Xiaochun Wei

Objective: To evaluate whether erector spinae plane block (ESPB) combined with local infiltration analgesia (LIA) provides better postoperative analgesia than ESPB alone, LIA alone, or placebo in patients undergoing posterior lumbar interbody fusion (PLIF).Methods: This prospective, double-blind, randomized controlled trial enrolled adults undergoing open PLIF for degenerative lumbar disease. Patients were randomly assigned in a 1:1:1:1 ratio to placebo, LIA, ESPB, or combined ESPB with LIA. Fluoroscopy-guided ESPB or placebo injection was performed before induction of general anesthesia, while LIA or placebo infiltration was given before wound closure. All patients received standardized general anesthesia and postoperative patient-controlled intravenous analgesia. The primary outcomes were postoperative sufentanil consumption and visual analogue scale (VAS) pain scores at rest and during movement at 4, 8, 12, 24, and 48 hours. Analyses were based on the modified intention-to-treat population. Longitudinal VAS trajectories were assessed using linear mixed-effects models, together with multiplicity-adjusted pairwise comparisons and factorial interaction analyses. A right-censoring sensitivity analysis of time to first patient-controlled intravenous analgesia (PCIA) bolus was performed using Kaplan-Meier, log-rank, and adjusted Cox proportional hazards analyses.Results: Of the 188 randomized patients, 182 were included in the modified intention-to-treat analysis. Baseline characteristics were similar across the 4 groups. Body-weight- and operative-time-normalized remifentanil and propofol consumption rates were lower in the ESPB-containing groups, whereas the rocuronium consumption rate did not differ significantly among groups. Linear mixed-effects models showed significant group×time interactions for both resting and movement VAS scores, indicating different postoperative pain trajectories among the groups. The combined ESPB with LIA group showed the most consistent short-term analgesic benefit, with lower pain scores at several early postoperative time points, lower postoperative sufentanil consumption, fewer analgesia pump activations, and a longer time to first PCIA bolus. After multiplicity adjustment, the postoperative rescue analgesia count was also lower in the combined group than in the control group. Factorial analyses identified a greater-than-additive effect only for time to first PCIA bolus, whereas the other analgesic outcomes showed no consistent evidence of statistical synergy. Right-censoring sensitivity analyses supported the longer time to first PCIA bolus in the combined group. Adverse-event rates were similar among the 4 groups, and no significant between-group differences were observed in VAS or Oswestry Disability Index scores at 3 months.Conclusion: Fluoroscopy-guided ESPB combined with LIA improved short-term postoperative analgesia after open PLIF. The combined regimen reduced postoperative opioid requirements and analgesia pump activations and prolonged the time to first PCIA bolus without increasing adverse events. Its benefit is better interpreted as an incremental, layered multimodal analgesic effect rather than a consistently synergistic effect across outcomes. No between-group differences in pain or functional outcomes were observed at 3 months.

Osteoarthritis (OA) is a prevalent degenerative joint disease and a leading cause of chronic pain and disability in the aging global population. Its pathogenesis is characterized by progressive articular cartilage degeneration, concomitant synovial inflammation, and aberrant subchondral bone remodeling. While the precise etiology is multifactorial and not fully elucidated, chronic, low-grade inflammation is recognized as a critical driver of disease progression. This inflammatory milieu disrupts the homeostatic balance between anabolic and catabolic processes in joint tissue. A complex network of cytokines and chemokines sustains this pathological state, with interleukin-1 (IL-1) emerging as a pivotal mediator. IL-1, particularly IL-1β, exerts potent catabolic effects by promoting the expression of matrix-degrading enzymes (e.g., MMPs, ADAMTS) while simultaneously suppressing the synthesis of essential extracellular matrix components, such as type II collagen and aggrecan. This dual action accelerates cartilage breakdown and undermines its repair capacity, identifying IL-1 signaling as a promising but clinically limited therapeutic target. This review details the central role of IL-1 in OA pathophysiology and dissects its key downstream signaling pathways, including NF-κB and MAPK activation. Furthermore, it provides a comprehensive summary and critical appraisal of current and emerging therapeutic strategies targeting the IL-1 pathway, evaluating their potential to modify disease progression and alleviate symptoms.

Osteoarthritis (OA) is a chronic degenerative joint disease characterized by pathological features such as chondrocyte loss and cartilage matrix degradation. Superficial zone chondrocytes (SFC), located in the outermost layer of articular cartilage and in direct contact with synovial fluid, are the first to respond to mechanical stress and friction. In this study, SFC were isolated and identified in vitro, and their proliferatives and anti-apoptotic properties were examined. Additionally, an early OA inflammatory environment was successfully simulated in cell experiments, demonstrating that inflammatory conditions reduce stemness-associated marker expression in SFC, activate multiple inflammatory pathways, and promote MMP3 expression. When SFC were subjected to cyclic mechanical stretching under inflammatory conditions, increased expression of the mechanosensitive channel Piezo1, enhanced calcium-associated mechanotransduction sensitivity, and disruption of the cytoskeleton were associated with aggravated catabolic responses and apoptosis under inflammatory mechanical stimulation. These findings elucidate the role of SFC in early OA pathogenesis and provide insight into early OA pathogenesis and suggest potential directions for mechanism-based intervention.

Background: The surface microstructures of cartilage are closely related to its functions. Accurate observation of cartilage surface is key to researching cartilage-related diseases. Traditional observation methods have limitations: conventional optical microscopes have a narrow depth of field and cannot clearly image the uneven cartilage surface; other methods either have low resolution or damage the sample. Ultra depth of field microscopy(UDFM)is a new high-precision method for cartilage surface research. It can non-invasively show clear 3D microstructural details of the cartilage surface without damaging the sample. At present, its application in cartilage surface research is still in the exploration stage, and it is of great significance to use this new method for related research. Methods: Fresh porcine knee joints and discarded cartilage tissue from human total knee arthroplasty were utilized to prepare a range of cartilage damage models and sectioned specimens. UDFM was employed to examine the cartilage surface, cross-sections, and lateral profiles at various magnifications (10–2000×), generating both two-dimensional and three-dimensional topographic images. The integrated UDFM software was used for qualitative assessment of surface morphology, cellular architecture, and damage characteristics, as well as for quantitative measurements of height differences, surface roughness, fissure length, and stained area. Results: UDFM provides non-destructive and direct visualization of the authentic three-dimensional morphology and subtle surface damage of articular cartilage, with 3D topographic mapping precisely delineating the depth and extent of lesions. This technology enables continuous, high-resolution observation of the macroscopic appearance, surface microarchitecture, and cellular morphology of cartilage across a broad range of magnifications. In fresh specimens, it reliably reveals in situ paired or clustered chondrocytes. The OPt-SEM special lighting mode further enhances the detection sensitivity for subtle surface damage. UDFM delivers rapid and highly accurate quantitative measurements of surface height differences, roughness, fissure length, and stained area, all with excellent reproducibility. In comparison to conventional techniques, UDFM is straightforward to operate, eliminates the need for complex sample preparation, and preserves the native structure of cartilage, thereby effectively addressing the inherent limitations of stereomicroscopy and scanning electron microscopy. Conclusion: Ultra depth of field microscopy is an efficient, non-destructive, and precise tool for three-dimensional observation of cartilage surfaces, offering high resolution, large depth of field, convenient operation, and strong quantitative capabilities. This technology can comprehensively and authentically reflect the microstructure and damage characteristics of cartilage surfaces, providing a new technical approach and objective quantitative method for basic and clinical cartilage research, early disease diagnosis, and evaluation of repair efficacy, with broad application prospects.

Objective: Articular cartilage relies on synovial fluid for substance exchange, with permeability being a key parameter linked to its physiological functions and degenerative disease mechanisms. Existing detection techniques are limited by detachment from physiological mechanical environments, insufficient quantification accuracy, and poor sealing. This study aimed to develop an accurate, reliable, and physiologically relevant device and method for cartilage permeability detection. Methods: Based on intra-articular convective transport and Darcy’s Law, a modular testing device (permeation, pressure supply, central control modules) was fabricated to simulate the synovial fluid–cartilage–subchondral bone unit under pressure. Porcine femoral condylar cartilage samples were tested with 4 N, 8 N, 16 N (n = 6, per group) constant pressure (1800 s) using an ElectroForce 3,200 system. Permeability coefficients were calculated via Darcy’s Law-derived formulas. Repeatability (single operator, fixed conditions, n = 6) and reproducibility (multiple operators, unified conditions, n = 6) were verified by CV and ANOVA. Human knee cartilage (n = 6) was used to validate practicality for clinical solutions. Data were analyzed with GraphPad Prism 9.5. Results: Friction force between the push rod and permeation tube was 2.5 N, with no leakage confirmed by eosin dye. Repeatability tests showed mean permeabilities of 1.50 × 10 ⁻¹⁷ m ² , 1.05 × 10 ⁻¹⁷ m ² and 0.67 × 10 ⁻¹⁷ m ² at 4 N, 8 N, 16 N (CV ≤ 6.4%). Reproducibility tests yielded a mean permeability of 1.05 × 10 ⁻¹⁷ m ² (CV = 7.4%, P = 0.9776 > 0.05). Osteoarthritic (OA) cartilage exhibited higher permeability to sodium hyaluronate (0.99 × 10 ⁻¹⁷ m ² ) and interleukin-1β (1.39 × 10 ⁻¹⁷ m ² ) than normal cartilage (0.71 × 10 ⁻¹⁷ m ² and 1.39 × 10 ⁻¹⁷ m ² ). Conclusion: The developed device and method address traditional limitations, featuring excellent physiological relevance, quantification accuracy, and stability. It provides a pivotal tool for studying cartilage physiology, OA pathology, optimizing repair materials and therapeutic strategies, and improving cartilage injury repair evaluation.