To evaluate the features of carotid web (CW) by ultrasonography.

A total of 66 patients with CW were retrospectively enrolled from January 2018 to June 2019 at Xuanwu Hospital, Capital Medical University. All patients were examined by both ultrasonography and CTA, and were divided into either a<50% stenosis group (54 cases) or a ≥50% stenosis group (12 cases). The ultrasonographic characteristics of CW, including the length, thickness, direction (forward or backward to the flow), acute angle between the web and carotid wall, and thrombus between the web and carotid wall were compared between the two groups. The stenosis degrees of carotid artery were compared between patients with and without ischemic stroke.

Forty-two (42/66, 63.6%) patients were diagnosed with CW by initial CDFI examination, of whom 21 (21/66, 31.8%) were diagnosed with ulcerative plaque and 3 (3/66, 4.5%) were diagnosed with carotid dissection at first but confirmed by second examination. There were no differences in the web length, thickness, direction, or thrombus detected between the two groups (P>0.05). The angle between the web and carotid wall in the<50% stenosis group was significantly smaller than that of the ≥50% stenosis group (median angel 39o vs 73o, P=0.002), and the percentage of patients with an angle≤ 60o in the<50% stenosis group was significantly higher than that of the ≥50% stenosis group (74.1% vs 41.7%, P=0.042). The diameter of the residual carotid artery at CW location in the<50% stenosis group was significantly larger and peak systolic velocity was significantly higher in the<50% stenosis group than in the≥50% stenosis group (P<0.001). The stenosis degrees of carotid artery were not statistically different between patients with and without ischemic stroke (P=0.321).

Ultrasonography can be used to evaluate the characteristics of carotid web in 2D and color mode. When the angle between the CW and carotid wall is large, the carotid artery stenosis ≥ 50% is more likely to happen, but carotid artery stenosis is not the main cause of ischemic stroke.

The aim of the present study was to evaluate the efficiency of sling exercise, therapeuticultrasound, therapeuticultrasound and sling exercise in patients to alleviate pain and improve lumbar function with lumbar disc herniation.

Individuals were selected from a list of patients being followed at the department of Rehabilitation in the third hospital of Hebei Medical University. 30 patients who were diagnosed with lumbar disc herniation were collected, the diagnoses were established upon medical history, physical examination, and results of imaging studies. The patients were randomly divided into three groups: therapeuticultrasound group received 14 sessions of ultrasonic therapy to the lumbar region, Sling exercise group received 14 sessions of sling exercise, and therapeuticultrasound and sling exercise group received therapeuticultrasound and sling exercise therapy 14 sessions of therapeuticultrasound to the lumbar region,7 sessions per week, 2 weeks. The VAS and ODI were compared with the assessment of the patients before and at the end of the therapy.

At the end of treatment, three groups VAS scores (F=3.069, P=0.043) and ODI scores (t=12.676, P<0.001) was lower than that at the beginning of treatment (P<0.05), at the end of treatment the VAS scores (F=59.400, P<0.001) and of the ODI scores (t=12.737, P<0.001) of ultrasonic and sling exercise therapy group was lower than the other group, the difference is significantly.

All three groups could reduce pain and improve lumbar function, and the ultrasonic and sling exercise therapy was most effective for lumbar disc herniation treatment in the three groups.

To analyze the treatment of different types of traumatic cerebral infarction in children, and explore its pathogenesis in combination with literature so as to improve the cure rate and reduce disability rate.

The clinical data of 42 cases of traumatic cerebral infarction in children were retrospectively analyzed in The Hospital of 81^st Group Army PLA from January 2015 to December 2019. The diagnosis of traumatic cerebral infarction in children was made by CT scan and MRI scan. According to different conditions, children with traumatic cerebral infarction were classified, and different treatment strategies were selected. Children with lacunar infarction were treated with calcium antagonists and neurotrophic drugs, supplemented by hyperbaric oxygen and exercise rehabilitation. The children of focal cerebral infarction and complex cerebral infarction treated by junior dehydrant and hormone also included the calcium antagonist and nutritional nerve drugs. The therapeutic regimen perhaps adjusted by the evolution of the disease. The children of extensive cerebral infarction underwent emergency cranial decompression, and was treated by reducing intracranial pressure and preventing complications after operation. The treatment results and recovery were observed.

In 42 cases of traumatic cerebral infarction in children, 35 cases (83.3%) were good recovery, 4 cases (9.5%) were moderate disability, 2 cases (4.8%) were severe disability, 1 case (2.4%) died, and no vegetative state. The good recovery rate of lacunar infarction was 100%, that of focal cerebral infarction was 62.5%, that of mixed cerebral infarction was 60%, and that of extensive cerebral infarction was 50%.

It is of great significance to improve the therapeutic effect and prognosis of children with traumatic cerebral infarction to adopt different treatment schemes for different types of cerebral infarction.

To characterize the patients with supratentorial hypertensive intracerebral hemorrhage (ICH) in the Tibetan Plateau over an altitude of 4000 meters.

A total of 68 cases with supratentorial hypertensive ICH were retrospectively included in Ali Regional People’s Hospital from January 2017 to September 2018. The clinical and laboratory data were collected. A simple linear correlation analysis was applied to analyze the correlation between the amount of bleeding and sex, age, nationality, time from onset , systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum triglyceride (TG), and cholesterol. According to computed tomography (CT) findings, 68 cases were divided into the basal ganglia ICH group (33 cases) and the lobar ICH group (35 cases). The characteristics between two groups were analyzed using t-test or χ² test.

The data of sex, age, nationality, time from onset, SBP, DBP, Hb, TG, and cholesterol of 68 cases on admission did not show any definitive correlation with the hematoma volumes (P＞0.05). The SBP and DBP of patients in the basal ganglia ICH group were significantly higher than that in the lobar ICH group, respectively [(184.9±28.5) mmHg vs (164.6±24.4) mmHg; (113.0±18.1) mmHg vs (103.0±18.4) mmHg] (t=0.499, 0.486; P=0.002, 0.033).

The relevant factors of hematoma volumes in patients with ICH in plateau area were not yet clear. Diastolic and systolic blood pressure of patients in the basal ganglia ICH group was higher than that in those in lobar ICH group.

To compare the efficacy evaluation of electrospun composite biomaterials and a porcine small intestine submucosa mesh for hernia repair.

A randomized, single-blind, controlled multicenter trial was performed in 3 hospitals in Shanghai. Eligible adult patients with primary unilateral reducible groin hernias were randomly assigned (1∶1) to electrospun composite biomaterials (experimental group) or porcine small intestine submucosa (control group) mesh groups. Patients were treated with the tARB technique and assessed at 1,3 and 6 months after the surgery. The primary endpoint was hernia recurrence. The secondary endpoints were postoperative complications including groin pain and operative site infections.

172 patients were assigned to experimental (n=86) and control (n=86) groups. At 6 months follow-up, postoperative complications occurred in 5 patients (5/86, 5.95%) and 2 (2/86, 2.35%) patients in the control and experimental groups, respectively (P>0.05). There was no significant difference in VAS or SVS score between the two groups.

We demonstrate that electrospun composite biomaterial mesh can be used as a ideal choice for inguinal hernia repair. Electrospun composite biomaterial has the characteristics of low recurrence rate, absorbability and long-term comfort.It can be further applied in clinical practice in the future.

Pancreaticoduodenectomy(PD)remains one of the most complicated hepatobiliary operations. The development of minimally invasive surgery for PD has always been an hot spot. Laparoscopic pancreaticoduodenectomy(LPD) has not been widespread carried out due to its difficulty and long learning curve. LPD accounts for 9% of all PD, according to the National Cancer Data base. Compared with laparoscopic surgery, robotic surgery system has significant advantages in the field of minimally invasive PD, including stereotactic amplified vision, filtering hand tremor and simulating the wrist. The article would review the surgical techniques and notes, which could provide clinical reference for other surgeons.

Liver cirrhosis can cause multiple severe complications, including portal hypertension-induced hypersplenism and oesophageal variceal bleeding. In recent years, with widespread application of different treatments such as drug therapy, splenic artery embolization and transjugular intrahepatic portosystemic shunt, the role of surgical resection in the management of portal hypertension has been gradually weakened. However, combined with the actual clinical situation in China, splenectomy, as the main surgical treatment for portal hypertension, is still of significance, which can not be completely replaced by alternative options.Splenectomy combined with selective pericardial devascularization is the most common procedure to treat hypersplenism and oesophageal variceal bleeding caused by portal hypertension, which has been widely applied in Chinese hospitals at all levels and saved the lives of patients. However, complications post-splenectomy limit further improvement in the quality of life of patients with portal hypertension. In this review, the complications after splenectomy were systematically analyzed, aiming to provide theoretical basis for refined management of patients with portal hypertension.

As a novel type of post-translational modification, protein lactylation has captivated extensive attention in the field of tumor biology in recent years. Hepatobiliary and pancreatic tumors are a type of malignant tumors in the digestive system with high incidence and poor prognosis. The complicated mechanism of incidence and development remains to be urgently unraveled. By regulating the metabolic reprogramming of tumor cells, promoting cell proliferation and mediating immune escape, protein lactylation has gradually become an important breakthrough point to understand the biological characteristics of hepatobiliary and pancreatic tumors. In this article, the molecular mechanism and detection methods of protein lactylation were systematically reviewed. The functional role and the potential of clinical application in hepatobiliary and pancreatic tumors were highlighted. Combined with the latest research progress, the challenges and future development trends in this field were illustrated, aiming to provide theoretical basis and novel ideas for optimizing basic research and clinical treatment strategies.

To explore the early efficacy of muscle energy technique in reverse total shoulder arthroplasty (RTSA).

The patients after RTSA with intact deltoid muscle and no axillary nerve or brachial plexus injury were enrolled, while the patients with incision site infection were excluded. Twenty-eight patients who underwent RTSA in Guangzhou Red Cross Hospital from October 2021 to December 2024 were randomly divided into the observation group (14 cases) and the control group (14 cases). Both groups received conventional rehabilitation treatment, while the observation group was additionally treated with muscle energy technique. The American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score of the patients were statistically analyzed at the first day, two and six weeks after surgery. Independent sample t test was used for data analysis.

On the first day after surgery, there was no statistically significant difference in the baseline ASES and UCLA scores between the two groups (P>0.05), indicating that the baseline data of the two groups were comparable. Two weeks after surgery, ASES score was 41.4±5.3 in the observation group while 38.1±6.1 in the control group, no statistically significant difference was observed (P>0.05). The UCLA score of the observation group was 18.3±2.4, which was significantly higher than 15.9±2.4 of the control group (t=2.670, P<0.05). Six weeks after surgery, the ASES score was 51.4±6.1 and UCLA score was 26.4±2.8 in the observation group, which were higher than 46.7±5.9 and 23.8±3.1 in the control group with statistically significant differences (ASES: t=2.110, UCLA: t=2.320, all P<0.05).

The use of muscle energy technique in the early stage of RTSA can achieve good clinical results.

Exploring the clinical characteristics of humeral lateral condyle fracture combined with elbow dislocation in children and the guiding value of classification based on the relative width of fracture fragments for diagnosis and treatment.

A retrospective analysis was performed on the clinical data of 19 patients with lateral humeral condyle fractures (LHCF) complicated by elbow dislocation admitted to the Department of Orthopedics, Children’s Hospital of Soochow University, from August 2021 to October 2024. Inclusion criteria: age <16 years, imaging-confirmed diagnosis, and complete follow-up records. Exclusion criteria: open fractures, severe multiple trauma, pathological fractures, and a history of prior elbow deformity or surgery. Patients were divided into two groups based on the ratio of the fracture fragment’s transverse diameter to the width of the lateral humeral condyle. The structural instability (SI) group (n=14) consisted of cases with a mean relative width >50%, while the ligamentous instability (LI) group (n=5) consisted of cases with a mean relative width <20%. Independent samples t tests, Mann-Whitney U tests, and Fisher’s exact tests were utilized to compare the differences between the two groups in terms of baseline characteristics, dislocation mechanisms, imaging features, treatment priorities, and clinical outcomes.

There were no statistically significant differences between the two groups in terms of gender, age, injury side, time from injury to hospitalization, neurovascular injury, and length of hospital stay (all P>0.05). Significant differences in imaging characteristics were observed between the two groups: fractures in the SI group involved the epiphyseal plate and articular surface, while fractures in the LI group were confined to the metaphysis or the lateral aspect of the epiphyseal plate, with the articular surface remaining intact. Treatment strategies also differed between the groups: all patients in the SI group underwent surgery to restore articular anatomy and bony stability, including four cases of closed reduction and 10 cases of open reduction, with four cases supplemented by elbow arthrography. In the LI group, three patients with small fracture fragments, minimal displacement, and stable joints received conservative treatment, while two patients with radial collateral ligament injuries underwent surgical ligament repair. No statistically significant difference in postoperative Mayo score and Hospital for Special Surgery (HSS) score was found between the two groups (all P>0.05), and both achieved 100.0% excellent and good rate. None of the patients experienced complications such as nonunion, delayed union, avascular necrosis of the distal humerus, or elbow deformity.

The SI/LI classification, based on the average relative width of fracture fragments, effectively distinguishes between two primary injury patterns: structural instability and ligamentous instability. This classification offers significant guiding value for radiologic assessment and the selection of targeted treatment strategies. All the patients included in this study achieved excellent clinical outcomes following the specific interventions tailored to their respective injury patterns.

To investigate the clinical efficacy of absorbable screws combined with quadratus femoris muscle pedicle bone flap transplantation in the treatment of osteonecrosis of the femoral head (ONFH).

A retrospective analysis was performed on 54 patients with ONFH. The patients with ARCO stage Ⅱ or ⅢA, and aged from 16 to 55 years were included. The patients with surgery history at involved side hip, severe osteoporosis or infections were excluded. The treatment group (n=20) underwent absorbable screw fixation combined with quadratus femoris bone flap transplantation; the control group (n=34) received traditional bone flap implantation. Continuous variables were described as

The treatment group presented longer operative time (1.42±0.21) h and more blood loss (95.70±10.20) ml than the control group (75.40±8.60) ml (t=13.251, 8.076, both P<0.001). Femoral head recovery rate was 80.0% in the treatment group which was higher than 52.9% in the control group (χ²=3.954, P<0.05). Necrosis rate was 5.0% in the treatment group which was lower than 29.4% in the control group (χ²=4.626, P<0.05). Harris excellent-good rate was 85.0% in the treatment group which was higher than 58.8% in the control group (χ²=4.105, P<0.05). Digital subtraction angiography showed higher microcirculation reconstruction rate in the treatment group than the control group (72.5% vs 43.9%) (χ²=4.378, P<0.05 ). The overall Harris hip function recovery rate was also higher in the treatment group (χ²=4.105, P<0.05).

This combined technique is effective for ONFH, yielding satisfactory improvement in femoral head blood supply and hip function.

To monitor the impact of extracorporeal shock wave therapy on the blood supply and microcirculation of the femoral head in patients with early-to-mid-stage osteonecrosis of the femoral head (ONFH) using musculoskeletal ultrasound and T2-weighted MRI for verification, so as to provide clinical data for the treatment of ONFH with shock waves.

Sixty patients diagnosed with osteonecrosis of the femoral head (ONFH) (ARCO stageⅠto Ⅲ A) in Shock Wave Therapy Center of Ningxia Hui Autonomous Region People’s Hospital were randomly divided into the medication treatment group (medication group) and the shockwave treatment group (shockwave group) using a computer-generated block randomization scheme. Inclusion criteria: patients diagnosed with ONFH, Association Research Circulation Osseous (ARCO) stages Ⅰto Ⅲ A (collapse <2 mm). Exclusion criteria: abnormal coagulation function, thrombosis in the treatment area, severe cognitive impairment, severe arrhythmia, pregnancy, local infection, etc. VAS score was assessed before treatment, after shockwave treatment (within one week), and at three, six and nine months after treatment to analyze inter-group differences and observe treatment efficacy. Musculoskeletal ultrasound examinations were performed in the shockwave group before and after treatment to record data such as blood flow resistance index (RI), vascular filling, and peak systolic velocity (PSV) of the medial and lateral circumflex femoral arteries, lateral femoral ascending branch, transverse branch, and descending branch on the affected side. MRI was used to verify the regression of edema and changes in the necrotic zone, confirming the treatment outcome. Shapiro-Wilk test was performed to evaluate normality. Measurement data were described as

There was no statistically significant difference in baseline data between the two groups before treatment (all P>0.05). Both the shockwave group and the conventional medication group showed significant pain relief after treatment. Although the onset of action in the shockwave group was slower, it had a longer duration of efficacy. The analgesic effect of the shockwave group was significantly better than that of the medication group in the later stages. Six and nine months after treatment, VAS scores in the shockwave group (2.7±1.2, 3.0±1.3) were lower than those in the medication group (4.0±1.1, 4.6±1.3), with statistically significant differences (t=4.12, 4.68, both P<0.05). Three and six months after treatment, musculoskeletal ultrasound examination of the five arteries related to the femoral head showed increased flow velocity and decreased vascular resistance, indicating a significant increase in blood flow in the femoral head of patients treated with shockwaves. Musculoskeletal ultrasound at three and six months after treatment in the shockwave treatment group showed a significant increase in PSV of the medial circumflex femoral artery, lateral circumflex femoral artery, and their branches compared to before treatment (all P<0.01), with a significant decrease in RI (all P<0.05), indicating improved blood flow. MRI T2-weighted imaging in six and 12 months after treatment showed reduced edema zone signals, with no significant changes in the hypointense zone, suggesting improvement in venous stasis or no significant increase in the necrotic area of the femoral head after shockwave treatment.

Extracorporeal shock wave therapy has significant therapeutic effects on patients with ONFH in ARCO stagesⅠ, Ⅱ, and some cases of stage Ⅲ A. The pain relief effect is superior to or at least comparable to that of the drug treatment group. Shock wave therapy can effectively improve the blood supply of the femoral head, increasing blood flow velocity and reducing vascular resistance in all five relevant vessels. MRI suggests that extracorporeal shock wave therapy stabilizes the condition of patients with ONFH in ARCO stagesⅠand Ⅱ, delaying the need for surgical intervention. Shock wave therapy for the femoral head in ARCO stagesⅠand Ⅱ has demonstrated good clinical outcomes and is worth promoting.

To evaluate the corrective effect of direct anterior approach total hip arthroplasty (DAA-THA) on leg length discrepancy (LLD) and pelvic obliquity (PO) in patients with developmental dysplasia of the hip (DDH), and to analyze the factors influencing improvement.

A retrospective analysis was conducted on 111 patients with DDH of Crowe typeⅠ-Ⅳ who underwent unilateral DAA-THA in Nanjing Drum Tower Hospital between January 2018 and June 2024. Inclusion criteria: radiologically confirmed DDH, primary unilateral DAA-THA, and complete imaging data. Patients with hip or lumbar surgery history, severe trauma, or other conditions affecting pelvic or lower limb alignment were excluded. The cohort included patients aged 42-84 years with a body mass index (BMI) of 18.7 to 34.0 kg/m²; 50 cases were left-sided (45.0%) and 61 were right-sided (55.0%). According to Crowe classification, 89 cases were type Ⅰ (80.2%), 15 cases of type Ⅱ (13.5%), five cases of type Ⅲ (4.5%), and two cases of type Ⅳ (1.8%). LLD, PO, and sacro-femoral-pubic (SFP) angle were measured on standardized anteroposterior pelvic radiographs. Data before and after operation were compared, and subgroup analyses were performed according to Crowe classification. Statistical analyses included paired t test, Mann-Whitney U test, and multivariate linear regression.

All the patients were followed for 2.0 (0, 6.0) months. The mean age was (60±11) years, and mean body mass index (BMI) was (25±5) kg/m². Median disease duration was 84 (36, 120) months. After surgery, LLD decreased from 9.0 (5.3, 17.3) mm to 7.9 (3.6, 12.8) mm (Z=−3.874, P<0.001). PO decreased from 2.5 (1.7, 4.2)° to 2.3 (1.2, 4.2)° (Z=−2.294, P=0.022). The SFP angle increased from 62.0 (58.0, 64.9)° to 67.2 (63.1, 71.8)° (Z=−8.358, P<0.001). In subgroup analysis, the LLD change was 4.25 (−2.93, 8.70) mm in the patients of Crowe typeⅠ-Ⅱ and 11.73 (3.31, 29.60) mm in the patients of Crowe type Ⅲ-Ⅳ, while PO change was 0.40 (−1.00, 1.80)° in Crowe typeⅠ-Ⅱ and 1.90 (0.10, 2.70)° in Crowe type Ⅲ-Ⅳ, none of the difference was statistically significant (U=231.0, 263.0, both P>0.05). Multivariate regression showed that preoperative LLD was an independent predictor of LLD correction [β=0.867, 95% confidence interval (CI) (0.723, 1.010), P<0.001]. In the PO model, intraoperative blood loss [β=−0.104, 95% CI (−0.198, −0.010), P=0.030] and BMI [β=0.156, 95% CI (0.046, 0.266), P=0.006] were significant predictors. In the SFP model, preoperative SFP angle (β=−0.241, 95% CI (−0.428, 0.055), P=0.012) and Crowe classification [β=0.296, 95% CI (0.110, 0.481), P=0.002] were independently associated with improvement.

DAA-THA effectively improves LLD and sagittal pelvic alignment in DDH. However, correction of PO shows a improvement trend with no statistically significant difference. DDH of Crowe type Ⅲ-Ⅳ demonstrates greater improvement in SFP angle compared with Crowe typeⅠ-Ⅱ. Preoperative LLD is the primary predictor of LLD correction, while PO correction is influenced by preoperative PO, BMI, and intraoperative blood loss. SFP angle improvement is associated with preoperative SFP angle and Crowe classification. DAA-THA provides favorable short-term radiographic outcomes, but further large-scale studies with longer follow-up are required to confirm long-term efficacy.

To explore the application effect of three dimensional (3D) printed custom osteotomy guide combined with 3D animation guidance in total knee arthroplasty (TKA) for diabetic patients, and to evaluate its impact on postoperative motor function and clinical efficacy.

A prospective randomized controlled trial was conducted. Inclusion criteria: diabetes duration more than five years; knee osteoarthritis of Kellgren-Lawrence grade Ⅲ to Ⅳ; age from 50 to 75 years, body mass index (BMI) 20 to 30 kg/m²; glycated hemoglobin (HbA1c) ≤8.5%. Exclusion criteria: severe vital organs dysfunction; periarticular infection of the knee joint; history of knee surgery or joint deformity; psychiatric disorders or cognitive impairment; allergy to 3D printing materials. A total of 180 diabetic patients with end-stage knee osteoarthritis who met the inclusion criteria were enrolled. They were divided into the observation group (90 cases) and the control group (90 cases) by random number table. The control group underwent TKA using traditional metal osteotomy guides, while the observation group received TKA with 3D-printed custom osteotomy guides combined with 3D animation-assisted surgery and rehabilitation guidance. The two groups were compared by t test, repeated measurement analysis of variance or chi square test in terms of surgery-related indicators (operation time, intraoperative blood loss, incision length, incidence of complications), imaging indicators such as hip-knee-ankle angle (HKA) deviation, differences between prosthetic angles and preoperative planning, knee range of motion (ROM), walking and balance function, and pain visual analogue scale (VAS), Knee Society score (KSS), blood glucose fluctuation.

Regarding the discrepancy between prosthesis angles and preoperative planning, the observation group exhibited significantly lower deviations from preoperative planning in the femoral-tibial angle (FTA), femoral flexion-extension angle (FFE), tibial lateral condylar angle (LTC), and femoral lateral condylar angle (LFC) compared to the control group, with statistically significant intergroup differences (t=5.495,6.524,7.631,4.842, all P<0.01). Knee joint ROM comparison at different time points showed that ROM in both groups exhibited an upward trend over time at one week, one month, and three months after surgery, with statistically significant temporal effects (F=428.615, P<0.001). ROM in the observation group was significantly higher than that in the control group at all the time points, with statistically significant intergroup effects (F=106.932, P<0.001). There was an interaction effect between group and time, with the observation group demonstrating superior ROM improvement (P<0.001). Three months after surgery, the observation group achieved longer distances on the six-minute walk test (6MWT) and shorter durations on the timed standing-up-walking test (TUGT) compared to the control group, with statistically significant intergroup differences (t=11.567,10.892, all P<0.001). The Berg balance scale (BBS) score in the observation group was significantly better than that in the control group (Z=-4.826, P<0.001).

Three dimensional-printed custom osteotomy guide combined with 3D animation guidance can improve the surgical accuracy of TKA in diabetic patients, reduce trauma and complications, promote postoperative motor function recovery, and enhance clinical efficacy, providing an optimized "surgery-rehabilitation" integrated solution for this population.

To investigate the differences in CT and MRI indicators between patients with knee osteoarthritis (KOA).

From April 2024 to September 2025, a total of 46 patients diagnosed with KOA and history of knee pain, aged from 40 to 80 years at the First Affiliated Hospital of Guangzhou Medical University were enrolled as the research subjects.The patients with knee infection, severe vital organs diseases, hemoragic tendency, etc. were excluded. According to the visual analogue scale (VAS) score, the patients were divided into two groups: the high-score group (VAS scoreequal or over three, n=23) and the low-score group (VAS scoreless than three, n=23). The Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores, as well as CT and MRI imaging indicators, were compared between the two groups using independent samples t test or Mann-Whitney U test, as appropriate.

The high-score group showed significantly higher scores in pain, stiffness, functional activity, and total WOMAC score than the low-score group (Z=-6.213, -4.550, -6.067, -6.066, all P<0.01). CT image findings: when the knee joint was flexed at 50 degrees, there was a significant difference in the patellar tilt angle (PTA) between the high-score group and the low-score group (Z=-2.169, P<0.05). MRI findings: the high-score group had higher scores than the low-score group in the following aspects: the percentage of cartilage defects in the corresponding area, the percentage of full-thickness cartilage defects in the corresponding area, osteophytes, meniscal signal abnormalities, and periarticular soft tissue signs (Z=-2.256, -2.070, -1.975, -3.238, -2.220, all P<0.05).

Patients in the high pain score group have significantly more severe knee joint dysfunction than those in the low pain score group. Meanwhile, imaging findings indicate that the level of pain score is associated with the narrowing of PTA when the knee joint is flexed at 50 degrees, as well as the severity of articular cartilage damage, osteophytes, meniscal degeneration, and periarticular soft tissue lesions.

To construct a differential diagnosis model for musculoskeletal ultrasound (MSUS)signs in patients with gouty arthritis (GA) and rheumatoid arthritis (RA).

A total of 180 patients from the Department of Rheumatology and Immunology of Xuzhou First People’s Hospital between January 2020 and May 2025 were selected. Inclusion criteria: age between 18 and 75 years old; present with typical symptoms of arthritis such as joint pain and swelling; Patients can cooperate to complete musculoskeletal ultrasound examination. Exclusion criteria: complicated with other types of arthritis, such as infectious arthritis, reactive arthritis, etc.; severe functional disorders of important organs like heart, liver, and kidney; pregnant or lactating women. Based on diagnostic results, they were divided into the GA group (n=92) and the RA group (n=88). High-frequency musculoskeletal ultrasound was used to detect synovial thickness, blood flow signals, bone erosion, the double-contour sign, and tophi. Differences in ultrasound findings between the two groups were compared by independent t test. Multivariate logistic regression and receiver operating characteristic (ROC) curve analysis were employed to evaluate the differential diagnostic performance of the ultrasound signs.

There were statistically significant differences between the two groups in terms of age (t=2.916), gender (χ²=17.370), body mass index (BMI) ( t=5.427), knee joint (χ²=4.447), toe joint involvement rate (χ²=13.310), wrist joint (χ²=11.117), shoulder joint involvement rate (χ²=5.692), double-track sign (χ²=59.732), punctate hyperechoic area (χ²=34.567), positive rate of gout stones (χ²=46.075), bone erosion depth (t=6.640), synovial hyperplasia (t=8.586), joint cavity effusion (t=9.164), blood flow signal over level two (χ²=17.759), and cartilage destruction (χ²=10.940) ( all P<0.05). Multivariate logistic regression analysis revealed that bone erosion [odds ratio (OR)=7.655, β=2.035], joint cavity effusion (OR=6.323, β=1.844), blood flow signal (OR=4.791, β=1.567), gender (OR=7.202, β=1.974), and BMI (OR=0.684, β=-0.38) (all P<0.05) were independent influencing factors for GA and RA. Additionally, ROC results demonstrated that the combined model of double-track sign, punctate hyperechoic, and tophus in GA differentiation had an area under the curve (AUC) of 0.921, with sensitivity of 82.4% and specificity of 94.3%. For RA differentiation, the combined model of bone erosion and joint cavity effusion had an AUC of 0.882, with sensitivity of 78.4% and specificity of 87.0%. The combined diagnostic models exhibited good diagnostic efficacy.

Musculoskeletal ultrasound signs are valuable in the differentiation between GA and RA, and the combination of characteristic signs such as double-track sign and gout stone can improve the diagnostic efficacy of GA, while bone erosion and joint cavity effusion are significant in the differentiation of RA.

To explore the mechanism of synovial macrophage-derived hepcidin and iron exporter protein (FPN1) in chondrocyte ferroptosis of knee osteoarthritis (KOA).

Animal experiment: 24 SD rats of six to eight weeks old were selected and randomly divided using a random number tableinto the sham operation group (the sham group) and the modified-Hult surgery (M-Hult) group (the surgical group), 12 rats in each group. The sham group only incised the joint capsule, while the M-Hult group established a model of KOA. After the model was successful, enzyme linked immunosorbent assay (ELISA) was used to detect the changes in hepcidin expression in rat serum. Micro-CT was employed to observe the morphological and structural changes of the rat knee joints. Hematoxylin-eosin (HE) staining, toluidine blue staining and safranin O/fast green violet staining were used to observe the morphological changes of the knee joint cartilage tissue. Immunohistochemistry was used to detect the expression of hepcidin, matrix metalloproteinase (MMP3) and type Ⅱ collagen (Col2a1) in the knee joint synovium of rats. Immunofluorescence technique was used to detect the expression of glutathione peroxidase 4 (GPX4) and nuclear factor erythroid 2-related factor 2 (NRF2) in the knee joint cartilage. Cell experiment: RAW264.7 cells were treated with interleukin ( IL)-6 to investigate the optimal time and concentration for IL-6 to induce the secretion of hepcidin by macrophages; the supernatant obtained after IL-6 intervention on RAW264.7 cells was used to intervene chondrocytes, and the expression of FPN1 in chondrocytes was observed; the chondrocytes were divided into blank control group, model group (hepcidin treated), and positive control group (erastin treated). The changes in chondrocytes were directly observed, the effect of hepcidin in macrophages on FPN1 in chondrocytes was detected by western blot, the expression of redox-related factor reactive oxygen species (ROS) was detected by immunofluorescence technology, and the oxidative-reductive indicators were detected using glutathione/glutathione disulfide (GSH/GSSG), MDA, and SOD kits. Single factor variance analysis and t test were performed for data analysis.

Compared with the sham group, the knee osteoarthritis model rats in the surgical group showed significant pathological changes in their knees: micro-CT revealed that the joint space in the model group narrowed, bone spurs formed, and the bone volume fraction (t=5.069, P<0.001), trabecular number (t=4.225, P<0.05), and thickness (t=5.879, P<0.001) significantly decreased, while the trabecular separation (t=2.691, P<0.01) increased, and the bone microstructure was severely damaged. Compared with the sham group, the osteoarthritis score in the surgical group was significantly elevated (t=7.778, P<0.001). Cartilage tissue staining revealed disorganized layers, sparse cell arrangement, and matrix fissure formation. Meanwhile, the expression of Col2a1 decreased (t=4.931, P<0.001), the expression of MMP3 upregulated (t=17.35, P<0.001), and a substantial loss of proteoglycans was observed. In the serum and synovial tissue of the model group rats, the expression of hepcidin significantly increased, while the expression of the iron export protein FPN1 in the cartilage tissue significantly down regulated (t=10.67, P<0.001). The expression levels of the ferroptosis core inhibitor GPX4 (t=15.93, P<0.001) and the antioxidant transcription factor NRF2 (t=14.26, P<0.001) in cartilage tissue were significantly decreased. Cell experiments demonstrated that 10 μg/L IL-6 could efficiently induce high expression of hepcidin in RAW264.7 cells, and its 10% conditioned medium could significantly inhibit the expression of FPN1 in chondrocytes. After hepcidin intervenes with chondrocytes, ROS accumulation occurs, the GSH/GSSG ratio decreases (F=395.1, P<0.001), the expression level of MDA increases (F=181.7, P<0.001), and the activity of SOD decreases (F=1160, P<0.001).

Hepcidin derived from synovial macrophages inhibits the function of FPN1 in chondrocytes, which triggers iron accumulation in chondrocytes, thereby activating the oxidative stress-lipid peroxidation pathway, and ultimately inducing ferroptosis of chondrocytes in KOA.

Osteoarthritis (OA) is the most common chronic degenerative joint disease in clinical practice. Its core characteristics include progressive degradation of articular cartilage, abnormal remodeling of subchondral bone, and synovial inflammation; to date, there remains no curative treatment. Autophagy, as a core degradation mechanism for maintaining intracellular homeostasis, plays a crucial role in the pathogenesis and progression of OA due to its functional dysregulation. It exhibits dynamic, phasic, and bidirectional regulatory characteristics throughout the OA process, and abnormalities in its activity directly affect the survival status of chondrocytes. This article systematically reviewed the multilevel interactive regulatory network of autophagy in OA, focusing on the mTOR-centered signaling pathway, key molecular nodes such as forkhead box O (FoxO)/silent mating type information regulation 2 homolog (SIRT)/hypoxia inducible factor (HIF), as well as the epigenetic regulatory roles of non-coding RNAs and exosome-mediated intercellular communication mechanisms, thereby providing a systematic theoretical basis for precision-targeted autophagy-based therapies for OA.