ABSTRACT Objective Total knee arthroplasty (TKA) is a well‐established intervention for end‐stage osteoarthritis (OA), offering substantial pain relief and functional improvement. However, a considerable proportion of patients remain dissatisfied postoperatively due to multifactorial causes. While numerous studies have investigated implant alignment, the sagittal plane alignment has received comparatively less attention, and its clinical relevance remains controversial. This systematic review aims to identify the optimal sagittal alignment (SA) parameters in TKA and to evaluate their impact on clinical outcomes. Methods A comprehensive literature search was conducted across four databases (PubMed, the Cochrane Library, Embase, and Web of Science) from their inception to April 1, 2025. Studies focusing on SA after primary TKA were considered. Articles meeting the inclusion and exclusion criteria were subjected to meta‐analysis. The SA parameters assessed included tibial slope, posterior condylar offset, tibial and femoral component angles, femoral bowing angle, and tibiofemoral alignment. Results The search yielded 1414 articles, after removing duplicates, of which 30 studies met the final inclusion criteria. The review confirmed that SA plays a critical role in postoperative outcomes. Malalignment in the sagittal plane was associated with complications such as instability, hyperextension, and impaired functional recovery. In particular, deviations in tibial slope and femoral bowing angle significantly influenced overall limb alignment and joint mechanics. Although achieving proper SA appears to reduce complications and improve functional outcomes, no universally accepted target values have yet been established. Conclusion Based on current evidence, achieving optimal SA during the perioperative period is essential for improving prosthesis longevity and patient satisfaction following primary TKA. Surgeons should pay close attention to SA parameters, and the use of emerging technologies is encouraged to enhance precision in component positioning. Trial Registration: PROSPERO Registration: CRD42023471336

BACKGROUND Hip fracture in elderly patients is often termed “the last fracture in life“. The incidence of hip re-fractures is high, but prognosis is poor, significantly impairing patients’ quality of life and imposing a substantial burden on healthcare systems. A reliable prediction model for re-fractures could play a crucial role in guiding preventive strategies. AIM To conduct a critical appraisal of existing prediction models for re-fractures in hip fracture patients. METHODS A systematic search was conducted across five databases, PubMed, EMBASE, the Cochrane Library, Web of Science, and the China National Knowledge Infrastructure, from inception to January 1, 2025. Eligible studies included those that developed prediction models for postoperative re-fractures following hip fractures. The Prediction Model Risk of Bias Assessment Tool was employed to evaluate the risk of bias and clinical applicability. A narrative synthesis summarised the characteristics, methodological quality, and predictive performance of the identified studies. Additionally, a meta-analysis was performed to quantitatively assess the performance of prediction models. RESULTS Of the 6056 studies retrieved, 8 studies with 28 predictive models were ultimately identified. Internal and external validation was performed for five (62.5%, internal), two (25.0%, external), and one (12.5%, internal and external) models. The number of predictors per model ranged from four to nineteen. The most frequently included predictors were age, rehabilitation exercise, osteoporosis, heart disease, and Alzheimer's disease. The models demonstrated area under the curve values of 0.69-0.98 in internal validation and 0.76-0.98 in external validation. Pooled analysis of the area under the curves yielded values of 0.970 (95%CI: 0.960-0.980) and 0.932 (95%CI: 0.907-0.959) for the model development and validation, respectively. All included models had a high risk of bias, while only two (25.0%) showed low concerns regarding applicability. CONCLUSION Current risk prediction models for postoperative re-fracture after hip fractures surgery lack robust validation and comprehensive evaluation. Future studies should prioritise refining model development, improving generalizability, and assessing clinical utility. Collaborative initiatives involving researchers, clinicians, and policymakers are crucial to transforming these models into effective tools for mitigating the burden of re-fractures in elderly populations.

BACKGROUND:Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty (pTHA). However, the literature demonstrates significant variability regarding the relative contributions of different factors. AIM:To investigate the key determinants of aseptic loosening, we performed a systematic review and meta-analysis. METHODS:A comprehensive search of PubMed, Web of Science, EMBASE, and the Cochrane Library was conducted, encompassing studies from database inception to January 1, 2025. Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA. Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility. Study quality was assessed using standardized categories. Pooled odds ratio (OR) with corresponding 95% confidence interval were calculated with random- or fixed-effects models to generate reliability estimates, and study heterogeneity was visualized using forest plots. Ten factors, categorized into patient-, surgeon-, and device-related domains, were reviewed and meta-analyzed. Funnel plot analysis demonstrated a relatively symmetrical distribution, suggesting minimal publication bias. RESULTS:A meta-analysis of 20 studies (520789 participants) found a pooled prevalence of 1.96%. Significant risk factors for aseptic loosening after pTHA included elevated body mass index (OR = 1.116, P < 0.001), higher Charlson comorbidity index (OR = 1.378, P < 0.001), prosthesis-related factors (OR = 1.497, P < 0.001), and adverse lifestyles (OR = 2.198, P = 0.037). Protective factors were non-white race (OR = 0.445, P < 0.001) and favorable genetics (OR = 0.723, P < 0.001). Male sex increased risk (OR = 1.232, P = 0.016), while age and anatomy were not significant. Surgical expertise showed a slight protective effect (OR = 1.048, P < 0.001). A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors, surgical expertise, and prosthesis characteristics. CONCLUSION:The identification of these factors is critical for risk mitigation. High-risk patients should receive targeted counseling regarding individualized profiles. Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.

In clinical settings, regenerating critical-sized calvarial bone defects presents substantial problems owing to the intricacy of surgical methods, restricted bone growth medications, and a scarcity of commercial bone grafts. To treat this life-threatening issue, improved biofunctional grafts capable of properly healing critical-sized bone defects are required. In this study, we effectively created anti-fracture hydrogel systems using spongy-like metal-organic (magnesium-phosphate) coordinated chitosan-modified injectable hydrogels (CPMg) loaded with a bioinspired neobavaisoflavone (NBF) component. The CPMg-NBF hydrogels showed outstanding anti-fracture capabilities during compression testing and retained exceptional mechanical stability even after 28 d of immersion in phosphate-buffered saline. They also demonstrated prolonged and stable release profiles of Mg2+ and NBF. Importantly, CPMg-NBF hydrogels revealed robust biphasic mineralization and were non-toxic to MC3T3-E1 cells. To better understand the underlying mechanism of Mg2+ and NBF component, as well as their synergistic effect on osteogenesis, we investigated the expression of key osteogenic proteins in the p38 MAPK and NOTCH pathways. Our results showed that CPMg-NBF hydrogels greatly increased the expression of osteogenic proteins (Runx2, OCN, OPN, BMPS and ALP). In vivo experiments showed that the implantation of CPMg-NBF hydrogels resulted in a significant increase in new bone growth within critical-sized calvarial defects. Based on these findings, we expect that the CPMg-NBF supramolecular hydrogel has tremendous promise for use as a therapeutic biomaterial for treating critical-sized calvarial defects.

CASE:A 51-year-old woman diagnosed with periprosthetic joint infection was referred to our hospital for reimplantation. Her femoral bone defect was classified as Paprosky type IV defect, which is challenged to reconstruct due to the lack of isthmus for stem fixation. She underwent isthmusoplasty to enhance the fixation of modular taper fluted titanium (TFT) stem and demonstrated satisfactory 50-month follow-up results in revision total hip arthroplasty (THA). CONCLUSION:The isthmusoplasty technique could be used to enhance the fixation for the modular TFT stem by reconstructing a conical canal in the coronal plane for Paprosky IV femoral bone defect reconstruction in revision THA.

OBJECTIVE:Sarcopenia, a progressive musculoskeletal disorder associated with aging, is characterized by the deterioration of muscle mass, strength, and physical performance. This condition significantly increases the risk of debilitating consequences including functional impairment, diminished life quality, and increased mortality. With the progress of aging, it will affect a large number of people in the world and bring many problems. Despite its clinical significance, there are no medicine used to treatment sarcopenia by FDA approval in clinical. This systematic review synthesizes current evidence on the diagnostic and therapeutic potential of irisin-a myokine induced by exercise-in sarcopenia, aiming to address two key questions: (1) Can irisin serve as a reliable biomarker for sarcopenia diagnosis? (2) Does irisin hold promise as a therapeutic agent for sarcopenia management? METHODS:A comprehensive literature search was conducted across multiple databases (Web of Science, PubMed, Cochrane Library, and Embase) to examine the relationship between irisin and sarcopenia. Eligible studies meeting our inclusion criteria underwent rigorous quality assessment. RESULT:364 studies were identified, of which only 21 met the inclusion criteria-12 involving human studies and 9 involving animal and cell experiments. In human studies, irisin may serve as a potential diagnostic marker for sarcopenia in the elderly and postmenopausal women. In addition, as a myokine of exercise induced, increased circulating levels of irisin may enhanced skeletal muscle mass. Moreover, animal and cellular experiments suggest that increased levels of irisin help improve muscle mass. CONCLUSION:In conclusion, this review indicates that irisin has potential therapeutic effects for sarcopenia and may become a promising treatment for sarcopenia in the future. However, there is currently a lack of high-quality studies on the use of irisin in treating sarcopenia, and the relevant mechanisms of action are not yet clear. Therefore, more studies are needed to clarify the relationship between irisin and sarcopenia in the future.

Background A former cohort study has raised concern regarding the unanticipated hazard of omeprazole in expediting osteoarthritis (OA) advancement. The precise nature of their causal evidence, however, remains undetermined. The present research endeavors to investigate the underlying causal link between omeprazole and OA through the application of mendelian randomization (MR) analysis. Methods The study incorporated the ukb-a-106 and ukb-b-14,486 datasets. The investigation of causal effects employed methodologies such as MR-Egger, Weighted median, Inverse variance weighted (IVW) with multiplicative random effects, and IVW (fixed effects). The IVW approach was predominantly considered for result interpretation. Sensitivity analysis was conducted, encompassing assessments for heterogeneity, horizontal pleiotropy, and the Leave-one-out techniques. Results The outcomes of the MR analysis indicated a causal relationship between omeprazole and OA, with omeprazole identified as a contributing risk factor for OA development (IVW model: OR = 1.2473, P < 0.01 in ukb-a-106; OR = 1.1288, P < 0.05 in ukb-b-14,486). The sensitivity analysis underscored the robustness and dependability of the above-mentioned analytical findings. Conclusion This study, employing MR, reveals that omeprazole, as an exposure factor, elevates the risk of OA. Considering the drug's efficacy and associated adverse events, clinical practitioners should exercise caution regarding prolonged omeprazole use, particularly in populations with heightened OA risks. Further robust and high-quality research is warranted to validate our findings and guide clinical practice.

In this study, we explore the cartilage defect repair mechanism by phosphocreatine-grafted chitosan hydrogels loaded with berberine-treated ATDC5 cells (CSMP@BBR@ATDC5). Under the optimal concentrations of LPS and BBR ideal conditions, ATDC5 cell toxicity and proliferation were detected with AM/PI and EdU staining. Additionally, qPCR and Western blot were employed to detect the expression of the SIRT1/BMP4 signaling pathway and chondrogenic-related factors in ATDC5 cells. Moreover, BBR-treated ATDC5 was seeded into a phosphocreatine-grafted chitosan hydrogel system. Subsequently, the cartilage defect was established in mice. After 4, 8, and 12 weeks, knee specimens were collected to evaluate the repair of cartilage defects. According to our findings, BBR can increase ATDC5 viability by LPS treatment. Likewise, it upregulates the SIRT1/BMP4 signaling pathway expression and chondrogenic-related factors. Another, it was shown by histological observation that the cartilage defect had been repaired more effectively in the CSMP@BBR@ATDC5 group than in the other groups. Finally, the expressions of chondrogenic-related factors and SIRT1/BMP4 signaling pathway were upregulates in CSMP@BBR@ATDC5 than in other groups. In vitro, BBR protects inflammatory ATDC5 cells and maintains the expression of chondrogenic-related factors. Subsequently, we successfully use CSMP@BBR@ATDC 5 to repair knee cartilage defects in mice.

Abstract Background Total hip arthroplasty (THA) is a successful treatment for many hip diseases. Length of stay (LOS) and hospital cost are crucial parameters to quantify the medical efficacy and quality of unilateral primary THA patients. Clinical variables associated with LOS and hospital costs haven’t been investigated thoroughly. Methods The present study retrospectively explored the contributors of LOS and hospital costs among a total of 452 unilateral primary THA patients from January 2019 to January 2020. All patients received conventional in-house rehabilitation services within our institute prior to discharge. Outcome parameters included LOS and hospital cost while clinical variables included patient characteristics and procedural variables. Multivariable linear regression analysis was performed to assess the association between outcome parameters and clinical variables by controlling confounding factors. Moreover, we analyzed patients in two groups according to their diagnosis with femur neck fracture (FNF) (confine THA) or non-FNF (elective THA) separately. Results Among all 452 eligible participants (266 females and 186 males; age 57.05 ± 15.99 year-old), 145 (32.08%) patients diagnosed with FNF and 307 (67.92%) diagnosed with non-FNF were analyzed separately. Multivariable linear regression analysis revealed that clinical variables including surgery duration, transfusion, and comorbidity (stroke) among the elective THA patients while the approach and comorbidities (stoke, diabetes mellitus, coronary heart disease) among the confine THA patients were associated with a prolonged LOS (P < 0.05). Variables including the American Society of Anesthesiologists classification (ASA), duration, blood loss, and transfusion among the elective THA while the approach, duration, blood loss, transfusion, catheter, and comorbidities (stoke and coronary heart disease) among the confine THA were associated with higher hospital cost (P < 0.05). The results revealed that variables were associated with LOS and hospital cost at different degrees among both elective and confine THA. Conclusions Specific clinical variables of the patient characteristics and procedural variables are associated the LOS and hospital cost, which may be different between the elective and confine THA patients. The findings may indicate that evaluation and identification of detailed perioperative factors are beneficial in managing perioperative preparation, adjusting patients’ anticipation, decreasing LOS, and reducing hospital cost.

Objective Enhanced recovery after surgery (ERAS) has been successfully adopted for the improvement of medical quality and efficacy in many diseases, but the effect thereof for ankle fracture patients can vary. The aim of the present study was to explore the short‐term postoperative outcomes of ERAS among ankle fracture patients. Methods The present study was a retrospective cohort study conducted between January 2019 and May 2019. One hundred and sixty ankle fracture participations (58 males and 102 females, aged 41.71 ± 14.51 years) were included. The participants treated with open reduction and internal fixation were divided into two groups (non‐ERAS vs. ERAS) depending on whether ERAS was applied. Postoperative outcomes included American Orthopedic Foot and Ankle Society (AOFAS) score, length of stay (LOS), hospital cost, complications, and consumption of opioids. To assess the association between the groups and outcomes, generalized estimating equation (GEE) modeling and multivariable linear regression analysis were performed. Results The average follow‐up periods of the participations were 24 months postoperatively. No significant differences were detected between the non‐ERAS group and ERAS group with respect to the demographic of patients in terms of gender, age, Danis‐Weber classification of fracture, dislocation of ankle joint, and comorbidity (P > 0.05). Significant differences in terms of a higher AOFAS score were found in the ERAS group compared with the non‐ERAS group (6.73, 95% CI, 5.10–8.37, p < 0.001) at 3 months postoperatively (PO3M) and (4.73, 95% CI, 3.02–6.45, p < 0.001) at 6 months postoperatively (PO6M). However, similar AOFAS scores were found at 12 months postoperatively (PO12M) (0.28, 95% CI, −0.32 to 0.89, P > 0.05) and at 24 months postoperatively (PO24M) (0.56, 95% CI, −0.07 to 1.19, P > 0.05). Additionally, the GEE analysis and group‐by‐time interaction of AOFAS score revealed that the ERAS protocol could facilitate faster recovery for ankle fracture patients, with higher PO3M and PO6M (both P < 0.05). At the same time, significant differences in terms of a shorter length of stay (−3.19, 95% CI, −4.33 to −2.04, P < 0.01) and less hospital cost (−6501.81, 95% CI, −10955.21 to −2048.42, P < 0.01) were found in the ERAS group compared with the non‐ERAS group. Conclusion By reducing LOS and hospital cost, the ERAS protocol might improve the medical quality and efficacy. The present study can provide a realistic evaluation and comparison of the ERAS protocol among ankle fracture patients, and ultimately guide clinical decision making.

Objectives: This study aims to investigate the possible association and comparison between anterolateral approach (ALA) and posterolateral approach (PLA) and postoperative lower limb discrepancy (LLD) in selective total hip arthroplasty (THA). Patients and methods: April 2021 and July 2021, a total of 266 consecutive patients (126 males, 140 females; mean age: 46.7±13.6 years; range, 22 to 60 years) who underwent unilateral primary THA via the ALA or the PLA were retrospectively analyzed. The operations were performed by a single surgical team. All patients were divided into two groups according to the approach: ALA group (n=66) and PLA group (n=200). Relevant data were recorded. Diagnosis including hip osteoarthritis, developmental dysplasia of the hip (DDH), aseptic avascular necrosis (AVN), and inflammatory arthritis were noted. Perioperative follow-up radiographs were evaluated and measured to compare the postoperative LLD and offset. The association between two approaches and postoperative LLD and offset was analyzed using the univariate and multivariate linear regression analysis. Results: The mean follow-up was 20±3.7 (range, 16 to 25) months. Univariate analysis revealed that the postoperative LLD, the postoperative acetabular offset, and hospital costs were lower in the ALA group than the PLA group (p <0.01). However, the offset and length of stay were comparable between the two groups (p>0.05). Multivariate analysis revealed that the PLA (β=4.71; 95% confidence interval [CI]: 1.78 to 7.64), preoperative LLD (β=0.29; 95% CI: 0.21 to 0.37), DDH (β=5.01; 95% CI: 1.47 to 8.55), and AVN (β=3.81; 95% CI: 0.50 to 7.12) were the main contributors to the postoperative LLD. Conclusion: Our study results suggest that the ALA may be superior to the PLA in controlling the postoperative LLD among some of the selective unilateral primary THA patients. Both the ALA and the PLA were comparable in terms of the restoration of offset.

Objectives: Variable approaches for total hip arthroplasty (THA) are promoted but investigations of associations between the approaches and the postoperative lower limb discrepancy (LLD) are limited. We intended to compare the efficacy between the anterolateral approach (ALA) and posterolateral approach (PLA) in controlling of postoperative LLD. Methods: Two retrospective cohorts were established including patients undergone unilateral primary THA. Preoperative and latest follow-up radiographs were compared and evaluated. Two hundred and sixty patients (140 females and 126 males; aged 46.70 ± 13.62 years) were recruited with around 20 months follow-up postoperatively. Results: Univariate analysis identified lower postoperative LLD, lower postoperative acetabular offset and lower hospital costs in the ALA group than in the PLA group (p＜0.01), however, the femoral and global offset and length of stay (LOS) are comparable between (p > 0.05). Multivariable liner regression revealed that PLA, preoperative LLD, developmental dysplasia of the hip and aseptic avascular necrosis are major contributors to the postoperative LLD (p<0.05). Conclusions: This study illustrates that the ALA might be superior to the PLA in controlling the postoperative LLD among some of the THA patients. Both ALA and PLA are comparable in regard to femoral and offset and LOS.

镁合金材料作为可生物降解植入材料因其可在体内逐渐降解、吸收、消耗和排泄,手术区域愈合后无需二次手术取出.该材料有良好的生物降解性和生物相容性,有与骨骼相似的机械性能,使其在临床上被广泛研究.然而,镁合金在生物体内易腐蚀,限制了其作为骨植入材料的应用.本文从镁合金的腐蚀机理出发,对近年来通过镁合金骨植入材料表面改性从而控制材料的降解速率和改善生物相容性的研究作一综述.

Although the use of bioactive ions and proteins are crucial for bone defect repair, delivering them in a stable and controlled manner remains challenging. To achieve controlled delivery of osteogenic active factor, we developed a novel double network (DN) hydrogel capable of co-delivering Mg2+ ions and BMP2 in a controlled localized manner. This DN hydrogel was composed of poly (acrylamide) and chitosan, in which the poly (acrylamide) was cross-linked via covalent bond and the chitosan was grafted using bisphosphonate (BP) to form metal coordination bonds with Mg2+ ions. Due to this dynamic dissociation and re-association of the “BP-Mg2+” coordination bond, it was possible to deliver Mg2+ ions in a stable and controlled manner. Additionally, the obtained DN hydrogel exhibited an effective tensile strength (0.62 MPa), perfect stretchability (973% fracture strain), and good creep and recovery properties due to the dynamic cross-linking effect of “BP-Mg2+”. Additionally, the hydrogel could synergistically promote the proliferation and differentiation of mouse embryo osteoblast precursor cells (MC3T3-E1 cells) in vitro via the BMP2/Wnt pathway. In the skull defect rat model, this positive delivery government of Mg2+ ions and BMP2 synergistically accelerated bone regeneration. In conclusion, this dynamic cross-linked hydrogel containing Mg2+ ions established a new platform for the sustained release of osteogenesis factor and accelerated the bone regeneration process.

Abstract Background Total hip arthroplasty (THA) is a successful treatment in the improvement of quality of life. Diagnosis-related groups (DRGs) payment has a significant impact on the hospital market in China and length of stay (LOS) is one of its crucial manifestations. Patient characteristics and medical provider factors can affect LOS but the relationship is uncertain. We intent to explore the relationship between patient characteristics and medical provider factors and LOS of primary THA patients. Methods We reviewed the database containing 461 patients who underwent primary THA between January 2014 to January 2019 and regressed the LOS against a variety of perioperative factors. A multivariable linear regression model was performed to assess the difference. Results For parts of patient characteristics, multivariable linear regression analysis revealed that comorbidities, pre-operation albumin < 30 g/L, and pre-operation CRP ≥ 5 mg/L were all significantly associated with LOS (p < 0.05). For parts of medical provider factors, multivariable linear regression analysis revealed that date of surgery, urinary catheter, and incision drainage were all significantly associated with LOS (p < 0.05). Conclusions Patient characteristics and medical provider factors are associated with LOS of THA patients. Evaluation and identification of risk factors are beneficial in patients' education, perioperative discussion and surgery decisions in the different primary THA patient populations.

1病例报告 患者男,38岁.2009年无明显诱因出现上腹部腹胀,左上腹部似可触及巨大肿物.彩超示腹腔内巨大混合性团块.2018年7月就诊于我院,完善相关检查:血生化均无异常,腹部CT提示腹膜后囊实性混杂密度影巨大占位(图1),位于胰腺后方并挤压胰腺向上移位,提示肿块与胰腺关系密切.大小约129mm×89mm×118mm.行手术治疗.

Background Coronavirus disease 2019 (COVID-19) has broken out and spread rapidly nationwide at the beginning of 2020, which has brought huge impacts to people and work. The current situation of prevention and control is severe and urges guidance for clinicians, especially for medical systems. In the hope of providing a reference and recommendation for the prevention and control of the COVID-19, we carried out research to improve the quality of patient care and prevention during this epidemic. Methods All of the staff were trained rapidly to master personal protection in our department. We reviewed the patients' discharged records who underwent surgery in our department during January 1 to March 1, 2019, and January 1 to March 1, 2020. The management of the surgery patients and flow charts were described and analyzed. Post-operation outcomes of the patients include duration, complications, surgical site infection (SSI), system infection, re-operation, and mortality. Both chi-squared test and Student'sttest were performed to determine the relationship between the two periods in terms of post-operation outcomes. Results Descriptive statistics analysis revealed that demographic of the patients between the two periods is similar. We had benefited from the strict flowcharts, smart robot, and protection equipment during the perioperative managements for orthopedic patients. With the help of the strict flow charts and smart equipment, post-operation outcomes of the patients revealed that the rates of the complications and re-operation had been reduced significantly (p< 0.05), while duration of operation, SSI, and system infection had no significant difference between two periods (p> 0.05). No patient and staff caught COVID-19 infection or mortality during the epidemic. Conclusions Our study indicated that medical quality and efficiency were affected little with the help of strategies described above during the epidemic, which could be a reference tool for medical staff in routine clinical practice for admission of patients around the world. What is more, the provided strategies, which may evolve over time, could be used as empirical guidance and reference for orthopedic peers to get through the pandemic and ensure the normal operation of the hospital.

背景:β-catenin基因抑制人间充质干细胞(hMSCs)成软骨分化,而Sox9基因促进hMSCs成软骨分化,但两者联合在hMSCs早期成软骨分化中的作用及其可能机制目前尚不明确.目的:探究β-catenin基因敲减与Sox9过表达联合对hMSCs早期成软骨分化的作用.方法:将骨髓来源hMSCs分为4组:阴性对照组,β-catenin基因敲减组,Sox9过表达组,β-catenin基因敲减与Sox9过表达联合组,加入成软骨分化培养基培养7d.转染24 h,RT-PCR检测β-catenin基因敲减效率与Sox9过表达效率,RT-PCR检测COL2A1和ACAN的mRNA表达量,番红固绿染色、甲苯胺蓝染色、免疫细胞化学检测COL2A1和Aggrecan蛋白.结果:RT-PCR结果显示转染成功,β-catenin基因敲减效率与Sox9过表达效率较高(P＜0.05).β-catenin基因敲减与Sox9过表达联合组中COL2A1和ACAN的mRNA表达量显著高于其他3组(P＜0.05),软骨成分染色更深(P＜0.05).免疫组化结果显示β-catenin基因敲减与Sox9过表达联合组的COL2A1和Aggrecan蛋白表达量显著高于其他3组(P＜0.05).结论:β-catenin基因敲减与Sox9过表达联合对hMSCs早期成软骨分化有促进作用.

Objectives The purpose of this study is to identify the factors that influence the length of stay (LOS) in total knee arthroplasty (TKA) patients with an enhanced recovery after surgery (ERAS) program. Methods Information from 167 patients (31 males and 136 females, range from 43 years to 88 years old) who underwent the unilateral elective primary TKA from January 2017 to January 2019 were reviewed retrospectively. Factors were analyzed by single-factor variance and multi-factor linear regression. Results By single-factor variance analysis, American Society of Anesthesiologists (ASA) physical status classification system, pre-operation albumin, pre-operation erythrocyte sedimentation rate (ESR), primary and merge diseases, hidden blood loss, and length of operation were correlated with LOS ( P < 0.05). Multi-factor linear regression results suggested that gender, ASA class, pre-operation Alb, and pre-operation ESR were associated with LOS ( P < 0.05). Moreover, ASA class 3 ( B value 4.84), pre-operation Alb < 30 g/L ( B value 18.33), and pre-operation ESR > 15 mmol/h ( B value 2.21) could increase the LOS, while males ( B value − 3.56) had a shortened LOS. Conclusions Overall, our research found that female, ASA class 3, pre-operation Alb < 30 g/L, and pre-operation ESR > 15 mmol/h could extend LOS in TKA patients with ERAS.

目的 探讨加速康复外科(ERAS)模式下全髋关节置换(THA)患者住院时长(LOS)的影响因素.方法 纳入行初次单侧THA的326例患者,统计性别、 年龄、 体重指数(BMI)、 美国麻醉医师协会分级(ASA)、 术前血红蛋白(Hb)和白蛋白(Alb)水平及围手术期指标.结果 单因素分析显示不同ASA、 术前Hb及Alb水平及有无合并症、 术中输血及留置引流管患者的LOS比较有统计学差异(P<0.05);多因素Logistic线性回归分析显示术中输血、 留置引流管和有合并症与患者的LOS有关(P<0.05).结论 患者ASA、 术前Hb及Alb水平、 存在合并症、 术中输血及术后留置引流管等可能不同程度地延长LOS.