The historical evolution of processed mirabilite in the formulation of Zixue san and its processing method / 中国药房

Zixue san is a preparation in Chinese Pharmacopoeia ，and is a commonly used representative formula in Liangkai formulation. In the previous editions of Chinese Pharmacopoeia ，for the item of the formulation and preparation method of Zixue san，“mirabilite”“mirabilite（prepare）”“Xuanming powder ”and other different descriptions have been repeatedly modified and amended；the methods of preparation of mirabilite in the processing specifications of different provinces and cities are also different，causing effects in actual production. Therefore ，the author has researched the historical evolution of Zixue ，the formulation and preparation method of Zixue san in the previous editions of Chinese P harmacopoeia，and has expounded the change process of mirabilite，mirabilite（prepare），Xuanming powder in the item of formulation and preparation method of Zixue san. In addition ，the author compares Chinese Pharmacopoeia with the processing methods of mirabilite in the national and provincial processing specifications ，in order to provide a basis for the processing of mirabilite in the formulation of Zixue san.

Intravenous route to choroidal neovascularization by macrophage-disguised nanocarriers for mTOR modulation

Retinal pigment epithelial (RPE) is primarily impaired in age-related macular degeneration (AMD), leading to progressive loss of photoreceptors and sometimes choroidal neovascularization (CNV). mTOR has been proposed as a promising therapeutic target, while the usage of its specific inhibitor, rapamycin, was greatly limited. To mediate the mTOR pathway in the retina by a noninvasive approach, we developed novel biomimetic nanocomplexes where rapamycin-loaded nanoparticles were coated with cell membrane derived from macrophages (termed as MRaNPs). Taking advantage of the macrophage-inherited property, intravenous injection of MRaNPs exhibited significantly enhanced accumulation in the CNV lesions, thereby increasing the local concentration of rapamycin. Consequently, MRaNPs effectively downregulated the mTOR pathway and attenuate angiogenesis in the eye. Particularly, MRaNPs also efficiently activated autophagy in the RPE, which was acknowledged to rescue RPE in response to deleterious stimuli. Overall, we design and prepare macrophage-disguised rapamycin nanocarriers and demonstrate the therapeutic advantages of employing biomimetic cell membrane materials for treatment of AMD.

Herbal Textual Research on Astragali Radix in Famous Classical Formulas / 中国实验方剂学杂志

Through consulting the ancient herbal medicine， prescription books and medical books， combined with modern relevant literature， standards and other information， this paper made a textual research on the name， origin， producing areas， harvesting and processing methods of Astragali Radix according to different historical development periods， providing a basis for the development of famous classical formulas containing Astragali Radix. According to the textual research， the original name of Astragali Radix is Huangqi， and "Qi" originally refers to the medicinal material Zhimu. Some people began to mistake it for Huangqi in the Ming dynasty， and then gradually used Astragali Radix as a medicinal material. The mainstream basis of Astragali Radix can be determined as the dried roots of Astragalus membranaceus var. mongholicus or A. membranaceus. In different historical periods， A. floridus， A. chrysopterus， A. emestii and other plants of Astragalus or even non-Astragalus were used as local Astragali Radix. The earliest production areas of Astragali Radix were Sichuan， Shaanxi， and Gansu， and then gradually expanded to the northeast. Since the Song dynasty， Mianqi in Shanxi province has been regarded as the genuine variety. In the Qing dynasty， besides Shanxi province， Inner Mongolia was also regarded as a genuine place. In the Republic of China， Huangqi produced in northeast China was praised highly. It is mainly produced in Shanxi， Inner Mongolia， Gansu， northeast and other provinces. The main commodity is cultivated products， and the quality of wild imitation cultivation in Datong and Xinzhou is better than other places. There are many processing methods of Huangqi recorded in the materia medica and prescription books， most of which are raw products， and honey processing is the mainstream of processed products. Based on the current situation of resource cultivation and production， 11 famous classical formulas in The Catalogue of Ancient Famous Classical Formulas （The First Batch） containing Huangqi suggested that all use A. membranaceus var. mongholicus， especially those from Datong and Xinzhou in Shanxi Province. In addition to honey processing of Qingxin Lianziyin， it is suggested to use raw products for other formulas.

Herbal Textual Research on Poria in Famous Classical Formulas / 中国实验方剂学杂志

Through consulting the ancient and modern literature， this paper makes a textual research on the name， origin， producing area， harvesting and processing of Poria， so as to provide a basis for the development of the famous classical formulas containing this medicinal material. The description of Poria and the characteristics of the attached figures in the Chinese herbal literature of the past dynasties are consistent with Poria cocos. The medicinal parts are dried sclerotia or P. cocos peel. Poria was originally produced in Taishan， Shandong province. In the Tang dynasty， along with the change of pine forest resources， producing area of Poria was transferred to Huashan area in Shaanxi province. In the Ming dynasty， the authentic producing area was transferred to Yunnan， and has continued to now. In ancient times， the processing methods of Poria were steaming， boiling， slicing， mashing and other subsequent processing after peeling. It is suggested that Poria in famous classical formulas should be sliced according to the 2020 edition of Chinese Pharmacopoeia.

Herbal Textual Research on Asini Corii Colla in Famous Classical Formulas / 中国实验方剂学杂志

Through consulting the ancient and modern literature， this paper makes a textual research on the name， origin， producing area， harvesting and processing methods of Asini Corii Colla， so as to provide a basis for the development of the famous classical formulas containing the medicinal material. Before the Tang dynasty， cow leather was the main source of Asini Corii Colla， and donkey was rare as an introduced species. From the end of Tang dynasty to Song dynasty， due to the development of doctors' understanding of the properties and effects of medicines， with the increase of the number of donkeys and the limitation of the use of cow leather， the source of Asini Corii Colla changed from cow leather to donkey skin. During the Ming and Qing dynasties， the theory of medicine property was further developed， and all doctors basically agreed that black donkey skin and E-well water were two essential factors for making genuine Asini Corii Colla. Therefore， it is suggested that Asini Corii Colla should take Equus asinus as the authentic origin in the development of the famous classical formulas， attach importance to the quality of water source， take Liaocheng in Shandong province as the authentic producing area， and the processing should be carried out in accordance with the requirements of the 2020 edition of Chinese Pharmacopoeia.

Herbal Textual Research on Magnoliae Officinalis Cortex in Famous Classical Formulas / 中国实验方剂学杂志

Based on the ancient literature of all dynasties， this article makes a systematic textual research on the name， origin， producing area， quality， harvesting and processing of Magnoliae Officinalis Cortex used in the famous classical formulas， and clarifies its information of each link in different historical periods， so as to provide a reference and basis for the development and utilization of the related formulas. The results showed that the main varieties of Magnoliae Officinalis Cortex were Magnolia officinalis or M. officinalis var. biloba. The main production areas are Hubei， Sichuan， Chongqing and other places， forming the famous authentic medicine. The processing methods of the past dynasties are mainly cleansing and processing with ginger. In the formulas clearly marked with ginger processing， ginger-processed products is suggested to choose. If not clearly marked， raw or ginger-processed products can be used as needed.

Herbal Textual Research on Jujubae Fructus in Famous Classical Formulas / 中国实验方剂学杂志

This paper made a systematic textual research on the historical evolution and changes of the name， origin， producing area， harvesting and processing methods of Jujubae Fructus used in famous classical formulas by referring to the ancient literature， so as to provide a basis for the sampling and research of the formulas containing the medicinal materials. According to textual research， there are many names of Jujubae Fructus， most of which are named by characters or producing areas， which are called Dazao. Ziziphus jujuba has always been the mainstream variety in all dynasties， and Z. jujuba var. inemmis has also been used. Considering that the differences between the two are not obvious， we can use Z. jujuba and Z. jujuba var. inemmis as the origins of Dazao. The germplasm resources of Jujubae Fructus are rich， which are distributed all over the country. Qingzhou （now Shandong）， Jinzhou （now Shanxi） Jiangzhou （now Shanxi）， Puzhou （now Shanxi） have been recorded as authentic producing areas of Jujubae Fructus in the past dynasties， especially in Shandong. At the beginning of the 21st century， the planting of Jujubae Fructus in Xinjiang gradually developed， and now has a high market recognition， becoming an emerging production area of high-quality samples. Harvest period of Jujubae Fructus is mostly August in the past dynasties， and this is basically the same as today. The main processing method is simple cleansing and drying. Through textual research， it is suggested that Jujubae Fructus in famous classical formulas should be mainly from Shandong， Shanxi and other traditional high-quality producing areas， the processing method should follow the 2020 edition of Chinese Pharmacopoeia for simple cleansing and drying.

Herbal Textual Research on Scrophulariae Radix in Famous Classical Formulas / 中国实验方剂学杂志

In this paper， the name， origin， producing area， quality evaluation， harvesting and processing methods of Scrophulariae Radix used in the famous classical formulas were researched by consulting related ancient materia medica， medical books and prescription books. The results showed that the name of Scrophulariae Radix originated from its shape and color. Scrophularia ningpoensis， one of the eight flavors of Zhejiang， has been highly praised in the past as a genuine base， and its authentic production area is Zhejiang. Quality of Scrophulariae Radix is best if it has a dry body， thin skin， thick branches， firm physique， black inner color， net basal part of stem， and no fine whiskers. In ancient times， the origin processing was divided into two types， including sun-dried after steaming and directly sun-dried. While it mostly used a combination of drying and sweating in modern times. Before the Ming dynasty， the processing of Scrophulariae Radix was mainly steamed. Occasionally， the stir-frying appeared. In the Ming dynasty and after the Ming dynasty， wine processing emerged such as hot wine mixed roasting， wine washing， wine steaming， because the ancients believed that wine could enhance its efficacy and reduce its cold property. In the Qing dynasty， the method of steaming and baking appeared in the water and fire system. According to the 2020 edition of Chinese Pharmacopoeia， the processing of Scrophulariae Radix includes removing rhizome residues and impurities， washing， moistening， cutting into thin slices， and drying， or soaking slightly， steaming thoroughly， drying slightly， cutting into thin slices， and drying. Referring to the relevant national documents， it is suggested that raw products of Scrophulariae Radix should be used in Liangditang and Simiao Yong′antang.

Herbal Textual Research on Chuanxiong Rhizoma in Famous Classical Formulas / 中国实验方剂学杂志

Based on various ancient documents such as materia medica， prescription books， classics and history， combined with relevant research materials in modern times， this paper made a textual research on the name， origin， geoherbalism， harvesting time， processing methods of Chuanxiong Rhizoma， which provides a basis for the development of famous classical formulas containing this herb. According to the textual research， the original name of Chuanxiong is Xiongqiong （芎䓖）， which was first recorded in Shennong Bencaojing ， there are many aliases and trade names in the past dynasties. Since the Song dynasty， doctors all take Xiongqiong produced in Sichuan as the best medicine， so they take Chuanxiong as the rectification of name. In the early stage， the origin of Chuanxiong Rhizoma was relatively complicated， and the main origin was Ligusticum chuanxiong， which was a cultivated and domesticated species of Ligusticum. However， wild related plants of Ligusticum are still used as medicine. After the Ming dynasty， new cultivated varieties appeared in various places， such as Jiangxi L. sinense cv. Fuxiong， which gradually turned to self-production and self-marketing after the Republic of China. After several changes in the authentic producing area of Chuanxiong Rhizoma， Tianshui in Gansu province was highly praised in the Tang dynasty， and Dujiangyan in Sichuan province was the best place in the Song dynasty and later dynasties. Chuanxiong Rhizoma has been widely used in the past dynasties as raw products， and it has also been processed with excipients. For example， wine-processed products can enhance the effect of promoting blood circulation， promoting Qi circulation and relieving pain. There are other processing methods such as stir-frying and vinegar processing. Chuanxiong Rhizoma in the famous classical formulas can be selected according to this research conclusion.

Herbal Textual Research on Maltose in Famous Classical Formulas / 中国实验方剂学杂志

In this paper， the name， varieties， raw materials and manufacturing technology of maltose in the famous classical formulas were researched by consulting the herbal medicines， medical books， prescription books and modern literature of past dynasties， which provided the basis for the development and utilization of formulas containing maltose. Through textual research， it can be seen that the name of maltose has been derived from its shape， texture， preparation method， raw materials and producing area. In ancient times， maltose was mainly divided into soft and hard types according to the texture. Those who are wet and soft as honey are called "syrup" or "jelly"， while those who are hard and white are called "malt" and "sugar". In modern times， they are mostly called malt sugar， only jelly is used as medicine， and malt is mostly used as food. Throughout the ages， medicinal maltose were made of Oryza sativa var. glutinosa as the raw material and Hordeum vulgare as malt， prepared by fermenting， decocting and concentrating. The maltose made from other cereals such as Setaria italica var. germanica， Panicum miliaceum is slightly inferior in quality. The 2020 edition of Chinese Pharmacopoeia did not include maltose， but included malt sugar， a pharmaceutical excipient， which was a crystal powder with high purity. But maltose was included in the national food standard and the local processing specification. Based on the textual research results， it is suggested that malt syrup in GB/T 20883-2017 can be used as the reference for the development of formulas containing maltose， and O. sativa var. glutinosa， H. vulgare are clearly used as raw materials.

Herbal Textual Research on Bambusae Caulis in Taenias in Famous Classical Formulas / 中国实验方剂学杂志

By consulting the ancient herbal and medical books， combined with modern literature， the name， origin， geoherbalism， harvesting and processing changes of Bambusae Caulis in Taenias in famous classical formulas were sorted out. According to the research， ancient doctors only approved three kinds of bamboo medicinal materials， namely， Jinzhu （䈽竹）， Kuzhu （苦竹） and Danzhu （淡竹）， and took bamboo leaves， made Bambusae Caulis in Taenias and Zhuli （竹沥） for medicine. Bamboo medicinal materials with different origins have different properties， tastes and effects， after clinical optimization， it is gradually considered that Danzhu is the best source of Bambusae Caulis in Taenias and Zhuli. According to the morphological description of the original plants and the attached drawings， it is considered that the Danzhu in ancient Chinese materia medica should be Phyllostachys nigra var. henonis， which has been included in the 2020 edition of Chinese Pharmacopoeia as one of the genuine sources of Bambusae Caulis in Taenias. Therefore， It is suggested that P. nigra var. henonis can be added as the source of Bambusae Caulis in Taenias in famous classical formulas， and the medicinal part is the dry middle layer of its stem. Ginger-processed can increase the anti emetic effect of Bambusae Caulis in Taenias， and the three formulas involving Bambusae Caulis in Taenias from The Catalogue of Ancient Famous Classical Formulas （The First Batch） all contain ginger， and the processing method of Bambusae Caulis in Taenias is not marked in the original formula， so it is suggested to use raw products in the three formulas of Jupi Zhurutang， Wendantang and Zhurutang.

Herbal Textual Research on Alismatis Rhizoma in Famous Classical Formulas / 中国实验方剂学杂志

In this study， name， origin， producing areas， harvesting time and processing methods of ancient Alismatis Rhizoma were systematically researched by consulting the literature of ancient herbs， medical and prescription books， so as to provide a basis for the development of famous classical formula containing this herb. According to textual research， the main base of ancient Alismatis Rhizoma was Alisma plantago-aquatica and A. orientale. A. canaliculatum and A. gramineum and other genera were sometimes used as the source of Alismatis Rhizoma， there was a confusion of medicinal varieties. The earliest producing area of Alismatis Rhizoma was in today's Henan province， and later Hanzhong， Shaanxi province， became the high-quality producing area of Alismatis Rhizoma. Since the Ming dynasty， its production area expanded to Fujian. In the Qing dynasty， Jian'ou in Fujian was the authentic production area of Alismatis Rhizoma. In the period of the Republic of China， Sichuan and Jiangxi were added to the production areas of Alismatis Rhizoma. Based on the research results， it is suggested that the dried tubers of A. orientale from Fujian and Jiangxi or A. plantago-aquatica from Sichuan should be used in the famous classical formulas. In ancient times， Alismatis Rhizoma was processed by wine， but most of the standards and specifications in modern times are no longer included the processing specifications of Alismatis Rhizoma with wine. Although salt-processed Alismatis Rhizoma is commonly used in modern times， it didn't become one of the main processing methods until the Qing dynasty. According to the relevant national documents， it is suggested that Alismatis Rhizoma without clear processing requirements in famous classical formulas should be used as raw products， and the formulas with processing requirements should be selected as processed products such as salt and wine according to the meaning of the formulas.

Herbal Textual Research on Dendrobii Caulis in Famous Classical Formulas / 中国实验方剂学杂志

Through consulting the ancient herbal and medical books， combined with the field investigation， the name， origin， collection and processing of Dendrobium medicinal materials were researched， which provided a basis for the development of famous classical formulas containing this kind of herbs. Due to the wide distribution of D. officinale， the Dendrobium species represented by D. officinale and D. huoshanense， which are short， fleshy and rich in mucus， should be the most mainstream of Dendrobium medicinal materials in previous dynasties. Compared with Shihu， Muhu with loose texture， long and hollow is born on trees. According to the characteristic description， it should be D. nobile， D. fimbriatum and so on， of which D. nobile was the mainstream. The Chinese meaning of Jinchai was confused in the past dynasties， so it was not suitable to be treated as a plant name. The production areas of Dendrobium medicinal materials in the past dynasties have changed with the discovery of varieties， artificial cultivation and other factors. Lu'an， Anhui province， was the earliest recorded in the Han and Wei dynasties. Since the Tang and Song dynasties， it had been extended to Guangdong and Guangxi， and it was considered that "Dendrobii Caulis in Guangnan was the best". In the Ming dynasty， Sichuan and Zhejiang products were highly praised， and in the Qing dynasty， Huoshan products were highly praised. Dendrobium medicinal materials had been used as medicine by stems in all dynasties. The medicinal materials were divided into fresh products and dry products. The fresh products can be used immediately after removing the sediment from the roots. The dry products need further processing， most of them used wine as auxiliary materials for steaming， simmer to paste or decoction into medicine. D. officinale and D. huoshanense have special processing specifications since the middle of Qing dynasty， that is， "Fengdou". According to the research results， in Ganluyin， the effect of Dendrobium medicinal materials is mainly heat clearing， and D. nobile with bitter taste can be selected. The main effect of Dendrobium medicinal materials in Dihuang Yinzi is tonic， D. officinale or D. huoshanense can be selected.

Textual Research on Perillae in Famous Classical Formulas / 中国实验方剂学杂志

Based on the ancient literature of all dynasties， this article makes a systematic textual research on the name， origin， producing area， quality， harvesting and processing of Zisu （Perillae） in the famous classical formulas， so as to clarify the information of the drug in different historical periods and provide a reference for the development and utilization of the related formulas. The main origin of Perillae in the ancient literature was Perilla frutescens var. frutescens （purple leaf type）， followed by P. frutescens var. acuta （purple leaf type）， but not Baisu. Modern chemical composition studies also show that there are obvious differences between Perillae and Baisu， which provides a scientific basis for distinguishing them. Although they are often treated as a species in plant classification， P. frutescens var. frutescens （purple leaf type） is recommended in the development of famous classical formulas， and Baisu should be avoided. Perillae is widely distributed， but its producing area did not record in most of the literature in the past dynasties， or the producing area is described as everywhere today. In the period of the Southern and Northern dynasties， the medicinal parts of Perillae included stems， leaves and seeds， and doctors in the Ming dynasty began to pay attention to the differentiation of different medicinal parts. The harvesting and processing methods of Perillae in the past dynasties are close to that of today. Perillae Fructus is mostly stir-fried and ground into medicine， Perillae Folium and Perillae Caulis are mainly simple cleansing. In production， we can refer to the 2020 edition of Chinese Pharmacopoeia.

Textual Research on Nelumbinis in Famous Classical Formulas / 中国实验方剂学杂志

The name， origin， place of origin， medicinal parts， harvesting and processing of lotus are verified by consulting ancient Chinese herbal medicines and medical books， combined with modern literature， providing a basis for the development of famous classical formulas containing lotus. According to textual research， the original base of lotus is Nelumbo nucifera since ancient times， rhizome （Nelumbinis Rhizomatis Nodus）， leaf （Nelumbinis Folium）， seed （Nelumbinis Semen）， embryo （Nelumbinis Plumula）， receptacle （Nelumbinis Receptaculum）， stamen （Nelumbinis Stamen） and other medicinal parts of N. nucifera can be used as medicine and have different clinical effects. Nelumbinis Semen was originally produced in Henan， and then gradually expanded to Jiangnan. Today， it can be cultivated and planted throughout the country， with Fujian， Hunan， and Jiangxi as the authentic production areas. After combing the medicinal parts of N. nucifera and the historical evolution of its processing， it is suggested that the dried and mature fruits of N. nucifera taking in autumn and removing the shell and Nelumbinis Plumula should be used in Qingxin Lianziyin. Nelumbinis Folium in Erdongtang should be harvested in summer and autumn， and the raw products was used as medicine and processed in accordance with the provision of the 2020 edition of Chinese Pharmacopoeia.

Treatment of Psoriasis Vulgaris with Medicated Thread Moxibustion of Zhuang Medicine: A Multicenter Randomized, Parallel Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To explore the efficacy and safety of Zhuang medicine medicated thread moxibustion (ZMTM) on psoriasis vulgaris.@*METHODS@#A multicenter, randomized, parallel controlled clinical trial was designed. A total of 241 outpatients with psoriasis vulgaris were randomly divided into a control group (120 cases) and a treatment group (121 cases) using a central block randomization from June 2015 to May 2018. The control group was treated with Western medicines alone including pidotimod dispersible tablets, vitamin B compound tablets, and compound cod liver oil-zinc oxide ointment. The treatment group was treated with ZMTM every 2 days combined with Western medicines. The two groups received continuous intervention for 30 days. The primary outcome was Psoriasis Area and Severity Index (PASI), and the secondary outcomes included Itch Rating Scale, Dermatology Quality of Life Index (DLQI), Hamilton Anxiety Rating Scale (HAMA), as well as PASI response rate. Meanwhile, adverse events were evaluated during the whole clinical trial. Follow-up was carried out 30 days after treatment.@*RESULTS@#There were 5 cases of shedding in this trial. In intention-to-treat analysis, 236 cases were included and each group contained 118 cases. On the 30th and 60th days, PASI scores of patients in each group were significantly lower than that at baseline (P<0.01) and the PASI score reduction of the treatment group was greater than that of the control group (P<0.01). Itch Rating Scale, DLQI, and HAMA scale were decreased in both groups after treatment, and the treatment group showed a better therapeutic effect (P<0.01). The response rates of PASI 50 and 75 were significantly higher than those in the control group [81.4% (96/118), 43.2% (51/118) vs. 41.5% (49/118), 11.0% (13/118), respectively, P<0.05]. During follow-up, the improvements in scores of PASI, Itch Rating Scale, DLQI, and HAMA of the treatment group were significantly greater than those of the control group (P<0.01). The response rates of PASI 50 and 75 in the treatment group were significantly higher than those in the control group, respectively (both P<0.05). No obvious adverse reaction was found in either group.@*CONCLUSION@#ZMTM combined with Western medicines showed a better therapeutic effect in the treatment of psoriasis vulgaris without obvious adverse reaction. (Trial Registration No. ChiCTR-IOR-16008159).

Establishment of a Mouse Model of Acquired Aplastic Anemia Mediated by Cyclophosphamide Combined with Cyclosporine / 中国实验血液学杂志

OBJECTIVE@#To establish a stable mouse model of acquired aplastic anemia.@*METHODS@#Female BALB/C mice aged 6 months were intraperitoneally injected with cyclophosphamide and cyclosporine for 14 days. The number of peripheral blood cells, the concentration of hemoglobin, the number of bone marrow nucleated cells, bone marrow smear, bone marrow pathological sections and other indexes were observed.@*RESULTS@#In BALB/C mice injected intraperitoneally with cyclophosphamide and cyclosporine, the number of peripheral blood cells and the concentration of hemoglobin were significantly decreased, especially the white blood cells and platelets. Bone marrow smear showed a significant decrease in the number of nucleated cells and bone marrow hyperplasia. Bone marrow pathology showed decreased hematopoietic cells and increased non-hematopoietic cells such as adipocytes.@*CONCLUSION@#The mouse model with intraperitoneal injection of cyclophosphamide and cyclosporine can meet the diagnostic criteria of acquired aplastic anemia, which can be used as a mouse model for the study of the pathogenesis and treatment of acquired aplastic anemia.

Clinical genetic analysis of an infant with 1q21.3-qter duplication and Xpter-p11 deletion caused by maternal balanced chromosomal translocation / 中华医学遗传学杂志

OBJECTIVE@#To investigate the clinical phenotype and genetic diagnosis of an infant featuring multiple hair and hyperbilirubinemia.@*METHODS@#Conventional G-banding analysis, chromosomal microarray analysis (CMA) and fluorescence in situ hybridization (FISH) for the patient were conducted, G-banding analyses of peripheral blood for the infant's parents were also performed.@*RESULTS@#We investigated an infant who carries a unbalanced, maternally inherited karyotype 46, X, der (X) t (X;1) (p11.22; q21.3) in which CMA and FISH analyses disclosed a 1q21.3q44 duplication of 93.03 Mb and Xp22.33p11.22 deletion of 54.53 Mb.@*CONCLUSION@#The phenotypes of this infant can probably be attributed to the 1q21.3q44 duplication and Xp22.33p11.22 deletion, which were maternally inherited.

Clinical features and management strategies of infection after lumbar transpedicular dynamic stabilization / 中华骨科杂志

Objective:To investigate the clinical features and treatment strategies of infection after lumbar transpedicular dynamic stabilization.Methods:A total of 1 623 cases with lumbar transpedicular dynamic stabilization conducted from January 2010 to June 2020 were retrospectively analyzed, including 854 males and 769 females and aged 47.56±12.76 years old. There were 1 150 cases with Dynesys fixation, 235 cases with K-Rod, 181 cases with Isobar, 52 cases with Fule and 5 cases with Waveflex. The primary diseases were as following, 984 cases (60.63%) with lumbar disc herniation, 280 cases (17.25%) with lumbar spinal stenosis, 174 cases (10.72%) with lumbar spondylolisthesis, 98 cases (6.04%) with lumbar degenerative scoliosis and 87 cases (5.36%) with discogenic low back pain. Some baseline indicators, such as the overall incidence of infection, the age, gender, smoking, drinking, diagnosis, previous operation history, concomitant disease, the number of fenestration, the number of discectomy, the number of fixed segments, operation duration, blood loss, blood transfusion, the number of the dura mater rupture, postoperative infection duration from primary operation, inflammation indicators (leukocytes, neutrophils, C-reactive protein, erythrocyte sedimentation rate and procalcitonin) of the infected patients, were recorded. According to the time when the infection occurred, the cases were divided into the early infection group (within 3 months after surgery) and the late infection group (more than 3 months after surgery). The clinical indicators and treatment strategies were compared between the two groups.Results:The overall infection rate was 1.66% (27/1 623), including 2.17% (25/1 150) in Dynesys fixation, 1.92% (1/52) in Fule fixation and 0.55% (1/181) in Isobar fixation. The follow-up duration was 51.89±32.55 months. The number of fenestrations was 1(1, 2). The number of discectomy was 1(1, 2), and that of fixed segments was 2(1, 3). The operation duration was 186.30±81.33 minutes, with the blood loss 200 (200, 500) ml and the blood transfusion volume 0(0, 345) ml. There was 1 case of cerebrospinal fluid leakage in early infection group. Thirteen cases of pathogenic bacteria were identified, included 5 cases of Staphylococcus epidermidis, 2 cases of Staphylococcus aureus and 1 case each of Salmonella, Escherichia coli, Pseudomonas aeruginosa, Enterobacter aerogenes, Acinetobacter baumannii, and Streptococcus lactis. A total of 21 patients underwent secondary surgery, including 10 cases of debridement and suturing, 2 cases of internal fixation replacement and 9 cases of internal fixation removal. The other 4 cases underwent puncture and irrigation, while 2 cases received only antibiotic treatment. There were 16 cases with early infection and 11 cases with late infection. There were no significant differences between the two groups in the number of fenestrations, discectomy, operation duration, blood loss, and blood transfusion ( P>0.05). The inflammation indexes of early infection group were higher than those of late infection group with significant difference ( P<0.05), except for procalcitonin. The detection rates of pathogenic bacteria in early and late infection group were 62.5% (10/16) and 27.3% (3/11), respectively. The main infection sites in early infection group were the incision (50.0%, 8/16) and around the internal fixation (18.8%, 3/16). However, the main infection sites in late infection group were around the internal fixation (90.9%, 10/11). In the early infection group, the main treatments including debridement and suturing were conducted in 9 cases, puncturing in 2 cases and internal fixation replacement in 2 cases. In the late infection group, internal fixation removal was performed in 8 cases and puncturing in 2 cases. Conclusion:The overall infection rate after lumbar transpedicular dynamic stabilization was 1.66%. The incidence of early infection was 0.99%, while that of late infection was 0.68%. The incidence of Dynesys fixation was 2.17%. In early infection, the internal fixation could be retained through some treatments as debridement and internal fixation replacement. In most late infection cases, removal of the internal fixation could be helpful to control the infection.

Comparison between discectomy combined with transpedicular dynamic stabilization and transforaminal lumbar interbody fusion in the treatment of single-level lumbar disc herniation / 中华骨科杂志

Objective:To compare the clinical effects of discectomy combined with transpedicular dynamic stabilization and transforaminal lumbar interbody fusion (TLIF) in treating single-level lumbar disc herniation.Methods:From November 2012 to November 2015, a total of 96 patients with single-level lumbar disc herniation (disc height decreased more than 1/3, the width of the basilar part of the herniated disc >6 mm, massive disc herniation or Modic type I endplate changes) treated by discectomy combined with Dynesys dynamic stabilization (Dynesys group, n=48) or TLIF (fusion group, n=48) were enrolled. Clinical assessments included operation duration, intraoperative blood loss, MacNab score, visual analogue scale (VAS), Oswestry disability index (ODI) and rate of complications. Radiographs were evaluated for lumbar mobility, intervertebral height, etc. Results:A total of 86 patients were included in the final analysis (44 in Dynesys group and 42 in fusion group) and were evaluated after 5 years follow-up. The operation duration of Dynesys group (159.61±37.29 min) was less than that of the fusion group (177.42±39.90 min) significantly ( t=2.140, P=0.035). Intraoperative blood loss in Dynesys group (151.78±50.88 ml) was less than that in fusion group (197.74±76.55 ml) with significant difference ( t=3.293, P=0.001). At 5 years follow-up, there were 2 cases with screw loosening and 5 cases with adjacent segmental degeneration in Dynesys group without symptom. In fusion group, there were 12 cases with adjacent segmental degeneration and two of them with symptom. There were significant differences in the incidence of adjacent segment degeneration between the two groups ( χ2=4.012, P=0.045). According to the MacNab criteria, excellent or good cases accounted for 95% in Dynesys group and 93% in fusion group without significant differences ( Z=0.425, P=0.671). VAS back, VAS leg and ODI scores were improved significantly in both groups after 2 years and 5 years ( P<0.05). However, there were no significant differences between the two groups ( P<0.05). The activity of the surgical segment was 4.59°±0.48° in Dynesys group and 1.00°±0.42° in fusion group at 5 years after surgery. The height of intervertebral space in Dynesys group decreased from 11.19±2.07 mm before surgery to 9.98±2.02 mm at 2 years after surgery and to 9.86±1.64 mm at 5 years after surgery ( F=6.462, P=0.002). However, there was no statistically significant difference between the 2 and 5 years follow-up ( q=0.415, P>0.05). At 5 years after surgery, the activity of the first proximal segment in the two groups was 9.74°±3.29° and 11.69°±3.89°, respectively ( t=2.514, P=0.014). Conclusion:Both discectomy combined with dynamic stabilization and TLIF can achieve satisfied clinical effects in treating single-level lumbar disc herniation. Dynamic stabilization preserves the intervertebral activity of surgical segments and results in a lower incidence of adjacent segment degeneration compared with that in fusion surgery. Furthermore, discectomy combined with dynamic stabilization is a less invasive intervention with shorter operation duration and less blood loss compared with TLIF.