Transcriptomic analyses and machine-learning methods reveal dysregulated key genes and potential pathogenesis in human osteoarthritic cartilage.

Aims: This study aimed to explore the biological and clinical importance of dysregulated key genes in osteoarthritis (OA) patients at the cartilage level to find potential biomarkers and targets for diagnosing and treating OA. Methods: Six sets of gene expression profiles were obtained from the Gene Expression Omnibus database. Differential expression analysis, weighted gene coexpression network analysis (WGCNA), and multiple machine-learning algorithms were used to screen crucial genes in osteoarthritic cartilage, and genome enrichment and functional annotation analyses were used to decipher the related categories of gene function. Single-sample gene set enrichment analysis was performed to analyze immune cell infiltration. Correlation analysis was used to explore the relationship among the hub genes and immune cells, as well as markers related to articular cartilage degradation and bone mineralization. Results: A total of 46 genes were obtained from the intersection of significantly upregulated genes in osteoarthritic cartilage and the key module genes screened by WGCNA. Functional annotation analysis revealed that these genes were closely related to pathological responses associated with OA, such as inflammation and immunity. Four key dysregulated genes (cartilage acidic protein 1 (CRTAC1), iodothyronine deiodinase 2 (DIO2), angiopoietin-related protein 2 (ANGPTL2), and MAGE family member D1 (MAGED1)) were identified after using machine-learning algorithms. These genes had high diagnostic value in both the training cohort and external validation cohort (receiver operating characteristic > 0.8). The upregulated expression of these hub genes in osteoarthritic cartilage signified higher levels of immune infiltration as well as the expression of metalloproteinases and mineralization markers, suggesting harmful biological alterations and indicating that these hub genes play an important role in the pathogenesis of OA. A competing endogenous RNA network was constructed to reveal the underlying post-transcriptional regulatory mechanisms. Conclusion: The current study explores and validates a dysregulated key gene set in osteoarthritic cartilage that is capable of accurately diagnosing OA and characterizing the biological alterations in osteoarthritic cartilage; this may become a promising indicator in clinical decision-making. This study indicates that dysregulated key genes play an important role in the development and progression of OA, and may be potential therapeutic targets.

Risk factors for postoperative surgical site infections after anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

OBJECTIVES: The primary aim was to evaluate risk factors for surgical site infections after anterior cruciate ligament reconstruction (ACLR). The secondary aim was to investigate the surgical site infection incidence rate and the mean time to postoperative surgical site infection symptoms. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Embase and Web of Science were searched from database inception to September 2021 and updated in April 2022. ELIGIBILITY CRITERIA: Quantitative, original studies reporting potential risk factors for surgical site infections after ACLR were included. RESULTS: Twenty-three studies with 3871 infection events from 469 441 ACLRs met the inclusion criteria. Male sex (OR 1.78, p< 0.00001), obesity (OR 1.82, p=0.0005), tobacco use (OR 1.37, p=0.01), diabetes mellitus (OR 3.40, p=0.002), steroid use history (OR 4.80, p<0.00001), previous knee surgery history (OR 3.63, p=0.02), professional athlete (OR 4.56, p=0.02), revision surgery (OR 2.05, p=0.04), hamstring autografts (OR 2.83, p<0.00001), concomitant lateral extra-articular tenodesis (OR 3.92, p=0.0001) and a long operating time (weighted mean difference 8.12, p=0.005) were identified as factors that increased the risk of surgical site infections (superficial and deep) after ACLR. Age, outpatient or inpatient surgery, bone-patellar tendon-bone autografts or allografts and a concomitant meniscus suture did not increase the risk of surgical site infections. The incidence of surgical site infections after ACLR was approximately 1% (95% CI 0.7% to 1.2%). The mean time from surgery to the onset of surgical site infection symptoms was approximately 17.1 days (95% CI 13.2 to 21.0 days). CONCLUSION: Male sex, obesity, tobacco use, diabetes mellitus, steroid use history, previous knee surgery history, professional athletes, revision surgery, hamstring autografts, concomitant lateral extra-articular tenodesis and a long operation time may increase the risk of surgical site infections after ACLR. Although the risk of surgical site infections after ACLR is low, raising awareness and implementing effective preventions for risk factors are priorities for clinicians to reduce the incidence of surgical site infections due to its seriousness.

Risk Factors for Revision or Rerupture After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

BACKGROUND: The rerupture or need for revision after anterior cruciate ligament reconstruction (ACLR) is a serious complication. Preventive strategies that target the early identification of risk factors are important to reduce the incidence of additional surgery. PURPOSE: To perform a systematic review and meta-analysis to investigate risk factors for revision or rerupture after ACLR. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 4. METHODS: Literature searches were performed in PubMed, Embase, and Web of Science from database inception to November 2021 and updated in January 2022. Quantitative, original studies reporting potential adjusted risk factors were included. Odds ratios (ORs) were calculated for potential risk factors. RESULTS: A total of 71 studies across 13 countries with a total sample size of 629,120 met the inclusion criteria. Fifteen factors were associated with an increase in the risk of revision or rerupture after ACLR: male sex (OR, 1.27; 95% CI, 1.14-1.41), younger age (OR, 1.07; 95% CI, 1.05-1.08), lower body mass index (BMI) (OR, 1.03; 95% CI, 1.00-1.06), family history (OR, 2.47; 95% CI, 1.50-4.08), White race (OR, 1.32; 95% CI, 1.08-1.60), higher posterolateral tibial slope (OR, 1.15; 95% CI, 1.05-1.26), preoperative high-grade anterior knee laxity (OR, 2.30; 95% CI, 1.46-3.64), higher baseline Marx activity level (OR, 1.07; 95% CI, 1.02-1.13), return to a high activity level/sport (OR, 2.03; 95% CI, 1.15-3.57), an ACLR within less than a year after injury (OR, 2.05; 95% CI, 1.81-2.32), a concomitant medial collateral ligament (MCL) injury (OR, 1.62; 95% CI, 1.31-2.00), an anteromedial portal or transportal technique (OR, 1.36; 95% CI, 1.22-1.51), hamstring tendon (HT) autografts (vs bone-patellar tendon-bone [BPTB] autografts) (OR, 1.60; 95% CI, 1.40-1.82), allografts (OR, 2.63; 95% CI, 1.65-4.19), and smaller graft diameter (OR, 1.21; 95% CI, 1.05-1.38). The other factors failed to show an association with an increased risk of revision or rerupture after ACLR. CONCLUSION: Male sex, younger age, lower BMI, family history, White race, higher posterolateral tibial slope, preoperative high-grade anterior knee laxity, higher baseline Marx activity level, return to a high activity level/sport, an ACLR within less than a year from injury, a concomitant MCL injury, an anteromedial portal or transportal technique, HT autografts (vs BPTB autografts), allografts, and smaller graft diameter may increase the risk of revision or rerupture after ACLR. Raising awareness and implementing effective preventions/interventions for risk factors are priorities for clinical practitioners to reduce the incidence of revision or rerupture after ACLR.

Novel monolithic integration scheme for high-speed electroabsorption modulators and semiconductor optical amplifiers using cascaded structure.

A new monolithic integration scheme, namely cascaded-integration (CI), for improving high-speed optical modulation is proposed and demonstrated. High-speed electroabsorption modulators (EAMs) and semiconductor optical amplifiers (SOAs) are taken as the integrated elements of CI. This structure is based on an optical waveguide defined by cascading segmented EAMs with segmented SOAs, while high-impedance transmission lines (HITLs) are used for periodically interconnecting EAMs, forming a distributive optical re-amplification and re-modulation. Therefore, not only the optical modulation can be beneficial from SOA gain, but also high electrical reflection due to EAM low characteristic impedance can be greatly reduced. Two integration schemes, CI and conventional single-section (SS), with same total EAM- and SOA- lengths are fabricated and compared to examine the concept. Same modulation-depth against with EAM bias (up to 5V) as well as SOA injection current (up to 60mA) is found in both structures. In comparison with SS, a < 1dB extra optical-propagation loss in CI is measured due to multi-sections of electrical-isolation regions between EAMs and SOAs, suggesting no significant deterioration in CI on DC optical modulation efficiency. Lower than -12dB of electrical reflection from D.C. to 30GHz is observed in CI, better than -5dB reflection in SS for frequency of above 5GHz. Superior high-speed electrical properties in CI structure can thus lead to higher speed of electrical-to-optical (EO) response, where -3dB bandwidths are >30GHz and 13GHz for CI and SS respectively. Simulation results on electrical and EO response are quite consistent with measurement, confirming that CI can lower the driving power at high-speed regime, while the optical loss is still kept the same level. Taking such distributive advantage (CI) with optical gain, not only higher-speed modulation with high output optical power can be attained, but also the trade-off issue due to impedance mismatch can be released to reduce the driving power of modulator. Such kind of monolithic integration scheme also has potential for the applications of other high-speed optoelectronics devices.

Laterally tapered undercut active waveguide fabricated by simple wet etching method for vertical waveguide directional coupler.

A novel structure, namely a laterally tapered undercut active-waveguide (LTUAWG) for an optical spot-size converter (SSC) is proposed and demonstrated in this paper. Using a selectively undercut-etching-active-region (UEAR) on a laterally tapered ridge to define a LTUAWG, a vertical waveguide directional coupler (VWGDC) can be fabricated simply by a wet etching-based technique. The VWGDC comprises a top LTUAWG and a bottom passive waveguide (PWG). An electroabsorption modulator (EAM) is monolithically integrated with a LTUAWG-VWGDC serving as the connecting active waveguide (AWG) and the optical transmission testing device. Through a loss budget analysis on an EAM-integrated VWGDC, an optical mode transfer loss of -1.6 dB is observed between the PWG and the AWG. By comparing the reverse directions of optical excitation, the identical optical transmission relations with bias are observed, further verifying the high efficiency properties in a SSC. Optical misalignment tolerance is employed to test the two transferred optical modes. 1dB misalignment tolerance of +/-2.9 microm (horizontal) and +/-2.2 microm (vertical) is obtained from the PWG, which is better than the value of +/-1.9 microm (horizontal) and +/-1.6 microm (vertical) from the AWG. Far-field angle measurement shows 6.0 degrees (horizontal) 9.3 degrees (vertical) and 11 degrees (horizontal) x 20 degrees (vertical) for the PWG and the AWG, respectively, exhibiting the capability of a mode transformer. All of these measurements are also examined by a 3D beam propagation method (BPM) showing quite consistent results. In this wet etching technique, no regrowth is needed during processing. Furthermore, UEAR processing controlled by in situ monitoring can lead to a simple way for submicron-size processing, showing that a highly reliable processing technique can thus be expected. A low cost of fabrication can also be realized, indicating that this method can be potentially used in optoelectronic integration.