Genetic link between depression and musculoskeletal disorders: insights from Mendelian randomization analysis.

Background: The association between depression and musculoskeletal diseases has long been a subject of contentious debate. However, the causal relationship between the two remains uncertain. This study employs a two-sample Mendelian randomization (MR) analysis to investigate the causality between depression and six musculoskeletal diseases. Methods: In this study, we performed MR analysis to systematically explore the causal relationship between depression and six musculoskeletal disorders. Single nucleotide polymorphisms (SNPs) that are linked to depression were employed as instrumental variables. To ensure robust and reliable conclusions, multiple analytical approaches were utilized, including inverse variance weighting(IVW), weighted median, and MR-Egger regression. Additionally, sensitivity analysis methods such as the MR-Egger intercept test, Cochran's Q test, leave-one-out analysis, and funnel plot were employed. Results: Our MR analysis revealed a significant association between depression and cervical spondylosis (depression: OR 1.003, 95% CI 1.002-1.005, P = 8.32E-05; major depressive disorder: OR 1.003, 95% CI 1.001-1.005, P = 0.0052). Furthermore, a strong correlation was noted between major depressive disorder (MDD) and knee osteoarthritis (KOA) (OR 1.299, 95% CI 1.154-1.463, P = 1.50E-5). Sensitivity analysis confirmed the robustness of these findings. Our independent validation study also corroborated these results. Conclusion: The MR analysis conducted in this study provides evidence supporting a genetic link between depression and cervical spondylosis, as well as KOA. Targeted interventions to manage depression in susceptible populations may contribute to lowering the risk of cervical spondylosis and KOA in these cohorts.

Clinical evaluation of platelet-rich plasma therapy for osteonecrosis of the femoral head: A systematic review and meta-analysis.

OBJECTIVE: This meta-analysis aims to assess the efficacy and safety of platelet-rich plasma (PRP) for osteonecrosis of the femoral head (ONFH). METHODS: We comprehensively searched randomized controlled trials in PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, WanFang, and Chinese BioMedical Literature Database from inception until October 25, 2024. The literature on the clinical efficacy of autologous PRP for ONFH was collated. According to the inclusion and exclusion criteria, the literature was screened, quality evaluated and the data was extracted. Meta-analysis was carried out with the software Review Manager 5.4.1 software and Stata 17.0 software. In addition, potential publication bias was detected by the funnel plot test and Egger's test. The GRADE system was used to evaluate the quality of evidence for outcome indicators. RESULTS: Fourteen studies involving 909 patients were included in this study. Compared with non-PRP, PRP exhibited significant improvements in the Harris hip score (HHS) at 3 months (MD = 3.58, 95% Cl: 1.59 to 5.58, P = 0.0004), 6 months (MD = 6.19, 95% Cl: 3.96 to 8.41, P < 0.00001), 12 months (MD = 4.73, 95% Cl: 3.24 to 6.22, P < 0.00001), ≥ 24 months (MD = 6.83, 95% Cl: 2.09 to 11.59, P = 0.0003), and the last follow-up (MD = 6.57, 95% Cl: 4.81 to 8.33, P < 0.00001). The PRP also showed improvement in HHS compared to baseline than the non-PRP at 3 months (MD = 3.60, 95% Cl: 1.26 to 5.94, P = 0.003), 6 months (MD = 6.17, 95% Cl: 3.74 to 8.61, P < 0.00001), 12 months (MD = 5.35, 95% Cl: 3.44 to 7.25, P < 0.00001), ≥ 24 months (MD = 8.19, 95% Cl: 3.76 to 12.62, P = 0.0003), and the last follow-up (MD = 6.94, 95% Cl: 5.09 to 8.78, P < 0.00001). The change in visual analog scale (VAS) score 3 months post intervention (MD = -0.33, 95% Cl: -0.52 to -0.13, P = 0.001), 6 months (MD = -0.69, 95% Cl: -0.90 to -0.48, P < 0.00001), 12 months (MD = -0.75, 95% Cl: -1.05 to -0.46, P < 0.00001), ≥ 24 months (MD = -1.05, 95% Cl: -1.20 to -0.89, P < 0.00001), and the last follow-up (MD = -0.75, 95% Cl: -0.97 to -0.54, P < 0.00001). The PRP also showed a decrease in VAS score compared to baseline than the non-PRP at 3 months (MD = -0.29, 95% Cl: -0.41 to -0.17, P = 0.003), 6 months (MD = -0.63, 95% Cl: -0.96 to -0.30, P = 0.0002), 12 months (MD = -0.78, 95% Cl: -1.22 to -0.33, P = 0.0006), ≥ 24 months (MD = -1.11, 95% Cl: -1.27 to -0.96, P < 0.00001), and the last follow-up (MD = -0.74, 95% Cl: -1.05 to -0.43, P < 0.00001). Additionally, it was found that the PRP group had the advantages in the following aspects: collapse rate of the femoral head (RR = 0.33, 95% Cl: 0.17 to 0.62, P = 0.0006), rate of conversion to total hip arthroplasty (RR = 0.37, 95% Cl: 0.18 to 0.74, P = 0.005), and overall complications (RR = 0.33, 95% Cl: 0.13 to 0.83, P = 0.02). The GRADE evidence evaluation showed overall complication as very low quality and other indicators as low quality. CONCLUSION: There is limited evidence showing benefit of PRP therapy for treatment of ONFH patients, and most of this evidence is of low quality. Caution should therefore be exercised in interpreting these results. It is recommended that future research involve a greater number of high-quality studies to validate the aforementioned conclusions. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/ #recordDetails, CRD42023463031.

Integrated Network Pharmacology and Experimental Validation Approach to Investigate the Mechanisms of Radix Rehmanniae Praeparata - Angelica Sinensis - Radix Achyranthis Bidentatae in Treating Knee Osteoarthritis.

Background: Knee osteoarthritis (KOA) is a persistent degenerative condition characterized by the deterioration of cartilage. The Chinese herbal formula Radix Rehmanniae Praeparata- Angelica Sinensis-Radix Achyranthis Bidentatae (RAR) has often been used in effective prescriptions for KOA as the main functional drug, but its underlying mechanism remains unclear. Therefore, network pharmacology and verification experiments were employed to investigate the impact and mode of action of RAR in the treatment of KOA. Methods: The destabilization of the medial meniscus model (DMM) was utilized to assess the anti-KOA effect of RAR by using gait analysis, micro-computed tomography (Micro-CT), and histology. Primary chondrocytes were extracted from the rib cartilage of a newborn mouse. The protective effects of RAR on OA cells were evaluated using a CCK-8 assay. The antioxidative effect of RAR was determined by measuring reactive oxygen species (ROS), superoxide dismutase (SOD), and glutathione (GSH) production. Furthermore, network pharmacology and molecular docking were utilized to propose possible RAR targets for KOA, which were further verified through experiments. Results: In vivo, RAR significantly ameliorated DMM-induced KOA characteristics, such as subchondral bone sclerosis, cartilage deterioration, gait abnormalities, and the degree of knee swelling. In vitro, RAR stimulated chondrocyte proliferation and the expression of Col2a1, Comp, and Acan. Moreover, RAR treatment significantly reduced ROS accumulation in an OA cell model induced by IL-1ß and increased the activity of antioxidant enzymes (SOD and GSH). Network pharmacology analysis combined with molecular docking showed that Mapk1 might be a key therapeutic target. Subsequent research showed that RAR could downregulate Mapk1 mRNA levels in IL-1ß-induced chondrocytes and DMM-induced rats. Conclusion: RAR inhibited extracellular matrix (ECM) degradation and oxidative stress response via the MAPK signaling pathway in KOA, and Mapk1 may be a core target.

Effect of pilose antler polypeptide on the mechanism of bone homeostasis in osteoporosis.

Osteoporosis stands out as a prevalent metabolic disorder, bearing significant repercussions on human well-being and overall quality of life. It remains an urgent concern within the global public health framework due to its widespread occurrence. Osteoporosis arises from an abnormal metabolism in osteoblasts and osteoclasts, resulting in a disruption of the delicate equilibrium between bone formation and bone resorption. Within this context, deer antler peptides emerge as natural active compounds, wielding a pivotal role in governing the differentiation, proliferation, and mineralization of osteoblasts, as well as influencing the activity of osteoclasts. This article aims to consolidate our comprehension of the mechanisms underpinning the dynamic balance between bone formation and resorption, meticulously orchestrated by osteoblasts and osteoclasts in osteoporosis. Furthermore, it offers a comprehensive overview of how deer antler peptides, through their modulation of relevant signaling pathways, contribute to the enhancement of bone homeostasis. These insights deepen our understanding of the pathological processes through which deer antler peptides ameliorate bone homeostasis, while also presenting novel strategies for osteoporosis management.

Physical Activity, Sedentary Behavior, and Osteoarthritis: A Two-Sample Mendelian Randomization Analysis.

Background: Sedentary behavior and physical activity are still ambiguous in their effects on osteoarthritis. We aimed to evaluate the effects of physical activity and sedentary behavior on osteoarthritis to provide a reference for the prevention of osteoarthritis. Methods: This study was conducted in Changchun, China in 2022. We used two-sample Mendelian randomization with the SNP as an instrumental variable to investigate the effect of physical activity and sedentary behavior on osteoarthritis. In addition, a two-step Mendelian randomization method was used to test whether mediating factors (BMI, smoking, Apolipoprotein B) were involved in mediating the effects of exposure factors on osteoarthritis. Results: TV watching was causally related to knee osteoarthritis and spine osteoarthritis, and they were positively correlated (knee osteoarthritis: OR=1.162,95 %CI: 1.027-1.315, P=0.017; spine osteoarthritis: OR=1.208,95 %CI: 1.033-1.413, P=0.018). BMI played a mediating role in the process of TV watching with knee osteoarthritis and spine osteoarthritis. ((The proportion of BMI mediating effect: knee osteoarthritis: 47.1% (95% CI: 36.7%~63.2%); spine osteoarthritis: 29.5% (95% CI: 19.3%~40.8%)). The proportion of Smoking mediating effect in the process of TV watching with spine osteoarthritis was 16.1% (95% CI: 3.7% ~ 31.6%). Conclusion: TV watching is a potential risk factor for osteoarthritis and plays a role through modifiable factors such as BMI and smoking, therefore, interventions on these factors have the potential to reduce the burden of osteoarthritis caused by longer TV watching times.

No evidence of a causal relationship between ankylosing spondylitis and cardiovascular disease: a two-sample Mendelian randomization study.

Objective: Observational studies have suggested an increased risk of cardiovascular disease in individuals with ankylosing spondylitis. However, these studies are prone to confounding factors and reverse causality. To address these limitations, we conducted a Mendelian randomization study to assess the causal relationship between AS and CVD. Methods: The study population comprises 9,069 individuals with ankylosing spondylitis and 509,093 individuals with either of six common cardiovascular diseases and a related indicator. Causal analysis using summary effect estimates and inverse variance weighting were employed as the main methods. Results: The CAUSE analysis showed no evidence of a causal relationship between AS and CVD. The odds ratios for total CVD, heart failure, myocardial infarction, valvular heart disease, ischemic heart disease, and venous thromboembolism, Arterial stiffness index, were as follows: OR, 1.01; 95% confidence interval, 0.96-1.05; P = 0.91; OR, 1.03; 95% CI, 0.99-1.08; P = 0.50; OR, 0.94; 95% CI, 0.86-1.03; P = 0.53; OR, 0.99; 95% CI, 0.94-1.04; P = 0.99; OR, 0.98; 95% CI, 0.91-1.04; P = 0.94; OR, 0.98; 95% CI, 0.91-1.04; P = 0.99; ß, -0.0019; 95% CI, 0.97-1.01; P = 0.99. The IVW and weighted median methods also yielded consistent results, and no heterogeneity or pleiotropy was found. Likewise, a reverse Mendelian randomization analysis did not uncover a heritable causal relationship between AS and CVD. Conclusion: This Mendelian randomization study does not support a causal relationship between AS and CVD. Further research is needed to confirm this association.

Effects of blood pressure and antihypertensive drugs on osteoarthritis: a mendelian randomized study.

BACKGROUND: Previous studies have suggested that antihypertensive drugs may play a role in the treatment of osteoarthritis, but these studies may be limited by confounding factors and lead to biased results. Therefore, we conducted a Mendelian randomization study to investigate the effects of blood pressure and antihypertensive drugs on osteoarthritis. METHODS: We used published large-scale genome-wide association data and applied univariate and multivariate Mendelian randomization methods. The main analysis model was inverse variance weighting, and the reliability of the results was tested using MR-Egger intercept analysis, Cochran's Q test, and leave-one-out analysis. We comprehensively evaluated the relationship between systolic blood pressure, diastolic blood pressure, 12 antihypertensive drugs, and osteoarthritis. We also conducted verification in the independent queue of UK Biobank and built a simple linear regression model to obtain an independent comparison. RESULTS: We found no evidence that systolic and diastolic blood pressure significantly affected osteoarthritis. However, among antihypertensive drugs, we observed a significant positive correlation between potassium-preserving diuretics and aldosterone antagonists and all osteoarthritis (OR: 0.560, 95% CI 0.406-0.772, P = 0.0004). Sensitivity analysis showed no horizontal pleiotropy or heterogeneity, and the leave-one-out analysis demonstrated the reliability of the results. This result was replicated with nominally statistical significance in the validation cohort and exhibited significant correlation in the linear regression analysis. CONCLUSIONS: Our study suggested that controlling the protein targets of potassium-sparing diuretics and aldosterone antagonists may have beneficial results for osteoarthritis. These findings provide valuable medication strategies for the control of hypertension in patients with osteoarthritis.

Visceral adipose tissue and osteoarthritis, a two-sample Mendelian randomized study.

Background: The relationship between visceral adipose tissue and osteoarthritis is not clear. The purpose of our study was to explore the relationship between visceral adipose tissue and osteoarthritis. Methods: We used a two-sample Mendelian randomization method to select single-nucleotide polymorphisms (SNPs) significantly associated with visceral adipose tissue as instrumental variables to explore the relationship between visceral adipose tissue and all osteoarthritis, hand osteoarthritis, hip osteoarthritis, knee osteoarthritis, and spine osteoarthritis. The reliability of the results was tested using sensitivity analysis. Results: Our findings indicated that visceral adipose tissue was associated with all osteoarthritis, hip osteoarthritis, knee osteoarthritis, and spine osteoarthritis (all osteoarthritis: OR = 1.399, 95% CI: 1.335-1.467, p = 7.95e-44; hip osteoarthritis: OR = 1.399, 95% CI: 1.284-1.524, p = 1.41e-14; knee osteoarthritis: OR = 1.794, 95% CI: 1.662-1.937, p = 1.33e-50; and spine osteoarthritis: OR = 1.445, 95% CI: 1.314-1.589, p = 2.89e-14). Sensitivity analysis demonstrated the reliability of these results. Conclusion: Our study suggests that genetically predicted visceral adipose tissue is associated with osteoarthritis. Reducing the accumulation of visceral adipose tissue could potentially have an impact on the incidence of osteoarthritis.

Analyzing network pharmacology and molecular docking to clarify Duhuo Jisheng decoction potential mechanism of osteoarthritis mitigation.

As a classic remedy for treating Osteoarthritis (OA), Duhuo Jisheng decoction has successfully treated countless patients. Nevertheless, its specific mechanism is unknown. This study explored the active constituents of Duhuo Jisheng decoction and the potential molecular mechanisms for treating OA using a Network Pharmacology approaches. Screening active components and corresponding targets of Duhuo parasite decoction by traditional Chinese medicine systems pharmacology database and analysis platform database. Combining the following databases yielded OA disease targets: GeneCards, DrugBank, PharmGkb, Online Mendelian Inheritance in Man, and therapeutic target database. The interaction analysis of the herb-active ingredient-core target network and protein-protein interaction protein network was constructed by STRING platform and Cytoscape software. Gene ontology functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis were carried out. PyMOL and other software were used to verify the molecular docking between the essential active components and the core target. 262 active ingredients were screened, and their main components were quercetin, kaempferol, wogonin, baicalein, and beta-carotene. 108 intersection targets of disease and drug were identified, and their main components were RELA, FOS, STAT3, MAPK14, MAPK1, JUN, and ESR1. Gene ontology analysis showed that the key targets were mainly involved in biological processes such as response to lipopolysaccharide, response to xenobiotic stimulus, and response to nutrient levels. The results of Kyoto Encyclopedia of Genes and Genomes analysis show that the signal pathways include the AGE - RAGE signaling pathway, IL - 17 signaling pathway, TNF signaling pathway, and Toll - like receptor signaling pathway. Molecular docking showed that the main active components of Duhuo parasitic decoction had a good bonding activity with the key targets in treating OA. Duhuo Jisheng decoction can reduce the immune-inflammatory reaction, inhibit apoptosis of chondrocytes, strengthen proliferation and repair of chondrocytes and reduce the inflammatory response in a multi-component-multi-target-multi-pathway way to play a role in the treatment of OA.

Prevalence and Distribution of Osteopenia in Chinese Population: A System Review and Meta-Analysis.

Background: The number of patients with osteoporosis ranks first in the world in China and as a precursor state of osteoporosis, the number and incidence of osteopenia are much higher than that of osteoporosis. This meta-analysis was conducted to evaluate the incidence and distribution of osteopenia in adults in mainland of China over 10 years to provides reference for the early prevention of osteoporosis and policymaking. Methods: Relevant data were extracted from the databases including CNKI, Wanfang, VIP, Web of Science, PubMed, EMBASE, and Medline about the surveys on osteoporosis and bone loss from 2010 to 2021 by searching. The random effects model was adopted for Meta-analysis, and the funnel plot was used to test publication bias. Results: Forty-seven literatures were included in this study, covering 27 provinces and 38 regions in the mainland of China, with the study of 135,688 cases, showing that the prevalence of osteopenia in adults in the past decade was 28.3%(95% CI 24-33%), aged 40∼60 yr old, reaching the highest level. The incidence of osteopenia in males was higher than that in females (P<0.05), without significant difference in south and north China. Conclusion: There is a large population with osteopenia in China, especially middle-aged population, both men and women should pay attention to osteopenia to delay its further progression.

A retrospective assessment of the clinical efficacy of different internal fixation methods in the treatment of distal fibula fractures in the elderly.

An ankle fracture is a fracture of the distal tibia or fibula that forms the ankle joint, usually associated with ligament and soft tissue injury, and is a common type of lower limb fracture and one of the most common types of fracture in the elderly. Although ankle fractures are one of the most common injuries seen by orthopedic trauma surgeons, there is no uniform protocol for the diagnosis and treatment of ankle fractures in the elderly, and there are many controversial indications for surgery. The aim of this study is to assess the clinical efficacy of different internal fixation methods in the treatment of distal fibular fractures in the elderly, in an effort to improve the rational selection and application of clinical acts. A retrospective analysis was performed on 68 cases of patients who suffered an ankle fracture and were treated with different internal fixation methods according to the fracture types and individual differences in distal fibula fractures. The postoperative therapeutic effect assessment was performed in terms of clinical examination, imaging evaluation, and AOFAS ankle-hind foot function scoring. There was no unhealed bone, ankle instability and loose/fractured internal fixation. Fracture healing time was 2.7 to 4.0 months (average 3.2 months). AOFAS score was 88.3 ± 6.2, of which, 34 excellent cases, 30 good cases, and 4 fair cases. Ankle activity dorsiflexion 6º~18º, average 15º; plantar flexion 26º~47º, average 37º. A good clinical efficacy could be achieved from the most appropriate individualized internal fixation for distal fibula fractures of elderly patients.

Multi-omics in Spinal Cord Injury: Diagnosis, Prognosis, and Treatment.

A spinal cord injury (SCI) can result in varying degrees of limb movement impairment and sensory impairment, affecting the quality of life severely. The study of the molecular mechanisms underlying SCI disease has advanced greatly. However, there is still room for improvement in terms of the cognitive and systematic approaches used for disease diagnosis, progression, treatment, and prognosis. This situation might change as multi-omics technology advances. Single omics technology has some limitations when it comes to fully comprehending the disease progression pattern and directing SCI treatment. Therefore, a thorough understanding of the state of the art in omics research on SCI can explain the pathogenesis and mechanism of the disease and offer new, multifaceted treatments for SCI. This article reviews recent developments in the application of various omics techniques to diseases associated with SCI and discusses the advantages and disadvantages of using these techniques for disease diagnosis, prognosis, and treatment.

Acupuncture for postoperative pain of lumbar disc herniation: A systematic review and meta-analysis.

BACKGROUND: Evidence for the effects of acupuncture on postoperative pain of Lumbar disc herniation (LDH) is inconsistent. We conducted this systematic review and meta-analysis to evaluate the efficacy of acupuncture for postoperative pain of LDH. METHODS: We performed a comprehensive search on PubMed, Embase, Web of Science, Cochrane Central, and four Chinese databases (CNKI, Wan Fang, CBMdisc, and VIP) for articles published before September 2021. The data extraction table was made for the ten included studies, and the risk of bias was assessed using the Cochrane collaboration tool, followed by statistical analysis using RevMan 5.3. RESULTS: A total of ten studies involving 838patients were included. The statistical meta-analysis showed that acupuncture treatment was significantly better than drugs in improving cure rate (OR = 2.24, 95% CI = [1.58, 3.19], P < .00001) and the total effectiveness rate (OR = 4.85, 95% CI = [2.59, 9.08], P < .00001). And the results from the meta-analysis showed that acupuncture group was superior to control group in debasing visual analog scale score (MD = -1.26, 95% CI = [-1.72, -0.79], P < .00001) and improving Japanese Orthopaedic Association score (MD = 4.21, 95% CI = [1.53, 6.90], P < .00001). In addition, acupuncture was statistically significantly better than drugs (OR = 0.27, 95% CI = [0.11, 0.62], P = .002) in the incidence of adverse events, However, there was no statistically significant difference between acupuncture and rehabilitation (OR = 0.36, 95% CI = [0.07, 1.98], P = .24). CONCLUSION: Acupuncture is an effective and safe treatment for postoperative pain of LDH. It can be recommended to manage patients with postoperative pain of LDH. However, considering the unsatisfactory quality of the included studies, more high-quality randomized controlled trials with a large sample size are needed to elucidate this issue.

Evaluation of the effectiveness and safety of icariin in the treatment of knee osteoarthritis: A protocol for a systematic review and meta-analysis.

BACKGROUND: Knee osteoarthritis (KOA) is a chronic degenerative disease involving cartilage and surrounding tissues. It causes a huge burden to social and medical resources and seriously affects people's living and working ability. In recent years, people have become increasingly interested in the application of Chinese medicine monomers to treat KOA. Among them, icariin plays an important role in the clinical treatment of KOA. Therefore, to evaluate the effectiveness and safety of icariin in the treatment of KOA, we conducted this study to provide a new basis for the clinical treatment of KOA. METHODS: We propose a systematic search of the PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and China Biomedical databases for all randomized controlled trials examining the use of icariin in the treatment of KOA patients up to October 20, 2021. The screening and data extraction processes will be performed independently by 2 researchers. We will use the Cochrane risk bias assessment tool to evaluate the quality of the studies that met the inclusion criteria. The data will be statistically analyzed using RevMan5.3 software. RESULT: This study will provide high-quality evidence for the effectiveness and safety of icariin in the treatment of KOA. CONCLUSION: The purpose of this study was to explore the efficacy of icariin in the treatment of KOA and to provide clinicians and patients with new treatment strategies. INPLASY REGISTRATION NUMBER: INPLASY2021110015.

Anti-inflammatory Role of Pilose Antler Peptide in LPS-Induced Lung Injury.

The present study was designed to investigate the effects of pilose antler peptide (PAP) on lipopolysaccharide (LPS)-induced lung injury. BalB/c mice intraperitoneally received PAP (10 and 20 mg/kg) or dexamethasone (2 mg/kg) 1 h prior to intratracheal instillation of LPS. PAP significantly decreased lung wet-to-dry weight (W/D) ratio and lung myeloperoxidase (MPO) activity and restored LPS-induced lung histopathological changes. PAP also increased super oxide dismutase (SOD) level and inhibited malondialdehyde (MDA) content and levels of pro-inflammatory cytokines including tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), and interleukin-6 (IL-6) in bronchoalveolar lavage fluid (BALF) in LPS-stimulated mice. Furthermore, we demonstrated that PAP inhibited Rho/NF-κB pathway in LPS-induced mice. Our experimental results indicated that the protective mechanism of PAP might be attributed partly to the inhibition of Rho/NF-κB pathway.

EQUITY AND SATISFACTION OF COMMUNITY HEALTH SERVICES IN TONGLIAO CITY, INNER MONGOLIA.

We aimed to describe the human resources and apparatuses of community health service (CHS) in Tongliao City of China and investigate the differences between CHS centers and stations. Field investigations and questionnaire-based surveys were conducted in 120 CHS organizations of Tongliao City, which were selected by a stratified multistage random cluster sampling method. Data were collected on the human resources, medical apparatuses, and satisfaction of covered residents. We found that the total number, educational background, and professional titles of staff were lower at stations than at centers. Although the categories of providing health services were comparable between centers and stations, stations provided fewer health services than centers did. In addition, stations owned fewer apparatuses compared with centers. The percentages of satisfaction on many items were lower among residents covered by stations than among those covered by centers. Desired health services provided by CHS organizations have been partially accomplished in Tongliao City. Attracting more highly educated professionals and purchasing more valuable apparatuses may be helpful to improve the unbalanced distribution in human resources and apparatuses between centers and stations. Appropriate modifications of corresponding policies should be taken into consideration by the local government in the future.

[Experimental study of velvet antler polypeptides against oxidative damage of osteoarthritis cartilage cells].

OBJECTIVE: To study reverse effect of the oxidative damage on cartilage cells of velvet antler polypeptides (VAPS), and to investigate the main mechanism of VAPS to protect cartilage cells through antioxidant. METHODS: Fifteen Japanese white rabbits of 5-month-old were selected in this study. Animal model was established by method of Hulth osteoarthritis animal model. The anterior and posterior cruciate ligament and medial collateral ligament were cut off and medial meniscus were cut, articular cartilage cell cultured in vitro. Cells in the sham operation group was the normal control group, osteoarthritis cartilage cells in the model groups were added VAPS 6.25, 12.5, 25 microg/ml respectively. A group of animals were sacrificed every week form the ninth weeks(two months) and the cartilage cells were isolated and cultured. For 8 weeks,the reactive oxygen species level in chondrocytes were detected by DCFH-DA, the content of NO, SOD and GSH-Px in cell culture supernatant were detected by Griess method. RESULTS: DCFH-DA detection of intracellular reactive oxygen species was (5.46 +/- 0.46)in the control group, (12.08 +/- 0.74) in the model groups. The model group compared with the control group by t test with the P value less than < 0.001. DCFH-DA detection of intracellular reactive oxygen species was (9.81 +/- 0.59)in VAPS 6.25 microg/ ml group, (7.83 +/- 0.63) in the VAPS 12.5 microg/ml group, (6.89 +/- 0.71) in the VAPS 25 microg/ml group, as compared with model group there were statistically significant difference (P < 0.05). The content of NaNO2, SOD and GSH-Px in osteoarthritis model group was (5.60 +/- 0.45) microM, (38.56 +/- 12.53) U/ml and (151.90 +/- 25.60) U, as compared with control group there were statistically significant difference (P < 0.001, P < 0.05); The content of NaNO2 was (4.34 +/- 0.39), M in VAPS 6.25 microg/ml group, (3.67 +/- 0.36) microM in the VAPS 12.5 microg/ml group, (3.20 +/- 0.27) microM in the VAPS 25 microg/ml group, as compared with model group there were statistically significant difference (P < 0.01). The content of SOD was (49.91 +/- 5.77) U/ml in VAPS 6.25 microg/ml group, (54.05 +/- 5.27) U/ml in the VAPS 12.5 microg/ml group, (57.44 +/- 5.70) U/ml in the VAPS 25 microg/mL group, as compared with model group there was statistically significant (P < 0.05). The content of GSH-Px was (172.50 +/- 18.65) U in VAPS 6.25 microg/ml group, (202.10 +/- 21.60) U in the VAPS 12.5 microg/ml group, (315.80 +/- 10.50) U in the VAPS 25 microg/ml group, the VAPS 12.5 microg/mL group and VAPS 25 microg/ml group was compared with model group, there were statistically significant difference (P < 0.01). CONCLUSION: The VAPS have antioxidative damage effect of osteoarthritis cartilage cells within a certain range and dose-dependent manner. It may be the main mechanism for velvet antler polypeptides to treat osteoarthritis.

Broader curve criteria for selective thoracic fusion.

STUDY DESIGN: Retrospective radiographic review. OBJECTIVE: To evaluate the outcome of selective thoracic fusion (STF) by using cantilever bending technique (CBT) and the direct vertebral rotation (DVR) technique for major thoracic-compensatory lumbar (MTCL) curves selected by new curve criteria, which are broader than Lenke curve criteria for STF. SUMMARY OF BACKGROUND DATA: Surgical treatment of MTCL curves aims to maximize the number of MTCL curves that can be treated with STF and optimize instrumented thoracic and spontaneous lumbar correction. Comparing current guidelines for STF shows that the surgical technique utilized for STF may affect the curve criteria for MTCL curves for successful STF and thoracic and lumbar correction. METHODS: Seventy-eight consecutive idiopathic scoliosis patients with major thoracic-compensatory "C" modifier lumbar curves who met the following three criteria: (1) main thoracic curve (MT) to compensatory lumbar curve (CL) ratios of Cobb magnitude and apical vertebral translation (AVT) greater than one; (2) MT/CL ratio of flexibility less than one; (3) Cobb magnitude of lumbar curve less than 35° on side bending, were treated with STF by using CBT and DVR. Radiographs were analyzed before surgery, immediately after surgery, and at the most recent follow-up (range, 2-5 years). RESULTS: All 78 MTCL curves were successfully treated with STF by using CBT and DVR. A mean 61% thoracic correction was matched by 55% lumbar correction at the most recent follow-up. Spontaneous correction of lumbar AVT occurred in all patients. Global coronal imbalance was common before surgery (mean, 14 mm) and remained so after surgery (mean, 12 mm). There were 49 MTCL curves that did not meet Lenke curve criteria for STF. All were successfully treated with STF by using CBT and DVR. Among these 49 MTCL curves, there were 14 Lenke 1C and 18 Lenke 2C curves with one or two, or all of MT/CL ratios of Cobb magnitude, AVT, and apical vertebral rotation of 1.2 or less, and 6 Lenke 3C and 11 Lenke 4C curves with the Cobb magnitude of residual lumbar curve on side bending between 25° and 35°. CONCLUSION: CBT and DVR can broaden the current curve criteria of MTCL curves for STF to have more MTCL curves treatable with STF and optimize instrumented thoracic and spontaneous lumbar correction. A more effective surgical technique can not only improve instrumented thoracic and spontaneous lumbar correction but also can broaden the MTCL curve criteria for STF to have more MTCL curves treatable with STF.

Quality control of reconstructed sagittal balance for sagittal imbalance.

STUDY DESIGN: Prospective radiographic study. OBJECTIVE: To investigate the feasibility of controlling quality of reconstructed sagittal balance for sagittal imbalance. SUMMARY OF BACKGROUND DATA: Patients with sagittal imbalance cannot walk or stand erect without overwork of musculature because of compromised biomechanical advantage. The result is muscle fatigue and activity-related pain. During reconstructive surgery, restoration of optimal sagittal balance is crucial for obtaining satisfactory clinical results. However, there is no way to control quality of reconstructed sagittal balance before or during surgery. METHODS: A method was developed to determine the lumbosacral curve in a way that theoretically would bring sagittal balance to an ideal state by calculation and simulation for each patient before surgery and then template rods of the curve and a blueprint were made accordingly for operative procedures. Ninety-four consecutive patients with sagittal imbalance due to lumbar kyphosis were treated for intractable pain and then followed up for a mean of 4.3 years. Radiographs were analyzed before surgery, 2 months after surgery, and at most recent follow-up. RESULTS: The mean estimated values of L1-S1 lordosis, sacral inclination angle, sacrofemoral distance, and distribution of L1-S1 lordosis at the closing-opening wedge osteotomy site and L4-S1 segments were 30.8°, 24.6°, 0 mm, 16.1% (-5°), and 62% (-19°), respectively. The mean reconstructed values were 41.1°, 23.3°, 3.9 mm, 41% (-17°), and 46% (-19°), respectively. There were significant differences between estimated and reconstructed values of L1-S1 lordosis and the percentage of distributions; however, there was no significant difference between the estimated and reconstructed magnitude of L4-S1 lordosis, sacral inclination angle, and sacrofemoral distance. A properly oriented pelvis can be brought nearly directly above the hip axis. The mean sagittal global balance, represented by the distance between the vertical line through the hip axis and sacral promontory, improved from 61.4 mm before surgery to 3.9 mm 2 months after surgery, and 1.3 mm at final follow-up. Normal sagittal global balance was reconstructed and maintained. The mean sagittal spinal balance measured as the horizontal distance between the C7 sagittal plumb line and the posterior superior corner of S1 improved from 97.4 mm before surgery to 11 mm 2 months after surgery. However, there was significant loss of sagittal spinal balance to 25.4 mm at the fi nal visit. Normal sagittal spinal balance was reconstructed and appeared to be maintained. The magnitude of T1-T12 kyphosis compensated from 13° before surgery to 25.2° 2 months after surgery and 34.5° at fi nal follow-up. CONCLUSIONS: Quality control of the reconstructed sagittal balance for sagittal imbalance is possible. Correctly orienting the pelvis, reconstructed by the restoration of enough L1-S1 lordosis with adequate distribution at L4-S1 segments, is a matter of critical importance for optimizing reconstructed sagittal balance. The correctly oriented pelvis can be determined before surgery. Preventing junctional fracture and persistent rehabilitation of surgically injured lumbar extensor musculature are crucial for maintaining the reconstructed sagittal balance.

[Chinese herbs application combined with operation for treating post-traumatic tibial osteomyelitis complicated with bone-skin defects].

OBJECTIVE: The aim of this study was to explore the method and clinical effects of integration of Chinese herbs and operation for the treatment of post-traumatic tibial osteomyelitis complication with bone-skin defect. METHODS: Among 28 patients with post-traumatic tibial osteomyelitis complicated with bone-skin defects, 18 patients were male and 10 females, ranging in age from 18 to 68 years, with an average of 32.5 years. All the patients were treated with transplantation of free iliac flaps to one-stage repair the bone-skin defects after infection controlled with Chinese herbs dressing. The curative effects were analyzed. RESULTS: All the patients were followed up and ranged from 8 to 56 months, with an average of 30 months. All of the flap survived, and the wounds got primary healing in 26 patients and secondary healing in 2 patients. All the grafted bone united in 2 to 14 months,with a mean time of 4.6 months. The osteomyelitis recurred in 2 patients and got healed by focal debridement. CONCLUSION: Chinese herbs application combined with operation for treating post-traumatic tibial osteomyelitis complicated with hone-skin defects is effective to control infection, one-stage repair the tissue defects, which is worthy popularizing.