Efficacy of stromal vascular fraction for knee osteoarthritis:A prospective,single-centre,non-randomized study with 2 years follow-up

BACKGROUND Current osteoarthritis(OA)treatments focus on symptom relief without addressing the underlying disease process.In regenerative medicine,current treatments have limitations.In regenerative medicine,more research is needed for intra-articular stromal vascular fraction(SVF)injections in OA,including dosage optimization,long-term efficacy,safety,comparisons with other treatments,and mechanism exploration.AIM To compare the efficacy of intra-articular SVF with corticosteroid(ICS)injections in patients with primary knee OA.METHODS The study included 50 patients with Kellgren-Lawrence grades II and III OA.Patients were randomly assigned(1:1)to receive either a single intra-articular SVF injection(group A)or a single intra-articular ICS(triamcinolone)(group B)injection.Patients were followed up at 1,3,6,12,and 24 months.Visual analog score(VAS)and International Knee Documentation Committee(IKDC)scores were administered before the procedure and at all followups.The safety of SVF in terms of adverse and severe adverse events was recorded.Statistical analysis was performed with SPSS Version 26.0,IBM Corp,Chicago,IL,United States.RESULTS Both groups had similar demographics and baseline clinical characteristics.Follow-up showed minor patient loss,resulting in 23 and 24 in groups A and B respectively.Group A experienced a notable reduction in pain,with VAS scores decreasing from 7.7 to 2.4 over 24 months,compared to a minor reduction from 7.8 to 6.2 in Group B.This difference in pain reduction in group A was statistically significant from the third month onwards.Additionally,Group A showed significant improvements in knee functionality,with IKDC scores rising from 33.4 to 83.10,whereas Group B saw a modest increase from 36.7 to 45.16.The improvement in Group A was statistically significant from 6 months and maintained through 24 months.CONCLUSION Our study demonstrated that intra-articular administration of SVF can lead to reduced pain and improved knee function in patients with primary knee OA.More adequately powered,multi-center,double-blinded,randomised clinical trials with longer follow-ups are needed to further establish safety and justify its clinical use.

Knee osteoarthritis:A review of animal models and intervention of traditional Chinese medicine

Background:Knee osteoarthritis(KOA)characterized by degeneration of knee cartilage and subsequent bone hyperplasia is a prevalent joint condition primarily affecting aging adults.The pathophysiology of KOA remains poorly understood,as it involves complex mechanisms that result in the same outcome.Consequently,researchers are interested in studying KOA and require appropriate animal models for basic research.Chinese herbal compounds,which consist of multiple herbs with diverse pharmacological properties,possess characteristics such as multicomponent,multipathway,and multitarget effects.The potential benefits in the treatment of KOA continue to attract attention.Purpose:This study aims to provide a comprehensive overview of the advantages,limitations,and specific considerations in selecting different species and methods for KOA animal models.This will help researchers make informed decisions when choosing an animal model.Methods:Online academic databases(e.g.,PubMed,Google Scholar,Web of Science,and CNKI)were searched using the search terms“knee osteoarthritis,”“animal models,”“traditional Chinese medicine,”and their combinations,primarily including KOA studies published from 2010 to 2023.Results:Based on literature retrieval,this review provides a comprehensive overview of the methods of establishing KOA animal models;introduces the current status of advantages and disadvantages of various animal models,including mice,rats,rabbits,dogs,and sheep/goats;and presents the current status of methods used to establish KOA animal models.Conclusion:This study provides a review of the animal models used in recent KOA research,discusses the common modeling methods,and emphasizes the role of traditional Chinese medicine compounds in the treatment of KOA.

Adipose-derived regenerative therapies for the treatment of knee osteoarthritis

Knee osteoarthritis is a degenerative condition with a significant disease burden and no disease-modifying therapy.Definitive treatment ultimately requires joint replacement.Therapies capable of regenerating cartilage could significantly reduce financial and clinical costs.The regenerative potential of mesenchymal stromal cells(MSCs)has been extensively studied in the context of knee osteoarthritis.This has yielded promising results in human studies,and is likely a product of immunomodulatory and chondroprotective biomolecules produced by MSCs in response to inflammation.Adipose-derived MSCs(ASCs)are becoming increasingly popular owing to their relative ease of isolation and high proliferative capacity.Stromal vascular fraction(SVF)and micro-fragmented adipose tissue(MFAT)are produced by the enzymatic and mechanical disruption of adipose tissue,respectively.This avoids expansion of isolated ASCs ex vivo and their composition of heterogeneous cell populations,including immune cells,may potentiate the reparative function of ASCs.In this editorial,we comment on a multicenter randomized trial regarding the efficacy of MFAT in treating knee osteoarthritis.We discuss the study’s findings in the context of emerging evidence regarding adipose-derived regenerative therapies.An underlying mechanism of action of ASCs is proposed while drawing important distinctions between the properties of isolated ASCs,SVF,and MFAT.

Acupotomy ameliorates knee osteoarthritis-related collagen deposition and fibrosis in rabbit skeletal muscle through the TGF-β/Smad pathway

Objective:To investigate the effects of acupotomy on skeletal muscle fibrosis and collagen deposition in a rabbit knee osteoarthritis(KOA)model.Methods: Rabbits(n=18)were randomly divided into control,KOA,and KOA+acupotomy(Apo)groups(n=6).The rabbits in the KOA and Apo groups were modeled using the modified Videman's method for 6 weeks.After modeling,the Apo group was subjected to acupotomy once a week for 3 weeks on the vastus medialis,vastus lateralis,rectus femoris,biceps femoris,and anserine bursa tendons around the knee.The behavior of all animals was recorded,rectus femoris tissue was obtained,and histomorphological changes were observed using Masson staining and transmission electron microscopy.The expression of transforming growth factor-β1(TGF-β1),Smad 3,Smad 7,fibrillar collagen types I(Col-I)and III(Col-III)was detected using Western blot and real-time polymerase chain reaction(RT-PCR).Results: Histological analysis revealed that acupotomy improved the microstructure and reduced the collagen volume fraction of rectus femoris,compared with the KOA group(P=.034).Acupotomy inhibited abnormal collagen deposition by modulating the expression of fibrosis-related proteins and mRNA,thus preventing skeletal muscle fibrosis.Western blot and RT-PCR analysis revealed that in the Apo group,Col-I,and Col-III protein levels were significantly lower than those in the KOA group(both P<.01),same as Col-I and Col-III mRNA levels(P=.0031;P=.0046).Compared with the KOA group,the protein levels of TGF-β1 and Smad 3 were significantly reduced(both P<.01),as were the mRNA levels of TGF-β1 and Smad 3(P=.0007;P=.0011).Conversely,the levels of protein and mRNA of Smad 7 were significantly higher than that in the KOA group(P<.01;P=.0271).Conclusion: Acupotomy could alleviate skeletal muscle fibrosis and delay KOA progress by inhibiting collagen deposition through the TGF-β/Smad pathway in the skeletal muscle of KOA rabbits.

Therapeutic effect of San Bi Tang combined with glucosamine sulfate capsules in cold-dampness-type knee osteoarthritis

BACKGROUND Cold-dampness-type knee osteoarthritis is a common middle-aged and elderly disease,but its pathogenesis is not fully understood,and its clinical treatment has limitations.Glucosamine sulfate capsules are commonly used for treating arthritis,and San Bi Tang is a classic formula of traditional Chinese medicine(TCM)that has the effects of warming yang,dispelling dampness,relaxing muscles,and activating collaterals.This research hypothesized that the combination of modified San Bi Tang and glucosamine sulfate capsules could enhance the clinical efficacy of treating cold-dampness-type knee osteoarthritis through complementary effects.AIM To analyze the clinical efficacy of San Bi Tang combined with glucosamine sulfate capsules when treating cold-dampness-type knee osteoarthritis.METHODS A total of 110 patients with cold-dampness-type knee osteoarthritis were selected as research subjects and randomly divided into a control group and an experimental group of 55 cases each.The control group received only treatment with glucosamine sulfate capsules,while the experimental group received additional treatment with modified San Bi Tang for a duration of 5 wk.The patients’knee joint functions,liver and kidney function indicators,adverse reactions,and vital signs were evaluated and analyzed using SPSS 26.0 software.RESULTS Before treatment,the two groups’genders,ages,and scores were not significantly different,indicating comparability.Both groups’scores improved after treatment,which could indicate pain and knee joint function improvement,but the test group had better scores.The TCM-specific symptoms and the clinical efficacy of the treatment in the test group were higher.Before and after treatment,there were no abnormalities in the patients’liver and kidney function indicators.CONCLUSION The combination of modified San Bi Tang and glucosamine sulfate capsules is superior to treatment with sulfated glucosamine alone and has high safety.

Autologous peripheral blood-derived orthobiologics:Different types and their effectiveness in managing knee osteoarthritis

Knees are the most commonly impacted weight-bearing joints in osteoarthritis(OA),affecting millions of people worldwide.With increasing life spans and obesity rates,the incidence of knee OA will further increase,leading to a significant increase in the economic burden.Conventional treatment modalities utilized to manage knee OA have limitations.Over the last decade,the role of various autologous peripheral blood-derived orthobiologics(APBOs)for the treatment of knee OA has been extensively investigated.This editorial provided an overview and focused on defining and shedding light on the current state of evidence based on the most recent published clinical studies concerning the use of APBO for the management of knee OA.While numerous studies have demonstrated promising results for these preparations,a notable gap exists in the comparative analysis of these diverse formulations.This absence of head-to-head studies poses a considerable challenge for physicians/surgeons in determining the optimal preparation for managing knee OA and achieving sustained longterm results.Thus,more adequately powered,multicenter,prospective,doubleblind,randomized controlled trials with longer follow-ups are needed to establish the long-term efficacy and to aid physicians/surgeons in determining the optimal APBO for the management of knee OA.

Study on compound Duzhong Jiangu granule in the treatment of knee osteoarthritis based on transcriptome analysis strategy

Duzhong Jiangu Granule in the treatment of primary osteoarthritis(POA)model of postmenopausal kidney deficiency type in Hartley female guinea pigs after ovariectomy,and the correlation between gene expression of bone marrow tissue,cartilage tissue,and knee osteoarthritis.Methods:383-months-old Hartley female guinea pigs after one week of adaptive feeding were weighed about 400 g±20 g,numbered,and sorted by ear tag.Six of them were selected as normal groups by looking up random number tables.The remainder were removed from the bilateral ovaries to construct the postmenopausal kidney deficiency model,and castrated guinea pigs were used to construct the postmenopausal kidney deficiency POA model.After the modeling cycle,a guinea pig from the blank group and a guinea pig from the model group were sacrificed and the right knee was observed.The model was established and the experiments continued.There were five guinea pigs in the blank group,and the remaining model guinea pigs were randomly divided into model control group,high-dose group of compound Duzhong Jiangu granules,middle-dose group of compound Duzhong Jiangu granules,low-dose group of compound Duzhong Jiangu granules and design group,with 5 guinea pigs in each group.Blanks and model groups were given a cellulose sodium solution by gavage.The guinea pigs were sacrificed after 30 days of intragastric administration.The left knee cartilage and bone marrow of the blank group,model group,middle dose group,and high dose group of compound Duzhong Jiangu granule were collected and applied to transcriptome sequencing,and the sequencing data were analyzed,including differential gene expression analysis,functional enrichment analysis of database established by Gene Ontology federation(GO)and Kyoto Encyclopedia of Gene and Genome(KEGG)pathway enrichment analysis.The complete specimens of the right knee joint were collected,and the morphological changes of the cartilage of the right knee joint in each group were observed by saffron rapid green staining,and the subchondral bone was quantitatively analyzed by Micro CT so that the expression of TRAF6,MIP-1βand IL-1βprotein in NF-kappa B signaling pathway was detected by Western Blot technique(WB).Results:The results of Safranin Fast Green staining showed that Compound Duzhong Jiangu Granules could effectively reduce the degree of morphological damage of articular cartilage in guinea pigs with the POA model.According to the analysis results of the subchondral bone structure under Micro CT,Compound Duzhong Jiangu Granules can improve the bone condition of the POA model,thus delaying the process of degenerative changes of the knee joint.From the results of transcriptome analysis,Compound Duzhong Jiangu Granules can inhibit the expression of related genes in POA model guinea pigs.According to the results of Wester Bolt verification,Compound Duzhong Jiangu Granules can effectively improve knee osteoarthritis.Conclusions:The effect of Compound Duzhong Jiangu Granules on OA is obvious,and its mechanism may be related to the expression of genes GZMK,Jchain,igkc,IGHV3-74,IGHV3-11,IGHV4-1,CCL5,and IGKV1–39.

Research Progress in Traditional Chinese Medicine Treatment of Knee Osteoarthritis

Knee osteoarthritis(KOA)is a degenerative disease characterized by pathological changes in the cartilage and subchondral bone of the knee joint.Initially,knee joint pain is the main symptom,and in the later stages,deformities and mobility disorders may occur.Modern medicine lacks effective treatment methods for early and mid stage KOA,and has drawbacks such as significant side effects and high costs.A large number of stud‐ies have confirmed that traditional Chinese medicine has unique advantages in treating KOA,and has obvious advantages such as small trauma,low cost,and definite therapeu‐tic effect,which are gradually being accepted by a large number of KOA patients.The commonly used methods for preventing and treating KOA with traditional Chinese medicine in clinical practice include:oral administration of traditional Chinese medi‐cine,external application of traditional Chinese medicine,fumigation,acupuncture therapy,massage therapy for regulating tendons,and targeted penetration therapy of tra‐ditional Chinese medicine.According to relevant literature,traditional Chinese medicine can significantly alleviate knee joint symptoms and improve knee joint function in patients with knee osteoarthritis,which is of great significance for the prevention and treatment of knee osteoarthritis.This article provides a review of the research progress in the prevention and treatment of KOA using traditional Chinese medicine in recent years.

Effectiveness of Maitland and Mulligan mobilization methods for adults with knee osteoarthritis:A systematic review and metaanalysis

BACKGROUND As a serious global problem,knee osteoarthritis(KOA)often leads to pain and disability.Manual therapy is widely used as a kind of physical treatment for KOA.AIM To explore further the efficacy of Maitland and Mulligan mobilization methods for adults with KOA.METHODS We searched PubMed,the Cochrane Library,EMbase,Web of Science and Google Scholar from inception to September 20,2020 to collect studies comparing Maitland and Mulligan mobilization methods in adults with KOA.The quality of the studies was assessed using the Physiotherapy Evidence Database Scale for randomized controlled trials.Data analyses were performed using Review Manager 5.0 software.RESULTS A total of 341 articles were screened from five electronic databases(PubMed,the Cochrane Library,EMbase,Web of Science and Google Scholar)after excluding duplicates.Ultimately,eight trials involving 471 subjects were included in present systematic review and meta-analysis.The mean PEDro scale score was 6.6.Mulligan mobilization was more effective in alleviating pain[standardized mean difference(SMD)=0.60;95%confidence interval(CI):0.17 to 1.03,P=0.007;I2=60%,P=0.020]and improving Western Ontario and McMaster Universities function score(SMD=7.41;95%CI:2.36 to 12.47,P=0.004;I2=92%,P=0.000).There was no difference in the effect of the two kinds of mobilization on improving the range of motion(SMD=9.63;95%CI:-1.23 to 20.48,P=0.080;I2=97%,P=0.000).CONCLUSION Mulligan mobilization technique is a promising intervention in alleviating pain and improving function score in KOA patients.

A comprehensive health education plus monitoring support program for older adults with knee osteoarthritis coexisting with overweight and type 2 diabetes

Objectives:To examine the patient outcomes of a comprehensive health education plus village health volunteer monitoring support program on older adults with knee osteoarthritis who are overweight and have type 2 diabetes.Methods:Quasi-experimental,two-group,pretest-posttest design was applied.Using random geographic cluster sampling,older adults who met the inclusion criteria were assigned to two groups,62 in the intervention group and 71 in the control group.The intervention group received the comprehensive health education plus village health volunteer monitoring support program.The control group received only the comprehensive health education program.Study outcomes,including blood glucose level,knee pain and range of motion,body weight,physical ability(Timed Up and Go Test),fatigue,depressive symptoms,quality of sleep,and quality of life,were assessed at baseline,3 months,and 6 months after enrollment and analyzed using descriptive statistics and multivariate analysis of variance.Results:One hundred and ten participants completed the study(55 participants in each group).Most patient outcomes in the two groups showed general improvement with statistical significance(P<0.001):pain decreased,physical ability improved,less depressive symptoms and fatigue,quality of life and sleep improved.The interaction effect(the group and time)demonstrated statistically significant differences between the intervention and control groups on pain,knee range of motion,and fatigue according to each time follow-up(P<0.001).Conclusions:The comprehensive health education plus village health volunteer monitoring support program promotes good patient outcomes in this population.The integrated health education resource and support for older adults with knee osteoarthritis and type 2 diabetes is an effective,non-surgical treatment that highlights professional nursing roles and non-professional rolesdvillage health volunteers.Nurses should consider implementing a health education plus monitoring support program to mitigate the effects of chronic diseases and improve patients’quality of life.

Comparative effectiveness of adipose-derived mesenchymal stromal cells in the management of knee osteoarthritis:A meta-analysis

BACKGROUND Osteoarthritis(OA)is the most common joint disorder,is associated with an increasing socioeconomic impact owing to the ageing population.AIM To analyze and compare the efficacy and safety of bone-marrow-derived mesenchymal stromal cells(BM-MSCs)and adipose tissue-derived MSCs(AD-MSCs)in knee OA management from published randomized controlled trials(RCTs).METHODS Independent and duplicate electronic database searches were performed,including PubMed,EMBASE,Web of Science,and Cochrane Library,until August 2021 for RCTs that analyzed the efficacy and safety of AD-MSCs and BM-MSCs in the management of knee OA.The visual analog scale(VAS)score for pain,Western Ontario McMaster Universities Osteoarthritis Index(WOMAC),Lysholm score,Tegner score,magnetic resonance observation of cartilage repair tissue score,knee osteoarthritis outcome score(KOOS),and adverse events were analyzed.Analysis was performed on the R-platform using OpenMeta(Analyst)software.Twenty-one studies,involving 936 patients,were included.Only one study compared the two MSC sources without patient randomization;hence,the results of all included studies from both sources were pooled,and a comparative critical analysis was performed.RESULTS At six months,both AD-MSCs and BM-MSCs showed significant VAS improvement(P=0.015,P=0.012);this was inconsistent at 1 year for BM-MSCs(P<0.001,P=0.539),and AD-MSCs outperformed BM-MSCs compared to controls in measures such as WOMAC(P<0.001,P=0.541),Lysholm scores(P=0.006;P=0.933),and KOOS(P=0.002;P=0.012).BM-MSC-related procedures caused significant adverse events(P=0.003)compared to AD-MSCs(P=0.673).CONCLUSION Adipose tissue is superior to bone marrow because of its safety and consistent efficacy in improving pain and functional outcomes.Future trials are urgently warranted to validate our findings and reach a consensus on the ideal source of MSCs for managing knee OA.

Effects of lower body positive pressure treadmill on functional improvement in knee osteoarthritis:A randomized clinical trial study

BACKGROUND Knee joint pain and stiffness are the two main symptoms of knee osteoarthritis(OA)and thus restrict a patient’s activities,such as walking and walking up and downstairs.The lower body positive pressure(LBPP)treadmill as one of the emerging body weight support system devices brings new hope for exerciserelated rehabilitation for knee OA patients.AIM To investigate the biomechanical effects and the subjective clinical assessment of LBPP treadmill walking exercise when compared with conventional therapy in mild to moderate knee OA patients.METHODS Eighteen patients with mild-to-moderate knee OA were recruited in this randomized controlled trial(RCT)study.The eligible knee OA patients were randomly assigned to two groups:LBPP and control groups.The patients in the LBPP group performed an LBPP walking training program for 30 min/session per day,6 d per week for 2 wk whereas the patients in the control group performed walking on the ground for the same amount.All patients underwent clinical assessments and three-dimensional gait analysis at pre-and 2-wk post-treatment.RESULTS The Western Ontario and McMaster Universities Arthritis Index and visual analog scale scores in both the LBPP group and control group were found to decrease significantly at the post-treatment point than the pre-treatment point(LBPP:70.25±13.93 vs 40.50±11.86;3.88±0.99 vs 1.63±0.52;control:69.20±8.88 vs 48.10±8.67;3.80±0.79 vs 2.60±0.70,P<0.001).Moreover,compared with the control group,the LBPP group showed more improvements in walking speed(P=0.007),stride length(P=0.037),and knee range of motion(P=0.048)during walking,which represented more improvement in walking ability.CONCLUSION The results of our RCT study showed that the LBPP group has a greater effect on improving gait parameters than the conventional group,although there was no significant advantage in clinical assessment.This finding indicates that LBPP treadmill walking training might be an effective approach for alleviating pain symptoms and improving lower extremity locomotion in mild to moderate knee OA patients.

Effect of acupotomy on chondrocyte proliferation and expression of CyclinD1,CDK4 and CDK6 in rabbits with knee osteoarthritis

Objective:The aim of this study was to investigate the mechanism of acupotomology(Apo)in the prevention of articular cartilage destruction via the promotion of chondrocyte proliferation and chondrocyte expression of cell cycle regulators,CyclinD1,CDK4 and CDK6 in a rabbit knee osteoarthritis(KOA)model.Methods:Twenty-eight rabbits were randomly divided into a control group,an OA(osteoarthritis)model group,an Apo(acupotomology)group and EA(electro-acupuncture)group(n Z 7).Improved Videman’s method was used to induce a rabbit model of KOA over 6 weeks.One week later,acupotomy and electro-acupuncture therapy was applied to animals in the respective groups and treatment lasted 4 weeks.Following these treatments,quantitative real-time PCR,immunohistochemical staining and western blotting were performed to assess the mRNA and protein levels of cell cycle regulators CyclinD1(Cell cycle protein D1),CDK4(Cyclin-dependent kinase 4)and CDK6(Cyclin-dependent kinase 6).Ethology measures and knee morphology were also compared among groups.Results:The Lequesne MG index score of morphology was increased(P<.01),and the passive range of motion(PROM)and the mRNA and protein levels of CyclinD1,CDK4,and CDK6 were significantly decreased(P<.01)in the OA model compared with the control group.The Lequesne MG index score and the morphology score were decreased in the Apo and EA group compared with the OA model group(P<.05 or P<.01),while the mRNA levels of CyclinD1,CDK4,and CDK6,and the protein levels of CDK4 were increased in the Apo and EA groups compared with the OA model group(P<.05 or P<.01).The PROM,and the protein levels of CyclinD1 and CDK6 were increased(P<.05)in the Apo group compared with the OA model group,while the PROM and the protein levels of CyclinD1 and CDK6 in the EA group were not significantly different(P>.05).Compared with the EA group,the morphology score was decreased in Apo group(P<.05).Conclusions:The mRNA levels of CyclinD1 and CDK4,and the protein level of CDK4 in chondrocytes are regulate by both Apo and EA.Apo is more effective than EA in regulating the protein levels of CyclinD1 and CDK6.According to the observed changes in morphology and cytokine levels,acupotomy can promote chondrocyte proliferation and can alleviate the destruction of articular cartilage in a model of KOA.

Modified treatment of knee osteoarthritis complicated with femoral varus deformity:A case report

BACKGROUND Surgical treatment of knee osteoarthritis(KOA)complicated by extra-articular deformity has always been controversial regardless of whether it is simultaneous or staged.Simultaneous total knee arthroplasty(TKA)combined with supracondylar osteotomy without plate for treatment of KOA complicated by femoral varus deformity has not been reported in the literature.CASE SUMMARY A 53-year-old Chinese woman complained of left knee pain for 6 years that worsened for 4 mo during her visit on April 3,2020,accompanied by instability in walking,which seriously affected quality of life.According to her medical history and preoperative imaging,the patient was diagnosed with left KOA with varus deformity.We used the angular center of rotation principle for osteotomy of the femur deformity and placed a poststabilized femur prosthesis into the knee joint.At the same time,a 13 mm×130 mm femur extension rod was used instead of a steel plate to fix the end of the femur osteotomy,reducing the possible complications caused by steel plate implantation and reducing the economic burden on patients.The operation successfully solved two major problems of KOA and varus deformity,and the clinical and imaging evaluation of postoperative followup were satisfactory.CONCLUSION TKA and supracondylar femoral osteotomy can be used for simultaneous KOA treatment and deformity correction.

Clinical effect of scraping therapy in the treatment of knee osteoarthritis

Objective:The objective of this study is to investigate the effect of scraping therapy in the treatment of knee osteoarthritis.Materials and Methods:A total of eighty patients with knee osteoarthritis were assigned to the moxibustion group and the scraping therapy group according to the random numerical table method,with forty cases in each group.Patients in both two groups received functional exercise and moxibustion therapy,and those in the scraping therapy group were supplemented with scraping therapy.The serum indexes of interleukin‑1(IL‑1),IL‑6,tumor necrosis factor‑alpha(TNF‑α),and superoxide dismutase(SOD)were detected before and after the treatment.The clinical syndrome integral and Visual Analog Scale(VAS)on pain of patients were assessed.The clinical therapeutic efficacy was evaluated and compared between the two groups.Results:Patients in the scraping therapy group received better outcomes of serum IL‑1,IL‑6,TNF‑α,and SOD compared with those in the moxibustion group at 2 months after treatment(P<0.05).The scores of clinical syndrome integral and VAS on pain were decreased in two groups at 2 months after the treatment and were lower in the scraping therapy group than those in the moxibustion group(P<0.05).The overall effective rate in the scraping therapy group was higher than that in the control group(87.50%vs.67.50%,P<0.05).Conclusion:The scraping therapy is potentially effective to ameliorate the clinical symptom and pain degree of patients with knee osteoarthritis.

The effect of hot intermittent cupping on pain,stiffness and disability of patients with knee osteoarthritis

Objective:The aim of this study was to investigate the effect of hot intermittent cupping on pain,stiffness and inability of patients with knee osteoarthritis(KO).Methods:The present study was a clinical trial,which was performed on 38 patients with KO referring to Gonabad Rheumatology Specialty Clinic.Based on permutation block method,the research units were divided into cupping therapy and control groups.For the cupping therapy group,four sessions of cupping therapy were performed every four days.To collect data,the form of demographic information,Visual Analogue Scale(VAS)and the Western Ontario and McMaster(WOMAC)osteoarthritis scale were used,and the data were analyzed by SPSS software v.16 using descriptive statistics and independent t-test,paired t-test,Chi-square test and Fishers exact test with a significance level of P<0.05.Results:Findings showed that there was no significant difference between the cupping therapy and control groups in terms of demographic characteristics and they were homogeneous.Findings indicated that,based on VAS,the mean pain intensity in the left(P<0.001)and the right knees(P<0.001),as well as based on WOMAC,stiffness(P=0.006),pain intensity(P<0.001)and disability(P<0.001)in the cupping therapy group significantly decreased compared to the control group.Conclusion:Findings showed that hot intermittent cupping therapy reduced the pain intensity,stiffness and disability in patients with KO.

Application of five-element music therapy in pain coping skills training in patients with knee osteoarthritis

Objective:The objective of this study is to assess the application effect of five elements music therapy introduced in the pain coping skills training of knee osteoarthritis(KOA).Materials and Methods:Totally,80 patients with KOA were selected and randomly divided into the experimental group(39 cases)and the control group(41 cases).The control group was only given routine nursing measures,and the experimental group was additionally treated with five-element music therapy on the basis of the control group,twice a day,28 days in total.The Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)was used to evaluate the functional status of the knee joint of the two groups.The clinical efficacy of the two groups was evaluated by Guiding Principles for Clinical Research of New Chinese Medicine in the Treatment of Osteoarthritis.Results:WOMAC score statistically significantly decreased in the experimental group(35.92±9.48 vs.16.17±5.43,P<0.01)and the control group(36.73±6.42 vs.22.53±7.51,P<0.01)after 28 days of intervention when compared with that before intervention;WOMAC score in the experimental group was lower than that of the control group after 28 days of intervention(16.17±5.43 vs.22.53±7.51,P<0.01).The total effective rate of the experimental group was statistically higher than that of the control group(82.0%vs.51.2%,χ2=11.97,P=0.003).Conclusion:The combination of five-element music therapy and routine nursing measures has better effect in relieving pain and bad emotions of patients with KOA when compared with routine nursing measures alone.

Decision aids can decrease decisional conflict in patients with hip or knee osteoarthritis: Randomized controlled trial

BACKGROUND The interest in shared decision making has increased considerably over the last couple of decades.Decision aids(DAs)can help in shared decision making.Especially when there is more than one reasonable option and outcomes between treatments are comparable.AIM To investigate if the use of DAs decreases decisional conflict in patients when choosing treatment for knee or hip osteoarthritis(OA).METHODS In this multi-center unblinded randomized controlled trial of patients with knee or hip OA were included from four secondary and tertiary referral centers.Onehundred-thirty-one patients who consulted an orthopedic surgeon for the first time with knee or hip OA were included between December 2014 and January 2016.After the first consultation,patients were randomly assigned by a computer to the control group which was treated according to standard care,or to the intervention group which was treated with standard care and provided with a DA.After the first consultation,patients were asked to complete questionnaires about decisional conflict(DCS),satisfaction,anxiety(PASS-20),gained knowledge,stage of decision making and preferred treatment.Follow-up was carried out after 26 wk and evaluated decisional conflict,satisfaction,anxiety,health outcomes(HOOS/KOOS),quality of life(EQ5D)and chosen treatment.RESULTS After the first consultation,patients in the intervention group(mean DCS:25 out of 100,SD:13)had significantly(P value:0.00)less decisional conflict compared to patients in the control group(mean DCS:39 out of 100,SD 11).The mean satisfaction score for the given information(7.6 out of 10,SD:1.8 vs 8.6 out of 10,SD:1.1)(P value:0.00),mean satisfaction score with the physician(8.3 out of 10,SD:1.7 vs 8.9 out of 10,SD:0.9)(P value:0.01)and the mean knowledge score(3.3 out of 4,SD:0.9 vs 3.7 out of,SD:0.6)(P value:0.01)were all significantly higher in the intervention group.At 26-wk follow-up,only 75 of 131 patients(57%)were available for analysis.This sample is too small for meaningful analysis.CONCLUSION Providing patients with an additional DA may have a positive effect on decisional conflict after the first consultation.Due to loss to follow-up we are unsure if this effect remains over time.

Regenerative Engineering for Knee Osteoarthritis Treatment： Biomaterials and Cell-Based Technologies

Knee osteoarthritis （OA） is the most common form of arthritis worldwide. The incidence of this disease is rising and its treatment poses an economic burden. Two early targets of knee OA treatment include the predominant symptom of pain, and cartilage damage in the knee joint. Current treatments have been beneficial in treating the disease but none is as effective as total knee arthroplasty （TKA）. However, while TKA is an end-stage solution of the disease, it is an invasive and expensive procedure, Therefore, innovative regenerative engineering strategies should be established as these could defer or annul the need for a TKA. Several biomaterial and cell-based therapies are currently in development and have shown early promise in both preclinical and clinical studies. The use of advanced biomaterials and stem cells independently or in conjunction to treat knee OA could potentially reduce pain and regenerate fo- cal articular cartilage damage. In this review, we discuss the pathogenesis of pain and cartilage damage in knee OA and explore novel treatment options currently being studied, along with some of their limitations.

Application Value of High-Frequency Ultrasound and Contrast-Enhanced Ultrasound in Patients with Knee Osteoarthritis with Different TCM Syndromes

Objective: To explore the application value of high-frequency ultrasound and contrast-enhanced ultrasound in different syndrome types of knee osteoarthritis, and to provide more imaging evidence for clinical diagnosis and treatment. Method: Sixty patients with KOA were selected according to TCM classification, which were mainly divided into Qi stagnation and blood stasis type and cold-dampness blockage type. All knee joints were routinely examined by high frequency ultrasound, and those with synovial hyperplasia were examined by contrast-enhanced ultrasound. High frequency ultrasound is the examination of synovium, cartilage and collateral ligament of knee joint based on two-dimensional ultrasound. Contrast-enhanced ultrasound (CEUS) refers to the contrast examination of synovium in knee joint patients with synovial hyperplasia. Result: Among them, the suprapatellar sac effusion and synovial thickening of Qi stagnation and blood stasis type were more obvious than those of cold-dampness arthralgia type (P < 0.05), and the degree of wear of the intercondylar cartilage of cold-dampness arthralgia type was more obvious than that of Qi stagnation. The blood stasis type is heavier and the meniscus bulge is higher (P < 0.05). The radiography of synovial hyperplasia showed that the area under the curve of Qi stagnation and blood stasis type was higher than that of cold dampness arthralgia type (P < 0.05), and the peak time was significantly shorter than that of cold dampness arthralgia type. There was no statistical difference in effective peak gradient and onset time of type (P > 0.05). Conclusion: To a certain extent, the high-frequency ultrasound and contrast-enhanced ultrasound performance of knee osteoarthritis can be used as a dialectical reference for different TCM syndrome types.