Liao Wang

Barium titanate (BaTiO₃) is a conventional piezoelectric material, but its biocompatibility is limited. Besides, its piezoelectric property is significantly different from that of natural bone tissue. To address this, we have developed an innovative coating material that mimics the piezoelectric characteristics of natural bone with a d₃₃ coefficient of 7.8 pm/V. The material was fabricated by replacing titanium (Ti) in the BaTiO₃ crystal lattice with copper (Cu), a strategy that not only augments the piezoelectric response but also harnesses the osteogenic potential of Cu. BaCu_xTi_1-xO₃ reveals an enhanced piezoelectric performance and actively promotes the adhesion, proliferation, and differentiation of MC3T3-E1 cells. Moreover, doped Cu modulates osteogenic differentiation through the upregulation of the Wnt4/β-catenin/SP7/Osterix signaling pathway. The synergistical effect caused by piezoelectricity and the biological activity of Cu contributed to promoting bone regeneration in vivo; in particular, H-BaCu_xTi_1-xO₃ led to a 15.6% increase of the bone volume percentage compared to BaTiO₃. Furthermore, H-BaCu_xTi_1-xO₃ promoted the accumulation of bone extracellular matrix components including Osteopontin (OPN) and Collagen Type I (COL-1), which, respectively, increased by 62.12 and 155%. The synergistic interplay between the piezoelectric property of BaCu_xTi_1-xO₃ and the osteogenic influence of Cu has significantly improved the repairing process of bone defects, offering a promising advancement in the field of orthopedic implant coatings.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a common comorbidity in hypertension. However, the impact of NAFLD and related fibrosis on hypertension and its control of cardiovascular disease (CVD) and mortality outcomes remains unclear. METHODS: Participants with hypertension were sourced from two cohorts, with 12 907 individuals from the National Health and Nutrition Examination Survey (NHANES) and 120 639 from the UK Biobank (UKBB). Mendelian randomization analyses explored the causal relationship among hypertension, NAFLD, and CVD. Cox regression models estimated the hazard ratios for CVD and mortality associated with NAFLD (defined by fatty liver index) and liver fibrosis (defined by fibrosis-4 index or NAFLD fibrosis score). RESULTS: The NHANES documented 3376 deaths over a median follow-up of 8.5 years, and the UKBB documented 15 864 deaths, 4062 incident ischemic strokes, and 5314 incident myocardial infarctions over a median follow-up of 13.5 years. The hazard ratios for CVD and mortality increased in accordance with NAFLD grading (ischemic stroke, 1.16 [95% CI, 1.01–1.33]; myocardial infarction, 1.64 [95% CI, 1.44–1.86] in UKBB; and all-cause mortality, 1.29 [95% CI, 1.09–1.54] in NHANES). High-risk fibrosis increased the hazard ratios for all-cause mortality by 91% and ischemic stroke by 42% in patients with NAFLD in UKBB and for all-cause mortality by 95% in NHANES. NAFLD partially mediates the risk of hypertension for incident CVD and mortality (NHANES, 6.45% of all-cause mortality; UKBB, 5.17% of all-cause mortality; and 8.20% of myocardial infarction). CONCLUSIONS: NAFLD and related liver fibrosis are associated with a higher risk of incident CVD and mortality in hypertensives. NAFLD and related liver fibrosis seem to partially mediate hypertension-induced CVD and mortality.

Objective: The traditional femoral stem is unsuitable for patients with severe proximal femoral bone defects or deformities. However, 3D‐printed customized designs offer improved proximal femoral canal contact and enhance the initial stability of the femoral prosthesis. Therefore, this study aims to compare the anatomical parameters, contact parameters, and performance of the 3D‐printed customized femoral short (CFS) stem with those of the traditional femoral stem following total hip arthroplasty (THA).Methods: An in vitro study simulating THA was performed using artificial femur models, with a 3D‐printed CFS stem as the experimental group and a Trilock stem as the control group. Anatomical parameters, fitness, filling, micro‐motion, and strain distribution were evaluated using artificial femoral models. Micro‐motion and strain were recorded under different simulated bodyweight loading using a 3D digital image correlation measurement system.Results: The neck‐shaft angles (NSA) and coronal femoral horizontal offset (CFHO) of the 3D‐printed CFS stem (NSA: 125.22°, CFHO: 41.03 mm) were closer to those of the intact femur (NSA: 127.37°, CFHO: 43.27 mm) compare with the Trilock stem (NSA: 132.61°, CFHO: 32.98 mm). In addition, the 3D‐printed CFS stem showed improved fitness at cross‐sections (The top of the lesser trochanter: 6.31%, the middle of the lesser trochanter: 23.42%, the bottom of the lesser trochanter: 26.61%) and reduced micro‐motion under different simulated bodyweight loads (1000: 0.043, 1375: 0.056, 2060 N: 0.061 mm).Conclusions: The 3D‐printed CFS stem provides improved restoration of anatomical parameters, enhanced fitness, and superior biomechanical performance compared with the Trilock stem.

Among hypertensive cohorts across different nations, the relationship between the triglyceride-glucose index (TyG) and its conjunction with obesity metrics in relation to cardiovascular disease (CVD) incidence and mortality remains to be elucidated. This study enrolled 9,283, 164,357, and 5,334 hypertensives from the National Health and Nutrition Examination Survey (NHANES), UK Biobank (UKBB), and Shanghai Pudong cohort. The related outcomes for CVD were defined by multivariate Cox proportional hazards models, Generalized Additive Models and Mendelian randomization analysis. Mediation analysis explored the mediating role of inflammatory markers in the above relationships. Five measures of insulin resistance were linked to CVD and related death in a U-shaped pattern, with the highest group having different risk increases. Higher glucose triglyceride-waist height ratio (TyG-WHTR) was linked to higher all-cause mortality (UKBB: HR 1.21, 95%CI 1.16–1.26, NHANES: HR 1.17, 95%CI 1.00–1.36), CVD mortality (UKBB: HR 1.36, 95%CI 1.23–1.49, NHANES: HR 1.32, 95%CI 1.00–1.72) risks. In the China Pudong cohort, higher triglyceride/high-density lipoprotein-cholesterol (TG/HDL_C) ratio was associated with higher risks of CVD and stroke (HR 1.31, 95%CI 1.00–1.73 and 1.67, 1.06–2.63). Inflammation markers like systemic inflammatory response index (SIRI) and C-reactive protein (CRP) partially explained these links, with CRP having a stronger effect. Genetically predicted TyG was also linked to stroke (OR 1.26, 95%CI 1.10–1.45) risk. An elevated TyG index and its related indices are significantly correlated with an increased risk of CVD and related mortality across three national cohorts. These indices are anticipated to serve as valid predictors of incident CVD and mortality in individuals with hypertension.

Background: The protective effect of a healthy diet combined with stair climbing on cardiovascular health is unclear. We aimed to assess the independent and joint associations of dietary patterns and stair climbing with major adverse cardiovascular events (MACEs). Methods: We included 117,384 participants with information on dietary intake and stair climbing from the UK Biobank (UKBB). We excluded participants with MACEs at baseline and death within two years of follow-up. We used restricted cubic spline (RCS) plots describing the linear or nonlinear associations between dietary patterns (the alternate Mediterranean diet score (AMED), dietary approaches to stop hypertension (DASH), the healthful planted-based diet index (HPDI) and the alternate healthy eating index-2010 (AHEI-2010)) and stair climbing and MACEs. COX regressions estimated the hazard ratios (HRs) for incident MACEs associated with dietary patterns combined with stair climbing, and adjusted for sociodemographic, lifestyle and medical factors. Results: The UKBB documented 9408 MACEs over a median follow-up of 13.3 years. Four dietary patterns were negatively and linearly associated with MACEs (P-nonlinear > 0.05), whereas daily stair climbing was negatively and nonlinearly associated with MACEs (P-nonlinear = 0.011). All of the dietary patterns had significant multiplicative interactions with stair climbing (all p-values < 0.05). The three dietary patterns had the lowest risk ratios for MACEs in the highest tertile (T3) combined with daily stair climbing of 60–100 steps (AMED: 0.78 (0.68, 0.89), DASH: 0.80 (0.70, 0.91) and HPDI: 0.86 (0.75, 0.98)), whereas the AHEI-2010 had the lowest HRs for MACEs in the T1 combined with stair climbing of 110–150 steps (AHEI-2010: 0.81 (0.71, 0.93)). Conclusions: Maintaining healthy dietary patterns and adhering to an average of 60–100 steps of stair climbing per day at home can be effective in preventing cardiovascular health-related events.

Objectives: Analyzing the lower limb coronal morphological parameters in populations without knee osteoarthritis (KOA) holds significant value in predicting, diagnosing, and formulating surgical strategies for KOA. This study aimed to comprehensively analyze the variability in these parameters among Chinese non‐KOA populations, employing a substantial sample size.Methods: A cross‐sectional retrospective analysis was performed on the Chinese non‐KOA populations (n = 407; 49.9% females). The study employed an in‐house developed artificial intelligence software to meticulously assess the coronal morphological parameters of all 814 lower limbs. The parameters evaluated included the hip‐knee‐ankle angle (HKAA), weight‐bearing line ratio (WBLR), joint line convergence angle (JLCA), mechanical lateral‐proximal‐femoral angle (mLPFA), mechanical lateral‐distal‐femoral angle (mLDFA), mechanical medial‐proximal‐tibial angle (mMPTA), and mechanical lateral‐distal‐tibial angle (mLDTA). Differences in these parameters were compared between left and right limbs, different genders, and different age groups (with 50 years as the cut‐off point).Results: HKAA and JLCA exhibited left–right differences (left vs. right: 178.2° ± 3.0° vs. 178.6° ± 2.9° for HKAA, p = 0.001; and 1.8° ± 1.5° vs. 1.4° ± 1.6° for JLCA, p < 0.001); except for the mLPFA, all other parameters show gender‐related differences (male vs. female: 177.9° ± 2.8° vs. 179.0° ± 3.0° for HKAA, p < 0.001; 1.5° ± 1.5° vs. 1.8° ± 1.7° for JLCA, p = 0.003; 87.1° ± 2.1° vs. 88.1° ± 2.1° for mMPTA, p < 0.001; 90.2° ± 4.0° vs. 91.1° ± 3.2° for mLDTA, p < 0.001; 38.7% ± 12.9% vs. 43.6% ± 14.1% for WBLR, p < 0.001; and 87.7° ± 2.3° vs. 87.4° ± 2.7° for mLDTA, p = 0.045); mLPFA increase with age (younger vs. older: 90.1° ± 7.2° vs. 93.4° ± 4.9° for mLPFA, p < 0.001), while no statistical difference exists for other parameters.Conclusions: There were differences in lower limb coronal morphological parameters among Chinese non‐KOA populations between left and right sides, different genders, and age.

Purpose: To investigate the conversion formulas between the Miniaci angle, presurgery parameters, and changes in presurgery parameters in open‐wedge high tibial osteotomy (OWHTO), including hip‐knee‐ankle (HKA) angle, weightbearing line (WBL) percentage, mechanical medial proximal tibial angle (mMPTA), ΔHKA angle, ΔWBL percentage, ΔmMPTA, and other parameters. Methods: From January 2012 to December 2019, 247 lower limbs of 144 patients with medial unicompartmental knee osteoarthritis combined with proximal tibia vara were enrolled. Inclusion criteria were adults, medial unicompartmental knee osteoarthritis, Kellgren‐Lawrence classification grade ≤ III, mMPTA ≤ 85°, normal mechanical lateral distal femoral angle (85°‐90°), and patella facing anterior in the bipedal standing position. Exclusion criteria were history of fracture, trauma, or orthopaedic surgery; developmental dysplasia of the hip or femoral head necrosis; femoral bowing deformity; deformity of the tibial shaft; and leg length discrepancy. Using standing whole‐leg radiographs, an OWHTO simulation was performed to determine the Miniaci angle by delivering the WBL to the Fujisawa point. The relationship of the Miniaci angle, the presurgery parameters, and the changes in presurgery parameters were analyzed by Spearman's correlation and linear regression analyses. The relationship between the postsurgery HKA angle and presurgery parameters was analyzed by multiple linear regression model. Results: The Miniaci angle showed a near‐perfect correlation with the presurgery HKA angle (y = −1.05x + 192.10, r ² = 0.99), presurgery WBL percentage (y = −0.25x + 15.14, r ² = 0.97), ΔHKA angle (y = 1.04x − 0.03, r ² = 1.00), ΔWBL percentage (y = 0.25x − 0.52, r ² = 0.97), and ΔmMPTA (y = 1.04x − 0.03, r ² = 1.00). The ΔHKA angle showed nearly perfect correlation with the ΔmMPTA (y = 1.00x, r ² = 1.00), and ΔWBL percentage (y = 0.24x − 0.47, r ² = 0.97). Conclusions: The presurgery HKA angle, presurgery WBL percentage, ΔHKA angle, ΔWBL, and ΔmMPTA percentage are nearly perfectly correlated to the Miniaci angle, whereas the ΔmMPTA and ΔWBL percentage are nearly perfectly correlated to the ΔHKA angle. With the conversion formulas determined in the current study, surgeons can calculate the Miniaci angle based on the presurgery parameters without the assistance of digital software for complex surgical simulation. The Miniaci angle is closely related to the gap of the medial opening wedge. Based on the Miniaci angle and the depth of the osteotomy, surgeons can calculate the gap required before surgery using trigonometric functions and then simply measure the gap during surgery.

Background: Precise preoperative planning improves postoperative outcomes in total hip arthroplasty (THA), especially in developmental dysplasia of the hip (DDH) cases. Previous studies used the T-line and midcortical-line as preoperative landmarks to predict postoperative stem anteversion (PSA). However, the most reliable landmark in predicting PSA in DDH patients remains unclear. To find the most reliable measurement to predict the PSA in DDH patients, this study compared the midcortical-line and T-line at different femoral neck levels.Methods: Pre- and postoperative Computed Tomography (CT) scans of 28 hips in 21 DDH patients who received THA were obtained for three-dimensional femoral models. The preoperative CT scan was used to measure the anteversion of the midcortical-line on the axial cross-sectional plane images (AM-CT), the anteversion of the midcortical-line from 3D models (AM-3D), and the T-line from 3D models (AT-3D) at simulated osteotomy planes at 5 and 10 mm heights proximal to the base of the lesser trochanter. The correlation between the preoperative femoral anteversion (AM-CT, AM-3D, AT-3D) and the PSA was assessed to evaluate the prediction accuracy.Results: The correlations between the AM-CT and the PSA were 0.86 (mean difference (MD) = 1.9°) and 0.92 (MD = −3.0°) at 5 and 10 mm heights, respectively. The correlation between the AM-3D and the PSA were 0.71 (MD = −11.6°) and 0.61 (MD = −12.9°) at 5 and 10 mm heights. The AT-3D was significantly greater (MD = 15.4°) than the PSA (p-value <0.01) at 5 mm cutting height, and the correlation between the AT-3D and the PSA was 0.57 (MD = 7.8°) at 10 mm cutting height.Conclusions: The AM-CT at the 10 mm height had the strongest correlation with the PSA and was more reliable in predicting the PSA when compared with the AM-3D and the AT-3D in DDH patients.