AIM: To compare the progression of myopia in children wearing orthokeratology lenses combined with low-concentration atropine before and after drug withdrawal, to determine the rebound effect of drug withdrawal in orthokeratology lens wearers, and to analyze its causes based on changes in pupil diameter.METHODS:A prospective case-control study was conducted to collect 80 children with myopia who were treated with orthokeratology lenses combined with 0.01% atropine ophthalmic gel at the Xi'an No.1 Hospital from January to June 2022. One year later, they were divided into a drug withdrawal group(Group A, 40 cases)and a continuous medication group(Group B, 40 cases)based on whether they stopped taking the medication. The progression of myopia before and after drug withdrawal was observed by analyzing changes in axial length(AL)and spherical equivalent(SE)in the group A within 1 a before and after drug withdrawal. The changes in AL, pupil diameter(PD), and SE were compared between the group A and group B within 2 a, and the correlation between PD and AL growth was analyzed.RESULTS:In the group A, the AL increased by 0.17±0.23 and 0.29±0.18 mm at 0.5 and 1 a after drug withdrawal, respectively, which were both greater than before drug withdrawal(t=5.318, 2.983, both P<0.001). There was no statistically significant difference in SE growth between the two time points(P>0.05). There were no statistically significant differences in AL and PD between the group A and group B at baseline, 0.5 and 1 a during combined medication(all P>0.05). At 1.5 a, the AL growth of the group A was greater than that of the group B(0.32±0.27 mm vs 0.26±0.20 mm, t=7.363, P<0.001), and the PD was smaller than that of the group B(3.60±1.25 mm vs 4.12±1.92 mm, t=-7.541, P<0.001). At 2 a, the AL growth of the group A was greater than that of the group B(0.44±0.18 mm vs 0.32±0.14 mm, t=5.709, P<0.001), and the PD was smaller than that of the group B(3.67±1.31 mm vs 4.02±1.67 mm, t=-4.281, P<0.001). Correlation analysis showed a negative correlation between PD and AL growth at 0.5 and 1 a follow-ups over 2 a(R2=-0.156, -0.190, both P<0.001).CONCLUSION: After stopping low-concentration atropine in children wearing orthokeratology lenses, AL increased more rapidly than before drug withdrawal, PD decreased, and SE changed little. Compared with continuous medication, discontinuation of medication led to faster progression of AL with little change in diopter, and the larger the PD during orthokeratology lens wear, the slower the progression of AL.

BACKGROUND:Because of its anti-inflammatory and antioxidant activities,Apelin-13 plays an effective role in the treatment of common clinical diseases such as neuroinflammation,cardiovascular injury and pneumonia.However,there is no relevant basic research on whether Apelin-13 also has a good effect in the treatment of inflammatory bone loss. OBJECTIVE:To explore the therapeutic effect and mechanism of Apelin-13 on inflammatory bone loss,in order to find potential drugs for the treatment of inflammatory bone loss. METHODS:(1)In vitro experiment:RAW264.7 cells were divided into three groups:control group,lipopolysaccharide group and treatment group.The control group was only added with DMEM complete medium;lipopolysaccharide group was added with lipopolysaccharide(100 ng/mL)induced inflammation DMEM medium;and the treatment group was added with 10 nmol/L Apelin-13+lipopolysaccharide induced inflammation DMEM medium.Then,24 hours after lipopolysaccharide induced inflammation,western blot was used to detect the marker proteins inducible nitric oxide synthase and CD86 of M1 macrophages,and cell immunofluorescence was extracted to detect the expression of inducible nitric oxide synthase.Finally,the same amount of receptor activator of nuclear factor-κB ligand(RANKL;50 ng/ml)was added to the control group,lipopolysaccharide group and treatment group to induce osteoclasts.The results of osteoclast induction were evaluated by tartrate-resistant acid phosphatase staining and F-actin staining after 6 days of induction.(2)In vivo experiment:Eighteen male C57bl/6 mice were randomly divided into three groups:sham group,lipopolysaccharide group and treatment group.The sham group received intraperitoneal injection of 0.1 mL of PBS;the lipopolysaccharide group was injected with 0.1 mL of PBS diluent containing lipopolysaccharide(5 mg/kg);and the treatment group was injected with 0.1 mL of PBS diluent containing lipopolysaccharide(5 mg/kg)+Apelin-13(100 μg/kg).After 7 days of continuous intraperitoneal injection,the mice in each group were killed on the 8th day,and two femurs of each mouse were collected.Half of them were scanned by micro-CT and analyzed by bone mineral density,and the other half were stained by hematoxylin-eosin staining RESULTS AND CONCLUSION:(1)In vitro experiment:Western blot results showed that the expressions of inducible nitric oxide synthase and CD86 in the lipopolysaccharide group were significantly higher than those in the control group,and Apelin-13 could significantly inhibit the M1 polarization of macrophages induced by lipopolysaccharide.Cell immunofluorescence results also showed that the expression of inducible nitric oxide synthase in the treatment group was lower than that in the lipopolysaccharide group.Besides,tartrate-resistant acid phosphatase staining and F-actin staining results showed that Apelin-13 inhibited the abnormal activation and bone resorption of lipopolysaccharide induced osteoclasts.(2)In vivo experiment:The results of micro-CT showed that systemic inflammation led to significant bone loss in the distal femur,while Apelin-13 could significantly inhibit bone loss in vivo.Hematoxylin-eosin staining results also showed that Apelin-13 could effectively alleviate inflammation induced bone loss in the distal femur of mice.To conclude,Apelin-13 can alleviate bone loss induced by systemic inflammation by inhibiting M1 polarization of macrophages,inhibiting abnormal activation of osteoclasts and bone resorption.

AIM: To observe related influence of eye-use behaviors on the onset and progression of myopia among primary school student in Minhang district, Shanghai under the background of “double reduction”, and evaluate the impact of eye-use habit and behavior on the myopia development in children and adolescents.METHODS:A stratified cluster sampling method was adopted to select study subjects for longitudinal observation. Random sampling was conducted among grade 1-4 students from three primary schools in Minhang District, Shanghai from September to December 2021 after the implementation of the “double reduction” policy, with a 2-year observation period. Annual vision screenings were performed to obtain uncorrected visual acuity, non-cycloplegic refraction data, and spherical equivalent(SE). Biometric measurements were taken to acquire axial length(AL)and corneal curvature(CR). Questionnaires were administered to investigate the eye-use behaviors of participants. Taking myopia ≤-0.50 D as the diagnostic criterion, myopia incidence were calculated. SE and AL changes were used to evaluate myopia progression. Logistic regression analysis was employed to identify risk factors for myopia, and analyze the relationship between eye-use behaviors and myopia development or progression.RESULTS:A total of 2 986 children complete a follow-up for 2 a. The baseline prevalence of poor vision was 32.74%, increasing to 38.92% and 43.73% at 1 and 2 a follow-up, respectively, demonstrating a yearly upward trend. Taking uncorrected visual acuity combined with non-cycloplegic refraction as clinical screening criteria for myopia, the incidence was 24.72%, 27.60%, and 29.64% at baseline, 1, and 2 a follow-ups, respectively. These showed no statistical significant difference compared to the diagnostic standard of cycloplegic refraction SE(23.98%, 27.03%, and 29.17%; all P>0.05). Logistic regression analysis found that daily outdoor and sleep duration were protective factors against myopia(OR=0.54, 0.84, all P<0.05), while age, parental myopia, duration of offline education, online education, electronic device usage, and poor visual posture were identified as risk factors(OR=2.72, 1.54, 1.72, 1.12, 1.47, 1.26, all P<0.001). Further analysis of myopia progression in baseline myopic children over 2 a revealed that age, parental myopia, baseline SE, duration of offline/online education, electronic device usage, and poor visual posture may contribute to rapid myopia progression.CONCLUSION:Under the background of “double reduction”, the eye-use behavior among primary school students in Minhang District, Shanghai has an important impact on the occurrence and development of myopia. In order to effectively prevent and control myopia, it is necessary to further strengthen the education and guidance of eye-use behavior.

BACKGROUND:With the aging of the global population,the incidence rate of osteoporosis is also increasing.It is very important to further understand its pathogenesis and propose new therapeutic targets.Recent studies have shown that ferroptosis is closely related to the pathogenesis of some bone diseases,such as inflammatory arthritis,osteoporosis and osteoarthritis. OBJECTIVE:To summarize the previous studies on the mechanism of ferroptosis in osteoporosis,so as to provide new therapeutic ideas and potential therapeutic targets for osteoporosis. METHODS:The first author used the computer to search the documents published from 2000 to 2022 in CNKI,WanFang,VIP,PubMed and Web of Science with the key words of"ferroptosis,osteoporosis,osteoblasts,osteoclasts,iron chelators,reactive oxygen species,nuclear factor erythroid 2-related factor 2,heme oxygenase-1,glutathione peroxidase 4,review"in Chinese and English.A total of 70 articles were finally included according to the inclusion criteria. RESULTS AND CONCLUSION:Ferroptosis is significantly different from necrosis,apoptosis and autophagy.In terms of cell morphology and function,it does not have the morphological characteristics of typical necrosis,nor does it have the characteristics of traditional apoptosis,such as cell contraction,chromatin condensation,the formation of apoptotic bodies and the disintegration of cytoskeleton.Contrary to autophagy,ferroptosis does not form a classical closed bilayer membrane structure(autophagic vacuole).Morphologically,ferroptosis is mainly manifested by obvious contraction of mitochondria,increased membrane density,and reduction or disappearance of mitochondrial cristae,which are different from other cell death modes.Iron overload can destroy bone homeostasis by significantly inhibiting osteogenic differentiation and stimulating osteoclast formation,leading to osteoporosis.Iron overload interferes with the differentiation of stem cells to osteoblasts,leading to a weakened osteoblast function and further imbalance of bone metabolism in the body,which eventually leads to osteoporosis.Stimulated by iron overload,osteoclast bone resorption is enhanced and bone loss exceeds new bone formation.Iron chelators have been proved to have osteoprotective effects by inhibiting osteoclast activity and stimulating osteogenic differentiation of osteoblasts.Its potential mechanism is related to inhibiting osteoclast differentiation and promoting osteoblast differentiation.Antioxidants can prevent reactive oxygen species production and inhibit bone absorption,thus improving bone metabolism and effectively preventing osteoporosis.

Osteoarthritis(OA)is a chronic progressive osteoarthropathy in the elderly.Osteoclast activation plays a crucial role in the occurrence of subchondral bone loss in early OA.However,the specific mechanism of osteoclast differentiation in OA remains unclear.In our study,gene expression profiles related to OA disease progression and osteoclast activation were screened from the Gene Expression Omnibus(GEO)repository.GEO2R and Funrich analysis tools were employed to find differentially expressed genes(DEGs).Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses demonstrated that chemical carcinogenesis,reactive oxygen species(ROS),and response to oxidative stress were mainly involved in osteoclast differentiation in OA subchondral bone.Furthermore,fourteen DEGs that are associated with oxidative stress were identified.The first ranked differential gene,heme oxygenase 1(HMOX1),was selected for further validation.Related results showed that osteoclast activation in the pathogenesis of OA subchondral bone is accompanied by the downregulation of HMOX1.Carnosol was revealed to inhibit osteoclastogenesis by targeting HMOX1 and upregulating the expression of antioxidant protein in vitro.Meanwhile,carnosol was found to alleviate the severity of OA by inhibiting the activation of subchondral osteoclasts in vivo.Our research indicated that the activation of osteoclasts due to subchondral bone redox dysplasia may serve as a significant pathway for the advancement of OA.Targeting HMOX1 in subchondral osteoclasts may offer novel insights for the treatment of early OA.

OBJECTIVE: To investigate the surgical technique and the short-term effectivenss of lateral unicompartmental knee arthroplasty (LUKA) through lateral approach in the treatment of valgus knee and to calculate the maximum value of the theoretical correction of knee valgus deformity. METHODS: A retrospective analysis was performed on 16 patients (20 knees) who underwent LUKA and met the selection criteria between April 2021 and July 2022. There were 2 males and 14 females, aged 57-85 years (mean, 71.5 years). The disease duration ranged from 1 to 18 years, with an average of 11.9 years. Knee valgus was staged according to Ranawat classification, there were 6 knees of type Ⅰ, 13 knees of type Ⅱ, and 1 knee of type Ⅲ. All patients were assigned the expected correction value of genu valgus deformity by preoperative planning, including the correction value of lateral approach, intra-articular correction value, and residual knee valgus deformity value. The actual postoperative corrected values of the above indicators were recorded and the theoretical maximum correctable knee valgus deformity values were extrapolated. The operation time, intraoperative blood loss, incision length, hospital stay, hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibia angle (mMPTA), joint line convergence angle (JLCA), posterior tibial slope (PTS), range of motion (ROM), Hospital for Special Surgery (HSS) score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were also recorded for effectiveness evaluation. RESULTS: The patients' incision length averaged 13.83 cm, operation time averaged 85.8 minutes, intraoperative blood loss averaged 74.9 mL, and hospital stay averaged 6.7 days. None of the patients suffered any significant intraoperative neurological or vascular injuries. All patients were followed up 10-27 months, with a mean of 17.9 months. One patient with bilateral knee valgus deformities had intra-articular infection in the left knee at 1 month after operation and the remaining patients had no complication such as prosthesis loosening, dislocation, and infection. The ROM, HSS score, and WOMAC score of knee joint significantly improved at each time point after operation when compared to those before operation, and the indicators further improved with time after operation, the differences were all significant ( P<0.05). Imaging measurement showed that HKA, mLDFA, JLCA, and PTS significantly improved at 3 days after operation ( P<0.05) except for mMPTA ( P>0.05). Postoperative evaluation of the knee valgus deformity correction values showed that the actual intra-articular correction values ranged from 0.54° to 10.97°, with a mean of 3.84°. The postoperative residual knee valgus deformity values ranged from 0.42° to 5.30°, with a mean of 3.59°. The actual correction values of lateral approach ranged from 0.21° to 12.73°, with a mean of 4.26°. CONCLUSION LUKA through lateral approach for knee valgus deformity can achieve good early effectiveness. Preoperative planning can help surgeons rationally allocate the correction value of knee valgus deformity, provide corresponding treatment strategies, and the maximum theoretical correction value of knee valgus deformity can reach 25°.
Male ; Female ; Humans ; Arthroplasty, Replacement, Knee/methods* ; Retrospective Studies ; Blood Loss, Surgical ; Osteoarthritis, Knee/surgery* ; Knee Joint/surgery*

Objective:To explore the early learning curve of OrthoPilot navigation assisted total knee arthroplasty (TKA).Methods:Data of 40 consecutive cases of OrthoPilot navigation assisted TKA completed by the same surgical team in our department were retrospectively analyzed. According to the operation order, 40 cases were divided into the original phase group (the first 20 cases) and the subsequent phase group (the second 20 cases). In original phase group, the average age was 69.85±6.86 years with mean body mass index 24.10±2.88 kg/m 2, preoperative HSS score 48.80±5.33, preoperative knee ROM 87.05°±11.02° and preoperative alignment deviation of 7.40°±5.59°. In subsequent phase group, the average age was 66.65±7.92 years with mean body mass index 22.85±3.15 kg/m 2, preoperative HSS score 49.00±5.47, preoperative knee ROM 85.80°±11.65° and preoperative alignment deviation of 8.22°±5.21°. Perioperative data such as operative duration, incision length, hemoglobin drop and postoperative hospital stay, radiographic outcomes including hip-knee-ankle angle (HKAA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), sagittal femoral component angle (sFCA), sagittal tibial component angle (sTCA), joint line convergence angle (JLCA), and functional scores were compared between the two groups. Results:All 40 cases were followed up for 24-33 months (mean, 27.38± 2.73 months). No severe postoperative complications such as infection and loosening occurred during the follow-up. The mean operative duration was 112.35±25.49 min in original phase group versus 82.10±10.96 min in subsequent phase group ( P< 0.05). The durations of tibial cutting was 11.95±3.27 min in original phase group versus 7.35±2.23 min in subsequent phase group ( P< 0.05); the femoral planning + cutting time was 20.95±6.91 min in original phase group versus 16.60±4.78 min in subsequent phase group, and trial + prosthesis implantation time was 39.65±7.72 min in original phase group versus 25.10±5.72 min in subsequent phase group,which was significantly higher in original phase group. There was no significant difference in other perioperative data such as incision length, hemoglobin drop and postoperative hospital stay between the two groups. As for radiographic outcomes, there was no statistical difference between the two groups in the postoperative angular deviation of HKAA (0.70°±0.80° vs. 0.80°±1.06°), mLDFA (0.89°±0.91° vs. 1.00°±0.86°), mMPTA (0.77°±0.53° vs. 0.76°±1.03°), sFCA (0.73°±0.48° vs. 0.87°±1.06°), sTCA (0.95°±0.58° vs. 1.16°±1.14°) and JLCA (0.27°±0.25° vs. 0.39°±0.18°). In original phase group, the HSS scores preoperative and 3 days postoperative were 48.80±5.33 and 60.05±5.10 respectively, and those in subsequent phase were 49.00±5.47 and 60.75±4.47 respectively, and both groups showed satisfactory functional recovery. There was no significant difference in HSS scores at all follow-up time points between two phases, as well as ROM (113.20°±9.82° vs. 113.50°±12.44°) and FJS-12 scores (78.00°±10.98° vs. 76.65°±10.29°) at 2 years postoperatively. Conclusion:In this study, we described a time-related early learning curve for OrthoPilot navigation-assisted TKA, in which the operative duration tended to be shorter after the first 20 cases. However, benefiting from good operative accuracy and repeatability, satisfactory radiographic and functional outcomes can be obtained in early stage of the learning curve.

Objective To investigate the preliminary clinical efficacy of percutaneous plate internal fixation with fracture reduction oriented forcep in the treatment of lower humeral fractures. Methods A retrospective case control study was conducted to analyze the clinical data of 46 patients with lower humeral fractures admitted to Wuzhong People's Hospital of Suzhou from October 2013 to March 2015. There were 25 males and 21 females, aged 19-76 years, with an average age of 45. 7 years. A total of 22 patients ( percutaneous group) were treated with minimally invasive percutaneous internal fixation with self-developed fracture reduction oriented forcep according to the dimensionality reduction method (DRM). The other 24 patients (control group) were treated with open reduction internal fixation. The length of incision, operation time, intraoperative blood loss, fracture healing time, the American Foot and Ankle Surgery Association ( AOFAS ) ankle-hindfoot score at the last follow-up, and postoperative complications were compared between the two groups. Results All patients were followed up for 12-24 months, with an average of 14. 6 months. There were statistically significant differences between percutaneous group and control group in incision length [(7.1 ±0.8)cm vs. (8.8 ±0.7)cm, operation time [(32.5 ±4.9)min vs. (39.2 ±4.3)min], intraoperative blood loss [(8.0 ±2.7) ml vs. (31.0 ± 11.4)ml], and fracture healing time (16.4 ±2.3)weeks vs. (19.5 ±2.9)weeks], respectively (all P<0.05). In percutaneous group, the AOFAS ankle-hindfoot score was (92.3 ±5.9)points (range, 75-99 points ) , and the overall results were good and excellent in 21/22 ( 96％) including excellent results in 18 patients, good in three, fair in one and poor in 0. In control group, the AOFAS ankle-hindfoot score was (91.8 ±4.9)points (range, 76-99 points), and the overall results were good and excellent in 23/24 (96％) including excellent results in 20 patients, good in three, fair in one and poor in 0. There was no significant difference in the excellent and good rate between two groups (P>0. 05). Poor wound healing was observed in one patient in control group. No case of nonunion was found in either group. Conclusion For lower humeral fractures, the percutaneous plate internal fixation with fracture reduction oriented forcep has the characteristics of simple operation, shortened operation time, reduced soft tissue injury and blood loss, and quick healing of the fracture, which is worthy of clinical application.

BACKGROUND:The incidence of low serum level of vitamin D in patients undergoing hip arthroplasty and its impact has not been reported in China, indicating that it has not been brought to the forefront. OBJECTIVE:To determine the prevalence of low serum level of vitamin D in patients before total hip arthroplasty and its relationship with the hip function scores. METHODS:Forty-eight hips from 48 patients undergoing primary hip arthroplasty from July 2013 to August 2014 in the First Affiliated Hospital of Suzhou University were enrol ed. According to the serum level of vitamin D, patients were assigned to low-level (<20μg/L) and high-level (20≥μg/L) groups. The general information of patients, the hip function scores before and after replacement at the last fol ow-up in the two groups were observed and compared. The relationship between the serum level of vitamin D and the hip function scores before and after replacement was analyzed by multiple linear regression analysis. And the average fol ow-up was 12 months (11-14 months). RESULTS AND CONCLUSION:(1) The incidence of low vitamin D level was 82%(20 ng/mL serving as standard). (2) Compared with patients with high vitamin D level, patients with low level of vitamin D had lower preoperative Harris scores and Merle D′Aubigne-Postel score (P<0.05), and also at the last fol ow-up (P<0.05. (3) Based on the preoperative and postoperative Harris, the multiple linear regression analysis showed that there was a positive correlation between the level of vitamin D and Harris score both preoperatively and postoperatively (P<0.05). (4) These results suggest that there is a higher incidence of low level of vitamin D in patients undergoing arthroplasty, and hip function scores before and after replacement in patients with low level of vitamin D are lower than the high level patients. Moreover, there is a positive correlation between the level of vitamin D and the hip joint function scores. Therefore, it is advisable to supplement vitamin D and calcium preoperatively, and the level of vitamin D wil be helpful for disease assessment and prognosis.

Background Tear meniscus gained by OCT device is essential to the dry eye diagnosis.Currently,RTVue Fourier-domain optical coherence tomography (FD-OCT) is commercially available to image the tear menisci.However,there were few studies to report the repeatability and reproducibility of lower and upper tear meniscus parameters measured by RTVue FD-OCT.Objective The purpose of this study was to assess the repeatability and reproducibility of lower and upper tear meniscus parameters measured by RTVue FD-OCT in normal and dry eyes.Methods In this prospective study,20 dry eyes of 20 patients were finally recruited,and 20 normal eyes of 20 age-and gender-matched healthy subjects were included during the same period.Successive three-time scans were performed at a 3-minute interval with RTVue FD-OCT in optional eye by one well-trained examiner,and the other operator performed the same measurement 10-15 minutes later.Six parameters of tear meniscus were yielded by custom software,including upper meniscus curvature (UMC),upper meniscus height(UMH),upper meniscus area (UMA),lower meniscus curvature (LMC),lower meniscus height (LMH) and lower meniscus area (LMA).The between-image repeatability was assessed using mean coefficient of repeatability (MCOR),while between-operator reproducibility were evaluated using coefficient of repeatability (COR) and interclass correlation of coefficients (ICC).Results As for the between-image repeatability,the results of MCOR for UMH,UMA,LMH and LMA were 5.11％,3.58％,4.98％ and 4.82％ respectively in the normal eyes and 5.60％,5.80％,5.03％ and 5.74％ respectively in the dry eyes.As for the between-operator reproducibility,the results of COR and ICC for UMA were 5.38％ and O.975,the COR and ICC for LMA were 5.28％ and 0.961 respectively in the normal eyes,and the results of COR and ICC for LMA were 9.69％ and 0.964 in the dry eyes.Conclusions The UMA,LMH and LMA tear meniscus parameters obtained by RTvue FD-OCT show good between-image repeatability,and LMA also presents good between-operator reproducibility.Measurement of tear meniscus parameters with RTVue FD-OCT measuring is a potential diagnostic index for the diagnosis of dry eye.