The Role and Future of Functional Graphenic Materials in Biomedical and Human Health Applications

Functional graphenic materials (FGMs) are materials derived from graphene oxide (GO) that hold a plethora of applications from electronics to nanomedicine. In this Perspective, we examine the history and evolution of biomedical applications of this carbon-based macromolecule. Following the carbon nanotube (CNT) movement, GO and FGMs became nanocarbons of interest because of their low cost and versatile functionality. The tunable chemistry enabled our work on FGMs coupled with biomacromolecules and allows FGMs to plays an important role in many biomedical applications, from tissue regeneration to controlled delivery. As we work to develop this material, it is critical to consider toxicity implications─in fresh materials as well as in degradation products. With this understanding, FGMs also hold potential roles in human health and environmental sustainability, making FGMs an important contemporary biomacromolecule.

Intra-Articular Administration of PBHSCs CD34+ as an Effective Modality of Treatment and Improving the Quality of Life in Patients with Coxarthrosis

Background/Objectives: In 2020, 595 million world citizens had osteoarthritis, and the largest growth in OA morbidity refers to the hip joint. Effective OA therapies have been sought for years. Assessing the treatment effectiveness and QoL improvement in hip OA after intra-articular administration of fresh peripheral blood hematopoietic CD34+ stem cells. Methods: The study comprised 49 adults (median age: 63). The SCs were injected into hip joints and straight to the bone. Hip manipulation was conducted. Patients were subjected to a standardized rehabilitation protocol. Hip degeneration was graded by Kellgren-Lawrence. Multi-factor statistical analyses, with replications, were performed. The study was an R&D project, co-financed by the E.U. Results: Patient-reported outcomes (HOOS, SF-36) ameliorated remarkably over 24 months (p < 0.0001). Ranges of movement improved significantly (p < 0.0001). The most noticeable improvement manifested 6 months after the SC administration. Its furtherance was maintained. Conclusions: Intra-articular administration of CD34+ cells significantly reduces pain and improves hip joint function, regardless of the severity of OA, according to K-L, over a 24-month follow-up period. The combination of CD34+ cell therapy with joint mobilization and rehabilitation allows for the postponement of hip arthroplasty by significantly improving patients' QoL over the 24-month follow-up period.

Continuous femoral nerve block as pain management following total knee arthroplasty: a systematic review

INTRODUCTION

The present systematic review evaluated the current level of I evidence on continuous femoral nerve block (FNB) as pain management following total knee arthroplasty (TKA), comparing different drugs.

MATERIALS AND METHODS

This study followed the 2020 PRISMA guidelines. PubMed, Embase and Web of Science were accessed in November 2024. All clinical studies concerning continuous FNB for pain management following TKA were considered.

RESULTS

Data from 22 RCTs were retrieved. The drugs included in the analyses were levobupivacaine, bupivacaine and ropivacaine in isolation or combined with prilocaine or dexmedetomidine. A statistically significant difference was found in VAS at rest in postoperative day (POD) 0 (p < 0.01): the bupivacaine group demonstrated the highest values, and the ropivacaine combined with dexmedetomidine group had the lowest values. No other statistically significant difference in VAS at rest was found for any group in POD 1, 2, and 3 (p = 0.1, p = 0.1, and p = 0.4, respectively). The groups receiving ropivacaine combined with dexmedetomidine and prilocaine had the lowest values of VAS during activity in POD2 (p < 0.01), while in POD3 the groups receiving ropivacaine combined with prilocaine and the bupivacaine one had the lowest values (p < 0.01). No significant difference was found in VAS during activity between any group in POD 0 (p = 0.4) and POD 1 (p = 0.3).

CONCLUSION

Ropivacaine combined with dexmedetomidine might be the best compound for continuous femoral nerve block to manage pain following TKA during the first PODs. Further high-quality investigations are necessary to validate these findings in clinical settings.

Development of regenerative therapies targeting fibrotic endometrium in intrauterine adhesion or thin endometrium to restore uterine function

Intrauterine adhesions (IUA) and thin endometrium (TE) represent significant challenges in human reproduction. The condition arises frequently from damage to the endometrial basal layer, leading to fibrous tissue replacing the functional endometrium and impairing the uterus's ability to accept embryo implantation. Conventional treatments, mainly including hysteroscopic adhesiolysis and estrogen therapies, have shown limited success, particularly in severe cases. Regenerative medicine, with its focus on stem cell-based therapies and biomaterials, offers a promising avenue for restoring endometrial function and structure. This review synthesizes the current landscape of endometrial regeneration, focusing on the therapeutic potential of stem cells, the supportive role of biomaterials, and the importance of understanding molecular mechanisms to develop effective strategies for reconstruction of endometrial functional and fertility restoration.

Characteristics of osteonecrosis of the femoral head after COVID-19 steroid treatment compared to steroid-associated osteonecrosis

BACKGROUND

Several studies have reported that the steroid dose of osteonecrosis of the femoral head (ONFH) after COVID-19 infection treatment was relatively low. However, the pathogenesis of ONFH after COVID-19 infection was not elucidated. This study aimed to analyze ONFH cases after COVID-19 infection and compare their characteristics with those of steroid-associated ONFH during the same period.

METHODS

This study includes 8 patients diagnosed with ONFH after steroid treatment for COVID-19 infection (COVID-19 group) from January 2020 to December 2023 in our institution and associated institutions. Nine patients diagnosed as steroid-associated ONFH without COVID-19 pneumonia treatment (SA-ONFH group) during same periods. Duration of steroid administration, cumulative dose of prednisolone equivalent, time to the onset of ONFH, history of alcohol and smoking, and blood test results were analyzed. Statistical analysis was performed between both groups using Mann-Whitney U test, Fisher's exact test (p < 0.05).

RESULTS

In COVID-19 group, the mean duration of steroid administration was 31 days, the mean cumulative dose of prednisolone equivalent was 719 mg, the mean time to the onset of ONFH was 9 months, 4 patients had a history of alcohol, 5 patients had a history of smoking. In SA-ONFH group, those were 681 days, 8,720 mg, 23 months, respectively; all patients have no alcohol and smoking history. In COVID-19 group, two patients had no history of alcohol and smoking. The administration duration of steroid in COVID-19 group was significantly shorter than that of SA-ONFH group. In addition, the mean cumulative dose of prednisolone equivalent was significantly lower than that of SA-ONFH group. A systematic inflammatory response and a hypercoagulable status could not be confirmed based on blood test results.

CONCLUSIONS

In our results, the mean cumulative dose in COVID-19 group was 719 mg, less than the diagnostic criteria (2000 mg) and our SA-ONFH group. Even in ONFH patients without history of alcohol and smoking in COVID-19 group, steroid dose were less than the criteria. Therefore COVID-19 infection itself or low-dose of steroid for COVID-19 patients may be a contributing factor to ONFH. Patients after COVID-19 infection treated with steroids should be followed for the possibility of developing ONFH.

Exosomal Manf originated from endothelium regulated osteoclast differentiation by down-regulating NF-κB signaling pathway

BACKGROUND

Endothelium-derived exosomes has been reported to enhanced osteogenesis. However, the role of endothelial exosomes on osteoclastgenesis is still unknown.

METHODS

Human umbilical vein endothelial cells (HUVECs) were used to isolate exosomes. PBS or HUVEC-Exos were used to treat RAW 264.7 cells. Then, the preconditioned RAW 264.7 cells were subjected to TRAP staining and RT-qPCR assays. In vivo, we constracted osteoporosis mice model. PBS or HUVEC-Exos were injected through tail vein after ovariectomy surgery. Bone mass was assessed by micro-CT and TRAP staining. Furthermore, we conducted RNA sequencing and found the genes that were differentially expressed.

RESULTS

Osteoclast differentiation was inhibited by endothelium-derived exosomes in this study. Moreover, HUVEC-Exos demonstrated a specific action on bones to promote in vivo bone resorption. Furthermore, exosomal Manf promoted bone resorption via down-regulating NF-κB signaling, and HUVEC-Exos Manf inhibited osteoclast differentiation in vivo.

CONCLUSION

HUVEC-exosomal Manf suppressed osteoclastogenesis via down-regulating NF-κB signaling.

Revealing COVID-19 breakthrough infection rates among vaccinated individuals at a tertiary care centre in South India

Background and Objectives

The COVID-19 pandemic was mitigated by the rapid development and deployment of vaccines. While vaccines reduce infection severity, breakthrough infections (BTIs) still occur. The CDC defines BTI as a positive SARS-CoV-2 test ≥14 days post-vaccination. This study investigates the occurrence of COVID-19 BTIs at a tertiary care hospital in Puducherry, South India.

Materials and Methods

This retrospective study analysed hospital tested qRT-PCR data of individuals from the ICMR portal (March 2021-March 2022). Demographic and vaccination details were extracted.

Results

Among 8001 tested individuals, 1452 were vaccinated. The BTI rate decreased from 16.6% to 1.2% after the first dose and from 58% to 40% after the second one. Odds ratio indicated a 74% reduction in infection risk for vaccinated individuals compared to unvaccinated. Males had higher infection rates than females, regardless of vaccination status.

Conclusion

Our study demonstrates a higher BTI rate after one vaccine dose compared to two doses. The BTI rate also increased four months post-vaccination, even with two doses, potentially due to waning immunity and the emergence of new variants. Therefore, continued adherence to preventive measures in conjunction with vaccination is crucial for minimizing COVID-19 transmission.

Past, Present, and Future: A History Lesson in Artificial Intelligence

Over the past 5 decades, artificial intelligence (AI) has evolved rapidly. Moving from basic models to advanced machine learning and deep learning systems, the impact of AI on various fields, including medicine, has been profound. In gastroenterology, AI-driven computer-aided detection and computer-aided diagnosis systems have revolutionized endoscopy, imaging, and pathology detection. The future promises further advancements in diagnostic precision, personalized treatment, and clinical research. However, challenges such as transparency, liability, and ethical concerns must be addressed. By fostering collaboration, robust governance and development of quality metrics, AI can be leveraged to enhance patient care and advance scientific knowledge.

Autologous Peripheral Blood-Derived Orthobiologics for the Management of Elbow Disorders: A Review of Current Clinical Evidence

INTRODUCTION

Elbow ailments are common, but conventional treatment modalities have shortcomings, offering only interim pain relief rather than targeting the underlying pathophysiology. The last two decades have seen a marked increase in the use of autologous peripheral blood-derived orthobiologics (APBOs), such as platelet-rich plasma (PRP), to manage elbow disorders. Platelet-rich plasma (PRP) is the most widely used APBO, but its efficacy remains debatable. Consequently, other APBOs, such as platelet lysate (PL), autologous conditioned serum (ACS), gold-induced cytokine (GOLDIC), plasma rich in growth factors (PRGF), autologous protein solution (APS), and hyperacute serum (HS), have been considered. Only a few reviews summarize the results of clinical studies investigating the efficacy of these APBOs in elbow disorders. This review documents the results of clinical studies involving APBOs in managing elbow disorders and summarizes the ongoing clinical studies on different clinical trial protocol repositories comprising these APBOs to manage elbow disorders.

METHODS

This systematic review adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. In December 2024, PubMed, Embase, and Web of Science were accessed with no additional filters or time constraints. All available clinical studies published in English, French, Spanish, German, or Italian concerning the management of elbow disorders by means of APBOs were considered.

RESULTS

Only three clinical studies met our predefined search and inclusion criteria. In particular, two and one studies involving the use of PL and ACS, respectively, were included in this review. Data from 99 patients were obtained. Of them, 57.6% (57 of 99 patients) were women. The mean length of follow-up was 11.9 ± 0.6 months, and the mean age was 42.0 ± 3.5 years. No complications were reported in any of the studies included. The included studies have low to medium risk of bias, and a very low score on methodological quality. Finally, no clinical studies involving the use of GOLDIC, PRGF, APS or HS were identified, and only one ongoing clinical study involving the use of PL was registered.

CONCLUSIONS

The current peer-reviewed published studies demonstrated that administering APBOs, including PL and ACS, might be safe and effective in reducing pain and improving function in patients with elbow disorders. Further, high-quality studies are required.

Volumetric Modulated Arc Therapy for 26 Gy in 5 Fractions Whole Breast Irradiation for Breast Cancer

Purpose

To report the dosimetric and toxicity outcomes of patients treated with 26 Gy in 5 fractions ultrahypofractionated (uHF) whole breast irradiation (WBI) using volumetric arc therapy (VMAT).

Methods and Materials

We identified 476 consecutive patients who underwent WBI using VMAT-uHF between 2020 and 2021. Study endpoints included acute toxicity and dosimetric parameters for target volume and organs at risk. The dosimetric results were compared with a historical cohort at the same institution who were treated with moderately hypofractionated WBI using 3-dimensional (3D)-conformal radiation therapy (3D-CRT, n = 392), with the total dose rescaled to 26 Gy.

Results

VMAT-uHF achieved a mean D95% and Dmax of the planning target volume of 96.2% and 102.8% of the prescribed dose, respectively. The VMAT-uHF group demonstrated significantly superior planning target volume coverage and improved dose homogeneity, with a 30.6% higher D95 and a 0.7% lower Dmax compared with the 3D-CRT group (both P < .05). Mean doses for the ipsilateral lung and heart were 3.12 ± 4.59 Gy and 0.92 ± 0.25 Gy, respectively, showing differences of < 0.3 Gy compared with the 3D-CRT group. The VMAT-uHF group exhibited a significantly lower left anterior descending artery Dmax (-3.73 Gy), while the contralateral breast showed a higher Dmean (+1.43 Gy), compared with the 3D-CRT group. Acute toxicity following VMAT-uHF was predominantly mild, with grade 1 toxicity observed in 114 out of 120 patients. No additional toxicities were reported after a median follow-up of 21.2 months.

Conclusions

The application of VMAT in ultrahypofractionation can enhance target coverage while maintaining radiation doses to organs at risk low, albeit with an increase in contralateral breast dose compared with 3D-CRT. Given the low toxicity profile observed in our cohort with VMAT-uHF, the clinical significance of these dosimetric differences requires further investigation.

A Long-Term Retrospective Observational Clinical Study Evaluating the Efficacy of Plasma Rich in Growth Factors (PRGF) in the Treatment of Back Pain

INTRODUCTION

Chronic back pain is a long-lasting disorder that is significantly associated with a reduction in the quality of life. Previously, the efficacy of intradiscal and epidural injections of plasma rich in growth factors (PRGF) was demonstrated at 6 months. The objective of this study was to retrospectively examine the medical records of these patients in order to determine whether the observed improvement at the 6-month follow-up was sustained over time.

METHODS

PRGF efficacy was evaluated using validated questionnaires: Core Outcome Measure Index (COMI) Pain score, COMI Disability score, COMI total score, and Oswestry Disability Index (ODI). Furthermore, an evaluation was conducted to determine whether the patients had undergone additional treatments.

RESULTS

the results demonstrated that 85.2% of the 27 patients who were enrolled exhibited sustained improvement across all scales over a median follow-up period of 24 months. The results of all questionnaires administered at 24 months exhibited statistically significant differences when compared to the baseline data (p < 0.01). Furthermore, there were no statistically significant differences between the results reported at 6 months and those at 24 months (p > 0.05).

CONCLUSIONS

the results of this retrospective study demonstrate that treatment of chronic back pain with PRGF was effective in maintaining pain reduction and improving function for at least 24 months after the end of treatment.

Optimizing orthobiologic therapies with exercise, diet, and supplements

Orthobiologic injections including platelet-rich plasma (PRP) and cell-based injections are becoming increasingly popular. Evidence suggests that these therapies can be effective in certain situations. The efficacy of these injections may be more dependent on the quality of the injectate, which given their autologous nature, may be dependent on lifestyle choices like exercise, diet, and supplements. The literature describing PRP injections shows that the number and activity of platelets can improve their efficacy. A multitude of lifestyle modifications can affect those factors. Exercise intensity appears to increase platelet count and increases adhesion as well as release of growth factors. Low inflammatory diets increase platelet counts and activity overall. Stress, some supplements, high cholesterol, or processed sugar diets can increase inflammation and potentially decrease platelet counts as well as quality of PRP injectate. Similarly, cell-based therapies can be affected by mesenchymal stromal cell (MSC) number and quality. Cell-based therapy is based upon limiting cellular senescence and increasing replication and differentiation. Exercise may limit senescence and improve replication and differentiation of these cell-based therapies, especially in older adult populations. There are a multitude of supplements that may potentiate these types of injections and patients should discuss the potential benefits and concerns when starting a supplement regimen. Certain foods as well as changes in oxygenation may limit cellular senescence and lower calorie intake may affect MSC viability and function as well. Overall, the current state of literature describes biologic plausibility of how exercise, diet and supplements might affect orthobiologic injection efficacy. Further translational research needs to be completed to describe the effect size and improve recommendations for clinical implementation.

Efficacy of Amniotic Suspension Allografts in the Treatment of Knee Osteoarthritis: A Systematic Review

Knee osteoarthritis significantly impacts mobility and quality of life. This condition is a leading cause of disability in aging populations, with total knee replacement commonly sought in advanced cases. Traditional nonoperative management strategies, including anti-inflammatories, corticosteroid injections, and hyaluronic acid, often provide limited relief, especially in severe cases. Recently, regenerative therapies such as amniotic suspension allografts (ASA) have emerged as promising alternatives due to their anti-inflammatory and regenerative properties, which may counteract the catabolic effects of osteoarthritis. This systematic review evaluated the efficacy and safety of ASA in reducing pain and improving function among knee osteoarthritis patients. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, a comprehensive search of PubMed and Embase databases initially identified 1,733 studies pertaining to ASA, of which 1,575 were screened, and 9 studies ultimately met the inclusion criteria for detailed analysis of ASA in the treatment of knee osteoarthritis. Data extraction and narrative synthesis focused on outcomes such as pain reduction and functional improvement using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as well as safety profiles. The results demonstrated notable improvements in pain scores following ASA treatment, as shown by studies reporting increases in KOOS pain scores over 6 months, which generally outperformed hyaluronic acid and saline treatments in pain reduction. Similarly, ASA treatment was associated with substantial improvements in physical function outcome scores, enhancing patients' ability to perform daily activities. Patient-reported outcomes also indicated higher quality of life and functional status, with most patients experiencing high levels of satisfaction. Additionally, ASA's safety profile was favorable, with adverse events primarily mild to moderate in nature, including a few transient events such as knee stiffness and myalgias. This systematic review highlights ASA as an effective therapeutic option for knee osteoarthritis, although further studies focusing on long-term radiographic outcomes and mechanisms of action are recommended to fully establish its benefits and optimize treatment protocols.

The status and hotspot analysis of research on extracellular vesicles and osteoarthritis: a bibliometric analysis

Background

Degenerative joint disease, known as osteoarthritis (OA), is characterized by pain, swelling, and decreased mobility. The illness has a major negative influence on patients' quality of life and is common around the world, especially among older people. Nevertheless, there are insufficient possibilities for early diagnosis and therapy. Extracellular vesicles, or EVs, control the immune response, tissue healing, and cellular communication.

Methods

This work offers a bibliometric representation of the areas of focus and correlations between extracellular vesicles and osteoarthritis. We searched for osteoarthritis and extracellular vesicles in publications in the Web of Science Core Collection (WoSCC) database. Bibliometrics, an R package, CiteSpace 6.1. R2, and VOSviewer 1.6.17 were used to perform bibliometric analyses of concentration fields, trends, and relevant factors.

Results

944 papers from 59 nations were published; the countries that contributed the most to the field were China, the USA, and Italy. Professors Laura and Enrico are the top contributors. Sichuan University, Istituto Ortopedico Galeazzi, and Shanghai Jiao Tong University are the top three universities. The International Journal of Molecular Sciences is an excellent publication. Exosome, expression, knee osteoarthritis, extracellular vesicle, mesenchymal stem cell, osteoarthritis, and inflammation are the most often occurring keywords.

Conclusion

These results suggest areas of interest and focus for future research on EVs and OA. This trend suggests that the volume of literature on OA and EVs will continue to rise, with more research being published in the future. This study helps scholars understand current research hotspots in the field and may inspire future research.

Intraarticular leukocyte-poor platelet-rich plasma injection is more effective than intraarticular hyaluronic acid injection in the treatment of knee osteoarthritis: a systematic review and meta-analysis of 12 randomized controlled trials

PURPOSE

We aim to compare the clinical effects of intraarticular leukocyte-poor platelet-rich plasma (LP-PRP) injection with those of intraarticular hyaluronic acid (HA) injection in adult patients with knee osteoarthritis.

METHODS

Two authors independently reviewed databases, including PubMed, Web of Science, and the Cochrane Library. Only randomized controlled trials (RCTs) were included in our meta-analysis. Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (WOMAC total, pain, stiffness, and physical function scores), visual analog scale (VAS) scores, EQ-VAS scores, International Knee Documentation Committee (IKDC) scores, and adverse events were used as outcome measurements to evaluate the efficacy of LP-PRP and HA treatment.

RESULTS

After screening 377 potential articles, 12 RCTs were included in this systemic review and meta-analysis. The WOMAC total scores and WOMAC physical function scores of the LP-PRP group were better than those of the HA group at 6 and 12 months. VAS scores of the LP-PRP group were better than those of the HA group at 3, 6, and 12 months. The LP-PRP group showed a better outcome of IKDC scores than the HA group at 6 months. There was no significant difference in adverse events between the LP-PRP and HA groups.

CONCLUSION

Intraarticular injections of LP-PRP showed better overall outcomes, such as WOMAC total scores, WOMAC physical function scores, VAS scores, and IKDC scores, compared with HA for adult patients with knee osteoarthritis at 6- and 12-month follow-up periods. Also, LP-PRP showed better pain relief compared with HA at 3-, 6-, and 12-month follow-up periods. Intraarticular LP-PRP improves pain relief and overall outcomes in patients with knee osteoarthritis.

Innovative Approaches for the Treatment of Spinal Disorders: A Comprehensive Review

This comprehensive review explores the latest advancements in the management of spinal disorders, including minimally invasive surgical techniques, treatment of complex deformities, disc replacement technologies, and non-surgical approaches. The review highlights the potential of innovations such as robotic-assisted surgeries, regenerative medicine, and artificial intelligence to enhance precision, reduce recovery times, and improve patient outcomes. It also discusses the integration of wearable technologies and personalized medicine in tailoring treatments. Challenges such as high costs, accessibility issues, and limited long-term data are critically analyzed, alongside gaps in research, including a lack of diversity in study populations and insufficient economic evaluations. Future directions emphasize the need for multidisciplinary collaboration to develop durable, accessible, and personalized solutions to address the global burden of spinal disorders.

A review on electrode materials of supercapacitors used in wearable bioelectronics and implantable biomedical applications

Supercapacitors, a class of electrochemical energy storage devices, offer a promising solution for powering wearable bioelectronics and implantable biomedical devices. Their high-power density, rapid charge-discharge capabilities, and long cycle life make them ideal for applications requiring quick bursts of energy and extended operation. To address the challenges of energy density, self-discharge, miniaturization, integration, and power consumption, researchers are exploring various strategies, including developing novel electrode materials, optimizing device architectures, and integrating advanced fabrication techniques. Metal oxides, carbon-based materials, MXenes, and their composites have emerged as promising electrode materials due to their high specific surface area, excellent conductivity, and biocompatibility. For wearable bioelectronics, supercapacitors can power a wide range of devices, including wearable sensors, smart textiles, and other devices that require intermittent or pulsed energy. In implantable biomedical devices, supercapacitors offer a reliable and safe power source for applications such as pacemakers, neural implants, and drug delivery systems. By addressing the challenges and capitalizing on emerging technologies, supercapacitors have the potential to revolutionize the field of bioelectronics and biomedical engineering, enabling the development of innovative devices that improve healthcare and quality of life.

Therapeutic interventions of platelet-rich plasma versus corticosteroid injections for lumbar radicular pain: a systematic review and meta-analysis

OBJECTIVE

Although epidural corticosteroid injections (ESIs) provide short-term relief for lumbar radicular pain caused by disc herniation, concerns remain regarding their long-term efficacy and complications. Platelet-rich plasma (PRP), with its dual anti-inflammatory and regenerative properties, is a promising alternative, but the comparative evidence between the two treatments remains inconclusive.

METHODS

A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library, with a cutoff date of January 10, 2025. The primary outcomes were the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. The risk of bias in the included studies was assessed using Cochrane ROB and ROBINS-I. The primary outcome measures were analyzed by evaluating standardized mean differences (SMDs).

RESULTS

A total of seven studies (four randomized controlled trials and three prospective studies) were included in the meta-analysis, comprising 416 patients. The results indicated that corticosteroids significantly reduced ODI scores at the initial follow-up (4 weeks) (SMD = 0.48, 95% CI: 0.20 to 0.75, p = 0.0008, I² = 15%), with no significant differences observed in VAS and ODI scores between the two groups at other time points. The complication rates for the PRP and corticosteroid groups were reported, with no severe adverse events reported.

CONCLUSIONS

Compared to PRP, corticosteroid injections showed significant early functional improvements in patients. Although no significant differences in pain and functional improvements were observed between the PRP and corticosteroid groups at other follow-up time points, future studies are needed to assess the efficacy and safety of PRP versus corticosteroid injections in treating lumbar radicular pain by standardizing PRP preparation, extending follow-up durations, and increasing sample sizes.

Mechanical versus kinematic alignment for total knee arthroplasty: a meta-analysis

INTRODUCTION

The present meta-analysis compared mechanical versus kinematic alignment in total knee arthroplasty (TKA). The outcomes of interest were patient-reported outcome measures (PROMs), range of motion (ROM), and revision rate.

METHODS

This study was conducted according to the 2020 PRISMA statement. In July 2024, PubMed, Web of Science, Google Scholar, and Embase were accessed without time constraints. All the clinical studies that compared mechanical versus kinematic alignment in total knee arthroplasty were accessed.

RESULTS

30 studies (3133 TKAs) were collected. The mean duration of the follow-up was 30.8 ± 38 months. No difference was found in Knee KSS-F, Knee Society Score (KSS, P = 0.2) and its function subscale (P = 0.3), visual analogue scale (VAS, P = 0.3), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, P = 0.2), Oxford Knee Score (OKS, P = 0.5). No difference was found in the rate of revision (P = 0.4). The ROM was slightly greater in the kinematic group (P < 0.0001).

CONCLUSION

PROMs and revision did not show a difference between mechanical and kinematic alignment in TKA. However, a minimal difference in the ROM was evidenced, which probably does not have clinical relevance.

LEVEL OF EVIDENCE

Level IV, systematic review and meta-analysis.

Bone marrow mesenchymal stem cell exosomes improve fracture union via remodeling metabolism in nonunion rat model

BACKGROUND

Nonunion of fractures is a major unsolved problem in clinical treatment and prognosis of orthopedics. Bone marrow mesenchymal stem cell (BMSC) exosomes have been proven to be involved in mediating tissue and bone regeneration in a variety of diseases. However, the role of BMSC exosomes in fracture nonunion is unclear.

METHODS

BMSC exosomes were injected into a rat model of nonunion fracture, and the fracture-healing site was detected by micro-CT and the serum metabolites were analyzed by LC-MS/MS.

RESULTS

The results showed that the exosomes could be successfully isolated from rat BMSCs cultured in an exosome-free medium. Compared with the model group, the fracture site of the exosome-treated rats were healing obviously. Compared with the PBS group, there were 158 up-regulated differential abundance metabolites (DAMs) and 79 down-regulated DAMs in the BMSC-exo group. The DAMs were enriched in 'Th1 and Th2 cell differentiation', 'ErbB signaling pathway', 'PPAR signaling pathway' and 'HIF-1 signaling pathway' that were related to the function of cell proliferation and differentiation. DAMs-PE in HIF-1 signaling pathway were the major metabolite to promote fracture healing.

CONCLUSIONS

Our study reveals the mechanism by which BMSC-exosome improves the fracture healing process through metabolic reprogramming and provides a reference for the treatment of fracture nonunion.

The Role of Exercise on Glial Cell Activity in Neuropathic Pain Management

Chronic pain is a widespread global health problem with profound socioeconomic implications, affecting millions of people of all ages. Glial cells (GCs) in pain pathways play essential roles in the processing of pain signals. Dysregulation of GC activity contributes to chronic pain states, making them targets for therapeutic interventions. Non-pharmacological approaches, such as exercise, are strongly recommended for effective pain management. This review examines the link between exercise, regular physical activity (PA), and glial cell-mediated pain processing, highlighting its potential as a strategy for managing chronic pain. Exercise not only improves overall health and quality of life but also influences the function of GCs. Recent research highlights the ability of exercise to mitigate neuroinflammatory responses and modulate the activity of GCs by reducing the activation of microglia and astrocytes, as well as modulating the expression biomarkers, thereby attenuating pain hypersensitivity. Here, we summarize new insights into the role of exercise as a non-pharmacological intervention for the relief of chronic pain.

A Carbon-Based Nanomaterial with Dichotomous Effects: Antineoplastic on Oral Cancer Cells and Osteoinductive/Chondroinductive on Dental Pulp Stem Cells

BACKGROUND

Oral cancer is an aggressive malignancy with modest survival rates. It also causes disfigurement following surgical removal of the tumor, thus highlighting the need for new cancer treatment and tissue repair modalities. Carbon-based nanomaterials have emerged as promising tools in both anticancer and regenerative therapies.

OBJECTIVES

We aimed to synthesize a new carbon-based nanomaterial (CBN) and test its antineoplastic effects, as well as its potential regenerative capacity.

MATERIALS AND METHODS

A carbon nanomaterial, obtained by ball milling graphite flakes, was functionalized with polyvinylpyrrolidone (CBN/PVP). Its physicochemical properties were explored with X-ray diffraction (XRD), attenuated total reflection-Fourier transform infrared spectroscopy (ATR-FTIR), micro-Raman spectroscopy, fluorescent and scanning electron microscopy, and wettability analysis. For the antineoplastic effects investigation, oral cancer cells were treated with CBN/PVP and examined with MTT and migration assays, as well as cell-cycle and ROS production analyses. Gene expression was determined by qPCR. To examine the pro-regenerative capacity of CBN/PVP, dental pulp stem cell cultures (DPSCs) were treated with the nanomaterial and subjected to osteo- and chondro-induction.

RESULTS

Lower concentrations of CBN/PVP (50, 100 μg/mL) applied on cancer cells exerted remarkable cytotoxic effects, induced G1 cell-cycle arrest, and reduced cancer cell invasion potential by different mechanisms, including downregulation of the PI3K/AKT/mTOR pathway. In contrast, the addition of 50 µg/mL of CBN/PVP to DPSCs stimulated their survival and proliferation. CBN/PVP significantly enhanced both the osteogenic (p < 0.05) and chondrogenic (p < 0.01) induction of DPSCs.

CONCLUSIONS

The novel carbon-based nanomaterial displays unique characteristics, making it suitable in anticancer and regenerative therapies concomitantly.

Clinical and Cellular Predictors of Outcomes in Autologous Conditioned Plasma Therapy for Knee Osteoarthritis: A Prospective Cohort Study

IntroductionAutologous conditioned plasma (ACP) is a single-spin, leukocyte-poor platelet-rich plasma (PRP) that provides a plasma with a platelet concentration 2 to 3 times the blood platelet concentration. The objective of this study was to investigate the clinical effectiveness of ACP intra-articular injection in patients with knee osteoarthritis (OA) and to identify any demographic, disease-associated, or biological predictors of outcome.MethodsA prospective cohort study was conducted between 2022 and 2023 in a single high-volume tertiary center, including 42 patients (54 knees) who consented to be enrolled. Patients underwent a series of 3 injections of ACP at weekly intervals, prepared using the Arthrex ACP Double-Syringe System. Lysholm scores were collected at baseline, 3-months, and 6-months post-injection.ResultsForty patients (49 knees) completed the follow-up and were included in the final analysis. The mean age was 53.8 ± 10.16 years (range 35-76 years), and the median body mass index (BMI) was 29 (interquartile range [IQR]: 27-34). There were 22 females and 18 males. Treatment failure occurred in 12 out of 49 cases (24.49%). The mean platelet concentration in the ACP was 588.5 ± 183.2 × 106/ml, with a mean platelet fold increase of 2.14 ± 0.71 compared to the baseline. Multi-linear regression modeling showed that older age and higher mean platelet concentration were predictors of higher post-injection Lysholm scores, with beta coefficients of 0.34 and 0.28, respectively, and p values of 0.013 and 0.036, respectively.ConclusionAutologous conditioned plasma provided clinical benefits in this cohort study of knee OA patients for at least 6 months post-injection. Older age and a higher mean platelet concentration in the ACP were identified as predictors of a higher Lysholm score.

Advancements in Regenerative Therapies for Orthopedics: A Comprehensive Review of Platelet-Rich Plasma, Mesenchymal Stem Cells, Peptide Therapies, and Biomimetic Applications

Background/Objectives: Regenerative therapies have gained interest in orthopedic applications for their potential to enhance tissue regeneration, functional recovery, and pain modification. This review evaluates the clinical efficacy of platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), peptide-based treatments, and biomimetic materials in orthopedic care, with a focus on pain reduction and functional outcomes. Methods: A structured literature search in PubMed (January 2009-January 2025) identified 160 studies. After applying inclusion criteria prioritizing randomized controlled trials (RCTs) and clinical trials, 59 studies were included: 20 on PRP, 20 on MSCs, 10 on peptide therapies, and 7 on biomimetics. Data extraction focused on pain reduction and functional recovery, with risk of bias assessed using the Cochrane Risk of Bias (RoB) tool and ROBINS-I tool. A random-effects meta-regression analysis was conducted to evaluate the impact of therapy type, sample size, and risk of bias on reported pain reduction outcomes. Results: Meta-regression analysis identified MSC therapy as the most effective intervention for pain reduction (β = 8.45, p < 0.05), with PRP and peptide-based therapies showing moderate improvements, and biomimetic therapies demonstrating the lowest effect. PRP provided short-term pain relief, particularly in acute injuries and tendon repair, though inconsistencies in preparation methods limited success in chronic conditions. MSC therapies demonstrated cartilage regeneration and early osteoarthritis improvement, but high costs and ethical concerns remain barriers to widespread adoption. Peptide-based therapies and biomimetic materials, including engineered scaffolds and autologous protein solutions, showed promise for infection control and wound healing, though further research is needed to optimize dosing, delivery methods, and long-term safety. Conclusions: Regenerative therapies offer significant potential in orthopedic care, with MSC therapies demonstrating the most reliable regenerative effects, PRP providing short-term symptomatic relief, and peptide-based and biomimetic treatments emerging as promising adjuncts. However, standardized protocols and large-scale clinical trials are needed to establish long-term efficacy and improve clinical translation for broader adoption.

Noradrenergic Mechanisms and Circuitry of Hyperkatifeia in Alcohol Use Disorder

Hyperkatifeia, the manifestation of emotional distress or pain, is a conceptual framework gaining traction throughout the alcohol and other substance use fields as an important driver of addiction. It is well known that previous or current negative life experiences can serve as powerful motivators for excessive alcohol consumption and precipitate the development of an alcohol use disorder (AUD). A major hallmark of later stages of AUD is the emergence of hyperkatifeia during withdrawal, which can persist well into protracted abstinence to drive relapse. Given these complex interactions, understanding the specific neuroadaptations that lie at the intersection of hyperkatifeia and AUD can inform ongoing therapeutic development. The monoamine norepinephrine is of particular interest. Noradrenergic dysfunction is implicated in AUD, anxiety, chronic stress, depression, and emotional and physical pain. Importantly, there are key sexual dimorphisms within the noradrenergic system that are thought to differentially impact the development and trajectory of AUD in women and men. In the current review, we discuss past and recent work on noradrenergic influences at each stage of the AUD cycle (binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation) through the lens of hyperkatifeia. Evidence from these studies support the prioritization of norepinephrine-specific drug development to treat AUD and the identification of AUD subpopulations that may benefit the most from these therapies (e.g., women or people with comorbid chronic pain or anxiety/stress disorders).

Effects of TGF-β3 on meniscus repair using human amniotic epithelial cells

BACKGROUND

Meniscus injury is one of the most common knee diseases, which is managed through conservative and surgical treatments. In recent years, biotherapy has shown great potential to treat various symptoms caused by meniscus injury repair. Human amniotic epithelial cells (hAECs), which are easy to acquire, non-tumorigenic, and high tri-lineage differentiation potential, are a promising cell source for biotherapy and tissue engineering applications. Studies have demonstrated that the Transforming Growth Factor-β3 (TGF-β3) can facilitate chondrocyte differentiation and maturation.

METHODS

Both in vitro test and in vivo test were employed. In the in vitro test, human amniotic epithelial cells (hAECs), human amniotic mesenchymal stem cells (hAMCs), and fibrochondrocytes (FCs) were extracted and identified by flow cytometry and immunohistochemistry (IHC). These cells were treated with TGF-β3 for one week, followed by IHC staining and qPCR to explore TGF-β3-induced fibrocartilage formation in hAECs. In the in vivo tests, a meniscus injury model was established based on rabbits, and the Sham, the control (normal saline), and the hAECs + TGF-β3 groups were used. Additionally, the meniscus was collected and checked through general examination and IHC analysis 90 d after surgery.

RESULTS

Routine transcriptome analysis confirmed that TGF-β3 induced the differentiation of amniotic epithelial cells (hAECs) into fibrochondrocytes through the Wnt signaling pathway. This finding was corroborated using Western blot (WB) and quantitative PCR (QPCR). Among the five experimental groups, the highest expression of target proteins and genes was detected in hAECs + TGF-β3 group, followed by the hAECs + hAMCs + TGF-β3 group, the hAMCs + TGF-β3 group, the hAECs + FCs group, and the FCs group. The observed differences were statistically significant (P < 0.05). In vivo, treatment with hAECs + TGF-β3 facilitated effective repair of damaged menisci.

CONCLUSIONS

hAECs + TGF-β3 can potentially promote the healing of meniscus injuries, laying the foundation for further research to promote its clinical translation.

TRIAL REGISTRATION

Not applicable.

Neurosurgical Interventions in Chronic Pain Management: A Review of Emerging Technologies and Accessibility

PURPOSE OF REVIEW

Chronic pain affects millions worldwide, reducing quality of life and posing a major healthcare challenge. This review aims to explore advancements in neurosurgical interventions for managing chronic pain, focusing on the latest neuromodulation techniques, and addressing how these innovations may offer alternative solutions for these patients.

RECENT FINDINGS

We reviewed advances in high-frequency spinal cord stimulation, dorsal root ganglion stimulation, and closed-loop neuromodulation systems, which optimize precision in pain control and reduce adverse effects. Improvements in targeted drug delivery enabled more accurate and sustained management of pain, with fewer unfavorable effects than traditional therapies. Additionally, we discussed emerging technologies, including artificial intelligence for personalized treatment adjustment, and gene therapy for addressing pain at a molecular level, innovations that also hold promise for future applications. Neurosurgical techniques have the potential to transform chronic pain management, offering improved control with fewer complications. However, challenges remain regarding accessibility, cost, and long-term efficacy. Further research is needed to refine, expand access, and enhance effectiveness.

Diabetic foot attack: Managing severe sepsis in the diabetic patient

Diabetic foot attack (DFA) is the most severe presentation of diabetic foot disease, with the patient commonly displaying severe sepsis, which can be limb or life threatening. DFA can be classified into two main categories: Typical and atypical. A typical DFA is secondary to a severe infection in the foot, often initiated by minor breaches in skin integrity that allow pathogens to enter and proliferate. This form often progresses rapidly due to the underlying diabetic pathophysiology of neuropathy, microvascular disease, and hyperglycemia, which facilitate infection spread and tissue necrosis. This form of DFA can present as one of a number of severe infective pathologies including pyomyositis, necrotizing fasciitis, and myonecrosis, all of which can lead to systemic sepsis and multi-organ failure. An atypical DFA, however, is not primarily infection-driven. It can occur secondary to either ischemia or Charcot arthropathy. Management of the typical DFA involves prompt diagnosis, aggressive infection control, and a multidisciplinary approach. Treatment can be guided by the current International Working Group on the Diabetic Foot/Infectious Diseases Society of America guidelines on diabetic foot infections, and the combined British Orthopaedic Foot and Ankle Society-Vascular Society guidelines. This article highlights the importance of early recognition, comprehensive management strategies, and the need for further research to establish standardized protocols and improve clinical outcomes for patients with DFA.

Genetic and Regulatory Mechanisms of Comorbidity of Anxiety, Depression and ADHD: A GWAS Meta-Meta-Analysis Through the Lens of a System Biological and Pharmacogenomic Perspective in 18.5 M Subjects

Background: In the United States, approximately 1 in 5 children experience comorbidities with mental illness, including depression and anxiety, which lead to poor general health outcomes. Adolescents with substance use disorders exhibit high rates of co-occurring mental illness, with over 60% meeting diagnostic criteria for another psychiatric condition in community-based treatment programs. Comorbidities are influenced by both genetic (DNA antecedents) and environmental (epigenetic) factors. Given the significant impact of psychiatric comorbidities on individuals' lives, this study aims to uncover common mechanisms through a Genome-Wide Association Study (GWAS) meta-meta-analysis. Methods: GWAS datasets were obtained for each comorbid phenotype, followed by a GWAS meta-meta-analysis using a significance threshold of p < 5E-8 to validate the rationale behind combining all GWAS phenotypes. The combined and refined dataset was subjected to bioinformatic analyses, including Protein-Protein Interactions and Systems Biology. Pharmacogenomics (PGx) annotations for all potential genes with at least one PGx were tested, and the genes identified were combined with the Genetic Addiction Risk Severity (GARS) test, which included 10 genes and eleven Single Nucleotide Polymorphisms (SNPs). The STRING-MODEL was employed to discover novel networks and Protein-Drug interactions. Results: Autism Spectrum Disorder (ASD) was identified as the top manifestation derived from the known comorbid interaction of anxiety, depression, and attention deficit hyperactivity disorder (ADHD). The STRING-MODEL and Protein-Drug interaction analysis revealed a novel network associated with these psychiatric comorbidities. The findings suggest that these interactions are linked to the need to induce "dopamine homeostasis" as a therapeutic outcome. Conclusions: This study provides a reliable genetic and epigenetic map that could assist healthcare professionals in the therapeutic care of patients presenting with multiple psychiatric manifestations, including anxiety, depression, and ADHD. The results highlight the importance of targeting dopamine homeostasis in managing ASD linked to these comorbidities. These insights may guide future pharmacogenomic interventions to improve clinical outcomes in affected individuals.

GM-CBAM-ResNet: A Lightweight Deep Learning Network for Diagnosis of COVID-19

COVID-19 can cause acute infectious diseases of the respiratory system, and may probably lead to heart damage, which will seriously threaten human health. Electrocardiograms (ECGs) have the advantages of being low cost, non-invasive, and radiation free, and is widely used for evaluating heart health status. In this work, a lightweight deep learning network named GM-CBAM-ResNet is proposed for diagnosing COVID-19 based on ECG images. GM-CBAM-ResNet is constructed by replacing the convolution module with the Ghost module (GM) and adding the convolutional block attention module (CBAM) in the residual module of ResNet. To reveal the superiority of GM-CBAM-ResNet, the other three methods (ResNet, GM-ResNet, and CBAM-ResNet) are also analyzed from the following aspects: model performance, complexity, and interpretability. The model performance is evaluated by using the open 'ECG Images dataset of Cardiac and COVID-19 Patients'. The complexity is reflected by comparing the number of model parameters. The interpretability is analyzed by utilizing Gradient-weighted Class Activation Mapping (Grad-CAM). Parameter statistics indicate that, on the basis of ResNet19, the number of model parameters of GM-CBAM-ResNet19 is reduced by 45.4%. Experimental results show that, under less model complexity, GM-CBAM-ResNet19 improves the diagnostic accuracy by approximately 5% in comparison with ResNet19. Additionally, the interpretability analysis shows that CBAM can suppress the interference of grid backgrounds and ensure higher diagnostic accuracy under lower model complexity. This work provides a lightweight solution for the rapid and accurate diagnosing of COVD-19 based on ECG images, which holds significant practical deployment value.

Empowering African Expertise: Enhancing Safety Data Integration and Signal Detection for COVID-19 Vaccines Through the African Union Smart Safety Surveillance Joint Signal Management Group

INTRODUCTION

The COVID-19 pandemic accelerated new vaccine development. Limited safety data necessitated robust global safety surveillance to accurately identify and promptly communicate potential safety issues. The African Union Smart Safety Surveillance (AU-3S) program established the Joint Signal Management (JSM) group to support identification of potential vaccine safety concerns in five pilot countries (Ethiopia, Ghana, Kenya, Nigeria, South Africa), accounting for approximately 35% of the African population.

OBJECTIVE

Our objective was to provide an overview of the JSM group's role in supporting signal management activities for the AU-3S program during the COVID-19 pandemic.

METHODS

Spontaneous, electronically reported COVID-19 vaccine adverse events following immunization (AEFI) from each country's safety data were integrated into the interim Data Integration and Signal Detection system. Statistical disproportionality methods were used to identify and review vaccine-event combinations (VECs) for potential safety concerns. The JSM group-which comprised pharmacovigilance and subject matter experts from National Medicine Regulatory Authorities, Expanded Programs on Immunization, and vaccine safety committees-conducted signal detection activities on cross-country safety data and provided recommendations.

RESULTS

From April 2021 to December 2023, a total of 48,294 spontaneously reported AEFI were analyzed for six COVID-19 vaccines (NRVV Ad [ChAdOx1 nCoV-19]; Ad26.COV2.S; Elasomeran; Tozinameran; Covid-19 vaccine [Vero Cell], Inactivated; NRVV Ad26 [Gam-Covid-Vac]) administered in Ethiopia (34.6%), Nigeria (30.3%), South Africa (16.9%), Ghana (13.5%), and Kenya (4.7%). Overall, 2,742 VECs were validated. A causal association between the COVID-19 vaccines and the reported AEFI cannot be inferred, as data were reported spontaneously. JSM group recommendations included monitoring for further evidence, no immediate action required, engaging marketing authorization holder(s) for additional information, or sensitizing healthcare providers and/or the public about events. Although no new safety signals were identified, nine safety-related recommendations were issued, including patient and healthcare provider education.

CONCLUSIONS

The JSM group established a scalable and replicable model for future signal management of other priority health products in low- and middle-income countries, fostering ongoing collaboration and capacity building. Knowledge and experience gained from this pilot initiative will guide stakeholders in future safety surveillance initiatives within the African continent.

"Cellularity as a predictive tool for mesenchymal stem cell concentration in bone marrow concentrates: Implications for regenerative medicine"

Background

Mesenchymal stem cells (MSCs) derived from bone marrow play an increasingly important role in regenerative medicine due to their capacity to promote tissue regeneration in various clinical contexts. Applications include the treatment of osteoarthritis, bone regeneration post-injury, and the management of conditions such as Crohn's disease, alopecia, and nervous system reconstruction. Accurate quantification of MSCs within Bone Marrow Concentrates (BMCs) is essential for ensuring the quality and efficacy of these cell therapy products in clinical settings.

Objective

This study aims to quantify the population of CD271+ and CD45- cells in BMCs prepared using the method we have selected and to provide a basis for comparing these results with other BMC products. Additionally, we seek to determine whether the total cell count in BMCs can serve as a reliable indicator of MSC numbers and if cellularity (the number of cells per ml) can predict a higher percentage of MSCs within the population.

Methods

Bone Marrow Aspirates (BMA) were collected from 41 patients undergoing knee or hip arthroplasty. Aspirates were processed using density gradient centrifugation and positive selection of CD271+ cells. Flow cytometry was applied to analyze cell subsets, and cell counts were determined with a NucleoCounter. The relationships between BMA cellularity (total cells per ml), MSC concentration (MSC count per ml), and MSC percentage (the proportion of MSCs within the total cell population) were assessed.

Results

The mean percentage of CD271+ CD45- cells in bone marrow samples was 0.03 % (SD 0.03 %). Cellularity varied significantly among samples, with a mean of 6 million cells/ml (SD 8.7 million cells/ml). A strong correlation was observed between BMC cellularity and MSC concentration (p < 0.05), although no correlation was found between cellularity and the MSC percentage.

Conclusion

Despite high variability in cellularity, the concentration of MSCs correlated strongly with BMC cellularity, suggesting that total cell counts can be used to estimate MSC numbers in BMCs. However, cellularity is not an indicator of a particularly high MSC content. This study supports the use of cell counts as a measure for estimating MSC concentration in BMCs. Future research should focus on establishing direct comparisons with other BMC products and exploring factors influencing cellularity and MSC percentages to enhance BMC quality for clinical applications.

Hyperbaric oxygen potentiates platelet-rich plasma composition and accelerates bone healing

Objective

This study aimed to investigate whether platelet-rich plasma (PRP) obtained from the blood of rats preconditioned with hyperbaric oxygen (HBOP) would enhance the biological activity of PRP and accelerate the healing process of femur fractures in a rat model.

Design

PRP was derived from blood samples of healthy rats subjected to either hyperbaric oxygen (hPRP) or normobaric air (nPRP). A closed femur fracture model was established in male Wistar rats, with treatments of hPRP or nPRP administered around the fracture site immediately post-fracture and on days 7, 14, 21, and 28. Growth factor concentrations in hPRP and nPRP were biochemically quantified. Bone healing was assessed weekly by X-ray, while histological and immunofluorescence analyses evaluated inflammatory status, osteoprotegerin (OPG), receptor activator of nuclear factor kappa-B ligand (RANKL) expression, and the presence of osteoblasts, osteoclasts, and osteocytes during healing. The effects of hPRP and nPRP on MC3T3-E1 preosteoblast migration and proliferation were also tested in vitro.

Results

hPRP showed significantly higher concentrations of growth factors such as activin-A, brain-derived neurotrophic factor, nerve growth factor, Flt-3 Ligand, granulocyte-macrophage colony-stimulating factor, hepatocyte growth factor, and platelet-derived growth factor, compared to nPRP. In vitro, hPRP demonstrated more significant effects on preosteoblast migration and proliferation. In vivo, hPRP treatment resulted in enhanced bone healing, higher OPG levels in osteoblasts and osteoclasts, and an elevated OPG/RANKL ratio compared to nPRP.

Conclusions

HBOP enhances the biological activity of PRP and accelerates bone healing in a closed femur fracture model in rats. This study highlights the regenerative potential of PRP when preconditioned with hyperbaric oxygen for use in bone fracture therapy.

Significance statement

PRP is widely used in treating bone defects and fractures, but its enhancement through HBOP remains underexplored. Our findings demonstrate that HBOP potentiates the biological activity of PRP, offering promising therapeutic potential for bone fracture healing.

The translational potential of this article

Enriching growth factors in PRP through HBOP could significantly improve tissue regeneration, especially in bone healing. The potential of hPRP in clinical applications is highly promising, particularly in orthopaedic surgery, trauma care, sports medicine, and managing bone healing in compromised patients.

Pathological Site Pain During Injections as a Predictive Sign for Clinical Response in Autologous Protein Solution and Hyaluronic Acid Injections for Knee Osteoarthritis

Objectives

Autologous peripheral blood-derived orthobiologics like platelet-rich plasma (PRP) have been gaining in popularity in symptomatic relief of knee osteoarthritis (OA). Autologous protein solution (APS) that is derived from PRP offers higher levels of growth factors and anti-inflammatory cytokines, reducing inflammation and improve cartilage quality. Additionally, hyaluronic acid (HA) has shown efficacy in relieving OA symptoms. This study aims to assess the clinical outcomes of combined APS and HA therapy, particularly a presence of pathological site pain (PSP) during injection as a predictive sign for clinical response.

Methods

Patients with early-stage OA received APS and HA injections. Patients were evaluated pre-injection and at 1-year follow-up. Patient-reported outcomes were assessed with WOMAC, KOOS, VAS pain score, and SF-36 survey. The OMERACT-OARSI criteria determined treatment effects. Satisfaction and expectation fulfillment were also recorded.

Results

32 patients were included in the final analysis. Statistically significant improvements were observed in all outcome scores at 1 year. The responder rate per OMERACT-OARSI criteria was 65.6 %, with 96.9 % of patients reporting satisfaction and expectation fulfillment. When comparing responder-rates and improvement in patient-reported outcome measures with other studies, combined therapy does not appear to confer additional therapeutic benefit over APS monotherapy at the 1-year mark. No severe adverse events related to the injections were reported. Patients with PSP had significantly better outcomes in terms of pain, stiffness, symptoms, activities of daily living, quality of life, as well as statistically significantly higher satisfaction rates of expectation fulfilment.

Conclusions

At 1-year post-injection, the APS and HA combination significantly improved WOMAC, KOOS, SF-36 PCS, and VAS scores, with a high rate of patient satisfaction. PSP during injection could possibly be predictive of better outcomes and expectation fulfilment.

Level of evidence

Level III.

Potential and challenges of utilizing exosomes in osteoarthritis therapy (Review)

Exosomes are integral to the pathophysiology of osteoarthritis (OA) due to their roles in mediating intercellular communication and regulating inflammatory processes. Exosomes are integral to the transport of bioactive molecules, such as proteins, lipids and nucleic acids, which can influence chondrocyte behavior and joint homeostasis. Given their properties of regeneration and ability to target damaged tissues, exosomes represent a promising therapeutic avenue for OA treatment. Exosomes have potential in promoting cartilage repair, reducing inflammation and improving overall joint function. However, several challenges remain, including the need for standardized isolation and characterization methods, variability in exosomal content, and regulatory hurdles. The present review aims to provide a comprehensive overview of the current understanding of exosome mechanisms in OA and their therapeutic potential, while also addressing the ongoing challenges faced in translating these findings into clinical practice. By consolidating existing research, the present review aims to pave the way for future studies aimed at optimizing exosome‑based therapies for effective OA management.

Neuroinflammation and pathways that contribute to tourette syndrome

Tourette syndrome (TS), a neurological and psychological disease, typically exhibit motor and phonic tics. The pathophysiology of TS remains controversial. Currently, the recognized pathogenesis of TS is the imbalance of neurotransmitters, involving abnormality of the cortex-striatum-thalamus-cortex circuit. Recently, clinical researches demonstrate that triggers such as infection and allergic reaction could lead to the onset or exacerbation of tic symptoms. Current studies have also suggested that neural-immune crosstalk caused by inflammation is also associated with TS, potentially leading to the occurrence of tics by inducing neurotransmitter abnormalities. Herein, we review inflammation-related factors contributing to the occurrence of TS as well as the mechanisms by which immune-inflammatory pathways mediate the onset of TS. This aims to clarify the pathogenesis of TS and provide a theoretical basis for the treatment of TS.

Establishing metrics of clinically meaningful change for treating knee osteoarthritis with a combination of autologous orthobiologics

Autologous bone marrow concentrate (BMC), platelet-rich plasma (PRP), and platelet lysate (PL) have emerged as promising orthobiologic treatment options for knee osteoarthritis (OA). The present observational study reports minimal clinically important difference (MCID) and substantial clinical benefit (SCB) values for several patient-reported outcome measures (PROMs) used to monitor changes in joint pain and function following percutaneous treatment of knee OA with a combination of BMC and platelet products (n = 295 knees). Distribution-based approaches were used to determine 12-month MCID values for the International Knee Documentation Committee (IKDC) subjective, Lower Extremity Functional Scale (LEFS), Numeric Pain Scale (NPS), and modified Single Assessment Numeric Evaluation (SANE) scores. Alternatively, a within-cohort, anchor-based approach, leveraging the modified SANE as a global transition question, was used to determine MCID values of 12.2, 8.4, and - 1.8, and SCB values of 29.5, 22.5, and - 3.0 for IKDC, LEFS, and NPS, respectively. Approximately 87% of treated knees reported change scores that met or exceeded an MCID value while 59% reported change scores that met or exceeded an SBC value for one or more PROMs. In reporting MCID and SCB values for PROMs following the treatment of knee OA with a combination of BMC and platelet products, we sought to provide a foundation for assessing the clinical efficacy of orthobiologic interventions in this developing field.

In Vivo Performance of a Novel Hyper-Crosslinked Carbohydrate Polymer Bone Graft Substitute for Spinal Fusion

Bone graft materials are essential for achieving arthrodesis after spine surgery. Safe bone graft products, with osteoinductive, osteoconductive properties and the ability to monitor fusion in real-time, are highly desirable. A novel hyper-crosslinked carbohydrate polymer (HCCP) bone graft substitute was shown to aid in bone regeneration in critical-size defect studies in a rabbit model. These studies further evaluated the in vivo application of HCCP as a bone graft substitute in an ovine model of spinal fusion and a retrospective study in adult human spine surgery patients. Sheep studies demonstrated the safety and efficacy of HCCP with no evidence of adverse histopathology over 6 months of follow-up. In human studies, patients (N = 63) underwent posterolateral fusion with HCCP, with follow-up to assess fusion success. No adverse reaction related to the HCCP bone graft substitute was identified. Fusion success was noted to be non-inferior to other bone graft substitutes. HCCP appears to be a safe bone void filler adjunct for use in spinal fusion surgery for both trauma and degenerative disease. It has a good degradation profile for forming bone with the ability to provide new vasculature and may also function as a scaffold to carry cells, medications, and growth factors. Given the safety profile experienced in our preclinical and clinical studies, future investigation into its efficacy to achieve solid fusion is currently ongoing.

The Regenerative Marriage Between High-Density Platelet-Rich Plasma and Adipose Tissue

The use of autologous biological preparations (ABPs) and their combinations fills the void in healthcare treatment options that exists between surgical procedures, like plastic reconstructive, cosmetic, and orthopedic surgeries; non-surgical musculoskeletal biological procedures; and current pharmaceutical treatments. ABPs, including high-density platelet-rich plasma (HD-PRP), bone marrow aspirate concentrates (BMACs), and adipose tissue preparations, with their unique stromal vascular fractions (SVFs), can play important roles in tissue regeneration and repair processes. They can be easily and safely prepared at the point of care. Healthcare professionals can employ ABPs to mimic the classical wound healing cascade, initiate the angiogenesis cascade, and induce tissue regenerative pathways, aiming to restore the integrity and function of damaged tissues. In this review, we will address combining autologous HD-PRP with adipose tissue, in particular the tissue stromal vascular fraction (t-SVF), as we believe that this biocellular combination demonstrates a synergistic effect, where the HD-PRP constituents enhance the regenerative potential of t-SVF and its adipose-derived mesenchymal stem cells (AD-MSCs) and pericytes, leading to improved functional tissue repair, tissue regeneration, and wound healing in variety of clinical applications. We will address some relevant platelet bio-physiological aspects, since these properties contribute to the synergistic effects of combining HD-PRP with t-SVF, promoting overall better outcomes in chronic inflammatory conditions, soft tissue repair, and tissue rejuvenation.

Amelioration of Astrocytic Dysfunction via AQP4/LRP1 Pathway by Zizania latifolia and Tricin in C6 Cells Exposed to Amyloid β and High-Dose Insulin and in Mice Treated with Scopolamine

Zizania latifolia and its bioactive compound tricin have been recognized for their anti-inflammatory, anti-allergic, and anti-aging properties. However, the impact of Z. latifolia extract (ZLE) and tricin on astrocyte dysfunction, particularly related to disruptions in the amyloid β (Aβ) clearance pathway, has not been extensively studied. This research aims to explore the regulatory effects of ZLE and tricin on astroglial dysfunction, utilizing astrocytic differentiated C6 cells (passages 75~85) subjected to Aβ and high-dose insulin, as well as scopolamine-induced mice. Results revealed that ZLE (500 μg/ml) and tricin (1 μg/ml) significantly upregulated the expression of astrocyte proteins GFAP and AQP4, brain-derived neurotrophic factor (BDNF), low-density lipoprotein receptor-related protein 1 (LRP1), and matrix metalloproteinases (MMPs) in C6 cells treated with Aβ and high-dose insulin. Furthermore, oral administration of ZLE (100 and 300 mg/kg) and tricin (0.3 mg/kg) in mice led to an increase in acetylcholine (ACh) levels and upregulation of insulin-degrading enzyme (IDE), LRP1, and MMPs, while reducing the levels of acetylcholinesterase (AChE), Aβ and ApoE4. These findings suggest that ZLE and tricin may ameliorate Aβ and high-dose insulin-induced astrocyte dysfunction in C6 cells and scopolamine-treated mice, potentially through the AQP4/LRP1 pathway.

Functional Ultrasound Imaging Reveals Activation Properties of Clinical Spinal Cord Stimulation Therapy Programming

Objective

Spinal cord stimulation (SCS) therapy is an established treatment for chronic neuropathic pain, but methodological limitations have prohibited detailed investigation of activation patterns it produces in the SC. Functional ultrasound imaging (fUS) is an emerging technology that monitors local hemodynamic changes in the brain with high sensitivity and spatiotemporal resolution that are tightly coupled to neural functional activity. In this study, fUS was used to investigate neuromodulation patterns produced by clinical SCS paradigms in an ovine model that enabled testing with implanted clinical hardware.

Materials and Methods

Activation of local superficial dorsal horn (SDH) regions during SCS therapy was evaluated using fUS to detect hemodynamic changes in spinal blood volume (∆SBV). Standard SCS leads were percutaneously implanted midline overlying the dura of the exposed cord (T12-L1) to enable stimulation and recording evoked compound action potentials (eCAPs). Hemodynamic activation patterns were mapped across two vertebral segments at amplitudes between 100-200% eCAP threshold for conventional tonic, multiphase, burst, high frequency and multi-frequency SCS paradigms.

Results

SCS stimulation resulted in significant activation of the SDH in differing patterns across two vertebral segments. The magnitude and volume of ∆SBV increased at higher amplitudes and was typically maximal in the SDH regions underlying the active electrodes. Therapy mode significantly influenced total area and depth of ∆SBV. Multiphase therapy produced the largest area of ∆SBV followed by multi-frequency and other SCS modes. Multiphase therapy also produced the greatest depth of ∆SBV followed by multi-frequency and burst therapies.

Conclusion

This work demonstrates that fUS can effectively measure SCS neural response patterns in the pain processing laminae of a large animal model implanted with a clinical SCS system. Hemodynamic responses in the SC varied significantly across SCS therapy modes, with multiphase stimulation providing a greater area of coverage and depth of response versus other common stimulation types.

Amniotic Fluid Reduces Liver Fibrosis By Attenuating Hepatic Stellate Cell Activation

Regardless of the source of injury or metabolic dysfunction, fibrosis is a frequent driver of liver pathology. Excessive liver fibrosis is caused by persistent activation of hepatic stellate cells (HSCs), which is defined by myofibroblast activation (MFA) and the epithelial-mesenchymal transition (EMT). Strategies to prevent or reverse this HSC phenotype will be critical for successful treatment of liver fibrosis. We have previously shown that full-term, cell-free human amniotic fluid (cfAF) inhibits MFA and EMT in fibroblasts in vitro. We hypothesize that cfAF treatment can attenuate HSC activation and limit liver fibrosis. We tested if cfAF could prevent liver fibrosis or HSC activation in murine models of liver damage, three-dimensional hepatic spheroids, and HSC cultures. Administering cfAF prevented weight loss and the extent of fibrosis in mice with chronic liver damage without stimulating deleterious immune responses. Gene expression profiling and immunostaining indicated that cfAF administration in carbon tetrachloride-treated mice reduced EMT- and MFA-related biomarker abundance and modulated transcript levels associated with liver metabolism, immune regulatory pathways, and cell signaling. cfAF treatment lowered MFA biomarker levels in a dose-dependent manner in hepatic spheroids exposed to ethanol. Treating HSCs with cfAF in vitro strongly repressed EMT. Multi-omics analyses revealed that it also attenuates TGFβ-induced MFA and inflammation-associated processes. Thus, cfAF treatment prevents liver fibrosis by safeguarding against persistent HSC activation. These findings suggest that cfAF may be a safe and effective therapy for reducing liver fibrosis and preventing the development of cirrhosis and/or hepatocellular carcinoma.

Real-world COVID-19 vaccine effectiveness in Zimbabwe: A test-negative case-control study

Background

COVID-19 vaccination is critical in sub-Saharan Africa to reduce the disease burden. This study assessed real-world vaccine effectiveness (VE) in Zimbabwe.

Aim

To determine COVID-19 VE and factors associated with disease severity and mortality in Zimbabwe.

Setting

The study setting comprised a test-negative case-control study across health facilities in Harare and Bulawayo (May 2023 - August 2023).

Methods

Adults (≥ 18 years) were recruited from COVID-19 registers (1:1 case-control; matched by sex, age and clinic visit date). Telephone interviews assessed vaccination status, disease severity (cases) and comorbidities. Conditional logistic regression estimated VE (1 - odds ratio*100), with stratification by age and comorbidities. Ordinal and simple logistic regression analysed factors associated with disease severity and vaccination-variant relationships.

Results

Overall vaccination coverage was 38% (fully vaccinated including boosters), with 62% unvaccinated. The median age was 38 years (interquartile range [IQR]: 30-50) with more females (n = 352). Overall VE against any COVID-19 infection was 32.2% (95% CI: 8.9, 49.5). Older age (45+ years) and chronic conditions were associated with increased hospitalisation risk. Among cases, hospitalisation rate was 34.8% (n = 174/500) and COVID-19-related mortality rate was 11.6% (n = 58/500).

Conclusion

This study found a moderate VE of COVID-19 vaccines in Zimbabwe, potentially influenced by age, comorbidities and variants. We highlight the need for targeted vaccination strategies and public health measures informed by these findings.

Contribution

This research informs public health strategies to optimise vaccination efforts and improve health outcomes across Africa, aligning with the journal's focus on public health issues.

Correlates of cannabis use and cannabis use disorder among adolescents with major depressive disorder and bipolar disorder in the National Comorbidity Survey-Adolescent Supplement (NCS-A)

BACKGROUND

Despite evidence regarding prevalence and correlates of cannabis use (CU) and cannabis use disorder (CUD) in major depressive disorder (MDD) and bipolar disorder (BD) in adults, little is known about this topic among adolescents.

METHODS

Data are from the 2001-2004 National Comorbidity Survey-Adolescent Supplement, an in-person, cross-sectional epidemiologic survey of mental disorders. Participants included adolescents, ages 13-18 years, with MDD (n = 354 with CU, n = 70 with CUD, n = 688 with no CU), BD (n = 79 with CU, n = 32 with CUD, n = 184 with no CU), or adolescents without mood disorders (n = 1413 with CU, n = 333 with CUD, n = 6970 with no CU). Analyses examined prevalence and correlates of CU and CUD within MDD and BD groups.

RESULTS

CU was most prevalent in adolescents with MDD followed by adolescents with BD then controls. CUD was most prevalent in adolescents with BD followed by adolescents with MDD then controls. In covariate-adjusted ordinal logistic regression models, within MDD and BD, CU and CUD groups had significantly higher odds of lifetime suicidal ideation/attempts, as well as other significant indicators of clinical severity.

LIMITATIONS

Based on changes in cannabis acceptance, potency, and availability in the two decades since this study was conducted, present findings may underestimate adverse cannabis associations.

CONCLUSION

CU and CUD are both associated with adverse clinical characteristics in a community-based sample of adolescents with MDD and BD. Evidence that risks of cannabis use extend across the spectrum of use is important for adolescents with MDD and BD, in whom cannabis-related consequences tend to be more severe.

Clinical efficacy of cell-free fat extract and its effects on bone marrow edema in patients with early to mid-stage knee osteoarthritis: a clinical trial in comparison with hyaluronic acid

BACKGROUND

Previous studies have shown that hyaluronic acid can delay the progression of knee osteoarthritis. Existing research has extracted a bright red fluid called cell-free fat extract from human adipose tissue, which may play an important role in delaying the progression of osteoarthritis. By comparing with intra-articular injection of hyaluronic acid, this study aimed to evaluate the effects of intra-articular injection of CEFFE on both clinical efficacy and the reduction of bone marrow edema in patients with early to mid-stage knee osteoarthritis.

METHODS

A total of 48 patients with KOA (Kellgren-Lawrence grade II-III) symptoms were randomly divided into CEFFE group (24 cases) and HA group (24 cases). The patients in the CEFFE group received five injections of CEFFE (2 ml, 1 time/week), and the patients in the HA group received five injections of HA (2 ml, 1 ml/10 mg, 1 time/week). All the patients underwent clinical assessments using rating scales, including VAS, WOMAC and Lysholm Knee Score. These assessments were conducted at pre-treatment and at 3-week, 6-week, 3-month, and 6-month follow-up timepoints post-treatment. The clinical efficacy was evaluated at the 6-month follow-up after the treatment. The changes in subchondral bone marrow edema before and 6 months after treatment were assessed by grading BME on MRI of the affected knees.

RESULTS

A total of 52 knees from 46 patients were included in the final analysis. Comparison of VAS score, WOMAC score, and Lysholm score between the two groups revealed that the differences between pre-treatment and 3 weeks post-treatment were not statistically significant (P > 0.05). For the VAS score and WOMAC score at 6 weeks, 3 months, and 6 months post-treatment, the CEFFE group was lower than the HA group (P < 0.05). For the Lysholm score, the CEFFE group was higher than the HA group (P < 0.05). Compared with pre-treatment, VAS scores and WOMAC scores were lower and Lysholm scores were higher at all post-treatment time points (P < 0.05). At 6 months post-treatment, the clinical efficacy of the CEFFE group was significantly better than that of the HA group (P < 0.05). At 6 months post-treatment, MRI grading showed that subchondral BME was reduced to different degrees in both groups, with the reduction being more pronounced in the CEFFE group (P < 0.05).

CONCLUSION

This study demonstrated that intra-articular injection of CEFFE into the knee joint could enhance the durability of tissue-specific cells (especially chondrocytes) and improve cellular metabolic processes, preventing the continued progression of osteoarthritis. Both CEFFE and HA were found to improve clinical symptoms and reduced subchondral bone marrow edema in the treatment of early to mid-stage knee osteoarthritis. However, CEFFE was more effective than HA in achieving these outcomes.

Development of a multiplex droplet digital PCR method for detection and differentiation of mpox virus clades

BACKGROUND

The current outbreak of mpox has been declared a public health emergency of international concern by the World Health Organization. However, distinguishing symptoms of mpox virus (MPXV) infection from other orthopoxviruses is atypical, necessitating laboratory confirmatory tests to aid in clinical diagnosis. Therefore, rapid and accurate detection and differentiation of various clades of MPXV are imperative.

OBJECTIVE

A multiplex droplet digital PCR (ddPCR) method was developed to detect and differentiate various clades of MPXV with subsequent evaluation of its sensitivity and accessibility through the analysis of 17 clinical samples.

METHODS

Primers and probes for multiple ddPCR were designed by comparing multiple complete genomes of orthopoxviruses. Primer and probe concentrations, reaction conditions were tentatively optimized on the Biorad QX200 platform. Seventeen clinical samples of MPXV were detected and verified by Sanger sequencing.

RESULTS

The established ddPCR method could detect and differentiate MPXV, and the results were consistent with those of Sanger sequencing.

CONCLUSION

Multiplex ddPCR could be used to detect and distinguish different clades of MPXV rapidly and accurately.

Pudendal Nerve Block by Adaptively Stepwise Increasing the Intensity of High-Frequency (10 kHz) Biphasic Stimulation

OBJECTIVE

The purpose of this study is to determine whether adaptively stepwise increasing the intensity of a high-frequency (10 kHz) biphasic stimulation (HFBS) can produce nerve conduction block without generating a large initial response.

MATERIALS AND METHODS

In anesthetized cats, three cuff electrodes were implanted on the left pudendal nerve for stimulation or block. The urethral pressure increase induced by pudendal nerve stimulation was used to measure the pudendal nerve block induced by HFBS.

RESULTS

HFBS applied suddenly with a large step increase in intensity induced a large (86 ± 16 cmH2O) urethral pressure increase before it blocked pudendal nerve conduction. However, HFBS applied by adaptively stepwise increasing the intensity every 10 to 60 seconds over a long period (33-301 minutes; average 108 ± 35 minutes) with many small intensity increases (0.005-0.1 mA) induced no response or low-amplitude high-frequency urethral pressure changes before it blocked pudendal nerve conduction. The minimal HFBS intensities required by the two different methods to block pudendal nerve conduction are similar.

CONCLUSION

This study is important for better understanding the possible mechanisms underlying the HFBS-induced nerve block and provides the possibility of developing a new nerve block method for clinical applications in which an initial large response is a concern.

Characterization of preclinical models to investigate spinal cord stimulation for neuropathic pain: a systematic review and meta-analysis

Despite advancements in preclinical and clinical spinal cord stimulation (SCS) research, the mechanisms of SCS action remain unclear. This may result from challenges in translatability of findings between species. Our systematic review (PROSPERO: CRD42023457443) aimed to comprehensively characterize the important translational components of preclinical SCS models, including stimulating elements and stimulation specifications. Databases (Embase, PubMed, Web of Science, and WikiStim) were searched on October 5, 2023, identifying 78 studies meeting the search criteria. We conducted a post hoc meta-analysis, including subgroup analyses and meta-regression, to assess SCS efficacy on mechanical hypersensitivity in rats subjected to neuropathic pain. Although monopolar electrodes were predominantly used as stimulating elements until 2013, quadripolar paddle and cylindrical leads gained recent popularity. Most research was conducted using 50 Hz and 200 µs stimulation. Motor threshold (MT) estimation was the predominant strategy to determine SCS intensity, which was set to 71.9% of MT on average. Our analysis revealed a large effect size for SCS (Hedge g = 1.13, 95% CI: [0.93, 1.32]) with similar magnitudes of effect between conventional (≤100 Hz) and nonconventional SCS paradigms while sham SCS had nonsignificant effect size. In addition, different stimulation intensity, frequency, and electrode design did not affect effect size. The risk of bias was assessed using Systematic Review Centre for Laboratory animal Experimentation criteria and was unclear, and only the frequency subgroup analysis showed publication bias. In summary, our review characterizes the critical components of preclinical SCS models and provides recommendations to improve reproducibility and translatability, thereby advancing the scientific foundation for SCS research.