Injury to anterior cruciate ligament (ACL) is the most common lesions of the knee joint. Reconstruction of ACL has been the primary treatment for the instability of the knee. Compared with the traditional reconstruction with patellar tendon, the hamstring tendon has many advantages, such as less damage to the donor site and less incidence of antero-patellar or kneeling pain. This paper highlights the basic and clinical research on ACL reconstruction.

Objective To evaluate and compare the clinical effects of forward and reverse anterior cruciate ligament (ACL) reconstruction through the arthroscopy. Methods From April 2008 to August 2009,97 cases with simple ACL injures were treated with eight strands of hamstring tendons in way of two-bundle and four-tunnel reconstruction. The patients were randomly divided into two groups according to the number of hospital admissions: odd numbers (A group, 47 cases) were treated with forward double-bundle reconstruction and even (B group,50 cases) were treated with reverse. The grafts were fixed with a suspension technique by mini-plates and mini-buttons. Mean follow-up exceeded one year. The function of knee joint were assessed by the IKDC, Lysholm and Tegner rating scale. Results Mean follow-up was 13.71 months.At the last follow-up, 2 patients in A group had a 10°extension deformity and 5 had a less than 15° flexion limitation. All patients in B group showed normal knee extension, and 4 had a 5° flexion limitation. According to Lachman test, there were one case with one plus positive and one with two plus positive in A group,and one with two plus in B. KT-1000 examination (30° flexion and 30 N) showed the side to side mean difference of anterior knee laxity was (1.04±1.11) mm in A group and (0.86±1.12)mm in B. According to objective IKDC evaluation, the results were graded as normal or nearly normal in 46 patients in A group and 48in B. There were no statistical differences in the IKDC, Lysholm, and Teguer scores between two groups.Conclusion Forward or reverse ACL double-bundle reconstruction with eight strands of hamstring tendons can both restore knee stability, and there is no significant deviation between the two techniques.

Objective The purpose of this study is to evaluate the relevance of the recovery of proprioception function and the reservation of residual torn ligamentous fiber in the anterior cruciate ligament (ACL)reconstruction.Methods A retrospective study was carried out in 65 cases of ACL injury,who were treated with double-bundle ACL reconstruction and tibial remnant preservation and tensioning.All the patients were divided into four groups according to the degree of tibial residual fiber observed in the operation,no residual fiber was found(Group A),the length of the residual fiber was less than one third of the normal ACL(Group B),the length of the residual fiber was more than one third less than two thirds of the normal (Group C),the length of the residual fiber was more than two thirds of the normal(Group D).After one year follow-up,the passive angle reproduction test was performed with magnetic angle instrument in 3 flexion ranges(flexion of 90°-60°,60°-30°,and 30°-0°).All the results were contrasted among the four groups by statistical methods.Results In the passive angle reproduction test of the 3 flexion ranges,Group A and B showed a significant difference between the test side and control side(P＜0.05),and Group C showed a significant difference between the test side and control side at the flexion of 30°-0°(P＜0.05),but Group D showed no significant difference at the 3 flexion ranges(P＞0.05).Conclusion During double-bundle ACL reconstruction,with the reservation of tibial residual tom ligamentous and tensioning may have a good effect on the recovery of proprioception function of the knees,which ensure a better functional outcome in the reconstructed knee.

ObjectiveTo comprehend the similarities and differences of postoperative quality of life between mastectomie avec dissection axillaire and modified radical mastectomy among patients with breast cancer,and in order to supply references for establishing corresponding nursing measures. Methods160patients with early breast cancer were selected,40 patients accepted the mastectomie avec dissection axillaire (the conservative group)and 120 patients accepted modified radical mastectomy (the radical group).The quality of life of patients was surveyed with questionnaires. ResultsThe EORTC QLQ-C30 score of the conservative group was not significant than the radical group.The EORTC QLQ-BR 23 score showed that the conservative group had a better self-evaluation of their configuration. ConclusionsThe patients who accepted the mastectomie avec dissection axillaire will live a better life than those who accepted modified radical mastectomy.

Objective : To investigate the efficacy and safty of radiofrequency ablation for arrhythmia. Methods: The clinical data of 1 065 patients with arrhythmia by Radiofrequency ablation treatment were analyzed retrospectively, including 537 cases of atrioventricular nodal reentrant tachycardia, 386 cases of atrioventricular reentrant tachycardia, 59 cases of ventricular premature, 26 cases of ventricular tachycardia, 35 cases of atrial flutter, and 8 cases of paroxysmal atrial fibrillation. Results:The procedural succeed rate was 96. 80% , and complication was 1. 56%. Conclusion: Radiofrequency ablation was an safe and effective method in treating arrhythmia.

ObjectiveTo investigate the effect of Zuoguiwan on pancreatic islet function in offspring of gestational diabetes mellitus （GDM） maternal rat model and explore the mechanisms of Zuoguiwan in improving pancreatic islet function based on postpartum pancreatic regeneration. MethodHealthy female SD rats with normal blood glucose levels were paired with male rats in a 2∶1 ratio and housed together. Pregnancy was confirmed based on vaginal plugs or vaginal smears. The pregnant rats were divided into the following groups： normal group， model group， insulin group （insulin Detemir， 20 U·kg^-1）， low-dose Zuoguiwan group （1.89 g·kg^-1）， and high-dose Zuoguiwan group （3.78 g·kg^-1）. The GDM rat model was induced using streptozotocin in rats except for those in the normal group. The model was confirmed by blood glucose testing in the maternal rats. Except for the normal and model groups， the other groups received daily administration of corresponding treatments. At 21 days after birth， fasting blood glucose （FBG） and fasting serum insulin （FINS） levels were measured in 6 offspring from each group. The homeostasis model assessment of insulin resistance （HOMA-IR） was calculated， and an oral glucose tolerance test （OGTT） was performed on additional 12 offspring from each group. Blood samples were taken from the abdominal aorta of the offspring at postnatal day 22， and enzyme-linked immunosorbent assay （ELISA） was used to measure insulin， glucagon （GC）， pancreatic polypeptide （PPY）， and somatostatin （SS） levels in the serum. Hematoxylin-eosin （HE） staining was performed to observe pathological changes in the pancreatic tissue of the offspring. Immunofluorescence （IF） was used to observe the area and structure of the pancreatic islets. Western blot was used to detect the expression of key proteins involved in the development and functional expression of pancreatic β-cells， namely pancreatic and duodenal homeobox factor 1 （Pdx1）， Nkx6.1， and Glucose transporter 2 （Glut2）. ResultCompared with the normal group， the model group showed significant increases in FBG and FINS levels， and HOMA-IR （P<0.01）. Compared with the model group， the insulin group showed significant decreases in FBG levels and HOMA-IR （P<0.01）， the low-dose Zuoguiwan group showed a significant decrease in FBG levels （P<0.05）， and the high-dose Zuoguiwan group showed significant decreases in FBG and FINS levels， and HOMA-IR （P<0.01）. Compared with the normal group， the model group showed significant increases in OGTT 60-min blood glucose levels and AUC index （P<0.05， P<0.01）. Compared with the model group， the high-dose Zuoguiwan group showed significant decreases in OGTT60-min blood glucose levels and area under the curve（AUC） index （P<0.05， P<0.01）. HE staining of pancreatic tissue showed that compared with the normal group， the model group had a reduced number of islets and a loose arrangement of acinar cells. Compared with the model group， the groups with drug treatment showed increased number of islets and a compact arrangement of acinar cells. Compared with the normal group， the model group had significantly increased levels of insulin， GC， PPY， and SS in the serum （P<0.01）. Compared with the model group， the low-dose and high-dose Zuoguiwan groups and the insulin group showed significantly decreased serum levels of insulin， GC， PPY， and SS （P<0.05， P<0.01）. IF results showed that compared with the normal group， the model group had a significantly lower positive rate of insulin （P<0.05）. Compared with the model group， the low-dose and high-dose Zuoguiwan groups showed a significant increase in the positive rate of insulin （P<0.05）. There was no significant difference in the positive rate of GC among the groups. In terms of the proportion of insulin and GC in individual islets， compared with the normal group， the model group showed a significant decrease in the proportion of insulin （P<0.01） and a significant increase in the proportion of GC （P<0.01）. Compared with the model group， the low-dose and high-dose Zuoguiwan groups showed significantly increased proportion of insulin （P<0.01） and significantly decreased proportion of GC （P<0.01）. Compared with the normal group， the model group showed significantly decreased expression levels of Pdx1， Nkx6.1， and Glut2 proteins in the pancreatic tissue of GDM offspring （P<0.05）. Compared with the model group， the insulin group and the low-dose Zuoguiwan group showed significant increases in the expression levels of Pdx1 and Nkx6.1 proteins in the pancreatic tissue of GDM offspring （P<0.05）， and the low-dose and high-dose Zuoguiwan groups showed significant increases in the expression levels of Glut2 protein （P<0.05）. ConclusionZuoguiwan can promote pancreatic islet development in offspring of GDM maternal rat model， improve pancreatic islet morphology and function， and alleviate insulin resistance. Its mechanism of action may be related to the regulation of Pdx1， Nkx6.1， and Glut2 protein expression in the pancreatic tissue of offspring.

Objective To describe the surgical technique and outcomes of arthroscopic reconstruction anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) and repair of the injured posteromedial complex (PMC) or posterolateral complex (PLC) structures of the knee joint in treatment of multiple ligaments injuries of knee. Methods From March 2005 to May 2007, 43 patients with multiple ligaments injuries of knee underwent arthroscopic reconstruction. Twenty-four patients were treated with arthroscopic reconstruction of combined ACL and PCL with allograft tendons and augmentation of PMC. The other 19 patients were treated with repair the PLC in addition to reconstruction of ACL and PCL. The International Knee Documentation Committee (IKDC) and Lysholm knee score were used for function evaluation. Results All patients were followed up for 24 to 48 months with an average of 33.10±9.65 months. The stability recovered when stress was applied to the knee at 0° and 20° of flexion. According to IKDC there was a significant improvement from severely abnormal (graded D) in 43 cases before surgery to normal (graded A) in 29 cases (67%), nearly normal (graded B) 11 cases (26%) and abnormal (graded C) 3 cases (7%) at follow-up. The average Lysholm score of the all cases were 46.7±4.2 and 89.6±2.8 before operation and at final follow-up, respectively (t=8.563, P＜0.01). Conclusion Excellence clinical results and good stability were achieved with arthrescopic reconstruction of ACL and PCL combined with repair or augmentation of the PMC and PLC simultaneously.

OBJECTIVE：To establish the HPLC fingerprints of Yuebi jiazhu decoction ，determine the contents of ephedrine hydrochloride and pseudoephedrine hydrochloride and carry out chemical pattern recognition analysis. METHODS ：Using ammonium glycyrrhizinate as control ，HPLC fingerprint of 10 batches of Yuebi jiazhu decoction was established and the similarity was evaluated with Similarity Evaluation System for TCM Chromatographic Fingerprint （2012 edition），and common peaks were identified in combination with mixed control. HPLC method was used to determine the contents of ephedrine hydrochloride and pseudoephedrine hydrochloride. SPSS 26.0 software was used for cluster analysis ；SIMCA 13.0 software was used for principal component analysis and partial least squares discriminant analysis ；the differential components affecting the quality were screened. RESULTS：There were 20 common peaks in the fingerprint of Yuebi jiazhu decoction ，and the similarities with control fringerprint were all greater than 0.92. Two peaks were identified ，which were liquiritin （peak 11）and ammonium glycyrrhizate （peak 18）. The linear range of ephedrine hydrochloride and pseudoephedrine hydrochloride were 0.98-48 μg/mL（r＝0.999 9）and 1.02-51 μg/mL （r＝0.999 2），respectively. RSDs of precision ，reproducibility and stability tests （24 h）were all less than 2％. The average recoveries were 105.67％（RSD＝2.88％，n＝9）and 104.15％（RSD＝2.02％，n＝9），respectively. The contents of ephedrine hydrochloride and pseudoephedrine hydrochloride were 0.008 1-0.014 3，0.002 5-0.011 8 mg/mL. Results of cluster analysis showed that among the 10 batches of Yuebi jiazhu decoction ，S1 was clustered into one class ，S3 was clustered into one class ，and S2，S4-S10 were clustered into one class. The results of principal component analysis showed that S 3 was located at the far right side of the scoring plot ，S1 at the right side of the scoring plot ，and S 2，S4-S10 at the middle of the scoring plot. The results of partial least squares discriminant analysis were basically consistent with the results of cluster analysis and principal component analysis. The variable importance projection values of peak 9，peak 3，peak 12，peak 8，peak 19，peak 18 （ammonium glycyrrhizinate），peak 13，peak 20 and peak 11（liquiritin）were greater than 1. CONCLUSIONS ：Established HPLC fingerprint and the method for content determination are simple and accurate. Combined with chemical pattern recognition ，they can be used for the quality control of Yuebi jiazhu decoction. Nine components such as peak 9 are the differential components affecting the quality of Yuebi jiazhu decoction.

OBJECTIVE: To observe the effects of herbal cake separated moxibustion on macrophage effector molecule T-cell immunoglobulin and mucin-domain containing-4 (Tim-4) and ubiquitination of programmed cell death protein 1 (PD-1) in rabbits with immunosuppression, and to explore the possible mechanism on herbal cake separated moxibustion in improving immunosuppression. METHODS: Thirty-two big-ear white rabbits were randomly divided into a normal group, a model group, a moxa stick moxibustion group and a herbal cake separated moxibustion group, 8 rabbits in each group. Except the normal group, the immunosuppression model was established by intraperitoneal injection of cyclophosphamide of60 mg/kg in the other 3 groups. "Shenque" (CV 8), "Shenshu" (BL 23), "Zusanli" (ST 36), etc. were selected in both the moxa stick moxibustion group and the herbal cake separated moxibustion group. Moxa stick moxibustion was applied in the moxa stick moxibustion group, one cone at each acupoint; herbal cake separated moxibustion was applied in the herbal cake separated moxibustion group, 5 cones at each acupoint. The intervention was given once every other day for 10 times in both groups. Leukocyte content in peripheral blood was detected by blood cell analyzer; the positive expression of PD-1 in CD⁺₄ T lymphocytes, CD⁺₈T lymphocytes and CD⁺₆₈ macrophages in peripheral blood was measured by flow cytometry, the serum levels of interleukin 2 (IL-2), CD₈, CD₆₈ and Tim-4 were detected by ELISA, and the expression of Tim-4 and F-box only protein 38 (FBXO38) in the liver and spleen tissues was measured by immunohistochemistry. RESULTS: Compared with the normal group, in the model group, white blood cell count (WBC) and percentage of neutrophils (NEU%) were decreased while percentage of lymphocyte (LYM%) was increased (P<0.01) in peripheral blood; the positive expression rates of PD-1 in CD⁺₄ T lymphocytes, CD⁺₈T lymphocytes and CD⁺₆₈ macrophages in peripheral blood were increased (P<0.01); the serum levels of IL-2, CD₆₈ and Tim-4 were increased (P<0.01), the serum level of CD₈ was decreased (P<0.01); the average optical density (AOD) of Tim-4 in the liver tissue and FBXO38 in the liver and spleen tissues was increased (P<0.01). Compared with the model group, in the moxa stick moxibustion group and the herbal cake separated moxibustion group, WBC and NEU% were increased (P<0.01); the positive expression rates of PD-1 in CD⁺₄ T lymphocytes, CD⁺₈T lymphocytes and CD⁺₆₈ macrophages in peripheral blood were decreased (P<0.01); the serum levels of IL-2, CD₆₈ and Tim-4 were decreased (P<0.01), the serum levels of CD₈ were increased (P<0.01); the AOD of Tim-4 and FBXO38 in the liver tissue and FBXO38 in the spleen tissue was decreased (P<0.01, P<0.05). Compared with the moxa stick moxibustion group, in the herbal cake separated moxibustion group, the positive expression rate of PD-1 in CD⁺₆₈ macrophages in peripheral blood was increased (P<0.05); serum level of Tim-4 was increased (P<0.01); AOD of Tim-4 in the liver tissue was decreased (P<0.05). CONCLUSION Herbal cake separated moxibustion can improve immunosuppression by regulating the expression of macrophage effector molecule Tim-4 and the FBXO38 mediated ubiquitination of PD-1, Tim-4 may be one of the specific indexes of immunomodulation involving with herbal cake separated moxibustion.
Animals ; Rabbits ; Interleukin-2/genetics* ; Moxibustion ; Programmed Cell Death 1 Receptor/genetics* ; Immunosuppression Therapy ; Ubiquitination

Immunotherapy targeting immune checkpoint molecules has emerged as a key approach in cancer treatment, representing the forefront of antitumor research. However, studies on immune checkpoint molecules have mainly focused on targeted therapies. Chinese medicine (CM) research as a complementary medicine has revealed that immune checkpoint molecules also undergo disease-specific changes in the context of autoimmune diseases. This review article presents a comprehensive analysis of CM studies on immune checkpoint molecules in the last 5 years, with a focus on their role in different diseases and treatment modalities. CM research predominantly utilizes oral administration of herbal plant extracts or acupuncture techniques, which stimulate the immune system by activating specific acupoints through temperature and needling. In this study, we analyzed the modulation and mechanisms of immune checkpoint molecules associated with different coinhibitory and costimulatory molecules, and reviewed the immune functions of related molecules and CM studies in treating autoimmune diseases and tumors. By summarizing the characteristics and research value of CM in regulating immune checkpoint molecules, this review aims to provide a useful reference for future studies in this field.
Humans ; Medicine, Chinese Traditional/methods* ; Immune Checkpoint Proteins ; Acupuncture Therapy/methods* ; Neoplasms/pathology* ; Autoimmune Diseases