Aqueous extract of Ormocarpum cochinchinense augments proliferation and promotes osteogenesis in osteoblast like MG63 cells

Background

Bone tissue engineering requires a high restorative index as a demand from modern day requirements. Therapeutic agents derived from natural sources play a vital role as modulators in promoting bone regeneration. Ormocarpum cochinchinense, a shrub, is used by the traditional healers of southern East Asia to treat bone fractures. However, there remains a dearth in the exploration of its bone healing properties.

Methods

The present study reports a systematic analysis of the aqueous extract of Ormocarpum cochinchinense (OCE) as a repository of natural bio-actives capable of eliciting in vitro biomineralization and thereby osteogenesis. MTT assay, and Live/dead cell staining assay were used to evaluate the cell viability of MG-63 cells. Alizarin staining evaluated the mineralization by OCE, and ALP enzyme activity was measured both qualitatively and quantitatively. Gene expression of osteogenic markers (Runx2, ALP, Collagen type 1, BMP2, Osteocalcin, and Osteopontin) was measured by RT-qPCR.

Results

The MTT, and Live/Dead staining results exemplified significant proliferation index. Augmented biomineralization as early as 7 days was validated by Alizarin Red staining with increased mineralized nodules. The activity of Alkaline phosphatase (an early bone marker) was significantly enhanced by OCE. Furthermore, the expression levels of early and late osteogenic markers were increased profoundly after OCE treatment in a dose-dependent manner.

Conclusion

The present study demonstrates the potential of Ormocarpum cochinchinense to promote osteogenesis, exemplifying its potential for bone tissue engineering.

Role of vitamins in the development and treatment of osteoporosis (Review)

Osteoporosis has escalated into a pressing public health challenge amidst global demographic aging. Conventional diagnostic approaches and therapeutic interventions demonstrate growing limitations in both risk stratification and epidemiological control. In this context, serological monitoring and targeted nutrient supplementation emerge as promising preventive strategies. Vitamins, fundamental regulators of cellular homeostasis, demonstrate particular significance in bone remodeling processes. The present comprehensive review elucidates the pathophysiological mechanisms through which specific vitamins differentially modulate osteoblastic activity and osteoclastic regulation, summarizing contemporary evidence from the molecular to clinical research levels. While vitamin A exhibits dual effects, other vitamins predominantly show positive impacts on bone homeostasis. Oxidative stress and inflammation are key pathological changes associated with osteoporosis. Vitamins play a protective role by enhancing the expression of antioxidant enzymes, activating antioxidant pathways and inhibiting the secretion of inflammatory cytokines, thereby mitigating these conditions. Serum vitamin concentrations exhibit significant correlations with bone mineral density alterations and osteoporosis progression, providing predictive biomarkers for fracture risk assessment. However, serum vitamin profiles exhibit marked heterogeneity across osteoporosis risk strata, necessitating population‑specific therapeutic protocols. Precision‑adjusted supplementation strategies effectively attenuate pathological bone resorption while preserving physiological remodeling homeostasis. The present review systematically delineates the therapeutic potential of vitamins in osteoporotic management, underscoring the necessity for evidence‑based precision nutrient protocols tailored to at‑risk populations to prevent disease progression.

Oxyberberine revokes letrozole-induced polycystic ovarian syndrome and depression-like behavior in female Sprague-Dawley rats

Polycystic ovarian syndrome (PCOS) is a prevalent endocrine disorder in reproductive-age women, which also negatively perturbs person's psychiatric health. Herein, we investigated the effect of oxyberberine on PCOS- and depression-like phenotypes in female Sprague-Dawley rats. To generate PCOS- and depression-like phenotypes, rats were injected with letrozole (1 mg/kg/day for 21 days) and exposed to 14 days of chronic-unpredictable mild stress (CUMS). We synthesized oxyberberine from its natural parent phytoconstituent i.e., berberine. Rats underwent letrozole + CUMS exposure displayed an increased number of neutrophils in a vaginal smear test indicating a PCOS-like phenotype (i.e., disrupted estrus cycle). Moreover, these rats also showed anhedonia-, depression-, and anxiety-like behaviors in the sucrose-preference test, forced-swimming test, and elevated plus-maze test. Peroral administration of oxyberberine for 21 days, at 50 and 100 mg/kg doses, reversed letrozole + CUMS generated perturbations in rats. The total exploratory behavior in the open field test remained unaffected across the treatment groups. Oxyberberine treatment also restored the organ-weight index of the ovary and uterus and follicular development of the ovary. Systemic and uterine levels of oxyberberine were found to be 0.17-0.80 ng/mL and 1.03-3.62 ng/mL, respectively measured using a liquid chromatography-mass spectrometry assay. Oxyberberine also positively modulated the levels of catalase and malondialdehyde in intestine and spleen, and testosterone and luteinizing hormones in the systematic circulation and CYP17A1, CYP19A1, and SHBG expression in the ovary. These results suggest that oxyberberine improves PCOS- and depression-like phenotypes in rats by modulating testosterone hormone, CYP17A1, CYP19A1, and SHBG enzyme expression in the ovary.

Sinomenine alleviates experimental autoimmune uveitis in rats: Possible involvement of PI3K/AKT and NF-κB signaling pathways

Uveitis is an inflammatory ocular condition characterized by an autoimmune etiology. Sinomenine (SIN), the main active constituent of the rhizome of Sinomenium acutum (Thunb.) Rehd. et Wils., exhibits both anti-inflammatory and immunosuppressive properties. The present study sought to investigate the therapeutic effects of SIN on experimental autoimmune uveitis (EAU) in rats and to elucidate its underlying mechanisms. A bioinformatics analysis was conducted to identify signaling pathways implicated in the pathogenesis of uveitis, leading to the identification of the PI3K/AKT and NF-κB pathways for further experimental validation. An EAU model was subsequently established, and the ocular surface morphology was examined using slit lamp microscopy and hematoxylin-eosin staining. Immunofluorescence was utilized to measure the protein expression and distribution. Enzyme-linked immunosorbent assay was used to determine the expression of inflammatory cytokines. Experimental findings demonstrated that SIN significantly decreased ocular inflammation scores. Further validation revealed that SIN significantly elevated levels of interleukin-10 (IL-10) while reducing levels of IL-17, tumor necrosis factor-α (TNF-α), and IL-1β in EAU rats. SIN significantly suppressed the expression of phosphorylated proteins in the PI3K/AKT and NF-κB pathways. In addition, it reduced the expression of RORγt while enhancing the expression of Foxp3, the transcription factors associated with Th17 cells and Tregs, respectively. In summary, our data demonstrate that SIN alleviates EAU inflammation by inhibiting the activation of the PI3K/AKT and NF-κB signaling pathways and restoring the balance between Th17 and Tregs. These findings highlight SIN as a promising therapeutic agent for the treatment of uveitis.

Unveiling the mechanisms of mechanical loading-induced knee osteoarthritis through transcriptomics

AIMS

To establish a novel model of mechanical loading-induced knee osteoarthritis (KOA) and explore its regulatory mechanisms through transcriptomics.

METHODS

Knee joints of Sprague-Dawley (SD) rats were mechanically loaded with 13 N, 20 N and 27 N for 2 or 4 weeks to construct mechanically-induced KOA model. Immunohistochemistry (IHC), quantitative real-time polymerase chain reaction (qRT-PCR), Western blot, Safranin O/fast green staining, enzyme-linked immunosorbent assay (ELISA), micro-computed tomography (Micro-CT) and behavioral analysis were used to evaluate damage on the right knee joint. Transcriptomic analysis combined with validation experiments were performed to explore the regulatory mechanism of excessive mechanical loading on KOA development.

RESULTS

A vertical load of 27 N resulted in calf fractures, whereas a 13 N load did not cause remarkable pathological alteration in the knee joint. Notably, applying compression at a load of 20 N for 4 weeks (w) significantly promoted the levels of pro-inflammatory factors IL-6, IL-β, NLRP3, iNOS and TNF-α in serum and joint fluids and markedly minimized the levels of anti-inflammatory factors IL-10 and TGF-β. Immunohistochemistry, qRT-PCR and Western blot analyses suggested that the 20 N load reduced the expression of anabolism markers (ACAN and COL2A1) and escalated the expression of catabolism markers (MMP13 and ADAMTS4). KEGG analysis and validation results showed that PIEZO1-Ca2+ signaling pathway, PI3K-AKT signaling pathway and NF-κB signaling pathway were significantly activated in the 20 N-4 w group.

CONCLUSION

Continuous loading with 20 N for 4 weeks can induce significant OA-like damage to the cartilage of the right knee in rats, which might be induced through the PIEZO1-Ca2+/PI3K-AKT/NF-κB signaling pathway.

Gusongan capsule enhances osteogenic differentiation to mitigate bone loss in ovariectomized rats via the TLR2/NF-κB pathway

BACKGROUND

Osteoporosis (OP) is a metabolic bone disease characterized by reduced bone mass and impaired bone microstructure, leading to an increased risk of fractures. In this context, the Gusongan (GSA) capsule has gained recognition for its osteogenic potential.

PURPOSE

This study sought to examine the therapeutic effects of GSA capsule on OP and to elucidate the molecular mechanisms underpinning its osteoprotective properties.

METHODS

An OP model was established in female Sprague-Dawley rats through bilateral ovariectomy (OVX), followed by gavage administration of varying doses of GSA capsule. The study included the control, OVX model, and positive control (alendronate) groups. Bone mineral density (BMD) and serum biomarkers of rats were analyzed using micro-computed tomography (micro-CT) and enzyme-linked immunosorbent assay (ELISA). RNA sequencing (RNA-seq)- and network pharmacology-based analyses were conducted to identify potential molecular targets. Additionally, in vitro experiments were performed to evaluate the impacts of GSA capsule on the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) and the TLR2/NF-κB pathway.

RESULTS

Micro-CT analysis demonstrated that GSA capsule treatment markedly improved BMD, trabecular number (Tb.N), and bone volume/total volume (BV/TV), while reducing trabecular separation (Tb.Sp) (p< 0.05). ELISA results further revealed that GSA capsule diminished serum levels of bone Gla protein (BGP), bone alkaline phosphatase (BALP), and tartrate-resistant acid phosphatase (TRACP) in OVX rats (p< 0.05), suggesting an inhibitory effect on bone resorption and turnover. RNA-seq- and network pharmacology-based analyses highlighted the downregulation of key factors in the TLR2/NF-κB pathway in BMSCs following GSA capsule treatment. Furthermore, GSA capsule enhanced BALP activity and mineralized nodule formation in BMSCs (p< 0.05). In vitro investigations corroborated that GSA capsule downregulated TLR2 and NF-κB p65 levels and fostered the expression of osteogenic genes, including COL1A1, RUNX2, and OPN (p< 0.05).

CONCLUSION

This study highlighted that GSA capsule attenuated inflammation and augmented osteogenic differentiation of BMSCs by targeting the TLR2/NF-κB pathway. These molecular mechanisms contributed to enhanced BMD and bone microarchitecture in OVX rats, suggesting the therapeutic potential of GSA capsule in OP management.

Exploring the Molecular Mechanisms of Fisetin in Treating Periodontitis Through Multiomics and Network Pharmacology

BACKGROUND

Periodontitis (PD) is a common chronic inflammatory oral disease that severely affects patients' quality of life. Fisetin has been shown to possess antioxidant and anti-inflammatory properties in various biological systems.

METHODS

This study first identified the molecular targets of fisetin for PD through network pharmacology analysis. The therapeutic effects of fisetin were then evaluated in an animal model of PD and validated through in vitro experiments. Additionally, we utilised single-cell and spatial transcriptomics technologies to identify key cell populations in PD and their spatial distribution.

RESULTS

The study demonstrated that fisetin significantly reduced alveolar bone destruction in the rat model of PD. Single-cell transcriptomics revealed that fisetin primarily affects fibroblast populations. In vitro experiments showed that fisetin alleviated the cytotoxicity caused by high oxidative stress levels in human periodontal ligament fibroblasts (PDLFs) .

CONCLUSION

Fisetin inhibits the progression of periodontitis by reducing oxidative stress levels in fibroblast populations. These findings support the potential of fisetin as a therapeutic agent for periodontitis and provide a scientific basis for future clinical trials and treatment strategies.

CLINICAL RELEVANCE

By significantly reducing alveolar bone destruction and modulating fibroblast function, fisetin presents a novel therapeutic strategy for managing periodontitis. These results provide a scientific foundation for the design of clinical trials aimed at evaluating the efficacy of fisetin in PD patients. If validated in clinical settings, fisetin could be incorporated into treatment regimens, offering a pharmacological option that complements conventional periodontal therapies, thereby improving patient outcomes and quality of life.

Return to the Pre-Injury Level of Sport after Anterior Cruciate Ligament Reconstruction

Returning to sport after anterior cruciate ligament reconstruction (ACLR) can be a challenging and complex process for the athlete, with the rate of return to the pre-injury level of sport observed to be less than athlete expectations. Of the athletes that do return to sport (RTS), knee re-injury rates remain high, and multiple studies have observed impaired athletic performance upon RTS after ACLR as well as reduced playing time, productivity, and career lengths. To mitigate re-injury and improve RTS outcomes, multiple RTS after ACLR consensus statements/clinical practice guidelines have recommended objective RTS testing criteria to be met prior to medical clearance for unrestricted sports participation. While the achievement of RTS testing criteria can improve RTS rates after ACLR, current criteria do not appear valid for predicting safe RTS. Therefore, there is a need to review the various factors related to the successful return to the pre-injury level of sport after ACLR, clarify the utility of objective performance testing and RTS criteria, further discuss safe RTS decision-making as well as present strategies to reduce the risk of ACL injury/re-injury upon RTS. This article provides a practical review of the current RTS after ACLR literature, as well as makes medical recommendations for rehabilitation and RTS decision-making after ACLR.

The Low Mini-Midvastus Approach for Minimally Invasive Total Knee Arthroplasty

The low mini-midvastus approach is a refinement of minimally invasive techniques in total knee arthroplasty (TKA). This technique involves making a precise muscle-splitting incision along the vastus medialis obliquus, retaining a 1-cm wide inferomedial cuff of the muscle belly, preserving the extensor mechanism while maintaining sufficient surgical exposure. We hypothesize that the low mini-midvastus approach minimizes postoperative pain, accelerates recovery, and enhances patient satisfaction by optimizing vastus medialis obliquus integrity. It is suitable for primary TKA and adaptable to challenging anatomical variations. In this study, we describe our surgical technique and experience with such an approach for conventional primary TKA that represents a refinement of the midvastus spectrum that prioritizes muscle preservation while maintaining adequate exposure.

Comparison of percutaneous endoscopic lumbar discectomy (PELD) and unilateral biportal endoscopic (UBE) discectomy in the treatment of far lateral lumbar disc herniation (FLLDH): a retrospective study

PURPOSE

This study aimed to compare the clinical efficacy of percutaneous endoscopic lumbar discectomy (PELD) and unilateral biportal endoscopic (UBE) discectomy in treating patients with far lateral lumbar disc herniation (FLLDH).

METHODS

From January 2020 to January 2022, 65 patients with FLLDH underwent either PELD or UBE discectomy. Among them, 35 were treated with PELD (25 males and 10 females, average age 35.3 ± 12.7), and 30 were treated with UBE (21 males and 9 females, average age 43.5 ± 9.2). Factors such as operation time, fluoroscopy frequency, length of hospitalization, in-bed time after operation, hospitalization cost, complications, visual analogue scale (VAS, 0-10), Oswestry Disability Index (ODI, 0-100%), and modified MacNab criteria were assessed and compared between the two groups.

RESULTS

The demographic data were well matched between the PELD group and UBE group, without significant differences (P > 0.05). After surgery, both surgical procedures achieved significant improvement in VAS and ODI scores (P < 0.05). Compared to the UBE group, the PELD group had lower VAS scores for low back pain on the first postoperative day (P < 0.05), but no significant differences were found in alleviating leg pain in patients postoperatively between these two surgical procedures (P > 0.05). The PELD group was superior to the UBE group, showing shorter hospital stay (P < 0.05). Conversely, the UBE group exhibited significantly longer operation time and higher hospitalization cost than the PELD group (P < 0.05).

CONCLUSIONS

Both PELD and UBE discectomy are safe and effective surgical procedures which can achieve satisfactory results in treating FLLDH. PELD causes less back pain in the immediate postoperative period. PELD offers advantages in rapid recovery, while UBE discectomy is a suitable option for patients with conditions such as high iliac crest, hypertrophy of the transverse process, or intolerance to pain under local anesthesia.

AI and machine learning in paediatric spine deformity surgery

Paediatric spine deformity surgery is a high-stakes procedure. It demands the surgeon to have exceptional anatomical knowledge and precise visuospatial awareness. There is increasing demand for precision medicine, which rapid advancements in computational technologies have made possible with the recent explosion of AI and machine learning (ML). We present the surgical and ethical applications of AI and ML in diagnosis, prognosis, image processing, and outcomes in the field of paediatric spine deformity.

Intra-articular metformin-curcumin cationic PLGA nanoparticles rejuvenate articular structure in MIA induced osteoarthritis model via modulating the crosstalk between miR93, TNFAIP3/TLR/NF-κB and AMPK/SIRT1 trajectories

Osteoarthritis (OA), a degenerative bone disease, restrains patient's productivity and quality of life. Herein, the potential of uncoated and hyaluronic acid (HA)-coated cationic - PLGA (cPL) nanoparticles loaded with metformin (MT) and curcumin (Cu) was investigated for IA administration for the first time. Optimized MT-Cu-cPL2 showed particle size 266.2 ± 2.35 nm, zeta potential +13.6 ± 0.6 mV; entrapment efficiency of 42.56 % ± 0.04 and 93.65 % ± 0.017 for MT and Cu, respectively. Optimized HA-MT-Cu-cPL4 displayed particle size 254.1 ± 3.96 nm, zeta potential -21.6 ± 0.4 mV; and entrapment efficiency of 71.4 % ± 1.06 and 93.2 % ± 0.93 for MT and Cu, respectively. HA-MT-Cu-cPL4 demonstrated a sustained release of MT and Cu over 24 h and stability over 3-months at 4 °C. The IA administration of MT-Cu-cPL2 and HA-MT-Cu-cPL4 to MIA-induced OA rats revealed their significant antiarthritic potential. Treatment with HA-MT-Cu-cPL4 showed the most significant repression of OA advancement due to enhancement of miR-93 and TNFAIP3 knee tissue expression levels that have been correlated to upregulation of AMPK/SIRT1 activity and downstream inhibition of TLR4/NF-κB signaling pathway. The optimized nano-formulations also exhibited anti-edematous, anti-nociceptive, and locomotor-enhancing activity, highlighting the IA MT-Cu combinational therapy as a prosperous approach for management of OA.

Complications of Platelet Rich Plasma Injection for Knee Osteoarthritis are Similar to Corticosteroids and Hyaluronic Acid, but are Significantly Greater than Placebo Injections: A Meta-Analysis of Randomized Controlled Trials

PURPOSE

The purpose of this review was to investigate complications of platelet rich plasma (PRP) injections for knee osteoarthritis (OA) compared to other injected substances including hyaluronic acid (HA), corticosteroids, and placebo saline.

METHODS

PubMed, Embase, Web of Science, and Cochrane databases were searched to identify randomized control trials (RCTs) comparing PRP to another injectable treatment for knee osteoarthritis with documented complications. Studies not mentioning complications or utilizing PRP during surgery were excluded. Complications were pooled to determine overall complication rate and the number needed to harm (NNH). Subgroup analyses were performed for studies comparing PRP to hyaluronic acid, corticosteroids, and placebo saline using DerSimonian-Laird random-effects models displaying odds ratios (OR).

RESULTS

Twenty-four RCTs were identified with 2751 total patients, 1318 of whom received PRP injections. There was a total of 246 complications in the PRP group and 131 in the comparison cohort (18.66% vs. 9.14%, respectively p < 0.01). The NNH was 11. Subgroup analysis showed no difference in odds of complications when PRP was compared to HA and corticosteroids (OR 1.33, p = 0.22 I2 = 0.0% and OR 3.07, p = 0.35, I2 = 63.49%, respectively), but significantly more complications compared to placebo (OR 4.88, p < 0.01, I2 = 0.00%). Only one patient reported severe pain; however all other complications were described as moderate or mild and self-limiting.

CONCLUSION

The use of PRP for knee OA is not innocuous with a significantly higher rate of complications compared to placebo. However, most complications were reported as mild to moderate, and the odds of complications are similar to that of HA or corticosteroid injections. Compared to all other injectables, the NNH for PRP is 11, which is important for physicians to consider prior to PRP therapy.

LEVEL OF EVIDENCE

Level II, meta-analysis of Level I and II RCTs.

Perioperative Leukocyte-Poor Platelet-Rich Plasma Associated with Reduced Risk of Retear After Arthroscopic Rotator Cuff Repairs: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

PURPOSE

To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) in the literature to ascertain the clinical efficacy of leukocyte-poor platelet-rich plasma (LP-PRP) in arthroscopic rotator cuff repair.

METHODS

A through literature search was performed from databases such as PubMed, SCOPUS, Embase, Cochrane Library, and Google Scholar using keywords. Eligible studies must be randomized controlled trials with Level I or II evidence, ≥80% follow-up rate, at least 12 months of follow-up, use of leukocyte-poor PRP in arthroscopic rotator cuff repair, and report of postoperative outcomes.

RESULTS

Our literature search yielded nine randomized-controlled trials consisting of 743 patients, with 380 patients receiving LP-PRP and 363 patients receiving a control or placebo. Postoperative outcomes analyzed were rotator cuff retear rates, VAS Pain Scores, ASES Scores, UCLA Scores, and Constant Scores. Retear rates were significantly lower in the LP-PRP treated group compared to controls (RR = 0.54; CI: [0.41, 0.71]; P < 0.00001), VAS Pain scores were significantly lower in the LP-PRP treated group compared to controls (MD = -0.12; CI: [-0.24, -0.01]; P < 0.04), ASES scores were significantly higher in the LP-PRP treated group compared to controls (MD = 1.88; CI: [0.46, 3.31]; P < 0.01), Constant scores were significantly higher in the LP-PRP treated group compared to controls (MD = 2.58; CI: [1.28, 3.89]; P < 0.0001), and UCLA scores were significantly higher in the LP-PRP treated group compared to controls (MD = 1.16; CI: [0.17, 2.16]; P < 0.02). Retear rates showed a relative risk reduction of about 46% in patients who received LP-PRP compared to controls, and while VAS Pain Scores, ASES Scores, Constant Scores, and UCLA Scores all were significantly improved, these clinical outcomes scores did not meet the minimal clinical important difference established within the literature.

CONCLUSION

Administration of LP-PRP is associated with significantly reduced post-operative retear rates at minimum 12 months follow up compared to a saline injection control group. However, its use did not demonstrate clinically meaningful effects on postoperative pain or patient-reported outcomes, highlighting its primary benefit as enhancing structural healing.

LEVEL OF EVIDENCE

Systematic Review and meta-analysis,of Level I and II Studies.

New-onset anxiety and depression after anterior cruciate ligament reconstruction: A national database study of incidence, risk-factors, and outcomes

BACKGROUND

Prior studies evaluating the mental-health burden of recovery from anterior cruciate ligament reconstruction (ACLR) have focused primarily on athletes. The purpose of this study is to evaluate rates of new-onset anxiety and depression (NOAD) after ACLR and identify risk factors in the broad population of ACLR patients.

METHODS

A retrospective review of the PearlDiver national database was performed. All patients included had no prior diagnosis of depression or anxiety prior to undergoing ACLR and had ≥1-year follow-up. The primary outcome was development of NOAD within 1-year postoperatively. Multivariate regression was used to assess predictors of NOAD; clinical outcomes were compared between patients with and without NOAD.

RESULTS

Of the 20,442 ACLR patients included, 1,284 (6.3%) were diagnosed with NOAD within 1-year postoperatively. Men (OR: 0.63, p < 0.001) and patients from the southern US (OR: 0.81, p = 0.007) had lower rates of NOAD. Conversely, older patients (OR: 1.02, p < 0.001), patients with alcohol disorders (OR: 2.19, p < 0.001), anemia (OR: 1.26, p = 0.008), headaches/migraines (OR: 1.60, p < 0.001), obesity (OR: 1.38; p < 0.001), sleep apnea (OR: 1.40, p < 0.001), tobacco use (OR: 2.15, p < 0.001), and preoperative opioid use (OR: 1.23, p = 0.001) had higher rates of NOAD. Postoperatively, patients with NOAD had higher rates of 90-day readmission (1.1% vs. 0.3%; p < 0.001), higher rates of opioid use at 1-year (30.7% vs. 20.4%; p < 0.001), and higher rates of additional knee surgery at 2-years (5.4% vs. 3.2%; p < 0.001).

CONCLUSION

The current study highlights risk factors for NOAD after ACLR that may be used to identify at-risk populations. The development of targeted multidisciplinary interventions may improve outcomes for these patients.

GALR1 and PENK serve as potential biomarkers in invasive non-functional pituitary neuroendocrine tumours

BACKGROUND

Some nonfunctioning pituitary neuroendocrine tumor (NFPitNET) can show invasive growth, which increases the difficulty of surgery and indicates a poor prognosis. However, the molecular mechanism related to invasiveness remains to be further studied. This study is to screen and identify the characteristic biomarkers of invasive NFPitNETs.

METHODS

Based on the data of 73 NFPitNETs microarray chips in the GSE169498 dataset, this study used weighted gene co-expression network (WGCNA), differential expression analysis, protein-protein interaction (PPI) network analysis and various machine learning methods (XGBOOST, LASSO regression, random forest, support vector machine) to screen candidate biomarkers for invasive NFPitNET. Then, using gene set enrichment analysis (GSEA) to explore the differences in biological activities and signaling pathways between invasive NFPitNET and non-invasive NFPitNET. Single-sample GSEA (ssGSEA) was used to analyze key biomarkers-related signaling pathways. Finally, the expression and function of the key biomarkers were verified by q-RT PCR, immunohistochemical (IHC) experiments and in vitro experiments.

RESULTS

Combined with WGCNA and differential expression analysis, 128 high-expression and 85 low-expression candidate biomarkers were preliminarily obtained. PPI analysis and four machine learning algorithms further identified GALR1, PENK and HOXD9. The receiver operating characteristic (ROC) curve results showed that the three biomarkers had good predictive ability of invasiveness. After combining the validation set data, GALR1 and PENK were the final key biomarkers. Finally, PCR and IHC results verified the decreased expression of GALR1 and PENK in invasive NFPitNET and promotes proliferation and invasive ablity of pituitary tumor cells.

CONCLUSION

This study confirmed that the reduced expression of GALR1 and PENK is an important molecular feature of invasive NFPitNETs, which may play an important role in inhibiting the development of NFPitNET.

Evidence-based evaluation for stroke guidelines mentioning traditional and complementary medicine rehabilitation

BACKGROUND

Traditional and complementary medicine (T&CM) is often sought as an significant alternative intervention in stroke prevention and rehabilitation, and is recommended in several guidelines. However, little is known about the quality and consistency of T&CM rehabilitation recommendations for stroke in the guidelines.

METHODS

We systematically searched PubMed, Embase, CNKI, WOS, CBM, Duxiu, Wanfang, VIP, GIN, NICE, NGC, SIGN, BGS, NCCN, WHO guidelines, Google Scholar, MedSci, and Medilive from January 1990 to April 2024 for stroke rehabilitation guidelines that include T&CM recommendations. Our search strategy used search terms related to stroke, complementary and alternative therapy, and CPGs. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument to evaluate the quality of the included guidelines. We summarized and analyzed the T&CM post-stroke rehabilitation recommendations.

RESULTS

Nineteen guidelines were included, of which nine were recommended for use according to the AGREE II scores. The highest scores were achieved in the domains of clarity of scope and purpose (90.50% ± 9.99%), while the lowest scores were achieved for applicability (45.56% ± 26.37%). Guidelines commonly recommended acupuncture to improve post-stroke spasticity and dysphagia. However, guidelines recommended against the addition of acupuncture to improve activities of daily living. Additionally, there was still controversy regarding the improvement of upper extremity motor function with acupuncture and specific recommendations for post-stroke cognitive impairment were scarce.

CONCLUSIONS

The quality of stroke rehabilitation guidelines is acceptable, though improvements are needed in some domains, particularly applicability. The recommended guidelines show a high degree of agreement in recommending acupuncture to improve dysphagia after stroke, but recommendations in the areas of upper extremity motor dysfunction and cognitive impairment after stroke need to be further addressed. However, the strength of these recommendations is typically conditional and the level of evidence still needs to be further improved.

Electroacupuncture ameliorates cartilage damage in a rat model of knee osteoarthritis and regulates expression of miRNAs and the TLR4/NF-κB pathway

BACKGROUND

Electroacupuncture (EA) has been shown to be effective in the treatment of knee osteoarthritis (KOA); however, its underlying mechanism remains unclear.

METHODS

40 KOA model rats were divided into control, untreated model, EA-treated model and celecoxib-treated model groups (n=10 each). Articular cartilage of the knee joint was stained with hematoxylin and eosin (HE), periodic acid-Schiff (PAS) and Alcian blue (AB)-PAS, and Moran/Mankin scores were used to evaluate articular cartilage injury across groups. Moreover, toll-like receptor (TLR)4/nuclear factor (NF)-κB pathway (TN-P)-related protein levels in the articular cartilage were detected using Western blotting. Oxidative stress and inflammatory biomarkers in the synovial fluid were measured by enzyme-linked immunosorbent assay (ELISA). MicroRNA (miRNA/miR) expression was measured by quantitative real-time polymerase chain reaction (qRT-PCR).

RESULTS

Compared with the control group, Moran scores increased and Mankin scores decreased in the KOA model rats. In addition, compared with those in the control group, levels of superoxide dismutase (SOD), glutathione peroxidase (GSHPx) and interleukin (IL)-10 were significantly decreased, while levels of IL-1β, IL-6, tumor necrosis factor (TNF)-α, malondialdehyde (MDA) and nitric oxide (NO) were significantly increased, in the synovial fluid of the KOA model group. Protein levels of TLR4, anti-myeloid differentiation primary response protein 88 (MyD88) and p65 NF-κB phosphorylation were significantly increased in the articular cartilage of the KOA model group. EA and celecoxib treatment reversed the trends of these protein levels. Moreover, expression of miR-15a/127/140/146a/216a-5p and miR-27a-3p in the articular cartilage were markedly increased in KOA rats, while EA and celecoxib treatment reduced their expression.

CONCLUSIONS

EA reduces inflammation, oxidative stress and cartilage damage in KOA model rats, likely through regulation of the miRNA/TLR4/NF-κB pathway.

NuanXin Formula inhibits bone resorption to combat osteoporosis by attenuating osteoclast oxidative phosphorylation

ETHNOPHARMACOLOGICAL RELEVANCE

Osteoporosis is a chronic metabolic bone disorder characterized by excessive bone resorption. The NuanXin Formula (NX) is a classical traditional Chinese medicine formula that can warm and tonify kidney Yang, as well as replenish Qi and blood, which are essential for maintaining bone health and regulating bone metabolism. Nevertheless, the functions and mechanisms of NX in osteoporosis therapy remain unclear.

AIM OF THE STUDY

This study aims to evaluate the effects and mechanisms of NX on osteoclastogenesis and to investigate its potential in combating osteoporosis.

MATERIALS AND METHODS

The inhibitory effects of NX on RANKL-induced osteoclastogenesis were evaluated using Western blotting, quantitative PCR (Q-PCR), TRAP staining, and pit-formation assays. Bone mass and structure were assessed through micro-CT, biomechanical testing, TRAP staining, and H&E staining. The mechanism of action of NX on osteoclasts was investigated using RNA sequencing, ROS staining, ATP measurement, and mitochondrial membrane potential assays.

RESULTS

The in vitro findings demonstrated that NX treatment significantly inhibited osteoclast differentiation and bone resorption activity. Q-PCR and WB analyses indicated that NX substantially downregulates the expression levels of key osteoclast markers, including Nfatc1, Ctsk, Mmp9, and Trap. In vivo experiments revealed that intragastric administration of NX effectively suppressed bone loss and bone resorption, while enhancing the biomechanical properties of bone in ovariectomized (OVX) mice. Mechanistically, NX inhibits oxidative phosphorylation (OXPHOS), decreases mitochondrial membrane potential, and reduces ATP production and reactive oxygen species generation, thereby impeding osteoclast differentiation and activity.

CONCLUSION

NX mitigates osteoporosis by modulating OXPHOS to inhibit osteoclast differentiation and activity, thus offering a potential therapeutic approach for osteoporosis management. However, the study has limitations that require further investigation. NX did not show a clear dose-dependent effect in animal tests, suggesting a need for improved dosing designs. Although we emphasize NX's therapeutic potential, more research is necessary to clarify its mechanism. Variability in plant materials and ingredient ratios might influence NX's pharmacological effects, with specific bioactive components potentially playing a major role. Future research should integrate network pharmacology with experimental validation for a more thorough understanding.

Metformin exhibits inhibitory effects on ferroptosis and alleviates chondrocyte metabolic imbalance in osteoarthritis models, as well as Erastin-induced ferroptosis, through the modulation of the P53/SLC7A11 pathway

Osteoarthritis (OA) is a prevalent degenerative disease, and metformin, the first-line treatment for type 2 diabetes, has shown potential in slowing the progression of OA, although its mechanism of action is not fully understood. This study aims to explore the role of ferroptosis in OA and evaluate the therapeutic effects and mechanisms of metformin on ferroptosis. We identified gene differences associated with OA through RNA-Seq data analysis and predicted potential targets using network pharmacology and molecular docking techniques. In vivo experimental methods, including histological examination, immunofluorescence, Western blotting, real-time quantitative PCR, biochemical analysis, and ELISA, were used to study the effects of metformin in the modified Hulth method and Erastin-induced OA models. The study found that metformin significantly inhibits chondrocyte ferroptosis by upregulating SLC7A11 and downregulating P53 expression, maintaining the balance of synthesis and catabolism in chondrocytes, and effectively slowing down the degeneration of knee joint cartilage in rats. Overall, this study not only provides further evidence for the anti-OA effects of metformin but also identifies its direct targets in the inhibition of ferroptosis in OA.

Comprehensive analysis of knee cysts: diagnosis and treatment

Knee cysts are a common finding in orthopedic practice, with diagnoses that range from benign fluid collections to more complex lesions requiring intervention. This comprehensive review explores the types of cysts around the knee, including popliteal (Baker's) cysts, meniscal cysts, proximal tibiofibular joint cysts, and ganglion cysts within the cruciate ligaments. The review highlights the mechanisms of formation, clinical presentations, diagnostic methods, differential diagnoses, and treatments for each cyst type. Imaging, particularly MRI, plays a critical role in accurate diagnosis, helping differentiate cysts from other pathologies, such as tumors and vascular lesions. Treatment options vary, from conservative management for asymptomatic cases to surgical interventions, such as arthroscopic cyst removal, for symptomatic cysts or those associated with intra-articular pathologies. Emerging biological treatments, including platelet-rich plasma (PRP) and mesenchymal stem cell (MSC) therapies, show promise for addressing underlying joint degeneration and inflammation associated with certain cysts, particularly those linked to osteoarthritis. This review underscores the importance of tailored, evidence-based approaches in managing knee cysts to optimize patient outcomes. Keywords: Knee Cysts, Popliteal Cyst, Meniscal Cyst, Proximal Tibiofibular Joint Cyst, Joint Pathology.

Perspectives for using platelet-rich plasma in the treatment of knee osteoarthritis: Can it be improved through modifications of the protocol?

PURPOSE

Autologous platelet-rich plasma (PRP) injections are widely used in regenerative medicine, including the knee osteoarthritis (OA) therapy. This study reviews methods to enhance PRP therapy for knee OA, aiming to boost articular cartilage recovery.

METHODS

The search was conducted in the eLIBRARY, PubMed (MEDLINE), Ovid, ScienceDirect, and Google Scholar databases extracting publications available by the end of 2023. Studies were included if they simultaneously met the following criteria: (1) effect of using PRP in the recovery of hyaline cartilage damage after OA; (2) at least one way to modify the PRP protocol aimed to increase its efficiency; (3) data on the molecular mechanisms underlying the increase in efficiency of the modified PRP therapy in OA.

RESULTS

The findings of this study highlight the significant role that the composition and modification of PRP protocols play in enhancing chondrogenesis for cartilage repair. Beyond the activation or non-activation of platelets or the inclusion or removal of leukocytes, which are factors that could somehow affect the effectiveness of PRP formulations, the elimination of growth factors such as VEGF and EGF, which negatively influence cartilage regeneration, offers a promising approach to optimize PRP therapy. While growth factors like TGF-β3, PDGF, and IGF have been shown to promote chondrogenesis, the removal of detrimental factors that could contribute to chronic inflammation or OA progression could significantly improve treatment outcomes. Practices such as combining with hyaluronic acid, pre-injection PRP activation, and multiple administrations are clinically common, while other methods like adjusting growth factors concentration are still in development.

CONCLUSION

Various modifications of this technology allow to use molecular mechanisms involved in the restoration of hyaline cartilage and improve the effectiveness of PRP for the treatment of OA. However, significant challenges remain in standardizing PRP preparation and administration protocols. Variability in platelet concentration, growth factor composition, and activation methods complicate the assessment of efficacy and reproducibility.

Novel target identification towards drug repurposing based on biological activity profiles

Rare diseases affect more than 30 million individuals, with the majority facing limited treatment options, elevating the urgency to innovative therapeutic solutions. Addressing these medical challenges necessitates an exploration of novel treatment modalities. Among these, drug repurposing emerges as a promising avenue, offering both potential and risk mitigation. To achieve this goal, we primarily focused on developing predictive models that harness cutting-edge computational techniques to uncover latent relationships between gene targets and chemical compounds towards drug repurposing. Building upon our previous investigation, where we successfully identified gene targets for compounds from the Tox21 in vitro assays, our endeavor expanded to a systematic prediction of potential targets for drug repurposing employing machine learning models built on diverse algorithms such as Support Vector Classifier, K-Nearest Neighbors, Random Forest, and Extreme Gradient Boosting. These models were trained on comprehensive biological activity profile data to predict the relationship between 143 gene targets and over 6000 compounds. Our models demonstrated high accuracy (>0.75), with predictions further validated by using public experimental datasets. Furthermore, several findings were evaluated via case studies. By elucidating these connections, we aim to streamline the drug repurposing process, ultimately catalyzing the discovery of more effective therapeutic interventions for rare diseases.

Luteolin: A potential therapeutic agent for respiratory diseases

Acute lung injury, COVID-19, lung cancer, and asthma are a few of the respiratory conditions that are the main causes of morbidity and mortality worldwide. The increasing incidence and mortality rates have attracted significant attention to the prevention and treatment of these conditions. In recent years, there has been a renewed interest in utilizing naturally derived compounds as therapeutic agents for respiratory diseases. Luteolin (Lut), a flavonoid compound, possesses an extensive range of pharmacological characteristics, encompassing anti-inflammatory, antioxidative, antineoplastic, and antimicrobial activities. However, a comprehensive summary of Lut's therapeutic effects and mechanisms in respiratory diseases remains lacking. This review examines the physicochemical properties, toxicity, and avenues of Lut's action in respiratory ailments. Lut exerts therapeutic effects through pathways such as nuclear factor kappa-B (NF-κB), nuclear factor erythroid 2-related factor 2 (Nrf2), mitogen-activated protein kinase (MAPK), janus kinase 1 (JAK1)/signal transducer and activator of transcription 3 (STAT3), phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT), and pyroptosis, modulating key processes such as the suppression of inflammatory mediators, attenuation of oxidative assault, and induction of apoptosis in lung cancer cells. This review strives to provide critical realizations into respiratory disease therapeutics and contribute to the foundation for drug development.

Surgical Antibiotic Prophylaxis Dosing in Adult Patients with Obesity: A Comprehensive Review of Pharmacokinetic and Pharmacodynamic Data

Surgical antibiotic prophylaxis is an important measure to prevent postoperative surgical site infections. Current guideline recommendations do not treat obesity specifically, although it can affect pharmacokinetics and pharmacodynamics. The objective of this review was to synthesize current evidence on the need for obesity-related dosing adjustments in surgical antibiotic prophylaxis. MEDLINE and Cochrane Library were searched for studies investigating antibiotic prophylaxis dosing in surgical patients with obesity. Outcomes of interest were pharmacokinetic parameters such as plasma and interstitial fluid concentrations, area under the concentration time curve in plasma and in interstitial fluid, and other pharmacokinetic measures. Thirty studies investigating cefazolin, cefoxitin, cefuroxime, piperacillin/tazobactam, meropenem, ertapenem, metronidazole, vancomycin, ciprofloxacin, and gentamicin were included in this analysis. Except for metronidazole, cefoxitin, and gentamicin, there is currently no evidence suggesting the need for dosing adjustments.

The Effect of Platelet-Rich Plasma on Synovial Fibrosis and Cartilage Degeneration in Knee Osteoarthritis

BACKGROUND

Synovial fibrosis is a prevalent pathological feature of osteoarthritis and a primary contributor to joint pain and stiffness. Studies indicate that platelet-rich plasma (PRP) is rich in growth factors and cytokines, exhibiting anti-inflammatory, anti-apoptotic, chemotactic, and proliferative properties that can facilitate tissue repair. However, little is known about its effect on synovial fibrosis in knee osteoarthritis (KOA).

PURPOSE

To determine the effect of PRP on synovial fibrosis and cartilage degeneration in KOA.

STUDY DESIGN

Controlled laboratory study.

METHOD

Anterior cruciate ligament transection was performed to induce KOA in male Sprague-Dawley rats, and then rats were randomly assigned to 4 different groups: sham operation, KOA only, KOA treated with phosphate-buffered saline (PBS), and KOA treated with PRP. Synovial collagen fiber deposition was observed using Masson and Sirius red staining, and synovial inflammation was assessed using hematoxylin and eosin (H&E) staining. Moreover, immunohistochemistry was conducted to analyze the expression of synovial fibrosis-related factors including PLOD2, COL1A1, TIMP1, TGF-β1, and α-SMA. KOA severity and articular cartilage degradation were assessed using micro-computed tomography (micro-CT), safranin O-fast green staining, H&E staining, immunohistochemistry, and the Osteoarthritis Research Society International (OARSI) criteria. A quantitative analysis of growth factors (platelet-derived growth factor, IGF-1, epidermal growth factor, TGF-β1, fibroblast growth factor, and endothelial growth factor) in activated PRP was performed using enzyme-linked immunosorbent assay.

RESULTS

Micro-CT imaging and histological staining showed that the KOA model had been successfully established. Compared with the KOA and PBS groups, Masson staining and Sirius red staining results showed that PRP aggravated the degree of synovial fibrosis, which was consistent with the results of immunohistochemistry analysis. Immunohistochemistry analysis showed that PRP promoted the protein expression of PLOD2, COL1A1, TIMP1, TGF-β1, and α-SMA, indicating that the degree of fibrosis was aggravated. However, the PRP group showed lower OARSI and synovitis scores, as well as attenuated abnormal tibial subchondral bone remodeling, suggesting that PRP inhibited further cartilage degeneration and synovial inflammation and improved the subchondral bone microarchitecture.

CONCLUSION

PRP may aggravate KOA synovial fibrosis, but it still has an inhibitory effect on cartilage degeneration and abnormal subchondral bone remodeling.

CLINICAL RELEVANCE

Synovial fibrosis is a significant pathological feature in KOA that is closely linked to clinical symptoms like joint pain and stiffness. This study offers insights into enhancing the effectiveness of PRP therapy for patients with KOA.

Pyroptosis: A spoiler of peaceful coexistence between cells in degenerative bone and joint diseases

BACKGROUND

As people age, degenerative bone and joint diseases (DBJDs) become more prevalent. When middle-aged and elderly people are diagnosed with one or more disorders such as osteoporosis (OP), osteoarthritis (OA), and intervertebral disc degeneration (IVDD), it often signals the onset of prolonged pain and reduced functionality. Chronic inflammation has been identified as the underlying cause of various degenerative diseases, including DBJDs. Recently, excessive activation of pyroptosis, a form of programed cell death (PCD) mediated by inflammasomes, has emerged as a primary driver of harmful chronic inflammation. Consequently, pyroptosis has become a potential target for preventing and treating DBJDs.

AIM OF REVIEW

This review explored the physiological and pathological roles of the pyroptosis pathway in bone and joint development and its relation to DBJDs. Meanwhile, it elaborated the molecular mechanisms of pyroptosis within individual cell types in the bone marrow and joints, as well as the interplay among different cell types in the context of DBJDs. Furthermore, this review presented the latest compelling evidence supporting the idea of regulating the pyroptosis pathway for DBJDs treatment, and discussed the potential, limitations, and challenges of various therapeutic strategies involving pyroptosis regulation.

KEY SCIENTIFIC CONCEPTS OF REVIEW

In summary, an interesting identity for the unregulated pyroptosis pathway in the context of DBJDs was proposed in this review, which was undertaken as a spoiler of peaceful coexistence between cells in a degenerative environment. Over the extended course of DBJDs, pyroptosis pathway perpetuated its activity through crosstalk among pyroptosis cascades in different cell types, thus exacerbating the inflammatory environment throughout the entire bone marrow and joint degeneration environment. Correspondingly, pyroptosis regulation therapy emerged as a promising option for clinical treatment of DBJDs.

Decoding human leukocyte antigen Beta-27; its active alleles in Ankylosing Spondylitis and computational insights of potential inhibitors: HLA-B27 in AS; its variants and inhibitors

OBJECTIVES

This study aimed to determine the diverse inborn and adventitious variables that contribute to the rise of Ankylosing Spondylitis (AS) and to elucidate the genotypic study of HLA-B*27 alleles along with sub-alleles and in-silico inhibition of their respective abnormal receptor proteins by natural compounds.

METHODS

Case-control study was piloted. Allele-specific DNA-based HLA typing was performed after DNA extraction. Patient questionnaires and Molecular docking was applied to identify AS prognosis and potential HLA-B*27 inhibitors respectively.

RESULTS

Results revealed a 72.72% prevalence of HLA-B*27 alleles in patients versus 9.09% in controls. Sub-alleles HLA-B*27:02, 04, and 05 were identified in 87.5% of patients but were absent in controls. The chi-square (χ2) values for HLA-B*27 alleles and sub-alleles were significant, with p-values of 0.0024 and 0.0220, respectively. The study found no significant association of AS with gender, age, marital status, or environmental factors, but a strong association with family history of back pain, elevated CRP, ESR, body inflammation, and uveitis. In silico analysis identified Rutin, curcumin, and coumaroylquinic acid as natural compounds with the highest binding affinity to HLA-B27 chains A and F, suggesting their probability to modulate the structure and function of HLA-B27 proteins.

CONCLUSIONS

AS is more prevalent in individuals with family history of backache, uveitis and elevated inflammatory markers, Sub-alleles of HLA-B*27 should be used as diagnostic tools alongside alleles, as they were found only in patients, not in healthy individuals. Furthermore, Rutin, curcumin, and coumaroylquinic acid may temper the function of HLA associated with AS.

No significant difference in skin contamination during anterior cruciate ligament reconstruction with and without preoperative skin cleaning

PURPOSE

This prospective study aimed to assess whether preoperative antiseptic skin cleansing reduces bacterial contamination and surgical site infections (SSI) following anterior cruciate ligament reconstruction (ACLR). We hypothesized that antiseptic cleaning would lower bacterial load, reducing contamination and early infections.

METHODS

One hundred and nineteen patients scheduled for ACLR were included in this prospective, nonrandomized study. Individuals were divided into two groups. Patients in the intervention group applied octenisan® wash lotion daily for three days before surgery and used the wash solution instead of their usual shower gel. Additionally, they swiped their leg with octenisan® soaked gloves on the morning of the operation. The control group followed their usual wash routine with no specific instructions. Fluid samples were taken before surgery from the irrigation bag and at 15-min intervals from the reservoir of the sterile surgical drape during the procedure. Suture material used for the ACL graft and meniscus repair were also collected for testing. The samples were subjected to a 14-day incubation period. Follow-up included outpatient visits at 6 weeks, 12 weeks and 6 months with a final evaluation at 12 months.

RESULTS

Contamination rates showed no significant difference between the control and intervention groups. The mean contamination rate in the control group was 6.4% (n = 22) and 6.6% (n = 24) in the intervention group (p = 0.28). At 12-month follow-up, 110 out of 119 participants were included (52 control, 58 intervention). T tests for age (p = 0.19), BMI (p = 0.66), and surgery duration (p = 0.38) showed no significant differences. No early SSI were observed in either group postoperatively.

CONCLUSION

Our results indicate that the use of antiseptic wash lotion and gloves does not influence the risk of bacterial contamination during surgery.

LEVEL OF EVIDENCE

Level III.

Integrating Serum Pharmacochemistry With Network Pharmacology to Elucidate the Mechanism of Wushen Decoction in the Prevention and Treatment of Lower Extremity Erysipelas

Lower extremity erysipelas (LEE), a frequently seen skin and soft tissue infection caused predominantly by streptococci, usually presents with fever, erythema and pain. Wushen Decoction (WSD), a Compound traditional Chinese medicine, has been used historically to treat LEE, though its exact mechanism of action remains unclear. In this study, we explored the therapeutic mechanisms of WSD in treating LEE by employing a combination of serum pharmacochemistry, network pharmacology, and molecular docking techniques. Initially, using UPLC-Q-Exactive Orbitrap-MS/MS, 39 candidate active compounds in the serum of rats treated with WSD were identified. Subsequently, network pharmacology analysis identified 35 overlapping targets between LEE and the active components, and 23 related signaling pathways. Further analysis and molecular docking studies have confirmed that the key active components (rutin, hyperoside and luteoloside) possess potential for effective therapeutic effects with the core targets (PTGS 2 and TNF). Furthermore, in vitro experiments demonstrated that WSD significantly downregulated the expression of PTGS 2 and TNF, thereby validating the network pharmacology findings and providing insights into the potential mechanisms. Results suggested that WSD may exert its therapeutic effects on LEE by modulating the TNF and NF-kappa B signaling pathway, offering a promising approach for the prevention and treatment of LEE.

Assessment of the Rotator Cuff Muscles: State-of-the-Art MRI and Clinical Implications

Rotator cuff (RC) tears are a common cause of shoulder pain and, depending on the tear pattern, can substantially limit daily activities and affect quality of life. After a tendon tear, the RC muscle undergoes degenerative changes, including fatty degeneration and volume atrophy. The extent of fatty muscle degeneration has been associated with poorer functional and surgical outcomes after RC reconstruction, and the evaluation of the RC muscles is one of the most important factors for deciding whether to perform an RC repair. A variety of qualitative and quantitative methods are available to assess RC fatty muscle degeneration and volume atrophy based on MRI. This review provides a detailed overview of the RC muscle assessment, including qualitative measurements to assess the RC muscles, such as Goutallier grading, tangent sign, and fish backbone sign. Another focus is state-of-the-art quantitative MRI techniques, including chemical shift-based techniques such as single-voxel MR spectroscopy, multipoint water-fat separation, and MR relaxometry. Furthermore, the clinical relevance of qualitative and quantitative intramuscular fat assessment is addressed, and its potential importance for treatment planning and patient outcomes is discussed.

Can MRI predict return to sport after anterior cruciate ligament reconstruction? A systematic review of the literature

PURPOSE

To analyze whether magnetic resonance imaging (MRI) can predict return to sport after anterior cruciate ligament (ACL) reconstruction and whether a correlation exists between return to sports, level of activity and MRI signals.

METHODS

The search terms selected for inclusion in the title, abstract, and keyword fields were as follows: 'anterior cruciate ligament' OR 'ACL' AND 'graft maturation' OR 'MRI' AND 'return to sport' OR 'sports activity.' For each study, patient data and the MRI protocol used to assess graft maturation were extracted. An analysis of the correlations between MRI and ACL reconstruction was performed.

RESULTS

A total of 394 patients were included from 7 studies. The mean radiological follow-up was 19.06 ± 11.02 months. Three studies reported no correlations between graft bending angle, signal/noise ratio, signal intensity or Howell score and return to sport. One study revealed that T2* was correlated with return to sport. A further investigation demonstrated that those who were able to regain their preinjury athletic performance exhibited considerably lower ACL/PCL ratio and ACL/muscle ratio of the ACL mid-substance compared to those who were unable to attain the same level of athletic performance. Only one study reported correlations between 12-month SNRs and 60-month Cincinnati, Lysholm and Tegner activity scales, whereas Biercevicz revealed that the combination of volume and the SI predicted the KOOS score at the 5-year follow-up.

CONCLUSIONS

There are no reliable radiological parameters available that correlate with return to sport after anterior cruciate ligament reconstruction, but MRI can potentially play a key role in closing this gap.

LEVEL OF EVIDENCE

Systematic review of level IV.

STUDY REGISTRATION

PROSPERO-CRD42024574365.

Efficacy and safety of moxibustion for knee osteoarthritis: A systematic review and meta-analysis

BACKGROUND AND PURPOSE

Although several reviews have examined moxibustion for knee osteoarthritis (KOA), they have some methodological limitations. This systematic review aims to synthesize current evidence on various moxibustion interventions for KOA pain relief.

METHODS

We conducted a comprehensive search across seven databases up to June 2024. The Cochrane risk of bias tool (ROB2) was used to assess the risk of bias, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criterion approach was employed to evaluate the certainty of evidence for primary outcomes. Primary outcomes included Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), stiffness, physical function, and total effective rate. Secondary outcomes encompassed adverse events (AEs) and treatment regimen of moxibustion for KOA. Meta-analysis was performed using STATA 17.0 and RevMan 5.4.1.

RESULTS

A total of 43 studies with 4008 participants were included in this review. Moxibustion significantly reduced WOMAC (-0.91, 95 % CI: -1.12, -0.70) and VAS scores (-0.95, 95 % CI: -1.18, -0.73). Electronic moxibustion was the most effective intervention. Treatment frequencies exceeding three times per week were more effective than fewer sessions. The total effective rate was 93.11 % for the moxibustion group versus 76.41 % for the controls. AEs were reported in sixteen studies, with one serious AE.

CONCLUSION

Moxibustion is more effective for pain relief than other treatments and has a lower incidence of AEs. Further high-level evidence is warranted to validate these findings.

Dietary essential oil components: A systematic review of preclinical studies on the management of gastrointestinal diseases

BACKGROUND

The gut is responsible for the digestion and absorption of nutrients, immune regulation, and barrier function. However, factors like poor diet, stress, and infection, can disrupt the balance of the gut microbiota and lead to intestinal inflammation and dysfunction.

PURPOSE

This systematic review aims to evaluate the effects of dietary plants-derived essential oil components on gut health and intestinal functions in animal models.

METHODS

The literature was gathered from the Scopus, Web of Science, PubMed, and Embase databases by using related search terms, such as "dietary plants", "dietary sources", "essential oils", "gut health", "intestine", "anti-inflammatory", "antioxidant", and "gut microbiota".

RESULTS

The results indicate that plant-derived dietary essential oil components, such as butyrolactone-I, carvacrol, cinnamaldehyde, citral, D-limonene, eugenol, farnesol, geraniol, indole, nerolidol, oleic acid, thymol, trans-anethole, vanillin, α-bisabolol, α-linolenic acid, α-pinene, α-terpineol, β-carotene, β-caryophyllene, and β-myrcene have been found to regulate gut health by influencing vital signalling pathways associated with inflammation. Dietary essential oil components modulate the expression of tumor necrosis factor alpha, interleukin 1 beta (IL-1β), interleukin (IL)-6, IL-10, inducible nitric oxide synthase, cyclooxygenase-2, toll-like receptor-4, matrix metalloproteinase, and interferon gamma in mitigating gut inflammation. The primary signalling molecules controlled by these molecules were AMP-activated protein kinase (AMPK), protein kinase B, extracellular signal-regulated kinase, c-Jun N-terminal kinase, mitogen-activated protein kinase, myeloid differentiation primary response 88, nuclear factor erythroid-2-related factor-2, and phosphoinositide 3-kinase (PI3K). Moreover, these phytochemicals have been shown to improve glucose homeostasis by regulating glucose transporter 4, glucagon-like peptide-1, peroxisome proliferator-activated receptor gamma, nuclear factor kappa B, AMPK, PI3K, and uncoupling protein-1. They can also reduce thiobarbituric acid reactive substance, malondialdehyde, and oxidative stress and enhance superoxide dismutase, catalase, and glutathione peroxidase levels.

CONCLUSION

In conclusion, dietary plants-derived essential oil components have the potential to mitigate inflammation and oxidative stress in the gut. However, additional clinical investigations are necessary to confirm their complete potential in improving human gut health functions.

Systemic administration of polyphenols from dealcoholized red wine reduces inflammation and bone resorption in established apical periodontitis in male rats

OBJECTIVE

To analyze the effect of supplementation with dealcoholized red wine on the severity of apical periodontitis after it had been established.

DESIGN

Thirty-two male Wistar rats were arranged into four groups: water as control, dealcoholized red wine, red wine, and alcohol. Apical periodontitis was induced by pulp exposure for 30 days when supplementation started and continued daily for 30 days. After the supplementation period, the rats were euthanized, and maxillae and jaws were removed to evaluate the inflammatory response and the bone resorption through microtomographic, histological and immunohistochemical analysis. Statistical tests were applied at 5 % significance.

RESULTS

The dealcoholized red wine group demonstrated a significant reduction in bone resorption volume and increase in bone volume fraction and trabecular parameters (p < 0.05). The dealcoholized red wine and red wine groups exhibited mild inflammation compared to the control and alcohol groups that showed moderate and severe inflammation respectively (p < 0.05). The immunoreaction was significantly lower in the dealcoholized red wine group than in the control and alcohol groups for the TNF-α, IL-1β and TRAP cells (p < 0.05). Furthermore, OPG in dealcoholized red wine was similar to red wine and control but higher than in the alcohol group (p < 0.05).

CONCLUSION

Supplementation with dealcoholized red wine in rats decreased inflammation and bone loss in established apical periodontitis. This study highlights the potential of systemic administration of polyphenols from red wine in decreasing inflammation and bone resorption of established apical periodontitis in rats.

Effect of neuromuscular control on the shoulder function of patients with healed rotator cuff and those with retear after arthroscopic rotator cuff repair

PURPOSE

To compare functional outcomes such as muscle strength, neuromuscular control and patient-reported outcomes (PROs) between patients with healed rotator cuffs and those with retears after arthroscopic rotator cuff repair (RCR).

METHODS

One hundred and nine patients who underwent arthroscopic RCR were included (85 in the healed group, 24 in the retear group). Shoulder muscle strength and neuromuscular control index (acceleration time [AT]) were evaluated using an isokinetic device. PROs were assessed using the pain visual analogue scale (VAS), Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) and University of California at Los Angeles (UCLA) scores. Continuous variables were compared using independent t tests. Multiple linear regression analysis was used to identify the influence of the predictor variables on the dependent variable.

RESULTS

The muscle strength and ATs for external rotators (ERs), internal rotators (IRs) and forward flexors as well as PROs including VAS, SST and ASES scores, were not significantly different between the two groups pre- and postoperatively (n.s.). Multiple linear regression analysis revealed that postoperative ATs for the IRs (p = 0.006) and ERs (p = 0.028) in the operated shoulders were closely associated with the postoperative UCLA score.

CONCLUSIONS

Compared with the healed group after arthroscopic RCR, the retear group had no clinically relevant differences in muscle strength, ATs and PROs, including VAS, SST, ASES and UCLA scores. However, postoperative ATs for IRs and ERs in the operated shoulders were a significant predictor of postoperative UCLA scores. Therefore, clinicians and therapists need to be aware of the importance of neuromuscular control in patients who have undergone arthroscopic RCR and prioritize therapeutic exercises to restore neuromuscular control.

LEVEL OF EVIDENCE

Level III.

Effects of obesity on function, pain, and complications after rotator cuff repair: An updated systematic review and meta-analysis

This meta-analysis aimed to determine the impact of obesity on function, pain, complication and patient-reported outcome measure following rotator cuff repair. This meta-analysis compares patients with obesity and without obesity undergoing rotator cuff repair surgery in terms of effectiveness, safety, and patient-reported measures. Four major databases were searched. Odds ratios, mean differences, and standard mean differences with 95 % confidence intervals (CIs) were calculated. The meta-analysis was performed using Review Manager version 5.4. Sixteen studies (n = 139,638 patients) were included. At the final follow-up, patients with obesity had significantly higher visual analogue scale (VAS) pain (SMD 0.16, 95 % CI 0.03-0.29). Patients with obesity had lower American Shoulder and Elbow Surgeons Shoulder Score (ASES) scores (MD -4.70, 95 % CI -7.57 to -1.82). No differences were observed in range of motion (ROM). Patients with obesity had a higher overall complication risk (OR 1.64, 95 % CI 1.38-1.95; I2 = 19 %) driven by obesity (OR 1.66, 95 % CI 1.29-2.13) and severely subgroups with obesity (OR 1.84, 95 %CI 1.43-2.37). Patients with obesity had significantly higher risks of thrombosis, myocardial infarction, cardiac arrest and renal complications. They also showed significantly higher reoperation (OR 1.31, 95 % CI 1.21-1.43) and readmission rates (OR 1.37, 95 % CI 1.31-1.44). Obesity is associated with worse pain and function and higher complication rates after rotator cuff repair. These findings have implications for perioperative counseling and management in this population.

Curculigoside is a Promising Osteoprotective Agent for Osteoporosis: Review

The prevention and treatment of osteoporosis (OP) is one of the major issues in coping with the aging population; however, there are limited treatments available for OP. In-depth study of OP pathogenesis and development of new therapeutic strategies has become an urgent medical need facing the aging society. Curculigoside is a natural product widely found in plants, which can modulate cellular differentiation and function in osteogenic cells and exert significant osteoprotective effects. In addition, curculigoside showed significant positive effects on the treatment of OP animal models. Specific mechanisms include inhibition of inflammatory responses, antagonism of oxidative stress, and modulation of various signaling. Therefore, we hypothesized that curculigoside could represent a novel therapeutic strategy for OP. This article reviews recent research advances in the treatment of OP with curculigoside, including the origin and basic characteristics of curculigoside, the mechanisms and therapeutic effects that may be involved in in vitro as well as in vivo studies. We also examine the pharmacokinetics of curculigoside and investigate modified uses that may augment its therapeutic efficacy. This article seeks to encourage additional investigation into curculigoside-based treatments for osteoporosis.

Perceptions, expectations and experiences of recovery before and after anterior cruciate ligament reconstruction: the patient voice - a protocol for a qualitative systematic review with meta-aggregation

INTRODUCTION

Anterior cruciate ligament (ACL) injuries are a common yet significant musculoskeletal problem and are increasingly prevalent outside of elite athlete populations. As a result, individuals may undergo ACL reconstruction (ACLR), but long-term complications frequently persist. Individuals commonly believe that post-ACLR, they will eventually return to preinjury levels of function. However, for multiple reasons, the reality is that more than half fail to reach this preinjury level. Rehabilitation has traditionally focused on physical factors, which have been researched extensively. More recently, psychological factors affecting recovery have been examined. However, most literature focuses on 'outcome', with the patient voice, in terms of their views and perceptions of ACLR neglected. Therefore, the aim of this systematic review is to understand individuals' perceptions, expectations and experiences pre-ACLR and post-ACLR and to understand key factors influencing this journey. Such knowledge would assist in maximising the chances of successful recovery.

METHODS AND ANALYSIS

This meta-aggregative systematic review protocol is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Medline, CINAHL, EMBASE and SportDiscus databases, grey literature and key journals will be searched from inception. Qualitative research of any study design that includes individuals aged 16+ years who are awaiting or have undergone ACL reconstruction will be included. Studies focusing on ACL revision, ACL repair or multiligament reconstruction surgeries will be excluded. Two independent reviewers will conduct searches, determine study eligibility, extract data, assess methodological quality (Joanna Briggs Institute (JBI) critical appraisal checklist for qualitative research) and rate the overall confidence in findings (JBI ConQual).

ETHICS AND DISSEMINATION

Findings will be published in a peer-reviewed journal, as well as presented at conferences and locally to physiotherapy teams. Ethical approval is not required for this systematic review.

PROSPERO REGISTRATION NUMBER

CRD42024594621.

Important issues on the prevention of surgical site infections and the management of prophylactic antibiotics

In this article, we have addressed the recent published article by Wang et al which examines risk factors associated with surgical site infections (SSIs) and evaluates the effectiveness of prophylactic antibiotics in their prevention. Wang et al identified several significant risk factors of SSIs, including age ≥ 60 years, diabetes mellitus, and surgical complications such as insufficient cystic duct stump closure, gallbladder perforation, empyema, and postoperative hematoma. Their findings suggest that prophylactic antibiotics can serve as a protective factor against SSIs. However, other reported risk factors and preventive strategies warrant consideration to further reduce the incidence of SSIs, lower healthcare costs, and enhance patient outcomes. Additionally, the judicious use of prophylactic antibiotics is crucial in light of the growing global challenge of antibiotic resistance caused by the misuse and overuse of antibiotics. Effective management strategies for prophylactic antibiotic use should be prioritized to balance infection control with the need to combat antimicrobial resistance.

Research Progress on the Therapeutic Mechanisms of Stigmasterol for Multiple Diseases

Stigmasterol is a plant-derived phytosterol that has attracted considerable attention because of its diverse biological activities and potential therapeutic applications. In this review, the chemical properties, biosynthesis, and biological effects of stigmasterol are exhaustively summarized. Furthermore, the anti-inflammatory, antioxidant, anticancer, neuroprotective, and hypolipidemic activities of stigmasterol have been discussed. Findings from various in vitro and in vivo studies have revealed its potential in treating various diseases, including cancer, diabetes, neurological disorders, and inflammatory conditions. The mechanisms underlying these effects are also discussed, particularly emphasizing the regulation of key signaling pathways and molecular targets, to further clarify the therapeutic role of stigmasterol. This review would provide a reference for further exploring the utility of stigmasterol as a therapeutic agent, thereby contributing to the improvement of human health.

Advancing osteoarthritis research: the role of AI in clinical, imaging and omics fields

Osteoarthritis (OA) is a degenerative joint disease with significant clinical and societal impact. Traditional diagnostic methods, including subjective clinical assessments and imaging techniques such as X-rays and MRIs, are often limited in their ability to detect early-stage OA or capture subtle joint changes. These limitations result in delayed diagnoses and inconsistent outcomes. Additionally, the analysis of omics data is challenged by the complexity and high dimensionality of biological datasets, making it difficult to identify key molecular mechanisms and biomarkers. Recent advancements in artificial intelligence (AI) offer transformative potential to address these challenges. This review systematically explores the integration of AI into OA research, focusing on applications such as AI-driven early screening and risk prediction from electronic health records (EHR), automated grading and morphological analysis of imaging data, and biomarker discovery through multi-omics integration. By consolidating progress across clinical, imaging, and omics domains, this review provides a comprehensive perspective on how AI is reshaping OA research. The findings have the potential to drive innovations in personalized medicine and targeted interventions, addressing longstanding challenges in OA diagnosis and management.

Comparative analysis of single-dose platelet-rich plasma and hyaluronic acid therapies in knee osteoarthritis: A 12-week follow-up study

OBJECTIVE

Osteoarthritis (OA) is a prevalent and disabling joint condition that affects millions worldwide, particularly in the knee joint, and it presents limited therapeutic options. Platelet-rich plasma (PRP) and hyaluronic acid (HA) have emerged as promising intra-articular treatments. This study aimed to compare the effects of single-dose PRP and HA on pain, functionality, and stiffness in patients with knee OA over a 12-week follow-up period.

METHODS

A retrospective analysis was conducted on 64 patients who underwent single-dose intra-articular HA or PRP treatment for knee OA between December 2021 and June 2022. Pain and functional outcomes were assessed using the Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Patient satisfaction was evaluated using a Likert scale. Appropriate statistical analyses were performed to compare treatment outcomes and p<0.05 was considered statistically significant.

RESULTS

Both PRP and HA treatments led to significant improvements in pain, functionality, and stiffness over the 12-week follow-up period. VAS pain scores decreased significantly in both groups, but a greater reduction was observed in the HA group. Additionally, the HA group exhibited superior improvement in the WOMAC physical function score at the 4-week mark (p=0.047).

CONCLUSION

This study is another novel contribution to the growing literature on treatment of PRP and HA treatments for knee OA, where we highlighted the potential benefits of single-dose HA in alleviating pain and enhancing physical function.

Trends in Celecoxib Prescribing: A Single Institution 16-Month Review

Background/Objectives: Celecoxib, a COX-2 selective nonsteroidal anti-inflammatory drug (NSAID), is widely prescribed for pain management due to its efficacy and improved gastrointestinal safety profile compared to traditional NSAIDs. Understanding prescription trends and their comparison to other NSAIDs provides valuable insight into prescribing behaviors in clinical settings. Methods: This retrospective study analyzed celecoxib prescriptions written by three pain management physicians in a single institution over a 16-month period from 1 January 2023 to 30 April 2024. Prescription data were collected and grouped into four 4-month intervals to assess temporal trends. Additionally, we compared celecoxib prescriptions to other commonly prescribed NSAIDs, including ibuprofen, meloxicam, naproxen, and diclofenac. Results: A total of 143 celecoxib prescriptions were identified during the study period, with a steady increase observed across consecutive intervals: 8 prescriptions from January-April 2023, 22 from May-August 2023, 46 from September-December 2023, and 67 from January-April 2024. In comparison, a total of 165 prescriptions were written for other NSAIDs over the same period, with 26 prescriptions from January-April 2023, 41 from May-August 2023, 45 from September-December 2023, and 53 from January-April 2024. While prescriptions for both celecoxib and other NSAIDs increased over time, the rate of celecoxib prescriptions showed a steeper rise. Conclusions: The findings demonstrate a notable increase in celecoxib prescriptions in this pain management clinic, outpacing the growth of other NSAIDs. This trend may reflect increasing provider preference for COX-2 selective inhibitors due to their favorable safety profile and efficacy. Further research is warranted to explore the underlying factors driving these prescribing patterns.

Enhancing the Therapeutic Potential of Human Umbilical Cord Mesenchymal Stem Cells for Osteoarthritis: The Role of Platelet-Rich Plasma and Extracellular Vesicles

Osteoarthritis (OA) is a chronic degenerative joint disease. Our previous study demonstrated that extracellular vesicles (EVs) secreted by human umbilical cord mesenchymal stem cells (HUCMSCs), which play a crucial role in regenerative medicine, have therapeutic effects on OA. Additionally, platelet-rich plasma (PRP) has been widely used in musculoskeletal diseases as it promotes wound healing, angiogenesis, and tissue remodeling; however, its efficacy as a stand-alone therapy remains controversial. Therefore, we investigated the therapeutic effects of combining stem cell-derived EVs with PRP in an OA model. HUCMSC-derived EVs treated with PRP were used as the experimental group, whereas HUCMSC-derived EVs cultured with serum-free (SF) or exosome-depleted fetal bovine serum (exo(-)FBS) and PRP served as controls. PRP-treated HUCMSCs maintained their surface antigen characteristics and potential to differentiate into adipocytes, osteoblasts, and chondrocytes. In the OA model, mice treated with HUCMSCs + 5% PRP-derived EVs showed significantly improved motor function compared to controls and were comparable to those treated with HUCMSCs +SF and +exo(-)FBS-derived EVs. Additionally, increased type II collagen and aggrecan and decreased IL-1β expression were observed in cartilage transplanted with various EVs. In conclusion, PRP enhances HUCMSC differentiation, whereas treatment with EVs improves OA outcomes, providing a promising strategy for future clinical applications.

Association of hematological parameters and inflammatory indices with sarcopenia in the United States and China: a cross-sectional study

BACKGROUND

In this study, we examined the association between hematological parameters and inflammatory indices and sarcopenia in the general population of the United States and China.

METHODS

The cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) (2011-2014) and the Affiliated Hospital of Anhui Medical University (2022-2024). We employed weighted restricted cubic spline (RCS) plots and multivariable logistic regression analyses to explore the association of hematological parameters and inflammatory indices with the prevalence of sarcopenia in American and Chinese populations.

RESULTS

A total of 8805 participants from NHANES, and 2598 individuals from the First Affiliated Hospital of Anhui Medical University were included in our analysis. In American and Chinese populations, the roughly J-shaped curve was detected in the RCS plots for mean platelet volume and platelet-to-lymphocyte ratio with the risk of sarcopenia. Additionally, the risk of sarcopenia was positively and linearly associated with white blood cells, lymphocytes and platelet, while it was inversely and linearly associated with mean cell volume.

CONCLUSIONS

We demonstrated a nonlinear association between some hematological parameters, inflammatory indices and sarcopenia in American and Chinese populations. The need to focus more on hematological parameters and inflammatory indices in the body could provide better prevention strategies for sarcopenia.

Naringin promotes osteoblast differentiation and ameliorates osteoporosis in ovariectomized mice

This study aimed to investigate the anti-osteoporotic mechanisms of naringin in osteoblasts and mice. In vitro, MC3T3-E1 cells were treated with naringin to detect cell proliferation, alkaline phosphatase (ALP) activity, and calcified nodule formation. Western blot was used to analyze the expression of osteogenic markers (OPN, COL1A1, RUNX2) and Wnt/β-catenin pathway proteins (Wnt3a, β-catenin). In vivo, ovariectomized (OVX) mice were treated with naringin for 3 months to observe bone microstructure, femoral histomorphology, and marker expression. Results showed that 0.1, 0.5, and 1 µmol/L naringin significantly promoted cell proliferation, enhanced ALP activity, and increased calcified nodule formation. Naringin also improved bone mineral density (BMD) and trabecular bone number in OVX mice. It elevated serum levels of bone formation markers (P1NP, OCN) while reducing the bone resorption marker CTX-1. Both in vitro and in vivo, naringin upregulated OPN, COL1A1, RUNX2, Wnt3a, and β-catenin expression, and induced β-catenin nuclear translocation. Notably, naringin antagonized the inhibitory effects of XAV939 (a Wnt/β-catenin pathway inhibitor) on OPN, COL1A1, and RUNX2 protein expression. These findings demonstrate that naringin enhances bone density in OVX mice and promotes osteogenic differentiation of MC3T3-E1 cells via activation of the Wnt/β-catenin pathway.

Quantitative analysis of the efficacy and associated factors of intra-articular hyaluronic acid with respect to osteoarthritis symptoms: A systematic review of randomized trials and model-based meta-analysis

OBJECTIVE

To quantitatively evaluate hyaluronic acid (HA) efficacy for osteoarthritis (OA) and identify potential responders who would benefit most from HA.

METHOD

Embase, MEDLINE (PubMed), and the Cochrane Library Central Register of Controlled Trials were searched from inception to March 13, 2023. A pharmacodynamic Bateman function model was used to quantitatively evaluate the efficacy characteristics of HA treatments as well as placebo, while a covariate model was employed to identify factors that significantly affected efficacy.

RESULTS

In total, 24 101 participants with symptomatic or radiographic OA from 168 studies with aggregate data were included. Simulation analysis from the pharmacodynamic time-effect model showed that HA treatment effects plateaued at approximately 2 months. The final model analysis indicated that intra-articular injection of HA combined with corticosteroids (CS) (the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] pain effect size [ES] = 4.4 [95% confidence interval {CI}: 3.0 to 5.7]) or platelet-rich plasma (PRP) (WOMAC pain ES = 4.0 [95% CI: 2.7 to 5.3]) achieved the best efficacy compared with other groups (contrast between meta-analyses: WOMAC pain ES = 1.9 [95% CI: 1.2 to 5.2]). Subgroups analysis showed that younger (age < 65), overweight (body mass index ≥ 25) knee OA patients, with more severe baseline symptoms and a lower Kellgren-Lawrence (KL) grade (≤ 2), could benefit more.

CONCLUSION

The quantitative model suggested that HA interventions were statistically more effective than placebo, with participants receiving HA+ CS or PRP experiencing the best efficacy. Patients with lower age, higher weight, higher severity of baseline symptoms, and lower KL grade appeared to benefit more from HA treatment.

Chemotaxis-driven hybrid liposomes recover intestinal homeostasis for targeted colitis therapy

Inflammatory bowel disease (IBD) is closely linked to the dysregulation of intestinal homeostasis, accompanied by intestinal epithelial barrier destruction, dysbiosis of gut microbiota, subsequent inflammatory factor infiltration, and excessive oxidative stress. Conventional therapeutics focus on suppressing inflammation and often suffer from metabolic instability as well as limited targeting, thereby leading to suboptimal remission rates and severe side effects. Here, we designed bacterial outer membrane vesicle (OMV, from Stenotrophomonas maltophilia)-fused and borneol-modified liposomes (BO/OMV-lipo@LU) for targeted delivery of luteolin to recover intestinal homeostasis by alleviating inflammation and modulating dysregulated intestinal epithelial barrier, redox balance, and gut microbiota in IBD. In a Caco-2/HT29-MTX monolayer model, the OMV and borneol-bifunctionalized liposomes enhanced the uptake efficiency of unfunctionalized liposomes with a 2-fold increase. Owing to the chemotaxis-driven colon-targeting ability of OMVs and the ability of borneol to promote intestinal epithelial uptake, the hybrid liposomes successfully targeted the inflamed colon. In a colitis mouse model, BO/OMV-lipo@LU exhibited enhanced efficacy following oral administration. The BO/OMV-lipo@LU treatment increased the colon length and body weights of mice suffering colitis by 40 % and 15 %, respectively, with values comparable to the healthy control group. Notably, BO/OMV-lipo@LU alleviated proinflammatory markers, modulated redox balance, and restored the intestinal epithelial barrier. In addition, the formulation increased the abundance of beneficial microbiota while decreasing the abundance of harmful microbiota. These results demonstrated that this biomimetic nanoplatform could be exploited as a safe and effective gut-targeted delivery system in IBD treatment.