[Expert consensus on clinical application of Wangbi Tablets in treating rheumatoid arthritis and knee osteoarthritis].

Wangbi Tablets are widely used in the treatment of rheumatoid arthritis, knee osteoarthritis and other diseases at pre-sent. Long-term clinical application and research have shown that this drug has a good effect in reducing the pain of related diseases and improving symptoms. Due to the lack of guidance in the instructions and currently no relevant norms to guide the clinical application of Wangbi Tablets, in order to further improve clinicians' understanding of the drug and fully tap the clinical advantages of the drug, the Professional Committee of Orthopedics and Traumatology Drug Research of China Association of Chinese Medicine organized experts in the fields of rheumatism, orthopedics, pharmacy and methodology in Chinese and western medicine to develop expert consensus on Chinese patent medicines in accordance with the relevant requirements of the consensus methodology. Based on full consideration of clinical research evidence and expert experience, the clinical issues were summarized in the consensus, and for those clinical problems supported by evidences, the internationally recognized recommendation evaluation and formulation method GRADE was used to evaluate the evidence and form recommendations; for those clinical issues not supported by evidences, a consensus was reached through the nominal group method to form consensus recommendations. The consensus adopted a concise and clear format to form re-commendations or reach consensus suggestions on the medication regimen, medication characteristics, intervention timing, usage and dosage, course of use and safety issues for the treatment of rheumatoid arthritis and knee osteoarthritis with Wangbi Tablets. It is suggested that its application will better improve the efficacy of Wangbi Tablets in the treatment of rheumatoid arthritis and knee osteoarthritis, at the same time provide a reference for clinicians to use Wangbi Tablets in a standardized, reasonable and safe manner.

Ultrathin chalcogenide nanosheets for photoacoustic imaging-guided synergistic photothermal/gas therapy.

Previous preclinical and clinical studies have shown that using only a single therapy makes it difficult to completely eradicate tumors and restrain cancer metastasis. To overcome this challenge, multi-modal synergistic treatments have attracted considerable attention. Herein, an ultrathin Cu-loaded CoCuFe-selenide (CCFS) was prepared by a facile topotactic transformation from CoCuFe layered double hydroxide (LDH) nanosheets (NSs), followed by surface modification with polyvinyl pyrrolidone (PVP) and l-arginine (L-Arg). The resultant CCFS-PVP-L-Arg (CPA) system shows excellent synergetic photothermal and gas therapy (PTT/GT). The CCFS NSs have strong LSPR absorbance characteristic, with enhanced light absorption in the near-infrared (NIR) region. This endows the CPA nanocomposite with an outstanding photothermal conversion efficiency of 72.0% (pH 7.4) and 81.0% (pH 5.4), among the highest reported for 2D chalcogenide nanomaterials. In addition, NO release from CPA is triggered by decomposition of L-Arg in the H2O2-rich and acidic tumor microenvironment, permitting localized NO gas therapy in the tumor site. In vitro experiments revealed 91.8% apoptosis of HepG2 cells, and in vivo studies showed complete tumor elimination upon treatment with the CPA nanocomposite under NIR irradiation. To the best of our knowledge, this is the first report of combined defect-induced high-efficiency PTT with H2O2 and pH targeted GT.

Structural and tribological characteristics of ultra-low-wear polyethylene as artificial joint materials.

Ultra-low-wear polyethylene (ULWPE) is a new metallocene catalyzed high density polyethylene (HDPE)material. Previous studies have demonstrated that it has excellent biocompatibility and wear resistance, whereupon indicating great potential in the applications to artificial joints. However, as a newly developed material, its tribological behavior and wear resistance mechanism has not been well understood. In the current study, we experimentally evaluated the tribological behavior of ULWPE, and investigated its high wear resistance mechanism in terms of microstructure, crystallization properties, mechanical, physical, and chemical properties. ULWPE manifested the best tribological performance on pin-on-disc (POD) wear tests compared with the most widely used artificial joints materials, with a wear volume of 0.720 ± 0.032 mm3/million cycles (Mc) and 0.600 ± 0.027 mm3/Mc against cobalt-chromium (CoCr) alloy disc and zirconia toughened alumina (ZTA) ceramic disc, respectively. The results of the wear morphology analysis showed that the surface of ULWPE was the slightest, with no obvious surface damage, debris shedding and wear pits. We reveal that three major factors mainly contributed to its high wear resistance. First, ULWPE demonstrated a high crystallinity and a compact crystalline morphology comprised of long linear molecular chains, which contributed to its good mechanical performance. As confirmed by the mechanical test, ULWPE had a very high density, hardness, and tensile elongation at break. The high hardness and strength laid a solid foundation to a low wear volume, and its high ductility and hardness helped to endure abrasive and adhesive wear, resulting in excellent wear resistance. Second, the results of wettability analysis showed that the contact angle formed on the surface of ULWPE was the lowest and the surface energy was the highest. The hydrophilicity of ULWPE provided good lubrication conditions in body fluid. Third, it also had a lower oxidation index. The high hardness, high strength, high ductility and good wetting of ULWPE materials reduced the damage of the material to adhesion and abrasive wear, resulting in excellent wear resistance.

The analgesic efficacy and safety of peri-articular injection versus intra-articular injection in one-stage bilateral total knee arthroplasty: a randomized controlled trial.

BACKGROUND: As an essential component of multimodal analgesia approaches after total knee arthroplasty (TKA), local infiltration analgesia (LIA) can be classified into peri-articular injection (PAI) and intra-articular injection (IAI) according to administration techniques. Currently, there is no definite answer to the optimal choice between the two techniques. Our study aims to investigate analgesic efficacy and safety of PAI versus IAI in patients receiving simultaneous bilateral TKA. METHODS: This randomized controlled trial was conducted from February 2017 and finished in July 2018. Sixty patients eligible for simultaneous bilateral total knee arthroplasty were randomly assigned to receive PAI on one side and IAI on another. Primary outcomes included numerical rating scale (NRS) pain score at rest or during activity at 3 h, 6 h, 12 h, 24 h, 48 h, and 72 h following surgery. Secondary outcomes contained active or passive range of motion (ROM) at 1, 2, and 3 days after surgery, time to perform straight leg raise, wound drainage, operation time, and wound complications. RESULTS: Patients experienced lower NRS pain scores of the knee receiving PAI compared with that with PAI during the first 48 h after surgery. The largest difference of NRS pain score at rest occurred at 48 h (PAI: 0.68, 95%CI[0.37, 0.98]; IAI: 2.63, 95%CI [2.16, 3.09]; P < 0.001); and the largest difference of NRS pain score during activity also took place at 48 h (PAI: 2.46, 95%CI [2.07, 2.85]; IAI: 3.90, 95%CI [3.27, 4.52]; P = 0.001). PAI group had better results of range of motion and time to perform straight leg raise when compared with IAI group. There were no differences in operation time, wound drainage, and wound complication. CONCLUSION: PAI had the superior performance of pain relief and improvement of range of motion to IAI. Therefore, the administration technique of peri-articular injection is recommended when performing local infiltration analgesia after total knee arthroplasty. TRIAL REGISTRATION: The trial was retrospectively registered in the Chinese Clinical Trial Registry as ChiCTR1800020420 on 29th December, 2018. LEVEL OF EVIDENCE: Therapeutic Level I.

Surgical Treatments of Tumor-Induced Osteomalacia Lesions in Long Bones: Seventeen Cases with More Than One Year of Follow-up.

BACKGROUND: Tumor-induced osteomalacia is a rare and fascinating paraneoplastic syndrome usually caused by a small, benign phosphaturic mesenchymal tumor. Most tumors are treated surgically, but we are unaware of any reports that compare the results of curettage and segmental resection for lesions in long bones. METHODS: Seventeen patients (ten male and seven female) with tumor-induced osteomalacia lesions in long bones, who underwent surgical treatment from December 2004 to August 2013 in our hospital, were included in this retrospective study. The mean follow-up (and standard deviation) was 35 ± 27 months (range, twelve to 116 months). The characteristics of the tumor and the effects of different surgical treatments (curettage compared with segmental resection) were evaluated. RESULTS: All patients showed typical clinical characteristics of tumor-induced osteomalacia, including elevated serum fibroblast growth factor-23 (FGF-23); 82% of tumors were in the epiphysis, and 82% grew eccentrically. The mean maximum diameter of the tumors was 2.4 ± 2.0 cm. The complete resection rates were similar for curettage (67%) and segmental resection (80%). However, the recurrence rate after curettage (50%) was higher than that after segmental resection (0%). The complete resection rate for secondary segmental resection (75%) was not different from that for primary segmental resection (83%). All of our cases of tumor-induced osteomalacia were caused by phosphaturic mesenchymal tumors. After successful removal of tumors, serum FGF-23 returned to normal within twenty-four hours and serum phosphorus levels returned to normal at a mean of 6.5 ± 3.5 days. CONCLUSIONS: Most lesions in long bones are located in the epiphysis, so curettage is first suggested to maintain joint function. If curettage is incomplete or there is a recurrence, secondary segmental resection should be considered curative. Changes of serum FGF-23 and phosphorus levels before and after the operation may be of prognostic help.