Osteoporosis is a chronic bone metabolic disease caused by the break of the dynamic balance between bone resorption and bone formation, which leads to bone loss, decreased bone mineral density, and the destruction of bone fine structure. In recent years, more and more studies have proved that exosome therapy will become an important field in the treatment of osteoporosis. Exosomes are lipid bilayer extracellular vesicles involved in cell-to-cell communication, which regulate the biological activity of recipient cells by delivering lipids, proteins, and nucleic acids. Exosomes come from a wide range of sources. They exist in a variety of biological fluids and are secreted by a variety of animal cells, such as mesenchymal stem cells. Adipose mesenchymal stem cells are one of the most promising multifunctional tools in cell therapy field. They not only have the simplicity of separation and minimal invasion, but also involve in bone repair, angiogenesis, nerve regeneration and biological links through differentiation into different cell lineages. They also regulate bone cell differentiation, proliferation and apoptosis through the paracrine signaling release of exosomes, and affect bone tissue microenvironment thereby preventing and relieving osteoporosis. This article reviews the application and mechanism of exosomes derived from adipose mesenchymal stem cells in osteoporosis, to provide a theoretical basis for the future application of adipose mesenchymal stem cell exosomes in the clinical treatment of osteoporosis.

脑干孤束核(NTS)中的胰高血糖素样肽-1(GLP-1)近年来在调控食欲、改善肥胖等方面受到广泛关注.这一效应涉及多条神经环路,其中奖赏环路是近几年的研究热点之一.中脑多巴胺能(DA)奖赏系统调控摄食的核团主要有腹侧被盖区(VTA)、伏隔核(NAc)和弓状核(ARC).这些区域存在大量GLP-1受体(GLP-1R),当受体被激活后,出现食物摄入量的减少.了解其中的神经生物学机制对进一步探索肥胖及相关疾病的治疗方法具有重要意义.本文以神经环路的角度作为切入点,分别阐述了中枢GLP-1通过直接或间接的神经投射调控奖赏环路,进而抑制摄食、改善肥胖的研究进展.

目的:观察以案例为基础的教学法(case based learning,CBL)结合情景模拟在高职高专院校康复治疗专业实习教学中的优势.方法:将40名高职高专康复治疗专业实习生分为联合教学组和传统教学组各20名,联合教学组采用CBL教学法结合情景模拟,传统教学组采用传统教学方法,通过观察两组学生实习5个月前后的理论知识水平、康复实践操作能力、教学效果自评量表的得分情况,分析两种教学方法在高职高专康复治疗专业实习生中的优劣.结果:两种教学法均能提升实习生的理论知识水平和康复操作能力(P<0.05),但CBL结合情景模拟教学提升程度更大(P<0.05);两组学生在理论知识水平和团队协作的自评上差异无统计学意义(P>0.05),CBL结合情景模拟能更好地提升实习生的操作技能和学习兴趣(P<0.05).结论:相比传统教学法,CBL教学法结合情景模拟在高职高专院校康复治疗专业实习教学中具有明显优势,值得在康复实习中应用.

目的:探究不同梗死时间的脑卒中大鼠腓肠肌(GM)超声弹性特征表现、肌肉脂肪改变,及两者之间的关系.方法:SD雄性大鼠跟据大脑中动脉栓塞(MCAO)造模的方式和术后时间,分为假手术组(n=6)、脑梗死1.5h组(n=7)和脑梗死2h组(n=6).各组大鼠在不同时间点完成体质量测量、改良神经功能缺损评估(MNSS)、背地性测试(negative geotaxis test),术后1月完成超声弹性成像评估GM硬度,取材后进行油红O测试.结果:超声结果显示,梗死2h组偏瘫侧GM的Young's模量均大于1.5h组和假手术组(P＜0.001),而1.5h组与假手术组之间没有统计学差异(P=0.242);2 h组、1.5h组和假手术组之间健侧GM的Young's模量的差别均有统计学意义(P均＜0.001).组内比较结果显示,2h梗死组和1.5h梗死组大鼠左右侧GM的Young's模量的差异均有统计学意义(2h组,t=-12.72,P＜0.001;1.5h组,t=-3.62,P=0.01).病理检查结果显示,三组大鼠双侧下肢GM均无明显脂肪增多.相关性结果显示,术后1月双侧GM的Young's模量差值与背地性测试结果、MNSS评分呈正相关(背地性测试,r=0.641,P=0.003;MNSS,r=0.778,P＜0.001).结论:MCAO大鼠造模术不同梗死时间对大鼠下肢GM的超声弹性特征有影响,且MCAO术后1月大鼠肌肉间脂肪组织的改变不明显,与早期下肢GM肌肉硬度的改变可能不相关.

Objective:To conduct a glucagon like peptide-1(GLP-1)controllability model rat by chemical genetics, and observe the impact of GLP-1 neuron excitability on appetite.Methods:Fifteen rats were evenly divided into Green fluorescent protein(GFP)group, HM3D group, and HM4D group. Various combinations of adeno-associated virus(rAAV)were injected into the nucleus tractus solitarius(NTS). rAAV-GLP-1-cre and rAAV-GFP-dio were administered in rats of GFP group. The rats of HM3D group were injected with rAAV-GLP-1-cre and rAAV-HM3D-mCherry-dio while rAAV-GLP-1-cre and rAAV-HM4D-mCherry-dio were injected in rats of HM4D group . The optimal dose of clozapine N-oxide(CNO)was selected based on feeding behavior and body weight changes of rats after intraperitoneal injection of different doses of CNO. The controllability of GLP-1 neurons was confirmed by comparing with intraperitoneal injection of saline. The number of activated GLP-1 neurons in the NTS area and the expression of POMC neurons in the hypothalamus were detected 30 minutes after CNO injection.Results:GLP-1 neurons in the NTS area of rats were successfully labeled. The rat of HM3D group revealed a decrease in food intake( P=0.021)while the rat of HM4D group showed an increase( P=0.002), when given 1 mg/kg of CNO, no changes at the dose of 0.5 mg/kg and 3.0 mg/kg. Immunofluorescence showed that the activity of GLP-1 neurons in NTS of GFP group was lower than that of HM3D group( P=0.022), and higher compared with that of the HM4D group( P=0.049). The expression of GLP-1 neurons in NTS and POMC neurons in the hypothalamus of the HM3D group after intraperitoneal injection of CNO was also higher than that in the HM4D group( P=0.003). Conclusion:Using chemical genetics technology, GLP-1 controllability model rat could be successfully established via injecting varying combinations of rAAV into the NTS area of rat. Injection of 1 mg/kg CNO can effectively activate or inhibit the neuron to regulate appetite.

目的 观察超早期介入关节活动对乳腺癌腋窝淋巴结清扫术后患者肩关节功能恢复的影响.方法 选取2018年8月-2019年12月武汉大学中南医院甲状腺乳腺外科收治的乳腺癌腋窝淋巴结清扫术后患者100例,将其随机分为早期活动组与超早期活动组,每组各50例.两组均按指南推荐进行早期康复干预,早期活动组和超早期活动组患者分别在术后第7天和第3天开始接受肩关节主动活动训练,3次/d,5 d/周,持续4周.比较两组患者术后3 d、1周、2周的疼痛值、引流量变化及术后1、2、3周的肩关节活动度变化,并分别通过Constant-Murley 评分表和健康调查简表(The Medical Outcomes Study 36-item Short-form Health Survey,SF-36)比较两组患者术后1、3、6、12周肩关节功能、生活质量的变化.结果 超早期活动组患者在术后3 d、1周、2周时的疼痛值和引流量与早期活动组比较差异无统计学意义(P＞0.05).超早期活动组患者在术后1、2、3周时的肩外展、屈曲、外旋活动度明显优于早期活动组(P＜0.05),术后1周时肩内旋活动度优于早期活动组(P＜0.05).超早期活动组患者在术后 1、3、6、12周时的 Constant-Murley 评分分别为(25.9±4.3)、(55.4±5.3)、(64.6±4.5)、(73.3±4.6)分,明显优于早期活动组[(21.3±3.8)、(48.9±7.8)、(57.3±4.7)、(70.7±3.0)分],差异有统计学意义(P＜0.05);SF-36量表评分与早期活动组比较差异无统计学意义(P＞0.05).结论 超早期关节活动可显著改善乳腺癌腋窝淋巴结清扫术后患者肩关节活动度和肩关节功能,且未增加早期引流量、疼痛,对后期生活质量无明显影响,值得临床推广应用.

目的 观察低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)治疗脑卒中后失眠的临床疗效.方法 收集2018年12月至2019年12月武汉大学中南医院康复医学科住院的脑卒中失眠患者58例,男35例,女23例,采用随机数字法将患者分为对照组(n=28)和rTMS治疗组(n=30),两组患者均接受常规基础性治疗和康复护理,对照组患者给予口服阿普唑仑片治疗失眠,rTMS治疗组患者接受低频rTMS治疗,疗程均为1个月.比较两组患者治疗前和治疗1个月后匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)评分、神经功能缺损评分(National Institutes of Health Stroke Scale,NIHSS)以及不良反应发生率的差异.结果 两组患者治疗前PSQI和NIHSS评分比较无统计学差异(均P>0.05);治疗1个月后,两组患者PSQI和NIHSS评分均较治疗前改善(均P<0.05),且rTMS治疗组PSQI及NIHSS评分改善程度高于对照组(P<0.05).对照组不良反应发生率高于治疗组(P<0.05).结论 低频rTMS能有效改善脑卒中后失眠患者的睡眠质量,促进患者神经功能的恢复,安全性高,值得临床推广应用.

Objective:To observe any effect of extracorporeal shock wave therapy (ESWT) on patients with moderate to severe breast cancer-associated lymphedema (BCAL) with skin fibrosis and upper limb symptoms receiving complex decongestive therapy (CDT).Methods:Forty patients with moderate to severe breast cancer-associated lymphedema were randomly divided into an ESWT+ CDT group and a CDT group, each of 20. Both groups received manual lymph drainage, 5 times per week for 4 weeks with short elastic bandages or compression cuffs. The ESWT+ CDT group was additionally provided ESWT (2.0 bar, 5 Hz, 2500 pulses) twice a week for 4 weeks. Limb swelling, skin fibrosis and symptoms of lymphedema were assessed using the circumference measurement method, modified Rodnan skin scores (mRSSs), and the Breast Cancer and Lymphedema Symptoms Experience Index (BCLE-SEI) before the treatment and after 2 and 4 weeks.Results:After 2 weeks the limb volume, skin sclerosis and lymphedema symptoms of both groups had improved significantly, with the average limb volume, mRSS score and BCLE-SEI score of the ESWT+ CDT group significantly better than those of the CDT group. After 4 weeks of treatment, the limb volume, skin sclerosis and lymphedema symptoms further improved in both groups with the ESWT+ CDT group again showing significantly greater improvement.Conclusion:ESWT can further accelerate the recovery of patients with lymphatic edema after breast cancer surgery receiving CDT therapy, correct the cycle of skin fibrosis and lymphedema, and relieve complications such as limb pain. It is worthy of clinical promotion and application.

Objective:To investigate the effect of electroacupuncture (EA) on synaptic plasticity and the expression of autophagy-related proteins in the hippocampus in Alzheimer′s disease (AD). To explore how EA might improve cognition in AD.Methods:Healthy male Sprague-Dawley rats were randomly divided into a sham operation group, a model group and an EA group. The rat model of AD was established by injecting Aβ1-42 into the bilateral CA1 area of the hippocampus. The sham operation group was injected with an equal amount of normal saline at the same site. Starting the day after the successful modelling, the EA group received 20 minutes of EA treatment at the Baihui (DU20) and bilateral Shenshu (BL23) acupoints once a day, 6 times a week for 2 weeks. The rats′ learning and memory were then tested using a Morris water maze. The long-term potentiation (LEP) in the hippocampus was assessed using a MED64 microelectrode array and any ultrastructural changes of autophagosomes were detected using an electron microscope. The expression of the autophagy-related proteins Beclin-1 and microtubule associated protein light chain 3 (LC3) in the hippocampus were determined using western blotting.Results:The escape latency was significantly shorter and the times crossing the platform increased significantly in the EA group compared with the model group. The average amplitude of the postsynaptic excitatory field potentials in the EA group was significantly higher than among the model group. There were many autophagosomes in the hippocampal neurons of the model group, significantly more than in the EA group. The LC3II/LC3I ratio and Beclin-1 protein expression decreased significantly in the EA group compared to the model group.Conclusions:EA can improve learning and memory and restore LEP in the hippocampus of rats modeling AD. The mechanism may be related to its regulation of autophagy in hippocampal neurons.

目的:观察成对关联刺激对缺血性脑卒中大鼠缺血半暗带区NogoA、NgR、RhoA蛋白表达的影响.方法:90只健康雄性SD大鼠随机分为假手术组、模型组和PAS组,每组又分为7d、14d、28d三个亚组(n=10).模型组和PAS组大鼠采用Longa线栓法制作MCAO模型,假手术组除不插入线栓外,其余操作与模型组和PAS组相同.PAS组于术后第1d开始给予0.05Hz、共90对脉冲的PAS治疗,每日1次,每次持续30min;模型组和假手术组不予任何干预措施,各时间点治疗结束后取缺血半暗带区脑组织,Western Blot和免疫荧光检测缺血半暗带NogoA、NgR、RhoA蛋白的表达和分布情况.结果:术后第7、14、28d,假手术组NogoA、NgR、RhoA蛋白的表达水平均最低,模型组在各时间点NogoA、NgR、RhoA含量均较假手术组明显升高(P＜0.05),PAS组术后各时间点NogoA、NgR、RhoA的含量高于假手术组(P＜0.05),低于同时间点模型组(P＜0.05),PAS组NogoA、NgR、RhoA蛋白在术后28d的含量低于同组第7d、14d(P＜0.05).结论:PAS可抑制NogoA/NgR/RhoA信号通路蛋白的表达,可能是PAS促进脑缺血大鼠神经再生,改善脑缺血大鼠的感觉运动功能障碍的内在分子机制之一.

失眠是临床最为常见的睡眠障碍类型,通常指患者对睡眠时间和(或)睡眠质量不满足并影响其日间社会功能的一种主观体验,其主要临床表现包括入睡困难(入睡时间超过30min)、睡眠维持障碍(整夜觉醒次数≥2次)、早醒、睡眠质量下降和总睡眠时间减少(通常少于6h)等,同时伴有日间功能障碍[1].

骨质疏松症已经成为世界范围内越来越引起人们重视的健康问题.近年来,作为一种安全有效的绿色疗法,针灸越来越多地应用于骨质疏松症的治疗.针灸治疗骨质疏松症的内在机制仍在不断的探索中.关于针灸治疗骨质疏松症机制的学说被不断提出并证明.该文将近5年的相关文献进行总结,发现针灸能够通过调节内分泌系统、相关信号通路、改善骨形态及生物力学等方式达到防治骨质疏松症的目的.

目的 观察推拿联合超声波导入治疗对膝骨性关节炎(KOA)患者的临床疗效.方法 将我院80例KOA患者随机分为治疗组和对照组,每组各40例.对照组予以推拿手法治疗,治疗组在推拿基础上加用超声波导入治疗,同时两组患者均予以健康教育指导,疗程均为1个月,比较两组患者Lequesne指数、VAS评分及疗效情况.结果 (1)研究期间,治疗组脱落2例,对照组脱落2例,最终完成试验者76例.(2)两组临床总有效率比较,治疗组明显优于对照组(P＜0.05).(3)组间治疗后比较,两组关节疼痛、最大步行距离、日常生活能力指数及综合指数、VAS评分差异有统计学意义,且治疗组明显低于对照组(P＜0.05).结论 推拿手法联合超声波导入治疗膝骨关节炎效果显著,可明显改善膝关节功能,减轻疼痛,提高患者生活质量.

2012年发表的国际卒中试验3(The third international stroke trial,IST3)[1]表明,脑卒中为全球范围内60岁以上人群的第二大死亡原因,其中以缺血性脑卒中最为常见,首次发病的脑卒中患者中近1/3会遗留下各种功能障碍,包括运动功能障碍、认知障碍、吞咽障碍等,严重影响患者的日常生活活动能力和生存质量,同时也给家庭和社会带来了沉重的精神负担和经济负担[2].缺血性脑卒中是指由于血氧供应不足而促发后续一系列级联反应,最终引起部分脑组织的坏死和凋亡,其病理生理过程十分复杂.近年来,随着基因组学、蛋白质组学和代谢组学的快速发展,脑缺血损伤机制研究被提高到一个新的水平,其主要的损伤机制包括兴奋性氨基酸(excitatory amino acids,EAAs)的毒性作用[3]、能量耗竭和酸中毒[4]、氧化应激[5]、炎症反应[6]等几个方面.脑卒中后组织的修复和功能重建一直是临床康复中的难题,越来越多的证据显示,神经可塑性是脑损伤后功能修复的基础.神经可塑性指神经系统具有改变其结构和功能以适应内外环境变化的能力,可从不同层面反映,小到突触、细胞水平,大到半球内和半球间的神经网络水平.成对关联刺激(paired associative stimulation,PAS)作为一种新的非侵入性大脑刺激(non-invasive brain stimulation,NIBS)技术,可直接调节大脑皮质的兴奋性,促进大脑的可塑性变化,已逐渐成为神经康复领域中研究的热点问题.

目的 观察电针对单纯性肥胖大鼠体重及脂质代谢的影响.方法 20只单纯性肥胖模型大鼠随机分为肥胖组和电针组,两组均给予高脂喂养,电针组在高脂喂养的基础上,取穴中脘、丰隆、足三里给予电针治疗,疗程为8周.检测两组0、2、4、6、8周的体重及血清血清游离脂肪酸(NEFA)、甘油三酯(TG)、胆固醇(TC)水平.结果 两组在8周干预过程中体重仍呈上升趋势,但电针组体重增长在第6周时被抑制(P＜0.05).8周后,电针组NEFA、TG、TC水平明显低于肥胖组(P＜0.05).结论 电针能够通过调节脂质代谢,改善大鼠的单纯性肥胖状态.

Objective To observe the effect of paired associative stimulation ( PAS) on the recovery of sensorimotor function and to explore the mechanism in terms of neural plasticity. Methods Ninety male adult Sprague-Dawley rats were randomly divided into a sham operation group (Sham group), a model group (Model group) and a paired associative stimulation group ( PAS group) , each of 30. Each group was then subdivided into 7-, 14-and 28-day subgroups with 10 rats in each. A model of focal cerebral ischemia and reperfusion was estab-lished using the Longa suture method in the Model and PAS groups. The rats in the Sham group underwent the same surgical procedure except for the occlusion of the middle cerebral artery. The rats received 30 minutes of paired pe-ripheral nerve stimulation and transcranial magnetic stimulation comprising 90 pairs at 0.05 Hz beginning 24 h after the occlusion. The impulse wave width of the peripheral nerve stimulation was 200 μs and the intensity was 6 mA. The intensity of the transcranial magnetic stimulation was 120％ of the resting motor threshold. The other two groups weren't given any intervention. Neurological function was tested using Garcia scores on the 1st, 7th, 14th and 28th day after surgery. The rats were then sacrificed and the expression of MAP-2 and GAP-43 in the ischemic penumbra were detected using western blotting and immunohistochemistry. Results No neurological dysfunction was ob-served in the Sham group at any time. Compared with the Sham group at the same time points, the average Garcia scores of the Model and PAS groups were significantly lower (P≤0.05). However, the average Garcia scores on the 7th, 14th and 28th day were significantly higher in the PAS group compared with the Model group at the same time points ( P≤0.05) . The average Garcia scores of the Model and PAS groups on the 28th day after surgery were significantly higher than those on the 1st day (P≤0.05), but only the PAS group's average Garcia score on the 28th day was significantly higher than that on the 7th day. Compared with the Sham group at the same time points, the expression of MAP-2 and GAP-43 protein in the Model and PAS groups was significantly higher, but with that of the Model group significantly lower than that of the PAS group ( all P≤0.05) . The protein expression of MAP-2 and GAP-43 protein in the PAS group on the 14th day was significantly higher than on the 7th and 28th day ( P≤0.05 for both) . Conclusions PAS can promote the recovery of sensorimotor function after cerebral thrombosis, at least in rats. That may be due to its promoting the expression of the neuroplasticity-associated proteins MAP-2 and GAP-43 in the ischemic penumbra.

Objective To observe the clinical curative effect of rehabilitation training combined with functional electrical stimulation in the treatment of foot drop caused by stroke. Method 132 cases of patients with foot drop caused by stroke were selected form January 2015 to January 2017 as the research object, randomly divided into two groups, control group with routine rehabilitation training treatment, observation group with rehabilitation training and functional electrical stimulation treatment. The clinical efficacy and other indicators of the two groups were compared. Result After treatment, the total effective rate of observation group was 90.91%, control group was 71.21%, the difference was statistically significant (P < 0.05). The score of FMA and BBS, Step Test time and 10mMWS of observation group respectively were (33.48±4.92) points, (41.39±6.22) points, (18.35±3.82) s, (58.12±9.41) m/min, the control group, respectively were (29.35±5.40) points, (36.95±6.80) points, (22.34±3.95) s, (51.03±10.22) m/min, the differences were statistically significant (P < 0.05). Conclusion Rehabilitation training combined with functional electrical stimulation can significantly improve clinical curative effect in patients with foot drop caused by stroke, and can significantly improve patients with lower limb motor function, balance function and walking function.

Objective To observe the effects of electroacupuncture ( EA) on learning and memory ability and the expression of N-ethylmaleimide-sensitive fusion factor ( NSF) in experimental Alzheimer′s disease ( AD) and to explore the mechanism involved. Methods Sixty healthy, male Sprague-Dawley rats were randomly divided into a normal group, a sham operation group, a model group and an EA group, each of 15.The model group and the EA group were injected with Aβ25-35 bilaterally in the CA1 area of the hippocampus, while the sham operation group was injected with the same amount of normal saline in the same regions. From the 1stday after the AD model had been es-tablished successfully, EA was applied to the Shen Shu ( BL23) and Bai Hui ( GV20) acupoints in the EA group once a day,6 days a week for 2 weeks. No EA was given to the other 3 groups. After the treatment, Morris water maze tests were conducted to determine assess the rats′ learning and memory ability, and immunohistochemical methods were used to test the expression level of NSF in the CA1 areas of the rats′hippocampus. Results The average es-cape latent period of the EA group was significantly shorter than that of the model group and their average platform crossing time was significantly longer. The average expression of NSF in the EA group measured as integrated optical intensity was significantly higher than that in the model group. Conclusion EA can effectively improve learning and memory ability in AD, at least in rats. The mechanism may involve increasing the expression of NSF in the CA1 area of the hippocampus.

Objective To investigate the effect of electroacupuncture on the expression ofα-amino-3-hydroxyl-5-methyl-4-isoxazole propionate (AMPA) receptor associated protein glutamate receptor interacting protein (GRIP)1 and GRIP2 in hippocampal neurons of rats with Alzheimer's disease (AD) model induced by Aβ25-35. Methods 40 Male Sprague-Dawley rats were randomly divided into normal group, sham operation group, model group and electroacupuncture group with 10 rats in each group. The AD rat model was prepared by injecting Aβ25-35 in the hippocampus CA1 of rats, while the sham operation group was injected with equal amount of normal saline at the same loca-tion. On the second day after successful modeling, the electroacupuncture group received electroacupuncture at Baihui (DU20) and bilateral Shenshu (BL23) acupoints, once a day, 6 times a week for 2 weeks. The expression of GRIP1 and GRIP2 were detected with immunohisto-chemistry. Results There was no difference in the expression of GRIP2 and GRIP1 proteins in hippocampus between the normal group and sham operation group (t<1.7438, P>0.05), but was lower in the model group and the electroacupuncture group than in the sham operation group (t>9.5928, P<0.001), and was higher in the electroacupuncture group than in the model group (t>9.5326, P<0.05). Conclusion Elec-troacupuncture may increase the number of AMPA receptors on the postsynaptic membrane by increasing GRIP1 and GRIP2.

骨关节炎(osteoarthritis,OA)指由多种因素引起关节软骨纤维化、皲裂、溃疡、脱失而导致的关节疾病.病因尚不明确,其发生与年龄、肥胖、炎症、创伤及遗传等因素有关.骨关节炎好发于负重大、活动多的关节,如膝、髋、踝、手、脊柱等关节,亦称为骨关节病、退行性关节炎等. 骨关节炎可分为原发性和继发性两类.原发性骨关节炎多发生于中老年,女性多于男性.发病原因不明,与遗传和体质因素有一定的关系.继发性骨关节炎可发生于青壮年,继发于创伤、炎症、关节不稳定、慢性反复的积累性劳损或先天性疾病等.