Platelet-rich plasma promotes skeletal muscle regeneration and neuromuscular functional reconstitution in a concentration-dependent manner in a rat laceration model.

Abnormal function of injured muscle with innervation loss is a challenge in sports medicine. The difficulty of rehabilitation is regenerating and reconstructing the skeletal muscle tissue and the neuromuscular junction (NMJ). Platelet-rich plasma (PRP) releases various growth factors that may provide an appropriate niche for tissue regeneration. However, the specific mechanism of the PRP's efficacy on muscle healing remains unknown. In this study, we injected PRP with different concentration gradients (800, 1200, 1600 × 109 pl/L) or saline into a rat gastrocnemius laceration model. The results of histopathology and neuromyography show that PRP improved myofibers regeneration, facilitated electrophysiological recovery, and reduced fibrosis in a concentration-dependent manner. Furthermore, we found that PRP promotes the activity of satellite cells by upregulating the expression of the myogenic regulatory factor (MyoD, myogenin). Meanwhile, PRP promotes the regeneration and maturation of acetylcholine receptor (AChR) clusters of the Neuromuscular junction (NMJ) on the regenerative myofibers. Finally, we found that the expression of the Agrin, LRP4, and MuSK was upregulated in the PRP-treated groups, which may contribute to AChR cluster regeneration and functional recovery. The conclusions proposed a hypothesis for PRP treatment's efficacy and mechanism in muscle injuries, indicating promising application prospects.

Endoscopic Iliotibial Band Release During Hip Arthroscopy for Femoroacetabular Impingement Syndrome and External Snapping Hip Had Better Patient-Reported Outcomes: A Retrospective Comparative Study.

PURPOSE: To compare patient-reported outcomes (PROs) in patients with femoroacetabular impingement (FAI) syndrome and external snapping hip (ESH) treated with hip arthroscopy with or without endoscopic iliotibial band (ITB) release. METHODS: Retrospective review case series with both FAI syndrome and ESH who underwent surgical treatment under same indications. According to the primary operation that was determined by patients themselves, the patients undergoing ITB release during hip arthroscopy for FAI syndrome were enrolled in the ITB-R group, and patients undergoing hip arthroscopy without ITB release were enrolled in non-ITB-R group. Patients with dysplasia, severe osteoarthritis, revision, and bilateral surgery were excluded. PROs including international Hip Outcome Tool (iHOT-33), modified Harris Hip Score (mHHS), visual analog scale for pain (VAS-pain) and VAS-satisfaction, and the rates of achieving minimal clinically important difference, patient acceptable symptomatic state (PASS), and substantial clinical benefit for the PROs at 2 years operatively were comparative analyzed. RESULTS: The prevalence of ESH in patients with FAI syndrome who underwent hip arthroscopy in our institution was 4.9% (30 of 612 hips). The mean age at the time of surgery was 33.1 ± 6.9 years (range 22-48 years). After exclusion, 16 patients (16 hips) were enrolled into ITB-R group and 11 patients (11 hips) enrolled into non-ITB-R group. PROs including iHOT-33, mHHS, VAS-pain, and VAS-satisfaction in patients in ITB-R group were better than that in non-ITB-R group at 2 years postoperatively (P = .013, .016, .002, and .005, respectively). The rates of achieving PASS for mHHS, PASS for VAS-pain, and substantial clinical benefit for iHOT-33 of patients in ITB-R group were significantly better than that in non-ITB-R group (P = .009, .006, and .027, respectively). CONCLUSIONS: Patients with both FAI syndrome and ESH undergoing ITB release during hip arthroscopy had better PROs than those undergoing hip arthroscopy without ITB release. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Medial Patellofemoral Ligament Reconstruction: A Comparison of Single-Bundle Transpatellar Tunnel and Double-Anchor Anatomic Techniques for the Treatment of Recurrent Lateral Patellar Dislocation in Adults.

PURPOSE: To compare the stability and clinical outcomes of 2 medial patellofemoral ligament reconstruction (MPFLR) techniques for the treatment of recurrent lateral patellar dislocation in adults. METHODS: Ninety-one patients with recurrent patellar dislocation were randomly divided into 2 groups, undergoing either the traditional single-bundle transpatellar tunnel technique (group A) or the double-anchor anatomic reconstruction technique (group B). Preoperatively and at follow-up, the patellar position and rotation were evaluated by computed tomography with the congruence angle, lateral patellar angle, patellar tilt angle, and lateral patellar translation; the subjective symptoms and functional outcomes were evaluated with Kujala, Lysholm, Tegner, and International Knee Documentation Committee subjective scores. Clinical examinations were also performed, and redislocations or episodes of instability were recorded. RESULTS: Patients were followed up for a mean period of 41.11 ± 7.40 months (range, 29-62 months). At the final point, no recurrent patellar dislocations occurred, except in 4 patients with instability symptoms in group A; however, no significant difference between the 2 groups was seen (χ2 = 2.503, P = .114). The measurement results from computed tomography decreased significantly to the normal range, and no significant difference was found between the 2 groups except for the lesser patellar tilt angle in group B (t = 2.175, P = .030). The clinical examination improved significantly, no patient exhibited a positive apprehension test in either group, and the number of patients with abnormal lateral patellar translation grade and firm end point showed no statistically significant differences between the 2 groups (P > .05). All score systems significantly improved with no significant difference between the 2 groups except for the higher Kujala score (t = -40.635, P = .001) and International Knee Documentation Committee score (t = -33.823, P = .003) in group B. CONCLUSIONS: Both MPFLR techniques achieved good results in the treatment of patellar dislocation. Compared with the single-bundle transpatellar tunnel technique, the double-anchor anatomic MPFLR technique may be more effective with a more congruous patellofemoral joint and better knee function. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Coracohumeral index and coracoglenoid inclination as predictors for different types of degenerative subscapularis tendon tears.

PURPOSE: To define and compare the coracohumeral index (CHI) and coracoglenoid inclination (CGI) in patients with different types of the subscapularis tendon tears. METHODS: Patients were divided into two groups: articular-sided lesion group (group A) and bursal-sided lesion group (group B). All the patients were examined using a 3.0-T magnetic resonance imaging scanner pre-operatively. The morphometric parameters of the coracoids, including the coracohumeral distance (CHD), CHI, and CGI, were measured on MRI. RESULTS: There were 165 (70.2%) and 70 (29.8%) patients in groups A and B, respectively. There was no significant difference in the average CHD (7.98 ± 1.7 mm vs 7.82 ± 2.1 mm, respectively) and CGI (50.5° ± 16.6° vs 44.9° ± 17.4°, respectively; P = 0.427) between the two groups. Conversely, there was a significant difference in the CHI between them (0.32 ± 0.08 vs 0.57 ± 0.11, respectively; P = 0.0001). According to the CHI and CGI, the coracoid process was divided into three types, and nearly half of the patients (46.8%) had standard coracoids with a hook tip, which are vulnerable to injury on the articular side. However, with overlapping coracoids and hook tips, the patients (16.2%) tended to experience injury on the bursal side. There was a significant difference in the incidence of articular or bursal side tear between the two groups. CONCLUSIONS: The CHI and CGI are potential valuable predictors of the types of degenerative subscapularis tendon tears. With standard hook coracoids, the lesions tend to appear on the articular side initially; otherwise, with overlapping hook coracoids, the subscapularis tendon tears are commonly seen on the bursal side.

Comparative study of different anticoagulants and coagulants in the evaluation of clinical application of platelet-rich plasma (PRP) standardization.

To investigate the impact of different anticoagulants and coagulants with autologous platelet-rich plasma (PRP) in order to evaluate the clinical application of PRP standardization. Bone marrow stem cells (BMSCs) were seeded into autologous PRP gel scaffolds with different anticoagulants (EDTA, heparin sodium HS, and sodium citrate SC) as well as control group (the whole blood group). Quality of PRP was evaluated and flow cytometric assay was used to detect the activity of the platelet (CD62p, PAC-1). BMSCs were also seeded into PRP with different coagulants (Thrombin, Collagen-I, ADP) as well as PRP un-activated (negative group) and L-DMEM complete culture without PRP (control group). The effects of different coagulants with PRP on proliferation, osteogenic differentiation of BMSCs were analyzed by methyl thiazolyl tetrazolium assay (MTT), ALP staining, Von Kossa staining, Confocal microscopic observation, RT-PCR and Western Blot at the morphological, cellular and molecular levels. Different anticoagulants (EDTA, HS, and SC) could affect the quality of PRP. EDTA group revealed the best quality and activity (CD62p, PAC-1). With different coagulants (Thrombin, Collagen-I and ADP) in the proliferation of BMSCs, the MTT assay showed that the proliferation of BMSCs was increased in all groups with time. On the sixth day of culture, the cell number of each PRP group was significantly higher than that in the control group (P < 0.05), while the most rapidly increasing was found in Collagen-I group. The cumulative release of growth factor (TGF-ß1, PDGF) at each time point in the PRP gel of the four groups was higher than that in the control group (P < 0.05). Collagen-I was considered as the best PRP coagulant. When thrombin was used as a platelet coagulant, the release of growth factor in PRP was rapid and direct, while the release of growth factor in Collagen-I-activated PRP was sustained and slow, and the total release of ADP-activated PRP growth factors was the lowest. The study demonstrated the similar outcome in osteogenic differentiation. In terms of gene expression and western bolt, the PCR results showed that the expression levels of OCN gene and RUNX2 protein in each PRP group were higher than that in the control group (P < 0.05). Different anticoagulants caused different degrees of lysis and spontaneous activation of platelets, which lead to different quality of PRP. Compared with HS and SC, EDTA could maintain the structural integrity of platelets, reduce their spontaneous activation, and increase the release of PRP growth factors for a longer period of time, thus ensuring the biomass of PRP. In addition, different coagulants also showed different results in the proliferation as well as osteogenic differentiation of BMSCs. Compared with Thrombin and ADP, Collagen-I may be a better choice.

Arthroscopic Fixation for Tibial Eminence Fractures: Comparison of Double-Row and Transosseous Anchor Knot Fixation Techniques with Suture Anchors.

BACKGROUND Tibial eminence fractures often occur during sports participation, but the optimum choice of technique for treatment is still controversial. The aim of the current work was to compare the clinical outcomes of 2 new arthroscopic anchor fixation techniques for tibial eminence fracture. MATERIAL AND METHODS We included 72 isolated tibial eminence fracture patients treated at our hospital from October 2010 to August 2015; 37 patients received the classic double-row (DR) suture anchor fixation technique and 35 received the transosseous anchor knot (TAK) fixation under arthroscopy. The clinical efficacies of the 2 techniques were assessed by radiographs, Lysholm score, and International Knee Documentation Committee (IKDC) score in follow-ups. RESULTS Patients were followed for 37.6 months (range, 18-54 months). There was no significant difference of the operative time between groups (P=0.169). Postoperative radiographs of all patients showed accurate reduction and fracture healing within 3 months. Lysholm and IKDC scores improved significantly compared with preoperative scores (P<0.001). However, no significant difference in the knee range of motion or improvement of Lysholm and IKDC scores was found between groups (P>0.05). CONCLUSIONS The DR and TAK techniques provide precise reduction and stable fixation methods for treating tibial eminence fractures, and the clinical outcomes of the 2 arthroscopic techniques with suture anchors are satisfactory.

Arthroscopic Fixation of Tibial Eminence Fractures: A Biomechanical Comparative Study of Screw, Suture, and Suture Anchor.

PURPOSE: To compare biomechanical outcomes of 4 different arthroscopic techniques for fixation of tibial eminence fractures. METHODS: Twenty-four skeletally mature, fresh-frozen cadaveric knees were divided into 4 comparison groups based on the fixation method: screw fixation (group A), traditional sutures fixation with 2 FiberWire sutures (group B), a modified suture technique with 2 FiberWire sutures that created neckwear knots to firmly trap the fracture fragment (group C), or suture anchors which was based on the suture bridge technique primarily used in the shoulder for repair of rotator cuff tears and greater tuberosity fractures (group D). A tibial eminence fracture was created in each knee for subsequent fixation. After fixation, each knee underwent cyclic loading of 100 N to assess the displacement change after 500 cycles of the fixation construct. Afterward, a single tensile failure test load was performed to assess the ultimate failure load, stiffness, and failure mode for each specimen. RESULTS: All specimens survived cyclic testing and were subsequently loaded to failure. Group C had the highest ultimate failure load (P < .05) and group D had the lowest displacement compared with the other 3 groups (P < .05). Different failure modes were found among the 4 groups. CONCLUSIONS: Suture fixation using the neckwear knots technique provides superior fixation with regard to higher ultimate failure load, and absorbable suture anchor fixation with the suture bridge technique provides less displacement under cyclic loading conditions. Both techniques exhibited superior biomechanical properties compared with traditional screw and suture fixation. CLINICAL RELEVANCE: The new techniques showed satisfactory biomechanical properties and provided more choice for surgeons in the treatment of tibial eminence fractures.

Comparison of Arthroscopic and Conservative Treatments for Knee Osteoarthritis: A 5-Year Retrospective Comparative Study.

PURPOSE: To compare the effectiveness of arthroscopic and conservative treatments in patients with knee osteoarthritis (KOA) with 5 years of follow-up. METHODS: Patients diagnosed with Kellgren-Lawrence grade 2 to 4 KOA who underwent arthroscopic or conservative treatment from May 2005 to May 2012 were included. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score was collected 1, 2, 3, 4, and 5 years after the initial treatment, and the number of patients who underwent total knee arthroplasty (TKA) at every time point was recorded. RESULTS: Three hundred eighty-two patients (168 in the conservative group and 214 in the arthroscopy group) were included. Five years after the initial treatment, 32 of the 214 patients who underwent arthroscopy (15.0%) compared with 30 of the 168 patients in the conservative treatment group (17.9%) ultimately underwent TKA, with no statistically significant difference between groups (P = .20). The WOMAC score was significantly lower in the arthroscopy group than in the conservative group at year 1 (24.33 ± 21.56 vs 36.43 ± 16.22, respectively) and year 2 (26.31 ± 17.84 vs 35.41 ± 19.21, respectively). There were no significant between-group differences at years 3, 4, and 5. CONCLUSIONS: Compared with conservative treatment, arthroscopy provided no benefit in decreasing or delaying arthroplasty surgery. However, arthroscopy had a greater ability to relieve symptoms at 1 and 2 years. Our results suggest that arthroscopy can relieve symptoms up to 2 years without elevating the risk of arthroplasty. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

BACKGROUND: Arthroscopic double-row suture-anchor fixation and open reduction and internal fixation (ORIF) are used to treat displaced greater tuberosity fractures, but there are few data that can help guide the surgeon in choosing between these approaches. QUESTIONS/PURPOSES: We therefore asked: (1) Is there a difference in surgical time between arthroscopic double-row suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures? (2) Are there differences in the postoperative ROM and functional scores between arthroscopic double-row suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures? (3) Are there differences in complications resulting in additional operations between the two approaches? METHODS: Between 2006 and 2012, we treated 79 patients surgically for displaced greater tuberosity fractures. Of those, 32 (41%) were considered eligible for our study based on inclusion criteria for isolated displaced greater tuberosity fractures with a displacement of at least 5 mm but less than 2 cm. During that time, we generally treated patients with displaced greater tuberosity fractures with a displacement greater than 1 cm or with a fragment size greater than 3×3 cm with open treatment, and patients with displaced greater tuberosity fractures with a displacement less than 1 cm or with a fragment size less than 3×3 cm with arthroscopic treatment. Fifty-three underwent open treatment based on those indications, and 26 underwent arthroscopic treatment, of whom 17 (32%) and 15 (58%) were available for followup at a mean of 34 months (range, 24-28 months). All patients with such fractures identified from our institutional database were treated by these two approaches and no other methods were used. Surgical time was defined as the time from initiation of the incision to the time when suture of the incision was finished, and was determined by an observer with a stopwatch. Patients were followed up in the outpatient department at 6, 12, and 24 weeks, and every 6 month thereafter. Radiographs showed optimal reduction immediately after surgery and at every followup. Radiographs were obtained to assess fracture healing. Patients were followed up for a mean of 34 months (range, 24-48 months). At the last followup, ROM, VAS score, and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate clinical outcomes. All these data were retrieved from our institutional database through chart review. Complications were assessed through chart review by one observer other than the operating surgeon. RESULTS: Patients who underwent arthroscopic double-row suture anchor fixation had longer surgical times than did patients who underwent ORIF (mean, 95.3 minutes, SD, 10.6 minutes vs mean, 61.5 minutes, SD, 7.2 minutes; mean difference, 33.9 minutes; 95% CI, 27.4-40.3 minutes; p < 0.001). All patients achieved bone union within 3 months. Compared with patients who had ORIF, the patients who had arthroscopic double-row suture anchor fixation had greater ranges of forward flexion (mean, 152.7°, SD, 13.3° vs mean, 137.7°, SD, 19.2°; p = 0.017) and abduction (mean, 146.0°, SD, 16.4° vs mean, 132.4°, SD, 20.5°; p = 0.048), and higher ASES score (mean, 91.8 points, SD, 4.1 points vs mean, 87.4 points, SD, 5.8 points; p = 0.021); however, in general, these differences were small and of questionable clinical importance. With the numbers available, there were no differences in the proportion of patients experiencing complications resulting in reoperation; secondary subacromial impingement occurred in two patients in the ORIF group and postoperative stiffness in one from the ORIF group. The two patients experiencing secondary subacromial impingement underwent reoperation to remove the implant. The patient with postoperative stiffness underwent adhesion release while receiving anesthesia, to improve the function of the shoulder. These three patients had the only reoperations. CONCLUSIONS: We found that in the hands of surgeons comfortable with both approaches, there were few important differences between arthroscopic double-row suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures. Future, larger studies with consistent indications should be performed to compare these treatments; our data can help inform sample-size calculations for such studies. LEVEL OF EVIDENCE: Level III, therapeutic study.

Arthroscopic Fixation of Tibial Eminence Fractures: A Clinical Comparative Study of Nonabsorbable Sutures Versus Absorbable Suture Anchors.

PURPOSE: To compare clinical outcomes of arthroscopic therapy for tibial eminence fracture with nonabsorbable suture and absorbable suture anchor. METHODS: Between February 2010 and September 2012, a total of 60 tibial eminence fracture patients were treated with nonabsorbable suture fixation or absorbable suture anchor fixation under arthroscopy. Patients with tibial plateau fractures and other significant injuries, including osteochondral lesions, meniscal tear, and anterior cruciate ligament (ACL) or mutiligament injuries, were excluded from the study. Radiographs, anterior drawer test (ADT), Lachman test, Lysholm score, and International Knee Documentation Committee (IKDC) 2000 subjective score were employed to evaluate clinical outcomes in follow-up. RESULTS: A total of 41 patients were analyzed. Among these patients, 22 were treated with nonabsorbable suture fixation and 19 with absorbable suture anchor fixation. According to the modified Meyers-McKeever classification, 15 cases were categorized as type II, 21 as type III, and 5 as type IV fractures. The mean time from injury to surgery was 7.1 days (range, 3 to 12 days). All patients were followed up for a median period of 33.7 months (range, 24 to 45 months). Radiographic evaluation showed optimal reduction immediately after operation and bone union within 3 months in all patients. At the final follow-up, there was no limitation of knee motion range in any patient. Grade II laxity was found in 2 cases from suture group and 1 from suture anchor group, showing no significant difference based on ADT (χ(2) = 0.538, P = .764) and Lachman test (χ(2) = 0.550, P = .760). Lysholm and IKDC 2000 subjective scores were significantly improved (P < .001). However, there were no significant differences in the improvement of Lysholm (t = 0.522, P = .604) and IKDC 2000 subjective scores (t = 0.644, P = .523) between the 2 groups. CONCLUSIONS: Nonabsorbable suture fixation and absorbable suture anchor fixation are equivalent techniques in terms of the clinical efficacy of arthroscopic tibial eminence fracture treatment. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

[Study on the accurate effects of radial shock wave therapy equipment].

The basic mechanical properties of a Radial Shock Wave Therapy Equipment (RSWTE) were experimentally studied in this paper. The output energy of the RSWTE working on the operation frequency of 10 Hz was measured by dynamic pressure transducer under the conditions of different operation pressure. The results showed that both operation pressure and operation frequency have effects on the output energy of the equipment. The output energy increases with the increase of operation pressure, and the magnitude of increased energy decreases with higher operation of frequency. With the increase of operation frequency, the output energy rises up in condition of lower operation pressure and drops off in condition of higher operation pressure. The accurate medical treatment should be selected with the optimized energy and condition according to the treatment requirement to different illness in clinical medical applications.

Hip Arthroscopy Debridement Combined with Multiple Small-Diameter Fan-Shaped Low-Speed Drilling Decompression in the Treatment of Early and Middle Stage Osteonecrosis of the Femoral Head: 14 Years Follow-Up.

OBJECTIVE: Osteonecrosis of the femoral head (ONFH) is a disease that occurs frequently in young and middle-aged people. Because of its high disability rate, it affects the ability to work, so the early treatment of this disease is particularly important. This retrospective study aimed to evaluate the clinical efficacy of hip arthroscopy combined with multiple small-diameter fan-shaped low-speed drilling decompression (MSFLD) in treating early-mid stage ONFH (ARCO II-IIIA) compared to MSFLD, with at least 10-year follow-up. METHODS: A total of 234 patients who underwent hip arthroscopy and MSFLD for ONFH from 1998 to 2012 were analyzed retrospectively. This study enrolled patients between 18 and 60 years old with ARCO stage II-III A, diagnosed clinically and through imaging, in accordance with the 2021 guidelines for the treatment of ONFH. Clinical data, including demographics, operation mode, BMI, pre- and postoperative Harris score, and femoral head survival rate, were collected. Patients were divided into hip arthroscopy + MSFLD and MSFLD groups based on the operation mode. The t-test was used to compare the postoperative efficacy, Harris scores, and survival rates of the femoral head between the two groups. RESULTS: Among the 234 patients, 160 cases were followed up, including 92 cases in the hip arthroscopy + MSFLD group and 68 cases in MSFLD group, the follow-up rate was 68.38%, and the follow-up time was (10-22)14.11 ± 3.06 years. The Harris score (80.65 ± 6.29) in the hip arthroscopy + MSFLD group was significantly higher than that in the MSFLD group (p = 0.00), and the survival rate of femoral head (5-year survival rate was 84.78%, 10-year survival rate was 23.91%) was also higher than that in the MSFLD group (5-year survival rate was 63.24%, 10-year survival rate was 8.82%). The 5-year and 10-year survival rates of patients with ARCO II were 82.11% and 28.42%, which were better than 54% and 33% for ARCO III A. The femur head survival rate of alcoholic ONFH (5-year survival rate 61.54%, 10-year survival rate 9.23%) was significantly higher than that of other types of ONFH. CONCLUSION: Clinical follow-up of at least 10 years suggests that hip arthroscopy combined with MSFLD is an effective treatment for early-mid stage ONFH, with good clinical effect and high survival rate of femoral head.

Exploring molecular mechanisms of intra-articular changes in osteonecrosis of femoral head using DIA proteomics and bioinformatics.

PURPOSE: This study is aimed to delve into the crucial proteins associated with hormonal osteonecrosis of the femoral head (ONFH) and its intra-articular lesions through data-independent acquisition (DIA) proteomics and bioinformatics analysis. METHODS: We randomly selected samples from eligible ONFH patients and collected samples from the necrotic area of the femoral head and load-bearing cartilage. The control group comprised specimens from the same location in patients with femoral neck fractures. With DIA proteomics, we quantitatively and qualitatively tested both groups and analyzed the differentially expressed proteins (DEPs) between groups. Additionally, we enriched the analysis of DEP functions using gene ontology terms and Kyoto Encyclopedia of Genes and Genomes pathways and verified the key proteins in ONFH through Western blot. RESULTS: Proteomics experiment uncovered 937 common DEPs (422 upregulated and 515 downregulated) between the two groups. These DEPs mainly participate in biological processes such as hidden attributes, catalytic activity, molecular function regulators, and structural molecule activity, and in pathways such as starch and sucrose metabolism, ECM-receptor interaction, PI3K-Akt signaling, complement and coagulation cascades, IL-17 signaling, phagosome, transcriptional misregulation in cancers, and focal adhesion. Through protein-protein interaction network target gene analysis and Western blot validation, we identified C3, MMP9, APOE, MPO, LCN2, ELANE, HPX, LTF, and THBS1 as key proteins in ONFH. CONCLUSIONS: With DIA proteomics and bioinformatics analysis, this study reveals the molecular mechanisms of intra-articular lesions in ONFH. A correlation in the necrotic area and load-bearing cartilage of ONFH at ARCO stages IIIB-IV as well as potential key regulatory proteins was identified. These findings will help more deeply understand the pathogenesis of ONFH and may provide important clues for seeking more effective treatment strategies.

Activation of Beta-adrenergic Receptors Upregulates the Signal-to-Noise Ratio of Auditory Input in the Medial Prefrontal Cortex and Mediates Auditory Fear Conditioning.

Norepinephrine (NE) is involved in auditory fear conditioning (AFC) in posttraumatic stress disorder (PTSD). However, it is still unclear how it acts on neurons. We aimed to investigate whether the activation of the ß-adrenergic receptor (ß-AR) improves AFC by sensitization of the prelimbic (PL) cortex at the animal, cellular, and molecular levels. In vivo single-cell electrophysiological recording was used to characterize the changes in neurons in the PL cortex after AFC. Then, PL neurons were locally administrated by the ß-AR agonist isoproterenol (ISO), the GABAaR agonist muscimol, or intervened by optogenetic method, respectively. Western blotting and immunohistochemistry were finally used to assess molecular changes. Noise and low-frequency tones induced similar AFC. The expression of ß-ARs in PL cortex neurons was upregulated after fear conditioning. Microinjection of muscimol into the PL cortex blocked the conformation of AFC, whereas ISO injection facilitated AFC. Moreover, PL neurons can be distinguished into two types, with type I but not type II neurons responding to conditioned sound and being regulated by ß-ARs. Our results showed that ß-ARs in the PL cortex regulate conditional fear learning by activating type I PL neurons.

Proteomic analysis of synovial fluid: insight into the pathogenesis of knee osteoarthritis.

PURPOSE: We conducted a proteomic analysis of synovial fluid (SF) to identify differentially expressed proteins and analyse their correlation with osteoarthritis (OA) severity. Our primary purpose was to gain insight into the pathogenesis of OA. METHODS: SF samples were acquired from 12 knee OA patients and 12 non-OA controls (ten had a meniscus injury, two had a discoid meniscus and all exhibited intact articular cartilage) and sequentially subjected to two-dimensional electrophoresis (2-DE). The radiographic grading of knee OA was performed using the Kellgren-Lawrence criteria. Differentially expressed proteins were identified by matrix-assisted laser desorption/ionisation time-of-flight/time-of-flight mass spectrometry (MALDI-TOF/TOF MS). Proteins of interest identified from SF were detected using an enzyme-linked immunosorbent assay (ELISA). RESULTS: A total of 31 protein spots showed significant differences (p < 0.05) between the sample groups; 25 of the 31 spots (80.6 %) were identified as proteins of interest. Among them 20 corresponded to up-regulation and five to down-regulation in OA samples. HLA-DR was one of the proteins up-regulated, which was confirmed by ELISA. CONCLUSIONS: These observations have implications in delineating the protein expression underlying the pathogenesis of OA and facilitate further elucidation of molecular mechanisms involved in disease progression. Substantial alterations of the protein profile in SF may be associated with OA severity.

Arthroscopic debridement and synovium resection for inflammatory hip arthritis.

OBJECTIVE: To evaluate the efficacy of arthroscopic surgery in inflammatory hip arthritis. METHODS: A retrospective clinical study was conducted inspecting 40 hips in 36 patients of inflammatory arthritis. There were 17 cases of ankylosing spondylitis, 11 cases of rheumatoid arthritis, and 8 cases of psoriatic arthritis. The joints were irrigated and the inflamed tissues were debrided with anthroscopy. The patients were followed up with Harris hip score, Oxford hip score, Visual Analog Scale (VAS), and magnetic resonance imaging (MRI). Statistical analysis was performed using Student t test. RESULTS: All of the 36 cases were followed up for 46-103 months, averaging 67.2±8.4 months. Harris and Oxford scores increased from 66.9±12.1 and 69.4±16.4 before operation to 78.4±19.3 and 80.2±18.8 after operation, respectively (P<0.05). VAS score decreased from pre-operative 8.5±2.5 to post-operative 7.2±2.5 (P<0.05). All the patients showed improved joint range of motion. MRI revealed alleviation of hip synovitis. The results were classified as excellent in 8 patients, good in 17 patients, fair in 8 patient, and poor in 3 according to Harris hip score. Twenty-seven patients were satisfied with the operative outcomes as they regained normal daily activities. CONCLUSIONS: Arthroscopy-assisted joint debridement and synovium resection is an effective procedure for hip lesion in inflammatory arthritis. The inflammatory lesion might be thereby controlled and the symptoms be relieved.

Green construction and release mechanism of lignin-based double-layer coated urea.

BACKGROUND: Lignin played an important role in the establishment of coated fertilizers coating material as a substitute for petrochemical raw materials. However, so far, the lignin-based coated fertilizers was limited in only the poor slow-release performance. To achieve good slow-release performance of lignin-based coated fertilizers, hydrophilic of lignin need to be resolved to establish an green and better controllable lignin-based coated fertilizers. RESULTS: In the study, a novel green double layer coating with lignin-based polyurethane (LPU) as the inner coating and epoxy resin (EP) as the outer coating was effectively constructed for coated urea. Fourier transform infrared spectra confirmed that lignin and polycaprolactone diol successfully reacted with Hexamethylene diisocyanate. The loss weight and water contact angle (WCA, 75.6-63.6°) of the LPUs decreased with the increased lignin content. The average particle hardness of the lignin-based double-layer coated urea (LDCU) first increased from 58.1 N (lignin of 30%) to 67.0 N (lignin of 60%), but then decreased to 62.3 N (lignin of 70%). The release longevity of the coated urea was closely related to the preparation parameters of the coating material. The optimal cumulative nutrient release rate (79.4%) of LDCU was obtained (lignin of 50%, -CNO/-OH molar ratios of 1.15, EP of 35%, and coating ratio of 5%). The aggregates of hydrone on the LDCU caused the dissolution and swelling of nutrients, and then the diffusion of nutrients through the concentration gradient. CONCLUSIONS: A though the nutrient release of the LDCUs was affected by many factors, the successful development of the LDCUs will help improve the rapid development of the coated fertilizer industry.

Defect-adaptive Stem-cell-microcarrier Construct Promotes Tissue Repair in Rabbits with Knee Cartilage Defects.

Although various reconstruction techniques are available for cartilage defects, the repair effects and conveniences remain to be further improved due to the limited regenerative capacity of cartilaginous tissues and difficulties in seamlessly fulfilling irregularly shaped defects. In the current study, we explored the repair efficacy of stem cell microcarrier construct (microcarriers loaded with human chondrogenic progenitor cells or bone marrow mesenchymal stem cells) in cartilage defect models. A total of 39 healthy New Zealand white rabbits were included, and femoral trochlear cartilage defect models were established (n = 33). Stem cell microcarrier constructs were implanted into cartilage defects (n = 6), the maintenance conditions of the implanted constructs were observed on days 4, 8, and 30 post implantation (n = 3). Gross observation and pathological analysis were performed to assay the reconstitution of cartilage defects at 12 weeks post-cartilage defect repair(n = 6). The microcarriers could fill the defect model with good plasticity to integrate well with the boundary native normal cartilage. At 3 months after implantation, the defects were filled with fibrous cartilage tissues in the microcarrier without stem cells group. In the microcarrier loaded with BMSCs group, newly formed tissue with a similar appearance of boundary cartilage fulfilled the defects, but the surface was not completely smooth. Promisingly, the defects were almost completely filled with newly regenerated cartilaginous tissues, which had a smooth appearance similar to that of normal cartilage in the microcarrier loaded with CPCs group. These results suggest the feasibility of stem cell microcarrier construct in repairing cartilage defects, indicating promising clinical application prospects.

In vitro sustained release of recombinant human bone morphogenetic protein-2 microspheres embedded in thermosensitive hydrogels.

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is a critical regulator of osteogenic capacity that is commonly used in bone grafts. The effectiveness of rhBMP-2 may be reduced as it can become unstable and degraded after injection into the body. Microspheres are considered appropriate vehicles for the sustained release of proteins in vivo. In this study, rhBMP-2 microspheres were manufactured using the water-in-oil-in-water (W/O/W) double-emulsion solvent-extraction technique by encapsulation in poly(lactic-co-glycolic) acid (PLGA). The microspheres were then embedded in two hydrogels made of either poloxamer 407 hydrogel or chitosan thioglycolic acid (CS-TA). The encapsulation efficiency and in vitro release of rhBMP-2 were examined and compared with the control release system (rhBMP-2 microspheres alone). The rhBMP-2 microspheres in the CS-TA hydrogel showed the lowest burst release (about 40% in the first 8h) among the three groups. The mechanisms may be the high viscosity of CS-TA hydrogel and the sustained release characteristics of CS-TA itself. The CS-TA hydrogel combined with PLGA microspheres can efficiently encapsulate rhBMP-2, control the burst release at early time points, and provide sustained release in vitro. It may be an appropriate rhBMP-2 vehicle for bone regeneration.

Full Soft Capacitive Omnidirectional Tactile Sensor Based on Micro-Spines Electrode and Hemispheric Dielectric Structure.

Flourishing in recent years, intelligent electronics is desirably pursued in many fields including bio-symbiotic, human physiology regulatory, robot operation, and human-computer interaction. To support this appealing vision, human-like tactile perception is urgently necessary for dexterous object manipulation. In particular, the real-time force perception with strength and orientation simultaneously is critical for intelligent electronic skin. However, it is still very challenging to achieve directional tactile sensing that has eminent properties, and at the same time, has the feasibility for scale expansion. Here, a fully soft capacitive omnidirectional tactile (ODT) sensor was developed based on the structure of MWCNTs coated stripe electrode and Ecoflex hemisphere array dielectric. The theoretical analysis of this structure was conducted for omnidirectional force detection by finite element simulation. Combined with the micro-spine and the hemispheric hills dielectric structure, this sensing structure could achieve omnidirectional detection with high sensitivity (0.306 ± 0.001 kPa-1 under 10 kPa) and a wide response range (2.55 Pa to 160 kPa). Moreover, to overcome the inherent disunity in flexible sensor units due to nano-materials and polymer, machine learning approaches were introduced as a prospective technical routing to recognize various loading angles and finally performed more than 99% recognition accuracy. The practical validity of the design was demonstrated by the detection of human motion, physiological activities, and gripping of a cup, which was evident to have great potential for tactile e-skin for digital medical and soft robotics.