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.

Based on the pathogenesis of “tendon off-position and joint subluxation”， combined with modern ana-tomy and biomechanics， the characteristic manifestations of “tendon off-position” and “joint subluxation” of the knee and the intrinsic connection between them are clarified. Through sorting out the relationship between “tendon off-position and joint subluxation” and knee osteoarthritis （KOA） in modern research， it is believed that “tendon off-position and joint subluxation” is the key mechanism for the occurrence and development of KOA， and accordingly， it is proposed to take the diet as the guide， use bone manipulation for external diagnosis and treatment， use traditional Chinese medicine decoction for internal treatment， and use Daoyin exercise throughout the whole process as the strategy for KOA's comprehensive traditional Chinese medicine treatment to improve the clinical effectiveness.

BACKGROUND:"Tendon off-position"is a disease name included in the International Classification of Diseases 11th Revision,and also a clinical indication of manipulation,acupuncture and other treatments.However,its specific mechanism is still unclear.It is urgent to establish an animal model that can reflect the clinical and pathological characteristics of"tendon off-position,"so as to further study the mechanism of effective clinical treatments. OBJECTIVE:To establish an animal model of"tendon off-position"in rats based on isometric contraction of skeletal muscles,and to explore the changes of skeletal muscle function and morphological phenotype after"tendon off-position." METHODS:Sixty rats were randomly divided into control group,static-loading group and extra loading group,with twenty rats in each group.Rats in the control group were kept normally without treatment.In the latter two groups,the rats were fixed by the self-made static-loading modeling device and a static-loading(the body mass of each rats was applied as the static-loading)was applied to cause sustained isometric contraction of the upper limb muscles.Then,animal models of"tendon off-position"were successfully established.In the extra loading group,50%of the body mass was added to the ankle joint after modeling.The skeletal muscle samples were harvested at 2 and 4 weeks after modeling.The changes of limb grip strength,wet mass of skeletal muscle,and serum levels of creatine kinase-muscle and lactate dehydrogenase A were measured,and the changes of skeletal muscle histomorphology and ultrastructure were observed. RESULTS AND CONCLUSION:At 2 weeks after modeling,the rats in the static-loading group and extra loading group showed significantly decreased grip strength and wet muscle mass,significantly increased serum levels of creatine kinase-muscle and lactate dehydrogenase A,and abnormal muscle fiber morphology and structure accompanied by a large number of deposited collagen fibers.Electron microscopy results showed that the structure of myofibrils was disordered,the Z-line was distorted,and the light and dark boundaries were blurred.At 4 weeks after modeling,the grip strength of the model rats was increased compared with that at 2 weeks,the serum creatine kinase-muscle and lactate dehydrogenase A levels were decreased,and the changes of muscle fiber morphology and ultrastructure were recovered to varying degrees.It is suggested that the rat skeletal muscle injury model based on continuous isometric contraction of skeletal muscle can well reflect the pathological characteristics of"tendon off-position"at 2 weeks,and can be used to study the mechanism of acupuncture and manipulation in the treatment of"tendon off-position."

Objective To systematically review the efficacy and safety of different oral Chinese patent medicines combined with conventional western medicines in the therapy of lumbar disc herniation(LDH).Methods PubMed,Embase,Cochrane Library,Medline,CNKI,WanFang data,VIP and SinoMed databases were electronically searched to collect randomized clinical trials(RCTs)on oral Chinese patent medicines combined with conventional western medicines in the treatment of LDH from the inception to April 10,2023.Two reviewers independently screened the literature,extracted data,and evaluated the risk of bias of included studies.Network Meta-analysis was then performed by Stata 17.0 and RevMan 5.4 softwares.Results A total of 26 RCTs were included,involving 16 Chinese patent medicines with a total sample size of 2 448 cases.The network Meta-analysis results showed that 13 Chinese patent medicines combined with conventional western medicines had better effects than conventional western medicines alone.Among them,in terms of a better VAS score,the top three interventions were Jingyaokang capsules+conventional western medicine＞Yaobitong capsules+conventional western medicine＞Huoxue Zhitong capsules+conventional western medicine;in terms of a better Japanese Orthopaedic Associationl(JOA)score,the top three interventions were Qufeng Zhitong capsules+conventional western medicine＞Yaobitong capsules+conventional western medicine＞Luchuan Huoluo capsules+conventional western medicine;in terms of the clinical effective rate,the top three interventions were Luchuan Huoluo capsules+conventional western medicine＞Xianling Gubao capsules+conventional western medicine＞Tongzhi Surunjiang capsules+conventional western medicine;in terms of safety,no serious adverse drug reactions occurred in all studies,and the overall incidence of adverse drug reactions in the oral Chinese patent medicines combined with conventional western medicines group was lower than that in the conventional western medicines group.Conclusion The combination of oral Chinese patent medicines and conventional western medicines has been shown to improve the clinical efficacy of LDH.Among these,Yaobitong capsules stand out for its ability to reduce VAS score,improve JOA score ranking,and increase the effective rate.Due to limited quality and quantity of the included studies,more high-quality studies are required to verify the above conclusions.

Objective To assess the prognostic value of APRI score and FIB-4 index for patients with chronic liver failure.Methods Clinical data of 426 patients with chronic liver failure admitted in the First Affiliated Hospital of Xinjiang Medical University from March 2005 to September 2014 were retrospectively analyzed.The MELD score,APRI score and FIB-4 index were calculated.Patients were divided into survival group and fatal group according to survival situation within 3 month after admission.Logistic regression was used to analyze the differences in all the indexes between the survival group and fatal group.Receiver operating characteristic (ROC) curve was used to assess the value of the above indexes in predicting the 3-month survival.Results Among 426 patients 244 died within three months after admission.Univariate analysis and multivariate Logistic regression showed that MELD score and FIB-4 index were statistically significant between the survival and fatal groups (Z =-4.783 and-4.104,x2 =26.31 and 11.34,both P ＜ 0.01).The area under the ROC curve of MELD score,APRI score and FIB-4 index was 0.635,0.511 and 0.616 for predicting 3-month survival,respectively.Compared with the APRI score,MELD score and FIB4 index were statistically different (x2 =13.669 and 6.341,P ＜ 0.05 or P ＜ 0.01).When MELD score ＞ 28,FIB-4 index ＞ 11.27,the patient has a high fatality rate and poor prognosis within three months.Conclusion FIB-4 index can be used to evaluate the short-term prognosis of patients with chronic liver failure,and the higher score of FIB-4 index predicts the worse prognosis.

Objective To evaluate the function of "high-dose methotrexate (HD-MTX) protocol" in the patients with HD-MTX-induced acute kidney injury (AKI).Methods The medical record data of patients with hematological malignancy received HD-MTX therapy in the First Affiliated Hospital of Soochow University from January 2013 to December 2016 were collected and retrospectively analyzed.The patients who received chemotherapy before the establishment of "HD-MTX protocol" were enrolled into the control group (between January 2013 to September 2014), and the patients who received chemotherapy after the establishment of "HD-MTX protocol" were enrolled into the observation group (between October 2014 to December 2016).The incidence of delayed MTX elimination and AKI between the 2 groups were compared.Results A total of 234 patients were enrolled in the study.There were 78 patients in the control group including 50 males and 28 females with the age 3 to 64 years and median age 25 years, of them, 57 patients with leukemia and 21 patients with lymphoma.There were 156 patients in the observation group including 92 males and 64 females with the age 6 to 64 years and median age 26 years, of them, 129 patients had leukemia and 27 patients had lymphoma.The percentage of patients with no-prehydration and no-preurine alkalinization in the control group was higher than that in the observation group[60.1% (47/78) vs.4.5% (7/156), 80.8% (63/78) vs.8.3% (13/156)], and the median volume of intravenous hydration was less than that in the observation group[0 (0-500) ml vs.1 750 (1 250-2 100) ml].The differences between the 2 groups were statistically significant (X2=91.168, P<0.001;X2=124.415, P<0.001;Z=-9.224, P<0.001).The incidence of delayed MTX elimination and AKI after MTX infusion in the control group was higher than that in the observation group [21.8% (17/78) vs.12.2% (18/156).20.5% (16/78) vs.10.3% (16/156)].The differences between the 2 groups were statistically significant (X2=4.300, P=0.038;X2=4.634, P=0.031).In the control group, there were 16 patients with AKI, the patients with grade Ⅰ, grade Ⅱ and grade Ⅲ were 6, 2 and 8 respectively.In the observation group, there were 16 patients with AKI, the patients with grade Ⅰ, grade Ⅱ and grade Ⅲ were 11, 4 and 1 respectively.The degree of kidney injury in the control group was higher than that in the observation group (Z=-2.286, P=0.022).Conclusion The "HD-MTX protocol" can significantly decrease the incidence of delayed MTX elimination and AKI, especially the incidence of grade Ⅲ AKI.

Objective To evaluate the function of "high-dose methotrexate (HD-MTX) protocol" in the patients with HD-MTX-induced acute kidney injury (AKI).Methods The medical record data of patients with hematological malignancy received HD-MTX therapy in the First Affiliated Hospital of Soochow University from January 2013 to December 2016 were collected and retrospectively analyzed.The patients who received chemotherapy before the establishment of "HD-MTX protocol" were enrolled into the control group (between January 2013 to September 2014), and the patients who received chemotherapy after the establishment of "HD-MTX protocol" were enrolled into the observation group (between October 2014 to December 2016).The incidence of delayed MTX elimination and AKI between the 2 groups were compared.Results A total of 234 patients were enrolled in the study.There were 78 patients in the control group including 50 males and 28 females with the age 3 to 64 years and median age 25 years, of them, 57 patients with leukemia and 21 patients with lymphoma.There were 156 patients in the observation group including 92 males and 64 females with the age 6 to 64 years and median age 26 years, of them, 129 patients had leukemia and 27 patients had lymphoma.The percentage of patients with no-prehydration and no-preurine alkalinization in the control group was higher than that in the observation group[60.1% (47/78) vs.4.5% (7/156), 80.8% (63/78) vs.8.3% (13/156)], and the median volume of intravenous hydration was less than that in the observation group[0 (0-500) ml vs.1 750 (1 250-2 100) ml].The differences between the 2 groups were statistically significant (X2=91.168, P<0.001;X2=124.415, P<0.001;Z=-9.224, P<0.001).The incidence of delayed MTX elimination and AKI after MTX infusion in the control group was higher than that in the observation group [21.8% (17/78) vs.12.2% (18/156).20.5% (16/78) vs.10.3% (16/156)].The differences between the 2 groups were statistically significant (X2=4.300, P=0.038;X2=4.634, P=0.031).In the control group, there were 16 patients with AKI, the patients with grade Ⅰ, grade Ⅱ and grade Ⅲ were 6, 2 and 8 respectively.In the observation group, there were 16 patients with AKI, the patients with grade Ⅰ, grade Ⅱ and grade Ⅲ were 11, 4 and 1 respectively.The degree of kidney injury in the control group was higher than that in the observation group (Z=-2.286, P=0.022).Conclusion The "HD-MTX protocol" can significantly decrease the incidence of delayed MTX elimination and AKI, especially the incidence of grade Ⅲ AKI.