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In recent decades, the biomedical applications of mesenchymal stem cells (MSCs) have attracted increasing attention. MSCs are easily extracted from the bone marrow, fat, and synovium, and differentiate into various cell lineages according to the requirements of specific biomedical applications. As MSCs do not express significant histocompatibility complexes and immune stimulating molecules, they are not detected by immune surveillance and do not lead to graft rejection after transplantation. These properties make them competent biomedical candidates, especially in tissue engineering. We present a brief overview of MSC extraction methods and subsequent potential for differentiation, and a comprehensive overview of their preclinical and clinical applications in regenerative medicine, and discuss future challenges.

Pancreatic ductal adenocarcinoma (PDAC), the most deadly solid malignancy, is typically detected late and at an inoperable stage. Early or incidental detection is associated with prolonged survival, but screening asymptomatic individuals for PDAC using a single test remains unfeasible due to the low prevalence and potential harms of false positives. Non-contrast computed tomography (CT), routinely performed for clinical indications, offers the potential for large-scale screening, however, identification of PDAC using non-contrast CT has long been considered impossible. Here, we develop a deep learning approach, pancreatic cancer detection with artificial intelligence (PANDA), that can detect and classify pancreatic lesions with high accuracy via non-contrast CT. PANDA is trained on a dataset of 3,208 patients from a single center. PANDA achieves an area under the receiver operating characteristic curve (AUC) of 0.986–0.996 for lesion detection in a multicenter validation involving 6,239 patients across 10 centers, outperforms the mean radiologist performance by 34.1% in sensitivity and 6.3% in specificity for PDAC identification, and achieves a sensitivity of 92.9% and specificity of 99.9% for lesion detection in a real-world multi-scenario validation consisting of 20,530 consecutive patients. Notably, PANDA utilized with non-contrast CT shows non-inferiority to radiology reports (using contrast-enhanced CT) in the differentiation of common pancreatic lesion subtypes. PANDA could potentially serve as a new tool for large-scale pancreatic cancer screening. A deep learning model provides high accuracy in detecting pancreatic lesions in multicenter data, outperforming radiology specialists.

This study aims to evaluate the variations in image quality of CCTA conducted at different time intervals and their clinical implications. A retrospective analysis of 641 patients who underwent CCTA between July 2023 and June 2024 was performed. The examination times were divided into morning group(8:00–12:00, 316 cases), and afternoon group༈14:00–18:00, 325 cases) for comparison. For patients with a heart rate ≥ 60 bpm, 25 mg of metoprolol was given orally to control heart rate, along with 0.5 mg of sublingual nitroglycerin before the CCTA examination. Image quality, initial heart rate, post-medication heart rate, heart rate differences (pre- and post-medication), percentage heart rate changes, radiation dose, age, and sex were compared between the two groups. Statistical analyses, including the Mann-Whitney U test, Spearman correlation coefficients, and logistic multivariate regression, were used to assess factors influencing image quality. Finally, receiver operating characteristic (ROC) curves were used to analyse the predictive value of examination timing on image quality. The image quality excellence rates for the morning group and the afternoon group were 87.9% and 74.1%, respectively, with no undiagnosable cases in either group. Significant differences ( P  < 0.05) were observed between the two groups in subjective image scores, post-medication heart rates, heart rate differences (pre- and post-medication), percentage heart rate changes, and age. However, no significant differences were found in initial heart rate, radiation dose, or sex ( P  > 0.05). Logistic multivariate regression analysis indicated a statistically significant association between image quality and both examination timing and age ( P  < 0.05). However, no significant associations were found with initial heart rate, heart rate differences (pre- and post-medication), percentage heart rate changes, radiation dose, or sex ( P  > 0.05). The regression equation was determined as Y = 11.386 + 0.873 × 1 + 0.023 × 2, where Y represents image quality, X1 represents the examination timing, and X2 represents age. For the morning group, the ROC curve area under the curve (AUC) for initial heart rate and post-medication heart rate were 0.598 and 0.890, with optimal thresholds of 79 bpm and 71 bpm, respectively. For the afternoon group, the AUC values were 0.596 and 0.812, with optimal thresholds of 75 bpm and 68 bpm, respectively. CCTA performed in the morning (8:00–12:00) yields superior image quality compared to the afternoon (14:00–18:00). Moreover, morning CCTA scans tolerated higher initial heart rates (up to 79 bpm) without affecting image quality, in contrast to the lower threshold of 75 bpm in the afternoon. These findings offer robust data to guide the timing of clinical CCTA procedures and heart rate management, indicating that morning CCTA scans may facilitate higher-quality imaging, especially for patients with elevated heart rates.

Background In this study, we present the unique case of a patient with knee osteoarthritis (OA) of the medial compartment and posterior cruciate ligament (PCL) deficiency who underwent simultaneous medial unicompartmental knee arthroplasty (UKA) and PCL reconstruction. Case presentation A 49-year-old male patient presented with a 1-year history of pain and instability in the left knee. The patient had previously experienced a trauma-related injury to the PCL of the left knee that was left untreated. Imaging and physical examination confirmed the presence of left medial knee OA along with PCL rupture. To address these issues, the patient underwent UKA combined with PCL reconstruction. The patient’s Lysholm score was 47 before surgery and 81 three months after surgery, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 29 before surgery and 18 three months after surgery, and the International Knee Documentation Committee (IKDC) subjective score was 56.3 before surgery and 74.7 three months after surgery. Six months after surgery, the patient's gait returned to normal, and he was able to jog. Conclusion This case report presents the first instance of UKA combined with PCL reconstruction and introduces a novel treatment approach for patients suffering from medial knee OA and ligament injury.

Objective Intermittent pneumatic compression (IPC) is considered the standard of care for preventing venous thromboembolism (VTE) in the hospital setting. However, its widespread adoption after hospitalization has been limited due to its shortcomings in obstruction of venous valves and blood reflux. The objective of this study is to compare the effects of continuous graduated pneumatic compression (CGPC), a new device with a novel mechanism, and IPC on lower hemodynamics and the incidence of VTE in patients undergoing arthroplasty. Methods We randomized 123 participants undergoing knee arthroplasty to receive either IPC or CGPC from June 2022 through August 2023. An experienced sonographer used a Doppler ultrasound scanner to obtain hemodynamic indicators of venous blood. The primary outcome was the blood velocity of the femoral vein measured by a Doppler scanner. Secondary outcomes included the hemodynamic of the femoral vein and popliteal vein, quality of life at discharge and 30 days after surgery, symptomatic and asymptomatic VTE up to 30 days, and adverse events related to the IPC and CGPC device. For statistical analyses, Student's t‐test, analysis of covariance, and the Mann–Whitney U test were used. Statistical significance was indicated with p < 0.05. Results There was no significant difference in femoral vein velocity between the IPC and CGPC groups. However, CGPC demonstrated a significant increase in femoral vein flow compared to the IPC group, with a median (interquartile) increasing from 158.9 (122.9, 204.3) to 265.6 (203.3, 326.8) mL/min in the CGPC group and from 139.0 (103.3, 175.9) to 189.6 (161.4, 270.8) mL/min in the IPC group (p < 0.001). Similar trends were observed in popliteal vein measurements. The differences between the two groups were similar in terms of quality of life, incidence of VTE, and adverse events. Conclusion The CGPC device provides a substantial increase in blood flow compared to the IPC device. Its safety and effectiveness have been preliminarily validated. The CGPC device presents a promising alternative for VTE prophylaxis in arthroplasty. Trial Registration: Chinese Clinical Trial Registry (registration number: ChiCTR2300078201) We developed and manufactured an innovative mechanical device for VTE prophylaxis, named continuous graded pneumatic compression (CGPC). Its safety and effectiveness have been confirmed through validation within a patient cohort undergoing knee arthroplasty. The CGPC device demonstrates comparable venous blood velocity in the popliteal and femoral veins, but it provides a pronounced increase in blood flow compared to the intermittent pneumatic compression device, which provides an advantage in reducing venous congestion. These findings suggest that CGPC may offer a more appealing alternative approach for VTE prophylaxis in orthopedic patients.

Objectives Despite the use of multimodal analgesia, patients undergoing knee arthroplasty still encounter residual moderate pain. The addition of betamethasone to local anesthetic has been shown to improve postoperative pain. However, it remains uncertain whether the positive effects of perineural or intravenous administration of betamethasone on analgesia outcomes lead to better early mobility and postoperative recovery. Methods Between June 2022 and February 2023, a total of 159 patients who were undergoing knee arthroplasty were included in this study. These patients were allocated randomly into three groups: (i) the NS group, received ropivacaine 0.375% and intravenous 3mL 0.9% normal saline; (ii) the PNB group, received ropivacaine 0.375% plus perineural betamethasone (12mg) 3mL and intravenous 3mL 0.9% normal saline; and (iii) the IVB group, received ropivacaine 0.375% and intravenous betamethasone (12mg) 3mL. Results Both perineural and intravenous administration of betamethasone led to improved median (IQR) numeric rating scale (NRS) scores on the 6‐meter walk test, with a score of 1.0 (1.0–2.0) for both groups, compared with 2.0 (1.0–2.0) for the NS group (p = 0.003). Compared to the NS group, both the PNB and IVB groups showed significant reductions in NRS scores at 24 and 36 h after surgery, along with a significant increase in ROM at 24, 36, and 48 h post‐operation. Additionally, it exhibited lower levels of cytokine IL‐1β and TNF‐α in fluid samples, as well as lower level of HS‐CRP in blood samples in the PNB and IVB groups compared to the NS group. Conclusion The administration of perineural and intravenous betamethasone demonstrated an enhanced analgesic effect following knee arthroplasty. Furthermore, it was associated with reduced levels of IL‐1β, TNF‐α, and HS‐CRP, as well as enhanced knee ROM, which is conducive to early ambulation and postoperative rehabilitation after knee arthroplasty. A: violin plot of 6‐meter walk test NRS score at 24 h after surgery. The purple solid line represents median and the black dotted line represents interquartile range (IQR). B: the concentration of HS‐CRP in blood at preoperative and postoperative. C: the concentration of IL‐1β in joint fluid at 24 h after surgery. D: the concentration of TNF‐α in joint fluid at 24 h after surgery. *Statistically significant difference, p < 0.05; **Statistically significant difference, p < 0.001.

Glucocorticoid-induced osteonecrosis of the femoral head is a joint dysfunction disease. Impaired local angiogenesis and reduced perfusion are early pathological features of glucocorticoid-induced osteonecrosis of the femoral head, resulting from vascular endothelial cell damage and suppressed angiogenesis caused by prolonged glucocorticoid exposure. This study focuses on the role of angiogenesis in glucocorticoid-induced osteonecrosis of the femoral head, particularly the potential of GDF11 in promoting angiogenesis. Our findings indicate that GDF11 expression diminished in patients with osteonecrosis of the femoral head compared to those with femoral neck fractures. We establish a male Sprague-Dawley rat model of glucocorticoid-induced osteonecrosis of the femoral head and utilize human umbilical vein endothelial cells to explore the role of GDF11 on osteogenesis and angiogenesis. A series of in vivo and in vitro experiments are conducted, the result shows that GDF11 could reverse the damaged angiogenic and osteogenic ability caused by methylprednisolone. We perform RNA sequencing in human umbilical vein endothelial cells and reveal that GDF11 promotes the expression of angiogenic factors and migration of endothelial cells through activating the PI3K/AKT/eNOS pathway, thereby promoting angiogenesis. Our study clarifies the role and mechanism of GDF11 in regulating local angiogenesis in glucocorticoid-induced osteonecrosis of the femoral head. GDF11 alleviates glucocorticoid-induced femoral head osteonecrosis by activating the PI3K/AKT/eNOS pathway to promote angiogenesis and osteogenesis, reversing the damage caused by glucocorticoids.

In patients with tibial plateau bone cysts undergoing total knee arthroplasty (TKA), bone defects commonly occur following tibial plateau resection. Current strategies for addressing these defects include bone grafting, bone cement filling, and the cement-screw technique. However, there remains no consensus on the optimal approach to achieve the best surgical outcomes. This study aims to evaluate the most effective repair method for residual bone defects following tibial plateau bone cyst repair during TKA from a biomechanical perspective. The treatment options for tibial plateau bone defects were classified into four categories: no treatment, cancellous bone filling, bone cement filling, and the cement-screw technique. Finite-element analysis (FEA) was employed to evaluate stress distribution and displacement across the models for each treatment group. In addition, static compression mechanical tests were used to assess the displacement of the models within each group. FEA results indicate that when employing the cement-screw technique to repair tibial plateau bone defects, the maximum stress on the prosthesis and the cement below the prosthesis is minimized, while the maximum stress on the cancellous bone is maximized. And the displacement of each component is minimized. Biomechanical tests results further demonstrate that the displacement of the model is minimized when utilizing the cement-screw technique for tibial plateau bone defects. Using cement-screw technique in treating residual tibial bone defects due to bone cysts in TKA offers optimal biomechanical advantages.

The goal of this study was to evaluate the accuracy of the lesser trochanter for entry of lag screw placement in the fixation of hip fractures. Radiographs of the pelvis with both hips in 50 Chinese patients were analyzed to determine the accuracy of using the lesser trochanter as a reference landmark for inserting lag screws. The femoral neck was divided into 4 parts, and the second distal part was classified as the safe zone. Cobb angles of 125° and 130° were used as representative lag screw insertion angles, referencing the lateral cortex of the lesser trochanter for measurement, and insertion tracks were drawn on the neck of the femur. The accuracy of lag screw placement in the defined safe zone was evaluated. Accuracy of placement in the safe zone for entry points at the superior tip, apex, and inferior tip of the lesser trochanter were 78%, 39%, and 0%, respectively, for the 125° Cobb angle. Rates for the superior tip, apex, and inferior tip of the lesser trochanter were 31%, 74%, and 6%, respectively, for the 130° Cobb angle. The entry point at the level of the inferior tip of the lesser trochanter had incidence rates of 95% and 71% for cutout for 125° and 130° screws, respectively. The authors found that the superior tip of the lesser trochanter was a good reference point for 125° lag screw insertion and that the apex of the lesser trochanter was a good reference point for 130° lag screw insertion. Entry at the level of the inferior tip of the lesser trochanter has a very high rate of cutout and should be avoided. [The goal of this study was to evaluate the accuracy of the lesser trochanter for entry of lag screw placement in the fixation of hip fractures. Radiographs of the pelvis with both hips in 50 Chinese patients were analyzed to determine the accuracy of using the lesser trochanter as a reference landmark for inserting lag screws. The femoral neck was divided into 4 parts, and the second distal part was classified as the safe zone. Cobb angles of 125° and 130° were used as representative lag screw insertion angles, referencing the lateral cortex of the lesser trochanter for measurement, and insertion tracks were drawn on the neck of the femur. The accuracy of lag screw placement in the defined safe zone was evaluated. Accuracy of placement in the safe zone for entry points at the superior tip, apex, and inferior tip of the lesser trochanter were 78%, 39%, and 0%, respectively, for the 125° Cobb angle. Rates for the superior tip, apex, and inferior tip of the lesser trochanter were 31%, 74%, and 6%, respectively, for the 130° Cobb angle. The entry point at the level of the inferior tip of the lesser trochanter had incidence rates of 95% and 71% for cutout for 125° and 130° screws, respectively. The authors found that the superior tip of the lesser trochanter was a good reference point for 125° lag screw insertion and that the apex of the lesser trochanter was a good reference point for 130° lag screw insertion. Entry at the level of the inferior tip of the lesser trochanter has a very high rate of cutout and should be avoided. [ Orthopedics. 2014; 37(12):e1080–e1084.]

Background. Chondrocyte metabolic disorder plays an important role in the development of osteoarthritis (OA). The use of statins in the treatment of OA has also been widely studied, but the mechanism is still confusing. The present study aims to investigate the effects of statin on osteoarthritis chondrocytes and its underlying mechanism. Major findings. An untargeted metabolomics study revealed that the treatment of statins significantly changed the metabolites of articular cartilage tissues collected from female osteoarthritis patients, and might be involved in the glycerophospholipid metabolism pathway. In vitro study showed that 5–50 μmol/L of pravastatin exerts no cytotoxicity on human chondrocytes. Besides, 50 μmol/L of pravastatin caused a significant decrease in the expression of matrix metalloproteinase (MMP)-1 and MPP-13, and intracellular cholesterol in interleukin-1β (IL-1β)-induced human chondrocytes. Furthermore, at both mRNA and protein levels, the expression of the proteins related to the cholesterol efflux pathway (liver X receptor and cholesterol efflux regulatory protein) were significantly up-regulated by 50 μmol/L of pravastatin in IL-1β-induced human chondrocytes. Conclusion. Pravastatin can reduce the expression of MMPs in IL-1β-induced human chondrocytes and protect the chondrocyte matrix. The mechanism may be related to promoting the expression of proteins related to the cholesterol efflux pathway and reducing the level of cellular cholesterol.