肠道微生物群,是一个动态的生物群集合,负责一系列代谢、免疫、结构和神经功能,如维持代谢稳态、免疫系统的发育和成熟、对感染的抵抗性和神经递质的产生[1].微生物功能失调,被定义为肠道微生物群的多样性、结构或功能的不利改变,导致了不同的病理状态和疾病.肠道微生物群产生广泛的分子,包括酶、短链脂肪酸( SCFAs)和代谢物,参与了炎症驱动性疾病的启动和进展.这些细菌产生的促炎性代谢产物,如脂多糖( LPS) ,从肠道泄漏一直延伸到系统循环,并诱导系统的炎症.由于LP S 水平的升高与肥胖和代谢综合征相关,这是骨关节炎( OA )高度相关的风险,至少很容易推测OA诱导的低级别炎症、代谢对微生物群的参与内毒素血症、巨噬细胞的激活和关节损伤.Dunn等首次在人类和小鼠的软骨中发现了肠道微生物的DNA,其变化与人类OA 的发展和进展有关[2].这些发现提示微生物可能通过直接接种或免疫细胞的运输参与关节炎启动进展,而软骨组织中这种肠道微生物DNA在OA发病中的详细作用目前还没有系统的综述描述这一主题.本综述目的是展示肠道菌群失调与软骨、软骨下骨血管生成的相关性.

Abstract Background Metabolomics is a tool to study the pathogenesis of diseases and their associated metabolites, but there are still insufficient metabolomic studies on severe knee osteoarthritis.To investigate the differences in serum metabolites between healthy populations and knee osteoarthritis (KOA) patients in Southern China using widely targeted metabolomics, and to explore biomarkers and their metabolic pathways that could be associated with the severity of KOA. Methods There were 10 healthy individuals in the control group and 32 patients with KOA. According to the Kellgren–Lawrence (KL) grading system, KOA was further divided into mild (n = 13, KL grade 1 and 2) and severe (n = 19, KL grade 3 and 4). Serum samples from all participants were collected and analyzed metabolomics based on ultra-performance liquid chromatography/electrospray ionization/tandem mass spectrometry. We screened for differential metabolites between patients and controls, and between mild and severe KOA. We explored the metabolic pathways involved in differential metabolism using the Kyoto Encyclopedia of Genes and Genomes database. Results Sixty-one metabolites were differentially expressed in the sera of the patient group compared with the control group (45 upregulated and 16 downregulated). Analysis of the mild and severe KOA groups showed a total of 12 differential metabolites. Receiver operating characteristic curve analysis showed N-alpha-acetyl-L-asparagine was a good predictor of advanced osteoarthritis(OA).Differential metabolites are enriched in multiple pathways such as arachidonic acid metabolism. Conclusion Widely targeted metabolomics found that upregulation of the amino acid metabolite N-α-acetyl-L-asparagine was significantly associated with severe KOA and could be a biomarker for predicting severity of KOA. Arachidonic acid metabolism may play an important role in patients with severe KOA.

Objective:To evaluate the short term efficacy of 160 biological revision handle in femoral revision.Methods:The patients who underwent the femoral revision of Chunli 160? handle in Guangdong Hospital of Traditional Chinese Medicine from August 2017 to September 2019 were retrospectively analyzed. The clinical and imaging manifestations before and at the last follow-up were evaluated and compared with the patients who underwent the revision of Johnson’s Solution? handle at the same time. The efficacy score of artificial hip joint (Harris score) and the hip score of Oxford University were evaluated before and at the last follow-up (OHS score). The paired sample t test was used, and independent sample t test was used for inter-group comparison.Results:A total of 35 patients who met the criteria were enrolled with completed follow-up, including 18 patients in the Chunli 160? handle group (the observation group) and 17 patients in the Solution? handle group (the control group). The Harris score of the observation group increased from preoperative (34±8) to postoperative (72±7) (t =-13.91, P<0.001), the control group increased from preoperative (30±6) to postoperative (68±11) (t =-10.98, P<0.001). The OHS score of the observation group decreased from preoperative (30±8) to postoperative (16±9) (t =9.40, P <0.001). The OHS score of the control group decreased from preoperative (34±2) to postoperative (16±2) (t =16.05, P<0.001) There was no statistically significant difference in the postoperative Harris score and OHS score between the two groups (t =-1.41, 0.19, both P>0.05). Imaging showed that the prosthesis was firmly fixed, and there was no significant difference in prosthesis sinking distance and prosthesis loosening rating between the two groups (Z =-0.857, -0.474, both P>0.05) .Conclusions:The 160? biological revision handle performs well in the short-term follow-up of hip revision patients. The short-term curative effect is equivalent to that of solution handle, and the long-term curative effect needs to be further observed.

目的:系统评价一期关节镜手术对比二期手术治疗肩袖损伤合并关节僵硬的有效性及安全性.方法:通过计算机系统检索中国知网、万方资源数据、维普数据库、PubMed、Web of Science、The Cochrane Library和Embase数据库.查找相关的随机对照试验.进行文献质量评价并采用RevMan 5.3软件进行系统评价.结果:共纳入3篇研究,包括169例患者.由于纳入文献数量少且结局指标有差异,采用描述性系统评价.研究所纳入的3个研究显示末次随访时2组患者的关节活动度、美国肩肘外科协会评分量表(ASES)评分和视觉模拟量表(VAS)评分均较术前显著改善(P<0.05),且组间差异无统计学意义(P>0.05).而在术后早期一期组活动度稍差于二期组.结论:一期手术组治疗肩袖损伤合并关节僵硬疗效确切,且与二期组相比,在末次随访时的活动度、ASES评分、VAS评分及肌力等方面无明显差异.然仍需要更多高质量研究来增强论证的强度.

目的 基于转录组测序分析鹿茸治疗骨关节炎大鼠后的基因表达差异以及对相关信号通路的影响.方法 将10只SD大鼠随机分为实验组和对照组,采用经典Hulth方法制备大鼠右膝骨关节炎疾病模型.造模6周后,实验组给予鹿茸(420 mg·kg-1)灌胃给药,对照组给予等量生理盐水灌胃,隔天灌胃1次,连续6周.末次灌胃给药2 h后,取各组大鼠右侧膝关节软骨,提取RNA进行RNA-Seq测序,对表达差异的基因进行筛选及KEGG功能注释分类和GO富集分析.结果 共筛选出3226个表达差异的基因(|log2FC|≥1,Q值<0.001).与对照组比较,实验组上调的基因有711个,下调的有2615个.KEGG基因分类和GO富集分析表明,上调基因主要参与调控骨骼肌发育、骨形态发生、骨矿化和骨成熟;下调基因主要参与调节细胞的凋亡和自噬、血管生成和炎症反应.结论 发现了鹿茸干预骨关节炎的一些关键基因和通路,如Ckm、Tnni2、Myh4、Myl1、Mylpf、Casq1、Actn3、S100a8及Ngp等基因,以及凋亡和自噬的信号通路、血管生成和肌肉收缩通路等,鹿茸可能通过这些基因和通路发挥治疗效果,这些差异基因可能成为骨关节炎的基因治疗靶点.

鹿茸为雄性梅花鹿或马鹿尚未骨化、带茸毛的幼角经制成的中药,相关药理学研究表明其中的成分可通过促进成骨细胞增殖的同时诱导破骨细胞凋亡,调节骨代谢.本文对近年来鹿茸提取物及复方制剂调节骨代谢方面的研究进行综述,包括基础研究、动物模型研究及临床研究,以期为运用鹿茸防治骨质疏松提供参考.

目的 对行Sledge单髁置换术人群进行临床研究,为术中准确判断假体大小,选择合适的单髁假体提供参考.方法 回顾性分析广东省中医院骨关节科2016年2月-2017年11月开展的159例Sledge单髁置换术人群的相关临床资料.对膝关节单髁置换术(UKA)假体中股骨和胫骨的尺寸分布进行总体统计,记录该人群的基本资料,如性别、年龄、BMI指数等.根据资料分析股骨和胫骨假体之间最佳匹配关系;筛选出Sledge单髁置换人群UKA假体的影响因素,预测股骨假体型号的准确度.结果 股骨假体型号里中号假体占21.4％,小号假体占62.8％,超小号假体占15.7％.胫骨假体型号里大号假体占19.5％,中号假体占52.8％,小号假体占27.8％.最佳匹配方案:胫骨小号匹配超小号股骨假体和小号股骨假体,胫骨大、中号匹配中号股骨假体.年龄和BMI指数这两项数据对股骨假体的判断选择无显著影响(均P＞0.05),而性别及身高(女性)的影响有显著差异(均P＜0.05).建立行Sledge单髁置换人群UKA假体相关参数的分布图.对数据进行分析得出,术前辅助准确选择假体型号的因素占比情况如下:性别对术前股骨假体型号选择准确率的提高达88.1％,其中女性结合身高的准确占比达95.0％;术中再行选择判断时,胫骨假体型号的准确占比为78.6％.结论 临床上可以通过术前身高、性别来预测Sledge单髁置换人群股骨假体型号大小.本次研究分析中所论述的Sledge UKA假体分布情况在预测判断上具备较高精度,可为术中准确判断假体大小提供有力的指导.

我院以胫骨外侧开放楔形截骨术 ( lateral opening wedge high tibial osteotomy,LOWHTO ) 治疗 1 例膝外翻患者,术后功能恢复良好,现报告如下. 临床资料 患者,男,40 岁,因"右膝关节疼痛 6 周余"入院,既往无重大内科病史.查体:右膝关节外翻畸形,右膝无肿胀,右下肢肌肉无萎缩,肤温肤色正常,外侧关节间隙压痛 ( + ),麦氏征 ( + ),前抽屉试验 ( - ),侧方应力试验 ( + - ),双下肢肌力、肌张力正常,活动度 0°～125°.

目的 比较中国广东地区骨关节炎(osteoarthritis,OA)患者与健康人群肠道菌群的宏基因组,初步分析其差异性及差异特征.方法 选取我院从2017年6～12月收集的29名健康人群,66例膝OA患者粪便样本,其中膝OA患者根据K-L分型分为轻度OA组17例,重度OA组49例.检测前进行对基线比较.样本提取DNA后,使用Simpson多样性指数分析群落多样性,使用LEfSe分析对群落关键物种进行筛选;差异物种GO分析及Pathway分析进行差异性菌群代谢功能预测.结果 3组在身高、年龄及体重上没明显差异(P>0.05);Simpson多样性指数分析表明轻度OA患者与健康人群肠道菌群多样性无显著差异,重度OA患者肠道微生物多样性显著低于健康人群.LEfSe分析发现,寡养单胞菌属(Stenotrphomonas)、黄单胞菌属(Xanthomonadacease)等18种菌群在膝骨关节炎患者人群中显著高丰度,毛螺旋菌属(Lachnospiraceae)、瘤胃球菌属(Ruminococcus)等6种菌群在膝骨关节炎患者人群中显著低丰度.寡养单胞菌属、黄单胞菌属两类菌群可以显著区分轻重型膝骨关节炎.差异物种GO分析提示寡养单胞菌属、黄单胞菌属等菌群的显著升高,对代谢类疾病、感染性疾病、心血管类疾病、免疫性疾病的发病具有增加的趋势.结论 广东地区膝骨关节炎患者肠道菌群丰度和某些菌群与健康人群有显著差异,寡养单胞菌属、黄单胞菌属两类菌群可以显著区分轻重型膝骨关节炎.

Background Pilose antler (PA) is a common Chinese medicine used to treat patients with osteoarthritis (OA) while its treating mechanism is still unknown. The purpose of our study is to clarify this mechanism by studying the effect of pilose antler on transcriptome genes expression in rats with knee osteoarthritis.MethodsTen Sprague Dawley (SD) rats are randomly divided into two groups, the pilose antler group (PA group) and the osteoarthritis group (OA group). The classic Hulth method was performed on the right knee of all the rats to establish the osteoarthritis model. Six weeks after the surgery, the PA group was given pilose antler and the OA group was given saline. This intervention lasted 6 weeks. Two hours after the last administration, cartilage tissues of all the rats were taken from their right knees. The samples were collected and sent to BGI, the genomic organization, to carry on the RNA-Seq measurement. The comparison of differentially expressed genes (DEGs), enrichment analysis, genes classification, and miRNA-mRNA linked network were studied within Dr.Tom system.ResultsSeveral DEGs(3226 in comparison between OA and PA group) were identified (|log2FC|≥1,Q value < 0.001). Compared with the OA group, 711 up-regulated genes and 2615 down-regulated genes were found in the PA group. According to the enrichment analysis, the up-regulated genes mainly enriched in muscle contraction and the down-regulated-genes are involved in inflammatory response. The miRNA-mRNA regulatory network was performed and the key genes were identified.ConclusionsOur studies have found that PA may alleviate the progression of OA through strengthening the muscle and positively regulate the inflammatory response. We also found some key genes, like Tnni2, Mylpf, Myl1, Actn3, Ifitm6, and Retnlg . These genes may be the potential target of pilose antler in the treatment of OA.