To raise clinical curative effect through quantitative and synthesize analysis of Traditional Chinese Medicine (TCM). According to Zhongjing’s medicine usage regulation and the author’s clinical fulfillment, a generalization, contrast and synthesize analysis among the same kind medicines is carried on in the text. It put forward the conception of "First-line medicine" for the first time and carried on detailed treatise of its nature, effect, classification, application and regulation. Meanwhile, the important role and function of "First-line medicine" is conf irmed in the text, and hope it is wished to helpful to the usage of TCM in clinical practice.

Objective To investigate the effects of TLR4 on the radiosensitivity of tumor cells.Methods The cell lines of RAW264.7,Lewis,MFC,Hepal-6,Bl6,and NIH3T3 were irradiated with 5 Gy X-rays or sham-irradiated.24 h after irradiation,the expression of TLR4 was detected by flow cytometry.According to the TKR4 level,cells were divided into three groups:without treatment,LPS stimulation and TAK242 block.CCK-8 kit and Annexin-V Apoptosis Kit were used to detect cell proliferation,apoptosis and cell cycle distribution of each group.Results After 24 h of 5 Gy ionizing radiation,TLR4 was significantly increased in Lewis cells (t =-8.68,P ＜0.01) but decreased in MFC cells (t =25.8,P ＜ 0.01) and had no significant changes in Hepal-6,B16 and RAW264.7 cells.In addition,the proliferation vitality (t =57.62,-6.23,P ＜ 0.01) and survival fraction (t =13.37,19.24,P ＜ 0.01) of the Lewis and MFC cells were reduced especially for the TLR4-blocked cells,and the apoptosis rates of both Lewis (t=-167.85,P＜0.01) and MFC cells (t=-26.45,P＜0.01) were elevated.The percentages of G0/G1 phase and S phase Lewis cells were significant increased (t =8.68,14.89,P ＜ 0.01) but its G2/M phase were reduced (t =-37.48,P ＜ 0.01).However,the percentages of G0/G1 phase and S phase MFC cells were obviously reduced (t =20.31,4.48,P ＜ 0.01) and G2/M phase increased (t =-13.06,P ＜ 0.01).For both cell lines of Lewis and MFC,the cycle distribution of TAK242 and LPS groups didn't change significantly.Conclusions High expression TLR4 in the Lewis cells is related to cell proliferation and apoptosis but not cell cycle distribution,and hence TLR4 could influence the radiosensitivity of tumor cells.

BACKGROUND:Perioperative hypothermia may lead to coagulation function for patients undergoing total knee arthroplasty,and an increase in blood loss.OBJECTIVE:To compare the influence of temperature protection with non-temperature protection on coagulation function in patients undergoing total knee arthroplasty.METHODS:Forty ASA Ⅰ-Ⅱ patients scheduled for total knee arthroplasty were randomly divided into temperature protection and non-temperature protection groups (n=20 per group).The patients in the temperature protection group underwent heat-preservation including preheating room temperature,actively blanket warmer,were infused or flushed with fluids of 37 ℃ by heating apparatus;the patients in the non-temperature protection group received full-body-covered cotton quilt only.The nasopharyngeal temperature were detected at postoperative 10 minutes,intraoperative 1 hour and postoperative 1 hour,and 1.25 mL of venous blood were collected to detect the fibrin formation time,blood clot formation time,and maximum amplitude using thrombelastography.Additionally,the intraoperative blood loss and volume of drainage at postoperative 24 hours were recorded.RESULTS AND CONCLUSION:(1) The nasopharyngeal temperature in the non-temperature protection group was significantly lower than that in the temperature protection group at postoperative 1 hour (P ＜ 0.05).(2) The intraoperative blood loss and volume of drainage at postoperative 24 hours in the temperature protection group were significantly less than those in the non-temperature protection group (P ＜ 0.05).(3) Compared with the temperature protection group,fibrin formation time and blood clot formation time at intraoperative and postoperative 1 hour were significantly lengthened,and maximum amplitude at postoperative 1 hour was significantly shortened in the non-temperature protection group (P ＜ 0.05).(4) These findings show that intraoperative hypothermia can weaken platelet function,inhibit coagulation factor activity,and increase the amount of blood loss and drainage.In the meanwhile,heat-preservation is able to reduce the loss of body heat,improve coagulation function and reduce blood loss for patients undergoing knee replacement.

Objective To explore the role of PLC/PIP2 signal pathway in the changes of mouse thymus CD4 + CD25 + NRP1 + Treg and TGF-β1 after different doses of X-ray irradiation Methods 36 ICR mice were randomly divided into 6 groups according to the irradiation doses of 0,0.5,1.0,2.0,4.0 and 6.0 Gy,respectively.Flow cytometry was used to detect the expression of NRP1 + Treg,and ELISA was used to detect the expression of TGF-β1 in mouse thymocytes at 16 h post-irradiation.The EL-4 cells were irradiated by X-rays at the dose of 4.0 Gy after co-cultured with the PMA and TMB-8 for 2 hours.Flow cytometry was used to detect the expression of NRP1 + Treg,and ELISA was used to detect the changes of TGF-β1 at 48 h post-irradiation.Results The NRP1 + Treg appeared a transient decrease at both 0.5 and 1.0 Gy irradiation and reached its valley value at 1.0 Gy (t =6.96,P ＜ 0.01),then showed a dosedependent increase and reached its peak at 6.0 Gy (t =6.70,P ＜ 0.01).The TGF-β1 level decreased after 0.5 Gy X-rays (t =12.53,P ＜0.01),then increased at a dose-dependent manner and reached its peak at 4.0 Gy (t =10.40-19.56,P ＜ 0.01).Compared with the sham-irradiation,NRP1 + Treg was decreased significantly after PMA treatment (t =3.06,P ＜ 0.01),while it was up-regulated significantly after irradiation in the presence of PMA (t =8.27,P ＜ 0.01).TGF-β1 was reduced in the presence of PMA with or without irradiation (t =10.46-39.69,P ＜ 0.01).NRP1 + Treg and TGF-β1 were increased significantly after TMB-8 treatment (t =5.53-44.26,P ＜ 0.01).Conclusions NRP1 + Treg cells and TGF-β1 were up-regulated after a high dose radiation,and the PLC/PIP2 signal pathway may participate in the regulation.

Objective:To investigate the genetic etiology of a child with epilepsy accompanied by motor retardation.Methods:A patient with epilepsy and motor retardation in Henan Provincial People′s Hospital in January 2020 and his parents′ peripheral blood 2 mL were collected.G-banded karyotyping and array-based comparative genomic hybridization (aCGH) were used to analyze the duplication / deletion of chromosome segments in child and her pa-rents.Results:The karyotype of the patient revealed 46, XX, and add(19)(p13.3→qter), whereas aCGH detected a 9.50 Mb duplication at 19q13.33q13.43[arr(hg19)(49593920_59092570)×3]. This region contains 471 genes.No abnormality was discovered in the karyotyping and aCGH analysis of the patient′s parents.The phenotypes of the patient conformed to the previously reported clinical characteristics of 19q13.3 duplication.Conclusions:The de novo 19q13.3 duplication is the cause of epilepsy and motor development retardation for the patient.Combined with aCGH, the traditional G banding is valuable to diagnose the patient with developmental delay.

Diffusion tensor imaging (DTI), which responds with the diffusion of water molecules in spinal cord white matter, may be used to detect the integrity of the spinal cord fiber bundles and the pathological changes after injury. It is sensitive in acute and chronic spinal cord injury, such as cervical spondylotic myelopathy, multiple sclerosis, brain damage secondary spinal cord injury, spinal nerve root damage, and so on. In basic studies, DTI can reveal the microstructure and pathological changes of the injured spinal, and be correlated with behavioral assessment, which involved mice, monkeys, calves, cats, swines, dogs, and so on.

Objective To explore the effect of salmon calcitonin on osteoporosis induced by spinal cord injury. Methods 100 patients with osteoporosis induced by spinal cord injury from September 2011 to September 2014 in our department were included. They were randomly divided into control group (n=50) and observation group (n=50). The control group received vitamin D3 only, while the observation group received vitamin D3 combined with salmon calcitonin on the basis of rehabilitation physiotherapy, for 6 months. Visual Analogue Scale (VAS) of pain was evaluated in different periods. The bone mineral density (BMD) of lumbar spine and femoral neck, the parathyroid hormone (PTH), bone gla protein (BGP) and 1,25- dihydroxy vitamin D3 (1,25-(OH)2D3) were tested and recorded. Results The VAS score was lower in the observation group than in the control group 1, 2, 3 and 6 months after treatment (P<0.001). The BMD of lumbar spine and femoral neck was significantly higher, the PTH and BGP were significantly lower and the 1,25-(OH)2D3 was significantly higher in the observation group than in the control group after treatment (P<0.001). Conclusion Combination of salmon calcitonin can effectively reduce the bone pain and improve the BMD in patients with osteoporosis induced by spinal cord injury.

Objective To explore the feasibility and effectiveness of lateral gastrocnemius muscle branch nerve transferring for deep pe-roneal nerve injury. Methods Thirty-two adult female Sprague-Dawley rats were divided into control group (n=8), sham group (n=8), nerve direct repairing group (n=8) and nerve transferring group (n=8). Twelve weeks after the anastomosis, the nerve anastomosis was observed vi-sually, the length of lateral of gastrocnemius muscle branch (L1), the diameter at the point of entering muscle (D1), the maximum detachable length of nervus peroneus communis (L2), the diameter of deep peroneal nerve (D2) and the distance between branch point and neck of fibu-la (S) were measured. The peroneal nerve functional index (PFI), the amplitude of compound muscle action potential (CMAP), nerve con-duction velocity (NCV), the weight of the tibialis anterior and the creatine kinase (CK) activity of theanterior tibial were compared among groups. Results L10.05). Conclusion It is feasible that lateral head muscular branches of gastrocnemius nerve transferring can repair deep peroneal nerve injury, which is needed to separate superficial peroneal nerve and deep peroneal nerve in the epineurium without damaging nerve for tension free neuroanastomosis. Lateral head muscular branches of gastrocnemius nerve transferring can repair the func-tion after deep peroneal nerve injury.