BACKGROUND:Recently, glucocorticoid-induced necrosis of femoral head has been much studied. However, the precise Wnt signaling pathway by which puerarin suppresses adipogenic differentiation of glucocorticoid-induced bone marrow mesenchymal stem cells adipogenic differentiation of glucocorticoid-induced bone marrow mesenchymal stem cells remains unconfirmed. OBJECTIVE:To investigate the expression of Wnt signaling pathway related genes and the key factor protein,β-catenin, during adipogenic differentiation of glucocorticoid-induced rat bone marrow mesenchymal stem cells treated by puerarin. METHODS:The third generation of bone marrow mesenchymal stem cells were cultured with Dulbecco’s modified Eagle’s medium containing blank serum (blank control group), dexamethasone (hormone group), dexamethasone with puerarin low dose group, the middle dose group and high dose group. After 6 days of culture, in the above five groups, the expressions of Wnt/β-catenin signaling pathway members, Wnt10b mRNA, GSK3βmRNA,β-catenin mRNA, were detected using RT-PCR assay, and the expression ofβ-catenin protein was detected using western blot assay.
RESULTS AND CONCLUSION:Compared with the control group, the Wnt10b mRNA,β-catenin mRNA andβ-catenin protein expressions were significantly higher in puerarin groups, but GSK3βmRNA expression was significantly lower in the puerarin groups. These findings suggest that puerarin effects on inhibition of adipogenic differentiation of glucocorticoid-induced bone marrow mesenchymal stem cells probably are realized through the activation of Wnt/β-catenin signal pathway and regulation of the key factor Wnt10b mRNA, GSK3βmRNA,β-catenin mRNA, andβ-catenin protein expressions. The mechanism by which puerarin prevents glucocorticoid-induced necrosis of femoral head not only improves local microcirculation of the femoral head, but also relates to its inhibitory effects on adipogenic differentiation of glucocorticoid-induced bone marrow mesenchymal stem cells.

Objective To determine the expression of interleukin-21 (IL-21) in patients infected with hepatitis B virus (HBV) and its association with HBV-DNA and ALT. Methods Clinical dates and blood specimen were collected from 25 unrelated healthy controls (HC) and 101 independent chronic HBV infected patients, including 25 patients in immune tolerant phase (IT), 25 in immune clearance phase (IC), 26 patients in inactive HBV carrier state (IA) and 25 patients in immune reactive phase (IR). Serum IL-21 levels were measured by Cytometric Bead Array (CBA). IL-21 mRNA and IL-21 receptor mRNA were measured by real-time PCR. Results Chronic HBV-infected patients had higher levels of serum IL-21 and IL-21 mRNA , with P <0.001 for both. In subgroup analysis, both serum IL-21 and IL-21 mRNA levels in IC, IR were higher than those in IT, IA and HC (all P < 0.001). Serum IL-21 level in IA was higher than that in HC and IT (P <0.001, P = 0.036). IL-21R mRNA levels were different between groups. Serum IL-21 level was associated with HBV-DNA (r = -0.472, P < 0.001), but not with ALT. Conclusion IL-21, up-regulated in chronic HBV infection, is associated with immune activity and may play a key role in HBV control.

Objective To investigate the perioperative effects of simultaneous fixation and staging fixation in polytrauma patients combined with spine injury and long bone fracture.Methods A retrospective case control study was conducted to analyze the clinical data of 41 severe polytrauma patients with unstable spine combined with long bone fracture admitted from June 2009 to June 2015.There were 30 males and 11 females,aged 21-66 years [(41.2 ± 12.2)years].The injured spinal segments included cervical vertebrae in 11 patients,thoracic vertebrae in 15,lumbar vertebrae in 23,sacrococcygeal vertebrae in two,as well as injuries at two or more different segments in 10 patients.The long bone fracture segments included humerus in six patients,radius and ulna in 14,femur in 15,tibia and fibula in 14,as well as injuries at two or more different segments in eight patients.The injury severity score (ISS) were all ≥ 15 points.According to the timing of operation,the patients were divided into the simultaneous operation group (20 patients) and the staging operation group (21 patients).In the simultaneous operation group,there were 16 males and four females,aged (43.1 ± 12.6)years,and internal or external fixations of spine and long bone were performed at stage Ⅰ.In the staging operation group,there were 14 males and seven females,aged (40.1 ± 11.9)years.Spine fixation surgery was performed first,and then surgery for long bone fracture was performed after the conditions were stabilized.Spinal surgery methods included anterior subtotal vertebral resection,bone graft plate internal fixation,posterior laminectomy and decompression,and lateral mass screw or pedicle screw internal fixation.Plate and interlocking nail were used for internal fixation of long bone fracture,and single arm bracket for external fixation.The preoperative hospitalization time,operation time,operative blood loss (intraoperative hemorrhage and postoperative drainage),postoperative complications,hospitalization time and Frankel score of spinal cord injury before and after operation were compared between the two groups.Results The preoperative hospital stay was (9.3 ± 6.7) days in the simultaneous operation group and (5.6 ± 5.0) days in the staging operation group (P ＞ 0.05).The simultaneous operation group had significantly longer operation time [(4.9 ± 2.0) hours] than the staging operation group [(3.2 ± 1.2) hours] (P ＜ 0.01),more operative blood loss [(1 322.6 ± 507.1) ml] than the staging operation group [(1 036.7 ± 233.9) ml] (P＜0.05),and shorter hospitalization stay [(22.8 ± 12.6)days] than the staging operation group [(33.0 ± 15.4) days] (P ＜ 0.05).The complication incidence of the simultaneous operation group [45％ (9/20)] was significantly lower than that of the staging operation group [86％ (18/21)] (P ＜ 0.01).No significant difference was found in Frankel score between the simultaneous operation group [(3.3 ±1.7)points] and the staging operation group [(3.1 ± 1.5)points] (P ＞0.05).Conclusion For polytrauma patients combined with spine injury and long bone fracture,simultaneous operation can reduce hospitalization time and complication incidence compared with staging operation.

Objective To observe the clinical efficacy of Zhuanyaotang Granules for the treatment of degenerative lumbar spinal stenosis(DLSS).Methods Using a randomized double blind controlled design,104 DLSS patients were divided into an experimental group and a control group using a random number table method,with 52 patients in each group.The treatment group took oral Zhuanyaotang Granules,methylcobalamin tablets and celecoxib capsule simulants.The control group used Zhuanyaotang Granules simulants,methylcobalamin tablets and celecoxib capsules.The course of treatment was 3 weeks for both groups.The follow-ups were conducted at 1 month and 3 months after treatment.The intermittent claudication distance,visual analogue scale(VAS)score and JOA efficacy rating criteria for low back pain score were observed in both groups before treatment,1,2,3 weeks of treatment and 1 month after treatment and 3 months after treatment.Adverse reactions during treatment were recorded.Results There were 5 cases of detachment and 2 cases of exclusion in the experimental group,and 5 cases of detachment and 1 case of exclusion in the control group.Compared with before treatment,there were statistically significant differences in intermittent claudication distance,VAS score,and JOA score between the two groups of patients at various time points during treatment and follow-up(P<0.05);there was no statistically significant difference in intermittent claudication distance,VAS score,and JOA score between the experimental group and the control group before treatment and 1 and 2 weeks of treatment(P>0.05);compared with the two groups at 3 weeks of treatment and 1 and 3 months after treatment,the intermittent claudication distance and JOA score in the experimental group were lower than those in the control group(P<0.05);There was no significant difference in VAS score between the two groups and the control group after 3 weeks of treatment(P>0.05).There were 2 adverse reactions(4.4%)in the experimental group and 5 adverse reactions(10.8%)in the control group,without statistical significance(P>0.05).Conclusion Zhuanyaotang Granules can effectively relieve pain and improve lumbar function in patients with DLSS,which is more effective and safer than oral celecoxib capsules and methylcobalamin tablets.