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18 September 2020, Volume 24 Issue 26 Previous Issue    Next Issue

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Combination of hip geometry mechanics and fracture risk assessment tool to predict fracture risk in middle-aged and elderly women Ye Yunjin, Li Jianyang, Ge Jirong, Xu Huijuan, Chen Sainan, Xie Lihua, Li Li 2020, 24 (26):  4101-4105.  doi: 10.3969/j.issn.2095-4344.2758 Abstract ( 406 )   PDF (20595KB) ( 360 )   Save BACKGROUND: Hip geometric mechanics indicates a mechanical study of hip structure (cortical thickness) based on dual energy X-ray absorptiometry images, which is a better compensation for the deviation of bone density. The fracture risk assessment tool (FRAX) can combine fracture probability with multiple clinical risk factors and bone density of the femoral neck to predict the probability of hip fracture within 10 years and the probability of major osteoporotic fractures (spine, forearm, hip or shoulder fracture). OBJECTIVE: To analyze the hip geometry mechanics and the correlation between the FRAX@ tool and fractures in middle-aged and elderly women, and to explore the clinical significance of the combination method to predict the risk of fragility fracture in middle-aged and elderly women. METHODS: A retrospective study of 1 089 middle-aged female subjects was conducted. According to the questionnaire, there were 225 cases of fractures and 864 cases of non-fractures. Bone mineral density was measured using a dual-energy X-ray absorptiometry, and hip geometrical parameters were analyzed using HSA software: cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), cross-sectional modulus (Z), cortical bone thickness (Cort) and the buckling ratio (BR) value. The FRAX@ tool was used to calculate the fracture rate at the main site and hip fracture rate over the next 10 years. The study was approved by the Ethics Committee of Fujian Institute of Traditional Chinese Medicine. RESULTS AND CONCLUSION: The age of the fracture group was significantly higher than that of the non-fracture group. The hip geometrical parameters of the two groups were compared: lumbar vertebra bone density, femoral neck bone density, CSA, CSMI, Cort, Z were significantly higher in the non-fracture group than the fracture group, while BR was lower in the non-fracture group than the fracture group. Logistic regression analysis of hip geometry mechanics indicated that Cort was a possible protective factor for fracture (odds ratio=0.000, 95% confidence interval: 0.000-0.000). FRAX calculation and analysis of different age groups indicated that the fracture rate at the main site and hip fracture rate of the fracture group were significantly higher than those of the non-fracture group in the next 10 years. In conclude, there is a significant correlation between hip geometric mechanics and fracture. The Cort of the femoral neck is a possible protective factor for fracture, and FRAX@ has a clinical guiding value for predicting fracture. The combination of the two can better predict osteoporotic fracture. Figures and Tables | References | Related Articles | Metrics

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Guided bone regeneration combined with kidney-tonifying therapy for repairing femoral bone defect in rats Xie Lei, Zhang Yan, Jiang Ziwei, Shen Zhen, Feng Junming, Hao Chengyi, Cai Yangting 2020, 24 (26):  4106-4111.  doi: 10.3969/j.issn.2095-4344.2665 Abstract ( 430 )   PDF (27987KB) ( 38 )   Save BACKGROUND: Guided bone regeneration technology, as a most widely used method for repairing bone defects, has been extensively used in the field of stomatology. However, there are few reports on the guided bone regeneration technology in long bone defects. OBJECTIVE: To explore the effects of guided bone regeneration combined with kidney-tonifying therapy on the repair of femoral bone defects in rats, and investigate its osteogenic efficacy and underlying mechanism. METHODS: Thirty-six Sprague-Dawley rats were randomly divided into six groups: blank group, guided bone regeneration group, high-, moderate-, and low-dose kidney-tonifying groups, and ossotide tablets group. The femur bone defect model of rats was established, and was treated by guided bone regeneration except for blank group. Bio-Gide collagen membrane combined with autologous bone was implanted by guided bone regeneration. The kidney-tonifying groups were given 0.216, 0.108 and 0.054 g/(kg•d) Qianggu capsule via gavage for 8 weeks. The ossotide tablets group was given 0.58 mg/(kg•d) ossotide tablets via gavage for 8 weeks. At 12 weeks after surgery, the osteogenesis was evaluated by X-ray examination, hematoxylin-eosin staining and Masson staining of bone tissue. The mRNA expression levels of alkaline phosphatase, Runx-2, vascular endothelial growth factor and bone morphogenetic protein-2 in bone tissues were detected by quantitative real-time RT-PCR. RESULTS AND CONCLUSION: Results of X-ray examination and hematoxylin-eosin staining and Masson staining of bone tissue showed that the scores of Lane Sandhu and Huddleston in each group were significantly higher than those in the blank group (P < 0.001). The scores in the high- and moderate-dose kidney-tonifying groups were significantly higher than those in the guided bone regeneration group (P < 0.01). RT-PCR results showed that the mRNA expression levels of alkaline phosphatase, Runx-2, vascular endothelial growth factor and bone morphogenetic protein-2 in bone tissue in the high- and moderate-dose kidney-tonifying groups were significantly higher than those in the blank group (P < 0.01), and were superior to the guided bone regeneration group (P < 0.05). In summary, guided bone regeneration combined with kidney-tonifying can significantly promote the repair of femoral bone defects, reduce bone absorption and improve osteogenic efficacy in rats. The mechanism of promoting bone regeneration and angiogenesis may be by up-regulating the expression of related osteogenic factors and angiogenic factors in the environment where the membrane barrier creates a dominant growth of bone tissue. Figures and Tables | References | Related Articles | Metrics

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Guided bone regeneration using preformed titanium mesh combined with bioabsorbable membranes in aesthetic area Zhang Xuan, Li Yunpeng, Zhang Xuejian, Yin Chuanrong, Deng Yue 2020, 24 (26):  4112-4117.  doi: 10.3969/j.issn.2095-4344.2760 Abstract ( 381 )   PDF (21976KB) ( 35 )   Save BACKGROUND: Absorbable and non-absorbable barrier membranes have their own merits and demerits in the guided bone regeneration. OBJECTIVE: To investigate the clinical effect of new preformed titanium mesh combined with different bone augmentation materials in anterior teeth with inadequate bone volume for dental implants. METHODS: Thirty-one patients with single maxillary anterior tooth loss were divided into three groups: Bio-Gide collagen membrane + Bio-oss bone group (C; n=12), titanium mesh + Bio-Gide collagen membrane + Bio-Oss bone group (TC; n=10), titanium mesh + concentrated growth factor + Bio-Gide collagen membrane + Bio-Oss bonegroup (TCC; n=9). Through clinical review, cone-beam CT and histological examination, osteogenic effects of the three treatment methods were compared and statistically analyzed at 0 day and 6 months after operation. The implementation of the study protocol complied with the relevant ethical requirements of Qingdao Stomatological Hospital, and each patient was fully informed of the trial process. RESULTS AND CONCLUSION: In the postoperative review, only two patients in the TC group had wound deformations, and the wound healed about 3 weeks postoperation. Six months after the operation, cone-beam CT results revealed significant differences in bone height between the TCC and TC groups and the C group (P < 0.05), as well as in bone width at the mark points of 2, 4 and 6 mm (P < 0.05). There was no significant difference in bone width between three groups at the mark point of 8 mm (P > 0.05). Hematoxylin-eosin staining of bone tissue around the implant showed that trabecular structure was visible in all three groups, but the structures was more mature and denser in the TCC group and sparser in the C group. These findings indicate that titanium mesh has good space maintenance function, better maintains the stability of bone graft material, and enhances the osteogenesis effect to a certain extent. Concentrated growth factors may promote soft tissue healing. Figures and Tables | References | Related Articles | Metrics

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Aerobic exercise combined with levothyroxine and vitamin D3 relieves osteoporosis in subclinical hypothyroidism rats Wen Shuangwei, Wu Qingmei 2020, 24 (26):  4118-4124.  doi: 10.3969/j.issn.2095-4344.2761 Abstract ( 529 )   PDF (30785KB) ( 46 )   Save BACKGROUND: Levothyroxine can significantly improve the symptoms of subclinical hypothyroidism, and some studies have pointed out that levothyroxine can partially improve the abnormal bone metabolism of experimental rats, but the therapeutic effect of levothyroxine on subclinical hypothyroid osteoporosis is rarely studied. OBJECTIVE: To observe the effects of aerobic exercise combined with levothyroxine and vitamin D3 on the symptoms of osteoporosis in subclinical hypothyroidism rats. METHODS: Wistar rats were divided into blank control group, sham-operated group and model group. The thyroid function was measured to determine whether the model was successfully established. The model group rats were further divided into eight groups: non-treatment group, exercise group, L-thyroxine group, vitamin D3 group, exercise + levothyroxine group, exercise + vitamin D3 group, levothyroxine + vitamin D3 group and exercise + levothyroxine + vitamin D3 group, with another normal control group. At the 52th day after treatments, the bone resorption markers, β isomer of C-terminal telopeptide of type I collagen (β-CTX) and tartrate-resistant acid phosphatase-5b (TRACP-5b), and the bone formation markers, bone-specific alkaline phosphatase (BLAP), type I procollagen amino-terminal propeptide (PINP), and serum osteocalcin (BGP) were detected. Bone mineral density of the rat skull, spine, upper limb and lower limb was scanned. Serum calcium and phosphorus levels and cathepsin K level in the right femur were measured. Hematoxylin-eosin staining of the rat femoral head was performed. RESULTS AND CONCLUSION: At the modeling stage, serum thyroid-stimulating hormone (TSH) level of rats in the model group was significantly higher than that in the sham-operated group and blank control group (P < 0.05). But there was no significant difference in serum T3 and T4 among the groups, indicating that the subclinical hypothyroidism rat model was successfully established. After treatment, compared with the rats without levothyroxine treatment, serum TSH levels in the rats of the levothyroxine group, the levothyroxine + vitamin D3 group, the exercise + levothyroxine group and the exercise + levothyroxine + vitamin D3 group were significantly decreased (P < 0.05), while the levels of T3 and T4 were not significantly changed. But the levels of β-CTx, TRACP-5b, BLAP, PINP, BGP and BMD in rats with levothyroxine treatment were significantly increased compared with those without levothyroxine treatment (P < 0.05). And the rats in the exercise + L-thyroxine + vitamin D3 group had the most significant improvement on the bone metabolism indexes and BMD (P < 0.05). Serum calcium and phosphorus levels of the rats in the levothyroxine + vitamin D3 group and the exercise + levothyroxine + vitamin D3 group were significantly higher than those in other groups with no vitamin D3 (P < 0.05). The rats in the levothyroxine group, the exercise + levothyroxine group, the levothyroxine + vitamin D3 and the exercise + levothyroxine group + vitamin D3 had the lower level of Cathepsin K level in femoral tissue than those in the other groups (P < 0.05). Moreover, the morphology of bone trabecular tissue was significantly improved in the rats with levothyroxine treatment than those with no levothyroxine treatment. To conclude, subclinical hypothyroidism can lead to osteoporosis in rats. Supplementation of levothyroxine is the most critical step of the treatments. Vitamin D3 can relieve osteoporosis by increasing serum calcium and phosphorus levels. Aerobic exercise can significantly enhance the improvement effect of levothyroxine and vitamin D3 on subclinical hypothyroidism osteoporosis. Therefore, comprehensive treatment of levothyroxine, vitamin D3 and aerobic exercise should be emphasized in the treatment of subclinical hypothyroidism osteoporosis. Figures and Tables | References | Related Articles | Metrics

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Effect of continuous loading pressure on apoptosis and Wnt/beta-catenin signaling pathway in nucleus pulposus cells Yin Xunlu, Zhu Liguo, Feng Minshan, Yu Jie, Zhan Jiawen, Liang Long, Han Tao 2020, 24 (26):  4125-4128.  doi: 10.3969/j.issn.2095-4344.2762 Abstract ( 444 )   PDF (18764KB) ( 143 )   Save BACKGROUND: Previous studies have found that continuous loading pressure can induce intervertebral disc degeneration by reducing the number of nucleus pulposus cells and reducing the expression of extracellular matrix in the nucleus pulposus. However, its mechanism of action is unclear. OBJECTIVE: To study the effect of continuous loading pressure on apoptosis and Wnt/β-catenin signaling pathway in nucleus pulposus cells. METHODS: The in vitro models of rabbit spinal motion segment under loading pressure were established and divided into control group (no treatment), pressure group (3 kg continuous loading pressure) and observation group (3 kg continuous loading pressure + 20 μmol/L SB216763). After 3 days of intervention, the pathological changes of nucleus pulposus cells were detected by hematoxylin-eosin staining, and the expression of caspase-3 and GSK-3β protein in nucleus pulposus tissue was detected by western blot assay. RESULTS AND CONCLUSION: Compared with the control group, the expression of Caspase-3 and GSK-3β protein increased significantly under the continuous load pressure (P < 0.05). Compared with the pressure group, the expression of Caspase-3 and GSK-3β protein decreased significantly in the observation group (P < 0.05). Pathological examination showed that the number of nucleus pulposus cells in the pressure group was reduced accompanied by morphological changes of the cells. In the observation group, the number of nucleus pulposus cells was relatively large and the cell morphology was relatively regular. In conclusion, continuous loading pressure can regulate Caspase-3 and GSK-3βexpression via Wnt/beta-catenin signaling pathway, and promote the apoptosis of nucleus pulposus cells. Figures and Tables | References | Related Articles | Metrics

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Mogroside V stimulates osteoblast proliferation and differentiation by promoting LncRNA TUG1 expression Yao Shunhan, Wei Huacheng, Qin Jiagang, Liao Liang 2020, 24 (26):  4129-4134.  doi: 10.3969/j.issn.2095-4344.2735 Abstract ( 412 )   PDF (22755KB) ( 35 )   Save BACKGROUND: Osteoporosis is a balance disorder between bone formation of osteoblasts and bone resorption of osteoclasts during bone remodeling. Strict control of bone remodeling at the cellular level is important to maintain bone homeostasis and avoid osteoporosis. Previous studies have shown that 1.25×10-2 g/L mogroside V can promote osteoblast proliferation and differentiation, and its mechanism may be related to LncRNA TUG1. OBJECTIVE: To investigate the role of LncRNA TUG1 in the promotion of osteoblast proliferation and differentiation by mogroside V. METHODS: Osteoblasts from neonatal Sprague-Dawley rats were extracted by two-step enzymatic digestion. The cells were divided into two groups and treated with 0 and 1.25×10-2 g/L Mogroside V. The LncRNA was detected after 2 days of culture. LncRNA TUG1 silencing virus was designed and synthetized. The newly extracted osteoblasts were divided into normal cell control group, mogroside V intervention group, mogroside V+negative virus group, TUG1 silent group, and mogroside V+TUG1 silent group. The proliferation of osteoblasts was observed by FDA fluorescence staining at 2, 4, and 6 days after processing according to the above grouping conditions. After 6 days of treatment on osteoblasts, the effect of TUG1 on osteoblast proliferation and differentiation was studied by alkaline phosphatase staining, alizarin red staining and qRT-PCR. RESULTS AND CONCLUSION: LncRNA detection showed that 1.25×10-2 g/L Mogroside V significantly promoted the expression of LncRNA TUG1 in osteoblasts. FDA fluorescent staining showed that silencing of TUG1 inhibited the positive effect of mogroside V on osteoblast proliferation. After 6 days of treatment, alkaline phosphatase staining and alizarin red staining showed that silencing of TUG1 inhibited the positive effect of mogroside V on mineralization of osteoblasts. The results of qRT-PCR showed that Runx2, BSP, OCN and COL1A1 genes were highly expressed in the mogroside V intervention group, but their expression was inhibited in the mogroside V+TUG1 silent group. Overall findings indicate that mogroside V stimulates the proliferation and differentiation of osteoblasts by promoting the expression of LncRNA TUG1. Figures and Tables | References | Related Articles | Metrics

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Arthroscopic osteochondral autografts with Wenyang Yisui Recipe for repairing cartilage lesions of the knee Zhang Peng, Jing Lin, Di Dongxue, Zhang Hongmei 2020, 24 (26):  4135-4140.  doi: 10.3969/j.issn.2095-4344.2763 Abstract ( 423 )   PDF (22233KB) ( 39 )   Save BACKGROUND: Wenyang Yisui Recipe is developed based on Yougui Pills according to many years of clinical practice. The clinical application of Wenyang Yisui Recipe in the treatment of early knee osteoarthritis as a prophylactic and therapeutic treatment has achieved favorable clinical effect.  OBJECTIVE: To investigate the clinical efficacy of Wenyang Yisui Recipe combined with arthroscopic osteochondral autografts in the treatment of cartilage lesions of the knee. METHODS: Eighty-three patients under arthroscopic osteochondral autografts for cartilage lesions of the knee were enrolled, including 49 males and 34 females, aged 40 to 67 years old, with an average of (50.2±4.8) years old. The course of disease ranged from 1 to 27 months, with an average of (12.3±5.2) months. According to the Doll’s method, all the patients were divided into study group and control group. The patients in the study group received arthroscopic osteochondral autografts, followed by oral Wenyang Yisui Recipe, 300 mL per day in two divided doses, beginning at 2 days postoperatively for 2 continuous weeks as a session, three sessions in total. The control group only undertook arthroscopic osteochondral autografts. The Lysholm score and visual analogue scale score were used for assessing the knee function and pain, respectively, before surgery and 3 months after surgery. The study protocol was implemented in line with the relevant ethical requirements of Wang Jing Hospital, China Academy of Chinese Medical Sciences in February 2014 (approval No. 221). RESULTS AND CONCLUSION: All patients were followed up for 3 months after surgery. The study group was superior to the control group in the improvement of knee joint pain and swelling score at 3 months after surgery, and the intergroup difference was statistically significant (P < 0.05). The visual analogue scale score was significantly better in the study group than the control group at 3 months after surgery (P < 0.001). The visual analogue scale scores in the two groups were both improved at 3 months after surgery (P < 0.001). Therefore, arthroscopic osteochondral autografts combined with oral Wenyang Yisui Recipe can significantly ameliorate knee pain and function, with definite clinical effects. Figures and Tables | References | Related Articles | Metrics

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The use of epigallocatechin gallate prevents white spot lesions during orthodontic treatment with fixed appliances Yang Liuqing, Xie Lili, Liang Jianmei 2020, 24 (26):  4141-4145.  doi: 10.3969/j.issn.2095-4344.2710 Abstract ( 356 )   PDF (19243KB) ( 131 )   Save BACKGROUND: Plenty of studies have already proved the effective usage of epigallocatechin gallate (EGCG) in clinical treatment. However, no current research has focused on the application of EGCG in preventing white spot lesions (WSLs) during orthodontics treatment with fixed appliances. OBJECTIVE: To study the value of EGCG in the prevention of WSLs during orthodontic treatment with fixed appliances. METHODS: In total 50 patients undergoing orthodontic treatment with fixed appliances were carefully screened and enrolled. Split-mouth design was adopted: the right side of teeth received experimental adhesive (1 g/L EGCG + Adper™ Single Bond 2); the left side of teeth acted as control. All the other clinical procedures and materials used were same. The enamel demineralization index (EDI) and the WSLs prevalence of targeted teeth (16, 11, 46, 26, 31, and 36) were detected at 3, 6, and 12 months during the treatment, and the percentage of bracket bonding failure was calculated for each group. The study protocol was implemented in line with the relevant ethical requirements of Liuzhou People’s Hospital. Patients and their guardians were fully informed of the whole trial procedures. RESULTS AND CONCLUSION: In this trial, the percentage of bracket bonding failure was significantly different between the EGCG group and control group (P > 0.05). After 3 months of treatment, the values of WSLs and EDI had no significant difference between the EGCG group and control group (P > 0.05). However, after 6 months and 12 months treatment, the EGCG group manifested significantly lower WSL and EDI values than the control group (P < 0.05). Therefore, addition of the adhesive containing 1 g/L EGCG has a considerable effect in preventing enamel demineralization and the occurrence of WSLs without influencing the enamel bonding strength, and it has a long-time effect which deserves the clinical expansion. Figures and Tables | References | Related Articles | Metrics

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Grape seed proanthocyanidins antagonize osteocyte apoptosis due to steroid-induced osteonecrosis of the femoral head Zhang Zhifeng, Wei Jing, Sun Tao, Song Jinling, Zhao Zhenqun, Huang Jian 2020, 24 (26):  4146-4151.  doi: 10.3969/j.issn.2095-4344.2759 Abstract ( 371 )   PDF (28570KB) ( 43 )   Save BACKGROUND: Steroid-induced avascular necrosis of the femoral head has a complex biological process, and its pathogenesis is unknown. To date, there is no effective treatment in clinical practice. Therefore, exploring the etiology of steroid-induced avascular necrosis of the femoral head is still an important content of research in this field. OBJECTIVE: To explore the effect of grape seed proanthocyanidins on osteocyte apoptosis due to steroid-induced osteonecrosis of the femoral head.   METHODS: Twenty-seven Japanese white rabbits were randomly divided into three groups. The model group was intravenously injected with E. coli endotoxin, 100 μg/kg, twice at an interval of 24 hours. Two injections of E. coli endotoxin were followed by intramuscular injection of methylprednisolone 20 mg/kg, for 3 times. The interval was 24 hours. The treatment group was intravenously injected with E. coli endotoxin, 100 μg/kg, twice at an interval of 24 hours. After the second injection of E. coli endotoxin, methylprednisolone 20 mg/kg and grape seed proanthocyanidin extract 200 μg/kg were injected intramuscularly three times at an interval of 24 hours. The control group was treated with the same dose of saline intravenously. The animals were killed by air embolization at the 4th week after the last injection. Under the relatively aseptic condition, the bilateral femoral heads were routinely fixed, decalcified, embedded and sliced. Histomorphological observation and hematoxylin-eosin staining were performed to count empty bone lacunae under light microscope. Hoechst staining was used to detect cell apoptosis. The expressions of Caspase-9 and Bcl-2 in the femoral head were detected by immunohistochemical staining. RESULTS AND CONCLUSION: The percentage of empty bone lacunae in the model group was significantly higher than that in the control group (P < 0.01). The percentage of empty bone lacunae in the treatment group was significantly lower than that in the model group (P < 0.05), but still higher than that in the control group (P < 0.01). There were few apoptotic cells in the femoral head of the control group, but a large number of apoptotic cells with densely stained nuclei in the model group. The number of apoptotic cells in the treatment group was reduced, but still higher than that in the control group (P < 0.01). The average absorbance value of Caspase-9 in the model group was significantly higher than that in the control group (P < 0.01). The average absorbance value decreased significantly in the treatment group as compared with the model group (P < 0.01), but there was no significant difference between the treatment and control groups. The average absorbance value of Bcl-2 in the model group was significantly lower than that in the control group (P < 0.05). The average absorbance value of Bcl-2 increased significantly in the treatment group as compared with the model group (P < 0.01). These findings indicate that osteocyte apoptosis is involved in the occurrence and development of steroid-induced osteonecrosis of the femoral head. Grape seed proanthocyanidins may inhibit osteocyte apoptosis by promoting the expression of Bcl-2 and inhibiting the expression of Caspase-9.  Figures and Tables | References | Related Articles | Metrics

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Electrical stimulation promotes wound healing and angiogenesis in diabetic rats Geng Kang, Ding Xiaobin, Tian Xinli, Wang Xue, Yang Yuting, Yan Hong 2020, 24 (26):  4152-4156.  doi: 10.3969/j.issn.2095-4344.2734 Abstract ( 462 )   PDF (21829KB) ( 110 )   Save BACKGROUND: Diabetic wound healing disorder is one of the common complications of diabetes, but its pathogenesis has not yet been elucidated. Electrical stimulation therapy is one of the commonly used methods in the clinical treatment of wound injury, which can effectively promote the healing of injured skin. OBJECTIVE: To investigate the effects of electrical stimulation therapy on wound healing and angiogenesis in diabetic rats and its potential mechanism.  METHODS: Forty-two SPF male Sprague-Dawley rats were enrolled in this study. A rat model of diabetic refractory wounds was established in 24 rats by tail vein injection of streptozotocin (50 mg/kg) combined with back skin wounds, and model rats were randomly divided into model group and electrical stimulation group. Meanwhile, normal rats were taken to cause back wounds as a blank control group. The electrical stimulation group was treated with electrical stimulation for 21 days. The blank control group and the model group were fed normally. The wound healing was evaluated on the 3rd, 7th, 14th and 21st days after treatment. After treatment, the rat serum and wound tissue were taken for index detection. The pathological morphology of rat wounds was observed by hematoxylin-eosin staining. The serum endothelial nitric oxide synthase, angiopoietin 1 and vascular endothelial growth factor levels were detected by enzyme-linked immunosorbent assay. The expression levels of angiopoietin receptor 2 and vascular endothelial growth factor receptor 2 proteins were detected by immunohistochemistry and western blot. An ethical approval was obtained from the Animal Experimental Ethics Committee of the Affiliated Hospital of Southwest Medical University. RESULTS AND CONCLUSION: The wound healing rate of diabetic rats was close to 90% on the 14th day after electrical stimulation, while the healing rate in the model group was less than 60% (P < 0.01). The serum endothelial nitric oxide synthase, angiopoietin 1 and vascular endothelial growth factor levels were significantly higher in the electrical stimulation group than the model group (P < 0.05 or P < 0.01). Meanwhile, compared with the model group, the electrical stimulation group had more neovascularization, larger vascular lumen, higher expression of angiopoietin receptor 2 and vascular endothelial growth factor receptor 2 around the blood vessels (P < 0.05 or P < 0.01). These findings indicate that electrical stimulation therapy can significantly promote wound healing and neovascularization in diabetic rats, and its mechanism is related to the increase of endothelial nitric oxide synthase, angiopoietin 1 and vascular endothelial growth factor levels and up-regulation of angiopoietin receptor 2 and vascular endothelial growth factor receptor 2 levels. Figures and Tables | References | Related Articles | Metrics

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Clinical assessment criteria of donor pancreas transplants for simultaneous pancreas-kidney transplantation Liu Luhao, Fang Jiali, Zhang Lei, Li Guanghui, Xu Lu, Lai Xingqiang, Xiong Yunyi, Chen Rongxin, Ma Junjie, Chen Zheng 2020, 24 (26):  4157-4161.  doi: 10.3969/j.issn.2095-4344.2733 Abstract ( 386 )   PDF (20845KB) ( 124 )   Save BACKGROUND: Simultaneous pancreas-kidney transplantation is the main method for the treatment of end-stage diabetic nephropathy. The quality of donor pancreas is directly related to the surgical safety and long-term survival of the recipient. However, there is yet no unified standard for the evaluation of pancreatic-kidney transplantation in China. OBJECTIVE: To summarize the assessment criteria of donor pancreas transplants base on 63 cases of donation after brain death. METHODS: From September 2016 to November 2018, clinical data of potential pancreas donors after brain death, donor acquisition, and simultaneous pancreas-kidney transplantation were evaluated in the Second  Affiliated Hospital of Guangzhou Medical University in China. Pancreas and kidney transplants were from organ donation launched by organ procurement organizations, and the diagnoses of brain death were based on the Criteria for Determination of Brain Death in Adults. We rigorously evaluated and screened potential donors based on the pancreas donor criteria for simultaneous pancreas-kidney transplantation. RESULTS AND CONCLUSION: A total of 168 potential pancreas donors after brain death were subjected to rigorous assessment and 63 donor pancreas transplants for simultaneous pancreas-kidney transplantation were successfully obtained. The time for cold ischemia was 145-320 minutes. Sixty-three transplant recipients were all operated with the ipsilateral simultaneous pancreas-kidney transplantation. The operation was successful in all the 63 patients. One patient needed to take oral antihyperglycemic drugs, and one patient had a demand for insulin therapy to control the blood glucose level in normal range. The levels of blood glucose in the other patients were normal with no need of oral antidiabetic drugs and insulin, and the outcome of treatment was satisfactory. To conclude, we provide a simple but effective way to assess pancreas allograft quality, improve the utilization of donor pancreas, and achieve favorable operation outcomes.   Figures and Tables | References | Related Articles | Metrics

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Effect of electrical stimulation on local microvessel regeneration and expression of plasma endothelin-1 and nitric oxide in a rat model of myofascial trigger points Liu Fei, Yuan Shiguo, Zhang Shifei, Chen Huanliang, Lin Wentao, Jing Yajun 2020, 24 (26):  4162-4168.  doi: 10.3969/j.issn.2095-4344.2736 Abstract ( 313 )   PDF (30181KB) ( 34 )   Save BACKGROUND: Plenty of evidences have revealed that electrical stimulation (ES) can promote local tissue vascular regeneration and regulate the expression of vasoactive substances, but it is unclear whether ES may promote local revascularization and change blood flow state in myofascial trigger points (MTrPs) or not. OBJECTIVE: To investigate the effect of ES on microvascular regeneration and plasma endothelin-1 and nitric oxide levels in MTrPs. METHODS: Fifty-four Sprague-Dawley rats were randomly divided into blank control, model and ES groups, with 18 rats in each group. And each group was equally subdivided into three subgroups (before, 7 and 15 days after intervention). In the model and ES groups, the rat model of MTrPs was established using combat and eccentric motion. Once the MTrPs model was made, the ES group was given ES intervention (depth: 2 mm, voltage: 6 V, frequency: 20 Hz, pulse width: 160 ms) at MTrPs, 30 minutes per day, for 15 days. Six rats from each group were executed at 7 and 15 days of intervention. Paraffin sections were manufactured for hematoxylin-eosin and immunohistochemical staining after the local tissues of MTrPs were dissected and separated. Subsequently, pathological changes were observed under light microscope. Microvessel density was counted and analyzed. The levels of plasma endothelin-1 and nitric oxide were detected by ELISA. The study protocol was approved by the Experimental Animal Ethics Committee of the Nanfang Hospital of Southern Medical University in China. RESULTS AND CONCLUSION: The changes of brittleness and insect-likes erosion in local MTrps tissues were observed under the light microscope in the model and ES groups. The micro-vessel density in MTrps increased and the tissue structure of MTrps gradually returned to be normal after ES intervention. The microvessel density in the model and ES groups was lower than that in the blank control group before intervention, but the microvessel density in the ES group was significantly higher than that in the other two groups at 7 and 15 days of intervention (both P < 0.01). In the ES group, the microvessel density was significantly increased with time after intervention. There was no statistically significant difference between the blank control and model group (P > 0.05). The levels of plasma endothelin-1 and nitric oxide were higher in the model and ES groups than the blank control group before intervention. After 15 days of intervention, the levels of plasma endothelin-1 in the ES group were decreased (P < 0.01, vs. 0 and 7 days), while the level of nitric oxide was slightly increased at 7 and 15 days of intervention (P < 0.01, vs. the former time point). There was no statistically significant difference between the blank control and model groups (P > 0.05). These results reveal that ES intervention can promote the regeneration of microvessels and regulate the expression of vasoactive substances in MTrPs tissue, improve ischemia and hypoxia state of MTrPs and contribute greatly to local tissue repair. Figures and Tables | References | Related Articles | Metrics

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Electroacupuncture stimulation of Foot-Yangming Stomach Meridian regulates mRNA and protein expression of Bax and Bcl-2 in spinal cord injury rats Wu Fan, Xu Quan, Zhou Binbin, Wei Weibing, Wang Zhu, Yan Chaolang 2020, 24 (26):  4169-4175.  doi: 10.3969/j.issn.2095-4344.2764 Abstract ( 395 )   PDF (28501KB) ( 45 )   Save BACKGROUND: Traditional Chinese medicine has proposed the theory that “treatment for flaccidity aims at Yangming meridian” in the Internal Canon of Medicine. However, relatively few reports focus on electroacupuncture at the Stomach Meridian of Foot-Yangming for the treatment of spinal cord injury. From the perspectives of Bcl-2 and Bcl-2 expression, the mechanism of electroacupuncture intervention at the Stomach Meridian of Foot-Yangming for the treatment of spinal cord injury was preliminarily explored in this study. OBJECTIVE: To investigate the effect of electroacupuncture on the expression of Bax and Bcl-2 in injured segments of spinal cord injury rats. METHODS: Sixty-four Sprague-Dawley female rats (SPF level) were randomly divided into four groups: control group, pre-labeling group, post-injury labeling group and electroacupuncture group, with 16 rats in each group. The control group and the pre-labeling group were given intraperitoneal injection of Brdu (5 mg/kg) for 10 continuous days prior to the operation to label the cells that had differentiation ability and vitality in the spinal cord. The control group underwent laminectomy at T10 segment on the 11th day of labeling, while a model of spinal cord injury was induced by the clamp method in the pre-labeling group. The post-injury labeling group and the electroacupuncture group were injected intraperitoneally with BrdU (5 mg/kg) for 10 continuous days to mark the activated and proliferated cells. In the electroacupuncture group, electroacupuncture stimulation was done at Zusanli and Futu acupoints of Foot-Yangming Stomach Meridian on the 3rd day after modeling, 5 times a week. Four rats were taken from each group at 3, 10, 17, and 24 days after modeling (0, 7, 14, and 21 days after electroacupuncture stimulation). Basso, Beattie and Bresnahan scores were used to evaluate the motor function, and the expressions of Bax and Bcl-2 protein and gene in the spinal cord were detected using qRT-PCR and western blot. RESULTS AND CONCLUSION: At 3-24 days after surgery, the neurological scores in the pre-labeling group, post-injury labeling group, and electroacupuncture group were significantly lower than those in the control group (P < 0.05). The neurological scores of the electroacpuncture group were significantly higher than those in the pre-labeling group and post-injury labeling group (P < 0.05). With the prolongation of spinal cord injury time, the mRNA and protein expressions of Bax increased first and then decreased, while the mRNA and protein expression of Bcl-2 decreased first and then increased. The ratio of Bax/Bcl-2 decreased gradually with the lapse of electroacupuncture intervention time. To conclude, electroacupuncture stimulation of the Stomach Meridian of Foot-Yangming can reduce apoptosis of nerve cells, and promote recovery of motor function in spinal cord injury rats by regulating the expression of Bcl-2 and Bax.  Figures and Tables | References | Related Articles | Metrics

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Macrolide antibiotics protects against ischemia-reperfusion injury after liver transplantation in rats Yang Feng, Chang Lipu, Huang Changshan, Gong Xiaoguang, Chang Shunwu 2020, 24 (26):  4176-4182.  doi: 10.3969/j.issn.2095-4344.2732 Abstract ( 349 )   PDF (28423KB) ( 47 )   Save BACKGROUND: Liver transplantation is the standard treatment for end-stage liver disease and liver failure. However, ischemia-reperfusion injury can reduce the success rate of liver transplantation. When a limited number of liver donors are available for transplantation, how to reduce liver ischemia-reperfusion injury has become the primary issue in liver transplantation. OBJECTIVE: To evaluate the effect of macrolide antibiotics on ischemia-reperfusion injury after liver transplantation in rats. METHODS: Rat autologous orthotopic liver transplantation model was constructed. Wistar rats were randomly divided into macrolide antibiotics group and control group. In the macrolide antibiotics group, the donor liver was treated with macrolide antibiotics (60 mg/kg roxithromycin, 20 mg/kg clarithromycin and 40 mg/kg erythromycin) 30 minutes before hepatectomy, and the above macrolide antibiotic mixture was injected into the portal vein immediately after orthotopic liver transplantation. In the control group, rats were pretreated with the same volume of saline for 30 minutes before hepatectomy, and the same volume of saline was injected into the portal vein immediately after orthotopic liver transplantation. The survival rate of the rats was observed within 7 days after liver transplantation. The serum aspartate aminotransferase and alanine aminotransferase activities were detected by automatic biochemical analyzer at 48 and 72 hours after liver transplantation. Hematoxylin-eosin staining and immunohistochemistry assay were used to detect the morphological changes of liver tissues and the number of Ki-67 positive cells in liver transplantation rats. TUNEL and western blot assay were used to detect the number of apoptotic hepatocytes and the expression of caspase-3 and cleaved caspase-3 proteins in liver transplantation rats, respectively. The Kupffer cell number changes and levels of interleukin-6, interleukin-1β, and tumor necrosis factor-α in rat liver tissues after liver transplantation were detected by immunofluorescence and ELISA, respectively. RESULTS AND CONCLUSION: Macrolide antibiotics increased the overall survival rate of liver transplanted rats, improved the dysfunction of transplanted liver, reduced the severity of ischemia-reperfusion injury after liver transplantation, increased the regenerative capacity of transplanted liver, reduced the number of apoptotic cells and the ratio of cleaved caspase-3/caspase-3 in the transplanted liver tissue, and decreased the number of Kupffer cells and the levels of interleukin-6, interleukin-1β and tumor necrosis factor-α in the transplanted liver. All the results indicate that macrolide antibiotics protect against ischemia-reperfusion injury in rats undergoing liver transplantation. Figures and Tables | References | Related Articles | Metrics

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The significance of immunoregulatory receptor TIGIT expression in thymus and peripheral blood mononuclear cells in an “anger” rat model Chen Junxian, Li Weiting, Yang Junping, Wang Ying, Jin Guilin 2020, 24 (26):  4183-4189.  doi: 10.3969/j.issn.2095-4344.2765 Abstract ( 418 )   PDF (26646KB) ( 66 )   Save BACKGROUND: Previous studies have shown that stress response can cause immune dysfunction in the body. T cell immunoglobulin and ITIM domain (TIGIT) is an immunoregulatory receptor that can inhibit T cell activity, promote T cell apoptosis and promote T cell subgroup distribution imbalance. Whether the immune response mechanism of stress response is related to the expression and function of TIGIT is still unclear. OJECTIVE: To investigate the expression of immunomodulatory receptor TIGIT in thymus cells and peripheral blood mononuclear cells in an anger rat model and its significance to immune function. METHODS: Forty-eight Wistar male rats were randomly divided into normal group, 7-, 14- and 21-day model groups, with 12 rats in each group. In addition to the blank group, social isolation method with plantar electric shock method was used to establish rat anger models in the other groups. The behavioral changes of rats were observed by open-field test and aggressive behavior test, and the changes in body mass and thymus index before and after the test were recorded. The positive expression of TIGIT in thymus and peripheral blood mononuclear cells of rats in each group was observed by immunohistochemistry, and the expression levels of CD4+ and CD8+ T cells in the peripheral blood were measured by flow cytometry. The correlation between TIGIT expression in thymus and peripheral blood mononuclear cells and the CD4+/CD8+ ratio of T cell subsets in the peripheral blood was analyzed. An ethical approval for the study was obtained from the Animal Ethics Committee of Jiangxi University of Traditional Chinese Medicine. RESULTS AND CONCLUSION: In the 14- and 21-day model groups, the scores of horizontal and vertical activities in the open-field test of rats were higher than the control group (P < 0.05 or P < 0.01). In the 7-, 14- and 21-day model groups, the attack hiding time of the attack behavior test was significantly shortened (P < 0.01), the number of attacks and the cumulative attack time were significantly increased (P < 0.01), and the body mass and thymus index were significantly decreased compared with the control group (P < 0.05 or P < 0.01). In the 7- and 14-day model groups, the expression level of TIGIT in thymus and peripheral blood mononuclear cells was significantly higher than the control group (P < 0.01), while the CD4+/CD8+ ratio level of the peripheral blood T cell subsets was significantly lower than the control group (P < 0.05 or P < 0.01). The CD4+/CD8+ ratio of T cell subsets in the peripheral blood of random samples of rats was negatively correlated with the expression level of TIGIT in T cells of thymus (r2=0.627 0, P < 0.000 1) and in mononuclear cells (r2=0.624 4, P < 0.000 1). These results indicate that the model rats in the stress-induced anger state have obvious changes in animal behavior, present with thymus atrophy and abnormalities in peripheral blood T lymphocyte subsets CD4+/CD8+ ratio and immune function. This phenomenon may be related to the thymus and peripheral blood mononuclear cells TIGIT expression level, but the specific mechanism needs to be elucidated further. Figures and Tables | References | Related Articles | Metrics

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Oral simvastatin for 3 continuous months improves learning and memory ability of chronic cerebral hypoperfusion rats Mou Zichao, Wang Dan, Wang Xiaoyan, Li Siyu, Wang Zhiqiang, Wang Qingsong 2020, 24 (26):  4190-4195.  doi: 10.3969/j.issn.2095-4344.2708 Abstract ( 365 )   PDF (26800KB) ( 34 )   Save BACKGROUND: Chronic cerebral hypoperfusion is significantly associated with cognitive decline. Our previous studies have found that mitochondrial aging, increased silent synapses and α-synuclein are important pathological changes of chronic cerebral hypoperfusion. Simvastatin is a traditional lipid regulation agent that can traverse the blood brain barrier, and exerts anti-atherosclerosis, anti-thrombosis and anti-inflammatory effects to improve cognitive function. OBJECTIVE: To observe the effect of continuous oral simvastatin for 3 months on cognitive function of chronic cerebral hypoperfusion male Sprague-Dawley rats, and explore the clinical significance of simvastatin in preventing and treating vascular cognitive impairment and dementia. METHODS: Sprague-Dawley rats were randomly divided into model group, sham group, solvent group and simvastatin group. In the model group, rats were subjected to bilateral common carotid artery occlusion. In the sham group, the bilateral common carotid arteries were not ligated. In the solvent group, the model rats were intragastrically treated with 0.5% carboxymethyl cellulose sodium. In the simvastatin group, the model rats were intragastrically treated with simvastatin suspension. Interventions in each group lasted for 3 months. Behavioral tests were then used to evaluate the learning and memory ability of rats in each group. The expressions of synaptophysin and post-synaptic density 95, key proteins of presynaptic and postsynaptic membrane, were detected by western blot. Ethical approval was obtained from the Animal Experimental Ethics Committee of the General Hospital of Western Theater Command with approval No. 2019ky79. RESULTS AND CONCLUSION: Compared with the sham group, the learning and memory functions of the rats in the model group were significantly impaired. In the open-field test, the moving distance within 5 minutes was significantly reduced in the model group compared with the sham group (P < 0.05), suggesting that autonomous exploration behavior was impaired. In the place navigation test, escape latency was significantly shortened in the model group, implicating the reference memory was damaged. In the spatial probe test, the frequency of passing through the platform and the time for passing through target quadrant were reduced, indicating that the space exploration ability was reduced. In the simvastatin group, however, these indexes were all improved. Western blot results showed that the protein expression of synaptophysin and post-synaptic density 95 decreased significantly in the model group (P < 0.05), but increased in the simvastatin group as compared with the solvent group. Therefore, chronic cerebral hypoperfusion can significantly impair learning and memory function and reduce cognitive level in rats. Continuous oral simvastatin for 3 months can improve cognitive function in chronic cerebral hypoperfusion rats, which indicates that simvastatin may be used as an adjunctive drug to improve the prognosis of patients with vascular cognitive impairment and dementia. Figures and Tables | References | Related Articles | Metrics

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Effects of different exercise intensities on visfatin level and glucose metabolism in type 2 diabetic rats Li Ying, Lin Wentao, Weng Xiquan 2020, 24 (26):  4196-4200.  doi: 10.3969/j.issn.2095-4344.2766 Abstract ( 220 )   PDF (22067KB) ( 63 )   Save BACKGROUND: Visfatin has an insulin-like hypoglycemic effect with positive significance in the treatment of type 2 diabetes. Different exercise intensities have different effects on the level of visfatin. OBJECTIVE: To observe the effects of 6-week aerobic exercise of different intensities on glucose metabolism and the level of visfatin in type 2 diabetic rats and to explore the relationship between them. METHODS: The male Sprague-Dawley rats were fed with high-fat diet and injected with streptozotocin to establish a type 2 diabetes model. The 43 model rats were randomly divided into quiet control group (n=10), exercise group I (n=11), exercise group II (n=11) and exercise group III (n=11). The exercise intensities of the three exercise groups were 10, 15, and 20 m/min, respectively. Exercises of different intensities were performed 1 h/d, 5 days per week, for 6 continuous weeks. Blood samples were collected at the end of 6 weeks for determination of glucose metabolism-related indicators and serum and visceral levels of visfatin. RESULTS AND CONCLUSION: The indexes related to glucose metabolism (fasting blood glucose, glycosylated serum protein, insulin, insulin resistance index, etc.) in the three exercise groups were improved. The serum level of visfatin in the exercise groups I and II were significantly decreased (P < 0.01), while the serum level of visfatin in the exercise group III was decreased to some extent, but not significantly (P > 0.05). There was a significant decrease in visfatin level in the three exercise groups (P < 0.05), especially in the exercise group II (P < 0.01). The results indicate that low-intensity aerobic exercise can effectively improve insulin resistance and reduce blood glucose concentration in type 2 diabetic rats, and it is related to the loss of visceral fat and the reduction of visfatin secretion, where visfatin may play a positive role. Figures and Tables | References | Related Articles | Metrics

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Diethylmorphine effect on action potential and calcium ion current of neonatal rat cardiomyocytes in vitro Su Liping, Liu Li, Lu Ziyang, Su Tianyuan, Hu Xiayun, Pu Hongwei 2020, 24 (26):  4201-4207.  doi: 10.3969/j.issn.2095-4344.2719 Abstract ( 396 )   PDF (29533KB) ( 38 )   Save BACKGROUND: Opioids can regulate the changes of membrane potential and Ca2+ current in cardiomyocytes, but whether diacetylmorphine can induce the changes of cardiac rhythm, cell action potential and Ca2+ current has not been reported. OBJECTIVE: To explore the effect of diacetylmorphine on action potential and calcium current of isolated cardiomyocytes from neonatal Sprague-Dawley rats. METHODS: Five concentrations of diacetylmorphine (0, 10-2, 10-3, 10-4, 10-5 mol/L) and 20 mol/L verapamil were used to treat the cardiomyocytes of neonatal Sprague-Dawley rats cultured in vitro. The cells were divided into control group, diacetylmorphine group, diacetylmorphine+verapamil group. The latter two groups were treated with diacetylmorphine and diacetylmorphine+verapamil (20 μmol/L), respectively, while the control group was treated with the same amount of PBS. The study protocol was approved by the Animal Ethics Committee of the First Affiliated Hospital of Xinjiang Medical University on May 21, 2018 with approval No. IACUC201805-K1. RESULTS AND CONCLUSION: At 24 hours of culture with different concentrations of diacetylmorphine, the number of cardiomyocytes with abnormal morphology increased significantly in a dose-dependent manner. When the concentration of diacetylmorphine increased, the number of survived cells decreased, with a reduction in the size of cytoplasm and number of pseudopods, the cell membrane was shrunk and the nuclear structure was blurred. Compared with the control group, when diacetylmorphine was added to intervene with the cardiomyocytes, there was a significant difference in the spontaneous beating frequency and rhythm of cardiomyocytes. The negative value of resting membrane potential decreased, while the time course of action potential increased significantly, and the amplitude of action potential decreased significantly. Compared with the control group, the number of cells with changes in the membrane potential significantly increased in the diacetylmorphine group. The addition of verapamil reduced the number of cells with changes in the membrane potential. Compared with the control group, the number of cells with variation of membrane potential was increased to some extents. These findings suggest that diacetylmorphine can induce cardiomyocyte morphological abnormality, increase the spontaneous beating frequency and rhythm of cardiomyocytes, and change the membrane potential and action potential of cardiomyocytes. Verapamil acts as a calcium channel blocker that can improve the rhythm abnormality of cardiomyocytes induced by diacetylmorphine. Figures and Tables | References | Related Articles | Metrics

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Prefabricated composite tissue flaps for repairing bone and soft tissue defects of the extremities Wang Zhenggang, Liu Mingjiang, Huang Xinfeng, Xiao Xiangjun 2020, 24 (26):  4208-4212.  doi: 10.3969/j.issn.2095-4344.2767 Abstract ( 359 )   PDF (21190KB) ( 108 )   Save BACKGROUND: Prefabricated composite tissue flaps have been used by Bakamjjan for cardiac repair since 1973, but have not been widely used due to technique limitations. Domestic research on prefabricated composite tissue flaps to repair limb bones is rarely reported. OBJECTIVE: To analyze the effects of prefabricated composite tissue flaps in the repair of limb bone and corresponding soft tissue defects. METHODS: New Zealand big rabbit models of bone fracture and soft tissue defect of the extremities were constructed (first operation) and randomly divided into three groups. In group A, prefabricated composite tissue flap was used to treat bone and soft tissue defects of the extremities at 10 days after modeling (second operation). In group B, free femur was used to treat bone and soft tissue defects of the extremities at 10 days after modeling. In group C, the incision was open and sutured with no treatment. General condition, body weight, imaging finding and histological findings were compared between groups. RESULTS AND CONCLUSION: There was 100% survival in all the three groups. Graft displacement was observed in 2 rabbits in the group B, but the deformity healed, which had little effect on the rabbit's mobility. The weight recovery and gain were higher in the group A than in the group B (P < 0.05). The imaging findings showed that a large number of calluses were formed in the group A at 2 weeks after operation, which were bridged in gap at 4 weeks after operation, filled in the defect gap at 8 weeks, and remodeled at 12 weeks. In the group B, a small amount of calluses were formed at 2 weeks after operation, and began to increase at 4 weeks. The femoral cut was obvious. A large number of calluses were formed at 8 weeks after operation, and the defect gap was filled at 12 weeks after operation. In the group C, the callus began to form at 8 weeks after operation, and the defect gap was still present, with osteosclerosis at the two ends. The Lane-Sandhu score was statistically different between the three groups at 8 and 12 weeks after second operation (P < 0.05). Histological observation indicated that a large number of newly formed osteoblasts and bone cells were formed in the group A at 4 weeks after operation, and the tubular structure increased and irregular bone island formed at 8 weeks; new bone formed at 12 weeks, with the presence of the medullary cavity containing yellow bone marrow dominated by adipocytes. In the group B, most of the grafted bones were degraded and absorbed at 4 weeks after operation, and osteoblasts were ossified at 8 weeks. The remaining implanted bones were still visible. Most of the osteoblasts were ossified and became lamellar bones at 12 weeks. In the group C, the defect area was filled with a large amount of fibrous connective tissues at 12 weeks after operation, and there was no bone formation. To conclude, the prefabricated composite tissue flap can be used to repair the bone and soft tissue defects of the extremities, and it has a faster and better therapeutic effect than the traditional free bone repair. Figures and Tables | References | Related Articles | Metrics

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Protective effect of notoginsenoside R1 on carbon tetrachloride-induced liver fibrosis in rats Wu Zhen, Ma Wei, Zang Chenghao, Liu Kuangpin, Liu Wei, Liu Jie, Liang Yu, Li Chunyan, Chen Zhiming, Ru Jin, Fan Chuming, Yang Jinwei, Guo Jianhui, Li Liyan 2020, 24 (26):  4213-4217.  doi: 10.3969/j.issn.2095-4344.2768 Abstract ( 543 )   PDF (18619KB) ( 117 )   Save BACKGROUND: Previous studies have found that panax notoginseng saponins have a certain protective effect on immunological liver injury in mice. OBJECTIVE: To explore the therapeutic effect of notoginsenoside R1 on carbon tetrachloride-induced liver fibrosis in rats. METHODS: Experimental liver fibrosis model was made by carbon tetrachloride in male Sprague-Dawley rats. Then 30 g/L notoginsenoside R1 (60 mg/kg) was given once daily for 4 and 6 weeks in the treatment group. Rats in the control and model group were given distilled water of the same volume. Histopathological observation with hematoxylin-eosin staining and Masson’s trichrome staining was used to evaluate the changes of liver structure and fibrosis degree. The expression of collage type I, α-smooth muscle actin and transforming growth factor-β1 mRNA of hepatic tissue was measured by qRT-PCR method. The experimental protocol was approved by the Animal Experiment Ethics Committee of Kunming Medical University (approval No. KMMU2018018). RESULTS AND CONCLUSION: Liver histopathology showed that notoginsenoside R1 improved the degree of liver fibrosis. The expression levels of collagen type I, α-smooth muscle actin and transforming growth factor-β1 mRNA were reduced significantly in the treatment group compared with the model group (P < 0.05). But there was no significant difference after 4 and 6 weeks of treatment with notoginsenoside R1. Overall findings indicate that notoginsenoside R1 can slow down the progression of carbon tetrachloride-induced liver fibrosis in rats to a certain extent. Figures and Tables | References | Related Articles | Metrics

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Molecular mechanism of icariin in the treatment of bone nonunion Yu Shaoyong, Zhang Xiaoyun, Chen Yueping, Liu Jianhang 2020, 24 (26):  4218-4223.  doi: 10.3969/j.issn.2095-4344.2718 Abstract ( 328 )   PDF (35900KB) ( 43 )   Save BACKGROUND: Nonunion is a common clinical complication in orthopedics, which seriously impacts the physical and mental health and quality of life of patients. In recent years, a large number of studies have found that icariin plays a significant role in promoting fracture healing and treating bone defects. Bone nonunion and fracture healing coexist, and the research on the mechanism of fracture healing actually focuses on the treatment of bone nonunion. OBJECTIVE: To review the research progress in the molecular mechanism of icariin in the treatment of bone nonunion. METHODS: The first author used “icariin, bone nonunion, bone marrow mesenchymal stem cells, periosteal cell, osteoblasts, osteoclast” as key words in English and Chinese to search PubMed, CNKI, WanFang and VIP databases. A total of 542 articles were retrieved and screened manually according to the selection criteria and exclusion criteria. Finally, 44 articles were included for result analysis. RESULTS AND CONCLUSION: Icariin can effectively promote fracture healing and treat bone nonunion by promoting the proliferation and differentiation of bone marrow mesenchymal stem cells and periosteal cells, promoting the proliferation and maturation of osteoblasts and inhibiting the osteoclast effect of osteoclasts. However, most of the experiments are still in the basic experimental research, and there is still a need for a large number of clinical studies as well as studies on related proteins and genes, to provide a new idea for the clinical use of Chinese herbs in the treatment of bone nonunion. Figures and Tables | References | Related Articles | Metrics

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Visualization analysis of CiteSpace knowledge maps regarding prevention and treatment of postmenopausal osteoporosis with traditional Chinese medicine Li Shaoshuo, Gu Yidan, Shao Yang, Yin Heng, Wang Jianwei 2020, 24 (26):  4224-4230.  doi: 10.3969/j.issn.2095-4344.2688 Abstract ( 362 )   PDF (42582KB) ( 53 )   Save BACKGROUND: Traditional Chinese medicine (TCM) has a long history of preventing and treating postmenopausal osteoporosis. With the social development, research in relevant fields is gradually developed. However, there are few analysis and systematic reviews regarding publications, core authors, and research strength in this field.   OBJECTIVE: Using visualization method of CiteSpace knowledge map to analyze the relevant literature about prevention and treatment of postmenopausal osteoporosis with TCM, to understand the development, research hot spots and trend of this field, and to offer evidence and advice for the subsequent development. METHODS: The relevant literature about prevention and treatment of postmenopausal osteoporosis with TCM (1993-2019) was retrieved from CNKI and exported in Refworks format. We analyzed the annual number of papers published, scientific research funding, and high-frequency cited literature. CiteSpace V software was used to create knowledge maps of the authors, research institutions and keywords, for visualization analysis. RESULTS AND CONCLUSION: A total of 453 articles were included. The research of this field started from 1993 and was gradually addressed. Journal articles were the main form of research literature in this field. Natural Science Foundation of China was the most financial support. There were 12 core authors in this field. Zheng Hongxin, Liang Wenna, and Ge Jianrong were the main researchers who established their own research team. The most important research institutions included Orthopaedic Hospital Affiliated to Guangzhou University of Chinese Medicine and Liaoning University of TCM. Nine typical clusters of keywords were formed and there was a shift in research direction. To conclude, the research on the prevention and treatment of postmenopausal osteoporosis with TCM have been developed for over 20 years and is still on the rise with the formation of multiple research forces and research themes. It is expected to promote and boom the development of TCM by integrating the research of TCM into national development strategies, by strengthening cooperation between regions and institutions, and by exploiting the characteristics of TCM. Figures and Tables | References | Related Articles | Metrics

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Recombinant human parathyroid hormone (1-34): pro-osteogenic action and application in oral field Dong Xiling, Zhang Xiaoming, Liu Tongbin 2020, 24 (26):  4231-4236.  doi: 10.3969/j.issn.2095-4344.2731 Abstract ( 419 )   PDF (34161KB) ( 47 )   Save BACKGROUND: Recombinant human parathyroid hormone 1-34 (rhPTH 1-34), also known as teriparatide, is the amino terminal fragment of parathyroid hormone. Teriparatide, as a bone anabolic drug, has become a research hotspot because it can directly stimulate new bone formation and increase bone mass. It also attracts attention and application in the oral field due to its strong osteogenesis effect. OBJECTIVE: To review the osteogenic mechanisms, efficacy and safety of teriparatide and its research progress in the oral field. METHODS: The first author searched the PubMed and WanFang databases for relevant literature published over the past two decades. The keywords were “rhPTH(1-34); teriparatide; osteoporosis; stomatology; Jaw; implant-osseointegration; periodontal” in English and Chinese, respectively. Fifty-six eligible articles were finally reviewed. RESULTS AND CONCLUSION: Teriparatide can directly stimulate the formation of osteoblasts in new bone and achieve effective anabolic metabolism. Studies of teriparatide in the oral field have shown good results in promoting implant-osseointegration, periodontal regeneration, bone defect healing and the stability of orthodontics, but increasing high-quality animal experiments and clinical studies are still needed. Future use of parathyroid hormone drugs and their analogues can be combined with bone tissue engineering technology to provide favorable effects in bone repair as well as in oral and maxillofacial repair. Figures and Tables | References | Related Articles | Metrics

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The rules of acupoint selection in the treatment of neurogenic bladder after spinal cord injury with acupuncture and moxibustion: based on data mining technology Liu Huimin, Leng Jun, Guo Wen, Fang Xiaolei, Zhang Chen, Wei Fangyue 2020, 24 (26):  4237-4242.  doi: 10.3969/j.issn.2095-4344.2769 Abstract ( 454 )   PDF (33967KB) ( 66 )   Save BACKGROUND: Increasing studies have shown that acupuncture has a significant effect on the treatment of neurogenic bladder after spinal cord injury, but there is no uniform acupuncture prescription standard for the treatment of this disease. OBJECTIVE: To investigate the rules of selecting acupoints in the treatment of neurogenic bladder after spinal cord injury with acupuncture and moxibustion. METHODS: Clinical literatures related to acupuncture treatment of neurogenic bladder after spinal cord injury were retrieved in China Knowledge Network, WanFang Data, VIP database and China Biology Medicine disc from 1989 to January 2020. Then, we established a database to perform descriptive analysis, relevance principle analysis and cluster analysis of the collected acupuncture prescriptions. RESULTS AND CONCLUSION: A total of 93 articles were included. Data collection and analysis showed that the acupoints and meridians with the highest frequency of neurogenic bladder after acupuncture treatment of spinal cord injury were Zhongji (CV3) (with the frequency of 55) and Bladder Meridian of Foot Taiyang (with the frequency of 161). Relevance principle analysis showed that combination of acupoints with strongest support is Guanyuan (CV4) and Zhongji (CV3). Cluster analysis of acupoints with the frequency ≥ 10 showed that acupoints could be divided into two categories. All these findings indicate that when acupuncture and moxibustion is used to treat neurogenic bladder after spinal cord injury, most of the acupoints along the meridians and local acupoints are selected. The results of relevance principle analysis and cluster analysis obtained from data mining can be used to select acupoints, match acupoints and reuse specific acupoints to improve the therapeutic efficacy. Figures and Tables | References | Related Articles | Metrics

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Assessments of bone morphogenetic proteins 2 and 7 in treating nonunion Cong Kai, Li Shanlong, Wang Fei, Cheng Hui, Li Baitong, Shang Jian 2020, 24 (26):  4243-4250.  doi: 10.3969/j.issn.2095-4344.2687 Abstract ( 275 )   PDF (49421KB) ( 40 )   Save BACKGROUND: Autologous bone transplantation combined with strong fixation is considered as the gold standard for the treatment of nonunion. At present, there are many cases in which bone nonunion is treated with bone morphogenetic proteins 2 and 7. OBJECTIVE: To describe the osteogenic pathway of bone morphogenetic proteins at the gene level, summarize the clinical cases of nonunion treated with bone morphogenetic protein, and compare the therapeutic effects of bone morphogenetic proteins 2 and 7 on nonunion, followed by evaluation and analysis. METHODS: The first author used a computer to search the full-text database of Chinese journals, WanFang database and PubMed database. The key words were “BMP, nonunion, pathway, external fixator, ORIF, bone graft, infected nonunion, bone defect, osteoblast, osteoporosis " and 59 articles were finally included in the result analysis. RESULTS AND CONCLUSION: Literature review indicates that the gene-level pathway of bone morphogenetic protein can provide therapeutic ideas in clinical practice. In the treatment of bone nonunion, bone morphogenetic proteins 2 and 7 are effective, but there are yet no specifications and standards for the use of bone morphogenetic proteins, such as usage amount and indications. From the overall treatment effect and the treatment effect on infected bone nonunion, we compare the use of bone morphogenetic proteins 2 and 7. The effect of bone morphogenetic protein 2 is better than that of bone morphogenetic protein 7, especially in the treatment of infected nonunion. Figures and Tables | References | Related Articles | Metrics

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Effectiveness of backward walking training on knee osteoarthritis: a systematic review and meta-analysis Chen Zehua, Ye Xiangling, Chen Weijian, Xu Xuemeng 2020, 24 (26):  4251-4256.  doi: 10.3969/j.issn.2095-4344.2770 Abstract ( 392 )   PDF (22139KB) ( 35 )   Save BACKGROUND: Backward walking is mainly considered to improve the symptoms of patients with knee osteoarthritis, which is used for rehabilitation and adjuvant treatment of knee osteoarthritis, but there is no evidence for evidence-based medicine. OBJECTIVE: To systematically review and quantify the evidence for the effect of backward walking on knee osteoarthritis in order to clarify the effect of backward walking on knee osteoarthritis. METHODS: PubMed, CINAHL, EMBASE, CNKI, CBM, WanFang and VIP were searched for relevant literature. After randomized controlled trials were screened, a meta-analysis was used to evaluate the effectiveness of backward walking on knee osteoarthritis. A total of 7 articles involving 231 patients were included in the result analysis. RESULTS AND CONCLUSION: Meta-analysis found that: compared with conventional treatment alone, the combination of conventional treatment with backward walking was better in pain relief [mean difference (MD)=-1.05, 95% confidence interval (CI) (-1.46, -0.63), P= 0.000 1], improving knee joint function [standardized mean difference (SMD)=-0.98, 95% CI (-1.33, -0.64), P < 0.000 01], enhancing quadriceps strength [SMD=1.07, 95% CI (0.52, 1.63), P=0.000 2] and improving timed up to go performance [MD=-0.41, 95% CI (-0.67, 0.16), P=0.001]. However, there was no significant difference in the WOMAC score after backward and forward walking [SMD=-0.43, 95% CI (-0.94, -0.08), P=0.10]. Meta-analysis results indicate that the combination of backward walking with conventional treatment has better clinical efficacy than conventional treatment alone for knee osteoarthritis patients. However, on the basis of conventional treatment, backward walking has comparable effects on WOMAC scores as compared with forward walking, which needs further large-sample high-quality randomized controlled trials to be verified. Figures and Tables | References | Related Articles | Metrics

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Platelet-rich plasma combined with negative pressure for chronic refractory wounds: a meta-analysis Gu Yingxuan, Huang Linfeng, Hu Xiaohui, Quan Xiaoming, Kang Liangqi, Zhou Linghan, Wang Xiaojun 2020, 24 (26):  4257-4264.  doi: 10.3969/j.issn.2095-4344.2642 Abstract ( 376 )   PDF (25057KB) ( 52 )   Save BACKGROUND: Platelet-rich plasma and negative pressure drainage therapy have been widely used and achieved good clinical outcomes in the treatment of various chronic wounds. However, there is no randomized controlled trial regarding their combined effect on chronic refractory wounds. OBJECTIVE: To systematically evaluate the efficacy of platelet-rich plasma with negative pressure therapy on chronic refractory wounds. METHODS: Databases of CNKI, VIP, WanFang, SinoMed, Web of Science, PubMed, and EMbase were searched for the randomized controlled trials regarding the efficacy of platelet-rich plasma combined with negative pressure therapy on chronic refractory wounds. Included studies were evaluated using the Cochrane system evaluation method. Meta-analysis was performed using RevMan 5.3 software. The primary outcomes included wound healing rate, time for wound healing, length of hospital stay, pain score and positive rate of bacteria. RESULTS AND CONCLUSION: A total of 11 randomized controlled trials were included, including 743 patients with chronic wounds. The observation group was treated with platelet-rich plasma combined with negative pressure drainage. The control group was treated with conventional dressing or simple negative pressure drainage. The Meta-analysis results showed that compared with the control group, there was significantly increased wound healing rate [relative risk (RR)=2.19, 95% confidence interval (CI) (1.82, 2.62), P < 0.000 01] , significantly shortened time for wound healing [mean standard difference=-0.81, 95%CI (-1.00, -0.62), P < 0.000 01], significantly shortened length of hospital stay [mean difference=-7.11, 95%CI (-8.12, -6.11), P < 0.000 01], and significantly lowered positive rate of bacteria [RR=0.35, 95%CI (0.22, 0.54), P < 0.000 01] in the observation group. There was no significant difference between the two groups in the pain score [SMD=-5.97, 95%CI (-14.33, 2.40), P=0.16]. To conclude, platelet-rich plasma combined with negative pressure drainage can promote the healing of chronic refractory wounds and reduce the incidence of infection. Figures and Tables | References | Related Articles | Metrics