Objective:This study aimed to explore the status of radiological Kashin-Beck disease (KBD) among school-aged children in Chamdo City, Tibet, through a 3-year monitoring survey, providing epidemiological evidence for prevention and control strategies.Methods:The target areas for this study were Luolong, Bianba, and Basu counties in Chamdo City, Tibet Autonomous Region, identified as having the most severe historical cases of KBD. Children aged 7-12 years attending school were enrolled as study subjects. Anteroposterior X-ray films of the right-hand were taken, and radiological diagnoses were made based on the "Diagnosis of Kashin-Beck Disease" criteria (WS/T 207-2010). Two experienced researchers independently reviewed the X-rays, and intra- and inter-group consistency were assessed using weighted Kappa values and percentage agreement. Cross-sectional surveys were conducted in 2017 and 2020 to describe the X-ray detection rates of KBD, and logistic regression analysis was employed to construct a predictive model of risk factors for radiological KBD cases.Results:In 2017, a total of 5,711 children aged 7-12 years in Chamdo City, Tibet, participated in the baseline cross-sectional survey (average age 9.2 years, 48.0% female), with 28 cases of radiological KBD. The age- and gender-standardized prevalence rate was 0.527%. In 2020, 6,771 participants (average age 9.3 years, 49.5% female) underwent a second cross-sectional survey, with 9 cases of radiological KBD and a standardized prevalence rate of 0.134%. Logistic regression analysis indicated that older age [ OR=2.439, 95% CI(1.299, 4.580), P=0.006] and female gender [ OR=8.157, 95% CI(1.016, 65.528), P=0.048] were independent risk factors for radiological KBD cases. Conversely, higher residential altitude, under the premise of Tibet's high altitude, was a protective factor [ OR=0.995, 95% CI(0.990, 0.999), P=0.032). Conclusion:The radiographically positive detection rate of KBD among school-aged children in Chamdo City, Tibet Autonomous Region, is at an extremely low level and showing a declining trend, reaching the historical standard in 2020. Considering the absence of positive signs in affected children, it suggests that local KBD has been effectively eliminated.

Objective:To assess causes for revision total knee arthroplasty (TKA) in China using the data of revision TKA in the past 15 years in our single center andcompare the differences in survival time, operation time and blood loss among different revision reasons.Methods:Data of 337 patients (345 knees) with revision TKAs at our institution from January 2007 to December 2021 (15 years) were retrospectively analyzed. The included population consists of 57 males and 288 females. The causes for first revision TKA were identified and compared according to the time of revision surgery as early (up to 2 years) and late revision (more than 2 years). The reason for revision before 2012 and after 2012 was also compared. Furthermore, the differences of survival time, operation time and blood loss among different revision reasons were compared.Results:The most common reasons for revision of knee joints in 345 cases were periprosthetic infection (133 knees, 38.6%), followed by aseptic loosening (97 knees, 28.1%) and joint instability (35 knees, 10.1%). Early revisions were performed in 171 knees (49.6%), while late revisions were performed in 174 knees (50.4%). Periprosthetic infection (96 knees, 56.1%) and aseptic loosening (86 knees, 49.4%) were the most common reasons for early and late revisions, respectively. There were 59 revisions performed before 2012 and 286 revisions performed after 2012, with periprosthetic infection being the main reason for revision in both groups. The percentage of revisions due to infection decreased from 64.4% before 2012 to 33.2% after 2012, and this difference was statistically significant (χ 2=18.790, P<0.001). The proportion of revisions due to aseptic loosening was 15.3% before 2012, which was significantly lower than the proportion of 30.8% after 2012 (χ 2=5.083, P=0.024). The median survival time of the prostheses in the included patients was 30 months, with shorter survival time observed in patients with stiffness, patellar complications, and periprosthetic infection, and longer survival time observed in patients with polyethylene wear and aseptic loosening. There were significant differences in operation time and blood loss among different reasons for revision ( P<0.001). Conclusion:In our specialized arthroplasty center periprosthesis infection was the most common reason for revision. Periprosthesis infection and aseptic loosening needed to be considered for early or late-stage revision. With the development of technique of total knee arthroplasty, the proportion of periprosthesis infection is decreasing, while the incidence of aseptic loosening is increasing.

Osteoarthritis, the most common degenerative musculoskeletal disease, has an increasingly heavy burden around the world. In 2019, approximately 530 million people suffered from osteoarthritis, with the age-standardized incidence rate of 492.2 per 100 000, the age-standardized prevalence rate of 6348.3 per 100 000 and the age-standardized rate of disability-adjusted life years (DALYs) of 228.0 per 100 000. The heaviest burden is observed in high-income North America while the fastest growth of burden is observed in high-income Asia Pacific. The age-standardized rate of incidence, prevalence and DALYs in China were 509.8 per 100 000, 6330.1 per 100 000 and 224.8 per 100 000, respectively, which were higher than the average level in Asia. Considering the large and aging population in China, the disease burden will continue to increase and the prevalent number and DALYs in 2044 are expected to be 1.5 times higher than those in 2019. Although osteoarthritis is frequently seen in the elderly, the negative impact on young adults should not be ignored. Besides, postmenopausal women, individuals with high body mass index, and residents in rural and mountainous areas are also at relatively higher risk of osteoarthritis. Osteoarthritis increases the risk of multiple diseases, including cardiovascular diseases, diabetes and psychological cognitive impairment, as well as the sarcopenia and fractures. The increasing disease burdens and medical requirements in China indicate that clinicians have to fully understand the burden and harm of the disease, and conduct initial screening and intervention for the osteoarthritis-related diseases for patients. The long-term goal is to relieve the disease burdens and to improve the quality of life for osteoarthritis patients.

Many people doubt about its clinical significance, such as prolonged operation duration, longer learning curve , increased medical expenses and robot related complications. On the contrary, with the popularization of technology, the above unfavorable factors also tend to change. Therefore, improving the scientific understanding of robot assisted arthroplasty can promote the development and intersection of related disciplines in this area. The present paper investigated the following advantages of robot in assisting arthroplasty from two aspects, improving the accuracy of prosthesis placement and realizing personalized preoperative planning. Further, the possible shortcomings were discussed in the learning curve, economic factors and related complications. Finally, based on the current clinical situation, the future application direction was pointed out.

Objective:To evaluate the early clinical outcomes of 5G remote telesupervised robot assisted total hip arthroplasty in the treatment of Kaschin-Beck disease with hip problems in Tibet through retrospective analysis of the hip surgery cohort.Methods:According to the operation procedure, 55 Kaschin-Beck disease patients (59 hips) undergoing total hip arthroplasty from November 2020 to November 2021 in the Karub District People's Hospital in Qamdo were divided into the conventional THA group (cTHA) and the 5G remote telesupervised robot assisted THA group (rTHA). Two of them underwent cTHA on both hips, while the other two patients underwent cTHA and rTHA separately of each hip, and the rest underwent single hip surgeries. In the cTHA group, there were 30 patients (32 hips), 16 males (17 hips) and 14 females (15 hips), aged 56.56±9.33 years (range, 36-76 years); In the rTHA group, there were 27 patients (27 hips), 10 males and 17 females, aged 55.41±10.90 years (range, 24 to 79 years). Before operation, Harris hip score was recorded and femoral offset (FO) and leg length difference (LLD) were measured via X-ray images. The operation time was collected during the hip surgery and an average network delay of 172.28±36.58 ms and a 1.08% data packet loss ratio is obtained during telesupervision. 24 hours post-operatively, the FO and LLD were both measured via the X-ray images, as well as the inclination and anteversion of the acetabular cup. The Harris scores were collected in the following up. The operation time, FO, LLD, inclination, anteversion and Harris score were compared between the two groups.Results:All cases in both groups were followed up for an average of 9.39±2.43 months (range, 6-19 months). There were no significant differences in pre-operative FO and LLD, preoperative Harris scores or average follow-up time between the two groups. The operation time in rTHA group was 126.41±12.78 min, which is significantly longer than the time 88.81±8.83 min in cTHA group ( t=13.31, P<0.001). After operation, the FO was significantly increased and the LLD was significantly decreased ( P<0.05). The postoperative LLD was 0.63±0.65 cm in the robot group and 1.15±0.71 cm in the conventional group, the difference was statistically significant ( t=2.88, P=0.006). However, there was no significant difference in the FO, inclination and anteversion between the two groups post-operatively ( P>0.05). The Harris scores of both groups were significantly improved compared with that before the operation. Additionally, the Harris score of the two groups was significantly higher than that before surgery, and the postoperative Harris score of the rTHA was 69.00±12.33 higher than that of the cTHA (62.31±11.87), with statistical significance ( t=2.12, P=0.039). The ratio of excellence of Harris score was 19% (5/27) in the rTHA and 9% (3/32) in the cTHA, with no significant difference between groups (χ 2=1.05, P=0.522). Conclusion:Compared to conventional surgery, 5G remote telesupervised robot assisted total hip arthroplasty has more advantages in improving the joint functions in the treatment of hip problems caused by Kashin-beck disease in Tibet Autonomous Region, and facilitates more accurate adjustment of lower limb length difference, even though it consumes more operation time.

Objective:To develop a tetramer probe targeting fibroblast activation protein (FAP), named 1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid (DOTA)-4P(FAP inhibitor (FAPI)) 4, evaluate its biodistribution and PET image in FAP-positive-tumor bearing nude mice, and explore its feasibility as a novel radio-regent for treatment of FAP-positive tumor. Methods:FAP tetramer probe was constructed on the FAPI-46 motif with four mini-polyethylene glycol (PEG)(PEG 3) spacers between the four FAPI motifs, denoted as 4P(FAPI) 4. DOTA was used as the chelator for radiolabeling with 68Ga and 177Lu. The FAP binding characteristics were test by in vitro cell competitive binding experiment. Small-animal PET, in vivo biodistribution, and radionuclide targeting therapy were performed in HT-1080-FAP tumor bearing nude mice ( n=39). Independent-sample t test was performed to analyze tumor uptake data, and two-factor repeated measures analysis of variance was utilized to compare tumor volume data in radioactive isotope therapy. Results:Cell experiment showed that FAPI-tetramer and FAPI-monomer had similar half maximal inhibitory concentration values (3.29 and 2.15 nmol/L). 68Ga/ 177Lu radiolabeled FAPI-tetramer had better tumor uptake and retention than FAPI-monomer in small-animal PET and in vivo biodistribution experiment, with the tumor uptake for 177Lu-DOTA-4P(FAPI) 4 and 177Lu-FAPI-46 at 48 h of (18.72±1.32) vs (2.72±1.20) percentage activity of injection dose per gram of tissue (%ID/g) ( t=15.55, P<0.001). 177Lu-DOTA-4P(FAPI) 4 group showed best anti-tumor efficacy compared with 177Lu-FAPI-46 and control group in radionuclide targeting therapy. On the 2nd day after the start of treatment, the tumor volume in the tetramer treatment group was significantly smaller than that in the control group (mean difference 67.19 mm 3, P=0.049); on the 14th day after the start of treatment, the tumor volume in the tetramer treatment group was significantly smaller than that in the monomer treatment group (mean difference 414.33 mm 3, P=0.005). Conclusion:FAPI-tetramer can improve tumor uptake and retention ability compared with FAPI-46, and 177Lu-DOTA-4P(FAPI) 4 can be a promising radio-agent for FAP-positive tumor therapy.

Objective:To analysis the relationship between symptomatic knee osteoarthritis and frailty in older Chinese adults.Methods:In this retrospective study, follow-up data between 2011 and 2015 from the China Health and Retirement Longitudinal Study(CHARLS)were analyzed.Participates over 60 years old were divided into a frailty group, a pre-frailty group, and a normal group, according to the frailty phenotype.Cross-sectional analysis was conducted to examine the relationship between frailty and symptomatic knee osteoarthritis, and the role of symptomatic knee osteoarthritis in the progression of frailty in normal elderly people was further analyzed using a retrospective cohort.Results:In 2011, 5.9% of the elderly were frail and 15.1% of the elderly suffered knee pain.Univariate and multivariate regression analysis indicated that knee pain was a risk factor for frailty( OR: 1.91, 95% CI: 1.37-2.61, P<0.01).After a 4 year-follow-up, 41.7% of the normal elderly participants progressed to the frail or pre-frail state.Multivariate regression analysis suggested that knee pain was a risk factor for normal elderly people to enter the frail or pre-frail state( OR: 1.57, 95% CI: 1.00-2.45, P<0.05). Conclusions:Knee pain is one of the important risk factors for the development of frailty in the elderly.Normal elderly people with knee pain are at an increased risk of frailty or pre-frailty in later years.

Kashin-Beck disease is a chronic, endemic and deformable osteoarthropathy that mainly occurs in children and adolescents in many areas of China, whose main pathological changes are multiple symmetrical degeneration, necrosis, and secondary degeneration of epiphyseal cartilage, epiphyseal plate cartilage and articular cartilage. Patients with Kashin-Beck disease mainly present with joint pain, thickening, deformation, restricted movement, and muscle atrophy. In severe cases, Kashin-Beck disease can cause short fingers, short limbs, and even short deformities. However, there is no specific treatment for Kashin-Beck disease currently. Common treatment methods include non-steroidal anti-inflammatory drugs, cartilage protecting drugs, traditional Chinese medicine, arthroscopy and arthroplasty. This article reviews the treatment methods and research progress of Kashin-Beck disease, aiming to provide a more comprehensive reference for the treatment of Kashin-Beck disease.

Objective:To evaluate the long-term effect of structured patient education and exercise therapy for knee osteoarthritis (KOA).Methods:Prospective cohort study, 162 patients with KOA were consecutively recruited from May 2016 to December 2019 to receive structured patient education and exercise therapy and were followed up 3 years after the recruitment. All the patients received two 1-hour educational courses and exercise therapy twice per week for six weeks under the supervision of physicians or physical therapists. Knee injury and osteoarthritis score (KOOS), visual analog score of pain (VAS), intermittent and constant OA pain (ICOAP), self-efficacy for arthritis were queried at 3-month and 36-month follow-up visit. We fitted linear mixed-effects models to examine the difference in scores between baseline and 3-month and 36-month visits.Results:109(67.3%) patients finished both 3-month and 36-month follow-up visits. The KOOS pain score increased from 70.8±1.7 at baseline to 79.7±1.8 at 36 months ( P<0.05). The KOOS symptom score increased from 66.8±2.0 at baseline to 74.9±2.1 at 36 months ( P<0.05). The KOOS daily function score increased from 81.7±1.4 at baseline to 87.0±1.5 at 36 months ( P<0.05). KOOS motor function score increased from 47.4±2.8 at baseline to 55.0±2.9 at 36 months ( P<0.05). The quality of life score of KOOS increased from 46.6±2.1 at baseline to 63.5±2.2 at 36 months ( P<0.05). Compared with the baseline data, there were statistically significant improvements in all subscales of KOOS in 36 months after exercise therapy intervention ( F=14.548, 8.102, 11.394, 5.687 and25.942, P<0.05). VAS pain score of left knee, VAS pain score of right knee, ICOAP score, self-efficacy pain score and other symptoms were also significantly improved ( F=17.643, 26.791, 8.290, 4.052 and 3.654, P<0.05). Conclusion:Structured patient education and exercise therapy are effective in improving knee pain and function as well as self-efficacy until as long as 36 months.

Objective:To investigate the orthopedists' cognition on Chinese Osteoarthritis Guideline (2018 Edition).Methods:Questionnaire about Chinese Osteoarthritis Guideline (2018 Edition) was developed and sent to orthopedists via an invitation link to fill out after authorization from Chinese Osteoarthritis Association. The content of the questionnaire included the basic personal information of the physician, the awareness rate of the guidelines, the evaluation of the guidelines, and its application effects. The survey duration was from September 2019 to December 2019. Multivariate logistic regression and linear regression analysis were performed for the guideline awareness rate and comprehensive score, respectively.Results:A total of 628 physicians completed the questionnaire, of which 623 of 628 (99.2%) were available. About 72.4% of the orthopedists knew the guideline. The awareness rate was statistically related to the education of the physicians ( P<0.05). Respondents' overall score for the guideline was 8.39 with methodological score 8.28. A total of 41.2% of orthopedists thought that the guideline was very good compared with the European and American guidelines, and the clinical problem coverage rate was 78.6%. There is a statistically significant difference in the appraisal of the recommendations ( χ2=138.9, P<0.05) . More than 40% of orthopedists believed that the guidelines were of great help to orthopedists and patients, and that the guide could be promoted to the primary hospitals. Conclusion:After one year publication of Chinese Osteoarthritis Guideline (2018 Edition), most orthopedists have understood the present guideline and applied recommendations in clinical practice. However, the guideline need to be further promoted and disseminated in the future.