Neuropathic pain (NP) is a common complication following spinal cord injury, with an incidence rate ranging from 38% to 70%. NP typically presents as sensation of burning, electric shocks, tingling or squeezing pain resulting from somatosensory nerve damage, which exerts a negative impact on patients′ physical and psychological well-being. After spinal cord injury, glial cells are activated to induce inflammatory cascade. Accordingly, various inflammatory mediators that may disrupt the neuronal function are released to promote abnormally increased neuronal excitability and pain signal transduction. Additionally, spinal cord injury can disrupt the release of neurotransmitters and neurotrophic factors, alter ion channel activity, and thereby impair the normal pain regulatory mechanisms and further increase pain perception. The interaction of these mechanisms contributes to the occurrence and persistence of NP after spinal cord injury. However, the precise pathogenesis of NP remains incompletely elucidated, making its therapeutic efficacy uncertain and clinical management difficult. It is of great significance to thoroughly understand the underlying pathophysiological mechanisms of NP following spinal cord injury for its treatment. For this reason, the authors reviewed the research progress on the characteristics and pathophysiological mechanisms of NP following spinal cord injury, aiming to serve as a reference for further research and development of more effective targeted therapies and management strategies.

BACKGROUND:Extracellular vesicles can regulate insulin resistance and control inflammatory response by participating in intercellular communication,while repairing skeletal muscles and promoting skeletal muscle regeneration,which is expected to be a novel treatment modality for sarcopenic obesity. OBJECTIVE:To review the biogenesis of extracellular vesicles,their biological functions,their relationship with sarcopenic obesity,and recent advances in the pathogenesis,diagnosis,and treatment of sarcopenic obesity. METHODS:The first author performed a computer search of PubMed,Embase,CNKI and other databases for relevant studies involving extracellular vesicle in sarcopenic obesity.The search keywords were"extracellular vesicle,exosome,sarcopenic obesity,obese sarcopenia,skeletal muscle regeneration,skeletal muscle mass regulation"in English and Chinese,respectively.The search period was from June 2022 to November 2022.After screening,87 articles were included for further review. RESULTS AND CONCLUSION:Extracellular vesicles are important vectors of bidirectional cell communication and participate in the regulation of normal physiological and pathological processes through autocrine,paracrine and endocrine ways.Sarcopenic obesity is a complex multi-factor disease.Extracellular vesicles are involved in the occurrence and development of sarcopenic obesity mainly by regulating the inflammatory response of skeletal muscle and the homeostasis of muscle cells.Cytokines secreted by adipose tissue and skeletal muscle are released into the extracellular circulation through extracellular vesicle encapsulation and interact with each other to promote skeletal muscle insulin resistance and lipogenesis,which is the main pathophysiology of skeletal muscle atrophy in sarcopenic obesity.Extracellular vesicles not only promote the development of sarcopenic obesity by providing specific pathogenic markers,but also are a valuable diagnostic indicator of sarcopenic obesity.Release of extracellular vesicles from skeletal muscle during exercise enhances metabolic response and promotes skeletal muscle regeneration.Extracellular vesicles can not only be used as therapeutic targets for sarcopenic obesity but also be used to treat sarcopenic obesity by loading drugs to effectively improve drug bioavailability.

Objective:To explore the clinical benefits of digital simulation surgery in the limited open reduction and intramedullary nail fixation for treatment of proximal humeral fractures.Methods:A retrospective study was conducted to analyze the clinical data of 40 patients who had been treated by limited open reduction and intramedullary nail fixation at Department of Trauma and Orthopedics, The People's Hospital of Weifang from June 2020 to September 2022 for 3-part proximal humeral fractures by Neer classification. The patients were assigned into 2 groups according to different preoperative strategies. In the observation group of 17 patients [4 males and 13 females with an age of (66.9±8.6) years], the angle of intramedullary nail placement into the humeral head and the sequence of reduction and fixation were simulated in the preoperative digital simulation surgery. In the control group of 23 patients [7 males and 16 females with an age of (63.0±8.6) years], routine reduction and fixation were performed based on the preoperative shoulder joint CT images and intraoperative fluoroscopy without preoperative digital simulation surgery. The 2 groups were compared in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, incidence of postoperative complications, fracture healing time, active range of motion of the shoulder joint at the last follow-up, as well as the intramedullary nail heights, humeral neck-shaft angles, Constant shoulder function scores, and visual analogue scale (VAS) pain scores at 3 days, 12 weeks, and 24 weeks postoperatively.Results:The 2 groups were comparable because there were no statistically significant differences in the preoperative general data between them ( P>0.05). The operation time in the observation group [(57.5±6.2) min] was significantly shorter than that in the control group [(71.3±10.2) min], and the intraoperative fluoroscopy frequency in the former [(28.5±4.4) times] significantly lower than that in the latter [(45.4±2.6) times] ( P<0.05).The 2 groups were followed up for (15.0±1.6) months. For the observation and the control groups, respectively, the fracture healing time was (10.5±2.4) weeks and (10.0±2.0) weeks, showing no statistically significant differences between groups ( P>0.05). There were no statistically significant differences between the 2 groups in the intraoperative blood loss, or in the intramedullary nail heights, humeral neck-shaft angles, Constant shoulder function scores, or VAS pain scores at 3 days, 12 weeks, or 24 weeks postoperatively, or in the active range of motion of the shoulder joint at the last follow-up ( P>0.05). Complications such as infection, humeral head necrosis, and screw removal occurred in none of the patients. Conclusion:In the treatment of proximal humeral fractures, before the routine limited open reduction and intramedullary nail fixation, digital simulation surgery can be performed to reduce the operation time and fluoroscopy frequency without sacrifice of the therapeutic efficacy.

Objective:To explore the clinical benefits of digital simulation surgery in the limited open reduction and intramedullary nail fixation for treatment of proximal humeral fractures.Methods:A retrospective study was conducted to analyze the clinical data of 40 patients who had been treated by limited open reduction and intramedullary nail fixation at Department of Trauma and Orthopedics, The People's Hospital of Weifang from June 2020 to September 2022 for 3-part proximal humeral fractures by Neer classification. The patients were assigned into 2 groups according to different preoperative strategies. In the observation group of 17 patients [4 males and 13 females with an age of (66.9±8.6) years], the angle of intramedullary nail placement into the humeral head and the sequence of reduction and fixation were simulated in the preoperative digital simulation surgery. In the control group of 23 patients [7 males and 16 females with an age of (63.0±8.6) years], routine reduction and fixation were performed based on the preoperative shoulder joint CT images and intraoperative fluoroscopy without preoperative digital simulation surgery. The 2 groups were compared in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, incidence of postoperative complications, fracture healing time, active range of motion of the shoulder joint at the last follow-up, as well as the intramedullary nail heights, humeral neck-shaft angles, Constant shoulder function scores, and visual analogue scale (VAS) pain scores at 3 days, 12 weeks, and 24 weeks postoperatively.Results:The 2 groups were comparable because there were no statistically significant differences in the preoperative general data between them ( P>0.05). The operation time in the observation group [(57.5±6.2) min] was significantly shorter than that in the control group [(71.3±10.2) min], and the intraoperative fluoroscopy frequency in the former [(28.5±4.4) times] significantly lower than that in the latter [(45.4±2.6) times] ( P<0.05).The 2 groups were followed up for (15.0±1.6) months. For the observation and the control groups, respectively, the fracture healing time was (10.5±2.4) weeks and (10.0±2.0) weeks, showing no statistically significant differences between groups ( P>0.05). There were no statistically significant differences between the 2 groups in the intraoperative blood loss, or in the intramedullary nail heights, humeral neck-shaft angles, Constant shoulder function scores, or VAS pain scores at 3 days, 12 weeks, or 24 weeks postoperatively, or in the active range of motion of the shoulder joint at the last follow-up ( P>0.05). Complications such as infection, humeral head necrosis, and screw removal occurred in none of the patients. Conclusion:In the treatment of proximal humeral fractures, before the routine limited open reduction and intramedullary nail fixation, digital simulation surgery can be performed to reduce the operation time and fluoroscopy frequency without sacrifice of the therapeutic efficacy.

OBJECTIVE: To review the research progress in the construction strategy and application of bone/cartilage immunomodulating hydrogels. METHODS: The literature related to bone/cartilage immunomodulating hydrogels at home and abroad in recent years was reviewed and summarized from the immune response mechanism of different immune cells, the construction strategy of immunomodulating hydrogels, and their practical applications. RESULTS: According to the immune response mechanism of different immune cells, the biological materials with immunoregulatory effect is designed, which can regulate the immune response of the body and thus promote the regeneration of bone/cartilage tissue. Immunomodulating hydrogels have good biocompatibility, adjustability, and multifunctionality. By regulating the physical and chemical properties of hydrogel and loading factors or cells, the immune system of the body can be purposively regulated, thus forming an immune microenvironment conducive to osteochondral regeneration. CONCLUSION Immunomodulating hydrogels can promote osteochondral repair by affecting the immunomodulation process of host organs or cells. It has shown a wide application prospect in the repair of osteochondral defects. However, more data support from basic and clinical experiments is needed for this material to further advance its clinical translation process.
Hydrogels ; Cartilage ; Bone and Bones ; Tissue Engineering/methods*

Objective To investigate the chemical composition from the flowers of Callerya speciosa,and reveal the metabolites difference at different flowering periods based on metabolomics technology.Methods The primary and secondary metabolites,volatile chemical components in flowers of C.speciosa were analyzed combined by GC-MS and UPLC-Q-Exactive MS.Principal component analysis(PCA),orthogonal partial least squares-discriminant analysis(OPLS-DA),and hierarchical cluster analysis(HCA)were performed to identify differential metabolites.Results A total of 332 compounds were identified by UPLC-Q-Exactive MS,mainly including secondary metabolites such as flavonoids,triterpenoids,phenylpropanoids.A total of 297 compounds were identified by GC-MS,mainly including primary metabolites and volatile chemical components,such as organic acids,amino acids,saccharides,heterocycles,alcohols.The PCA analysis demonstrated that the metabolites of the four flowering periods were divided into two groups:bud,initial bloom and blooming periods clustered into one group,while wilting period clustered into the other group,the main differences were filtered and identified as flavonoids and triterpenoids,organic acids,respectively.Compared to the upright type,the flowers of vine type contained more characteristic flavonoids as differential metabolites during the bud,initial bloom and blooming periods,and some flavonoids decrease gradually with the development of flowering.Conclusion The results indicated that the flowers of C.speciosa possessed abundant active flavonoid metabolites for further utilization,and the best harvest stage is initial bloom,the best harvest plant is vine type.This study provides a scientific basis for the scientific development and rational use of the flowers of C.speciosa.

Objective:To establish the mouse model with radiation-induced pulmonary fibrosis, and to identify and analyze it from the aspects of function, imaging and pathology.Methods:Thirty C57BL/6 mice were randomly divided into the control group, 16 Gy irradiation group and 20Gy irradiation group. The mice in the irradiation groups received a single 16 Gy or 20 Gy chest X-ray irradiation, and underwent functional examination, imaging examination and pathological examination at 3 and 6 months after irradiation.Results:At 6 months after irradiation, hair on the chest and back of the mice turned white and fell off, and the airway resistance was increased significantly. CT images showed extensive patch shadows and consolidation in the lung. Three dimensional reconstruction suggested that the lung of mice was distorted and deformed, and the volume was decreased significantly. Pathological examination confirmed that there was extensive pulmonary fibrosis.Conclusions:Significant pulmonary fibrosis occurs after 6 months of chest irradiation in mice. The animal model of radiation-induced pulmonary fibrosis in C57BL/6 mice was successfully established.

Osteoporosis seriously threatens the living quality of people, especially the elderly, and causes a huge economic burden to society. In the past, bisphosphonates, denosumab and other first-line drugs were used in the treatment of osteoporosis. However, these drugs can only inhibit bone resorption, but can not promote bone formation. Studies have shown that mesenchymal stem cells (MSCs) can be used to treat osteoporosis, however, it has some defects and deficiencies, such as genetic instability, limited cell survival and increased risk of cancer. However, mesenchymal stem cell-derived exosomes (MSCs-Exos) can regulate the differentiation and proliferation of osteoblasts by mediating wingless and int-1 (Wnt)/β-catenin and mitogen-activated protein kinase (MAPK) signaling pathways, promote bone regeneration, and thus has an impact on osteoporosis. In this paper, preclinical studies on MSCs and MSCs-Exos in the treatment of osteoporosis in recent years were reviewed, in order to provide a new idea for the treatment of osteoporosis.

For non-small cell lung cancer (NSCLC) patients with positive surgical margins, the survival rates can be dramatically decreased. However, high-level evidence is lacking in the standard adjuvant treatment for NSCLC patients with positive surgical margins. In this article, consensus and disputes on the adjuvant therapy for NSCLC patients with positive surgical margins were reviewed.

BACKGROUNDPelvic fractures are uncommon in elderly patients and so are infrequently addressed in the literature. The purpose of this study was to investigate the management and outcome of pelvic fractures in elderly patients.

METHODSWe retrospectively reviewed the records of pelvic fractures in elderly patients (age ≥55 years) who were treated in our department from September 1997 to May 2010.

RESULTSA total of 40 elderly patients with pelvic fractures were identified. Their mean age was 65.8 years (range 55-87 years). About 68% (n = 27) were men. The average Injury Severity Score (ISS) was 17.8 (range 6-45). Twelve (30%) patients required blood transfusion (mean 10 units) during the first 24 hours. The fractures were most frequently due to falling from a standing position (48%). Almost half (48%) were grade I breaks. Associated injuries were present in 70% (n = 28) of patients, and 65% (n = 26) had medical co-morbidities. Altogether, 29 patients (73%) underwent non-surgical management of their pelvic fracture. The average hospital stay was 25 days. There were five in-hospital deaths and one death 10 months after discharge. High ISSs (>25) were associated with increased in-hospital mortality (P = 0.018). At the final assessment (mean follow-up 15 months), 52% of the surviving patients had experienced decreased self-sufficiency.

CONCLUSIONSPelvic fractures in elderly patients result in high morbidity and mortality rates. A high ISS (>25) can be used to identify a patient at high risk. We recommend aggressive resuscitation and intensive care for that patient. For patients with an unstable pelvic or displaced acetabular fracture (≥2 mm) who can endure surgery, open reduction and internal fixation can provide adequate fixation for early weight-bearing and restoration of the bone stock.

Aged ; Aged, 80 and over ; Blood Transfusion ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; etiology ; surgery ; therapy ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Pelvic Bones ; injuries ; Retrospective Studies