Rheumatoid arthritis(RA)is a chronic inflammatory and destructive arthropathy with a high deformity rate.Despite numerous studies and clinical trials,no curative treatment is available for large weight-bearing joints....Rheumatoid arthritis(RA)is a chronic inflammatory and destructive arthropathy with a high deformity rate.Despite numerous studies and clinical trials,no curative treatment is available for large weight-bearing joints.Intra-articular(IA)injections could deliver high concentrations of drug to the afflicted joint and improve the drug efficacy while reducing systemic toxicity.However,free drugs are rapidly cleared from synovial fluid and do not significantly halt the progression of joint disease.Herein,a phospholipids-based controlledrelease gel was prepared for sustained IA delivery of celastrol(CEL)and the therapeutic efficiencywas evaluated in a rheumatoid arthritis rabbitmodel.The CEL-loaded gel(CEL-gel)contained up to 70%phospholipids yetwas easy to inject.After injecting into the joint cavity,CEL-gel achieved sol to gel phase transition without special stimuli and gelling agent.In vitro release and in vivo pharmacokinetic studies evidenced the stable and sustained release action of CEL-gel.A single IA injection of CEL-gel could maintain therapeutic efficiency for about 25 d and showed much better anti-arthritic efficacy compared to repeated injections of free drug solution(CEL-sol).Furthermore,the IA injection of CEL-gel greatly reduced the systemic toxicity of CEL.With good biocompatibility and biodegradability,CEL-gel might be a promising IA drug delivery system.展开更多
BACKGROUND Non-steroid anti-inflammatory drugs(NSAIDs)have played a crucial role in the treatment of osteoarthritis,especially in the early stages.However,the cardiovascular risk and adverse gastrointestinal reactions...BACKGROUND Non-steroid anti-inflammatory drugs(NSAIDs)have played a crucial role in the treatment of osteoarthritis,especially in the early stages.However,the cardiovascular risk and adverse gastrointestinal reactions of oral NSAIDs in elderly people cannot be underestimated.Intra-articular injection of NSAIDs may be a new attempt for early knee osteoarthritis treatment.Parecoxib may be a suitable drug for intra-articular injection.AIM To observe the clinical efficacy of the intra-articular injection of parecoxib for early knee osteoarthritis.METHODS Early knee osteoarthritis patients(n=110)were retrospectively analyzed.These patients were divided into three groups:Basic treatment+oral glucosamine(group A,n=37),oral celecoxib+basic treatment+oral glucosamine(group B,n=37),and intra-articular injection of parecoxib+basic treatment+oral glucosamine(group C,n=36).Intra-articular injection of parecoxib was performed once every 2 wk at a dose of 40 mg each time,for three times total.The three groups were compared in terms of visual analogue scale(VAS)scores,Hospital for Special Surgery(HSS)scores and patient satisfaction before and after treatment.The levels of inflammatory cytokines in the synovial fluid were detected in the three groups before and after treatment.RESULTS All patients were followed up for an average of 15.5±2.7 mo.The clinical efficacy was estimated by VAS and HSS scores at 12 mo after treatment.Inflammatory cytokine levels in the synovial fluid were evaluated at 3 mo after treatment.VAS and HSS scores were significantly improved in each group compared with before(P<0.001).There were significant differences among the three groups in VAS and HSS scores(P<0.001).The clinical efficacy of group C was superior to that of groups A and B(P<0.001),while group B outperformed group A in this respect(P<0.001).The patient satisfaction was the highest in group C(P<0.001).After treatment,the levels of tumor necrosis factorα(TNF-α)and interleukin(IL)-6 in the synovial fluid decreased in each group compared with before(P<0.001),while the levels of IL-10 increased(P<0.001).The three groups differed significantly in the levels of TNF-a,IL-6 and IL-10 in the synovial fluid after treatment(P<0.001).CONCLUSION For patients with early knee osteoarthritis,intra-articular injection of parecoxib could effectively improve clinical symptoms.This method may be a reliable alternative for early knee osteoarthritis.展开更多
Tetramethylpyrazine(TMP) is a traditional Chinese herbal medicine with strong antiinflammatory and cartilage protection activities, and thus a promising candidate for treating osteoarthritis. However, TMP is rapidly c...Tetramethylpyrazine(TMP) is a traditional Chinese herbal medicine with strong antiinflammatory and cartilage protection activities, and thus a promising candidate for treating osteoarthritis. However, TMP is rapidly cleared from the joint cavity after intra-articular injection and requires multiple injections to maintain efficacy. The aim of this study was to encapsulate TMP into poly(lactic-co-glycolic acid)(PLGA) microspheres to enhance the TMP retention in the joint, reducing injection frequencies and decreasing dosage. TMP microspheres were prepared by emulsion/solvent evaporation method. The intra-articular retention of the drug was assessed by detecting the drug concentration distributed in the joint tissue at different time points. The therapeutic effect of TMP microspheres was evaluated by the swelling of knee joints and histologic analysis in papain-induced OA rat model. The prepared freezedried microspheres with a particle size of about 10 μm can effectively prolong the retention time of the drug in the articular cavity to 30 d, which is 4.7 times that of the TMP solution.Intra-articular injection of TMP microspheres efficiently relieved inflammatory symptoms,improved joint lesions and decreased the depletion of proteoglycan. In conclusion, intraarticular injection of TMP loaded microspheres was a promising therapeutic method in the treatment of OA.展开更多
The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters fol...The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius （IFDR） in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after I week and 3, 6 and 12 months. After 3 months, the plating group had better pronation （P = 0.001）, supination, （P = 0.047） and extension （P = 0.043） scores. These differences were somewhat attenuated by 6 months and disappeared at I year. The plating group had a greater occurrence of wound infection （P = 0.043）, tendonitis, （P = 0.024） and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the ＂gross motor＂ category （walking upstairs, bending over, walking 500 yards; P = 0.023）. Internal fixation was more advantageous than external fixation in the early rehabilitation period; after I year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries.展开更多
AIM: To test whether intra-articular injection of porcine adipose-derived stem cells(ADSCs) can treat canine osteoarthritis(OA).METHODS: To enroll in this study dogs must have stifle joint OA that had lasted ≥ 3 mo a...AIM: To test whether intra-articular injection of porcine adipose-derived stem cells(ADSCs) can treat canine osteoarthritis(OA).METHODS: To enroll in this study dogs must have stifle joint OA that had lasted ≥ 3 mo and been treated with OA medication without significant improvement. Three dogs fulfilled these criteria and were thus subjects for ADSCs treatment. ADSCs were isolated from abdominal adipose tissue of a 2-mo-old female Yorkshire pig. Their stem cell marker expression was examined by immunofluorescence staining. For treatment, 5 million ADSCs were injected into the diseased joint of each dog. In the next 48 h, the patient was observed for signs of inflammatory and allergic reactions. Thepatient was then discharged to the owner and, at 2, 6, and 12 wk, followed up with orthopedic assessment, owner questionnaire, X-ray imaging, and force-plate gait analysis.RESULTS: Porcine ADSCs expressed mesenchymal stem cell markers CD90 and CD105. Injection of porcine ADSCs into canine stifle joints did not cause any inflammatory or allergic reactions. Orthopedic evaluation found improvements in two dogs, particularly at the longest time point. Owners' evaluation found increased capacity and decreased pain in all three dogs' activities such as walking and running. Radiographic evaluation did not find statistically significant differences before and after treatment. Force-plate analysis found significant improvements in all three dogs after treatment.CONCLUSION: Xenotransplantation of ADSCs for the treatment of OA is feasible. Further studies are needed to validate this novel treatment modality, which can then be implemented for the routine treatment of OA in veterinary medicine.展开更多
Objectives: To evaluate the postoperative analgesic yield of continuous intra-articular (IA) ropivacaine/tramadol infusion as against infusion of ropivacaine alone after total knee arthroplasty. Patients and Methods: ...Objectives: To evaluate the postoperative analgesic yield of continuous intra-articular (IA) ropivacaine/tramadol infusion as against infusion of ropivacaine alone after total knee arthroplasty. Patients and Methods: Sixty patients accompanied by arthrosis were randomly divided into three equal groups: The ropivacaine group, which obtained a continuous intraarticular (IA) infusion of ropivacaine alone;the combination group, which obtained a continuous (IA) infusion of a combination of ropivacaine and tramadol at a rate of 6 ml/h for 72 h postoperatively;and the control group, which did not receive IA medications. After release of the ischemic tourniquet and assurance of haemostasis, a vacuum drainage tube was applied. The (IA) infusion was delivered through a multipored catheter for 72 h. Postoperative pain was assessed using visual analogue pain scale (VAS), and intravenous meperidine was administered as rescue analgesia if the (VAS) pain score was greater than or equal to (4) or on patient’s request. The total rescue analgesia consumption, angle of flexion of the knee and hospital stay were recorded. Results: The ability to achieve better angle of flexion was significantly higher in the combination group compared with the other groups, with a significant difference in favour of the ropivacaine group compared with the control group. At 2 h postoperatively, the mean pain (VAS) scores were significantly lower in patients who received (IA) analgesia compared with the control group and in the ropivacaine/tramadol group versus the ropivacaine group. The number of requests and total dose of rescue analgesia consumed were significantly lower with (IA) analgesia, with a significant difference in favour of the combination group. There was significant correlation between pain (VAS) scores and angle of flexion of the knee joint. Conclusion: Continuous (IA) ropivacaine/tramadol infusion safely reduced postoperative pain and spared administration of rescue analgesics with a significantly improved range of joint movement.展开更多
PRIMARY synovial chondromatosis is a rarecondition in which foci of cartilage develop in thesynovial membrane of joints, bursae and tendonsheaths. It typically involves a single large jointin a young adult male.1 The ...PRIMARY synovial chondromatosis is a rarecondition in which foci of cartilage develop in thesynovial membrane of joints, bursae and tendonsheaths. It typically involves a single large jointin a young adult male.1 The ectopic foci of cartilage canresult in painful joint effusion, and the generation of loosebodies can cause mechanical symptoms.2,3 The etiology ofprimary synovial chondromatosis remains unknown, butmetaplastic theory is the most popular hypothesis. Thecommonly involved joints are knee, elbow, and hip.^4 Theshoulder is a rare site of synovial chondromatosis2,3,5 andthe extra-articular involvement even rarer, with only fewcases presented in literature. This report presents a rarecase of primary combined intra-articular andextra-articular synovial chondromatosis of shoulder jointtreated with arthroscopy.展开更多
The comparison of biochemical composition and biophysical properties of synovial fluid and blood serum leads to a conclusion about the pathogenetic expediency of using serum as a corrector of synovial medium of osteoa...The comparison of biochemical composition and biophysical properties of synovial fluid and blood serum leads to a conclusion about the pathogenetic expediency of using serum as a corrector of synovial medium of osteoarthritic joints. Serum modification was realized by preliminary prescription of a single-dose drug to the patient. Then, the patient’s blood was sampled in the period of its maximal saturation with the drug. Autoserum from such blood samples was injected thrice into the knee joints affected by osteoarthritis of the 2nd or 3rd stages. The value of treatment results after 4 - 6 months of described therapeutics shows a significantly better therapeutic effect in the experimental of patient’s group as compared with the control group. The effect is connected with pain diminishing, normalization of the tissue joint nutrition, suppression of the local inflammation, and improvement of cartilage lubrication.展开更多
Objective: To study the effect of intramuscular calcitonin injection combined with intra-articular ozone injection on the expression of the IL family and MMPs family of knee osteoarthritis. Methods: A total of 128 pat...Objective: To study the effect of intramuscular calcitonin injection combined with intra-articular ozone injection on the expression of the IL family and MMPs family of knee osteoarthritis. Methods: A total of 128 patients with knee osteoarthritis who were treated in the hospital between January 2015 and January 2017 were collected and divided into control group and observation group by random number table, each with 64 cases. Control group received intra-articular ozone injection therapy, and observation group received intramascular calcitonin injection combined with intra-articular ozone injection therapy. The differences in serum levels of IL family members and MMPs family members were compared between the two groups before and after treatment. Results: Before treatment, the differences in serum levels of IL family members and MMPs family members were not statistically significant between the two groups. 1 week after treatment, serum levels of IL family members IL-1β, IL-15, IL-17 and IL-18 as well as MMPs family members MMP-1, MMP-2, MMP-3 and MMP-13 of both groups of patients were significantly lower than those before treatment, and serum IL-1β, IL-15, IL-17, IL-18, MMP-1, MMP-2, MMP-3 and MMP-13 levels of observation group were significantly lower than those of control group. Conclusion: Intramuscular calcitonin injection combined with intra-articular ozone injection therapy can effectively inhibit the expression of IL family and MMPs family in patients with knee osteoarthritis.展开更多
BACKGROUND Knee osteoarthritis(KOA)is a common orthopedic condition with an uncertain etiology,possibly involving genetics and biomechanics.Factors like changes in chondrocyte microenvironment,oxidative stress,inflamm...BACKGROUND Knee osteoarthritis(KOA)is a common orthopedic condition with an uncertain etiology,possibly involving genetics and biomechanics.Factors like changes in chondrocyte microenvironment,oxidative stress,inflammation,and immune responses affect KOA development.Early-stage treatment options primarily target symptom relief.Mesenchymal stem cells(MSCs)show promise for treatment,despite challenges.Recent research highlights microRNAs(miRNAs)within MSC-released extracellular vesicles that can potentially promote cartilage regeneration and hinder KOA progression.This suggests exosomes(Exos)as a promising avenue for future treatment.While these findings emphasize the need for effective KOA progression management,further safety and efficacy validation for Exos is essential.AIM To explore miR-29a’s role in KOA,we’ll create miR-29a-loaded vesicles,testing for early treatment in rat models.METHODS Extraction of bone marrow MSC-derived extracellular vesicles,preparation of engineered vesicles loaded with miR-29a using ultrasonication,and identification using quantitative reverse transcription polymerase chain reaction;after establi-shing a rat model of KOA,rats were randomly divided into three groups:Blank control group injected with saline,normal extracellular vesicle group injected with normal extracellular vesicle suspension,and engineered extrace-llular vesicle group injected with engineered extracellular vesicle suspension.The three groups evaluation,histological detection,and immunohistochemical detection to compare and evaluate the progress of various forms of arthritis.RESULTS General behavioral observation results showed that the extracellular vesicle group and engineered extracellular vesicle group had better performance in all four indicators of pain,gait,joint mobility,and swelling compared to the blank control group.Additionally,the engineered extracellular vesicle group had better pain relief at 4 wk and better knee joint mobility at 8 wk compared to the normal extracellular vesicle group.Imaging examination results showed that the blank control group had the fastest progression of arthritis,the normal extracellular vesicle group had a relatively slower progression,and the engineered extracellular vesicle group had the slowest progression.Gross histological observation results showed that the blank control group had the most obvious signs of arthritis,the normal extracellular vesicle group showed signs of arthritis,and the engineered extracellular vesicle group showed no significant signs of arthritis.Using the Pelletier gross score evaluation,the engineered extracellular vesicle group had the slowest progression of arthritis.Results from two types of staining showed that the articular cartilage of rats in the normal extracellular vesicle and engineered extracellular vesicle groups was significantly better than that of the blank control group,and the engineered extracellular vesicle group had the best cartilage cell and joint surface condition.Immunohistochemical detection of type II collagen and proteoglycan showed that the extracellular matrix of cartilage cells in the normal extracellular vesicle and engineered extracellular vesicle groups was better than that of the blank control group.Compared to the normal extracellular vesicle group,the engineered extracellular vesicle group had a better regulatory effect on the extracellular matrix of cartilage cells.CONCLUSION Engineered Exos loaded with miR-29a can exert anti-inflammatory effects and maintain extracellular matrix stability,thereby protecting articular cartilage,and slowing the progression of KOA.展开更多
Recently,we read an article published by the Yang et al.The results of this study indicated that engineered exosomes loaded with microRNA-29a(miR-29a)alleviate knee inflammation and maintain extracellular matrix stabi...Recently,we read an article published by the Yang et al.The results of this study indicated that engineered exosomes loaded with microRNA-29a(miR-29a)alleviate knee inflammation and maintain extracellular matrix stability in Sprague Dawley rats.The study’s results provide useful information for treating knee osteoarthritis(KOA).This letter,shares our perspectives on treating KOA using engineered exosomes for miR-29a.展开更多
目的:探讨几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎的临床疗效。方法:回顾性分析2021年6月—2022年12月在南京医科大学第一附属医院骨科门诊就诊并随访的膝骨关节炎患者共164例。按治疗方式分为3组:A组(对照组,口服给...目的:探讨几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎的临床疗效。方法:回顾性分析2021年6月—2022年12月在南京医科大学第一附属医院骨科门诊就诊并随访的膝骨关节炎患者共164例。按治疗方式分为3组:A组(对照组,口服给药)55例,B组(几丁糖关节腔注射+口服给药)53例,C组(几丁糖联合小剂量糖皮质激素关节腔注射给药)56例。比较3组治疗前后的疼痛视觉模拟评分(visual analogue scale,VAS)、Lysholm评分、美国特种外科医院(Hospital for Special Surgery,HSS)评分和关节液炎性细胞因子白介素(interleukin,IL)-1、IL-6和肿瘤坏死因子(tumor necrosis factor,TNF)-α水平的变化,并对临床疗效进行评价。结果:所有病例均获得随访,随访时间7~12个月,无失访病例。每组治疗后的VAS评分、Lysholm评分、HSS评分和关节液炎性细胞因子IL-1、IL-6和TNF-α水平均优于治疗前,差异有统计学意义(P<0.05)。治疗前VAS评分、Lysholm评分、HSS评分和关节液炎性细胞因子IL-1、IL-6和TNF-α水平在3组间的差异无统计学意义(P>0.05);但治疗后各项指标在3组间的差异有统计学意义(P<0.05);两两比较显示,C组优于A、B两组,B组优于A组,差异均有统计学意义(P<0.05)。3组临床疗效评价比较,差异有统计学意义(P<0.05)。结论:几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎临床疗效显著,具有创伤小,起效迅速,疗效持久的特点,同时避免了外用或口服非甾体类抗炎药的不良反应,作为一线治疗方案,建议在临床推广和使用。展开更多
目的评价股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的安全性和有效性。方法选择滨州医学院附属医院骨关节外科2022年1月至6月因半月板损伤、游离体、骨性关节炎计划行单侧膝关节镜手术患者120例,随机分为股神经阻滞联合关节腔浸润...目的评价股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的安全性和有效性。方法选择滨州医学院附属医院骨关节外科2022年1月至6月因半月板损伤、游离体、骨性关节炎计划行单侧膝关节镜手术患者120例,随机分为股神经阻滞联合关节腔浸润麻醉组(F/I组)和腰硬联合麻醉组(CSEA组),每组60例。F/I组中男32例,女28例,年龄(38.75±11.35)岁;CSEA组中男25例,女35例,年龄(37.80±10.85)岁。比较两组术中补救例数、术后视觉模拟评分法(VAS)评分、术后感觉恢复时间及首次下地活动时间、术后并发症、住院花费及住院天数等指标的差异。采用t检验、χ^(2)检验、Fisher确切概率法。结果F/I组术后6 h VAS评分低于CSEA组[(2.08±0.61)分比(2.54±0.64)分],差异有统计学意义(t=-2.484,P=0.018)。F/I组感觉恢复时间长于CSEA组[(6.25±0.40)h比(3.60±0.31)h,首次下地活动时间短于CESA组[(2.99±1.05)h比(8.14±1.88)h],差异均有统计学意义(t=14.095、-12.263,均P<0.001)。术后并发症:F/I组术中加用麻醉发生率3.3%(2/60)、尿潴留发生率0、下肢静脉血栓发生率1.7%(1/60)、恶心呕吐发生率3.3%(2/60),CSEA组术中加用麻醉发生率0、尿潴留发生率10.0%(6/60)、下肢静脉血栓发生率5.0%(3/60)、恶心呕吐发生率16.7%(10/60),两组尿潴留、恶心呕吐发生率比较差异均有统计学意义(均P<0.05)。F/I组住院时间为(3.90±0.63)d、住院费用为(9612.67±507.15)元,CESA组分别为(5.27±0.75)d、(11401.52±530.01)元,差异均有统计学意义(t=-8.862、-15.425,均P<0.001)。结论股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中能够减少术后并发症、缩短住院时间、降低住院费用,并提供良好的麻醉效果。展开更多
基金financially supported by the National Natural Science Foundation of China (Nos. 82173758, China)Sichuan major science and technology project on biotechnology and medicine (2018SZDZX0018, China)
文摘Rheumatoid arthritis(RA)is a chronic inflammatory and destructive arthropathy with a high deformity rate.Despite numerous studies and clinical trials,no curative treatment is available for large weight-bearing joints.Intra-articular(IA)injections could deliver high concentrations of drug to the afflicted joint and improve the drug efficacy while reducing systemic toxicity.However,free drugs are rapidly cleared from synovial fluid and do not significantly halt the progression of joint disease.Herein,a phospholipids-based controlledrelease gel was prepared for sustained IA delivery of celastrol(CEL)and the therapeutic efficiencywas evaluated in a rheumatoid arthritis rabbitmodel.The CEL-loaded gel(CEL-gel)contained up to 70%phospholipids yetwas easy to inject.After injecting into the joint cavity,CEL-gel achieved sol to gel phase transition without special stimuli and gelling agent.In vitro release and in vivo pharmacokinetic studies evidenced the stable and sustained release action of CEL-gel.A single IA injection of CEL-gel could maintain therapeutic efficiency for about 25 d and showed much better anti-arthritic efficacy compared to repeated injections of free drug solution(CEL-sol).Furthermore,the IA injection of CEL-gel greatly reduced the systemic toxicity of CEL.With good biocompatibility and biodegradability,CEL-gel might be a promising IA drug delivery system.
基金National Natural Science Foundation of China,NO.81774274Project of Jiangsu Provincial Hospital of Traditional Chinese Medicine,NO.Y19058
文摘BACKGROUND Non-steroid anti-inflammatory drugs(NSAIDs)have played a crucial role in the treatment of osteoarthritis,especially in the early stages.However,the cardiovascular risk and adverse gastrointestinal reactions of oral NSAIDs in elderly people cannot be underestimated.Intra-articular injection of NSAIDs may be a new attempt for early knee osteoarthritis treatment.Parecoxib may be a suitable drug for intra-articular injection.AIM To observe the clinical efficacy of the intra-articular injection of parecoxib for early knee osteoarthritis.METHODS Early knee osteoarthritis patients(n=110)were retrospectively analyzed.These patients were divided into three groups:Basic treatment+oral glucosamine(group A,n=37),oral celecoxib+basic treatment+oral glucosamine(group B,n=37),and intra-articular injection of parecoxib+basic treatment+oral glucosamine(group C,n=36).Intra-articular injection of parecoxib was performed once every 2 wk at a dose of 40 mg each time,for three times total.The three groups were compared in terms of visual analogue scale(VAS)scores,Hospital for Special Surgery(HSS)scores and patient satisfaction before and after treatment.The levels of inflammatory cytokines in the synovial fluid were detected in the three groups before and after treatment.RESULTS All patients were followed up for an average of 15.5±2.7 mo.The clinical efficacy was estimated by VAS and HSS scores at 12 mo after treatment.Inflammatory cytokine levels in the synovial fluid were evaluated at 3 mo after treatment.VAS and HSS scores were significantly improved in each group compared with before(P<0.001).There were significant differences among the three groups in VAS and HSS scores(P<0.001).The clinical efficacy of group C was superior to that of groups A and B(P<0.001),while group B outperformed group A in this respect(P<0.001).The patient satisfaction was the highest in group C(P<0.001).After treatment,the levels of tumor necrosis factorα(TNF-α)and interleukin(IL)-6 in the synovial fluid decreased in each group compared with before(P<0.001),while the levels of IL-10 increased(P<0.001).The three groups differed significantly in the levels of TNF-a,IL-6 and IL-10 in the synovial fluid after treatment(P<0.001).CONCLUSION For patients with early knee osteoarthritis,intra-articular injection of parecoxib could effectively improve clinical symptoms.This method may be a reliable alternative for early knee osteoarthritis.
文摘Tetramethylpyrazine(TMP) is a traditional Chinese herbal medicine with strong antiinflammatory and cartilage protection activities, and thus a promising candidate for treating osteoarthritis. However, TMP is rapidly cleared from the joint cavity after intra-articular injection and requires multiple injections to maintain efficacy. The aim of this study was to encapsulate TMP into poly(lactic-co-glycolic acid)(PLGA) microspheres to enhance the TMP retention in the joint, reducing injection frequencies and decreasing dosage. TMP microspheres were prepared by emulsion/solvent evaporation method. The intra-articular retention of the drug was assessed by detecting the drug concentration distributed in the joint tissue at different time points. The therapeutic effect of TMP microspheres was evaluated by the swelling of knee joints and histologic analysis in papain-induced OA rat model. The prepared freezedried microspheres with a particle size of about 10 μm can effectively prolong the retention time of the drug in the articular cavity to 30 d, which is 4.7 times that of the TMP solution.Intra-articular injection of TMP microspheres efficiently relieved inflammatory symptoms,improved joint lesions and decreased the depletion of proteoglycan. In conclusion, intraarticular injection of TMP loaded microspheres was a promising therapeutic method in the treatment of OA.
基金supported by National Natural Science Foundation of China Grant 81560350
文摘The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius （IFDR） in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after I week and 3, 6 and 12 months. After 3 months, the plating group had better pronation （P = 0.001）, supination, （P = 0.047） and extension （P = 0.043） scores. These differences were somewhat attenuated by 6 months and disappeared at I year. The plating group had a greater occurrence of wound infection （P = 0.043）, tendonitis, （P = 0.024） and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the ＂gross motor＂ category （walking upstairs, bending over, walking 500 yards; P = 0.023）. Internal fixation was more advantageous than external fixation in the early rehabilitation period; after I year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries.
文摘AIM: To test whether intra-articular injection of porcine adipose-derived stem cells(ADSCs) can treat canine osteoarthritis(OA).METHODS: To enroll in this study dogs must have stifle joint OA that had lasted ≥ 3 mo and been treated with OA medication without significant improvement. Three dogs fulfilled these criteria and were thus subjects for ADSCs treatment. ADSCs were isolated from abdominal adipose tissue of a 2-mo-old female Yorkshire pig. Their stem cell marker expression was examined by immunofluorescence staining. For treatment, 5 million ADSCs were injected into the diseased joint of each dog. In the next 48 h, the patient was observed for signs of inflammatory and allergic reactions. Thepatient was then discharged to the owner and, at 2, 6, and 12 wk, followed up with orthopedic assessment, owner questionnaire, X-ray imaging, and force-plate gait analysis.RESULTS: Porcine ADSCs expressed mesenchymal stem cell markers CD90 and CD105. Injection of porcine ADSCs into canine stifle joints did not cause any inflammatory or allergic reactions. Orthopedic evaluation found improvements in two dogs, particularly at the longest time point. Owners' evaluation found increased capacity and decreased pain in all three dogs' activities such as walking and running. Radiographic evaluation did not find statistically significant differences before and after treatment. Force-plate analysis found significant improvements in all three dogs after treatment.CONCLUSION: Xenotransplantation of ADSCs for the treatment of OA is feasible. Further studies are needed to validate this novel treatment modality, which can then be implemented for the routine treatment of OA in veterinary medicine.
文摘Objectives: To evaluate the postoperative analgesic yield of continuous intra-articular (IA) ropivacaine/tramadol infusion as against infusion of ropivacaine alone after total knee arthroplasty. Patients and Methods: Sixty patients accompanied by arthrosis were randomly divided into three equal groups: The ropivacaine group, which obtained a continuous intraarticular (IA) infusion of ropivacaine alone;the combination group, which obtained a continuous (IA) infusion of a combination of ropivacaine and tramadol at a rate of 6 ml/h for 72 h postoperatively;and the control group, which did not receive IA medications. After release of the ischemic tourniquet and assurance of haemostasis, a vacuum drainage tube was applied. The (IA) infusion was delivered through a multipored catheter for 72 h. Postoperative pain was assessed using visual analogue pain scale (VAS), and intravenous meperidine was administered as rescue analgesia if the (VAS) pain score was greater than or equal to (4) or on patient’s request. The total rescue analgesia consumption, angle of flexion of the knee and hospital stay were recorded. Results: The ability to achieve better angle of flexion was significantly higher in the combination group compared with the other groups, with a significant difference in favour of the ropivacaine group compared with the control group. At 2 h postoperatively, the mean pain (VAS) scores were significantly lower in patients who received (IA) analgesia compared with the control group and in the ropivacaine/tramadol group versus the ropivacaine group. The number of requests and total dose of rescue analgesia consumed were significantly lower with (IA) analgesia, with a significant difference in favour of the combination group. There was significant correlation between pain (VAS) scores and angle of flexion of the knee joint. Conclusion: Continuous (IA) ropivacaine/tramadol infusion safely reduced postoperative pain and spared administration of rescue analgesics with a significantly improved range of joint movement.
文摘PRIMARY synovial chondromatosis is a rarecondition in which foci of cartilage develop in thesynovial membrane of joints, bursae and tendonsheaths. It typically involves a single large jointin a young adult male.1 The ectopic foci of cartilage canresult in painful joint effusion, and the generation of loosebodies can cause mechanical symptoms.2,3 The etiology ofprimary synovial chondromatosis remains unknown, butmetaplastic theory is the most popular hypothesis. Thecommonly involved joints are knee, elbow, and hip.^4 Theshoulder is a rare site of synovial chondromatosis2,3,5 andthe extra-articular involvement even rarer, with only fewcases presented in literature. This report presents a rarecase of primary combined intra-articular andextra-articular synovial chondromatosis of shoulder jointtreated with arthroscopy.
文摘The comparison of biochemical composition and biophysical properties of synovial fluid and blood serum leads to a conclusion about the pathogenetic expediency of using serum as a corrector of synovial medium of osteoarthritic joints. Serum modification was realized by preliminary prescription of a single-dose drug to the patient. Then, the patient’s blood was sampled in the period of its maximal saturation with the drug. Autoserum from such blood samples was injected thrice into the knee joints affected by osteoarthritis of the 2nd or 3rd stages. The value of treatment results after 4 - 6 months of described therapeutics shows a significantly better therapeutic effect in the experimental of patient’s group as compared with the control group. The effect is connected with pain diminishing, normalization of the tissue joint nutrition, suppression of the local inflammation, and improvement of cartilage lubrication.
文摘Objective: To study the effect of intramuscular calcitonin injection combined with intra-articular ozone injection on the expression of the IL family and MMPs family of knee osteoarthritis. Methods: A total of 128 patients with knee osteoarthritis who were treated in the hospital between January 2015 and January 2017 were collected and divided into control group and observation group by random number table, each with 64 cases. Control group received intra-articular ozone injection therapy, and observation group received intramascular calcitonin injection combined with intra-articular ozone injection therapy. The differences in serum levels of IL family members and MMPs family members were compared between the two groups before and after treatment. Results: Before treatment, the differences in serum levels of IL family members and MMPs family members were not statistically significant between the two groups. 1 week after treatment, serum levels of IL family members IL-1β, IL-15, IL-17 and IL-18 as well as MMPs family members MMP-1, MMP-2, MMP-3 and MMP-13 of both groups of patients were significantly lower than those before treatment, and serum IL-1β, IL-15, IL-17, IL-18, MMP-1, MMP-2, MMP-3 and MMP-13 levels of observation group were significantly lower than those of control group. Conclusion: Intramuscular calcitonin injection combined with intra-articular ozone injection therapy can effectively inhibit the expression of IL family and MMPs family in patients with knee osteoarthritis.
基金Project of the National Natural Science Foundation of China,No.82172398Key Research Project of the Department of Education of Liaoning Province,No.LJKZZ20220148+1 种基金Dalian Medical Science Research Project,No.2111038Dalian Dengfeng Plan Medical Key Specialty Construction Project(2021),No.243.
文摘BACKGROUND Knee osteoarthritis(KOA)is a common orthopedic condition with an uncertain etiology,possibly involving genetics and biomechanics.Factors like changes in chondrocyte microenvironment,oxidative stress,inflammation,and immune responses affect KOA development.Early-stage treatment options primarily target symptom relief.Mesenchymal stem cells(MSCs)show promise for treatment,despite challenges.Recent research highlights microRNAs(miRNAs)within MSC-released extracellular vesicles that can potentially promote cartilage regeneration and hinder KOA progression.This suggests exosomes(Exos)as a promising avenue for future treatment.While these findings emphasize the need for effective KOA progression management,further safety and efficacy validation for Exos is essential.AIM To explore miR-29a’s role in KOA,we’ll create miR-29a-loaded vesicles,testing for early treatment in rat models.METHODS Extraction of bone marrow MSC-derived extracellular vesicles,preparation of engineered vesicles loaded with miR-29a using ultrasonication,and identification using quantitative reverse transcription polymerase chain reaction;after establi-shing a rat model of KOA,rats were randomly divided into three groups:Blank control group injected with saline,normal extracellular vesicle group injected with normal extracellular vesicle suspension,and engineered extrace-llular vesicle group injected with engineered extracellular vesicle suspension.The three groups evaluation,histological detection,and immunohistochemical detection to compare and evaluate the progress of various forms of arthritis.RESULTS General behavioral observation results showed that the extracellular vesicle group and engineered extracellular vesicle group had better performance in all four indicators of pain,gait,joint mobility,and swelling compared to the blank control group.Additionally,the engineered extracellular vesicle group had better pain relief at 4 wk and better knee joint mobility at 8 wk compared to the normal extracellular vesicle group.Imaging examination results showed that the blank control group had the fastest progression of arthritis,the normal extracellular vesicle group had a relatively slower progression,and the engineered extracellular vesicle group had the slowest progression.Gross histological observation results showed that the blank control group had the most obvious signs of arthritis,the normal extracellular vesicle group showed signs of arthritis,and the engineered extracellular vesicle group showed no significant signs of arthritis.Using the Pelletier gross score evaluation,the engineered extracellular vesicle group had the slowest progression of arthritis.Results from two types of staining showed that the articular cartilage of rats in the normal extracellular vesicle and engineered extracellular vesicle groups was significantly better than that of the blank control group,and the engineered extracellular vesicle group had the best cartilage cell and joint surface condition.Immunohistochemical detection of type II collagen and proteoglycan showed that the extracellular matrix of cartilage cells in the normal extracellular vesicle and engineered extracellular vesicle groups was better than that of the blank control group.Compared to the normal extracellular vesicle group,the engineered extracellular vesicle group had a better regulatory effect on the extracellular matrix of cartilage cells.CONCLUSION Engineered Exos loaded with miR-29a can exert anti-inflammatory effects and maintain extracellular matrix stability,thereby protecting articular cartilage,and slowing the progression of KOA.
基金National Natural Science Foundation of China,No.82074469.
文摘Recently,we read an article published by the Yang et al.The results of this study indicated that engineered exosomes loaded with microRNA-29a(miR-29a)alleviate knee inflammation and maintain extracellular matrix stability in Sprague Dawley rats.The study’s results provide useful information for treating knee osteoarthritis(KOA).This letter,shares our perspectives on treating KOA using engineered exosomes for miR-29a.
文摘目的:探讨几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎的临床疗效。方法:回顾性分析2021年6月—2022年12月在南京医科大学第一附属医院骨科门诊就诊并随访的膝骨关节炎患者共164例。按治疗方式分为3组:A组(对照组,口服给药)55例,B组(几丁糖关节腔注射+口服给药)53例,C组(几丁糖联合小剂量糖皮质激素关节腔注射给药)56例。比较3组治疗前后的疼痛视觉模拟评分(visual analogue scale,VAS)、Lysholm评分、美国特种外科医院(Hospital for Special Surgery,HSS)评分和关节液炎性细胞因子白介素(interleukin,IL)-1、IL-6和肿瘤坏死因子(tumor necrosis factor,TNF)-α水平的变化,并对临床疗效进行评价。结果:所有病例均获得随访,随访时间7~12个月,无失访病例。每组治疗后的VAS评分、Lysholm评分、HSS评分和关节液炎性细胞因子IL-1、IL-6和TNF-α水平均优于治疗前,差异有统计学意义(P<0.05)。治疗前VAS评分、Lysholm评分、HSS评分和关节液炎性细胞因子IL-1、IL-6和TNF-α水平在3组间的差异无统计学意义(P>0.05);但治疗后各项指标在3组间的差异有统计学意义(P<0.05);两两比较显示,C组优于A、B两组,B组优于A组,差异均有统计学意义(P<0.05)。3组临床疗效评价比较,差异有统计学意义(P<0.05)。结论:几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎临床疗效显著,具有创伤小,起效迅速,疗效持久的特点,同时避免了外用或口服非甾体类抗炎药的不良反应,作为一线治疗方案,建议在临床推广和使用。
文摘目的评价股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的安全性和有效性。方法选择滨州医学院附属医院骨关节外科2022年1月至6月因半月板损伤、游离体、骨性关节炎计划行单侧膝关节镜手术患者120例,随机分为股神经阻滞联合关节腔浸润麻醉组(F/I组)和腰硬联合麻醉组(CSEA组),每组60例。F/I组中男32例,女28例,年龄(38.75±11.35)岁;CSEA组中男25例,女35例,年龄(37.80±10.85)岁。比较两组术中补救例数、术后视觉模拟评分法(VAS)评分、术后感觉恢复时间及首次下地活动时间、术后并发症、住院花费及住院天数等指标的差异。采用t检验、χ^(2)检验、Fisher确切概率法。结果F/I组术后6 h VAS评分低于CSEA组[(2.08±0.61)分比(2.54±0.64)分],差异有统计学意义(t=-2.484,P=0.018)。F/I组感觉恢复时间长于CSEA组[(6.25±0.40)h比(3.60±0.31)h,首次下地活动时间短于CESA组[(2.99±1.05)h比(8.14±1.88)h],差异均有统计学意义(t=14.095、-12.263,均P<0.001)。术后并发症:F/I组术中加用麻醉发生率3.3%(2/60)、尿潴留发生率0、下肢静脉血栓发生率1.7%(1/60)、恶心呕吐发生率3.3%(2/60),CSEA组术中加用麻醉发生率0、尿潴留发生率10.0%(6/60)、下肢静脉血栓发生率5.0%(3/60)、恶心呕吐发生率16.7%(10/60),两组尿潴留、恶心呕吐发生率比较差异均有统计学意义(均P<0.05)。F/I组住院时间为(3.90±0.63)d、住院费用为(9612.67±507.15)元,CESA组分别为(5.27±0.75)d、(11401.52±530.01)元,差异均有统计学意义(t=-8.862、-15.425,均P<0.001)。结论股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中能够减少术后并发症、缩短住院时间、降低住院费用,并提供良好的麻醉效果。
