OBJECTIVE To conduct a reevaluation of the systematic review （SR）/meta-analysis on the use of Xianling gubao capsules （XLGBC） for knee osteoarthritis （KOA）， and provide evidence-based support for the clinical use of the drugs. METHODS Computerized searches including CNKI， Wanfang Data， VIP， China Biomedical Literature Database， the Cochrane Library， PubMed， Embase and Web of Science were conducted to collect systematic reviews （SR） or meta-analyses of XLGBC for the treatment of KOA from the inception to May 31st， 2024. The report quality， methodological quality， risk of bias and evidence quality were assessed using the PRISMA 2020 statement， AMSTAR 2 scale， ROBIS tool and GRADE tool， respectively. A comprehensive quality analysis of the quantitative results from the SR/meta-analysis was also performed. RESULTS A total of five SR/meta-analyses were included. The evaluation results based on the PRISMA 2020 statement showed that one study report was relatively complete （21 points）， while four studies had deficiencies （18-20 points）. The assessment using the AMSTAR 2 scale indicated that the methodological quality of all five studies was rated as very low. According to the ROBIS tool evaluation， the risk of comprehensive bias in all five studies was classified as high. GRADE tool evaluation revealed that among 49 outcome indicators， 5 （10.2%） were rated as moderate-quality evidence （10.2%）， 12 as low-quality evidence （24.5%）， and 32 as very low-quality evidence （65.3%）. The results of comprehensive quality analysis showed that the clinical efficacy， visual analogue scale score， pain relief time， comprehensive indexes of knee joint function， the levels of inflammatory factors and the incidence of adverse events in patients with XLGBC combined with conventional treatment were significantly better than conventional treatment alone （P＜0.05）. CONCLUSIONS Compared with conventional treatment， XLGBC in combination with conventional treatment for KOA may have some efficacy and safety advantages. However， due to the low quality of evidence for the outcome indicators included in the studies， the conclusions should be interpreted with caution.

OBJECTIVE To conduct a reevaluation of the systematic review （SR）/meta-analysis on the use of Xianling gubao capsules （XLGBC） for knee osteoarthritis （KOA）， and provide evidence-based support for the clinical use of the drugs. METHODS Computerized searches including CNKI， Wanfang Data， VIP， China Biomedical Literature Database， the Cochrane Library， PubMed， Embase and Web of Science were conducted to collect systematic reviews （SR） or meta-analyses of XLGBC for the treatment of KOA from the inception to May 31st， 2024. The report quality， methodological quality， risk of bias and evidence quality were assessed using the PRISMA 2020 statement， AMSTAR 2 scale， ROBIS tool and GRADE tool， respectively. A comprehensive quality analysis of the quantitative results from the SR/meta-analysis was also performed. RESULTS A total of five SR/meta-analyses were included. The evaluation results based on the PRISMA 2020 statement showed that one study report was relatively complete （21 points）， while four studies had deficiencies （18-20 points）. The assessment using the AMSTAR 2 scale indicated that the methodological quality of all five studies was rated as very low. According to the ROBIS tool evaluation， the risk of comprehensive bias in all five studies was classified as high. GRADE tool evaluation revealed that among 49 outcome indicators， 5 （10.2%） were rated as moderate-quality evidence （10.2%）， 12 as low-quality evidence （24.5%）， and 32 as very low-quality evidence （65.3%）. The results of comprehensive quality analysis showed that the clinical efficacy， visual analogue scale score， pain relief time， comprehensive indexes of knee joint function， the levels of inflammatory factors and the incidence of adverse events in patients with XLGBC combined with conventional treatment were significantly better than conventional treatment alone （P＜0.05）. CONCLUSIONS Compared with conventional treatment， XLGBC in combination with conventional treatment for KOA may have some efficacy and safety advantages. However， due to the low quality of evidence for the outcome indicators included in the studies， the conclusions should be interpreted with caution.

PURPOSE: End-stage knee osteoarthritis (OA) patients are the primary candidates for total knee arthroplasty (TKA). However, most morphological refinements of TKA prosthesis are based on anatomical data from the knees of healthy individuals. This study aimed to determine whether differences exist in key bony morphological characteristics of the distal femur and proximal tibia between osteoarthritic knees and healthy knees. METHODS: This was a retrospective cross-sectional observational study with a case-control design. Patients who were aged ≥ 50 years, had no history of trauma, fracture, or surgery in the studied knee, and had no obvious knee flexion contracture were included in this study by CT scans. Patients who met the American College of Rheumatology clinical criteria for knee OA were included in the study group. Kellgren-Lawrence grade III or IV knees were studied (for bilateral cases, the more severely affected knee was chosen). Patients who presented with unilateral knee pain or trauma were included in the control group, with CT scans from the opposite (asymptomatic) knee used for analyzing. The studied knee had a Kellgren-Lawrence grade of 0 or I and showed no abnormalities upon physical examination. Archived knee CT scans from 160 patients were divided into 2 groups: the study group (80 moderate-to-severe OA knees) and the control group (80 healthy knees). After 3-dimensional reconstruction and virtual cutting using a CT workstation, 13 morphological parameters of the distal femur and proximal tibia were compared between the 2 groups using independent-samples t-tests. RESULTS: No significant group differences in the femoral anteroposterior dimension (p = 0.797), height of the lateral femoral condyle (p = 0.268), posterior condylar angle (p = 0.240), tibial anteroposterior dimension (p = 0.536), or tibial lateral anteroposterior dimension (p = 0.702) were observed. However, the femoral mediolateral dimension (p = 0.002), distal femoral aspect ratio (femoral mediolateral dimension/femoral anteroposterior dimension) (p < 0.001), height of the femoral trochlear groove (p < 0.001), height of the medial femoral condyle (p < 0.001), tibial mediolateral dimension (p = 0.001), proximal tibial aspect ratio (tibial mediolateral dimension/tibial anteroposterior dimension) (p = 0.004), tibial medial anteroposterior dimension (p = 0.005), and tibial asymmetry ratio (tibial medial anteroposterior dimension/tibial lateral anteroposterior dimension) (p = 0.006) were all significantly greater in the study group. CONCLUSION Knees with moderate-to-severe OA are significantly wider than healthy knees, and OA is a risk factor for increased tibial platform asymmetry. When refining the morphological parameters of TKA prostheses, the specific bony morphological characteristics of OA knees should be taken into account to reduce the potential risk of femoral or tibial component underhang and facilitate optimal balance between tibial component fit and rotational alignment.
Humans ; Osteoarthritis, Knee/pathology* ; Male ; Female ; Cross-Sectional Studies ; Retrospective Studies ; Arthroplasty, Replacement, Knee ; Middle Aged ; Aged ; Case-Control Studies ; Prosthesis Design ; Knee Prosthesis ; Femur/anatomy & histology* ; Tibia/anatomy & histology* ; Tomography, X-Ray Computed ; Knee Joint/diagnostic imaging*

Objective To investigate the causal relationship between gut microbiota and pigmented villonodular synovitis using Mendelian randomization analysis.Methods We conducted a two-sample Mendelian randomization analysis to investigate the causal relationship between 211 gut microbiome taxa and pigmented villonodular synovitis based on GWAS summary data,with inverse variance weighted(IVW)analysis as the primary result and the other methods as supplementary analyses.The reliability of the results was tested using Cochran's Q test,MR-Egger regression,MR-PRESSO method and conditional Mendelian randomization analysis(cML-MA).Results The increased abundance of Barnesiella(OR=3.12,95%CI:1.15-8.41,P=0.025)and Rumatococcaceae UCG010(OR=4.03,95%CI:1.19-13.68,P=0.025)may increase the risk of pigmented villous nodular synovitis,and elevated abundance of Lachnospiraceae(OR=0.33,95%CI:0.12-0.91,P=0.032),Alistipes(OR=0.16,95%CI:0.05-0.53,P=0.003),Blautia(OR=0.20,95%CI:0.06-0.61,P=0.005),and Lachnospiraceae FCS020 group(OR=0.38,95%CI:0.15-0.94,P=0.036)and Ruminococcaceae UCG014(OR=0.36,95%CI:0.14-0.94,P=0.037)were all associated with a reduced risk of pigmented villonodular synovitis,which were supported by the results of sensitivity analyses.Reverse Mendelian randomization analysis did not reveal any inverse causal association.Conclusion Increased abundance of specific intestinal microorganisms is associated with increased or decreased risks of developing hyperpigmented villonodular synovitis,and gut microbiota plays an important role in the pathogenesis of this disease.

Objective To investigate the causal relationship between gut microbiota and pigmented villonodular synovitis using Mendelian randomization analysis.Methods We conducted a two-sample Mendelian randomization analysis to investigate the causal relationship between 211 gut microbiome taxa and pigmented villonodular synovitis based on GWAS summary data,with inverse variance weighted(IVW)analysis as the primary result and the other methods as supplementary analyses.The reliability of the results was tested using Cochran's Q test,MR-Egger regression,MR-PRESSO method and conditional Mendelian randomization analysis(cML-MA).Results The increased abundance of Barnesiella(OR=3.12,95%CI:1.15-8.41,P=0.025)and Rumatococcaceae UCG010(OR=4.03,95%CI:1.19-13.68,P=0.025)may increase the risk of pigmented villous nodular synovitis,and elevated abundance of Lachnospiraceae(OR=0.33,95%CI:0.12-0.91,P=0.032),Alistipes(OR=0.16,95%CI:0.05-0.53,P=0.003),Blautia(OR=0.20,95%CI:0.06-0.61,P=0.005),and Lachnospiraceae FCS020 group(OR=0.38,95%CI:0.15-0.94,P=0.036)and Ruminococcaceae UCG014(OR=0.36,95%CI:0.14-0.94,P=0.037)were all associated with a reduced risk of pigmented villonodular synovitis,which were supported by the results of sensitivity analyses.Reverse Mendelian randomization analysis did not reveal any inverse causal association.Conclusion Increased abundance of specific intestinal microorganisms is associated with increased or decreased risks of developing hyperpigmented villonodular synovitis,and gut microbiota plays an important role in the pathogenesis of this disease.

Objective:To develop the Nutrition Impact Symptom Scale for Colorectal Cancer Patients.Methods:Guided by the theory of unpleasant symptoms, the initial draft of the scale was formed through literature research, expert consultation, and small sample pre-survey. From March to May 2023, convenience sampling was used to select 127 colorectal cancer patients who visited Jiangsu Cancer Hospital as the research subject for item analysis and reliability and validity testing of the scale.Results:The final scale consisted of five dimensions and a total of 17 items. The content validity index of the scale was from 0.83 to 1.00, with an average content validity index of 0.97. Exploratory factor analysis extracted five common factors, and the cumulative variance contribution rate was 61.622%. The total Cronbach's α coefficient of the scale was 0.708, and the coefficients for each dimension were 0.762, 0.642, 0.625, 0.510, and 0.644, respectively. The half reliability coefficient of the scale was 0.824.Conclusions:The development process of the Nutrition Impact Symptom Scale for Colorectal Cancer Patients is scientific, with good reliability and validity, and can be used to evaluate the nutrition impact symptom of colorectal cancer patients.

Objective:To explore the effect of knee arthroscopic operation training simulation system in clinical teaching of traditional Chinese medicine osteomatology resident doctor standardized training students.Methods:A total of 40 trainees were selected in Department of Orthopedics and Traumatology of the First Affiliated Hospital of Tianjin University of Chinese Medicine from January 2023 to September 2023. The trainees were divided into an experimental group and a control group according to the random number table method, with 20 in each group. Trainees in the control group was taught by presentations and video demonstrations. Trainees in the experimental group was taught by knee arthroscopic operation training simulation system. Trainees in each group were taught by a same teacher for a total of 2 weeks, with 2 class hours per week. After the teaching, the results of the assessment of theoretical knowledge, the results of the questionnaire survey on the mastery of teaching content and the results of the questionnaire survey on the evaluation of teaching methods were recorded. Then compared the results between the two groups.Results:Compared with the control group, there was no significant difference in the initial theoretical assessment scores between the two groups ( P > 0.05). The improvement rate of the test group was higher than that of the control group, with statistical significance ( P < 0.05). In terms of the mastery of teaching content, the experimental group was higher than the control group in three aspects: whether the teaching method was beneficial to the study of knee anatomy, imaging and surgical procedure, the difference was statistically significant ( P < 0.05); whether the teaching method was beneficial to the study of the selection of surgical indications, there was no statistically significant difference between the two groups ( P > 0.05). In the evaluation of teaching methods, there was no significant difference in the scores of teaching participation between the two groups ( P > 0.05), and the scores of the experimental group in six aspects of teaching interest, teaching effectiveness, teaching understanding, learning initiative, teaching course evaluation and course satisfaction were higher than those of the control group, with statistical significance ( P < 0.05). Conclusions:The application of knee arthroscopic operation training simulation operating system can significantly improve the theoretical achievements of traditional Chinese medicine bone injury training students, which is beneficial to master clinical teaching content and improve clinical teaching satisfaction.

Objective:To provide references for the application of finite element model in the study of cervical vertebra by statistically analysing the frequency, numerical value, properties, and boundary setting of the finite element model and the corresponding material features as well as boundary settings in the literature.Methods:The literature on cervical vertebra-related finite element models was collected from CNKI, Wanfang, VIP, PubMed, Web of Science, and Embase databases from January 2013 to December 2023. The quality assessment was followed by manual screening. The data sources, application classification, material properties (Young’s modulus and Poisson’s ratio), and boundary conditions of cervical vertebra, cervical intervertebral, and cervical ligaments were statistically analyzed.Results:A total of 102 papers were included. The finite element models of the cervical vertebra were derived from medical image reconstruction modeling techniques, predominantly CT plain scan and magnetic resonance imaging. Among the 102 cervical vertebra models, the C3-C7 (lower cervical segment) model appeared with the highest frequency (19). The Young’s modulus of the cortical bone, cancellous bone, and posterior structure of cervical vertebrae were set at about 12 000 or 10 000, 440, and 3 600 MPa, respectively, and the Poisson’s ratios were mainly set at about 0.29 or 0.30, 0.29, and 0.29. The Young’s modulus of the cervical intervertebral disc endplate, nucleus pulposus, and annulus fibrosus were concentrated around 500 or 2 000, 1, and 100 MPa, respectively, and the Poisson’s ratios were set at about 0.40, 0.50, and 0.40, respectively. The Young’s modulus of the anterior longitudinal ligament, posterior longitudinal ligament, transverse ligament, ligamentum flavum, interspinous ligament, capsular ligament, and articular cartilage of the cervical spine were set around 30, 20, 20, 6-10, 4-8, 10 or 20, 10 MPa, and the Poisson’s ratios were set at aoubt 0.30, 0.30, 0.30, 0.30, 0.30, 0.40, and 0.30, respectively. The Young’s modulus of the upper cervical interdental ligament, lamina, cruciate ligament, nuchal ligament, and pterygoid ligament were set at about 10, 10, 10 or 20, 20, and 5 MPa, respectively, and the Poisson’s ratios were set at about 0.30. Head weight settings were more common at 50, 74, and 100 N.Conclusions:The finite element model of the cervical vertebra has great value in the study of cervical spondylosis, but further optimization is still needed in the assignment of material properties, mesh division, and model verification to improve the accuracy and clinical applicability of the model.

BACKGROUND:Based on different algorithms of machine learning,how to carry out clinical research on lumbar disc herniation with the help of various algorithmic models has become a trend and hot spot in the development of intelligent medicine at present. OBJECTIVE:To review the characteristics of different algorithmic models of machine learning in the diagnosis and treatment of lumbar disc herniation,and summarize the respective advantages and application strategies of algorithmic models for the same purpose. METHODS:The computer searched PubMed,Web of Science,EMBASE,CNKI,WanFang,VIP and China Biomedical(CBM)databases to extract the relevant articles on machine learning in the diagnosis and treatment of lumbar disc herniation.Finally,96 articles were included for analysis. RESULTS AND CONCLUSION:(1)Different algorithm models of machine learning provide intelligent and accurate application strategies for clinical diagnosis and treatment of lumbar disc herniation.(2)Traditional statistical methods and decision trees in supervised learning are simple and efficient in exploring risk factors and establishing diagnostic and prognostic models.Support vector machine is suitable for small data sets with high-dimensional features.As a nonlinear classifier,it can be applied to the recognition,segmentation and classification of normal or degenerative intervertebral discs,and to establish diagnostic and prognostic models.Ensemble learning can make up for the shortcomings of a single model.It has the ability to deal with high-dimensional data and improve the precision and accuracy of clinical prediction models.Artificial neural network improves the learning ability of the model,and can be applied to intervertebral disc recognition,classification and making clinical prediction models.On the basis of the above uses,deep learning can also optimize images and assist surgical operations.It is the most widely used model with the best performance in the diagnosis and treatment of lumbar disc herniation.The clustering algorithm in unsupervised learning is mainly used for disc segmentation and classification of different herniated segments.However,the clinical application of semi-supervised learning is relatively less.(3)At present,machine learning has certain clinical advantages in the identification and segmentation of lumbar intervertebral discs,classification and grading of the degenerative intervertebral discs,automatic clinical diagnosis and classification,construction of the clinical predictive model and auxiliary operation.(4)In recent years,the research strategy of machine learning has changed to the neural network and deep learning,and the deep learning algorithm with stronger learning ability will be the key to realizing intelligent medical treatment in the future.

BACKGROUND:Anterior cruciate ligament rupture is one of the injuries that seriously affect life and sports performance,and the anterior cruciate ligament as a stabilizing structure is irreplaceable in maintaining sports performance.In view of its severe injury manifestations,the current treatment for anterior cruciate ligament rupture is a surgery for anterior cruciate ligament reconstruction.Since an anterior cruciate ligament injury can cause loss of mechanoreceptors,which in turn causes a reduction in proprioception,it is a great problem for patients to recover their motor performance. OBJECTIVE:To summarize the effects of proprioceptive training on clinical outcomes after anterior cruciate ligament reconstruction and to explore the underlying mechanisms,thereby providing more references for clinical prevention and treatment. METHODS:A computerized search of PubMed,CNKI,WanFang Data,and VIP databases was conducted for literature(from January 2013 to March 2023)related to proprioceptive training after anterior cruciate ligament reconstruction that improves joint stability and motor balance ability.A total of 108 articles were finally included for review. RESULTS AND CONCLUSION:Proprioceptive training can effectively improve the proprioceptive functions of patients,such as positional sense and kinesthetic sense after anterior cruciate ligament reconstruction,and improve joint stability,postural control and motor ability.The proprioceptive training improves the proprioceptive function through three mechanisms:stimulation of periprosthetic receptors around the knee joint,activation of spinal reflex stimulation,reinforcement of motor control in the brain,and enhancement of cognitive processing.The proprioceptive training may improve proprioceptive functions by activating the potential mechanisms of growth associated protein-43 activity,Piezo2 mechanotransducer,and NT-3/TrkC signaling pathway.Hydrotherapy is the mainstay in the early stages,while neuromuscular training,individual strength training and visual feedback training are prioritized in the middle and late stages.There exists an as-yet-unsegmented reconstructive surgery graft,sex,and a lack of devices or proprioceptive training methods based on the idea of combining multiple sensory stimuli.