Metabolic Syndrome and Tendon Disease: A Comprehensive Review.

Metabolic syndrome (MS) is a multifaceted pathological condition characterized by the atypical accumulation of various metabolic components such as central obesity or excess weight, hyperlipidemia, low-density lipoprotein (LDL), hypertension, and insulin resistance. Recently, MS has been recognized as a notable contributor to heart and circulatory diseases. In addition, with increasing research, the impact of MS on tendon repair and disease has gradually emerged. Recent studies have investigated the relationship between tendon healing and diseases such as diabetes, dyslipidemia, obesity, and other metabolic disorders. However, diabetes mellitus (DM), hypercholesterolemia, obesity, and various metabolic disorders often coexist and together constitute MS. At present, insulin resistance is considered the major pathological mechanism underlying MS, central obesity is regarded as the predominant factor responsible for it, and dyslipidemia and other metabolic diseases are known as secondary contributors to MS. This review aims to evaluate the current literature regarding the impact of various pathological conditions in MS on tendon recovery and illness, and to present a comprehensive overview of the effects of MS on tendon recovery and diseases, along with the accompanying molecular mechanisms.

Minimally invasive surgery role in central squamous lung cancer after neoadjuvant chemoimmunotherapy.

Background: The present body of literature provides restricted evidence concerning the application of video-assisted thoracoscopic surgery (VATS) in individuals diagnosed with centrally located, locally advanced, and initially surgically challenging squamous cell lung carcinoma (SqCLC) following neoadjuvant chemoimmunotherapy (CIT). Further research is warranted to elucidate the role and potential benefits of VATS in this particular patient population. Methods: We performed a retrospective analysis on individuals diagnosed with centrally located and locally advanced SqCLC who received preoperative CIT at a single institution. The study evaluated the percentage of VATS performed, conversion rates, and perioperative outcomes. Furthermore, survival outcomes related to the resection extent were compared between patients who underwent standard lobectomy (SL) and extended lobectomy (EL, e.g., sleeve, bilobectomy or pneumonectomy) after neoadjuvant CIT. Results: A total of 27 cases of centrally located SqCLC underwent neoadjuvant CIT followed by VATS, with one case requiring conversion to thoracotomy due to adhesions. Comparison of perioperative outcomes and long-term cancer-specific mortality between the VATS group (N=24) and the thoracotomy group (N=13) did not yield any statistically significant differences. However, the VATS group exhibited a significantly higher frequency of SL (66.7% vs. 30.8%, P=0.046). Notably, within the VATS group, all three patients who experienced tumor relapse or died due to tumor recurrence were from the SL subgroup. Conclusions: This study contributes valuable real-world evidence demonstrating the feasibility and safety of utilizing VATS in the management of patients with centrally located and locally advanced SqCLC following neoadjuvant CIT. However, careful consideration might be given to the extent of resection to optimize patient long-term outcomes.

Advances focusing on the application of decellularization methods in tendon-bone healing.

BACKGROUND: The tendon or ligament is attached to the bone by a triphasic but continuous area of heterogeneous tissue called the tendon-bone interface (TBI). The rapid and functional regeneration of TBI is challenging owing to its complex composition and difficulty in self-healing. The development of new technologies, such as decellularization, has shown promise in the regeneration of TBI. Several ex vivo and in vivo studies have shown that decellularized grafts and decellularized biomaterial scaffolds achieved better efficacy in enhancing TBI healing. However further information on the type of review that is available is needed. AIM OF THE REVIEW: In this review, we discuss the current application of decellularization biomaterials in promoting TBI healing and the possible mechanisms involved. With this work, we would like to reveal how tissues or biomaterials that have been decellularized can improve tendon-bone healing and to provide a theoretical basis for future related studies. KEY SCIENTIFIC CONCEPTS OF THE REVIEW: Decellularization is an emerging technology that utilizes various chemical, enzymatic and/or physical strategies to remove cellular components from tissues while retaining the structure and composition of the extracellular matrix (ECM). After decellularization, the cellular components of the tissue that cause an immune response are removed, while various biologically active biofactors are retained. This review further explores how tissues or biomaterials that have been decellularized improve TBI healing.

Real-time, random-access organ screening for carbapenem-resistant organisms (CRO) reduces CRO-associated, donor-derived infection mortality in lung transplant recipients.

PURPOSE: Donor-derived infection (DDI) has become an important factor affecting the prognosis of lung transplantation patients. The risks versus benefits of using donor organs infected with multidrug-resistant organisms (MDRO), especially carbapenem-resistant organisms (CRO), are frequently debated. Traditional microbial culture and antimicrobial susceptibility testing at present fail to meet the needs of quick CRO determination for donor lungs before acquisition. In this study, we explored a novel screening method by using Xpert® Carba-R assay for CRO in donor lungs in a real-time manner to reduce CRO-associated DDI mortality. METHODS: This study was registered on chictr.org.cn (ChiCTR2100053687) on November 2021. In the Xpert Carba-R screening group, donor lungs were screened for CRO infection by the Xpert Carba-R test on bronchoalveolar fluid (BALF) before acquisition. If the result was negative, donor lung acquisition and subsequent lung transplantation were performed. In the thirty-five potential donors, nine (25.71%) with positive Xpert Carba-R results in BALF were declined for lung transplantation. Twenty-six recipients and the matching CRO-negative donor lungs (74.29%) were included in the Xpert Carba-R screening group. In the control group, nineteen recipients underwent lung transplants without Xpert Carba-R screening. The incidence and mortality of CRO-associated DDI were collected and contrasted between the two groups. RESULTS: Multivariate analysis showed that CRO-related death due to DDI within 60 days was significantly lower in the Xpert Carba-R screening group than that in the control group (OR = 0.05, 95% CI 0.003-0.74, p = 0.03). CONCLUSION: Real-time CRO screening of donor lungs before transplantation at the point of care by the Xpert Carba-R helps clinicians formulate lung transplantation strategies quickly and reduces the risk of subsequent CRO infection improving the prognosis of lung transplantation.

1.2†W single-frequency Tm3+/Ho3+ co-doped fiber oscillator at 2050†nm.

In this Letter, a watt-level single-frequency fiber oscillator at 2050 nm was demonstrated for the first time, to the best of our knowlegde, in a linear laser cavity with a piece of an un-pumped Tm3+/Ho3+ co-doped fiber serving as a saturable absorber. With delicate optimization of mode filtering effect of the dynamic gratings formed in the saturable absorber, a maximum single-frequency laser output power of 1.2 W was achieved under a total bidirectional pump power of 5.8 W at 1570 nm, and the corresponding optical efficiency is 20.7%. This is, to the best of our knowledge, the highest power of a single-frequency fiber oscillator at the wavelength above 2 µm.

Widely tunable single-frequency Er-doped ZBLAN fiber laser with emission from 3.37 to 3.72†µm.

We demonstrate a widely tunable single-frequency Er-doped ZBLAN fiber laser operating on a 4F9/2→4I9/2 transition band. An uncoated germanium (Ge) plate serves as a narrow-bandwidth etalon and is inserted in the cavity to achieve a single longitudinal mode selection. Wavelength tuning from 3373.8 nm to 3718.5 nm was demonstrated by using a blazed diffraction grating at 3.5 µm. At the emission peak of 3465.6 nm, the laser yields over 100 mW single-frequency output power, with a 3 dB linewidth <6.9 MHz, and a slope efficiency (with respect to the incident 1990 nm pump power) of 20.3%. Such a tunable mid-infrared single-frequency fiber laser may serve as a versatile laser source in spectroscopy and sensing applications.

Efficient continuous-wave Nd:YVO4/KGW intracavity Raman laser.

We demonstrate an efficient Nd:YVO4/KGW intracavity Raman laser in continuous-wave (CW) scheme. With a V-shaped fundamental laser cavity and a short Stokes cavity in it, the oscillating beam sizes are designed to alleviate the thermal effect and to enhance the Raman gain for efficient CW operation. The output power of CW Stokes wave at 1177 nm reached 9.33 W under an incident laser diode pump power of 36.65 W, with corresponding optical efficiency being 25.5%. To the best of our knowledge, these are the highest Stokes output power and conversion efficiency of CW intracavity Raman lasers.

Engineered exosomes: A promising strategy for tendon-bone healing.

BACKGROUND: Due to the spatiotemporal complexity of the composition, structure, and cell population of the tendon-bone interface (TBI), it is difficult to achieve true healing. Recent research is increasingly focusing on engineered exosomes, which are a promising strategy for TBI regeneration. AIM OF REVIEW: This review discusses the physiological and pathological characteristics of TBI and the application and limitations of natural exosomes in the field of tendon-bone healing. The definition, loading strategies, and spatiotemporal properties of engineered exosomes were elaborated. We also summarize the application and future research directions of engineered exosomes in the field of tendon-bone healing. KEY SCIENTIFIC CONCEPTS OF REVIEW: Engineered exosomes can spatially deliver cargo to targeted sites and temporally realize the sustained release of therapeutic molecules in TBI. This review expounds on the multidifferentiation of engineered exosomes for tendon-bone healing, which effectively improves the biological and biomechanical properties of TBI. Engineered exosomes could be a promising strategy for tendon-bone healing.

Pump quantum efficiency optimization of 3.5 µm Er-doped ZBLAN fiber laser for high-power operation.

976 nm + 1976 nm dual-wavelength pumped Er-doped ZBLAN fiber lasers are generally accepted as the preferred solution for achieving 3.5 µm lasing. However, the 2 µm band excited state absorption from the upper lasing level (4F9/2 → 4F7/2) depletes the Er ions population inversion, reducing the pump quantum efficiency and limiting the power scaling. In this work, we demonstrate that the pump quantum efficiency can be effectively improved by using a long-wavelength pump with lower excited state absorption rate. A 3.5 µm Er-doped ZBLAN fiber laser was built and its performances at different pump wavelengths were experimentally investigated in detail. A maximum output power at 3.46 µm of ~ 7.2 W with slope efficiency (with respect to absorbed 1990 nm pump power) of 41.2% was obtained with an optimized pump wavelength of 1990 nm, and the pump quantum efficiency was increased to 0.957 compared with the 0.819 for the conventional 1976 nm pumping scheme. Further power scaling was only limited by the available 1990 nm pump power. A numerical simulation was implemented to evaluate the cross section of excited state absorption via a theoretical fitting of experimental results. The potential of further power scaling was also discussed, based on the developed model.

Single knotless-anchor with two ethicon 2# for Ellman grade III bursal-side partial thickness rotator cuff tears: a cadaveric biomechanical study and short-term clinical evaluation.

BACKGROUND: Several surgical techniques are used to treat bursal-side partial thickness rotator cuff tears (PTRCTs). However, use of single knotless-anchor with two Ethicon 2# repair technique for PTRCTs has not been reported. MATERIALS AND METHODS: Bursal-side PTRCTs (Ellman grade III, 75% thickness of tears) were created in the supraspinatus tendon in 16 fresh-frozen cadaveric shoulders. The specimens were randomly assigned to two equal groups: (1) Group A (Transtendon repair), a single knotless-anchor repair with two Ethicon 2#; (2) Group B, Conversion repair (Double-row, DR). Post-repair, each specimen was subjected to cyclic loading test from 5 to 100 N (50 cycles), followed by an ultimate failure test. The displacement of greater tuberosity (mm) and ultimate (N) were recorded. In the clinical study, 12 patients diagnosed with Ellman grade III Bursal-side PTRCTs (using a single knotless anchor with two Ethicon 2# repair techniques) were operated on and analyzed. Visual analog scale (VAS), American Shoulder and Elbow Surgeons Score (ASES), Constant-Murley Score (CMS), and range of motion (ROM) were assessed before surgery and at final minimum follow-up (>1year). RESULTS: There was no significant between-group difference with respect to load-to-failure test (Group A, 359.25 ± 17.91 N; Group B, 374.38 ± 13.75 N, P > 0.05). There were no significant differences with respect to rotator cuff displacement of 10 mm (Group A, 190.50 ± 8.52 N; Group B, 197.25 ± 6.84 N, P > 0.05) and 15 mm (Group A, 282.25 ± 12.20 N; Group B, 291.13 ± 14.74 N, P > 0.05). However, there was significant between-group difference with respect to displacement of 3 and 5 mm (P < 0.05). In the clinical trial, all patients were followed up for an average of 20.4 months (12-29 months). At the last follow-up after surgery(minimum>1year), the VAS score was 0.50 ± 0.67 (0-2), the ASES score was 86.50 ± 3.96 (79-92), the CMS score was 85.08 ± 5.65 (74-93), the mean Forward flexion ROM was 154.00°± 12.48° (131°-169°), and the abduction ROM was 165.00°±13.26° (138°-173°). There was a statistically significant difference between the results of the preoperative and the last postoperative follow-up. The results of the last postoperative follow-up were statistically different from those of the preoperative follow-up (P < 0.05). Regarding complications, stiffness (2 cases) and shoulder impingement (1 case) occurred in 3 cases (25%). CONCLUSION: A single knotless anchor with two Ethicon 2# may provide a biomechanically and clinically feasible option for the treatment of bursal-side Ellman grade III PTRCTs, particularly in resource-constrained settings. MESH KEYWORDS: Bursal-side Ellman Grade III; Single Knotless-anchor; Double-row repair; Biomechanical study; Short-term clinical evaluation.

The effect of neutrophil extracellular traps in venous thrombosis.

Neutrophil extracellular traps (NETs) as special release products of neutrophils have received extensive attention. They are composed of decondensed chromatin and coated with nucleoproteins, including histones and some granulosa proteins. NETs can form a network structure to effectively capture and eliminate pathogens and prevent their spread. Not only that, recent studies have shown that NETs also play an important role in venous thrombosis. This review provides the most important updated evidence regarding the mechanism of NETs formation and the role of NETs in the process of venous thrombosis. The potential prophylactic and therapeutic value of NETs in venous thrombotic disease will also be discussed.

External stimulation: A potential therapeutic strategy for tendon-bone healing.

Injuries at the tendon-bone interface are very common in the field of sports medicine, and healing at the tendon-bone interface is complex. Injuries to the tendon-bone interface can seriously affect a patient's quality of life, so it is essential to restore stability and promote healing of the tendon-bone interface. In addition to surgical treatment, the healing of tendons and bones can also be properly combined with extracorporeal stimulation therapy during the recovery process. In this review, we discuss the effects of extracorporeal shock waves (ESWs), low-intensity pulsed ultrasound (LIPUS), and mechanical stress on tendon-bone healing, focusing on the possible mechanisms of action of mechanical stress on tendon-bone healing in terms of transcription factors and biomolecules. The aim is to provide possible therapeutic approaches for subsequent clinical treatment.

Bone cemented K-wire fixation versus elastic stable intramedullary nailing fixation of paediatric proximal humerus fractures: A prospective cohort study.

BACKGROUND: The objective of this study is to compare the treatments of pediatric displaced proximal humerus fractures with external-fixation technique using the combination of K-wires and bone-cement versus close reduction and internal fixation technique using elastic stable intramedullary nail. METHODS: From April 2016 to March 2020, 72 children with proximal humeral fractures were allocated to group A and 44 children with proximal humeral fractures were allocated to group B. Patients in group A were treated with bone-cemented K-wire fixation, and patients in group B were treated with elastic stable intramedullary nailing. The function of the upper limb was assessed using the Shortened Version of the Disabilities of the Arm, Shoulder and Hand questionnaire and Neer score. Patient satisfaction was assessed using the 10-cm visual analogue scale. RESULTS: Bone healing was achieved in group A and B after a mean time of 6.1 ± 1.2 and 6.4 ± 1.1 weeks, respectively. The mean surgical time of groups was 33 ± 9 and 54 ± 12 minutes, respectively. The mean Quick Disabilities of the Arm, Shoulder and Hand questionnaire score of groups were 0.5 ± 1.4 and 0.7 ± 1.5, respectively. Based on Neer score, we obtained 69 excellent and 3 good results in group A, and 41 excellent and 3 good results in group B. There were significant differences regarding duration of operation, cost of treatment, and postoperative angle at bone healing (P < .05). CONCLUSIONS: The external cemented K-wire fixation is a useful and reliable alternative technique for the treatment of severely displaced proximal humerus fractures in children. The technique is a minimally invasive procedure with minimal complications.

High-power, high-efficiency single-frequency DBR fiber laser at 1064†nm based on Yb3+-doped silica fiber.

A high-power, high-efficiency single-frequency fiber laser at 1064 nm was demonstrated based on a distributed Bragg reflector (DBR) all-silica-fiber configuration. A single-frequency laser with an output power of 642 mW and slope efficiency of 66.4% with respect to absorbed pump power was achieved from a 1.2-cm-long commercially available Yb3+-doped silica fiber. To the best of our knowledge, this is the highest single-frequency laser power and efficiency obtained from the DBR all-silica fiber laser. The work presented here paves the way for the development of high-power, robust, and cost-effective single-frequency Yb3+-doped all-silica fiber lasers.

Efficacy of arthroscopic internal fixation with countersunk screw in the treatment of talus fracture.

Objective: To explore clinical effects of arthroscopic internal fixation with countersunk screw in the treatment of talus fracture. Methods: Forty-eight patients with talus fracture treated in hospital of Chengde Medical University from February 2015 to December 2019 were enrolled for present investigation. The patients with talus fracture were randomly assigned into two groups, with twenty-four patients per group. The patients with talus fracture in the observation group were treated with arthroscopic internal fixation with countersunk screw, while the traditional open reduction and internal fixation were applied for the ones in control group. The clinical efficacy of the patients was evaluated three months after the operation, and the preoperative and postoperative ankle joint functions, fracture-healing time, hospital stay, and complications were carefully compared between observation and control group. Results: A total efficiency as high as 91.67% was showed in observation group, which is distinctly better than the effective rate of control group (66.67%, P<0.05). Before operation, ankle function scores (AOFAS) of control group and observation group is 42.08 ± 4.29 and 41.75±5.31 with no significantly difference (P>0.05); while after the surgery, AOFAS scores of control group is significantly lower than that of observation group: (66.28±7.51 vs. 53.0 ±6.79, P<0.05). Moreover, healing time and hospitalized duration of observation group are 3.19±1.04 months and 3.57±0.97 days, which are also significantly shorter than 4.18±1.25 months and 8.28±2.54 days in control group, respectively, (P < 0.05). And the total complication rate in control group is 20.83%, which is higher than 8.33% in observation group (P >0.05). Conclusion: Arthroscopic internal fixation with countersunk screw can significantly improve the efficacy and ankle joint functions, shorten the fracture-healing time and hospital stays without increasing the incidence of complications.

Aloe Vera-Fermented Beverage Ameliorates Obesity and Gut Dysbiosis in High-Fat-Diet Mice.

Aloe vera has been proven to have various medicinal properties, including anti-inflammatory and anti-obesity functions. However, the effects of Aloe vera-fermented beverages (AFB) on obesity and its complications are still not clear. In this study, HepG2 cells in high-fat environment and high-fat diet (HFD) mice were used to investigate the potential obesity-preventing function of AFB. We found that AFB intervention decreased the amount of lipid droplets of HepG2 cells, suppressed the body weight gain and adipose accumulation, and reduced the serum contents of total cholesterol (TC), alanine aminotransferase (ALT), and interleukin 10 (IL-10) of HFD-mice. In addition, it also changed the composition of the gut microbiota. The ratio of Firmicutes/Bacteroidetes was decreased, while the relative abundance of Muribaculaceae, Alistipes and Rikenellaceae_RC9_gut_group was increased after the administration of AFB compared with HFD-mice. These results demonstrated that AFB can prevent diet-induced obesity (DIO) and provides a new option to modulate obesity-related gut dysbiosis.

Noncoding RNA PVT1 in osteosarcoma: The roles of lncRNA PVT1 and circPVT1.

Osteosarcoma (OS) is the most common primary malignant bone tumor in children and teenagers and is characterized by high malignant potential, rapid disease progression and high disability and mortality rates. Recently, noncoding RNAs (ncRNAs) have attracted the attention of many scholars due to their major regulatory roles in gene expression. Among them, lncRNA PVT1 and circPVT1 encoded by the PVT1 gene have been the focus of many studies; they are upregulated in OS, and abundant evidence indicates that lncRNA PVT1 and circPVT1 play key roles in the occurrence and development of OS. This review summarizes the mechanisms of action of lncRNA PVT1 and circPVT1 in regulating apoptosis, proliferation, glycolysis, invasion, migration and epithelial-mesenchymal transition (EMT) in OS and discusses their clinical applications in diagnosis, prognosis determination and drug resistance treatment, with the aim of helping researchers better understand the regulatory roles of lncRNA PVT1 and circPVT1 in OS progression and providing a theoretical basis for the development of early screening and accurate targeted treatment strategies and prognostic biomarkers for OS based on lncRNA PVT1 and circPVT1.

Single-frequency fiber laser at 880†nm.

Single-frequency fiber lasers with extremely low noise and narrow spectral linewidth have found many scientific and practical applications. There is great interest in developing single-frequency fiber lasers at new wavelengths. In this paper, we report a single-frequency Nd3+-doped phosphate fiber laser operating at 880 nm, which is the shortest demonstrated wavelength for a single-frequency fiber laser thus far, to the best of our knowledge. An output power of 44.5 mW and a slope efficiency of 20.4% with respect to the absorbed pump power were obtained with a 2.5-cm-long 1 wt.% Nd3+-doped phosphate fiber. Our simulation results show that higher single-frequency laser output can be achieved with 1.5 wt.% or 2 wt.% Nd3+-doped phosphate fiber with mitigated ion clustering.

Erbium-doped ZBLAN fiber laser pumped at 1.7 µm for emission at 2.8 µm.

In this paper, a novel, to the best of our knowledge, efficient pump scheme for an erbium-doped fluoride fiber laser with emission at 2.8 µm in the mid-infrared region is proposed and demonstrated. A singular pump source at 1.7 µm is used to excite Er3+ ions from ground state 4I15/2 to lower laser level 4I13/2, and then further boost the ions to 4I9/2, where a non-radiation transition occurs for the Er3+ ions to reach upper laser level 4I11/2. This scheme can efficiently recycle ions on the lower laser level 4I13/2 by excited-state absorption, therefore realizing population inversion and enhancing laser efficiency. In our demonstration, a 660-mW laser output at 2.8 µm is achieved from a 1.7-µm core-pumped erbium-doped fluoride fiber laser, where the slope efficiency versus launched pump power is 23.7%. The proposed innovative pump scheme shows great potential to realize high-power, high-efficiency erbium-doped fiber lasers at 2.8 µm.

Single-frequency Tm-doped fiber laser with 215†mW at 2.05 µm based on a Tm/Ho-codoped fiber saturable absorber.

We demonstrate an efficient single-frequency Tm-doped fiber laser at 2050 nm. A ring cavity scheme is employed to boost the net gain at the wavelength. A piece of Tm/Ho-codoped fiber with an absorption coefficient at 2050 nm higher than that of a Tm-doped fiber is used to establish the dynamic Bragg grating for enhancing the frequency selection capability. A single-frequency output of 215 mW is obtained under 2 W of 1570-nm pump power, with the slope efficiency being 22%. To the best of our knowledge, this is the highest single-frequency all-fiber laser oscillator output power above 2 µm.