Methods: This retrospective study analyzed 32 consecutive IDS patients who underwent UEDD surgery. Clinical features, laboratory data (erythrocyte sedimentation rate and C-reactive protein), and treatment outcomes were analyzed. Results: Definite microorganisms were identified in 27 patients (84.3%), with 24 (88.9%) meeting cure criteria. The cure rate was significantly higher in the detected pathogen group compared to the undetected pathogen group (88.9% vs. 80%; χ²=19.36, p<0.0001). Metagenomic next generation sequencing (mNGS) provided faster diagnosis (41.72±6.81 hours) compared to tissue culture (95.74±35.47 hours, p<0.05). The predominant causative pathogen was Mycobacterium tuberculosis, followed by Staphylococcus aureus. Significant improvements were observed in Visual Analog Scale pain scores, from a mean of 7.9 preoperatively to 1.06 at 1 year postoperatively. The Oswestry Disability Index revealed a similar trend, showing significant improvement (p<0.05). Conclusions UEDD is a viable alternative to traditional open surgery for managing IDS in high-risk patients. UEDD offers a dual therapeutic-diagnostic advantage during the initial admission phase, enabling simultaneous debridement, neurological decompression, and targeted biopsy in a single intervention. Compared with traditional tissue culture, mNGS enables rapid microbiological diagnosis and extensive pathogen coverage.

OBJECTIVE: To analyze the effectiveness of three internal fixation methods, namely hollow screw combined with Kirschner wire tension band, hollow screw combined with anchor nail, and modified 1/3 tubular steel plate, in the treatment of avulsion fracture of tibial tubercle (AFTT) in adolescents. METHODS: Between January 2018 and September 2023, 19 adolescent AFTT patients who met the selection criteria were admitted. According to different internal fixation methods, patients were divided into group A (8 cases, hollow screw combined with Kirschner wire tension band), group B (6 cases, hollow screw combined with anchor nail), and group C (5 cases, modified 1/3 tubular steel plate). There was no significant difference in the baseline data of age, gender, side, cause of injury, Ogden classification, and time from injury to operation among the three groups ( P>0.05). The range of motion (ROM), weight-bearing time, normal activity time of knee joint, and the hospital for special surgery (HSS) score at last follow-up were recorded and compared among the three groups. Recorded whether the fracture was displaced, whether the fracture line was blurred at 1 month after operation, whether there was epiphyseal dysplasia, and whether there was incision infection and other complications. RESULTS: There was no significant difference in hospital stay between the groups ( P>0.05). All patients were followed up 10-24 months, with an average of 14.3 months; there was no significant difference between the groups ( P>0.05). All the incisions healed well without soft tissue irritation or fracture nonunion, and no limb shortening deformity or epiphyseal dysplasia was found during follow-up. At 1 month after operation, the knee joint ROM and hospitalization expenses in group A were better than those in groups B and C, the fracture healing time, knee joint weight-bearing time, and normal activity time of knee joint were better than those in group C, and the hospitalization expenses in group C were better than those in group B, with significant differences ( P<0.05); there was no significant difference in the other indicators between the groups ( P>0.05). In group A, the fracture line was blurred 1 month postoperatively, the fracture ends were in close contact, and there was no fracture displacement; in groups B and C, the fracture line was clear in 2 cases, and 1 case in group C had slight fracture displacement; except for 1 case in group B, there was no fracture split in the other two groups. There was no significant difference in the incidences of blur of fracture line, fracture displacement, and intraoperative bone split between the groups at 1 month after operation ( P>0.05). At last follow-up, the HSS scores of knee joints in the three groups were excellent and good, and there was no significant difference between the groups ( P>0.05). CONCLUSION Hollow screw combined with Kirschner wire tension band technique is effective in treating adolescent AFTT, which has the advantages of stabilizing fracture, accelerating fracture healing and rehabilitation, early feasible knee joint functional exercise, and reducing hospitalization expenses.
Humans ; Tibial Fractures/surgery* ; Adolescent ; Male ; Fracture Fixation, Internal/instrumentation* ; Female ; Fractures, Avulsion/surgery* ; Bone Wires ; Bone Screws ; Bone Plates ; Treatment Outcome ; Range of Motion, Articular ; Bone Nails ; Weight-Bearing ; Fracture Healing

OBJECTIVE: To explore effectiveness of intermediate screw assisted reduction and fixation technique in the treatment of Schatzker type Ⅴ and Ⅵ tibial plateau fractures. METHODS: A clinical data of 22 patients with Schatzker type Ⅴ and Ⅵ tibial plateau fractures, who were admitted between June 2022 and December 2023 and met the selection criteria, was retrospectively analyzed. During operation, the intermediate screw assisted reduction and fixation technique was used. There were 14 males and 8 females with an average age of 46.3 years (range, 17-65 years). The fractures were caused by traffic accident in 13 cases, by falls in 5 cases, and by falling from height in 4 cases. According to Schatzker classification criteria, 9 cases were type Ⅴ and 13 cases were type Ⅵ. The interval between injury and operation was 5-12 days (mean, 7.9 days). The operation time, intraoperative fluoroscopy times, and length of hospital stay were recorded. The range of motion of knee joint and Hospital for Special Surgery (HSS) score were recorded at last follow-up. X-ray films were taken to review the fracture healing. Rasmussen score, tibial plateau varus angle (TPVA), and posterior tibial slope (PTS) were estimated before operation, at immediate after operation, and at last follow-up in order to evaluate the fracture reduction effect and postoperative outcome. RESULTS: The operation time was 85-140 minutes (mean, 103.9 minutes). Intraoperative fluoroscopy was performed 7-15 times (mean, 10.1 times). All incisions healed by first intention after operation, and no complication such as nerve or blood vessel injury occurred. The length of hospital stay ranged from 8 to 17 days (mean, 12.4 days). All patients were followed up 10-22 months (mean, 14.8 months). At last follow-up, the range of motion of knee joint was 110°-140° (mean, 125°). HSS score was rated as excellent in 16 cases, good in 5 cases, and fair in 1 case, with an excellent and good rate of 95.5%. X-ray films reexamination showed that all fractures healed with the healing time of 12-17 weeks (mean, 14.8 weeks). No internal fixation failure occurred. Rasmussen score, TPVA, and PTS at immediate after operation and at last follow-up were significantly superior to those before operation ( P<0.05). And there was no significant difference between immediately after operation and last follow-up ( P>0.05). CONCLUSION The treatment of Schatzker type Ⅴ and Ⅵ tibial plateau fractures with intermediate screw assisted reduction and fixation technique is reliable, which can reduce the difficulty of reduction and fixation, improve the efficiency of reduction and fixation, reduce the operation time, achieve satisfactory reduction and fixation effect and postoperative prognosis, and achieve good recovery of knee joint function.
Humans ; Tibial Fractures/diagnostic imaging* ; Male ; Female ; Adult ; Middle Aged ; Bone Screws ; Fracture Fixation, Internal/instrumentation* ; Retrospective Studies ; Adolescent ; Aged ; Young Adult ; Treatment Outcome ; Range of Motion, Articular ; Operative Time ; Length of Stay ; Tibial Plateau Fractures

OBJECTIVE: To evaluate the effectiveness of V-shaped stealth decompression technique using ultrasonic bone scalpel in anterior surgery for adjacent two-level cervical spondylosis. METHODS: A clinical data of 41 patients with adjacent two-level cervical spondylosis, who admitted between January 2020 and December 2023 and met the selection criteria, was analyzed retrospectively. Among them, 22 cases were treated with anterior cervical discectomy and fusion (ACDF) assisted by V-shaped stealth decompression technique using ultrasonic bone scalpel (group A) and 19 cases with anterior cervical corpectomy and fusion (ACCF) (group B). There was no significant difference between the two groups in age, gender, disease duration, surgical segment, preoperative Japanese Orthopedic Association (JOA) score, neck dysfunction index (NDI), pain visual analogue scale (VAS) score, and the anteroposterior diameter of the spinal canal in the responsibility space of axial CT ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, hospital stay, complications during follow-up, JOA score, NDI, and VAS score at last follow-up, and the incidences of intervertebral fusion at 3 months after operation, and cage subsidence at last follow-up were compared between the two groups. RESULTS: The operations in the two groups were successfully completed. The operation time, intraoperative blood loss, postoperative drainage volume, and hospital stay in group A were significantly less than those in group B ( P<0.05). Two cases (9.1%) in group A and 4 cases (21.1%) in group B developed complications, with no significant difference in the incidence between the two groups ( P>0.05). All patients in the two groups were followed up 6-12 months (mean, 9.3 months). There was no significant difference in follow-up time between the two groups ( P>0.05). At last follow-up, the JOA score and VAS score in both groups significantly improved when compared with those before operation ( P<0.05). The change values of VAS score and the improvement rate of JOA score in group A were significantly superior to group B ( P<0.05). There was no significant difference in the change values of NDI and JOA score between the two group ( P>0.05). Imaging reexamination showed that the rate of intervertebral fusion at 3 months after operation was significantly higher in group A (81.8%) than in group B (52.6%) ( P<0.05), and all patients obtained bony intervertebral fusion at last follow-up. At last follow-up, 2 cases (9.1%) in group A and 11 cases (57.9%) in group B had cage sinking, and the difference in the incidence was significant ( P<0.05). No loosening or fracture of internal fixators occurred in all patients. CONCLUSION Using ultrasonic bone scalpel can transform single vertebral ACCF into two-segment ACDF in anterior cervical spondylosis surgery. The V-shaped stealth decompression technique is safe and efficient, with the advantages of minimal trauma, fewer postoperative complications, and rapid recovery of patients.
Humans ; Spondylosis/surgery* ; Male ; Female ; Middle Aged ; Decompression, Surgical/instrumentation* ; Retrospective Studies ; Cervical Vertebrae/surgery* ; Spinal Fusion/instrumentation* ; Diskectomy/instrumentation* ; Adult ; Treatment Outcome ; Aged ; Ultrasonic Surgical Procedures/methods* ; Operative Time

OBJECTIVE: To explore the mechanism by which ω-3 polyunsaturated fatty acids (hereinafter referred to as "ω-3") exert antioxidant stress protection and promote osteogenic differentiation in MC3T3-E1 cells, and to reveal the relationship between ω-3 and the key antioxidant stress pathway involving nuclear factor E2-related factor 2 (Nrf2) and NAD (P) H quinone oxidoreductase 1 (NQO1) in MC3T3-E1 cells. METHODS: The optimal concentration of H ₂O ₂ (used to establish the oxidative stress model of MC3T3-E1 cells in vitro) and the optimal intervention concentrations of ω-3 were screened by cell counting kit 8. MC3T3-E1 cells were divided into blank control group, oxidative stress group (H ₂O ₂), low-dose ω-3 group (H ₂O ₂+low-dose ω-3), and high-dose ω-3 group (H ₂O ₂+high-dose ω-3). After osteoblastic differentiation for 7 or 14 days, the intracellular reactive oxygen species (ROS) level was measured by fluorescence staining and flow cytometry, and the mitochondrial morphological changes were observed by biological transmission electron microscope; the expression levels of Nrf2, NQO1, heme oxygenase 1 (HO-1), Mitofusin 1 (Mfn1), and Mfn2 were detected by Western blot to evaluate the cells' antioxidant stress capacity; the expression levels of Runt-related transcription factor 2 (RUNX2) and osteocalcin (OCN) were detected by immunofluorescence staining and Western blot; osteogenic potential of MC3T3-E1 cells was evaluated by alkaline phosphatase (ALP) staining and alizarin red staining. RESULTS: Compared with the oxidative stress group, the content of ROS in the low and high dose ω-3 groups significantly decreased, and the protein expressions of Nrf2, NQO1, and HO-1 significantly increased ( P<0.05). At the same time, the mitochondrial morphology of MC3T3-E1 cells improved, and the expressions of mitochondrial morphology-related proteins Mfn1 and Mfn2 significantly increased ( P<0.05). ALP staining and alizarin red staining showed that the low-dose and high-dose ω-3 groups showed stronger osteogenic ability, and the expressions of osteogenesis-related proteins RUNX2 and OCN significantly increased ( P<0.05). And the above results showed a dose-dependence in the two ω-3 treatment groups ( P<0.05). CONCLUSION ω-3 can enhance the antioxidant capacity of MC3T3-E1 cells under oxidative stress conditions and upregulate their osteogenic activity, possibly through the Nrf2/NQO1 signaling pathway.
Oxidative Stress/drug effects* ; NF-E2-Related Factor 2/metabolism* ; NAD(P)H Dehydrogenase (Quinone)/metabolism* ; Animals ; Mice ; Osteogenesis/drug effects* ; Cell Differentiation/drug effects* ; Fatty Acids, Omega-3/pharmacology* ; Signal Transduction/drug effects* ; Osteoblasts/drug effects* ; Reactive Oxygen Species/metabolism* ; Cell Line ; Hydrogen Peroxide/pharmacology* ; Core Binding Factor Alpha 1 Subunit/metabolism* ; Antioxidants/pharmacology* ; Heme Oxygenase-1/metabolism*

Traumatic brain injury (TBI) is intricately linked to the most severe clinical manifestations of brain damage. It encompasses dynamic pathological mechanisms, including hemodynamic disorders, excitotoxic injury, oxidative stress, mitochondrial dysfunction, inflammation, and neuronal death. This review provides a comprehensive analysis and summary of biomaterial-based tissue engineering scaffolds and nano-drug delivery systems. As an example of functionalized biomaterials, nano-drug delivery systems alter the pharmacokinetic properties of drugs. They provide multiple targeting strategies relying on factors such as morphology and scale, magnetic fields, pH, photosensitivity, and enzymes to facilitate the transport of therapeutics across the blood-brain barrier and to promote selective accumulation at the injury site. Furthermore, therapeutic agents can be incorporated into bioscaffolds to interact with the biochemical and biophysical environment of the brain. Bioscaffolds can mimic the extracellular matrix environment, regulate cellular interactions, and increase the effectiveness of local treatments following surgical interventions. Additionally, stem cell-based and exosome-dominated extracellular vesicle carriers exhibit high bioreactivity and low immunogenicity and can be used to design therapeutic agents with high bioactivity. This review also examines the utilization of endogenous bioactive materials in the treatment of TBI.

Background and Aims:Obesity is often accompanied by symptoms of disordered eating.Although bariatric metabolic surgery can alleviate these symptoms,there are significant individual differences in postoperative outcomes,and effective predictive indicators are lacking.Liver and kidney function,along with lipid profiles,are closely related to metabolic status and may serve as useful markers for preoperative risk stratification and prognosis prediction.This study was conducted to explore the relationship between preoperative metabolic indicators and symptoms of disordered eating,thereby identifying postoperative recovery patterns among obese patients to support individualized management strategies.Methods:A total of 41 obese patients who underwent sleeve gastrectomy at Shanghai Sixth People's Hospital between September 2020 and June 2023 were enrolled,along with 36 healthy volunteers recruited during the same period.Participants completed the Eating Disorder Inventory-2(EDI-2)questionnaire,and serum samples were collected to assess liver function,kidney function,and lipid levels prior to surgery.The Mantel test was used to analyze correlations between metabolic indicators and EDI-2 scores.Latent profile analysis(LPA)was conducted using the indicators significantly correlated with EDI-2 scores to identify subgroups within the obese cohort.Linear mixed models were then applied to examine the trajectories of postoperative symptom changes across subgroups.Results:Levels of cystatin C,cholinesterase,gamma-glutamyl transferase,triglycerides,and apolipoprotein E were significantly higher in the obese group compared to the healthy group(all P＜0.05),and EDI-2 total score was also significantly elevated(P＜0.05);the prealbumin level in the healthy group was significantly higher than that in the obese group(P＜0.05).These six indicators were positively correlated with EDI-2 score(all r＞0.20,P＜0.05).Based on these markers,the LPA classified the obese group into two subgroups,with subgroup 2 exhibiting higher levels of most metabolic indicators than subgroup 1.During the 18-month postoperative follow-up,both subgroups showed reductions in EDI-2 score,but symptom improvement in subgroup 2 occurred later(month 6)compared to subgroup 1(month 4).Conclusion:Preoperative levels of cholinesterase,gamma-glutamyl transferase,prealbumin,triglycerides,and apolipoprotein E may serve as predictive indicators for improvement in disordered eating symptoms.Recovery patterns after bariatric surgery vary among obese patients with different metabolic profiles,highlighting the need for tailored intervention strategies.

BACKGROUND:Low-grade,chronic inflammation is thought to play a central role in the pathogenesis of osteoarthritis.However,the specific molecular mechanisms are still unclear.OBJECTIVE:To screen and explore the potential hub genes and immune cell infiltration in osteoarthritis.METHODS:We merged data from the GSE206848 on the GPL570 and the GSE55235 and GSE55457 on the GPL96 to form the row dataset.Outlier samples were removed using weighted gene co-expression network analysis,followed by the identification of differentially expressed genes,and subsequent functional enrichment analysis of differentially expressed genes.Further,a protein-protein interaction network of differentially expressed genes was constructed,and hub genes were identified using two different algorithms in Cytoscape.Additionally,the CIBERSORT algorithm was employed to assess differences in immune cell infiltration proportions between osteoarthritis samples and normal controls.Finally,the diagnostic efficacy of hub genes for osteoarthritis was validated using quantitative reverse transcription polymerase chain reaction experiments conducted on synovial tissue samples collected from patients with osteoarthritis,in conjunction with the GSE12021 dataset from the GPL96 sequencing platform as an independent dataset.RESULTS AND CONCLUSION:After eliminating 5 outlier samples,we identified a total of 340 differentially expressed genes,comprising 159 up-regulated genes and 181 down-regulated genes.Six hub genes were obtained by weighted gene co-expression network analysis and Cytoscape.CIBERSORT analysis revealed a difference in the proportion of multiple types of immune cell infiltration in osteoarthritic tissues compared with normal tissues.Moreover,the expression levels of the six hub genes exhibited strong correlation with the relative proportion of multiple immune cells in osteoarthritis.The results of RT-qPCR indicated that the relative expression levels of the six genes were down-regulated relative to normal tissues.However,there was no significant difference in the expression of NFKBIA and PTGS2(P>0.05).Simultaneously,receiver operator characteristic curves in both the original and external datasets demonstrated that the six hub genes exhibited strong diagnostic capabilities for osteoarthritis(area under the curve>0.8).To conclude,four hub genes,CDKN1A,MYC,C-X-C motif chemokine ligand 2,and vascular endothelial growth factor A,are finally identified and may serve as molecular targets for future treatment by mediating immune response and inflammatory processes.

Acute lateral ankle sprain (ALAS) is one of the most common sport injuries, with high incidence, recurrence and disability rates. Currently, exercise rehabilitation-based non-surgical treatment is the primary management approach for ALAS. However, there remain improper practices such as excessive immobilization or uncontrolled activity, which contribute to recurrent sprains and chronic ankle instability, significantly impairing patients′ athletic function and quality of life. To standardize the non-surgical management of ALAS, improve the cure rates, and reduce the recurrence and disability rates, Chinese Sports Rehabilitation Medicine Training Project of Chinese Medical Association, Foot and Ankle Basics and Orthopedics Group, Orthopedic Branch of Chinese Medical Doctor Association, and Sports Medicine Branch of Jiangsu Medical Association organized relevant experts to formulate Expert consensus on non-surgical treatment for acute lateral ankle sprain ( version 2025), following the principles of scientific vigor, practicality, and innovation. Thirteen recommendations were proposed for standardized treatment protocols across different healing phases, aiming to provide references for standard management of ALAS and improve the therapeutic outcomes.

The prevalence of chronic constipation among the elderly is significant, exerting adverse effects on both their physical and mental health.Presently, pharmacological therapy remains the predominant treatment modality for elderly patients with chronic constipation; however, prolonged use can lead to drug dependence, tolerance, and adverse effects.This article systematically reviews non-pharmacological interventions for chronic constipation in elderly patients, both domestically and internationally, aiming to provide a comprehensive reference for clinical practice.