Association of breastfeeding related musculoskeletal pain, sleep quality and physical activity among postpartum women: a literature review

Women often report musculoskeletal ailments during perinatal period resulting in less sleep hours and decline in physical activity. It has been speculated that physical activity can lower the frequency of muscular pain and enhance good quality sleep among women. Hence, the review aimed to investigate the association of breastfeeding related musculoskeletal pain, sleep quality and physical activity thus refining quality of life among women. Literature search was performed using search strategy on PubMed, Scopus and Pedro databases during 2019-2023. A total 54,037 articles were found via database searching out of which only 16 studies were relevant meeting the inclusion criteria. All the studies found that breastfeeding related musculoskeletal pain, sleep quality and physical activity are associated with each other. To lower the incidence of muscular pain and improve sleep quality, physical activity can be incorporated thus preventing occurrence of future complications. Hence, it has been suggested that physical activity is key solution of emerging musculoskeletal pain and broken sleep quality. Evidence from this literature supports that prenatal education emphasizing necessity of physical activity should be routinely integrated into maternal care in an effort to reduce chances of future complications.

Ejercicio terapéutico en la disminución del dolor en pacientes con artrosis de rodilla grado 1: revisión sistemática / Therapeutic exercise to reduce pain in patients with grade 1 knee arthrosis: systematic review / Exercício terapêutico para reduzir a dor em pacientes com artrose grau 1 do joelho: revisão sistemática

La artrosis de rodilla grado 1 es un problema frecuente a escala mundial. La fisioterapia se presenta como una alternativa prometedora para el tratamiento conservador de esta patología, ya que reduce eficazmente la artralgia. Objetivo. Describir la eficacia de los ejercicios terapéuticos para aliviar el dolor en la artrosis de rodilla grado I. Metodología. Se trata de una revisión sistemática, que abarcó una búsqueda exhaustiva en varias bases de datos como Pubmed, Scielo y Elsevier. Los criterios de búsqueda incluyeron ensayos de control aleatorios, experimentales y cuasiexperimentales realizados entre los años 2017 y 2023. Resultados. De un total de 82 documentos se excluyeron 40 al ser estudios secundarios. Posteriormente, se excluyeron 21 estudios adicionales debido a la escasa relación entre las variables del estudio y a su falta de disponibilidad. Finalmente, se seleccionaron 21 artículos que cumplieron con los criterios de evaluación de calidad metodológica mediante la escala CRF-QS. Para evaluar el dolor, la rigidez, la funcionalidad y la calidad de vida, se utilizaron escalas como EVA, NPRS, WOMAC y OXFORD. Los ejercicios isocinéticos resultaron ser los más efectivos, ya que demostraron un aumento de la fuerza y el grosor del cartílago articular, lo que resultó en una disminución de las puntuaciones de EVA de 8,05 a 3,75. Conclusión. El ejercicio terapéutico supervisado centrado en el fortalecimiento de las extremidades inferiores ha demostrado ser una alternativa efectiva para el tratamiento conservador de la artrosis de rodilla grado I. Este enfoque alivia eficazmente el dolor, mejora la calidad de vida e incluso puede detener la progresión de la enfermedad.

Grade 1 knee osteoarthritis is a common problem worldwide. Physiotherapy is presented as a promising alternative for the conservative treatment of this pathology, since it effectively reduces arthralgia. Aim. To describe the effectiveness of therapeutic exercises to relieve pain in grade I knee osteoarthritis. Methodology. This is a systematic review, which included an exhaustive search in several databases such as Pubmed, Scielo and Elsevier. Search criteria included randomized, experimental and quasi-experimental control trials conducted between the years 2017 and 2023. Results. Of a total of 82 documents, 40 were excluded as they were secondary studies. Subsequently, 21 additional studies were excluded due to poor relationships between study variables and lack of availability. Finally, 21 articles were selected that met the methodological quality evaluation criteria using the CRF-QS scale. To evaluate pain, stiffness, functionality and quality of life, scales such as VAS, NPRS, WOMAC and OXFORD were used. Isokinetic exercises were found to be the most effective, demonstrating an increase in articular cartilage strength and thickness, resulting in a decrease in VAS scores from 8.05 to 3.75. Conclusion. Supervised therapeutic exercise focused on strengthening the lower extremities has been shown to be an effective alternative to the conservative treatment of grade I knee osteoarthritis. This approach effectively relieves pain, improves quality of life, and may even stop the progression of osteoarthritis. disease.

A osteoartrite do joelho grau 1 é um problema comum em todo o mundo. A fisioterapia apresenta-se como uma alternativa promissora para o tratamento conservador desta patologia, uma vez que reduz eficazmente a artralgia. Mirar. Descrever a eficácia dos exercícios terapêuticos no alívio da dor na osteoartrite de joelho grau I. Metodologia. Trata-se de uma revisão sistemática, que incluiu uma busca exaustiva em diversas bases de dados como Pubmed, Scielo e Elsevier. Os critérios de pesquisa incluíram ensaios de controle randomizados, experimentais e quase-experimentais realizados entre os anos de 2017 e 2023. Resultados. De um total de 82 documentos, 40 foram excluídos por se tratarem de estudos secundários. Posteriormente, 21 estudos adicionais foram excluídos devido às más relações entre as variáveis do estudo e à falta de disponibilidade. Por fim, foram selecionados 21 artigos que atenderam aos critérios de avaliação da qualidade metodológica pela escala CRF-QS. Para avaliar dor, rigidez, funcionalidade e qualidade de vida foram utilizadas escalas como VAS, NPRS, WOMAC e OXFORD. Os exercícios isocinéticos foram considerados os mais eficazes, demonstrando um aumento na força e espessura da cartilagem articular, resultando em uma diminuição nos escores VAS de 8,05 para 3,75. Conclusão. O exercício terapêutico supervisionado focado no fortalecimento das extremidades inferiores tem se mostrado uma alternativa eficaz ao tratamento conservador da osteoartrite do joelho grau I. Esta abordagem alivia eficazmente a dor, melhora a qualidade de vida e pode até interromper a progressão da osteoartrite.

Acute sarcoidosis Löfgren Syndrome treated by Chinese medicinal formula based on Syndrome Differentiation: a case - based review / Tratamiento de síndrome de Löfgren de sarcoidosis con fórmula medicinal china basada en diferenciación de síndrome: una revisión basada en casos

Löfgren syndrome (LS) is a unique acute manifestation of sarcoidosis and characterized by erythema nodosum, bilateral hilar lymphadenectasis, and/or bilateral ankle arthritis or periarthritis. A 37 - year - old female patient with LS presented with fever accompanied by multiple joint swelling and pain, nodular skin erythema, and bilateral hilar lymphadenectasis. The patient had received treatment involving non - steroidal anti - inflammatory drugs and glucocorticoids in other hospitals, but the effects were poor, and the conditions reemerged. The LS duration has lasted for more than 3 months. Following traditional Chinese medicine (TCM) treatment, syndrome differentiation as well as giving patients oral Chinese medicine decoction, the symptoms of the patient were rapidly relieved within one week and did not recur during a six - month follow - up period. This case is the first clinical report of acute sarcoidosis LS treated using T CM and reflects the significant advantages of this form of therapy in emergency treatment

El síndrome de Löfgren (LS) es una manifest ación única y aguda de sarcoidosis, caracterizada por eritrema nodoso, linfadenectasis hilar bilateral, y/o a r tritis de tobillo bilateral o periartritis. Una paciente de 37 años de sexo femenino con LS se presentó con fiebre, acompañada de inflamación y do lor múltiple de articulaciones, eritrema nodular cutáneo, y linfadenectasis hilar bilateral. La paciente recibió un tratamiento que consistió en antiinflamatorios no esteroidales y glucocorticoides en otros hospitales, pero los efectos fueron leves y las c ondiciones reemergieron. El LS ha durado más de tres meses. Siguiendo el tratamiento de medicina tradicional china (MTC), la diferenciación de síndrome, así como darles a los pacientes una decocción de medicina china por vía oral, los síntomas de la pacien te rápidamente fueron aliviados en el curso de una semana y no recidivaron durante los seis meses de un seguimiento. El caso es el primer reporte clínico de tratamiento de sarcoidosis aguda asociada a LS usando TCM y refleja las significativas ventajas de esta forma de terapia en el tratamiento de emergencia.

Inhibition of HSP70 release by geniposide improves angiogenesis in moist heat arthralgia spasm syndrome collagen induced arthritis rats / 中国药理学通报

Aim To investigate the relation between the effect of geniposide (GE) in improving angiogenesis in arthralgia spasm syndrome collagen induced arthritis (CIA) rats and the modulation of heat shock proteins 70 (HSP70) release. Methods A CIA model was constructed by multiple intradermal injections of complete Freund's adjuvant (CFA) and an equal volume mixture of chicken type II collagen (CCII) into the dorsal and caudal root regions of rats, on the basis of which a rheumatic fever stimulus was given to build up a moist heat arthralgia spasm syndrome in CIA rats. After successful modeling, the groups were randomly grouped, and the administered groups were gavaged with GE (60, 120 mg · kg

Características clínicas y laboratoriales de pacientes adultos ambulatorios con Chikungunya del Hospital Nacional de Itauguá de Paraguay durante la epidemia 2022-2023

Introducción: La infección aguda por chikungunya produce una infección auto-limitada caracterizada principalmente por fiebre alta, artralgias, artritis, cefalea, mialgias y exantema pruriginoso; una minoría presenta síntomas persistentes que puede evolucionar a la cronicidad. Objetivo: describir las características clínicas y laboratoriales de pacientes adultos ambulatorios con chikungunya en un hospital de referencia durante la epidemia del 2022-2023 en Paraguay. Metodología: estudio descriptivo de corte trasversal de pacientes adultos con chikungunya que consultaron en el Hospital Nacional de Itauguá entre enero-marzo de 2023. Resultados: Se incluyeron 140 pacientes entre 19 y 79 años (edad media: 46,6±13,6), 77,9 % del sexo femenino y 89,3 % del departamento Central. El 72,9 % de los pacientes fueron confirmados por RT-PCR y el resto por la serología o nexo epidemiológico. El 48,6 % tenía alguna comorbilidad, el 65% se encontraba en la fase aguda, y el resto en la fase subaguda (35 %). Los síntomas más frecuentes fueron la poliartralgia (96,4 %); artritis (98,6 %), fiebre (95,7 %), astenia (100 %), mialgias (96,4 %), cefalea (82,9 %), exantema (95 %). Los síntomas gastrointestinales fueron menos frecuentes; náuseas (37 %), vómitos (15,7 %) y diarrea (20 %). Entre los principales hallazgos laboratoriales se encontraron la proteína C reactiva aumentada (45,7 %), leucopenia (23,6 %), eritrosedimentación aumentada (27,9 %), citólisis hepática leve (13,6 %). Todos fueron tratados con paracetamol; el 60,4 % y el 87,8 % de los pacientes en fase aguda y subaguda recibieron AINES, respectivamente. Discusión: La combinación de fiebre alta y artralgia severa fue el rasgo característico de la infección por el virus chikungunya en la epidemia en Paraguay.

Introduction: Acute infection by chikungunya produces a self-limited infection characterized mainly by high fever, arthralgia, arthritis, headache, myalgia and pruritic rash; a minority presents persistent symptoms that can evolve to chronicity. Objective: to describe the clinical and laboratory characteristics of adult ambulatory patients with chikungunya at a referral hospital during the 2022-2023 epidemic in Paraguay. Method: descriptive cross-sectional study of adult patients with chikungunya infection who consulted at the Hospital National de Itauguá between January-March 2023. Results: 140 patients between 19 and 79 years old (mean age: 46.6 ± 13.6), 77.9% female and 89.3% from the Central department, were included. 72.9% of the patients were confirmed by RT-PCR and the rest by serology or epidemiological nexus. 48.6% had some comorbidity, 65% were in the acute phase, and the rest in the subacute phase (35%). The most frequent symptoms were polyarthralgia (96.4%); arthritis (98.6%), fever (95.7%), fatigue (100%), myalgia (96.4%), headache (82.9%), rash (95%). Gastrointestinal symptoms were less frequent such as; nausea (37%), vomiting (15.7%) and diarrhea (20%). Increased C-reactive protein (45.7%), leukopenia (23.6%), increased erythrocyte sedimentation rate (27.9%), and mild hepatic cytolysis (13.6%) were among the main laboratory findings. All patients were treated with paracetamol; 60.4% and 87.8% of the patients in the acute and subacute phase, respectively, received NSAIDs. Discussion: The combination of high fever and severe arthralgia can be considered the characteristic feature of chikungunya virus infection in this epidemic.

Metallic artifact suppression with MAVRIC-SL in magnetic resonance imaging for assessing chronic pain after hip or knee arthroplasty / Supressão do artefato metálico na ressonância magnética com MAVRIC-SL na avaliação da dor crônica em artroplastia de quadril ou joelho

Abstract Objective: To analyze the association between osteolysis at the prosthesis interfaces, as determined by magnetic resonance imaging (MRI) with multiacquisition variable-resonance image combination selective (MAVRIC-SL) sequences, and clinical severity after knee or hip arthroplasty, as well as to assess interobserver and intraobserver agreement on periprosthetic bone resorption. Materials and Methods: This was a cross-sectional study of 47 patients (49 joints) under postoperative follow-up after knee or hip arthroplasty, with chronic pain, between March 2019 and August 2020. All of the patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. The component interfaces were evaluated and ordered into two groups: osseointegrated and osteolytic. Nonparametric tests were used. Results: There were significant differences between the two groups in terms of the mean WOMAC scores: total (p = 0.010); stiffness domain (p = 0.047); and function (p = 0.011) domains. There was substantial interobserver and intraobserver agreement for most analyses of the components. Conclusion: Periprosthetic osteolysis appears to be associated with clinical complaints of pain in the post-arthroplasty scenario, and MAVRIC-SL provides reproducible assessments. It could prove to be an important tool for orthopedists to use in the evaluation of challenging cases of chronic pain after arthroplasty.

Resumo Objetivo: Analisar associação entre osteólise nas interfaces protéticas por ressonância magnética com sequências MAVRIC-SL e a gravidade clínica dos pacientes submetidos a artroplastias de joelho ou quadril. Determinar concordância intraobservador e interobservador na reabsorção óssea peri-implante. Materiais e Métodos: Foi realizado estudo transversal entre março de 2019 e agosto de 2020, com 47 pacientes (49 articulações) em seguimento pós-operatório de artroplastias de joelho ou quadril, com dor crônica, que responderam ao questionário WOMAC. As interfaces dos componentes foram avaliadas e definiram dois grupos: osteointegrado e osteólise. Testes não paramétricos foram usados. Resultados: Houve diferença significativa na média do escore WOMAC entre os grupos (p = 0,010), assim como nos domínios rigidez (p = 0,047) e função (p = 0,011). Houve concordância substancial interobservador e intraobservador para a maioria dos componentes analisados. Conclusão: Osteólise periprótese parece estar associada com a queixa clínica de dor pós-artroplastia, com avaliação reprodutível pela MAVRIC-SL. Isto pode ser uma importante ferramenta para o ortopedista na avaliação de casos desafiadores de dor crônica pós-artroplastia.

Correlation between body mass index and joint pain intensity with gait performance in individuals with osteoarthritis / Correlação entre o índice de massa corporal e intensidade da dor articular com o desempenho da marcha em indivíduos com osteoartrite

ABSTRACT BACKGROUND AND OBJECTIVES: Individuals with osteoarthritis (OA) often have joint pain and are overweight or obese. Thus, the objective of this study was to observe whether there is correlation between body mass index and joint pain intensity with gait performance in individuals with OA. METHODS: Cross-sectional study, which evaluated 60 volunteers, being 30 with clinical diagnosis of knee osteoarthritis and 30 without the disease, of both sexes and aged between 50-82 years. Joint pain intensity was assessed using the Visual Analog Scale, gait-related functional tasks using the Dynamic Gait Index, and the functional mobility using the Timed Up and Go test. RESULTS: There was a correlation between overweight/obesity and high levels of joint pain intensity (p=0.018), with worse performance in gait-related functional tasks (p=0.000) and with worse functional mobility (p=0.034) only for the individuals with OA. High levels of joint pain intensity also correlated with worse performance in the gait-related functional tasks (p=0.000) in the OA group, and also with worse functional mobility in the OA group (p=0.001) and also in the group of individuals without the disease (p=0.032). CONCLUSION: This study identified a correlation between overweight/obesity and high levels of joint pain intensity and worse gait performance in individuals with osteoarthritis. High levels of pain intensity also correlated with worse gait performance in individuals with OA.

resumo JUSTIFICATIVA E OBJETIVOS: Indivíduos com osteoartrite (OA) frequentemente apresentam dor articular e sobrepeso ou obesidade. Assim, o objetivo deste estudo foi observar se existe correlação entre o índice de massa corporal e a intensidade da dor articular com o desempenho da marcha em indivíduos com OA. MÉTODOS: Estudo de corte transversal, que avaliou 60 indivíduos, sendo 30 com diagnóstico clínico de osteoartrite de joelho e 30 sem a doença, de ambos os sexos e com faixa etária entre 50 e 82 anos. A intensidade da dor articular foi avaliada pela Escala Analógica Visual, as tarefas funcionais relacionadas à marcha pelo Dynamic Gait Index e a mobilidade funcional pelo teste Timed Up and Go. RESULTADOS: Houve correlação entre o sobrepeso/obesidade e níveis elevados de intensidade da dor articular (p=0,018), com um pior desempenho nas tarefas funcionais relacionadas à marcha (p=0,000) e com menor mobilidade funcional (p=0,034) apenas para os indivíduos com OA. Os níveis elevados de intensidade de dor articular também mostraram correlação com um pior desempenho nas tarefas funcionais relacionadas à marcha (p=0,000) no grupo com OA, e ainda, com uma menor mobilidade funcional no grupo com OA (p=0,001) e também no grupo de indivíduos sem a doença (p=0,032). CONCLUSÃO: Este estudo identificou correlação entre o sobrepeso/obesidade com níveis elevados de intensidade da dor articular e com um pior desempenho na marcha nos indivíduos com OA. Os elevados níveis de intensidade da dor também mostraram correlação com pior desempenho na marcha nos indivíduos com OA.

Radiographic findings in acromegaly: pictorial essay / Achados radiográficos da acromegalia: ensaio iconográfico

Abstract Acromegaly is an uncommon metabolic disorder, often diagnosed after a long delay. One symptom seen in many patients with acromegaly is arthralgia, a finding that calls for the use of conventional radiography, which can reveal subtle changes that can go unnoticed. The objective of this pictorial essay is to portray the radiographic aspects of acromegaly, seeking to demonstrate the importance of conventional radiography, which, despite its simplicity, can suggest the diagnosis, even in the early stages, thus altering the clinical course of the disease.

Resumo A acromegalia é um distúrbio metabólico pouco frequente, muitas vezes apresentando grande atraso diagnóstico. A artralgia é um dos sintomas mais comumente encontrados nos pacientes acromegálicos, motivando a realização de radiografias convencionais, as quais podem apresentar achados sutis que podem passar despercebidos. O objetivo deste ensaio é retratar os achados radiográficos da acromegalia, buscando demonstrar a importância deste método que, apesar de simples, pode sugerir o diagnóstico, mesmo em fases iniciais, alterando assim o curso clínico da doença.

Effect of Danggui Niantongtang on Intestinal Flora in Adjuvant-induced Arthritis Rats of Wind-dampness-heat Arthralgia：Based on 16S rDNA Sequencing / 中国实验方剂学杂志

ObjectiveTo explore the mechanism of Danggui Niantongtang （DGNTT） against adjuvant-induced arthritis （AA） in rats with wind-dampness-heat arthralgia （FSR） based on the variation of intestinal flora. MethodA total of 60 SD rats were randomized into normal （control） group， FSR group， low-， medium-， and high-dose DGNTT （5.67， 11.34， 22.68 g·kg-1） groups， and methotrexate （MTX） group （1.35 mg·kg-1）， with 10 rats in each group. The rats， except the control group， were injected with Mtb adjuvant and then exposed to artificial climatic chamber （hot and humid with wind） for 64 h for modeling. The rats were treated with water， DGNTT or MTX for 28 days from the day of injection. Arthritis index （AI） of rats was measured and paw volume was determined with a volume meter. The morphology of synovial tissues of the knees was observed based on hematoxylin-eosin （HE） staining and the changes of intestinal flora were analyzed based on 16S rRNA sequencing. ResultDGNTT can alleviate the hyperplasia of synovial tissue and inflammation of AA rats with FSR and inhibit the formation of pannus. The results of 16S rRNA sequencing showed that the relative abundance of Firmicutes， Lactobacillus， Prevotella 9， and Alloprevotella decreased （P<0.05， P<0.01） and the relative abundance of Bacteroidetes and Bacteroides increased （P<0.01） in FSR group compared those in the control group. Compared with the FSR group， all DGNTT groups and MTX group had high relative abundance of Lactobacillus （P<0.05， P<0.01） and low relative abundance of Bacteroidetes （P<0.01） and medium-dose and high-dose DGNTT groups and MTX group showed high abundance of Firmicutes， Prevotella 9， and Alloprevotella and low abundance of Bacteroides （P<0.05， P<0.01）. Spearman's correlation analysis suggested that the abundance of Bacteroides and Helicobacter was in positive correlation with AI （P<0.05）， while the abundance of Prevotella 9 and Candidatus Saccharimonas was in negative correlation with AI （P<0.01， P<0.05）. There was a negative correlation between the abundance of Prevotella 9 and paw volume （P<0.01）， and the abundance of Ruminococcaceae NK4A214 group， Christensenellaceae R-7 group， and Bacteroides was in negative correlation with spleen index （P<0.05）. The abundance of Prevotella 9 was in negative correlation with spleen index （P<0.01）. ConclusionDGNTT is effective for arthritis with FSR， as it can regulate the composition of intestinal flora in AA rats by increasing the abundance of probiotics and inhibiting the growth of pathogenic bacteria. The mechanism is the likelihood that it improves intestinal immune metabolism to ensure intestinal homeostasis.

Investigation of pharmacological characteristics and mechanisms of Qufeng Gutong Cataplasm based on a "disease-syndrome-symptom-formula" association network analysis / 药学学报

Growing clinical evidence shows that Qufeng Gutong Cataplasm may exert a significant analgesic effect. However, the pharmacological characteristics and mechanisms underlying this prescription are still unclear. In the current study, a "disease-syndrome-symptom-formula" association network analysis was performed to explore the pharmacological characteristics and mechanisms of Qufeng Gutong Cataplasm against osteoarthritis (OA), neuropathic pain (NP), chronic inflammatory pain (CIP) and myofascial pain syndrome (MPS) by integrating clinical phenomics data, transcriptomics data and biological interaction network mining. As a result, the three functional modules (Qufeng Sanhan-QFSHG, Shujin Huoxue-SJHXG and Xiaozhong Zhitong-XZZTG) enriched by the drug network targets were all related to the pharmacological effects of Qufeng Gutong Cataplasm, including dispersing cold and relieving pain, activating blood and relieving pain, reducing swelling and relieving pain. In addition, the main pharmacological effects of QFSHG and XZZTG were dispelling wind and dispersing cold and dehumidifying, promoting Qi and reducing swelling and relieving pain, respectively. In terms of reversing the imbalance of "immune-inflammation-vascular axis", the main pharmacological effects of SJHXG were regulating the liver and promoting Qi, activating blood circulation and removing stasis. Mechanically, the key network targets of Qufeng Gutong Cataplasm against OA, NP, CIP and MPS may play a therapeutic role in relieving hyperalgesia and paresthesia by reversing the "neuro-endocrine-immune" imbalance system during the occurrence and progression of diseases. In conclusion, our data indicate that Qufeng Gutong Cataplasm may relieve the pain and wind-cold-dampness arthralgia syndrome related symptoms by regulating the "neuro-endocrine-immune" system, neurological and endocrine disorders and reversing the imbalance of "immunity-inflammation". The relevant results may provide a network-based evidence for clinical positioning of Qufeng Gutong Cataplasm, and offer a direction for further clinical and experimental validation.

To explore the quality markers of Huangqin Qingre Chubi capsule in the treatment of rheumatoid arthritis based on network pharmacology combined with pharmacokinetics and target verification / 药学学报

As an effective prescription for the treatment of rheumatoid arthritis (RA), Huangqin Qingre Chubi capsule (HQC) is still blank in quality control. This study aims to explore quality markers (Q-markers) for HQC in the treatment of RA by integrating network pharmacology and pharmacokinetics. By constructing the visualization network of "pharmacodynamic ingredient-target-pathway", the potential Q-Marker of HQC treatment for RA was preliminatively predicted. A rat model of rheumatic heat obstruction syndrome collagene-induced arthritis (CIA) was established to elucidate the dynamic quantification law of pharmacodynamic components of HQC in the disease state of rats. To establish the inflammatory model of RA synovial fibroblasts (MH7A) induced by tumor necrosis factor-α (TNF-α) in vitro. The effects of active ingredients on protein expression of sphingosin kinase-1 (Sphk1) and p-SphK1 were detected. The network pharmacological results showed that baicalin, geniposide, luteolin, coixol and amygdalin were the important active components of HQC treatment for RA. Quantitative analysis results further verified the measurability of these five components. The expression of Sphk1 and p-SphK1 was significantly inhibited by geniposide and baicalin by Western blotting. The above studies determined that the above 5 components could be used as Q-markers in the treatment of RA by HQC. This experiment was approved by the Experimental Animal Ethics Committee of Anhui University of Chinese Medicine (approval number: AHUCM-rats-2021049). All procedures were conducted in strict accordance with the principles of animal use and care.

Condición postCOVID-19 en trabajadores de la salud. La Habana. Un año de seguimiento

Introducción: La COVID-19 es una enfermedad con brechas en su conocimiento. Se requiere explorar sus manifestaciones clínicas en el tiempo y consecuencias para el desempeño en la población trabajadora. Objetivo: Identificar características clínica-epidemiológicas y aptitud para el trabajo en trabajadores de la salud convalecientes de la COVID-19. Material y Métodos: Se realizó un estudio longitudinal prospectivo con trabajadores de la salud de La Habana. La población estuvo constituida por 40 trabajadores, quienes acudieron a consulta de convalecientes de la COVID-19 en mayo de 2021, a los que se les dio seguimiento hasta mayo de 2022. Resultados: Persistieron al cierre del año, la disnea (18,8 %), insomnio (18,8 %), artralgia (12,5 %). La hipertensión arterial, obesidad y asma bronquial fueron las principales comorbilidades. Aptos para el puesto trabajo, 100 % de los trabajadores. Conclusiones: Los síntomas postCOVID-19 disminuyeron considerablemente a partir de los 8 meses del inicio de la enfermedad y persistieron la disnea, artralgia e insomnio al cierre del año.

Introduction: COVID-19 is a disease with gaps in its knowledge. It is required to explore its clinical manifestations over time and consequences for performance in the working population. Objective: To identify the clinico-epidemiological characteristics and the fitness to work in health workers convalescing from COVID-19. Material and Methods: A prospective longitudinal study was carried out on health workers in Havana. The population consisted of 40 workers who attended the COVID-19 convalescent consultation and were followed up in May 2022. Results: Dyspnea (18.8 %), insomnia (18.8 %), and arthralgia (12.5 %) persisted at the end of the year. Hypertension, obesity and bronchial asthma were the main comorbidities. In addition, 100 % of workers were fit for work. Conclusions: PostCOVID-19 symptoms deceased considerably 8 months after the onset of the disease; dyspnea, arthralgia, and insomnia persisted at the end of the year.

The impact of Chikungunya chronic arthralgia on women's upper limbs motor function: a cross-sectional study / O impacto da artralgia crônica pós-Chikungunya na função motora dos membros superiores de mulheres: um estudo transversal / El impacto de la artralgia crónica poschikunguña en la función motora del miembro superior de mujeres: un estudio transversal

ABSTRACT Post-Chikungunya chronic arthralgia (PCCA) may lead to musculoskeletal repercussions and functional loss. The objective was to assess the upper limb physical disability and symptoms during daily, work, and leisure activities of women presenting PCCA compared to healthy controls (HC). This was a cross-sectional study conducted with 52 women. The participants were divided into PCCA (37) and HC (15) groups. Handgrip strength, range of motion, level of pain (numerical rating scale), and participants' physical disability and symptoms (Disabilities of the Arm, Shoulder, and Hand Questionnaire - DASH) were evaluated. Differences between groups were evaluated using the Students t-test and Pearson's correlations. The chi-square test was applied for categorical variables. The significance was set at α=0.05. The disease duration was 19.5±13.1 months. We found no differences between groups for peak force (PCAA:23.6±7.4kgf; HC: 24.5±6.2kgf; p=0.676). The results showed a significant difference between groups regarding range of motion (PCCA: 63.5±17.3o; HC: 77.2±9.6o), level of hand pain (PCCA: 5.8±2.2; HC: 0.4±1.5), and upper limbs functional levels (PCCA: 44.5±17.4; HC: 16.2±20.5). Participants related severe difficulty or inability to perform tasks such as opening a jar (78.4%), placing objects above head height (48.7%), doing heavy household chores (56.8%), and gardening (51.4%). Impairment in the upper limb physical function in daily, work, and leisure activities shows the higher prevalence in the long-term.

RESUMO A artralgia crônica pós-Chikungunya (ACPC) pode gerar repercussões musculoesqueléticas e perda funcional. Nesse sentido, o objetivo deste estudo foi avaliar a incapacidade física e os sintomas de membros superiores de mulheres com ACPC durante atividades diárias, laborais e de lazer comparadas aos controles saudáveis (CS). Para tanto, realizou-se um estudo transversal conduzido com 52 mulheres. As participantes foram divididas entre os grupos com ACPC (37) e CS (15). Foram avaliados força de preensão, amplitude de movimento (ADM), nível de dor (escala numérica de dor) e incapacidade física e sintomas por meio do Disabilities of the Arm, Shoulder and Hand Questionnaire (Dash). Diferenças entre os grupos foram avaliadas pelo teste t de Student e correlações de Pearson. O teste qui-quadrado foi utilizado para variáveis categóricas e α=0,05 foi estabelecido como nível de significância. Verificou-se que a duração da ACPC foi de 19,5±13,1 meses. Não houve diferença entre os grupos para a força pico (ACPC: 23,6±7,4kgf; CS: 24,5±6,2kgf; p=0,676). Os resultados demonstraram diferença significativa entre os grupos em termos de ADM (ACPC: 63,5±17,3o; CS: 77,2±9,6o), nível de dor nas mãos (ACPC: 5,8±2,2; CS: 0,4±1,5) e níveis funcionais dos membros superiores (ACPC: 44,5±17,4; CS: 16,2±20,5). As participantes relataram extrema dificuldade ou incapacidade para realizar tarefas como abrir um pote (78,4%), colocar objetos em um local acima da cabeça (48,7%), realizar atividades domésticas pesadas (56,8%) e atividades de jardinagem (51,4%). Conclui-se que a função física dos membros superiores durante as atividades diárias, laborais e de lazer constitui o maior comprometimento apresentado a longo prazo.

RESUMEN La artralgia crónica poschikunguña (ACPC) puede tener como efecto repercusiones musculoesqueléticas y pérdida funcional. En este sentido, el objetivo de este estudio fue evaluar la discapacidad física y los síntomas de miembros superiores de mujeres con ACPC durante las actividades diarias, laborales y de ocio en comparación con controles sanos (CS). Por ello, se realizó un estudio transversal con 52 mujeres. Las participantes se dividieron en los grupos ACPC (37) y CS (15). La fuerza de agarre, el rango de movimiento (ROM), el nivel de dolor (escala numérica de dolor), la discapacidad física y los síntomas se evaluaron mediante el Disabilities of the Arm, Shoulder and Hand Questionnaire (Dash). Las diferencias entre los grupos se evaluaron con la aplicación de la prueba t de Student y las correlaciones de Pearson. Se utilizó la prueba de chi-cuadrado para las variables categóricas y se estableció como nivel de significación α=0,05. Se encontró que la duración de la ACPC fue de 19,5±13,1 meses. No hubo diferencia entre los grupos para la fuerza máxima (ACPC: 23,6±7,4kgf; CS: 24,5±6,2kgf; p=0,676). Los resultados mostraron una diferencia significativa entre los grupos respecto al ROM (ACPC: 63,5±17,3o; CS: 77,2±9,6o), el nivel de dolor en la mano (ACPC: 5,8±2,2; CS: 0,4±1,5) y los niveles funcionales de miembros superiores (ACPC: 44,5±17,4; CS: 16,2±20,5). Las participantes informaron una extrema dificultad o incapacidad para realizar tareas como abrir un frasco (78,4%), poner objetos en un lugar más alto (48,7%), realizar actividades domésticas pesadas (56,8%) y actividades de jardinería (51,4%). Se concluyó que la función física de los miembros superiores durante las actividades diarias, laborales y de ocio constituye el mayor compromiso a largo plazo.

Clinical Signs and Symptoms Associated with COVID-19: A Cross Sectional Study / Signos y Síntomas Clínicos Asociados a COVID-19: Un Estudio Transversal

ABSTRACT: Covid-19 is a viral disease that has spread throughout the world, becoming a pandemic. Dysgeusia and anosmia are some of its most frequent symptoms. The aim of the study was to determine the frequent signs and symptoms associated with COVID-19 patients. A cross-secional study from 370 patients with acute respiratory illness admitted by emergenc y services of a hospital in Acapulco. An institutional survey was applied to all patients as a data collection instrument, and a SARS-CoV-2 test, by RT-PCR processed by a certified laboratory. Statistical analysis was performed using the STATA V13 program. The numerical variables without normality were reported in medians, 25th and 75th percentiles, and the Mann W ithney U test was performed for differences between groups. The categorical variables were presented in percentages and differences between groups with Chi-square test. A generalized linear models (GLM) analysis was carried out to determine the most frequent symptoms and signs associated with COVID-19. Clinical signs and symptoms associated to COVID-19 in the bivariate análysis were dysgeusia, odynophagia, anosmia, arthralgia, myalgia, conjunctivitis, and age older than 40 years. In the final multivariate model only age older than 40 years (OR) 2.2; CI 95 % 1.3,3.8) and dysgeusia (OR 2.1; CI95 % 1.2,3.6) kept significance. Dysgeusia, odynophagia, anosmia, arthralgia, myalgia and conjunctivitis are clinical signs and symptoms that can appear in the early stages of the disease, so they could be important for an early diagnosis.

RESUMEN: El Covid-19 es una enfermedad viral que se ha extendido por todo el mundo, convirtiéndose en una pandemia. La disgeusia y la anosmia son algunos de sus síntomas más frecuentes. El objetivo del estudio fue determinar los signos y síntomas frecuentes asociados con los pacientes con COVID-19. Estudio transversal de 370 pacientes con enfermedad respiratoria aguda ingresados por los servicios de emergencia de un hospital de Acapulco. A todos los pacientes se les aplicó una encuesta institucional como instrumento de recolección de datos, y una prueba de SARS-CoV-2, por RT-PCR procesada por un laboratorio certificado. El análisis estadístico se realizó utilizando el programa STATA V13. Las variables numéricas sin normalidad se reportaron en medianas, percentiles 25 y 75, y se realizó la prueba U de Mann Withney para diferencias entre grupos. Las variables categóricas se presentaron en porcentajes y diferencias entre grupos con la prueba de Chi-cuadrado. Se realizó un análisis de modelos lineales generalizados (GLM) para determinar los síntomas y signos más frecuentes asociados a la COVID-19. Los signos y síntomas clínicos asociados a COVID-19 en el análisis bivariado fueron disgeusia, odinofagia, anosmia, artralgia, mialgia, conjuntivitis y edad mayor de 40 años. En el modelo multivariado final solo la edad mayor de 40 años (OR) 2,2; IC 95 % 1,3,3,8) y la disgeusia (OR 2,1; IC95 % 1,2,3,6) mantuvieron significanca estadística. Disgeusia, odinofagia, anosmia, artralgias, mialgias y conjuntivitis son signos y síntomas clínicos que pueden aparecer en etapas tempranas de la enfermedad, por lo que podrían ser importantes para un diagnóstico precoz.

Diagnóstico clínico y por imagen de rodilla de Charcot por neuroartropatía diabética

RESUMEN Introducción: La neuroartropatía es una afección secundaria a enfermedades metabólicas, infecciosas o genéticas. Su localización usual está reportada en el pie, pero puede afectar cualquier articulación, compromete su estado vascular y modifica la condición ósea, genera fracturas, contracturas y luxaciones. Objetivos: Reportar los hallazgos clínicos e imagenológicos de una paciente con neuroartropatía de Charcot por diabetes mellitus, en una localización articular, poco frecuente. Caso Clínico: Paciente femenina de 62 años, procedente del suroccidente colombiano, con antecedentes de diabetes mellitus y complicaciones micro y macrovasculares. Presentó un cuadro clínico de dolor articular en la rodilla derecha, que evolucionó a una imposibilidad para la marcha. En su atención se realizaron diferentes estudios de imagen; se encontró una fractura del cóndilo femoral izquierdo y de los platillos tibiales. Estas características radiológicas típicas, más los cambios clínicos de la articulación, llevaron al diagnóstico de rodilla de Charcot. Se realizaron intervenciones farmacológicas analgésicas, además de inmovilización articular, con adecuada evolución en el seguimiento clínico. Conclusiones: La neuroartropatía con rodilla de Charcot es una afección que debe ser evaluada en todos los pacientes con diabetes mellitus y otras enfermedades, ampliar el panorama de revisión articular a localizaciones menos frecuentes, como la rodilla. Una intervención temprana y multidisciplinaria puede favorecer los desenlaces clínicos positivos.

ABSTRACT Introduction: Neuroarthropathy is a condition secondary to metabolic, infectious, or genetic diseases. Its usual localization is reported in the foot, but it can affect any joint, compromising its vascular status and modifying the bone condition generating fractures, contractures, and dislocations. Objectives: To report the clinical and imaging findings of a patient with Charcot neuroarthropathy due to diabetes mellitus in a rare joint location. Clinical Case: A 62-year-old woman from Colombian southwestern, with a history of diabetes mellitus, in addition to micro and macrovascular complications. She presented a clinical picture of joint pain in the right knee that evolved to an inability to walk. During her care, different imaging tests were performed, finding a fracture of the left femoral condyle and tibial plateau, these typical radiological characteristics plus the clinical changes of the joint, led to the diagnosis of Charcot's knee. Pharmacological interventions were performed in pain in addition to joint immobilization, with adequate evolution in clinical follow-up. Conclusions: Neuroarthropathy is a condition that should be evaluated in all patients with diabetes mellitus and other conditions, expanding the joint revision panorama to less frequent locations such as the knee; early and multidisciplinary intervention can favor positive clinical outcomes.

Expression of LINC00638 in rheumatoid arthritis patients with damp-heat obstruction syndrome and the regulatory mechanisms for inflammation and oxidative stress / 中南大学学报(医学版)

OBJECTIVES@#Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation and joint destruction. Both inflammatory response and oxidative stress contribute to the pathogenesis of RA. Oxidative damage can induce and aggravate the imbalance of immune inflammation and promote cell and tissue damage. In this study, the expression of long non-coding RNA (lncRNA) LINC00638 in peripheral blood of patients with RA damp-heat arthralgia syndrome was observed, and the correlation between LINC00638 and disease activity, immune inflammation and oxidative stress indicator was investigated. Subsequently, the mechanisms for LINC00638 in regulating the inflammatory response and oxidative stress in RA fibroblast-like synoviocyte (FLS) under the condition of overexpression and interference were further explored.@*METHODS@#In this study, 48 RA patients with damp-heat arthralgia syndrome and 27 normal healthy subjects, who came from Department of Rheumatology, First Affiliated Hospital of Anhui University of Chinese Medicine, were included; and they were divided into a RA group and a control group. The expression of LINC00638 in peripheral blood mononuclear cells (PBMC) from the subjects was detected by real-time PCR. Enzyme linked immunosorbent assay (ELISA) was used to detect serum interleukin (IL)-10, IL-17, tumor necrosis factor-α (TNF-α), malondialdehyde (MDA), heme oxygenase 1 (HO-1) and superoxide dismutase 2 (SOD2) expression. Spearman method was used to study the relationship between LINC00638 and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (anti-CCP), and to observe the relation between LINC00638 and the Disease Activity Score of 28 Joint (DAS28), Quantitative Score of Damp Heat Syndrome, Visual Analogue Scale (VAS), Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). RA-FLS was induced by RA-PBMC, and the RA in vitro cell experimental model was established. LINC00638 overexpression plasmid and small interfering RNA (siRNA) were constructed and transfected into RA-FLS. The cell experiments were divided into 4 groups: a pcDNA3. 1- control group, a pcDNA3.1-LINC00638 group, a siRNA-control group, and a siRNA-LINC00638 group. The transfection efficiency of overexpression plasmid and siRNA was detected by real-time PCR, the expression of TNF-α and IL-10 was detected by ELISA, and the expression of antioxidant proteins HO-1 and SOD2 was detected by immunofluorescence.@*RESULTS@#Compared with the control group, the expression of LINC00638 in the RA group was lower (P<0.01). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve of LINC00638 was 0.9271. The DAS28 in RA group was 5.70 (5.40-6.50), the Quantitative Score of Damp-heat Syndrome was 20.0 (17.0-23.0), and the VAS score was 7.0 (6.3-8.0). Compared with the control group, the ESR, CRP, RF, anti-CCP, SAS and SDS scores in the RA group were significantly increased (all P<0.01). Spearman correlation analysis showed that: LINC00638 was negatively correlated with ESR (r=-0.532, P<0.01), CRP (r=-0.367, P<0.05), TNF-α (r=-0.375, P<0.01), MDA (r= -0.295, P<0.05), DAS28 (r=-0.450, P<0.01), and which was positively correlated with SOD2 (r=0.370, P<0.05). After the induction of RA-FLS, the expression level of LINC00638 was significantly decreased (P<0.01), indicating that the stimulation of PBMC could effectively reduce the expression of LINC00638 in RA-FLS, so the experimental model of RA-FLS-induced by PBMC was utilized. Compared with the pcDNA3.1-control group, the expressions of LINC00638, IL-10, SOD2, and HO-1 in the pcDNA3.1-LINC00638 group were significantly increased (all P<0.01), and the expression of TNF-α was decreased (P<0.01). Compared with siRNA-control group, LINC00638, IL-10, SOD2 and HO-1 in the siRNA-LINC00638 group were significantly decreased (all P<0.01), and TNF-α was significantly increased (P<0.01).@*CONCLUSIONS@#LINC00638 is down-regulated in the peripheral blood of RA patients with damp-heat arthralgia syndrome, which is correlated with disease activity, immune inflammation and oxidative stress. Overexpression of LINC00638 can down-regulate pro-inflammatory factors, up-regulate anti-inflammatory factors, and increase antioxidant enzyme activity, thereby improving inflammation and oxidative stress in RA. LINC00638 is the differential lncRNA obtained by the research group's previous high-throughput sequencing of the whole transcriptome of peripheral blood PBMCs in RA patients and validation of clinical samples. In order to deepen the molecular biology research of this gene, the microRNA and mRNA targeted by LINC00638 can be further studied from the perspective of competing endogenous RNAs.

Discussion on medication rules of constipation in Guide to Clinical Practice with Medical Records based on data mining / 国际中医中药杂志

Objective:To explore the medication rules of Ye Tianshi in the treatment of constipation from his clinical records. Methods:The drugs in the prescriptions of intestinal obstruction and stool closure were collected in Guide to Clinical Practice with Medical Records. Then the frequency of the prescriptions and the herbs for the treatment,as well as the herbal natures, flavors and meridian belongings were analyzed by Excel, SPSS 22.0 and SPSS Modeler software. Results:The main syndrome types of Ye's treatment of fecal occlusive disease were internal accumulation of dampness and heat, deficiency of kidney Yang, hyperactivity of fire due to yin deficiency, deficiency of liver and kidney Yin, and dysfunction of lung. The medicinal properties were mainly warm, cold and flat, and the tastes were mainly sweet, pungent and bitter, and the meridians mainly belonged to spleen and stomach, lung, liver, kidney and heart. Armeniacae Semen Amarum, Angelica sinensis, Poria, Semen Platycladi, Trichosanthes kirilowii Maxim, Semen Persicae were often used. The commonly used drug pairs, included Armeniacae Amarum Semen and Trichosanthes kirilowii Maxim, Armeniacae Amarum Semen and Radix Curcumae Aromaticae, Angelica sinensis and Semen Platycladi and so on. Conclusions:Ye Tianshi takes spleen and stomach as the center, pays attention to the important position of dampness pathogen in the pathogenic process, and pays attention to lung Qi purging, liver Qi drainage and bladder gasification. It provides new treatment ideas and methods, guiding future doctors.

Efficacy and influential factors of opening wedge high tibial osteotomy for the treatment of knee osteoarthritis / 中国基层医药

Objective:To investigate the efficacy of opening wedge high tibial osteotomy (OWHTO) in the treatment of knee osteoarthritis, and analyze the related factors that affect its clinical efficacy.Methods:The clinical data of 80 patients with knee osteoarthritis who underwent OWHTO between December 2016 and May 2020 in Hospital of the Marine Police Corps of the Chinese People's Armed Police Force were retrospectively analyzed. These patients were divided into effective group ( n = 76) and ineffective group ( n = 4) according to clinical efficacy. The Visual Analogue Scale (VAS), the Hospital for Special Surgery Knee Score (HSS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used to assess the severity of knee osteoarthritis before and 3 months after surgery. The influential factors of clinical efficacy were analyzed. Results:VAS score, WOMAC score, HSS score, joint pain, joint function, joint range of motion, muscle strength, and flexion deformity of 80 patients post-surgery were improved compared with those pre-surgery ( t = 24.92, 21.45, 52.62, 15.87, 10.88, 15.28, 42.54, 11.07, all P < 0.05). After surgery, excellent outcomes were observed in 29 (36.25%) patients, good outcomes in 34 (42.50%) patients, fair outcomes in 13 (16.25%) patients, and poor outcomes in 4 (5.00%) patients. Body mass index, preoperative VAS score, and preoperative WOMAC score in the effective group were (24.10 ± 3.06) kg/m 2, (5.55 ± 1.57) points, and (36.96 ± 9.62) points, respectively, which were significantly lower than those in the ineffective group [(27.64 ± 3.62) kg/m 2, (7.87 ± 1.39) points, (47.95 ± 9.63) points, t = 2.23, 2.89, 2.22]. HSS score in the effective group was significantly higher than that in the ineffective group [(52.81 ± 3.71) points vs. (46.83 ± 3.69) points, t = 3.14, P < 0.05)]. Body mass index, preoperative VAS score, and preoperative WOMAC score were positively correlated with clinical efficacy ( r = 0.24, 0.31, 0.24, P < 0.05), and preoperative HSS score was negatively correlated with clinical efficacy ( r = -0.33, P < 0.05). Logistic regression analysis was performed to analyze the above markedly related factors. Preoperative HSS score was an independent protective factor of clinical efficacy of OWHTO, and body mass index and preoperative VAS score were risk factors of clinical efficacy of OWHTO. Conclusion:OWHTO can greatly improve knee function of patients with knee osteoarthritis and reduce postoperative pain. It should be noted that excessive obesity may affect the clinical efficacy of OWHTO, and preoperative VAS score and WOMAC score should be controlled in patients with excessive obesity.

Mechanism of Danggui Niantongtang on Adjuvant Arthritis Rats with Wind-dampness-heat Arthralgia Based on Quantitative Proteomics / 中国实验方剂学杂志

ObjectiveTo explore the mechanism of Danggui Niantongtang （DGNT） against adjuvant arthritis （AA） rats with wind-dampness-heat arthralgia by quantitative proteomics. MethodSixty SD rats were randomly divided into normal group， model group， angelica came pain soup low， medium and high dose group and methotrexate （MTX） group， each group of 10， only the rat tail root subcutaneously inactivated mycobacterium tuberculosis （Mtb） of adjuvant to build model of AA， artificial climate box intervention 16 d rheumatic fever bi syndrome model is set up， building the day began to drug intervention， The intervention lasted for 28 days. The proteins of synovial tissues in experimental rats were extracted. The differential proteins in the medium-dose DGNT group and the model group were detected and analyzed by 4D label-free quantification （4D-LFQ） proteomics. The differentially expressed proteins associated with mitochondrial pathway apoptosis were verified by immunohistochemistry and Western blot. ResultA total of 4 756 proteins were identified from rat synovial tissues， of which 4 234 proteins contained quantitative information. There were 814 differential proteins between the model group and the DGNT group. As revealed by Gene Ontology （GO） and Kyoto Encyclopedia of Gene and Genome （KEGG） enrichment analyses， DGNT had an effect on the synovial proteome of AA rats with wind-dampness-heat arthralgia， and the differential proteins were enriched in the regulation of the immune system， response to acute inflammation， and apoptosis regulation. As demonstrated by the results of immunohistochemistry and Western blot， compared with the model group， the DGNT groups and the MTX group showed increased protein expression of B-cell lymphoma 2 （Bcl-2）-associated X protein （Bax） and cytochrome C （Cyt C）（P<0.05， P<0.01）， reduced Bcl-2 level （P<0.05， P<0.01）， elevated level of cleaved cysteinyl aspartate-specific protease 9 （Caspase-9）/Caspase-9 （P<0.01）， and decreased level of phosphorylated protein kinase B （p-Akt）/Akt（P<0.05， P<0.01）. ConclusionDGNT involved multiple targets in the treatment of AA with wind-dampness-heat arthralgia and it may exert its effect in the prevention and treatment by regulating the Akt/Bax/Bcl-2 pathway and promoting the cell apoptosis in the mitochondrial pathway.

Radiographic aspects in individuals infected by human T-lymphotropic virus type 1 (HTLV-1) with joint pain

Abstract Background: Joint pain in the absence or with little synovitis is observed in a large percentage of HTLV-1 infected subjects. As the virus infect CD4 +and CD8 +positive, macrophages and B cells an exaggerated production of pro-inflammatory cytokines is detected in these patients. However, the possible association of HTLV-1 infection with autoimmune diseases has not been documented definitively and the clinical characteristics of HTLV-1 associated arthropathy has not been defined. The objective this study is to describe clinic and radiographic features in HTLV-1-infected individuals with complaints of joint pain. Methods: Cross-sectional study enrolling HTLV-1-infected individuals with chronic joint pain, aged up to 75 years, both genders and seronegative controls with osteoarthritis. All participants underwent conventional radiography of the hips, knees and ankles. Results: Eighty-one HTLV-1 infected patients and 30 subjects with osteoarthritis participated in the study. Polyarticular and symmetrical arthritis prevailed in the HTLV-1 positive group (54%), while oligoarticular and asymmetrical (44%) were more common in controls ( p < 0.05). The frequency of enthesophytes (90%) in HTLV-1-infected patients was greater than in the control group (73%) ( p < 0.05). Radiographic features were similar in HTLV-1 carriers and in patients with probable or definite HTLV-1 associated myelopathy. The presence of enthesophytes in the absence of joint space reduction or osteophytes was only observed in HTLV-1-infected individuals ( p < 0.001). Magnetic resonance imaging of the ankles of five HTLV-1-infected patients and five controls demonstrated a higher frequency of enthesitis, bursitis and osteitis in the HTLV-1 infected group. Conclusion: HTLV-1-associated arthropathy is clinically characterized by symmetrical polyarthralgia and the main radiological finding is the presence of enthesophytes in the absence of osteophytes and joint space narrowing.