Duzhong Jiangu Granule in the treatment of primary osteoarthritis(POA)model of postmenopausal kidney deficiency type in Hartley female guinea pigs after ovariectomy,and the correlation between gene expression of bone ...Duzhong Jiangu Granule in the treatment of primary osteoarthritis(POA)model of postmenopausal kidney deficiency type in Hartley female guinea pigs after ovariectomy,and the correlation between gene expression of bone marrow tissue,cartilage tissue,and knee osteoarthritis.Methods:383-months-old Hartley female guinea pigs after one week of adaptive feeding were weighed about 400 g±20 g,numbered,and sorted by ear tag.Six of them were selected as normal groups by looking up random number tables.The remainder were removed from the bilateral ovaries to construct the postmenopausal kidney deficiency model,and castrated guinea pigs were used to construct the postmenopausal kidney deficiency POA model.After the modeling cycle,a guinea pig from the blank group and a guinea pig from the model group were sacrificed and the right knee was observed.The model was established and the experiments continued.There were five guinea pigs in the blank group,and the remaining model guinea pigs were randomly divided into model control group,high-dose group of compound Duzhong Jiangu granules,middle-dose group of compound Duzhong Jiangu granules,low-dose group of compound Duzhong Jiangu granules and design group,with 5 guinea pigs in each group.Blanks and model groups were given a cellulose sodium solution by gavage.The guinea pigs were sacrificed after 30 days of intragastric administration.The left knee cartilage and bone marrow of the blank group,model group,middle dose group,and high dose group of compound Duzhong Jiangu granule were collected and applied to transcriptome sequencing,and the sequencing data were analyzed,including differential gene expression analysis,functional enrichment analysis of database established by Gene Ontology federation(GO)and Kyoto Encyclopedia of Gene and Genome(KEGG)pathway enrichment analysis.The complete specimens of the right knee joint were collected,and the morphological changes of the cartilage of the right knee joint in each group were observed by saffron rapid green staining,and the subchondral bone was quantitatively analyzed by Micro CT so that the expression of TRAF6,MIP-1βand IL-1βprotein in NF-kappa B signaling pathway was detected by Western Blot technique(WB).Results:The results of Safranin Fast Green staining showed that Compound Duzhong Jiangu Granules could effectively reduce the degree of morphological damage of articular cartilage in guinea pigs with the POA model.According to the analysis results of the subchondral bone structure under Micro CT,Compound Duzhong Jiangu Granules can improve the bone condition of the POA model,thus delaying the process of degenerative changes of the knee joint.From the results of transcriptome analysis,Compound Duzhong Jiangu Granules can inhibit the expression of related genes in POA model guinea pigs.According to the results of Wester Bolt verification,Compound Duzhong Jiangu Granules can effectively improve knee osteoarthritis.Conclusions:The effect of Compound Duzhong Jiangu Granules on OA is obvious,and its mechanism may be related to the expression of genes GZMK,Jchain,igkc,IGHV3-74,IGHV3-11,IGHV4-1,CCL5,and IGKV1–39.展开更多
Background:The purpose of the study was to investigate the active ingredients and potential biochemical mechanisms of Juanbi capsule in knee osteoarthritis based on network pharmacology,molecular docking and animal ex...Background:The purpose of the study was to investigate the active ingredients and potential biochemical mechanisms of Juanbi capsule in knee osteoarthritis based on network pharmacology,molecular docking and animal experiments.Methods:Chemical components for each drug in the Juanbi capsule were obtained from Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform,while the target proteins for knee osteoarthritis were retrieved from the Drugbank,GeneCards,and OMIM databases.The study compared information on knee osteoarthritis and the targets of drugs to identify common elements.The data was imported into the STRING platform to generate a protein-protein interaction network diagram.Subsequently,a“component-target”network diagram was created using the screened drug components and target information with Cytoscape software.Common targets were imported into Metascape for GO function and KEGG pathway enrichment analysis.AutoDockTools was utilized to predict the molecular docking of the primary chemical components and core targets.Ultimately,the key targets were validated through animal experiments.Results:Juanbi capsule ameliorated Knee osteoarthritis mainly by affecting tumor necrosis factor,interleukin1β,MMP9,PTGS2,VEGFA,TP53,and other cytokines through quercetin,kaempferol,andβ-sitosterol.The drug also influenced the AGE-RAGE,interleukin-17,tumor necrosis factor,Relaxin,and NF-κB signaling pathways.The network pharmacology analysis results were further validated in animal experiments.The results indicated that Juanbi capsule could decrease the levels of tumor necrosis factor-αand interleukin-1βin the serum and synovial fluid of knee osteoarthritis rats and also down-regulate the expression levels of MMP9 and PTGS2 proteins in the articular cartilage.Conclusion:Juanbi capsule may improve the knee bone microstructure and reduce the expression of inflammatory factors of knee osteoarthritis via multiple targets and multiple signaling pathways.展开更多
BACKGROUND Osteoarthritis(OA)is the most common joint disorder,is associated with an increasing socioeconomic impact owing to the ageing population.AIM To analyze and compare the efficacy and safety of bone-marrow-der...BACKGROUND Osteoarthritis(OA)is the most common joint disorder,is associated with an increasing socioeconomic impact owing to the ageing population.AIM To analyze and compare the efficacy and safety of bone-marrow-derived mesenchymal stromal cells(BM-MSCs)and adipose tissue-derived MSCs(AD-MSCs)in knee OA management from published randomized controlled trials(RCTs).METHODS Independent and duplicate electronic database searches were performed,including PubMed,EMBASE,Web of Science,and Cochrane Library,until August 2021 for RCTs that analyzed the efficacy and safety of AD-MSCs and BM-MSCs in the management of knee OA.The visual analog scale(VAS)score for pain,Western Ontario McMaster Universities Osteoarthritis Index(WOMAC),Lysholm score,Tegner score,magnetic resonance observation of cartilage repair tissue score,knee osteoarthritis outcome score(KOOS),and adverse events were analyzed.Analysis was performed on the R-platform using OpenMeta(Analyst)software.Twenty-one studies,involving 936 patients,were included.Only one study compared the two MSC sources without patient randomization;hence,the results of all included studies from both sources were pooled,and a comparative critical analysis was performed.RESULTS At six months,both AD-MSCs and BM-MSCs showed significant VAS improvement(P=0.015,P=0.012);this was inconsistent at 1 year for BM-MSCs(P<0.001,P=0.539),and AD-MSCs outperformed BM-MSCs compared to controls in measures such as WOMAC(P<0.001,P=0.541),Lysholm scores(P=0.006;P=0.933),and KOOS(P=0.002;P=0.012).BM-MSC-related procedures caused significant adverse events(P=0.003)compared to AD-MSCs(P=0.673).CONCLUSION Adipose tissue is superior to bone marrow because of its safety and consistent efficacy in improving pain and functional outcomes.Future trials are urgently warranted to validate our findings and reach a consensus on the ideal source of MSCs for managing knee OA.展开更多
Objective:To investigate whether acupotomy could inhibit subchondral bone remodeling in knee osteoarthritis(KOA)rabbits by regulating the activity of osteoblasts and osteoclasts.Methods:KOA rabbits were prepared by im...Objective:To investigate whether acupotomy could inhibit subchondral bone remodeling in knee osteoarthritis(KOA)rabbits by regulating the activity of osteoblasts and osteoclasts.Methods:KOA rabbits were prepared by immobilization for 6 and 9 weeks by Videman method.Nine groups of rabbits(control,6 weeks and 9 weeks model,6 weeks and 9 weeks acupotomy,6 weeks and 9 weeks electroacupuncture,and 6 weeks and 9 weeks drug groups)received acupotomy,electroacupuncture and risedronate sodium intervention,respectively,for 3 weeks.Results:Acupotomy can inhibit the activity of osteoclasts and osteoblasts in subchondral bone by reducing the proteins expression of cathepsin K(CK)and tartrate-resistant acid phosphatase(TRAP)and decreasing the proteins expression of osteocalcin(OCN)and alkaline phosphatase(ALP),to intercept the abnormal bone resorption and bone formation of subchondral bone in 6-week and 9-week immobilization-induced KOA rabbits.Conclusion:These findings indicated that acupotomy may be more advantageous than risedronate sodium intervention in modulating subchondral bone remodeling in KOA rabbits,especially in 9-week immobilization-induced KOA rabbits.展开更多
Knee osteoarthritis,as a chronic disabling disease,not only brings trouble to the patients,but also brings great psychological and economic burden to their families.Although there are various treatment methods,the cur...Knee osteoarthritis,as a chronic disabling disease,not only brings trouble to the patients,but also brings great psychological and economic burden to their families.Although there are various treatment methods,the curative effect is not good,mainly relieving symptoms,and cannot intervene the disease progression.Necroptosis and ferroptosis are two new pathways of programmed cell death discovered in recent years,they play a key role in the occurrence and development of knee osteoarthritis and also provide a new opportunity for the prevention and treatment of knee osteoarthritis.This article reviews necroptosis and ferroptosis and their related studies in knee osteoarthritis.展开更多
Objective: To evaluate the curative effect of the Traditional Chinese Medicine (TCM) external therapy on knee osteoarthritis patients with different TCM constitutions using musculoskeletal ultrasonography and contrast...Objective: To evaluate the curative effect of the Traditional Chinese Medicine (TCM) external therapy on knee osteoarthritis patients with different TCM constitutions using musculoskeletal ultrasonography and contrast-enhanced ultrasonography, and to explore the application value of contrast-enhanced ultrasonography in knee joint diseases. Methods: A total of 57 patients diagnosed with knee osteoarthritis in Shaanxi University of Traditional Chinese Medicine from December 2019 to May 2021 were collected, and they were divided into qi stagnation and blood stasis type group (23 cases) and cold-dampness obstruction type group (34 cases) according to the traditional Chinese medicine method. All patients were given acupuncture combined with TCM fumigation and washing. All patients underwent musculoskeletal ultrasonography and contrast-enhanced ultrasonography before and after treatment, observed and recorded relevant data, and compared the treatment effects between the two groups. Results: 85.96% (49/57) of knee osteoarthritis (KOA) patients had suprapatellar bursa effusion, 42.1% (24/57) had iliotibial band bursae effusion, some of which had poor sound transmission, and thickened synovium was seen in most effusions, 33.33% (19/57) had osteophyte formation. Compared with before treatment, the depth of suprapatellar sac effusion in the Qi stagnation and blood stasis type group decreased after treatment (P Conclusion: Musculoskeletal contrast-enhanced ultrasonography was used to quantitatively evaluate the efficacy of TCM external therapy on KOA for different TCM constitutions. Dynamic observation of synovial lesions of knee osteoarthritis provides a valuable imaging method for evaluating the efficacy of traditional Chinese medicine.展开更多
Knee osteoarthritis(KOA)is a chronic degenerative Osteoarthritis disease.The majority of patients with knee osteoarthritis were elderly patients.The disease not only greatly affects the work and life of patients but a...Knee osteoarthritis(KOA)is a chronic degenerative Osteoarthritis disease.The majority of patients with knee osteoarthritis were elderly patients.The disease not only greatly affects the work and life of patients but also brings serious burden to families and society.The traditional Chinese medicine has a long history in China,which has shown a multi-pathway and multitarget mechanism for the prevention and treatment of knee osteoarthritis.According to the properties of Chinese medicine,it was divided into four categories:drugs to promote blood circulation and remove blood stasis,drugs to clear heat,drugs to dispel wind dampness and drugs to tonify deficiency.In addition,the relevant literatures at home and abroad in recent five years were reviewed to summarize and generalize the mechanism of traditionalChinese medicine in the treatment of knee osteoarthritis,in order to provide reference for the treatment of knee osteoarthritis with traditional Chinese medicine.展开更多
BACKGROUND Considering the limited effectiveness of clinical interventions for knee osteoarthritis(KOA),it is necessary to continue to explore appropriate and effective treatment strategies to improve the condition of...BACKGROUND Considering the limited effectiveness of clinical interventions for knee osteoarthritis(KOA),it is necessary to continue to explore appropriate and effective treatment strategies to improve the condition of KOA patients.AIM To clarify the influence of ankle flexion and extension exercises combined with a psychological intervention on the psychological status and activities of daily living(ADLs)of patients with KOA.METHODS The research participants were 116 KOA patients admitted to The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine between May 2019 and May 2022,including 54 patients receiving routine treatment,care and psychological intervention(control group)and 62 patients additionally treated with ankle flexion and extension exercises(research group).The two groups were comparatively analyzed in terms of psychological status(Self-rating Anxiety/Depression Scale,SDS/SAS),ADLs,knee joint function(Lysholm Knee Scoring Scale),pain(Visual Analog Scale,VAS),fatigue(Multidimensional Fatigue Inventory,MFI),and quality of life(QoL;Short-Form 36 Item Health Survey,SF-36).RESULTS After evaluation,it was found that the postinterventional SDS,SAS,VAS,and MFI scores in the research group were significantly reduced compared with the baseline(before the intervention)values and those of the control group,while the postinterventional Lysholm,ADL and SF-36 scores were markedly elevated.CONCLUSION Therefore,ankle flexion and extension exercises are highly effective in easing negative psychological status,enhancing ADLs,daily living ability,knee joint function and QoL,and relieving pain and fatigue in KOA patients,thus warranting clinical promotion.展开更多
Background: Osteoarthritis is a chronic disease associated with pain, inflammation, stiffness and synovial effusion, with progressive functional limitation, compromising quality of life. It progressively leads to loss...Background: Osteoarthritis is a chronic disease associated with pain, inflammation, stiffness and synovial effusion, with progressive functional limitation, compromising quality of life. It progressively leads to loss or decrease in joint function. Pharmacological and non-pharmacological therapy seeks symptomatic management, complicated by a lack of adherence. After acetaminophen, non-steroidal anti-inflammatory drugs such as diclofenac are the most widely used medications. Objectives: The primary objective compared the analgesic effect of diclofenac 150 mg once daily vs. 50 mg three times daily in patients with knee osteoarthritis. The secondary objective assessed changes in quality of life. Method: One group received diclofenac 150 mg OD with placebo TTD. Another group received placebo OD and 50 mg active diclofenac (reference) TTD, both for 30 days. The evaluation of pain was carried out by a visual analog scale (VAS), at the beginning, 2, 3, 4, 15 and 30 days, quality of life (the WOMAC scale) and adverse effects, at 15 and 30 days. Results: Pain decreased significantly on days 15 and 30, compared to day 0, in both groups, without differences between groups. The total results in the WOMAC scale showed a very marked improvement at 15 and 30 days, without differences between groups. The most frequent adverse effects were constipation 6% in the reference group, and gastric discomfort 30.3% in the reference group vs 28.1%, in the Test group. Conclusions: Prolonged-release diclofenac 150 mg OD is as effective as diclofenac 50 mg TID for the treatment of patients with knee osteoarthritis.展开更多
Objective: To evaluate the efficacy based on clinical symptom and on magnetic resonance image of platelet-rich plasma therapy in combination with mesenchymal stem cells from autologous adipose tissue for knee osteoart...Objective: To evaluate the efficacy based on clinical symptom and on magnetic resonance image of platelet-rich plasma therapy in combination with mesenchymal stem cells from autologous adipose tissue for knee osteoarthritis treatment. Patients and Method: 30 patients including 26 females and 4 males;correspondingly, 60 knee joints were diagnosed with osteoarthritis with stages II - III of Kellgren and Lawrence, their mean age was 58.63 ± 11.11. All were injected with autologous platelet-rich plasma that was extracted by PRP set, APC 30 PRP PRCEDURE PRAK and autologously extracted mesenchymal stem cells from abdominal adipose tissue using the ADI-25-01 ADIPOSEPRCEDURE PRAK of USA. Results: After 12 months: the pain level according to VAS score at the right knee joint was decreased from 6.0 ± 1.28 before treatment to 1.9 ± 0.3;VAS score at the left knee joint was decreased from 6.43 ± 1.19 to 2.25 ± 0.43. Total Lequene score at right knee joint was decreased from 16.04 ± 1.57 before treatment to 4.31 ± 1.04, at left knee joint was decreased from 17.52 ± 1.74 before treatment to 5.15 ± 1.48. Total WOMAC score at right knee joint was decreased from 55.93 ± 5.56 to 10.37 ± 1.56;at left knee joint was decreased from 53.97 ± 5.57 to 10.07 ± 1.59. There were 86.77% joints with cartilage thickness change and the patellar cartilage thickness was increased from 1.56 ± 0.09 mm before treatment to 1.65 ± 0.09 mm. Conclusion: The treatment of knee osteoarthritis by platelet-rich plasma therapyin combination with mesenchymal stem cells from autologous adipose tissue is effective in reducing pain, improving patient's mobility and walking function, reforming articular cartilage thickness on magnetic resonance image.展开更多
Knee osteoarthritis(KOA)is a chronic derivative joint issue that mainly damages the artistic cartilage and leads to pain,swelling,and stiffness around the joint,which is commomly worldwide.With the aging of society an...Knee osteoarthritis(KOA)is a chronic derivative joint issue that mainly damages the artistic cartilage and leads to pain,swelling,and stiffness around the joint,which is commomly worldwide.With the aging of society and the increment in obesity rate,the incidence of KOA increases sharply,which seriously effects the quality of human life.Before,how to take effective treatment methods is very important.Severe ways to treat the disease include non-steroidal drugs,local injections,surgery,and cell and gene therapies.However,each therapy has certain defections,such as gastrotestinal tract irritation,cardiovascular safety,or high medical costs for patients.Traditional Chinese medicine has a long history in treating KOA,reported by acupuncture,massage,internal administration of traditional Chinese medicine,and external use of traditional Chinese medicine.In clinical practice,patients can be treated from the root agreement to different etiology,and patients can be treated agreement to different syndrome types by syndrome difference to achieve effect.Studies have shown that warm acupuncture is effect in treating KOA.It has two kinds of treatment methods:acupuncture and moxibustion at the same time.It has fewer side effects and is more acceptable to patients.However,there are still some problems in the basic research and clinical application of warm acupuncture and moxibustion in treating KOA.This paper discussed the existing problems from the followingfive aspects:lack of unified synthesis difference and treatment system,problems in clinical research,weak basic research,problems in the study of moxibustion,and lack of the best treatment program recognized by the academic community.Meanwhile,the selection of acupoints,the relationship between acupuncture depth and anatomy should be further studied in order to offer research ideas for the healthy development of the treatment of KOA with warming acupuncture and moxibustion in the future.展开更多
BACKGROUND Osteoarthritis(OA)is the most prevalent form of degenerative whole-joint disease.Before the final option of knee replacement,arthroscopic surgery was the most widely used joint-preserving surgical treatment...BACKGROUND Osteoarthritis(OA)is the most prevalent form of degenerative whole-joint disease.Before the final option of knee replacement,arthroscopic surgery was the most widely used joint-preserving surgical treatment.Emerging regenerative therapies,such as those involving platelet-rich plasma,mesenchymal stem cells,and microfragmented adipose tissue(MFAT),have been pushed to the forefront of treatment to prevent the progression of OA.Currently,MFAT has been successfully applied to treat different types of orthopedic diseases.AIM To assess the efficacy and safety of MFAT with arthroscopic surgery in patients with knee OA(KOA).METHODS A randomized,multicenter study was conducted between June 2017 and November 2022 in 10 hospitals in Zhejiang,China.Overall,302 patients diagnosed with KOA(Kellgren-Lawrence grades 2-3)were randomized to the MFAT group(n=151,were administered MFAT following arthroscopic surgery),or the control group(n=151,were administered hyaluronic acid following arthroscopic surgery).The study outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score,the visual analog scale(VAS)score,the Lequesne index score,the Whole-Organ Magnetic Resonance Imaging Score(WORMS),and safety over a 24-mo period from baseline.RESULTS The changes in the WOMAC score(including the three subscale scores),VAS pain score,and Lequesne index score at the 24-mo mark were significantly different in the MFAT and control groups,as well as when comparing values at the posttreatment visit and those at baseline(P<0.001).The MFAT group consistently demonstrated significant decreases in the WOMAC pain scores and VAS scores at all follow-ups compared to the control group(P<0.05).Furthermore,the WOMAC stiffness score,WOMAC function score,and Lequesne index score differed significantly between the groups at 12 and 24 mo(P<0.05).However,no signicant between-group differences were observed in the WORMS at 24 mo(P=0.367).No serious adverse events occurred in both groups.CONCLUSION The MFAT injection combined with arthroscopic surgery treatment group showed better mid-term clinical outcomes compared to the control group,suggesting its efficacy as a therapeutic approach for patients with KOA.展开更多
Knee osteoarthritis(OA)is a common disease that impairs knee function and causes pain.Currently,studies on the detection of knee OA mainly focus on X-ray images,but X-ray images are insensitive to the changes in knee ...Knee osteoarthritis(OA)is a common disease that impairs knee function and causes pain.Currently,studies on the detection of knee OA mainly focus on X-ray images,but X-ray images are insensitive to the changes in knee OA in the early stage.Since magnetic resonance(MR)imaging can observe the early features of knee OA,the knee OA detection algorithm based on MR image is innovatively proposed to judge whether knee OA is suffered.Firstly,the knee MR images are preprocessed before training,including a region of interest clipping,slice selection,and data augmentation.Then the data set was divided by patient-level and the knee OA was classified by the deep transfer learning method based on the DenseNet201 model.The method divides the training process into two stages.The first stage freezes all the base layers and only trains the weights of the embedding neural networks.The second stage unfreezes part of the base layers and trains the unfrozen base layers and the weights of the embedding neural network.In this step,we design a block-by-block fine-tuning strategy for training based on the dense blocks,which improves detection accuracy.We have conducted training experiments with different depth modules,and the experimental results show that gradually adding more dense blocks in the fine-tuning can make the model obtain better detection performance than only training the embedded neural network layer.We achieve an accuracy of 0.921,a sensitivity of 0.960,a precision of 0.885,a specificity of 0.891,an F1-Score of 0.912,and an MCC of 0.836.The comparative experimental results on the OAI-ZIB dataset show that the proposed method outperforms the other detection methods with the accuracy of 92.1%.展开更多
X-Ray knee imaging is widely used to detect knee osteoarthritis due to ease of availability and lesser cost.However,the manual categorization of knee joint disorders is time-consuming,requires an expert person,and is ...X-Ray knee imaging is widely used to detect knee osteoarthritis due to ease of availability and lesser cost.However,the manual categorization of knee joint disorders is time-consuming,requires an expert person,and is costly.This article proposes a new approach to classifying knee osteoarthritis using deep learning and a whale optimization algorithm.Two pre-trained deep learning models(Efficientnet-b0 and Densenet201)have been employed for the training and feature extraction.Deep transfer learning with fixed hyperparameter values has been employed to train both selected models on the knee X-Ray images.In the next step,fusion is performed using a canonical correlation approach and obtained a feature vector that has more information than the original feature vector.After that,an improved whale optimization algorithm is developed for dimensionality reduction.The selected features are finally passed to the machine learning algorithms such as Fine-Tuned support vector machine(SVM)and neural networks for classification purposes.The experiments of the proposed framework have been conducted on the publicly available dataset and obtained the maximum accuracy of 90.1%.Also,the system is explained using Explainable Artificial Intelligence(XAI)technique called occlusion,and results are compared with recent research.Based on the results compared with recent techniques,it is shown that the proposed method’s accuracy significantly improved.展开更多
Aim: To evaluate the effects based the changes on ultrasound and on magnetic resonance for knee osteoarthritis treatment by platelet-rich plasma therapy in combination with mesenchymal stem cell from autologous adipos...Aim: To evaluate the effects based the changes on ultrasound and on magnetic resonance for knee osteoarthritis treatment by platelet-rich plasma therapy in combination with mesenchymal stem cell from autologous adipose tissue. Objects and Methods: 30 patients, 26 females, 4 males, mean age 58.63 ± 11.11, mean disease duration 5.3 ± 4.6 years, respectively 60 knee joints were diagnosed with osteoarthritis at stage II - III according to the Kellgren and Lawrence classifications. After ultrasound and magnetic resonance imaging in the first time, all patients were injected with platelet-rich plasma combined with mesenchymal stem cells from autologous adipose tissue into both knee joints. Results: After treatment 12 months by platelet-rich plasma injection combined with mesenchymal stem cells from autologous adipose tissue: The thickness of articular cartilage on ultrasound increased significantly from 2.08 ± 0.36 mm to 2.48 ± 0.36 mm with p Conclusion: The treatment of knee osteoarthritis by platelet-rich plasma combined with mesenchymal stem cells from autologous adipose tissue was effective in improving cartilage thickness on ultrasound and magnetic resonance, thereby improving the motor function of the knee joint.展开更多
BACKGROUND As a serious global problem,knee osteoarthritis(KOA)often leads to pain and disability.Manual therapy is widely used as a kind of physical treatment for KOA.AIM To explore further the efficacy of Maitland a...BACKGROUND As a serious global problem,knee osteoarthritis(KOA)often leads to pain and disability.Manual therapy is widely used as a kind of physical treatment for KOA.AIM To explore further the efficacy of Maitland and Mulligan mobilization methods for adults with KOA.METHODS We searched PubMed,the Cochrane Library,EMbase,Web of Science and Google Scholar from inception to September 20,2020 to collect studies comparing Maitland and Mulligan mobilization methods in adults with KOA.The quality of the studies was assessed using the Physiotherapy Evidence Database Scale for randomized controlled trials.Data analyses were performed using Review Manager 5.0 software.RESULTS A total of 341 articles were screened from five electronic databases(PubMed,the Cochrane Library,EMbase,Web of Science and Google Scholar)after excluding duplicates.Ultimately,eight trials involving 471 subjects were included in present systematic review and meta-analysis.The mean PEDro scale score was 6.6.Mulligan mobilization was more effective in alleviating pain[standardized mean difference(SMD)=0.60;95%confidence interval(CI):0.17 to 1.03,P=0.007;I2=60%,P=0.020]and improving Western Ontario and McMaster Universities function score(SMD=7.41;95%CI:2.36 to 12.47,P=0.004;I2=92%,P=0.000).There was no difference in the effect of the two kinds of mobilization on improving the range of motion(SMD=9.63;95%CI:-1.23 to 20.48,P=0.080;I2=97%,P=0.000).CONCLUSION Mulligan mobilization technique is a promising intervention in alleviating pain and improving function score in KOA patients.展开更多
BACKGROUND Knee joint pain and stiffness are the two main symptoms of knee osteoarthritis(OA)and thus restrict a patient’s activities,such as walking and walking up and downstairs.The lower body positive pressure(LBP...BACKGROUND Knee joint pain and stiffness are the two main symptoms of knee osteoarthritis(OA)and thus restrict a patient’s activities,such as walking and walking up and downstairs.The lower body positive pressure(LBPP)treadmill as one of the emerging body weight support system devices brings new hope for exerciserelated rehabilitation for knee OA patients.AIM To investigate the biomechanical effects and the subjective clinical assessment of LBPP treadmill walking exercise when compared with conventional therapy in mild to moderate knee OA patients.METHODS Eighteen patients with mild-to-moderate knee OA were recruited in this randomized controlled trial(RCT)study.The eligible knee OA patients were randomly assigned to two groups:LBPP and control groups.The patients in the LBPP group performed an LBPP walking training program for 30 min/session per day,6 d per week for 2 wk whereas the patients in the control group performed walking on the ground for the same amount.All patients underwent clinical assessments and three-dimensional gait analysis at pre-and 2-wk post-treatment.RESULTS The Western Ontario and McMaster Universities Arthritis Index and visual analog scale scores in both the LBPP group and control group were found to decrease significantly at the post-treatment point than the pre-treatment point(LBPP:70.25±13.93 vs 40.50±11.86;3.88±0.99 vs 1.63±0.52;control:69.20±8.88 vs 48.10±8.67;3.80±0.79 vs 2.60±0.70,P<0.001).Moreover,compared with the control group,the LBPP group showed more improvements in walking speed(P=0.007),stride length(P=0.037),and knee range of motion(P=0.048)during walking,which represented more improvement in walking ability.CONCLUSION The results of our RCT study showed that the LBPP group has a greater effect on improving gait parameters than the conventional group,although there was no significant advantage in clinical assessment.This finding indicates that LBPP treadmill walking training might be an effective approach for alleviating pain symptoms and improving lower extremity locomotion in mild to moderate knee OA patients.展开更多
Objective:The aim of this study was to investigate the mechanism of acupotomology(Apo)in the prevention of articular cartilage destruction via the promotion of chondrocyte proliferation and chondrocyte expression of c...Objective:The aim of this study was to investigate the mechanism of acupotomology(Apo)in the prevention of articular cartilage destruction via the promotion of chondrocyte proliferation and chondrocyte expression of cell cycle regulators,CyclinD1,CDK4 and CDK6 in a rabbit knee osteoarthritis(KOA)model.Methods:Twenty-eight rabbits were randomly divided into a control group,an OA(osteoarthritis)model group,an Apo(acupotomology)group and EA(electro-acupuncture)group(n Z 7).Improved Videman’s method was used to induce a rabbit model of KOA over 6 weeks.One week later,acupotomy and electro-acupuncture therapy was applied to animals in the respective groups and treatment lasted 4 weeks.Following these treatments,quantitative real-time PCR,immunohistochemical staining and western blotting were performed to assess the mRNA and protein levels of cell cycle regulators CyclinD1(Cell cycle protein D1),CDK4(Cyclin-dependent kinase 4)and CDK6(Cyclin-dependent kinase 6).Ethology measures and knee morphology were also compared among groups.Results:The Lequesne MG index score of morphology was increased(P<.01),and the passive range of motion(PROM)and the mRNA and protein levels of CyclinD1,CDK4,and CDK6 were significantly decreased(P<.01)in the OA model compared with the control group.The Lequesne MG index score and the morphology score were decreased in the Apo and EA group compared with the OA model group(P<.05 or P<.01),while the mRNA levels of CyclinD1,CDK4,and CDK6,and the protein levels of CDK4 were increased in the Apo and EA groups compared with the OA model group(P<.05 or P<.01).The PROM,and the protein levels of CyclinD1 and CDK6 were increased(P<.05)in the Apo group compared with the OA model group,while the PROM and the protein levels of CyclinD1 and CDK6 in the EA group were not significantly different(P>.05).Compared with the EA group,the morphology score was decreased in Apo group(P<.05).Conclusions:The mRNA levels of CyclinD1 and CDK4,and the protein level of CDK4 in chondrocytes are regulate by both Apo and EA.Apo is more effective than EA in regulating the protein levels of CyclinD1 and CDK6.According to the observed changes in morphology and cytokine levels,acupotomy can promote chondrocyte proliferation and can alleviate the destruction of articular cartilage in a model of KOA.展开更多
BACKGROUND Surgical treatment of knee osteoarthritis(KOA)complicated by extra-articular deformity has always been controversial regardless of whether it is simultaneous or staged.Simultaneous total knee arthroplasty(T...BACKGROUND Surgical treatment of knee osteoarthritis(KOA)complicated by extra-articular deformity has always been controversial regardless of whether it is simultaneous or staged.Simultaneous total knee arthroplasty(TKA)combined with supracondylar osteotomy without plate for treatment of KOA complicated by femoral varus deformity has not been reported in the literature.CASE SUMMARY A 53-year-old Chinese woman complained of left knee pain for 6 years that worsened for 4 mo during her visit on April 3,2020,accompanied by instability in walking,which seriously affected quality of life.According to her medical history and preoperative imaging,the patient was diagnosed with left KOA with varus deformity.We used the angular center of rotation principle for osteotomy of the femur deformity and placed a poststabilized femur prosthesis into the knee joint.At the same time,a 13 mm×130 mm femur extension rod was used instead of a steel plate to fix the end of the femur osteotomy,reducing the possible complications caused by steel plate implantation and reducing the economic burden on patients.The operation successfully solved two major problems of KOA and varus deformity,and the clinical and imaging evaluation of postoperative followup were satisfactory.CONCLUSION TKA and supracondylar femoral osteotomy can be used for simultaneous KOA treatment and deformity correction.展开更多
Objective:The objective of this study is to assess the application effect of five elements music therapy introduced in the pain coping skills training of knee osteoarthritis(KOA).Materials and Methods:Totally,80 patie...Objective:The objective of this study is to assess the application effect of five elements music therapy introduced in the pain coping skills training of knee osteoarthritis(KOA).Materials and Methods:Totally,80 patients with KOA were selected and randomly divided into the experimental group(39 cases)and the control group(41 cases).The control group was only given routine nursing measures,and the experimental group was additionally treated with five-element music therapy on the basis of the control group,twice a day,28 days in total.The Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)was used to evaluate the functional status of the knee joint of the two groups.The clinical efficacy of the two groups was evaluated by Guiding Principles for Clinical Research of New Chinese Medicine in the Treatment of Osteoarthritis.Results:WOMAC score statistically significantly decreased in the experimental group(35.92±9.48 vs.16.17±5.43,P<0.01)and the control group(36.73±6.42 vs.22.53±7.51,P<0.01)after 28 days of intervention when compared with that before intervention;WOMAC score in the experimental group was lower than that of the control group after 28 days of intervention(16.17±5.43 vs.22.53±7.51,P<0.01).The total effective rate of the experimental group was statistically higher than that of the control group(82.0%vs.51.2%,χ2=11.97,P=0.003).Conclusion:The combination of five-element music therapy and routine nursing measures has better effect in relieving pain and bad emotions of patients with KOA when compared with routine nursing measures alone.展开更多
基金Shaanxi Provincial Administration of Traditional Chinese Medicine Integrated Traditional Chinese and Western Medicine Prevention and Treatment of Bone Degenerative Diseases“Double Chain Fusion”Young and Middle-aged Scientific Research Innovation Team Project(2022-SLRH-LJ-001)Shaanxi University of Traditional Chinese Medicine Discipline Construction Innovation Team(Bone and Joint and Spinal Degenerative Diseases Integrated Traditional Chinese and Western Medicine Prevention and Treatment Innovation Team)Project(2019YL-02)+1 种基金Chang'an Medical Guanzhong Li's Bone Injury Academic School Inheritance Studio Construction Project(Shaanxi Traditional Chinese Medicine No.40)Shaanxi Province Bone Degenerative Diseases Integrated Traditional Chinese and Western Medicine Prevention and Treatment Key Research Room Construction Project(Shaanxi Traditional Chinese Medicine No.32).
文摘Duzhong Jiangu Granule in the treatment of primary osteoarthritis(POA)model of postmenopausal kidney deficiency type in Hartley female guinea pigs after ovariectomy,and the correlation between gene expression of bone marrow tissue,cartilage tissue,and knee osteoarthritis.Methods:383-months-old Hartley female guinea pigs after one week of adaptive feeding were weighed about 400 g±20 g,numbered,and sorted by ear tag.Six of them were selected as normal groups by looking up random number tables.The remainder were removed from the bilateral ovaries to construct the postmenopausal kidney deficiency model,and castrated guinea pigs were used to construct the postmenopausal kidney deficiency POA model.After the modeling cycle,a guinea pig from the blank group and a guinea pig from the model group were sacrificed and the right knee was observed.The model was established and the experiments continued.There were five guinea pigs in the blank group,and the remaining model guinea pigs were randomly divided into model control group,high-dose group of compound Duzhong Jiangu granules,middle-dose group of compound Duzhong Jiangu granules,low-dose group of compound Duzhong Jiangu granules and design group,with 5 guinea pigs in each group.Blanks and model groups were given a cellulose sodium solution by gavage.The guinea pigs were sacrificed after 30 days of intragastric administration.The left knee cartilage and bone marrow of the blank group,model group,middle dose group,and high dose group of compound Duzhong Jiangu granule were collected and applied to transcriptome sequencing,and the sequencing data were analyzed,including differential gene expression analysis,functional enrichment analysis of database established by Gene Ontology federation(GO)and Kyoto Encyclopedia of Gene and Genome(KEGG)pathway enrichment analysis.The complete specimens of the right knee joint were collected,and the morphological changes of the cartilage of the right knee joint in each group were observed by saffron rapid green staining,and the subchondral bone was quantitatively analyzed by Micro CT so that the expression of TRAF6,MIP-1βand IL-1βprotein in NF-kappa B signaling pathway was detected by Western Blot technique(WB).Results:The results of Safranin Fast Green staining showed that Compound Duzhong Jiangu Granules could effectively reduce the degree of morphological damage of articular cartilage in guinea pigs with the POA model.According to the analysis results of the subchondral bone structure under Micro CT,Compound Duzhong Jiangu Granules can improve the bone condition of the POA model,thus delaying the process of degenerative changes of the knee joint.From the results of transcriptome analysis,Compound Duzhong Jiangu Granules can inhibit the expression of related genes in POA model guinea pigs.According to the results of Wester Bolt verification,Compound Duzhong Jiangu Granules can effectively improve knee osteoarthritis.Conclusions:The effect of Compound Duzhong Jiangu Granules on OA is obvious,and its mechanism may be related to the expression of genes GZMK,Jchain,igkc,IGHV3-74,IGHV3-11,IGHV4-1,CCL5,and IGKV1–39.
基金funding from the Basic Research Project of the Education Department of Shaanxi Province(21JC010,21JP035)the Young and Middle-Aged Scientific Research and Innovation Team of the Shaanxi Provincial Administration of Traditional Chinese Medicine(2022SLRHLJ001)the 2023 Central Financial Transfer Payment Local Project“Innovation and Improvement of Five Types of Hospital Preparations,Such as Roumudan Granules”.
文摘Background:The purpose of the study was to investigate the active ingredients and potential biochemical mechanisms of Juanbi capsule in knee osteoarthritis based on network pharmacology,molecular docking and animal experiments.Methods:Chemical components for each drug in the Juanbi capsule were obtained from Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform,while the target proteins for knee osteoarthritis were retrieved from the Drugbank,GeneCards,and OMIM databases.The study compared information on knee osteoarthritis and the targets of drugs to identify common elements.The data was imported into the STRING platform to generate a protein-protein interaction network diagram.Subsequently,a“component-target”network diagram was created using the screened drug components and target information with Cytoscape software.Common targets were imported into Metascape for GO function and KEGG pathway enrichment analysis.AutoDockTools was utilized to predict the molecular docking of the primary chemical components and core targets.Ultimately,the key targets were validated through animal experiments.Results:Juanbi capsule ameliorated Knee osteoarthritis mainly by affecting tumor necrosis factor,interleukin1β,MMP9,PTGS2,VEGFA,TP53,and other cytokines through quercetin,kaempferol,andβ-sitosterol.The drug also influenced the AGE-RAGE,interleukin-17,tumor necrosis factor,Relaxin,and NF-κB signaling pathways.The network pharmacology analysis results were further validated in animal experiments.The results indicated that Juanbi capsule could decrease the levels of tumor necrosis factor-αand interleukin-1βin the serum and synovial fluid of knee osteoarthritis rats and also down-regulate the expression levels of MMP9 and PTGS2 proteins in the articular cartilage.Conclusion:Juanbi capsule may improve the knee bone microstructure and reduce the expression of inflammatory factors of knee osteoarthritis via multiple targets and multiple signaling pathways.
基金Supported by the Basic Science Research Program through the National Research Foundation of Korea,NRF-2021R1I1A1A01040732 and NRF-2022R1I1A1A01068652the National Research Foundation of Korea grant funded by the Korean Government,Ministry of Science and ICT,2020R1A2C2009496.
文摘BACKGROUND Osteoarthritis(OA)is the most common joint disorder,is associated with an increasing socioeconomic impact owing to the ageing population.AIM To analyze and compare the efficacy and safety of bone-marrow-derived mesenchymal stromal cells(BM-MSCs)and adipose tissue-derived MSCs(AD-MSCs)in knee OA management from published randomized controlled trials(RCTs).METHODS Independent and duplicate electronic database searches were performed,including PubMed,EMBASE,Web of Science,and Cochrane Library,until August 2021 for RCTs that analyzed the efficacy and safety of AD-MSCs and BM-MSCs in the management of knee OA.The visual analog scale(VAS)score for pain,Western Ontario McMaster Universities Osteoarthritis Index(WOMAC),Lysholm score,Tegner score,magnetic resonance observation of cartilage repair tissue score,knee osteoarthritis outcome score(KOOS),and adverse events were analyzed.Analysis was performed on the R-platform using OpenMeta(Analyst)software.Twenty-one studies,involving 936 patients,were included.Only one study compared the two MSC sources without patient randomization;hence,the results of all included studies from both sources were pooled,and a comparative critical analysis was performed.RESULTS At six months,both AD-MSCs and BM-MSCs showed significant VAS improvement(P=0.015,P=0.012);this was inconsistent at 1 year for BM-MSCs(P<0.001,P=0.539),and AD-MSCs outperformed BM-MSCs compared to controls in measures such as WOMAC(P<0.001,P=0.541),Lysholm scores(P=0.006;P=0.933),and KOOS(P=0.002;P=0.012).BM-MSC-related procedures caused significant adverse events(P=0.003)compared to AD-MSCs(P=0.673).CONCLUSION Adipose tissue is superior to bone marrow because of its safety and consistent efficacy in improving pain and functional outcomes.Future trials are urgently warranted to validate our findings and reach a consensus on the ideal source of MSCs for managing knee OA.
基金supported by the Beijing Municipal Natural Science Foundation(7192110)。
文摘Objective:To investigate whether acupotomy could inhibit subchondral bone remodeling in knee osteoarthritis(KOA)rabbits by regulating the activity of osteoblasts and osteoclasts.Methods:KOA rabbits were prepared by immobilization for 6 and 9 weeks by Videman method.Nine groups of rabbits(control,6 weeks and 9 weeks model,6 weeks and 9 weeks acupotomy,6 weeks and 9 weeks electroacupuncture,and 6 weeks and 9 weeks drug groups)received acupotomy,electroacupuncture and risedronate sodium intervention,respectively,for 3 weeks.Results:Acupotomy can inhibit the activity of osteoclasts and osteoblasts in subchondral bone by reducing the proteins expression of cathepsin K(CK)and tartrate-resistant acid phosphatase(TRAP)and decreasing the proteins expression of osteocalcin(OCN)and alkaline phosphatase(ALP),to intercept the abnormal bone resorption and bone formation of subchondral bone in 6-week and 9-week immobilization-induced KOA rabbits.Conclusion:These findings indicated that acupotomy may be more advantageous than risedronate sodium intervention in modulating subchondral bone remodeling in KOA rabbits,especially in 9-week immobilization-induced KOA rabbits.
基金National Natural Science Foundation Regional Fund Project (No.82160912)。
文摘Knee osteoarthritis,as a chronic disabling disease,not only brings trouble to the patients,but also brings great psychological and economic burden to their families.Although there are various treatment methods,the curative effect is not good,mainly relieving symptoms,and cannot intervene the disease progression.Necroptosis and ferroptosis are two new pathways of programmed cell death discovered in recent years,they play a key role in the occurrence and development of knee osteoarthritis and also provide a new opportunity for the prevention and treatment of knee osteoarthritis.This article reviews necroptosis and ferroptosis and their related studies in knee osteoarthritis.
文摘Objective: To evaluate the curative effect of the Traditional Chinese Medicine (TCM) external therapy on knee osteoarthritis patients with different TCM constitutions using musculoskeletal ultrasonography and contrast-enhanced ultrasonography, and to explore the application value of contrast-enhanced ultrasonography in knee joint diseases. Methods: A total of 57 patients diagnosed with knee osteoarthritis in Shaanxi University of Traditional Chinese Medicine from December 2019 to May 2021 were collected, and they were divided into qi stagnation and blood stasis type group (23 cases) and cold-dampness obstruction type group (34 cases) according to the traditional Chinese medicine method. All patients were given acupuncture combined with TCM fumigation and washing. All patients underwent musculoskeletal ultrasonography and contrast-enhanced ultrasonography before and after treatment, observed and recorded relevant data, and compared the treatment effects between the two groups. Results: 85.96% (49/57) of knee osteoarthritis (KOA) patients had suprapatellar bursa effusion, 42.1% (24/57) had iliotibial band bursae effusion, some of which had poor sound transmission, and thickened synovium was seen in most effusions, 33.33% (19/57) had osteophyte formation. Compared with before treatment, the depth of suprapatellar sac effusion in the Qi stagnation and blood stasis type group decreased after treatment (P Conclusion: Musculoskeletal contrast-enhanced ultrasonography was used to quantitatively evaluate the efficacy of TCM external therapy on KOA for different TCM constitutions. Dynamic observation of synovial lesions of knee osteoarthritis provides a valuable imaging method for evaluating the efficacy of traditional Chinese medicine.
基金This study was supported by Guangxi Science and Technology Project(1598012-48)National Natural Science Foundation of China(81460747)。
文摘Knee osteoarthritis(KOA)is a chronic degenerative Osteoarthritis disease.The majority of patients with knee osteoarthritis were elderly patients.The disease not only greatly affects the work and life of patients but also brings serious burden to families and society.The traditional Chinese medicine has a long history in China,which has shown a multi-pathway and multitarget mechanism for the prevention and treatment of knee osteoarthritis.According to the properties of Chinese medicine,it was divided into four categories:drugs to promote blood circulation and remove blood stasis,drugs to clear heat,drugs to dispel wind dampness and drugs to tonify deficiency.In addition,the relevant literatures at home and abroad in recent five years were reviewed to summarize and generalize the mechanism of traditionalChinese medicine in the treatment of knee osteoarthritis,in order to provide reference for the treatment of knee osteoarthritis with traditional Chinese medicine.
文摘BACKGROUND Considering the limited effectiveness of clinical interventions for knee osteoarthritis(KOA),it is necessary to continue to explore appropriate and effective treatment strategies to improve the condition of KOA patients.AIM To clarify the influence of ankle flexion and extension exercises combined with a psychological intervention on the psychological status and activities of daily living(ADLs)of patients with KOA.METHODS The research participants were 116 KOA patients admitted to The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine between May 2019 and May 2022,including 54 patients receiving routine treatment,care and psychological intervention(control group)and 62 patients additionally treated with ankle flexion and extension exercises(research group).The two groups were comparatively analyzed in terms of psychological status(Self-rating Anxiety/Depression Scale,SDS/SAS),ADLs,knee joint function(Lysholm Knee Scoring Scale),pain(Visual Analog Scale,VAS),fatigue(Multidimensional Fatigue Inventory,MFI),and quality of life(QoL;Short-Form 36 Item Health Survey,SF-36).RESULTS After evaluation,it was found that the postinterventional SDS,SAS,VAS,and MFI scores in the research group were significantly reduced compared with the baseline(before the intervention)values and those of the control group,while the postinterventional Lysholm,ADL and SF-36 scores were markedly elevated.CONCLUSION Therefore,ankle flexion and extension exercises are highly effective in easing negative psychological status,enhancing ADLs,daily living ability,knee joint function and QoL,and relieving pain and fatigue in KOA patients,thus warranting clinical promotion.
文摘Background: Osteoarthritis is a chronic disease associated with pain, inflammation, stiffness and synovial effusion, with progressive functional limitation, compromising quality of life. It progressively leads to loss or decrease in joint function. Pharmacological and non-pharmacological therapy seeks symptomatic management, complicated by a lack of adherence. After acetaminophen, non-steroidal anti-inflammatory drugs such as diclofenac are the most widely used medications. Objectives: The primary objective compared the analgesic effect of diclofenac 150 mg once daily vs. 50 mg three times daily in patients with knee osteoarthritis. The secondary objective assessed changes in quality of life. Method: One group received diclofenac 150 mg OD with placebo TTD. Another group received placebo OD and 50 mg active diclofenac (reference) TTD, both for 30 days. The evaluation of pain was carried out by a visual analog scale (VAS), at the beginning, 2, 3, 4, 15 and 30 days, quality of life (the WOMAC scale) and adverse effects, at 15 and 30 days. Results: Pain decreased significantly on days 15 and 30, compared to day 0, in both groups, without differences between groups. The total results in the WOMAC scale showed a very marked improvement at 15 and 30 days, without differences between groups. The most frequent adverse effects were constipation 6% in the reference group, and gastric discomfort 30.3% in the reference group vs 28.1%, in the Test group. Conclusions: Prolonged-release diclofenac 150 mg OD is as effective as diclofenac 50 mg TID for the treatment of patients with knee osteoarthritis.
文摘Objective: To evaluate the efficacy based on clinical symptom and on magnetic resonance image of platelet-rich plasma therapy in combination with mesenchymal stem cells from autologous adipose tissue for knee osteoarthritis treatment. Patients and Method: 30 patients including 26 females and 4 males;correspondingly, 60 knee joints were diagnosed with osteoarthritis with stages II - III of Kellgren and Lawrence, their mean age was 58.63 ± 11.11. All were injected with autologous platelet-rich plasma that was extracted by PRP set, APC 30 PRP PRCEDURE PRAK and autologously extracted mesenchymal stem cells from abdominal adipose tissue using the ADI-25-01 ADIPOSEPRCEDURE PRAK of USA. Results: After 12 months: the pain level according to VAS score at the right knee joint was decreased from 6.0 ± 1.28 before treatment to 1.9 ± 0.3;VAS score at the left knee joint was decreased from 6.43 ± 1.19 to 2.25 ± 0.43. Total Lequene score at right knee joint was decreased from 16.04 ± 1.57 before treatment to 4.31 ± 1.04, at left knee joint was decreased from 17.52 ± 1.74 before treatment to 5.15 ± 1.48. Total WOMAC score at right knee joint was decreased from 55.93 ± 5.56 to 10.37 ± 1.56;at left knee joint was decreased from 53.97 ± 5.57 to 10.07 ± 1.59. There were 86.77% joints with cartilage thickness change and the patellar cartilage thickness was increased from 1.56 ± 0.09 mm before treatment to 1.65 ± 0.09 mm. Conclusion: The treatment of knee osteoarthritis by platelet-rich plasma therapyin combination with mesenchymal stem cells from autologous adipose tissue is effective in reducing pain, improving patient's mobility and walking function, reforming articular cartilage thickness on magnetic resonance image.
文摘Knee osteoarthritis(KOA)is a chronic derivative joint issue that mainly damages the artistic cartilage and leads to pain,swelling,and stiffness around the joint,which is commomly worldwide.With the aging of society and the increment in obesity rate,the incidence of KOA increases sharply,which seriously effects the quality of human life.Before,how to take effective treatment methods is very important.Severe ways to treat the disease include non-steroidal drugs,local injections,surgery,and cell and gene therapies.However,each therapy has certain defections,such as gastrotestinal tract irritation,cardiovascular safety,or high medical costs for patients.Traditional Chinese medicine has a long history in treating KOA,reported by acupuncture,massage,internal administration of traditional Chinese medicine,and external use of traditional Chinese medicine.In clinical practice,patients can be treated from the root agreement to different etiology,and patients can be treated agreement to different syndrome types by syndrome difference to achieve effect.Studies have shown that warm acupuncture is effect in treating KOA.It has two kinds of treatment methods:acupuncture and moxibustion at the same time.It has fewer side effects and is more acceptable to patients.However,there are still some problems in the basic research and clinical application of warm acupuncture and moxibustion in treating KOA.This paper discussed the existing problems from the followingfive aspects:lack of unified synthesis difference and treatment system,problems in clinical research,weak basic research,problems in the study of moxibustion,and lack of the best treatment program recognized by the academic community.Meanwhile,the selection of acupoints,the relationship between acupuncture depth and anatomy should be further studied in order to offer research ideas for the healthy development of the treatment of KOA with warming acupuncture and moxibustion in the future.
基金the National Natural Science Foundation of China,No.82274547the Major Program of the National Natural Science Foundation of Zhejiang Province,No.LD22C060002+1 种基金the State Administration of Traditional Chinese Medicine of Zhejiang Province,No.GZY-ZJ-KJ-23064the Zhejiang Provincial Research Foundation for Basic Public Welfare Research,No.LGF20H270005.
文摘BACKGROUND Osteoarthritis(OA)is the most prevalent form of degenerative whole-joint disease.Before the final option of knee replacement,arthroscopic surgery was the most widely used joint-preserving surgical treatment.Emerging regenerative therapies,such as those involving platelet-rich plasma,mesenchymal stem cells,and microfragmented adipose tissue(MFAT),have been pushed to the forefront of treatment to prevent the progression of OA.Currently,MFAT has been successfully applied to treat different types of orthopedic diseases.AIM To assess the efficacy and safety of MFAT with arthroscopic surgery in patients with knee OA(KOA).METHODS A randomized,multicenter study was conducted between June 2017 and November 2022 in 10 hospitals in Zhejiang,China.Overall,302 patients diagnosed with KOA(Kellgren-Lawrence grades 2-3)were randomized to the MFAT group(n=151,were administered MFAT following arthroscopic surgery),or the control group(n=151,were administered hyaluronic acid following arthroscopic surgery).The study outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score,the visual analog scale(VAS)score,the Lequesne index score,the Whole-Organ Magnetic Resonance Imaging Score(WORMS),and safety over a 24-mo period from baseline.RESULTS The changes in the WOMAC score(including the three subscale scores),VAS pain score,and Lequesne index score at the 24-mo mark were significantly different in the MFAT and control groups,as well as when comparing values at the posttreatment visit and those at baseline(P<0.001).The MFAT group consistently demonstrated significant decreases in the WOMAC pain scores and VAS scores at all follow-ups compared to the control group(P<0.05).Furthermore,the WOMAC stiffness score,WOMAC function score,and Lequesne index score differed significantly between the groups at 12 and 24 mo(P<0.05).However,no signicant between-group differences were observed in the WORMS at 24 mo(P=0.367).No serious adverse events occurred in both groups.CONCLUSION The MFAT injection combined with arthroscopic surgery treatment group showed better mid-term clinical outcomes compared to the control group,suggesting its efficacy as a therapeutic approach for patients with KOA.
基金The authors extend their appreciation to the Jilin Provincial Natural Science Foundation for funding this research work through Project Number(20220101128JC).
文摘Knee osteoarthritis(OA)is a common disease that impairs knee function and causes pain.Currently,studies on the detection of knee OA mainly focus on X-ray images,but X-ray images are insensitive to the changes in knee OA in the early stage.Since magnetic resonance(MR)imaging can observe the early features of knee OA,the knee OA detection algorithm based on MR image is innovatively proposed to judge whether knee OA is suffered.Firstly,the knee MR images are preprocessed before training,including a region of interest clipping,slice selection,and data augmentation.Then the data set was divided by patient-level and the knee OA was classified by the deep transfer learning method based on the DenseNet201 model.The method divides the training process into two stages.The first stage freezes all the base layers and only trains the weights of the embedding neural networks.The second stage unfreezes part of the base layers and trains the unfrozen base layers and the weights of the embedding neural network.In this step,we design a block-by-block fine-tuning strategy for training based on the dense blocks,which improves detection accuracy.We have conducted training experiments with different depth modules,and the experimental results show that gradually adding more dense blocks in the fine-tuning can make the model obtain better detection performance than only training the embedded neural network layer.We achieve an accuracy of 0.921,a sensitivity of 0.960,a precision of 0.885,a specificity of 0.891,an F1-Score of 0.912,and an MCC of 0.836.The comparative experimental results on the OAI-ZIB dataset show that the proposed method outperforms the other detection methods with the accuracy of 92.1%.
基金supported by“Human Resources Program in Energy Technology”of the Korea Institute of Energy Technology Evaluation and Planning (KETEP),granted financial resources from the Ministry of Trade,Industry&Energy,Republic of Korea.(No.20204010600090).
文摘X-Ray knee imaging is widely used to detect knee osteoarthritis due to ease of availability and lesser cost.However,the manual categorization of knee joint disorders is time-consuming,requires an expert person,and is costly.This article proposes a new approach to classifying knee osteoarthritis using deep learning and a whale optimization algorithm.Two pre-trained deep learning models(Efficientnet-b0 and Densenet201)have been employed for the training and feature extraction.Deep transfer learning with fixed hyperparameter values has been employed to train both selected models on the knee X-Ray images.In the next step,fusion is performed using a canonical correlation approach and obtained a feature vector that has more information than the original feature vector.After that,an improved whale optimization algorithm is developed for dimensionality reduction.The selected features are finally passed to the machine learning algorithms such as Fine-Tuned support vector machine(SVM)and neural networks for classification purposes.The experiments of the proposed framework have been conducted on the publicly available dataset and obtained the maximum accuracy of 90.1%.Also,the system is explained using Explainable Artificial Intelligence(XAI)technique called occlusion,and results are compared with recent research.Based on the results compared with recent techniques,it is shown that the proposed method’s accuracy significantly improved.
文摘Aim: To evaluate the effects based the changes on ultrasound and on magnetic resonance for knee osteoarthritis treatment by platelet-rich plasma therapy in combination with mesenchymal stem cell from autologous adipose tissue. Objects and Methods: 30 patients, 26 females, 4 males, mean age 58.63 ± 11.11, mean disease duration 5.3 ± 4.6 years, respectively 60 knee joints were diagnosed with osteoarthritis at stage II - III according to the Kellgren and Lawrence classifications. After ultrasound and magnetic resonance imaging in the first time, all patients were injected with platelet-rich plasma combined with mesenchymal stem cells from autologous adipose tissue into both knee joints. Results: After treatment 12 months by platelet-rich plasma injection combined with mesenchymal stem cells from autologous adipose tissue: The thickness of articular cartilage on ultrasound increased significantly from 2.08 ± 0.36 mm to 2.48 ± 0.36 mm with p Conclusion: The treatment of knee osteoarthritis by platelet-rich plasma combined with mesenchymal stem cells from autologous adipose tissue was effective in improving cartilage thickness on ultrasound and magnetic resonance, thereby improving the motor function of the knee joint.
基金Supported by the National Key Research and Development Program of China,No.2018YFF0301104.
文摘BACKGROUND As a serious global problem,knee osteoarthritis(KOA)often leads to pain and disability.Manual therapy is widely used as a kind of physical treatment for KOA.AIM To explore further the efficacy of Maitland and Mulligan mobilization methods for adults with KOA.METHODS We searched PubMed,the Cochrane Library,EMbase,Web of Science and Google Scholar from inception to September 20,2020 to collect studies comparing Maitland and Mulligan mobilization methods in adults with KOA.The quality of the studies was assessed using the Physiotherapy Evidence Database Scale for randomized controlled trials.Data analyses were performed using Review Manager 5.0 software.RESULTS A total of 341 articles were screened from five electronic databases(PubMed,the Cochrane Library,EMbase,Web of Science and Google Scholar)after excluding duplicates.Ultimately,eight trials involving 471 subjects were included in present systematic review and meta-analysis.The mean PEDro scale score was 6.6.Mulligan mobilization was more effective in alleviating pain[standardized mean difference(SMD)=0.60;95%confidence interval(CI):0.17 to 1.03,P=0.007;I2=60%,P=0.020]and improving Western Ontario and McMaster Universities function score(SMD=7.41;95%CI:2.36 to 12.47,P=0.004;I2=92%,P=0.000).There was no difference in the effect of the two kinds of mobilization on improving the range of motion(SMD=9.63;95%CI:-1.23 to 20.48,P=0.080;I2=97%,P=0.000).CONCLUSION Mulligan mobilization technique is a promising intervention in alleviating pain and improving function score in KOA patients.
基金the Medical Ethics Association of the Fifth Affiliated Hospital of Guangzhou Medical University(No.KY01-2018-10-18).
文摘BACKGROUND Knee joint pain and stiffness are the two main symptoms of knee osteoarthritis(OA)and thus restrict a patient’s activities,such as walking and walking up and downstairs.The lower body positive pressure(LBPP)treadmill as one of the emerging body weight support system devices brings new hope for exerciserelated rehabilitation for knee OA patients.AIM To investigate the biomechanical effects and the subjective clinical assessment of LBPP treadmill walking exercise when compared with conventional therapy in mild to moderate knee OA patients.METHODS Eighteen patients with mild-to-moderate knee OA were recruited in this randomized controlled trial(RCT)study.The eligible knee OA patients were randomly assigned to two groups:LBPP and control groups.The patients in the LBPP group performed an LBPP walking training program for 30 min/session per day,6 d per week for 2 wk whereas the patients in the control group performed walking on the ground for the same amount.All patients underwent clinical assessments and three-dimensional gait analysis at pre-and 2-wk post-treatment.RESULTS The Western Ontario and McMaster Universities Arthritis Index and visual analog scale scores in both the LBPP group and control group were found to decrease significantly at the post-treatment point than the pre-treatment point(LBPP:70.25±13.93 vs 40.50±11.86;3.88±0.99 vs 1.63±0.52;control:69.20±8.88 vs 48.10±8.67;3.80±0.79 vs 2.60±0.70,P<0.001).Moreover,compared with the control group,the LBPP group showed more improvements in walking speed(P=0.007),stride length(P=0.037),and knee range of motion(P=0.048)during walking,which represented more improvement in walking ability.CONCLUSION The results of our RCT study showed that the LBPP group has a greater effect on improving gait parameters than the conventional group,although there was no significant advantage in clinical assessment.This finding indicates that LBPP treadmill walking training might be an effective approach for alleviating pain symptoms and improving lower extremity locomotion in mild to moderate knee OA patients.
基金the National Natural Science Foundation of China program(No.81574067).
文摘Objective:The aim of this study was to investigate the mechanism of acupotomology(Apo)in the prevention of articular cartilage destruction via the promotion of chondrocyte proliferation and chondrocyte expression of cell cycle regulators,CyclinD1,CDK4 and CDK6 in a rabbit knee osteoarthritis(KOA)model.Methods:Twenty-eight rabbits were randomly divided into a control group,an OA(osteoarthritis)model group,an Apo(acupotomology)group and EA(electro-acupuncture)group(n Z 7).Improved Videman’s method was used to induce a rabbit model of KOA over 6 weeks.One week later,acupotomy and electro-acupuncture therapy was applied to animals in the respective groups and treatment lasted 4 weeks.Following these treatments,quantitative real-time PCR,immunohistochemical staining and western blotting were performed to assess the mRNA and protein levels of cell cycle regulators CyclinD1(Cell cycle protein D1),CDK4(Cyclin-dependent kinase 4)and CDK6(Cyclin-dependent kinase 6).Ethology measures and knee morphology were also compared among groups.Results:The Lequesne MG index score of morphology was increased(P<.01),and the passive range of motion(PROM)and the mRNA and protein levels of CyclinD1,CDK4,and CDK6 were significantly decreased(P<.01)in the OA model compared with the control group.The Lequesne MG index score and the morphology score were decreased in the Apo and EA group compared with the OA model group(P<.05 or P<.01),while the mRNA levels of CyclinD1,CDK4,and CDK6,and the protein levels of CDK4 were increased in the Apo and EA groups compared with the OA model group(P<.05 or P<.01).The PROM,and the protein levels of CyclinD1 and CDK6 were increased(P<.05)in the Apo group compared with the OA model group,while the PROM and the protein levels of CyclinD1 and CDK6 in the EA group were not significantly different(P>.05).Compared with the EA group,the morphology score was decreased in Apo group(P<.05).Conclusions:The mRNA levels of CyclinD1 and CDK4,and the protein level of CDK4 in chondrocytes are regulate by both Apo and EA.Apo is more effective than EA in regulating the protein levels of CyclinD1 and CDK6.According to the observed changes in morphology and cytokine levels,acupotomy can promote chondrocyte proliferation and can alleviate the destruction of articular cartilage in a model of KOA.
文摘BACKGROUND Surgical treatment of knee osteoarthritis(KOA)complicated by extra-articular deformity has always been controversial regardless of whether it is simultaneous or staged.Simultaneous total knee arthroplasty(TKA)combined with supracondylar osteotomy without plate for treatment of KOA complicated by femoral varus deformity has not been reported in the literature.CASE SUMMARY A 53-year-old Chinese woman complained of left knee pain for 6 years that worsened for 4 mo during her visit on April 3,2020,accompanied by instability in walking,which seriously affected quality of life.According to her medical history and preoperative imaging,the patient was diagnosed with left KOA with varus deformity.We used the angular center of rotation principle for osteotomy of the femur deformity and placed a poststabilized femur prosthesis into the knee joint.At the same time,a 13 mm×130 mm femur extension rod was used instead of a steel plate to fix the end of the femur osteotomy,reducing the possible complications caused by steel plate implantation and reducing the economic burden on patients.The operation successfully solved two major problems of KOA and varus deformity,and the clinical and imaging evaluation of postoperative followup were satisfactory.CONCLUSION TKA and supracondylar femoral osteotomy can be used for simultaneous KOA treatment and deformity correction.
基金The study is supported by the project of independent topic selection of Beijing University of Traditional Chinese Medicine in 2019(No.:2019-jyb-js-105).
文摘Objective:The objective of this study is to assess the application effect of five elements music therapy introduced in the pain coping skills training of knee osteoarthritis(KOA).Materials and Methods:Totally,80 patients with KOA were selected and randomly divided into the experimental group(39 cases)and the control group(41 cases).The control group was only given routine nursing measures,and the experimental group was additionally treated with five-element music therapy on the basis of the control group,twice a day,28 days in total.The Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)was used to evaluate the functional status of the knee joint of the two groups.The clinical efficacy of the two groups was evaluated by Guiding Principles for Clinical Research of New Chinese Medicine in the Treatment of Osteoarthritis.Results:WOMAC score statistically significantly decreased in the experimental group(35.92±9.48 vs.16.17±5.43,P<0.01)and the control group(36.73±6.42 vs.22.53±7.51,P<0.01)after 28 days of intervention when compared with that before intervention;WOMAC score in the experimental group was lower than that of the control group after 28 days of intervention(16.17±5.43 vs.22.53±7.51,P<0.01).The total effective rate of the experimental group was statistically higher than that of the control group(82.0%vs.51.2%,χ2=11.97,P=0.003).Conclusion:The combination of five-element music therapy and routine nursing measures has better effect in relieving pain and bad emotions of patients with KOA when compared with routine nursing measures alone.
