Tengbin Shi

Background: Spinal cord injury (SCI) often leads to neuropathic pain (NeP), severely impacting patients’ function and rehabilitation. Vitamin D deficiency, highly prevalent in SCI due to reduced sun exposure and mobility, has been implicated in NeP in other conditions, but its role in chronic SCI-related NeP remains unclear. Methods: This cross-sectional study enrolled 182 adults with chronic traumatic SCI (≥6 month post-injury) currently admitted to 2 rehabilitation centers. Vitamin D status {serum 25-hydroxyvitamin D [25(OH)D]} was measured via high-performance liquid chromatography–tandem mass spectrometry (HPLC-MS/MS). NeP was diagnosed using the Douleur Neuropathique 4 (DN4) questionnaire (score ≥4/10) in combination with clinical assessment by a physician. Multivariate logistic regression, controlling for confounders (e.g., age, comorbidity, Charlson Comorbidity Index, CCI), injury severity (American Spinal Injury Association Impairment Scale, and AIS grade), assessed the association between vitamin D levels and NeP. Receiver operating characteristic (ROC) curve analysis was performed to identify a predictive cutoff. Results: The prevalence of NeP was 52.7% (96/182). Vitamin D deficiency or insufficiency [25(OH)D < 30 ng/mL] affected 64.8% (118/182) of participants. Lower vitamin D levels were strongly and independently associated with NeP risk. Individuals in the lowest vitamin D tertile (2.00–11.68 ng/mL) had significantly higher adjusted odds of NeP compared to those in the highest tertile (16.71–23.03 ng/mL) [adjusted odds ratio: 4.8, 95% CI: (3.4, 6.8), p < 0.001]. ROC analysis identified a serum 25(OH)D level <16.35 ng/mL as a predictive cutoff for NeP (area under the curve = 0.812, sensitivity 79.1%, specificity 71.9%). Conclusion: Vitamin D deficiency is highly prevalent and a strong, independent predictor of neuropathic pain in individuals with chronic SCI. These cross-sectional findings suggest routine screening for vitamin D deficiency might be indicated; however, interventional trials are needed to confirm a potential therapeutic role of vitamin D supplementation in managing SCI-related NeP.

Severe acetabular bone defects (Paprosky type III) pose significant challenges for reconstruction and stable implant fixation. This study aimed to analyze the biomechanical properties and clinical safety of personalized 3D-printed porous titanium alloy reinforcement augments and evaluate their therapeutic efficacy in reconstructing these complex defects. We reviewed three cases of Paprosky type III acetabular defects reconstructed using personalized 3D-printed porous titanium alloy augments. Finite element analysis (FEA) simulated the defects, utilizing a commercial augment as a control. Stress distribution within the augments, fixation screws, acetabular cups, and surrounding bone was analyzed under simulated single-leg standing (1 × body weight), walking (4 × BW), and jogging (6 × BW) loading conditions, with comparisons made to the control. Under all loading conditions, the peak stresses observed on the augment screws and acetabular cups in all three cases were lower than the buckling strength of titanium alloy and were consistently lower than those recorded in the control group. This indicates that the personalized augments provided stable support for acetabular cup fixation, aiding in the restoration of the hip rotation center and lower limb length. Personalized 3D-printed porous titanium alloy augments demonstrate favorable biomechanical safety and clinical efficacy based on FEA and initial case review. For severe acetabular bone defects, these custom augments offer good initial stability, promoting bone integration for long-term fixation, and potentially reducing risks associated with cup loosening, dislocation, and periprosthetic fracture.

Bone defects are a prevalent clinical issue that presents a serious medical challenge. Bone tissue engineering (BTE) has emerged as an effective approach for treating large bone defects. Hydrogels, as hydrophilic three-dimensional polymers, are recognized as suitable material for BTE due to their excellent biocompatibility and degradability. However, the sub-micron and nano-porous structure of hydrogels limits the survival of osteoblasts, hindering bone tissue regeneration. In recent years, 3D printing technology has attracted appreciable attention. Use of hydrogels as 3D-printed ink facilitates the printing of hydrogels in any desired shape, enabling personalized or more complex requirements. This article provides a systematic review of the latest applications of 3D-printed hydrogels in BTE. These hydrogels sever as a multifunctional platform for the next generation technology in treating bone defects. The advantages and limitations of 3D-printed hydrogels in BTE are discussed, and future research directions are explored. This review can form the basis for future hydrogel design.

Objective: Spinal cord injury (SCI) is a severe type of neurological trauma. N6-methyladenosine (m6A) modification is one of the most common internal modifications of RNA. The role of METTL3, the predominant methylation enzyme of m6A modification, in SCI remains unclear. This study aimed to investigate the role of methyltransferase METTL3 in SCI.Methods: After establishing the oxygen-glucose deprivation (OGD) model of PC12 cells and rat spinal cord hemisection model, we found that the expression of METTL3 and the overall m6A modification level were significantly increased in neurons. The m6A modification was identified on B-cell lymphoma 2 (Bcl-2) messenger RNA (mRNA) by bioinformatics analysis, and m6A-RNA immunoprecipitation and RNA immunoprecipitation. In addition, METTL3 was blocked by the specific inhibitor STM2457 and gene knockdown, and then apoptosis levels were measured.Results: In different models, we found that the expression of METTL3 and the overall m6A modification level were significantly increased in neurons. After inducing OGD, inhibition of METTL3 activity or expression increased the mRNA and protein levels of Bcl-2, inhibited neuronal apoptosis, and improved neuronal viability in the spinal cord.Conclusion: Inhibition of METTL3 activity or expression can inhibit the apoptosis of spinal cord neurons after SCI through the m6A/Bcl-2 signaling pathway.

Objective Previous research has shown that many patients with musculoskeletal diseases suffer from sleep disturbances. However, the sleep quality of patients with cervical radiculopathy (CR) has yet to be fully investigated. This study aims to investigate the prevalence and status of sleep disturbances in patients with CR and identify the mechanisms and risk factors associated with this condition. Methods We conducted a cross-sectional study of patients diagnosed with CR. The Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were used to evaluate the sleep quality of patients and determine whether patients experience sleep disturbances. In addition, we analyzed the clinical and radiological risk factors of sleep disturbance and determined the key risk factors related to sleep disturbance by multivariable analysis. Results According to specific inclusion and exclusion criteria, 186 patients with CR were finally included, with a mean age of 59.1 ± 14.3 years, of which 113 (60.8%) were female. Sleep disturbance was defined as a PSQI score ≥ 6 and was identified in 56.5% of patients (105/186). By performing multivariate analysis, we determined that sleep disturbance was closely related to the female gender, a higher Beck Depression Inventory (BDI) score, a reduction in cervical mobility, an increase in C2-C7 sagittal vertical axis (C2-C7 SVA), and severe asymmetry of the paravertebral muscle at C5 and C6 levels. Conclusion In this study, we identified the high prevalence and potential high-risk factors of sleep disturbance in patients with CR. Clinicians should closely evaluate and monitor such patients and consider appropriate treatment strategies. Level of evidence IV.

Objective: Failed internal fixation of intertrochanteric fractures (FIF‐ITF) is often treated by conversion hip arthroplasty (CHA). This study aimed to evaluate the results and complications of using standard and long femoral stems in this operation.Methods: This retrospective, multi‐center study enrolled 31 total hip arthroplasty (THA) and 23 hemiarthroplasties (HA) cases (30 women, 24 men; mean age 76 years) after FIF‐ITF between 2012 and 2019, divided into two groups: standard stem group (n = 20) and long stem group (n = 34). The initial internal fixation includes 38 cases of proximal femoral nail anti‐rotation (PFNA), eight cases of the dynamic hip screw (DHS), and eight cases of locking proximal femoral plate (LPFP). The indications for CHA included 38 cases of failure of fixation, seven cases of nonunion, and nine cases of avascular necrosis or posttraumatic osteoarthritis. Perioperative data and complications related to fracture and operation were collected, and preoperative and postoperative clinical and radiological data were analyzed. Clinical outcomes were assessed using Harris hip score (HHS) and 36‐item Short Form survey (SF‐36: including physical function (PF) score and body pain (BP) score). Statistical analyses were performed using the chi‐square or Fisher's exact test, and the 2‐sample t‐test or Wilcoxon rank sum test.Results: At an average of 5.6 years with a minimum of 2 years follow‐up. A significant overall surgeon‐related complication rate was detected (27.8% [15/54]), five cases had an intraoperative femur fracture, one case had a late periprosthetic femoral fracture, two cases had a stem penetration, one case had a cement leakage, and two patients had an early postoperative dislocation, one infection and three cases of stem loosening or subsidence. Long stems had an increased risk of complication (13/34) compared to standard stems (2/20) (P = 0.031). The operation time and blood loss in the long stem group were higher than those in the standard stem group (P = 0.002; 0.017). HHS and SF‐36 significantly improved in both groups from preoperative to the final follow‐up and did not present significant differences at the final follow‐up (P > 0.05).Conclusion: CHA following FIF‐ITF showed a successful mid‐term clinical result, long stem arthroplasty should be approached with caution for the risks of higher complication rate, especially intraoperative femoral fractures.

The aim of this systematic review was to characterize the clinical features of adults with Salmonella osteomyelitis and summarize diagnosis and treatment methods to provide guidance for clinicians. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. We conducted a literature search in the PubMed, EMBASE, and Cochrane Library databases. Article screening and data extraction were performed by two reviewers individually. All the included studies were independently evaluated by two reviewers using the Methodological Index for Non‐Randomized Studies (MINORS) criteria. A total of 67 articles published between 1970 and 2019 were selected, which include 69 patients with an average age of 47.5 years (range, 18–79).The majority of cases (47.76%) occurred in immunocompetent adults without common risk factors. Aspiration and biopsy cultures were all positive in Salmonella osteomyelitis patients who underwent aspiration or biopsy. All infections were monomicrobial, and a total of 12 different serotypes were identified. The three most commonly reported Salmonella serotypes were Salmonella typhi (19 cases), Salmonella typhimurium (12 cases), and Salmonella enteritidis (11 cases). Only 12 of the 67 cases in our data (17.91%) had diarrhea symptoms, and 44 of the 67 cases (65.67%) had fever symptoms. Fifty‐nine of the 67 cases (88.06%) had local inflammatory manifestations, such as erythema, swelling, and tenderness in the affected area. The commonly reported involved sites were the vertebrae, femur, and tibia. Antibiotic therapy alone was utilized in 30 cases, and 24 patients (80.00%) were eventually cured. In total, 75.68% of patients achieved satisfactory results after treatment with surgery and antibiotics. Third‐generation cephalosporins were most commonly utilized, and antibiotic treatment was administered for an average of 11.3 weeks (95%CI, 8.31–14.37 weeks). Salmonella osteomyelitis should be considered in patients without any common risk factors. Aspiration or biopsy can facilitate the identification of pathogens to guide antibiotic choice. Empirical therapy with a third‐generation cephalosporin is recommended until the susceptibility of the strain is determined.

Objective: Fusobacterium nucleatum is an anaerobic gram‐negative bacilli that is one of the oral and other mucosal surface microbiota. It involves a wide range of human diseases and was first found in periodontal diseases, but reports of bone‐related infections caused by F. nucleatum are rare, especially periprosthetic joint infections (PJI).Methods: Here, we present the first case of acute hematogenous PJI of the hip joint caused by F. nucleatum, and debridement, antibiotics, and implant retention (DAIR) was performed.Results: The patient was successfully treated with DAIR, identification of isolates by metagenomics next‐generation sequencing was confirmed by polymerase chain reaction.Conclusions: For stable acute hematogenous PJI after hip replacement, quick and accurate diagnosis, the identification of pathogenic microorganisms, and the use of DAIR combined with sufficient sensitive antibiotics have a certain clinical effect and can achieve the purpose of both preserving the prosthesis and infection control.