OBJECTIVE:To establish the quality standard for Mongolian medicine Yishen powder. METHODS:TLC was used for the qualitative identification of Rheum palmatum and Terminalia chebula in the preparation;HPLC was used for the contents de-termination of aloe emodin,rhein,emodin,chrysophanol and physcion:the column was Inertsil C18 with mobile phase of metha-nol-0.1% phosphoric acid(gradient elution)at a flow rate of 1.0 mL/min,detection wavelength was 254 nm,column temperature was 35 ℃ and the injection volume was 10 μL. RESULTS:The TLC pots of R. palmatum and T. chebula were clear and well-sepa-rated,negative control without interference. The linear range was 23.55-117.75 ng for aloe emodin(r=0.9999),44.72-223.62 ng for rhein(r=0.9998),43.18-215.90 ng for emodin(r=0.9997),77.41-387.12 ng for chrysophanol(r=0.9999)and 46.02-230.10 ng for physcion (r=0.9997);RSDs of precision,stability and reproducibility tests were lower than 2.0%;recoveries were 95.80%-99.66%(RSD=1.21%,n=6),95.01%-98.07%(RSD=0.92%,n=6),95.06%-97.84%(RSD=0.5%,n=6),95.19%-97.66%(RSD=1.07%,n=6)and 95.07%-98.20%(RSD=0.95%,n=6). CONCLUSIONS:The established standard can be used for the quality control of Mongolian medicine Yishen powder.

Objective To observe the effect of meisoindigo on co-culture leukemic cells and bone marrow stromal cells.Methods Bone marrow stromal cells were cultured using bone marrow mononuclear cells from patients with leukemia,and built the co-culture leukemic cells and bone marrow stromal cells.Trypan-blue-exclusion test detected the proliferation of leukemic cells.The expression levels of membrane CXCR4 on leukemic cells were assessed by flow cytometric analysis.Results Bone marrow stromal cell of leukemia could inhibit leukemic cells proliferation,leukemic cells could be promoted their growth when exposed to low concentration (5 μmol/L) of meisoindigo.Abnormal high expression of CXCR4 in leukemic cells,and meisoindigo could markedly inhibit the expression of CXCR4 in HL-60 and del leukemic cells.Expression of CXCR4 in leukemic cells can up-regulated by bone marrow stromal cells from patients with leukemia.Conclusion Meisoindigo can down regulate expression of CXCR4 in leukeimic cells to antileukemic cells.

Aim To explore the effect of genetic poly-morphisms of POR on the stable warfarin maintenance doses in Han Chinese patients receiving mechanical heart valve replacement. Methods The association between POR gene polymorphisms and warfarin doses of 185 Han Chinese patients were investigated through ANOVA or t test. SNPs of POR and VKORC1 were de-tected by Sequenom? DNA MassArray genotyping method. CYP2C9*3 was genotyped by polymerase chain reaction-restriction fragment length polymorphism method ( PCR-RFLP ) . Patients ’ clinical characteris-tics, INR value and daily dose were obtained from their medical records. Statistical analysis was performed by SPSS 21. 0 software. Results No mutant carriers of POR rs17148944 , POR rs56256515 and rs72553971 were found in this study. The genotype frequencies of other SNPs were in accordance with Hardy-Weinberg e-quilibrium. In the group of patients with CYP2C9*1*1 , the mutant type carriers ( T carriers ) of POR rs17685 had a significantly higher dose than CC carri-ers(3. 50 ± 1. 07) mg·d-1 vs (3. 14 ± 0. 94) mg· d-1,P =0. 03. Also, in the group of patients with CYP2 C9*1*1 and VKORC1 rs9934438 G allele carri-ers, the mutant type carriers ( T carriers ) of POR rs17685 had a significantly higher dose than CC carri-ers(4. 76 ± 0. 90) mg·d-1 vs (4. 08 ± 1. 03) mg· d-1 ,P=0. 04. No significant difference was found in different genotypes of POR rs2868177 . Conclusion These results illustrate that POR rs17685 T carrier is closely associated with a higher warfarin maintenance dose, suggesting that this SNP is useful for clinical guidance of warfarin.

Objective To discuss the clinical characteristics and treatment of upper cervical spine injuries in the elderly. Methods A retrospective study was done on clinical data of 28 elderly patients ( > 60 years old) with upper cervical spine injuries treated from January 2003 to December 2007. There were 20 males and 8 females, at age range of 60-86 years (mean 68.1 years). Injury causes included slip in 16 patients, traffic injury in eight and fall from height in four. Atlas fractures occurred in five patients and axis ones in 15,of which there were eight patients with odontoid fractures, six with C2 vertebral arch fractures and one with C2 body fractures. Upper cervical spine injury was combined with lower cervical spine injuries in five patients. There were combined atlantoaxial injuries including odontoid fractures combined with lateral atlas fracture in one and edontoid fractures combined with anterior atlas arch fracture in one. Atlantoaxial dislocation occurred in one patient and combined spinal injury in four. Of all, eight patients were treated conservatively, eight with open surgical operation and 12 with minimally invasive surgery. Results The average hospital stay was 16.5 days, with no statistical difference be-tween conservative treatment group and open surgical operation group ( P > 0.05 ). While the average hos-pital stay in minimally invasive surgery group was shorter than that in conservative treatment and open sur-gical operation groups ( P < 0.05 ). Of all, two patients in conservative treatment group and one in open surgical operation group died and the other 25 patients were followed up for average 16.8 months (9-56 months). The satisfaction rate was 50% in conservative treatment group, 72% in open surgical operation group and 75% in minimally invasive surgery group. Complications occurred in four patients in conserva-tive treatment group, three in open surgical operation group and two in minimally invasive surgery group. Conclusions With odontoid fracture the most common injury type, upper cervical spine injuries arema-inly caused by low-energy force and characterized by low mobidity of spinal cord injuries and high possi-bility of missed diagnosis in the elderly patients. The surgical treatment especially minimally invasive surgery can bring good results compared with conservative methods.

Objective To explore different treatment choices for unilateral cervical facet locking. Methods The study involved 32 patients with cervical unilateral facet locking. Successful reduction by the skull traction was done in eight patients, of whom three were fixated by the head and neck chest plas-ter after a month of traction. Five patients were treated with anterior decompression and internal fusion fixation. The other 23 patients resulted in failure of traction and then were treated with anterior reduction, discectomy and internal fusion fixation in 14 patients, subtotal vertebral decompression and bone graft fix-ation in three, posterior open reduction and anterior bone graft fixation in one, posterior reduction, fixation and internal fusion fixation in three and posterior reduction and decompression plus anterior discectomy decompression and bone graft fixation in two. Due to misdiagnosis, one patient was treated with anterior decompression and fusion eight months after injury. Results A follow-up for average 18 months showed cervical instability in two patients who were treated with only traction, without fusion. The patients treated with anterior cervical fusion obtained bone union after 12 weeks, with satisfactory cervical physiological curvature and vertebral height. There were no internal fixation complications or neurological complications. Conclusions The treatment of lower cervical unilateral facet locking needs a compre-hensive considerations on whether there associates with disc injury, posterior column fractures or spinal cord injuries. As for patients with lower cervical unilateral facet locking combined with traumatic cervical disc herniation, the anterior reduction and decompression is the choice of treatment. While for those with-out disc herniation, traction or posterior open reduction and fixation can be carried out directly.

[Objective] To optimize the conditions of the extracting process of Hujin Granules. [Methods] The orthogonal design was applied. With the total emodin and the total anthraquinone (TA) content as the parameters for the alcohol-extraction, the concentration of alcohol, the volume of solvent and the extracting time were used for optimization of alcohol-extraction. With the total polysaccharide (TP) as the parameters for water-extraction, the soaking time, the volume of water and the extracting time were used for optimization of water-extraction. [Results] The optimum conditions of alcohol-extraction were: extracting with 70% alcohol 245 mL for 2 hours and extracting twice. The optimum conditions of water-extraction were: extracting with 80 mL water (not for soaking) for 1.5 hours, extracting 3 times. [Conclusion] The results indicate that the extracting process is rational and feasible, and can provide evidence for the extracting process of Hujin Granules.

Objective To evaluate the mid-term clinical effects and the imaging changes of Coflex interspinous dynamic internal fixation for low back pain. Methods From February 2007 to June 2009,Coflex interspinous dynamic internal fixation was performed in a consecutive 45 patients. They included 26 males and 19 females, with an average of 51.4 years ranging in age from 45 to 70 years. Thirty-two cases were in L4.5 level, 11 in L5S1 level and 2 in both two levels. The patients were treated with limited laminectomy and implanted with Coflex device. Clinical outcomes were assessed by Oswestry disability index (ODI)scores and Japanese Orthopaedic Association (JOA) questionnaires before and after operation. The imaging examination was obtained to assess height of the intervertebral space, area of the intervertebral foramen,segment movement of the operation level, low lumbar curvature and signal of the lumbar disc on MRI. Results The follow-up time ranged from 10 to 34 months, with an average of 24 months. The ODI scores decreased significantly from 62.82±10.42 preoperatively to 11.80±3.35 postoperatively. The JOA scores were improved remarkably from 9.00±2.63 preoperatively to 24.65±1.86 postoperatively. The proportion with optimal effect was 89% (40 cases). The Cobb angle after operation of L4.5 and L5S1 level was 15.1°±3.9° and 16.3°±3.8° respectively, which was significantly decreased after operation. The range of motion of the L4.5 level increased from 6.5°±1.5° to 8.4°±2.6° while the L5S1 level did not change notedly. The heights of the dorsal intervertebral disc, distance of the spinous processes, intervertebral foramen height and area were significantly higher than those before operation. Conclusion The Coflex interspinous dynamic internal fixation is available to reserve segment movement, to increase intervertebral space height and foramen area. Meanwhile,it is effective to self-repair and prevent degeneration for the disc in adjacent levels.

Objective To investigate complications associated with Coflex interspinous process device for degenerative lumbar disc diseases and methods to treat.Methods Clinical data of 121 patients with degenerative lumbar disc diseases,who had undergone surgical decompression and additional fixation of Coflex between November 2007 and June 2011,was analyzed retrospectively.There were 76 males and 45 females,aged from 37 to 75 years (average,54.6 years).Surgery-related complications and sequelae were recorded and analyzed.Results Surgery-related complications occurred in 10 patients,and the incidence was 8.3％ (10/121).There were 3 cases of device-related complications,including wing break in 1 case,prosthetic loosening in 1 case and spinal process fracture in 1 case; all 3 cases were treated conservatively and received good results.There were 7 cases of non-device-related complications,including dura mater dilaceration in 2 cases,superficial wound infection in 1 case,insufficient decompression of spinal canal in 2 cases,recurrence of disc herniation in 1 case,and intraspinal hematoma in 1 case; the former 3 patients recovered after corresponding treatment,and the latter 4 patients also recovered after re-operation.Conclusion The incidences of complications and re-operation associated with application of Coflex are low,and the incidence of device-related complications is also low.The precise intraoperative manipulation is the key to reduce incidence of device-related complications.It's absolutely necessary to strictly master surgical indications and perform sufficient decompression in order to receive good surgical results and avoid non-device-related complications.

Objective: To investigate the efficacy of enticavir and lamivudine in preventing rituximab-associated hepatitis B virus(HBV) reactivation in patients with B-cell non-Hodgkin lymphoma complicated with resolved hepatitis B during chemotherapy. Methods: This retrospective study included 216 B-cell non-Hodgkin lymphoma patients with complete data from January 2012 to January 2018 treated in 3 hospitals.Of 78 patients with resolved hepatitis B, they were divided into lamivudine prophylactic group(17 cases), entecavir prophylactic group(11 cases) and control group(50 cases). The changes of HBVM, HBV DNA and liver function before or after rituximab combination chemotherapy were analyzed.The incidence of HBV reactivation, liver function injury and chemotherapy delay were compared. Results: Compared to the other 71 patients, 7 cases experienced HBV reactivation in 78 patients with resolved hepatitis B. There were no statistically significant differences between the two groups in patient demographics, pathological pattern, chemotherapy regimen.Six patients in the control group developed HBV reactivation(12%) and 1 patient in lamivudine prophylactic group(5.88%), none had HBV reactivation in enticavir prophylactic group.There was statistically significant difference among three groups(Fisher P=0.016). A total of 7 cases experienced HBV reactivation in 78 patients with resolved hepatitis B respectively, 2 cases in the first chemotherapy period, 2 cases in the third chemotherapy period, 1 case in the fifth chemotherapy period, the last one occurred after the completion of chemotherapy.Four patients had HBsAg reverse seroconversion, occurred in the 1, 3, 5 cycles during and after the completion of chemotherapy.Twenty patients (40.0%) experienced liver function parameters abnormal in the control group, 4 cases(23.5%) in lamivudine prophylaxis group, 2 cases (18.2%) in enticavir prophylaxis group during chemotherapy. Conclusion Antiviral prophylaxic therapy can potentially prevent rituximab associated HBV reactivation in patients with resolved hepatitis B. Entecavir can more reduce the risk of rituximab associated HBV reactivation than lamivudine.

Objective:To ascertain the activity concentration of gross α and β in foods around Fuqing nuclear power plant (NPP) site.Methods:Totally 167 food samples of 25 kinds within 6 categories were collected from the surveillance areas and control areas around Fuqing NPP site. The total radioactivity was analyzed using the food samples. Paired rank sum test was used to determine the influence of the operation of Fuqing NPP on the total radioactivity in foods in surrounding areas. The multiple local rank sum test was used to assess the difference in total radioactivity in different types of foods.Results:The average gross α in poultry meat, vegetables, crops, aquatic products, milk and tea was 0.65, 1.96, 1.41, 3.80, 1.33, 7.67 Bq/kg in surveillance areas and 0.56, 3.24, 2.04, 3.70, 2.24, 9.05 Bq/kg in reference areas, respectively, around Fuqing NPP site. The average gross β (subtracting 40K) in poultry meat, vegetables, crops, aquatic products, milk and tea was 7.0, 10.5, 6.1, 23.5, 24.7, 8.6 Bq/kg in surveillance areas and 7.4, 8.3, 14.5, 22.1, 21.3, 11.0 Bq/kg in reference areas, respectively, around Fuqing NPP site. The Wilcoxon paired rank test showed that there was no significant difference in the gross α and β in foods between surveillance and reference areas around Fuqing NPP site ( P>0.05). The Kruskal-Wallis H test showed that the radioactivity of gross α and β in different foods was statistically significant ( χ2=23.325, 13.918, P<0.05). Conclusions:The increase was not found in total radioactivity in the surrounding foods since the operation of Fuqing NPP in 2015.