Geriatric femoral neck fracture (FNF) represents a pressing global health challenge, imposing substantial burdens on medical resources while being associated with high complication rates and suboptimal clinical outcomes. In recent years, the direct anterior approach (DAA) has emerged as a mainstream surgical strategy for hip joint arthroplasty (HJA) in developed countries, owing to its minimally invasive nature, neuromuscular-sparing anatomical interval, preservation of soft tissue integrity, and alignment with enhanced recovery after surgery principles, collectively contributing to significant improvements in clinical outcomes of HJA for elderly patients with FNF. However, no unified consensus exists regarding standardized techniques and procedural protocols for DAA-HJA in this specific patient population. Consequently, there is an urgent need to develop an evidence-based expert consensus to address key clinical dilemmas inherent to DAA-HJA in geriatric FNF. Sponsored by the Joint Surgery Group of the Chinese Medical Association, this expert consensus builds upon the foundational Chinese Expert Consensus on Direct Anterior Approach Hip Arthroplasty for the Surgical Treatment of Geriatric Femoral Neck Fracture (2023 Edition). A multidisciplinary expert panel was convened to standardize core issues and procedural norms for DAA-HJA in geriatric FNF. Two rounds of modified Delphi questionnaires and one consensus conference were conducted for voting, with a predefined consensus threshold of ≥ 70

Femoral neck fracture (FNF) in the elderly poses significant challenge for global health, consuming substantial medical resources, and resulting in high complication rates and suboptimal outcomes. Hip joint arthroplasty (HJA) is currently the primary treatment for elderly FNF, but traditional surgical approaches still face issues such as dislocation, limping, and leg length discrepancy. In the recent years, direct anterior approach (DAA) has become the mainstream for HJA in developed countries, due to its minimal invasive philosophy, neuromuscular interval, soft tissue retention and accelerated recovery, and it significantly improves the clinical outcomes of HJA for elderly FNF. However, there is currently a lack of unified understanding regarding the techniques and processes for DAA-HJA in treating elderly FNF. Therefore, the expert panel of this consensus previously published the "Chinese Expert Consensus on the Surgical Treatment of Femoral Neck Fracture by Direct Anterior Approach Hip Arthroplasty for Elderly Patient (2023 Edition)", which normalized the indications, surgical techniques, and standard procedures for DAA-HJA in elderly FNF. With the rapid progress of robotic technology in joint surgery and the extensive investigation probing its clinical value, we have supplemented and revised the application of robotic surgery in elderly FNF with 9 modified recommendations. These recommendations aim to further promote standardized, systematic, and individualized diagnostic and treatment concepts, ultimately improving patients' functional prognosis.

BACKGROUND:Reconstructing bone defects in the upper extremities and restoring their functions poses a significant challenge. In this study, we describe a novel workflow for designing and manufacturing customized bone cement molds using 3D printing technology to reconstruct upper extremity defects after bone tumor resection.METHODS:Computer tomography data was acquired from the unaffected upper extremities to create a detachable mold, which can be customized to fit the joint precisely by shaping the bone cement accordingly. Fourteen patients who underwent reconstructive surgery following bone tumor resection in the proximal humerus (13 cases) or distal radius (1 case) between January 2014 and December 2022 were retrospectively evaluated. The medical records of this case series were reviewed for the demographic, radiological, and operative data. Metastasis, local recurrence, and complication were also reviewed. Additionally, Musculoskeletal Tumor Society Score (MSTS) and Visual Analogue Scale (VAS) were used to assess clinical outcomes.RESULTS:The mean follow-up period was 49.36 ± 15.18 months (range, 27-82 months). At the end of follow-up, there were no cases of metastasis or recurrence, and patients did not experience complications such as infection, dislocation, or implant loosening. Two cases complicated with subluxation (14.3%), and 1 case underwent revision surgery for prosthetic fracture (7.1%). The average MSTS score was 23.2 ± 1.76 (77.4%, range, 66.7%-86.7%), and the postoperative VAS score was 1.86 ± 1.03 (range, 1-4), which was significantly lower than that before surgery (average preoperative VAS score was 5.21 ± 2.00 (range, 2-8)) (P < .001).CONCLUSION:Customized 3D molds can be utilized to shape bone cement prostheses, which may serve as a potential alternative for reconstructing the proximal humerus and distal radius following en bloc resection of bone tumors. This reconstruction strategy offers apparent advantages, including precise matching of articular surfaces and comparatively reduced costs.

ABSTRACT Osteosarcoma and osteochondroma are the most common malignant and benign bone tumours. In order to distinguish osteosarcoma from osteochondroma, divide-specific areas and distinguish different lesions. Herein, a computer-aided medical diagnosis was developed for the first time based on existing mask regional convolutional neural network (Mask R-CNN) to detect them in X-ray radiographs used for their initial screening. Mask R-CNN was trained using an amplified training and validation sets consisting of 378 and 52 ×-ray radiographs and propose the removing heterogeneous module and the de-overlapping module in the post-processing process to obtain the predictive segmentation mask. Two tests were used to predict, which were composed of 84 images from 72 patients involved in the training set but different from the images used within, and 61 images from 35 new patients who were not included in the training set. The mean Average Precision, mean Precision, mean Recall and mean Intersection Over Union were introduced metrics to evaluate the performance, which were 0.9486, 0.9211, 0.9545 and 0.6603 for test sets 1, and 0.9290, 0.8690, 0.9481 and 0.6222 for test 2. The results demonstrated that the developed method was convincing in distinguishing the type and detecting the region of osteosarcoma and osteochondroma compared with manual work.

Objective. The purpose of this study was to reveal the antibacterial activity of carbon-based nanofilm titanium alloy. Methods. The experiments were performed both in vitro and in vivo of animals using two circular-piece test specimens of the same specification, which were made from carbon-based nanofilm coated titanium alloy and commonly used in artificial joints Co-Cr-Mo alloy, respectively. In the in vitro experiments, the two test specimens were cocultured with standard strains of Staphylococcus aureus and Escherichia coli, and the antibacterial properties of the two test specimens were evaluated via inhibition zone size, scanning electron microscopy, fluorescence staining, colony forming unit count, and others; the cytotoxicities of the two test specimens were evaluated by coculturing and them with rabbit bone marrow mesenchymal stem cells (BMSCs). In the in vivo experiments, the two test specimens were implanted in the muscle tissue of experimental rabbits to evaluate their histocompatibilities. Results. Both in vitro cocultures of the carbon-based nanofilm titanium alloy and the Co-Cr-Mo alloy with Staphylococcus aureus and Escherichia coli failed to form inhibition zone. However, some biofilms were observed on the surface of the Co-Cr-Mo alloy. Fewer bacteria adhered to the carbon-based nanofilm titanium alloy can be observed via scanning electron microscopy and fluorescence staining techniques. Meanwhile, the colony forming counts showed that, compared with the Co-Cr-Mo alloy, the carbon-based nanofilm titanium alloy had fewer bacteria adhered (P<0.05). After coculture of the two test specimens with rabbit BMSCs, there was no significant difference in cell count, and both cell counts showed no cytotoxicity. In the in vivo experiment of animals, there are relatively fewer giant cells and better histocompatibility in tissues near the carbon-based nanofilm titanium alloy. Conclusion. Compared with Co-Cr-Mo alloy, the novel carbon-based nanofilm titanium alloy enjoys stronger in vitro antibacterial activity and better in vivo histocompatibility.

Osteoarthritis (OA) is a chronic cartilage degeneration disease affecting total joint and with a wide global impact. Stem cell therapy has emerged as a potential stock for the treatment of OA. Exosomes are the mainstay of the paracrine function in stem cells, acting as an important mediator of intercellular communication. The purpose of this review is to sort out the close relationships among OA, MSCs, and exosomes. We find though majority of researches on exosomes focus on normal MSC-derived exosomes to restore tissues, studies demonstrate that OA or inflammation-induced microenvironment can alter exosomes, which in turn affect the biological behaviors and functions of receptor cells in the joint cavity, including proliferation and differentiation of MSCs. Exosomes, MSCs and OA form a triangular relationship. More future research directions are exploring the effects of OA-derived exosomes on chondrogenic differentiation of MSCs, especially on mitochondria to disclose the reasons for failure endogenous repair by MSCs, and normalizing the OA exosomes to treat OA.

Cartilage and joint damage easily degenerates cartilage and turns into osteoarthritis (OA), which seriously affects human life and work, and has no cure currently. The temporal and spatial changes of multiple microenvironments upon the damage of cartilage and joint are noticed, including the emergences of inflammation, bone remodeling, blood vessels, and nerves, as well as alterations of extracellular and pericellular matrix, oxygen tension, biomechanics, underneath articular cartilage tissues, and pH value. This review summarizes the existing literatures on microenvironmental changes, mechanisms, and their negative effects on cartilage regeneration following cartilage and joint damage. We conclude that time-dependently rebuilding the multiple normal microenvironments of damaged cartilage is the key for cartilage regeneration after systematic studies for the timing and correlations of various microenvironment changes.

Objective To investigate the relief of low back pain after hip arthroplasty in patients with hip joint and spinal degenerative diseases, and to discuss the effects of unilateral and bilateral hip surgery on the relief of low back pain. Methods In this retrospective study, we followed 153 patients (69 males and 84 females, age: 43–88 years) who had undergone total hip arthroplasty (THA) via a posterolateral approach and also suffered from lumbar degenerative diseases in the period of 2009 to 2019. The inclusion criteria were: (i) patients who had been diagnosed with severe hip degenerative disease and also been diagnosed with lumbar degenerative disease; (ii) patients who had undergone THA surgery; and (iii) patients who were retrospectively recruited. The exclusion criteria were: (i) patients who had undergone lumbar fusion or internal fixation surgery; or (ii) patients who had vascular claudication, history of major trauma, diabetic polyneuropathy, lumbar and pelvic infections, tumor diseases; (iii) or patients who had undergone THA because of femoral neck fracture or ankylosing spondylitis. The improvement of hip joint function and the relief of low back pain (LBP) were studied, and the effect of unilateral and bilateral THA on the relief of LBP were discussed. Hip pain and function were evaluated by the Harris Hip Score (HHS), LBP was evaluated by Visual Analog Scale (VAS), and lumbar function was evaluated by the Japanese Orthopaedic Association (JOA) scoring system. Results The average follow‐up time was 44.3 months (24–108 months). All patients recovered smoothly without complications. The LBP VAS of 153 patients decreased from 4.13 ± 1.37 preoperatively to 1.90 ± 1.44 postoperatively. The average HHS increased from 45.33 ± 13.23 preoperatively to 86.44 ± 7.59 postoperatively at the latest follow‐up. According to Japanese Orthopaedic Association scoring system, the proportion of patients with good response to treatment in these 153 patients reached 93.46%. LBP VAS decreased from 4.18 ± 1.38 preoperatively to 1.95 ± 1.49 postoperatively in unilateral group and from 3.94 ± 1.32 preoperatively to 1.73 ± 1.23 postoperatively in bilateral group, respectively. There were only nine patients with persistent or aggravated LBP after operation. Among them, six patients underwent subsequent lumbar surgery (five patients had pain relieved after reoperation and one patient had not) and the other three patients chose conservative treatment for pain. Conclusion THA can relieve LBP while relieving hip pain and restoring hip function in patients with both hip and lumbar degenerative disease, thus possibly avoiding further spinal surgery.

Patient-specific instrumentation (PSI) was usually applied in total knee arthroplasty (TKA) to acquire a favourable alignment. We hypothesized that using PSI had a potential risk of notching in the anterior femoral cortex, because the femoral component may be placed in an overextension position due to the distal femoral sagittal anteversion. The aim of this study was to figure out the relationship between the notch and the distal femoral sagittal anteversion in PSI-assisted TKA. One hundred thirty-one patients who were to undergo total knee arthroplasty (TKA) were randomly divided into conventional instrumentation (CI) group and PSI group. The computed tomography (CT) data of lower extremities was collected and imported to the Mimics software to reconstruct the three-dimensional (3D) bone image of the femur. The angle between distal femoral anatomic axis (DFAA) and femoral mechanical axis (FMA) on sagittal plane was defined as distal femoral sagittal anteverted angle (DFSAA) and measured. The number of notch intra-operative and post-operative was recorded. Then, we calculated the incidence of the notch and analyzed its relationship with DFSAA. The average DFSAA of 262 femurs is 2.5° ± 1.5° (range, 0.0°–5.7°). When DFSAA ≥ 3°, the incidence of notch was 7.10% in CI group and 33.30% in PSI group, respectively, which shows significant statistical difference in the two groups (P = 0.016 < 0.05). When DFSAA < 3°, the incidence of notch was 6.50% in CI group and 5.30% in PSI group, respectively, which shows no significant statistical difference in the two groups (P = 0.667 > 0.05). DFSAA could be taken as an indicator to predict the notch when performing TKA assisted with PSI. Especially when the DFSAA ≥ 3°, the risk of notch could be markedly increased.

Background: With the aging of population, the number of patients suffering from hip osteoarthritis complicated with lumbar degenerative disease is increasing. Both diseases may require surgery, however, which is first? the sequence of total hip arthroplasty (THA) and lumbar surgery remains controversial. Methods: The data of our hospital, from 2010 to 2019 were retrieved, and a group of patients who had undergone total hip replacement (THA, n = 153) and also suffered from lumbar degenerative diseases were identified. We studied the improvement of hip joint function and the relief of low back pain (LBP), and also discussed the effect of unilateral and bilateral THA on the relief of LBP. Results: The LBP visual analysis scale (VAS) of 153 patients decreased from (4.13 ± 1.37) preoperatively to (1.90 ± 1.44) postoperatively. The average Harris Hip score (HHS) increased from 45.33 ± 13.23 preoperatively to 86.44 ± 7.59 postoperatively of the latest follow-up. According to Japanese Orthopedic Association (JOA) scoring system, the proportion of patients with good response to treatment in the clinical results of these 153 patients reached 93.46%. LBP VAS decreased from 4.18 ± 1.38 preoperatively to 1.95 ± 1.49 postoperatively in unilateral group and from 3.94 ± 1.32 preoperatively to 1.73 ± 1.23 postoperatively in bilateral group respectively. These results showed that the lumbar pain was relieved significantly after surgery. Conclusion: THA can relieve LBP while relieve hip pain and restore hip function. And the relief of LBP and recovery of lumbar function in unilateral operation group were better than those in bilateral operation group. These findings can be helpful to surgeons in making decisions. For patients with both hip disease and lumbar degenerative disease, THA first may bring additional benefits to patients.

Objective: The aim of this study was to evaluate the association between the morphology of the proximal tibiofibular joint (PTFJ) and the presence of knee osteoarthritis (OA).Methods: Twenty-eight OA subjects and 30 healthy subjects were enrolled in this study. A 3D model of the lower limb of each subject was constructed from CT scans and used to measure the characteristics of the PTFJ, including the shape of the articular facets, articular surface area, joint inclination, relative articular height, and joint declination. The association between the characteristics of the PTFJ and presence of knee OA was assessed using binomial logistic regression analysis.Results: There was a significant difference between the OA and healthy groups in terms of the inclination (p = 0.028) and declination (p = 0.020) of the PTFJ and relative articular height (p = 0.011). A greater inclination angle (OR: 1.463, 95% CI: 1.124–1.582, p = 0.021), greater declination angle (OR: 1.832, 95% CI: 1.691–2.187, p = 0.009), and lower relative articular height (OR: 0.951, 95% CI: 0.826–0.992, p = 0.008) were found to be associated with an increased likelihood of knee OA being present.Conclusion: The results of this study suggest that abnormal PTFJ morphology is associated with the presence of knee OA.

Malnutrition is common and associated with poor outcomes in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Recently, the geriatric nutritional risk index (GNRI) was reported as a novel tool for evaluating nutritional status. However, the association between GNRI and renal outcome, cardiovascular (CVD) events, and mortality in patients with CKD remains unclear. A prospective cohort study with adult patients with CKD stages 1–4 was conducted at 39 centers around China starting in 2011. Patients were divided into quartiles (Q1, Q2, Q3, and Q4) according to their GNRI category. A total of 2791 CKD patients within a median follow-up of 4.38 years were included. A low GNRI quartile was independently associated with progression to ESRD, CVD events, and overall mortality. Compared to that in the Q1 group (the reference group), belonging to a higher GNRI quartile significantly reduced the risk of progression to ESRD in the crude and multivariate-adjusted models. Moreover, a significant inverse association was found between those in the high GNRI quartiles and overall mortality among patients with CKD (HR 0.25; 95% CI 0.15–0.43; p = 0.0007, Q4 vs. Q1) after multivariate adjustment. In addition, there was also a significant association between GNRI and CVD events (HR 0.57; 95% CI 0.39–0.84; p = 0.005, Q4 vs. Q1). Moreover, after adjusting for other confounders, only the Q3 group remained significantly fewer CVD events (HR 0.44; 95% CI 0.19–0.98; p = 0.04). These findings suggest that GNRI might be a useful prognostic tool for patients with CKD.

Previous studies reported that magnesium deficiency was associated with vascular calcifications, atherosclerosis and cardiovascular disease, which might play an independent pathogenic role in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. However, the results of these studies were somewhat underpowered and inconclusive. Literature was identified by searching PubMed, EMBASE, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL). We included studies that investigated the association between serum magnesium with mortality risk in CKD and ESRD patients. Unadjusted and adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) were pooled. Twenty studies involving 200,934 participants were included, and the results showed that there was a strong association between hypomagnesemia and the risk of all-cause mortality in patients with CKD and ESRD (HR 1.32; 95% CI 1.19–1.47; p < 0.00001) (hypomagnesemia vs. normal magnesium or hypermagnesemia) after multivariable adjusted. On the contrary, hypermagnesemia was inversely associated with all-cause mortality in patients with CKD and ESRD (HR 0.86; 95% CI 0.79–0.94; p = 0.001) (per unit increase). Moreover, a significant association between hypermagnesemia and decreased risk of cardiovascular mortality was observed (HR 0.71; 95% CI 053–0.97, p = 0.03) in the adjusted model. In addition, subgroup analysis found that hypomagnesemia was strongly associated with increased all-cause mortality in hemodialysis patients (HR 1.29; 95% CI 1.12–1.50; p = 0.0005) (hypomagnesemia vs. normal magnesium or hypermagnesemia). Our results indicate that hypomagnesemia is significantly associated with cardiovascular and all-cause mortality in patients with CKD and ESRD. Further studies evaluating benefits of magnesium correction in CKD and dialysis patients with hypomagnesemia should be performed.

Background: This study aimed to explore a new surgical technique for gap balance by tightening the medial collateral ligament (MCL) in total knee arthroplasty (TKA) in patients with fixed valgus deformity. Materials and Methods: A prospective analysis was performed on 15 patients (16 knees) with a fixed valgus deformity that was corrected by tightening the MCL during TKA. A single surgeon performed all the 16 TKAs using nonconstrained posterior substituting implant, with two knees treated with long-stem tibial prosthesis. Clinical scores, knee stability, and radiographic evaluations were recorded preoperatively and postoperatively. Results: Complete weight-bearing could be carried out under the protection of the brace postoperatively. At the third month after surgery, X-rays showed the brace was not worn. The mean follow-up was 26.6 months (range 12–42 months). The average preoperative mechanical axis was 15.4 ± 2.3° (range 11–25°), and postoperatively it was 0.6 ± 0.1° (range 0–2°). No complication relative to the technique occurred. Conclusion: This new surgical technique has demonstrated excellent early clinical results and can be a good supplement for fixed valgus knee arthroplasty. Level of Evidence: III.

Patients with diabetes often experience multiple disease complications. Hypoglycemic agents can have both positive and negative effects on diabetic complications, which should be carefully assessed when personalized treatment strategies are developed. In this study we report that dipeptidyl peptidase 4 inhibitors (DPP-4is), a group of widely used antihyperglycemic agents, can improve diabetic wound healing, independent of their beneficial effects on glycemic control. In particular, DPP-4is promoted the migration and epithelial-mesenchymal transition of keratinocytes, directly and indirectly, by inducing stromal cell-derived factor 1α production of fibroblasts in vitro and in diabetic mice. In addition, DPP-4is attenuated collagen synthesis and deposition, which may diminish scar formation. Furthermore, the results of a randomized clinical trial (NCT02742233) involving 67 patients with type 2 diabetes supported the role of DPP-4i treatment in diabetic wound healing. Our findings support the application of DPP-4i as a preferred option for treating ulcers in patients with diabetes.

OBJECTIVE:To explore the clinical efficacy of the arthroscopic Mender II stapler for the treatment of patients with meniscus anterior horn injury needing meniscal suture repair. METHODS:Among 47 patients with meniscus anterior horn injury, 29 patients were male and 18 patients were female, ranging in age from 12 to 31 years old, with a mean age of (20.53± 4.12) years old. The duration of disease ranged from 3 to 35 days, and the average duration was (12.43±5.74) days. The Mender II stapler was used to carry out arthroscopic suture from outside to inside. The Lysholm knee scoring system was used to evaluate and analyze preoperative and postoperative symptoms, such as pain, limping embolism and so on. RESULTS:Forty-six patients were followed up, and the duration ranged from 12 to 48 months, with a mean of (20.53±4.12) years. The incision healed at the first stage without important vessels and nerves injuries. The symptoms of the locked knee joint disappeared, and symptoms such as pain, limp, swelling and limitation of activity improved. The Lysholm score increased from preoperative 52.33±7.31 to postoperative 86.74±6.92. CONCLUSION:Using Mender II stapler to treat patients with meniscus anterior horn injury who were treated with arthroscopic suture from outside to inside is effective to improve symptoms, and to obtain good short-term results.

Background Primary total knee arthroplasty (TKA) in severe valgus knees may prove challenging, and choice of implant depends on the severity of the valgus deformity and the extent of soft-tissue release. The purpose of this study was to review 8 to 11 years (mean, 10 years) follow-up results of primary TKA for varient-III valgus knee deformity with use of different type implants. Methods Between January 2002 and January 2005, 20 women and 12 men, aged 47 to 63 (mean, 57.19±6.08) years old, with varient-III valgus knees underwent primary TKA. Of the 32 patients, 37 knees had varient-III deformities. Pie crusting was carefully performed with small, multiple inside-out incisions, bone resection balanced the knee in lieu of soft tissue releases that were not used in the series. Cruciate-retaining knees (Gemini MKII, Link Company, Germany) were used in 13 knees, Genesis II (Simth & Nephew Company, USA) in 14 knees, and hinged knee (Endo-Model Company, Germany) in 10 knees. In five patients with bilateral variant-III TKAs, three patients underwent 1-stage bilateral procedures, and two underwent 2-stage procedures. All implants were cemented and the patella was not resurfaced. The Hospital for Special Surgery (HSS) knee score was assessed. Patients were followed up from 8 to 11 years. Results The mean HSS knee score were improved from 50.33±11.60 to 90.06±3.07 (P <0.001). The mean tibiofemoral alignment were improved from valgus 32.72°±9.68° pre-operation to 4.89°±0.90° post-operation (P <0.001). The mean range of motion were improved from 93.72°±23.69° pre-operation to 116.61±16.29° post-operation (P <0.001). No patients underwent revision. One patient underwent open reduction and internal fixation using femoral condylar plates for supracondylar femoral fractures secondary to a fall at three years. Three patients developed transient peroneal nerve palsies, which resolved within nine months. Two patients developed symptomatic deep vein thrombosis that was managed with rivaroxaban and thrombo-embolic deterrent stockings. There was no incidence of pulmonary embolism. Postoperative patient satisfaction was 80.7±10.4 points in the groups. Prosthetic survival rate was 100% at mean 10 years postoperative. Conclusions Not only hinged implants can be successfully used in variant-III valgus knees. As our results show, if proper ligament balancing techniques are used and proper ligament balance is attained, the knee may not require the use of a more constrained components. Our results also present alternative implant choices for severe knee deformities.

Objective The purpose of this study are to investigate the expression of microRNA (miRNA)-34a in chondrocyte relatived to apoptosis in early osteoarthritis,and to investigate the effect of silencing miRNA-34a on chondrocyte apoptosis in a rabbit OA model.Methods 6 weeks rabbit OA model were established,and the chondrocyte were collected in normal(A group),and in 3 weeks and 6 weeks of OA,respectively.The expression of miRNA-34a,inducible nitric oxide synthase (iNOS) and type Ⅱ collagen (Col2a1) were analysis by the real time quantitative polymerase chain reaction (Real-time PCR),immunocytochemistry,the apoptosis were analysis by toluidine blue staining,and TdT-mediated dUTP nick end labeling (TUNEL) before and after silencing miRNA-34a by LNA-miRNA-34a.Results The expression of miRNA-34a in group B and C were significantly up-regulated by 2.70 times and 3.05 times comparable to group A,after silencing of miRNA-34a,the expression of miRNA-34a in group B and C significantly down-regulation in 2.07 times and 3.03 times respectively.The up-regulation of iNOS in 13.50 times and 16.70 times in group B and C comparable to A group before silencing were observed,after silencing,41.00％ 和 37.00％ were reduced respectively as comparable to that before silencing.46.80％ 和30.00％ down-regulation were recorded in expression of Col2a1 in group B and group C as comparable to group A,after silencing,the expression of Col2a1 were up-regulation in 2 times and 2.95 times respetively.Immunocytochemistry showed the more Col2a1 positive cells after silencing,and the apoptosis cells were significantly reduced.Conclusion The expression of miRNA-34a in early OA were up-regulation,it could be inhibited by LNA-miRNA-34a,miRNA-34a silencing could significantly reduce apoptosis of chondrocyte in early osteoarthritis.

OBJECTIVE:To study the variation of CD105+/CD166+ cells and its multilineage potential in early osteoarthritis (OA) cartilage so as to lay a foundation for cartilage repair and pathologic cartilage remodeling in arthritis. METHODS:The knee OA model was established in the right knee of 30 adult New Zealand rabbits (8-12 months old). The chondrocytes were harvested from normal cartilage of the left knee (group A), OA cartilage of the right knee at 2 weeks (group B), at 4 weeks (group C), and at 8 weeks (group D) after modeling, and BMSCs were used in group E for the expression of CD105 and CD166. The percentage of CD105+/CD166+ cells in each group was counted by flow cytometry, and CD105+/CD166+ cells were isolated and purified by magnetic-activated cell sorting. The expressions of CD105 and CD166 were observed in 5 groups by laser scanning confocal microscope. Chondrogenesis, osteogenesis, and adipogenesis were evaluated with Alcian blue cytochemistry and collagen type II immunohistochemistry, by detecting the deposition of calcium, and with oil red O staining, respectively. RESULTS:The percentage of CD105+/CD166+ cells in group A, B, C, and D was significantly lower than that in group E (P < 0.05); it was significantly higher in groups B, C, and D than in group A (P < 0.05), and in group D than in groups B and C (P < 0.05), but no significant difference was found between groups B and C (P > 0.05). Laser scanning confocal microscope results confirmed the expressions of CD105+ and CD166+ cells in groups A, B, C, D, and E, no obvious difference in expression was shown among 5 groups. At 1 week after chondrogenic induction, positive expressions of proteoglycan and collagen type II were observed in 5 groups, no obvious difference was noticed among 5 groups. At 2 weeks after osteogenic induction, calcium level in group E was significantly higher than that in groups A, B, C, and D (P < 0.05), but no significant different was found among groups A, B, C, and D (P > 0.05). At 4 weeks after adipogenic induction, there were more red lipid droplets in group E than in groups A, B, C, and D. CONCLUSION:CD105+/CD166+ cells in early OA cartilage increase, which show chondrogenic differentiation potential.

OBJECTIVE:The correct management of multiple-ligament injured knees (MLIKs) remains controversial. This study aimed to summarize the epidemiological features and short-term results of patients treated in our department. METHODS:Sixty-six patients diagnosed with MLIKs from 2009 to 2011 were enrolled. Relevant patient characteristics and clinical variables were analyzed to characterize the epidemiology. A surgical algorithm based on a knee dislocation classification system and postoperative rating scales, including Lysholm and Tegner rating, as well as joint mobility, stability and radiography were collected for functional evaluation at 2.5-year follow-up. RESULTS:The epidemiological profile demonstrated that 30- to 50-year-old men were at the highest risk. The primary causes were vehicle accidents and falls and most common injury type cruciate combined collateral ligament injuries. Final follow-up analysis comparing operative versus conservative management and surgically treated mild versus severe MLIKs showed significant differences in Lysholm and Tegner scale scores, as well as knee mobility and stability. CONCLUSION:The therapeutic outcome of MLIKs depends on various clinical variables and a surgical algorithm. Satisfactory restoration of function was acquired in the majority of our surgically treated MLIK cases; however, most patients had not achieved their pre-injury activity levels by the follow-up endpoint.