Unraveling the molecular landscape of osteoarthritis: A comprehensive review focused on the role of non-coding RNAs.

Osteoarthritis (OA) poses a significant global health challenge, with its prevalence anticipated to increase in the coming years. This review delves into the emerging molecular biomarkers in OA pathology, focusing on the roles of various molecules such as metabolites, noncoding RNAs (ncRNAs), including microRNAs (miRNAs) and long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs). Advances in omics technologies have transformed biomarker identification, enabling comprehensive analyses of the complex pathways involved in OA pathogenesis. Notably, ncRNAs, especially miRNAs and lncRNAs, exhibit dysregulated expression patterns in OA, presenting promising opportunities for diagnosis and therapy. Additionally, the intricate interplay between epigenetic modifications and OA progression highlights the regulatory role of epigenetics in gene expression dynamics. Genome-wide association studies have pinpointed key genes undergoing epigenetic changes, providing insights into the inflammatory processes and chondrocyte hypertrophy typical of OA. Understanding the molecular landscape of OA, including biomarkers and epigenetic mechanisms, holds significant potential for developing innovative diagnostic tools and therapeutic strategies for OA management.

Epidemiological Characteristics of Pediatric Supracondylar of Humerus Fractures in a Tertiary Hospital in Iran.

Objectives: Supracondylar humerus fracture (SHF) is the most common fracture observed in children. The present study aimed to assess the characteristic parameters in one of the most extensive available pediatric SHF series referred to a tertiary hospital in Iran. Methods: The medical profiles of the SHF patients who were referred to our tertiary hospital between January 2017 and January 2022 were retrospectively reviewed. The inclusion criteria entailed age < 14 years and a radiographically confirmed diagnosis of SHF. The collected data included age, gender, side of injury, mechanism of injury, season of the injury, concurrent complications, type of fracture, and treatment. Results: A total of 1,309 patients with a mean age of 7.7±2.7 years were included in this study. The incidence of SHF was 1.8-fold higher in males, while the mean age of incidence was significantly lower in female patients (7.2 vs. 8 years; P<0.001). Falling was the most frequent mechanism of injury (97%). Gartland type I was the most prevalent type of injury (n=482; 36.8%). Moreover, the majority of fractures were extension-type (n=1,249; 95.4%). Most patients were managed conservatively (n=785; 60%). Concurrent fractures as well as neuralgic, vascular, and muscular complications were present in 3%, 1.45%, 1.22%, and 0.5% of patients, respectively. Conclusion: As evidenced by the results of this study, SHF is prevalent among the Iranian pediatric population. Therefore, greater awareness is required regarding the high incidence of this fracture in this population and its adequate management with respect to concurrent complications, particularly neurovascular compromise.

All-inside anterior cruciate ligament reconstruction with and without anterolateral ligament reconstruction: a prospective study.

BACKGROUND: There is no clear consensus regarding the superiority of a combined anterior cruciate ligament reconstruction (ACLR) with anterolateral ligament reconstruction (ALLR) versus an isolated ACLR. In this study, we compared the postoperative stability profile, complications, and patient-reported outcomes of these procedures. METHODS: Twenty-one patients with an anterior cruciate ligament (ACL) tear who were either treated by an isolated all-inside ACLR (n = 21) or a combined all-inside ACLR and ALLR (n = 20) were included. The outcomes were evaluated in the last follow-up and included the postoperative stability profile evaluated by the Lachman test, pivot shift test, and KT-1000 side-to-side difference, postoperative complications, and patient-reported outcomes evaluated by the International Knee Documentation Committee (IKDC) score and Lysholm knee scale. RESULTS: The baseline characteristics of the two groups were not significantly different. The residual Lachman and pivot shift were not significantly different between the two groups (P = 0.41 and P = 0.18, respectively). The mean KT-1000 side-to-side difference was 1.93 ± 1.9 mm in the isolated and 1.635 ± 0.91 mm in the combined group (P = 0.01). The mean improvement of the IKDC score was not significantly different between the isolated and combined groups (24.7 vs. 25.2, P = 0.28). The mean improvement of the Lysholm scale was not significantly different between the isolated and combined groups (33.5 vs. 34.1, P = 0.19). ACL re-rupture occurred in three patients of the isolated group and no patient of the combined group. CONCLUSION: The outcomes of patients in the present study support performing a combined ALL and ACL reconstruction.

Acetabular and sacral insufficiency fractures in a patient with a long-term history of Alendronate consumption; a case report.

BACKGROUND: Long-term Bisphosphonate consumption has been reported to be associated with the incidence of atypical or insufficiency fracture, particularly in the proximal femur. We observed a case of acetabular and sacral insufficiency fractures in a patient with a long-term history of Alendronate consumption. CASE PRESENTATION: A 62-year-old woman was admitted with a complaint of pain in right lower limb following low-energy trauma. The patient had a history of Alendronate consumption for more than 10 years. The bone scan revealed increased radiotracer uptake in the right side of the pelvic, proximal right femur, and sacroiliac joint. The radiographs showed type 1 sacrum fracture, acetabulum fracture with femur head protrusion into the pelvis, quadrilateral surface fracture, fracture of the right anterior column, and right superior and inferior pubic fracture. The patient was treated with total hip arthroplasty. CONCLUSION: This case highlights the concerns regarding long-term bisphosphonate therapy and its potential complications.

Emerging role of mesenchymal stem/stromal cells (MSCs) and MSCs-derived exosomes in bone- and joint-associated musculoskeletal disorders: a new frontier.

Exosomes are membranous vesicles with a 30 to 150 nm diameter secreted by mesenchymal stem/stromal cells (MSCs) and other cells, such as immune cells and cancer cells. Exosomes convey proteins, bioactive lipids, and genetic components to recipient cells, such as microRNAs (miRNAs). Consequently, they have been implicated in regulating intercellular communication mediators under physiological and pathological circumstances. Exosomes therapy as a cell-free approach bypasses many concerns regarding the therapeutic application of stem/stromal cells, including undesirable proliferation, heterogeneity, and immunogenic effects. Indeed, exosomes have become a promising strategy to treat human diseases, particularly bone- and joint-associated musculoskeletal disorders, because of their characteristics, such as potentiated stability in circulation, biocompatibility, low immunogenicity, and toxicity. In this light, a diversity of studies have indicated that inhibiting inflammation, inducing angiogenesis, provoking osteoblast and chondrocyte proliferation and migration, and negative regulation of matrix-degrading enzymes result in bone and cartilage recovery upon administration of MSCs-derived exosomes. Notwithstanding, insufficient quantity of isolated exosomes, lack of reliable potency test, and exosomes heterogeneity hurdle their application in clinics. Herein, we will deliver an outline respecting the advantages of MSCs-derived exosomes-based therapy in common bone- and joint-associated musculoskeletal disorders. Moreover, we will have a glimpse the underlying mechanism behind the MSCs-elicited therapeutic merits in these conditions.

Simultaneous femoral head reduction osteotomy (FHRO) combined with periacetabular osteotomy (PAO) for the treatment of severe femoral head asphericity in Perthes disease.

BACKGROUND: The purpose of this study is to describe the midterm clinical and radiologic outcomes of concurrent femoral head reduction osteotomy (FHRO) and periacetabular osteotomy (PAO) in Legg-Calvé-Perthes disease (LCPD) patients with major aspherical femoral head deformities. METHODS: The study included four Perthes patients in Stage IV of Waldenstrom's classification with a mean age of 10.5 and severe femoral head asphericity. They were treated with a combination of FHRO + PAO and followed for at least 2 years. An evaluation of the radiological outcome of the surgery was carried out based on the lateral center to edge angle (LCEA), the anterior center to edge angle (ACEA), the Tönnis angle, the head sphericity index, the Stulberg classification, the extrusion index, and Shenton's line integrity. An evaluation of the clinical outcome was made by evaluating hip range of motion (ROM), Harris hip score (HHS), and Merle d'Aubigne´-Postel score. RESULTS: All radiographic measures improved; three patients were classified as Stulberg class II and one as class III. The LCEA, ACEA, and Tönnis angle improved by 29° (from 3° to 32°), 16° (from 14° to 30°), and - 10° (from 18° to 8°), respectively. The mean femoral head sphericity index and extrusion index improved by 12% (from 83 to 95%) and - 33% (from 40 to 7%). No disruption was observed in the postoperative Shenton's line. According to HHS, all patients have shown excellent hip function, which improved by 27 points (from 69 to 96). Moreover, the hip ROM was increased from 222° to 267°. The follow-up period did not reveal any serious postoperative complications, such as osteonecrosis or conversion to arthroplasty. CONCLUSIONS: Combined FHRO with PAO may improve the hip joint's morphology and function in patients with residual femoral head deformity and acetabular dysplasia due to LCPD. Despite being considered a complex and demanding hip surgery, these results suggest a more widespread implication of the salvage procedure.

Length of hospital stay and mortality of hip fracture surgery in patients with Coronavirus disease 2019 (COVID-19) infection: A systematic review and meta-analysis.

Coronavirus disease 2019 (COVID-19) patients who undergo hip fracture surgery are expected to have worse outcomes because they are vulnerable to developing COVID-19-associated complications. The present review attempted to assess the in-hospital and 30-day mortality rates as well as the length of hospital stay in patients with COVID-19 infection who had hip fracture surgery. METHODS: Two authors independently searched Google Scholar, PubMed, Web of Knowledge, SCOPUS, and Embase, based on the MeSH-matched scientific keywords. The nine-star Newcastle-Ottawa Scale (NOS) scoring system was employed to assess the methodological quality of all eligible studies. RESULTS: Eleven cohort studies that included 336 patients comprised the study. Three studies reported in-hospital mortality. Eight studies reported 30-day postoperative mortality. The pooled in-hospital mortality rate was 29.8% (95% CI: 26.6%-35.6%). The pooled 30-day postoperative mortality rate was 35.0% (95% CI: 29.9%-40.5%). The mean hospital stay was 11.29 days (95% CI: 10.65 days-11.94 days). CONCLUSIONS: The rates of in-hospital and 30-day mortality in COVID-19 patients who undergo hip fracture surgery is high. These data suggest delaying hip fracture surgery until COVID-19 infection of the patients is controlled. LEVEL OF EVIDENCE: Level II.

Experimental Study on Protective Role of NSAID on Articular Cartilage Destruction in Septic Arthritis.

BACKGROUND: Surgical drainage and antibiotic therapy are the cornerstones of treatment protocols in septic arthritis; however, in some circumstances, the diagnosis and initiation of treatment may be retarded by slow disease progression or the time when the patient's condition precludes early surgery. Therefore, it is beneficial to find ways to reduce the amount of articular injury. This study aimed to evaluate the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on the prevention of articular cartilage damage in an animal model of staphylococcal septic arthritis. METHODS: Knee joints of 40 rabbits were infected by the intra-articular injection of 105 colony-forming units of Staphylococcus aureus. Subsequently, they were categorized into four groups. The first (i.e., control group) and second groups were treated with a placebo and intramuscular injection of Ceftriaxone, respectively. Moreover, the third and fourth groups were treated with Naproxen alone and a combination of Ceftriaxone and Naproxen, respectively. All medications were started 24 h after the inoculation of microorganisms into the knee joint and continued for 3 days. Following that, the cartilage was evaluated using the International Cartilage Repair Society (ICRS) Visual Histological Assessment Scale. RESULTS: The group treated with the combination of Ceftriaxone and Naproxen obtained better results in terms of cell viability in tibial side cartilage and surface in both tibial and femoral cartilages (P<0.0125), compared to the group treated with antibiotics alone. CONCLUSION: According to the results, in case of septic arthritis, the early administration of NSAID in conjunction with an appropriate systemic antibiotic may decrease further articular cartilage damage that is evoked by an infection.

Potential Role of Local Estrogen in Enhancement of Fracture Healing: Preclinical Study in Rabbits.

BACKGROUND: Effects of estrogen on bone metabolism and its protective role on prevention of osteoporosis are well documented. However, the efficacy of estrogen treatment on bone healing is not well investigated. The drug can be delivered both systemically or locally to the bone with differences in concentrations and side effects. The aim of this study was to investigate the effect of local and systemic administration of estrogen on the fracture healing process. METHODS: Standardized tibial fractures with 4 millimeter gaps were created in twenty four adult male Dutch rabbits. Fractures were fixed using intramedullary wires and long leg casts. Rabbits were randomly divided into three groups. Group A was treated with twice a week administration of long acting systemic estrogen; group B was treated with a similar regimen given locally at the fracture gap; and group C received sham normal saline injections (control). Fracture healing was assessed at six weeks post fracture by gross examination, radiographic and histomorphometric analysis. RESULTS: Group B had significantly higher gross stability, radiographic union and gap reduction than the two other groups. Histomorphometric analysis showed higher cartilaginous proportion of periosteal callus area in the control group. CONCLUSIONS: Our results showed that estrogen may enhance fracture healing of long bone in rabbits. Furthermore, local estrogen treatment might have better effect than systemic treatment.

Mental health status of infertile couples based on treatment outcome.

BACKGROUND: Infertility is accompanied by numerous psychological and social problems. Infertile couples are more anxious and emotionally distressed than other fertile people. Previous studies suggested that infertility is more stressful for women than men. OBJECTIVE: The purpose of this study was to determine the status of general health of infertile couples. MATERIALS AND METHODS: This cross-sectional study evaluated general health of 150 infertile couples attending to Yazd Research and Clinical Center for Infertility that were selected consequently. The data were gathered by the researchers, based on face to face interview before and after three months of treatment by two questionnaires. The first questionnaire had questions on demographic information and the second one was the General Health Questionnaire-28 (GHQ-28). This questionnaire has four sub- scales areas. All data were transferred directly to SPSS 15 and analyzed. RESULTS: The mean age of women was 28.3 and men were 32.4 years. The scores for all sub- scales of GHQ in women were more than men. There was significant difference between age and general health at physical symptoms scales (p=0.002), anxiety and sleep disorders (p=0.003). The age group 25-29 years had higher scores (more than 7) than other age groups. There was significant difference between the scale of social dysfunction and results of treatment. CONCLUSION: Our results, similar to the previous studies have revealed negetive social and mental effects of infertility on women is more than men, so there is need that they be educated specially.

Evaluation of the general health of the infertile couples.

BACKGROUND: The prevalence of infertility is variable between 5-30% around the world. In Iran, more than 2 million couples suffer from infertility. Infertility causes depression, anxiety, social isolation and sexual dysfunction. OBJECTIVE: This descriptive study was undertaken to determine general health in infertile couples. MATERIALS AND METHODS: One hundred and fifty infertile couples attending Yazd Research and Clinical Center for Infertility were randomly selected during March till September 2009. The GHQ-28 questionnaires were completed by researchers, based on face to face interview. It contains 28 items, which have been divided to four sub- items. The results come out by scoring the patients answer from 0 to 84. All data were analyzed by Chi-square and t-test in SPSS software. RESULTS: GHQ scores of all sub-scales and total in women were more than men, which shows general health condition in women is worse than men. There was no relation between the duration of infertility and general health scores. CONCLUSION: This study suggests that the infertility has significant effect (p=0.001) on health situation of infertile couples, especially infertile women. They are at risk of somatic symptoms (p=0.0001), social dysfunction (p=0.0001) and severe depression (p=0.0001). GHQ could provided help and support in order to improve the health situation of infertile couples.