ABSTRACT Piezoelectric materials have been widely applied in tissue regeneration. With the rapid development of tissue engineering, they have become important biomaterials for treating various tissue defects. Through material modification or co‐doping with other components, their piezoelectric performance and biocompatibility can be greatly enhanced, enabling more efficient conversion of mechanical stimuli into bioelectrical signals and providing an original tissue‐like microenvironment that promotes cell adhesion, proliferation, and differentiation, ultimately supporting structural and functional tissue regeneration. This review summarizes recent advances in scaffolds incorporating piezoelectric materials for tissue reconstruction. We first highlighted the roles of intrinsic bioelectrochemical signals in regulating cellular activities and the molecular mechanisms by which piezoelectric materials convert mechanical stimuli into electrical signals to direct cell differentiation. We then classified major piezoelectric materials and described activation strategies for composite scaffolds, including direct mechanical loading, perfusion‐induced stress, and ultrasound stimulation. Finally, we discussed current applications, key challenges, and future prospects, such as improving biosafety and interfacial compatibility, coordinating degradation and functional stability, enhancing biomimetic design, and integrating piezoelectric materials with intelligent medical devices. By integrating the latest research and development trends, this review provides a concise framework and development roadmap for advancing piezoelectric composite scaffolds in tissue regeneration.

Cartilage is difficult to self-repair, and it is a great challenge in clinical practice. Herein, we developed a biomimetic biphasic scaffold with hierarchical porous structures and functionalized topographical interfaces for osteochondral repair. The hierarchical structures with macro/micro/nano scaffolds were fabricated via a combination of 3D printing and hydrothermal treatment. The cartilage phase (cartilage scaffold) was composed of a SilMA hydrogel (mimicking the compositional and mechanical properties of native cartilage), while the bone phase was a 3D-printed hydroxyapatite (HAp) porous scaffold (mimicking the mineral phase of subchondral bone). Then, the osteochondral interface was constructed by integrating the two phases through photo-cross-linking, forming a continuous and stable connection between the cartilage and bone layers. Mechanical tests confirmed that the biphasic scaffold possessed excellent load-bearing capacity, matching the biomechanical requirements of the osteochondral tissue microenvironment. In vitro experiments demonstrated that the scaffold effectively promoted the differentiation of bone marrow mesenchymal stem cells (BMSCs) into chondrocytes and osteoblasts, as evidenced by the enhanced expression of chondrogenic (Collagen II, Aggrecan) and osteogenic (Collagen I, Osteocalcin) markers. Furthermore, in vivo evaluations in an osteochondral defect model revealed significant regeneration of hyaline cartilage-like tissue in the cartilage phase and robust formation of subchondral bone in the bone phase, with a well-integrated osteochondral interface. Collectively, this study indicates that the biomimetic biphasic scaffold with hierarchical porous structures and topographical interfaces provides a promising therapeutic strategy for articular cartilage regeneration, offering potential clinical application value for osteochondral defect repair.

Functional reconstruction and ligament-bone integration are a current challenge in anterior cruciate ligament (ACL) reconstruction. In previous studies, decellularized tendon matrix material was considered as a promising material for tendon and ligament repair due to its easy availability, good biocompatibility and low immunogenicity. In addition, extracellular vesicles derived from bone marrow mesenchymal stem cells (BMSCS-EVs) have been repeatedly reported in recent years to play a crucial role in promoting bone regeneration and graftbone integration, though their retention in vivo is low. This study designed a type I collagen (Col-I) targeting fusion peptide (TKKTLRTGGGGSCRHSQMTVTSRL) to engineer BMSCs-EVs. Further, the engineered BMSCs-EVs was coupled with decellularized porcine tendon sheets (DPTS) scaffold to construct a new bioactive scaffold DPTS@PEVs-DPTS-DPTS@PEVs for ACL reconstruction and its osseous integration. Our results confirmed that the bioactive scaffold improved the therapeutic concentration and duration of BMSCs-EVs in the graft-bone repair area. Moreover, the bioactive scaffold significantly promoted the adhesion, proliferation, migration and osteogenic differentiation of BMSCs, significantly inhibit M1 but promote M2 type polarization of macrophages. In addition, the novel DPTS@PEVs-DPTS-DPTS@PEVs bioactive scaffold showed good graft-bone integration and biomechanical properties after ACL reconstruction in New Zealand white rabbits, the above advantages may provide a promising new idea for surgical reconstruction of ACL in clinic.

BackgroundFemoral neck fractures are prevalent in orthopedic injuries, often leading to complications such as nonunion and osteonecrosis of the femoral head (ONFH). Studies indicate that after healing and removal of internal fixation devices, some patients develop ONFH, while others experience osteosclerosis around the screw holes due to prolonged fixation, increasing ONFH risk. Despite such observations, biomechanical studies on this phenomenon are limited. This study assesses the risk of femoral head collapse post-internal fixation device removal and investigates the biomechanical effects of bone grafting at screw removal sites.MethodsUsing CT data, femoral anatomy was reconstructed. For control, the femoral head’s collapse area was identified. Experimental models, divided into those with and without bone grafts in screw holes, incorporated three fixation techniques, namely, triple cannulated screws (3CS), dynamic hip screws with cannulated screws (DHS+CS), and the femoral neck system (FNS), further subclassified into normal and sclerotic screw-hole models. Stress distribution, stress values, stress index, and strain range were assessed.ResultsIn both models, DHS+CS showed the highest stress in the overall model, while 3CS had the highest stress in the collapse area. The 3CS configuration also resulted in the largest strain range, which was observed in the central pillar of normal screw-hole models and the lateral pillar of sclerotic screw-hole models. The bone graft models exhibited lower peak, average stress, and strain values than the normal and sclerotic screw-hole models.ConclusionThe FNS screw hole demonstrates a relatively lower mechanical risk of femoral head collapse. In contrast, sclerotic screw holes increase this risk, while bone grafting may improve the biomechanical behavior after fixation removal, potentially reducing the likelihood of femoral head collapse.

BACKGROUND:Post-traumatic elbow stiffness poses significant clinical challenges for upper limb surgeons and severely impairs patients' ability to perform essential daily activities, including eating, dressing, and personal hygiene, thereby imposing substantial socioeconomic burdens. Open arthrolysis is widely employed when conservative therapies fail, yet current literatures demonstrate considerable heterogeneity in treatment concepts, surgical techniques, and perioperative management. This evidence-based clinical practice guideline aims to standardize treatment profiles and improve surgical outcomes for open arthrolysis of post-traumatic elbow stiffness in adult patients globally. METHODS:The Chinese National Center for Orthopaedics (Shanghai and Beijing, China) and Asan Medical Center (Seoul, Korea) initiate, sponsor, and organize a collaboration among worldwide experts in the field of elbow to develop this guideline, adhering to the Reporting Items for Practice Guidelines in Healthcare. Evidence searches focus on meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case-control studies, and case series studies. The Grading of Recommendations Assessment, Development and Evaluation system and Delphi method process are used to assess the level of evidence and strength of recommendations. RESULTS:Finally, a total of 28 evidence-based recommendations for open arthrolysis in adult post-traumatic elbow stiffness are formulated in response to 13 most concerned important clinical questions. On the whole, recommendations span 4 domains: (1) Indications/Timing; Q1-Q2, 2 recommendations; (2) Surgical Techniques; Q3-Q8, 15 recommendations; (3) Perioperative Care; Q9-Q11, 8 recommendations; and (4) Complication Prevention; Q12-Q13, 3 recommendations. CONCLUSION:This multinational initiative provides the first comprehensive clinical practice guideline for open arthrolysis in adult post-traumatic elbow stiffness. The recommendations provided herein are grounded in a comprehensive review of existing literatures, and they establish actionable standards for preoperative decision-making, intraoperative techniques, and postoperative care, ultimately hoping to enhance patients' functional recovery and quality of life.

Myocardial infarction (MI) causes cardiac dysfunction and threatens global health. Timely reperfusion following MI unavoidably contributes to additional cardiomyocyte death, a phenomenon known as myocardial ischemia/reperfusion injury (I/RI). The surge in free radicals and extensive cardiomyocyte loss significantly promote the progression toward heart failure, a condition that remains a major therapeutic challenge. Development of microRNA (miRNA)-based therapeutics for I/RI is hindered by poor intracellular delivery of miRNA and its rapid degradation in vivo. Nanozymes with enzyme-mimetic activities offer promising platforms for miRNA delivery while concurrently mitigating oxidative stress. Hollow ceria nanozymes decorated with gold nanoparticles (AuNPs) are developed to deliver miR-486, whose cavernous rooms enable them to accommodate miRNA. Elevated miR-486 expression is shown to suppress myocardial apoptosis and alleviate I/RI. Equipped with cardiac target peptide, miR-486@CeO2/Au-pep nanoparticles are integrated with superior enzyme-mimicking functions than a single entity, reactive oxygen species (ROS) scavenging, and improved miR-486 delivery. In myocardial I/RI mice, miR-486@CeO2/Au-pep can specifically accumulate at the heart and promote miR-486 to escape from lysosomes, which further boosts the bioactivity of miR-486 in cardiomyocytes. These combined effects confer cardioprotection and inhibit adverse ventricle remodeling. The nanosystem through synergetic works of miRNA and nanozymes provides an effective approach to treating myocardial I/RI.

ABSTRACT Objective This study provides a comparative analysis of clinical outcomes between primary and salvage reverse shoulder arthroplasty (RSA), offering valuable insights into the management of proximal humerus fracture (PHF). To evaluate the outcomes of patients treated with RSA as a primary procedure for acute PHF and to compare these with patients undergoing salvage RSA as a revision procedure for fracture sequelae of PHF. Methods A retrospective cohort study was conducted on 42 patients undergoing RSA for PHF between December 2014 and April 2022. The primary RSA group (n = 28, mean age 73.8 ± 4.5 years, 66–81 years) included patients with acute fractures, while the salvage RSA group (n = 14, mean age 62.1 ± 12.3 years, 47–83 years) comprised revision cases for fracture sequelae. Active range of motion (ROM), Visual Analog Scale (VAS), Constant score, and American Shoulder and Elbow Surgeons (ASES) scores were assessed for all patients. Outcomes between the two groups were compared, along with radiographic outcomes and complications recorded at each follow‐up. Categorical variables were analyzed using chi‐square or Fisher's exact tests, while continuous variables were compared using independent t‐tests or Mann–Whitney U tests based on data distribution. Results At a mean follow‐up of 56 months (24–106 months), no significant differences in gender (p = 0.469) or follow‐up duration (p = 0.087) were observed. The salvage group exhibited comparable postoperative ROM (anterior flexion (AF): 101.4° ± 52.3° vs. 115.9° ± 29.1°; external rotation (ER): 26.4° ± 16.4° vs. 28.8° ± 14.1°; internal rotation (IR): 7 ± 2 vs. 7 ± 2; all p > 0.05) and clinical scores (VAS: 1.6 ± 1.9 vs. 1.2 ± 1.5; Constant: 74.1 ± 23.3 vs. 79.4 ± 15.9; ASES: 81.9 ± 15.4 vs. 84.0 ± 13.8; all p > 0.05) to the primary group. However, the salvage group demonstrated significant preoperative‐to‐postoperative improvements in AF (50.9°, p < 0.001), ER (5.4, p = 0.017), and functional scores (VAS: −4.6; Constant: + 36.9; ASES: + 45.8; all p < 0.05). Complications occurred in 14.3% of salvage cases (2 revisions for periprosthetic fracture and aseptic loosening) versus 3.6% in the primary group. No other major complications such as deep infection, instability, acromial stress fracture, or dislocation were recorded. Conclusion RSA achieves comparable functional and radiographic outcomes for both acute PHF and fracture sequelae over 4 years of follow‐up. Salvage RSA provides substantial clinical improvement but carries a higher complication risk, emphasizing the need for meticulous surgical technique and patient selection.

BackgroundIt has been increasingly recognized that adults living alone have a higher likelihood of developing Major Depressive Disorder (MDD) than those living with others. However, there is still no prediction model for MDD specifically designed for adults who live alone.ObjectiveThis study aims to investigate the effectiveness of utilizing personal health data in combination with a stacked ensemble machine learning (SEML) technique to detect MDD among adults living alone, seeking to gain insights into the interaction between personal health data and MDD.MethodsOur data originated from the US National Health and Nutrition Examination Survey (NHANES) spanning 2007 to 2018. We finally selected a set of 30 easily accessible variables encompassing demographic profiles, lifestyle factors, and baseline health conditions. We constructed a SEML model for MDD detection, incorporating three conventional machine learning algorithms as base models and a Neural Network (NN) as the meta-model. Furthermore, SHapley Additive exPlanations (SHAP) analysis was used to explain the impact of each predictor on MDD.ResultsThe study included 2,642 adult participants who lived alone, of whom 10.6% (279 out of 2,642) had a PHQ-9 score of 10 or above, indicating the presence of MDD. The performance of our SEML model was robust, with an area under the curve (AUC) of 0.85. Further analysis using SHAP revealed positive correlations between the occurrence of MDD and factors such as sleep disorders, number of prescription medications, need for specific walking aids, leak urine during nonphysical activities, chronic bronchitis, and Healthy Eating Index (HEI) scores for sodium. Conversely, age, the Family Monthly Poverty Level Index (FMMPI), and HEI scores for added sugar showed negative correlations with MDD occurrence. Additionally, a U-shaped relationship was noted between the occurrence of MDD and both sleep duration and Body Mass Index (BMI), as well as HEI scores for dairy.ConclusionThe study has successfully developed a predictive model for MDD, specifically tailored for adults living alone using a stacked ensemble technique, enhancing the identification of MDD and its risk factors among adults living alone.

Alginate-based biomaterials have been widely used for tissue repair and regeneration, owing to their tunability, biocompatibility, biodegradability, and low cytotoxicity. With the rapid advancement of bioprinting technology, alginate has increasingly become a preferred bioink selection for fabricating various tissue substitutes. Notably, through emerging modifications or blending with other biomaterials, alginate bioinks can achieve substantial enhancements in printability and physicochemical properties, in turn, providing a favorable microenvironment for seed cells, achieving the integrated structural and functional repair of target tissues. In this review, we systematically analyzed recent advances in alginate-based 3D bioprinting strategies for tissue regeneration. First, we reported the synthesis and preparation of alginate as a bioink, 3D bioprinting techniques, alginate-based bioinks, and seed cell selection. Furthermore, the challenges and future perspectives of alginate-based 3D bioprinting strategies, including the construction of the vascular network, modification of alginate's physicochemical properties, optimization of printing methods, local delivery of active factors, seed cells in alginate bioinks, 4D bioprinting, artificial intelligence, and clinical translation, were also discussed. This review establishes a comprehensive framework that serves as a blueprint for the development and application of alginate-based bioinks in bioprinting. By synthesizing cutting-edge research and emerging trends, this review offers actionable insights into alginate-based 3D bioprinting strategies for structure-function integrated tissue regeneration.

BackgroundPedicle screw fixation using the cortical bone trajectory (CBT) enhances stability by engaging cortical bone, offering a valuable alternative to the traditional pedicle screw trajectory (TT). This study used finite element analysis to compare L4-5 instrumentation with CBT and TT screws, investigating whether the increased cortical bone engagement in CBT improves stability but makes it more susceptible to fatigue failure.MethodsA L3-sacrum model was generated using anonymized CT patient data, validated against existing studies, showing consistent ROM (range of motion) values. A mono-segmental L4-5 instrumentation with an interbody fusion cage was configured with both TT and CBT models, differentiated for healthy and osteoporotic bone (reduced Young’s modulus). Both models were exposed to simulated biomechanical loading conditions (compression, flexion, extension, lateral bending, and rotation) to calculate screw loosening and breakage risk. Screw loosening was assessed by measuring micro-movements within the screw hole, while screw breakage was evaluated based on maximum stress values and their frequency at the same locations.ResultsIn both healthy and osteoporotic bone, the CBT model exhibited smaller micro-movements compared to the TT model across all motions. For maximum stress in healthy bone, CBT showed lower stress during right rotation but higher stress in the other six motions. In osteoporotic bone, CBT stress exceeded TT stress in all conditions. The TT model in healthy bone showed stress concentrations at three locations, while CBT distributed stress across five sites. In osteoporotic bone, CBT showed stress at three locations, while TT distributed stress at four. Notably, in the TT model, maximum stress occurred at the screw head in six of seven movements, whereas in the CBT model, three movements showed maximum stress at the screw head and three at the screw tail.ConclusionCBT screws, by traversing three cortical layers, achieve greater integration with the vertebral bone compared to TT screws, thus reducing the risk of screw loosening. Although this increases the maximum stress on the screws, the stress is more evenly distributed, with the screw tail helping to reduce the risk of breakage.

RATIONALE:Open anterior hip dislocation resulting in vascular injury is extremely rare and is a severe orthopedic emergency that can potentially lead to limb necrosis and even life-threatening consequences. PATIENT CONCERNS:A 51-year-old woman presented to our hospital with an open anterior dislocation of the left hip secondary to a fall from height. The patient had a severe infection in the left inguinal area; at presentation, there was dislocation of the femoral head lasting for the past 5 days. Doppler ultrasound revealed left common femoral vein thrombosis. DIAGNOSES:The patient was diagnosed with a multiple-injury patient with an acetabular fracture, femoral head fracture, and open anterior dislocation of the hip with vascular injury and infection. INTERVENTIONS:After placement of an inferior vena cava filter, the reduction was performed under general anesthesia. The common femoral artery ruptured during the process. After suturing, continuous drainage was maintained. During the subsequent treatment, the infection gradually eroded the common femoral artery and formed a pseudoaneurysm. Lower limb vascularity was restored by autologous saphenous vein grafting, repeated debridement, and sensitive antibiotics. OUTCOMES:The infection of the patient was gradually controlled, and the lower limb was successfully preserved. During the 1-year follow-up, the patient returned to normal life without disability. LESSONS:From this rare case, we suggest that a therapeutic approach should be evaluated after adequate exclusion of deep vein thrombosis to prevent thromboembolic events. Moreover, gentle reduction operation, thorough debridement, and timely infection control are essential to prevent complications and improve the functional prognosis of patients.

Background:This study aimed to explore risk factors for osteonecrosis in patients with systemic lupus erythematosus by meta-analysis. Methods:PubMed, Embase, Web of Science, and Cochrane Library were searched for case-control/cohort studies on the occurrence of osteonecrosis in patients with systemic lupus erythematosus from the time the database was created until 1 December 2024. Data were analyzed using Stata 15.0, and the quality of the included studies was evaluated using the NOS score. Result:A total of 14 articles, including 3,890 patients, were included in the study, and the meta-analysis indicates that younger age in SLE patients [SMD = -0.23, 95% CI (-0.39, -0.06)], diabetes mellitus [OR = 1.78, 95% CI (1.03, 3.09)], hypertension [OR = 1.33, 95% CI (1.03, 1.72)], arthritis [OR = 1.57, 95% CI (1.24, 2.00)], Raynaud's phenomenon [OR = 1.76, 95% CI (1.35, 2.30)], and cyclophosphamide use [OR = 2.24, 95% CI (1.38, 3.63)] are risk factors for the development of osteonecrosis in patients with SLE. Conclusion:The current study found that younger age, hypertension, diabetes, arthritis, Raynaud's phenomenon, and cyclophosphamide use are independent risk factors for the development of osteonecrosis in patients with SLE.

INTRODUCTION:Calf muscular vein thrombosis (CMVT) is a type of distal deep vein thrombosis, which is common in geriatric hip fracture patients. However, studies focusing on whether the orthopedic operation has an impact on the prognosis of geriatric hip fracture patients with CMVT are very limited. Therefore, the aim of this study was to explore whether geriatric hip fractures with CMVT affect the mortality of patients within one year postoperatively. The difficulty of the operation, postoperative complications, the status of thrombosis, and function scores were also compared. MATERIALS AND METHODS:Geriatric hip fracture patients who underwent surgery between January 2019 and January 2021 were included. Patients were divided into groups with and without CMVT by preoperative color Doppler ultrasound examination. Propensity score-matching (PSM) was performed in a ratio of 1:1 between the patient with and without CMVT groups. Baseline characteristics, laboratory results, perioperative indicators and prognosis of patients were collected retrospectively. Intraoperative and postoperative comparisons were conducted between patients with and without CMVT. RESULTS:Two hundred and sixty geriatric hip fracture patients were included. Eighty-nine patients in each group were matched after PSM. There was no significant difference in mortality between the two groups at one-month, three-month, six-month, and one-year postoperatively. However, patients with CMVT had longer hospital stays, a higher incidence of postoperative complications, and a higher incidence of thrombosis progression than patients without CMVT in the follow-up. CONCLUSION:No significant difference in mortality within one year postoperatively was observed in Chinese geriatric hip fracture patients with or without CMVT formation. Strategies such as close monitoring the status of thrombosis, individualized care, and strengthening rehabilitation are recommended to reduce the risk of complications and optimize patient outcomes in this patient population. TRIAL REGISTRATION:Chinese Clinical Trial Registry (ChiCTR2300069411). Registered March 15, 2023, https://www.chictr.org.cn/showproj.html?proj=192079 .

BackgroundIn elderly individuals suffering from hip fractures, a prolonged hospital length of stay (PLOS) not only heightens the probability of patient complications but also amplifies mortality risks. Yet, most elderly hip fracture patients present compromised baseline health conditions. Additionally, PLOS leads to increased expenses for patient treatment and care, while also diminishing hospital turnover rates. This, in turn, jeopardizes the prompt allocation of beds for urgent cases.MethodsA retrospective study was carried out from October 2021 to November 2023 on 360 elderly hip fracture patients who underwent surgical treatment at West China Hospital. The 75th percentile of the total patient cohort’s hospital stay duration, which was 12 days, was used to define prolonged hospital length of stay (PLOS). The cohort was divided into training and testing datasets with a 70:30 split. A predictive model was developed using the random forest algorithm, and its performance was validated and compared with the Lasso regression model.ResultsOut of 360 patients, 103 (28.61%) experienced PLOS. A Random Forest classification model was developed using the training dataset, identifying 10 essential variables. The Random Forest model achieved perfect performance in the training set, with an area under the curve (AUC), balanced accuracy, Kappa value, and F1 score of 1.000. In the testing set, the model’s performance was assessed with an AUC of 0.846, balanced accuracy of 0.7294, Kappa value of 0.4325, and F1 score of 0.6061.ConclusionThis study aims to develop a prognostic model for predicting delayed discharge in elderly patients with hip fractures, thereby improving the accuracy of predicting PLOS in this population. By utilizing machine learning models, clinicians can optimize the allocation of medical resources and devise effective rehabilitation strategies for geriatric hip fracture patients. Additionally, this method can potentially improve hospital bed turnover rates, providing latent benefits for the healthcare system.

Background: Wound management is a critical component of clinical practice. Promoting timely healing of wounds is essential for patient recovery. Traditional treatments have limited efficacy due to prolonged healing times, excessive inflammatory responses, and susceptibility to infection. Methods: In this research, we created an injectable hydrogel wound dressing formulated from gelatin methacryloyl (GelMA) that encapsulates quercetin-loaded zeolitic imidazolate framework-8 (Qu@ZIF-8) nanoparticles. Next, its ability to promote skin wound healing was validated through in vitro experiments and animal studies. Results: Research conducted both in vitro and in vivo indicated that this hydrogel dressing effectively mitigates inflammation, inhibits bacterial growth, and promotes angiogenesis and collagen synthesis, thus facilitating a safe and efficient healing process for wounds. Conclusions: This cutting-edge scaffold system provides a novel strategy for wound repair and demonstrates significant potential for clinical applications.

As a progressive inflammatory disease, diabetes mellitus significantly changes the immuno-microenvironment, causing an elevation in M1 macrophages and inflammatory mediators. This inflammation condition possesses a negative impact on the cellular function of osteoblasts and vascular endothelial cells, resulting in impaired bone defect repair involving both angiogenesis and osteogenesis. In our study, a good biocompatible hydrogel, GB@SIS, was successfully fabricated for bone repair under diabetic conditions. This hydrogel consists of a porcine small intestinal submucosal (SIS) extracellular matrix with thermosensitivity, bionic structure, and pro-angiogenic properties, and BMP-4 loaded on graphene oxide (GO) can be sustainably released from the hydrogel. In vitro studies have shown that the composite hydrogel possesses a good ability to promote angiogenesis and enhance osteogenesis. Additionally, the hydrogel was also able to promote macrophage conversion from M1 to M2 macrophages, which subsequently results in the release of osteogenesis-related factors, specifically BMP-2. In a diabetic rat model with critical-size cranial defects, the GB@SIS hydrogel modulates the inflammatory microenvironment and significantly accelerates the process of bone repair. Subsequent investigations have revealed that the GB@SIS hydrogel exerts immunomodulatory effects via the suppression of the NLRP3 signaling pathway and the elevation of adhesion-related protein expression. In conclusion, the GB@SIS hydrogel demonstrates promising osteogenic characteristics as a biomaterial, exhibiting bone immunomodulatory properties that hold potential for its application in bone regeneration therapy specifically for diabetic patients.

The aim of this study is to compare external fixation versus intramedullary (IM) nailing to determine which strategy was more suitable for patients with open tibial shaft fractures. Eleven RCTs that compared the therapeutic outcomes between external fixation and IM nailing in patients suffering from open tibial shaft fractures were screened out from the PubMed, Embase, and Cochrane Library in this analysis. For open tibia fractures of Gustilo-Anderson I-IIIA, significantly lower incidence of malunion and superficial infection was revealed for the IM nailing group when compared with the external fixation group. Further subgroup analyses within I-IIIA fractures showed comparable results between fractures managed with IM nails and ring external fixators. In conclusion, IM nailing is recommended over external fixation for open tibia fractures of I-IIIA. In addition, the use of ring external fixators may be more suitable than the ordinary external fixators for the treatment of I-IIIA fractures.