Tourniquet use in bilateral TKA can reduce intraoperative time but was associated with a higher incidence of wound complications and larger postoperative knee swelling.

Objective: To investigate whether intravenous combined with topical administration of tranexamic acid (TXA) is superior to intravenous administration alone in terms of blood loss, incision complications, functional recovery, and pain relief in high tibial osteotomy (HTO). Methods:Clinical data of patients with knee osteoarthritis (OA) treated with unilateral HTO were retrospectively reviewed. The patients were grouped according to the TXA administration method, with 24 patients in the combined group and 21 in the solo group. In the combined group, 100 mL saline containing 1 g TXA was intravenously administered before application of a tourniquet, and 20 mL saline containing 2 g TXA was injected through a drainage tube after closure of the incision. Alternatively, 100 mL of saline containing 1 g TXA was intravenously administered before application of a tourniquet in the solo group. The blood loss and adverse events were compared between the two groups.Results: All patients were followed for more than half a year. The drainage volume on the first day and total blood loss on the second day after surgery in the combined and single treatment groups were 130.06 AE 29.22 and 165.35 AE 43.08 mL (P < 0.05), respectively, and 327.17 AE 64.26 and 385.45 AE 63.31 mL (P < 0.05). There were no blood transfusions in either group. One case of delayed incision healing was observed in the solo group, and no such event occurred in the combined group. There were no significant differences between the two groups in terms of the following factors: the activated partial thromboplastin time (APTT) and prothrombin time (PT); levels of fibrinogen (FIB) and D-dimer on the second day after surgery; numbers of hospitalization days and thromboembolism events; and knee joint function and visual analog score 6 months after surgery.Conclusion: Intravenous combined with topical TXA administration in HTO is superior to intravenous administration alone for reducing postoperative blood loss and drainage volume without thromboembolic complications. However, even with only intravenous TXA administration, no cases of blood transfusion and only 1 case of incision complication occurred. At the same time, the combined use of TXA did not improve the recovery of knee joint function and pain relief after HTO.

The development of covalent organic framework (COF) sonosensitizers with intrinsic sonodynamic effects is highly desirable. However, such COFs are generally constructed using small‐molecule photosensitizers. Herein, we report that the reticular chemistry‐based synthesis of COFs from two inert monomers yields a COF‐based sonosensitizer (TPE‐NN) with inherent sonodynamic activity. Subsequently, a nanoscale COF TPE‐NN is fabricated and embedded with copper (Cu)‐coordinated sites to obtain TPE‐NN‐Cu. Results show that Cu coordination can enhance the sonodynamic effect of TPE‐NN, whereas ultrasound (US) irradiation for sonodynamic therapy can augment the chemodynamic efficacy of TPE‐NN‐Cu. Consequently, TPE‐NN‐Cu upon US irradiation shows high‐performance anticancer effects based on mutually reinforced sono‐/chemo‐nanodynamic therapy. This study reveals the backbone‐originated sonodynamic activity of COFs and proposes a paradigm of intrinsic COF sonosensitizers for nanodynamic therapy.

Background:The traditional management for osteonecrosis of the femoral head (ONFH) includes core decompression (CD) and quadratus femoris muscle pedicle bone graft (QF-MPBG). The aim of this study was to investigate the effects of CD and QF-MPBG on the patients with nontraumatic ONFH in an early stage.Materials and Methods:39 patients (47 hips) with ONFH in an early stage (Ficat Stage I or II) were randomly divided into two groups according to random number table method. One group was treated with CD and cancellous bone grafting. Another group was treated QF-MPBG with cancellous bone grafting. The hip function was evaluated using Harris hip score (HHS). The repair of the femoral head was estimated through X-ray, computed tomography (CT), or magnetic resonance imaging (MRI). The surgical time and intraoperative blood loss was calculated.Results:All patients were followed for an average 2.5 years (range from 1.5 to 4 years). Two hips in CD group progressed into stage 3 and three hips in QF-MPBG group processed into stage 3. No patient accepted the THA at the last followup. The HHSs significantly increased in both groups after surgery (P < 0.05). No statistical differences were found between CD and QF-MPBG groups in postoperative HHSs at last followup (P > 0.05). X-ray and CT showed that the femoral head did not progress to collapse after operation in both groups. In addition, MRI showed that the edema signals decreased. However, the surgical time was longer in QF-MPBG group than that in CD group (P < 0.05). The intraoperative blood loss was more in QF-MPBG than that in CD group (P < 0.05).Conclusion:The CD with bone graft could relieve hip pain, improve hip function with much lesser surgical trauma compared to QF-MPBG. Hence, the CD with bone graft should be generally used for the treatment of patients with an early stage (Ficat Stage I or II) ONFH.

Ewing sarcoma (ES) is the most common malignant bone tumor in children and young adults. It is characterized by chromosomal translocations fusing the EWS gene with an ETS oncogene, most frequently FLI1. In the present study, the authors aimed to investigate the function of EWS-FLI1 in autophagy in ES cells, and identified that EWS-FLI1 positively regulates autophagy in ES cells. ATG4B expression was observed markedly upregulated by EWS-FLI1 overexpression, and silencing of ATG4B dramatically inhibits autophagy in ES cells. Furthermore, apoptosis was inhibited in ATG4B overexpressed ES cells, and ATG4B-potentiated autophagy is required for ES cells survival. Taken together, the authors demonstrated the role of EWS-FLI1 and ATG4B in autophagy in ES cells, and suggested EWS-FLI1 and ATG4B as potential therapeutic targets for ES.