The key to the onset and progression of the functional impairments of orthopedic diseases is imba-lance of deficiency and excess， disharmony of movement and stillness， dislocation of sinews and bones， imbalance of rigidity and flexibility， and disharmony of body and spirit. Based on this， the "five views" treatment principle has been proposed for traditional Chinese medicine （TCM） orthopedic rehabilitation， which include the view of balancing deficiency and excess， combining movement and stillness， focusing on both sinews and bones， integrating rigidity and flexibility， and harmonizing body and spirit. Correspondingly， the "five views" collaborative rehabilitation clinical model is established， providing a reference for enhancing the systematization and targeting of TCM orthopedic rehabilitation.

BACKGROUND:Needle-knife release of the ligamentum flavum can effectively improve symptoms in patients with lumbar degeneration,and ultrasound guidance can increase the precision of needle-knife release;however,the specific effects of needle-knife release of the ligamentum flavum on the degenerated intervertebral discs and the possible mechanisms remain to be clarified. OBJECTIVE:To investigate the effect of ultrasound-guided needle-knife release of the ligamentum flavum. METHODS:Twenty-four New Zealand rabbits were randomized into control(n=6)and model(n=18)groups.A rabbit model of lumbar disc degeneration model was established in the model group by cutting the supraspinous and interspinous ligaments of the L5/6 and L6/7 segments to maintain a standing posture and apply axial load to the lumbar spine.After successful modeling,the model rabbits were subdivided into a control group,a model group,an ultrasonic needle-knife group,and a sham needle-knife group according to a random number table method,with six animals in each group.The ultrasonic needle-knife group underwent ultrasound-guided needle-knife release of the right yellow ligament of L7/S1,once every week,for a total of four times.The needle-knife approach in the sham needle-knife group was the same as that in the ultrasound needle-knife group,but the ligamentum flavum was not released.At 30 days after the intervention,MRI was used to observe the changes in the signal intensity of the nucleus pulposus within the L7/S1 segment.Hematoxylin-eosin staining was used to observe the morphological changes of the L7/S1 segment.Immunohistochemical staining was used to detect the expression of type I and II collagen in the nucleus pulposus of the L7/S1 segment.RT-PCR and western blot were used to detect the expression of integrin α5 and β1,p38,and nuclear factor κB in the L7/S1 segment. RESULTS AND CONCLUSION:MRI findings indicated that the nucleus pulposus of the intervertebral disc of rabbits in the model group was gray-black in color,and the gray value of the nucleus pulposus was significantly lower than that of the control group(P<0.01).The brightness of the nucleus pulposus of the intervertebral disc of the rabbits in the ultrasonic needle-knife group was elevated compared with that of the model group,and the gray value of the nucleus pulposus was higher than that of the model group(P<0.01).Results from hematoxylin-eosin staining showed that in the model group,the shape of the nucleus pulposus was irregular,the number of nucleus pulposus cells was reduced,the extracellular matrix was compressed,the fibrous ring was ruptured,the structure and boundary of the end plate were unclear,and the chondrocytes were arranged disorderly.Compared with the model group,the ultrasonic needle-knife group showed an increase in the number of the nucleus pulposus,an improvement in the rupture of the fibrous ring,and more regular arrangement of cartilage endplate cells.Results from immunohistochemical staining showed an increase in positive expression of type I collagen(P<0.01)and a decrease in positive expression of type II collagen in the nucleus pulposus of the model group compared with the control group as well as a decrease in positive expression of type I collagen and an increase in positive expression of type II collagen in the nucleus pulposus of the ultrasonic needle-knife group compared with the model group(P<0.01).RT-PCR and western blot assays showed that the mRNA and protein expression of integrin α5,integrin β1,p38,and nuclear factor κB in the intervertebral discs of rabbits in the model group were increased compared with that in the control group(P<0.01);the mRNA and protein expression of integrin α5,integrin β1,p38,and nuclear factor κB in the intervertebral discs of rabbits in the ultrasonic needle-knife group was decreased compared with that in the model group(P<0.01).To conclude,ultrasound-guided needle-knife release of the ligamentum flavum can improve the degree of lumbar disc degeneration in rabbits,which may be related to the inhibition of p38 and nuclear factor-κB expression by modulating integrin α5 and β1 expression.

BACKGROUND:Cartilaginous endplate stromal homeostasis is closely related to intervertebral disc degeneration.Acupotomy that releases posterior wall ligamentum flavum of the interforaminal orifice can improve the symptoms of patients with lumbar disc degeneration.Whether the mechanism of action is related to the regulation of cartilaginous endplate stromal homeostasis remains to be clarified.OBJECTIVE:To investigate the effect of ultrasound-guided needle-knife relaxation of the internal orifice of the rabbit L7/S1 intervertebral foramina on the matrix homeostasis of the rabbit cartilage endplate.METHODS:A total of 24 male New Zealand rabbits were randomly divided into a control group(n=6)and a modeling group(n=18).Lumbar disc degeneration modeling was performed by intermittent standing after transection of the supraspinous interspinous ligament for 12 weeks.After modeling,the modeling group was randomly divided into model group,needle-knife group and fake needle knife group,with 6 rabbits in each group.In the needle-knife group,the ultrasound-guided needle-knife released the ligamentum flavum posterior wall of the right intervertebral foramina,while in the fake needle-knife group,the needle-knife only reached the surface of the posterior wall ligamentum flavum of the intervertebral foramina,with a total of four interventions,each time at an interval of 1 week.No intervention was performed in the control and model groups.Thirty days after the intervention,the disc degeneration was observed by MRI.The morphology of L7/S1 intervertebral disc cartilaginous endplate,nucleus pulposus and annulus fibrosus were observed with hematoxylin-eosin and safranin O-fast green staining and was then scored.The expressions of type II collagen,proteoglycan and matrix metalloproteinase-13 in nucleus pulposus and cartilage endplate of L7/S1 intervertebral disc were detected by immunohistochemistry.RESULTS AND CONCLUSION:MRI results showed that the relative gray value of L7/S1 nucleus pulposus was significantly lower in the model group than in the control group(P<0.01),and higher in the needle-knife group than in the model group and the fake needle-knife group(P<0.05).Hematoxylin-eosin and safranin O-fast green staining showed obvious degeneration of the nucleus pulposus and annulus fibrosus,thinning of the cartilaginous endplate,and obvious calcification at the junction with bone endplate in the model group.The morphology of the cartilaginous endplate and degeneration of the nucleus pulposus were improved in the needle-knife group compared with the model group.The morphological scores of the model group,needle-knife group and fake needle-knife group were significantly higher than those of control group(P<0.01).The morphological score of the needle-knife group was significantly lower than that of the model group and fake needle-knife group(P<0.01).Immunohistochemistry results showed that compared with the control group,the expressions of type II collagen and Aggrecan in the nucleus pulposus and cartilage endplate in the model group and fake needle-knife group were significantly decreased(P<0.01),while the expression of matrix metalloproteinase-13 was significantly increased(P<0.01).Compared with the model group and fake needle-knife group,the expressions of type II collagen and Aggrecan in the nucleus pulposus and cartilage endplate were increased in the needle-knife group(P<0.05),while the expression of matrix metalloproteinase-13 was decreased significantly(P<0.01).In conclusion,the relaxation of the interforaminal orifice by needle knife can regulate the matrix homeostasis of the rabbit cartilage endplate and improve the degeneration of the intervertebral disc.

BACKGROUND:Cartilaginous endplate stromal homeostasis is closely related to intervertebral disc degeneration.Acupotomy that releases posterior wall ligamentum flavum of the interforaminal orifice can improve the symptoms of patients with lumbar disc degeneration.Whether the mechanism of action is related to the regulation of cartilaginous endplate stromal homeostasis remains to be clarified.OBJECTIVE:To investigate the effect of ultrasound-guided needle-knife relaxation of the internal orifice of the rabbit L7/S1 intervertebral foramina on the matrix homeostasis of the rabbit cartilage endplate.METHODS:A total of 24 male New Zealand rabbits were randomly divided into a control group(n=6)and a modeling group(n=18).Lumbar disc degeneration modeling was performed by intermittent standing after transection of the supraspinous interspinous ligament for 12 weeks.After modeling,the modeling group was randomly divided into model group,needle-knife group and fake needle knife group,with 6 rabbits in each group.In the needle-knife group,the ultrasound-guided needle-knife released the ligamentum flavum posterior wall of the right intervertebral foramina,while in the fake needle-knife group,the needle-knife only reached the surface of the posterior wall ligamentum flavum of the intervertebral foramina,with a total of four interventions,each time at an interval of 1 week.No intervention was performed in the control and model groups.Thirty days after the intervention,the disc degeneration was observed by MRI.The morphology of L7/S1 intervertebral disc cartilaginous endplate,nucleus pulposus and annulus fibrosus were observed with hematoxylin-eosin and safranin O-fast green staining and was then scored.The expressions of type II collagen,proteoglycan and matrix metalloproteinase-13 in nucleus pulposus and cartilage endplate of L7/S1 intervertebral disc were detected by immunohistochemistry.RESULTS AND CONCLUSION:MRI results showed that the relative gray value of L7/S1 nucleus pulposus was significantly lower in the model group than in the control group(P<0.01),and higher in the needle-knife group than in the model group and the fake needle-knife group(P<0.05).Hematoxylin-eosin and safranin O-fast green staining showed obvious degeneration of the nucleus pulposus and annulus fibrosus,thinning of the cartilaginous endplate,and obvious calcification at the junction with bone endplate in the model group.The morphology of the cartilaginous endplate and degeneration of the nucleus pulposus were improved in the needle-knife group compared with the model group.The morphological scores of the model group,needle-knife group and fake needle-knife group were significantly higher than those of control group(P<0.01).The morphological score of the needle-knife group was significantly lower than that of the model group and fake needle-knife group(P<0.01).Immunohistochemistry results showed that compared with the control group,the expressions of type II collagen and Aggrecan in the nucleus pulposus and cartilage endplate in the model group and fake needle-knife group were significantly decreased(P<0.01),while the expression of matrix metalloproteinase-13 was significantly increased(P<0.01).Compared with the model group and fake needle-knife group,the expressions of type II collagen and Aggrecan in the nucleus pulposus and cartilage endplate were increased in the needle-knife group(P<0.05),while the expression of matrix metalloproteinase-13 was decreased significantly(P<0.01).In conclusion,the relaxation of the interforaminal orifice by needle knife can regulate the matrix homeostasis of the rabbit cartilage endplate and improve the degeneration of the intervertebral disc.

Objective:To analyze the effect of hyperbaric oxygen (HBO) assisted treatment on fetal growth restriction (FGR).Methods:A total of 110 pregnant women with FGR admitted in Gansu Provincial Maternity and Child-care Hospital from June 2018 to June 2019 were selected as research objects. They were randomly divided into observation group and control group in a ratio of 1∶1, with 55 cases in each group. The control group was treated with low molecular heparin combined with aspirin, and the observation group was treated with HBO on the basis of the treatment of the control group for 6 weeks. The fetal growth was examined by color Doppler ultrasound. The clinical effect and fetal hemodynamic parameters before and after treatment were compared. The maternal and infant outcomes such as complications of pregnancy and neonatal conditions were statistically analyzed. The coagulation functions of pregnant women before and after treatment were also analyzed.Results:The effective rate of the observation group (83.64%) was significantly higher than that of the control group (63.64%) with statistical difference ( χ2=5.666, P=0.017). After treatment, the high systolic blood flow/late diastolic blood flow (S/D), resistance index (RI), and pulse index (PI) of the two groups were all remarkably decreased ( P<0.01), and those of the observation group were lower than those of the control group ( P<0.05) before and after treatment. There was no statistical difference in the comparisons of neonatal complications and pregnancy complications after treatment between the two groups ( P>0.05). The coagulation function index of both two groups after treatment were all improved than those before treatment with statistically significant difference ( P<0.05), but there was no statistically significant difference between the coagulation function index of the observation group and that of the control group after treatment( P>0.05). Conclusion:HBO combined with aspirin and low molecular heparin in the treatment of FGR can significantly improve the fetal hemodynamic parameters, and therefore improve the clinical efficacy.

Objective:To analyze the effect of hyperbaric oxygen (HBO) assisted treatment on fetal growth restriction (FGR).Methods:A total of 110 pregnant women with FGR admitted in Gansu Provincial Maternity and Child-care Hospital from June 2018 to June 2019 were selected as research objects. They were randomly divided into observation group and control group in a ratio of 1∶1, with 55 cases in each group. The control group was treated with low molecular heparin combined with aspirin, and the observation group was treated with HBO on the basis of the treatment of the control group for 6 weeks. The fetal growth was examined by color Doppler ultrasound. The clinical effect and fetal hemodynamic parameters before and after treatment were compared. The maternal and infant outcomes such as complications of pregnancy and neonatal conditions were statistically analyzed. The coagulation functions of pregnant women before and after treatment were also analyzed.Results:The effective rate of the observation group (83.64%) was significantly higher than that of the control group (63.64%) with statistical difference ( χ2=5.666, P=0.017). After treatment, the high systolic blood flow/late diastolic blood flow (S/D), resistance index (RI), and pulse index (PI) of the two groups were all remarkably decreased ( P<0.01), and those of the observation group were lower than those of the control group ( P<0.05) before and after treatment. There was no statistical difference in the comparisons of neonatal complications and pregnancy complications after treatment between the two groups ( P>0.05). The coagulation function index of both two groups after treatment were all improved than those before treatment with statistically significant difference ( P<0.05), but there was no statistically significant difference between the coagulation function index of the observation group and that of the control group after treatment( P>0.05). Conclusion:HBO combined with aspirin and low molecular heparin in the treatment of FGR can significantly improve the fetal hemodynamic parameters, and therefore improve the clinical efficacy.

In this research,Microtox technology was used to evaluate the comprehensive toxicity of Shen-Fu injection,which was an exclusive product of the pharmaceutical company.Firstly,vibrio fischeri was used as test strain.The best test system and methodology were identified.Under the best test conditions,vibrio fischeri was firstly used in the luminescent bacteria comprehensive toxicity of the exclusive product Shen-Fu injection.The results showed that in the 2 mL reaction system,the best recovery liquid volume was 0.9 mL/ freeze-dried vial,50 μL bacterial suspensions/ sample,the detection time was 10 min after adding bacterial suspensions,the pH was 5-10,the luminous intensity was 800 000-12 000 000 for 10 rin.The RSD of replication experiment and intermediate precision test was ? and ?,respectively,which fitted to the requirements.There was no significant difference on EC50 values among 9 batches of tested Shen-Fu injection (41.07％,RSD ＜ 5％).It was concluded that there was significant concentration-effect relationship between Shen-Fu injection and the toxicity of vibrio fischeri.There was no significant difference on EC50 values among different batches.It indicated that there was small quality volatility among different batches of Shen-Fu injection.The control on product manufacturing was strong.

Microtox technology is one of quick toxicity test methods for determining the poisonous or toxic substances in the environment by luminous bacteria as a indicator organism.This paper reviewed the appearance and development of microtox technology.Besides,we expounded the methods and stepwise technique map and addressed key questions of microtox technology for the evaluation of the comprehensive toxicity of Chinese medicinal materials.In conclusion,microtox technology is a promising method from a vantage point of the toxicity detection of Chinese medicinal materials.

This study aimed at exploring the application of microtox technology to the evaluation of comprehensive toxicity of Sheng Mai injections.Characteristic parameters of vibrio fischeri (CS234) were measured by methodology inspection under different conditions to optimize the reaction condition with reliable technology.It was the first experiment to accomplish the comprehensive toxicity of Sheng Mai injections from various manufacturers using vibrio fischeri under the target condition.It was found that parameters of the optimum condition contained 0.9 mL recovery liquid volume in each freeze-dried vial and 50 μ L bacteria suspension of each sample,being included in 2 mL solution in aggregate under 10 mins' detection time after adding bacteria suspension with the favorable pH value ranging from 5 to 10 and luminous intensity from 0.8 to 1.2 million within 10 mins.The relative standard deviation values of replication experiment and precision test were all below 15％.Under this optimum detection condition,it was found that the EC50 values were 22.10％,34.10％ and 46.04％,respectively,presenting significant statistical differences (P＜0.05).These results demonstrated that the growth of biological detection standards of Sheng Mai injection was highlighted a long way to go.Besides,the microtox-based fast test for the evaluation of the comprehensive toxicity of Sheng Mai injection showed a prospective application to controlling the quality of different products from manufacturers.

In this research,we chiefly explored a new fast test method--microtox technology to evaluate the comprehensive toxicity of Shen Mai injection.We investigated characteristic parameters of vibrio fischeri (CS234) under different conditions in the pursuit of the optimum test parameters of the reliable method;and then locked the best parameters for Shen Mai injection assay with the products from different manufacturers by microtox fast test.As a result,the optimum reaction condition included 0.9 mL recovery liquid in each freeze-dried vial and 50 μL bacteria suspension of each sample within 2 mL solution in aggregate with 10-mins detection after adding bacteria suspension which pH value ranging from 5 to 10 and luminous intensity from 0.8 to 1.2 million in 10 mins.The relative standard deviation values of replication experiment and precision test were all below 15％.Under this optimum detection condition,it was found that the EC50 values were 35.60％,92.34％ and 146.57％,differing among the samples from three representative drug manufacturers,respectively (P ＜ 0.01).In conclusion,the concentration-effect relationship of Shen Mai injection existed in the toxicity assessment of vibrio fischeri with various ECs0 values from the three manufacturers.These results suggested that biological detection standards of Shen Mai injection presented great growth potential.Microtox-based fast test in the evaluation of comprehensive toxicity of ShenMai injection showed favorable application prospects over controlling the quality of different sources of products.