BACKGROUND:Bone marrow mesenchymal stem cells play a crucial role in treatment of diseases,such as femoral head necrosis,and the therapeutic efficacy is closely related to the quality of the cells.The empowerment of cells has become a research focus.OBJECTIVE:To investigate the effects of hypoxia mimetic dimethylglyoxal glycine pretreatment on mitophagy and differentiation capacity of human bone marrow mesenchymal stem cells.METHODS:Bone marrow mesenchymal stem cells were extracted from the bone marrow of patients' iliac crest and cultured in vitro to the third passage.The cells were treated with dimethylglyoxal glycine at 0,10,50,and 100 μmol/Lfor 24 hours,followed by the replacement with an osteogenic induction differentiation medium,which constituted the pretreatment group.The continuous treatment group was cultured directly in osteogenic induction medium containing 0,10,50,and 100 μmol/L dimethylglyoxal glycine after cell adhesion.After 7 days of induction,alkaline phosphatase staining was performed to select the most favorable conditions for osteogenic differentiation for subsequent experiments,with normally cultured bone marrow mesenchymal stem cells serving as the control group.Alkaline phosphatase staining,alkaline phosphatase activity,oil red O staining,and related RT-qPCR were used to evaluate the osteogenic and adipogenic differentiation differences of bone marrow mesenchymal stem cells between the two groups.MitoSox staining was used to detect mitochondrial reactive oxygen species levels.Mito-tracker and Lyso-tracker staining were used to detect the co-localization of mitochondria and lysosomes.The fluorescent probe JC-1 was used to measure mitochondrial membrane potential.RESULTS AND CONCLUSION:Alkaline phosphatase staining indicated that the most beneficial treatment for bone marrow mesenchymal stem cell osteogenesis was pretreatment with 10 μmol/L dimethylglyoxal glycine for 24 hours.Compared with the control group,the experimental group showed enhanced alkaline phosphatase staining expression,increased alkaline phosphatase activity and osteogenic gene expression,reduced lipid droplet formation and adipogenic gene expression as indicated by oil red O staining,decreased mitochondrial reactive oxygen species production,increased co-localization of mitochondria and lysosomes,and elevated mitochondrial membrane potential.The results suggest that 10 μmol/L dimethylglyoxal glycine pretreatment can promote osteogenic differentiation of bone marrow mesenchymal stem cells,inhibit adipogenic differentiation,and enhance mitophagy.

BACKGROUND:Bone marrow mesenchymal stem cells play a crucial role in treatment of diseases,such as femoral head necrosis,and the therapeutic efficacy is closely related to the quality of the cells.The empowerment of cells has become a research focus.OBJECTIVE:To investigate the effects of hypoxia mimetic dimethylglyoxal glycine pretreatment on mitophagy and differentiation capacity of human bone marrow mesenchymal stem cells.METHODS:Bone marrow mesenchymal stem cells were extracted from the bone marrow of patients' iliac crest and cultured in vitro to the third passage.The cells were treated with dimethylglyoxal glycine at 0,10,50,and 100 μmol/Lfor 24 hours,followed by the replacement with an osteogenic induction differentiation medium,which constituted the pretreatment group.The continuous treatment group was cultured directly in osteogenic induction medium containing 0,10,50,and 100 μmol/L dimethylglyoxal glycine after cell adhesion.After 7 days of induction,alkaline phosphatase staining was performed to select the most favorable conditions for osteogenic differentiation for subsequent experiments,with normally cultured bone marrow mesenchymal stem cells serving as the control group.Alkaline phosphatase staining,alkaline phosphatase activity,oil red O staining,and related RT-qPCR were used to evaluate the osteogenic and adipogenic differentiation differences of bone marrow mesenchymal stem cells between the two groups.MitoSox staining was used to detect mitochondrial reactive oxygen species levels.Mito-tracker and Lyso-tracker staining were used to detect the co-localization of mitochondria and lysosomes.The fluorescent probe JC-1 was used to measure mitochondrial membrane potential.RESULTS AND CONCLUSION:Alkaline phosphatase staining indicated that the most beneficial treatment for bone marrow mesenchymal stem cell osteogenesis was pretreatment with 10 μmol/L dimethylglyoxal glycine for 24 hours.Compared with the control group,the experimental group showed enhanced alkaline phosphatase staining expression,increased alkaline phosphatase activity and osteogenic gene expression,reduced lipid droplet formation and adipogenic gene expression as indicated by oil red O staining,decreased mitochondrial reactive oxygen species production,increased co-localization of mitochondria and lysosomes,and elevated mitochondrial membrane potential.The results suggest that 10 μmol/L dimethylglyoxal glycine pretreatment can promote osteogenic differentiation of bone marrow mesenchymal stem cells,inhibit adipogenic differentiation,and enhance mitophagy.

Robotic joint surgery (RJS) has demonstrated high precision and reproducibility in total hip and knee arthroplasty,the integration of artificial intelligence(AI) has further enhanced the intelligence level of key processes,including surgical planning,registration,surgical manipulator control,and robot autonomy. AI-powered surgical planning improves implant positioning accuracy through deep learning,while AI-powered registration overcomes the limitations of traditional methods in precision and efficiency. Additionally,reinforcement learning and neural networks have optimized surgical manipulator control,improving operational accuracy and human-robot interaction. As AI continues to advance,RJS is expected to make significant strides in automation,multimodal sensing,and human-robot collaboration,driving arthroplasty surgeries toward higher levels of intelligence and individual treatment.

Robotic joint surgery (RJS) has demonstrated high precision and reproducibility in total hip and knee arthroplasty,the integration of artificial intelligence(AI) has further enhanced the intelligence level of key processes,including surgical planning,registration,surgical manipulator control,and robot autonomy. AI-powered surgical planning improves implant positioning accuracy through deep learning,while AI-powered registration overcomes the limitations of traditional methods in precision and efficiency. Additionally,reinforcement learning and neural networks have optimized surgical manipulator control,improving operational accuracy and human-robot interaction. As AI continues to advance,RJS is expected to make significant strides in automation,multimodal sensing,and human-robot collaboration,driving arthroplasty surgeries toward higher levels of intelligence and individual treatment.

Objective To explore the clinical effectiveness of full endoscopic lamina fenestration discec-tomy(Endo-LOVE)in combination with nerve root pulsed radiofrequency(NR-PRF)in the treatment of lumbar degenerative disease(LDD),along with the amelioration of postoperative residual symptoms.Methods A retro-spective analysis was performed on 102 patients with LDD who were treated in our hospital between January 2022 and June 2023.Among them,53 cases were assigned to the observation group(receiving Endo-LOVE combined with NR-PRF),and 49 cases were included in the control group(undergoing Endo-LOVE alone).The mean follow-up period was 15.05±1.15 months.The general data of the two groups were compared.Observations were carried out at preoperative,1-day,7-day,1-month,3-month,6-month,and final follow-up time points postopera-tively.The perioperative data and follow-up outcomes of the two groups were compared.Results Prior to surgery,no significant disparities were detected in the general conditions and clinical observation indicators(VAS,M-JOA,and ODI scores)between the two groups.Postoperatively,both groups exhibited a notable improvement in clinical indicators when compared to the preoperative levels(P<0.05).Within three months after surgery,the observation group showed significantly more pronounced improvement in all clinical indicators than the control group(P<0.05).At six months postoperatively and during the final follow-up,no statistically significant differences in clinical indi-cators were found between the two groups.Moreover,at the final follow-up,there was no statistically significant difference in the Macnab scores between the two groups(P>0.05).Conclusion Endoscopic decompression for the treatment of LDD exhibits high safety and reliability.When combined with endoscopic NR-PRF,it enhances the clinical efficacy,reduces the incidence of postoperative residual symptoms,and facilitates rapid postoperative recovery.This complementary combination presents a novel therapeutic strategy for LDD.

Objective:To compare the protective effects of the static cold storage (SCS) and normothermic machine perfusion (NMP) on the skeletal muscle of the amputated limbs of pigs.Methods:Four Landrace pigs were selected, from which eight limbs were amputated and divided into SCS group ( n=5) and NMP group ( n=3) according to the random number table method. After blood collection from the carotid artery, an amputated limb model was established by amputating the limbs at the scapulohumeral joints. The limbs in the SCS group were wrapped in sterile cloth and stored at 4 ℃ for 24 hours. In the NMP group, the limbs were mechanically perfused with a red blood cell-containing perfusion fluid at 37 ℃ for 24 hours, with 70% of the perfusion fluid replaced every 6 hours. Before the experiment, cross-matching tests with the saline medium were conducted between donor and recipient pigs to evaluate blood coagulation and blood safety in the NMP group. An allogeneic red blood cell perfusion fluid was prepared and the levels of pH, Na +, K +, Cl -, Ca 2+, glucose (Glu), hematocrit (Hct), lactic acid (Lac) and osmotic pressure of the perfusion fluid were measured. At 0, 6, 12, 18, and 24 hours after perfusion, the skin temperature and oxyhemoglobin saturation (SaO 2) levels in the NMP group were monitored and the levels of pH, Glu, creatine kinase (Ck), K +, Ca 2+, and Na +levels of the perfusion fluid were analyzed to evaluate the metabolism of the skeletal muscle in the amputated limbs. The mean intercellular distance and apoptosis index of the myocytes were quantitatively analyzed and histopathological changes were observed by performing HE staining and TUNEL staining on the skeletal muscle of the amputated limbs in both groups at 0 and 24 hours after perfusion. After perfusion was ended, the weight gain rate and swelling degree of the amputated limbs were compared between the two groups and the overall state of the amputated limbs was evaluated. Results:The result of the cross-matching test between donor and recipient pig blood was negative. The parameters in the prepared red blood cell-containing perfusion fluid generally maintained within a normal range: pH 7.38±0.04, Na + concentration (138.30±4.48)mmol/L, K + concentration (3.50±0.26)mmol/L, Glu concentration (6.11±2.08)mmol/L, and osmotic pressure (305.67±3.79)mmol/L. However, slightly higher Cl - and Ca 2+ concentrations [(118.34±12.00)mmol/L and (2.00±0.15)mmol/L] and lower Hct and lactate concentrations [0.30±0.03 and (1.54±0.38)mmol/L] were detected when compared with the reference range. During the perfusion, the average skin temperature of the amputated limbs in the NMP group was (36.13±0.98)℃, with the skin temperatures at 6, 12, 18, and 24 hours after perfusion being significantly higher than that at 0 hour ( P<0.01), while no significant difference among the skin temperatures at 6, 12, 18, and 24 hours after perfusion was observed ( P>0.05). The SaO 2 levels in the skin of the amputated limbs in the NMP group averaged over 95%, which showed no significant difference at 0, 12, 18, and 24 hours after perfusion ( P>0.05), while a significant elevation was observed at 6 hours compared with that at 0 hour ( P<0.05). There were no significant differences in pH, Glu, Na +, and Ca 2+ levels in the NMP group at 0, 6, 12, 18, and 24 hours after perfusion ( P>0.05), while the Ck levels at 18 and 24 hours were both significantly higher than that at 6 hours after perfusion ( P<0.05), and the Ck levels at 6, 12, 18, and 24 hours were all significantly higher than that at 0 hour ( P<0.05). The K + level progressively increased with the perfusion time, with significant elevations at 18 and 24 hours after perfusion compared with that at 0 hour ( P<0.05). HE staining revealed well-preserved muscle fiber continuity and regular arrangement in the NMP group and the SCS group at 0 hour, with an intercellular distance of (8.95±0.60)μm. At 24 hours, the NMP group exhibited slight skeletal muscle fiber rupture and swelling, with a slightly increased intercellular distance of (14.75±0.90)μm, significantly greater than that at 0 hour ( P<0.01). At 24 hours, the SCS group showed marked skeletal muscle fiber rupture and swelling, with a significantly increased intercellular distance of (23.51±1.49)μm, significantly larger than those at 0 hour in the same group and at 24 hours in the NMP group ( P<0.01). TUNEL immunofluorescence staining indicated a tiny amount of apoptotic cells in the skeletal muscle in both groups at 0 hour, with an apoptotic index of (4.26±1.62)%. There was a small number of apoptotic cells in the skeletal muscle in the NMP group at 24 hours, with an apoptotic index of (25.94±2.69)%, significantly larger than that in the same group at 0 hour ( P<0.01). The SCS group exhibited a large number of apoptotic cells at 24 hours, with an apoptotic index of (62.97±3.22)%, significantly larger than those at 0 hour in the same group and at 24 hours in the NMP group ( P<0.01). In comparison with the SCS group at 24 hours, the amputated limbs in the NMP group showed red color in the appearance, no symptoms of ischemic muscle contracture and good joint movement despite slight edema in the subcutaneous layer. At 24 hours, the weight gain rate of the amputated limbs was (15.82±0.89)% in the NMP group, significantly higher than (0.97±0.28)% in the SCS group ( P<0.01). Conclusion:Compared with SCS, NMP with the red blood cell-containing perfusion fluid prepared with the allogeneic blood for the amputated limbs of pigs can alleviate the ischemic injury of the muscle fibers and inhibit the apoptosis of the muscle cells by sustaining stable energy and oxygen supply and balancing ion homeostasis and pH of the perfusion fluid.

Objective:To explore and practice the construction of an innovative ecosystem that integrates innovation in the National Clinical Research Center for Orthopedics and Sports Rehabilitation, providing references and insights for driving high-quality development of medical care.Methods:Guided by a national policy framework and Industry-Academia-Research-Government-Enterprise Collaborative Innovation, the Center had established six innovation platforms and three systemic pillars. The study analyzed its integrated strategy, which encompassed ecosystem design, platform-enabled empowerment, comprehensive system support, end-to-end coverage, a folded innovation approach, and a standardization-driven mechanism.Results:The Center had built a highly integrated innovation ecosystem, creating a powerful driver for technological advancement and commercialization in orthopedics and sports rehabilitation, accelerating the industrialization of key technologies like surgical robots and 3D-printed implants.Conclusions:Guided by the principle of ″simplifying complex surgeries and standardizing common procedures″, the Center will leverage digital intelligence throughout clinical care, aiming to bridge gaps in healthcare quality so that patients can receive top-tier treatment for major diseases within their home provinces. This commitment to homogenized, high-quality care presents a ″China Model″ for global health and advance the national ″Healthy China″ initiative.

The landscape of modern warfare is undergoing profound transformation. With the large-scale, clustered application of high-kinetic weapon systems and intelligent munitions, combat trauma has exhibited distinct characteristics: diversified injury patterns, a significant increase in the proportion of complex injuries, a drastically shortened golden window for treatment, more stringent time-critical requirements, and highly fragmented allocation of medical resources. These emerging trends pose systemic challenges to traditional combat trauma care systems, highlighting deficiencies including delayed injury assessment, experience-dependent medical decision-making, and low efficiency in multi-link coordination. Intelligent technologies for combat trauma care, underpinned by artificial intelligence, the Internet of Things, robotics, and brain-computer interfaces, offer new pathways to address the limitations of traditional care systems. Starting from the new challenges in modern combat trauma care, the author elaborated on the application of intelligent orthopedics across key stages including pre-hospital, in-hospital, and post-hospital care, identified potential issues and countermeasures, aiming to provide theoretical and practical references for the development of an intelligent combat trauma care system.

Objective To investigate the role of the ROS/NLRP3/Caspase-1 pyroptosis signaling pathway in mediating the inflammatory response of nerve roots in a rabbit model of lumbar disc herniation(LDH)following acupotomy intervention.Methods Forty New Zealand white rabbits were randomly assigned to four groups:a blank control group(10 rabbits),a model control group(10 rabbits),an electroacupuncture intervention group(positive control group,10 rabbits),and an acupotomy intervention group(10 rabbits).The LDH nerve root inflammatory response model was established in the model control group,electroacupuncture intervention group,and acupotomy intervention group using the classical autologous nucleus pulposus transplantation method.Following successful model establishment,corresponding interventions were administered.Dorsal root ganglion tissues were then collected for analysis.Reactive oxygen species levels were assessed using fluorescent probe staining.The expression of NLRP3 inflammasome-related proteins(NLRP3,ASC,GSDMD-N,and Caspase-1)was evaluated by Western blot.Mitochondrial permeability transition pore opening was assessed via Calcein AM staining.Results The comparison of relative fluorescence intensity of reactive oxygen species in dorsal root ganglion tissue among the groups indicated that the model control group exhibited significantly higher levels compared to the blank control group(P＜0.05).Both the electroacupuncture intervention group and the acupotomy intervention group demon-strated significantly lower levels than the model control group(P＜0.05).Western blot analysis revealed that the expression levels of NLRP3,ASC,GSDMD-N,and Caspase-1 in the model control group were significantly elevated compared to those in the blank control group(P＜0.05).Both intervention groups showed markedly reduced expression of these proteins compared to the model control group(P＜0.05).Additionally,the assessment of mito-chondrial permeability transition pore activity based on relative fluorescence intensity showed a significant increase in the model control group compared to the blank control group(P＜0.05),with both intervention groups exhibiting significantly lower levels than the model control group(P＜0.05).Conclusions Acupotomy therapy modulates the ROS/NLRP3/Caspase-1 signaling pathway,thereby inhibiting pyroptosis and attenuating the inflammatory response in nerve roots.This elucidates the potential molecular mechanism underlying the therapeutic effects of acupotomy on LDH through the regulation of ROS/NLRP3/Caspase-1-mediated downstream signaling cascades.

Objective:To compare the protective effects of the static cold storage (SCS) and normothermic machine perfusion (NMP) on the skeletal muscle of the amputated limbs of pigs.Methods:Four Landrace pigs were selected, from which eight limbs were amputated and divided into SCS group ( n=5) and NMP group ( n=3) according to the random number table method. After blood collection from the carotid artery, an amputated limb model was established by amputating the limbs at the scapulohumeral joints. The limbs in the SCS group were wrapped in sterile cloth and stored at 4 ℃ for 24 hours. In the NMP group, the limbs were mechanically perfused with a red blood cell-containing perfusion fluid at 37 ℃ for 24 hours, with 70% of the perfusion fluid replaced every 6 hours. Before the experiment, cross-matching tests with the saline medium were conducted between donor and recipient pigs to evaluate blood coagulation and blood safety in the NMP group. An allogeneic red blood cell perfusion fluid was prepared and the levels of pH, Na +, K +, Cl -, Ca 2+, glucose (Glu), hematocrit (Hct), lactic acid (Lac) and osmotic pressure of the perfusion fluid were measured. At 0, 6, 12, 18, and 24 hours after perfusion, the skin temperature and oxyhemoglobin saturation (SaO 2) levels in the NMP group were monitored and the levels of pH, Glu, creatine kinase (Ck), K +, Ca 2+, and Na +levels of the perfusion fluid were analyzed to evaluate the metabolism of the skeletal muscle in the amputated limbs. The mean intercellular distance and apoptosis index of the myocytes were quantitatively analyzed and histopathological changes were observed by performing HE staining and TUNEL staining on the skeletal muscle of the amputated limbs in both groups at 0 and 24 hours after perfusion. After perfusion was ended, the weight gain rate and swelling degree of the amputated limbs were compared between the two groups and the overall state of the amputated limbs was evaluated. Results:The result of the cross-matching test between donor and recipient pig blood was negative. The parameters in the prepared red blood cell-containing perfusion fluid generally maintained within a normal range: pH 7.38±0.04, Na + concentration (138.30±4.48)mmol/L, K + concentration (3.50±0.26)mmol/L, Glu concentration (6.11±2.08)mmol/L, and osmotic pressure (305.67±3.79)mmol/L. However, slightly higher Cl - and Ca 2+ concentrations [(118.34±12.00)mmol/L and (2.00±0.15)mmol/L] and lower Hct and lactate concentrations [0.30±0.03 and (1.54±0.38)mmol/L] were detected when compared with the reference range. During the perfusion, the average skin temperature of the amputated limbs in the NMP group was (36.13±0.98)℃, with the skin temperatures at 6, 12, 18, and 24 hours after perfusion being significantly higher than that at 0 hour ( P<0.01), while no significant difference among the skin temperatures at 6, 12, 18, and 24 hours after perfusion was observed ( P>0.05). The SaO 2 levels in the skin of the amputated limbs in the NMP group averaged over 95%, which showed no significant difference at 0, 12, 18, and 24 hours after perfusion ( P>0.05), while a significant elevation was observed at 6 hours compared with that at 0 hour ( P<0.05). There were no significant differences in pH, Glu, Na +, and Ca 2+ levels in the NMP group at 0, 6, 12, 18, and 24 hours after perfusion ( P>0.05), while the Ck levels at 18 and 24 hours were both significantly higher than that at 6 hours after perfusion ( P<0.05), and the Ck levels at 6, 12, 18, and 24 hours were all significantly higher than that at 0 hour ( P<0.05). The K + level progressively increased with the perfusion time, with significant elevations at 18 and 24 hours after perfusion compared with that at 0 hour ( P<0.05). HE staining revealed well-preserved muscle fiber continuity and regular arrangement in the NMP group and the SCS group at 0 hour, with an intercellular distance of (8.95±0.60)μm. At 24 hours, the NMP group exhibited slight skeletal muscle fiber rupture and swelling, with a slightly increased intercellular distance of (14.75±0.90)μm, significantly greater than that at 0 hour ( P<0.01). At 24 hours, the SCS group showed marked skeletal muscle fiber rupture and swelling, with a significantly increased intercellular distance of (23.51±1.49)μm, significantly larger than those at 0 hour in the same group and at 24 hours in the NMP group ( P<0.01). TUNEL immunofluorescence staining indicated a tiny amount of apoptotic cells in the skeletal muscle in both groups at 0 hour, with an apoptotic index of (4.26±1.62)%. There was a small number of apoptotic cells in the skeletal muscle in the NMP group at 24 hours, with an apoptotic index of (25.94±2.69)%, significantly larger than that in the same group at 0 hour ( P<0.01). The SCS group exhibited a large number of apoptotic cells at 24 hours, with an apoptotic index of (62.97±3.22)%, significantly larger than those at 0 hour in the same group and at 24 hours in the NMP group ( P<0.01). In comparison with the SCS group at 24 hours, the amputated limbs in the NMP group showed red color in the appearance, no symptoms of ischemic muscle contracture and good joint movement despite slight edema in the subcutaneous layer. At 24 hours, the weight gain rate of the amputated limbs was (15.82±0.89)% in the NMP group, significantly higher than (0.97±0.28)% in the SCS group ( P<0.01). Conclusion:Compared with SCS, NMP with the red blood cell-containing perfusion fluid prepared with the allogeneic blood for the amputated limbs of pigs can alleviate the ischemic injury of the muscle fibers and inhibit the apoptosis of the muscle cells by sustaining stable energy and oxygen supply and balancing ion homeostasis and pH of the perfusion fluid.