Target NF-κB p65 for preventing posttraumatic joint contracture in rats.

RelA/p65 is as a crucial component of the nuclear factor κB (NF-κB) signaling pathway that has a significant impact on various fibrotic diseases. However, its role in the fibrosis of tissues surrounding the joint after traumatic injury remains unclear. In this study, rats were divided into three groups: non-operated control (NC) group, p65-siRNA treated (siRNA-p65) group, and negative siRNA treated (siRNA-neg) group. Then, 10 µL (10 nmol) of p65-siRNA was injected into the joint of the siRNA-p65 group. Meanwhile, 10 µL of negative siRNA was administered to the knee joint of the operated siRNA-neg group for comparison. The rats in the NC group did not receive surgery or drug intervention. After 4 weeks of right knee fixation in each group, X-ray measurements revealed significantly reduced degree of knee flexion contracture following p65-siRNA treatment (siRNA-neg: 77.73° ± 2.799°; siRNA-p65: 105.7° ± 2.629°, p < 0.0001). Histopathological examination revealed that the number of dense fibrous connective tissues decreased following p65-siRNA inhibition. Western blot analysis revealed significantly different expression levels of fibrosis-related proteins between the siRNA-p65 and siRNA-neg groups. Immunohistochemical analysis revealed a reduction in the average number of myofibroblasts in the siRNA-p65 group compared with that in the siRNA-neg group. Thus, intra-articular p65-siRNA injection could attenuate fibroblast activation and fibrosis-related protein production, suppress periarticular tissue fibrosis, and prevent joint contracture by downregulating the NF-κB p65 pathway. Statement of clinical significance: Intra-articular injection of p65-siRNA could reduce myofibroblast proliferation and fibrosis-related protein expression by downregulating the NF-κB p65 pathway, inhibit periarticular tissue fibrosis, and prevent joint adhesion, which represents a potential therapy in the prevention of joint fibrosis following traumatic injury.

Mild synthesis of ultra-bright carbon dots with solvatochromism for rapid lipid droplet monitoring in varied physiological processes.

Lipid droplets (LDs) participating in various cellular activities and are increasingly being emphasized. Fluorescence imaging provides powerful tool for dynamic tracking of LDs, however, most current LDs probes remain inconsistent performance such as low Photoluminescence Quantum Yield (PLQY), poor photostability and tedious washing procedures. Herein, a novel yellow-emissive carbon dot (OT-CD) has been synthesized conveniently with high PLQY up to 90%. Besides, OT-CD exhibits remarkable amphiphilicity and solvatochromic property with lipid-water partition coefficient higher than 2, which is much higher than most LDs probes. These characters enable OT-CD high brightness, stable and wash-free LDs probing, and feasible for in vivo imaging. Then, detailed observation of LDs morphological and polarity variation dynamically in different cellular states were recorded, including ferroptosis and other diseases processes. Furthermore, fast whole imaging of zebrafish and identified LD enrichment in injured liver indicate its further feasibility for in vivo application. In contrast to the reported studies to date, this approach provides a versatile conventional synthesis system for high-performance LDs targeting probes, combing the advantages of easy and high-yield production, as well as robust brightness and stability for long-term imaging, facilitating investigations into organelle interactions and LD-associated diseases.

Combined effect of SDF-1 peptide and angiogenic cues in co-axial PLGA/gelatin fibers for cutaneous wound healing in diabetic rats.

Skin regeneration is hindered by poor vascularization, prolonged inflammation, and excessive scar tissue formation, which necessitate newer strategies to simultaneously induce blood vessel regeneration, resolve inflammation, and induce host cell recruitment. Concurrent deployment of multiple biological cues to realize synergistic reparative effects may be an enticing avenue for wound healing. Herein, we simultaneously deployed SDF (stromal cell-derived factor)- 1α, VEGF (vascular endothelial growth factor)-binding peptide (BP), and GLP (glucagon like peptide)- 1 analog, liraglutide (LG) in core/shell poly(L-lactide-co-glycolide)/gelatin fibers to harness their synergistic effects for skin repair in healthy as well as diabetic wound models in rats. Microscopic techniques, such as SEM and TEM revealed fibrous and core/shell type morphology of membranes. Boyden chamber assay and scratch-wound assay displayed significant migration of HUVECs (human umbilical vein endothelial cells) in SDF-1α containing fibers. Subcutaneous implantation of membranes revealed higher cellular infiltration in SDF-1α loaded fibers, especially, those which were co-loaded with LG or BP. Implantation of membranes in an excisional wound model in healthy rats further showed significant and rapid wound closure in dual cues loaded groups as compared to control or single cue loaded groups. Similarly, the implantation of dressings in type 2 diabetes rat model revealed fast healing, skin appendages regeneration, and blood vessel regeneration in dual cues loaded fibers (SDF-1α/LG, SDF-1α/BP). Taken together, core/shell type fibers containing bioactive peptides significantly promoted wound repair in healthy as well as diabetic wound models in rats.

Electrophysiological, biomechanical, and finite element analysis study of sacral nerve injury caused by sacral fracture.

Background: We aimed to study the mechanism of sacral nerve injury caused by sacral fractures and the relationship between nerve decompression and nerve function. Methods: First, we observed the anatomical features of lumbosacral nerve root region in Sprague-Dawley rats. Next, the rats were divided into the sham, 10 g, 30 g, and 60 g groups for electrophysiological studies on nerve root constriction injury. Then we studied the biomechanical properties of rat nerve roots, lumbosacral trunk, and sacrum. Finally, we established a finite element analysis model of sacral nerve roots injury in rats and determined the correlation between sacral deformation and the degree of sacral nerve roots injury. Result: Anatomical study showed L5 constitutes sciatic nerve, the length of the L5 nerve root is 3.67 ± 0.15 mm, which is suitable for electrophysiological research on nerve root compression injury. After a series of electrophysiological study of L5 nerve roots, our results showed that nerve root function was almost unaffected at a low degree of compression (10 g). Nerve root function loss began at 30 g compression, and was severe at 60 g compression. The degree of neurological loss was therefore positively correlated with the degree of compression. Combining biomechanical testing of the lumbosacral nerve roots, finite element analysis and neuroelectrophysiological research, we concluded when the sacral foramina deformation is >22.94%, the sacral nerves lose function. When the compression exceeds 33.16%, early recovery of nerve function is difficult even after decompression. Conclusion: In this study, we found that the neurological loss was positively correlated with the degree of compression. After early decompression, nerve root function recovery is possible after moderate compression; however, in severe compression group, the nerve function would not recover. Furthermore, FEA was used to simulate nerve compression during sacral fracture, as well as calculate force loading on nerve with different deformation rates. The relationship between sacral fractures and neurological loss can be analyzed in combination with neurophysiological test results.

Human osteoprogenitor cells obtained from traumatic heterotopic ossification samples showed enhanced osteogenic differentiation potential and ERK/hedgehog signaling than that from normal bone.

Traumatic heterotopic ossification (HO) refers to the abnormal ectopic osteogenesis following trauma, causing limb dysfunction and seriously lowering the life quality of patients. Aberrant osteogenic behavior of progenitor cells that ectopically accumulated within the soft tissues are believed to be responsible for HO formation. However, the detailed mechanism still remained to be clarified. Here in this study, we successfully isolated osteoprogenitors from human heterotopic ossification tissues (HO-ops) and identified their stemness and multi-directional differentiation potential. Using alkaline phosphatase staining together with alizarin red staining, we confirmed that the HO-ops in the heterotopic ossified tissues gained greater osteogenic potential than the normal human bone marrow mesenchymal stem cells (HBMSCs). RT-qPCR also indicated that HO-ops obtained more gene transcriptions of critical osteogenic determinators than HBMSCs. In addition, through Western blot, we proved that ERK signaling pathway and hedgehog signaling pathway were significantly activated in the HO-ops. When U0126 and cyclopamine were used to inhibit ERK signaling and hedgehog signaling respectively, the osteogenic potential of HO-ops decreased significantly. The hedgehog signaling and ERK signaling also showed cross-talk in HO-ops during osteogenic differentiation in HO-ops during osteogenic differentiation. The elevated ERK signaling and hedgehog signaling were further confirmed in the human traumatic HO sample sections by immunohistochemical staining. In sum, our results showed that the activation of ERK and hedgehog signaling pathway jointly enhanced the osteogenic potential of HO-ops to induce the formation of traumatic HO, which provides novel insights into the molecular basis of HO formation and offers promising targets for future therapeutic strategy.

Adjusted association between type 2 immunity and low risk thyroid nodules: a retrospective cohort study.

BACKGROUND: Immune responses, especially type 2 immunity, might be related to the prevalence of thyroid nodules, while the key regulators and potential pathways are remaining largely unknown. In addition, the immune status of individuals could be affected by mixed metabolic background. Herein our aim was to investigate the adjusted association between ultrasound-diagnosed low risk thyroid nodules and immune responses, excluding the interference of metabolic effects on immunity. METHODS: We retrospectively enrolled 1764 subjects who underwent a thorough thyroid ultrasound examination. To eliminate the interference of confounders, we used propensity score matching (PSM) to match age, gender, cigarette smoking and alcohol drinking, parameters that are related with metabolic syndrome (MetS). Then the potential effectors of immune responses involved in the laboratorial assays were evaluated. Binary logistic regression analysis was used to assess the independent predictors of thyroid nodules in a multivariate manner. RESULTS: The 1172 subjects were remained after PSM, and differences of demographic background between subjects with and without thyroid nodules were eliminated. Metabolic parameters comprising blood pressure, fasting blood glucose, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein and serum uric acid were shown no significant difference between post-PSM subjects with and without thyroid nodules. Among the biochemistry and hematological parameters, white blood cell count and the positive rate of eosinophil percentage were increased in subjects with thyroid nodules than in those without thyroid nodules. In contrast, the positive rate of basophil percentage was lower in subjects with thyroid nodules than in those without thyroid nodules. In addition, the thyroid function test results showed that subjects with thyroid nodules had higher positive rates of antithyroglobulin antibody (TgAb) and antithyroid peroxidase antibody (TPOAb) than subjects without thyroid nodules. The logistic regression analysis indicated that the positive value of TgAb as well as high level of white blood cell count and BMI could serve as independent risk factors of thyroid nodules. CONCLUSIONS: The type 2 immune responses mediated by increased level of eosinophils, along with positive value of TgAb and TPOAb were associated with the presence of thyroid nodules. In addition, the potential role of basophils in protecting against thyroid nodules and the pathogenesis of immune-metabolic status remains to be elucidated.

Water-Involved Ring-Opening of 4-Phenyl-1,2,4-triazoline-3,5-dione for "Photo-Clicked" Access to Carbamoyl Formazan Photoswitches In Situ.

Cyclic azodicarbonyl derivatives, particularly 4-phenyl-1,2,4-triazoline-3,5-dione (PTAD), commonly serve as arenophile, dienophile, enophile and electrophile. Perplexed by its instability in aqueous environment, there are few studies focused on the transient intermediate produced by hydrolysis of PTAD to achieve synthetic significance. Herein, we describe a "photo-click" method that involves nitrile imine (NI) from diarylsydnone to capture the diazenecarbonyl-phenyl-carbamic acid (DACPA) generated by water-promoted ring-opening of PTAD. DFT calculation reveal that H-bonding interactions between PTAD and water are vital to form DACPA which exhibited an umpolung effect during ligation by nature bond orbit (NBO) analysis. The ultra-fast ligation resulted in carbamoyl formazans, as a unique Z↔E photo-switchable linker on target molecules, including peptide and drugs, with excellent anti-fatigue performance. This strategy is showcased to construct highly functionalized carbamoyl formazans in situ for photo-pharmacology and material studies, which also expands the chemistry of PTAD in aqueous media.

One-step synthesis of multifunctional nanoparticles for CT/PA imaging guided breast cancer photothermal therapy.

Advances in nanotheranostics have promoted the development of precision medicine, which has great potential as a weapon for clinical diagnosis and therapy of tumors. However, the combination of three functional principle components (imaging probes, therapeutic agents and surface coating) in traditional theranostic system is difficult to be achieved in only one step, while undergoing multiple synthesis procedures, time-consuming process and unknown toxicity. Herein, we fabricated iodinated polyaniline (LC@I-PANi) nanoparticles via a facile one-step synthesis approach integrating chemical oxidative polymerization and iodine-doping process for computed tomography (CT) imaging and photoacoustic (PA) imaging-guided photothermal therapy (PTT). Iodic acid (HIO3) as an oxidant induces chemical oxidation polymerization of aniline monomers. Meanwhile, iodine is incorporated into the polyaniline structural units in the process of polymerization to obtain LC@I-PANi nanoparticles. Moreover, thel-cysteine (LC) has an effect on diameter of LC@I-PANi nanoparticles, which enables nanoparticles have size-controlled spherical morphology and good colloidal stability. The hemolysis assay and cytotoxicity assessment verified the good biocompatibility of LC@I-PANi. Moreover, our LC@I-PANi nanoparticles could not only exhibit appealing PTT efficiency, but also achieve excellent CT/PA dual-mode imaging effect. The histological evaluations suggested the negligible toxicity of LC@I-PANi in vivo. This is the first time to our knowledge that multifunctional LC@I-PANi nanoparticles were prepared by an ingenious one-step method. This work not only highlights a one-step strategy that simplified the complex synthesis of LC@I-PANi nanoparticles, but also provides insight for further biomedical application of "all-in-one" theranostic agent.

Synthesis and evaluation of photo-activatable ß-diarylsydnone-l-alanines for fluorogenic photo-click cyclization of peptides.

Herein, we design and synthesize a series of photoactivatable ß-diarylsydnone-l-alanines (DASAs), which have excellent photo-reactivity with high fluorescence turn-on toward alkenes in a biocompatible environment. The environmental sensing properties of the resulting fluorescent pyrazoline-alanine facilitate its probing capability. By introducing the DASA residue on the side chain of linear peptides, the macrocyclic peptides resulting from the in situ photo-cyclization toward the alkene residue exhibited fluorogenic translocation through live cell membranes.

Photo-accelerated "click" reaction between diarylsydnones and ring-strained alkynes for bioorthogonal ligation.

We constructed a library of diarylsydnone (DASyd) candidates in search of a photoclickable reaction toward alkynes, enabling an ultra-accelerated reactivity, while suppressing the background cycloaddition in the dark. The in vitro and in vivo protein labelling experiments revealed that the photo-accelerated DASyd-alkyne cycloaddition exhibits robust selectivity.

Dual Colorimetric/Fluorometric Double-Throw pH-Switches: The Dimroth Rearrangement of N,9-Diaryl 8-Azaadenines.

A library of 12N,9-Diaryl 2-methyl-8-azaadenine (DAMA) compounds was designed and constructed through an aryl-pairing combination strategy for identifying a nucleobase-containing molecular switch that functions by the pH-regulated Dimroth rearrangement. By utilizing 2D thin-layer chromatography/mass spectrometry (2D-TLC-MS), the DAMA compounds were easily screened to identify which compounds could be used as molecular switches. The pH-switching ability of the DAMA was achieved by incorporating the acridine group as the key structural unit, as well as dual-modal colorimetric/fluorometric on/off properties as the probe functions. The real-time tracing of the switching process clearly indicated that the paired aromatics on both terminals of the DAMA molecule play a key role in tuning the switching kinetics.

Discovery of Fluorogenic Diarylsydnone-Alkene Photoligation: Conversion of ortho-Dual-Twisted Diarylsydnones into Planar Pyrazolines.

A small library of diarylsydnones (DASyds) was constructed based on aryl-pairing combinations and subjected to click reaction toward alkenes under photoirradiation with high efficiency. We were able to demonstrate the utility of DASyds for highly fluorescent turn-on ligation targeting the trans-cyclooct-4-en-1-ol moieties on protein.

Possible mechanism underlying analgesic effect of Tuina in rats may involve piezo mechanosensitive channels within dorsal root ganglia axon.

OBJECTIVE: To demonstrate the analgesic effect of Tuina mainly from mechanically sensitive ion channels in peripheral myelinated nerve fibers. METHODS: A total of 40 healthy and pathogen-free adult male Sprague-Dawley rats were used in the study [weight: (220.0 ¡À 1.4) g, Shanghai Slac Laboratory Animal Co., Ltd., Shanghai, China; license No. Shanghai ICP 05033115]. The rats were housed in cages with free access to water and food in a temperature-controlled room [(22 ¡À 1) ¡æ and 12-h/12-h light-dark cycle. Thirty-two rats were randomly divided into five groups: naive, sham, chronic compression of dorsal root ganglion (CCD), Tuina (7 d) and Tuina (21 d). CCD rat model was established via unilateral DRG compression by ""L"" liked steel bar. Chinese Tuina treatment was accepted once per day. Behavior monitoring of paw withdrawal threshold (PWT) and paw withdrawal latency (PWL) were tested. The expression of Piezo1 and Piezo2 in myelinated nerve fiber were analyzed by immunohistochemistry and Western-blotting. RESULTS: There was a high expression of Piezo2 and a low expression of Piezo1 in the naive and CCD groups. In contrast, the expression of Piezo2 was down regulated and Piezo1 was increased after a period of Tuina. There was significant difference (P¡Ü0.05) between the groups. CONCLUSION: Our findings suggest that Tuina therapy can increase the expression of Piezo2 and decrease the expression of Piezo1 in the test rats. The different changes in the expressions of Piezo1 and Piezo2 may play an important role in alleviating CCD-induced allodynia and hyperalgesia.

RelA/p65 inhibition prevents tendon adhesion by modulating inflammation, cell proliferation, and apoptosis.

Peritendinous tissue fibrosis which leads to poor tendon function is a worldwide clinical problem; however, its mechanism remains unclear. Transcription factor RelA/p65, an important subunit in the NF-κB complex, is known to have a critical role in many fibrotic diseases. Here, we show that RelA/p65 functions as a core fibrogenic regulator in tendon adhesion and that its inhibition exerts an anti-fibrogenic effect on peritendinous adhesion. We detected the upregulation of the NF-κB pathway in human tendon adhesion using a gene chip microarray assay and revealed the overexpression of p65 and extracellular matrix (ECM) proteins Collagen I, Collagen III, and α-smooth muscle actin (α-SMA) in human fibrotic tissues by immunohistochemistry and western blotting. We also found that in a rat model of tendon injury, p65 expression correlated with tendon adhesion, whereas its inhibition by small interfering (si)RNA prevented fibrous tissue formation and inflammatory reaction as evidenced by macroscopic, biomechanical, histological, immunohistochemical, and western blotting analyses. Furthermore, in cultured fibroblasts, p65-siRNA, p65-specific inhibitor, Helenalin and JSH23 suppressed cell proliferation and promoted apoptosis, whereas inhibiting the mRNA and protein expression of ECM components and cyclo-oxygenase-2, an inflammatory factor involved in tendon adhesion. Our findings indicate that p65 has a critical role in peritendinous tissue fibrosis and suggest that p65 knockdown may be a promising therapeutic approach to prevent tendon adhesion.

Efficient and Non-Toxic Biological Response Carrier Delivering TNF-α shRNA for Gene Silencing in a Murine Model of Rheumatoid Arthritis.

Small interfering RNA (siRNA) is an effective and specific method for silencing genes. However, an efficient and non-toxic carrier is needed to deliver the siRNA into the target cells. Tumor necrosis factor α (TNF-α) plays a central role in the occurrence and progression of rheumatoid arthritis (RA). In this study, we pre-synthetized a degradable cationic polymer (PDAPEI) from 2,6-pyridinedicarboxaldehyde and low-molecular-weight polyethyleneimine (PEI, Mw = 1.8 kDa) as a gene vector for the delivery of TNF-α shRNA. The PDAPEI/pDNA complex showed a suitable particle size and stable zeta potential for transfection. In vitro study of the PDAPEI/pDNA complex revealed a lower cytotoxicity and higher transfection efficiency when transfecting TNF-α shRNA to macrophages by significantly down-regulating the expression of TNF-α. Moreover, the complex was extremely efficient in decreasing the severity of arthritis in mice with collagen-induced arthritis. PDAPEI delivered TNF-α shRNA has great potential in the treatment of RA.

Analgesic effects of Chinese Tuina massage in a rat model of pain.

Previous clinical trials have suggested that the Chinese Tuina massage may exert transient analgesic effects. However, further investigation regarding the underlying mechanism has been hindered by the lack of a suitable animal model of pain. The present study established a rat model of hind leg pain by injecting 5.8% hypertonic saline solution (HSS) into the left gastrocnemius muscle. The effects of various Tuina massages on the pain thresholds of the rats were then measured. In addition, the effects of ipsilateral and contralateral Tuina massages on C-fiber-evoked field potentials following electrical stimulation of the left sciatic nerve were determined. Alterations in the gastrocnemius muscle tissues following various Tuina applications were investigated using hematoxylin and eosin, and desmin staining, as well as malondialdehyde and superoxide dismutase assays. Heavy hand pressure transiently reduced the pain sensitivity of both posterior limbs, despite HSS only being injected into the left hind leg. Tuina massage treatments that lasted for 15 min were associated with the best results and an absence of local tissue changes. The results of electrical sciatic nerve stimulation demonstrated that ipsilateral and contralateral Tuina massage may decrease the level of peripheral nociceptive C-fiber activity. In the present study, the Chinese Tuina massage exerted analgesic effects in a rat model of pain, which did not involve tissue damage, following a 15 min massage. Therefore, the rat model of pain used in the present study may provide a novel approach for investigating the molecular and physiological mechanisms underlying the therapeutic effects of Tuina massage.

The use of SHP-2 gene transduced bone marrow mesenchymal stem cells to promote osteogenic differentiation and bone defect repair in rat.

Bone tissue engineering is a promising approach for bone regeneration, in which growth factors play an important role. The tyrosine phosphatase Src-homology region 2-containing protein tyrosine phosphatase 2 (SHP2), encoded by the PTPN11 gene, is essential for the differentiation, proliferation and metabolism of osteoblasts. However, SHP-2 has never been systematically studied for its effect in osteogenesis. We predicted that overexpression of SHP-2 could promote bone marrow-derived mesenchymal stem cell (BMSC)osteogenic differentiation and SHP-2 transduced BMSCs could enhance new bone formation, determined using the following study groups: (1) BMSCs transduced with SHP-2 and induced with osteoblast-inducing liquid (BMSCs/SHP-2/OL); (2) BMSCs transduced with SHP-2 (BMSCs/-SHP-2); (3) BMSCs induced with osteoblast-inducing liquid (BMSCs/OL) and (4) pure BMSCs. Cells were assessed for osteogenic differentiation by quantitative real-time polymerase chain reaction analysis, western blot analysis, alkaline phosphatase activity and alizarin red S staining. For in vivo assessment, cells were combined with beta-tricalcium phosphate scaffolds and transplanted into rat calvarial defects for 8 weeks. Following euthanasia, skull samples were explanted for osteogenic evaluation, including micro-computed tomography measurement, histology and immunohistochemistry staining. SHP-2 and upregulation of its gene promoted BMSC osteogenic differentiation and therefore represents a potential new therapeutic approach to bone repair. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 1871-1881, 2016.

Optimization of parameters of Yi Zhi Chan Tuina manipulation promotes peripheral circulation.

OBJECTIVE: To explore the most effective parameters of Yi Zhi Chan Tuina manipulation for improving peripheral blood circulation. METHODS: A total of 45 volunteers were recruited from Pudong district in Shanghai, China, from October to December 2010, and randomly divided into nine groups using computer-generated random numbers. Participants received Yi Zhi Chan Tuina manipulation on Chengjin (BL 56) acupoint; each group received a particular combination of manipulation force and treatment time. We used a two-factor, three-level factorial design to examine the effects of force and treatment time on changes in popliteal artery average volume flow, pulsatility index, and vessel diameter to determine the optimal parameter group. Outcomes were assessed at baseline and after Tuina manipulation by interviewers blind to treatment group status. RESULTS: After manipulation, two of the nine groups showed an increase in popliteal artery volume flow. An inter-participants effect test showed that for main effect of time, F = 0.331, P = 0.720; for main effect of force, F = 2.934, P = 0.066; and for the force-time interaction effect, F = 1.072, P = 0.385, indicating no interaction between force and time. However, a pairwise comparison of the three levels of time showed that a treatment time of 10 min was significantly more effective than that of 2 min (P = 0.024). A pairwise comparison of light force, medium force, and heavy force showed a statistically significant effect for medium force (P = 0.035). CONCLUSION: Yi Zhi Chan Tuina manipulation with vertical force of 9.31 N for 10 min is most effective in improving peripheral circulation.

[The theorotical basis for chronic fatigue syndrome from bladder meridian of foot-taiyang].

The bladder meridian of foot-taiyang is considered as key of six meridians and the yang of the yang, which is the pivot of transportation for qi and blood in the meridians and zang-fu. The running route and treatment characteristic of bladder meridian is closely related with chronic fatigue syndrome (CFS). The bladder meridian belongs to brain and connects with governor vessel, which has a close relationship with zang-fu function, quality of sleep and fatigue. Besides, the running route of bladder meridian is highly consistent with the surface projections of important anatomical structures such as muscle, nerve and sympathetic trunk, etc. Therefore, regulating the meridian-qi of bladder meridian can harmonize five-zang and calm the mind, but also effectively relieve physical and mental fatigue in CFS.

Limited Medial and Lateral Approaches to Treat Stiff Elbows.

Open arthrolysis is an effective way to treat elbow stiffness. However, previous approaches led to significant surgical trauma. The goal of the current study was to evaluate the outcome of open arthrolysis with limited medial and lateral approaches combined with hinged external fixation to treat elbow stiffness. A total of 18 patients (18 elbows) with elbow stiffness were retrospectively reviewed. The same inclusion and exclusion criteria were used for all patients. Preoperatively, the mean flexion arc was 43°±28° and the mean Mayo Elbow Performance Score was 62 points. Limited medial and lateral approaches were used to provide safe and complete arthrolysis. The other protocols included ulnar nerve transposition, medial epicondyle osteotomy, radial head resection, ligament repair, and hinged external fixation. Patients were encouraged to begin early rehabilitation 24 hours after surgery. At a mean follow-up of 20 months, the flexion arc improved to 130°±11° and the mean Mayo Elbow Performance Score was 97 points (15 excellent, 3 good). One patient had elbow instability, but function met the requirements of his daily life. Transient ulnar nerve palsy without infection occurred in 4 patients. With limited medial and lateral approaches, elbow stiffness can be treated effectively with open arthrolysis. This method is trauma controlled. Furthermore, a hinged external fixator can provide sufficient and safe rehabilitation. The use of open arthrolysis with limited medial and lateral approaches combined with hinged external fixation is an effective and safe method to treat elbow stiffness.