Steroid-induced osteonecrosis of the femoral head (SONFH) causes severe pain and limited mobility, significantly impairing patients' quality of life. Cinnamomi Cortex (CC) has been shown to effectively alleviate this condition, yet its mechanism of action remains unclear. This study aims to identify the active compounds of CC and explore their mechanisms in SONFH. Active constituents were screened using the HERB 2.0, PubChem, and SwissADME databases, and their corresponding targets were predicted using the Swiss Target Prediction database. Targets for SONFH were identified by intersecting targets from GEO, DisGeNET, GeneCards, and OMIM databases with the compound-related targets. A protein-protein interaction (PPI) network was constructed using the STRING database, and GO and KEGG enrichment analyses were conducted via the DAVID database. The most promising compound-target interactions were validated through molecular docking (MD) and molecular dynamics simulations. The researchers identified 563 potential targets, including 61 SONFH-related targets, with AKT1, HIF-1α, and STAT3 serving as central nodes. KEGG enrichment analysis highlighted the HIF-1α signaling pathway as a key mechanism. Furthermore, animal experiments demonstrated that the active fraction of CC effectively mitigated femoral head structural damage in a mouse model with SONFH. The findings suggest that CC may improve SONFH by coordinating hypoxia adaptation and regulating angiogenesis and osteogenesis.

OBJECTIVES:Osteoporosis (OP) is a prevalent bone disease characterized by reduced bone mass and increased fracture risk, in part due to impaired osteogenic differentiation of bone marrow-derived mesenchymal stromal cells (BMSCs). Loss of AT-rich interactive domain-containing protein 2 (ARID2) attenuates BMSC osteogenesis, but the underlying mechanism remains to be elucidated. METHODS:Human BMSCs were induced to undergo osteogenic or adipogenic differentiation. Lentiviral transduction was used to silence ARID2 and/or overexpress serine/threonine kinase 39 (STK39). Effects on BMSC fate were assessed by quantitative reverse-transcription PCR (qRT-PCR), MTT assay, alkaline phosphatase (ALP) staining, Alizarin Red S (ARS) staining, Oil Red O staining, and western blotting. RESULTS:ARID2 expression increased over time during osteogenic induction. ARID2 silencing reduced BMSC proliferation and osteogenic differentiation while favoring adipogenesis. Conversely, STK39 overexpression enhanced proliferation and osteogenic differentiation and attenuated nuclear factor κB (NF-κB) signaling during osteogenic induction; these effects were reversed by ARID2 silencing. CONCLUSION:The STK39-ARID2 axis promotes osteogenic differentiation and suppresses adipogenic differentiation of BMSCs, at least in part via inhibition of NF-κB signaling. These findings highlight a potential molecular target for therapeutic strategies in OP.

Interoception is a core process through which the body perceives its internal state and regulates physiological homeostasis via bidirectional communication between the central and peripheral nervous system. Skeletal interoception is a specific circuitry for the brain control of the weight-bearing system, particularly responsible for sensing bone-derived internal signals to maintain skeletal homeostasis in response to mechanical loading. Recent studies uncovered that prostaglandin E2 (PGE2) plays a crucial role in skeletal interoception, and is therefore involved in major skeletal disorders and pain conditions such as low back pain, osteoarthritis and particularly ankle osteoarthritis (AOA). Ankle pain is clinically common, with a prevalence of 9%-15% among adults, severely impairing work productivity and quality of life. This article reviews the progress of skeletal interoception in skeletal pathogenesis and pain, with AOA as an example. Specifically, it discusses PGE2 and skeletal interoception in relation to pain and inflammation. We also attempted to interpret non-steroidal anti-inflammatory drugs (NSAIDs), surgical interventions and Traditional Chinese Medicine (TCM) therapies, especially acupuncture and electroacupuncture, in the therapy of pain and osteoarthritis from the viewpoint of skeletal interoception. Interoception is an emerging science in understanding how the brain regulates peripheral organs. Skeletal interoception mediated by PGE2 provides an opportunity to understand the potential of NSAIDs and acupuncture in regulating interoception for the treatment of skeletal disorders including ankle pain.

Osteoporosis (OP) is a metabolic bone disorder characterized by a progressive decrease in bone mass. Yigu Decoction polysaccharides (YGDP) is a traditional Chinese herbal formula, preliminary clinical and basic research has demonstrated its therapeutic advantages in treating osteoporosis (OP). However, the specific mechanism by which it mediates bone formation through the gut microbiota (GM) and metabolites remains incompletely understood. The aim of this study is to elucidate the mode of action of YGDP in OP treatment through an integrated approach involving multi-omics analysis and in/ex-vivo experiments. Our findings suggest that YGDP may treat OP by improving GM and metabolite levels, primarily through its ability to alter the OP mice GM structure restoring to a level comparable to that of controls. Cluster and difference analyses revealed significant changes at the genus level, particularly in Alistipes. Metabolomics identified key metabolic pathways associated with significant differential metabolites, including the citrate cycle (TCA cycle), amino acid biosynthesis, and ABC transporters et al. Furthermore, integrated analysis indicated that Alistipes and metabolite oxaloacetic acid (OAA) might be key mediators of the effect of YGDP on OP. Molecular docking confirmed the strong binding capacity of OAA to Osteocalcin (OCN)/ Osterix (OSX)/ Runt-related transcription factor 2 (RUNX2)/ Alkaline Phosphatase (ALP)/ Collagen Type I (COL1). Experimental evidence has shown that YGDP and OAA enhance bone microarchitecture in OP mice and upregulate the expression of OCN/OSX/RUNX2/ALP/COL1, thereby improving OP. In conclusion, this study provided evidence that YGDP improves osteoporosis by enhancing bone microarchitecture in osteoporotic mice through improving GM and mediating metabolite OAA, while upregulating the expression of OCN/OSX/RUNX2/ALP/COL1.

Background Yigu decoction (YGD) is a traditional Chinese medicine prescription for the treatment of osteoporosis, although many clinical studies have confirmed its anti-OP effect, but the specific mechanism is still not completely clear.Methods In this study, through the methods of network pharmacology and molecular docking, the material basis and action target of YGD in preventing and treating OP were analyzed, and the potential target and mechanism of YGD in preventing and treating OP were clarified by TMT quantitative protein and experiment.Results Network pharmacology and molecular docking revealed that the active components of YGD were mainly stigmasterol and flavonoids. Molecular docking mainly studied the strong binding ability of stigmasterol to the target. Animal proteomics verified the related mechanism of YGD in preventing and treating OP. Based on the KEGG enrichment of network pharmacology and histology, our animal experiments in vivo verified that YGD may play a role in the treatment of OP by mediating hif1- α/vegf/glut1 signal pathway.Conclusions YGD prevention and treatment of OP may be achieved by interfering with multiple targets. This study confirmed that it may promote osteoblast proliferation and protect osteoblast function by up-regulating the expression of proteins related to HIF signal pathway.

BackgroundPostmenopausal osteoporosis (PMOP) is a serious condition that affects elderly individuals. Our previous study revealed that Yigu decoction (YGD) effectively improved bone mineral density (BMD) in elderly individuals, but the mechanism underlying this effect remains unclear. In this study, we investigated the relationships among YGD, microRNAs (miRNAs), and bone metabolism by assessing the effects of YGD on the miRNA levels in patient plasma to provide a scientific basis for treating PMOP with YGD.MethodsIn this clinical trial, 60 patients were randomly assigned to the YGD group or the control group (ratio of 1:1) and treated for 3 months. The primary outcome measure was BMD, and the secondary outcome measures included plasma miRNA levels, visual analogue scale (VAS) scores, alkaline phosphatase (ALP) levels, anti-tartrate acid phosphatase (TRACP-5b) levels and traditional Chinese medicine (TCM) syndrome scores. We assessed the regulatory roles of miRNAs in PMOP patients by analysing publicly available data from the Gene Expression Omnibus (GEO) database. Bioinformatics methods were also used to explore the mechanism by which YGD regulates miRNAs that are involved in bone metabolism.ResultsCompared with those before treatment, the BMD, ALP levels, TRACP-5b levels, TCM syndrome scores and VAS scores improved in both groups after 3 months of treatment (P < 0.05). A total of 82 miRNAs differed between the groups. After analysing data from the GEO database, we confirmed that miR-133a-3p is the key molecule that mediates the effects of YGD intervention on PMOP. GO analysis of key genes suggested that gene enrichment was more pronounced in response to hormones, cellular response to growth factor stimulation, and positive regulation of physiological and metabolic processes. KEGG analysis revealed that these genes were enriched mainly in the PI3K-Akt, FOXO, and JAK-STAT pathways and other pathways. The results of the protein‒protein interaction (PPI) network analysis revealed that epidermal growth factor receptor (EGFR), Insulin-like growth factor 1 (IGF-1), Caveolin-1 (Cav-1) and others were core proteins.ConclusionThis study demonstrated that YGD is beneficial in the treatment of PMOP, ameliorating clinical symptoms and bone turnover indices. Moreover, the inhibition of miR-133a-3p expression may be the key mechanisms by which YGD regulates bone metabolism in the treatment of PMOP, although YGD regulates bone metabolism in a multitarget and multipathway manner.

姚新苗认为痛风的病因为肝肾受损、筋脉不利.病机为肝肾精血亏虚,筋脉失于濡养,不荣则痛.病位在半表半里之间,病性为本虚标实.在具体的临证过程中,姚师首辨虚实缓急,次辨寒热表里,根据患者所苦,对症用药,重视肝肾同治,同时也注重全身调护,防止正虚邪恋,病情反复,迁延难愈.

Objective:This study aimed to explore the research trends of percutaneous endoscopic lumbar discectomy in treating lumbar disc herniation using bibliometrics over the past ten years.Methods:Relevant publications on the clinical application of percutaneous endoscopic lumbar discectomy in lumbar disc herniation were searched in the Web of Science Core Collection. Subsequently, the characteristics of all these articles were collected. Visualizing data of annual publications, journals, cited journals, authors, cited authors, countries, institutions, keywords, and cited references was performed by using CiteSpace (6.1.R6).Results:A total of 642 publications were extracted between 2013 and 2022. The number of publications peaked in the year 2020. The most prolific journal was World Neurosurgery (81), and Spine (597) as the cited journal was the most popular one. China (393) was the most prolific country, followed by South Korea (100). The institution with the most productivity was Tongji University (35). Yue Zhou (20) was the most prolific author, and Sebastian Ruetten (310) was the most cited author. The keyword "interlaminar" was top of research developments with the highest citation burst (8.69). "Lumbar disc herniation", "surgical technique", and "complication" were popular keywords. The surgical procedures and complications of percutaneous endoscopic lumbar discectomy have been the hot topics of recent research.Conclusion:This study summarized the current situation and development trends of percutaneous endoscopic lumbar discectomy clinical research in the form of visualization, and these findings may help researchers explore new directions in the future.

Background:Disordered gut microbiota (GM) structure and function may contribute to osteoporosis (OP). This study explores how traditional Chinese medicine (TCM) intervention affects the structure and function of the GM in patients with OP.Method:In a 3-month clinical study, 43 patients were randomly divided into two groups receiving conventional treatment and combined TCM (Yigu decoction, YGD) treatment. The correlation between the intestinal flora and its metabolites was analyzed using 16S rDNA and untargeted metabolomics and the combination of the two.Results:After three months of treatment, patients in the treatment group had better bone mineral density (BMD) than those in the control group (P < 0.05). Patients in the treatment group had obvious abundance changes in GM microbes, such as Bacteroides, Escherichia-Shigella, Faecalibacterium, Megamonas, Blautia, Klebsiella, Romboutsia, Akkermansia, and Prevotella_9. The functional changes observed in the GM mainly involved changes in metabolic function, genetic information processing and cellular processes. The metabolites for which major changes were observed were capsazepine, Phe-Tyr, dichlorprop, D-pyroglutamic acid and tamsulosin. These metabolites may act through metabolic pathways, the citrate cycle (TCA cycle) and beta alanine metabolism. Combined analysis showed that the main acting metabolites were dichlorprop, capsazepine, D-pyroglutamic acid and tamsulosin.Conclusion:This study showed that TCM influenced the structure and function of the GM in patients with OP, which may be one mechanism by which TCM promotes the rehabilitation of patients with OP through the GM.

浙江省国医名师姚新苗教授,从事中医骨伤、康复学临床和基础研究四十余载,提出了骨质疏松症"因虚致瘀,亏瘀致痿"的致病理论,并创制补肾活血方——益骨汤分级诊疗骨质疏松症,形成了益骨汤联合传统中医功法防治骨质疏松症的方案;提出"骨筋经"理论、以"针药功"三法并用分期分度诊治腰椎间盘突出症与脊柱相关疾病的新策略;强调导引练功治未病,注重"古今相融、中西交融",倡导骨筋经动态平衡观,形成"以筋为主""荣经为先"的学术思想;践行"针药功结合"的中医综合治疗技术,形成"理筋为先,针药并重,结合正骨调曲,练功贯彻始终"的治疗主干线.文章就其学术思想和治疗经验作了介绍,并附相关医案.

目的 评价益骨汤治疗老年性骨质疏松症(senile osteoporosis,SOP)的临床疗效和安全性.方法 采用多中心随机对照的临床设计方案,从2015年1月至2016年12月的住院患者中,选取214例患有SOP的患者,按照治疗方案随机分为治疗组和对照组.对照组105例,其中男性43例,女性62例,年龄(77.1±6.6)岁,运用基础治疗(元素钙600 mg、维生素D 125 U,每日1次,连续服用;福善美70 mg/片,每周1次,连续服用3个月;结合运动疗法).治疗组109例,其中男性52例,女性57例,年龄(76.5±7.1)岁,在对照组的治疗方案基础上再加服益骨汤.两组患者均以3个月为一个疗程,随访期为6个月.治疗后,采用视觉模拟评分法(visual analogue scale,VAS)评分、腰椎骨密度(bone mineral density,BMD)、骨折风险评估(fracture risk assessment,FRAX)、中医证候评分以及骨代谢指标(碱性磷酸酶ALP和血浆抗酒石酸酸性磷酸酶TRAP5b)评定两组临床疗效.结果 214例患者获得随访,治疗后SOP患者VAS评分、BMD、FRAX、中医证候评分和骨代谢指标(ALP、TRAP5b)较治疗前均有明显改善,差异有统计学意义(P<0.05),且经治疗后,治疗组改善程度较对照组明显,VAS评分及中医证候评分比较差异有统计学意义(P<0.01).观察组总有效率82.6％高于对照组68.6％,对比差异具有统计学意义(P<0.05).结论 在常规抗SOP的同时口服中药益骨汤,可以提高BMD,促进骨形成,在缓解SOP患者疼痛程度及综合活动功能方面,优势更加明显,具有较好的临床疗效和安全性.

Background Tennis elbow has long been one of the most controversial subjects in orthopaedics. Many scholars thought the use of open or arthroscopic surgery was reserved for patients with refractory symptoms. Therapy with percutaneous acupotomy performed under local anaesthesia also removes degenerated tissue, releases strain, and therefore provides an alternative treatment option to surgical excision. Methods The aim of this single-blinded randomized control trial was to examine the long-term clinical effectiveness of a nonsurgical percutaneous release technique (acupotomy) and the current recommended treatment (steroid injection) in people diagnosed with a refractory tennis elbow. Ninety patients with refractory symptoms were included. The intervention period was 6 weeks. According to the classification, 38 patients had extra-articular tennis elbow, 36 patients had intraarticular tennis elbow, and 16 patients had mixed type tennis elbow. Forty-five patients were randomly assigned to treatment with percutaneous release by acupotomy according to their classified condition, and 45 patients were randomly assigned to treatment with steroid injection alone. The visual analogue scale (VAS), a tenderness assessment, a grip assessment, and the Nirschl staging system were used for outcome evaluation at pretreatment and the posttreatment timepoints from 12 to 48 weeks. Results During the first weeks, there were no differences observed between the groups. By 6, 24 and 48 weeks, significant differences were observed between the two groups. The acupotomy group scored significantly better in visual analogue scale score (VAS) of pain, tenderness during palpation, pain-free grip strength (PFGS) and Nirschl staging than the corticosteroid group. Conclusions For patients with lateral epicondylitis, acupotomy is just as effective as corticosteroid injections in the short term (< 6 weeks). In the long term, acupotomy has greater efficacy and is associated with a lower rate of recurrence than corticosteroid injections in the management of lateral epicondylitis. Trial registration : The National Health Commission announced the "ethical review measures for biomedical research involving people" in 2019, which was not mandatory in previous studies.

颈源性高血压(CHBP)属于继发性高血压,是一种起病隐匿的功能性疾病,主要表现为颈部活动不利伴随血压异常,多见于椎动脉型、交感神经型颈椎病的患者.该病好发于青壮年,主要是由于现代人的工作性质多以长期伏案、姿势不端导致颈椎结构紊乱,力线发生改变,椎间盘突出压迫周围神经、血管使得局部血流不畅从而引起该病的发生.由于血压的不稳定,所以极容易被误诊为高血压[1].中医药综合疗法在治疗CHBP的过程中,以"见效快、痛苦少、副作用小、不易复发"的特点展现出独特的优势,本研究通过随机对照试验对比针刀联合天麻钩藤饮治疗CHBP的效果,现将结果报道如下.

Abstract Background Tennis elbow has long been one of the most controversial subjects in orthopaedics. Many scholars thought the use of open or arthroscopic surgery was reserved for patients with refractory symptoms. Therapy with percutaneous acupotomy performed under local anaesthesia also removes degenerated tissue, releases strain, and therefore provides an alternative treatment option to surgical excision. Purpose The aim of this single-blinded randomized control trial was to examine the long-term clinical effectiveness of a nonsurgical percutaneous release technique (acupotomy) and the current standard of care (steroid injection) in people diagnosed with a refractory tennis elbow. Methods Ninety patients with refractory symptoms were included. The intervention period was 6 weeks. According to the classification, 38 patients had extra-articular tennis elbow, 36 patients had intraarticular tennis elbow, and 16 patients had mixed type tennis elbow. Forty-five patients were randomly assigned to treatment with percutaneous release by acupotomy according to their classified condition, and 45 patients were randomly assigned to treatment with steroid injection alone. The visual analogue scale (VAS), a tenderness assessment, a grip assessment, and the Nirschl staging system were used for outcome evaluation at pretreatment and the posttreatment timepoints at 1, 6, 12, 24 and 48 weeks. Results During the first weeks, there were no differences observed between the groups. By 6, 24 and 48 weeks, significant differences were observed between the two groups. The acupotomy group scored significantly better in nearly all outcome measures than the corticosteroid group. Conclusions For patients with lateral epicondylitis, acupotomy is just as effective as corticosteroid injections in the short term (< 6 weeks). In the long term, acupotomy has greater efficacy and is associated with a lower rate of recurrence than corticosteroid injections in the management of lateral epicondylitis.

目的 探讨中西医结合多模式止痛方案改善肩关节镜术后肿胀、疼痛的有效性.方法 回顾性分析2016年7月～2019年6月浙江中医药大学附属第三医院收治的肩关节镜术后中重度疼痛病例66例,根据中医中药治疗情况分为观察组和对照组各33例.观察组是采用中西医结合多模式止痛方案治疗,对照组采用常规方法治疗.记录患者年龄、性别、体质量指数及手术侧别等资料,观察记录肩关节镜术后关节功能评分情况、测量术前及术后第1、2、14天疼痛视觉模拟评分(VAS)、肢体肿胀增量值及并发症情况,评价分析中西医结合多模式止痛方案改善肩关节镜术后肿胀、疼痛的疗效.结果 观察组治疗优良率为87.88％(29/33),高于对照组的66.67％(22/33),差异有统计学意义(P<0.05);对照组患者术后第1、2、14天VAS疼痛评分数与肿胀增量值均明显高于观察组,差异有统计学意义(P<0.05);两组患者术后并发症发生率比较,差异无统计学意义(P>0.05).结论 关节镜手术疗效确切,虽然属于微创操作,但术后疼痛仍然比较常见,中医药内治法及外治法能在一定程度上辅助改善关节镜术后疼痛,减轻肿胀,具有一定应用前景,值得进一步研究.

目的 对比不同手术方式治疗腰椎间盘突出症(LDH)的临床效果.方法 选取2017年3月至2021年5月本院收治的腰椎间盘突出患者64例为研究对象,研究人员根据数字表法将患者分为两组,对照组32例,行小切口椎板间开窗髓核摘除术(SIIF)治疗,观察组32例,行经皮椎间孔镜腰椎间盘摘除术(PTED)治疗.结果 研究组患者的手术时间、术中出血量、术后卧床时间、住院时间均明显少于对照组(P<0.05);术后半年,研究组患者并发症发生率明显低于对照组(P<0.05);术前及术后半年,研究组患者的ODI评分与对照组无明显差异(P>0.05);两组患者术后半年的ODI评分均显著小于手术治疗前(P<0.05);两组患者术后半年MacNab优良率无明显差异(P>0.05).结论 对于LDH患者,PTED与SIIF均可有效改善患者的临床症状,且PTED对患者的手术创伤更小,术后并发症发生率更低,患者恢复速度更快.

糖尿病是一种与能量代谢异常相关的疾病,起病相对隐匿,病程较长,防治难度较高[1].相关研究显示,糖尿病伴见并发症的概率为67.5％,骨骼系统破坏作为伴发症状常被忽视[2].其中,糖尿病性骨质疏松症(diabetic osteoporosis,DOP)是糖尿病最常见的并发症之一,往往在继发骨折后才被确诊[3].研究发现,糖尿病引发骨质疏松后导致糖尿病性骨折的发病率为21.1％[4],因此需要重视DOP的预防和治疗.二肽基肽酶Ⅳ(dipeptidyl-peptidase 4,DPP4)抑制剂是应用于治疗2型糖尿病的一类降糖药物(列汀类药物),主要的作用是减少糖化血红蛋白(HbA1c)含量、降糖同时减少低血糖症状的发生.DPP4抑制剂由于其良好的有效性、安全性、耐受性,已得到足够的重视和广泛的应用.但是其对DOP的影响不甚清楚,本文对DPP4抑制剂与DOP的相关性做综述.

Introduction As populations age, osteoporosis has become a hot topic of global public concern. The beneficial effects of traditional Chinese exercises on the musculoskeletal system have been demonstrated. However, previous research findings on osteoporosis are inconsistent, and it is unclear which type of exercise and its frequency and duration have the best effect on osteoporosis. This study aims to investigate the most appropriate exercise modality for people with osteoporosis through systematic evaluation and network meta-analysis to guide clinical practice. Methods and analysis The Cochrane Library, Web of Science, MEDLINE, Embase, China Biomedical Literature, China Knowledge Network, China Science and Technology Journal and Wanfang databases will be searched until January 2022. The language of the articles should be English or Chinese. All clinical randomised controlled trials on the effect of traditional Chinese exercises on osteoporosis will be included. We will use RevMan, Stata and GeMTC software to complete our network meta-analysis. We will perform risk of bias assessment, subgroup analysis and sensitivity analysis to correct the results. Finally, we will use the Grading of Recommendations Assessment, Development and Evaluation guideline development tool and Confidence in Network Meta-Analysis (CINeMA, a new method for assessing CINeMA results) approach to evaluate the reliability of our final results. Ethics and dissemination All data for this study will be obtained from published studies, so no ethical review will be needed. We will publish the results of the study in a peer-reviewed journal. PROSPERO registration number CRD42022323622.

China Biomedical Literature Database, China Knowledge Network, China Science and Technology Journal Database, and Wanfang Database.The time period is from the inception of the database to January 2022.The language of the article should be English or Chinese.