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Background: Osteoarthritis (OA) is a common degenerative joint disease, leading to pain and restricted mobility. Age-related endoplasmic reticulum (ER) stress has been implicated in the pathogenesis of OA, but the underlying mechanisms remain unclear. This study aims to explore the relationship between age-related ER stress, YAP overexpression, and chondrocyte phenotype loss in the development of OA. Methods: Cartilage samples were collected from patients undergoing amputation, and age-related ER stress markers and YAP expression were assessed using immunohistochemical staining and qPCR. Transgenic mice with cartilage-specific YAP overexpression (YAPOE) were created, and Pamrevlumab was administered to evaluate its therapeutic effects. Results: Higher expression of ER stress markers and YAP were showed in aged tissues compared to younger tissues. YAP overexpression led to decreased levels of cartilage phenotype markers and increased osteogenesis-related proteins. In vivo , YAPOE mice exhibited OA-like cartilage degeneration, which was mitigated by Pamrevlumab treatment. Conclusion: Age-related ER stress induces YAP overexpression, contributing to OA pathogenesis. Pamrevlumab effectively prevents this phenotype loss in YAPOE mice, suggesting its potential as a therapeutic agent for OA. These findings provide new insights into the molecular mechanisms of OA and highlight the importance of targeting the ER stress-YAP-CTGF signaling pathway in OA treatment and prevention. [ABSTRACT FROM AUTHOR]

Endoscopic submucosal dissection (ESD) is a curative treatment for laterally spreading tumors (LSTs). However, the outcomes of ESD for LSTs with hemorrhoids remain largely unknown. Our study aimed to evaluate the usefulness of ESD in managing LSTs with hemorrhoids. We retrospectively collected 418 consecutive LST patients treated with ESD between 2011 and 2023. A retrospective comparative analysis was conducted. There were 85 patients included in the hemorrhoids group and 333 patients included in the other group. The en-bloc resection rate, R0 resection rate, and curative resection rate were comparable in these two groups (p > 0.05). The LSTs with hemorrhoids have a significantly higher intraoperative bleeding rate during ESD when compared to the other group (12.9% vs. 5.4%, p = 0.028). Rates of intraoperative perforation and anal pain in the hemorrhoid group were significantly higher than those in the no-hemorrhoid group (2.4% vs. 0%, p = 0.041; 9.4% vs.0.6%, p < 0.001; respectively). Moreover, most of the related manifestations caused by hemorrhoids were relieved to various degrees after ESD. ESD is a safe and effective treatment strategy for LSTs with hemorrhoids. A multi-center and prospective study should be conducted in the future to validate our results. [ABSTRACT FROM AUTHOR]

Background: To mitigate the possibility of infection after arthroplasty, intraoperative irrigation is essential to remove contaminating bacteria. Previous studies have demonstrated that irrigation with an EDTA solution before wound closure is superior to irrigation with normal saline in removing contaminating bacteria in a rat model of open fractures. However, the effectiveness of an EDTA solution in a model with a contaminated intra-articular implant remains unclear.Questions/purposes: (1) Does irrigation with an EDTA solution decrease the proportion of culture-positive joints compared with normal saline, benzalkonium chloride, and povidone iodine? (2) Is an EDTA solution toxic to cells resident in joints including chondrocytes, osteoblasts, and synovial fibroblasts? (3) Does irrigation with an EDTA solution have adverse effects including arthrofibrosis and hypocalcemia?Methods: We first established a model of contaminated intra-articular implants. Female Sprague-Dawley rats (n = 30 for each treatment group) underwent knee arthrotomy and implantation of a femoral intramedullary wire with 1 mm of intra-articular communication. To simulate bacterial contamination, the inserted wire was inoculated with either Staphylococcus aureus or Escherichia coli. After 1 hour, the wound and implant were irrigated with normal saline, benzalkonium chloride, povidone iodine, or an EDTA solution (1 mM). The animals were euthanized 1 week later, and the distal femur, knee capsule, and implanted wire were harvested for bacterial culture using standard techniques. In this study, we used a well-established animal model of an intra-articular implant and inoculated the implant to simulate the clinical setting of intraoperative contamination. The proportion of culture-positive joints in normal saline, benzalkonium chloride, povidone-iodine, and EDTA groups were compared. The viable cell numbers (chondrocytes, osteoblasts, and synovial fibroblasts) were counted and compared after treatment with either solution. Measurement of blood calcium level and histological examination of the joint were performed to rule out hypocalcemia and arthrofibrosis after EDTA irrigation.Results: With S. aureus inoculation, EDTA irrigation resulted in fewer culture-positive joints than normal saline (37% [11 of 30] versus 70% [21 of 30]; p = 0.019), benzalkonium chloride (83% [25 of 30]; p < 0.001), and povidone iodine (83% [25 of 30]; p < 0.001) irrigation. Likewise, infection rates for implant inoculation with E. coli were also lower in the EDTA irrigation group (13% [four of 30]) than in the normal saline (60% [18 of 30]; p < 0.001), benzalkonium chloride (77% [23 of 30]; p < 0.001), and povidone iodine (80% [24 of 30]; p < 0.001) groups. Between normal saline control and EDTA, there were no differences in cell viability in chondrocytes (normal saline: 98% ± 18%; EDTA: 105% ± 18%; p = 0.127), osteoblasts (normal saline: 102 ± 19%, EDTA: 103 ± 14%; p = 0.835), and synovial fibroblasts (normal saline: 101% ± 21%, EDTA: 110% ± 13%; p = 0.073). EDTA irrigation did not result in hypocalcemia (before irrigation: 2.21 ± 0.32 mmol/L, after irrigation: 2.23 ± 0.34 mmol/L; p = 0.822); and we observed no arthrofibrosis in 30 histologic samples.Conclusions: In a rat model of a bacteria-contaminated intra-articular implants, intraoperative irrigation with 1 mmol/L of an EDTA solution was superior to normal saline, 0.03% benzalkonium chloride, and 0.3% povidone iodine in preventing surgical-site infection and caused no adverse effects including death of resident cells, arthrofibrosis, and hypocalcemia. Future studies should seek to replicate our findings in other animal models, perhaps such as dog and goat.Clinical Relevance: If other animal models substantiate the efficacy and safety of the EDTA solution, clinical trials would be warranted to determine whether the use of an EDTA irrigation solution might reduce the risk of periprosthetic joint infections in patients compared with traditional irrigation solutions. [ABSTRACT FROM AUTHOR]

Background: Quality assessment of vascular anastomosis primarily depends on the experience of the treating surgeon. This highlights the need for an objective index. The main goal of our study was to establish a method of assessing the quality of vascular anastomosis in digit replantation.Methods: A total of 182 digits from 141 patients were included in this study. The patients underwent replantation of completely amputated digits between June 1, 2015, and February 1, 2017. Patency tests of arterial and venous anastomoses were conducted for each replantation and recorded on digital video at 1,000 frames per second. We divided the study into 2 phases. In phase I (103 digits from 80 patients), we investigated whether the refilling velocity ratio (RVR) was associated with replantation failure. In phase II (79 digits from 61 patients), we adopted the RVR as a guiding parameter during surgery and compared the replantation success rate with that of the historical control of phase I.Results: In phase I, ischemia time (>12 hours), arterial RVR (<0.4), and venous RVR sum (<1.0) were significantly associated with the rate of replantation failure in 82 cases with single arterial anastomosis. In phase II, we set the arterial RVR goal to 0.4 and venous RVR sum goal to 1.0. Under the guidance of the RVR test, the survival rate significantly increased compared with that of the historical control of phase I (96% versus 87%; p = 0.037).Conclusions: The patency test, with assistance of high-speed video recording, is a useful tool that can improve the success rate of digit replantation.Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Fourth and fifth carpometacarpal fracture-dislocations with unsatisfactory closed reduction commonly require later open reduction and internal fixation. However, the optimal method of internal fixation for these is unknown. The purpose of this study was to determine through objective clinical measures which method is superior for fourth and fifth carpometacarpal fracture-dislocations: a K-wire or a plate.Methods: We conducted a retrospective review of hospital records of patients who had received treatment for fourth and fifth carpometacarpal fracture-dislocations at one hospital between May 2007 and May 2015. A total of 86 patients who had received open reduction either with plate or K-wire fixation were included. Demographic and clinical characteristics of the two groups of patients were collected. Patients received standardised clinical tests one year after fixation. Clinical outcomes included tests of grip strength and scores on the Michigan Hand Outcomes Questionnaire and Disabilities of Arm, Shoulder, and Hand. Student's t tests and Chi-square tests were used to statistically evaluate whether plate or K-wire fixation was superior on the clinical variables.Results: The two groups were statistically indistinguishable on their demographic and clinical characteristics. Generally, the clinical outcomes of internal fixation were satisfactory. The average DASH and MHQ scores of the K-wire group were superior to those of the plate group (DASH 2.3 versus 9.8, P = 0.01; MHQ 96.7 versus 86.6, P = 0.02). Grip strength was not significantly different between the two groups (89.5 ± 5.8% versus 90.1 ± 4.9%, P = 0.36).Conclusions: This non-randomly controlled, retrospective study suggests that clinical outcomes after K-wire fixation is superior to plate fixation for fourth and fifth carpometacarpal fracture-dislocations. This is especially the case for hand functions related to work. The present results suggest that K-wire fixation is the gold-standard technique for the treatment of fourth and fifth CMC fracture-dislocations. [ABSTRACT FROM AUTHOR]

Purpose: The primary objective of this study was to evaluate factors that influence the survival rate after digit replantation.Methods: A total of 291 digits of 200 patients who received digital replantation after complete amputation from 1 January 2014 to 31 December 2015 were included in this study. Univariate and multivariate analysis were performed to evaluate the correlation between potential risk factors and the failure rate. Age, gender, smoking status, Tamai level of amputation, causes of injury and ischemia time were recorded before replantation.Results: Age, smoking, causes of injury and ischemia time were pre-operative predictors for survival. On the contrary, gender and Tamai level did not alter the survival rate significantly. We divided patients into four groups according their smoking status: none, mild (<10 cigarettes per day), moderate (10-20 cigarettes per day) and heavy (>20 cigarettes per day). Our data demonstrated that the risks of failure only increased in heavy group.Conclusions: Mild and moderate cigarette consumption (<20 cigarettes per day) did not increase the risk for replant failure of digits. Heavy (>20 cigarettes per day) cigarette consumption, increased age (>45 years), non-cut injury and prolonged ischemia time (>12 hours) were risk factors for replant failure. [ABSTRACT FROM AUTHOR]