Adolescent idiopathic scoliosis (AIS) is a prevalent spinal deformity affecting 0.47%–5.2% of adolescents. Surgical intervention remains the mainstay of treatment for progressive curves, with the open posterior midline (OPM) approach being the traditional standard. In recent years, the minimally invasive scoliosis surgery (MISS) approach has gained increasing attention for its potential to minimize surgical trauma while maintaining effective deformity correction. This narrative review compares the outcomes of MISS and OPM in AIS management based on literature published from 2009 to 2024. Thirteen studies meeting inclusion criteria were analyzed. Both MISS and OPM demonstrated comparable coronal plane correction, while sagittal alignment results varied among studies, with some favoring MISS but without clear clinical significance. MISS generally employed a higher screw density and achieved similar functional and patient-reported outcomes compared to OPM. Although the MISS technique was associated with longer operative times, it offered notable perioperative advantages, including reduced intraoperative blood loss and shorter hospitalization. Complication rates were comparable between the two approaches. Overall, MISS provides similar radiographic and clinical results to OPM, with certain perioperative benefits, supporting its role as a viable alternative for AIS correction. Further large-scale, long-term studies are warranted to validate these findings and refine patient selection criteria.

OBJECTIVE:To compare outcomes of unilateral biportal endoscopy (UBE) decompression with percutaneous pedicle screw fixation (PPSF) versus open surgery for thoracolumbar burst fractures with neurological deficits. METHODS:We retrospectively analyzed 38 patients (T11-L2 burst fractures, ASIA C-D) treated between 2020 and 2024. Eighteen underwent UBE-assisted unilateral laminotomy for bilateral decompression with PPSF (UBE group); 20 received open decompression and instrumentation (Open group). Baseline severity was assessed using TLICS and McCormack scores. Outcomes included perioperative metrics, clinical scores (VAS, ODI) evaluated at 1, 6, and 12 months postoperatively, neurological recovery, and vertebral body (VB) height restoration at 12 months. RESULTS:Baseline characteristics were comparable. Median blood loss was significantly lower in the UBE group (125 vs. 475 mL, P<0.001), with fewer transfusions (5.6% vs. 40%, P=0.021) and shorter hospital stays (7 vs. 12 days, P<0.001). The UBE group demonstrated greater VB height restoration, calculated at the patient level and reported in percentage points (38 vs. 23 percentage points, P=0.003). Both groups achieved comparable functional and neurological improvements across all follow-up intervals. CONCLUSIONS:UBE combined with PPSF represents a feasible, minimally invasive alternative to traditional open surgery for thoracolumbar burst fractures. In this preliminary cohort, UBE significantly minimized early surgical morbidity and achieved robust anatomical restoration while providing comparable clinical outcomes. Larger prospective studies are required to definitively establish its comparative safety and long-term efficacy.

Malignant bone cancer, primarily osteosarcoma and chondrosarcoma, are highly aggressive neoplasms originating from bone tissue and characterized by a strong propensity for lung metastasis. Tumor cells evade anoikis through reactive oxygen species (ROS)-mediated redox homeostasis, which modulates signaling cascades that promote proliferation, survival, and metastatic invasion into distant sites. Melatonin, synthesized primarily by the pineal gland, has been implicated in cancer prevention and therapy due to its inhibitory effects on bone cancer growth and progression. Little is known about the mechanisms underlying anoikis resistance in bone cancer cells or whether melatonin can therapeutically modulate this process. We demonstrated that glutamine metabolism is essential for bone cancer cells to maintain anoikis resistance. Melatonin treatment disrupted glutamine metabolism and altered redox homeostasis, as evidenced by increased ROS accumulation and reduced NADPH/NADP⁺ ratios under anchorage-independent conditions. Notably, solute carrier family 38 member 5 (SLC38A5), a glutamine transporter, was identified as a critical regulator of bone cancer progression, with higher SLC38A5 expression correlating with poorer clinical outcomes. Melatonin suppressed SLC38A5 expression and attenuated anoikis resistance through inhibition of the PI3K-Akt signaling pathway. Consistently, reduced SLC38A5 expression was associated with decreased lung metastasis in melatonin-treated groups in an orthotopic mouse model. Collectively, our findings reveal a previously unrecognized role of melatonin in modulating glutamine-dependent redox balance and anoikis resistance in bone cancer. This study highlights SLC38A5-mediated glutamine metabolism as a critical determinant of metastatic potential and supports melatonin and SLC38A5 as promising therapeutic targets for osteosarcoma and chondrosarcoma.

Abstract Background: Epidural venous bleeding during full-endoscopic lumbar decompression can obscure visualization, prolong operative time, and increase the risk of neural injury. Conventional hemostatic methods, such as bipolar cautery, carry a risk of thermal spread, while other hemostatic agents have limitations related to swelling, cost, or application complexity. Objectives: This study evaluates the efficacy and safety of the Surgicel™ packing technique for epidural venous bleeding control during spinal endoscopic decompression. Materials and Methods: A retrospective review was conducted of 40 patients undergoing lumbar endoscopic unilateral laminectomy for bilateral decompression for central lumbar spinal stenosis at a regional hospital in Taiwan. Sixteen patients (24 levels) received the Surgicel™ packing technique, and 24 patients (36 levels) served as controls. Operative time, mean arterial pressure (MAP) at admission and intraoperatively, use of additional hemostatic agents, and complications were recorded. Results: The mean operative time was significantly shorter in the Surgicel™ group compared with controls (72.5 ± 9.7 vs. 89.0 ± 11.6 min, P < 0.005). Additional hemostatic agents were required in 6.25% of Surgicel™ patients versus 33.3% of controls ( P < 0.005). No significant differences were found in preoperative or intraoperative MAP between groups. All epidural venous bleeding in the Surgicel™ group was controlled without recurrence. No complications, including dural tears, new-onset neuralgia, or delayed bleeding, were reported. Conclusions: The Surgicel™ packing technique is a safe, efficient, and cost-effective method for controlling epidural venous bleeding during full-endoscopic lumbar decompression. It reduces operative time and the need for additional hemostatic agents, with no observed complications. This technique may improve surgical efficiency. However, prospective, multicenter studies are warranted to validate these findings.

Background Fluoroscopic imaging is indispensable in orthopaedic surgery but exposes surgeons to scatter radiation. Protective lead gowns reduce exposure, but differences in gown design, C-arm orientation, and seated positioning may influence protection efficiency at critical anatomical sites. Eye exposure is of particular concern due to the revised occupational dose limit of 20 mSv/year by the International Commission on Radiological Protection (ICRP). This study aimed to quantify scatter radiation exposure at the eye, thyroid, and groin under different gown configurations and positions during seated fluoroscopy. Our study was the first study to incorporate clinical parameters and settings into our study design. Methods Radiation exposure experiments were performed using a standardized C-arm fluoroscopy setup (46 kVp, 0.61 mA) with a full-sized mannequin seated at an orthopaedic surgical arm table. Raysafe i3 dosimeters were placed externally (outside gown) and internally (beneath gown) at the eye, thyroid, and groin. Two protective gowns were tested: a two-piece skirt–vest and a one-piece cross-back gown. Three seated positions were evaluated: (i) upright with knees 15 cm apart, (ii) inverted C-arm with knees 15 cm apart, and (iii) upright with knees 45 cm apart. Continuous fluoroscopy was applied for 1, 3, and 5 minutes. Mean values were analyzed using two-way ANOVA (gown × position) and regrouped for upright versus inverted C-arm comparisons, with effect sizes (η², Cohen’s d ) calculated. Results Internal eye doses ranged from 0.1–3.8 µSv with the one-piece gown and 0.2–1.7 µSv with the two-piece gown, corresponding to 19–91% reductions compared to external measurements. Two-way ANOVA showed that position significantly affected internal eye dose (F(2,14) = 7.93, p = 0.005, η² = 0.51, large), while gown type had no significant effect (F(1,14) = 1.28, p = 0.276). External eye doses were not significantly influenced by either factor. When regrouped by C-arm orientation, inverted positioning produced significantly higher internal eye doses (F(1,16) = 16.59, p = 0.0009, Cohen’s d = − 2.04, very large). External doses trended higher in inverted orientation but were not statistically significant (F(1,16) = 2.56, p = 0.129, d = − 0.80). Internal thyroid and groin exposures were consistently 0 µSv across all conditions, corresponding to complete protection, while external values increased with time and position. Conclusions Protective lead gowns provided complete shielding at the thyroid and groin, but ocular exposure remained strongly dependent on C-arm orientation and body positioning. The inverted C-arm significantly increased ocular dose despite gown use, underscoring the vulnerability of the lens to scatter radiation. Gown design alone did not significantly alter protection to the eyes. These findings support strict adherence to upright C-arm orientation whenever feasible, routine thyroid collar use, and adoption of lead glasses to further reduce ocular risk. Optimizing fluoroscopic setup and reinforcing protective practices remain essential to minimizing occupational radiation hazards in orthopaedic surgery. This study is the first to evaluate scatter radiation exposure using clinically measured, real-time surgeon positioning during seated orthopaedic fluoroscopy.

Dystrophic neurofibromatosis type I (NF1) kyphoscoliosis presents unique challenges for corrective spinal surgery due to anatomical abnormalities. To compare the radiographic and clinical outcomes of dystrophic neurofibromatosis type 1 (NF1) kyphoscoliosis patients undergoing three-column osteotomy (3CO), halo-gravity traction (HGT), or posterior column osteotomy (PCO) and to evaluate their efficacy and safety in this cohort, different treatment strategies and their associated complication rates warrant further comprehensive investigation. Dystrophic NF1 kyphoscoliosis were divided into 3CO, HGT, and PCO groups based on the surgical strategy. Radiographic parameters were measured preoperatively, postoperatively, and at each follow-up. Intraoperative and postoperative complications were recorded for each patient, and patient-reported outcomes were assessed using the Scoliosis Research Society-22 (SRS-22) questionnaire. Differences among the three groups were analyzed. A total of 9 patients were included in the 3CO, 22 in HGT group, 95 in PCO groups, respectively. Significant differences among the three groups were found in terms of operation time (p = 0.011), estimated blood loss (p = 0.003), and number of satellite rod techniques (p = 0.013). At pre-operation, the Cobb angles of main curves were 84.3 ± 24.6° in 3CO group, 99.1 ± 24.3° in HGT group, 60.0 ± 16.8° in PCO group. At post-operation, significant post-operative improvements were found in the Cobb angles of the main curves, apical vertebral translation (AVT), segmental kyphosis (SK), and deformity angular ratio (DAR) in all three groups (p < 0.001). No significant correction loss was observed during the follow-up. Six complications were found in the 3CO group, 13 in the HGT group, and 40 in the PCO group. PCO, 3CO, and HGT could be applied to dystrophic NF1 patients. The 3CO is also associated with increased perioperative complications. IV.

Objective: The aim of this study was to observe possible risks for traversing root injuries during endoscopic transforaminal lumbar interbody fusion (endo-TLIF) via an accessory portal. Methods: Twenty patients were recruited for this study according to our inclusion and exclusion criteria. An accessory portal was made 3 cm caudal to the working portal, and a 30 degrees/4.3mm endoscope was utilized to observe possible risks for traversing root injuries throughout the entire process of disc preparation and cage implantation. Results: The traversing root was observed via the accessory portal throughout the process of disc preparation and cage implantation in 20 patients. Endo-TLIF was shown to be a suitable method for decompression and cage implantation as it provided a sufficient working space and window. No cases of traversing root injuries were observed in our study. Conclusion: Endo-TLIF was found to be a suitable method for disc preparation and cage implantation. Our observations showed that endo-TLIF is a safe method for decompression, disc preparation, and cage implantation.

Study DesignRetrospective cohort comparative study.ObjectiveTo investigate whether specific upper instrumented vertebra (UIV) pedicle screw characteristics-particularly screw slope (UIV SS), tip-to-endplate distance (TED), and tip-to-anterior cortex distance (TAD)-are associated with the development of upper instrumented vertebra fracture (UIVF) following adult spinal deformity (ASD) surgery.MethodsThis retrospective study included 132 patients (mean age: 68.4 years) who underwent corrective surgery from 2013 to 2022, with a minimum follow-up of 2 years. The radiographic parameters and UIV screw characteristics were analyzed. Patients were categorized into UIVF and non-UIVF groups. Logistic regression and Receiver Operating Characteristic (ROC) curve analyses were used to identify the risk factors and cutoff values.ResultsUIVF occurred in 28.8% (38/132) of the patients. Post-thoracic kyphosis (Post-TK) and TED of the upper UIV screw (Post-TEDupper) were independently associated with UIVF. Cutoff values predictive of UIVF were post-TK > 36.5° and Post-TEDupper < 6.5 mm. Patients with a TEDupper < 6.5 mm had a significantly higher incidence of UIVF (HR = 2.417, P = 0.010). Kaplan-Meier analysis showed that UIVF commonly occurred within 3 months postoperatively. Progressive reduction in TED was observed over time, particularly in the UIVF group.ConclusionPost- TK > 36.5° and Post-TEDupper < 6.5 mm are significant predictors of UIVF. Based on the study findings, a postoperative TED of ≥ 6.5 mm may be associated with a reduced risk, and could be considered as a potential target in surgical planning, while acknowledging the limitations of the retrospective design and the model's moderate predictive accuracy.

Study design Retrospective cohort study. Objective To analyze the efficacy and safety of Halo-femoral traction (HFT) following spinal release, and preoperative Halo-gravity traction (HGT) in patients with severe spinal kyphoscoliosis and spinal cord risk classification (SCRC) type 3 at the apex. Methods A total of 73 patients (24 males, 49 females, mean age 22.4 ± 6.4 years) and 56 patients (15 males, 41 females, mean age 22.9 ± 10.4 years) were included in the HFT and HGT group, respectively. Radiographic parameters were measured at the initial assessment, post-traction, post-final surgery, and during each follow-up. Neurologic function was assessed using the Frankel score system. IONM alerts and all complications were documented. Quality-of-life was evaluated using the SF-36 questionnaire. Results In the HFT vs HGT group, the total correction rates were 39.9 ± 7.2% v.s. 41.3 ± 6.8% for the major Cobb and 36.6 ± 9.3% v.s. 44.4 ± 9.2% for global kyphosis (GK) after final surgery, respectively. The traction contributions were 57.6 ± 11.1% v.s. 52.3 ± 9.3% for major Cobb and 70.1 ± 10.5% v.s. 63.9 ± 11.1% for global kyphosis (GK), respectively. More than half of the total correction can be achieved gradually and safely through preoperative traction with patients in an awake state. No deterioration in neurological function was found post-final surgery. During the last follow-up, SF-36 questionnaire scores improved significantly in both groups ( P < .05). Conclusions Significant outcomes can be expected in patients with severe kyphoscoliosis, even with spinal cord risk classification (SCRC) type 3 at the apex undergoing HFT and HGT.

Study Design Retrospective cohort study. Objective Reciprocal changes (RCs) in unfused spinal segments can significantly affect the global alignment after corrective surgery. Identifying radiographic thresholds for guiding surgical strategies is critical for optimizing the outcomes. Materials and Methods Ninety-eight ASD patients who underwent staged surgeries, including lateral lumbar interbody fusion (LLIF) and posterior spinal fusion (PSF), were analyzed. According to the final follow-up image, the patients were classified into balanced (BG) and imbalanced (IG) groups, with IG further stratified into proximal junctional kyphosis/failure (IG-PJK/PJF) and non-PJK/PJF (IG-NPJK/PJF). Radiographic and clinical data were collected preoperatively, postoperatively, and at 2-year follow-up. Results The IG exhibited greater RCs in thoracic kyphosis (TK) and PI-LL mismatch from postoperative to follow-up than the BG ( P = .030, P = .008). Significant predictors included Age >65.5 y/o (AUC: .672) and Post-PT >17.5° (AUC: .852) for imbalance and Post-TK >34.5° (AUC: .755) for IG-PJK/PJF. IG-PJK/PJF showed poorer ODI scores than BG and IG-NPJK/PJF ( P = .021 and P = .022, respectively). IG-PJK/PJF showed poorer total SRS-22 scores than IG-NPJK/PJF ( P = .021). Conclusion Increased RCs in TK was associated with adverse outcomes. Extending the upper instrumented vertebra (UIV) to the upper thoracic spine and addressing excessive TK (>34.5°) may improve alignment and reduce complications. Radiographic thresholds can provide actionable guidance in surgical planning.

Chondrosarcoma is the second most common form of primary bone cancer originating from cartilage. Chondrosarcoma cells have a high propensity to spread to other organs during the advanced stage, with the lung being a preferred site. Although surgery is the most effective treatment for chondrosarcoma, it has low efficacy in the metastasis stage. Antrodia cinnamomea is the source of the triterpenoid antcin K, which exhibits immunomodulatory and anti‑inflammatory properties. However, the therapeutic function of antcin K on chondrosarcoma has not yet been elucidated. The inhibitory effect of antcin K was evaluated using migration and invasion assays while cell toxicity was determined using the MTT assay. Molecular function regulation by antcin K was investigated by RNA sequencing and Ingenuity Pathway Analysis. The present study revealed that antcin K decreases migration and invasion in two chondrosarcoma cell lines. RNA sequencing revealed that MMP‑7 serves a key role in antcin K‑mediated motility of chondrosarcoma cells. Antcin K diminished MMP‑7 expression, and overexpression of MMP‑7 antagonized antcin K‑induced inhibition of cell migration and invasion. Antcin K abolished the activation of PI3K, Akt, mTOR and NF‑κB pathways. The present study demonstrated that antcin K is a novel candidate for chondrosarcoma motility inhibition by decreasing the PI3K, Akt, mTOR and NF‑κB signaling cascades, which inhibits MMP‑7 production.

Two-stage surgeries are increasingly used to minimize complications in adult spinal deformity (ASD) correction, yet the specific contributions of lateral lumbar interbody fusion (LLIF) and posterior column osteotomy/posterior spinal fusion (PCO/PSF) remain underexplored. This study evaluates their roles in deformity correction and establishes predictive thresholds for optimizing surgical planning. A total of 151 ASD patients (mean age 69.5 years) underwent staged LLIF and PCO/PSF surgeries one week apart. Radiographic parameters were analyzed preoperatively (Pre-), post- 1st LLIF (M-), post- 2nd PCO/PSF (Post-), and at two-year follow-up (F-). Correction rates were 80.9% for PI-LL mismatch (35.5% LLIF, 64.5% PCO/PSF), 40.5% for pelvic tilt (39.4% LLIF, 60.6% PCO/PSF), and 69.1% for C7 SVA (45.7% LLIF, 54.3% PCO/PSF). Coronal correction of the Cobb angle reached 76.7% (33.1% LLIF, 66.9% PCO/PSF). Significant ODI and SRS-22 score improvements were noted at two years. Predictive thresholds for imbalance were M-SVA 75.3 mm, M-PI-LL 32.5°, and M-PT 35.5°. The 2nd PCO/PSF contributes more to correction, and predictive thresholds aid surgical planning, reducing postoperative imbalance for better outcomes.

Chondrosarcoma is a rare type of bone cancer that develops in cartilage cells. In recent years, the incidence of chondrosarcomas has steadily increased worldwide. During the advanced stages, chondrosarcoma carries a significant risk of metastasis and exhibits resistance to both chemotherapy and radiation therapy. Hence, the development of potent treatments for chondrosarcoma is an urgent requirement. Ugonin V is a flavonoid compound that has been extracted from the plant Helminthostachys zeylanica (L.) Hook. This study examined the molecular therapeutic effects of ugonin V on chondrosarcoma metastasis. Analysis of the GSE30835 dataset, which consists of chondrosarcoma tissues and normal cartilage, revealed significant upregulation of three cathepsin proteases in chondrosarcoma, namely cathepsin (CTS) A, L, and V. Notably, ugonin V specifically suppressed cathepsin V mRNA expression. We also found that ugonin V strongly inhibits chondrosarcoma cell motility by regulating CTSV expression. In addition, through miRNA sequencing, we observed that ugonin V targets CTSV via miR-4799-5p to effectively suppress chondrosarcoma cell migration and invasion. Our in vitro and in vivo studies provide an initial investigation of the involvement of cathepsin V and miR-4799-5p in chondrosarcoma metastasis after ugonin V treatmen

The aging population is experiencing a rising incidence of musculoskeletal problems and degenerative spinal deformities. Adult spinal deformity (ASD) presents challenges, with associated risks in open surgery. Minimally invasive surgery (MIS) is becoming increasingly popular due to its positive outcomes and potential benefits. This study aims to explore the clinical outcome and complications of posterior approach MIS in patients with ASD. We conducted a retrospective analysis of patients with adult spinal deformity who underwent posterior minimally invasive surgery. 46 patients meeting the criteria were identified between June 2017 and September 2023. Comprehensive data were collected, including demographic details, surgical information, full-length radiographic measurements, and visual analog scale (VAS) pain scores. These data were obtained preoperatively, postoperatively, and at the final follow-up. A total of 46 patients were included in the study, with a mean age of 68.58 years and a minimum follow-up period of 6 months. The mean operative time was 327 min, and the mean blood loss was 307 ml. Preoperative radiographic measurements were as follows: Coronal Cobb angle, 18.60 ± 11.35°; lumbar lordosis (LL), 22.79 ± 21.87°; pelvic incidence (PI), 53.05 ± 14.13°; PI-LL mismatch, 30.26 ± 23.48°; pelvic tilt (PT), 32.53 ± 10.38°; T1 pelvic angle (TPA), 31.91 ± 12.39°; and sagittal vertical axis (SVA), 77.77 ± 60.47 mm. At the final follow-up, coronal Cobb angle was 10.08 ± 6.47° (P <0.0001), LL was 26.16 ± 16.92° (P = 0.4293), PI was 54.17 ± 12.13° (P = 0.6965), PI-LL mismatch was 28.00 ± 17.03° (P = 0.6144), PT was 27.74 ± 10.24° (P = 0.0345), TPA was 25.10 ± 10.95 (P = 0.0090) and SVA was 47.91 ± 46.94 mm (P = 0.0129). Functional outcomes improved as well, with the mean Oswestry Disability Index (ODI) decreasing from 34.9 to 23.6 and the Visual Analog Scale (VAS) score for back pain reducing from 8.4 to 3.4. Surgical complications occurred in 39.1

Chronic systemic inflammation and autoimmunity are hallmarks of rheumatoid arthritis (RA), an inflammatory illness that gradually deteriorates the joints and results in permanent disability. An important pathogenic mechanism in RA is angiogenesis, which draws inflammatory leukocytes into the synovium and encourages the synthesis of damaging proteases and proinflammatory cytokines. High-mobility group box-1 (HMGB1) is a common nuclear protein with extracellular inflammatory ability that plays a crucial function in inflammatory disorders. Using data from the GEO dataset, the present report determined that the expression levels of HMGB1, the vascular marker CD34, and the angiogenic factor PDGF-B were remarkably higher in RA patients than in normal controls. HMGB1 treatment enhanced PDGF-B production in RA synovial fibroblasts (RASFs), while a PDGF-B antibody blocked HMGB1-treated RASFs-induced angiogenesis in HUVECs. We also revealed that the RAF, MEK, and ERK signaling pathways mediate HMGB1-induced PDGF-B production and angiogenesis. Thus, the HMGB1/PDGF-B axis may serve as a novel target for RA treatment.

Background: Skeletal muscle, functioning as an endocrine organ, produces a variety of molecules that contribute to the pathophysiology of sarcopenia, leading to muscular injury and inflammation. Antcin K, a bioactive compound derived from Antrodia cinnamomea and used in traditional Chinese medicine for its anti-inflammatory properties, was evaluated in this study with the aim of assessing its effects on resisting the progression of sarcopenia both in vitro and in vivo. Methods: Cardiotoxin (CTX)-induced muscle injury and the treatment of Antcin K in C2C12 cells were both used for RNA sequencing and ingenuity pathway analysis. We also stably cloned an IL-10 knockdown (IL-10-/+) C2C12 cell line for the effects of Antcin K treatment on CTX-induced muscle injury. CTX-induced muscle injury in a mouse model. Results: Antcin K ameliorated the CTX-induced muscle injury and inflammation in myoblasts and differentiated myocytes. Bioinformatics analysis results demonstrated the ability of Antcin K to modulate inflammation and enhance myogenesis via upregulated IL-10. Antcin K enhances IL-10 production via the PI3K/Akt signaling pathways. For the in vivo results, Antcin K protects against CTX-induced skeletal muscle inflammation and injury. Conclusion: Antcin K ameliorated CTX-induced muscle injury and inflammation through PI3K and Akt and upregulated IL-10 in vitro. The CTX-induced injury mouse model was rescued by intraperitoneal injection of Antcin k in vivo. Antcin K shows promise as a prospective candidate for the development of an innovative treatment for muscular injury, with significant implications for sarcopenia.

The regulation of bone mass relies on a dynamic interplay between bone‑forming osteoblasts and bone‑resorbing osteoclasts. Imbalances in this regulatory system favor bone resorption and are implicated in the development of osteolytic disorders such as osteoporosis. Although current treatments targeting osteoclast activity are effective, safety concerns remain a notable limitation. As a multifunctional adipokine, apelin (APLN) serves a role in angiogenesis and metabolic regulation. However, to the best of our knowledge, its involvement in osteoclast differentiation has not yet been characterized. The present study thus examined the effects of APLN on osteoclastogenesis using a murine‑macrophage model stimulated with receptor activator of NF‑κB ligand (RANKL). The results revealed that APLN augmented RANKL‑induced osteoclast differentiation, promoting the formation of tartrate‑resistant acid phosphatase‑positive multinucleated cells and the development of organized F‑actin rings. Transcriptome analyses of a public dataset confirmed the temporal upregulation of osteoclast‑related genes under RANKL stimulation. It was further discovered that co‑treatment with APLN and RANKL significantly enhanced the expression of these osteoclast‑specific markers. APLN co‑treatment with RANKL upregulated the ERK, JNK, p38 and NF‑κB signaling pathways, and this activation was effectively attenuated by specific pathway inhibitors. In conclusion, these findings identified APLN as an enhancer of RANKL‑dependent osteoclast differentiation and signaling, suggesting that the modulation of APLN activity may provide a promising strategy for controlling excessive bone resorption in skeletal diseases.

Background Pelvic and acetabular fractures are associated with significant morbidity and mortality. The efficacy of 3D printing technology in improving surgical outcomes for these fractures has not been conclusively demonstrated. Purposes This study aimed to evaluate the efficacy of 3D simulation and printing in managing AO/OTA 61C and 62 B/62C pelvic and acetabular fractures. Methods A retrospective cohort study was conducted on patients aged >18 years with AO/OTA 61C and 62 B/62C fractures treated at a tertiary hospital between 2017 and 2022. Outcomes included postoperative complications, the need for total hip arthroplasty (THA), and quality of life measures, including the EuroQol Visual Analogue Scale (EQ-VAS), the EuroQol 5-Dimension 5-Level utility score (EQ-5D-5 L), and the Majeed pelvic score, assessed at 6 months, 1 year, and 2 years post-surgery. Results 92 patients were analyzed, with 28 in the 3D printing group and 64 in the traditional treatment group. The mean age was 44.9 years. After adjusting for confounders, no significant differences were observed between the two groups in EQ-VAS, Majeed Pelvic Scores, or EQ-5D-5 L utility scores at 2 years (all p > .05). No significant differences were observed in the risk of THA or postoperative complications between the two groups. Conclusions The use of 3D printing for complex pelvic and acetabular fractures did not demonstrate an improvement in the primary outcomes of this study, including complications and the need for THA. This indicates that benefits of 3D printing observed in preoperative planning did not translate into improved clinical outcomes. Further research with larger, randomized trials is still warranted.

Posterior-stabilized cement articulating spacers (PS spacers) have superior knee scores and a greater range of motion in a two-stage exchange for chronic prosthetic knee infections (PKIs); however, mechanical complications are associated with the use of PS spacers. In the present study, we investigated a novel post-cam endoskeleton-reinforced PS spacer and its outcomes. This single-surgeon retrospective cohort study included patients with chronic PKIs treated with PS spacers between 2015 and 2022. PS spacers with three different configurations, based on endoskeleton reinforcement, were compared: non-reinforced (n-PS), cam-reinforced alone (C-PS), and post- and cam-reinforced (PC-PS). Rates of mechanical complications, reoperation, and infection eradication were evaluated. The constraint choice of the revision prosthesis and risk factors for mechanical complications were analysed. In total, 186 patients, including 75 with n-PS, 61 with C-PS, and 50 with PC-PS spacers, were included. All patients were followed up for 2 years. The rate of overall mechanical complications was lowest in patients treated with PC-PS spacers, particularly in patients with unstable joints after femoral cam and tibial post fracture and tibial spacer dislodgement. Moreover, neither spacer exchange nor rotating-hinge knee revision prosthesis was required in PC-PS spacers. Independent risk factors for mechanical complications were body mass index ≥ 25 kg/m2, femoral spacer size ≤ 2, and intra-operative maximum flexion ≥ 110°. The novel PC-PS spacers prevented mechanical complications, spacer exchange, and the need for high-level constraint revision prostheses. We recommend the use of novel PC-PS spacers in two-stage exchange for chronic PKIs, especially in patients with a high body mass index, small femoral spacer size, and high knee flexion.

Osteoarthritis (OA) and rheumatoid arthritis (RA) are highly prevalent joint diseases globally. The common pathological features include synovial inflammation, swelling, joint destruction, and bone remodeling. Arthritis development is associated with joint inflammation, particularly in inflamed synovial cells. Synovial inflammation contributes to joint destruction. The receptor activator of nuclear factor kappa-B ligand (RANKL) is a vital factor that is linked to the activity of osteoclasts and the erosion of bone. Increased levels of RANKL play a role in the course of arthritis. Adverse effects and individual differences in therapeutic efficacy are limits of arthritis medications. More effective treatment and drug options are needed to improve disease progression. miRNAs directly modulate gene transcription as a potential option for arthritis therapeutics. The GEO dataset from the synovium of normal, OA, and RA patients indicated that the expression levels of RANKL were upregulated and related to arthritis features. We found that RANKL stimulation in OA and RA synovial fibroblasts decreased miR-548aj-3p and miR-3127-3p expression and enhanced interleukin-1 beta (IL-1β), interleukin-6 (IL-6), and matrix metalloproteinase-13 (MMP-13) production by using quantitative reverse transcription polymerase chain reaction (RT-qPCR) and enzyme-linked immunosorbent assay (ELISA). miRNA sequencing analysis and target prediction tools identified that miR-548aj-3p and miR-3127-3p regulate IL-1β, IL-6, and MMP-13 expression and are inhibited by RANKL stimulation. Administration of miR-548aj-3p and miR-3127-3p mimics significantly inhibited RANKL-induced expression of IL-1β, IL-6, and MMP-13 at both the mRNA and protein levels. We propose a potentially efficacious miRNA therapeutic approach for the treatment of arthritis, with a specific focus on OA and RA.