Objective We aimed to evaluate the efficacy and safety of anti-interleukin-1 therapeutics, including IL-1 antibodies, interleukin-1 receptor antagonists (IL-1 Ras) and IL-1 inhibitors, for knee osteoarthritis (KOA) treatment. Methods Databases (Medline, Embase, Web of Science and CENTRAL) and ClinicalTrials.gov were systematically searched for randomized controlled trials (RCTs) of anti-interleukin-1 therapeutics from inception to August 31, 2022. The outcomes were the mean change in pain and function scores and the risk of adverse effects (AEs). Results In the 12 studies included, anti-interleukin-1 therapeutics were superior to placebo in terms of pain relief (standardized mean difference [SMD] =  − 0.38, 95% confidence interval [CI] =  − 1.82 to − 0.40, p < 0.001, I2 = 77%) and functional improvement (SMD =  − 1.11, 95% CI =  − 1.82 to − 0.40, p = 0.002, I2 = 96%). The incidence of any AE (risk ratio [RR] = 1.02, 95% CI = 0.88–1.18, p < 0.001, I2 = 76%) was higher following treatment with anti-interleukin-1 therapeutics than placebo, while no significant difference was found in the incidence of serious AEs (SAEs) or discontinuations due to AEs. Subgroup analyses showed that IL-1 antibodies and the IL-1 inhibitor provided pain relief (IL-1 antibodies: SMD =  − 0.61, 95% CI =  − 0.92 to − 0.31, p < 0.001; IL-1 inhibitor: SMD =  − 0.39, 95% CI =  − 0.72 to − 0.06, p = 0.02, I2 = 74.0%) and functional improvement (IL-1 antibodies: SMD =  − 1.75, 95% CI =  − 2.10 to − 1.40, p < 0.001; IL-1 inhibitor: SMD =  − 0.28, 95% CI =  − 0.83 to 0.27, p = 0.31, I2 = 88%) superior to those of placebo, whereas IL-1 Ras did not. However, the IL-1 inhibitor increased the incidence of any AE (RR = 1.35, 95% CI = 0.92–1.98, p < 0.001, I2 = 85%) but not the risk of SAEs or discontinuations due to AEs. IL-1 antibodies and IL-1 Ras showed no difference in safety compared with placebo. Conclusions Anti-interleukin-1 therapeutics could relieve OA-related pain and improve function, but is probably associated with an increased risk of adverse events. Specially, IL-1 antibodies and an IL-1 inhibitor could relieve OA-related pain and improve function, whereas IL-1 Ras could not. IL-1 antibodies and IL-1 Ras were relatively safe options, but IL-1 inhibitors were associated with safety concerns.

Purpose: To compare the efficacy and safety of micropercutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy (FURS) in the treatment of single upper ureteral calculi larger than 10 mm. Methods: This is a retrospective study that incorporates medical record review with an outcomes management database.163 patients who underwent MPCNL and 137 patients who underwent FURS were identified from January 2017 to December 2021. Demographic data,operation time,hospitalization time,stone free rate and complication rate were collected and analyzed. Results: Preoperative general data of sex, age, BMI,serum creatinine, time of stone existence,stone hardness,stone diameter preoperative hydronephrosis and preoperative infection of the MPCNL group have no statistically significant difference with that of the FURS group.All of the MPCNL or FURS surgeries in two groups were successfully completed, with no one returned to opening or other surgery.Patients treated by MPCNL had significantly shorter operation time (49.6 vs 72.4 minutes;P＜0.001) but longer hospitalization time (9.1 vs 3.9days;P＜0.001) than those treated by FURS.Stone free rate in the MPCNL group was better than that of the FURS group(90.8% vs 71.5%;P＜0.001). There was no statistically significant difference in complication rate between two groups(13.5% vs 15.3%;P＝0.741). Conclusion: Both MPCNL and FURS are effective and safe surgical options for patients with single upper ureteral calculi larger than 10 mm. FURS had shorter hospitalization time than MPCNL,but with a relatively lower stone free rate and longer operation time.There was no significant differences between two groups in complication rate. Trial registration: No.

Backgroud: Femoral neck fractures are associated with substantial morbidity and mortality for older adults. Total hip arthroplasty (THA) and hemiarthroplasty (HA) are widely used in elderly patients with displaced femoral neck fractures (DFNF), but there is still controversy refer to the optimal chose for the management of DFNF in active elderly patients. Methods：This is a retrospective cohort study that incorporates medical record review with an outcomes management database. 73 patients who underwent HA and 66 patients who underwent THA were identified from January 2015 to December 2017. Data of age, gender, BMI, comorbidity status, operation time, blood loss, hospitalization time, in-hospital complication were collected and analyzed. Follow-up clinical and radiographic examinations were performed at approximately five years,and hip complications,Harris Hip Score and EuroQol-5 Dimensions (EQ-5D) were assessed. Results: Preoperative general data of sex, age, BMI and charlson comorbidity score of THA group(n=55) has no statistically significant difference with that of HA group. Patients treated by THA had significantly longer operation time (105.5 vs 76.7 minutes;P＜0.001),more blood loss (524.1 vs 350.1ml;P＜0.001) and longer hospitalization time (15.8 vs 13.8 days;P＜0.001).There was no significant differences between two groups in complications(32.7% vs 25.8%,P=0.432). No patients died during the hospitalization. After five years,only 33 patients in the THA group and 34 patents in the HA group were still alive,and the fraction surviving were not statistically significant between two groups(60.0% vs 54.8%,P> 0.05). The differences in hip function in favor of THA appeared to increase after the five-year follow-up, and the difference was significant in terms of the total Harris hip score(81.3 vs 73.1, P＜0.001) as well as in the dimensions of pain(38.9 vs 35.9, P=0.033), function(33.7 vs 29.2, P=0.001),absence of deformity(4.0 vs 3.9, P=0.023) and range of motion(4.6 vs 4.2, P=0.008). There was no significant differences between groups in hip dislocation rate(6.1% vs 0.0%, P=0.239). The erosion rate of hip joint in the THA group was significantly lower than that of the HA group(0.0% vs 26.5%, P=0.002). The health-related quality of life, according to EQ-5D index score, was found to be higher(0.69 vs 0.63, P= 0.001) in the THA group than the HA group after five years. Conclusion: THA may be a preferred management option for active elderly patients over 75 years.The more extensive surgery of THA is not associated with higher in-hospital complication rate or mortality rate. These patients can benefit from THA in terms of hip function and quality of life. Trial registration: No.