Objective To observe the changes of combined therapy on disci intervertebrales and their surrounding tissues and thus to determine its therapeutic effects on lubar intervertebral disc protrusion with magnafic resonance imaging. Methods After combined therapy including physical agents, drugs, traction, manipulation and remedial exercises had been adopted to treat 40 iubax intervertebral disc protrusion patients for 30 days, morphologic changes of disci intervertebrales and their surrounding tissues of these patients were observed by magnetic resonance imaging. Results The effective rate of combined therapy on lubar intervertebral disc protrusion was 82.5%, there were no obvious changes of thickness, salient degree of disci intervertebrales, anteroposterior diameter, transverse diameter and latero-cryptae extent of vertebral canal after the treatment. Conclusion Though the combined therapy can not change the morphous of lobar intervertebral disc protrusion, it may efficiently relief the clinical symptoms of patients with lobar intervertebral disc protrusion.

Low back pain is becoming an important factor affecting people's quality of life, while the age of its onset is getting younger and younger, and the social and economic losses caused by low back pain are huge every year. Intervertebral disc degeneration (IDD) is an important cause of low back pain. Due to multiple factors, biomechanical and structural changes occur in intervertebral disc tissue, including rupture of annulus fibrosus, protrusion of nucleus pulposus, which cause compression of spinal cord and nerve root, and lower back pain. Micro-RNA (miRNA) is a kind of single-stranded non-coding small molecule RNA, with 18-24 nucleotides in length, which exists widely in eukaryotes. As one of the important regulatory molecules of gene expression, it has been proved to play a key role in the initiation and progression of many diseases, and it may also play an important role in intervertebral disc degeneration. At present, the clinical treatment for IDD is mainly surgical treatment to alleviate clinical symptoms. Even if surgical treatment can achieve good results, it will bring great physical trauma and economic burden to patients. The role of miRNA in IDD is one of the hotspots in the current academic research. Studies have shown that miRNA has abnormal expression patterns in degenerative intervertebral disc tissues and participates in a variety of pathological processes of IDD. At present, some miRNAs have been proved to be related to a variety of pathological processes in IDD, including nucleus pulposus cell apoptosis and proliferation, extracellular matrix degradation, autophagy, inflammation and cartilage endplate degeneration. The comparative study of gene chip showed that there were significant differences in the expression of some miRNAs between degenerative and normal nucleus pulposus cells. These differentially expressed miRNAs may be involved in the process of nucleus pulposus cell degeneration by regulating their respective upstream or downstream pathways. Most of the regulatory pathways are crossed and parallel, thus constructing a huge miRNA regulatory network. Understanding the target genes and mechanisms of miRNA in the pathogenic process can provide an important reference for the origin, development and prognosis of IDD. In this article, the important role of miRNA in IDD and the potential significance of clinical treatment are reviewed. With the in-depth study of miRNA and the molecular biological mechanism can provide new ideas for the diagnosis and treatment of IDD, which is likely to become a new strategy for biological treatment of IDD.

Intervertebral disc degeneration (IDD) refers to the biomechanical and structural changes of intervertebral disc tissues due to the effects of a variety of factors. Theses physical or chemical factors lead to the rupture of the annulus fibrous, protrusion of the nucleus pulposus tissue, compression of the spinal cord and nerve roots and causing the patient's back and leg pain ultimately. Degeneration of intervertebral disc is a common condition in clinical practice, which affects working ability and daily living quality of patients seriously. Due to the change of living habits, the population with IDD tend to be younger recently. The etiology, pathogenesis and diagnosis and interventions of IDD have always been hot topics in spinal surgery. Thus, animal models of IDD close to the human body has a of great clinical significance for exploring the etiology, pathological mechanism and non-surgical treatment of IDD. At present, the establishment of IDD model mainly includes two following aspects, in vitro model and in vivo model. There are two main in vitro models, cell culture and tissue or organ culture. There are seven kinds of in vivo models, which can be divided into two categories, namely spontaneous and induced model. Among them, the spontaneous degeneration model is also regarded as age-related degeneration, while the induced model refers to the construction of the animal model of IDD by injuring the structure of the intervertebral disc, changing the biomechanical structure of the vertebral body, development spinal instability caused by surgery or constructing nerve root compression and gene knockout. Although there are many methods of animal modeling and literature reports, each method has its own advantages and disadvantages. The advantages and disadvantages should be weighed when choosing the animal models.

Objective To analyze a case of hyperhemolytic syndrome(HHS)and explore the laboratory diagnostic method and clinical treatment strategy.Methods Serological tests such as blood typing,direct antiglobulin test(DAT),an-ti-screening and antibody identification were performed,The complete blood count(CBC),as well as hemolysis indicators such as lactate dehydrogenase(LDH)and bilirubin were tested,and the changes and progression of hemolysis were moni-tored.By using genotyping methods to test 32 common rare blood type antigens in clinical practice,the accuracy of antibody identification results was supported.Results The patient had anti-E antibodies and autoantibodies in her serum.After blood transfusion,LDH and bilirubin increased significantly,but hemoglobin dropped sharply,far lower than before transfusion,presenting with unique manifestations such as hemoglobinuria.The patient made a full recovery after treatment with high-dose intravenous immunoglobulin and corticosteroids.Conclusion HHS is a rare and potentially fatal diseases,which is mainly manifested by hemolysis and severe anemia,and the hemoglobin level after blood transfusion is often lower than that before blood transfusion.This patient had typical clinical manifestations of post-transfusion hyperhemolytic reaction.After timely and correct treatment,the patient recovered completely and was discharged,accumulating valuable clinical experience for the diagnosis and treatment of such disease.

Low back pain is becoming an important factor that affects people's quality of life today, and the social losses caused by lowback pain are hugeevery year. Lumbar disc herniation (LDH) is one of the main diseases that cause low back pain. The mechanism of lumbar disc herniation in the biomedical science is still controversial. Inflammatory factor is a cytokine secreted by tissue cells and involved in mediating the inflammatory response. Studies have shown that some factors stimulated by the extrusive nucleus pulposus, like inflammatory factors, degeneration-related genes and downstream expression products, can cause the degeneration of intervertebral disc. IL-1, IL-6, TNF-α, MMPs, and TGF-β have become the hot topicin disc degeneration. Signaling pathway is the main pathway for inflammatory factors to participate in the regulation of various biochemical reactions in cells. The inflammatory factors interact with different proteins to activate or inhibit different pathways, thereby achieving regulation of the cell cycle, regulates gene expression, induces immune inflammatory response, and apoptosis. Research on the role of various inflammatory factors in the body and related molecular signaling pathways will help us understand the mechanism of LDH. Most of the experimental studies only focus on the influence of a certain cytokine or single pathway on intervertebral disc degeneration, but different inflammatory factors and their signaling pathways often crosstalk with each other through special channels, forming a complex and precise signal transduction regulation network jointly regulates various physiological or pathological processes in the body, and the occurrence of disease is often accompanied by multiple factors. Studying the effect of a single signal network on the disease cannot fully explain the cause of the disease and related clinical manifestations. Therefore, clarifying the role of various inflammatory factors in IDD and exploring and analyzing the ways in which each factor regulates each other will provide ideas for understanding the mechanism of lumbar degeneration and exploring new methods for preventing and treating LDH in the future.

Objective:Resorption can occur after lumbar disc herniation, and Thymic stromal lymphopoietin (TSLP) is considered to be a key factor mediating reabsorption. Studies have found that under the action of inflammatory factors like TNF-α, IL-6, etc,the expression of TSLP in intervertebral disc tissue was increased, and then mononuclear macrophage chemokine-1 (MCP-1) was induced to induce infiltration of macrophage to promote reabsorption. To determine the mechanism, we design the experiment to explore the mechanism of IL-6-mediated JAK/STAT pathway and TGF-β/Smad pathway to promote the reabsorption of intervertebral disc by regulating the expression of TSLP.Methods:Rat bone marrow mesenchymal stem cells (MSC) and rat nucleus pulposus cells (NPC) were cultured in vitro, treating the cells withrat IL-6 recombinant protein, STAT3inhibitor and Smad2/3 inhibitorrespectively, and use real-time quantitative PCR (qRT-PCR) technology to detect the expression of JAK1, STAT3, Smad2, TSLP mRNA under different conditions; Western blot to detect the expression of TSLP, Smad2 and phosphate STAT3 protein; using enzyme-linked immunosorbent assay (Elisa) to detect the expression of TGF-β in two rat cells under the treatment of IL-6.Results:After stimulation ofIL-6 (10 ng/ml or 100 ng/ml) the expression of JAK1in MSC (10 ng/ml: 5.13±1.21; 100 ng/ml: 5.23±0.35; control group: 0.97±0.03), STAT3 (10 ng/ml: 6.50±0.38; 100 ng/ml: 6.74±0.61; control group: 0.87±0.19) was significantly increased, and TSLP also showed high expression in MSC (10 ng/ml: 4.26±0.38; 100 ng/ml: 5.05±0.46; control group: 1.04±0.04).The expression of STAT3 (10 ng/ml: 2.91±0.08; control group: 1.12±0.11), TSLP (10 ng/ml: 7.32±0.37; control group: 1.03±0.03) in NPC also increased. After stimulation of IL-6, the expression of Smad2 increasing in MSC was observed (10 ng/ml: 15.92±0.62; 100 ng/ml: 20.28±0.58; control group: 0.96±0.08), and increased expression of Smad2 in NPC (10 ng/ml: 5.01±0.17; control group: 0.96±0.03). The expression of TSLP in MSC decreased after adding STAT3 inhibitor (BP group, BP group: 0.17±0.01; control group: 0.90±0.09), the expression of TSLP also decreased in NPC (BP group: 0.42±0.11; control group: 0.90±0.11). After adding Smad2/3 inhibitor (SB group), the expression of TSLP in MSC decreased (SB group: 0.33±0.01; control group: 1.02±0.02), and the expression of TSLP in NPC also decreased (SB group: 0.40±0.04; control group: 0.99±0.01).Conclusion:IL-6 up-regulates TSLP expression via the JAK1/STAT3 signaling pathway and promotes prominent intervertebral disc reabsorption. At the same time, IL-6 can activate the TGF-β/Smad2/3 pathway and up-regulate the expression of TSLP, which play a synergistic role in the reabsorption process.

ObjectiveTo investigate the changes in cerebral blood perfusion in patients with acute cerebral infarction after taking Tongnaoyin， a traditional Chinese medicine， based on head and neck computed tomography （CT） angiography （CTA） combined with brain CT perfusion imaging （CTP）. MethodA total of 240 patients with cerebral infarction of phlegm and blood stasis syndrome treated in Jiangsu Province Hospital of Traditional Chinese Medicine from March 2018 to September 2023 were randomly divided into a control group （99 cases） and a Tongnaoyin group （141 cases）. Based on the guidelines， the control group was treated with conventional treatment such as anti-aggregation， anticoagulation， lipid-lowering and plaque stabilization， brain protection， and supportive treatment. The Tongnaoyin group was treated with Tongnaoyin of 200 mL in warm conditions in the morning and evening on the basis of the control group. Both groups underwent CTA combined with CTP within 24 hours after admission， and they were reexamined by CTA and CTP in the sixth month after admission. The degree of intracranial artery stenosis was determined according to the North American Symptomatic Carotid Endarterectomy Trial （NASCET） method. The relative cerebral blood volume （rCBV）， relative cerebral blood flow （rCBF）， mean transit time （MTT）， and time to peak （TTP） of the lesion area before and after treatment were compared. The adverse outcomes of the two groups within six months after discharge were compared. ResultCompared with the group before treatment， the degree of vascular stenosis in the Tongnaoyin group was significantly reduced， and the difference was statistically significant （Z=105.369，P<0.05）. Compared with the control group after treatment， the improvement rate of vascular stenosis in the Tongnaoyin group was higher （χ²=84.179，P<0.01）， and the curative effect was better.After treatment， the rCBV and rCBF of patients in the Tongnaoyin group were significantly increased， and the difference was statistically significant （P<0.01）. MTT and TTP showed a trend of shortening， but the difference was not statistically significant. There was no statistically significant difference in rCBV， rCBF， MTT， and TTP in the control group. Compared with those in the control group after treatment， the rCBV and rCBF in the Tongnaoyin group were significantly increased， while MTT and TTP were significantly reduced （P<0.01）. After six months of discharge， the risk of poor prognosis in the Tongnaoyin group was significantly reduced compared with the control group （P<0.05）. ConclusionTongnaoyin has a good effect on improving cerebral blood perfusion in patients with acute cerebral infarction. It can be used as an effective supplement for the conventional treatment of ischemic stroke to improve clinical efficacy.

ObjectiveTo evaluate the effects of Tongnaoyin on the blood-brain barrier status and neurological impairment in acute ischemic stroke （AIS） patients with the syndrome of phlegm-stasis blocking collaterals by dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI）. MethodsA total of 63 patients diagnosed with AIS in the Jiangsu Province Hospital of Chinese Medicine from October 2022 to December 2023 were enrolled in this study. According to random number table method，the patients were assigned into a control group （32 cases） and an observation group （31 cases）. The control group received conventional Western medical treatment，and the observation group took 200 mL Tongnaoyin after meals，twice a day from day 2 of admission on the basis of the treatment in the control group. After 7 days of treatment，the patients were examined by DCE-MRI. The baseline data for two groups of patients before treatment were compared. The National Institute of Health Stroke Scale （NIHSS） score and modified Rankin Scale （mRS） score were recorded before treatment and after 90 days of treatment for both groups. The rKtrans，rKep，and rVe values were obtained from the region of interest （ROI） of the infarct zone/mirror area and compared between the two groups. ResultsThere was no significant difference in the NIHSS or mRS score between the two groups before treatment. After 90 days of treatment，the NIHSS and mRS scores declined in both groups，and the observation group had lower scores than the control group （P<0.05）. After treatment，the rKtrans and rVe in the observation group were lower than those in the control group （P<0.01）. ConclusionCompared with conventional Western medical treatment alone，conventional Western medical treatment combined with Tongnaoyin accelerates the repair of the blood-brain barrier in AIS patients，thereby ameliorating neurological impairment after AIS to improve the prognosis.