Comparison of intra-articular injection of parecoxib vs oral administration of celecoxib for the clinical efficacy in the treatment of early knee osteoarthritis

BACKGROUND Non-steroid anti-inflammatory drugs(NSAIDs)have played a crucial role in the treatment of osteoarthritis,especially in the early stages.However,the cardiovascular risk and adverse gastrointestinal reactions of oral NSAIDs in elderly people cannot be underestimated.Intra-articular injection of NSAIDs may be a new attempt for early knee osteoarthritis treatment.Parecoxib may be a suitable drug for intra-articular injection.AIM To observe the clinical efficacy of the intra-articular injection of parecoxib for early knee osteoarthritis.METHODS Early knee osteoarthritis patients(n=110)were retrospectively analyzed.These patients were divided into three groups:Basic treatment+oral glucosamine(group A,n=37),oral celecoxib+basic treatment+oral glucosamine(group B,n=37),and intra-articular injection of parecoxib+basic treatment+oral glucosamine(group C,n=36).Intra-articular injection of parecoxib was performed once every 2 wk at a dose of 40 mg each time,for three times total.The three groups were compared in terms of visual analogue scale(VAS)scores,Hospital for Special Surgery(HSS)scores and patient satisfaction before and after treatment.The levels of inflammatory cytokines in the synovial fluid were detected in the three groups before and after treatment.RESULTS All patients were followed up for an average of 15.5±2.7 mo.The clinical efficacy was estimated by VAS and HSS scores at 12 mo after treatment.Inflammatory cytokine levels in the synovial fluid were evaluated at 3 mo after treatment.VAS and HSS scores were significantly improved in each group compared with before(P<0.001).There were significant differences among the three groups in VAS and HSS scores(P<0.001).The clinical efficacy of group C was superior to that of groups A and B(P<0.001),while group B outperformed group A in this respect(P<0.001).The patient satisfaction was the highest in group C(P<0.001).After treatment,the levels of tumor necrosis factorα(TNF-α)and interleukin(IL)-6 in the synovial fluid decreased in each group compared with before(P<0.001),while the levels of IL-10 increased(P<0.001).The three groups differed significantly in the levels of TNF-a,IL-6 and IL-10 in the synovial fluid after treatment(P<0.001).CONCLUSION For patients with early knee osteoarthritis,intra-articular injection of parecoxib could effectively improve clinical symptoms.This method may be a reliable alternative for early knee osteoarthritis.

Intra-articular delivery of tetramethylpyrazine microspheres with enhanced articular cavity retention for treating osteoarthritis

Tetramethylpyrazine(TMP) is a traditional Chinese herbal medicine with strong antiinflammatory and cartilage protection activities, and thus a promising candidate for treating osteoarthritis. However, TMP is rapidly cleared from the joint cavity after intra-articular injection and requires multiple injections to maintain efficacy. The aim of this study was to encapsulate TMP into poly(lactic-co-glycolic acid)(PLGA) microspheres to enhance the TMP retention in the joint, reducing injection frequencies and decreasing dosage. TMP microspheres were prepared by emulsion/solvent evaporation method. The intra-articular retention of the drug was assessed by detecting the drug concentration distributed in the joint tissue at different time points. The therapeutic effect of TMP microspheres was evaluated by the swelling of knee joints and histologic analysis in papain-induced OA rat model. The prepared freezedried microspheres with a particle size of about 10 μm can effectively prolong the retention time of the drug in the articular cavity to 30 d, which is 4.7 times that of the TMP solution.Intra-articular injection of TMP microspheres efficiently relieved inflammatory symptoms,improved joint lesions and decreased the depletion of proteoglycan. In conclusion, intraarticular injection of TMP loaded microspheres was a promising therapeutic method in the treatment of OA.

External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients

The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius （IFDR） in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after I week and 3, 6 and 12 months. After 3 months, the plating group had better pronation （P = 0.001）, supination, （P = 0.047） and extension （P = 0.043） scores. These differences were somewhat attenuated by 6 months and disappeared at I year. The plating group had a greater occurrence of wound infection （P = 0.043）, tendonitis, （P = 0.024） and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the ＂gross motor＂ category （walking upstairs, bending over, walking 500 yards; P = 0.023）. Internal fixation was more advantageous than external fixation in the early rehabilitation period; after I year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries.

Intra-articular transplantation of porcine adipose-derived stem cells for the treatment of canine osteoarthritis: A pilot study

AIM: To test whether intra-articular injection of porcine adipose-derived stem cells(ADSCs) can treat canine osteoarthritis(OA).METHODS: To enroll in this study dogs must have stifle joint OA that had lasted ≥ 3 mo and been treated with OA medication without significant improvement. Three dogs fulfilled these criteria and were thus subjects for ADSCs treatment. ADSCs were isolated from abdominal adipose tissue of a 2-mo-old female Yorkshire pig. Their stem cell marker expression was examined by immunofluorescence staining. For treatment, 5 million ADSCs were injected into the diseased joint of each dog. In the next 48 h, the patient was observed for signs of inflammatory and allergic reactions. Thepatient was then discharged to the owner and, at 2, 6, and 12 wk, followed up with orthopedic assessment, owner questionnaire, X-ray imaging, and force-plate gait analysis.RESULTS: Porcine ADSCs expressed mesenchymal stem cell markers CD90 and CD105. Injection of porcine ADSCs into canine stifle joints did not cause any inflammatory or allergic reactions. Orthopedic evaluation found improvements in two dogs, particularly at the longest time point. Owners' evaluation found increased capacity and decreased pain in all three dogs' activities such as walking and running. Radiographic evaluation did not find statistically significant differences before and after treatment. Force-plate analysis found significant improvements in all three dogs after treatment.CONCLUSION: Xenotransplantation of ADSCs for the treatment of OA is feasible. Further studies are needed to validate this novel treatment modality, which can then be implemented for the routine treatment of OA in veterinary medicine.

An intra-articular injectable phospholipids-based gel for the treatment of rheumatoid arthritis

Rheumatoid arthritis(RA)is a chronic inflammatory and destructive arthropathy with a high deformity rate.Despite numerous studies and clinical trials,no curative treatment is available for large weight-bearing joints.Intra-articular(IA)injections could deliver high concentrations of drug to the afflicted joint and improve the drug efficacy while reducing systemic toxicity.However,free drugs are rapidly cleared from synovial fluid and do not significantly halt the progression of joint disease.Herein,a phospholipids-based controlledrelease gel was prepared for sustained IA delivery of celastrol(CEL)and the therapeutic efficiencywas evaluated in a rheumatoid arthritis rabbitmodel.The CEL-loaded gel(CEL-gel)contained up to 70%phospholipids yetwas easy to inject.After injecting into the joint cavity,CEL-gel achieved sol to gel phase transition without special stimuli and gelling agent.In vitro release and in vivo pharmacokinetic studies evidenced the stable and sustained release action of CEL-gel.A single IA injection of CEL-gel could maintain therapeutic efficiency for about 25 d and showed much better anti-arthritic efficacy compared to repeated injections of free drug solution(CEL-sol).Furthermore,the IA injection of CEL-gel greatly reduced the systemic toxicity of CEL.With good biocompatibility and biodegradability,CEL-gel might be a promising IA drug delivery system.

Continuous Intra-Articular Ropivacaine/Tramadol Combination Infusion Therapy Improves Postoperative Outcome of Total Knee Arthroplasty

Objectives: To evaluate the postoperative analgesic yield of continuous intra-articular (IA) ropivacaine/tramadol infusion as against infusion of ropivacaine alone after total knee arthroplasty. Patients and Methods: Sixty patients accompanied by arthrosis were randomly divided into three equal groups: The ropivacaine group, which obtained a continuous intraarticular (IA) infusion of ropivacaine alone;the combination group, which obtained a continuous (IA) infusion of a combination of ropivacaine and tramadol at a rate of 6 ml/h for 72 h postoperatively;and the control group, which did not receive IA medications. After release of the ischemic tourniquet and assurance of haemostasis, a vacuum drainage tube was applied. The (IA) infusion was delivered through a multipored catheter for 72 h. Postoperative pain was assessed using visual analogue pain scale (VAS), and intravenous meperidine was administered as rescue analgesia if the (VAS) pain score was greater than or equal to (4) or on patient’s request. The total rescue analgesia consumption, angle of flexion of the knee and hospital stay were recorded. Results: The ability to achieve better angle of flexion was significantly higher in the combination group compared with the other groups, with a significant difference in favour of the ropivacaine group compared with the control group. At 2 h postoperatively, the mean pain (VAS) scores were significantly lower in patients who received (IA) analgesia compared with the control group and in the ropivacaine/tramadol group versus the ropivacaine group. The number of requests and total dose of rescue analgesia consumed were significantly lower with (IA) analgesia, with a significant difference in favour of the combination group. There was significant correlation between pain (VAS) scores and angle of flexion of the knee joint. Conclusion: Continuous (IA) ropivacaine/tramadol infusion safely reduced postoperative pain and spared administration of rescue analgesics with a significantly improved range of joint movement.

Primary Combined Intra-articular and Extra-articular Synovial Osteochondromatosis of Shoulder: a Case Report

PRIMARY synovial chondromatosis is a rarecondition in which foci of cartilage develop in thesynovial membrane of joints, bursae and tendonsheaths. It typically involves a single large jointin a young adult male.1 The ectopic foci of cartilage canresult in painful joint effusion, and the generation of loosebodies can cause mechanical symptoms.2,3 The etiology ofprimary synovial chondromatosis remains unknown, butmetaplastic theory is the most popular hypothesis. Thecommonly involved joints are knee, elbow, and hip.^4 Theshoulder is a rare site of synovial chondromatosis2,3,5 andthe extra-articular involvement even rarer, with only fewcases presented in literature. This report presents a rarecase of primary combined intra-articular andextra-articular synovial chondromatosis of shoulder jointtreated with arthroscopy.

Target Transfusion Intra-Articular Therapy for Osteoarthritic Joints

The comparison of biochemical composition and biophysical properties of synovial fluid and blood serum leads to a conclusion about the pathogenetic expediency of using serum as a corrector of synovial medium of osteoarthritic joints. Serum modification was realized by preliminary prescription of a single-dose drug to the patient. Then, the patient’s blood was sampled in the period of its maximal saturation with the drug. Autoserum from such blood samples was injected thrice into the knee joints affected by osteoarthritis of the 2nd or 3rd stages. The value of treatment results after 4 - 6 months of described therapeutics shows a significantly better therapeutic effect in the experimental of patient’s group as compared with the control group. The effect is connected with pain diminishing, normalization of the tissue joint nutrition, suppression of the local inflammation, and improvement of cartilage lubrication.

Effect of intramuscular calcitonin injection combined with intra-articular ozone injection on the expression of the IL family and MMPs family of knee osteoarthritis

Objective: To study the effect of intramuscular calcitonin injection combined with intra-articular ozone injection on the expression of the IL family and MMPs family of knee osteoarthritis. Methods: A total of 128 patients with knee osteoarthritis who were treated in the hospital between January 2015 and January 2017 were collected and divided into control group and observation group by random number table, each with 64 cases. Control group received intra-articular ozone injection therapy, and observation group received intramascular calcitonin injection combined with intra-articular ozone injection therapy. The differences in serum levels of IL family members and MMPs family members were compared between the two groups before and after treatment. Results: Before treatment, the differences in serum levels of IL family members and MMPs family members were not statistically significant between the two groups. 1 week after treatment, serum levels of IL family members IL-1β, IL-15, IL-17 and IL-18 as well as MMPs family members MMP-1, MMP-2, MMP-3 and MMP-13 of both groups of patients were significantly lower than those before treatment, and serum IL-1β, IL-15, IL-17, IL-18, MMP-1, MMP-2, MMP-3 and MMP-13 levels of observation group were significantly lower than those of control group. Conclusion: Intramuscular calcitonin injection combined with intra-articular ozone injection therapy can effectively inhibit the expression of IL family and MMPs family in patients with knee osteoarthritis.

Management of intra-articular fracture of the fingers via mini external fixator combined with limited internal fixation

Background Intra-articular fractures of the fingers are common problems to emergency physicians and hand surgeons Inappropriate management of these injuries may result in chronic pain, stiffness, deformity, or post traumatic arthritis. Ideal treatment necessitates the restoration of a stable and congruent joint that will allow early mobilization. The purpose of this study was to investigate the results of intra-articular fracture of the fingers by mini external fixator combined with limited internal fixation. Methods From May 2005 to May 2007, a total of 26 patients with intra-articular fracture of the fingers were treated by mini external fixator combined with limited internal fixation. Of the 26 cases, 11 involved in metacarpophalangeal joint, and 15 interphalangeal joint in proximal interphalangeal. Kirschner wire, mini wire and absorbable suture were used for limited internal fixation. All patients were followed up and patients were accomplished with total active motion （TAM） of fingers. Results All patients were reviewed by an independent observer. The mean follow up was 13 months （range 9 to 24 months）. Subjective, objective and radiographic results were evaluated. X-ray films revealed fracture union and the average radiographic union time was 7 weeks with a range of 5-12 weeks and the phalange shortening or rotation in 2 cases, joint incongruity （less than 1 mm） and joint space narrowing in 3 cases respectively. Phalangeal shortening or rotation was observed in 2 cases and joint incongruity or joint space narrowing was observed in 3 cases. An artificial implant was performed on one case for traumatic arthritis 1.5 years after surgery. Based on TAM the overall good-excellent rate of joint motion function was 80.8%. Conclusion Mini external fixator combined with limited internal fixation is a reliable and effective method for treatment of intra-articular fracture of the fingers.

肩袖损伤行MRI间接造影技术对关节内结构异常诊断评估的价值

目的 探究肩袖损伤行磁共振成像(MRI)间接造影技术对关节内结构异常诊断评估的价值。方法收集2022年10月至2023年9月经关节镜检查证实的肩袖损伤106例患者资料,关节镜检查前均接受MRI平扫和MRI肩关节间接造影,以关节镜检查结果为“金标准”,评价MRI间接造影结束对关节内结构异常的诊断价值。结果 106例患者经关节镜检查证实肩袖变性6例、肩袖部分撕裂47例、肩袖完全撕裂32例、肩袖撕裂合并盂唇损伤21例;MRI肩关节间接造影检查正确检出肩袖变性6例、肩袖部分撕裂43例、肩袖完全撕裂30例、肩袖撕裂合并盂唇损伤21例,MRI间接造影技术检查对肩袖撕裂合并盂唇损伤的诊断准确率为100%,对袖损伤关节内结构异常的总体准确率为94.34%,均显著高于MRI平扫的76.19%和84.90%,差异有统计学意义(P<0.05)。结论肩袖损伤患者接受MRI间接造影技术对关节内结构异常具有较高诊断准确性,值得临床推广。

Clinical study of warm needling moxibustion plus intra-articular injection of sodium hyaluronate for chondromalacia patellae

Objective To observe the therapeutic efficacy of warm needling moxibustion plus intra-articular injection of sodium hyaluronate in treating chondromalacia patellae and its effect on inflammatory factors in knee joint fluid.Methods Sixty-eight patients with chondromalacia patellae were randomized into a control group and an observation group,with 34 cases in each group.The control group was treated with intra-articular injection of sodium hyaluronate,while the observation group was given additional warm needling moxibustion treatment.Before and after treatment,the two groups were scored using Western Ontario and McMaster Universities osteoarthritis index(WOMAC)and visual analog scale(VAS),examined by magnetic resonance imaging(MRI)and determined for the levels of nuclear factor-KB(NF-kB),tumor necrosis factor(TNF)-αand interleukin(IL)-1βin knee joint fluid.Clinical efficacy was estimated after treatment.Results The effective rate was higher in the observation group than in the control group(P<0.05).After treatment,the scores of pain,stiffness and daily activities,as well as the general score of WOMAC declined significantly in both groups(all P<0.05),and were lower in the observation group than in the control group(all P<0.05);the time cost for climbing up and down one staircase and VAS score decreased markedly in both groups(all P<0.05),and were shorter or lower in the observation group than in the control group(both P<0.05);the MRI grading showed no significant change in the control group after intervention(P>0.05),while the grading in the observation group showed notable improvement(P<0.05),and was better than that in the control group(P<0.05);the levels of NF-kB and IL-1βin knee joint fluid dropped significantly in the control group after treatment(both P<0.05),while the levels of NF-kB,TNF-αand IL-1βin knee joint fluid all decreased significantly in the observation group(all P<0.05)and were lower than those in the control group(all P<0.05).Conclusion Warm needling moxibustion plus intra-articular injection of sodium hyaluronate can produce definite efficacy in treating chondromalacia patellae;it can mitigate the clinical symptoms,improve the lesion extent of chondromalacia and down-regulate the levels of NF-kB,TNF-αand IL-1βin knee joint fluid.

用于治疗骨关节炎的非甾体抗炎药关节内递送系统研究进展

非甾体抗炎药(NSAIDs)是骨关节炎(OA)患者缓解疼痛和改善关节功能最常用的药物。但口服和局部外用NSAIDs的疗效不佳和不良反应限制了其使用。关节腔注射是临床治疗OA的常用给药方法,NSAIDs以溶液的形式注射时,药物迅速从关节腔清除。开发关节内缓释药物递送系统(DDS)是延长NSAIDs在关节腔停留时间和提高疗效的一种有前景的策略。本文对关节腔注射NSAIDs溶液在OA中的应用进行了概述,综述了治疗OA的NSAIDs关节内缓释DDS的研究进展,旨在为NSAIDs关节内缓释DDS的研发提供参考。

玻璃酸钠腔内注射联合肩关节镜下肩袖修补术治疗肩袖损伤患者的效果

目的:观察玻璃酸钠腔内注射联合肩关节镜下肩袖修补术治疗肩袖损伤患者的效果。方法:选取2020年12月至2023年12月该院收治的86例肩袖损伤患者进行前瞻性研究,按照随机数字表法将其分为研究组和对照组各43例。对照组采用肩关节镜下肩袖修补术治疗,研究组在对照组基础上联合玻璃酸钠腔内注射治疗。比较两组临床疗效,治疗前后肩关节功能[美国加州大学洛杉矶分校肩关节评分系统(UCLA)、美国肩肘外科医师协会(ASES)]评分、肩关节活动度,以及并发症发生率。结果:研究组治疗总有效率为93.02%(40/43),高于对照组的76.74%(33/43),差异有统计学意义(P<0.05);治疗后,两组UCLA、ASES评分均高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05);治疗后,两组外旋、内旋、外展、前屈等肩关节活动度均大于治疗前,且研究组大于对照组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:玻璃酸钠腔内注射联合肩关节镜下肩袖修补术治疗肩袖损伤患者可提高治疗总有效率和肩关节功能评分,改善肩关节活动度,效果优于单纯肩关节镜下肩袖修补术治疗。

Results of fixation of dorsally displaced intra-articular distal radius fractures with non angular stable implants

Objective Intra-articular fractures of the distal radius in young adults comprise a distinet fracture pattern that is diffficuh to manage and associated with a high frequency of post-traumatic arthritis.Restoration of articular congruency and alignment should improve the outcome.Methods In this study we prospectively re- viewed the results of 21 consecutive cases of dorsally displaced intra-articular distal radius fractures which were treated with internal fixation after failing to achieve articular congruency with closed reduction.Results 3 patients were lost to follow-up.For the rest of 18 patients,follow-up time ranges from 18 to 75 weeks the fractures had healed with highly satisfactory radiographic and functional results.The final volar tilt averaged 4.9°;radial inclination 23.9°;radial length 14mm;and articular incongruity,0.1 mm.Wrist motion at final follow-up examination aver- aged flexion 62°,extension 60°,radial deviation 16°,ulnar deviation 27°,pronation 77°and supination 74°.Grip strength averaged 83% of the uninjured side.The overall outcome of 18 patients(94.4%)had a good or excellent result according to the system of Gartland and Werley and 18 patients(72.2%)had a good result according to the modified system of Green and O'Brien at the most recent evaluation.The only complication in this series was a superficial pin tract infection,which was rapidly resolved with removal of pins at 5th week of external fixation. Conclusion Thus restoration of articular congruency and alignment is possible with minimal complication using modern non-angular stable methods of internal fixation.

关节腔内移植物长度测量在前交叉韧带全内重建的应用研究

目的:探讨关节镜下测量关节腔内移植物长度在前交叉韧带(anterior cruciate ligament,ACL)全内重建应用的临床疗效。方法:回顾性分析2020年1月至2022年1月收治的ACL损伤患者60例的资料,其中男37例,女23例,年龄22~44岁。按照手术方式的不同,分为传统手术组(常规组)和拉线测量组(测量组),每组各30例。常规组男20例,女10例,年龄(30.00±3.95)岁;身体质量指数(body mass index,BMI)为(22.58±1.41)kg·m^(-2);左侧9例,右侧21例;受伤至手术时间(3.00±1.35)d。测量组男17例,女13例,年龄(32.00±4.29)岁;BMI为(23.29±1.39)kg·m^(-2);左侧12例,右侧18例;受伤至手术时间(3.00±1.27)d。记录患者术前及术后6、12个月的临床资料。从术后视觉模拟评分法(visual analogue scale,VAS)、膝关节损伤与骨关节炎评分(knee injury and osteoarthritis outcome score,KOOS)、Lysholm评分、国际膝关节文献委员会(International Knee Documentation Committee,IKDC)膝关节评估表、膝关节稳定性(Lachman试验、前抽屉试验和轴移试验)、术后不同阶段CT测量骨隧道直径增宽程度和MRI评分系统等方面比较两种方法的临床疗效。结果:术后6个月两组VAS比较差异无统计学意义(P>0.05),术后12个月测量组VAS(2.23±1.01)分,低于常规组(3.30±1.02)分(P<0.001)。术后12个月,两组KOOS评分除症状评分差异无统计学意义(P=0.221),其余各项评分差异均有统计学意义(P<0.05)。术后6个月,测量组Lysholm总分和IKDC总分均高于常规组(P<0.05)。术后12个月,测量组Lachman试验、前抽屉试验和轴移试验和常规组比较,差异均无统计学意义(P>0.05);但是,整体膝关节不稳定性分析,测量组膝关节稳定性优于对照组(P=0.038)。术后2 d及术后6、12个月两组患者影像学评估结果显示,测量组股骨和胫骨的肌腱隧道直径增宽程度均较常规组术后减少(P<0.05);MRI评分测量组患者均高于常规组(P<0.05)。结论:关节镜下测量关节腔内移植物长度在全内技术ACL重建,肌腱利用率高,稳定性好,1年内膝关节功能恢复满意,疗效肯定。

Extracellular vesicles derived from mesenchymal stem cells mediate extracellular matrix remodeling in osteoarthritis through the transport of microRNA-29a

BACKGROUND Knee osteoarthritis(KOA)is a common orthopedic condition with an uncertain etiology,possibly involving genetics and biomechanics.Factors like changes in chondrocyte microenvironment,oxidative stress,inflammation,and immune responses affect KOA development.Early-stage treatment options primarily target symptom relief.Mesenchymal stem cells(MSCs)show promise for treatment,despite challenges.Recent research highlights microRNAs(miRNAs)within MSC-released extracellular vesicles that can potentially promote cartilage regeneration and hinder KOA progression.This suggests exosomes(Exos)as a promising avenue for future treatment.While these findings emphasize the need for effective KOA progression management,further safety and efficacy validation for Exos is essential.AIM To explore miR-29a’s role in KOA,we’ll create miR-29a-loaded vesicles,testing for early treatment in rat models.METHODS Extraction of bone marrow MSC-derived extracellular vesicles,preparation of engineered vesicles loaded with miR-29a using ultrasonication,and identification using quantitative reverse transcription polymerase chain reaction;after establi-shing a rat model of KOA,rats were randomly divided into three groups:Blank control group injected with saline,normal extracellular vesicle group injected with normal extracellular vesicle suspension,and engineered extrace-llular vesicle group injected with engineered extracellular vesicle suspension.The three groups evaluation,histological detection,and immunohistochemical detection to compare and evaluate the progress of various forms of arthritis.RESULTS General behavioral observation results showed that the extracellular vesicle group and engineered extracellular vesicle group had better performance in all four indicators of pain,gait,joint mobility,and swelling compared to the blank control group.Additionally,the engineered extracellular vesicle group had better pain relief at 4 wk and better knee joint mobility at 8 wk compared to the normal extracellular vesicle group.Imaging examination results showed that the blank control group had the fastest progression of arthritis,the normal extracellular vesicle group had a relatively slower progression,and the engineered extracellular vesicle group had the slowest progression.Gross histological observation results showed that the blank control group had the most obvious signs of arthritis,the normal extracellular vesicle group showed signs of arthritis,and the engineered extracellular vesicle group showed no significant signs of arthritis.Using the Pelletier gross score evaluation,the engineered extracellular vesicle group had the slowest progression of arthritis.Results from two types of staining showed that the articular cartilage of rats in the normal extracellular vesicle and engineered extracellular vesicle groups was significantly better than that of the blank control group,and the engineered extracellular vesicle group had the best cartilage cell and joint surface condition.Immunohistochemical detection of type II collagen and proteoglycan showed that the extracellular matrix of cartilage cells in the normal extracellular vesicle and engineered extracellular vesicle groups was better than that of the blank control group.Compared to the normal extracellular vesicle group,the engineered extracellular vesicle group had a better regulatory effect on the extracellular matrix of cartilage cells.CONCLUSION Engineered Exos loaded with miR-29a can exert anti-inflammatory effects and maintain extracellular matrix stability,thereby protecting articular cartilage,and slowing the progression of KOA.

低剂量类固醇激素联合玻璃酸钠治疗粘连性肩关节囊炎的临床效果

目的比较低剂量类固醇激素、高剂量类固醇激素及低剂量类固醇激素联合玻璃酸钠治疗粘连性肩关节囊炎的效果。方法选取2020年12月至2021年12月我科收治的60例粘连性肩关节囊炎患者为研究对象,采用随机数字表法将其分为低剂量组、高剂量组和联合组,各20例。低剂量组给予关节腔内注射0.5 mL复方倍他米松注射液,高剂量组给予关节腔内注射1 mL复方倍他米松注射液,联合组给予关节腔内注射0.5 mL复方倍他米松注射液联合2.5 mL玻璃酸钠。比较三组的治疗效果。结果治疗后2、4、8、16周,三组的视觉模拟评分法(VAS)、肩关节疼痛与功能障碍指数(SPADI)评分低于治疗前(P<0.05);治疗后2、4、8、16周,联合组的VAS、SPADI评分低于低剂量组(P<0.05);治疗后2、4、8、16周,联合组和高剂量组的VAS、SPADI评分无明显差异(P>0.05)。治疗后2、4、8、16周,三组的肩关节外展活动度及肩关节外旋活动度大于治疗前(P<0.05);治疗后2、4、8、16周,三组的肩关节外展活动度及肩关节外旋活动度无明显差异(P>0.05)。结论低剂量类固醇激素联合玻璃酸钠可以缓解粘连性肩关节囊炎患者的疼痛,改善关节功能,其效果与高剂量类固醇激素相当,优于低剂量类固醇激素。

超声引导下关节腔药物注射治疗类风湿性关节炎的效果分析

目的分析类风湿关节炎实施超声引导关节腔药物注射治疗的作用。方法选取2022年12月—2023年12月滕州市中心人民医院收治的98例类风湿性关节炎患者为研究对象,根据不同的治疗方案分为对照组和观察组,各49例,对照组实施常规药物+超短波治疗,观察组实施超声引导关节腔药物注射治疗。比较两组膝关节功能、类风湿因子、治疗有效率、不良反应发生率。结果治疗后1、3、5个月,观察组膝关节功能评分均高于对照组,类风湿因子水平均低于对照组,差异有统计学意义(P均<0.05)。观察组治疗有效率为95.92%(47/49),高于对照组的79.59%(39/49),差异有统计学意义(χ^(2)=6.078,P=0.014)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论超声引导关节腔药物注射治疗类风湿性关节炎的应用价值较高,可渐进性地提升患者的关节功能,加快类风湿因子的消除,且安全性较高。

Additional comments on extracellular vesicles derived from mesenchymal stem cells mediate extracellular matrix remodeling in osteoarthritis

Recently,we read an article published by the Yang et al.The results of this study indicated that engineered exosomes loaded with microRNA-29a(miR-29a)alleviate knee inflammation and maintain extracellular matrix stability in Sprague Dawley rats.The study’s results provide useful information for treating knee osteoarthritis(KOA).This letter,shares our perspectives on treating KOA using engineered exosomes for miR-29a.