Preterm birth (PTB), predominantly induced by intraamniotic inflammation, stands as the foremost contributor to neonatal morbidity and mortality globally. Fetal inflammatory response syndrome, stemming from the activation of the innate immune system, signifies the occurrence of funisitis or chorionic vasculitis. Maternal-fetal complications associated with infection-related PTB encompass maternal sepsis, fetal demise, neonatal sepsis, neonatal neurological impairment, and chronic lung disease. The inflammatory cascade is initiated when Toll-like receptors present on immune cells within the fetal membranes and the female reproductive tract encounter pathogen-associated molecular patterns derived from infectious agents. Subsequently, the nuclear factor kappa-light-chain-enhancer of activated B cells facilitates the transcription of cytokines. The accumulation of neutrophils compromises the tissue integrity of the fetal membranes, leading to membrane rupture via the secretion of matrix metalloproteinases. Elevated prostaglandin levels prompt uterine contractions and cervical remodeling, resulting in progressive cervical effacement and dilation, ultimately culminating in fetal delivery. The diagnosis of PTB should encompass three pivotal criteria: gestational age, uterine activity, and the consequences of that uterine activity. The diagnosis of chorioamnionitis is established through a combination of clinical manifestations, laboratory findings, identification of infectious microorganisms, and placental pathology. Fetal monitoring involves antenatal ultrasonography and non-stress testing. The management of infection-related PTB involves controlling and treating the infection, timing delivery to coincide with optimal fetal lung maturity, and optimizing outcomes for both the mother and neonate. Current preventive strategies for PTB primarily focus on inhibiting myometrial contractions that arise from the inflammatory cascade initiating PTB. An understanding of these pathways serves as the cornerstone for the development of therapeutic interventions aimed at preventing PTB.

Preterm birth (PTB), predominantly induced by intraamniotic inflammation, stands as the foremost contributor to neonatal morbidity and mortality globally. Fetal inflammatory response syndrome, stemming from the activation of the innate immune system, signifies the occurrence of funisitis or chorionic vasculitis. Maternal-fetal complications associated with infection-related PTB encompass maternal sepsis, fetal demise, neonatal sepsis, neonatal neurological impairment, and chronic lung disease. The inflammatory cascade is initiated when Toll-like receptors present on immune cells within the fetal membranes and the female reproductive tract encounter pathogen-associated molecular patterns derived from infectious agents. Subsequently, the nuclear factor kappa-light-chain-enhancer of activated B cells facilitates the transcription of cytokines. The accumulation of neutrophils compromises the tissue integrity of the fetal membranes, leading to membrane rupture via the secretion of matrix metalloproteinases. Elevated prostaglandin levels prompt uterine contractions and cervical remodeling, resulting in progressive cervical effacement and dilation, ultimately culminating in fetal delivery. The diagnosis of PTB should encompass three pivotal criteria: gestational age, uterine activity, and the consequences of that uterine activity. The diagnosis of chorioamnionitis is established through a combination of clinical manifestations, laboratory findings, identification of infectious microorganisms, and placental pathology. Fetal monitoring involves antenatal ultrasonography and non-stress testing. The management of infection-related PTB involves controlling and treating the infection, timing delivery to coincide with optimal fetal lung maturity, and optimizing outcomes for both the mother and neonate. Current preventive strategies for PTB primarily focus on inhibiting myometrial contractions that arise from the inflammatory cascade initiating PTB. An understanding of these pathways serves as the cornerstone for the development of therapeutic interventions aimed at preventing PTB.

Total hip arthroplasty(THA)is an effective treatment for elderly femoral neck fractures,mid-to late-stage femoral head necrosis,and end-stage hip osteoarthritis.However,serious complications such as aseptic loosening of the prosthesis,peripheral fractures,and dislocation of the prosthesis still exist following THA,which makes the selection of the appropriate hip prosthesis type and placement position before THA an important challenge for surgeons.Currently,the commonly used preoperative planning methods for THA mainly rely on static images from two-dimensional(2D)X-ray or three-dimensional(3D)computed tomography(CT),which fail to adequately consider the hip joint in weight-bearing as well as motion,lumbar-hip joint changes,and prosthetic impingement during motion.Recently,the dual fluoroscopic imaging system,as a new in-vivo,dynamic radiological imaging technology,provides comprehensive and accurate dynamic 3D data for THA preoperative planning.However,the technical process and expert consensus on preoperative 3D planning of THA using a dual fluoroscopic imaging system have not yet been established,which affects the promotion and application of this technology.In light of the above,national orthopaedic experts and related professional representatives discussed and proposed seven consensus issues,and the'expert recommendation rate'and'strong recommendation rate'were obtained through a questionnaire survey on the recommendations of the participating experts.This consensus aims to provide guidance and reference for the standardised application of preoperative 3D planning of THA using the dual fluoroscopic imaging system.

Total hip arthroplasty(THA)is an effective treatment for elderly femoral neck fractures,mid-to late-stage femoral head necrosis,and end-stage hip osteoarthritis.However,serious complications such as aseptic loosening of the prosthesis,peripheral fractures,and dislocation of the prosthesis still exist following THA,which makes the selection of the appropriate hip prosthesis type and placement position before THA an important challenge for surgeons.Currently,the commonly used preoperative planning methods for THA mainly rely on static images from two-dimensional(2D)X-ray or three-dimensional(3D)computed tomography(CT),which fail to adequately consider the hip joint in weight-bearing as well as motion,lumbar-hip joint changes,and prosthetic impingement during motion.Recently,the dual fluoroscopic imaging system,as a new in-vivo,dynamic radiological imaging technology,provides comprehensive and accurate dynamic 3D data for THA preoperative planning.However,the technical process and expert consensus on preoperative 3D planning of THA using a dual fluoroscopic imaging system have not yet been established,which affects the promotion and application of this technology.In light of the above,national orthopaedic experts and related professional representatives discussed and proposed seven consensus issues,and the'expert recommendation rate'and'strong recommendation rate'were obtained through a questionnaire survey on the recommendations of the participating experts.This consensus aims to provide guidance and reference for the standardised application of preoperative 3D planning of THA using the dual fluoroscopic imaging system.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

Objective:To investigate the short-term efficacy of hip arthroscopy for different types of femoroacetabular impingement syndrome (FAI).Methods:A retrospective analysis was conducted of the 85 FAI patients who had been treated by hip arthroscopy at Department of Orthopaedic Surgery, General Hospital of Southern Theater Command of PLA from January 2016 to December 2018. They were 52 males and 33 females, aged from 19 to 59 years (average, 36.9 years). According to the anatomical morphology of the acetabulum and proximal femur, there were 26 cases of cam type, 16 cases of pincer type and 43 cases of mixed type. Routine hip arthroscopy was performed to remove the proliferative synovium. Femoral head and neck plasty was conducted for the cases of cam type, resection of the overly covered acetabulum followed by labral suture for those of pincer type, and resection of overly covered acetabulum and labral suture followed by femoral head and neck plasty for those of mixed type. Hip function was assessed one year after surgery using the modified Harris hip score (mHHS), nonarthritic hip score(NAHS), and hip outcome score activity of daily living scale (HOS-ADL); the alpha angle and central edge(CE) angle were measured after CT reconstruction.Results:The 85 patients were successfully followed up for an average of 21 months (range, from 12 to 48 months). The mHHS, NAHS and HOS-ADL for all the patients were improved significantly from preoperative 63.1±7.9, 62.5±7.5 and 62.3±7.9 to 83.4±8.7, 82.9±8.2 and 83.6±8.8 one year after surgery, respectively (all P<0.05) while the mHHS, NAHS and HOS-ADL for the patients of cam, pincer and mixed types were all significantly improved compared to their preoperative values (all P<0.05). The preoperative alpha angles for the cam and mixed types (67.3°±5.2° and 64.2°±5.2°) were significantly reduced to 50.3°±2.9° and 49.6°±2.8° one year postoperatively ( P<0.05); the preoperative CE angles for the pincer and mixed types (52.9°±4.6° and 50.9°±3.6°) were significantly reduced to 33.1°±4.5° and 31.3°±4.3° one year postoperatively ( P<0.05). Conclusion:Hip arthroscopy can effectively treat FAI of cam, pincer and mixed types, leading to good short-term efficacy.

Anterior knee pain continues to be a major problem following total knee arthroplasty (TKA). Patellofemoral joint is closely associated to the occurrence of the anterior knee pain, so it is also called patellofemoral joint pain. Overstuff of patellofemoral joint and patella maltracking are the main factors for anterior part of the post-operative pain. They are resulted from the change of native morphology and Q angle of patellofemoral joint after operation. Instead of non-modifiable patients' congenital and genetic factors, they are mainly related to the improper surgical techniques and the mismatch between prostheses and native patellofemoral morphology. The reason of the mismatch is that the prosthesis is unable to cover all kinds of differences of the patellofemoral morphology among races and genders. In addition, some surgical techniques, including patellar replacement, circumpatellar denervation, femoral and patellar prostheses location, and the selection of the type of prosthesis, also affect the occurrence of anterior knee pain. The above mentioned factors may eventually lead to excessive and uneven distribution of the patella-femoral loads, which would compress and simulate the peripheral nerves around the joint. Ultimately, they result in the anterior knee pain. Therefore, the following effective strategies could lead to relief anterior knee pain and improve patients overall satisfaction after TKA, including improvements of prostheses design, patellar resurfacing, circumpatellar denervation, infrapatellar fat padpreservation or using mobile-bearing rotating-platform.

Objective To investigate the associations between lifestyle factors and social network and cognitive impairment among the elderly in three communities in China.Methods From November 2017 to May 2018,1 200 elderly individuals were selected from three Chinese communities (Beijing,Hefei,and Lanzhou) using a random cluster sampling method.Data were collected on lifestyle,social network,and cognition.A conditional logistic regression analysis was conducted to identify the associations between lifestyle and social network and cognitive impairment.Results A total 1 115 participants (92.9％) were administered both social network and cognition questionnaires.After adjustment by age,sex,education,marital status,health,and living status,only low participation in physical activity was found to be associated with cognitive impairment (OR=0.65,95％ CI=0.45-0.93,P=0.019).A larger social network (OR=0.50,95％ CI=0.29-0.85,P=0.010),especially more friends (0R=0.44,95％ CI=0.29-0.65,P＜0.001),may decrease the risk of cognitive impairment.The interactions between lifestyle factors and social network were not associated with cognitive impairment.Conclusion Our findings suggest that larger social networks and physical activity are associated with cognitive function among the elderly.Identification and intervention of risk factors are crucial in the delay and prevention of cognitive impairment and the improvement of quality of life among the elderly.

Objective To study the feasibility and early efficacy of matrix?induced autologous chondrocyte implantation repairing knee joint cartilage injury. Methods The Matrix?induced autologous chondrocyte implantation was used to repair knee joint cartilage injury in 13 cases (11 males and 2 females) with knee joint cartilage injury from April 2012 to March 2013. The av?erage age was 27.5 years old. All cases were suffering from unilateral focal cartilage defect of knee joint with International Carti?lage Repair Society (ICRS) chondral defect classification system grade III or IV, visual analogue scale (VAS)>3, and all of which had corresponding pain symptoms. The average defect area was 4.2 cm2. Standardized rehabilitation exercise was carried out after matrix?induced autologous chondrocyte implantation. Patients were followed up for 1 years, and knee injury and use osteoarthritis outcome score(KOOS), International Knee Documentation Committee (IKDC), subjective knee form and Lysholm score were col?lected to assess the function. Meanwhile, magnetic resonance observation of cartilage repair tissue (MOCART) score was used to assess the magnetic resonance imaging. Results All patients had been followed?up for 1 year. One patient had meniscus repair under arthroscopy for the meniscus injury caused by downstairs sprain in 6.5 months postoperative, so the score of 12 months post?operative was excluded. The knee range of motion was decreased in 3 months postoperative (123.1°±8.0°) compared to preopera?tive one (135.4°±5.7°), and has no difference in 6 months (136.1°±6.1°) and 12 months postoperative (135.1°±3.6°) compared to preoperative one. The 5 subsets of KOOS score were decreased in 3 months compared to preoperative one, and were significantly increased in 6 months and 12 months. The IKDC has no difference in 3 months (26.1±3.9) compared to preoperative one (43.5± 6.5), and were significantly increased in 6 months (53.3±5.8) and 12 months (62.8±7.2) compared to preoperative one. The magnet?ic resonance observation of cartilage repair tissue (MOCART) score was increased in 12 month(73.3±17.9)compared to preopera?tive one(51.5 ± 12.6). Conclusion MACI is a good technology for knee joint cartilage injury. It has a good clinical effect on re? pairing cartilage injury effectively and restoring the function of knee joint.

BACKGROUND:The methods used to repair articular cartilage defects currently have the cons and pros. Fibrocartilages are commonly used to repair tissues, and the fibrocartilage lacks of the tissue biomechanical properties and chemical properties of normal hyaline cartilage. OBJECTIVE:To investigate the feasibility of biological osteochondral xenogenic graft transplantation to repair articular cartilage defects. METHODS:The normal goats were randomly divided into two groups. The donor pig knee joints were the experimental group. Cylindrical osteochondral with the diameter of 4.5 mm and length of 10 mm were col ected with the Smith&Nephew osteochondral transplantation device, and the patented technology was used for deantigen. The donor goat knee joint osteochondrals were the control group and preserved with cryopreservation. The lesions on femoral trochlea and weight-bearing surface of medial condyle were selected respectively for osteochondral implantation, and the animals were sacrificed at 16 and 32 weeks after operation for the general and pathological section observation. RESULTS AND CONCLUSION:General observation in the experimental showed that the lesions were covered by fibroid tissue;some cartilage of the grafts turned yel ow and there was clear boundary between the surface and the peripheral cartilages;the general and section observation under microscope showed that lesions of the control group were covered by the grafts basical y, and cracks could be seen on the edge of the transplant part. The results show that there is difference between effects of biological osteochondral xenogenic graft transplantation and osteochondral al ograft transplantation for the repairing of articular cartilage defects, and osteochondral al ograft transplantation bas better effect.