The aim of the present study was to observe whether autophagy was induced by matrine, and to investigate the role of autophagy in the antitumor effects of matrine on human osteosarcoma MG-63 cells and its underlying mechanism. MG-63 cells were cultured in vitro in matrine at a concentration of 0.6, 0.8, 1.0 and 1.2 g/l for 0, 24, 48 and 72 h. A MTT assay was used to evaluate the proliferation inhibition of MG-63 cells by matrine, and Annexin V-fluorescein isothiocyanate/propidum iodide (PI) staining flow cytometry was used to analyze the apoptotic rate. Alterations in cell morphology was assessed by PI and Hoechst 33258 cell staining. Matrine-induced autophagy in MG-63 cells was confirmed by green fluorescent protein-microtubule-associated protein 1-light chain 3 (LC3) b transfection and fluorescence microscopy, and cell viability was investigated by MTT assay following inhibition of autophagy by chloroquine (CQ) pretreatment. The expression level of apoptosis-associated proteins B-cell lymphoma-2 (Bcl-2) and Bcl-2-like protein 4 (Bax), autophagy-associated LC3II protein, and the activation of extracellular signal-regulated kinase (ERK) was detected by western blotting. Cell proliferation was clearly inhibited by matrine in a dose-and time-dependent manner. Flow cytometry and Hoechst 33258/PI staining verified that matrine induced apoptosis in a time-dependent manner when cells were exposed to 1.1 g/l matrine; fluorescence microscopy demonstrated that green fluorescence puncta were enhanced with prolonged time of matrine incubation. Western blotting confirmed that the expression of pro-apoptosis-associated proteins Bax and LC3II, and phosphorylated-ERK were upregulated, and anti-apoptosis protein Bcl-2 was downregulated in a time-dependent manner following treatment with matrine. The cell viability of the matrine + CQ group was increased compared with the matrine group alone, which revealed that matrine treatment alone induced protective autophagy in MG-63 cells. In addiiton, expression of LC3II/LC3I decreased and the expression of BAX/Bcl-2 increased in the matrine + U0126 group compared with the matrine alone group. The present study demonstrated, to the best of our knowledge, for the first time that matrine induced protective autophagy via ERK activation in MG-63 cells, and matrine combined treatment with CQ or U0126 led to an increase in apoptosis in osteosarcoma cells.

Background Osteoarthritis (OA) is the most prevalent type of arthritis and the main reason for the progressive disability in middle-aged and older people. Studies of candidate genes may provide a novel insight and treatment strategy for KOA. The aim of this study was to investigated the relationship between knee osteoarthritis (KOA) susceptibility and single-nucleotide polymorphism (SNP) of the ADAMTS-5 gene. Materials and methods The case group included 188 patients from Luoyang Orthopedic Hospital with clinically and radiographically diagnosed primary KOA, and the control group included 100 age-matched individuals without KOA. Fifteen ADAMTS-5 SNPs were assayed using MALDI-TOF MS. Allelic and haplotypic frequencies were compared between the groups. The relationship between genotype distribution and risk of KOA was analyzed by multivariate logistic regression. Results The frequency of A allele in rs2249350 site in the KOA group was significantly lower (odds ratio [OR]: 0.761; 95% confidence interval [95% CI]: 0.612–0.947; P = 0.016), while that of C allele was higher than that in the control group (OR: 1.176; 95% CI: 1.025–1.351; P = 0.016). AA genotype and gene model, especially recessive gene model at rs2249350 locus, negatively correlated with KOA risk after adjustment for sex, body mass index, age, and occupation (AA vs. CC: OR: 0.288; 95% CI: 0.124–0.669; P = 0.004; AA vs. CA + CC: OR: 0.348; 95% CI: 0.162–0.749; P = 0.007). Meanwhile, one protective haplotype, GA (rs229054, rs2249350) (OR: 0.763; 95% CI: 0.614–0.949; P = 0.017), and one high-risk haplotype, GC (rs229054, rs2249350) (OR: 1.259; 95% CI: 1.032–1.537; P = 0.019), were found in this study. Conclusion Despite a limited sample size, our study suggests that the rs2249350 polymorphism in the ADAMTS-5 gene is one of the genetic factors influencing the risk of KOA. The A allele and AA genotype of rs2249350 may protect from KOA, whereas C allele and CC genotype increase the risk of KOA. In addition, the GA haplotype (rs229054, rs2249350) might be associated with a decreased risk of KOA, whereas the GC haplotype (rs229054, rs2249350) may be a risk factor for KOA. Additional larger-sized studies in more ethnically diverse populations are needed to confirm these findings.

Diverse academic schools have emerged during the development of traditional Chinese medicine（TCM）.Pingle Guo′s orthopedic and traumatology school has become a typical one because of the clear development process, sound theoretical system, distinct academic thought, and simultaneous inheritance and innovation.This paper briefly introduced the history and current status of Pingle Guo′s orthopedic and traumatology school and then analyzed the role of this school in the development of TCM orthopedics and traumatology.Finally, suggestions were put forward to boost the development of TCM academic schools for the flourishing of TCM,aiming to giving full play to the role of TCM in the Healthy China initiative.

目的 本研究应用平乐正骨手法结合闭合顺行多针髓内固定对成人肱骨干骨折进行治疗，评估其临床疗效。方法 选取我科2016年7月至2021年7月收治的50例成人肱骨干骨折患者，应用平乐正骨手法结合闭合顺行多针髓内固定治疗，其中男28例，女32例。年龄18~81岁，平均48岁，均为闭合性肱骨骨折，其中，上段骨折12例，中段骨折28例，中下段骨折10例（单段骨折6例，双段骨折4例）；左侧28例，右侧22例；摔伤29例，坠落伤13例，交通意外伤5例，其他3例；伤后就诊时间为1h~8d，平均1.5d。按照中医病症诊断疗效标准中对肱骨骨折的疗效评价标准，及肩关节（Constant-Murley）功能评分，观察骨折愈合、肩关节功能恢复及并发症发生情况，综合评价其临床疗效。结果 本组50例患者均获随访，术中均良好复位，手术时间(20.6±3.9)min，住院时间(6.5±1.8)d。按上述标准评定治愈41例，占82%，好转5例，占10%，未愈4例，占8%。除4例未愈病例外，余均获得骨性愈合，愈合时间12～32周，平均16周。末次随访时，Constant-Murley肩关节功能评分，疼痛（15.5±1.5）分，日常生活水平（20.6±1.4）分，活动度（36.5±2.5）分，肌力（25.8±1.2）分，总分91.3±1.7；优16例，良25例，可5例，差4例。5例患者术后出现皮肤激惹症状，考虑针尾顶住皮肤刺激所致，在稳定骨折端的情况下拔出部分钢针后症状消失。未愈病例考虑病人体型肥胖，上肢重量较重导致骨折端分离，建议改行其他手术方案。结论 平乐正骨闭合复位顺行多针髓内固定治疗肱骨干骨折，复位效果好，手术时间和住院时间短，骨折愈合和肩关节功能恢复良好，该法无需特殊手术器械，可用于急诊手术，如其手术失败，并不影响其它方法治疗，适合基层医院推广应用。

目的 调查当前中医骨伤科学专业课程内容设置存在的问题,为培养"中西并举且具有中医特色"的中医骨伤科学专业人才提供参考依据.方法 随机抽取师生及用人单位,就"现阶段中医骨伤科学专业课程内容设置"等问题展开问卷调查.结果 教师、学生与用人单位对课程设置满意度不同;课程内容设置方面,本、专科院校一致认同西医知识对人才培养的重要性,本科院校更加重视中医传统文化课程及中医四大经典课程;本、专科院校均支持中医骨伤科学复兴走中医为主西医为辅的中西医结合道路,并注重前沿最新理论、技术与教学相融合.结论 中医骨伤科学专业课程内容建设有待加强,要探索具有扎实中医理论基础并兼容先进西医知识的新时代中医骨伤科学课程体系.

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.

近年来,关于髌骨软化症的研究主要围绕临床诊断与治疗开展,动物实验等基础研究领域空白较多.手术造模方法操作复杂,不能排除手术干预对实验结果的影响,也不符合疾病的自然进程,在应用上有诸多限制.非手术造模对人的髌骨软化症进程也较有借鉴意义,但是缺乏重复实验的验证,造模成功率与稳定性需要更多的实验数据支持.期待未来能从髌骨形态、活动度,髌股关节发育、力学关系以及劳损等角度,结合髌骨软化症的致病因素与易感因素进行探索,或许能够发现更全面、稳定的动物模型.了解髌骨软化症动物模型的研究现状,为髌骨软化症的实验研究提供参考与依据,促进基础研究的发展.

总结膝骨关节炎的易感因素,发现年龄、性别、饮食、体质量、关节形态、基因、生活方式等因素都与发病密切相关.通过多方位的考量确认膝骨关节炎的易感人群,制定出合理完善的预防机制.对于拥有多个易感因素的人群,要保持良好的生活习惯,尽早控制体质量和进行肌肉锻炼等有针对性的防治手段,以减少疾病的发生,或者延缓病程进展,获得更高的生活质量.

BackgroundSome patients with knee osteoarthritis (KOA) show pain, stiffness and limited flexion and extension at the back of the knee, leading to dysfunction and affecting life. This may be related to changes in the biomechanical properties of skeletal muscles. Shear wave elastography (SWE) can detect these changes by measuring muscle shear modulus.AimsTo investigate hamstring muscle shear modulus of healthy people and patients was studied using SWE method, and the correlation analysis between the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score of patients’ subjective feeling and shear modulus of objective quantification was conducted.MethodsThe hamstring shear modulus was measured by SWE in 50 patients and 50 healthy individuals. Pearson correlation coefficient was used to evaluate the correlation between hamstring stiffness and shear modulus in patients.ResultsThe hamstring shear modulus were significantly higher in the KOA group [the semimembranosus (SM) 15.23 ± 7.23, the semitendinosus (ST) 15.94 ± 5.40, the biceps femoris long tendinitis (BFL) 14.21 ± 6.55] than in the control group (the SM 10.95 ± 2.41, the ST 11.25 ± 2.23, the BFL 9.98 ± 2.81) (p = 0.000, p = 0.000, p = 0.001). The hamstring shear modulus in the KOA group was moderately positively correlated with pain, shear modulus, and physical function score.ConclusionPreliminary results show that the shear modulus of the hamstring of KOA patients is higher than that of healthy people, the WOMAC score and the shear modulus of patients are moderately correlated. These preliminary results show that ultrasonic shear wave elastography measurement of shear modulus may be enough to sensitive, can detect these effects, more targeted in order to assist the doctor’s diagnosis and treatment.

背景:以髌股关节软骨损伤为主要特征的疾病临床发病率高,但目前的研究对其病因认识不足.过度活动是临床广泛认可的病理机制之一,对认识髌股关节损伤的发生与发展有重要的意义.目的:观察顺轴疲劳运动对髌股关节软骨的影响,探究疲劳运动对兔髌股关节软骨造成的损害,为了解过度活动对髌股关节软骨病变的影响提供实验依据.方法:将8只新西兰大耳白兔适应性饲养1周后,选取右后膝为实验侧,将右后膝固定于造模机上进行顺轴疲劳运动,活动角度设置为0°-95°,活动频率为60次/min,每天活动90 min,持续2周;左后膝不做处理.造模结束后采集动物膝关节MRI图像,之后麻醉处死动物并取材,对髌股关节进行软骨组织切片观察以及软骨Mankin评分.结果 与结论:①实验侧髌骨软骨出现明显的损害;②顺轴疲劳运动2周后,实验侧髌骨软骨颜色晦暗、可见裂隙存在,髌骨软骨面粗糙,髌骨-股骨接触面边缘增生;对照侧没有发现明显的软骨退变;③膝关节MRI结果显示,实验侧髌骨软骨信号不均匀;④苏木精-伊红染色后,光镜下观察实验侧软骨表面不光滑,可见软骨细胞增殖,排列紊乱,多条潮线;实验侧Mankin评分明显高于对照侧,差异有显著性意义(P＜0.05);⑤提示持续2周的顺轴疲劳运动可以造成兔髌股关节软骨轻度病损,出现软骨肿胀、裂隙等病理改变.

目的:通过网络药理学和分子对接技术研究筋骨痛消丸治疗髌骨软化症(chondromalacia patellae)的作用机制.方法:首先通过中药系统药理学数据库与分析平台(TCMSP)挖掘筋骨痛消丸中各种中药的活性成分并预测其作用靶点,TCMSP数据库中缺失的中药利用文献检索与Swiss Target Prediction数据库获得有效成分及对应靶点.利用UniProt数据库,将获得的靶点蛋白的名称标准化.登录GeneCards、PharmGkb等数据库,获取髌骨软化症的疾病靶点.之后将药物靶点和疾病靶点取交集,制作出韦恩图.运用Cytoscape软件,筛选并构建"药物-活性成分-交集靶点-疾病"网络;利用String数据库构建蛋白互作(PPI)网络,并使用R语言对预测靶点进行GO富集分析和KEGG通路分析.最后通过Autodock软件对药物的主要活性成分和核心作用靶点进行分子对接验证.结果:研究结果显示筛选得到筋骨痛消丸治疗髌骨软化症的活性成分188个及靶点249个,主要活性成分为槲皮素、柚皮素、山奈酚、木犀草素、β-谷甾醇等,PPI网络主要计算出AKT1、CASP8、CASP3、JUN、BCL2L1、MYC等6个关键靶点.GO富集分析涉及生物过程(BP)1458个,细胞组分(CC)19个,分子功能(MF)65个;KEGG通路富集分析筛选得到43条与髌骨软化相关的通路,主要作用于脂质和动脉粥样硬化信号通路、细胞凋亡信号通路、AGE-RAGE信号通路以及病毒相关信号通路等.分子对接结果表明,药物组成中的主要活性化合物能够分别与代表性的靶点结合并展现出较好的亲和力.结论:本研究表明筋骨痛消丸治疗髌骨软化症涉及多条信号通路及生物学过程,其主要活性成分山奈酚、木犀草素、槲皮素与关键靶点AKT1、CASP3、MYC的结合可能是发挥作用的重要机制之一.

针灸和药物治疗作为膝骨关节炎(KOA)的两种不同治疗方法,均能改善膝关节功能,减轻疼痛症状.对膝骨关节炎患者同时施以针灸和药物两种治疗措施,可发挥标本兼顾、协同增效的作用,获得更好的临床效果.从针灸疗法结合药物内服、药物外用、药物注射、药物离子导入等方面阐述针药结合治疗膝骨关节炎的临床研究进展,为临床提供参考.

在新的时代背景下,中医学术流派是促迸中医药蓬勃发展的重要环节.本文简述了第一批全国中医学术流派——平乐郭氏正骨流派的历史沿革及发展现状,总结其近些年在学术体系建设、流派特色开发、人才队伍建设及流派品牌建设四个方面的实践经验,并结合中医药发展需求本文迸一步提出了中医学术流派做好传承发展的几点思考与建议,以期为中医学术流派助力中医药繁荣复兴提供参考.

现代医学研究表明,膝骨关节炎与关节软骨、滑膜、骨骼肌以及软骨下骨的病理改变密切相关.软骨、滑膜、骨骼肌等组织属于中医学"筋"的范畴,软骨下骨属于中医学"骨"的范畴."筋骨互用平衡论"认为,筋骨失衡是引起膝骨关节炎的重要病机,恢复筋骨协调平衡是防治膝骨关节炎的宗旨.从现代医学视角下辨析"筋伤"与"骨病"两者在膝骨关节炎病程中的生理、病理联系,将"筋骨并重"理念融入到膝骨关节炎诊疗过程中,对恢复筋骨协调平衡,更好地发挥中西医结合防治膝骨关节炎的优势具有重要意义.

构建中医骨亚健康学是时代发展的需要,目前该学科的构建尚处于初级阶段.平乐正骨养骨理论以养筋护骨、强筋壮骨、维持筋骨系统平衡、改善筋骨失衡状态为核心,中医特色鲜明、理论内容丰富,可为中医骨亚健康学的构建提供指导.本文基于平乐正骨养骨理论,围绕中医骨亚健康学的学科性质、与其他学科的关系、研究对象、发展目标、主要任务及学科特点等方面,对中医骨亚健康学的学科构建进行了探讨.

"治未病"是祖国医学的核心思想之一,融防与治为一体,几千年来被历代医家奉为圭臬.时至今日,在各种筋骨系统疾病和亚健康问题肆虐的情形下,"治未病"理念在骨伤科疾病的防治中仍然具有重要的现实意义.平乐正骨"平衡理论"体系蕴含着丰富的"治未病"理念,其以"筋骨互用平衡"为核心,倡导筋骨协调平衡状态下注重养生以防病,筋骨失衡的亚健康或疾病状态下注重调摄,恢复筋骨平衡以防变,最终达到到养筋护骨、强筋壮骨、健康平衡的目的.

目的 设计一种熏蒸床集中控制系统.方法 采用台达可编程控制器(Programmable Logic Controller,PLC)作为整个系统的控制核心,实现对语音播报、超温保护、防干烧保护等功能的集中控制;采用PID算法结合PWM技术实现对熏蒸温度的精准控制;通过人机界面实现操作者与PLC之间的信息交互.结果 设计出的样机保护接地阻抗<0.1Ω;温度偏差

平乐郭氏正骨医术有二百余年的传承历史,通过口传心授,其后的几代传人都秉承祖训,致力于中医骨伤医学的传承、教育、发展、创新,尤其是1958年河南省平乐正骨学院的建立,打破了中医教育家传、跟师学徒传统传承模式的局限性,为国家培养了大批优秀中医骨科人才,被誉为我国中医骨伤学教育的"黄埔军校",通过对平乐正骨传承教育的文献研究,基于儒、释、道教育思想对平乐正骨教育理念形成的影响,对其教育模式及思想理念进行探讨,可为中医骨伤学科人才传承提供有利参考.

目的:观察浮针结合筋骨痛消丸治疗髌骨软化症(chondromalacia patella,CP)的临床疗效.方法:将符合标准的82例患者按随机数字法分为观察组和对照组各41例,观察组采用浮针结合筋骨痛消丸治疗,对照组采用双氯芬酸钠结合玻璃酸钠关节腔注射治疗;2组治疗时间4周,分别于治疗前、治疗4周和12周随访时进行疼痛视觉模拟量表(VAS)评分,西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分,及膝关节活动度和髌韧带软硬度测量.结果:治疗前2组在WOMAC、VAS及关节活动度及髌韧带硬度的比较无差异,无统计学意义(P＞0.05).随着时间推移,2组患者的关节活动度评分显著增高,差异有统计学意义(P＜0.05),疼痛评分显著降低,差异有统计学意义(P＜0.05),关节活动度显著改善,差异有统计学意义(P＜0.05),髌韧带硬度显著降低,差异有统计学意义(P＜0.05),同时期比较观察组各项指标均优于对照组,差异有统计学意义(P＜0.05).结论:浮针结合筋骨痛消丸治疗髌骨软化症,能够缓解疼痛,降低髌韧带硬度,改善关节活动度,效果优于双氯芬酸钠配合玻璃酸钠的治疗.

目的:探讨三伏贴贴敷联合臭氧关节腔注射治疗膝骨关节炎阳虚寒凝证的临床疗效.方法:2018年6月至2020年6月,采用三伏贴贴敷联合臭氧关节腔注射治疗膝骨关节炎阳虚寒凝证患者20例.男8例,女12例.年龄40～65岁,中位数59岁.左膝10例,右膝6例,双膝4例.按照Kellgren-Lawrence分级标准,Ⅰ级10膝、Ⅱ级14膝.病程3个月至9年,中位数66个月.分别于治疗前和治疗结束后5周,采用酶联免疫吸附法测定膝关节液中白细胞介素(interleukin,IL)-1β、肿瘤坏死因子(tumor necrosis factor,TNF)-α和基质金属蛋白酶(matrix metalloproteinase,MMP)-13的含量,采用膝部疼痛视觉模拟量表(visual ana-logue scale,VAS)和西安大略和麦克马斯特大学(Western Ontario and McMaster Universities,WOMAC)骨关节炎指数评价临床疗效.结果:所有患者均完成治疗及疗效评价.治疗结束后5周,患者膝关节液中IL-1β、TNF-α、MMP-13的含量及膝部疼痛VAS评分、WOMAC骨关节炎指数均低于治疗前[(8.75±2.83)ng·L-1,(3.72±2.21)ng·L-1,t=6.252,P=0.000;(89.51±11.76)ng·L-1,(41.83±7.85)ng·L-1,t=15.081,P=0.000;(4.06±1.23)ng·L-1,(2.03±0.67)ng·L-1,t=6.482,P=0.000;(5.63±1.21)分,(2.16±1.09)分,t=9.592,P=0.000;(40.28±13.12)分,(17.14±9.87)分,t=6.303,P=0.000].结论:三伏贴贴敷联合臭氧关节腔注射治疗膝骨关节炎阳虚寒凝证,能够抑制炎症反应和软骨基质降解,缓解疼痛,改善膝关节功能.