Objective To observe the clinical efficacy of the TESSYS (transforaminal endoscopic spine system) technique of percutaneous transforaminal endoscopic discectomy combined with oral use of Chinese medicine for the treatment of lumbar disc herniation.Methods Thirty-nine patients with lumbar disc herniation were treated by the TESSYS technique of percutaneous transforaminal endoscopic discectomy,and then received oral use of modified herbal medicine Xubi Recipe,a formula mainly having the actions of tonifying kidney and strengthening governor vessel for 4 weeks after the operation.The visual analogue scale (VAS) and Oswestry disability index (ODI) and modified MacNab criteria were employed to assessed the surgical outcomes before the operation,and 3 and 6 months after the operation.Results (1) All of the 39 cases completed the operation successfully,and were followed up for 6-12 months after the operation.(2) Three and 6 months after the operation,the VAS scores and ODI scores were obviously lower than those before the operation,and the differences were significant (P ＜ 0.05).(3) Six months after the operation,the excellent rate of clinical efficacy assessed by modified MacNab criteria was 89.74％.(4) Only 4 cases had severer transient pain and numbness in the affected limbs,and there was no occurrence of complications of permanent neural root trauma,dural tear,vascular injury,intestinal damage,spondylodiscitis or retroperitoneal hematoma.Conclusion The TESSYS technique of percutaneous transforaminal endoscopic discectomy combined with oral use of Chinese medicine is effective for the treatment of the lumbar disc herniation with the advantages of satisfactory short-term effect,less bleeding,less trauma,faster recovery and less complications.

ObjectiveTo investigate the clinical effect of laparoscopic liver resection (LLR) versus open liver resection (OLR) in the treatment of patients with hepatocellular carcinoma (HCC) complicated by liver cirrhosis. MethodsA total of 136 patients who were diagnosed with HCC complicated by liver cirrhosis in Linxia Municipal People′s Hospital from January 2006 to December 2007 were enrolled and underwent LLR (LLR group, 64 patients) or OLR (OLR group, 72 patients). The short-term outcome, pathological factors, and long-term outcome were compared between the two groups. The t-test was used for comparison of continuous data between groups, the chi-square test was used for comparison of categorical data between groups, and the log-rank test was used for comparison of survival functions. ResultsThere were significant differences between the LLR group and the OLR group in time of operation ((86.43±23.55) min vs (6231±19.61) min, t=8.539, P＜0.001) and length of postoperative hospital stay ((7.22±3.45) d vs (12.27±5.31) d, t=2764, P=0.024), while there were no significant differences in intraoperative blood loss, time of hepatic portal occlusion, and overall fatality rate(all P＞005). There were also no significant differences in number of tumors, presence or absence of liver cirrhosis, microvascular invasion, resection margin, and maximum tumor diameter between the two groups (all P＞0.05). As for long-term outcome, the 1-, 3-, and 5-year disease-free survival rates were 83.30%, 48.61%, and 38.29% in the LLR group and 78.64%, 51.26%, and 4301% in the OLR group; the 1-, 3-, and 5-year overall survival rates were 97.42%, 95.13%, and 89.23% in the LLR group and 96.41%, 94.28%, and 90.06% in the OLR group. There were no significant differences in these survival rates between the two groups (all P＞005). ConclusionIn patients with HCC complicated by liver cirrhosis, LLR helps to achieve rapid postoperative recovery and similar long-term outcome compared with OLR; therefore, it holds promise for clinical application.

BACKGROUND:The problem of intervertebral disc injury and degeneration has been studied in many ways.Many studies have shown that intervertebral disc injury and degeneration is driven by mechanical loading factors.However,the potential relationship between common phenotypes of intervertebral disc injury and degeneration and mechanical loading factors has been rarely summarized. OBJECTIVE:To summarize the types of common structural abnormalities exhibited by intervertebral disc injury and degeneration in the published literature,and sum up the potential links to the types of mechanical loading that lead to these structural abnormalities in in vitro and ex vivo experimental studies. METHODS:Using the terms"intervertebral disc failure,intervertebral disc injury,mechanical load,mechanical factor,load factor,biomechanics"as Chinese and English key words in PubMed,CNKI,and WanFang databases,articles related to intervertebral disc injury degeneration and mechanical load factors were retrieved.Literature screening was performed according to the inclusion and exclusion criteria,and 88 articles were finally included. RESULTS AND CONCLUSION:(1)Common structural abnormalities of intervertebral discs include decreased intervertebral disc height,disc bulge,osteophyte formation,annulus fibrosus tear,intervertebral disc herniation or disc prolapse,endplate damage,Schmorl nodes and intervertebral disc calcification.Intervertebral discs are susceptible to mechanical load types such as compression,bending,axial rotation,and compound loads.(2)The compressive load mainly causes the decrease of the proteoglycan content and the water-binding ability of the intervertebral disc,leading to the decrease or swelling of the intervertebral disc and further damage and degeneration of the intervertebral disc.In addition,the excessive compressive load causes greater damage to the endplate.(3)Bending load and axial rotation load damage the annulus fibrosus more than the endplate,and prolonged or repeated bending loads can cause tearing of the fibrous annulus and herniation or prolapse of the intervertebral disc,while pure axial rotation loads can induce less damage to the intervertebral disc and only cause the tear of the annulus fibrosus.(4)However,when different load types act in combination,it is more likely to result in high stress on the disc and a greater risk of disc injury.(5)Injury and degeneration of the intervertebral disc present progressive structural damage,and early prevention and protection are particularly important in clinical practice.Future tissue engineering research can start with early repair of the intervertebral disc.