Reliable prediction of implant size and axial alignment in AI-based 3D preoperative planning for total knee arthroplasty.

The size and axial alignment of prostheses, when planned during total knee replacement (TKA) are critical for recovery of knee function and improvement of knee pain symptoms. This research aims to study the effect of artificial intelligence (AI)-based preoperative three dimensional (3D) planning technology on prosthesis size and axial alignment planning in TKA, and to compare its advantages with two dimensional (2D) X-ray template measurement technology. A total of 60 patients with knee osteoarthritis (KOA) who underwent TKA for the first time were included in the AI (n = 30) and 2D (n = 30) groups. The preoperative and postoperative prosthesis size, femoral valgus correction angle (VCA) and hip-knee-ankle angle (HKA) were recorded and compared between the two groups. The results of the University of Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the American Knee Association Score (AKS) were evaluated before surgery, 3 months, 6 months, and 12 months after surgery. The accuracy of prosthesis size, VCA and HKA prediction in AI group was significantly higher than that in 2D group (P < 0.05). The WOMAC and AKS scores in AI group at 3 months, 6 months and 12 months after surgery were better than those in 2D group (P < 0.05). Both groups showed significant improvement in WOMAC and AKS scores at 12 months follow-up. AI-based preoperative 3D planning technique has more reliable planning effect for prosthesis size and axial alignment in TKA.

Prevalence, Risk Factors, and Prognostic Factors of Primary Malignant Bone Neoplasms with Bone Metastasis at Initial Diagnosis: A Population-Based Study.

Background: Bone metastasis (BM) has been proven to be responsible for the poor prognosis of primary malignant bone neoplasms (PMBNs). We aimed to identify the prevalence, risk factors, and prognostic factors for PMBNs patients with BM based on the Surveillance, Epidemiology, and End Results (SEER) database. Methods: 4,758 patients diagnosed with PMBNs from 2010 to 2018 were selected from the SEER database. All patients were divided into two groups: the BM group or the non-BM group. Pearson's chi-square test and Fisher's exact method were used to assess baseline characteristics, and logistic regression analysis was applied to assess risk factors. In addition, a nomogram was constructed based on the results of Cox regression analysis among 227 patients with BM. The good performance and clinical applicability of the nomogram were tested by the concordance index, operating characteristic curve, area under the curve, calibration curves, and decision curve analysis. Results: 227 (4.8%) patients had metastasis to bone at diagnosis. Primary site outside the extremities (axial: odds ratio, OR = 1.770; others: OR = 1.951), Ewing sarcoma (OR = 2.845), larger tumor size (5-8 cm: OR = 3.403; >8 cm: OR = 5.562), tumor extension beyond the periosteum (OR = 2.477), and regional lymph node metastasis (OR = 2.900) were associated with a higher risk of BM at the initial diagnosis of PMBNs. Five independent prognostic factors were found in the survival analysis: pathological type (chondrosarcoma vs. osteosarcoma: hazard ratio, HR = 0.342; Ewing sarcoma vs. osteosarcoma: HR = 0.592; and chordoma vs. osteosarcoma: HR = 0.015), marital status (HR = 2.457), pulmonary metastasis (HR = 1.934), surgery at the primary site (HR = 0.164), and chemotherapy (HR = 0.084). A nomogram based on these prognostic factors could be a good predictor of cancer-specific survival. Conclusions: We identified the prevalence, risk factors, and prognostic factors correlated with BM in PMBNs patients. The related nomogram could be a practical tool for therapeutic decision-making and individual counseling.

Comparing the minimum local anesthetic dose of ropivacaine in real-time ultrasound-guided spinal anesthesia and traditional landmark-guided spinal anesthesia: a randomized controlled trial of knee surgery patients.

BACKGROUND: Through previous studies and clinical practice, we have found that real-time ultrasound-guided (UG) spinal anesthesia (SA) and traditional landmark-guided (LG) SA each require a different minimum local anesthetic dose (MLAD) of ropivacaine. For this study, we used Dixon's up-and-down sequential method to analyze and compare the MLAD of different ropivacaine concentrations required for the UG and LG SA methods. METHODS: A total of 120 patients undergoing knee surgery were consecutively recruited and randomly divided into four groups (30 patients per group). These groups were categorized as follows: Group I: high ropivacaine ultrasound-guided (HRUG), Group II: low ropivacaine ultrasound-guided (LRUG), Group III: high ropivacaine landmark-guided (HRLG), and Group IV: low ropivacaine landmark-guided (LRLG). SA was established by a bolus administration of up-and-down doses of 0.75% or 0.5% plain ropivacaine. Initial doses of 16, 18, 12, and 14 mg were administered to groups I-IV, and after that, increased or decreased by 1.5 mg according to dose effectiveness. Upon identifying the intervertebral puncture level, a lumbar X-ray was performed with metal markers, and actual radiographic findings were identified and compared to the initial markings. RESULTS: For UG groups, the MLAD in the LRUG group was significantly higher than in the HRUG group [20.192 mg (95% CI, 19.256-21.174) versus 17.176 mg (95% CI, 16.276-18.124), respectively; P<0.001]. For LG groups, the MLAD in the LRLG group was significantly higher than in the HLRG group [14.478 mg (95% CI, 13.364-15.500) versus 13.201 mg (95% CI, 11.959-14.571), respectively; P=0.047]. When comparing both high ropivacaine groups (HRGs: I/III) to the low ropivacaine groups (LRGs: II/IV), we found that both UG subgroups (I/II) had a significantly higher MLAD than LG subgroups (III/IV) (P<0.001). US identified L4-5 in up to 90% of cases. Comparatively, palpation was successful in only 33.3% of patients. The rates of cephalad localization by US and palpation were 6.67% vs. 66.67%, respectively (P=0.002). CONCLUSIONS: We found a higher MLAD of ropivacaine was required for UG SA at the L4-5 level due to the method providing a more accurate (less cephalad) localization than traditional LG SA. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000033158.

Effect of melittin on iNOS and NF-κB expression induced by IL-1ßin C518 cells.

Melittin (Mel), a natural detergent, is a major component of bee venom. Mel exhibits favorable clinical effects on the treatment of rheumatoid osteoarthritis, myositis, lumbar muscle strain, and peripheral neurological disorders. Interleukin-1ß (IL-1ß) contributes to the progression of osteoarthritis and is one of the key proinflammatory cytokines. However, the effect of Mel on IL-1ß-induced osteoarthritis has not been reported. We examined the effects of Mel on the expressions of inducible NO synthase (iNOS), nuclear transcription factor κB (NF-κB), and I kappa B (I-κB) in the knee joint cells of C518 rats induced by IL-1ß. Western blot and qPCR results showed that Mel at 0.1µg/mL or higher significantly inhibited iNOS expression. Similarly, 1µg/mL of Mel prevented IL-ß-induced I-κB degradation in the cytoplasm and NF-κB migration from cytoplasm to nucleus. Mel exerts an inhibitory effect on IL-ß-induced NF-κB activation by inhibiting both I-κB degradation and NF-κB migration and can potentially be developed as a new anti-osteoarthritis drug. Further research is needed to clarify the detailed mechanism.

Promotive Role of CircATRNL1 on Chondrogenic Differentiation of BMSCs Mediated by miR-338-3p.

AIM: Bone marrow mesenchymal stem cells (BMSCs) are ideal seed cells for tissue engineering cartilage construction. However, the underlying mechanism of it has not been illuminate well. In this study, the effects of circATRNL1 (hsa_circ_0020093) on the differentiation of BMSCs into chondrocytes were investigated. METHODS: The degrees of chondrogenic differentiation of BMSCs on day 0, 14 and 21 mediums were detected by Alcian blue staining. Expressions of cartilage differentiation related factors SOX9, COL2 and Aggrecan, and circATRNL1 in BMSCs under differentiation were determined by western blot and quantitative real-time polymerase chain reaction (qRT-PCR) as needed. circATRNL1 knockdown or overexpression was performed in BMSCs. Then the viability of BMSCs and cartilage differentiation related factors were separately investigated through MTT assay, qRT-PCR, and western blot. Target gene of circATRNL1 and binding site were predicted using starbase and validated it by dual luciferase reporter. The effect of circATRNL1 and its target gene on chondrogenic differentiation of BMSCs was assessed using Alcian blue staining further. RESULTS: The degrees of chondrogenic differentiation of BMSCs were increased with time. Expressions of SOX9, COL2 and Aggrecan as well as circATRNL1 were enhanced during chondrogenic differentiation. Furthermore, overexpression of circATRNL1 enhanced BMSCs proliferation, SOX9, COL2 and Aggrecan expressions and the degree of chondrogenic differentiation of BMSCs. Further research showed that circATRNL1 targeted miR-338-3p. MiR-338-3p inhibited differentiation of BMSCs into cartilage but overexpression of circATRNL1 reversed it. CONCLUSION: CircATRNL1 is beneficial to BMSCs differentiation into cartilage by regulating miR-338-3p, which may be a new mechanism of action in the treatment of cartilage repair.