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Background While sciatic nerve injury has been described as a complication of acetabular fractures, iatrogenic nerve injury remains sparsely reported. This study aims to assess iatrogenic sciatic nerve injuries occurring during acetabular fracture surgery, tracking their neurological recovery and clinical outcomes, and investigating any correlation between recovery and the severity of neurologic injury to facilitate physicians in providing prediction of prognosis. Case Presentation We present two cases of male patients, aged 56 and 22, who developed sciatic palsy due to iatrogenic nerve injury during acetabular fracture surgery. Iatrogenic sciatic nerve injury resulted from operatively treated acetabular fractures. Surgical exploration, involving internal fixation removal and nerve decompression, successfully alleviated symptoms in both cases postoperatively. At the latest follow‐up, one patient achieved full recovery with excellent function, while the other exhibited residual deficits at the L5/S1 root level along with minimal pain. Conclusion Sciatic nerve injury likely stemmed from reduction techniques and internal fixation procedures for the posterior column, particularly when performed with the hip flexed, thereby placing tension on the sciatic nerve. Our case reports underscore the significance of liberal utilization of electrophysiologic examinations and intraoperative monitoring for the prediction of prognosis. Surgical exploration, encompassing internal fixation removal and nerve decompression, represents an effective intervention for resolving sciatic palsy, encompassing both sensory neuropathy and motor symptoms.

Abstract Background To investigate the clinical effects of a unilateral external fixator combined with bone transport and tibio-talar fusion in the treatment of severe postoperative infection of peri-ankle fractures. Methods The clinical data of 32 patients (22 men and 10 women) with severe postoperative infection of peri-ankle fractures were retrospectively analyzed. Patients’ age ranged from 26 to 62 (mean, 42 ± 9.5) years old. The types of fractures were distal tibia fracture (25 cases), distal tibia and fibula fracture (5 cases), and talus fracture (2 cases). All patients underwent treatment with unilateral external fixation combined with bone transport and tibio-talar fusion. 6 patients with severe infection received two-stage treatment involving focal debridement and external fixation, osteotomy, and bone transport. The remaining 26 patients underwent debridement, external fixation, and osteotomy simultaneously. The length of bone transport, total fixation time of the external fixator, and postoperative complications were recorded for all patients. The efficacy of the treatment was assessed using the American Association of Foot and Ankle Society (AOFAS) ankle–hindfoot score. Results Patients were followed up for 16–36 months, with an average follow-up time of 24 months. The length of tibia bone transport ranged from 5 to 15 cm, with a mean length of 8.5 cm. The external fixator was applied for 12–24 months, with an average duration of 16 months. One patient suffered from refracture at tibio-talar fusion site, and one patient had external fixation pin-tract infection. No complications, such as recurrent infections (especially the MRSA infection), poor mineralization, refracture, iatrogenic nerve damage or fusion failure, were found in the remaining patients. The preoperative AOFAS ankle–hindfoot function score was 40.0 ± 3.8 (range, 30–52) points, and it increased to 75.0 ± 3.0 (range, 67–78) points at the last follow-up. Conclusion A unilateral external fixator combined with bone transport and tibio-talar fusion is an effective method for treating severe postoperative infection of peri-ankle fractures. This approach is capable of reconstructing large bone defects that remain after clearing the infected lesion. Additionally, it provides stability to the ankle, enhances ankle–hindfoot function, and improves the patient’s quality of life.

Abstract Background The long-term nonunion of bone defects is always a difficult problem in orthopaedics treatment. Artificial bone implants made of polymeric materials are expected to solve this problem due to their suitable degradation rate and good biocompatibility. However, the lack of mechanical strength, low osteogenic induction ability and poor hydrophilicity of these synthetic polymeric materials limit their large-scale clinical application. Results In this study, we used bioactive glass (BG) (20%, W/W) and polycaprolactone (PCL, 80%, W/W) as raw materials to prepare a bone repair scaffold (PCL@BG20) using fused deposition modelling (FDM) three-dimensional (3D) printing technology. Subsequently, stromal cell-derived factor-1α (SDF-1α) chemokines were loaded into the PCL@BG20 scaffold pores with gelatine methacryloyl (GelMA) hydrogel. The experimental results showed that the prepared scaffold had a porous biomimetic structure mimicking that of cancellous bone, and the compressive strength (44.89 ± 3.45 MPa) of the scaffold was similar to that of cancellous bone. Transwell experiments showed that scaffolds loaded with SDF-1α could promote the recruitment of bone marrow stromal cells (BMSCs). In vivo data showed that treatment with scaffolds containing SDF-1α and BG (PCL@BG-GelMA/SDF-1α) had the best effect on bone defect repair compared to the other groups, with a large amount of new bone and mature collagen forming at the bone defect site. No significant organ toxicity or inflammatory reactions were observed in any of the experimental groups. Conclusions The results show that this kind of scaffold containing BG and SDF-1α serves the dual functions of recruiting stem cell migration in vivo and promoting bone repair in situ. We envision that this scaffold may become a new strategy for the clinical treatment of bone defects.

BackgroundRotator cuff injuries and tears are common causes of shoulder pain and dysfunction, necessitating accurate diagnostic methods to guide clinical decision-making. This study evaluates the diagnostic utility of three-dimensional (3D) shoulder sonography in identifying rotator cuff injury and tear patterns.MethodsA comprehensive search across seven electronic databases, which included Cochrane Library, Embase, PubMed, Cochrane Library, China Biology Medicine (CBM) database, CNKI, Wanfang, and VIP database. These databases were utilized to retrieve articles that assess the diagnostic value of 3D shoulder sonography for identifying rotator cuff injuries and tear patterns. The effectiveness of 3D shoulder sonography was assessed in terms of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). For each parameter, the 95% confidence intervals were calculated. Additionally, summary receiver operating characteristic curves (SROCs) were constructed, allowing for a comprehensive evaluation of diagnostic accuracy, which is reflected in the area under the SROC curve (AUC).ResultsScreening of 8,508 identified nine literatures eligible for inclusion in the meta-analysis, encompassing a total of 366 patients. The analysis of detecting any rotator cuff tear revealed a sensitivity of 0.97 and specificity of 0.87, yielding a DOR of 90.03 and an AUC of 0.98. Furthermore, 3D shoulder sonography demonstrated satisfactory accuracy in detecting both full and partial-thickness rotator cuff tears (Sensitivity: 0.92 vs. 0.83, specificity: 0.94 vs. 097, and AUC: 0.96 vs. 0.95).ConclusionThis study indicates that three-dimensional sonography has satisfied accuracy for detecting rotator cuff tears.

Abstract Background Currently, there is a lack of research investigating the feasibility of employing anterograde lag screw fixation through the iliac crest for minimally invasive percutaneous treatment of the posterior acetabular column, which encompasses retrograde and anterograde screw fixation in posterior acetabular lag screw fixation. And consequently, the purpose of this study was to examine the anatomical parameters of anterograde lag screw fixation of the posterior column of the pelvis through the iliac crest as well as to investigate the intraoperative fluoroscopy technique, to furnish a scientific rationale supporting the practical utilization of this method within clinical settings. Methods In this study, pelvic CT data of 60 healthy adults, including 30 males and 30 females, were accumulated. The mimics 21.0 software was developed to reconstruct the three-dimensional pelvis model, simulate the anterograde lag screw fixation of the posterior column of the acetabulum through use of the iliac crest, and precisely identify the insertion point: Utilizing the widest iliac tubercle as the starting point, the insertion point was moved toward the anterior superior iliac spine by 1.0 cm at a time until it reached 4.0 cm. With a total of five insertion points, all oriented toward the lesser sciatic notch, the initial diameter of the virtual screw measured 5.0 mm, and it was progressively enlarged by 1.0 mm increments until reaching a final diameter of 8.0 mm. Besides, the longest lengths of virtual screws with distinct diameters at divergent entry points were measured and compared. At the same time, the intraoperative fluoroscopy technique for optimal access was analyzed. Results The cross-section from the iliac crest to the lesser sciatic notch was irregular, with multiple curved shapes. Furthermore, the diameter of the screw was determined by the anteroposterior radians and width of the iliac crest plate, while the screw length was determined by the curvature of the square body. On the condition that the screw diameter of the D channel (3.0 cm outward from the widest part of the iliac tubercle to the lesser sciatic notch) was 5 mm, 6 mm as well as 7 mm, the longest screw lengths were (145.6 ± 12.8) mm, (143.6 ± 14.4) mm and (139.9 ± 16.6) mm, correspondingly, indicating statistically substantial distinctions from other channels (P

Objective To compare the clinical results of a new femoral neck system (FNS) and cannulated compression screws (CCS) for the treatment of femoral neck fractures in younger patients. Methods Retrospective study was performed in younger patients with femoral neck fractures that were treated with FNS or CCS from August 2017 to August 2022. The hip functional outcomes were assessed with the Harris hip score (HHS). Secondary outcomes included the surgical time, surgical blood loss, satisfaction visual analog scale (VAS), fluoroscopy frequency, fracture healing time and complications. Results A total of 49 patients (22 FNS and 27 CCS) with a minimum follow-up of 12 months were included. There was also no significant difference in HHSs (p = 0.27) and satisfaction VAS (p = 0.10) between them. Patients with FNS had more blood loss (50.45 ± 5.28 mL vs. 20.67 ± 4.71 ml, p

The diagnostic process for psychiatric conditions is guided by the Diagnostic and Statistical Manual of Mental Disorders (DSM) in North America. Revisions of the DSM over the years have led to lowered diagnostic thresholds across the board, incurring increased rates of both misdiagnosis and over-diagnosis. Coupled with stigma, this ambiguity and lack of consistency exacerbates the challenges that clinicians and scientists face in the clinical assessment and research of mood disorders such as Major Depressive Disorder (MDD). While current efforts to characterize MDD have largely focused on qualitative approaches, the broad variations in physiological traits, such as those found in the gut, suggest the immense potential of using biomarkers to provide a quantitative and objective assessment. Here, we propose the development of a probiotic Escherichia coli (E. coli) multi-input ingestible biosensor for the characterization of key gut metabolites implicated in MDD. DNA writing with CRISPR based editors allows for the molecular recording of signals while riboflavin detection acts as a means to establish temporal and spatial specificity for the large intestine. We test the feasibility of this approach through kinetic modeling of the system which demonstrates targeted sensing and robust recording of metabolites within the large intestine in a time- and dose- dependent manner. Additionally, a post-hoc normalization model successfully controlled for confounding factors such as individual variation in riboflavin concentrations, producing a linear relationship between actual and predicted metabolite concentrations. We also highlight indole, butyrate, tetrahydrofolate, hydrogen peroxide, and tetrathionate as key gut metabolites that have the potential to direct our proposed biosensor specifically for MDD. Ultimately, our proposed biosensor has the potential to allow for a greater understanding of disease pathophysiology, assessment, and treatment response for many mood disorders.

Abstract Background Reports on traumatic sciatic nerve injury associated with acetabular fracture are rare. In this study, we investigated the demographics of these injuries, their clinical characteristics, management, and factors potentially influencing neurological recovery. Methods We retrospectively reviewed all patients diagnosed to have acetabular fracture at our trauma center between January 2014 and June 2021. Data on patient demographics, characteristics of sciatic nerve injury, neurological recovery, factors potentially influencing neurological recovery were analyzed. Results Eighteen patients (bilateral in one case) met the diagnostic criteria. All these injuries involved the posterior wall or posterior column, and most patients had posterior dislocation of the hip joint. Four of the 19 sides with traumatic sciatic nerve injury involved the common peroneal nerve division and 15 involved both the common peroneal and tibial nerve divisions. Seventeen patients (18 sides) underwent intraoperative nerve exploration, which revealed abnormalities in 7 sides and no obvious abnormality in 11 sides. At the last follow-up, 10 sides (52.6%) had complete recovery and 9 (47.4%) had partial recovery; the difference was statistically significant between those with or without abnormal nerve damage during exploration (P = 0.046). Linear regression analysis showed that a nerve abnormality detected intraoperatively was a predictor of nerve recovery (P = 0.009). The mean recovery time was significantly longer for partial recovery than for complete recovery (13.78 months vs. 6.70 months; P = 0.001). Conclusions All the injuries in this series involved the posterior wall or posterior column, and most patients had posterior dislocation of the hip joint. Damage to the common peroneal nerve division was more severe than that to the tibial nerve division preoperatively. However, the degree of recovery of the common peroneal division was not worse than that of the tibial division. There was a relationship between the degree of neurological recovery and whether there was an abnormality at the time of intraoperative nerve exploration. Patients with partial recovery took longer to recover.

Abstract Purpose Kinesiophobia (fear of movement) is a major limiting factor in the return to pre-injury sport level after surgery of rotator cuff tears. The study aims to gain insights into how kinesiophobia affects shoulder pain and function after the repair of full-thickness rotator cuff tears. Methods A prospective study was conducted to evaluate patients who underwent rotator cuff repair between January 2019 and December 2019 in our institution. The patients were divided into a trial group with a high kinesiophobia (Tampa Scale for Kinesiophobia [TSK], TSK > 37) and a control group with a low kinesiophobia (TSK ≤ 37). The indicators of interest included the Constant-Murley scores, numerical rating scale (NRS), visual analogue scale (VAS), Oxford Shoulder Score (OSS), and the American shoulder and elbow score (ASES), shoulder function and strength, and range of motion (ROM) at 3 days, 6 weeks, and 12 months after repair of full-thickness rotator cuff tears. Results In total, 49 patients who underwent repair of full-thickness rotator cuff tears were enrolled, which was divided into a trial group involving 26 patients (mean TSK 52.54) and a control group involving 23 patients (mean TSK 33.43). There were no statistically significant differences in basic information such as age, gender, and length of stay in the two groups. The preoperative and early postoperative functional scores and the Tampa Scale for Kinesiophobia were statistically significant differences between the two groups. However, long-term postoperative follow-up showed no statistically significant difference in ASES, and Constant-Murley scores, OSS, and VAS scores between the two groups as the kinesiophobia changed from positive to negative. Conclusion Degree of kinesiophobia reduced during post-operative rehabilitation of rotator cuff repair patients, but high kinesiophobia is still present in a large portion of the patients after rotator cuff repair. Patients after rotator cuff repair will benefit from early recognition and prevention of kinesiophobia.

Abstract Purpose To evaluate the effectiveness of pelvic packing (PP) in pelvic fracture patients with hemodynamic instability. Materials and methods Three databases—PubMed, Embase and the Cochrane Library—were systematically searched to identify studies presenting comparisons between a protocol including PP and a protocol without PP. Mortality, transfusion requirement and length of hospitalization were extracted and pooled for meta-analysis. Relative risk (RR) and standard mean difference (SMD), along with their confidence intervals (CIs), were used as the pooled statistical indices. Results Eight studies involving 480 patients were identified as being eligible for meta-analysis. PP usage was associated with significantly reduced overall mortality (RR = 0.61, 95% CI = 0.47–0.79, p

Abstract Purpose Double-endobutton technique, as a widely accepted strategy for the treatment of acromioclavicular joint dislocation, is undergoing constant improvement. This study aims to assess the clinical effect of a modified single-endobutton combined with the nice knot in the fixation of Rockwood type III or V acromioclavicular joint dislocation. Methods From January 2016 to June 2019, 16 adult patients (13 males and 3 females) with Rockwood type III or V acromioclavicular joint dislocation were treated with a modified single-endobutton technique combined with the nice knot in our department. The age ranged from 18 to 64 years old with an average of 32.8 years old. Operative time, intraoperative blood loss, post-operative clinical outcomes and radiographic results were recorded and analyzed. Preoperative and last follow-up scores in the Constant-Murley Scale, Neer score, Rating Scale of the American Shoulder and Elbow Surgeons and VAS scale and complications such as infection, re-dislocation, implant loosening, medical origin fracture and hardware pain were recorded and evaluated. Results Sixteen patients were followed up for 6 to 18 months with an average of 10.3 months. The operative time was 50–90 min with an average of (62.5 ± 3.10) min. The intraoperative blood loss was 30–100 ml, with an average of (55.0 ± 4.28) ml. The complications, such as wound infection, internal fixation failure and fractures, were not found in these cases. According to Karlsson criteria, there were excellent in 14 cases, good in 2 cases at the final follow-up. The mean VAS score of the patients was 5.88 ± 0.26 preoperatively, compared with 0.19 ± 0.14 at the final follow-up evaluation. The difference was statistically significant (P

Abstract Background The treatment of complex 3- and 4-part proximal humeral fractures has been controversial due to numerous postoperative complications. With the further study of medial support and blood supply of humeral head, new techniques and conception are developing. The study aims to illustrate the medial approach of the proximal humeral fracture through cadaver autopsy. Method Upper limbs from 19 cadavers have been dissected to expose the shoulder joint. We selected the coracoid process as the bony reference. Vernier caliper will be used to measure the following data, including distance from coracoid process to circumflex brachial artery, distance between anterior humeral circumflex artery (ACHA) and posterior circumflex brachial artery (PCHA) and their diameters. Assessment included the characteristics of the vascular supply around the humeral head, identification of the structures at risk, quality of exposure of the bony structures, and feasibility of fixation. Results The medial approach is appropriate in 86.84% anatomical patterns. Between the lower part of the shoulder capsule and the insertion of conjoined tendon, the bony surface exposed was limited by the interval between ACHA and PCHA. An interval of 2 to 3 cm (24.29 ± 3.42 mm) was available for medial plate. ACHA (49.35 ± 8.13 mm, 35.14–68.53 mm) and PCHA (49.62 ± 7.82 mm, 37.67–66.76 mm) were about 5 cm away from the coracoid process. Risk structures including ACHA and PCHA originate in common, PCHA originated from the deep brachial artery (DBA), the presence of perforator vessels, musculocutaneous nerve intersects with ACHA, the diameter of PCHA: ACHA

BackgroundIn lumbo-iliac fixation, the iliac screw can be placed in several locations and directions. There is no uniform standard for the placement of a single iliac screw. Biomechanical tests and finite element analyses were used to compare the effect of bilateral single iliac screws with three channels on pelvic stability to determine the best channel.MethodsFive embalmed adult cadaver pelvic specimens were selected. An unstable Tile C1 pelvic injury model was established. Lumbo-iliac fixation for the treatment of left sacral Denis II fracture includes the following: three channels of bilateral, single iliac screws (channel A from posterior superior iliac spine (PSIS) to anterior inferior iliac spine (AIIS), channel B from 1 cm medial and 1 cm caudal of PSIS to AIIS, and channel C from 2 cm below PSIS to AIIS). Biomechanical testing was performed for stiffness evaluations. A finite element model was established to study the stress distribution of the model and the maximum von Mises stress of internal fixation.ResultsBiomechanical tests revealed that under vertical compression loading. The compressive stiffness fixed by channel B (246.15 ± 27.85 N/mm) was better than that fixed by channel A and channel C. Under torsional load, the torsional stiffness fixed by channel B (2.234 ± 0.223 N·m/°) was stronger than that fixed by channel A and channel C. However, there was no significant difference in terms of compressive and torsional stiffness between channel B and channel A (P > 0.05). Finite element analyses conformed that the maximum von Mises stress of the internal fixator fixed in channel B under the conditions of vertical, forwards bending, backwards extension, left bending, left rotating, and right bending (213.98 MPa, 338.96 MPa, 100.63 MPa, 297.06 MPa, 200.95 MPa and 284.75 MPa, respectively) was significantly lower than those fixed in channel A and channel C.ConclusionsThe construct stiffness of the channel from 1 cm medial and 1 cm caudal of PSIS to AIIS is better than that of the other two channels. This channel has the advantages of good biomechanical stability, small maximum von Mises stress of internal fixation.

Background: The combination of pelvic fractures with lower urinary tract injuries (LUTIs) is a severe traumatic injury. This study was performed to determine the relationship between LUTIs and pelvic fracture types. Methods: Patients who sustained pelvic fractures combined with LUTIs between 1 January 2018 and 1 January 2022 in our institution were retrospectively analyzed. The patients’ demographics, mechanism of injury, presence of open pelvic fractures, types of pelvic fractures, patterns of LUTIs, and early complications were analyzed. The association between pelvic fracture types and the identified LUTIs was statistically analyzed. Results: This study involved 54 patients diagnosed with pelvic fractures combined with LUTIs. The overall incidence of pelvic fractures combined with LUTIs was 7.7% (n = 54/698). All patients had unstable pelvic fractures. The male:female ratio was approximately 2.4:1.0. The incidence of LUTIs was higher in men than women with pelvic fractures (9.1% vs. 4.4%). Bladder injuries occurred at roughly equal rates in men and women (4.5% vs. 4.4%, p = 0.966), but urethral injuries were more frequent in men (6.1% vs. 0.5%, p = 0.001). The most common pelvic injury pattern was a type C fracture according to the Tile classification and a vertical-shear-type fracture according to the Young–Burgess classification. The Young–Burgess fracture classification was related to the severity of bladder injury in men (p = 0.037). There was no significant difference in bladder injury according to the two classifications among women (p = 0.524 vs. p = 1.000) or among the entire cohort (p = 0.454 vs. p = 0.342). Conclusions: Men and women are equally likely to sustain a bladder injury, but a urethral injury with pelvic fracture is more frequent in men. LUTIs tend to be accompanied by unstable pelvic fractures. It is imperative to be vigilant for potential bladder injury when men sustain vertical-shear-type pelvic fractures.

Abstract Background Sonication fluid culture of antibiotic-loaded bone cement spacer has been used to predict reinfection of two-stage revision, but its value remains disputable. This study aims to evaluate the association between the culture result of the sonicated spacer and the status of patients with periprosthetic joint infection receiving two-stage revision. Materials and methods A comprehensive electronic literature search was performed through four databases including PubMed, Embase/Ovid, and EBSCO, and the Cochrane Library to retrieve studies in which sonication fluid culture of the antibiotic spacer was conducted before reimplantation. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated to assess the association between the culture result of sonicated spacer and prognosis of the two-stage revision. Results Eleven eligible studies comprising 603 artificial joints with PJI (134 suffering a clinical failure of two-stage revision) were included in the quantitative analysis. The pooled incidences of positive culture of sonicated spacer and intraoperative tissue were 0.14 (95% confidence interval [CI] 0.08–0.21) and 0.14 (95% CI 0.08–0.20), respectively. A positive culture of sonicated antibiotic-loaded bone cement spacer illustrated moderate sensitivity (0.31, 95% CI 0.13–0.58) but high specificity (0.94, 95% CI 0.86–0.98) for the diagnosis of therapeutic failure of two-stage revision; the pooled DOR was 7.67 (95% CI, 3.63–16.22). Meanwhile, the pooled sensitivity, specificity, and DOR of intraoperative tissue culture during the two-stage revision to predict therapeutic failure were 0.32 (95% CI, 0.20–0.47), 0.96 (95% CI, 0.92–0.98), and 10.62 (95% CI, 4.90–23.01), respectively. Conclusions Sonication fluid culture of antibiotic-loaded bone cement spacer revealed high accuracy for confirming eradication of infection before reimplantation of new prostheses and therefore could be used as a supplement for assessing therapeutic effect for PJI. However, both sonication fluid culture and intraoperative tissue culture from antibiotic-loaded bone cement spacer showed restricted yield for the prediction of a septic failure after the two-stage revision of PJI. Large-scale, prospective studies are still needed to testify current findings.

Abstract Purpose The Nice knots have been widely used in orthopedic surgeries to fix torn soft tissue and fracture in recent years. The study aims to investigate the clinical efficacy and prognosis of intraoperative and postoperative Nice Knots-assisted reduction in the treatment of displaced comminuted clavicle fracture. Methods From Jan 2014 to Dec 2019, 75 patients diagnosed with unilateral closed displaced comminuted clavicle fracture were treated with open reduction and internal fixation (ORIF) in this study. Nice knot group (the NK group) included 38 patients and the other 37 patients were in the traditional group (the TK group). The time of operation and the amount of bleeding during operation were recorded. Post-operative clinical outcomes and radiographic results were recorded and compared between these two groups. The Visual Analogue Scale (VAS), Neer score, Rating Scale of the American Shoulder and Elbow Surgeons, Constant-Murley score and complications such as infection, nonunion, implant loosening, fragment displacement and hardware pain were observed in the two groups. Results In the comparison between the two groups, there was no significant difference in age, sex, the cause of displaced clavicle fracture, and other basic information between the two groups. The operation time, intraoperative fluoroscopy time, and intraoperative blood loss were significantly reduced in the NK group (P

Abstract Background and hypothesis The typical anterolateral approach is widely used to treat proximal humerus fractures with lateral locking fixation. However, lateral fixation cannot completely avoid medial reduction loss and varus deformity especially in the cases of an unstable medial column. We present a novel medial surgical approach and technique together with a minimally invasive lateral locking plate to fix proximal humerus fractures with an unstable medial column. Materials and methods We performed an anatomical study and reported 8 cases of proximal humerus fractures with unstable medial columns treated with plate fixation through a minimally invasive anterolateral approach and medial approach. All surgeries were performed by the same single surgeon. Patients were followed clinically and radiographically at 1, 3, 6, and 12 months postoperatively. Results There was a safe region located at the medial part of the proximal humerus just beneath the articular surface. An anatomical medial locking proximal humerus plate could be placed in the medial column and did not affect the axillary nerve, blood supply of the humeral head, or stability of the shoulder joint. Successful fracture healing was achieved in all 8 cases. The function and range of motion of the shoulder joint were satisfactory 24 months postoperatively, with an average Constant score (CS) of 82.8. No reduction loss (≥ 10° in any direction), screw cutout, nonunion, or deep infection occurred. Conclusions The combined application of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation is effective in maintaining operative reduction and preventing varus collapse and implant failure in proximal humerus fractures with an unstable medial column.

Abstract Background To investigate the clinical efficacy and outcomes of skin stretch suturing with self-locking sliding Nice knots in the treatment of small- or medium-sized wounds. Methods From June 2015 to May 2018, 26 patients with small- or medium-sized wounds were included in the present study. Skin stretch suturing with self-locking slide Nice knots was performed to gradually close the soft-tissue defects in these patients. The time of wound closure and healing was recorded. The color and blood supply of the skin, cutaneous sensation, the stretch of skin, and the hair growth situation of the skin wound were observed and recorded. Results There were 17 males and 9 females with an average age of 30.65 years (range, 15–48 years). The areas of the soft-tissue defects were between 3.2 × 7.1 cm and 8.0 × 15.2 cm. All patients underwent stretch suturing with self-locking slide Nice knots to close the soft-tissue defects. All wounds were successfully closed and healed. The mean time of wound closure was 10.69 days (range, 5–20 days), and the mean time of wound healing was 16.85 days (range, 10–24 days). The cutaneous sensation of skin wound recovered normally, and the color of the skin wounds was the same as that of normal skin at the last follow-up. The hair growth situation of the skin wounds also returned to normal. Conclusions This study revealed that Nice knots yielded an accepted clinical result as a new method to close small- or medium-sized wounds that was simple and less minimally invasive, resulted in progressive tension, did not return to previous results, and partially replace flaps or free skin grafts.

Abstract Background Short stem total hip arthroplasty (SHA) preserves femoral bone stock and is supposed to provide a more natural load transfer compared to standard stem total hip arthroplasty (THA). As comparative biomechanical reference data are rare we used a finite element analysis (FEA) approach to compare cortical load transfer after implantations of a metaphyseal anchoring short and standard stem in native biomechanical femora. Methods The subject specific finite element models of biomechanical femora, one native and two with implanted metaphyseal anchoring SHA (Metha, B. Braun Aesculap) and standard THA (CLS, Zimmer-Biomet), were generated from computed tomography datasets. The loading configuration was performed with an axial force of 1400 N. Von Mises stress was used to investigate the change of cortical stress distribution. Results Compared to the native femur, a considerable reduction of cortical stress was recorded after implantation of SHA and standard THA. The SHA showed less reduction proximally with a significant higher metaphyseal cortical stress compared to standard THA. Moreover, the highest peak stresses were observed metaphyseal for the SHA stem while for the standard THA high stress pattern was observed more distally. Conclusions Both, short and standard THA, cause unloading of the proximal femur. However, the metaphyseal anchoring SHA features a clearly favorable pattern in terms of a lower reduction proximally and improved metaphyseal loading, while standard THA shows a higher proximal unloading and more distal load transfer. These load patterns implicate a reduced stress shielding proximally for metaphyseal anchoring SHA stems and might be able to translate in a better bone preservation.

Bone mesenchymal stem cells (BMSCs) of multi-directional differentiation and reproductive activity are attractive candidates for bone and cartilage repair. However, the molecular mechanisms underlying the early phase of osteogenesis, adipogenesis, and chondrogenesis of BMSCs are still far from understood. In the current study, BMSCs are isolated from rats, and the gene expressions during the initiation of differentiation (phase I), lineage acquisition (phase II), and early lineage progression (phase III) of three-directional differentiation of BMSCs were detected by using high-throughput sequencing. Then, 356, 540, and 299 differentially expressed genes (DEGs) were identified in phases I, II, and III of osteogenesis, respectively. The numbers are 507, 287, and 428 for adipogenesis, respectively, and 412, 336, and 513 for chondrogenesis, respectively. Time-dependent expression patterns of genes were also validated during three-directional differentiation in BMSCs. Hub genes including Ccna2, Cdc20, and Il6 may act as common participants in initiating osteogenesis, adipogenesis, and chondrogenesis. Mex3b, Sertad1, and Hopx showed an enhanced expression throughout three early phases during the osteogenic differentiation but no significant change in other two-directional differentiation. A similar pattern of Dtx4 and Ibsp expression occurred in adipogenesis and chondrogenesis, respectively. Our findings will help understand the underlying mechanism determining the differentiation fate of BMSCs and provide theoretical support for the clinical treatment of osteoporosis, osteoarthritis, and other age-related bone diseases.

Abstract Background Numerous quantitatively biomechanical studies measuring the fixation stability of femoral stem using micromotions at the bone-implant interfaces in different directions and levels remain inconclusive. This network meta-analysis performed systematically aims to explore the rank probability of micromotions at the bone-implant interfaces based on biomechanical data from studies published. Methods Two electronic databases, PubMed/MEDLINE and Embase, were utilized to retrieve biomechanical studies providing the data of micromotions at the bone-stem interfaces. After screening and diluting out, the studies that met inclusion criteria will be utilized for statistical analysis. In order to contrast the stability of commonness and differences of the different parts of the femoral stem, the horizontal and vertical comparison of micromotions at the bone-implant interfaces were conducted using the pooled evaluation indexes including the mean difference (MD) and the surface under the cumulative ranking (SUCRA) curve, while inconsistency analysis, sensitivity analysis, subgroup analyses, and publication bias were performed for the stability evaluation of outcomes. Results Screening determined that 20 studies involving a total of 249 samples were deemed viable for inclusion in the network meta-analysis. Tip point registered the highest micromotions of 13 measurement points. In the horizontal level, the arrangements of 4 measurement points at the proximal (P1–P4), middle (P5–P8) and distal part of the stem (P9–P12) were P1 = P2 = P3 = P4, P7 > P8 > P6 = P5 and P10 ≥ P12 = P9 = P11, respectively. In the vertical level, the arrangements of 3 measurement points at the anterior, posterior, medial, and lateral directions was P9 > P5 = P1, P10 > P6 > P2, P11 > P7 > P3, and P12 > P8 > P4, respectively. Conclusion The network meta-analysis seems to reveal that the distal part of the femoral stem is easier to register higher micromotion, and tip point of femoral stem registers the highest micromotions.

Abstract Background It is still controversial whether the combination of anterior cruciate ligament (ACL) reconstruction and extra-articular reconstruction (EAR) have good clinical efficacy. This meta-analysis aims systematically to compare the clinical effectiveness of ACL reconstruction and combined reconstruction. Methods Electronic databases, including Medline/PubMed, Embase and the Cochrane Library, were systematically searched to identify targeted studies. A meta-analysis were performed to pool the outcome estimates of interest, such as the Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores and the results from the KT-1000/2000 arthrometer test, the Lachman test and the pivot shift test. Results Twelve studies involving 1146 knees were identified. Compared with single ACL reconstruction, combined reconstruction had better results for a pivot shift of grade 1 (relative ratio [RR] = 0.88, 95% CI: 0.83–0.94) and grade 2 (RR = 0.95, 95% CI: 0.91–0.99) rather than grade 3 (RR = 0.98, 95% CI: 0.90–1.06) and no statistically significant difference for both Lachman grade 1 (RR = 0.96, 95% CI: 0.89–1.05) and grade 2 (RR = 0.96, 95% CI: 0.90–1.03). Combined reconstruction resulted in significant improvements on the instrumented joint laxity test when considering a failure standard of more than 5 mm (a side-to-side arthrometric difference) (RR = 0.94, 95% CI: 0.89–0.98) rather than 3 mm (RR = 0.94, 95% CI: 0.86–1.03). Moreover, combined reconstruction increased the IKDC score at the 12-month (weighted mean difference [WMD] = − 6.38, 95% CI: − 9.66 to − 3.10), 24-month (WMD = − 5.60, 95% CI: − 8.54 to − 2.66) and 36-month follow-ups (WMD = − 4.71, 95% CI: − 7.59 to − 1.83) and the Tegner score at the 36-month follow-up (WMD = − 0.53, 95% CI: − 0.97 to − 0.09), but it did not increase the Lysholm score at the 36-month follow-up (WMD = − 0.84, 95% CI: − 2.02 to 0.34). Conclusion With the advances in reconstruction techniques, combined reconstructions were found to be effective in improving rotational stability and to lead to good functional scores. However, obviously, the combined reconstruction technique is more time-consuming and requires an additional incision, which is not suitable for all ACL-deficient patients. Therefore, programs should be personalized and customized for the specific situation of each patient.

Abstract Background Numerous quantitatively studies have focused on the diagnosis of bursal-sided partial-thickness rotator cuff tears (RCTs); however, the accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) remains inconclusive. This study was performed systematically to compare the diagnostic value of MRA and MRI for the bursal-sided partial-thickness RCTs. Methods Three electronic databases, PubMed, Embase, and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting bursal-sided partial-thickness RCTs. After screening and diluting out the articles that met the inclusion criteria to be used for statistical analysis, the pooled evaluation indexes include sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curve (AUC). Results Twelve studies involving 1740 patients and 1741 shoulders were identified. The pooled sensitivity, specificity, DOR, and AUC of MRA to diagnose bursal-sided partial-thickness RCTs were 0.77 (95% CI, 0.67–0.85), 0.98 (95% CI, 0.95–0.99), 73.01 (95% CI, 35.01–152.26), and 0.88 (95% CI, 0.85–0.91), respectively. The pooled sensitivity, specificity, DOR, and AUC of MRI were 0.77 (95% CI, 0.66–0.86) and 0.96 (95% CI, 0.81–0.99), and 37.12 (95% CI, 8.08–170.64) and 0.82 (95% CI, 0.78–0.85), respectively. Conclusions This meta-analysis reveals that MRA and MRI have similar diagnostic value for the diagnosis of bursal-sided partial-thickness rotator cuff tears.

Abstract Background Multiple published studies quantitatively analysing the diagnostic value of MRI, MR arthrography (MRA) and CT arthrography (CTA) for labral lesions of the shoulder have had inconsistent results. The aim of this meta-analysis was to systematically compare the diagnostic performance of MRI, MRA, CTA and CT. Methods Two databases, PubMed and EMBASE, were used to retrieve studies targeting the accuracy of MRI, MRA, CTA and CT in detecting labral lesions of the shoulder. After carefully screening and excluding studies, the studies that met the inclusion criteria were used for a pooled analysis, including calculation of sensitivity and specificity with 95% confidence intervals (CIs) and the area under the hierarchical summary receiver operating characteristic (HSROC) curves. Results The retrieval process identified 2633 studies, out of which two reviewers screened out all but 14 studies, involving a total of 1216 patients who were deemed eligible for inclusion in the meta-analysis. The results assessing the diagnostic performance of MRI vs. MRA for detecting labral lesions showed a pooled sensitivity of 0.77 (95% CI 0.70–0.84) vs. 0.92 (95% CI 0.84–0.96), a specificity of 0.95 (95% CI 0.85–0.98) vs. 0.98 (95% CI 0.91–0.99), and an area under the HSROC curve of 3.78 (95% CI 2.73–4.83) vs. 6.01 (95% CI 4.30–7.73), respectively. Conclusion MRA was suggested for use in patients with chronic shoulder symptoms or a pathologic abnormality. MRI is by far the first choice recommendation for the detection of acute labral lesions. CT should be a necessary supplemental imaging technique when there is highly suspected glenoid bone damage.

BackgroundAccurate diagnosis of bone metastasis status of prostate cancer (PCa) is becoming increasingly more important in guiding local and systemic treatment. Positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) have increasingly been utilized globally to assess the bone metastases in PCa. Our meta-analysis was a high-volume series in which the utility of PET/CT with different radioligands was compared to MRI with different parameters in this setting.Materials and MethodsThree databases, including Medline, Embase, and Cochrane Library, were searched to retrieve original trials from their inception to August 31, 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The methodological quality of the included studies was assessed by two independent investigators utilizing Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). A Bayesian network meta-analysis was performed using an arm-based model. Absolute sensitivity and specificity, relative sensitivity and specificity, diagnostic odds ratio (DOR), and superiority index, and their associated 95% confidence intervals (CI) were used to assess the diagnostic value.ResultsForty-five studies with 2,843 patients and 4,263 lesions were identified. Network meta-analysis reveals that 68Ga-labeled prostate membrane antigen (68Ga-PSMA) PET/CT has the highest superiority index (7.30) with the sensitivity of 0.91 and specificity of 0.99, followed by 18F-NaF, 11C-choline, 18F-choline, 18F-fludeoxyglucose (FDG), and 18F-fluciclovine PET/CT. The use of high magnetic field strength, multisequence, diffusion-weighted imaging (DWI), and more imaging planes will increase the diagnostic value of MRI for the detection of bone metastasis in prostate cancer patients. Where available, 3.0-T high-quality MRI approaches 68Ga-PSMA PET/CT was performed in the detection of bone metastasis on patient-based level (sensitivity, 0.94 vs. 0.91; specificity, 0.94 vs. 0.96; superiority index, 4.43 vs. 4.56).Conclusions68Ga-PSMA PET/CT is recommended for the diagnosis of bone metastasis in prostate cancer patients. Where available, 3.0-T high-quality MRI approaches 68Ga-PSMA PET/CT should be performed in the detection of bone metastasis.

The imbalance of osteogenic, adipogenic, and chondrogenic differentiation in bone marrow mesenchymal stem cells (BMSCs) occurred in multiple age-related degenerative diseases such as osteoporosis and osteoarthritis. In order to improve our understanding and control of multi-directional differentiation of BMSCs in rats, using high-throughput sequencing, we identified key gene regulatory events in the early stages of lineage commitment. Data analysis revealed two transcription factors (TFs, Tsc22d3, and Epas1) with elevated expression throughout the initiation of differentiation (3 h), lineage acquisition (12 h), and early lineage progression (72 h) of three-directional differentiation. For osteogenic differentiation, 792, 1,042, and 638 differentially expressed genes including 48, 59, and 34 TFs were identified at three time points, respectively. Moreover, the functional analysis demonstrated that 4, 12, and 5 TFs were only differentially expressed during osteogenic differentiation at 3, 12, and 72 h, respectively, and not during other two-directional differentiation. Hopx showed enhanced expression throughout three early phases during the osteogenic differentiation but no significant change in other two-directional differentiation. A similar pattern of Gbx2 expression occurred in chondrogenic differentiation. Thus, Hopx and other early responder TFs may control the osteogenic cell fate of BMSCs and participate in the development of osteoporosis. Gbx2 and other early responder TFs should be considered in mechanistic models that clarify cartilage-anabolic changes in the clinical progression of osteoarthritis.

Abstract Background Numerous quantitatively based studies measuring the association between gout and the risk of fractures remain inconclusive. In order to determine whether gout could increase the risk of fractures, a meta-analysis was performed systematically. Methods Electronic databases, MEDLINE/PubMed, Embase, and Cochrane Library were systematically searched to identify studies evaluating the association of gout and the risk of fractures. No restrictions on language, publication date, or journal of publication were imposed. Meta-analysis was performed to pool the outcome estimates of interest such as fracture incidence, fracture risk, and fracture risk in different sites and at different time points in the follow-up period. Results Screening determined that seven studies involving a total of 684,964 participants (151,002 in the gout group and 533,962 in the control group) were deemed viable for inclusion in the meta-analysis. The results of the analysis showed that gout would not significantly have a relatively higher risk of any fracture (RR = 1.11, 95% CI 0.98–1.26). Subgroup analysis showed consistent results for sexuality (female: RR = 1.13, 95% CI 0.93–1.37; male: RR = 0.99, 95% CI 0.91–1.07) and several occurring sites (humerus, wrist, vertebra, hip, upper limbs, and lower limbs). Additionally, the results demonstrated that urate-lowering drugs prescribed early during disease had neither adverse nor beneficial effect on the long-term risk of fractures (RR = 0.89, 95% CI 0.76–1.05). Conclusions This meta-analysis confirmed that gout was not associated with an increased risk of fractures. Urate-lowering drugs prescribed early during the course of disease had neither adverse nor beneficial effect on the long-term risk of fractures.

Abstract Background The purpose of this meta-analysis is to examine changes in radiological variables and clinical outcomes between open and closed wedge high tibial osteotomy (OWHTO and CWHTO, respectively), which have ongoing controversial issues in numerous quantitative clinical studies. Methods PubMed, Embase, and the Cochrane Library were systematically searched for suitable controlled trials between Jan 1, 1999, and Feb 2, 2018. The inclusion criteria included studies written in English, studies with a level of evidence of I–IV, and studies presenting comparisons between OWHTO and CWHTO. The main clinical and radiographic results were extracted and pooled using Stata 12.0. Results After searching for and screening trials, 28 trials involving 2840 knees were eligible for the meta-analysis. After OWHTO or CWHTO, clinical scores, including the American Knee Society Score, Hospital for Special Surgery Knee Score, Lysholm score, and Visual Analog Scale pain score, improved (p < 0.05), but the range of motion was unchanged (p > 0.05). The anatomical femorotibial angle (SMD 0.04, 95% CI − 0.66 to 0.74) and hip-knee-ankle angle (SMD 0.11, 95% CI − 0.11 to 0.33) data suggested that the OWHTO and CWHTO groups were similar in function of correction. Posterior tibial slope increased (SMD − 0.71, 95% CI − 1.04 to − 0.37) after OWHTO but decreased (SMD 0.72, 95% CI 0.35 to 1.08) after CWHTO. OWHTO decreased patellar height (p < 0.05), while patellar height did not change significantly after CWHTO (p > 0.05). Conclusion This meta-analysis indicates that compared with CWHTO, OWHTO increases the posterior slope, decreases the patellar height, and provides a similar accuracy of correction; however, CWHTO leads to a decreased posterior slope and an unchanged patellar height. Therefore, programs should be personalized and customized for the specific situation of each patient.

Abstract Background Multiple trials have attempted to assess the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in osteosarcoma with results remaining inconclusive. This study aims to investigate the effectiveness of 18F-FDG PET and PET/CT in the diagnosis, staging, recurrence and metastasis formation observations of osteosarcoma through systematic review followed by meta-analysis. Methods Three electronic databases, Medline/PubMed, Embase and the Cochrane Library were utilized in this study. Eligible studies that assessed the performance of 18F-FDG PET/CT for the diagnosis, staging, restaging and recurrence monitoring of osteosarcoma were retrieved utilizing specific search criteria. After screening and diluting out the non-conforming articles, all relevant articles and their data were identified and extracted to calculate the summary metrics involving sensitivity, specificity, diagnostic odd ratio (DOR), and area under the curve (AUC) to determine the effectiveness of 18F-FDG PET in diagnosing osteosarcoma clinically. Results Out of 1976 articles searched, twenty-six studies were identified that were viable. All data from these articles, utilized in the quantitative analyses, showed after meta-analysis that when utilizing 18F-FDG PET or PET/CT it was better with a success rate of 90–100% for detecting primary lesions and distant metastases of patients with osteosarcoma. Similar results were also obtained for detecting lung and bone metastases in a subgroup analysis. Conclusions As such the investigation demonstrated that 18F-FDG PET and PET/CT are very accurate for the diagnosis, staging and recurrence monitoring of osteosarcoma. 18F-FDG-avid lesions should be further examined in osteosarcoma, especially for suspicious lung lesions.

As a critical foundation for train traffic management, a train stop plan is associated with several other plans in high-speed railway train operation strategies. The current approach to train stop planning in China is based primarily on passenger demand volume information and the preset high-speed railway station level. With the goal of efficiently optimising the stop plan, this study proposes a novel method that uses machine learning techniques without a predetermined hypothesis and a complex solution algorithm. Clustering techniques are applied to assess the features of the service nodes (e.g., the station level). A modified Markov decision process (MDP) is conducted to express the entire stop plan optimisation process considering several constraints (service frequency at stations and number of train stops). A restrained MDP-based stop plan model is formulated, and a numerical experiment is conducted to demonstrate the performance of the proposed approach with real-world train operation data collected from the Beijing-Shanghai high-speed railway.

Train capacity utilization (TCU), usually represented by passenger load factor (PLF), is a critical measure of effectiveness for rail operation. In literature, efforts are usually made to improve capacity utilization by optimizing rail operation and management strategies. Comparably little attention is paid to analyzing the factors that affect TCU and to understanding the behavioral patterns behind it. This paper applies exploratory data mining techniques to a 3-month long real world train operation data of the Beijing-Shanghai High-Speed Railway. Principal component analysis (PCA) is conducted to find the principal components that can efficiently represent the collected data. Clustering techniques are then applied to understand the unique characteristics that affect PLF and the travel pattern. The findings can be further used to guide train operation planning and facilitate better decision-making.

The diagnostic process for psychiatric conditions is guided by the Diagnostic and Statistical Manual of Mental Disorders (DSM) in North America. Revisions of the DSM over the years have led to lowered diagnostic thresholds across the board, incurring increased rates of both misdiagnosis and over-diagnosis. Coupled with stigma, this ambiguity and lack of consistency exacerbates the challenges that clinicians and scientists face in the clinical assessment and research of mood disorders such as Major Depressive Disorder (MDD). While current efforts to characterize MDD have largely focused on qualitative approaches, the broad variations in physiological traits, such as those found in the gut, suggest the immense potential of using biomarkers to provide a quantitative and objective assessment. Here, we propose the development of a probiotic Escherichia coli (E. coli) multi-input ingestible biosensor for the characterization of key gut metabolites implicated in MDD. DNA writing with CRISPR based editors allows for the molecular recording of signals while riboflavin detection acts as a means to establish temporal and spatial specificity for the large intestine. We test the feasibility of this approach through kinetic modeling of the system which demonstrates targeted sensing and robust recording of metabolites within the large intestine in a time-and dose- dependent manner. Additionally, a post-hoc normalization model successfully controlled for confounding factors such as individual variation in riboflavin concentrations, producing a linear relationship between actual and predicted metabolite concentrations. We also highlight indole, butyrate, tetrahydrofolate, hydrogen peroxide, and tetrathionate as key gut metabolites that have the potential to direct our proposed biosensor specifically for MDD. Ultimately, our proposed biosensor has the potential to allow for a greater understanding of disease pathophysiology, assessment, and treatment response for many mood disorders. [ABSTRACT FROM AUTHOR]