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BACKGROUND:Currently,there have been a variety of conservative and surgical treatment plans for spontaneous osteonecrosis of the knee,achieving excellent results.However,a broad consensus on indication and guide of surgical treatment has not been announced.In clinical practice,there is still a misunderstanding that unicondylar replacement or total knee arthroplasty should be performed upon the discovery of spontaneous osteonecrosis of the knee,while an urgent need for universal access to the concept of stepwise therapy. OBJECTIVE:To summarize and find the factors leading to the poor effect of conservative treatment in spontaneous osteonecrosis of the knee,which occurred on the medial femoral condyle,from the literature and clinical cases,at the same time,combined with the Koshino stage,to propose the strategy of stepwise spontaneous osteonecrosis of the knee treatment on the medial femoral condyle. METHODS:A systematic search of the literature database was conducted to summarize the factors leading to poor outcomes of conservative treatment in spontaneous osteonecrosis of the medial femoral condyle.Meanwhile,according to the Clinical&Health Records for analytics&Sharing system,the cases receiving conservative and surgical treatment in spontaneous osteonecrosis of the medial femoral condyle in the Department of Orthopedics of Guangdong Provincial Hospital of Chinese Medicine from January 2017 to January 2023 were analyzed retrospectively,then the causes of success and failure in typical cases were summarized and analyzed. RESULTS AND CONCLUSION:(1)Early diagnosis and treatment of spontaneous osteonecrosis of the knee were very important for prognosis.For sudden knee pain in some patients,if no obvious abnormality was found in the X-ray examination,and the symptoms persisted and could not be relieved for more than 1 week,an MRI examination was recommended to detect early spontaneous osteonecrosis of the knee.(2)The X-ray images of Koshino stage 1 and stage 2 of spontaneous osteonecrosis of the medial femoral condyle were difficult to be distinguished,which needed to be probed by MRI.MRI images of Koshino stage 1 were mainly characterized by bone marrow edema,and an osteonecrosis area with a clear boundary was not formed,while MR images of Koshino stage 2 showed a necrotic area with a clear boundary.(3)Five factors leading to the poor effect of conservative treatment on spontaneous osteonecrosis of the medial femoral condyle were summarized:a.The necrotic area was>5 cm2;b.The necrotic area accounted for more than 40%of the condyle;c.relative compression percentage of medial meniscus≥33%(with or without medial meniscus injury and subchondral bone marrow edema);d.MRI depth of necrotic area(anterior-posterior diameter of sagittal necrotic area)>20 mm;e.varus deformity of lower limb>6°.(4)Conservative treatment of spontaneous osteonecrosis of the knee in Koshino stage 1 was good.For spontaneous osteonecrosis of the knee in Koshino stage 2,conservative treatment was preferred or combined with drilling decompression.If there was no relief or improvement of symptoms or in MRI after 3 months,while the patient had any of the previous five factors,then knee preservation surgery should be considered.For spontaneous osteonecrosis of the knee in Koshino stage 3 and stage 4,knee preservation surgery should be selected based on the previous five factors,including age,gender and activity level of the patient.Total knee arthroplasty was used for spontaneous osteonecrosis in Koshino stage 4,which was associated with symptomatic patellofemoral arthritis,valgus alignment,or necrotic area,which greatly affected the stability of unicondyle prosthesis.
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Objective:To evaluate the role of glutamate receptor 2 (GluR2) in cognitive dysfunction induced by chronic neuroinflammation in mice.Methods:Sixty adult male C57BL/6 mice, aged 8-10 weeks, weighing 18-25 g, were divided into 4 groups ( n=15 each) using a random number table method: control + dimethyl sulfoxide (DMSO) group (group C+ DMSO), control + AMPA receptor selective non-competitive antagonist CFM-2 group (group C+ CFM-2), lipopolysaccharide (LPS)+ DMSO group and LPS + CFM-2 group.In C+ DMSO group and C+ CFM-2 group, normal saline 0.2 ml was intraperitoneally injected every day for 10 consecutive days, and 10% DMSO 0.165 ml and CFM-2 33 μmol/kg (diluted to 0.165 ml with 10% DMSO) were intraperitoneally injected, respectively, on the 10th day after injection of normal saline.In LPS + DMSO group and LPS + CFM-2 group, LPS 0.5 mg/kg (diluted to 0.2 ml with normal saline) was intraperitoneally injected every day for 10 consecutive days, and 10% DMSO 0.165 ml and CFM-2 33 μmol/kg (diluted to 0.165 ml with 10% DMSO) were intraperitoneally injected, respectively, after LPS injection on the 10th day.The Y-maze test was performed at 48 h after the end of administration, then the animals were sacrificed, and the hippocampal tissues were taken for determination of the expression of GluR2, ionized calcium binding adapter molecule 1 (Iba1), tumor necrosis factor-α (TNF-α) (by Western blot) and the number of microglia in hippocampal CA1 area (by immunofluorescence). Results:Compared with group C + DMSO, the percentage of spontaneous alternation was significantly decreased, the expression of GluR2, Iba1 and TNF-α in hippocampus was up-regulated, the number of microglia in hippocampal CA1 area was increased ( P<0.05), and no significant change was found in the parameters mentioned above in group LPS + DMSO ( P>0.05). Compared with group LPS + DMSO, the percentage of spontaneous alternation was significantly increased, the expression of GluR2, Iba1 and TNF-α in hippocampus was down-regulated, and the number of microglia in hippocampal CA1 area was decreased in group LPS+ CFM-2 ( P<0.05). Conclusions:GluR2 is involved in chronic neuroinflammation-induced cognitive dysfunction through activation of microglia in mice.
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OBJECTIVE:To ex plore the protective effects of Longbie capsule contained serum (called“LBJN”for short )on the apoptosis of chondrocytes induced by YAP inhibitor verteporfin and its mechanism. METHODS :Primary human knee osteoarthritis(OA)chondrocytes were extracted by two-step enzymatic digestion ,and then identif ied by toluidine blue staining and type Ⅱ collagen immunofluorescence staining. The effects of 2,5 μmol/L verteporfin alone or combined with 5%LBJN on cell apoptosis were detected by flow cytometry. Solvent control (0.1% DMSO)and 5% LBJN were set. Western blot assay was adopted to detect the expression of apoptosis related proteins (YAP,Bcl-2,cleaved-caspase-3) after treated with 0.1%DMSO(solvent control ),2 μmol/L verteporfin,2 μmol/L verteporfin+5%LBJN 和 0(blank control ),2.5% LBJN and 5% LBJN for 48 h. The expression of autophagy related proteins (mTOR,Beclin-1,LC3A/B) after treated with 0 (blank control ),2.5%,5% LBJN for 48 h were det ected by Western blot assay. RESULTS :The isolated cells accorded with the characteristics of chondrocytes. Compared with 0.1%DMSO, the apoptosis rates of cells were increased significantly after treated with 2,5 μmol/L verteporfin(P<0.05),and the effects of the two concentrations were similar (P>0.05). Compared with verteporfin alone ,2,5 μmol/L verteporfin combined with 5%LBJN could significantly decrease the apoptotic rate of cells (P<0.05). Compared with 0.1%DMSO,the protein expression of YAP and Bcl-2 were decreased significantly after treated with 2 μ mol/L verteporfin (P<0.05), while the protein expression of cleaved-caspase-3 were increased significantly (P<0.05). Compared with 2 μmol/L verteporfin,protein expression of YAP and Bcl-2 were increased significantly after treated with 2 μmol/L verteporfin+5%LBJN(P<0.05),while the protein expression of cleaved-caspase-3 were decreased significantly (P<0.05). Compared with blank control ,the protein expression of YAP ,Bcl-2 and Beclin-1 were increased significantly after treated with 2.5%,5%LBJN(P<0.05),while protein expression of cleaved-caspase- 3 and mTOR were decreased significantly (P<0.05). CONCLUSIONS :LBJN can block the apoptosis of chondrocytes induced by YAP inhibitor verteporfin ,and its mechanism may be related to regulating the expression of apoptosis related proteins and enhancing autophagy of chondrocytes.
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Neck myoclonus is part of sleep-related dyskinesia characterized by sudden myoclonus during night sleep. Myoclonus causes pronounced brief rotation or flexion of the head. As a single event, neck myoclon ususually occurs during rapid eye movement (REM) sleep, and it lasts longer than 0.5-1.0 s. At present, neck myoclonus is rarely reported. A 28-year-old male whose clinical manifestation was repeated head swing during sleep was admitted to Tangdu Hospital. Video-polysomnography showed that all the events occurred during REM sleep, and some of them were accompanied by micro-arousal reaction and leg movement. Small does of clonazepam could relieve symptoms.
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OBJECTIVE: To study the effects of ligustrazine on miR-20b/VEGF and BMP2/Smad1 pathways in subchondral bone of knee osteoarthritis (KOA) model rats, and to investigate the mechanism of ligustrazine for KOA prevention and treatment. METHODS: Totally 18 healthy male SD rats were randomly divided into normal control group, model group and ligustrazine group, with 6 rats in each group. The rats in the latter two groups were used to establish KOA model by intra-articular injection of 4% papain solution. From the 2nd day after the last injection, ligustrazine group was given intragastrical administration of Ligustrazine suspension (100 mg/kg) 2 mL; normal control group and model group were given intragastrical administration of isometrical normal saline, once a day, for consecutive 6 weeks. After the last after medication, the situation of bilateral knee articular cartilage of rats were observed after exposure. The knee joints of rats were sectioned and stained with HE. The pathological change of articular cartilage were observed by microscope and scored by modified Mankin’s score. mRNA expression of VEGF, BMP2 and Smad1, and the expression of miR-20b were detected by RT-PCR; the protein expression of VEGF, BMP2 and Smad1 were detected by Western blot assay. RESULTS: Model group and ligustrazine group suffered from cartilage injury of knee joint at varying degrees. Compared with normal control group, Mankin’s scores of knee joint and cartilage tissue were increased significantly in model group (P<0.01); mRNA and protein expression of BMP and Smad1, the expression of miR-20b in subchondral bone of model group were decreased significantly, while mRNA and protein expression of VEGF were increased significantly (P<0.01). Compared with model group, Mankin’s score of cartilage tissue were decreased significantly in ligustrazine group (P<0.01); mRNA and protein expression of BMP and Smad1, the expression of miR-20b in subchondral bone were increased significantly, while mRNA and protein expression of VEGF were decreased significantly (P<0.05 or P<0.01). CONCLUSIONS: Ligustrazine can repair damaged articular cartilage in KOA model rats, the mechanism of which may be associated with inhibiting the protein expression of VEGF and activating BMP-2/Smad1 signaling pathway via up-regulating the expression of miR-20b, and promoting the degradation of VEGF mRNA in subchondral bone.
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Objective To explore the risk factors of hidden blood loss after UKA.Methods A retrospec-tive study was conducted on 273 patients who underwent UKA from January 2015 to December 2016,including 79 males and 194 females,age between 46 to 87 years old,mean age(67.21± 8.23)years old. The clinical data were collected and the blood volume was calculated according to the Nadler formula. The Gross equation was used to calculate the blood loss and the amount of occult blood loss at 3 days after operation. The risk factors were analyzed statistically. Results The volume of hidden blood loss after operation was(75.36 ± 10.21)mL,and the volume of total blood lost after operation was(187.35± 60.31)mL.Sex,BMI and type of prosthesis were risk factors for hidden blood loss after UKA. Conclusions The volume of hidden blood loss after UKA was related to sex, BMI,and type of prosthesis. For the obese and male patients,we should actively take bleeding management and choose the type of prosthesis reasonably.
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Objective To explore the expression and function of galanin and its receptor in the female mice of anxiety-and depression-like behavior.Methods In situ hybridization was used to detect the expression of galanin,GalR1,GalR2 and GalR3 in the hippocampus of C57BL/6J female mice.A total of thirty female mice was divided into two groups:experiment group (n=15) and control group (n=15).The experiment group was subjected to the chronic unpredictable mild stress (CUMS) for four weeks,and the control group was not subjected to any treatment.Four weeks later,a series of tests were performed on those two groups,including the sucrose preference test,the novel object recognition test,the open field test and suspension tail test.After behavior tests,the hippocampus RNA was extracted from eight mice in each group to test the expression of galanin and its receptor through qPCR.The rest part of mice were used to mark C-Fos immunostaining in the dentate gyms (DG) of hippocampus.Results The result of in situ hybridization showed that galanin,GalR1 and GalR2 distributed in the Hillus of ventral hippocamous,GalR3 had no positive signal.In the sucrose preference test,the experiment group drunk less sucrose when compared with the control group (P<0.05).In the novel object recognition test,the experiment group contacted shorter time to the novel object when compared with the control group (P<0.05).In the open field test,the experiment group had shorter in session time when compared with the control group (P<0.05).In the suspension tail test,the experiment group had longer immobility time when compared with the control group (P<0.05).The qPCR result showed that the higher expression of galanin and GalR1 in the hippocampus of experiment group (P<0.05).More C-Fos positive cells in the DG of hippocampus of experiment mice were immunostained (P<0.05).Conclusions Galanin,GalR1 and GalR2 mainly distribute in the Hillus of the ventral hippocampus.Galanin may be involved in the anxiety-and depression-like behavior of C57BL/6J through GalR1.
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BACKGROUND:Kidney-tonifying herbs have been reported to promote tendon-bone healing in rabbits after anterior cruciate ligament reconstruction (ACLR). OBJECTIVE:To verify the effects of kidney-tonifying herbs on tendon-bone healing after ACLR. METHODS:Seventy patients with anterior cruciate ligament injury undergoing ACLR were randomly assigned to study group (administration of Liuwei dihuang pil s+celecoxib) and control group (administration of celecoxib alone). Preoperative, postoperative 6-and 12-month assessments of patients by the Lysholm Knee Scoring Scale, International Knee Documentation Committee (IKDC) Subjective Knee Form and MRI imaging were performed. RESULTS AND CONCLUSION:Postoperative Lysholm scores were significantly increased compared with preoperation in the study and control groups (P<0.05), and the scores of sections stair-climbing and instability and total scores of the Lysholm Knee Scoring Scale in the study group were superior to those in the control group (P<0.05). Postoperative IKDC scores were significantly increased compared with pre-operation in the study and control groups (P<0.05), and the scores of section flaccid leg and subjective function and total scores of the IKDC in the study group were superior to the control group (P<0.05). The enlargement rate of middle and proximal parts of grafts was significantly increased in the study group compared with the control group 6 months postoperatively (P<0.05), and the enlargement rate of middle and distal parts of grafts was significantly increased in the study group compared with the control group 12 months postoperatively (P<0.05). The tibial and femoral tunnel enlargement was observed in both groups at 6 and 12 months postoperatively (P<0.05). The enlargement rate of the tibial tunnel was significantly decreased in the study group compared with in the control group (P<0.05). The signal-noise ratio of the femoral end and middle part of grafts in the study group was significantly higher than that in the control group 6 months postoperatively (P<0.01). In contrast, the signal-noise ratio of the femoral end and middle part of grafts in the study group was significantly lower than that in the control group 12 months postoperatively (P<0.05). Our results indicate that kidney-tonifying herbs can improve the tendon-bone healing after ACLR.
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BACKGROUND: Total knee arthroplasty is a procedure for treatment of knee osteoarthritisa with standardized, mature technology and affirmative efficacy. Total knee arthroplasty can result in overt excessive bleeding, decreased hemoglobin levels, patient mouth infection and other complications. As a new technology, autologous blood transfusion device can effectively reduce the rate of blood transfusion through reinfusing the unwashed and filterable drainage blood after operation. Up to now, no systematic reviews incorporating meta-analyses have found directly sufficient evidence to compare autologous blood transfusion drainage and no drainage after primary total knee arthroplasty. OBJECTIVE: To study the clinical efficacy, safety and potential advantages of the application of autologous blood transfusion device/no drainage based on the meta-analysis. METHODS:PubMed, Embase, the Cochrane Library, CBMdisc, China HowNet, VIP, Wanfang database were searched comprehensively by computer. The search strategies were developed by the way of MeSH terms combining with free words: “total knee replacement” OR “total knee arthroplasty” OR “total knee prosthesis” OR “unicompartmental” OR “unicondylar” OR “unicompartmenta” OR “arthroplasty, replacement, knee” [MeSH terms] AND “autologous blood transfusion” OR “Autotransfusion” OR “blood transfusion, autologous” [MeSH Terms] OR “Intraoperative Blood Salvage” OR “Intraoperative Blood” OR “Postoperative Blood Salvage” OR “Intraoperative Blood Cel Salvage” OR “Operative Blood Salvage” [MeSH Terms]. Data included in the final literature were analyzed using RevMan 5.3.5 software recommended by Cochrane. The main outcome measure was the rate of transfusion. The secondary outcome measures were the average change in hemoglobin, hemoglobin levels at the 3rd day, hospitalization time and intraoperative mouth infection rate. RESULTS AND CONCLUSION:Five randomized controlled trials, a total of 667 patients were enroled. Meta-analysis results showed that there were no significant differences in the transfusion rate (OR=0.73, 95%CI: 0.47-1.13;Z=1.41,P=0.16), average change in hemoglobin (WMD=0.20, 95%CI:-0.28-0.68;Z=0.82,P=0.41), the hemoglobin levels at the 3rdday (WMD=0.41, 95%CI:-0.26-1.09;Z=1.20,P=0.23), hospitalization time (OR=1.01, 95%CI: 0.06-16.27;Z= 0.01,P=1.00), intraoperative mouth infection rate (OR=1.01, 95%CI: 0.06-16.27;Z=0.01,P=1.00) between the postoperative use of autologous blood transfusion and no drainage. These results suggest that the meta-analysis of outcome measures has not provided the evidence-based medical support for the clinical efficacy of autologous blood transfusion device (including blood transfusion rate, the average change in hemoglobin, average hemoglobin change at the 3rd day, hospitalization time). Given the inherent limitations of the quality of the included studies and the publication bias, future high-quality, large-volume, multi-center randomized controled trials are awaited to confirm and update the findings of this analysis.
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Objective To assess the clinical efficiency , safety and potential advantages of autologous blood transfusion (ABT) drains compared with the closed-suction/no drainage. Methods Pubmed, Embase, Cochrane Library, CBMdisc, CNKI, VIP and WANGFANG were searched comprehensively. The statistical anal-ysis was conducted by using the Cochrane Collaboration review Manager 5.3.5. Results The pooled data of seventeen RCTs including a total of 1 993 patients showed that the patients in the ABT drainage group might benefit from the low rate of blood transfusion [ 16 . 59% and 37 . 47%, OR: 0 . 28 ( 0 . 14 ~ 0 . 55 ); 13 . 05% and 16.91%, OR: 0.73 (0.47 ~ 1.13), respectively]. The ABT drainage and the closed-suction drainage/no drainage have the similar clinical efficiency and safety length of hospital stay and wound infection on days 3 post-operative haemoglobin. Conclusion This systematic review provides the evidence that the ABT drainage offers a safe and efficient alternative to CS/no drainage with the lowered blood transfusion rate.
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<p><b>OBJECTIVE</b>To analyze the risk factors to impact biochemical recurrence after radical prostatectomy.</p><p><b>METHODS</b>A total of 1 090 patients who received radical prostatectomy from May 2002 to December 2013 in Department of Urology of Fudan University Shanghai Cancer Center were recruited. The average age of the patients was 67.9 years (ranged from 41 to 84 years) and the average preoperative prostate specific antigen (PSA) level was 32.7 (ranged from 3.2 to 256.3) µg/L. The distribution of patients with respect to clinical stage was: 20.09% (219/1 090) had T1, 50.09% (546/1 090) had T2 and 29.82% (325/1 090) had T3. The biochemical-free-survival curve was drawn by Kaplan-Meier method and the univariate and multivariate Cox regression models were used to evaluate the clinical and pathological variables for the development of biochemical recurrence.</p><p><b>RESULTS</b>Of all the 1 090 patients, the biochemical recurrence free survival was 95.99%, 81.90% and 70.89% at 1, 3 and 5 years. PSA level at diagnosis (P=0.000), neo-adjuvant hormonal therapy (P=0.001), pre-operative Gleason score (P=0.000), clinical stage (P=0.010), surgical margin status (P=0.028), post-operative Gleason score (P=0.000), pathological stages (P=0.000) and pelvic lymph-node metastasis (P=0.000) were associated with biochemical recurrence in the univariate analysis. However, in the multivariate analysis, only PSA level at diagnosis (P=0.000), pre-operative Gleason score (P=0.020), pathological stages (P=0.014) and pelvic lymph-node metastasis (P=0.017) were independent prognostic factors.</p><p><b>CONCLUSION</b>For the patients who received radical prostatectomy, PSA level at diagnosis, pre-operative Gleason score, pathological stages and pelvic lymph-node metastasis status are independent prognostic factors for biochemical recurrence.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , China , Lymphatic Metastasis , Multivariate Analysis , Neoplasm Recurrence, Local , Pelvis , Pathology , Postoperative Period , Proportional Hazards Models , Prostate-Specific Antigen , Blood , Prostatectomy , Prostatic Neoplasms , Pathology , General Surgery , Risk FactorsABSTRACT
Objective To retrospectively analyze the effect of abdominal acupuncture for the casino workers with sleep disorder in chronic fatigue syndrome and analyze the correlation between them.Method 65 patients were all from the Acupuncture Department of Health Center of the Black Sand, Macao Health Bureau, 2011 October to 2013 January, who were diagnosed with sleep disorder in chronic fatigue syndrome and in accordance with the inclusion criteria. They were received abdominal acupuncture treatment for 4 weeks. Pittsburgh sleep quality index(PSQI) and Fatigue Assessment Instrument(FAI)were adopted to evaluate the effect before treatment 、after treatment and one month follow-up. Multiple regression analysis model was used to analyze the correlation of each factor of FAI and PSQI. Results Compared with before treatment (13.78± 3.23), the total score of PSQI after treatment(8.66 ± 4.26)and follow-up(8.26 ± 4.66) were significant decreased(P<0.05);the score of 6 dimensions(sleep quality, Time to fall asleep, sleep time, sleep efficiency, sleep disorders daytime function) after treatment and follow-up were significant decreased(P<0.05),compared with those before treatment;the FAI score after treatment (92.60±14.64) and follow-up(90.75±14.75) were significant lower(P<0.05)than those before treatment (147.55±7.03) .Multiple regression analysis showed that 4 dimensions of PSQI (sleep quality, sleep time, sleep disorders, daytime function)had close relationship with FAI score(r=0.373~0.702, P<0.05). Conclusion Abdominal acupuncture can improve the casino workers' sleep disorder in chronic fatigue syndrome and is worth of further study.
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ObjectiveTo observe the clinical efficacy of external application of sihuang-honey for aseptic inflammation after total knee arthroplasty.Methods 30 cases of total knee arthroplasty patients were recruited into two groups,of 15 cases in each group.The treatment group was treated with sihuang-honey (made of rhubarb,scutellaria,phellodendron,coptis according to the same proportion of powder with honey ),which was placed on a sterile plastic sheet,0.5 cm thickness.The sheet was applied on the knee of the highest skin temperature for 6 hours,removed it for 2 hours interval,and reapplied on it,for altogether 24 hours before changing another sheet.The control group were treated by continued covering ice on the knee every day,with the ice completely surrounded the knee.Both groups were treated for 2 weeks.Clinical efficacy was observed before the treatment,and 3 d,7 d,14 d after the treatment.ResultsAfter the treatment,compared with the control group,the treatment group was effective in terms of VAS score (4.12± 1.08) points in 3d,(3.34±0.61)points in the first 7 days; skin temperature (37.56±0.40) ℃,activity (98.56±3.24) ° in 3d,and the difference was statistically significant (P<0.05).The degree of swelling in 3 d (5.80±2.00) %,7 d (9.33±2.55)%,14 d (12.13 ± 2.70)% in the treatment group were better than the control group (P<0.05); The rate of pain relief of treatment group was 93.33% and satisfaction was 66.67%,although better than 86.67% and 46.67% of the control group,the difference was not statistically significant (x2 were 1.33,3.04,P>0.05).Conclusion Sihuang-honey was effective for the treatment of aseptic inflammation after the surgery of total knee arthroplasty.