BACKGROUND:Intervertebral disc degeneration is the main pathological factor causing low back pain,which is closely related to macrophage-mediated immune inflammation.Tongdu Huoxue Decoction is a proven prescription for the treatment of intervertebral disc degeneration,but it is still unclear whether it can treat intervertebral disc degeneration by regulating the polarization phenotype of macrophages to inhibit inflammation in intervertebral disc tissue.OBJECTIVE:To investigate the regulatory effects of Tongdu Huoxue Decoction on the expression of macrophage-related inflammatory factors in intervertebral disc tissues of rats,as well as its mechanisms for the treatment of intervertebral disc degeneration.METHODS:Twenty-four Sprague-Dawley rats were randomly divided into sham operation group,model group,and Tongdu Huoxue Decoction group,with eight rats in each group.An intervertebral disc degeneration model was established using the annulus fibrosus puncture method in the latter two groups.On the 1st postoperative day,10.8 g/kg Tongdu Huoxue Decoction was given by gavage in the Tongdu Huoxue Decoction group,and the same dose of saline was given by gavage in the sham operation group and the model group,once a day.After 4 weeks of intervention,histopathological changes in the intervertebral disc tissues were assessed using hematoxylin-eosin.Immunohistochemistry and quantitative real-time PCR were performed to detect the relative expression levels of CD68,CD206,interleukin 1β,interleukin 10,type II collagen,and matrix metalloproteinase 13 proteins or mRNA in the intervertebral disc tissues.RESULTS AND CONCLUSION:(1)Hematoxylin-eosin staining results revealed that the model group exhibited a significant decrease in intervertebral disc height,disorganized annulus fibrosus structure with fissures,and unclear demarcation between the nucleus pulposus and the annulus fibrosus.The Tongdu Huoxue Decoction group showed organized arrangement of the annulus fibrosus with pyknosis.(2)Immunohistochemical results demonstrated that,compared with the model group,the Tongdu Huoxue Decoction group had significantly lower expressions of CD68,interleukin 1β,and matrix metalloproteinase 13,and significantly higher expressions of CD206,type II collagen and interleukin 10(P<0.05 or P<0.01).(3)qPCR results showed that there were significant differences in the mRNA expression of CD68,CD206,interleukin 1β,matrix metalloproteinase 13,type II collagen,and interleukin 10 between the three groups(P<0.001).To conclude,Tongdu Huoxue Decoction can improve intervertebral disc degeneration in the rat model of intervertebral disc degeneration,and its mechanism is associated with the inhibition of macrophage-related inflammatory responses in the intervertebral discs.

BACKGROUND:Intervertebral disc degeneration is the main pathological factor causing low back pain,which is closely related to macrophage-mediated immune inflammation.Tongdu Huoxue Decoction is a proven prescription for the treatment of intervertebral disc degeneration,but it is still unclear whether it can treat intervertebral disc degeneration by regulating the polarization phenotype of macrophages to inhibit inflammation in intervertebral disc tissue.OBJECTIVE:To investigate the regulatory effects of Tongdu Huoxue Decoction on the expression of macrophage-related inflammatory factors in intervertebral disc tissues of rats,as well as its mechanisms for the treatment of intervertebral disc degeneration.METHODS:Twenty-four Sprague-Dawley rats were randomly divided into sham operation group,model group,and Tongdu Huoxue Decoction group,with eight rats in each group.An intervertebral disc degeneration model was established using the annulus fibrosus puncture method in the latter two groups.On the 1st postoperative day,10.8 g/kg Tongdu Huoxue Decoction was given by gavage in the Tongdu Huoxue Decoction group,and the same dose of saline was given by gavage in the sham operation group and the model group,once a day.After 4 weeks of intervention,histopathological changes in the intervertebral disc tissues were assessed using hematoxylin-eosin.Immunohistochemistry and quantitative real-time PCR were performed to detect the relative expression levels of CD68,CD206,interleukin 1β,interleukin 10,type II collagen,and matrix metalloproteinase 13 proteins or mRNA in the intervertebral disc tissues.RESULTS AND CONCLUSION:(1)Hematoxylin-eosin staining results revealed that the model group exhibited a significant decrease in intervertebral disc height,disorganized annulus fibrosus structure with fissures,and unclear demarcation between the nucleus pulposus and the annulus fibrosus.The Tongdu Huoxue Decoction group showed organized arrangement of the annulus fibrosus with pyknosis.(2)Immunohistochemical results demonstrated that,compared with the model group,the Tongdu Huoxue Decoction group had significantly lower expressions of CD68,interleukin 1β,and matrix metalloproteinase 13,and significantly higher expressions of CD206,type II collagen and interleukin 10(P<0.05 or P<0.01).(3)qPCR results showed that there were significant differences in the mRNA expression of CD68,CD206,interleukin 1β,matrix metalloproteinase 13,type II collagen,and interleukin 10 between the three groups(P<0.001).To conclude,Tongdu Huoxue Decoction can improve intervertebral disc degeneration in the rat model of intervertebral disc degeneration,and its mechanism is associated with the inhibition of macrophage-related inflammatory responses in the intervertebral discs.

Explainable artificial intelligence (AI) promotes the development of medicine and raises different ethical challenges. This new challenge is manifested in two aspects, including pre-interpretation and post-interpretation. The technical root of the ethical issues leading to the medical application of explainable AI is the negative effects of explainable technology, the social root is the lack of relevant moral principles and legislation, and the root of subjectivity lies in the diversity of interests of various stakeholders. Therefore, the solutions to the problem are to strengthen technological innovation, explainable AI medical application ethics education, training of medical staff and interdisciplinary cooperation, improve relevant moral principles, laws and regulations, and realize personalized interactive interpretation.

Objective To investigate the clinical application of 3.0 T mobile iMRI and neuronavigation in the microsurgical operation for the high grade gliomas in brain functional area.Methods The clinical data of 47 cases which were operated from April,2012 to August,2014 assisted by intraoperative magnetic resonance and neruonavigation system were analyzed retrospectively,including 19 cases of near the frontal motor areas,21 cases of closed to the dominant hemisphere language areas,and 7 cases of involved multiple lobes of the brain.The operative plans were made before the operative day using 3.0 T iMRI for T1-MPRAGE plain and enhancement magnetic resonance imaging sequence,diffusion tensor imaging (DTI) sequence and blood oxygenation level dependent functional MRI (BOLD-fMRI) sequence scanning.Before the start of operation,the margin of the tumor was marked on the scalp,and removed the tumor under the microscopy,according to the need 1-4 iMRI plain scan and enhanced scan were applied to reconstruct the real-time imaging of the residual tumors and corticospinal tract,and gained once more chances to remove the tumor repeatedly,until the tumor was removed totally,accurately and safely.Results The total resection rate increased from 63.8％ (30/47) to 95.7％ (45/47) by repeated resection,and 2 cases (4.3％ lesions) with subtotal resection.The dysfunction of motion and the language barrier got worse in 4 patients (8.5％).No cases with sever complication such as death and severe disability after operation.There were no intracranial hemorrhage,infection and other adverse events.Patients were followed up with nervous system symptoms and head MRI,the follow-up period was 3 months-2 years.Twenty-eight cases (59.6％) ob-tained good clinical efficacy;the dysfunction of motion and the language barrier got worse in 4 cases (8.5％);the symptoms and tumors recurrenced in 15 cases (31.9％).Conclusion The 3.0 T mobile iMRI system combined with functional neuronavigation can accurately display the relationships among the motor and language cortex,tumors and white matter fiber bundles real-timely.The extent of the tumor resection can be assessed accurately by real-time images provided by iMRI,and the residual tumor have chames to be resected repeatedly,until the tumors were resected totally before operation finished.The iMRI system can correct intraoperative brain shift timely.The total resection rate can be improved safely and accurately by one or more times resection.