Demographic and clinical correlates of depression among older adults with arthritis in Nigeria

BACKGROUND

Older adults have a high prevalence of chronic conditions like arthritis with morbidities, especially depression ranging up to 40% - 70%. Therefore, it is important to explore depression in older adults with arthritis.

AIM

This study aimed to determine if any demographic and clinical factors are associated with depression in older adults aged ≥ 60 years with arthritis attending a rheumatology clinic.

SETTING

This is a cross-sectional study conducted over 6 months among 127 older adults on follow-up care in a university teaching hospital in the North-Eastern region of Nigeria.

METHODS

A clinical proforma with information about the type of arthritis, duration of illness, hospitalisation, use of medications, co-morbidity was utilised for the data collection. The Geriatric Depression Scale (GDS-30), sociodemographic questionnaire and clinical proforma were administered. Data were analysed using Statistical Product and Service Solutions (SPSS) version 26.0 with the level of significance set as 0.05.

RESULTS

The mean age (± standard deviation [s.d.]) was 66.6 (± 5.5) years, with males constituting 57.5%. The prevalence of depression was 57.8%. Osteoarthritis 30.2%, while 69.8% had rheumatoid arthritis. Sociodemographic factors associated with depression include age (p = 0.049), marital status (p = 0.001), and level of education (p = 0.001). Duration of illness (p = 0.02), hospitalisation (p = 0.03), and number of medications (p = 0.01) were clinical factors associated with depression score.

CONCLUSION

The prevalence of depression in older people with arthritis is high and was associated with females, the widowed, no formal education; and those with long duration of illness, those using multiple medications, and those with repeated hospitalisation.

CONTRIBUTION

This finding can enhance the suspicion index for depression to establish standard operating procedures, which will help to improve therapeutic practice for caring for the older adult age group.

Quadriceps and Hamstrings Activation Peaks Earlier as Athletes Repeatedly Hop, but There are Differences Depending on ACL Reconstruction Technique

BACKGROUND

After Anterior Cruciate Ligament Reconstruction (ACLR) athletes face the challenge of regaining their previous competitive level while avoiding re-injury and early knee joint cartilage degeneration. Quadriceps and hamstrings strength reductions and neuromuscular alterations potentially related to risk of re-injury are present after ACLR and relate to deficits in muscle activation.

DESIGN

Cross-sectional laboratory study.

PURPOSE

To examine quadriceps and hamstrings muscle activation during repeated hops in healthy pivoting-sport athletes and those who had undergone ACLR (bone-tendon-bone and semitendinosus graft) who had met functional criteria allowing return to training.

METHODS

Surface electromyography (SEMG) was recorded from vastus medialis and lateralis and medial and lateral hamstrings bilaterally during 30 seconds' repeated hopping in male athletes on average eight months after ACLR surgery (5-12 months). All patients underwent hamstring (HS) (n=24) or bone-tendon-bone (BTB) reconstruction (n=20) and were compared to healthy controls (n=31). The SEMG signals were normalized to those obtained during maximal voluntary isometric contraction.

RESULTS

A significant time shift in peak muscle activation (earlier) was seen for: vastus medialis and vastus lateralis activation in the control group, in the BTB group's healthy (but not injured) leg and both legs of the HS group. A significant time shift in peak muscle activation was seen for lateral hamstrings (earlier) in all but the BTB group's injured leg and the medial hamstrings in the control group only. Lower peak activation levels of the vastus lateralis (p\<0.001) and vastus medialis (p\<0.001) were observed in the injured compared to healthy legs and lower peak lateral hamstrings activity (p\<0.009) in the injured leg compared to control leg. Decline in medial hamstring peak activation (p\<0.022) was observed between 1st and 3rd phase of the hop cycle in all groups.

CONCLUSION

Repeated hop testing revealed quadriceps and hamstring activation differences within ACLR athletes, and compared to healthy controls, that would be missed with single hop tests.

LEVEL OF EVIDENCE

3.

Effectiveness of community pharmacist-led interventions in osteoarthritis pain management: A cluster-randomized trial

BACKGROUND

Community pharmacists contribute in osteoarthritis management via evidence-based pain management services. However, their roles and impacts on osteoarthritis management in low- and middle-income countries have yet to be explored.

OBJECTIVE

This study aims to evaluate the effectiveness of community pharmacist-led educational intervention and medication review among osteoarthritis patients.

METHODS

A 6-month cluster-randomized controlled study was conducted in 22 community pharmacies of Nepal. Patients clinically diagnosed with osteoarthritis, aged 18 years and above, with a poor knowledge level of osteoarthritis and pain management were enrolled in the study. The intervention groups were educated on osteoarthritis and pain management, and had their medications reviewed while control group received usual care. Primary outcomes evaluated for the study were the change in pain levels, knowledge, and physical functional scores at 3 and 6 months. Repeated analyses of covariance were performed to examine the outcomes.

RESULTS

A total of 158 participants were recruited for the study. The intervention group reported improvements in pain score (mean difference 0.473, 95 % CI 0.047 to 0.900) at 3 months and the end of the study (mean difference 0.469, 95 % CI 0.047 to 0.891) as compared to control. Similarly, improvement in knowledge scores were observed in the intervention group at 3 months (mean difference 5.320, 95 % CI 4.982 to 5.658) and 6 months (mean difference 5.411, 95 % CI 5.086 to 5.735). No differences were observed in other outcomes, including physical functional score, depression, and quality of life.

CONCLUSION

Community pharmacist-led intervention improved patients' knowledge of osteoarthritis and pain management. While pain scores improved, physical functional score, depression, and quality of life score remained unchanged.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT05337709.

The efficacy and tolerability of proteoglycan F in the treatment of knee osteoarthritis: A prospective, randomized, double-blind controlled trial

OBJECTIVE

To identify the efficacy and tolerability of Proteoglycan F in patients with primary knee OA.Design: A 24-week randomized, placebo-controlled, double-blind clinical trial with two arms: (1) Proteoglycan F (received 10 ​mg proteoglycan daily, for 24 weeks) and (2) control group (received placebo). Knee symptoms and joint cartilage status (evaluated by ultrasound and MRI of knee joints), quality of life, serum cytokine levels (IL-1β and TNF-α), and safety evaluation were measured before, during, and after the treatment.

RESULTS

After 24-week treatment, pain reduction (in the KOOS pain score) of at least 20% and at least 50% (NRS scale) compared to baseline in the PGF group was significantly higher than those in the control group. The PGF group had greater reductions in the total scores of subchondral bone marrow edema, and bone cocoon under cartilage on knee MRI (classification according to WORMs), which were -2.27 (-4.0; -0.51) and -1.77 (-3.08; -0.46), respectively (p ​< ​0.05). The two groups had no statistically significant difference in knee ultrasound characteristics. After 4 weeks, 12, and 24 weeks compared to baseline, there was no statistically significant difference in levels of urea, creatinine, aspartate aminotransferase, and alanine aminotransferase within the group and between the two study groups.

CONCLUSIONS

Salmon cartilage PG with 10 ​mg per day has potential to improve pain symptoms and subchondral bone marrow edema and bone cocoon under cartilage lesions in primary knee OA. However, the efficacy of PGF should be viewed with caution, and future studies are needed for more specific evaluation.

Prospects of Disease-Modifying Osteoarthritis Drugs

Osteoarthritis (OA) causes a massive disease burden with a global prevalence of nearly 23% in 2020 and an unmet need for adequate treatment, given a lack of disease-modifying drugs (DMOADs). The author reviews the prospects of active DMOAD candidates in the phase 2/3 clinical trials of drug development pipeline based on key OA pathogenetic mechanisms directed to inflammation-driven, bone-driven, and cartilage-driven endotypes. The challenges and possible research opportunities are stated in terms of the formulation of a research question known as the PICO approach: (1) population, (2) interventions, (3) comparison or placebo, and (4) outcomes.

Five Factors for Effective Policy to Improve Attitudes towards People with Disability

Improving community attitudes and behaviours is core to improving inclusion for people with disability. To identify ways to achieve such change, we analysed data from qualitative interviews with sixty-one expert stakeholders in Australia, informed by our preceding literature review on effective interventions. We identified five themes describing factors with the potential to change attitudes and behaviours to improve inclusion and reduce discrimination: ensuring people with disability have active presence across all life domains; leadership by people with disability, together with organisational and governmental leadership that values the diverse contribution of people with disability; a holistic approach to policy and interventions that targets multiple levels of change; long-term and adequately resourced initiatives to achieve structural and sustained change; and commitment to measuring and monitoring change interventions, to inform decisions and maintain accountability.

Analysis of lower limb muscle strength characteristics of amateur runners with patellofemoral pain: A cross-sectional study

To analyze the lower limb muscle strength characteristics of amateur runners with patellofemoral pain (PFP). Sixty amateur runners (30 in the knee pain group, 30 in the control group) underwent measurements of hip abduction strength, knee extension strength, and knee flexion strength. Additionally, the hamstring/quadriceps ratio and limb strength symmetry index were calculated for all participants. Statistical analyses were conducted using linear mixed models. The hip abduction and knee extensors strength of amateur runners with PFP was significantly lower than that of the control group. The hamstring/quadriceps ratio was significantly higher in the male knee pain group compared to the control group, while no significant difference was found between the female knee pain group and the control group. Furthermore, both the hip abduction strength symmetry index and knee extensors symmetry index were significantly lower in the knee pain group compared to the control group. Amateur runners with PFP exhibit distinct lower limb strength characteristics compared to non-knee pain runners. Additionally, differences in lower limb strength characteristics between male and female amateur runners with PFP were observed. These findings emphasize the importance of considering functional and gender differences in PFP rehabilitation training.

Investigating the pathogenesis of vitreous in postmortem COVID patients via untargeted metabolomics based bioinformatics model

SARS-CoV-2 virus has become a worldwide pandemic causing millions of death. This severe disaster lead to a immense panic and stress all over the world. Several studies were dedicated to understand its mechanism, pathogenesis and spreading characteristics. By this way, scientists try to develop different therapy and diagnose strategies. For these reasons, several metabolomics, proteomics and genomics studies were also carried out to improve knowledge in this newly identified virus. In this study, we are aimed to explain the pathogenesis of SARS-CoV-2 exposure on postmortem COVID (+) patients via untargeted metabolomics analysis. To carry out this study, a Data Independent Acquisition SWATH method is optimized and performed. Vitreous samples were analyzed in both MS1 and MS2 ESI(+) mode. An orthogonal Partial Least Square Discriminant Analysis were performed for classification. It was observed that lipid metabolism, several amino acids and oxidative stress biomarkers were strongly affected due to high inflammation and possible cytokine storm.

Association of Wearable Device-Measured Step Volume and Variability With Blood Pressure in Older Chinese Adults: Mobile-Based Longitudinal Observational Study

BACKGROUND

The paucity of evidence on longitudinal and consecutive recordings of physical activity (PA) and blood pressure (BP) under real-life conditions and their relationships is a vital research gap that needs to be addressed.

OBJECTIVE

This study aims to (1) investigate the short-term relationship between device-measured step volume and BP; (2) explore the joint effects of step volume and variability on BP; and (3) examine whether the association patterns between PA and BP varied across sex, hypertension status, and chronic condition status.

METHODS

This study used PA data of a prospective cohort of 3070 community-dwelling older adults derived from a mobile health app. Daily step counts, as a proxy of step volume, were derived from wearable devices between 2018 and 2022 and categorized into tertiles (low, medium, and high). Step variability was assessed using the SD of daily step counts. Consecutive daily step count recordings within 0 to 6 days preceding each BP measurement were analyzed. Generalized estimation equation models were used to estimate the individual and joint associations of daily step volume and variability with BP. Stratified analyses by sex, the presence of hypertension, and the number of morbidities were further conducted.

RESULTS

A total of 3070 participants, with a median age of 72 (IQR 67-77) years and 71.37% (2191/3070) women, were included. Participants walked a median of 7580 (IQR 4972-10,653) steps and 5523 (IQR 3590-7820) meters per day for a total of 592,597 person-days of PA monitoring. Our results showed that higher levels of daily step volume were associated with lower BP (systolic BP, diastolic BP, mean arterial pressure, and pulse pressure). Compared with participants with low step volume (daily step counts <6000/d) and irregular steps, participants with high step volume (≥9500/d) and regular steps showed the strongest decrease in systolic BP (-1.69 mm Hg, 95% CI -2.2 to -1.18), while participants with medium step volume (6000/d to <9500/d) and regular steps were associated with the lowest diastolic BP (-1.067 mm Hg, 95% CI -1.379 to -0.755). Subgroup analyses indicated generally greater effects on women, individuals with normal BP, and those with only 1 chronic disease, but the effect pattern was varied and heterogeneous between participants with different characteristics.

CONCLUSIONS

Increased step volume demonstrated a substantial protective effect on BP among older adults with chronic conditions. Furthermore, the beneficial association between step volume and BP was enhanced by regular steps, suggesting potential synergistic protective effects of both increased step volume and step regularity. Targeting both step volume and variability through PA interventions may yield greater benefits in BP control, particularly among participants with hypertension and a higher chronic disease burden.

Optimizing young tennis players' development: Exploring the impact of emerging technologies on training effectiveness and technical skills acquisition

The research analyzed the effect of weekly training plans, physical training frequency, AI-powered coaching systems, virtual reality (VR) training environments, wearable sensors on developing technical tennis skills, with and personalized learning as a mediator. It adopted a quantitative survey method, using primary data from 374 young tennis players. The model fitness was evaluated using confirmatory factor analysis (CFA), while the hypotheses were evaluated using structural equation modeling (SEM). The model fitness was confirmed through CFA, demonstrating high fit indices: CFI = 0.924, TLI = 0.913, IFI = 0.924, RMSEA = 0.057, and SRMR = 0.041, indicating a robust model fit. Hypotheses testing revealed that physical training frequency (β = 0.198, p = 0.000), AI-powered coaching systems (β = 0.349, p = 0.000), virtual reality training environments (β = 0.476, p = 0.000), and wearable sensors (β = 0.171, p = 0.000) significantly influenced technical skills acquisition. In contrast, the weekly training plan (β = 0.024, p = 0.834) and personalized learning (β = -0.045, p = 0.81) did not have a significant effect. Mediation analysis revealed that personalized learning was not a significant mediator between training methods/technologies and acquiring technical abilities. The results revealed that physical training frequency, AI-powered coaching systems, virtual reality training environments, and wearable sensors significantly influenced technical skills acquisition. However, personalized learning did not have a significant mediation effect. The study recommended that young tennis players' organizations and stakeholders consider investing in emerging technologies and training methods. Effective training should be given to coaches on effectively integrating emerging technologies into coaching regimens and practices.

Towards Precision Medicine in Spinal Surgery: Leveraging AI Technologies

This critique explores the implications of integrating artificial intelligence (AI) technology, specifically OpenAI's advanced language model GPT-4 and its interface, ChatGPT, into the field of spinal surgery. It examines the potential effects of algorithmic bias, unique challenges in surgical domains, access and equity issues, cost implications, global disparities in technology adoption, and the concept of technological determinism. It posits that biases present in AI training data may impact the quality and equity of healthcare outcomes. Challenges related to the unique nature of surgical procedures, including real-time decision-making, are also addressed. Concerns over access, equity, and cost implications underscore the potential for exacerbated healthcare disparities. Global disparities in technology adoption highlight the importance of global collaboration, technology transfer, and capacity building. Finally, the critique challenges the notion of technological determinism, emphasizing the continued importance of human judgement and patient-care provider relationship in healthcare. The critique calls for a comprehensive evaluation of AI technology integration in healthcare to ensure equitable and quality care.

Ferroptosis: Regulatory mechanisms and potential targets for bone metabolism: A review

Bone homeostasis is a homeostasis process constructed by osteoblast bone formation and osteoclast bone resorption. Bone homeostasis imbalance and dysfunction are the basis for the development of various orthopedic diseases such as osteoporosis, osteoarthritis, and steroid-induced avascular necrosis of femoral head. Previous studies have demonstrated that ferroptosis can induce lipid peroxidation through the generation of reactive oxygen species, activate a number of signaling pathways, and participate in the regulation of osteoblast bone formation and osteoclast bone resorption, resulting in bone homeostasis imbalance, which is an important factor in the pathogenesis of many orthopedic diseases, but the mechanism of ferroptosis is still unknown. In recent years, it has been found that, in addition to iron metabolism and intracellular antioxidant system imbalance, organelle dysfunction is also a key factor affecting ferroptosis. This paper takes this as the starting point, reviews the latest literature reports at home and abroad, elaborates the pathogenesis and regulatory pathways of ferroptosis and the relationship between ferroptosis and various organelles, and summarizes the mechanism by which ferroptosis mediates bone homeostasis imbalance, with the aim of providing new directions for the research related to ferroptosis and new ideas for the prevention and treatment of bone and joint diseases.

BMSC-derived exosomes promote osteoporosis alleviation via M2 macrophage polarization

Osteoporosis is characterized by reduced bone mass due to imbalanced bone metabolism. Exosomes derived from bone mesenchymal stem cells (BMSCs) have been shown to play roles in various diseases. This study aimed to clarify the regulatory function and molecular mechanism of BMSCs-derived exosomes in osteogenic differentiation and their potential therapeutic effects on osteoporosis. Exosomes were extracted from BMSCs. Bone marrow-derived macrophages (BMDMs) were cultured and internalized with BMSCs-derived exosomes. Real-time quantitative PCR was used to detect the expression of macrophage surface markers and tripartite motif (TRIM) family genes. BMDMs were co-cultured with human osteoblasts to assess osteogenic differentiation. Western blot was performed to analyze the ubiquitination of triggering receptor expressed on myeloid cell 1 (TREM1) mediated by TRIM25. An ovariectomized mice model was established to evaluate the role of TRIM25 and exosomes in osteoporosis. Exosomes were successfully isolated from BMSCs. BMSCs-derived exosomes upregulated TRIM25 expression, promoting M2 macrophage polarization and osteogenic differentiation. TRIM25 facilitated the ubiquitination and degradation of TREM1. Overexpression of TREM1 reversed the enhanced M2 macrophage polarization and osteogenic differentiation caused by TRIM25 overexpression. TRIM25 enhanced the protective effect of BMSCs-derived exosomes against bone loss in mice. These findings suggested that BMSCs-derived exosomes promoted osteogenic differentiation by regulating M2 macrophage polarization through TRIM25-mediated ubiquitination and degradation of TREM1. This mechanism might provide a novel approach for treating osteoporosis.

Exploring the Impact of Astaxanthin Supplementation in Conjunction with a 12-Week CrossFit Training Regimen on Selected Adipo-Myokines Levels in Obese Males

OBJECTIVE

Obesity is associated with an exacerbated metabolic condition that is mediated through impairing balance in the secretion of some adipo-myokines. Therefore, the objective of the present study was to explore the impact of astaxanthin supplementation in conjunction with a 12-week CrossFit training regimen on some selected adipo-myokines, insulin insensitivity, and serum lipid levels in obese males.

MATERIAL AND METHODS

This study is a randomized control trial design; 60 obese males were randomly divided into four groups of 15, including the control group (CG), supplement group (SG), training group (TG), and combined training and supplement group (TSG). The participants were subjected to 12 weeks of astaxanthin (AST) supplementation [20 mg/d capsule, once/d] or CrossFit training or a combination of both interventions. The training regimen comprised 36 sessions of CrossFit, each lasting 60 min, conducted three times per week. The metabolic indices, body composition, anthropometrical, cardio-respiratory, and also some plasma adipo-myokine factors, including decorin (DCN), activin A, myostatin (MST), transforming growth factor (TGF)-β1, and follistatin (FST), were examined 12 and 72 h before the initiation of the main interventional protocols, and then 72 h after the final session of the training protocol.

RESULTS

There was no significant difference in the baseline data between the groups (p > 0.05). There were significant interactions between group x time for DCN (η2 = 0.82), activin A (η2 = 0.50), FST (η2 = 0.92), MST (η2 = 0.75), and TGFB-1 (η2 = 0.67) (p < 0.001 for all the variables). Significantly changes showed for DCN in TSG compared to TG and SG and also TG compared to SG (p = 0.0001); for activin A in SG compared to TG (p = 0.01) and TSG (p = 0.002); for FST in SG compared to TG and TSG (p = 0.0001), also in TSG compared to TG (p = 0.0001); for MST in SG, TG, and TSG compared to CG (p = 0.0001) and also in TSG compared to SG (p = 0.0001) and TG (p = 0.001); for TGFB-1 in SG, TG, and TSG compared to CG (p = 0.0001) and also TSG compared to SG (p = 0.0001) and TG (p = 0.001).

CONCLUSIONS

The 12-week CrossFit training concurrent with AST supplementation reduced anthropometric and metabolic factors and also serum lipid levels while producing positive changes in body composition and cardiovascular factors. Increased FST and DCN and reduced activin A, MST, and TGF-β1 were other affirmative responses to both interventions.

From trauma to chronicity: Understanding the incidence and early immune changes of chronic complications in polytrauma patients

OBJECTIVE

Polytrauma is a complex condition associated with poor outcomes and high mortality rates resulting from severe damage and complicated complications. This study sought to ascertain the incidence of chronic complications in polytrauma patients, as well as the early immune changes and risk factors.

METHODS

A multicenter, prospective and observational cohort study was conducted at the emergency surgery or traumatic intensive care unit (TICU) of the Advanced Trauma Center from August 2020 to July 2023. A total of 2033 consecutive trauma patients were included in the study. In the first 1, 7, and 14 days after admission, flow cytometry and immunoassay kits were used to examine cytokine release and lymphocyte count.

RESULTS

Trauma patients were reported 33.8% (687/2033) chronic complication rates, with monotrauma patients reported 8.1% (55/683) and polytrauma patients reported 59.4% (802/1350). And the four most frequent chronic complications in polytrauma patients were chronic musculoskeletal pain (30.4%), post-traumatic osteoarthritis (27.2%), chronic wound (21.6%), and chronic lung injury (14.1.%) .There were significant differences in lymphocyte ratios and cytokine levels, at 1, 7, and 14 day of admission between chronic complication groups (CCP) and not chronic complication groups (N-CCP) in polytrauma. Polytrauma patients with characteristics of higher ratio of Ts7d ratio (95% CI: 2.01-6.21), Treg14d (95% CI: 1.12-5.43) and level of IL-67d (95% CI: 1.22-4.43), TNF-α7d (95% CI: 1.05-3.83), IL-1014d (95% CI: 2.01-6.84) were found to have a higher likelihood of experiencing a chronic complication. Conversely, a higher ratio of Tc1d (95% CI: 0.53-0.86), Th1d (95% CI: 0.64-0.95) and Th/Ts14d (95% CI: 0.21-0.64) were identified as independent protective factors against a chronic complication event.

CONCLUSION

Polytrauma patients exhibit a notable prevalence of chronic complications. Some immune and inflammatory indicators can be observed early in combination after injury to predict the risk of chronic complications after polytrauma.

A high throughput cell stretch device for investigating mechanobiology in vitro

Mechanobiology is a rapidly advancing field, with growing evidence that mechanical signaling plays key roles in health and disease. To accelerate mechanobiology-based drug discovery, novel in vitro systems are needed that enable mechanical perturbation of cells in a format amenable to high throughput screening. Here, both a mechanical stretch device and 192-well silicone flexible linear stretch plate were designed and fabricated to meet high throughput technology needs for cell stretch-based applications. To demonstrate the utility of the stretch plate in automation and screening, cell dispensing, liquid handling, high content imaging, and high throughput sequencing platforms were employed. Using this system, an assay was developed as a biological validation and proof-of-concept readout for screening. A mechano-transcriptional stretch response was characterized using focused gene expression profiling measured by RNA-mediated oligonucleotide Annealing, Selection, and Ligation with Next-Gen sequencing. Using articular chondrocytes, a gene expression signature containing stretch responsive genes relevant to cartilage homeostasis and disease was identified. The possibility for integration of other stretch sensitive cell types (e.g., cardiovascular, airway, bladder, gut, and musculoskeletal), in combination with alternative phenotypic readouts (e.g., protein expression, proliferation, or spatial alignment), broadens the scope of high throughput stretch and allows for wider adoption by the research community. This high throughput mechanical stress device fills an unmet need in phenotypic screening technology to support drug discovery in mechanobiology-based disease areas.

Preoperative Synovial Tissue and Synovial Fluid Biomarkers as Predictors for Outcomes After Knee Arthroscopy and ACL Reconstruction: A Narrative Review

BACKGROUND

Biomarkers collected in synovial tissue and fluid have been identified as potential predictors of outcomes after arthroscopy.

PURPOSE

To provide a narrative review of the current literature that assesses the associations between preoperative biomarkers in the synovial fluid or synovial tissue and patient outcomes after knee arthroscopy.

STUDY DESIGN

Narrative review.

METHODS

We searched the PubMed database with keywords, "biomarkers AND arthroscopy," "biomarkers AND anterior cruciate ligament reconstruction," and "biomarkers AND meniscectomy." To be included, studies must have collected synovial fluid or synovial tissue from patients before or during arthroscopic knee surgery and analyzed the relationship of biomarkers to postoperative patient outcomes. Biomarkers were classified into 4 main categories: metabolism of aggrecan in cartilage, metabolism of collagen in cartilage (type II collagen), noncollagenous proteins in the knee, and other. When biomarker levels and outcomes were expressed with continuous variables, we abstracted the Pearson or Spearman correlation coefficients as the effect measure. If the biomarker values were continuous and the outcomes binary, we abstracted the mean or median biomarker values in those with favorable versus unfavorable outcomes. We calculated effect sizes as the difference between means of both groups divided by the standard deviation from the mean in the group with better outcomes.

RESULTS

Eight studies were included in the review. Each study reported different patient outcomes. Biomarkers associated with metabolism of aggrecan, type II collagen metabolism, and noncollagenous proteins as well as inflammatory biomarkers had statistically significant associations with a range of patient outcomes after knee arthroscopy. Difference across studies in sample size and outcome measures precluded choosing a single biomarker that best predicted patient outcomes.

CONCLUSION

The findings suggest that biomarkers associated with metabolism of aggrecan, type II collagen metabolism, noncollagenous proteins, as well as inflammatory biomarkers may help surgeons and their patients anticipate surgical outcomes.

Biomimetic strategies for the deputization of proteoglycan functions

Proteoglycans (PGs), which have glycosaminoglycan chains attached to their protein cores, are essential for maintaining the morphology and function of healthy body tissues. Extracellular PGs perform various functions, classified into the following four categories: i) the modulation of tissue mechanical properties; ii) the regulation and protection of the extracellular matrix; iii) protein sequestration; and iv) the regulation of cell signaling. The depletion of PGs may significantly impair tissue function, encompassing compromised mechanical characteristics and unregulated inflammatory responses. Since PGs play critical roles in the function of healthy tissues and their synthesis is complex, the development of PG mimetic molecules that recapitulate PG functions for tissue engineering and therapeutic applications has attracted the interest of researchers for more than 20 years. These approaches have ranged from semisynthetic graft copolymers to recombinant PG domains produced by cells that have undergone genetic modifications. This review discusses some essential extracellular PG functions and approaches to mimicking these functions.

A New Tissue Engineering Strategy to Promote Tendon-bone Healing: Regulation of Osteogenic and Chondrogenic Differentiation of Tendon-derived Stem Cells

In the field of sports medicine, repair surgery for anterior cruciate ligament (ACL) and rotator cuff (RC) injuries are remarkably common. Despite the availability of relatively effective treatment modalities, outcomes often fall short of expectations. This comprehensive review aims to thoroughly examine current strategies employed to promote tendon-bone healing and analyze pertinent preclinical and clinical research. Amidst ongoing investigations, tendon-derived stem cells (TDSCs), which have comparatively limited prior exploration, have garnered increasing attention in the context of tendon-bone healing, emerging as a promising cell type for regenerative therapies. This review article delves into the potential of combining TDSCs with tissue engineering methods, with ACL reconstruction as the main focus. It comprehensively reviews relevant research on ACL and RC healing to address the issues of graft healing and bone tunnel integration. To optimize tendon-bone healing outcomes, our emphasis lies in not only reconstructing the original microstructure of the tendon-bone interface but also achieving proper bone tunnel integration, encompassing both cartilage and bone formation. In this endeavor, we thoroughly analyze the transcriptional and molecular regulatory variables governing TDSCs differentiation, incorporating a retrospective analysis utilizing single-cell sequencing, with the aim of unearthing relevant signaling pathways and processes. By presenting a novel strategy rooted in TDSCs-driven osteogenic and chondrogenic differentiation for tendon-bone healing, this study paves the way for potential future research avenues and promising therapeutic applications. It is anticipated that the findings herein will contribute to advancing the field of tendon-bone healing and foster the exploration of TDSCs as a viable option for regenerative therapies in the future.

Optimizing Tissue Engineering for Clinical Relevance in Rotator Cuff Repair

Rotator cuff tear (RCT) is the most common cause of disability in the upper extremity. It results in 4.5 million physician visits in the United States every year and is the most common etiology of shoulder conditions evaluated by orthopedic surgeons. Over 460,000 RCT repair surgeries are performed in the United States annually. Rotator cuff (RC) retear and failure to heal remain significant postoperative complications. Literature suggests that the retear rates can range from 29.5% to as high as 94%. Weakened and irregular enthesis regeneration is a crucial factor in postsurgical failure. Although commercially available RC repair grafts have been introduced to augment RC enthesis repair, they have been associated with mixed clinical outcomes. These grafts lack appropriate biological cues such as stem cells and signaling molecules at the bone-tendon interface. In addition, they do little to prevent fibrovascular scar tissue formation, which causes the RC to be susceptible to retear. Advances in tissue engineering have demonstrated that mesenchymal stem cells (MSCs) and growth factors (GFs) enhance RC enthesis regeneration in animal models. These models show that delivering MSCs and GFs to the site of RCT enhances native enthesis repair and leads to greater mechanical strength. In addition, these models demonstrate that MSCs and GFs may be delivered through a variety of methods including direct injection, saturation of repair materials, and loaded microspheres. Grafts that incorporate MSCs and GFs enhance anti-inflammation, osteogenesis, angiogenesis, and chondrogenesis in the RC repair process. It is crucial that the techniques that have shown success in animal models are incorporated into the clinical setting. A gap currently exists between the promising biological factors that have been investigated in animal models and the RC repair grafts that can be used in the clinical setting. Future RC repair grafts must allow for stable implantation and fixation, be compatible with current arthroscopic techniques, and have the capability to deliver MSCs and/or GFs.