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18 July 2020, Volume 24 Issue 20 Previous Issue    Next Issue

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Serum Nesfatin-1 changes in osteonecrosis of the femoral head  Shen Yingshan, Chen Xiaojun, Pang Fengxiang, Huang Junyuan, Chen Zhenqiu, Zhou Yingchun, He Wei, Wei Qiushi 2020, 24 (20):  3117-3121.  doi: 10.3969/j.issn.2095-4344.2572 Abstract ( 314 )   PDF (20750KB) ( 126 )   Save BACKGROUND: Nesfatin-1, a novel feeding regulator, has been found to be closely linked to orthopedic diseases in recent years. The correlation between Nesfatin-1 and osteonecrosis of the femoral head (ONFH) remains unclear. OBJECTIVE: To determine the changes in plasma Nesfatin-1 level in patients with ONFH and to study its correlation with the development of ONFH.  METHODS: From May to December 2016, we enrolled 86 patients with ONFH who were hospitalized in the Hip Preserving Ward, No. 3 Orthopedic Department, the First Affiliated Hospital of Guangzhou University of Chinese Medicine (including 13 ARCO stage II, 26 ARCO stage III, and 47 ARCO stage IV) and 86 healthy controls. In the ONFH group, there were 26 cases of steroid-induced ONFH, 40 cases of alcoholic ONFH, 12 cases of traumatic ONFH, and 8 cases of idiopathic ONFH. The levels of Nesfatin-1 in peripheral venous blood were measured by enzyme-linked immunosorbent assay (ELISA). Comparison was performed between different ARCO stages, different etiologies as well as before and after collapse. The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine (No. 20140307), and each patient had signed an informed consent form prior to inclusion in the study. RESULTS AND CONCLUSION: Plasma Nesfatin-1 level was significantly higher in ONFH patients than healthy controls (P=0.000). There were insignificant differences among different etiologies (P=0.956), but significant differences among different ARCO stages (P=0.011) as well as before and after collapse (P=0.003). There was a positive correlation between plasma Nesfatin-1 level and ARCO stages. Receiver operator characteristic curve analysis showed that Nesfatin-1 level had sensitivity (52.05%) and specificity (92.31%) in the diagnosis of ONFH. These findings indicate that Nesfatin-1 is closely related to the development of ONFH. It can reflect the degree of necrosis, which can provide reference for clinical diagnosis and treatment of ONFH. Figures and Tables | References | Related Articles | Metrics

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Xinjiang Sambucus sibirica Nakai bark extract promotes fracture healing Wulan•Saitahemaiti, Ailijiang•Asila, Nuerhanati•Shayilanbieke, Nuerman•Yixijian, Asihati•Nuermaimaiti, Fang Rui 2020, 24 (20):  3122-3129.  doi: 10.3969/j.issn.2095-4344.2697 Abstract ( 462 )   PDF (31339KB) ( 44 )   Save BACKGROUND: Studies have found that Sambucus sibirica Nakai can promote osteoblast division, proliferation, and secretion of alkaline phosphatase to accelerate bone matrix calcification, promote new bone formation, and promote the absorption of necrotic bone. OBJECTIVE: To observe the effects of two extracts of Xinjiang Sambucus sibirica Nakai bark in promoting fracture healing in rats. METHODS: A total of 108 male Sprague-Dawley rats, 3 months old, were randomly divided into sham-operated group, model group, Zhong Hua Die Da Wan group (0.54 g/kg, negative control group), high-, middle- and low-dose ethanol extract groups (0.314, 0.157, 0.078 g/kg), high-, middle, and low-dose water extract groups (0.340, 0.170, 0.085 g/kg). Except for the sham-operated group, the middle segment of the femoral shaft was cut off to make a model of open femoral fracture. In the sham-operated group, only the femoral shaft was exposed and no osteotomy was performed. Intragastric administration began at 1 day after modeling and continued for 6 weeks (1 time/day). At 2, 4, 6 weeks after modeling, the effects of two extracts of Sambucus sibirica Nakai bark on serum-related biochemical indicators, X-ray imaging, biomechanical indicators and hematoxylin-eosin staining were observed. RESULTS AND CONCLUSION: (1) Serum biochemical indicators: The serum calcium level of the high-dose ethanol extract group in each phase was lower than that of the sham-operated group and the model group, indicating that a faster osteogenesis in the high-dose ethanol extract group, followed by middle-dose ethanol extract group, low-dose ethanol extract group, and high-dose water extract group. The serum phosphorus level of ethanol extract groups was higher than that of sham-operated group, model group, and Zhong Hua Die Da Wan group; the serum alkaline phosphatase level of high-dose ethanol extract group at each stage was significantly higher than the other groups, indicating that a stronger osteoblast activity in the high-dose ethanol extract group, followed by the high-dose water extract group. (2) X-ray film: Fracture healing was significant in the high-dose ethanol extract group, fair in the Zhong Hua Die Da Wan group, high-dose water extract, middle-dose water extract group, middle-dose ethanol extract group, and poor in the low-dose ethanol extract group and low-dose water extract group. (3) Three-point bending test: At 6 weeks, the maximum load and maximum deflection of the femurs of the two extract groups were higher than those in the model group. The maximum load and maximum deflection of the femurs increased significantly in the high-dose ethanol extract group followed by the high-dose water extract group, middle-dose water extract group and middle-dose ethanol extract group. (4) Hematoxylin-eosin staining: Fibrous epiphysis gradually formed in the fracture area, and the bone marrow cavity was communicated. Bone healing was better in the high-dose ethanol extract and high-dose water extract groups than in the other groups. To conclude, these two extracts of Xinjiang Sambucus sibirica Nakai bark are capable of improving fracture healing. Moreover, different extraction methods and dosages of Sambucus sibirica Nakai bark demonstrate various effects on fracture healing. Compared with water extracts, ethanol extracts are better to promote fracture healing, and high-dose extracts have better effects than middle- and low-dose extracts.  Figures and Tables | References | Related Articles | Metrics

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Pulsed electromagnetic fields stimulation combined with sclerostin antibody improves bone metabolism and bone microstructure in postmenopausal osteoporosis rabbits Qian Guang, Yu Yueming, Dong Youhai, Hong Yang, Wang Minghai 2020, 24 (20):  3130-3134.  doi: 10.3969/j.issn.2095-4344.2611 Abstract ( 346 )   PDF (20662KB) ( 122 )   Save BACKGROUND: Both pulsed electromagnetic fields (PEMF) stimulation and sclerostin antibody (Scl-Ab) have good effects on the bone metabolism of ovariectomized (OVX) New Zealand rabbits, but research on the combined intervention of PEMF and Scl-Ab in the OVX rabbits is rarely reported. OBJECTIVE: To explore the effect of PEMF combined with Scl-Ab on postmenopausal osteoporosis and to explore the therapeutic value for osteoporosis. METHODS: An animal model of postmenopausal osteoporosis was made in New Zealand white rabbits after ovariectomy. The experimental animals were randomly divided into OVX control group, PEMF group, Scl-Ab group and PEMF+Scl-Ab group, with 10 rats in each group. On the 1st day after surgery, the PEMF group was given PEMF magnetic therapy once a day; the Scl-Ab group was given subcutaneous injection of Scl-Ab twice a week; the PEMF+Scl-Ab group received PEMF magnetic therapy once a day, five times a week, and Scl-Ab subcutaneous injections twice a week; the OVX group was injected subcutaneously with the same dose of normal saline twice a week for 8 weeks. After 8 weeks of treatment, bone metabolism index, bone mineral density, and MicroCT bone microstructure parameters were detected. All animal procedures were approved by the Department of Experimental Animal Science, Fudan University (approval No. 20171263A193). RESULTS AND CONCLUSION: Bone mineral density was significantly decreased in the New Zealand white rabbits after 6 months of OVX, suggesting that the osteoporosis model was successfully established. Compared with the OVX group, the bone mineral density of the L3 vertebral body in the PEMF group, the Scl-Ab group and the PEMF+Scl-Ab group increased significantly (P < 0.05). Compared with the OVX group, serum bone-specific alkaline phosphatase levels were significantly higher, and serum tartrate-resistant acid phosphatase 5b levels were significantly lower in the PEMF group, the Scl-Ab group and the PEMF+Scl-Ab group. The serum tartrate-resistant acid phosphatase 5b level in the PEMF+Scl-Ab group was significantly lower than that in the PEMF group and the Scl-Ab group. The bone metabolism index and bone microstructural parameters (bone volume fraction, trabecular thickness, trabecular number, and trabecular separation) of the PEMF+Scl-Ab group were significantly better than those of the PEMF group and the Scl-Ab group (all P < 0.05). These findings indicate that the combination of Scl-Ab and PEMF can enhance bone mineral density and improve bone metabolism and bone microstructure in postmenopausal osteoporosis New Zealand white rabbits. Figures and Tables | References | Related Articles | Metrics

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Effect of different courses of heat-sensitive moxibustion on the morphology of surrounding connective tissue and spinal cord in a rat model of osteoporosis  Wu Huiting, Cui Tiantian, Ouyang Hougan, Ouyang Yanchu, Yi Lan, Chen Chu 2020, 24 (20):  3135-3139.  doi: 10.3969/j.issn.2095-4344.2554 Abstract ( 318 )   PDF (24402KB) ( 72 )   Save BACKGROUND: It has been proved in clinical practice and basic research that acupuncture and moxibustion at Mingmen acupoint is an effective treatment for primary osteoporosis. As a new therapeutic method, heat-sensitive moxibustion has achieved good results in clinical practice, but the research on its mechanism is still in the blank stage. OBJECTIVE: To study the therapeutic mechanism of heat-sensitive moxibustion from the perspective of connective tissue and nervous system, and to explore the optimal therapeutic time of heat-sensitive moxibustion in a certain time range. METHODS: Female Sprague-Dawley rats of SPF grade were randomly divided into five groups: normal group, model group, 4-, 7-, and 14-day heat-sensitive moxibustion groups. Osteoporosis models were prepared by ovariectomy and treated with heat-sensitive moxibustion at different times. After treatment, the superficial subcutaneous fascia 0.5-1.5 cm around the Mingmen acupoint and the spinal cord were stained with fluorescence and hematoxylin-eosin staining. The concentrations of phosphorus ion, calcium ions and alkaline phosphatase in rat serum were detected before and after 14 days of heat-sensitive sensitive moxibustion. RESULTS AND CONCLUSION: (1) Morphological changes of intrafascial fibers by fluorescence staining: In the normal and model groups, collagen fibers were interlaced and arranged in a network. In the 4-day heat-sensitive moxibustion group, the arrangement of collagen fibers showed no changes. After 14 days of intervention the collagen fibers were stretched and pulled significantly under the effect of heat-sensitive moxibustion, and showed a centripetal arrangement toward the Mingmen acupoint. (2) Hematoxylin-eosin staining results of the spinal cord: After 4 days of heat-sensitive moxibustion, the rat spinal cord had no obvious change compared with the model group. After 7 days of heat-sensitive moxibustion, anterior cornual neurons increased in number and size, and the number of glial cells in the spinal dorsal horn increased. After 14 days of heat-sensitive moxibustion, anterior horn neurons increased significantly in number and in size, with large and round nuclei, obvious nucleoli, and enlarged and regularly arranged nerve fibers; glial cells in the posterior horn increased significantly in number and arranged densely. (3) Serum concentration determination: After 14 days of heat-sensitive moxibustion, the concentrations of phosphorus ions and alkaline phosphatase in rat serum increased significantly (P < 0.01), and the concentration of calcium ions decreased significantly (P < 0.05). These findings indicate that heat-sensitive moxibustion can ameliorate the symptoms of osteoporosis through the morphological changes of connective tissue and nerve-body fluid regulation. Heat-sensitive moxibustion for 14 days can achieve ideal results. Figures and Tables | References | Related Articles | Metrics

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Arthroscopic repair for osteoporosis in the greater tuberosity of patients with rotator cuff tear due to chronic moderate to severe tendon retraction Qi Yusen, Han Mengguang, Luo Jinwei, Guan Chenwei, Hu Jiayang, Xu Cong, Lü Yongming 2020, 24 (20):  3140-3145.  doi: 10.3969/j.issn.2095-4344.2698 Abstract ( 580 )   PDF (23775KB) ( 45 )   Save BACKGROUND: Rotator cuff injury is the most common type of shoulder joint injury. So far, there are few studies on the relationship between local osteoporosis of the greater tuberosity of the humerus and rotator cuff tears in China. The bone mineral density (BMD) in the footprint area is a key factor affecting the intraoperative anchor placement. The recovery of BMD after operation is worth further study. OBJECTIVE: To compare preoperative and postoperative BMD of the bilateral greater tuberosity of the humerus and analyze the improvement of BMD after arthroscopic rotator cuff suture. METHODS: Data of 37 patients with unilateral rotator cuff injury who received arthroscopic suture in the Department of Joint Surgery of the Affiliated Hospital of Chengde Medical College were retrospectively analyzed. There were 16 males and 21 females. The average age was 55.8 years (age range: 35-73 years). Rotator cuff injuries were classified according to Patte's degree of tendon retraction: mild retraction in 17 cases, moderate and severe retraction in 20 cases. BMD of the bilateral greater tuberosity of the humerus measured by dual-energy X-ray absorptiometry was collected, and the relationship between the course of disease, tendon retraction and the difference of BMD before and 1 year after surgery was analyzed. RESULTS AND CONCLUSION: The BMD difference of the bilateral greater tuberosity of the humerus in the mild retraction group was significantly lower than that in the moderate and severe retraction group (P < 0.05), and the BMD difference in the acute mild retraction group was significantly lower than that in the chronic moderate and severe retraction group (P < 0.05). The local osteoporosis of the greater tuberosity was severer in the patients with chronic moderate and severe retraction. During 1-year follow-up after surgery, the BMD difference of the 37 patients was significantly lower than that before surgery (P < 0.05). The BMD difference had no significant difference in the mild retraction group before and after surgery, while in the moderate and severe retraction group, the BMD difference was significantly lowered after surgery (P < 0.05). The BMD difference in the chronic moderate and severe retraction group was significantly lowered after surgery (P < 0.05). At the last follow-up, imaging examination showed no re-tears in all the enrolled patients. To conclude, local osteoporosis of the greater tuberosity is the most obvious in rotator cuff injury with chronic moderate to severe tendon retraction. Arthroscopic repair of rotator cuff injury under shoulder arthroscopy can restore local bone substance to a certain extent, regardless of the course of the disease. Figures and Tables | References | Related Articles | Metrics

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Bushen Tiaogan prescription reverses prednisone-induced osteoporosis in zebrafish Lin Jiebin, Shi Yuling, Gao Fenghe, Liang Zujian 2020, 24 (20):  3146-3151.  doi: 10.3969/j.issn.2095-4344.2695 Abstract ( 561 )   PDF (24102KB) ( 86 )   Save BACKGROUND: Our previous studies have found that Bushen Tiaogan prescription can significantly reduce pain and improve the clinical symptoms of traditional Chinese medicine in elderly patients with osteoporosis. The clinical effect is positive, but there is no relevant experimental evidence. OBJECTIVE: To explore the safety of Bushen Tiaogan prescription and its therapeutic effect on prednisolone-induced osteoporosis. METHODS: The zebrafish juveniles 5 hours after fertilization were evenly distributed into 24-well plates at a density of 20 per well. Different concentrations of Bushen Tiaogan prescription (crude drug concentrations 10, 50, 100, 250, 500 mg/L) were added to the corresponding wells. The development of the embryos was observed at 24, 48, 72, 96 hours after fertilization, and the cumulative survival rate and hatching rate were used to evaluate the safety of Bushen Tiaogan prescription. The zebrafish juveniles 3 days after fertilization were randomly divided into blank control group (0.5% dimethyl sulfoxide), 25 μmol/L prednisolone model group, alendronate sodium positive drug group and Bushen Tiaogan prescription (10, 50, 100, 250, 500 mg/L) groups, with 40 in each group. The culture fluid was changed every day and executed at the 8th day. Zebrafish juveniles were dyed using alizarin red for microscopic detection and digital imaging and the bone staining area was quantitatively analyzed by image software to evaluate the anti-osteoporosis activity of Bushen Tiaogan prescription. RESULTS AND CONCLUSION: The low-concentration Bushen Tiaogan prescription had no effect on embryo survival rate and hatching rate, while the high-concentration Bushen Tiaogan prescription could reduce embryo survival rate and hatching rate. Prednisolone, 25 μmol/L, was able to successfully induce significant loss of bone mass in zebrafish. Compared with the model group, 50, 100 and 250 mg/L Bushen Tiaogan prescription could resist prednisolone-induced zebrafish osteoporosis in a concentration-dependent manner. At low concentrations, there was no significant anti-osteoporosis effect, and at high concentrations, anti-osteoporosis effect showed a downward trend. These findings indicate that 25 μmol/L prednisolone successfully induces the establishment of zebrafish osteoporosis model, and successfully evaluates the initial safety of Bushen Tiaogan prescription. Bushen Tiaogan prescription begins to show an anti-osteoporosis effect at 50 mg/L, and has the most significant anti-osteoporosis effect at 250 mg/L. Figures and Tables | References | Related Articles | Metrics

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Establishment and evaluation of a cadaveric model of chronic strain-induced upper cervical spine instability based on fascia-bone theory Liang Long, Yu Jie, Wei Xu, Zhou Shuaiqi, Yin Xunlu, Liu Guangwei, Xie Rui, Xie Rong, Zhuang Minghui, Zhu Liguo, Feng Minshan 2020, 24 (20):  3152-3156.  doi: 10.3969/j.issn.2095-4344.2610 Abstract ( 441 )   PDF (19464KB) ( 117 )   Save BACKGROUND: Studies regarding the instability of upper cervical spine in cadaveric specimens are mostly based on an acute violence model, and there is still no chronic strain-induced upper cervical instability model. OBJECTIVE: To construct and evaluate the cadaveric model of the upper cervical spine instability caused by chronic strain according to the theory of “fascia and bone.” METHODS: Nine fresh cadaveric cervical spine specimens were prepared and the normal vertebral range of motion was detected by Motion Analysis Motion Capture System. The upper cervical spine instability model was constructed by using BOSE dynamic fatigue testing machine with maximum flexion, extension and rotation fatigue loading. Then, the vertebral range of motion was tested again. The anterior flexion, posterior extension, left flexion, right flexion, left and right rotation of the occipitoatlantoaxial joint, the atlantoaxial joint and the whole upper cervical spine were compared before and after modeling. The implementation of the study protocol complied with the relevant ethical requirements of Southern Medical University, and the specimens were voluntarily donated. RESULTS AND CONCLUSION: (1) During anterior flexion, the range of motion of the atlantoaxial joint (C1-2) and the entire upper cervical vertebra (C0-2) of the specimens after modeling was significantly larger than that before modeling (P < 0.05). During posterior extension, the range of motion of the atlantooccipital joint (C0-1) and the entire upper cervical vertebra (C0-2) of the specimens after modeling was significantly larger than that before modeling (P < 0.05). During both flexion and extension, the range of motion of the atlantoaxial joint (C1-2) and the entire upper cervical vertebra (C0-2) of the specimens after modeling was significantly larger than that of the pre-modeling specimen (P < 0.05). (2) During lateral flexion, the range of motion of the atlantooccipital joint (C0-1), the atlantoaxial joint (C1-2), and the entire upper cervical vertebra (C0-2) of the specimens after modeling was increased compared with that before modeling. However, there was no significant difference (P > 0.05). (3) During right rotation, the range of motion of the whole upper cervical spine (C0-2) of the specimens after modeling was significantly increased compared with that before modeling (P < 0.05). During both left and right rotation, the range of motion of the atlantoaxial joint (C1-2) and the whole upper cervical spine (C0-2) of the specimens was significantly larger than that of the specimens before modeling (P < 0.05). Therefore, this model can be used to reflect the state of upper cervical instability caused by chronic strain. Figures and Tables | References | Related Articles | Metrics

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Structure and mechanical properties of high- and low-weight-bearing areas of hip cartilage at micro and nano levels Guo Jiangbo, Liang Ting, Che Yanjun, Hou Junjun, Yang Huilin, Luo Zongping 2020, 24 (20):  3157-3161.  doi: 10.3969/j.issn.2095-4344.2608 Abstract ( 547 )   PDF (20157KB) ( 186 )   Save BACKGROUND: Articular cartilage has a high-weight-bearing area and a low-weight-bearing area. There are different macroscopic elastic moduli in the two regions, but the modulus of the two areas at the micro and nano levels is unknown. Such information is important for further understanding of cartilage micro and nano mechanics. Moreover, the micro and nano structures of the two areas, which influence the cartilage mechanical properties, should be discussed. OBJECTIVE: To investigate the mechanical properties and structure of high- and low-weight-bearing areas of the hip articular cartilage at the micro and nano levels. METHODS: Normal porcine femoral head cartilage was used. Atomic force microscopy with a spherical tip of 5 μm in diameter was used to measure the microscale compressive elastic modulus of different weight-bearing areas of the cartilage. The nanoscale compressive elastic modulus, nano structure, and collagen fiber diameter were measured using a ScanAsyst-Air probe with a radius of curvature of 5 nm. Scanning electron microscopy was employed to identify the microstructure of different weight-bearing areas of the cartilage. RESULTS AND CONCLUSION: The microscale elastic modulus of the high-weight-bearing area of the femoral head cartilage was (433.05±146.52) kPa, and the microscale elastic modulus of the low-weight-bearing area was (331.19±84.88) kPa. The nanoscale elastic modulus of the high- and low-weight-bearing areas of the femoral head cartilage was (1.24±0.42) GPa and (1.28±0.41) GPa, respectively. While no statistically significant differences were found in the elastic modulus of collagen fibers at the nano level (P=0.846 2). The collagen fibers of the high-weight-bearing area arranged more regularly than those of the low-weight-bearing area at the micro level. No significant differences between collagen fiber diameter of the two areas at the nano level were observed (P=0.926 4). To conclude, the collagen fibers of the high-weight-bearing area are cross-linked more regularly than those of low-weight-bearing area. Therefore, the compressive elastic modulus of the high-weight-bearing area at the micro level is significantly higher than that of the low-weight-bearing area, which is consistent with the macroscopic compressive elastic modulus trend. However, high-weight-bearing has no impact on individual collagen fibers at the nano level.  Figures and Tables | References | Related Articles | Metrics

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Three-dimensional finite element analysis of traction under different lumbar physiological curvatures Li Min, Zhou Ling, Wang Guizhen, Chen Jian 2020, 24 (20):  3162-3167.  doi: 10.3969/j.issn.2095-4344.2619 Abstract ( 483 )   PDF (24016KB) ( 34 )   Save BACKGROUND: In recent years, the finite element analysis of lumbar biomechanics has become a hot topic. Lumbar lordosis is considered to reduce the pressure load on the lumbar intervertebral disc and protect the lumbar spine. OBJECTIVE: To study the biomechanical effects of lumbar traction on L1-L5 lumbar segments in normal physiological curvature, flexion position and maximum overextension position, and to evaluate the optimal physiological curvature of lumbar traction.  METHODS: A healthy male volunteer, aged 26 years, with a height of 174 cm and a weight of 60 kg, was selected, who had no history of lumbar spine diseases. With the L3 segment as the traction site, a finite element model of the whole lumbar spine was established based on lateral radiographs of the lumbar spine at the initiation site and during the maximal overextension as photographed by a DR machine. Based on the three-dimensional finite element model of the lumbar spine, the stress values and distributions of the lumbar vertebrae, the intervertebral joints, the intervertebral discs and the anterior longitudinal ligaments of the whole lumbar spine under different physiological curvatures were calculated. The patient was fully informed of the study protocol and signed an informed consent. The study protocol was approved by the Ethics Committee of Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine. RESULTS AND CONCLUSION: (1) Under six kinds of simulated working conditions, the range of motion of L1-L2 was 9.31° for flexion and extension, 9.84° for right and left bending, and 4.43° for right and left rotation; the range of motion of L2-L3 was 10.22° for flexion and extension, 12.35° for left and right bending, and 4.57° for left and right rotation; the range of motion of L3-L4 was 11.20° for flexion and extension, 11.63° for left and right bending, and 5.32° for left and right rotation; the range of motion of L4-L5 was 13.16° for flexion and extension, 11.58° for left and right bending, and 5.05° for left and right rotation. Under the normal physiological curvature of the lumbar vertebrae, the stress value of different lumbar spine structures was much greater than the stress value of hyperextension traction. The normal curvature of the anterior longitudinal ligament was 2.47 MPa, and the curvature of hyperextension traction value was 21.20 MPa. The stress value of L3 was the highest, which was four times that of the hyperextension traction. The stress value of the intervertebral joints at L2-L3 and intervertebral disc was highest than that of any other segment of the lumbar spine. These findings indicate that the pressure of lumbar vertebrae, intervertebral joints and intervertebral discs in hyperextension position is less than that in normal physiological curvature traction, and the pressure of anterior longitudinal ligament is always within the safe range. Lumbar traction may have better clinical efficacy and definite security in hyperextension position. Figures and Tables | References | Related Articles | Metrics

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Facet joint injection versus percutaneous kyphoplasty for mild vertebral fragility fractures: rapid analgesia and restoration of spinal stability Luo Wei, Chen Jianping, Sun Qianqian, Chen Chen, Li Hang, Ma Chenglong, Su Rui, Feng Xiaoyue, Sun Yurui 2020, 24 (20):  3168-3173.  doi: 10.3969/j.issn.2095-4344.2609 Abstract ( 412 )   PDF (23803KB) ( 53 )   Save BACKGROUND: Percutaneous kyphoplasty (PKP) for the treatment of osteoporotic compression fractures has been widely recognized in clinical practice, but clinicians are still impelled to seek for new treatment regimens due to complications such as bone cement leakage and adjacent vertebral re-fracture. OBJECTIVE: To compare the therapeutic efficacy of facet joint injection (FJI) and PKP in the treatment of mild vertebral fragility fractures. METHODS: Forty-six patients with mild vertebral fragility fractures (osteoporotic fractures) were divided into FJI group and PKP group according to the treatment regimens. The two groups of patients were treated with FJI and PKP separately based on standardized anti-osteoporosis treatment. The data of each group were recorded before and 1 week, 1, 3, 6, and 12 months after treatment. The analgesic efficacy was evaluated by visual analogue scale (VAS) and Oswestry disability index (ODI). Spine stability was evaluated by anterior vertebral height, kyphotic angle and lumbar spine density and the incidence of re-fracture were compared. The study protocol was implemented in line with the ethic requirements of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences in China. Informed consent was obtained from each patient. RESULTS AND CONCLUSION: Intragroup comparison: VAS and ODI scores of patients in both groups were significantly decreased in each period after treatment compared with the baseline (P < 0.05), and vertebral bone density was significantly increased at the 12th month after treatment (P < 0.05). The anterior vertebral height and kyphosis angle of the PKP group were better than the baseline (P < 0.05). Intergroup comparison: At the 1st week and 1st month after treatment, the VAS and ODI scores of the FJI group were significantly higher than those of the PKP group (P < 0.05), while at the 3rd, 6th, and 12th month, there was no significant difference between the two groups (P > 0.05). After treatment, the anterior vertebral body height and kyphosis angle in the PKP group were better than those in the FJI group (P < 0.05), and there was no significant difference in the incidence of re-fracture (P > 0.05). Standardized anti-osteoporosis treatment with either FJI or PKP can provide effective analgesia for patients with mild vertebral fragility fracture, and PKP has certain advantages in rapid analgesia and recovery of spinal stability. Figures and Tables | References | Related Articles | Metrics

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Regulatory mechanism of the extracellular matrix during the development of bone-tendon junction overuse injury Chen Xiaolan, Liang Xiaotian, Zhang Ning, Liu Haitao, Qu Yi, Wang Bo, Wang Lin 2020, 24 (20):  3174-3179.  doi: 10.3969/j.issn.2095-4344.2696 Abstract ( 302 )   PDF (23913KB) ( 48 )   Save BACKGROUND: Overuse tendinopathy is a common disease with no ideal treatment because the pathogenesis of tendinopathy is still unclear. OBJECTIVE: To explore the effects of enzymes affecting collagen synthesis on the metabolism of collagen I and collagen III during load accumulation in a model of patella-patellar tendon junction overuse injury. METHODS: Thirty-two adult female New Zealand white rabbits were randomly divided into a jumping group (n=16) and a control group (n=16). In the jump group, rabbits were subjected to jump training for 2, 4, 6, and 8 weeks, 150 jumps per day, 5 days per week. No intervention was performed in the control group. Bilateral patella-patellar tendon junction samples were taken at 24 hours after 2-, 4-, 6-, and 8- week training. The time-series changes of matrix metalloproteinase 1 (MMP1), tissue inhibitor of metalloproteinase 1 (TIMP1), collagen I, and collagen III were measured by immunohistochemistry. The study was performed with an ethic approval from the Animal Ethical Committee of Beijing Sport University, China (approval No. BSU2015022). RESULTS AND CONCLUSION: Compared with the control group, the MMP1 activity was significantly lower within the first 6 weeks of training, TIMP1 activity was significantly higher at 4-8 weeks of training, and TIMP1/MMP1 was significantly higher at 4-8 weeks of training. Compared with the control group, the expression of collagen I was significantly increased in the first 6 weeks of training, but the expression of collagen III was significantly lowered after 8 weeks of training. TIMP1 activity was significantly positively correlated with collagen I expression, and MMP1 activity was significantly negatively correlated with collagen I expression. To conclude, the patella-patellar tendon junction, during jumping load accumulation, mainly responded to load stimulation by increasing collagen I expression. In the first 2 weeks of load accumulation, the expression of collagen I was mainly increased by inhibiting MMP1 activity; in the period of 4 to 6 weeks of load accumulation, the expression of collagen I was mainly increased by increasing the activity of TIMP1 and inhibiting the activity of MMP1; and after 8 weeks of load accumulation, TIMP1 could promote collagen synthesis but with inability to antagonize the degradation of collagen I and III by MMP1. Then the expression of collagen I decreased from the peak level after 6 weeks of training to the control group level, and the level of collagen III decreased to be less than the level of the control group. Figures and Tables | References | Related Articles | Metrics

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Effect of AMPK/PGC1 alpha on improving skeletal muscle atrophy in type 2 diabetic rats by aerobic exercise Wang Ji, Yang Zhongya, Zhang Long, Li Wenbo, Zhou Yue 2020, 24 (20):  3180-3185.  doi: 10.3969/j.issn.2095-4344.1913 Abstract ( 533 )   PDF (25430KB) ( 68 )   Save BACKGROUND: The regulation of mitochondrial energy metabolism by adenylate activated protein kinase (AMPK) is an important cause of fat accumulation in obese and type 2 diabetic patients. Chronic inflammation will further induce skeletal muscle atrophy. Aerobic exercise can increase the activity of AMPK and regulate energy metabolism, but the mechanism of aerobic exercise in improving skeletal muscle atrophy in type 2 diabetes by increasing AMPK is unclear. OBJECTIVE: To explore the effect of aerobic exercise on skeletal muscle atrophy in type 2 diabetic rats and the role of AMPK. METHODS: The model of type 2 diabetic rats was established by high fat feeding and streptozotocin injection, and the rats were divided into four groups: control group (n=6), exercise group (n=9), diabetic control group (n=8) and diabetic exercise group (n=12). The control group and the diabetic control group were kept for 4 weeks, and the exercise group and the diabetic exercise group were given aerobic exercise intervention for 4 weeks. After 4 weeks of aerobic exercise (running speed 16 m/min, 60 min/d, 5 days/week), the muscle atrophy of soleus was observed by immunohistochemical staining. The expression levels of AMPK, PGC-1 α, MAFbx and MuRF1 were detected by western blot assay. The study protocol was approved by the Ethical Committee of School of Sport Science, Beijing Sport University in China on June 25, 2016, with approval No. 2016014. RESULTS AND CONCLUSION: Blood glucose of type 2 diabetes rats was significantly increased, and body weight and insulin levels of type 2 diabetes rats were significantly decreased (P < 0.01). The mean cross sectional area of soleus fiber in the diabetic group was significantly lower than that in the control group (P < 0.01), and the cross sectional area of soleus muscle fiber in the diabetic exercise group was significantly higher than that in the diabetic group (P < 0.01). The expression levels of AMPK and PGC-1 α in the soleus muscle of diabetic rats were significantly lower than those in the control group, and the expression levels of MAFbx and MuRF1 were significantly higher than those in the control group (P < 0.01). The expression levels of AMPK, MAFbx and MuRF1 in the diabetic exercise group were significantly higher than those in the diabetic group (P < 0.01). These results suggest that aerobic exercise can improve mitochondrial function, inhibit the expression of MAFbx and MuRF1, improve skeletal muscle atrophy and restore the metabolic balance of type 2 diabetes mellitus to some extent by activating AMPK/PGC-1α signaling pathway. Figures and Tables | References | Related Articles | Metrics

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Correlation between apoptosis rate and expression of Bcl-2, Bax and tumor necrosis factor alpha in diabetic foot ulcer with different disease courses Zheng Min, Yin Xueli, Huang Suqun 2020, 24 (20):  3186-3190.  doi: 10.3969/j.issn.2095-4344.2578 Abstract ( 383 )   PDF (21661KB) ( 58 )   Save BACKGROUND: Non-healing of refractory ulcer wounds is found to be associated with imbalance of apoptosis and dysregulation of inflammation. Previous studies have sampled a certain type of tissue in different individuals, but individual differences maybe exist among the study data. There is still no report on the correlation between apoptotic rate, expression levels of Bcl-2, Bax, Bax/Bcl-2 and tumor necrosis factor α (TNF-α) in wound tissue of diabetic foot ulcer with different disease courses. OBJECTIVE: To study the relationship between apoptotic rate and expression levels of Bcl-2, Bax and TNF-α in the wound tissue of diabetic foot ulcer with different disease courses and the mechanism of action. METHODS: Fifteen patients with typical diabetic foot of Wagner grades 2-3 were selected from the Department of Emergency, Chongqing Medical University. The wound tissue was classified as necrotic, transitional and normal tissue using the “4C” method after infection control. The apoptotic rate and levels of Bcl-2, Bax, TNF-α and Bax/Bcl-2 were detected using immunohistochemistry, and the results were statistically analyzed. The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Chongqing Medical University, with the approval No. (2019)329. All patients signed an informed consent. RESULTS AND CONCLUSION: The apoptotic rates of normal, transitional and necrotic tissues of diabetic foot were significantly different, which were (16.67±2.48)%, (43.68±2.22)% and (72.12±4.53)%, respectively (P < 0.01). Significant differences in Bcl-2, Bax, TNF-α and Bax/Bcl-2 levels were also found in normal, transitional and necrotic tissues (P < 0.01). The Bcl-2 level was ranked as necrotic tissue < transitional tissue < normal tissue; and the Bax, TNF-α, and Bax/Bcl-2 levels were ranked as necrotic tissue > transitional tissue > normal tissue. There was a curve relationship between Bcl-2, Bax, Bax/Bcl-2, TNF-α expression and apoptotic rate. The curvilinear regression analysis indicated that the expression of TNF-α had a highly positive correlation with the expression of Bax and Bax/Bcl-2 and had a highly negative correlation with the expression of Bcl-2. Therefore, apoptotic mechanism and inflammatory reaction are involved in the pathological process of diabetic food ulcer, and the mechanism may be related to the down-regulation of Bcl-2 expression, up-regulation of Bax and TNF-α expression, and increase of Bax/Bcl-2, thereby increasing the apoptotic rate. Figures and Tables | References | Related Articles | Metrics

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Preparing an animal model of critical femoral defect in rabbit femoral condyle and the critical bone defect size Xu Shizhuang, Wang Jin, Pan Wenzhen, Liu Lei, Yang Guangjie, Zhao Fengchao 2020, 24 (20):  3191-3195.  doi: 10.3969/j.issn.2095-4344.2614 Abstract ( 897 )   PDF (21418KB) ( 143 )   Save BACKGROUND: Rabbit model of distal femoral bone defect has been widely used to test bone tissue engineering materials for bone defects. However, there is no uniform standard for the size of the cylindrical bone defect model of the rabbit femoral condyle, which ranges 5-9 mm in diameter and 8-12 mm in depth. OBJECTIVE: To establish the bone defect model of adult rabbit femoral condyle with different sizes and to determine the critical bone defect size of the femoral condyle METHODS: Eighteen male New Zealand White rabbits aged 6 months were randomly divided into three groups according to the diameter of bone defect: 5 mm diameter group, 6 mm diameter group, and 7 mm diameter group. The defect depth was 10 mm. These rabbits underwent bilateral radial surgery, a total of 12 sides. Computed Tomography (CT) scan and three-dimensional reconstruction were performed at 1 day, 4, 8, 12 weeks after surgery. The CT-Hedberg score was used to evaluate the healing of bone defects. The rabbits were sacrificed at 12 weeks after surgery, and the femoral condyle specimens were taken out. Healing of the defect was analyzed by gross observation and hematoxylin-eosin staining. The study protocol was approved by the Animal Ethics Committee of Xuzhou Medical University. RESULTS AND CONCLUSION: All rabbits survived after surgery. The gross observation showed that the defect of 5 mm diameter group was filled with new bone tissue, the femoral condyle was well shaped, and the bone defect was completely repaired. In 6 mm and 7 mm diameter groups, depressed deformation was obviously observed in the defect area, with less new bone tissue, and the defect was was not repaired. The CT images showed that the defect area of 5 mm diameter group gradually decreased, and the broken ends of the defect were bridged. In the defect area of 6 mm and 7 mm diameter groups, only a small amount of new bone tissue was implanted, and the defect area was slightly reduced. At the 12th week after surgery, the cortical bone structure of 5 mm diameter group was intact and continuous, the femoral condyle was well shaped, and the bone defect was completely repaired. The defects of 6 mm and 7 mm diameter groups were partially or not repaired, and the defect cavity was still visible in the 7 mm diameter group. The CT-Hedberg scores of 6 mm diameter group were significantly lower than those of 5 mm diameter group at different time points (P < 0.05), and there was no significant difference in the CT-Hedberg scores between 6 mm and 7 mm diameter groups (P > 0.05). Histological results showed that there were irregular trabecular structures in the defect area of 5 mm diameter group, with a large amount of new bone tissue. In the other two groups, there were some new bone trabeculae around the bone defect, but the defect area was less filled with new bone tissue. During the 12-week observation period, the femoral condyle defect with a diameter of > 6 mm and a depth of 10 mm could not heal spontaneously, while the defect with a diameter of < 6 mm could be completely repaired, which met the criteria of critical bone defect. Therefore, the diameter of < 6 mm could be used as the critical bone defect size of rabbit femoral condyle. Figures and Tables | References | Related Articles | Metrics

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Ultrasound-guided platelet-rich plasma injection for repair of sciatic nerve crush injury Zhu Yaqiong, Jin Zhuang, Wang Jing, Fang Jie, Li Chaochao, Hu Yongqiang, Tian Xiaoqi, Zhang Ying, Song Qing, Wang Yuexiang, Luo Yukun 2020, 24 (20):  3196-3201.  doi: 10.3969/j.issn.2095-4344.2581 Abstract ( 396 )   PDF (23669KB) ( 264 )   Save BACKGROUND: Platelet-rich plasma (PRP) contains growth factors that affect tendon, ligament, muscle and bone healing. On this basis, researchers gradually realize that such molecules released after PRP activation can regulate the early inflammation of peripheral nerve injury, activate Schwann cells, promote the polarization of macrophages, and actively prevent the hyperplasia of collagen fibers, thus becoming the key drivers of nerve function recovery. OBJECTIVE: To evaluate the value of ultrasound-guided PRP injection in the repair of sciatic nerve crush injury. METHODS: Twenty-eight healthy New Zealand white rabbits (provided by the Beijing Longan Experimental Animal Breeding Center) were randomly divided into normal group, control group, single PRP group and multiple PRPs group. In the normal group, the right sciatic nerve was exposed and then sutured directly. In the control group, a compression injury model of the right sciatic nerve was established. In the single PRP group, autologous PRP was injected around the injured nerve under ultrasound guidance at 24 hours after modeling. In the multiple PRPs group, autologous PRP was injected around the injured nerve under ultrasound guidance at 24 hours after modeling, and then the PRP injection was performed once at the 3rd and 5th weeks after modeling. Histological and morphological observation of regenerated nerves, wet weight recovery and histological manifestations of the denervated muscle were evaluated at 12 weeks after modeling. The study protocol was approved by the Administrative Committee of Experimental Animals in PLA General Hospital with the approval No. 2015-x10-02. RESULTS AND CONCLUSION: The integral optical density values of NF-200 and S100 staining, myelinated nerve fiber density, myelinated nerve fiber diameter and myelin sheath thickness were significantly increased in the single PRP and multiple PRPs groups compared with the control group (all P < 0.05), and the multiple PRPs group showed better outcomes than the single PRP group (all P < 0.05), but was still inferior to the normal group (all P < 0.05). Compared with the control group, wet weight and cross-sectional area of muscle fibers significantly increased in the single PRP group and multiple PRPs group (P < 0.05), and the multiple RPRs group showed better outcomes than the single PRP group, but was still inferior to the normal group (P < 0.05). To conclude, ultrasound-guided multi-frequency injection of autologous PRP has a good effect on the repair of sciatic nerve crush injury. Figures and Tables | References | Related Articles | Metrics

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Effects of hypoxic exercise on Nesfatin-1 and Ghrelin in hypothalamus of rats with alimentary obesity Fan Jinqin, Weng Xiquan, Xu Guoqin, Wu Juhua, Lin Wentao 2020, 24 (20):  3202-3208.  doi: 10.3969/j.issn.2095-4344.2558 Abstract ( 412 )   PDF (31449KB) ( 46 )   Save BACKGROUND: Balanced diet and scientific exercise are generally accepted as safe, effective and economical body mass management interventions. However, exercises sometimes increase the appetite of dieters. Combining hypoxic environment stimulation with aerobic exercise intervention may achieve the best effect on weight loss. As the central part of the body that regulates food intake and energy balance, the hypothalamus is concerned about the relationship between its regulating factors and the pathogenesis of obesity. OBJECTIVE: To observe the levels of nesfatin-1 and ghrelin in the hypothalamus of obese rats, so as to explore the neuroendocrine mechanisms of feeding and body mass by hypoxia and/or exercise. METHODS: Sixty Sprague-Dawley male rats with alimentary obesity were divided into six groups: quiet group, aerobic exercise group, 16.3% hypoxia quiet group, 16.3% hypoxic exercise group, 13.3% hypoxia quiet group and 13.3% hypoxic exercise group. A low-oxygen generator was used to create hypoxia environment at a volume fraction of 16.3% oxygen and 13.3% oxygen. Under hypoxia environment, the rats were continuously fed with high-fat food, and subjected to a treadmill exercise, 20 m/min (0° slope), 40 min/d, 5 days per week for 8 continuous weeks. Body mass and food intake were recorded, and Lee’s index was calculated. Levels of nesfatin-1 and ghrelin in the rat hypothalamus were measured after intervention by means of ELISA kit. RESULTS AND CONCLUSION: (1) The body mass and Lee’s index after intervention: the effect of simple hypoxic environment stimulation on body mass and Lee’s index of rats was not as obvious as that of simple aerobic exercise stimulation. When hypoxic environment was combined with exercise, the effect was better than that of single stimulation. (2) Daily food intake during the intervention period: The daily food intake remained stable in the normoxic quiet group, and decreased in all other groups decreased, especially in the 16.3% hypoxic exercise group and 13.3% hypoxic exercise group. (3) Levels of nesfinin-1 and ghrelin in the hypothalamus: hypoxia combined with exercise could change nesfinin-1 levels in the hypothalamus of rats, and the nesfinin-1 level was highest in the 13.3% hypoxic exercise group. Exercise or hypoxia alone could affect the ghrelin level in the hypothalamus of rats, and the effect of single exercise stimulation was better than that of single hypoxia stimulation. Moreover, the combination of exercise and hypoxia made a further reduction in the ghrelin level. (4) Bivariate analysis of variance: Body mass and ghrelin level were affected by exercise; body mass, Lee’s index and food intake were affected by O2 concentration; and body mass, nesfinin-1 and ghrelin levels were affected by exercise×O2 concentration. These findings indicate that 8-week hypoxic exercise may decrease the rats’ food intake, inhibit the increase of body mass and reduce the Lee’s index by regulating nesfinin-1 and ghrelin levels in the hypothalamus, but the specific mechanism is not clear. Figures and Tables | References | Related Articles | Metrics

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Biomechanical characteristics of children’s different strike patterns during running Zhao Panchao, Wen Ruixiang, Li Jiahui, Ji Zhongqiu, Jiang Guiping 2020, 24 (20):  3209-3216.  doi: 10.3969/j.issn.2095-4344.2604 Abstract ( 526 )   PDF (31526KB) ( 43 )   Save BACKGROUND: Foot strike patterns in adults during running have always been the focus of worldwide research, and the strike patterns of children are also something that cannot be ignored. OBJECTIVE: Using biomechanical methods to explore the differences in kinematics and kinetics of children in different strike patterns during the running process, and to provide a scientific basis for children’s correct way of running. METHODS: Seventy-four children were randomly selected from a public kindergarten in Haidian District, Beijing, and were divided into 3-year-old group, 4-year-old group and 5-year-old group. The kinematics and kinetics data of enrolled children in different strike patterns during running were acquired simultaneously using the BTS infrared motion capture system, the Kistler three-dimensional force table and the VIXTA video analysis system. The muscle strength index of the lower limbs was calculated using the Anybody 5.2 simulation modeling software. Before participation in the trial, children’s parents were fully informed of study protocol and signed the informed consent form. The trial protocol met the relevant ethical requirements of Beijing Normal University. RESULTS AND CONCLUSION: (1) In the 3-year-old group, the proportion of mid foot strike (MFS) was the highest, and the proportion of fore foot strike (FFS) was the lowest. In the 5-year-old group, the proportion of MFS was the lowest, and the proportion of FFS was the highest. The rear foot strike (RFS) extension time was longer than that of FFS (P < 0.01) and MFS (P < 0.05). (2) At the moment of landing, the flexion angle of FFS was greater than that of RFS (P < 0.01) and MFS (P < 0.05), and the flexion angle of MFS was greater than that of RFS (P < 0.05). The hip adduction-abduction angle of RFS was greater than that of FFS (P < 0.01) and MFS (P < 0.05). The maximum hip abduction angle of RFS was greater than that of FFS (P < 0.01) and MFS (P < 0.01). The amount of joint changes in the RFS hip adduction and abduction was greater than that of FFS (P < 0.01) and MFS (P < 0.05). The minimum flexion and extension of RFS was greater than that of FFS (P < 0.05). The maximal hip adduction-abduction angular velocity of RFS was greater than that of FFS (P < 0.05), and the maximal knee adduction-abduction angular velocity of RFS was greater than that of FFS (P < 0.01) and MFS (P < 0.05). (3) The muscle strength of the short bones of the tibia, the long tibia and the third metatarsal muscle of FFS and MFS was greater than that of RFS (P < 0.05). The bundle muscle strength of the medial femoral muscle, the lateral femoral muscle bundle, the lateral femoral muscle bundle, the medial femoral muscle bundle, the medial femoral muscle bundle, and the medial femoral muscle of RFS were greater than that of FFS (P < 0.01) and MFS (P < 0.05). (4) In the 3-6 years old, children often run in the heel or full-foot landing mode to meet their stability during the running process. As the age increases, the running pattern with the forefoot landing gradually appears. To keep the movement steady, RFS can trigger more hip and knee frontal motions, FFS and MFS can offer more muscle strength on the anterior and posterior sides of the calf, while RFS can offer more muscle strength on the anterior side of the thigh. Figures and Tables | References | Related Articles | Metrics

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Nell-1 in bone tissue engineering Jin Liangyu, Li Weiming 2020, 24 (20):  3217-3225.  doi: 10.3969/j.issn.2095-4344.2546 Abstract ( 344 )   PDF (54990KB) ( 173 )   Save BACKGROUND: Nel-like type 1 molecule (Nell-1) is a secreted glycoprotein that has been proven both in vitro and in vivo to be a potent osteoinductive factor that effectively promotes bone growth. Furthermore, it has been shown to repress adipogenic differentiation and inflammation. OBJECTIVE: To review the current research progress of Nell-1 in bone tissue engineering. METHODS: PubMed database was searched for relevant articles published from January 1996 to June 2019. Search words were “Nell-1; bone regeneration and repair; regulatory factor; signal path; bone morphogenetic protein; osteoporosis; marrow derived mesenchymal stem cells.” After removal of repetitive studies and inconsistent literature, 61 articles were finally analyzed. RESULTS AND CONCLUSION: Nell-1 has been proved to be a factor that can effectively promote bone tissue growth. Local application of Nell-1 has a good effect on the growth of long bone, spine and cartilage as well as cranial suture closure. Nell-1 is a new growth factor that has relatively simple bioeffects, so it has better biosafety and higher accuracy relative to the other bone growth factors. Nell-1 can synergize with other osteogenic factors such as bone morphogenetic proteins 2, 9. Nell-1 inhibits inflammatory reaction and lipogenesis induced by bone morphogenetic protein 2 and promotes osteogenesis. This provides a theoretical basis for the combination of Nell-1 and bone morphogenetic protein 2 to improve the clinical safety and efficacy in bone regeneration. Figures and Tables | References | Related Articles | Metrics

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Important roles of growth hormone-releasing peptide in bone growth and development Ye Nan, Huang Jian, Wang Dan 2020, 24 (20):  3226-3233.  doi: 10.3969/j.issn.2095-4344.2540 Abstract ( 681 )   PDF (48377KB) ( 45 )   Save BACKGROUND: Growth hormone-releasing peptide (Ghrelin) can promote the secretion of growth hormones, regulate the balance of energy metabolism and have some unknown pharmacological properties, which are closely related to the body’s metabolic state. OBJECTIVE: To review the regulatory effect of Ghrelin on skeletal cell function and its integration in bone metabolism and energy metabolism, in order to clarify the important role of Ghrelin in skeletal development. METHODS: PubMed database was searched for relevant literature published from January 1993 to January 2017. Search words were “ghrelin, bone metabolism, leptin, osteoblast, osteoclast, castric resection, cartilage cells.” After removal of repetitive studies and inconsistent literature, 74 eligible articles were included in final analysis. RESULTS AND CONCLUSION: The remodeling of the body’s skeletal system is a highly energy-consuming process. Correspondingly, the growth and development of the skeleton involves the energy metabolism of peripheral and central nervous systems, including the sympathetic nervous system and hormones such as leptin. Recent studies abroad have shown that Ghrelin can regulate the differentiation and function of osteoblasts, induce the proliferation and differentiation of bone marrow stem cells, and regulate the state of Ghrelin-insulin axis in different ways. Ghrelin can also regulate bone metabolism and energy metabolism through interaction with leptin, thus affecting the skeletal growth. Figures and Tables | References | Related Articles | Metrics

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Trends in global research on bone and joint tuberculosis: bibliometrics and visual analysis  He Xiaoming, Gong Shuidi, Zheng Xiaolong, Shen Yingshan, Pang Fengxiang, Chen Lixin, Li Weifeng, Yang Fan, Liu Shaojun, He Wei, Wei Qiushi 2020, 24 (20):  3234-3239.  doi: 10.3969/j.issn.2095-4344.2462 Abstract ( 373 )   PDF (34131KB) ( 79 )   Save BACKGROUND: Herein, we investigate the research status and development trend of bone and joint tuberculosis in recent years, and deepen the understanding of bone and joint tuberculosis, which may provide clues for early diagnosis and timely treatment of bone and joint tuberculosis. OBJECTIVE: To analyze the global research status and development trend of bone and joint tuberculosis. METHODS: Web of science was searched for publications addressing bone and joint tuberculosis from 1994 to 2018. Retrieval data were statistically analyzed by bibliometrics method. The Vos viewer software was used for the visualization transformation of co-occurrence analysis and co-production analysis. The current situation and trend of bone and joint tuberculosis in recent years were then analyzed. RESULTS AND CONCLUSION: A total of 2 761 studies were included in the study, indicating a global increase in the number of publications year by year. The United States has the largest number of publications, highest times cited and H index. China ranks 3rd in global literature publication, 12th in total citations and 13th in the H index. Publications in PloS One, Journal of Immunology and Infection and Immunity rank top three. The University of Central South, the University of Cape Town and University College London are the top three institutions in terms of the number of publications. Studies on bone and joint tuberculosis could fall into six categories: early diagnosis and treatment of tuberculosis, treatment and complications of spinal tuberculosis, characteristics of pathogenesis in bone and joint tuberculosis, molecular detection of bone and joint tuberculosis, cytology of bone and joint tuberculosis, and relationship between osteoarthritis tuberculosis and immunology. GeneXpert MTB/RIF may become the hot research topic. The trend of global research on bone and joint tuberculosis indicates that literature regarding bone and joint tuberculosis is increasing, and the United States is the largest contributor. Current studies have focused on the diagnosis and treatment of bone and joint tuberculosis, and the relationship between GeneXpert MTB/RIF and bone and joint tuberculosis may become the hot research topic. Figures and Tables | References | Related Articles | Metrics

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Analysis of physiological and biomechanical factors affecting running economy Li Tianyi, Xu Lin, Xu Shengjia 2020, 24 (20):  3240-3247.  doi: 10.3969/j.issn.2095-4344.2699 Abstract ( 770 )   PDF (754KB) ( 127 )   Save BACKGROUND: Running economy is considered as an important indicator of the performance of endurance athletes, especially long-distance runners. It is usually defined as the energy demand of running at a given speed, and expressed as the oxygen intake at a given speed. OBJECTIVE: To review the existing physiological and biomechanical factors affecting the running economy of runners. METHODS: With “running economy, physiological factors, biomechanical and neuromuscular characteristics, spatiotemporal factors, lower limb kinematic factors, kinetic factors, nutritional interventions” as search terms, PubMed database (1960-2018) was searched to include literatures related to running performance, acute or chronic interventions, and other influencing factors. RESULTS AND CONCLUSION: A total of 113 literatures were obtained. According to the inclusion and exclusion criteria, 58 literatures were analyzed. Current evidence shows that cardiopulmonary function, muscle fiber type, muscle strength, leg stiffness and other physiological factors are related to the improvement of running economy. However, there is no unified conclusion on the relationship between the temperature change of runners and the elastic potential energy and running economy. The biomechanical factors that are beneficial to improve running economy include stride frequency or length, vertical oscillation, lower limb moment of inertia, leg extension when toes are off the ground, and arm swing. However, the contact time between the feet and the ground, trunk inclination and other factors are inconsistent with running economy. Among other influencing factors, high-altitude adaptation can improve running economy; the relationship between extensibility and flexibility and running economy remains to be determined. Some nutritional interventions are also of concern, most notably dietary nitrates. Although most of the factors affecting running economy have been summarized in this paper, future studies can focus on individual runners in order to determine how the athlete's structure and functional abilities affect running economy, as well as subsequent performance and athletic injuries. Figures and Tables | References | Related Articles | Metrics

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Alternative treatment for liver failure repair: current status and development countermeasures Guo Wei, Lu Shan, Fan Hong, Li Jun 2020, 24 (20):  3248-3255.  doi: 10.3969/j.issn.2095-4344.2529 Abstract ( 586 )   PDF (798KB) ( 90 )   Save BACKGROUND: In order to solve the problem that the clinical application of liver transplantation is limited by the shortage of supply sources of liver, scientists from all over the world are actively exploring and have successively studied and developed technical means such as artificial liver, tissue-engineered liver and xenotransplantation. It can be used as a corrective or alternative treatment for liver failure. OBJECTIVE: To expound the development history, research status and future expectation of repair and alternative treatment for liver failure. METHODS: Relevant articles published from 2000 to 2019 were searched in the Web of Science and WanFang databases. The keywords were “active liver, liver tissue engineering, hepatic failure” in English and Chinese, respectively. RESULTS AND CONCLUSION: For advanced liver diseases such as liver failure, there are some repair and alternative treatments, including in situ liver transplantation, cell transplantation, artificial liver system, and tissue-engineered liver. To date, a number of hospitals and institutions in China have independently developed artificial liver devices. Although bioartificial liver and mixed artificial liver have shown good prospects in the treatment of liver failure, most of them are still in the experimental stage of animals. Further investigations on the development of bioreactors to enhance cell survival in scaffolds are necessary. Tissue-engineered liver constructed by biological materials and seed cells can to some extent simulate the physiological functions of liver synthesis, detoxification, metabolism, and secretion, which can be transplanted into the body to treat end-stage liver disease. It is a research hotspot in the field of tissue function. Efforts to solve the clotting problem and to promote the vascular formation of scaffold are warranted in this field. Xenograft is the best way to solve the serious shortage of human organ donors, but there is still a long way for this technique away from clinical application. Figures and Tables | References | Related Articles | Metrics

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Mechanism by which autophagy-mediated exercise improves bone metabolic disorder in type 2 diabetes Lu Pengcheng, Chen Xianghe, Yang Kang, Yu Huilin, Liu Bo 2020, 24 (20):  3256-3262.  doi: 10.3969/j.issn.2095-4344.2684 Abstract ( 433 )   PDF (819KB) ( 49 )   Save BACKGROUND: Autophagy can regulate bone metabolism disorders in type 2 diabetes mellitus via nuclear factor KB receptor activating factor ligand, mammalian target of rapamycin, Wnt/β-catenin pathway, and p38 mitogen-activated protein kinase. OBJECTIVE: To analyze and summarize the role and possible molecular mechanism of autophagy to improve bone metabolism disorder in type 2 diabetes mellitus. METHODS: Using “autophagy; exercise; type 2 diabetes mellitus; bone metabolism” as keywords, we retrieved literature regarding autophagy for improving bone metabolism disorder in type 2 diabetes mellitus in PubMed and China Knowledge Network, and logically analyzed and summarized the included studies. RESULTS AND CONCLUSION: Autophagy can improve bone metabolism disorders in type 2 diabetes mellitus through activation of signaling pathways, such as PPAR-γ, Hedgehog, MITF, and peroxisome proliferator-activated receptors. Autophagy can up-regulate the differentiation capacity of osteoblasts, down-regulate the absorption capacity of osteoclasts in type 2 diabetes mellitus, and has an important effect on bone formation and osteocalcin mineralization. Figures and Tables | References | Related Articles | Metrics

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Research target and progress in hemoglobin-based oxygen carriers Yang Kang, Zhao Huimin 2020, 24 (20):  3263-3268.  doi: 10.3969/j.issn.2095-4344.2463 Abstract ( 534 )   PDF (736KB) ( 95 )   Save BACKGROUND: As a kind of blood substitutes, hemoglobin-based oxygen carriers have been studied for more than 40 years. The research efforts to achieve this goal have so far gone through three different generations of hemoglobin-based oxygen carriers. While the first and second generations entail the hemoglobin’s chemical modification, the third generation of hemoglobin-based oxygen carriers involves the encapsulation of hemoglobin within a synthetic membrane. OBJECTIVE: To summarize the latest progress in hemoglobin-based oxygen carriers. METHODS: Using “hemoglobin-based oxygen carriers, red blood cell substitutes, artificial oxygen carriers, artificial blood” as the key words in Chinese and English, respectively, we retrieved the related literatures on the preparation of hemoglobin-based oxygen carriers published from 2000 to 2019 in PubMed, CNKI, and WanFang databases. RESULTS AND CONCLUSION: Hemoglobin from fetus, invertebrate, and reptilian and β-subunit mutant hemoglobin have certain advantages in the preparation of hemoglobin-based oxygen carriers. Latest progress has been made mainly in the modification and encapsulation of hemoglobin. And combined use of other drugs can reduce the vascular toxicity of hemoglobin-based oxygen carriers. Some new possibilities in the application of hemoglobin oxygen carriers have been found, but the application of new hemoglobin-based oxygen carriers as red blood cell substitutes needs more animal experiments and clinical trials in the future. Figures and Tables | References | Related Articles | Metrics

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Autophagy and epigenetic modification in inflammatory bowel disease Guo Yajing, Huang Yan, Shi Yin 2020, 24 (20):  3269-3274.  doi: 10.3969/j.issn.2095-4344.2532 Abstract ( 474 )   PDF (733KB) ( 106 )   Save BACKGROUND: Inflammatory bowel disease is a chronic inflammatory disease associated with intestinal immune, and autophagy is a cell approach to promote immune regulation. Abnormal expression of autophagy-related genes is closely related to intestinal inflammation and immune response. However, the mechanism by which epigenetic modification regulates autophagy in inflammatory bowel disease has not been fully clarified. OBJECTIVE: To introduce the role of epigenetic modification in autophagy, and to promote a further understanding of inflammatory bowel disease. METHODS: A computer-based online research of PubMed database was performed with the key words of “inflammatory bowel disease, autophagy, autophagy-related genes, epigenetic modification, DNA methylation, histone modification, chromatin remodeling, miRNA.” The search time was from January 1998 to April 2019. Finally, 61 eligible articles were included in result analysis. RESULTS AND CONCLUSION: Epigenetic modifications such as DNA methylation, histone modification, chromatin remodeling, non-coding RNA can regulate intestinal inflammation, immune and autophagy through susceptibility genes AGL and IRGM, thereby mediating the occurrence and development of inflammatory bowel disease. Figures and Tables | References | Related Articles | Metrics

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Fibroblast growth factor 21 regulates browning of white fat: the role of exercise Wang Lu, Yu Liang 2020, 24 (20):  3275-3280.  doi: 10.3969/j.issn.2095-4344.2647 Abstract ( 688 )   PDF (774KB) ( 61 )   Save BACKGROUND: Fibroblast growth factor 21 (FGF-21) is a newly discovered metabolic regulator that has been expressed in various tissues and organs such as liver, fat and skeletal muscle. Numerous studies have shown that FGF-21 is involved in the browning of white fat, but there is less review of this aspect worldwide. Especially the mediation of exercise is still controversial. OBJECTIVE: To explore the inducing factors and mechanism of FGF-21 regulating the browning of white fat, especially the effects of exercise on it, in order to provide new targets for the treatment of obesity and related metabolic diseases. METHODS: A computer-based search of CNKI and PubMed databases was performed for relevant articles published from January 2001 to July 2019 using the keywords of “FGF-21, browning, exercise, fat” in Chinese and English, respectively. Finally, 45 eligible articles were included in results analysis according to the inclusion criteria. RESULTS AND CONCLUSION: FGF-21 can enter the blood in autocrine, endocrine and paracrine patterns to regulate glycolipid metabolism, improve insulin resistance, prevent liver disease, and promote the browning of white fat. Exercise can induce the secretion and expression of FGF-21, thereby effectively regulating the activation of brown fat and browning of white fat to achieve fat loss. Due to differences in exercise patterns, exercise intensity, and exercise time, the current process of exercise-mediated FGF-21 involvement in the browning of white fat needs further study. Figures and Tables | References | Related Articles | Metrics