New abietane and tigliane diterpenoids from the roots of Euphorbia fischeriana and their cytotoxic activities.

Three new abietane and two new tigliane diterpenoids were isolated from the roots Euphorbia fischeriana. Their structures were elucidated by spectroscopic methods and quantum chemical calculation. Compounds 4 and 5 exhibited the inhibitory activities against human cancer cells HeLa and HepG2, with IC50 ranging from 3.54 to 11.45 µM.

Non-targeted metabolomics analysis of indoleamine 2,3-dioxygenase inhibitor treatment in a mouse model of early-stage lung adenocarcinoma.

Background: Lung adenocarcinoma is a common malignant tumor, and its early diagnosis and treatment are key to improving patient survival rates. However, due to the non-specific early symptoms, many patients are already at an advanced stage when diagnosed. Non-targeted metabolomics analysis, as a method for comprehensive analysis of metabolites in the body, has been shown to have potential in the early diagnosis of cancer. This study aims to identify early-stage lung adenocarcinoma-specific biomarkers using non-targeted metabolomics analysis in an established mouse model. The intervention mechanism of indoleamine 2,3-dioxygenase (IDO) inhibitor in early-stage lung adenocarcinoma is explored to provide evidence for clinical disease treatment. Methods: Twenty specific-pathogen-free-grade female Kunming mice were divided into control group, experimental group, Epacadostatlow group, and Epacadostathigh group. After modeling, immune therapy intervention (epacadostat) was administered to the mice, and plasma and urine samples were collected from all mice on day 7 and day 28. Ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS) analysis was performed to identify potential biomarkers for diagnosing early-stage lung adenocarcinoma. Cluster analysis and correlation analysis were used to explore the differential expression patterns of metabolites in different samples. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis was used to identify enriched pathways of differentially expressed metabolites. Results: A total of 348 metabolites were identified after merging the positive and negative ion modes. Among them, organic acids and derivatives (16.954%) and lipids and lipid-like molecules (15.517%) were the two major classes of metabolites in the early-stage lung adenocarcinoma mice. Anthranilic acid (vitamin L1), 1-methylhistidine, 12(R)-HETE, and hippuric acid were the major differentially expressed metabolites on both day 7 and day 28, and they showed correlations with each other. Metabolic pathway analysis revealed multiple dysregulated pathways in lung adenocarcinoma mice. Conclusions: UPLC-QTOF-MS analysis is a feasible method for identifying biomarkers of lung adenocarcinoma. Epacadostat, a novel and promising IDO inhibitor, may exert its therapeutic effect by modulating 1-methylhistidine and anthranilic acid (vitamin L1).

Crosstalk between lncRNAs and Wnt/ß-catenin signaling pathways in lung cancers: From cancer progression to therapeutic response.

Lung cancer (LC) is considered to have the highest mortality rate around the world. Because there are no early diagnostic signs or efficient clinical alternatives, distal metastasis and increasing numbers of recurrences are a challenge in the clinical management of LC. Long non-coding RNAs (lncRNAs) have recently been recognized as a critical regulator involved in the progression and treatment response to LC. The Wnt/ß-catenin pathway has been shown to influence LC occurrence and progress. Therefore, discovering connections between Wnt signaling pathway and lncRNAs may offer new therapeutic targets for improving LC treatment and management. In this review, the purpose of this article is to present possible therapeutic approaches by reviewing particular relationships, key processes, and molecules associated to the beginning and development of LC.

Artificial intelligence-assisted measurements of coronary computed tomography angiography parameters such as stenosis, flow reserve and fat attenuation for predicting major adverse cardiac events in patients with coronary arterial disease.

Advancements in artificial intelligence (AI) offer promising tools for improving diagnostic accuracy and patient outcomes in cardiovascular medicine. This study explores the potential of AI-assisted measurements in enhancing the prediction of major adverse cardiac events (MACE) in patients with coronary artery disease (CAD). We conducted a retrospective cohort study involving patients diagnosed with CAD who underwent coronary computed tomography angiography (CCTA). Participants were classified into MACE and non-MACE groups based on their clinical outcomes. Clinical characteristics and AI-assisted measurements of CCTA parameters, including CT-derived fractional flow reserve (CT-FFR) and fat attenuation index (FAI), were collected. Both univariate and multivariable logistic regression analyses were performed to identify independent predictors of MACE, which were used to build predictive models. Statistical analyses revealed three independent predictors of MACE: severe stenosis, CT-FFR ≤ 0.8, and mean FAI (P < 0.05). Seven predictive models incorporating various combinations of these predictors were developed. The model combining all three predictors demonstrated superior performance, as evidenced by the receiver operating characteristic (ROC) curve, with an area under the curve (AUC) of 0.811 (95% CI 0.774 - 0.847), a sensitivity of 0.776, and a specificity of 0.726. Our findings suggest that AI-assisted CCTA analysis, particularly using FFR and FAI, could significantly improve the prediction of MACE in CAD patients, thereby potentially aiding clinical decision-making.

Tanshinone I attenuates estrogen-deficiency bone loss via inhibiting RANKL-induced MAPK and NF-κB signaling pathways.

AIM OF THE STUDY: This study aims to reveal the role of Tanshinone I (TI) in inhibiting osteoclast activity and bone loss in vitro and in vivo, as well as elucidate its underlying molecular mechanism. MATERIALS AND METHODS: A mouse model of estrogen deficiency was used to assess the inhibitory effect of TI on osteoclast activity and subsequent bone loss. To validate the impact of TI on osteoclast formation, TRAcP staining and pseudopodia belt staining were conducted. The expressions of osteoclast-specific genes and proteins were evaluated using RT-PCR and Western Blot analyses. Additionally, immunofluorescence staining was employed to examine the effect of TI on p65 nuclear translocation and the expression level of reactive oxygen species (ROS). RESULTS: TI demonstrated significant efficacy in alleviating bone mass loss and suppressing osteoclast activity and function in ovariectomized mice. This outcome was predominantly ascribed to a decrease in ROS levels, thereby impeding the NF-κB signaling pathway and the translocation of p65 to the nucleus. Additionally, TI hindered the RANKL-induced phosphorylation of the MAPK signaling pathway. Moreover, TI played a role in the reduction of osteoclast-specific genes and proteins. CONCLUSIONS: To summarize, this study sheds light on TI's capacity to modulate various signaling pathways triggered by RANKL, effectively impeding osteoclast formation and mitigating bone loss resulting from estrogen deficiency. Consequently, TI emerges as a promising therapeutic option for estrogen-deficiency bone loss.

Cycloastragenol prevents bone loss via inhibiting osteoclast activity in glucocorticoid-induced osteonecrosis of the femoral head: An in vivo study.

Background: Glucocorticoid-induced osteonecrosis of the femoral head (GIONFH) is a common bone and joint disease. There is currently a lack of effective treatment for GIONFH, and the disease progression may lead to total hip arthroplasty (THA). The exact mechanism of GIONFH pathogenesis remains unsettled, and emerging evidence indicates that the overactivation of osteoclasts plays a pivotal role in the occurrence and progression of this condition. Our previous study has shown that cycloastragenol (CAG), a triterpenoid saponin with multiple bioactivities, is a natural osteoclast inhibitor and has a protective effect on bone loss. However, its effect on GIONFH remains unclear. Methods: In this study, methylprednisolone (MPS) (20 mg/kg) was administered via gluteal muscle injection to female Sprague-Dawley (SD) rats to induce GIONFH, and different doses of CAG (5 and 15 mg/kg) were dispensed intraperitoneally for intervention. Micro-CT screening and angiography were applied to determine the shaping of necrotic lesions, the loss of trabecular bone, and the change in the local blood supply. The molecular mechanism was established by Real-time qPCR and Western blotting. Hematoxylin and eosin (H&E) staining was performed to identify empty lacunae in the femoral head. Results: CAG treatment shanked the necrotic lesion area, inhibited the trabecular bone loss, and improved the local blood supply in the femoral head. In addition, CAG medication lowered the ratio of Tnfsf11 (encoding RANKL) to Tnfrsf11b (encoding OPG) and the expression of osteoclast-specific genes, including Acp5 and Ctsk. Consistently, CAG treatment exhibited a dose-dependent weakening effect on the expression of osteoclastogenesis and bone resorption-related proteins, including TRAP, CTSK, and MMP9. CAG addition also alleviated the occurrence of empty lacunae in the subchondral region. Conclusion: Our discoveries demonstrate that CAG is a potential option for hip preservation therapy in GIONFH patients. Translational potential of this article: The protective effect of CAG on rats with GIONFH can be translated into clinical use.

One in five patients require conversion to arthroplasty after non-vascularized bone grafts in patients with osteonecrosis of the femoral head: a systematic review.

BACKGROUND: Non-vascularized bone grafting (NVBG) has demonstrated to treat osteonecrosis of the femoral head (ONFH). There are a number of articles updating the use of NVBG to treat the ONFH, but the percentage of patients subsequently undergoing a total hip arthroplasty (THA) is controversial. METHODS: Several electronic databases, including PubMed, Embase, Web of Science, and Cochrane databases, were searched to find studies using NVBG to treat ONFH. The pooled rate and 95% confidence interval (CI) were used to assess the conversion rate to THA after NVBG. In addition, we performed subgroup, sensitivity, and publication bias analysis. RESULTS: A total of 37 studies describing 2599 hips were included. The mean weighted follow-up time was 50.5 months and the mean age at surgery was 36.3 years. The conversion rate to THA after NVBG was 21% (95%CI: 17% to 25%), and subgroup analyzes indicated lightbulb, trapdoor and Phemister techniques incidences with THA of 15%, 19%, and 24%, respectively. CONCLUSIONS: This study preliminarily obtained the general trend of the survival rate of NVBG patients, but these results should be interpreted cautiously. Pooled results from 2599 hips and of these nearly 80% with early stage of osteonecrosis, showed that approximately 21% of patients underwent a THA following NVBG. NVBG treatment for patient with ONFH appears to defer or at least delay the need for THA.

Dihydrotanshinone I attenuates estrogen-deficiency bone loss through RANKL-stimulated NF-κB, ERK and NFATc1 signaling pathways.

Postmenopausal osteoporosis, a chronic condition that predominantly affects postmenopausal women, presents a significant impediment to their overall well-being. The condition arises from estrogen deficiency, leading to enhanced osteoclast activity. Salvia miltiorrhiza, a well-established Chinese herbal medicine with a history of clinical use for osteoporosis treatment, contains diverse active constituents that have shown inhibitory effects on osteoclast formation and bone loss. Dihydrotanshinone I (DTI), a phenanthrenonequinone compound derived from the root of Salvia miltiorrhiza, has been identified as a potential therapeutic agent, although its mechanism of action on osteoclasts remains elusive. In this study, we aimed to elucidate the inhibitory potential of DTI on RANKL-induced osteoclastogenesis. We observed the ability of DTI to effectively impede the expression of key osteoclast-specific genes and proteins, as assessed by Real-time PCR and Western Blotting analyses. Mechanistically, DTI exerted its inhibitory effects on osteoclast formation by modulating critical signaling pathways including NF-κB, ERK, and calcium ion signaling. Notably, DTI intervention disrupted the nuclear translocation and subsequent transcriptional activity of the NFATc1, thus providing mechanistic insights into its inhibitory role in osteoclastogenesis. To further assess the therapeutic potential of DTI, we employed an ovariectomized osteoporosis animal model to examine its impact on bone loss. Encouragingly, DTI demonstrated efficacy in mitigating bone loss induced by estrogen deficiency. In conclusion, our investigation elucidates the ability of DTI to regulate multiple signaling pathways activated by RANKL, leading to the inhibition of osteoclast formation and prevention of estrogen-deficiency osteoporosis. Consequently, DTI emerges as a promising candidate for the treatment of osteoporosis.

Dragon blood resin ameliorates steroid-induced osteonecrosis of femoral head through osteoclastic pathways.

Objective: Dragon's Blood resin (DBR) is a traditional medicinal substance renowned for its diverse pharmacological effects, which consists of potent anti-inflammatory, antioxidant and angiogenic properties. This study aimed to elucidate its therapeutic mechanism in alleviating steroid-induced osteonecrosis of the femoral head (SIONFH). Methods: Techniques such as SPR and LC-MS were employed to identify and analyze the target proteins of DBR in bone marrow macrophages (BMMs). In vitro, BMMs were treated with RANKL and DBR, and TRAcP staining and actin belt staining were utilized to assess osteoclast activity. The inhibitory effects and underlying mechanisms of DBR on osteoclastogenesis and reactive oxygen species (ROS) generation were determined using real-time PCR, western blotting and immunofluorescence staining. An in vivo SIONFH rat model was set up to assess the curative impacts of DBR using micro-CT scanning and pathological staining. Results: Bioinformatic tools revealed a pivotal role of osteoclast differentiation in SIONFH. Proteomic analysis identified 164 proteins binding in BMMs. In vitro assessments demonstrated that DBR hindered osteoclastogenesis by modulating the expression of specific genes and proteins, along with antioxidant proteins including TRX1 and Glutathione Reductase. Notably, the resin effectively inhibited the expression of crucial proteins, such as the phosphorylation of JNK and the nuclear localization of p65 within the TRAF6/JNK and NFκB signaling pathways. In vivo experiments further confirmed that DBR mitigated the onset of SIONFH in rats by curbing osteoclast and ROS activities. Conclusion: These findings underscore the potential of Dragon's Blood as an effective administration for early-stage SIONFH, shedding light on its therapeutic influence on ROS-mediated osteoclastic signaling pathways.

Development of a Practical Model to Predict Conversion to Total Hip Arthroplasty Following Non-Vascularized Bone Grafting.

Objective: To identify risk factors of failure after Non-Vascularized Bone Grafting (NVBG) in osteonecrosis patients, establish and validate a nomogram predictive model of hip survival after NVBG. Methods: Data on ONFH patients undergoing NVBG at our institution between 2010 and 2017 were retrospectively collected. Preoperative risk factors potentially associated with failure after NVBG were assessed by univariate Cox regression analyses. A predictive nomogram was developed based on multivariate Cox regression model. The performance of the nomogram model was evaluated by C statistic. Subjects were stratified according to total points calculated from the nomogram and Kaplan-Meier curves were plotted to further evaluate the discrimination of the model. The model was also internally validated through calibration curves. Results: The overall 2-year and 5-year hip survival percentages were 91.8 and 84.6%, respectively. Age, etiology, Association Research Circulation Osseous stage and range of necrotic lesion were independent risk factors of failure after NVBG. The C statistic of the nomogram model established with these predictors was 0.77 and Kaplan-Meier curves of the tertiles showed satisfactory discrimination of the model. Internal validation by calibration curves indicated favorable consistency between actual and predicted hip survival rate. Conclusion: This predictive model may be a practical tool for patient selection of NVBG. However, future studies are still needed to externally validate this model.

Influence of less invasive hip preservation surgery on subsequent hip arthroplasty for osteonecrosis of the femoral head.

The purpose of this study was to evaluate the outcomes of total hip arthroplasty (THA) following less invasive hip-preserving procedures (LIHPs) and present a critical overview of the literature to aid in better result interpretation. The search time was from the establishment of the database to September 2021, and the outcome indicators were extracted and analyzed by Cochrane Collaboration Review Manager software (RevMan version 5.4). Finally, 10 articles were included in this meta-analysis by searching Chinese databases and English databases. Three of them were published in Chinese, and the remaining studies were published in English. LIHP was further divided into the tantalum rod implantation group and the non-tantalum rod implantation group. The results showed that prior tantalum rod implantation increased the difficulty of conversion to THA, which was reflected mainly in the longer operative time [weighted mean difference (WMD) = 24.50, 95% confidence interval (CI) = 14.09-34.91, P < 0.00001] and greater intraoperative blood loss (WMD = 114.74, 95% CI = 33.52-195.96, P = 0.006), while no significant difference was found between the non-tantalum rod implantation group and the control group. Simultaneously, easier intraoperative fracture [odds ratio (OR) = 5.88, 95% CI = 0.93-37.05, P = 0.06] and stem malalignment (OR = 4.17, 95% CI = 1.18-14.71, P = 0.03) in the LIHP group tended to be observed than in the control THA group. However, there was no significant difference in cup anteversion and inclination angle, ectopic ossification, postoperative Harris Hip Score and survivorship between the LIHP group and the control group. Although LIHP increased the difficulty of the conversion to THA, it does not detrimentally affect the clinical results of subsequent THA in the mid-term follow-up.

Integrated Bioinformatic Analysis of the Shared Molecular Mechanisms Between Osteoporosis and Atherosclerosis.

Background: Osteoporosis and atherosclerosis are common in the elderly population, conferring a heavy worldwide burden. Evidence links osteoporosis and atherosclerosis but the exact underlying common mechanism of its occurrence is unclear. The purpose of this study is to further explore the molecular mechanism between osteoporosis and atherosclerosis through integrated bioinformatic analysis. Methods: The microarray data of osteoporosis and atherosclerosis in the Gene Expression Omnibus (GEO) database were downloaded. The Weighted Gene Co-Expression Network Analysis (WGCNA) and differentially expressed genes (DEGs) analysis were used to identify the co-expression genes related to osteoporosis and atherosclerosis. In addition, the common gene targets of osteoporosis and atherosclerosis were analyzed and screened through three public databases (CTD, DISEASES, and GeneCards). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed by Metascape. Then, the common microRNAs (miRNAs) in osteoporosis and atherosclerosis were screened out from the Human microRNA Disease Database (HMDD) and the target genes of whom were predicted through the miRTarbase. Finally, the common miRNAs-genes network was constructed by Cytoscape software. Results: The results of common genes analysis showed that immune and inflammatory response may be a common feature in the pathophysiology of osteoporosis and atherosclerosis. Six hub genes (namely, COL1A1, IBSP, CTSD, RAC2, MAF, and THBS1) were obtained via taking interaction of different analysis results. The miRNAs-genes network showed that has-let-7g might play an important role in the common mechanisms between osteoporosis and atherosclerosis. Conclusion: This study provides new sights into shared molecular mechanisms between osteoporosis and atherosclerosis. These common pathways and hub genes may offer promising clues for further experimental studies.

Integrated Analysis of Crucial Genes and miRNAs Associated with Osteoporotic Fracture of Type 2 Diabetes.

Purpose: The aim of this study is to explore pathological mechanisms of bone fragility in type 2 diabetes mellitus (T2DM) patients. Methods: Identifying common genes for T2DM and osteoporosis by taking the intersection is shared by the Comparative Toxicogenomics Database (CTD), DISEASES, and GeneCards databases. The differentially expressed genes (DEGs) and the differentially expressed miRNAs (DEMs) were identified by analyzing the Gene Expression Omnibus (GEO) datasets (GSE35958, GSE43950, and GSE70318). FunRich and miRNet were applied to predict potential upstream transcription factors and downstream target genes of candidate DEMs, respectively. The Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed to explore potential mechanisms using Metascape. Eventually, a miRNA-gene network was constructed by Cytoscape software. Results: 271 common targets and 35 common DEGs between T2DM and osteoporosis were screened out in the above databases, and a total of ten DEMs were obtained in the GSE70318. SP1 was predicted to potentially regulate most of the DEMs. Enrichment analysis showed the PI3K-Akt signaling pathway and AGE-RAGE signaling pathway in diabetic complications may play an important role in diabetic skeletal fragility. Two genes (NAMPT and IGFBP5) were considered as key genes involving in the development of diabetic osteoporosis. Through the construction of the miRNA-gene network, most of the hub genes were found to be potentially modulated by miR-96-5p and miR-7-5p. Conclusion: The study uncovered several important genes, miRNAs, and pathological mechanisms involved in diabetic skeletal fragility, among which the PI3K-Akt signaling pathway and AGE-RAGE signaling pathway in diabetic complications may play important roles.

Loureirin B downregulates osteoclast differentiation of bone marrow macrophages by targeting the MAPK signaling pathway.

Excessive absorption of osteoclasts will break the balance between osteoclasts and osteoblasts, leading to bone loss, decreased bone density, and increased bone fragility. We have shown that Loureirin B (LrB) can inhibit osteoclasts. In this study, we demonstrated the targeting-inhibitory mechanism of LrB acting on osteoclast precursor. Using SPR, HPLC and MALDI-TOF-MS to capture and analyze the target protein of Loureirin B in bone marrow macrophages (BMMs), we used this method to detect all target proteins that LrB acts on BMMs, and analyzed the distribution and enrichment rate of the target protein by DAVID enrichment analysis. Ledock molecular docking was used to detect the binding of LrB. We used Western Blot for verification. The target proteins of LrB acting on BMMs were Serpine1, Atp6ap1, Dvl1, Rhd, Fzd2, MAPK1, MAP2K2, MAPK3 and so on. MAPK1, MAP2K2 and MAPK3 were the most relevant. LrB treatment attenuated the expression of phosphorylated JNK and p38 kinases of the MAPK signaling pathway. Our research further confirmed that LrB affects the MAPK signaling pathway in BMMs, thereby inhibiting the differentiation of BMMs into osteoclasts. This discovery can confirm the mechanism by which LrB acts on BMMs.

High-quality nursing can reduce the incidence of adverse events in esophageal cancer patients after operation in the intensive care unit and improve postoperative rehabilitation.

OBJECTIVE: This research aimed at observing the effect of applying high-quality nursing in the intensive care unit (ICU) to esophageal cancer (EC) patients after radical resection. METHODS: From January 2015 to February 2020, 155 EC patients who underwent radical resection were divided into the control group (CG; n=77) and the observation group (OG; n=78). The CG was given conventional nursing intervention, and the OG was given high-quality nursing intervention. The scores of the visual analogue scale (VAS), clinical related indexes, complications, self-rating anxiety scale (SAS), self-rating depression scale (SDS), nursing satisfaction and SF-36 of patients were compared. RESULTS: After nursing, compared with the CG, the duration of the indwelling drainage tube, time to getting out of bed, recovery of bowel sounds and hospitalization in the OG was shorter, and the incidence of postoperative complications was less. In addition, after nursing, the VAS, SAS and SDS scores of patients in both groups decreased, and these indexes in the OG decreased more than those in the CG. Patients were investigated upon discharge, and it was revealed that the nursing satisfaction of patients in the OG was obviously better than that in the CG. Three months after the operation, the scores of general health (GH), mental health (MH), role-physical (RP), role emotional (RE) and vitality (VT) of patients in the OG were higher than those in the CG. CONCLUSION: High-quality nursing exerts a better effect in the ICU for patients who underwent EC surgery; it can reduce pain and adverse events and promote rehabilitation.

Risk factors of postoperative delirium after cardiac surgery: a meta-analysis.

BACKGROUND: Postoperative delirium is a frequent event after cardiac surgery. This meta-analysis aimed to identify relevant risk factors. METHOD: In this meta-analysis, all original researches regarding patients undergoing mixed types of cardiac surgery (excluding transcatheter procedures) and postoperative delirium were evaluated for inclusion. On July 28th 2020, we searched PubMed, Embase, Web of Science and Scopus. Data about name of first author, year of publication, inclusion and exclusion criteria, research design, setting, method of delirium assessment, incidence of delirium, odds ratio (OR) and corresponding 95% confidence interval (CI) of risk factors, and other information relevant was collected. OR and 95% CI were used as metrics for summarized results. Random effects model was applied. RESULTS: Fourteen reports were included with a total sample size of 13,286. The incidence of delirium ranged from 4.1 to 54.9%. Eight risk factors were identified including aging, diabetes, preoperative depression, mild cognitive impairment, carotid artery stenosis, NYHA functional class III or IV, time of mechanical ventilation and length of intensive care unit stay. CONCLUSION: In this study several risk factors associated with postoperative delirium after cardiac surgery were identified. Utilizing the information may allow us to identifying patients at high risk of developing postoperative delirium prior to delirium onset.

Jintiange Capsule May Have a Positive Effect on Pain Relief and Functional Activity in Patients with Knee Osteoarthritis: A Meta-Analysis of Randomized Trials.

BACKGROUND: Knee osteoarthritis (KOA) occurs frequently in the elderly and causes pain, especially when they walk. Traditional Chinese medicine treatment is effective in releasing knee osteoarthritis. Jintiange (JTG) capsule is widely used in treating knee osteoarthritis, but its clinical effects such as pain relief are still unclear. This meta-analysis aims to evaluate the clinical results systematically and negative effects of JTG capsule in patients with knee osteoarthritis. METHODS: A meta-analysis of clinical randomized controlled trials (RCTs) on JTG capsule treatment was carried out in KOA patients. The search time was from the establishment of the database to May 2021. The database included PubMed, Cochrane Library, EMBASE, Web of Science database, Chinese Biomedical database (CBM), Chinese VIP information, China National Knowledge Infrastructure (CNKI), and WanFang database. The outcome indicators were extracted from the included literature and analyzed, and the risk of bias was assessed through Cochrane Handbook 5.0.1. RESULTS: Twenty-two articles analyzed in this study involved 1887 patients. JTG capsule used alone or used with other interventions affects total effective rate significantly (RR: 1.19; 95% Cl: 1.11, 1.29; P=0.045), VAS score (SMD: -0.74; 95% Cl: -0.90, -0.59; P ≤ 0.001), WOMAC score (SMD: -0.77; 95% Cl: -0.96, -0.59; P ≤ 0.001), and Lequesne score (SMD: -0.82; 95% Cl: -1.02, -0.61; P=0.010). CONCLUSION: Our current evidence indicated that JTG capsule may release the pain of KOA patients and improve their functional activity. However, considering the unsatisfactory quality of the included trials, more high-quality trials are needed to prove this issue.

One-stage posterior approach for treating multilevel noncontiguous thoracic and lumbar spinal tuberculosis.

OBJECTIVES: Multilevel noncontiguous thoracic and lumbar spinal tuberculosis (MNST) is a relatively rare entity. The objective of this retrospective study was to investigate whether a technique involving a one-stage posterior debridement and decompression, combined with an intervertebral fusion and posterior instrumentation, is effective for treating MNST. METHODS: Thirteen patients, with an average age of 40.69 (18-67) years, who had MNST and were surgically treated in our department from January 2008 to October 2013, were reviewed. RESULTS: The average follow-up time was 37.54 ± 10.49 (19-58) months. The mean Cobb angle range was 15.69° ± 00A09.09° (-3° to 33°). The mean erythrocyte sedimentation rate (ESR) was 47.69 ± 9.30 mm/h (range 30-62 mm/h) before the operation. Neurological deficits were evaluated using the Frankel grade system. The mean Cobb angle decreased to 6.92° ± 3.93° postoperatively. Three months after the operation, the Cobb angle was 7.54° ± 4.35°, and the average ESR was 10.38 ± 4.54 mm/h that was normal for all cases in this retrospective observational study. Solid fusion was achieved in all cases. No severe complications occurred. CONCLUSIONS: The study demonstrated that a one-stage posterior debridement and decompression, combined with an intervertebral fusion and posterior instrumentation, was effective for treating MNST.