A randomized, parallel control and multicenter clinical trial of evidence-based traditional Chinese medicine massage treatment VS External Diclofenac Diethylamine Emulgel for the treatment of knee osteoarthritis.

BACKGROUND: Both massage and topically administered NSAIDs are safe and effective treatments for knee osteoarthritis (KOA); however, different massage technique sects in China caused assessment difficulties for the treatment of KOA. In order to standardize the massage techniques and procedures, we organized multi-disciplinary experts in China to acquire an evidence-based traditional Chinese medicine massage treatment of knee osteoarthritis. The purposes of this study will be to provide clinicians a complementary and alternative therapy for patients and to evaluate the efficacy and safety of evidence-based traditional Chinese medicine massage treatment of KOA compared to External Diclofenac Diethylamine Emulgel. METHODS AND DESIGN: A randomized controlled trial in which 300 participants diagnosed with KOA will be recruited and randomly allocated to either the experimental group or the control group in a ratio of 2:1. Two hundred participants will receive evidence-based traditional Chinese medicine massage 2 sessions per week for 10 weeks as the experimental group, and 100 participants will receive External Diclofenac Diethylamine Emulgel 3-4 times per day for 10 weeks as the control group. The patients in the two groups will receive follow-up at two time points at 5 weeks and 10 weeks from the beginning of treatment, respectively. The MRI scans and X-ray will be performed at baseline and at the end of the intervention. The primary outcome will be the changes in the Western Ontario and McMaster Osteoarthritis Index (WOMAC). Secondary outcomes will be measured by the PRO scale for knee osteoarthritis based on the concept of traditional Chinese medicine (Chinese scale for knee osteoarthritis (CSKO)), X-ray evaluation, and MRI scan evaluation. The data of WOMAC and CSKO will be analyzed at the baseline, 5 weeks, and 10 weeks from the beginning of treatment. The data from MRI scans and X-rays will be analyzed at baseline and at the end of the intervention. The significance level sets as 5%. The safety of interventions will be evaluated after each treatment session. DISCUSSION: This study will provide clinicians with much-needed knowledge for the treatment of KOA through a controlled trial. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1800014400 . Registered on 10 January 2018.

Research Progress on Pharmacological Effect of Astragali Radix-Angelicae Sinensis Radix on Invigorating Qi and Activating Blood / 中国实验方剂学杂志

Astragali Radix-Angelicae Sinensis Radix （AA） is a basic pair of drugs mainly targeting the syndrome characteristics of Qi and blood diseases. LI Dong-yuan's Danggui Buxuetang （DBT） is composed of AA， which is mainly used to tonify Qi and generate blood， with main indications of Qi deficiency and blood deficiency， blood heat and so on. It is favored by doctors because of its refined prescription and remarkable curative effect. However， there are many compatibility ratios of AA in different prescriptions in ancient books， and their efficacy and indications are also slightly different. This research showed that DBT also had the effect of invigorating Qi and activating blood， and the previous study of the group showed that 3∶1 compatibility ratio of the two herbs in the total amount of 36 g had more obvious effect of invigorating Qi and activating blood. By consulting the relevant literature， it was found that the drug pair had a certain effect of invigorating Qi and activating blood in various compatibility ratios such as 1∶1， 3∶1， 1∶5， 3∶2， 2∶1， 5∶1. The corresponding pharmacological effect mainly included regulating the energy metabolism of substances， regulating immune function， reducing blood viscosity， anti-oxidation stress， anti-inflammation， lowering blood lipids， lowering blood sugar， protecting heart function， protecting blood vessel wall， intervening angiogenesis， fighting against organ tissue fibrosis and so on. Regardless of the AA single-medicine's activating blood effect and the theory that "Qi circulation leads to blood circulation" or the drug pair's manifestation in modern pharmacological effects， all of these have confirmed that AA's effect of invigorating Qi and activating blood does exist， and the difference of action performance caused by different ratios of AA is closely related to dosage and proportion， which needs further study. Based on the study focusing on the effect of tonifying Qi and generating blood， it is easy to ignore the effect of invigorating Qi and activating blood， which limits the clinical application of the latter. Therefore， the tonifying Qi and activating blood circulation effect of the drug pair is reviewed in this paper， so as to provide a theoretical basis for its clinical rational drug use and related research.

Clinical observation of jianpi bushen formula to prevent collapse of osteonecrosis of femoral head / 中国中药杂志

To observe the clinical effect of Jianpi Bushen formula to prevent the collapse of osteonecrosis of femoral head (ONFH) of type phlegm and blood stasis obstructing the collaterals. 50 cases (including 73 hips) of non-collapse ONFH (ARCO I, II, III a) were selected from the out-patient department of orthopedic in Guang'anmen Hospital attached to China Academy of Chinese Medical Science. All the cases fit for diagnostic criteria were given Jianpi Bushen formula and followed up. Staging criteria was ARCO classification. Harris score evaluated the hip function. The mean follow-up time was 4.2 years (3-5.4 years). After a mean of 4.2 years (3-5.4 years) followed-up, 12 hips collapse occurred while 61 hips not (the non-collapse rate was 83.56%). Collapse did not occurred among the all 7 hips at stage ARCO I (the non-collapse rate was 100%). Among the 49 hips at stage ARCO II, 9 hips collapse occurred while 40 hips not (the non-collapse rate was 81.63%). Among the 17 hips at stage ARCO III a, 3 hips collapse occurred while 14 hips not (the non-collapse rate was 82.35%). Kaplan-Meier analysis showed the average survival time of non-collapse was 5 years (4. 8-5.2 years). The 3 year survival rate of non-collapse was 92.5%. The 4 year survival rate was 74% and the condition tended to be stability trend. The Harris score was 71.93 +/- 11.25 before treatment and 81.63 +/- 12.16 after treatment, significantly different. These results suggest that: Jianpi Bushen formula is an effective method for treating ONFH of type phlegm and blood stasis obstructing the collaterals. It can delay or prevent the collapse of femoral head and significantly improve the hip function.

Meta-analysis on efficacy and safety of external use of tradition Chinese medicines and western medicines in treating knee osteoarthritis / 中国中药杂志

<p><b>OBJECTIVE</b>To assess the efficacy and safety of the external use of tradition Chinese medicine (TCM) in treating knee osteoarthritis.</p><p><b>METHOD</b>By computer retrieval of MEDLINE, CNKI and VIP database on data from the establishment of database to May 2011,all of the randomized controlled trials on the external use of TCMs in treating knee osteoarthritis with western medicines as the control drugs were collected to screen out literatures in line with the inclusion standards. The quality of the included literatures was strictly assessed, and a meta-analysis was conducted by RevMan 5.1 software.</p><p><b>RESULT</b>Totally 25 RCTs involving 2 159 patients were included [1152 patients in the TCM group (TCMG), 1007 patients in the western medicine group (WMG)], in which 21 articles were brought into the analysis on efficacy. The results of meta-analyses showed that the efficient rates of the TCMG and the WMG were 92.35% (941/ 1019) and 81.19% (712/877), respectively, OR = 2.88 [2.16-3.83], with a hypothesis testing on total effect of Z = 7.20 (P < 0.00001)], suggesting that the external use of TCMs had a better efficacy than the WMG. A total of 25 literatures were brought into the analysis on adverse effect. The adverse effects rate of the TCMG and the WMG were 1.30% (15/1 152) and 5.36% (54/1007), respectively, OR = 0.40 [0.11-1.38], Z = 1.46 (P = 0.15)], indicating no significant difference between them. The sub group analysis shows that compared with the external use of western medicines,the adverse effect rate of the two groups are similar [(1.87% (11/589): 1.60% (9/564)], OR = l.12 [0.48-2.58], Z = 0.26 (P = 0.80). But as for inhibitors NSAIDS and COX-2 for oral,the adverse effect rate of the TCMG was lower than that of the WMG [(1.07% (4/375): 15.46% (45/291)], OR = 0.11 [0.01-0.87], Z = 2.09 (P = 0.04).</p><p><b>CONCLUSION</b>The efficacy of the external use of TCMs in treating OA is better than that of western medicines. The adverse effect rates of the external use of TCMs is equivalent to that of western medicines, and significantly lower than that of oral western medicines. But because of the poor quality of the included literatures, the final conclusion for the efficacy of TCMs in treating knee osteoarthritis could not be reached only based on this Meta-analysis and remain to be proved with the results of high-quality clinical studies.</p>

Screen and identification of the relative protein expressed in the acute tractive spinal cord injury in rats / 中华外科杂志

<p><b>OBJECTIVE</b>To screen and identify the relative protein expressed in the acute tractive spinal cord injury (TSCI) in rats.</p><p><b>METHODS</b>Ten adult Sprague Dawley rats were randomly divided into Sham group and TSCI group, 5 rats in each group. Rats from Sham group and TSCI group at 1 day after surgery were sacrificed for harvesting T₁₃-L₂ spinal tissue specimens. The extraction and quantitation of protein in the spinal tissue was finished firstly. Proteins from spinal tissue were separated by two-dimensional electrophoresis (2-DE) and identified by mass spectrometry (MS). The different expression map was established in each group, and proteins express differently was determined by comparing the level of each spot with gel imaging software and manually. Proteins were identified by High performance liquid chromatography-electrospray tandem (NanoUPLC-ESI-MS/MS) and peptide sequence tag with tandem MS combining with database respectively. After that, the function of these identified proteins was known and classified.</p><p><b>RESULTS</b>There were 22 differential protein expression spots were found between Sham group and TSCI group. Among them, 18 spots were up-regulated and 4 were down-regulated. 4 differential protein expression spots were newly found in TSCI group. Sixteen significant proteins were identified by NanoUPLC-ESI-MS/MS. Four kind of proteins were related to apoptosis, 3 in nerve signal transduction and 6 in metabolism, respectively. Unnamed proteins were 3.</p><p><b>CONCLUSIONS</b>The differential expression proteins were found between Sham group and TSCI group. These identified proteins may play important role in the process of injury and recovery through transduction nerve signal, regulating nerve cells apoptosis and metabolism.</p>

Multicenter cross-sectional study of anemia in patients with gastric and colorectal cancer before and after the operation / 中华外科杂志

<p><b>OBJECTIVES</b>To determine the prevalence of cancer-related anemia and iron deficiency anemia (IDA) in patients with gastric and colorectal cancer in North of China.</p><p><b>METHODS</b>A cross-sectional study of 262 inpatients diagnosed with gastric or colorectal cancer admitted to eight general hospitals in Beijing from August 2009 to December 2009 was performed. The blood samples were took on the day after admission and the seventh day after operation for the tests of hemoglobin, serum iron and ferritin. The morbidity of cancer-related anemia and IDA before and after the surgery was also compared respectively.</p><p><b>RESULTS</b>The preoperative morbidity of cancer-related anemia was 36.6% in 131 patients with gastric cancer, and the morbidity of IDA was 52.1%. The mean age of the anemic patients was higher than that in cases without anemia [(62 ± 11) yrs vs. (57 ± 12) yrs, P < 0.05]; the postoperative morbidity of IDA increased to 72.6% (P < 0.05). In the 131 cases with colorectal cancer, the preoperative incidence of cancer-related anemia and IDA was 37.4% and 61.2%, respectively. About 45% of the cases with anemia had a tumor in the right colon. Postoperative incidence of IDA was significantly higher than that before the surgery (76.7%, P < 0.05). Only 10.3% of the anemic patients were treated with chalybeate therapy before surgical procedures, and the proportion was 22.7% after the operation. More than 50% of anemic patient received blood transfusion.</p><p><b>CONCLUSIONS</b>Cancer-related anemia is a common clinical manifestation in patients with gastrointestinal cancer, and anemia occurs more frequently in elder and patients with right colon tumor. The treatment to cancer-related anemia is insufficient and a systematic therapy is needed to be established.</p>

Treatment of complex fracture--dislocation of elbow with external fixator with joint and limited internal fixation / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the method and the effect of external fixator and limited internal fixation with joint applied for complex fracture-dislocation of elbow.</p><p><b>METHODS</b>From Mar. 2005 to Mar. 2008, 17 patients with complex fracture-dislocation of elbow were treated with external fixator with joint and limited internal fixation. Nine of them were on the left side and 8 on the right side. There were 11 males and 6 females. The age was from 21 to 57 years with an average of 37 years. The clinical effects were evaluated according to Mayo scoring of elbow joint function (including pain, rang of motion, joint stability and so on).</p><p><b>RESULTS</b>All patients were followed up from 5 to 10 months with an average of 8 months. The mean mayo score was 82 +/- 10 (62-96). The results were excellent in 7 cases, good in 7, fair in 3.</p><p><b>CONCLUSION</b>The technique of external fixator with joint and limited internal fixation for complex fracture-dislocation of elbow can restore anatomical articular surface with advantage of early functional training which can decrease the occurrence of elbow stiff and soft tissue contracture. It is a satisfactory method in treating complex fracture-dislocation of elbow.</p>

Treatment of subtrochanteric femoral fracture with long proximal femoral nail antirotation / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Subtrochanteric femoral fractures are severe injuries. Although many treatment methods have been developed, controversy exists regarding the optimal management of these fractures. This study evaluated the clinical outcome of subtrochanteric femoral fractures fixed with long proximal femoral nail antirotation (PFNA-long).</p><p><b>METHODS</b>Between October 2006 and February 2008, 25 patients with traumatic subtrochanteric fractures of the femur were treated with PFNA-long. Closed reduction and fixation were performed in 20 cases. In the remaining 5 cases, closed reduction was difficult, so limited open reduction was performed, with bone grafting in 4 cases and circumferential wiring in 4 cases.</p><p><b>RESULTS</b>The average follow-up time was 16.1 months. All subtrochanteric femoral fractures healed uneventfully except one case of delayed union. The mean union time was 26.2 weeks. Technical difficulties with nail insertion were encountered in 3 cases. No implant failure was observed.</p><p><b>CONCLUSION</b>PFNA-long is effective in treatment of subtrochanteric femoral fractures, with a high rate of bone union, minor soft tissue damage, early return to functional exercise and few implant-related complications.</p>

Screening of Psychrotrophic Bacteria and Their Application to Treatment of Livestock Wastewater / 微生物学通报

Fourteen psychrotrophic bacteria were isolated from swamp soil collected in Ruoergai plateau wetland,and their generation time and degrading ability of livestock wastewater CODcr was determined.The results showed that the generation time was within 4.9 h to 11.6 h.Based on the generation time,9 psychro-trophic strains(NLJ1,NLJ6,NLJ7,NLJ9,NLJ10,NLJ11,NLJ12,NLJ13 and NLJ14),whose generation time was within 4.9 h to 5.6 h,were chosen to treat livestock wastewater.The results suggested that these 9 strains had different CODcr disposal ability when treating livestock wastewater singly at 6?C for 6 h,and strains NLJ6,NLJ7,NLJ9,NLJ10,NLJ11 and NLJ13 had good ability to degrade livestock wastewater,the CODcr degrading rate was about 60%~70%,hence,they were used as high efficient strains;However,the CODcr degrading rate of the other strains was less than 50%.After inoculating mixture culture of these six strains into the distilled livestock wastewater,after 6 h's treating,the CODcr degrading rate reached to 85.42%.Furthermore,activated sludge collected from Yaan,Dujiangyan and Chengdu were inoculated by the mixture culture of those six strains,and used to treat livestock wastewater for 6 h.The results showed that the average CODcr degrading rate was 81.67%,76.32% and 70.56%,respectively;Variance analysis showed that there was no significant differentiation between each treatment,which revealed that those six psychrotrophic strains had good adaptability to different source of activated sludge.