Chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH) are both chronic progressive respiratory diseases that cannot be completely cured. COPD is characterized by irreversible airflow limitation, chronic airway inflammation, and gradual decline in lung function, whereas PH is characterized by pulmonary vasoconstriction, remodeling, and infiltration of inflammatory cells. These diseases have similar pathological features, such as vascular hyperplasia, arteriolar contraction, and inflammatory infiltration. Despite these well-documented observations, the exact mechanisms underlying the occurrence and development of COPD and PH remain unclear. Evidence that mitochondrial dynamics imbalance is one major factor in the development of COPD and PH. Mitochondrial dynamics is precisely regulated by mitochondrial fusion proteins and fission proteins. When mitochondrial dynamics equilibrium is disrupted, it causes mitochondrial and even cell morphological dysfunction. Mitochondrial dynamics participates in various pathological processes for heart and lung disease. Mitochondrial dynamics may be different in the early and late stages of COPD and PH. In the early stages of the disease, mitochondrial fusion increases, inhibiting fission, and thereby compensatorily increasing adenosine triphosphate (ATP) production. With the development of the disease, mitochondria decompensation causes excessive fission. Mitochondrial dynamics is involved in the development of COPD and PH in a spatiotemporal manner. Based on this understanding, treatment strategies for mitochondrial dynamics abnormalities may be different at different stages of COPD and PH disease. This article will provide new ideas for the potential treatment of related diseases.
Humans ; Mitochondrial Dynamics/physiology* ; Pulmonary Disease, Chronic Obstructive/metabolism* ; Hypertension, Pulmonary/metabolism* ; Mitochondria/metabolism* ; Animals

OBJECTIVE: To review and evaluate the advantages and disadvantages of minimally invasive treatment techniques for tibial plateau fractures (TPFs), as well as the research progress and limitations. METHODS: The relevant domestic and international research literature on the minimally invasive treatment of TPFs in recent years was reviewed. The advantages, disadvantages, and clinical efficacy of various technologies were summarized and analyzed, and an outlook on future development trends was provided. RESULTS: Surgery remains the primary method for treating displaced TPFs. Although traditional open reduction and internal fixation has advantages such as direct reduction and simplicity of procedure, it has gradually fallen out of favor with clinical orthopedic doctors due to extensive soft tissue removal, excessive bleeding, tissue adhesion, and postoperative complications such as skin infection, fracture nonunion, and joint dysfunction. As medical technology continues to develop, minimally invasive surgery and precise diagnosis and treatment are gradually being introduced to orthopedic trauma. Guided by concepts such as "minimally invasive treatment", "homeopathic repositioning of fractures", and "internal compression fixation", many traction reduction devices, internal fixation devices, minimally invasive reduction techniques, and computer-aided navigation technologies have been widely used in the clinical treatment of TPFs. This has greatly helped to overcome the challenges of intraoperative reduction, secondary reduction loss, and postoperative functional impairment and effectively promoting the adoption of minimally invasive treatment techniques in the clinical treatment of TPFs. CONCLUSION Minimally invasive treatment techniques have made significant progress in the clinical treatment of TPFs, particularly with regard to the reduction, and have demonstrated unique advantages. While relevant research results have received international recognition, there is still a need for orthopedic scholars to conduct real-world research to further explore the underlying principles and mechanisms of action.
Humans ; Minimally Invasive Surgical Procedures/instrumentation* ; Tibial Fractures/surgery* ; Fracture Fixation, Internal/instrumentation* ; Tibial Plateau Fractures

OBJECTIVE: To evaluate the effectiveness and safety of minimally invasive treatment for bilateral tibial plateau fractures using the double reverse traction reducer. METHODS: The clinical data of 4 patients with bilateral tibial plateau fractures who met the selection criteria and treated between January 2016 and April 2024 were retrospectively analyzed. The cohort included 3 males and 1 female, aged 30-65 years (mean, 52.5 years). Injury mechanisms comprised traffic accidents (2 cases) and falls (2 cases). According to the Schatzker classification, 2 limbs were type Ⅱ and 6 were type Ⅵ. The time from injury to surgery ranged from 5 to 9 days (mean, 7 days). All patients underwent minimally invasive reduction using the double reverse traction reducer. Surgical duration, intraoperative blood loss, and hospitalization time were recorded. Functional outcomes were assessed at last follow-up using the Hospital for Special Surgery (HSS) knee score and range of motion (ROM), while fracture reduction quality was evaluated using the Rasmussen radiological score. RESULTS: All 4 patients successfully completed the procedure without conversion to open reduction. The total mean operation time was 80.25 minutes (range, 73-86 minutes), with a mean total intraoperative blood loss of 132.5 mL (range, 100-150 mL). The mean hospitalization time was 13.5 days (range, 11-16 days). All incisions healed primarily without neurovascular complications. X-ray film at 1 day after operation confirmed satisfactory reduction and articular surface alignment. Follow-up time ranged from 12 to 26 months (mean, 17.0 months). Fractures achieved clinical union at an average of 13 weeks (range, 12-16 weeks). No complication, such as deep vein thrombosis, joint stiffness, post-traumatic arthritis, or implant failure, was observed. At last follow-up, the mean HSS score was 92.9 (range, 90-97), mean knee ROM was 128.1° (range, 115°-135°), and mean Rasmussen radiological score was 16.4 (range, 15-19), with 2 limbs rated as excellent and 6 as good. CONCLUSION The double reverse traction reducer facilitates minimally invasive treatment of bilateral tibial plateau fractures with advantages including minimal trauma, shorter surgical duration, precise reduction, and fewer complications, effectively promoting fracture healing and functional recovery of the knee joint.
Humans ; Tibial Fractures/diagnostic imaging* ; Middle Aged ; Male ; Minimally Invasive Surgical Procedures/instrumentation* ; Female ; Adult ; Retrospective Studies ; Aged ; Traction/methods* ; Treatment Outcome ; Fracture Fixation, Internal/instrumentation* ; Range of Motion, Articular ; Operative Time ; Tibial Plateau Fractures

OBJECTIVE: To investigate the biomechanical characteristics of Schatzker type Ⅱ tibial plateau fracture fixed by different bone grafting methods and internal fixations. METHODS: Twenty-four embalmed specimens of adult knee joint were selected to make Schatzker type Ⅱ tibial plateau fracture models, which were randomly divided into 8 groups (groups A1-D1 and groups A2-D2, n=3). After all the fracture models were restored, non-structural iliac crest bone grafts were implanted in group A1-D1, and structural iliac crest bone grafts in groups A2-D2. Following bone grafting, group A was fixed with a lateral golf locking plate, group B was fixed with lateral golf locking plate combined compression bolt, group C was fixed with lateral tibial "L"-shaped locking plate, and group D was fixed with lateral tibial "L"-shaped locking plate combined compression bolt. Compression and cyclic loading tests were performed on a biomechanical testing machine. A distal femur specimen or a 4-cm-diameter homemade bone cement ball were used as a pressure application mould for each group of models. The specimens were loaded with local compression at a rate of 10 N/s and the mechanical loads were recorded when the vertical displacement of the split bone block reached 2 mm. Then, compressive and cyclic loading tests were conducted on the fixed models of each group. The specimens were compression loaded to 100, 400, 700, and 1 000 N at a speed of 10 N/s to record the vertical displacement of the split bone block. The specimens were also subjected to cyclic loading at 5 Hz and 10 N/s within the ranges 100-300, 100-500, 100-700, and 100-1 000 N to record the vertical displacement of the split bone block at the end of the entire cyclic loading test. The specimens were subjected to cyclic loading tests and the vertical displacement of the split bone block was recorded at the end of the test. RESULTS: When the vertical displacement of the collapsed bone block reached 2 mm, the mechanical load of groups A2-D2 was significantly greater than that of groups A1-D1 ( P<0.05). The mechanical load of groups B and D was significantly greater than that of group A under the two bone grafting methods ( P<0.05); the local mechanical load of group D was significantly greater than that of groups B and C under the structural iliac crest bone grafts ( P<0.05). There was no significant difference ( P>0.05) in the vertical displacement of the split bone blocks between the two bone graft methods when the compressive load was 100, 400, 700 N and the cyclic load was 100-300, 100-500, 100-700 N in groups A-D. However, the vertical displacement of bone block in groups A1-D1 was significantly greater than that in groups A2-D2 ( P<0.05) when the compressive loading was 1 000 N and the cyclic load was 100-1 000 N. The vertical displacement of bone block in group B was significantly smaller than that in group A, and that in group D was significantly smaller than that in group C under the same way of bone graft ( P<0.05). CONCLUSION Compared with non-structural iliac crest bone grafts implantation, structural iliac crest bone grafts is more effective in preventing secondary collapse of Schatzker type Ⅱ tibial plateau fracture, and locking plate combined with compression bolt fixation can provide better articular surface support and resistance to axial compression, and the lateral tibial "L"-shaped locking plate can better highlight its advantages of "raft" fixation and show better mechanical stability.
Humans ; Bone Transplantation/methods* ; Tibial Fractures/physiopathology* ; Fracture Fixation, Internal/instrumentation* ; Biomechanical Phenomena ; Bone Plates ; Ilium/transplantation* ; Adult ; Tibia/surgery* ; Bone Cements ; Knee Joint/surgery* ; Male ; Tibial Plateau Fractures

Surgical treatment has been established as the standard method for the treatment of intertrochanteric fractures in the elderly. The design of internal fixation devices has become the key to improve surgical outcomes and reduce postoperative complications. Centered on optimizing biomechanical performance and minimally invasive implantation, coupled with continuous material improvements, the design philosophy of internal fixation devices has also been constantly evolving. There have been several milestone advancements, such as the transition from eccentric fixation to central fixation, the adoption of sliding compression fixation, the replacement of traditional screws with spiral blades, and the shift from single to double (combination) nails. However, the incidence of internal fixation-related complications has remained at a relatively high level of 5% to 10%, without significant breakthroughs. Increasing evidence suggests that in-depth analysis of the anatomy, physiological mechanisms, and mechanical transmission characteristics of the proximal femur can help elucidate the root causes of internal fixation failures. Based on this, the proximal femoral bionic nail (PFBN) has emerged as a new design concept. By fully mimicking the anatomical, mechanical, and biological characteristics of the proximal femur, the PFBN can regulate the local mechanical environment, providing a revolutionary solution and a new approach for the treatment of proximal femoral fractures. This innovative design also has the potential to drive the paradigm shift in the treatment strategies of other fractures.

Surgical treatment has been established as the standard method for the treatment of intertrochanteric fractures in the elderly. The design of internal fixation devices has become the key to improve surgical outcomes and reduce postoperative complications. Centered on optimizing biomechanical performance and minimally invasive implantation, coupled with continuous material improvements, the design philosophy of internal fixation devices has also been constantly evolving. There have been several milestone advancements, such as the transition from eccentric fixation to central fixation, the adoption of sliding compression fixation, the replacement of traditional screws with spiral blades, and the shift from single to double (combination) nails. However, the incidence of internal fixation-related complications has remained at a relatively high level of 5% to 10%, without significant breakthroughs. Increasing evidence suggests that in-depth analysis of the anatomy, physiological mechanisms, and mechanical transmission characteristics of the proximal femur can help elucidate the root causes of internal fixation failures. Based on this, the proximal femoral bionic nail (PFBN) has emerged as a new design concept. By fully mimicking the anatomical, mechanical, and biological characteristics of the proximal femur, the PFBN can regulate the local mechanical environment, providing a revolutionary solution and a new approach for the treatment of proximal femoral fractures. This innovative design also has the potential to drive the paradigm shift in the treatment strategies of other fractures.

Objective:To explore whether tryptophan metabolism is related to bone growth by comparing the differences in tryptophan metabolism after rotator cuff tear (RCT) repair between rats with normal bone remodeling capability and those with defective bone remodeling capability.Methods:Of the 50 adult female Sprague Dawley (SD) rats used for this study, 18 were randomly selected to undergo bilateral ovariectomy (OVX) (OVX group), and the remaining 32 underwent bilateral OVX sham surgery (sham surgery group). All rats were maintained in standard conditions. Three months after surgery, 4 rats were randomly selected from OVX group and the sham surgery group, respectively, for Micro CT identification of bone loss at the rat humeral head. The remaining rats in OVX group underwent RCT modeling and surgical repair of acute supraspinatus muscle transection (OVX+RCT group) ( n=14); the remaining rats in the sham surgery group were subjected to either surgical repair of acute supraspinatus muscle transection (RCT group, n=14) or RCT sham surgery (SO group, n=14). The grip power of the rats was tested 2 weeks after surgery. The supraspinatus tendon-bone complex was harvested for evaluation of new bone formation and growth through real-time fluorescence quantitative polymerase chain reaction (qPCR), hematoxylin eosin (HE) staining, and immunohistochemistry (IHC) staining. The tryptophan metabolism was analyzed using ultra high performance liquid chromatography (UPLC). Results:The grip power test showed that SO group had the greatest grip power, followed by RCT group and OVX+RCT group, with statistically significant differences between the 3 groups ( P<0.05). The qPCR showed that the relative expression of osteosclerosis in the tendon-bone complex in SO group was significantly higher than that in OVX+RCT group and RCT group; IHC staining showed that the relative expression of osteocalcin in RCT group was significantly higher than that in SO group and OVX+RCT group ( P<0.05). The UPLC showed that the content of tryptophan in the rotator cuff tendon-bone complex was similar among SO, RCT, and OVX+RCT groups, showing no significant difference ( P>0.05). The qPCR showed that the expression of indoleamine 2, 3-dioxygenase 2 in the Kynurenic acid metabolism pathway showed an increasing trend from SO group to RCT group to OVX+RCT group, with OVX+RCT group significantly higher than SO group ( P<0.05). The expression of 3-hydroxybenzoate 3, 4-dioxygenase in OVX+RCT group was significantly higher than that in RCT group and in SO group ( P<0.001). The subtypes A and B of monoamine oxidase in the 5-hydroxytryptamine metabolism pathway increased from SO group to RCT group to OVX+RCT group. The subtypes A and B of monoamine oxidase in the 5-hydroxytryptamine metabolism pathway increased among SO, RCT, and OVX+RCT groups( P<0.001). The expression of dopamine decarboxylase in the indole metabolism pathway in OVX+RCT group was significantly higher than that in SO group ( P<0.01). The expression of cytochrome P450 oxidoreductase increased from SO group to RCT group to OVX+RCT group ( P<0.001). Conclusions:The tryptophan metabolism in the supraspinatus tendon-bone complex after RCT in rats is mainly dominated by kynurenic acid metabolism, followed by 5-hydroxytryptamine metabolism. In RCT bone remodeling, the 5-hydroxytryptamine metabolic pathway changes the most, followed by the indole pathway. The contents of niacin and xanthurenic acid in the kynurenic acid metabolism pathway are related to bone growth; the 5-hydroxytryptamine, hydroxyindoleacetic acid, and melatonin in the 5-hydroxytryptophan metabolic pathway are related to bone growth; the tryptophan and indole lactate in the indole metabolism pathway are related to bone growth. Therefore, tryptophan metabolism is related to bone growth, providing potential therapeutic targets for RCT repair.

Objective:To compare the short-term efficacy between proximal femoral bionic nails (PFBN) and 3G Gamma nails in the fixation intertrochanteric femoral fractures in the elderly.Methods:A retrospective study was conducted to analyze the data of 78 elderly patients with intertrochanteric femoral fracture who had been admitted to Department of Trauma Surgery, The Hospital Affiliated to Qingdao University from October 2021 to December 2022. There were 35 males and 43 females with an age of (76.0±7.9) years. By Evans classification: 6 cases of type Ⅰ, 21 cases of type Ⅱ, 24 cases of type Ⅲ, 23 cases of type Ⅳ, and 4 cases of type Ⅴ. The patients were divided into 2 groups according to their internal fixation methods: a PFBN group of 35 patients fixed by PFBN and a Gamma group of 43 cases fixed with 3D Gamma nails. The time from injury to operation, hospital stay, operation time, intraoperative blood loss, weight-bearing time, fracture healing time, and Harris hip score, visual analogue scale (VAS) and incidence of complications at 6 months after operation were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). All patients were followed up for (14.0±4.0) months. There were no significant differences between the PFBN and Gamma groups in operation time [(58.9±8.2) min versus (58.1±6.8) min], intraoperative blood loss [(138.0±24.9) mL versus(126.8±25.7) mL], hospital stay [(10.9±2.9) d versus (10.3±4.0) d],fracture healing time [(5.0±1.3) months versus (5.1±1.3) months], or good and excellent rate by the Harris hip score [82.9% (29/35) versus 76.7% (33/43)], VAS score [0(0, 1) points versus 1(0, 1) points], or incidence of complications at 6 months after operation [2.9% (1/35) versus 4.7% (2/43)] (all P>0.05). However, the complete weight-bearing time for the PFBN group was (5.3±1.2) weeks, significantly earlier than that for the Gamma group [(6.9±1.4) weeks] ( P<0.05). Conclusion:In the fixation of intertrochanteric femoral fractures in the elderly patients, both PFBN and 3D Gamma nails can achieve satisfactory short-term efficacy, but PFBN is more beneficial to the functional recovery of the hip joint because it leads to earlier complete weight-bearing time than 3D Gamma nails.

Objective:To compare the therapeutic effects of intramedullary nail fixation, simple tibial plate fixation, and tibial plate + posterior-to-anterior screw fixation in the surgical treatment of lower 1/3 spiral fracture of the tibia combined with posterior malleolar fracture.Methods:A retrospective study was conducted to analyze the clinical data of 78 patients with lower 1/3 spiral fracture of the tibia combined with posterior malleolar fracture who had been treated at Department of Orthopedics, The Hospital Affiliated to Qingdao University from June 2015 to June 2022. There were 46 males and 32 females with an age of (48.9±14.6) years. The patients were divided into 3 groups according to their fixation methods. Group A (18 patients) underwent simple intramedullary nail fixation, group B (40 patients) simple tibial plate fixation, and group C (20 patients) tibial plate fixation for tibial fractures and posterior-to-anterior screw fixation for posterior malleolar fractures. The operation time, intraoperative blood loss, fracture union time, postoperative complications, as well as ankle-hindfoot scores of American Orthopaedic Foot and Ankle Society (AOFAS) and Baird-Jackson scores at pre- and post-operation were compared among the 3 groups.Results:The differences in the preoperative baseline data were not statistically significant among the 3 groups, indicating comparability ( P>0.05). All patients were followed up for (24.9±10.1) months. The fracture union time in Group A was 14.0(13.0, 14.0) weeks, significantly longer than that in groups B and C [13 (13, 14) weeks] ( P<0.05). The AOFAS ankle-hindfoot score and Baird-Jackson score at the last postoperative follow-up in all patients were better than those before surgery ( P<0.05). The AOFAS ankle-hindfoot scores at the last follow-up in groups B and C [95.5 (86.0, 96.0) points and 96.0 (89.5, 98.5) points] were significantly higher than that in group A [86.5 (78.0, 93.0) points] ( P<0.05), and the Baird-Jackson scores at the last follow-up in groups B and C [93.0 (88.8, 95.0) points and 95.0 (91.0, 98.0) points] were also significantly higher than that in group A [86.0 (78.0, 89.5) points] ( P<0.05). All the 7 cases of complications (3 ones of poor fracture union and 4 ones of anterior knee pain) were observed in group A. Conclusion:In the surgical treatment of lower 1/3 spiral fracture of the tibia combined with posterior malleolar fracture, tibial plate fixation and tibial plate + posterior-to-anterior screw fixation can achieved better therapeutic effects than intramedullary nail fixation.

Bone Transplantation/adverse effects* ; Transplantation, Autologous/adverse effects*