Osteosarcoma is a highly aggressive bone tumor that primarily affects children and adolescents. It is characterized by high rates of recurrence and metastasis, with the tumor microenvironment playing a pivotal role in disease progression. Exosomes, small extracellular vesicles secreted by various cell types, exert dual roles in osteosarcoma. On one hand, exosomes derived from osteosarcoma cells remodel the microenvironment to facilitate tumor progression. For instance, they carry miR-501-3p to activate the PTEN/PI3K/Akt signaling pathway, promoting osteoclastogenesis and bone destruction; TGF-β1/3 stimulates bone marrow-derived mesenchymal stem cells (BMSCs) to secrete IL-6 and IL-8, enhancing the inflammatory microenvironment; and miR-25-3p suppresses DKK3, thereby promoting angiogenesis and invasion. Moreover, exosomes contribute to the formation of a pre-metastatic niche by transporting miR-21 and miR-675, which promote lung metastasis, activate cancer-associated fibroblasts, and enhance invasiveness via the linc00881/miR-29c-3p/MMP2 axis. Conversely, exosomes derived from mesenchymal stem cells deliver tumor-suppressive miRNAs such as miR-1913, miR-150, and miR-206, which target NRSN2, IGF2BP1, and TRA2B, thereby inhibiting tumor growth. In the context of drug resistance, osteosarcoma-derived exosomes transport MDR-1 mRNA and circRNA_103801, contributing to chemotherapy resistance. Additionally, TGF-β-induced IL-6 activates the STAT3 pathway, further enhancing resistance. In terms of immune modulation, these exosomes suppress T cell and NK cell activity and upregulate PDL1 expression, promoting immune evasion. Exosomes also hold therapeutic potential. They can serve as drug delivery vehicles, for example, carrying doxorubicin or kanamycin, to achieve targeted cytotoxicity via ferroptosis or apoptosis. Engineered exosomes enriched with miR-101 or MEG3 have been shown to inhibit metastasis, while plant-derived exosome-like nanoparticles activate the P38/JNK pathway to induce apoptosis. These approaches aim to improve therapeutic efficacy while minimizing adverse effects. In summary, exosomes play multifaceted roles in the pathogenesis of osteosarcoma and offer promising avenues for early diagnosis, prognostic assessment, and precision therapy, including pathway-targeted strategies. However, challenges remain in optimizing exosome isolation, standardizing large-scale production, and validating clinical applications. Addressing these issues is essential for translating laboratory findings into effective clinical treatments.

Osteosarcoma is a highly aggressive bone tumor that primarily affects children and adolescents. It is characterized by high rates of recurrence and metastasis, with the tumor microenvironment playing a pivotal role in disease progression. Exosomes, small extracellular vesicles secreted by various cell types, exert dual roles in osteosarcoma. On one hand, exosomes derived from osteosarcoma cells remodel the microenvironment to facilitate tumor progression. For instance, they carry miR-501-3p to activate the PTEN/PI3K/Akt signaling pathway, promoting osteoclastogenesis and bone destruction; TGF-β1/3 stimulates bone marrow-derived mesenchymal stem cells (BMSCs) to secrete IL-6 and IL-8, enhancing the inflammatory microenvironment; and miR-25-3p suppresses DKK3, thereby promoting angiogenesis and invasion. Moreover, exosomes contribute to the formation of a pre-metastatic niche by transporting miR-21 and miR-675, which promote lung metastasis, activate cancer-associated fibroblasts, and enhance invasiveness via the linc00881/miR-29c-3p/MMP2 axis. Conversely, exosomes derived from mesenchymal stem cells deliver tumor-suppressive miRNAs such as miR-1913, miR-150, and miR-206, which target NRSN2, IGF2BP1, and TRA2B, thereby inhibiting tumor growth. In the context of drug resistance, osteosarcoma-derived exosomes transport MDR-1 mRNA and circRNA_103801, contributing to chemotherapy resistance. Additionally, TGF-β-induced IL-6 activates the STAT3 pathway, further enhancing resistance. In terms of immune modulation, these exosomes suppress T cell and NK cell activity and upregulate PDL1 expression, promoting immune evasion. Exosomes also hold therapeutic potential. They can serve as drug delivery vehicles, for example, carrying doxorubicin or kanamycin, to achieve targeted cytotoxicity via ferroptosis or apoptosis. Engineered exosomes enriched with miR-101 or MEG3 have been shown to inhibit metastasis, while plant-derived exosome-like nanoparticles activate the P38/JNK pathway to induce apoptosis. These approaches aim to improve therapeutic efficacy while minimizing adverse effects. In summary, exosomes play multifaceted roles in the pathogenesis of osteosarcoma and offer promising avenues for early diagnosis, prognostic assessment, and precision therapy, including pathway-targeted strategies. However, challenges remain in optimizing exosome isolation, standardizing large-scale production, and validating clinical applications. Addressing these issues is essential for translating laboratory findings into effective clinical treatments.

Objective:To compare the clinical efficacy between robot-assisted and free-hand percutaneous cannulated screwing (PCS) in the treatment of femoral neck fractures in the middle-aged and young patients.Methods:A retrospective study was conducted to analyze the clinical data of 53 patients with femoral neck fracture who had been treated with PCS from May 2020 to May 2022 at Department of Traumatic Surgery, Maoming Hospital Affiliated to Southern Medical University. In the robot group of 25 patients subjected to robot-assisted PCS, there were 11 males and 14 females with an age of (48.2 ± 11.9) years; in the free-hand group of 28 patients subjected to free-hand PCS, there were 13 males and 15 females with an age of (48.5 ± 9.8) years. The 2 groups were compared in terms of operation time, intraoperative bleeding, intraoperative guide drills, intraoperative fluoroscopy frequency, fracture union time, Harris hip score at the last follow-up and postoperative complications. Postoperative imaging examination was performed to evaluate distribution accuracy of the cannulated screws in the femoral neck (deviation between the screws and the femoral neck axis, parallelism between the screws and distance between the screws and the neck cortex).Results:There was no statistically significant difference between the robot and free-hand groups in the general clinical data before operation, showing comparability ( P>0.05). The robot group showed significantly shorter operation time [(32.7 ± 4.8) min], significantly less intraoperative bleeding [(14.6 ± 4.8) mL], significantly less intraoperative guide drillings [(3.5 ± 0.7) times] and significantly less intraoperative fluoroscopy frequency [(7.9 ± 1.4) times] than the free-hand group [(56.9 ± 11.3) min, (27.0 ± 7.3) mL, (9.1 ± 1.8) times and (16.3 ± 6.0) times)] (all P<0.05). Postoperative imaging showed that the deviation between the screws and the femoral neck axis was 4.4° ± 1.1° on the anteroposterior X-ray film and 3.2° ± 0.8° on the lateral X-ray film, the parallelism between the screws 4.9° ± 0.8° on the anteroposterior X-ray film and 3.0° ± 0.7° on the lateral X-ray film, and the distance between the screws and the femoral neck cortex (10.4 ± 2.7) mm in the robot group, all significantly smaller than those in the free-hand group [10.5° ± 2.8°, 4.9° ± 1.1°, 12.1° ± 4.0°, 5.1° ± 1.3°, and (15.4 ± 3.2) mm] (all P<0.05). All the 53 patients were followed up for (22.2 ± 8.5) months. All fractures got united. The fracture union time in the robot group [(20.6 ± 4.6) weeks] was insignificantly shorter than that in the free-hand group [(23.7 ± 7.7) weeks] ( P>0.05). At the last follow-up, the Harris hip score in the robot group [(88.6 ± 5.6) points] was significantly higher than that in the free-hand group [(84.8 ± 6.3) points] ( P<0.05). Follow-ups revealed 2 cases of internal fixation loosening, 1 case of screw head cutting and 1 case of femoral head necrosis in the free-hand group but none of such complications in the robot group. Conclusion:In the treatment of femoral neck fractures in the middle-aged and young patients, compared with free-hand PCS, robot-assisted PCS shows advantages of shorter intraoperative time, less bleeding, less fluoroscopic radiation, higher accuracy of screw placement, a lower incidence of postoperative complications and better functional recovery of the hip joint.

Objective:To evaluate the follow-up clinical results of W-shaped acetabular angular plate for the treatment of acetabular posterior wall fractures through a direct posterior approach (DPA).Methods:Fifteen cases (10 males and 5 females, average aged 42.1±10.0 years) were involved in this study, with acetabular posterior wall fractures treated by using the W-shaped acetabular angular plate through a DPA between March 2017 and June 2019. Nine patients with fractures were injured by traffic accidents and the other 6 cases by falling. Based on the three-column classification for acetabular fractures, all of the cases belonged to posterior wall fractures (A2.1), which included 6 cases of simple fractures and 9 cases of comminuted fractures. The mean time interval between injury and surgery was 5.6±1.1 (range, 4-8) days. The DPA was adopted in all cases. The posterior wall fractures of the acetabulum were reduced and fixed with W-shaped acetabular angular plates. The reduction quality of the acetabulum was evaluated by X-ray and CT scan during follow-up visits according to the criteria proposed by Matta. The function of the hip joint was assessed by the Merle d'Aubigné-Posteal score modified by Matta.Results:The length of the surgical incision was 9.5±1.1 (range, 8-12) cm. The operation time was 45.3±10.1 (range, 35-75) mins. The amount of intraoperative blood loss was 248.0±94.7 (range, 100-380) ml. All the patients who were followed up for 20.5±6.3 (range, 16-38) months. All cases were evaluated according to Matta's reduction quality criteria, the satisfactory ratio of reduction was 100%. Among cases, 10 cases were matched the anatomic reduction, and the other 5 cases have belonged to satisfy. All cases of fractures had healed (the mean of healing time was 9.4±1.3 (range, 8-12 weeks). At the final follow-up visit, the mean of modified Merle d'Aubigne-Postel score was 16.9±1.6 (range, 13-18). Excellent clinical outcomes were obtained in 10 cases, good in 3 cases, and fair in 2 cases. One case had deep venous thrombosis of the lower extremities. The clots disappeared after anticoagulation treatment. One case had the heterotopic ossification, Brooker grade I, without any special treatment due to not affecting the hip joint activity in the follow-up visits. One patient had incision fat liquefaction and the wound healed after intensive dressing change. No internal fixation loosening or losing of fracture reduction was found at the follow-up visits.Conclusion:This study shows that using W-shaped acetabular angular plate for the treatment of acetabular posterior wall fractures through the DPA could obtain early satisfactory clinical outcomes.

OBJECTIVE:To observe the clinical efficacy and safety of sodium hyaluronate combined with glucosamine in the treatment of knee osteoarthritis. METHODS:1 220 patients with knee osteoarthritis were randomly divided into observation group and control group. The patients in control group were treated with Sodium hyaluronate injection alone,once a week;while the ob-servation group was additionally and orally treated with Glucosamine hydrochloride capsules two tablets,three times a day. The course of treatment was 5 weeks in both groups. The relevant physicotherapeutics and oral medication in the treatment of the dis-ease should be stopped. The clinic efficacy,visual analog scale(VAS)and lysholm knee score before and after treatment,and inci-dence of adverse reaction were observed. RESULTS:Total effective rate of observation group was significantly higher than control group,with statistically significant difference(P<0.05). After treatment,VAS and lysholm knee scores in both groups were signifi-cantly lower than before,and observation group was lower than control group,with significant differences(P<0.05). There were no severe adverse reactions during treatment. CONCLUSIONS:Sodium hyaluronate combined with glucosamine has more signifi-cant clinical efficacy in the treatment of knee osteoarthritis than sodium hyaluronate alone,with good safety.