Objective To measure the serum levels of angiopoietin-like protein (ANGPTL) 3, ANGPTL4 and RANKL in patients with rheumatoid arthritis (RA), and the relationship between ANGPTL3/ANGPTL4 and clinical manifestations were analyzed. Methods Blood samples were drawn from 72 patients with RA and 28 healthy subjects. Serum levels of ANGPTL3, ANGPTL4 and RANKL were tested by enzyme linked immuno-sorbent assay (ELISA). Nonparametric rank sum test was used for the comparisons between groups and Spearmanˊs correlation test was used for correlation analysis. Results ① The serum level of ANGPTL3 was significantly increased in RA group compared to healthy group [800.325(577.477, 1 750.636) pg/ml vs 487.900 (382.340, 565.499) pg/ml, P<0.05, Z=-6.082]. ② The serum level of ANGPTL4 was significantly increased in RA group compared to healthy group [1 036.199(853.347, 1 746.677) pg/ml vs 706.095(558.571, 807.302) pg/ml, Z=-5.962, P<0.05].③ The serum levels of ANGPTL3 and ANGPTL4 in RA patients were increased with the rise of disease activity (DAS 28) [ANGPTL3 in the low disease activity groupwas 457.265 (373.709, 605.296) pg/ml, that of the moderate disease activity group was 785.815(679.156, 1 308.785) pg/ml, that of the high disease activity group was 1 502.038 (817.713, 1 960.493) pg/ml, P<0.05; ANGPTL4 in the low disease activity group was 737.604 (467.040, 918.222) pg/ml, that of the moderate disease activity group was 991.227 (819.456, 1 699.972) pg/ml, and that of the high disease activity group was 1 842.310 (1 252.023, 2 669.902) pg/ml, P<0.05].④ANGPTL3 and ANGPTL4 was positively correlated with RANKL (r=0.554, 0.619, P<0.01).⑤ The serum level of ANGPTL4 was significantly increased in patients with bone destruction, compared to those without bone destruction [1 624.071(949.432, 2 622.371) pg/ml vs 927.590(737.604, 1 409.798) pg/ml, Z=-2.483, P<0.05]. Conclusion The serum levels of ANGPTL3 and ANGPTL4 are increased in RA, and are both positively correlated with disease activity, moreover, ANGPTL4 is associated with pathological bone destruction.

Objective To discuss the selection of operation methods of total hysterectomy in obese women. Methods We reviewed clinical data of 116 obese women with the body mass index (BMI) ≥ 28 kg/m~2 treated with total hysterectomy. According to the operative procedure, 56 women underwent the vaginal total hysterectomy (Vaginal Group) and 60 women, abdominal total hysterectomy (Abdominal Group). Intra- and post-operative records were compared between the two groups. Results As compared with the Abdominal Group, the Vaginal Group presented a significantly shorter operation time (t=-3.693,P=0.000) and hospital stay (t=-7.019, P=0.000), a significantly less intraoperative blood loss (t=-4.006,P=0.000), and a significantly lower postoperative pyrexia rate (?~2=4.388,P=0.036) and complication rate (?~2=5.243,P=0.022). Conclusions Vaginal hysterectomy is superior to abdominal hysterectomy in obese women, but should be used with caution in those with severe adhesions or multiple abdominal operation history.

Areca catechu ranks the first of China's precious "four southern medicines", with a history of more than 1 800 years of medicinal use and extensive clinical application. The pharmacological effects of A. catechu mainly focus on insect repellent, anti-tumor, anti-aging, anti-atherosclerosis and the effects on digestive system and nervous system. In recent years, safety problems such as oral cancer caused by consumption of A. catechu have been frequently reported, and the main chemical components of both medicinal and edible A. catechu are arecoline, so the clinical safety of medicinal A. catechu has been questioned. Based on the chemical composition, this paper analyzes the pharmacological and toxicological characteristics of A. catechu, discusses the points for attention in clinical application, in order to provide a reference basis for the clinical safe and rational use of A. catechu.

"Guiding herbs" is one of the characteristics of the special way of taking Chinese materia medica (CMM). However, some people have misunderstanding or lack of basic knowledge about how to choose the guiding herbs and its effect, leading to the poor clinical effect or even toxic effects because of improper decoction. This study attempts to analyze the action of the common guiding herbs in the Chinese Pharmacopoeia (2015 edition) from the perspective of reducing toxicity and increasing efficacy, returning drug to its channels, and put forward exploratory thinking on how to choose the guiding herbs to provide scientific evidence for promoting the rational use of drugs in clinic.

“Decoction wrapped” is one of the characteristics of the special decoction of Chinese material medica. However, Some people have a certain misunderstanding or lack of basic knowledge about Chinese material medica for “decoction wrapped”, leading to the bad clinical effect or even side effects because of improper decoction. This study attempts to analyze the causes and attentions of Chinese materia medica for decocting based on multiple literatures, and put forward exploratory thinking on Methods: for decoction wrapped in order to provide scientific evidence for promoting clinical rational decoction for Chinese materia medica.

Asari Radix et Rhizoma has been used for more than 2000 years with wide application in medicine. In recent years, there are many poisoning cases of Asari Radix et Rhizoma being reported in clinic, the rational application in clinic of Asarum Radix et Rhizoma has been widely concerned due to its poisonous componets of safrole and aristolochic acid. The present paper traces the historical evolution of Asari Radix et Rhizoma through accessing Web of Science and multiple databases for biomedicinal sciences, and analyzes the characteristics of its toxic reaction, and discusses the matters needing attention in its rational application from the perspective of chemical composition, so as to promote the safe and reasonable application of Asari Radix et Rhizoma.

Sophorae Tonkinensis Radix et Rhizoma is known as the important drug for treating sore throat and is widely used in clinic. Because of the coexisting of its efficacy and poison, Sophorae Tonkinensis Radix et Rhizoma often leads to a series of safety problems in the clinical application process. In this study, we attempt to analyze the ultimate cause of the toxicity of Sophorae Tonkinensis Radix et Rhizoma by reviewing nearly 20 years of literature, discuss the substance of its efficacy/toxicity from the point of view of chemical composition, and put forward exploratory thinking on its clinical rational application.

“Decoction later” is one characteristic feature of the special decoction of Chinese materia medica (CMM). However, some patients have misunderstanding or lack of basic knowledge about CMM for “decoction later” leading to the bad clinical effect or even toxic effects because of inappropriate decoction. This study attempts to analyze the causes of CMM for decoction later based on ancient and modern literatures, and put forward exploratory thinking on methods for decoction later in order to provide scientific evidence for promoting clinical rational drug use for decoction later of CMM.

"Decoction first" is one of the characteristics of the special decoction of Chinese materia medica (CMM). However, some people have misunderstanding or lack of basic knowledge about the CMM for decoction first leading to the poor cruative effect or even toxic effects because of improper decoction. This study attempts to analyze the causes of CMM for decocting first from the perspective of reducing toxicity and increasing efficacy, discuss its matters needing attention from the point of view of the effect of decoction time and crushing degree on the decoction first based on ancient and modern literature, and put forward exploratory thinking on methods for decocting first in order to provide scientific evidence for promoting clinical rational decoction for CMM.

Objective To explore the significance and the ultrastructural changes of platelets in patients with acute cerebral infarction.Methods Changes of platelets in 20 patients with acute cerebral infarction were observed by transmission electron microscope.Results The ultrastructural changes of platelets within 24 hours after the onset were significant,including more pseudopodium,aggregation and fusion;there were remarkable fewer alpha granules and mitochondria,the remain of mitochondria swelled and more disruption of platelet membrance were found.The degree of platelet changes consisted with the severity and sizes of cerebral infarction.The ultrastructural change of platelets was obviously restored after 2 weeks,but no restoration was found in 3 patients with large area infarction.Conclusion Ultrastructural changes of platelets in acute period of cerebral infarction were remarkable,especially a lack of alpha granules,this might be regarded as an objective index in the judgment of severity and prognosis of cerebral infarction.