Shoulder pathoanatomy in marathon kayakers.

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Abstract

[Indexed for MEDLINE] 11. Biomaterials. 2027 Jan;336:124443. doi: 10.1016/j.biomaterials.2026.124443. Epub 2026 Jul 8. Energy-responsive multi-catalytic nanogenerator hydrogels synergistically enhance diabetic tendon-to-bone healing via the ages/RAGE/PIEZO2 axis. Hua Y(1), Duan W(2), Liu R(3), Shu Y(4), Peng J(5), Xu W(3), Zhao Q(6), Xu S(6), Cui H(6), Hao X(7), Hao L(8). Author information: (1)School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, PR China; Department of Orthopedics, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330088, PR China. (2)Department of Orthopedics, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330088, PR China; Institute of Orthopedics of Jiangxi Province, Nanchang, Jiangxi, 330006, PR China; Jiangxi Provincial Key Laboratory of Spine and Spinal Cord Disease, Nanchang, Jiangxi, 330006, PR China; Institute of Minimally Invasive Orthopedics, Nanchang University, Nanchang, Jiangxi, 330006, PR China. (3)Department of Orthopedics, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330088, PR China; Institute of Orthopedics of Jiangxi Province, Nanchang, Jiangxi, 330006, PR China. (4)Department of Orthopedics, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330088, PR China; Jiangxi Provincial Key Laboratory of Spine and Spinal Cord Disease, Nanchang, Jiangxi, 330006, PR China. (5)Department of Orthopedics, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330088, PR China; Institute of Minimally Invasive Orthopedics, Nanchang University, Nanchang, Jiangxi, 330006, PR China. (6)School of Public Health & Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330031, PR China. (7)School of Public Health & Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330031, PR China. Electronic address: xian.hao@ncu.edu.cn. (8)School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, PR China; Department of Orthopedics, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330088, PR China; Institute of Orthopedics of Jiangxi Province, Nanchang, Jiangxi, 330006, PR China; Jiangxi Provincial Key Laboratory of Spine and Spinal Cord Disease, Nanchang, Jiangxi, 330006, PR China; Institute of Minimally Invasive Orthopedics, Nanchang University, Nanchang, Jiangxi, 330006, PR China. Electronic address: ndefy07018@ncu.edu.cn. Rotator cuff tears (RCTs) represent a significant clinical challenge with high post-operative re-tear rates, especially in diabetic patients. Through comprehensive bioinformatic analysis of a publicly available transcriptomic dataset (GSE236746), we identified the significant downregulation of the mechanosensitive hub gene PIEZO2 and the aberrant activation of oxidative stress/inflammatory pathways as primary pathological barriers in diabetic patients. This metabolic dysfunction triggers the advanced glycation end products (AGEs)/receptor for AGEs (RAGE) axis, creating a self-amplifying oxidative stress loop that traps macrophages in a persistent pro-inflammatory M1 phenotype and impairs the recruitment of bone/tendon progenitor cells. Addressing these interconnected metabolic and mechanical barriers, we engineered an energy-responsive, multi-catalytic nanocomposite (Au-Pd/BTO, termed APB) integrated into a thermosensitive Pluronic F127 hydrogel (APBF). The APBF platform functions as a "metabolic-electric" dual-regulator: the cascade enzyme mimetic activities (glucose oxidase [GOD]-, superoxide dismutase [SOD]-, and catalase [CAT]-like) of the Au-Pd alloy effectively attenuate the glucose-reactive oxygen species (ROS)-AGEs/RAGE cascade. Thereby resolving the inflammatory niche and promoting M2 macrophage polarization. Simultaneously, piezoelectric Barium Titanate (BTO) nanocrystals generate endogenous electrical signals under physiological mechanical loading to compensate for the intrinsic PIEZO2-mediated mechanosensing deficiency, thereby enhancing angiogenesis, osteogenesis, and chondrogenesis. Systematic in vivo evaluation, including micro-computed tomography (micro-CT) analysis analysis, biomechanical testing, and histological assessment, demonstrated that APBF successfully restores the structural integrity and mechanical strength of the tendon-bone interface (TBI). Based on transcriptomic evidence, this study designed of physiology-matched biomaterials for complex tissue regeneration. Copyright © 2026 Elsevier Ltd. All rights reserved. DOI: 10.1016/j.biomaterials.2026.124443