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This study aimed to compare the clinical efficacy and radiological results between unilateral pedicle screw fixation (UPSF) and bilateral pedicle screw fixation (BPSF) for treating two-level lumbar degenerative diseases. The study involved 106 patients with two-level lumbar degenerative diseases. In the UPSF group ( n  = 52), 28 underwent intervertebral fusion (IF), 17 underwent posterolateral fusion (PLF), and 7 underwent IF & PLF. In the BPSF group ( n  = 54), 43 underwent IF, 2 underwent PLF, and 9 underwent IF & PLF. The clinical efficacy and radiological data were evaluated and compared. The UPSF group was significantly lower than the BPSF group regarding operation time, intraoperative blood loss, and hospitalization expenses. Postoperative visual analog scale scores and oswestry disability index were significantly decreased in both groups compared with pre-surgery. At the last follow-up, the intervertebral disc height of the cranial adjacent segment decreased more in the UPSF group compared with the BPSF group. The incidence of screw loosening in the UPSF group was significantly higher compared with the BPSF group. Compared to BPSF, UPSF can achieve similar and satisfactory clinical efficacy for the treatment of two-level lumbar degenerative diseases with less operation time, muscle damage, blood loss, and hospitalization expenses. However, the occurrence of pedicle screw loosening was higher in the UPSF group.

Current assessment of preoperative deep vein thrombosis (DVT) in elderly patients with femoral neck fracture is limited. We aimed to identify independent risk factors for preoperative DVT in patients with femoral neck fracture and to develop and validate a predictive nomogram. Patients diagnosed with femoral neck fracture from October 2014 to April 2019 were retrospectively analyzed. Baseline data, treatment information and laboratory test results were collected, and the occurrence of DVT in the preoperative period was regarded as the study outcome event. Multivariable logistic regression identified independent risk factors associated with a higher incidence of preoperative DVT. The predictive nomogram was constructed based on the analysis results. The stability of the model was further assessed in this study using patients from May 2019 to September 2022 as an external validation set. A total of 921 patients were enrolled in the study, of which 639 were used in the training cohort and the other 282 for the validation cohort. Multivariate analysis revealed age (OR 1.100, 95% CI 1.042–1.162), BMI ≥ 28 (OR 3.969, 95% CI 1.792–8.793), smoking (OR 2.998, 95% CI 1.255–7.165), LDL-C > 3.4 mmol/L (OR 2.628, 95% CI 1.316–5.250), and d-dimer > 0.475 mg/L (OR 3.157, 95% CI 1.565–6.368) were the independent risk factors of preoperative DVT. The concordance index (C-index) of the nomogram were 0.832 in the training set, and the corrected values after internal validation were 0.759. The receiver-operating characteristic (ROC) curve, the calibration curve, the Hosmer–Lemeshow test and the decision curve analysis (DCA) performed well in both the training and validation cohorts. In this study, we developed a personalised predictive nomogram containing five high-risk factors, which can help surgeons stratify the risk of preoperative DVT in elderly patients with femoral necks and guide high-risk patients to ultrasound scans or prophylactic anticoagulation as soon as possible.

To the Editor: Core decompression (CD), the predominant hip-preserving procedure for pre-collapse osteonecrosis of the femoral head (ONFH), is renowned for its improved short-term outcomes and relatively low postoperative complication rates; however, the reported medium-to-long-term survival rates in the literature vary and are a subject of controversy. [...]we conducted a large, prospective cohort study to assess the frequency and timing of conversion from CD to total hip arthroplasty (THA) and the factors associated with it. [...]our unique postoperative management, involving herbal prescriptions and extended non-weight-bearing periods, differs from traditional methods. [...]though our analysis identifies MCV as a strong risk factor for THA conversion, the wide CI (95% CI:

Purpose This study aims to identify independent risk factors for preoperative lower extremity deep venous thrombosis (DVT) in patients with non-traumatic osteonecrosis of the femoral head (NONFH), and to develop a prediction nomogram. Methods Retrospective analysis of prospectively collected data on patients presenting with non-traumatic osteonecrosis of the femoral head between October 2014 and April 2019 was conducted. Duplex ultrasonography (DUS) was routinely used to screen for preoperative DVT of bilateral lower extremities. Data on demographics, chronic comorbidities, preoperative characteristics, and laboratory biomarkers were collected. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors associated with DVT which were combined and transformed into a nomogram model. Result Among 2824 eligible patients included, 35 (1.24%) had preoperative DVT, including 15 cases of proximal thrombosis, and 20 cases of distal thrombosis. Six independent risk factors were identified to be associated with DVT, including Sodium ≤ 137 mmol/L (OR = 2.116, 95% confidence interval [CI]: 1.036–4.322; P  = 0.040), AGE ≥ 49 years (OR = 7.598, 95%CI: 1.763–32.735; P  = 0.008), D-Dimer > 0.18 mg/L (OR = 2.351, 95%CI: 1.070–5.163; P  = 0.033), AT III ≤ 91.5% (OR = 2.796, 95%CI: 1.387–5.634; P  = 0.006), PLT ≥ 220.4*10⁹ /L (OR = 7.408, 95%CI: 3.434–15.981; P  = 0.001) and ALB < 39 g/L (OR = 3.607, 95%CI: 1.084–12.696; P  = 0.042). For the nomogram model, AUC was 0.845 (95%CI: 0.785–0.906), and C-index was 0.847 with the corrected value of 0.829 after 1000 bootstrapping validations. Moreover, the calibration curve and DCA exhibited the tool’s good prediction consistency and clinical practicability. Conclusion These epidemiologic data and the nomogram may be conducive to the individualized assessment, risk stratification, and development of targeted prevention programs for preoperative DVT in patients with NONFH.

Fibrosis is a disease that negatively affects liver regeneration, resulting in severe complications after liver surgery. However, there is still no clinically effective treatment for promoting fibrotic liver regeneration because the underlying hepatocellular mechanism remains poorly understood. Through microRNA microarrays combined with the application of AAV6, we found that high expression of miR-181a-5p in activated hepatic stellate cells (HSCs) suppressed the expression of hepatic growth factor (HGF) and partially contributed to impaired regeneration potential in mice with hepatic fibrosis that had undergone two-thirds partial hepatectomy. As nanotherapeutics, mesenchymal stem-cell-derived extracellular vesicles (MSC-EVs) have been verified as effective treatments for liver regeneration. Here we observe that MSC-EVs can also promote fibrotic liver regeneration via enriched lncEEF1G, which acts as a competing endogenous RNA to directly sponge miR-181a-5p, leading to the upregulated expression of HGF in HSCs. Finally, engineered MSC-EVs with high expression of lncEEF1G (lncEEF1G OE -EVs) were constructed, suggesting greater potential for this model. In summary, our findings indicate that lncEEF1G OE -EVs have a nanotherapeutic effect on promoting regeneration of fibrotic livers by modulating the miR-181a-5p/HGF pathway in HSCs, which highlights the potential of extracellular vesicle engineering technology for patients with hepatic fibrosis who have undergone hepatic surgery. Engineered mesenchymal stem cells that overexpress lncEEF1G can secrete extracellular vesicles that are rich in lncEEF1G (lncEEF1G OE -EVs). Upon injection of lncEEF1G OE -EVs into a fibrotic 70% partial hepatectomy mouse model, lncEEF1G competitively binds to miR-181a-5p in hepatic stellate cells, preventing the interaction between miR-181a-5p and the messenger RNA of hepatocyte growth factor. This consequently leads to an increase in the secretion of hepatocyte growth factor and the promotion of hepatocyte proliferation. Engineered extracellular vesicles enhance liver regeneration Partial hepatectomy is a common treatment for liver diseases, but liver fibrosis can hinder recovery. This study explores how mesenchymal stem-cell-derived extracellular vesicles (MSC-EVs) might help fibrotic livers regenerate after partial hepatectomy. Researchers found that MSC-EVs can boost liver regeneration by increasing hepatocyte growth factor production in hepatic stellate cells. The study uses a mouse model with liver fibrosis induced by carbon tetrachloride and then performed a partial hepatectomy. Researchers isolated MSCs from umbilical cords and extracted EVs from these cells. They injected these MSC-EVs into the mice and observed their effects on liver regeneration. MSC-EVs were found to be taken up by hepatic stellate cells, leading to increased hepatocyte growth factor production, which is crucial for liver cell proliferation. The results suggest MSC-EVs could be a promising treatment to enhance liver regeneration in fibrotic conditions. This summary was initially drafted using artificial intelligence, then revised and fact-checked by the author.

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 The primary objectives of this study were to focus on one - year unplanned readmissions after THA in ONFH patients and to investigate rates, causes, and independent risk factors. Methods Between October 2014 and April 2019, eligible patients undergoing THA were enrolled and divided into unplanned readmission within one year and no readmission in this study. All unplanned readmissions within 1 year of discharge were reviewed for causes and the rate of unplanned readmissions was calculated. Demographic information, ONFH characteristics, and treatment-related variables of both groups were compared and analysed. Results Finally, 41 out of 876 patients experienced unplanned readmission. The readmission rate was 1.83% in 30 days 2.63% in 90 days, and 4.68% in 1 year. Prosthesis dislocation was always the most common cause at all time points studied within a year. The final logistic regression model revealed that higher risks of unplanned readmission were associated with age > 60 years (P = 0.001), urban residence (P = 0.001), ARCO stage IV (P = 0.025), and smoking (P = 0.033). Conclusions We recommend the introduction of a strict smoking cessation program prior to surgery and the development of comprehensive management strategies, especially for the elderly and end-stage ONFH patients, and pay more attention to preventing prosthesis dislocation in the early days after surgery.

Background No large cohort study has evaluated the surgical outcomes of THA between different stages of ONFH patients. This study aimed to compare the surgical outcomes of ONFH patients who underwent THA in ARCO stage III versus IV, in terms of operative parameters, one-year hip function assessments and postoperative at least five-year complications, to inform optimized management of ONFH. Method From our prospectively collected database, 876 patients undergoing THA between October 2014 and April 2017 were analyzed and divided into ARCO stage III group ( n  = 383) and ARCO stage IV group( n  = 493). Details of demographics, medical record information, adverse events and clinical scores of both groups were collected and compared. Proper univariate analysis was used for the analysis. Result There were no statistically significant differences in baseline characteristics between the two groups. Compared to ARCO stage IV patients, ARCO stage III patients showed a shorter operative time ( p  < 0.01), less bleeding ( p  < 0.01), fewer one-year readmissions ( p  = 0.026) and complications ( p  = 0.040), and significantly higher HHS ( p  < 0.01) one year after THA. In addition, ARCO stage IV patients seem more likely to suffer prosthesis dislocation ( p  = 0.031). Conclusion Although ARCO stage IV patients in the study cohorts appeared to suffer more one-year complications, no significant difference was observed at long-term follow-up. Enhanced clinical guidance on preventing early prosthesis dislocation may help improve the prognosis of final-stage ONFH patients.

Background Assessment of postoperative ambulation in osteonecrosis of the femoral head (ONFH) patients treated with total hip arthroplasty (THA) is limited. This study aimed to define the incidence and risk factors for losing walking independence (LWI) at one-year postoperatively in patients with ONFH undergoing primary THA, and to establish and validate a predictive nomogram. Methods This was a retrospective analysis of prospective collected data from patients admitted to a tertiary referral hospital with ONFH who underwent primary unilateral THA from October 2014 to March 2018. The Functional Independence Measure-Locomotion scale was used to quantify walking independence and was documented at a one-year continuous postoperative follow-up, which classified patients with a final score below 6 as LWI. Multivariate logistic regression identified independent risk factors for LWI, and a predictive nomogram was constructed based on the analysis results. The stability of the model was assessed using patients from April 2018 to April 2019 as an external validation set. Results 1152 patients were enrolled in the study, of which 810 were used in the training cohort and the other 342 for the validation cohort. The incidence of LWI was 5.93%. Multivariate analysis revealed that age 62 years or older (odd ratio (OR) = 2.37, 95% confidence interval (CI) 1.07–5.24), Charlson’s comorbidity index 3 or higher (OR = 3.64, 95% CI 1.09–12.14), Association Research Circulation Osseous stage IV (OR = 2.16, 95% CI 1.03–4.54), reduced femoral offset (OR = 2.41, 95% CI 1.16–5.03), and a higher controlling nutritional status score (OR = 1.14, 95% CI 1.01–1.30) were independent risk factors of LWI. The nomogram had a concordance index of 0.773 and a Brier score of 0.049 in the training set, with corrected values of 0.747 and 0.051 after internal validation. The receiver-operating characteristic curve, calibration curve, Hosmer-Lemeshow test, and decision curve analysis all performed well in both the training and validation cohorts. Conclusions This study reported a 5.93% incidence of LWI and established a risk prediction model in patients undergoing THA for ONFH, supporting targeted screening and intervention to assist surgeons in assessing ambulation capacity and managing rehabilitation.

The aim of this study was to compare the biomechanical results of long proximal femoral bionic nail (PFBN) and three conventional intramedullary nails in the treatment of subtrochanteric fractures (STFs). Using finite element analysis, we compared the therapeutic efficacy of four long intramedullary nails: the PFBN, reconstruction nail (RCN), InterTAN nail (ITN), and proximal femoral nail antirotation (PFNA) for the treatment of Seinsheimer type IIIA and type V STFs. The biomechanical stability of the implants was evaluated by calculating of von Mises stress (VMS), contact pressure and displacement for three loading scenarios. The results showed that the PFBN group had the lowest VMS values under axial, bending and torsional loads. Under axial loading conditions, the VMS of PFBN was 480.04 MPa, followed by ITN (726.39 MPa), PFNA (730.48 MPa), and RCN (837.24 MPa) in the type V fracture groups. In the PFBN group, the contact pressure was 19.22 MPa and the tangential micromotion was 0.089 mm for the type IIIA group, 23.69 MPa and 0.08 mm for the type V group. Compared to the ITN, PFNA and RCN groups, the PFBN group exhibited the lowest contact pressure and tangential micromotion at the fracture sites. The superior biomechanical properties of the PFBN under axial, bending, and torsional loads not only reduced stress at the fracture site, but also improved structural stability.