The hypoxic and hypobaric conditions of high-altitude environments significantly impair osteogenesis and angiogenesis, leading to delayed bone healing and posing clinical challenges. In this study, we developed Yoda1-loaded chitosan sustained-release microspheres (Yoda1@CSM) to locally deliver the Piezo1 agonist Yoda1 and enhance bone regeneration under simulated high-altitude conditions. The microspheres were fabricated using a water-in-oil-in-water (W/O/W) double emulsion method. Their biological effects were assessed in vitro using bone marrow mesenchymal stem cells (BMSCs) and human umbilical vein endothelial cells (HUVECs) under normoxic and hypoxic conditions. Results demonstrated that Yoda1@CSM significantly enhanced alkaline phosphatase (ALP) activity and upregulated osteogenic markers (ALP, BMP-2, RUNX2) in BMSCs, while also promoting tube formation and VEGF secretion in HUVECs. These findings indicate that Yoda1@CSM effectively stimulates osteogenesis and angiogenesis in hypoxic environments and holds promising potential for the treatment of bone defects at high altitude.

Objective:To evaluate the early effectiveness of total talar replacement (TTR) with personalized three-dimensional (3D)-printed titanium talus prostheses in the treatment of steroid-induced talar avascular necrosis (TAN). Methods:The clinical data of 11 patients with steroid-induced TAN who met the selection criteria between June 2022 and June 2024 were retrospectively analyzed. There were 8 males and 3 females with an average age of 51 years ranging from 26 to 67 years. The duration of hormone use ranged from 12 to 36 months, with an average of 19.6 months. The TTR treatment was performed with the personalized 3D-printed titanium alloy talus prosthesis. Radiographic evaluation was performed preoperatively and at last follow-up to assess prosthesis-related conditions, including loosening, subsidence, and adjacent joint degeneration. Clinical outcomes were assessed using the visual analogue scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Ankle Osteoarthritis Scale (AOS), 36-Item Short Form Survey (SF-36) [including physical health score (PCS) and mental health score (MCS)], and ankle range of motion (ROM) to assess functional recovery. Results:All surgeries were completed successfully. The operation time was 40-60 minutes (mean, 51 minutes), and intraoperative blood loss was 5-20 mL (mean, 10 mL). All incisions healed by first intention without early complications such as infection, skin necrosis, hematoma, neurovascular injury, or deep vein thrombosis. All 11 patients were followed 15-33 months (mean, 22.8 months). One superficial wound infection occurred at 2 weeks postoperatively and resolved after conservative treatment. No prosthetic joint infection, loosening, subsidence, adjacent joint degeneration, or reoperation was observed. At last follow-up, the VAS score, AOFAS ankle-hindfoot score, AOS score, PCS score, and MCS score improved significantly when compared with preoperative ones ( P<0.05), whereas ankle ROM showed no significant difference ( P>0.05). Conclusion:Personalized 3D-printed titanium talus prostheses effectively relieve pain and improve ankle function and quality of life in patients with steroid-induced TAN, providing a viable joint-preserving treatment option.

Diabetic foot ulcer (DFU) is highly prevalent and remains a major clinical challenge. It is characterized by impaired microvasculature, persistent oxidative stress, chronic infection, and immune dysregulation, which collectively lead to chronic non-healing wounds. The tibial cortex transverse transport (TTT) technique has been shown to enhance DFU healing by restoring distal limb perfusion, with Piezo1 likely acting as a key mediator in this signal transduction process. Inspired by this mechanism, we used the Piezo1 agonist Yoda1 to pharmacologically replicate the effects of TTT and investigate its therapeutic potential in enhancing diabetic wound repair. To address the poor water solubility and narrow therapeutic window of Yoda1, we encapsulated it in ROS-responsive micelles and further incorporated them into a stimuli-responsive hydrogel composed of silk fibroin (SF) and hyaluronic acid. The hydrogel was crosslinked via dynamic boronate ester bonds, conferring responsiveness to pH, ROS, and glucose, thereby enabling controlled, sustained drug release. In addition, short cationic antimicrobial peptides (AMPs) were modified with a C14 fatty acid chain to form self-assembling structures with enhanced stability and antimicrobial potency, which were then incorporated into the hydrogel. Within the pathological DFU microenvironment, the SF-based hydrogel gradually degraded, releasing AMPs and Yoda1 to exert synergistic therapeutic effects, including potent antimicrobial activity, attenuation of oxidative stress, promotion of M2 macrophage polarization, and enhanced angiogenesis. Comprehensive in vitro cellular assays and in vivo evaluations in a rat DFU model demonstrated significant therapeutic efficacy. Overall, these findings suggest that this multifunctional, stimuli-responsive, dual-nanoparticle delivery hydrogel represents a potential strategy for DFU treatment.

Osteoporosis, a common condition of low bone mineral density (BMD), significantly increases fracture risk. Denosumab and alendronate are both established anti-resorptive therapies, yet their comparative effectiveness remains inconsistent across studies. The aim of this meta-analysis was to systematically evaluate the efficacy of denosumab versus alendronate for improving BMD at multiple skeletal sites in osteoporosis patients, aiming to provide evidence for clinical decision making. Multiple databases were searched for relevant randomised controlled trials published in English (as of November 2024). The primary outcomes were mean change of BMD at different skeletal sites. Data were pooled using fixed- or random-effects models to determine the mean differences (MDs) and 95

Diabetic foot ulcers (DFUs) pose significant therapeutic challenges owing to their intricate microenvironment. Conventional biomaterials often target only a single pathological factor, rendering them inadequate for halting the progressive deterioration of DFUs. To address this limitation, we developed a multifunctional drug delivery platform based on amine-yne click chemistry. The system was constructed using quaternized chitosan (QCS) and tetra-arm polyethylene glycol propiolate (4A-PEG-PA), incorporating metal-polyphenol nanoparticles (MPNs) formed by epigallocatechin gallate (EGCG) and magnesium ions (Mg2+) as the drug-loading component. This platform not only fills ulcer cavities to eliminate dead space but also adheres firmly to irregular wound surfaces, minimizing physical disruption. Additionally, the drug delivery system exhibits pH-responsive behavior, along with potent antioxidant and hypoglycemic effects, effectively lowering reactive oxygen species (ROS) and glucose levels in the wound microenvironment by modulating pH, thereby promoting healing. In vitro studies revealed that the material safeguards mitochondrial function and integrity by counteracting oxidative stress. In vivo evaluations further demonstrated its antimicrobial, anti-inflammatory, pro-angiogenic, and re-epithelialization properties. Collectively, this hydrogel-based platform integrates multiple bioactive functions, presenting a promising strategy for the clinical management of DFUs.

Objective:To evaluate effectiveness of three-dimensional (3D) printed patient-specific cutting guides (PSCGs) in Cole midfoot osteotomy for treatment of rigid pes cavus deformity associated with Charcot-Marie-Tooth (CMT) disease, and to analyze learning curve for PSCGs-assisted surgery. Methods:A retrospective analysis was conducted of 20 patients (40 feet) with rigid pes cavus deformity associated with CMT who were admitted between March 2021 and July 2023 and met the inclusion criteria. The cohort comprised 13 men and 7 women, with ages ranging from 17 to 62 years (mean, 37.3 years). All patients underwent whole-genome sequencing, which identified 17 patients with CMT type 1 and 3 patients with CMT type 2. Preoperatively, 3D models of bilateral feet were reconstructed based on CT data, and PSCGs were designed and fabricated accordingly. All patients underwent a Cole midfoot osteotomy assisted by the guides. Operation time, number of intraoperative fluoroscopic exposures, and intraoperative complications were recorded. Pre- and post-operative outcomes were compared using the visual analogue scale (VAS) score for pain, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and domain scores of the 36-Item Short Form Health Survey (SF-36), as well as radiographic parameters including the Meary's angle, Pitch angle, talo-first metatarsal angle (T1MT), talocalcaneal angle (TCA), and Djian-Annonier angle, to assess the corrective effect of the osteotomy. A modified cumulative sum analysis was performed to evaluate the learning curve for PSCGs-assisted surgery. Results:All procedures in the 20 patients (40 feet) were completed successfully, with no cases of massive hemorrhage or injury to critical neurovascular or tendinous structures. The operation time ranged from 63 to 129 minutes (mean, 82.9 minutes), and fluoroscopy was performed 2-11 times (mean, 4.7 times). Postoperatively, 1 patient (1 foot) developed a mild superficial surgical-site infection, which resolved with symptomatic treatment; no deep infections occurred. All patients were followed up 8-43 months (mean, 17 months). At last follow-up, the AOFAS ankle-hindfoot score and all domain scores of the SF-36 were significantly higher than preoperative values, and the VAS score, the Meary's angle, T1MT, TCA, and Djian-Annonier angle significantly decreased, Pitch angle significantly increased ( P<0.05). The imaging confirmed osteotomy union in all feet, and no fixation-related complications was observed. Learning-curve analysis indicated that both operation time and fluoroscopy usage plateaued after the 13th case, suggesting stabilization of surgical performance from that point onward. Conclusion:The use of PSCGs during Cole midfoot osteotomy enables precise and efficient correction of complex midfoot deformities while significantly reducing intraoperative fluoroscopic exposure. Moreover, this technique appears to have a short learning-curve and good reproducibility, which may facilitate its broader adoption in clinical practice.

Chitosan-based (CS-based) materials have attracted considerable attention owing to their excellent biocompatibility and intrinsic hemostatic activity, rendering them promising candidates for emergency hemorrhage control. Nevertheless, their clinical performance is often constrained by inadequate wettability and limited mechanical strength. In this study, we developed a superelastic hemostatic sponge (HMCT-NP) through a facile freeze-drying approach by incorporating hydrophobically modified CS, tannic acid (TA)-mediated cross-linking, and functional Fe-baicalin nanoparticles (Fe-Ba NPs). The grafted hydrophobic alkyl chains can insert into the membranes of red blood cells (RBCs) and platelets, thereby promoting their active adhesion and aggregation to accelerate rapid coagulation. TA enhances the mechanical properties of the sponge via hydrogen-bond-mediated cross-linking while also providing antibacterial and antioxidant functionalities. The incorporation of nanoparticles enhanced the antibacterial and antioxidant properties of the sponge and, notably, led to a significant improvement in its mechanical robustness. Through this modular design and synergistic functional enhancement, HMCT-NP effectively mitigates the intrinsic poor wettability of CS-based hemostatic sponges, demonstrating a water uptake capacity of approximately 95 g/g and a volumetric expansion greater than 200% upon hydration, thereby enabling rapid fluid imbibition and enhancing blood cell aggregation at the bleeding interface. Furthermore, its high compressibility and rapid fluid-triggered shape recovery enable effective deployment in narrow or deep wounds while maintaining biosafety and minimizing tissue irritation. In various bleeding models, HMCT-NP sponge demonstrated enhanced procoagulant activity and hemostatic performance. Meanwhile, the sponge effectively accelerated the healing of infected wounds. Collectively, these results underscore the potential of the HMCT-NP sponge as a versatile and promising strategy for clinical hemorrhage management.

The complex pathologic microenvironment of diabetic wounds—characterized by impaired angiogenesis, neuropathy, bacterial infection, and immune dysfunction—severely disrupts the normal healing process. This study presents a cascade nanozyme hydrogel dressing that releases nitric oxide (NO) and oxygen (O2) to enhance neuro-vascular coupling and immunomodulation for accelerated diabetic wound repair. The hydrogel was rapidly formed under UV illumination, integrating dopamine-modified gelatin (Gel-DA) and quaternary ammonium-lipoic acid-modified chitosan (LQCS) as an adhesive matrix, alongside Cu/Mg-tannic acid nanozymes loaded with the NO donor BNN6 (PTA-Cu-Mg/BNN6) as the functional core. In this design, the Gel-DA and LQCS matrix provides excellent tissue adhesion and inherent antibacterial capability, while the PTA-Cu-Mg/BNN6 nanozymes enable near-infrared (NIR)-triggered NO release and catalase-like decomposition of endogenous H2O2 for sustained O2 generation. Under NIR irradiation, the simultaneous release of NO and O2 from the hydrogel demonstrated effective antibacterial activity, promoted macrophage polarization toward the M2 phenotype, enhanced endothelial cell proliferation and angiogenic gene expression, and facilitated neurite outgrowth. In vivo results confirmed that the hydrogel significantly accelerated the healing of infected diabetic wounds by eradicating bacteria, modulating the immune microenvironment, and synergistically promoting angiogenesis and nerve regeneration. This easily fabricated NO/O2-releasing cascade nanozyme hydrogel represents a promising therapeutic strategy with great potential for clinical translation.

Rationale:The healing of severe infected burn wounds is impeded by a vicious cycle of bacterial biofilms, oxidative stress, immune dysregulation, and hypoxia. Existing microneedle (MN) platforms often fail to address these multifactorial barriers due to insufficient mechanical robustness, lengthy fabrication times, and limited therapeutic scope. Our goal was to develop a multifunctional, on-demand MN platform that can simultaneously overcome these challenges by systematically dismantling pathological barriers and activating endogenous regenerative pathways. Methods:We developed a multifunctional MN platform based on a semi-Interpenetrating Polymer Network (sIPN) of hyaluronic acid methacrylate (HAMA) and ethoxylated trimethylolpropane triacrylate (ETPTA). This platform was co-encapsulated with a triad of therapeutic agents: a biofilm-dismantling antisense oligonucleotide (ASO) targeting the bacterial gene yycF, nanoceria (CeO₂) for reactive oxygen species (ROS) scavenging and in-situ oxygen generation, and anthocyanin (An) as an antioxidant and anti-inflammatory agent. The therapeutic efficacy of the MN platform was evaluated in a rat model of MRSA-infected full-thickness burns. Healing was assessed through macroscopic observation, histological analysis, and immunofluorescence staining. The underlying molecular mechanisms were investigated using transcriptomic and protein analyses of wound tissues. Results:The fabricated sIPN MNs exhibited exceptional mechanical strength, rapid fabrication time, and strong tissue adhesion. In the rat model, the MNs effectively dismantled biofilms, reduced oxidative stress, alleviated hypoxia, and shifted the immune balance towards M2 macrophage polarization. This comprehensive microenvironment remodeling led to accelerated wound closure, promoted angiogenesis, and encouraged ordered collagen deposition, resulting in higher-quality tissue regeneration compared to control groups. Transcriptomic and protein analyses revealed that this enhanced healing was driven by the significant activation of the epidermal Wnt/KLF5 signaling axis. Conclusions:Our study presents a mechanistically elucidated, multimodal sIPN MN platform that effectively promotes the healing of infected burn wounds. By remodeling the pathological microenvironment and activating the Wnt/KLF5 regenerative axis, this on-demand platform demonstrates significant potential for clinical translation in the management of complex wounds.

Diabetic foot osteomyelitis (DFO) often manifests as persistent, non-healing infection with progressive bone destruction. Poor glycemic control and concomitant peripheral vascular and neuropathic injury are key drivers. Effective clinical solutions remain limited. Current management typically involves debridement of infected and necrotic tissues, local or systemic antibiotics, and bone/soft-tissue reconstruction. However, impaired local circulation makes it difficult to sustain therapeutic antibiotic levels at the lesion site. Recurrence is therefore common. Bone regeneration is also hard to achieve, which prolongs the overall course and results in repeated procedures, long recovery cycles, and high costs. To overcome these limitations, we propose a microenvironment-matched strategy as a practical direction for DFO therapy. The DFO niche is characterized by bacterial persistence and recurrent infection, severe oxidative stress and chronic inflammation, immunometabolic dysregulation, and microvascular plus neural injury that suppress osteogenesis. These constraints converge on three intertwined therapeutic targets: infection, inflammation, and bone defects. Treatment should thus be precise, sequential, and coordinated across targets, rather than relying on isolated interventions. This review systematically summarizes advances in multitarget antibacterial approaches, anti-inflammatory and immunometabolic modulation, and multifunctional biomaterial platforms that integrate angiogenesis, neurorestoration, and osteogenic regeneration. We further highlight microenvironment-responsive, integrated strategies that optimize drug dosing and release timing, aiming to improve the durability of infection control and the quality of bone reconstruction. Ultimately, we provide researchers with testable material design and synthesis logic, and offer clinicians new therapeutic paradigms and stage-adaptive, precision care pathways.

Falls among older adults pose a major healthcare and social burden, making early identification of high-risk individuals essential for prevention. This study presents a portable, non-invasive AI-based wearable system that predicts fall risk using surface electromyography (sEMG) and plantar-pressure measurements collected during overground walking. sEMG electrodes were placed bilaterally over eight key lower-limb muscles—tibialis anterior, peroneus longus, medial and lateral gastrocnemius, rectus femoris, vastus medialis, vastus lateralis, and biceps femoris—while pressure insoles captured loading at eight anatomical foot regions. Ninety-four older adults (mean age 69.6 ± 10.0 years; 57 females), including 57 non-fallers and 37 individuals who met ICD-10 diagnostic criteria for “propensity to fall,” participated in the modeling study. The signals from both devices were streamed wirelessly to a central acquisition unit for synchronized processing. Extracted features included muscle activation contribution, mean frequency, mean power frequency, and cumulative plantar-pressure impulses. These features served as model input. To reduce data dimensionality, Principal Component Analysis (PCA) and Linear Discriminant Analysis (LDA) were applied. PCA retained a variance structure, whereas LDA maximized class separability. Three machine-learning classifiers—Support Vector Machine (SVM), Random Forest (RF), and Extreme Gradient Boosting (XGB)—were trained using Leave-One-Out Cross-Validation. LDA substantially improved performance across all models, with LDA + SVM achieving the highest accuracy (0.88), precision (0.92), recall (0.85), and F1-score (0.87). An independent clinical validation study involving ten additional older adults demonstrated that LDA-based models generalized well beyond the original dataset. Compared with existing fall-detection or multimodal EMG-based systems that focus on simulated falls, young participants, or non-portable laboratory equipment, the proposed framework enables physiologically interpretable, clinically deployable fall-risk prediction during natural gait. These findings highlight the promise of dual-modality wearable sensing for proactive fall prevention in geriatric populations.

Osteomyelitis (OM) is an infectious disease caused by the invasion of bone tissue by pathogenic microorganisms. It is frequently associated with biofilm formation, residual sequestra, local ischemia and hypoxia, elevated oxidative stress, and immune dysfunction. Conventional treatments rely on systemic antibiotics, surgical debridement, antibiotic-loaded bone cement, and bone transport techniques. Although these approaches can control infection in some cases, they remain limited by insufficient drug penetration, nondegradable materials, the need for secondary surgery, difficulty in repairing bone defects, and the risk of recurrence. In recent years, emerging biomaterials have provided new therapeutic strategies for OM by enabling the local delivery of antimicrobial agents, antimicrobial peptides, metal ions, or gaseous molecules, often in combination with photothermal therapy, sonodynamic therapy, pH/enzyme-responsive systems, and immunomodulation. The aim of this mini-review is to briefly summarize the pathological features of OM, outline the major design strategies of biomaterials currently used for OM treatment, and discuss the challenges associated with their clinical translation.

Malunions of tibial pilon fractures pose significant challenges for corrective reconstruction due to the solidly healed displaced fracture fragments and frequently defective articular cartilage. This study aims to introduce a joint-preserving reconstruction strategy for managing tibial pilon fracture malunions in young patients and to evaluate the clinical outcomes. We retrospectively analyzed 39 patients (mean age: 32.7 ± 10.4 years) with malunions of tibial pilon fractures who were treated with corrective reconstruction surgeries from 2013 to 2021. This cohort included 11 patients who underwent corrective intra-articular osteotomy, 17 who received combined osteoperiosteal iliac autograft transplantation, and 11 who underwent combined osteochondral autograft transplantation. The median duration from the initial injury to joint-preserving treatment was 7.4 months (interquartile range [IQR], 4.4–11.1). Radiographic assessments included plain radiographs and computed tomography (CT) scans. Clinical outcomes were evaluated using the visual analog scale (VAS), the American Orthopaedic Foot Ankle Society (AOFAS) ankle-hindfoot score, the 36-Item Short Form Health Survey (SF-36) score, and ankle range of motion (ROM). After a median follow-up of 41.5 months, patients showed significant improvements in pain and function. The median VAS score improved from 5 (IQR, 6–7) to 2 (IQR, 1–3), and the median AOFAS score increased from 42 (IQR, 33–58) to 79 (IQR, 73–87) (P < 0.001). The mean SF-36 scores increased from 37.2 ± 12.2 to 71.2 ± 9.6 (P < 0.001), and the median ankle ROM improved from 20 degrees (IQR, 16–30) to 25 degrees (IQR, 20–34) (P = 0.004). Major complications included two patients requiring reoperation, and two patients progressing to radiographic end-stage arthritis; however, the pain remained tolerable, and no secondary arthrodesis or arthroplasty was performed by the final follow-up. Joint-preserving corrective reconstruction surgeries can offer reasonable improvement over a four-year follow-up period, making them a viable alternative for the reconstruction of tibial pilon fractures malunions in young patients.

Due to the inherent limited regenerative capacity of tendons, rendering countermeasures for tendon injury remains challenging. The pathophysiology of tendon healing is complex and contains three sequential phases including inflammation, proliferation and remodeling. Aiming at the treatment of different stages of tendon injury, in our work, an injectable small intestinal submucosa hydrogel/sodium alginate microspheres (SIS/SA) composite co-encapsulating stromal cell derived factor-1α (SDF-1α) and bone morphogenetic protein-12 (BMP-12) was developed for effective tendon regeneration. BMP-12 was initially embedded into SA microspheres by microfluid method, and then, microspheres were subsequently encapsulated into the SDF-1α loaded SIS hydrogel. The two bioactive molecules were released in a biphasic and controlled manner to facilitate cell recruitment in the early stage and tendon differentiation in the long-time stage, respectively. Meanwhile, with the degradation of hydrogel/microspheres composite, the regeneration process was accelerated through multiple pathways encompassing immune regulation, angiogenesis, and extracellular matrix (ECM) synthesis. The findings of this study present a compelling translational strategy with significant clinical potential for advancing tendon regeneration therapies.

Alveolar bone defects are often irregular in shape and can severely affect patients' physical and psychological well-being, posing significant challenges in treatment, particularly in cases complicated by systemic diseases. This study presents a shape-adaptive hydrogel with sequential antibacterial and osteogenic functions designed to repair irregular bone defects associated with osteoporosis. Naringin, an estrogen analogue, was conjugated to the hydrogel via disulfide bonds and then uniformly mixed with nano-hydroxyapatite (nano-HAP) to create microspheres. These microspheres were uniformly dispersed within the naringin-loaded hydrogel, forming an injectable and photocurable suspension. Upon implantation, naringin is rapidly released due to diffusion along the concentration gradient and initial hydrogel degradation, providing antibacterial effects and preventing infection. As bone repair progresses, the hydrogel undergoes further degradation and the disulfide bonds break, so that naringin is continuously released, which enhances osteoblast differentiation and inhibits osteoclast differentiation. Material characterization confirmed the presence of disulfide bonds and the sustained release profile of naringin. Both in vitro and in vivo experiments demonstrated the hydrogel's excellent biocompatibility and its effectiveness in repairing regular mandibular defects as well as irregular alveolar bone defects associated with osteoporosis. This hydrogel provides a promising strategy for the development of advanced biomaterials tailored to the complex requirements of irregular bone defect repair under osteoporotic conditions.

OpenCap, a smartphone-based markerless system, offers a cost-effective alternative to traditional marker-based systems for gait analysis. However, its kinematic measurement accuracy must be evaluated before widespread use in clinical practice. This study aimed to evaluate OpenCap for lower-limb joint angle measurements during walking in patients with knee osteoarthritis (OA) and to compare error metrics between patients and healthy controls. Lower-limb kinematic data were simultaneously collected from 53 patients with knee OA and 30 healthy individuals using OpenCap and a marker-based motion capture system while walking at a self-selected speed. Evaluation was assessed through root mean square error (RMSE) and intraclass correlation coefficient (ICC). Two-way repeated measures analyses of variance were employed to evaluate the main effects of and interactions between group (knee OA patients vs. healthy controls) and walking direction (toward vs. away from the camera). The results demonstrated a grand mean RMSE of 6.1° and an ICC of 0.67 for knee OA patients when walking toward the camera. Patients with knee OA exhibited significantly higher RMSE and lower ICC values compared to healthy controls. Additionally, walking toward the camera was associated with significantly lower RMSE and higher ICC values than walking away from the camera. OpenCap’s minimal hardware costs, free software, and user-friendly interface suggest its potential for widespread clinical implementation. The sagittal hip and knee angles demonstrate strong agreement with the marker-based system; however, caution is warranted in clinical decision-making for this population, as errors in most joint angles slightly surpass acceptable thresholds.

Expert consensus on clinical application of absorbable polymer screw in foot and ankle surgery was developed by Foot and Ankle Committee of Orthopedic Branch of Chinese Medical Doctor Association, Foot and Ankle Committee of Sports Medicine Physician Branch of Chinese Medical Doctor Association, Foot and Ankle Group of Orthopedic Branch of Shanghai Medical Associationand, and Foot and Ankle Alliance of National Orthopedic Medical Center of Shanghai Sixth People's Hospital. Based on evidence-based medicine and expert clinical experience, this consensus provides academic guidance for foot and ankle surgeons regarding the clinical use of absorbable polymer screw. The key topics include clinical indications, practical applications, and relevant considerations for absorbable nail rod systems in foot and ankle surgery.

BACKGROUND:All-inside arthroscopic procedures are now frequently employed to manage chronic lateral ankle instability (CLAI) with satisfactory functional outcomes. Currently, no evidence-based guidelines exist for all-inside arthroscopic procedures for CLAI. Many surgical decisions remain uncertain and challenging. SOURCES OF DATA:Published scientific literature in PubMed, MEDLINE, Web of Science, EMBASE, and Cochrane databases. AREAS OF AGREEMENT:All-inside arthroscopic repair and reconstruction procedures are reliable treatments for CLAI. AREAS OF CONTROVERSY:The all-inside arthroscopic procedures for CLAI present significant challenges, particularly in the following aspects. GROWING POINTS:Given the lack of guidelines for the all-inside arthroscopic procedures for CLAI, this evidence-based clinical practice guideline provides 11 recommendations to address the controversy. AREAS TIMELY FOR DEVELOPING RESEARCH:In patients with CLAI undergoing all-inside arthroscopic procedures, comparative studies are urgently needed to establish the optimal timing for weight-bearing, as well as return to work and sports.

Challenges still exist to develop an ideal cell-free nerve guidance conduit (NGC) providing a favorable microenvironment for rapid and successful nerve regeneration. Proteomic analysis revealed that extracellular matrix (ECM) derived from smooth muscle cells (SMCs) was abundant in nerve-related active proteins and significantly enriched signaling pathways involved in nerve regeneration. However, whether NGCs based on SMCs-derived ECM modification strategy promote nerve regeneration remains unclear. In the study, we investigated the neuroregenerative effect of SMCs-derived ECM and developed a novel NGC (MyoNerve) by coating small intestinal submucosa (SIS) with SMCs-derived ECM. The SMCs-ECM was rich in neurotrophic factors, which endowed MyoNerve with remarkable neuroregenerative capabilities by promoting the expression of genes implicated in aspects of neuronal maintenance and activating signaling pathways involved in nerve regeneration. In vitro, MyoNerve exhibited excellent bioactivity for accelerating angiogenesis, regulating macrophages polarization, promoting the proliferation, migration and elongation of Schwann cells, enhancing differentiation of PC12 cells, and inducing the neurite outgrowth of dorsal root ganglia. In the model of rat sciatic nerve 10 mm defect, MyoNerve showed great potential for functional nerve regeneration by promoting angiogenesis, proliferation and migration of Schwann cells and neuron, axonal regeneration, remyelination, and neurological functional recovery.