目的:观察推拿治疗结合等速肌力训练对膝关节骨性关节炎的治疗效果.方法:从膝关节骨性关节炎(KOA)患者中随机选取60例作为观察对象,60例患者随机分为推拿结合等速治疗组(试验组)和单纯推拿治疗组(对照组).分别将两组治疗前后的膝关节西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、等速屈伸肌力测试对比分析.结果:两组治疗后膝关节WOMAC评分均较治疗前有显著改善(P＜0.01),其中推拿结合等速组膝关节WOMAC评分由(62.93±16.17)降为(26.20±12.68),改善较单纯推拿组更为显著(P＜0.01).两组治疗干预前等速肌力测试各指标比较没有显著性差异.经过8周治疗后推拿加等速训练组膝关节伸肌峰力矩、峰力矩/体重、达峰时间、平均功率,膝关节屈肌峰力矩、达峰时间与本组治疗前比较明显改善,差异有显著性(P＜0.01);膝关节伸肌平均功率与本组治疗前比较有改善,差异有显著性(P＜0.05);推拿加等速训练组膝关节伸肌峰力矩、峰力矩/体重、达峰时间、膝关节屈肌达峰时间、屈肌/伸肌比单纯推拿组治疗后改善明显,差异有显著性(P＜0.05);推拿加等速训练组膝关节屈肌峰力矩与单纯推拿组治疗后比较提高明显,差异有显著性(P＜0.01).结论:推拿结合等速肌力训练可以提高KOA患者膝关节屈伸肌肉力量,对于KOA的治疗具有良好的临床疗效,且明显优于单纯推拿治疗.

目的:通过通络止痛方中君药的活性成分桂皮醛(CA)和白芍总苷(TGP)的对滑膜成纤维细胞(FLS)的干预,研究固有免疫系统中TLR2和TLR4及其介导的信号通路的下游产物白介素1β (IL-1β)和基质金属蛋白酶(MMP-13)在骨关节炎滑膜炎性反应中的表达及其相互关系.方法:将高、低浓度的CA和TGP分别对经脂多糖(LPS)活化的FLS进行干预,收集细胞上清采用ELISA法测定IL-1 β和MMP-13的浓度;收集细胞采用流式细胞术测定FLS表面TLR2和TLR4的表达,并分析它们之间的相关性.结果:LPS对滑膜炎性反应有显著的诱导活化作用,高、低CA和TGP均可不同程度抑制IL-1β、MMP-13的释放和TLR2、TLR4的表达,其中CA高浓度组抑制作用最强(P＜0.05).TLR2、TLR4、IL-1β、MMP-13之间均存在显著的正相关性,具体为:TLR2与TLR4(r=0.862,P＜0.05),IL-1β与MMP-13(r=-0.994,P＜0.05),TLR2与IL-1β(r=0.754,P＜0.05),TLR2与MMP-13(r=-0.717,P＜0.05),TLR4与IL-1β(r=0.929,P＜0.05),TLR4与MMP-13(r=0.929,P＜0.05).结论:CA和TGP在通过调控固有免疫应答进程进而抑制滑膜炎性反应的作用,明确了固有免疫效应网中不同环节的元件的相关性,为中药有效成分作用靶点的探寻及未来防治OA有效方案的制定提供数据支持及新的思路.

OBJECTIVE:To investigate expression features and correlation of genes expression on MyD88-dependent signaling pathway in synovial membrane (SM) of progression of knee osteoarthritis (OA).METHODS:Sixty Wistar rats were randomly divided into 6 groups, including blank group (N), false surgical group, model groups[2 weeks (2W), 4 weeks (4W), 8 weeks (8W) and 12 weeks (12W)], with 10 rats in each group. The models were established by using Hulth method. Control group was experienced no surgery, while false surgical group was only opened joint cavity and sutured. The SM samples was collected according to the time designed above. The relative expression quantity of MyD88, TLR4 and NF-κB was detected by Real-time PCR after the extraction of the total RNA and reverse transcription. The correlation analysis was obtained by SPSS.RESULTS:There was no significant difference in each gene mRNA expression between false surgical and blank group(P> 0.05), while enhanced expression was found in the model groups(P<0.05). The correlation index among MyD88, TLR4 and NF-κB was 0.91 and 0.86 respectively, and had significant difference among them.CONCLUSIONS:Positively relative among MyD88, TLR4 and NF-κB played main role in TLR4/NF-κB signal passway, and could predicate the expression of other genes in the passway. It also could further provide the basis for clarify the pathologic mechanism of knee OA.

Objective:To investigate the influence of miRNA-146a gene disturbances and cinnamic aldehyde (CA) on TLR4,NO,and MMP-13,which was released by synovioblast,and to explore their roles in the molecular mechanism of synovial inflammation in osteoarthritis (OA).Methods:Plasmids of miR-146a gene mimics and inhibitors were loaded into LPS-induced FLS using lipofection transfection.Then the interferential FLS were treated with CA,and the release amount of TRL4,NO and MMP-13 were detected.Results:After the miRNA-146a related plasmid transfection,the variation tendency of the concentrations of TLR4,NO and MMP-13 were almost the same.Compared with control group,the inhibitor group was elevated,and mimics group was declined (P ＜ 0.05).Compared with the control group,when the interferential FLS was treated with CA alone,TLR4,its release of TLR4,NO and MMP-13 were significantly decreased (P ＜ 0.05),whereas the mimics and CA coordinated intervention,the release was significantly decreased (P ＜ 0.05).Conclusion:Both of the miR-146a and CA have effects on synovial inflammation in OA,especially when mimics and CA were combined,the inhibition of inflammation was best.It could provide an experimental basis to clarify molecular mechanism,identify and develop novel drug targets of OA.

[Objective] To discuss the regulatory mechanism of total glucosides of paeonia (TGP) on proliferation, apoptosis and cell cycle of fibroblast-like synovial cells (FLS) in the process of osteoarthritis (OA). [Methods] With FLS being the object of action, Methylthiazolyldiphenyl-tetrazolium bromide (MTT) was used to detect the proliferation of FLS, and flow cytometry (FCM) was used to detect the apoptosis and cell cycle. [Results] The concentration dependence of FLS was existed in the concentration of TGP. In addition, the inhibitory effect of TGP on FLS mainly through inducing late apoptosis, as well as prolonging G2 phase (P<0.05) and blocking S phase (P<0.05) in the cell cycle of FLS. [Conclusion] TGP could inhibit the abnormal growth of FLS by regulating its proliferation, apoptosis and cell cycle. The findings above laid the groundwork for confirming the regulatory mechanism and curative effect of active components of Chinese medicine.

颈椎病又称颈椎综合征,是以颈椎退行性病理变化为基础的一种疾病,是临床常见病、多发病.颈椎病的临床表现多种多样,因不同的组织受到刺激或压迫而表现出一系列不同的临床症状.根据临床症状的不同大致分为颈型、神经根型、椎动脉型、脊髓型以及混合型.其中神经根型颈椎病发病率最高,在颈椎病发病中占50％～60％,并有逐年增加及年轻化趋势,值得广大读者认识和了解.

介绍了外科伤口换药的目的、换药原则、换药方法,认为给病人换药时密切配合医生,做好心理护理,可促进伤口愈合。

目的 探讨骶尾部潜毛窦的治疗和护理方法.方法 回顾性分析收治的12例骶尾部潜毛窦患者的临床资料.结果 12例均行B超或CT检查,均提示骶尾部软组织块影或脓腔改变;12例均经合适的手术治疗与护理后治疗,均获得良好的效果,伤口愈合良好,无复发.结论 潜毛窦容易误诊,有许多患者感染的伤口反复换药后经久不愈,应考虑合理干预,有助于早期的鉴别诊断.术前应行合理的诊断措施,明确手术范围,加强手术护理,彻底手术切除是主要治疗手段。

<正>外科切开引流术换药及护理是外科护理工作的重要组成部分[1]。我科实施切开引流术,应用依沙吖啶纱条作为引流物,同时给予积极护理配合,效果满意,现将护理体会报告如下。1临床资料

目的探讨门诊拔甲术的治疗与护理方法。方法:分析45例门诊拔甲手术病例的病情、手术方法及术后溃疡油纱换药与护理措施。结果:所有病人都完成拔甲术,7～10d甲床创面愈合,无明显并发症。结论:我们需要在门诊宣教中对易发人群通过增强拔甲术防护意识,一旦发病应及早就诊,可大大减小复发率及手术率和术后并发症。