Objective: To evaluate the diagnostic performance and clinical utility of targeted next-generation sequencing (tNGS) in primary osteoarticular infections (POI).Methods: Eighty-seven patients diagnosed with POI at the Bone Infection Ward of Ningxia Medical University General Hospital between September 2023 and September 2024 were enrolled, including cases of tuberculous osteoarticular infection (35 cases), Brucella-related osteoarticular infection (21 cases), and pyogenic osteoarticular infection (31 cases). Using bacterial culture, Xpert MTB/RIF assay, Brucella agglutination test, and histopathological examination as reference standards, the diagnostic value of tNGS in pathogen identification and resistance gene analysis was systematically evaluated.Results: All patients had complete follow-up data. The cohort comprised 87 POI patients (mean age: 55.36 ± 17.24 years; male-to-female ratio: 1.35:1). tNGS demonstrated significantly higher overall sensitivity than conventional bacterial culture (85.0% vs. 31.0%, P < 0.001). For resistance profiling, tNGS identified Mycobacterium tuberculosis complex mutations associated with resistance to isoniazid (2 cases), rifampicin (2 cases), ethambutol (1 case), pyrazinamide (5 cases), and streptomycin (1 case). Additionally, one fluoroquinolone resistance gene and one extended-spectrum β-lactamase (ESBL)-producing pathogen were detected. Notably, one multidrug-resistant (MDR) case harbored mutations conferring resistance to five anti-tuberculosis agents. Receiver operating characteristic (ROC) curve analysis revealed that tNGS exhibited superior diagnostic accuracy for tuberculous osteoarticular infections (AUC = 0.926), Brucella-related osteoarticular infections (AUC = 0.891), and pyogenic osteoarticular infections (AUC = 0.912), outperforming Xpert MTB/RIF (0.814), Brucella agglutination test (0.832), bacterial culture (0.652), and histopathology (0.704) (all P < 0.05).Conclusion: tNGS enables simultaneous pathogen identification and resistance gene detection with high efficiency, broad coverage, and accuracy, demonstrating significant advantages in POI diagnosis. This technology holds critical value in guiding optimized antimicrobial therapy and is recommended as a first-line molecular diagnostic tool for POI.

Epidemiological and clinical analyses of Brucellar spondylitis (BS) are crucial for public health authorities to enhance disease surveillance and optimize case management strategies. However, clinical epidemiological research on BS remains limited. This study analyzed the clinical and epidemiological characteristics of hospitalized BS patients at a hospital in Ningxia, aiming to provide evidence to support region-specific strategies for BS prevention and control. We retrospectively collected demographic profiles, epidemiological characteristics, clinical presentations, laboratory/imaging findings, therapeutic regimens, and prognostic outcomes of BS inpatients admitted to the orthopedic department of a hospital in Ningxia from January 2012 to December 2023. A total of 821 patients with BS were included, consisting of 564 males (68.7%; 564/821) and 257 females (31.3%; 257/821), with a median age of 55 years (range: 18–88 years). Among all patients (n = 821), 466 (56.76%) were agricultural or pastoral workers, and 578 (70.4%) had a documented history of contact with cattle or sheep. Low back pain was the most common presenting symptom, reported in 779 cases (94.88%; 779/821). The combined positive rate of the Rose Bengal Plate Test (RBPT) and the Standard Agglutination Test (SAT) in serological testing was 90.99% (747/821). Blood cultures were performed in 618 patients, of whom 217 (35.11%; 217/618) yielded positive results. Imaging examinations revealed that the lumbar spine was the most frequently involved region (59.81%; 491/821), with the L4–L5 segment being the most commonly affected (20.83%; 171/821). Single-segment involvement was observed in 668 patients (81.37%; 668/821), single-vertebra involvement in 44 patients (5.36%; 44/821), and multi-segment or trans-segment involvement in 109 patients (13.28%; 109/821). Of the 465 patients who underwent surgical treatment, the most common procedure was posterior fixation combined with lesion debridement, performed in 215 cases (46.24%; 215/465). Among the 754 patients who completed follow-up, the most frequently used antibiotic regimen was doxycycline plus rifampicin (60.05%; 493/754). Relapse occurred in 26 patients during follow-up (3.45%; 26/754). Brucellar spondylitis in Ningxia exhibits a temporal pattern aligned with regional brucellosis trends. Strengthening imaging-based diagnosis, clinical evaluation, and targeted follow-up of high-risk populations may help reduce recurrence and improve disease control. Not applicable.

Objective: This study aims to investigate the treatment strategies for lumbar brucellar spondylitis by comparing the outcomes of pure pharmacological treatment with diseased intervertebral fixation fusion, with or without lesion clearance.Methods: A total of 157 patients with lumbar brucellar spondylitis were categorized into three groups: Group A (52 cases) received pure pharmacological treatment, Group B (53 cases) underwent posterior vertebral fixation fusion, and Group C (52 cases) received posterior (or anterior) lesion clearance followed by posterior vertebral fixation fusion. Clinical data were analyzed, and the efficacy of the three treatment methods was evaluated.Results: The surgical groups showed better outcomes at various time points compared to the pharmacological treatment group (P < 0.05). The pure fixation group outperformed the lesion clearance fusion group during the perioperative period (P < 0.05). The ESR, CRP, ODI scores, imaging evaluation and complications of the lesion clearance followed by fixation group were all better than those of the other two groups (P < 0.05). Surgical treatment groups showed no statistically significant difference in VAS scores (P > 0.05), and both were superior to the pharmacological treatment group. There were no statistically significant differences in clinical efficacy among the three groups at the last follow-up.Conclusion: Surgical treatment achieves early recovery goals compared to pharmacological treatment for brucellar spondylitis. However, individualized treatment principles should guide surgical decisions to select the most suitable approach for patients.

Objectives: To analyze and compare the biomechanical differences and clinical efficacy of artificial vertebral bodies (AVBs) versus traditional titanium mesh cages (TMCs) reconstruction following total en bloc spondylectomy (TES).Materials and Methods: Finite Element Analysis: A finite element model of T12-L5 vertebrae from a healthy adult was utilized to construct two reconstruction models following L2 TES: Group A (AVB) and Group B (TMC). Using ANSYS software, flexion-extension, lateral bending, and axial rotation loading conditions were simulated to comparatively analyze stress distribution at the prosthesis-endplate interface and biomechanical characteristics of the fixation system; Clinical research: This retrospective study included 20 thoracolumbar tumor patients who underwent posterior TES at our institution from January 2014 to October 2024, divided into AVBs (n = 10) and TMCs (n = 10) reconstruction groups. Systematic comparisons were performed for perioperative parameters (operative time, blood loss, hospital stay), with dynamic assessments of preoperative to final follow-up Visual Analog Scale (VAS) pain scores, American Spinal Injury Association (ASIA) neurological classifications, and Karnofsky Performance Status (KPS) scores. Radiographic measurements of vertebral height and angular alignment changes were conducted to comprehensively evaluate reconstruction outcomes.Results: Finite element analysis revealed that the TMC model exhibited significant stress concentration phenomena across all motion modes compared to the AVB model. Specifically, the stress on the L1 inferior endplate was 50.09%, 17.48%, 74.07%, 133.83%, and 87.23% higher during extension, left lateral bending, right lateral bending, left axial rotation, and right axial rotation, respectively. The L3 superior endplate demonstrated similar stress patterns but with smaller magnitudes. In both implant models, peak stresses occurred during extension and axial rotation, followed by lateral bending, with minimal stress observed during flexion. For the posterior fixation system, no significant differences in maximum stress were observed between the two prosthetic configurations; Clinically, Group A demonstrated significantly lower implant subsidence rates (10% vs 70%) and superior outcomes in intervertebral height loss (1.33 ± 0.82 mm vs 12.36 ± 7.79 mm) and angular loss (p < 0.05). No statistically significant differences were identified between groups regarding hospitalization duration, operative time, intraoperative blood loss, VAS scores, KPS scores, or ASIA grade improvements (p > 0.05).Conclusion: Following TES, the AVB demonstrated more uniform stress distribution and superior biomechanical performance compared to the TMC. Additionally, the AVB effectively reduced implant subsidence rates, maintained intervertebral height, corrected kyphotic deformities, and exhibited enhanced biomechanical stability and clinical efficacy.

Bone is one of the distant metastases in patients with Breast Cancer (BC). However, the mechanism of BC bone metastasis is not fully understood. The aim of this study was to investigate the potential mechanisms linking bone metastasis-related genes and BC.The training set consisted of data from The Cancer Genome Atlas (TCGA)-BC dataset, which included 1,104 breast cancer samples (comprising 50 with bone metastasis and 1,052 without) and 114 adjacent normal samples. Differentially expressed genes (DEGs1) between breast cancer and normal tissues, as well as DEGs2 between breast cancer bone metastatic and non-bone metastatic tissues, were identified. Weighted gene co-expression network analysis (WGCNA) was then applied to screen breast cancer-related module genes. The intersection of these three sets was taken to obtain candidate genes. Diagnostic genes were identified via univariate Cox regression and Least Absolute Shrinkage and Selection Operator (LASSO) analysis to construct a risk model, which was subsequently validated using the Gene Expression Omnibus (GEO) dataset GSE20685 (327 samples, validation set). Furthermore, immune infiltration analysis, mRNA-miRNA-lncRNA regulatory network construction, and drug sensitivity analysis were performed in the training set. Finally, quantitative reverse transcription polymerase chain reaction (qRT-PCR) was conducted on clinical samples for validation.There were 756 DEGs between BC and control samples. A sum of 6 BC-related modules were acquired by WGCNA. After screening, 997 bone metastasis-associated genes and 73 candidate genes were acquired. A total of 6 diagnostic genes, namely ABHD8, ESRRA, DHPS, ISOC2, MRPL34 and OGFR, were obtained to construct the risk model. Results of the immune microenvironment analysis revealed that the high-risk group exhibited lower levels of certain immune cells, such as T cells and CD8+ T cells. Based on the public database,ESRRA was regulated by various miRNAs, such as hsa-miR-185-3p, hsa-miR-2115-5p. Based on the results of molecular docking experiments, a sum of 67 drugs had significant differences in IC50 between two risk subgroups. Transcriptomic data from TCGA indicated that all six diagnostic genes were significantly upregulated in the BC group (p < 0.05). However, qRT-PCR validation showed that ESRRA and OGFR were significantly downregulated in the BC group (p < 0.05), while the expression trends of the remaining four genes were consistent with the transcriptomic data.We explored the diagnostic genes (ABHD8, ESRRA, DHPS, ISOC2, MRPL34, and OGFR) of bone metastasis in BC, providing a reference for disease-related study.

Objective: To investigate the biomechanical characteristics and clinical outcomes after lesion debridement at varying degrees of sacroiliac joint destruction, and to assess the role of internal fixation in postoperative stability. Materials and Methods: Finite element analysis: An intact three-dimensional finite element model of the pelvis was established based on CT data from a healthy adult. On this basis, unilateral sacroiliac joint articular surface destruction of 25%, 50%, 75%, and 100% was simulated. For each destruction level, two postoperative models were constructed: debridement alone and debridement combined with internal fixation. Under physiological standing load conditions, pelvic global displacement, relative displacement of the sacroiliac joint surface, and displacement and stress distributions of the sacrum and ilium were comparatively analyzed among different models. Clinical analysis: A retrospective analysis was performed on 20 patients with sacroiliac joint tuberculosis who underwent lesion debridement at our institution between January 2010 and December 2025. Based on preoperative imaging, all patients had mild sacroiliac joint destruction ( 0.05). However, under moderate-to-severe destruction, all parameters increased significantly ( P < 0.05), indicating a marked reduction in both global and local pelvic stability. Following the addition of internal fixation, overall pelvic displacement, local stress, and relative joint displacement were all significantly reduced under moderate-to-severe destruction conditions. Clinical results showed that, in patients with mild bone destruction, there were no significant differences between the debridement-alone group and the debridement combined with internal fixation group in terms of pain relief, functional recovery, or radiographic improvement during follow-up ( P > 0.05). Both groups achieved satisfactory clinical outcomes, with no evident recurrence or complications. Conclusion: This study provides an initial biomechanical arithmetic modeling framework and compares its outputs with relevant clinical findings. The degree of sacroiliac joint destruction is closely associated with postoperative pelvic stability. In cases of mild destruction, debridement alone yields satisfactory outcomes, with no additional benefit observed from adjunctive internal fixation. As the severity of destruction increases, pelvic stability progressively declines, and the stabilizing effect of internal fixation becomes increasingly evident.