The Effect of Antibacterial-Osteogenic Surface Modification on the Osseointegration of Titanium Implants: A Static and Dynamic Strategy.

Titanium (Ti) and its alloys are widely used biomaterials in bone repair. Although these biomaterials possess stable properties and good biocompatibility, the high elastic modulus and low surface activity of Ti implants have often been associated with infection, inflammation, and poor osteogenesis. Therefore, there is an urgent need to modify the surface of Ti implants, where changes in surface morphology or coatings loading can confer specific functions to help them adapt to the osseointegration formation phase and resist bacterial infection. This can further ensure a healthy microenvironment for bone regeneration as well as the promotion of immunomodulation, angiogenesis, and osteogenesis. Therefore, in this review, we evaluated various functional Ti implants after surface modification, both in terms of static modifications and dynamic response strategies, mainly focusing on the synergistic effects of antimicrobial activities and functionalized osteogenic. Finally, the current challenges and future perspectives are summarized to provide innovative and effective solutions for osseointegration and bone defect repair.

Discrimination and simultaneous quantification of poly(ethylene terephthalate) and poly(butylene terephthalate) microplastics in environmental samples via gas chromatography-tandem mass spectrometry.

A method has been developed to quantify PET and PBT microplastics (MPs) based on depolymerization and detection of depolymerization products by gas chromatography-tandem mass spectrometry (GC-MS/MS) without a complex separation process from environmental samples. Under the optimal depolymerization conditions, PET and PBT were efficiently converted to ethylene glycol (78%) and 1,4-butanediol (87%), respectively. Subsequently, the linear curves were constructed between signal intensities of depolymerization products and polymer masses by GC-MS/MS, and the correlation coefficients of PET and PBT were 0.996 and 0.997, respectively. The spiking and recovery experiments of PET and PBT in the environmental samples showed that the recovery was stable in the range 89-100%, and the limit of detection was 4.95 µg and 1.39 µg of PET and PBT, respectively. The method has been proven to be capable of simultaneous identification and quantification of PBT and PET MPs in real environmental water samples without complex separation process, which provided a scheme for the determination of microplastics.

Investigation into the effect of deltoid ligament injury on rotational ankle instability using a three-dimensional ankle finite element model.

Background: Injury to the lateral collateral ligament of the ankle may cause ankle instability and, when combined with deltoid ligament (DL) injury, may lead to a more complex situation known as rotational ankle instability (RAI). It is unclear how DL rupture interferes with the mechanical function of an ankle joint with RAI. Purpose: To study the influence of DL injury on the biomechanical function of the ankle joint. Methods: A comprehensive finite element model of an ankle joint, incorporating detailed ligaments, was developed from MRI scans of an adult female. A range of ligament injury scenarios were simulated in the ankle joint model, which was then subjected to a static standing load of 300 N and a 1.5 Nm internal and external rotation torque. The analysis focused on comparing the distribution and peak values of von Mises stress in the articular cartilages of both the tibia and talus and measuring the talus rotation angle and contact area of the talocrural joint. Results: The dimensions and location of insertion points of ligaments in the finite element ankle model were adopted from previous anatomical research and dissection studies. The anterior drawer distance in the finite element model was within 6.5% of the anatomical range, and the talus tilt angle was within 3% of anatomical results. During static standing, a combined rupture of the anterior talofibular ligament (ATFL) and anterior tibiotalar ligament (ATTL) generates new stress concentrations on the talus cartilage, which markedly increases the joint contact area and stress on the cartilage. During static standing with external rotation, the anterior talofibular ligament and anterior tibiotalar ligament ruptured the ankle's rotational angle by 21.8% compared to an intact joint. In contrast, static standing with internal rotation led to a similar increase in stress and a nearly 2.5 times increase in the talus rotational angle. Conclusion: Injury to the DL altered the stress distribution in the tibiotalar joint and increased the talus rotation angle when subjected to a rotational torque, which may increase the risk of RAI. When treating RAI, it is essential to address not only multi-band DL injuries but also single-band deep DL injuries, especially those affecting the ATTL.

Multifaceted Materials for Enhanced Osteogenesis and Antimicrobial Properties on Bioplastic Polyetheretherketone Surfaces: A Review.

Implant-associated infections and the increasing number of bone implants loosening and falling off after implantation have become urgent global challenges, hence the need for intelligent alternative solutions to combat implant loosening and falling off. The application of polyetheretherketone (PEEK) in biomedical and medical therapy has aroused great interest, especially because its elastic modulus close to bone provides an effective alternative to titanium implants, thereby preventing the possibility of bone implants loosening and falling off due to the mismatch of elastic modulus. In this Review, we provide a comprehensive overview of recent advances in surface modifications to prevent bone binding deficiency and bacterial infection after implantation of bone implants, starting with inorganics for surface modification, followed by organics that can effectively promote bone integration and antimicrobial action. In addition, surface modifications derived from cells and related products of biological activity have been proposed, and there is increasing evidence of clinical potential. Finally, the advantages and future challenges of surface strategies against medical associated poor osseointegration and infection are discussed, with promising prospects for developing novel osseointegration and antimicrobial PEEK materials.

Effects of short- and long-term exposures to multiple air pollutants on depression among the labor force: A nationwide longitudinal study in China.

BACKGROUND: Depression prevalence has surged within the labor force population in recent years. While links between air pollutants and depression were explored, there was a notable scarcity of research focusing on the workforce. METHODS: This nationwide longitudinal study analyzed 27,457 workers aged 15-64. We estimated monthly mean concentrations of fine particulate matter (PM2.5), its primary components, and Ozone (O3) at participants' residences using spatiotemporal models. To assess the relationship between short- (1 to 3 months) and long-term (1 to 2 years) exposure to various air pollutants and depressive levels and occurrences, we employed linear mixed-effects models and mixed-effects logistic regression. We considered potential occupational moderators, such as labor contracts, overtime compensation, and total annual income. RESULTS: We found significant increases in depression risks within the workforce linked to both short- and long-term air pollution exposure. A 10 µg/m3 rise in 2-year average PM2.5, black carbon (BC), and O3 concentrations correlated with increments in depressive scores of 0.009, 0.173, and 0.010, and a higher likelihood of depression prevalence by 0.5 %, 12.6 %, and 0.7 %. The impacts of air pollutants and depression were more prominent in people without labor contracts, overtime compensation, and lower total incomes. CONCLUSION: Exposures to air pollutants could increase the risk of depression in the labor force population. The mitigating effects of higher income, benefits, and job security against depression underscore the need for focused mental health interventions.

The application of small intestinal submucosa in tissue regeneration.

The distinctive three-dimensional architecture, biological functionality, minimal immunogenicity, and inherent biodegradability of small intestinal submucosa extracellular matrix materials have attracted considerable interest and found wide-ranging applications in the domain of tissue regeneration engineering. This article presents a comprehensive examination of the structure and role of small intestinal submucosa, delving into diverse preparation techniques and classifications. Additionally, it proposes approaches for evaluating and modifying SIS scaffolds. Moreover, the advancements of SIS in the regeneration of skin, bone, heart valves, blood vessels, bladder, uterus, and urethra are thoroughly explored, accompanied by their respective future prospects. Consequently, this review enhances our understanding of the applications of SIS in tissue and organ repair and keeps researchers up-to-date with the latest research advancements in this area.

DNA methylation mediates the effects of PM2.5 and O3 on ceramide metabolism: A novel mechanistic link between air pollution and insulin resistance.

Insulin resistance (IR), linked to air pollution, is an initial stage of early-onset Type 2 diabetes mellitus (T2DM). While ceramide metabolism plays an important role in IR pathogenesis, the effects of air pollution on this process and its mechanisms remain unclear. We recruited young adults aged 18-30 years to a panel study in Wuhan, China. Using personal portable devices and stationary monitoring stations, we tracked particulate matter with aerodynamic diameters≤ 2.5 µm (PM2.5) and Ozone (O3) levels. Liquid chromatography/mass spectrometry (LC-MS) based metabolomics quantified ceramide metabolism, and Illumina Infinium Human Methylation 850 kBeadChip assay measured deoxyribonucleic acid (DNA) methylation. Linear mixed-effects models assessed relationships of air pollution with i) IR indexes, ii) ceramide metabolism, and iii) DNA methylation. Mediation analysis was subsequently performed to evaluate the potential mediating effect of DNA methylation in the association between air pollution and ceramide metabolism. PM2.5 and O3 were associated with elevated IR. Specifically, each 10 µg/m3 increase in PM2.5 and O3 at lag0-12 h significantly increased triglyceride­glucose index (TyG index) and TyG-BMI (TyG - Body mass index) by 0.88%, 0.89% and 0.26%, 0.26%, respectively. Furthermore, levels of eight ceramides were altered by air pollution exposure, and nine methylated CpG sites in inflammation genes mediated the effects of air pollution on ceramide metabolism. Our findings imply the existence of a novel mechanism connecting air pollution to IR.

The Impact of Air Pollution on Physical Functioning Decline and the Benefits of Greenness: Evidence From a Nationwide Cohort Study.

BACKGROUND: Physical functional limitations (PFLs) increase the vulnerability of adults, but their pathogenesis remains unclear. METHODS: We conducted a nationwide longitudinal study on 62 749 records from 18 878 adults (aged ≥45) from 28 provinces in China. Risk of PFLs was assessed using a validated 9-item questionnaire. Exposure levels of air pollutants (PM10, PM2.5, and PM1) and greenness (normalized difference vegetation index, NDVI) were estimated using a satellite-based spatiotemporal model. We used the cumulative link mixed effects model to estimate the associations between short-term and long-term exposure to air pollutants, greenness, and risk of PFLs. We employed the interaction effect model to evaluate interactions between air pollutants and greenness. RESULTS: Participants were 60.9 ±â€…9.6 years, with an average follow-up of 5.87 (1.65) years. Exposure to air pollution was significantly associated with a higher risk of PFLs. For instance, the odds ratio (OR) associated with each 10 µg/m3 higher in 6-month averaged PM10, PM2.5, and PM1 were 1.025 (95% CI: 1.015-1.035), 1.035 (95% CI: 1.018-1.054), and 1.029 (95% CI: 1.007-1.050), respectively. Conversely, exposure to greenness was associated with decreased risk of PFLs; the OR associated with each 1-unit higher in 1-year averaged NDVI was 0.724 (95% CI: 0.544-0.962). Furthermore, higher greenness levels were found to mitigate the adverse effects of 1-year, 6-month, 1-month averaged PM10, and 1-year averaged PM2.5 on the risk of PFLs. CONCLUSIONS: Air pollution raises the risk of PFLs, whereas greenness could mitigate the adverse effects. Reducing air pollution and enhancing greenness could prevent physical functioning.

Bone marrow edema at ligament insertion is an accurate MRI sign of deltoid ligament injury.

BACKGROUND: Magnetic resonance imaging (MRI) is effective in diagnosing deltoid ligament (DL) injury but its sensitivity in chronic cases is low. Additional diagnostic signs are required to reduce the risk of a false negative diagnosis. PURPOSE: To evaluate the added diagnostic value of bone marrow edema at the ligament insertion (BMELI) of DL to the MRI assessment of chronic DL injury. MATERIAL AND METHODS: One hundred patients who consecutively came to our institution between November 2018 and December 2021 and underwent arthroscopic surgery for chronic ankle instability (CAI) were enrolled in the present study. Preoperative MR images were retrospectively reviewed by two orthopedic surgeons to evaluate the sensitivity, specificity and interobserver reliability of three MRI signs in diagnosing chronic DL injury, namely, abnormal ligamentous morphological characteristics (ALMC), BMELI and medial clear space (MCS). RESULTS: Taking arthroscopy as the reference standard, there were 34 patients with and 66 without DL injury. ALMC had 64.71% (22/34; 46.47-79.70) sensitivity and 83.33% (55/66; 71.71-91.00) specificity, BMELI had 70.59% (24/34; 52.33-84.29) sensitivity and 95.45% (63/66; 86.44-98.82) specificity and MCS had 26.47% (9/34; 13.51-44.65) sensitivity and 92.42% (61/66; 82.50-97.18) specificity. Compared with ALMC, BMELI had similar efficacy in superficial cases (P = 0.06) and greater efficacy in deep cases (P = 0.04). All three signs showed good interobserver agreement (kappa values all above 0.7). CONCLUSION: BMELI can reliably indicate concomitant injury to the DL in CAI patients. Using BMELI as a sign of chronic DL injury when ALMC is unclear may reduce the risk of a false negative diagnosis.

The value of multimodal ultrasound in diagnosis of cervical lymphadenopathy: can real-time elastography help identify benign and malignant lymph nodes?

Aim: To investigate the multimodal ultrasound(MMUS) features of cervical lymphadenopathy and to assess its value in the differential diagnosis of benign and malignant cervical lymph nodes. Methods: A retrospective analysis of 169 patients with cervical lymph node enlargement who attended Hangzhou Red Cross Hospital from March 2020 to October 2022. All patients underwent conventional ultrasound (CUS), contrast-enhanced ultrasound (CEUS), and real-time elastography (RTE), and were divided into training set and validation set. Univariate analysis was applied to screen out statistically significant parameters, and CUS model and MMUS model were constructed by multifactorial logistic regression analysis. The receiver operator characteristic (ROC) curve was established, and the area under the curve (AUC) was used to compare CUS model with MMUS model to assess the value of MMUS. Results: Of the cervical 169 lymph nodes in 169 patients included in the study. The 169 enrolled patients were divided into a training set (132 patients) and a validation set (37 patients). In the training set, univariate analysis showed statistically significant differences in long diameter/short diameter(L/S), border, margin, hilus, dermal medulla boundary, blood flow type, enhancement mode, enhancement type, and RTE score (all p< 0.05). Multifactor logistic analysis showed that L/S, blood flow type, enhancement mode and enhancement type were correlates of malignant lymph nodes (all p< 0.05). The comparison of AUC demonstrated that the discriminative ability of the MMUS model was superior to using the CUS model, both in the training set(p = 0.004) and validation set (p<0.001). Conclusion: In this study, MMUS shows higher diagnostic efficiency than CUS. Ultrasound features such as L/S, blood flow type, mode of enhancement, type of enhancement are helpful in distinguishing benign and malignant lymphadenopathy. The addition of CEUS can greatly improve the sensitivity and specificity of ultrasonic diagnosis of malignant cervical lymph nodes. RTE score is of limited value in the diagnosis of malignant cervical lymph nodes.

Macrophage polarization in spinal cord injury repair and the possible role of microRNAs: A review.

The prevention, treatment, and rehabilitation of spinal cord injury (SCI) have always posed significant medical challenges. After mechanical injury, disturbances in microcirculation, edema formation, and the generation of free radicals lead to additional damage, impeding effective repair processes and potentially exacerbating further dysfunction. In this context, inflammatory responses, especially the activation of macrophages, play a pivotal role. Different phenotypes of macrophages have distinct effects on inflammation. Activation of classical macrophage cells (M1) promotes inflammation, while activation of alternative macrophage cells (M2) inhibits inflammation. The polarization of macrophages is crucial for disease healing. A non-coding RNA, known as microRNA (miRNA), governs the polarization of macrophages, thereby reducing inflammation following SCI and facilitating functional recovery. This study elucidates the inflammatory response to SCI, focusing on the infiltration of immune cells, specifically macrophages. It examines their phenotype and provides an explanation of their polarization mechanisms. Finally, this paper introduces several well-known miRNAs that contribute to macrophage polarization following SCI, including miR-155, miR-130a, and miR-27 for M1 polarization, as well as miR-22, miR-146a, miR-21, miR-124, miR-223, miR-93, miR-132, and miR-34a for M2 polarization. The emphasis is placed on their potential therapeutic role in SCI by modulating macrophage polarization, as well as the present developments and obstacles of miRNA clinical therapy.

Safe Talar Tunnel Placement During Reconstruction of the Deep Layer of the Deltoid Ligament: A Comparison of 4 Different Anatomic Landmarks on the Lateral Malleolus.

Background: Deltoid ligament reconstruction of the ankle can be considered when the ruptured ligament is insufficient for direct repair. Purpose: To compare the safety of talar tunnels oriented toward 4 different anatomic landmarks on the lateral malleolus during reconstruction of the deep layer of the deltoid ligament (DDL). Study Design: Descriptive laboratory study. Methods: A total of 30 computed tomography scans of the ankle joint in healthy adults were collected to generate 3-dimensional models. Virtual talar tunnels with a diameter of 5 mm and with different lengths (20.0, 25.0, and 30.0 mm) were created from the talar insertion of the DDL and were oriented toward the talar neck as well as the most anterior, the most distal, and the most posterior points of the distal fibula. The minimal safe distance (MSD) of a drilling route was calculated for the tunnels, and the safe distance from the end of the tunnel to the bone surface was measured for each tunnel. The nonpaired Student t test was used to detect differences among the safe distances of the 4 different bone tunnels. Results: For the 20.0-mm tunnels, the safe distance of the tunnel oriented toward the talar neck (5.90 ± 1.16 mm) did not meet the MSD (6.0 mm). For the 25.0-mm tunnels, the safe distances of the tunnels oriented toward the talar neck (4.53 ± 1.13 mm) and the anterior point of the fibula (5.91 ± 1.52 mm) did not meet the MSD (6.9 mm). Conclusion: Tunnels that were 5 mm in diameter and 20.0 and 25.0 mm in length, oriented toward the most distal or most posterior point of the distal fibula, were safe for DDL reconstruction. Clinical Relevance: Knowledge of safe talar tunnel placement is important, especially to avoid bone surface penetration during DDL reconstruction.

Exposures to ambient air pollutants increase prevalence of sleep disorder in adults: Evidence from Wuhan Chronic Disease Cohort Study (WCDCS).

BACKGROUND: Sleep disorder contributes to memory dysfunction and chronic diseases. Clear evidence of environment disturbance, such as residential noise, are associated with an increased risk of sleep disorder. However, not enough studies have been conducted on association between residential air pollutants and sleep disorder. We sought to determine whether exposures to residential air pollutants associated with risk of sleep disorder among adults. METHODS: Using the dataset of the Wuhan Chronic Disease Cohort Study (WCDCS), we investigated the prevalence of sleep disorder and five sleep disorder symptoms in the study. The data of air pollutants (including PM10, PM2.5, NO2, SO2 and O3) were obtained from 10 air quality monitoring stations in Wuhan. We utilized logistic regression model to evaluate the associations of five types of air pollutants with odds ratio (OR) of sleep disorder and symptoms. The potential moderating effects of socio-demographic factors in the associations were explored using the interaction effects model. RESULTS: Of the study participants, 52.1 % had sleep disorder. Exposures to higher concentrations of air pollutants were associated with increased prevalence of sleep disorder. For example, per interquartile range (IQR) increases in concentrations of PM10, PM2.5 or SO2 corresponded to the increase of sleep disorder increased prevalence at 14.7 % (adjusted odds ratio (aOR) = 1.147, 95 %CI:1.062, 1.240), 8.9 % (aOR = 1.089, 95 %CI: 1.003, 1.182) and 15.8 % (aOR = 1.158, 95 %CI: 1.065, 1.260). For symptoms specific analyses, significant linkages of PM10, PM2.5, SO2 with difficulty in falling asleep, wake up after falling asleep and early awaken were observed. Moderating effects of age and place of residence on the linkages of PM10 with increased prevalence of sleep disorder were identified. CONCLUSION: Higher level of air pollution exposure could increase the prevalence of sleep disorder. Middle-aged and elderly population, as well as the rural residents are more likely to suffer from sleep disorder.

Independent and interactive associations between greenness and ambient pollutants on novel glycolipid metabolism biomarkers: A national repeated measurement study.

This study aims to investigate the independent and interactive effects of greenness and ambient pollutants on novel glycolipid metabolism biomarkers. A repeated national cohort study was conducted among 5085 adults from 150 counties/districts across China, with levels of novel glycolipid metabolism biomarkers of TyG index, TG/HDL-c, TC/HDL-c, and non-HDL-c measured. Exposure levels of greenness and ambient pollutants (including PM1, PM2.5, PM10, and NO2) for each participant were determined based on their residential location. Linear mixed-effect and interactive models were used to evaluate the independent and interactive effects between greenness and ambient pollutants on the four novel glycolipid metabolism biomarkers. In the main models, the changes [ß (95% CIs)] of TyG index, TG/HDL-c, TC/HDL-c, and non-HDL-c were -0.021 (-0.036, -0.007), -0.120 (-0.175, -0.066), -0.092 (-0.122, -0.062), and -0.445 (-1.370, 0.480) for every 0.1 increase in NDVI, and were 0.004 (0.003, 0.005), 0.014 (0.009, 0.019), 0.009 (0.006, 0.011), and 0.067 (-0.019, 0.154) for every 1 µg/m3 increase in PM1. Results of interactive analyses demonstrated that individuals living in low-polluted areas could get greater benefits from greenness than those living in highly-polluted areas. Additionally, the results of mediation analyses revealed that PM2.5 mediated 14.40% of the association between greenness and the TyG index. Further research is needed to validate our findings.

Overview of CircRNAs Roles and Mechanisms in Liver Fibrosis.

Liver fibrosis represents the reversible pathological process with the feature of the over-accumulation of extracellular matrix (ECM) proteins within the liver, which results in the deposition of fibrotic tissues and liver dysfunction. Circular noncoding RNAs (CircRNAs) have the characteristic closed loop structures, which show high resistance to exonuclease RNase, making them far more stable and recalcitrant against degradation. CircRNAs increase target gene levels by playing the role of a microRNA (miRNA) sponge. Further, they combine with proteins or play the role of RNA scaffolds or translate proteins to modulate different biological processes. Recent studies have indicated that CircRNAs play an important role in the occurrence and progression of liver fibrosis and may be the potential diagnostic and prognostic markers for liver fibrosis. This review summarizes the CircRNAs roles and explores their underlying mechanisms, with a special focus on some of the latest research into key CircRNAs related to regulating liver fibrosis. Results in this work may inspire fruitful research directions and applications of CircRNAs in the management of liver fibrosis. Additionally, our findings lay a critical theoretical foundation for applying CircRNAs in diagnosing and treating liver fibrosis.

Structural insights into the human niacin receptor HCA2-Gi signalling complex.

The hydroxycarboxylic acid receptor 2 (HCA2) agonist niacin has been used as treatment for dyslipidemia for several decades albeit with skin flushing as a common side-effect in treated individuals. Extensive efforts have been made to identify HCA2 targeting lipid lowering agents with fewer adverse effects, despite little being known about the molecular basis of HCA2 mediated signalling. Here, we report the cryo-electron microscopy structure of the HCA2-Gi signalling complex with the potent agonist MK-6892, along with crystal structures of HCA2 in inactive state. These structures, together with comprehensive pharmacological analysis, reveal the ligand binding mode and activation and signalling mechanisms of HCA2. This study elucidates the structural determinants essential for HCA2 mediated signalling and provides insights into ligand discovery for HCA2 and related receptors.

Exposure to air pollution and prevalence of metabolic syndrome: A nationwide study in China from 2011 to 2015.

BACKGROUND: Evidence concerning the influence of air pollution on metabolic syndrome (MetS) is still limited. We aimed to investigate whether sustained exposure to air pollutants are associated with increased prevalence of MetS and its individual components. METHODS: We conducted a cross-sectional study comprised of 14,097 individuals participated in the first or third survey of the CHARLS. The personal cumulative (3-year averaged) exposure concentrations of nitrogen dioxide (NO2), particulate matter (PM) with a diameter of 1.0 µm or less (PM1), PM with a diameter of 10 µm or less (PM10) and PM with a diameter of 2.5 µm or less (PM2.5) were estimated using a spatiotemporal random forest model at 0.1° × 0.1° spatial resolution based on residential address of each participant provided. We utilized logistic regression models to estimate the associations of the four air pollutants with the prevalence of MetS and its individual components, and performed interaction analyses to evaluate potential effect modifications by gender, health status, age and drinking status. RESULTS: Sustained exposure to air pollutants is associated with increased prevalence of MetS. For every 10 µg/m3 increase in NO2, PM1, PM10 and PM2.5, the adjusted odds ratio (OR) of MetS was 2.276 (95 % CI: 2.148, 2.412), 1.207 (95 % CI: 1.155, 1.263), 1.027 (95 % CI: 1.006, 1.048) and 1.027 (95 % CI: 0.989, 1.066), respectively. For MetS components, we observed significant associations between NO2, PM1, PM10 and central obesity, high blood pressure, elevated fasting glucose and low high-density lipoprotein cholesterol. For example, the adjusted OR of low high-density lipoprotein cholesterol for every 10 µg/m3 increase in NO2 was 1.855 (95 % CI: 1.764, 1.952). We also identified that age could significantly modified the association between NO2 and prevalence of MetS. CONCLUSIONS: Chinese adults sustained exposure to higher concentrations of air pollutants are associated with increased prevalence of MetS and its components.

Effects of air pollution and residential greenness on sleep disorder: A 8-year nationwide cohort study.

BACKGROUND: Sleep disorder influencing the quality of life, however, its contributing factors have not been fully identified yet. Recently the potential effects of environmental exposures like air pollution and greenness on sleep disorder have attracted attention, but the evidence in China is limited, particularly in the middle-aged and elderly. METHODS: We conducted a nationwide prospective study that included 21,878 Chinese citizens aged 45 years or above. For each participant, the 3-year averaged exposure concentrations of air pollutants (including PM10, PM2.5, PM1, NO2) and greenness (assessed by NDVI) were estimated based on residential address. We used mixed-effects logistic models to examine the associations of sustained air pollutants and greenness exposures with the occurrence of sleep disorder, and used linear mixed-effects models to assess the associations with sleep duration. Specifically, interaction effects models were employed to identify potential modificators of the above associations. RESULTS: A total of 39,580 survey responses were received, with the overall occurrence rate of sleep disorder was 25.7%. A 10 µg/m3 increment in PM10 and PM2.5 were associated with increased occurrence of sleep disorder at 2% (aOR = 1.02, 95%CI:1.01, 1.04) and 7% (aOR = 1.07, 95%CI: 1.04, 1.11), and were associated with reduced sleep duration by 0.07 (95% CI: 0.08, 0.05) and 0.04 (95% CI: 0.05, 0.03) hours, respectively. Residential greenness appears to the potential protective factor for sleep disorder, that a 0.1 higher of the NDVI was associated a 9% (aOR = 0.91, 95%CI: 0.86, 0.96) decreased occurrence of sleep disorder and 0.09 h (95% CI: 0.05, 0.13) longer of sleep duration. Age and residence were identified as modificators of the above significant associations. CONCLUSION: Sustained exposure to air pollutants can increase the occurrence of sleep disorder and can reduce sleep duration, while exposure to higher levels of greenness can protect sleep health from the side effects of air pollutants.

Deltoid ligament (DL) repair produced better results than DL nonrepair for the treatment for rotational ankle instability.

PURPOSE: To compare the clinical and magnetic resonance imaging (MRI) results after arthroscopic deltoid ligament (DL) repair versus DL nonrepair in patients with rotational ankle instability. METHODS: All patients with rotational ankle instability were enrolled in this retrospective cohort study. Clinical evaluation was performed by the American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), and Tegner activity score preoperatively and at a minimum follow-up of 2 years. MRI at follow-up was performed to evaluate the DL morphology. RESULTS: A total of 50 patients were enrolled in this study. Among them, 24 patients received DL repair (the repair group), whereas 26 patients did not (the nonrepair group). No significant difference was found in the AOFAS score (98 ± 4 vs. 97 ± 4; n.s.), KAFS (94 ± 7 vs. 93 ± 9; n.s.), or Tegner activity score (5 ± 2 vs. 5 ± 1; n.s.) between the repair group and the nonrepair group at the final follow-up. However, the repair group had a significantly shorter return-to-sport time than the nonrepair group (4.6 ± 1.6 mo vs. 6.0 ± 2.5 mo; p = 0.03). Comparison of the postoperative deltoid ligament showed that the repair group had a lower signal intensity than the nonrepair group. CONCLUSION: Arthroscopic treatment of rotational ankle instability revealed good to excellent clinical results. However, patients who underwent DL repair had a significantly earlier return to sports as well as a lower signal intensity of DL than those who did not undergo DL repair. LEVEL OF EVIDENCE: Level III.

Diagnostic performance of ultrasound and computed tomography in parallel for the diagnosis of lymph node metastasis in patients with thyroid cancer: a systematic review and meta-analysis.

Background: Currently, there is no evidence-based medical evidence for the diagnosis of lymph node metastasis (LNM) of thyroid cancer (TC) by ultrasound combined with computed tomography (US + CT), and the results of various studies on its diagnostic efficacy are inconsistent. Therefore, the diagnosis of cervical LNM by US + CT is controversial at present. The aims of the present systematic review and meta-analysis were to evaluate the diagnostic performance of US + CT in parallel for diagnosing cervical LNM in patients with TC. Methods: We searched PubMed, EMBASE, Cochrane Library, Web of Science, and Wanfang Medical Network (Core journals only) for studies prior to May 2022 on the performance of US and CT in parallel for diagnosing cervical lymph nodes. The studies were screened according to inclusion and exclusion requirements, and the methodologic quality of the included studies was independently assessed by 2 reviewers using tailored questionnaires and criteria provided by Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). We calculated the sensitivity, specificity, and diagnostic odds ratio (DOR) of cervical LNM for the central region, lateral neck, and whole neck. Meta-regression was performed to determine which parameters caused high diagnostic heterogeneity. Results: We included 11 studies of 6,261 patients with TC and 8,394 non-TC patients were included in the study. Most of the risk assessments included in the study were low risk, with no high-risk items. For the parallel test of US + CT, pooled sensitivity and specificity in the central region and lateral neck were 0.73 [95% confidence interval (CI): 0.56-0.85] and 0.80 (95% CI: 0.72-0.85), respectively. The calculated positive likelihood ratio was 3.6 (95% CI: 2.9-4.4), negative likelihood ratio was 0.34 (95% CI: 0.20-0.56), and DOR was 11 (95% CI: 6-18). The area under the curve was 0.83. For US + CT, the pooled sensitivity and specificity in the central region and lateral neck were 0.73 (95% CI: 0.56-0.85) and 0.80 (95% CI: 0.72-0.85), respectively. Discussion: The diagnostic efficiency of CT for lateral cervical LNM is greater than for central cervical LNM. CT has high sensitivity and accuracy for the diagnosis of central cervical LNMs. US + CT is important for the preoperative examination of cervical LNMs in TC.