Objective To assess the clinical effect of manipulation on lumbar intervertebral disc protrusion.Methods Seventy cases with lumbar intervertebral disc protrusion were randomly divided into two groups,namely the medicine group and the manipulation group. To assess the clinical effect according to curative effect and symptom score. Results The total effective rate of the manipulation group was 88.6 %, while the medicine control group was 77.1%. It was significant different between the two groups(P＜0.05). And the score of the two groups has very significant different(P＜0.01). The clinical effect of the manipulation group was better. Conclusion Manipulation in the treatment of lumbar intervertebral disc protrusion is effective and safety.

Objective To observe the clinical efficacy of Xiaoyusan simplified plaster in the treatment of knee osteoarthritis and the significance of intervention in cartilage metabolism.Methods Totally 105 patients with knee osteoarthritis were divided into Xiaoyusan simplified prescription group,Xiaoyusan group and diclofenac diethylamine group according to random number table method.Xiaoyusan simplified prescription group:Apply it to the swollen and painful area,covering the entire lesion area,and change the dressing every 24 hours;Xiaoyusan group:Apply it to the swollen and painful area,covering the entire lesion area,and change the dressing every 24 hours;diclofenac diethylamine group:Apply evenly to the swollen and painful area,3 times a day;all the groups were treated for 2 courses(4 weeks).The changes of VAS score,WOMAC score,knee joint activity and the content of cartilage metabolism index HA,type Ⅱ collagen,COMP and CTX-Ⅱ before and after treatment were compared.Safety indicators of the three groups were monitored.Results The total effective rates of Xiaoyusan simplified plaster group and Xiaoyusan group were all over 97.1%(33/34),better than the diclofenac diethylamine group(81.8%,27/33),with statistical significance in the three groups(P<0.05).Xiaoyusan simplified plaster group and Xiaoyusan group were superior to diclofenac diethylamine group in VAS score,WOMAC score,sitting-standing 5 times time(P<0.05);Xiaoyusan simplified plaster group and Xiaoyusan group were superior to diclofenac diethylamine group in delaying the decrease of HA content and the increase of COMP content,with statistical significance(P<0.05).After treatment,there was no significant difference in VAS score,WOMAC score,knee joint activity and bone metabolism index content between Xiaoyusan simplified plaster group and Xiaoyusan group(P>0.05).The blood routine,urine routine,liver function,kidney function and electrocardiogram examinations before and after treatment in the three groups were all normal.Conclusion Xiaoyusan simplified plaster has the same efficacy as Xiaoyusan,which can reduce the pain of knee osteoarthritis patients,increase the knee joint activity and daily living ability of patients,and delay the cartilage injury metabolism.

ObjectiveUsing transcriptome sequencing to screen the differentially expressed genes between the synovial tissue of rats with knee osteoarthritis (KOA) induced by monosodium iodoacetate (MIA) and that of normal rats, and then screen the target of fraxetin in the treatment of synovitis. MethodsSD rats were divided into KOA group and the negative control (NC) group. Rat right knee KOA model was prepared by MIA knee joint injection in KOA group and none treatments in NC group. Four weeks after modeling, the right knee synovial tissue of rats in each group was taken for transcriptome sequencing. Then the differential gene expression analysis, GO enrichment analysis, KEGG function enrichment analysis and PPI protein network interaction analysis were performed. The synovial macrophage Raw264.7 cells were divided into the control group, lipopolysaccharide (LPS) intervention group and LPS+60 μmol/L fraxetin intervention group, then RNA-sequencing results were verified by qRT-PCR in the three groups. ResultsThe results of differential gene-expression analysis showed that there were 1 730 up-regulated genes and 1 546 down-regulated genes in the KOA group compared with the control group, among which the significantly up-regulated genes were mmp12, Acod1, Acan, Col2a1, Atp6v0d2 (|log2(FoldChange)|≥1, adjusted P<0.01). KEGG cluster analysis and GO cluster analysis showed that differential genes were mainly involved in the regulation of inflammation and immune metabolism, such as tricarboxylic acid cycle and mitochondrial function. The expressions of Acod1 and Atp6v0d2 in Raw264.7 cells after LPS intervention were significantly higher. Compared with the LPS intervention group, the expression level of Atp6v0d2 in Raw264.7 cells after LPS+fraxetin combined intervention was significantly lower. ConclusionAfter modeling KOA induced by MIA, macrophage-related genes mmp12, Acod1 and Atp6v0D2, which mediate inflammation and immune metabolism, were highly expressed in the synovial tissue of rats, suggesting that there might be immune metabolism changes mediated by synovial macrophages during the occurrence and development of KOA. The increased expression of Acod1 and Atp6v0d2 in macrophages Raw264.7 after LPS intervention can preliminarily confirm this result. Among them, Atp6v0d2 may be a potential target of fraxetin in the treatment of synovitis, which provides a new idea for KOA treatment.

ObjectiveTo study the effect of Xiaoyusan new formula on the articular cartilage of knee osteoarthritis (KOA) rabbits and its mechanism. MethodsA total of 42 New Zealand white rabbits aged 6 months were randomly divided into normal group, model group, ointment of Xiaoyusan group, and ointment of Xiaoyusan new formula group, with 10 rabbits in each group (the other 2 rabbits were used for model validation). Except for the normal group, the right knee joints of all rabbits in the other groups were prepared as KOA models according to the modified Hulth method. After 5 weeks of molding, the rabbits in ointment of Xiaoyusan group, ointment of Xiaoyusan New Formula group were given corresponding ointments for knee arthritis treatment, once a day, each time for 10 hours. After 2-week continuous administration and treatment, the knee joint cartilage of the four groups of rabbits was taken and the cartilage damage of each group was evaluated by Outerbridge grading method. The pathological changes of the cartilage, calcified layer and subchondral bone of the knee joint of rabbits in each group were observed by HE staining method under the light microscope, and the degree of cartilage degeneration was evaluated by Mankin's method. The expression of matrix metalloproteinase-13 (MMP-13) in the cartilage of rabbit knee joint in each group was deteced by immunohistochemistry. Results After the general observation of articular cartilage, the Outerbridge grading showed that the number of high-grade animals in ointment of Xiaoyusan group was reduced compared with the model group (P<0.05), and the number of high-grade animals in ointment of Xiaoyusan new formula group was also reduced (P<0.05) compared with ointment of Xiaoyusan group. HE staining showed that Mankin's scores of articular cartilage in the four groups ranked from high to low: model group (10.82±1.76), ointment of Xiaoyusan group (6.19±1.23), ointment of Xiaoyusan new formula group (2.64±1.18) and normal group (0.28±0.17). The difference among four groups was statistically significant (P<0.05). Immunohistochemical detection showed that the positive rates of MMP-13 expression in rabbit articular cartilage tissues in each group were (67.90±13.94)% of model group, (37.10±19.16)% of ointment of Xiaoyusan group, (13.60±3.10)% of ointment of Xiaoyusan new formula group and (3.20±2.39) % of normal group, ranking from high to low, and the difference among four groups was statistically significant (P<0.05). ConclusionXiaoyusan new formula can repair articular cartilage degeneration in KOA rabbits and decrease the expression of MMP-13 in cartilage, which may be one of the mechanisms of the treatment.