OBJECTIVE: To standardize the operative procedure for tissue-engineered cartilage repair, by demonstrating surgical technique of arthroscopic implantation of decalcified cortex-cancellous bone scaffolds, and summarizing the surgical experience of the sports medicine department team at Peking University Third Hospital. METHODS: This article elaborates on surgical techniques and skills, focusing on the unabridged implantation technology and surgical procedure of decalcified cortex-cancellous bone scaffolds under arthroscopy: First, the patient was placed in the supine position. After anesthesia had been established, the surgeon established an arthroscope and explored the damaged area under the scope. After confirming the size and location of the injury site, the surgeon cleaned the damaged cartilage, and also trimmed the edges of the cartilage to ensure that the cut surface was smooth and stable. the surgeon performed the micro-fracture surgery in the area of cartilage injury, and then measured the size of the injured area under the scope. Next, the surgeon manually trimmed the tissue-engineered scaffold based on the measurements taken under the arthroscope, and then directly implanted the scaffold using a sleeve. A honeycomb-shaped fixator was used to implant absorbable nails to fix the scaffold. After the scaffold was installed, the knee was repeatedly flexed and extended for 10-20 times to ensure stability and range of motion. Finally, the arthroscope was withdrawn and the wound was closed. RESULTS: Decalcified cortex-cancellous bone scaffolds possessed unparalleled advantages over synthetic materials in terms of morphology and biomechanics. The cancellous bone part of the scaffold provided a three-dimensional, porous space for cell growth, while the cortical bone part offered the necessary mechanical strength. The surgery was performed entirely under arthroscopy to minimize invasiveness to the patient. Absorbable pins were used for fixation to ensure the stability of the scaffold. This technique could effectively improve the prognosis of the patients with cartilage injuries and standardized the surgical procedures for arthroscopic tissue-engineered scaffold operations in the patients with cartilage damage. CONCLUSION With the standard arthroscopic tissue-engineered scaffold repair technique, it is possible to successfully repair damaged cartilage, alleviate symptoms in the short term, and provide a more ideal long-term prognosis. The author and their team explain the surgical procedures for tissue-engineered scaffolds under arthroscopy, with the aim of guiding future clinical practice.
Tissue Engineering/methods* ; Humans ; Tissue Scaffolds ; Arthroscopy/methods* ; Cartilage, Articular/surgery*

To investigate the therapeutic effects of ZLY16, a novel peroxisome proliferator-activated receptor (PPAR) β agonist, on Duchenne muscular dystrophy (DMD), C57BL/10ScSnJGpt-Dmdem3Cd4/Gpt (mdx) mice were gavaged with 30 mg/kg ZLY16 for 6 weeks. Expression of proteins associated with muscle regeneration, exercise ability, blood lipids content and skeletal muscle damage in mdx mice were investigated by behavioral experiments, histopathology, blood biochemical analysis, immunofluorescence and Western blot. A high-fat-induced myoblast differentiation inhibition model was established to examine lipid content and myoblast differentiation-related protein expression in myoblasts using Nile Red staining, immunofluorescence and Western blot. The results demonstrated that ZLY16 increased muscle grip strength, reduced triglyceride (TG) and total cholesterol (TC) levels, attenuated muscle fiber necrosis, fibrosis and inflammatory cell infiltration, and promoted muscle regeneration in mdx mice. ZLY16 promoted myoblast differentiation and myotube fusion in vitro by reducing lipid accumulation in murine skeletal muscle myoblast line (C2C12) cells. These findings suggest that ZLY16 improves motor function in mdx mice by decreasing lipid accumulation and promoting muscle regeneration.

Objective:To explore the inhaled allergen sensitization status of children with allergic rhinitis in Beijing City, and to provide evidence for diagnosis and treatment, allergen avoidance and disease management.Methods:In this cross-sectional study, data from 8 741 children with allergic rhinitis treated in Children′s Hospital affiliated to Capital Institute of Pediatrics from January 2020 to December 2021 were retrospectively analyzed. The subjects were divided into toddlers (1 y-≤3 y), preschool children (3 y-≤6 y), school aged children (6 y-≤12 y) and adolescents (12 y-≤18 y) and according to season the subjects were divided 4 groups: spring, summer, autumn, winter. The ImmunoCAP system was used to detect serum allergens sIgE.Results:The positive rates of inhaled allergens among subjects in sequence from high to low were: mx2 [molds (penicillium speciosum/mycosporum multiflorum/aspergillus fumigatus/alternatia/demodex longum)], w6 (artemisiaargyi), wx5[weeds pollen combination (ragweed/artemisia argyi/marguerite/dandelion/goldenrod)], w1(ragweed), tx5[trees pollen combination (populus tomentosa/hazel/elm/willow)], d2(dermatophagoides farina), d1(dermatophagoides pteronyssinus), ex1[animal dander combination (catdander/dogdander/horsedander/cowdander)], i6(blattella germanica). Boys have higher positive rates of sIgE responses than girls (54.20% vs. 47.96%, χ 2= 8 923.000, P<0. 001). The primacy inhaled allergen in toddlers, preschool children and school aged children was mx2 (37.75%, 39.99% and 42.46%), and in adolescents w6 (45.45%), d2 (41.51%) and d1 (37.74%) were the largest categories. Except for mold, the positive detection rate of inhaled allergens increased gradually with age. In different seasons, the positive rates of ex1 (24.77% vs. 18.26% vs. 17.10% vs. 12.39%, χ 2= 31.469, P<0.001), wx5 (20.18% vs. 28.62% vs. 39.96% vs. 12.53%, χ 2= 155.788, P<0.001), mx2 (31.79% vs. 50.96% vs. 36.99 vs. 28.81, χ 2= 208.444, P<0.001), tx5 (28.14% vs. 27.01% vs. 26.77% vs. 9.64%, χ 2= 60.613, P<0.001) and w6 (26.57% vs. 34.39% vs. 52.11% vs. 25.35%, χ 2= 17.710, P<0.001) were statistically different among groups. Mx2 in spring and summer was the highest categories (31.79%, 50.96%), and w6 in autumn was the highest (52.11%). Conclusions:In this study, mx2 was the most important allergen in children (≤12 y) and w6 was the highest in adolescents treated in Children′s Hospital affiliated to Capital Institute of Pediatrics from January 2020 to December 2021 in Beijing City. The types of allergens and positivity rates were different for different sexes, ages and seasons.

Objective:To explore the inhaled allergen sensitization status of children with allergic rhinitis in Beijing City, and to provide evidence for diagnosis and treatment, allergen avoidance and disease management.Methods:In this cross-sectional study, data from 8 741 children with allergic rhinitis treated in Children′s Hospital affiliated to Capital Institute of Pediatrics from January 2020 to December 2021 were retrospectively analyzed. The subjects were divided into toddlers (1 y-≤3 y), preschool children (3 y-≤6 y), school aged children (6 y-≤12 y) and adolescents (12 y-≤18 y) and according to season the subjects were divided 4 groups: spring, summer, autumn, winter. The ImmunoCAP system was used to detect serum allergens sIgE.Results:The positive rates of inhaled allergens among subjects in sequence from high to low were: mx2 [molds (penicillium speciosum/mycosporum multiflorum/aspergillus fumigatus/alternatia/demodex longum)], w6 (artemisiaargyi), wx5[weeds pollen combination (ragweed/artemisia argyi/marguerite/dandelion/goldenrod)], w1(ragweed), tx5[trees pollen combination (populus tomentosa/hazel/elm/willow)], d2(dermatophagoides farina), d1(dermatophagoides pteronyssinus), ex1[animal dander combination (catdander/dogdander/horsedander/cowdander)], i6(blattella germanica). Boys have higher positive rates of sIgE responses than girls (54.20% vs. 47.96%, χ 2= 8 923.000, P<0. 001). The primacy inhaled allergen in toddlers, preschool children and school aged children was mx2 (37.75%, 39.99% and 42.46%), and in adolescents w6 (45.45%), d2 (41.51%) and d1 (37.74%) were the largest categories. Except for mold, the positive detection rate of inhaled allergens increased gradually with age. In different seasons, the positive rates of ex1 (24.77% vs. 18.26% vs. 17.10% vs. 12.39%, χ 2= 31.469, P<0.001), wx5 (20.18% vs. 28.62% vs. 39.96% vs. 12.53%, χ 2= 155.788, P<0.001), mx2 (31.79% vs. 50.96% vs. 36.99 vs. 28.81, χ 2= 208.444, P<0.001), tx5 (28.14% vs. 27.01% vs. 26.77% vs. 9.64%, χ 2= 60.613, P<0.001) and w6 (26.57% vs. 34.39% vs. 52.11% vs. 25.35%, χ 2= 17.710, P<0.001) were statistically different among groups. Mx2 in spring and summer was the highest categories (31.79%, 50.96%), and w6 in autumn was the highest (52.11%). Conclusions:In this study, mx2 was the most important allergen in children (≤12 y) and w6 was the highest in adolescents treated in Children′s Hospital affiliated to Capital Institute of Pediatrics from January 2020 to December 2021 in Beijing City. The types of allergens and positivity rates were different for different sexes, ages and seasons.

Osteochondral lesion of talus (OLT) is a foot and ankle disease characterized by ankle pain, which may impact the joint function and life quality. If managed improperly, it may lead to a further ankle arthritis, severely compromising the prognosis. The therapeutic effect of conservative treatment for OLT is still uncertain. Surgery is still the main treatment modality for OLT with various techniques. However, the optimized surgical technique is still inconclusive, furthermore, regeneration and repair of cartilage after debridement is also a great challenge for the treatment of OLT. Platelet-rich plasma (PRP) with good repair effect on cartilage injury is gradually applied in the treatment of OLT. However, there still lacks the unified understanding of the technique and specification of PRP for the treatment of OLT. Therefore, National Orthopedics Center of Shanghai Sixth People′s Hospital allied Foot Ankle Basic Research & Orthopedics Group, Chinese Association of Orthopedic Surgeons; Foot and Ankle Committee of Chinese Association of Sports Medicine Physicians; and Foot and Ankle Group of Orthopedic Specialized Branch of Shanghai Medical Association to organize related experts to formulate the Expert consensus on platelet- rich plasma treatment for osteochondral lesion of talus ( version2023). Fifteen recommendations were put forward upon PRP preparation, indications, contraindications and treatment methods of PRP for OLT, so as to standardize the PRP treatment for OLT.

Objective:To evaluate the feasibility, accuracy, effectiveness and safety of a novel manual placement of cervical 7 pedicle screws via the posterior approach of cervicothoracic junction.Methods:A retrospective case series study was conducted to analyze the 35 patients with injury to the lower cervical spine or cervicothoracic junction who had been treated by a novel manual placement of cervical 7 pedicle screws at Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University from March 2015 to July 2021. There were 16 males and 19 females, with an age of (52.7±13.2) years. The core of this placement was to determine the entry point of cervical 7 pedicle screws. After the intersection of the upper edge of the cervical 7 lamina and the medial edge of the superior articular process was recorded as point A while the intersection of the lateral edge of the inferior articular process and the lower edge of the transverse process as point B, the intersection of the outer and middle 1/3 of the AB line was taken as the screw entry point, with the screw placement angle perpendicular to the lamina line or slightly inclined from 30° to 40° to the head side and outward. The length, diameter and placement angle of the cervical 7 pedicle screws were recorded and compared postoperatively between the left and right sides to explore the feasibility of this novel manual placement. According to the Rampersaud method, the screw positions were graded 1 week and 6 months after operation to evaluate the accuracy of this manual placement. The visual analogue scale (VAS) and the Japanese Orthopaedic Association (JOA) score were compared between preoperation, 1 week and 6 months after operation to evaluate the effectiveness of this placement. The postoperative complications were counted to evaluate the safety of this method. Loosening, displacement and breakage of the screws were observed by CT scanning at 6 months after operation.Results:This case series was followed up for (9.8±1.7) months. There was no significant difference in the length, diameter or placement angle of the screws between the left and right sides ( P>0.05). A total of 66 cervical 7 pedicle screws were placed. There was no change in the screw position grading at 1 week or 6 months after surgery. Grade A was achieved in 64 screws, Grade B in 2 screws, and Grade C or D in none. The VAS scores before operation, 1 week and 6 months after operation were respectively 4.4±1.7, 3.8±1.0 and 1.1±1.1, and the JOA scores respectively 6.7±2.2, 13.2±1.5 and 15.3±1.2. The VAS and JOA scores at 1 week and 6 months after operation were significantly improved compared with the preoperative values ( P<0.05). The improvement rates in JOA at 1 week and 6 months after operation were 62.7%±13.3 % and 83.9%±11.6%, respectively. There were no complications related to the placement of cervical 7 pedicle screws; there was no wound hematoma or infection. No loosening, displacement or breakage of the screws was observed by the 6-month follow-up. Conclusion:The novel manual placement of cervical 7 pedicle screws via the posterior approach of cervicothoracic junction is feasible, accurate, effective and safe.

Lateral ankle avulsion fracture is a common sports injury that can lead to chronic lateral ankle instability and substantial deterioration of the joint function. Currently, problems such as misdiagnosis, inappropriate treatment, disparate outcomes and lack of standardization are usually met in the diagnosis and treatment of lateral ankle avulsion fracture. The Foot and Ankle Committee of Chinese Association of Sports Medicine Physicians thus organized a working group of experts in the field of sports medicine and ankle surgery from China to develop "An evidence-based clinical guideline for the diagnosis and treatment of lateral ankle avulsion fractures (2022 version)" in accordance with the principle of evidence-based medicine and scientificity and practicability. The guideline covered the topics of imaging diagnosis, indications and methods of non-operative and operative treatment as well as postoperative rehabilitation, in order to provide guidance for the diagnosis and treatment of lateral ankle avulsion fracture.

Objective:To evaluate the differential expression of blood routine in different types of infection and the diagnostic value of C-reactive protein (CRP), procalcitonin (PT), ferritin (SF) and lactate dehydrogenase (LDH) in bacterial and mycoplasma pneumonia and their early warning value in severe cases.Method:A total of 627 patients, including 176 cases of bacterial pneumonia, 275 cases of mycoplasma pneumonia, 176 cases of viral infection and 180 cases of normal control were collected from May 2018 to December 2019 in children′s Hospital Affiliated to Capital Institute of Pediatrics. The mycoplasma pneumonia group was divided into mild group (151 cases) and severe group (124 cases) according to the results of lavage fluid RNA-examination. All patients received completed blood routine test at the first day of admission, patients in bacteria group and Mycoplasma group received the examination of four inflammatory indicators. The Kruskal-Wallis test was used to analyze the differences in blood routine results between different infection groups, and the differences of inflammatory indexes between bacterial group and Mycoplasma mild and severe group. The receiver operating characteristic (ROC)-curve method was used to analyze the predictive value of inflammatory indexes between different infection groups.Results:There were significant differences in leukocyte count, neutrophil, lymphocyte and monocyte percentage between bacterial pneumonia, mycoplasma pneumonia, viral infection and normal control group ( P<0.05). The differences of four inflammatory indexes in bacterial group, mild Mycoplasma group and severe group were statistically significant ( P<0.05). The rest of the index (CRP, PCT, LDH, SF and white blood cell count) were P<0.05 (CRP: area under curve [AUC] 0.799; PCT: AUC 0.579; LDH: AUC 0.651; SF: AUC 0.854), in mild and severe mycoplasma group, except WBC, by ROC-curves analysis. The AUC value of the area under the curve of CRP and SF is high, and the sensitivity and specificity at the diagnostic critical point are high, which has great diagnostic value (CRP: diagnostic critical point 12.55 mg/L, sensitivity 0.719, specificity 0.755; SF: diagnostic critical point 176.02 μg/L, sensitivity 0.765, specificity 0.960). ROC curve results also showed that of PCT, White blood cell and neutrophil percentage had the diagnostic value in bacterial infection and mycoplasma infection, P<0.05 (PCT: AUC 0.658; leukocyte: AUC 0.804; neutrophil: AUC 0.630). Leukocyte count is the best differential index (diagnostic critical point 9.585×10 9/L, sensitivity 0.778, specificity 0.698), PCT has higher sensitivity at the diagnostic critical point of 0.55 μg/L, but the specificity is slightly lower (diagnostic critical point of 0.55 μg/L, sensitivity 0.862, specificity 0.366). Conclusions:PCT and leukocyte count can be used as the preferred inflammatory indexes to distinguish bacterial and mycoplasma infection. CRP, LDH, PCT and SF can be used as early warning indexes to evaluate severe mycoplasma infection.

Objective:To compare the mid-to long-term clinical outcomes between suture anchor and simple suture for acute injury to lateral ankle ligament (cauda equina tear near the insertion).Methods:This retrospective study included 146 patients (professional and semi-professional athletes) who had been treated for acute injury to lateral ankle ligament (cauda equina tear near the insertion) at Department of Sports Medicine, The Third Hospital Affiliated to Peking University from June 2007 to May 2017.They were 101 males and 45 females, with an age of (27.1±10.3) years (from 12 to 62 years). Depending on ligament repair techniques, the patients were divided into a suture anchor group of 81 cases subjected to reconstruction of the torn ligament with a 1.8 mm suture anchor, and a simple suture group of 65 cases subjected to direct suture of the torn ligament with a braided thread. The 2 groups were compared in terms of visual analog scale (VAS) pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and Tegner scores at preoperation and the last follow-up, time and level of postoperative motion recovery, proportion of limited joint motion, incidence of re-sprain and patient satisfaction.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P>0.05). The mean follow-up duration was (46.1±14.1) months (from 36 to 132 months). The VAS pain score, AOFAS ankle-hindfoot score and Tegner score at the last follow-up were significantly improved than those before operation in all the patients ( P<0.05). Postoperatively, there was no significant difference between the 2 groups in VAS pain score, AOFAS ankle-hindfoot score, Tegner score, incidence of re-sprain or proportion of limited joint motion ( P> 0.05). The suture anchor group was significantly better than the simple suture group in the level of postoperative motion recovery (92%±13% versus 89%±13%) and time of postoperative motion recovery [(4.2±1.1) months versus (4.6±1.0) months] ( P<0.05). Conclusions:Ligament repair, either by suture anchor or by simple suture, is a reliable procedure for patients with high sports demands after severe acute injury to the lateral ankle ligament. Compared with simple suture, suture anchor may accelerate postoperative motion recovery to the pre-injury level.

Objective: To investigate clinical outcomes of modified reattachment of superior peroneal retinaculum (SPR) for patients with recurrent peroneal tendon dislocation. Methods: A total of 24 cases with recurrent peroneal tendon dislocation from December 2012 to June 2017 were treated with modified reattachment of SPR. There were 20 males and 4 females. The average age was 24.9±9.3 years (14-48 years). The average BMI was 23.18±3.50 kg/m² (15.8-32.2 kg/m²). A 4-5 cm incision was made along the lateral margin of the fibula and curved distally around the fibular tip in line with the peroneal excursion. The superior peroneal retinaculum, peroneus longus and peroneus brevis were exposed. The periosteum and SPR were stripped from the fibula. The false pouch was formed. Two suture anchors were inserted into the postero-lateral ridge of the lateral malleolus without damaging the cartilaginous ridge, after which the SPR was reattached to the lateral malleolus with the anchored suture. The inner layer of the false pouch was incised, while the outer layer (periosteum) was sutured with the SPR in a pants-over-vest style. The following items, including American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), rate of return to previous sports level, time to return to sports activity, complication, and patients satisfaction were evaluated preoperatively and at the final follow-up. Results: The average operation duration was 36.1±8.8 min (20-51 min). The blood loss was 1-10 ml, average 4.1±2.7 ml. The follow-up was carried out in 22 cases for mean 33.9±15.7 months (13-61 months). AOFAS score was improved from 77.8±7.8 points to 95.5±4.3 points significantly (t=-11.89, P<0.001). VAS score was reduced from 4.2±2.4 to 0.3±0.8 significantly (t=7.69, P<0.001). Mean duration return to sports activity was 5.0±1.9 months (3-10 months). A total of 20 patients (91%) returned to their previous sports level. Only one patient (5%) was found with limitation of range of motion, while two patients (9%) reported pain at the scar site without recurrence. The satisfaction rate was 91%. Conclusion Clinical outcomes of modified reattachment of SPR for patients with recurrent peroneal tendon dislocation was safe and effective.