Background: Reactive oxygen and nitrogen species (RONS such as H₂O₂, nitric oxide) are generated within the organism. Whereas physiological formation rates confer redox regulation of essential cellular functions and provide the basis for adaptive stress responses, their excessive formation contributes to impaired cellular function or even cell death, organ dysfunction and severe disease phenotypes of the entire organism. Therefore, quantification of RONS formation and knowledge of their tissue/cell/compartment-specific distribution is of great biological and clinical importance. Methods: Here, we used a high-performance/pressure liquid chromatography (HPLC) assay to quantify the superoxide-specific oxidation product of the mitochondria-targeted fluorescence dye triphenylphosphonium-linked hydroethidium (mitoSOX) in biochemical systems and three animal models with established oxidative stress. Type 1 diabetes (single injection of streptozotocin), hypertension (infusion of angiotensin-II for 7 days) and nitrate tolerance (infusion of nitroglycerin for 4 days) was induced in male Wistar rats. Results: The usefulness of mitoSOX/HPLC for quantification of mitochondrial superoxide was confirmed by xanthine oxidase activity as well as isolated stimulated rat heart mitochondria in the presence or absence of superoxide scavengers. Vascular function was assessed by isometric tension methodology and was impaired in the rat models of oxidative stress. Vascular dysfunction correlated with increased mitoSOX oxidation but also classical RONS detection assays as well as typical markers of oxidative stress. Conclusion: mitoSOX/HPLC represents a valid method for detection of mitochondrial superoxide formation in tissues of different animal disease models and correlates well with functional parameters and other markers of oxidative stress.

Background/Objectives: Total knee arthroplasty (TKA) is a common procedure for knee osteoarthritis. While conventional TKA (C-TKA) remains standard, robot-assisted TKA (RA-TKA) has been introduced to enhance implant positioning and clinical outcomes. However, its comparative benefits remain unclear. This systematic review and meta-analysis compared RA-TKA with C-TKA, examining the influence of robotic system, surgeon experience, and follow-up duration. Methods: A systematic search was conducted across the PubMed, Scopus, Web of Science, and Cochrane Library databases. Randomized controlled trials (RCTs) comparing RA-TKA with C-TKA were included. Outcomes were categorized into clinical, radiographic, and safety endpoints. Subgroup and meta-regression analyses explored factors influencing outcome variability, including robotic system, number of surgeons, and follow-up duration. Results: Twenty-five RCTs (5614 patients) were analyzed. RA-TKA showed modest improvements in clinical outcomes, such as KSS and VAS pain scores, but results varied across subgroups. RA-TKA demonstrated a significantly better flexion range of motion (ROM) in certain countries (e.g., Russia, MD = 10; 95%CI: 5.44, 14.56) and with specific robotic systems (e.g., NAVIO). No significant differences were found in OKS and HSS scores. Radiographic outcomes, including the HKA Angle, varied by robotic system, with NAVIO and YUANHUA showing better alignment than C-TKA. Complication rates were comparable, though RA-TKA had a higher risk of conversion to open surgery (10% vs. 2%). Meta-regression identified robotic system and surgeon experience as key predictors of outcome variability. Conclusions: RA-TKA offers advantages in implant alignment and postoperative pain reduction. However, benefits are inconsistent across settings, and some robotic systems may not provide improvements over C-TKA.

Background: Femoral neck fractures pose significant surgical challenges with high morbidity and mortality. Traditional freehand screw placement often yields variable outcomes. Recent robotic advancements offer a promising alternative with enhanced precision. Methods: This systematic review compares the efficacy and safety of robot-assisted versus freehand techniques. A comprehensive literature search across multiple databases up to July 2024 included studies comparing both techniques. Primary outcomes were the union rate and time, functional outcomes, operative time, intraoperative parameters, and complication rates. Meta-regression analyses identified treatment response determinants. Results: Twenty-four studies (1437 patients) were included. Robot-assisted screw placement significantly improved the union rate, reduced the union time, and showed superior functional outcomes. Additionally, it resulted in shorter operative times, less intraoperative blood loss, and fewer instances of fluoroscopy and guide pin insertion. The risk of femoral neck necrosis was notably lower with robotic assistance. Meta-regression highlighted the robot type, patient age, and sample size as significant factors. Conclusions: Despite the promise of robot-assisted screw placement, limitations exist. The evidence being mainly from China raises concerns about generalizability. The lack of long-term follow-up data hinders assessment of technique durability. Unreported surgeon expertise levels and learning curves affect result validity. High initial costs and steep learning curves of robotic systems also present barriers to widespread adoption.

Background: Native vertebral osteomyelitis (NVO) presents diagnostic and therapeutic challenges requiring adherence to complex clinical guidelines. The emergence of large language models (LLMs) offers new avenues for real-time clinical decision support, yet their utility in managing NVO has not been formally assessed. Methods: This study evaluated four LLMs—Consensus, Gemini, ChatGPT-4o Mini, and ChatGPT-4o—using 13 standardized questions derived from the 2015 IDSA guidelines. Each model generated 13 responses (n = 52), which were independently assessed by three orthopedic surgeons for accuracy (4-point scale) and comprehensiveness (five-point scale). Results: ChatGPT-4o produced the longest responses (428.0 ± 45.4 words), followed by ChatGPT-4o Mini (392.2 ± 97.4), Gemini (358.2 ± 60.5), and Consensus (213.2 ± 68.8). Accuracy ratings showed that ChatGPT-4o and Gemini achieved the highest proportion of “Excellent” responses (54% and 51%, respectively), while Consensus received only 20%. Comprehensiveness scores mirrored this trend, with ChatGPT-4o (3.95 ± 0.79) and Gemini (3.82 ± 0.68) significantly outperforming Consensus (2.87 ± 0.66). Domain-specific analysis revealed that ChatGPT-4o achieved a 100% “Excellent” accuracy rating in therapy-related questions. Statistical analysis confirmed significant inter-model differences (p < 0.001). Conclusions: Advanced LLMs—especially ChatGPT-4o and Gemini—demonstrated high accuracy and depth in interpreting clinical guidelines for NVO. These findings highlight their potential as effective tools in augmenting evidence-based decision-making and improving consistency in clinical care.

Background/Objectives: Trochanteric femoral fractures pose significant surgical challenges, particularly in elderly patients. Intramedullary nailing (IMN) and plate fixation (PF) are the primary operative strategies, yet their comparative efficacy and safety remain debated. This meta-analysis synthesizes randomized controlled trials (RCTs) to evaluate clinical, functional, perioperative, and biomechanical outcomes of IMN versus PF specifically in trochanteric fractures. Methods: A systematic search of six databases was conducted up to 20 May 2024, to identify RCTs comparing IMN and PF in adult patients with trochanteric femoral fractures. Data extraction followed PRISMA guidelines, and outcomes were pooled using random-effects models. Subgroup analyses examined the influence of fracture stability, implant type, and patient age. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Results: Fourteen RCTs (n = 4603 patients) were included. No significant differences were found in reoperation rates, union time, implant cut-out, or mortality. IMN was associated with significantly reduced operative time (MD = −5.18 min), fluoroscopy time (MD = −32.92 s), and perioperative blood loss (MD = −111.68 mL). It also had a lower risk of deep infection. Functional outcomes and anatomical results were comparable. Subgroup analyses revealed fracture stability and nail type significantly modified operative time, and compression screws were associated with higher reoperation rates than IMN. Conclusions: For trochanteric femoral fractures, IMN and PF yield comparable results for most clinical outcomes, with IMN offering some advantages in surgical efficiency and perioperative morbidity, though functional outcomes were comparable. Implant selection and fracture stability influence outcomes, supporting individualized surgical decision making.

Purpose: Optimal surgical strategy for multilevel cervical myelopathy remains debated. We compared anterior decompression and fusion (ADF) versus posterior decompression with fusion (PDF) across functional, health-related quality of life, radiographic, perioperative, and safety outcomes. Methods: We updated a prior review with searches of PubMed, Scopus, and Web of Science (January 2023–24 August 2025). Comparative adult studies of multilevel disease treated with ADF or PDF were pooled using random-effects models to estimate mean differences (MD) or odds ratios (OR) with 95% CIs. Heterogeneity (I²), leave-one-out analyses, and Egger’s tests assessed robustness and small-study effects. Results: Thirty-one studies (2 RCTs, 29 cohorts; 5,613 patients: 2,427 ADF; 3,186 PDF) met criteria. ADF was associated with higher postoperative JOA (MD 0.76; 95% CI 0.36–1.16; I²=81.7%) and greater JOA recovery (MD 9.12%; 1.34–16.89; I²=93.4%), although the recovery benefit was not robust after removing one study or under Hartung–Knapp adjustment. NDI favored ADF (MD − 1.24; −2.30 to − 0.17; I²=72.2%) but attenuated in sensitivity and was sensitive to small-study effects. EQ-5D favored ADF (MD 0.07; 0.03–0.11; I²=0%); SF-36 did not differ overall (MD 3.48; −0.43 to 7.38) but favored ADF on sensitivity. Cervical lordosis improved more with ADF (C2–C7 Cobb MD 4.15°; 1.29–7.00; I²=89.7%). LOS was shorter with ADF (MD − 1.92 days; −2.32 to − 1.52; I²=49.9%), while operative time and blood loss were overall similar. Overall complications did not differ significantly between approaches (OR 1.48; 1.00–2.20; I²=65.9%); dysphagia was higher with ADF (OR 7.28; 4.19–12.64; I²=0%) and C5 palsy lower (OR 0.35; 0.15–0.82; I²=0%) versus PDF. Revision and axial pain were comparable. Egger’s tests suggested small-study effects for NDI and LOS only; in meta-regression, OPLL status and study quality explained much of the between-study heterogeneity, and GRADE certainty was low to very low for most outcomes. Conclusion: For multilevel cervical myelopathy, ADF was associated with modest improvements in neurological function, health-related quality of life, cervical alignment, and shorter hospitalization compared with PDF, although several between-group differences were below minimal clinically important difference thresholds and some were sensitive to influential studies. Trade-offs were approach-specific: dysphagia was higher after ADF, whereas C5 palsy was more frequent after PDF; overall complications did not differ significantly. Given the predominance of observational data and low-to-very-low GRADE certainty, approach selection should remain patient-tailored.