Luoyang Orthopedic-Traumatological Hospital of Henan Province

The choice of surgical approach in total hip arthroplasty (THA) significantly influences early recovery and complication rates. However, comprehensive evidence comparing the efficacy and safety of multiple contemporary approaches remains limited. We conducted a systematic review and network meta-analysis of randomized controlled trials (RCTs) from PubMed, Cochrane Library, Embase, and Web of Science (inception to July 2025). We included 85 RCTs (6,575 patients) comparing 13 surgical approaches. Frequentist framework NMA was performed, with effects reported as mean differences (MD), standardized mean differences (SMD), or risk ratios (RR) with 95% confidence intervals. Treatment rankings were assessed using surface under the cumulative ranking curve (SUCRA) values. The analysis of 85 RCTs (6,575 patients) demonstrated distinct performance profiles among the 13 surgical approaches. For functional recovery, the ranking probabilities suggested that minimally invasive anterolateral approach (MIS-ALA) was most likely to achieve the best early postoperative HHS (SUCRA = 88.7%), while modified direct anterior approach (DAA-Modified) ranked highest for medium-to-long-term HHS (SUCRA = 97.8%). regarding surgical efficiency, the minimally invasive posterolateral approach (MIS-PLA) was associated with the highest probability of having the shortest operative time (SUCRA = 98.4%), whereas MIS-ALA had the highest SUCRA value for blood loss control (SUCRA = 90.9%). For surgical trauma, MIS-PLA had the highest SUCRA value indicating the potential for the smallest postoperative CK increase (SUCRA = 82.4%), while anterior approaches (DAA-Modified, bikini direct anterior approach (DAA-Bikini), direct anterior approach (DAA)) ranked highest for suppressing CRP elevation (SUCRAs: 88.2%, 83.4%, and 80.8%). DAA had the highest SUCRA value for walking speed recovery (SUCRA = 91.8%), and supercapsular percutaneously-assisted total hip (SuperPath) had the highest SUCRA value for the physical component summary score (SUCRA = 95.4%). Safety analysis revealed direct lateral approach (DLA) had the highest SUCRA value for the lowest complication risk (SUCRA = 92.9%), while DAA-Bikini had the highest adverse event incidence. THA surgical approaches present distinct efficacy-safety profiles with varying probabilities of advantage. Clinical selection should be individualized based on patient characteristics and surgical expertise, as no single approach is universally superior across all outcomes.

Renal cell carcinoma (RCC) is a common urologic malignancy with limited treatment options. The neuropeptide vasoactive intestinal peptide (VIP) regulates diverse biological processes by binding to VPAC1 and VPAC2 receptors, but its role in RCC remains unclear. The proliferation of RCC Caki-1 cells was evaluated using the Cell Counting Kit-8 (CCK-8), while lactate dehydrogenase (LDH) and γ-glutamyl transpeptidase (γ-GPT) release were measured using commercial kits. Reactive oxygen species (ROS) levels were analyzed via dihydroethidium (DHE) staining. Superoxide dismutase (SOD) activity and malondialdehyde (MDA) levels were quantified using commercial assay kits. Autophagy was assessed through monodansylcadaverine (MDC) staining, and the expression levels of related mRNAs and proteins were quantified by RT-PCR and Western blotting, respectively. VIP treatment (0-50 μM) exhibited dose-dependent cytotoxic effects, including reduced cell viability, increased LDH and γ-GPT release, and induction of oxidative stress as evidenced by elevated ROS and MDA levels with concomitant decrease in SOD2 activity. At concentrations of 5-10 μM, VIP induced autophagic responses characterized by enhanced MDC staining, increased microtubule-associated protein 1 light chain 3 (LC3)-II/LC3-I ratio, upregulated Beclin1 expression, and accelerated p62 degradation. Mechanistically, VIP-mediated autophagy was associated with sirtuin 3 (SIRT3) downregulation and increased Ac-FOXO1 levels, with SIRT3 overexpression effectively counteracting the VIP-induced autophagic effects. Our findings demonstrate that VIP induces both cytotoxic effects and autophagy in VPAC1-expressing RCC cells through modulation of the SIRT3/FOXO1 signaling pathway, highlighting its potential therapeutic value for renal cell carcinoma.

ABSTRACTTo assess whether surgical treatment with predominantly volar locking plates has superior clinical and radiographic outcomes to conservative treatment with cast immobilization in the treatment of distal radius fractures by reviewing and investigating the literature with a high level of evidence. Thus, we systematically searched PubMed, Web of Science, and Embase databases for clinical trials comparing surgical and conservative treatments for distal radius fractures. Data extraction was performed to access parameters that included: wrist functional assessment, such as mobility and grip strength; subjective outcomes, such as DASH score, PRWE score, and quality of life score (EQ‐5D); radiographic assessment (palmar inclination, ulnar variance, and articular subluxation, etc.); and complications, such as fracture nonunion, reoperation, infection, and neurologic symptoms, and then to conduct data organization and quantitative synthesis. Finally, a total of 19 clinical trials with 2729 patients were included in this report, including 1378 in the conservative treatment group and 1351 in the surgical treatment group. In terms of recovery of wrist function, wrist joints undergoing cast immobilization gained a greater range of extension (MD 1.5°, p = 0.02), whereas surgical treatment of the range of wrist rotation was significantly greater than with conservative treatment (MD 3°, p = 0.03), and wrist grip strength was significantly improved (MD 2 kg, p = 0.04). There were no significant differences between the two groups of patients in terms of wrist flexion and anterior rotation activities. In terms of patient subjective scores, patients in the plaster immobilization group showed significant improvement in PRWE scores compared with the surgical treatment group at 3 and 12 months after treatment (MD 3–7 points, p < 0.05). There was no significant difference between the two groups in terms of ulnar varus and dorsal tilt angle correction (p > 0.05). At the level of complications, the overall complication rate was significantly lower in patients who underwent surgical treatment than in the conservative treatment group (202/1046 [19.3%] vs. 361/1065 [33.9%], p = 0.001). The conclusions drawn were that when treating distal radius fractures, surgical treatment with predominantly metacarpal plate fixation achieves superior anatomical fracture repositioning and a lower complication rate compared to cast immobilization. However, no significant advantage was demonstrated in terms of recovery of wrist function and subjective patient perception. Overall, surgical treatment is an appropriate choice for patients with high motor function requirements who need to recover quickly, whereas more conservative treatments can be considered for patients with lower functional requirements.

There have been many studies on neuromuscular adaptation after anterior cruciate ligament (ACL) reconstruction, while the understanding of muscle activation patterns in unreconstructed patients with ACL rupture is still limited. The aim of this study was to investigate the lower limb electromyographic characteristics of unreconstructed patients with complete ACL rupture in a single-legged hopping landing task in order to deepen the understanding of motor control strategies in the ACL-deficient state and to provide a reference for rehabilitation assessment and intervention. Forty-two subjects were recruited for this study using a case-control design, with an ACL injury group (n = 21) of patients with unilateral non-contact complete rupture without reconstruction and a control group (n = 21) of healthy individuals matched for gender, dominant leg, and level of exercise. All subjects completed a single-leg hop landing task and synchronized Noraxon Ultium surface EMG signals with Bertec force plate data via the QUALISYS 3D motion capture system. EMG data were recorded from the lateral femoral (VL), medial femoral (VM), biceps femoris (BF), semitendinosus (ST), and gluteus maximus (Gmax) muscles before and after the landing for 100 ms each. Calculated metrics included activation onset time (onset-IC), peak appearance time (peak-IC), activation duration, and standardized root mean square (RMS) values. Data were analyzed by two-way ANOVA or nonparametric Scheirer-Ray-Hare test, and the significance level was set at p < 0.05. BF (p = 0.0409) and Gmax (p = 0.0469) sustained activation of the dominant leg in the injury group was significantly longer than that of the dominant leg in the control group. The onset-IC of BF (p = 0.0457), ST (p = 0.0277), and Gmax (p = 0.0192) of the dominant leg in the injury group was significantly earlier than that of the dominant leg in the control group. The peak-IC of BF (p = 0.0457) and ST (p = 0.0280) of the dominant leg in the injury group was significantly later than that of the dominant leg in the control group. The peak RMS of VL (p = 0.0171), VM (p = 0.0054), and Gmax (p = 0.0003) in the dominant leg of the injury group was significantly lower than that of the dominant leg of the control group in 100 ms after IC. Unreconstructed patients, averaging 18 months after ACL injury, continued to maintain a similar muscle pre-activation sequence as healthy individuals during the jump landing task, but showed a prolonged activation duration and reduced activation intensity, suggesting that neuromuscular activity was adjusted to maintain the kinematic profile. The delay in the peak of the posterior muscle groups (especially BF and ST) may be used to synergize tibial rearward movement and reduce forward movement and internal rotation, thus constituting a compensatory protective mechanism. The results of this study provide evidence for neuromuscular adaptation in the ACL-deficient state and are informative for preoperative functional assessment and rehabilitation intervention strategies.

Abstract Background Venenum bufonis (VB) is a traditional Chinese medicine (TCM) extracted from toad venom that has been used to treat various tumours. Cinobufagin (CBG), a major bioactive compound derived from the VB, has demonstrated clinical efficacy against metastatic bone tumours, but its LncRNA-modulating mechanisms in osteosarcoma (OS) remain unknown.This study investigates a novel mechanism by which CBG exerts its anti-tumor effects through targeting long non-coding RNAs (LncRNAs). Methods OS cell lines were treated with CBG. A series of cell biological experiments were performed to detect the effects of CBG on the proliferation, migration and invasion of osteosarcoma cells. RNA sequencing identified CBG-regulated lncRNAs. Proteome microarray analysis was used to screen for transcription factors that bind to CBG. Molecular docking and microscale thermophoresis experiments confirmed the binding of CBG to POU6F1. Chromatin immunoprecipitation and dual-luciferase reporter assays validated POU6F1 binding and the transcriptional regulation of LINC01410. In vivo , the efficacy of CBG in the treatment of OS proliferation and pulmonary metastasis was evaluated in subcutaneous xenograft and lung metastasis models. Results The experimental results show that CBG inhibits the malignant progression of OS, including proliferation and lung metastasis. RNA-seq revealed that LINC01410 is a key oncogenic lncRNA downregulated by CBG. Mechanistically, CBG directly binds to the transcription factor POU6F1 and inhibits its occupancy of the LINC01410 promoter, thereby inhibiting PI3K/AKT/mTOR signalling. Our study provides the first evidence for the mechanism by which CBGs target lncRNAs. Conclusions CBG exerts anti-OS effects by disrupting POU6F1-mediated transcription of LINC01410, thereby inactivating PI3K/AKT/mTOR signalling. This study supports the development of CBG as a therapeutic agent derived from TCM.

BackgroundPatients with clonal cytopenia of undetermined significance (CCUS) who undergo hip replacement surgery are at risk of serious complications such as bleeding, infection, and anemia. There are certain difficulties in clinical treatment. Such cases have not been reported in international medical journals.Case DescriptionA 35-year-old man with CCUS for 4 years developed bilateral avascular necrosis of the femoral head 1 year after hormone therapy for the blood disorder. The patient required arthroplasty surgery due to hip pain and functional limitations. The patient’s persistent severe deficiency of platelets, red blood cells, and granulocytes limited the operation. Before surgery, the multidisciplinary team formulated the blood transfusion treatment plan for correcting blood system abnormalities, the treatment plan for basic internal medicine diseases, the minimally invasive manipulation anesthesia plan, the surgical plan, the postoperative refined care and the rapid recovery plan. We completed bilateral hip arthroplasty surgery for patients and had good recovery of hip joint function during the 6-month follow-up after surgery (Harris Hip Score =90 points).ConclusionsCCUS patients have a higher operation risk when perform the total hip arthroplasty. Under the collaborative treatment of the multidisciplinary team, we successfully completed the patient’s surgery and achieved a good surgical outcome.

BackgroundHigh-intensity chemotherapy for non-Hodgkin lymphoma (NHL) has been shown to improve survival outcomes. However, its substantial toxicity may induce or exacerbate patient frailty, which is strongly associated with treatment interruptions, increased adverse effects, and reduced survival rates. Despite this, the dynamic progression of frailty and its specific contributing factors among patients with NHL undergoing chemotherapy remain poorly understood.ObjectiveThis study aims to investigate the heterogeneity of frailty trajectories and explore their risk factors in patients with NHL. We seek to generate insights into the dynamic relationship between frailty and disease course. The findings may offer health care professionals dynamic insights into frailty progression and could help inform strategies for the early identification of high-risk populations through the systematic assessment of key factors. Ultimately, this work seeks to contribute to the evidence base for developing interventions that could mitigate or prevent frailty.MethodsThis longitudinal mixed methods study will recruit 250 patients newly diagnosed with NHL from multicenter hospitals in China. Quantitative data will be collected at 3 time points: before chemotherapy, during the third cycle of chemotherapy, and at the end of chemotherapy. We will use validated questionnaires (ie, the Tilburg Frailty Indicator) to gather information on sociodemographics, frailty, cognition, physical condition, health literacy, anxiety, and nutrition. Qualitative data will be collected via semistructured interviews and observations at the end of chemotherapy. The growth mixture model and logistic regression analysis will be used to analyze quantitative data, and the diachronic analysis method and the directed content analysis method will be used for the qualitative data. Both types of data will be analyzed in parallel and separately. Finally, we will integrate the datasets to identify areas of confirmation, complementation, or discordance.ResultsThe research protocol and informed consent form were approved by the Medical Ethics Committee of the First Affiliated Hospital of Henan University of Science and Technology (2024-03-K171). Recruitment began in January 2025, with 168 participants enrolled as of September 2025. The data collection and analysis processes are expected to be finalized by March 2026. Data management is still ongoing; therefore, data analysis has not yet been conducted.ConclusionsAs a pilot trial, this research is primarily designed to assess the feasibility of our methods and generate preliminary data on frailty progression. The findings could offer initial insights and help inform the development of future strategies for the early identification of high-risk populations through systematic screening, with the ultimate goal of informing interventions that may prevent frailty.

Abstract Background Pelvic fractures have consistently been a focal point in orthopedic research. This study aims to provide a comprehensive analysis of the literature on pel-vic fractures published between 1983 and 2023, revealing research trends, hotspots, and frontiers in this field. Objective This study aimed to provide a comprehensive bibliometric and knowledge graph–based analysis of pelvic fracture literature published between 1983 and 2023, identifying research trends, hotspots, and emerging frontiers in this field. Methods We searched the Web of Science database using a predefined strategy restricted to review articles and original research articles, excluding studies outside orthopedics and surgery. Medical entities and relationships were extracted to construct a comprehensive knowledge graph. Entity recognition, relationship extraction, and network topology analyses were performed to map research evolution and collaboration networks. Results A total of 5248 articles were included for analysis. The results show a steady increase in the annual publication of pelvic fracture research, particularly after 2005. The United States, Germany, and China are the top three coun-tries in terms of the number of publications, with the University of Wash-ington, University of California, and University of San Francisco ranking the top three regions. Pohlmann T published the most significant number of ar-ticles, and Vaidya R was the strongest citation bursts author. Research on pelvic fractures has made significant progress over the past forty years, espe-cially in treatment techniques and methods. Bibliometric analysis reveals re-search hotspots in this field, such as hemostasis control, fracture fixation techniques, and osteoporotic fractures. Conclusions: This study employs bibliometrics to quantify and delineate the contemporary research landscape and trends in pelvic fracture research, aspiring to provide scholars with a compass for navigating the realm of pelvic fracture-related research.

Refractory lateral epicondylitis poses a significant clinical challenge. In patients with persistent symptoms refractory to conservative treatment, surgical intervention represents an effective approach for achieving durable symptomatic relief. Advances in arthroscopic techniques now offer a more minimally invasive and refined approach. While there is no consensus regarding the superiority of one arthroscopic treatment over another, resection of the lesion tissue remains a critical consideration. This article describes an arthroscopic extensor carpi radialis brevis tendon resection technique, which facilitates precise visualization and targeted resection of pathological tendon tissue, avoiding excessive resection of healthy tissue or incomplete resection of pathological lesions, while simultaneously addressing any concomitant intra-articular pathology.