[Objective]To evaluate the clinical outcome of lumbar spinal canal stenosis treated by microendoscopic decompressive laminotomy with facet-preserving technique.[Method]Twenty-nine consecutive patients of posterior lumbar spinal canal stenosis were treated by microendoscopic unilateral approach and bilateral decompression with facet-preserving technique using the METRxTM microendoscopic spinal system.Moreover,operation time,blood loss,use of diclofenac suppositories,intra-and postoperative complications and Imaging evaluation were investigated.Clinical outcomes were evaluated by the Japanese Orthopaedic Association scoring system for lumbar disease.[Result]Twenty-four patients were followed up for 7 to 24 months,mean 15.3 months.Mean preoperative JOA scores were(14.5?3.7),and postoperative JOA scores were(22.4?2.3).The mean recovery rate was 54.7%.Operation time was 94.2 minutes for one level decompression,and mean blood loss was 56.4 ml.The use of diclofenac suppositories was average 0.37 times.Intra and postoperative complications were due to one misjudgment of the vertebral level,one dural tears.Intraoperative endoscopic photograph showed satisfactory decompression of dural sac and contralateral nerve root from ipsilateral laminotomy could be performed completely.Postoperative CT and 3DCT showed bilateral decompression from ipisilateral laminotomy and revealed no damage of the facet joints.[Conclusion]Microendoscopic unilateral approach and bilateral decompression with facet-preserving technique using the METRxTM microendoscopic spinal system minimizes resection of the pathologic compression tissues and is a safe,effective and ideal decompressive method for lumbar spinal canal stenosis.

Telemedicine is a medical type that develops with communication and information technology.Its main goal is to provide professional health care for poor areas or rescue of dangerous patients.It integrates long-range communication technology,medical technology and health informatics technology.The development of telemedicine system has gone through the first telemedicine system based on wired telephone,microwave and satellite communications on behalf of the second generation of long-distance medical system until today's mobile communications and the Internet which represent the third generation.Telemedicine has been widely applied,for example,remote diagnosis and treatment,remote consultation,remote surgery,telemonitoring and remote rescue.At present,telemedicine has become a multi-disciplinary high-tech that develops very rapidly,and a new model of health care service into the armed forces medical services and medical care.

Objective To explore the relationship among cytokine levels and Toll-like receptor (TLR) 2,4 in hepatitis B virus (HBV) related cirrhosis. Methods Heparin anticoagulated venous blood of 35 randomly selected HBV related cirrhosis and 35 healthy volunteers were collected aseptically. Plasma tumor necrosis factor (TNF)-α concentration was determined using enzyme-linked immunosorbent assay (ELISA). Peripheral blood mononuclear cells (PBMC) were separated and stained with anti-TLR2,4 monoclonal antibodies, then analysed by flow cytometry. Total RNA was extracted from PBMC and TLR2,4 mRNA expression levels were evaluated by real-time quantitative polymerase chain reaction (PCR) using SYBR Green detection. Means of normal distribution were compared by t test and one factor analysis of variance. The data of abnormal distribution were analyzed using Mann-Whithey U test, Kruskal-Wallis H test and Spearman correlation analysis. Results The plasma concentration of TNF-α in the cirrhotic patients was significantly higher than that in the healthy controls (33.52 ng/L vs 6.07 ng/L, Z=-6.584, P<0. 01), which was parellel with Child-Pugh score. TLR2 positive rate in PBMC from the cirrhotic patients was significantly higher than that from the healthy controls (20.65% vs 12.04%, Z=-4.458, P<0.01), which was positively correlated with plasma TNF-α level (r= 0.448 3, P<0.05), and parellel with Child-Pugh score. Between the cirrhotic and healthy groups, there was no significant difference of TLR4 positive rate in PBMC. The mRNA expression level of TLR2/GAPDH in PBMC from the cirrhotic patients was significantly higher than the controls (0.234 2 vs 0.043 1, Z=-6.83, P<0.01), which was positively correlated with plasma TNF-α level (r=0.411 1, P<0.05), and parellel with Child-Pugh score. Between the two groups, there was no significant difference of TLR4 mRNA expression level in PBMC. Conclusions The expression of TLR2 in PBMC from cirrhotic patients is significantly elevated, which is positively correlated with plasma TNF-α level and the severity of liver disease. The expression of TLR4 in PBMC from cirrhotic patients is unchanged. It suggests that TLR2 but not TLR4, plays an important role in the progression of liver cirrhosis.

Percutaneous vertebroplasty (PVP) is a minimally-invasive technique,which has been widely employed in the treatment of hemangiomas,vertebral compression fractures,spinal metastases,myeloma and other diseases.Clinically,it is generally believed that the curative effect of PVP is closely related to the injected amount of bone cement.However,there is still great controversy over the optimal injection volume of bone cement.Based on the current researches both at home and abroad,this article aims to make a brief introduction about the relevant vertebral biomechanical factors that might affect the injection volume of bone cement,the influence of the injected volume of bone cement on the vertebral strength,rigidity and adjacent vertebral bodies.The main current disputes are pointed out so as to lay the foundation for further study.

Along with the aging of population in China,more and more people suffer from osteoporosis.As a consequence,osteoporotic vertebral compression fracture has become one of the major clinical issues.More and more patients like to take percutaneous vertebroplasty (PVP) as the preferred treatment,thus,the number of patients who develop recurrent vertebral fracture after PVP is also increased.In recent years,more and more attention has been paid to the recurrent fractures after PVP for vertebral compression fractures by clinicians.In order to reduce the incidence of recurrent vertebral fracture after PVP,it is necessary to make the further and deep studies on the risk factors that cause recurrent vertebral fractures.This paper aims to make a comprehensive review about the risk factors that may cause recurrent vertebral fractures after PVP for osteoporotic vertebral compression fracture.

Objective:To compare the effect and clinical significance of unilateral and bilateral percutaneous kyphoplasty (PKP) combined with hyperextension reduction in the treatment of fresh osteoporotic vertebral compression fracture (OVCF).Methods:The clinical data of OVCF patients treated in Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University from January to December 2018 were retrospectively analyzed.A total of 62 patients were included.According to the surgical approach, 62 patients were divided into unilateral puncture approach group and bilateral puncture approach group, with 31 cases in each group.The patients in the unilateral puncture group were treated with limb hyperextension reduction combined with unilateral PKP.In the bilateral puncture approach group, limb hyperextension reduction combined with bilateral PKP was used.The changes of visual analogue pain scale (VAS), Oswestry disability index (ODI), vertebral anterior height, vertebral midline height and Cobb angle were observed and compared before operation, 1 day and 2 weeks after operation.At the same time, the operation time, intraoperative fluoroscopy times, intraoperative bone cement injection and adverse reactions were compared between the two groups.Results:The VAS scores of patients in the unilateral puncture approach group before operation, 1 day and 2 weeks after operation were (8.10±0.17), (2.20±0.26) and (1.90±0.39), respectively.The scores of bilateral puncture approach group were (8.10±0.13), (2.30±0.26) and (2.00±0.30), respectively.The results of repeated measurement ANOVA showed that F intra-group=13 790.444, P<0.001, F inter-group=1.951, P=0.168, F interaction=0.735, P=0.481.There were significant differences in VAS scores between the two groups 1 day and 2 weeks after operation (all P<0.05). There was significant difference in VAS score between the two groups 1 day after operation and 2 weeks after operation (all P<0.05). The ODI scores of patients in the unilateral puncture group before operation, 1 day and 2 weeks after operation were (40.30±5.30), (23.20±3.40), (22.30±4.49) points respectively, and those in the bilateral puncture group were (41.00±4.49), (21.90±2.48), (20.70±5.70) points, respectively.The results of repeated measurement ANOVA showed that F intra-group=339.046, P<0.001, F inter-group=1.385, P=0.244, F interaction=1.083, P=0.342.There were significant differences in ODI scores between the two groups 1 day and 2 weeks after operation (all P<0.05). There was significant difference in ODI score between the two groups 1 day after operation and 2 weeks after operation (all P<0.05). The anterior height of vertebral body in unilateral puncture group was (18.26±2.40), (21.97±1.17), (22.03±1.35) mm before operation, 1 day and 2 weeks after operation, and that in bilateral puncture group was (18.94±1.80), (22.06±2.79), (20.29±1.19) mm.The results of repeated measurement ANOVA showed that F intra-group=51.228, P<0.001, F inter-group=1.594, P=0.212, F interaction=6.452, P=0.002.There were significant differences in the anterior vertebral height between the two groups 1 day and 2 weeks after operation (all P<0.05). The height of vertebral midline in the unilateral puncture group was (17.97±2.14), (26.13±1.43), (26.00±1.79) mm before operation, 1 day and 2 weeks after operation, and in the bilateral puncture group was (18.84±1.77), (24.74±1.77), (24.68±2.06) mm.The results of repeated measurement ANOVA showed that F intra-group=358.837, P<0.001, F inter-group=3.850, P=0.054, F interaction=9.117, P<0.001.There were significant differences in the height of vertebral midline between the two groups 1 day and 2 weeks after operation (all P<0.05). The Cobb angles in the unilateral puncture group were (21.74±2.11)°, (11.77±1.91)° and (10.94±1.12)° before operation, 1 day and 2 weeks after operation, respectively, and in the bilateral puncture group were (22.13±2.50)° and (12.0±2.38)° and (11.71±1.37°, respectively.The results of repeated measurement ANOVA showed that F intra-group=674.732, P<0.001, F inter-group=1.975, P=0.165, F interaction=0.376, P=0.688.There were significant differences in Cobb angle between the two groups 1 day and 2 weeks after operation (all P<0.05). There were significant differences in operation time ((52.0±3.8) min and (67.0±6.7) min), intraoperative fluoroscopy times ((15.0±5.8) times and (32.0±6.1) times), and bone cement injection volume ((4.6±0.3) mL and (5.0±0.1) mL) between unilateral puncture approach group and bilateral puncture approach group (all P<0.001). Conclusion:Unilateral and bilateral PKP combined with hyperextension reduction can alleviate the pain of OVCF, restore the lost vertebral height and correct kyphosis.The unilateral puncture approach PKP combined with hyperextension reduction has the advantages of shorter operation time, concise operation process, fewer times of intraoperative fluoroscopy and less use of bone cement.

Objective:To analyze the efficacy of anterior cervical Hybrid surgery and posterior cervical expansive open-door laminoplasty(EODL)in the treatment of multilevel cervical spondylotic myelopathy,and to discuss the selection of surgical methods for the patients with multilevel cervical spondylotic myelopathy.Methods:The retrospective analysis was conducted of 70 patients with multilevel cervical spondylotic myelopathy who underwent surgery at Affilated Beijing Traditional Chinese Medicine Hospital of Capital Medical University from July 2017 to July 2020.Based on the different surgical methods,the patients were divided into anterior group(n=35)and posterior group(n=35).The patients in anterior group underwent Hybrid surgery[anterior cervical discectomy and fusion(ACDF)combined with artificial cervical disc replacement(ACDR)],and the patients in posterior group underwent EODL.The hospitalization time,operation time,intraoperative blood loss,and postoperative drainage volume of the patients in two groups were recorded;the efficacy was evaluated by Japanese orthopaedic association(JOA)score,JOA improvement rate,neck disability index(NDI),visual analogue scale(VAS)for pain,and postoperative satisfaction score;the complications of the patients in two groups after surgery were recorded.Results:Compared with posterior group,the intraoperative blood loss,postoperative drainage volume,hospitalization time,and operation time of the patients in anterior group were significantly decreased(P<0.01),and the preoperative score had no significant difference(P>0.05).At the final follow-up after surgery,compared with posterior group,the JOA score and JOA improvement rate of the patients in anterior group were significantly increased(P<0.01),and the NDI score and VAS score were significantly decreased(P<0.01).Compared with before surgery,the JOA scores of the patients in two groups at the final follow-up after surgery were increased(P<0.01),and the NDI and VAS scores were significant decreased(P<0.01).The postoperative satisfaction of the patients in two groups was high based on the postoperative satisfaction score.There was no significant difference in the incidence of postoperative complication of the patients between two groups(P>0.05).Conclusion:Both the anterior cervical Hybrid surgery and EODL achieve the satisfactory results in the treatment of multilevel cervical spondylotic myelopathy.Hybrid surgery has the advantages of less bleeding and shorter surgery time,and the most suitable surgical method should be chosen clinically based on the actual situation of the patients.

Objective:This study evaluates the performance of chemiluminescence assay, which is designed to detect Hepatitis D Virus (HDV) Immunoglobulin G (IgG) antibodies.Methods:A comparative analysis was conducted among chemiluminescence anti-HDV IgG reagent, the magnetic particle-based domestic reagent A and domestic reagent B, and the Robo Gene HDV RNA kit, using 1909 HBsAg-positive plasma samples. This comparison aimed to delineate clinical specificity and detection accuracy. The anti-HDV IgG reagent precision was assessed at three different concentration levels following the Clinical Laboratory Standards Institute EP5-A2 guidelines. The specificity of the assay was validated using 200 HAV IgM positive, 545 HBsAg-positive but anti-HDV IgG-negative, 350 anti HCV positive plasma samples and 200 healthy human blood samples. Additionally, a concordance study was conducted with 545 HBsAg-positive and 37 anti-HDV IgG-positive plasma samples, comparing the anti-HDV IgG reagent against reagent A.Results:1 909 HBsAg-positive plasma samples were tested using 3 anti HDV IgG reagent and 1 HDV RNA reagent, 19 samples were identified as anti-HDV IgG-positive. The anti-HDV IgG demonstrated superior accuracy and specificity. The assay exhibited excellent precision, with intra-assay coefficient of variation (CV) values ranging from 1.57% to 4.30%, and inter-assay CV values between 1.71% and 4.67% for detecting samples at high, medium, and low concentration levels. Concordance with Reagent A showed consistent results in both positive and negative detections.Conclusion:In this study, the anti-HDV IgG reagent (chemiluminescence method) displayed outstanding specificity in detecting clinical samples and exhibited a high conformity rate with commercialized reagents, making it potentially suitable for screening anti-HDV IgG in HBsAg-positive samples.

Objective:This study aims to evaluate the quality and explore the preliminary clinical applications of a domestically developed hepatitis D virus nucleic acid quantification reagent (abbreviated as"domestic HDV RNA reagent").Methods:The sensitivity and accuracy of the reagent were evaluated in accordance with the WHO HDV RNA international standard, employing the Bio-Rad CFX Opus 96 real-time fluorescence quantitative PCR analysis system. Serial dilutions of pseudo-viruses or cell culture-derived virus were used to determine the linear range of the domestic HDV RNA reagent. Specificity was assessed using positive samples of HAV, HBV, HCV infection, and HEV national reference materials. Precision was evaluated with samples at both high and low concentrations. In a comparative analysis, 30 HDV IgG positive samples were tested using both the domestic HDV RNA reagent and the RoboGene HDV RNA kit based on the ABI 7500 FAST DX system. The Pearson correlation coefficient (r) was used to examine the correlation between the two reagents.Results:The domestic HDV RNA reagent demonstrated a high sensitivity of up to 6 IU/ml, consistent with that of the comparator reagent. The calibration curve for WHO HDV RNA standards had a slope of -3.286, with an amplification efficiency of 101.6%. The linear detection range spanned from 10 to 10 8 IU/ml for eight HDV genotypes. The domestic HDV RNA reagent exhibited exceptional specificity, without cross-reactivity observed with HAV, HBV, HCV, or HEV. Accuracy assessments at five concentration levels met the required standards, with intra-assay precision coefficient of variation ( CV) ranging from 1.20% to 4.20%, and inter-assay precision CV from 1.20% to 7.90%. The detection results for HDV IgG positive samples were highly correlated with the comparator reagent ( r=0.984, P<0.001), achieving a diagnostic accuracy of 100% compared to sequencing results. Conclusion:In this study, the domestic HDV RNA reagent possesses excellent specificity, accuracy, precision, and a broad linear range, attaining a sensitivity level on par with international reagents of the same type.