Return to sport at the pre-injury level following anterior cruciate ligament reconstruction is influenced by patients' perceived knee status and psychological readiness, and does not correlate with functional ability

OBJECTIVES

The purposes of this study were to (1) prospectively evaluate clinical and functional outcomes of athletes following anterior cruciate ligament (ACL) reconstruction up to 12 months after surgery, (2) to identify the correlations between functional and subjective tests, and (3) to determine which factors influence patients' capability to resume sports at pre-injury level.

METHODS

Patients who underwent ACL reconstruction using doubled autologous hamstring graft were prospectively assessed pre-operatively, 6, and 12 months after surgery using International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner activity level, and ACL-Return to Sport after Injury (ACL-RSI) scale. Jumping ability was instrumentally assessed using a test battery including bipodalic squat jump (SJ), bipodalic countermovement jump (CMJ), monopodalic CMJ, and monopodalic side-hop test.

RESULTS

Thirty-three patients were available for clinical evaluation at 12-months follow-up. Average age was 34.0 years (SD 11.5, range 19-50). Male/female ratio was 31:2. Mean overall IKDC, and ACL-RSI scores increased from 52.5 to 47.1 preoperatively, to 89.9 (SD: 12.2, range 36.8-100) and 81.3 (SD 21.7, range 10-98.3), respectively at last follow-up (p ​< ​0.001). Monopodalic jump tests showed improvements at 12-month evaluation compared to 6-month follow-up (p ​< ​0.01). No statistically significant correlation was reported for ACL-RSI and jump limb symmetry index (LSI) (p ​= ​0.08 vs. CMJ; p ​= ​0.07 vs. side-hop test). No differences were observed in terms of jump LSI between patients who returned to pre-injury activity level and those who did not (p ​= ​0.11 for CMJ, p ​= ​0.09 for side-hop test). A significantly higher IKDC score at 6 months was observed in patients who did not return to pre-injury levels (p ​= ​0.009). Patients who did not return to pre-injury activity reported lower ACL-RSI scores at 12-months follow-up (p ​= ​0.007).

CONCLUSIONS

One year after ACL reconstruction, an improvement in jumping ability was observed, while a persistence of lower limbs asymmetries when performing jump tests was noted at 6-months follow-up. The ability to perform vertical jumps was not influenced by psychological outcomes 12 months following surgery. Higher values of subjective knee score and psychological readiness weakly correlated to return to sport at preinjury level, while no correlation was reported concerning jumping performance.

The systemic immune inflammation index is a reliable and novel risk factor for metabolic dysfunction-associated fatty liver disease

BACKGROUND

Metabolic dysfunction-associated fatty liver disease (MAFLD) can trigger inflammation, hepatocellular damage, cirrhosis, and hepatocellular carcinoma. There is a need for non-invasive, cost-effective diagnostic markers for MAFLD, as current methods like liver biopsy are invasive. This study investigates the potential of the systemic immune inflammation index (SII) as a useful tool in diagnosis of MAFLD.

METHODS

A cohort of 806 individuals, including 426 with MAFLD and 380 controls, was analyzed. SII values, along with various biochemical and inflammatory markers, were compared between groups.

RESULTS

The MAFLD group exhibited significantly higher SII values, which correlated with key markers of liver inflammation and function. Median SII levels of the MAFLD patients (581 (45-4553)) were significantly higher than that of the control group (423 (112-2595)) (p <0.001). SII showed moderate sensitivity (72%) and specificity (56%) in detecting MAFLD. Logistic regression analysis identified SII as an independent risk factor for MAFLD, with a unit increase in SII increasing the risk by 1.21 times.

CONCLUSIONS

These findings suggest that SII could serve as a useful, noninvasive marker for diagnosing and monitoring MAFLD, warranting further longitudinal studies to explore its role in disease progression and treatment response.

A critical overview of systematic reviews and meta-analyses of intra-articular injection of platelet rich plasma versus hyaluronic acid for knee osteoarthritis

This study is to summarize and evaluate the available evidence for the efficacy of platelet-rich plasma (PRP) and hyaluronic acid (HA) for knee osteoarthritis (KOA). Eight databases were searched from inception to September 15, 2024. All systematic reviews (SRs)/meta-analyses (MAs) treated with PRP versus HA for KOA were collected. Literature screening and data extraction were independently performed by two reviewers. The methodological quality, reporting quality, risk of bias, evidence quality, and evidence overlap rate of the included studies were evaluated by using AMSTAR 2, PRISMA 2020, ROBIS, GRADE, and GROOVE systems. Seventeen SRs were included. The results showed that the effectiveness and safety of PRP in the treatment of KOA may be superior to HA. The methodological quality of all 17 documents was extremely low quality. Sixteen of them had poor reporting quality, and there were relatively serious information deficiencies. All SRs were determined to be at high risk. Among the 221 outcome indicators, there were two medium-quality evidences, 30 low-quality evidences, and 189 extremely low-quality evidences. It was found that there was a very high overlap among the included articles. Currently, the quality of SRs on the treatment of KOA with PRP versus HA is relatively low. Future authors of SRs should adhere to quality assessment tool criteria, expand sample sizes to reduce overlap, and evaluate the quality of evidence for merged study results, in order to provide more reliable and rigorous evidence-based support for clinical practice.

Osteoking inhibits apoptosis of BMSCs in osteoporotic rats via PI3K/AKT signaling pathway

In China, Osteoking is a commonly used treatment and preventive measure for osteoporosis. The pathophysiology of osteoporosis is closely associated with apoptosis; however, it remains unclear whether the role of Osteoking in promoting bone formation is linked to apoptosis.

AIM OF STUDY

This study aims to investigate whether Osteoking inhibits apoptosis of BMSCs in osteoporotic rats via the PI3K/AKT signaling pathway and to conduct a detailed exploration of this mechanism. The goal is to provide a theoretical basis for the clinical application of Osteoking in osteoporosis treatment.

METHODS

A rat model of osteoporosis was established through bilateral ovariectomy (OVX), followed by treatment with Osteoking. After ten weeks of therapy, BMD was evaluated. The biomechanics of the left tibia were measured, the left femur was sequenced, and the right tibia was stained using histomorphometric and Masson's staining methods. Peripheral serum was collected to measure bone-related markers, including E2, PINP, and CTX. RNA-Seq results were verified using the remaining bone samples. Comparative analysis demonstrated the efficacy of Osteoking in treating osteoporosis and provided preliminary insights into the underlying mechanisms. Primary BMSCs were cultured using bone marrow apposition. CCK8 assays were conducted to screen the intervention conditions of Osteoking and LY294002. Various concentrations of Osteoking-containing serum and LY294002 were tested separately to determine the optimal intervention concentration for drug delivery. The impact of Osteoking on lipid formation was also evaluated. Following treatment of BMSCs from OVX rats with Sham serum, OVX serum, OVX + LY294002 serum, and Osteoking + LY294002 serum, the expression of PI3K/AKT/mTOR, osteogenesis-related regulatory factors, and apoptosis-related regulatory factors was assessed. Flow cytometry was employed to evaluate apoptosis in BMSCs.

RESULTS

Osteoking significantly improved whole-body BMD and bone biomechanical indices in OVX rats. It also significantly elevated the serum levels of E2 and PINP while reducing the level of CTX, which significantly improved bone microstructure and promoted new bone formation. RNA-seq analysis indicated that the therapeutic mechanism involved the PI3K/AKT signaling pathway. Osteoking increased the expression of RUNX2 and decreased the expression of PPAR-γ, a marker of lipogenesis, in OVX rats. Extraction of BMSCs for subsequent studies revealed a significant reduction in proliferation and osteogenic differentiation, along with an increase in lipogenic differentiation, in the OVX group. Osteoking treatment inhibited the expression of PPAR-γ and increased the expression of RUNX2 in BMSCs. Additionally, Osteoking reversed the LY294002-mediated inhibition of PI3K/AKT/mTOR signaling pathway activation, increased the expression of the apoptosis-protecting protein Bcl2, and decreased the expression of apoptosis-associated proteins Caspase3 and Bax.

CONCLUSION

Osteoking markedly improved bone microstructure, biomechanics, and bone density in OVX rats. Osteoking-containing serum reversed the imbalance in lineage differentiation in OVX rats, characterized by reduced osteogenic differentiation and increased lipid differentiation of BMSCs. Furthermore, Osteoking-containing serum significantly increased BMSC proliferation and prevented apoptosis in OVX rats through the PI3K/AKT signaling pathway.

Primary Anterior Cruciate Ligament Reconstruction Performed With Hamstring Tendon Autograft Leads to an Over 4 Times Greater Rate of Second Anterior Cruciate Ligament Rupture After Return to Sport in Patients With Generalized Joint Hypermobility Compared With Bone-Patellar Tendon-Bone Autograft

PURPOSE

To examine the rate of (1) second anterior cruciate ligament (ACL) rupture (graft rupture or contralateral ACL rupture) and (2) graft rupture alone in patients with generalized joint hypermobility (GJH) at 12 months, at 24 months, and at the longest available time (LAT) following return to sport (RTS) after ACL reconstruction depending on graft choice, that is, hamstring tendon (HT) autograft or bone-patellar tendon-bone (BPTB) autograft.

METHODS

Data were extracted from a rehabilitation registry that comprised patients who had undergone ACL reconstruction between 2014 and 2022. Patients with GJH aged between 16 and 50 years who had minimum 24-month follow-up following RTS after ACL reconstruction with HT autograft (GJH-HT) or BPTB autograft (GJH-BPTB) were included. A Cox proportional hazard regression model was used to examine the rate of (1) second ACL rupture (graft rupture or contralateral ACL rupture) and (2) graft rupture alone at 12 months, at 24 months, and at the LAT after RTS.

RESULTS

This study included 82 patients (54 in the GJH-HT group and 28 in the GJH-BPTB group), of whom 72.0% were female patients, and the average age was 22.7 ± 7.4 years. The proportion of second ACL ruptures was greater in the GJH-HT group than in the GJH-BPTB group at 12 months (11 of 54 [20.4%] vs 0 of 28 [0%], P = .013), at 24 months (13 of 54 [24.1%] vs 1 of 28 [3.6%], P = .028), and at the LAT (16 of 54 [29.6%] vs 2 of 28 [7.1%], P = .024) after RTS. The rate of second ACL rupture was greater in the GJH-HT group than in the GJH-BPTB (hazard ratio = 4.98, P = .032) at the LAT after RTS. The proportion of patients with graft rupture was greater in the GJH-HT group than in the GJH-BPTB group at 12 months (8 of 54 [14.8%] vs 0 of 28 [0%], P = .046), at 24 months (10 of 54 [18.5%] vs 0 of 28 [0%], P = .013), and at the LAT (12 of 54 [22.2%] vs 0 of 28 [0%], P = .006) after RTS.

CONCLUSIONS

An over 4 times greater rate of second ACL rupture after RTS was reported for patients with GJH who underwent ACL reconstruction with HT autograft compared with BPTB autograft. Patients with GJH who were treated with BPTB autograft for ACL reconstruction did not experience graft rupture after RTS.

LEVEL OF EVIDENCE

Level III, retrospective study.

Network Pharmacology Analysis and Biological Validation Systemically Identified the Active Ingredients and Molecular Targets of Kudzu Root on Osteoporosis

As a traditional medicinal food, Kudzu root (KR) has been proven to be an effective medicine for treating osteoporosis (OP). However, its precise targets and underlying integrated pharmacological mechanisms on OP have not yet been systematically investigated. The aim of the present study was to systemically explore the active ingredients, molecular targets, and ingredient-target network of KR against OP by the methods of network pharmacology followed by biological validation in a glucocorticoid-induced bone loss model of zebrafish. Our results identified a total of 15 active compounds with good pharmacokinetic properties in KR and 119 targets related to OP from correspondent databases, forming an ingredient-target network. Additionally, the protein-protein interaction (PPI) network further identified 39 core targets. Enrichment analyses with functional annotation revealed that the TNF signaling pathway and osteoclast differentiation process were significantly enriched by multi-targets including AKT1, P65, MAPK14, JUN, TNF-α, MMP9, IL6, and IL1B, etc., and served as the critical targets for molecular docking, molecular dynamics simulation, and in vivo experiment validation. These critical targets performed effectively in molecular docking and molecular dynamics, with AKT1, MMP9, and TNF-α exhibiting more prominent binding energy with Coumestrol, Genistein, and Genistein 7-glucoside, respectively. Further experimental validation in a zebrafish model indicated that KR could regulate the expressions of critical targets (AKT1, P65, MAPK14, JUN, TNF-α, and MMP9). This study provides a systemic perspective of the relationships between the active ingredients of KR and their multi-targets in OP, thereby constructing a pharmacological network to clarify the mechanisms by which KR ameliorates OP.

The Prognostic Value of Inflammatory Indices in Acute Pulmonary Embolism

Background: Acute pulmonary embolism (PE) is a condition with increased morbidity and mortality. It is important to identify patients with high mortality risk. Inflammation and thrombosis are interconnected in the pathophysiology of PE. The aim of the study was to investigate the prognostic value of multiple blood cellular indices such as neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte platelet ratio (NLPR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI) and aggregate index of systemic inflammation (AISI) in acute PE. Methods: A total of 157 patients with acute PE confirmed by chest computed tomographic angiography (CTPA) were enrolled. These patients were divided into two categories according to the simplified pulmonary embolism severity index (sPESI): high risk and low risk. Results: Univariate logistic regression analysis showed that right ventricle dysfunction, NLR, SII and SIRI were significantly associated with high risk of acute PE. NLR of 4.32 was associated with high-risk PE with a sensitivity of 57.4% and specificity of 65.7% (AUC = 0.635). SII of 1086.55 was associated with high-risk PE with a sensitivity of 55.7% and specificity of 71.4% (AUC = 0.614). SIRI of 2.87 was associated with high-risk PE with a sensitivity of 59% and specificity of 62.9% (AUC = 0.624). Multivariate logistic regression analysis demonstrated that right ventricle dysfunction, NLR, PLR and NLPR are independent predictors of high-risk acute PE. Secondly, NLR, NLPR, SII and SIRI were significantly correlated with in-hospital mortality of acute PE. Based on receiver-operating characteristic (ROC) curve values of 7.66 for NLR (AUC 0.911, sensitivity of 85.7% and sensibility of 83%), 0.02 for NLPR (AUC 0.871, sensitivity of 85.7% and sensibility of 70%), 1542.71 for SII (AUC 0.782, sensitivity of 71.4% and sensibility of 72%) and 5.72 for SIRI (AUC 0.788, sensitivity of 71.4% and sensibility of 73%) could predict in-hospital mortality. Conclusions: The blood cellular indices (NLR, NLPR, SII and SIRI) are associated with high-risk acute PE and in-hospital mortality. Right ventricular dysfunction, NLR and NLPR are independent predictors for high-risk acute PE.

Efficacy and Safety of a Novel Low-Dose Water-Dispersible Turmeric Extract in the Management of Knee Osteoarthritis: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Purpose

Turmeric extract is a well-known nutraceutical ingredient recognized for its benefits in managing musculoskeletal health. This study evaluated the efficacy and safety of a novel low-dose water-dispersible turmeric extract containing 60% natural curcuminoids (WDTE60N) in participants with mild-to-moderate knee osteoarthritis.

Patients and Methods

This double-blind, randomized, placebo-controlled trial was conducted at two orthopedic centers in Uttar Pradesh, India (July 2023-November 2023). Participants aged 45-75 years with unilateral or bilateral OA of the knee for >3 months were randomized in 1:1 ratio to receive WDTE60N (250 mg) or placebo capsules once daily for three months. Study endpoints included assessment of changes from baseline to day 90 in pain intensity (visual analog scale [VAS], knee injury and osteoarthritis outcome score [KOOS]), inflammatory biomarkers, and safety profile. Data were analyzed using independent t-test, chi-square test, and analysis of co-variance test.

Results

In total, 139 participants (WDTE60N, n = 70; placebo, n = 69) with mean age and BMI of 56.35 years and 23.89 kg/m2, respectively, were included. The mean reduction (95% CI) in VAS score from baseline to day 90 was significantly higher in the WDTE60N group than in the placebo group (14.41 [13.08, 15.75] vs 6.02 [5.00, 7.05]; p < 0.0001). In the WDTE60N group, the mean change in VAS scores was significantly reduced from as early as day 07 (p = 0.0076), which continued until day 90 (p < 0.0001), compared to the placebo group. Improvement in the mean KOOS scores (baseline-Day 90) was evident, with significantly higher mean scores for each domain (pain, symptoms, activities of daily living, function in sport and recreation, and knee-related quality of life [QoL]) on Day 90 in the WDTE60N group than in the placebo group (p < 0.05). Inflammatory biomarkers (hsCRP, TNF-α, IL-6, and IL-1β) were significantly reduced from baseline to day 90 in the WDTE60N group compared to the placebo group (p < 0.0001). Four mild adverse events were reported during the study period.

Conclusion

Supplementation with the low-dose water-dispersible turmeric extract containing 60% natural curcuminoids for three months was safe and effective in alleviating pain, improving functional status and quality of life and reducing inflammation in participants with mild-to-moderate knee osteoarthritis.

CTRI Registration Number

CTRI/2023/07/055411.

Associations between neutrophil percentage to albumin ratio and rheumatoid arthritis versus osteoarthritis: a comprehensive analysis utilizing the NHANES database

Objectives

The association between the neutrophil percentage to albumin ratio (NPAR) and the risk of osteoarthritis (OA) and rheumatoid arthritis (RA) remains unclear. This study aims to investigate the association between NPAR and the risk of OA and RA.

Methods

This cross-sectional study analyzed data from 92,062 American adults in the NHANES database between 1999 and 2016. Various statistical analyses were conducted to investigate the associations between NPAR and the risks of OA and RA, including multivariable logistic regression, subgroup analysis, smooth curve fitting, and threshold effect analysis.

Results

After screening, the final study population included 36,147 participants, with 3,881 individuals diagnosed with OA and 2,178 with RA. After adjusting for confounding factors, higher NPAR levels were associated with an increased risk of RA (OR=1.05; 95% CI: 1.03-1.07; P <0.0001), but not with OA (OR=1.01; 95% CI: 0.99-1.02; P =0.755). This association was remarkably consistent across subgroups by age, sex, body mass index (BMI), alcohol consumption, hypertension, diabetes, and smoking status. Further analyses using curve fitting and threshold effect models revealed a nonlinear association between NPAR and RA, with an inflection point identified at 15.56.

Conclusion

High levels of NPAR is positively associated with the prevalence of RA. This provides us with new insights for the management and treatment of RA patients.

Characterization of rectus femoris lesions in knee osteoarthritis at different stages and the effect of ultrasound-guided acupotomy

Introduction

Chronic injury to the rectus femoris muscle induces and exacerbates the progression of knee osteoarthritis (KOA). However, the lesion characteristics of the rectus femoris muscle in KOA at different stages have not been fully characterized. The aim of this study was to analyze the pattern of lesion characteristics of the rectus femoris muscle at different stages of KOA and to investigate the mechanism by which ultrasound-guided acupotomy operations can prevent and control KOA.

Methods

Early, middle, and late-stage rabbit KOA models were constructed using the modified Videman method. Ultrasonography was used to record the elastic modulus and cross-sectional area of the rectus femoris muscle, and morphology was used to observe the ultramicroscopic changes in the rectus femoris muscle and assess the degree of fibrosis. Additionally, ultrasound-guided acupotomy operations were performed on the rabbit model of late-stage KOA, and alterations in the key molecular markers of rectus femoris fibrosis were determined using Western Blot and qPCR methods.

Results

As the disease progressed, the elastic modulus of the rectus femoris muscle in KOA rabbits gradually increased, the cross-sectional area gradually decreased, and the degree of fibrosis increased. In contrast, the degree of fibrosis in the rectus femoris muscle improved after ultrasound-guided acupotomy intervention.

Conclusion

These findings highlight the gradual increase in the modulus of elasticity, the gradual decrease in cross-sectional area, and the increased fibrosis of the rectus femoris muscle in KOA rabbits as the disease progressed. Ultrasoundguided acupotomy operations have been shown to have a protective effect on KOA cartilage and to delay the progression of KOA by ameliorating pathological changes in the rectus femoris muscle. The mechanism may involve reducing chronic injury to the rectus femoris muscle and protecting joint homeostasis by attenuating the degree of rectus femoris fibrosis.

Intravenous Tranexamic Acid Does Not Improve Visual Field Clarity During Hip Arthroscopy: A Double-Blind, Randomized, Placebo-Controlled Trial

PURPOSE

To determine the effectiveness of administering intravenous (IV) tranexamic acid (TXA) on altering visual field clarity (VFC) during arthroscopic hip preservation surgery for patients with femoroacetabular impingement syndrome (FAIS).

METHODS

This randomized, double-blind, parallel-design trial was conducted over a 7-month period between October 2023 and May 2024 at a single tertiary musculoskeletal hospital. The inclusion criteria were consecutive patients who received a diagnosis of FAIS through clinical history, physical examination, and advanced imaging and was indicated for hip arthroscopy after failure of conservative management. This trial prospectively randomized 78 participants (39 assigned to receive 1,000 mg of TXA in a 100-mL/0.9% normal saline solution bolus and 39 assigned to receive a 100-mL/0.9% normal saline solution bolus only). Treatment intervention was administered within 15 minutes of incision. The primary outcome was arthroscopic VFC assessed on a Likert-style numeric rating scale and graded by the surgeon at 15-minute intervals as follows: 1, poor visibility (active bleeding to the degree that vision was too poor to perform the operation); 2, fair visibility (mild bleeding that interfered with vision, but the operation could still be performed); or 3, good visibility (clear vision without obvious blood). The percentage of good VFC ratings (i.e., the percentage of surgeon ratings equal to 3 on the numeric rating scale throughout the procedure) was quantified for each patient. No minimum follow-up was required because the primary endpoint was intraoperative.

RESULTS

The baseline characteristics of the TXA cohort (mean age, 37.3 years; 61.5% male sex; 76.9% white) were not significantly different from those of the placebo group (mean age, 33.6 years; 59% male sex; 86.8% white) (P > .05 for all). TXA was not associated with improved VFC compared with placebo at any intraoperative time point or when considering composite overall VFC scores (2.51 ± 0.41 in TXA group vs 2.64 ± 0.42 in placebo group, P = .16). Furthermore, no significant difference was observed in the percentage of good VFC ratings between treatment groups (56.4% in TXA group vs 66.4% in placebo group, P = .17). Multivariate regression analysis adjusted for demographic and intraoperative covariates did not show an association between TXA and VFC ratings (β = -0.14, P = .14) or percentage of good VFC ratings (β = -11.6, P = .15). No medical or intraoperative complications related to the treatment intervention were observed in either treatment arm.

CONCLUSIONS

Among patients with FAIS undergoing arthroscopic hip preservation surgery, administration of TXA did not improve arthroscopic VFC when compared with placebo. Therefore, the results of this randomized trial do not support the routine use of TXA in arthroscopic hip preservation surgery for improvement in arthroscopic visualization.

LEVEL OF EVIDENCE

Level I, prospective randomized controlled trial.

Compliance with research participant protection guidelines by Nigerian medical journals

BACKGROUND

Stakeholders in medical research have roles in ensuring that research participants are protected. Medical journals play gatekeeping roles in the responsible conduct of research. They help guard against the publication of findings of unethical research, such as those with compromised participant welfare. Nigerian medical journals are being created to support the growing number of research enterprises. In this study, we aimed to determine the compliance of Nigerian medical journals with guidelines on research participant protection.

METHODS

This was a descriptive cross-sectional study of Nigerian medical journals and articles. We used a checklist to obtain information on journal characteristics and the presence of recommendations from the International Committee of Medical Journal Editors (ICMJE) on the protection of research participants in the journal instructions to authors and articles. The data were analysed via IBM SPSS version 23.

RESULTS

We studied 40 journals and 350 journal articles. Thirty-one (77.5%) journals required ethical approval and the Declaration of Helsinki statement in their instructions to the authors, while informed consent was present in 26 (65.0%) journals; 6 (15.0%) journals had no participant protection guidelines. Forty-one (11.7%) articles complied with all three recommendations on research participant protection, whereas 60 (17.1%) articles did not. Ethical approval was most common in 268 (76.6%) articles, whereas it was least common in statements on the Declaration of Helsinki in 50 (14.3%) articles. The presence of participant protection recommendations in instructions to authors was not associated with compliance with these recommendations in published articles (p > 0.05).

CONCLUSION

Although there is fairly good compliance of Nigerian medical journals with research participant protection recommendations, there are still gaps, which highlight the need for remedial measures.

Hierarchy Reproduction: Multiphasic Strategies for Tendon/Ligament-Bone Junction Repair

Tendon/ligament-bone junctions (T/LBJs) are susceptible to damage during exercise, resulting in anterior cruciate ligament rupture or rotator cuff tear; however, their intricate hierarchical structure hinders self-regeneration. Multiphasic strategies have been explored to fuel heterogeneous tissue regeneration and integration. This review summarizes current multiphasic approaches for rejuvenating functional gradients in T/LBJ healing. Synthetic, natural, and organism-derived materials are available for in vivo validation. Both discrete and gradient layouts serve as sources of inspiration for organizing specific cues, based on the theories of biomaterial topology, biochemistry, mechanobiology, and in situ delivery therapy, which form interconnected network within the design. Novel engineering can be constructed by electrospinning, 3-dimensional printing, bioprinting, textiling, and other techniques. Despite these efforts being limited at present stage, multiphasic scaffolds show great potential for precise reproduction of native T/LBJs and offer promising solutions for clinical dilemmas.

Current Status of Plant-Based Bioactive Compounds as Therapeutics in Alzheimer's Diseases

Alzheimer's disease (AD) is a common central neurodegenerative disease disorder characterized primarily by cognitive impairment and non-cognitive neuropsychiatric symptoms that significantly impact patients' daily lives and behavioral functioning. The pathogenesis of AD remains unclear and current Western medicines treatment are purely symptomatic, with a singular pathway, limited efficacy, and substantial toxicity and side effects. In recent years, as research into AD has deepened, there has been a gradual increase in the exploration and application of medicinal plants for the treatment of AD. Numerous studies have shown that medicinal plants and their active ingredients can potentially mitigate AD by regulating various molecular mechanisms, including the production and aggregation of pathological proteins, oxidative stress, neuroinflammation, apoptosis, mitochondrial dysfunction, neurogenesis, neurotransmission, and the brain-gut microbiota axis. In this review, we analyzed the pathogenesis of AD and comprehensively summarized recent advancements in research on medicinal plants for the treatment of AD, along with their underlying mechanisms and clinical evidence. Ultimately, we aimed to provide a reference for further investigation into the specific mechanisms through which medicinal plants prevent and treat AD, as well as for the identification of efficacious active ingredients derived from medicinal plants.

A meta-analysis and systematic review of the clinical efficacy and safety of platelet-rich plasma combined with hyaluronic acid (PRP + HA) versus PRP monotherapy for knee osteoarthritis (KOA)

INTRODUCTION

KOA, a chronic degenerative joint disease, is commonly treated with intra-articular HA and PRP, used alone or in combination. However, the efficacy and safety of combination therapy (PRP + HA) remain unclear.

AIM

The aim of this systematic review and meta-analysis is to assess the clinical effectiveness and safety profile of PRP + HA versus PRP monotherapy for KOA.

MATERIAL AND METHODS

A systematic search was conducted using four electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) to select publications published in peer-reviewed journals. The mean difference (MD) and risk ratio (RR) was calculated, along with their 95% confidence intervals. We assessed heterogeneity using Cochrane Q and I2statistics and the appropriate p-value. The analysis used RevMan 5.4. GRADE system was used for evidence assessment for each outcome parameter.

RESULTS

This meta-analysis of 11 RCTs (n = 1023 KOA patients) revealed that PRP + HA has substantial effectiveness than PRP alone in reducing OMAC total scores [MD -1.77 (95% CI -2.20 to - 1.34); I2 = 10%, and p < 0.001], VAS scores [MD -4.27 (95% CI -4.96 to - 3.58); I2 = 13%, and p < 0.001], and Lequesne index score [MD -5.48 (95% CI -6.56 to - 4.40); I2 = 16%, and p < 0.001], while increasing IKDC scores [MD -2.10 (95% CI -3.70 to - 0.50); I2 = 9%, and p = 0.01], with low risk of adverse events [RR 0.41 (95% CI 0.35 to 0.48); I2 = 12%, and p < 0.001].

CONCLUSION

This meta-analysis reveals that, for patients with KOA, PRP + HA therapy is safe and yields better outcomes in pain relief and functional improvement compared to PRP monotherapy.

Two-stage revision anterior cruciate ligament reconstruction reduces failure risk but leads to lesser clinical outcomes than single-stage revision after primary anterior cruciate ligament graft failure: a retrospective cohort study

BACKGROUND

There are no studies that compare the outcomes and complications of single-versus two-stage revision anterior cruciate ligament reconstruction (ACLR) after primary ACLR failure. This purpose of this study is to examine clinical and functional outcomes and complications associated with single and two-stage revision ACLR after primary ACLR failure.

METHODS

All patients who underwent single or two-stage revision ACLR after primary ACLR failure between 2012 and 2021 with a minimum of a 2 year follow-up were included. Patients were excluded if they were not treated at our single academic institution, had inadequate follow-up, or had incomplete medical records. Revision intraoperative data, concomitant injuries, and complications were collected by chart review. Return to sport, numerical pain rating scale (NPRS) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Veteran Rands 12-item health survey (VR-12 scores) were collected.

RESULTS

The final analysis included 176 patients. A total of 147 (83.5%) had a single-stage revision ACLR (87 male, 60 female), and 29 (16.5%) had a two-stage revision ACLR (13 male, 16 female). Two-stage revision ACLR was significantly associated with anterior knee pain [odds ratio (OR) 4.36; 95% confidence interval (CI) 1.5 to 12.65; P = 0.007] but with lower failure rates (OR 0.12, 95% CI 0.02 to 0.9; P = 0.04). On multivariate analysis, a two-stage revision ACLR reduced the risk of graft failure by 85% (OR 0.15; 95% CI 0.02 to 1.17; P = 0.07). Two-stage revision ACLR was significantly associated with a lower KOOS pain score (OR -11.7; 95% CI -22.35 to -1.04; P = 0.031), KOOS symptoms score (OR -17.11; 95% CI -28.85 to -5.36; P = 0.004), KOOS Activities of Daily Living (ADL) score (OR -11.15; 95% CI -21.71 to -0.59; P = 0.039) and Veterans RAND 12-Item Health Survey (VR-12) physical component score (OR -9.99; 95% CI -15.77 to -4.22; P = 0.001).

CONCLUSIONS

The clinical outcomes and subjective patient scores significantly differed between the single-stage and two-stage revision ACLR after primary ACLR failure. Patients with a two-stage revision ACLR had a significantly reduced risk of revision graft failure but higher rates of postoperative anterior knee pain, lower pain scores, and lesser knee functional scores than single-stage revision patients.

STUDY DESIGN

Retrospective cohort study; level of evidence, 3.

Assessment of a novel unidirectional mid-term absorbable barbed suture versus a competitor barbed suture for vaginal cuff closure after gynaecology surgery, study protocol of a randomized controlled trial - BARHYSTER

BACKGROUND

Total laparoscopic hysterectomy (TLH) is nowadays the standard to treat benign and malignant disease occurring in the uterus, but the number of robotic-assisted surgeries is increasing worldwide. To facilitate the handling of sutures in a bi- and tri-dimensional plane, a new type of suture material has been developed, named barbed sutures, which are in use in different indications. In comparison to conventional suture materials, the barbs anchor the suture in the tissue, provide tissue approximation and prevent slippage without the need for knot tying. Several meta-analyses and systematic reviews have shown that they are safe and efficient. The current study investigates the clinical outcome of a novel unidirectional mid-term absorbable barbed suture which differs in its configuration from other barbed sutures. The collected data will be prospectively compared to the results of a competitor's unidirectional mid-term absorbable barbed suture and retrospectively to the findings reported for conventional sutures after hysterectomy in the literature.

METHODS

An international, randomised, multicentric, single-blinded design was chosen. A total of 132 patients will be included receiving randomly either the novel unidirectional barbed suture versus the competitor unidirectional barbed suture in a 3:1 ratio. Both suture materials will be applied to close the vaginal cuff after laparoscopic hysterectomy and the time for suturing is the primary endpoint. As secondary objectives, the following parameters will be collected and compared in both suture groups: intraoperative handling of the suture material, quality of life using the Female Sexual Function Index (FSFI), patient satisfaction, pain, and complications occurring in the short-term and long-term follow-up. For each patient, the study lasts 6 months after surgery.

DISCUSSION

This study will assess the clinical performance of a novel unidirectional mid-term absorbable barbed suture material for the first time in gynaecology surgery and, to our knowledge, it will be the second largest RCT performed so far in total laparoscopic hysterectomy using unidirectional mid-term absorbable barbed suture materials.

TRIAL REGISTRATION

The study was prospectively registered before the enrolment of the first patient. Registration was performed under www.

CLINICALTRIALS

gov , NCT06024109. Registered on 15 August, 2023.

The mediating role of inflammatory biomarkers in the association between serum copper and sarcopenia

This study aims to investigate the association between serum copper (Cu), selenium (Se), zinc (Zn), Se/Cu and Zn/Cu ratios and the risk of sarcopenia. In this study, which involved 2766 adults aged ≥ 20 years enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2016, multivariable logistic regression, restricted cubic spline (RCS) models and mediation analyses were used. After full adjustment, multivariable logistic regression revealed that higher serum copper levels were correlated with an increased risk of sarcopenia. Conversely, higher serum Se/Cu (OR 0.45, 95% CI 0.23-0.89, P = 0.023) and Zn/Cu (OR 0.49, 95% CI 0.27-0.90, P = 0.024) were associated with a decreased risk of sarcopenia. The RCS curve indicated a non-linear, roughly inverted L-shaped relationship between serum Cu and sarcopenia risk (P non-linear < 0.001). Additionally, Se/Cu (P non-linear = 0.179) and Zn/Cu (P non-linear = 0.786) showed negative linear associations with sarcopenia risk. Furthermore, white blood cell (WBC) count, neutrophil count, and systemic inflammation index (SII) were identified as significant mediators in the relationship between serum Cu and the risk of sarcopenia, with mediation proportions of 6.34%, 6.20%, and 4.37%, respectively (all P < 0.05). Therefore, balancing essential trace metals is crucial for maintaining muscle health.

Identification of biomarkers for knee osteoarthritis through clinical data and machine learning models

Knee osteoarthritis (KOA) represents a progressive degenerative disorder characterized by the gradual erosion of articular cartilage. This study aimed to develop and validate biomarker-based predictive models for KOA diagnosis using machine learning techniques. Clinical data from 2594 samples were obtained and stratified into training and validation datasets in a 7:3 ratio. Key clinical features were identified through differential analysis between KOA and control groups, combined with least absolute shrinkage and selection operator (LASSO) regression. The SHapley Additive Planning (SHAP) method was employed to rank feature importance quantitatively. Based on these rankings, predictive models were constructed using Logistic Regression (LR), Random Forest (RF), eXtreme Gradient Boosting (xGBoost), Naive Bayes (NB), Support Vector Machine (SVM), and Decision Tree (DT) algorithms. Models were developed for subsets of variables, including the top 5, top 10, top 15, and all identified features. Receiver operating characteristic (ROC) curves were applied to compare diagnostic performance across models. Additionally, a risk stratification framework for KOA prediction was designed using recursive partitioning analysis (RPA). Using difference analysis and LASSO, 44 critical clinical features were identified. Among these, age, plasma prothrombin time, gender, body mass index (BMI), and prothrombin time and international normalized ratio (PTINR) emerged as the top five features, with SHAP values of 0.1990, 0.0981, 0.0471, 0.0433, and 0.0422, respectively. Machine learning analysis demonstrated that these variables provided robust diagnostic performance for KOA. In the training set, area under the curve (AUC) values for LR, RF, xGBoost, NB, SVM, and DT models were 0.947, 0.961, 0.892, 0.952, 0.885, and 0.779, respectively. Similarly, in the validation dataset, these models achieved AUC values of 0.961, 0.943, 0.789, 0.957, 0.824, and 0.76. Among them, RF consistently exhibited superior diagnostic accuracy for KOA. Additionally, RPA analysis indicated a higher prevalence of KOA among individuals aged 54 years and older. The integration of the top five clinical variables significantly enhanced the diagnostic accuracy for KOA, particularly when employing the RF model. Moreover, the RPA model offered valuable insights to assist clinicians in refining prognostic assessments and optimizing clinical decision-making processes.

Diagnostic efficacy of dual-energy CT virtual non-calcium technique in the diagnosis of bone marrow edema of sacroiliac joints in ankylosing spondylitis

OBJECTIVE

In-depth investigation of the diagnostic performance of dual-energy CT (DECT) virtual non-calcium (VNCa) technique for sacroiliac joint bone marrow edema (BME) in patients with ankylosing spondylitis(AS).

METHODS

A total of 42 patients with AS)who underwent sacroiliac joint MRI and DECT scans on the same day at our Rheumatology and Immunology Department between August 2022 and June 2023 were selected. Using MRI as the reference standard, the presence of BME on the iliac and sacral surfaces was evaluated, resulting in the categorization of patients into BME-positive and BME-negative groups. Subsequently, the DECT scan data was processed using the "Bone Marrow" algorithm to generate VNCa color-coded images of the bone marrow. The diagnostic performance of DECT in detecting BME was assessed through visual qualitative evaluation and objective quantitative analysis.

RESULTS

Visual qualitative assessment analysis showed good agreement between the results of BME analysis on virtual non-calcium images and MRI images by both physicians (Kappa > 0.61). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of visual qualitative assessment for BME by Physicians A and B were as follows: iliac facet [(92.5%, 88.6%, 88.1%, 92.9%, 90.5%), (90.0%, 90.9%, 90.0%, 90.9%, 90.5%)], sacral facet [(88.4%, 87.8%, 88.4%, 87.8%, 88.1%), (90.7%, 85.3%, 86.7%, 89.7%, 88.1%)].In terms of objective quantitative analysis, the CT values of the edematous areas on the iliac and sacral surfaces were (-41.4 ± 15.9) Hu and (-38.8 ± 19.7) Hu, respectively, while the CT values of normal bone marrow areas were (-79.6 ± 18.2) Hu and (-72.8 ± 14.8) Hu, respectively. The CT values of the edematous areas were higher than those of the non-edematous areas. Based on the receiver operating characteristic curve analysis, the area under the curve for the iliac and sacral surfaces were 0.90 and 0.89, respectively. The optimal CT cutoff values were - 57.4 Hu and - 56.8 Hu, with corresponding sensitivities of 92.5% and 86.4% and specificities of 90.7% and 87.8%.

CONCLUSION

The DECT VNCa technique has a high diagnostic efficacy in the diagnosis of BME in the sacroiliac joints in ankylosing spondylitis in terms of visual qualitative assessment and objective quantitative analysis.

Therapeutic potential of short-chain fatty acids for acute lung injury: a systematic review and meta-analysis of preclinical animal studies

Background

Short-chain fatty acids (SCFAs), derived from the fermentation of dietary fiber by intestinal commensal bacteria, have demonstrated protective effects against acute lung injury (ALI) in animal models. However, the findings have shown variability across different studies. It is necessary to conduct a comprehensive evaluation of the efficacy of these treatments and their consistency.

Objective

This systematic review and meta-analysis aimed to explore the effects of SCFAs on ALI based on preclinical research evidence, in order to provide new treatment strategies for ALI.

Methods

We included studies that tested the effects of SCFAs on ALI in animal models. This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search for relevant studies was conducted in the PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases up to February 2024. The data were extracted in accordance with the established selection criteria, and the risk of bias was evaluated for each study.

Results

A total of 16 articles were finally included in the meta-analysis. The results indicated that the SCFAs significantly reduced lung wet-to-dry weight (SMD = -2.75, 95% CI = -3.46 to -2.03, p < 0.00001), lung injury scores (SMD = -5.07, 95% CI = -6.25 to -3.89, p < 0.00001), myeloperoxidase (SMD = -3.37, 95% CI = -4.05 to -2.70, p < 0.00001), tumor necrosis factor-alpha (SMD = -3.31, 95% CI = -4.45 to -2.16, p < 0.00001) and malondialdehyde (SMD = -3.91, 95% CI = -5.37 to -2.44, p < 0.00001) levels in animal models of ALI. The results of the subgroup analysis indicated that the efficacy of SCFAs varies significantly with dosage and duration of treatment.

Conclusion

SCFAs can reduce inflammation and oxidative stress in animal models of ALI. The clinical efficacy of SCFAs for ALI deserves further in-depth research.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=584008, CRD42024584008.

EZH2/miR-142-3p/HMGB1 axis mediates chondrocyte pyroptosis by regulating endoplasmic reticulum stress in knee osteoarthritis

BACKGROUND

Knee osteoarthritis (OA) is still challenging to prevent or treat. Enhanced endoplasmic reticulum (ER) stress and increased pyroptosis in chondrocytes may be responsible for cartilage degeneration. This study aims to investigate the effect of ER stress on chondrocyte pyroptosis and the upstream regulatory mechanisms, which have rarely been reported.

METHODS

The expression of the histone methyltransferase enhancer of zeste homolog 2 (EZH2), microRNA-142-3p (miR-142-3p), and high mobility group box 1 (HMGB1) and the levels of ER stress, pyroptosis, and metabolic markers in normal and OA chondrocytes were investigated by western blotting, quantitative polymerase chain reaction, immunohistochemistry, fluorescence in situ hybridization, fluorescein amidite-tyrosine-valine-alanine-aspartic acid-fluoromethyl ketone (FAM-YVAD-FMK)/Hoechst 33342/propidium iodide (PI) staining, lactate dehydrogenase (LDH) release assays, and cell viability assessments. The effects of EZH2, miR-142-3p, and HMGB1 on ER stress and pyroptosis and the hierarchical regulatory relationship between them were analyzed by chromatin immunoprecipitation, luciferase reporters, gain/loss-of-function assays, and rescue assays in interleukin (IL)-1β-induced OA chondrocytes. The mechanistic contribution of EZH2, miR-142-3p, and HMGB1 to chondrocyte ER stress and pyroptosis and therapeutic prospects were validated radiologically, histologically, and immunohistochemically in surgically induced OA rats.

RESULTS

Increased EZH2 and HMGB1, decreased miR-142-3p, enhanced ER stress, and activated pyroptosis in chondrocytes were associated with OA occurrence and progression. EZH2 and HMGB1 exacerbated and miR-142-3p alleviated ER stress and pyroptosis in OA chondrocytes. EZH2 transcriptionally silenced miR-142-3p via H3K27 trimethylation, and miR-142-3p posttranscriptionally silenced HMGB1 by targeting the 3'-UTR of the HMGB1 gene. Moreover, ER stress mediated the effects of EZH2, miR-142-3p, and HMGB1 on chondrocyte pyroptosis. In vivo experiments mechanistically validated the hierarchical regulatory relationship between EZH2, miR-142-3p, and HMGB1 and their effects on chondrocyte ER stress and pyroptosis.

CONCLUSIONS

A novel EZH2/miR-142-3p/HMGB1 axis mediates chondrocyte pyroptosis and cartilage degeneration by regulating ER stress in OA, contributing novel mechanistic insights into OA pathogenesis and providing potential targets for future therapeutic research.

Lidocaine Shows Significant Antimicrobial Effects Against Staphylococcus Species: An In-Vitro Study Comparing Different Combinations of Lidocaine and Clinically Used Injectables, like Steroids and Hyaluronan, in the Context of Arthritis Management

INTRODUCTION

Intra-articular injections, commonly used in osteoarthritis treatment, are debated due to their potential link to septic arthritis, though its incidence remains low. Lidocaine, used as a "carrier" for therapeutic substances like hyaluronan or triamcinolone, has pain-relieving and antimicrobial properties. This study investigates the concentration-dependent antimicrobial effects of lidocaine in combination with hyaluronan and triamcinolone in both standard and synovial fluid cultures.

METHODS

The antimicrobial efficacy of lidocaine against Staphylococcus aureus was investigated, with variations in bacterial and lidocaine concentrations. Bacterial growth was monitored using a UV/VIS spectrometer at 600 nm. Lidocaine solutions of 1% and 2% were tested, both alone and in combination with hyaluronic acid or Triam40, in tryptic soy broth (TSB), to reflect knee joint applications. The groups included pure lidocaine (L), Triam (T), hyaluronan (H), and combinations (LT, LH, TH, LTH) with 1% or 2% lidocaine. A bacterial inoculum of 300 CFU/mL was used, and samples were incubated for 12 and 24 h. Additional tests were conducted on Staphylococcus epidermidis and methicillin-resistant Staphylococcus aureus (MRSA), as well as on S. aureus in human synovial fluid.

RESULTS

Lidocaine showed a concentration-dependent antimicrobial effect, with greater inhibition at higher concentrations and lower bacterial densities. All lidocaine-containing combinations significantly reduced the bacterial levels of S. aureus in TSB. Similar results were seen for S. epidermidis and MRSA, with notable inhibition in synovial fluid after 12 h, especially with 2% lidocaine.

CONCLUSIONS

Lidocaine exhibits dose-dependent antimicrobial effects against key pathogens responsible for septic arthritis. Its combination with Triam40 and hyaluronan may reduce the risk of septic arthritis, supporting its clinical relevance.

Effect of Luteolin on cadmium-inhibited bone growth via suppressing osteoclastogenesis in laying chickens

Luteolin (Lut) is a flavonoid derived from several plant sources. Cadmium (Cd) is a widespread environmental contaminant and potential toxin with detrimental effects on animal health. However, the effect of Lut on Cd-induced inhibition of bone growth in laying chickens remains unclear. This study investigates the effects of Lut on Cd-induced inhibition of bone growth in the femur and tibia of laying chickens. A total of sixty 1-d-old green-eggshell yellow feather laying chickens were randomly assigned to 4 groups after a 5-d acclimation period: basal diet (Con), cadmium chloride (CdCl2, Cd), Lut, and Lut + Cd. Bone microstructure, serum biomarkers of bone remodeling, the levels of Cd, calcium (Ca), phosphorus (P), and trace metal elements were assessed using the micro-computed tomography (Micro-CT), enzyme-linked immunosorbent assay (ELISA), and microwave digestion, respectively. Bone remodeling biomarkers, late endosomal/lysosomal adaptor and MAPK and mTOR activator 1 (LAMTOR1), as well as the phosphorylation of AMP-activated protein kinase α (AMPKα) and protein kinase B (Akt), were quantified using the qRT-PCR and western blot. The results indicated that Lut effectively mitigated Cd-induced bone mass loss compared to the Cd group, resulting in increased bone volume (BV), bone surface/BV (BS/BV), connectivity density (Conn.Dn), and the length and weight of the femur and tibia in laying chickens. Mechanistically, compared to the Cd group, Lut restored the ratio of osteoprotegerin (OPG)/receptor activator of NF-κB ligand (RANKL) in serum and bone tissue, enhanced the expression of bone morphogenetic protein-2 (BMP-2), runt-related transcription factor 2 (Runx2), osteocalcin (OCN), and Osterix (OSX), while reducing the levels of Ca, Cd, and alkaline phosphatase (ALP) activity, as well as the expression of osteopontin (OPN), c-Fos, osteoclast stimulatory-transmembrane protein (OC-STAMP), tartrate-resistant acid phosphatase, cathepsin K (CTSK), matrix metalloprotein-9 (MMP-9), LAMTOR1, and the phosphorylation of AMPKα and Akt. Therefore, Lut alleviates Cd-induced damage to the femur and tibia of chickens by promoting osteogenesis and inhibiting osteoclastogenesis, positioning Lut as a potential therapeutic plant extract for enhancing bone growth in laying chickens.

Strategies to mitigate complications in arthroscopic rotator cuff repair

The rotator cuff, a vital group of tendons and muscles in the shoulder, is essential for stabilizing the joint and enabling a wide range of arm movements. Rotator cuff tears, common across all age groups, often cause significant pain and functional limitations. Rotator cuff repair surgery aims to alleviate pain, restore function, and improve quality of life. Recent advances, particularly in arthroscopic techniques, have enhanced surgical outcomes and shortened recovery times. Nevertheless, risks remain, including surgical site infections, tendon retears, stiffness, severe postoperative pain, and nerve injuries. This article explores the complexities of rotator cuff repair, dividing complications into intraoperative and postoperative categories. Key challenges in arthroscopic techniques include ensuring optimal visualization, preventing anchor pullout, and managing chondral damage. Postoperative concerns such as infections, stiffness, and retears are also discussed, with an emphasis on preoperative skin preparation and emerging interventions like benzoyl peroxide application and platelet-rich plasma. By incorporating surgical innovations, evidence-based protocols, and comprehensive patient management, clinicians can enhance outcomes and recovery rates. The ongoing exploration of new treatments and collaborative research efforts are crucial for refining treatment protocols and advancing orthopedic patient care.

A comprehensive analysis of the acromial morphology and etiological factors of partial rotator cuff tears

Background

Rotator cuff tears are divided into complete and partial tears, and partial rotator cuff tears include articular-sided tears and bursal-sided tears. Tears are caused by extrinsic, intrinsic, or traumatic factors; however, the mechanisms by which partial tears occur remain unknown. Recent reports have described the correlation between acromial morphology and rotator cuff tears. To date, no reports have investigated acromial morphology in partial tears. The purpose of this study is to evaluate the incidence of abnormal acromial morphology in both partial articular-sided and bursal-sided rotator cuff tears.

Methods

Patients with supraspinatus tendons that had articular-sided tears were categorized into Group A, and patients who had bursal-sided tears were categorized into Group B. Patients who underwent arthroscopic rotator cuff repair for rotator cuff tears were assessed based on their diagnosis of Group A or Group B according to arthroscopic findings. The following items were examined: age, sex, presence of diabetes mellitus, acromiohumeral distance (AHD), critical shoulder angle (CSA), lateral acromial angle (LAA), sagittal and coronal morphologies of the acromion, and traumatic shoulder tears.

Results

There were 39 patients in Group A and 95 patients in Group B. A significantly greater rate of presence of diabetes was found in the Group A. There were no significant differences in age, sex, or frequency of traumatic shoulder tears. The mean AHD, CSA, and LAA in Group A and Group B were as follows: AHD, 9.4 ± 1.5 and 9.3 ± 1.4 mm; CSA, 32.1 ± 4.6 and 35.3 ± 4.4 degrees; LAA, 82.2 ± 7.2 and 79.9 ± 7.0 degrees. There were no significant differences between the groups. Although the CSA was significantly greater in Group B, there was no significant difference in the AHD or LAA. There was no significant difference in sagittal acromial morphology; however, Group B had significantly more inferior osteophytes of the acromial center in the coronal plane.

Conclusion

Group B was found to have a significantly larger mean CSA compared to Group A. Group B occurred more often in patients with inferior osteophytes of the acromial center on the acromion, suggesting the involvement of extrinsic factors.

One-stage revision anterior cruciate ligament reconstruction: Preoperative evaluation, planning and surgical techniques. A review of current concepts

The increased rate of anterior cruciate ligament (ACL) tears has led to a greater number of revisions. Revision surgery can be performed in one or two stages. Single-stage revision ACL reconstruction (ssRACLR) may be performed when prior tunnels can be re-used or bypassed whereas a two-stage procedure is indicated when bone grafting of dilated tunnels prior to revision is necessary. While both approaches have shown similar functional outcomes and failure risk, ssRACLR is preferred, when possible, to avoid the increased morbidity, inconvenience and cost associated with two-stage RACLR. In adequately planning for RACLR, a surgeon should investigate the mechanism and timing of injury as well as the previous graft selection, associated pathology and the tunnel placement and size. It is especially important to obtain radiographs and three-dimensional imaging including magnetic resonance imaging (MRI) and computed tomography (CT), which allow the surgeon to accurately evaluate the entire tunnel architecture to determine surgical staging. Following a detailed assessment of the pathoanatomy, the surgeon may determine graft and hardware type, tunnel placement and utilization of lateral extra-articular tenodesis (LET) and other procedures. In our experience, ssRACLR can be carried out for over 90% of revision cases with creative pre-operative planning using autograft with bone plug(s), divergent tunnel creation on the femur (when necessary) and convergent tunnel creation on the tibia (when appropriate) and suspensory or interference fixation as needed. In revision scenarios, we believe that autografts with bone plugs provide the best opportunity for graft healing and incorporation and that LET can be a useful adjunct to reduce re-tear rates. The purpose of this review is to report on the preoperative considerations and surgical techniques for performing ssRACLR, as well as the outcomes.

Level of Evidence

Level V expert opinion.

An evidence-based tailored eHealth patient education tool for patients with knee osteoarthritis: A randomized controlled trial

Background

An evidence-based eHealth education tool was developed for patients with knee osteoarthritis (KOA). This study aimed to evaluate the long-term effectiveness on patient knowledge level and analyzed the patient's satisfaction with the proposed tool.

Methods

A two-arm randomized controlled trial was performed, with 218 KOA patients allocated 1:1 to two groups by balanced block randomization. Both groups received usual care and additionally, the eHealth group used the proposed eHealth tool during the process. The primary outcome measure was the validated osteoarthritis patient knowledge questionnaire (PKQ-OA). The secondary outcome was patients' satisfaction with the eHealth tool. Measurements were taken at baseline, post-intervention (T1), 1-month (T2), 3-month (T3), and 6-month (T4) follow-up. Statistical analyses, including ANOVA and chi-square tests, were employed to compare outcomes between the groups.

Results

The results of the PKQ-OA indicated that patients in the eHealth group (38.7% ± 25%, 95% confidence interval (CI), 33.9%-43.4%) performed significantly better than the usual care group (28.8% ± 21.1%, 95% CI, 24.9%-32.9%) in terms of correct responses to the knowledge assessment in T1(P = 0.001). In addition, a higher percentage of patients in the eHealth group (39.4%) achieved a score of at least 50% on the knowledge assessment compared to the usual care group (14.6%). Patients who received eHealth education perceived it as a valuable tool for education. The analysis of follow-up data showed that the knowledge level of the eHealth group was higher than that of the control group at 6 months (F = 0.727, P = 0.471), but there was no significant difference.

Conclusion

Patients educated using an evidence-based eHealth education tool showed significant improvements in knowledge and were more likely to achieve an adequately informed status. The evidence-based eHealth tool could offer a low-cost, effective educational device.

Causal Relationships Between 4 Exposure Factors and Rotator Cuff Syndrome Using Mendelian Randomization Analysis

Background

Although previous studies have investigated the risk factors for rotator cuff syndrome (RCS), there remains controversy due to uncontrolled and uncertain confounding factors in their analyses.

Purpose

To perform Mendelian randomization (MR) analysis using single-nucleotide polymorphisms to investigate the causal relationship between RCS and 4 risk factors: type 2 diabetes mellitus (T2DM), high blood pressure (HBP), body mass index (BMI), and low high-density lipoprotein cholesterol (HDL-C).

Study Design

Descriptive epidemiology study.

Methods

Genome-wide association study (GWAS) data for T2DM (ebi-a-GCST006867), BMI (ieu-b-40), HBP (finn-b-I9_HYPTENS), HDL-C (ieu-b-109), and RCS (ukb-b-50) were obtained from the IEU Open GWAS Project. The dataset of each risk factor was combined with the dataset of RCS, generating 4 datasets. Potential confounders and single-nucleotide polymorphisms related to RCS were excluded from these datasets. The causal relationships between the exposure factors and RCS were analyzed using 5 regression models: MR-Egger, weighted median estimate (WME), inverse-variance weighting (IVW), simple mode, and weighted mode. Heterogeneity in the causal effects was assessed using MR-Egger regression and IVW analyses. Sensitivity analyses were performed to determine the stability of the results.

Results

The MR-Egger regression intercepts for T2DM, BMI, HBP, and HDL-C showed no horizontal pleiotropic effects. The results of the Cochran Q test showed P values of .075 and .080 for BMI in the MR-Egger regression and IVW models, respectively, indicating the absence of heterogeneity between BMI and RCS. The results of the weighted median estimate and IVW regression analyses showed a significant causal association between BMI and RCS, with odds ratios of 1.002 (95% CI, 1-1.004; P = .038) and 1.003 (95% CI, 1.001-1.005; P = .0003), respectively. No significant associations were found for T2DM, HDL-C, or HBP.

Conclusion

In the present study, BMI was positively associated with the risk of developing RCS, while T2DM, HBP, and low HDL-C were not associated with RCS development.

Exploring the Mechanisms of Sanguinarine in the Treatment of Osteoporosis by Integrating Network Pharmacology Analysis and Deep Learning Technology

BACKGROUND

Sanguinarine (SAN) has been reported to have antioxidant, antiinflammatory, and antimicrobial activities with potential for the treatment of osteoporosis (OP).

OBJECTIVE

This work purposed to unravel the molecular mechanisms of SAN in the treatment of OP.

METHODS

OP-related genes and SAN-related targets were predicted from public databases. Differential expression analysis and VennDiagram were adopted to detect SAN-related targets against OP. Protein-protein interaction (PPI) network was served for core target identification. Molecular docking and DeepPurpose algorithm were further adopted to investigate the binding ability between core targets and SAN. Gene pathway scoring of these targets was calculated utilizing gene set variation analysis (GSVA). Finally, we explored the effect of SAN on the expressions of core targets in preosteoblastic MC3T3-E1 cells.

RESULTS

A total of 21 candidate targets of SAN against OP were acquired. Furthermore, six core targets were identified, among which CASP3, CTNNB1, and ERBB2 were remarkably differentially expressed in OP and healthy individuals. The binding energies of SAN with CASP3, CTNNB1, and ERBB2 were -6, -6.731, and -7.162 kcal/mol, respectively. Moreover, the GSVA scores of the Wnt/calcium signaling pathway were significantly lower in OP cases than in healthy individuals. In addition, the expression of CASP3 was positively associated with Wnt/calcium signaling pathway. CASP3 and ERBB2 were significantly lower expressed in SAN group than in DMSO group, whereas the expression of CTNNB1 was in contrast.

CONCLUSION

CASP3, CTNNB1, and ERBB2 emerge as potential targets of SAN in OP prevention and treatment.

Smoking, alcohol consumption, and risk of recurrent falls in community-dwelling Japanese people aged 40-74 years: The Murakami cohort study

AIM

Evidence is lacking regarding associations between smoking/drinking and falls. This study aimed to determine longitudinal associations between smoking, alcohol consumption, and fall risk in middle-aged and older people.

METHODS

Participants of this cohort study were 7542 community-dwelling Japanese people aged 40-74 years. The baseline self-administered questionnaire survey was conducted in 2011-2013, and the second survey was conducted 5 years later. Predictors were smoking level and alcohol consumption. The outcome was the occurrence of recurrent falls. Information on self-reported falls in the previous year was obtained. Covariates were demographics, lifestyle factors, body mass index, general health status, and disease history.

RESULTS

The mean age of participants was 60.3 years. Higher smoking levels were associated with a higher recurrent fall risk (adjusted P for trend = 0.0386), with the ≥20 cigarettes/day group having a higher risk (adjusted odds ratio [OR] = 1.93, 95% confidence interval [CI]: 1.20-3.10) than lifetime non-smokers. The association between smoking and recurrent fall risk tended to be stronger in drinkers than in non-drinkers (adjusted OR = 2.75, 95% CI: 1.57-4.81), suggesting a potential interaction (P for interaction = 0.1035). Although there were no dose-dependent associations between alcohol consumption and recurrent fall risk overall, moderate alcohol consumption (150-299 g ethanol/week) was associated with a lower risk (adjusted OR = 0.57, 95% CI: 0.33-0.98) compared with no consumption in men.

CONCLUSIONS

Smoking, but not alcohol consumption, is dose-dependently associated with high fall risk. However, moderate alcohol consumption may be associated with a decreased fall risk. Moreover, there may be a potential interaction between smoking and alcohol consumption on fall risk. Geriatr Gerontol Int 2025; 25: 67-74.

Patient-specific cutting guides allow 1° precision in asymmetric anterior closing-wedge osteotomy

Purpose

Asymmetric anterior closing-wedge high tibial osteotomy (ACWHTO) allows correction of both excessive posterior tibial slope (PTS) and varus deformity. However, the complexity of this surgery requires a high degree of accuracy, which is less likely to be achieved with standard instrumentations. This study aimed to determine the accuracy of 3D patient-specific cutting guides (PSCGs) to provide the accurate planned correction in the frontal and sagittal planes.

Methods

Eight sawbones tibiae were identically printed from the same patient data. An ACWHTO with a PSCG was performed on each sawbone. Postoperative measurements of PTS, mechanical medial proximal tibial angle (mMPTA), hinge area and hinge-posterior cruciate ligament (hinge-PCL) distance were compared with the preoperative planned measurements. The precision was defined as the absolute difference (∆) between the target planned values and postoperative values.

Results

The mean accuracy was 0.6° ± 0.74° for PTS, 0.8° ± 0.71° for mMPTA, 0.3 ± 0.2 cm2 for hinge area and 0.1 ± 0.06 mm for hinge-PCL distance.

Conclusion

In the setting of sawbones, the use of PSCGs was a reliable and accurate method of achieving simultaneous correction in the frontal and sagittal planes during asymmetric ACWHTO.

Level of Evidence

Level V, basic science biomechanical laboratory study.

Gait Characteristics over the Six-minute Walk Test in Older Women of a Specific Portuguese Community: A Cross-Sectional Study

INTRODUCTION AND OBJECTIVE

There is limited research on the changes that can occur in the gait biomechanical parameters of older adults over long-distance walking. Thus, this study aimed to evaluate the gait characteristics of older women of a specific Portuguese community over the six-minute walk test (6MWT) along with gait spatial and temporal parameters and angular kinematics of the lower limb joints.

MATERIALS AND METHODS

Twenty-six older women voluntarily participated. Each woman performed the 6MWT, and during this, their spatial and temporal parameters were collected through plantar pressure data (100Hz) and angular kinematics through an inertial sensor system (100Hz). The 6MWT was divided into four intervals, and the Friedman test was used to compare them. The median age of the women was calculated, and the Mann-Whitney test was used to compare women above and below the median age value.

RESULTS

An increase in gait speed, stance phase, and double stance phase along the intervals was observed, as well as larger angular displacements of the hip, knee, and ankle (p<0.05). Women below or above the median age value also yielded these behaviours. Gait speed, cadence, stride length, and step length were higher in women below the median age value, while stride and step duration were lower (p<0.05).

CONCLUSION

Older women yielded changes in gait spatial and temporal parameters along the 6MWT, as well as larger angular displacements of the lower limb joints. Older women (compared to younger ones) yielded lower gait speed, cadence, stride length, and step length, higher stance and double stance phases, and shorter angular displacements of the lower limb joints.

Outcomes of All-Inside Arthroscopic ACL Reconstruction with Lateral Extra-Articular Tenodesis (ACLR + LET)

Background

Anatomic single-bundle ACL reconstruction (ACLR) produces good results when the graft and tunnel are positioned in the anatomic footprint on the femoral and tibial insertion sites in a more oblique orientation. The Anterolateral Complex of the knee and its biomechanical role in controlling rotational laxity, internal rotation, and pivot shift has led to adding adjunctive procedures like extra-articular augmentation and lateral extra-articular tenodesis (LET) to decrease rotational laxity. We prospectively analyzed young adults with rotational instability and generalized laxity undergoing an arthroscopic single bundle ACLR with an additional LET procedure.

Methods

42 patients, aged between 20 and 50, undergoing all-inside ACLR augmented with concomitant lateral extra-articular tenodesis between November 2020 and October 2021 were included. All patients were followed up for one year and functional assessment comprised of the International Knee Documentation Committee [IKDC] score, visual analogue score [VAS], and Lysholm Knee Scoring Scale at 6 months and 1 year. Return to activity was assessed using the Tegner Activity Score.

Results

The Lysholm score, IKDC score, and VAS showed significant improvements at 6 months after ACLR + LET (p < 0.0001) and further improved significantly at 1 year. The patients had a significant decline in the Tegner Activity Scale at 6 months but returned to the near pre-injury level (5.98 ± 0.924) at 1 year (5.67 ± 0.816) which was insignificant (p = 0.1067). Three patients sustained mild complications. 93% were satisfied with the surgery, 66% returned to sports and no patient underwent re-operation.

Conclusions

Combination of LET with ACLR produces good functional outcomes, high rates of return to sports activities, and no graft failure in young patients at high risk of failure.

Sarcopenia and the biological determinants of aging: A narrative review from a geroscience perspective

BACKGROUND

The physiopathology of sarcopenia shares common biological cascades with the aging process, as does any other age-related condition. However, our understanding of the interconnected pathways between diagnosed sarcopenia and aging remains limited, lacking sufficient scientific evidence.

METHODS

This narrative review aims to gather and describe the current evidence on the relationship between biological aging determinants, commonly referred to as the hallmarks of aging, and diagnosed sarcopenia in humans.

RESULTS

Among the twelve hallmarks of aging studied, there appears to be a substantial association between sarcopenia and mitochondrial dysfunction, epigenetic alterations, deregulated nutrient sensing, and altered intercellular communication. Although limited, preliminary evidence suggests a promising association between sarcopenia and genomic instability or stem cell exhaustion.

DISCUSSION

Overall, an imbalance in energy regulation, characterized by impaired mitochondrial energy production and alterations in circulatory markers, is commonly associated with sarcopenia and may reflect the interplay between aging physiology and sarcopenia biology.

High incidence of anterior cruciate ligament injuries in professional men's handball: Analysis of the 'ACL registry in German Sports' over seven consecutive seasons

PURPOSE

The purpose of this study was to generate knowledge about the epidemiology and risk factors for anterior cruciate ligament (ACL) injuries in handball. It was hypothesised that the incidence of ACL injuries is high and comparable to other pivoting sports like football.

METHODS

This study is based on the prospective 'ACL registry in German Sports' implemented in the 2016-2017 season. Professional (first and second leagues) male handball players were analysed regarding the incidence and risk factors for ACL injuries. Injuries were registered according to the direct reports of the injured players to the study office and double-checked via media analysis. After injury registration, the players received a standardised questionnaire. Data were analysed from the 2016-2017 to the 2022-2023 season.

RESULTS

A total of 84 ACL injuries were registered. 46.3% of ACL injuries were re-ruptures. This represents a total incidence of 0.044 ACL injuries per 1000 h of exposure in training and matches per player over the study period. An increased incidence rate of 0.064/1000 h in the first league compared to 0.031/1000 h in the second league was reported (p ˂ 0.001). The mean number of injuries in the first division was 8.3, and in the second division, 6.6 ACL ruptures per season. Risk factors for ACL injury include previous knee injury and increased match exposure.

CONCLUSION

The incidence of ACL injuries in professional handball is high and comparable to football with an increased risk in the first league compared to the second league in Germany. There was a high incidence of re-injury. Other risk factors for ACL injuries include previous injuries to the affected knee in general as well as increased match exposure.

LEVEL OF EVIDENCE

Level II prospective cohort study.

Intra-Articular Injection of Stem Cells for the Regeneration of Knee Joint Cartilage: a Therapeutic Option for Knee Osteoarthritis - a Narrative Review

Current approaches to regulating osteoarthritis primarily focus on symptom management; however, these methods often have significant side effects and may not be suitable for long-term care. As an alternative to conventional treatments, injecting stem cells into knee joint cartilage is a promising option for repairing damaged cartilage. In this review, we outline the general procedure for stem cell treatment of knee joint cartilage regeneration, emphasizing the potential of intra-articular stem cell injections as a therapeutic option for osteoarthritis. We examined and summarized patient evaluation and preparation for knee joint stem cell therapy, stem cell harvesting, stem cell preparation, injection procedures for stem cell therapy, post-injection care and monitoring, potential outcomes of stem cell therapy, and considerations and risks associated with stem cell therapy. Overall, stem cell injections for knee joint cartilage damage represent a promising frontier in orthopedic care. They offer potential benefits such as pain and inflammation reduction, promotion of cartilage repair and regeneration, and the possibility of avoiding more invasive treatments such as knee surgery. Ongoing collaboration among researchers, clinicians, and regulatory organizations is crucial for advancing this field and translating scientific discoveries into effective clinical applications.

Selection of the Anti-Osteoporosis Active Ingredients of Fructus Psoraleae-Eucommia-Drynariae Rhizoma Based on Solid-Phase Bio-Cell Chromatography and HPLC-MS Analysis

Osteoporosis (OP) is a prevalent metabolic bone disease globally. Currently, the development of Traditional Chinese Medicine (TCM) resources to unblock joints, strengthen bones, and enhance muscle function to regulate anti-osteogenic and anabolic metabolism and thus reshape intraosseous homeostasis was an effective way to alleviate OP. The F-E-D formula, comprising Fructus Psoraleae, Eucommia, and Drynariae Rhizoma, has shown efficacy in treating OP. However, its complex natural components necessitate the screening and simplification of bioactive compounds to further elucidate their therapeutic mechanisms and enhance therapeutic efficacy. In this study, we first used drug-target binding to produce different effects, which in turn exhibited different retention characteristics on the stationary phase. Using osteoblasts and osteoclasts as stationary phases, a chromatographic system (Solid-phase Bio-cell Chromatography, SBC) had been constructed to mimic the drug-target interaction, and the separation, analysis, and bioactivity screening of the chemical components of F-E-D had been performed. Then, the above collected eluates were analyzed by fine metabolomics, and 95 effective metabolites were initially screened and combined with database screening to finally select betaine, L-fucose, and itaconic acid as potentially active candidate compound monomers for the interaction with osteoblast-osteoclast in F-E-D. In terms of cell validation experiments, we found that the screened active monomers significantly inhibited the formation of osteoclasts, and the itaconic acid-treated group played a significant inhibitory effect on the expression of inflammatory factors TNF-α and IL-6. The above experimental data showed that the monomeric active ingredients in TCM could be effectively screened by solid-phase bio-chromatography and HPLC-MS, and the in vitro cellular experiments verified that the active monomers of TCM slowed down the progression of OP by inhibiting osteoclast production and alleviating the expression of inflammation.

Editorial Commentary: Early Outcomes of Suture Tape Augmentation in Quadriceps Tendon Autograft Anterior Cruciate Ligament Reconstruction Are Promising but Require Long-term Proof

The management of anterior cruciate ligament (ACL) injuries continually evolves, with new interest in all-soft tissue quadriceps tendon autograft, as well as new interest in suture tape augmentation of the graft, particularly in high-risk patients with young age; female sex; lower-limb alignment, tibial, or femoral abnormalities; hyperlaxity; concomitant meniscal and/or additional ligamentous injuries; or participation in high-risk sports. Load-sharing suture tape enhances the biomechanical stability of the reconstructed ACL, especially during the initial ingrowth and ligamentization phase, and biomechanical evidence highlights a reduced risk of graft elongation and failure under the loads encountered during daily physical activities and sport. Optimal tape tensioning could be achieved in knee hyperextension, when the ACL is at maximal length, to avoid overconstraint. The published 2-year outcomes of this technique are excellent. Current comparative studies, however, have not shown superiority. Additional controlled studies and studies with longer-term follow-up are needed, as well as comparison to extra-articular tenodesis augmentation.

A dual-phase biologic augmentation of rotator cuff healing in a preclinical rat model using interleukin-17F and low-dose lithium

Background

Rotator cuff tendon tears are a common cause of shoulder dysfunction in adults. Yet, impaired healing continues to result in higher failure rates after surgical repair resulting in patient dysfunction and prolonged recovery. This has spurred increased investigation of biologic augmentation to improve tendon healing. This study examines the outcome of peritendinous interleukin-17F (IL-17F) administration and oral low-dose lithium carbonate (Li) on rotator cuff healing following acute surgical repair in a rat model.

Methods

Treatment group included an open supraspinatus peel and repair followed by a local injection of IL-17F at the bone-tendon interface and a 7-day course of oral Li. Control rats received no additional intervention before surgical closure. Evaluation of healing was then preformed using MRI imaging, biomechanical testing, and histological analysis at the bone-tendon interface.

Results

Eighteen rats (9 control, 9 experimental) underwent complete testing. Combined treatment of peritendinous IL-17F and oral low-dose Li after rotator cuff repair improved rotator cuff healing in all outcomes when compared to controls. MRI imaging in the treatment group showed complete healing of all supraspinatus tendons across the anatomic footprint after repair. We also found significant increases in biomechanical stiffness compared to controls (P < .01). At the histological level, treatment groups also had decreased osteoclasts (P < .001), and increased histologic organization of fibroblasts compared to controls. These findings are consistent with an increase in biomechanical stiffness.

Conclusion

We demonstrated that the combined treatment of IL-17F and oral low-dose lithium improved rotator cuff tendon healing quality following acute surgical repair in a rat model.

Efficacy of Curcuma longa in relieving pain symptoms of knee osteoarthritis patients: a systematic review and meta-analysis of clinical trials

Objective

Osteoarthritis (OA), particularly knee OA, affects 24% of adults and is a significant cause of disability. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used but have many adverse effects. Antioxidant and anti-iflammatory properties of Curcuma longa might decrease pain thus improving joint function.

Methods

This systematic review and meta-analysis evaluated randomized controlled trials (RCTs) on Curcuma longa efficacy for knee OA. We reported mean differences (MD) with 95% confidence interval (CI) for continuous outcomes and evaluated Visual Analog Scale (VAS) for pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) total score over 4 to 6 weeks for treatment effects.

Results

Ten RCTs with 786 patients were included. Curcuma longa significantly improved VAS for pain than placebo (MD 18.25, 95% CI 7.79 to 28.72, p=0.0006). It was not inferior to NSAIDs in WOMAC total score improvement (MD -11.99, 95% CI -39.21 to 15.23, p=0.39). Both dosages (<1,000 and ≥1,000 mg/day) of Curcuma longa demonstrated similar improvement in VAS for pain compared to placebo (MD 27.02, 95% CI 1.45 to 52.60, p=0.04; MD 21.48, 95% CI 1.78 to 41.18, p=0.03).

Conclusion

Curcuma longa benefits knee OA pain and function, being more effective than placebo and comparable to NSAIDs. Despite positive results, limitation and heterogeneity of the studies necessitates further research to explore optimal dosages and administration methods of Curcuma longa as therapeutic option for knee OA.

Tomatidine Alleviates Intervertebral Disc Degeneration by Activating the Nrf2/HO-1/GPX4 Signaling Pathway

Purpose

Intervertebral disc degeneration (IDD) is a leading cause of low back pain, and developing new molecular drugs and targets for IDD is a new direction for future treatment strategies. The aim of this study is to investigate the effects and mechanisms of tomatidine in ameliorating lumbar IDD.

Methods

Nucleus pulposus cells (NPCs) exposed to lipopolysaccharides were used as an in vitro model to investigate changes in the expression of extracellular matrix components and associated signaling pathway molecules. A lumbar instability model was used to simulate IDD. Tomatidine (Td) was then administered intraperitoneally, and its effects were evaluated through histopathological analysis.

Results

In vitro, Td significantly promoted ECM anabolism, inhibited ECM catabolism, and reduced oxidative stress and ferroptosis in LPS-stimulated NPCs. When Nrf2 expression was inhibited, oxidative stress and ferroptosis were exacerbated, and the protective effects of Td on NPCs were lost, suggesting the Nrf2/HO-1/GPX4 axis is critical for the therapeutic effects of Td. In vivo, histopathological analysis demonstrated that Td ameliorated IDD in a murine model.

Conclusion

Td alleviates IDD in vitro and in vivo by activating the Nrf2/HO-1/GPX4 pathway to inhibit ferroptosis in NPCs. This mechanism suggests Td is a promising candidate for IDD treatment.

Modified Zuo Gui Wan Ameliorates Ovariectomy-Induced Osteoporosis in Rats by Regulating the SCFA-GPR41-p38MAPK Signaling Pathway

Objective

Modified Zuo Gui Wan (MZGW) was a combination of Zuo Gui Wan and red yeast rice used for treating osteoporosis (OP), but its mechanism remains unclear. We aimed to validate the anti-OP effect of MZGW and explore its underlying mechanism.

Methods

An ovariectomy (OVX) rat model in vivo and a RANKL-induced osteoclasts (OCs) model in vitro were established. Key active ingredients in MZGW high dose (MZGW-H) group were detected by UPLC-MS/MS. Micro-CT scans and histomorphology analysis were performed in OVX rats. 16S rRNA gene sequencing was performed to investigate the relationship between the anti-OP effect of MZGW-H and intestinal flora. CCK-8 assay was applied to examine the optimal concentration of Modified Zuo Gui Wan drug serum (MZGW-DS) on osteoclasts. The qRT-PCR and Western blotting were utilized to explore the potential anti-OP pathway of MZGW, namely the SCFA-GPR41-p38MAPK signaling pathway. GPR41 was knocked down to further reverse to verify whether the pathway was the key pathway for MZGW-DS to exert its inhibitory effect on osteoclasts.

Results

The three main blood components, Ferulic acid, L-Ascorbic acid and Riboflavin, were examined mainly by UPLC-MS/MS. 16S rRNA gene sequencing showed that MZGW-H changed the metabolism of SCFAs. In vivo studies verified that MZGW-H ameliorated microstructure damage, improved histological changes and reduced TRAP, BALP, and BGP in OVX rats by regulating the SCFA-GPR41-p38MAPK signaling pathway. CCK-8 revealed that 5% MZGW-DS group was the most optimal concentration of MZGW-DS to inhibit osteoclast differentiation. In vitro, MZGW-DS was better than peripheral blood concentration of SCFAs in inhibiting osteoclasts. After the knockout of GPR41, MZGW-DS could not inhibit the expression of osteoclast-related protein (CTSK and NFATc1) via SCFA-GPR41-p38MAPK signaling pathway.

Conclusion

MZGW-H effectively ameliorates OVX-induced osteoporosis partially achieved by increasing SCFAs metabolism and modulating the SCFA-GPR41-p38MAPK signaling pathway.

Effects of Jintiange on the healing of osteoporotic fractures in aged rats

OBJECTIVE

To examine the effects of Jintiange on enhancing the healing of osteoporotic fractures in aged rats.

METHODS

An osteoporotic fracture model of femur was established using 70 SD rats (aged > 12 months), which were randomly numbered and divided into an experimental group and a control group, each with an equal sample size (n = 35). The experimental group received Jintiange capsule ingredients via intragastric administration, while the control group received an equal volume of saline via the same method. X-ray examinations were conducted at the 4th and 12th weeks to evaluate fracture healing in the rats. After 12 weeks, micro-CT scanning was employed to assess the microstructure of the healthy femurs, and the parameters of the experimental and control groups were compared.

RESULTS

After 4 weeks, the mean fracture healing scores were 0.78 ± 0.43 in the experimental group and 0.56 ± 0.51 in the control group. After 12 weeks, the mean scores were 1.50 ± 0.71 in the experimental group and 0.96 ± 0.68 in the control group. The scores in the experimental group were higher than those in the control group (P < 0.05). Micro-CT examination of the femurs showed an improvement trend in bone microarchitecture in the experimental group, indicated by increased bone volume fraction (BV/TV), trabecular number (Tb. N), and trabecular thickness (Tb. Th). However, these improvements were not statistically significant. A negative correlation with statistical significance was observed between trabecular separation (Tb. Sp) and fracture healing scores.

CONCLUSIONS

Jintiange may promote osteoporotic fracture healing in aged rats by enhancing bone microstructure.

Cinnamon for Metabolic Diseases and Their Cardiovascular and Hepatic Complications: A Mechanistic Review

Cinnamon is one of the world's oldest and most popular spices, and is derived from the inner bark of several tree species from the genus Cinnamomum. During the last two decades, cinnamon has demonstrated beneficial metabolic effects not only in animal experiments but also in clinical trials. Even recent meta-analyses have shown the protective effects of cinnamon on different components of metabolic syndrome and their complications. In the last 5 years, several experimental studies have unraveled the intricate molecular mechanisms underlying the antihypertensive, antihyperglycemic, lipid-lowering, weight-lowering, and cardioprotective properties of cinnamon. This review paper will discuss how cinnamon and its active components, particularly cinnamaldehyde, suppress inflammation and oxidative stress, modulate mitochondrial dysfunction, and regulate glucose uptake, insulin resistance, lipogenesis, beta-oxidation, Ca2+ signaling, and other cellar events at the molecular level. Specifically, we will delve into the molecular mechanisms involved in the metabolic effects of cinnamon to provide a deeper insight into how cinnamon can bring such beneficial effects. This review hopes to encourage the use of cinnamon in clinical settings, guide the combination of cinnamon with other drugs used to treat different components of metabolic syndrome based on their mechanism of action, and support the concept of complementary medicine for metabolic diseases.

Preoperative Physical Therapy Is Protective From Construct Failure in Anterior Cruciate Ligament Reconstruction

BACKGROUND

Risk factors for anterior cruciate ligament reconstruction (ACLR) construct failure have been studied extensively. However, while some studies account for variables such as activity level, construct types, preoperative physical therapy, or patient demographics individually, comprehensive studies that control for all these factors simultaneously are scarce.

HYPOTHESIS

By utilizing a robust multivariable analysis, the factors associated with an increased risk of ACLR construct failure can be determined.

STUDY DESIGN

A single-center, retrospective cohort study was conducted, encompassing patients who underwent primary ACLR between January 2015 and December 2021.

LEVEL OF EVIDENCE

Level 3.

METHODS

Eligible patients were identified using the current procedural terminology code 29888. Datapoints collected included demographics, body mass index, injury setting, graft type, graft size, fixation type, concomitant ligamentous injuries, notchplasty, operating surgeon, preoperative physical therapy, and instances of construct failure. The prevalence of construct failure was analyzed using chi-square tests, comparing across all graft and fixation type combinations in ACLR procedures. A mixed-effects logistic regression model was utilized to account for the potential influence of all relevant variables on construct failure.

RESULTS

Out of 1245 patients, the construct failure rate was 5.62% (n = 70), with >95% of patients having >2 years of retrospective follow-up (95% CI [4.34-6.90]), with a median failure time of 502.5 days (interquartile range [265.5-1033.8]). The mixed-effect logistic model identified preoperative physical therapy (odds ratio, 0.404, 95% CI [0.193-0.844]) as the only significant factor in possibly preventing construct failure.

CONCLUSION

Contrary to conventional focus on graft and fixation types, this study emphasizes the protective role of preoperative physical therapy in reducing ACLR construct failure.

CLINICAL RELEVANCE

Our findings suggest the integration of preoperative physical therapy in clinical practices to mitigate ACLR construct failure risk, warranting further exploration in future studies.

Osteoporosis: Causes, Mechanisms, Treatment and Prevention: Role of Dietary Compounds

Osteoporosis is a chronic disease that is characterized by a loss of bone density, which mainly affects the microstructure of the bones due to a decrease in bone mass, thereby making them more fragile and susceptible to fractures. Osteoporosis is currently considered one of the pandemics of the 21st century, affecting around 200 million people. Its most serious consequence is an increased risk of bone fractures, thus making osteoporosis a major cause of disability and even premature death in the elderly. In this review, we discuss its causes, the biochemical mechanisms of bone regeneration, risk factors, pharmacological treatments, prevention and the effects of diet, focusing in this case on compounds present in a diet that could have palliative and preventive effects and could be used as concomitant treatments to drugs, which are and should always be the first option. It should be noted as a concluding remark that non-pharmacological treatments such as diet and exercise have, or should have, a relevant role in supporting pharmacology, which is the recommended prescription today, but we cannot ignore that they can have a great relevance in the treatment of this disease.

Needle knife therapy combined with chinese herbal medicine in the treatment of knee osteoarthritis: a meta-analysis

OBJECTIVE

To systematically evaluate the effectiveness of the combined Needle Knife Therapy (NKT) and Chinese Herbal Medicine (CHM) treatment for knee osteoarthritis (KOA) and to provide clinical evidence supporting its application in managing the condition.

METHODS

Relevant articles were retrieved from PubMed, Medline, Embase, Wanfang, and China National Knowledge Network (CNKI) from the inception of the databases up to February 18, 2023. Randomized controlled trials (RCTs) on the efficacy of NKT combined with CHM were appraised for inclusion. The meta-analysis was conducted using RevMan 5.3 and was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) (202470051).

RESULTS

A total of 11 RCTs involving 880 patients were included. The meta-analysis showed that the combined therapy was superior to NKT alone in the treatment of KOA [relative risk (RR) = 1.09; 95% confidence interval (CI): (1.03, 1.14); P = 0.002]. The combined therapy showed a significant reduction in the Visual Analog Scale (VAS) score [RR = -0.98; 95% CI: -1.12, -0.84; P < 0.00001] and symptom scores [RR = -1.75; 95% CI: (-1.87, -1.63); P < 0.00001] compared to single NT therapy. There was no significant difference in the Traditional Chinese Medicine (TCM) syndrome scores between the two groups [RR = -0.23; 95% CI: (-0.56, 0.10); P = 0.18]. Furthermore, we observed a marked increase in lysholmy scores in the combination group than in the control group [RR = -1.04; 95% CI: (-1.31, -0.77); P < 0.00001].

CONCLUSIONS

The combination of needle-knife therapy and Chinese herbal medicine exhibits promising clinical efficacy in the treatment of KOA.

Mechanism and application prospect of ferroptosis inhibitors in improving osteoporosis

Osteoporosis, a prevalent bone metabolic disorder, has emerged as a pressing global public health concern. Recent studies have illuminated a crucial link between ferroptosis and the pathogenesis of osteoporosis. Nevertheless, the intricate mechanisms underlying the role of ferroptosis in this condition remain largely unexplored. Therefore, this article comprehensively reviews the regulatory mechanisms of ferroptosis and the modulating effects on the development and progression of osteoporosis, as reported in recent years. Furthermore, this review summarizes the current state of the interventional strategies employed by both Western medicines and traditional Chinese medicines (TCMs) in addressing osteoporosis. This review aims to uncover potential novel avenues for the prevention and control of osteoporosis by synthesizing the modes of action and clinical efficacy of these therapeutic modalities.