BACKGROUND:The number of patients receiving total knee arthroplasty has been increasing globally each year.Pain management is a crucial aspect following total knee arthroplasty,as effective pain control can facilitate early mobilization,reduce complications,enhance patient satisfaction,and accelerate the rehabilitation process.OBJECTIVE:To construct a visual map of post-total knee arthroplasty pain,understand the international research status and trends in this field,and provide a reference for future studies.METHODS:Relevant research articles on post-total knee arthroplasty pain were retrieved from the CNKI,WanFang Data,and Web of Science core databases,covering the period from January 2000 to December 2023.The CiteSpace software(version 6.2.3)was used to analyze the annual publication output,authors,institutions,countries,keywords,and references.Utilizing R programming language(version 4.4.1),a database was established to create line charts and bar graphs.RESULTS AND CONCLUSION:(1)Our analysis included 3 796 publications,predominantly in Chinese(3 509 articles)with the remainder in English(287 articles).(2)The United States was the most productive country in English literature,with Harvard University leading institutional output.Guangzhou University of Chinese Medicine was the top publishing institution in Chinese literature.(3)Keyword clustering identified"quality of life,""phobia,"and"acupuncture"as emerging focal points in Chinese literature,while"satisfaction"and"psychological factors"were prominent in English literature over the past five years.Co-occurrence and clustering analysis revealed dense internal connections among institutions,authors,and publications,but sparse external collaborations.(4)The study's bias on visualization analysis may have introduced bias by excluding less influential papers.(5)Regarding research hotspots,domestic research emphasized the efficacy and exploration of analgesic methods,in contrast to international research that focused on pain mechanism subtyping and analgesic drug innovation.Future research is expected to trend towards traditional Chinese medicine for postoperative pain,multimodal analgesia,and the investigation and prevention of pain typing mechanisms.

BACKGROUND:The number of patients receiving total knee arthroplasty has been increasing globally each year.Pain management is a crucial aspect following total knee arthroplasty,as effective pain control can facilitate early mobilization,reduce complications,enhance patient satisfaction,and accelerate the rehabilitation process.OBJECTIVE:To construct a visual map of post-total knee arthroplasty pain,understand the international research status and trends in this field,and provide a reference for future studies.METHODS:Relevant research articles on post-total knee arthroplasty pain were retrieved from the CNKI,WanFang Data,and Web of Science core databases,covering the period from January 2000 to December 2023.The CiteSpace software(version 6.2.3)was used to analyze the annual publication output,authors,institutions,countries,keywords,and references.Utilizing R programming language(version 4.4.1),a database was established to create line charts and bar graphs.RESULTS AND CONCLUSION:(1)Our analysis included 3 796 publications,predominantly in Chinese(3 509 articles)with the remainder in English(287 articles).(2)The United States was the most productive country in English literature,with Harvard University leading institutional output.Guangzhou University of Chinese Medicine was the top publishing institution in Chinese literature.(3)Keyword clustering identified"quality of life,""phobia,"and"acupuncture"as emerging focal points in Chinese literature,while"satisfaction"and"psychological factors"were prominent in English literature over the past five years.Co-occurrence and clustering analysis revealed dense internal connections among institutions,authors,and publications,but sparse external collaborations.(4)The study's bias on visualization analysis may have introduced bias by excluding less influential papers.(5)Regarding research hotspots,domestic research emphasized the efficacy and exploration of analgesic methods,in contrast to international research that focused on pain mechanism subtyping and analgesic drug innovation.Future research is expected to trend towards traditional Chinese medicine for postoperative pain,multimodal analgesia,and the investigation and prevention of pain typing mechanisms.

Objective:To explore protective effect and possible mechanism of electroacupuncture at Zusanli combined with Yupingfengsan Jiawei on rats with acute lung injury.Methods:A total of 50 Wistar rats were randomly divided into control group,model group,Yupingfengsan Jiawei group(YPFSJW),electroacupuncture group(EA),acupuncture-medicine combination group(EA+YPFSJW),and acute lung injury model rats were constructed by intraperitoneal injection of lipopolysaccharide except control group.Lung tissue injury,oxidative damage and inflammatory factors were detected by wet/dry weight ratio,HE staining,TUNEL staining,myeloperoxidase(MPO),malondialdehyde(MDA),superoxide dismutase(SOD)and ELISA.qRT-PCR,immunohistochemical staining and Western blot were used to detect mRNA and related protein expressions.Results:Compared with control group,structure of lung tissue in model group was significantly damaged,alveolar wall was thickened,accompanied by pathological damage such as congestion and inflammatory cell infiltration,wet/dry ratio of lung tissue,apoptosis rate,inflammatory factors,oxidative damage level and mRNA expressions were significantly increased,and protein expressions of TLR4,MyD88,p-p65 and p-IκBα were significantly increased(P<0.05);compared with model group,Yupingfengsan Jiawei group,electroacupuncture group and acupuncture-medicine combination group had less inflammatory cell infiltration and congestion in lung tissue,wet/dry weight ratio of lung tissue,cell apopto-sis rate,inflammatory factors,oxidative damage levels and mRNA expressions were decreased,and TLR4,MyD88,p-p65,p-IκBαprotein expressions were decreased(P<0.05);compared with Yupingfengsan Jiawei group and electroacupuncture group,lung tissue alveolar structure of combined acupuncture and medicine group was relatively complete and clear,wet/dry weight ratio of lung tissue,cell apoptosis rate,inflammatory factors,oxidative damage levels and mRNA expressions were decreased,TLR4,MyD88,p-p65,p-IκBα protein expressions were decreased(P<0.05).Conclusion:Electroacupuncture combined with Yupingfengsan Jiawei can reduce acute lung injury in rats,whose mechanism may be related to regulation of protein levels related to NF-κB signaling pathway.

AIM To evaluate the quality of Gegen Formula Granules.METHODS Linear calibration with two reference substances(LCTRS)was adopted in the predicting of retention time with puerarin and daidzein as internal standards.UPLC characteristic chromatograms were established.The contents of 3'-hydroxy puerarin,puerarin(internal standard),3'-methoxy puerarin,puerarin 6"-O-xyloside,puerarin apioside and daidzin were determined by quantitative determination analysis multi-components by a single marker(QAMS),after which their transfer rates were calculated.RESULTS Compared with relative retention time method,LCTRS demonstrated higher positional accuracy for characteristic peaks and wider application range for columns.There were 9 characteristic peaks in the characteristic chromatograms for 14 batches of formula granules and 15 batches of standard decoctions with the similarities of more than 0.95.The contents and transfer rates of various constituents in formula granules and standard decoctions were basically consistent.CONCLUSION The chemical constituents in formula granules and their standard decoctions of Puerariae lobatae Radix display good consistency,reliable preparation process is observable in the former.

Objective To explore the molecular mechanism of Guben Zhike Pingchuan Granules in treating cough variant asthma(CVA)through network pharmacology and molecular docking technology;To use CVA model rats for validation;To provide a basis for the basic research and clinical application of Guben Zhike Pingchuan Granules.Methods TCMSP and BATMAN-TCM databases were used to retrieve the active components and corresponding targets of Guben Zhike Pingchuan Granules,and CVA disease targets were screened using OMIM,GeneCards,DrugBank,PharmGKB databases to obtain drug disease intersection targets.Cytoscape 3.10.1 software was used to construct the drug-component-target network and screen the key components;STRING database was used to construct protein-protein interaction(PPI)network and screen core targets;GO and KEGG enrichment analysis was conducted using DAVID platform;AutoDock Vina software was used to conduct molecular docking on the core targets and key components with high degree value respectively.CVA rat model was established by smoking combined with intraperitoneal and subcutaneous multi-point injection of ovalbumin.The rats were randomly divided into blank group,model group,montelukast sodium tablets group,Guben Zhike Pingchuan Granules low-and high-dosage groups.The groups received corresponding medicine for 15 d.HE staining was used to observe the morphology of lung tissue;ELISA was used to detect the contents of serum interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α);immunohistochemistry was used to detect the positive expressions of AKT,EGFR and NFKB1 in lung tissue.Results A total of 9 996 active components and 1 119 potential targets of Guben Zhike Pingchuan Granules,2 740 CVA targets,467 drug and disease intersection targets were screened out;PPI network topology analysis showed that AKT1,STAT3,EGFR,NFKB1 and MTOR were the core targets;the results of enrichment analysis showed that Guben Zhike Pingchuan Granules played an anti-inflammatory role in the treatment of CVA mainly through the interaction of EGFR/PI3K-Akt/NF-κB signaling pathway;molecular docking showed good binding ability between the core targets and key components,with a binding energy of<-7.0 kcal/mol for EGFR and Quercetin.Animal experiment results showed that after intervention with Guben Zhike Pingchuan Granules,the alveolar walls of the lung tissue in the model rats narrowed,the size of the alveoli became uniform,lymphocyte infiltration improved significantly,bronchioles contracted,and mucus in the lumen decreased;compared with the model group,the serum contents of IL-1β and TNF-α decreased in Guben Zhike Pingchuan Granules low-and high-dosage groups and montelukast sodium tablets group,and the positive expressions of AKT,EGFR and NFKB1 in lung tissue decreased(P<0.05,P<0.01).Conclusion Guben Zhike Pingchuan Granules may mediate the inflammatory response through the EGFR/PI3K-Akt/NF-κB signaling pathway,significantly improve the structural damage of CVA lung tissue,inhibit inflammatory cell infiltration,down-regulate the expressions of inflammatory factors,and thus exert therapeutic effects on CVA.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective To elucidate the impact of chronic kidney disease(CKD)on the clinical outcomes of patients with left main coronary artery disease(LMCAD)undergoing intravascular ultrasound(IVUS)-guided percutaneous coronary intervention(PCI).Methods This retrospective study enrolled consecutive patients with LMCAD who underwent IVUS-guided PCI at Wuhan Asia Heart Hospital between January 2017 and December 2020.Patients were stratified into CKD and non-CKD groups according to the presence of CKD.Clinical data were systematically retrieved from the electronic health record system.Demographic,clinical,and angiographic characteristics were compared between groups.The primary endpoint was major adverse cardiovascular events(MACE),defined as a composite of all-cause mortality,myocardial infarction,and ischemic stroke.Results A total of 325 LMCAD patients[mean age(62.56±9.86)years;73.54％male]were included,with 31 patients(9.54％)in the CKD group.During a median follow-up of 5 years,CKD patients exhibited significantly older age[(70.13±9.77)years vs.(61.77±9.54)years,P＜0.001],higher prevalence of three-vessel disease(64.52％vs.38.10％;P=0.040)and left main bifurcation lesion(45.16％vs.37.76％,P=0.011),greater IVUS-detected calcification burden(P=0.029),and higher median SYNTAXⅡ scores[(34.10(30.30,39.25)vs.26.75(22.42,31.58),P＜0.001)].The cumulative incidence of MACE was significantly higher in the CKD group compared to the non-CKD group(32.26％vs.9.18％,P＜0.001).Univariate Cox regression analysis and Kaplan-Meier survival curves confirmed a 5.877-fold increased risk of MACE in CKD patients(95％CI 2.765-12.494).After adjusting for age and cardiac function,CKD remained an independent predictor of MACE(HR 3.611,95％CI 1.634-7.978).Conclusions LMCAD patients with concomitant CKD present with advanced age,impaired cardiac function,more extensive coronary disease,and severe calcification.The presence of CKD is associated with a significantly worse long-term prognosis.

OBJECTIVE: To compare the effectiveness of using a composite loop plate to reconstruct the coracoclavicular ligament around the coracoid process and using a clavicular hook plate for fixation in treatment of Rockwood type Ⅲ acute acromioclavicular joint dislocation. METHODS: A retrospective analysis was conducted on the clinical data of 60 patients with Rockwood type Ⅲ acute acromioclavicular joint dislocation who were admitted between June 2022 and September 2023 and met the selection criteria. Among them, 30 patients were treated with the composite loop plate to reconstruct the coracoclavicular ligament around the coracoid process (loop plate group) and 30 with clavicular hook plate fixation (hook plate group). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, injured side, cause of injury, disease duration, preoperative visual analogue scale (VAS) score for pain, and Constant-Murley score. The incision length, operation time, length of hospital stay, and the occurrence of complications during follow-up were recorded. The Constant-Murley score and VAS score were used to evaluate shoulder joint function and pain, and the differences (change values) of the indicators between before operation and at 6 months after operation were calculated for inter-group comparison. In the loop plate group, the coracoclavicular distance (CCD) on the anteroposterior X-ray films of the acromioclavicular joint was measured at 1 day and 6 months after operation to assess the loss of acromioclavicular joint reduction. RESULTS: The incision length of the loop plate group was significantly shorter than that of the hook plate group ( P<0.05). There was no significant difference in the operation time and the length of hospital stay between the two groups ( P>0.05). All incisions healed by first intention after operation. All patients were followed up 12-18 months (mean, 16.3 months). There was no significant difference in the follow-up time between groups ( P>0.05). The Constant-Murley scores and VAS scores of both groups significantly improved at 6 months after operation when compared with those before operation ( P<0.05); the differences in the change values of the two indicators between groups were significant ( P<0.05). The CCD of the loop plate group were (10.40±0.83) mm at 1 day and (10.70±0.68) mm at 6 months and no repositioning loss was observed. Three cases in the hook plate group had residual shoulder joint pain after operation. The difference in the accidence of complications between groups was not significant ( P>0.05). CONCLUSION For Rockwood type Ⅲ acute acromioclavicular joint dislocation, compared with the clavicular hook plate fixation, the composite loop plate for reconstructing the coracoclavicular ligament around the coracoid process has the advantages of simple operation, safety, minimally invasive, good functional recovery, and fewer complications. Moreover, it avoids the need for a second surgery to remove the internal fixation device, and the patient acceptance and satisfaction are higher.
Humans ; Acromioclavicular Joint/surgery* ; Bone Plates ; Male ; Retrospective Studies ; Female ; Adult ; Ligaments, Articular/injuries* ; Joint Dislocations/surgery* ; Coracoid Process/injuries* ; Treatment Outcome ; Middle Aged ; Plastic Surgery Procedures/instrumentation* ; Fracture Fixation, Internal/instrumentation* ; Young Adult ; Clavicle/surgery*

OBJECTIVE: To compare clinical effect of anterior tibial plateau fracture line and anterior tibial fenestration reduction in treating anterolateral tibial plateau column fracture combined with posterior lateral column collapse. METHODS: Fifty-two patients with Schatzker typeⅡ tibial plateau anterolateral column fracture combined with posterolateral column collapse admitted from January 2016 to December 2021 were retrospectively analyzed and divided into two groups according to fracture reduction methods. There were 27 patients in fracture line group, including 19 males and 8 females, aged from 26 to 62 years old with an average of (43.2±11.4) years old;the time from injury to operation ranged from 4 to 8 days with an average of (5.8±1.5) days;treated with reduction and internal fixation via fracture line of lateral platform front. There were 25 patients in fenestrate group, including 13 males and 12 females, aged from 22 to 69 years old with an average of (40.8±11.1) years old;the time from injury to operation ranged from 4 to 8 days with an average of (6.0±1.4) days;treated with tibial fenestration reduction and internal fixation. The amount of bone graft, operation time, fracture healing time and complications were compared between two groups. Posterior slope angle (PSA) and posterior slope angle of the lateral tibial plateau was compared before surgery, 2 days and 6 months after surgery. The knee function was evaluated by Hospital for Speical Surgery (HSS) at 2 days and 6 months after surgery, respectively. Fracture reduction was evaluated by Rasmussen anatomic score of knee joint. RESULTS: Both of group were followed up from 12 to 24 months (16.0±3.4) months. No redisplacement of fracture, internal and external inversion deformity of knee joint, or instability of knee joint were found between two groups during follow-up. In fracture line group, 1 patient occurred wound fat liquefaction and 2 patients occurred lower limb intermuscular venous thrombosis occurred. In fenestration group, 1 patient occurred joint stiffness, 1 patient occurred lower limb intermuscular venous thrombosis, and 1 patient occurred superficial wound infection;there were no significant difference in complications between two groups (P>0.05). Bone graft volume, operative time and fracture healing time in fracture line group were (3.6±2.3) cm³, (123.4±18.2) min and (13.8±1.8) weeks, while in feneplast group were (4.8±1.8) cm³, (135.5±22.5) min and (15.2±2.0) weeks, respectively;the difference between two groups was statistically significant (P<0.05). The collapse depth of lateral platform articular surface at 2 days and 6 months after surgery were (0.8±0.1) and (0.9±0.1) mm in fracture line group, which were lower than those in fenestration group (0.9±0.1) and (1.1±0.1) mm, respectively (P<0.05). After 2 days and 6 months, , PSA in fracture line group were (9.4±1.5) ° and (10.1±1.9) °, respectively, which were lower than those in fenestration group (10.5±1.5) ° and (11.3±1.9) ° (P<0.05). Rasmussen anatomical scores in fracture line group at 2 days and 6 months were 16(16, 18) and 16(14, 16) points, respectively, which were better than those in fenestrated group (16, 16) and 14(14, 16) points (P< 0.05). The collapse depth, PSA and Rasmussen anatomical score between two groups were better than those before surgery (P<0.05). There was no significant difference in HSS score between two groups at 2 days after surgery (P>0.05). At six months after surgery, HSS score in fracture line group (86.7±3.6) was higher than that in fenestration group (84.1±3.91) (P<0.05). HSS score at 6 months after surgery was better than that at 2 days after surgery (P<0.05). CONCLUSION Both anterior tibial plateau fracture line and anterior tibial fenestration could be used to treat anterolateral tibial plateau column fracture with posterior lateral column collapse. Compared with fenestration group, transfracture line group had advantages of less intraoperative bone grafting, shorter operative time, shorter fracture healing time, better articular surface reduction effect and better knee functional recovery.
Humans ; Male ; Female ; Middle Aged ; Tibial Fractures/physiopathology* ; Adult ; Fracture Fixation, Internal/methods* ; Aged ; Retrospective Studies ; Tibia/injuries* ; Tibial Plateau Fractures

OBJECTIVE: To reveal the molecular basis of knee osteoarthritis (KOA) with Yang deficiency and blood stasis syndrome by analyzing the gene expression profiles in synovial fluid and blood of KOA patients with this syndrome. METHODS: A total of 80 KOA patients were recruited from October 2022 to June 2024, including 40 cases in the non-Yang deficiency and blood stasis group (27 males and 13 females), with an average age of (61.75±3.45) years old;and 40 cases in the Yang deficiency and blood stasis group (22 males and 18 females), with an average age of (62.00±2.76) years old. The levels of body mass index (BMI), high-density lipoprotein (HDL), low-density lipoprotein (LDL), fibrinogen, total cholesterol, and D-dimer were recorded and summarized. Blood and synovial fluid samples from patients were collected for gene expression profile microarray sequencing, and then PCR and immunohistochemistry were used for clinical verification on the patients' synovial fluid and cartilage samples. RESULTS: Logistic regression analysis showed that compared with KOA patients with non-Yang deficiency and blood stasis syndrome, those with Yang deficiency and blood stasis syndrome had increased BMI, LDL, fibrinogen, total cholesterol, and D-dimer, and decreased HDL, with a clear correlation between the two groups. There were 562 differential genes in the blood, among which 322 were up-regulated and 240 were down-regulated;755 differential genes were found in the synovial fluid, with 350 up-regulated and 405 down-regulated. KEGG signaling pathway analysis of synovial fluid revealed changes in lipid metabolism-related pathways, including cholesterol metabolism, fatty acid metabolism, and PPARG signaling pathway. Analysis of the involved differential genes identified 6 genes in synovial fluid that were closely related to lipid metabolism, namely LRP1, LPL, ACOT6, TM6SF2, DGKK, and PPARG. Subsequently, PCR and immunohistochemical verification were performed using synovial fluid and cartilage samples, and the results were consistent with those of microarray sequencing. CONCLUSION This study explores the clinical and genomic correlation between traditional Chinese medicine syndromes and knee osteoarthritis from the perspective of lipid metabolism, and proves that abnormal lipid metabolism is closely related to KOA with Yang deficiency and blood stasis syndrome from both clinical and basic aspects.
Humans ; Male ; Female ; Middle Aged ; Synovial Fluid/metabolism* ; Osteoarthritis, Knee/metabolism* ; Yang Deficiency/complications* ; Aged