Distortions in gut microbiota homeostasis may contribute to abnormal bone metabolism and osteoporosis. This study aimed to examine the association between the dietary index for gut microbiota (DI-GM) and osteoporosis among U.S. adults, identify key dietary components, and develop a clinically applicable risk prediction model incorporating dietary and clinical factors. We conducted a cross-sectional analysis of 9065 adults. DI-GM was calculated from the dietary intake data, and osteoporosis was the primary outcome. Weighted multivariable logistic regression models were used to evaluate the association between DI-GM and osteoporosis, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Additionally, least absolute shrinkage and selection operator regression was applied to identify critical dietary components. Finally, a prediction model integrating clinical and nutritional factors was developed and evaluated using receiver operating characteristic curve analysis. Each unit increase in DI-GM reduced the risk of osteoporosis by 10% (adjusted OR = 0.90, 95% CI: 0.83-0.99). A higher intake of DI-GM-beneficial components was also associated with reduced osteoporosis risk (OR: 0.88; 95% CI: 0.79-0.98). Least absolute shrinkage and selection operator highlighted soy, fermented dairy, and processed meat as the most influential dietary factors; higher intake of soybeans and fermented dairy was associated with a decreased risk of osteoporosis, whereas higher processed meat intake was associated with an increased risk. The prediction model demonstrated good discrimination (area under the curve = 0.757). A higher DI-GM was associated with a reduced risk of osteoporosis, and specific dietary components may drive this association. The proposed model may support individualized dietary risk stratification and prevention strategies for populations with an elevated osteoporosis risk.

IntroductionThis retrospective case series was conducted to evaluate the effects of the modified quadriceps snip technique applied during primary total knee arthroplasty (TKA) in patients with end-stage hemophilic arthritis.MethodsA total of 9 patients (10 knees) with hemophilic stiff knees who underwent primary TKA using the modified quadriceps snip technique between January 2022 and June 2023 were retrospectively reviewed. The primary outcome was defined as the improvement in knee range of motion (ROM) from baseline to the final follow-up. Secondary outcomes included the Knee Society Score (KSS) clinical and functional scores and Hemophilia Joint Health Score version 2.1 (HJHS 2.1).ResultsROM improved significantly from 19.5 ± 11.17° preoperatively to 80 ± 11.54° postoperatively (60.50°, 95% CI: 48.29°–72.71°, p < 0.01). KSS clinical scores increased from 28.4 ± 20.46 to 70 ± 21.21 (41.60, 95% CI: 25.67–57.53, p < 0.01), and KSS functional scores improved from 42.25 ± 20.85 to 78 ± 25.85 (33.50, 95% CI: 18.60–48.40, p < 0.01). HJHS 2.1 scores decreased from 32 ± 8.65 to 18.1 ± 9.01 (13.90, 95% CI: -17.72 to -10.08, p < 0.01). No cases of infection, implant loosening, or revision surgery were recorded at the final follow-up, with a mean follow-up of 21 months (range: 16–34 months).ConclusionIn this case series, the modified quadriceps snip technique was associated with improvements in knee range of motion and clinical scores. These preliminary findings suggest that prospective controlled studies are still warranted to validate its clinical value.

目的 探讨3D打印辅助髋关节置换个体化治疗高原地区复杂髋关节病的临床疗效.方法 回顾性分析2020年8月-2021年8月林芝市人民医院收治的9例高原地区复杂髋关节疾病患者临床资料.所有研究对象均进行3D打印辅助髋关节置换个体化治疗.观察患者手术时间、术中出血量、末次随访的髋关节Harris评分,术后测量髋臼假体置入外展角、前倾角,评估髋臼假体置入的准确程度.结果 结合术前的计划,所有患者的髋臼假体型号大小均与术前规划一致.手术时间65～121 min,平均手术时间(87.78±16.75)min;术中出血量100～300 ml,平均术中出血量(208.33±56.47)ml;术后髋臼假体的外展角36°～47°,平均术后髋臼假体的外展角(41.00±3.43)°;前倾角13°～20°,平均前倾角(15.89±2.23)°.随访时间6～12个月,平均随访时间(9.44± 1.64)个月,末次随访时Harris髋关节评分为83～95分,平均评分(86.22±5.22)分.结论 3D打印辅助髋关节置换术个体化治疗高原地区复杂髋关节疾病可以优化手术方案、缩短手术时间、减少术中出血、提高手术精确度和临床效果,在高原复杂髋关节疾病的手术治疗方面有较好的临床应用价值.

膝关节炎是老年人群常见的退行性关节疾病之一,晚期的骨性关节炎会严重影响行走功能.高原地区由于海拔较高,空气稀薄,再加上营养结构不均衡,缺乏功能锻炼,导致膝关节炎高发、多发[1].人工全膝关节置换术(total knee arthro-plasty,TKA)技术成熟,疗效确切,是治疗晚期膝关节炎的有效方法.加速康复外科(enhanced recovery after surgery,ERAS)是经过循证医学证据证明有效的围术期管理方案,可有效减少并发症,提高就医体验,缩短住院时间.

背景:血管新生参与早期膝骨关节炎进展,滑膜、软骨及软骨下骨均具有血管新生病理表现,探讨川芎嗪和过表达miR-20b-5p对这些组织病理性血管新生的抑制能力及相关作用途径,有助于开发新的早期膝骨关节炎治疗药物.目的:通过组织学观察探讨川芎嗪和过表达miR-20b-5p对早期膝骨关节炎大鼠滑膜、软骨及软骨下骨血管新生的影响及可能发挥作用的途径.方法:将25只SD大鼠进行早期膝骨关节炎造模,造模成功后分5组,每组5只:A组膝关节腔注射与灌胃给予生理盐水,B组膝关节腔注射agomir NC,C组膝关节腔注射miR-20b-5p agomir,D组灌胃给予川芎嗪+膝关节腔注射agomir NC,E组灌胃给予川芎嗪+膝关节腔注射miR-20b-5p agomir,膝关节腔注射为单次给药,灌胃给药为1次/d,连续灌胃4周.4周后处死大鼠,取完整左膝关节制作石蜡切片,进行苏木精-伊红染色、番红O-固绿染色与免疫组织化学染色.结果 与结论:①滑膜组织:苏木精-伊红染色与免疫组化染色显示,C、D、E组的血管密度、炎症细胞浸润程度及血管内皮生长因子蛋白、Notch1蛋白表达均低于A、B组(P<0.05),E组血管密度、炎症细胞浸润程度及血管内皮生长因子蛋白、Notch1蛋白表达低于C、D组(P<0.05);②软骨及软骨下骨组织:苏木精-伊红染色、番红O-固绿染色与免疫组织化学染色显示,C、D、E组的软骨基质流失程度及血管侵袭情况轻于A、B组,C、D、E组的骨关节炎软骨组织病理学评分及血管内皮生长因子蛋白、Notch1蛋白表达均低于A、B组(P<0.05),E组的骨关节炎软骨组织病理学评分及血管内皮生长因子蛋白、Notch1蛋白表达低于C、D组(P<0.05);③结果 表明,在早期膝骨关节炎大鼠滑膜、软骨及软骨下骨中,川芎嗪和过表达miR-20b-5p可能通过抑制血管内皮生长因子/Notch1信号通路介导的血管新生在一定程度上改善多方面的组织学表现,抑制早期膝骨关节炎的进展.

背景:补肾健脾活血方是临床常用于治疗骨质疏松症的经验用方,但其潜在的分子作用机制尚需深入探讨.目的:通过网络药理学方法探讨补肾健脾活血方治疗骨质疏松症的潜在分子机制,并初步验证其通过组蛋白甲基化修饰发挥作用的可能性.方法:通过网络药理学的方法,利用相关数据库及软件筛选出补肾健脾活血方的活性药物成分及作用靶点,获取骨质疏松症相关疾病靶点,取交集得到补肾健脾活血方治疗骨质疏松症的潜在作用靶点.使用String和Cytoscape软件构建药物成分-靶点网络,筛选出核心作用靶点.于GO生物学分析结果提取组蛋白修饰相关功能及相关基因,从核心作用靶点中找到与组蛋白修饰相关靶点基因.结合文献分析靶点基因在骨质疏松症与组蛋白修饰中可能发挥的生物学作用,采用体外细胞实验验证补肾健脾活血方影响与靶点密切相关的组蛋白去甲基化酶JMJD2B在骨质疏松症中可能发挥的促成骨分化作用.结果 与结论:①共筛选出补肾健脾活血方治疗骨质疏松症相关活性药物成分118个,对应靶点165个,核心靶点为IL6、TP53、FOS、JUN、STAT3、RELA、CCND1、MYC、MAPK1、MAPK8、MAPK14、VEGFA、AKT1、ESR1、TNF、NR3C1等;②GO生物学功能分析得出,对药物的反应、对营养水平的反应、对氧化应激的反应、对类固醇激素的反应、转录调节、转录因子结合、磷酸酶结合、蛋白酶结合、类固醇激素受体活性等生物学功能与共同靶点密切相关;③MAPK8、VEGFA和TP53等核心靶点与组蛋白修饰功能有关,木犀草素、槲皮素和山奈酚等可能是影响组蛋白修饰功能治疗骨质疏松症的主要药物成分;④体外细胞实验结果表明,补肾健脾活血方含药血清干预下大鼠骨髓间充质干细胞的成骨相关碱性磷酸酶和JMJD2B、RUNX2蛋白表达均升高(P<0.05);⑤与补肾健脾活血方网络药理学靶点密切相关的组蛋白去甲基化酶JMJD2B可能发挥着促成骨分化作用以治疗骨质疏松症.

Purpose:This clinical research aims to assess the safety and efficacy of a combination of fusiform capsulectomy of the posterior capsule and percutaneous flexion tendon release in the treatment of a fused knee with severe flexion contracture during total knee arthroplasty (TKA). Methods:A retrospective analysis was performed in three patients (six knees) who had preoperative severe bony fused flexion contracture (>80°) prior to TKA and received a combination of fusiform capsulectomy of posterior capsule and percutaneous flexion tendon release during TKA between January 2016 and December 2019. The range of motion (ROM), knee functional score, postoperative complications, and radiographic results were evaluated. Result:Three patients (six knees) were enrolled in this study. The mean duration of follow-up was 42.83 ± 15.77 months. The postoperative knee ROM was 100.0 (76.0, 102.75) (p < 0.01). The knee society score (KSS) clinical score increased from a preoperative 30.0 (25.0, 36.0) to a postoperative 64.0 (65.0, 78.0) (p < 0.01), and the KSS function score increased from a preoperative 0.0 (0.0, 30.0) to a postoperative 55.0 (40.0, 55.0) (p < 0.01). No implant loosening, infection, neurovascular complications, or revision were recorded in the cohort until the last follow-up. Conclusion:The technique of a combination of fusiform capsulectomy of the posterior capsule and percutaneous flexion tendon release is an effective and safe method during primary TKA for a fused knee with severe flexion contracture.

Background A variety of proteins including epigenetic factors are involved in the differentiation of human bone marrow mesenchymal stem cells. These cells also exhibited an epigenetic plasticity that enabled them to trans-differentiate from adipocytes to osteoblasts (and vice versa) after commitment. Further in-depth study of their epigenetic alterations may make sense. Methods Chromatin Immunoprecipitation-PCR (ChIP-PCR) was used to detect the methylation enrichment status of H3K9me2 in the Runx2 promoter, alizarin red and alkaline phosphatase (ALP) staining were used to detect osteogenic differentiation and mineralization ability, western blot and quantitative RT-PCR were used to measure the differential expression of osteogenesis-related proteins and genes. Recombinant Lentivirus mediated gain-of-function and loss-of-function study. The scale of epigenetic modification was detected by laser confocal. Results Our results showed that compared with human bone marrow mesenchymal stem cells (hBMSCs) without osteogenic differentiation treatment, hBMSCs after osteogenic differentiation significantly promoted osteogenic differentiation and mRNA expression such as JMJD2B/KDM4B, osteogenesis-related genes like Runx2 and FAM210A in hBMSCs cells, suggesting that upregulation of JMJD2B/KDM4B is involved in the promoting effect of osteogenesis. After overexpression and silencing expression of JMJD2B, we found a completely opposite and significant difference in mRNA expression of osteogenesis-related genes and staining in hBMSCs. Overexpression of JMJD2B/KDM4B significantly promoted osteogenic differentiation, suggesting that JMJD2B/KDM4B could promote osteogenesis. In addition, ChIP-PCR showed that overexpression of JMJD2B/KDM4B significantly reversed the methylation enrichment status of H3K9me2 in Runx2 promoter. Furthermore, overexpression of JMJD2B/KDM4B significantly reverses the inhibitory effect of BIX01294 on H3K9me2, suggesting that JMJD2B/KDM4B regulates the osteogenic differentiation of hBMSCs by changing the methylation status of H3K9me2 at the Runx2 promoter. Conclusions Taken together, these results suggest that JMJD2B/ KDM4B may induce the osteogenic differentiation of hBMSCs by regulating the methylation level of H3K9me2 at the Runx2 promoter.

背景:血管新生是早期膝骨关节炎膝关节微环境的重要病理特征,通过膝关节腔注射microRNA的方式抑制血管新生可能为早期膝关节的治疗提供新的作用靶点.目的:观察miR-20b-5p激动剂对早期膝骨关节炎大鼠关节软骨、软骨下骨血管生成的影响,探讨miR-20b-5p对早期膝骨关节炎大鼠软骨及软骨下骨可能的保护机制.方法:从12只SD雄性大鼠中随机抽取3只作为空白组,余下9只制备早期膝骨关节炎模型后随机分组,即模型组、miR-20b agomir组及miR-20b agomir NC组,每组3只大鼠.造模后1周,空白组不予处理,模型组、miR-20b agomir组、miR-20b agomir NC组分别于双后膝注射0.2 mL生理盐水、miR-20b-5p agomir溶液、miR-20b-5p agomir NC溶液1次.4周后处死各组大鼠取膝关节进行番红O-固绿、免疫组织化学染色及国际骨关节炎研究学会"软骨病理评价系统"评分,实时荧光定量PCR及Western blot检测软骨及软骨下骨中缺氧诱导因子1α、血管内皮生长因子的mRNA和蛋白表达水平.结果 与结论:①miR-20b agomir组国际骨关节炎研究学会"软骨病理评价系统"评分明显低于模型组和miR-20b agomir NC组(P<0.05);模型组与miR-20b agomir NC组的国际骨关节炎研究学会"软骨病理评价系统"评分相比差异无显著性意义(P>0.05);②膝关节病理切片显示,相比空白组,其他各组均有软骨基质流失和软骨、软骨下骨的缺氧诱导因子1α、血管内皮生长因子蛋白表达水平增加,其中miR-20b agomir组的软骨基质流失程度以及软骨、软骨下骨的缺氧诱导因子1α、血管内皮生长因子蛋白表达水平低于模型组和miR-20b agomir NC组(P<0.05);③miR-20b agomir组软骨、软骨下骨的缺氧诱导因子1α、血管内皮生长因子的mRNA及蛋白表达水平均低于模型组和miR-20b agomir NC组(P<0.05);④提示过表达miR-20b-5p可下调早期膝骨关节炎软骨及软骨下骨缺氧诱导因子1α、血管内皮生长因子表达,抑制膝骨关节炎软骨及软骨下骨的血管新生,达到保护关节软骨的作用.

This study aimed to evaluate the safety and efficacy of fusiform capsulectomy of posterior capsule in correcting severe flexion contracture during total knee arthroplasty (TKA). A retrospective analysis was performed in the patients who had preoperative severe flexion contracture (> 30 degrees) prior to TKA and received fusiform capsulectomy of posterior capsule during TKA between December 2013 and November 2018. Range of motion (ROM), knee functional score, forgotten joint score (FJS), post-operative complications, and radiographic results were collected and evaluated. Twenty patients (32 knees) were enrolled in this study. The mean duration of follow-up was 27.19 ± 15.92 months. The flexion contracture improved from pre-operative 37.69 ± 11.79° to post-operative 5.78 ± 4.44° (p < 0.001), and ROM increased from pre-operative 63.50 ± 21.74° to post-operative 97.88 ± 13.20° (p < 0.001). KSS clinical score increased from pre-operative 32.94 ± 11.03 to post-operative 82.34 ± 10.73 (p < 0.001), and KSS function score increased from pre-operative 28.97 ± 18.43 to post-operative 68.75 ± 15.96 (p < 0.001). The post-operative FJS was 76.08 ± 2.14. There was no implant loosening, infection, obvious haematoma formation, resultant instability, neurovascular complications, or revision for any reasons in the cohort until the last follow-up. The technique of fusiform capsulectomy of posterior capsule to correct the severe flexion contracture during primary TKA is safe and effective and could provide good short-term results.

目的 观察四黄膏外敷结合清热利湿通络法治疗急性痛风性关节炎(湿热蕴结证)的临床疗效并探讨其作用机制.方法 71例门诊患者按随机数字表法分为治疗组35例与对照组36例,对照组给予口服依托考昔片,治疗组予以口服清热利湿通络中药,同时在发病部位贴敷四黄膏,两组均治疗14 d,观察两组患者在治疗后第3日、第7日、第14日的11点疼痛程度数字等级量表(NRS-11)积分、关节肿胀及活动受限情况,观察患者在治疗前后(2周)的血尿酸(BUA)、血沉(ESR)、C反应蛋白(CRP)的变化情况,同时分析两组患者的并发症发生情况.结果 治疗组总有效率为91.43％,显著高于对照组的72.22％ (P＜ 0.05).与治疗前相比较,两组患者治疗后第3日、第7日以及两周后的NRS-11、关节肿胀、关节活动受限3项主要临床症状指标均明显改善(P＜0.05),实验室指标BUA和CRP均有明显下降(P＜0.05).1个疗程治疗后两组患者在关节肿胀及CRP两项指标上表现出明显的差异(P＜0.05),两组患者在NRS-11、关节活动受限、ESR方面,没有明显差异(P＞0.05).在不良反应方面,治疗组患者明显较少.结论 四黄膏外敷结合清热利湿通络法治疗急性痛风性关节炎(湿热蕴结证)可以有效缓解疼痛,改善关节肿胀,较好地减轻机体炎症反应,安全性较好.

A well-studied subject of epigenetics, the histone methylation located at lysine and arginine is overseen via methyltransferases and demethylases. Lysine-specific demethylase 4A (KDM4A) comprises a lysine demethylase and possesses specificity for H3K9me3 and H3K36me3, which is capable of being used in order to activate histone transcription. Our team examined the expression of KDM4A within Sprague Dawley (SD) rats and further investigated the mechanism via which this phenomena regulates osteogenic variation within the present study. The overexpression of KDM4A facilitated the process of osteoblast differentiation in bone mesenchymal stem cells (BMSC), while the knocking down differentiation via osteoblast was restrained via the suppression of the expression of Runx2, Osterix, alkaline phosphatase (ALP), and osteocalcin (OCN). Knocking down KDM4A lowered levels of the promoter expression of Runx2, osterix, and OCN, and raised levels of H3K27me3 expression. The results demonstrated that KDM4A possesses a crucial role within the differentiation of osteoblasts and furthermore regulates the expression of Runx2, Osterix, and OCN via H3K9me3. The present research may provide new insights into the treatment of bone healing.

OBJECTIVE:To explore the safety and effectiveness of quadriceps snip in complex total knee arthroplasty (TKA). METHODS:A clinical data of 19 cases (29 knees) with complex TKA assisted with quadriceps snip between January 2016 and May 2017 were retrospectively analyzed. There were 9 males (13 knees) and 10 females (16 knees). The age of patients ranged from 34 to 66 years (mean, 50.2 years). Four patients (8 knees) were ankylosing spondylitis, 5 patients (7 knees) were rheumatoid arthritis, and 10 patients (14 knees) were knee osteoarthritis. The average disease duration was 10.9 years (range, 8-15 years). There were 12 knees of Kellgren-Lawrence grade Ⅲ and 17 knees of Kellgren-Lawrence grade Ⅳ. The range of motion (ROM) of knee was (19.86±7.23)°. The clinical and function scores of knee society score (KSS) were 47.86±11.26 and 15.52±11.21, respectively. Postoperative complications, ROM, KSS scores, extensor lag, and prosthesis loosening were observed to evaluate the effectiveness. RESULTS:All incisions healed by first intention, and no infection or cardiovascular and cerebrovascular accidents occurred. All patients were followed up 25-39 months (mean, 30.3 months). At last follow-up, the ROM of knee was (91.03±7.30) °, the KSS clinical score was 83.62±9.99 and functional score was 66.38±7.89, showing significant differences when compared with preoperative ones ( P<0.05). Postoperative extensor lag (10°, 10°, 15°) occurred in 3 cases. There was no evidence of prosthesis loosening or osteolysis on X-ray films during follow-up. CONCLUSION:The application of quadriceps snip in complex TKA can effectively improve the operative field exposure and reduce incidence of complications such as patella tendon tearing, patella fracture, and quadriceps tendon injury. The surgical technique of Krackow tendon suture can effectively guarantee early rehabilitation without occurrence of other complications.

BACKGROUND: Knee osteoarthritis is the most common degenerative joint disease with high morbidity and disability, which severely threatens the life quality of patients. Chinese herbs that invigorate the kidney and spleen and activate blood circulation can improve the clinical symptoms of knee osteoarthritis, but its specific mechanism is still unclear. OBJECTIVE: To study the mechanism of invigorating kidney, invigorating spleen and activating blood circulation herbs regulating the IL-1β/ERRα/SOX9/Col2α1 signaling pathway in the treatment of knee osteoarthritis in ovariectomized rats. METHODS: Six-month-old female Sprague-Dawley rats were randomly divided into blank control group, model group, experimental group and positive control group. The ovariectomy and excision of the cruciate ligament and medial meniscus were performed in the latter three groups to make the rat models of knee osteoarthritis. Two weeks after operation, the rats were treated with invigorating kidney, invigorating spleen and activating blood circulation herbs, celecoxib capsules, or normal saline. Serum samples and knee cartilage tissues were collected after 6 weeks of continuous gastric administration. Serum estradiol content was detected by ELISA. Expression of IL-1β/ERRα/SOX9/Col2α1 signaling pathway in articular cartilage tissues was detected by fluorescence quantitative PCR and western blot. RESULTS AND CONCLUSION: Compared with the blank control group, the expression of IL-1β in the model group increased significantly, while the expression of estradiol, ERRα, SOX9 and Col2α1 decreased significantly (P < 0.05). Compared with the model group, the expression of IL-1β in the experimental group decreased significantly, while the expression of estradiol, ERRα, SOX9 and Col2α1 increased significantly (P < 0.05). Compared with the positive control group, the expression of IL-1β, ERRα, and Col2α1 in the experimental group was significantly increased, while the expression of SOX9 decreased significantly (P < 0.05). These results indicate that the IL-1β/ERRα/SOX9/Col2α1 signaling pathway is involved in knee osteoarthritis-induced cartilage lesion, and Chinese herbs for invigorating kidney and spleen and activating blood circulation play a therapeutic role through this mechanism.

Objective: To compare the lipid metabolism characteristics of patients with three types of TCM syndrome of femur head necrosis ( FHN). Methods: Ninety-seven patients with FHN enrolled in the study were classified according to TCM syndrome differentiation, and their blood was drawn from peripheral vein. The serum contents of total cholesterol ( TC), triglyceride ( TG), high density lipoprotein cholesterol ( HDL-C), low density lipoprotein cholesterol ( LDL-C), apolipoprotein ( Apo) -A1 and Apo-B were measured and compared between patients with different types of TCM syndrome of FHN. Results: Phlegm-stagnation syndrome ( 32 cases), kidney-deficiency-blood-stasis syndrome ( 45 cases) and qi-stagnation-blood-stasis syndrome ( 20 cases) were found in the 97 patients. There was no statistical difference in the serum contents of HDL-C, Apo-A1 and Apo-B between the patients with three types of TCM syndrome ( HDL-C: 0. 99 +/-0. 42, 1. 14 +/-0. 34, 0. 88 +/-0. 41 mmol/L, F = 0. 182, P = 0. 834; Apo-A1: 1. 18 +/-0. 27, 1. 15 +/-0. 22, 1. 08 +/-0. 23 g/L, F = 0. 919, P = 0. 402; Apo-B: 0. 84 +/-0. 22, 0. 82 +/-0. 21, 0. 72 +/-0. 20 g/L, F = 0. 167, P = 0. 846). There was statistical difference in the serum contents of TC, TG and LDL-C between the patients with three types of TCM syndrome ( TC: 4. 77 +/-0. 97, 4. 34 +/-0. 81, 4. 00 +/-1. 25 mmol/L, F = 6. 211, P = 0. 003; TG: 2. 13 +/-1. 49, 1. 54 +/-0. 98, 1. 83 +/-1. 27 mmol/L, F = 3. 107, P = 0. 049; LDL-C: 2. 95 +/-1. 01, 2. 86 +/-0. 77, 2. 39 +/-1. 14 mmol/L, F = 3. 589, P = 0. 031). The serum contents of TC and LDL-C were higher in patients with phlegm-stagnation syndrome compared to patients with qi-stagnation-blood-stasis syndrome ( P =0. 007; P = 0. 039), and there was no statistical difference in the serum contents of TC and LDL-C between patients with phlegm-stagnation syndrome and patients with kidney-deficiency-blood-stasis syndrome and between patients with qi-stagnation-blood-stasis syndrome and patients with kidney-deficiency-blood-stasis syndrome ( TC: P = 0. 061, P = 0. 192; LDL-C: P = 0. 662, P = 0. 068). The serum contents of TG were higher in patients with phlegm-stagnation syndrome compared to patients with kidney-deficiency-blood-stasis syndrome ( P = 0. 040), and there was no statistical difference in the serum contents of TG between patients with phlegm-stagnation syndrome and patients with qi-stagnation-blood-stasis syndrome and between patients with kidney-deficiency-blood-stasis syndrome and patients with qi-stagnation-blood-stasis syndrome ( P = 0. 407, P = 0. 367). Conclusion: Lipid metabolism of patients with phlegm-stagnation-type FHN is significantly different from that of patients with kidney-deficiency-blood-stasis-type FHN and patients with qi-stagnation-blood-stasis-type FHN.

目的:探讨自体富血小板(platelet-rich plasma,PRP)关节腔内注射治疗晚期膝骨关节炎对疼痛及疼痛介质的影响.方法:100例晚期膝骨关节炎患者按照随机数字表法分为实验组和对照组,每组各50例.实验组关节腔注射PRP 4 mL,对照组注射复方倍他米松和利多卡因混合液4 mL.评价治疗前后两组患者视觉模拟评分(visual analogue scalescore,VAS),并根据VAS分数评价临床疗效,检测血清疼痛介质(PGE2、SP、DA、5-HT)、白三烯(LTB4、LTC4、LTD4)、促炎因子(TNF-α、IL-1β)的表达水平.结果:实验组治疗有效率(90％)与对照组(68％)比较,差异有统计学意义(P<0.05).治疗前,两组患者疼痛介质、白三烯、促炎因子比较,差异无统计学意义(P>0.05);治疗后,两组患者疼痛介质、白三烯、促炎因子均下降,且实验组下降程度大于对照组(P<0.05).结论:PRP关节腔注射疗法可有效改善晚期膝骨关节炎患者疼痛症状,修复关节软骨,控制炎症反应,适合在临床推广.

背景:股骨头坏死塌陷后骨髓水肿广泛存在,骨髓水肿可能是评估股骨头坏死“带塌陷生存”的重要影像学指标.目的:分析股骨头坏死塌陷后骨髓水肿存在情况与股骨头影像学改变的关系,探讨骨髓水肿在股骨头坏死“带塌陷生存”治疗中的意义.方法:病例资料来自于广州中医药大学第一附属医院股骨头坏死专科门诊(2012至2016年),为“广东省优势病种(股骨头坏死)突破项目”登记入组的股骨头坏死非手术治疗患者,对其中60例(81髋)已塌陷的股骨头坏死病例进行随访,其中男43例61髋,女17例20髋,按照改良的骨髓水肿分级(无骨髓水肿、轻度骨髓水肿、重度骨髓水肿)进行分组,其中无骨髓水肿(0级)15髋,轻度骨髓水肿(1级和2级)37髋,重度骨髓水肿(3级)29髋.所有患者对治疗及试验方案均知情同意,且得到医院伦理委员会批准.采用中医药非手术治疗,并指导功能锻炼.每3个月复查双髋关节正蛙位X射线片,观察入组病例在正蛙位塌陷、头臼匹配、关节稳定方面X射线改变,分析骨髓水肿分级对股骨头坏死塌陷后X射线改变的影响.结果 与结论:①60例(81髋)已塌陷病例随访资料完整,随访时间为4-72个月;②经R*C列联表的x2检验,不同骨髓水肿分级会全面影响股骨头坏死塌陷后的X射线进展(正蛙位塌陷、头臼匹配、关节稳定),并且差异有显著性意义(P＜0.05);③提示股骨头坏死塌陷后骨髓水肿广泛存在,骨髓水肿会全面影响塌陷后的X射线改变;骨髓水肿分级越高,正蛙位塌陷、头臼匹配、关节稳定出现X射线进展的概率越大;骨髓水肿是评估股骨头坏死塌陷后治疗的重要影像学指标.

Abstract Background: Sarco-osteopenia (SOP) is a new type of geriatric syndrome, resulting from the combination of sarcopenia (SP) and osteoporosis (OP). Xianling Gubao capsule (XLGBC), made from several traditional Chinese medicine, is reported to have a therapeutic effect on diseases of bones and joints. This protocol will be designed to assess the efficacy of XLGBC in the treatment of SOP. Methods: Relevant randomized controlled trial literatures evaluating the effect of XLGBC on patients with SOP will be obtained by searching the following 7 electronic databases: Cochrane Library, PubMed, Embase, Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Chinese Biomedical and Medical Database (CBM), and Wanfang Database, from inception to March 2019. The primary outcomes will be bone mineral density, skeletal muscle mass index, handgrip strength, and gait speed. Stata V.13.0 software will be used for data synthesis and analysis, sensitivity analysis, subgroup analysis, and risk of bias assessment. Reporting bias will be evaluated utilizing a funnel, with Egger tests assessing funnel plot symmetries. Quality of evidence will be evaluated according to guidance of the Recommendations Assessment, Development, and Evaluation guideline. Result: This study will provide a rational synthesis of current evidences for XLGBC on SOP. Conclusion: The conclusion of this study will provide evidence to judge the effectiveness and safety of XLGBC on SOP. Ethics and dissemination: This systematic review will be contributed to peer-reviewed publications, aiming to provide evidence about efficacy of XLGBC on SOP. Trial registration number: CRD42019128223.

BACKGROUND:Sarco-osteopenia (SOP) is a new type of geriatric syndrome, resulting from the combination of sarcopenia (SP) and osteoporosis (OP). Xianling Gubao capsule (XLGBC), made from several traditional Chinese medicine, is reported to have a therapeutic effect on diseases of bones and joints. This protocol will be designed to assess the efficacy of XLGBC in the treatment of SOP. METHODS:Relevant randomized controlled trial literatures evaluating the effect of XLGBC on patients with SOP will be obtained by searching the following 7 electronic databases: Cochrane Library, PubMed, Embase, Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Chinese Biomedical and Medical Database (CBM), and Wanfang Database, from inception to March 2019. The primary outcomes will be bone mineral density, skeletal muscle mass index, handgrip strength, and gait speed. Stata V.13.0 software will be used for data synthesis and analysis, sensitivity analysis, subgroup analysis, and risk of bias assessment. Reporting bias will be evaluated utilizing a funnel, with Egger tests assessing funnel plot symmetries. Quality of evidence will be evaluated according to guidance of the Recommendations Assessment, Development, and Evaluation guideline. RESULT:This study will provide a rational synthesis of current evidences for XLGBC on SOP. CONCLUSION:The conclusion of this study will provide evidence to judge the effectiveness and safety of XLGBC on SOP. ETHICS AND DISSEMINATION:This systematic review will be contributed to peer-reviewed publications, aiming to provide evidence about efficacy of XLGBC on SOP. TRIAL REGISTRATION NUMBER:CRD42019128223.

BACKGROUND: Preliminary studies have found that ligustrazine can effectively improve the levels of nitric oxide and prostaglandin E2, and alleviate the inflammatory response of osteoarthritis, but the related mechanism remains unclear. OBJECTIVE: To observe the effect of ligustrazine on the expression levels of type Ⅱ collagen fiber α 1, vascular endothelial growth factor (VEGF) mRNA and miR20b in the articular cartilage of knee osteoarthritis model, and to explore the mechanism of ligustrazine for early-stage knee osteoarthritis in rats. METHODS: Healthy male Sprague-Dawley rats were randomized into normal, model, high- and low-dose ligustrazine, and positive control groups. Rats in the latter four groups were used to establish the model of early-stage knee osteoarthritis by intra-articular injection of papain, and were then intragastrically given the administration of normal saline, 100 and 50 mg/kg ligustrazine, and 24 mg/kg celecoxib, respectively. The normal group was given the same volume of normal saline. The treatment in each group lasted for 6 weeks. Then, the rat cartilage was taken, and changes of cartilage tissues were assessed by Mankin scores. Expression levels of type Ⅱ collagen fiber α 1, VEGF mRNA and miR20b in the cartilage were detected by qRT-PCR. RESULTS AND CONCLUSION: The order of Mankin scores was as follows: normal group < high-dose ligustrazine group < positive control group < low-dose ligustrazine group < model group (P < 0.05). The mRNA expression levels of type Ⅱ collagen fiber α 1 and VEGF were the highest in the normal group, followed by the high-dose ligustrazine group, positive control group, low-dose ligustrazine group, and model group (P < 0.05). The expression level of miR20b was significantly up-regulated except the model group, and its order was follows: high-dose ligustrazine group < positive control group < low-dose ligustrazine group. Our results indicate that ligustrazine has a positive effect on early-stage knee osteoarthritis in rats, and the possible mechanisms by which ligustrazine promotes cartilage repair are to up-regulate miR20b expression and to inhibit VEGF mRNA expression.