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To analyze the current status and trends in the burden of musculoskeletal diseases in China from 1990 to 2023, providing evidence-based support for formulating and optimizing prevention and control strategies for musculoskeletal diseases in China. Based on the 2023 Global Burden of Disease (GBD) study database, the study integrated incidence, prevalence, disability-adjusted life years (DALYs), and age-standardized rates of musculoskeletal diseases in the Chinese population from 1990 to 2023, stratified by gender and age. The proportional contribution to all-cause prevalence was calculated, and regression models were constructed using Joinpoint software to assess temporal trends. In 2023, the five major musculoskeletal diseases collectively accounted for approximately 25.0% of all-cause prevalence in China. Among these, osteoarthritis contributed the most (11.68%), followed by low back pain (6.89%) and neck pain (3.52%). Gout (1.28%) and rheumatoid arthritis (0.36%) had relatively lower contributions. From 1990 to 2023, the overall burden of the five major musculoskeletal diseases remained substantial, with heterogeneous temporal patterns across diseases. Stratified by age and gender, the five diseases exhibited low levels during childhood and adolescence, increased significantly in middle and older adulthood, and peaked in the elderly. Except for gout, the burden of the other four diseases was higher in females than in males across most age groups. The scale of each disease varied considerably. Osteoarthritis showed the most significant increase in prevalence, with prevalent cases increasing from 53.7668 million to 161.7424 million, and the age-standardized DALYs rate rising by 16.19%. Gout showed the fastest growth in disease burden, with age-standardized DALYs rates rising from 19.88/100 000 to 25.14/100 000 (a 26.46% increase). Although low back pain showed a decline, it remained a major source of disability over the long term, with the age-standardized DALYs rate decreasing from 740.83/100 000 to 551.92/100 000 (a 25.49% decrease). Neck pain remained generally stable with a age-standardized DALYs rate increase of 1.18%. The age-standardized incidence rate of rheumatoid arthritis increased by 19.41%, and the age-standardized DALYs rate decreased by 8.38%. Over the past 30 years, the burden of musculoskeletal diseases in China has shown a persistent upward trend with significant gender and age disparities. Future prevention and control strategies should place greater emphasis on early identification and proactive interventions, advocating for more targeted comprehensive measures for high-risk populations. Concurrently, efforts must be made to enhance standardized diagnosis and treatment capabilities at the primary care level, alongside strengthening continuous rehabilitation management. 分析1990—2023年中国肌肉骨骼疾病的疾病负担现状及其变化趋势，为我国肌肉骨骼疾病防控策略的制定与优化提供循证依据。. 基于2023年全球疾病负担研究（Global Burden of Disease，GBD）数据库，整合中国人群1990—2023 年肌肉骨骼疾病在性别与年龄分层下的发病人数、患病人数、伤残调整寿命年（disability-adjusted life years，DALYs）及其年龄标准化率，计算其在全因患病率中构成比，运用Joinpoint软件分析构建回归模型评估时间趋势。. 2023年我国5种主要肌肉骨骼疾病在全因患病率中合计占25.0%，其中骨关节炎贡献最高（11.68%），其次为下腰痛（6.89%）与颈痛（3.52%），痛风（1.28%）和类风湿性关节炎（0.36%）占比较低。1990—2023年我国上述5种主要肌肉骨骼疾病总体负担较重，发病人数、患病人数及DALYs整体呈上升趋势。年龄与性别分层显示，5种疾病在儿童青少年期均处于低水平，中老年期显著升高并在高龄段达峰值；除痛风外，其余4种疾病在多数年龄段均表现为女性负担高于男性。不同疾病规模变化差异明显，骨关节炎患病规模增长最显著，患病人数从5 376.68万例增长至1 6174.24万例，标化DALYs率增加16.19%；痛风疾病负担增长最快，标化DALYs率增加达26.46%；下腰痛虽有下降但长期为主要伤残来源，标化DALYs率下降25.49%；颈痛整体疾病负担波动较小，标化DALYs率增加1.18%；类风湿性关节炎标化发病率增加19.41%，标化DALYs率下降8.38%。. 中国肌肉骨骼疾病负担呈持续上升趋势并存在明显性别、年龄差异。未来防控策略应更强调早期识别与前置干预，倡导对高风险人群实施更具针对性的综合措施，并同步提升基层规范化诊疗与持续性康复管理能力。.

This study examined hip fracture trends in older Chinese adults from 1990 to 2023, finding a sharp rise in cases, especially from falls, but less disability over time. It highlights the need for better prevention, particularly for women, to ease the growing health burden as China's population ages. With China's rapidly aging population, hip fractures have become a leading cause of disability and healthcare burden among older adults. This study examined the incidence and disability burden of hip fractures among adults aged 60 years and above from 1990 to 2023 in mainland China and described sex-specific patterns and changes over time. Data were obtained from the Global Burden of Disease (GBD) 2023 study. We extracted the number of hip fractures, crude incidence rate, and years lived with disability (YLDs) rate for adults aged 60 years and older in mainland China. Age standardization followed the 2020 China census population. Temporal changes were assessed by comparing percent differences between the 1990 and 2023 estimates, with all results reported together with their 95% uncertainty intervals. In 2023, mainland China had an estimated 3.23 million hip fractures among adults aged 60 years and above (2.28 to 4.43 million), including 1.16 million cases among males (0.83 to 1.59 million) and 2.07 million among females (1.45 to 2.85 million). The age-standardized incidence rate reached 1065.47 per 100,000 population (685.35 to 1597.70) in 2023, increasing by 58.3% compared with 1990. The age-standardized rate was higher in females at 1312.98 per 100,000 (833.36 to 1976.11) than in males at 799.29 per 100,000 (517.93 to 1202.45). In contrast, the age-standardized YLD rate showed a modest decline from 1990 to 2023, decreasing from 222.51 (151.48 to 304.89) to 197.35 (135.20 to 277.92). Across causes, falls remained the leading contributor to hip fractures throughout the study period. Hip fractures among older adults in mainland China continued to rise in both number and incidence rate from 1990 to 2023, with women experiencing a consistently higher burden than men. The decrease in age-standardized YLDs suggests some improvement in post-fracture management, although the growing incidence highlights the need for strengthened prevention strategies, particularly fall prevention and osteoporosis management in older adults.

Educational standards require physical therapy (PT) orthopedic and sports residency and fellowship curricula to include diagnostic imaging instruction. Prior research found that clinicians with advanced training through post-professional education had the requisite diagnostic imaging knowledge and skills. Curricular design or graduate proficiency in diagnostic imaging has not been investigated. The purpose of this study was to assess diagnostic and procedural imaging curricula, instructional methods, and graduate expertise in orthopedic and sports physical therapy residency and fellowship programs. A 42-item electronic survey was distributed to all American Board of Physical Therapy Residency & Fellowship Education (ABPTRFE) orthopedic and sports programs. Content categories included (1) program characteristics, (2) diagnostic imaging curriculum, (3) instructional methods, (4) self-reported graduate proficiency, and (5) perception that direct referral for diagnostic imaging is within the scope of PT practice. Survey responses from 101 programs (84 residency; 17 fellowship) represent 67 orthopedic and 34 sports PT programs. Curricula include radiography (n = 90), magnetic resonance imaging (88), computed tomography (77), bone scintigraphy (55), and ultrasound (60). Eighty-two (97%) curricula instruct how to integrate imaging results with other clinical data and 80 (94%) how to incorporate imaging results into clinical decisions. Twenty-five (29.4%) taught how to directly refer patients for imaging studies. Curricula include diverse educational methods, resources, and assessment techniques. Programs perceived graduates were proficient in all requisite diagnostic imaging skills, but the lowest perceived proficiency was referring to imaging studies. Imaging curricula are widely included in post-professional orthopedic and sports PT programs. Learning experiences embedded in the clinical setting are well positioned to provide meaningful training for appropriate imaging utilization.

Parkinson disease (PD) impairs gait, balance, and quality of life, and wearable devices have been proposed to support rehabilitation, but evidence for their clinical efficacy remains uncertain. This study aimed to evaluate, within the International Classification of Functioning, Disability, and Health (ICF) framework, the effects of wearable-device interventions on gait performance, balance, and health-related quality of life in people with PD by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched PubMed, Web of Science, Cochrane Library, Embase, and ClinicalTrials.gov from inception to November 18, 2025, for RCTs in people with PD comparing wearable-device interventions with control conditions. We used Hartung-Knapp random-effects models to pool mean differences (MDs) or standardized mean differences (SMDs) and reported 95% prediction intervals when ≥3 studies were pooled. Risk of bias was assessed using the Cochrane Risk of Bias (RoB) tool, and certainty of evidence was rated using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Nine RCTs involving 260 participants were included. Wearable devices produced a small improvement in stride length (MD 0.10 meter, 95% CI 0.03-0.17), but there was no clear benefit for the 10-Meter Walk Test time (MD 0.04 second, 95% CI -0.06 to 0.15). Double support time showed no reduction (MD -1.59% gait cycle, 95% CI -3.79 to 0.61). Freezing of gait (Freezing of Gait Questionnaire [FOG-Q] and New Freezing of Gait Questionnaire [NFOG-Q]) did not significantly improve (SMD -0.24, 95% CI -0.72 to 0.24). Motor severity (Unified Parkinson Disease Rating Scale Part III [UPDRS III]) showed a small, nonsignificant trend favoring wearable devices (MD -2.16 points, 95% CI -4.39 to 0.07). For balance, pooled results from the Berg Balance Scale (BBS), Mini Balance Evaluation Systems Test (Mini-BESTest), and Performance-Oriented Mobility Assessment Balance Subscale (POMA balance) suggested a borderline effect (SMD 0.48, 95% CI -0.02 to 0.98). Wearable devices did not meaningfully improve Parkinson Disease Questionnaire (PDQ) scores (SMD -0.28, 95% CI -0.74 to 0.17), EQ-5D utility (MD 0.10, 95% CI -0.24 to 0.44), or Falls Efficacy Scale-International (FES-I) scores (MD -0.04, 95% CI -1.10 to 1.02). Prediction intervals frequently crossed the null, suggesting effects may vary by setting and population. Wearable device interventions for Parkinson disease produced a small improvement on average in stride length, with no consistent benefits for other gait outcomes, balance, or patient-centered outcomes. By integrating ICF mapping with Hartung-Knapp meta-analysis, prediction intervals, and GRADE, and avoiding pooling of conceptually distinct gait measures used in prior reviews, this review clarifies where evidence is most consistent, supports using wearables as adjuncts to rehabilitation, and underscores the need for larger, longer RCTs with standardized outcomes to determine who benefits and how to implement them. PROSPERO CRD42024585686; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024585686.

Redox homeostasis is crucial for maintaining cellular processes and is closely linked to human skeletal health. Prior research has demonstrated that oxidative stress is important for regulating osteoblast and osteoclast differentiation in the bone microenvironment, leading to a reduction in bone mass and skeletal degradation. The bone marrow is a complex niche containing various cell types, including bone marrow adipocytes (BMAs), which engage in dynamic interplay with osteo-associated cells through processes governed by redox equilibrium within the marrow compartment. During aging, a decrease in osteoblasts coincides with an increase in BMAs counts. Evidence suggests that oxidative stress influences the differentiation of BMAs, leading to the accumulation of bone marrow adipose tissue (BMAT) and contributing to bone remodeling imbalances. The fate of BMAs is determined by a precise molecular network that involves transcription factors, epigenetic regulators, and ncRNAs. The expansion of BMAT affects the commitment and differentiation of bone marrow-derived mesenchymal stem cells (BMSCs), resulting in poor osteoblast differentiation, enhancing osteoclast differentiation and function, and accelerating bone loss. Consequently, elucidating oxidative stress dynamics in pathological marrow states and delineating their correlation with aberrant BMAs differentiation emerges as a research imperative. This comprehensive review delineates the mechanistic interplay whereby oxidative stress within the osseous niche orchestrates BMAs differentiation, while simultaneously exploring how expanded BMAs reciprocally amplify oxidative stress levels. Furthermore, we dissect how maladaptive BMAs differentiation cascades perturb osteoblast-osteoclast equilibrium through paracrine signaling and microenvironmental reprogramming. By synthesizing these molecular insights, we aim to unravel the pathogenic nexus between BMAs-driven redox imbalance and compromised bone remodeling, ultimately proposing innovative therapeutic strategies for osteopathic disorders. The translational potential of this article: The growing interest in BMAs originates from their significant yet underexplored functions in bone metabolism and systemic energy homeostasis, establishing them as a novel and promising component for managing osteoporosis and related metabolic bone disorders. Clinically, this focus addresses two critical gaps in current osteoporotic care, which predominantly relies on anti-resorptive agents and bone-forming medications. While these conventional treatments demonstrate efficacy, they face limitations such as potential long-term safety concerns, the presence of treatment-resistant patients, and an incomplete ability to restore bone quality and mechanical strength. Targeting BMAs presents a complementary or alternative therapeutic strategy by addressing a fundamental cellular element within the bone marrow microenvironment that actively participates in bone remodeling. Mastering the regulation of BMAs enables a shift toward a more comprehensive "whole-bone" therapeutic approach, aiming not merely to increase bone mineral density but also to enhance bone quality and fracture healing, thereby fundamentally addressing the pathogenesis of skeletal fragility in aging populations and pathological conditions characterized by aberrant marrow fat accumulation.

Psychological readiness is increasingly recognized as a return-to-sport (RTS) determinant after shoulder stabilization surgery. The Shoulder Instability-Return to Sport After Injury (SIRSI) score is a tool to assess psychological recovery, yet prognostic value at intermediate postoperative milestones remains unclear. The purpose was to evaluate whether 6-month SIRSI scores relate to 1-year patient-reported outcome measures (PROMs) and RTS in adolescents after shoulder stabilization surgery. It was hypothesized that higher 6-month SIRSI scores would be associated with improved 1-year PROMs and RTS rates. Case series; Level of evidence, 4. This study included patients aged 14 to 18 years who underwent surgical shoulder stabilization between August 2022 and August 2023 with follow-up at 6 months and ≥1 year. Psychological readiness was assessed with the SIRSI score, and the following PROMs were collected: American Shoulder and Elbow Surgeons assessment form, Tegner Activity Scale, Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, and Pediatric/Adolescent Shoulder Survey. Associations between 6-month SIRSI scores and 1-year PROMs and RTS were analyzed. Twenty-three athletes were included (mean ± SD age, 16.7 ± 1.1 years; 65.2% male; 69.6% dominant-arm surgery), including 5 (21.7%) anterior labral repairs, 1 (4.3%) posterior labral repair, and 17 (74.0%) combined anterior-posterior labral repairs. At 1 year, 17 athletes (73.9%) returned to their primary sport. Six-month SIRSI scores demonstrated moderate positive correlations with 1-year American Shoulder and Elbow Surgeons score (ρ = 0.42) and Tegner score (ρ = 0.51). Athletes who returned to their primary sport had higher median 6-month SIRSI scores (78.3) as compared with those who did not (46.7; P = .006). Improvements were observed across all PROMs from 6 months to 1 year. Six-month SIRSI scores are associated with 1-year functional outcomes and RTS success in adolescent athletes after shoulder stabilization surgery. Incorporating SIRSI into routine 6-month postoperative assessment may help identify athletes whose recovery-related confidence and readiness to RTS lag postoperative milestones, particularly in the context of limitations such as weakness, stiffness, or pain. Future research should stratify by surgical technique, sex, and other variables to better understand individualized recovery patterns and explore interventions that target psychological as well as physical readiness.

Background/Objectives: This review and meta-analysis assessed whether combining transarterial chemoembolization (TACE) with iodine-125 brachytherapy (I-125 brachytherapy) offers greater efficacy and safety than TACE alone in treating hepatocellular carcinoma (HCC). Methods: PubMed, EMBASE, the Cochrane Library, Scopus, and Web of Science were searched for articles published between 1 January 2010 and 30 November 2023. Eligible studies compared TACE with and without I-125 brachytherapy from randomized controlled trials (RCTs) and non-randomized comparative studies published in English. The primary outcome was overall survival (OS) at 1, 2, and 3 years. The secondary outcomes included progression-free survival (PFS), overall response rate (ORR), disease control rate (DCR), and adverse events. ROB-2 and ROBINS-I tools were used to assess study quality. Results: Eighteen studies (n = 1872 patients) were included. All 18 studies originated from China, with the majority being retrospective cohorts (n = 16), one non-randomized prospective study, and one RCT. Compared with TACE alone, TACE + I-125 brachytherapy significantly improved OS at 1 year (OR = 3.64, 95% CI: 2.92-4.55), 2 years (OR = 3.93, 95% CI: 2.29-6.77), and 3 years (OR = 4.12, 95% CI: 2.24-7.56). The tumor response rates, including the ORR and DCR, were also significantly higher in the combination group. Subgroup analysis revealed that the survival benefit was maintained in studies without systemic chemotherapy (OR = 3.68, 95% CI: 2.89-4.70) and in studies with systemic chemotherapy (OR = 4.13, 95% CI: 1.69-10.09). Although larger effect estimates were observed with low-dose I-125 brachytherapy (<80 Gy; OR = 8.55, 95% CI: 4.32-16.92) compared to high-dose (&#x2265;100 Gy; OR = 2.87, 95% CI: 2.05-4.00), this finding is hypothesis-generating rather than conclusive and should be interpreted cautiously as it is based on only three studies. Adverse event rates were comparable between groups. GRADE assessment indicated low to very low certainty for all outcomes, primarily due to the retrospective nature of most included studies. Conclusions: TACE combined with I-125 brachytherapy was associated with improved survival and tumor response without a statistically significant increase in adverse events. High-quality, multicenter RCTs are warranted to confirm these results.

Systematic review and meta-analysis. To conduct a meta-analysis of high-level prospective evidence studies evaluating changes in Visual Analogue Scale (VAS), SI joint pain scores, Oswestry Disability Index (ODI) outcomes, and adverse events (SAE) requiring an additional operation. Low back pain is a leading cause of disability, and the sacroiliac joint (SIJ) is implicated as a primary pain generator in up to 25% of cases. However, SIJ-mediated pain is difficult to diagnose, and is often one of exclusion confirmed by diagnostic injections. Minimally invasive SIJ fusion has emerged as a treatment option for patients with confirmed SIJ dysfunction who fail nonoperative care. A systematic review and meta-analysis were performed according to PRISMA guidelines. Eleven studies (9 prospective cohort and 2 randomized control trials) met inclusion criteria based on study design, quality of evidence, and reporting of patient-reported outcomes. Demographic data, baseline characteristics, surgical indications, and outcomes were extracted. Meta-analyses were conducted to calculate pooled estimates of VAS and ODI improvements, and reoperation rates. Eleven studies reporting on 1,181 sacroiliac joint fusions were included, with a mean follow-up of 27.8 months. Sacroiliac joint pathology was confirmed by diagnostic SIJ injection in 92.7% of patients. Meta-analysis showed a VAS improvement of 45.5 points (95% CI: 38.6-52.3) and an ODI improvement of 23.3 points (95% CI: 21.0-25.7), both exceeding established MCID thresholds (P < 0.001). The meta-analysis of reoperation rates for implant-related serious adverse events was 3% (95% CI: 2%-4%). Minimally invasive SIJ fusion, performed across multiple implant systems and surgical techniques, yields large, clinically meaningful, and reproducible improvements in pain and disability with a low reoperation rate. Outcomes are most favorable when patient selection is rigorous and SIJ dysfunction is accurately identified as the primary pain generator using diagnostic SIJ injection, underscoring the importance of standardized diagnostic pathways in optimizing surgical benefit.

To evaluate the outcomes following revision surgery for failed primary arthroscopic Bankart repair and describe the influence of preoperative injury characteristics on postoperative revision outcomes in a competitive athlete population. Patients who underwent revision surgery after a previously failed arthroscopic Bankart repair between 2000 and 2014 were retrospectively reviewed. The type of revision surgeries included revision arthroscopic Bankart repair (n&#x2009;=&#x2009;12, 15%), open Bankart repair (n&#x2009;=&#x2009;9, 11.3%), Latarjet procedure (n&#x2009;=&#x2009;30, 37.5%), and distal tibia allograft (n&#x2009;=&#x2009;27, 33.8%). Patients were evaluated with the American Shoulder and Elbow Surgeon score, Western Ontario shoulder instability index, and Single Assessment Numerical Evaluation score at a minimum of 2 years follow-up. Demographic and intraoperative findings as a percentage of glenoid bone loss, Hill-Sachs lesions, labral and capsule pathologies, and complications were also reported. A total of 78 patients (97.4% male) met inclusion criteria with a median age of 25.9 years (18.2-49.3), mean follow-up period of 2.6 years (range 1.8-6.2 years), and mean 18.0%&#x2009;&#xb1;&#x2009;8.1% glenoid bone loss at final follow-up. The revision arthroscopic Bankart and open Bankart groups had statistically lower postoperative American Shoulder and Elbow Surgeon score, Single Assessment Numerical Evaluation score, and Western Ontario Shoulder Index scores than the Latarjet and distal tibia allograft groups (P&#x2009;<&#x2009;.001). In addition, there was a significant difference in American Shoulder and Elbow Surgeon score between patients who presented with failure of arthroscopic stabilization and glenoid bone loss <25% (91) and >25% (94) (P&#x2009;=&#x2009;.035). There was no significant difference in the post-revision functional outcomes between differences in the size of Hill-Sachs lesion, labral and capsule pathologies. In the setting of a failed primary arthroscopic Bankart procedure, patients presented with high amounts of glenoid bone loss, frequently exceeding 15% at revision. Patients who underwent either Latarjet procedure or distal tibia allograft showed higher functional outcomes than soft tissue stabilization procedures after failed arthroscopic Bankart repair in a competitive athlete population. Level III, retrospective cohort study.

Bibliometric analyses are increasingly used to explore how scientific knowledge is created, disseminated, and perceived. In orthopaedics, research output has expanded rapidly over the past decade, yet the factors determining whether an article achieves wide visibility and scholarly impact remain poorly understood. Beyond the inherent quality of a study, elements such as authorship patterns, title construction, and open access (OA) availability may play an essential role in shaping citation performance. However, evidence in this field is still limited and sometimes contradictory, highlighting the need for large-scale, field-specific analyses. Orthopaedic publications from 2010 to 2020 were identified in Scopus using the keyword 'orthopaedic'. After duplicate removal, 97,806 unique articles were included with complete data on authorship, titles, citation counts, study design, and OA status. Citation rates were normalised per year since publication. Associations between bibliographic features and citation performance were assessed using multiple linear regression, while differences across title styles and study designs were evaluated with comparative statistical testing. Exploratory modelling was performed to identify combinations of authorship and title characteristics linked to the highest predicted citation rates. Larger author teams were associated with higher citation rates (&#x3b2;&#x2009;=&#x2009;0.108 citations/year per additional author, 95% confidence interval [CI] 0.103-0.114, p&#x2009;<&#x2009;0.001). OA articles achieved a mean increase of 0.175 citations/year compared with non-OA (p&#x2009;=&#x2009;0.001). Title length in characters correlated positively with citation rate (&#x3b2;&#x2009;=&#x2009;0.023 per character, p&#x2009;<&#x2009;0.001), whereas title length in words showed a negative association (&#x3b2;&#x2009;=&#x2009;-0.183 per word, p&#x2009;<&#x2009;0.001). The presence of a colon (+0.314 citations/year, p&#x2009;<&#x2009;0.001) or dash (+0.187, p&#x2009;=&#x2009;0.001) increased citation performance, while question marks (-0.476, p&#x2009;<&#x2009;0.001) and all-capital titles (mean 0.71 citations/year) reduced it. Regarding study design, network meta-analyses achieved the highest citation rate (mean 6.64 citations/year), followed by systematic reviews (5.66), meta-analyses (5.08) and narrative reviews (4.81). Randomised controlled trials (3.90) and clinical trials (3.86) performed at an intermediate level, whereas observational studies (2.40), case series (1.79), technical notes (1.33), case reports (0.77), editorials (0.51) and commentaries (0.25) showed consistently lower citation performance (p&#x2009;<&#x2009;0.0001). In orthopaedic research, collaboration, OA availability and concise, well-structured titles with selected punctuation contribute to higher citation performance, while unconventional title formatting reduces visibility. Although useful for optimising dissemination, ethical authorship practices and rigorous scientific standards remain more critical than citation metrics.

Fencing is a highly asymmetrical sport that combines both repetitive upper-extremity and lower-extremity actions. Although fencing related injuries have been described in clinical- and competition-based cohorts, population level data capturing both training and competition exposures and cumulative injury burden remains limited. To characterize injury patterns, mechanisms, and anatomical distribution among adult competitive fencers and to examine associations between training related exposures and reported injury burden. Adult competitive fencers registered with USA Fencing were invited to complete an anonymous web-based survey capturing demographics, training and competition exposures, and self-reported fencing related injuries. Injury burden was defined as experiencing three or more lifetime fencing-related injuries among injured respondents. Multivariable logistic regression was used to examine associations between training exposures and injury burden with continuous predictors modeled using restricted (natural) cubic splines to allow for non-linear relationships. Descriptive analyses, correlation analyses, and Poisson regression were performed as sensitivity analyses. Among 303 respondents, 270 (89.1%) reported at least one fencing related injury, accounting for 571 total injuries. Overuse injuries predominated and most frequently involved the knee, ankle and dominant upper extremity with gradual-onset, non-contact mechanisms accounting for the majority of the injuries. Upper-extremity injuries were significantly more likely to occur on the dominant side. In multivariable analyses, years of fencing experience demonstrated a significant non-linear association with higher injury burden, while weekly training volume showed a non-linear association that approached statistical significance. Age at starting fencing, competition frequency, and sex were not independently associated with injury burden. Sensitivity analyses using Poisson regression yielded qualitatively similar findings. Among adult competitive fencers, higher injury burden is most strongly associated with cumulative training exposure, particularly years of fencing experience, with additional contribution from weekly training volume. Injury patterns are characterized by overuse and pronounced dominant-side upper-extremity involvement, consistent with the sport's asymmetrical biomechanical demands. These findings underscore the importance of monitoring cumulative exposure and addressing asymmetrical loading to mitigate recurrent injury burden in fencing.

The Open and Reproducible Musculoskeletal Imaging Research community is a scientific community dedicated to promoting openness and reproducibility in musculoskeletal imaging, image processing, and computational modeling. In this perspective paper, we outline the motivations for conducting transparent research and provide practical guidelines for implementing it. We start by defining open and reproducible research and describing the benefits and challenges of working transparently. Next, we redefine the outputs of a computational research study as-ideally-a combination of data, code, and a publication, recommend a folder and file structure that reflects these three study outcomes, and describe how to maintain and update such a structure during the study and at study publication. Finally, we emphasize that working in an open and reproducible manner is a learning process, and the best way to acquire the necessary competencies is simply to start.

Physical inactivity contributes to systemic inflammation and metabolic dysfunction. Neuromuscular electrical stimulation (NMES) offers an alternative to exercise for individuals unable to perform voluntary physical activity. This study investigated whether a single submaximal NMES session alters inflammation-related proteins, muscle-damage markers and glucose levels in healthy adults. Thirty-six healthy adults underwent a 2-hour NMES-session targeting the quadriceps, hamstring and gluteal muscles using wearable NMES-pants. Stimulation was delivered at individually tolerated intensities (visual analogue scale, (0-10), <&#x2009;4). Venous blood samples were collected immediately before and after NMES. Inflammatory proteins and myoglobin were quantified using OLINK multiplex proteomic panel (92 proteins), and metabolic markers including glucose, lactate, pH and electrolytes were assessed using standard laboratory methods. Of the 92 inflammatory proteins analyzed, 13 were nominally affected by NMES. After correction for multiple comparison, FMS-like tyrosine kinase 3 ligand (Flt3L) and fibroblast growth factor 19 (FGF19) remained significantly downregulated (Flt3L: 9.45&#x2009;&#xb1;&#x2009;0.12 to 9.11&#x2009;&#xb1;&#x2009;0.17, p&#x2009;<&#x2009;0.001; FGF19; 9.43&#x2009;&#xb1;&#x2009;0.88 to 8.80&#x2009;&#xb1;&#x2009;0.84, p&#x2009;<&#x2009;0.001; both normalized protein expression (NPX)). Myoglobin increased (7.70&#x2009;&#xb1;&#x2009;0.50 to 8.24&#x2009;&#xb1;&#x2009;0.83 NPX; p&#x2009;<&#x2009;0.001), while blood glucose decreased modestly (5.35&#x2009;&#xb1;&#x2009;0.73 to 5.17&#x2009;&#xb1;&#x2009;0.36 mmol/L; p&#x2009;=&#x2009;0.039). Lactate, pH, sodium and potassium remained unchanged. A single submaximal NMES-session elicited acute systemic responses characterized by downregulation of key inflammation-related proteins, mild myoglobin elevation and lower glucose levels - changes that mirror patterns observed after moderate exercise. These findings suggest that NMES at well-tolerated submaximal intensities can induce metabolic adaptations and may represent a safe, exercise-mimicking intervention to counteract inflammation and metabolic dysfunction in individuals with limited physical activity.

The drop vertical jump (DVJ) is used to identify biomechanical risk factors associated with non-contact anterior cruciate ligament (ACL) injuries, which often occur during eccentric loading. However, the influence of the horizontal jump distance, sex, and limb laterality on lower extremity and trunk biomechanics remains unclear. This cross-sectional study recruited 132 adolescents (83 males, 49 females, 15.0&#x202f;&#xb1;&#x202f;1.6&#x202f;y) from a school strength and conditioning program. Athletes jumped from a 0.30&#x202f;m box at two distances (0.15&#x202f;m and 0.45&#x202f;m). Kinematic and kinetic data were collected using markerless motion capture and force plates. Statistical Parametric Mapping analyzed the effects of sex, leg, and jump distance on lower extremity and trunk biomechanics during the eccentric phase landing. Greater horizontal distance increased frontal plane knee moments, with males and the non-dominant limb exhibiting greater moments. Females showed less sagittal plane trunk flexion than males. Greater horizontal jump distance led to an increase in frontal trunk lean over the ipsilateral limb. Horizontal distance, leg dominance, and sex are important factors in landing mechanics of DVJ. The increased frontal plane knee abduction moments (KAM), and ipsilateral trunk lean associated with longer distances, along with the asymmetries observed between legs indicate that increasing horizontal jump distance can magnify high-risk biomechanical patterns, which could make DVJ protocols more sensitive to identifying at-risk athletes. This information could make screening tools, such as single-leg DVJs with longer horizontal components, more sensitive to exposing deficits and could also be used to guide targeted neuromuscular training interventions.

Excessive inflammation and exacerbated oxidative stress are significant hallmarks of the diabetic bone microenvironment, which give rise to dysregulated immune reactions and impaired bone homeostasis, thereby hindering bone defect healing and increasing the incidence of bone nonunion. A biodegradable photothermal hybrid (SC/MTZ) was developed through the in situ self-assembly of zeolitic imidazolate framework-8 (ZIF-8) nanoparticles on tannic acid (TA)-functionalized Ti3C2Tx MXene nanosheets, which were then integrated into a methacrylated silk fibroin/carboxymethyl chitosan methacryloyl matrix. The integration of in situ photopolymerization and chelation coordination for double crosslinking, along with the incorporation of heterojunction MXene@TA/ZIF-8 (MTZ) nanosheets, enhances the physicochemical properties and biological activity of the hydrogels, providing optimal mechanical support and prolonged retention at the defect site. The hydrogel platform demonstrated outstanding antibacterial properties and effectively reprogrammed macrophages from the proinflammatory M1 phenotype to the anti-inflammatory M2 phenotype. This was achieved through the combined effects of localized mild hyperthermia and stimuli-responsive release of bioactive agents (TA and Zn2+), which also enhanced mitochondrial function and inhibited RANKL-induced osteoclast formation and bone resorption. In situ injection of the photoactivated SC/MTZ hydrogel markedly accelerated cranial defect healing in diabetic rats by synergistically enhancing immune homeostasis, osteogenesis, and angiogenesis while suppressing osteoclast activity. In summary, this study proposes an innovative method for developing multifunctional photothermal nanosheet-encapsulated hybrid hydrogels aimed at effectively managing diabetic bone defects.

Operating rooms represent one of the most material and resource-intensive areas of a hospitals and substantially contribute to the environmental footprint of healthcare systems. Beyond energy consumption, surgical supplies, medical devices and the associated inventory management and procurement processes have gained increasing attention as key levers for sustainability. This narrative review summarizes the current international evidence on sustainable inventory management and procurement strategies in the operating room. Particular emphasis is placed on different stocking models, standardization of surgical sets and modern procurement and supply chain approaches. Systematic reviews and implementation studies consistently demonstrate that structured inventory and procurement strategies can significantly reduce material waste, costs and environmental impact without compromising patient safety or quality of care. Sustainable effects require a&#xa0;systemic approach integrating organizational, logistical and clinical perspectives. Der Operationsbereich z&#xe4;hlt zu den material- und ressourcenintensivsten Funktionsbereichen eines Krankenhauses und leistet einen relevanten Beitrag zum &#xf6;kologischen Fu&#xdf;abdruck des Gesundheitswesens. Neben dem Energieverbrauch r&#xfc;cken zunehmend Verbrauchsmaterialien, Medizinprodukte sowie deren Lagerhaltung und Beschaffung in den Fokus nachhaltiger Strategien. Der vorliegende Beitrag analysiert auf Basis der aktuellen internationalen Literatur nachhaltige Konzepte der Lagerhaltung und Beschaffung im Operationsbereich. Im Mittelpunkt stehen unterschiedliche Modelle der Materialbevorratung, der Standardisierung chirurgischer Sets sowie moderne Beschaffungs- und Belieferungsstrategien. Systematische &#xdc;bersichtsarbeiten und Implementierungsstudien zeigen konsistent, dass strukturierte Lager- und Beschaffungsstrategien zu einer signifikanten Reduktion von Materialverschwendung, Kosten und Umweltbelastungen beitragen k&#xf6;nnen, ohne die Patientensicherheit oder Versorgungsqualit&#xe4;t zu beeintr&#xe4;chtigen. Voraussetzung f&#xfc;r nachhaltige Effekte ist eine systemische Herangehensweise, die organisatorische, logistische und klinische Aspekte integriert.

N6-methyladenosine (m6A) modification has emerged as a critical post-transcriptional regulatory mechanism in osteoarthritis (OA). However, the contribution of m6A-dependent regulation of circular RNAs (circRNAs) to chondrocyte senescence and OA progression remains poorly understood. We aimed to elucidate whether m6A-mediated control of circRNAs regulates chondrocyte senescence and to define the underlying molecular mechanisms contributing to OA progression. Here, we identified an OA-associated circRNA, circHIPK2, and demonstrated that its abundance and function are regulated by an m6A reader-dependent decay mechanism. circHIPK2 expression was reduced in human OA cartilage, and its depletion exacerbated chondrocyte senescence, increased senescence-associated secretory phenotype (SASP) gene expression, and impaired autophagy both in vitro and in the destabilization of the medial meniscus (DMM) model. Mechanistically, YTH N6-methyladenosine RNA-binding protein 2 (YTHDF2) recognized m6A-modified circHIPK2 and facilitated its degradation, thereby reducing circHIPK2 stability. Functionally, circHIPK2 directly interacted with RAB22A. Loss of circHIPK2 weakened this interaction, enhanced RAB22A-PI3K association, activated the PI3K-AKT-mTOR signaling pathway, disrupted autophagic flux, and accelerated senescence-associated phenotypes. Notably, the protective effects of circHIPK2 were abolished in RAB22A-binding-deficient circHIPK2 mutants, establishing a direct link between molecular interaction and functional outcome. Furthermore, we encapsulated circHIPK2 into lipid nanoparticles (circHIPK2-LNP) for transient intra-articular delivery. Intra-articular administration of circHIPK2-LNP attenuated chondrocyte senescence and alleviated OA progression in DMM mice. Collectively, m6A-dependent YTHDF2-mediated degradation of circHIPK2 promotes chondrocyte senescence and OA progression by disrupting autophagy, identifying circHIPK2 as a potential therapeutic target and prognostic biomarker for cartilage aging in OA.

Total joint arthroplasty (TJA) is one of the most frequent orthopaedic surgeries in the United States; however, disparities in utilization and outcomes based on race, sex, and socioeconomic level have been well documented. The impact of rural geographic location, a characteristic that may impact access to TJA care and postoperative outcomes, remains understudied. This systematic review investigated associations between rural location and several metrics in total hip arthroplasty and total knee arthroplasty to investigate whether disparities are present based on rural geographic location. In November 2024, PubMed, Web of Science, Scopus, EMBASE, and Cochrane Review databases were queried. Ten studies investigating TJA utilization and outcomes that included patients in a rural location were included. Study quality was assessed using a modified Newcastle-Ottawa Scale. Ten articles were included in the final analysis. Differences in complications, readmission rates, and length of stay due to rural location of patient and/or hospital were reported. Results indicate urban TJA patients more frequently discharge to rehab. Patient-reported outcome measures following TJA do not appear different between rural and urban patient groups. Rural geographic location is associated with different TJA utilization and outcomes and may point to disparities in care. Continued efforts dedicated to eliminating inequalities in TJA care should consider the impact geographic location may have on exacerbating other forms of inequity. The reporting of urban-rural classification of patients in arthroplasty research is important for advancing this area of study. Access to care for all patients should be prioritized.

People with longstanding hip and groin pain (LHGP) are often referred to orthopaedic care. Physical therapist-led interventions are recommended in consensus statements as the first line of treatment, but it is unknown if structured interventions are more effective than usual care. The aim of this trial is to evaluate the effectiveness of a structured physical therapist-led treatment model (HIPSTER) compared with usual care on hip-related quality of life at 4 months for people with LHGP referred to orthopaedic care. This is a preregistered (clinicaltrials.gov, NCT05853640) study protocol for a double-blinded two-armed pragmatic randomised controlled trial. Patients with LHGP (n=122), referred to the Department of Orthopaedics at a university hospital in Sweden, will be randomised into the HIPSTER model or usual care. The HIPSTER model is a 16-week structured, individualised progressive treatment using exercise therapy and patient education. Usual care consists of a recommendation to contact a physical therapist in primary care. Both groups will undergo standard examinations and a surgical consultation at the Department of Orthopaedics. The primary outcome will be the mean group change in the International Hip Outcome Tool from baseline to 4 months, according to intention-to-treat principles. Secondary outcomes include patient-reported outcomes (such as perceived improvement, psychological factors and physical activity), physical impairment tests and radiographic measures. Additional time points will be 1, 2 and 5 years after baseline. Subgroups of patients will complete semistructured interviews and report additional data on psychosocial variables to provide more information on patient experience as well as determinants of adherence. The Swedish Ethical Review Authority approved this study (Dnr 202205023-01). The results of this study will be published, regardless of results, in scientific journals and as plain language summaries for participants. NCT05853640.