Titanium (Ti) implants are widely used in orthopedic and dental applications due to their excellent mechanical strength, corrosion resistance, and biocompatibility. However, their limited osteointegration and susceptibility to bacterial infections remain major clinical challenges. Recent advancements in surface modification techniques have significantly improved the osteogenic and antibacterial properties of Ti implants. This review summarizes key strategies, including ion doping, hydroxyapatite (HAp) coatings, nanostructured surfaces, and graphene-based modifications. Zinc (Zn)-doped coatings increase osteoblast proliferation by 25%, enhance cell adhesion by 40%, and inhibit Staphylococcus aureus by 24%. Magnesium (Mg)-doped Ti surfaces enhance osteoblast differentiation, with 38% increased alkaline phosphatase (ALP) activity and a 4.5-fold increase in cell proliferation. Copper (Cu)-doped coatings achieve 99.45% antibacterial efficacy against S. aureus and 98.65% against Escherichia coli (E. coli). Zn-substituted HAp promotes mineralized nodule formation by 4.5-fold and exhibits 16.25% bacterial inhibition against E. coli. Graphene-based coatings stimulate bone marrow stem cells (BMSCs) and provide light-responsive surface potentials for enhanced osteogenesis. Despite these advancements, challenges remain in optimizing ion release kinetics and long-term stability. Future research should focus on multi-functional coatings that integrate osteogenic, antibacterial, and immunomodulatory properties to enhance clinical performance and patient outcomes.

PURPOSE:To evaluate the efficacy and safety of intra-articular injection of mesenchymal stem cells (MSCs) versus hyaluronic acid (HA) in the treatment of knee osteoarthritis (KOA). METHODS:Eligible randomized controlled trials (RCTs) were identified through a search of PubMed, Embase, the Cochrane Library, Web of Science, SinoMed, and CNKI databases from inception to March 2024. For meta-analysis, data on clinical outcomes were measured using visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and data on cartilage repair were measured using the Whole-Organ Magnetic Resonance Imaging Score (WORMS); data on safety were evaluated by the incidence of adverse events. Two researchers independently read the included literature, extracted data and evaluated the quality, used the Cochrane risk bias assessment tool for bias risk assessment, and used RevMan5.3 software for meta-analysis. RESULTS:Ten RCTs involving 818 patients with KOA ranging from I to Ⅲ on the Kellgren-Lawrence grading scale were included in this meta-analysis. Meta-analysis results showed that at 12 months, the WOMAC total score (mean difference [MD] = -10.22, 95% confidence interval [CI]: -14.86 to -5.59, P < .0001, Z = 4.32), VAS score (MD = -1.31, 95% CI: -1.90 to -0.73, P < .0001, Z = 4.40); and WORMS score (MD = -26.01, 95% CI: -31.88 to -20.14, P < .001, Z = 8.69) of the MSCs group all decreased significantly (P < .05) compared with the HA control group and reached the minimal clinically important differences. Furthermore, there was no significant difference in the incidence of adverse events (relative risk = 1.54, 95% CI: 0.85-2.79, P = .16, I2 = 0) between the 2 groups (P > .05). CONCLUSIONS:In terms of efficacy, the clinical effects of intra-articular injection therapy using MSCs for KOA are superior to those of HA, and the cartilage repair effect of MSCs is also markedly better than that of HA. Although the clinical effects varied across time periods, the functional score reached the minimum clinically significant difference at both 6 and 12 months. In terms of safety, adverse reactions mainly manifest as joint pain, swelling, and joint effusion. Both intra-articular injections of MSCs and HA did not result in severe adverse reactions, indicating that MSCs and HA have similar safety profiles. LEVEL OF EVIDENCE:Level I, meta-analysis of Level I studies.

Background and purposeSurgical indications for Bernese periacetabular osteotomy (PAO) are well-established. However, the extent of postoperative functional recovery varies widely, as observed in clinical follow-ups. Thus, preoperative evaluation is crucial. This study aims to identify factors that influence functional recovery post-PAO and to develop a predictive nomogram.Patients and methodsRetrospective data were collected between December 2016 and March 2022 at The First Affiliated Hospital of Shandong First Medical University. The dataset included demographic and imaging data of patients who underwent PAO. The least absolute shrinkage and selection operator (LASSO) regression was utilized to identify influencing factors, which were further analyzed using multivariate logistic regression to construct a predictive nomogram for post-PAO functional recovery.ResultThe analysis identified critical factors affecting functional recovery post-PAO, namely, the preoperative distance from the innermost surface of the femoral head to the ilioischial line, the surgical approach, preoperative acetabular depth, and the continuity of the preoperative Calve line. A nomogram was developed using these significant predictors. The model's validity was demonstrated by the receiver operating characteristic curve, with an area under the curve of 0.864. Additionally, the calibration curve confirmed the nomogram's accuracy, showing a strong correlation between observed and predicted probabilities, indicating high predictive accuracy.ConclusionThis predictive nomogram effectively identifies patients most suitable for PAO, providing valuable guidance for selecting surgical candidates and determining the appropriate surgical approach.

ObjectiveTo investigate the early effect of high tibial osteotomy (HTO) compared with combined arthroscopic surgery.MethodsA retrospective study was conducted on patients who underwent HTO at The First Affiliated Hospital of Shandong First Medical University from January 2018 to January 2022. 138 patients (163 knees) with knee osteoarthritis (KOA) treated with HTO were selected. The medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), femoral tibial angle (FTA), hip-knee-ankle (HKA) angle, weight-bearing line (WBL) ratio of the knee joint, opening gap, opening angle, American Knee Society score (KSS), US Hospital for Special Surgery (HSS) score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were measured to determine the different effects between HTO and HTO combined with arthroscopic by logistic regression analysis.ResultsPatients with HTO combined with arthroscopic surgery have improved functional scores as well as imaging perspectives compared to preoperative. By multivariate logistic analysis, it was concluded that arthroscopic surgery and gender are influential factors in the outcome of HTO surgery. The postoperative KSS score was 2.702 times more likely to be classified as excellent in the HTO combined with arthroscopy group than in the HTO group [Exp (β) = 2.702, 95% CI (1.049–6.961), P = 0.039]; the postoperative KSS score was 0.349 times more likely to be classified as excellent in women than in men [Exp (β) = 0.349, 95% CI (0.138–0.883), P = 0.026].ConclusionBetter results with HTO combined with arthroscopic surgery. HTO combined with arthroscopy is a better choice in the surgical treatment of KOA.

Objective:Study on the effectiveness of arthroscopy for high tibial osteotomy (HTO).Methods:A retrospective study of patients who underwent HTO at the First Affiliated Hospital of Shandong First Medical University from 2018.01-2022.03, and a total of 142 patients were included according to the inclusion and exclusion criteria, of whom 70 (49.3%) were male and 72 (50.7%) were female, with a mean age of 53.62±0.388 years and 168 affected limbs. Patients were divided into two groups (HTO group; HTO combined with arthroscopy group) according to whether they underwent HTO with or without combined arthroscopy. The medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), hip-knee-ankle (HKA) angle, femoral tibial angle (FTA), weight-bearing line (WBL) ratio of the knee joint, opening gap, opening angle, US Hospital for Special Surgery (HSS) score, American Knee Society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lysholm score. The effect of arthroscopy in HTO surgery was studied by logistic regression analysis to determine whether arthroscopy is an influential factor in the outcome of HTO surgery.Results:Both groups of patients with and without HTO combined with arthroscopy showed significant improvement in functional scores and imaging indexes after surgery compared with preoperative scores(Postoperatively, MPTA increased compared to preoperative, JLCA decreased, FTA decreased, HKA angle increased, and WBL% increased; postoperatively, HSS score, KSS score, and Lysholm score increased significantly, and WOMAC score decreased). Multifactorial analysis showed that both arthroscopic and preoperative WOMAC scores were independent influences on the outcome of the procedure, and the probability of Lysholm score being classified as excellent after surgery in the HTO combined arthroscopy group was 4.037 times greater than that in the HTO group postoperatively [OR=4.037, 95% CI: 1.555, 10.480, P=0.004]; each unit increase in preoperative WOMAC score was associated with 0.939 times greater probability of postoperative Lysholm score being classified as excellent [OR=0.939, 95% CI: 0.906, 0.973, P=0.000].Conclusions:Functional scores and imaging indexes were significantly improved after HTO combined with arthroscopy compared with preoperative scores. Arthroscopic and preoperative WOMAC scores were influential factors in the outcome of HTO surgery; patients with higher preoperative WOMAC scores had poorer postoperative functional recovery of the knee, and patients in the HTO combined arthroscopy group had better postoperative functional scores and functional recovery than those in the non-combined arthroscopy group.

ObjectiveTo introduce a surgical technique (the “Y” line technique) that will control leg length discrepancy (LLD) after total hip arthroplasty and to observe its effectiveness and influencing factors.MethodsAccording to the inclusion and exclusion criteria, a total of 350 patients were selected in this study; 134 patients in whom used the “Y” line technique was used to control lower limb length were included in Group A and 166 patients treated with freehand methods to control lower limb length were included in Group B. A total of 50 patients in whom the standard anteroposterior x-ray of bilateral hips was taken preoperatively and in whom the “Y” line technique was used during the operation were included in Group C.ResultsThe postoperative LLD of Group A was 4.74 mm (3.93), that of Group B was 5.85 mm (4.60), and that of Group C was 2 mm (1.00)—the difference was statistically significant (p < 0.001). There were significant statistical differences when comparisons were made between any two groups (p < 0.01). The distribution of postoperative LLD in Group A was better than that in Group B, and this factor was better in Group C than in Group A—the difference was statistically significant (p < 0.001). Severe unequal length rates of the lower extremities (LLD > 10 mm) were 5.97% (8/134) in Group A, 14.3% (24/166) in Group B, and 0% (0/50) in Group C—the difference was statistically significant (p < 0.001). There were significant differences between Group A and Group B and between Group B and Group C (p < 0.05), but there was no significant difference between Group A and Group C (p = 0.078).ConclusionThe “Y” line technique, which does not increase the operating time and patient cost, can effectively reduce postoperative LLD. Insufficient internal rotation of the healthy lower extremity and the low projection position in the preoperative anteroposterior x-ray of the bilateral hips were important factors affecting the accuracy of the “Y” line technique.

Abstract Background and purpose There are recognized surgical indications for Bernese periacetabular osteotomy (PAO), but the degree of postoperative functional recovery is significantly different through clinical observation and follow-up. Therefore, it is necessary to do a preoperative evaluation. This study aims to screen the factors influencing functional recovery after PAO and construct a predictive nomogram.Patients and methods: Retrospective data were collected between December 2016 and March 2022 at The First Affiliated Hospital of Shandong First Medical University, including demographic data and imaging materials of patients undergoing PAO. The least absolute shrinkage and selection operator regression was used to screen the influencing factors, and then multivariate logistic regression analysis was employed to construct a predictive nomogram for predicting functional recovery after PAO.Result The influencing factors of functional recovery after PAO were screened out, namely the preoperative distance from the innermost surface of the femoral head to the ilioischial line, surgical approach, preoperative acetabular depth, and preoperative Calve line continuity. A nomogram model was established using these significant predictors. The receiver-operating characteristic curve was drawn, and the area under the curve was calculated to be 0.864. The calibration curve showed that the constructed nomogram model was well calibrated. There was sufficient consistency between the observed and estimated prediction probabilities to indicate that the clinical prediction model had high accuracy.Conclusion This predictive nomogram can identify the patients most suitable for PAO and can be used to guide the selection of surgical patients and surgical approaches.

Objective:To explore the influencing factors of postoperative functional recovery of Bernese periacetabular osteotomy(PAO) and influencing factors of pain degree.Methods:A retrospective study was conducted on the patients with developmental dysplasia of the hip (DDH) who underwent Bernese periacetabular osteotomy with a modified Smith-Peterson approach between January 2017 and November 2019. The inclusion criteria was all the DDH patients who received PAO during this period. Exclusion criteria: history of hip joint trauma, existing diseases of nerve, muscle or connective tissue, history of hip surgery, incomplete image data, acetabular retroversion (positive cross sign), the iliac-inguinal approach patients, and the patients who were lost during the follow-up. The preoperative and postoperative imaging indicators were measured. The acetabular top tilt angle, lateral central edge angle, acetabular abduction angle, femoral head extrusion index, sphericity index of femoral head, Shenton line, Tonnis grade of osteoarthritis, joint congruency, p/a ratio, acetabular anteversion angle, Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain score and modified Harris hip score (MHHS) were measured and recorded. Multiple regression analysis was applied to determine the preoperative pain degree and postoperative function influencing factors.Results:A total of 75 patients underwent Bernese PAO. Among them, 16 cases using the iliac-inguinal approach were excluded, five cases were lost during follow-up, eight cases had incomplete imaging data, and there were two cases of acetabular retroversion. Eventually the study was conducted on 44 patients. The follow-up time was (2.1±1.4) years on average. The MHHS increased from 70(55, 84) points before the surgery to 91(88, 91) points after the surgery (Z=-7.067, P <0.01), WOMAC pain score decreased from 4(1, 8) points before surgery to zero after the surgery (Z=-4.920, P<0.01). According to the logistic regression analysis, for every unit increased in the lateral center-edge angle, the postoperative modified Harris score was 1.2 times more likely to be classified as excellent[odds ratio(OR)=1.183, 95%confidence interval(CI)(1.077, 1.299), P<0.01]. For each increase of age by one unit, the probability of preoperative pain level increasing by one level was 1.1 times higher [OR=1.090, 95%CI(1.018, 1.157), P=0.012]. For each increase in body mass index by one unit, the probability of preoperative pain level increasing by one level was 1.2 times higher [OR=1.244, 95%CI(1.050, 1.474), P=0.011]. Regression analysis of other factors showed no significant correlation with preoperative pain and postoperative functional score.Conclusions:The overall function score of patients after Bernese periacetabular osteotomy is significantly improved, and the pain symptoms are significantly reduced. The patients with larger lateral center-edge angle may have better joint function after surgery, while the patients with elder age and lager body mass index may suffer more severe pain.

Objective:According to the digital anatomical characteristics of the hip joint, a calibrated femoral canal file, and corresponding femoral stem prosthesis and its measuring method are developed. To explore the effect of this technique on controlling the leg length in total hip arthroplasty (THA) and analyze the causes for the results obtained by this method.Methods:Retrospective cohort study. A total of 300 patients who underwent the first unilateral THA in Qianfoshan Hospital of Shandong Province from June 2017 to July 2020 were selected. Among them, there were 154 males and 146 females, aged 27-86 (59.5±11.3) years old. Patients were divided into groups according to the methods used of controlling their leg length discrepancy (LLD) during the operation: 134 patients with calibrated femoral canal files to control leg length were included in the observation group, meanwhile, 166 patients with unarmed methods were included in the control group. Observation indicators: (1) the baseline data of equal sex, height, preoperative LLD, and operation side were compared between the two groups. (2) the differences between LLD and the distribution of LLD were measured and compared between the two groups. (3) to compare the proportion of patients with LLD >10 mm in the two groups, and to analyze the causes of postoperative LLD >10 mm.Results:All patients completed their primary wound healing. (1) There was no significant difference found in gender, height, preoperative LLD, and operation side between the two groups (all P values >0.05). (2) The postoperative LLD of the observation group was 4.76 (2.98,7.18) mm, and that of the control group was 5.85 (3.78,8.38) mm, the difference was statistically significant ( Z=-2.84, P=0.004), and the distribution of the LLD of the observation group was better than that of the control group, and the difference was statistically significant ( Z=3.078, P=0.002). (3) In the observation group, 8 cases (5.97%, 8/134) had postoperative LLD >10 mm, and in 24 cases in the control group (14.46%, 24/166), the difference was statistically significant (χ 2=5.61, P=0.018). Cause analysis: It was related to the mismatch between the prosthesis and the patients (3 cases in the observation group and 4 cases in the control group; it was related to the lower orientation of Kirschner wire caused by obvious hyperplasia of osteophytes in the lower edge of the acetabulum (5 cases in the observation group and 3 cases in the control group). Conclusion:The use of calibrated femoral canal file in the THA can control postoperative LLD more effectively than the unarmed method, the mismatch of the prosthesis, and the lower orientation of Kirschner wire caused by hyperplasia of osteophytes in the lower edge of the acetabulum affect the control of LLD by this method.

Aim This study is to investigate the additive effect of Vitamin D-binding protein (VDBP) and 1,25(OH)2D3 on the viability and apoptosis of synovial cells from patients with rheumatoid arthritis (RA). Methods Synovial tissues and synovial fluid of patients with RA and osteoarthritis (OA) were collected. The expression of VDBP was analyzed with immunohistochemistry and ELISA. CCK-8 assay was applied to detect cell viability. Flow cytometry was used to analyze cell cycle and apoptosis. Results Immunohistochemical results showed that the expression of VDBP in the synovium of RA patients was significantly lower than that of OA (P<0.05). Similarly, ELISA results presented a lower expression of VDBP in the synovial fluid of RA patients. The results of CCK-8 assay showed that both 1,25(OH)2D3 and VDBP significantly inhibited the viability of rheumatoid arthritis synovial fibroblasts (RASF) (P<0.05). The treatment with 1,25(OH)2D3+VDBP led to more significantly inhibited viability of RASF, compared with 1,25(OH)2D3 alone (P<0.05). The results of flow cytometry showed that 1,25(OH)2D3 and VDBP both promoted the apoptosis of RASF (P<0.05) and 1,25(OH)2D3+VDBP led to a higher proportion of RASF apoptosis, compared with 1,25(OH)2D3 alone (P<0.05). However, 1,25(OH)2D3 and VDBP had no significant effect on the cell cycle of RASF. Additionally, 1,25(OH)2D3 promoted the expression of VDBP in RASF, but not concentration-dependently. Conclusion VDBP is reduced in the synovial tissue and synovial fluid of RA patients and can inhibit viability of RASF and promote the apoptosis of RASF. The 1,25(OH)2D3 can upregulate the expression of VDBP in RASF. Additionally, VDBP can enhance the effects of 1,25(OH)2D3 on viability and apoptosis of RASF.

Objective: To introduce a surgical technique (the ‘Y’ line technique) which is to control the leg length discrepancy (LLD) after total hip arthroplasty. Methods: A total of 350 patients were selected; 134 patients who were used the ‘Y’ line technique to control lower limb length were included in Group A and 166 patients treated with free hand methods to control lower limb length were included in Group B. 50 patients who were taken standard anteroposterior X-ray of bilateral hips preoperatively and used the ‘Y’ line technique during the operation were included in Group C. Results: The postoperative LLD of the three groups was statistically significant (p < 0.001). There were significant differences statistically in comparison between any two groups (P<0.01). Severe unequal length rates of the lower extremities (LLD > 10 mm) were 5.97% (8/134) in Group A, 14.3% (24/166) in Group B and 0% (0/50) in Group C – the difference was statistically significant (p < 0.001). There were significant differences between Group A and Group B, Group B and Group C (P < 0.05), but there was no significant difference between Group A and Group C (P = 0.078). Conclusion: The ‘Y’ line technique, which does not increase the operation time, can effectively reduce postoperative LLD. Insufficient internal rotation of the healthy lower extremity and the low projection position in the preoperative anteroposterior X-ray of bilateral hips were important factors affecting the accuracy of the ‘Y’ line technique.

Objectives To explore factors affecting the efficacy of Bernese periacetabular osteotomy for the treatment of hip dysplasia. Methods A retrospective study was conducted on 44 patients with hip dysplasia who underwent Bernese periacetabular osteotomy with a modified Smith‐Peterson approach between January 2017 and November 2019. Among them, 40 were women and four were men. The average age was 31.2 ± 9.4. Preoperative and postoperative imaging parameters were measured. The acetabular top tilt angle, lateral central edge angle, acetabular abduction angle, femoral head extrusion index, sphericity index of femoral head, Shenton line, Tonnis grade of osteoarthritis, joint congruency, p/a ratio, acetabular anteversion angle, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale scores, and modified Harris hip score (MHHS) were observed. MHHS were divided into three clinically relevant categories: poor (<70 points), good (70–85 points), and excellent (86–91 points). Patient demographic data, as well as preoperative and postoperative radiographic parameters, were subjected to univariate logistic regression analysis. Multiple regression analysis was used to determine factors influencing postoperative MHHS. Results The follow‐up time was 1.0–3.9 years after surgery, with an average of 1.6 years. By the last follow‐up, MHHS increased from 70 points before surgery to 91 points after surgery (P < 0.001), WOMAC pain score decreased from 4 points before surgery to 0 points after surgery (P < 0.001). WOMAC functional score decreased (Preoperative: 18.0 [4.0]; Postoperative: 4.0 [0], P = 0.004). Six patients had sensory disturbance of the lateral femoral cutaneous nerve, four of which recovered completely during follow‐up. No other complications related to surgical approach, osteotomy, acetabular displacement, acetabular fixation, and postoperative stage were found. There was no significant vascular, nerve, or visceral injuries in any of the patients. On multiple regression analysis, the probability of the postoperative modified Harris hip score of a hip joint with a preoperative lateral center edge angle ≥4.5° being classified as excellent was six times that of angles <4.5° (Exp[β]: 6.249, 95% CI: 1.03–37.85, P = 0.046). Regression analysis of other factors found no significant correlation with postoperative functional scores. Conclusion Overall functional scores post‐PAO significantly improved, and pain symptoms were significantly reduced. Patients with a preoperative lateral center edge angle ≥4.5° had better joint function after surgery.

目的 通过对骨盆CT及三维重建图像测量髋臼横韧带(TAL)的解剖学前倾角,以明确其是否可以作为臼杯前倾角安放的参考.方法 研究选取自2017年1月至2018年12月行骨盆CT三维重建且无明显骨性解剖异常的成年人共87例(174髋),其中男49例(98髋),女38例(76髋).通过三维重建图像测量TAL解剖学前倾角,比较性别、左右侧别及年龄差异,统计位于安全区内的比例.测量髋臼解剖学前倾角,比较其与髋臼横韧带之间的差异.应用独立样本t检验或配对t检验比较性别及侧别间差异,应用单向方差分析比较年龄组间的差异.结果 髋臼解剖学前倾角的均值为(22±4)°,性别之间(t=-1.491)及侧别组间(t=-1.518)差异无统计学意义(P>0.05).TAL解剖学前倾角均值为(18±5)°,性别之间(t=-0.319)、侧别之间(t=-1.437)差异无统计学意义(P>0.05),年龄组间差异亦无统计学意义(F=0.828,P>0.05),位于安全区内的比例为98.85％.TAL解剖学前倾角小于髋臼解剖学前倾角,差异有统计学意义(t=7.859,P<0.001).结论 在无髋臼发育异常患者中,TAL可以作为全髋关节置换术中臼杯前倾角安放的参考.

Synovial inflammation is observed in patients with osteoathritis (OA) and likely contributed to its exacerbation. Regulatory B (Breg) cells are shown to suppress inflammation in various diseases, including rheumatoid arthritis (RA). To examine whether Breg cells also participated in OA, we examined the synovial fluid from OA patients, and compared with that in RA patients. In OA synovial fluid, IL-10-producing B cells were present directly ex vivo and were increased upon stimulation, indicating that B cells were a source of IL-10 directly at the affected site of OA patients. Interestingly, the frequency of IL-10+ cells in synovial B cells was higher in OA patients than in RA patients, but the total number of IL-10+ B cells in OA was lower than that in RA, suggesting that OA patients presented lower B cell infiltration than RA patients. Phenotypical analysis demonstrated that the IL-10+ B cells were IgM+ and CD27+, but not CD24hi or CD38hi. To allow functional analysis of IgM+CD27+ B cells, the IgM+CD27+ B cells in the blood of OA patients were examined. These blood IgM+CD27+ B cells expressed more IL-10, but less CD80 and CD86 than non-IgM+CD27+ B cells. Blood IgM+CD27+ B cells suppressed the proliferation and IFN-γ expression of autologous T cells, and this effect could be reverted if IL-10 was inhibited. Furthermore, we found that patients with more severe OA presented lower levels of IL-10+ B cells in the synovial fluid. Together, our study described an IgM+CD27+ B cell subset in OA patients, which represented the major IL-10-secreting B cell type in the synovial fluid of OA patients and possessed regulatory function.

An aggressive proliferation of synoviocytes is the hallmark of rheumatoid arthritis (RA). Emerging evidence shows that inhibiting the NF-κB signaling pathway with 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] may be a therapeutic approach for controlling inflammatory diseases. In this study, we demonstrated the protective effects of three different 1,25(OH)2D3 concentration on adjuvant-induced arthritis (AA) rats through the NF-κB signaling pathway and their pro-apoptotic roles in cultured adjuvant-induced arthritis synoviocytes (AIASs). AA rats were prepared by injecting complete Freund's adjuvant and independently given daily intraperitoneal injection of 1,25(OH)2D3 at concentrations of 50, 100, and 300 ng/day/kg. Subsequently, AIASs were isolated from the inflamed joints of AA rats to test the effects of 1,25(OH)2D3 on AIASs in vitro. Intraperitoneal injection of 1,25-(OH)2D3 was found to induce a concentration- and time-dependent improvement in relieving the symptoms of AA. We found an increased paw withdrawal thermal latency (PWTL) in the affected paw of AA rats as the concentration of 1,25-(OH)2D3 increased. 1,25-(OH)2D3 treatment reduced levels of inflammatory factors in synovial tissues of AA rats. In the case of cultured AIASs, 1,25-(OH)2D3 was shown to inhibit cell proliferation and induce cell apoptosis in a concentration-dependent manner. Additionally, 1,25-(OH)2D3 inhibited the activation of the NF-κB signaling pathway. In conclusion, our study provides evidence emphasizing that 1,25(OH)2D3 has the potential to attenuate disease severity in RA potentially due to its contributory role in synoviocyte proliferation and apoptosis. The protective role of 1,25(OH)2D3 against RA depends on the NF-κB signaling pathway.

Barbed suture has been widely used in surgeries. However, this technique may raise many problems. Here, we report that the barbed suture of deep fascia walks away and pierces through skin far from the incision in a 61-year-old male 6 weeks after total hip arthroplasty.

Objecyive To explore the incidence of complication and effect of knee joint activities of limited tourniquet usage in total knee arthroplasty (TKA).Methods From Sep 2015 to May 2016,120 patients were treated unilateral primary TKA,randomly divided into group A,group B and group C within 40 cases each.In group A,the tourniquet was used before the procedure starting and released after wound closure and press dressing,that is to say the tourniquet was used in full-couse.In group B,the tourniquet was used before the osteotomy starting and released after the prosthesis installing and bone cement solidifying,that is to say the tourniquet was limited to be used.In group C,the tourniquet was not used in the whole procedure.Compare three groups of operative time,tourniquet time,blood loss,the incidence of soft tissue injuries and thrombus,the knee earlier ROM.Results There were significant differences in group A,B and C in terms of blood loss during operation and postoperation (P＜0.05),the cases of soft tissue injuries of group A and B were more than that of group C.But there was no significant differences in group A,B and C in terms of operative time and in total blood lose (P＞0.05),the symptomatic DVT and PE were not found in the three groups.There was no significant differences in group A,B and C at 1th day and 7th day after operation (P＞0.05),while differences were confirmed at 3th day and 5th day after operation9 (P＜0.05).Conclusion The limited usage of tourniquet reduce the surgical time and incidence of complication,it is beneficial to early postoperative rehabilitation exercise.

Rheumatoid arthritis (RA) is a chronic autoimmune disorder. Earlier studies have demonstrated that regulatory T (Treg) cells, the main cell type mediating immune tolerance, appeared to be enriched in the inflamed synovial tissues. It is still unclear why the Treg cells in RA patients are unable to limit exacerbated inflammation. Here, we found that the frequency of Tim3 + Foxp3 + Treg cells, which were potent suppressors of proinflammatory responses, was downregulated in RA patients. Reduction in Tim3 + Foxp3 + Treg frequency was correlated with increased RA disease activity. Furthermore, we observed that Tim3 + Foxp3 + Tregs were expressed more interleukin (IL)-10 than Tim3 − Foxp3 + Tregs. CD4 + CD25 + Tim3 + T cells had higher capability of inhibiting interferon (IFN)-γ and tumor necrosis factor (TNF)-α secretion from T cells and peripheral blood mononuclear cells (PBMCs) than CD4 + CD25 + Tim3 − T cells. Compared to that in healthy individuals, CD4 + CD25 + T cells in RA patients were less potent in suppressing IFN-γ and TNF-α production from PBMCs. Blocking Tim3 on CD4 + CD25 + T cells from healthy controls resulted in an elevation of IFN-γ and TNF-α production from PBMCs, suggesting that Tim3 expression on CD4 + CD25 + T cells was required for optimal Treg function. However, this phenomenon was not observed in RA patients. In conclusion, our study suggested that the CD4 + CD25 + Foxp3 + Treg cells from RA patients demonstrated a reduction of Tim3 and were less functional than Treg cells from healthy controls in a Tim3-related manner.

Background/objective: The transverse acetabular ligament (TAL) can be used to position the acetabular cup and may help to improve the accuracy of primary total hip arthroplasty (THA). However, because the TAL may be covered by osteophytes, the ability to find the TAL varies greatly in the reported literature. In the present study, we introduce 2 methods and make a comparison between them to identify the easier procedure for finding an osteophyte-covered TAL.Methods: During primary THA operations conducted from January 2012 to June 2015, a total of 100 patients (100 hips) were confirmed to have an osteophyte-covered TAL following the exposure of the acetabulum and removal of all soft tissues covering the TAL. These 100 patients were enrolled in this study. 2 methods were used to identify the TAL: the use of a bone chisel or a small reamer, and patients were allocated randomly to 1 of these 2 methods. The proportion of patients in whom TAL was identified was compared between the 2 methods using the chi-square test.Results: The percentage of patients in whom the TAL was found using a bone chisel was 54.1% (26/48), whereas the percentage was 94.2% (49/52) in patients for whom a small reamer was used. The difference between the 2 methods was statistically significant (chi-square test, p<0.05).Conclusions: The TAL can be found more easily with a small reamer than with a bone chisel.