BACKGROUND:Acupotomy is effective in the treatment of knee osteoarthritis,but its mechanism is not very clear. OBJECTIVE:To observe the effect of acupotomy on the apoptosis of knee chondrocytes in knee osteoarthritis rats based on osteoclast associated receptor(OSCAR)-tumor necrosis factor-associated apoptosis-inducing ligand(TRAIL)-osteoprotetin(OPG)pathway. METHODS:Twenty-seven Sprague-Dawley rats were randomly divided into normal group(n=9),model group(n=9)and acupotomy group(n=9).Rats in the normal group were routinely housed without any treatment.Animal models of knee osteoarthritis were established by knee injection of papain.Acupotomy intervention was performed 1 week after modeling,once a week for a total of three times.Relevant tests were performed at the end of the intervention. RESULTS AND CONCLUSION:The Lequesne MG behavioral scores of rats in the model group were elevated compared with the normal group(P<0.01),while the Lequesne MG behavioral scores of rats in the acupotomy group were decreased comparedwith the model group(P<0.01).Hematoxylin-eosin staining results showed that compared with the normal group,the cartilage surface of the rat's knee joints in the model group was worn and uneven and the chondrocytes were swollen,ruptured,reduced in number,and arranged disorderly;while the cartilage surface of the rat's knee joints in the acupotomy group was relatively smooth,and the chondrocytes were high in number and arranged in an orderly manner,with the structure basically clear.Immunohistochemical staining results showed that compared with the normal group,the positive expressions of OSCAR and TRAIL were increased in the model group(P<0.01),while the positive expression of OPG was decreased(P<0.01).Compared with the model group,the positive expressions of OSCAR and TRAIL in the acupotomy group were decreased(P<0.01),while the positive expression of OPG was increased(P<0.01).TUNEL staining results showed that compared with the normal group,the number of apoptotic cells in the model group were increased(P<0.01);compared with the model group,the number of apoptotic cells in the acupotomy group decreased(P<0.01).RT-qRCR and western blot results showed that compared with the normal group,the protein expressions of OSCAR,TRAIL and Bax in the model group were increased(P<0.01),and the protein expressions of OPG and Bcl-2 were decreased(P<0.01);compared with the model group,the protein expressions of OSCAR,TRAIL,and Bax in the acupotomy group were decreased(P<0.01),and the protein expressions of OPG and Bcl-2 were increased(P<0.01).To conclude,acupotomy can reduce cartilage injury of the knee joint in rats with knee osteoarthritis,which may be related to the blockage of mitochondrial pathway apoptotic signaling release by the OSCAR-TRAIL-OPG pathway.

Objective:To investigate the safety of selective feticide by radiofrequency ablation (RFA) in dichorionic triamniotic (DCTA) triplets and factors related to the clinical outcome.Methods:A retrospective cohort study was designed to review the clinical records and pregnancy outcome of DCTA triplets patients who underwent RFA for selective feticide performed at the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital from January 1,2016 to January 1,2020. Placentas were collected after delivery for gross examination and perfusion study with the mixture of vinylidene chloride and self-curing denture acrylic.Results:A total of 12 DCTA cases were recruited. Selective feticide by RFA were performed at a mean gestational age of 15.6 weeks, and cases delivered at a mean gestational age of 36.9 weeks (34 +4-38 +2 weeks). Eight of the cases undertook invasive prenatal diagnosis weeks after RFA. The interval between RFA to delivery and gestational ages at delivery were similar between women undertook prenatal diagnosis and those who did not ( P>0.05). Six of the 23 newborns (26%) were small for gestational age. The average birth weight of either monochorionic singleton fetus or the remained co-twin of the monochorionic diamniotic (MCDA) twin as lower than that of singleton pregnancy ( P<0.001). One case of DCTA (8.3%) underwent intrauterine fetal death of the MCDA co-twin 4 h after RFA. Fetal tachycardia and cessation of fetal movement of the co-twin were observed before death. By the time of delivery, placental examination revealed the pale anemia look of the placental part of the co-twin and the reddish appearance of the part of the reduced fetus, which suggested a hypovolemic shock after an uncompleted RFA as the cause of co-twin death. A total of 10 MCDA placentas from cases with a living MCDA co-twins were collected. Various degree of placental perfusion on the reduced fetal side of placenta was noticed in nine cases. The co-twin with the placenta which did not have such kind of perfusion had a birth weight at the lowest percentile. Conclusion:Selective feticide by RFA is a safe procedure for DCTA triplet, and prenatal diagnosis has no adverse impact on pregnancy outcome. Ultrasound monitoring of fetal heart rate and fetal movement of the MCDA co-twin after RFA is helpful for predicting clinical outcome. Postnatal placental examination provides clues for adverse outcome, and the growth potential of the MCDA co-twin might be related to the type of anastomosis between the two fetuses.

Objective:To investigate the safety of selective feticide by radiofrequency ablation (RFA) in dichorionic triamniotic (DCTA) triplets and factors related to the clinical outcome.Methods:A retrospective cohort study was designed to review the clinical records and pregnancy outcome of DCTA triplets patients who underwent RFA for selective feticide performed at the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital from January 1,2016 to January 1,2020. Placentas were collected after delivery for gross examination and perfusion study with the mixture of vinylidene chloride and self-curing denture acrylic.Results:A total of 12 DCTA cases were recruited. Selective feticide by RFA were performed at a mean gestational age of 15.6 weeks, and cases delivered at a mean gestational age of 36.9 weeks (34 +4-38 +2 weeks). Eight of the cases undertook invasive prenatal diagnosis weeks after RFA. The interval between RFA to delivery and gestational ages at delivery were similar between women undertook prenatal diagnosis and those who did not ( P>0.05). Six of the 23 newborns (26%) were small for gestational age. The average birth weight of either monochorionic singleton fetus or the remained co-twin of the monochorionic diamniotic (MCDA) twin as lower than that of singleton pregnancy ( P<0.001). One case of DCTA (8.3%) underwent intrauterine fetal death of the MCDA co-twin 4 h after RFA. Fetal tachycardia and cessation of fetal movement of the co-twin were observed before death. By the time of delivery, placental examination revealed the pale anemia look of the placental part of the co-twin and the reddish appearance of the part of the reduced fetus, which suggested a hypovolemic shock after an uncompleted RFA as the cause of co-twin death. A total of 10 MCDA placentas from cases with a living MCDA co-twins were collected. Various degree of placental perfusion on the reduced fetal side of placenta was noticed in nine cases. The co-twin with the placenta which did not have such kind of perfusion had a birth weight at the lowest percentile. Conclusion:Selective feticide by RFA is a safe procedure for DCTA triplet, and prenatal diagnosis has no adverse impact on pregnancy outcome. Ultrasound monitoring of fetal heart rate and fetal movement of the MCDA co-twin after RFA is helpful for predicting clinical outcome. Postnatal placental examination provides clues for adverse outcome, and the growth potential of the MCDA co-twin might be related to the type of anastomosis between the two fetuses.