Plantar Pressure Analysis after Medial Opening Wedge High Tibial Osteotomy Treatment of Medial Single Compartmental Knee Osteoarthritis / 医用生物力学

Objective To analyze the plantar pressure distribution of knee osteoarthritis ( KOA) patients after medial opening wedge high tibial osteotomy ( MOWHTO), so as to provide biomechanical references for the surgical treatment and rehabilitation of patients. Methods A total of 31 patients with medial single compartmental KOA after unilateral MOWHTO treatment were selected as the experimental group, and 35 healthy subjects at same age were selected as the control group. The Pedomedic 40 􀅺 pressure measuring system was used to test dynamic plantar pressure. By comparing the maximum pressure ( pmax ), force-time integral ( FTI) and contact area (CA) of different plantar zones between the experimental group (operative side and unoperated side) and the control group during walking, the changes of plantar pressure in patients with medial single compartmental KOA after MOWHTO were evaluated. Results Compared with the unoperated side and the control group, the CA and FTI of the 1st metatarsal head (MH1) were higher (P<0. 05), the CA of the 4th metatarsal head (MH4)was smaller (P<0. 001), the pmax and FTI of the 5th metatarsal head (MH5) were smaller (P<0. 05), the CA of the lateral middle foot (MF-L) was smaller (P<0. 001), and the CA of the medial rear foot (RF-M) was larger (P<0. 05). Compared with the control group, the pmax of MH1 and MH2 was smaller (P<0. 05), the CA and FTI of MH5 were larger (P<0. 05), the pmax of MF-L was larger (P<0. 001), and the FTI of lateral rear foot (RF-L) was larger (P<0. 05). Conclusions Compared with healthy people, patients with medial single compartmental KOA have abnormal plantar pressure residual after MOWHTO. In clinical practice, targeted intensive rehabilitation therapy is necessary to restore the normal plantar distributions of patients.

Effect of needle-knife on chondrocyte apoptosis of knee joint in rabbits with knee osteoarthritis based on CircSERPINE2-miR-1271-5P-ERG axis / 中国针灸

OBJECTIVE@#To observe the effect of needle-knife on the chondrocyte apoptosis of knee joint in rabbits with knee osteoarthritis (KOA) based on the CircSERPINE2-miR-1271-5P-E26 specific transformation-related gene (ERG) axis, and to explore the mechanism of needle-knife for KOA.@*METHODS@#Thirty-six New Zealand white rabbits were randomly divided into a normal group, a model group, a needle-knife group and a sham needle-knife group, 9 rabbits in each group. The rabbits in the model group, the needle-knife group and the sham needle-knife group were treated with modified Videman method to prepare KOA model. After successful modeling, the rabbits in the needle-knife group were treated with needle-knife at cord adhesion and nodules near quadriceps femoris tendon and internal and external collateral ligament on the affected knee joint; the rabbits in the sham needle-knife group were treated with sham needle-knife baside the needle insertion point of the needle-knife group (needle-knife was only inserted, without any operation). The treatment was given once a week, 3 times in total. The Lequesne MG behavioral score was used to evaluate the knee joint damage in each group before and after intervention. After intervention, HE staining and transmission electron microscopy were used to observe the cartilage tissue morphology and ultrastructure of chondrocytes in the knee joint in each group; TUNEL method was used to detect the level of chondrocyte apoptosis in the knee joint; real-time fluorescence quantitative PCR was used to detect the expression of CircSERPINE2, miR-1271-5P and ERG mRNA in knee cartilage tissue in each group.@*RESULTS@#After intervention, compared with the normal group, the Lequesne MG behavioral score in the model group was increased (P<0.01). Compared with the model group and the sham needle-knife group, the Lequesne MG behavioral score in the needle-knife group was decreased (P<0.01). In the model group and the sham needle-knife group, the number of chondrocytes and organelles was decreased, the cell nucleus was shrunk, mitochondria was swelling or disappeared; in the needle-knife group, the number of chondrocytes and organelles was increased, the cell nucleus was not obviously shrunk and the mitochondria was not obviously swelling. Compared with the normal group, the level of chondrocyte apoptosis in the model group was increased (P<0.01); compared with the model group and the sham needle-knife group, the level of chondrocyte apoptosis in the needle-knife group was decreased (P<0.01, P<0.05). Compared with the normal group, the expression of CircSERPINE2 and ERG mRNA in the model group was decreased (P<0.01), and the expression of miR-1271-5P mRNA was increased (P<0.01); compared with the model group and the sham needle-knife group, the expression of CircSERPINE2 and ERG mRNA in the needle-knife group was increased (P<0.01), and the expression of miR-1271-5P mRNA was decreased (P<0.01).@*CONCLUSION@#Needle-knife could reduce the knee joint damage and chondrocyte apoptosis in KOA rabbits, which may be related to up-regulating the expression of CircSERPINE2 and ERG mRNA, and inhibiting the expression of miR-1271-5P mRNA.

Study on the value of Xiaozeng Qianggu tablet combined with Zhengshishuhuo tincture in treating knee osteoarthritis combined with osteoporosis:an assessment based on quantitative MRI and QCT / 中国医学装备

Objective:To assess the value of Xiaozeng Qianggu tablet combined with Zhengshishuhuo tincture in treating knee osteoarthritis(KOA)combined with osteoporosis(OP)on the basis of quantitative magnetic resonance imaging(MRI)and quantitative CT(QCT).Methods:A total of 80 patients with KOA combined with OP admitted to the hospital were selected,and they were divided into an observation group and a control group according to the random number table method,with 40 cases in each group.The observation group was treated with Xiaozeng Qianggu Tablets combined with Zhengshishuhuo tincture that coordinated local massage,while the control group was treated with Zhengshishuhuo tincture alone coordinated local massage.The visual analogue scale(VAS),Westerm Ontario and Mcmaster Universities Osteoarthritis Index(WOMAC)and short form-36(SF-36)scores before and after treatment of the two groups of patients were compared,as well as the changes of serum IL-1β,IL-6 and TNF-α levels of patients.Quantitative MRI and QCT were used to measure the imaging changes of the patients'knee joints before and after treatment,and whole organ magnetic resonance imaging score(WOMRIS)and bone mineral density(BMD)values of knee joint before and after treatment between two groups were further compared.Results:After treatment,the VAS and WOMAC scores of the patients in the observation group were significantly lower than those of the control group,and the SF-36 scores of that was significantly lower than that of the control group,the differences were statistically significant(t=2.518,t=2.017,t=2.262,P<0.05),respectively.The serum TNF-α,IL-1β,and IL-6 levels of the observation group were significantly lower than those in the control group,and the differences were statistically significant(t=2.429,t=2.641,t=4.065,P<0.05).The scores of subchondral bone marrow edema,meniscal injury and degeneration and joint effusion of observation group were significantly lower than those of the control group,and the differences were statistically significant(t=2.641,t=2.216,t=2.262,P<0.05).The BMD values of the four parts included the femoral medial condyle,lateral condyle,tibial lateral platform and tibial medical platform of the observation group were respectively higher than those of control group,and the differences were statistically significant(t=2.864,t=3.985,t=4.276,t=2.714,P<0.05).Conclusion:Xiaozeng Qianggu Tablets combined with Zhengshishuhuo tincture that coordinated local massage can effectively relieve pain of patients with KOA combined with OP,and improve joint function,and delay osteoporosis of knee joint.

Characteristics of Proprioception in Patients with Knee Osteoarthritis / 医用生物力学

Objective To explore the proprioception characteristics of knee joints for knee osteoarthritis (KOA) patients before unicondylar knee arthroplasty (UKA) and total knee arthroplasty (TKA). Methods Twenty-nine single-compartment KOA patients were selected. Fifteen patients were treated with UKA (UKA group) and fourteen patients were treated with TKA (TKA group). The test was performed 1 to 3 days before the operation.The keen society scores (KSS) of KOA patients in UKA group and TKA group were compared, and their joint position sense and kinesthesia were compared with control group. Results Significant differences in KSS were found in TKA group and UKA group, and the knee joint position sense and kinesthesia showed no significant differences between TKA group and UKA group.There were no significant differences in the knee joint position sense and kinesthesia between the operated leg and unoperated leg in TKA group and UKA group, and between the left leg and right leg in control group. Compared with control group, there were significant differences between UKA group and TKA group in 60° position sense of the operated leg and unoperated leg.The kinesthesia of the operated leg and unoperated leg in UKA group and TKA group were also significantly different from that in control group. Conclusions Compared with control group, the proprioception of the knee joint in KOA patients was significantly reduced before the surgery, but the characteristics of proprioception in UKA group and TKA group were similar.

Mechanism of Yougui Pills in the treatment of knee osteoarthritis based on network pharmacology and molecular docking / 西安交通大学学报(医学版)

【Objective】 To explore the mechanism of Yougui Pills in the treatment of knee osteoarthritis （KOA） based on network pharmacology and molecular docking. 【Methods】 The active components of Yougui Pills were obtained by searching TCMSP database. With the active component targets predicted by TCMSP， SwissTargetPrediction and TargetNet， we searched TCMIP， CTD， DisGeNET and GeneCards databases for KOA related targets. By crossing the two sets of targets， we obtained therapeutic targets of Yougui Pills for KOA. FDA-approved drugs for KOA and their targets were searched in the DrugBank database， and the drug-target network was constructed by using Cytoscape. Then the protein-protein interaction （PPI） network was constructed by using STRING database. After Go and KEGG enrichment analyses， the network of “traditional Chinese Medicine-active components-key targets-significant pathways-biological process” was constructed. 【Results】 A total of 132 active components were obtained from the nine herbal medicines of Yougui Pills， corresponding to 490 targets， of which 76 were potential therapeutic targets. Of them 13 were the same as the targets of 5 Western medicines for KOA. We screened out 18 key targets by the PPI network. Go enrichment analysis revealed 1281 biological processes， 60 molecular functions， and 17 cellular components， which were mainly related to inflammation， infection and oxidative stress. KEGG enrichment analysis showed that 50 pathways were significantly enriched， including IL-17 signaling pathway and TNF signaling pathway， whose functions were mainly involved in immune system， signal transduction， endocrine system， cell growth and death and other biological processes. 【Conclusion】 With multiple compounds acting on multiple molecular targets， Yougui Pills can treat KOA through molecular mechanisms including inhibiting inflammation， reducing oxidative stress， and promoting cartilage cell proliferation.

Effects of Bilateral Knee Osteoarthritis on Dynamic Balance Ability of Ankle Strategy in Aged Women / 医用生物力学

Objective To investigate the effect of bilateral knee osteoarthritis (KOA) ondynamic balance ability of ankle strategy in aged women. Methods The dynamic balance ability tester was used to test the balance score, the rotation speed, the maximum rotation speed, and the percentage of the target ball's residence time in each area of KOA patients (KOA group)and the general elderly (control group), and a comparative analysis between groups was conducted. Results The balance score of KOA group was lower than that of control group; the dynamic balance control ability of KOA group in the horizontal direction was basically the same as that of control group, but the dynamic balance control ability of KOA group in the vertical direction was weaker than that of control group.Bilateral KOA reduced dynamic balance ability of ankle strategy in the aged women.It could not affect the left-right symmetric balance ability of the aged women, but it would reduce its forward-backward symmetrical balance ability. Conclusions Bilateral KOA aged women may be more likely to fall forward or backward, while not easy to fall laterally. For elderly female patients with bilateral KOA, methods such as strengthening ankle joint strength, proprioception and responsiveness can be used to prevent falls that may be caused by reduced dynamic balance ability, especially falls in the forward and backward directions.

Ultrasound anatomy and needle-knife insertion approach of common tendon lesions in knee osteoarthritis based on meridian sinew theory / 中国针灸

OBJECTIVE@#To explore the ultrasonic anatomical characteristics and needle-knife insertion approach of common tendon lesions in knee osteoarthritis (KOA), so as to provide the references for accurate release of KOA by needle- knife along tendon lesions based on meridian sinew theory.@*METHODS@#Sixty patients with one-knee KOA were selected. High-frequency musculoskeletal ultrasound was used to collect sonograms at the anatomical positions of "Hedingci" "Binwaixia" "Binneixia" and "Yinlingshang". The anatomic levels were marked on the sonograms. The anatomic levels and sonographic features of lesions were compared and analyzed, and the relevant data of needle-knife simulation approach was measured.@*RESULTS@#The "Hedingci" lesions were mainly located at the attachment of quadriceps tendon to patella and suprapatellar bursa. The "Binwaixia" and "Binneixia" lesions were mainly located at the attachment of retinaculum patellae laterale and retinaculum patellae mediale to patella and infrapatellar fat pad. The "Yinlingshang" lesions were mainly located at the attachment of goose foot tendon to medial tibial condyle and bursa of goose foot. With "Hedingci" as an example, when the needle-knife entry point was 1 cm above the patella, the attachment of quadriceps tendon to patella was released, and the average depth of needle-knife was (3.60±0.10) cm, and the needle body was perpendicular to the skin. The average depth of needle-knife for releasing suprapatellar bursa was (2.35±0.17) cm, and the needle body was 45° towards head.@*CONCLUSION@#The musculoskeletal ultrasound could clearly show the local detailed anatomical level, ultrasonic characteristics and anatomical level of common tendon lesions of KOA, and could improve the accuracy of needle-knife along tendon lesions with non-direct vision, which has important reference value for needle-knife medical standardization and standardized operation.

Heat-sensitive moxibustion of different suspension moxibustion methods and imitation moxibustion apparatus on moxibustion sensation and clinical efficacy in knee osteoarthritis / 中国针灸

OBJECTIVE@#To observe the moxibustion sensation and the clinical therapeutic effect of heat-sensitive moxibustion of two different suspension moxibustion methods and imitation moxibustion apparatus on mild to moderate knee osteoarthritis (KOA), and compare the therapeutic effect of different moxibustion methods.@*METHODS@#A total of 90 patients with mild to moderate KOA were randomized into a hand-held group (30 cases, 1 case dropped off), an imitation moxibustion apparatus group (30 cases) and a moxibustion shelf group (30 cases, 1 case dropped off). @*RESULTS@#The compositions of moxibustion sensation and numbers of moxibustion sensation types in individuals in the hand-held group and the moxibustion shelf group were richer, the moxibustion sensation intensity was higher than that in the imitation moxibustion apparatus group (@*CONCLUSION@#Heat-sensitive moxibustion can effectively treat knee osteoarthritis, while the different suspension moxibustion methods have an influence on clinical therapeutic effect, hand-held suspension moxibustion has the best efficacy.

Effect of acupuncture on knee injury and osteoarthritis outcome score in patients with knee osteoarthritis / 中国针灸

OBJECTIVE@#To verify the clinical effect of acupuncture on knee osteoarthritis (KOA).@*METHODS@#Forty-two patients with KOA were randomly divided into an acupuncture group (21 cases, 1 case dropped off) and a sham acupuncture group (21 cases, 1 case dropped off). The patients in the acupuncture group were treated with routine acupuncture at 5-6 local acupoints [Dubi (ST 35), Neixiyan (EX-LE 4), Heding (EX-LE 2), Yinlingquan (SP 9), Xuehai (SP 10), Zusanli (ST 36), etc.] and 3-4 distal acupoints [Fengshi (GB 31), Waiqiu (GB 36), Xuanzhong (GB 39), Zulinqi (GB 41), etc.]. The patients in the sham acupuncture group were treated with shallow needling technique at non-acupoint. The needles were retained for 30 min in both groups. All the treatment was given three times a week for 8 weeks. Knee injury and osteoarthritis outcome score (KOOS) were recorded before and after treatment and 18-week follow-up.@*RESULTS@#Compared before treatment, the scores of 5 dimensions of KOOS [pain, symptoms (except pain), daily activities, sports and entertainment, and quality of life] were increased after treatment and during follow-up in the two groups (@*CONCLUSION@#Acupuncture can reduce the pain symptoms and improve daily activities in patients with KOA.

Difference of musculoskeletal ultrasound imaging of focus of knee joint tendon between patients with knee osteoarthritis and healthy subjects / 中国针灸

OBJECTIVE@#To observe the imaging features of focus of knee joint tendon in patients with knee osteoarthritis (KOA) by musculoskeletal ultrasound (MSUS) technique.@*METHODS@#One hundred KOA patients and 100 healthy subjects were included. All the KOA patients were palpated by the sequence of foot @*RESULTS@#The top-5 focus of knee tendon of KOA patients were located in medial inferior patella, medial tibial condyle, inferior patella, Zusanlici and Hedingci. The thickness of ligaments and tendons in extension and flexion positions in KOA patients were thicker than that in healthy subjects (@*CONCLUSION@#The focus of knee joint tendon in KOA patients shows significantly thickened musculoskeletal imaging features.

Protective Effect of Cangxi Tongbi Capsule on Articular Cartilage of KOA Rats Based onp38 MAPK Signaling Pathway / 中国实验方剂学杂志

Objective:To observe the therapeutic effect and mechanism of Cangxi Tongbi capsule on knee osteoarthritis (KOA) model rats. Method:Sixty 4-week-old SPF healthy male SD rats were randomly divided into blank group, model group, dimethyl sulfoxide (DMSO) group, Cangxi Tongbi capsule group, SB203580 group and Cangxi Tongbi capsule combined with SB203580 group. In addition to the normal group, the modified Hulth method was used to establish the koa model. After the model was established successfully, the Cangxi Tongbi capsule group was given 0.25 g·kg-1 Cangxi Tongbi capsule solution by gavage every day, the SB203580 group was given 0.015 g·kg-1 SB203580 solution by gavage, the Cangxi Tongbi capsule combined with SB203580 group was given a mixed solution containing 0.015 g·kg-1 SB203580 and 0.25 g·kg-1 Cangxi Tongbi capsule by gavage, the DMSO group was given 1% DMSO solution by gavage, the model group and blank group were given normal saline by gavage The stomach was killed and the material was taken after 4 weeks of drug intervention. The expression levels of interleukin-1β （IL-1β） and tumor necrosis factor-α（TNF-α）in the supernatant of peripheral blood were detected by ELISA. p38, p-p38, matrix metalloproteinase-13(MMP-13), Collagen Ⅱ mRNA and protein in p38 MAPK signal pathway were detected by Real-time fluorescence quantification PCR （Real-time PCR） and Western blot, and the localization expression of p-p38 was detected by immunohistochemistry. Result:Compared with normal group，the expression levels of p38，p-p38，MMP-13 in articular cartilage of the model group were up-regulated (P<0.01), the expression levels of CollagenⅡ was down-regulated (P<0.01). The contents of IL-1β and TNF-α in serum were significantly increased (P<0.01). Compared with model group, the expression levels of p38，p-p38，MMP-13 in articular cartilage of the Cangxi Tongbi capsule group, SB203580 group and Cangxi Tongbi capsule combined with SB203580 group were down-regulated (P<0.01), the expression levels of CollagenⅡ was up-regulated (P<0.01). The contents of IL-1β and TNF-α in serum were significantly decreased (P<0.01). Conclusion:Cangxi Tongbi capsule can effectively protect the cartilage of KOA rats, and its mechanism may be related to the targeted blocking of p38 MAPK signal pathway.

Effects of Electro-Acupuncture on Vertical Ground Reaction Force and Impulse Symmetry of Patients with Knee Osteoarthritis during Stair Climbing / 医用生物力学

Objective To observe the effects of electro-acupuncture on loading of lower limb joints in patients with knee osteoarthritis (KOA) during stair climbing and explore the related biomechanical mechanism. Methods Forty patients with KOA were randomly assigned, with 20 patients in observation group (electro-acupuncture group, EA group) and 20 patients in control group (superficial acupuncture group, SA group). Finally 18 patients in each group completed the study. In observation group, seven knee acupuncture points were chosen and patients were connected with electro-acupuncture instrument; while in control group, the electro-acupuncture instrument was connected but not electrified after superficial acupuncture at non-acupoint points. The three-dimensional gait analysis system was used to assess the biomechanical characteristics during stair climbing before and after treatment, including peak vertical force (PFz), vertical impulse (IFz) and symmetry index (SI%). Results After 3 weeks of treatment in EA group, PFz of the right foot during stair ascent and PFz of the left foot during stair descent increased (P＜0.05); IFz of both feet during stair ascent and IFz of the right foot during stairs descent significantly decreased (P＜0.05); no significant differences were found in SI% of peak and impulse (P＞0.05). In SA group, only SI of impulse during stairs ascent increased (P＜0.05). There was no significant difference between two groups before and after treatment (P＞0.05). Conclusions Electro-acupuncture can effectively improve the joint load capacity and reduce the dynamic cumulative load of patients w

Clinical efficacy of different waves of electroacupuncture on knee osteoarthritis and its effect on TGF-β1 in joint fluid / 中国针灸

OBJECTIVE@#To observe the therapeutic effects of different waves of electroacupuncture (EA) on knee osteoarthritis (KOA), and to explore the mechanism of different waves of EA on promoting cartilage repair.@*METHODS@#Ninety- seven patients with KOA were randomly divided into a dilatational wave group (32 cases, 2 cases dropped off), a continuous wave group (32 cases, 2 cases dropped off) and a discontinuous wave group (33 cases, 3 cases dropped off). The same acupoints of Xuehai (SP 10), Liangqiu (ST 34), Dubi (ST 35) and Neixiyan (EX-LE 4) were selected in the three groups. The dilatational wave (frequency of 2 Hz/10 Hz) was used in the dilatational wave group, the continuous wave (frequency of 10 Hz) was used in the continuous wave group, and the discontinuous wave (frequency of 10 Hz) was used in the discontinuous wave group. All the needles were retained for 30 min. All the treatment was given 3 times a week (on Monday, Wednesday and Friday) for 4 weeks. Lysholm knees scoring scale (LKSS) was used to evaluate the knee joint function before and after treatment, and the content of transforming growth factor-β1 (TGF-β1) in the joint effusion before and after treatment was determined by enzyme-linked immunosorbent assay (ELISA).@*RESULTS@#Compared before treatment, the total score and each score of LKSS were increased after treatment in the three groups (all <0.05). The improvements of total score, pain score, instability score, swelling score of LKSS in the continuous wave group and the dilatational wave group were superior to those in the discontinuous wave group (all <0.05). The content of TGF-β1 in the joint effusion in each group was increased after treatment (<0.05), and the improvement in dilatational wave group was superior to thoes in the continuous wave group and the discontinuous wave group (all <0.05).@*CONCLUSION@#The three different waves of EA could all improve the clinical symptoms of KOA, which may promote cartilage repair by increasing TGF-β1 content. The dilatational wave had the best overall effect, which can be used as a clinical optimal treatment.

Safety and efficacy of focused low-intensity pulsed ultrasound therapy for the treatment of knee osteoarthritis / 上海交通大学学报（医学版）

Objective • To investigate the safety and efficacy of focused low-intensity pulsed ultrasound (FLIPUS) therapy on the patients with knee osteoarthritis (KOA). Methods • A total of 100 subjects with KOA from August 2018 to August 2019 in the Department of Rehabilitation Medicine at the Second Affiliated Hospital of Chongqing Medical University were sequentially randomized into group A and group B. Among them, FLIPUS was adopted to treat the 50 patients in group A, and the diclofenac sodium was adopted to treat the other 50 patients in group B. Visual analogue scale (VAS), Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne index (LI) were used to evaluate knee joint pain, the structure and function of the affected knee joint, and the severity of the affected knee joint at baseline, on day 3, day 6 and day 10 after treatment respectively. The knee range of motion (KROM) and maximum walking speed (MWS) were used to evaluate the knee joint movement and walking function at baseline and on day 10 after treatment respectively. Results • There were on significant differences between two groups with respect to KOA evaluation indexes (P>0.05). Compared with those in group B, patients in group A showed significant improvements in VAS and WOMAC scores on day 6 and day 10 after treatment (P=0.021, P=0.000; P=0.005, P=0.001). Meanwhile, patients in group A had higher LI scores than those in group B on day 10 after treatment (P=0.000). In addition, patients in group A showed significant improvements in MWS (P=0.006) and non-significant improvements in KROM (P=0.064) on day 10 after treatment. Conclusion • FLIPUS is a safe and effective treatment modality for relieving pain and improving the functions of patients with KOA.

Effect of electroacupuncture at Wnt/β-catenin signaling pathway on inhibiting cartilage degeneration in rats with knee osteoarthritis / 中国针灸

OBJECTIVE@#To explore the action mechanism of electroacupuncture (EA) for knee osteoarthritis (KOA) based on Wnt/beta-catenin (Wnt/β-catenin) signaling pathway.@*METHODS@#Ten rats were randomly selected into a sham-operation group among 50 male 2-month-old SD rats, and the KOA model was established in the remaining 40 rats by modified Hulth method. Four weeks after the model establishment, the rats were randomly divided into a model group, an experimental A group, an experimental B group and an experimental C group, 10 rats in each group. The rats in the sham-operation group and model group did not receive any intervention. The rats in the experimental A group were treated with EA at "Neixiyan" (EX-LE 4) and "Dubi"(ST 35) for 15 min. The rats in the experimental B group were treated with EA at "Neixiyan" (EX-LE 4) and "Dubi"(ST 35) for 30 min. The rats in the experimental C group were treated with EA at non-acupoint for 15 min. EA intervention was given once a day, five times a week, and totally 12-week treatment was given. After 12 weeks, the knee cartilage tissues were stained and the morphological changes were observed under light microscopy; the severity of cartilage degeneration was evaluated by modified Mankin's score; the content of interleukin-1β (IL-1β) in synovium tissues was detected by ELISA method; the content of Wnt-4, β-catenin and matrix metalloprotein-13 (MMP-13) in cartilage tissues was detected by Western blot method.@*RESULTS@#Compared with the sham-operation group, in the model group the morphology and structure of cartilage were disordered, the number of cells was significantly reduced, the matrix was decontaminated and tidal line was incomplete; the Mankin's score was significantly increased (0.05).@*CONCLUSION@#EA at "Neixiyan" (EX-LE 4) and "Dubi"(ST 35) may reduce the expression of MMP-13 and the production of inflammatory factor IL-1β through Wnt/β-catenin signaling pathway, thus inhibit the degradation of cartilage matrix and the apoptosis of chondrocyte, and improve the morphology and structure of cartilage.

Randomized controlled clinical trial of acupuncture treatment for knee osteoarthritis in the early stage / 针刺研究

OBJECTIVE: To observe the therapeutic effect of acupuncture in the treatment of patients with knee osteoarthritis (KOA) in the early stage. METHODS: A total of 60 KOA patients were randomized into medication group and acupuncture combined with medication (acupuncture) group (n＝ 30 in each group). Patients of the medication group were treated by external application of Diclofenac Diethylamine Emulgel around the affected joint, 3 times a day for 2 successive weeks and reasonable exercising training. Patients of the acupuncture group received routine medication and reasonable exercising training and acupuncture of Ashi-points, Zusanli (ST36), Yanglingquan (GB34), Yinlingquan (SP9), Neixiyan (EX-LE4) and Dubi (ST35) at affected side with filiform needles which were manipulated with uniform reinforcing-reducing method for a while, followed by retaining the needles for 30 min. The treatment was conducted once every other day for 2 weeks. The pain degree was assessed by using visual analog scale (VAS) and the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scale (0－240 points) was used to evaluate the severity of KOA, and the "Diagnosis of Syndromes of Traditional Chinese Medicine" was used to assess the therapeutic effect after the treatment. RESULTS: After the treatment, the VAS and WOMAC scores of both medication and acupuncture groups were significantly and respectively decreased in comparison with their own pre-treatment (P0.05). CONCLUSION: Acupuncture combined with medication has a better therapeutic effect in the treatment of KOA in the early stage than that of the simple medication.

Effect of p38 MAPK Signaling Pathway in Diagnosis and Treatment of Knee Ksteoarthritis by Traditional Chinese Medicine / 中国实验方剂学杂志

Knee osteoarthritis (KOA) is a kind of joint disease characterized by progressive degeneration of articular cartilage, synovitis and pain. Its pathogenesis is not yet completely clear. Generally, it is believed that age, sex, obesity, trauma, inflammation, genetic susceptibility and other mechanical and biological factors together lead to the degradation and synthetic coupling imbalance of cartilage cells, extracellular matrix and subchondral bone. In recent years, signaling pathway has become a hot spot in the research of KOA chondrocyte proliferation and apoptosis, and the research of signal pathway in the pathogenesis and targeted therapy of KOA also began. It usually involves the expressions of cytokines, relevant genes and proteins in KOA chondrocyte. These researches mainly focus on the proliferation and apoptosis of chondrocytes, the synthesis and degradation of extracellular matrix, and the sclerosis of subchondral bone. More studies focus on p38 mitogen-activated protein kinase (p38 MAPK) signaling pathway. Literatures show that p38 MAPK signaling pathway can regulate the proliferation and apoptosis of chondrocytes, maintain the balance of extracellular matrix metabolism, regulate the production of matrix metalloproteinases and pro-inflammatory factors, participate in the degradation of collagen and proteoglycan, and play an important regulatory role in the pathological process of KOA. Traditional Chinese medicine(TCM) therapy under the guidance of holistic concept and dialectical treatment theory has a strong pertinence and remarkable curative effect, and can control the development of the disease fundamentally. Starting with the relationship between p38 MAPK and the pathogenesis of KOA, this paper summarizes the research progress of p38 MAPK signaling pathway in the diagnosis and treatment of KOA by TCM, and provides new targets for the clinical diagnosis and treatment of KOA.

Acupuncture combined with cinesiotherapy cupping for knee osteoarthritis with stagnation and blood stasis syndrome: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical efficacy between acupuncture combined with cinesiotherapy cupping and acupuncture combined with conventional cupping for knee osteoarthritis (KOA) with stagnation and blood stasis syndrome, and to seek a better solution for KOA.@*METHODS@#A total of 78 patients of KOA with stagnation and blood stasis syndrome were randomly divided into an observation group and a control group, 39 cases in each group (3 cases in the observation group and 2 cases in the control group lost contact). Both groups were treated with acupuncture at Neixiyan (EX-LE 4), Dubi (ST 35), Xuehai (SP 10), Liangqiu (ST 34), Heding (EX-LE 2), Zusanli (ST 36), Yinlingquan (SP 9), Yanglingquan (GB 34) and Xuanzhong (GB 39). Based on the acupuncture treatment, the control group was treated with conventional cupping. The No. 4 cupping glass was used for Xuehai (SP 10), Liangqiu (ST 34) and Fengshi (GB 31), while the No. 3 cupping glass was used for Yinlingquan (SP 9), while the cupping with appropriate size was used for points; the cupping glass was retained for 5 min. Based on the acupuncture treatment, the observation group was treated with cinesiotherapy cupping. The selection of acupoint and cupping glass was identical as the control group. The patients were instructed to perform knee flexion-extension, hip abduction-adduction, weight-bearing and other active exercise while cupping; the treatment was given once a day, 10 times as a course of treatment; totally three courses were given with an interval of 2 days between the courses. The patient's symptom scores, pain scores and knee function scores were recorded before and after treatment. The amount of joint effusion was measured by ultrasound; the level of interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) in joint effusion were measured by ELISA.@*RESULTS@#After treatment, the total effective rate in the observation group was 94.4% (34/36), which was significantly higher than 86.5% (32/37) in the control group (0.05).@*CONCLUSION@#The acupuncture combined with cinesiotherapy cupping could alleviate pain, improve joint function and reduce joint effusion, which is superior to acupuncture combined with conventional cupping.

Effects of inner-heating acupuncture on apoptosis of chondrocytes and expression of Caspase-3 and Caspase-9 in rats with knee osteoarthritis / 中国针灸

OBJECTIVE@#To investigate the effect of inner-heating acupuncture on apoptosis of chondrocytes and expression of Caspase-3 and Caspase-9 in rats with knee osteoarthritis (KOA).@*METHODS@#A total of 32 rats were divided into a normal group, a model group, a control treatment group and a treatment group by random number grouping method, 8 rats in each one. The rats in the normal group received no intervention. The rats in the remaining three groups adopted modified Videman method to develop KOA model, the ankle joint of left posterior leg was fully extended and fixed with a resin bandage for 6 weeks. After successful modeling, the rats in the model group received no intervention. The rats in the control treatment group were treated with medium-frequency pulse electrotherapy. The rats in the treatment group were treated with inner- heating acupuncture, 30 min each treatment, once a day, five days per week, and totally 3-week treatment was given. After 3 weeks, the damaged cartilage tissue was collected, and HE staining was used to observe the pathological changes of the cartilage tissue of the knee joint. ELISA was used to detect the content of cytochrome-C in the tissue homogenate supernatant. The chondrocytes in damaged cartilage tissue were isolated, flow cytometer was used to detect the changes of apoptosis and mitochondrial membrane potential. The mRNA and protein expression of Caspase-3 and Caspase-9 in chondrocytes were detected by real-time quantitative PCR (qRT-PCR) and Western blot (WB), respectively.@*RESULTS@#Compared with the normal group, the damage of cartilage tissue in the model group was significant, and the expression level of Cyt-C in the homogenate supernatant of damaged cartilage tissue was increased (<0.01); the chondrocyte apoptosis was increased significantly (<0.01); the chondrocyte mitochondrial membrane potential was decreased significantly (<0.01); the mRNA and protein expression of Caspase-3 and Caspase-9 was increased significantly (all <0.01). Compared with the model group, the cartilage injury in the control treatment group and the treatment group was significantly relieved; the expression level of Cyt-C in the supernatant of damaged cartilage tissue homogenate was decreased (both <0.01); the chondrocyte apoptosis was significantly reduced (both <0.01); the chondrocyte mitochondrial membrane potential was increased significantly (both <0.01). Moreover, the mRNA and protein expression of Caspase-3 and Caspase-9 was significantly reduced (all <0.01). Compared with the control treatment group, the treatment group was more effective in the treatment of KOA.@*CONCLUSION@#The inner-heating acupuncture could significantly improve the pathological changes of KOA rats, inhibit the apoptosis of chondrocytes, which may be closely related to the suppression of Caspase-3 and Caspase-9 expression.

Efficacy of -needle radiofrequency for knee osteoarthritis guided by meridians-muscles theory / 中国针灸

OBJECTIVE@#To observe the efficacy difference between -needle radiofrequency guided by meridians-muscles theory and oral administration of medication for knee osteoarthritis (KOA).@*METHODS@#One hundred patients with KOA were randomly divided into an acupuncture group and a medication group, 50 cases in each one. The patients in the acupuncture group were treated with -needle radiofrequency guided by meridians-muscles theory at tendon nodes around knee joints ( points), 4 points per treatment, once every two weeks and two treatments were given. The patients in the medication group were treated with oral administration of celecoxib capsules, 1 capsule every day for 4 weeks. The visual analogue scale (VAS) and Western Ontario and McMaster Universities (WOMAC) in the two groups were observed before treatment, after treatment and during 4-week follow-up visit. The clinical efficacy was evaluated.@*RESULTS@#Compared before treatment, the VAS was reduced in the two groups after treatment and during 4-week follow-up visit (all <0.05), and the VAS score in the acupuncture group was lower than that in the medication group (both <0.05). Compared before treatment, the pain score, stiffness score, activity function score and total score of WOMAC were reduced in the two groups after treatment and during 4-week follow-up visit (all <0.05), and the scores in the acupuncture group were lower than those in the medication group (all <0.05). After treatment, the total effective rate was 80.0% (40/50) in the acupuncture group, which was superior to 56.0% (28/50) in the medication group (<0.05). During 4-week follow-up visit, the total effective rate was 76.0% (38/50) in the acupuncture group, which was superior to 40.0% (20/50) in the medication group (<0.05).@*CONCLUSION@#The efficacy of -needle radiofrequency guided by meridians-muscles theory is superior to oral administration of celecoxib capsules for KOA, which could relieve joint pain and stiffness, improve joint mobility, and has long effective duration.