Five or more gender- and size-diverse customizations of distal femur prostheses are needed to improve fit for Chinese knees.

PURPOSE: Mismatch between partial imported prostheses and Chinese anatomy affects the clinical outcome of the procedure. The purpose of this study was to measure the anatomical dimensions of Chinese distal femurs to provide guidance for the design of more compatible distal femoral prostheses. METHODS: A total of 406 healthy distal femurs were reconstructed and measured. Consistency of these measurements and differences in sides, gender, and populations were examined. Parameter correlations were analyzed, and pairs with strong correlations underwent linear regression analysis. The design of distal femoral prostheses was referenced from the results of K-means and hierarchical clustering analysis. RESULTS: Ten parameters were measured, including the trans-epicondylar axis, width of the distal femur (ML), anteroposterior diameter of the distal femur (AP), etc. The intra-class correlation coefficient ranged from 0.795 to 0.999 for intra-observer consistency, and from 0.796 to 0.998 for inter-observer consistency. Males exhibited significantly larger parameters than females, except for the posterior condylar angle (all P values < 0.05). Compared to other populations, substantial differences were observed for most parameters, such as ML, AP, width of lateral femoral condyle, etc. (all P values < 0.05). Clustering analysis suggested that distal femoral prostheses should include at least five sizes to adequately accommodate the sampled population. ML sizes for males were 68, 70, 83, 73, and 89 mm, and for females 64, 65, 71, 67, and 77 mm. AP sizes for males were 56, 60, 60, 64, and 64 mm, and for females 48, 52, 54, 57, and 58 mm. CONCLUSIONS: Chinese distal femur morphology, as analyzed using 3D techniques, varies significantly between genders and when compared with international data. For improved patient fit, the creation of five or more distal femur prostheses, diversified by gender and size and informed by the associated morphological parameters, is recommended. LEVEL OF EVIDENCE: IV.

Three-dimensional computed tomography mapping techniques in the morphometric analysis of AO/OTA 33A and 33C distal femoral fractures: a retrospective single-center study.

Purpose: Complex distal femoral fractures involve a challenging set of considerations that must be known to provide optimal management. This study aimed to determine the location and frequency of fracture lines and comminution zones in AO/OTA types 33A and 33C distal femoral fractures using three-dimensional computed tomography mapping. Methods: Seventy-four consecutive eligible patients were included. Fracture fragments for each patient were reconstructed, virtually reduced, and adjusted to match the distal femoral template. Then, all fracture lines and comminuted areas were extracted in transparent mode, and corresponding heat maps were constructed. Finally, these maps, along with the quantitative analysis findings of the counts and volumes of each fragment, were used to summarize the characteristics of the fractures. Results: Thirty-four females and 40 males [average age, 58 years (range, 18-92 years)] presented with a distal femoral fracture. There were 53 AO/OTA type 33A fractures, and 21 AO/OTA type 33C fractures. These two patterns differed significantly on fracture fragment count, comminuted zone fracture fragment count, and mean comminuted zone fracture fragment volume (p < 0.05). Most of the fracture line heat zones were in the femoral epiphysis, intercondylar notch of the femur, and patellofemoral joint. The comminuted area heat regions were mostly found on the lateral, anterior, and posterior femoral diaphysis, with less involvement on the medial side. Conclusion: Our findings may serve as a guide for the surgical approach selection of complex distal femur fractures, the placement strategy of the internal fixation, and the optimization of the osteotomy plan for biomechanical studies.

Transosseous-Equivalent/Suture Bridge Technique in Combination With Platelet-Rich Plasma Application Yield Optimal Clinical Outcomes in Arthroscopic Rotator Cuff Repair: A Bayesian Network Analysis of Randomized Controlled Trials.

PURPOSE: To assess the clinical evidence defining the optimal combination of arthroscopic suture technique and platelet-rich products (PRP), and application for arthroscopic rotator cuff repair (ARCR). METHODS: All level of evidence (LOE) I randomized controlled trials (RCT) focusing on arthroscopic suture technique and/or PRP application in ARCR were included. The exclusion criteria were LOE II or worse, studies with other interventions, studies reported none of the predetermined clinical outcomes; studies unable to extract any precise data; studies from the same patient group of included studies. A pair-wise meta-analysis and Bayesian network analysis were performed on each comparison. The intervention options were ranked by Bayesian network analysis. RESULTS: 27 studies comprising 1,947 individuals met the inclusion criteria. The application of transosseous equivalent/suture bridge repair (SB) with PRP (SB+PRP) significantly reduced retear rate (risk ratio [RR], 0.29; 95% confidence interval [CI], [0.15, 0.55].) and increased Constant-Murley score (mean difference, 1.90; 95% CI, [0.14, 3.74]), compared to SB repair. Single-row repair (SR) with PRP usage (SR+PRP) significantly reduced retear rate (RR, 0.27; 95% CI, [0.12, 0.55]) and pain visual analog scale (VAS) (mean difference: -0.84; 95% CI [-1.39, -0.46].), increased University of California, Los Angeles (UCLA) shoulder score (mean difference: 1.48; 95% CI [0.50, 2.58]) and Constant-Murley score (mean difference: 4.53; 95% CI [2.65, 6.38]), compared to SR repair. The ranking for outcomes demonstrated SB+PRP resulted in the best retear rate, UCLA shoulder score, with the second-best postoperative pain, Constant-Murley score, while SR+PRP resulted in the best postoperative pain, Constant-Murley score, with the second-best retear rate and UCLA score. CONCLUSION: Arthroscopic rotator cuff repair utilizing SB+PRP yields optimal retear rate and UCLA shoulder score, with the second-best postoperative pain and Constant-Murley shoulder outcome score, while SR+PRP yields the best in these two parameters. LEVEL OF EVIDENCE: Level I, Bayesian network analysis of level I RCT.

Cinematic rendering improves the AO/OTA classification of distal femur fractures compared to volume rendering: a retrospective single-center study.

Purpose: Correctly classifying distal femur fractures is essential for surgical treatment planning and patient prognosis. This study assesses the potential of Cinematic Rendering (CR) in classifying these fractures, emphasizing its reported ability to produce more realistic images than Volume Rendering (VR). Methods: Data from 88 consecutive patients with distal femoral fractures collected between July 2013 and July 2020 were included. Two orthopedic surgeons independently evaluated the fractures using CR and VR. The inter-rater and intra-rater agreement was evaluated by using the Cicchetti-Allison weighted Kappa method. Accuracy, precision, recall, and F1 score were also calculated. Diagnostic confidence scores (DCSs) for both imaging methods were compared using chi-square or Fisher's exact tests. Results: CR reconstruction yielded excellent inter-observer (Kappa = 0.989) and intra-observer (Kappa = 0.992) agreement, outperforming VR (Kappa = 0.941 and 0.905, respectively). While metrics like accuracy, precision, recall, and F1 scores were higher for CR, the difference was not statistically significant (p > 0.05). However, DCAs significantly favored CR (p < 0.05). Conclusion: CR offers a superior visualization of distal femur fractures than VR. It enhances fracture classification accuracy and bolsters diagnostic confidence. The high inter- and intra-observer agreement underscores its reliability, suggesting its potential clinical importance.

Identification of hub genes correlated with tumor-associated M1-like macrophage infiltration in soft tissue sarcomas.

Soft tissue sarcomas (STS) are a heterogeneous series of tumors that might result in severe disability and death. Tumor-associated M1-like macrophage infiltration plays a critical role in tumor development and progression. This study aimed at identifying the hub genes associated with M1-like macrophage infiltration in STS cells. First, the expression profiles from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases were imported to calculate the level of M1-like macrophage infiltration by CIBERSORTx. Afterward, the Kaplan-Meier survival analysis was performed to evaluate the correlation between macrophage infiltration and prognosis. Then, weighted gene co-expression network analysis (WGCNA) and protein-protein interaction analysis of GEO data were applied to identify the key gene related to M1-like macrophage infiltration, followed by the functional analysis using TCGA cohort to validate downstream signaling associated with the gene. Finally, pan-cancer analysis was conducted to investigate the gene function in other types of tumors. We found LCK expression positively related to the M1-like macrophage infiltration level, and it positively regulated the expression level of genes regulated to macrophage polarization, and chemotaxis, including interferon-γ (INF-γ), interleukin-12 (IL12), tumor necrosis factor (TNF), PI3K, NF-κB, and CXCL9, 10, and 11. In summary, an 'LCK-INF-γ/IL-12-TNF/PI3K-NF-κB' axis might exist in STS cells that regulate M1-like macrophage infiltration.

MicroRNA-330-3p Expression Indicates Good Prognosis and Suppresses Cell Proliferation by Targeting Bmi-1 in Osteosarcoma.

BACKGROUND/AIMS: Growing evidence has shown that miR-330-3p is closely related to the biological behavior of cancer, including proliferation, metastasis, and prognosis. However, there have been no reports on miR-330-3p expression and function in osteosarcoma. METHODS: Expression of miR-330-3p in osteosarcoma tissues and cell lines was examined by quantitative PCR. Effects of miR-330-3p on osteosarcoma cell proliferation were investigated in vitro with the Cell Counting Kit-8 colorimetric assay. Targets of miR-330-3p were identified by dual-luciferase reporter assay. RESULTS: The results showed that expression of miR-330 decreased in osteosarcoma tissues and cell lines. Prognosis of patients with high miR-330-3p expression was much better than that of those with low expression (P=0.001), and multivariate analysis suggested that miR-330-3p is an independent prognostic factor for osteosarcoma. In addition, miR-330-3p overexpression significantly inhibited the growth of MG-63 and U2OS osteosarcoma cells. Dual-luciferase reporter assay demonstrated that Bmi-1 was a direct target gene of miR-330-3p, and in a recovery experiment, miR-330-3p suppressed osteosarcoma cell proliferation by directly targeting Bmi-1. CONCLUSION: Our results suggest that miR-330-3p acts as a tumor suppressor by regulating Bmi-1 expression in osteosarcoma. Thus, miR-330-3p may represent a novel therapeutic target for the treatment of osteosarcoma.