Steroid-induced osteonecrosis of the femoral head is a severe osteoarticular condition resulting from glucocorticoid overuse, characterized by femoral head bone structure collapse and cell death, now predominant among nontraumatic femoral head necroses. The increasing clinical use of glucocorticoids has led to a rise in the incidence of steroid-induced osteonecrosis of the femoral head, yet its precise molecular mechanisms remain incompletely understood, posing challenges for clinical management. This review proposes that the "GC-induced metabolic-inflammatory-oxidative stress vicious cycle" serves as the core driver propelling the activation of the SONFH multi-pathway PCD network. Centered on this thesis, the review systematically examines the synergistic and antagonistic interactions among PCD pathways-including pyroptosis, autophagy, and ferroptosis-in SONFH, emphasizing the pivotal role of mitochondrial dysfunction and ROS bursts. This framework not only integrates the independent functions of each PCD pathway but also reveals their interwoven molecular networks, offering novel perspectives for developing multi-target synergistic therapeutic strategies.

Objective To quantify rotational displacement following intramedullary nail fixation for intertrochanteric femoral fractures using three-dimensional (3D) CT imaging, analyze associated risk factors, and evaluate its clinical significance. Methods This study enrolled a cohort of 252 patients who underwent intramedullary nail fixation for intertrochanteric femoral fractures between 2019 and 2023. All participants underwent postoperative three-dimensional computed tomography (3D CT) and were followed for a minimum of 1 year. Postoperative femoral anteversion on the affected side was quantitatively assessed. An analysis was conducted to evaluate its correlation with potential risk factors, including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, nail length, type of internal fixation, reduction quality, AO Foundation/Orthopaedic Trauma Association (AO/OTA) fracture classification, presence of medial cortical defect, bone mineral density (T-score), Singh’s index, relative lateral wall thickness (rLWT), tip-apex distance (TAD), neck-shaft angle, and fracture classification. The impact of differences in anteversion on long-term clinical outcomes, including Visual Analog Scale (VAS) pain scores and Harris Hip Scores (HHS), was assessed through follow-up evaluations. Results After screening for exclusion criteria, a total of 210 patients were enrolled in the study: 33 patients (15.7%) exhibited differences in anteversion exceeding 15°; 177 patients (84.3%) were under 15°. In the subgroup with version deviations <15°, precise anatomical restoration (anteversion ≤5°) was achieved in 138 cases (77.9%), consistent with optimal biomechanical reconstruction targets; functionally compensated malrotation (5° < anteversion <15°) occurred in 39 patients (22.1%), within the tolerance range for gait adaptation without clinical impairment. Single-nail fixation, medial cortical defects, T-score >2.5, rLWT and fracture classification were identified as the primary factors contributing to rotational displacement exceeding 15°. At the 1-year follow-up, patients with smaller rotational displacement demonstrated better functional recovery, as reflected by improved Visual Analog Scale (VAS) pain scores and Harris Hip Scores (HHS). The multivariate linear regression analysis demonstrated that the rLWT showed significant correlation with rotational displacement of fracture fragments after intramedullary nail fixation. Conclusion Bone rotation and displacement are frequently observed following intramedullary nail fixation for intertrochanteric fractures. The rLWT is closely associated with these complications. Therefore, meticulous attention to surgical technique is essential to minimize complications and optimize outcomes.

Objective:To quantify rotational displacement following intramedullary nail fixation for intertrochanteric femoral fractures using three-dimensional (3D) CT imaging, analyze associated risk factors, and evaluate its clinical significance. Methods:A total of 210 patients who underwent intramedullary nail fixation for intertrochanteric femoral fractures between 2020 and 2022 were included. All patients received postoperative 3D CT scans and were followed for at least 1 year. The range of postoperative femoral anteversion on the affected side was measured, and its correlation with risk factors was analyzed. Results:Among the 210 participants: six patients exhibited anteversion changes exceeding 15°; seven patients had anteversion changes between 10° and 15°; forty-three patients showed reduced anteversion (indicating increased external rotation of the affected limb), ranging from -1° to -14°, with a mean of -2.58°; in 103 patients, anteversion increased postoperatively, ranging from 1° to 22°, with a mean of 3.90°; sixty-four patients achieved restoration of normal anteversion. Single-nail fixation, poor reduction quality, medial cortical defects, T-score ≤ -2.5, Singh's index (Ⅰ-Ⅲ), lateral wall thickness, and insufficient tip-apex distance (TAD) were identified as the primary factors contributing to rotational displacement exceeding 3°. At the 1-year follow-up, patients with smaller rotational displacement demonstrated better functional recovery. The multivariate logistic regression analysis demonstrated that several factors showed significant correlations with rotational displacement of fracture fragments after intramedullary nail fixation, including the severity of medial cortical defects, presence of medial cortical disruption, T-scores ≤ -2.5, low-grade Singh's index classifications (I-III), diminished lateral wall thickness, inadequate TAD, Visual Analog Scale (VAS), and the Harris Hip Score (HHS). Conclusion:Bone rotation and displacement are frequently observed following intramedullary nail fixation for intertrochanteric fractures. Numerous risk factors are closely associated with these complications. Therefore, meticulous attention to surgical technique is essential to minimize complications and optimize outcomes.

ObjectiveThe current investigation sought to utilize finite element analysis to replicate the biomechanical effects of different fixation methods, with the objective of establishing a theoretical framework for the optimal choice of modalities in managing Pauwels type III femoral neck fractures.MethodsThe Pauwels type III fracture configuration, characterized by angles of 70°, was simulated in conjunction with six distinct internal fixation methods, including cannulated compression screw (CCS), dynamic hip screw (DHS), DHS with de‐rotational screw (DS), CCS with medial buttress plate (MBP), proximal femoral nail anti‐rotation (PFNA), and femoral neck system (FNS). These models were developed and refined using Geomagic and SolidWorks software. Subsequently, finite element analysis was conducted utilizing Ansys software, incorporating axial loading, torsional loading, yield loading and cyclic loading.ResultsUnder axial loading conditions, the peak stress values for internal fixation and the femur were found to be highest for CCS (454.4; 215.4 MPa) and CCS + MBP (797.2; 284.2 MPa), respectively. The corresponding maximum and minimum displacements for internal fixation were recorded as 6.65 mm for CCS and 6.44 mm for CCS + MBP. When subjected to torsional loading, the peak stress values for internal fixation were highest for CCS + MBP (153.6 MPa) and DHS + DS (72.8 MPa), while for the femur, the maximum and minimum peak stress values were observed for CCS + MBP (119.3 MPa) and FNS (17.6 MPa), respectively. Furthermore, the maximum and minimum displacements for internal fixation were measured as 0.249 mm for CCS + MBP and 0.205 mm for PFNA. Additionally, all six internal fixation models showed excellent performance in terms of yield load and fatigue life.ConclusionCCS + MBP had the best initial mechanical stability in treatment for Pauwels type III fracture. However, the MBP was found to be more susceptible to shear stress, potentially increasing the risk of plate breakage. Furthermore, the DHS + DS exhibited superior biomechanical stability compared to CCS, DHS, and PFNA, thereby offering a more conducive environment for fracture healing. Additionally, it appeared that FNS represented a promising treatment strategy, warranting further validation in future studies.

股骨颈骨折(FNF)是临床常见的骨折类型之一,具有发病率、死亡率、并发症发生率和再手术率高的临床特点.中青年Pauwels Ⅲ型FNF多由于高能量损伤所致,骨折断端存在巨大的剪切力,一直是临床治疗中的难点.该文从Pauwels分型的研究进展入手、强调Pauwels Ⅲ型骨折解剖复位和坚强内固定的必要性,并分析目前临床中常用的内固定方式的优势与不足,旨在为临床治疗该类骨折提供一定的参考依据.

Objective:To review the research progress of rapid surgery for hip fracture in elderly patients.Methods:The published studies, expert consensus, and guidelines at home and abroad were systematically summarized from the aspects of the characteristics of aging population, the benefits of rapid surgery, the disadvantages of delayed surgery, and the recommendations of current guidelines, so as to further guide clinical practice.Results:Hip fracture is a common fracture type in the elderly population. As elderly patients generally have poor physique and often have a variety of underlying diseases, such as hypostatic pneumonia, bedsore, lower limb vein thrombosis, and other complications in conservative treatment, its disability rate and mortality are high, so surgical treatment is the first choice. At present, most relevant studies and expert consensus and guidelines at home and abroad support rapid surgery, that is, preoperative examination should be started immediately after admission, and adverse factors such as taking anticoagulant drugs, serious cardiovascular diseases, and severe anemia should be clearly and actively corrected, and surgery should be completed within 48 hours after admission as far as possible. Rapid surgery can not only significantly reduce the mortality of patients, but also reduce the length of hospital stay and the incidence of perioperative cognitive impairment, which is conducive to the recovery of patients with pain during hospitalization and postoperative function, and improve the prognosis of patients.Conclusion:In order to avoid many problems caused by delayed surgery, the elderly patients with hip fracture should be operated as soon as possible under the condition of actively correcting the adverse factors. Comprehensive evaluation and preparation, the development of an individualized surgical plan, and the formation of a multidisciplinary medical team can reduce surgical risks and improve effectiveness.

Abstract Objective: To systematically evaluate the risk factors for deep vein thrombosis (DVT) in patients after hip replacement. Methods: A computer search of PubMed, EMbase, The Cochrane Library, China Biology Medicine (CBM), China National Knowledge Internet (CNKI) and WanFang Data databases was conducted to collect case-control studies, cohort studies and cross-sectional studies on risk factors for DVT in hip replacement patients. January 2020. Meta-analysis was carried out using Stata 16.0 software after 2 researchers independently screened the literature, extracted data and evaluated the risk of bias of the included studies. Results: A total of 27 studies were included, including 82,872 subjects with 16 risk factors, and the results of the meta-analysis showed that women [OR=3.06 (1.36, 6.88), p=0.0001], age [OR=2.04, 95% CI (1.73, 2.42), p<0.0001], body mass index (BMI) [OR=0.0001], and men [OR=0.0001] were at risk of bias. 3.95, 95% CI (2.69, 5.78), p=0.007], hypertension [OR=2.52, 95% CI (1.42, 4.46), p<0.0001], hyperlipidemia [OR=2.47, 95% CI (1.44, 4.24), p<0.0001]. Combined cardio-vascular underlying diseases [OR=2.53, 95% CI (1.47, 4.37), p<0.0001], varicose veins or DVT [OR=4.21, 95%]. CI (3.24, 5.47), p=0.012], anaesthetic methods [OR=3.55, 95% CI (1.85, 6.82), p<0.0001], duration of operation [OR=2.33, 95% CI (1.35, 4.04), p<0.0001 0.0001], bone cement prosthesis [OR=2.79, 95% CI (2.37, 3.29), p<0.0001] are risk factors for DVT in hip replacement patients, and appropriate postoperative training reduces the risk of DVT in these patients [OR=0.40, 95% CI (0.32, 0.51)]. Conclusions: Current evidence of this study suggests that women, older age, high BMI, hypertension, hyperlipidemia, combined cardio-vascular underlying diseases, varicose veins or deep vein disease, general anesthesia, prolonged operation time and the use of bone cement prosthesis are risk factors for the development of DVT in hip replacement patients. Healthcare professionals should enhance the protection of high-risk patients with these risk factors in order to reduce the incidence of DVT after hip replacement and to improve the clinical outcome of patients.

Objective To investigate the distribution and influence of comminution in femoral neck fracture (FNF) patients after cannulated screw fixation (CSF). Methods From January 2019 to June 2020, a total of 473 patients aged 23–65 years with FNF treated by CSF were included in the present study. Based on location of the cortical comminution, FNF patients were assigned to two groups: the comminution group (anterior comminution, posterior comminution, superior comminution, inferior comminution, multiple comminutions) or the without comminution group. The incidence of postoperative complications, quality of life and functional outcomes was recorded at 1-year follow-up. Results Comminution was more likely to appear in displaced FNF patients (86.8%) compared with non-displaced FNF patients (8.9%), and the rate of comminution was closely associated with Pauwels classification (3.2% vs 53.5% vs 83.9%, P < 0.05). The incidence of osteonecrosis of the femoral head (ONFH, 11.3% vs 2.9%, P < 0.05), nonunion (7.5% vs 1.7%, P < 0.05), femoral neck shortening (21.6% vs 13.4%, P < 0.05) and internal fixation failure (11.8% vs 2.9%, P < 0.05) was significantly higher in FNF patients with comminutions, especially with multiple comminutions, than those without. Furthermore, there was a significant difference in the Harris hip score (HHS, 85.6 ± 15.6 vs 91.3 ± 10.8, P < 0.05) and EuroQol five dimensions questionnaire (EQ-5D, 0.85 ± 0.17 vs 0.91 ± 0.18, P < 0.05) between FNF patients with comminution and those without. There was no significant difference in Visual analogue scale scores (VAS, 1.46 ± 2.49 vs 1.13 ± 1.80, P > 0.05) between two groups at 1 year post-surgery. Conclusion Comminution is a risk factor for postoperative complications in young- and middle-aged patients with displaced and Pauwels type III FNF who undergo CSF. This can influence the recovery of hip function, thereby impacting quality of life. Further evaluation with a more comprehensive study design, larger sample and long-term follow-up is needed.

随着人口老龄化,髋部骨折的发生率正在迅速增加,由于高病死率,髋部骨折现在已成为世界范围内最重要的健康问题之一.手术时机对其预后的影响已被广泛讨论,尽管老年髋部骨折的治疗指南各不相同,但大多数机构建议尽快行早期手术,以帮助患者获得最有利的结果.根据研究报道,虽然关于延迟手术与术后病死率之间的关系有不同的看法,但是早期手术与术后结果的改善(例如褥疮发生、术后功能改善、住院时长)有很强的相关性.不足之处是,现有的研究主要是基于观察性研究,这些研究容易受到固有偏见的影响.希望未来能通过大规模的随机对照实验来进一步明确手术时机对预后的影响,为手术时机的确定提供更精准的数据.

髋关节镜在许多髋关节疾病的治疗中具有重要的诊断和治疗价值,但是当前对于髋关节镜术后镇痛方法的研究仍然较少,临床尚缺乏相对一致的观点和指南.本文通过回顾近些年来髋关节镜术后镇痛策略的相关文献,分析多种镇痛方法(口服镇痛药物、周围神经阻滞镇痛、关节腔内麻醉药物注射、局麻药物伤口浸润)的优劣,结果提示,与周围神经阻滞相比,关节腔内麻醉药物注射或伤口局部浸润麻醉联合术前或术后服用止痛药物能够起到更加安全的镇痛效果.文章从髋关节镜术后镇痛策略的发展、神经解剖学基础、操作方法及临床应用等方面进行综述,旨在为进一步开展髋关节镜镇痛策略提供最佳治疗方案.

Background:Femoral nerve block (FNB) and fascia iliac compartment block (FICB) are alternative methods of pain relief during hip surgery. Nevertheless, the effectiveness and safety of FNB compared with FICB are yet to be fully determined. Methods:Electronic databases were systematically searched. Only randomized controlled trials (RCTs) on hip surgery were included. Postoperatively, the pain scores at different time points, narcotic requirements in 24 h, mean arterial pressure, spinal anesthesia (SA) time, patient satisfaction, and adverse effect rates between the two groups were extracted throughout the study. Results:Fourteen RCTs including 1179 patients were included. Compared to the FICB, FNB decreased the VAS scores postoperatively at 24 h at rest (P < 0.05) and the incidence rate of some side effects (nausea, vomiting, and sedation) (P < 0.05). However, compared to the FICB, no significant difference was found in the FNB regarding the VAS scores postoperatively at any of the other time points (2 min, 20 min, 2 h, 24 h at movement, 48 h at rest, and 48 h at movement). Patients in both groups had similar narcotic needs after 24 h, mean arterial pressure, SA time, and patient satisfaction (P > 0.05). Conclusions:FNB has more advantages in reducing VAS scores postoperatively at 24 h at rest and the odds of some adverse effects. A better quality RCT is needed to properly compare FNB with FICB.

IntroductionPain management modalities after proximal femoral fracture are variable and have been studied extensively. Regional anesthesia, specifically femoral nerve (FNB) and fascia iliaca compartment blocks (FICB), can be used to provide analgesia preoperatively.MethodsSystematic searches of all related literature were conducted in the Medline, Embase, and Cochrane Central Register of Controlled Trials databases. Randomized controlled trials (RCTs) of proximal femoral fractures were included. The pain scores at different time points, opioid requirement in 24 h, mean arterial pressure, time for spinal anesthesia, patient satisfaction, and incidence of side effects between the 2 groups were extracted throughout the study.ResultsFifteen RCTs including 1240 patients met the inclusion criteria. The present meta-analysis indicated that compared with FNB, FICB could decrease the visual analog scale (VAS) scores at 4 h after surgery (P < .05). The incidence of side effects (nausea, vomiting, and sedation) was lower in the FNB group (P < .05). Compared to the FICB, no significant difference was found at any other observed time point. Additionally, no difference was found in opioid requirement at 24 h, mean arterial pressure, time for spinal anesthesia, or patient satisfaction (P > .05).ConclusionsFICB demonstrates a reduction in VAS score at 4 while FNB decreases the risk of several adverse events. More high-quality RCTs are necessary for proper comparison of the efficacy and safety of FNB and FICB.

骨水泥植入综合征(BCIS)是指在手术中置入骨水泥时患者可能出现的一系列严重临床并发症,以顽固性低氧血症、血压骤降以及伴或不伴意识障碍为主要临床表现.BCIS多在骨水泥置入前后的时段发生,当前的主要治疗方法为及时使用血管活性药物、迅速补充血容量、足量的液体支持以及呼吸循环支持等.正确认识BCIS患者的各种危险因素,了解骨水泥的各种特性,明晰不良综合征报告等级,选择合适的麻醉方式是预防BCIS的重要前提.术中要注意细致轻柔操作,降低在打入假体过程中的髓腔压力,减少栓塞风险.此外,围手术期使用激素等药物也可以有效降低BCIS的风险.

目的 采用Meta分析的方法系统评价髂筋膜间隙阻滞(FICB)对老年患者髋部骨折手术围术期镇痛效果及安全性的影响.方法 检索Medline、Ovid、Cochrane、Embase、知网、万方、维普等数据库,收集1996—2020年发表的FICB用于老年患者髋部骨折手术的随机对照试验(RCT),对照组在围术期给予生理盐水.按Cochrane指导手册的方法选择文献、提取资料及评价研究质量.采用RevMan 5.3软件进行Meta分析.结果 共纳入9篇发表于2007—2019年的RCT研究,共计675例患者,其中研究组353例,对照组322例.与对照组比较,研究组术后24 h内患肢活动时VAS疼痛评分明显降低(SMD=-1??82,95％CI-2??26～-1??38),术后24 h内阿片类药物累计用量明显减少(SMD=-0??69,95％CI-0??95～-0??42).两组术后24 h内患肢静息时VAS疼痛评分(SMD=-0??56,95％CI-1??44～0??31)、爆发痛发生率(RR=0??66,95％CI 0??36～1??23)、总住院时间(SMD=0??36,95％CI-1??50～2??23)以及术后恶心呕吐发生率(RR=2??31,95％CI 0??24～22??53)差异无统计学意义.结论 围术期使用髂筋膜间隙单次阻滞能够缓解老年患者髋部骨折术后早期运动疼痛程度及总体麻醉药用量,但不会缩短住院时间.

Objective:To investigate the effects of cortical comminution on therapeutic outcomes and postoperative complications in young patients with femoral neck fracture after fixation with femoral neck system (FNS).Methods:A retrospective study was conducted of the 86 patients with femoral neck fracture who had been treated by FNS fixation from January 2020 to December 2020 at Department of Hip Orthopaedic Trauma, Tianjin Hospital. Of them, 41 had cortical comminution at the fracture ends of the femoral neck. They were 16 males and 25 females with a mean age of 53.0 (40.5, 57.0) years. The other 45 patients had intact cortical bone at the fracture ends of the femoral neck. They were 21 males and 24 females with a mean age of 55.0 (44.5, 62.5) years. The 2 groups were compared in terms of incidence of postoperative complications, Harris hip score, Barthel index and visual analogue scale (VAS) pain score after 6-month follow-up.Results:There were no statistically significant differences between the 2 groups in baseline data or reduction mode except for fracture classification, showing comparability between groups ( P>0.05). In the cortical comminution group, the incidences of nonunion [17.1%(7/41)] and femoral neck shortening [29.3%(12/41)] were significantly higher than those in the cortical intact group [0% (0/45) and 11.1% (5/45)], the Harris hip score and Barthel index [82.0 (72.5, 91.5) points and 100.0 (90.0, 100.0)] at 6 months postoperatively were significantly lower than those in the cortical intact group [94.0 (88.0, 98.0) points and 100.0 (100.0, 100.0)], the VAS pain score [1.5 (0, 4.5) points] was significantly higher than that in the cortical intact group [0 (0, 1.0) points] (all P<0.05). However, there was no significant difference between the 2 groups in osteonecrosis of the femoral head or internal fixation failure ( P> 0.05). Conclusions:Cortical comminution following femoral neck fracture is a major risk factor for post-operative complications after FNS fixation, because it may seriously affect the recovery of hip function and quality of life in young patients.

Objectives: Osteoporosis is a metabolic bone disease caused by various factors. As a prosthetic group of haemoglobin, heme can promote the formation of blood vessels and the regeneration of related cells by increasing the proliferation level of endothelial cells and reticulocytes. This study observed the anti-osteoporosis effect of heme on preosteoblast (POB) cells and rat models. Methods: Heme mimics were transfected into POB cells of patients in stable culture, and the effect of heme transfection on the activity of POB cells was detected via the cell scratch test and cell migration assay. 45 SD female rats were randomly divided into group A, the rats were only treated with surgery ( n = 15); group B, the rats were given 30 mg/kg of heme chloride by tail vein injection on the 1st, 7th, and 14th days after surgery ( n = 15); group C, rats were injected with the same amount of saline in the tail vein ( n = 15). The mRNA and protein expressions of alkaline phosphatase (ALP), bone-specific alkaline phosphatase (B-ALP), and type I collagen C-terminal peptide (CTX) in rats serum were detected via western blot and real-time PCR (real-time polymerase chain reaction). The expressions of IL-6 and TNF-α in rats serum were detected via Elisa. The pathological changes in the morphology of distal femur were observed by Hematoxylin-eosin staining. Results: After transfected with heme mimics, the proliferation, migration and invasion ability of the patient’s cells increased significantly, and the apoptosis rate of the cells decreased significantly. The relative expression levels of ALP and CTX mRNA and protein in serum of osteoporosis patients and rat significantly decreased 24 hours after transfection of heme mimics ( p < 0.05), while B-ALP significantly increased. The expression of IL-6 and TNF-α in the rat model of osteoporosis group significantly increased ( p < 0.05), but after transfection with heme mimic, the expression of IL-6 and TNF-α in the rat reduced significantly. HE showed that, after transfection, the femoral trabeculae were substantially broader and thicker, and the number also increased significantly. The number of trabecular fractures and fat cells was decreased, the trabecular bones were smoother and close to the control group. Conclusion: Heme can significantly promote the proliferation, migration and invasion of POB cells in the body, and also can achieve the anti-osteoporosis effect by adjusting the expression of ALP, B-ALP, and CTX, IL-6 and TNF-α in osteoporosis model of rat.

Objective To investigate the expression and clinical implication of miR-494 and its target gene JunD in intervertebral disc herniation (IDH).Methods Six intervertebral disc tissue samples of spinal burst fracture were collected during operation,and then the nucleus pulposus cells were cultured.TNF-α of different concentration (0,10,50 and 100 ng/ml) were added to the cells to induce apoptosis.The apoptosis rate of nucleus pulposus cells and the expression of miR-494 were detected at different time after the stimulation (0,8,16 and 24 h) using qRT-PCR and flow cytometry respectively.Then,AntigomiR-494 was transfected into nucleus pulposus cells after lentivirus packaging,followed by the use of TNF-α (100 ng/ml,16 h) to induce apoptosis.The experiments contained blank control group,AntigomiR-494 + TNF-α group,and negative control + TNF-o group.Flow cytometry was used to detect the apoptosis in each group,and Western blot the expressions of JunD and cytochrome C.The luciferase double report based analysis and bioinformatics methods were used to investigate the relationship between miR-494 and JunD gene.Results The expression of miR-494 and the apoptosis rate of nucleus pulposus cells increased along with the increase of concentration of TNF-α and length of stimulation (P ＜ 0.05).After transfection,the expression of miR-494 and the apoptosis rate in AntigomiR-494 + TNF-α group were significantly lower than those in negative control + TNF-α Group (P ＜ 0.05).The results of Western blot showed that the expression level of JunD protein in AntigomiR-494 + TNF-α group was significantly higher than that of the negative control group (P ＜ 0.05),and the expression level of cytochrome C protein was significantly lower than that of the negative control + TNF-α group (P ＜ 0.05).Luciferase double report gene validation and bioinformatics prediction confirmed that miR-494 directly targeted JunD.Conclusion TNF-α can induce apoptosis of nucleus pulposus cells in a time and dose dependent manner.The expression of miR-494 increases with the increase of TNF-α concentration and length of stimulation.MiR-494 might be the key regulator of the apoptosis of nucleus pulposus cells under the induction of TNF-o.MiR-494 gene knockout can protect the nucleus pulposus cells,through the possible mechanism of upregulating target gene JunD and mediating the cytochrome C apoptosis pathway.MiR-494-JunD-cytochrome C signaling pathway might be one of the potential mechanisms of intervertebral disc degeneration.

OBJECTIVE:Femoral neck fracture is considered a difficult fracture to treat and often gives rise to unsatisfactory treatment results. Cannulated cancellous screws (CCS) or a sliding hip screw (SHS) are the mainstream internal fixations used for osteosynthesis of femoral neck fractures. There is a need to integrate existing data through a meta-analysis to investigate the safety and effectiveness of CCS and SHS in the treatment of femoral neck fractures.METHOD:According to the Cochrane Handbook for Systematic Reviews of Interventions, we screened for the relevant studies by searching Google Scholar, the Cochrane Controlled Trials Register, the Cochrane Library, Web of Science, EMBASE, and PubMed. The PICOS criteria was used to make sure the included studies fulfilled the inclusion criteria.RESULTS:Pooled data showed that there were no significant differences between the SHS and CCS groups for the Harris Hip Score. Significant differences were found between the SHS and CCS groups in terms of union time, postoperative complications, blood loss, operation time, incision length and length of hospital stay.CONCLUSIONS:Although the SHS and CCS groups showed similar functional recovery in treatment of femoral neck fracture in terms of the Harris Hip Score, the SHS group showed fewer postoperative complications and faster union time for patients with femoral neck fractures. Therefore, compared with CCS, the use of SHS may be a more effective treatment of femoral neck fractures.

OBJECTIVE:To determine the signaling pathways mediated by teriparatide in MLO-Y4 cell lines based on the evaluation of reactive oxygen species (ROS) through AKT pathways, which regulate apoptosis of bone cells.METHODS:We performed the DCFH-DA assay to investigate the role of ROS in MLO-Y4 cells caused by dexamethasone (Dex). Four groups were included: Dex group, Dex+NAC, Dex+ teriparatide group and control group (without any dispose). Real-time reverse transcriptase polymerase chain reaction was used to test the SOD2 and Cat mRNA expression. Western blot (WB) was used to investigate the AKT and caspase-3 protein expression. A Cell Counting Kit-8 (CCK-8) assay test was conducted to explore the cell viability, and we also studied the apoptosis through western blot assay. A glucocorticoid-induced osteoporosis (GIOP) model was used to confirm the anti-ROS and anti-apoptosis ability of teriparatide.RESULTS:The CCK-8 assay revealed that Dex reduced the proliferative capability of cells significantly, whereas incubation with teriparatide resulted in a remarkable increase in the proliferation of osteocytes. In addition, teriparatide can rescue the effect of inhibiting cell proliferation due to Dex treatment. Immunofluorescence analysis showed that ROS levels increased in Dex-treated MLO-Y4 cells when compared with control groups. However, the Dex+Teriparatide group showed less ROS when compared with the Dex group. The expression of Sod2 and Cat, two antioxidant enzymes crucial for ROS elimination, was decreased in the Dex group, indicating a defect of the enzymatic antioxidant system. Compared to the Dex group, incubation with teriparatide resulted in a significant decrease in caspase-3 level; when compared with the control group, the caspase-3 level was not significantly different, indicating that teriparatide can rescue apoptosis during Dex exposure. Moreover, teriparatide promotes the expression of AKT, and rescues the apoptosis effect caused by Dex. The results of immunofluorescence also showed that Akt was highly expressed in the teriparatide group when compared with the Dex group. The microstructural parameters Tb.Th, BV/TV, and Tb.N in the methylprednisolone (MPS) group were markedly reduced compared with the control group, but additional treatment with teriparatide could remarkably reverse the methylprednisolone-induced reduction of these parameters. Moreover, the parameter Tb.Sp was significantly increased in the methylprednisolone group compared to the control group, and this increase could be inhibited by teriparatide.CONCLUSIONS:Teriparatide can reduce the cellular ROS level caused by glucocorticoids to facilitate the proliferation of osteocytes through activating the AKT pathway. Meanwhile, the activated AKT can inhibit the activity of proteolytic enzyme caspase-3 and prevent the activation of apoptosis cascade.

Femoral shaft nonunion is a common thorny issue in clinical setting,however,the exact factors impacting the nonunion are still unclear.This paper aimed to review the latest research progress in the factors affecting treatments for femoral shaft nonunion,and provide references for clinical works in the future.