ABSTRACT
Objective:To explore the mechanism of extracorporeal shock wave combined with platelet rich plasma in the treatment of articular cartilage injury in knee osteoarthritis (KOA) rats based on the silent information regulator 1 (Sirt1)/forkhead transcription factor O1 (FoxO1) pathway.Methods:15 SD rats were used for platelet rich plasma extraction and 35 SD rats were randomly divided into blank control group, model group, extracorporeal shock wave group, platelet rich plasma group, and extracorporeal shock wave + platelet rich plasma group. Each group had 7 cases. After the intervention, HE staining of articular cartilage tissue was used to observe changes in articular cartilage morphology, Mankin score was used for pathological evaluation, CCK-8 method was used to detect chondrocyte vitality and proliferation, ELISA method was used to detect inflammatory factor levels in joint fluid, and Western Blot method was used to detect the expression levels of Sirt1 and acely-FoxO1/FoxO1 in five groups of articular cartilage tissue.Results:The HE staining of articular cartilage tissue showed that model group, extracorporeal shock wave group, platelet rich plasma group, and extracorporeal shock wave + platelet rich plasma group had varying degrees of pathological damage, with model group having the most severe pathological damage, while the other three experimental groups had no significant differences. The Mankin score and the level of acely-FoxO1/FoxO1 in articular cartilage tissue showed that blank control group < extracorporeal shock wave + platelet rich plasma group < platelet rich plasma group < extracorporeal shock wave group < model group (all P < 0.05). The results of Sirt1 level in articular cartilage tissue, activity, and proliferation ability of articular chondrocytes showed that model group < extracorporeal shock wave group < platelet rich plasma group < extracorporeal shock wave + platelet rich plasma group < blank control group (all P < 0.05). Comparison of inflammatory factor levels in joint fluid, blank control group < extracorporeal shock wave + platelet rich plasma group < extracorporeal shock wave group < platelet rich plasma group < model group (all P < 0.05). Conclusions:The combination of extracorporeal shock wave and platelet rich plasma can promote the proliferation of osteoarthritis chondrocytes and alleviate joint inflammation and cartilage damage in KOA rats by upregulating Sirt1 expression and downregulating FoxO1 acetylation levels.
ABSTRACT
Objective To analyze the total cost and clinical effectiveness of internal fixation and hemiar-throplasty in the treatment of femoral neck fracture for the elderly. Methods From October 2013 to May 2015,85 patients above 60-year old who were diagnosed as displaced femoral neck fracture and received operation in our hospital. All the patients were divided into internal fixation(IF)group and hemiarthroplasty(HA)group respec-tively. There were 40 cases in the IF group and 45 cases in the HA group. The total cost associated with fracture in a year was collected by medical record ,telephone interview and standard methods. At the last follow-up ,we ap-plied Harris scores to evaluate the clinical outcome for each group. Results All the patients completed the operation successfully. During 1 year follow-up the total cost in the IF group was less than that in the HA group including higher primary hospitalization cost and less post-discharge cost. The total cost was 44,556.1 Yuan in the IF group and 72,198.0 Yuan in the HA group respectively. The data showed that the total cost of HA was 1.6 times higher than that of IF. At the last follow-up the mean Harris scores was 71.1 ± 12.1 in the IF group and 74.3 ± 10.3 in the HA group while the EQ-5D index was 0.74 ± 0.15 and 0.76 ± 0.13 respectively which showed no significant differ-ence(P > 0.05). Conclusions Both internal fixation and hemiarthroplasty have effective treatment for elderly pa-tients with femoral neck fracture. Compared to hemiarthroplasty IF can provide similar clinical effectiveness with less total cost. Therefore IF may contribute to decrease the economic burden for elderly patients in China.