Yongtao Mao

Objectives: The discoid lateral meniscus (DLM) is the most prevalent variant type of the lateral meniscus, and its formation is closely related to specific anatomical features of the tibial plateau. The objective of this study was to systematically evaluate the combined predictive contribution of multiple tibial plateau anatomical parameters and to develop subtype-specific machine-learning models using routinely obtainable radiographic features for the identification of both CDLM and the comparatively understudied ICDLM. Methods: This was a retrospective clinical study, and a total of 494 patients were included, of which the experimental group consisted of 145 patients with complete discoid lateral meniscus (CDLM) and 64 patients with incomplete discoid lateral meniscus (ICDLM), and the control group consisted of 285 patients with normal lateral meniscus (NLM). A number of tibial plateau anatomical parameters were measured radiographically, including tibial plateau width, fibular head height, lateral joint space, height of lateral tibial spine, height of medial tibial spine, lateral slope of the lateral tibial spine, lateral slope of the medial tibial spine, tibial spinous width and tibial eminence width. All data were analyzed by gender grouping in order to compare differences between and within groups. Subsequently, the Least Absolute Shrinkage with Selection Operator (LASSO) regression algorithm was used to screen the feature variables. Seven machine learning prediction models (including: Random Forest, XGBoost, Support Vector Machine (SVM), Logistic Regression, K-Nearest Neighbor (KNN), Naive Bayes, and Gradient Boosting) were constructed based on the screened feature variables, and the best model was selected. Using SHAP (Shapley Additive Explanations) to quantitatively analyze the contribution of each characteristic variable, thereby assessing the relative importance of the characteristic factors and increasing the interpretability of the model. Results: Gender, lateral joint space, height of lateral tibial spine, lateral slope of the lateral tibial spine, lateral slope of the medial tibial spine, and tibial eminence width/tibial plateau width can be used as characteristic parameters of lateral discoid meniscus and lateral incomplete discoid meniscus. Based on these parameters, the best-performing models achieved good discriminative performance for both CDLM and ICDLM in the held-out validation sets, with AUC values of 0.885 and 0.861, respectively. Conclusion: Tibial plateau anatomical parameters may facilitate the identification of DLM. Machine-learning models integrating these parameters provide an efficient radiograph-based approach to support the early recognition of DLM.

Osteomyelitis is a disease with a complex etiology and a high recurrence rate, which causes significant distress to both patients and physicians. There is currently no clear understanding of the factors that influence the progression of osteomyelitis. Previously, only small-sample observational studies have demonstrated an association between osteomyelitis, plasma lipidomics and immune cell characteristics. The objective of this study is to analyze the causal relationship between lipidomics and osteomyelitis by Mendelian randomization and to determine the mediating role of immune cells in this process. This study validated the causal relationship between osteomyelitis and 179 lipid species by two-sample Mendelian randomization analysis using publicly available genetic data. To ensure the reliability of the findings, this study employed both sensitivity analysis and inverse Mendelian randomization analysis. Furthermore, this study used two-step Mendelian to quantify the proportion of immune cell characteristics mediated lipidomics in osteomyelitis. After rigorous screening of instrumental variables, and multiple Mendelian randomization methods, this study identified a causal relationship between 5 lipid species and 20 immune cell traits and osteomyelitis. Through a comprehensive analysis of causality, this study identified an increased risk of osteomyelitis with increased Diacylglycerol (d40:2) levels (inverse variance-weighted method, [OR] per SD increase in osteomyelitis = 1.147 [95% CI 1.46–1.276], P = 0.004) and 10.665% was mediated through CD27 on IgD-CD38dim. However, It has been demonstrated that an increase in Diacylglycerol (16:1_18:1) levels (inverse variance-weighted method, [OR] per SD increase in osteomyelitis = 0.887 [95% CI 0.800–0.983], P = 0.023) reduces the risk of osteomyelitis and 6.640% was mediated through CD20 on IgD+ . This study reveals that increased Ceramide (d40:2) levels increase the risk of developing osteomyelitis, with CD27 on IgD-CD38dim mediating part of the effect. At the same time, Diacylglycerol (16:1_18:1) levels were increased and would reduce the risk of developing osteomyelitis, partly mediated through CD20 on IgD+ . This study further reveals the factors affecting the development and progression of osteomyelitis and provides new ideas for the treatment of osteomyelitis.

Background: Osteoporosis is a multifactorial bone disease in which lipid metabolism plays an important role. Bone Mineral Density (BMD) measured by Dual-energy X-ray Absorptiometry (DXA) is a critical indicator for diagnosing osteoporosis. The cardiometabolic index (CMI) is a novel metric that combines two quantitative indicators of blood lipids—triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C). This study explores the association between CMI and BMD and seeks to elucidate the role of lipid metabolism in the context of bone health.Methods: Based on the data of the National Health and Nutrition Examination Survey (NHANES) 2017–March 2020-pre-pandemic, weighted multiple linear regression and smooth curve fitting were used to study the relationship between CMI and femoral BMD. Stratified analyses were also conducted for age, gender, BMI, ethnicity, diabetes and hypertension status. And, the saturation threshold effect of CMI was further analyzed using a two-stage linear regression model.Result: This study enrolled a total of 1,650 participants (48.7% males), with an average age of 63.0 ± 8.6 years. After adjusting for multiple confounding factors, CMI was positively correlated with total femur BMD, trochanter BMD, and intertrochanter BMD, while the correlation with femur neck BMD was not statistically significant. In the fully adjusted model, each unit increase in CMI was associated with a 0.026 (g/cm²) increase in total femur BMD, a 0.022 (g/cm²) increase in trochanter BMD, and a 0.034 (g/cm²) increase in intertrochanter BMD. Subjects in the highest quartile of CMI had a 0.034 (g/cm²) increase in total femur BMD, a 0.035 (g/cm²) increase in trochanter BMD, and a 0.039 (g/cm²) increase in intertrochanter BMD in the fully-adjusted model compared to those in the lowest quartile. In addition, saturation was observed between CMI and total femur BMD, trochanter BMD and intertrochanter BMD, with saturation thresholds of 1.073, 1.431 and 1.073, respectively.Conclusion: CMI is strongly associated with BMD, indicating its potential relevance in bone metabolism. However, the role of CMI in the context of bone health, especially regarding osteoporosis risk, requires further investigation in large-scale prospective studies.

Purpose: To identify MRI-detected anatomical risk factors for non-contact anterior cruciate ligament (ACL) injuries across genders. Methods: A retrospective analysis was performed on 141 ACL-reconstructed patients (35 females, 106 males) and 142 controls (37 females, 105 males) from January 2020 to April 2022. Inclusion criteria were primary non-contact ACL injuries. The tibial plateau slope, lateral femoral condyle index, Insall-Salvati index, and patellar tendon angle were measured, using binary logistic regression for gender-specific risk evaluation. Results: Increased lateral tibial plateau slope, reduced intercondylar notch width index, lateral femoral condyle index, and patellar tendon angle correlated with ACL injuries in both genders. The Insall-Salvati index was a significant risk factor in females but not in males. Conclusion: This study identifies the lateral tibial plateau slope, notch width index, lateral femoral condyle index, and patellar tendon angle at near-extension as risk factors for ACL injuries in both genders, with the Insall-Salvati index also implicated in females.

Background Relationship between lead exposure and children's bone health remains controversial. The aim of this study was to investigate the relationship between blood lead levels (BLL) and femur bone mineral density (BMD). All data came from the National Health and Nutrition Examination Survey (NHANES) database, 2005–2010. Methods A total of 3331 subjects aged 8–18 years were enrolled in this study. Multivariate linear regression models were used to explore the relationship between BLL and femur BMD. And further stratified analyses by gender and ethnicity. Additionally smooth curve fitting was used to explore the saturation threshold effect between the two. Result There was a significant negative correlation between BLL and BMD in different parts of the femur in children. For every 1ug/dl increase in BLL, total femur BMD, femoral neck BMD, femoral trochanter BMD, and femoral intertrochanteric BMD decreased by 0.008 g/cm2, 0.007 g/cm2, 0.007 g/cm2, and 0.008 g/cm2, and the saturation threshold for BLL were 1.73ug/dl; 1.61ug/dl, 1.80 ug/dl, and 1.66ug/dl. Conclusion This study shows that low-dose blood lead levels, even those within the reference range, can have a significant negative impact on children's bone health.

Early recognition of malnutrition is essential to improve the prognosis of older patients with hip fracture. The Nutritional Risk Screening 2002 (NRS-2002), the Short-Form Mini Nutritional Assessment (MNA-SF) and the Global Leadership Initiative on Malnutrition (GLIM) are widely used in malnutrition diagnosis. However, criteria for predicting postoperative hip joint motor function in older patients with hip fractures are still necessary. The objective of this study was to select the most appropriate criteria from the NRS-2002, the MNA-SF and the GLIM in predicting the postoperative hip joint motor function recovery 1 year after surgery. This retrospective observational study included 161 patients aged ≥ 65 years with hip fractures. The nutritional status of patients was determined by the NRS-2002, MNA-SF and GLIM. The Harris hip joint score (HHS), the primary outcome of this study, was used to evaluate hip joint motor function. HHS was classified as excellent (HHS > 75) or non-excellent outcomes (HHS ≤ 75). Logistic regression models for hip joint motor function recovery were constructed. Both the receiver operating characteristic curve and the decision curve analysis were used to select the most predictive criteria. The overall mean age of the 161 patients was 77.90 ± 8.17. As a result, NRS-2002 (OR:0.06, 95%CI [0.01, 0.17]), MNA-SF (OR:0.05, 95%CI [0.00, 0.23]) and GLIM (OR of moderate: 0.03, 95%CI [0.01, 0.11]; OR of severe: 0.02 [0.00, 0.07]) were predictive for recovery of hip joint motor function. Additionally, both the area under curve of the receiver operating characteristic curve (NRS-2002: 81.2 [73.8, 88.6], MNA-SF: 76.3 [68.5, 84.2], GLIM: 86.2 [79.6,92.8]) and the decision curve analysis showed the GLIM was better than others. Compared with NRS-2002 and MNA-SF, GLIM was a more suitable nutritional assessment criteria to predict the postoperative recovery of hip joint motor function for older patients with hip fracture 1 year after surgery.

In the present study, we aimed to investigate the clinical outcomes of arthroscopic discoid lateral meniscus (DLM) plasty and the adaptive changes in the patellofemoral joint after surgery. From September 2010 to March 2012, 25 patients with DLM injuries who underwent arthroscopic meniscus plasty were enrolled in the prospective study. All patients underwent clinical evaluation before the operation and at the last follow-up, and imaging evaluation was performed by upright magnetic resonance imaging before and 1 month after the operation as well as at the last follow-up. Clinical evaluation included Lysholm score, Kujala score, McMurray’s sign, patellar mobility, patella grind test, and quadriceps atrophy. Imaging evaluation included bisect offset index, patella tilt angle (PTA), and cartilage damage. Lysholm score, Kujala score, McMurray’s sign, and quadriceps atrophy at the last follow-up were significantly improved compared with the preoperative levels (P < .05). At the last follow-up, there were no statistical differences in patella mobility and patella grind test compared with the preoperative levels. In addition, bisect offset index and PTA showed a dynamic trend of rising and then falling over time (P < .05). At 1 month after the operation, bisect offset index and PTA were significantly increased compared with the preoperative levels or the values at the last follow-up (P < .05), while there were no differences between the preoperation and the last follow-up. Cartilage damage became worse with time (P < 0.05), and the 2 were positively correlated (Spearman = 0.368). At the last follow-up, the degree of cartilage damage was significantly increased compared with the preoperative level (P < .017), while there was no significant difference between the 1-month postoperative grade and the preoperational grade or the last follow-up grade. The effect of arthroscopic DLM plasty on the patellofemoral joint was dynamic, with the position of the patella deviating in the early stages and recovering in the mid-term, especially when the knee was in the biomechanical standing position. In addition, the patellofemoral joint cartilage might undergo accelerated degeneration after the operation, while the mid-term effect of the operation was positive, and the patellofemoral joint function was acceptable.