Objective To investigate the interactive effects of diabetes and lipid abnormalities on the treatment efficacy of rheumatoid arthritis(RA)and their predictive significance,providing a basis for individualized treatment of RA patients with metabolic disorders.Methods A total of 180 RA patients who visited the hospital between June 2022 and June 2023 were selected as research subjects.Based on whether patients had diabetes and dyslipidemia,they were divided into Group A(RA only,n=45),Group B(RA with diabetes,n=45),Group C(RA with dyslipidemia,n=45),and Group D(RA with both diabetes and dyslipidemia,n=45).All patients received conventional anti-rheumatic treatment according to the 2018 Chinese Rheumatoid Arthritis Diagnosis and Treatment Guidelines.Patients in Group B and D were additionally treated with metformin for blood glucose control,while patients in Group C and D received statins for lipid regulation.Treatment efficacy was assessed after 3 months of treatment.The Observed indicators included American College of Rheumatology(ACR)20/50/70 response rates,Disease Activity Score(DAS28),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),glycated hemoglobin(HbA1c),fasting plasma glucose(FPG),total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C).Multivariate logistic regression analysis was used to evaluate the impact of blood glucose and lipid levels on RA treatment efficacy.Additive and multiplicative models were constructed to evaluate the interaction between HbA1c and HDL-C.Results After treatment,Group A showed significantly higher ACR20/50 response rates than the other three groups,and also showed a higher trend in ACR70 response rate.Group D had the lowest response rates across all criteria(P<0.05).Group D also exhibited significantly higher levels of DAS28,CRP,and ESR than the other three groups,while Group A had the lowest levels(P<0.05).Baseline HbA1c level,baseline HDL-C level and baseline DAS28 scores are independent influencing factors for ACR20 response(P<0.05).Comparison of additive and multiplicative models suggested that the effects of HbA1c and HDL-C on ACR20 response might be independent of each other(P=0.652).Conclusion Diabetes and dyslipidemia have significant negative impacts on RA treatment efficacy,but their interaction is not significant.For RA patients with metabolic disorders,it is important to actively control blood glucose and regulate lipid levels while undergoing anti-rheumatic treatment to improve therapeutic outcomes.Baseline HbA1c and HDL-C levels can serve as important predictors for RA treatment response.

BACKGROUND: It is often difficult to determine the cause of low back pain (LBP) in the patients with lumbar disc herniation. The herniated disc has long been thought to be an important cause of the patient's complaint about LBP and sciatica. Whether the adjacent degenerative disc results in LBP needs further confirmations. OBJECTIVE: This study sought to determine whether the degenerative disc adjacent to the herniated disc in patients with LBP and radicular pain can result in discogenic LBP, as assessed by provocative discography, and to report the outcomes of the residual LBP when adjacent symptomatic disc were treated with methylene blue after microendoscopic discectomy. METHODS: Twenty lumbar disc herniation patients complaint about LBP and radicular pain underwent provocative discography. There was one degenerative herniated disc with one or more adjacent degenerative discs in their MRI. Provocative discography was performed on all degenerative discs and at least one normal disc for control. The severity of LBP and leg pain of all patients was assessed using visual analog scale before discography. All patients underwent microendoscopic discectomy at herniated level, and intradiscal injection of methylene blue was given at painful adjacent level in five patients after microendoscopic discectomy. RESULTS AND CONCLUSION: Discographies were performed on 64 discs of 20 patients, from L2-3 to L5-S1. There were 11 discs satisfying the positive response criteria, including 6 in degenerative segment adjacent to the herniated disc and 5 in the herniated disc that induced corresponding radiculopathy. The leg pains were evidently improved in all patients, while LBP was partially improved after microendoscopic discectomy. Six patients with symptomatic adjacent degenerative disc still had evident LBP, influencing their daily living. Five of them received intradiscal injection of methylene blue treatment and the LBP was relived. One patient refusing to the treatment still complained the LBP. Results evidenced that accompanying LBP for many LDH patients may come from the degenerative levels adjacent to the herniated disc.

[Objective]This study was designed to construct a recombinant adenovirus vector contains LMP-1 gene,and investigate the osteoinductive activity of MSC which were transfected recombinated adenoviral vector carrying LMP-1 gene.[Methods]Total RNA was extracted from mt osteoblast and the LMP-1 gene was acquired by RT-PCR,the LMP-1 gene and entry vector pENTR/D-TOPO were used to create the entry clone with the directional TOPO clone technology,then the entry clone and the expression vector were used to create the expression clone throush the LR recombination reaction.The adenovirus expression clone was linearized by PacI and transfected to the 293A cell line to harvest a high titer.Ad-LMP-1 was infected into the 3rd passage MSC,the expression of LMP-1 was detected by Western blot.The osteogenic activity of MSC was evaluated by the expression of collagen Ⅰ,ALP,osteocalcin and the formation of bone nodule.[Result]The LMP-1 gene was successfully acquired and confirmed,the entry clone and the expression clone were both verified by enzymes digestion,and the expression clone was further confirmed by sequenced.The expression of LMP-1 was detected successfully in MSC.The increasing expression of collagen Ⅰ,osteocalcin.ALP and bone nodule were observed by comparing to the control group.[Conclusion]Gateway technology not only make construction of the pAd-LMP-1 recombination adenovirus vector simple and fast,but also get a high transfection efficacy in MSC.LMP-1 gene can induce the osteoblast differention of MSCs,and improve its osteogenic activity.The adenovirus vector is reliable to be used in further gene therapy research.

Objective To study the incidence and prognosis of avascular necrosis after talus fracture. Methods A retrospective survey was performed in 12 patients ( 13 feet) with talus fractures admitted into hospital from July 2004 to November 2009 to analyze necrosis rate, ankle function recovery and disability rate. According to Hawkin' s classification system, there were two patients with type Ⅰ feet, four with type Ⅱ feet, five with type Ⅲ feet and two with type Ⅳ feet. Results All patients were followed up for average period of 19.6 months (range 11-52 months). Avascular necrosis was detected in eight feet, of which one foot was treated with ankle fusion, one with subtalar arthrodesis and one with bone implantation. The other five feet had good ankle and subtalar function, with no collapse or osteoarthritis. According to Maryland foot score, the result was excellent in eight patients, good in two, fair in one and failure in two, with excellence rate of 77%. Conclusion The incidence of avascular necrosis after talus fracture is related to the location and energy of trauma. However, the function prognosis of the talus shows no correlation with necrosis.

Objective To analyze the causes of the complications of one-stage surgical management for spinal tuberculosis and its countermeasures.Methods From May 1997 to December 2008,116 patients with spinal tuberculosis underwent operations.Among them,6 were in cervical vertebra,3 in cervicothoracie vertebra,29 in thoracic vertebra,37 in thoracolumbar vertebra.29 in lumbar vertebra and 12 in hmbrosacrum vertebra.All cases underwent the anterior and/or radical debridement,decompression,autogenous bone grafting or radical debridement,decompression,autogenous bone grafting and internal fixation.The causes of the complications of surgical management and the countermeasures were analyzed.Results One hundred and ehven cases were followed upfor an average of(3.86±2.16)years(range 6 months to 12 years).The rate of complication was 13.5%(15/111).Recurrent spinal tuberculosis occarred in 5 cases,internal fixation loosened in 1 case,rupture of the external iliac vein occurred in 2 cases,lateral ventral syndrome in 1 case,venous embolism of the lower extremity in 1 csse,reactional psychosis in 2 cases,pneumatothorax in 2 cases and femoral nerve irritating syndrome in 1 case.Among the recurrent cages,2cases with anterior debridement and 2 cases with posterior debridement underwent anterior operation again andgot good results, 1 case with anterior debridement gave up the reoperafion.Other cases relieved after conservative therapy.Conclusions Standardized anti-tuberculosis thempy is fundamental for preventing the recurrence of tuberculosis.Correct approach for the operation and thorough radical debddement are the key points for preventing the recurrence of tuberculosis.Good and effective therapy surround the operation is helpful for preventing the recurrence of tuberculosis.

Objective To explore the indications of anterior and posterior approach operations for unstable thoraco-lumbar fractures coupled with neurologic deficits and prevention of intraoperative and postoperative complications. Methods We investigated 107 consecutive eases of thoraco-lumbar fractures coupled with spinal cord injury who had been operated on from January 2000 to December 2006.Their average age was 37.8(range.17 to 78) years old. They were 71 males and 36 females. Anterior approach was selected for 46 cases and posterior approach for 61 cases according to their McCormack grades. By the Frankle system for neurologie deficits, 7 cases were graded as A,16 as B,39 as C and 45 as D. Fracture height vecoveries before and after surgery were analyzed statistically. Kyphotic deformity was assessed on lateraJ radiographs using the Cobb method. Results The mean follow-up of 97 cases was 2.8(range,0.5 to 6) years. In both groups. All the cases gained at least 1 grade improvement except those with Frankle grade A. The mean kyphotic angles before operation, after operation and at the latest follow-up were 23.7°,10.6°and13.1°respectively, with significant differences(P＜0.01),in the anterior approach group, while 16.3°,8.4°and 11.7°respectively, with significant differences(P＜0.01),in the posterior approach group. Some complications, such as deficit of cutaneous nerve of thigh, appeared in the 2 groups. Conclusions In treatment of unstable thoraco-lumbar fractures coupled with neurologic deficits, the anterior approach may be better than the posterior approach. The posterior approach can be applied for the cases with less than 7 points in McCormack index. Correct selection of operative approach, careful operation and good rehabilitation after operation are necessary for the prevention of complications.

BACKGROUND: In order to conserve blood and keep the operating field clean, cell saver is often used with electrocautery in hip arthroplasty. When applying the principle of thermal coagulation, electrocautery produces tissue self-burning with noxious gas byproducts, including carbon monoxide(CO). However the existing blood salvage systems do not have any reoxygenation or filtration function for CO.OBJECTIVE: To evaluate the effects of simultaneous use of electrocautery and a cell saver system on the blood levels of CO in patients undergoing hip arthroplasty.DESIGN: A comparative observation.SETTING: Department of Orthopedics, Duisburg-Essen University.PARTICIPANTS: From August 2002 to August 2003, patients undergoing hip arthroplasty including the use of electrocautery as well as intended use of a cell saver system were selected from the Department of Orthopedics, Duisburg-Essen University. Exclusive criteria: ① smoking history; ② history of anemia, hemoglobinopathy or coagulopathy; ③history of organ dysfunction, including lung, liver and kidney; ④ preoperative abnormal electrocardiogram (ECG), including cardiac ischemia and/or arrhythmia.Among all the enrolled patients, those who ultimately received the retransfusion of processed salvaged blood were counted as the observed group,whereas the others who did not receive any retransfusion for inadequate salvaged volume or possible contamination within salvaging were added as the control group, and no allogenic blood was transfused. All the patients agreed to participate in the study.METHODS: ① All the operations were performed under combined intravenous and inhalation general anesthesia. ② Electrocautery was used for coaluation during the incision of subcutaneous tissues, fascias, muscles as well as capsules. ③ A cell saver system (Haemonetics Cell Saver #5 System, manufactured by Haemonetics Corporation, U.S.A.) was applied during the operation. Salvaged blood were retransfused into the patients after the procedure of filtration and wash. ④ Blood CO-Oximetry: Blood CO levels were measured by carboxyhemoglobin (CO-Hb) concentration with a spectrophotometric blood gas analyzer (ABL 700 series, manufactured by Radiometer, Copenhagen, Denmark). In both groups, systemic blood samples were collected from a radial arterial catheter at 3 time points, including preoperatively, postoperatively and merely before the retransfusion of salvaged blood and at 6 hours postoperatively. In the observed group, additionally samples were collected instantly after skin incision from the aspirator connected to the cell saver reservoir, directly after femoral stem implantation also from the aspirator and immediately before retransfusion from the collecting sac, to reveal the trend of CO-Hb levels in salvaged blood.MAIN OUTCOMEMEASURES: CO-Hb levels in the systemic blood and salvaged blood at different time points were mainly observed.RESULTS: Totally 49 patients were involved in the analysis of results. ① General data: Forty-nine ASA Ⅰ -Ⅱ patients were enrolled in this study.There were 35 and 14 patients in the observed and control group, respectively, with 7 and 3 had a history of coronary heart diseases (heart function of class Ⅰ - Ⅱ ) correspondingly. There were no obvious differences in the sex, age, mean operative time and mean estimated blood loss between the two groups (P ＞ 0.05). The vital signs were stable in all the patients. ② CO-Hb concentration: In the observed group, the CO-Hb concentration in systemic blood at 6 hours postoperatively was significantly increased as compared with the preoperative and postoperative ones [(2.2±0.54)%,(1.6±0.34)%, (1.7±0.19)%, P ＜ 0.05]; the CO-Hb concentration in salvaged blood was (2.6±0.62)%, which was significantly higher than that in systemic blood preoperatively and postoperatively (P ＜ 0.01). In the control group, the CO-Hb concentration in systemic blood at 6 hours postoperatively had no obvious differences as compared with the preoperative and postoperative ones (P ＞ 0.05). ③ Postoperative conditions: In the observed group, sinus tachycardia and inferior myocardial ischemia were detected by ECG monitoring in 2 patients with pre-existing coronary heart disease,which complained of precardial discomfort at 4-6 hours postoperatively.Higher levels of CO-Hb were detected in salvaged blood before retransfusion (39% and 4.5%) and in systemic blood at 6 hours postoperatively(3.5% and 4.2%). No patient in the control group demonstrated symptoms of CO intoxication or cardiovascular compromise, also no abnormal changes were revealed by ECG monitoring.CONCLUSION: Retransfusion of salvaged blood in hip arthroplasty with simultaneous use of electrocautery and a cell saver system leads to a significant increase of systemic CO-Hb concentration, which can provoke the cardiovascular compromise. Therefore, it is suggested to measure CO-Hb level in salvaged blood, the retransfusion of which should be cautious, especially to patients with pre-existing heart diseases.

BACKGROUND:How to obtain sufficient autogeneic chondrocytes is a problem which must be answered as soon as possible in both the transplantation of chondrocytes and the development of cartilage engineering.Bone marrow-derived mesenchymal stem cells have the potential of multidirectional differentiation. Under different induced conditions, they can differentiate into multiple tissue cells, such as chondrocyte, osteoblasts , sarcoblast, nerve cells and so on. Insulin-like growth factor-I plays an important role in regulating the formation and development of limb and cartilage.OBJECTIVE:To observe the effect of the insulin-like growth factor-I and culture solution of chondrocyte on inducing bone marrow-derived mesenchymal stem cells to differentiate into chondrocytes in vitro.DESIGN:Open experiment.MATERIALS:This experiment was carried out at the Medical Study Center, Second Hospital Affiliated to Sun Yat-sen University from March to November 2003.Human bone marrow-derived mesenchymal stem cells were harvested from 4 to 6-month old embryos, all of which were from pregnant women who needed to terminate of pregnancy by induction delivery with water bag for health.METHODS:Human embryonic mesenchymal stem cells were isolated with Percoll separating medium. Subsequently, the cells were amplified in vitro,and the expression of surface makers of bone marrow-derived mesenchymal stem cells, such as CD44, CD71, CD34 and CD45 were measured with flow cytometer to identify the cells in our experiment. 100 μg/L insulin-like growth factors and culture solution of chondrocytes were added in the culture medium of bone marrow-derived mesenchymal stem cells of the fourth generation. The morphological changes of induced cells were observed with an inverted microscope. The expression of type Ⅱ cartilage matrix was observed by collogen immunohistochemistry. The proteoglycan level in the cells was detected, too.MAIN OUTCOME MEASURES:Phenotype of bone marrow-derived mesenchymal stem cells was identified through detecting the expressions of CD34, CD44 and CD4.Type Ⅱ collagen immunohistochemistry and the change of cellular ability to secrete proteoglycan after induction were observed to determine whether bone marrow-derived mesenchymal stem cells can differentiate into chondrocytes.RESULTS: ① Being observed under an inverted microscope,the bone marrow-derived mesenchymal stem cells presented a morphology like fibroblasts when they were cultured in vitro. ②Identification of surface antigen of bone marrow-derived mesenchymal stem cells: These cells were detected to have good homogenicity with flow cytometer. The fourth generation of bone marrow-derived stem cells positively expressed CD44, negatively expressed CD34 and CD45, suggesting these cells had the characteristics of bone marrow-derived mesenchymal stem cells. ③Observation of the morphological change of chondrocytes induced by bone marrow-derived mesenchymal stem cells under optical microscope: chondrocyte condition culture solution and insulin-like growth factors-Ⅰ were added to co-culture.During the process of culture, bone marrow-derived mesenchymal stem cells were seen to have a shape of round gradually. Fifteen days later, some cells presented a shape of short-shuttle or polygon with short mutations,which were the shape characteristics of chondrocytes. ④Immunohistochemical staining of Type Ⅱ collagen: In the insulin-like growth factor group,72.5% cells had many brown granules in cytoplasm, which were weakly positive or strongly positive expression of Type Ⅱ collagen. In the control group, bone marrow-derived mesenchymal stem cells was negative expression of type Ⅱ collagen on the 15th day. ⑤ Measurement of proteoglycan level: After co-culture with insulin-like growth factor-Ⅰ and chondrocyte culture solution for 15 days, proteoglycan was higher in the cells of co-culture group [ (8.92±0.91) μg/L ] than in culture group [(2.56±0.26) μg/L,P ＜ 0.05], but lower than in the chondrocyte group[(13.69±1.51) μg/L, P＜ 0.05].CONCLUSION:Insulin-like growth factor-Ⅰ and chondrocyte culture solution can induce bone marrow-derived mesenchymal stem cells to differentiate into chondrocytes.

Objective To study hIGF-1 gene expression and the influence on aggrecan expression of degenerative intervertebral disk. Methods Twenty four male New-Zealand rabbits IDD models were established and randomly divided into Ad/CMV-hIGF-1、hIGF-1 growth factor and PBS group. Twenty five mL of Ad/CMV-hIGF-1(T=80?109 PFU/L), hIGF-1 growth factor(100 ?g/L) and PBS were respectively injected into L4-5, L5-6 intervertebral disk through fluoroscopic guidance. One,two,four and eight weeks after-operation, rabbits were sacrificed, intervertebral disk samples were collected. Total protein of equal mass intervertebral disks were extracted, isolated by SDS-PAGE and transferred to polyvinylidene difluoride (PVDF) Millipore. The hIGF-1 growth factor expression were indentified with Western blot. Aggrecan gene fragments were amplified with RT-PCR,and relative expression was checked with GAPDH as intern control. Results The hIGF-1 interest protein existed at 7.6 kilo-Dalton. One week after injection, its expression quantities were almost equal between Ad/CMV-hIGF-1 and hIGF-1 growth factor group. At two week after injection, it obviously declined in hIGF-1 growth factor group. Four week after injection, it was still expressed in Ad/CMV-hIGF-1 group. Eight week after injection, it did not express in three groups. Aggrecan gene relative expression increased significantly from one to four weeks after injection, declined slightly by the end of eight weeks in Ad/CMV-hIGF-1 group. However, it appeared to decrease continuously in the other two groups with time. Conclusion Ad/CMV-hIGF-1 successfully infected degenerative intervertebral disk. The hIGF-1 gene expression lasted four weeks and could stimulate aggrecan synthesis in Ad/CMV-hIGF-1 group.

[Objective]To study the stresses value and distribution of the facet joint of the normal L4、5 segment model and that of the denucleated lumbar segment model. [Method]A finite element model of the intact L4、5 segment was developed through Ansys software.The property of nucleus pulposus was changed to be negligible to model lumbar discectomy through anterior approach.Then the finite element model of the denucleated lumbar spine segment was created.The inferior end plate of L5 was fixed.Models were subjected to 6 Nm flexion,extension or right rotation moment in combination with 400 N axial compression preload.Forces were applied to the superior L4 end plate.Stresses value and distribution of the lumbar facet joint were analyzed under different loading conditions.[Result]Finite element models of the intact L4、5 segment and the denucleated lumbar spine segment were created.The facet joint was treated as a three dimensional contact,linear frictionless problem.The facet joint was composed of the inferior and superior facet surface and ligamentous structure.Both facet joints,especially the left of the intact model produced larger stresses in right rotation.Comparing with that of the intact model,stresses of the facet joint of the denucleated model increased in flexion,extension and right rotation.[Conclusion]The region of contact of each facet joint varies according to different loading conditions.So does the stresses value and distribution.The facet stresses of the lumbar segment increase in flexion,extension and rotation after discectomy.