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Surgical management of the diabetic foot:The current evidence

World Journal of orthopedics 2024年第5期15卷 404-417页

作者： Richard Henry Randall Roberts Gareth Rhys Davies-Jones James Brock Vaishnav Satheesh Greg AJ Robertson department of trauma and Orthopaedics Wrexham Maelor HospitalWrexham LL137TDUnited Kingdom department of trauma and Orthopaedics The Robert Jones and Agnes Hunt Orthopaedic HospitalOswestry SY107AGUnited Kingdom

The prevalence of diabetes mellitus and its associated complications,particularly diabetic foot pathologies,poses significant healthcare challenges and economic burdens *** review synthesises current evidence on the surgical management of the diabetic foot,focusing on the interplay between neuropathy,ischemia,and infection that commonly culminates in ulcers,infections,and,in severe cases,*** escalating incidence of diabetes mellitus underscores the urgency for effective management strategies,as diabetic foot complications are a leading cause of hospital admissions among diabetic patients,significantly impacting morbidity and mortality *** review explores the pathophysiological mechanisms underlying diabetic foot complications and further examines diabetic foot ulcers,infections,and skeletal pathologies such as Charcot arthropathy,emphasising the critical role of early diagnosis,comprehensive management strategies,and interdisciplinary care in mitigating adverse *** addressing surgical interventions,this review evaluates conservative surgeries,amputations,and reconstructive procedures,highlighting the importance of tailored approaches based on individual patient profiles and the specific characteristics of foot *** integration of advanced diagnostic tools,novel surgical techniques,and postoperative care,including offloading and infection control,are discussed in the context of optimising healing and preserving limb function.

关键词： Diabetes Diabetic foot Charcot Osteomyelitis Amputation Diabetic foot attack Conservative surgery

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Outcome of meniscal repairs in paediatric population:A tertiary centre experience

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World Journal of orthopedics 2024年第6期15卷 547-553页

作者： Ayman Gabr Samson Williams Sophie Dodd Nick Barton-Hanson department of trauma&Orthopaedics West Suffolk HospitalSuffolk IP332QZUnited Kingdom department of trauma and Orthopaedics Alder Hey Children's HospitalLiverpool L145ABUnited Kingdom

BACKGROUND Meniscal sparing surgery is a widely utilised treatment option for unstable meniscal tears with the aim of minimising the risk of progression towards ***,there is limited data in the literature on meniscal repair outcomes in skeletally immature *** To evaluate the re-operation rate and functional outcomes of meniscal repairs in children and *** We performed a retrospective review of all patients who underwent arthroscopic meniscal repair surgery between January 2007 and January *** patients were under the age of 18 at the time of *** were all performed by a single *** was gathered from our hospital Electronic Patient Records *** primary outcome measure was re-operation rate(need for further surgery on the same meniscus).Secondary outcome measures were surgical complications and patient reported outcome measures that were International Knee Documentation Committee(IKDC),Tegner and Lysholm *** We identified 59 patients who underwent 66 All-inside meniscal repairs(32 medial meniscus and 34 Lateral meniscus).Meniscal repairs were performed utilizing FasT-Fix(Smith and Nephew)*** were 37 males and 22 females with an average age of 14 years(range 6-16).The average follow-up time was 53 months(range 26-140).Six patients had concomitant anterior cruciate ligament reconstruction surgery along with the meniscal *** were no requiring further meniscal repairs and 9 patients underwent partial *** mean postoperative IKDC score was 88(44-100),Tegner score was 7(2-10)and Lysholm score was 94(57-100).CONCLUSION Our results showed that arthroscopic repair of meniscal tears in the paediatric population is an effective treatment option that has a low failure rate and good postoperative clinical with the advantage of preserving meniscal tissues.

关键词： Meniscus Meniscal repair Outcome Meniscal preservation

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Confocal laser endomicroscopy as a new diagnostic tool for poorly differentiated gastric adenocarcinoma

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World Journal of Clinical Cases 2024年第26期12卷 5845-5849页

作者： Giuseppe Evola Marco Vacante Francesco R Evola department of surgery "Garibaldi"HospitalCatania 95100Italy department of General surgery and Medical-Surgical Specialties University of CataniaCatania 95123Italy department of surgery Division of Orthopedics and Trauma Surgery“Cannizzaro”HospitalCatania 95100Italy

Gastric cancer(GC)is a multifactorial disease,where both environmental and genetic features can have an impact on its occurrence and *** represents one of the leading causes of cancer-related deaths *** is most frequent in males and is believed to arise from a series of premalignant *** detection of GC at an early stage is crucial because early GC,which is an invasive stomach cancer confined to the mucosal or submucosal lining,may be curable with a reported 5-year survival rate of more than 90%.Advanced GC usually has a poor prognosis despite current treatment *** diagnostic efficacy of conventional endoscopy(with light endoscopy)is currently *** laser endomicroscopy is a novel imaging technique that allows real-time in vivo histological examination of mucosal surfaces during *** laser endomicroscopy may be of great importance in the surveillance of precancerous gastric lesions and in the diagnosis of *** this editorial we commented on the article about this topic published by Lou et al in the recent issue of the World Journal of Clinical Cases.

关键词： Confocal laser endomicroscopy In vivo microscopy Optical histology Helicobacter pylori Intestinal metaplasia Gastric atrophy Gastric cancer Early gastric cancer

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Comparison of Surgical Techniques Used in Treating Acromioclavicular Dislocation in Patients Participating in Sports: A Systematic Review

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Open Journal of orthopedics 2024年第1期14卷 41-52页

作者： Walter Hugo Brandão Nascimento Paulo Renan Matos Sucupira Cunha João Pedro Pimentel Abreu Lethycia Pereira Rosa Kamilly Iêda Silva Veigas Rodrigo Martins Silva Caetano orthopedic and trauma Surgeon Brazilian Army Rio de Janeiro Brazil orthopedic and trauma Surgeon S&atildeo Luís Brazil Scholarship Holder National Council for Scientific and Technological Development (CNPq) S&atildeo Luís Brazil School of Medicine Federal University of Maranh&atildeo (UFMA) S&atildeo Luís Brazil orthopedic and trauma Surgeon Shoulder and Elbow Surgery Specialist University Hospital of the Federal University of Maranh&atildeo (HUUFMA/EBSERH) S&atildeo Luís Brazil

Introduction: The acromioclavicular joint is a superficial diarthrodial joint that surrounds the medial articular facet of the acromion and the distal portion of the clavicle. Due to its anatomy and biomechanics, it is highly susceptible to trauma and in young men who play contact sports, acromioclavicular dislocation is common. This article aimed to systematically review the literature and compare the surgical techniques used in the treatment of acromioclavicular dislocation in patients who practice sports. Methods: This systematic review was conducted according to the International Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Eligible studies for this systematic review included articles in English or Spanish published between 2013 and 2023, which mention the occurrence of acromioclavicular dislocation during sports practices. Additionally, only studies that addressed the surgical treatment of acromion-clavicular dislocation and contained original data on the topic were included. Results: We found 144 eligible studies after searching the LILACS and PubMed databases. Based on the inclusion and exclusion criteria and the reviewers’ consensus, we selected four studies for the systematic review. 133 patients with AC joint displacement were evaluated. Mean Age: approximately 31.90 years. 81.92 of these injuries occurred during sports practice. Surgical Procedures Used: titanium plates fixation (49 patients), arthroscopy (24), single tunnel technique (30) and coracoid sling technique (30). The results of the visual analog scale and Constant-Murley scores varied between the techniques used. Twenty-two complications after surgical treatment were identified. Conclusion: A significant variability of operative techniques can be used in the surgical approach of acromioclavicular dislocation, such as arthroscopy, single tunnel, coracoid sling and titanium plates. Although it presented excellent functional results compared to the other three tech

关键词： Acromioclavicular Joint Shoulder Dislocation Surgical Procedure Postoperative Complications Postoperative Care

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CircZFR promotes colorectal cancer progression via stabilizing BCLAF1 and regulating the miR-3127-5p/RTKN2 axis

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Science China(Life Sciences) 2024年第9期67卷 1881-1898页

作者： Jiaxin Chen Huijuan Wang Jianbin Xu Engeng Chen Qing Meng Jiawei Wang Haoyi Xiang Wei Zhou Ge Shan Zhenyu Ju Zhangfa Song department of Colorectal surgery Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou 310016China Key Laboratory of Biological Treatment of Zhejiang Province Hangzhou 310016China department of Pulmonary and Critical Care Medicine Regional medical center for National Institute of Respiratory DiseaseSir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou 310016China Key Laboratory of Regenerative Medicine of Ministry of Education Institute of Aging and Regenerative MedicineJinan UniversityGuangzhou 510632China department of Breast surgery the Second Affiliated HospitalZhejiang University School of MedicineHangzhou 310009China department of orthopedic surgery the Second Affiliated HospitalZhejiang University School of MedicineHangzhou 310009China

Aberrant expression of circular RNAs(circ RNAs)is frequently linked to colorectal cancer(CRC).Here,we identified circ ZFR as a promising biomarker for CRC diagnosis and *** ZFR was upregulated in CRC tissues and serum exosomes and its level was linked to cancer incidence,advanced-stages,and *** both in vitro and in vivo settings,circ ZFR promoted the growth and spread while suppressing apoptosis of *** with circ ZFR overexpression promoted the proliferation and migration of cocultured CRC ***,epithelial splicing regulatory protein 1(ESRP1)in CRC cells may enhance the production of circ ***2-associated transcription factor 1(BCLAF1)bound to circ ZFR,which prevented its ubiquitinated ***,circ ZFR sponged mi R-3127-5p to boost rhotekin 2(RTKN2)*** TCP1-CD-QDs nanocarrier was able to carry and deliver circ ZFR si RNA(si-circ ZFR)to the vasculature of CRC tissues and cells,which inhibited the growth of tumors in patient-derived xenograft(PDX)*** together,our results show that circ ZFR is an oncogenic circ RNA,which promotes the development and spread of CRC in a BCLAF1 and mi R-3127-5p-dependent *** ZFR is a possible serum biopsy marker for the diagnosis and a desirable target for further treatment of CRC.

关键词： circZFR exosome ESRP1 BCLAF1 miR-3127-5p nanoparticle(NP)

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Silk-based nerve guidance conduits with macroscopic holes modulate the vascularization of regenerating rat sciatic nerve

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Neural Regeneration Research 2025年第6期20卷 1789-1800页

作者： Carina Hromada Patrick Heimel Markus Kerbl LászlóGál Sylvia Nürnberger Barbara Schaedl James Ferguson Nicole Swiadek Xavier Monforte Johannes C.Heinzel Antal Nógrádi Andreas H.Teuschl-Woller David Hercher department Life Science Engineering University of Applied Sciences Technikum WienViennaAustria Austrian Cluster for Tissue Regeneration ViennaAustria Ludwig Boltzmann Institute for traumatology The Research Center in Cooperation with AUVAViennaAustria University Clinic of Dentistry Medical University of ViennaViennaAustria department of Plastic Reconstructive and Aesthetic SurgeryLandesklinikum Wiener Neustadt2700 Wiener NeustadtAustria department of Anatomy Histology and EmbryologyAlbert Szent-Györgyi Medical SchoolUniversity of SzegedSzegedHungary Medical University of Vienna Department of Orthopedics and Trauma SurgeryDevision of Trauma SurgeryViennaAustria department of Hand- PlasticReconstructive and Burn SurgeryBG Unfallklinik TuebingenUniversity of TuebingenTuebingenGermany

Peripheral nerve injuries induce a severe motor and sensory deficit. Since the availability of autologous nerve transplants for nerve repair is very limited, alternative treatment strategies are sought, including the use of tubular nerve guidance conduits(tNGCs). However, the use of tNGCs results in poor functional recovery and central necrosis of the regenerating tissue, which limits their application to short nerve lesion defects(typically shorter than 3 cm). Given the importance of vascularization in nerve regeneration, we hypothesized that enabling the growth of blood vessels from the surrounding tissue into the regenerating nerve within the tNGC would help eliminate necrotic processes and lead to improved regeneration. In this study, we reported the application of macroscopic holes into the tubular walls of silk-based tNGCs and compared the various features of these improved silk^(+) tNGCs with the tubes without holes(silk^(–) tNGCs) and autologous nerve transplants in an 8-mm sciatic nerve defect in rats. Using a combination of micro-computed tomography and histological analyses, we were able to prove that the use of silk^(+) tNGCs induced the growth of blood vessels from the adjacent tissue to the intraluminal neovascular formation. A significantly higher number of blood vessels in the silk^(+) group was found compared with autologous nerve transplants and silk^(–), accompanied by improved axon regeneration at the distal coaptation point compared with the silk^(–) tNGCs at 7 weeks postoperatively. In the 15-mm(critical size) sciatic nerve defect model, we again observed a distinct ingrowth of blood vessels through the tubular walls of silk^(+) tNGCs, but without improved functional recovery at 12 weeks postoperatively. Our data proves that macroporous tNGCs increase the vascular supply of regenerating nerves and facilitate improved axonal regeneration in a short-defect model but not in a critical-size defect model. This study suggests that further optimizatio

关键词： axon regeneration blood vessel functional recovery macroporous nerve lesion peripheral nerve repair sciatic nerve silk-based nerve guidance conduit vascularization

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Enhancing the clinical relevance of haemorrhage prediction models in trauma

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Military Medical Research 2024年第3期11卷 467-468页

作者： Sankalp Tandle Jared M.Wohlgemut Max E.R.Marsden Erhan Pisirir Evangelia Kyrimi Rebecca S.Stoner William Marsh Zane B.Perkins Nigel R.M.Tai Centre for trauma Sciences Blizard InstituteQueen Mary University of LondonLondon E12ATUK The Royal London Hospital Barts Health NHS TrustLondon E11FRUK Academic department of Military surgery and trauma Research and Clinical InnovationThe Royal Centre for Defence MedicineBirmingham B152WBUK department of Electronic Engineering and Computer Science Queen Mary University of LondonLondon E14NSUK

We read with interest the recent systematic reviewaArtificial intelligence and machine learning for hemorrhagic trauma careoby Peng et al.[1],which evaluated literature on machine learning(ML)in the management of trau... 详细信息

关键词： trauma Injury Blood transfusion Massive transfusion Prediction Artificial intelligence Machine learning

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Bone-targeting engineered small extracellular vesicles carrying anti-miR-6359-CGGGAGC prevent valproic acid-induced bone loss

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Signal Transduction and Targeted Therapy 2024年第2期9卷 751-765页

作者： Xudong Xie Peng Cheng Liangcong Hu Wu Zhou Detai Zhang Samuel Knoedler Guodong Liu Yuan Xiong Hang Xue Yiqiang Hu Barbara Kern Doha Obed Adriana CPanayi Lang Chen Chenchen Yan Ze Lin Guandong Dai Bobin Mi Yingze Zhang Guohui Liu department of orthopedics Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration Wuhan 430022China department of Clinical Laboratory Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei 430022P.R.China Division of Plastic surgery Brigham and Women’s HospitalHarvard Medical SchoolBostonMA 02152USA department of Plastic surgery and Hand surgery Klinikum Rechts der IsarTechnical University of MunichMunichGermany Medical Center of trauma and War Injuries Daping HospitalArmy Medical UniversityChonqing 400042China department of Plastic surgery Campus CharitéMitte|Campus Virchow-KlinikumCharité-Universitätsmedizin Berlincorporate member of Freie Universität BerlinHumboldt-Universität zu Berlin and Berlin Institute of HealthBerlinGermany Berlin Institute of Health Charité-Universitätsmedizin BerlinBerlinGermany department of Plastic AestheticHand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany department of Hand Plastic and Reconstructive SurgeryMicrosurgeryBurn CenterBG Trauma Center LudwigshafenUniversity of HeidelbergLudwig-Guttmann-Strasse 1367071 Ludwigshafen/RhineGermany Pingshan District People’s Hospital of Shenzhen Pingshan General Hospital of Southern Medical UniversityShenzhenGuangdong 518118China department of Orthopaedic surgery The Third Hospital of Hebei Medical UniversityNO.139 Ziqiang RoadShijiazhuang 050051China

The clinical role and underlying mechanisms of valproic acid(VPA)on bone homeostasis remain ***,we confirmed that VPA treatment was associated with decreased bone mass and bone mineral density(BMD)in both patients and *** effect was attributed to VPA-induced elevation in osteoclast formation and *** RNA-sequencing,we observed a significant rise in precursor miR-6359 expression in VPA-treated osteoclast precursors in vitro,and further,a marked upregulation of mature miR-6359(miR-6359)in vivo was demonstrated using quantitative real-time PCR(qRT-PCR)and miR-6359 fluorescent in situ hybridization(miR-6359-FISH).Specifically,the miR-6359 was predominantly increased in osteoclast precursors and macrophages but not in neutrophils,T lymphocytes,monocytes and bone marrow-derived mesenchymal stem cells(BMSCs)following VPA stimulation,which influenced osteoclast differentiation and bone-resorptive ***,VPA-induced miR-6359 enrichment in osteoclast precursors enhanced reactive oxygen species(ROS)production by silencing the SIRT3 protein expression,followed by activation of the MAPK signaling pathway,which enhanced osteoclast formation and activity,thereby accelerating bone ***,there are no medications that can effectively treat VPA-induced bone ***,we constructed engineered small extracellular vesicles(E-sEVs)targeting osteoclast precursors in bone and naturally carrying anti-miR-6359 by introducing of EXOmotif(CGGGAGC)in the 3’-end of the anti-miR-6359 *** confirmed that the E-sEVs exhibited decent bone/osteoclast precursor targeting and exerted protective therapeutic effects on VPA-induced bone loss,but not on ovariectomy(OVX)and glucocorticoid-induced osteoporotic models,deepening our understanding of the underlying mechanism and treatment strategies for VPA-induced bone loss.

关键词： miR protective stimulation

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The efficacy of vitamin E in preventing arthrofibrosis after joint replacement

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Animal Models and Experimental Medicine 2024年第2期7卷 145-155页

作者： Yingfang Fan Jean Yuh Sashank Lekkala Mehmet D.Asik Andrew Thomson Madeline McCanne Mark A.Randolph Antonia F.Chen Ebru Oral Harris Orthopaedic Laboratory Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA department of Orthopaedic surgery Harvard Medical SchoolBostonMassachusettsUSA department of surgery Harvard Medical SchoolBostonMassachusettsUSA department of Orthopaedic surgery Brigham and Women's HospitalBostonMassachusettsUSA

Background:Arthrofibrosis is a joint disorder characterized by excessive scar formation in the joint *** E is an antioxidant with potential anti-fibroblastic *** aim of this study was to establish an arthrofibrosis rat model after joint replacement and assess the effects of vitamin E supplementation on joint ***:We simulated knee replacement in 16 male Sprague–Dawley *** immobilized the surgical leg with a suture in full *** control groups were killed at 2 and 12 weeks(n=5 per group),and the test group was supplemented daily with vitamin E(0.2 mg/mL)in their drinking water for 12 weeks(n=6).We performed histological staining to investigate the presence and severity of *** staining andα2-macroglobulin(α2M)enzyme-linked immunosorbent assay(ELISA)were used to assess local and systemic *** weight bearing(total internal reflection)and range of motion(ROM)were collected for functional ***:The ROM and weight-bearing symmetry decreased after the procedure and recovered slowly with still significant deficit at the end of the study for both *** analysis confirmed fibrosis in both lateral and posterior periarticular *** E supplementation showed a moderate anti-inflammatory effect on the local and systemic *** vitamin E group exhibited significant improvement in ROM and weight-bearing symmetry at day 84 compared to the control ***:This model is viable for simulating arthrofibrosis after joint *** E may benefit postsurgical arthrofibrosis,and further studies are needed for dosing requirements.

关键词： arthrofibrosis range of motion total knee arthroplasty vitamin E

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Icariin accelerates bone regeneration by inducing osteogenesisangiogenesis coupling in rats with type 1 diabetes mellitus

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World Journal of Diabetes 2024年第4期15卷 769-782页

作者： Sheng Zheng Guan-Yu Hu Jun-Hua Li Jia Zheng Yi-Kai Li department of Traditional Chinese orthopedics and traumatology Center for Orthopedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhou 510630Guangdong ProvinceChina School of Traditional Chinese Medicine Southern Medical UniversityGuangzhou 510515Guangdong ProvinceChina department of Endocrinology Peking University First HospitalBeijing 100034China

BACKGROUND Icariin(ICA),a natural flavonoid compound monomer,has multiple pharmacological ***,its effect on bone defect in the context of type 1 diabetes mellitus(T1DM)has not yet been *** To explore the role and potential mechanism of ICA on bone defect in the context of *** The effects of ICA on osteogenesis and angiogenesis were evaluated by alkaline phosphatase staining,alizarin red S staining,quantitative real-time polymerase chain reaction,Western blot,and ***-related assays were conducted to investigate the relationship between osteogenesis and angiogenesis.A bone defect model was established in T1DM *** model rats were then treated with ICA or placebo and micron-scale computed tomography,histomorphometry,histology,and sequential fluorescent labeling were used to evaluate the effect of ICA on bone formation in the defect *** ICA promoted bone marrow mesenchymal stem cell(BMSC)proliferation and osteogenic *** ICA treated-BMSCs showed higher expression levels of osteogenesis-related markers(alkaline phosphatase and osteocalcin)and angiogenesis-related markers(vascular endothelial growth factor A and platelet endothelial cell adhesion molecule 1)compared to the untreated *** was also found to induce osteogenesis-angiogenesis coupling of *** the bone defect model T1DM rats,ICA facilitated bone formation and CD31hiEMCNhi type H-positive capillary ***,ICA effectively accelerated the rate of bone formation in the defect *** ICA was able to accelerate bone regeneration in a T1DM rat model by inducing osteogenesis-angiogenesis coupling of BMSCs.

关键词： Icariin Osteogenesis-angiogenesis coupling Type 1 diabetes mellitus Bone defect Bone regeneration

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