CCL17, a chemotactic cytokine produced by macrophages, is known to promote inflammatory and fibrotic effects in multiple organs, but its role in mediating renal fibrosis is unclear. In our study cohort of 234 chronic kidney disease (CKD) patients and 65 healthy controls, human cytokine array analysis revealed elevated CCL17 expression in CKD that correlated negatively with renal function. The area under the receiver operating characteristic curve of CCL17 to predict the development of CKD stages 3b–5 was 0.644 (p < 0.001), with the optimal cut-off value of 415.3 ng/mL. In vitro over-expression of CCL17 in HK2 cells had no effect on cell viability, but increased cell motility and the expression of α-SMA, vimentin and collagen I, as shown by western blot analysis. In a unilateral ureteral obstruction (UUO) mouse model, we observed significantly increased interstitial fibrosis and renal tubule dilatation by Masson’s Trichrome and H&E staining, and markedly increased expression of CCL17, vimentin, collagen I, and α-SMA by IHC stain, qRTPCR, and western blotting. CCL17 induced renal fibrosis by promoting the epithelial-mesenchymal transition, resulting in ECM accumulation. CCL17 may be a useful biomarker for predicting the development of advanced CKD.

We aimed to investigate the association between preoperative body mass index (BMI) and postoperative long-term mortality in patients who underwent a vertebroplasty. We retrospectively enrolled patients with a vertebral compression fracture who underwent a vertebroplasty between May 2013 and June 2020 in a medical center in Taiwan. The survival status of the study sample was confirmed by the end of March 2021. Cox-proportional hazard models were conducted to examine the effects of being overweight/obese (≥25 kg/m² vs. <25 kg/m²) and BMI (as a continuous variable) on all-cause mortality after adjusting for age, sex, history of smoking, diabetes, hypertension, chronic kidney disease, and osteoporosis. A total of 164 patients were analyzed (mean age 75.8 ± 9.3 years, male 25.6%, mean BMI 24.0 ± 4.1 kg/m²) after a median follow-up of 785 days. Compared with a BMI < 25 kg/m², a BMI ≥ 25 kg/m² was associated with a significantly lower risk of all-cause mortality (HR 0.297, 95% CI 0.101 to 0.878, p = 0.028). These findings were consistent when BMI was examined as a continuous variable (HR 0.874, 95% CI 0.773 to 0.988, p = 0.031). A low BMI (<22 kg/m²) should be considered as a risk factor for postoperative long-term mortality in this ageing population.

Background Various studies have discussed the benefits of applying three-dimensional (3D) techniques, specifically its advantages with respect to ergonomics, feasibility, and the rate of learning achievable in microsurgery training. However, no study has been conducted that compares the operator experience of using two-dimensional (2D) and 3D systems in microsurgical training. The aim of this study is to compare 2D- and 3D-assisted microsurgical training in novices based on anastomosis of chicken femoral arteries. Methods The participants were grouped by previous microsurgical experience. Group A includes novice participants. Group B includes 2D-experienced participants. Group C includes both participants in groups A and B. A questionnaire composed of 10 parameters in the field of image quality, dexterity, ergonomic, and feasibility will be filled out after each participant finished their anastomoses by the 2D and 3D systems. Results The results demonstrated 3D system was scored better on “field of view” (p = 0.004), “less tremor” (p = 0.005), “neck/upper back comfort” (p = 0.043), “lower back comfort” (p = 0.015), “technical feasibility” (p = 0.020), and “educational feasibility” (p = 0.004) in group A (N = 12). In group B (N = 9), 3D system was scored better on “field of view” (p = 0.041) but worse on “image resolution” (p = 0.031). Conclusion With the 3D visualization system for microsurgical anastomosis of chicken femoral model, there are significant improvements in the field of view, stability, ergonomics, and educational value compared with 2D system among all participants. Accordingly, 3D-assisted microsurgery training can be a novel and potential popular training method.

Background: Total knee arthroplasty (TKA) effectively relieves pain in end-stage osteoarthritis, yet a proportion of patients remain dissatisfied despite advances in surgical technique. Medial-congruent (MC) bearings are designed to recreate native medial-pivot kinematics, which depend on appropriate medial compartment soft tissue tension. Robotic-assisted TKA (RA-TKA) has been shown to improve the accuracy and soft tissue balance. However, evidence of its additional benefits in MC TKA remains limited. Methods: We retrospectively identified consecutive primary TKAs with the same MC bearing performed between April 2022 and June 2024 at a tertiary center. After performing 1:1 propensity score matching to reduce baseline imbalance, 36 patients who received RA-TKA and 36 who underwent manual TKA (M-TKA) were included. Primary outcomes were evaluated with the 12-month Oxford Knee Score (OKS) and KOOS-JR. Secondary outcomes included radiographic alignment parameters, outlier rates, operative time, liner thickness, and hospital stay. Results: Baseline characteristics and liner thickness were comparable, and operative time was longer in the RA-TKA group than in the M-TKA group. Both RA-TKA and M-TKA produced significant 12-month improvements in OKS and KOOS-JR with no difference in mean scores. RA-TKA had fewer posterior tibial slope outliers (mean slope 4.3° ± 1.8 vs. 5.9° ± 3.1; outlier rate 16.7% vs. 41.7%; p = 0.02), whereas coronal alignment parameters did not differ between groups. Conclusions: RA-TKA with MC bearing provides functional outcomes comparable to M-TKA and may decrease sagittal alignment variability; long-term follow-up studies are needed to determine whether this potential benefit translates into sustained functional gains or improved implant survivorship.

Introduction: Oswestry Disability Index (ODI) and EuroQol-5D (EQ-5D) have been widely used to assess general health quality and function in clinical studies of patients with vertebral fractures. We aimed to investigate the associations of preoperative ODI and EQ-5D with long-term mortality in patients undergoing percutaneous vertebroplasty.Material and methods: We retrospectively identified adult patients who had a single-level vertebral compression fracture and received percutaneous vertebroplasty between 2013 and 2020. Patients with traumatic fractures, burst fractures, and pathologic fractures, as well as those who had missing information on preoperative assessment of ODI and EQ-5D, were excluded. Survival status of the study patients was confirmed at the end of March 2021. The associations of preoperative ODI and EQ-5D with all-cause mortality were examined using Cox-proportional hazard models.Results: A total of 167 patients were analyzed (mean age 75.8 ± 9.3 years, 25.7% male). There were 28 patients who died during a median follow-up duration of 2.1 years (63.6 per 1000 patient-years). Preoperative ODI was significantly associated with all-cause mortality after vertebroplasty (HR 1.049, 95% CI 1.008 to 1.092, p=0.018). In contrast, preoperative EQ-5D was independently associated with a lower risk of all-cause mortality after the surgery (HR 0.202, 95% CI 0.043 to 0.936, p=0.041).Conclusions: Preoperative assessment of ODI (HR 1.049, 95% CI 1.008 to 1.092) and EQ-5D (HR 0.202, 95% CI 0.043 to 0.936) may help determine postoperative long-term mortality risk in this aging surgical population.