Traditional Chinese medicine for knee osteoarthritis: An overview of systematic review

Epimedin C alleviated osteoarthritis development by regulating chondrocyte Nrf2-mediated NLRP3 inflammasome axis

Osteoarthritis (OA) is a prevalent musculoskeletal disorder globally. This study explored the therapeutic potential of Epimedin C (Epi C) in OA and its mechanisms. We isolated primary chondrocytes from mice and induced inflammatory damage using interleukin-1β (IL-1β) to evaluate Epi C's capacity to preserve cell viability and inhibit apoptosis, employing cell counting kit (CCK8) assays, EdU staining, and flow cytometry. Additionally, its anti-inflammatory effects were quantified using enzyme-linked immunosorbent assay (ELISA), Western blot, and real-time fluorescence quantitative polymerase chain reaction (RT-qPCR), alongside assessments of extracellular matrix (ECM) degradation. In vivo, OA was induced in mice through destabilization of the medial meniscus (DMM), followed by Epi C administration. Cartilage integrity was evaluated via micro-computed tomography (CT) and histology. Nuclear factor erythroid 2-related factor 2 (Nrf2) pathway involvement was investigated through siRNA knockdown and oxidative stress markers, while NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome expression was measured to establish Epi C's modulatory effect. Our study revealed that Epi C protected against IL-1β-induced chondrocyte damage by enhancing cell viability, reducing apoptosis, and dampening inflammatory responses. The in vivo studies demonstrated Epi C's role in preserving cartilage structure, activating nuclear factor erythroid 2-related factor 2 (Nrf2), and inhibiting NLRP3 expression in DMM-induced OA mice. Conclusively, our findings provide substantial evidence of Epi C's therapeutic efficacy in OA, primarily through its modulation of the Nrf2-mediated NLRP3 inflammasome pathway, offering novel insights into its management role in OA.

Bushen Huoxue decotion-containing serum prevents chondrocyte pyroptosis in a m6A-dependent manner in facet joint osteoarthritis

BACKGROUND

Facet joint osteoarthritis (FJOA) is a common lumbar osteoarthritis characterized by degeneration of small joint cartilage. Bushen Huoxue decotion (BSHXD) has good therapeutic effects on OA. Our work aimed to further probe the pharmacological effects of BSHXD-containing serum (BSHXD-CS) on FJOA and define underlying the mechanisms invovled.

METHODS

To establish a FJOA cell model, primary rat chondrocytes were treated with LPS. The mRNA and protein expressions were assessed using qRT-PCR and western blot, respectively. The secretion levels of pro-inflammatory cytokines were measured by ELISA. Cell viability was determined by CCK8 assay. The global m6A level was detected by the kit, and NLRP3 mRNA m6A level was determined by Me-RIP assay. The molecular interactions were analyzed by RIP and RNA pull-down assays.

RESULTS

BSHXD-CS treatment relieved LPS-induced cell injury, inflammation, NLRP3 inflammasome and pyroptosis in chondrocytes (all p < 0.05). LPS-induced NLRP3 upregulation in chondrocytes was related to its high m6A modification level (p < 0.05). It was also observed that BSHXD-CS reduced LPS-induced m6A modification in chondrocytes via repressing STAT3 (all p < 0.05), suggesting BSHXD-CS could repress NLRP3 expression via m6A-dependent manner. Moreover, DAA, a m6A specific inhibitor, was proved to strengthen the protectively roles of BSHXD-CS on LPS-challenged pytoptosis (all p < 0.05).

CONCLUSION

BSHXD-CS inhibited NLRP3 inflammasome activation and pyroptosis in chondrocytes to repress OA progression by reducing RNA m6A modification.

Gubi decoction mitigates knee osteoarthritis via promoting chondrocyte autophagy through METTL3-mediated ATG7 m6A methylation

Knee osteoarthritis (KOA) is a chronic joint disease that significantly affects the health of the elderly. As an herbal remedy, Gubi decoction (GBD) has been traditionally used for the treatment of osteoarthritis-related syndromes. However, the anti-KOA efficacy and mechanism of GBD remain unclear. This study aimed to experimentally investigate the anti-KOA efficacy and the underlying mechanism of GBD. The medial meniscus (DMM) mice model and IL-1β-stimulated chondrocytes were, respectively, constructed as in vivo and in vitro models of KOA to evaluate the osteoprotective effect and molecular mechanism of GBD. The UPLC-MS/MS analysis showed that GBD mainly contained pinoresinol diglucoside, rehmannioside D, hesperidin, liquiritin, baohuoside I, glycyrrhizic acid, kaempferol and tangeretin. Animal experiment showed that GBD could alleviate articular cartilage destruction and recover histopathological alterations in DMM mice. In addition, GBD inhibited chondrocyte apoptosis and restored DMM-induced dysregulated autophagy evidenced by the upregulation of ATG7 and LC3 II/LC3 I but decreased P62 level. Mechanistically, METTL3-mediated m6A modification decreased the expression of ATG7 in DMM mice, as it could be significantly attenuated by GBD. METTL3 overexpression significantly counteracted the protective effect of GBD on chondrocyte autophagy. Further research showed that GBD promoted proteasome-mediated ubiquitination degradation of METLL3. Our findings suggest that GBD could act as a protective agent against KOA. The protective effect of GBD may result from its promotion on chondrocyte autophagy by suppressing METTL3-dependent ATG7 m6A methylation.

Mechanism of drug-pairs Astragalus Mongholicus-Largehead Atractylodes on treating knee osteoarthritis investigated by GEO gene chip with network pharmacology and molecular docking

Investigations into the therapeutic potential of Astragalus Mongholicus (AM, huáng qí) and Largehead Atractylodes (LA, bái zhú) reveal significant efficacy in mitigating the onset and progression of knee osteoarthritis (KOA), albeit with an elusive mechanistic understanding. This study delineates the primary bioactive constituents and their molecular targets within the AM-LA synergy by harnessing the comprehensive Traditional Chinese Medicine (TCM) network databases, including TCMSP, TCMID, and ETCM. Furthermore, an analysis of 3 gene expression datasets, sourced from the gene expression omnibus database, facilitated the identification of differential genes associated with KOA. Integrating these findings with data from 5 predominant databases yielded a refined list of KOA-associated targets, which were subsequently aligned with the gene signatures corresponding to AM and LA treatment. Through this alignment, specific molecular targets pertinent to the AM-LA therapeutic axis were elucidated. The construction of a protein-protein interaction network, leveraging the shared genetic markers between KOA pathology and AM-LA intervention, enabled the identification of pivotal molecular targets via the topological analysis facilitated by CytoNCA plugins. Subsequent GO and KEGG enrichment analyses fostered the development of a holistic herbal-ingredient-target network and a core target-signal pathway network. Molecular docking techniques were employed to validate the interaction between 5 central molecular targets and their corresponding active compounds within the AM-LA complex. Our findings suggest that the AM-LA combination modulates key biological processes, including cellular activity, reactive oxygen species modification, metabolic regulation, and the activation of systemic immunity. By either augmenting or attenuating crucial signaling pathways, such as MAPK, calcium, and PI3K/AKT pathways, the AM-LA dyad orchestrates a comprehensive regulatory effect on immune-inflammatory responses, cellular proliferation, differentiation, apoptosis, and antioxidant defenses, offering a novel therapeutic avenue for KOA management. This study, underpinned by gene expression omnibus gene chip analyses and network pharmacology, advances our understanding of the molecular underpinnings governing the inhibitory effects of AM and LA on KOA progression, laying the groundwork for future explorations into the active components and mechanistic pathways of TCM in KOA treatment.

Therapeutic Potential of Ginsenosides on Bone Metabolism: A Review of Osteoporosis, Periodontal Disease and Osteoarthritis

Ginsenosides, bioactive compounds from the genus Panax, have potential therapeutic effects on diverse ailments, including diabetes. Emerging evidence suggests their involvement in bone metabolism. The present review summarizes the current understanding of the effects of ginsenosides on osteoporosis, periodontal disease, and osteoarthritis. Their mechanisms of action include effects on osteoblasts, osteoclasts, periodontal ligament fibroblasts (PDLFs), and chondrocytes, which are pivotal in maintaining bone, periodontal tissue, and cartilage homeostasis. Ginsenosides may exert their beneficial effects by enhancing PDLF and osteoblast activity, suppressing osteoclast function, augmenting chondrocyte synthesis in the cartilage matrix, and mitigating connective tissue degradation. Moreover, they possess antioxidant, anti-inflammatory, antimicrobial, and anti-pyroptotic properties. Their efficacy in increasing bone density, ameliorating periodontitis, and alleviating osteoarthritis symptoms has been demonstrated in preclinical studies using animal models. In terms of their mechanism of action, ginsenosides modulate cellular differentiation, activity, and key signaling pathway molecules, such as mitogen-activated protein kinases (MAPKs), while also regulating various mediators. Furthermore, the symptomatic relief observed in animal models lends further credence to their therapeutic utility. However, to translate these preclinical findings into clinical practice, rigorous animal and clinical investigations are imperative to ascertain the safety, efficacy, and optimal dosing regimens in human subjects.

Heat and Acupuncture to Manage Osteoarthritis of the Knee (HARMOKnee): Protocol for an Effectiveness-Implementation Hybrid Randomized Controlled Trial

BACKGROUND

Knee osteoarthritis (KOA) is one of most prevalent and fastest-growing causes of pain, impaired mobility, and poor quality of life in the rapidly aging population worldwide. There is a lack of high-quality evidence on the efficacy of traditional Chinese medicine (TCM), particularly acupuncture, and a lack of KOA practice guidelines that are tailored to unique population demographics and tropical climates.

OBJECTIVE

Our HARMOKnee (Heat and Acupuncture to Manage Osteoarthritis of the Knee) trial aims to address these gaps by evaluating the short- and medium-term clinical and cost-effectiveness of acupuncture with heat therapy in addition to standard care, compared to standard care alone. Through a robust process and economic evaluation, we aim to inform evidence-based practice for patients with KOA to facilitate the large-scale implementation of a comprehensive and holistic model of care that harmonizes elements of Western medicine and TCM. We hypothesize that acupuncture with heat therapy as an adjunct to standard care is clinically more effective than standard care alone.

METHODS

A multicenter, pragmatic, parallel-arm, single-blinded, effectiveness-implementation hybrid randomized controlled trial will be conducted. We intend to recruit 100 patients with KOA randomized to either the control arm (standard care only) or intervention arm (acupuncture with heat therapy, in addition to standard care). The inclusion criteria are being a community ambulator and having primary KOA, excluding patients with secondary arthritis or previous knee replacements. The primary outcome measure is the Knee Osteoarthritis Outcome Score at 6 weeks. Secondary outcome measures include psychological, physical, quality of life, satisfaction, and global outcome measures at 6, 12, and 26 weeks. A mixed method approach through an embedded process evaluation will facilitate large-scale implementation. An economic evaluation will be performed to assess financial sustainability.

RESULTS

Patient enrollment has been ongoing since August 2022. The recruitment process is anticipated to conclude by July 2024, and the findings will be analyzed and publicized as they are obtained. As of November 6, 2023, our patient enrollment stands at 65 individuals.

CONCLUSIONS

The findings of our HARMOKnee study will contribute substantial evidence to the current body of literature regarding the effectiveness of acupuncture treatment for KOA. Additionally, we aim to facilitate the creation of standardized national guidelines for evidence-based practice that are specifically tailored to our unique population demographics. Furthermore, we seek to promote the adoption and integration of acupuncture and heat therapy into existing treatment models.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05507619; https://clinicaltrials.gov/study/NCT05507619.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54352.

Emerging Roles of Macrophage Polarization in Osteoarthritis: Mechanisms and Therapeutic Strategies

Osteoarthritis (OA) is the most common chronic degenerative joint disease in middle-aged and elderly people, characterized by joint pain and dysfunction. Macrophages are key players in OA pathology, and their activation state has been studied extensively. Various studies have suggested that macrophages might respond to stimuli in their microenvironment by changing their phenotypes to pro-inflammatory or anti-inflammatory phenotypes, which is called macrophage polarization. Macrophages accumulate and become polarized (M1 or M2) in many tissues, such as synovium, adipose tissue, bone marrow, and bone mesenchymal tissues in joints, while resident macrophages as well as other stromal cells, including fibroblasts, chondrocytes, and osteoblasts, form the joint and function as an integrated unit. In this study, we focus exclusively on synovial macrophages, adipose tissue macrophages, and osteoclasts, to investigate their roles in the development of OA. We review recent key findings related to macrophage polarization and OA, including pathogenesis, molecular pathways, and therapeutics. We summarize several signaling pathways in macrophage reprogramming related to OA, including NF-κB, MAPK, TGF-β, JAK/STAT, PI3K/Akt/mTOR, and NLRP3. Of note, despite the increasing availability of treatments for osteoarthritis, like intra-articular injections, surgery, and cellular therapy, the demand for more effective clinical therapies has remained steady. Therefore, we also describe the current prospective therapeutic methods that deem macrophage polarization to be a therapeutic target, including physical stimulus, chemical compounds, and biological molecules, to enhance cartilage repair and alleviate the progression of OA.

Network analysis, in vivo, and in vitro experiments identified the mechanisms by which Piper longum L. [Piperaceae] alleviates cartilage destruction, joint inflammation, and arthritic pain

Osteoarthritis (OA) is characterized by irreversible joint destruction, pain, and dysfunction. Piper longum L. [Piperaceae] (PL) is an East Asian herbal medicine with reported anti-inflammatory, analgesic, antioxidant, anti-stress, and anti-osteoporotic effects. This study aimed to evaluate the efficacy of PL in inhibiting pain and progressive joint destruction in OA based on its anti-inflammatory activity, and to explore its potential mechanisms using in vivo and in vitro models of OA. We predicted the potential hub targets and signaling pathways of PL through network analysis and molecular docking. Network analysis results showed that the possible hub targets of PL against OA were F2R, F3, MMP1, MMP2, MMP9, and PTGS2. The molecular docking results predicted strong binding affinities for the core compounds in PL: piperlongumine, piperlonguminine, and piperine. In vitro experiments showed that PL inhibited the expression of LPS-induced pro-inflammatory factors, such as F2R, F3, IL-1β, IL-6, IL-17A, MMP-1, MMP-2, MMP-3, MMP-9, MMP-13, NOS2, PTGS2, PGE2, and TNF-β. These mechanisms and effects were dose-dependent in vivo models. Furthermore, PL inhibited cartilage degradation in an OA-induced rat model. Thus, this study demonstrated that multiple components of PL may inhibit the multilayered pathology of OA by acting on multiple targets and pathways. These findings highlight the potential of PL as a disease-modifying OA drug candidate, which warrants further investigation.

Research of the analgesic effects and central nervous system impact of electroacupuncture therapy in rats with knee osteoarthritis

It aimed to observe the effects of TongDu TiaoShen (TDTS) electroacupuncture (EA) on the analgesia and central system of knee osteoarthritis (KOA) rats and explore its mechanism. SD rats were rolled into the blank group, model group (KOA), control group (duloxetine 500 mg/kg/d, Ctrl), conventional EA group, and TDTS-EA group. Radiometric pain measurements and the Lequesne MG scale were used to evaluate the behavioral performance of the rats. Dopamine (DA), norepinephrine (NE), 5-hydroxytryptamine (5-HT), β-endorphin (β-EP), and leucine-enkephalin (L-ENK) were detected in the midbrain and spinal cord of lumbar enlargement. Interleukin (IL)-1β protein expression was detected by Western blot. The incubation period of thermal pain and foot contraction was decreased in the KOA group versus blank group, the Lequesne MG score was increased, DA, NE, 5-HT, β-EP, and L-ENK in the midbrain and spinal cord were increased, and synovial tissue IL-1β protein expression was increased (P < 0.05). EA group and TDTS-EA group had an increased incubation period of thermal pain contraction, decreased Lequesne MG score, decreased DA, NE, etc. In the midbrain, increased 5-HT and NE in the spinal cord, and decreased IL-1β in the synovial tissue versus KOA group (P < 0.05). The Lequesne MG score and midbrain DA, NE, 5-HT, β-EP, and synovial tissue IL-1β expression were decreased in TDTS-EA group versus EA group (P < 0.05). EA can effectively improve the behavioral score of KOA and participate in central analgesia by regulating central DA, NE, 5-HT, β-EP, and L-ENK.

Paeoniflorin shows chondroprotective effects under IL-1β stress by regulating circ-PREX1/miR-140-3p/WNT5B axis

BACKGROUND

Osteoarthritis (OA) is a chronic and degenerative bone and joint disease, and paeoniflorin shows anti-arthritis role in OA. This study planned to investigate the mechanism related to chondroprotective role of paeoniflorin in OA.

METHODS

Real-time quantitative PCR and western blotting were performed to measure expression levels of circ-PREX1, microRNA (miR)-140-3p, Wingless-type MMTV integration site family, member 5B (WNT5B), B cell lymphoma (Bcl)-2, and Bcl-2 Associated X Protein (Bax). MTT assay, EdU assay, flow cytometry and enzyme-linked immunosorbent assay evaluated cell viability, proliferation, apoptosis and inflammatory response, respectively. Dual-luciferase reporter assay and RNA immunoprecipitation assay identified the relationship among circ-PREX1, miR-140-3p, and WNT5B.

RESULTS

IL-1β highly induced apoptosis rate, Bax expression and TNF-α product, accompanied with decreased cell viability, cell proliferation and IL-10 secretion, whereas these effects were partially reversed after paeoniflorin pretreatment. Expression of circ-PREX1 was upregulated and miR-140-3p was downregulated in cartilage tissues of patients with knee OA (KOA) and IL-1β-induced human chondrocytes (C28/I2). Circ-PREX1 overexpression and miR-140-3p silencing attenuated the suppressive effect of paeoniflorin in IL-1β-induced C28/I2 cells. Furthermore, miR-140-3p was negatively regulated by circ-PREX1. WNT5B was a downstream target of miR-140-3p and could be modulated by the circ-PREX1/miR-140-3p pathway in IL-1β-induced C28/I2 cells.

CONCLUSION

Paeoniflorin might protect human chondrocytes from IL-1β-induced inflammatory injury via circ-PREX1-miR-140-3p-WNT5B pathway, suggesting a potential preventative agent and a novel target for the treatment of KOA.

Protective effects of ginseng and ginsenosides in the development of osteoarthritis (Review)

Osteoarthritis (OA) is a chronic inflammatory joint disease. Traditional chinese medicine provides a resource for drug screening for OA treatment. Ginseng and the associated bioactive compound, ginsenosides, may reduce inflammation, which is considered a risk factor for the development of OA. Specifically, ginsenosides may exhibit anti-inflammatory and anti-oxidative stress activities, and inhibit extracellular matrix degradation by suppressing the NF-κB and MAPK signaling pathways. Notably, specific ginsenosides, such as compound K and Rk1, may physically interact with IκB kinase and inhibit the associated phosphorylation. Thus, ginsenosides exhibit potential as therapeutic candidates in the management of OA. However, the low water solubility limits the clinical applications of ginsenosides. Numerous effective strategies have been explored to improve bioavailability; however, further investigations are still required.

Stem of Sorbus commixta Hedl. Extract Inhibits Cartilage Degradation and Arthritic Pain in Experimental Model via Anti-Inflammatory Activity

Osteoarthritis (OA) is a widespread joint disease that affects millions of people worldwide. Conventional treatments for OA, including non-steroidal anti-inflammatory drugs (NSAIDs) and steroids, have a risk of various adverse events, including liver, gastrointestinal, cardiovascular, and kidney disease, which are unsatisfactory in their effectiveness. In this study, Sorbus commixta Hedl. Stem extracts (SCE) were evaluated in animal models as potential inhibitors for the progression of OA. Sorbus commixta Hedl., which was found to have substantial anti-inflammatory and antioxidant activities in earlier investigations, has shown potential as a candidate for OA treatment. To mimic human OA symptoms, male rats were injected using sodium iodoacetate (MIA) in their knee joints. SCE significantly reduced MIA-induced weight-bearing loss in rats after the MIA injection and alleviated cartilage degradation and subchondral bone injury caused by MIA. In addition, SCE administration reduced levels of TNF-α and IL-1β such as pro-inflammatory cytokines in serum, as well as the levels of matrix metalloproteinases (MMPs) such as MMP-1, -3, -8 and -13 in the joint cartilage. SCE significantly inhibited the writhing responses in acetic acid-administered mice and was used to quantify pain. In lipopolysaccharide (LPS)-activated RAW264.7, SCE suppressed NO production and reduced the expression of TNF-α, PGE2, IL-6, IL-1β, MMP1, MMP3, MMP8, and MMP-13. Our study showed that SCE alleviated inflammation and cartilage degradation in arthritis through its anti-inflammatory activities on multiple targets.

A comparison of jade moxibustion and traditional moxibustion in the treatment of knee osteoarthritis: A randomized clinical trial

BACKGROUND

This study was developed to compare the relative clinical efficacy of traditional moxibustion and Jade moxibustion in an effort to define the most effective approaches to treating knee osteoarthritis.

METHODS

In total, 94 patients were randomly assigned at a 1:1 ratio to the traditional moxibustion (TM) and Jade moxibustion (JM) groups. For JM, a jade kneepad was preheated for 3 minutes via electrification, with the jade in the kneepad being pressed onto acupoints when reaching an initial temperature of 46°C. For patients in the TM group, moxa cones were applied to acupoints for treatment. In total, 12 treatments were performed for patients in each group, with treatment being conducted 3 times per week. Study outcomes included 36-item short-form health survey and Western Ontario and McMaster Universities Osteoarthritis Index knee stiffness scores. In addition, serum levels of osteoarthritis-related cytokines were measured.

RESULTS

Overall, 89/94 patients completed this study, including 44 and 45 in the TM and JM groups, respectively. The 36-item short-form health survey physical functioning at weeks 12 and 24 (P = .033, 0.001), role-physical at weeks 4 and 24 (P = .030, 0.014), and role-emotional at week 4 (P = .045) were the only scores to differ significantly between the TM and JM groups. Western Ontario and McMaster Universities Osteoarthritis Index stiffness scores in the JM groups improved significantly relative to baseline at weeks 4, 8, 12, and 24 (all P < .01). The scores in the TM group differed significantly at all time points relative to baseline (all P < .01), with no differences between groups (all P > .05). Serum Interleukin-2 levels were lower in both groups (all P < .01). Cartilage oligomeric matrix protein and monocyte chemotactic protein-1 only differed significantly for patients treated via JM (P < .05, P < .01), with the same also being true for Interleukin-1β and Interleukin-8 in the TM group (all P < .01). No significant differences in other cytokines were observed, nor did they differ significantly between groups (all P > .05).

CONCLUSION

These results suggest that JM treatment can improve knee osteoarthritis patient quality of life, alleviating joint stiffness and restoring joint function with a level of efficacy comparable to TM.

Comparative effectiveness of moxibustion and acupuncture for the management of osteoarthritis knee: A systematic review and meta-analysis

Background

Moxibustion, a traditional Chinese medicine approach, stimulates blood circulation by burning wormwood at acupuncture points and is frequently used in conjunction with acupuncture for managing knee osteoarthritis. This review aims to compare the effectiveness of moxibustion and acupuncture in the management of knee osteoarthritis.

Methods

Our team conducted a comprehensive search across several databases: PubMed Central, EMBASE, MEDLINE, the Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and the Cochrane Library, covering the timeframe from January 1964 up until April 2022. We implemented a meta-analysis, utilizing a random-effects model, and we've presented the pooled standardized mean difference (SMD) and risk ratio (RR) inclusive of the 95% confidence intervals (CIs), in accordance with the nature of the outcome.

Results

21 studies were included, of which, half were identified as having high risk of bias. The pooled SMD for the pain score was found to be -0.53 (95% CI: -0.91 to -0.15). In-depth analysis focusing on the kind of moxibustion indicated that fire needle moxibustion was more effective in pain reduction (SMD = -0.56; 95% CI: -1.10 to -0.01) compared to alternative moxibustion methods (SMD = -0.47; 95% CI: -0.80 to -0.13). The pooled RR for the success rate in treatment was 1.39 (95% CI: 1.19 to 1.62). Subgroup analysis demonstrated that fire needle moxibustion reported a superior success rate (RR = 1.43; 95% CI: 1.19 to 1.72) in comparison to other types of moxibustion (RR = 1.33; 95% CI: 1.02 to 1.74).

Conclusion

Moxibustion, specifically fire needle moxibustion, demonstrated superior effectiveness in managing knee osteoarthritis compared to acupuncture.

Warm needle acupuncture for osteoarthritis: An overview of systematic reviews and meta-analysis

Background

Osteoarthritis (OA) is a chronic disease that is a major cause of pain and functional disability. Warm needle acupuncture (WA) therapy has been widely used to treat OA. This overview summarizes the evidence from systematic reviews (SRs) and assesses the methodological quality of previous SRs that evaluated the use of WA therapy for OA.

Methods

We searched electronic databases to identify SRs that evaluated the efficacy of WA therapy for OA. Two reviewers independently extracted data and assessed the methodological quality of the reviews according to the A Measurement Tool to Assess Systematic Reviews (AMSTAR 2) tool. The reporting quality was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 (PRISMA 2020) guidelines. The quality of evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results

Fifteen SRs were included in this study. WA therapy was more effective than control conditions for the treatment of OA. The results of the AMSTAR 2 tool showed that the methodological quality of all included studies was critically low. The items with the lowest scores were item 2 (reporting the protocol), item 7 (listing excluded studies and justifying the exclusions), and item 16 (including conflicts of interest). Regarding the PRISMA guidelines, 2 SRs exhibited greater than 85% compliance. The overall quality of evidence in the included SRs ranged from "very low" to "moderate."

Conclusion

This overview shows that WA therapy was more effective than the control treatment for OA. However, the methodological quality of the reviews was low, indicating the need for improvements in the collection of evidence. Future studies are needed to collect high-quality evidence regarding the use of WA for OA.

Systematic review registration

https://www.researchregistry.com/, Research Registry (reviewregistry1317).

Protective effects of Pudilan Tablets against osteoarthritis in mice induced by monosodium iodoacetate

Osteoarthritis (OA) is a complicated disorder that is the most prevalent chronic degenerative joint disease nowadays. Pudilan Tablets (PDL) is a prominent traditional Chinese medicine formula used in clinical settings to treat chronic inflammatory illnesses. However, there is currently minimal fundamental research on PDL in the therapy of joint diseases. As a result, this study looked at the anti-inflammatory and anti-OA properties of PDL in vitro and in vivo, as well as the mechanism of PDL in the treatment of OA. We investigated the anti-OA properties of PDL in OA mice that were generated by monosodium iodoacetate (MIA). All animals were administered PDL (2 g/kg or 4 g/kg) or the positive control drug, indomethacin (150 mg/kg), once daily for a total of 28 days starting on the day of MIA injection. The CCK-8 assay was used to test the vitality of PDL-treated RAW264.7 cells in vitro. RAW264.7 cells that had been activated with lipopolysaccharide (LPS) were used to assess the anti-inflammatory properties of PDL. In the MIA-induced OA model mice, PDL reduced pain, decreased OA-induced cartilage damages and degradation, decreased production of pro-inflammatory cytokines in serum, and suppressed IL-1β, IL-6, and TNF-α mRNA expression levels in tibiofemoral joint. In RAW264.7 cells, PDL treatment prevented LPS-induced activation of the ERK/Akt signaling pathway and significantly decreased the levels of inflammatory cytokines, such as IL-1β, IL-6, and TNF-α. In conclusion, these results suggest that PDL is involved in combating the development and progression of OA, exerts a powerful anti-inflammatory effect on the knee joint, and may be a promising candidate for the treatment of OA.

β Boswellic Acid Blocks Articular Innate Immune Responses: An In Silico and In Vitro Approach to Traditional Medicine

Osteoarthritis (OA) is hallmarked as a silent progressive rheumatic disease of the whole joint. The accumulation of inflammatory and catabolic factors such as IL6, TNFα, and COX2 drives the OA pathophysiology into cartilage degradation, synovia inflammation, and bone destruction. There is no clinical available OA treatment. Although traditional ayurvedic medicine has been using Boswellia serrata extracts (BSE) as an antirheumatic treatment for a millennium, none of the BSE components have been clinically approved. Recently, β boswellic acid (BBA) has been shown to reduce in vivo OA-cartilage loss through an unknown mechanism. We used computational pharmacology, proteomics, transcriptomics, and metabolomics to present solid evidence of BBA therapeutic properties in mouse and primary human OA joint cells. Specifically, BBA binds to the innate immune receptor Toll-like Receptor 4 (TLR4) complex and inhibits both TLR4 and Interleukin 1 Receptor (IL1R) signaling in OA chondrocytes, osteoblasts, and synoviocytes. Moreover, BBA inhibition of TLR4/IL1R downregulated reactive oxygen species (ROS) synthesis and MAPK p38/NFκB, NLRP3, IFNαβ, TNF, and ECM-related pathways. Altogether, we present a solid bulk of evidence that BBA blocks OA innate immune responses and could be transferred into the clinic as an alimentary supplement or as a therapeutic tool after clinical trial evaluations.

High-dose Tiger-Gian formula protects the knee joint from surgically induced osteoarthritis in rats

AIM

Although the Tiger-Gian formula (TGF) has proven clinically effective at improving the symptoms of knee osteoarthritis (KOA), the pharmacological effects and underlying mechanisms of TGF have not been examined in any animal model. This study assessed the effects of TGF in male Sprague-Dawley rats with anterior cruciate ligament transection (ACLT) -induced KOA.

METHODS

Thirty rats underwent ACLT surgery and were assigned to either the control group, ACLT alone, ACLT + low-dose TGF (1000 mg/kg), ACLT + high-dose TGF (3000 mg/kg), or ACLT + celecoxib (30 mg/kg). All rats were subjected to micro-computed tomography (micro-CT), weight-bearing behavioral testing, and histological inspections of the knee joint for evidence of structural changes in articular bone, cartilage and synovium.

RESULTS

After 6 weeks, force discrepancies in weight-bearing distribution between the normal hind and postoperative limbs revealed superiority with high-dose TGF (18.00 ± 5.93 g) and celecoxib (18.68 ± 5.29 g) versus both ACLT alone (41.29 ± 7.06 g) and low-dose TGF (37.00 ± 7.40 g). Micro-CT images revealed that high-dose TGF and celecoxib similarly improved subchondral bone architecture, protected articular cartilage after ACLT, and downregulated proinflammatory cytokines interleukin-1β and tumor necrosis factor-α in the cartilage and synovial sections.

CONCLUSION

High-dose TGF induced the smallest amount of KOA-associated bone loss. Anti-inflammatory, anti-oxidative, and immunomodulatory effects of TGF were accompanied by reductions in proinflammatory cytokines and improvements in pain and function. TGF-induced anti-osteoporotic activity and inhibition of cartilage degradation were reflected by micro-CT and histological analysis. The findings help to explain how TGF alleviates symptoms of KOA.

Zhuanggu Guanjie herbal formula mitigates osteoarthritis via the NF-κB transduction mechanism

The Zhuanggu Guanjie herbal formula has been a famous Chinese prescription for treating bone diseases since time immemorial. The anti-osteoarthritis (OA) properties of this botanical prescription are well documented in the Chinese Pharmacopoeia. However, the detailed mechanisms behind the phenomenon have not been elucidated. Hence, we aimed to investigate the anti-OA efficacy of the Zhuanggu Guanjie herbal formula and its underlying mechanism. The anti-OA properties of Zhuanggu Guanjie capsule (ZGC) were determined by the cytokine contents and inflammatory-related proteins, which were measured by RT-PCR, flow cytometry, Western blot, and laser confocal assay in ATDC5 cells. The levels of interleukin-6, tumor necrosis factor-α, inducible nitric oxide synthase, cyclooxygenase-2, and prostaglandin synthesis E2 have been markedly reduced after being treated with ZGC for 48 h in a dose-dependent manner. Furthermore, ZGC prevented the translocation of NF-κB from the cytosol to the nucleus. On the other hand, we used the mono-iodoacetate (MIA)-induced OA model to confirm the in vivo efficacies of this herbal formula. Oral administration of ZGC attenuated MIA-induced OA damage through changes in histopathological and knee joint volumes. The serum matrix metalloproteinase-13 contents in the ZGC treatment group declined as compared to those in the MIA model group. Through our in vitro and in vivo studies, we confirmed the anti-OA efficacy of ZGC and uncovered its detailed mechanism, and this treatment shed light on OA pathophysiology.

Factors associated with Chinese herbal medicine use among middle-aged and older women with arthritis: evidence from China

Chinese herbal medicine (CHM) has been used for arthritis in China and elsewhere across the world. However, knowledge about the prevalence and profile of middle-aged and older women who used CHM for arthritis in China is limited. This study aims to identify potentially important insights into the factors associated with CHM use amongst middle-aged and older women with arthritis in China. Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), a population-based survey of Chinese adults aged 45 years or older, comprising 10,833 Chinese women who completed a questionnaire in 2015. Stepwise multiple logistic regression modeling was conducted to determine the key factors (demographic, health condition, and health services use) predicting the use of CHM for the treatment of arthritis. Results revealed that 17.2% of women with arthritis were taking CHM for their arthritic symptoms. Women with arthritis who used CHM were more likely to experience finger pain (OR = 1.70), had difficulty in stooping, kneeling, crouching (OR = 1.40), visited a Traditional Chinese hospital (OR = 2.22), consulted massage therapists (OR = 2.06) and/or had experienced a fall (OR = 1.41). The prevalence of CHM use is high amongst middle-aged and older Chinese women with arthritis. Given the high risk of functional disability and impaired mental health, further research is needed to explore the potential health benefits of CHM for women with arthritis in order to help facilitate the efficacious and safe use of CHM alongside conventional medical care.

Proteomic Analyses Reveals the Mechanism of Acupotomy Intervention on the Treatment of Knee Osteoarthritis in Rabbits

Acupotomy intervention (AI) is an available treatment for knee osteoarthritis (KOA) in China, which is a common health problem over the world. However, the underlying mechanism of AI on the KOA treatment is still unknown. To further understand the mechanism of acupotomy in treating KOA, the morphological observation and TMT proteomic analyses were conducted in rabbits. By using X-ray and MRI, we found that the space of the knee joint was bigger in AI than in KOA. Moreover, the chondrocytes were neatly arranged in AI but disordered in KOA. With proteomic analyses in chondrocytes, 68 differently accumulated proteins (DAPs) were identified in AI vs. KOA and DAPs related to energy metabolism and the TCA cycle were suggested to play a central role in response to AI. Furthermore, AIFM1 was proposed to be an important regulator in controlling the energy production in mitochondrial. Besides, FN1, VIM, COL12A1, COL14A1, MYBPH, and DPYSL3 were suggested to play crucial roles in AI for the treatment of KOA. Our study was systematically elucidating the regulation mechanism of acupotomy intervention in the treatment of KOA.

Zhuifeng tougu capsules inhibit the TLR4/MyD88/NF-κB signaling pathway and alleviate knee osteoarthritis: In vitro and in vivo experiments

Background: Knee osteoarthritis (KOA), a chronic degenerative disease, is mainly characterized by destruction of articular cartilage and inflammatory reactions. At present, there is a lack of economical and effective clinical treatment. Zhuifeng Tougu (ZFTG) capsules have been clinically approved for treatment of OA as they relieve joint pain and inflammatory manifestations. However, the mechanism of ZFTG in KOA remains unknown.

Purpose: This study aimed to investigate the effect of ZFTG on the TLR4/MyD88/NF-κB signaling pathway and its therapeutic effect on rabbits with KOA.

Study design:In vivo, we established a rabbit KOA model using the modified Videman method. In vitro, we treated chondrocytes with IL-1β to induce a pro-inflammatory phenotype and then intervened with different concentrations of ZFTG. Levels of IL-1β, IL-6, TNF-α, and IFN-γ were assessed with histological observations and ELISA data. The effect of ZFTG on the viability of chondrocytes was detected using a Cell Counting Kit-8 and flow cytometry. The protein and mRNA expressions of TLR2, TLR4, MyD88, and NF-κB were detected using Western blot and RT-qPCR and immunofluorescence observation of NF-κB p65 protein expression, respectively, to investigate the mechanism of ZFTG in inhibiting inflammatory injury of rabbit articular chondrocytes and alleviating cartilage degeneration.

Results: The TLR4/MyD88/NF-κB signaling pathway in rabbits with KOA was inhibited, and the levels of IL-1β, IL-6, TNF-α, and IFN-γ in blood and cell were significantly downregulated, consistent with histological results. Both the protein and mRNA expressions of TLR2, TLR4, MyD88, NF-κB, and NF-κB p65 proteins in that nucleus decreased in the ZFTG groups. Moreover, ZFTG promotes the survival of chondrocytes and inhibits the apoptosis of inflammatory chondrocytes.

Conclusion: ZFTG alleviates the degeneration of rabbit knee joint cartilage, inhibits the apoptosis of inflammatory chondrocytes, and promotes the survival of chondrocytes. The underlying mechanism may be inhibition of the TLR4/MyD88/NF-kB signaling pathway and secretion of inflammatory factors.

An umbrella review of Lianhua Qingwen combined with Western medicine for the treatment of coronavirus disease 2019

Lianhua Qingwen combined with Western medicine (LHQW+WM) has been proposed as a viable treatment for coronavirus disease 2019 (COVID-19). Interestingly, umbrella reviews of systematic reviews (SRs), which provide the most comprehensive evidence, are the best evidence in evidence-based medicine. Therefore, an umbrella review of SRs that summarizes and evaluates the efficacy of LHQW+WM for COVID-19 is urgently required.

Methods

Overall, 6 databases were used to conduct a comprehensive literature search from inception to January 22, 2022. The corrected covered area (CCA) was used to analyze the overlapping between SRs. Meta-analysis was conducted when that of the included SRs was inappropriate. A MeaSurement Tool to Assess Systematic Reviews (AMSTAR-2) was also employed to assess the quality of the included SRs.

Results

In total, 12 SRs were identified, which included 12 unique primary studies. The included SRs ranged in quality from moderate to critically low and had an extremely high CCA (36.4%). Compared to conventional treatment, LHQW+WM showed efficacy concerning fatigue recovery [risk ratio (RR) = 1.69, 95% confidence interval (CI): 1.04-2.73, n = 2, I2 = 0%], cough recovery (RR = 1.65, 95% CI: 1.09-2.51, n = 3, I2 = 39.1%), and overall effective rates (RR = 1.17, 95% CI: 1.07-1.28, n = 3, I2 = 17.5%).

Conclusion

LHQW+WM may improve the clinical symptoms of patients with COVID-19; however, the results should be interpreted cautiously because of the rigorous processes in the included SRs.

Graphical abstract

http://links.lww.com/AHM/A32.

Molecular mechanism analysis of Miao medicine Jinwujiangu decoction in treating osteoarthritis based on a network pharmacology approach

OBJECTIVE

To investigate molecular mechanisms of Jinwujiangu decoction (, JWJG) in treating osteoarthritis (OA) using network pharmacology analysis.

METHODS

Principal active compounds of JWJG were screened out via the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) and BATMAN-TCM, and potential targets for OA treatment were identified through Online Mendelian Inheritance in Man (OMIM) and GeneCards databases. The JWJG network diagrams of both principal chemical compound-action targets and OA treatment target-OA disease were constructed applying the Cytoscape 3.7.2 software. The diagram of protein-protein interaction network was plotted for core analysis. Meanwhile, the common targets and relevant signaling pathways involved in both networks were analyzed using the Gene Ontology function analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment. The predicted results were ultimately verified through animal experiments.

RESULTS

Effects of JWJG were indicated in acting on key targets interleukin-6, insulin, protein kinase B, glyceraldehyde-3-phosphate dehydrogenase, and mitosis-specific MRE11-RAD50-NBS1 associated protein by regulating signaling pathways of phosphoinositide 3-kinase- protein kinase B, mitogen-activated protein kinases, tumor necrosis factor, and colorectal cancer. Meanwhile, it inhibited the over-activation of signaling pathways and the release of inflammatory factors in OA treatment. Following a signaling pathway analysis utilizing network pharmacology technique, it was demonstrated that JWJG could treat OA through the Wnt/β-catenin signaling pathway verified by animal experiments.

CONCLUSIONS

The present study preliminarily analyzed the pharmacological mechanism of JWJG in treating OA on a network pharmacology approach and provided a great theoretical significance for clinical application.

Deep Learning-Based CT Imaging to Evaluate the Therapeutic Effects of Acupuncture and Moxibustion Therapy on Knee Osteoarthritis

The study was aimed at analyzing the application value of deep learning-based computed tomography (CT) in evaluating the effect of acupuncture for knee osteoarthritis (KOA). Specifically, 124 patients with KOA were selected in the test group (warm acupuncture and moxibustion) and the control group (simple acupuncture), with 62 cases in each group. Deep learning-based CT scanning was performed before and after treatment to compare the Lequesne-Mery, Visual Analog Scale (VAS), Western Ontario and McMaster Universities (WOMAC), Hospital Special Surgery (HSS), and Knee Society Score (KSS) scores as well as the overall effective rate. The results showed that the trabecular thickness, quantity, bone mineral density (BMD), connection density, structural model index, and articular cartilage thickness were different significantly between the two groups (P < 0.05). After treatment, the Lequesne-Mery was 4.78, the VAS was 0.87, and the WOMAC score was 14.89 of the test group, which were reduced (P < 0.05). The KSS and HSS scores of the test group were improved significantly after treatment (P < 0.05). The total effective rate of the test group was 85.48%, and that of the control group was 51.61%; the former was significantly higher than the latter (P < 0.05). In conclusion, acupuncture could improve the clinical effect on KOA patients, and CT scanning under deep learning algorithm could evaluate the clinical effect of acupuncture for KOA.

Current Situation and Influencing Factors of Traditional Chinese Medicine Nursing Clinic in Henan Province

Objective

To explore the current situation and influencing factors of traditional Chinese medicine (TCM) nursing clinic in Henan Province. A self-made questionnaire was made and entered into the questionnaire star. In August 2020, through "the snowball sampling method," the nursing branch of Henan Society of Traditional Chinese Medicine was used to calculate the sample size that would be further used for this study.

Results

Of the 370 medical institutions in 17 district-level cities in our province, 47 have set up TCM nursing clinics, accounting for 12.70%. From the perspective of regional distribution, there are 14 TCM nursing clinics in Zhengzhou, 8 in Luoyang, 6 in Kaifeng, 4 in Shangqiu, 3 in Jiyuan, and 3 in Zhoukou. The number of TCM nursing clinics in Jiaozuo City, Xinxiang City, Anyang City, Hebi City, Puyang City, Zhumadian City, and Nanyang City is relatively small, and there are no TCM nursing clinics in Pingdingshan City, Sanmenxia City, and Xinyang City. Among the 47 medical institutions offering TCM nursing clinics, there are 38 TCM hospitals, 5 integrated traditional Chinese and Western medicine hospitals, 3 Western medicine hospitals, and 1 ethnic medicine hospital. Among them, 31 medical institutions are tertiary care hospitals and 16 are secondary care hospitals. First-class and undetermined medical institutions do not set up TCM nursing clinics. (1) Management mode: among the 47 medical institutions, 26 medical institutions have separate nursing units, which are managed by the nursing department head nurse, and 13 medical institutions are managed by the director head nurse of the department. (2) Performance management: of the 47 medical institutions that set up TCM nursing clinics, 18 adopted independent accounting, 21 adopted secondary distribution of departmental performance, and 7 adopted average awards and other methods. (3) The process of seeing a doctor: there are three kinds of medical procedures: 124 medical institutions are treated by TCM nursing outpatients by hanging the consultation number of doctors in various departments. 210 medical institutions are treated by traditional Chinese medicine nursing outpatient nurses by hanging the consultation number of traditional Chinese medicine nursing outpatient doctors. Thirty-five medical institutions are retreated by hanging the number of nurses in the nursing clinic of TCM. (4) Allocation of human resources: in the survey of the total number of nurses in TCM nursing clinics in 74 medical institutions, the largest number of nurses was 46 in one of the TCM nursing clinics. In terms of personnel qualification requirements, 43 medical institutions put forward requirements for nurses' qualifications. Among them, 39 medical institutions have requirements for nurses' professional titles, 38 medical institutions have requirements for nurses working years, and 22 medical institutions have more specific requirements for nurses. For example, nurses are required to be the backbone of TCM nursing that includes specialist nurses, nurses who graduated from TCM colleges, and nurses who have obtained hospital assessment and certification. In terms of working years, 87.96% of medical institutions require nursing service of more than 5 years. The average number of TCM nursing technical projects offered by 47 medical institutions is about 10, a maximum of 34 and a minimum of 1. The commonly carried out TCM nursing techniques include scraping, auricular point pressing, cupping, moxibustion, and ear tip bloodletting, and among all of them, scraping technology is most important and 40 medical institutions offer this technology, followed by auricular point pressing technique, cupping, and moxibustion.

Conclusion

The construction of TCM nursing clinics in Henan Province has initially formed a scale, and all kinds of medical institutions at all levels should further strengthen the construction of TCM nursing clinics in all other provinces.

Fuzi decoction ameliorates pain and cartilage degeneration of osteoarthritic rats through PI3K-Akt signaling pathway and its clinical retrospective evidence

BACKGROUND

Osteoarthritis (OA) is a difficult disease but the clinic lacks effective therapy. As a classic formula of traditional Chinese medicine (TCM), Fuzi decoction (FZD) has been clinically applied for treating OA-related syndromes, but its anti-OA efficacy and mechanism remain unclear.

PURPOSE

To experimentally and clinically determine the anti-OA efficacy of FZD and clarify the underlying mechanism.

METHODS

UPLC/MS/MS was applied to identify the main components of FZD. A monoiodoacetate (MIA)-induced OA rat model was employed to evaluate the in vivo efficacy of FZD against OA, by using pain behavior assessment, histopathological observation, and immunohistochemical analysis. Primary rat chondrocytes were isolated to determine the in vitro effects of FZD by using cell viability assay, wound healing assay, and real-time PCR (qPCR) analysis on anabolic/catabolic mRNA expressions. RNA sequencing (RNA-seq) and network pharmacology analysis were conducted and the overlapping data were used to predict the mechanism of FZD, followed by verification with qPCR and Western blot assays. Finally, a retrospective analysis was performed to confirm FZD's efficacy and safety in OA patients.

RESULTS

The UPLC/MS/MS result showed that FZD contained atractylenolide I, benzoylhypaconitine, benzoylmesaconitine, benzoylaconitine, hypaconitine, mesaconitine, aconitine, lobetyolin, paeoniflorin, and pachymic acid. The in vivo data showed that FZD restored the cartilage degeneration in MIA-induced OA rats by ameliorating pain behavior parameters, recovering histopathological alterations, benefitting cartilage anabolism (up-regulating Col2 expression), and suppressing catabolism (down-regulating MMP13 and Col10 expressions). The in vitro data showed that FZD increased cell viability and wound healing capacity of chondrocytes, and restored the altered expressions of anabolic and catabolic genes of chondrocytes. The overlapping results of RNA-seq and network pharmacology analysis suggested that PI3K/Akt signaling mediated the anti-OA mechanism of FZD, which was verified by qPCR and Western blot experiments. Clinically, the anti-OA efficacy and safety of FZD were confirmed by the retrospective analysis on OA patients.

CONCLUSION

The scientific innovation of this study was the determination of anti-OA efficacy of FZD by experimental and clinical evidence and the discovery of its mechanism by integrated RNA-seq, network pharmacology, and molecular experiments, which suggests FZD as a promising TCM agency for OA treatment.

The Traditional Chinese Medicine "Hu-Qian-Wan" Attenuates Osteoarthritis-Induced Signs and Symptoms in an Experimental Rat Model of Knee Osteoarthritis

BACKGROUND

Knee osteoarthritis (KOA) is a chronic, low-grade inflammatory disease that affects knee joints and causes functional disability in the elderly. KOA is typically treated with oral NSAIDs, which are commonly associated with gastrointestinal side effects or cardiovascular complications. Traditional Chinese medicine (TCM) is widely used by patients with KOA in Taiwan; the Hu-Qian-Wan (HQW) formula is typically prescribed. We investigated the therapeutic role of a modified version of the HQW decoction in Sprague-Dawley rats with KOA induced by anterior cruciate ligament transection (ACLT) of the right knee.

MATERIALS AND METHODS

Thirty rats were randomly assigned to five groups (six animals each): arthrotomy alone (sham surgery, controls), ACLT only, ACLT + low-dose (1,000 mg/kg) HQW, ACLT + high-dose (3,000 mg/kg) HQW, and ACLT + celecoxib (30 mg/kg). All study groups underwent weight-bearing behavioral testing, micro-computed tomography (CT), and histological examinations of the knee joint cartilage, as well as immunohistochemical analyses of levels of interleukin (IL) 1β and tumor necrosis factor (TNF) α expression in articular cartilage.

RESULTS

At 6 weeks, compared with ACLT group only, ACLT rats administered high-dose HQW or celecoxib exhibited the fewest weight-bearing deficits, the greatest improvements from baseline in articular cartilage architecture, and the lowest amounts of TNF-α and IL-1β staining in cartilage and synovial sections (all values were significant compared with the ACLT-only group). The only values that were significantly increased by ACLT + low-dose HQW compared with ACLT alone were bone mineral density and trabecular numbers.

CONCLUSION

Our findings suggest that high-dose HQW improves weight-bearing asymmetry, decreases bone loss, and reduces levels of TNF-α and IL-1β in the affected joint in ACLT-induced KOA rats. More evidence is needed to support our findings.

Confirmation of inhibitingTLR4/MyD88/NF-κB Signalling Pathway by Duhuo Jisheng Decoction on Osteoarthritis: A Network Pharmacology Approach-Integrated Experimental Study

This study was conducted to identify whether the TLR4/MyD88/NF-κB signalling pathway plays a vital role in osteoarthritis (OA) treatment with Duhuo Jisheng Decoction (DHJSD) on the basis of a network pharmacology approach (NPA)-integrated experiment. Two experiments were conducted as follow: NPA for DHJSD using six OA-related gene series and the key pathway was screened out using NPA. NPA identified a vital role for the TLR4/MyD88/NF-κB signalling pathway in OA treatment with DHJSD, the conventional western blot analysis and qPCR confirmed it. Furthermore, changes of miR-146a-5p and miR-34a-5p in the cellular models were recovered by DHJSD administration, which synergistically contributed to OA therapy. The toll-like receptor signalling pathway and the NF-κB signalling pathway were meaningfully enriched by the miRNA-regulated gene pathways. This study identified and confirmed the TLR4/MyD88/NF-κB signalling pathway is an essential inflammatory signalling pathway in the DHJSD underlying OA treatment. The results provide a basis for further evaluation of the regulatory mechanism of the drug’s efficacy in treating OA.

Overview of Traditional Mongolian Medical Warm Acupuncture

Mongolian medical warm acupuncture is a traditional therapy of Mongolian medicine and was developed by people living on the Mongolian Plateau. This kind of traditional oriental medicine has a long history. The main characteristics of Mongolian medical warm acupuncture are the acupoints and the needles used. Its theory is based on the human anatomical structure and the distinct local culture. Mongolian medical warm acupuncture has been practiced for centuries and proved to be very effective in the treatment of age-related diseases, including the musculoskeletal and nervous diseases. This paper aims to briefly introduce the history and scope of Mongolian medical warm acupuncture, with a particular focus on age-related diseases, where Mongolian medical warm acupuncture has shown significant beneficial effects.

Effect of Tongluozhitong Prescription-Assisted Intra-Articular Injection of Sodium Hyaluronate on VAS Score and Knee Lysholm Score in Patients with Knee Osteoarthritis

Knee osteoarthritis (KOA) has become one of the leading causes of workforce loss in the middle-aged and elderly population and a global public health problem second only to cardiovascular disease, so we need to find more effective treatments for this disease. In this study, we selected 120 patients with KOA admitted to our hospital from June 2018 to December 2020 and divided them into treatment group 1, treatment group 2, and joint group according to the random number table method, with 40 patients in each group. Treatment group 1 was treated with Tongluozhitong prescription dip-soaking therapy, treatment 2 group was treated with intra-articular injection of sodium hyaluronate, and the joint group was treated with a combination of both modalities for 4 weeks in all three groups. Clinical efficacy, visual analogue scale (VAS), Lysholm knee score (LKS), activity of daily living score (ADL), the levels of bone metabolic markers such as cartilage oligomeric matrix protein (COMP), type II collagen degradation maker (CTX-II), and matrix metalloproteinase-3 (MMP-3), and the levels of inflammatory mediators such as interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and hypersensitive C-reactive protein (hs-CRP) were used as observations to compare and analyze the therapeutic effects of the three treatment regimens in KOA patients. The results showed that the clinical excellence rates of the joint group, treatment group 1, and treatment group 2 were 72.50%, 50.00%, and 90.00%, respectively, with statistically significant differences between any two comparisons. After treatment, VAS scores, serum COMP, CTX-II, MMP-3, IL-1β, TNF-α, and hs-CRP levels decreased in all three groups, and the levels of each index were as follows: joint group < treatment group 1 < treatment group 2, and the difference between any two comparisons was statistically significant. The LKS score and ADL score increased in all three groups, and the levels of each index were as follows: joint group > treatment group 1 > treatment group 2, with statistically significant differences in any two groups compared. None of the patients in the three groups experienced any significant adverse effects during treatment. This suggests that the dip-soaking therapy of Tongluozhitong prescription is more advantageous than intra-articular sodium hyaluronate injection treatment in suppressing the level of serum bone metabolic markers and inflammatory mediators, reducing pathological joint damage, relieving symptoms of pain, alleviating degenerative joint symptoms, and improving knee function in KOA patients. The combination of the two in KOA patients can significantly improve the efficacy and has a good safety profile.

Self-Reported Weather Sensitivity is Associated with Clinical Symptoms and Structural Abnormalities in Patients with Knee Osteoarthritis: A Cross-Sectional Study

INTRODUCTION

Patients with knee osteoarthritis (KOA) often complain about clinical symptoms affected by weather-related factors. The purpose of the present study was to use cross-sectional analysis to determine whether weather sensitivity was associated with clinical symptoms, as well as structure abnormalities, in KOA patients.

METHODS

Data from 80 participants were obtained from the Feng Hans Shi Effects on OA (FHS) study, an OA cohort study initiated in China in 2015. The weather sensitivity of each participant was determined by a self-reported questionnaire. The following measurements were used to assess clinical outcomes: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for symptoms, and semi-quantitative Whole-Organ Magnetic Resonance Imaging Score (WORMS) for cartilage defects and marrow abnormalities of magnetic resonance imaging (MRI). Chi-square with Cochran-Armitage test for trend and regression analysis were used to evaluate the associations between weather sensitivity and WOMAC and WORMS of KOA patients.

RESULTS

Most of the KOA participants (57.5%) perceived the weather as affecting their knee-joint clinical symptoms. After adjusting for age, gender, and body mass index (BMI), weather sensitivity was not only associated with knee pain [OR = 3.3 (95% CI 1.1, 9.9), P = 0.032], dysfunction [OR = 5.5 (95% CI 1.8, 16.8), P = 0.003], and overall clinical symptoms [OR = 3.3 (95% CI 1.1, 10.2), P = 0.034], but also associated with cartilage defect [OR = 3.1 (95% CI 1.1, 8.5), P = 0.027] and marrow abnormality [OR = 3.0 (95% CI 1.1, 8.1), P = 0.029].

CONCLUSIONS

In KOA patients, weather sensitivity was associated with clinical symptoms and structural abnormalities. Future longitudinal study is warranted for the causal relationship. INFOGRAPHIC.

Study on the potential active components and molecular mechanism of Xiao Huoluo Pills in the treatment of cartilage degeneration of knee osteoarthritis based on bioinformatics analysis and molecular docking technology

Background

Knee osteoarthritis is a common joint degenerative disease. Xiao Huoluo Pills (XHLP) has been used to treat degenerative diseases such as osteoarthritis and hyperosteogeny. However, XHLP’s specific effective ingredients and mechanism of action against osteoarthritis have not been explored. Therefore, bioinformatics technology and molecular docking technology are employed in this study to explore the molecular basis and mechanism of XHLP in the treatment of knee osteoarthritis.

Methods

Public databases (TCMSP, Batman-TCM, HERB, DrugBank, and UniProt) are used to find the effective active components and corresponding target proteins of XHLP (screening conditions: OB > 30%, DL ≥ 0.18). Differentially expressed genes related to cartilage lesions of knee osteoarthritis are obtained based on the GEO database (screening conditions: adjust P value < 0.01, |log₂ FC|≥1.0). The Venn package in R language and the BisoGenet plug-in in Cytoscape are adopted to predict the potential molecules of XHLP in the treatment of knee osteoarthritis. The XHLP-active component-target interaction network and the XHLP-knee osteoarthritis-target protein core network are constructed using Cytoscape software. Besides, GO/KEGG enrichment analysis on core genes is performed using the Bioconductor package and clusterProfiler package in the R language to explain the biological functions and signal pathways of the core proteins. Finally, molecular docking is performed through software such as Vina, LeDock, Discovery Studio 2016, PyMOL, AutoDockTools 1.5.6, so as to verify the binding ability between the active components of the drug and the core target protein.

Results

XHLP has been screened out of 71 potentially effective active compounds for the treatment of OA, mainly including quercetin, Stigmasterol, beta-sitosterol, Izoteolin, and ellagic acid. Knee osteoarthritis cartilage lesion sequencing data (GSE114007) was screened out of 1672 differentially expressed genes, including 913 upregulated genes and 759 downregulated genes, displayed as heat maps and volcano maps. Besides, 33 core target proteins are calculated by Venn data package in R and BisoGenet plug-in in Cytoscape. The enrichment analysis on these target genes revealed that the core target genes are mainly involved in biological processes such as response to oxygen levels, mechanical stimulus, vitamin, drug, and regulation of smooth muscle cell proliferation. These core target genes are involved in signaling pathways related to cartilage degeneration of knee osteoarthritis such as TNF signaling pathway and PI3K-Akt signaling pathway. Finally, the molecular docking verification demonstrates that some active components of the drug have good molecular docking and binding ability with the core target protein, further confirming that XHLP has the effect of inhibiting cartilage degeneration in knee osteoarthritis.

Conclusions

In this study, based on the research foundation of bioinformatics and molecular docking technology, the active components and core target molecules of XHLP for the treatment of cartilage degeneration of knee osteoarthritis are screened out, and the potential mechanism of XHLP inhibiting cartilage degeneration of knee osteoarthritis is deeply explored. The results provide theoretical basis and new treatment plan for XHLP in the treatment of knee osteoarthritis.

Chinese Herbal Medicine Xingnaojing Injection for Acute Ischemic Stroke: An Overview of Systematic Reviews and Meta-Analyses

Background: Xingnaojing injection (XNJ) is the only Chinese herbal injection approved for both intracerebral hemorrhage and ischemic stroke (IS) first-aid on ambulances in China; many systematic reviews (SRs) and meta-analyses (MAs) of XNJ on stroke have been published. The purpose of this research was to evaluate and summarize the current evidence on XNJ for IS. Methods: A comprehensive search was conducted for SRs and MAs of XNJ on IS in seven databases up to January 1, 2021. Two authors independently identified SRs and MAs, extracted data, assessed the quality of the included SRs and MAs using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2), and assessed quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: A total of 10 SRs met the inclusion criteria. The quality of included SRs using AMSTAR 2 was critically low as the critical items were poorly reported. Only 10% of SRs reported 50% of the 16 items, while the remaining 90% SRs reported just less than half of the items on AMSTAR 2. For GRADE, 7 (35%) of outcomes had low-quality evidence, 10 (50%) with very low, and 3 (15%) with moderate quality evidence. Very low to low quality of evidence indicated XNJ plus conventional therapy (CT) alleviated the neurological deficits of acute IS. Moderate-quality evidence showed XNJ plus CT reduced mortality when compared to Danshen injection plus CT, and very low-quality evidence showed XNJ plus CT could not improve the degree of coma, while low-quality evidence indicated the opposite. Mild adverse events in the CT group were less than those in the XNJ plus CT group, and there were no serious adverse events, but there was no statistical difference between the two groups. The included 10 SRs indicated that XNJ was used for acute IS, but only four SRs (40%) reported the course of disease. Conclusion: XNJ appears to be effective and safe for acute IS in improving the neurological deficits, but the evidence is not robust enough. However, whether administering XNJ immediately after or within 24 h of IS is best remains unknown due to the lack of data. Well-designed large-scale randomized controlled trials with measurable outcomes are required in future studies.

A randomized controlled trial on the effect of focal thermal therapy at acupressure points treating osteoarthritis of the knee

Background

Osteoarthritis of the knee is a common degenerative joint disorder in our ageing population. A combination of thermal therapy with a self-management exercise have shown a positive effect in the management of osteoarthritis of the knee. This study aimed to compare the effectiveness of topical heat pack versus focal application of heat therapy at the acupressure points in the treatment of osteoarthritis of the knee.

Methods

A randomized controlled trial was conducted in 76 patients with osteoarthritis of the knee, diagnosed by an experienced orthopedic surgeon. Following inclusion and exclusion selection, patients were randomly allocated to group 1 (Heat pack) or group 2 (Thermal gun). All patients received 30 min of treatment in each session, twice a week for 4 weeks. They also received an education program and taught home knee exercises. Outcome measurements were the visual analog scale (VAS) for pain intensity, muscle power, knee ROM, WOMAC and SF-12v2.

Results

In the Thermal gun group, function and total scores (WOMAC) and Physical Composite Scale (SF-12v2) were significantly improved after 8 sessions. Quadriceps strength was significantly improved after 8 weeks (from 4.42 to 4.63; p = 0.02). In the Heat pack group, flexion was significantly improved after 8 sessions (p = 0.02). Mean VAS scores after Heat pack treatment was consistently better (lower) than mean VAS scores after Thermal gun treatment.

Conclusion

The combination of focal thermal therapy at acupressure points is a viable conservative treatment in osteoarthritis of the knee. The pressure at the acupressure points has a synergistic benefit than topical thermal therapy alone.

Trial registration

ClinicalTrials.gov, NCT04735029

Date of registration: February 2, 2021 (Retrospectively registered)

Healthcare Utilization and Knee Osteoarthritis Symptoms among Urban Older Malaysian

Knee osteoarthritis (OA) is a prevalent chronic disorder in the older population. While timely management is important to minimize the consequences of knee OA, information on the utilization of healthcare services among this population remains limited. Therefore, the objectives of this study were to determine the healthcare utilization and its associated factors in older persons with knee OA. Cross-sectional data from 1073 participants aged 60 years and above from the Malaysian Elders Longitudinal Research (MELoR) study were included. The utilization rate of healthcare services was quantified. Factors related to the utilization of healthcare services were determined using logistic regression analysis. Healthcare utilization among participants with knee OA was significantly higher than those without knee OA (p < 0.01). Outpatient usage was higher (p < 0.01) in comparison to inpatient and pharmacotherapy. Being married and having an income were significantly associated with seeking outpatient care (OR: 11.136, 95% CI: 1.73–52.82, p < 0.01) and pharmacotherapy (OR: 10.439, 95% CI: 1.187–91.812, p < 0.05), while females were less likely to utilize inpatient care services (OR: 0.126, 95% CI: 0.021–0.746, p < 0.05). The higher rate of healthcare utilization among older persons with knee OA indicates the increased healthcare needs of this population, who are commonly assumed to suffer from a benign disease.

Baduanjin exercise for patients with knee osteoarthritis: A protocol for systematic review and meta-analysis

BACKGROUND

Knee osteoarthritis (KOA) is a common chronic degenerative disorder with an increasingly prevalence among the older individuals and the leading cause of pain in the elderly. Baduanjin, one of the ancient traditional Chinese mind-body exercise routine, has been recognized to have clinical benefits for KOA. We aim to evaluate the efficacy and safety of Baduanjin for patients with KOA through this systematic review and meta-analysis.

METHODS

Four English databases (Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Web of Science), and 4 Chinese databases (China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, and Wanfang Database), will be searched from establishment of the database until October 2020. The reference lists and the citation lists of studies meeting the inclusion criteria will also be searched to identify further studies for inclusion. The search languages are English and Chinese. The randomized controlled trials of Baduanjin training for patients with KOA will be included. The primary outcome will be assessed according to the Western Ontario and McMaster Universities Osteoarthritis Index. Meta-analysis will be conducted with the use of RevMan 5.3.

RESULTS

The results of this research will be submitted to a peer-reviewed publications.

CONCLUSION

This systematic review aims to present evidence for whether Baduanjin training is an effective intervention which can improve both physical condition and life quality in patients suffering KOA.

INPLASY REGISTRATION NUMBER

INPLASY202090051.

Complementary and alternative therapies for knee osteoarthritis: A protocol for systematic review and network meta-analysis

BACKGROUND

Knee osteoarthritis (KOA) is a degenerative disease, making a unique contribution to chronic pain, edema, and limited mobility of knee joint. This disease is an important factor affecting the quality of life of middle-aged and elderly people. Complementary and alternative medicine (CAM) therapies have been used clinically to treat KOA; however, the selection strategies of different CAM interventions in clinical practice are still uncertain, and the purpose of this study is to evaluate the efficacy and acceptability of different CAM therapies using systematic review and network meta-analysis.

METHODS

According to the strategy, the authors will retrieve a total of 7 electronic databases by October 2020, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chongqing VIP, and Wan-fang databases After a series of screening, 2 researchers will use Aggregate Data Drug Information System and Stata software to analyze the data extracted from the randomized controlled trials of CAM therapies for the KOA. Finally, the evidence grade of the results will be evaluated.

RESULTS

This study will provide a reliable evidence for the selection of CAM therapies for KOA.

CONCLUSION

The results of this study will provide references for evaluating the influence of different CAM therapies for KOA, and provide decision-making references for clinical research.

ETHICS AND DISSEMINATION

This study does not require ethical approval. The results will be disseminated through a peer-reviewed publication.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/GJMF4.

Complementary medicine in orthopaedic and trauma surgery: a cross-sectional survey on usage and needs

OBJECTIVES

Complementary and alternative medicine (CAM) is frequently used in Western countries within general medicine and internal medicine. Information on the use in orthopaedic and trauma surgery is widely lacking. The aim of this study was to investigate usage and needs regarding CAM for these patients.

DESIGN

Prospective paper-based, pseudoanonymous, cross-sectional survey.

SETTING

From August to December 2018, a questionnaire composed of 17 questions was distributed to all eligible patients.

PARTICIPANTS

In-house patients in orthopaedic and trauma surgery at a high-volume medical centre in Germany.

PRIMARY AND SECONDARY OUTCOME MEASURES

Previous or current usage of CAM, interest and requests towards CAM as well as communication about CAM.

RESULTS

Overall, 457 orthopaedic and trauma surgical patients took part in the survey. They were on average 52 years old and 54% were male. Most of the patients were admitted due to bone fractures and most underwent operative therapy. Previous or current CAM usage was stated by 76% and 30% of patients, respectively. Most of the patients stated to be interested in usage of CAM and demanded for more clinical usage of CAM and reliable information about CAM. More than 90% of patients did not discuss CAM interest or usage with their treating physicians. Patients stated that physicians should have knowledge about CAM. They wish to be treated in a holistic manner and want to strengthen self-efficacy.

CONCLUSIONS

Usage of CAM of patients in orthopaedic and trauma surgery appears to be high. Only a few patients discuss their interest and usage of CAM with their treating physician. Therefore, surgeons should ask their patients about CAM and should consider evidence-based CAM approaches for complementary treatment.

TRIAL REGISTRATION NUMBER

DRKS0001544.

Effects of bushen huoxue method for knee osteoarthritis: A protocol for systematic review and meta-analysis

BACKGROUND

Knee osteoarthritis (KOA) is a common progressive joint disorder in old people. Bushen huoxue (BSHX) is a classical method of TCM in treating KOA. However, there is no systematic review related to BSHX for KOA. The purpose of this study is to provide a comprehensive and reliable evaluation of the clinical evidence of BSHX in the treatment of KOA.

METHODS

We searched relevant studies on BSHX for KOA from the databases of PubMed, Embase, MEDLINE, Cochrane Library Central Register of Controlled Trials, China national knowledge infrastructure database (CNKI), Wan fang database, Chongqing VIP information, and SinoMed from their inception to May 2020. Two researchers will select and evaluate qualified studies independently. The primary outcomes of this review will focus on pain intensity. The meta-analyses will be performed by using the RevMan 5.3.

RESULTS

The study will provide a comprehensive evaluation of the efficacy and safety of the BSHX method for patients with KOA.

CONCLUSION

The results of this systematic review will provide evidence to judge whether BSHX is an effective intervention for patients with KOA.

The knowledge and self-management educational needs of older adults with knee osteoarthritis: A qualitative study

Knee osteoarthritis (KOA) is closely related with ageing, physical disability and functional dependency. The course of KOA is considered progressive and irreversible. Engagement with self-management may, however, minimize the impact of KOA. To be fully engaged with self-management activities, knowledge about KOA is a prerequisite. There is limited empirical data on older adults’ understanding on KOA and their information needs about KOA. Therefore, the aims of this study were to explore older adults’ knowledge about KOA and their perspectives on the information required to enable self-management. Three focus groups were conducted with 16 older adults with KOA. The sample consisted of three men and thirteen women with the mean age 73.2 years (range from 61 to 89). Thematic content analysis revealed two themes which were understanding about KOA and information needed about KOA. Participants’ knowledge about KOA varied between individuals with many expressing that they needed more information about KOA. A targeted strategy is needed to educate older adults about KOA in order to support and prepare them for self-management.

Comparison of kidney-tonifying and blood-activating medicinal herbs vs NSAIDs in patients with knee osteoarthritis: A protocol for a systematic review and meta-analysis

BACKGROUND

Knee osteoarthritis (KOA) is one of the most common chronic muscular diseases in old people. In recent years, people are more and more interested in the use of Chinese herbal medicine (CHM) in the treatment of KOA, such as kidney-tonifying and blood-activating medicinal herbs (KTBAMs) in the treatment of KOA. Many studies have confirmed that KTBAMs are effective in the treatment of KOA. However, it is still unknown whether KTBAMs and NSAIDs are more effective in the treatment of KOA. Therefore, we evaluated the efficacy and safety of KTBAMs and NSAIDs in the treatment of KOA.

METHODS

Randomized controlled trials (RCTs) from online databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Data, and Chinese Biomedical Literature Database that compared the efficacy of KTBAMs and NSAIDs in the treatment of KOA were retrieved. The main outcomes included the evaluation of functional outcomes, pain and adverse effects. The Cochrane risk of bias (ROB) tool was used to assess methodological quality.

RESULTS

The literature will provide a high-quality analysis of the current evidence supporting KTBAMs for KOA based on various comprehensive assessments including the total effective rate, visual analog scale scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequence scores, Knee Society Scale (KSS) scores, and adverse effects.

CONCLUSION

This proposed systematic review will provide up-to-date evidence to assess the effect of KTBAMs in the treatment for patients with KOA. RESEARCH REGISTRY REGISTRATION NUMBER: : reviewregistry 783.

Are Kidney-Tonifying and Blood-Activating Medicinal Herbs Better than NSAIDs for Knee Osteoarthritis? A Systematic Review and Meta-Analysis

Objective

To compare the efficacy and safety of kidney-tonifying and blood-activating medicinal herbs (KTBAMs) and nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of knee osteoarthritis (KOA).

Methods

Randomized controlled trials (RCTs) from online databases that compared the efficacy of KTBAMs and NSAIDs in the treatment of KOA were retrieved. The main outcomes included the evaluation of functional outcomes, pain, and adverse effects. The Cochrane risk-of-bias (ROB) tool was used to assess methodological quality.

Results

A total of 38 RCTs (3994 participants) were included in our meta-analysis. We found that KTBAMs had a significantly higher total effective rate (P < 0.00001, risk ratio (RR) = 1.08, confidence interval (CI) = 1.05 to 1.11, I² = 4%) and a lower gastrointestinal adverse reaction rate (P < 0.00001, RR = 0.36, CI = 0.24 to 0.53, I² = 33%) than NSAIDs. KTBAMs showed greater improvements in the Knee Society Scale (KSS) scores (mean difference (MD) = 7.17, 95% CI 0.71 to 13.64, P=0.03). Regarding the visual analog scale (VAS) scores, WOMAC scores, and Lequence scores, there were no significant differences between the KTBAM group and the NSAID group. The GRADE quality level of this systematic review indicated that the very low-quality evidence showed that KTBAMs had a higher total effective rate, while the moderate-quality evidence showed that the adverse reactions of KTBAMs were lower and the KSS scores were higher. Low-quality evidence showed no significant differences in improving VAS scores, WOMAC scores, or Lequence scores.

Conclusion

KTBAMs were superior to NSAIDs in terms of a higher total effective rate, a lower adverse reaction rate, and a higher KSS score. There were no significant differences between KTBAMs and NSAIDs in improving VAS scores, WOMAC scores, and Lequence scores of patients with KOA. Therefore, KTBAMs may be an alternative effective method for treating KOA. However, high-quality, well-designed RCTs with long-term follow-up are still required.

The necessity to develop a national classification system for Iranian traditional medicine

BACKGROUND

Classification of disease and interventions in traditional medicine (TM) is necessary for standardised coding of information. Currently, in Iran, there is no standard electronic classification system for disease and interventions in TM.

OBJECTIVE

The current study aimed to develop a national framework for the classification of disease and intervention in Persian medicine based on expert opinion.

METHOD

A descriptive cross-sectional study was carried out in 2018. The existing systems for the classification of disease and interventions in TM were reviewed in detail, and some of the structural and content characteristics were extracted for the development of the classification of Iranian traditional medicine. Based on these features, a self-administered questionnaire was developed. Study participants (25) were experts in the field of Persian medicine and health information management in Tehran medical universities.

RESULTS

Main axes for the classification of disease and interventions were determined. The most important applications of the classification system were related to clinical coding, policymaking, reporting of mortality and morbidity data, cost analysis and determining the quality indicators. Half of the participants (50%) stated that the classification system should be designed by maintaining the main axis of the World Health Organization classification system and changing the subgroups if necessary. A computer-assisted coding system for TM was proposed for the current study.

CONCLUSION

Development of this classification system will provide nationally comparable data that can be widely used by governments, national organisations and academic researchers.

The effectiveness and safety of acupuncture for knee osteoarthritis: An overview of systematic reviews

BACKGROUND

Knee osteoarthritis (KOA), known as severe degenerative arthritis, commonly occurs in middle-aged and elderly people all over the world. Acupuncture as traditional oriental intervention is getting widely used and several systematic reviews (SRs) have reported the effectiveness of acupuncture on pain relief and functional recovery in patients with KOA.

OBJECTIVE

Conducting an overview of SRs to provide more reliable evidence-based medical references for clinical practitioners and researchers of the effectiveness and safety of acupuncture for KOA.

DATA SOURCES

EMBASE, Medline, Web of science, the Cochrane library, China National Knowledge Infrastructure, the Chinese Science and Technology Periodical Database, China Biology Medicine, Wan Fang Digital Journals, and PROSPERO databases from inception to December 2018, magazines, websites, and unpublished sources.

SELECTION CRITERIA

Potential SRs were independently selected by 2 reviewers following a predetermined protocol.

DATA EXTRACTION

Data information of included SRs were independently extracted by 2 reviewers following a predetermined standardized data extraction form.

REVIEW APPRAISAL

The risk of bias and reporting quality of included SRs were evaluated by the Risk of Bias in Systematic reviews (ROBIS) tool and the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) statement. The quality of evidence of outcomes was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

RESULTS

A total of 12 SRs were included. All the SRs were published in recent 12 years, ranging from 2006 to 2017. According to ROBIS, 4 SRs were in low risk in domain 1 and 7 in domain 3 of phase 2, and 2 SRs were low risk in phase 3. Among 27 items of PRISMA, 19 items were reported over 70% of compliance. Using GRADE assessment, of 34 outcomes, high quality of evidence was found in 5 outcomes, 17 outcomes were rated moderate quality, and 11 outcomes were low quality. According to high-quality outcomes, acupuncture had more total effective rate, short-term effective rate, and less adverse reactions than western medicine in treating KOA. In terms of Lequesne index and Lysholm knee score scale score, the effectiveness of electroacupuncture was better than that of western medicine.

LIMITATIONS

There might be missing information. There may be duplicated clinical trials included by each SR that might have impact on the synthetic findings.

CONCLUSIONS

According to the high-quality evidence, we concluded that acupuncture may have some advantages in treating KOA. However, there are some risk of bias and reporting deficiencies still needed to be improved.

Role of SREBP2 gene polymorphism on knee osteoarthritis in the South Indian Hyderabad Population: A hospital based study with G595C variant

Introduction

Osteoarthritis (OA) is a multifactorial disease with genetic factors playing a crucial role, and it has been associated with a family history of obesity. G595C polymorphism in the sterol regulatory element-binding protein 2 (SREBP2) gene has demonstrated an association with knee osteoarthritis (KOA) patients. However, this polymorphism has been never explored in an Indian population. Hence, the current study aimed to examine whether G595C (rs2228314) polymorphism in SREBP2 gene was associated with KOA susceptibility in the South Indian Hyderabad population.

Methods

G595C polymorphism was genotyped with 200 KOA cases and 200 healthy controls using polymerase chain reaction-restriction fragment length polymorphism analysis.

Results

A significant association was observed between age, body mass index (BMI), and family histories in KOA cases and controls (p < 0.05). The current allele (C vs G; OR-2.8 [95%CI = 2.1-3.7]; p < 0.0001) and genotype analysis confirms the significant association with (GC + CC vs GG; OR-3.5 [95%CI = 2.3-5.3]; p < 0.0001 & GC vs GG + CC; OR-1.7 [95%CI = 1.0-2.9]; p = 0.02) KOA vs. control subjects. On stratification analysis, genotype CC and C allele were associated with KOA. Gender association failed to demonstrate positive genotype frequencies (p > 0.05). Multifactor-dimensionality reduction (MDR) analysis showed a positive association with BMI and G595C genotypes (p < 0.05); 51% of the homozygous variant CC genotypes were present in obesity subjects.

Conclusion

In conclusion, our findings suggest that G595C polymorphism in SREBP2 gene is associated with KOA in the South Indian Hyderabad population and presents scope for further investigation of the gene's function in KOA.

Natural products: An upcoming therapeutic approach to cancer

Cancer is one of the leading causes of death across the world. Different environmental and anthropogenic factors initiate mutations in different functional genes of growth factors and their receptors, anti-apoptotic proteins, self-renewal developmental proteins, tumor suppressors, transcription factors, etc. This phenomenon leads to altered protein homeostasis of the cell which in turn induces cancer initiation, development, progression and survival. From ancient times various natural products have been used as traditional medicine against different diseases. Natural products are readily applicable, inexpensive, accessible and acceptable therapeutic approach with minimum cytotoxicity. As most of the target-specific anticancer drugs failed to achieve the expected result so far, new multi-targeted therapies using natural products have become significant. In this review, we have summarized the efficacy of different natural compounds against cancer. They are capable of modulating cancer microenvironment and diverse cell signaling cascades; thus playing a major role in combating cancer. These compounds are found to be effective against several signaling pathways, mainly cell death pathways (apoptosis and autophagy) and embryonic developmental pathways (Notch pathway, Wnt pathway and Hedgehog pathway). This review article is expected to be helpful in understanding the recent progress of natural product research for the development of anticancer drug.

Therapeutic efficacy of extracorporeal shock wave combined with hyaluronic acid on knee osteoarthritis

This retrospective study investigated the efficacy and safety of extracorporeal shock wave (EPSW) combined with hyaluronic acid (HA) for patients with knee osteoarthritis (KOA).This retrospective study included 70 patients with KOA. Of those subjects, 35 of them received EPSW combined HA, and were allocated to a treatment group, while the other 35 participants received HA alone and were allocated to a control group. Patients in both groups were treated for a total of 8 weeks. The primary outcome was measured by visual analog scale (VAS). The secondary outcomes were measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and knee injury and osteoarthritis outcome score (KOOS). In addition, adverse events (AEs) were also evaluated. All outcomes were measured before and after the treatment.After the treatment, patients in the treatment group exhibited better efficacy in VAS (P < .01), WOMAC scale (pain, P < .01; function, P < .01; and stiffness, P < .01), and KOOS scores (pain, P < .01; function in daily living, P < .01; symptoms, P < .01; sport and recreation, P < .01; and quality of life, P < .01), than patients in the control group. In addition, no significant differences regarding the AEs were found between 2 groups.The findings of this study demonstrated that the efficacy of EPSW combined with HA is superior to the HA alone for patients with KOA.

Chrysin protects human osteoarthritis chondrocytes by inhibiting inflammatory mediator expression via HMGB1 suppression

High‑mobility group box chromosomal protein (HMGB‑1) contributes to osteoarthritis (OA) by modulating various oxidative, inflammatory and apoptotic signaling pathways. The effect of chrysin (CH), a natural plant flavonoid, and its functional interaction with HMGB‑1, was investigated in a chondrocyte model of OA. Human chondrocytes were pre‑treated with CH, and then subsequently treated with IL‑1β to induce the formation of chondrocytes similar to those found in OA joints. Next, the expression level of HMGB‑1 was determined by immunofluorescence and western blot analysis. Additionally, inflammatory factor expression was measured by ELISA, and cell apoptosis was analyzed with flow cytometry. To further explore the effects of CH, HMGB‑1 expression was silenced following CH treatment with small interfering (si)RNA. The results demonstrated that CH inhibited cell apoptosis, dose‑dependently reduced matrix metalloproteinase (MMP) 13, collagenase and IL‑6 expression, and increased collagen α‑1 (II) chain (COL2A1) expression in human osteoarthritis chondrocytes. These effects of CH were accompanied by decreased HMGB‑1 expression. Additionally, the expression of MMP13, collagenase, IL‑6 and COL2A1, as well as apoptosis, was significantly reduced by HMGB‑1 siRNA. These results demonstrated that HMGB‑1 is critical for the protective effect of CH on human osteoarthritis chondrocytes, including cell apoptosis and inflammatory factor inhibition, which suggests that CH may have potential therapeutic effect in treating OA by protecting human osteoarthritis chondrocytes via HMGB1 suppression.