Objective To evaluate the efficacy of total glucosides of paeony(TGP) in the treatment of undifferentiated spondyloarthropathies(uSpA) and investigate its mechanism.Methods One hundred and sixteen cases of uSpA were randomly assigned to 2 groups,one group was treated with TGP and diclofenac sodium,the other group with SASP and diclofenac sodium.The efficacy and side effects of the two groups were compared after 12 weeks treatment.The level of IL-6,IL-10 and TNF-? was determined at the same time.Result After 12 weeks treatment,the major clinical manifest and the indexes of disease activity were no difference of statistical significance in the two groups.The incidence of parenterally side effects was 8.6% in TGP group,and 25.9% in SASP group.There was difference at statistical significance between the two groups(? 2 =6.042,P=0.014).Before treatment,the level of IL-6,IL-10 and TNF-? in the serum of two groups were no statistical difference,while there was obviously difference after 12 weeks treatment(t= 2.672,2.483 and 2.088,P=0.009,0.014 and 0.039).Conclusion The efficacy of TGP and SASP has no significant difference in the treatment of uSpA.But the incidence of parenterally side effects in the TGP group was less than SASP group.The mechanism of efficacy of TGP may be related to inhibiting the production of IL-6,IL-10 and TNF-?.

OBJECTIVE: To study the effect of Yiqi Huayu Recipe on neurons in neuromuscular junction after L5 nerve root compression in rats. METHODS: By using immunohistochemistry, confocal laser scanning techniques and protein gene product 9.5 as a neuronal marker, the motor endplates were visualized with fluorescein-conjugated alpha-BTX. The effect of Yiqi Huayu Recipe on nerve terminals of neuromuscular junction at 10, 20, 30, 60 days after L5 nerve root compression was observed in rat soleus muscles during regeneration. The overlap areas of terminals and endplates were measured with NIH image technique. RESULTS: As for the aggregates, sprouts, extension of nerve terminal during regeneration, the connecting speed and range of nerve terminal with endplates, as well as the reformation of neuromuscular junctions during regeneration, Yiqi Huayu Recipe group was better than that of the control group. CONCLUSION: Yiqi Huayu Recipe can promote the hyperplasia of neurons and enhance the regeneration function. It also can accelerate the neuromuscular junction reformation and shorten the process of regeneration.

Objective To investigate the effect of total glucosides of paeony(TGP) on hepatic dysfunction caused by Methotrexate (MTX) and Leflunomide (LEF) in patients with moderate or severe rheumatoid arthritis (RA).Methods From July 2010 to February 2011,204 cases with definite-diagnosed rheumatoid arthritis were included in three hospitals in Anhui province.All these patients suffered from moderate or severe rheumatoid arthritis and they were divided randomly into two groups,the therapeutic groups were treated with TGP combined with MTX and LEF and the control group were treated without TGP.The incidence of hepatic dysfunction was observed.Statistical anylysis was carried out by using t test and x2 test.Results One hundred and ninty-four patients had completed observation for at least 12 weeks.In the therapeutic group,only 10 of 105 patients had hepatic dysfunction compared to 31 of 89 patients in the control group.The incidence of hepatic dysfunction of the therapeutic group was significantly lower than the control group.After 12 weeks treatment with TGP,the effective respohse rates of the therapeutic group was 81.9％,which was higher than 74.6％ in the control group.The good response rate in the therapeutic group was 21.6％,which was better than 11.7％ in the control group.Although the difference between the two groups was not statistically significant,we could observed the tendency of increasing in effectiveness and the good response rate in the therapeutic group when compared with the control group.Conclusion TGP can decrease the incidence of hepatic dysfunction during the treatment with MTX and LEF,and it may improve the therapeutic effecacy of patients with RA.

Objective To discuss the formation mechanism of teardrop fracture of the axis and observe the clinical efficacy of anterior or posterior induction operation according to the fracture type.Methods Thirteen patients with teardrop fracture of the axis treated from May 2001 to October 2010 were involved in the study.There were 10 males and 3 females,at age range of 18-55 years (mean,35.5 years).Four patients were combined with cervical spinal cord injury (one patient with grade C and two with grade D according American Spinal Injury Association,ASIA).Injury causes included traffic injury in 11 patients and fall from height in two.After admission,the anteroposterior,lateral and mouth X-ray films,spiral CT sagittal reconstruction and MRI examination of the cervical vertebra were performed in all the patients.According to the injury mechanism,there were 10 patients with extension fractures treated with C2,3 intervertebral bone fusion and internal fixation through submandibular retropharyngeal approach and three with flexion fractures treated with posterior C2,3 intervertebral bone fusion and pedicle screw fixation.The clinical efficacy was also observed. Results All patients received complete exposure and effective reduction and fixation.The average time of anterior exposure and posterior exposure was 77 minutes and 125 minutes,respectively.No surgical complications occurred.All patients were followed up for 9-34 months (mean,13 months).Reexamination at four months after operation displayed bone healing in all patients.There was no lessening or breakage of the internal fixators.The spinal function of three patients with ASIA grade D injury and that of one patient with ASIA grade C injury recovered to normal at postoperative 1.5 and 6 months respectively. Conclusion The surgical approaches for teardrop fracture of the axis developed in the light of the fracture formation mechanism are beneficial and safe.

Objective To investigate the feasibility and clinical effect of the posterior single segment anterolateral decompression and anterior column reconstruction in the treatment of thoracolumbar burst fractures. Methods A retrospective study was done on 21 patients with type Denis B thorocalumbar burst fractures who were treated by posterior approach minimal incision pedicle SCreW fixation,single segment anterolateral decompression and titanium mesh and bone graft from August 2007 to August 2009.There were 15 males and six males at mean age of 35.6 years(range,23-50 years).The involved segments included T12 in six patients,L1 in 11,L2 in three,and L3 in one.The preoperative spinal canal enemachment rate was 62.5%and the anterior-middle vertebral compression of all patients was less than 50%.CT scanning showed normal vertebral body and inferior endplate structure.The fracture reduction,graft fusion,neurological function recovery,correction loss,lumbar activities and adjacent lumbar disc degeneration were observed through preoperative,immediate postoperative and final follow up X-ray,CT and neurological examinations. Results The operation duration was 1.5-3.2 hours(average 2.1hours),with the bleeding of 350-1 000 ml(average 580 ml).All the patients were followed up for 4-26months(average 10.3 months),which showed that the vertebral fusion time was 4-6 months,with no loss of the vertebral height,implant breakage,loosening or extrusion.The nerve function was improved for 1-2 grades. Conclusions With correct selection of the indications,the posterior single segment anterolateral decompression and anterior column reconstruction is a reliable fixation,for it takes advantages of simple operation,minor trauma,less fusion segments and fast recovery.

To investigate the gene expression changes in the degenerated cervical intervertebral discs of rats, and to study the function of Yiqi Huayu Bushen Recipe, a compound Chinese herbal medicine, and its discomposed formulas in regulating gene expressions in the degenerated cervical intervertebral discs.

Objective To explore the effect of high loading dose of clopidogrel on myocardial microcirculation in patients with ST segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(PCI). Methods Sixty-four STEMI patients were divided into 300 mg clopidogrel group(n =32)and 600 mg clopidogrel group(n = 32)randomly. Myocardial blush grades,sum-ST-segment resolution (sumSTR%),placental growth factor(PIGF),soluble CD40 ligand(sCD40L)and left ventricular ejection fraction (LVEF%)were compared after PCI. Results There was no significant difference between the two groups in basic clinical or angiographic characteristics before PCI(P＞0. 05). Compared with the 300 mg clopidogrel group,patients in the 600 mg clopidogrel group had higher percentage of blush grade 3 of infarct related arteris(21.88%vs. 50. 00% ,P ＜0.05)and higher sumSTR%((70. 90 ±9. 51)% vs.(60. 70 ± 15.06)% ,P ＜0. 05). There were lower serum PIGF levels(14.37 ± 1.32)ng/L vs.(15. 85 ± 1.71)ng/L,P ＜ 0. 05)and sCD40L levels(4. 93 ±0. 71)μg/L vs.(5.68 ± 0. 77)μg/L,P ＜ 0.05)in patients in the 600 mg clopidogrel group after PCI. Seven days after PCI,the LVEF was significantly increased in the 600 mg clopidogrel group(70.96 ± 9. 51)% vs.(65. 27 ±9. 85)% ,P ＜ 0.05). Conclusions High loading dose of clopidogrel before primary PCI can improve myocardium microcirculation in patients with STEMI.

Objective The aim of this study is to examine the expressions of Toll like receptor (TLR) 7 and TLR9 in the peripheral blood B lymphocytes of SLE patients and to analyze the correlation between TLR7/9 and clinical parameters. Methods lntracellular expression of TLR7/9 in the peripheral blood CD19+Blymphocytes was analyzed in 50 SLE patients and 30 healthy controls by flow cytometry. The difference of intracellular TLR7/9 expression levels in two groups was compared. Furthermore,the correlation between TLR7/9 expression and clinical parameters such as ESR, CRP, complement 3 (C3), complement 4 (CA), the level of serum IgG, anti-double stranded DNA antibody, anti-nuclear antibodies, SLEDAI score and urine protein excretion level, were analyzed. Results Compared with healthy subjects, the proportion of B cells expressing TLR7 and TLR9 was higher among SLE patients. Positive correlation was observed between TLR7 expression levels and clinical measurement of the SLEDAI and ESR. Negative correlation was observed between TLR7 expression levels and serum C3 levels. Positive correlation was observed between TLR9 expression levels and SLEDAI scores. Negative correlation was observed between TLR9 expression levels and serum C3 levels. Conclusion TLR7 and TLR9 expression is increased in the peripheral blood B cells of SLE patients, and correlates well with clinical parameters.

OBJECTIVE: To study the effects of Gegen Recipe and Guizhi Recipe regulating the expression of IL-1beta, iNOS, TNFalpha and TGFbeta mRNA in degenerated intervertebral disk caused by stimulation of wind, cold and damp. METHODS: Thirty-six rabbits were randomly separated into six groups, viz. control group, stimulation by wind, cold and damp group, head in low-location group, compound model group (head in low-location plus stimulation of wind, cold and damp), Gegen Recipe group and Guizhi Recipe group. The gene expression of IL-1beta, iNOS, TNFalpha and TGFbeta mRNA in degenerated cervical intervertebral disks were assayed by RT-PCR. RESULTS: Compared with the control group, IL-1beta mRNA and iNOS mRNA expression were up-regulated in each model group(P<0.01). Both Gegen Recipe and Guizhi Recipe down-regulated IL-1beta mRNA, iNOS mRNA expression, which had significant differences compared with the stimulation model group(P<0.01 or <0.05). TNFalpha mRNA expression was significantly enhanced in the compound model group compared with the control group (P<0.01). There was no significant difference between the head in low-location group and the stimulation model group. Gegen Recipe down-regulated TNFalpha mRNA expression compared with the stimulation group(P<0.01),while the effect of Guizhi Recipe was not significant. Compared with the control group, TGFbeta mRNA expression went down in each model group(P<0.01). Gegen Recipe up-regulated TGFbeta mRNA expression(P<0.01), while the effect of Guizhi Recipe on adjusting TGFbeta mRNA was not significant. CONCLUSION: Stimulation by wind, cold and damp, head in low-location, and compound of both can down-regulate the expressions of IL-1beta, iNOS, TNFalpha mRNA, and up-regulate the expression of TGFbeta mRNA. These researches certify that these factors take part in the progression of intervertebral disk degeneration. IL-1beta, iNOS, TNFalpha accelerate the degeneration and TGFbeta defers the degeneration. Gegen Recipe down-regulates the expression of TNFalpha mRNA and up-regulates the expression of TGFbeta mRNA. The effect on regulating the cell factors expressions by Guizhi Recipe is lower than that of Gegen Recipe.

OBJECTIVE: To study the effect of Yiqi Huayu Recipe on peanut agglutinin-binding molecules (PNA-BMs) and Schwann's cells (Sc) of the neuromuscular junction after L5 nerve root compression in rats. METHODS: The rats were given Yiqi Huayu Recipe at the 10th, 20th, 30th and 60th day after L5 nerve root compression. Using immunohistochemistry and confocal laser scanning techniques, we observed the distributions of PNA-BMs and S-100 in the soleus muscle. The overlap area of PNA-BMs and S-100 was measured with NIH image technique. RESULTS: The extracellular matrix (ECM) recognized by PNA played an important role in guiding the sprouting and extending of the Schwann's cells. The agglomeration, sprouting and extension of the terminal Sc and the overlap area of Sc with PNA-BMs in the Yiqi Huayu Recipe group were better than those in the control group. CONCLUSION: Yiqi Huayu Recipe can promote the growth of ECM and Schwann's cells and accelerate the nerve regeneration process.