Abstract Background Numerous studies have been conducted to investigate the relationship between ABO and Rhesus (Rh) blood groups and various health outcomes. However, a comprehensive evaluation of the robustness of these associations is still lacking. Methods We searched PubMed, Web of Science, Embase, Scopus, Cochrane, and several regional databases from their inception until Feb 16, 2024, with the aim of identifying systematic reviews with meta-analyses of observational studies exploring associations between ABO and Rh blood groups and diverse health outcomes. For each association, we calculated the summary effect sizes, corresponding 95% confidence intervals, 95% prediction interval, heterogeneity, small-study effect, and evaluation of excess significance bias. The evidence was evaluated on a grading scale that ranged from convincing (Class I) to weak (Class IV). We assessed the certainty of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation criteria (GRADE). We also evaluated the methodological quality of included studies using the A Measurement Tool to Assess Systematic Reviews (AMSTAR). AMSTAR contains 11 items, which were scored as high (8–11), moderate (4–7), and low (0–3) quality. We have gotten the registration for protocol on the PROSPERO database (CRD42023409547). Results The current umbrella review included 51 systematic reviews with meta-analysis articles with 270 associations. We re-calculated each association and found only one convincing evidence (Class I) for an association between blood group B and type 2 diabetes mellitus risk compared with the non-B blood group. It had a summary odds ratio of 1.28 (95% confidence interval: 1.17, 1.40), was supported by 6870 cases with small heterogeneity (I2 = 13%) and 95% prediction intervals excluding the null value, and without hints of small-study effects (P for Egger’s test > 0.10, but the largest study effect was not more conservative than the summary effect size) or excess of significance (P < 0.10, but the value of observed less than expected). And the article was demonstrated with high methodological quality using AMSTAR (score = 9). According to AMSTAR, 18, 32, and 11 studies were categorized as high, moderate, and low quality, respectively. Nine statistically significant associations reached moderate quality based on GRADE. Conclusions Our findings suggest a potential relationship between ABO and Rh blood groups and adverse health outcomes. Particularly the association between blood group B and type 2 diabetes mellitus risk.

Abstract Objective: To investigate the efficacy of Desomumab in the treatment of adjacent segment disease (ASD) after lumbar fusion surgery. Methods: a total of 100 patients who underwent lumbar fusion surgery in orthopedics department from December 2020 to December 2021 were selected as the study subjects. Patients who volunteered to experiment with Desomumab were the experimental group and those who did not use Desomumab were the control group. The imaging changes, occurrence of ASD, bone mineral density, JOA score and postoperative pain degree of the two groups were retrospectively observed and compared. Results: Physiological curvature of the lumbar spine appeared to improve after Desomumab treatment. Although the incidence of ASD did not change significantly, specific measures of ASD, such as increased Pfimnan grading, intervertebral height loss percentage, and increased osteoporosis, appeared to be better than those who did not receive Desomumab. At follow-up, bone mineral density, JOA scores, and VAS scores were significantly better in the Desomumab group than in the untreated group. Conclusions: Desomumab can indeed improve BMD, promote postoperative recovery, reduce patient pain, and reduce the likelihood of ASD.

Background The repair of large bone defects is a great challenge for orthopedics. Although the development of three-dimensional (3D) printed titanium alloy (Ti6Al4V) implants with optimized the pore structure have effectively promoted the osseointegration. However, due to the biological inertia of Ti6Al4Vsurface and the neglect of angiogenesis, some patients still suffer from postoperative complications such as dislocation or loosening of the prosthesis. Methods The purpose of this study was to construct 3D printed porous Ti6Al4V scaffolds filled with bone marrow mesenchymal stem cells (BMSC) and endothelial progenitor cells (EPC) loaded hydrogel and evaluate the efficacy of this composite implants on osteogenesis and angiogenesis, thus promoting osseointegration. Results The porosity and pore size of prepared 3D printed porous Ti6Al4V scaffolds were 69.2 ± 0.9 % and 593.4 ± 16.9 μm, respectively, which parameters were beneficial to bone ingrowth and blood vessel formation. The BMSC and EPC filled into the pores of the scaffolds after being encapsulated by hydrogels can maintain high viability. As a cell containing composite implant, BMSC and EPC loaded hydrogel incorporated into 3D printed porous Ti6Al4V scaffolds enhancing osteogenesis and angiogenesis to repair bone defects efficiently. At the transcriptional level, the composite implant up-regulated the expression levels of the osteogenesis-related genes alkaline phosphatase ( ALP ) and osteocalcin ( OCN ), and angiogenesis-related genes hypoxia-inducible factor 1 alpha ( HIF-1α ), and vascular endothelial growth factor ( VEGF ). Conclusions Overall, the strategy of loading porous Ti6Al4V scaffolds to incorporate cells is a promising treatment for improving osseointegration.

OBJECTIVE:To compare conventional sensitivity encoding turbo spin-echo (SENSE-TSE) with compressed sensing plus SENSE turbo spin-echo (CS-TSE) in lumbar vertebrae magnetic resonance imaging (MRI).METHODS:This retrospective study of lumbar vertebrae MRI included 600 patients; 300 patients received SENSE-TSE and 300 patients received CS-TSE. The SENSE acceleration factor was 1.4 for T1WI, 1.7 for T2WI, and 1.7 for PDWI. The CS total acceleration factor was 2.4, 3.6, 4.0, and 4.0 for T1WI, T2WI, PDWI sagittal, and T2WI transverse, respectively. The image quality of each MRI sequence was evaluated objectively by the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) and subjectively on a five-point scale. Two radiologists independently reviewed the MRI sequences of the 300 patients receiving CS-TSE, and their diagnostic consistency was evaluated. The degree of intervertebral foraminal stenosis and nerve root compression was assessed using the T1WI sagittal and T2WI transverse images.RESULTS:The scan time was reduced from 7 min 28 s to 4 min 26 s with CS-TSE. The median score of nerve root image quality was 5 (p > 0.05). The diagnostic consistency using CS-TSE images between the two radiologists was high for diagnosing lumbar diseases (κ > 0.75) and for evaluating the degree of lumbar foraminal stenosis and nerve root compression (κ = 0.882). No differences between SENSE-TSE and CS-TSE were observed for sensitivity, specificity, positive predictive value, or negative predictive value.CONCLUSION:CS-TSE has the potential for diagnosing lumbar vertebrae and disc disorders.

Abstract BACKGROUND: The repair of large bone defects is a great challenge for orthopedics. Although the development of three-dimensional (3D) printed metal implants with optimized the pore structure have effectively promoted the osseointegration. However, due to the biological inertia of titanium alloy (Ti6Al4V) surface and the neglect of angiogenesis, some patients still suffer from postoperative complications such as dislocation or loosening of the prosthesis. METHODS: The purpose of this study was to construct 3D printed porous Ti6Al4V scaffolds filled with bone marrow mesenchymal stem cells (BMSC) and endothelial progenitor cells (EPC) loaded hydrogel and evaluate the effects of this composite implants on angiogenesis and osteogenesis, thus promoting osseointegration. RESULTS: The porosity and pore size of prepared 3D printed porous Ti6Al4V scaffolds were 69.2 ± 0.9 % and 593.4±16.9 μm, respectively, which parameters were beneficial to blood vessel formation and bone ingrowth. The BMSC and EPC filled into the scaffold pores after being encapsulated by hydrogels can maintain high viability. As a cells containing composite implant, BMSC and EPC loaded hydrogel incorporated into 3D printed porous Ti6Al4V scaffolds enhancing angiogenesis and osteogenesis to repair bone defects efficiently. At the transcriptional level, the composite implant up-regulated the expression levels of the osteogenesis-related genes alkaline phosphatase (ALP) and osteocalcin (OCN), and angiogenesis-related genes hypoxia-inducible factor 1 alpha (HIF-1α), and vascular endothelial growth factor (VEGF). CONCLUSION: Overall, the strategy of loading porous Ti6Al4V scaffolds to incorporate cells is a promising treatment for improving osseointegration.

Developmental dysplasia of the hip (DDH) is one of the most common limb deformities in pediatric orthopedics. Patients who cannot achieve closed reduction, or cannot maintain concomitant reduction, suffer from repeated dislocation or delay in diagnosis, treatment and need to undergo open reduction (OR) therapy. However, since researchers have demonstrated that patients treated by OR are prone to continue to experience acetabular dysplasia and dislocation,[1] it is recommended that OR and pelvic osteotomy should be performed at the same time in order to correct dysplasia, reduce the incidence of residual acetabular dysplasia and the rate of long-term reoperation. By performing pelvic osteotomy, acetabular coverage can be increased and the occurrence of hip instability can be avoided in the long run.[2] In recent years, Dega osteotomy has been widely applied in clinical practice because of its wide indications, simplicity of operation, low trauma, and lack of necessity to take the history of hip surgery into account. Nowadays, most studies in the analysis of open reduction combined with Dega osteotomy (ORCWDO) are based on X-ray.[3] Using common X-ray techniques, the degree of reduction cannot be fully understood, because X-rays show posterior femoral positions after reduction and details of the fixed hips poorly and inadequately. Magnetic resonance imaging (MRI) can determine the factors that hinder reduction and deliver a comprehensive assessment of hip recovery after reduction. To date, there have not been many international studies on ORCWDO using MRI. In this article, MRI was applied to compare and analyze the results of OR and ORCWDO before and after follow-up. Both the recovery on MRI after the two operative short-term follow-ups was compared and the postoperative acetabulum was evaluated. These data can provide the required reference information for clinical treatments of DDH in children and optimize the individualized choice of treatment and prognosis. The research program was approved by the Ethics Committee of our hospital (No.2017PS28K) and informed consent was obtained from the parents of each examined child. The imaging data of DDH children who underwent OR or ORCWDO from September 2012 to April 2017 in Shengjing Hospital were collected. There were 15 DDH children (16 hips) who underwent OR. Among them, one patient had bilateral dislocation, 10 patients had dislocation of the left hip, and four patients of the right hip. There were 20 DDH patients (21 hips) who underwent ORCWDO. Among them, one case had bilateral hip dislocation, while the dislocation was on the left side in seven cases, and on the right side in 12. Using a 3.0T (Philips Ingenia 3.0T, Best, Netherlands) superconducting magnetic resonance (MR) scanner, the children were placed in a supine position and the lower limbs were neutral. Anal anesthesia was induced with diluted chloral hydrate (0.5 mL/kg; 1 g of chloral hydrate diluted with 10 mL of 0.9% saline) before the MRI examination. Imaging was performed using a picture archiving and communication systems (PACS) V5.5.0.5005 imaging diagnosis workstation at the Department of Radiology. The bony/cartilaginous structure of the acetabulum was measured on MR images. The degree of dislocation in children with DDH was graded on X-ray images using the Tönnis criteria before operation, and the acetabular index (AI) was measured. Severin imaging evaluation criteria were used for classification of the imaging results to assess postoperative outcomes in the short-term follow-up. The treatment outcome was evaluated as satisfactory (Severin grades I or II) or unsatisfactory (Severin grades III or IV). SPSS 24.0 software (IBM Corp., Armonk, NY, USA) was used for statistical analysis. Continuous variables were expressed as mean ± standard deviation, and categorical variables were statistically described by frequency. The measurement parameters of the two groups were compared through an independent sample t test, and the degree of dislocation was compared by the Mann-Whitney U test. The paired sample t test was also used to compare measurement parameters within the group. COX regression analysis was used to compare the prognosis of two surgical short-term images. The receiver operating characteristic (ROC) curve was used to explore the critical value of ORCWDO evaluated by MRI and X-ray. The difference was statistically significant (P < 0.050). Preoperative X-ray Tönnis criteria were as follows: only two hips were classified as grade II before operation, seven were preoperative grade III, and seven were preoperative grade IV and were treated with OR. The postoperative recovery was satisfactory in five hips and unsatisfactory in 11 hips; nine preoperative hips graded III and 12 preoperative hips graded IV were treated with ORCWDO. A total of 14 hips recovered satisfactorily, while seven hips recovered unsatisfactorily. The degree of preoperative dislocation between the two groups were tested by Mann-Whitney U test (P value 0.275), and there was no statistical difference. The various preoperative and postoperative short-term follow-up MRI measurement indicators of the OR and ORCWDO groups are shown in Supplementary Digital Content, Table 1; https://links.lww.com/CM9/A650, and the postoperative improvement rates of the two operations are shown in Supplementary Digital Content, Table 2; https://links.lww.com/CM9/A650. The improvement in cartilage structure was more obvious than the improvement in bone structure. The bone and cartilaginous structure of the ORCWDO group improved more perceptibly than that of the OR group. The results of preoperative and postoperative MRI measurement of the two surgical methods were compared. The preoperative-only osseous acetabular index (OAI) was statistically significant (P = 0.047), The preoperative OAI of the OR group was 29.13 ± 4.33°, and the OAI of the ORCWDO group was 32.67 ± 4.68°. Based on ROC analysis, it was ascertained that the area under the ROC curve was 0.692, the P = 0.048, and the 95% confidence interval (CI) was 0.520 to 0.864, which was used to determine the critical value on the MRI image of ORCWDO, which was 27.50°. On plain radiographs, the AI was >30.50°, the area under the ROC curve was 0.696, P = 0.043, and 95% CI was 0.526 to 0.867. The surgical method affected the prognosis of hip dislocation (P = 0.035). The risk of poor prognosis of hip dislocation with ORCWDO was lower than that of OR (95% CI: 1.078–8.802). The choice of ORCWDO prognostic osteotomy compared with the same conditions treated by OR led to a good postoperative prognosis. MRI with good tissue resolution has been used to assess the immature hip joint cartilage and osseous acetabulum anatomy.[4] Early DDH lesions are located on the acetabular side. Changes to the femur in older children are secondary to the pressure the acetabulum or iliac bone exerts on the femoral head. The detection of acetabular development after reduction is essential. We performed routine MRI on children with DDH who underwent OR and ORCWDO using T1 sequence data to measure, since T1 sequence can clearly discern the anatomical structure. In our study, the cartilage acetabular index (CAI) was restored from 18.81° preoperatively to 11.19° after OR and restoration, while the OAI improved from 29.13° preoperatively to 22.75° postoperatively. The CAI in the ORCWDO group recovered from 20.48° before surgery to 8.95° at the last follow-up. OAI recovered from 32.67° before surgery to 17.10° at the last follow-up. The results of the improvement in the OAI were in accordance with the results of the AI in 26 cases of DDH in children reported by Karlen et al[3] from 37.00° before operation to 15.00° after operation. In the past, there was no detailed description of the acetabular cartilage structure in the study of OR and ORCWDO. Our study further contributed to the comprehensive acetabular development analysis and comprehensive comparison and determination of acetabular remodeling. In this study, cartilage measurement was also considered as one of the prognostic indicators, rather than simply the bone structure. Cartilage measurements were improved in follow-up, and the improvement of cartilage was more obvious than that of the bony structure. The remodeling ability of acetabular cartilage is limited, but more attention should be paid to the evaluation of cartilage structure, so as to understand the real coverage of the acetabulum of the femoral head, and provide more accurate information for clinical diagnosis and treatment. In the comparison of the center-edge angle of the final follow-up between the two groups, it was confirmed that there was a difference between the two groups. In the short term, ORCWDO was more helpful to restore biomechanical stimulation in the head and to achieve concentric reduction. After analysis, the results of postoperative recovery in the two groups showed that the ORCWDO group had better recovery than the OR group. When patients experience delayed diagnosis, manual reduction failure, and repeated dislocation, ORCWDO can be performed for children with DDH to achieve femoral head and acetabular concentric reduction and restoration of hip function. The Dega osteotomy does not require internal fixation and does not require secondary surgery to remove the internal fixation. If there is a need to be able to correct both sides at the same time, this will not cause a difference in leg length between the lower limbs. Kothari et al[1] confirmed that the long-term reoperation rate of OR was 56.00%, while the rate of ORCWDO was 11.00%. OR combined with pelvic osteotomy can reduce avascular necrosis of the femoral head and produce good clinical and imaging results. In addition, OR combined with additional pelvic osteotomy can eliminate residual acetabular dysplasia. The Dega osteotomy had a lower risk of tissue structure damage than other osteotomy, and Dega osteotomy could reposition and reshape the acetabulum, and the osteotomy was performed before the closure of the tri-radiate cartilage. OR and simultaneous pelvic osteotomy can thus be used to avoid dysplasia due to the enlarged hip space. Based on the above studies we confirmed that the prognosis following ORCWDO is better than that after OR; thus when the OAI is >27.50°, ORCWDO should be performed for DDH children to ensure the normal development of acetabular cartilage and provide sufficient coverage for the femoral head to restore the concentric reduction. At the same time, we measured the outcomes of ORCWDO when the AI > 30.50° on X-ray film. Karashima et al[2] followed up children aged 24.4 to 48.6 months for at least 2 years. They report that pelvic osteotomy should be performed at the first operation when the central marginal angle is <0.00° (severe dysplasia of the hip) or when the central marginal angle is 3.50 to 14.50° (moderate dysplasia). Avascular necrosis (AVN) of the femoral head is one of the common postoperative complications in children with dysplasia of the hip. Some scholars have followed up children aged 1.2 to 12.8 years old with DDH after Dega osteotomy for 3 to 9 years, and the incidence of AVN was 5.80%. They thus consider that Dega osteotomy can obtain better results. OR combined with pelvic osteotomy can effectively treat hip dysplasia and maintain hip stability.[5] The phased and continuous functional MR examination will establish the basis of a diagnosis and treatment platform for children's hip diseases based on noninvasive, multi-dimensional, and high-resolution MRI analysis. MRI is the best way to evaluate DDH after operation. It is noninvasive and has higher sensitivity and specificity, it can confirm the location of the acetabulum and femoral head after reduction, and it can avoid occurrence of occult subluxation and incomplete dislocation. This study has the limitation of being based on a small number of cases; we will continue to collect cases and conduct long-term follow-up. Using MRI, we will further evaluate and report the outcomes of ORCWDO of DDH patients. To summarize, ORCWDO could achieve more satisfactory imaging results than OR. When the OAI was >27.50° (X-ray was >30.50°), we could perform ORCWDO on children ≤3-year-old with the aim of achieving concentric reduction of the femoral head. ORCWDO was an effective way to correct DDH in children. Acknowledgments This work was supported by grants from the 345 Talent Project and the Natural Science Foundation of Liaoning Province (No. 2019-ZD-0794) and the Science and Technology Program of Liaoning Province (No. 2018010185) Conflicts of Interest None.

Background T2 mapping is useful for evaluating the cartilage matrix. Purpose To determine the variations in the acetabular cartilage T2 relaxation values between healthy individuals and those with developmental dysplasia of the hip (DDH). Material and Methods Thirty-three patients with unilateral DDH underwent 3-T magnetic resonance imaging (MRI) between January 2018 and February 2019. Fifteen volunteers (30 hips) were enrolled as controls. T2 values were measured with the T2 mapping sequence in all layers and were equally divided into three layers (deep, middle, and superficial) with equal thickness. We calculated the mean T2 relaxation values for the full thickness, deep, middle, and superficial layers and compared the values between the different groups. In addition, the inter- and intra-observer agreements were calculated. Results The T2 relaxation values in the DDH arm were significantly lower in the middle, superficial, and full thickness layers compared with those of the volunteers and contralateral hips. The T2 relaxation values of the deep layers showed no significant difference between the different groups. The acetabular cartilage T2 relaxation values increased from the deep layer to the superficial layer in the control and contralateral groups. Both inter- and intra-observer agreements were good. Conclusion MRI T2 mapping may help to diagnose developmental disorders of the acetabular cartilage matrix in infants and children with DDH. Abnormal acetabular cartilage T2 relaxation values may be due to the extraordinary stress load of the femoral head.

Purpose : T2 mapping and diffusion tensor imaging (DTI) enable the detection of changes in the skeletal muscle microenvironment. We assessed T2 relaxation times, DTI metrics, performed histological characterization of frostbite-induced skeletal muscle injury and repair, and provided diagnostic imaging biomarkers. Design and Methods : Thirty-six Sprague Dawley rats (200 ± 10 g) were obtained. Thirty rats were used for establishing a skeletal muscle frostbite model, and six were untreated controls. Functional MR sequences were performed on rats on days 0, 3, 5, 10, and 14 ( n = 6 per time point). Rats were then sacrificed to obtain the quadriceps muscles. Tensor eigenvalues ( λ 1, λ2, and λ3), mean diffusivity (MD), fractional anisotropy (FA), and T2 values were compared between the frostbite model and control rats. ImageJ was used to measure the extracellular area fraction (EAF), muscle fiber cross-sectional area (fCSA), and skeletal muscle tumor necrosis factor α (TNF- α ), and Myod1 expression. The correlation between the histological and imaging parameters of the frostbitten skeletal muscle was evaluated. Kolmogorov–Smirnoff test, Leven’s test, one-way ANOVA, and Spearman coefficient were used for analysis. Results: T2 relaxation time of frostbitten skeletal muscle was higher at all time points ( p < 0.01). T2 relaxation time correlated with EAF, and TNF- α and Myod1 expression ( r = 0.42, p < 0.05; r = 0.86, p < 0.01; r = 0.84, p < 0.01). The average tensor metrics (MD, λ 1, λ2, and λ3) of skeletal muscle at 3 and 5 days of frostbite increased ( p < 0.05), and fCSA correlated with λ 1, λ2, and λ3, and MD ( r = 0.65, p < 0.01; r = 0.48, p < 0.01; r = 0.52, p < 0.01; r = 0.62, p < 0.01). Conclusion: T2 mapping and DTI imaging detect frostbite-induced skeletal muscle injury early. This combined approach can quantitatively assess skeletal muscle repair and regeneration within 2 weeks of frostbite. Imaging biomarkers for the diagnosis of frostbite were suggested.

ObjectiveTo seek optimal keV settings for imaging carpal tunnel in adults by dual-energy computed tomography (DECT) monoenergetic technique; to describe anatomic characteristics of carpal tunnel and to observe correlation between carpal bony and soft tissue structures.METHODSDECT images of 20 wrists (11 left and 9 right wrists; 14 men, mean age 26.93±1.38 years, range 23 to 28, and 6 women, mean age 24.17 ± 0.98 years, range 23 to 26) were evaluated. Monoenergetic images were reconstructed at 42, 62, 82, 102, 122, and 142 keV. Image quality was assessed along a 5-point Likert scale, and the highest-quality images were chosen for quantitative analysis. Two musculoskeletal radiologists performed both analyses independently.RESULTSThe optimal energy spectrum with the best contrast-to-noise ratio (CNR) for monoenergetic images were at 62 keV (19 wrists, 95%) and 61 keV (1 wrist, 5%). There was substantial interobserver agreement between the readers in the 5-point Likert scale analysis of image quality (k= 0.793). Bland-Altman plots also indicated good agreement between observers in quantitative analysis. Intra-category 1 and 2 correlation was mostly discovered at hamate hook level and middle level of pisiform (P < 0.05), while bony and soft tissue structures partly reached correlation (P < 0.05).CONCLUSIONSThe optimal energy spectrum for monoenergetic DECT imaging of carpal tunnel structures was 62 keV. DECT monoenergetic imaging could predict changes in soft tissue structures and demonstrate carpal tunnel anatomic structures.