Abstract:BACKGROUND:Early prediction of cervical instability is crucial for the prevention and treatment of cervical spondylosis,and deep learning technology can provide robust support for intelligent prediction of cervical instability. OBJECTIVE:To develop a deep learning model of cervical instability based on cervical magnetic resonance imaging for early intelligent prediction of cervical instability. METHODS:This study recruited young and middle-aged participants(18-45 years),including both cervical instability patients and healthy controls,through the Spine Department Outpatient Clinic of Wangjing Hospital,China Academy of Chinese Medical Sciences,as well as community-based recruitment.All participants underwent cervical magnetic resonance imaging examinations.On the axial magnetic resonance imaging images,five key anatomical structures were manually annotated:intervertebral disc,facet,prevertebral muscle,deep muscle group in the back of the neck,and superficial muscle group in the back of the neck.A deep learning algorithm was then employed to develop a predictive model for cervical instability,utilizing both the original images and the delineated regions of interest.Finally,the model's predictive performance was systematically evaluated and validated. RESULTS AND CONCLUSION:(1)The study included a total of 308 young and middle-aged participants,comprising 196 individuals with cervical instability and 112 healthy controls.Based on enrollment time,the subjects'data were allocated to either the model training set or the test set.(2)The model demonstrated high predictive performance,with an area under the curve values of 0.97,an F1-score of 0.98,a precision of 0.98,and a recall of 0.97 in the training set.In the test set,these metrics were 0.97,0.95,1.00,and 0.90,respectively.(3)The results indicate that the deep learning model based on cervical magnetic resonance imaging images can effectively enable early intelligent prediction of cervical instability,exhibiting strong diagnostic accuracy.

Abstract:BACKGROUND:Acanthopanax and its extracts exhibit osteogenic effects,but the osteogenic potential and mechanisms of acanthopanax exosome-like nanovesicles remain unclear. OBJECTIVE:To investigate the molecular mechanism by which acanthopanax exosome-like nanovesicles promote osteogenic differentiation of human bone marrow mesenchymal stem cells and their preventive role in osteoporosis. METHODS:(1)Human bone marrow mesenchymal stem cells were extracted by gradient density centrifugation.Exosome-like nanovesicles derived from acanthopanax were isolated by differential centrifugation and sucrose gradient density centrifugation.(2)Human bone marrow mesenchymal stem cells were treated with 0,2.5,and 5 μg/mL acanthopanax exosome-like nanovesicles.Osteogenic differentiation was assessed by alkaline phosphatase staining,Alizarin red staining,qRT-PCR,and western blot assay.(3)Key pathways were identified by transcriptome sequencing and validated with a transforming growth factor β1 receptor inhibitor.(4)An ovariectomized rat model of osteoporosis was established.After 12 weeks of intraperitoneal injection of exosome-like nanovesicles derived from acanthopanax,bone microstructure was analyzed by micro-CT and osteogenic protein expression was assessed by histological staining. RESULTS AND CONCLUSION:(1)Acanthopanax exosome-like nanovesicles exhibited a cup-shaped or discoid morphology.(2)In vitro,acanthopanax exosome-like nanovesicles dose-dependently promoted osteogenic differentiation of bone marrow mesenchymal stem cells,as evidenced by increased alkaline phosphatase activity,enhanced mineralization nodule formation,and upregulated osteogenic gene expression.(3)Transcriptome analysis revealed that exosome-like nanovesicles activated the transforming growth factor-β1/Smad2/3 pathway,upregulating transforming growth factor-β1 and phosphorylated Smad2/3 protein expression.Moreover,the transforming growth factor-β1 receptor inhibitor partially inhibited the osteogenic effects.(4)Animal experimental results demonstrated that treatment with 5 mg/kg exosome-like nanovesicles from acanthopanax significantly increased bone mineral density,bone volume fraction,and trabecular thickness in ovariectomized rats(P<0.05),significantly enhanced collagen fibrillogenesis,and upregulated the expression of Runt-related transcription factor 2,osteocalcin,and transforming growth factor-β1 proteins in bone tissue.No significant toxicity was observed in major organ histological observations.Results showed that exosome-like nanovesicles derived from acanthopanax promote osteogenic differentiation of human bone marrow mesenchymal stem cells by activating the transforming growth factor β1/Smad2/3 pathway and effectively improve osteoporosis.

Abstract:BACKGROUND:Vancomycin is widely used as a first-line drug for treating methicillin-resistant Staphylococcus aureus infections in orthopedic perioperative infection prevention and treatment.However,its narrow therapeutic window and large individual differences make blood drug concentration monitoring crucial for ensuring efficacy and safety. OBJECTIVE:To establish the ultra-performance liquid chromatography-tandem mass spectrometry method to determine the concentration of vancomycin in plasma,and explore the correlation of blood drug concentration changes with clinical efficacy and acute renal impairment. METHODS:Totally 200 orthopedic patients with bone infection who were hospitalized in Beijing Jishuitan Hospital Guizhou Hospital from January 2020 to May 2022 were selected.Blood drug concentration was measured by ultra-performance liquid chromatography-tandem mass spectrometry.Renal function indexes(blood creatinine and urea nitrogen)were monitored,and the clinical efficacy and acute renal impairment of patients with different blood drug concentration levels were analyzed. RESULTS AND CONCLUSION:(1)The established ultra-performance liquid chromatography-tandem mass spectrometry method showed a linear range of 0.5-120.0 μg/mL(R²=0.997),with an intra-day relative standard deviation of 4.82%-6.57%,an inter-day relative standard deviation of 10.2%-12.3%,and an accuracy of 97.3%-106%.(2)The clinical effective rate in the group with a blood drug concentration of 10-20 μg/mL(82%)was significantly higher than that in the group with a blood drug concentration of<10 μg/mL(67%)(P<0.05).(3)The incidence of renal function impairment in the group with a trough blood drug concentration of>20 μg/mL(35.0%)was significantly higher than that in the 10-20 μg/mL group(16.0%)and the<10 μg/mL group(6.7%)(P<0.05).(4)It is suggested that the established ultra-performance liquid chromatography-tandem mass spectrometry method is sensitive and accurate,and can be used for clinical monitoring of vancomycin blood concentration.Maintaining the blood drug concentration within the range of 10-20 μg/mL can achieve the best clinical efficacy and reduce the risk of nephrotoxicity.Monitoring blood drug concentration is of great significance for guiding individualized drug administration.

Abstract:BACKGROUND:The occurrence of diabetic encephalopathy may be closely related to neuronal aging,but its underlying molecular mechanism is not fully understood.Therefore,exploring the role of neuronal aging in diabetic encephalopathy is of great significance for further revealing the pathogenesis of diabetic encephalopathy. OBJECTIVE:To explore role and mechanism of emodin in slowing down the senescence of HT-22 cells induced by high glucose. METHODS:HT-22 cells were divided into a control group(glucose concentration of 25 mmol/L),a high glucose group(glucose concentration of 55 mmol/L),and a high glucose+emodin group(glucose concentration of 55 mmol/L,emodin concentration of 100 µmol/L)and cultured for 48 hours.Cell growth in each group was observed microscopically.Cell viability was assessed by CCK-8 assay.Telomerase reverse transcriptase activity was measured by ELISA in each group.Expression of senescence-related proteins P53,P21,and P16 in each group was determined by RT-qPCR and western blot assay.Expression of lamin A/C in each group was determined by immunofluorescence,RT-qPCR,and western blot assay. RESULTS AND COUCLUSION:(1)Compared with the control group,the cells in the high-glucose group showed obvious growth inhibition under the microscope,which was manifested as a decrease in the number of cells,an increase in size,and a flattened morphology.Compared with the high-glucose group,the number of cells in the high-glucose emodin group increased significantly,and the morphology tended to be regular.(2)Compared with the control group,the cell viability of the high glucose group was significantly decreased(P<0.000 1).Compared with the high glucose group,the cell viability in the high glucose+emodin group was significantly increased(P<0.000 1).(3)Compared with the control group,the telomerase reverse transcriptase activity in the high glucose group was significantly decreased(P<0.001).(4)Compared with the control group,the expression levels of P53,P21,and P16 in the high glucose group were significantly increased(P<0.05).Compared with the high glucose group,the expression levels of P53,P21,and P16 in the high glucose+emodin group were significantly decreased(P<0.05).(5)Compared with the control group,the expression level of lamin A/C in the high glucose group was significantly decreased(P<0.000 1).Compared with the high glucose group,the expression levels of lamin A/C in the high glucose+emodin group were significantly increased(P<0.05).These results suggest that emodin may mitigate high glucose-induced senescence in HT-22 cells by upregulating lamin A/C expression.

Abstract:BACKGROUND:Surgical management of acute Rockwood type III-V acromioclavicular joint dislocations remains controversial.While clavicular hook plate fixation is widely adopted,it carries risks of postoperative complications.The emerging arthroscopy-assisted loop titanium plate technique,despite its minimally invasive advantages,requires further validation regarding long-term efficacy and cost-effectiveness. OBJECTIVE:To compare the clinical efficacy and cost-effectiveness of modified arthroscopic loop titanium plate fixation versus clavicular hook plate fixation for the treatment of acute Rockwood type III-V acromioclavicular joint dislocations. METHODS:Eighty eligible patients with acute Rockwood type III-V acromioclavicular joint dislocations admitted at Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine between January 2021 and July 2024 were enrolled and randomly assigned to either the loop titanium plate group(n=40)or the hook plate group(n=40).Ultimately,31 and 33 patients in each group completed follow-up,respectively.The loop titanium plate group underwent fixation using the FixButtonTM suspension system with 2.4 mm bone tunnel drilling,while the hook plate group received open reduction and internal fixation with a clavicular hook plate.Outcome measures included operative time,incision length,intraoperative blood loss,hospitalization costs,visual analogue scale score for pain,Constant-Murley Score,coracoclavicular distance,acromioclavicular distance,and complication rates,with a follow-up period of 6 months. RESULTS AND CONCLUSION:(1)The loop titanium plate group had a longer operative time,shorter incision length,and less blood loss,but higher hospitalization costs(P<0.05).(2)At 6 months postoperatively,the loop titanium plate group demonstrated a significantly higher excellent-good rate(94%vs.82%;P<0.05),lower visual analogue scale scores,higher Constant-Murley Score(P<0.05),and better restoration of coracoclavicular and acromioclavicular distances(P<0.05).(3)The total complication rate was lower in the loop titanium plate group(6%vs.12%;P<0.05).(4)It is concluded that although the modified arthroscopic loop titanium plate technique requires longer operative time and incurs higher costs,it can significantly reduce surgical trauma,alleviate pain,improve shoulder joint function,and lower the risk of complications.Its short-term clinical efficacy is superior.Despite the higher costs,the potential reduction in secondary surgeries may bring long-term economic benefits.It is more suitable for patients with high demands for incision aesthetics and functional recovery.Future studies with larger sample sizes and extended follow-up periods are warranted for further validation.

Abstract:BACKGROUND:High-altitude hypoxia has been reported to damage the male reproductive system,but whether stem cells can protect against male reproductive damage caused by high-altitude hypoxia has not been reported. OBJECTIVE:To investigate the preventive effect of human umbilical cord mesenchymal stem cell transplantation on reproductive damage in hypoxia-exposed male mice. METHODS:Human umbilical cord mesenchymal stem cells were isolated and cultured to identify the three-lineage differentiation and specific phenotype markers.Totally 21 C57BL/6 male mice were randomly divided into control,hypoxia,and stem cell groups(n=7).A mouse model of chronic-intermittent hypoxia was established to simulate hypoxia exposure at an altitude of 5 000 m(11.1%oxygen volume fraction)in the hypoxia and stem cell groups.On the last day of each week of hypoxia exposure,mice in the stem cell group were injected with 1×106 human umbilical cord mesenchymal stem cells through the tail vein once a week for a total of 6 injections,while the other groups were injected with PBS.Mouse body weight,food and water intake were monitored during the experiment.After the end of hypoxia exposure,the testes were analyzed for morphology,ultrastructure,reactive oxygen species level and mitochondrial membrane potential.The epididymal tissues were analyzed for hematoxylin-eosin staining and sperm motility.The homing ability of the stem cells was observed by DIL tracer method. RESULTS AND CONCLUSION:(1)Human umbilical cord mesenchymal stem cell transplantation significantly improved water and food intake in hypoxic mice,but had no significant effect on body weight.(2)Morphological analysis revealed that hypoxia induced edema in the testes and epididymides of mice,accompanied by the shedding of spermatogenic cells.In contrast,human umbilical cord mesenchymal stem cell transplantation alleviated the structural damage caused by hypoxia exposure and the swelling and atrophy of germ cell mitochondria.Additionally,human umbilical cord mesenchymal stem cell transplantation significantly reduced the reactive oxygen species levels induced by hypoxia exposure,restored the mitochondrial membrane potential,and enhanced sperm motility in hypoxic mice.(3)Tracer experiments indicated that human umbilical cord mesenchymal stem cells,after being injected into mice through the tail vein,mainly accumulated in the lung tissue and had a lower homing capacity in the testis.In conclusion,human umbilical cord mesenchymal stem cell transplantation effectively protected the mitochondrial structure and function of germ cells,alleviated testicular and epididymal edema caused by hypoxia,and thus restored spermatogenesis and sperm motility in mice.

Abstract:BACKGROUND:Conventional rectangular targeting devices are divided into two modules,one left and one right,which hinders flexible intraoperative use and is prone to deformation and error.Even after connection,repeated fluoroscopic confirmation is still required for screw drilling and placement. OBJECTIVE:To investigate the key technology development and clinical application of a modified rectangular locking device for precise distal locking screw placement in intramedullary nailing of femoral shaft fractures. METHODS:Medical records of patients with femoral shaft fractures admitted to Affiliated Suqian Hospital of Xuzhou Medical University and Suyu District People's Hospital from 2021 to 2023 were collected.Patients aged 18-65 years,diagnosed with femoral shaft fractures(AO classification:A,B,or C)by radiographic examination,who underwent closed reduction and intramedullary nailing with distal locking screw placement using the modified rectangular locking device,and whose clinical data(including medical history,radiographic findings,surgical records,and follow-up records)were selected.Forty-one eligible patients were included,including 30 males and 11 females,aged 20-62 years(mean,41.17±8.14 years).The following data were collected:number of intraoperative fluoroscopic examinations during distal locking screw placement,the locking success rate,the time to successful distal locking screw placement,the American Knee Society Score at 1 month after surgery and after fracture healing,and the time to fracture healing. RESULTS AND CONCLUSION:(1)Among 41 consecutive patients with femoral shaft fractures treated via intramedullary nailing using the modified rectangular locking device,intraoperative distal locking required 0-2 fluoroscopy attempts(mean 1.1±0.5),achieved a 98%success rate,and was completed within 6-10 minutes(mean 7.0±1.5 minutes).Postoperative 1-month American Knee Society Score ranged from 140 to 190(mean 150±15).(2)Totally 38 cases completed the 12-24 months of follow-up.Fracture healing occurred at 9-14 months(mean 10.5±2.5 months),with post-healing American Knee Society Score improving to 150-190(mean 185±8),yielding 35 excellent and 3 good outcomes.(3)These findings indicate that freehand locking,oblique fluoroscopy-guided locking,arthroscopy-assisted locking,and electromagnetic navigation-assisted locking,the modified device eliminates dependencies on specialized equipment(e.g.,arthroscopy systems or electromagnetic navigators),reduces procedural complexity,ensures high accuracy and reproducibility,significantly minimizes radiation exposure,and requires minimal surgical expertise.

Abstract:BACKGROUND:Interlocking intramedullary nail fixation is the"gold standard"for the treatment of femoral shaft fractures,and the difficulty of distal locking nail implantation has always been a difficult problem to solve. OBJECTIVE:By comparing the clinical effects of correction leverage technique and free-hand locking nail technique,it is further explained whether the correction leverage technique can be fast and accurate.The distal locking screw of femoral intramedullary nail was placed without direct X-ray radiation exposure,so as to solve the difficulty of distal locking screw placement. METHODS:A total of 52 patients with femoral shaft fractures who experienced difficulty in distal locking screw placement during femoral interlocking intramedullary nail fixation at the Department of Orthopedics,Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University between July 2022 and September 2024 were enrolled.Participants were randomly divided into two groups according to the implantation scheme:the correction leverage group(n=26)underwent the compression bar technique,while the freehand locking nail group(n=26)received conventional freehand locking screw placement for distal femoral intramedullary nail fixation.The distal locking screw placement time,X-ray projection times and first distal screw placement accuracy were compared between the two groups. RESULTS AND CONCLUSION:(1)The distal locking nail placement time in the correction leverage group was significantly shorter than that in the freehand locking nail group(t=-4.136,P<0.001),with a statistically significant difference.(2)The number of X-ray fluoroscopies in the correction leverage group was less than that in the freehand locking nail group(t=-19.696,P<0.001),with a statistically significant difference.(3)In terms of the accuracy of the first nail placement in both groups,the correction leverage group(100%)was higher than the freehand locking nail group(71%),with a statistically significant difference(x2=5.253,P<0.05).(4)The results show that the correction leverage technique has the advantages of fast nail locking,high accuracy,and low X-ray radiation compared with pure freehand nail placement.This technique does not require other auxiliary equipment and is highly maneuverable.Further clinical validation is warranted for its widespread application in femoral shaft fracture fixation with interlocking intramedullary nailing.

Abstract:BACKGROUND:Multiple chronic liver diseases that fail to heal will progress to the stage of liver fibrosis.If not treated in a timely manner,they will eventually develop into liver cancer,severely threatening the safety of patients'lives.However,there is currently no specific drug for the treatment of liver fibrosis.Recent studies have demonstrated that mesenchymal stem cell therapy has significant advantages over traditional treatment protocols,providing a new direction for the treatment of liver fibrosis. OBJECTIVE:To review the mechanisms of action of mesenchymal stem cells and their derivatives in the treatment of liver fibrosis. METHODS:The Chinese and English keywords"mesenchymal stem cells,mesenchymal stromal cells,MSCs,liver fibrosis,hepatic fibrosis,hepatocyte death,liver cell death,hepatocyte-like cells,immunomodulation,macrophage,hepatic stellate cells,clinical trials,clinical studies"were used and searched in CNKI and PubMed databases,a total of 81 eligible articles were selected for this review. RESULTS AND CONCLUSION:Through summarizing existing studies,the mechanisms by which mesenchymal stem cells and their derivatives exert anti-fibrotic effects and delay disease progression have been identified.These specific mechanisms include reducing hepatocyte death,differentiating into hepatocyte-like cells,regulating immune responses,and inhibiting the activation of hepatic stellate cells.These findings confirm that mesenchymal stem cells and their derivatives can serve as a new research direction for the treatment of liver fibrosis-related diseases.

Abstract:BACKGROUND:Although the clinical manifestations of spinal tuberculosis and Brucella spondylitis are similar,the treatment options are different,and traditional imaging examinations are difficult to accurately distinguish them.Diffusion-weighted imaging can quantify the diffusion differences of water molecules in tissues through apparent diffusion coefficient,which may provide a new way for early identification.However,the correlation between apparent diffusion coefficient and inflammatory markers under different diffusion sensitivity coefficients is not clear. OBJECTIVE:To explore the clinical value of diffusion-weighted imaging with different diffusion sensitivity coefficients in the diagnosis of spinal tuberculosis and Brucella spondylitis,and to analyze the correlation between apparent diffusion coefficient and inflammatory indicators. METHODS:Sixty patients with spinal tuberculosis and 60 patients with Brucella spondylitis who were admitted and diagnosed in Shengjing Hospital Affiliated to China Medical University from June 2021 to June 2024 were randomly selected as the research objects.Among them,there were 35 males and 25 females in the spinal tuberculosis group,with an average age of(53.36±5.45)years.There were 38 males and 22 females in the Brucella spondylitis group,with an average age of(55.47±6.43)years.The area under the curve was used to evaluate the diagnostic value of diffusion-weighted imaging-apparent diffusion coefficient under different diffusion sensitivity coefficients in differentiating spinal tuberculosis from Brucella spondylitis.Pearson correlation analysis was used to test the relationship between variables.The apparent diffusion coefficients between operator A and operator B were compared using a paired t-test.The intraclass correlation coefficient was used to analyze the consistency of measurement between different operators and the same operator. RESULTS AND CONCLUSION:(1)There were significant differences in erythrocyte sedimentation rate,C-reactive protein,white blood cell level,and the distribution of lumbar and thoracic vertebrae involved between the two groups(P<0.05).Spinal tuberculosis was most likely to affect the lumbar and thoracic vertebrae,and Brucella spondylitis was most likely to affect the lumbar spine.(2)The apparent diffusion coefficients of different vertebral bodies in spinal tuberculosis group were significantly higher than those in Brucella spondylitis group under different diffusion sensitivity coefficients(P<0.05).In the same group,the apparent diffusion coefficient of lesion vertebral body and paravertebral abscess was significantly different under different diffusion sensitivity coefficients(P<0.05).(3)When the diffusion sensitivity coefficient was 400 s/mm2,the apparent diffusion coefficient had the highest differential diagnostic efficacy.The sensitivity was 95.00%and the specificity was 96.67%.(4)The intraclass correlation coefficients of diffusion weighted imaging-apparent diffusion coefficient in patients with spinal tuberculosis and patients with Brucella spondylitis by different operators were all greater than 0.75.(5)Pearson correlation analysis showed that the apparent diffusion coefficient of the diseased vertebral body under different diffusion sensitivity coefficients(1.03×10-3-1.49×10-3 mm2/s)was significantly correlated with erythrocyte sedimentation rate,C-reactive protein,and white blood cell level(P<0.001).(6)It is concluded that diffusion weighted imaging is a simple and stable method for the detection of spinal tuberculosis and Brucella spondylitis.When the diffusion sensitivity coefficient is 400 s/mm2,the apparent diffusion coefficient of diffusion weighted imaging has the highest diagnostic efficiency for the differentiation of spinal tuberculosis and Brucella spondylitis,and the apparent diffusion coefficient of the diseased vertebral body under different diffusion sensitivity coefficients is closely related to the state of inflammation.

Abstract:BACKGROUND:With an increasing understanding of the health benefits of exercise,research on the mechanisms of exercise intervention has become a focal point.Traditional studies rely on in vivo animal models or multi-omics techniques to indirectly infer exercise intervention mechanisms,but the research is not in-depth enough,and many disease models cannot achieve the prescribed exercise intensity.Therefore,in vitro cell-based exercise environment simulation techniques are of particular significance.Existing technologies primarily focus on the replication of single signals,failing to comprehensively simulate the interaction of multi-dimensional signals during exercise,which limits the understanding of exercise adaptation mechanisms. OBJECTIVE:To explore the technological advancements in in vitro cell-based exercise environment simulation,analyze the advantages of existing signal simulation techniques,and propose a new framework integrating multi-dimensional signals to promote the precise replication of exercise mechanisms and application research in related fields. METHODS:This study conducted a search in the PubMed and Web of Science databases using keywords such as Exercise,Physiology,Molecular Signals,Myokines,Exerkines,etc.Relevant original research and review articles were selected,and after the initial search and removal of duplicates,a total of 5 046 related articles were identified.After further screening,99 articles were ultimately included in the study. RESULTS AND CONCLUSION:Existing in vitro cell-based exercise simulation technologies have made progress in replicating certain specific attributes of exercise,such as mechanical stretch and electrical signals.However,these technologies have yet to fully replicate the multi-dimensional signal interactions that occur during exercise.By integrating mechanical forces,electrophysiological stimulation,and bioactive factors,future simulation technologies are expected to more accurately replicate the impact of exercise on cell metabolism,gene expression,and phenotypic shaping,providing a more precise experimental platform for studying exercise mechanisms.Moreover,innovations and optimizations in in vitro exercise simulation technologies will offer crucial support for exercise medicine,drug development,and regenerative medicine.

Abstract:BACKGROUND:With the widespread application of total knee arthroplasty in China,non-infectious prosthesis loosening has become one of the main reasons for postoperative revision.For complex loosening cases,traditional revision techniques are relatively complex and difficult.The application of artificial intelligence-assisted preoperative planning combined with Sleeve extension rods and mobile bearing tray prostheses provides a new solution for precisely reconstructing joint stability and mechanical alignment,which is expected to improve the long-term outcomes of revision surgeries. OBJECTIVE:To explore the mid-and early-term clinical efficacy of revision surgery for non-infectious total knee prosthesis loosening using Sleeve extension rods combined with mobile bearing tray prostheses under the assistance of artificial intelligence-assisted preoperative planning. METHODS:A retrospective analysis was conducted on 17 patients with non-infectious prosthesis loosening after total knee arthroplasty in Department of Orthopedics and Traumatology,Jiangsu Provincial Hospital of Traditional Chinese Medicine from January 2021 to September 2024.There were 6 males and 11 females,aged from 59 to 81 years old,with an average age of(72.06±6.10)years.There were 8 cases on the left side and 9 cases on the right side.The service life of the prosthesis ranged from 2 to 22 years,with an average of(10.53±4.60)years.All cases were revisions after primary replacement.The reasons for revision included periprosthetic osteolysis with liner wear in 15 cases,old femoral condyle fracture leading to prosthesis loosening in 1 case,and tibial plateau prosthesis fracture in 1 case.Among them,13 cases were of AORI type IIB and 4 cases were of AORI type IIA.The prosthesis models designed by artificial intelligence before surgery were recorded and compared with the models actually used during surgery.The visual analog scale scores,American Knee Society knee scores,knee hip-knee-ankle angles,and knee joint ranges of motion of the patients before surgery,1 week,6,and 12 months after surgery were compared and the surgical efficacy was assessed. RESULTS AND CONCLUSION:(1)Except for 1 case with poor wound healing 1 month after surgery,the rest of the patients recovered well without adverse events such as deep vein thrombosis of the lower extremities,infection,periprosthetic fracture,and prosthesis loosening.(2)The follow-up time ranged from 6 to 41 months,with an average of(23.63±12.50)months.At the last follow-up,two patients had slight soreness and discomfort after activity,and one patient had obvious pain during activity.(3)After revision treatment,the visual analog scale pain scores of the patients,rest pain,exercise pain,the range of motion of the affected side,hip-knee-ankle angle,and American Knee Society knee score were significantly improved(P<0.01),with statistically significant differences.(4)The matching rate of the femoral condyle and tibial plateau prostheses designed by artificial intelligence pre-operatively was 85%;the matching rate of the remaining components was 62%.(5)It is concluded that the use of Sleeve extension rods combined with mobile bearing tray prostheses for non-infectious knee revision surgery can effectively correct the joint alignment,fill bone defects,relieve pain,improve the range of motion of the knee joint,and enhance the quality of life of patients with severe bone defects.The mid-and early-term postoperative efficacy is good.Artificial intelligence-assisted preoperative planning can help improve surgical accuracy,reduce surgical difficulty,minimize surgical risks,and promote postoperative recovery of patients.

Abstract:OBJECTIVE:In recent years,many scholars have applied 3D-printed artificial vertebrae to anterior cervical vertebral subtotal vertebral resection and bone grafting fusion,but whether it is more effective than traditional titanium cages remains controversial.This study aims to systematically evaluate the effectiveness and safety of 3D-printed artificial vertebrae compared with traditional titanium cages as implants for anterior cervical corpectomy and fusion in the treatment of spondylosis. METHODS:Databases such as CNKI,WangFang,CBM,VIP,PubMed,EMBASE,and The Cochrane Library were searched to collect the clinical research on the application of 3D-printed artificial vertebrae in anterior cervical corpectomy and fusion from the establishment of each database to February 2025.After screening the literature,extracting the data and evaluating the methodological quality of the included studies,the meta-analysis was performed using Rev Man 5.4. RESULTS:(1)A total of 10 articles were included,including 2 prospective randomized controlled studies,6 retrospective cohort studies,and 2 prospective cohort studies all of which were high-quality studies.The included literature comprised a total of 534 patients,including 273 in the 3D printing group and 261 in the control group.(2)The results of the meta-analysis showed that operation time[SMD=-1.13,95%CI(-1.87,-0.39),P=0.003],the loss of disc height at the last follow-up[SMD=-3.01,95%CI(-5.74,-0.29),P=0.03],the Neck Disability Index score(postoperative 3 months)[SMD=-0.34,95%CI(-0.66,-0.03),P=0.03],the prosthesis subsidence rate[OR=0.19,95%CI(0.11,0.32),P<0.000 01],and the incidence of postoperative dysphagia[OR=0.43,95%CI(0.21,0.90),P=0.03]were better in the 3D printing group than those in the control group,with significant differences.There was no statistically significant difference in the amount of intraoperative blood loss,hospital stay,postoperative Japanese Orthopaedic Association score,postoperative Visual Analog Scale score,postoperative Neck Disability Index score(6 months after surgery,at the last follow-up),and the rate of vertebral fusion between the two groups(P>0.05). CONCLUSION:Compared with traditional titanium cages,3D-printed artificial vertebrae have obvious advantages in improving surgical efficiency,maintaining postoperative intervertebral height,reducing the incidence of postoperative swallowing discomfort and titanium cage subsidence.

Abstract:BACKGROUND:Due to the relatively special symptoms and anatomical structure of scaphoid fractures,untreated fractures or those with delayed treatment often lead to non-union of the fracture,carpal joint collapse,or loss of function,subsequently resulting in persistent or intermittent pain,swelling,and limited mobility in the carpal joint.Currently,although there are a wide variety of bone grafting techniques and the choice of treatment methods is complex,there is still no consensus on which bone grafting surgical method is superior. OBJECTIVE:To review the research status of scaphoid nonunion,summarize different bone grafting surgeries for the treatment of nonunion of fractures at home and abroad in recent years,explore the clinical efficacy,advantages and disadvantages of various bone grafting techniques,and provide guidance for clinical diagnosis and treatment. METHODS:A computer was used to search for relevant articles published in the PubMed,MEDLINE,EMBASE,CNKI,China Medical Library,VIP,and WanFang databases from 1980 to 2024.The Chinese and English search terms were"scaphoid nonunion,surgery,bone graft,bone flap,scaphoid proximal pole."A total of 687 articles were retrieved,and 54 articles were selected for review through inclusion and exclusion criteria. RESULTS AND CONCLUSION:(1)Non-vascularized graft is still the mainstream treatment for scaphoid nonunion.Among them,simple cancellous bone transplantation has fast bone formation(healing rate 85%-100%)and is suitable for cases without deformity;cortical cancellous bone has strong support(healing rate 88%-93%),which is more conducive to restoring the morphology of the scaphoid.(2)There is no significant difference in the healing rate between iliac bone and distal radial donors,but the distal radial donor site has fewer complications(5%vs.18%).(3)Vascularized grafts can significantly improve the efficacy of complex cases:the healing rate of radial styloid bone flap is 81%-92%;the healing rate of pronator quadratus pedicle flap is 93.3%;the free medial femoral condyle flap has outstanding effect in reconstructing the articular surface(healing rate 95%),and the success rate of free iliac bone flap is up to 91.7%-100%,but the technical requirements are high.(4)The treatment of scaphoid fracture nonunion must follow the principle of individualization:bloodless transplantation is suitable for simple fractures with good blood supply,while blood-supply transplantation is for ischemic necrosis or complex deformities.(5)In the future,standardized imaging evaluation(such as MRI grading),bioenhancement technology(bone morphogenetic protein 2,3D printing scaffolds),and microsurgery should be popularized to improve the efficacy,and the optimal plan should be formulated in combination with the patient's age and occupational needs to balance functional recovery and complication prevention and control.

Abstract:BACKGROUND:Allogeneic hematopoietic stem cells may be transplanted with complications of the central nervous system that are not related to primary disease infiltration.There is no clear conclusion on the clinical symptoms,possible causes,and prognosis. OBJECTIVE:To explore the clinical characteristics,risk factors,and prognosis of complications related to non-primary infiltration of central nervous system after allogeneic hematopoietic stem cell transplantation,in order to provide evidence-based basis for early clinical diagnosis,etiological intervention,and prognosis improvement. METHODS:The clinical data,laboratory characteristics,and treatment process of 298 hematopathy patients with non-primary infiltration-related central nervous system complications after allogeneic hematopoietic stem cell transplantation from January 2015 to June 2024 were retrospectively analyzed.They were divided into the non-primary infiltration-related central nervous system complication group(n=19)and the control group(no non-primary infiltration-related central nervous system complications,n=279).The risk factor analysis was carried out through statistical methods.The clinical symptoms,possible causes of the disease,and prognosis of the patients were evaluated. RESULTS AND CONCLUSION:(1)Among the 298 patients undergoing allogeneic hematopoietic stem cell transplantation,19 cases experienced central nervous system complications related to non-primary infiltration,with an incidence rate of 6.4%.(2)The median time of onset was 16 days after transplantation(2-45 days).Patients mainly use convulsions as the first symptom,accompanied by increased blood pressure,headache,vision loss,consciousness disorders,and mental behavior abnormalities.(3)Univariate analysis showed that the time of granule implantation,platelet implantation time,history of central nervous system leukemia before transplantation,and the occurrence of graft-versus-host disease in degree III-IV were significantly associated with the incidence of central nervous system complications related to non-primary infiltration.The results of specific etiology analysis show that 2 cases of calcitric acid inhibitor-related encephalopathy,4 cases of central nervous system damage,4 cases of central nervous system infection,4 cases of transplant-related thrombotic microvascular disease,1 case of graft-versus-host disease in the central nervous system,2 cases of intracranial hemorrhage,1 case of endocrine and metabolism-related encephalopathy,and 1 case of unknown cause.(4)As of the follow-up date,the cumulative mortality rate of 19 patients with non-primary infiltration-related central nervous system complications after allogeneic hematopoietic stem cell transplant was 47%(9/19),which was significantly higher than the cumulative mortality rate of 28.6%(80/279)in the control group.Further analysis showed that the expected overall survival rates of patients with the non-primary infiltration-related central nervous system complication group were significantly lower than those of the control group.In short,the central nervous system complications related to non-primary infiltration after allogeneic hematopoietic stem cell transplantation are a rare,difficult to diagnose and highly lethal acute central nervous system disease,which is caused by a variety of transplant-related factors.Timely identification of pathogenic factors and accurate diagnosis and treatment is crucial to improve the prognosis of patients with transplant-related non-primary infiltration of central nervous system complications.

Abstract:BACKGROUND:Periprostatic adipose tissue is the white visceral adipose tissue that closest to the prostate,which is part of the prostate cancer microenvironment and plays a key role in the occurrence and progression of prostate cancer. OBJECTIVE:To investigate the ability of adipose-derived stem cells derived from periprostatic adipose tissue to form three-dimensional cell sheets. METHODS:Periprostatic adipose tissue was harvested from patients undergoing radical prostatectomy.Adipose-derived stem cell suspensions were prepared using a combination of enzymatic digestion and mechanical dissection.Adipose-derived stem cell proliferation was assessed using a CCK-8 assay.Expression of stem cell-associated antigens CD34/CD44/CD45/CD90/CD105 was determined by flow cytometry.Multidirectional differentiation potential of the stem cells was assessed using osteogenic/adipogenic/chondrogenic differentiation assays.Adipose-derived stem cells were cultured for three weeks in low-glucose DMEM supplemented with 100 μg/mL vitamin C and 10%fetal bovine serum to form cell sheets.Histological analysis and scanning electron microscopy were performed. RESULTS AND CONCLUSION:(1)The cell morphology of periprostatic adipose-derived stem cells was long spindles or long spindles,grew in the same direction and relatively consistent.After 9-10 days of primary culture,95%of the cells were fused,and the cell activity was good.No obvious signs of cell senescence were seen even when the cells were passed through passage 15.(2)The expression rates of CD44,CD90,and CD105 were 98.24%,84.99%and 89.14%,respectively.The expression rates of CD34 and CD45 were 0.64%and 1.02%.After 3 weeks of osteogenic/lipogenic/chondrogenic induction,periprostatic adipose tissue-adipose-derived stem cells could be induced into osteoblast,adipoblast,and chondroblast in multiple directions.(3)Continuous culture of periprostatic adipose tissue-adipose-derived stem cells for 3 weeks could form three-dimensional cell sheet tissue.The surface of the sheet was smooth with uniform texture,and it was rich in extracellular matrix,such as fibronectin and type 1 collagen.The results of scanning electron microscopy observation showed that the surface of the cell sheet was smooth and the long spindle-shaped cells were arranged in a consistent direction,with a large amount of extracellular matrix deposited between cells.In this study,adipose-derived stem cells were successfully isolated from prostate cancer patient derived periprostatic adipose tissue.Vitamin C was used to stimulate extracellular matrix secretion,and three-dimensional cell membranes were successfully constructed after three weeks of continuous culture.

Abstract:BACKGROUND:Mixed lineage kinase domain-like protein is one of the key executor proteins in the necroptosis pathway and plays an important role in various diseases.However,the mechanism by which its lactylation affects the formation and differentiation of breast tumor stem cells remains unclear. OBJECTIVE:To investigate the effect of mixed lineage kinase domain-like protein K230 site lactylation on the stemness expression of breast tumor stem cells. METHODS:The differences in protein lactylation between breast tumor MCF-7 adherent cells and spheroidal stem cells were analyzed by mass spectrometry.The mixed lineage kinase domain-like protein and its lactylation sites related to tumor stem cells were screened.A mixed lineage kinase domain-like protein K230R mutant plasmid vector was constructed and transfected into MCF-7 breast tumor cells.The proliferation and migration abilities of the cells were detected by CCK-8 and scratch assays.The effect of mixed lineage kinase domain-like protein K230R mutation on the formation of breast tumor stem cells was verified by cell suspension spheroid formation experiments.The expression of tumor stem cell-related and epithelial-mesenchymal transition-related proteins was detected by western blot assay. RESULTS AND CONCLUSION:Mixed lineage kinase domain-like protein K230 is highly lactylated in breast cancer stem cells.Compared with wild-type cells,K230R mutant cells showed significantly reduced wound healing and stem cell sphere formation rates,significantly increased expression of epithelial-associated proteins,and significantly decreased expression of interstitial-associated proteins and stemness-associated proteins.It is indicated that lactic acidification at the K230 site of mixed lineage kinase domain-like protein promotes epithelial-mesenchymal transition,enhances the formation of breast tumor stem cells,and thereby contributes to the occurrence and development of breast tumors.

Abstract:BACKGROUND:Stem cells have the potential for self-renewal and multi-directional differentiation,which can enhance tissue repair through direct differentiation or paracrine and immunomodulatory microenvironments.Acupuncture can promote the proliferation and differentiation of stem cells through multi-pathway synergy,which expands the application range of acupuncture. OBJECTIVE:To review the types of stem cells and their differentiation potential,and to explore the role and mechanism of acupuncture in promoting stem cell proliferation and differentiation. METHODS:Articles related to acupuncture to promote stem cell proliferation and differentiation published from inception to March 2025 were searched on PubMed and CNKI databases,with"electroacupuncture,acupuncture,neural stem cells,bone marrow mesenchymal stem cells,adipose mesenchymal stem cells"as Chinese and English search terms.After excluding content unrelated to the topic,76 articles were finally selected for inductive analysis. RESULTS AND CONCLUSION:(1)Stem cells belong to the category of kidney essence,and stem cells play a synergistic role with kidney essence,which can be used to guide the treatment of kidney essence deficiency disease,and explain modern medicine with traditional Chinese medicine theory.(2)Acupuncture can activate a variety of signaling pathways and regulate the expression of growth factors,thereby promoting the proliferation and differentiation of endogenous or exogenous stem cells,and providing new ideas for clinical treatment.(3)Although acupuncture plays an important role in stem cell proliferation and differentiation,it also faces many challenges in the application process.The establishment of stem cell engineering standards and the innovative development of acupuncture therapy are the primary prerequisites and important means to deeply explore the mechanism of action of acupuncture and stem cell therapy combination therapy,so as to ensure the stability and efficiency of the treatment effect.

Abstract:BACKGROUND:In patients with Pauwels type III femoral neck fracture who are unable to undergo closed reduction,the traditional cannulated compression screw internal fixation method cannot effectively counteract the large shear force.To solve this problem,this study personalized an internally supported plate and used it in conjunction with the cannulated compression screw internal fixation protocol to improve treatment outcomes. OBJECTIVE:To compare the biomechanical performance of two internal fixation methods for Pauwels type III femoral neck fractures under gait loading:an"inverted triangle"arrangement of three screws and an"inverted triangle"arrangement of three screws combined with a medial support plate by finite element calculation. METHODS:Based on the CT scan data,inverse modeling was first performed using Mimics software to generate a point cloud model of the femur.Subsequently,the model was refined using Geomagic software to optimize its geometry and ensure the accuracy of the model.Finally,the processed model was imported into NX software to establish a femoral neck fracture model with a Pauwels angle of 70°.The mechanical and fatigue life results of the 3-nail[fully threaded(model 1),unthreaded(model 2)]model,3-nail+personalized internal support plate[fully threaded(model 3),unthreaded(model 4)]model were computed based on the Ansys software for the gait loading. RESULTS AND CONCLUSION:(1)Under gait loading,the introduction of an internal support plate reduced the mean femoral stress compared with the 3-nail fixation approach,including a decrease in fracture and stump stresses of 6.6 MPa and 11.0 MPa,respectively;a decrease in displacement of 0.24 mm and 0.12 mm,respectively,and a decrease in relative displacement of the fracture surface.(2)The internal fixation method reduced the fatigue life of the bone system,and the life was reduced even more with the addition of the internal support plate.(3)It is concluded that finite element analysis is more sensitive to thread parameters,so the thread type and characteristics of the screws should be considered in model construction.The fixation method with the addition of an internal support plate reduces the level of stress and deformation and provides a more stable mechanical environment for bone healing compared with the threaded triple-nail fixation scheme only.In terms of fatigue life,the internal fixation method reduces the life span of the femoral system,and the higher the number of internal implants,the lower the life span,and the incorporation of the internal support plate resulted in the lowest longevity of the fixation scheme.(4)This suggests that the impact of implants on long-term healing should be fully considered when designing the fixation program,and the number of implants and fixation methods should be taken into account.

Abstract:BACKGROUND:Exosomes derived from mesenchymal stem cells play an important role in regulating apoptosis,promoting cell regeneration,and improving the wound microenvironment,making them a hot research topic in the treatment of diabetic foot ulcers. OBJECTIVE:To explore the clinical application value of exosomes derived from human umbilical cord mesenchymal stem cells in the repair of diabetic foot ulcers. METHODS:A retrospective analysis was conducted on the data from 72 patients with diabetic foot ulcers treated between May 2022 and April 2025.Thirty-six patients received treatment with exosomes derived from human umbilical cord mesenchymal stem cells(observation group),and 36 patients were managed with vacuum-assisted closure therapy(control group).Ulcer healing rate,incidence of adverse events,serum inflammatory markers,growth factor levels,total wound healing time,and ulcer recurrence rate during follow-up were compared between the two groups after 2 weeks of treatment. RESULTS AND CONCLUSION:(1)After 2 weeks of treatment,the ulcer healing rate in the observation group(48.03±6.12)%was significantly higher than that in the control group(30.13±6.38)%,with a statistically significant difference(P<0.05).(2)All patients in both groups achieved ulcer healing.The healing time was significantly shorter in the observation group than in the control group(30.42±2.30 versus 43.94±3.46 days),with a statistically significant difference(P<0.05).(3)The incidence of adverse events during treatment was 13.89%in the control group and 19.44%in the observation group,with no significant difference(P>0.05).(4)Serum interleukin-6,C-reactive protein,and procalcitonin levels decreased significantly in both groups,with greater reductions in the observation group,with a statistically significant difference(P<0.01).Serum vascular endothelial growth factor,basic fibroblast growth factor,and platelet-derived growth factor levels increased significantly in both groups,with greater increases in the observation group,with a statistically significant difference(P<0.01).(5)Following ulcer healing,the mean follow-up durations were 9.4 months in the observation group and 9.8 months in the control group;ulcer recurrence occurred in 5 and 10 patients,respectively,with a significantly lower recurrence rate in the observation group than in the control group(13.9%versus 27.8%),with a statistically significant difference(P<0.05).These findings indicate that compared with the use of closed negative pressure drainage,the application of exosomes derived from mesenchymal stem cells for treating diabetic foot ulcers effectively suppresses inflammation,promotes ulcers healing,reduces recurrence rates,and does not increase the risk of related adverse events.This approach exhibits both clinical efficacy and safety.