早期症状性膝骨关节炎的治疗进展

目前,早期症状性膝骨关节炎越来越受到临床医生关注。关于早期症状性膝骨关节炎的病因,许多学者不仅仅关注到膝关节局部问题,更多的注意到髋、膝周围软组织失衡所致膝关节力线不平衡为重要的影响因素。基于对这一病因的认识,从中西医方面对早期症状性膝骨关节炎的治疗进展进行总结,并探讨各种疗法的治疗规律、特点和疗效

Study of the effect of Strong-bone granules on the differentiation of ROS1728 osteoblasts with silenced ER expression

目的探讨健骨颗粒对成骨细胞中ERalpha介导的TERT信号通路的调控作用。方法采用雌激素受体拮抗剂ICI182780(Faslodex)阻断成; 骨细胞中雌激素受体alpha(ERalpha)的表达,建立ER抑制的大鼠成骨细胞株ROS1728细胞模型,采用酶联免疫吸附法(ELISA)检测成; 骨细胞液中碱性磷酸酶(alkaline phosphatase,ALP) 、骨钙素(osteocalcin,BGP); 、Ⅰ型胶原(collagen I,Col Ⅰ)的含量。采用实时荧光定量SYBR; GREEN法检测ERE、ERalpha、c-MYCmRNA的表达。采用Western Blot检测TERT、ERalpha、c-; MYC蛋白的表达。结果ELISA法检测结果显示:随着干预时间的延长,培养液中的ALP、BGP、ColⅠ的含量逐渐上升。其中对照组3种信号因子的含; 量最高血,雌激素组次之,健骨颗粒组再次之,模型组最低,各组比较差异有统计学意义(P < 0.05),; 4组TERT、ERalpha、c-MYCmRNA及蛋白表达量情况以对照组的蛋白表达含量最高,雌激素组次之,健骨颗粒组再次之,模型组最低。各组比较; 均有统计学意义(P < 0.05); 。结论雌激素介导TERT信号通路及其相关因子与成骨细胞分化的关系密切,而补肾健脾中药健骨颗粒可通过雌激素介导TERT信号通路促进成骨细胞分化。Objective To investigate the effect of Strong-bone granules on the; regulation of TERT signaling pathway mediated by ER alpha in; osteoblasts. Methods The estrogen receptor antagonist ICI182780; (Faslodex) was used to inhibit the expression of ER in osteoblasts and; to establish the ER-silenced model of rat osteoblast cell line ROS1728.; Serum ALP,BGP,and Col I were determined using enzyme-linked; immunosorbent assay. The mRNA expression of ERE,ERalpha,and c-MYC was; determined using real time quantitative SYBR GREEN assay. The protein; expression of ERE,ERalpha,and c-MYC was detected using Western blotting.; Results The results of ELISA showed that the content of ALP,BGP,and Col; in the culture medium increased gradually with the prolonging of; intervention time. The levels were the highest in the control group,then; followed in estrogen group,Strong-bone granules group,and the model; group,and the difference among the groups was significant (P < 0.05).; The mRNA and protein expression of TERT,ER alpha,and c-MYC was the; highest in the control group,then followed in estrogen group,Strong-bone; granules group,and the model group,and the difference among the groups; was significant (P < 0.05). Conclusion The estrogen mediated TERT; signaling pathway and its related factors are closely related to the; differentiation of osteoblasts. Strong-bone granules promote osteoblast; differentiation through estrogen mediated TERT signaling pathway.国家自然科学基金; 福建省卫生厅中医课题; 福州市卫生系统科技项

基于质谱技术分析补骨颗粒对软骨细胞蛋白质组学的影响

目的:通过定量观察补骨颗粒对大鼠膝关节软骨细胞蛋白质表达的影响,探讨补肾活血中药对软骨细胞的作用机制。方法:将软骨细胞经补骨颗粒含药血清传代培养后通过定量蛋白质组学串联质谱标签标记技术进行检测,使用Maxquant(v1.5.2.8)进行检索。选择UniProt-GOA数据库注释工具对差异蛋白进行基因功能聚类GO分析;采用KEGG在线服务工具KAAS对提交的蛋白进行注释,之后通过KEGG mapper将注释过的蛋白匹配入数据库相应的通路中进行检索分析;使用预测亚细胞定位的软件wolfpsort对所提交的蛋白进行亚细胞定位注释。结果:通过数据库检索,补骨颗粒含药血清及空白血清干预软骨细胞后共鉴定到5028个蛋白质,包含25 423个肽段,其中4297个蛋白质包含定量信息。以1.3倍为变化阈值,t检验中P <0.05为标准,空白血清组中163个蛋白表达发生上调,188个蛋白表达发生下调;补骨颗粒含药血清干预后有164个蛋白表达发生上调,58个蛋白表达发生下调。其中,具有生物学信息的目标差异蛋白有腺苷酸转位酶1、热休克蛋白27、肌浆/内质网钙ATP酶1、钠/钾转运ATP酶、果糖二磷酸醛缩酶A、3-磷酸甘油醛脱氢酶、磷酸甘油酸变位酶1、β-烯醇化酶、L-乳酸脱氢酶、糖原合成酶、肉碱棕榈酰转移酶1。结论:补骨颗粒能够影响软骨细胞的腺苷酸转位酶1、热休克蛋白27、醛缩酶A、β-烯醇化酶及肉碱棕榈酰转移酶1等表达,对于揭示软骨细胞的凋亡机制具有重要意义。福建省自然科学基金资助项目(2016J01597)福州市科技计划项目(2017-S-130-5

支撑应力对骨小梁分布的影响及股骨头坏死因素的研究

目的通过犬股骨颈骨折螺钉内固定模型的力学检测及组织学观察,从微观角度认识骨小梁重建对股骨头坏死的影响。方法选取18只成年田园犬制作成股骨颈骨折螺钉内固定模型,于造模后12周确认所有股骨颈骨折已愈合随机分为取钉组、取钉植骨组及不取钉组,于造模后20周分离所有犬的股骨并进行股骨颈力学测试及组织学观察。结果取钉组、取钉植骨组及不取钉组断裂点载荷、最大载荷差异有统计学意义(P0.05),不取钉组与取钉植骨组断裂点载荷大于取钉组;不取钉组最大载荷大于取钉植骨组与取钉组,取钉植骨组最大载荷大于取钉组。取钉组、取钉植骨组及不取钉组骨小梁宽度与新鲜骨面积差异有统计学意义(P<0.05);不取钉组骨小梁宽度、新鲜骨面积大于取钉植骨组,且取钉植骨组大于取钉组。结论支撑应力的改变将导致骨小梁重新分布,骨小梁再分布是影响股骨头坏死塌陷的重要因素。福建省卫生系统中青年骨干人才培养项目(2014-ZQNJC-34

术中自体血回输在骨盆骨折中的应用研究

目的通过分析自体血回输技术在骨盆骨折手术中的应用情况,为自体血回输技术在临床骨科应用的有效性及安全性提供一定参考。方法通过收集2015年2月至2018年2月期间骨盆骨折术中单纯使用自体血回输或异体血输血的患者,对符合纳入标准患者的基本信息、术中出血量、输血量、血常规、ATP酶活性、TNF-α及C3b,并使用SPSS 20.0软件进行统计学分析。结果自体血回输组与异体血输血组均为20例,其中自体血回输组术中出血量为1 127.50 ml,回输自体血量为464.00 ml;异体血输血组术中出血量为745.00 ml,异体血输血量为300.00 ml。术前自体血回输组的血红蛋白及红细胞比容（Hb:112.80 g/L,Hct:32.9%）与异体血输血组（Hb:112.00 g/L,Hct:33.4%）比较差异无统计学意义（Hb:P=0.908,Hct:P=0.510）;输血后2 h及术后第3天两组的血红蛋白及红细胞比容有所下降,但组间比较差异无统计学意义。通过对比自体血回输与异体血输血后发现两组患者在输血后ATP酶活性都有所降低,但是采用自体血回输方法能够抑制ATP酶活性的降低,组间比较发现自体血回输组ATP酶活性明显高于异体血输血组（P=0.002）。输血后两组TNF-α与C3b值都有所升高,输血前后组间比较差异均无统计学意义。结论术中自体血回输可以提高患者红细胞水平,且与异体血回输相比有更高的ATP酶活性,但并不会明显增加机体的炎症反应,是一种值得推广应用的血液管理方法。福建省自然科学基金资助项目(2016J01597);;\n福州市卫生计生科技计划项目(2016-S-wq2);;\n福州市科技计划项目(2017-S-130-5

桂枝芍药知母汤联合甲氨蝶呤治疗寒热错杂型类风湿关节炎41例临床观察

目的:观察桂枝芍药知母汤联合甲氨蝶呤治疗寒热错杂型类风湿关节炎的临床疗效和安全性。方法:将82例寒热错杂型活动期类风湿关节炎患者随机分为治疗组和对照组,每组41例。对照组口服甲氨蝶呤治疗,治疗组在对照组治疗基础上加用桂枝芍药知母汤治疗,2组均根据疼痛程度酌情使用塞来昔布胶囊。2组均以12周为1个疗程。观察2组中医证候疗效、实验室指标及DAS28-ESR积分。结果:治疗组脱落1例,显效10例,有效28例,无效2例,总有效率为95.00%;对照组脱落2例,显效6例,有效18例,无效15例,总有效率为61.54%。2组比较,差异有统计学意义(P <0.05)。治疗后,2组患者C-反应蛋白、红细胞沉降率、类风湿因子、免疫球蛋白(Ig G、Ig A、Ig M)水平及DAS28-ESR积分较治疗前均明显降低(P <0.05),且治疗组低于对照组(P <0.05)。在塞来昔布胶囊使用的数量、天数及不良反应发生率方面,治疗组均明显少于对照组(P <0.05)。结论:桂枝芍药知母汤联合甲氨蝶呤治疗寒热错杂型活动期类风湿关节炎,能进一步改善患者实验室指标及关节功能,减轻疼痛,临床疗效与安全性更优。福建省卫生系统中青年骨干人才培养项目(2014-ZQN-JC-34

补骨颗粒含药血清对大鼠软骨细胞凋亡及Trx2信号通路的影响

目的观察补骨颗粒含药血清对体外培养的大鼠膝关节软骨细胞凋亡及对Trx2、ASK1及Caspase3表达的影响,从而探讨补骨颗粒预防骨性关节炎发生发展的作用机制。方法采用两步酶消化法分离培养大鼠软骨细胞,并进行传代培养。应用膜联蛋白V-FITC/PI染色后经流式细胞仪检测软骨细胞的凋亡情况。同时,通过电泳分离蛋白并通过蛋白质印迹分析Trx2、ASK1及Caspase3的表达情况。结果软骨细胞培养15 d左右铺满80%～90%的培养皿,大部分细胞呈梭形。流式细胞检测结果显示空白血清组的细胞凋亡率为22.80%,明显高于含药血清组(P<0.05),而20%含药血清组(15.91%)与30%含药血清组(17.93%)的细胞凋亡率又明显低于10%含药血清组(21.58%),各组间比较差异具有统计学意义(P<0.05)。蛋白质印迹分析结果显示含药血清组Trx2的表达量都明显增多,以10%含药血清组的表达量最多;空白组与10%含药血清组的ASK1与Caspase3的表达量比20%与30%含药血清组多。结论补骨颗粒可以通过激活Trx2信号通路而抑制软骨细胞的凋亡,从而起到预防骨性关节炎发生发展的作用

Morel-Lavallée损伤合并股骨转子间骨折1例并文献回顾

Morel-Lavallée损伤是一种严重的深部软组织脱套伤,常发生于四肢骨性凸起部位并多合并骨折,临床误诊、漏诊率高,给患者治疗效果带来严重的不良影响。在临床治疗中当Morel-Lavallée损伤合并骨折...福建省卫生系统中青年骨干人才培养项目(编号:2014-ZQN-JC-34

The properties of action potential and sodium-calcium exchange tail current of rabbit right ventricular outflow tract myocytes

目的研究兔右室流出道(rVOT)心肌细胞动作电位及钠钙交换尾电流(InCX,TAIl)相关特性,探讨源于rVOT室性心律失常的发生机制。方法采用全细胞膜片钳技术记录兔右室(rV)游离壁和rVOT心肌细胞的动作电位,在不更换细胞及电极内液情况下连续记录InCX,TAIl,对比分析两者动作电位和InCX,TAIl特性。结果兔rVOT心室肌细胞动作电位复极时程(APd)的变异程度大于rV游离壁心肌细胞。在rVOT心肌细胞记录到早期后除极及显著延长的APd。动作电位显著延长及后除极的rVOT心肌细胞所对应的InCX,TAIl到达峰值时程较动作电位正常的细胞延迟,并且电流强度大于rV游离壁对照组心肌细胞(P<0.05)。结论 rVOT心肌细胞APd变异程度大,而且APd显著延长的rVOT细胞InCX,TAIl到达峰值时程延迟及相应电流显著增大,这是rVOT部位好发触发活动的重要机制。Objective To explore the electrophysiological basis of arrhythmogenesis in right ventricular outflow tract(RVOT) myocytes of rabbit heart.The properties of action potential and sodium-calcium exchange tail current(INCX,tail) in rabbit RVOT cells were observed.Methods Patch-clamp technique was used to measure INCX,tail and action potential in single myocytes obtained by enzymatic dispersion of rabbit ventricle.Results Marked variability of action potential repolarization was observed in rabbit RVOT cardiomyocytes.The events of early afterdepolarization(EAD) and marked action potential duration(APD) extension were recorded in RVOT cells.The peak of INCX,tail was delayed significantly in marked APD extension RVOT cells compared to RV free wall cells,and the amplitude of INCX,tail in the former was larger than the latter ones(P<0.05).Conclusion In rabbit RVOT cardiomyocytes,prolonged APD might be the induction factor of delayed afterdeporization and EAD genesis.Under this precondition,the late-peaking and larger amplitude of INCX,tail in RVOT cells might play pivotal role in the mechanism of RVOT arrhythmogenesis.厦门市卫生局资助项目(No.A0000258

Effect of Ginsenoside Rgl on Expression of Integrin and Regulation of Signal Transduction Pathway in Osteoblasts Co-cultured with Ti Particles

目的：通过研究人参皂甙Rg1对体外钛微粒诱导的成骨细胞整合素通路相关因子的影响,以期为临床运用人参皂甙Rg1防治人工关节无菌性松动提供实验依据。方法：用人参皂甙Rg1与钛微粒共培养成骨细胞,通过ELISA法检测细胞液中的FN,Col-Ⅰ及VN含量,Western Blot检测MG-63细胞FAK和FAK（pTyr397）蛋白的含量,qPCR法检测MG-63细胞内FAK,Integrinαv及Integrinβ1 mRNA的表达。结果：正常组细胞较大,视野内细胞数最多,实验组细胞数量次之,对照组最少且形态较小,钛微粒周围无细胞生长,并可见凋亡细胞。实验组细胞液中FN,Col-Ⅰ及VN的表达较对照组有明显增高,细胞mRNA与蛋白中FAK,FAK（pTyr397）,Integrinαv及Integrinβ明显高于对照组。结论：人参皂甙Rg1可能通过直接或间接作用于MG-63Integrin及其相关信号因子,使与钛微粒共培养的MG-63细胞被抑制的FAK磷酸化再次增强,从而VN和FN功能增强,加速细胞的分裂增殖。Objective：To study the effect of Ginsenoside Rgl on integrin pathway-related factors of osteoblasts induced by titanium particles in vitro, so as to provide experimental basis for the clinical application of Ginsenoside Rgl in the prevention and treatment of aseptic loosening of artificial joints. Methods：The osteoblasts were co-cultured with Ginsenoside Rgl and Ti particles. The con- tent of FN,Col-I and VN in cytoplasm was detected by ELISA method,the content of FAK and FAK（pTyr397） protein in MG- 63 cells was detected by western blot, the expression of FAK, integrinav and integrint31 mRNA in MCJ-63 cells was detected by qPCR method. Results：The cells in the normal group were larger, and the number of the cells within the view was the highest. The number of cells in the experimental group was the second, while the control group was the smallest and the morphology was smal- ler. There was no cell growth around Ti particles, and apoptotic cells were found near the Ti particles. The expression of FN,Col- I and VN in the cytoplasm in the experimental group was increased significantly than that in the control group. The expression of mRNA,FAK,FAK（pTyr397） ,Integrinav and Integrin]3 protein was significantly higher when compared with the control groups. Conclusion：Ginsenoside Rgl may enhance the phosphorylation of FAK again, which is inhibited by MC,-63 cells co-cultured with Ti particles,by direct or indirect acting on MG-63 Integrin and its related signaling factors,so that the function of VN and FN is enhanced to accelerate cell division and proliferation.国家自然科学基金（81302986）; 福建省卫生厅中医课题（wzgs201308