BACKGROUND:Lumbar disc herniation (LDH), as one of the most common causes of lower back pain, imposes a heavy economic burden on patients and society. Conservative management is the first-line choice for the majority of LDH patients. Traditional Chinese medicine (TCM) is an important part of conservative treatment and has attracted more and more international attention.STUDY DESIGN:Evidence-based guideline.METHODS:We formed a guideline panel of multidisciplinary experts. The clinical questions were identified on the basis of a systematic literature search and a consensus meeting. We searched the literature for direct evidence on the management of LDH and assessed its certainty-generated recommendations using the grading of recommendations, assessment, development, and evaluation (GRADE) approach.RESULTS:The guideline panel made 20 recommendations, which covered the use of Shentong Zhuyu decoction, Shenzhuo decoction, Simiao San decoction, Duhuo Jisheng decoction, Yaobitong capsule, Yaotongning capsule, Osteoking, manual therapy, needle knife, manual acupuncture, electroacupuncture, Chinese exercise techniques (Tai Chi, Baduanjin, or Yijinjing), and integrative medicine, such as combined non-steroidal anti-inflammatory drugs, neural nutrition, and traction. Recommendations were either strong or weak, or in the form of ungraded consensus-based statement.CONCLUSION:This is the first LDH treatment guideline for TCM and integrative medicine with a systematic search, synthesis of evidence, and using the GRADE method to rate the quality of evidence. We hope these recommendations can help support healthcare workers caring for LDH patients.

Objective:To analyze the correlation between postoperative complications and combined deflection angle classification adduction type (CDAC-ADT) of femoral neck fractures after cannulated screw internal fixation. Methods:The clinical data of 121 patients with CDAC-ADT femoral neck fracture admitted between January 2018 and December 2021 and met the selected criteria were retrospectively analyzed. There were 69 males and 52 females, the age ranged from 19 to 79 years (mean, 48.1 years). The causes of injury included 52 cases of traffic accident, 24 cases of falling from height, and 45 cases of fall. The time from injury to operation ranged from 2 to 12 days, with an average of 6.0 days. Among them, there were 18 cases of CDAC-ADT type Ⅰ, 46 cases of type Ⅱ, and 57 cases of type Ⅲ; 6 cases of Garden type Ⅱ, 103 cases of type Ⅲ, and 12 cases of type Ⅳ; and according to the location of the fracture line, there were 26 cases of subcapitate type, 88 cases of transcervical type, and 7 cases of basal type. All patients were treated with cannulated screw internal fixation. The occurrence of complications (including internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head) was recorded, and the correlation between complications and CDAC-ADT typing, Garden typing, and fracture line location were analyzed. Results:The patients were followed up 8-44 months, with a mean of 24.9 months. There were 10 cases of internal fixation failure, 7 cases of fracture nonunion, and 30 cases of osteonecrosis of the femoral head after operation. Correlation analysis showed that patients' CDAC-ADT typing was significantly correlated with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head ( P<0.05), and the Pearson coefficient of contingency were 0.435, 0.251, 0.254, and 0.241, respectively. Garden typing did not correlate with the overall incidence of complication and the incidence of internal fixation failure and fracture nonunion ( P>0.05), but correlated with the incidence of osteonecrosis of the femoral head ( P<0.05), and the Pearson coefficient of contingency was 0.251. Fracture line position typing had no correlation with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head ( P>0.05). Conclusion:CDAC-ADT typing has obvious correlation with postoperative complications of femoral neck fracture and can be used to predict complications of femoral neck fracture.

淫羊藿苷是传统中草药淫羊藿的重要活性成分,具有促进成骨细胞增殖并提高其活性、抑制破骨细胞的分化形成与骨吸收、诱导骨髓间充质干细胞(bone marrow mysenchymal stem cells,BMSCs)的成骨分化以及保护股骨头部位血管的作用.同时,淫羊藿苷可与各类复合材料支架相结合,在动物实验中取得了令人满意的效果,这种结合可能是未来淫羊藿苷应用于股骨头坏死与骨缺损手术治疗的重点.临床研究亦发现含有淫羊藿苷成分的方剂也对股骨头坏死具有明显的防治作用.但目前对于淫羊藿苷的研究以基础实验为主,且对其复杂机制层面的研究相对薄弱;缺乏淫羊藿苷结合复合材料应用于人体的相关报道以及单独使用淫羊藿苷治疗股骨头坏死的临床报道,应进一步关注淫羊藿苷的临床应用及其对于人体的影响,为股骨头坏死的治疗提供新思路;此外,淫羊藿苷治疗股骨头坏死的最适药物浓度有待商榷,考虑到动物模型的局限性,应开展更多种类的哺乳类动物实验或通过临床试验数据加以证实,找到淫羊藿苷在人体内的最适浓度.

Objective To verify the clinical efficacy of Zhang’s Xibi formula (ZSXBF) and explain the mechanism underlying its therapeutic effect. Methods Preliminary elucidation of the clinical efficacy of ZSXBF in treating KOA in self-control studies, exploration of its mechanism of action with network pharmacology methods, and validation in animal experiments. Results In clinical studies, ZSXBF administration effectively improved patient quality of life and reduce pain. Network pharmacology was used to explore the possible mechanisms underlying its treatment effect, and after verification in clinical experience and animal experiments, it was found that ZSXBF regulated the expression of immune-related proteins such as IL-17, ERK1, and TP53 in mouse knee joints. Conclusion ZSXBF, which is a traditional Chinese medicine compound that is used to clear heat and detoxify, can effectively improve the clinical symptoms of KOA patients, and its underlying mechanism includes the regulation of human immune-related proteins.

Background: We aimed to explore the molecular mechanisms underlying the effect of Gugutouhuaisiyu Capsule (GGTHSYC) on traumatic osteonecrosis of the femoral head (ONFH) using rabbit models.Methods: New Zealand rabbits (n = 24) were randomly placed into the control, model, and 30 and 60 mg/kg GGTHSYC treatment groups. Animals in the model and GGTHSYC treatment groups were subjected to surgically induced ONFH. Rabbits in the 30 and 60 mg/kg GGTHSYC treatment groups were administered GGTHSYC via the gastrointestinal route. MRI (magnetic resonance imaging) was employed to assess osteonecrosis. The mRNA and protein expression levels of BMP-2 (bone morphogenetic protein 2), RUNX2 (runt related transcription factor 2), VEGF (vascular endothelial growth factor), HIF-1a (hypoxic-induced factor-1a), and OPG (osteoprotegerin) in femoral head tissues were measured using reverse transcription-quantitative polymerase chain reaction and western blotting and immunochemistry, respectively.Results: GGTHSYC significantly enhanced osteocalcin activities in rabbits with traumatic ONFH by increasing ALP (alkaline phosphatase) expression (p = 0.008). Administration of GGTHSYC also significantly increased the mRNA and protein levels of HIF-1, VEGF, RUNX2, BMP-2, OPG, and BSP (bone sialoprotein) (p < 0.05).Conclusions: Administration of GGTHSYC improved bone regeneration following traumatic ONFH, which was accompanied by increased expression of the transcription factors HIF-1a and RUNX2 as well as other related proteins, suggesting that the transcription factors HIF-1a and RUNX2 may be a potential target for the treatment of traumatic ONFH.

目的:比较分析富血小板血浆联合股骨头坏死愈胶囊治疗不同面积股骨头坏死的疗效.方法:回顾性分析2018年8月至2020年6月接受富血小板血浆联合股骨头坏死愈胶囊治疗的80例(109髋)ARCO Ⅱ期非创伤性股骨头坏死患者的病例资料,运用股骨头坏死面积统计软件评估所有患髋治疗前的坏死面积比例,并将其分为两组,坏死面积比例≤30％组39例(54髋),坏死面积比例＞30％组41例(55髋);比较两组患者治疗后6个月及末次随访时的临床疗效与影像资料.结果:两组患者随访时间均为18个月以上,平均为(25.48±8.48)个月.治疗后6个月时,坏死面积比例≤30％组在疼痛视觉模拟量表(VAS)评分、Harris评分及髋伸屈范围等方面显著优于坏死面积比例＞30％组,差异有统计学意义(P＜0.05);末次随访时,坏死面积比例≤30％组VAS评分、Harris评分以及髋伸范围、内外旋范围、内收外展范围均显著优于坏死面积比例＞30％组,差异有统计学意义(P＜0.05).末次随访时两组的影像评级、骨髓水肿分级差异均有统计学意义(P＜0.05);随访过程中所有病例均未出现严重不良反应.结论:富血小板血浆联合股骨头坏死愈胶囊可明显改善ARCO Ⅱ期股骨头坏死的症状,改善其髋关节功能,对小面积坏死者(坏死面积比例≤30％)效果更优.

目的:探究股骨头坏死硬化带分型与骨髓水肿分级及髋关节疼痛程度的相关性.方法:回顾性分析2016年3月至2021年4月确诊为股骨头坏死的病例资料,共126例195 髋.运用硬化带分型方法将坏死股骨头分为三种类型,即稳定型、中度不稳定型及重度不稳定型,分析不同分型与髋关节疼痛程度及骨髓水肿分级之间的关系.结果:通过R×C列联表卡方检验,结果表明不同股骨头坏死患者各髋关节疼痛程度与骨髓水肿分级有相关性;通过多个独立样本的非参数检验,表明各疼痛程度下骨髓水肿分级的平均秩次呈递增趋势,说明疼痛程度越高,骨髓水肿越严重;不同股骨头坏死患者各硬化带分型与骨髓水肿分级、疼痛程度的差异均有相关性,通过多个独立样本的非参数检验,表明各硬化带分型下骨髓水肿分级及髋关节疼痛程度的平均秩次呈递增趋势,说明硬化带分型分级越高,骨髓水肿分级越高,髋关节疼痛越严重.结论:股骨头坏死硬化带分型与髋关节疼痛程度和骨髓水肿分级之间有相关性,硬化带分型分级越高,骨髓水肿分级越高,髋关节疼痛越严重.

目的:观察腰腹联合手法对退行性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)患者腰椎功能、多裂肌肌肉形态及腹壁紧张度的影响.方法:选取120例DLS患者,按照随机数字表法分为对照组、观察A组和观察B组,每组各40例.对照组给予常规中药熏洗,观察A组给予中药熏洗+常规推拿,观察B组给予中药熏洗+腰腹联合手法,3组均治疗两周.比较治疗前后3组患者Oswestry功能障碍指数(Oswestry disability index,ODI)评分、多裂肌肌肉形态指标[前后径(antero-posterior,A-P)、横径(lateral diameter,Lat)、横截面积(cross sectional area,CSA)]及腹壁紧张度,并观察3组患者临床疗效.结果:(1)对照组有效率为65.00％,观察A组有效率为77.50％,观察B组有效率为95.00％,观察B组有效率显著高于其余两组,差异有统计学意义(P<0.05).(2)治疗后,观察A组ODI评分为(36.68±7.19)分,观察B组ODI评分为(29.35±6.05)分;随访1个月时,观察A组ODI评分为(19.49±3.97)分,观察B组ODI评分为(14.26±2.85)分;与对照组比较,治疗后和随访1个月观察A组、B组ODI评分均显著降低;随访1个月时,3组以上指标均低于同组治疗后,且观察B组以上指标低于观察A组(P<0.05).(3)治疗后,观察A组多裂肌A-P为(2.81±0.56)cm、Lat为(3.12±0.62)cm、CSA为(7.08±1.41)cm,观察B组多裂肌A-P为(2.94±0.58)cm、Lat为(3.31±0.65)cm、CSA为(7.28±1.45)cm;随访1个月时,观察A组多裂肌A-P为(3.01±0.60)cm、Lat为(3.35±0.67)cm、CSA为(7.42±1.48)cm,观察B组多裂肌A-P为(3.15±0.62)cm、Lat为(3.58±0.71)cm、CSA为(7.65±1.51)cm;治疗后和随访1个月,观察A组、B组多裂肌A-P、Lat、CSA水平均明显升高,且随访1个月时上述指标均高于治疗后,观察B组以上指标均高于同期观察A组(P<0.05).(4)治疗后,观察A组腹壁紧张度2°～3°占比为16％,观察B组腹壁紧张度2°～3°占比为7％;随访1个月,观察A组腹壁紧张度2°～3°占比为8％,观察B组腹壁紧张度2°～3°占比为2％;治疗两周和随访1个月,观察A组、B组腹壁紧张度2°～3°占比均明显下降,且随访1个月3组上述指标均低于本组治疗后,观察B组低于同期观察A组(P<0.05).结论:腰腹联合手法可改善DLS患者腰椎功能、缓解多裂肌萎缩、降低腹壁紧张度,临床疗效确切.

Human bone marrow mesenchymal stem cells (hBMMSCs) are a promising cell source for bone engineering owing to their high potential to differentiate into osteoblasts. The objective of the present study is to assess microRNA-126 (miR-126) and examine its effects on the osteogenic differentiation of hBMMSCs. In this study, we investigate the role of miR-126 in the progression of osteogenic differentiation (OD) as well as the apoptosis and inflammation of hBMMSCs during OD induction. OD is induced in hBMMSCs, and matrix mineralization along with other OD-associated markers are evaluated by Alizarin Red S (AR) staining and quantitative PCR (qPCR). Gain- and loss-of-function studies are performed to demonstrate the role of miR-126 in the OD of hBMMSCs. Flow cytometry and qPCR-based cytokine expression studies are performed to investigate the effect of miR-126 on the apoptosis and inflammation of hBMMSCs. The results indicate that miR-126 expression is downregulated during the OD of hBMMSCs. Gain- and loss-of function assays reveal that miR-126 upregulation inhibits the differentiation of hBMMSCs into osteoblasts, whereas the downregulation of miR-126 promotes hBMMSC differentiation, as assessed by the determination of osteogenic genes and alkaline phosphatase activity. Furthermore, the miR-126 level is positively correlated with the production of inflammatory cytokines and apoptotic cell death. Additionally, our results suggest that miR-126 negatively regulates not only B-cell lymphoma 2 (Bcl-2) expression but also the phosphorylation of extracellular signal‑regulated protein kinase (ERK) 1/2. Moreover, restoring ERK1/2 activity and upregulating Bcl-2 expression counteract the miR-126-mediated suppression of OD in hBMMSCs by promoting inflammation and apoptosis, respectively. Overall, our findings suggest a novel molecular mechanism relevant to the differentiation of hBMMSCs into osteoblasts, which can potentially facilitate bone formation by counteracting miR-126-mediated suppression of ERK1/2 activity and Bcl-2 expression.

目的:评价针刀疗法治疗膝骨关节炎(knee osteoarthritis,KOA)的临床疗效.方法:应用计算机检索万方医学数据库、中国知网、维普资讯、PubMed及The Cochrane Library数据库,检索其中关于针刀疗法治疗KOA的随机对照临床试验文献,检索时间范围均为建库至2020年12月31日.中文检索词包括"针刀""小针刀""膝骨关节炎""膝骨性关节炎""膝关节骨性关节炎";英文检索词包括"small needle knife""needle knife""knee osteoarthritis".针刀组的主要干预措施为普通针刀治疗,针刺组的主要干预措施为普通针刺治疗,两组均可联合应用其他相同的非手术疗法.按照事先确定的文献纳入和排除标准筛选文献,提取入选文献中的相关数据.以Cochrane偏倚风险评估工具对纳入的各项研究进行质量评价后,采用Review Manager 5.4.1软件进行Meta分析和发表偏倚分析.结果:①文献检索及质量评价:共纳入20篇随机对照临床试验文献,均为中文文献,共涉及2 068例患者,其中针刀组1 035例、针刺组1 033例;Cochrane偏倚风险评估工具的评价结果显示,纳入文献的方法学质量普遍较低.②Meta分析:针刀组的治疗有效率高于针刺组[x2=11.920,P=0.610,I2=0％,RR=1.16,95％CI(1.11,1.22),P=0.000];进一步亚组分析显示,采用《中医病证诊断疗效标准》评价治疗有效率的7篇文献和采用《中药新药临床研究指导原则》评价治疗有效率的8篇文献,针刀组的治疗有效率也均高于针刺组[《中医病证诊断疗效标准》:x2=6.440,P=0.380,I2=7％,RR=1.17,95％CI(1.08,1.26),P=0.000;《中药新药临床研究指导原则》:x2=5.420,P=0.610,12=0％,RR=1.16,95％CI(1.09,1.23),P=0.000].针刀组治疗后的膝关节疼痛视觉模拟量表评分低于针刺组[x2=94.340,P=0.000,I2=89％,MD=-1.24,95％CI(-1.58,-0.90),P=0.000].针刀组治疗后的西安大略和麦克马斯特大学骨关节炎指数低于针刺组[x2=42.690,P=0.000,12=88％,MD=-9.06,95％CI(-13.34,-4.78),P=0.000].③发表偏倚分析:基于治疗有效率的漏斗图显示,纳入的各项研究分布不完全对称,不排除存在发表偏倚的可能.结论:针刀疗法是治疗KOA的有效方法,其疗效优于针刺疗法.

Osteonecrosis of the femoral head (ONFH) is a refractory disease, which often leads to collapse of the femoral head.1,2 Each year, approximately 22,000 new cases occur in the USA and 75,000 to 150,000 in China.3 There is no consensus on the pathogenesis of ONFH, despite many studies on the topic. Increasing evidence points to inflammatory osteoimmunology playing an indispensable role in the pathogenesis of ONFH.48

Objective:To discuss the displacement characteristics of Garden type III femoral neck fracture and investigate the reliability, validity and clinical value of the frontal Garden index in assessing the displacement degree of Garden type III femoral neck fracture.Methods:The pelvis X-ray films of 98 patients with Garden type III femoral neck fracture treated at Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital) from October 2010 to October 2018 were collected, including 47 males and 51 females; aged 19-89 years [(64.9±16.2) years]. Three-dimensional data of the hip with 64-slice CT were available in 21 patients. Each patient′s frontal Garden index was measured three times by three senior doctors, which was repeated twice in turn. The distribution characteristics of the frontal Garden index were statistically described. The reliability of the frontal Garden index was tested by Spearman correlation coefficient and Kappa coefficient, including test-retest reliability and intra-rater consistency. The contact area of fracture ends and upper-shift distance of the femoral neck were calculated based on three-dimensional CT data of the hip in 21 patients. Correlation analysis of the contact area of fracture ends and upper-shift distance of the femoral neck with the frontal Garden index was performed by multiple correlation analysis to assess the validity of the frontal Garden index.Results:The Frontal Garden index of 98 patients with Garden type III femoral neck fracture was (136±15) °, with the minimum value of 90 ° and maximum value of 159 °, and was found to be normally distributed ( P>0.05). Spearman correlation coefficient of the test-retest reliability was 0.93, 0.97 and 0.95, respectively (all P<0.01). Kappa coefficient of the intra-rater consistency was 0.87, 0.91 and 0.86, respectively (all P<0.01). The frontal Garden index was positively correlated with the contact area of fracture ends ( r=0.80, P<0.01), and was negatively with the upper-shift distance of the femoral neck ( r=-0.77, P<0.01). Conclusions:The displacement degree of Garden type III femoral neck fracture shows diversity and normal distribution. The frontal Garden index can credibly and effectively measure the displacement degree of Garden type III femoral neck fracture, which may help to choose the treatment plan.

Our study showed that Signal transducer and activator of transcription (STAT)1 and STAT3 phosphorylation was firstly upregulated in the early stage of osteogenic differentiation (OD), and quickly eliminated in hours. Following with phosphorylation of STAT1/3, its downstream feedback regulator Suppressor of cytokine signaling 1 (SOCS1) protein also underwent a quick elevation. Further activation and deactivation of STAT1/3, by administrated with Colivelin and Nifuroxazide in Bone mesenchymal stem cells (BMSCs), increased and decreased SOCS1 expression, inhibited and promoted OD of BMSCs, respectively, as evidenced by Alizarin staining, alkaline phosphatase (ALP) activity, and determination of Run-related transcription factor 2 (RUNX2), Osteocalcin (OCN), ALP, and Bone sialoprotein (BSP). In addition, administration of Colivelin and Nifuroxazide caused and blocked inflammation and apoptosis of BMSCs. To further elucidate the role of STAT1/3-SOCS1 regulatory loop on OD of BMSCs, we overexpressed or silenced SOCS1 in BMSCs during OD. WB data showed that overexpression of SOCS1 repressed STAT1/3 phosphorylation, and knockdown of SOCS1 increased the phosphorylated STAT1/3. Further mechanism study showed that OD of BMSCs was elevated or reduced by SOCS1 overexpression or knockdown, respectively. The findings presenting indicated that the STAT1/3-SOCS1 axis may be exploited as an innovative strategy to enhance osteogenesis in regenerative medicine.

目的 筛选7-羟基黄烷酮抑制大鼠生长板软骨细胞凋亡的最适药物浓度并观察其对大鼠骨骺闭合和胫骨生长的影响.方法 解剖大鼠胫骨生长板软骨,体外分离生长板软骨细胞并进行鉴定.然后采用IL-1β诱发软骨细胞凋亡,分别加入含有10、20、40、60 μM的7-羟基黄烷酮培养液进行培养,采用MTT法初步观察各浓度抑制软骨细胞凋亡效果,筛选出最佳药物浓度.随后采用流式细胞仪对筛选出的最佳浓度进行验证.此外给予大鼠100 mg/kg 7-羟基黄烷酮灌胃,观察其对骨骺闭合及胫骨生长的影响.结果 软骨细胞免疫荧光鉴定结果显示,分离培养的细胞符合软骨细胞的生物学特征.MTT法实验结果显示,10、20、40、60μM7-羟基黄烷酮均可以不同程度地抑制生长板软骨细胞凋亡,其中抑制软骨细胞凋亡的最佳药物浓度为40 μM,通过流式细胞仪进一步验证显示40 μM 7-羟基黄烷酮抑制细胞凋亡作用明显,且效果优于阳性对照组.此外,100 mg/kg 7-羟基黄烷酮灌胃结果显示其能够延缓骨骺闭合并促进大鼠胫骨生长.结论 本次研究结果显示,7-羟基黄烷酮能够抑制大鼠生长板软骨细胞凋亡,最适药物浓度为40 μM.此外,体外实验证实给予大鼠灌胃7-羟基黄烷酮的确能够延缓骨骺愈合,促进胫骨生长.

本文利用Cite Space可视化软件,对CNKI收录的2000～2020年343篇关于医院档案和医院文化研究文献,从时间和内容两个维度进行统计分析,对该研究领域的发文机构、关键词时间线和关键词聚类等进行可视化图谱分析,从宏观上把握其研究现状和研究热点,以期为该领域的深入研究提供参考.

目的 分析近20年中医药治疗股骨头坏死研究文献,探索该领域研究热点和趋势.方法 计算机检索中国知识资源总库(CNKI)2001年1月1日-2020年12月31日收录的中医药治疗股骨头坏死研究文献.采用Excel2019分析发文量、高被引文献、来源期刊、常用中药复方,采用CiteSpace5.8绘制作者、研究机构、关键词共现网络图谱,绘制关键词聚类时间线并进行突现分析.结果 纳入文献578篇,近20年发文整体呈先上升后下降趋势;发文最多的来源期刊是《中国中医骨伤科杂志》;被引频次最高的文献为《健脾活骨方治疗早中期非创伤性股骨头坏死的前瞻性临床研究》;最常用的内服中药为通络生骨胶囊,最常用的外治法为中药外敷.共涉及550位作者,其中核心作者24位,形成了分别以何伟、陈卫衡、曾平、曹玉举和刘又文为代表的研究团队.涉及405个研究机构,发文量>3篇的机构有10个,发文量>6篇的机构有5个,发文最多的是广州中医药大学第一附属医院.图谱纳入156个关键词,其中频次>20的有7个.结论 中医药治疗股骨头坏死研究发展前景良好,尤其是临床疗效研究方面.该领域发文量总体呈现缓慢下降的趋势,近年来研究热点集中在非创伤性股骨头坏死与激素性股骨头坏死方面,研究趋势由临床观察转变为实验研究,研究干预手段逐渐从中西医结合转变为中医药治疗.建议加强研究团队、机构间合作,开展高质量临床研究及规范化研究.

目的:研究补肾活血法对糖皮质激素作用下MC3T3-E1细胞自噬的影响及可能机制.方法:将MC3T3-E1细胞分5组进行实验:对照组(A组)、地塞米松组(B组)、地塞米松+200 μg/mL补肾活血药组(C组)、地塞米松+400 μg/mL补肾活血药组(D组)、地塞米松+400 μg/mL补肾活血药+Compound C组(E组).Western Blot检测各组AMPK/mTOR信号通路中p-AMPK、p-mTOR,自噬相关Beclin-1 及LC3Ⅱ/Ⅰ,成骨相关RUNX-2表达水平;细胞免疫荧光观察各组p-AMPK、Beclin-1及LC3表达情况;透射电镜观察各组自噬小体情况;CCK-8检测各组细胞增殖能力.结果:与A组比较,B组细胞自噬水平增强,p-AMPK、Beclin-1、LC3Ⅱ/Ⅰ表达显著升高(P＜0.05),p-mTOR、RUNX-2表达显著降低(P＜0.05),细胞增殖受到抑制(P＜0.05).与B组比较,D组细胞自噬水平进一步增强,p-AMPK、Beclin-1、LC3Ⅱ/Ⅰ、RUNX-2进一步升高(P＜0.05),p-mTOR进一步降低(P＜0.05),24、36 h时细胞增殖能力显著增强(P＜0.05),而AMPK抑制剂Compound C可以明显减少补肾活血药对自噬的激活.结论:补肾活血法可通过激活AMPK/mTOR信号通路提高MC3T3-E1细胞自噬水平,从而缓解糖皮质激素对MC3T3-E1细胞增殖及成骨活性的抑制作用.

Objective: A number of miRNAs and their targets were dragged in the differentiation of bone marrow mesenchymal stem cells (BMSCs). We aimed to elaborate the underlying molecular mechanisms of miRNA-320a in the osteoblast and adipocyte differentiation. Methods: Trauma-induced osteonecrosis of the femoral head (TIONFH) and normal control samples (n 1/4 10 for each group) were collected, followed by miRNA chip analysis to identify the differentially expressed miRNAs. H&E staining was used to observe the pathological development of TIONFH. Lentiviral vector was used for overexpression and inhibition of miRNA-320a in vitro. Quantitative real-time PCR (qPCR), Western blotting and immunohistochemistry staining were employed to determine the expression of interested genes at mRNA or protein level. Luciferase report assay was employed to determine the binding of miRNA-320a and RUNX2. Alkaline phosphatase (ALP) and Alizarin red staining were performed to observe the osteogenesis and Oil red O staining were conducted to visualize the adipogenesis. Results: Expression of miRNA-320a was up-regulated while RUNX2 expression was down-regulated in TIONFH than Normal control. Luciferase report assay confirmed that miRNA-320a directly targeted to the 30UTR of RUNX2. miRNA-320a overexpression significantly declined the expressions of osteogenesisrelated markers: RUNX2, OSTERIX, Collagen I, Osteocalcin and Osteopontin. ALP and Alizarin red staining confirmed the inhibition function of miRNA-320a in osteogenesis of BMSCs. miRNA-320a inhibition significantly decreased the expression of adipogenesis-related markers: AP2, C/EBPa, FABP4 and PPARg. Oil Red O staining confirmed the miRNA-320a inhibition reduced adipogenesis of BMSCs. Conclusions: miRNA-320a inhibits osteoblast differentiation via targeting RUNX2 and promotes adipocyte differentiation of BMSCs. (c) 2022, The Japanese Society for Regenerative Medicine. Production and hosting by Elsevier B.V.

目的 观察养血止痛汤联合腕踝针对腰椎间盘突出症开放减压术后残余疼痛的治疗效果.方法 64例患者按随机数字表法分为对照组与治疗组各32例,两组患者术后均常规抗感染、脱水、营养神经、预防下肢静脉血栓形成及功能锻炼等治疗.对照组在常规治疗基础上予以塞来昔布胶囊口服,治疗组在常规治疗基础上予以养血止痛汤、腕踝针治疗,疗程均为10d.比较两组治疗前后VAS评分、JOA评分、临床疗效及不良反应.结果 两组治疗前VAS评分比较差异无统计学意义(P＞0.05).治疗组治疗1、3、10d后VAS评分均低于本组治疗前(均P＜0.05),对照组治疗3、10d后VAS评分均低于本组治疗前(均P＜0.05),而对照组治疗1d后与本组治疗前VAS评分比较差异无统计学意义(P＞0.05).治疗组治疗1、3、10d后VAS评分均低于对照组同期(均P＜0.05).两组治疗前JOA评分比较差异无统计学意义(P＞0.05).两组治疗后JOA评分均高于本组治疗前(均P＜0.05),且治疗组治疗后JOA评分高于对照组(P＜0.05).治疗组有效率为93.75％高于对照组的75.00％(P＜0.05).对照组有2例患者出现腹痛、腹泻等不适,治疗组患者无明显不良反应.结论 养血止痛汤联合腕踝针可快速、有效缓解腰椎间盘突出症患者开放减压术后残余疼痛,有助于术后功能恢复,提高手术治疗效果及患者满意度.