This review systematically summarizes the common rehabilitation devices used in postoperative rehabilitation of knee replacement and their roles at different stages of recovery. Knee replacement is a primary treatment for knee osteoarthritis, and postoperative rehabilitation is crucial for functional recovery and improvement in patients quality of life. Based on the different stages of rehabilitation, the goals are categorized into pain relief and swelling reduction, restoration of joint mobility, strengthening of muscle power, and improvement of gait and balance. This paper provides a detailed overview of the commonly used medical devices at each stage, such as cold therapy devices, patient-controlled analgesia pumps, continuous passive motion machines, transcutaneous electrical nerve stimulation devices, neuromuscular electrical stimulation devices, and gait training equipment. Although the efficacy of some devices remains controversial, particularly in pain management and joint mobility restoration, they have demonstrated positive effects in accelerating postoperative recovery and enhancing patient satisfaction. With the promising prospects of virtual reality and robot-assisted rehabilitation devices, future personalized rehabilitation plans are expected to further optimize the recovery experience and outcomes for patients.

With the development of modern medicine, enhanced recovery after surgery(ERAS), a concept that is being accepted by more and more doctors and applied in clinical practice, has been widely used in many surgical fields.However, due to the difficulty of spine surgery and the relatively high risk and complication rates, there is relatively little experience with the use of ERAS in spine surgery in China.This article provides an overview of ERAS in three areas of spine surgery: preoperative, intraoperative and postoperative, with the aim of providing theoretical evidence for the implementation of ERAS protocols in the perioperative period for spine surgery patients.

As a novel medical concept, the concept of enhanced recovery after surgery(ERAS)has been widely applied in developed countries, such as Europe and the United States. Important developments in recent years have been observed in various clinical fields, including gynecology, pediatrics, hepatobiliary surgery, urology and oncology, with satisfactory clinical effects. ERAS is a multimodal and multidisciplinary evidence-based surgical method, which aims to optimize perioperative management and prognosis, so as to achieve the goals of reducing perioperative stress response and the incidence of complications, shortening the length of hospitalization, and promoting the recovery of physical and psychological conditions. Fracture is usually an emergency and surgical treatment is required, resulting in high medical expenses. Patients with high-risk factors, such as advanced age and multiple comorbidities, exhibited longer hospital stays and a high risk of complications. Postoperative rehabilitation exercises are crucial for limb function recovery. Therefore, implementation of ERAS principles in fracture patients is necessary. This article summarizes the current status of ERAS in fracture treatment to provide a reference for future clinical applications.

A large amount of clinical evidence-based medicine research has proven the effectiveness of enhanced recovery after surgery(ERAS). A scientific anaesthesia plan can alleviate stress reactions, reduce postoperative complications, shorten hospital stay, and accelerate postoperative recovery. Orthopaedic surgery is the most common type of surgery, and patients often experience pain in the perioperative period, which seriously affects prognosis. Ultrasound-guided regional block has advantages such as precise analgesic effect, saving analgesic drugs, fewer side effects, and improved quality of postoperative recovery, and is mainly used for intraoperative anaesthesia and postoperative analgesia. This article reviews the research progress and application of ultrasound-guided regional block in orthopaedic surgery under the ERAS concept.

Adhesive capsulitis of the shoulder is highly prevalent among middle-aged and elderly populations, accounting for a significant proportion of chronic shoulder pain cases. Over the past century and a half, our understanding of the diseases characteristics, pathological progression, and clinical manifestations has deepened. However, the root cause and optimal treatment approach for adhesive capsulitis remain unclear. This article provides a comprehensive review of the epidemiological features, pathogenesis, and treatment advances of adhesive capsulitis based on key literature from the past two decades. It aims to offer a systematic overview for clinicians, physical therapists, and researchers engaged in related basic studies, with evidence-based insights to inform clinical practice and research directions.

Elderly patients undergoing hip fracture surgery are prone to nutritional problems such as malnutrition and sarcopenia, which will adversely affect the clinical outcome. Standardized nutrition screening, assessment and diagnosis can help early detection of nutritional risks or malnutrition, and timely scientific nutrition intervention can help improve clinical outcomes. However, there is a lack of guidelines or consensus on nutritional management for elderly patients undergoing hip fracture surgery. This paper aims to probe the relevant research progress at home and abroad in recent years, understand the application of nutritional screening, nutritional assessment and nutritional diagnostic tools in elderly patients undergoing hip fracture surgery, as well as its nutritional intervention strategies in the perioperative and rehabilitation periods, provide reference for future relevant studies, and further accelerate the application in clinical practice.

This article aims to establish a consensus on accelerated rehabilitation of knee function following total knee arthroplasty(TKA), based on the principles of enhanced recovery after surgery(ERAS). The goal is to optimize perioperative rehabilitation measures and promote rapid recovery of knee function post-surgery. The consensus was developed using the Delphi method, conducted in two phases: an online questionnaire survey and online meetings. Initially, the corresponding authors drafted 17 clinical issues related to accelerated rehabilitation after TKA, which were reviewed and summarized by a panel of experts. A total of 50 experts participated in the anonymous survey, providing feedback through voting. Two online meetings were held to discuss the draft and conduct real-time voting, ultimately finalizing the consensus. The consensus follows the Oxford Centre for Evidence-Based Medicines standards for evidence grading and recommendation strength. Voting results were categorized as follows: 51%-74% agreement indicated "consensus", 75%-99% indicated "strong consensus", and 100% indicated "complete consensus". The consensus outlines 13 key items for postoperative knee function recovery, including rehabilitation evaluation, patient education, preoperative rehabilitation training, postoperative pain management, sleep management, and early postoperative activities. Most items received high levels of support, with voting approval rates ranging from 88% to 100%. Notably, key measures such as postoperative pain management(100% consensus)and early postoperative activities(95.45%-100% consensus)demonstrated a high degree of agreement among experts. Items related to rehabilitation evaluation and patient education also received strong consensus, with over 90% agreement. The consensus outlined in this article focuses on accelerating knee function recovery following TKA, providing valuable reference for clinicians and therapists in developing appropriate rehabilitation plans.

Objective To compare the early complications and clinical outcomes of total knee arthroplasty(TKA)for end-stage rheumatoid arthritis(RA)and osteoarthritis(OA)under the concept of enhanced recovery after surgery(ERAS). Methods A retrospective analysis was conducted on the clinical data of 96 patients with TKA in the Department of Joint and Sports Medicine at the First Affiliated Hospital of Shandong First Medical University. The patients were divided into RA group(n=25)and OA group(n=71). The intraoperative and postoperative blood loss, incidence of anemia, and postoperative complications such as superficial and deep infections were compared between the two groups. The early clinical outcomes of the patients were evaluated using the Forgotten Joint Score-12(FJS-12)at 1 year postoperatively. Results The proportion of moderate and severe anemia postoperatively was higher in the RA group compared to the OA group ［9(36.0%)vs. 11(15.5%), P=0.030］. There were no significant differences in intraoperative, postoperative, and total blood loss between the two groups(P>0.05). No statistically significant differences were observed in the occurrence of complications such as deep venous thrombosis, pulmonary embolism, superficial and deep infections, and rehospitalization within 90 days postoperatively between the two groups(P>0.05). The FJS-12 score at 1 year postoperatively was lower in the RA group compared to the OA group［(71.28±13.45)vs.(77.59±10.10, P=0.016)］, and the proportion of patients achieving a forgotten joint status was higher in the OA group compared to the RA group ［1(4.0%)vs. 17(23.9%), P=0.035］. However, there was no significant difference in the passing rate between the two groups. Conclusion Under the ERAS concept, the incidence of moderate and severe anemia and length of stay in RA patients after TKA are higher than those of OA patients, while OA patients are more likely to experience a forgotten knee after TKA. Orthopedic surgeons should focus on correcting preoperative anemia in RA patients and continuously optimize the ERAS protocol for these patients.

Objective To evaluate the analgesic effect of ultrasound-guided genicular nerve block(GNB)and local infiltration analgesia(LIA)after total knee arthroplasty(TKA). Methods A total of 60 patients undergoing unilateral TKA under general anesthesia were randomsied into LIA and GNB groups, with 30 patients in each group. After induction of general anesthesia, the GNB group underwent ultrasound-guided GNB(20 mL of 0.2% ropivacaine)while the LIA group received periarticular LIA(100 mL of 0.2% ropivacaine)before the end of surgery. The primary outcome was the numerical rating scale(NRS)score at rest at 24 h postoperatively. Secondary outcomes included the NRS scores at rest(6, 48 h)and during movement(6, 24, 48 h), sufentanil consumption at 24 h and 48 h, 20 m walk test times at 24 h, nausea and vomiting at 48 h postoperatively, patient satisfaction and hospital stay. Results Compared to the LIA group, patients in the GNB group had significantly lower NRS scores at rest(3.6±1.0 vs. 2.4±0.8, P<0.001)and during movement(5.4±1.4 vs. 3.9±1.1, P<0.001)at 24 h postoperatively and at rest(4.2±1.2 vs. 3.4±0.9, P=0.010)and during movement(5.7±1.4 vs. 4.4±1.2, P<0.001)at 48 h postoperatively. Sufentanil consumption in the GNB group was significantly lower than in the LIA group at both 24 h ［(56.9(49.2-62.4)vs. 43.1(38.5-48.1), P<0.001］ and 48 h ［90.4(85.1-105.5) vs. 81.7(75.9-90.6), P=0.002］ postoperatively. The two groups showed no significant difference in NRS score at 6 h postoperatively, nausea and vomiting within 48 h, 20 m walk test times at 24 h, satisfaction scores and hospital stay(P>0.05). Conclusion Compared with LIA, ultrasound-guided GNB can significantly reduce pain scores and opioid consumption at 24 and 48 h postoperatively in TKA patients.

Objective To explore the potential regulatory mechanism of curcumin on osteogenic differentiation of bone marrow-derived mesenchymal stem cells(BMSCs). Methods The target genes of curcumin regulating osteogenic differentiation were obtained through network pharmacology, and a protein-protein interaction network(PPI)was constructed. Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis and molecular docking were performed. CCK-8 and cell cloning were used to screen the concentration of curcumin. ALP staining and activity assay, AR staining and quantitative analysis were used to evaluate the macro-regulatory effect of curcumin on osteogenic differentiation. RT-qPCR and Western blotting were used to detect the micro-expression differences of mRNA and protein related to the Wnt/β-catenin gignaling pathway. Results A total of 92 target genes for curcumin regulation of osteogenic differentiation were screened, mainly involving biological processes such as the intracellular response to chemical stimuli and the response to oxidative compounds. Three target genes acted on the Wnt/β-catenin signaling pathway and could be effectively docked with curcumin. In addition, low concentrations of curcumin(5, 10 μmol)showed no obvious toxicity to rat bone marrow-derived mesenchymal stem cells(rBMSCs), enhanced alkaline phosphatase activity, increased calcium deposition(P<0.05), up-regulated the expression of osteogenic-related genes and proteins(P<0.05), and promoted osteogenic differentiation of rBMSCs. However, high concentration of curcumin(15 μmol)had a potential inhibitory effect on the osteogenic differentiation of rBMSCs. Conclusion Curcumin can regulate the expression of osteogenic-related genes by modulating the Wnt/β-catenin signaling pathway, thereby regulating the osteogenic differentiation of BMSCs.

Objective To explore the relationship between autophagy levels mediated by Fusobacterium nucleatum(Fn)and changes in cellular refractive index using optical surface wave sensing technology and to preliminarily investigates the potential of optical surface wave technology for detecting autophagy levels in cancer cells. Methods CCK-8 was used to assess the impact of Fn on the proliferation activity of colorectal cancer cells. The effects of Fn on autophagy levels were examined using both Western blotting and dual-labeling fluorescence microscopy techniques. Additionally, optical surface wave technology was employed to monitor changes in cellular refractive index under different Fn infection states, and to observe their correlation with autophagy levels. Results When multiplicity of infection was 100 and the infection time was 4 hours, the protein expression levels of Beclin-1 and LC3 were increased(P<0.05), while the expression level of P62 was decreased(P<0.01), indicating elevated autophagy levels. Concurrently, optical surface wave showed that the refractive indices of HCT116 and HT29 cells also increased with the elevation of autophagy levels(P<0.01). Further investigation revealed that changes in cellular refractive index were primarily due to variations in autophagosome levels within the cells, and were not influenced by factors such as cell proliferation or extracellular substances. Conclusion The autophagy levels mediated by Fn correlate with cellular refractive index, indicating that optical surface wave sensing technology can dynamically reflect changes in Fn-mediated autophagy levels. This suggests that optical surface wave technology could serve as a rapid, intuitive, and non-invasive method to assess autophagy levels without affecting cellular viability.

Objective To evaluate the predictive value of the perivascular fat attenuation index(FAI)based on coronary computed tomography angiography(CCTA)for revascularization in chronic total occlusion(CTO)of coronary artery. Methods A total of 204 patients with coronary artery total occlusion and treated with percutaneous coronary intervention(PCI)between November 2012 and June 2023 were retrospectively analyzed and divided into the successful group(n=144)and the unsuccessful group(n=60)according to the outcome of the procedure. The general clinical data, FAI of the occluded segment, and the morphological characteristics of CCTA of CTO lesions, including lesion site ［right coronary artery(RCA), left anterior descending artery(LAD), left circumflex artery(LCX)］, lesion length, lesion CT value, the volume of calcified plaques in the lesion, the stump morphology of the lesion entrance, whether the angle of curvature of the lesion was >45°, and whether the lesion was negatively remodeled, were analyzed and compared between the two groups. Independent factors affecting the revascularization of CTO lesion were screened by binary Logistic regression analysis, and a conventional model of morphological characteristics and a combined model of morphological characteristics and FAI were established. The predictive performance of each model was evaluated by the receiver operating characteristic(ROC)curve. Results The differences in FAI ［(-82.33±10.61)HU vs.(-71.70±10.91)HU, P<0.001］, CT value［69.85(55.95, 86.25)HU vs. 58.25(47.00, 72.83)HU, P<0.001］, calcified volume［20.92(2.25, 52.80)mm³ vs. 5.69(0.00, 25.75)mm³, P<0.001］, and length［23.60(13.90, 34.50)mm vs. 14.65(9.43, 19.60)mm, P<0.001］of the occluded segment were all statistically significant. The occluded segment length >23.05 mm, FAI of the occluded segment <-77.50 HU, CT value of the occluded segment >58.15 HU, and negative remodeling of the occluded vessel were identified as independent predictors of failure of CTO lesion revascularization. A conventional morphological characteristics model was established by combining the three morphological characteristics factors, and another model was established by combining the conventional morphological characteristics model with FAI. The combined model demonstrated superior predictive performance for the outcome of revascularization compared to the conventional morphological characteristics model, with AUC being 0.857 and 0.787, respectively, P<0.001. Conclusion The FAI may serve as a novel predictor of the outcomes of PCI surgery for CTO of the coronary artery. Based on the conventional morphological characteristics, FAI provides a novel approach to predicting the surgical outcomes of CTO patients.

Objective To investigate the therapeutic effects of idebenone in patients with Parkinsons disease-related cognitive impairment and to explore its mechanisms of action. Methods A total of 216 patients with Parkinsons disease-related cognitive impairment who were hospitalized in the The First Affiliated Hospital of Shandong First Medical University from January 2017 to January 2024 were included. The patients were randomly divided into the conventional treatment group(n=82)and the idebenone treatment group(n=134). The changes of the Montreal Cognitive Assessment(MoCA)and its subdomain cognitive scores, the Mini-Mental State Examination(MMSE), the Unified Parkinsons Disease Rating Scale Ⅲ(UPDRS-Ⅲ), the Cholinergic Pathways Hyperintensities Score(CHIPS), interleukin-6(IL-6), peripheral blood superoxide dismutase(SOD), liver function, and kidney function were monitored for both groups before drug treatment and after 12 months of continuous drug treatment. Results There were no statistically significant differences in general data, Hoehn-Yahr(H-Y)staging, various scale scores and hematological indicators before treatment(P>0.05). After 12 months of drug treatment, the increase in MoCA scores and their single-domain visuospatial executive ability and language was higher in the idebenone treatment group than in the conventional treatment group(P<0.05), and the decrease in UPDRS-Ⅲ scores was even more pronounced(P<0.05). The IL-6 levels in the idebenone treatment group decreased, while those in the conventional treatment group increased, with a statistically significant difference between the two groups(P<0.05). The SOD levels in the idebenone treatment group increased, while those in the conventional treatment group decreased, with a statistically significant difference between the two groups(P<0.05). There were no statistically significant differences in liver and kidney function-related indicators between the two groups(P>0.05). After adjusting for pre-treatment CHIPS scores, disease duration, and age covariates, the CHIPS score in the idebenone treatment group was 2.19 points lower than that in the conventional treatment group(F=229.16, P<0.01, R2=0.91, adjusted R2=0.90). Conclusion Idebenone can significantly alleviate cognitive impairment, improve motor symptoms, delay the damage of white matter hyperintensities to the cholinergic pathways, increase peripheral blood SOD levels, and reduce IL-6 levels in patients with Parkinsons disease.

Objective To compare different diaphragmatic ultrasound functional indices, diaphragmatic excursion during quiet breathing(DE-QB), diaphragmatic excursion during deep breathing(DE-DB), thickening fraction of diaphragm(TFdi), in predicting postoperative pulmonary complications(PPCs)after abdominal surgery. Methods A total of 154 patients scheduled for elective laparoscopic abdominal surgery under general anesthesia were selected. DE-QB, DE-DB, and TFdi were measured by bedside ultrasound before and 24 hours after surgery. Postoperative pulmonary complications were recorded for 7 days. Patients were divided into two groups according to the occurrence of pulmonary complications: the pulmonary complications group(PPCs group, n=48)and the non-pulmonary complications group(n-PPCs group, n=106). The differences in diaphragm function indices between the two groups were compared, and those with significant differences were selected to plot ROC curves. The ROC curves were compared to assess the predictive value of three ultrasound diaphragmatic functional indices for postoperative pulmonary complications after abdominal surgery. A predictive model for postoperative pulmonary complications was created using Lasso Logistic regression analysis and compared with individual diaphragmatic functional indices. Results The differences in preoperative DE-QB, DE-DB, and TFdi between the two groups were not statistically significant(P>0.05). However, the postoperative DE-QB, DE-DB, and TFdi in the PPCs group were lower than those in the n-PPCs group, with statistically significant differences(P<0.001). The areas under the ROC curve(AUC)for postoperative DE-QB, DE-DB, and TFdi were 0.780, 0.779, and 0.713, respectively, with no significant differences. Patients were divided into high-risk PPCs and low-risk PPCs groups according to the optimal cut-off value of the ROC curves of the three functional indices. When patients were differentiated by postoperative DE-QB(optimal cut-off value of 0.93 cm), the incidence of pulmonary complications differed between the high-risk and the low-risk groups(14.1% vs. 61.8%, P<0.001); when patients were differentiated by postoperative DE-DB(optimal cut-off value of 2.41 cm), there was a difference in the incidence of pulmonary complications between the high-risk and the low-risk groups(13.3% vs. 56.3%, P<0.001); when patients were differentiated by postoperative TFdi(optimal cut-off value of 0.23), there was a difference in the incidence of pulmonary complications between the high-risk and the low-risk groups(16.5% vs. 52.4%, P<0.001). By Lasso Logistic regression analysis, the final risk factors included in the prediction model were age, smoking history, duration of surgery, DE-QB(postoperative), and DE-DB(postoperative), and the Lasso Logistic regression model(AUC=0.851)outperformed any single index of diaphragm function. Conclusion The DE-QB, DE-DB and TFdi measured at 24h post-operatively alone can predict the occurrence of post-operative pulmonary complications(PPCs)to some extent when used individually, however the measurement of diaphragmatic excursion(DE)provided better predictive value for PPCs than TFdi. The predictive model established by Lasso Logistic regression can better predict the incidence of PPCs than any single diaphragm function index.