Objective This study aimed to systematically investigate the pharmacological substances and potential mechanisms of Zhenzhu Tongluo Wan in the treatment of peripheral nerve disorders.Methods Based on the TCMSP database and related literature,the active ingredients of Zhenzhu Tongluo Wan were determined.Target proteins for these active ingredients and those associated with peripheral neuropathy were predicted using the TCMSP,SwissTarget Prediction,GeneCard,OMIM,and DisGeNET databases.The intersection of these two sets of proteins was once considered a key target for the treatment of peripheral neuropathy.A protein-protein interaction(PPI)network of the intersection targets was constructed using the STRING database and analyzed using Cytoscape 3.9.1 software.Key targets obtained from the network were subjected to GO enrichment analysis and pathway annotation analysis using the DAVID database.The UHPLC-Q-Orbitrap HRMS technique was used to characterize the major chemical components of Zhenzhu Tongluo Wan.In addition,molecular docking,animal and cell experiments were performed to explore the mechanisms underlying the treatment of peripheral neuropathy with Zhenzhu Tongluo Wan.Results A total of 147 potential active ingredients and 333 intersection targets of Zhenzhu Tongluo Wan were screened.GO function and KEGG pathway analysis revealed that the major pathways involved include MAPK signaling pathway,NF-κB signaling pathway,PI3K-Akt signaling pathway,MAPK cascade and inflammatory response,among others.Based on high-resolution mass spectrometry analysis,33 major active ingredients were identified from Zhenzhu Tongluo Wan,focusing on those compounds with a Dgree value greater than the median.Molecular docking results further demonstrate good binding interactions between compounds such as luteolin,quercetin,tryptophan,arginine and kaempferol found inZhenzhu Tongluo Wan and key targets.Western blotting experiments showed that luteolin,quercetin and tryptophan could significantly inhibit the expression of MAPK8,P65 and TNF proteins in inflammatory cells.Animal experiments showed that Zhenzhu Tongluo Wan significantly improved hyperalgesia in rats with diabetic peripheral neuropathy,which may be related to the modulation of the expression of MAPK8,P65 and TNF proteins in the dorsal root ganglion.Conclusion Zhenzhu tongluo pills may play a role in the treatment of peripheral neuropathy by acting on the targets of MAPK8,P65 and TNF.This study lays a foundation for further research on the mechanism and pharmacodynamic substances of Zhenzhu Tongluo Wan in the treatment of peripheral neuropathy.

Objective This study aimed to systematically investigate the pharmacological substances and potential mechanisms of Zhenzhu Tongluo Wan in the treatment of peripheral nerve disorders.Methods Based on the TCMSP database and related literature,the active ingredients of Zhenzhu Tongluo Wan were determined.Target proteins for these active ingredients and those associated with peripheral neuropathy were predicted using the TCMSP,SwissTarget Prediction,GeneCard,OMIM,and DisGeNET databases.The intersection of these two sets of proteins was once considered a key target for the treatment of peripheral neuropathy.A protein-protein interaction(PPI)network of the intersection targets was constructed using the STRING database and analyzed using Cytoscape 3.9.1 software.Key targets obtained from the network were subjected to GO enrichment analysis and pathway annotation analysis using the DAVID database.The UHPLC-Q-Orbitrap HRMS technique was used to characterize the major chemical components of Zhenzhu Tongluo Wan.In addition,molecular docking,animal and cell experiments were performed to explore the mechanisms underlying the treatment of peripheral neuropathy with Zhenzhu Tongluo Wan.Results A total of 147 potential active ingredients and 333 intersection targets of Zhenzhu Tongluo Wan were screened.GO function and KEGG pathway analysis revealed that the major pathways involved include MAPK signaling pathway,NF-κB signaling pathway,PI3K-Akt signaling pathway,MAPK cascade and inflammatory response,among others.Based on high-resolution mass spectrometry analysis,33 major active ingredients were identified from Zhenzhu Tongluo Wan,focusing on those compounds with a Dgree value greater than the median.Molecular docking results further demonstrate good binding interactions between compounds such as luteolin,quercetin,tryptophan,arginine and kaempferol found inZhenzhu Tongluo Wan and key targets.Western blotting experiments showed that luteolin,quercetin and tryptophan could significantly inhibit the expression of MAPK8,P65 and TNF proteins in inflammatory cells.Animal experiments showed that Zhenzhu Tongluo Wan significantly improved hyperalgesia in rats with diabetic peripheral neuropathy,which may be related to the modulation of the expression of MAPK8,P65 and TNF proteins in the dorsal root ganglion.Conclusion Zhenzhu tongluo pills may play a role in the treatment of peripheral neuropathy by acting on the targets of MAPK8,P65 and TNF.This study lays a foundation for further research on the mechanism and pharmacodynamic substances of Zhenzhu Tongluo Wan in the treatment of peripheral neuropathy.

Objective To investigate the correlation between knee joint line and anterior knee pain after total knee arthroplasty (TKA).Methods From January 2008 to December 2010,76 patients with osteoarthritis underwent primary TKA in our hospital,including 11 males and 65 females,aged from 47 to 83 years (average,68.88±7.61 years).Fixed-bearing posterior stabilized TKA (PFC) was used in all patients.All patients were followed up every 12 months after TKA.According to the Figgie's method,pre-and post-operative knee joint line was measured,and the changes of pre-and post-operative knee joint line were calculated.If the knee joint line was elevated,it was defined as positive; on the contrary,it was defined as negative.The Feller's patellar score was used to assess pre-and post-operative patellar function.The correlation between joint line level and Feller's patellar score was analyzed 24 months after operation.Results The joint line level ranged from-6.8 to 10.44 mm (average,2.69±3.31 mm).With the rise of the joint line,the patient's patella score decreased.There is a negative correlation between the elevated joint line level and Feller's patellar score (r=-0.763,P=0.000).The Feller's patellar score decreased with the fall of joint line level,and there is a positive correlation between them (r=0.914,P=0.000).The Feller's patellar score was higher in patients whose joint line change was less than 4 mm than that in patients whose joint line change was greater than 4 mm (t=12.648,P=0.000; t=l 1.775,P=0.000).Conclusion The joint line change was correlated to anterior knee pain after TKA with fixedbearing posterior stabilized prosthesis.The joint line change less than 4 mm can result in a better knee joint function.

Objective To establish the quality standard for Tibetan medicine MNXT granule.Methods Inula racemosa,Tinospora sinensis were identified by TLC; Isoalantolactone and alantolactone were determined by HPLC.Results Inula racemosa,Tinospora sinensis could be identified by TLC.The concentration of isoalantolactone was linear in the range of 0.281～0.842 μg,r=0.9998,with the average recovery rate being 98.5％,RSD being1.14％.The concentration of alantolactone was linear in the range of 0.232～0.696 μg,r=0.9999,with the average recovery rate being 97.4％,RSD being 1.10％.Conclusion The method was simple,accurate,repeatable and able to control the quality of preparation effectively.

OBJECTIVE:To establish a method for the quality control of Jiuweiniuhuang pills.METHODS:TLC was applied for the quantitative identification of Bostaurus domesticus,Carthamus tinctorius and Aucklandia lappa in this prescription as well as the testing of the limit of Aristolochic acid A. RP-HPLC method was established for determination of Costunolide and Dehydrocostuslactone.RESULTS: The TLC spots were clear,well-separated,specific and free from interference of negative sample. The content of Aristolochic acid A which stood at less than 2.5 ?g?6 g-1 was up to the standard.Costunolide showed a linear relationship at the concentration range of 0.26～1.3 ?g with an average recovery of 99.8% (RSD=1.1%,n=6); and Dehydrocostuslactone showed a linear relationship at the concentration range of 0.258～1.29 ?g with an average recovery of 98.2%(RSD=1.7%,n=6).CONCLUSION: The method is suitable for the quality control of Jiuweiniuhuang pills.

Objective To discuss the clinical outcomes of two-stage anterior osteotomy and posterior correction to serious congenital scoliosis in children. Methods 14 patients with serious congenital scoliosis was typeⅠin 2 cases, type Ⅱin 6 cases, and combination of type Ⅰ and Ⅱ in 6 cases according to MacEwen's classification. There were 4 boys and 10 girls, and the age was ranged from 8 to 13 years with a mean of 11.2 years. The preoperative coronal Cobb's angle was ranged from 63? to 95? with an average of 72.1?. The hemivertebra ranging from T2 to L4. All cases were treated by anterior osteotomy, resection of hemivertebrae, and release of unilateral unsegmented bar, combined with posterior correction, and fusion with bone graft. The average range of osteotomy was 5.5 segments in anterior procedure, and all the patients were instrumented with pedicle screws in posterior procedure. Results In this group, the blood loss was 300 to 500 ml in first stage and 700 to 1200 ml in second stage respectively. After the first-stage surgery, the coronal Cobb's angle was ranged from 48? to 60? with a mean of 51.5?, and the correction rate ranged from 19.6% to 37.8% with an average of 28.6%. After the second-stage surgery, the Cobb's angle was ranged from 5? to 45? with a mean of 30.5? and the correction rate was from 52.6% to 87.5% with an average of 62.5%. All cases were followed up for 8 to 30 months (mean, 12.1 months). There were no loss of correction and major complications of the fixations, and the spinal fusions were excellent. Complications were observed in 2 cases, one was the loosening of the screw cap, and another was the T1 radicular pain after operations. Conclusion The combined anterior and posterior approach is an effective technique for serious congenital scoliosis in children of 8 to 12 years.