Total ankle replacement versus ankle fusion for end-stage ankle arthritis: A meta-analysis.

PURPOSE: This study aims to systematically review the efficacy and safety of total ankle replacement (TAR) and ankle fusion (AF) as treatment options for end-stage ankle arthritis. METHODS: A comprehensive literature search was conducted on data from multiple databases, including PubMed, The Cochrane Library, Construction and Building Materials, Embase, Web of Science, and Scopus for RCTs and prospective cohort studies comparing TAR and AF in patients with end-stage ankle arthritis from inception up to June, 2023. Our primary outcomes of interest included patients' clinical function scores and complications. We employed Review Manager 5.4 and Stata/MP 14.0 software for the meta-analysis. RESULTS: Our analysis incorporated 13 comparative studies, including 11 prospective studies, one pilot RCT, and one RCT. The pooled results revealed no significant difference in postoperative Short Form-36 scores between the TAR and AF groups (MD = -1.19, 95% CI: -3.89 to 1.50, p = .39). However, the postoperative Foot and Ankle Ability Measure scores in the AF group were significantly higher than in the TAR group (MD = 8.30, 95% CI: 1.01-15.60, p = .03). There was no significant difference in postoperative complication rates between the TAR and AF groups (RR = 0.95, 95% CI: 0.59 to 1.54, p = .85). CONCLUSION: Currently available evidence suggests no significant disparity in postoperative outcomes between TAR and AF. In the short term, TAR demonstrates better clinical scores than AF and lower complication rates. Conversely, in the long term, AF exhibits superior clinical scores and lower complication rates, although this difference is not statistically significant.

State-of-the-art of minimally invasive treatments of bone metastases.

Bone metastases is a common manifestation of advanced malignant tumors. With the recent advances in medical technology, the survival period of patients with malignant tumors is prolonged, and the probability of bone metastases is significantly increased. Approximately 70% to 80% of patients with breast or prostate cancer will eventually develop bone metastases. In addition, thyroid, lung, and kidney carcinomas are all known to cause bone metastases, with a 30% to 40% incidence upon postmortem assessment. Bone metastases often lead to severe pain, pathological fractures, and nerve damage and have become a critical factor affecting the quality of life and life expectancy of cancer patients. Although treatments for bone metastases are diverse, choosing the appropriate treatment is difficult. Both conservative treatment and open surgery have certain drawbacks and may not be appropriate for all patients. Interventional procedures have the advantages of less trauma with quicker recovery and represent a viable alternative. This review provides updates on the progress of research on the interventional treatment of bone metastases and directions regarding relevant further studies.

Different internal fixation methods for unstable distal clavicle fractures in adults: a systematic review and network meta-analysis.

BACKGROUND: Surgical treatment is advised for unstable distal clavicle fractures (UDCFs). Various kinds of internal fixation methods have been used, but the best fixation is still controversial. METHODS: We systematically searched all studies comparing postoperative outcomes of coracoclavicular (CC) reconstruction (TightRope, EndoButton, Mersilene tape, suture anchor or suture), fracture osteosynthesis (clavicular hook plate (HP), locking compression plate (LCP), Kirschner wire and tension band (KWTB), Kirschner wire (KW)), and a combination of the two methods (LCP + CC or KWTB + CC) for UDCF in PubMed, Web of Science Core Collection via Ovid, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and China Biology Medicine (CBM) databases up to September 16, 2021, with no language restrictions. A network meta-analysis (NMA) was conducted to integrate direct and indirect evidence and assess the relative effects of the internal fixation methods. The probability of being the best treatment was assessed by the surface under the cumulative ranking curve (SUCRA). RESULTS: A total of 41 studies were included, involving 1969 patients and seven internal fixation methods. The NMA showed that LCP + CC fixation was associated with better efficacy (odds ratio (OR) 0.60, 95% CI 0.19-1.02, probability rank = 0.93) and fewer complications (odds ratio (OR) 0.22, 95% CI 0.09-0.51, probability rank = 0.69) than any other internal fixation method for UDCFs. The SUCRA probabilities of LCP + CC fixation were 98.6% for the Constant-Murley score and 93.9% for total complications. CONCLUSIONS: The results of this study indicate that LCP + CC appears to be the best internal fixation method for UDCF. Limited to the quality and quantity of the included studies, much larger and higher-quality RCTs are required to confirm these conclusions.

Heterotopic ossification in the post cruciate ligament of the knee: a case report and literature review.

BACKGROUND: Heterotopic ossification (HO) is noted most frequently in periarticular muscles and has not yet been reported in the cruciate ligaments of the knee. We present a rare case of symptomatic ossification of the posterior cruciate ligament (PCL). CASE PRESENTATION: A 59-year-old woman had a 2-year history of knee pain that was getting worse during knee motion and had restricted knee motion for 1 year. X-rays could not show the lesion clearly. Multi-planar computed tomography demonstrated ossification within the PCL with mild osteoarthritic changes and excluded any other intra-articular pathology. The patient underwent arthroscopic debridement and then experienced immediate relief of pain and complete recovery of range of motion. CONCLUSION: This is the first report of HO in the PCL as a possible cause of knee pain and restricted knee motion. On the basis of literature review, this case elaborates the difference between HO and calcification in the ligaments, the related factors inducing HO and the undefined pathogenesis, and favorable prognosis after adequate treatment.

Theobromine mitigates IL-1ß-induced oxidative stress, inflammatory response, and degradation of type II collagen in human chondrocytes.

Osteoarthritis is one of the major causes of disability in elderly adults. Chondrocytes are responsible for the formation and remodeling of articular cartilage in joint tissue. The dysfunction of chondrocytes is a significant factor in the development of osteoarthritis. In the current study, we found that theobromine, a constituent of the cacao plant, possesses a preventive effect against interleukin (IL)-1ß-induced chondrocyte dysfunction. Theobromine ameliorates IL-1ß-induced production of cellular reactive oxygen species (ROS) and inflammatory mediators including cyclooxygenase-2 (COX-2) and prostaglandin E2 (PGE2). The presence of theobromine suppresses IL-1ß-induced inducible nitro oxide synthase (iNOS) expression and cellular nitro oxide (NO) production. Theobromine also suppresses IL-1ß-induced production of the pro-inflammatory cytokines tumor necrosis factor-α (TNF-α) and monocyte chemoattractant protein-1 (MCP-1), as well as matrix metalloproteinases (MMP)-3 and MMP-13. Additionally, theobromine mitigates IL-1ß-induced type II collagen degradation. Mechanistically, we show that theobromine inhibits IL-1ß-induced IκBα activation, nuclear factor-κB (NF-κB) protein p65 accumulation, and transfected NF-κB promoter activity, indicating that theobromine suppresses the NF-κB pathway in chondrocytes. Collectively, our study demonstrates that the natural molecule theobromine has a protective effect to counter cytokine-induced chondrocyte dysfunction, implying its beneficial effect in the prevention of osteoarthritis.

Moracin attenuates LPS-induced inflammation in nucleus pulposus cells via Nrf2/HO-1 and NF-κB/TGF-ß pathway.

The present study was designed to investigate the protective effect of moracin on primary culture of nucleus pulposus cells in intervertebral disc and explore the underlying mechanism. Moracin treatment significantly inhibited the LPS-induced inflammatory cytokine accumulation (IL-1ß, IL-6 and TNF-α) in nucleus pulposus cells. And moracin also dramatically decreased MDA activity, and increased the levels of SOD and CAT induced by LPS challenge. Moreover, the expressions of Nrf-2 and HO-1 were decreased and the protein levels of p-NF-κBp65, p-IκBα, p-smad-3 and TGF-ß were increased by LPS challenge, which were significantly reversed after moracin treatments. Moracin treatments also decreased the levels of matrix degradation enzymes (MMP-3, MMP-13) as indicated by RT-PCR analysis. However, Nrf-2 knockdown abolished these protective effects of moracin. Together, our results demonstrated the ability of moracin to antagonize LPS-mediated inflammation in primary culture of nucleus pulposus in intervertebral disc by partly regulating the Nrf2/HO-1 and NF-κB/TGF-ß pathway in nucleus pulposus cells.

Comparisons of front plate, percutaneous sacroiliac screws, and sacroiliac anterior papilionaceous plate in fixation of unstable pelvic fractures.

BACKGROUND: This observational study was aimed at comparing the clinical efficacy of sacroiliac anterior plate fixation (SAPF), sacroiliac anterior papilionaceous plate (SAPP), and percutaneous sacroiliac screw internal fixation (PSCIF) introduced for patients with unstable pelvic fracture. METHODS: Seventy-eight patients with unstable pelvic fracture (Tile type B or C) were recruited. Twenty-six patients underwent SAPF, 26 underwent SAPP, and 26 underwent PSCIF. Matta scores were calculated to evaluate the reduction of pelvic fractures, and Majeed scores were applied for the assessment of functional recoveries after surgery. Other perioperative clinical indicators were also recorded, including operation time, bleeding status, length of incision, ambulation time, fracture healing time, and incision infection. RESULTS: Total operation time of PSCIF was remarkably shorter than that of SAPF and SAPP (P < .05), and the bleeding volume of SAPF and SAPP group was almost 26∼29 times as high as that of PSCIF group (P < .05). Besides, SAPP resulted in significant blood loss compared with SAPF (P < .05), while SAPF resulted in significantly larger operative incision length than SAPP and PSCIF (P < .05). Moreover, patients' stay time was prolonged in both SAPF and SAPP groups than in the PSCIF group (P < .05). Patients who received PSCIF exhibited significantly higher Matta and Majeed scores than those who received SAPF (all P < .05). Finally, SAPP was associated with fewer complications than SAPF, and complications were barely observed in the PSCIF group. CONCLUSION: PSCIF may be more appropriate for patients with unstable pelvic fractures in comparison with SAPP and SAPF. Besides, SAPP is likely to be more efficacious than SAPF especially for Tile C patients.

Diagnostic accuracy of ultrasonography in assessing meniscal injury: meta-analysis of prospective studies.

BACKGROUND: The accuracy of ultrasonography for diagnosing meniscal injury remains controversial. The aim of the present meta-analysis was to establish the role of ultrasonography in the diagnosis of meniscal injury by analyzing the data from prospectively designed studies. METHODS: A systematic review was performed by searching electronic bibliographic databases prior to November 2014. Studies with diagnostic results that fulfilled the inclusion criteria were included. The methodological quality of the studies was assessed. Sensitivity, specificity and other measures of the accuracy of ultrasonography in the diagnosis of meniscal injury were summarized. Summary receiver-operating characteristic (SROC) curves were used to summarize overall test performance. Publication bias was assessed used Deek's funnel plot asymmetry test. RESULTS: Seven prospective studies with 551 patients were eligible for the meta-analysis. The Quality Assessment of Diagnostic Accuracy Studies scores for the included studies ranged from 10-13. The summary estimates of the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of ultrasonography in the diagnosis of meniscal injury were 0.88 (95 % CI 0.84-0.91), 0.90 (95 % CI 0.86-0.93), 7.07 (95 % CI 4.34-11.52), 0.17 (95 % CI 0.10-0.26) and 58.13 (95 % CI 24.38-138.62), respectively. There was moderate to significant heterogeneity across the above measures (P < 0.05). The area under the curve of the SROC was 0.948, indicating a high overall diagnostic accuracy. No publication bias was noted across the studies (P = 0.393), which suggested little influence of publication bias on the overall results. CONCLUSION: Our results suggest that the diagnostic accuracy of ultrasonography for diagnosing meniscal injury is acceptable, with a high specificity but moderate sensitivity.

Smad3 controls ß-1,3-glucuronosyltransferase 1 expression in rat nucleus pulposus cells: implications of dysregulated expression in disc disease.

OBJECTIVE: To study the regulation of expression of ß-1,3-glucuronosyltransferase 1 (GlcAT-1), an important regulator of glycosaminoglycan (GAG) synthesis, by Smad3 in nucleus pulposus (NP) cells. METHODS: GlcAT-1 expression was examined in rat NP and anulus fibrosus (AF) cells treated with transforming growth factor ß (TGFß). The effects of Smad signaling and Smad suppression on GlcAT-1 were examined in rat NP cells. GlcAT-1 expression was analyzed in the discs of Smad3-null mice and in degenerated human NP tissue. RESULTS: TGFß increased the expression of GlcAT-1 in rat NP but not rat AF cells. Suppression of GlcAT-1 promoter activity was evident with dominant-negative ALK-5 (DN-ALK-5). Cotransfection with Smad3 strongly induced promoter activity independent of TGFß. Bioinformatics analysis indicated the presence of several Smad binding sites in the promoter; deletion analysis showed that the region between -274 and -123 bp was required for Smad3 response. DN-Smad3, Smad 3 small interfering RNA, and Smad7 strongly suppressed basal as well as TGFß-induced promoter activity. Induction of promoter activity by Smad3 was significantly blocked by DN-Smad3; Smad7 had a very small effect. Lentiviral transduction of NP cells with short hairpin RNA Smad3 resulted in a decrease in GlcAT-1 expression and accumulation of GAG. Compared to wild-type mice, significantly lower expression of GlcAT-1 was seen in the discs of Smad3-null mice. Analysis of degenerated human NP tissue specimens showed no positive correlation between GlcAT-1 and TGFß expression. Moreover, isolated cells from degenerated human tissue showed a lack of induction of GlcAT-1 expression following TGFß treatment, suggesting an altered response. CONCLUSION: Our findings demonstrate that in healthy NP cells, the TGFß-Smad3 axis serves as a regulator of GlcAT-1 expression. However, an altered responsiveness to TGFß during disc degeneration may compromise GAG synthesis.