Therapeutic effects of ginsenosides on osteoporosis for novel drug applications.

Osteoporosis (OP) is a metabolic bone disease with a high incidence rate worldwide. Its main features are decreased bone mass, increased bone fragility and deterioration of bone microstructure. It is caused by an imbalance between bone formation and bone resorption. Ginsenoside is a safe and effective traditional Chinese medicine (TCM) usually extracted from ginseng plants, having various therapeutic effects, of which the effect against osteoporosis has been extensively studied. We searched a total of 44 relevant articles with using keywords including osteoporosis, ginsenosides, bone mesenchymal cells, osteoblasts, osteoclasts and bone remodeling, all of which investigated the cellular mechanisms of different types of ginsenosides affecting the activity of bone remodeling by mesenchymal stem cells, osteoblasts and osteoclasts to counteract osteoporosis. This review describes the different types of ginsenosides used to treat osteoporosis from different perspectives, providing a solid theoretical basis for future clinical applications.

[Influences of clinical symptoms on the selection of surgical options for adult degenerative scoliosis].

OBJECTIVE: To retrospectively analyze the interactions between the clinical symptoms and surgical options and evaluate the surgical efficacies for adult degenerative scoliosis (DS). METHODS: A total of 35 adult DS patients underwent operations at Tianjin hospital from May 1996 to December 2008. There were 23 females and 12 males with a mean age of 59.1 years (range: 45 - 74). Clinical symptoms, physical examinations and radiological findings for all patients were recorded at different stages, at 1 week, 3 months, 6 months, 1 year post-operation and per year respectively. According to different surgical options, they were classified into 3 groups: A: limited decompression; B: selective decompression & short-segment fusion; C: selective decompression & long-segment correction & fusion. RESULTS: All patients had complete records with a mean follow-up period of 42.4 months (range: 24 - 168). Firstly, 9 patients in group A had no complaint of a low-back pain at pre-operation. The average coronal Cobb's angles were 15.6 ± 2.3° at pre-operation and 17.1 ± 3.3° at the latest follow-up. The radicular symptoms became greatly relieved at 1 year. Three cases complained of the aggravation of back pain. Secondly, 15 patients in group B mainly complained of a low-back pain at pre-operation. It was combined with lower-limb radiation pain in 6 patients and nerve claudication in 9 cases. The average coronal Cobb's angles were 14.1 ± 4.6° at pre-operation and 24.4 ± 6.7° at the latest follow-up. However, 12 patients experienced the progression of scoliosis. Thirdly, 11 patients in group C experienced a low-back pain at pre-operation while 5 cases with lower-limb radiation pain and 6 with claudication. The mean coronal Cobb's angles were 22.3 ± 9.2° at pre-operation and 12.2 ± 4.7° at the latest follow-up. Among 4 patients with residual pains, none required revision. CONCLUSIONS: For the DS patients, it is quite important for the surgical options to comprehensively analyze the neurological signs, imaging data and clinical symptoms. However, the fusion end vertebrae should always avoid the vicinity or apex of curve if the short-segment fusion is selected.

[Surgical options and result analyses in adult degenerative lumbar scoliosis].

OBJECTIVE: To investigate the clinical and radiographic outcomes for varying degrees of degenerative lumbar scoliosis using different surgical options with a minimal 5-year follow-up. METHODS: From May 1998 to November 2002, 31 patients with degenerative lumbar scoliosis underwent operations at our hospital. The mean age of 19 females and 12 males was 55.8 years old (range: 45 to 71). All patients were divided into 4 groups: Group A, mild coronal deformity with obvious sagittal deformity, 13 cases; Group B, obvious coronal deformity with mild sagittal deformity; Group C, both significant coronal and sagittal deformities; Group D, both mild coronal and sagittal deformities. Posterior decompression, internal fixation and bone graft fusion were performed in Groups A, B and C. And posterior decompression was performed in Group D. All patients were followed up for at least 5 years. Patients answered the Oswestry low back pain disability questionnaire at pre-operation, and 1 year, 5 year post-operation. RESULTS: Thirty patients were followed up for the whole process. According to Cobb's angle methods, there was great post-operative improvement for patients with internal fixation (Groups A, B, C) while there was no significant difference for patients with posterior decompression at pre-and post-operation. After surgery, the average Oswestry Disability Index score in the patients with internal fixation (Groups A, B, C) was significantly lower than the preoperative score (25.8 vs 58.0; P < 0.001). However there was statistical difference for patients with internal fixation between 1 year and 5 year postoperatively. No perioperative death or major medical complications occurred. Ten patients had adjacent segment degeneration. CONCLUSIONS: The surgical aim for adults with a spinal deformity is to achieve a stable, balanced and pain-free spine. Surgical treatments should consist of decompression and fusion with segmental instrumentation to avoid instability and curb progression. Despite the complexity of adult lumbar degenerative scoliosis, it might improve the quality of life for patients by choosing an appropriate operation option on the basis of varying degrees of lumbar deformity.

Immune Tolerance Therapy: A New Method for Treatment of Traumatic Brain Injury.

OBJECTIVE: Due to the special anatomical structure and pathophysiological mechanism of the central nervous system (CNS), there is a big difference between the repair of brain injury and other systems of the body. More and more evidence shows that targetedly reducing the autoimmune response of brain tissue without affecting the immune function in other parts of the body will be the best optimized treatment for brain injury. DATA SOURCES: This review was based on data in articles published in PubMed up to June 5, 2017, with the following keywords: "immune tolerance", "traumatic brain injury", and "central nervous system". STUDY SELECTION: Original articles and critical reviews on immune tolerance and brain damage were selected for this review. References of the retrieved articles were also screened to search for potentially relevant papers. RESULTS: The CNS is isolated from the immune system through the blood-brain barrier. After brain injury, brain antigens are released into the systemic circulation to induce damaging immune responses. Immune tolerance can effectively reduce the brain edema and neurological inflammatory response after brain injury, which is beneficial to the recovery of neurological function. The clinical application prospect and theoretical research value of the treatment of immune tolerance on traumatic brain injury (TBI) is worth attention. CONCLUSIONS: The establishment of immune tolerance mechanism has a high clinical value in the treatment of TBI. It opens up new opportunities for the treatment of brain damage.

Identify practice gaps in medication education through surveys to patients and physicians.

BACKGROUND: Effective communication and education formats between health care providers and patients about medication use are associated with patients' satisfaction, recall of information, and eventually their health status. Limited research exists on physician-delivered education interventions, as well as on whether the current content of medication education and delivery formats satisfies the needs of both patients and physicians. Our objective was to identify the practice gaps regarding medication education content and delivery. METHODS: Separate surveys were obtained from ambulatory care patients presenting to the outpatient pharmacy for medication pickups, and physicians working at the hospital clinics. RESULTS: A total of 108 patients completed the patient survey, and 116 hospital clinic physicians completed the physician survey. Female patients had a higher degree of concern regarding medication information compared with male patients (4.04±0.65 versus 3.58±0.66, P=0.001). Physicians were less likely to educate patients regarding their medications' on drug-drug interactions (24.3%), drug-food interactions (24.3%), and what to do about their prescriptions if an adverse reaction is experienced (24.3%) during physician-patient encounters. Patients' most desired education format was physician counseling (82.4%) and the second most desired education format was pharmacist counseling (50.9%). Medication device demonstration (7.0%) was the least used educational format delivered to patients by physicians, and patients would like to see an increased education delivery format through medication device demonstration (Method desired [MD] - Method received [MR] =12.0%). Patients would like to see expanded roles of patient focused handout (MD-MR=22.2%), telephone consultation (21.2%), pharmacist counseling (12.9%), the use of medication database embedded within the hospital information system (12.2%) and device demonstration (12.0%). CONCLUSION: This study illustrates that there are practice gaps in current medication education both in terms of content and delivery format. The study provided valuable information in designing and implementing future education activities that are drivers of good medication use and adherence.

[Effects of male reproductive health information education communication on mastering STDs knowledge among young couples].

OBJECTIVES: To increase the knowledge of STDs control and prevention among young couples by intervention, and to improve their reproductive health. METHODS: The intervention plan was made and carried out on the basis of the information from baseline interview and Focus Group Discussions. The activities of the intervention included lectures given by experts, counseling service, delivering knowledge foldouts and knowledge competition. The final survey was conducted. The data of baseline and final survey were analyzed with SAS software. RESULTS: Before intervention, young couples knowledge of STDs was similar between the experimental and the control group. After intervention, proportion of knowing numbers of STDs kinds in experiment group significantly was higher than that in control group(P < 0.01); The proportion of knowing harm of STDs and knowing to use consom to prevent STDs couples were significantly higher in experiment group than that in control group(P < 0.01). CONCLUSIONS: The intervention activities including lectures and counseling services were positive and great sociological affects on family planning and reproductive health improvement for young couples which has one child.

[Study on the association of oral contraceptives, angiotensinogen gene polymorphisms and the risk of stroke in women].

OBJECTIVE: To evaluate the associations of oral contraceptives (OC) exposure, angiotensinogen (AGT) gene polymorphism and joint effects on the risk of stroke in Chinese women. METHODS: On the basis of a prospective female cohort of contraceptive use, the first-ever-developed (FED) stroke cases, as well as, two sets of age-(± 3 years) and region-matched controls (including neighborhoods and hospitalized patients) were recruited. Between 1 July 2000 and 30 June 2009, a total of 453 FED stroke cases and 919 controls were recruited. Genotyping for polymorphisms of AGT gene was detected by Taqman method. RESULTS: (1) The risk of stroke gradually increased with the cumulative time of OC use in women (P < 0.0001). Compared with the non-users, the risk of hemorrhagic stroke slightly increased among those with OC use (OR = 1.83, 95%CI: 1.25 - 2.66). (2) Women with AG/GG genotypes of A-6G locus or CA/AA genotypes of C11535A locus indicated that there was a slightly reduced risk of stroke (OR = 0.78, 95%CI: 0.61 - 0.99; OR = 0.73, 95%CI: 0.56 - 0.95). (3) Women with AA genotypes of A-20C locus and AG/GG genotypes of A-6G, when incorporated with CA/AA genotypes of C11535A locus with OC, it could increase the risk of hemorrhagic stroke (OR = 1.99, 95%CI: 1.34 - 2.97; OR = 1.84, 95%CI: 1.15 - 2.94; OR = 1.73, 95%CI: 1.06 - 2.85). CONCLUSION: The AGT gene polymorphisms showed that they did have an impact on the risk of stroke. And the joint effect between women using OC and AGT gene polymorphisms could slightly increase the risk of stroke.

Leptin's effect on accelerated fracture healing after traumatic brain injury.

OBJECTIVE: To investigate mechanisms behind the faster rehabilitation of limb fractures when associated with traumatic brain injury (TBI). METHODS: New Zealand rabbits were divided into TBI group and sham-operation group for four studies as follows: (1) blood and cerebrospinal fluid (CSF) were drawn on days 1, 3, and 7 to demonstrate changes in serum leptin, growth hormone (GH), insulin-like growth factor 1 (IGF-1), and CSF leptin; (2) bone defection was created by drilling in the tibial bone and either leptin or normal saline was injected into rabbit's cerebellomedullary cistern. X-ray was taken at 1 days, 2 weeks, and 5 weeks and evaluated by criteria to determine rate of bone healing; (3) FITC-labeled rabbit leptin was injected into TBI and sham-operation groups, and frozen sections of rabbit brain were observed to identify differences in central nervous system (CNS) leptin by fluorescence; (4) polymerase chain reaction (PCR) was used to evaluate the expression of leptin production by brain tissue. RESULTS: Serum and CSF leptin, GH, and IGF-1 concentrations were found to be higher in the TBI group than the sham-operation group at days 1, 3, and 7 (P<0·05). CSF leptin of the TBI group was positively correlated with serum leptin on day 1 (P<0·05), and positively correlated with GH and IGF-1 on days 3 and 7 (P<0·05). X-ray criteria demonstrated that leptin administration caused significantly faster healing calluses at 3 and 5 weeks as compared to control animals (P<0·05). FITC-labeled leptin study demonstrated that TBI animals had stronger expression of leptin in the brain than sham-operated animals. However, PCR of brain tissue leptin showed no significant differences between TBI and sham-operated animals in the expression of leptin. CONCLUSIONS: Our study suggests that increased CSF leptin, likely from blood-brain barrier breakdown, combined with elevated serum GH and IGF-1 after TBI, leads to accelerated fracture healing.

Continuous permeability measurements record healing inside the Wenchuan earthquake fault zone.

Permeability controls fluid flow in fault zones and is a proxy for rock damage after an earthquake. We used the tidal response of water level in a deep borehole to track permeability for 18 months in the damage zone of the causative fault of the 2008 moment magnitude 7.9 Wenchuan earthquake. The unusually high measured hydraulic diffusivity of 2.4 × 10(-2) square meters per second implies a major role for water circulation in the fault zone. For most of the observation period, the permeability decreased rapidly as the fault healed. The trend was interrupted by abrupt permeability increases attributable to shaking from remote earthquakes. These direct measurements of the fault zone reveal a process of punctuated recovery as healing and damage interact in the aftermath of a major earthquake.

[Study on the association of oral contraceptives, angiotensin-converting enzyme gene polymorphisms and risk of stroke in women].

OBJECTIVE: To evaluate the associations of oral contraceptives (OC) exposure, angiotensin-converting enzyme (ACE) gene polymorphism and their joint actions with the risk of stroke in Chinese women. METHODS: A case-control study, based on a set cohort, was carried out. Incident cases of stroke identified between July 1 1997 and June 30 2009 were enrolled. One hospital control and healthy community control were matched on region and age (± 3 years). A total of 453 women with stroke and 919 controls were recruited. I/D gene polymorphism was detected by polymerase chain reaction (PCR) and amplification fragment length polymorphism (AFLP), A-240T polymorphism were detected by TagMan. RESULTS: (1) The risk of stroke gradually increased with the cumulative time of OC being used in women (P < 0.0001). Compared with non-users, the risk of stroke significantly increased among those with cumulative time of using OC longer than 20 years (adjusted OR was 2.07, with 95%CI as 1.30 - 3.29). (2) ID/DD genotype of I/D locus indicated significantly an increased risk of hemorrhagic stroke (adjusted OR, 2.37; 95%CI, 1.46 - 3.84). (3) Women with ID/DD genotype of I/D locus or with TA/TT genotype of A-240T locus and using OC could significantly increase the risk of hemorrhagic stroke (adjusted OR was 4.59; with 95%CI as 2.21 - 9.51 and OR was 2.50; with 95%CI as 1.42 - 4.38). (4) Data from multivariate analyses showed that both OC and ID/DD genotypes were important risk factors for hemorrhagic stroke. CONCLUSION: ID/DD and TA/TT genotypes of ACE gene, OC and their joint action might increase the risk of stroke, especially on hemorrhagic stroke in Chinese women.