Telomere length (TL), mitochondrial DNA copy number (mtDNAcn), and DNA methylation age (DNAmAge) are common aging biomarkers. However, research on the associations between these three markers at birth and subsequent metabolic status was limited. This study aimed to evaluate the association between TL, mtDNAcn, and DNAmAge in newborns and the variation in metabolic hormones of children at 3 years old. This research involved 895 mother-child pairs from a birth cohort in China, with TL and mtDNAcn measured using quantitative real-time PCR, DNA methylation (DNAm) assessed using Infinium MethylationEPIC Beadchip, and DNAm age (DNAmAge) determined using Horvath's epigenetic clock. Insulin and leptin levels were measured via electrochemiluminescence assay. Multivariable adjusted linear regression and restricted cubic spline (RCS) analysis were utilized to examine the association between aging markers and metabolic hormones. The linear regression analysis indicated the percentage change of metabolism hormones for per doubling of aging biomarkers alterations and found significant associations between DNAmAge and insulin levels (adjusted percent change (95% CI), - 13.22 (- 23.21 to - 1.94)), TL and leptin levels (adjusted percent change (95% CI), 15.32 (1.32 to 31.24)), and mtDNAcn and leptin levels (adjusted percent change (95% CI), - 14.13 (- 21.59 to - 5.95)). The RCS analysis revealed significant non-linear associations between TL (Ln transformed) and insulin (Ln transformed) (P = 0.024 for nonlinearity), as well as DNAmAge (Ln transformed) and leptin (Ln transformed) (P = 0.043 for nonlinearity). Specifically, for TL and insulin, a positive association was observed when TL (Ln transformed) was less than - 0.05, which transitioned to an inverse association when TL (Ln transformed) was greater than - 0.05. Regarding DNAmAge and leptin, there was a sharp decline when DNAmAge (Ln transformed) was less than - 1.35, followed by a plateau between - 1.35 and - 0.67 and then a further decline when DNAmAge (Ln transformed) was greater than - 0.67. In this prospective birth cohort study, variation in metabolic hormones of children at 3 years old was associated with TL, mtDNAcn, and DNAmAge at birth. These findings suggested that TL, mtDNAcn, and DNAmAge might play a role in the biological programming of metabolic health from birth.
Recurrent Patellar Dislocation (RPD) is a common knee sports injury, mainly affecting pediatric and adolescent populations, posing a significant challenge in orthopedic clinical practice. Although a variety of treatments have been reported, and many of them have shown good initial results, there is a lack of long-term follow-up results. Each treatment method has its own unique characteristics and limitations, and there is no standardized and unified treatment plan. This article provides a comprehensive review of current treatments for RPD. We believe that regardless of the surgical method used, patellar dislocation should not occur at 0°-90° of postoperative knee flexion and extension, and the range of motion should not be limited. Our ultimate goal is to restore patellar stability and improve lower limb alignment, thereby restoring knee function as much as possible. In addition, future treatment options for RPD are also discussed. In the future, there should be more in-depth research on the risk factors and pathogenesis that lead to recurrent patellar dislocation, as well as more randomized controlled trials focusing on different treatment methods. A comprehensive understanding of these is crucial for implementing preventive measures and developing targeted treatment strategies. The goal of this narrative review is to offer clinicians a deeper understanding of RPD treatment, enhance clinical decision-making skills, and encourage personalized and efficient management of RPD treatment.
Background: For patients with osteoporosis and rotator cuff tears, there is still no consensus on current treatment methods. The material, structure, and number of anchors have important effects on the repair outcome. Purpose: To investigate the use of chitosan quaternary ammonium salt–coated nickel-titanium memory alloy (NTMA) anchors to treat rotator cuff injury in shoulders with osteoporosis in a rabbit osteoporosis model. Study Design: Controlled laboratory study. Methods: A novel winged NTMA anchor was designed to test in normal and osteoporotic bone models in vitro. These models were assessed for maximum failure load and bone damage in various traction directions. A chitosan–sodium alginate composite was coated onto NTMA anchor surfaces using glutaraldehyde cross-linking and electrostatic layering techniques. An osteoporotic rabbit model was created using ovariectomy combined with glucocorticoid treatment. A rabbit model with acute injury to the supraspinatus muscle was established and repaired using titanium alloy anchors, NTMA anchors, and coated NTMA (CNTMA) anchors. To evaluate the efficacy of the anchors, biomechanical testing and staining with hematoxylin and eosin were performed 6 and 12 weeks after surgery. A micro–computed tomography scan was performed 12 weeks after surgery. Results: In the osteoporotic bone model, NTMA anchors exhibited greater failure loads than titanium anchors under 45° and 90° traction forces ( P < .05). The surface-modified material showed a lower contact angle compared with unmodified material. Cell Counting Kit-8 (CCK-8) assays showed that the composite coating promoted osteoblast proliferation. The CNTMA anchor group exhibited the greatest maximum failure load at each time point. Hematoxylin and eosin staining revealed greater trabecular thickness in the CNTMA anchor group than in the other groups at 6 and 12 weeks after surgery. At 12 weeks after surgery, micro–computed tomography revealed an increased number and thickness of bone trabeculae in the NTMA anchor group, along with a widened trabecular gap ( P < .05). After the NTMA anchor biplane unfolded, the gap between the biplane and anchor showed bone tissue growth. Conclusion: Chitosan quaternary ammonium salt–coated NTMA anchors enhanced fixation strength and promoted local osteogenesis during osteoporotic rotator cuff repair, suggesting that the use of these anchors facilitates the repair of osteoporotic rotator cuff injuries in osteoporotic bones. Clinical Relevance: Innovations in anchor nailing may be effective in reducing rates of repair failure for rotator cuff tears combined with osteoporosis.
Tendon-bone insertion (TBI) injuries are common, primarily involving the rotator cuff (RC) and anterior cruciate ligament (ACL). At present, repair surgery and reconstructive surgery are the main treatments, and the main factor determining the curative effect of surgery is postoperative tendon-bone healing, which requires the stable combination of the transplanted tendon and the bone tunnel to ensure the stability of the joint. Fibrocartilage and bone formation are the main physiological processes in the bone marrow tract. Therefore, therapeutic measures conducive to these processes are likely to be applied clinically to promote tendon-bone healing. In recent years, biomaterials and compounds, stem cells, cell factors, platelet-rich plasma, exosomes, physical therapy, and other technologies have been widely used in the study of promoting tendon-bone healing. This review provides a comprehensive summary of strategies used to promote tendon-bone healing and analyses relevant preclinical and clinical studies. The potential application value of these strategies in promoting tendon-bone healing was also discussed.
Objective
To analyze the factors influencing the incidence of refracture after surgery for femoral shaft fracture in children and put forward their countermeasures.
Methods
A retrospective study was conducted in the children who had been treated at Department I of Pediatric Orthopaedics, Zhengzhou Orthopaedic Hospital from September 2013 to May 2017 for primary femoral shaft fracture or refracture after surgery for femoral shaft fracture. Their clinic data were collected concerning age, gender, height, weight, primary fracture, treatment protocol, time for removal of fixation, time and site of refracture, and violence for refracture. The likely factors associated with refracture were identified by comparing the gender ratios, age distributions and primary fractures between the children with primary fracture and those with refracture, and by comparing the proportions of overweight and obese ones between the children with refracture and their normal counterparts.
Results
A total of 278 children, with a male to female ratio of 2.43∶1, were treated for primary femoral shaft fracture while 22 children, with a male to female ratio of 0.83∶1, for refracture contemporarily. In the children with primary fracture and those with refracture, respectively, there were 172 (61.9%) cases and 2 cases (9%) aged from 0 to 4 years, 85 cases (30.6%) and 10 cases (45.5%) aged from 5 to 9 years, 21 cases (7.5%) and 10 cases (45.5%) aged from 10 to 14 years. There were significant differences between the 2 groups in gender ratio and proportions of age (P 0.05).
Conclusions
Refracture after surgery for femoral shaft fracture in children may be closely associated with their gender, age and overweight. Care should be taken to avoid refracture in children with high risks.
Key words:
Femoral fractures; Risk factors; Child; Sex factors; Body weight
Osteoporosis (OP) is a widespread age-related disorder marked by decreased bone density and increased fracture risk, presenting a significant public health challenge. Central to the development and progression of OP is the dysregulation of the mechanistic target of the rapamycin (mTOR)-signaling pathway, which plays a critical role in cellular processes including autophagy, growth, and proliferation. The mTOR-autophagy axis is emerging as a promising therapeutic target due to its regulatory capacity in bone metabolism and homeostasis. This review aims to (1) elucidate the role of mTOR signaling in bone metabolism and its dysregulation in OP, (2) explore the interplay between mTOR and autophagy in the context of bone cell activity, and (3) assess the therapeutic potential of targeting the mTOR pathway with modulators as innovative strategies for OP treatment. By examining the interactions among autophagy, mTOR, and OP, including insights from various types of OP and the impact on different bone cells, this review underscores the complexity of mTOR's role in bone health. Despite advances, significant gaps remain in understanding the detailed mechanisms of mTOR's effects on autophagy and bone cell function, highlighting the need for comprehensive clinical trials to establish the efficacy and safety of mTOR inhibitors in OP management. Future research directions include clarifying mTOR's molecular interactions with bone metabolism and investigating the combined benefits of mTOR modulation with other therapeutic approaches. Addressing these challenges is crucial for developing more effective treatments and improving outcomes for individuals with OP, thereby unveiling the therapeutic potentials of targeting the mTOR-autophagy axis in this prevalent disease.
Osteoarthritis (OA) is a debilitating joint disorder that affects millions of people worldwide. Despite its prevalence, our understanding of the underlying mechanisms remains incomplete. In recent years, transient receptor potential vanilloid (TRPV) channels have emerged as key players in OA pathogenesis. This review provides an in-depth exploration of the role of the TRPV pathway in OA, encompassing its involvement in pain perception, inflammation, and mechanotransduction. Furthermore, we discuss the latest research findings, potential therapeutic strategies, and future directions in the field, shedding light on the multifaceted nature of TRPV channels in OA.
Background Arthroplasty has been shown to be superior regarding low risk of reoperation and better function score to internal fixation for treatment of displaced femoral neck fractures at short-term followup. However, there are unanswered questions regarding the efficacy of arthroplasty in the longer term compared with internal fixation. Questions/purposes We performed a meta-analysis comparing arthroplasty (hemiarthroplasty or THA) with internal fixation in patients with displaced femoral neck fractures with respect to (1) mortality, (2) reoperation, (3) functional recovery, and (4) complications, including only randomized trials with a minimum of 4 years followup. Methods Computerized databases, including PubMed (MEDLINE), EMBASE, Cochrane Register of Controlled Trials databases, and Web of Science™ were searched for studies published from the inception date for each database to March 2014. Eleven randomized controlled trials that compared arthroplasty (either hemiarthroplasty or THA) with internal fixation for treatment of patients with a femoral neck fracture were included in our analysis. The quality of the trials was assessed according to the Cochrane Handbook and meta-analyses were conducted using RevMan 5.2 software from the Cochrane Collaboration. The heterogeneity among studies was evaluated by the I-squared index (I2) and publication bias was assessed using forest plots. Results There were no differences between the internal fixation and arthroplasty groups for patient mortality at mid-term (48.4% vs 46.8%) or long-term followup (83.2% vs 81.5%). Arthroplasty was associated with a lower risk of reoperation at mid-term (7.2% vs 39.8%; relative risk [RR] = 0.10; 95% CI, 0.06-0.07) and at long-term followup (14.3% vs 43.8%; RR = 0.10; 95% CI, 0.06-0.07). Arthroplasty was associated with better functional recovery at mid-term followup (standard mean difference [SMD] = 0.55; 95% CI, 0.02-1.09), whereas function at long-term followup (SMD = 0.14; 95% CI, −0.35 to 0.62) was not different between the arthroplasty and internal fixation groups. There were no significant differences in subsequent ipsilateral fractures (1.5% vs 1.2%; RR = 2.18; 95% CI, 0.32-14.67; p = 0.42) and deep infections (2.7% vs 2.9%; RR = 0.89; 95% CI, 0.40-2.01; p = 0.78) between patients treated with arthroplasty and internal fixation. Conclusions Based on our results, we found that compared with internal fixation, arthroplasty may result in a lower rate of subsequent reoperation at mid- and long-term followup, and better mid-term functional recovery. Future studies should investigate the mid- and long-term results of THAs compared with hemiarthroplasty.
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