The differentially expressed genes of postmenopausal osteoporosis were identified by bioinformatics and clinical samples were collected for verification.

The gene expression microarray of postmenopausal osteoporosis patients and healthy controls was screened by GEO database; the differentially expressed miRNAs was screened by GEO2R, and the target genes were predicted by miRDB, miRTarBase and Targetscan online databases; the target genes were analyzed by GO enrichment analysis and KEGG signal pathway analysis by DAVID database; protein-protein interaction (PPI) network was constructed by STRING online website and visualized in Cytoscape software. The MCODE plug-in was used to analyze the PPI network, and the Hubba plug-in was used to screen the Hub gene with the correlation degree > 10 as the standard. Collect clinical samples and use qRT-PCR and Westernblot to verify the key genes identified above at gene and protein level.

In this study, 46 differentially expressed miRNAs were identified, and the target genes were predicted by miRDB, miRTarBase and Targetscan online databases. The predicted results were screened and intersected by multiple databases, and 97 target genes were selected from the three databases. Through GO and KEGG enrichment analysis, it was observed that differentially expressed genes were mainly enriched in striated muscle regulation in biological process; in Cellular Component, genes were mainly enriched in cytoplasm and nucleus; in terms of molecular function, genes were mainly concentrated in transcriptional coactivator binding; in signal pathway, genes were mainly enriched in FoxO signal pathway and so on. Using STRING online website to build PPI network and visualization in Cytoscape software, it is concluded that the Hub genes in PPI network are CCND1, FOSL1, JUNB, IGF1R, BTG2 and so on. QRT-PCR and Westernblot methods were used to verify the above identified genes in clinical samples. Among them, the expression of BTG2, CCND1, JUNB and IGF1R in osteoporosis group was significantly higher than that in osteoporosis group, but there was no significant difference in FOSL1 expression between the two groups.

In this study, the differentially expressed key genes were identified by bioinformatics methods and clinical samples were collected for verification, which is helpful to explore new targets for diagnosis and treatment of postmenopausal osteoporosis. It provides a new starting point for the clinical diagnosis and treatment of postmenopausal osteoporosis.

To explore the effect of pressure vaccination training in patients with irrational fear of movement after total knee arthroplasty.

Prospective collection of 91 patients who underwent total knee arthroplasty at University of Healthy and Rehabilitation Science Qingdao Hospital from March 2022 to December 2022 and met the inclusion and exclusion criteria. There were 45 males and 46 females with an average age of (67.45±5.87) years. They were divided into a control group (n=45) and an intervention group (n=46) based on their length of stay. The control group was given routine nursing intervention, and the test group was given pressure vaccination training intervention. The differences of functional exercise compliance, anxiety, depression and phobia between the two groups before and after the intervention were compared.

After intervention, the total score of functional exercise compliance and various dimensions including psychological, active learning, and physical scores in the intervention group were (66.48 ±3.01), (36.28±2.38), (17.18±1.83), and (13.15±2.07), respectively, higher than those in the control group (62.89±4.12), (34.96±2.50), (15.76±2.88), and (9.65±3.07), with statistically significant differences (t=4.754, 2.591, 2.799, 2.544, all P<0.05). After intervention, the scores of the intervention group on the Self-rating anxiety scale and Self-rating depression scale and Tampa scale of kinesiophobia were (41.11±6.28), (50.17±4.74), and (22.48±5.87), respectively, lower than those of the control group (43.36±4.82), (53.67± 6.76), and (29.64±6.14), with statistically significant differences (t=2.279, 2.850, 5.695, all P<0.05).

Pressure vaccination training can effectively improve the compliance of patients with functional exercise, reduce the level of anxiety and depression, reduce the occurrence of phobia,and promote the early functional recovery of knee joint.

To compare the effectiveness of total ankle replacement (TAR) using modified anterolateral and anterolateral approaches in the treatment of elderly ankle osteoarthritis (OA).

The medical records of 87 elderly patients with ankle joint OA who were diagnosed and treated in the hospital from August 2019 to December 2023 were retrospectively collected, among which 83 cases received complete follow-up. There were 46 males and 37 females with an average age of (66.55±2.76) years. According to the different approaches of TAR surgery, the medical records of 41 patients who received anterior lateral approach TAR treatment were assigned to Group A, while the medical records of the remaining 42 patients who received modified anterior lateral ankle approach TAR treatment were assigned to Group B. Perioperative indicators, ankle joint function, ankle joint range of motion, and postoperative complications were ompared between two groups.

83 elderly patients with ankle osteoarthritis were fully followed up, with a follow-up rate of 95.40% and a follow-up time of 6-14 months, with an average of (10±2) months. The follow-up period for Group A was 6-13 months, with an average of (9±2) months. The follow-up period for Group B was 7-14 months, with an average of (10±2) months. The first postoperative time for getting out of bed in Group B (7.32±1.84) weeks was shorter than that in Group A [(8.42±2.24) weeks, t=2.447, P=0.017]. The initial weight-bearing walking time of Group B (14.11±1.97) weeks was shorter than that of Group A [(15.73±2.78) weeks, t=3.069, P=0.003]. After 6 months of surgery, the American Association of Foot and Ankle Surgeons (AOFAS) scores (51.35±4.21), 63.21±3.52, and 72.11±2.64) in Group B were higher than those in Group A [48.53±3.46, 60.42±3.61, and 69.45±2.56, P<0.001]. After 6 months of surgery, the range of motion of the dorsiflexion, plantar flexion, eversion, and varus joints in Group B [(31.55±3.85) °, (36.63±5.21) °, (24.64±3.71) °, (25.58±4.75) °] was higher than that in Group A [(28.63±4.64) °, (33.53±5.31) °, (21.31±3.64) °, (22.46±3.53) °], t=3.123, t=2.685, t=3.390, P=0.003, P=0.009, P<0.001, P=0.001]. The incidence of postoperative complications in Group B (9.52%) was not statistically significant compared to Group A (7.32%) (P=1.000).

Compared to the anterior lateral approach, the modified anterior lateral ankle joint approach for TAR treatment can shorten the postoperative time for getting out of bed and weight-bearing activities in elderly patients with ankle osteoarthritis, which is more conducive to improving postoperative ankle joint function and range of motion, and does not increase the incidence of complications.

To explore the clinical characteristics of complex lumbosacral radiculopathy in order to enhance the understanding of its complex etiology.

A retrospective study was conducted, collecting data from 11 patients with clearly diagnosed lumbosacral radiculopathy who were treated at Fuxing Hospital Affiliated to Capital Medical University and Beijing Tsinghua Changgung Hospital from September 2018 to January 2025. Demographic information, clinical baseline data, laboratory tests, neurophysiological studies, imaging data, and surgical procedures were systematically reviewed. The clinical features were summarized, and the diagnostic and treatment processes were analyzed.

Among the 11 patients, 3 were male and 8 were female, with ages ranging from 29 to 71 years and disease durations from 20 days to 5 years. The initial symptom in all patients was unilateral or asymmetric low back pain, gradually progressing to unilateral/bilateral focal lower limb pain. As the disease advanced, varying degrees of muscle weakness and atrophy developed, with severe cases leading to an inability to walk independently and urinary/fecal dysfunction. All patients were initially diagnosed with lumbar degenerative disease, but symptoms worsened despite symptomatic treatment. The final diagnoses revealed complex etiologies of lumbosacral radiculopathy. Among the 11 patients, 2 had Brucellosis infection, 2 had tuberculosis infection, and 1 had herpes zoster virus infection. These 5 patients showed significant clinical improvement after active anti-Brucellosis, anti-tuberculosis, and antiviral treatments. One patient was pathologically confirmed to have a myxopapillary ependymoma, with a good prognosis after surgical resection. One patient had lumbosacral radiculopathy due to local infiltration from recurrent rectal cancer, with a poor prognosis. One patient developed lumbosacral radiculopathy after radiotherapy for cervical cancer. Three patients were diagnosed with hematologic diseases via bone marrow biopsy: 1 with mantle cell lymphoma, 1 with chronic lymphocytic leukemia, and 1 with acute lymphocytic leukemia.

Lumbosacral radiculopathy is a common clinical condition with diverse symptoms and complex etiologies. While lumbar degenerative disease is a common cause, complex and rare causes include infections, hematologic malignancies, pelvic tumors, and post-radiation injury. For patients with lumbosacral pain who do not improve or even worsen after conventional treatment, the possibility of complex lumbosacral radiculopathy should be considered. Increasing the use of necessary auxiliary examinations to improve the understanding of complex etiologies is crucial for patient treatment and prognosis.

For patients with lateral patellar compression syndrome after surgery, to compare the effect of increasing the vastus medialis exercise and pushing the patella inward in the postoperative rehabilitation with the routine rehabilitation program.

A retrospective analysis was conducted on 47 patients with lateral patellar compression syndrome who underwent arthroscopic release of the lateral retinaculum from August 2020 to July 2023. There were 15 males and 32 females with an average age of (46.07± 3.81) years. The patients were divided into two groups, 23 cases in the conventional group and 24 cases in the experimental group. The routine group carried out the routine postoperative rehabilitation process of lower limbs, and the experimental group added the special rehabilitation steps of raising legs straight in the lateral position, sitting with legs holding the ball, and pushing the patella inward.

Anova of repeated measurement design was performed before surgery, 3 months after surgery, 6 months after surgery and 12 months after surgery between the conventional group and the experimental group. There were statistically significant differences in Lysholm, IKDC2000 and Kujala scores between the two groups (P<0.05), and there were statistically significant differences at different time points (P=0.000). There was an interaction between the groups and time points (P<0.05), and the difference between the two groups was statistically significant at each time point except before surgery (P<0.05). There was no statistically significant difference in VAS score between the two groups, there was statistically significant difference between different time points (P=0.000), there was no interaction between the groups and time points, and there was no statistically significant difference between the two groups at each time point. At 3, 6 and 12 months after operation, the muscle atrophy rate of the experimental group was lower than that of the conventional group, and the subjective satisfaction of the experimental group was higher than that of the conventional group. The overall rehabilitation effect of the experimental group was better than that of the conventional group.

In the postoperative patients with lateral patellar compression syndrome, increasing the exercise of the vastus medialis and internal push of the patella in the rehabilitation process can improve the knee function and subjective satisfaction.

To explore the effects of remimazolam combined with general anesthesia on postoperative delirium, serum Aβ-42 amyloid protein (Aβ-42) and Tau protein in elderly patients with hip fracture.

A total of 122 elderly patients undergoing hip replacement in the hospital were enrolled between May 2023 and March 2024. There were 63 males and 59 females, with an age of 73.52±3.77 years. According to random number table method, they were divided into group R (remimazolam group) and group P (propofol group), 61 cases in each group. The mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS) before induction (T0), at 1min before intubation (T1), immediately after intubation (T2), at 1min after intubation (T3), 3min after intubation (T4) and 5min after intubation (T5), incidence of postoperative deliriumat 1 d (T6), 2 d (T7) and 3 d (T8) after surgery by follow-up, serum Aβ-42, Tau protein and adverse reactions(nausea and vomiting, injection pain, bradycardia, hypotension) in the two groups were recorded.

Repeated ANOVA showed that there were significant differences in HR between the two groups at T0, T1, T2, T3, T4 and T5 (P<0.05), and there was interaction between group and time point (P<0.05), and differences between the two groups were statistically significant at all time points except T0 (P<0.05). There was no significant difference in HR at different time points in either group (P>0.05). Repeated ANOVA showed that there were significant differences in MAP between the two groups at T0, T1, T2, T3, T4 and T5 (P<0.05), and there was interaction between group and time point (P<0.05), and differences between the two groups were statistically significant at all time points except T0 (P<0.05). There were significant difference in MAP at different time points in both groups (P<0.05). Repeated ANOVA showed that there was no significant difference in BIS between the two groups at T0, T1, T2, T3, T4 and T5 (P>0.05), and there was no interaction between group and time point (P>0.05), and difference between the two groups was not statistically significant at any time point (P>0.05). There were significant differences in BIS at different time points in both groups (P<0.05). At T6, incidence of delirium in group R was lower than that in group P (P<0.05), but there was no significant difference in the incidence of delirium between the two groups at T7 and T8 (P>0.05). Repeated ANOVA showed that there were significant differences in levels of serum Aβ-42 and Tau protein between the two groups before and at 3 d after surgery (P<0.05), and there was interaction between group and time point (P<0.05), and differences between the two groups were statistically significant at 3 d after surgery (P<0.05).There were significant differences in levels of serum Aβ-42 and Tau protein before and at 3 d after surgery in both groups (P>0.05). The incidence of adverse reactions in group R was lower than that in group P (P<0.05).

Remimazolam combined with general anesthesia can effectively alleviate heart rate and blood pressure fluctuation in elderly patients with hip fractureduring anesthesia induction, reduce the incidence of postoperative delirium and adverse anesthesia reactions.

To compare efficacy of bone transport technology combined with segmented filling with bone cement and the bone shortening-lengthening surgery in treating patients with large tibial bone defects after trauma.

A total of 63 patients (there were 40 males and 23 females with an average age of (48.75±6.13) years) with post-traumatic large tibial bone defect admitted to our hospital from January 2018 to August 2023 were divided into control group (30 cases were treated by bone handling technology combined with bone cement segmental packing) and experimental group (33 cases were treated by bone shortening and lengthening) according to different surgical methods. The general condition, the degree of bone healing, lower limb function score, complications, and fracture healing time were compared between the two groups.

The intraoperative and postoperative blood loss and total drainage volume in the experimental group were significantly higher than those in the control group (P<0.05); There was no statistically conspicuous difference in excellent rate of bone healing between experimental group and control group (90.91%, 96.67%) (P>0.05). The knee score and ankle Baird-Jackson score obtained by the Hospital for Special Surgery (HSS) of the experimental group and the control group at 1, 3 and 6 months after surgery by repeated measurement ANvariance analysis showed statistically significant differences between the experimental group and the control group (F=5.085, P=0.025; F=6.129, P=0.014), except before surgery, the difference was statistically significant at different time points (F=203.151, P<0.001; F=189.122, P<0.001), there was no interaction between groups and time (F=1.339, P=0.262; F=2.262, P=0.082) There was no statistically conspicuous difference in incidence of primary and secondary complications between experimental group and control group (primary: 12.12%, 23.33%; secondary: 30.30%, 46.67%) (P>0.05). The natural healing time of bone defects in experimental group was conspicuously shorter than that in control group (P<0.05).

Bone transport technology combined with segmented bone cement packing and bone shortening - lengthening surgery can both effectively promote bone healing in patients with large tibial bone defects after trauma, improve the functions of the knee and ankle joints of patients, and have similar complication rates. However, the intraoperative and postoperative blood loss and drainage volume of bone transport technology combined with segmented bone cement packing are less, and the fracture healing time of bone shortening - lengthening surgery is relatively shorter.

The theoretical and technological framework in the field of orthopedic rehabilitation is highly complex, presenting significant challenges for rehabilitation professionals in acquiring the necessary knowledge, and to some extent, impacting the efficiency and effectiveness of clinical practice. Therefore, constructing a systematic clinical approach and achieving the integration and simplification of the knowledge framework is of substantial clinical importance. This paper introduces the CEST clinical approach for orthopedic rehabilitation, proposed by the Sixth People’s Hospital of Shanghai. Centered on clinical assessment, rehabilitation phases, and rehabilitation techniques, this approach adopts a systematic and modular design, organically integrating these three core components, thereby providing important theoretical foundation and practical pathways for achieving both individualized and standardized orthopedic rehabilitation.

Pelvic insufficiency fractures (PIF) are a special category of pelvic fractures with normal stress or minor trauma acting on the weakened pelvis, whereas those that cause nonspecific lumbar and/or groin pain, and interfere with ambulation with subtle radiographic imaging changes. With the aggravation of the aging society, the incidence of PIF is increasing. PIF commonly results from osteoporosis, and may also occur due to radiation and chronic steroid usage. PIF is often misdiagnosed because of its insidious onset without special clinical symptoms. Pelvic X-ray is mostly used for screening and follow-up, whereas CT and MRI can confirm the diagnosis and is helpful to therapy. The conservative treatment of PIF includes analgesics, bed rest, physical therapy and orthoses. Patients who are unresponsive to this management and who have intractable pain are candidates for percutaneous iliosacral screw fixation or sacroplasty. We reviewed the literature on PIF in recent years, in order to provide reference for clinicians in the diagnosis and treatment of PIF.