Persistent neuropathic-like pain may limit recovery after arthroscopic repair of massive rotator cuff tears, but its postoperative occurrence, associated factors, and preoperative risk stratification remain insufficiently characterized. This study estimated the 6-month occurrence proportion, examined associated factors, and developed an internally validated preoperative four-domain risk score. This single-center retrospective cohort screened 418 consecutive adults treated between January 2019 and December 2024; 346 met the eligibility requirements, including ascertainable 6-month primary-outcome and 12-month follow-up phenotype data. The primary outcome required persistent or recurrent pain in the operated shoulder and related region at 6 months, a Douleur Neuropathique 4 (DN4) questionnaire score ≥ 4, a painDETECT score ≥ 13, at least 1 documented abnormality on a prespecified bedside sensory examination, and exclusion of a more plausible cause. painDETECT scores of 13–18 provided supportive evidence within the composite definition, for which all criteria were required, whereas scores ≥ 19 defined the strict sensitivity-analysis outcome. The 4 domains prespecified before outcome modeling were the central sensitization-related symptoms–poor sleep composite phenotype (Central Sensitization Inventory [CSI] ≥ 40 and Pittsburgh Sleep Quality Index [PSQI] > 5), preoperative subthreshold neuropathic-like symptoms, a magnetic resonance imaging (MRI)-based degeneration–tension phenotype, and limited socioeconomic and rehabilitation resources. Each domain contributed 1 point. A logistic regression model with the total score as the sole predictor was evaluated using 1,000 bootstrap resamples. The phenotype occurred in 46 of 346 patients (13.3

Research shows that transplanted bone marrow mesenchymal stem cells (BMSCs) have been shown to improve functional outcomes in mice with spinal cord injury (SCI). Many experimental centers have demonstrated that systemic delivery of MSCs in mice can treat neurological diseases, but whether or how it works in acute spinal cord injury is not understood. Various methods such as Basso, Beattie, and Bresnahan (BBB) locomotor rating scale score and biological detection of inflammatory factors were used to test the changes in inflammatory factors of spinal cord injury at different time points in 24 h, 7 d, and 14 d. Twenty-four hours after injury, the functional measurement results of the injured group were significantly weakened compared with the control rats. The functional results of the BMSCs injection injured group were also significantly weakened compared with the control rats. There was no statistical difference between the injured group and the BMSCs injection group. However, the injury group had the highest mortality rate (p < 0.05). Biochemical results showed that compared with the control group, the expression of high-mobility group box 1 (HMGB1) and receptor for advanced glycation end-products (RAGE) and related inflammatory factors in the injury group and BMSCs injection group increased significantly at 7 d after the experiment in Western blot. Similarly, the expression of HMGB1 and RAGE in the injury group was also greater than that in the injection group, and there was a statistical difference in immunohistochemical assessment. Injecting BMSCs into rats with acute spinal cord injury could reduce rat mortality and improve prognostic functional measurements after SCI. BMSCs may promote spinal cord re-repair by inhibiting the HMGB1/RAGE signaling pathway after acute contusive spinal cord injury.

Rheumatoid arthritis (RA) is a prevalent chronic inflammatory disorder characterized by synovial hyperplasia, wherein the proliferating synovial tissue comprises fibroblast-like synoviocytes (FLS). The eradication of FLS is presently the focal point of study in the therapy of RA. Pyroptosis, a distinct form of controlled cell death, has garnered significant interest in recent study. Consequently, alongside diverse conventional therapy methods, precisely targeting the development of FLS pyroptosis and augmenting the capacity to eliminate FLS has emerged as a novel avenue for investigating RA. This study presents a unique multifunctional nanotherapeutic platform for the treatment of rheumatoid arthritis, utilizing defect-rich zinc oxide (D.ZnOx)‑gold (Au)-Sodium borohydride (NaBH4) (D. ZAN) nanoparticles. It alters the material via flawed engineering and incorporates Au nanoparticles to create a Schottky junction, thereby augmenting the efficacy of sonodynamic therapy (SDT) under the piezoelectric effect. Additionally, by releasing acid-responsive zinc ions (Zn2+) and hydrogen (H2), it activates the cysteine-dependent aspartate-specific protease (Caspase)-1 / Gasdermin D (GSDMD)-dependent pathway to induce pyroptosis in FLS. The integration of the material's photothermal impact with the targeting capability of vasoactive intestinal peptide (VIP) facilitates the accurate elimination of FLS, thereby inhibiting the growth of synovial tissues and halting the advancement of RA.

OBJECTIVE:This study is designed to assess the effect of internal fixation (IF) versus artificial hip replacement (AHR) on stroke during and after hip fracture. METHODS:A total of 120 elderly patients with hip fractures who were treated in our hospital were retrospectively analyzed and divided into an IF group and an AHR group according to the surgical method. Comparisons were made between patients of two groups in general data, intraoperative and postoperative general conditions, hip function scores, and hip joint excellence rate. According to whether or not patients have had a postoperative stroke, they were classified into the occurrence and non-occurrence groups in order to analyze the influence of single factor and multivariate analysis on the postoperative hip fracture of the elderly patients. RESULTS:All patients were followed up for 12 months postoperatively. In contrast to the IF group, the AHR group showed better intraoperative and postoperative conditions, higher Harris function score, higher hip joint excellent rate, and lower incidence of postoperative stroke (all P < 0.05). In 120 cases of patients, 18 cases of postoperative stroke occurred, with the incidence rate of 15.00 %. The results of the multivariate analysis reflected that the risk factors for postoperative stroke during hospitalization for hip fracture included advanced age, ASA III and above, long-term anticoagulant medication, and IF surgery (all OR > 1, P < 0.05). CONCLUSION:Compared with IF, giving AHR treatment to elderly hip fracture patients can considerably optimize the surgical indicators, improve the hip function of elderly patients, and provide better postoperative recovery.

BackgroundThe design of femoral stem prostheses requires a precise understanding of the femoral marrow cavity. Traditional measurements of morphological parameters in the upper femur, particularly the medullary cavity and cortical region, are primarily based on coronal and sagittal axes, which may not fully capture the true three-dimensional structure of the femur.MethodsPropose a Monte Carlo-based method for a more comprehensive analysis of the femoral marrow cavity, using CT scans of femurs from a selected group of patients. The study aimed to define and calculate anatomically semantic morphological parameters to enhance the understanding of the femoral marrow cavity's anatomical morphological changes, ultimately improving the design and clinical selection of femoral stem prostheses. To enhance the accuracy of femoral stem prosthesis design, this study aims to develop a Monte Carlo-based method for a more comprehensive analysis of the femoral marrow cavity. The proposed method transforms the non-random problem of determining cross-sectional size into a random issue, allowing for the calculation of the size of the medullary cavity and cortical region. Anatomically semantic morphological parameters are then defined, calculated, and analyzed.ResultsThe experimental results indicate that the newly defined parameters complement existing ones, providing a more rational scientific basis for understanding the anatomical morphological changes of the femoral marrow cavity.ConclusionThis research offers essential scientific theoretical support for improved morphologic research, design, and clinical selection of femoral stem prostheses. It holds significant importance and application value in clinical practice, contributing to a more accurate and comprehensive understanding of femoral anatomy for prosthetic design.

AIMS:Necroptosis is one of programmed death that may aggravate spinal cord injury (SCI). We aimed to investigate the effect and mechanism of exendin-4 (EX-4) on the recovery of motor function and necroptosis after SCI. METHODS:The SD rats with left hemisection in the T10 spinal cord as SCI model were used. The behavior tests were measured within 4 weeks. The effects of EX-4 on necroptosis-associated proteins and autophagy flux were explored. In addition, the SHSY5Y cell model was introduced to explore the direct effect of EX-4 on neurons. The effect of lysosome was explored using mTOR activator and AO staining. RESULTS:EX-4 could improve motor function and limb strength, promote the recovery of autophagy flux, and accelerate the degradation of necroptosis-related protein at 3 d after injury in rats. EX-4 reduced lysosome membrane permeability, promoted the recovery of lysosome function and autophagy flux, and accelerated the degradation of necroptosis-related proteins by inhibiting the phosphorylation level of mTOR in the SHSY5Y cell model. CONCLUSION:Our results demonstrated that EX-4 may improve motor function after SCI via inhibiting mTOR phosphorylation level and accelerating the degradation of necroptosis-related proteins in neurons. Our findings may provide new therapeutic targets for clinical treatment after SCI.

Objective:To explore the effectiveness of the combined anteversion angle technique in total hip arthroplasty (THA) for treating ankylosing spondylitis (AS) affecting the hip joint. Methods:A retrospective analysis was conducted on the clinical data of 73 patients with AS affecting the hip joint who underwent THA between August 2018 and August 2021. According to whether the combined anteversion angle technique was used in THA, the patients were divided into study group (37 cases, combined anteversion angle technique was used in THA) and control group (36 cases, traditional THA). There was no significant difference in baseline data such as gender, age, body mass index, disease duration, preoperative Harris score, range of motion (ROM), acetabular anteversion angle, acetabular abduction angle, femoral anteversion angle, and combined anteversion angle between the two groups ( P>0.05). The operation time, hospital stay, and complications of the two groups were recorded and compared. The Harris score and hip ROM were compared between the two groups before operation, at 1, 3, 6, 12 months after operation, and at last follow-up. The acetabular component anteversion angle, femoral component anteversion angle, acetabular component abduction angle, and component combined anteversion angle were measured postoperatively. Results:The operation time in the study group was significantly shorter than that in the control group ( P<0.05), and there was no significant difference in hospital stay between the two groups ( P>0.05). There was no intraoperative complication such as acetabular and proximal femoral fractures, neurovascular injuries in both groups, and the incisions healed by first intention. All patients were followed up 2-3 years, with an average of 2.4 years; there was no significant difference in the follow-up time between the two groups ( P>0.05). During the follow-up period, there was no complication such as hip dislocation, wound infection, delayed wound healing, deep venous thrombosis, and hip dislocation in both groups. The hip Harris score and ROM of the two groups gradually increased with time after operation, and the differences were significant when compared with those before operation ( P<0.05); the above two indicators of the study group were significantly better than those of the control group at each time point after operation ( P<0.05). Extensive bone ingrowth on the surface of the components could be observed in the anteroposterior X-ray films of the hip joint of the two groups at 12 months after operation, and the acetabular components was stable without femoral stem subsidence, osteolysis around the components, and heterotopic ossification. At last follow-up, the acetabular component anteversion angle, femoral component anteversion angle, and component combined anteversion angle in the study group were significantly superior to those in the control group ( P<0.05), except that there was no significant difference in the acetabular component abduction angle between the two groups ( P>0.05). Conclusion:For patients with AS affecting the hip joint, the use of the combined anteversion angle technique during THA effectively promotes the recovery of hip joint function and enhances the postoperative quality of life of patients when compared to traditional THA.

ObjectiveIncreasing evidence has shown that calf muscular vein thrombosis (CMVT) can develop into proximal deep vein thrombosis, even causing pulmonary embolism. However, opinions about the prevalence and risk factors are still controversial. This study aimed to investigate the prevalence and risk factors for CMVT in elderly patients with hip fractures to facilitate their preoperative management.MethodsWe included 419 elderly patients with hip fracture who were treated in the orthopaedic department of our hospital from June 2017 to December 2020. The patients were divided into CMVT and non‐CMVT groups based on color Doppler ultrasound screening of the venous system in the lower extremities. Clinical data, such as age, sex, body mass index, time from injury to admission, and laboratory data were collected. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors for CMVT. A receiver operating characteristic curve was used to analyze the predictive effectiveness of the model. Finally, the clinical utility of the model was analyzed using decision curve analysis and clinical impact curves.ResultsThe prevalence of preoperative CMVT was 30.5% (128/419). Independent predictors of preoperative CMVT identified by univariate and multivariate logistic regression analyses were sex, time from injury to admission, American Society of Anesthesiologists (ASA) classification, C‐reactive protein (CRP) level, and D‐dimer level (p < 0.05). The area under curve (AUC) was 0.750 (95% CI: 0.699–0.800, p < 0.001) and the sensitivity and specificity were 0.698 and 0.711, respectively, which meant the prediction model has a good efficacy in the prediction of CMVT risk. In addition, the fitting degree of the prediction model was also good (Hosmer–Lemeshow χ2 = 8.447, p > 0.05). The clinical utility of the model was verified using decision curve analysis and clinical impact curves.ConclusionSex, time from injury to admission, ASA classification, CRP level, and D‐dimer levels are independent preoperative predictors of CMVT in elderly patients with hip fractures. Measures should be taken for patients with these risk factors to prevent the occurrence and deterioration of CMVT.

Background: Incidental thyroid abnormalities found on magnetic resonance imaging (MRI) of the neck are not uncommon. This study aimed to investigate the prevalence of incidental thyroid abnormalities in the cervical spine MRI of the degenerative cervical spondylosis (DCS) population indicated for surgery and to identify patients who require additional workup based on the recommendations of the American College of Radiology (ACR). Methods: All consecutive patients with DCS and indications for cervical spine surgery from October 2014 to May 2019 in the Affiliated Hospital of Xuzhou Medical University were reviewed. All MRI scans of the cervical spine routinely include the thyroid. Cervical spine MRI scans were retrospectively evaluated for the prevalence, size, morphologic characteristics, and location of incidental thyroid abnormalities. Results: A total of 1,313 patients were included in the analysis, 98 (7.5%) of whom were found to have incidental thyroid abnormalities. The most frequent thyroid abnormality was thyroid nodules (5.3%), followed by goiters (1.4%). Other thyroid abnormalities included Hashimoto thyroiditis (0.4%) and thyroid cancer (0.5%). There was a statistically significant difference in age and sex between patients with DCS with and without incidental thyroid abnormalities ( P=0.018 and P=0.007). Stratified by age, the results showed that the highest incidence of incidental thyroid abnormalities was found in patients aged 71 to 80 years (12.4%). Eighteen patients (1.4%) needed further ultrasound (US) and relevant workups. Conclusions: Incidental thyroid abnormalities are common in cervical MRI, with a prevalence of 7.5% identified in patients with DCS. Incidental thyroid abnormalities are large or have suspicious imaging features, and further evaluation with a dedicated thyroid US examination should be completed before cervical spine surgery is undertaken.

In the clinic, valgus knees are relatively infrequent. To achieve a balance between the soft tissue and bone and prevent nerve injury, treatments for valgus deviations >20° provide a surgical challenge. The implications of lower-limb valgus deformity greater than 20°, a unique condition, have not been thoroughly examined in many articles. We described a 66-year-old woman who had a severe, permanent valgus deformity in her right knee. The patient's right knee had a preoperative range of motion (ROM) of 30-95° of flexion and a 25° permanent valgus deformity.

Objective: This study aimed to assess the safety and efficacy of triple-dose intravenous tranexamic acid (TXA) in patients following total hip arthroplasty (THA) using thromboelastography (TEG). Methods: One hundred thirty patients undergoing THA were prospectively enrolled in the study. According to the intravenous infusion TXA dose, patients were divided into single -dose (n = 65; mean age = 60.8 +/- 8.1 years) and triple-dose groups (n = 65; mean age = 61.8 +/- 8.6 years). Complete blood count (CBC), conventional coagulation tests (CCT), and TEG were conducted 1 day before the operation, on postoperative day 1 (POD1), and postoperative day 7 (POD7). Color Doppler ultrasonography was performed 1 day before the operation and on POD7. Drainage blood loss, total blood loss (TBL), hidden blood loss (HBL), deep vein thrombosis (DVT) incidence, and blood transfusion rates were calculated and recorded. The CCT, CBC, and TEG parameters were compared between the 2 groups. Results: Single- and triple-dose groups had significantly different hematocrit on POD7 (P < .05). No significant differences were found in CCT and hemoglobin at any corresponding time point between the 2 groups (P > .05). Despite the reaction time (R) on POD1 (P < .05), there were no significant differences in other TEG parameters at any other time point between the 2 groups (P > 0.05). For drainage blood loss and TBL, the triple-dose group had lesser blood loss than the single -dose group (P < .05). However, no significant differences were found for blood transfusion rate, HBL, or incidence of DVT (P > .05). Conclusion: Compared with single -dose, triple-dose TXA can be more effective in decreasing blood loss without increasing DVT incidence in patients undergoing THA. Although there is a notable disparity in the R time on POD1, the administration of triple-dose TXA does not substantially impact the coagulation status as assessed by TEG and CCT.

Hydrogen (H2) therapy is a new and effective approach for treatment of inflammation-related diseases. Nevertheless, the non-polarity and poor solubility of H2 under physiological status lead to its limited therapeutic effect. Here, we developed spatially separated Au/TiO2 nanodumbbells (NDs) as H2 generators and further conjugated them with Arg-Gly-Asp (RGD) peptides (labeled R-Au/TiO2) to achieve inflammatory joint targeting for precise treatment of rheumatoid arthritis (RA). The Au/TiO2 NDs structure combines the surface plasmon resonance (SPR) excitation of gold nanorods (Au NRs) and Schottky junction to exhibit very efficient photocatalytic H2 production under near-infrared light irradiation. In situ generated H2 gas acts as an active ingredient to scavenge reactive oxygen species (ROS) and clear inflammation. Through active H2 scavenging of ROS and inflammation, R-Au/TiO2 alleviated oxidative stress and reduced levels of inflammatory cytokines, showing considerable reduction in joint destruction and suppression of arthritis severity in a collagen-induced arthritis mouse model. Furthermore, the photothermal properties of R-Au/TiO2 nanoparticles (NPs) endow them with photothermal therapeutic effects, which synergize with the anti-inflammatory and anti-oxidative stress of H2, further enhancing the therapeutic effect. Therefore, R-Au/TiO2 NPs show great promise for treating RA and advancing clinical translation.

目的:比较直接前方入路与后外侧入路全髋关节置换治疗股骨颈骨折的疗效及术后髋关节功能的影响因素分析.方法:选取2019年5月至2021年12月徐州医科大学附属医院收治并行全髋关节置换治疗股骨颈骨折患者96例,按照手术方法的不同分为直接前方入路组(n=48)和后外侧入路组(n=48).观察两组围术期指标、并发症发生情况,比较两组治疗前后Harris评分、视觉模拟评分法(VAS).并应用单因素、多因素Logistic回归分析患者术后髋关节功能的影响因素.结果:直接前方入路组下床时间、切口长度、住院时间显著短于后外侧入路组,术中失血量、术后引流量显著低于后外侧入路组,而手术时间显著长于后外侧入路组(P＜0.05).直接前方入路组术后1、3个月Harris评分显著高于后外侧入路组,VAS评分显著低于后外侧入路组(P＜0.05).两组术后并发症发生率比较,无统计学差异(P＞0.05).两组治疗6个月后髋关节功能优良率比较,差异无统计学意义(P＞0.05).多因素Logistic回归分析结果显示:体质量指数≥24kg/m2、术后锻炼时间＜3 h/d、合并骨质疏松是接受全髋关节置换治疗的股骨颈骨折患者术后髋关节功能不良的危险因素(P＜0.05).结论:直接前方入路全髋关节置换术较后外侧入路全髋关节置换术短期内优势明显,表现为对患者的创伤更小,术后疼痛程度较轻,有利于患者的髋关节功能恢复.体质量指数≥24kg/m2、术后锻炼时间＜3 h/d、合并骨质疏松是接受全髋关节置换治疗的股骨颈骨折患者术后髋关节功能不良的危险因素.

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint hypoxia and the proliferation of M1 macrophages. Therefore, relieving hypoxia and removing M1 macrophages will be a new direction in the treatment of RA. Folic acid (FA)-loaded PCP nanoparticles Fe-Co prussian blue analogue@CeO2@PDA (F-PCP) were used for in situ oxygen (O2) production/chemodynamic/photothermal/treatment of RA. On one hand, PDA-mediated photothermal therapy also has a certain effect on the removal of proliferative M1 macrophages. On the other hand, under the irradiation of NIR laser, F-PCP has obtained excellent photothermal therapy (PTT) performance, which accelerates the Fenton/Fenton-like reaction to produce reactive oxygen species and O2, so as to achieve the chemodynamic therapy (CDT) that inhibits the proliferation of M1 macrophages. It is worth noting that the RA was improved by the synergistic action of CDT and PTT, and the generation of oxygen can alleviate RA hypoxia, which is a means to improve CDT. Therefore, the F-PCP NPs show great potential in improving the therapeutic effect of RA.

The overall objective of this study was to investigate the mechanism of inflammation on chondrocyte injury and the protective effect of catalpol on chondrocytes in an inflammatory environment. Chondrocytes were isolated and cultured from the knee joints of three-day-old newborn mice. Alcian Blue staining and the immunocytochemistry staining of type II collagen were used to identify the purity of chondrocytes. Primary chondrocytes were stimulated by IL-1β (10 ng/mL) and subjected to transcriptome analysis. Differentially expressed genes (DEGs) were further analyzed based on Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. In this experimental study, we performed the viability assay to determine the effects of different concentrations of catalpol on the cell viability of chondrocytes. Chondrocytes were seeded in six-well plates and exposed to 10 μM catalpol 2 h prior to treatment with IL-1β (10 ng/mL). Quantitative real-time (qPCR) and Western blotting were performed to evaluate the RNA and protein expression, respectively. Based on the results of transcriptomics analysis, we found the NOD2 signaling pathway, the NF-kappa B signaling pathway, and the MAPK signaling pathway showed significant changes in chondrocyte damage caused by inflammation. Catalpol (10 μM and 100 μM) could significantly reduce NO, IL-6, IL-1β, and TNF-α in supernatant of chondrocytes. Catalpol significantly inhibited the mRNA expression of IL-1, IL-6, and IL-12 in chondrocytes induced by IL-1β. Catalpol markedly inhibited MMP3, MMP13 mRNA, and protein levels. Catalpol could significantly reduce TNF-α mRNA levels in inflammatory chondrocytes. Inflammation causes significant increases in mRNA levels and protein levels of NOD2, mRNA levels, and protein levels were markedly suppressed by catalpol. In addition, catalpol could significantly increase IKBα protein levels and significantly lower intranuclear P65 levels. Catalpol significantly lowered the phosphorylation protein levels of ERK, p38, and JNK. Our transcriptomic analysis demonstrated that the activation of NOD2 and its downstream pathways, NF-κB and MAPK, is an important cause of the inflammatory injury to chondrocytes induced by IL-1β. Catalpol inhibited the activation of the NOD2 signaling pathway, which reduced the phosphorylation of ERK, p38, and JNK, inhibited the degradation of IκBα, inhibited p65 translocation into the nucleus, reduced the release of inflammatory cytokines, and attenuated the inflammatory damage to chondrocytes.

Context:Associations between genes and diseases manifest as the influence of gene expression on disease development as well as the impact of variations in the disease-related genes themselves. It's important to determine the genetic variations that can lead to compressed fractures of osteoporotic, thoracic lumbar vertebrae to develop personalized clinical methods to prevent or delay the disease's development.Objective:The study intended to explore the correlations between the gene polymorphisms and gene expressions of the interleukin-6 (IL-6) gene and the transforming growth factor-beta (TGF-β) gene and osteoporotic, thoracolumbar, vertebral compression fracture.Design:The research team performed an observational study using data from medical records.Setting:The study took place at Xuzhou Medical University in Xuzhou, China.Participants:Participants were 200 patients with an osteoporotic, thoracolumbar, vertebral compression fracture who had been admitted to the hospital at the university between 2019 and 2021 prior to the study and 200 healthy people The research team divided the participants into two groups. The patients became participants in the disease group, and the healthy individuals became participants in the control group.Outcome Measures:The research team: (1) collected peripheral blood from the two groups, (2) extracted genomic deoxyribonucleic acids (DNAs) from karyocytes, (3) examined the IL-6 and TGF-β gene polymorphisms, and (4) analyzed and correlated participants' clinical data with the gene polymorphisms and expressions. The team used a quantitative polymerase chain reaction (qPCR) to examine the expression levels of IL-6 and TGF-β.Results:Compared to the control group, the disease group: (1) had allele distributions that were significantly different at the rs2069829 locus of the IL-6 gene (P < .001) and at the rs3087453 of the TGF-β gene (P = .004); (2) had significantly higher frequencies of allele T at the rs2069829 locus of the IL-6 gene and of allele G at the rs3087453 locus of the TGF-β gene; (3) had genotype distributions that were significantly different at the rs2069829 locus (P < .001) and the rs2069857 locus (P = .048) of the IL-6 gene and at the rs3087453 locus (P < .001) of the TGF-β gene; (4) had frequencies that were significantly higher of the TT genotype at the rs2069829 locus, the CC genotype at the rs2069857 locus, and the GC genotype at the rs3087453 locus of the IL-6 gene and the TGF-β gene; (5) had dominant models that were significantly different at the rs2069829 locus of the IL-6 gene (P = .009) and at rs3087453 locus of the TGF-β gene (P = .026) and had a recessive model that was significantly different at the rs2069857 locus of the IL-6 gene (P = .040); (6) had significantly different haplotypes CC (P < .001) and TC (P < .001) at the rs2069829 locus and the rs2069857 locus of the IL-6 gene and a significantly different haplotype AC (P = .011) at the rs1800469 locus and the rs3087453 locus of the TGF-β gene; (7) had an IL-6 gene polymorphism at the rs2069857 locus that was related to the expression of the IL-6 gene (P < .05) and an expression of the IL-6 gene for participants with the AA genotype that was significantly lower than for other genotypes; (8) had a TGF-β gene polymorphism at the rs1800469 locus that was associated with the expression of the TGF-β gene (P < .05), and an expression for participants with the GG genotype that was significantly higher than for other genotypes; (9) had an IL-6 gene polymorphism at the rs2069857 locus with an overt correlation with the genotype of osteoporotic, thoracolumbar, vertebral compression fracture (P < .001). Also, participants in the disease group with the genotype CC mainly had type 2 and 3 fractures, while those with genotype AA primarily had type 0 and 1 fractures.Conclusions:IL-6 and TGF-β gene polymorphisms and expressions are significantly related to osteoporotic, thoracolumbar, vertebral compression fracture.

BACKGROUND: In recent years, the number of patients with simultaneous lumbar and hip joint diseases and undergoing surgery has increased. The mid-term prognosis of patients with lumbar fusion after total hip arthroplasty is rarely studied.OBJECTIVE: To investigate the mid-term effect of total hip arthroplasty in patients with lumbar fusion.METHODS: Clinical and imaging data of patients who received initial total hip arthroplasty at the Affiliated Hospital of Xuzhou Medical University from January 2014 to January 2019 were retrospectively analyzed. Patients were divided into a fusion group and a non-fusion group according to whether there was lumbar fusion before surgery. There were 41 patients in the fusion group. Among the patients with concurrent total hip arthroplasty, gender, age, body mass index ±5, visual analog scale score ±2, preoperative Harris hip score ±10 maintained 1:2 matching, and 82 patients were selected as the non-fusion group. The complications and Harris hip score of the two groups at the last postoperative follow-up were compared, and the fusion group was divided into a pelvic stiffness group（ΔPT＜20°） and a non-pelvic stiffness group（ΔPT≥20°） according to the changes of pelvic tilt angle（ΔPT） between standing and sitting positions before surgery. The difference in curative effect was compared between the two groups. RESULTS AND CONCLUSION:（1） All patients were followed up for more than 36 months. The rate of dislocation in the fusion group was higher than that in the non-fusion group（P=0.035）.（2） The range of motion score（P=0.030） and total Harris hip score（P=0.001） in the fusion group were lower than those in the nonfusion group.（3） The Harris hip score of the patients of pelvic stiffness group at the last follow-up was significantly lower than that of the non-pelvic stiffness group（P=0.032）.（4） It is concluded that the prognosis of patients with lumbar fusion after total hip arthroplasty was worse than that of patients with general total hip arthroplasty, especially those with pelvic stiffness. Moreover, patients with lumbar fusion have a higher risk of dislocation after surgery. This provides support for routine preoperative spinal imaging in patients with prior lumbar fusion and pre-total hip arthroplasty and provides the patient with postoperative expectations.

PurposeTo determine the side-to-side difference in intraindividual rotation alignment of patients with bilateral varus-type knee osteoarthritis (OA) and compare it with control subjects.MethodsThis retrospective study enrolled 60 patients with bilateral varus-type knee OA and 50 control subjects. All cases underwent bilateral lower limb CT angiography. Bilateral femoral and tibial rotation alignment were measured, and the overall lower limb rotation was calculated by two different methods. Method 1 was calculated by subtracting angle of the femoral torsion from the tibial torsion and method 2 was determined by relative rotation of the femoral neck angle to bimalleolar angle. The intraindividual variance and differences between the two groups were analyzed.ResultsBoth OA and control samples showed significant differences between right and left for all measurements. Femoral torsion for control group was 10.4 ± 5.5°, tibial torsion was −22.1 ± 6.1°, and overall leg rotation by method 1 was −15.6 ± 7.2° and method 2 was −11.7 ± 8.2°. Femoral torsion, tibial torsion, method 1, and method 2 in the patients with OA were 8.2 ± 6.3°, −18.6 ± 4.1°, −14.9 ± 7.9°, and −10.4 ± 7.6°, respectively. Patients with OA showed a more pronounced retroversion in the femur (p = 0.008) and more internal rotation in the tibia (p < 0.001). No statistical significance of both methods was found between the two groups. Patients with OA had a greater median side-to-side absolute difference in all measurements, though the differences of both two methods of overall lower limb rotation were not statistically significant.ConclusionsThe discrepancy of side-to-side differences of bilateral lower limb rotation ought to be noticed with caution in diagnosing and treating rotational deformities of the lower limb, especially for patients with bilateral knee OA.

Intervertebral disc degeneration (IVDD) is commonly caused by imbalanced oxygen metabolism-triggered inflammation. Overcoming the shortcomings of antioxidants in IVDD treatment, including instability and the lack of targeting, remains challenging. Microfluidic and surface modification technologies were combined to graft chitosan nanoparticles encapsulated with strong reductive black phosphorus quantum dots (BPQDs) onto GelMA microspheres via amide bonds to construct oxygen metabolism-balanced engineered hydrogel microspheres (GM@CS-BP), which attenuate extracellular acidosis in nucleus pulposus (NP), block the inflammatory cascade, reduce matrix metalloproteinase expression (MMP), and remodel the extracellular matrix (ECM) in intervertebral discs (IVDs). The GM@CS-BP microspheres reduce H2O2 intensity by 229%. Chemical grafting and electrostatic attraction increase the encapsulation rate of BPQDs by 167% and maintain stable release for 21 days, demonstrating the antioxidant properties and sustained modulation of the BPQDs. After the GM@CS-BP treatment, western blotting revealed decreased acid-sensitive ion channel-3 and inflammatory factors. Histological staining in an 8-week IVDD model confirmed the regeneration of NP. GM@CS-BP microspheres therefore maintain a balance between ECM synthesis and degradation by regulating the positive feedback between imbalanced oxygen metabolism in IVDs and inflammation. This study provides an in-depth interpretation of the mechanisms underlying the antioxidation of BPQDs and a new approach for IVDD treatment.

Damaged hyaline cartilage has no capacity for self-healing, making osteoarthritis (OA) "difficult-to-treat". Cartilage destruction is central to OA patho-etiology and is mediated by matrix degrading enzymes. Here we report decreased expression of miR-17 in osteoarthritic chondrocytes and its deficiency contributes to OA progression. Supplementation of exogenous miR-17 or its endogenous induction by growth differentiation factor 5, effectively prevented OA by simultaneously targeting pathological catabolic factors including matrix metallopeptidase-3/13 (MMP3/13), aggrecanase-2 (ADAMTS5), and nitric oxide synthase-2 (NOS2). Single-cell RNA sequencing of hyaline cartilage revealed two distinct superficial chondrocyte populations (C1/C2). C1 expressed physiological catabolic factors including MMP2, and C2 carries synovial features, together with C3 in the middle zone. MiR-17 is highly expressed in both superficial and middle chondrocytes under physiological conditions, and maintains the physiological catabolic and anabolic balance potentially by restricting HIF-1α signaling. Together, this study identified dual functions of miR-17 in maintaining cartilage homeostasis and prevention of OA.