Osteoarthritis (OA) is characterized by cartilage degeneration and synovial inflammation, with chondrocytes playing a pivotal role in this disease. However, inflammatory mediators, mechanical stress, and oxidative stress can compromise functionality. The occurrence and progression of OA are intrinsically linked to the immune response. Current research on the treatment of OA mainly concentrates on the synergistic application of drugs and tissue engineering. The surface of engineered hydrogel materials can be immunomodified to affect the function of chondrocytes in drug therapy, gene therapy, and cell therapy. Prior studies have concentrated on the drug-loading function of hydrogels but overlooked the immunomodulatory role of chondrocytes. These modifications can inhibit the proliferation and differentiation of chondrocytes, reduce the inflammatory response, and promote cartilage regeneration. The surface immunomodification of engineered hydrogel materials can significantly enhance their efficacy in the treatment of OA. Thus, immunomodulatory tissue engineering has significant potential for treating osteoarthritis.

Objectives: This study aims to explore postoperative pain trajectories in patients undergoing total joint arthroplasty (TJA) and to identify patterns of pain change and their influencing factors. Methods: We used convenience sampling to select 374 patients with total joint arthroplasty at a Grade A tertiary hospital. Among them, 304 completed perioperative pain assessments from before surgery to postoperative day 90. Latent class growth model (LCGM) was used to distinguish subgroups of pain trajectories, and multivariate logistic regression was applied to analyze the influencing factors. Results: LCGM identified three pain trajectory groups: rapid remission (n=39, 12.83%), gradual remission (n=223, 73.36%), and basically stable (n=42, 13.82%). Multivariate analysis showed that, compared with gradual remission, preoperative pain duration >3 months was negatively associated with rapid remission trajectory (odds ratio [OR]=0.18, 95% confidence interval [CI]: 0.04-0.84, P =0.029). Compared with rapid remission, a lower preoperative WOMAC score (OR=0.96, 95%CI: 0.94-0.99, P =0.003) and POD7 nonopioid combination analgesia (OR=25.90, 95%CI: 2.49-269.71, P =0.006) were independent predictors of the basically stable trajectory. Discussion: There are three heterogeneous trajectories of postoperative pain after TJA. We recommend implementing stratified interventions based on key factors, including the preoperative WOMAC score, preoperative pain duration, and time-specific postoperative analgesic regimens, providing a new approach to precise analgesia.

Objectives To evaluate the impact of the DRG payment reform on the hospitalization expenses, service efficiency, and expense structure of patients undergoing orthopedic internal fixation surgery. Methods A retrospective interrupted time-series analysis was conducted by including 720 patients who underwent orthopedic internal fixation surgery at a tertiary first-class hospital in Jiangsu Province (360 cases before the reform and 360 cases after the reform). Data from 2019 (before the reform) and 2022 (after the reform) were analyzed, using segmented regression models, new grey relational analysis, and structural variation analysis. The primary outcome indicators included total hospitalization expenses, the length of hospital stay, and changes in expense structure. Results After the DRG payment reform, medical efficiency improved significantly, with the average length of hospital stay declining from 12.44 days to 10.68 days (-14.15%, P = 0.010). However, there was no significant change in the average total hospitalization expense (decreasing from 27,071.09 yuan to 26,286.35 yuan, i.e., 2.90%, P = 0.688), while the medical insurance reimbursement expense increased slightly by almost 2.95%, indicating a significant reshaping of the structure of inpatient expenses. The most prominent change was a 61.88% increase in examination and test fees (P < 0.001). Medical service, drug, and consumable fees all showed a downward trend (decreasing by 10.88%, 13.21%, and 9.30%, respectively). However, none of these reached statistical significance (all P-values > 0.05). When stratified by age, the average cost per case decreased significantly in the 50‒59 and ≥ 60 years age groups, with 23.25% (P = 0.018) and 19.52% (P = 0.015), respectively. In terms of surgical complexity, the cost and length of hospital stay for grade IV complex surgeries showed the greatest improvement: cost decreased by 36.11% (P < 0.001) and length of hospital stay decreased by 27.24% (P = 0.003). Conclusion The DRG payment reform successfully improved medical efficiency and shifted the expense structure from a consumable- and drug-dependent to a diagnosis-driven model. The differential impacts of the reform on different age groups and surgical complexity levels suggest that the risk adjustment mechanism must be further refined.