Contribution for new genetic markers of rheumatoid arthritis activity and severity: sequencing of the tumor necrosis factor-alpha gene promoter

The objective of this study was to assess whether clinical measures of rheumatoid arthritis activity and severity were influenced by tumor necrosis factor-alpha (TNF-alpha) promoter genotype/haplotype markers. Each patient's disease activity was assessed by the disease activity score using 28 joint counts (DAS28) and functional capacity by the Health Assessment Questionnaire (HAQ) score. Systemic manifestations, radiological damage evaluated by the Sharp/van der Heijde (SvdH) score, disease-modifying anti-rheumatic drug use, joint surgeries, and work disability were also assessed. The promoter region of the TNF-alpha gene, between nucleotides -1,318 and +49, was sequenced using an automated platform. Five hundred fifty-four patients were evaluated and genotyped for 10 single-nucleotide polymorphism (SNP) markers, but 5 of these markers were excluded due to failure to fall within Hardy-Weinberg equilibrium or to monomorphism. Patients with more than 10 years of disease duration (DD) presented significant associations between the -857 SNP and systemic manifestations, as well as joint surgeries. Associations were also found between the -308 SNP and work disability in patients with more than 2 years of DD and radiological damage in patients with less than 10 years of DD. A borderline effect was found between the -238 SNP and HAQ score and radiological damage in patients with 2 to 10 years of DD. An association was also found between haplotypes and the SvdH score for those with more than 10 years of DD. An association was found between some TNF-alpha promoter SNPs and systemic manifestations, radiological progression, HAQ score, work disability, and joint surgeries, particularly in some classes of DD and between haplotypes and radiological progression for those with more than 10 years of DD.     

Assessment of care of children with sickle cell disease: implications for neonatal screening programmes.

OBJECTIVE--To assess the quality of care provided by hospitals for young children with sickle cell disease. DESIGN--Retrospective survey. SETTING--Teaching hospital in London. PATIENTS--31 Children (mean age 4 years 4 months, range 4 months to 7 years 5 months) born with sickle cell disease between 1978 and 1985 identified from Hospital Activity Analysis data, an outpatient diagnostic register, and registers of the haematology department. Eight had been diagnosed on neonatal screening and at least four of these had not been followed up. MAIN OUTCOME MEASURES--Aspects of quality of outpatient care (blood testing, clinic attendance, and prophylactic drug treatment) and family care (adequate support and carers'' knowledge about the disease) as assessed by reviewing the notes and administering a semistructured questionnaire to the carers, in relation to a devised list of standards deemed necessary to ensure achievement of the aims of screening. RESULTS--There were 93 outpatient attendances during the previous 12 months, but 13 children had not attended at least every six months and four not at all for more than a year. Only eight children had had three of the blood tests considered to be necessary for good care; three had had none. Prophylactic treatment with penicillin and folic acid was erratic; three children with sickle cell anaemia were not receiving regular prophylactic penicillin. IMPLICATION--Diagnosis of sickle cell disease on neonatal screening must be linked with follow up to ensure optimal management.     

Physical condition,longevity, and social performance of Dutch haemophiliacs, 1972-85.

A study was carried out among haemophiliacs in The Netherlands to evaluate the effect of modern substitution treatment (replacing the missing clotting factors) on medical and social performance. Three questionnaires were sent between 1972 and 1985. The use of prophylactic treatment in the group of patients with severe and moderately severe haemophilia increased from 21% (n = 242) in 1972 to 36% (n = 559) in 1985. Home treatment programmes increased from 4% to 53%. Overall mortality was 2.1 times higher than in the general male population, which leads to a calculated life expectancy of 66 years compared with 74 years in the general male population. Severe joint impairment was prominent in the older age groups, reflecting insufficient treatment in the past. A sharp decrease in the use of inpatient and outpatient hospital facilities was observed as well as much less absence from school and work. It is concluded that the high costs of modern substitution treatment are fully justified.     

Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study.

In a multicentre study of sepsis after total hip or knee replacement the operations performed by each surgeon were allocated at random between control and ultraclean-air operating rooms. Records were obtained from over 8000 such operations. In the patients whose prostheses were inserted in an operating room ventilated by an ultraclean-air system the incidence of joint sepsis confirmed at reoperation within the next one to four years was about half that of patients who had had the operation in a conventionally ventilated room at the same hospital. When whole-body exhaust-ventilated suits had been worn by the operating team in a theatre ventilated by an ultraclean-air system the incidence of sepsis was about a quarter of that found after operations performed with conventional ventilation. When all groups in the trial were considered together the analysis showed deep sepsis after 63 out of 4133 operations in the control group (1.5%) and after 23 out of 3922 operations in the ultraclean-air groups (0.6%) (ratio 2.6, 95% confidence limits 1.6-4.2; p less than 0.001). The design of the study did not include a strictly controlled test of the effect of prophylactic antibiotics, but their use was associated with a lower incidence of sepsis than in patients who had received no antibiotic prophylaxis at their operations (0.6% (34/5831) v 2.3% (52/2221); ratio 4.0).     

Association of male pattern baldness with angiographic coronary artery disease severity and collateral development

Objective

We aimed to investigate whether there is an association between male pattern baldness and angiographic coronary artery disease (CAD) severity and collateral development, which has not been reported previously.

Methods

Coronary arteriograms, CAD risk factors, lipid parameters and presence and severity of baldness in 511 male patients were prospectively evaluated. Baldness was classified into five groups. Severity of CAD was evaluated with the Gensini scoring system and collateral development with Rentrop scores.

Results

Although subjects with a higher Gensini score had more frequent and severe baldness, they were older than the group with lower Gensini scores. Bald patients had a higher Gensini score when compared with their non-bald counterparts. In univariate analysis, age more than 60, body mass index more than 30, smoking and baldness were predictors of high Gensini scores. In multivariate analysis, only age more than 60, body mass index more than 30 and smoking were independent predictors of a high Gensini score. There were no differences in terms of presence and severity of baldness in subjects with and without adequate collateral development.

Conclusions

There was no relation between presence, severity and age of occurrence of male pattern baldness and Gensini and Rentrop scores, which are important measures of presence and severity of CAD.     

Evaluation of a course for general practitioners on muscles and joints.

We attempted to evaluate a course on muscle and joint problems for general practitioners using a practice log diary and a factual test paper, which were completed both before and after the course by the doctors attending. A significant improvement was shown in the group score in the test paper taken after the course (p less than 0.001). Scores in the tests before and after had a negative correlation with age (p less than 0.001). In comparing the data in the second log diary with those in the first there was a significant reduction in the prescribing of drugs (p less than 0.001), use of heat treatment (p less than 0.001), and in "other" forms of treatment (p less than 0.01). No appreciable change in investigations or number of hospital referrals was shown. Those doctors who had low scores in the first factual test referred appreciably more patients to hospital and requested more x ray examinations (p less than 0.01).     

Symptomatic epilepsy associated with intracranial calcifications in children with acute lymphoblastic leukemia (ALL)

Acute and long-term sequels of central nervous system (CNS) prophylaxis with irradiation and intrathecal chemotherapy in children suffering from acute lymphoblastic leukemia (ALL) include vasculopathies, leucoencephalopathies, intracranial calcifications, intellectual and neurological impairment. We report two children at the age 5 and 8 years who manifested partial motor or complex seizures and intracranial calcifications 2-4 years after the diagnosis of ALL had been established. The occurrence of these disorders was much earlier than reported in the literature. Both children received prophylactic CNS treatment with irradiation and intrathecal methotrexate (MTX). Their brain CT scans and EEG had been normal before the first epileptic seizure was registered. Children are now seizure free on carbamazepine, and a boy with complex partial and myoclonic seizures is also on valproate and vigabatrine. Symptomatic epilepsy associated with intracranial calcifications and persisting EEG changes might occur as side effects of ALL treatment.     

针刺加艾灸结合疗法对类风湿性关节炎的近远期疗效

目的:探讨针刺加艾灸配合治疗类风湿关节炎的近远期疗效。方法:选择我院2013年4月~2014年1月门诊病房治疗的74例类风湿关节炎患者为研究对象,以随机数字表法分组,观察组37例,对照组37例,对照组实施西医疗法治疗,观察组在对照组基础上采取针刺配合艾灸治疗,对两组患者治疗后效果进行分析。结果:观察组治疗后1个月有效率为89.19%,对照组为70.27%,差异显著(P0.05);治疗后1年疗效显示,对照组有效率为59.46%,观察组94.59%,两组差异存在统计学意义(P0.05);治疗前两组患者晨僵时间、关节压痛指数、关节肿胀指数、关节功能评分、握力等指标水平无明显差异,治疗后两组患者均有变化,观察组治疗后以上指标水平明显优于对照组,两组差异有统计学意义(P0.05);治疗前血沉(ESR)、C-反应蛋白(CRP)与类风湿因子(RF)指标无明显差异,治疗后均有改善,但是观察组治疗后各项指标水平明显低于对照组,差异有统计学意义(P0.05);对照组治疗后不良反应发生率为16.22%,观察组为2.70%,两组差异有统计学意义(P0.05)。结论:艾灸配合针刺治疗类风湿关节炎可取得较好近远期疗效,提高了患者关节功能及握力,有效缓解晨僵、关节疼痛、肿胀等症状。     

Antibiotic treatment and post-handling survival of reindeer calves in Alaska

Free ranging reindeer (Rangifer tarandus tarandus) are driven into corral systems and handled each summer on the Seward Peninsula (Alaska, USA). During June and July of 1995-96 reindeer calves were inspected for injury, handled, weighed, and randomly treated with long-acting oxytetracycline. Calves that returned to subsequent handlings within the same year, received treatment only if they had been treated during their first handling. The effects of prophylactic antibiotic treatment and other factors, including weight, handling related injury, and sex on post-handling survival in reindeer calves were evaluated. Return rates of yearlings in 1996 and 1997 were analyzed using logistic regression. Weight change of calves between handlings was examined using a general linear model. Calf weight and handling injury were the only factors that significantly affected calf survival. No factor had a significant effect on calf weight change between handlings. Apparently, long-acting oxytetracycline was not an effective prophylactic treatment for this capture operation. The benefits of prophylactic antibiotic treatment have not been quantified and further studies of the effects and efficacy of prophylactic treatments are recommended. Ineffective treatments should be avoided because they may add additional stress to the captured animal. Managers should evaluate the potential effectiveness of a prophylactic treatment before indiscriminately applying one. Preventing calf injuries was the most effective method of reducing post-handling mortality in this study and should be given a high priority in the design of capture operations.     

改良拔河针法对膝关节骨性关节炎患者远期关节功能和生活质量的影响

摘要 目的：探讨改良拔河针法对膝关节骨性关节炎患者远期关节功能和生活质量的影响，以期为膝关节骨性关节炎患者的治疗提供更加合理方案。方法：选取2016年3月至2019年10月深圳市中西医结合医院收治的60例膝关节骨性关节炎患者为研究对象。采用系统随机化法分为常规针刺组、改良拔河针法组各30例。常规针刺组采用常规针刺治疗，改良拔河针法组采用改良拔河针法治疗。分别于疗程结束时比较两组临床有效率，于治疗前、治疗后及治疗后3个月比较两组患者疼痛评级指数（PRI）评分、Oswestry功能障碍指数问卷表（ODI）评分及简明健康状况调查量表（SF-36）评分。结果：改良拔河针法组临床有效率86.67%，略高于常规针刺组的80.00%，但组间比较差异无统计学意义（P＞0.05）。组内比较显示，两组患者治疗后、治疗后3个月的PRI评分、ODI评分及SF-36评分较治疗前均降低（P＜0.05），且治疗后3个月的PRI评分、ODI评分及SF-36评分低于治疗后（P＜0.05）。组间比较显示，两组患者治疗前、治疗后PRI评分、ODI评分及SF-36评分比较差异均无统计学意义（P＞0.05），但改良拔河针法组治疗后3个月的ODI评分及SF-36评分优于常规针刺组（P＜0.05）。结论：改良拔河针法治疗膝关节骨性关节炎患者可获得普通针刺法相当的临床效果，且在改善患者远期关节功能和生活质量方面效果更佳，值得临床推广应用。     

微波射频保肢术及截肢术治疗胫骨远端骨肉瘤的临床疗效比较

目的:探讨和比较截肢术和微波射频保肢术治疗胫骨远端骨肉瘤的临床效果和安全性。方法:选择2000年-2013年我院收治的明确诊断为胫骨远端骨肉瘤的患者79例,其中27例给予截肢治疗(截肢组),52例给予微波射频保肢和重建治疗(保守治疗组)。评价和比较两组患者的生存情况、局部复发情况、MSTS关节功能评分及并发症的发生情况。结果:两组患者的生存曲线、局部复发率和并发症的发生率比较均无统计学差异(P0.05),但保守治疗组的MSTS关节功能评分显著高于截肢组,差异有统计学意义(P0.05)。结论:微波射频保肢术治疗胫骨远端骨肉瘤患者不会降低患者的生存几率,且在改善患者的关节功能方面有明显的优势。     

老年膝关节骨性关节炎保守治疗与置换术的疗效对比分析

目的：比较老年膝关节骨性关节炎予以保守治疗以及外科膝关节置换手术的治疗效果,以探讨其合理的干预方法。方法：选 取我院2009 年1 月-2013 年12 月间收治的50 例临床资料完整的老年膝关节骨性关节炎疾病患者,将其根据治疗方式的不同分 为保守治疗组17 例以及外科手术治疗组33 例,手术方法为膝关节置换术。比较术后的KSS 评分情况,HSS评分、膝关节优良率。 结果：治疗后手术治疗组患者的KSS 评分较治疗前明显改善,P<0.05。治疗后外科手术组患者的HSS 各项评分均明显优于保守治 疗组,治疗后手术组患者的膝关节功能优良率达到了100 %（33/33）,明显优于保守治疗组35.29 %（6/17）的优良率,组间比较有统 计学差异,P<0.05。结论：对于老年膝关节骨性关节炎进行保守治疗可能不会对疾病的进展起到干预作用,而明确诊断的患者行全 膝关节置换术可以有效改善膝关节功能,提高生活质量。     

关节镜下应用带跟骨异体跟腱一期联合治疗膝关节脱位合并不稳定

目的：探讨关节镜下应用带跟骨异体跟腱一期联合重建治疗膝关节脱位合并不稳定的治疗效果。方法：2008年1月至2010年1月,我们于关节镜下应用带跟骨异体跟腱一期联合重建治疗膝关节脱位合并不稳定患者11例,男9例,女2例;年龄17～45岁,平均22.3岁;右膝6例,左膝5例。患者在排除手术禁忌后,分别在关节镜下采用带跟骨异体跟腱一期联合重建后交叉韧带（PCL）、内侧副韧带（MCL）、前交叉韧带（ACL）和外侧副韧带（LCL）。结果：术后所有切口均于2周后I期愈合。10例获得随访,随访时间24～36个月,平均30个月。术后24个月,Lysholm评分由术前的42.2±3.5,升至84.5±6.2分,其中A级9例,B级1例,C级0例;国际膝关节文献委员会（IKDC）评分有术前的41.7±6.5分,升至82.3±10.3分。术前与术后Lysholm评分及IKDC评分有显著差别（P〈0.05）。术后膝关节活动范围,与术前相比具有显著性差异（P〈0.05）。结论：关节镜下应用带跟骨异体跟腱一期联合重建治疗膝关节脱位能够较好的恢复患者膝关节稳定和活动范围,具有令人满意的临床效果。     

A Systematic Review and Meta-Analysis of Antibiotic-Impregnated Bone Cement Use in Primary Total Hip or Knee Arthroplasty

Background

Antibiotic-impregnated bone cement (AIBC) has been widely used for the treatment of infected revision arthroplasty, but its routine use in primary total joint arthroplasty (TJA) remains considerably controversial. With this meta-analysis of published randomized controlled trials, we intended to assess the antimicrobial efficacy and safety of AIBC for its prophylactic use in primary TJA.

Methods

A literature search was performed in MEDLINE, Embase, CBMdisc and the Cochrane Library until June, 2013. The studies were divided into two sub-groups according to the type of the control group. Outcomes of interest included postoperative infection rates, radiographic outcomes and clinical joint score. Study quality was evaluated using the Jadad scale (five points).

Results

In total, eight studies were included, with a sample size of 6,381 arthroplasties. The overall pooled data demonstrated that, compared with the control (plain cement or systemic antibiotic), AIBC did not reveal an advantage in decreasing the rate of superficial infection (relative risk [RR] = 1.47; 95% CI, 1.13–1.91; P=0.004), while there were significant differences in deep infection rate between the AIBC and control group (RR = 0.41; 95% CI, 0.17–0.97; P=0.04). For the analysis of gentamicin and cefuroxime subgroups, the gentamicin was superior to the cefuroxime in reducing deep infection rate (P=0.0005 versus P= 0.10). However, no significant differences were found in their radiographic outcomes and clinical joint score.

Conclusion

This meta-analysis had proven that the prophylactic use of AIBC could lower the deep infection rate in primary TJA, while AIBC did not show an improvement in reducing the superficial infection rate compared with the control. More sufficiently powered studies would be required to further evaluate the efficacy and safety of AIBC for primary TJA.     

血液透析联合血液灌流及依达拉奉对尿毒症RLS患者外周血清中毒素水平、临床症状及睡眠质量的影响

摘要 目的：探讨高通量血液透析（HFD）联合血液灌流（HP）及依达拉奉对尿毒症不宁腿综合征（RLS）患者外周血清中毒素水平、临床症状、睡眠质量、负性情绪的影响。方法：选择2018年2月至2019年12月我院肾内科收治的174例尿毒症RLS患者,采用随机数字表法将患者分为三组。常规血液透析（HD）组（58例）采用常规血液透析治疗,联合A组（58例）采用HFD联合HP治疗,联合B组（58例）采用HFD联合HP及依达拉奉治疗。观察三组治疗前后肾功能[尿素氮（BUN）、血肌酐（SCr）、尿白蛋白排泄率（UAER）]、血清毒素[甲状旁腺激素（PTH）、硫酸吲哚酚（IS）、硫酸对甲酚（PCS）]水平、RLS评分、睡眠质量、负性情绪以及不良反应的差异。结果：三组治疗后血清BUN、SCr、UAER、PTH、IS、PCS水平、RLS评分、匹兹堡睡眠质量指数（PSQI）评分、汉密尔顿焦虑量表（HAMA)评分、汉密尔顿抑郁量表（HAMD）评分均有所下降（P＜0.05）。联合B组、联合A组治疗后血清BUN、SCr、UAER、PTH、IS、PCS水平低于HD组（P＜0.05）,联合B组、联合A组上述指标比较无统计学差异（P＞0.05）。联合B组治疗后RLS评分、PSQI评分、HAMA评分、HAMD评分均低于联合A组和HD组（P＜0.05）,联合A组低于HD组（P＜0.05）。三组治疗期间不良反应发生率比较无统计学差异（P＞0.05）。结论：HFD联合HP及依达拉奉可改善尿毒症RLS患者的临床症状和肾功能,可降低血清毒素水平,并改善睡眠质量和负性情绪。     

Colchicine Use for Familial Mediterranean Fever—Observations Associated With Long-term Treatment

Of 85 patients with familial Mediterranean fever receiving continuous prophylactic colchicine therapy, 62 (73 percent) have had a significant reduction in the severity and frequency of their attacks. All 62 have been observed for three years or more, for a total of 4,680 patient-months and a mean duration of 75.5 months. Of the 85 patients, 23 (27 percent) did not complete three years of treatment for a variety of reasons. Diarrhea was the most common side effect, necessitating reduction of colchicine dosage in 12 patients, but discontinuation of treatment in only one. No other significant side effects were observed. Continuous, prophylactic colchicine therapy is effective in preventing the recurrent febrile paroxysms of familial Mediterranean fever and is indicated in those patients who are incapacitated by frequent attacks or who are at risk for amyloidosis developing.     

Childhood antecedents of schizophrenia and affective illness: social adjustment at ages 7 and 11.

OBJECTIVE--To investigate the social adjustment in childhood of people who as adults have psychiatric disorders. DESIGN--Subjects in a prospectively followed up cohort (the national child development study) who had been admitted as adults to psychiatric hospitals were compared with the rest of the cohort on ratings of social behaviour made by teachers at the ages of 7 and 11 years. SUBJECTS--40 adult patients with schizophrenic illnesses, 35 with affective psychoses, and 79 with neurotic illness who had been admitted for psychiatric reasons by the age of 28. 1914 randomly selected members of the cohort who had never been admitted for psychiatric treatment. MAIN OUTCOME MEASURES--Overall scores and scores for overreaction (externalising behaviour) and underreaction (internalising behaviour) with the Bristol social adjustment guide at ages 7 and 11. RESULTS--At the age of 7 children who developed schizophrenia were rated by their teachers as manifesting more social maladjustment than controls (overall score 4.3 (SD 2.4) v 3.1 (2.0); P < 0.01). This was more apparent in the boys (5 (2.6)) than the girls (3.4 (1.8)) and related to overreactive rather than underreactive behaviour. At both ages prepsychotic (affective) children differed little from normal controls. By the age of 11 preneurotic children, particularly the girls, had an increased rating of maladjustment (including overreactions and underreactions). CONCLUSION--Abnormalities of social adjustment are detectable in childhood in some people who develop psychotic illness. Sex and the rate of development of different components of the capacity for social interaction are important determinants of the risk of psychosis and other psychiatric disorders in adulthood.     

The Association between Quality of HIV Care,Loss to Follow-Up and Mortality in Pediatric and Adolescent Patients Receiving Antiretroviral Therapy in Nigeria

Access to pediatric HIV treatment in resource-limited settings has risen significantly. However, little is known about the quality of care that pediatric or adolescent patients receive. The objective of this study is to explore quality of HIV care and treatment in Nigeria and to determine the association between quality of care, loss-to-follow-up and mortality. A retrospective cohort study was conducted including patients ≤18 years of age who initiated ART between November 2002 and December 2011 at 23 sites across 10 states. 1,516 patients were included. A quality score comprised of 6 process indicators was calculated for each patient. More than half of patients (55.5%) were found to have a high quality score, using the median score as the cut-off. Most patients were screened for tuberculosis at entry into care (81.3%), had adherence measurement and counseling at their last visit (88.7% and 89.7% respectively), and were prescribed co-trimoxazole at some point during enrollment in care (98.8%). Thirty-seven percent received a CD4 count in the six months prior to chart review. Mortality within 90 days of ART initiation was 1.9%. A total of 4.2% of patients died during the period of follow-up (mean: 27 months) with 19.0% lost to follow-up. In multivariate regression analyses, weight for age z-score (Adjusted Hazard Ratio (AHR): 0.90; 95% CI: 0.85, 0.95) and high quality indicator score (compared a low score, AHR: 0.43; 95% CI: 0.26, 0.73) had a protective effect on mortality. Patients with a high quality score were less likely to be lost to follow-up (Adjusted Odds Ratio (AOR): 0.42; 95% CI: 0.32, 0.56), compared to those with low score. These findings indicate that providing high quality care to children and adolescents living with HIV is important to improve outcomes, including lowering loss to follow-up and decreasing mortality in this age group.     

经皮穴位电刺激联合下肢康复机器人在膝关节前交叉韧带损伤重建术后康复中的应用效果分析

摘要 目的：探讨经皮穴位电刺激联合下肢康复机器人在膝关节前交叉韧带损伤重建术后康复中的应用效果。方法：选取我院2019年1月到2022年12月收治的120例采取膝关节前交叉韧带损伤重建术的患者作为研究对象,分为观察组与对照组,每组60例。对照组采取常规术后康复治疗,观察组采取经皮穴位电刺激联合下肢康复机器人康复治疗,对比两组患者康复治疗效果,位置觉和运动觉,疼痛情况与肿胀情况,膝关节功能以及生活质量。结果：观察组治疗总有效率高于对照组（P＜0.05）;治疗前两组患者患肢肿胀值、视觉模拟量表（VAS）评分对比无差异（P＞0.05）,治疗后均降低,且观察组较对照组低（P＜0.05）;两组患者的治疗前膝关节75度、45度、15度位置觉,伸膝、屈膝运动觉对比无差异（P>0.05）,治疗后两组患者膝关节75度、45度、15度位置觉,伸膝、屈膝运动觉均下降,且观察组较对照组低（P＜0.05）;治疗前两组患者膝关节主观（IKDC）评分、膝关节功能（Lysholm）评分对比无差异（P＞0.05）,治疗后均降低,且观察组较对照组低（P＜0.05）;两组患者治疗前生活质量相关评分对比无差异（P＜0.05）,治疗后均升高,且观察组较对照组高（P＜0.05）。结论：经皮穴位电刺激联合下肢康复机器人在膝关节前交叉韧带损伤重建术后康复中应用效果显著,能够改善患者膝关节位置觉和运动觉,减轻远期疼痛情况与肿胀情况,提升膝关节功能,患者生活质量较好。     

Hyaluronan injection affects neither osteoarthritis progression nor loading of the OA knee in dogs

We previously reported that intraarticular injections of hyaluronan (HA), administered prophylactically to dogs in whom knee osteoarthritis had been induced by transection of the anterior cruicate ligament, did not significantly modify the intraarticular pathology but decreased the proteogylcan concentration of the articular cartilage by as much as 30%. Because the cartilage proteoglycan concentration is directly related to the stiffness of the tissue, these results raised the possibility that intraarticular HA therapy could exacerbate OA. In the present study, using a different HA formulation, with a longer interval between intraarticular HA injection and examination of joint tissues, we found that neither prophylactic nor therapeutic administration of HA had an effect on the severity of OA pathology, the magnitude of vertical ground reaction forces generated by the unstable hind limb (a surrogate for joint pain), or the cartilage proteoglycan concentration. The data suggest that the suppression of proteoglycan synthesis induced by HA is temporary and fully reversible and that HA injections do not result in overloading of the OA extremity. A significant correlation was noted between the severity of chondropathy and the magnitude of the vertical ground reaction forces generated by the unstable limb.