BACKGROUND: Although the clinical effect of cervical disk replacement in short term has been ascertained, but the middle and long term result is not known, especially for the adjacent level. OBJECTIVE: To observe clinical result and effect of cervical disk replacement on adjacent level in middle and long term. DESIGN, TIME AND SETTING: Retrospective case analysis was performed at Beijing Jishuitan Hospital from December 2003 to March 2005. PARTICIPANTS: Thirty-three patients (aged 35-73 years) undergoing cervical disc replacement were followed up for 3 years. Of them, 25 patients received one-level disk replacement, and 8 received two-level disk replacement. METHODS: The clinical results and imaging before and after operation were compared. MAIN OUTCOME MEASURES: Clinical indexes including JOA grade, Odom’s grade, NDI, SF-36; X-ray: Kellgren X-ray grade, disk cervical height, disk motion, Pfirrmann disk grade, sigittal diameter of spinal cord, and compression of the spinal cord. RESULTS: The point of JOA is 13.62?2.31 before operation, 15.75?1.55 after operation; the differences were significant (P=0.000). For Kellgren X-ray, 10 levels occurred degeneration above the disk replacement level, accounted for 33% (P=0.004), and 9 levels developed degeneration below the disk replacement level, accounted for 32% (P=0.011). No obvious changes in imaging indexes were observed before and after surgery. CONCLUSION: The clinical outcome of cervical disk replacement is good in middle-term follow up. Some adjacent level degeneration may occur after cervical disk replacement, and the degeneration type is osteophyte formation in the adjacent level. This kind of adjacent level degeneration does not affect the clinical outcome in middle term follow-up.

Recently traditional Chinese medicine (TCM)-induced liver injury has been an unresolved critical issue which impacts TCM clinical safety. The premise and key step to reduce or avoid drug-induced liver injury (DILI) is to identify the drug source of liver injury in early stage. Then the timely withdrawal of drug and treatment can be done. However, the current diagnosis of DILI is primarily governed by exclusive method relying on administering history supplied by patients and experience judgment from doctors, which lacks objective and reliable diagnostic indices. It is obvious that diagnosis of TCM-induced liver injury is especially difficult due to the complicated composition of TCM medication, as well the frequent combination of Chinese and Western drugs in clinic. In this paper, we proposed construction of research pattern and method for objective identification of TCM-related DILI based on translational toxicology, which utilizes clinical specimen to find specific biomarkers and characteristic blood-entering constituents, as well the clinical biochemistry and liver biopsy. With integration of diagnosis marker database, bibliographic database, medical record database and clinical specimen database, an integrative diagnosis database for TCM-related DILI can be established, which would make a transformation of clinical identification pattern for TCM-induced liver injury from subjective and exclusive to objective and index-supporting mode. This would be helpful to improve rational uses of TCM and promote sustainable development of TCM industry.
Animals ; Biomarkers, Pharmacological ; metabolism ; Biopsy ; methods ; Chemical and Drug Induced Liver Injury ; diagnosis ; metabolism ; pathology ; Early Diagnosis ; Humans ; Liver ; drug effects ; pathology ; Medicine, Chinese Traditional ; adverse effects ; Rats

Based on the main schemes of the prevention and therapy for SARS issued by the state and provincial administrations of traditional Chinese medicine (TCM), the characters and regulations for the application and performance of TCM in preventing and treating SARS were studied by cluster analysis. Some problems in the rational exertions of TCM in preventing and treating SARS were also discussed. Some proposals for the rational uses of traditional Chinese drugs (TCD) in preventing and treating SARS were offered finally in this article.
Cluster Analysis ; Diagnosis, Differential ; Drug Combinations ; Drugs, Chinese Herbal ; isolation & purification ; therapeutic use ; Humans ; Medicine, Chinese Traditional ; Phytotherapy ; Plants, Medicinal ; chemistry ; Severe Acute Respiratory Syndrome ; drug therapy ; prevention & control

Adolescent ; Adult ; Arsenic Poisoning ; drug therapy ; Child ; Chronic Disease ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy

Objective To observe the recent clinical efficacy of the sequential therapy hormone in the treatment of active rheumatoid arthritis.Methods In accordance with the principle of digital sheet,160 patients with active rheumatoid arthritis were randomly divided into the observation group and the control group,80 cases in each group.On the basis of methotrexate and leflunomide in both groups,the hormone sequential therapy was given in the observation group,but prednisone was given in the control group.The clinical efficacy of treatment after 1 week and 3 months were compared in two groups.Results In the observation group,the indicators in 7 d after treatment were significantly reduced,compared with untreated(t =19.90,7.63,14.73,7.58,6.84,14.09,all P ＜0.01),In the control group,three indicators of the duration of morning stiffness,joint tenderness index and joint swelling index in 7d after treatment were significantly reduced,compared with untreated (t =13.42,3.34,7.24,all P ＜ 0.01),Compared the indicators in the two groups in 7 d after treatment,there were statistically significant differences (t =13.07,4.92,10.51,5.23,5.74,15.03,all P ＜ 0.01).The indicators in the 3 months after treatment in both groups were signifi cantly decreased,buttherewasnosignificantdifferencebetweenthetwogroups (t =1.80,1.73,1.59,1.22,1.21,1.35,all P ＞ 0.05).The total effective rate was 80% in the observation group; but the rate was 75 % in the control group;there was no statistically significant difference in the two groups(x2 =0.57,P ＞ 0.05).Conclusion The sequential hormone therapy is an effective means for the treatment of active rheumatoid arthritis,by controlled the symptoms of rheumatoid arthritis effectively and alleviated the patient's condition.

Objective To examine the relationship between smoking and tobacco-related mortality in a cohort of the aged Chinese armymen.Methods A cohort study was carried out in Xi'an,China from 1987 to 2005.A total of 1 268 retired male military cadres aged 55 or older were examined in 1987 and followed up in the next 18 years.At baseline,388 men were non-smokers,461 were former smokers,and 419 were current smokers.The current smoking rate was 33.04%,Quitted rate was 52.39%.The terminal main observation items included all-cause and tobacco-associated mortality.Results Up to Jun 30,2005,a total of 491 subjects died.Compared with non-smokers,the relative risks(95% confidence intervals(CI)) of ever-smokers for all-cause deaths,chronic obstructive pulmonary disease(COPD),lung cancer,and coronary heart disease(CHD) were 1.24(1.01-1.53),1.91(1.06-3.46),2.91(1.36-6.23),and 1.15(0.68-1.93),respectively.Compared with current smokers,the risks of total mortality and death from lung cancer for former smokers were decreased by 66.7% and 14.98%,respectively.Conclusions Cigarette smoking was a major death risk factor in the cohort and quitting smoking could save lives.

Good medicinal herbs, good drugs. Good evaluation method and indices are the prerequisite of good medicinal herbs. However, there exist numerous indices for quality evaluation and control in Chinese medicinal materials. However, most of these indices are non-interrelated each other, as well as having little relationship with efficiency and safety. The results of different evaluatior methods may not be consistent, even contradictory. Considering the complex material properties of Chinese medicinal materials, single method and index is difficult to objectively and comprehensively reflect the quality. Therefore, it is essential to explore the integrated evaluation methods. In this paper, oriented by the integrated evaluation strategies for traditional Chinese medicine quality, a new method called integrated quality index (IQI) by the integration of empirical evaluation, chemical evaluation, and biological evaluation was proposed. In addition, a study case of hypertoxic herb Aconitum carmichaelii Debx. was provided to explain this method in detail. The results suggested that in the view of specifications, the average weight of Jiangyou aconite was the greatest, followed by Weishan aconite, Butuo aconite, Hanzhong aconite, and Anxian aconite; from the point of chemical components, Jiangyou aconite had the characteristic with strong efficacy and weak toxicity, next was Hanzhong aconite, Butuo aconite, Weishan aconite, and Anxian aconite; taking toxicity price as the index, Hanzhong aconite and Jiangyou aconite have the lower toxicity, while Butuo aconite, Weishan aconite, and Anxian aconite have the relatively higher one. After the normalization and integration of evaluation results, we calculated the IQI value of Jiangyou aconite, Hanzhong aconite, Butuo aconite, Weishan aconite, and Anxian aconite were 0.842 +/- 0.091, 0.597 +/- 0.047, 0.442 +/- 0.033, 0.454 +/- 0.038, 0.170 +/- 0.021, respectively. The quality of Jiangyou aconite is significantly better than the others (P < 0.05) followed by Hanzhong aconite, which is consistent with the traditional understanding of genuineness. It can be concluded that IQI achieves the integrated control and evaluation for the quality of Chinese medicinal materials, and it is an exploration for building the good medicinal herbs standards. In addition, IQI provides technical supports for the geoherbalism evaluation, selective breeding, the development of precision decoction pieces, high quality and favourable price in market circulation, and rational drug use.
Aconitum ; chemistry ; Drugs, Chinese Herbal ; standards ; Medicine, Chinese Traditional ; standards

The stable and controllable quality of decoction pieces is an important factor to ensure the efficacy of clinical medicine. Considering the dilemma that the existing standardization of processing mode cannot effectively eliminate the variability of quality raw ingredients, and ensure the stability between different batches, we first propose a new strategy for Chinese medicine processing technologies that coupled with individuation processed and cybernetics. In order to explain this thinking, an individual study case about different grades aconite is provided. We hope this strategy could better serve for clinical medicine, and promote the inheritance and innovation of Chinese medicine processing skills and theories.
Chemistry, Pharmaceutical ; methods ; standards ; Cybernetics ; standards ; Drug Therapy ; standards ; Drugs, Chinese Herbal ; chemistry ; standards ; toxicity ; Humans ; Quality Control

Quality control is one of the key scientific tissues in the modernization of traditional Chinese medicines (TCM). In order to overcome the deficiencies of assessment indexes, including little systematization and quantification, as well as loose association with clinical efficacy and dosage, a new integrated method named controllability pyramid ( CP) is first proposed in this paper. In addition, some study cases are used to explain how this model is constructed. We hope the establishment of CP could promote the clinical-orien- ted integrated innovation research of TCM, and provide control strategy and technology examples for improving the quality of Chinese medicines and clinical efficacy.
China ; Drug Evaluation ; methods ; standards ; Drug Therapy ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; standards ; Humans ; Medicine, Chinese Traditional ; standards ; Quality Control

OBJECTIVETo investigate the dosage-efficacy/toxicity relationship of prepared rhubarb, in order to explore the bidirectional effects in hepatoprotection and hepatotoxicity of prepared rhubarb and the objective authenticity for attenuating toxicity by processing.

METHODNormal and pathological animals were adopted simultaneous to investigate the effect of total extracts from prepared rhubarb within a high dose range (2.0, 5.4, 14.7, 40.0 g x kg(-1) x d(-1)) on normal state, biochemical index and histopathology of experimental animals. The factor analytic approach was used to analyze the dosage-efficacy/toxicity relationship of prepared rhubarb.

RESULTThe factor analytic approach was used to extract two common factors from the nine biochemical indexes. The firs common factor was mainly dominated by HA, LN and TGF-β1, and could be explained as fibrotic factors. The second common factor was mainly dominated by ALT, AST and ALP, and could be explained as cellular factor. The results of the factor analysis suggested that prepared rhubarb showed significant bidirectional effects in hepatoprotection and hepatotoxicity, which could protect liver in CC14 injured chronic hepatic injury, but had a certain hepatotoxic effect to normal animals. The pathological examination showed consistent results with the factor analysis. Under comparable dosages, prepared rhubarb showed a stronger liver protecting effect than crude rhubarb, with a lower toxicity.

CONCLUSIONAlthough prepared rhubarb has a certain hepatotoxic effect to normal animals, it has also a significant therapeutic effect to animals with liver injury. The results proved the symptom-based prescription theory and the scientificity of the symptom-based medication. The symptom-based prescription theory is important to correctly realize the dosage-efficacy/toxicity relationship of traditional Chinese medicines and guide the symptom-based medication.

Animals ; Dose-Response Relationship, Drug ; Drug Prescriptions ; Drugs, Chinese Herbal ; pharmacology ; toxicity ; Female ; Fibrosis ; Liver ; drug effects ; metabolism ; pathology ; Male ; Rats ; Rats, Sprague-Dawley ; Rheum ; chemistry ; Toxicity Tests