OBJECTIVE: To compare early graft healing between over-the-top (OTT) and anatomic single-bundle (SB) anterior cruciate ligament (ACL) reconstruction. METHODS: A clinical data of 40 patients underwent ACL reconstruction, who admitted between June 2021 and October 2022 and met the selective criteria, was retrospectively analyzed. Among them, 20 patients were treated with OTT reconstruction (OTT group) and 20 with SB reconstruction (SB group). There was no significant difference between groups ( P>0.05) in the gender, age, affected side, disease duration, degree of meniscus injury, body mass index, and preoperative International Knee Documentation Committee (IKDC) score, Lysholm score, pain visual analogue scale (VAS) score, and KT-2000 measurement. At 3, 6, and 12 months, MRI was performed to measure the signal noise quotient (SNQ) of the proximal end, middle, and distal end of the graft in the two groups, as well as at the corner of the graft with lateral femoral condyle and 1 cm around the femoral fixation point in the OTT group, to observe the degree of graft healing. Before operation and at 3, 6, and 12 months, the knee function and pain were evaluated by IKDC score, Lysholm score, and VAS score. Before operation and at 12 months after operation, the KT-2000 measurement was taken to evaluation the knee joint stability. RESULTS: All operations were successfully completed in both groups and the incisions healed by first intention. All patients were followed up 12-15 months (mean, 12.9 months), with no significant difference in the follow-up time between groups ( P>0.05). After operation, the IKDC score, VAS score, and Lysholm score improved gradually over time in both groups, with significant differences between different time points ( P<0.05). The differences between groups at 3, 6, and 12 months after operation were not significant ( P>0.05). The anterior and posterior stability of the knee joint improved significantly in both groups at 12 months after operation, and the difference in KT-2000 measurements was significant when compared with the preoperative value ( P<0.05), but the difference of pre- and post-operation between groups was not significant ( P>0.05). At 3, 6, and 12 months after operation, MRI showed that the differences in the SNQ of the proximal end and middle of the grafts between the two groups were not significant ( P>0.05), and the SNQ of distal end was significantly higher in the SB group than in the OTT group ( P<0.05). At each time point, grafts in the OTT group had the highest SNQ at the corner and the lowest at the fixation point, and the differences were significant compared to the other sites ( P<0.05). In the two groups, except for the fixation point, the SNQ of the remaining sites were highest at 6 months and lowest at 12 months ( P<0.05). In addition, there were significant differences in SNQ between the different sites of grafts ( P<0.05), and the SNQ was lowest at proximal end and highest at distal end. At last follow-up, the knee grafts in both groups were in good shape and no graft necrosis or loosening of the internal fixation was observed. CONCLUSION The knee joint function and graft healing after OTT reconstruction of ACL are similar to those of SB reconstruction, but it should be noted that the healing at the corner of the graft is slower.
Retrospective Studies ; Treatment Outcome ; Anterior Cruciate Ligament Reconstruction/rehabilitation* ; Follow-Up Studies ; Tibial Meniscus Injuries/surgery* ; Patient Positioning/methods* ; Recovery of Function ; Pain Measurement ; Knee Joint/surgery* ; Humans ; Male ; Female ; Adult ; Wound Healing

Objective To analyze the correlations of autoimmune diseases(AIDs)with the risk of developing pancreatic endocrine and exocrine diseases.Methods A total of 451,497 participants from the UK Biobank were recruited,with the primary outcomes being pancreatic endocrine and exo-crine diseases.International Classification of Diseases 9/10(ICD9/10)codes were used to define each AIDs,the pancreatic endocrine and exocrine diseases.Multivariable Cox proportional hazards models were employed to assess the relationships between AIDs and pancreatic endocrine and exocrine diseases,with adjustments for age,gender,ethnicity,Townsend deprivation index,smoking,alcohol consumption,body mass index,waist circumference,hip circumference,hypertension,dyslipidemia,and gallstones.Results A total of 415,497 participants were included,among which 37,482 de-veloped pancreas-related diseases during follow-up.Among patients with AIDs,the proportions of those with pancreatic exocrine and endocrine diseases were significantly increased(P＜0.05).Rheumatoid arthritis[HR(95％CI):1.438(1.161 to 1.781)],ankylosing spondylitis[HR(95％CI):1.675(1.009 to 2.780)],ulcerative colitis[HR(95％CI):1.335(1.037 to 1.719)],and Crohn's disease[HR(95％CI):1.530(1.154 to 2.028)]were all associated with an increased risk of de-veloping pancreatic exocrine diseases(all P＜0.05);additionally,rheumatoid arthritis[HR(95％CI):1.119(1.004 to 1.248)],ulcerative colitis[HR(95％CI):1.324(1.175 to 1.491)],sys-temic sclerosis[HR(95％CI):2.08(1.355 to 3.191)],and Crohn's disease[HR(95％CI):1.394(1.197 to 1.624)]were also associated with an increased risk of developing pancreatic en-docrine diseases(all P＜0.05).Conclusion Overall AIDs and some specific AIDs are associated with an increased risk of developing pancreatic endocrine and exocrine diseases,and early preven-tion of pancreatic diseases in patients with AIDs should be emphasized in clinical practice.

Crohn's disease (CD) is a chronic progressive inflammatory bowel disease. With the introduction of the "treat-to-target (T2T) " concept, the treatment goals for CD have become clearer and more specific. Traditional surgical treatment for CD typically follows a "complication-driven" approach, in which surgery is usually performed only after severe complications, such as bowel obstruction, fistulas, perforation, or cancer have occurred. The emergence of the treat-to-target strategy and the concept of disease clearance has transformed the surgical treatment of CD from a "passive rescue" model to an "active intervention" approach. Treatment goals have shifted from merely addressing complications and improving symptoms to achieving both short and long-term therapeutic objectives within the framework of treat-to-target. Achieving these goals helps to prevent CD-related complications, delay disease progression, reduce the risk of recurrence and malignancy, and improve the quality of life.

Objective:To identify circulating proteins associated with cardiovascular, renal, and cardiorenal comorbidity events in individuals with metabolic syndrome, to construct a predictive model incorporating these proteins to improve prediction accuracy and to investigate their mediating effects on the interplay between cardiovascular and renal diseases.Methods:Data from the UK Biobank cohort were utilized. Cox proportional hazards models were applied to identify circulating proteins associated with various outcomes, followed by time-truncated sensitivity analyses. A predictive model incorporating protein scores was then developed using the LightGBM algorithm and compared with other models. Gene Ontology(GO) functional enrichment analysis was performed to explore the biological pathways of the identified proteins. Finally, mediation effect analysis was conducted to assess the role of circulating proteins in cardiorenal interactions. Results:The Cox analysis identified 180, 275, and 322 circulating proteins associated with cardiovascular events, renal events, and cardiorenal comorbidity events, respectively. Incorporating protein scores significantly improved model performance; the areas under the curve(AUC) for cardiovascular, renal, and cardiorenal events were 0.833, 0.907, and 0.890, respectively. GO functional enrichment analysis demonstrated significant enrichment in pathways such as cytokine activity(GO: 0005125), glycosaminoglycan binding(GO: 0005539), and humoral immune response(GO: 0006959) among all outcome-related proteins. Notably, EDA2R, GDF15, and WFDC2 exhibited significant mediating effects, each with mediation proportions exceeding 10%. Conclusions:A predictive model incorporating circulating protein scores can substantially improve prediction accuracy for cardiovascular and renal outcomes in individuls with metabolic syndrome.

Crohn's disease (CD) is a chronic progressive inflammatory bowel disease. With the introduction of the "treat-to-target (T2T) " concept, the treatment goals for CD have become clearer and more specific. Traditional surgical treatment for CD typically follows a "complication-driven" approach, in which surgery is usually performed only after severe complications, such as bowel obstruction, fistulas, perforation, or cancer have occurred. The emergence of the treat-to-target strategy and the concept of disease clearance has transformed the surgical treatment of CD from a "passive rescue" model to an "active intervention" approach. Treatment goals have shifted from merely addressing complications and improving symptoms to achieving both short and long-term therapeutic objectives within the framework of treat-to-target. Achieving these goals helps to prevent CD-related complications, delay disease progression, reduce the risk of recurrence and malignancy, and improve the quality of life.

Objective:To identify circulating proteins associated with cardiovascular, renal, and cardiorenal comorbidity events in individuals with metabolic syndrome, to construct a predictive model incorporating these proteins to improve prediction accuracy and to investigate their mediating effects on the interplay between cardiovascular and renal diseases.Methods:Data from the UK Biobank cohort were utilized. Cox proportional hazards models were applied to identify circulating proteins associated with various outcomes, followed by time-truncated sensitivity analyses. A predictive model incorporating protein scores was then developed using the LightGBM algorithm and compared with other models. Gene Ontology(GO) functional enrichment analysis was performed to explore the biological pathways of the identified proteins. Finally, mediation effect analysis was conducted to assess the role of circulating proteins in cardiorenal interactions. Results:The Cox analysis identified 180, 275, and 322 circulating proteins associated with cardiovascular events, renal events, and cardiorenal comorbidity events, respectively. Incorporating protein scores significantly improved model performance; the areas under the curve(AUC) for cardiovascular, renal, and cardiorenal events were 0.833, 0.907, and 0.890, respectively. GO functional enrichment analysis demonstrated significant enrichment in pathways such as cytokine activity(GO: 0005125), glycosaminoglycan binding(GO: 0005539), and humoral immune response(GO: 0006959) among all outcome-related proteins. Notably, EDA2R, GDF15, and WFDC2 exhibited significant mediating effects, each with mediation proportions exceeding 10%. Conclusions:A predictive model incorporating circulating protein scores can substantially improve prediction accuracy for cardiovascular and renal outcomes in individuls with metabolic syndrome.

OBJECTIVE: To evaluate the clinical diagnostic value of knee MRI at 90° flexed position for Ramp lesions of medial meniscus. METHODS: A total of 228 patients with knee pain as the main complaint who were admitted between September 2021 and September 2023 was selected as the research subjects, of which 51 patients met the selection criteria and were enrolled in the study. There were 31 males and 20 females with an average age of 38.6 years (range, 15-67 years). Body mass index was 17.2-28.7 kg/m ² (mean, 23.9 kg/m ²). There were 25 cases of left knee and 36 cases of right knee. The time from injury to admission was 0.1-14.3 weeks (mean, 2.1 weeks). Preoperative knee MRI at fully extended position (knee extension position) and 90° flexed position (knee flexion position) were performed to determine the presence of irregular signs at the posterior edge of the medial meniscus, and PHMM fluid high signal [i.e. complete fluid filling between the posterior horn of the medial meniscus (PHMM) and the capsule margin]. Findings obtained under arthroscopy served as the "gold standard" to analyze the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of MRI at knee extension and flexion positions for the two specific signs of Ramp lesion. RESULTS: Twenty-one patients (41.2%) were diagnosed with Ramp lesions by using arthroscopy, including 1 case of Thaunat type Ⅰ, 2 cases of type Ⅱ, 6 cases of type Ⅲ, 7 cases of type Ⅳ, and 5 cases of type Ⅴ. The positive rates of irregular signs at the posterior edge of the medial meniscus on MRI at knee extension and flexion positions were significantly different from the diagnosis of Ramp injury under arthroscopy ( P<0.05). The sensitivity, specificity, accuracy, PPV, and NPV of MRI in the diagnosis of irregular signs were 76.1%, 60.0%, 66.7%, 57.1%, and 78.3% respectively at knee extension position, and 85.7%, 73.3%, 78.4%, 69.2%, and 88.0% respectively at knee flexion position. The positive rates of PHMM fluid high signal on MRI at knee extension and flexion positions were significantly different from the diagnosis of Ramp injury under arthroscopy ( P<0.05). The sensitivity, specificity, accuracy, PPV, and NPV of MRI in diagnosing PHMM fluid high signal were 38.1%, 100%, 74.5%, 100%, and 69.8% respectively at knee extension position, and 85.7%, 100%, 94.1%, 100%, and 90.9% respectively at knee flexion position. CONCLUSION Knee MRI at 90° flexed position improves the diagnostic performance of the detection of medial meniscal Ramp lesions compared with MRI at fully extended position.
Humans ; Magnetic Resonance Imaging/methods* ; Female ; Male ; Tibial Meniscus Injuries/diagnostic imaging* ; Adult ; Menisci, Tibial/diagnostic imaging* ; Middle Aged ; Adolescent ; Young Adult ; Arthroscopy/methods* ; Aged ; Knee Injuries/diagnostic imaging* ; Range of Motion, Articular ; Knee Joint/diagnostic imaging* ; Sensitivity and Specificity

Objective To evaluate the value of conventional shoulder physical examination tests as well as the capture test in the diagnosis of long head of biceps tendon(LHBT) and pully injuries. Methods Totally 216 shoulder painpatients undergoing arthroscopic surgery in Xinhua Hospital,Dalian University were performed such conventional shoulder examination tests as the Yergason test,Speed test,Upper cut test,and BT test,as well as the new examination method--the capture test. The sen-sitivity,specificity,positive likelihood ratio and negative likelihood ratio of each test were compared with the results of arthroscopic examination as the gold standard in the diagnosis of LHBT injury and gliding injury,so as to determine their predictive value for clinical diagnosis. Results A total of 216 patients underwent surgery,101 males and 115 females,ranging in age from 22 to 71 years. For the diagnosis of LHBT and pully injury,the Capture test had the highest sensitivity of 0.77 and 0.84(P<0.05) and showed an advantage over the Speed test in terms of specificity(0.57 vs. 0.68,P=0.016;0.44 vs. 0.61,P=0.017),without significant differences from the other three tests(P>0.05). The cap-ture test had the lowest negative likelihood ratio(0.40/0.36) for diagnosing both LHBT and scooter inju-ries(P<0.05). Moreover,according to regression analysis,it can be concluded that in the diagnosis of pulley injuries,OR of the capture test,the Yergason test,the BT test,the Upper cut test and the Speed test were 29.85(P<0.05),0.43(P=0.006),3.82(P=0.014),1.2 and 0.59(P>0.05),respectively. However,in the diagnosis of biceps long head tendon injury,the corresponding values were 30.1(P<0.05),0.034(P<0.05),4.472(P=0.006),3.34 and 0.07(P>0.05),respectively. Conclusion In the diag-nosis of LHBT and pully injuries,the Capture test has the highest sensitivity and lowest negative like-lihood ratio compared to conventional testing and can be used as a promising screening test in the fu-ture.

Objective:To investigate the clinical efficacy of over-the-top reconstruction combined with the modified Lemaire technique in the treatment of anterior cruciate ligament (ACL) injuries with pivot-shift positive.Methods:From March 2020 to October 2021, a total of 46 patients with ACL injury and pivot-shift test grade II or above were admitted to Xinhua Hospital Affiliated to Dalian University. There were 28 males and 18 females, aged 28.0±10.5 years (range, 15-45 years). All cases were unilateral, including 17 cases of left knee and 29 cases of right knee. The pivot-shift test showed that 30 cases were grade II and 16 cases were grade III, and the cause of injury was sports injury. The semitendinosus muscle and gracilis muscle were harvested, and the ACL was reconstructed with the over-the-top combined modified Lemaire technique. The International Knee Documentation Committee (IKDC) score, Lysholm score and KT-2000 side-to-side difference before and after operation were compared.Results:All patients successfully completed the operation and were followed up for 26.6±2.3 months (range, 24-28 months). The Lysholm scores of the patients at 3 months and 24 months after operation were 73.6±4.3 and 91.6±2.8, which were higher than those before operation (58.5±4.6), and the difference was statistically significant ( F=18.351, P<0.001). The IKDC scores of patients at 3 months and 24 months after operation were 59.0±2.0 and 91.8±3.2, respectively, which were higher than those before operation 50.3±2.8, and the difference was statistically significant ( F=17.290, P<0.001). The side-to-side difference of KT-2000 was 1.7±0.8 mm and 1.5±0.4 mm at 3 and 24 months after operation, respectively, which was lower than that before operation (5.9±1.1 mm), and the difference was statistically significant ( F=14.192, P<0.001). At 24 months after operation, 3 patients had pivot shift test grade I and 4 patients had Lachman test grade I, but they complained of good knee stability and did not receive further treatment. At the last follow-up, there were no complications such as incision and intra-articular infection, deep vein thrombosis, knee stiffness, quadriceps musculus ossificans myositis, and reconstruction ligament rupture. All patients returned to sports with an average time of 15.7±2.6 months (range, 12-24 months). Conclusion:Over-the-top reconstruction combined with the modified Lemaire technique for the treatment of ACL injury with positive pivot shift test effectively improves knee function and promotes the patient's return to sports, with a low incidence of surgical complications.

Objective:To evaluate the short-term clinical outcomes of meniscus reconstruction using autologous peroneus longus tendon grafts.Methods:A retrospective analysis was conducted on 20 patients (12 males, 8 females) with a mean age of 37.8±5.7 years (range, 31-47 years) and a mean body mass index (BMI) of 26.3±5.8 kg/m 2 (range, 20.1-31.3 kg/m 2) who underwent meniscal reconstruction with autologous peroneus longus tendon in Affiliated Xinhua Hospital of Dalian University from June 2020 to June 2022. A control group of 20 patients (15 males, 5 females), with a mean age of 39.1±6.2 years (range, 32-47 years) and a mean BMI of 25.6±5.4 kg/m 2 (range, 20.2-32.7 kg/m 2), underwent partial meniscectomy during the same period. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm score, visual analogue scale (VAS) for pain, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 3, 6, 12, and 24 months postoperatively. The morphology and signal intensity of grafts, Recht grading for cartilage damage, and the need for secondary arthroscopy were also evaluated. Results:The mean follow-up duration was 24.3±4.3 months for the tendon graft group and 24.2±3.6 months for the partial meniscectomy group. At 3 and 6 months postoperatively, the partial meniscectomy group demonstrated superior knee function scores compared to the tendon graft group ( P<0.05). Similarly, VAS were lower in the partial meniscectomy group at 3 months postoperatively ( P<0.05), although no significant difference was found at 6 months ( P>0.05). By 12 months postoperatively, differences in pain and function between the two groups were no longer statistically significant ( P>0.05). At 24 months, the tendon graft group exhibited significantly better outcomes in terms of the Lysholm score (84.31±12.20 vs. 72.67±14.18), IKDC score (82.21±10.55 vs. 74.09±11.68), VAS score (2.10±1.74 vs. 3.80±1.81), and KOOS score (85.37±13.14 vs.75.14±17.94) compared to the partial meniscectomy group ( P<0.05). Regarding graft healing, 19 patients in the tendon graft group demonstrated a grade 3 graft-residual meniscus complex at 24 months, significantly improved from 5 patients at 3 months postoperatively. Furthermore, no grafts showed a grade 3 signal intensity at 3 months, while 19 patients showed such improvements by 24 months. MRI at the 24-month follow-up revealed cartilage damage in 7 patients in the tendon graft group and 20 patients in the partial meniscectomy group, with severe cartilage damage (Recht grade>II) observed in 1 patient in the tendon graft group and 7 patients in the partial meniscectomy group. All 20 patients in the tendon graft group achieved minimal clinically significant differences by 24 months, and 4 of them underwent secondary arthroscopy, which revealed vascularization between the graft and residual meniscal tissue. Conclusion:The use of the peroneus longus tendon for meniscal reconstruction reduces knee pain, enhances knee function, and effectively fills the tibiofemoral joint space while protecting the articular cartilage through graft remodeling.