Injury to the palmar supporting structures of the fetlock alters limb stiffness and fetlock angle.

BACKGROUND: In vivo measurement of limb stiffness and conformation provides a non-invasive proxy assessment of superficial digital flexor tendon (SDFT) and suspensory ligament (SL) function. Here, we compared it in fore and hindlimbs and after injury. OBJECTIVES: To compare the limb stiffness and conformation in forelimbs and hindlimbs, changes with age, and following injury to the SDFT and SL. STUDY DESIGN: Retrospective cohort study. METHODS: Limb stiffness was calculated using floor scales and an electrogoniometer taped to the dorsal fetlock. The fetlock angle and weight were simultaneously recorded five times with the limb weight-bearing and when the opposite limb was picked up (increased load). Limb stiffness of both limbs was calculated from the gradient of the regression line of angle versus load. Fetlock angle when the weight was zero was extrapolated from the graph and used as a measure of conformation. Limb stiffness was measured in uninjured forelimbs (n = 42 limbs), hindlimbs (n = 19 limbs), forelimbs with SDFT injury (n = 18) and hindlimbs with SL injury (n = 5). RESULTS: Limb stiffness correlated with weight in forelimbs as shown previously (p < 0.001) but also in hindlimbs (p = 0.006). When normalised to the horse's weight (503 kg, IQR 471.5-560), forelimb stiffness was significantly higher (22.3 [±4.5] × 10-3 degree-1) than for the hindlimb (16.4 [±4.0] × 10-3 degree-1; p < 0.001). While there were no significant differences between forelimb and hindlimb conformation in unaffected or SDFT injury, both limb stiffness and conformation was significantly greater in limbs with SL injury (p = 0.009 and p = 0.002, respectively). MAIN LIMITATIONS: Small sample size, lack of clinical data including lameness and quantification of injuries. CONCLUSIONS: Injury to the forelimb SDFT does not alter limb stiffness or conformation in the long-term, while hindlimb SL injury simultaneously increases limb stiffness and fetlock angle, suggesting an increase in SL length following injury.

Ubiquitin C-terminal hydrolase L1 activation in periodontal ligament cells mediates orthodontic tooth movement via the MAPK signaling pathway.

PURPOSE: Periodontal ligament cells (PDLCs) play a significant role in orthodontic force induced bone remodeling. However, the molecular mechanisms by which PDLCs respond to mechanical stimuli and influence osteoclastic activities remain unclear. This study aims to investigate the role of UCHL1, a key deubiquitinating enzyme involved in protein degradation and cellular responses, in force-treated PDLCs during orthodontic tooth movement (OTM). MATERIALS AND METHODS: In this study, we conducted in vivo and in vitro experiments using human PDLCs and a rat model of OTM. Mechanical stress was applied to PDLCs, and UCHL1 expression was analyzed through quantitative real-time polymerase chain reaction (qPCR), Western blot, and immunofluorescence staining. UCHL1 knockdown was achieved using siRNA, and its effects on osteoclast differentiation were assessed. The role of the MAPK/ERK pathway was investigated using the MEK-specific inhibitor U0126. An animal model of OTM was established, and the impact of UCHL1 inhibitor-LDN57444 on OTM and osteoclastic activity was evaluated through micro-CT analysis, histological staining, and immunohistochemistry. RESULTS: Mechanical force induced UCHL1 expression in PDLCs during OTM. UCHL1 knockdown downregulated the RANKL/OPG ratio in PDLCs, affecting osteoclast differentiation. LDN57444 inhibited OTM and osteoclastic activity. UCHL1 activation correlated with ERK1/2 phosphorylation in force-treated PDLCs. CONCLUSIONS: Mechanical force mediated UCHL1 activation in PDLCs promotes osteoclast differentiation via the ERK1/2 signaling pathway during OTM.

Importance of gap evaluation in the ossification of posterior longitudinal ligament lesions using three-dimensional computed tomography.

BACKGROUND CONTEXT: Evaluating the gaps within the ossification of the posterior longitudinal ligament (OPLL) lesions, which may contribute to neurological symptoms, using conventional imaging techniques is challenging. OBJECTIVE: This study aimed to investigate the importance of evaluating gaps using three-dimensional computed tomography (3D-CT) and their association with the occurrence of magnetic resonance imaging (MRI) T2 high intensity in the spinal cord. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Retrospective analysis of 116 patients diagnosed with cervical OPLL. OUTCOME MEASURES: Presence of gaps in OPLL, presence of T2 high intensity in the cervical spinal cord, and OPLL thickness were evaluated. METHODS: Lateral X-ray, CT, and reconstructed 3D-CT images were reviewed to assess lesion characteristics and the presence of gaps. MRI was used to evaluate the change in spinal cord signal intensity. The relationship among gap presence, lesion morphology, and MRI T2 high intensity in the spinal cord was examined. RESULTS: A significant difference in gap detection accuracy was observed between CT and 3D-CT (p = 0.0054). CT demonstrated false-positive results in the detection of gaps as compared with 3D-CT. The presence of gaps was significantly associated with an increased likelihood of MRI T2 high intensity in the spinal cord (p = 0.037). Patients with thicker lesions and smaller space available for the spinal cord (SAC) were more likely to exhibit T2 high intensity. Meanwhile, patients with gaps co-occurring with T2 high intensity exhibited significantly thinner lesions (p = 0.011) and larger SACs (p = 0.0002). Patients with gaps had a significantly lower JOA scores (p = 0.0035), which indicates that patient with gaps are likely to exhibit more severe clinical neurological symptoms. CONCLUSION: 3D-CT showed superiority in accurately identifying gaps within OPLL lesions, while CT demonstrated false-positive results in the detection of gaps. Furthermore, the gap presence was a risk factor for MRI T2 high intensity in the spinal cord, independent of lesion thickness. In addition, gaps are related to more severe clinical symptoms. This study highlighted the importance of evaluating gaps within OPLL lesions using 3D-CT to clarify neurological pathogenesis.

Role of sodium-dependent vitamin C transporter 2 in human periodontal ligament fibroblasts.

AIM: Ascorbic acid (AA) is a water-soluble vitamin that has antioxidant properties and regulates homeostasis of connective tissue through controlling various enzymatic activities. Two cell surface glycoproteins, sodium-dependent vitamin C transporter (SVCT) 1 and SVCT2, are known as ascorbate transporters. The purpose of this study was to investigate the expression pattern and functions of SVCTs in periodontal ligament (PDL) and PDL fibroblast (PDLF). METHODS: Gene expression was examined using real-time polymerase chain reaction (PCR) and reverse transcription PCR. SVCT2 expression was determined by immunofluorescence staining, western blot and flow cytometry. ALP activity and collagen production were examined using ALP staining and collagen staining. Short interfering RNA was used to knock down the gene level of SVCT2. Change of comprehensive gene expression under SVCT2 knockdown condition was examined by RNA-sequencing analysis. RESULTS: Real-time PCR, fluorescent immunostaining, western blot and flowy cytometry showed that SVCT2 was expressed in PDLF and PDL. ALP activity, collagen production, and SVCT2 expression were enhanced upon AA stimulation in PDLF. The enhancement of ALP activity, collagen production, and SVCT2 expression by AA was abolished under SVCT2 knockdown condition. RNA-sequencing revealed that gene expression of CLDN4, Cyclin E2, CAMK4, MSH5, DMC1, and Nidgen2 were changed by SVCT2 knockdown. Among them, the expression of MSH5 and DMC1, which are related to DNA damage sensor activity, was enhanced by AA, suggesting the new molecular target of AA in PDLF. CONCLUSION: Our study reveals the SVCT2 expression in PDL and the pivotal role of SVCT2 in mediating AA-induced enhancements of ALP activity and collagen production in PDLF. Additionally, we identify alterations in gene expression profiles, highlighting potential molecular targets influenced by AA through SVCT2. These findings deepen our understanding of periodontal tissue homeostasis mechanisms and suggest promising intervention targeting AA metabolism.

Anterior talofibular ligament footprint dimension measured using three-dimensional magnetic resonance imaging.

OBJECTIVE: Knowledge of footprint anatomy is essential for ankle anterior talofibular ligament repair and reconstruction. We aimed to determine the intra- and inter-rater measurement reliability of the anterior talofibular ligament footprint dimension using three-dimensional MRI. METHODS: MRI images of 20 ankles with intact ligaments, including 11 with a single bundle and nine with double-bundle ligaments, were analyzed. Imaging was performed using a 3.0-Tesla MRI. Isotropic three-dimensional proton density-weighted images with a voxel size of 0.6 mm were obtained. The fibular and talar footprints were manually segmented using image processing software to create three-dimensional ligament footprints. The lengths, widths, and areas of each sample were measured. A certified orthopedic surgeon and a senior orthopedic fellow performed the measurements twice at 6-week intervals. The intra- and inter-rater differences in the measurements were calculated. RESULTS: The length, width, and area of the single-bundle fibular footprint were 8.7 mm, 5.4 mm, and 37.4 mm2, respectively. Those of the talar footprint were 8.4 mm, 4.3 mm, and 30.1 mm2, respectively. The inferior bundle of the double-bundle ligament was significantly smaller than the single and superior bundles (p < 0.001). No differences were observed between intra-rater measurements by either rater, with maximum differences of 0.7 mm, 0.5, and 1.7 mm2, in length, width, and area, respectively. The maximum inter-rater measurement differences were 1.9 mm, 0.5, and 2.4 mm2, respectively. CONCLUSION: Measurements of the anterior talofibular ligament dimensions using three-dimensional MRI were sufficiently reliable. This measurement method provides in vivo quantitative data on ligament footprint anatomy.

Native Anterior Talo-Fibular Ligament Tensile Characteristics Compared to Allograft, Suture Tape, and Copolymer Augmentation Elements: A Biomechanical Study.

Surgical augmentation methods have been introduced to the Modified Broström (MB) technique to support native anterior talo-fibular ligament (ATFL) healing and function. This study aimed to investigate the isolated biomechanical performance of common MB augmentation elements, including allograft, suture tape, and copolymer, compared to native ATFL. Six cadaveric feet were dissected, isolating the ATFL from all surrounding soft tissue. The fibula and talus were clamped on the testing frame so that the ligament was in line with the load cell. Six samples per augment group were fixed on a test frame with a gauge length of 20 mm to replicate ATFL length. All samples were pulled to failure at 305 mm/min. Biomechanical outcomes included stiffness, elongation, and ultimate load. Mean ± standard deviation was reported. Stiffness was highest for suture tape (246.4±52.1N/mm), followed by allograft (114.2±26.2 N/mm), native ATFL (78.6±31.8 N/mm), and copolymer (9.4±2.9 N/mm). Significant differences in stiffness were observed between all groups except when comparing ATFL stiffness to allograft (P=0.086). Copolymer resulted in significantly larger elongation at ultimate load compared to native ATFL, suture tape, and allograft (P<0.001). Elongation at ultimate failure was highest for copolymer (30.0±8.7 mm) and significantly greater than all other groups (P<0.001). Ultimate load was highest for suture tape (544.1±59.7 N), followed by native ATFL (338.5±63.7 N), allograft (308.3±98.5 N) and copolymer (146.7±8.9 N). Suture tape ultimate load was significantly greater than copolymer (P<0.001). Isolated biomechanical data of augment materials can be utilized by foot and ankle surgeons when considering appropriate ligament augmentation options. Level of Clinical Evidence 5, controlled laboratory study.

Is there a duration-characteristic relationship for trypsin exposure on tendon? A study on anterior cruciate ligament reconstruction in a rabbit model.

Background: Decellularized allograft tendons are highly regarded for their accessibility and the reduced risk of immune rejection, making them a promising choice for grafting due to their favorable characteristics. However, effectively integrating reconstructed tendons with host bone remains a significant clinical challenge. Purpose: This study aims to investigate the relationship between the duration of tendon exposure to trypsin and its impact on tendon biomechanical properties and healing capacity. Methods: Morphological assessments and biochemical quantifications were conducted. Allograft tendons underwent heterotopic transplantation into the anterior cruciate ligament (ACL) in a rabbit model, with specimens harvested 6 weeks post-surgery for a comparative analysis of cell adhesion strength and mechanical performance. Duration-response curves were constructed using maximum stress and cell adhesion quantity as primary indicators. Results: The trypsin treatment enhanced cell adhesion on the tendon surface. Adhesion rates in the control group vs. the experimental groups were as follows: 3.10 ± 0.56% vs. 4.59 ± 1.51%, 5.36 ± 1.24%, 6.12 ± 1.98%, and 8.27 ± 2.34% (F = 6.755, p = 0.001). However, increasing treatment duration led to a decline in mechanical properties, with the ultimate load (N) in the control vs. experimental groups reported as 103.30 ± 10.51 vs. 99.59 ± 4.37, 93.15 ± 12.38, 90.42 ± 7.87, and 82.68 ± 6.89, F = 4.125 (p = 0.013). Conclusion: The findings reveal an increasing trend in adhesion effectiveness with prolonged exposure duration, while mechanical strength declines. The selection of the optimal processing duration should involve careful consideration of the benefits derived from both outcomes.

Two-Dimensional and 3-Dimensional MRI Assessment of Progressive Collapsing Foot Deformity-Adult Acquired Flat Foot Deformity.

This article is meant to serve as a reference for radiologists, orthopedic surgeons, and other physicians to enhance their understanding of progressive collapsing foot deformity, also known as adult acquired flat foot deformity. Pathophysiology, imaging findings, especially on MRI and 3-dimensional MRI are discussed with relevant illustrations so that the readers can apply these principles in their practice for better patient managements.

High-resolution Ultrasound of the Foot and Ankle.

High-resolution ultrasound (US) can be used to assess soft tissue abnormalities in the foot and ankle. Compared to MRI, it has lower cost, is widely available, allows portability and dynamic assessment. US is an excellent method to evaluate foot and ankle tendon injuries, ligament tears, plantar fascia, peripheral nerves, and the different causes of metatarsalgia.

Diagnostic Musculoskeletal Ultrasound for Medial Collateral Ligament Injuries: Applications in Rehabilitation.

Medial collateral ligament (MCL) injuries are prevalent in sports and other physical activities and constitute a significant cause of knee pain and dysfunction. Traditional diagnostic modalities such as magnetic resonance imaging (MRI) are often utilized for their detailed visualization capabilities. However, musculoskeletal ultrasound (MSK-US) has emerged as a pivotal diagnostic tool in the evaluation of MCL injuries due to its non-invasive nature, cost-effectiveness, and dynamic imaging capabilities. This article reviews the utility and advantages of MSK-US in diagnosing MCL injuries, with a specific focus on its implications for rehabilitation providers. We discuss the technical aspects of ultrasound (US) imaging, including the sonographic appearance of MCL injuries across various grades, and compare its diagnostic accuracy with other imaging modalities such as MRI. Additionally, the role of US in monitoring the healing process and guiding rehabilitation strategies is explored. This review emphasizes the practical application of MSK-US in clinical settings, offering rehabilitation providers a comprehensive understanding of how US can be integrated into patient management protocols to enhance outcomes in patients with MCL injuries.

Cadaveric Insights into Pudendal Nerve Variations for Sacrospinous Ligament Fixation: A Case Series.

INTRODUCTION AND HYPOTHESIS: The proximity of the pudendal nerve to the sacrospinous ligaments (SSLs) can lead to serious complications during sacrospinous ligament fixation (SSLF). This case series is aimed at providing an overview of the anatomy of the pudendal nerve, including insights from cadaver dissections and discussions on rare variations observed during these dissections. METHODS: Dissections were conducted on five female cadavers using a posterior gluteal approach on both sides. The course, morphometric features and variations in the branches of the pudendal nerve were assessed at the level of the SSL and within the pudendal canal. RESULTS: The number of pudendal trunks cranial to the SSL ranged from one to three, with double trunks being the most common (70%). In 2 out of 10 (20%) sides inferior rectal nerves (IRNs) pierced through the SSL. In Case 1, IRNs pierced the SSL bilaterally before entering the pudendal canal and exiting at distances of 23.81 mm and 41.18 mm from the ischial spine on the right and left sides respectively. In Case 2, nerves with a width of 2.12 mm and 2.49 mm pierced the SSL and joined the IRN, piercing the SSL at 13.38 mm and 12.55 medial to the ischial spine and 16.80 mm and 19.32 mm lateral to the sacrum, on the left and right sides respectively. In 60% of cases, the IRN entered the pudendal canal, exiting at a median distance of 21.25 mm from the ischial spine. CONCLUSIONS: We identified significant variations in the number of trunks and branching patterns of the pudendal nerve around the SSL and the course of the IRN caudal to the SSL. We documented IRNs or nerves joining the IRNs piercing the SSL. Identifying these variations is crucial for surgeons to minimize the risk of pudendal nerve injury during SSLF.

Examination of the Tensile Strength of the Peroneus Longus Muscle.

INTRODUCTION: The peroneus longus tendon (PLT) is increasingly used as a tendon autograft in ligament and tendon reconstructions. The aim of this study is to evaluate the biomechanical properties of the PLT to assess its usability in frequently performed reconstructions. METHODS: Six fresh-frozen, below-knee cadavers with a mean age of 65 years, no previous surgical operation, and no history of chronic disease were used. PLTs were harvested, freed from muscle tissue, and prepared for tensile strength testing at a tensile force rate of 2 mm/min using a Shimadzu Autograph AG-IS 100 kN instrument (Shimadzu Corporation, Kyoto, Japan). RESULTS: The maximum tensile force varied between 600.7 N and 1131.313 N, with a median of 758.185 N. All tendons had diameters of 8 mm or more. The elongation at maximum force ranged from 9.0 mm to 16.0 mm, with a median of 14.0 mm. CONCLUSION: According to this study, PLT is a viable choice for surgeries involving autograft reconstruction. However, further clinical studies are needed to confirm its efficacy in reconstructive surgeries.

Does chronic ankle instability patients lead to changes in biomechanical parameters associated with anterior cruciate ligament injury during landing? A systematic review and meta-analysis.

Objective: This study aimed to determine if patients with chronic ankle instability (CAI) exhibit biomechanical changes associated with the increased risk of anterior cruciate ligament (ACL) injury during landing tasks. Study Design: This study was conducted through systematic review and meta-analysis. Data Sources: Searches were conducted in May 2024 across five electronic databases, including Web of Science, Scopus, PubMed, SPORTDiscus, and Cochrane Library. Eligibility Criteria: Studies were included if they (1) involved subjects with CAI and healthy controls and (2) assessed biomechanical variables such as ground reaction forces, joint angles, and joint torques. Results: Of the 675 identified studies, 171 were included in the review, and 13 were eligible for meta-analysis. The reviewed studies clearly defined research objectives, study populations, consistent participant recruitment, and exposures, and they used valid and reliable measures for outcomes. However, areas such as sample size calculation, study sample justification, blinding in assessments, and addressing confounders were not robust. This meta-analysis involved 542 participants (healthy group: n = 251; CAI group: n = 291). Compared with healthy individuals, patients with CAI exhibited a greater peak vertical ground reaction force (peak VGRF; SMD = 0.30, 95% CI: 0.07-0.53, p = 0.009), reduced hip flexion angles (SMD = -0.30, 95% CI: -0.51 to -0.17, p < 0.0001), increased trunk lateral flexion (SMD = 0.47, 95% CI: 0.05 to 0.9, p = 0.03), greater hip extension moments (SMD = 0.47, 95% CI: 0.09-0.84, p = 0.02), and increased knee extension moments (SMD = 0.39, 95% CI: 0.02-0.77, p = 0.04). Conclusion: During landing tasks, patients with CAI demonstrate increased hip extension moments and knee extension moments, decreased hip flexion angles, increased peak VGRF, and increased trunk lateral flexion angles. These biomechanical variables are associated with an elevated risk of ACL injuries.Systematic Review Registration: Identifier CRD42024529349.

Internal Hernia Through Acquired Broad Ligament Defect: A Case Report.

Internal hernias are relatively uncommon occurrences in cases of mechanical bowel obstructions. They occur when the small bowel herniates through a recess or defect within the abdominal cavity. Herniation through a defect in the broad ligament is particularly rare among internal herniations. We present the case of an 88-year-old female who presented to the emergency department with a history of abdominal pain and obstipation. The patient had undergone open tubectomy 43 years ago. Erect abdominal radiograph and contrast-enhanced computed tomography confirmed the presence of intestinal obstruction. Exploratory laparotomy revealed a viable small intestinal loop herniating through a defect in the right broad ligament. The herniated bowel loop was reduced, and the defect was closed. The contralateral side was examined to confirm the absence of defects in the left broad ligament. Early diagnosis of internal hernia through broad ligament defect requires a high index of suspicion, and the advent of computed tomography has facilitated early preoperative diagnosis. Rapid management is necessary to prevent catastrophic sequelae such as strangulation and gangrenous changes in the herniated bowel.

What do we need to address when we treat neglected Monteggia fracture in children.

Monteggia fracture is a relatively uncommon injury in pediatric patients, accounting for less than 2% of forearm fractures, characterized by a combination of ulna fracture and radial head dislocation. Neglected Monteggia fractures define as those that have not received treatment within 3 weeks. In children, ulna fractures are easily diagnosed while radial head dislocation may be overlooked, necessitating open reduction after neglecting the Monteggia fracture and potentially causing additional trauma to the child. This study aims to review the pathological characteristics of neglected Monteggia fractures based on the length ratio of the ulna and radius, relative positions between the proximal ends of the ulna and radius, the integrality of annular ligament and the pathological change of proximal radioulnar joint. The findings will provide valuable insights and guidance for managing neglected Monteggia fractures.

Reliability of pre-resection ligament tension assessment in imageless robotic assisted total knee replacement.

BACKGROUND: Ligament tension balance is a major determinant for the success of total knee replacement (TKR). The present study aimed at determining the inter-rater and intra-rater reliability in performing ligament tension assessment using an imageless robotic-assisted TKR. METHODS: Twenty-four knees in 21 patients who received robotic-assisted TKR for end-stage varus osteoarthritis were examined. Three orthopedic specialists and six orthopedic trainees participated in the operations. Data from the ligament tension assessment were collected during the operations. RESULTS: For the inter-rater reliability, "extension medial" and "flexion medial" had excellent reliability whilst "extension lateral" and "flexion lateral" had good-to-excellent reliability. For the intra-rater reliability, "extension medial" showed excellent reliability, "extension lateral" and "flexion medial" showed good-to-excellent reliability, and "flexion lateral" showed moderate-to-excellent reliability. CONCLUSIONS: Robotic-assisted technology provides a reliable solution to improve ligament tension assessment. All ligament tension assessments with the use of the technology could demonstrate at least good-to-excellent reliability except for the intra-rater reliability of "flexion lateral".

Bone marrow stromal and anterior cruciate ligament remnant cell co-culture-derived extracellular vesicles promote cell activity in both cell types.

The significance of anterior cruciate ligament (ACL) remnants during reconstruction remains unclear. Co-culturing ACL remnant cells and bone marrow stromal cells (BMSCs) may reduce apoptosis and enhance hamstring tendon activity. This study investigated whether extracellular vesicles (EVs), which facilitate cell-cell interactions, act as the active components, improving graft maturation in this co-culture. The effects of EVs on cell viability, proliferation, migration and gene expression in the rabbit ACL remnant cells and BMSCs were assessed using control (BMSC-only culture), co-culture (ACL remnant cells and BMSCs, CM) and co-culture without EVs (CM ∆ EVs) media. EVs were isolated from control (BMSC-EV) and co-culture (CM-EV) media and characterized. CM significantly enhanced the proliferation, migration and expression of transforming growth factor (TGF-ß)-, vascular endothelial growth factor (VEGF)-, collagen synthesis- and tenogenesis-related genes. However, CM-induced effects were reversed by the CM ∆ EVs treatment. CM-EV treatment exhibited higher potential to enhance proliferation, migration and gene expression in the ACL remnant cells and BMSCs than BMSC-EV and non-EV treatments. In conclusion, EVs, secreted under the coexistence of ACL remnant cells and BMSCs, primarily increase the cell viability, proliferation, migration and gene expression of collagen synthesis-, TGF-ß-, VEGF- and tenogenesis-related genes in both cell types.

Enzymatic activity of fibroblast activation protein-α is essential for TGF-ß1-induced fibroblastic differentiation of human periodontal ligament cells.

Human periodontal ligament cells (hPDLCs) contain multipotent postnatal stem cells that can differentiate into PDL fibroblasts, osteoblasts, and cementoblasts. Interaction between the extracellular environment and stem cells is an important factor for differentiation into other progenitor cells. To identify cell surface molecules that induce PDL fibroblastic differentiation, we developed a series of monoclonal antibodies against membrane/ECM molecules. One of these antibodies, an anti-PDL25 antibody, recognizes approximately a 100 kDa protein, and this antigenic molecule accumulates in the periodontal ligament region of tooth roots. By mass spectrometric analysis, we found that the antigenic molecule recognized by the anti-PDL25 antibody is fibroblast activation protein α (FAPα). The expression level of FAPα/PDL25 increased in TGF-ß1-induced PDL fibroblasts, and this protein was localized in the cell boundaries and elongated processes of the fibroblastic cells. Ectopic expression of FAPα induced fibroblastic differentiation. In contrast, expression of representative markers for PDL differentiation was decreased by knock down and antibody blocking of FAPα/PDL25. Inhibition of dipeptidyl peptidase activity by a potent FAPα inhibitor dramatically inhibited PDL fibroblastic marker expression but did not affect in cell proliferation and migration.

Anatomic femoral tunnel and satisfactory clinical outcomes achieved with the modified transtibial technique in anterior cruciate ligament reconstruction: A systematic review and meta-analysis.

Background: Anatomic anterior cruciate ligament (ACL) reconstruction is considered the gold standard treatment for ACL injuries because it aims to restore the knee's normal anatomy and stability, while also protecting long-term knee health. Long-term clinical and radiological outcomes after ACL reconstruction using the modified TT technique are unclear. Objective: To assess the clinical and radiological outcomes following ACL reconstruction using modified transtibial (TT) techniques at a minimum 12-month follow-up. Design: A systematic review with meta-analysis. Methods: PubMed, EMBASE, Web of Science, the Cochrane Library, and MEDLINE databases were searched from the inception to December 1, 2022. PICO search strategy was used to identify studies applying modified TT techniques on patients with ACL reconstruction and a minimum follow-up of 12 months. Eligible studies were identified independently by two reviewers. We extracted data on patient demographics, surgical characteristics, patient reported outcomes including subjective evaluations and clinical outcomes. Radiological data including femoral and tibial tunnel position, femoral and tibial tunnel length, and femoral tunnel angle were also extracted. The tunnel position was evaluated using the quadrant method based on three-dimensional computed tomography (3D CT) images. The standardized mean difference (SMD) and 95 % confidence interval (CI) were calculated for clinical and radiological outcomes. Results: Sixteen studies involving 628 patients were finally included. The SMD of Lysholm (90.39; 95 % CI 83.41-97.38), IKDC (86.07; 95 % CI 79.84-92.31), and Tegner (6.15; 95 % CI 3.96-8.33) scores were considered satisfactory. The depth of the femoral tunnel showed a pooled SMD of 30.08 % (95 % CI 28.25-31.91 %), and the height showed a pooled SMD of 37.72 % (95 % CI 35.75-39.70 %). The pooled SMD for the femoral tunnel angle in the coronal plane was 48.27°(95 % CI 43.14-53.40°), and the pooled SMD for the femoral tunnel length was 33.98 mm (95 % CI 29.03-38.93 mm). Conclusions: This investigation has shown that modified TT technique can create an anatomic femoral tunnel and maintain optimal tunnel length and angulation. Most patients had satisfactory subjective outcomes and physical examinations after ACL reconstruction using modified TT technique. This information may assist in guiding expectations of clinicians and patients following ACL reconstruction with modified TT technique.

Preliminary investigation on the mechanism of anti-periodontitis effect of Scutellariae Radix based on bioinformatics analysis and in vitro verification.

Objective: To investigate the material basis, targets and molecular mechanism of Scutellariae Radix against periodontitis to provide theoretical basis for clinical applications. Materials and methods: The active compounds and targets of Scutellariae Radix were obtained from Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) database, and the periodontitis-related targets were collected by integrating Online Mendelian Inheritance in Man (OMIM), Therapeutic Target Database (TTD), Genecards and Gene Expression Omnibus (GEO) database together. The potential targets of Scutellariae Radix against periodontitis were obtained from the intersection of two target sets. Metascape database was used for Gene Ontology (GO) term enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Discovery Studio software was used for molecular docking between key targets and compounds to evaluate their binding affinity. Western blot was used to check the expression of PTGS2 and MMP9 to verify the regulatory effects of baicalein, the main active compound of Scutellariae Radix, on human periodontal ligament stem cells (hPDLSCs) cultured under inflammatory environment which induced by lipopolysaccharide (LPS). Results: 15 active compounds of Scutellariae Radix and 53 common targets for periodontitis treatment were identified. Among these targets, the 10 core targets were AKT1, IL-6, TNF, VEGFA, TP53, PTGS2, CASP3, JUN, MMP9 and HIF1A. GO and KEGG analysis mainly focused on response to LPS and pathways in cancer. Molecular docking showed that the main active compounds had good binding affinity with key targets. Cell experiments confirmed that baicalein can interfere the expression of pro-inflammatory factors PTGS2 and MMP9 proteins and exert anti-inflammatory effects. Conclusion: Current study preliminarily analyzed the mechanism of Scutellariae Radix against periodontitis, which provide a new idea for the utilization of Scutellariae Radix and the development of novel medicine for the clinical treatment of periodontitis.