BackgroundIntermittent parathyroid hormone (PTH) 1–34 administration stimulates osteogenesis and increases bone marrow mesenchymal stem cell (MSC) density; however, its effect on the circulating MSCs is unknown. This study aimed to examine the effect of intermittent PTH 1–34 administration on circulating MSCs in the peripheral blood of postmenopausal osteoporotic women.Material/MethodsFifty-four postmenopausal osteoporotic women at high risk of fracture were enrolled and administered either teriparatide (PTH 1–34) or alendronate for 12 months. Whole blood samples were obtained at baseline, 1, 3, 6, and 12 months after initiation of treatment. Flow cytometry analyses were performed to identify circulating MSCs (CD73+, CD90+, CD105+, CD34−, and CD45−). Serum markers of bone formation, bone resorption, as well as bone mineral density (BMD) were serially measured. Circulating MSCs were isolated from peripheral blood of teriparatide treated women and cultured in osteogenic medium to examine their osteogenic differentiation potential.ResultsTeriparatide treatment increased circulating MSCs to 141±96% (P<0.001) by month 1, persisting until month 12; this increase was positively associated with increases in bone formation and bone resorption biomarkers (at month 6) and spine BMD (at month 12). Furthermore, intermittent PTH 1–34 administration promoted in vitro osteogenic differentiation of circulating MSCs, evident from increased alkaline phosphatase (ALP) activity, ALP-expressing cell density, calcium deposition, and Runx-2, OSX, COL 1a1, and osteocalcin mRNA upregulation.ConclusionsIntermittent PTH 1–34 administration increased circulating MSC density in women with postmenopausal osteoporosis and enhanced in vitro osteogenic differentiation potential of these cells.

Background The number of Parkinson’s patients (PD) undergoing total knee arthroplasty (TKA) is increasing. The purpose of the study was to characterize quality of life (QOL) outcomes for patients with coexisting PD and knee osteoarthritis (KOA) following TKA. Methods Patients with coexisting PD and KOA undergoing TKA between June 2014 and June 2020 were included. These patients were matched to controls with KOA alone by age, gender, basic social background information and Knee society score (KSS). The primary measure was to assess the QOL by the absolute changes in the EuroQOL5-Dimensions (EQ-5D), Pain and Disability Questionnaire (PDQ), and Patient Health Questionnaire-9(PHQ-9) at the last follow-up (LFU). Secondary measures were changes in QOL that exceeded the minimum clinically important difference value (MCID). Data on the health status and QOL of all patients were collected. Simple and multivariate regression analysis was used to evaluate the impact of PD on their QOL. Results Twelve KOA patients with PD were compared with 48 controls. Control patients experienced QOL improvement across all three measures:EQ-5D index (0.545–0.717, P < 0.01), PDQ (81.1–52.3, P < 0.01) and PHQ-9(8.22–5.91, P < 0.01) were significantly improved at the LFU; while in patients with PD, only PDQ (91.0–81.4, P = 0.03) slightly improved. There were significant differences in the improvement of QOL between PD patients and the control group through EQ-5D (0.531 vs.0.717, P < 0.01) and PDQ (81.4vs.52.3, P < 0.01) at the LFU. Conclusion TKA has no benefit of QOL beyond a slight improvement in pain-related disability in the KOA patients with PD.

Background: The number of Parkinson's patients (PD) undergoing total knee arthroplasty (TKA) is increasing. The purpose of the study was to characterize quality of life (QOL) outcomes for patients with coexisting PD and knee osteoarthritis (KOA) following TKA.Methods: Patients with coexisting PD and KOA undergoing TKA between June 2014 and June 2020 were included. These patients were matched to controls with KOA alone by age, gender, basic social background information and Knee society score（KSS）. The primary measure was to assess the QOL by the absolute changes in the EuroQOL5-Dimensions (EQ-5D), Pain and Disability Questionnaire (PDQ), and Patient Health Questionnaire-9(PHQ-9) at the last follow-up (LFU). Secondary measures were changes in QOL that exceeded the minimum clinically important difference value (MCID). Data on the health status and QOL of all patients were collected. Simple and multivariate regression analysis was used to evaluate the impact of PD on their QOL.Results: Twelve KOA patients with PD were compared with 48 controls. Control patients experienced QOL improvement across all three measures：EQ-5D index (0.545-0.717, P <0.01), PDQ (81.1-52.3, P < 0.01) and PHQ-9(8.22-5.91, P < 0.01) were significantly improved at the LFU; while in patients with PD, only PDQ (91.0-81.4, P =0.03) slightly improved. There were significant differences in the improvement of QOL between PD patients and the control group through EQ-5D (0.531 vs.0.717, P< 0.01) and PDQ (81.4vs.52.3, P <0.01) at the LFU.Conclusion: TKA has no benefit of QOL beyond a slight improvement in pain-related disability in the KOA patients with PD.

Background: This study was performed to compare the clinical effect of bipolar hemiarthroplasty via the direct anterior approach (DAA) or minimally invasive posterolateral approach (MIPA) in elderly patients with femoral neck fracture. Methods: In total, 196 elderly patients with femoral neck fractures were divided into the DAA group ([Formula: see text]) and MIPA group ([Formula: see text]). The clinical data, postoperative pain and complications, time until able to remain seated for 1 hour and walk independently, postoperative Harris score of functional activity at 6 weeks and 2 years postoperatively, and mortality at 2 years postoperatively were compared between the groups. Results: The DAA group had a longer operation time but a lower incidence of pneumonia 72 hours postoperatively, lower visual analogue scale score 24 hours postoperatively, and earlier time until able to remain seated for 1 hour and walk independently ([Formula: see text]). Six weeks postoperatively, the Harris scores for putting on socks, tying shoelaces, sitting comfortably on a chair, and climbing stairs were better in the DAA than the MIPA group ([Formula: see text]). After 2 years, there was no significant difference in the Harris scores between the two groups ([Formula: see text]). Conclusion: In elderly patients undergoing bipolar hemiarthroplasty, the DAA can be more effective than the MIPA in reducing the incidence of complications associated with long-term bed rest, relieving early postoperative pain, and improving early postoperative hip function.

Background To compare the clinical effect after bipolar hemiarthroplasty（BHA）via the direct anterior approach（DAA）or minimally invasive posterolateral approach（MIPA）following the elderly patients with femoral neck fracture. Methods 196 elderly patients with femoral neck fracture were divided into DAA group (n=98) and MIPA group (n=98) according to the surgical approach. The clinical data，postoperative pain and complications，the time to keep seating for 1 hour and walking independently，postoperative Harris score of functional activity in 6 weeks and 2 years and mortality at 2 years after surgery were compared between the two groups. Results （1）The patients in group DAA had longer operation time, but the patients with pneumonia 72 hours after the operation was less，the VAS score of DAA patients decreased after 24 hours of operation, and the time of keep seating for 1 hour and walking independently was earlier (P< 0.05).（2）6 weeks after the operation, the Harris score of wearing socks and shoelaces , sitting on chairs and climbing stairs in the DAA group was better than that in the MIPA group (P< 0.05). After 2 years, there was no significant difference in Harris scores between the two groups (P> 0.05). Conclusion In the elderly patients with BHA, DAA can be more effective than MIPA to reduce the incidence of complications associated with long-term bed rest, relieve early postoperative pain, and improve the early postoperative hip function.