Expert consensus for Jingtong Granules in treatment of cervical radiculopathy in clinical application / 中国中药杂志

With the effects of activating blood and resolving stasis, and moving Qi to relieve pain, Jingtong Granules is widely used in the treatment of cervical radiculopathy in China. Long-term clinical application and related evidence have shown that the prescription has ideal effect in alleviating the pain in neck, shoulder, and upper limbs, stiffness or scurrying numbness, and scurrying pain caused by this disease. However, there is a lack of consensus on the clinical application of Jingtong Granules. Therefore, clinical first-line experts and methodology experts from all over the country were invited to compile this expert consensus. This expert consensus is expected to guide clinicians to use Jingtong Granules in a standardized and reasonable way, improve clinical efficacy, reduce medication risks, and benefit patients. First, according to the clinical experience of experts and the standard development procedures, the indications, syndrome characteristics, clinical advantages, and possible adverse reactions of Jingtong Granules were summarized. Then, through face-to-face interview of clinical doctors in traditional Chinese medicine and western medicine and survey of the clinical application, the clinical problems were summed up, and the consensus was reached with the nominal group method to form the final clinical problems. Third, evidence retrieval was carried out for the clinical problems, and relevant evidence was evaluated. The GRADE system was employed to rate the quality of evidence. Fourth, 5 recommendation items and 3 consensuses items were summarized with the nominal group method. Opinions and peer reviews on the consensus content were solicited through expert meetings and letter reviews. The final consensus includes the summary of evidence on the clinical indications, effectiveness, and safety of Jingtong Granules, which can serve as a reference for clinicians in hospitals and primary health institutions.

Effective Components and Mechanisms of Drynariae Rhizoma Anti-osteoporosis Based on Network Pharmacology / 中国实验方剂学杂志

Objective:To predict the target of active components of Drynariae Rhizoma by the network pharmacology, map related targets of osteoporosis (OP), and analyze key nodes of interaction topologically, so as to comprehensively explore the pharmacological mechanism of anti-op of osteoclasts. Method:Firstly, the main active components of Drynariae Rhizoma were screened out from TCMSP based on the pharmacokinetic characteristics, and the related targets were predicted by Pubchem and Swiss Target Prediction database according to the Two-dimensional/Three-dimensional(2D/3D)structural similarity. Then, through Online Mendelian Inheritance in Man (OMIM) and Pubmed text, known OP therapeutic targets were mined, based on putative targets, String database was imported to build Drynariae Rhizoma treatment target OP interaction network diagram. With the help of CytoNCA software, the interaction key nodes were topologically identified according to relevant node parameters, and then imported into String database to build the protein interaction network graph. Finally, biological functions and metabolic pathways of key nodes were analyzed through DAVID database. Result:Sixteen active components of Drynariae Rhizoma were screened out, and 118 related targets were predicted according to the target prediction technique. Totally 316 known therapeutic targets for OP were retrieved. The protein interaction network was constructed according to the String network database. A total of 97 key nodes were screened via CytoNCA topology. The enrichment analysis showed that Drynariae Rhizoma may play an anti-osteoporosis role by regulating stem cells, osteoblasts, osteoclasts and immune cells through multiple signaling pathways in aspects of proliferation, differentiation, immunity and oxidative stress. Conclusion:Studies based on network pharmacology have shown that Drynariae Rhizoma may play an anti-op role through direct or indirect targets and multiple major signaling pathways and affect the proliferation and differentiation of multiple types of cells, in order to provid a scientific basis for explaining the material basis and mechanism of Drynariae Rhizoma's anti-osteoporosis effect.

Anterior corpectomy decompression and titanium mesh bone iraft fusion combined with titanium nate fixation for the treatment of the multilevel cervical spondylotic myelopathy / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of anterior corpectomy decompression and titanium mesh bone graft fusion combined with titanium plate fixation in treatting multilevel cervical spondylotic myelopathy.</p><p><b>METHODS</b>The clinical data of 48 patients with multilevel cervical spondylotic myelopathy underwent surgical operation were retrospectively analyzed from October 2010 to January 2013. There were 37 males and 11 females, aged from 37 to 76 years old with an average of 54.6 years. Thirty-five cases were two-segment lesion, 7 cases were three-segment lesion, 6 cases were four-segment lesion. All the patients were treated by anterior corpectomy decompression and titanium mesh bone graft fusion combined with titanium plate fixation. ROM, JOA, VAS and SF-36 scores were recorded before and after operation(including 3, 6, 12 months after operation and final follow-up). Fusion degree and spinal canal decompression condition were observed by radiographic data.</p><p><b>RESULTS</b>All patients were followed up from 14 to 48 months, with an average of 27.3 months. At 12 months after surgery, radiographic data showed that all patients obtained bony fusion, spinal canal decompression were sufficient. Preoperative vertebral canal sagittal diameter of the most serious segment were (5.13 +/- 1.32) mm, 12 months after surgery were (9.94 +/- 1.22) mm, there was statistically significance (t=2.463, P=0.014); the degree of vertebral canal decompression were (92.15 +/- 2.35)%. Postoperative ROM, JOA, VAS and SF-36 scores were obviously improved than that of preoperative (P<0.05); there was no statistically significance of ROM, JOA, VAS and SF-36 scores in each time after operation (P>0.05).</p><p><b>CONCLUSION</b>Anterior corpectomy decompression and titanium mesh bone graft fusion combined with titanium plate fixation can obtain higher fusion rate, complete thoroughly decompression, improvement of clinical symptoms and well safety in treating multilevel cervical spondylotic myelopathy.</p>

Effect of Yaobitong capsule on histomorphology of dorsal root ganglion and on expression of p38mark phosphorylation in autologous nucleus pulposus transplantation model of rats

OBJECTIVE@#To discuss the effect of Yaobitong capsule on histomorphology of dorsal root ganglion and on expression of p38MARK phosphorylation in autologous nucleus pulposus transplantation model of rats.@*METHODS@#A total of 60 SD rats were randomly divided into the blank group, model group and Yaobitong capsule group, with 20 rats in each group. The animal model of autologous nucleus pulposus transplantation around the lumbar nerve root was built. Three days after the modeling, rats were given the drugs for the first time, while rats in the model group were given the equivalent normal saline. After 30 d of continuous administration, samples were collected from rats. HE staining was performed on the dorsal root ganglion of L4 and L5 spinal cord of rats in each group and the expression of p38MARK phosphorylation was measured. All data were treated with the statistical analysis.@*RESULTS@#The histological examination showed that the histomorphology of dorsal root ganglion in the Yaobitong capsule group was more significantly improved than the one in the model group, while the results of western blot showed that Yaobitong capsule could significantly inhibit the level of p38MAPK phosphorylation of dorsal root ganglion cells.@*CONCLUSIONS@#Yaobitong capsule can improve the symptoms and nerve radiculopathy of autologous nucleus pulposus transplantation of rats and its mechanism may be associated with its inhibiting effect on the level of p38MAPK phosphorylation.

Naringin reduced polymethylmethacrylate-induced osteolysis in the mouse air sacs model / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the influence of naringin on PMMA-induced osteoclastic bone resorption using the mouse air sacs model.</p><p><b>METHODS</b>Total 48 female Balb/c mices with the age of 8 to 10 weeks were chosen in the study. Air were injected into the back in 32 mices and formed the air sacs, 6 d later, the skulls (originated from other 16 mices) were implanted to the air sacs. Thirty-two animals were divided into naringin treatment group (with 2 concentrations of 150 mg/kg and 30 mg/ kg) , DMSO group and PBS blank group, 8 animals in each group. Polymethylmethacrylate (PMMA) particles were injected into the air sacs in naringin treatment groups and DMSO group so as to irritate inflammatory reaction. Naringin with 2 concentrations of 150 mg/kg and 30 mg/kg were dissolved in DMSO of 0.2 ml, and were injected into air sacs, respectively. In PBS black group, no stimulation with PMMA particles, only injected PBS, and in DMSO group, injected DMSO without naringin. Tartrate resistant acid phosphatase (TRAP), Ca2+ release, modified Masson stain and histological analysis were performed on the 7th day after stimulation.</p><p><b>RESULTS</b>Compared with DMSO group, naringin treatment group's cellular infiltration decreased (P < 0.01); concentration of 150 mg/kg was better than that of concentrations of 30 mg/kg (8.90 ± 1.75 vs 15.23 ± 1.86). Naringin can decrease calcium release in the lavage of the air sacs bone resorption model, especially obvious in naringin with concentration of 150 mg/kg. Naringin can ameliorate the inflammatory reaction and the subsequent bone resorption (including bone collagen loss, TRAP positive cells amount and so on) in air sacs with bone implant and PMMA particles. Naringin with concentration of 150 mg/kg appeared to be an optimal dosage to deliver the therapeutic effects.</p><p><b>CONCLUSION</b>Naringin inhibits PMMA-induced osteoclastogenesis and ameliorates the PMMA-associated inflammatory reaction and the subsequent bone resorption.</p>

Effect of Yaobitong capsule on histomorphology of dorsal root ganglion and on expression of p38mark phosphorylation in autologous nucleus pulposus transplantation model of rats

Objective: To discuss the effect of Yaobitong capsule on histomorphology of dorsal root ganglion and on expression of p38MARK phosphorylation in autologous nucleus pulposus transplantation model of rats. Methods: A total of 60 SD rats were randomly divided into the blank group, model group and Yaobitong capsule group, with 20 rats in each group. The animal model of autologous nucleus pulposus transplantation around the lumbar nerve root was built. Three days after the modeling, rats were given the drugs for the first time, while rats in the model group were given the equivalent normal saline. After 30 d of continuous administration, samples were collected from rats. HE staining was performed on the dorsal root ganglion of L4 and L5 spinal cord of rats in each group and the expression of p38MARK phosphorylation was measured. All data were treated with the statistical analysis. Results: The histological examination showed that the histomorphology of dorsal root ganglion in the Yaobitong capsule group was more significantly improved than the one in the model group, while the results of western blot showed that Yaobitong capsule could significantly inhibit the level of p38MAPK phosphorylation of dorsal root ganglion cells. Conclusions: Yaobitong capsule can improve the symptoms and nerve radiculopathy of autologous nucleus pulposus transplantation of rats and its mechanism may be associated with its inhibiting effect on the level of p38MAPK phosphorylation.