Application prospects of urine-derived stem cells in neurological and musculoskeletal diseases

Urine-derived stem cells(USCs)are derived from urine and harbor the potential of proliferation and multidirectional differentiation.Moreover,USCs could be reprogrammed into pluripotent stem cells[namely urine-derived induced pluripotent stem cells(UiPSCs)]through transcription factors,such as octamer binding transcription factor 4,sex determining region Y-box 2,kruppel-like factor 4,myelocytomatosis oncogene,and Nanog homeobox and protein lin-28,in which the first four are known as Yamanaka factors.Mounting evidence supports that USCs and UiPSCs possess high potential of neurogenic,myogenic,and osteogenic differentiation,indicating that they may play a crucial role in the treatment of neurological and musculoskeletal diseases.Therefore,we summarized the origin and physiological characteristics of USCs and UiPSCs and their therapeutic application in neurological and musculoskeletal disorders in this review,which not only contributes to deepen our understanding of hallmarks of USCs and UiPSCs but also provides the theoretical basis for the treatment of neurological and musculoskeletal disorders with USCs and UiPSCs.

Frequency of Comorbid Musculoskeletal Problems in Patients with Parkinson’s Disease: What and When?

Background: Musculoskeletal problems, deteriorating posture and pain are common complaints/comorbidities in Parkinson’s disease (PD). The aim of this study was to investigate the frequency of comorbid musculoskeletal problems in PD, and their relationship with disease stage and severity. Methods: The study was approved by the local ethical committee of Duzce University numbered with 2018/52 on date 26.03.2018. Patients with PD (pwPD) underwent a detailed examination to investigate the possible comorbidity of musculoskeletal findings in the orthopedics and traumatology clinic. Socio-demographic features, disease characteristics, motor and non-motor scores were recorded. Results: Thirty-seven pwPD were enrolled in the study. Mean age was 68.75 ± 10.75 years. Comorbid musculoskeletal problems were rotator cuff syndrome (27%), knee osteoarthritis (24.3%), meniscus (13.5%), lumber disc herniation (10.8%), kyphosis (8.1%), myotendinous diseases (16.3%). Rotator-cuff disease and knee osteoarthritis were most common comorbidities, especially in the “mild” and “moderate” stages of pwPD. Conclusion: Since most of the pwPD, especially the ones that have musculoskeletal complaints prior to the diagnosis of PD, present to the orthopedics and traumatology clinics or physiotherapists, it is mandatory to enhance the awareness of the orthopedic surgeons, and physiotherapy specialist in order to keep PD in mind.

Unusual site of recurrent musculoskeletal hydatid cyst: Case report and brief review of the literature

A case of a large multiplex recurrent hydatid cyst involving the left gluteal muscle and the left iliopsoas, accompanied with degeneration of the musculature of the left upper leg is presented along with a review of the relevant literature. Very few such cases have been reported worldwide. The presented case is also distinguished by the involvement of muscles of distant anatomic areas.

Hepatomusculoskeletal disorders:Coining a new term might improve the management of the musculoskeletal manifestations of chronic liver disease

Chronic liver disease can affect many body systems including the musculoskeletal system.The pathogenetic crosstalk between the liver and organs such as the brain and the kidneys has already been described with compound terms merging the organs affected by the pathology,such as the hepatorenal syndrome.Nevertheless,the musculoskeletal manifestations of chronic liver disease have not been coined with such a term to date.Because of this shortage,documenting the musculoskeletal implications of chronic liver disease in both research and clinical practice is challenging.To fill this gap,the authors propose the term hepatomusculoskeletal disorders,a compound term of Greek origin that encompasses all the body structures involved in the aforementioned pathologic crosstalk.

Immunosuppressive therapy selectively modulates B-cell responses in patients with rheumatic and musculoskeletal diseases receiving the inactivated COVID-19 vaccine

Background:Immunosuppressive medication reduces the immunogenicity of the coronavirus disease 2019(COVID-19)vaccines in patients with rheumatic and musculoskeletal diseases(RMDs).However,the underlying mechanism remains unclear.The primary aim of our study was to dissect the impact of immunosuppressive medication on cellular and humoral immune responses in RMD patients receiving the inactivated COVID-19 vaccine.Methods:A total of 28 RMD patients and five healthy controls(HCs)receiving two doses of the inactivated COVID-19 vaccine(Sinovac-CoronaVac)were prospectively enrolled.Blood samples were collected before the primary vaccination(Week 0)and one week after the second vaccination(Week 5).Neutralizing antibody(nAb)titers and autoantibody titers were measured by a pseudovirus-based neutralization assay and enzyme-linked immunosorbent assay,respectively.CD4^(+)T-cell and CD19^(+)B-cell subsets and serum cytokines were analyzed by flow cytometry.Results:The inactivated COVID-19 vaccine was immunogenic in RMD patients and HCs after the second vaccination,but the nAb titers were lower in RMD patients than those in HCs.Only patients with systemic lupus erythematosus(SLE)had notably increased nAb titers.Remarkably,IgG^(+)CD27^(+),IgG^(+)IgG1^(+),and IgG^(+)IgG1^(−)B cells were reduced,whereas IgG−IgG1^(+)B cells,and total IgA and IgG titers were markedly increased.However,Tfh cell and Tfr cell subsets and cytokines produced by Tfh cells were not increased.The flare rate was low in RMD patients with comparable autoantibody titers,unchanged CD4^(+)T cell subsets and serum proinflammatory cytokines(interleukin[IL]-6,IL-17,interferon-γ,and tumor necrosis factor-α)after the second vaccination.Conclusions:Immunosuppressive therapy decreased the immunogenicity of the vaccine and maintained a low flare rate by selectively modulating B cell but not CD4^(+)T cell responses in RMD patients receiving the inactivated COVID-19 vaccine.Optimization of the treatment regimen might ensure a durable and robust COVID-19 vaccination response.

Use of orthotics with orthotic sandals versus the sole use of orthotics for plantar fasciitis:Randomised controlled trial

BACKGROUND Plantar fasciitis(PF)affects around 10%of the population.Prefabricated orthotics with arch support has been shown to provide symptom relief in PF by decreasing the repetitive stress sustained by the plantar fascia.However,prefabricated orthotics are only effective when shoes are worn,meaning the foot may be left unsupported when it is impractical to wear shoes.Using orthotic sandals in conjunction with prefabricated orthotics may increase PF symptom relief,as they can be worn inside the home,extending the period in which the foot is supported.AIM To compare the combined use of prefabricated orthotics and orthotic sandals vs the sole use of prefabricated orthotics in the treatment of PF.METHODS 98 participants with PF were randomised into two groups.The intervention group received the Aetrex L420 Compete orthotics and the Aetrex L3000 Maui Flips(orthotic sandals),whilst the control group received the Aetrex L420 Compete orthotics only.Foot pain was assessed both by the numerical rating scale(NRS)and the pain sub-scale of the foot health status questionnaire(FHSQ).Foot functionality was measured using the function sub-scale of the FHSQ.Symptom change was measured using the global rating of change scale(GROC).RESULTS Foot pain scores measured both by NRS and FHSQ pain sub-scale showed statistically significant reductions in foot pain in both groups(P<0.05)at six months.Both groups also reported statistically significant improvements(P<0.05)in function as measured by the FHSQ function subscale and improvement of symptoms as measured by the GROC scale.Between-group analysis showed that the intervention group with the combined use of orthotics and orthotic sandals scored better on all four outcome measures as compared to the control group with the sole use of orthotics.However,the between-group analysis only reached statistical significance on the NRS pain score(P<0.05).CONCLUSION Combined use of prefabricated orthotics and orthotic sandals provides a greater decrease in foot pain and improvement in foot function in PF compared to using prefabricated orthotics alone.

儿童骨骼肌肉系统疾病影像学研究现状与进展

随着医学影像学技术的快速发展,影像学研究儿童骨骼肌肉系统疾病已取得显著进展。凭借三维重建、血管成像等技术,CT能准确评估病变范围、程度及血管情况,而双能CT、自适应统计迭代重建对于降低辐射剂量发挥了重要作用,但仍需进一步探索。MRI无辐射、可多参数成像、分辨率高,有助于充分显示儿童骨骼发育和信号变化特征,但如何在保证图像质量的前提下缩短扫描时间是亟待解决的临床问题。此外,基于人工智能(AI)的计算机辅助检测与诊断近年已逐渐成为影像学的重要研究方向之一。本文就CT、MRI及其与AI融合用于儿童骨骼肌肉系统疾病研究现状与进展进行述评。

肌骨超声在附着点炎评估中的应用进展

附着点炎在健康成人及风湿免疫性疾病人群中发病率均较高,且其与部分风湿免疫性疾病患者的疾病活动度、生活质量均有一定的关系。目前已有较多共识建议关注风湿免疫性疾病患者附着点炎,并进一步强调了附着点的临床作用。肌骨超声作为目前评估外周附着点的首选影像学检查方法,为研究附着点炎开发了较多超声评分系统,但均存在一定不足。本文就附着点炎的评估方法、肌骨超声评估附着点炎的应用现状等进行综述,并对未来附着点炎超声评估研究进行了合理的展望。

主动脉支架体外开窗与Castor分支型覆膜支架TEVAR重建LSA治疗主动脉弓部病变的临床疗效比较

【目的】比较主动脉支架体外开窗与Castor分支型覆膜支架主动脉腔内修复术(TEVAR)重建左锁骨下动脉(LSA)治疗主动脉弓部病变的临床疗效。【方法】选取2020年1月至2023年1月本院收治的71例主动脉弓部病变的患者,根据LSA重建方式不同将其分为体外开窗组(主动脉支架体外开窗,n=51)和外分支组(Castor分支型覆膜支架TEVAR重建LSA,n=21)。比较两组患者围术期指标、手术成功率及术后并发症发生率,1年后随访预后情况,夹层术后的夹腔重塑情况及患者假腔血栓化情况。【结果】外分支组手术时间、器械释放成功率、手术费用均高于体外开窗组(P<0.05)。支架段L1、L3、L4,外分支组真腔面积变化率[R(ATL)]高于体外开窗组(P<0.05);支架段L3外分支组假腔面积变化率[R(AFL)]、真腔直径变化率[R(DTL)]高于体外开窗组,L4 R(DTL)高于体外开窗组(P<0.05)。两组患者假腔血栓化程度再支架段和非支架段比较,差异均无统计学意义(P>0.05)。【结论】主动脉支架体外开窗与Castor分支型覆膜支架TEVAR重建LSA治疗主动脉弓部病变均具有良好的安全性与有效性,Castor分支型覆膜支架TEVAR操作时间较短且支架近端重塑效果优于体外开窗TEVAR。

端粒长度与10种常见肌肉骨骼疾病的关系孟德尔随机化分析

背景:多项观察性研究表明,端粒长度与肌肉骨骼疾病之间存在潜在的关联,然而它们之间的潜在机制仍不清楚。目的:利用两样本孟德尔随机化分析来探索端粒长度与肌肉骨骼疾病之间的遗传因果关系。方法:从英国生物银行中获得端粒长度的全基因组关联研究汇总数据。从FinnGen财团中获得了关于10种常见肌肉骨骼疾病(骨坏死、骨髓炎、骨质疏松、类风湿关节炎、腰痛、椎管狭窄、痛风、肩周炎、强直性脊柱炎和下肢深静脉血栓)的全基因组关联研究汇总数据。使用逆方差加权、孟德尔随机化-Egger和加权中位数方法评估端粒长度与10种肌肉骨骼疾病的因果关系,逆方差加权作为主要的孟德尔随机化分析方法,并进行敏感性分析探讨结果稳健性。结果与结论:①逆方差加权法结果表明,遗传预测的端粒长度与类风湿关节炎(OR=0.78,95%CI:0.64-0.95,P=0.015)和骨坏死(OR=0.56,95%CI:0.36-0.90,P=0.016)风险之间存在负向因果关系,但未发现端粒长度与其他8种肌肉骨骼疾病之间存在因果关系(P均>0.05)。②敏感性分析结果表明因果关系稳健,孟德尔随机化-Egger截距分析未检测到潜在的水平多效性(P均>0.05)。③此项孟德尔随机化研究支持端粒长度对类风湿关节炎和骨坏死的保护作用的结论,然而,未来将需要更多的基础和临床研究来验证。

肌骨超声特征评分与类风湿关节炎患者病情严重程度的相关性

目的:探讨肌骨超声特征评分与类风湿关节炎患者病情严重程度的相关性。方法:回顾性分析2021年1月至2022年12月该院收治的70例类风湿关节炎患者的临床资料,根据类风湿关节炎疾病活动度评价表(DAS28)评分将其分为缓解期组(n=12,DAS28评分≤2.6分)、低活动期组(n=18,2.6分5.1分),比较四组肌骨超声特征评分,并采用Pearson相关性分析其与类风湿关节炎患者病情严重程度的相关性。结果:四组关节积液、滑膜增生、关节骨侵蚀及滑膜内血流信号等肌骨超声特征评分为高活动期组>中活动期组>低活动期组>缓解期组,差异均有统计学意义(P<0.05);Pearson相关性分析结果显示,关节积液、滑膜增生、关节骨侵蚀及滑膜内血流信号等肌骨超声特征评分均与类风湿关节炎患者病情严重程度呈正相关(r>0,P<0.05)。结论:关节积液、滑膜增生、关节骨侵蚀及滑膜内血流信号等肌骨超声特征评分均与类风湿关节炎患者病情严重程度呈正相关。

体外冲击波治疗疼痛研究进展的可视化分析

背景:体外冲击波因对各种肌肉骨骼疾病的潜在益处而备受关注,越来越多的研究证明其具有缓解疼痛和功能恢复等优良效果。然而,针对体外冲击波治疗疼痛相关可视化研究相对缺乏。目的:对体外冲击波治疗疼痛相关研究进行可视化分析,梳理国内外该领域的知识结构、探索研究现状及热点趋势。方法:检索Web of Science(WOS)核心合集数据库及中国知网(CNKI)数据库中2002-2022年间体外冲击波治疗疼痛相关研究的文献,利用Citespace软件进行可视化分析制作图谱并解读其涵义。结果与结论:①共纳入文献2101篇,发文量呈波动性上升趋势,美国和中国在发文量具有一定优势;发文机构多为大学和医院,发文作者多属于独立团队,发文机构及作者彼此交流有待加强,跨机构、跨地域合作度较低;关键词可视化分析表明体外冲击波在肌骨疾病应用广泛,未来研究侧重于多学科深入研究及联合疗法的临床疗效观察。②体外冲击波应用于疼痛领域的研究主要集中在足底筋膜炎、肩周炎、网球肘等肌肉骨骼疾病的治疗。近年来与超声引导注射治疗、中国传统治疗技术的联合治疗及新领域的拓展是研究趋势及关注热点。

小儿腹腔镜下阑尾切除术后30 d内再入院的影响因素分析

【目的】探讨小儿腹腔镜下阑尾切除术(laparoscopic appendectomy,LA)后30 d内再入院的影响因素。【方法】选取2019年1月至2024年3月在湖南省儿童医院行LA后30 d内再入院的53例急性阑尾炎患儿的临床资料,根据是否再次手术分为再次手术组(n=7)和非再次手术组(n=46)。收集所有患儿年龄、性别、首次入院时急性阑尾炎炎症反应评分(appendicitis inflammatory response score,AIR)、首次病程时间、首次住院时间、病理类型、首次起病至入院时间、再入院前症状持续时间,首次出院和再次入院时白细胞(white blood cell,WBC)计数、中性粒细胞与淋巴细胞比值(neutrophil lymphocyte ratio,NLR)、C-反应蛋白(C-reactive protein,CRP),分析患儿LA后30 d内再入院的相关危险因素。【结果】53例再入院患儿中,诊断为腹腔脓肿22例(43.51%)、肠梗阻19例(35.85%)、肠梗阻合并腹腔脓肿6例(11.32%)、腹腔脓肿合并伤口感染5例(9.43%)、阑尾残株炎1例(1.89%)。再次入院时WBC计数、NLR均高于首次出院时(P<0.05),CRP水平与首次出院时比较,差异无统计学意义(P>0.05)。再手术组和非再手术组再次住院时间比较,差异有统计学意义(P<0.05);两组首次入院时AIR、首次起病至入院时间、首次住院时间及再入院前症状持续时间比较,差异无统计学意义(P>0.05)。53例再入院患儿经治疗皆好转出院。【结论】小儿阑尾炎术后再入院因素主要为腹腔脓肿及肠梗阻,早期干预可降低阑尾炎术后并发症发生率及再入院患儿比例。

足痿理法方药文献研究

足痿首见于《素问》,从历代医家差异性注释中归纳提炼出足痿阳明虚弱、肾虚受湿、湿热交阻、寒湿阻滞、湿邪困脾五类病因病机。通过对足痿理法方药进行全面考察梳理,并探寻足痿与现代疾病之间的联系,揭示足痿诊治的规律性,以期为当今治疗足痿相关疾病,以及统编教材《中医内科学》痿疾的修订提供参考。

肌骨超声半定量技术与类风湿关节炎疾病活动度的相关性分析

目的分析肌骨超声半定量技术对类风湿关节炎患者病情活动度的相关影响因素,探讨肌骨超声半定量技术的临床应用价值。方法选取2021年6月至2022年5月间于秦皇岛市第一医院确诊为类风湿关节炎的96例患者为研究对象,将入组患者按照疾病活动度评分(Disease Activity Score 28,DAS28)方法分为轻度活动受限组(2.63.2),其中轻度活动受限组44例、中重度活动受限组52例。记录患者肌骨超声半定量评分中关节积液、滑膜内增生、滑膜内血流及骨侵蚀得分情况,并对患者的临床指标进行统计分析,包括类风湿因子(Rheumatoid Factor,RF)、血小板(Platelet,PLT)、C反应蛋白(C-Reactive Protein,CRP)和红细胞沉降率(Erythrocyte Sedimentation Rate,ESR),分析肌骨超声半定量评分同临床指标的相关性。并运用受试者工作特征(Receiver Operating Characteristic,ROC)曲线对肌骨超声半定量评分、RF、PLT、CRP、ESR在类风湿关节炎疾病活动度中的评估价值进行分析。结果肌骨超声半定量评分结果显示,轻度活动受限组的关节积液、滑膜内增生、滑膜内血流、骨侵蚀评分及半定量评分总分均显著低于中重度活动受限组,差异具有统计学意义(P<0.05);血清学指标结果显示,轻度活动受限组的RF、PLT、CRP、ESR水平均显著低于中重度活动受限组,差异具有统计学意义(P<0.05);肌骨超声半定量评分同RF、PLT、CRP、ESR水平间呈明显正相关性(r=0.487、0.396、0.295、0.543,P<0.05);ROC曲线结果显示,肌骨超声半定量评分、RF、PLT、CRP、ESR水平对类风湿关节炎疾病活动度评估的曲线下面积为0.696~0.913。结论肌骨超声半定量评分对类风湿关节炎患者的疾病活动度有较高的评估价值,为临床的诊疗提供了新的思路,值得在临床中推广使用。

八段锦联合心脏康复七步训练法干预对行心脏外科手术治疗的冠心病患者生活能力及心理状态的影响

【目的】探讨八段锦联合心脏康复七步训练法干预对行心脏外科手术治疗的冠心病患者生活能力及心理状态的影响。【方法】选择2020年1月至2021年12月本院收治的80例行心脏外科手术治疗的冠心病患者,根据随机数字表法分为对照组(实施常规康复干预)和观察组(在对照组的基础上行八段锦联合心脏康复七步训练法干预),每组40例。比较两组患者日常生活能力量表(ADL)评分、心理状态评分及术后并发症发生率。【结果】干预后,两组患者ADL评分高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。干预后,两组患者紧张、沮丧、愤怒、迟钝评分均低于干预前,且观察组低于对照组;两组患者活力评分均高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。【结论】八段锦联合心脏康复七步训练法法能够有效改善行心脏外科手术治疗的冠心病患者的日常生活能力,改善其心理状态,降低其并发症的发生率,值得临床推广。

肌骨超声在风湿免疫疾病中的应用进展

超声影像检查技术在临床中的应用历史悠久,随着技术的不断发展和进步,超声影像学被应用到不同的领域中。风湿免疫疾病多为病因复杂、临床表现多样、诊治困难的系统性病症,需借助更多的检查手段。20世纪末超声影像技术开始应用于肌肉骨骼系统的检查中,现肌骨超声已广泛应用于风湿免疫疾病的诊治中,逐步成为风湿免疫疾病的常规辅助检查方式。本文总结了肌骨超声在几种常见风湿免疫疾病中的临床应用,并对临床可能出现的问题进行了简单的总结和拓展,以期对临床有一定的指导价值。

机械取栓与急诊动脉内溶栓治疗急性脑梗死患者的疗效比较

【目的】比较机械取栓(MT)与急诊动脉内溶栓(IAT)治疗急性脑梗死患者的疗效。【方法】回顾性分析本院收治的118例行MT或IAT治疗的急性脑梗死患者的资料,其中,MT组66例,IAT组52例。比较两组患者的临床疗效、治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、穿刺至血管再通时间、血管再通率、≤30%残余狭窄率、24 h内症状性颅内出血发生率、术后90 d病死率。【结果】MT组总有效率高于IAT组(P<0.05);治疗后3 d,两组患者NIHSS评分均低于治疗前(P<0.05),且MT组低于IAT组(P<0.05);MT组穿刺至血管再通时间短于IAT组(P<0.05),MT组血管再通率高于IAT组(P<0.05);两组患者≤30%残余狭窄率、24 h内症状性颅内出血发生率、术后90 d病死率比较,差异均无统计学意义(P>0.05)。【结论】与IAT相比,MT治疗急性脑梗死患者可以提高血管再通率,改善患者预后。

微波疗法联合递增负荷连续离心训练在慢性肌骨疼痛中的应用及对肌肉适能、疼痛介质的影响

目的探讨微波疗法联合递增负荷连续离心训练在慢性肌骨疼痛中的应用及对肌肉适能、疼痛介质的影响。方法选取2021年9月—2022年9月收治的慢性肌骨疼痛189例,根据干预方案不同将其分为A、B和C组3组各63例,A组给予微波疗法联合递增负荷连续离心训练,B组给予递增负荷连续离心训练,C组给予微波疗法。比较3组治疗前和治疗1、2个疗程疼痛程度[视觉模拟评分法(VAS)]、疼痛性质(ID pain评分)、肌肉适能(峰力矩、力矩加速能量、平均功率)、疼痛介质[前列腺素E_(2)(PGE_(2))、P物质、β-内啡肽(β-EP)]和匹兹堡睡眠质量指数(PSQI)评分,以及治疗前和治疗2个疗程简明健康生活状况调查表(SF-36)、国际骨性关节炎评分标准(Lequesne)评分。结果治疗1和2个疗程,A组VAS和ID pain评分均低于B组和C组;治疗2个疗程,A组峰力矩、力矩加速能量和平均功率屈肌和伸肌均高于B组和C组,B组峰力矩、力矩加速能量和平均功率屈肌和伸肌均低于C组(P<0.05)。治疗1和2个疗程,A组血清PGE_(2)和P物质低于B组和C组,血清β-EP高于B组和C组;B组血清PGE_(2)和P物质低于C组,血清β-EP高于C组(P<0.05)。治疗前及治疗1、2个疗程,3组组内PSQI评分呈降低趋势(P<0.05)。治疗1和2个疗程,A组PSQI评分均低于B和C组(P<0.05)。治疗2个疗程,3组组内SF-36评分均高于治疗前,Lequesne评分均低于治疗前(P<0.01);A组SF-36评分高于B组和C组,Lequesne评分低于B组和C组(P<0.05)。结论微波疗法联合递增负荷连续离心训练可用于慢性肌骨疼痛治疗中,能促进患者肌肉适能指标、疼痛介质改善,从而恢复患者睡眠质量、日常生活质量及骨关节功能。

经皮神经电刺激治疗肌骨关节疾病的研究进展

经皮神经电刺激(TENS)是一种有效的物理治疗手段,常用于缓解肌肉和骨关节疼痛。近年来,经皮神经电刺激在临床实践中广泛应用,并取得了一定的研究进展。TENS可以改善人体的肌肉力量和运动能力、促进细胞组织修复和再生,并减轻疼痛和炎症,还可以与其他治疗方法(牵引、按摩、热敷等)相结合,以达到更好的治疗效果。目前TENS的研究仍存在一些争议和不足,针对不同病情和个体化的治疗方案尚未完全明确,需要进一步的研究和探索。