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    18 February 2020, Volume 24 Issue 5 Previous Issue    Next Issue
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    Difference in the effect of metformin on bone strength of lumbar vertebrae and hind limbs in diabetic rats
    Yu Peiyuan, Zhang Zhida, Liang Lichang, Yang Zhidong, Huang Jinjing, Peng Jiancheng, Liang Ziyang, He Jiahui, Zhao Wenhua, Yu Fuyong, Chen Guifeng, Liang De, Jiang Xiaobing
    2020, 24 (5):  657-661.  doi: 10.3969/j.issn.2095-4344.1912
    Abstract ( 381 )   PDF (21043KB) ( 50 )   Save

    BACKGROUND: Metformin has been shown to regulate bone metabolism to some extent, but its effect on bone strength is rarely reported.

    OBJECTIVE: To observe the difference in the effect of metformin on the bone strength of lumbar vertebrae and hind limb in diabetic rats. 

    METHODS: The study was approved by the Laboratory Animal Ethical Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine. Six rats randomly selected from 30 rats were as blank group. The remaining 24 rats were given the intraperitoneal injection of streptozotocin (40 mg/kg) once after 6 weeks of high-sugar and high-fat diet to establish the model of type 2 diabetes mellitus. Twelve of them were successfully selected and divided into model group and metformin group. After modeling, in the metformin group, 300 mg/kg per day metformin suspension 2 mL was intragastrically administered once a day; the blank group and the model group were intragastrically administered 0.9% sodium chloride 2 mL once a day. Each group was administered for 12 weeks. The maximal load and elastic modulus of lumbar vertebrae, femur and tibia of each group were measured at 8 and 12 weeks after administration. The maximum load improvement rate of metformin on the central and peripheral bone at 12 weeks was calculated. 

    RESULTS AND CONCLUSION: (1) The maximum load of the tibia was increased after 8 and 12 weeks of administration in the metformin group. The maximum load on the lumbar spine and femur was also increased after 12 weeks of administration (P < 0.05). (2) After 12 weeks of administration, the elastic modulus of lumbar vertebrae and tibia in the metformin group was higher than that in the model group (P < 0.05). (3) After 12 weeks of administration, the maximal load improvement rate of the lumbar spine in the metformin group was 38.35%, the maximum femur repair rate was 24.05%, and the maximum tibia load improvement rate was 14.70%. (4) These findings suggest that metformin has a certain improvement on the bone strength of the lumbar vertebrae and hind limb in diabetic rats, and the improvement of the bone strength on the central axis (lumbar spine) is better than that of the peripheral bone (femur, tibia).

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    Biomechanical characteristics of ankle joint in volleyball players during stop-jump
    Bao Chunyu, Yan Mingming
    2020, 24 (5):  662-666.  doi: 10.3969/j.issn.2095-4344.1878
    Abstract ( 365 )   PDF (19143KB) ( 131 )   Save

    BACKGROUND: The biomechanical studies of ankle joint focus on methodology, and the biomechanical characteristics of the ankle joint under combined modes are little reported.

    OBJECTIVE: To analyze the kinematics and dynamics characteristics of the ankle joints in the movement of stop-jump of volleyball players.

    METHODS: Twenty male and 20 female volleyball players at Tianjin University of Sport were selected. The three-dimensional motion capture system (Vicon) and the three-dimensional force plate (Kistler) were mainly used to synchronously collect the kinematics and dynamics parameters of the ankle joint when the subjects were taking off and landing. Statistical methods were used to conduct comparative analysis of the data. The study was in accordance with the ethical requirements of Tianjin University of Sport, and the subjects signed the informed consents.

    RESULTS AND CONCLUSION: (1) Under this mode, the plantar flexion angle of the ankle joint in males was less than that in females. During the take-off phase, the ankle joint was in an inversion and internal rotation state, during the landing buffer phase, the ankle joint was in an inversion and external rotation state, and the angle in males was slightly larger than in the females, which was likely to cause ankle injury. (2) The three-dimensional peak torque and force value when stop-jump in males were higher than those in females. The appearing time of peak torque and force value in different directions in males was later than that in females, and imbalances between two legs and landing at different time occurred.
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    Comparisons of induced membrane vascularization and osteogenic factor expression in different tissue sites
    Li Shuyuan, Zhou Qishi, Li Yue, Zhou Hongliang, Yang Jiabao, Hu Cheng
    2020, 24 (5):  667-672.  doi: 10.3969/j.issn.2095-4344.1937
    Abstract ( 382 )   PDF (26692KB) ( 79 )   Save

    BACKGROUND: Studies have found that polymethylmethacrylate bone cement implanted in the subcutaneous region, muscle and other parts can form induced membrane. The induced membrane favors vascularization and secretes multiple osteogenic factors.

    OBJECTIVE: To investigate the differences in the level of vascularization and the expression of osteogenic factors in the induced membrane among subcutaneous region, muscle and femoral bone defects.

    METHODS: Thirty-six male SD rats (purchased from the Experimental Animal Center of Guangzhou University of Chinese Medicine) were randomly divided into three groups (n=12/group). PolymethyImethacrylate antibiotic cement spacers were implanted in the subcutaneous tissue, muscle and femoral bone defects of the hind limbs. At 6 weeks after implantation, the induced membrane around the bone cement was removed. The change in membrane morphology was observed by hematoxylin-eosin staining. Expression of bone morphogenetic protein-2, transforming growth factor-β1 and vascular endothelial growth factor in the induced membrane was detected by western blot, RT-qPCR and immunohistochemistry. This study was approved by Animal Ethics Committee, Guangzhou University of Chinese Medicine, China (approval No. 20181101006).

    RESULTS AND CONCLUSION: Hematoxylin-eosin staining showed that induced membrane formed in each group. The number of vessels in the outer layer of the membrane tissue section was higher in the femoral bone defect groups than that in the muscle and subcutaneous tissue group. The number of fibroblasts and myofibroblasts in the inner layer close to the bone cement was higher in the femoral bone defect group than in the muscle and subcutaneous tissue groups. Immunohistochemical staining revealed that bone morphogenetic protein-2, transforming growth factor-β1 and vascular endothelial growth factor expression levels were highest in the femoral bone defect group and lowest in the subcutaneous tissue group. Western blot and RT-qPCR showed that bone morphogenetic protein 2, transforming growth factor β1 and vascular endothelial growth factor expression levels were significantly higher in the femoral bone defect group than in the muscle and subcutaneous tissue groups (P < 0.001). These findings suggest that different surrounding tissue conditions have different important influences on tissue structure and osteogenic factor expression in the induced membrane. Polymethylmethacrylate bone cement implanted in the femoral bone defects can improve the quality of induced membrane formation, lead to a larger amount of newly formed vessels and higher osteogenic factor expression in the induced membrane.

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    Lovastatin combined with insulin effects on fracture healing in rat models of bilateral ovariectomized type 2 diabetic mellitus
    Cao Guolong, Tian Faming, Liu Jiayin
    2020, 24 (5):  673-681.  doi: 10.3969/j.issn.2095-4344.2440
    Abstract ( 370 )   PDF (34630KB) ( 60 )   Save

    BACKGROUND: Osteoporotic fracture combined with type 2 diabetic mellitus in female patients is often accompanied by dyslipidemia and hyperglycemia. In addition to insulin treatment, statins are often prescribed for combination therapy, but the combined effect of these two drugs on fracture healing has not been reported in such patients.

    OBJECTIVE: To investigate the effect of lovastatin combined with insulin on the fracture healing of bilateral ovariectomized rats suffering from type 2 diabetic mellitus.

    METHODS: The study was approved by the Ethical Committee of North China University of Science and Technology. Thirty-two female Sprague-Dawley rats were divided into control, diabetic ovariectomized, insulin and combined groups. A model of type 2 diabetes and osteoporosis fracture was established in all rats except for the control group. At 7 days after the type 2 diabetic model was successfully established by injection of streptozotocin, the rats in the insulin and combined groups received the subcutaneous injection of insulin (2-4 U in the morning, and 4-6 U in the evening) until the end of the experiment. The rats in the combined group were given 20 mg/kg lovastatin via gavage daily, and those in the other two groups were not treated. All rats were sacrificed at 3 weeks after fracture. Radiographic, clinical and histomorphometric detections of the callus were performed. The expression levels of bone morphogenetic protein 2, vascular endothelial growth factor and collagen type II were detected. All above results were used to analyze the fracture healing in each group.

    RESULTS AND CONCLUSION: (1) The radiographic score, micro-CT index, histologic score and the expression levels of vascular endothelial growth factor and collagen type II in the diabetic ovariectomized group were significantly poorer than those in the control group (P < 0.05). (2) All above indexes in the insulin group were significantly improved compared with the diabetic ovariectomized group (P < 0.05), which promoted the fracture healing of model rats. (3) After combined with lovastatin, although the expression levels of vascular endothelial growth factor and bone morphogenetic protein 2 in the callus were significantly increased (< 0.05), there was no significant improvement in the radiographic appearance and microstructure of the callus.

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    Effects of different intensities of exercises on BNIP3-mediated mitophagy in skeletal muscle  

    Yu Liang, Zhao Zeming, Zhao Binting, Li Lin, Liu Ziming, Wang Zhen, Wang Ruiyuan
    2020, 24 (5):  682-688.  doi: 10.3969/j.issn.2095-4344.1920
    Abstract ( 644 )   PDF (27647KB) ( 53 )   Save

    BACKGROUND: Different intensities of exercises make different effects on human body, and the changes of skeletal muscle after exercise remain unclear. Physical change of human body during exercise is a hotspot.

    OBJECTIVE: To investigate the effect of different intensities of exercises on the mass of rat skeletal muscle, and the role of BNIP3-mediated mitophagy in maintaining skeletal muscle mass.

    METHODS: The study was approved by the Laboratory Animal Ethical Committee of Beijing Sport University. Twenty-four healthy male Sprague-Dawley rats aged 8 weeks were randomly divided into three groups: control, moderate-intensity exercise (5°, 15 m/min, 1 hour, 60% VO2max) and high-intensity exercise (5°, 35 m/min, 20 minutes, 85% VO2max) groups (n=8/group), 6 times weekly. The rat soleus and gastrocnemius were removed to measure the wet weights. The cross-sectional area of muscle fiber was detected by immunofluorescence. The protein expression levels of BNIP3, p62 and LC3 in the soleus and gastrocnemius were detected by western blot assay.

    RESULTS AND CONCLUSION: (1) The wet weight of gastrocnemius in the exercise groups was significantly lower than that in the control group (P < 0.01). (2) The cross-sectional area of gastrocnemius fiber in the exercise groups was significantly less than that in the control group (P < 0.01), and the cross-sectional area of soleus fiber in the exercise groups was significantly more than that in the control group (P < 0.01). (3) The moderate-intensity exercise induced increased mitophagy, and the expression level of BNIP3 and LC3-II/LC3-I were up-regulated (P < 0.05), while p62 was down-regulated (P < 0.05) compared with the control group. The expression level of LC3-II/LC3-I in the high-intensity exercise group was higher (P < 0.05), but the expression level of p62 was lower than that in the moderate-intensity exercise group and the expression of BNIP3 was decreased (P < 0.05). (4) To conclude, 4-week moderate-intensity exercise can promote the removal of damaged mitochondria and maintain skeletal muscle function by increasing BNIP3-regulated mitophagy in skeletal muscle. In high-intensity exercise, the level of autophagy is higher, but will cause harmful effect on skeletal muscle.
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    Effects of phellinus igniarius crude polysaccharides on sporting ability and free radical metabolism of skeletal muscle in mice suffering passive smoking
    Wan Huazhe, Chai Guangxin, Xiao Xiaoling, Huang Wenying
    2020, 24 (5):  689-693.  doi: 10.3969/j.issn.2095-4344.1910
    Abstract ( 401 )   PDF (21838KB) ( 76 )   Save


    BACKGROUND: Cigarette smoke contains a large number of types of oxygen free radicals and cytotoxic components. Passive smoking will impair respiratory and cardiovascular system functions, and result in oxidative damage of skeletal muscle and decreased exercise ability.

    OBJECTIVE: To investigate the effect of phellinus igniarius crude polysaccharides on the exercise capacity and free radical metabolism of skeletal muscle in mice suffering passive smoking, so as to provide ideas for the prevention and treatment of peroxidative damage of skeletal muscle and depression of exercise capacity in rats suffering passive smoking.

    METHODS: Twenty-one male Kunming mice were randomly assigned to three groups: gavage with phellinus igniarius crude polysaccharides and suffering passive smoking (phellinus group), gavage with distilled water and suffering passive smoking (control group), and only gavage with distilled water (blank group). After 4 consecutive weeks, the mice were forced to take an exhausted swimming, and sacrificed subsequently. Exhausted swimming time was recorded. The bilateral gastrocnemius muscle tissues were obtained, in which the vitality of superoxide dismutase, catalase, glutathion reductase and Ca2+-Mg2+-ATP and Na+-K+-ATP activity, and the concentration of malonaldehyde were measured.

    RESULTS AND CONCLUSION: (1) The swimming time of mice in the control group was shorter than that in the blank group (P < 0.01). The swimming time of mice in the phellinus group was longer than that in the control group (P < 0.01). (2) Compared with the blank group, the vitality of superoxide dismutase, catalase, glutathion reductase and Ca2+-Mg2+-ATP and Na+-K+-ATP activity in the control group were decreased (P < 0.01), and the concentration of malonaldehyde was increased (P < 0.01). (3) When compared with the control group, the vitality of those metabolic index in the phellinus group were increased (P < 0.05, P < 0.01), and the concentration of malonaldehyde was decreased (P < 0.01). (4) Correlation analysis showed that exhausted swimming time was positively correlated with the vitality of glutathion reductase, catalase and superoxide dismutase (r > 0.6, P < 0.05), and was negatively correlated with the concentration of malonaldehyde (r=-0.637, P < 0.05). Ca2+-Mg2+-ATP and Na+-K+-ATP activities were positively correlated with the vitality of glutathion reductase, catalase and superoxide dismutase (> 0.6, P < 0.05), and negatively correlated with the concentration of malonaldehyde (r < -0.6 , P < 0.05). (5) In summary, phellinus igniarius crude polysaccharides can improve the antioxidative enzyme activity of skeletal muscle, inhibit lipid peroxidation reaction, and thus increase exercise ability of mice suffering passive smoking. The study was approved by the Ethical Committee of Jiangxi Normal University, approval No. 201703.

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    Changes in related factors in synovial fluid of osteoarthritis rabbits after treatment with different molecular weights of sodium hyaluronate injection
    Ma Zhigang, Guo Liping, Zhang Jianning, Li Yonggang
    2020, 24 (5):  694-698.  doi: 10.3969/j.issn.2095-4344.1932
    Abstract ( 313 )   PDF (21840KB) ( 97 )   Save

    BACKGROUND: Clinical studies have shown that sodium hyaluronate at different molecular weights exhibits therapeutic effects on osteoarthritis.

    OBJECTIVE: To investigate the changes in interleukin-1 beta, tumor necrosis factor-alpha, and matrix metalloproteinase-3 in synovial fluid of osteoarthritis rabbits after treatment with different molecular weights of sodium hyaluronate injection.

    METHODS: Forty rabbits (purchased from Qinghai Experimental Animal Center, China) were randomly divided into normal, model, macromolecule, and small molecule groups, with 10 rabbits in each group. The control group did not undergo any treatment. Rabbits in the remaining three groups were injected with papain via the right knee joint cavity to establish rabbit models of osteoarthritis. At 7 days after successful modeling, the right knee joint cavity of rabbits in the macromolecule and small molecule groups were injected with 0.3 mL of (1.5-2.5)×106 Da and (0.8-1.5)×106 Da sodium hyaluronate injection. Rabbits in the model group were injected with equal amounts of physiological saline, once a week, for 5 successive weeks. At 7 days after the last injection, the right knee joint cavity was examined by MRI, cartilage tissue was stained with hematoxylin-eosin, the level of inflammatory factors in the washing fluid was determined, and proteoglycan and collagen gene expression was detected. This study was approved by the Medical Ethics Committee of Qinghai Red Cross Hospital, China (No. 201802065).

    RESULTS AND CONCLUSION: MR imaging: There were joint effusion and incomplete cartilage surface in the model group. In the macromolecule group, cartilage surface was rough and cartilage layer became thinner compared with the model group. Hematoxyin-eosin staining: Obvious cartilage injury was observed in the model, macromolecule, and small molecule groups, but the injury in the macromolecule, and small molecule groups was milder than that in the model group. The injury in the small molecular group was milder than that in the macromolecule group. Measurement of inflammatory factors: Compared with the control group, the levels of interleukin-1 beta, tumor necrosis factor-alpha and matrix metalloproteinase-3 increased in the model group (P < 0.05). Compared with the model group, the levels of interleukin-1 beta, tumor necrosis factor-alpha and matrix metalloproteinase-3 decreased in the macromolecule and small molecule groups (< 0.05). The levels of interleukin-1 beta and matrix metalloproteinase-3 in the small molecule group were lower than those in the macromolecule group. There was no significant difference in the level of tumor necrosis factor-alpha between small molecule and macromolecule groups. Gene detection: Proteoglycan and collagen gene expression levels were significantly lower in the model group than in the control, macromolecule and small molecule groups (P < 0.05). Proteoglycan and collagen gene expression levels were significantly lower in the macromolecule group than in the small molecule group (P < 0.05). These results suggest that compared with large molecular weight of sodium hyaluronate, small molecular weight of sodium hyaluronate can promote the repair of cartilage tissue in osteoarthritis and alleviate synovitis inflammation.

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    Olfactory ensheathing cell transplantation promotes the ultrastructure repair at the lesion site of rat models of spinal cord injury
    Wang Guoyu, Cheng Zhijian, Yang Baohui, Li Haopeng, He Xijing
    2020, 24 (5):  699-703.  doi: 10.3969/j.issn.2095-4344.1893
    Abstract ( 431 )   PDF (23958KB) ( 284 )   Save

    BACKGROUND: Olfactory ensheathing cell transplantation for treating spinal cord injury is an issue of concern, which mainly explores the changes of microenvironment after spinal cord injury. However, the effect of olfactory ensheathing cell transplantation on the ultrastructure of spinal cord after spinal cord injury is never reported.

    OBJECTIVE: To investigate the ultrastructure alterations of neurocytes, axons, myelin sheaths, synapses, and glial scar after spinal cord injury, and the effect of olfactory ensheathing cell transplantation on the protection and regeneration of nerve repair after spinal cord injury.

    METHODS: The study was approved by the Ethical Committee of Biomedicine of Medical Department of Xi’an Jiaotong University, approval No. 2018-2048. Twenty female Sprague-Dawley rats were divided into three groups: blank control group (n=4, complete laminectomy of T10, partial laminectomy of T9 and T11), DF12 group (n=8, cordotomy+injection of DF12 solution), and olfactory ensheathing cell transplantation group (n=8, cordotomy+olfactory ensheathing cell transplantation). The spinal cord was removed under anesthesia to observe the ultrastructure alterations of neurocytes under transmission electron microscope at 1, 7, 28 and 56 days after injury.

    RESULTS AND CONCLUSION: (1) Compared with the blank control group, the organelles in the neurons of the injured lesions were significantly reduced, and the obvious changes were found in the ultrastructure of axon, synapses and myelin sheath in the DF12 group. In the olfactory ensheathing cell transplantation group, the organelles in the neurons of the injured lesions were significantly increased with obvious nucleolus, the regeneration of axon, myelin sheath and synapses were significantly promoted, and the glial scar was significantly decreased. (2) The degree of reaction of the astrocytes and pericytes in the olfactory ensheathing cell transplantation group was light. (3) These findings suggest that olfactory ensheathing cell transplantation can effectively protect the nerve tissues in the lesions after spinal cord injury, promote the regeneration of axon, myelin sheath and synapses, and inhibit the hyperplasia of astrocytes and pericytes, so that the post-injury microenvironment is available for the regeneration of neurons, axons and synapses.
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    Application of digital subtraction angiography in dog hindlimb arteriography
    Zhang Shiyong, Wang Chengwei, Wang Xue, Yan Xiangli, Wang Jie
    2020, 24 (5):  704-708.  doi: 10.3969/j.issn.2095-4344.2402
    Abstract ( 458 )   PDF (23280KB) ( 114 )   Save

    BACKGROUND: The research on lower extremity vascular disease is becoming popular. In the experiment of large animals as research platform, it is necessary to detect the shape and density of lower extremity vascular in order to study and verify the effectiveness of intervention measures, and this detection method needs high feasibility and repeatability.

    OBJECTIVE: To investigate the feasibility, influencing factors and application value of digital subtraction angiography in lower limb arteriography of a canine animal model.

    METHODS: Six Beagle dogs were fixed on the working bed after anesthesia and punctured percutaneously through the femoral artery with an indwelling needle. Contrast agent was injected artificially. Digital subtraction angiography bolus chase technology was used to collect contrast images. The image effect and influencing factors were analyzed.

    RESULTS AND CONCLUSION: (1) The final arteriography images of all six Beagle dogs’ hind limbs were clear, and the branches of small vessels could be distinguished without artifacts. (2) The first beagle shook when encountering contrast agent stimulation during the initial angiography, resulting in poor image effect. After fixing the limbs and diluting the contrast agent, the clear images were obtained by re-angiography. (3) These results indicate that arteriography using digital subtraction angiography can clearly reveal the shape and density of blood vessels in canine animal models. It is simple and reproducible, and is of great significance for research on animal models of limb ischemia.
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    Changes of subchondral bone in rat models of knee osteoarthritis treated by elcatonin
    Wu Qi, Liao Ying, Sun Guanghua, Zhou Guijuan, Liao Yuan, Liu Jing, Zhong Peirui, Cheng Guo, Deng Chengyuan, Wang Tiantian
    2020, 24 (5):  709-715.  doi: 10.3969/j.issn.2095-4344.2433
    Abstract ( 433 )   PDF (26579KB) ( 66 )   Save

    BACKGROUND: Imbalance between subchondral bone resorption and bone formation occurs in osteoarthritis. Our preliminary study has found that the subchondral bone changes precede the articular cartilage changes in knee osteoarthritis rats.

    OBJECTIVE: To observe the changes of subchondral bone in knee osteoarthritis rats, and to explore the effect of elcatonin on the expression of p38 MAPK and absorption of subchondral bone.

    METHODS: Female Sprague-Dawley rats, 3 months of age, were randomly divided into three groups: sham operation group (n=6, the adipose tissue of the same size as the ovary was removed without ovariectomy, the bilateral knee joints were opened, but without cruciate ligament injury); model group (n=6, bilateral ovariectomy plus bilateral cruciate ligament injury, no treatment); elcatonin group (n=6, ovariectomy plus cruciate ligament injury, intramuscular injection of 5 IU/kg elcatonin, twice weekly). The bone mineral density and p38 protein expression levels in subchondral bone were detected at 12 weeks. The serum levels of C-terminal crosslinking telopeptides of type I collagen, C-terminal crosslinking telopeptides of type II collagen, interleukin-1, interleukin- 6 and bone-specific alkaline phosphatase, tartrate resistant acid phosphatase 5b were detected.

    RESULTS AND CONCLUSION: (1) The bone volume fraction and trabecular bone number in the elcatonin group were significantly higher than those in the model group (P < 0.05), and the trabecular separation in the elcatonin group was lower than that in the model group (P < 0.05). (2) The bone volume fraction, trabecular bone number and trabecular thickness in the model group were lower than those in the sham operation group (< 0.01 or P < 0.05), and the trabecular separation was higher than that in the sham operation group (P < 0.01). (3) The serum levels of C-terminal crosslinking telopeptides of type I collagen, C-terminal crosslinking telopeptides of type II collagen, interleukin-1, interleukin- 6 and tartrate resistant acid phosphatase 5b in the elcatonin group was significantly lower than those the model group (P < 0.05),and the above levels in the model group were significantly higher than those in the sham operation group (P < 0.05). (4) The p38 expression level in subchondral bone in the elcatonin group was significantly lower than that in the model group (P < 0.01), and the level in the model group was significantly higher than that in the sham operation group (P < 0.01). (5) These results indicate that elcatonin may inhibit the secretion of osteoarthritis pro-inflammatory factors and subchondral bone resorption by down-regulating the expression level of p38 MAPK.

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    Establishment and evaluation of traumatic neuroma model
    Wang Jing, Lu Changfeng, Peng Jiang, Zhu Chen, Xu Wenjing, Cheng Xiaoqing, Fang Jie, Zhu Yaqiong, Zhao Yanxu, Jiang Wen, Xu Hongguang, Wang Yu
    2020, 24 (5):  716-719.  doi: 10.3969/j.issn.2095-4344.2431
    Abstract ( 491 )   PDF (17295KB) ( 115 )   Save

    BACKGROUND: Traumatic neuroma is a common complication of peripheral nerve injury, and basic research on peripheral nerve repair and regeneration through a traumatic neuroma model is rarely reported.

    OBJECTIVE: To establish and identify a traumatic neuroma model.

    METHODS: The study was approved by the Laboratory Animal Ethical Committee of Chinese PLA General Hospital. Fifteen healthy Sprague-Dawley rats aged 8 weeks old were selected to expose the sciatic nerve under microscope, and the sciatic nerve was cut 1 cm away from the posterior gluteal muscle branch using microscissors. The proximal nerve was sutured to the surrounding muscle with 11-0 microlines, and the distal nerve was left open and reflexed. After 3 weeks, ultrasonic and histological examinations were used to verify the formation of neuroma.

    RESULTS AND CONCLUSION: (1) Ultrasound: After 3 weeks of modeling, the proximal nerve showed obvious spindle enlargement, which was a hypoechoic parenchymal nodule without echo. (2) Gross observation: The proximal nerves were enlarged and slightly stiffened, with fibrous connective tissue hyperplasia and adhesion to the surrounding tissues. (3) Hematoxylin-eosin staining indicated hyperplasia of fibrous tissue and disorderly growth of nerve fibers in the tumor. Immunofluorescence staining (S100, NF200) revealed irregular hyperplasia of Schwann cells and nerve axons in the tumor. (4) These results suggest that the model of traumatic neuroma is successfully constructed.

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    Characterization of aggrephagy in exercise-induced muscle damage
    Gao Yang, Liang Xiaotian, Wang Bo, Li Junping, Wang Ruiyuan
    2020, 24 (5):  720-725.  doi: 10.3969/j.issn.2095-4344.2430
    Abstract ( 396 )   PDF (27284KB) ( 51 )   Save

    BACKGROUND: A high-intensity eccentric exercise may lead to skeletal muscle damage, endoplasmic reticulum stress, increasing misfolded proteins. Aggrephagy works as an effective way of controlling quality of proteins and plays an important role in damage repair.

    OBJECTIVE: To discover the activation degree of aggrephagy in the damage repair process after an overload eccentric exercise, and to discuss the role of aggrephagy in the exercise-induced muscle damage, which is supplementary to the protein degradation pathway in skeletal muscle damage.

    METHODS: Sixty-four male adult Sprague Dawley rats were randomly divided into a static control group (n=8) and seven exercise groups according to post-exercise time (0, 3, 6, 12, 24, 48 and 72 hours, eight rats in each). Damage models were established by downhill running (-16°, 16 m/min, 90 minutes). Subsequently, the histological changes of the rat soleus muscle was observed under an electron microscope and protein expressions of histone deacetylase 6 and microtubule-associated protein 1 light chain 3II/I related to aggrephagy were detected using western bot assay.

    RESULTS AND CONCLUSION: (1) Under the transmission electron microscope, the rat soleus muscle was disordered and widened and appeared to have transient sarcomere, the Z line was water wave-like, broken and disappeared, and the mitochondria were swollen and unevenly distributed with an unclear structure after high-intensity eccentric exercise. The model rats suffered severest muscle damage at 12 hours and recovered completely at 72 hours after high-intensity eccentric exercise. (2) After one-time eccentric exercise, the expression of histone deacetylase 6 had a transient increase. The histone deacetylase 6 expression reached the peak at 6 hours, then gradually reduced and recovered at 72 hours after exercise. The microtubule-associated protein 1 light chain 3II/I expression was significantly increased at 3 hours after exercise, reached the peak at 12 hours, then reduced significantly and recovered at 72 hours after exercise. All these findings indicate that aggrephagy transiently happens and exerts important roles in the clearance of misfolded proteins, maintenance of cellular environmental homeostasis and recovery of skeletal muscle damage. 

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    Effects of different calcium supplementation pathways on calcium ion in calcium-free regional citrate anticoagulation-continuous renal replacement therapy: study protocol for a prospective randomized cross-over trial 
    Jiang Biantong, Zhang Zhigang, Jin Xiu, Wang Haiye, Wu Yuchen, Zhang Caiyun
    2020, 24 (5):  726-730.  doi: 10.3969/j.issn.2095-4344.1921
    Abstract ( 332 )   PDF (19624KB) ( 64 )   Save

    BACKGROUND: When regional citrate anticoagulation (RCA) is used in continuous renal replacement therapy (CRRT), one of the key aspects to achieve safe and effective extracorporeal circulation is the management of calcium ions. For calcium-free RCA-CRRT, there are generally two ways to do this: the deep vein and the venous line. The anticoagulant effects of different calcium supplementation pathways have not yet been explored.

    OBJECTIVE: In this trial, we would test our hypothesis that compared with the subclavian vein, when calcium was infused through the venous line of blood filter catheter, the arterial iCa2+ was lower.

    METHODS: This was a prospective, single-center, randomized crossover trial. From December 2018 to December 2019, 48 patients with RCA-CRRT at the Department of Intensive Care Unit of the First Hospital of Lanzhou University were selected. According to the different calcium sites, the patients were randomly divided into two groups. The calcium supplementation order of group A (n=24) was the venous line of the blood filter catheter-subclavian vein. Group B (n=24) was supplemented with subclavian vein-the venous line. Blood gas analysis results were compared using blood gas analyzers before and after replacement of the calcium supplementation route in all cases. The primary measurement outcome was the differences between arterial iCa2+ and post-filtration iCa2+ with different calcium supplementation pathways, and the simultaneous recording of pH, K+, and total hemoglobin. The secondary measurement outcomes were the incidences of catheter dysfunction and hypocalcemia during the intervention. The trial was approved by the Ethics Committee of the First Hospital of Lanzhou University (approval No. LDYYLL2018-165) in December 2018. The study was registered on the China Clinical Trial Registration Center (ChiCTR1800020046) in December 2018. Sample and data collection time is from December 2018 to November 2019, data analysis time and test completion time is December 2019.

    DISCUSSION: This is the first trial on the anticoagulant effects of calcium-free RCA-CRRT through different calcium supplement routes. We will confirm that the arterial iCa2+ level is slightly lower when calcium is infused in the venous line of blood filter catheter than in the subclavian vein, and the incidence rates of catheter dysfunction and hypocalcemia will help us to determine which site is safer.

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    Analysis of programs on tissue engineering funded by the National Natural Science Foundation of China between 2013 and 2018
    Yan Shu, Lu Yan, Ouyang Zhaolian
    2020, 24 (5):  731-735.  doi: 10.3969/j.issn.2095-4344.2404
    Abstract ( 454 )   PDF (23500KB) ( 74 )   Save

    BACKGROUND: Tissue engineering as an important branch of regenerative medicine has interdisciplinary characteristics and plays a role in repairing, maintaining or improving the function of damaged organs and tissues, which is highly valued in the biomedical field. The National Natural Science Foundation of China has supported basic research on tissue engineering for years, and the funded programs can reflect the discipline development to some extent.

    OBJECTIVE: To analyze the information of China tissue engineering funding programs and illustrate its development status and trend.

    METHODS: Internet-Based Science Information System developed by the National Natural Science Foundation of China was used as a source to retrieve tissue engineering programs funded between 2013 and 2018. Excel and Bibexcel were used to analyze the project data including award year, program name, approval amount, funded organization, funding mechanism, and keywords.

    RESULTS AND CONCLUSION: In the past 6 years, the basic research programs of tissue engineering funded by the National Natural Science Foundation of China have reduced slightly. The funded programs are mainly from the Department of Life Sciences and the Department of Health Sciences, and the main funding mechanisms are general program and young scientist funds. Most of the organizations funded are universities or colleges, and some of them with strong research ability and wide research ranges can be funded for their programs involving various fields. Bone and cartilage, blood vessels and heart, oral, nerve and skin tissue engineering are the main sub-fields; vascularization, microenvironment, mesenchymal stem cells, hydrogels, three-dimensional printing, directed differentiation are the hot nesearch topics.
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    Plantar pressure and gait characteristics in older adult patients with diabetes
    Bu Yueli, Wang Fang, Zhang Jianguo, Li Xiaolin, Cao Zijun, Li Xuemei
    2020, 24 (5):  736-740.  doi: 10.3969/j.issn.2095-4344.1928
    Abstract ( 458 )   PDF (22327KB) ( 98 )   Save

    BACKGROUND: Plantar pressure is one of the major risk factors for diabetic foot ulcers.

    OBJECTIVE: To explore the characteristics of plantar pressure under natural gait in older adult patients with diabetes and compare them with those in healthy older adults, providing data for preventing foot diseases and designing foot decompression products.

    METHODS: The study protocol was performed in accordance with the Medical Ethics Committee of Tianjin Medical University, China. Forty-one older adult patients with diabetes and 30 healthy older adults, both aged over 60 years, received plantar pressure detection using an insole-type root pressure measurement system. Peak plantar pressure, percentage of peak time, X offset, Y offset, 95% confidence ellipse area, step frequency, step velocity, stride length, standing phase, and swing phase were measured. After fully understanding the study protocol, each participant provided written informed consent. 

    RESULTS AND CONCLUSION: Compared with healthy older adults, peak plantar pressure was significantly increased in the 2nd-4thmetatarsal region, the peak time was decreased in most area of the left foot and increased in the right root heel and arch area in older adult patients with diabetes (P < 0.05). Compared with healthy older adults, standing phase was decreased, swing phase was increased, step frequency was decreased, stride length in males was increased, step velocity was increased, stride length in females was decreased, and step velocity was decreased in older adult patients with diabetes. Compared with healthy older adults, 95% confidence ellipse area was decreased, and X offset and Y offset were increased in older adult patients with diabetes. These results suggest that the stability and flexibility of older adult patients with diabetes are lower than those of healthy older adults. In older adult patients with diabetes, plantar pressure is obviously transferred from the heel to the humerus. Therefore, much attention should be paid to plantar pressure in foot care.

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    Changes of lumbosacral nerve roots innervation in lumbar disc herniation patients with transitional vertebrae
    Wang Xin, Wang Dawei, Sun Yiqiang, Zhao Zihao, Dou Yongfeng, Hu Peng, Geng Xiaopeng
    2020, 24 (5):  741-746.  doi: 10.3969/j.issn.2095-4344.2401
    Abstract ( 564 )   PDF (23040KB) ( 52 )   Save

    BACKGROUND: Lumbosacral transitional vertebra is a commonly seen congenital spinal deformity, and the changes in the muscle innervation pattern and the sensory dermatomes of the lumbosacral nerve roots have been reported, but the changes and its guidance significance for the surgeries of lumbar disc herniation have not been clarified systematically.

    OBJECTIVE: To explore the possibility of changes in the muscle innervation pattern and the sensory dermatomes of the lumbosacral nerve roots when there is a lumbosacral transitional vertebra.

    METHODS: The study was in accordance with the ethical requirements of Affiliated Hospital of Binzhou Medical University, and the subjects and their families signed the informed consents. The medical records of 321 patients with single segment lumbar disc herniation who underwent surgical treatment were analyzed retrospectively. Lumbosacral transitional vertebrae were present in 38 of 321 patients (11.8%). There were 26 cases of sacral lumbarization and 12 cases of lumbar sacralization. Among these 26 patients with sacral lumbarization, 23 had herniated discs at L5/S1 (L6) compressing the S1 (L6) nerve root. Of the 12 patients with lumbar sacralization, 8 had herniated discs at L3/4 compressing the L4 nerve root. In the 283 normally configured patients, 138 had herniated discs at L5/S1 compressing the S1 nerve root, 95 had herniated discs at L4/L5 compressing the L5 nerve root, and 47 had herniated discs at L3/L4 compressing the L4 nerve root. The preoperative symptoms of S1 nerve root compression in the patients with sacral lumbarization and of L4 nerve root compression in the patients with lumbar sacralization were compared with those of L4, L5 or S1 nerve root compression in the patients with normal configuration.

    RESULTS AND CONCLUSION: (1) The distribution of motor function depression caused by S1 nerve root compression was significantly different between sacral lumbarization patients group and normal group (P < 0.05). (2) The distribution of motor function depression caused by L4 nerve root compression was also significantly different between lumbar sacralization patients group and normal group (P < 0.05). (3) The motor function depression caused by S1 nerve root compression in sacral lumbarization patients was similar to that of the L5 nerve root compression in the normal configuration, while the motor function depression caused by L4nerve root compression in lumbar sacralization patients was similar to that of the Lnerve root compression in the normal configuration. The analysis of the sensory dermatomes also showed similar results. (4) Our results suggest that the function of lumbosacral nerve roots changes in patients with transitional vertebrae. The S1 nerve roots in patients with sacral lumbarization tend to serve the usual function of L5 nerve roots (nerve roots move up), and the L4 nerve roots in patients with lumbar sacralization tend to serve the usual function of Lnerve roots (nerve roots move down).

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    Susceptibility genes related to non-traumatic femoral head necrosis: improving detection accuracy and developing new treatment strategy
    Xu Qi, Zhang Chao, Ha Chengzhi, Wang Dawei
    2020, 24 (5):  747-752.  doi: 10.3969/j.issn.2095-4344.1892
    Abstract ( 444 )   PDF (35702KB) ( 44 )   Save

    BACKGROUND: Although the mechanism of femoral head necrosis has a series of explanations such as glucocorticoids, ethanol, decompression sickness, sickle cell anemia, and genetic susceptibility, the specific pathogenesis is still unclear.

    OBJECTIVE: To highlight the genetics of non-traumatic femoral head necrosis by combining recent genetic studies, thus providing new treatments for the repair and reconstruction of femoral head.

    METHODS: A computer-based online retrieval of CNKI, WanFang, PubMed and Web of Science databases was performed to search the related articles published from January 2000 to April 2019. The keywords were “non-traumatic femoral head necrosis, susceptibility genes, pathogenesis” in Chinese and English, respectively. According to the inclusion and exclusion criteria, the irrelevant and repetitive articles were excluded, and finally 49 eligible articles were included for analysis.

    RESULTS AND CONCLUSION: Non-traumatic femoral head necrosis is an extremely complex disease whose pathogenesis is caused by a combination of factors rather than a single genetic gene. COL2A1 genetic mutation is the high susceptibility gene to non-traumatic femoral head necrosis. High-coagulation and low-fibrinolytic state-related loci in the blood, interleukin-related gene loci in immune system and lipid-related loci become more and more important in inducing non-traumatic femoral head necrosis. With the deep understanding of human genetic technology, the accuracy of detecting susceptible genes will be continuously improved, which is conducive to the prevention, diagnosis and precise individualized treatment of non-traumatic femoral head necrosis.

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    Application of bisphosphonates in avascular necrosis of the femoral head
    Ge Juncheng, Ma Jinhui, Wang Bailiang, Yue Debo, Sun Wei, Wang Weiguo, Guo Wanshou, Li Zirong
    2020, 24 (5):  753-759.  doi: 10.3969/j.issn.2095-4344.1885
    Abstract ( 520 )   PDF (44249KB) ( 53 )   Save

    BACKGROUND: Animal experiments have shown that bisphosphonates exhibit a preventive effect on femoral head collapse. However, clinical application of bisphosphonates remains disputed. Systematic administration of bisphosphonates has many adverse reactions. There is an increasing number of studies on local application of bisphosphonates.

    OBJECTIVE: To review the research progress of bisphosphonates in the treatment of avascular necrosis of the femoral head.

    METHODS: The first authors (GJC and MJH) searched PubMed and CNKI databases to retrieve papers regarding bisphosphonate treatment of osteonecrosis of the femoral head using the search terms “osteonecrosis of the femoral head, bisphosphonates, systemic therapy, topical therapy, osteogenesis, bone destruction, bone remodeling” in English and Chinese. Sixty-two eligible papers were included in the final analysis.

    RESULTS AND CONCLUSION: It remains disputed whether bisphosphonates inhibit or activate osteoblasts. Current studies have shown that low concentration of bisphosphonates can promote the proliferation of osteoblasts, while high concentration of bisphosphonates can inhibit the proliferation of osteoblasts. Long term systematic application of bisphosphonates can induce mandibular osteonecrosis and other side effects. Topical application of bisphosphonates for treatment of avascular necrosis of the femoral head is still in the experimental stage. The optimal bisphosphonate concentration and the duration of efficacy in the treatment of avascular necrosis of the femoral head have not been determined. These should be clarified by in-depth high-quality experiments prior to clinical application. 

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    Treatment of rheumatoid arthritis based on the collateral disease theory
    Wu Zhancheng, Zhao Jing, Zhu Xiuhui, Zhang Shaoying, Gao Zhiqiang, Huo Wengang, Jiang Fubin
    2020, 24 (5):  760-765.  doi: 10.3969/j.issn.2095-4344.2475
    Abstract ( 443 )   PDF (34302KB) ( 58 )   Save

    BACKGROUND: Although ancient physicians had rich discussions on rheumatoid arthritis, few have discussed based on the theory of collaterals diseases.

    OBJECTIVE: To summarize the drug treatment classification, etiology analysis, and “collateral-interest accumulation.”

    METHODS: CNKI, EI, SCI, and ISTP databases were searched for articles published after 1900. The keywords were “The bone erosion of rheumatoid arthritis, TCM collaterals theory.” Data from more than 10 domestic and foreign articles were selected to analyze the drug treatment classification, etiology analysis, and “collateral-interest accumulation.”

    RESULTS AND CONCLUSION: (1) One of the causes of rheumatoid arthritis bone disease is the collaterals disease of traditional Chinese medicine. The development of intractable diseases should follow the law of the development of diseases from the meridians to the collaterals, from the gas to the blood, and from the functional lesions to the organic diseases. (2) The pathogenesis of rheumatoid arthritis lies in the accumulation of collaterals, which causes joint swelling, joint deformity and damage. (3) The treatment of “collaterals for the use of circulation” for rheumatoid arthritis is to keep the collaterals, organs and blood-gas in fluent, thus ensuring the fluent circulation to alleviate the symptoms of rheumatoid arthritis. 

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    Basic science related to tendinopathy: microbiomechanics and stress shielding
    Liu Chunyu, Han Xiaoyan, Wang Lin
    2020, 24 (5):  766-772.  doi: 10.3969/j.issn.2095-4344.2436
    Abstract ( 497 )   PDF (40577KB) ( 53 )   Save

    BACKGROUND: Tendon is a special connective tissue that can transmit the force generated by the muscle to the bone through the enthesis. The occurrence of tendinopathy is closely related to the mechanical characteristics of tendon and enthesis and its micro-structure, but the specific mechanism still remains controversial.

    OBJECTIVE: To summarize the micro-structure of tendon and enthesis, the biomechanical characteristics of tendon, the healing and repair of tendon injuries, and the biomechanical factors related to chronic tendinopathy.

    METHODS: CNKI, VIP, CBM, WanFang, PubMed and Embase databases were searched. The articles concerning micro-structure of tendon and enthesis, relationship between tendinopathy/enthesis and stress, and biomechanical mechanisms of tendinopathy/enthesis were selected.

    RESULTS AND CONCLUSION: The biomechanical properties of tendon and enthesis are closely related to their microstructures. The biomechanical properties of tendon are reduced due to the damage of their microstructures in the process of repair. The occurrence and development of chronic tendinopathy are related to the microstructures and biomechanical characteristics of enthesis. Compression load and stress shielding of enthesis may play a key role, but further high-quality studies on the specific mechanism are still required.
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    Effects of physical activity on hippocampal plasticity and cognition
    Chen Yanlin, Xu Lin, Xu Shengjia
    2020, 24 (5):  773-779.  doi: 10.3969/j.issn.2095-4344.1915
    Abstract ( 501 )   PDF (42664KB) ( 61 )   Save

    BACKGROUND: As a practical model, physical activity can study the relationship between exercise and brain health in various ways, so as to better understand the promotion of exercise to the brain. In particular, how physical activity changes the structure and function of the hippocampus.

    OBJECTIVE: To review the researches on the physical activity, hippocampus and cognition, and to put forward the problems that need to be solved in current practice and research application.

    METHODS: PubMed database was retrieved for relevant studies published from 1995 to 2019. The keywords were “physical activity, exercise, hippocampus, cognition, neuroplasticity, adaptive, mechanisms” in English. The articles about the practical application and regulation mechanism for physical activity, hippocampus and cognition were included.

    RESULTS AND CONCLUSION: Totally 142 collected articles were searched firstly, the irrelevant and repetitive articles were excluded, and finally 89 eligible articles were included. The hippocampal dentate gyrus has the ability to regenerate nerves. Regular physical activity has a profound effect on the health of the body and brain, and can promote the nerve regeneration of hippocampus dentate gyrus, which can be increased by 2-3 times. This type of nerve mainly occurs in the dorsal side of dentate gyrus. In addition, exercise is also important for changes in neuronal maturation, morphology, and connectivity, and can alter the integration pathways of new neurons and increase the number of incoming neonatal and afferent cell synapses. The nerve regeneration of dentate gyrus is related to various factors induced by exercise. Exercise can promote changes in hippocampal synaptic plasticity by regulating excitatory and inhibitory neurotransmitters. Exercise-induced increase in serum brain derived neurotrophic factor levels may reduce hippocampal volume changes. The duration and intensity of exercise can differentially regulate cerebral blood flow, which in turn affect neuronal activity. Overexpression of vascular endothelial growth factor after long-term exercise can promote the proliferation of hippocampus and increase the hippocampal neurogenesis. Besides, exercise can also alter the synaptic plasticity and connectivity of adult newborn neurons, enhancing the integration of adult newborn neurons with existing hippocampal-enveloping pathways.

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    3D printing technology and tissue engineering technology in tracheal replacement: application and hotspot research
    Liang Yanan, Zhang Jianhua
    2020, 24 (5):  780-786.  doi: 10.3969/j.issn.2095-4344.2205
    Abstract ( 401 )   PDF (42529KB) ( 65 )   Save

    BACKGROUND: Functional tracheal reconstruction remains a surgical challenge due to the lack of satisfactory tracheal substitutes.

    OBJECTIVE: To review the research hotspot, clinical application, and main obstacles of tissue-engineered trachea.

    METHODS: A computer-based search of PubMed, Medline, and WanFang databases was performed to retrieve relevant articles published from 2004 to 2019 with the search terms “3D printing, tissue-engineered trachea, trachea reconstruction, tracheal replacement” in English and Chinese. A total of 47 literatures were included in the final analysis.

    RESULTS AND CONCLUSION: At present, the methods of tracheal reconstruction mainly include artificial tracheal transplantation, allotransplantation, autologous tissue transplantation and tissue-engineered tracheal transplantation. Artificial trachea transplants often fail due to rupture, infection and narrowing of the trachea. Allotransplantation requires long-term immunosuppressive therapy, and death is often caused by necrosis and infection because of insufficient angiogenesis after transplantation. Autogenous tissue has limited ability to replicate the structure and function of the trachea and also has surgical trauma. Tissue-engineered trachea can simulate the biological structure and function similar to natural trachea by selecting suitable scaffold materials and implanting seed cells evenly in the scaffold. It seems to be an ideal tracheal substitute. An intact tracheal scaffold was prepared with biodegradable material using 3D printing technology combined with tissue engineering technology and then implanted into the tissue-engineered trachea cultured with mesenchymal stem cells. This provides a new approach to long-segment tracheal defect reconstruction. 
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    Biological mechanism of platelet-rich plasma for tendinopathy repair: a visual study based on scientific knowledge map 
    Qiu Guorong, He Benxiang, Wang Chun
    2020, 24 (5):  787-795.  doi: 10.3969/j.issn.2095-4344.2444
    Abstract ( 303 )   PDF (48283KB) ( 55 )   Save

    BACKGROUND: Regeneration and repair using platelet-rich plasma provide a new insight for treating tendinopathy, which exhibits good outcomes in the treatment of refractory tendon and ligament degenerative diseases.

    OBJECTIVE: To explore the current research hotspot in the treatment of tendinopathy with platelet-rich plasma worldwide through drawing the scientific knowledge map of the treatment to tendinopathy by using the information visualization tool.

    METHODS: Using citation analysis method, we searched Web of Science core database for the studies on platelet-rich plasma and tendinopathy since 2008. The scientometric and visual analyses of literature were carried out by using Cite Space V scientific knowledge map tool.

    RESULTS AND CONCLUSION: (1) A total of 515 papers on repair of tendinitis with platelet-rich plasma were recruited. Eight papers on key nodes were obtained, and 27 keywords were found at high frequency. (2) In recent decade, high-yield authors have formed a research group based on the state and research institutions. The inter group cooperation is close, but there is a lack of cross-group scientific research cooperation. (3) Platelet-rich plasma has been widely used in the clinical treatment of tendinopathy, but there are some shortcomings in the design of clinical practice and experimental research, leading to controversy about the therapeutic effect of platelet-rich plasma. In order to evaluate the efficacy of platelet-rich plasma in tendinopathy, basic experimental studies should be carried out on the premise of controlling the experimental conditions and overcoming the shortcomings in experimental design. (4) The research of platelet-rich plasma on tendinopathy in foreign countries has gradually developed from the initial clinical study of platelet-rich plasma on the treatment of tendinopathy to the in vitro experiment with time, which has become a hotspot. In the selection of experimental indicators, the functional study of cytokines contained in platelet-rich plasma has shifted to focus on gene expression in cell biology. It is still unclear which cell transduction pathways platelet-rich plasma can affect tendon healing. From the trend of research, future research in this field will focus on microbiological mechanism of platelet-rich plasma in tendinopathy treatment.
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    Acromioclavicular joint dislocation: how to achieve anatomical reduction, sustained stability and micro-motion
    Fang Yi, Zhao Wenzhi, Pan Deyue, Han Xin, Zhang Lu, He Hongtao, Shi Feng, Tian Tingxiao
    2020, 24 (5):  796-802.  doi: 10.3969/j.issn.2095-4344.2438
    Abstract ( 499 )   PDF (42591KB) ( 129 )   Save

    BACKGROUND: There are many ways to treat acromioclavicular joint dislocation, but there is no uniform standard. The therapeutic efficacy is affected by the damage mechanism, the type of dislocation, the choice of treatment mode and postoperative exercise.

    OBJECTIVE: To summarize the research progress in acromioclavicular joint dislocation.

    METHODS: The first author searched literature from PubMed (2010-2019) and WanFang (2010-2019) databases. The key words were “acromioclavicular; dislocation; diagnosis; therapy; anatomical reconstruction; endobutton; internal fixators" in English and Chinese, respectively. After repeated studies were excluded, totally 2 187 articles were retrieved, and 55 eligible articles were included for result analysis.

    RESULTS AND CONCLUSION: At present, Rockwood types I and II are usually treated nonoperatively, while injures of Rockwood types IV-VI are treated surgically. The treatment of Rockwood type III is still controversial. In order to maximize the shoulder function, it is recommended to take active surgery for young and functionally demanding patients. Non-surgical treatment is mainly based on strap fixation. Surgical treatment is increasingly oriented to minimally invasive anatomical reconstruction of the coracoclavicular ligament, for example, Endobutton technique assisted by arthroscopy. Although good short-term results can be obtained, long-term follow-up studies with large samples are still needed to confirm its value in clinical application. Further investigations on the treatment of acromioclavicular joint dislocation are warranted. It has been sought for a surgical method that can achieve anatomical reduction and durable stability and ensure micro-motion of the acromioclavicular joint.
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    Meta-analysis of bone morphogenetic protein versus autologous bone grafting for limb long bone nonunion
    Xie Chengxin, Yu Chengqiang, Wang Wei, Wang Chenglong, Yin Dong
    2020, 24 (5):  803-810.  doi: 10.3969/j.issn.2095-4344.1888
    Abstract ( 429 )   PDF (30013KB) ( 55 )   Save

    BACKGROUND: Bone morphogenetic proteins have strong bone induction properties and have been proved to promote bone healing in fracture, bone defect and other diseases. However, few studies are reported on the use of bone morphogenetic proteins in the treatment of bone nonunion, and the results of various studies remain controversial, which makes the role of bone morphogenetic proteins in the treatment of limb long bone nonunion unclear.

    OBJECTIVE: Meta-analysis was used to systematically evaluate the advantages and disadvantages of bone morphogenetic protein versus autogenous bone grafting in the treatment of limb long bone nonunion.

    METHODS: PubMed, Elsevier, Web of Science, Cochrane Library, CNKI and WanFang databases were searched to retrieve the randomized controlled trials and non-randomized controlled trials of bone morphogenetic proteins for limb long bone nonunion published before April 2019. Quality evaluation and data extraction of the included literatures were performed. Meta-analysis of outcome indicators was performed using RevMan 5.1 software provided by Cochrane system.

    RESULTS AND CONCLUSION: Eight articles were enrolled, including 4 randomized controlled trials and 4 non-randomized controlled trials, all of which were small sample-size studies involving 30-124 cases. A total of 613 cases of nonunion were included. In the study group, patients received bone morphogenetic proteins or bone morphogenetic proteins in combination with bone grafting. In the control group, patients received autologous bone grafting. Meta-analysis results showed that there were no significant differences in postoperative healing rate, infection rate, secondary operation rate, and postoperative improvement in limb function between study and control groups (P > 0.05). The mean healing time in the study group was significantly shorter than that in the control group [WMD=-1.24, 95%CI(-1.70, -0.79), P < 0.01]. Intraoperative blood loss in patients receiving simple bone morphogenetic protein was less than that in patients receiving autologous bone grafting (P < 0.05). The hospitalization cost of bone morphogenetic protein in combination with autologous bone grafting was significantly higher than that of autologous bone grafting (P< 0.01). There was no significant difference in hospital stay between patients receiving simple bone morphogenetic protein and patients receiving autologous bone grafting (P > 0.05). These results suggest that bone morphogenetic protein can provide a viable alternative to autologous bone grafting, and it is also a safe adjuvant for autologous bone grafting, which has the potential advantage of accelerating fracture healing, but the current evidence does not support bone morphogenetic protein in combination with autologous bone grafting.

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    Systematic evaluation of anterior cruciate ligament reconstruction with peroneus longus tendon and hamstring tendon
    Shi Weifa, Guo Zhimin, Deng Huiyun, Shen Yanling, Shi Lingling, Wu Shilong, Huang Zebin
    2020, 24 (5):  811-820.  doi: 10.3969/j.issn.2095-4344.1964
    Abstract ( 466 )   PDF (32707KB) ( 127 )   Save

    BACKGROUND: In recent years, it has been reported that peroneus longus tendon can be used as a new graft material for anterior cruciate ligament reconstruction and can achieve the same effect as hamstring tendon. Therefore, it is necessary to systematically evaluate the two graft materials for anterior cruciate ligament reconstruction.

    OBJECTIVE: To evaluate the clinical effect of reconstruction of anterior cruciate ligament with peroneus longus tendon and hamstring tendon by meta-analysis.

    METHODS: We retrieved controlled clinical trials which compared the long peroneal tendons and hamstring tendons in reconstructing anterior cruciate ligament respectively in Chinese database (WanFang, CNKI, VIP, Chinese biological medicine) and English database (Ovid, PubMed, Web of Science, Embase, the Cochrane library). The retrieval time was from database creation to March 2019. Literature screening and evaluation and data extraction were performed by two evaluators. Meta-analysis was evaluated using Revman5.3 software.

    RESULTS AND CONCLUSION: (1) A total of 413 Chinese or English literatures were retrieved and 10 of them were included in the final analysis. Among 647 patients receiving anterior cruciate ligament reconstruction, 271 patients used peroneus longus tendon reconstruction and 376 patients used hamstring tendon reconstruction. (2) Meta-analysis results: postoperative functional score: There was significant difference in Lysholm score at postoperative 12 months (MD=1.23, 95%CI[0.31, 2.51], P=0.000 9) and IKDC score at postoperative 6 months (MD=3.19, 95%CI[0.07, 6.31], P=0.02) between peroneus longus tendon reconstruction and hamstring tendon groups. The occurrence of postoperative complications in the peroneus longus tendon group was significantly lower than that in the hamstring tendon group (OR=0.15, 95%CI[0.03, 0.69], P=0.01). However, there were no significant differences in Tegner scores, degree of joint motion, degree of joint relaxation at postoperative 6 and 12 months between peroneus longus tendon reconstruction and hamstring tendon groups. No significant difference was found in Lysholm score at postoperative 6 months and in IKDC score at postoperative 12 months between these two groups. The results showed that the clinical effect of peroneus longus tendon in reconstruction of anterior cruciate ligament was comparable to that of hamstring tendon; in the peroneus longus tendon reconstruction group, the Lysholm score at postoperative 12 months and IKDC score at postoperative 6 months were significantly superior to those in the hamstring tendon group. The incidence of postoperative complications in the peroneus longus tendon reconstruction group was lower than that in the hamstring tendon group. The peroneus longus tendon can be clinically recommended to substitute hamstring tendon in the reconstruction of the anterior cruciate ligament. However, the quality of included literatures is limited; therefore higher quality of evidence is required to validate this conclusion. 

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