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    18 November 2021, Volume 25 Issue 32 Previous Issue    Next Issue
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    Changes in serum tumor necrosis factor alpha, transforming growth factor beta 1, and interleukin-6 levels in patients with chronic obstructive pulmonary disease combined with osteoporosis#br#
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    Li Yinglian, Chang Qiong
    2021, 25 (32):  5085-5090.  doi: 10.12307/2021.208
    Abstract ( 198 )   PDF (800KB) ( 20 )   Save
    BACKGROUND: Tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and transforming growth factor-β (TGF-β) are important systemic inflammation-related factors that have been clinically clearly related to the pathogenesis and development of chronic obstructive pulmonary disease (COPD). However, their relationship with COPD combined with osteoporosis is rarely reported.
    OBJECTIVE: To explore the clinical significance of serum TNF-α, TGF-β and IL-6 levels in patients with COPD combined with osteoporosis.
    METHODS: A total of 120 COPD patients were selected as the research subjects in accordance with the principle of prospective case control. According to their bone mass, the patients were assigned into a COPD with normal bone mass group, a COPD with osteopenia group and a COPD with osteoporosis group (n=40 per group). The clinical data, serum TNF-α, TGF-β1, and IL-6 levels were compared among three groups. A correlation analysis was conducted between serum TNF-α, TGF-β1, IL-6 and lung function, bone mineral density, and bone metabolism in the COPD with osteoporosis group. Partial correlation analysis was used to analyze the relationship between serum TNF-α, TGF-β1, IL-6 and COPD combined with osteoporosis. The receiver operating characteristic curve was used to evaluate the diagnostic value of serum TNF-α, TGF-β1, and IL-6. The study protocol was implemented in line with the relevant ethics requirements of the Affiliated Hospital of Qinghai University.
    RESULTS AND CONCLUSION: Pearson correlation analysis showed that serum TNF-α and IL-6 in COPD with osteoporosis group were negatively correlated with the forced expiratory volume in one second as a percentage of the predicted value (FEVl%Pre), the ratio of the forced expiratory volume in one second to forced vital capacity (FEV1/FVC), and bone mineral density of the lumbar spine and femoral neck, as well as positively correlated with osteoprotegerin and degradation product of β-cross linked C-telope-ptide of type I collagen. The level of TGF-β1 was positively correlated with FEV1%Pre, FEV1/FVC, and bone mineral density of the lumbar spine and femoral neck, and negatively correlated with steoprotegerin and degradation product of β-cross linked C-telope-ptide of type I collagen (P < 0.05). After controlling lung function, bone metabolism, bone mineral density and other factors, serum TNF-α, TGF-β1, and IL-6 were still significantly correlated with COPD combined with osteoporosis (P < 0.05); the area under the receiver operating characteristic curve of serum TNF-α, TGF-β1, and IL-6 in the diagnosis of COPD with osteopenia and COPD with osteoporosis were 0.870 and 0.850, respectively. To conclude, serum levels of TNF-α, TGF-β1, and IL-6 are related to lung function and bone metabolism. The combined detection of the three can provide a reference for clinical evaluation of COPD combined with osteoporosis. 

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    Effects of paeonol on forkhead box O3a/Wnt signal pathway and vertebral bone mineral density in ovariectomized osteoporosis rats
    Zhang Fucai, Zheng Feng, Wang Furong, Chen Gang
    2021, 25 (32):  5091-5096.  doi: 10.12307/2021.209
    Abstract ( 206 )   PDF (728KB) ( 19 )   Save
    BACKGROUND: Paeonol can inhibit inflammation and relieve the clinical symptoms of chronic osteoarthritis. As a natural drug component with less side effects and more safety, it is of great clinical significance to explore the treatment of osteoporosis.
    OBJECTIVE: To investigate the effects of paeonol on the signal pathway of forkhead box O3a/Wnt and the density of vertebrae in ovariectomized osteoporosis (OVX-OP) rats. 
    METHODS: Female Sprague-Dawley rats were randomly divided six groups (n=10 per group). Rats in the sham operation only underwent removal of adipose tissue adjacent to the ovary, and the other 50 rats were used to make OVX-OP rat models by bilateral ovariectomy. The rat models were randomly divided into OVX-OP group, estrogen group (ethinylestradiol 10 μg/kg/d), low- (paeonol 125 mg/kg/d), medium- (paeonol 250 mg/kg/d), and high-dose (paeonol 500 mg/kg/d) groups. The rats were administered by gavage. Sham operation group and OVX-OP group were given the same amount of normal saline. The intervention lasted for 12 weeks. The levels of serum estrogen, osteoprotegerin and osteocalcin were measured by enzyme-linked immunosorbent assay. Bone mineral density of the femur and vertebrae was measured by dual energy X-ray animal bone mineral density meter. The biomechanical indexes of the femur and vertebrae, elastic modulus, maximum load and yield load, were measured by orthopedic biomechanical tester. The expression levels of forkhead box O3a and Wnt2 mRNA were detected by real-time fluorescence quantitative PCR. The expression levels of forkhead box O3a, Wnt2 and nucleus β-catenin proteins were detected by western blot.
    RESULTS AND CONCLUSION: After the treatment, the bone mineral density, elastic modulus, maximum load, and yield load in the 4th and 5th lumbar vertebrae, serum estradiol and osteoprotegerin levels, Wnt2 mRNA and protein levels, and nucleus β-catenin protein level were significantly lower in the OVX-OP group than the sham operation group (P < 0.05), while serum osteocalcin and vertebral forkhead box O3a mRNA and protein levels were significantly higher in the OVX-OP group (P < 0.05). Compared with the OVX-OP group, low-, medium, and high-dose paeonol significantly increased the bone mineral density, elastic modulus, maximum load, and yield load in the 4th and 5th lumbar vertebrae, serum estradiol and osteoprotegerin levels, Wnt2 mRNA and protein levels in the vertebrae (P < 0.05), and decreased the levels of serum osteocalcin and vertebral FOXO3a mRNA and protein (P < 0.05). Moreover, the above-mentioned indexes were better in the high-dose paeonol group than the estrogen group (P < 0.05). To conclude, paeonol can increase bone mineral density of the vertebrae, improve the biomechanical condition, and relieve osteoporosis in OVX-OP rats, which may be related to the inhibition of forkhead box O3a and the promotion of Wnt2/β-catenin pathway activation.

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    Clinical application of improved digital guide and occlusal guide in the precise localization for maxillary Le Fort I osteotomy
    Zheng Haiying, Guo Xiujuan, Hou Xueyang, Zhang Lei, Zhang Siqing, Li Hui, Hui Ruizong, Geng Haixia
    2021, 25 (32):  5097-5102.  doi: 10.12307/2021.210
    Abstract ( 227 )   PDF (817KB) ( 15 )   Save
    BACKGROUND: Maxillary Le Fort I osteotomy is the most common method to correct the upper jaw deformity and abnormal position. Traditional model surgery is difficult to accurately implement the operation plan in the operation. In recent years, 3D-printed digital guides have been widely used in orthognathic surgery.
    OBJECTIVE: To discuss the application efficacy of improved digital guide in the precise localization for maxillary Le Fort I osteotomy. 
    METHODS: Twenty patients with maxillary hypoplasia who underwent Le Fort I osteotomy were enrolled. All the patients underwent preoperative cranial-maxillofacial CT scanning, and the CT data were imported into Mimics 20.0 software to establish a digital model, and the surgical virtual design was carried out. At the same time, the digital osteotomy guide, repositioning guide and occlusal guide were designed and printed, and these three guides were combined to perform the maxillary osteotomy and repositioning. One week after the operation, the cranial-maxillofacial CT was reviewed and the design scheme was verified. 
    RESULTS AND CONCLUSION: The absolute value of the median distance deviation between the simulated maxillary position and the actual postoperative position was less than 1 mm. The absolute value of the median angle deviation in the occlusal plane was less than 1°. In the analysis of image fusion deviation, root mean square value was (0.789±0.275) mm, whose mean was less than 1 mm. These findings indicate that the combined application of digital guides in maxillary Le Fort I osteotomy is safe, convenient and accurate.

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    Correlation of human barefoot morphological characteristics contact area with body height and mass: a statistical analysis
    Gao Yi, Ma Yue, Zhao Zeyu, Wang Biao
    2021, 25 (32):  5103-5108.  doi: 10.12307/2021.211
    Abstract ( 335 )   PDF (724KB) ( 23 )   Save
    BACKGROUND: Currently, forensic anthropology, ergonomics and footprint studies have all found that there is a significant correlation between foot information (such as foot length and foot width) and body height and mass. However, there is no enough quantitative research on barefoot morphological characteristics contact area (BMCCA) as well as human body height and mass.
    OBJECTIVE: To analyze the correlation between BMCCA and body mass and height, and to innovate the theoretical systems of forensic anthropology and ergonomics, thereby providing reference for individual recognition by barefoot footprint.
    METHODS: Samples were collected using traditional plane footprint ink printing method, and digital software MATLAB was then used for image processing. A total of 100 healthy young men with a height distribution between 165-190 cm were randomly selected as subjects. Body height and mass were recorded. BMCCA was obtained under normal walking for statistical analysis. The implementation of the study complied with the Declaration of Helsinki and the relevant ethical requirements of Criminal Investigation Police University of China.
    RESULTS AND CONCLUSION: For healthy young men with normal arch of the foot (excluding interrupted arch of the foot and expanded arch of the foot), there is a significant positive correlation between BMCCA and height and mass (P < 0.01). The relationship between BMCCA and human body height can be applied for height analysis in forensic anthropology, ergonomics, and footprint. Compared with body mass, body height has a more significant impact on BMCCA and is more directly related.

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    Gene expression profiling of the medial meniscus in a minipig model of varus knee
    Fang Yehan, Zhang Jian, Huang Hui, Zhou Gang, Xiong Xiaolong, Lin Jianping
    2021, 25 (32):  5109-5115.  doi: 10.12307/2021.212
    Abstract ( 160 )   PDF (746KB) ( 18 )   Save
    BACKGROUND: Varus-type osteoarthritis is often accompanied by obvious medial meniscus lesions. However, the underlying mechanism of its occurrence is yet unclear.
    OBJECTIVE: To explore the molecular mechanism of medial meniscus lesions secondary to varus knees.
    METHODS: The anterior cruciate ligament and lateral collateral ligament of the right rear limbs of seven Wuzhishan minipigs were resected to establish a varus knee model (experimental side), while the left hind legs were subjected to sham operation (control side). Medial meniscus samples were taken for a gene chip analysis at 26 weeks after modeling. An ethic approval was obtained from the Medical Ethics Committee of Hainan General Hospital with an approval No. Med-Eth-Re[2020]5 on December 5, 2017.
    RESULTS AND CONCLUSION: The samples in the two groups showed significant differences in the gene expression. A total of 893 differentially expressed genes were found, in which 537 were upregulated and 356 were downregulated. The significantly affected biological processes included sex determination, interstitial morphogenesis, and regulation of nitric oxide biosynthetic process. The significantly affected cellular components included intrinsic component of membrane, integral component of plasma membrane, endoplasmic reticulum membrane, and epinuclear membrane-endoplasmic reticulum network. The significantly affected molecular functions included transition metal ion binding and iron ion binding. The significantly affected pathways included type II diabetes mellitus, inflammatory mediator regulation of TRP channels, and AMPK signaling pathway. These findings suggest significant changes in gene expression of varus knee meniscus, and these differentially expressed genes may reveal the mechanism of medial meniscus lesions secondary to varus knee, providing a potential target for its treatment and early diagnosis. 
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    Effects of total flavone of Rhizoma Drynariae on the coupling of angiogenesis and osteogenesis in bone remodeling through notch signaling pathway
    Huang Minling, Lu Zhaoqi, Shen Zhen, Lin Haixiong, Feng Junjie, Huang Feng, Jiang Ziwei, Cai Qunbin
    2021, 25 (32):  5116-5122.  doi: 10.12307/2021.213
    Abstract ( 187 )   PDF (2110KB) ( 18 )   Save
    BACKGROUND: Bone defect is a clinical difficulty in orthopedics. Total flavone Rhizoma Drynariae has a definite therapeutic effect on bone defects, but the specific mechanism is not clear. 
    OBJECTIVE: To explore the effects of the total flavone of Rhizoma Drynariae on angiogenesis and bone formation during bone remodeling.
    METHODS: Forty-eight Sprague-Dawley rats were divided into four groups, 12 in each group, including model group, traditional Chinese medicine (TCM) group, TCM + DAPT group, and DAPT group. femoral bone defect model was established in each rat and interventions with the total flavone of Rhizoma Drynariae and the Notch signaling pathway blocker DAPT were given in corresponding groups. Osteogenesis was evaluated by X-ray, Micro-CT, and hematoxylin-eosin staining at 12 weeks of interventions. The levels of vascular endothelial growth factor, CD31, Hes1, bone morphogenetic protein 2, and Notch1 in bone tissue were detected by immunohistochemistry. 
    RESULTS AND CONCLUSION: X-ray, Micro-CT and hematoxylin-eosin staining showed that TCM group showed significantly better osteogenesis than the other three groups. Immunohistochemistry detection indicated that compared with the model group, the average absorbance values of vascular endothelial growth factor, CD31, Hes1, bone morphogenetic protein 2, and Notch1 were significantly higher in the TCM group (P < 0.05). Compared with the DAPT group, the average absorbance values of vascular endothelial growth factor, Hes1, and bone morphogenetic protein 2 were significantly increased in the TCM+DAPT group, while there was no significant difference in the expression of CD31 and Notch1 between the two groups. These findings indicate that the total flavone of Rhizoma Drynariae can promote the coupling of angiogenesis-osteogenesis in bone remodeling by activating the Notch pathway, thereby promoting bone repair.
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    Cardiomyocyte direct reprogramming: a scientometric and visualization analysis based on the Web of Science
    Hui Xiaoshan, Zhang Jinsheng, He Qingyong, Wang Shiqi, Yang Shuai, Zhang Hui, Wang Jie
    2021, 25 (32):  5123-5131.  doi: 10.12307/2021.214
    Abstract ( 239 )   PDF (1714KB) ( 22 )   Save
    BACKGROUND: Cardiomyocyte direct reprogramming has been a research hotspot in the field of regenerative medicine in recent years. It may become a new way to treat heart disease and has a broad application prospect and development direction.
    OBJECTIVE: To explore and understand the research process, research hotspots and development trends of cardiomyocyte direct reprogramming through a scientometric and visualization analysis using CiteSpace knowledge map, thereby providing references in relevant research fields.
    METHODS: Cardiomyocyte direct reprogramming related documents were retrieved in the Web of Science Core Collection using the key words of “direct reprogramming, reprogramming, cardiomyocytes, cardiomyocyte, cardiac muscle cell” on July 29, 2020. CiteSpace was used to visually analyze the authors, institutions and keywords in the included literature. 
    RESULTS AND CONCLUSION: A total of 277 articles were included, which mainly focus on cell biology, bioengineering and applied microbiology. University of California, San Francisco and the University of North Carolina are two main forces in this field. There were nine representative keyword clusters: direct reprogramming, regeneration, pluripotent stem cell, induction, marrow stromal cell, progenitor cell, maturation, transdifferentiation, and induced pluripotent stem cell. The research direction was multi-directional with the development of time. Differentiation of induced stem cells into cardiomyocytes was a research hotspot around 2005, and the direct reprogramming technology gradually attracted wide attention around 2013. This review also suggests that transcription factors, myocyte enhancer factor 2C and heart regeneration may be the research frontiers in the field of direct reprogramming of cardiomyocytes.
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    Molecular mechanism of curcumin in the treatment of knee osteoarthritis based on bioinformatics and network pharmacology
    Zou Kun, Guo Wanshou, Deng Yawen, Zhang Qidong, Liu Pei, Wang Weiguo
    2021, 25 (32):  5132-5140.  doi: 10.12307/2021.215
    Abstract ( 265 )   PDF (1842KB) ( 30 )   Save
    BACKGROUND: Curcumin is a plant polyphenol extracted from turmeric, which can be used to treat knee osteoarthritis. However, the specific mechanism is still unclear.
    OBJECTIVE: Based on bioinformatics and network pharmacology, to explore the molecular mechanism of curcumin in the treatment of knee osteoarthritis, thereby providing a new research direction for the treatment of knee osteoarthritis.
    METHODS: Curcumin-related targets were analyzed by TCMSP database, STITCH database, Drugbank database, SEA database, SwissTargetPrediction database and Binding DB database. Differentially expressed genes were obtained by GEO2R analysis combined with curcumin-related chips in GEO database. TTD, OMIM, DisGeNET, Drugbank, and GeneCards were used to obtain the disease targets related to knee osteoarthritis and identify the curcumin-knee osteoarthritis common targets and the key targets by setting the degree value. STRING database was used to construct the protein-protein interaction relationship of common targets, and R language was used to analyze gene ontology and Kyoto Encyclopedia of Genes and Genomes pathways of common genes. IGEMDOCK software was used to perform molecular docking analysis on the key targets. 
    RESULTS AND CONCLUSION: A total of 339 curcumin-related targets were obtained by searching the above-mentioned drug databases; a chip with the curcumin-related sequence number GSE10896 was determined by searching the GEO database, and 397 differential genes were screened out. A total of 1 903 disease-related targets were obtained by searching the above-mentioned disease databases, and the typical targets included AKT1, NFKB1, RELA, and IKBKB. The protein-protein interaction network diagram of 129 common targets was constructed by using the STRING database. The gene ontology analysis showed that the biological process of curcumin treatment of knee osteoarthritis mainly covered DNA-binding transcription factor, DNA binding transcription activator activity, RNA polymerase II specificity, endopeptidase activity, protein serine/threonine kinase activity, nuclear receptor activity, ligand activated transcription factor activity, metal peptidase activity, and phosphatase binding. The mainly signal pathways were the PI3K-Akt, MAPK, interleukin-17, tumor necrosis factor and hypoxia-inducible factor-1 signaling pathways. The molecular docking analysis revealed that the key targets such as insulin-like growth factor 1 receptor, estrogen receptor, epidermal growth factor receptor, and CYP19A1 had a good affinity with the target proteins. To conclude, there were eight key targets involved in the treatment of knee osteoarthritis with curcumin, including MAPK3, epidermal growth factor receptor, estrogen receptor 1, MDM2, CYP19A1, MAPK14, estrogen receptor, and insulin-like growth factor 1. These targets inhibit inflammation and chondrocyte apoptosis through PI3K-Akt, MAPK, interleukin-17, tumor necrosis factor, and hypoxia-inducible factor 1 signaling pathways for treating knee osteoarthritis with curcumin.
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    Protective mechanism of Gushukang granule in a rat osteoporosis model based on TMT proteomic analysis
    Lin Ruohui, Chen Sainan, Ye Yunjin, Chen Juan, Xie Lihua, Huang Jingwen, Ge Jirong, Li Shengqiang
    2021, 25 (32):  5141-5147.  doi: 10.12307/2021.216
    Abstract ( 236 )   PDF (1234KB) ( 20 )   Save
    BACKGROUND: The specific mechanism and target of Gushukang in the treatment of osteoporosis are still unclear, which need further explorations.
    OBJECTIVE: To explore the protective mechanism of Gushukang on bone metabolism in osteoporotic rats and to analyze the differentially expressed proteins by bioinformatics.
    METHODS: Twenty-four osteoporosis model rats were established by ovariectomy, 12 in model group and 12 in Gushukang group. Another 12 rats without ovariectomy were used as sham operation group. Gushukang capsule, 4.32 g/kg/d, was intragastrically administered once a day in the Gushukang group, and rats in the other two groups were given the same volume of normal saline. Treatment in each group lasted for 3 months. Bone mineral density of the tibia was measured. The proteomic analysis of the lumbar vertebrae of osteoporotic rats was carried out by TMT-LC-MC/MC technique, and the differentially expressed proteins were screened, analyzed by gene ontology, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and protein-protein interaction, thereby constructing a protein-protein interaction network. An ethical approval was obtained from the Animal Ethics Committee of Fujian Academy of Traditional Chinese Medicine.
    RESULTS AND CONCLUSION: A total of 32 up-regulated and 49 down-regulated proteins were screened between Gushukang group and model group. Gene ontology enrichment analysis showed that these differentially expressed proteins were involved in biological processes, such as immunoglobulin receptor binding and vascular endothelial growth factor receptor binding, and molecular functions, such as nucleic acid template transcription and RNA biosynthesis. KEGG enrichment analysis showed that the differentially expressed proteins in the Gushukang group and model group were mainly involved in tyrosine metabolism, ethanol metabolism, JAK-STAT and other signal pathways. Protein-protein interaction analysis showed that among the common differential proteins in the Gushukang group and model group, Mecp2, Aldh3b1, Ryr1 and Myoz1 were located at the nodes of protein interaction network and were closely related to bone metabolism. These findings indicate that Gushukang granule may be involved in protecting the bone metabolism of osteoporotic rats by regulating differential proteins, tyrosine metabolism, JAK-STAT and other important signal pathways.
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    Medication rules and mechanism of femoral head necrosis: an analysis based on data mining and network pharmacology
    Wang Ding, Lin Tianye, Chen Weijian, Chen Jianfeng, Ou Huizhi, Li Hongzhu, Yang Peng, Wei Qiushi, He Wei, Feng Zongquan
    2021, 25 (32):  5148-5154.  doi: 10.12307/2021.217
    Abstract ( 188 )   PDF (2064KB) ( 20 )   Save
    BACKGROUND:  Traditional Chinese medicine is often used as an auxiliary method in the treatment of femoral head necrosis. However, its medication rules, prescription principles, and mechanism of action are still unclear.
    OBJECTIVE: To explore the rules of prescriptions for the treatment of femoral head necrosis in the hip-protecting ward of the Third Orthopedics Department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine using data mining, and to explore the mechanism of action of potential new prescription combinations.
    METHODS: From January 2017 to December 2019, the prescriptions for the treatment of femoral head necrosis in the Third Orthopedics Department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine were collected. Data mining was conducted through the TCM inheritance auxiliary platform (V2.5), and prescription drugs were analyzed with respect to the frequency of medication uses, drug associations, and potential new prescription combinations. TCMSP, String and KEGG databases were used to analyze the interaction relationship between drug targets in the “new prescription” and to analyze the related pathways obtained.
    RESULTS AND CONCLUSION: A total of 126 prescriptions were screened, containing 84 Chinese herbs, and 4 potential new prescription combinations were evolved (prescription 1: peach kernel-astragalus-achyranthes bidentata-angelica-duhuo; prescription 2: Chuanxiong-white peony-dipsacus- atractylodes; prescription 3: Panax notoginseng-poria-rehmannia-salvia-eucommia; prescription 4: safflower-gentiana-psoralen-codonopsis). There were 74 main chemical components (sitosterol α1, gibberellin 17, etc.) of potential new prescription combination 1 (“new prescription”). This study predicted that there were 202 targets for the active ingredients of the “new prescription,” and 121 potential targets for the treatment of femoral head necrosis were obtained after mapping, such as JUN, AKT1, MAPK1, RELA, interleukin-6, etc. The Kyoto Encyclopedia of Genes and Genomes pathway involved in Chinese medicine-disease targets mainly included the MAPK signaling pathway, Toll-like receptors, nuclear factor-κB signaling pathway and hypoxia-inducible factor-1 signaling pathway. The results confirmed that traditional Chinese medicine for the treatment of femoral head necrosis is mainly based on promoting blood circulation to remove blood stasis, nourishing liver and kidney, replenishing qi and blood, supplemented by drugs that clear meridians and dispel rheumatism. The “new prescription” is characterized by multiple components and multiple targets (JUN, AKT1, MAPK1, RELA, interleukin-6, etc.), and its mechanism may be through involvement in promoting angiogenesis, regulating bone metabolism, etc. to regulate the development of femoral head necrosis.

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    Protective effect of red ginger extract on articular cartilage of rats with early knee osteoarthritis
    Luo Zhen, , Li Hongxu, Lu Qigui, Yu Jin, Yu Xiang, Li Feilong, , Chai Shengting,
    2021, 25 (32):  5155-5161.  doi: 10.12307/2021.218
    Abstract ( 247 )   PDF (904KB) ( 29 )   Save
    BACKGROUND: Studies have reported that the combined use of ginger extract to reduce the levels of serum pro-inflammatory cytokines, including interleukin-1β, interleukin-6, tumor necrosis factor-α,  is related to the reduction of cartilage injury in knee osteoarthritis.
    OBJECTIVE: To observe the protective effect of red ginger extract on articular cartilage and the expression of serum interleukin-1β, interleukin-6, tumor necrosis factor-α and cartilage tissue type II collagen α1 mRNA in rats with early knee osteoarthritis, and to explore the protective effect of red ginger extract on articular cartilage of rats with early knee osteoarthritis and its possible mechanism.
    METHODS: Fifty SPF Sprague-Dawley rats were randomly divided into blank group, model group, low-dose red ginger, high-dose red ginger and positive control group (n=10 per group). Except for the blank group, the rats in the other four groups were used to prepare knee osteoarthritis models by intraarticular injection of 4% papain 0.2 mL+0.03 mol/L L-cysteine mixed solution. The rats in the blank and model groups were fed routinely, and the low-dose red ginger, high-dose red ginger and positive control groups were given 50 mg/kg red ginger extract aqueous solution, 100 mg/kg red ginger extract aqueous solution and 18 mg/kg celecoxib capsule aqueous solution respectively. All the interventions were conducted once a day, for 4 continuous weeks. Four weeks after treatment, the rats in each group were killed and the knee joints were stained with safranin O-fast green. The articular cartilage was scored by Mankin scoring. The expression levels of interleukin-1β, interleukin-6, tumor necrosis factor-α in serum and type II collagen α1 mRNA in cartilage were detected. The study protocol was approved by the Animal Ethics Committee of Guangzhou University of Chinese Medicine, with an approval No. 20190917002.
    RESULTS AND CONCLUSION: The pathological section of knee cartilage showed that there was cartilage matrix loss in the model and each treatment group, and the Mankin score of each treatment group was significantly higher than that of the blank group (P < 0.05) and lower than that of the model group (P < 0.05). There was no significant difference between the high-dose group and the positive control group (P > 0.05), but the scores of the two groups were lower than that of the low-dose group. The levels of interleukin-1β, interleukin-6, and tumor necrosis factor-α were upregulated in the positive control group, high-dose red ginger group and low-dose red ginger group compared with the blank group and down-regulated compared with the model group (P < 0.05). Moreover, and the levels of these cytokines were ranked as follows: positive control group < high-dose red ginger group < low-dose red ginger group (P < 0.05). The level of type II collagen α1 mRNA in cartilage showed no significant difference between the blank group and the high-dose red ginger group and the positive control group (P > 0.05), whereas the expression of type II collagen α1 mRNA was significantly increased in the model group and low-dose red ginger group compared with the other three groups (P < 0.05). To conclude, red ginger extract may protect the articular cartilage of knee osteoarthritis by inhibiting interleukin-1β, interleukin-6, and tumor necrosis factor-α, thereby delaying the development of knee osteoarthritis. Compared with the low-dose group, high-dose red ginger extract has better anti-inflammatory effect.
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    Proinflammatory factors and matrix metalloproteinases: status and roles in the pathogenesis of osteoarthritis
    Fan Chongshan, Sun Mingshuai, Han Wenchao
    2021, 25 (32):  5162-5170.  doi: 10.12307/2021.219
    Abstract ( 240 )   PDF (724KB) ( 26 )   Save
    BACKGROUND: Although some risk factors related to osteoarthritis have been proposed, including genetic susceptibility, aging, obesity, joint structure and force line abnormalities, the pathogenesis of osteoarthritis is still unclear to a large extent. 
    OBJECTIVE: To review the related literature worldwide, and summarize the mechanism of proinflammatory factors and matrix metalloproteinases in osteoarthritis as well as relevant therapeutic advances. 
    METHODS: With the key words of “osteoarthritis, interleukin-1, interleukin-6, interleukin-17, C-reactive protein, tumor necrosis factor-α, matrix metalloproteinase, treatment” as the key words in English and Chinese respectively, the first author searched for the basic and clinical research in PubMed and CNKI databases in the period from January 1990 to present.
    RESULTS AND CONCLUSION: Osteoarthritis is a kind of joint disease caused by many factors. The pathogenesis is complex, mainly regulated by a variety of signal pathways, among which the role of inflammatory cytokines and matrix metalloproteinases in the pathogenesis of osteoarthritis has become increasingly obvious. However, in-depth investigations on regulating the occurrence and development of osteoarthritis are still required. It is believed that in the near future, clarifying the pathogenic mechanism of osteoarthritis and developing new treatments, especially introducing stem cell therapy and gene therapy, are expected to greatly target the treatment and prevention of osteoarthritis.
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    Monoclonal antibody therapy for osteoarthritis
    Zhang Xinchao, Wang Bingnan, Ge Zhe
    2021, 25 (32):  5171-5177.  doi: 10.12307/2021.220
    Abstract ( 186 )   PDF (664KB) ( 25 )   Save
    BACKGROUND: Studies have shown that a large amount of inflammatory factors produce in the occurrence of osteoarthritis, and antibodies against inflammatory factors have recently become a research hotspot.
    OBJECTIVE: To summarize the latest research progress of monoclonal antibodies for the treatment of osteoarthritis, and to provide references for the clinical treatment of osteoarthritis.
    METHODS: A computer search of CNKI, WanFang, PubMed and Web of Science databases was conducted for relevant articles published from January 2006 to May 2020. The key words were “osteoarthritis; monoclonal antibody; inflammatory factors.” After consulting related articles, a total of 69 articles were finally included for result analysis. 
    RESULTS AND CONCLUSION: Osteoarthritis is an inflammatory and degenerative disease. Compared with traditional non-steroidal anti-inflammatory drugs, monoclonal antibodies have shown good effects in the treatment of osteoarthritis pain due to their good targeting and low side effects. Some monoclonal antibodies will increase the risk of joint replacement in patients, so the choice of drugs should vary from person to person. As research continues to deepen, more monoclonal antibodies against different targets will be produced, providing more options for clinical treatment of osteoarthritis
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    Optimizing the ratio of buccal gallery: a consideration on the therapeutic effect from a three-dimensional and multi-level perspective
    Wei Hui, Zhang Chao, Zhang Wenzhong
    2021, 25 (32):  5178-5183.  doi: 10.12307/2021.221
    Abstract ( 237 )   PDF (643KB) ( 19 )   Save
    BACKGROUND: Orthodontic treatment should not only improve the static profile and occlusal relationship, but also improve patient’s frontal smile aesthetics. As one of the most important evaluation indexes of positive dynamic smile aesthetics, buccal gallery has gradually become a research hotspot.
    OBJECTIVE: To review the factors that affect the aesthetics and size of the buccal space and the influence of the size of the buccal space on the aesthetics of orthodontic smile, and further summarize and sort out how to better grasp the buccal space to create the beauty of smile in orthodontic clinic, and prospect its future development, so as to provide a theoretical basis for the diagnosis and treatment of dynamic smile in orthodontic clinic.
    METHODS: A computer-based search was conducted for the relevant literatures from July 1999 to October 2020 in CNKI, WanFang, PubMed and Web of Science with the key words of “buccal corridor spaces, orthodontic, smile aesthetics”in Chinese and English, respectively. According to the inclusion and exclusion criteria, 51 articles were finally selected and summarized.
    RESULTS AND CONCLUSION: Existing clinical evidence is not enough to prove that tooth extraction can influence the patient’s frontal smile aesthetics. For non-extraction cases of crowded dentition, orthodontists can choose a suitable self-locking bracket correction system to better coordinate the relationship between the width of the dental arch and the soft tissues of the buccal and facial area, making the patient show an appropriate size of the buccal gallery when smiling after correction, and effectively improving the frontal smile aesthetics. In the orthodontic treatment, the “full smile” should be pursued. Orthodontists should coordinate the buccal space and facial morphology, and take improving the buccal space as the goal of orthodontic design and treatment. From static profile aesthetics to dynamic positive aesthetics, the treatment effect is considered from three-dimensional and multi-level perspectives.

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    Effect of side cutting foot strike pattern and angle on the biomechanics of lower extremities
    Zhou Wenxing, Wang Lin
    2021, 25 (32):  5184-5190.  doi: 10.12307/2021.222
    Abstract ( 258 )   PDF (585KB) ( 22 )   Save
    BACKGROUND: In sports, side cutting is the most common attacking technique, which is influenced by landing mode and angle. The different patterns and angles of side cutting during landing may increase the risk of knee injury in the lower limbs. 
    OBJECTIVE: To explain the impact of different foot strike patterns and angles in side cutting on the biomechanics of the lower extremity.
    METHODS: PubMed, Web of Science, and CNKI databases were searched for relevant studies published before August 2020. The keywords were “cutting maneuver; cutting maneuver angle; cutting foot strike; cutting biomechanics; change-of-direction” in Chinese and English, respectively.
    RESULTS AND CONCLUSION: The use of rear-foot strike patterns and larger angles for side cutting indicates an increased risk of anterior cruciate ligament injury. However, the current research only focuses on the analysis of foot strike patterns or larger angles alone, and rarely combines the foot strike patterns with the angle of side cutting. There is no clear conclusion about the interaction between foot strike patterns and angles in the side cutting, and there is not enough evidence to support that changing the foot strike pattern when the side cut angle increases will reduce the risk of lower extremity injury, which still requires a lot of research for in-depth demonstration.
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    Effects of resolvin on vital pulp conservation and regeneration during the inflammatory environment of dental pulp, periapical and periodontal tissues
    Qiu Wandi, Cui Caiyun, Li Yanjun
    2021, 25 (32):  5191-5196.  doi: 10.12307/2021.223
    Abstract ( 209 )   PDF (673KB) ( 22 )   Save
    BACKGROUND: Bacterial infection is an important cause of infection of the dental pulp and periapical tissue. Vital pulp conservation and regeneration of the dental pulp are becoming new clinical strategies for the treatment of pulp and periapical diseases. Resolvin is a lipid mediator derived from omega-3 polyunsaturated fatty acids. It promotes the resolution of tissue inflammation and the recovery of inflammatory conditions.
    OBJECTIVE: To review the research progress in the effect of resolvin in inflammation regulation and its application in the inflammation of dental pulp, periapical and periodontal tissues, providing evidence for inflammatory recovery and regeneration of the dental pulp.
    METHODS: PubMed, VIP, WanFang and CNKI were searched for relevant literatures published from January 2014 to June 2020 using the keywords of “resolvin, effect, signaling pathway” in Chinese and English, respectively. Thirty-five articles regarding resolvin and its application were included and analyzed. These databases were also searched using the keywords of “resolving, pulptitis, periapical, periodontitis, dental” in Chinese and English, and 31 articles were included for analyzing the application of resolving in different tissues and diseases, and another 3 articles were further explained of the literature content.
    RESULTS AND CONCLUSION: In this article, we systematically review the types and effects of resolvin, and detail the role and mechanism of resolvin in inflammatory diseases of the dental pulp, periapical and periodontal tissues. This will so provide the research basis for the preservation and regeneration of vital pulp after its clinical use for dental inflammation. 

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    Characteristics of randomized controlled trials on acupuncture for stress urinary incontinence in women
    Bai Fuyu, Wang Mengqi, Xue Feng, Li Zhenrui, Yan Qinghao, Zhang Zhiyi, Wang Feng
    2021, 25 (32):  5197-5203.  doi: 10.12307/2021.224
    Abstract ( 377 )   PDF (843KB) ( 323 )   Save
    BACKGROUND: Numerous literatures have reviewed and analyzed acupuncture and moxibustion for stress urinary incontinence; however, there are some limitations, such as no comprehensive or targeted analysis of the individual efficacy of acupuncture and moxibustion on female patients.
    OBJECTIVE: To analyze the characteristics of clinical research regarding acupuncture for treating stress urinary incontinence to provide reference for acupuncture in clinical practice. 
    METHODS: Randomized controlled trials (RCTs) related to acupuncture intervention on stress urinary incontinence published before March 15, 2020 were searched in PubMed, Embase, Cochrane Library, Clinical Evidence, CNKI, VIP, WanFang and SinoMed. Bibliometrics was used to extract data and information from the documents that met the inclusion criteria, and Cochrane was used to evaluate the quality of literature. We quantitatively analyzed acupuncture treatment for stress urinary incontinence from the number of publications, diagnostic criteria, treatment methods, selection of acupoints and meridians, frequency and duration of treatment, curative effect standards and outcome indicators, characteristics of acupuncture operation methods, and design of clinical research methods. 
    RESULTS AND CONCLUSION: A total of 115 Chinese and English documents that met the requirements were screened out. The number of publications has been increasing year by year and tends to be stablely increased since 2012. The use of diagnostic criteria and efficacy criteria is not uniform and standardized; treatment methods are mainly acupuncture alone or in combination with other therapies (pelvic floor muscle training and biofeedback), moxibustion alone or in combination with other therapies, acupuncture combined with other therapies. Single acupuncture therapy is mostly body acupuncture and electric acupuncture. The top 10 acupoints used are Guanyuan (RN 4), Zhongji (RN 3), Sanyinjiao (SP 6), Qihai (RN 6), Shenshu (BL 23), Huiyang (BL 35), Zusanli (ST 36), Zhongliao (BL 33), Ciliao (BL 32), Baihui (DU 20). The BL, RN, GB and KI meridians are the most used. Subjective and objective indicators are combined with each other, and the effective rate is the most frequently used as the outcome indicator. Both clinical operation methods and the course of treatment are different in the documents. The quality of methodology and clinical reports are generally poor, and researches with high argumentation intensity are rare. Methods of acupuncture for stress urinary incontinence are various, mainly based on local selection of acupoints combined with acupoints selection along the meridian. The standards of design and method are different in the clinical researches, which need to be standardized and improved in the future.
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    Pyroptosis in the progression of osteoarthritis
    Zhi Jiajia, Du Chaozheng, Wang Yuze
    2021, 25 (32):  5204-5209.  doi: 10.12307/2021.225
    Abstract ( 527 )   PDF (669KB) ( 55 )   Save
    BACKGROUND: Recently, it has been discovered that pyroptosis is involved and plays a role in the pathological progress of osteoarthritis.
    OBJECTIVE: To understand the latest research progress in the role of cell pyroptosis in osteoarthritis, and to explore their relationship, so as to provide a new target for the research, diagnosis and treatment of osteoarthritis.
    METHODS: Relevant literatures were retrieved from databases such as CNKI, WanFang, VIP, ScienceDirect, Nature, Springer, and PubMed. The Chinese and English search terms included osteoarthritis (OA), pyroptosis, nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3), nuclear factor kappa B (NF-κB), caspase, interleukin (IL), and gasdermin D (GSDMD). According to the inclusion criteria, 61 relevant literatures were included for further analysis.
    RESULTS AND CONCLUSION: Pyroptosis is certainly related to the degradation of cartilage, inflammation, and synovial damage in osteoarthritis. Some proteins and cytokines involved in the activation of pyroptosis activation are differentially expressed, such as NLRs, caspases, interleukins and GSDMD. Although these proteins and cytokines are known to be involved in the pathological progress of osteoarthritis, their mechanism underlying osteoarthritis has not been completely understood.
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    Evaluation methods of animal models of femoral head necrosis: merits and demerits
    Lou Pengqiang, Wei Wei, Hou Decai
    2021, 25 (32):  5210-5214.  doi: 10.12307/2021.226
    Abstract ( 200 )   PDF (665KB) ( 15 )   Save
    BACKGROUND: The pathogenesis of osteonecrosis of the femoral head (ONFH) still needs to be further studied, so it is necessary to establish an animal model that can highly simulate ONFH in humans. However, how to correctly evaluate the animal model of ONFH is a prerequisite for establishing the animal model of ONFH.
    OBJECTIVE: To summarize the evaluation methods of ONFH animal models worldwide in recent years, review the advantages and disadvantages of each evaluation method, explore new evaluation methods, and provide reference for the establishment of animal models.
    METHODS: Literatures related to the evaluation methods of ONFH animal models published from January 2010 to September 2020 were retrieved in CNKI, WanFang, VIP, PubMed, Web of Science and Medline with the terms “osteonecrosis of femoral head, femoral head necrosis, animal model, evaluation methods” as the retrieval words.
    RESULTS AND CONCLUSION: A total of 51 articles were included according to the inclusion criteria, including 33 in Chinese and 18 in English. In recent years, with the development of imaging technology and the introduction of new technologies, the evaluation options of ONFH animal model increase. Choosing a reasonable evaluation method can reduce the workload in the process of establishing animal models and provide reference for the follow-up research. So, the further improvement is necessary.
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    Different modes of blood flow restriction in the treatment of senile sarcopenia: therapeutic effects and safety factors 
    Chen Rong, Zeng Qing, Gong Ze, Huang Guozhi,
    2021, 25 (32):  5215-5221.  doi: 10.12307/2021.227
    Abstract ( 243 )   PDF (657KB) ( 62 )   Save
    BACKGROUND: Geriatric muscular dystrophy increases the incidence of falls, fractures, and cardiovascular adverse events. The blood flow restriction therapy combine with exercise is appropriate for preventing and treating sarcopenia.
    Studies have reported merits and demerits of blood flow restriction therapy in the middle-aged and elderly with regard to muscular fitness, in which blood flow restriction therapy has been basically affirmed to be scientific and effective for improving muscle strength and mass in the middle-aged and elderly people. However, there is yet no report to review the application and mechanism of different modes of blood flow restriction therapy in senile sarcopenia.
    OBJECTIVE: To review the efficacy, safety and adverse reactions of blood flow restriction therapy in sarcopenia, and to provide new ideas for such patients about how to choose scientific and effective treatment methods.
    METHODS: Related literatures were searched in PubMed, Science Direct, Web of Science, WanFang, VIP and CNKI from January 2005 to July 2020, with the key words of “blood flow restriction or exercise or therapy; KAATSU training; sarcopenia; senile sarcopenia; motor function; mechanism; muscular strength’’ in English and Chinese, respectively. Eventually, 50 articles that met the criteria were included.
    RESULTS AND CONCLUSION: The blood flow restriction therapy, especially in combination with exercise, can increase muscle strength and muscle volume in sarcopenia patients suffering few less adverse reactions. Blood flow restriction therapy may play a role by increasing the rate of protein synthesis and degradation in muscle tissues, elevating the level of mitochondrial energy metabolism and improving the level of tissue microcirculation. However, the mechanism of blood flow restriction therapy is still controversial and needs further verification. For senile sarcopenia patients, doctors should focus on blood flow occlusion pressure and exercise load, because there is no clear exact safety conclusion.

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    Peroxisome proliferator-activated receptor signaling pathway is involved in the metabolic regulation of obesity by intestinal flora and brown adipose tissue
    Ye Erbai, Xiao Xiaoling, He Ziyu, Yang Chun, Du Yikuan
    2021, 25 (32):  5222-5226.  doi: 10.12307/2021.228
    Abstract ( 252 )   PDF (632KB) ( 97 )   Save
    BACKGROUND: There are a complex regulatory mechanism and extensive relationship between intestinal flora and brown adipose tissue. However, the mechanism has not yet been clarified.
    OBJECTIVE: To reveal the potential relationship between brown adipose tissue and intestinal flora and to provide experimental ideas for further research.
    METHODS: The first author used the computer to search for relevant articles published from January 1, 1994 to June 1, 2020 in PubMed, WanFang, VIP, and CNKI. The search terms included “brown adipose tissue, intestinal flora, obesity, peroxisome proliferator-activated receptor family” in English and Chinese, respectively. The author further screened, analyzed, summarized the relevant contents of the included literatures, and finally included 38 articles for final review.
    RESULTS AND CONCLUSION: The imbalance of intestinal flora can influence peroxisome proliferator-activated receptors (PPARs), and PPARs have an impact on the metabolism of brown adipose tissue and thereupon regulate obesity. PPARα, PPARβ and PPARγ are all related to adipose metabolism and can be activated by corresponding activators to promote the expression of brown adipose tissue. PPARγ is most closely related to the intestinal flora and brown adipose tissue. Changes in intestinal flora metabolism can up-regulate the expression of PPARγ, thus activating brown adipose tissue to achieve the purpose of weight loss. Regulating the relationship between the intestinal flora and brown adipose tissue can be used as a therapeutic strategy for obesity. Overall, there is a great prospect for developing anti-obesity drugs based on brown adipose tissue and PPARs signaling pathway.

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    Arthroscopic reconstruction of anterior cruciate ligament with and without remnant preservation: a Meta-analysis of prospective, randomized, and controlled studies
    Huang Honghui, Pan Huashan, Lai Chunbai
    2021, 25 (32):  5227-5231.  doi: 10.12307/2021.229
    Abstract ( 157 )   PDF (992KB) ( 17 )   Save
    OBJECTIVE: Arthroscopic reconstruction of the anterior cruciate ligament has become the preferred choice for anterior cruciate ligament injuries, but there is still a big controversy about whether to preserve the tibial remnant of the anterior cruciate ligament. Here, we attempt to systematically evaluate the clinical effect of anterior cruciate ligament reconstruction with and without remnant preservation under arthroscopy.
    METHODS: PubMed, EMbase, the Cochrane Library, CBM, WanFang Data, CNKI and VIP databases were searched for clinical controlled studies regarding arthroscopic anterior cruciate ligament reconstruction with or without remnant preservation. The retrieval time was from inception of the databases to September 2019. Two researchers independently screened the literature, extracted data and evaluated the risk of bias in the included studies. Revman 5.3 software was then used for Meta-analysis.
    RESULTS: Compared with the reconstruction without remnant preservation, there was higher Lysholm score [mean difference (MD)=2.20, 95% confidence interval (CI) (0.82, 3.58), P=0.001], higher International Knee Documentation Committee score (MD=2.28, 95% CI (1.20, 3.37), P < 0.001), lower KT1000/KT2000 score [MD =-0.29, 95% CI (-0.52, -0.06), P=0.01] after remnant-preserved reconstruction. There were no significant differences in the axial displacement test, Lachman test and the diameter of the tibial tunnel between the reconstruction with or without remnant preservation. Compared with the reconstruction without remnant preservation, the reconstruction with remnant preservation led to a better proprioception [MD=0.41, 95%CI (0.13, 0.69), P=0.004]. 
    CONCLUSION: Existing evidence has shown that remnant-preserved reconstruction of the anterior cruciate ligament can improve the functional score, proprioception and objective stability of the knee joint after surgery, but there is no evidence that it is beneficial to subjective stability and to protecting the tibial tunnel.

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    Meta-analysis of acupuncture and moxibustion combined with Duhuo Jisheng Decoction in treating rheumatoid arthritis
    Li Hongzhu, Yuan Si, Zhao Jiaying, Lu Liming, Xu Nenggui
    2021, 25 (32):  5232-5239.  doi: 10.12307/2021.230
    Abstract ( 271 )   PDF (1698KB) ( 92 )   Save
    OBJECTIVE: Rheumatoid arthritis is an immune-mediated multi-system inflammatory disease that mainly involves synovium and joints. It has a high incidence and a long course of disease. This paper evaluates the clinical effect of acupuncture and moxibustion combined with Duhuo Jisheng Decoction in treating rheumatoid arthritis through a systematic evaluation.
    METHODS: PubMed, Embase, CNKI, Sinomed, WanFang, and VIP were searched for randomized controlled trials (RCTs) regarding acupuncture and moxibustion combined with Duhuo Jisheng Decoction for treating rheumatoid arthritis. The retrieval time was from the inception of the databases to August 2020. Two researchers independently conducted literature search, screening and data extraction. According to RCT risk of bias tool provided by Cochrane collaboration network, a bias risk assessment of all included literatures was conducted followed by Meta-analysis using RevMan 5.3 software.
    RESULTS: A total of 16 RCTs were included, and scored according to the modified Jadad scale, including 1 article with 4 points, 4 articles with 3 points, 8 articles with 2 points, and 3 articles with 1 point. The overall quality of the included RCTs was low. A total of 1 551 cases were involved in these 16 RCTs, including 777 cases in the trial group (Duhuo Jisheng Decoction) and 774 cases in the control group (western medicine). The results of meta-analysis showed acupuncture and moxibustion combined with Duhuo Jisheng Decoction were all better than the control group in terms of overall response rate (relative risk (RR)=1.20, 95% confidence interval (CI): 1.15 to 1.25,                         P < 0.000 01), morning stiffness time (weighted mean difference (WMD)=-0.86, 95% CI: -1.13 to -0.58, P < 0.000 01), 20-meter walk time (WMD=-4.64, 95% CI: -5.24 to -4.04, P < 0.000 01), joint swelling index (< 49 years old) (WMD=-2.42, 95% CI: -2.58 to -2.26, P < 0.000 01), erythrocyte sedimentation rate (WMD=-1.56, 95% CI: -1.73 to -1.40, P < 0.000 01), C-reactive protein (WMD=-1.18, 95% CI: -1.34 to -1.02, P < 0.000 01), rheumatoid factor (WMD=-2.26, 95% CI: -2.55 to -1.97, P < 0.000 01), tumor necrosis factor-α (WMD=-42.28, 95% CI: -47.47 to -37.09, P < 0.000 01) and adverse reaction incidence (RR=0.36, 95% CI: 0.17 to 0.80, P=0.01). 
    CONCLUSION: Compared with western medicine, acupuncture and moxibustion combined with Duhuo Jisheng Decoction for treating rheumatoid arthritis has advantages in the overall response rate, improvement of clinical symptoms, incidence of adverse reactions, and safety, but due to the limitations of literature quality and publication bias, high-quality, multicenter, large-sample RCTs are required to further assess the efficacy and safety.

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    Clinical efficacy of small needle knife combined with traditional Chinese medicine in the treatment of knee osteoarthritis: a network Meta-analysis
    Huang Cihui, Liu Jiayue, Huang Yingjie, Zhuang Zeqin, Lin Yunxin, Li Dan, Zheng Liang
    2021, 25 (32):  5240-5248.  doi: 10.12307/2021.231
    Abstract ( 212 )   PDF (1454KB) ( 33 )   Save
    OBJECTIVE: There are many treatments for knee osteoarthritis, but there is no specific treatment. In recent years, increasing clinical studies have confirmed the effectiveness of small needle knife combined with Chinese medicine for knee osteoarthritis. However, there is still a lack of systematic evaluation to provide evidence-based support. In this paper, we aimed to systematically evaluate the clinical efficacy of small needle knife combined with traditional Chinese medicine in the treatment of knee osteoarthritis, so as to provide evidence-based reference for clinical decision-making in the treatment of knee osteoarthritis. 
    METHODS: The randomized controlled trials of small needle knife combined with traditional Chinese medicine in the treatment of knee osteoarthritis were searched by computer. The total effective rate was the main outcome, and the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, Visual Analogue Scale (VAS) and Lysholm scores were the secondary outcomes. Among them, the total effective rate was expressed as a binary variable, and the other indicators were expressed as continuous variables. The quality evaluation and data extraction were carried out using Cochrane Hand Book 5.1.0 after the included literatures were screened layer by layer, and the data were processed by Stata15.0 software followed by a network Meta-analysis.
    RESULTS: A total of 26 randomized controlled trials involving 2 940 patients were included. The Jadad score showed that the quality of the included literature was low. The results showed that: Compared with small needle knife, traditional Chinese medicine, acupuncture plus Chinese medicine treatment, acupuncture treatment, and western medicine, small needle knife plus traditional Chinese medicine could significantly improve the total effective rate (P < 0.05); compared with western medicine, acupuncture, acupuncture plus traditional Chinese medicine, small needle knife plus traditional Chinese medicine could significantly reduce the WOMAC score; compared with small needle knife, traditional Chinese medicine and western medicine, small needle knife plus traditional Chinese medicine could significantly reduce the VAS score (P < 0.05) and significantly improve Lysholm knee joint function score (P < 0.05). The area under curve results showed that small needle knife plus traditional Chinese medicine had the best effect in improving the effective rate, reducing WOMAC score, reducing VAS score and improving Lysholm knee function score in the included six methods. 
    CONCLUSION: Small needle knife combined with traditional Chinese medicine has significant clinical efficacy in the treatment of knee osteoarthritis, and this combined treatment is significantly superior to western medicine, traditional Chinese medicine, and small needle knife alone in alleviating pain and improving knee joint function. The conclusion of this study provides certain evidence-based reference for the clinical treatment of knee osteoarthritis, but further high-quality clinical application research is required.
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