Achilles tendon injury remains a major clinical challenge because of its limited intrinsic healing capacity and the high risk of disorganized extracellular matrix remodeling during repair. In this study, we developed an injectable gelatin methacryloyl (GelMA) hydrogel loaded with GsMTx4, a mechanosensitive ion channel modulator, for sustained local delivery and evaluated its therapeutic potential for Achilles tendon healing in vitro and in vivo. The hydrogel exhibited favorable physicochemical properties, injectability, and local retention capacity. Biological evaluation showed that treatment with this delivery system was associated with improved cell compatibility, reduced matrix degradation, and enhanced expression of tendon-related markers. In the Achilles tendon injury model, local administration promoted histological repair, improved collagen organization, and alleviated pathological changes in the injured tissue. These beneficial effects were accompanied by modulation of extracellular matrix remodeling and mechanosensitive responses. Collectively, these findings suggest that this injectable GelMA hydrogel-based delivery strategy may serve as a promising local therapeutic approach for improving Achilles tendon repair.

Polymethyl methacrylate (PMMA) bone cement is the earliest and most widely used in clinical applications. However, PMMA bone cement has high hardness and high modulus, which leads to secondary fracture of adjacent vertebrae. In this study, a PMMA/polylactic acid (PLA)/carbon nanotube (CNT) compound bone cement with decreased compression modulus is developed for overcoming the limitation of PMMA commercial bone cement (CBC). Compared with CBC, the compression modulus of composite PMMA/PLA/CNT bone cements is reduced from 893.34 MPa (CBC) to 487.25 MPa (54.54% of the CBC), which is beneficial for reducing stress concentration at the bone implantation site. The cytotoxicity studies also indicate that the prepared composite cements are nontoxic and harmless, which has the necessary condition for orthopedic clinical applications.

Geriatric femoral neck fracture (FNF) represents a pressing global health challenge, imposing substantial burdens on medical resources while being associated with high complication rates and suboptimal clinical outcomes. In recent years, the direct anterior approach (DAA) has emerged as a mainstream surgical strategy for hip joint arthroplasty (HJA) in developed countries, owing to its minimally invasive nature, neuromuscular-sparing anatomical interval, preservation of soft tissue integrity, and alignment with enhanced recovery after surgery principles, collectively contributing to significant improvements in clinical outcomes of HJA for elderly patients with FNF. However, no unified consensus exists regarding standardized techniques and procedural protocols for DAA-HJA in this specific patient population. Consequently, there is an urgent need to develop an evidence-based expert consensus to address key clinical dilemmas inherent to DAA-HJA in geriatric FNF. Sponsored by the Joint Surgery Group of the Chinese Medical Association, this expert consensus builds upon the foundational Chinese Expert Consensus on Direct Anterior Approach Hip Arthroplasty for the Surgical Treatment of Geriatric Femoral Neck Fracture (2023 Edition). A multidisciplinary expert panel was convened to standardize core issues and procedural norms for DAA-HJA in geriatric FNF. Two rounds of modified Delphi questionnaires and one consensus conference were conducted for voting, with a predefined consensus threshold of ≥ 70

Femoral neck fracture (FNF) in the elderly poses significant challenge for global health, consuming substantial medical resources, and resulting in high complication rates and suboptimal outcomes. Hip joint arthroplasty (HJA) is currently the primary treatment for elderly FNF, but traditional surgical approaches still face issues such as dislocation, limping, and leg length discrepancy. In the recent years, direct anterior approach (DAA) has become the mainstream for HJA in developed countries, due to its minimal invasive philosophy, neuromuscular interval, soft tissue retention and accelerated recovery, and it significantly improves the clinical outcomes of HJA for elderly FNF. However, there is currently a lack of unified understanding regarding the techniques and processes for DAA-HJA in treating elderly FNF. Therefore, the expert panel of this consensus previously published the "Chinese Expert Consensus on the Surgical Treatment of Femoral Neck Fracture by Direct Anterior Approach Hip Arthroplasty for Elderly Patient (2023 Edition)", which normalized the indications, surgical techniques, and standard procedures for DAA-HJA in elderly FNF. With the rapid progress of robotic technology in joint surgery and the extensive investigation probing its clinical value, we have supplemented and revised the application of robotic surgery in elderly FNF with 9 modified recommendations. These recommendations aim to further promote standardized, systematic, and individualized diagnostic and treatment concepts, ultimately improving patients' functional prognosis.

Advanced aging invariably triggers an overabundance of apoptosis, stemming from diminished autophagy or a disarray in cellular autophagic processes. This, in turn, leads to an accelerated breakdown of muscle proteins, which exacerbates the ongoing deterioration of skeletal muscle and intensifies the severity of senile sarcopenia. This study aimed to investigate the role and mechanism of miRNA-regulated autophagy in senile sarcopenia. The miRNAs associated with sarcopenia were screened, and the target genes of significant miRNAs were predicted. The effects of significantly differentially expressed miRNA-144-5p on cell aging and autophagy were validated in vivo and in vitro. The inhibition of miR-144-5p enhanced the multiplication of mouse myoblasts, increased the expression of MHC and autophagic markers LC3II/LC3I and Beclin-1, facilitated the formation of autophagosomes in mouse myoblasts, and reduced the number of aging cells and the expression of senescence-related proteins acetylated p53, p53, and p21 expression in mouse myoblasts. miR-144-5p affects myoblast senescence, myogenic differentiation, and autophagy by regulating the downstream target gene, Atg2A. Inhibiting miR-144-5p markedly increased the grip strength of the posterior limb in old mice, and the CSA of old mice and young mice was also markedly increased. All experiments have demonstrated that miRNA-144-5p has a significant impact on the regulation of autophagy and the development of senile sarcopenia.

Numerous observational studies have identified a link between osteoporosis and stroke. However, the causal genetic relationship between these conditions remains unclear. This study employs a two-sample bidirectional Mendelian randomization (MR) approach to ascertain the causal relationship between osteoporosis and stroke. We conducted a two-sample Mendelian randomization (MR) study to investigate the potential causal relationship between osteoporosis and stroke, including its subtypes. Genetic data for osteoporosis and stroke, along with their subtypes, were sourced from published genome-wide association studies (GWAS). Single nucleotide polymorphisms (SNPs) demonstrating genome-wide significance (p < 5 × 10^ − 8) and independence (r^2 < 0.001) were selected for further analysis, provided they had an F-statistic ≥ 10. The inverse-variance weighted (IVW) method was employed to evaluate causality, with results reported as odds ratios (ORs). Heterogeneity was assessed using Cochran’s Q test, while pleiotropy was tested using the MR-Egger intercept test. A leave-one-out sensitivity analysis was performed to ensure the robustness of the results. Employing the IVW method, MR Egger method, and median-weighted method, we found no significant bidirectional causal relationship between osteoporosis and stroke or its subtypes, irrespective of the inclusion of potential pleiotropic SNPs. Sensitivity analyses affirmed the reliability and stability of these findings. Our study findings indicate that there is no direct causal relationship between osteoporosis and stroke or its subtypes in either direction. Based on our results, although no direct link was found, secondary effects do exist.

世界卫生组织数据显示,2019 年,全球 60 岁及以上人口达 10 亿.到 2030 年,这一数字将增至 14 亿,到2050 年将增至 21 亿 [1-2].随着人口老龄化加剧,我国每年约有 100 万人发生髋部骨折,其中大部分为老年人,一旦发生髋部骨折,其致残致死风险极高,严重威胁老年人生命健康 [3].

Falls are an important factor in significantly deteriorating quality of life of older adults, consequently leading to both physical and psychological harm. A wearable-based fall-related recognition system (WFRS) indeed facilitates the prediction, detection, and classification of fall events in helping fallers. Previous studies have provided a relatively comprehensive introduction to WFRSs from the perspective of sensor types and recognition algorithms. However, while these studies provide a clear technical direction, how to choose the appropriate technology for each phase of the experiment is a stumbling block for newly interested researchers. Accordingly, a comprehensive review article covering the mainstream technologies of WFRSs is imperative and meaningful. This review analyzes 48 state-of-the-art researches in WFRSs from three databases (i.e., IEEE Explorer, ScienceDirect, and MDPI) and introduces the pipeline techniques that consist of data acquisition, preprocessing, feature extraction, model training, and evaluation. Specifically, we first analyze the pros and cons of the use of different number of sensors for data collection. We then introduce the widely used preprocessing techniques including filtering and data augmentation. Afterwards, we detail the extraction of various features and illustrate methods for the selection, training, and evaluation of fall recognition models. We finally discuss factors affecting the overall performance of a model and offer suggestions for future research.

老年股骨颈骨折(FNF)是目前全球范围内的重大健康挑战,医院资源消耗大、并发症发生率高、结果和转归欠理想.髋关节置换术(HJA)是当前治疗老年FNF的主流方法,但传统的手术入路和技术方法仍然面临一系列瓶颈问题,如脱位、跛行、肢体不等长等.近年来,直接前路(DAA)-HJA成为关节置换领域的新方法.DAA入路由于通过神经肌肉间隙完成手术,符合软组织保留和术后加速康复理念,可提升HJA治疗老年FNF的临床效果.但DAA-HJA治疗老年FNF的标准技术与规范流程尚缺乏统一认识.因此,中华医学会骨科学分会髋关节学组、全军骨科专业委员会青年关节学组、重庆市医学会骨科专业委员会、重庆市医师协会骨科医师分会、重庆市医学会运动医疗分会组织相关专家,依据循证医学方法制订《老年股骨颈骨折直接前路髋关节置换技术规范专家共识(2023版)》,主要针对DAA-HJA在老年FNF中应用的适应证、手术设计与假体选择、手术技术与操作流程、术后管理等方面提出13条推荐意见,旨在推广规范化、系统化、个体化诊疗理念,改善患者功能预后.

Background: Spinal cord injury (SCI) is currently not completely curable. Exosomes have been widely used in preclinical studies of spinal cord injury. Here, in this meta-analysis, we focused on evaluating the overall efficacy of therapies based on miRNA-modified exosomes on functional recovery in animal models of SCI. Methods: PubMed, embase and Web of Science library databases were searched. Relevant literature was included, and the random effects model was used to assess the overall effect of the intervention, with outcomes expressed as SMD. The primary outcome included motor function scores. Risk of bias (ROB) was assessed using the ROB tool of the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE). R version 4.1.1software and Review Manager software were used for meta-analysis. Results: A total of 11 preclinical studies were included. The meta-analysis revealed that miRNA-modified exosome therapy was effective in improving motor function scores compared with exosomes alone or control therapy (standardized mean difference: 4.21; 95% confidence interval: 3.39-5.04). There was significant asymmetry in the funnel plot, and trim-and-fill analysis revealed four unpublished studies of motor scores. The quality of all included studies was evaluated with SYRCLE's ROB tool. The SCI model, administration time and dose had an impact on the effect of the treatment. Conclusion: MiRNA-modified exosomes have shown great potential in the treatment of SCI. Moreover, the efficacy of miRNA-modified exosomes was superior to that of exosomes alone.

BACKGROUND:The short-term therapeutic efficacy of kyphoplasty on Kummell's disease is obvious. However, postoperative refracture and adjacent vertebral fracture occur occasionally and are difficult to treat. Parkinson's disease (PD) is a pathological disorder associated with heterotopic ossification. In a patient with PD, an intervertebral bridge was formed in a short period of time after postoperative refracture and adjacent vertebral fracture, providing new stability.CASE SUMMARY:A 78-year-old woman had been suffering from PD for more than 10 years. Three months before operation, she developed lower back pain and discomfort. The visual analog scale (VAS) score was 9 points. Preoperative magnetic resonance imaging indicated collapse of the L2 vertebra. Kyphoplasty was performed and significantly decreased the severity of intractable pain. The patient's VAS score for pain improved from 9 to 2. Fifty days postoperatively, the patient suddenly developed severe back pain, and the VAS score was 9 points. X-ray showed L2 vertebral body collapse, slight forward bone cement displacement, L1 vertebral compression fracture, and severe L1 collapse. The patient was given calcium acetate capsules 0.6 g po qd and alfacalcidol 0.5ug po qd, and bed rest and brace protection were ordered. After conservative treatment for 2 mo, the patient's back pain was alleviated, and the VAS score improved from 9 to 2. Computed tomography at the 7-mo follow-up indicated extensive callus formation around the T12-L2 vertebrae and intervertebral bridging ossification, providing new stability.CONCLUSION:Kyphoplasty is currently a conventional treatment for Kummell's disease, with definite short-term effects. However, complications still occur in the long term, and these complications are difficult to address; thus, the treatment needs to be selected carefully. To avoid refracture, an interlaced structure of bone cement with trabeculae should be created to the greatest extent possible during the injection of bone cement. Surgical intervention may not be urgently needed when a patient with PD experiences refracture and adjacent vertebral fracture, as a strong bridge may help stabilize the vertebrae and relieve pain.

随着人口老龄化程度加重,老年病患者越来越多.肌肉减少症(简称肌少症)作为发病率较高的骨骼肌运动系统疾病,一直是国内外研究者关注的热点[1].肌少症可以影响老年人日常生活,严重者可致跌倒,引起残疾,不但增加了患者住院率和病死率,而且加重了家庭及社会的经济负担.肌少症的早期筛查和积极干预对提高老年人生活质量具有重要价值.本文对老年肌少症的研究进展进行了综述.

Fractures are frequently encountered diseases troubling the senior population, and the research on fracture repair and the exploration of effective treatment methods are of great significance. This study aimed to clarify the effect of human umbilical cord mesenchymal stromal cell-derived extracellular vesicles (hUMSC-EVs) on the proliferation and osteogenic differentiation of autologous bone marrow stem cells (ABMSCs). The two kinds of cells were co-cultured firstly, 5-Ethynyl-2’- deoxyuridine (EDU) staining and alizarin red staining were used to detect the proliferation and osteogenic differentiation of ABMSCs. The exosomes of hUMSCs were subsequently extracted to process ABMSCs to further test the effect on the cells. The EDU positive rate of ABMSCs and Collagen II expression were elevated, whereas the TdT-mediated dUTP nick end labeling (TUNEL) positive rate and Matrix Metallopeptidase 13 (MMP13) were markedly decreased after the co-culture of hUMSCs and ABMSCs using Transwell chamber assays. The results indicated that hUMSCs could increase the proliferation of ABMSCs, reduce apoptosis, and promote matrix metabolism. The hUMSCs exosomes were separated and added to ABMSCs. As the exosomes content increased, the proliferation of ABMSCs increased simultaneously, and ABMSCs apoptosis decreased. Meanwhile, ABMSCs that migrated to the submembrane increased compared with untreated ABMSCs. Western blot, qPCR and immunofluorescence results revealed that increased exosomes contents promoted the expression of ABMSCs anabolic-related indicators gradually, while decreased the expression of catabolism-related indicators gradually. The previously described results indicated that hUMSCs promoted the proliferation and osteogenic differentiation of ABMSCs by secreting exosomes.

MutS homolog 2 (MSH2) is a crucial participant in human DNA repair, and lots of the studies functionally associated with it were begun with hereditary nonpolyposis colorectal cancer (HNPCC). MSH2 has also been reported to take part in the progresses of various tumors' formation. With the help of GTEx, CCLE, and TCGA pan-cancer databases, the analysis of MSH2 gene distribution in both tumor tissues and normal control tissues was carried out. Kaplan-Meyer survival plots and COX regression analysis were conducted for the assessment into the MSH2's impact on tumor patients' clinical prognosis. In an investigation to the association of MSH2 expression with immune infiltration level of various tumors and a similar study on tumor immune neoantigens, microsatellite instability was subsequently taken. It was found that high expression of MSH2 is prevalent in most cancers. MSH2's efficacy on clinical prognosis as well as immune infiltration in tumor patients revealed a fact that expression of MSH2 in prostate adenocarcinoma (PRAD), brain lower-grade glioma (LGG), breast-invasive carcinoma (BRCA), and head and neck squamous cell carcinoma (HNSC) posed a significant correlation with the immune cell infiltration level of patients. Likewise as above, MSH2's expression comes in a similar trend with tumor immune neoantigens and microsatellite instability. MSH2's expression in the majority of tumors is a direct factor to the activation of tumor-associated pathways as well as immune-associated pathways. MSH2's early screening or even therapeutic target role for sarcoma (SARC) diagnosis is contributing to the efficiency of early screening and overall survival in SARC patients.

目的 通过文献回顾分析PBL教学方法与医学生毕业后职业方向之间的关系.方法 进行系统性文献回顾,对包括PubMed,Medline,Cochrane和ERIC数据库以及合适的参考书目进行分析.职业发展轨迹通过官方匹配方案、问卷调查和正式定义的职业发展里程碑来确定.结果 有11篇研究符合入选条件.大部分研究均显示PBL教学方法并不能使学员更易于从事某种特定专业(7/11,64％),但有三篇研究报道相对于无PBL教学的学员,PBL教学的毕业生更倾向于从事社区医疗.结论 文献显示PBL教学方法并不能使医学生更易于从事社区医疗或其他专业,未来还需要大量的相似研究继续探讨.

自从1941年美国骨科医生Moore研制出第一个人工股骨头,并将其用于临床以来,人工髋关节置换技术的发展日新月异,传统人工关节置换在髋关节骨折、股骨头坏死、髋关节发育不良、各类骨关节炎等疾病已得到广泛应用,越来越多的研究表明其长期临床效果比较满意.但由于传统手术入路存在切口软组织损伤大、术后疼痛较重、并发症多等一系列问题,给骨科提出了新的挑战,各种微创髋关节置换术应运而生.该文通过检索髋关节直接前方入路、微创后外侧入路以及直接外侧入路、前后双切口入路、前外侧入路等相关文献进行综述,阐述其发展、各自优势及弊端,给广大骨科医生在临床工作和学习中提供一定的参考.

临床微生物学检验是一门实验室科学与临床医学相结合的学科,临床实习阶段是深化理论知识、提升专业实践能力的关键阶段.带教教师拥有不断更新的教学理念,设计出切实可行的带教流程,是实习带教的核心.该文从实验室安全培训、专业知识培训与考核、科研创新等方面阐述了临床微生物带教方案的实施过程,从而达到提升实习生专业实践能力和综合思维能力的目的.

目的 探讨双侧矢状面交叉穿刺经皮穿刺椎体成形术(PVP)治疗Kümmell病的疗效.方法 2015年6月至2017年9月重庆大学附属中心医院骨科收治的78例Kümmell病病人实施该手术.观察指标包括骨水泥渗漏、椎体内骨水泥分布、伤椎前缘高度、矢状面Cobb角、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI).结果 78例病人均获得24个月随访.1例病人出现骨水泥渗漏,无严重并发症发生.骨水泥在椎体内分布均匀,同时接触上、下终板.伤椎前缘高度、Cobb角、VAS、ODI评分术后2 d[(21.5±2.4)mm、(12.7±2.3)°、(2.3±0.6)分、(25.1±4.1)％]、1月[(20.7±2.5)mm、(13.1±2.0)°、(2.1±0.5)分、(22.1±3.5)％]、12月[(20.4±2.2)mm、(13.3±2.1)°、(1.9±0.4)分、(21.1±3.1)％]、24月[(20.1±1.6)mm、(14.1±1.5)°、(2.2±0.1)分、(24.1±2.5)％]较术前[(14.1±2.1)mm、(21.1±3.0)°、(7.7±0.9)分、(73.9±3.3)％]显著改善(P<0.05),术后1月、12月、24月与术后2 d相比较差异无统计学意义(P>0.05).随访24个月,病人无骨水泥松动、移位及手术椎体再骨折发生.结论 双侧矢状面交叉穿刺PVP治疗Kümmell病疗效确切,安全可靠.此技术能使骨水泥同时接触上、下终板,全椎体强化,降低手术椎体再骨折风险.

[目的]探讨非植骨融合单纯经皮短节段椎弓根螺钉固定治疗伴有后方韧带复合体损伤的屈曲-牵张型(AO分类B型)不稳定胸腰段脊柱骨折的临床疗效.[方法]回顾性分析2015年1月～2018年10月本院采用非植骨融合单纯经皮短节段椎弓根螺钉固定治疗的39例伴后方韧带复合体损伤的屈曲-牵张型不稳定胸腰椎骨折患者,总结围手术期、随访和影像资料.[结果]所有患者手术顺利完成,术中未发生脊髓神经根、血管损伤;手术时间(85.52±6.10) min,术中出血量(60.34±23.12) ml,支具保护下地行走时间(2.61±0.35)d,住院天数(9.47±1.61)d.所有患者随访(14.22±1.16)个月,随时间推移,39例患者的VAS和ODI评分均显著减少(P＜0.05).影像方面,与术前相比,术后39例患者椎体前缘高度显著增加(P＜0.05),而矢状面Cobb角显著减少(P＜0.05).术后椎体前缘高度和矢状面Cobb角无显著改变(P＞0.05).至末次随访时,未出现内固定断裂或松动.[结论]非植骨融合单纯经皮微创后路短节段椎弓根螺钉固定治疗无神经功能损害的伴有后方韧带复合体损伤的屈曲-牵张型不稳定胸腰段脊柱骨折安全有效.

少数病例报告描述了与急性髌骨脱位有关的股骨髁骨软骨骨折[1-3].其发生率并不十分确切.如果骨软骨块几乎全部是软骨性的,而骨性很小,则可能无法通过普通X线影像诊断.这种损伤的发病机理尚不清楚.髌骨与股骨滑车之间的高速低能量剪切力会导致软骨或骨软骨骨折[4],这与引起髌骨脱位的机制相似,这类骨折可以发生在股骨髁的多个部位.通常情况,轻度屈膝状态下的髌骨脱位,骨折部位好发于股骨前外侧髁的非承重部分和髌骨下内缘[5-6].创伤性骨软骨碎块通常仅作为关节内游离体,在手术清创时切除[7-9].骨折部位通过形成纤维软骨样组织愈合,最终导致膝关节疼痛、早期退行性关节炎.