全身振动对兔膝骨性关节炎关节软骨和软骨下骨的影响

目的:探讨全身振动(whole body vibration, WBV)对兔膝骨关节炎(osteoarthritis, OA)关节软骨的保护作用和软骨下骨重塑的影响。方法:48只新西兰大白兔分为四组:空白对照组(CON组)、骨关节炎对照组(ACLT组)、盐酸氨基葡萄糖组(GH组)、全身振动组(WBV组),每组12只。CON组不进行任何干预;ACLT组给予造模手术后不进行干预;GH组动物造模手术8周后进行盐酸氨基葡萄糖灌胃;WBV组在造模术后8周,使用WBV治疗仪进行干预。造模术后12周,取动物血液进行Elisa检测,取左侧胫骨近端进行大体标本观察,取左侧胫骨近侧进行HE染色、番红O-固绿染色、甲苯胺蓝染色,用于软骨组织学的Mankin评分和软骨下骨组织形态计量学分析。结果:CON组、WBV组软骨下骨骨小梁面积百分比,骨小梁数量均显著高于ACLT组。两组的骨小梁分离度均显著低于ACLT组和GH组。GH组骨小梁分离度亦显著低于ACLT组。骨小梁宽度各组间差异无显著性意义。ACLT组CTX-Ⅱ值较CON组显著升高,WBV组和GH组的CTX-Ⅱ值均较ACLT组显著降低。ACLT组PⅡANP值较CON组显著降低,GH组的PⅡANP值亦较ACLT组显著降低,WBV组的PⅡANP值与ACLT组差异无显著性意义,显著降低。结论:WBV治疗增加了兔OA关节胫骨软骨下骨骨小梁面积百分比、骨小梁数量,降低骨小梁分离度,降低膝OA兔的血清CTX-Ⅱ水平,有利于延缓兔OA关节软骨退变。     

消瘀接骨散对兔膝骨关节炎模型血清COMP、CTX-Ⅱ含量影响的实验研究

目的:观察消瘀接骨散对兔中期膝骨关节炎模型血清中COMP、CTX-Ⅱ含量的影响,探讨消瘀接骨散对膝骨关节炎的治疗作用及机制。方法:日本大耳白兔32只,造模后随机分为正常组、模型组、治疗组(消瘀接骨散组)、对照组(扶他林组),每组8只。治疗组予消瘀接骨散外用,对照组予扶他林外用,连续给药30d后,取耳源静脉血,ELISA法检测各组血清中COMP、CTX-Ⅱ含量。结果:模型组COMP含量显著高于正常组、治疗组、对照组(均是P0.01),对照组与模型组之间无差异(P0.05),治疗组低于对照组(P0.01);模型组血清中CTX-Ⅱ含量高于正常组、治疗组、对照组,差异有统计学意义(P0.01),治疗组、对照组均显著低于模型组(P0.01),治疗组与对照CTX-Ⅱ水平差异有统计学意义(P0.05)。结论:证实COMP、CTX-Ⅱ在KOA病理过程中有不同表达;消瘀接骨散有抑制血清中CTX-Ⅱ、COMP表达的作用,且对CTX-Ⅱ的抑制能力优于扶他林。     

跑步运动对大鼠不稳定膝关节软骨的影响

目的研究跑步运动对大鼠不稳定膝关节软骨的影响。 方法将20只切断膝关节前交叉韧带的8周龄SD大鼠按随机数字表法分为自由活动组（对照组）和跑步训练组（实验组）,每组10只大鼠,2组再根据处死取材时间分为造模成功3周和6周各2个亚组,每个亚组5只大鼠。实验组按15m/min强度进行跑步训练,每天训练1h;对照组自由活动,不接受任何干预。于造模成功3周和6周后采用苏木精-伊红（HE）、甲苯胺蓝及免疫组化染色、透射电镜等方法分别观察和比较2组大鼠膝关节的软骨厚度、Mankin评分、蛋白多糖含量、软骨基质Ⅱ型胶原含量及软骨形态结构。 结果造模成功6周后,2组大鼠关节软骨的厚度和Mankin评分与组内造模成功3周后比较,差异均有统计学意义（P<0.05）;造模成功3周和6周后,实验组软骨厚度分别为（154±13）μm和（131±15）μm,Mankin评分分别为（9.93±1.36）分和（11.23±1.57）分,分别与对照组同时间点比较,差异均有统计学意义（P<0.05）。造模成功6周后,2组大鼠膝关节软骨甲苯胺蓝染色阳性光密度与组内造模成功3周后比较,差异有统计学意义（P<0.05）;造模成功3周和6周后,实验组甲苯胺蓝染色阳性光密度分别与对照组同时间点比较,差异均有统计学意义（P<0.05）。造模成功6周后,2组大鼠膝关节软骨Ⅱ型胶原纤维免疫组化染色阳性光密度与组内造模成功3周后比较,差异有统计学意义（P<0.05）;造模成功3周和6周后,实验组Ⅱ型胶原纤维免疫组化染色阳性光密度分别与对照组同时间点比较,差异均有统计学意义（P<0.05）。造模成功3周后,实验组透射电镜显示软骨细胞减少,软骨表面有部分断裂;造模成功6周后,实验组透射电镜可见软骨表面多处有破损,软骨细胞坏死。 结论跑步运动对不稳定膝关节软骨具有破坏效应,可加重关节损伤和软骨基质的破坏,加速软骨细胞的退行性变。     

重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白关节腔注射对胶原诱导性关节炎大鼠骨及软骨代谢的影响

目的探讨重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(Rh TNFR:Fc)关节腔注射对胶原诱导性关节炎(CIA)大鼠疾病活动性、软骨及骨代谢的影响。方法将30只CIA大鼠随机分为3组,给予每周1次共4次右踝关节注射。Ⅰ组大鼠首次注射Rh TNFR:Fc,随后三次注射生理盐水,Ⅱ组及Ⅲ组大鼠则分别注射4次Rh TNFR:Fc或生理盐水。在基线期及每次治疗1周后(分别定义为随访1、2、3及4)通过测量右足体积评估病情。完成随访4后检测血清核因子κB受体活化因子配体(RANKL)、骨保护素(OPG)、Ⅱ型胶原C端肽(CTX-Ⅱ)及软骨寡聚基质蛋白(COMP)的水平,分离右踝关节以Mankin评分评价软骨病理改变。结果Ⅰ组大鼠随访1时右足体积显著下降(P 0. 05),之后逐渐回升。Ⅱ组大鼠各随访期右足体积逐渐下降,而Ⅲ组大鼠右足体积逐渐上升。完成随访4后Ⅰ组大鼠血清RANKL、RANKL/OPG值、CTX-Ⅱ、COMP及右踝关节Mankin评分显著高于Ⅱ组大鼠(P 0. 05),但明显低于Ⅲ组大鼠(P 0. 05)。血清OPG趋势与之相反。结论关节腔注射RhTNFR:Fc在缓解大鼠CIA病情的同时,改善骨及软骨代谢。     

关节镜下微骨折术后早期CPM对膝关节软骨损伤修复效果的影响研究

目的探究关节镜下微骨折术后早期持续被动活动(continuous passive motion, CPM)对膝关节软骨损伤修复效果的影响。方法选取我院2013年6月—2017年6月收治的行关节镜下微骨折术治疗的61例膝关节软骨损伤患者,根据术后开始CPM时间的不同分为观察组32例(术后6 h开始CPM)和对照组29例(术后24 h开始CPM)。比较两组术前及术后2周时膝关节液指标[白细胞介素1β(IL-1β)、肿瘤坏死因子α(TNF-α)、基质金属蛋白酶13(MMP-13)、Ⅱ型胶原C-端肽(CTX-Ⅱ)]差异,术前及术后24周时膝关节功能、生活满意度差异,并记录两组治疗期间并发症发生情况。结果术后2周时,两组膝关节液IL-1β、TNF-α、MMP13、CTX-Ⅱ水平均较术前降低,且观察组上述指标均低于对照组,差异均有统计学意义(P0.05或P0.01)。术后24周时,两组中文版牛津膝关节评分、Tegner运动功能评分、膝关节曲度及生活满意度量表评分均较术前升高,且观察组上述指标均高于对照组,差异均有统计学意义(P0.05或P0.01)。两组均未出现明显并发症。结论关节镜下微骨折术后早期CPM对膝关节软骨损伤患者治疗效果有显著促进作用,可降低术后关节腔内炎性反应程度,减少软骨组织降解,促进关节软骨修复及膝关节功能恢复,改善患者生活满意度,且安全性良好。     

大鼠膝关节软骨与不同强度跑台运动的影响

背景:适量的运动是维持正常关节组织形态结构及生理功能的必要条件,过度运动或制动均可导致关节软骨退变。目的:观察不同强度跑台运动对大鼠膝关节软骨的影响。方法:将18只雄性成年Wistar大鼠随机分安静组、低强度运动组、高强度运动组。6周后ELISA法测定血清基质金属蛋白酶3水平,并行蕃红-O染色、基质金属蛋白酶3与Ⅱ型胶原免疫组织化学染色及Mankin评分,反转录聚合酶链反应检测软骨基质金属蛋白酶3的mRNA表达。结果与结论:高强度运动组Mankin评分、血清及软骨中基质金属蛋白酶3表达均显著高于安静组与低强度运动组(P<0.05),基质糖氨多糖及Ⅱ型胶原含量均显著低于安静组与低强度运动组(P<0.05);低强度运动组与安静组差异无显著性意义。说明高强度运动可造成大鼠膝关节软骨退行性变,且软骨运动性损伤可能与基质金属蛋白酶3表达增强有关。     

电针对老年大鼠关节软骨及软骨下骨极化相关蛋白表达的影响

目的 探讨电针治疗对老年大鼠的关节软骨及软骨下骨极化相关蛋白表达的影响。方法 16只24月龄SD雄性大鼠随机分为老年组和电针组，每组8只；8只6月龄SD雄性大鼠为青年组。电针组接受电针治疗，穴取双侧“太溪”、“足三里”、“阳陵泉”、“血海”。电针参数：疏密波，疏波频率3 Hz，密波15 Hz，电流强度1 mA,1次/d,30 min/次，每周5 d，连续8周。其余两组用胶带固定无菌针，连接电针仪但不开机。8周后取材，ELISA法检测血清Ⅱ型胶原C端肽（CTX-Ⅱ）含量；显微CT(Micro-CT)检测左侧胫骨软骨下骨微结构；番红-固绿染色在光镜下观察左胫骨平台软骨组织形态结构，并采用改良Mankin′s评分评估关节软骨退变程度。RT-qPCR、Western blot检测基质金属蛋白酶-1(MMP-1)，基质金属蛋白酶-3(MMP-3)，基质金属蛋白酶-13(MMP-13)，肿瘤坏死因子-α(TNF-α)，白细胞介素-1β(IL-1β)，巨噬细胞甘露糖受体（MMR），精氨酸酶1(Arg1)mRNA及蛋白表达水平。结果 （1）与青年组大鼠相比，老年组大鼠血液中CTX-Ⅱ含量增高（P &l...     

3.0T MR T1ρ及T2mapping评估兔股骨内侧髁关节软骨退变

目的 观察3.0T MR T1ρ及T2 mapping评估兔股骨内侧髁关节软骨退变的价值。方法 将40只兔随机分为2周组、4周组、6周组及对照组各10只。对2周组、4周组及6周组兔建立右后肢膝骨关节炎模型并分别制动2、4及6周,对照组不予处理;行T1ρ及T2 mapping成像。处死动物后取股骨内侧髁关节软骨病变最严重区域行病理切片及染色;根据国际骨关节炎研究学会(OARSI)分级标准分为正常组、退变早期组及退变中晚期组,测定Ⅱ型胶原、蛋白多糖、β-Catenin及基质金属蛋白酶(MMP)-13,观察T1ρ及T2 mapping评估其关节软骨退变的价值。结果 最终对37只兔造模成功,正常组8只、早期退变组20只、中晚期退变组9只;3组股骨内侧髁关节软骨T1ρ值及T2值差异均有统计学意义(P均<0.05),两两比较差异亦有统计学意义(P均<0.05)。T1ρ值及T2值与OARSI分级(r=0.72、0.73,P均<0.01)、MMP-13表达(r=0.84、0.59,P均<0.01)及β-Catenin表达(r=0.76、0.66,P均<0.01)均呈正相关...     

有氧运动在预防兔膝骨关节炎发生中的作用及其机制研究

目的通过观察有氧运动对兔膝骨关节炎(OA)软骨中Ⅱ型胶原和糖胺聚糖（GAG）含量及软骨细胞凋亡率的影响,探讨有氧运动对OA的预防作用及其可能的作用机制。 方法将新西兰大白兔20只按随机数字表法分为A、B、C、D四组,每组5只大白兔。入组后,A组笼内自由活动9周;B组笼内自由活动4周;C组接受有氧运动,训练速度为0.5km/h,每周3次,每次20min,训练4周;D组亦接受有氧运动,训练速度为1.5km/h,每周5次,每次20min,共4周。B、C、D3组均于活动或训练4周后,采用木瓜蛋白酶法建立OA模型,1周后经磁共振成像（MRI）检查,均确认造模成功,然后笼内自由活动4周。入组9周后,将4组大白兔处死,采用Mankin评分比较各组间关节软骨损伤程度,并对软骨Ⅱ型胶原的表达、软骨GAG的含量以及软骨细胞凋亡率进行检测。 结果入组9周后,B、C、D 3组大白兔的Mankin评分、Ⅱ型胶原和GAG含量均显著低于A组,差异均有统计学意义（P<0.05）,B组的Mankin评分、Ⅱ型胶原和GAG含量亦显著低于D组,差异均有统计学意义（P<0.05）。入组9周后,A组的软骨细胞凋亡率为（3.45±18）%,显著低于B、C、D 3组,差异均有统计学意义（P<0.05）,且C、D 2组的软骨细胞凋亡率亦显著低于与B组,差异均有统计学意义（P<0.05）。 结论有氧运动可能通过抑制骨性关节炎关节软骨基质中Ⅱ型胶原和GAG总量的减少预防兔膝关节软骨的退变,其作用机制可能与软骨细胞凋亡的减少有关。     

电针对实验性兔膝骨关节炎病变软骨BMP-2/Smad1表达的影响

目的:观察电针(EA)治疗兔膝骨关节炎(KOA)模型关节软骨中骨形态发生蛋白-2(BMP-2)、Smad1表达的变化,探讨电针治疗KOA的作用机制。方法:制作兔膝关节炎模型,将建模成功的新西兰兔纳入模型对照组;正常组和模型组行常规饲养,不行治疗;电针组行电针治疗20d。实验结束后,分别观察各组兔行为学评分、右膝关节宽度、软骨大体形态及组织学评分、软骨BMP-2、Smad1免疫组化及实时荧光定量PCR的变化。结果:电针组与模型组在行为学评分、软骨大体形态及组织学评分(Mankin评分)方面差异均无显著性(P0.05),电针组兔右膝关节宽度小于模型组(P0.05)。各组BMP-2免疫组化结果无显著差异,电针组较模型组Smad1蛋白质表达降低。模型组和模型对照组BMP-2 m RNA表达水平较正常组上调,差异无显著性意义(P0.05),模型组Smad1m RNA表达水平较模型对照组和正常组均显著上调(P0.05),电针组BMP-2及Smad1 m RNA表达水平较模型对照组和模型组均显著下调(P0.05)。结论:电针可能通过下调早期兔膝骨关节炎软骨BMP-2/Smad1的表达抑制骨赘形成,延缓膝骨关节炎的病理进程。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."