Publications by authors named "Wei-Heng Chen"

34 Publications

Clinical Practice Guideline for Glycosides/ Tablets in the Treatment of Rheumatoid Arthritis.

Front Pharmacol 2020 14;11:608703. Epub 2021 Jan 14.

Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China.

Hook F (HF) is one of the most commonly used and effective traditional Chinese herbal medicines against rheumatoid arthritis (RA). Both Tripterygium Glycoside Tablets (TGT) and Tablets (TWT) are the representative HF-based agents enrolled into the 2019 edition of Medicine Catalog for National Basic Medical Insurance, Injury Insurance, and Maternity Insurance. However, individual differences in TGT/TWT response across patients usually exist in the process of treating RA, implying that the clinical application of the two agents may not be standardized leading to the ineffective treatment and the risk of side effects. Growing evidence show that the bioactive constituents of HF may often have toxicity, the package insert of TGT and TWT may not be described in detail, and the therapeutic windows of the two agents are narrow. Thus, it is an urgent task to develop a standardized clinical practice guideline for TGT and TWT in the treatment of RA. In the current study, a group of clinical experts of traditional Chinese medicine and Western medicine in the research field of rheumatism diseases, pharmacists, and methodologists of evidence-based medicine were invited to select the clinical questions, to determine the levels of the evidence and the strength of the recommendations, and to develop the recommendations and good practice points. The guideline is formed based on the combination of clinical research evidence and expert experience (evidence-based, consensus, supplemented by experience). The clinical problems which are supported by clinical evidence may form recommendations, and the clinical problems without clinical evidence may form experts' suggestions. Both recommendations and experts' suggestions in this guideline summarized the clinical indications, usage, dosage, combined medication, and safety of TGT and TWT against RA systematically and comprehensively, which may offer a professional guidance in the context of the clinical application of the two HF-based agents.
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http://dx.doi.org/10.3389/fphar.2020.608703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7845140PMC
January 2021

[Editorial explanation for Clinical practice guideline for Tripterygium Glycosides/Tripterygium wilfordii Tablets in treatment of rheumatoid arthritis].

Zhongguo Zhong Yao Za Zhi 2020 Sep;45(17):4154-4157

Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences Beijing 100700, China.

Clinical practice guideline for Tripterygium Glycosides/Tripterygium wilfordii Tablets in the treatment of rheumatoid arthritis(T/CACM 1337-2020) was approved on June, 2020 by the Standardization Office of Chinese Association of Chinese Medicine. Our group developed this guideline for the clinical application of Tripterygium Glycosides/Tripterygium wilfordii Tablets according to the manual for the clinical experts consensus of Chinese patent medicine from January, 2018, when this project was approved by Chinese Association of Chinese Medicine. In this article, the detailed information on our compilation process was provided, in order to facilitate the understanding and the application of the guideline, as well as provide reference for the development of clinical practice guideline for other Chinese patent medicine.
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http://dx.doi.org/10.19540/j.cnki.cjcmm.20200709.405DOI Listing
September 2020

[Clinical practice guideline for Tripterygium Glycosides/Tripterygium wilfordii Tablets in treatment of rheumatoid arthritis].

Zhongguo Zhong Yao Za Zhi 2020 Sep;45(17):4149-4153

Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences Beijing 100700, China.

Tripterygium wilfordii Hook.f.(TwHF) is one of the most effective traditional Chinese herbal medicines against rheumatoid arthritis. As the representative agents of TwHF, Tripterygium Glycoside Tablets(TGT) and Tripterygium wilfordii Tablets(TWT) were included as Class A drugs in the 2019 edition of Medicine Catalogue for National Basic Medical Insurance, Injury Insurance and Maternity Insurance, and TGT was also included in 2018 edition of National Essential Drug List and 2015 edition of Chinese Pharmacopoeia. However, it is difficult to grasp the specific clinical applications of TGT and TWT. Side effects occur from time to time. The curative effect is uneven in patients. And the package inserts of TGT and TWT are not described in details. In order to standardize the clinical application of Tripterygium wilfordii preparations, 38 authoritative units and 48 well-known experts in rheumatoid immunology clinical department, drug supervision and management, pharmacy and evidence-based medicine research fields jointly developed Tripterygium Glycoside Tablets and Tripterygium wilfordii Tablets Medication Guide for reference in clinical application, teaching and scientific research. The guideline followed the "evidence-based, consensus-assisted and experience-based" principles to form "recommendations" for the evidence supported ones, and form "consensus suggestions" for those without evidence support by using nominal group method. In this way, the medication recommendations on function, usage and dosage, drug combinations, precautions, efficacy, safety and other aspects of TGT and TWT can be provided. The application of this Guide will help to avoid or reduce the adverse reactions of T. wilfordii preparations, enhance the efficacy and reduce the cost of medicine, with certain demonstration and promotion values to improve the rational use level of traditional Chinese medicine.
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http://dx.doi.org/10.19540/j.cnki.cjcmm.20200710.501DOI Listing
September 2020

Current Treatment Modalities for Osteonecrosis of Femoral Head in Mainland China: A Cross-Sectional Study.

Orthop Surg 2020 Dec 15;12(6):1776-1783. Epub 2020 Oct 15.

The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China.

Objective: To investigate the application of treatment modalities for patients with osteonecrosis of the femoral head (ONFH) in mainland China.

Methods: This cross-sectional study was based on the online application of China Osteonecrosis of the Femoral Head Database (CONFHD). Between July 2016 to December 2018, the CONFHD program planned to recruit ONFH patients from 12 administrative areas across mainland China. Real-world medical records of treatment regimens for these patients, including surgeries and prescriptions, were approved to upload to the CONFHD application for further analysis. The surgeries performed on these patients were classified into total hip arthroplasty and hip-preserving procedures, and the latter was further classified into core decompression, bone grafting, and tantalum rod implantation. Prescription medications were classified into chemical medicine and Chinese herbal medicine (CHM); chemical medicine was further classified according to their chemical compounds, and CHM was classified according to therapeutic functions based on traditional Chinese medicine theory. Descriptive analysis was performed to summarize the application of different treatment regimens on the overall sample.

Results: A total of 1491 patients (2381 hips) who fulfilled the protocol criteria were included. There were 1039 males and 452 females with a mean age of 47.29 ± 12.69 years. The causes of ONFH were alcoholism in 642 patients (43%), corticosteroid in 439 patients (29%), trauma in 239 patients (16%), and idiopathic ONFH in 171 patients (11%). Operative treatments (including total hip arthroplasty and hip-preserving procedures) were performed on 49% of patients (43% of hips), chemical medicine therapy (including bisphosphonate, statins, and prostacyclin) was given to 37% of patients (37% of hips), and CHM was administrated to 72% of patients (75% of hips). The aforementioned interventions were not always used alone, since 47% of patients (52% of hips) received combined regimens with multiple interventions. Among hips treated by surgery, all hips with ARCO stage IV ONFH received THA (305 hips), and THA was also performed on 63 hips with stage II ONFH. Over half of hips with stage I (81%), II (91%), and III (92%) ONFH had received pharmacological treatments. Prostacyclin and bisphosphonate were the top two most prescribed medicines used alone. CHM therapies with multiple CHM functions were more commonly prescribed.

Conclusion: Current treatment modalities for ONFH patients in mainland China include operative treatment, chemical medicine, and CHM. Combined regimens with different treatment modalities are common in real-world clinical practices.
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http://dx.doi.org/10.1111/os.12810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767781PMC
December 2020

Exploring the Risk Factors for the Misdiagnosis of Osteonecrosis of Femoral Head: A Case-Control Study.

Orthop Surg 2020 Dec 16;12(6):1792-1798. Epub 2020 Oct 16.

Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China.

Objective: The purpose of the present study was to evaluate the present situation and risk factors for the misdiagnosis of osteonecrosis of femoral head (ONFH), providing the basis for accurate diagnosis of ONFH.

Methods: For this retrospective study, 1471 patients with ONFH were selected from the China Osteonecrosis of Femoral Head Database (CONFHD). These patients had been recruited between July 2016 and December 2018. According to whether or not they were misdiagnosed, the patients were divided into two groups, with 1168 cases (22-84 years old) included in the diagnosis group and 303 cases (21-80 years old) in the misdiagnosis group. Misdiagnosis was measured using the following criteria: (i) the patient had the same symptoms and signs, and the second diagnosis was not consistent with the initial diagnosis within 6 months; and (ii) the patient was admitted to a hospital participating in CONFHD and the previous diagnosis was inconsistent with the diagnosis given by the expert group. Comparisons of age, visual analogue scale for pain, and body mass index between the two groups were performed using a t-test. Gender, causes of ONFH, primary diseases requiring corticosteroids, methods of corticosteroid use, corticosteroid species, type of trauma, onset side of the disease, pain side, whether symptoms are hidden, and type of imaging examination at the initial visit were compared using the χ -test. Years of alcohol consumption, weekly alcohol consumption, and physician title at the initial visit were compared using a Mann-Whitney U-test. Furthermore, the statistically significant factors were evaluated using multiple regression analysis to investigate the risk factors of misdiagnosis.

Results: A total of 303 patients (20.6%) were misdiagnosed: 118 cases were misdiagnosed as lumbar disc herniation, 86 cases as hip synovitis, 48 cases as hip osteoarthritis, 32 cases as rheumatoid arthritis, 11 cases as piriformis syndrome, 5 cases as sciatica, and 3 cases as soft-tissue injury. Whether symptoms are hidden (P = 0.038, odds ratio [OR] = 1.546, 95% confidence interval [CI] = 1.025-2.332), physician title at the initial visit (P < 0.001, OR = 3.324, 95% CI = 1.850-5.972), X-ray examination (P < 0.001, OR = 4.742, 95% CI = 3.159-7.118), corticosteroids (P < 0.001, OR = 0.295, 95% CI = 0.163-0.534), alcohol (P < 0.001, OR = 0.305, 95% CI = 0.171-0.546), and magnetic resonance imaging (MRI) examination (P = 0.042, OR = 0.649, 95% CI = 0.427-0.985) were each found to be associated with misdiagnosis.

Conclusion: Osteonecrosis of the femoral head is easily misdiagnosed as lumbar disc herniation, hip synovitis, hip osteoarthritis, and rheumatoid arthritis. Patient history of corticosteroid use or alcohol abuse and MRI examination at the initial diagnosis may be protective factors for misdiagnosis. Hidden symptoms, physician title at the initial visit (as attending doctor or resident doctor), and only X-ray examination at the initial diagnosis may be risk factors for misdiagnosis.
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http://dx.doi.org/10.1111/os.12821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767694PMC
December 2020

Prediction of Collapse Using Patient-Specific Finite Element Analysis of Osteonecrosis of the Femoral Head.

Orthop Surg 2019 Oct;11(5):794-800

Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China.

Objective: To develop a prediction method for femoral head collapse by using patient-specific finite element analysis of osteonecrosis of the femoral head (ONFH).

Methods: The retrospective study recruited 40 patients with ARCO stage-II ONFH (40 pre-collapse hips). Patients were divided into two groups according to the 1-year follow-up outcomes: patient group without femoral head collapse (noncollapse group, n = 20) and patient group with collapse (collapse group, n = 20). CT scans of the hip were performed for all patients once they joined the study. Patient-specific finite element models were generated based on these original CT images following the same procedures: segmenting the necrotic lesion and viable proximal femur, meshing the computational models, assigning different material properties according to the Hounsfield unit distribution, simulating the stress loading of the slow walking gait, and measuring the distribution of the von Mises stress. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance of the maximum level of the von Mises stress. The optimal cut-off value was selected based on the Youden index and the corresponding predictive accuracy was reported as well.

Results: The mean level of the maximum von Mises stress in the collapse group was 2.955 ± 0.539 MPa, whereas the mean stress level in the noncollapse group was 1.923 ± 0.793 MPa (P < 0.01). ROC analysis of the maximum von Mises stress found that the area under the ROC curve was 0.842 (95% CI: 0.717-0.968, P < 0.01). The maximum Youden index was 0.60, which corresponded to two optimal cut-off values: 2.7801 MPa (sensitivity: 0.70; specificity: 0.90; predictive accuracy: 80.00%; LR+: 7), and 2.7027 MPa (sensitivity: 0.75; specificity: 0.85; predictive accuracy: 77.50%; LR+: 5).

Conclusion: Finite element analysis is a potential method for femoral head collapse prediction among pre-collapse ONFH patients. The maximum level of the von Mises stress on the weight-bearing surface of the femoral head could be a good biomechanical marker to classify the collapse risk. The collapse prediction method based on patient-specific finite element analysis is, thus, suitable to apply to clinical practice, but further testing on a larger dataset is desirable.
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http://dx.doi.org/10.1111/os.12520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819171PMC
October 2019

[Meta-analysis of laboratory index of Tripterygium Glycosides Tablets in treatment of rheumatoid arthritis].

Zhongguo Zhong Yao Za Zhi 2019 Aug;44(16):3542-3550

Institute of Chinese Materia Medica,China Academy of Chinese Medical Sciences Beijing 100700,China.

The aim of this study was to systematically evaluate the clinical efficacy of Tripterysium Glycosides Tablets( TGT) alone or in combination with methotrexate( MTX) in the treatment of rheumatoid arthritis( RA) based on the laboratory index criteria and to provide a basis for the clinical application of TGT against RA. Six databases including CNKI,Wan Fang,VIP,PubMed,EMbase and Cochrane were retrieved for randomized controlled trials( RCT) about TGT alone or combination with MTX in the treatment of RA.Then risk assessment tools were used for quality evaluation of the studies,and data extraction and analysis were conducted by using Rev Man 5.3 software for Meta-analysis. A total of 1 709 articles were retrieved,and finally 25 studies were included,with a total sample size of 2 507 cases. Meta-analysis results showed that between TGT alone and TGT alone,MDESR=-2. 66,95%CI[-8.17,2.86],P = 0.35; MDCRP=-2.38,95%CI[-9.01,4.24],P = 0.48; between TGT combined with MTX and MTX alone,MDESR= 8.74,95%CI[6.72,10.76],P<0.000 01; MDCRP= 5.37,95%CI[3.71,7.03],P<0.000 01; SMDRF= 1.05,95%CI[0.51,1.60],P = 0.000 1.The effect of TGT on decreasing CRP and ESR in RA patients was similar to the MTX. In addition,TGT combined with MTX were more effective in decreasing CRP,ESR,RF than MTX alone. However,due to the potential bias in the included studies,more and high-quality randomized controlled trials would be needed to improve the level of evidence.
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http://dx.doi.org/10.19540/j.cnki.cjcmm.20190612.503DOI Listing
August 2019

Can early rehabilitation after osteoarthritis reduce knee and hip arthroplasty risk?: A national representative cohort study.

Medicine (Baltimore) 2019 May;98(21):e15723

Department of Medical Research, Tainan Municipal Hospital (Managed By Show Chwan Medical Care Corporation), Tainan City, Taiwan ROC.

This retrospective cohort study evaluated the effects of different frequencies of physical therapy intervention on the total knee arthroplasty (TKA) and total hip arthroplasty (THA) risk of osteoarthritis (OA) patients.We sampled 438,833 insurants from Taiwan National Health Insurance Research Database for patients diagnosed as having OA during 2000 to 2013. OA who received physical therapy within in the first year of OA diagnosis were divided based on the number of sessions they received in that first year: >24, 13-23, and <12 sessions.The results revealed that the TKA and THA incidence rates among patients aged 60 to 80 years were respectively 3.5% and 0.9% in the >24 cohort and 4.9% and 1.4% (all P < .001) in the comparison cohort. Moreover, the HRs of TKA and THA in the >24 cohort were 0.77 (0.67-0.87, P < .001) and 0.71 (0.53-0.96, P = .024), respectively. By contrast, no significant differences were noted between the 13-23 and <12 cohorts and their respective comparison cohorts.In conclusion, our study results indicated that elderly patients aged 60 to 80 years who underwent >24 physical therapy sessions within 1 year of receiving an OA diagnosis exhibited reduced of TKA and THA risks.
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http://dx.doi.org/10.1097/MD.0000000000015723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571258PMC
May 2019

[Study on the risk factors for the misdiagnosis of femoral head osteonecrosis].

Zhongguo Gu Shang 2017 Nov;30(11):1000-1003

The Third Department of Bone and Joint, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China;

Objective: To evaluate the status and risk factors for the misdiagnosis of femoral head osteonecrosis, providing the basis for accurate diagnosis of osteonecrosis of femoral head.

Methods: The data of 314 hospitalized patients were collected from March 2015 to March 2016, and the risk factors for osteonecrosis of femoral head were analyzed by Logistic regression model. Misdiagnosis was defined that the diagnosis given on the first time was different from that on the second time or that given by expert group with the same symptoms and signs. The general data, predisposing factors, time of onset, hospital visits, clinical manifestations, X-ray film of hip joint, MRI and other data were statistically analyzed.

Results: Total 127 patients experienced misdiagnosis (up to 40.8%). Among them, the patients with osteonecrosis of femoral head misdiagnosed as other diseases accounted for 77.2% and the patients with other diseases misdiagnosed osteonecrosis of femoral head accounted for 22.8%. Statistical analysis showed that the predisposing factors, history of glucocorticoid and alcohol intake, diseased lower limb, pained lower limb, hidden disease attack, the level of first reception hospital and expert were significantly related with the misdiagnosis of femoral head osteonecrosis based on the logistic regression model (<0.05) . The relationship between misdiagnosis and gender, age, primary disease taking glucocorticoid, approach and time of glucocorticoid use, the type of alcohol, drinking time had no statistical significance(>0.05). The Logistic regression analysis showed that the hidden disease attack(OR=3.059) and level of first reception expert(OR=2.778) were the high risk factors associated with the misdiagnosis in which the femoral head necrosis was misdiagnosed as other diseases(<0.01), and glucocorticoid intake history was the low risk factors(OR=0.387)(<0.05). The Logistic regression analysis showed that the level of first reception expert (OR=3.573) was the high risk factor associated with the misdiagnosis in which the other diseases were misdiagnosed as necrosis of femoral head.

Conclusions: Misdiagnosis rate of femoral head necrosis is high. Hidden disease attack and low level of first reception expert are the high risk factors associated with the misdiagnosis in which the femoral head necrosis was misdiagnosed as other diseases, however, glucocorticoid intake history is the protective factor of misdiagnosis. Low level of first reception expert is the high risk factor associated with the misdiagnosis in which other diseases were misdiagnosed as necrosis of femoral head.
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http://dx.doi.org/10.3969/j.issn.1003-0034.2017.11.006DOI Listing
November 2017

[Study on optimization of a fewest layer measuring method of osteonecrotic area in femoral head].

Zhongguo Gu Shang 2016 Sep;29(9):853-858

The Third Department of Arthropathy, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China.

Objective: To optimize a measuring method of osteonecrotic area by analyzing the average osteonecrotic areas and osteonecritic volume using multi layer MR images.

Methods: The MRI images of 87 cases (120 hips) of ONFH(ARCO II) were collected retrospectively from January 2011 to January 2012 in Wangjing Hospital of China Academy of Chinese Medicine Science. PHILIPS Achieval 1.5T MR was used to obtain coronal TSE T1 weighted (T1W) images. The scanning parameters were shown as follows:slice thickness, 3.5 mm; gap, 0.3 mm; images repetition time(TR), 500 ms;echo time(TE), 20 ms;field of view (FOV), 374 mm;total 12 layers. According to the distribution rule of osteonecrotic lesion, the layer of coronal T1-weighted imaging showing most of femoral neck was marked as layer 0(L0). The layers before L0 were marked in sequence L1, L2, L3, L4... , and the layers after L0 were marked in sequence L-1, L-2, L-3, L-4... . Auto CAD 2007 was used to measure the percentage of osteonecrotic area and calcu late the average data, and then decreased the layer from low to high layer successively based on frequency of osteonecrotic occurrences. First, the layer with lowest frequency of osteonecrotic occurrenoses L3 was removed, then calculated the average osteonecrotic area of the ramaining 8 layers. L5, L4, L-2, L-1, L3 layers were gradually removed, resulting in the calculation of avereage osteonecrotic areas in 7, 6, 5, 4, 3 layers. These areas were compared to the osteonecrotic volume in MR imagings, leading to the optimization of the fewest layer measuring method of osteonecrotic area using a statistical analysis.

Results: The percentage of osteonecrotic volume in 120 hips was 0.333±0.151. The average osteonecrotic areas of 9 to 3 layers were 0.321±0.117, 0.317±0.136, 0.312±0.147, 0.333±0.153, 0.348±0.172, 0.365±0.174, 0.377±0.202 respectively. There were no statistical differences of the average osteonecrotic areas and osteonecrotic volume in 9 to 3 layers(>0.05), but when the osteonecrotic layers were reduced to 3, there were statistical differences(<0.05). Total 120 hips were grouped according to osteonecrotic volume based on ARCO staging criteria, among them, 12 hips were grade A, 43 were B, 65 were C. According to average osteonecrotic areas of 4 layers, 10 hips were A grade, 32 were B, 78 were C. There were no statistical differences between two methods(>0.05). There was a high degree of concordance among two methods.

Conclusions: The results of 4(L0, L1, L2, L3) layers measuring method and osteonecrotic volume measuring method are similar. The 4 layers measuring method is an accurate, convenient, valuable method measuring the esteonecrotic area with the fewest layers, which is worth to be popularized in clinical application.
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http://dx.doi.org/10.3969/j.issn.1003-0034.2016.09.016DOI Listing
September 2016

[Case-control study on Chinese medicine fumigation and massage therapy for the treatment of knee stability and func tional recovery after anterior cruciate ligament reconstruction operation].

Zhongguo Gu Shang 2016 May;29(5):397-403

Objective: To study clinical outcomes of Chinese medidine fumigation and massage therapy for the treatment of knee stability and functional recovery after anterior cruciate ligament reconstruction operation,and to explore the effect on tendon-bone healing.

Methods: Total 50 patients were divided into two groups: the control group (normal rehabilitation therapy group),the treatment group (Chinese medicine fumigation and manipulation group). There were 25 patients in the control group, including 16 males and 9 females, who were treated with isometric muscle training, with the gradually enlarging amplitude of flexion and progressive loading of bearing training for knee recovery. There were 25 patients in the treatment group, including 15 males and 10 females,who were treated with the conventional rehabilitation therapy combined with Chinese medicine fumigation and massage therapy. The Chinese herbs named as Haitongpi decoction was steamed by a special equipment to fumigate the knee after operation; Based on the biomechanical parameters of the ligament reconstruction, the massage therapy was designed to control the degree of the knee flexion and release the adhesion for early recovery of knee functions. The Lysholm knee function evaluation system was used, and MRI examination was performed to measure the change in width of ligament tunnel in femur and tibia to evaluate the safety and stability of the treatment.

Results: Lysholm system showed that two groups both had improving results from the 1st month after operation to the 3rd month (treatment group, F=36.54, P<0.05; the control group, F=28.12, P<0.05), and the results of the treatment group was better than that of the control group at the observation point (the 1st month, t=0.105, P<0.05; the 3rd month, t=5.361, P<0.01). There was no difference between the two groups when evaluating the bone and tendon healing 3 and 12 months after operation (P>0.05), indicating that Chinese rehabilitation therapy was a safety treatment without the influence on the loosing of tendon.

Conclusion: Chinese medicine fumigation and massage therapy can early improve the knee function after the anterior cruciate ligament reconstruction operation without the disturbance of the knee stability.
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May 2016

Diagnosis and management of knee osteoarthritis: Chinese medicine expert consensus (2015).

Chin J Integr Med 2016 Feb 19;22(2):150-3. Epub 2015 Dec 19.

Department of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.

Literature review shows that Chinese medicine and other related treatment are still the main stream treatment of knee osteoarthritis. Currently, there is short of handbook guiding Chinese medicine from evidence-based medical evidence, so it is a top priority to develop a clinical guideline from the expert consensus. After several rounds of discussion during the conference and examination by letter, which has collected opinions from nearly one hundred experts, consensus was reached. Nonpharmacologic interventions include health education, medical exercise, acupuncture, massage, acupotomology, and physiotherapy. Pharmacological interventions are as follows. Topical application includes fumigation, application, hot compressed, ironing and iontophoresis with Chinese herbs, etc. Chinese patent medicine for external use includes plaster, ointment, etc. Western medicine for external use mainly includes emulsion, ointment, plaster and embrocation containing nonsteroidal anti-inflammatory drugs (NSAIDs). Intraarticular injection mainly includes sodium hyaluronic acid, chitosan (for injection) with prudent use of glucocorticoid. Chinese herbal medicine and Chinese patent medicine can be taken referring to syndrome differentiation which mainly includes syndromes of qi stagnation and blood stasis, cold dampness, deficiency of Gan (Liver) and Shen (Kidney), deficiency of qi and blood. Western medicine mainly includes analgesic, NSAIDs, diseases modifying drugs. Surgery procedures mainly include joint irrigation, arthroscopic surgery, osteotomy, arthroplasty, etc.
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http://dx.doi.org/10.1007/s11655-015-2432-7DOI Listing
February 2016

Effects of lead exposure on dendrite and spine development in hippocampal dentate gyrus areas of rats.

Synapse 2016 Mar 9;70(3):87-97. Epub 2016 Jan 9.

School of Life Sciences, University of Science and Technology of China, Hefei, Anhui, 230027, People's Republic of China.

Lead exposure has been implicated in the impairment of synaptic plasticity in the hippocampal dentate gyrus (DG) areas of rats. However, whether the degradation of physiological properties is based on the morphological alteration of granule neurons in DG areas remains elusive. Here, we examined the dendritic branch extension and spine formation of granule neurons after lead exposure during development in rats. Dendritic morphology was studied using Golgi-Cox stain method, which was followed by Sholl analysis at postnatal days 14 and 21. Our results indicated that, for both ages, lead exposure significantly decreased the total dendritic length and spine density of granule neurons in the DG of the rat hippocampus. Further branch order analysis revealed that the decrease of dendritic length was observed only at the second branch order. Moreover, there were obvious deficits in the proportion and size of mushroom-type spines. These deficits in spine formation and maturity were accompanied by a decrease in Arc/Arg3.1 expression. Our present findings are the first to show that developmental lead exposure disturbs branch and spine formation in hippocampal DG areas. Arc/Arg3.1 may have a critical role in the disruption of neuronal morphology and synaptic plasticity in lead-exposed rats.
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http://dx.doi.org/10.1002/syn.21873DOI Listing
March 2016

Sanmiao formula inhibits chondrocyte apoptosis and cartilage matrix degradation in a rat model of osteoarthritis.

Exp Ther Med 2014 Oct 24;8(4):1065-1074. Epub 2014 Jul 24.

Institutes of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, P.R. China.

Sanmiao formula (SM) is a basic prescription for the treatment of gouty and rheumatoid arthritis that has been used in China over a long period of history. However, there is no evidence associating SM with the treatment of osteoarthritis (OA). In this study, a characterization of the anti-OA effect of SM was conducted using an rat model induced by anterior cruciate ligament transection and medial meniscus resection (ACLT plus MMx), together with studies using chondrocytes for further molecular characterization. Rats subjected to ACLT plus MMx were treated with SM at doses of 0.63, 1.25 and 2.5 g/kg per day for three or six weeks. SM treatment significantly inhibited the histopathological changes of articular cartilage damage and synovial inflammation in the rats following ACLT plus MMx. SM (2.5 g/kg) clearly inhibited chondrocyte apoptosis and prevented cartilage matrix degradation, which was indicated by the increased proteoglycan and collagen content, particularly with regard to type II collagen expression in articular cartilage. Furthermore, SM (2.5 g/kg) markedly inhibited the release of interleukin (IL)-1β, tumor necrosis factor-α and nitric oxide in serum, while simultaneously increasing the levels of bone morphogenetic protein-2 and transforming growth factor-β in the circulation. Notably, SM (2.5 g/kg) clearly attenuated the OA-augmented expression of matrix metalloproteinase (MMP)-13 and augmented the OA-reduced expression of tissue inhibitor of metalloproteinase (TIMP)-1 in the knee joints. In addition, SM significantly reduced the proportion of early and late apoptotic and sub-G phase cells, and clearly decreased the expression of MMP-13 and increased that of TIMP-1 at the mRNA and protein levels in IL-1β-induced chondrocytes. These findings provide the first evidence that SM effectively treats OA by inhibiting chondrocyte apoptosis, cartilage matrix degradation and the inflammatory response.
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http://dx.doi.org/10.3892/etm.2014.1862DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151698PMC
October 2014

Effect of Ermiao Recipe with medicinal guide Angelicae Pubescentis Radix on promoting the homing of bone marrow stem cells to treat cartilage damage in osteoarthritis rats.

Chin J Integr Med 2014 Aug 5;20(8):600-9. Epub 2014 Aug 5.

Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China.

Objective: To investigate the effect of Ermiao Recipe (, EMR) with medicinal guide Angelicae Pubescentis Radix (APR) on the homing of bone marrow stem cells (BMSCs) to focal zone in osteoarthritis (OA) rats.

Methods: Forty-eight Sprague-Dawley rats were randomly assigned to the sham-operated, model, EMR, and EMR plus APR groups (12 rats in each group). The OA rat model was induced by anterior cruciate ligament transection and medial meniscus resection. All rats were injected with recombinant human granulocyte colonystimulating factor [rhG-CSF, 30 μg/(kg·d) for continuous 7 days], and rats in the EMR and EMR plus APR groups were treated with EMR or EMR plus APR at 1.6 or 1.9 g/(kg·d) for 3 or 6 weeks, respectively. Cartilage histopathologic changes were observed by hematoxylin and eosin staining. Chondrocytes apoptosis and cartilage matrix components were tested by transferase-mediated deoxyuridine triphosphate-biotin nick end labeling assay and special staining. Interleukin-1β (IL-1 β), tumor necrosis factor α (TNF-α), bone morphogenetic protein 2 (BMP-2), and transforming growth factor beta-1 (TGF-β1) in serum were detected by enzyme-linked immunosorbent assay or radioimmunoassay assay. Matrix metalloproteinase (MMP)-13, tissue inhibitors of metalloproteinase (TIMP)-1, bromodeoxyuridine (BrdU), cluster of differentiation 34 (CD34), and stromal cell derived factor 1 (SDF-1) were measured by immunohistochemistry assay.

Results: EMR and EMR plus APR significantly inhibited articular cartilage damage and synovium inflammation in OA rats at 3 or 6 weeks of treatment, the most obvious changes in these parameters were found in the EMR plus APR group. At 6 weeks, compared with EMR treatment, EMR plus APR remarkably inhibited chondrocytes apoptosis and the release of IL-1β and TNF-α, obviously decreased MMP-13 expression, and significantly increased expressions of proteoglycan, collagen, type II collagen and TIMP-1, serum levels of BMP-2 and TGF-β1 as well as expressions of BrdU, CD34 and SDF-1 in cartilage articular (P<0.01 or P<0.05).

Conclusion: The medicinal guide APR improved the therapeutic effects of EMR on OA rats by promoting directional homing of BMSCs to focal zone.
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http://dx.doi.org/10.1007/s11655-014-1761-2DOI Listing
August 2014

[Treating early-to-middle stage nontraumatic osteonecrosis of femoral head patients by jianpi huogu recipe: a retrospective study].

Zhongguo Zhong Xi Yi Jie He Za Zhi 2013 Aug;33(8):1054-8

Third Department of Bone Joints, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing (100102), China.

Objective: To observe the efficacy and features of treating early-to-middle stage nontraumatic osteonecrosis of femoral head (NONFH) patients by Jianpi Huogu Recipe (JHR).

Methods: Using retrospective paired control method, early-to-middle stage NONFH patients treated by JHR and followed-up for 2 years were recruited as the test group (47 cases). Those accepted surgery of core decompression, focus debridement and bone graft were recruited as the control group (48 cases). Radiographic images and clinical data of patients were collected before and after treatment. The stable rate and excellent rate of Harris score were taken as efficacy evaluation indicators.

Results: (1) There was no statistical difference in excellent rate of Harris score between the two groups (95.74% vs. 79.17%, P > 0.05). But better effects were obtained in the test group in relieving pain, improving joint deformation, joint mobility, and total Harris score (P < 0. 05, P < 0. 01). There was no statistical difference in the stable rate of radiography between the two groups (74.47% vs. 75.00%, P > 0.05). (2) There was no statistical difference in the stable rate of radiography at phase II and Ill [staging by Association Research Circulation Osseous (ARCO)] between the two groups (82.05% vs. 80.00%, 37.50% vs. 50.00%, P > 0.05). (3) The stable rate of radiography and excellent rate of Harris score were obviously higher in ARCO phase II patients than in ARCO phase Il patients (82.05% vs. 37.50%,97.44% vs. 87.50%, P < 0.01).

Conclusions: Equivalent stable rate of radiography to that of surgery could be obtained in treating early-to-middle stage NONFH patients by JHR. But it was better than surgery in relieving pain, improving joint deformation and joint mobility.
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August 2013

[Effects of promoting blood circulation to remove meridian obstruction combined with medicinal guides on related osteogenesis factors in rabbits with femoral head necrosis].

Zhongguo Gu Shang 2013 Jul;26(7):591-6

Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China.

Objective: To observe effects of blood circulation promoting compounds combined with medicinal guides on content of bone glaprotein (BGP), bone morphogenetic protein-2 (BPM-2) and expression of BMP-2 mRNA in rabbits with femoral head necrosis, and explore its mechanism.

Methods: Ninety-eight healthy Spragur-Dawley male rabbits were collected and weighted 2.2 to 2.8 kg. Eighty-four rabbits were built femoral head necrosis model by freezing left femoral head in liquid nitrogen, then randomly divided into 6 groups, 14 in each group. The 6 groups included model group,promoting blood circulation to remove meridian obstruction group,promoting blood circulation to remove meridian obstruction combined with achyranthes bidentata group,radix angelicae pubescentis, asarum group, and platycodon grandiflorum group,other 14 rabbits were sham operation group. While drug groups were administrated corresponding Chinese herb after molding,model group and shamp operation group were given saline. Recombinant human granulocyte-colony stimulating factor ( 30 microg x kg(-1) x d(-1))were injected into all rabbits for 7 days. Samples were taken on the second and fourth week,the content of BGP and BMP-2 were detected by enzyme-linked immunosorbent assay (ELSA) and radioimmunoassay (RIA), histopathological changes of left femoral head were observed by Hematoxylin and Eeosin staining (HE), and expression of BMP-2 mRNA were tested by fluorescence in situ hybridization.

Results: Compared with sham operation group, the rate of empty lacunae femoral head were obviously increased in model group, and the content of BGP were increased on the second week, and BMP-2 and BMP-2 mRNA were decreased on the fourth week. Compared with model group, the content of BGP, BMP-2 and BMP-2 mRNA were higher both of the second and fourth week in promoting blood circulation to remove meridian obstruction group. The rate of empty la- cunae femoral head were lower in achyranthes bidentata group, BGP, BMP-2 and BMP-2 mRNA were higher on the fourth week. The rate of empty lacunae femoral head were lower in platycodon grandiflorum group, and BGP were decreased on the second and fourth week, BMP-2 were lower on the second week ,while BMP-2 mRNA were decreased on the fourth week; the content of BMP-2 and BMP-2 mRNA were increased in radix angelicae pubescentis group on the second week; while there was no change in asarum group.

Conclusion: Radix angelicae pubescentis can increase the content of BGP, BMP-2 and expression of BMP-2 mRNA ,which is an effective mechanism of preventing femoral head necrosis.
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July 2013

Treatment with SiMiaoFang, an anti-arthritis chinese herbal formula, inhibits cartilage matrix degradation in osteoarthritis rat model.

Rejuvenation Res 2013 Oct;16(5):364-76

1 Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences , Beijing, China .

A Chinese herbal preparation, SiMiaoFang (SMF), has been used clinically for treating arthralgia by virtue of its anti-inflammatory and pain-relieving activities. However, no evidence base links SMF to anti-osteoarthritis (OA), particularly its link to inhibiting cartilage matrix degradation. In this study, we undertook a characterization of anti-OA activity of SMF using an in vivo rat model induced by anterior cruciate ligament transection and medial meniscus resection (ACLT+MMx) together with in vitro studies with chondrocytes for further molecular characterization. ACLT+MMx rats were treated with SMF at doses of 0.63, 1.25, and 2.5 grams/kg per day for 6 weeks. SMF treatments significantly inhibited cartilage matrix degradation, as indicated by increasing proteoglycan and collagen content, particularly type II collagen expression in articular cartilage, decreasing CTX-II (collagen type II degradation marker), and increasing CPII (collagen type II synthesis marker) in circulation. Moreover, SMF suppressed synovial inflammation and inhibited release of interleukin-1β (IL-1β) and tumor necrosis factor-α in serum. The levels of serum prostaglandin E₂ and nitric oxide productions were decreased via suppression of the production of cyclooxygenase-2 and inducible nitric oxide synthase, respectively. Importantly, SMF interfered with OA-augmented expression of matrix metalloproteinases (MMPs) -3 and -13 and aggrecanases (ADAMTS) -4 and -5, which are considered to be key enzymes in cartilage matrix degradation, and simultaneously augmented OA-reduced tissue inhibitors of metalloproteinases (TIMPs) -1 and -3 expression in the joints. The largest changes in these parameters were found at the highest dose. Meanwhile, SMF significantly decreased MMP-3 and -13 and increased TIMP-1 and -3 at mRNA and protein levels in IL-1β-induced chondrocytes. These findings provide the first evidence that SMF effectively treats OA by inhibiting cartilage matrix degradation.
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http://dx.doi.org/10.1089/rej.2013.1439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3804322PMC
October 2013

Effects of huogu I formula (I) on correlated factors of bone regeneration in chickens with steroid-induced necrosis of femoral head.

Chin J Integr Med 2012 May 2;18(5):378-84. Epub 2012 May 2.

Fujian University of Traditional Chinese Medicine, Fuzhou, China.

Objective: To study the mechanism of Huogu I formula (I) in treating osteonecrosis of femoral head.

Methods: Forty-eight healthy female Leghorn chickens were randomly divided into control group, model group and Huogu I group, and each group consisted of 16 chickens. At the meantime of model establishment, chickens of the Huogu I group were administrated with decoction, while the model and control group with distilled water by gavage. At the 8th and 16th week after medication, blood samples were obtained for blood lipid detection while both sides of femoral head were harvested for the rest of examinations. Specifically, expressions of bone morphogenetic protein-2 (BMP2), transforming growth factor beta1 (TGFβ(1)), Smad4 and Smad7 were evaluated by immunohistochemistry, while expression of osteoprotegerin/receptor activator of nuclear factor kappaB ligand (OPG/RANKL) mRNA was detected by in situ hybridization.

Results: Compared with the control group, serum levels of total cholesterol (TC), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) in the model group rose significantly. Positive cell counting of BMP2, TGFβ(1), Smad4 and OPG in femoral head of the model group dropped prominently. Positive cell counting of Smad7 and RANKL increased dramatically. In contrast with the model group, levels of TC, TG and LDL-C in Huogu I group reduced significantly. Positive cell counting of BMP2, TGFβ(1), Smad4 and OPG in femoral head of the Huogu I group increased prominently. Indices of Smad7 and RANKL both decreased significantly. Especially at the 8th week, these variations were more significant.

Conclusion: Huogu I formula is effective in promoting repair of necrotic femoral head by regulating the expressions of BMP2, TGFβ(1), Smads and OPG/RANKL of osteoclast in femoral head.
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http://dx.doi.org/10.1007/s11655-012-1086-yDOI Listing
May 2012

Effect of Huogu II Formula (II) with medicinal guide Radix Achyranthis Bidentatae on bone marrow stem cells directional homing to necrosis area after osteonecrosis of the femoral head in rabbit.

Chin J Integr Med 2012 Oct 12;18(10):761-8. Epub 2012 Jan 12.

Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China.

Objective: To investigate the effect of Huogu II Formula (II) with medicinal guide Radix Achyranthis Bidentatae (Ach) on bone marrow stem cells (BMSCs) homing to necrosis area after osteonecrosis of the femoral head (ONFH) frozen by liquid nitrogen in rabbit as well as to explore the mechanism of prevention and treatment for ONFH.

Methods: The animal model of ONFH was established by liquid nitrogen frozen on the rabbit left hind leg. Forty-eight Japanese White rabbits were randomly assigned to sham-operated group, model group, Huogu II group, and Huogu II plus Ach group, with 12 rabbits in each. During the course of ONFH animal model establishment, all rabbits were subcutaneously injected with recombinant human granulocyte colony-stimulating factor [rhG-CSF, 30 μg/(kg·day) for continuous 7 days]. Meanwhile, normal saline and decoction of the two formulae were administrated by gavage, respectively. White blood cells (WBC) were counted in peripheral blood before and after injection of rhG-CSF. Materials were drawn on the 2nd and 4th weeks after model built; bone glutamine protein (BGP) and bone morphogenetic protein 2 (BMP2) levels in serum were tested. Histopathologic changes were observed by hematoxylin and eosin (HE) staining. BMP2 mRNA levels were detected with in situ hybridization (ISH) staining. 5-Bromo-2'-deoxyuridine (BrdU) and stromal cell derived factor 1 (SDF-1) were measured by immunohistochemical assay in femoral head of the left hind leg.

Results: Compared with the shamoperated group, the ratio of empty lacuna, serum BGP, and SDF-1 level in the model group increased significantly, and BMP2 in both serum and femoral head decreased significantly. However, in comparison with the model group, the empty lacuna ratio of Huogu II group and Huogu II plus Ach group decreased obviously in addition to the levels of serum BGP and BMP2, and the expressions of BMP2 mRNA, BrdU, and SDF-1 increased significantly. Above changes were particularly obvious in Huogu II plus Ach group. BGP and SDF-1 on the 2nd week and empty lacuna rate and serum BMP2 level on the 4th week in Huogu II group significantly exceeded their counterparts. On the 2nd week, only in Huogu II plus Ach group that the BrdU counting rose significantly. On the 4th week, empty lacuna rate and serum BMP2 level in Huogu II plus Ach group exceeded those in Huogu II group distinctively.

Conclusions: To a certain extent, the medicinal guide Ach improves the preventive and therapeutic effects of Huogu II Formula on experimental ONFH model. The possible mechanism of this is related to its promoting effect on directional homing of BMSCs to the necrosis area.
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http://dx.doi.org/10.1007/s11655-011-0940-7DOI Listing
October 2012

[Experimental research progress of warming yang and reinforcing kidney of Chinese medicine to promote the differentiation of bone marrow stromal cells].

Zhongguo Gu Shang 2011 Apr;24(4):352-6

Fujian University of Chinese Medicine, Fuzhou 350108, Fujian, China.

Bone marrow stromal cells (BMSCs), a kind of stem cells residing in bone marrow, have self-renewal, high proliferative capacity and the potential of multilineage differentiation. It has a good prospect in application of the cell replacement therapy, the gene therapy and the tissue engineering and so on. As the content of BMSCs is extremely low in bone marrow, BM-SCs must be amplified in vitro and induced to differentiation to meet the clinical needs. Researches of the recent years suggest there is a very promising way that Chinese medicine could induce BMSCs proliferation, differentiation. Based on the Chinese medicine theory, "the kidney generating marrow and dominating bone" and "kidney storing essence, essence and marrow", the TCM scholars have done some researches to explore the function of warming yang and reinforcing kidney of Chinese medicine to promote bone marrow stromal cells and found that these drugs can promote the BMSCs to proliferate and to differentiate into osteogenic, cartilage and nerve cells. This article elaborates and presents the researches on this aspect.
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April 2011

[Effects of different Chinese drugs on bone histomorphology of hormone induced femoral head necrosis].

Zhongguo Gu Shang 2010 Dec;23(12):915-9

Institute of Chinese Materia Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.

Objective: To evaluate and compare the histopathology effects and mechanisms of the methods of "invigorating spleen to remove phlem & promoting blood circulation to remove meridian obstruction" and "invigorate the kidney & promoting blood circulation to remove meridian obstruction" preventing hormone induced femoral head necrosis in hens.

Methods: Sixty-four healthy hens were randomly divided into 4 groups: blank control group, model group, Jianpi group (with therapeutics of invigorating spleen to remove phlem), Bushen group (with the effect of warming kidney for duresis). All hens were injected intramuscularly with Medrat once a week for 16 weeks but normal saline in blank control group. Bilateral femoral heads were dissected on 8 weeks or 16 weeks. Paraffin tissue sections were prepared to detect histopathologic change with hematoxylin and eosin, or mason staining.

Results: Histological analysis showed that Huogu recipe I and Huogu recipe II can promote osteogenesis and repair osteonecrosis, increase blood circulation of bone marrow, and inhibit pimelosis of bone marrow. Compared with blank control group, the areas of adipose cells increased significantly (t = -12.9, P < 0.01), the area of immature collagen increased significantly (t = -2.0, P < 0.05) and the ratio of empty lacuna in medullary cavity (t = -3.7, P < 0.05). Compared with model group, both the area of adipose cells and the ratio of empty lacuna decreased in Jianpi group and Bushen group (F = 26.8, 13.5, P < 0.01), so it was with the Bushen group immature collagen (F = 4.6, P < 0.01).

Conclusion: Both the methods of "invigorating spleen to remove phlem & promoting blood circulation to remove meridian obstruction" and "invigorate the kidney & promoting blood circulation to remove meridian obstruction" can prevent hormone induced femoral head necrosis. The time taking effect in the method of "invigorating spleen to remove phlem" was shorter.
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December 2010

[Grading treatment of hip osteoarthritis].

Zhongguo Gu Shang 2010 Sep;23(9):665-7

Department of the 1st Orthopaedics Bone and Joint, Wangjing Hospital, China Academy of Chinese Medicine Sciences, Beijing 100102, China.

Objective: To investigate therapeutic effects of intra-articular injection of sodium hyaluronate, arthroscopy and total hip replacement for the treatment of different severity hip osteoarthritis.

Methods: Eighty-nine patients were treated with the three methods from June 2004 to August 2008. There were 33 males and 56 females, ranging in age from 30 to 72 years, averaged 51.8 years. The disease course ranged from 3 to 360 months, with a mean of 58.7 months. All the patients had hip pain and limited movement of hip joint. The patients were treated according to ISOA score and Kellgren-Lawrance (K-L) grades of hip osteoarthritis. The preoperative and postoperative Harris scores were compared.

Results: After the operation, 83 patients were followed up, and the duration ranged from 3 to 58 months. The Harris scores results: the patients with slight hip osteoarthritis and K-L grade I got an averaged preoperative score of (70.50 +/- 4.62) and postoperative score of (91.75 +/- 4.01); the patients with slight hip osteoarthritis and K-L grade II got an averaged preoperative score of (70.15 +/- 3.79) and postoperative score of (82.18 +/- 3.92). The patients with moderate hip osteoarthritis and K-L grade III got an averaged preoperative score of (57.12 +/- 2.19) and postoperative score of (89.94 +/- 1.13) score. The patients with serious hip osteoarthritis and K-L grade IV got an averaged preoperative score of (48.63 +/- 2.21) and postoperative score of (90.76 +/- 1.14); the patients with very serious hip osteoarthritis and K-L grade IV got an averaged preoperative score of (42.67 +/- 3.17) and postoperative score of (91.97 +/- 2.24); the patients with extremely serious hip osteoarthritis and K-L grade IV got an averaged preoperative score of (36.46 +/- 2.96) and postoperative score of (82.69 +/- 1.19). There were significant differences in scores of all groups before and after treatment.

Conclusion: The hip osteoarthritis should be treated according to its serious degree such as slight, moderate and severe, as well as based on its X-ray classification, which is the best method to get satisfactory results.
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September 2010

[Radiographic imaging feature and differential diagnosis of early femoral head necrosis].

Zhongguo Gu Shang 2010 May;23(5):344-8

Wangjing Hospital of China, Academy of Chinese Medical Science ,Beijing 100102,China.

Objective: To study early femoral head necrosis radiographic imaging features to provide objective basis for the clinical differential diagnosis and therapeutic schedule's choice.

Methods: Ninty-one patients with femur head necrosis of ARCO stage I and II whom were diagnosed by clinic and MRI and treated from March 2007 to June 2008 were analyzed retrospectively. There were 32 males and 59 females with an average age of (34.83 +/- 9.57) years ranging from 21 to 60 years. The course of disease were from 2 to 12 months. There were 17 cases of unilateral and 74 of bilateral; 48 cases caused by steroid, 35 cases by alcohol and 8 cases for unknown reasons. The images of X-ray, CT and MRI of femoral head were analyzed to summarize the characteristic and to distinguish with the imaging of similar osteonecrosis.

Results: Ninety-one cases had linear low signal on T1WI in weight-bearing area of femoral head and high signal of the "dual taxation" on T2WI. But the shapes had different characteristics. There were 36 cases (39.56%) of line type shapes, 28 cases (30.77%) of oval shapes, 14 cases (15.38%) of map-like shapes, 13 cases (14.29%) of wedge shapes. The X-rays of the disease similar to bone necrosis including primary hip osteoarthritis, developmental dysplasia of hip arthritis, femoral head epiphysitis (coxa plana), rheumatoid hip arthritis, hip arthritis of ankylosing spondylitis, transitional synovitis of hip joint, femoral head bone marrow edema etc, had the similar performance to femur head necrosis like cystic changes, joint space narrowing, femoral head deformation. MRI performance had their own characteristics.

Conclusion: Mastering the image features of the early femoral head necrosis will help the early diagnosis and treatment of hip joint necrosis disease.
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May 2010

Protective effects of omega-3 fish oil on lead-induced impairment of long-term potentiation in rat dentate gyrus in vivo.

Sheng Li Xue Bao 2010 Jun;62(3):225-30

School of Public Health, Anhui Medical University, Hefei, China.

In order to evaluate the effect of omega-3 fish oil supplement by gavage (0.4 mL/100 g body weight) on the chronic lead-induced (0.2% lead acetate) impairments of long-term potentiation (LTP) in rat dentate gyrus (DG) in vivo, we designed the experiments which were carried out in four groups of newborn Wistar rats (the control, the lead-exposed, the control with fish oil treatment and the lead-exposed with fish oil treatment, respectively). The excitatory postsynaptic potential (EPSP) and population spike (PS) amplitude were measured in the DG of rats with above different treatments at the age of 80-90 d in response to stimulation applied to the lateral perforant path. The results showed (1) postnatal chronic lead-exposure impaired LTP measured on both EPSP slope and PS amplitude in DG area of the hippocampus; (2) in the control rats, omega-3 fish oil had no effect on LTP while in the lead-exposed rats, omega-3 fish oil had a protective effect on LTP. These results suggest that omega-3 fish oil supplement could protect rats from the lead-induced impairment of LTP. Omega-3 fish oil might be a preventive substance in reducing LTP deficits induced by lead.
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June 2010

[Experimental study on avascular necrosis of femoral head in chickens induced by different glucocorticoides].

Zhongguo Gu Shang 2010 Mar;23(3):184-7

Wangling Hospital Affiliated to China Academy of Chinese Medical Science, Beijing 100102, China.

Objective: To study the effects of Methylprednisolone and Dexamethasone on the avascular necrosis of femoral head in chickens.

Methods: Thirty-six chickens were randomly divided into 6 groups (n = 6): control group (group A), Methylprednisolone low dose group (group B), Methylprednisolone large dose group (group C), small dose Dexamethasone and horse serum group (group D), middle dose Dexamethasone and horse serum group (group E), and Dexamethasone large dose group (group F). On the 6th and 12th weeks, blood samples were obtained to determine the level of total cholesterol triglyeride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL). On the 12th week, femoral heads were taken off. Paraffin tissue sections were prepared to detect histopathologic change with hematoxylin and eosin staining.

Results: On the 6th week, compared with group A, the level of CHO increased significantly in group C and group F (P < 0.05), and TG increased in group B, C and group E, while HDL decreased in group B, C and group E. On the 12th week, the level of TG and CHO increased in group B, C, E and group F, and HDL decreased in group C, D and group E (P < 0.05). LDL was not detected in most chickens. The ratio of empty lacuna was higher in group C and group E compared with those of the control group (P < 0.05).

Conclusion: Methylprednisolone is easier to induce osteonecrosis of femoral head than Dexamethasone. The condition of metabolic disorder in blood may be the basic pathomechanism of steroid-induced necrosis of femoral head.
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March 2010

Effects of chronic administration of melatonin on spatial learning ability and long-term potentiation in lead-exposed and control rats.

Biomed Environ Sci 2009 Feb;22(1):70-5

School of Life Science, University of Science and Technology of China, Hefei 230027, Anhui, China.

Objective: To explore the changes in spatial learning performance and long-term potentiation (LTP) which is recognized as a component of the cellular basis of learning and memory in normal and lead-exposed rats after administration of melatonin (MT) for two months.

Methods: Experiment was performed in adult male Wistar rats (12 controls, 12 exposed to melatonin treatment, 10 exposed to lead and 10 exposed to lead and melatonin treatment). The lead-exposed rats received 0.2% lead acetate solution from their birth day while the control rats drank tap water. Melatonin (3 mg/kg) or vehicle was administered to the control and lead-exposed rats from the time of their weaning by gastric gavage each day for 60 days, depending on their groups. At the age of 81-90 days, all the animals were subjected to Morris water maze test and then used for extracellular recording of LTP in the dentate gyrus (DG) area of the hippocampus in vivo.

Results: Low dose of melatonin given from weaning for two months impaired LTP in the DG area of hippocampus and induced learning and memory deficit in the control rats. When melatonin was administered over a prolonged period to the lead-exposed rats, it exacerbated LTP impairment, learning and memory deficit induced by lead.

Conclusion: Melatonin is not suitable for normal and lead-exposed children.
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http://dx.doi.org/10.1016/S0895-3988(09)60025-8DOI Listing
February 2009

Quality of reporting of randomized clinical trials in tai chi interventions-a systematic review.

Evid Based Complement Alternat Med 2011 23;2011:383245. Epub 2011 Jun 23.

Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, USA.

Objectives. To evaluate the reporting quality of published randomized clinical trials (RCTs) in the Tai Chi literature following the publication of the CONSORT guidelines in 2001. Data Sources. The OVID MEDLINE and PUBMED databases. Review Methods. To survey the general characteristics of Tai Chi RCTs in the literature, we included any report if (i) it was an original report of the trial; (ii) its design was RCT; (iii) one of the treatments being tested was Tai Chi; and (iv) it was in English. In addition, we assessed the reporting quality of RCTs that were published between 2002 and 2007, using a modified CONSORT checklist of 40 items. The adequate description of Tai Chi interventions in these trials was examined against a 10-item checklist adapted from previous reviews. Results. The search yielded 31 Tai Chi RCTs published from 2002 to 2007 and only 11 for 1992-2001. Among trials published during 2002-2007, the most adequately reported criteria were related to background, participant eligibility and interpretation of the study results. Nonetheless, the most poorly reported items were associated with randomization allocation concealment, implementation of randomization and the definitions of period of recruitment and follow-up. In addition, only 23% of RCTs provided adequate details of Tai Chi intervention used in the trials. Conclusion. The findings in this review indicated that the reporting quality of Tai Chi intervention trials is sub-optimal. Substantial improvement is required to meet the CONSORT guidelines and allow assessment of the quality of evidence. We believe that not only investigators, but also journal editors, reviewers and funding agencies need to follow the CONSORT guidelines to improve the standards of research and strengthen the evidence base for Tai Chi and for complementary and alternative medicine.
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http://dx.doi.org/10.1093/ecam/nep022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140169PMC
August 2012

[Effects of apolipoprotein A1 and B gene polymorphism on avascular necrosis of the femoral head in Chinese population].

Zhongguo Gu Shang 2008 Feb;21(2):99-102

Institute of Basic Theory of China Academy of Chinese Medical Science, Beijing 100700, China.

Objective: To investigate the effects of Apo A1 and B gene polymorphism on avascular necrosis of the femoral head (ANFH) in north Chinese Han population.

Methods: Polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP) technique was used in samples of 143 cases with documented ANFH and 92 healthy control matched by age and sex individuals selected from north Chinese Han nationality. The studied loci include promoter region (-75bp) and the intron 1 (+83 bp) of Apo A1 gene, Eco RI,Xba I of Apo B gene; polymerase chain reaction was used to study 3'-VNTR of Apo B gene.

Results: At -75 bp in promoter, the frequency of A/A genotype in ANFH group was significantly higher than that in control group (P < 0.01), while the frequency of G/A genotype in ANFH group was significantly lower than that in control group (P < 0.01). No difference was found in the frequency of genotype at +83bp in intron 1 of Apo A1 gene, Eco RI, Xba I and 3'-VNTR loci of Apo B gene.

Conclusion: Apolipoprotein A1 gene A/A substitution at position -75 in promotor is associated with ANFH, the mutation may be one of the sensitive genes of ANFH, first reported inside and abroad. But no evident relationship was found between gene polymorphism of +75 bp loci of Apo A1 gene, Eco RI loci of Apo B gene, Xba I loci of Apo B gene or 3'-VNTR of Apo B gene and ANFH.
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February 2008

Modulation of long-term potentiation by individual subtypes of muscarinic acetylcholine receptor in the rat dentate gyrus.

Hippocampus 2008 ;18(10):989-95

School of Life Sciences, University of Science and Technology of China, Hefei, Anhui, People's Republic of China 230027.

The roles of the muscarinic acetylcholine (ACh) receptors (mAChRs) in long-term potentiation (LTP) at many areas of the central nervous system including the hippocampus, have been extensively studied. However, not much is known about the modulation of LTP through individual subtypes of mAChR (M(1)-M(5) subtype). In this study, we investigated the involvement of each individual subtypes of mAChR in LTP induction by intrahippocampal administration of cholinergic ligands at the dentate gyrus (DG) of anesthetized rats. We found atropine, an antagonist of mAChRs, suppressed the induction of LTP. This observation confirmed that the muscarinic system is involved in LTP. We then examined the effects of M(1)AChR antagonists (pirenzepine and telenzepine), M(2/4)AChR antagonists (Methoctramine and {11-[[2-[(diethylamino)methyl]-1-piperidinyl]acetyl]-5,11-dihydro-6H-pyrido[2,3-b][1,4]benzodiazepin-6-one}(AFDX-116)), and M(3/5)AChR antagonist (4-diphenylacetoxy-N-methylpiperidine methiodide (4-DAMP)) on LTP. Our results showed that both M(1)AChR and M(2/4)AChR antagonists but not M(3/5)AChR antagonist suppressed the amplitude of LTP. We also examined the effects of these cholinergic ligands on basal synaptic transmission and found that only pirenzepine augmented the amplitude of population spike. This study suggests that individual mAChR subtypes play different modulation roles in LTP induction in the DG of rats.
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http://dx.doi.org/10.1002/hipo.20461DOI Listing
December 2008
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