Review of pre-metastatic niches induced by osteosarcoma-derived extracellular vesicles in lung metastasis: A potential opportunity for diagnosis and intervention.

Osteosarcoma (OS) has a high propensity for lung metastasis, which is the leading cause of OS-related death and treatment failure. Intercellular communication between OS cells and distant lung host cells is required for the successful lung metastasis of OS cells to the lung. Before OS cells infiltrate the lung, in situ OS cells secrete extracellular vesicles (EVs) that act as mediators of cell-to-cell communication. In recent years, EVs have been confirmed to act as bridges and key drivers between in situ tumors and metastatic lesions by regulating the formation of a pre-metastatic niche (PMN), defined as a microenvironment suitable for disseminated tumor cell engraftment and colonization, in distant target organs. This review summarizes the current knowledge about the underlying mechanisms of PMN formation induced by OS-derived EVs and the potential roles of EVs as targets or drug carriers in regulating PMN formation in the lung. We also provide an overview of their potential EV-based therapeutic strategies for hindering PMN formation in the context of OS lung metastasis.

Intra-articular administration of adrenaline plus an irrigation pump system for visibility during the arthroscopic reconstruction of multiple knee ligaments without a tourniquet.

Objective: Multiple ligament knee injuries (MLKIs) are rare but severe systemic trauma. Single surgery in the acute setting is preferred, although with an extended operation time. To avoid the complications associated with a tourniquet, we herein describe a method for visibility without a tourniquet: intra-articular administration of adrenaline plus an irrigation pump system. Study design: This is a cohort study with a level of evidence of 3. Methods: From April 2020 to February 2022, 19 patients with MLKIs were reviewed retrospectively. All patients got intra-articular administration of adrenaline plus an irrigation pump system for visibility without a tourniquet. The following parameters were assessed: visibility, range of motion, knee stability, visual analog scale (VAS) score, range of motion (ROM), Lysholm score, Tegner activity level, and International Knee Documentation Committee Subjective Knee Form (IKDC). Results: All patients were followed up for at least 6 months. At the latest follow-up, the mean VAS score, ROM, Lysholm score, and IKDC were 1.79 ± 0.86, 121.21 ± 10.96, 88.16 ± 5.21, and 88.53 ± 5.06, respectively. The average Tegner activity level decreased significantly from preinjury to postoperation (5.16 ± 0.83 vs. 3.11 ± 0.88, P < 0.001). Of the 19 patients, 17 (89.47%) had good knee function, while only two patients (10.53%) had asymptomatic knees with positive Lachman tests. A total of 17 patients (89.47%) had good or excellent visualization during arthroscopy. Of the 19 patients, three (15.79%) required an increased fluid pressure to achieve a clear operative view. Two patients converted to tourniquet inflation due to persistent intra-articular bleeding after using shavers. Conclusions: The intra-articular administration of adrenaline plus an irrigation pump system is recommended as an alternative to a tourniquet to achieve a good visual field. Further evidence-based work with a larger sample is needed.

An novel and alternative treatment method for large heel ulceration in diabetic patients: Proximal tibial cortex transverse distraction.

Heel ulceration in patients with diabetes mellitus (DM) is a major clinical challenge, manifesting with a protracted and uncertain healing process. The prefer treatment of heel ulceration is still controversial. This study aims at describing a newly alternative surgical method with the proximal transverse tibial bone transport technique, as an attempt to achieve wound healing in diabetic patients with large heel ulceration. Retrospective clinical study. A total of 21 diabetic patients with large heel ulceration were enrolled and followed up at least 6 months. The following parameters were assessed: Visual analogue scale (VAS), healing time, ulcer healing rate, ulcer recurrence rate and limb salvage rate. All patients got fully follow-up and achieved wound healing uneventfully. Eighteen patients returned to independent walking without any helper while three patients walked using a crutch. Limb salvage was achieved in all 21 patients (100%). The mean wound area was 67.43 ± 13.31 cm2 (range: 46-97 cm2 ). The mean healing time was 128.62 ± 16.76 days (range: 91-160 days). 16 out of 21 patients without calcaneal osteomyelitis achieved ulcer healing with a mean duration of 124.69 ± 14.42 days (range: 91-143 days), while the other five patients with calcaneal osteomyelitis were 141.20 ± 19.12 days (range: 110-160 days). 2 out of 21 patients got superficial rupture at the previous wounds and healed after outpatient dressing change combined with oral antibiotics. The novel technique described is particularly applicable for large heel ulceration in diabetic patients. It offers a better alternative for achieving wound healing with a favourable encouraging outcome.

Relationship between Charlson comorbidity index, early recovery and 2-year mortality in elderly patients undergoing surgical treatment of inter-trochanteric fractures: a retrospective analysis.

The aim of this study was to evaluate how the Charlson Comorbidity Index (CCI) scores contribute to early recovery and 2-year mortality in elderly patients undergoing surgical treatment of inter-trochanteric fractures. 60 cases with unilateral intertrochanteric fracture were retrospectively analyzed and divided into Low-CCI group (CCI: 1-4) or high-CCI groups (CCI: 5-6). All the patients' electronic hospital records were reviewed. The preoperative situations (demographic data, comorbidities and fracture conditions), perioperative situations (wait time, operation time, implant choice, blood loss, transfusion or not) and postoperative situations (complications, first time out of bed, function about 1-/2- week and 2-year mortality) were recorded. 51.67% were in low-CCI group and 48.33% in high-CCI group. The survival rates in low- and high-CCI group were 93.5% and 86.2% respectively. According to the functional results of 1- or 2- week after operation, no significant difference was found (P = 0.955, 0.140). Log-rank analysis showed that the main prognostic factors were blood loss, first time out of bed and complication (P < 0.05). Multivariate analysis confirmed that complication and first time out of bed were significant factor on survival rate (P = 0.029, 0.010). Charlson comorbidity index maybe not the indicator of 2-year mortality in older patients with intertrochanteric fractures. In order to improve the prognosis, more attentions should be paid to reduce the complications and encourage postoperative earlier excise out of bed.

The severity of ulnar variance compared with contralateral hand: its significance on postoperative wrist function in patients with distal radius fracture.

The aim of this study was to detect the severity of ulnar variance (UV) compared with contralateral hand on postoperative wrist function in patients with distal radius fracture. 116 cases with unilateral distal radius fracture were retrospectively analyzed and divided into high or low UV severity groups (Dividing value = 2.5 mm). The following parameters were used to evaluate the effect: palmar tilt, radial inclination, VAS score, DASH score and wrist function. The severity of UV existed widely, accounting for 93.1% (108 cases). The severity of UV correlated with palmar tilt, radial inclination, grip strength, VAS score, DASH score and the wrist function (P < 0.05). Log-rank analysis showed that the severity of UV, palmar tilt, radial inclination were important factors influencing the joint function postoperatively (P < 0.0 5). Multivariate analysis confirmed that the severity of UV was an independent and significant factor on wrist function (P = 0.010). And the palmar tilt was also an important factor influencing wrist function (P = 0.047). The severity of ulnar variance compared with contralateral hand is an independent and significant factor on wrist function, which should be considered as an important step during preoperative plan.

Minimally invasive transforaminal lumbar interbody Concorde fusion for prolapsed and sequestrated lumbar disc herniation / 中国组织工程研究

BACKGROUND:As one of the most serious pathological types of lumbar disc herniation, the nucleus pulposus of prolapsed style lumbar intervertebral disc herniation is like a cord or mass. And the nucleus pulposus compresses nerve roots and dural sac, which brings severe low back pain and/or cauda equina injury symptoms.OBJECTIVE:To compare the clinical efficacy of simple discectomy under the Quadrant system and minimally invasive transforaminal lumbar interbody Concorde fusion (MIS-TLIF) in the treatment of prolapsed and sequestrated lumbar disc herniation.METHODS:From January 2012 to January 2015, 58 patients with prolapsed and sequestrated lumbar disc herniation were enrolled in this study, including 36 patients in simple Quadrant group and 22 patients in MIS-TLIF group.RESULTS AND CONCLUSION:Significant difference was recorded in the visual analogue scale scores and Oswestry disability index at 1 week, 3 months and 18 months postoperation compared with preoperation in the two groups (P 0.05). There were two patients with recurrent lumbar disc herniation in the simple Quadrant group. In summary, simple discectomy under the Quadrant system could achieve the similar satisfied effect as the MIS-TLIF, but the MIS-TLIF provides less low back pain.

Impact of Preemptive Analgesia on inflammatory responses and Rehabilitation after Primary Total Knee Arthroplasty: A Controlled Clinical Study.

The aim of this study was to investigate the effects of preemptive analgesia on the inflammatory response and rehabilitation in TKA. 75 patients with unilateral primary knee osteoarthritis were conducted in this prospective study. All patients were randomly divided into two groups (MMA with/without preemptive analgesia group). The following parameters were used to evaluate analgesic efficacy: knee flexion, pain at rest and walking, functional walking capacity (2 MWT and 6 MWT), WOMAC score, and hs-CRP level. Patients in MMA with preemptive analgesia group had lower hs-CRP level and less pain at rest and walking during the first week postoperatively (P < 0.05). The 2 MWT was significantly better in MMA with preemptive analgesia group (17.13 ± 3.82 VS 14.19 ± 3.56, P = 0.001). The 6 MWT scores and WOMAC scores increased significantly within Groups (P = 0.020, 0.000), but no difference between groups postoperatively (P > 0.05). Less cumulative consumption of morphine was found in MMA with preemptive analgesia group at 48 h (P = 0.017, 0.023), but no difference at total requirement (P = 0.113). Preemptive analgesia added to a multimodal analgesic regime improved analgesia, reduced inflammatory reaction and accelerated functional recovery at the first week postoperatively, but not improved long-term function.

Viper system and pedicle screw fixation for treating thoracolumbar compression fractures / 中国组织工程研究

BACKGROUND:Thoracolumbar spine as highly concentrated stress, often prone to vertebral fractures. With the further development of the biomechanics and anatomical structure of the spine, posterior open reduction and internal fixation with pedicle screw has been widely accepted by clinicians. OBJECTIVE:To explore the clinical results and safety of percutaneous pedicle screw fixation system (Viper system) used in thoracolumbar compression fractures. METHODS:We retrospectively analyzed 40 patients with thoracolumbar compression fractures from Department of Orthopedics, Changzhou Traditional Chinese Medicine Hospital and Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA from January 2013 to February 2014. According to the type of graft, patients were randomly divided into experiment group and control group, with 20 patients in each group. They were respectively subjected to Viper percutaneous pedicle screw fixation system and open reduction and pedicle screw fixation. RESULTS AND CONCLUSION:Al vertebra got bone unions. Operative time and time to bone union were shorter in the experiment group than in the control group. Moreover, intraoperative blood loss was less in the experiment group than in the control group. Cobb’s angle, height percentage of leading edge and wedge angle were similar between the two groups. However, at 12 months after internal fixation, height percentage of leading edge was lower in the experiment group than in the control group. Visual Analogue Scale scores and Oswestry Disability Index were noticeably improved after fixation in both groups. Visual Analogue Scale scores and Oswestry Disability Index were lower in the experiment group than in the control group immediately after fixation. These results suggest that compared with open reduction and pedicle screw fixation, Viper percutaneous pedicle screw fixation system for thoracolumbar compression fractures can stably restore the structure and function of spine, and does not increase perioperative complications.

Total hip arthroplasty for ankylosing spondylitis：the spine-pelvis sagittal balance and quality of life / 中国组织工程研究

BACKGROUND:Total hip arthroplasty is usualy taken to cure patients with ankylosing spondylitis combined with affected hip, to increase their life quality. But, its effects on sagittal balance of the spine-pelvis are not wel known. OBJECTIVE:To analyze the effects of total hip arthroplasty on sagittal balance of the spine-pelvis and life quality in patients with ankylosing spondylitis combined with affected hip. METHODS: Clinic data of 47 consecutive patients with ankylosing spondylitis combined with affected hip who had total hip arthroplasty and were folowed up for more than one year after operation from December 2008 to December 2013 were retrospectively analyzed. The spine-pelvis sagittal balancing parameters were measured. According to the SF-36 questionnaire, the dimensional scores were calculated to assess the life quality. Pearson correlation analysis was performed to analyze the correlation between the balancing parameters and SF-36 scores pre-operation, and the change of the balancing parameters and SF-36 scores pre- and post-operation were analyzed. RESULTS AND CONCLUSION:According to the data before total hip arthroplasty, sagittal vertical axis was negatively correlated with physiological function, body pain and vitality. Total kyphosis was negatively correlated with physiological function and general health. Lumbar lordosis was positively correlated with physiological function. Pelvic tilt angle was negatively correlated with the vitality and social function. Pelvic incident angle was negatively correlated with body pain, vitality and emotional role. No significant correlation was shown between sacral inclination angle and SF-36 items. After total hip arthroplasty, lumbar lordosis and sacral inclination angles were significantly increased, while sagittal vertical axis and pelvic tilt angle were significantly decreased compared with those before surgery. Total kyphosis and pelvic incident angle showed no significant differences before and after surgery. The SF-36 scores al got a statisticaly significant increase. Results showed that, sagittal vertical axis, total kyphosis, lumbar lordosis, pelvic incident angle and pelvic tilt angle are the potential factors influencing the life quality in patients with ankylosing spondylitis combined with affected hip. The total hip arthroplasty, which induces a better sagittal balance with an increased lumbar lordosis and sacral inclination angle, and a decreased sagittal vertical axis and pelvic tilt angle, can result in better life quality.

Autogeneic cancellous bone transplantation for non-traumatic and posteromedial subchondral osteonecrosis of trochlea tali / 医学研究生学报

Objective Non-traumatic and posteromedial subchondral osteonecrosis of trochlea tali (NTPSOTT) is a special type of necrosis of the talus , for which early diagnosis and treatment are particularly important .This study investigated the clinical ef-fectiveness of autogeneic cancellous bone transplantation in the treatment of NTPSOTT . Methods We retrospectively analyzed 21 cases of NTPSOTT treated by autogeneic cancellous bone transplantation and evaluated using the Clinical Rating System of the American Orthopedic Foot and Ankle Society ( AOFAS) , Visual Analogue Scale ( VAS) , and X-ray and CT examinations . Results The pa-tients were followed up for 12-26 months and all healed desirably , with the graft well integrated into the surrounding tissue , but no as-similation, collapse of the articular surface , or narrowing of the joint space .The last follow-up visit revealed significantly improved AOFAS score (90.55 ±6.73 vs 50.87 ±11.42, P=0.009) and VAS score (1.32 ±0.81 vs 6.43 ±1.66, P=0.027) as compared with the baseline . Conclusion Autogeneic cancellous bone transplantation is preferable for the treatment of NTPSOTT , which can effectively reduce the pain in the ankle , maintain the joint space , and protect the function of the ankle .