Prognosis after autologous peripheral blood stem cell transplantation for osteonecrosis of the femoral head in the pre-collapse stage: a retrospective cohort study.

OBJECTIVES: Autologous peripheral blood stem cell (auto-PBSC) transplantation is an effective therapeutic for the osteonecrosis of the femoral head (ONFH) but without prognosis estimation. This study mainly aimed to (1) determine whether auto-PBSC transplantation is a promising option, (2) assess the risk of hip-preservation failure, (3) achieve a predictive model of femoral head survival after the intervention, and (4) eventually identify clinical indications for auto-PBSC transplantation in future. METHODS: After reviewing the in-patient database of the First Affiliated Hospital of Zhejiang Chinese Medicine University from June 2012 to June 2014, 37 eligible patients with Association Research Circulation Osseous stage I or II ONFH who were receiving intra-arterial infusion of auto-PBSCs were recruited. A case form was designed to retrieve relevant data. Hip-preservation failure was defined as the endpoint. All participants were stratified by the categorical risk of collapse, which was statistically tested through log-rank analysis. All significant factors were evaluated using Cox proportional hazards regression model, and a predictive nomogram plot was generated. RESULTS: In total, 47 hips were followed up for 53.96 ± 21.09 months; the median survival time was 60.18 months. Among the predictors, body mass index (BMI; P = 0.0015) and Harris hip score (HHS; P < 0.0001) independently affected femoral head survival. Patients with BMI ≥ 24 kg/m2 exhibited a 2.58 times higher risk of hip-preservation failure [95% confidence interval (CI), 1.32-5.45] than those with BMI < 24 kg/m2, whereas those with HHS ≥ 70 exhibited a 0.19 times lower risk (95% CI, 0.09-0.38) than those with HHS < 70. Hazard ratios associated with age (P = 0.042), BMI (P = 0.012), HHS (P = 0.022), and necrotic volume (P = 0.000) were 1.038 (95% CI, 1.001-1.075), 1.379 (95% CI, 1.072-1.773), 0.961 (95% CI, 0.928-0.994), and 1.258 (95% CI, 1.120-1.412), respectively. A nomogram plot (score test P = 0.000; C-index = 0.8863) was available for the orthopedic doctor to predict hip survival probability. CONCLUSIONS: The results suggest that intra-arterial infusion of auto-PBSCs prolongs femoral head survival. Age, BMI, HHS, and necrotic volume can influence the efficacy of this intervention. This study was approved by ethics committee of the trial center, number 2019-KL-075-01.

Effect of Auricular Point Acupressure on Axial Neck Pain After Anterior Cervical Discectomy and Fusion: A Randomized Controlled Trial.

Objectives: To evaluate the effect of auricular point acupressure (APA) on axial neck pain after anterior cervical discectomy and fusion (ACDF) surgery. Design: A prospective randomized controlled trial was performed. Subjects and setting: Twenty-nine participants were randomly divided into two groups, real or sham APA. Participants were enrolled from Shaoxing Hospital of Traditional Chinese Medicine, affiliated with Zhejiang Chinese Medical University. Methods: Eligible participants received a four-week real or sham APA treatment according to their assigned groups. The clinical outcomes were assessed by the criteria of Hosono et al., the Brief Pain Inventory Short Form (BPI), and the 36-item Short Form Health Survey (SF-36). In addition, plasma interleukin (IL)-1ß, IL-6, and tumor necrosis factor (TNF)-α were analyzed. Results: Patients with severe or moderate axial neck pain accounted for 28.6% and 35.7% in the real APA group at the end of treatment and one-month follow-up. BPI scores were decreased in the real APA group at the end of treatment and one-month follow-up. The total mean score of SF-36 was improved in the real APA group and significantly higher than in the sham APA group. Additional, the levels of IL-1ß, IL-6, and TNF-α were decreased in the real APA group. Conclusions: The findings supported the therapeutic effect of APA treatment on axial neck pain after ACDF surgery, and they exert the possible therapeutic effect on downregulating the levels of plasma IL-1ß, IL-6, and TNF-α.

[Extracapsular arthroscopic excision of popliteal cysts through anterior combined with posterior approach].

OBJECTIVE: To study the clinical effect of arthroscopic excision of popliteal cysts through a combined anterior and posterior approach. METHODS: From January 2010 to December 2012,20 patients with popliteal cysts were treated with arthroscopic excision. There were 14 males and 6 females, with an average age of 49.5 years old, ranging from 45 to 65 years old. The lump has been found for 4 to 18 months,with a mean time of 12 months. Their mean sagittal diameter was 4.5 cm (ranged from 3 to 7 cm). There were 12 popliteal cysts in the left and 8 popliteal cysts in the right. The main clinical manifestation included lump at popliteal fossa, swelling and pain at knee joint and some extent of dysfunction. All diagnoses were determined according to MRI, which clearly showed the communication of cyst and articular cavity. The cyst was removed under arthroscopy, through the posterior approach and then the intra-articular lesion was treated via the anterior approach. According to Rauschning and Lindgren classification, 2 patients were grade I, 6 patients were grade II, and 12 patients were grade III. The guidelines of Rauschning and Lindgren were used to evaluate the clinical effects. RESULTS: No complications such as the injury of blood vessel and nerve, or incision infection occurred in all patients. All the patients were followed up, and the duration ranged from 8 to 24 months, with a mean time of 16 months. According to the criteria of Rauschning and Lindgren, there were 14 cases of grade 0, and 6 cases of grade I after operation, which was improved obviously compared with that pre-operation. No cyst reoccurred and the knee joint pain was relieved. CONCLUSION: Treatment of popliteal cysts with arthroscopic excision through a combined anterior and posterior approach is effective to remove the cyst sac and treat intra-articular diseases simultaneously, resulting in the decrease recurrence rate of cyst.

[Methods and evaluations on the sterioid-induced osteoporosis mice model with the type of Kidney-Yin deficiency].

OBJECTIVE: To establish the steriod-induced osteoporosis model with the type of Kidney-Yin deficiency. METHODS: Totally 45 female Kunming mice were randomly divided into normal group,model group and Liuwei Dihuang pills(Chinese character: see text)group. The model was established by intramuscular injecting of Dexamethasone. Liuwei Dihuang pills (Chinese character: see text) group was administered orally with Liuwei Dihuang pills (Chinese character: see text). The signs and symptoms of mice were observed dynamically. All the animals were sacrificed at the end of the 6th weeks. The level of ACTH, cAMP, cGMP, TSH and E2 in serum were detected to evaluate deficiency of Kidney-Yin. Morphological changes and bone density were observed to evaluate osteoporosis. RESULTS: (1) Compared with control group, mice in model group appeared obvious Kidney-Yin deficiency symptoms, including hair dry, restlessness, excitability, hard stool, and yellow. (2) Compared with control group,the weight of mice in model group gained slower (P<0.01); the index of adrenal gland,liver and spleen decreased (P<0.01, P<0.01 ,P<0.01); the level of ACTH and TSH increased (P<0.01 ,P<0.01), the level of E2 decreased (P<0.01) and the ratio of cAMP/cGMP increased (P< 0.05). (3)Compared with control group,the bone density of lumbar vertebra and femur in model group were significantly decreased (P<0.01, P<0.05); HE staining revealed osteoporosis in model group mice. (4)However, the Liuwei Dihuang pills (Chinese character: see text) group can partly antagonize the inhibition of the HPA axis, alter the disordered sex hormone and the ratio of cAMP/cGMP, and reverse the osteoporosis partly. CONCLUSION: the model of osteoporosis with type of Kidney-Yin deficiency could be established by Dexamethasone intramuscular injection. With less interference, it wight be a stable and reliable modeling method for integration of disease and syndrome in TCM.

Osteoarthritis pathogenesis: a review of molecular mechanisms.

Osteoarthritis (OA), the most prevalent chronic joint disease, increases in prevalence with age, and affects majority of individuals over the age of 65 and is a leading musculoskeletal cause of impaired mobility in the elderly. Because the precise molecular mechanisms which are involved in the degradation of cartilage matrix and development of OA are poorly understood and there are currently no effective interventions to decelerate the progression of OA or retard the irreversible degradation of cartilage except for total joint replacement surgery. In this paper, the important molecular mechanisms related to OA pathogenesis will be summarized and new insights into potential molecular targets for the prevention and treatment of OA will be provided.

The effects of Liuwei Dihuang on canonical Wnt/ß-catenin signaling pathway in osteoporosis.

ETHNOPHARMACOLOGICAL RELEVANCE: The Liuwei Dihuang (LWDH), a wellknown classic traditional Chinese medicine formula, consists of six herbs including Rehmannia glutinosa Libosch. (family: Scrophulariaceae), Cornus officinalis Sieb. (family: Cornaceae), Dioscorea opposite Thunb. (family: Dioscoreaceae), Alisma orientale (G. Samuelsson) Juz (family: Alismataceae), Poria cocos (Schw.) Wolf (family: Polyporaceae) and Paeonia suffruticosa Andrews (family: Paeoniaceae). It has been used clinically in the treatment of many types of diseases with signs of deficiency of Yin in the kidneys for more than 1000 years in China. The purpose of this study was to observe the effects of LWDH on canonical Wnt/ß-catenin signaling pathway in osteoporosis. MATERIALS AND METHODS: Osteoporosis model was induced by ovariectomy (OVX) in 8-week-old female Sprague-Dawley (SD) rats. After 12 weeks of treatment with LWDH by intragastric administration, the rats were put to death in batch. The changes of alkaline phosphatase (ALP), osteocalcin (BGP) and estradiol (E2) in serum were determined, bone mineral density (BMD) and histomorphology of right femur were observed, biomechanics of lumbar vertebra were measured, and the expression of Lrp-5, ß-catenin, Runx2, Osx involving the canonical Wnt/ß-catenin signaling pathway were detected by RT-PCR. In addition, osteoblasts isolated from neonatal rat calvariae were used in this study to investigate the effects of LWDH on the canonical Wnt/ß-catenin signaling pathway. Cell proliferation and differentiation were observed by the MTT test, ALP activity and calcified nodules. The expression of Lrp-5, ß-catenin, Runx2, Osx mRNA of cells were also detected. All the data were analyzed by SPSS 13.0. RESULTS: Twelve weeks of treatment with LWDH could significantly decrease the level of ALP and BGP in serum, increase the BMD of femurs, and improve the biomechanical capabililty of vertebral body in maximum loading and elastic modulus. Concerning histomorphology, we found ordered arrangement of trabeculae, slightly thinning of trabeculae and none obvious slight fractures in femurs after twelve weeks of treatment with LWDH. In osteoblast, serum containing LWDH elicited significantly increase in cell viability (at day 6), alkaline phosphatase activity (at days 2, 4 and 6) and amount of calcified nodules. The expression of Lrp-5, ß-catenin, Runx2 and Osx involved in the canonical Wnt/ß-catenin signaling pathway were significantly up-regulated in the presence of LWDH both in vivo and in vitro experiment. CONCLUSIONS: Our results suggest that Liuwei Dihuang could alleviate osteoporosis induced by ovariectomy, in part, through up-regulation of canonical Wnt/ß-catenin signaling pathway of osteoblast.

The effects of autologous bone marrow mesenchymal stem cell arterial perfusion on vascular repair and angiogenesis in osteonecrosis of the femoral head in dogs.

PURPOSE: The purpose of this study was to observe the effects of marrow mesenchymal stem cell (MSCs) arterial perfusion on vascular repair and angiogenesis in osteonecrosis of the femoral head (ONFH). METHODS: Twelve healthy male adult Beagle dogs were randomly divided into two groups: group A (the control group) and group B (the MSCs arterial perfusion group). ONFH animal models were established by hip dislocation and liquid nitrogen. At the same time, MSCs were obtained, cultured and proliferated. After three weeks, arterial perfusion was performed in all animals. Group B was given 1 ml MSCs (5 × 10(6)-1 × 10(7)/ml), while 0.9 % normal saline was used in group A. After four weeks or eight weeks, the dogs were put to death. The changes of main arteries, the expression of vascular endothelial growth factor (VEGF), VEGF mRNA and microvessel density (MVD) of ONFH were observed. All the data were analysed by SPSS13.0. RESULTS: In digital subtraction angiography (DSA), after four or eight weeks of treatment, the quantity and diameter of the main arteries of the femoral head in group B were improved, compared to group A (P < 0.05,P < 0.01). Concerning histology and immunohistochemistry, after four or eight weeks of treatment, the expression of VEGF and MVD were significantly higher than that of group A (P < 0.05, P < 0.01). For real-time quantitative polymerase chain reaction (RT-PCR), after four or eight weeks of treatment, the expression of VEGF mRNA in group B was significantly higher than that of group A (P < 0.05, P < 0.01), and after eight weeks of treatment, the expression of VEGF mRNA were significantly higher than that of four-weeks treatment in group A (P <0.01). CONCLUSIONS: MSCs arterial perfusion can promote vascular repair and angiogenesis and then improve blood supply and repair of femoral head.