Comparative Biomechanical Analysis of Anterior Process Locking Plate Alone versus Combined with Percutaneous Cannulated Screw Fixation for Sanders Type II Calcaneal Fractures: A Finite Element Study.

BACKGROUND Calcaneal fractures are the most common tarsal bone fractures, and account for 75% of intra-articular fractures. The purpose of this study was to compare the biomechanical stability of the anterior process locking plate combined with the percutaneous cannulated screw fixation (screw group) versus the anterior process locking plate fixation alone (plate group) for the treatment of Sanders type II calcaneal fractures using finite element analysis to provide a theoretical basis for clinical work. MATERIAL AND METHODS We established a 3D model of Sanders type II calcaneal fracture; assigned material properties to the internal fixation systems; applied loads; set up analysis criteria; analyzed the displacement of the fracture, relative displacement, stress state of bone tissue, and internal fixation; and compared mechanical stability. RESULTS For Sanders type II A, II B, and II C calcaneal fractures, the degree of displacement and relative displacement of the fracture in the screw group was less than that of the plate group. For all subtypes of Sanders type II calcaneal fractures, the screw group had better mechanical stability than the plate group. CONCLUSIONS Both fixation methods (screw and plate group) were within a reasonable range for restoring the levelling effect of the joint surface and maintaining the strength of fixation, and both had good mechanical stability. Finite element analysis is a relatively reliable method, and biomechanics and clinical studies must further verify the experimental results.

A Web-Based Calculator to Predict Early Death Among Patients With Bone Metastasis Using Machine Learning Techniques: Development and Validation Study.

BACKGROUND: Patients with bone metastasis often experience a significantly limited survival time, and a life expectancy of <3 months is generally regarded as a contraindication for extensive invasive surgeries. In this context, the accurate prediction of survival becomes very important since it serves as a crucial guide in making clinical decisions. OBJECTIVE: This study aimed to develop a machine learning-based web calculator that can provide an accurate assessment of the likelihood of early death among patients with bone metastasis. METHODS: This study analyzed a large cohort of 118,227 patients diagnosed with bone metastasis between 2010 and 2019 using the data obtained from a national cancer database. The entire cohort of patients was randomly split 9:1 into a training group (n=106,492) and a validation group (n=11,735). Six approaches-logistic regression, extreme gradient boosting machine, decision tree, random forest, neural network, and gradient boosting machine-were implemented in this study. The performance of these approaches was evaluated using 11 measures, and each approach was ranked based on its performance in each measure. Patients (n=332) from a teaching hospital were used as the external validation group, and external validation was performed using the optimal model. RESULTS: In the entire cohort, a substantial proportion of patients (43,305/118,227, 36.63%) experienced early death. Among the different approaches evaluated, the gradient boosting machine exhibited the highest score of prediction performance (54 points), followed by the neural network (52 points) and extreme gradient boosting machine (50 points). The gradient boosting machine demonstrated a favorable discrimination ability, with an area under the curve of 0.858 (95% CI 0.851-0.865). In addition, the calibration slope was 1.02, and the intercept-in-large value was -0.02, indicating good calibration of the model. Patients were divided into 2 risk groups using a threshold of 37% based on the gradient boosting machine. Patients in the high-risk group (3105/4315, 71.96%) were found to be 4.5 times more likely to experience early death compared with those in the low-risk group (1159/7420, 15.62%). External validation of the model demonstrated a high area under the curve of 0.847 (95% CI 0.798-0.895), indicating its robust performance. The model developed by the gradient boosting machine has been deployed on the internet as a calculator. CONCLUSIONS: This study develops a machine learning-based calculator to assess the probability of early death among patients with bone metastasis. The calculator has the potential to guide clinical decision-making and improve the care of patients with bone metastasis by identifying those at a higher risk of early death.

Three-dimensional orientation and location-dependent varying rules of radiographic angles of the acetabular cup.

AIM: The aim of this study is to demonstrate the varying rules of radiographic angles following varying three-dimensional (3D) orientations and locations of cup using an accurate mathematical model. METHODS: A cone model is established to address the quantitative relationship between the opening circle of cup and its ellipse projection on radiograph. The varying rules of two-dimensional (2D) radiographic anteversion (RA) and inclination (RI) angles can be analyzed. RESULTS: When the centre of cup is located above X-ray source, with proper 3D RI/RA angles, 2D RA angle can be equal to its 3D counterpart, and 2D RI angle is usually greater than its 3D counterpart. Except for the original point on hip-centered anterior-posterior radiograph, there is no area on radiograph where both 2D RA and RI angles are equal to their 3D counterparts simultaneously. DISCUSSION: This study proposes an innovative model for accurately explaining how 2D RA/RI angles of cup are varying following different 3D RA/RI angles and location of cup. The analysis results provide clinicians an intuitive grasp of knowledge about 2D RA/RI angles greater or smaller than their 3D counterparts post-operatively. The established model may allow determining the effects of pelvic rotations on 2D radiographic angles of cup.

Experimental study on treatment of acetabular anterior column fractures: applyment of a minimally invasive percutaneous lag screw guide apparatus.

BACKGROUND: The aim of this study was to design a new minimally invasive percutaneous lag screw guide apparatus and to verify its adjuvant treatment of acetabular anterior column fracture on pelvis specimens. METHODS: This guide apparatus was self-developed based on the principles of "two points form a line" and "Rectangle". Using C-arm fluoroscopy, this guide apparatus was used to conduct minimally invasive percutaneous lag screw internal fixation of acetabular anterior column fractures. Ten hollow lag screws were placed into 5 pelvis specimens. RESULT: Result showed no sign of any screws puncturing the cortex or entering into the hip joint on radiological assessment. The cross-section reconstructed vertical distance to the screw, on the cross-section acetabular notch and the cross-section of the screw where the distance of between the screw and the iliopectineal line's arc roof was at its shortest, indicate that at all points (T, R-r) under the line with an inclination of 1 (namely T = R-r) the screw is within the cortex and does not puncture the acetabula anterior column or enter into the hip joint. CONCLUSIONS: We may conclude that this self-developed guide apparatus solves the screw precision problem during the treatment of acetabular anterior column fractures through a minimally invasive percutaneous lag screw.

Tantalum rod implantation for femoral head osteonecrosis: survivorship analysis and determination of prognostic factors for total hip arthroplasty.

PURPOSE: The purpose of this study was to evaluate the moderate survival data of porous tantalum rod implants for the treatment of osteonecrosis of the femoral head (ONFH). Additionally, some independent prognostic factors for conversion to total hip arthroplasty (THA) were identified. METHODS: The porous tantalum rod population was obtained from a prospective, consecutive group of patients treated for Steinberg stage I and II osteonecrosis from April 2009 through July 2011. The historical core decompression and impaction of bone filling particle subjects underwent surgery from April 2007 through March 2009. Surgical data including time of surgery, blood loss, and cell transfusions were recorded. Post-operative values were measured for hospitalization length as well as days requiring a patient-controlled analgesia (PCA) pump. Primary outcomes were Harris hip score and survivorship analysis. Demographics and baseline characteristics included age, sex, etiology, bilateral disease, associated chronic systemic disease, Steinberg stage, Harris hip score, accompanied with bone marrow edema of femoral head, and osteonecrotic lesion size. RESULTS: Demographic/baseline characteristics were similar between two groups. At the post-operative follow-up of 62 months, Harris hip scores were significantly increased (P < 0.0001) when compared to that before surgery in both groups. The magnitude of increase in the tantalum rod implant group was significantly greater than that in the control group (P = 0.0426). With an average follow-up of 48 months (range, 38-62 months), the tantalum rod group had an 84.6 % survival rate. With an average follow-up of 72 months (range, 67-85 months), the control group had a 63.3 % survival rate. A comparison of Kaplan-Meier curves showed significantly higher cumulative survival rates (P = 0.048) for hips with implantation of the porous tantalum rod (74.1 % at 62 months) than for those with impaction composite bone material (49.9 % at 62 months). The Cox proportional-hazard model revealed that implantation of tantalum rod (P = 0.012), bone marrow edema (P = 0.003), corticosteroids intake (P = 0.007), and age less than 50 years (P = 0.014) were the independent prognostic factors related to conversion into THA. CONCLUSIONS: Compared with the traditional impaction composite bone material technique, implantation of tantalum rod in the treatment of Steinberg stages I and II ONFH can obtain better clinical results and higher cumulative survival rates. For patients without the use of corticosteroids, and especially for hips without bone marrow oedema, the clinical results from our study show highly encouraging survival rates and a delay in or prevention of conversion into THA.

A Meta-Analysis of Arthroscopic versus Open Repair for Treatment of Bankart Lesions in the Shoulder.

BACKGROUND: The optimal treatment for Bankart lesion remains controversial. Therefore, we performed this meta-analysis to compare the clinical outcomes of patients managed with open Bankart repair versus arthroscopic Bankart repair. MATERIAL AND METHODS: After systematic review of online databases, a total of 11 trials with 1022 subjects were included. The methodological quality of randomized controlled trials (RCTs) was assessed using the PEDro critical appraisal tool, and non-RCTs were evaluated by Newcastle-Ottawa (NO) quality assessment tool. Outcomes of shoulder stability, range of motion (ROM), functional scales, and surgical times were analyzed. RESULTS: Data synthesis showed significant differences between the two strategies, with regards to stability of the shoulder (P=0.008, RR=0.94, 95% CI: 0.89 to 0.98), and ROM (P<0.001, SMD=-0.47, 95% CI: -0.72 to -0.22). CONCLUSIONS: Open Bankart repair produced a more stable shoulder but had a relatively poor shoulder motion, compared with arthroscopic Bankart repair, for the treatment of Bankart lesion.

Association of CD44 Gene Polymorphism with Survival of NSCLC and Risk of Bone Metastasis.

BACKGROUND: Previous studies have reported CD44 expression played an important role in the development and progression of tumor. The aim of study was to investigate whether single nucleotide polymorphisms (SNPs) of CD44 gene were associated with risk of non-small cell lung cancer (NSCLC), survival and occurrence rate of bone metastasis in patients with NSCLC. MATERIAL AND METHODS: A total of 234 patients with NSCLC between 2003 and 2010 were enrolled in this study and 468 healthy persons were used as controls. Two polymorphisms, rs13347 and rs187115, in the CD44 gene were genotyped using DNA from blood lymphocytes. For statistical analysis we used the chi-square test, Fisher's exact test, Kaplan-Meier method, and log-rank test. RESULTS: CD44 gene rs13347 polymorphism was not associated with NSCLC risk. For rs187115, the association with NSCLC risk was observed (P<0.001). Allele G carriers had significantly higher occurrence rates of bone metastasis (OR=0.4, 95%CI: 0.20-0.64, P<0.001) and more advanced tumor stage (OR=2.6, 95%CI: 1.50-4.45, P=0.001) compared to carriers of allele A. The survival rates for patients with AA genotype were significantly higher than for patients with the AG+GG genotypes (P<0.001). In multivariate analysis of survival in NSCLC patients, significant predictors were CD44 gene (AG+GG) (RR=0.48, 95%CI: 0.34-0.68, P<0.001), tumor stage (RR=0.45, 95%CI: 0. 0.31-0.65, P<0.001), and bone metastasis (RR=1.52, 95%CI: 1.05-2.21, P=0.027). CONCLUSIONS: CD44 gene rs187115 polymorphism is a potential predictive marker of survival in NSCLC patients, and is significantly correlated with bone metastasis and tumor stage.

The Effect of Polymorphisms in SPP1 on Risk of Fracture: A Case-Control Study.

BACKGROUND The purpose of the study was to investigate the correlation between rs4754 and rs6840362 polymorphisms of secreted phosphoprotein 1 (SPP1) gene and fracture risk. MATERIAL AND METHODS rs4754 and rs6840362 were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 130 patients with fracture and 107 healthy controls matched with the former by age and sex. Hardy-Weinberg equilibrium (HWE) was assessed in the control group based on the genotype distributions of SSP1 poylmorphisms. The differences in genotype, allele, and haplotype frequencies between cases and controls were detected by the chi-square test, and the relative risk of fracture is expressed by odds ratio (OR) and 95% confidence interval (CI). The linkage disequilibrium (LD) and haplotype analyses were conducted with HaploView software. RESULTS The TT genotype in rs4754 had significant difference in patients with fracture and controls (10.77% and 4.59%, P=0.04) and the results showed that people carrying TT genotype of rs4754 were more susceptible to fractures than CC genotype carriers (OR=3.00, 95%CI=1.02-8.89). The T allele also had 1.54 times higher risk of fractures (OR=1.54, 95%CI=1.04-2.30), but this was not true for the rs6840362 polymorphism. LD between the 2 polymorphisms and haplotype C-T (rs6840362-rs4754) increased the susceptibility to fracture (OR=2.01, 95%CI=1.23-3.28). CONCLUSIONS SPP1 rs4754 polymorphism may be related to risk of fracture, but not rs6840362.

A computer aided measurement method for unstable pelvic fractures based on standardized radiographs.

BACKGROUND: To set up a method for measuring radiographic displacement of unstable pelvic ring fractures based on standardized X-ray images and then test its reliability and validity using a software-based measurement technique. METHODS: Twenty-five patients that were diagnosed as AO/OTA type B or C pelvic fractures with unilateral pelvis fractured and dislocated were eligible for inclusion by a review of medical records in our clinical centre. Based on the input pelvic preoperative CT data, the standardized X-ray images, including inlet, outlet, and anterior-posterior (AP) radiographs, were simulated using Armira software (Visage Imaging GmbH, Berlin, Germany). After representative anatomic landmarks were marked on the standardized X-ray images, the 2-dimensional (2D) coordinates of these points could be revealed in Digimizer software (Model: Mitutoyo Corp., Tokyo, Japan). Subsequently, we developed a formula that indicated the translational and rotational displacement patterns of the injured hemipelvis. Five separate observers calculated the displacement outcomes using the established formula and determined the rotational patterns using a 3D-CT model based on their overall impression. We performed 3D reconstruction of all the fractured pelvises using Mimics (Materialise, Haasrode, Belgium) and determined the translational and rotational displacement using 3-matic suite. The interobserver reliability of the new method was assessed by comparing the continuous measure and categorical outcomes using intraclass correlation coefficient (ICC) and kappa statistic, respectively. RESULT: The interobserver reliability of the new method for translational and rotational measurement was high, with both ICCs above 0.9. Rotational outcome assessed by the new method was the same as that concluded by 3-matic software. The agreement for rotational outcome among orthopaedic surgeons based on overall impression was poor (kappa statistic, 0.250 to 0.426). Compared with the 3D reconstruction outcome, the interobserver reliability of the formula method for translational and rotational measures was perfect with both ICCs more than 0.9. CONCLUSIONS: The new method for measuring displacement using a formula was reliable, and could minimise the measurement errors and maximise the precision of pelvic fracture description. Furthermore, this study was useful for standardising the operative plan and establishing a theoretical basis for robot-assisted pelvic fracture surgery based on 2-D radiographs.

[A modified porous tantalum implant technology for osteonecrosis of the femoral head: survival and prognostic evaluations of conversion into total hip arthroplasty].

OBJECTIVE: To assess the survival and prognostic significance of various demographic and radiographic parameters for conversion into total hip arthroplasty after treatment with a modified porous tantalum implant technology for early and intermediate stages of osteonecrosis of the femoral head (ONFH). METHODS: This study included 45 patients (59 hips) with Steinberg Stage I-IV A ONFH undergoing progressively core decompression, impaction bone grafting of 5 mm-composite bone filling material and inserting of a porous tantalum implant. Weight-bearing was forbidden within the first 3 months after implants. RESULTS: A total of 57 hips (44 patients) were available during a mean follow-up period of 44.8 (11-62) months. Their mean age was 43 (21-70) years. The mean Harris hip score significantly improved from 59.93 ± 2.80 preoperative to 77.84 ± 2.95 at the last follow-up (P < 0.001). Overall, 11 hips (19.30%) were converted into total hip arthroplasty. The overall survival rate was 72.49% at 60 months postoperatively. The Cox proportional hazard model revealed that bone marrow edema was an independent prognostic factor related with a conversion into total hip arthroplasty. CONCLUSION: Higher survival rates may be obtained from modified tantalum implant technology for early and intermediate stages of ONFH. And prognosis was poor for patients of ONFH with bone marrow edema.

A New Treatment Strategy for Spinal Metastasis: The "Systemic Conditions, Effectiveness of Systemic Treatment, Neurology, and Oncology" Decision Framework System.

BACKGROUND AND OBJECTIVES: Treating metastatic spinal tumors poses a significant challenge because there are currently no universally applied guidelines for managing spinal metastases. This study aims to propose a new decision framework for the 12-point epidural spinal cord compression grading system to treat patients with metastatic spinal tumors and investigate its clinical effectiveness in a multicenter analysis. METHODS: This study analyzed 940 patients with metastatic spinal tumors between December 2017 and March 2023. The study provided the clinical evidence for the systemic conditions, effectiveness of systemic treatment, neurology, and oncology (SENO) decision framework among spine metastases. The SENO decision framework was launched in January 2021 in our hospitals, classifying patients into 2 groups: The non-SENO group (n = 489) consisted of patients treated between December 2017 and January 2021, while the SENO group (n = 451) comprised patients treated from January 2021 to March 2023. RESULTS: Patients in the SENO group were more likely to receive minimally invasive surgery (67.85% vs 58.69%) and less chance of receiving spinal cord circular decompression surgery (14.41% vs 24.74%) than patients in the non-SENO group ( P < .001). Furthermore, patients in the SENO group experienced fewer perioperative complications (9.09% vs 15.34%, P = .004), incurred lower hospitalization costs ( P < .001), had shorter length of hospitalization ( P < .001), and received systematic treatments for tumors earlier ( P < .001). As a result, patients in the SENO group (329.00 [95% CI: 292.06-365.94] days) demonstrated significantly improved survival outcomes compared with those in the non-SENO group (279.00 [95% CI: 256.91-301.09], days) ( P < .001). At 3 months postdischarge, patients in the SENO group reported greater improvements in their quality of life, encompassing physical, social, emotional, and functional well-being, when compared with patients in the non-SENO group. CONCLUSION: The SENO decision framework is a promising approach for treating patients with metastatic spinal tumors.

Promoting postoperative recovery in patients with metastatic epidural spinal cord compression based on the concept of ERAS: a multicenter analysis of 304 patients.

BACKGROUND CONTEXT: Enhanced recovery after surgery (ERAS) has proven beneficial for patients undergoing orthopedic surgery. However, the application of ERAS in the context of metastatic epidural spinal cord compression (MESCC) remains undefined. PURPOSE: This study aims to establish a medical pathway rooted in the ERAS concept, with the ultimate goal of scrutinizing its efficacy in enhancing postoperative outcomes among patients suffering from MESCC. STUDY DESIGN/SETTING: An observational cohort study. PATIENT SAMPLE: A total of 304 patients with MESCC who underwent surgery were collected between January 2016 and January 2023 at two large tertiary hospitals. OUTCOME MEASURES: Surgery-related variables, patient quality of life, and pain outcomes. Surgery-related variables in the study included surgery time, surgery site, intraoperative blood loss, and complication. METHODS: From January 2020 onwards, ERAS therapies were implemented for MESCC patients in both institutions. Thus, the ERAS cohort included 138 patients with MESCC who underwent surgery from January 2020 to January 2023, whereas the traditional cohort consisted of 166 patients with MESCC who underwent surgery from January 2016 to December 2019. Clinical baseline characteristics, surgery-related features, and surgical outcomes were collected. Patient quality of life was evaluated using the Functional Assessment of Cancer Therapy-General Scale (FACT-G), and pain outcomes were assessed using the Visual Analogue Scale (VAS). RESULTS: Comparison of baseline characteristics revealed that the two cohorts were similar (all p>.050), indicating comparable distribution of clinical characteristics. In terms of surgical outcomes, patients in the ERAS cohort exhibited lower intraoperative blood loss (p<.001), shorter postoperative hospital stays (p<.001), lower perioperative complication rates (p=.020), as well as significantly shorter time to ambulation (P<0.001), resumption of regular diet (p<.001), removal of urinary catheter (p<.001), initiation of radiation therapy (p<.001), and initiation of systemic internal therapy (p<.001) compared with patients in the traditional cohort. Regarding pain outcomes and quality of life, patients undergoing the ERAS program demonstrated significantly lower VAS scores (p<.010) and higher scores for physical (p<.001), social (p<.001), emotional (p<.001), and functional (p<.001) well-being compared with patients in the traditional cohort. CONCLUSIONS: The ERAS program, renowned for its ability to expedite postoperative recuperation, emerges as a promising approach to ameliorate the recovery process in MESCC patients. Not only does it exhibit potential in enhancing pain management outcomes, but it also holds the promise of elevating the overall quality of life for these individuals. Future investigations should delve deeper into the intricate components of the ERAS program, aiming to unravel the precise mechanisms that underlie its remarkable impact on patient outcomes.

Application of image recognition-based tracker-less augmented reality navigation system in a series of sawbone trials.

BACKGROUND: This study introduced an Augmented Reality (AR) navigation system to address limitations in conventional high tibial osteotomy (HTO). The objective was to enhance precision and efficiency in HTO procedures, overcoming challenges such as inconsistent postoperative alignment and potential neurovascular damage. METHODS: The AR-MR (Mixed Reality) navigation system, comprising HoloLens, Unity Engine, and Vuforia software, was employed for pre-clinical trials using tibial sawbone models. CT images generated 3D anatomical models, projected via HoloLens, allowing surgeons to interact through intuitive hand gestures. The critical procedure of target tracking, essential for aligning virtual and real objects, was facilitated by Vuforia's feature detection algorithm. RESULTS: In trials, the AR-MR system demonstrated significant reductions in both preoperative planning and intraoperative times compared to conventional navigation and metal 3D-printed surgical guides. The AR system, while exhibiting lower accuracy, exhibited efficiency, making it a promising option for HTO procedures. The preoperative planning time for the AR system was notably shorter (4 min) compared to conventional navigation (30.5 min) and metal guides (75.5 min). Intraoperative time for AR lasted 8.5 min, considerably faster than that of conventional navigation (31.5 min) and metal guides (10.5 min). CONCLUSIONS: The AR navigation system presents a transformative approach to HTO, offering a trade-off between accuracy and efficiency. Ongoing improvements, such as the incorporation of two-stage registration and pointing devices, could further enhance precision. While the system may be less accurate, its efficiency renders it a potential breakthrough in orthopedic surgery, particularly for reducing unnecessary harm and streamlining surgical procedures.

Core decompression and implantation of bone marrow mononuclear cells with porous hydroxylapatite composite filler for the treatment of osteonecrosis of the femoral head.

BACKGROUND: Implanted bone marrow mononuclear cells (BMMCs) may promote both osteogenesis and angiogenesis in the femoral head. The aim of this study was to investigate the effectiveness of core decompression and implantation of BMMCs with porous hydroxyapatite bone filler for the treatment of osteonecrosis of the femoral head (ONFH). METHODS: Patients with ONFH underwent core decompression and implantation of nano-hydroxyapatite/polyamide bone filler with or without BMMCs. Primary outcomes were changes in Harris hip and visual analogue scale (VAS) pain scores. Secondary outcomes included radiological and clinical success rates, adverse events, and complications. RESULTS: Demographic/baseline characteristics were similar between groups (BMMC, n = 17 with 26 ONFH hips; control, n = 17 with 27 ONFH hips). Harris hip scores were significantly increased (P < 0.05) in both groups of patients after surgery (last follow-up). The magnitude of increase was significantly greater in the BMMC as compared with the control group (28.6 ± 0.5 vs. 18.4 ± 1.7 %, P < 0.001). VAS scores were significantly decreased (P < 0.05) in both groups after surgery (last follow-up). The magnitude of decrease was significantly greater in the BMMC as compared with the control group (-66.3 ± 1.4 vs. -51.7 ± 2.9 %, P < 0.001). Radiological and clinical success rates were significantly higher in the BMMC as compared with the control group (82.5 vs. 40.7 % and 75.4 vs. 37.0 %, respectively, P < 0.001). Postoperative collapse of the femoral head was less common in the BMMC as compared with the control group (17.5 vs. 59.3 %, P < 0.01). CONCLUSIONS: Both core decompression with or without implantation of BMMC are effective treatment for ONFH. However, core decompression with implantation of BMMCs and porous hydroxyapatite bone filler may be a more effective treatment for ONFH.

[Efficacies of bone-marrow-derived mononuclear cells with a hydroxylapatite composite in the treatment of osteonecrosis of the femoral head].

OBJECTIVE: To evaluate the efficacies of core decompression and implantation of concentrated autologous bone marrow containing mononuclear cells (BMMCs) with porous hydroxylapatite composite in the treatment of osteonecrosis of the femoral head. METHODS: A total of 35 patients with 57 osteonecrosis hips with ARCO stage I, stage II and stage IIIA disease were treated by BMMCs with a porous hydroxylapatite composite. The mean age at surgery was 39.4 (26-58) years and the mean period of follow-up 28 (12-40) months. In the control group, cell-free porous hydroxylapatite composite was implanted into 17 patients (27 hips) with osteonecrosis of the femoral head and the outcomes were compared. RESULTS: At the last follow-up, postoperative Harris hip scores significantly increased in both groups (P < 0.0001). The magnitude of increase was significantly greater in the BMMCs group compared with the control group (28.3% ± 0.9% vs 18.4% ± 1.7%, P < 0.01). Postoperative visual analog scale (VAS) scores significantly decreased in both groups (P < 0.01). The magnitude of decrease was significantly greater in the BMMCs group compared with the control group (-70.2% ± 2.1% vs -51.7% ± 2.9%, P < 0.001). The clinical success rate was significantly higher in the BMMCs group compared with the control group (75.4% vs 37.0%, P < 0.01). The radiological success rates were similar between the BMMCs and control groups (59.6% vs 40.7%, P = 0.1046). CONCLUSION: The combined regimen of core decompression and implantation of concentrated autologous BMMCs with porous hydroxylapatite composite appears to confer benefits in the treatment of in stages I-IIIA osteonecrosis of the femoral head.

Mathematical modeling and application of IL-1ß/TNF signaling pathway in regulating chondrocyte apoptosis.

Introduction: Mathematical model can be used to model complex biological processes, and have shown potential in describing apoptosis in chondrocytes. Method: In order to investigate the regulatory mechanisms of TNF signaling pathway in regulating chondrocyte apoptosis, a fractional-order differential equation model is proposed to describe the dynamic behavior and mutual interaction of apoptosis-related genes under the activation of TNF signaling pathway. Compared with the traditional molecular biology techniques, the proposed mathematical modeling has advantages to providing a more comprehensive understanding of the regulatory mechanisms of TNF signaling pathway in chondrocyte apoptosis. Result: In this paper, differentially expressed genes induced by IL-1ß in human chondrocyte apoptosis are screened using high-throughput sequencing. It is found that they were significantly enriched in the TNF signaling pathway. Therefore, a mathematical model of the TNF signaling pathway is built. Using real-time PCR experiments, mRNA data is measured and used to identify the model parameters, as well as the correlation coefficient. Finally, the sensitivity of the model parameters is discussed by using numerical simulation methods, which can be used to predict the effects of different interventions and explore the optimal intervention strategies for regulating chondrocyte apoptosis. Discussion: Therefore, fractional-order differential equation modeling plays an important role in understanding the regulatory mechanisms of TNF signaling pathway in chondrocyte apoptosis and its potential clinical applications.

Development of a novel 12-point grading system for evaluating epidural spinal cord compression and its clinical implications.

BACKGROUND CONTEXT: The assessment of epidural spinal cord compression (ESCC) plays a crucial role in clinical decision-making, yet the current grading system lacks reliability and requires improvements. PURPOSE: The study aims to develop a reliable grading system for evaluating ESCC and to investigate its association with the neurological status of patients. STUDY DESIGN/SETTING: A prospective cohort study. PATIENT SAMPLE: A total of 330 patients with metastatic spinal disease were included in the study. OUTCOME MEASURES: The main outcome was the neurological status evaluated using the American Spinal Injury Association (ASIA) scale. METHODS: We proposed a novel grading system, called the 12-point ESCC grading system, to evaluate ESCC based on findings from spinal magnetic resonance imaging (MRI). This new grading system consists of 12 grades, ranging from Grade 0 to 3, with higher grades indicating more severe ESCC. The detailed information about the sagittal image of the spine and the severity of spinal cord swelling was considered in this new grading system. The Spearman correlation analysis and logistic regression analysis were employed to investigate the correlation between the previous 6-point grading system and ASIA, as well as between the new 12-point ESCC grading system and ASIA. The prediction effectiveness was evaluated using the area under curve (AUC) analysis. RESULTS: Patients with higher grades in the 12-point ESCC grading system exhibited a higher likelihood of experiencing a worse neurological condition. Specifically, patients with grades 2a to 2d and 3a to 3d according to the new 12-point ESCC grading system were significantly associated with more complete paralysis (p<.001) compared with patients with grade 0. The Spearman correlation coefficient was 0.729 between the previous 6-point ESCC grading system and ASIS and 0.750 between the new 12-point ESCC grading system and ASIS. When categorizing ASIS into complete paralysis and other neurological statuses, the 6-point ESCC score yielded an AUC of 0.820, which increased to 0.860 with the new 12-point ESCC grading system. Furthermore, when ASIS was divided into normal and abnormal neurological statuses, the AUC increased from 0.889 to 0.906. Additionally, spinal cord swelling was significantly associated with more complete paralysis (p<.001) and abnormal neurological status (p<.001) based on the new 12-point ESCC grading system. CONCLUSIONS: The new 12-point ESCC grading system provides more detailed information and further improves the prediction effectiveness for evaluating neurological status compared with the previous 6-point ESCC grading system. In the new 12-point ESCC grading system, higher grades or the presence of spinal cord swelling are indicative of a worse neurological condition.

Treatment of patients with metastatic epidural spinal cord compression using an enhanced recovery after surgery program.

Purpose: The aims of this study were to introduce a new medical, pathway based on the concept of "enhanced recovery after surgery" (ERAS) for patients with metastatic epidural spinal cord compression (MESCC), and to test whether the ERAS program could improve clinical metrics among such patients. Methods: Data from patients with MESCC (n = 98), collected between December 2016 and December 2019 (Non-ERAS cohort), and from 86 patients with metastatic epidural spinal cord compression collected between January 2020 and December 2022 (ERAS cohort), were retrospectively analyzed. Patients were treated by decompressive surgery combined with transpedicular screw implantation and internal fixation. Patient baseline clinical characteristics were collected and compared between the two cohorts. Surgical outcomes analyzed included operation time; intraoperative blood loss; postoperative length of hospital stay; time to ambulation, regular diet, urinary catheter removal, and radiation therapy; perioperative complications; anxiety; depression; and satisfaction with treatment. Results: No significant differences in clinical characteristics were found between the non-ERAS and enhanced recovery after surgery cohorts (all p > 0.050), indicating that the two cohorts were comparable. Regarding surgical outcomes, the enhanced recovery after surgery cohort had significantly less intraoperative blood loss (p < 0.001); shorter length of postoperative hospital stay (p < 0.001); shorter time to ambulation (p < 0.001), regular diet (p < 0.001), urinary catheter removal (p < 0.001), radiation administration (p < 0.001), and systemic internal therapy (p < 0.001); lower perioperative complication rate (p = 0.024); less postoperative anxiety (p = 0.041); and higher score for satisfaction with treatment (p < 0.001); whereas operation time (p = 0.524) and postoperative depression (p = 0.415) were similar between the two cohorts. Compliance analysis demonstrated that ERAS interventions were successfully conducted in the vast majority of patients. Conclusion: The enhanced recovery after surgery intervention is beneficial to patients with metastatic epidural spinal cord compression, according to data on intraoperative blood loss; length of hospital stay; time to ambulation, regular diet, urinary catheter removal, radiation exposure, and systemic internal therapy; perioperative complication; alleviation of anxiety; and improvement of satisfaction. However, clinical trials to investigate the effect of enhanced recovery after surgery are needed in the future.

Machine learning-based algorithms to predict severe psychological distress among cancer patients with spinal metastatic disease.

BACKGROUND CONTEXT: Metastatic spinal disease is an advanced stage of cancer patients and often suffer from terrible psychological health status; however, the ability to estimate the risk probability of this adverse outcome using current available data is very limited. PURPOSE: The goal of this study was to propose a precise model based on machine learning techniques to predict psychological status among cancer patients with spinal metastatic disease. STUDY DESIGN/SETTING: A prospective cohort study. PATIENT SAMPLE: A total of 1043 cancer patients with spinal metastatic disease were included. OUTCOME MEASURES: The main outcome was severe psychological distress. METHODS: The total of patients was randomly divided into a training dataset and a testing dataset on a ratio of 9:1. Patients' demographics, lifestyle choices, cancer-related features, clinical manifestations, and treatments were collected as potential model predictors in the study. Five machine learning algorithms, including XGBoosting machine, random forest, gradient boosting machine, support vector machine, and ensemble prediction model, as well as a logistic regression model were employed to train and optimize models in the training set, and their predictive performance was assessed in the testing set. RESULTS: Up to 21.48% of all patients who were recruited had severe psychological distress. Elderly patients (p<0.001), female (p =0.045), current smoking (p=0.002) or drinking (p=0.003), a lower level of education (p<0.001), a stronger spiritual desire (p<0.001), visceral metastasis (p=0.005), and a higher Eastern Cooperative Oncology Group (ECOG) score (p<0.001) were significantly associated with worse psychological health. With an area under the curve (AUC) of 0.865 (95% CI: 0.788-0.941) and an accuracy of up to 0.843, the gradient boosting machine algorithm performed best in the prediction of the outcome, followed by the XGBooting machine algorithm (AUC: 0.851, 95% CI: 0.768-0.934; Accuracy: 0.826) and ensemble prediction (AUC: 0.851, 95% CI: 0.770-0.932; Accuracy: 0.809) in the testing set. In contrast, the AUC of the logistic regression model was only 0.836 (95% CI: 0.756-0.916; Accuracy: 0.783). CONCLUSIONS: Machine learning models have greater predictive power and can offer useful tools to identify individuals with spinal metastatic disease who are experiencing severe psychological distress.