Beijing Jishuitan Hospital

To evaluate the long-term efficacy and safety of iguratimod (IGU) in patients with knee osteoarthritis (KOA). This retrospective study included patients diagnosed with KOA at Beijing Jishuitan Hospital between July 2023 and January 2024. All participants received IGU monotherapy at a dose of 25mg twice daily for 3months and were subsequently followed for a total duration of 12months. Clinical data, including demographic characteristics, laboratory tests, and imaging assessments, were systematically collected and analyzed. Pain intensity, global disease assessment, physical function, and adverse events were evaluated at baseline, 3months, and 12months. A total of 62 patients were included in the analysis, of whom 77.4% were female. The mean age was 58.56 ± 8.57years, and disease duration ranged from less than 1year to more than 10years. At baseline, the mean Visual Analogue Scale (VAS) score was 6.08 ± 1.56, and the mean Patient Global Assessment (PGA) score was 3.94 ± 1.34. Significant reductions in both scores were observed at 3 and 12months. The VAS score decreased to 2.39 ± 1.64 at 3months and 2.65 ± 1.70 at 12months, while the PGA score declined to 1.39 ± 1.07 and 1.53 ± 1.21, respectively (all p < 0.001). The median total functional score improved markedly from 6.00 (IQR: 5.00) at baseline to 1.00 (IQR: 3.00) at 3months and 1.00 (IQR: 2.00) at 12months (p < 0.001). At 3months, 51.6% of patients achieved a squat test score of 0, and 66.1% achieved a stair climbing test score of 1; these functional gains were maintained at 12months (p < 0.001). Similar improvements were observed across additional functional domains. At both follow-up time points, 58.1% of patients reported no restriction in the chair rise test, 98.4% reported no joint stiffness, and 91.9% reported no limitation in walking distance (p < 0.001 for all comparisons). The incidence of adverse events associated with IGU monotherapy was 0.03%, and the treatment was generally well tolerated. IGU demonstrated sustained efficacy and a favorable safety profile in patients with KOA. Significant improvements in pain and physical function were observed after 3months of treatment and were maintained for at least 12months. These findings support the potential role of IGU as a long-term therapeutic option for KOA. Key Points •This study supports the potential of iguratimod as an effective long-term treatment option for patients with non-inflammatory phenotypes of KOA. •Significant and sustained improvements were observed in VAS, PGA, and physical functional scores from baseline to 3 and 12 months.

Osteosarcoma, the most common primary malignant bone tumour, presents significant treatment challenges due to its complex tumour microenvironment and the development of chemoresistance. This study employs single-cell transcriptomics to investigate chemotherapy-induced changes in osteosarcoma at both the cellular and molecular levels. Single-cell RNA sequencing data were analysed to identify cell subpopulations and their responses to chemotherapy. Differential gene expression and pathway enrichment analyses were performed to elucidate chemotherapy-induced changes. Additionally, we developed and validated a predictive model based on pyroptosis-related genes, named Pyroscore, using 101 different machine-learning algorithms. Chemotherapy led to an increased proportion of osteoclasts, endothelial cells, mesenchymal stem cells and pericytes, while decreasing T and NK cells, B cells, chondroblasts, monocytes and macrophages. Chemotherapy markedly upregulates the pyroptosis pathway in tumour cells, suggesting that chemotherapy induces programmed cell death in cancer cells through the activation of pyroptosis. Metabolic pathway analysis revealed significant inhibition of sulphur metabolism, starch and sucrose metabolism, pentose phosphate pathway, inositol phosphate metabolism, nitrogen metabolism and fatty acid metabolism. The Pyroscore model, which incorporates BAK1, CASP1, CASP5 and CASP6, demonstrated robust prognostic value across multiple data sets, with high scores correlating with improved survival outcomes. This study highlights the impact of chemotherapy on osteosarcoma cell subpopulations and the tumour microenvironment. The activation of the pyroptosis pathway and the development of the pyroscore prognostic model provide new insights into the mechanisms of chemotherapy response and potential therapeutic targets. These findings underscore the importance of personalized treatment strategies in improving outcomes for osteosarcoma patients.

BackgroundArtificial intelligence (AI) has shown promise for automating spinal alignment assessment in adolescent idiopathic scoliosis (AIS). However, AI models typically exhibit reduced accuracy and robustness when deployed across multiple medical centers due to variability in imaging protocols and data characteristics, potentially compromising clinical diagnosis and treatment decisions.ObjectiveThis study aimed to develop a real-time, plug-and-play data transformation method to enhance the robustness of deep learning models against data heterogeneity in radiographs, thereby improving their performance in assessing AIS across multiple medical centers.MethodsIn this retrospective multicenter study, 3899 full-spine radiographs from 7 hospitals (2 from Hong Kong and 5 from Mainland China), collected between January 2012 and August 2024, were included. Data from 2 hospitals in Hong Kong (n=3034) were used for model training and internal validation, while radiographs from the 5 mainland hospitals (n=865) formed 5 independent external validation datasets. A novel pixel intensity–based data transformation method was developed to standardize image contrast and brightness across datasets and integrated into the model training process to enhance our previously developed AI model, SpineHRNet+. The enhanced model's accuracy and robustness for cobb angle (CA) prediction and severity classification were evaluated using both internal and external datasets. Data heterogeneity across centers was quantified by brightness and contrast differences. CA prediction accuracy was evaluated using residual analysis, linear regression (coefficient of determination [R²]), and Bland-Altman analyses. Model performance for disease severity classification was assessed using sensitivity, specificity, precision, negative predictive value, accuracy, and confusion matrix analysis. The transformation method aligns pixel intensity distributions across datasets using statistical profiling and optimization, ensuring consistent image characteristics while preserving anatomical integrity.ResultsThe developed data transformation method significantly reduced contrast variability between datasets, improving consistency in image characteristics and enabling more reliable AI analysis. The enhanced SpineHRNet+ achieved consistent and accurate CA predictions across external validation datasets, with mean prediction errors within 4° (SD 3.12°), and maintained an R² greater than 0.90 for all centers. The sensitivity and negative predictive value for disease severity grading improved to 90.18% and 93.16%, respectively. Bland-Altman analyses demonstrated robust agreement, with 95% limits of agreement within 7.51° across all datasets.ConclusionsThe proposed data transformation approach effectively addressed data heterogeneity, significantly improving the accuracy and robustness of SpineHRNet+ in multicenter AIS assessments. The real-time processing capability and preservation of anatomical integrity underscore the method’s clinical practicality, enabling scalable and reliable AI applications in diverse health care environments.

The management of finger flexor spasticity (FFS) remains challenging. Traditional surgical approaches like peripheral neurotomies (PNs) and C8 cervical nerve root transection often achieve initial success in relieving FFS but are prone to rebound and recurrence. To address this limitation, we propose T1 nerve root neurectomy as a novel intervention. Among 19 patients with finger and thumb flexion spastic paralysis treated with T1 neurectomy, two also underwent contralateral C7 (CC7) or phrenic nerve (PhN) transfer for T1 repair. Patients were divided by preoperative finger extension strength into Group A (complete paralysis, n=10) and Group B (preserved function, n=9). Changes in extrinsic finger flexor muscle tone (EFFMT) and flexor pollicis longus muscle tone (FPLMT), as well as hand function, were assessed using the Modified Ashworth Scale (MAS) and the House Functional Classification (HFC), respectively. The median follow-up duration was 24.0 months (IQR 20.0-44.0). Both EFFMT and FPLMT showed a significant decrease in MAS grades, from 4 (IQR 3-4) to 2 (IQR 1-3) (P < 0.001) and from 4 (IQR 4-4) to 1 (IQR 1-3) (P < 0.001), respectively. The HFC grade for hand function improved by a median of 1 grade in Group A (IQR 0.8-2.0; P = 0.01) and 3 grades in Group B (IQR 2.5-3.5; P = 0.01). Group B demonstrated significantly greater improvement compared to Group A (β = 1.83, P = 0.012). T1 neurectomy demonstrated durable efficacy in relieving FFS and significantly improved hand function, particularly in patients with preserved finger extension function.

Reverse shoulder arthroplasty (RSA) is a promising option for proximal humerus fractures (PHFs) and also used as a salvage procedure for failed treatment. Whether the timing of RSA would influence the clinical outcomes is controversial. This meta-analysis compared outcomes between immediate RSA (iRSA) and salvage RSA (sRSA) in geriatric patients with PHFs. PubMed, Embase, Web of Science and Cochrane Library databases were searched up to 1st April 2024. Comparative studies reporting outcomes of iRSA and sRSA in geriatric patients with PHFs were included. A random-effects model was used for meta-analysis. The primary outcome was the revision rate. Secondary outcomes included shoulder function and complications. Risk ratios (RR) were calculated for dichotomous outcomes, and weighted mean differences (WMDs) were used for continuous variables. Meta-regression model and subgroup analysis were used to explore sources of potential heterogeneity for the primary outcome. Seventeen studies with 27,756 cases (24442 receiving iRSA and 3314 receiving sRSA) were included. Compared with sRSA, iRSA was associated with a lower risk of revision (RR = 0.41, P < 0.001), greater range of motion (ROM) (abduction: WMD = 11.32°, P < 0.001; forward flexion: WMD = 11.51°, P < 0.001; external rotation: WMD = 3.77°, P = 0.048) and statistically superior shoulder functional scores (Constant-Murley score: WMD = 5.57, P < 0.001; American Shoulder and Elbow Surgeons score: WMD = 10.38, P < 0.001; Simple Shoulder Test score: WMD = 0.91, P = 0.001; Shoulder Pain and Disability Index: WMD = - 14.50, P < 0.001), and lower risk of complications (infection: RR = 0.42, P = 0.019; dislocation: RR = 0.34, P = 0.007; nerve palsy: RR = 0.49, P = 0.026). The meta-regression model and subgroup analysis showed that sRSA after failed prior surgery had the highest revision rate (9.4%) as compared with iRSA (3.7%). In elderly patients with PHFs, iRSA is associated with lower revision and complication rates, as well as statistically superior shoulder function and ROM, compared with sRSA. However, the clinical significance of some functional differences remains uncertain. CRD42024534751.

Background Displaced pelvic fractures present real surgical challenges because of complex three-dimensional deformity patterns and proximity to vital structures, with conventional manual reduction techniques limited by accuracy constraints and radiation exposure. Although robotic assistance shows promise in preclinical studies, its clinical effectiveness remains unproven in randomized clinical trials (RCTs). Questions/purposes (1) Does robotic closed reduction improve reduction quality compared with manual closed reduction in displaced pelvic fractures? (2) Can robotic closed reduction reduce intraoperative radiation exposure while maintaining functional outcomes? Methods In this multicenter RCT conducted at six tertiary trauma centers in China involving 10 senior orthopaedic traumatologists, 92 adult patients with acute closed, displaced pelvic fractures (Tile Type B or C) were randomized 1:1 to robotic closed reduction (n = 46) or manual closed reduction (n = 46) groups. At 12 weeks, loss to follow-up for patient-reported outcomes was 9% (4 of 46) in the robotic group and 4% (2 of 46) in the manual group; the remainder were handled in a prespecified per-protocol analysis. In the robot group, reduction was planned using CT-based three-dimensional reconstruction with contralateral pelvic symmetry as the target and executed by a robotic arm with adjunct elastic traction and contralateral pelvic stabilization. In the manual group, reduction was performed using traction and manual manipulation under fluoroscopic guidance. Surgeons and patients were not blinded; radiographic outcome assessors and data analysts were blinded. Primary outcome was reduction quality assessed using Matta criteria (excellent ≤ 4 mm residual displacement, good 5 to 10 mm, acceptable 10 to 20 mm, poor &gt; 20 mm), analyzed as the proportion of excellent to good reductions. Secondary outcomes included intraoperative surgeon fluoroscopic exposure and 12-week Majeed pelvic scores (0 to 100 points across seven domains; higher scores indicate better function). The primary analysis was intention to treat. Results In the intention-to-treat analysis, a higher proportion of patients who underwent robotic closed reduction achieved an excellent or good reduction than did those who received manual closed reduction (96% [44 of 46] versus 48% [22 of 46], relative risk 2.00 [95% confidence interval (CI) 1.47 to 2.72]; p &lt; 0.001). Median (IQR) intraoperative surgeon fluoroscopic exposure was lower in the robotic closed reduction group (0 [0 to 0] versus 38 [14 to 78] fluoroscopic exposures; p &lt; 0.001). No differences were found in 12-week Majeed functional scores between groups (mean ± SD 69 ± 16 versus 71 ± 17, mean difference -3 [95% CI -11 to 6]; p = 0.55). One superficial infection occurred in the manual closed reduction group, and there were no serious complications in either group. Conclusion Surgeons treating acute displaced pelvic ring fractures should consider robotic closed reduction, when available, to improve reduction quality and reduce intraoperative fluoroscopic exposure, although it did not result in improved patient-reported outcome scores at short term in this randomized trial. Future studies should evaluate longer term functional benefits, define the fracture patterns most likely to benefit, and evaluate implementation factors including learning curve and cost-effectiveness across varied trauma settings. Level of Evidence Level I, therapeutic study.

Osteoporosis (OP), a prevalent disease among middle-aged and elderly individuals, is characterized by a decrease in bone mineral density (BMD), which predisposes individuals to fragile fractures. The core pathological process involves excessive bone resorption over bone formation. The etiology of OP is intricate, and increasing recent studies have focused on the role of gut microbiota (GM) in its pathogenesis. Harmful bacteria exacerbate OP, whereas probiotics are beneficial for bone metabolism and delay the progression of OP. GM influences the progression of OP through various mechanisms, including the production of metabolites, modulation of the intestinal barrier, and regulation of intestinal immunity and osteoimmunology. In this review, we summarize the role of GM in the pathogenesis of OP based on the latest understandings, and highlight the promising potential of strategies targeting GM for the intervention and management of OP.