Two distinct public datasets of osteoarthritis and muscle atrophy (GSE82107 and GSE205431) were subjected to differential gene expression analysis and gene set enrichment analysis (GSEA) to probe for common differentially expressed genes (DEGs) and conduct transcription factor (TF) enrichment analysis from such genes. Venn diagrams were used to identify the target TF, followed by the construction of a protein-protein interaction (PPI) network of the common DEGs governed by the target TF. Hub genes were determined through the CytoHubba plug-in whilst their biological functions were assessed using GSEA analysis in the GTEx database. To validate the study, reverse transcriptase real-time quantitative polymerase chain reaction (qRT-PCR), enzyme-linked immunosorbent assay (ELISA), and Flow Cytometry techniques were employed.
Results A total of 138 common DEGs of osteoarthritis and muscle atrophy were identified, with 16 TFs exhibiting notable expression patterns in both datasets. Venn diagram analysis identified early growth response gene-1 (EGR1) as the target TF, enriched in critical pathways such as epithelial mesenchymal transition, tumor necrosis factor-alpha signaling NF-κB, and inflammatory response. PPI analysis revealed five hub genes, including EGR1, FOS, FOSB, KLF2, and JUNB. The reliability of EGR1 was confirmed by validation testing, corroborating bioinformatics analysis trends.
Conclusions EGR1, FOS, FOSB, KLF2, and JUNB are intricately involved in muscle atrophy development. High EGR1 expression directly regulated these hub genes, significantly influencing postoperative muscle atrophy progression inKOA patients.
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Background: Osteoporosis is a major public health problem. Dietary inflammatory preference and body mass index (BMI) are emerging factors that tends to affect bone health......
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Background: Osteoporosis is a major public health problem. Dietary inflammatory preference and body mass index (BMI) are emerging factors that tends to affect bone health. There is limited evidence regarding the joint influence of BMI and dietary status on the bone health. This study aimed to investigate the relationship between dietary inflammatory index (DII) and bone health among adults under different levels of BMI utilizing the National Health and Nutrition Examination Survey (NHANES).
Methods: Data were collected from 2005–2010, 2013–2014 to 2017–2018 in NHANES. In total, 10,521 participants who aged ≥ 20 years and had complete data for dietary intake interview, bone mineral density (BMD) and bone mineral content (BMC) were included. DII was performed to evaluate the dietary inflammatory potential based on dietary intake interview. We evaluated bone health by femoral neck BMD and BMC measured by dual energy X-ray absorptiometry. Weighted multivariable linear regression and BMI-stratified subgroup analysis were performed.
Results: The average DII score for 10,521 participants was 1.24 ± 0.04, mean femoral neck BMD was 0.82 ± 0.00 g/ cm2 and mean BMC was 4.37 ± 0.01 g. In the fully adjusted model, there was a negative correlation between DII with BMD (β = − 0.016, P < 0.001) and BMC (β = − 0.011, P < 0.001) in the most anti-inflammatory diet. Using BMI-stratified subgroup analysis, this correlation became more evident in both the overweight (BMD: β = − 0.024, P < 0.001; BMC: β = − 0.058, P = 0.042) and obese groups (BMD: β = − 0.015, P = 0.049; BMC: β = − 0.009, P = 0.042), while this correlation was opposite in DII tertile 2 (middle DII score) in the underweight group (BMD: β = 0.047, P = 0.038; BMC: β = 0.274, P = 0.010).
Conclusion: Relationship between higher consumption of pro-inflammatory and increased risk of lower BMD andBMC was only existed in overweight and obese participants.
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Authors: Li Jian, Long Shi‑wei, Jing Dan, Wu Juan and Zheng Wei
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The expression of GPR84 in bone marrow-derived monocytes/macrophages (BMMs) can inhibit osteoclast formation; however, its role in bone metastasis of colorectal cancer (CRC) is still unknown. To.....
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Authors: Li Jian, Long Shi‑wei, Jing Dan, Wu Juan and Zheng Wei
The expression of GPR84 in bone marrow-derived monocytes/macrophages (BMMs) can inhibit osteoclast formation; however, its role in bone metastasis of colorectal cancer (CRC) is still unknown. To investigate the effects of GPR84 on bone metastasis of CRC, the murine CRC cell line MC-38 was injected into tibial bone marrow. We found that the expression of GPR84 in BMMs was gradually downregulated during bone metastasis of CRC, and the activation of GPR84 significantly prevented osteoclastogenesis in the tumor microenvironment. Mechanistically, the MAPK pathway mediated the effects of GPR84 on osteoclast formation. Moreover, we found that IL-11 at least partly inhibited the expression of GPR84 in the tumor microenvironment through the inactivation of STAT1. Additionally, activation of GPR84 could prevent osteolysis during bone metastasis of CRC. Our results suggest that CRC cells downregulate the expression of GPR84 in BMMs to promote osteoclastogenesis in an IL-11-dependent manner. Thus, GPR84 could be apotential therapeutic target to attenuate bone destruction induced by CRC metastasis.
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Authors: Mohamed Gomaa Sobeeh, Karima Abdelaty Hassan, Anabela Gonçalves da Silva, Enas Fawzy Youssef, Nadia Abdelazim Fayaz and Maha Mostafa Mohammed
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Background: Complex regional pain syndrome (CRPS) is a chronic condition following inciting events such as fractures or surgeries with sensorimotor and autonomic manifestations and poor.....
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Authors: Mohamed Gomaa Sobeeh, Karima Abdelaty Hassan, Anabela Gonçalves da Silva, Enas Fawzy Youssef, Nadia Abdelazim Fayaz and Maha Mostafa Mohammed
Background: Complex regional pain syndrome (CRPS) is a chronic condition following inciting events such as fractures or surgeries with sensorimotor and autonomic manifestations and poor prognosis. This review aimed to provide conclusive evidence about the sensory phenotype of CRPS based on quantitative sensory testing (QST) to understand the underlying pain mechanisms and guide treatment strategies.
Databases: Eight databases were searched based on a previously published protocol. Forty studies comparing QST outcomes (thermal, mechanical, vibration, and electric detection thresholds, thermal, mechanical, pressure, and electric pain thresholds, wind-up ratio, mechanical pain sensitivity, allodynia, flare area, area after pinprick hyperalgesia, pleasantness after C-tactile stimulation, and pain ratings) in chronic CRPS (adults and children) versus healthy controls were included.
Results: From 37 studies (14 of low quality, 22 of fair quality, and 1 of good quality), adults with CRPS showed: (i) significant loss of thermal, mechanical, and vibration sensations, significant gain of thermal and mechanical pain thresholds, significant elevation of pain ratings, and no difference in wind-up ratio; (ii) significant reduction of pleasantness levels and increased area of pinprick hyperalgesia, in the affected limb. From three fair-quality studies, adolescents and children with CRPS showed loss of cold detection with cold hyperalgesia in the affected limb. There was moderate to substantial overall heterogeneity.
Conclusion: Diffuse thermal and mechanical hypoesthesia with primary and secondary hyperalgesia, enhanced pain facilitation evidenced by increased area of pinprick hyperalgesia, and elevated pain ratings are dominant in adults with CRPS. Adolescents and children with CRPS showed less severe sensory abnormalities.
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