Background: This study aimed to investigate immunoregulatory role of IL-2/STAT5/CD4+CD25+Foxp3 Treg pathway in pathogenesis of chronic osteomyelitis (COM). Methods: Sprague-Dawley (SD) rats were injected with Staphylococcus aureus to establish COM model. 4 weeks later, the lesioned bones were collected and subjected to HE staining for examination of inflammatory infiltration. Enzyme-linked immunosorbent assay (ELISA) was employed to detect IL-2 expression in peripheral blood; flow cytometry was performed to detect CD25+CD4+Foxp3 Treg cells in peripheral blood. The mRNA expression of Foxp3 and CTLA-4 was detected by RT-PCR and the protein expression of STAT5 and p-STAT5 was detected by Western Blotting in CD25+CD4+Foxp3 Treg cells. Results: In COM group, the periosteal thickening was observed in femur, and there were a large number of inflammatory cells in medullary cavity, accompanied by bone destruction. At 1, 2 and 4 weeks, IL-2 expression significantly increased, the proportion of CD4+CD25+FoxP3 Treg cells in peripheral monocytes markedly increased, the mRNA expression of Foxp3 and CTLA-4 and p-STAT5 protein expression increased dramatically in Treg cells as compared to control group (P<0.001). Conclusions: IL-2/STAT5/CD4+CD25+Foxp3 Treg pathway may be involved in the pathogenesis of COM, and excessive immunosuppression may lead to persistent infectious inflammation, which may become a key target for future treatment of COM.

Background: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and oblique lateral interbody fusion (OLIF) are widely used in the treatment of lumbar degenerative diseases. In the present study, a meta-analysis was conducted to compare the clinical and radiographic efficacy of these two procedures. Methods: A systematic literature review was performed, and the quality of retrieved studies was evaluated with the Newcastle-Ottawa Scale (NOS). Clinical outcomes, including operation time, intraoperative blood loss, improvement in Visual Analogue Scale (VAS), improvement in Oswestry Disability Index (ODI), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) effectiveness rate and complications, in addition to radiographic outcomes, including restoration of disc height, disc angle, overall lumbar lordosis, fusion rate and subsidence, were extracted and input into a fixed or random effect model to compare the efficacy of MIS-TLIF and OLIF. Results: Seven qualified studies were included. Clinically, OLIF resulted in less intraoperative blood loss and shorter operation time than MIS-TLIF. Improvement of VAS for leg pain was more obvious in the OLIF group (P < 0.0001), whereas improvement of VAS for back pain (P = 0.08) and ODI (P = 0.98) as well as JOABPEQ effectiveness rate (P = 0.18) were similar in the two groups. Radiographically, OLIF was more effective in restoring disc height (P = 0.01) and equivalent in improving the disc angle (P = 0.18) and lumbar lordosis (P = 0.48) compared with MIS-TLIF. The fusion rate (P = 0.11) was similar in both groups, while the subsidence was more severe in the MIS-TLIF group (P < 0.00001). Conclusions: The above evidence suggests that OLIF is associated with a shorter operation time (with supplementary fixation in the prone position) and less intraoperative blood loss than MIS-TLIF and can lead to better leg pain alleviation, disc height restoration and subsidence resistance. No differences regarding back pain relief, functional recovery, complications, disc angle restoration, lumbar lordosis restoration and fusion rate were found. However, due to the limited number of studies, our results should be confirmed with high-level studies to fully compare the therapeutic efficacy of MIS-TLIF and OLIF. Trial registration: PROSPERO ID: CRD42020201903.

Superparamagnetic iron oxide (SPIO), an alternative mapping agent, can be used to identify sentinel lymph nodes in patients with clinically node-negative breast cancer. However, its performance in comparison with the standard method, using a radioisotope (technetium-99 m, Tc) alone or in combination with blue dye, remains controversial. Hence, a systematic review and meta-analysis were conducted to evaluate the diagnostic accuracy of SPIO and its clinical impact in the management of breast cancer. The PubMed, Embase, and Cochrane databases were comprehensively searched from inception to 1 May 2022. Cohort studies regarding the comparison of SPIO with standard methods for sentinel lymph node identification were included. A total of 19 prospective cohort studies, which collectively included 2298 clinically node-negative breast cancer patients undergoing sentinel lymph node identification through both the standard method and SPIO, were identified. The detection rate for sentinel lymph nodes (RR, 1.06; 95% CI, 1.05–1.08; p < 0.001) was considerably higher in the SPIO cohorts than in the standard method cohorts, although this difference was not significant in detected patients, patients with positive sentinel lymph nodes, or positive sentinel lymph nodes. Compared with the standard method, the SPIO method could be considered as an alternative standard of care for sentinel lymph node detection in patients with clinically node-negative breast cancer.

Background: Osteomyelitis (OM) is a severe bone infection with rising incidence rates, particularly among elderly and diabetic patients. The immune–inflammatory axis is implicated in OM pathogenesis, but its complex interplay remains poorly defined. This study aims to explore the causal relationships between immunophenotypes, plasma inflammatory proteins, and OM using Mendelian randomization (MR) and bioinformatics. Methods: Utilizing publicly available genetic data, we undertook a series of quality control measures to identify instrumental variables (IVs) associated with exposure. Subsequently, we conducted MR using inverse variance weighting to explore the causal relationships between immunophenotypes, plasma inflammatory proteins, and OM. Bioinformatics tools were applied to explore the functional enrichment and protein–protein interaction networks of the implicated genes. Results: The MR analysis identified 13 immune cell phenotypes and 2 plasma inflammatory proteins associated with risk of OM. Notably, higher levels of HLA DR on plasmacytoid dendritic cells, memory B cell absolute counts, and CD8dim T cell percentages were associated with increased OM risk. Additionally, elevated levels of CD6 and IL‐12 subunit B were correlated with OM risk. Bioinformatics analysis revealed the enrichment of related genes in immune‐related pathways and highlighted the complex interaction networks of the implicated proteins. Conclusions: This study provides novel insights into the immune–inflammatory axis in OM and identifies potential biomarkers for risk assessment. The findings warrant further validation in diverse populations and pave the way for developing targeted preventive and therapeutic strategies for OM.

Objective. To study the role of bacterial biofilm (BBF) in the formation of chronic osteomyelitis and its prevention and treatment. Methods. In this paper, a large amount of relevant literature was searched for analysis and summary, and the key words chronic osteomyelitis, bacterial biofilm, infection, and debridement were searched in databases, mainly CNKI, Wanfang, and Wipu. The search was conducted until December 2020. The role of bacterial biofilm formation in chronic osteomyelitis and its prevention were analyzed. Results. Chronic osteomyelitis is formed mainly due to poor blood supply and drug-resistant bacteria, of which cellular biofilm is the most important cause. BBF forms on the surface of necrotic soft tissue and bone tissue, which has a protective effect on bacteria and greatly enhances their resistance to antibiotics, leading to difficulties in complete bacterial clearance and recurrent infections in osteomyelitis. Conclusion. Through an in-depth study of the molecular biology and signal transduction of osteomyelitis biofilm, antibiotic biofilm treatment strategies and surgical debridement remain the focus of clinical translation of chronic osteomyelitis.

Background: Osteomyelitis (OM) is a serious infection of the bone, often resulting from diabetic foot ulcers, trauma, or surgical interventions. Given its complex pathophysiology and recurrent nature, identifying reliable risk factors is essential for early diagnosis and intervention. This study identifies independent OM risk factors through a systematic review and meta-analysis method. Methods: A search was conducted across several databases up to January 2025. Data were extracted independently, and study quality was assessed using the Newcastle–Ottawa Scale. Statistical analysis was performed with RevMan 5.3 and Stata 15.0 software, using univariate and multivariate analyses. Heterogeneity was assessed by methods of subgroup analysis and sensitive analysis, and publication bias was evaluated with Egger’s test and funnel plots. Results: A total of 4019 potential articles were systematically reviewed, with 27 studies (n = 11 941 participants) were included. These studies were analyzed to identify risk factors across five categories: demographic features, medical history, clinical features, laboratory findings, and bacterial characteristics. Medical history factors, such as history of foot ulcers/foot disease (OR = 2.520), operation duration time (>3 hours, OR = 1.740), and incision length >10 cm (OR = 6.530), were significant. Clinical features including inflamed ulcer (OR = 6.200), fever (OR = 2.200), and ulcer size >4/5 cm ² (OR = 2.740) also increased OM risk. Laboratory findings such as elevated HbA1c (OR = 1.140), hypoalbuminemia (OR = 1.740), anemia (OR = 1.540), and microbiological perspective such as polymicrobial infections (OR = 2.580) were also recognized as independent risk factors of OM. Subgroup analysis accounted for heterogeneity arising from the type of OM and different risk factor characteristics. Sensitivity analysis confirmed the reliability of the results. Additionally, both funnel plots and Egger tests showed no evidence of publication bias. Conclusions: This is the first meta-analysis to integrate univariate and multivariate evidence on OM risk factors. It establishes clinically preventable risk factors across OM subtypes, enabling early targeted interventions to reduce amputations and healthcare burdens.