Effect of Bugu granules in a drug-containing serum on chondrocyte apoptosis and the Trx2 signaling pathway.

Traditional Chinese medicine for invigorating the kidney and promoting blood circulation is commonly prescribed for the treatment of osteoarthritis associated with kidney deficiency and blood stasis. However, the specific mechanisms of these medicines are still unclear. The present study aimed to evaluate the protective effects of Bugu granules against sodium nitroprusside-induced chondrocyte apoptosis and elucidate the underlying molecular mechanisms. Drug-containing serum was prepared by administering rats with Bugu granules and harvesting the serum. Chondrocytes were exposed to different dilutions of serum, and apoptosis assessed by flow cytometry after staining with annexin V­FITC/PI. Flow cytometry showed that chondrocyte apoptosis increased significantly after incubation with 2 mol/L sodium nitroprusside for 24 h (t = -48.221, P = 0.000), and the apoptotic rate of chondrocytes decreased with increasing concentrations of drug-containing serum (F = 33.965, P = 0.000). Cellular levels of Trx2, ASK1, caspase­3, and reactive oxygen species (ROS) were detected by enzyme-linked immunosorbent assay. The cellular content of Trx2 increased gradually with increasing concentrations of drug-containing serum (F = 2610.593, P = 0.000), while that of ASK1 (F = 2473.545, P = 0.000), caspase­3 (F = 209.921, P = 0.000), and ROS (F = 1666.435, P = 0.000) all decreased significantly. The mRNA expression levels were analyzed by RT-qPCR, which revealed that expression levels of Trx2 and caspase­3 mRNA increased and decreased significantly, respectively, following exposure to Bugu granules in the drug-containing serum (F = 6.974, P = 0.003 and F = 3.691, P = 0.191; respectively), but the expression of ASK1 mRNA was not significantly different between treatment groups (F = 1.784, P = 0.191). Taken together, these results support the hypothesis that the Trx2 signaling pathway is activated by Bugu granules, which in turn inhibits chondrocyte apoptosis. This may play a role in preventing the development of osteoarthritis.

Diagnosis and treatment of ankle syndesmosis injuries with associated interosseous membrane injury: a current concept review.

BACKGROUND: Tibiofibular syndesmosis injury leads to ankle pain and dysfunction when ankle injuries are not treated properly. Despite several studies having been performed, many questions about diagnosis and treatment remain unanswered, especially in ankle syndesmosis injury with interosseous membrane injury. Therefore, the purpose of this study was to help guide best practice recommendations. METHODS: This review explores the mechanism of injury, clinical features, diagnosis methods, and the treatment strategy for ankle syndesmosis injury with interosseous membrane injury to highlight the current evidence in terms of the controversies surrounding the management of these injuries. RESULTS: Radiological and CT examination are an important basis for diagnosing ankle syndesmosis injury. Physical examination combined with MRI to determine the damage to the interosseous membrane is significant in guiding the treatment of ankle syndesmosis injury with interosseous membrane injury. In the past, inserting syndesmosis screws was the gold standard for treating ankle syndesmosis injury. However, there were increasingly more controversies regarding loss of reduction and broken nails, so elastic fixation has become more popular in recent years. CONCLUSIONS: Anatomical reduction and effective fixation are the main aspects to be considered in the treatment of ankle syndesmosis injury with interosseous membrane injury and are the key to reducing postsurgery complications.

An updated meta-analysis evaluating limb management after total knee arthroplasty-what is the optimal method?

PURPOSE: Postoperative knee flexion protocol has been widely recognized as a highly attractive, simple, and cost-effective tactic to improve patient's outcomes after primary total knee arthroplasty (TKA). However, optimal knee position and duration of knee flexion are still controversial. The purpose of this meta-analysis was to compare the effectiveness of different postoperative knee flexion protocols, as an aid to find out optimal limb management strategy following TKA. METHODS: We conducted a meta-analysis to identify the available and relevant randomized controlled trials (RCTs) with regard to the influence of different postoperative knee positions on clinical outcomes after primary TKA in electronic databases, including PubMed, EMBASE, the Cochrane Library, Web of Science, CNKI, Wanfang Med Online, and VIP, up to May 2018. In this meta-analysis, three major subgroups based on diverse postoperative knee flexion protocols were considered: long-term (≥ 24 h) high flexion (> 30°), short term (< 24 h) high flexion (> 30°), and long-term (≥ 24 h) mild flexion (≤ 30°). The statistical analysis was performed using the Review Manager (RevMan) version 5.3 software. RESULTS: A total of 16 trials were finally included in this meta-analysis. The result of subgroup analysis indicated that keeping the knee in high flexion (> 30°) postoperatively for a long time (≥ 24 h) significantly reduced total blood loss (P < 0.00001), hidden blood loss (P < 0.00001), and transfusion requirements (P = 0.003) and led to a significant improvement in range of motion (ROM) at 1 week after operation (P < 0.00001); keeping the knee in high flexion (> 30°) postoperatively for a short time (< 24 h) significantly reduced total blood loss (P = 0.006) and hidden blood loss (P < 0.00001) but not significantly improved ROM at 1 week after operation (P = 0.34) and reduced transfusion requirements (P = 0.62); and keeping the knee in mild flexion (≤ 30°) postoperatively for a long time (≥ 24 h) significantly reduced total blood loss (P = 0.02) and transfusion requirements (P = 0.02) and improved ROM at 1 week after operation (P < 0.00001) but not significantly reduced hidden blood loss (P = 0.11). Furthermore, there was no significant difference with respect to the rates of wound-related infection and DVT between the three knee flexion subgroups. CONCLUSIONS: This meta-analysis showed that the long-term (≥ 24 h) high flexion (> 30°) protocol could be an optimal limb management to reduce blood loss and blood transfusion requirements and facilitate early postoperative rehabilitation exercises in patients after primary TKA without increasing in complication rate.

[External therapies of traditional Chinese medicine combined with sodium hyaluronate injected in articular cavity therapy on knee osteoarthritis: Meta-analysis].

To systematically evaluate the efficacy and safety of external therapies of traditional Chinese medicine(TCM) combined with sodium hyaluronate(SH) injected in articular cavity therapy on knee osteoarthritis(KOA). The following databases such as CNKI, WanFang, VIP, CBM, PubMed and Medline were researched to collect the randomized controlled trails on external therapies of TCM combined with sodium hyaluronate injected in articular cavity therapy on KOA. The selection of studies, assessment of methodological quality and data extraction were performed independently by two researchers. The methodological quality was assessed by using the Cochrane system evaluation methodology and Meta-analysis were performed by using Cochrane Collaboration's the RevMan 5.3 software. Forteen studies involving 1 449 patients were included. All of the trails were not adequate enough in methodological quality. Meta-analysis indicated that compared with control group, external therapies of TCM combined with sodium hyaluronate injected in articular cavity could raise effectiv rate(P<0.000 01) and cure-rate(P<0.000 01), improve Lysholm score(P=0.003) and reduce VAS score(P<0.000 1). But two groups have no difference in Womac score (P=0.13).Compared with the treatment with sodium hyaluronate injected in articular cavity, external therapies of TCM combined with sodium hyaluronate injected in articular cavity, a promising treatment options, can be complementary advantages, improve the clinical curativ effect. But it still needs low risk and high quality clinical trials to verify.

Internal fixation vs conservative treatment for displaced distal radius fractures: a meta-analysis of randomized controlled trials.

BACKGROUND: The aim of the present study was to compare clinical outcomes of internal fixation and conservative approach in the treatment of displaced distal radius fractures. METHODS: Reports of studies were retrieved from the PubMed, Cochrane Library, EMBASE, BIOSIS, Ovid, CNKI, and Wanfang Data databases, as well as other sources. Methodological quality of the trials was critically assessed, and relevant data were extracted. Review Manager (RevMan) meta-analysis software (version 5.0; Cochrane Collaboration, London, UK) was used for data analysis. RESULTS: A total of 10 randomized controlled trials, which included 653 patients, were eligible for inclusion in the present meta-analysis, 7 of which were in English, and 3 of which were in Chinese. The trials had medium risk of bias. Results of meta-analysis showed that patients undergoing conservative treatment for distal radius fractures had better restoration of pronation (MD=1.80, 95% confidence interval [CI]=0.18-3.42, p=0.03; heterogeneity p=0.17, I2=43%), but shorter restoration of radial length (MD=2.62, 95% CI=1.47-3.76, p<0.00001; heterogeneity p=0.02, I2=73%). Wrist range of motion other than pronation, grip strength, radiographic parameters other than radial length, and rates of complications were not significantly different between the 2 treatments. CONCLUSION: Very few clinical differences were found between results of internal fixation and conservative treatment for displaced distal radius fractures. Best course of of treatment must be determined based on concrete conditions.

Reamed or unreamed intramedullary nailing for tibial fractures: a meta-analysis.

OBJECTIVE: To compare the treating effects of different intramedullary nailing methods on tibial fractures in adults. METHODS: Literature reports in both Chinese and English languages were retrieved (from the earliest available records to October 1, 2013) from the PubMed, FMJS, CNKI, Wanfang Data using randomized controlled trials (RCTs) to compare reamed and unreamed intramedullary nailing for treatment of tibial fractures. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman 5.0 was used for data-analysis. RESULTS: A total of 12 randomized controlled trials, comprising 985 patients (475 in the unreamed group and 510 in the reamed group), were eligible for inclusion in this meta-analysis. The results of meta-analysis showed that there were no statistically significant differences between the two methods in the reported outcomes of infection (RR=0.64; 95%CI, 0.39 to 1.07; P=0.09), compartment syndrome (RR=1.44; 95%CI, 0.8 to 2.41; P=0.16), thrombosis (RR=1.29; 95%CI, 0.43 to 3.87; P=0.64), time to union (WMD=5.01; 95%CI, -1.78 to 11.80; P=0.15), delayed union (nonunion) (RR=1.56; 95%CI, 0.97 to 2.49; P=0.06), malunion (RR=1.75; 95%CI, 1.00 to 3.08; P=0.05) and knee pain (RR=0.94; 95%CI, 0.73 to 1.22; P=0.66). But there was a significantly higher fixation failure rate in the unreamed group than in the reamed group (RR=4.29; 95%CI, 2.58 to 7.14; P<0.00001). CONCLUSION: There is no significant difference in the reamed and unreamed intramedullary nailing for the treatment of tibial fractures, but our result recommends reamed nails for the treatment of closed tibial fractures for their lower fixation failure rate.