BackgroundIntertrochanteric femoral fractures are common osteoporotic injuries in elderly women, and disruption of the lateral femoral wall has been recognized as a key factor contributing to fracture instability and fixation failure. Low bone mineral density (BMD), impaired bone metabolism, and decreased body mass index (BMI) are known to influence fracture patterns in the elderly; however, the specific factors predisposing patients to concomitant lateral wall involvement remain unclear. Therefore, the purpose of this study was to compare BMD, bone turnover markers, BMI, and age between elderly women with isolated intertrochanteric fractures and those with additional lateral wall involvement, and to identify independent risk factors associated with lateral wall fractures.MethodsBetween January 2023 and February 2024, 49 postmenopausal women with intertrochanteric femoral fractures were treated at our institution. Among them, 29 had isolated intertrochanteric fractures and 20 sustained concomitant lateral wall fractures. Independent-samples t tests were used to compare age, BMI, and BMD between groups, whereas Mann–Whitney U tests were applied for P1NP and β-CTX. Binary logistic regression was performed with age, BMI, lumbar BMD, and hip BMD as covariates to assess their associations with lateral wall involvement.ResultsSignificant differences were observed between groups in age, BMI, lumbar BMD, and hip BMD, whereas P1NP and β-CTX showed no significant differences. Logistic regression revealed that lower BMI, lumbar BMD, and hip BMD were independently associated with the occurrence of lateral wall fractures.ConclusionLow BMI and decreased lumbar and hip BMD are significant risk factors for lateral wall involvement in intertrochanteric femoral fractures among elderly women.Trial RegistrationClinicalTrials.gov identifier: NCT07196982.

Objective:To investigate the clinical efficacy of arthroscopic limited incision of the articular capsule to repair the glenoid labrum in the treatment of borderline developmental dysplasia of the hip (BDDH) complicated with labral tear.Methods:A retrospective study was conducted to analyze the data of 18 patients with BDDH complicated with labral tear who had been admitted to Department of Orthopaedics, The Second Hospital Affiliated to Suzhou University from January 2016 to December 2019 (observation group). There were 12 males and 6 females with an age of (41.8 ± 8.5) years. Simultaneously, another 18 patients were selected as the control group whose hip development was normal but age and gender were matched with those in the observation group. There were 9 males and 9 females with an age of (43.5 ± 10.3) years. Both groups were treated by arthroscopic limited incision of the articular capsule to repair the glenoid labrum. The 2 groups were compared in terms of modified Harris hip score (MHHS), Hip Outcome Score Activities of Daily Living Subscale (HOS-ADL), and visual analogue scale (VAS).Results:There was no significant difference in the demographic data like age, gender ratio, body mass index, severity of labral tear or time from injury to operation between the 2 groups, indicating comparability between groups ( P>0.05). The observation and control groups were followed up for (38 ± 7) and (43 ± 6) months, respectively. For the observation and control groups, respectively, MHHS was (97.1 ± 3.3) points and (95.4 ± 4.2) points, HOS-ADL (92.6 ± 2.8) points and (91.4 ± 4.1) points, and VAS (0.6 ± 0.5) points and (1.0 ± 0.8) points, all showing no significant difference between groups ( P>0.05). Conclusion:In the treatment of BDDH patients complicated with labral tear, simple arthroscopic limited incision of the articular capsule to repair the glenoid labrum can lead to the same good medium-term efficacy as it can in those with normal hip development.

We here showed that ADCK1 (AarF domain-containing kinase 1), a mitochondrial protein, is upregulated in human osteosarcoma (OS) tissues and OS cells. In primary and established OS cells, ADCK1 shRNA or CRISPR/Cas9-induced ADCK1 knockout (KO) remarkably inhibited cell viability, proliferation and migration, and provoked apoptosis activation. Conversely, ectopic ADCK1 overexpression exerted pro-cancerous activity by promoting OS cell proliferation and migration. ADCK1 depletion disrupted mitochondrial functions in OS cells and induced mitochondrial membrane potential reduction, ATP depletion, reactive oxygen species production. Significantly, ADCK1 silencing augmented doxorubicin-induced apoptosis in primary OS cells. mTOR activation is important for ADCK1 expression in OS cells. The mTOR inhibitors, rapamycin and AZD2014, as well as mTOR shRNA, potently decreased ADCK1 expression in primary OS cells. In nude mice, the growth of subcutaneous pOS-1 xenografts was largely inhibited when bearing ADCK1 shRNA or ADCK1 KO construct. Moreover, ADCK1 KO largely inhibited pOS-1 xenograft in situ growth in proximal tibia of nude mice. ADCK1 depletion, apoptosis activation and ATP reduction were detected in pOS-1 xenografts bearing ADCK1 shRNA or ADCK1 KO construct. Together, the mitochondrial protein ADCK1 is required for OS cell growth and is a novel therapeutic target of OS.

Objective To evaluate the midterm outcomes and the capsular healing in patients who had interportal capsulotomy versus periportal capsulotomy of hip arthroscopy. Methods Retrospectively reviewed 33 patients with labral tear received hip arthroscopy, with an average age of 41 (27‐67) years, including 13 cases of Cam deformity and three cases of Pincer deformity. All patients had positive sign of flexion adduction internal rotation or flexion abduction external rotation. With MRI and radiographic (CT, X plain) imageological examination. MRI showed that all patients had labral tear. Radiographic finding (CT, X plain) showed the pathological changes of acetabular and femoral neck osteophyte. One group with 23 patients were treated with periportal capsulotomy. Another group with 10 patients were treated with interportal capsulotomy. All patients did not close the capsule. Clinical outcomes were measured with the Hip Outcome Score Activities of Daily Living (HOS‐ADL) and the modified Harris Hip Score (mHHS), patient satisfaction measured with visual analogue scale (VAS). The healing of the capsule was evaluated by MRI. MRI showed continuous capsular indicated healing, discontinuous capsular indicated unhealing. Postoperatively 6 months, mHHS and HOS‐ADL were obtained. Randomized controlled trials were used in this study for analysis. Results All patients were followed up with average time of 9.3 months(3‐29 months). The postoperative symptoms were obviously relieved, the VAS decreased from (4.9 ± 0.6) to (1.2 ± 0.2) after 3 months postoperative. Follow up 6 months post‐operation, patients in the interportal group, the mHHS and HOS‐ADL scores improvement were respectively 69.4 ± 9.3 & 70 ± 8.8 pre‐operation, and 92.5 ± 5.0 & 86.6 ± 5.4 post‐operation ( P < 0.05); Patients in the periportal group, the mHHS and HOS‐ADL scores improvement were respectively 69.9 ± 15.8, 68.1 ± 15.0 pre‐operation, and 90.1 ± 9.3 & 86.7 ± 7.9 post‐operation ( P < 0.05).The differences were statistically significant. Six months after operation, MRI showed that 23 patients with periportal capsulotomy, the capsule have healed, without other complications. Three of the ten patients with interportal capsulotomy were healed and seven were not. Conclusion Interportal and periportal capsulotomy had good outcomes. The technique of periportal capsulotomy had little damage to the joint capsule. Although the capsule did not close, the capsule healed well in postoperative follow‐up. The nonunion rate of the joint capsule was high in the interportal capsulotomy without close the capsule.

随着教学改革的推进,近年来各高校都在逐步推广PBL和CBL教学,在骨科临床教学中引入了PBL和CBL教学模式给医学生进行授课.总结近年来实施PBL和CBL教学存在的问题和经验,分享一些体会和看法.

Gastric cancer (GC) is one of the leading causes of human mortality around the world. We have previously shown that Gαi1 (the inhibitory subunit 1 of the heterotrimeric guanine nucleotide-binding protein) recruitment to ligand-activated receptor tyrosine kinases (RTKs) is essential for signaling. Testing its role in GC cancer-promoting functions, we found that Gαi1 is upregulated in human GC, correlating with poor overall survival. In established and primary human GC cells, Gαi1 shRNA (small hairpin RNA) or knockout produced significant anti-GC cell activity, proliferation and migration was inhibited, and apoptosis was activated. Conversely, ectopic Gαi1 overexpression promoted proliferation and migration of GC cells in vitro. By examining the tumor-suppressive miRNA microRNA-200a (miR-200a), we found that miR-200a directly silenced Gαi1 to induce anti-GC cell activity. The expression of miR-200a was downregulated in human GC, correlating with upregulation of a novel miR-200a-targeting long non-coding RNA (LncRNA), PINK1 (PTEN Induced Kinase 1)-AS. RNA immunoprecipitation, RNA-pull down, and RNA fluorescence in situ hybridization assays confirmed that PINK1-AS directly binds to miR-200a. Silencing PINK1-AS in GC cells led to miR-200a accumulation, Gαi1 downregulation, and inhibition of GC cell progression in vitro, whereas PINK1-AS upregulation produced the converse results. Significantly, anti-GC cell activity induced by PINK1-AS shRNA was ameliorated by the expression of miR-200a antisense or the 3ʹ-UTR (untranslated region)-depleted Gαi1. In vivo, the growth of subcutaneous MGC-803 xenografts in nude mice was inhibited by PINK1-AS shRNA, but accelerated by PINK1-AS overexpression. Patient-derived GC xenograft growth in nude mice was largely inhibited after intratumoral injection of PINK1-AS shRNA lentivirus. In conclusion, PINK1-AS promotes Gαi1-driven GC progression by sponging miR-200a.

HBO1 (KAT7 or MYST2) is a histone acetyltransferase that acetylates H3 and H4 histones. Methods: HBO1 expression was tested in human OS tissues and cells. Genetic strategies, including shRNA, CRISPR/Cas9 and overexpression constructs, were applied to exogenously alter HBO1 expression in OS cells. The HBO1 inhibitor WM-3835 was utilized to block HBO1 activation. Results:HBO1 mRNA and protein expression is significantly elevated in OS tissues and cells. In established (MG63/U2OS lines) and primary human OS cells, shRNA-mediated HBO1 silencing and CRISPR/Cas9-induced HBO1 knockout were able to potently inhibit cell viability, growth, proliferation, as well as cell migration and invasion. Significant increase of apoptosis was detected in HBO1-silenced/knockout OS cells. Conversely, ectopic HBO1 overexpression promoted OS cell proliferation and migration. We identified ZNF384 (zinc finger protein 384) as a potential transcription factor of HBO1. Increased binding between ZNF384 and HBO1 promoter was detected in OS cell and tissues, whereas ZNF384 silencing via shRNA downregulated HBO1 and produced significant anti-OS cell activity. In vivo, intratumoral injection of HBO1 shRNA lentivirus silenced HBO1 and inhibited OS xenograft growth in mice. Furthermore, growth of HBO1-knockout OS xenografts was significantly slower than the control xenografts. WM-3835, a novel and high-specific small molecule HBO1 inhibitor, was able to potently suppressed OS cell proliferation and migration, and led to apoptosis activation. Furthermore, intraperitoneal injection of a single dose of WM-3835 potently inhibited OS xenograft growth in SCID mice. Conclusion: HBO1 overexpression promotes OS cell growth in vitro and in vivo.

Objective:To investigate the roles of toll-like receptor 4 (TLR4) and nuclear factor-κB (NF-κB) in regulating the endogenous hydrogen sulfide-producing enzyme cystathionine β synthetase (CBS) protein expression and the mechanism that was involved in increasing sciatic nerve hypersensitivity in lumbar disc herniation (LDH).Methods:We generated a LDH rat model. We measured excitability with patch-clamp techniques. We recorded the synaptic neuron excitability and transmission in the substantia gelatinosa (SG) of spinal cord using patch clamping in vitro. Western blotting was used to detect the protein expression of TLR4, NF-κB, and CBS in dorsal horn of spinal cord (SC) from sham and LDH rats. The behavior study was used to measure the pain sensitive of animals. Results:LDH enhanced the excitation ( t=2.564, P<0.01) and spontaneous excitatory neurotransmission in SG neurons ( t=2.225, P<0.05). We detected significant upregulation of TLR4, NF-κB, and CBS proteins in SC neurons in the LDH rat model ( t=7.071, t=2.40, t=2.767, P<0.05). Intrathecal administration of the TLR4-selective inhibitor, CLI095, significantly suppressed the expression of NF-κB, and CBS proteins ( t=10.070, P<0.01; t=2.531, P<0.05) and the frequency of glutamatergic synaptic activities of SG neurons ( t=4.334, t=2.437, P<0.05) and attenuated sciatic hypersensitivity in LDH rats. Conclusion:LDH increased the expression of TLR4 and NF-κB proteins, which in turn sensitized sciatic nerve hypersensitivity by upregulating CBS-H2S protein levels, finally leading to the pathological pain.

Objective To study the impact on bone mineral density,serum bone metabolism markers,and the expression of osteoprotegerin（OPG） and receptor activator of NF-κB ligand（RANKL） in the adult offspring exposed

目的 探讨CBL/PBL联合教学模式应用于骨科学专业型研究生教学中的效果.方法 选取2015年9月-2018年6月于该院骨科进行专业型研究生培养的硕士研究生70名作为研究对象,每组各35名.分别实施传统讲授式教学和CBL/PBL联合教学模式教学,观察教学效果.结果 CBL/PBL联合教学组研究生在理论基础和实际操作的考核评分高于传统组,差异有统计学意义(P＜0.05).CBL/PBL联合教学组学生对教学目标明确、增强互动和学习兴趣、提高分析问题能力、提高临床技能操作掌握程度、提高临床思维和文献检索能力的评分高于传统组,差异有统计学意义(P＜0.05).结论 CBL/PBL联合教学模式应用于骨科学专业型研究生临床教学教学中的效果显著.

Osteoporosis is one of common bone disorders, affecting millions of people worldwide. Treatments of osteoporosis consist of pharmacotherapy and non-pharmacological interventions, such as mineral supplementation, lifestyle changes, and exercise programs. Due to the minimum side effects and favorable cost-effective therapeutic effects, herbal medicine has been widely applied in clinical practices for more than 2,000 years in China. Of the many traditional formulas reported for treating bone diseases, 4 single herbs namely (1) Herba Epimedii, (2) Rhizoma Drynariae, (3) Fructus Psoraleae, and (4) Cortex Eucommiae, are considered as the featured "Kidney-Yang" tonics, and frequently and effectively applied for preventing and treating osteoporosis. With the accruing development of modern chemistry, hundreds of active compounds have been identified and isolated for their anti-osteoporotic effects. This review would first sketch the phytochemistry of these featured "Kidney- Yang" tonics and present the pharmacological characteristics of the most abundant and bioactive compounds derived from the herb Herba Epimedii and Rhizoma Drynariae, including icariin and naringin. Then, the cellular and molecular underpinnings under anti-osteoporotic effects of icariin and naringin are discussed. The concerned structure-function relationships of the featured active herbal compounds would also be reviewed so as to pave the way for future drug design in treating osteoporosis.

Poly-D-L lactide (PDLLA) biodegradable implants to heal fractures are widely applied in orthopedic surgeries. However, whether the process of fracture healing is regulated differently when PDLLA is used compared with traditional metal materials remains unclear. Runt-related transcription factor 2 (Runx2) and canonical Wnt signaling are essential and may interact reciprocally in the regulation of osteogenesis during bone repair. In the present study, a rat femoral open osteotomy model was used to compare the curative efficacy of a PDLLA rod and Kirschner wire under intramedullary fixation for fracture treatment. The dynamic expression of Runx2 and key components of the canonical Wnt signaling in callus tissue during fracture healing was also investigated. The results of the current study indicate that at weeks 4 and 6 following fixation, the callus bone structural parameters of microCT were significantly improved by PDLLA rod compared to that of Kirschner wire. In addition, at weeks 4 and 6 after fixation, the protein and mRNA expression of Runx2 and the positive regulators of canonical Wnt signaling, such as Wnts and β-catenin, were significantly increased. However, the protein and mRNA expression levels of the negative regulators of canonical Wnt signaling, such as glycogen synthase kinase-3β, were significantly decreased in callus tissue when treated with PDLLA rod compared with Kirschner wire. Collectively, these data indicate that compared to the traditional metal material, using PDLLA internal fixation for fracture treatment may further improve bone formation, which is associated with the increased expression of Runx2 and the enhancement of canonical Wnt signaling.

Objective To compare and evaluate the differences of curative effects and biological mechanisms underlying the posttraumatic bone healing,as well as the study of the regulation of Runt related transcription factor 2 (Runx2) signal pathway mechanism of osteogenesis by using Salidroside.Methods To establish an close osteotomy model of SD rats.40 rats divide into experimental group and control group.Using microCT to evaluate and compare the curative efficacy about the posttraumatic bone healing.Using the method of enzyme linked immunosorbent assay (ELISA),the serum concentrations of alkaline phosphatase (ALP),osteoprotegerin (OPG) were assessed.Using the method of real-time quantitative polymerase chain reaction (Real-time PCR),the mRNA expression levels of Runx2,hypoxia inducible factor (HIF) 2A,Wnt4,Wnt10b,β-catenin,glycogen synthase kinase (GSK)-3β,T-cell factor (TCF)-1 in callus tissue were determined.Results At 2 and 4 weeks after surgery,the callus bone structural parameters of microCT were significantly improved in experimental group compared to that of control group (P ＜ 0.05).In addition,at weeks 2 and 4 after surgery,the mRNA expressions of Runx2 (2 w:1.83 ± 0.11,4 w:2.23±0.11),HIF2A (2 w:1.37±0.12,4 w:1.50±0.12),Wnt4 (2w:1.78±0.10,4 w:1.66 ± 0.11),Wnt10b (2 w:1.89 ± 0.12,4 w:1.92 ± 0.13),β-catenin (2 w:1.65 ± 0.08,4 w:1.72 ±0.10) were significantly increased,whereas the mRNA expressions of GSK-3ββ (2 w:0.61 ± 0.08,4 w:0.56 ± 0.09) were significantly decreased (P ＜ 0.05).The serum concentrations of ALP [2 w:(335.34±9.23) IU/L,4 w:(312.45 ±10.56) IU/L]P,OPG [2 w:(40.02 ±2.90) IU/L,4 w:(45.56 ± 3.20) pg/ml] were significantly increased (P ＜ 0.05).Conclusion Compared with the Control group,the Salidroside group make an effect to fracture healing.

Objective To compare the different effect of PDLLA absorbable materials and traditional metal fixation products for post-traumatic bone healing and osteogenesis/osteoclast.Methods The project will establish an open osteotomy model of SD rats using traditional metal internal fixation products (Kirschner) and PDLLA absorbable intramedullary rod fixation.We compared the osteoblasts/osteoclasts effects of the two materials by dynamic monitoring of relevant indicators of bone repair in wound healing process.Furthermore, wehaveanalyzed the signaling pathways and transcription factor expression levels of osteoblast/osteoclast differentiation and maturation in healing process.We thoroughly studied the differenceof the cellular and molecular mechanisms in the treatment of traumatic fractures by PDLLA intramedullary rod fixation and traditional metal products.We measured the soluble receptor activateor of nuclear factors-κB ligand (sRANKL), osteoprotegerin (OPG), RANKL, OPG by the enzyme linked immunosorbent assay (ELISA) to evaluate the fracture healing.We compared the osteoblasts/osteoclasts effects of the two materials by X-ray and MicroCT.We observed the protein of Wnt OPG and RANKL by histology method.Compared the expression of mRNA of Wnt OPG and RANKL by real-time quantitative polymerase chain reaction (Real-time PCR).Results At 4 and 6 weeks after surgery, compared to that of metal intramedullary fixation products, after using the PDLLA absorbable material for intramedullary fixation, the growth of trabecula in callus was significantly promoted [4 W: (0.522 ± 0.06) 1/mm;6 W: (0.709 ±0.06) 1/mm];The serum concentrations of sRANKL [4 W: (132.66 ± 2.87) ng/L;6 W: (131.08 ±2.09) ng/L], OPG [4W: (42.68 ± 3.99) ng/L;6 W: (44.88 ± 3.90) ng/L], and the ratio of OPG/sRANKL (4 W:0.34 ±0.06;6W:0.34 ±0.08) were significantly increased;The serum concentrations of TRACP-5b[4 W:(86.48 ±5.11) ng/L;6 W:(90.05 ±5.13) ng/L]was decreased(P ＜0.05).At 4 and 6 weeks after surgery, compared to that of metal intramedullary fixation products, the protein and mRNA expression levels of RANKL, OPG, Wnt, β-catenin in callus tissue were significantly elevated (P ＜ 0.05).Conclusion Compared with the control group, the PDLLA group make an effect to fracture healing.

Multimodal imaging probes represent an extraordinary tool for accurate diagnosis of diseases due to the complementary advantages of multiple imaging modalities. The purpose of the work was to fabricate a simple dual-modality MR/CT probe for osteosarcoma visualization in vivo. Protein-directed synthesis methods offer a suitable alternative to MR/CT probe produced by synthetic chemistry. Bovine serum albumin (BSA) bound to gadolinium nanoparticles (GdNPs) was first prepared via a biomimetic synthesis method and was subsequently iodinated by chloramine-T method. The final iodinated BSA-GdNPs (I-BSA-GdNPs) showed excellent chemical stability and biocompatibility, intense X-ray attenuation coefficient, and good MR imaging ability. However, an iodinated protein nanoparticles synthesis for MR/CT imaging, as well as its useful application, has not been reported yet. Intravenous injection of I-BSA-GdNPs into orthotopic osteosarcoma-bearing rats led to its accumulation and retention by the tumor, allowing for a noninvasive tumor dual-modality imaging through the intact thigh. The long-circulating dual-model I-BSA-GdNPs probes possess potential application for image-guided drug delivery and image-guided surgery. Our study is therefore highlighting the properties of albumin in this field combined with its useful use in dual-model MR/CT osteosarcoma visualization, underlining its potential use as a drug carrier for a future therapy on cancer.

目的 交流探讨肢体显影小异物的定位与取出方法.方法 对23 例肢体软组织内X线能显影的小异物,用自制的瞄准定位器定位后,用髓核钳取出异物.结果 23 例患者共29枚异物均顺利取出,手术时间最短2 min,最长32 min,平均8 min.结论 自制的瞄准器能准确定位,髓核钳探取小异物简单、容易,成功率高.

Objective To evaluate the clinical efficacy of minimally invasive locking compression plate(LCP) osteosynthesis in the treatment of distal femur fracture.Methods A total of 21 cases with distal femur fracture was treated with minimally invasive LCP.Operation time,blood loss, length of incisions, function of the knee and clinical healing condition were analyzed.Results The operation time was 60 to 130 min.The blood loss was 200 to 400 ml.The length of incision was 5 to 6 era.The patients were followed up for 6 to 20 months.The function of the knee was graded HSS excellent and good rate of 90.48%.Conclusion The clinical application of minimally invasive LCP osteosynthesis in distal femur fracture has the advantages of less operation time, invasion and blood loss, stable fixation, early mobilization, and high union.

In the new medical environment,clinical practice is a key step that 7-year clinic medical students take to become doctors.It is very important for the cultivation of 7-year clinic medical students' ethics,the solid:fication of basic theories and improvement of basic clinical skills.The quality of the practice has a direct effect on whether they are qualified for clinical jobs.Based on analyzing the factors that may influence the quality of practice,some countermeasures are put forward for improving the quality of medical students' clinical practice.

<正>虽然后交叉韧带是膝关节内非常重要的韧带,具有很多功能,能够限制胫骨过度后移,限制伸膝位侧方活动及膝关节旋转活动。但是如果患者的后交叉韧带,或者前交叉韧带不正常,一般不保留后交叉韧带,因为前交叉韧带异常往往会引起后交叉韧带的严重改变。临床发现,往往需要全膝关节置换的患者,