Orthopedic Diseases Research Articles

Clinical use and efficacy of Chinese patent medicines for external use containing pyritum, a mineral medicine mainly used for oral administration: A systematic review.

Pyritum, a mineral drug, has been used primarily orally in traditional medicine to treat traumatic injuries, broken tendons, and fractures. Due to growing concerns about the accumulation of heavy metals in the body, this systematic review aims to evaluate the efficacy and safety of Chinese patent medicine containing pyritum for external use (CPMPE) to determine the effectiveness of external use of pyritum. A literature search was performed through China National Knowledge Infrastructure, Wanfang, EMBASE, Cochrane Library, and PubMed from inception to February 2023. "Pyrite," "pyritum," "zirantong," "traditional medicine," "oriental medicine," etc, were the keywords from the database. In this systematic review, RCTs and case reports were referred to analyze the efficacy rate and clinical status of CPMPE. About 36 studies were reviewed. Of 36 studies, 23 were RCTs and 13 were case reports. The total effective rate in 34 studies was used to evaluate the efficacy of CPMPE for various disease classifications. The effectiveness of CPMPE was confirmed in case reports, and RCTs showed that using CPMPE as a single or combined treatment had a more significant effect than not using CPMPE in anorectal diseases, orthopedic diseases, obstetrics and gynecology diseases, and skin diseases. This review concluded that CPMPE might be a safe and effective alternative treatment method for various diseases and has potential benefits in preventing postoperative complications, reducing pain, relieving symptoms, and accelerating healing compared to the control group, which employs unused CPMPE.

Variability of Knee Joint Anatomy and the Impact of Its Individual Parameters on the Topography of the Anterior Cruciate Ligament

Introduction. The anatomical features of the knee joint are significant as potential predictors of various diseases and injuries. However, the relationship between the anatomical position of the ACL and the structural parameters of the knee remains insufficiently studied. This work aims to identify statistically significant correlations between individual knee parameters and their association with the topography of the ACL within the joint.Purpose of the study. To determine statistically significant relationships between individual knee parameters and their potential impact on the positioning of the ACLin the joint based on MRI data.Materials and methods. The study involved the analysis of MRI images of 391 knee from patients of different sexes. Measurements were taken for 19 parameters using standard tools for linear and angular measurements. The data underwent statistical processing.Results and discussion. Six factors influencing the positioning of the ACL were identified. The study results challenge the validity of existing knee structure classifications, highlighting the need to explore the relationships between joint parameters. Factor analysis of the measured knee values allows for the identification of new systems of interrelated parameters, including those independent of patient sex. The study emphasizes the importance of developing new MRI analysis methods for the knee using multiparametric models.Conclusion. Our research highlights important correlations between knee parameters and the positioning of the ACL. Factors affecting this dynamic underscore the need for an individualized approach to planning ACL reconstruction. The results provide a basis for developing more accurate analysis methods and personalized treatment strategies for orthopedic diseases, enhancing the efficacy of clinical practice.

Optimizing Interhospital Transfers in Orthopedics and Trauma Surgery: Challenges, Insights, and Proposals for Standardized Care in Germany.

Germany's high density of under-equipped hospitals and anticipated surge in orthopedic and trauma surgery-related diseases by 2030, combined with personnel shortages, are expected to increase patient transfers between hospitals, an issue that urgently needs standardized protocols. Despite some existing cooperative agreements, such as between joint-replacement centers or within the Trauma Network DGU®, these measures do not adequately address the full range of patient-transfer cases, including those due to a lack of specialization or staff shortages, resulting in delayed treatment and potential health risks. This study aims to dissect the intricacies of interhospital transfers in orthopedics and trauma surgery across Germany, focusing on understanding the underlying reasons for transfers, comparing the operational structures of small and large hospitals, and laying the groundwork for future standardized protocols to enhance patient care. A cross-sectional study was conducted in the form of an online survey via SoSci Survey, which was directed at orthopedic surgeons and trauma surgeons working in hospitals in Germany. The 22-question survey gathered information on participants' clinic roles, departmental details, transfer processes, frequent diagnoses, perceptions of transfer quality, and improvement areas. The survey was sent to orthopedic and trauma surgeons in Germany by the specialist society. The data were analyzed using descriptive and inferential statistics to ensure a comprehensive insight into interhospital transfer practices. The study involved 152 participants from various hospital ranks and located in different hospital sizes and types across rural and urban areas. A significant difference was observed between the care structures of basic/regular care and central/maximum care hospitals, especially regarding the available facilities and specialties. These findings suggest improvements such as better patient documentation, increased digital communication, optimized patient distribution, and standardization of transfer requests, among others. This study highlights the urgent need for improved protocols and resource allocation to eliminate inequalities in transfers between hospitals in orthopedics and trauma surgery in Germany.

82 Relationships between performance traits and osteochondrosis of the hock in Standardbred racehorses

Abstract Equine osteochondrosis (OC) is a developmental orthopedic disease that results in abnormal articular cartilage and often the formation of osteochondral bone chips (osteochondrosis dissecans). Standardbreds, a breed predominately used in harness racing, are prone to the development of OC. This study aimed to quantify the relationship between OC and key performance traits, fastest mile time, annual earnings, and consistency in race times over career, using a cohort of 347 North American Standardbred horses. Radiographic examination of the tarsi was previously performed to identify horses as OC-affected (n = 155) or healthy (n = 192). Performance data was acquired from the United States Trotting Association (USTA) detailing horse identification, performance, and lifetime race record. Linear mixed multiple regression models were constructed to evaluate the relationship between OC and performance. A total of 24 performance related variables (e.g., age, gait, track) were evaluated for inclusion in the model through subset variable selection and goodness of fit as determined by Schwarz’s Bayesian Information Criterion (SBC). Preliminary results indicate that healthy horses exhibit significantly faster mile times (P < 0.001) compared with their OC-affected counterparts. However, no significant association was detected between OC status and annual earnings (P > 0.2) or consistency in race times over career (P > 0.2). Ongoing analyses are currently being conducted to assess additional predictors and performance variables for a potential association with osteochondrosis. This study emphasizes the importance of implementing effective strategies for OC management and improving breeding selection practices when producing offspring with desired performance characteristics.

Research Progress on Inhibition of Osteoclast Differentiation by Traditional Chinese Medicine

Background: Bone tissue undergoes continuous remodeling to maintain a steady state of bone equilibrium. During this process, osteoblasts actively stimulate bone formation, while osteoclasts continuously engage in bone resorption. The dynamic equilibrium between bone formation and bone resorption is crucial for maintaining bone structure. In a healthy human skeletal structure, the two components are constantly in a state of benign dynamic equilibrium. However, due to factors such as aging, trauma, bone diseases, and other influences, the activity of osteoblasts decreases while the activity of osteoclasts increases. This disrupts the dynamic equilibrium, leading to a decrease in bone metabolism. As a result, bone resorption gradually surpasses bone production, making it challenging to maintain a normal amount of bone mass. The effectiveness of traditional Chinese medicine in treating bone-related disorders is extraordinary, and its molecular biological mechanism has become a widely discussed subject. Objectives: This study aims to unravel the classical signaling pathways and potential targets involved in the effects of traditional Chinese medicine on osteoclast differentiation, and to provide evidence for its clinical efficacy. Methodology: The main keywords chosen for this study were “Traditional Chinese Medicine (TCM)”, “osteoclast differentiation”, “natural plant”, and “medicinal plant”. To gather relevant literature, we utilized multiple online search engines, including PubMed, Web of Science, and CNKI, as well as other publication resources. Results: The results indicated that Traditional Chinese Medicine (TCM) can modulate signaling pathways, including NF-κB, MAPKs, STATs, and Wnt/β-catenin pathways., to influence osteoclast differentiation. This modulation involves maintaining the balance of inflammatory interactions, inhibiting oxidative stress. Conclusion: The impact of traditional Chinese medicine on osteoclast differentiation is reflected on multiple levels and through various pathways. Future research is envisioned to delve deeper from the perspective of precision-targeted therapy, aiming to provide insights for identifying the core targets of traditional Chinese medicine in treating orthopedic diseases.

USING FOETAL SKELETOGENESIS TO EVALUATE AND IMPROVE IN VITRO CHONDROGENESIS PROTOCOLS

The reliable production of _in vitro_ chondrocytes that faithfully recapitulate _in vivo_ development would be of great benefit for orthopaedic disease modelling and regenerative therapy(1,2). Current efforts are limited by off-target differentiation, resulting in a heterogeneous product, and by the lack of comparison to human tissue, which precludes detailed evaluation of _in vitro_ cells(3,4).We performed single-cell RNA-sequencing of long bones dissected from first-trimester fetal limbs to form a detailed ‘atlas’ of endochondral ossification. Through 100-gene in-situ sequencing, we placed each sequenced cell type into its anatomical context to spatially resolve the process of endochondral ossification. We then used this atlas to perform deconvolution on a series of previously published bulk transcriptomes generated from _in vitro_ chondrogenesis protocols to evaluate their ability to accurately produce chondrocytes.We then applied single-nuclear RNA-sequencing to cells from the best performing protocol collected at multiple time points to allow direct comparison between the differentiation of _in vitro_ and _in vivo_ cells.We captured 275,000 single fetal cells, profiling the development of chondrocytes from multipotent mesenchymal progenitors to hypertrophic cells at full transcriptomic breadth. Using this atlas as the ground truth for evaluating _in vitro_ cells, we found substantial variability in cell states produced by each protocol, with many showing little similarity to _in vivo_ cells, and all exhibiting off-target differentiation.Trajectory alignment between _in vivo_ and _in vitro_ single-cell data revealed key differences in gene expression dynamics between _in vitro_ and _in vivo cells,_ with several osteoblastic transcription factors erroneously unregulated _in vitro,_ including _FOXO1._Using this information, we inhibited _FOXO1_ in culture to successfully increase chondrocyte yield _in vitro._This study presents a new framework for evaluating tissue engineering protocols, using single-cell data to drive improvement and bring the prospect of true engineered cartilage closer to reality.

Regulation of endoplasmic reticulum stress on autophagy and apoptosis of nucleus pulposus cells in intervertebral disc degeneration and its related mechanisms.

Intervertebral disc degeneration (IVDD) is a common and frequent disease in orthopedics, which seriously affects the quality of life of patients. Endoplasmic reticulum stress (ERS)-regulated autophagy and apoptosis play an important role in nucleus pulposus (NP) cells in IVDD. Hypoxia and serum deprivation were used to induce NP cells. Cell counting kit-8 (CCK-8) assay was used to detect cell activity and immunofluorescence (IF) was applied for the appraisement of glucose regulated protein 78 (GRP78) and green fluorescent protein (GFP)-light chain 3 (LC3). Cell apoptosis was detected by flow cytometry and the expression of LC3II/I was detected by western blot. NP cells under hypoxia and serum deprivation were induced by lipopolysaccharide (LPS), and intervened by ERS inhibitor (4-phenylbutyric acid, 4-PBA) and activator (Thapsigargin, TP). Then, above functional experiments were conducted again and western blot was employed for the evaluation of autophagy-, apoptosis and ERS-related proteins. Finally, NP cells under hypoxia and serum deprivation were stimulated by LPS and intervened using apoptosis inhibitor z-Val-Ala-DL-Asp-fluoromethyl ketone (Z-VAD-FMK) and autophagy inhibitor 3-methyladenine (3-MA). CCK-8 assay, IF, flow cytometry and western blot were performed again. Besides, the levels of inflammatory cytokines were measured with enzyme-linked immunosorbent assay (ELISA) and the protein expressions of programmed death markers were estimated with western blot. It showed that serum deprivation induces autophagy and apoptosis. ERS was significantly activated by LPS in hypoxic and serum deprivation environment, and autophagy and apoptosis were significantly promoted. Overall, ERS affects the occurrence and development of IVDD by regulating autophagy, apoptosis and other programmed death.

Unlocking the potential of exosomes: a breakthrough in the theranosis of degenerative orthopaedic diseases.

Degenerative orthopaedic diseases pose a notable worldwide public health issue attributable to the global aging population. Conventional medical approaches, encompassing physical therapy, pharmaceutical interventions, and surgical methods, face obstacles in halting or reversing the degenerative process. In recent times, exosome-based therapy has gained widespread acceptance and popularity as an effective treatment for degenerative orthopaedic diseases. This therapeutic approach holds the potential for "cell-free" tissue regeneration. Exosomes, membranous vesicles resulting from the fusion of intracellular multivesicles with the cell membrane, are released into the extracellular matrix. Addressing challenges such as the rapid elimination of natural exosomes in vivo and the limitation of drug concentration can be effectively achieved through various strategies, including engineering modification, gene overexpression modification, and biomaterial binding. This review provides a concise overview of the source, classification, and preparation methods of exosomes, followed by an in-depth analysis of their functions and potential applications. Furthermore, the review explores various strategies for utilizing exosomes in the treatment of degenerative orthopaedic diseases, encompassing engineering modification, gene overexpression, and biomaterial binding. The primary objective is to provide a fresh viewpoint on the utilization of exosomes in addressing bone degenerative conditions and to support the practical application of exosomes in the theranosis of degenerative orthopaedic diseases.

Exploration of the mode of death and potential death mechanisms of nucleus pulposus cells.

Intervertebral disc degeneration (IVDD) is a common chronic orthopaedic disease in orthopaedics that imposes a heavy economic burden on people and society. Although it is well established that IVDD is associated with genetic susceptibility, ageing and obesity, its pathogenesis remains incompletely understood. Previously, IVDD was thought to occur because of excessive mechanical loading leading to destruction of nucleus pulposus cells (NPCs), but studies have shown that IVDD is a much more complex process associated with inflammation, metabolic factors and NPCs death and can involve all parts of the disc, characterized by causing NPCs death and extracellular matrix (ECM) degradation. The damage pattern of NPCs in IVDD is like that of some programmed cell death, suggesting that IVDD is associated with programmed cell death. Although apoptosis and pyroptosis of NPCs have been studied in IVDD, the pathogenesis of intervertebral disc degeneration can still not be fully elucidated by using only traditional cell death modalities. With increasing research, some new modes of cell death, PANoptosis, ferroptosis and senescence have been found to be closely related to intervertebral disc degeneration. Among these, PANoptosis combines essential elements of pyroptosis, apoptosis and necroptosis to form a highly coordinated and dynamically balanced programmed inflammatory cell death process. Furthermore, we believe that PANoptosis may also crosstalk with pyroptosis and senescence. Therefore, we review the progress of research on multiple deaths of NPCs in IVDD to provide guidance for clinical treatment.

CARMA3 Drives NF-κB Activation and Promotes Intervertebral Disc Degeneration: Involvement of CARMA3-BCL10-MALT1 Signalosome.

Intervertebral disc degeneration (IDD) diseases are common and frequent diseases in orthopedics. The caspase recruitment domain (CARD) and membrane-associated guanylate kinase-like protein 3 (CARMA3) is crucial in the activation of the NF-κB pathway. However, the biological function of CARMA3 in IDD remains unknown. Here, CARMA3 expression was elevated in nucleus pulposus (NP) tissues of IDD rats and nutrient deprivation (ND)-induced NP cells. The main pathological manifestations observed in IDD rats were shrinkage of the NP, reduction of NP cells, fibrosis of NP tissues, and massive reduction of proteoglycans. These changes were accompanied by a decrease in the expression of collagen II and aggrecan, an increase in the expression of the extracellular matrix (ECM) catabolic proteases MMP-3, MMP-13, and metalloprotease with ADAMTS-5, and an increase in the activity of the pro-apoptotic protease caspase-3. The expression of p-IκBαSer32/36 and p-p65Ser536 was also upregulated. However, these effects were reversed with the knockdown of CARMA3. Mechanistically, CARMA3 bound to BCL10 and MALT1 to form a signalosome. Knockdown of CARMA3 reduced the CARMA3-BCL10-MALT1 signalosome-mediated NF-κB activation. CARMA3 activated the NF-κB signaling pathway in a manner that bound to BCL10 and MALT1 to form a signalosome, which affects NP cell damage and is involved in the development of IDD. This supports CARMA3-BCL10-MALT1-NF-κB as a promising targeting axis for the treatment of IDD.

Anthropometric measures of obesity in patients with knee joint pathology: Body surface area versus body mass index.

Obesity is quantified using body mass index. Body surface area may provide a superior and more anthropometric method of quantifying obesity in patients with musculoskeletal knee disease. This study compares the effect of weight, height, age and gender on body mass index and body surface area in a population with orthopaedic knee disease. An observational cohort study was conducted of patients presenting with musculoskeletal knee disease. Associations between body mass index, body surface area, age, gender, height, weight and operative versus non-operative management were analysed. A total of 151 patients were included. Body surface area was more strongly correlated to weight than body mass index (r = 0.98, p < 0.001 versus r = 0.84, p < 0.001). Body surface area also reflects height which body mass index under presents (r = 0.65, p < 0.001 versus r = -0.08, p = 0.35). Body mass index and body surface area were correlated with one another (r = 0.70, p < 0.001). Age was inversely correlated with body surface area (r = -0.20, p = 0.013) but not body mass index (r = 0.05, p = 0.585). Body mass index did not differ between males and females (30.1 versus 30.9, p = 0.37); however, BSA scores were significantly higher in males than females (2.11 versus 1.91, p < 0.001). Neither body surface area nor body mass index scores influenced operative versus non-operative treatment. Body surface area could be a useful alternative to body mass index when considering obesity in patients with musculoskeletal knee pathology. Body surface area better reflects the effects of height, weight, age and gender than body mass index.

Changes in the Optical Density of the First Rib and the Coracoid Process of Scapula in Men Depending on Age and Chest Shape According to Computed Tomography

The purpose of the study was to evaluate the dynamics of changes in the optical density of bone tissue of the first rib and the base coracoid process of scapula in men of different ages without signs of osteoporosis depending on chest shape. Material and methods. The study was performed on tomograms of the chest of 191 men aged from 20 to 70 years. Measurements on tomograms were carried out in the axial plane using the RadiAnt program. The scans measured the optical density of the first rib tubercle, the distal bony part of the first rib, and the base of scapula coracoid process. All measurements were taken in men randomized by age and chest shape. The results of osteometry were processed by statistical methods. Results. The chest shape determines age-related changes in the optical density of bone tissue. In individuals with intermediate and transverse chest shapes, a decrease in the optical density of bone tissue at the base of scapula coracoid process begins to appear at the age of 30–50 years. These changes are most pronounced for the base of coracoid process, regardless of the chest shape, at the age of over 50 years. A decrease in the optical density of the first rib tubercle manifests over the age of 50 years in individuals with intermediate and transverse chest shape. In individuals with a gracile chest shape, the optical density of the bone structure is more stable. The tubercle of the first rib, along with the base of coracoid process, can serve as a prognostic area in the diagnosis of systemic osteoporosis in individuals with transverse and intermediate chest shape. Conclusion. A deterministic approach to the described indicators of changes in the optical density of bone tissue of the first rib and scapula in individuals with different chest shapes, according to SCT tomograms, objectively helps to predict and subsequently verify the manifestations of osteoporosis. The dependences we have identified on changes in bone tissue density and in the structure of correlations between the studied parameters of the first rib and the coracoid process indicate pronounced somatotypic variability, which must be taken into account when developing restorative treatment and predicting the course of orthopedic diseases in people of different age.

Clinical study on treatment of cervical spondylotic radiculopathy (Qi stagnation and blood stasis syndrome) with Gao's nape needle and Shentong Zhuyu decoction.

Cervical spondylotic radiculopathy is currently one of the common orthopedic diseases, mainly characterized by neck pain, stiffness, limited mobility, and related symptoms of nerve root compression, which seriously troubles people's work and life. Ninety cases of cervical spondylotic radiculopathy (Qi stagnation and blood stasis syndrome) were randomly divided into treatment group and control group, 45 cases in each group. The control group was treated with western medicine (nerve nutrition, pain relief, and circulation improvement drugs), and the treatment group was treated with Gao's nape needle combined with modified Shentong Zhuyu decoction on the basis of the control group. Before and after 2 weeks, TCM syndrome score, TCM curative effect, visual analogue scale score, numbness score, neck disability index score, related serum inflammatory factors (interleukin-10 [IL-10], interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α]), related hemorheological indexes (plasma viscosity, high shear whole blood viscosity, low shear whole blood viscosity level) were used as evaluation indexes to evaluate the effect. After treatment, the total effective rate of the treatment group was 91.11%, which was better than that of the control group (78.78%), and the TCM syndrome scores of the 2 groups were decreased, the treatment group was better than that of the control group, and the differences were statistically significant (P < .05). After treatment, the visual analogue scale score, numbness score, and neck disability index score were decreased in both groups, and the decrease in the treatment group was more significant than that in the control group, and the differences were statistically significant (P < .05). After treatment, the related serum inflammatory factors (IL-10, IL-6, TNF-α) and related hemorheological indexes (plasma viscosity, high-shear whole blood viscosity, low-shear whole blood viscosity) were decreased in both groups, and the decrease in the treatment group was more significant than that in the control group, and the differences were statistically significant (P < .05). The treatment of cervical spondylotic radiculopathy (Qi stagnation and blood stasis syndrome) with Gao's nape needle and modified Shentong Zhuyu decoction can improve the curative effect of traditional Chinese medicine, improve the related discomfort symptoms (neck tenderness, adverse activity, numbness, etc), improve the neck function, reduce IL-10, IL-6, TNF-α, and other related serum inflammatory factors, and improve hemorheological indicators.

Exploring the impact of pathogenic microbiome in orthopedic diseases: machine learning and deep learning approaches.

Osteoporosis, arthritis, and fractures are examples of orthopedic illnesses that not only significantly impair patients' quality of life but also complicate and raise the expense of therapy. It has been discovered in recent years that the pathophysiology of orthopedic disorders is significantly influenced by the microbiota. By employing machine learning and deep learning techniques to conduct a thorough analysis of the disease-causing microbiome, we can enhance our comprehension of the pathophysiology of many illnesses and expedite the creation of novel treatment approaches. Today's science is undergoing a revolution because to the introduction of machine learning and deep learning technologies, and the field of biomedical research is no exception. The genesis, course, and management of orthopedic disorders are significantly influenced by pathogenic microbes. Orthopedic infection diagnosis and treatment are made more difficult by the lengthy and imprecise nature of traditional microbial detection and characterization techniques. These cutting-edge analytical techniques are offering previously unheard-of insights into the intricate relationships between orthopedic health and pathogenic microbes, opening up previously unimaginable possibilities for illness diagnosis, treatment, and prevention. The goal of biomedical research has always been to improve diagnostic and treatment methods while also gaining a deeper knowledge of the processes behind the onset and development of disease. Although traditional biomedical research methodologies have demonstrated certain limits throughout time, they nevertheless rely heavily on experimental data and expertise. This is the area in which deep learning and machine learning approaches excel. The advancements in machine learning (ML) and deep learning (DL) methodologies have enabled us to examine vast quantities of data and unveil intricate connections between microorganisms and orthopedic disorders. The importance of ML and DL in detecting, categorizing, and forecasting harmful microorganisms in orthopedic infectious illnesses is reviewed in this work.

Yes-associated protein regulates the differentiation and osteoporosis of bone marrow mesenchymal stem cells

Mammalian Yes-associated protein (YAP) is involved in the regulation of various biological behaviors. Osteoporosis (OP) is a common orthopedic disease. However, the role of YAP in the differentiation and osteoporosis of Bone marrow mesenchymal stem cells (BMSCs) is unclear. Ovariectomy (OVX)-induced OP rat model was constructed and YAP plasmid was transfected to detect bone density and alkaline phosphatase (ALP) activity. Rat BMSCs were assigned into 3 groups: sham group, OP group, and YAP group, in which YAP plasmid was transfected followed by analysis of YAP expression by real-time PCR. After 14 days of induction culture, type I collagen, Osterix and FABP4 mRNA expression was detected by real-time PCR along with Wnt5 protein expression by western blot and TGF-β secretion by ELISA. In OP rats, YAP expression was significantly down-regulated and the bone density and ALP activity decreased (P &lt;0.05). YAP transfection in OP rats reversed the changes in OP rats. In OP group, YAP expression was decreased, and type I collagen and Osterix expression decreased, FABP4 expression increased, β-catenin expression and TGF-β secretion decreased (P &lt;0.05). Transfection of YAP plasmid in BMSCs of OP group significantly reversed the above changes (P &lt;0.05). In conclusion, YAP level decreases in OP and up-regulating its expression in BMSCs can promote osteogenic differentiation and inhibit adipogenic differentiation by regulating Tnt5/TGF-β signaling.

Fabrication of 3D porous polyurethane-graphene oxide scaffolds by a sequential two-step processing for non-load bearing bone defects

Bone defects as a common orthopedic disease lead to severe pains over a long period. Scaffolds are novel approaches in tissue engineering to treat bone problems and deal with their challenges. Here, 3D porous polyurethane (PU) scaffolds containing graphene oxide (GO) with different percentages (0, 0.1, 0.3, and 0.5 wt%) were developed through a combination of freeze-drying and salt etching techniques for bone tissue engineering applications. The morphologies of scaffolds, physicochemical properties, the degree of crystallinity, and hydrophilicity were evaluated by SEM, FTIR, XRD, and water contact angle assay, respectively. The porosity, degradation behavior, compressive strength, and elastic modulus of 3D porous scaffolds were also determined. To assess the scaffold bioactivity, the morphology of the deposited calcium phosphate layer on the scaffold with macro-structure was evaluated by SEM images. The viability and adhesion of MG63 osteoblast-like cells cultured on the fabricated scaffolds were examined by MTT assay and SEM images, respectively. The results show that adding GO particles not only had no effect on the interconnectivity and porosity of 3D porous macroscopic structures of neat PU but also smaller and more uniformed microscopically pores were obtained. The crystallinity, water contact angle, and weight loss of scaffolds increased as the higher GO concentrations were employed. Followed by increasing GO contents from 0 to 0.5 wt%, the compressive strength and Young’s modulus were increased by 232% and 245%, respectively. The bioactivity of scaffolds was fostered as GO concentration increased. Although, the MTT assay proved the biocompatibility of PU scaffolds containing 0.1 and 0.3 wt% GO, the samples loaded with 0.5 GO had a negative impact on the viability of MG63 cell lines. In conclusion, the present study demonstrates a high potential of PU scaffolds loaded with 0.1 and 0.3 wt% GO particles in bone tissue engineering applications.

The application of extracellular vesicles in orthopedic diseases

AbstractOrthopedic diseases, such as osteoarthritis and fractures, place a significant burden on individuals and healthcare systems worldwide. Extracellular vesicles (EVs), which are membrane‐derived particles, have emerged as a novel tool in the field of orthopedics. EVs play a crucial role in diagnosing, regenerating, and treating orthopedic diseases. In terms of diagnosis, EVs serve as potential biomarkers, carrying unique donor cell information and circulating effectively in bodily fluids. Specific biomolecules within EVs, including proteins, nucleic acids, and microRNAs, hold promise as biological markers for the early detection and monitoring of orthopedic diseases. EVs have shown significant potential in promoting bone and cartilage regeneration. They can enhance tissue regeneration by stimulating various stem cells to proliferate, migrate, and differentiate into mature chondrocytes and osteocytes. EVs can also target specific tissues, making them attractive candidates for drug delivery in orthopedic diseases. They can efficiently deliver therapeutic cargo, such as anti‐inflammatory agents and growth factors, to the affected sites, enhancing treatment efficacy while minimizing toxicity and adverse effects. In conclusion, EVs have significant potential in diagnosing, regenerating, and treating orthopedic diseases.

Selective Strength Training Changes the Morphology and Ankle Strength of the Peroneus Longus and the Peroneus Brevis.

This study aimed to investigate the 8-week selective training effect of the peroneus longus (PL) and the peroneus brevis (PB) on muscle morphology, echogenicity, and ankle strength and to examine post-intervention detraining effects. Twenty healthy participants without orthopedic disease in the lower extremities were assigned to either the PL intervention group (training consisted of pushing the Thera-Band® out from the ball of the foot to emphasize ankle eversion) or the PB intervention group (training consisted of pulling the Thera-Band® from the base of the fifth metatarsal to enhance ankle valgus and external rotation). Each intervention was performed three times per week for 8 weeks. The cross-sectional area (CSA), thickness, echogenicity, and ankle strength of the PL and the PB were measured before week 1 and after each training session. Detraining effects were evaluated after the 8-week intervention. The results revealed a significant interaction between within-group (week) and between-group (type of intervention) variables on CSA and ankle strength of both the PL and the PB. Over the 8-week training period, the CSA and ankle strength of the PL significantly increased in the PL intervention group, as did the CSA and ankle strength of the PB in the PB intervention group (p < 0.05). The residual effect of muscle hypertrophy was observed during the detraining period. In conclusion, 8-week selective PL and PB training interventions can increase the CSA and ankle strength of these muscles over time. Long-term selective intervention is required to improve peroneus muscle morphology and function, with separate assessments of the CSA and ankle strength of the PL and the PB.

Effects of simulated radioulnar synostosis on supination and pronation in cats. A cadaveric study.

To evaluate the effect of an induced synostosis with a screw on pronation and supination in cats. Ex vivo biomechanical study. A total of 58 feline forelimbs. A total of 58 cadaveric feline thoracic limbs were mounted on a custom-built jig with the elbow and carpus flexed at a 90° angle. To exclude any orthopedic disease, radiographs of the forelimbs were performed prior to the mechanical tests. Radioulnar synostosis was imitated with a 2 mm cortical screw through the radius into the ulna in the proximal (Group P; n = 54), middle (Group M; n = 52), and distal (Group D; n = 53) radial diaphysis. The angles of pronation and supination were recorded after manually applying a two-finger tight rotational force to the metacarpus. Rotational tests were performed without a screw (Group N) and with a screw in each of the aforementioned positions. Pairwise comparisons between the groups were performed based on their angles of rotation with a paired t-test with the Benjamini-Hochberg procedure and a mixed model ANOVA. Mean angles of rotation decreased between Group N (129.5 ± 15.9°) and all groups with imitated radioulnar synostosis to a mean angle of 37.5 ± 14.5° (p < .0001). Mean angles of rotation did not differ between the groups with imitated radioulnar synostosis. Induced radioulnar synostosis decreases antebrachial rotation by more than two-thirds, regardless of location. Implants fixating the radius to the ulna should be avoided in cats, regardless where they are located along the radial diaphysis.

A New Method Used to Enhance the SPAIR Image of the Spine MRI.

Magnetic resonance imaging (MRI) is a handy diagnostic tool for orthopedic disorders, particularly spinal and joint diseases. The lumbar intervertebral disc is visible in the T1 and T2 weight sequences of the spine MRI, which aids in diagnosing lumbar disc herniation, lumbar spine tuberculosis, lumbar spine tumors, and other conditions. The lumbar intervertebral disc cannot be seen accurately in the Spectral Attenuated Inversion Recovery (SPAIR) due to weaknesses in the fat and frequency offset parameters, which is not conducive to developing the intelligence diagnosis model of medical image. In order to solve this problem, we propose a composite framework, which is first to use the contrast limited adaptive histogram equalization (CLAHE) method to enhance the SPAIR image contrast of the spine MRI and then use the non-local means method to remove the noise of the image to ensure that the image contrast is uniform without losing details. We employ the Information Entropy (IE), Peak signal-to-noise ratio (PSNR), and feature similarity index measure (FSIM) to quantify image quality after enhancement by the composite framework. The outcomes of the experiments' output images and quantitative data indicate that our composite framework is better than others.