Clinical study on core decompression in treating osteonecrosis of the femoral head of the necrotic bone-in different site / 中国骨伤

OBJECTIVE@#To analyze the clinical effect of decompression and bone grafting on osteonecrosis of the femoral head(ONFH) at different sites of necrotic lesions.@*METHODS@#A total of 105 patients with ARCOⅡstage ONFH admitted from January 2017 to December 2018 were retrospectively analyzed. There were 71 males and 34 females, with an average age of (55.20±10.98) years old. The mean course of all patients was(15.91±9.85) months. According to Japanese Inveatigation Committee (JIC) classification, all patients were divided into 4 types:17 cases of type A, 26 cases of type B, 33 cases of type C1 and 29 cases of type C2. All four groups were treated with decompression of the pulp core and bone grafting. Visual analogue scale(VAS) and Harris hip joint score were used before and at 3, 6, 12, and 24 months after the operation, and the collapse of the femoral head was observed by X-ray examination within 2 years.@*RESULTS@#All 105 patients were successful on operation without complications, and the mean follow-up duration was (24.45±2.75) months. Harris score showed that there was no statistical difference among four groups before surgery and 3, 6 months after surgery (P>0.05);at 12 and 24 months after surgery, there were significant differences among all groups (P<0.01). There were significant differences in intragroup Harris scores at preoperative and postoperative time points among four groups (P<0.01). VAS showed that there was no statistical difference among four groups before and 3, 6 months after surgery (P>0.05);at 12 and 24 months after surgery, there were significant differences among all groups (P<0.01). There were significant differences in VAS at preoperative and postoperative time points among four groups (P<0.01). None of the patients in four groups had femoral head collapse before and 3, 6 months after surgery. At 12 months after operation, there were 3 cases of femoral head collapse in group C and 4 cases in group C2(P>0.05);At 24 months after operation, 1 case of femoral head collapse occurred in group B, 6 cases in group C1 and 8 cases in group C2(P<0.05).@*CONCLUSION@#Core decompression and bone grafting can improve the effect of ONFH and hip preservation. The effect of hip preservation for ONFH is closely related to the location of the osteonecrosis lesion, so the influence of the location of lesion on the effect of hip preservation should be considered in clinical treatment, so as to make better preoperative hip preservation plan.

Early-onset preeclampsia with or without fetal growth restriction: an analysis of 591 cases / 中华围产医学杂志

Objective To investigate whether fetal growth restriction (FGR) could be used as an indicator for severe early-onset preeclampsia.Methods A retrospective analysis was conducted on 591 women with early-onset preeclampsia and their fetuses and newborns in Departments of Obstetrics and Gynecology,Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine,and the Third Affiliated Hospital of Guangzhou Medical University from January 2011 to December 2017.These cases were divided into two groups according to whether they were complicated by FGR (n=206,FGR group) or not (n=385,non-FGR group).Clinical datas were analyzed by t test or Chi-square test.Results (1) There was no significant difference between the two groups in terms of average maternal age,the ratio of primipara,the proportion of women with hypertension history,abnormal blood glucose or who received regular antenatal examination,gestational age at onset and termination or cesarean section rate.No maternal death was reported.(2)The systolic blood pressure and the incidence of hemolysis,elevated liver enzyme,low platelet count (HELLP) syndrome in the FGR group were lower than those in the non-FGR group [(167.0±21.5) vs (174.0±21.8) mmHg,t=-3.729 (1 mmHg=0.133 kPa);6.8％ (14/206) vs 13.8％ (53/385),x2=6.486].Although the incidence of absent or reverse diastolic umbilical artery flow in the FGR group was significantly higher [24.3％ (50/206) vs 14.5％ (56/385),x2=8.625],and the amniotic fluid index and placental weight were lower than those in the non-FGR group [(77.82±29.78) vs (90.53±43.83) mm,t=-2.837;(302.83±80.01) vs (330.98±61.01) g,t=-2.823],the stillbirth rate was lower[2.4％ (5/206) vs 6.5％ (25/385),x2=4.605] (all P ＜ 0.05).(3) Platelet counts in the FGR group were higher than those in the non-FGR group [(189.96 ± 65.43) vs (173.77 ± 62.88)× 109/L,t=2.923],while serum creatinine and D-dimer were lower [(70.99±22.97) vs (78.98±50.87) μ mol/L,t=-2.109;(491.01 ±401.98) vs (635.67±386.21) μg/L,t=-2.276] (all P ＜ 0.05).There was no significant difference in 24-hour urine protein excretion between the two groups.Conclusions FGR should not be used as an indicator for severe early-onset preeclampsia.

Effects of Sinomenine on Expressions of TLR-2, TLR-4 and MyD88 in Cartilage of Rabbit Knee Osteoarthritis Model / 中国中医药信息杂志

Objective To observe the effects of different doses of sinomenine on toll-like receptor (TLR) 2, TLR4 and myeloid differentiation factor 88 (Myd88) in cartilage of rabbit knee osteoarthritis model; To discuss its mechanism of action. Methods Knee osteoarthritis model was established by Hulth method. Experimental rabbits were randomly divided into control group, model group, sinomenine low-, medium-and high-dose groups. Blank group received no processing. Model group, sinomenine low-, medium-and high-dose groups received intra-articular injection of normal saline and sinomenine 0.2 mL (5 mg), 0.35 mL (8.75 mg) and 0.5 mL (12.5 mg) respectively, for 10 times. Real-time fluorescence quantitative PCR and Western blot were used to detect m RNA and protein expressions of TLR2, TLR4 and My D88 in cartilage. Results m RNA and protein expressions of TLR2, TLR4 and MyD88 in model group significantly increased compared with control group (P＜0.01); compared with model group, m RNA and protein expressions of TLR2, TLR4 and My D88 in sinomenine medium-and high-dose groups decreased significantly (P＜0.05, P＜0.01). Conclusion Sinomenine can inhibit the cartilage immune response of rabbit knee osteoarthritis by down-regulating expressions of key molecules in the TLR/My D88 pathway.

Regulating effect of anodonta glucan HBP-A on chondrocytes through Wnt pathway / 中国骨伤

<p><b>OBJECTIVE</b>To investigate regulation function of anodonta glucan HBP-A on chondrocytes through Wnt pathway in vitro.</p><p><b>METHODS</b>Rat chondrocytes were cultured and differentiated induced with IL-1beta (10 ng/ml) in vitro. Chondrocytes were divided into five groups:IL-13 group,IL-1beta + IWP-2 (5 microM,Wnt pathway inhibitor) group, IL-1beta + HBP-A (0.3 mg/ml) group and IL-1beta + IWP-2 + HBP-A group. Wnt-3a, beta-catenin (24 h,48 h,72 h) and MMP-13(72 h) genes expression were detected by Rt-PCR, while beta-catenin, MMP-13, Sox-9 and coll-II (48 h) protein expression were measured by Western-blot.</p><p><b>RESULTS</b>After induction of IL-1beta, gene expression of Wnt-3a, beta-catenin and MMP-13 were increased,so were the protein expression of beta-catenin and MMP-13. In contrast,protein expression of Sox-9 and Coll-II were declined. Following addition of HBP-A, Wnt-3a, beta-catenin and MMP-13 were shown as induction of IL-1beta, but protein expression of Sox-9 and Coll-II were upgraded. Combining HBP-A with IWP-2 led to the lowest level in Wnt-3a, beta-catenin gene and beta-catenin protein expression and highest expression of Sox-9 protein.</p><p><b>CONCLUSION</b>HBP-A could not only delay the differentiation of chondrocytes through downgrading the signal expression of Wnt/beta-catenin,but also adjust the expression of Wnt-3a, beta-catenin and Sox-9 when combinated with the Wnt inhibitor.</p>

Application of biomarker CTX- II in osteoarthritis / 中国骨伤

Effective biomarkers for clinical usage of osteoarthritis are still limited. It was confirmed that C-terminal crosslinking telopeptide of type I collagen (CTX- II) was a specific marker reflecting degradation of articular cartilage. Detection of CTX- II could promptly reflect level of cartilage injury and degradation ,diagnose OA,predict its progress,monitor effects of drug treatment, thus, reflect the condition of osteoarthritis patient indirectly. Application of CTX- II focused mainly on in the early stage of OA and need together to detect with other biomarkers,in order to more accurately reflection of the pathological changes of OA,but the specific clinical significance of CTX- II results still need to improve further.

Study on the diagnostic value of whole-organ magnetic resonance imaging score (WORMS) in knee osteoarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To explore the diagnostic value of whole-organ magnetic resonance imaging score (WORMS) in knee osteoarthritis (KOA).</p><p><b>METHODS</b>From November 2009 to January 2011,70 patients with KOA combined with knee effusion among outpatient and inpatient were analyzed retrospectively. Among the patients, 12 patients were male, 58 patients were female,ranging in age from 46 to 75 years,with a mean age of (59.66 +/- 9.93) years. The clinical symptoms were evaluated by WOMAC, the imaging of KOA was assessed by K-L score and WORMS, and COMP and CTX- II were measured respectively by ELISA. The correlation analyses and multiple linear regression analysis were studied to determine associations among biomarkers, clinical variables and radiographic findings of knee joints.</p><p><b>RESULTS</b>The average scores of WOMAC and WORMS were (57.50 +/- 8.20) and (64.54 +/- 16.45) respectively. The median of CTX- II nd COMP were 2.42 ng/ml and 4.56 ng/ml respectively. Grouped by less than the lowest quartile and more than the highest quartile of WORMS, COMP was significantly different (Z=2.04, P=0.039), but there was no significant difference in CTX-II (Z=0.79, P=0.427). WORMS were positively correlated with WOMAC and K-L score (r=0.777, P<0.01; r=0.716, P<0.01; respectively); WOMAC was also positively correlated with K-L score (r=0.692, P<0.01). WORMS's cartilage, osteophytes and synovitis were positively correlated with WOMAC, K-L score and COMP respectively (r=0.771, P<0.01; r=0.509, P<0.01; r=0.917, P<0.01). It was determined by stepwise regression that the KOA was mainly affected by WORMS, K-L score (P=0.015, P=0.025 respectively) when WOMAC as a dependent variable, age, gender, K-L score, WORMS, COMP and CTX- II as independent variables (F=20.327, P<0.01).</p><p><b>CONCLUSION</b>WORMS has a better reference value for diagnosis of KOA. The expression of COMP is high in the synovial fluid when WORMS at the high point. The clinical symptoms of knee osteoarthritis are mainly affected by WORMS and K-L score.</p>

Cut-off points of fasting fingertip capillary blood glucose for detecting both undiagnosed diabetes and pre-diabetes / 中华流行病学杂志

Objective To determine the efficient cut-off points of fasting fingertip blood glucose test for undiagnosed diabetes mellitus(DM), impaired glucose tolerance(IGT), and impaired fasting glucose(IFG)in community-based residents aged above 45 years old. Methods A cluster-randomized study was conducted from May 2008 to January 2009. A total of 3250 subjects aged above 45 years in two communities of Baoding city received questionnaire investigation and tested for fingertip blood glucose. Those subjects whose capillary blood glucose level ≥5.1 mmol/L were subjected to 75 g oral glucose tolerance test. Undiagnosed diabetes mellitus and pre- diabetes were identified by fasting plasma glucose and OGTT. In this study, the cut-off points of fasting capillary blood glucose for detecting undiagnosed diabetes and pre-diabetes were evaluated, using receiver operator characteristic curve(ROC). Results Of 1351 subjects that having had oral glucose tolerance test, 230 cases were diagnosed as diabetes mellitus(7.3%), 166 cases(5.2%)as IFG, and 204(6.7%)as IGT under fasting capillary blood glucose as test variable and state variables according to the following criteria.(1)FPG≥7.0 mmol/L or/and 2hPG≥11.1 mmol/L(2)FPG<5.6 mmol/L (3)FPG<7.0 mmol/L and 7.8 mmol/L≤2hPG≤ 11.1 mmol/L, areas under three ROC curves were 0.905, 0.633 and 0.719, respectively. The cut-offvalues of screening for undiagnosed DM, IGT and IFG were 6.0 mmol/L, 5.7 mmol/L, and 5.7 mmol/L, respectively. When cut-off value of screening for undiagnosed DM was 6.0 mmol/L, the maximal sensitivity was 78.0% and specificity was 89.3%.But there were both lower sensitivity and specificity in screening for IFG and IGT according to the best predicting value(5.7 mmol/L)from the ROC curves(50.3% and 28.0% vs. 60.8% and 28.0%). Conclusion Fasting capillary blood glucose with the lower cut-point of 6.0 mmol/L in screening for undiagnosed diabetes mellitus alone, was relatively reliable, whereas for both IFG and IGT the fasting fingertip blood glucose tests were fallible. It was convenient and could be used in screening the DM at the community level.

Effect of the mixed liquor of danshen and magnesium sulfate injection on IgG and IgM in serum of rabbits with lumbar intervertebral disc herniation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the effect of the mixed liquor of danshen and magnesium sulfate injection on inflammatory reaction caused by autoimmune response of rabbits with lumbar intervertebral disc herniation.</p><p><b>METHODS</b>Sixty rabbits were divided into blank group (10 rabbits), sham operation group (10 rabbits), model group (40 rabbits) according to method of random digits table. Then model group was divided into made group (group A, 10 rabbits), normal saline group (group B, 10 rabbits), aescin natrium group (group C, 10 rabbits) and danshen and magnesium sulfate injection group (group D,10 rabbits). After model success of lumbar intervertebral disc herniation, different drugs were given to rabbits with lumbar intervertebral disc herniation by ear margin vein. The rabbits of the group C,B,D were respectively given aescin natriu (0.5 mg/kg), normal saline (5 ml/kg), danshen and magnesium sulfate injection (2.0 mg/kg). The rabbits of blank group, sham operation group and group A were not given any disposal. The IgG and IgM level in serum of different groups were determined with ELISA method in fourteen day after model success and drugs given.</p><p><b>RESULTS</b>The level of IgG and IgM in the group A was higher than that of blank group and sham operation group (P < 0.05). The level of IgG and IgM in the group D was lower than that of group B,C (P < 0.05).</p><p><b>CONCLUSION</b>The mixed liquor of danshen () and magnesium sulfate injection could inhibit inflammatory reaction caused by autoimmune response of lumbar intervertebral disc herniation,which provides a new alternative for lumbar intervertebral disc herniation.</p>

Effect of Xianlong granules on immunological function in rats of adjuvant arthritis / 中国中药杂志

<p><b>OBJECTIVE</b>To study the effect of Xianlong granules (XLG) on immunological function in the rat of adjuvant arthritis (AA).</p><p><b>METHOD</b>Rats were randomly divided into normal group, AA model group, prednisone group and low, middle and high dose XLG groups, 10 rats in each group. All rats were treated by intragastric administration from the 18 days after arthritis was induced by the complete Freud's adjuvant and the effect of XLG on toes swelling was observed. On the 30th days after modeling, proliferation of the splenic and thymic lymphocytes, and IgG secreted by splenocytes were detected respectively by MTT assay and ELISA.</p><p><b>RESULT</b>Compared with the model group, both the high and middle dose XLG groups had significant therapeutic effects on toes dwelling in the rat of AA (P < 0.05 or P < 0.01); The low, middle and high dose XLG groups strengthened the PHAM-inhibited proliferation of splenic lymphocytes (P < 0.05), and inhibited the PHAM-augmented proliferation of thymic lymphocytes (P < 0.05); XLG did not significantly effect on IgG level secreted by splenocytes in rats of AA.</p><p><b>CONCLUSION</b>XLG can cure toes swelling in rats of AA, which is related with regulation of the abnormal immunlological function.</p>

Clinical observation on effect of gufusheng capsule in treating early stage Legg-Calve-Perthes disease / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of Gufusheng capsule (GFSC) in treating early stage Legg-Calve-Perthes disease.</p><p><b>METHODS</b>Adopting randomized single controlled trial, 45 cases with Legg-Calve-Perthes disease in early stage were randomly divided into 2 groups, 23 patients in the control group were treated with arthrectomy hip synovial membrane excision of affected lateral, femoral head decompression and transplantation of muscle-bone flap from ileum, above treatment were also given to the 22 patients in the treated group but combined with orally taking of GFSC. The treatment course for both groups was 6 months.</p><p><b>RESULTS</b>Short-term effect after 6 months' treatment showed that the total effective rate in the treated group and the control group was 90.9% and 78.3% respectively, and the excellent rate was 72.7% and 60.9% respectively. The pain visual analogue scoring, clinical symptom and syndrome scoring markedly decreased before and after treatment, showing significant difference between the two groups (P < 0.05, P < 0.01). Long-term effect after 1-year to 4-year follow-up showed that the total effective rate and excellent rate between the treated group and the control group was significantly different ( chi2 = 8. 5976, P < 0.05).</p><p><b>CONCLUSION</b>GFSC has marked effect in alleviating pain and ameliorating function of hip joint, being an effective compound recipe for treatment of early stage Legg-Calve-Perthes disease. Therefore, it is worthy of researching and developing furthermore.</p>