Computed tomography (CT) images with slice spacing up to 3 mm are generally sufficient for accurate 3D reconstructions of patient anatomy. For designing patient-specific instruments, particularly for forearm and wrist osteotomies, higher-resolution imaging (slice spacing of 0.4–1.25 mm) is commonly used. However, it remains unclear whether CT slice spacing meaningfully affects the surface fit of 3D-printed patient-specific instruments. This in-vitro study quantified the impact of CT slice spacing on the positional accuracy of instruments for the distal radius. Data from 12 patients were analysed. Each had a high-resolution CT image (0.625 mm slice spacing), from which a reference 3D radius model and a patient-specific instrument were designed. The original images were downsampled to slice spacings of 1.0, 1.25, 1.5, 1.875, and 2.5 mm to generate corresponding radius models and instrument bases. An experienced hand surgeon, blinded to slice spacing, fixated each 3D-printed instrument base onto its reference 3D-printed radius model in a simulated surgery. The assembled constructs were scanned, and the translation and rotation deviations of each lower-resolution instrument position were measured relative to the gold-standard instrument from the original scan. Mean rotational deviations across all slice spacings remained consistently low (< 1°), with the largest of 0.56° around the Z-axis at 2.5 mm. Translational deviations were similarly small (< 0.2 mm), with the greatest mean deviation of − 0.14 mm along the Z-axis at 1 mm. No systematic trend toward increasing error with decreasing image resolution was observed. CT slice spacing had a generally small effect on the positional accuracy of 3D-printed patient-specific instruments for the distal radius in vitro. These results indicate that clinically acceptable instrument accuracy may be achieved across a broad range of CT slice spacing commonly used in musculoskeletal imaging, potentially reducing the need for high-resolution protocols in selected clinical scenarios.
Transcriptomic studies have identified miR‑324‑3p as a hub dysregulated miRNA in Diabetic foot ulcer (DFU) lesions, and bioinformatic prediction suggests potential targeting of GPX4, a core regulator of ferroptosis. This study aimed to explore the clinical correlation and intrinsic regulatory mechanism of the miR-324-3p/GPX4 axis in the progression of DFU. A total of 320 human subjects, including 100 healthy controls (HC), 100 patients with uncomplicated T2DM (DM), and 120 patients with DFU, were enrolled in this cross‑sectional study. Serum relative expression of miR‑324‑3p and GPX4 enzymatic activity were measured. Their correlations with routine metabolic/inflammatory clinical markers, Wagner ulcer grade, and 28‑day wound‑healing outcomes were analyzed. Human umbilical vein endothelial cells (HUVECs) treated with high glucose (HG) served as an in‑vitro cellular model of diabetic injury. Clinically, circulating miR‑324‑3p expression increased progressively whereas serum GPX4 enzymatic activity decreased across healthy controls, uncomplicated type 2 diabetic patients and DFU patients. Circulating miR‑324‑3p was positively associated with glycemic and inflammatory markers, advanced Wagner grades, and higher 28‑day non‑healing risk in DFU patients, and showed inverse correlation with serum GPX4 activity. In HUVECs, high‑glucose exposure up‑regulated miR‑324‑3p and suppressed GPX4 expression. Inhibition of miR‑324‑3p restored endothelial proliferation and migration, improved intracellular redox homeostasis, and reduced pro‑inflammatory IL‑6 and TNF‑α secretion; these protective effects were completely abolished following GPX4 knockdown. The miR‑324‑3p/GPX4 axis correlates with diabetic foot ulcer severity. In‑vitro data suggest that this axis may participate in high‑glucose‑mediated endothelial dysfunction via regulating inflammation and ferroptosis‑associated injury. This endothelial‑centered pathway may partially contribute to DFU pathogenesis, although clinical findings remain correlative and require further independent validation.
Total knee arthroplasty (TKA) is an effective treatment for end-stage knee osteoarthritis (OA). However, a substantial proportion of patients continue to experience suboptimal functional recovery and remain dissatisfied after surgery. As an objective, non-invasive biomechanical assessment tool, plantar pressure analysis enables the quantification of dynamic changes in foot–ground interaction after correction of lower limb alignment, thereby providing a unique distal endpoint perspective for evaluating postoperative outcomes following TKA. This narrative review summarizes the current evidence regarding the application of plantar pressure analysis before and after TKA. Article based on a PubMed/MEDLINE search up to May 2026. Available studies have demonstrated that individuals with varus knee OA exhibit a characteristic lateralized plantar pressure distribution pattern. Following TKA, plantar pressure distribution in most patients gradually normalizes toward a pattern comparable to that observed in healthy individuals, although persistent abnormalities may remain in some cases. Furthermore, plantar pressure parameters may demonstrate only partial concordance with radiographic measures of lower limb alignment and patient-reported functional outcome scores. Differences in postoperative plantar pressure recovery have also been reported among different surgical techniques. Overall, plantar pressure analysis has the potential to serve as a valuable complementary tool for postoperative functional assessment and rehabilitation planning following TKA.
Epidural injection (EI) is a commonly utilized intervention for managing lower back and radicular leg pain stemming from a herniated lumbar disc (HLD). Three primary EI techniques are currently employed: transforaminal (TFEI), interlaminar (ILEI), and caudal epidural injections (CEI). This network meta-analysis (NMA) aimed to assess the relative effectiveness of TFEI, ILEI, and CEI in alleviating pain and enhancing function among patients with HLD. PubMed, Embase, Cochrane Library, Web of Science were comprehensively searched from inception to January 9, 2026 for randomized controlled trials (RCTs). Studies that compared different EI techniques for patients with HLD were included in this NMA. Weighted mean differences (WMDs) in Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) score changes were calculated for short-term and long-term evaluations. The NMA was performed using R software with gemtc package. Treatment hierarchy was evaluated using the Surface Under the Cumulative Ranking Curve (SUCRA) probabilities. The Confidence in Network Meta-Analysis (CINeMA) framework was applied to evaluate the certainty of evidence. Ten RCTs involving 902 patients were included. The NMA revealed that no statistically significant differences among the three EI techniques for any outcomes (P > 0.05). However, SUCRA-based probability ranking analysis indicated that TFEI had the highest likelihood of being the most effective treatment for pain reduction and functional improvement across both short- and long-term assessment periods. The certainty of evidence for all comparisons across all outcomes ranged from low to very low, indicating limited confidence in the effect estimates. Although probability rankings based on SUCRA values suggested that TFEI might be the preferred intervention, the NMA revealed no statistically significant differences among TFEI, ILEI, and CEI in reducing pain or improving function. Critically, the certainty of evidence was rated as low to very low across all comparisons. Current findings do not support the superiority of any one injection approach over the others and are insufficient to guide clinical decision-making.
Clonal hematopoiesis of indeterminate potential (CHIP) is an age-related condition characterized by somatic mutations in hematopoietic stem cells and is increasingly recognized as a driver of systemic inflammation and diverse age-related diseases. Whether CHIP contributes to intervertebral disc degeneration (IDD) remains unknown. Thus, this study aimed to examine the association between CHIP and the incident risk of IDD and its subtypes—cervical and lumbar disc degeneration (CDD and LDD). Using data from 258,566 eligible UK Biobank participants with available exome sequencing data for CHIP and complete covariate information, this study employed Cox proportional hazards models to estimate hazard ratios (HRs) across three adjustment models. Incident IDD was identified from ICD-coded clinical diagnoses. Exploratory gene-specific analyses were conducted to evaluate particular CHIP driver mutations associated with IDD risk. Mediation analyses were performed to investigate the roles of systemic inflammatory markers in mediating the CHIP–IDD relationship. Among 258,566 eligible participants, 8113 (3.14
