Multiple myeloma (MM) is a complex hematological malignancy characterized by the abnormal proliferation of malignant plasma cells in the bone marrow. This study aims to provide a comprehensive assessment of MM’s global epidemiology, disease burden, and attributable risk factors from 1990 to 2021, with projections to 2045. A descriptive epidemiological analysis was conducted using data from the Global Burden of Disease (GBD) 2021 study, encompassing 204 countries and territories. Key metrics such as incidence, prevalence, mortality, years lived with disability(YLDs), years of life lost (YLLs), disability-adjusted life years (DALYs), and age-standardized rates (ASRs) were analyzed. Statistical analyses, including Joinpoint regression and decomposition analysis, were employed to identify trends and driving factors behind disease burden changes. Projections to 2045 were generated using BAPC and Nordpred models. Analyses were stratified by age, sex, region, and socio-demographic index (SDI) levels. Between 1990 and 2021, global MM incidence, prevalence, and mortality increased 2-3-fold, reaching approximately 148,754 new cases, 394,482 prevalent cases, and 116,360 deaths in 2021. High-income regions such as North America and Western Europe showed higher disease burdens, reflecting better diagnostics and aging populations, while low-income regions likely underestimated the true burden due to limited healthcare access. High BMI was identified as the only risk factor, with its attributable burden rising significantly. Decomposition analysis revealed population aging and growth as key contributors to the increasing burden, while epidemiological changes in high SDI regions mitigated mortality and disability rates. Projections to 2045 indicate continued growth in absolute case numbers, though ASRs are expected to decline slightly. The global burden of MM has risen substantially over the past three decades, driven by demographic transitions and increasing risk factors such as obesity. High-income regions have achieved better outcomes through advances in diagnostics and therapies, but low SDI regions remain disproportionately affected. Efforts to address MM’s global impact must focus on equitable access to healthcare, targeted prevention strategies, and continued research to understand disease mechanisms and optimize interventions. Projections emphasize the urgent need for integrated global health policies to mitigate MM’s impact.

Background Diabetic peripheral neuropathy (DPN) causes progressive peripheral nerve dysfunction with limited recovery. Tibial cortex transverse transport (TTT) is an orthopedic mechanotherapy used in ischemic limb disorders, but its potential for peripheral nerve repair in DPN remains unclear. Methods DPN rats (high-fat diet plus low-dose streptozotocin) were assigned to Control, DPN, Sham, TTT, and TTT plus nerve growth factor (NGF) neutralization groups. Sensory behavior, gait-related function, motor/sensory nerve conduction, and histological outcomes were evaluated. In vitro, serum from each group was applied to Schwann cells, and a Schwann cell–dorsal root ganglion (DRG) neuron co-culture system was used to assess neurite outgrowth. Results TTT improved sensory function and gait performance, increased motor and sensory conduction velocities, and ameliorated structural abnormalities in sciatic nerve and intraepidermal nerve fibers. Sciatic nerve NGF showed a modest increase after TTT, and TTT-derived serum enhanced Schwann cell viability, increased NGF secretion, and promoted DRG neurite extension in vitro. NGF neutralization attenuated multiple TTT-associated benefits in vivo and in vitro. Conclusions TTT confers neurofunctional and structural benefits in experimental DPN, with NGF signaling contributing to its effects, supporting TTT as a promising mechanotherapy for peripheral nerve repair.

BACKGROUND:Diabetic foot ulcer (DFU) is a severe complication of diabetes with limited therapeutic options. Tibial cortex transverse transport (TTT) shows clinical efficacy in DFU treatment, but its regenerative mechanisms remain unclear. Small extracellular vesicles (sEVs) have been implicated in bone-related tissue regeneration; however, their role in TTT-mediated wound healing has not been defined. A TTT rat model was established to investigate the contribution of sEVs to diabetic wound repair. Angiogenesis and inflammation were assessed using histology, immunofluorescence, qRT-PCR, and Western blotting. Plasma-derived sEVs from TTT-treated rats (TTT-sEVs) were isolated and evaluated for their effects on HUVECs and RAW264.7 macrophages in vitro. The therapeutic efficacy of TTT-sEVs was further examined in diabetic dorsal wounds using an sEV-loaded PF127 hydrogel. TTT significantly accelerated wound healing, enhanced angiogenesis, and reduced inflammation, whereas inhibition of sEV release attenuated these effects. TTT-sEVs promoted endothelial proliferation, migration, and tube formation, upregulated pro-angiogenic factors, and suppressed inflammatory mediators in macrophages. In vivo delivery of TTT-sEVs markedly improved diabetic wound healing and angiogenic responses. These findings demonstrate that sEVs are critical mediators of TTT-induced DFU repair by promoting angiogenesis and suppressing inflammation.

Tibial cortex transverse transport (TTT) is an emerging surgical technique used to promote revascularization in ischemic lower limbs. This video demonstrates a reproducible rat model of TTT, detailing the surgical creation of a cortical bone fragment, the transport protocol, and postoperative assessments. The procedure enables controlled upward and downward transport of a bone fragment to stimulate angiogenic responses. Representative X-ray images acquired on postoperative days 1, 7, and 12, together with microvascular perfusion imaging performed on Day 19 after euthanasia, show clear bone fragment movement and improved limb perfusion following TTT. This model provides a practical and reproducible platform for investigating the molecular mechanisms underlying TTT-induced angiogenesis and evaluating potential therapeutic strategies for ischemic diseases. To construct this model, we simulated the clinical TTT procedure in Sprague-Dawley rats, involving three main surgical steps: ligation of the superficial femoral artery, creation and mobilization of a cortical bone fragment, and application of a custom external fixator. Over 12 days, the fragment was gradually transported forward and then backward. Perfusion imaging confirmed enhanced vascularization in the ischemic limb after the completion of the transport cycle. Overall, this standardized rat model closely mimics clinical TTT procedures and offers a valuable experimental system for studying mechanotransduction, angiogenesis, and vascular regeneration in ischemic limb conditions.

Diabetic wounds are difficult to heal due to infections caused by multidrug-resistant bacteria. Although photodynamic therapy (PDT) and antimicrobial peptides (AMPs) have emerged as promising alternatives, each faces inherent limitations: PDT-generated reactive oxygen species (ROS) have an extremely short lifespan (10-320 ns) and limited diffusion (10-55 nm), while AMPs are structurally unstable, potentially cytotoxic at high doses, and even induce bacterial resistance. To overcome these drawbacks, we developed a synergistic nanoplatform by integrating the AMP Indolicidin with the photosensitizer PTBT, further encapsulated within a thermosensitive F127 hydrogel (PTBT/I@F127). The system formed uniform, highly photosensitive nanoparticles in which Indolicidin, located on the outer surface, first disrupted bacterial membranes, facilitating the contact of PTBT with bacteria. Subsequently, abundant ROS were generated for rapidly killing bacteria under an 808-nm laser irradiation, which effectively compensated for the limited diffusion of ROS and reinforced the antibacterial effect of Indolicidin before its degradation. In vitro, PTBT/I@F127 effectively killed methicillin-resistant Staphylococcus aureus (MRSA) and E. coli with a remarkable synergy. In diabetic mice and pig models, wound healing rates reached 98% and 83%, respectively, with remarkable angiogenesis and collagen deposition, after receiving PTBT/I@F127. Transcriptomic analysis revealed that Wnt/β-catenin signaling pathways were involved in promoting tissue regeneration, while inflammation-associated signaling pathways, such as NF-κB and IL-17, were concurrently regulated, thereby alleviating inflammation and reshaping the immune microenvironment in infected wounds. Collectively, this PTBT/Indolicidin-based thermosensitive hydrogel effectively eliminated resistant bacteria, mitigated inflammation, stimulated angiogenesis, and accelerated healing of infected diabetic wounds, offering a safe, controllable, and translationally promising therapeutic strategy.

Background: Achilles tendinitis (AT) is a prevalent musculoskeletal disorder with unclear etiology. This study aimed to investigate the causal relationships between circulating inflammatory cytokines (ICs), metabolites, and AT risk using bidirectional Mendelian randomization (MR), and to identify potential metabolite-mediated pathways. Methods: A bidirectional MR design was implemented, integrating genetic instruments for 91 ICs and 1400 metabolites with GWAS summary statistics from the FinnGen consortium. Causal inferences were drawn using inverse variance weighting (IVW), MR-Egger regression, and weighted median approaches, accompanied by sensitivity and mediated analyses. Results: CCL19, CCL23, and IL17A were identified as protective factors for AT, with CCL23 demonstrating consistent associations across multiple MR methods. 65 metabolite traits were significantly associated with disease risk. Glycochenodeoxycholate glucuronide showed a protective effect (P = 0.002), whereas the alpha-tocopherol to glycerol ratio increased risk (P = 0.011). Mediation analysis indicated six pathways: CCL19-pantothenate-AT; CCL19-Picolinate-AT; CCL19-X-21845-AT; CCL23-X-12822-AT; CCL23-X-18921-AT; IL17A-cysteinylglycine disulfide-AT. Conclusion: This is the first MR study to systematically assess the causal roles of ICs and metabolites in AT, identifying CCL19, CCL23, and IL17A as protective factors and highlighting multiple metabolite signatures linked to disease risk, offering novel insights for mechanistic research and targeted intervention.

Aims: Tibial cortex transverse transport (TTT) represents an innovative surgical technique used in managing lower limb ischaemic conditions, focusing specifically on diabetic foot ulcers. This study aimed to assess the safety of TTT by evaluating the stress magnitude and distribution on the tibia and tibial osteotomy blocks. Methods: A 3D finite element model was developed to simulate the TTT system, including the tibia, osteotomy blocks, skin, and TTT device. The models were reconstructed using Mimics, Geomagic, and SolidWorks, and analyzed with Ansys finite element processing software. To estimate the fracture risk under specific conditions, we calculated the stress limits and distribution the tibia could withstand without fracturing under various loading scenarios, such as torsion and axial compression. Results: The results indicate that stress on the tibial cortex increased progressively with the advancement of bone transport fixation adjustment, and was primarily concentrated around the pinholes used to lift the osteotomy block. No significant differences were observed between the control and TTT groups. Conclusion: Through finite element analysis, it was determined that TTT does not compromise the overall stability of the tibia, and the TTT device provides protection against bone fracture caused by window-cutting in diabetic patients. Therefore, to preserve the TTT system’s stability, its components must be protected from high-impact forces. Cite this article: Bone Joint Res 2025;14(4):281–291.

ObjectiveDiabetic foot ulcer (DFU) poses a major clinical burden. This study, for the first time, establishes and validates a finite element (FE) biomechanical model of tibial cortex transverse transport (TTT) in diabetic rats. By integrating micro-CT data at multiple time points, we provide a novel computational approach to assess the biomechanical safety and stability of TTT, thus bridging preclinical animal research and potential clinical translation.MethodsThis study utilized a customized transverse osteotomy transport frame to establish a model of TTT for treating lower limb ischemic ulcer in diabetic rats. Postoperatively, the tibiae and fibulae Dicom were harvested by ex-vivo micro-CT scaning. The imaging data are processed and analyzed using mechanical analysis software by Mimics, 3-matic Medical, Geomagic Studio, Hypermesh, MSC.Patran, and MSC. Nastran to simulate the loading characteristics of the rat’s tibia and fibula with the TTT.Results1. Peak von Mises stresses in the transport tibial bone fragment under axial compression (7.04 Mpa), axial torsion (16.91 Mpa), and three-point bending (9.40 Mpa), showed no significant differences between postoperative time points (3, 6, 9, 12, and 30 days), indicating that the overall stress change in the tibia during the tibial transverse transport process is minimal. 2. Over 8-week healing period, dynamic load sharing occurred among the transported bone fragment, original tibia, and adjustable external fixator. Progressive healing of the transported bone fragment with the surrounding bone tissue reduced the structural bearing stress of the adjustable TTT fixation. The overall stiffness of the tibia increases as the transported fragment and tibia gradually restore, further enhancing the stability of the overall tibia. 3. Under biomechanical testing conditions including axial compression, axial torsion, and three-point bending, the application of adjustable external fixators successfully repositioned free bone fragments to their anatomical alignment in the tibia without exceeding the ultimate yield strength of cortical bone tissue. Secondary fracture initiation or catastrophic structural failure was not observed during testing. The current experimental results shows the TTT fixation satisfies the required strength criteria for rat experiment.ConclusionThe TTT rat model demonstrated biomechanical stability and surgical safety in silico, supporting its translational potential. However, further experimental validation is required.

This study aims to compare the effects of tibial cortex transverse transport (TTT) and platelet-rich plasma (PRP) on the healing of severe diabetic foot ulcers, evaluate the clinical efficacy of TTT, and explore its potential impact on lower limb circulation. A retrospective analysis was conducted on two patient groups treated at our hospital between July 2019 and June 2022. One group underwent TTT, while the other received PRP therapy. Both groups had Wagner level 3 or higher ulcers. An 18-month follow-up was performed for both groups, during which we documented wound healing progress and healing times to assess clinical efficacy. To investigate lower limb blood flow recovery, lower limb arterial ultrasound was used to measure blood flow velocities in the affected popliteal and dorsalis pedis arteries. Additionally, ELISA was employed to measure the stromal cell-derived factor-1 (SDF-1) levels of angiogenic factors in peripheral blood. A total of 60 diabetic foot ulcers (DFUs) patients were enrolled in our study, with 30 patients in each group: TTT-treated and PRP-treated. During the 18-month follow-up, the wound healing rate in the TTT-treated group was significantly higher than in the PRP-treated group [96.67% (29/30) vs. 80% (24/30), p < 0.05]. Furthermore, the healing time in the TTT-treated group was shorter (3.02 ± 0.84 vs. 6.04 ± 0.85 months, p < 0.001). The amputation rate [3.33% (1/30) vs. 20% (6/30), p < 0.05] and recurrence rate [6.67% (2/30) vs. 26.67% (8/30), p < 0.05] in the TTT-treated group were lower than those in the PRP-treated group. After 1 month and 18 months of treatment, the flow velocities in the popliteal artery (68.93 ± 2.69 vs. 58.14 ± 2.48 cm/s, p < 0.001; 55.68 ± 3.43 vs. 46.07 ± 3.02 cm/s, p < 0.001) and dorsalis pedis artery (46.45 ± 2.77 vs. 36.46 ± 2.83 cm/s, p < 0.001; 38.63 ± 2.40 vs. 29.82 ± 2.15 cm/s, p < 0.001) in the TTT-treated group were significantly higher than in the PRP-treated group. Additionally, the TTT-treated group showed higher levels of SDF-1 expression (375.36 ± 13.52 vs. 251.93 ± 9.82 pg/ml, p < 0.001; 256.62 ± 13.19 vs. 239.96 ± 10.78 pg/ml, p < 0.001). Our results suggest that TTT treatment is more clinically effective than PRP for treating severe DFUs. This increased efficacy may be attributed to enhanced lower limb blood flow, which is potentially driven by elevated SDF-1 levels.

BACKGROUND:Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by persistent inflammation and joint destruction. Although the roles of inflammatory cytokines and metabolites in RA pathogenesis have caught a lot of attention, there is a lack of systematic studies, and their causal relationships remain unclear. METHODS:We conducted a two-step mendelian randomization analysis utilizing genetic data from genome-wide association studies (GWAS) of inflammatory cytokines, metabolites, and RA. The first step assessed the causal effect of 91 inflammatory cytokines and 1400 metabolites on RA risk using inverse variance weighted method, complemented by MR-Egger, weighted median, simple mode and MR-PRESSO to ensure robustness and assess pleiotropy. The second step evaluated the mediation effects of selected metabolites on the relationship between cytokines and RA. RESULTS:The analysis identified 9 inflammatory cytokines, including IL-1α and IL-10, which significantly increase RA risk, while TNF-β exhibited a protective effect. Additionally, 6 metabolites were associated with increased RA risk, including 1-(1-enyl-palmitoyl)-2-arachidonoyl-GPE and arachidonate (20:4n6). Conversely, 5 metabolites, such as docosatrienoate (22:3n3) and Cholesterol, were found to reduce RA risk. The mediation analysis revealed that TNF-β may exerts its protective effect through its influence on specific metabolites, and X-24949, which accounted for a -2.58% mediated effect in the TNF-β-RA causal pathway. CONCLUSION:This study explores the complex interplay between inflammatory cytokines, metabolites, and RA. The findings suggest potential biomarkers for early diagnosis and novel therapeutic targets, particularly those related to lipid metabolites and specific cytokines like TNF-β. Key message What is already known on this topic  Inflammatory factors and metabolites are considered to be related to the onset and progression of RA. What this study adds  We conducted a MR analysis to identify all inflammatory factors and metabolites associated with RA and calculated the mediation effect of inflammatory cytokines on RA through metabolites. This study contributes to a comprehensive understanding of the pathophysiological processes of RA. How this study might affect research, practice or policy  This has laid the groundwork for developing early diagnosis methods and future treatments.

Tibial Cortex Transverse Transport (TTT) represents an innovative surgical method for treating lower extremity diabetic foot ulcers (DFUs), yet its underlying mechanisms remain elusive. Establishing an animal model that closely mirrors clinical scenarios is both critical and novel for elucidating the mechanisms of TTT. We established a diabetic rat model with induced hindlimb ischemia to mimic the clinical manifestation of DFUs. TTT was applied using an external fixator for regulated bone movement. Treatment efficacy was evaluated through wound healing assessments, histological analyses, and immunohistochemical techniques to elucidate biological processes. The TTT group demonstrated expedited wound healing, improved skin tissue regeneration, and diminished inflammation relative to controls. Marked neovascularization and upregulation of angiogenic factors were observed, with the HIF-1α/SDF-1/CXCR4 pathway and an increase in EPCs being pivotal in these processes. A transition toward anti-inflammatory M2 macrophages indicated TTT's immunomodulatory capacity. Our innovative rat model effectively demonstrates the therapeutic potential of TTT in treating DFUs. We identified TTT's roles in promoting angiogenesis and modulating the immune system. This paves the way for further in-depth research and potential clinical applications to improve DFU management strategies.

Background. Diabetic foot ulcers (DFUs) represent one of the most severe late-stage complications of diabetes. Tibial cortex transverse transport (TTT) surgery stands as the prevailing method for addressing DFUs. This surgical intervention holds the promise of expediting DFU wound healing and diminishing the rate of amputations, with the mitigation of inflammatory responses playing a pivotal role. In this study, we aim to explore the correlation between inflammation and TTT surgery, with the overarching goal of facilitating swift prognostic assessments in clinical practice. Objectives. The correlation between the severity of DFUs and clinical test results remains ambiguous. A clinical prediction model was devised to explore the connection between DFU severity and the efficacy of TTT surgery, utilizing straightforward and efficient clinical indicators. Materials and methods. Clinical data and examination results were gathered by tracking hospitalized DFU patients who underwent TTT surgery at the First Affiliated Hospital of Guangxi Medical University (Nanning, China). Indicators associated with DFU severity and wound healing time post-surgery were identified through logistic regression and least absolute shrinkage and selection operator (LASSO) regression analyses. Subsequently, a clinical prediction model was constructed. Finally, the intersection of these 2 sets of indicators revealed factors correlated with wound severity and post-operative healing duration. Results. Our study was comprised of 202 patients who were categorized into 2 groups based on Wagner's grading classifications. Utilizing Student's t-tests, LASSO regression and logistic regression analyses, we identified 3 factors indicative of DFU severity: platelet-to-lymphocyte ratio (PLR), mixed lymphocyte reaction (MLR) and hemoglobin (HGB). Univariate COX regression analysis revealed 12 factors such as: white blood cells (WBC), neutrophils (NEUT), monocytes (MO), PLR, MLR, neutrophil-to-lymphocyte ratio (NLR), erythrocyte sedimentation rate (ESR), age, lymphocytes (LY), monocyte-to-neutrophil ratio (MNR), uric acid (UA), and albumin (ALB) associated with the postoperative healing duration. Ultimately, we identified 2 factors, PLR and MNR, at the intersection of these 2 datasets. Conclusions. Platelet-to-lymphocyte ratio and MNR were identified as factors associated with both the severity of DFUs and the prognosis following TTT surgery.

Purpose: Management of severe diabetic foot ulcers (DFUs) remains challenging. Tibial cortex transverse transport (TTT) facilitates healing and limb salvage in patients with recalcitrant DFUs. However, the underlying mechanism is largely unknown, necessitating the establishment of an animal model and mechanism exploration. Methods: Severe DFUs were induced in rats, then assigned to TTT, sham, or control groups (n=16/group). The TTT group underwent a tibial corticotomy, with 6 days each of medial and lateral transport; the sham group had a corticotomy without transport. Ulcer healing was assessed through Laser Doppler, CT angiography, histology, and immunohistochemistry. Serum HIF-1 alpha, PDGF-BB, SDF-1, and VEGF levels were measured by ELISA. Results: The TTT group showed lower percentages of wound area, higher dermis thickness (all p < 0.001 expect for p = 0.001 for TTT vs Sham at day 6) and percentage of collagen content (all p < 0.001) than the other two groups. The TTT group had higher perfusion and vessel volume in the hindlimb (all p < 0.001). The number of CD31(+) cells (all p < 0.001) and VEGFR2(+) cells (at day 6, TTT vs Control, p = 0.001, TTT vs Sham, p = 0.006; at day 12, TTT vs Control, p = 0.003, TTT vs Sham, p = 0.01) were higher in the TTT group. The activity of HIF-1 alpha, PDGF-BB, and SDF-1 was increased in the TTT group (all p < 0.001 except for SDF-1 at day 12, TTT vs Sham, p = 0.005). The TTT group had higher levels of HIF-1 alpha, PDGF-BB, SDF-1, and VEGF in serum than the other groups (all p < 0.001). Conclusion: TTT enhanced neovascularization and perfusion at the hindlimb and accelerated healing of the severe DFUs. The underlying mechanism is related to HIF-1 alpha-induced angiogenesis.

Abstract Objective The comparison analysis uses the clinical efficacy of the tibial cortex transverse transport and the enrichment of platelet plasma to treat severe diabetic foot ulcers and the effects of vascular endothelial cell vitality.Methods Retrospective analysis was performed on two groups of patients treated at our hospital from July 2019 to June 2022. One group received tibial cortex transverse transport (TTT) and the other received platelet-rich plasma (PRP). Both groups had Wagner level 3 or greater. We compared clinical efficacy, wound healing, arterial and posterior tibial arterial blood flow rates, and horizontal SDF-1 levels in peripheral blood between the groups.Results TTT group had higher healing rates at 1.5-year follow-up than the PRP group (96.67% [29/30] versus 80% [24/30], p < 0.05). The healing time of the TTT group was shorter than the control group (3.02 ± 0.84 versus 6.04 ± 0.85 months, p = 0.000). The amputation rate (3.33% [1/30] versus 20% [6/30], p < 0.05) and recurrence rate (6.67% [2/30] versus 26.67% [8/30], p < 0.05) of the TTT group were lower than the control group. One month after surgery and last follow-up, the SDF-1 concentration in the perimeter of the TTT group was significantly higher than the PRP group (375.36 ± 13.52 versus 251.93 ± 9.82 pg/ml, p = 0.000; 256.62 ± 13.19 versus 239.95 ± 10.78 pg/ml, p = 0.000). The average blood flow speed in the arterial artery of the TTT group was faster than the PRP group (68.93 ± 2.69 versus 58.14 ± 2.48 cm/s, p = 0.000) 4 weeks postoperatively and (55.68 ± 3.43 versus 46.07 ± 3.02 cm/s, p = 0.000) last follow-up.Conclusion The findings showed that TTT had better efficacy than PRP in treating severe diabetic foot ulcers. It could effectively stimulate SDF-1 expression, promote vascular hyperplasia, and accelerate wound healing.

目的 比较胫骨中段皮质横向搬移(MTCTT)和胫骨近端皮质横向搬移(PTCTT)治疗糖尿病足溃疡(DFU)的疗效和安全性.方法 选择接受MTCTT治疗的100例DFU患者为MTCTT组,同期接受PTCTT治疗且一般资料与MTCTT组均衡可比的90例DFU患者为PTCTT组.对比两组患者的手术相关情况、足部溃疡愈合率、愈合时间、截肢率、复发率及术后并发症发生率.结果 所有患者均获随访,随访时间3～24个月,平均5.2个月.MTCTT组手术时间、住院时间、术中出血量均长/多于PTCTT组,差异均有统计学意义(均P＜0.05).两组足部溃疡愈合率、愈合时间、截肢率和复发率比较,差异均无统计学意义(均P＞0.05).MTCTT组术后骨折、截骨块区域感染的发生率均高于PTCTT组,差异均有统计学意义(均P＜0.05).结论 MTCTT和PTCTT均能有效地促进糖尿病溃疡愈合,降低复发率及截肢率,是治疗DFU的有效方法.但PTCTT创伤更小,并发症发生风险更低,是更理想和安全的手术方式.

Background: Tibial Cortex Transverse Transport (TTT) has been demonstrated to be an effective treatment for unilateral diabetic foot ulcers (UDFUs). However, this retrospective study was designed to compare the efficacy and safety of unilateral TTT on bilateral diabetic foot ulcers (BDFUs).Methods: This retrospective study included a review of patients with TTT treated from January 2017 to August 2019, Propensity Score Matching (PSM) was performed to compare patients with BDFUs to those with UDFUs. Ulcer healing, recurrence, and major amputation rates were evaluated at 1-year follow-up. Changes in foot vessels were assessed in the BDFUs group using computed tomography angiography (CTA).Results: A total of 140 patients with DFUs (106 UDFUs and 34 BDFUs) were included in the study. UDFUs and BDFUs were matched in a 1:1 ratio (34 in each group) using PSM. No significant difference was observed at 1 -year-follow-up [91.2% (31/34) vs. 76.5% (26/34), OR 0.315 (95% CI 0.08 to 1.31), P = 0.10] and 6-month -follow-up [70.6% (24/34) vs. 50.0% (17/34), OR 0.85 (95% CI 0.15 to 1.13), P = 0.08] in two groups. Signif-icant differences in rates of major amputation and recurrence between the groups (P > 0.05) were not observed. The BDFUs group appeared more angiogenesis of the foot by CTA after 8 weeks of operation.Conclusion: Results of this study suggest that severe BDFUs can be effectively treated by unilateral TTT. TTT is easy to operate and effective, which may be a good alternative for treating severe BDFUs. The translational potential of this article: In previous retrospective clinical studies, TTT has demonstrated promising clinical outcomes in the management of diabetic foot ulcers. In this current study, we aim to investigate the potential use of TTT in treating distant tissue defects by evaluating the limited availability and safety of TTT for the management of bilateral diabetic foot. While additional basic and clinical research is necessary to fully elucidate the underlying mechanisms, our study offers insight into the potential therapeutic use of TTT for this condition.

Category: Trauma; Other Introduction/Purpose: Large area of deep wounds (LADW) usually undergoes flap grafting, in this study, we propose an innovative treatment for LADW. The objective of our study was to evaluate the efficacy of TTT for the treatment of LADW in the lower extremities and provide indications for the TTT. Methods: A retrospective review of consecutive patients with Large Area of Deep Wounds in the lower extremities who underwent reconstruction using the TTT procedure from 2018.1 to 2021.6 was conducted. Inpatient follow-up was performed at 1 month after surgery and outpatient follow-up at 3, 6, and 12 months after surgery. Ulcer healing and healing time, recurrence rate, major amputation rate, and complications were assessed during this 1-year follow-up. All patients were evaluated by computed tomography angiography (CTA) 1 month after surgery for changes in the small blood vessels of the lower extremities. Results: A total of 36 patients, including 21 males and 15 females, with a mean age of 62.5 years, were in this study. These included infected skin defects (20 cases), traumatic skin defects (9 cases), tumor resection skin defects (6 cases), and burns (1 case). Among them, the healing rate was 94.4% and the average healing time was 6 months without recurrence, nail tract infection, osteomyelitis, incisional infection, and related complications. Conclusion: The results showed that TTT can safely and effectively treat total skin defects of the lower extremity. TTT is relatively simple to perform without grafting, making it an effective method for treating total skin defects of the lower extremity.

Abstract Objectives: The aim of this study was to establish a clinical prediction model to predict the prognosis of diabetic foot ulcer (DFU) patients treated with tibial cortex transverse transport surgery (TTT). Methods: This was a single-center, retrospective study. The clinical data and inspection results were collected by following up on DFU patients hospitalized at the First Affiliated Hospital of Guangxi Medical University and treated with TTT surgery. 202 patients’ clinical data were collected finally and they were divided into two groups according to Wagner’s grading classification. The indicators related to the severity of DFU and with the time of wound healing after surgery were confirmed through logistic regression and Lasso regression analysis. In addition, a clinical prediction model was established. Finally, the intersection of the two sets of indicators yielded the indicators related to wound severity and the postoperative healing time. Results: 202 patients were separated into Wagner 2/3 group(n=135,mean age 62.40±9.68 years) and Wagner 4 group(n=67, mean age 61.12±9.07 years).After the student’s t-test, Lasso regression, and Logistic regression analysis, three factors were identified to describe the severity of the DFU between the two groups: platelet-to-lymphocyte ratio (PLR) (OR: 0.992, 95% CI: 0.987-0.998), monocyte-to-neutrophil ratio (MNR) (OR: 0.000, 95% CI: 0.000-0.050), Hemoglobin (HGB) (OR: 0.965, 95% CI: 0.938-0.992). Univariate COX regression analysis determined 12 factors (PLR, MNR, ect) related to the healing time after the operation. Conclusions: PLR and MNR were factors related to DFU severity and prognosis after TTT surgery.

背景:骨膜牵张也具有促进成骨和微血管生成作用,但能否用于治疗糖尿病足目前尚未明确.目的:对骨膜牵张促进骨和血管再生的研究进展进行综述,以明确该技术用于糖尿病足治疗的理论基础,并介绍其在治疗糖尿病足中的初步应用.方法:计算机检索万方医学网、中国知网、PubMed及Elsevier数据库收录的相关文献,中文检索词为:"牵张成组织技术、牵张成骨、胫骨横向骨搬移与糖尿病足、骨膜牵张、骨膜牵张成骨、骨膜牵张与糖尿病足";英文检索词为"Distraction histogenesis,Distraction osteogenesis,Tibia transverse transport and diabetic foot,Periosteal distraction osteogenesis,Periosteal distraction and diabetic foot".最终纳入42篇文献进行综述分析.结果 与结论:①基于Ilizarov张力-应力法则或牵张成组织原理,牵张成骨技术已用于治疗骨缺损、骨不连等疾病,而牵张成骨伴随的成血管原理催生了胫骨横向骨搬移技术,该技术已经成功应用于治疗包括糖尿病足在内的下肢难愈性溃疡,取得良好的治疗效果.②研究发现对骨膜进行持续、稳定、缓慢的牵张可以促进骨和血管再生,即骨膜牵张成骨和成血管现象,该现象的机制可能与骨膜的结构和成分有关.③目前关于骨膜牵张的研究主要聚焦于其成骨功能,且主要停留在动物实验阶段而极少用于人体.与胫骨横向骨搬移促进血管再生从而用于治疗糖尿病足类似,骨膜牵张促进血管再生也可能用于治疗糖尿病足,此即骨膜牵张用于治疗糖尿病足的理论基础.④该课题组已初步将骨膜牵张用于临床治疗糖尿病足,且治疗效果良好,该文章通过展示用于骨膜搬移的器械、手术方法及典型病例.初步结果显示,由于骨膜牵张技术不需要截骨,手术操作要比胫骨横向骨搬移更加简单,手术时间更短;因为骨膜牵张技术缺少对胫骨钻孔和骨搬移的操作,缺乏对胫骨髓腔的"开窗减压"作用及骨组织的搬移,可能促血管生成和创面愈合的效果要弱于胫骨横向骨搬.未来还需对骨膜牵张促进骨和血管再生的具体机制以及手术适应证及禁忌证等进一步研究.

BackgroundOsteoblasts-Osteoclasts has been a major area in bone disease research for a long time. However, there are few systematic studies in this field using bibliometric analysis. We aimed to perform a bibliometric analysis and visualization study to determine hotspots and trends of osteoblasts-osteoclasts in bone diseases, identify collaboration and influence among authors, countries, institutions, and journals, and assess the knowledge base to develop basic and clinical research in the future.MethodsWe collected articles and reviews for osteoblasts-osteoclasts in bone diseases from the Web of Science Core Collection. In addition, we utilized scientometrics software (CiteSpace5.8 and VOSviewer1.6.18) for visual analysis of countries/regions, institutions, authors, references, and keywords in the field.ResultsIn total, 16,832 authors from 579 institutions in 73 countries/regions have published 3,490 papers in 928 academic journals. The literature in this field is rapidly increasing, with Bone publishing the most articles, whereas Journal of Bone and Mineral Research had the most co-cited journals. These two journals mainly focused on molecular biology and the clinical medicine domain. The countries with the highest number of publications were the US and China, and the University of Arkansas for Medical Sciences was the most active institution. Regarding authors, Stavros C. Manolagas published the most articles, and Hiroshi Takayanagi had the most co-cited papers. Research in this field mainly includes molecular expression and regulatory mechanisms, differentiation, osteoprotection, inflammation, and tumors. The latest research hotspots are oxidative stress, mutation, osteocyte formation and absorption, bone metabolism, tumor therapy, and in-depth mechanisms.ConclusionWe identified the research hotspots and development process of osteoblasts-osteoclasts in bone disease using bibliometric and visual methods. Osteoblasts-osteoclasts have attracted increasing attention in bone disease. This study will provide a valuable reference for researchers concerned with osteoblasts-osteoclasts in bone diseases.