Objective To compare the effects of hypoxia-inducible drugs using deferoxamine (DFO) and accordion technique (AT) on activating the hypoxia-inducible factor 1α (HIF-1α)/vascular endothelial growth factor (VEGF) signaling pathway to promote bone regeneration and remodelling during consolidation phase of distraction osteogenesis (DO). Methods Forty-five specific-pathogen-free adult male Sprague-Dawley (SD) rats were randomly divided into the control group, DFO group, and AT group, with 15 rats in each group. All rats underwent osteotomy to establish a right femur DO model. Then, continuous distraction was started for 10 days after 5 days of latency in each group. During the consolidation phase after distraction, no intervention was performed in the control group; DFO was locally perfused into the distraction area in the DFO group starting at the 3rd week of consolidation phase; cyclic stress stimulation was given in the AT group starting at the 3rd week of consolidation phase. The general condition of rats in each group was observed. X-ray films were conducted at the end of the distraction phase and at the 2nd, 4th, and 6th weeks of the consolidation phase to observe the calcification in the distraction area. At the 4th and 6th weeks of the consolidation phase, peripheral blood was taken for ELISA detection (HIF-1α, VEGF, CD31, and Osterix), femoral specimens were harvested for gross observation, histological staining (HE staining), and immunohistochemical staining [HIF-1α, VEGF, osteopontin (OPN), osteocalcin (OCN)]. At the 6th week of the consolidation phase, Micro-CT was used to observe the new bone mineral density (BMD), bone volume/tissue volume (BV/TV), trabecular separation (Tb.Sp), trabecular number (Tb.N), and trabecular thickness (Tb.Th) in the distraction area, and biomechanical test (ultimate load, elastic modulus, energy to failure, and stiffness) to detect bone regeneration in the distraction area. Results The rats in all groups survived until the termination of the experiment. ELISA showed that the contents of HIF-1α, VEGF, CD31, and Osterix in the serum of the AT group were significantly higher than those of the DFO group and control group at the 4th and 6th weeks of the consolidation phase (P<0.05). General observation, X-ray films, Micro-CT, and biomechanical test showed that bone formation in the femoral distraction area was significantly better in the DFO group and AT group than in the control group, and complete recanalization of the medullary cavity was achieved in the AT group, and BMD, BV/TV, Tb.Sp, Tb.N, and Tb.Th, as well as ultimate load, elastic modulus, energy to failure, and stiffness in the distraction area, were better in the AT group than in the DFO group and control group, and the differences were significant (P<0.05). HE staining showed that trabecular bone formation and maturation in the distraction area were better in the AT group than in the DFO group and control group. Immunohistochemical staining showed that at the 4th week of consolidation phase, the expression levels of HIF-1α, VEGF, OCN, and OPN in the distraction area of the AT group were significantly higher than those of the DFO group and control group (P<0.05); however, at 6th week of consolidation phase, the above indicators were lower in the AT group than in the DFO group and control group, but there was no significant difference between groups (P>0.05). Conclusion Both continuous local perfusion of DFO in the distraction area and AT during the consolidation phase can activate the HIF-1α/VEGF signaling pathway. However, AT is more effective than local perfusion of DFO in promoting the process of angiogenesis, osteogenesis, and bone remodelling.
Objective To investigate the latent categories of symptom cluster characteristics in patients with knee osteoarthritis (KOA) after total knee arthroplasty (TKA), and compare the quality of life between these categories. Methods Patients undergoing TKA for KOA in the joint surgery departments of four tertiary-level A hospitals in Urumqi, Xinjiang between November 2023 and March 2024 were selected for the study using the convenience sampling method. Symptoms of postoperative pain, swelling, anxiety, depression, and sleep disorders were collected from patients for latent class analysis using Mplus 8.3 software, and their influencing factors and differences in quality of life between categories were analyzed using SPSS 26.0 software. Results A total of 380 copies of questionnaire were distributed and 362 valid ones were returned, with a validity rate of 95.3%. Of the 362 patients, 342 (94.5%) had symptom cluster. The 342 patients aged 47-85 years, with a mean age of (65.25±7.03) years; 83 (24.3%) were male and 259 (75.7%) were female. According to the postoperative symptom cluster, the patients could be categorized into 3 latent categories: high-symptomatic group (16.1%), low-symptomatic group (51.8%), and high swelling group (32.2%). Compared to the low-symptomatic group, the current being the first joint surgery was a risk factor for the high-symptomatic group [odds ratio (OR)=2.732, 95% confidence interval (CI) (1.216, 6.139), P=0.015], whereas body mass index between 24.0 and 27.9 kg/m2 was a protective factor for the high-symptomatic group [OR=0.362, 95%CI (0.156, 0.840), P=0.018]; body mass index <24.0 kg/m2 was an independent risk factor for the high swelling group [OR=2.769, 95%CI (1.321, 5.803), P=0.007]. Comparison of the quality of life of patients in the 3 latent categories revealed that the high-symptomatic group had the lowest quality of life scores (P<0.05). Conclusion Post-TKA symptom cluster in patients with KOA can be classified into 3 potential categories, and the quality of life performance is different among different categories, so precise symptom management strategies should be provided according to the symptom characteristics of the patients to improve their quality of life.