Objective: Our meta-analysis aims to assess the efficacy of genetically modified stem cell therapy in preclinical osteoporosis models.
Methods: We executed a thorough literature search across PubMed, Embase, Web of Science, and the Cochrane Library databases from inception to September 15, 2023. We used a random-effect model for pooled analysis of the effect of genetically modified stem cell therapy on animals with osteoporosis. The primary outcomes included bone mineral density (BMD) and bone volume fraction. (BV/TV). All meta-analyses were performed employing the Cochrane Collaboration's Review Manager (version 5.3) in conjunction with Stata 15.0 statistical software.
Results: A total of 2567 articles were reviewed, of which 16 articles met inclusion criteria. Of these, 13 studies evaluated the BMD and 11 studies evaluated BV/TV. Compared to the control group, genetically modified stem cell therapy was associated with significantly improved BMD (standardized mean difference [SMD] = 1.85, 95% Confidence Interval [CI]: 1.06-2.63, P < 0.001, I2 = 69%) and BV/TV (standardized mean difference [SMD] = 2.11, 95% Confidence Interval [CI]: 1.10-3.12, P < 0.001, I2 = 78%).
Conclusion: Genetically modified stem cell therapy is a safe and effective method that can significantly improve the BMD and BV/TV in animal models of osteoporosis. These results provide an important basis for future translational clinical studies of genetically modified stem cells.
Background: The duration of a single fascia iliaca compartment block (FICB) with ropivacaine is limited. This study investigated whether methylene blue as an adjuvant anesthetic in FICB can enhance the postoperative analgesic effect following total hip arthroplasty (THA).
Methods: Patients who planned to undergo THA were recruited for this randomized clinical trial from June 2023 to February 2024. Ninety elderly patients undergoing THA were randomly divided into two groups that received ultrasound-guided FICB with either ropivacaine and methylene blue (MB + R group, n = 45) or ropivacaine only (R group, n = 45) before induction of general anesthesia. The primary outcomes were postoperative Visual Analog Scale (VAS) scores. Secondary outcomes included inflammatory factor levels, heart rate (HR), mean arterial pressure (MAP), postoperative analgesic use, postoperative activity, and adverse events.
Results: The MB + R group had significantly lower VAS scores at both rest and with activity at 24 and 48 h postoperatively than the R group (P < 0.001). Additionally, the hypersensitive C-reactive protein, procalcitonin, and neutrophil-to-lymphocyte ratio values were significantly lower in the MB + R group than in the R group on the first and second days after surgery (P < 0.05). The number of patients requiring supplemental analgesia postoperatively was significantly lower in the MB + R group (P = 0.020). Additionally, the MB + R group had a significantly longer walking distance on the first time out of bed and a higher number of out-of-bed activities within 48 h postoperatively (P < 0.001).
Conclusion: Compared to ropivacaine alone, the combination of ropivacaine and methylene blue in FICB provided better analgesic effects over a longer duration. Additionally, the addition of methylene blue reduced the postoperative production of inflammatory markers and promoted patients' functional recovery.
Trial registration: ClinicalTrials.gov, Registration number: NCT06284941, Retrospectively registered, Date of registration: February 04, 2024.
Objective: To study the relationship between red blood cell distribution width (RDW) and short-term mortality of hip fracture in middle-aged and older adults.
Methods: A retrospective cohort of electronic medical records at a single hospital over a 2-year period between 2020 and 2021. We received the records of 233 patients aged > 50 years who suffered from hip fracture. the clinical data including patients demographics, comorbidities at the time of admission, type of surgery, blood examination, 3-months mortality, 6-months mortality and 1-year mortality. the relationship between RDW and short-term mortality of hip fracture were analyzed. the cohort was then divided into two groups based on their RDW levels at the time of admission: low (RDW < 13.6%) and high (RDW ≥ 13.6%).
Results: Results the mean age was 78.03 ± 12.09 years; 64.81% were woman. At admission, 80 patients (34.33%) had high RDW levels and 153 patients (65.67%) had low RDW levels. there were no statistically significant differences between the groups with regard to sex, type of operation, duration of surgery and hospitalization length. Patients with high RDW had more comorbidities when compared to patients with low RDW levels (p < 0.05). All-cause mortality was higher for patients with high RDW levels, at 3 months (p < 0.05), 6 months (p < 0.05), and 12 months (p < 0.05).
Conclusion: RDW is significantly related with short-term mortality in hip fracture. The higher RDW, the higher risk of mortality.
Purpose: Excessive sliding of cephalic components of cephalomedullary nails has been established to be significantly associated with the development of mechanical failures and unfavorable results in the surgical treatment of intertrochanteric fractures. This study aims to elucidate the risk factors that contribute to excessive sliding in elderly patients treated with PFNA-II devices for the fixation of intertrochanteric fracture.
Methods: We conducted a retrospective analysis of patients aged 65 and older who presented with intertrochanteric fractures and underwent surgical treatment using PFNA-II devices at a university teaching hospital between January 2020 and December 2021. All patients were subjected to a minimum of one year of follow-up. We collected data on patient demographics, as well as preoperative, perioperative, and postoperative radiographic information, identifying mechanical failures during routine follow-ups. Patients were categorized into an excessive sliding group and a normal sliding group based on the sliding distance, with the optimal cut-off determined by receiver operating characteristic (ROC) curve analysis. Binary logistic regression was employed to identify independent risk factors associated with excessive sliding.
Result: Among the 507 eligible patients, the mean postoperative sliding distance was 4.45 mm (SD, 5.39 mm; range, 0-31.67 mm). The cut-off for excessive sliding was determined as 6.75 mm, with 61 patients (12.0%) classified as hving excessive sliding, of whom 18 (29.5%) experienced mechanical failures. Binary logistic analysis indicated that poor reduction quality (OR = 11.493, 95% CI: 3.386-39.014, P < 0.001), and Subtype P in LAT reduction (OR = 15.621, 95% CI: 5.984-40.779, P < 0.001) were independently associated with excessive sliding distance. Their associations were robust across subgroup analyses.
Conclusions: Poor reduction quality and the Subtype P in LAT reduction were identified as independent risk factors for excessive sliding. It is essential for surgeons to be mindful of these two risk factors during preoperative assessment and intraoperative procedures.
Background: Bi-cruciate retaining (BCR) total knee arthroplasty (TKA) is considered to provide improved clinical function and kinematics compared with conventional TKA, but it is unclear which factors affect clinical outcomes after BCR TKA. This study aimed to investigate whether rotational alignment of the femoral and tibial components and rotational mismatch between the femoral and tibial components affected early clinical outcomes after BCR TKA, according to the 2011 version of the Knee Society Score (2011KSS).
Methods: This retrospective cohort study included 39 knees that underwent BCR TKA. Rotational alignment of the femoral and tibial components and rotational mismatch between the components were measured by computed tomography based three-dimensional evaluation software. 2011KSS was obtained at 3, 6, and 12 months postoperatively. The relationship of each of rotational alignment and rotational mismatch with 2011KSS was analyzed.
Results: Rotational alignment of the femoral and tibial components was not correlated with symptoms, patient satisfaction, patient expectations, or functional activities at 3, 6, or 12 months postoperatively. Rotational mismatch was negatively correlated with symptoms, patient satisfaction and functional activities at 3 months; negatively correlated with symptoms and functional activities at 6 months; and negatively correlated with symptoms, patient satisfaction, patient expectations and functional activities at 12 months postoperatively.
Conclusions: Rotational mismatch between the femoral and tibial components was negatively correlated with 2011KSS, whereas no relationship of rotational alignment of the femoral and tibial components with 2011KSS was observed. Excessive external rotation of the tibial component relative to the femoral component resulted in worse early clinical outcomes.
Objective: Early exercise is a physical adjuvant therapy that begins on day 1 postoperatively. It prevents postoperative stiffness, fatty infiltration, muscle atrophy and loss of range of motion. Usually, use of a brace fixation that immobilizes the shoulder in 30° of abduction during the postoperative rehabilitation period reduces tension on the repaired tendon, which improves tendon-bone healing. To investigate the effect of early exercise and brace fixation on postoperative recovery after arthroscopic rotator cuff repair by systematic review, thereby providing evidence-based evidence for clinical practice.
Methods: Chinese and English databases (PubMed, Web of Science, Cochrane Library, CNKI, Wanfang database, and VIP database) were searched by keywords until November 15, 2024. Randomized controlled studies comparing early exercise versus brace fixation after arthroscopic rotator cuff repair surgery were included, along with an evaluation of such studies using the Cochrane Collaboration risk assessment tool. Afterward, the effect of the intervention on the visual analogue scale (VAS) for pain, function, shoulder range of motion (forward flexion, abduction, internal rotation, external rotation), and postoperative complications (stiffness, re-tear) was evaluated based on a fixed or random effects model.
Results: Eleven high-quality randomized controlled studies were included. Compared with brace fixation, early exercise improved the range of motion of the subjects' shoulders. Compared with brace fixation, shoulder flexion (WMD of 6 weeks = 10.57, 95% CI: 1.30, 19.84, WMD of 3 months = 12.39, 95% CI: 7.51, 17.27, WMD of 6 months = 2.88, 95% CI: 1.02, 4.73, WMD of 1 year = 2.59, 95% CI: 0.40, 4.77) and shoulder abduction (WMD of 6 weeks = 13.17, 95% CI: 9.80, 16.55, respectively). The improvement degree of WMD = 2.28 in 6 months and internal rotation (WMD = 5.08, 95% CI: 3.16, 7.01, in 6 weeks and WMD = 8.23, 95% CI: 4.23, 12.23, in 3 months) was statistically different. Early exercise also reduced the risk of postoperative stiffness (RR = 0.34; 95%CI:0.19, 0.60). However, compared with brace fixation, there was no statistical difference in pain score (WMD = 0.05, 95% CI:0.09, 0.18) and shoulder joint recovery score (SMD = 0.05, 95% CI: 0.12, 0.03).
Conclusion: Early exercise can improve the range of motion of early shoulder joint and reduce the risk of postoperative stiffness, but the effect of pain and function improvement is not obvious, which can play a positive role in postoperative rehabilitation of patients, but it needs more comprehensive research and improvement to guide clinical practice.
Introduction: Friction massage (FM) is a conservative treatment for managing myofascial trigger points (MTrPs). Although many studies have demonstrated the effects of FM, this manual technique significantly loads the therapist's hands. Therefore, there is a need to evaluate FM compared to other physical therapy methods to help clinicians choose the best one.
Objective: This systematic review aimed to investigate the effect of FM on pain intensity, pressure pain threshold (PPT), and joint range of motion (ROM) in individuals with MTrPs.
Methods: PubMed/Medline, Scopus, Web of Science, Science Direct, and Google Scholar were searched from inception to 15 April 2024. All randomized control and clinical trials that assessed the effect of FM on pain intensity, PPT, and joint ROM in individuals with MTrPs were included.
Results: Twelve studies were included. The within-group results showed that FM could significantly improve pain intensity, PPT, and joint ROM, but compared to the control group, there was no significant superiority for improving pain intensity and PPT, and the results were inconclusive for the effect of FM on joint ROM improvement because of controversial findings.
Conclusion: In the short term, there is level C evidence indicating that FM may effectively reduce VAS and the PPT of MTrPs in upper trapezius. Nonetheless, high-quality and long-term research is needed to address improvements in ROM and NPRS. Due to nature of level C evidence, future well-designed RCTs should overcome the existing limitations using adequate sample sizes, long intervention periods, and long-term follow-up.
Background: This study aimed to evaluate the effect of patient participation on clinical and functional outcomes, satisfaction, and compliance with postoperative rehabilitation in patients undergoing surgery for anterior cruciate ligament (ACL) injury.
Methods: Sixty-one patients who underwent isolated ACL reconstruction (ACLR) were included. Thirty patients in the participation group were shown the arthroscopy screen and allowed to communicate with the surgeon during surgery. For clinical and functional evaluation, knee joint range of motion (ROM), International Knee Documentation Committee Subjective Knee Form (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Scoring Scale (LKSS), Short Form-36 (SF-36) score, and Tegner Activity Scale (TAS), were used. The Pain Quality Assessment Scale was used to assess pain. Additionally, the patient's satisfaction and exercise compliance were evaluated using a 5-point Likert scale and percentage of exercise participation, respectively.
Results: At 3rd week, the ROM, SF-36, LKSS values, and pain scores were better in the participation group compared to the control group(p <.05). At 6th month, the IKDC, KOOS, SF-36 values and pain scores were also better in the participation group compared to the control group (p <.05). However, the ROM, LKSS, and TAS values were similar between groups at the 6th month(p >.05). Postop satisfaction at 3rd week and 6th month and exercise compliance postoperatively were significantly better in the participation group compared to the control group(p <.05).
Conclusion: Patient participation during ACLR surgery by communicating with the surgeon positively affects clinical and functional outcomes. It also contributes to patient satisfaction and compliance with the rehabilitation program postoperatively.
Clinical trial number: Not Applicable.
Background: Nonunion is a common complication following foot and ankle arthrodesis. This study endeavoured to determine the risk factors for nonunion in foot and ankle arthrodesis.
Methods: This was a retrospective case-control study using the National Health Insurance Research Database. Patients who underwent foot and ankle arthrodesis with a minimum follow-up duration of 6 months were included. International Classification of Diseases codes were used to identify diagnoses and treatment. Patients with nonunion were matched by age and sex with patients with union at a ratio of 1:4. Logistic regression was performed to compare between patients with nonunion and controls with union to ascertain the effects of various risk factors.
Results: A total of 107 joints were identified as nonunion, and 428 age- and sex-matched controls were selected. Patients with diabetes mellitus had a 1.710 times (95% CI = 1.060 - 2.756, p = 0.0278) higher risk of nonunion than those without. No significant differences were observed in the risk of nonunion in relation to which joint was treated; the presence of osteoarthritis, traumatic osteoarthritis, rheumatoid arthritis, osteoporosis, or open/arthroscopic arthrodesis; internal or external fixation; or the usage of a bone graft. For patients without diabetes mellitus, those who underwent arthrodesis in the tarsometatarsal joint had a 6.507 times (95% CI: 1.045 - 40.522, p = 0.0256) higher risk of nonunion compared to those who underwent arthrodesis in the ankle joint.
Conclusion: Diabetes mellitus increases the risk of nonunion among patients with and without diabetes mellitus. For those without diabetes mellitus, arthrodesis in the tarsometatarsal joint is associated with the highest risk of nonunion.
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