OBJECTIVE: To explore the clinical effect of the simple nucleus pulposus removal and small incision interlaminar window in the treatment of prolapsed and displaced lumbar disc herniation. METHODS: From February 2016 to February 2018, 35 patients with single-segment prolapse and displaced lumbar disc herniation were treated by the simple nucleus pulposus removal and small incision interlaminar window under general anesthesia. Among them, there were 21 males and 14 females;aged (42±17) years;27 cases of L RESULTS: All the operations were successful and the operation time was 30 to 60 min with an average of 40 min, the intraoperative blood loss was 10 to 30 ml with an average of 20 ml. All the patients were followed up for 1 to 3 years with an average of 1.2 years. Thirty-five patients with low back pain and lower limb symptoms were significantly relieved or disappeared. According to modified Macnab standard, 29 cases obtained excellent results, 5 good, and 1 fair. CONCLUSION Applying the concept of minimally invasive operation, small incision interlaminar window and simple nucleus pulposus removal for the treatment of prolapsed and displaced lumbar disc herniation has the advantages of short operation time, definite curative effect, and less trauma. And it is a safe and effective surgical method under the premise of strict control of the indications.
Adult ; Diskectomy, Percutaneous ; Endoscopy ; Female ; Humans ; Intervertebral Disc Displacement/surgery* ; Lumbar Vertebrae/surgery* ; Male ; Middle Aged ; Nucleus Pulposus ; Prolapse ; Retrospective Studies ; Treatment Outcome

This study evaluated the effects of early treatment with β-adrenergic blocker metoprolol on ventricular remodeling and function after acute myocardial infarction (AMI) by using high frequency ultrasound. The relationship between the efficacy and the expression level of cardiac myocardial inflammatory cytokine was examined in rats. The rat model of AMI was induced by ligating the left anterior descending artery. The surviving rats were randomly assigned to two experimental groups: MI control (MI) group and MI metoprolol (MI-B) group, with the rats undergoing sham operation serving as normal control (Sham). MI-B group was given metoprolol for 4 weeks (refer to the CCS-2 protocol) and the other two groups received equal volume of saline via intragastric (i.g.) administration. The ventricular remodeling and function were evaluated by high frequency ultrasound 4 weeks after the treatment. Then all rats were sacrificed for pathological examination and immunohistochemistrical detection of inflammatory cytokines, including IL-1β, IL-6, IL-10 and TNF-α. Compared with the MI group, the left ventricular end-systolic dimension, end-diastolic dimension, end-systolic volume and end-diastolic volume of the MI-B group were significantly decreased (P<0.01), while the left ventricular anterior wall end-diastolic thickness, ejection fraction and fractional shortening were obviously increased (P<0.01). The conspicuous improvement in the left ventricular morphology and function was coincident with the markedly reduced TNF-α and IL-1β expression and the increased IL-10 expression. We are led to conclude that early metoprolol treatment for AMI can regulate myocardial inflammatory cytokine expression to improve cardiac function and the underlying mechanism might be that it decreases the level of pro-inflammatory cytokines and increases the level of its anti-inflammatory counterparts in cardiac myocytes. Our study also showed that echocardiography is a useful technique for the structural and functional assessment of left ventricle after acute myocardial infarction.

Objective To observe the effects of stress treatment for different time on autonomic behaviors and spatial learning-memory abilities of rats and to investigate the therapeutic efficacy of Chaihu Shugan San(CSS). Methods Seventy-five 8-week-old Wistar rats were randomly divided into blank control group, model control group, and low-, middle-, and high- dose CSS groups, 15 rats in each group. Chronic multi-stress model was set up. The rat body weight in various groups was measured. The autonomic behaviors of rats were observed by open field test, and the abilities of spatial learning-memory of rats were examined by Morris water maze test. Results (1)On modeling day 20, 30, the model control group had lighter body weight than the blank control group (P < 0.01); the middle-, high- dose CSS groups had higher body weight than the model control group (P < 0.05 or P < 0.01) , and the high-dose CSS group had the highest body weight, the difference being insignificant compared with the blank control group (P > 0.05). (2)Open field test results showed as follows:Compared with the blank control group, the total distance and central-area distance were shortened (P < 0.01) and the average speed was decreased(P < 0.01) in the model control group at different modeling time points, the effect being positively correlated with the modeling time; compared with the model control group, the total distance and central-area distance were prolonged(P < 0.05 or P < 0.01) and the average speed was increased (P < 0.05 or P < 0.01) in the low-, middle-, and high- dose CSS groups at different modeling time points, and the therapeutic efficacy of high- dose CSS group was approach to the blank control group. (3)Morris water maze test results showed as follows: Compared with blank control group, the average latent period was prolonged and the times of platform crossing were decreased in the model control group (P < 0.01); compared with the model control group, the average potential time was shortened and the times of platform crossing were increased in the middle- and high-dose CSS groups (P<0.01), the efficacy being not significantly different from that of the blank control group (P > 0.05). Conclusion The chronic stress may decrease the excitability, reduce autonomic behaviors, and injure spatial learning and memory abilities of rats, the effect being positively correlated with the modeling time. And CSS has an effect on improving the above indexes, in particular the middle-and high-dose of CSS.

OBJECTIVETo discuss clinical effects of headless pressure screw with local complication of PRP in treating old metatarsal intra-articular fracture.

METHODSFrom January 2010 to June 2016, 7 patients with old metatarsal intra-articular fracture treated by open reduction headless compression screw internal fixation by local application PRP, including 5 males and 2 females, aged from 21 to 52 years old, 5 patients injured by falling down and 2 patients caused by crushing, the time from injury to operation ranged from 3 to 6 weeks. Preoperative anteroposterior, lateral and oblique X-ray film and three-dimensional CT reconstruction were examined, and the results showed 2 patients on the second metatarsal, 2 patients on the third metatarsal, 3 patients on the fourth metatarsal. Regular X-ray as postoperative examination was observed, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle scoring system at the final follow-up was evaluated.

RESULTSSeven patients were followed up from 6 to 17 months. All incisions healed at stage I without joint stiffness, traumatic arthritis and related complications. Imaging examination showed fracture reached bone healing, healing time ranged from 3 to 6 months. No joint stiffness and traumatic arthritis occurred. One of seven patients occurred stiffness of metatarsophalangeal joints. AOFAS score increased from 40.5±4.2 before operation to 85.0±10.5 at 12 months after operation, and 4 patients got excellent results, 2 moderate and 1 poor. The active motion of metatarsophalangeal joint showed dorsal flexion ranged from 35° to 40°, plantar flexion ranged from 25° to 35°.

CONCLUSIONSHeadless pressure screw with local complication of PRP in treating old metatarsal intra-articular fracture could recover articular surface of metatarsal head, improve metatarsophalangeal joints activity, which do not need the second operation, and could receive good clinical results with early exercise.

Objective To investigate the effect of high frequency (10 Hz),low frequency (1 Hz) and theta burst stimulation (TBS) mode of repetitive transcranial magnetic stimulation (rTMS) on the recovery of motor function in hemiplegic patients following acute ischemic stroke.Methods Seventy-two patients with hemiplegia after acute ischemic stroke were randomly grouped with the random number table.They were treated with low frequency (n=18),high frequency (n=18),and TBS (n=18) rTMS or sham stimulation (control group,n=18),once a day,for 2 weeks.Fugl-Meyer Assessment (FMA) and National Institutes of Health Stroke Scale (NIHSS) were used to evaluate neurological function in all patients before rTMS treatment (on the day before the first treatment) and after treatment (on the day after the last treatment).Results After treatment,the FMA and NIHSS scores in the 4 groups were significantly improved compared with before treatment (all P<0.05).After rTMS treatment,the FMA and NIHSS scores were improved significantly in the high frequency group,low frequency group and TBS group compare with the control group (all P<0.05).There were no significant differences among all the treatment groups.Conclusion sHigh frequency,low frequency and TBS rTMS can improve the recovery of motor function in hemiplegic patients following acute ischemic stroke.There were no significant differences among all the treatment modes.

Objective To study the best diagnostic imaging procedure after acute stroke.Methods 53 patients with acute stroke were recruited within 72 hours after symptom onset.CT was performed in all patients firstly, then T1 weighted-imaging( T1 WI), T2 weighted-imaging( T2WI ), gradient recalled echo T2 * weighted-imaging( GRE-T2 * WI) and diffusion-weighted imaging(DWI) were examined at 1.5T.Furthermore 15 patients with ischemic stroke received perfusion-weighted imaging(PWI) examination.Results 15 patients with acute cerebral hemorrhage and one patient of hemorrhagic brain tumor appeared clear on GRE-T2 * WI.3 patients with transient ischemic attack(TIA) were normal on T1WI ,T2WI ,GRE-T2* WI and DWI.18 cases with cerebral infarction appeared normal on GRE-T2 * WI within 6 hours after symptom onset, and 7 cases of them underwent PWI examination, the signal intensity of 3 cases were PWI ≥ DWI and of 4 cases were PWI = DWI.14 patients appeared hyperintense on GRE-T2 * WI within 6 ～72 hours after symptom onset.8 patients of them underwent PWI examination,the signal intensity of 6 cases were PWI≥DWI and of 2 cases were PWI = DWI.Of 14 patients,7 patients appeared as 1 ～ 18 dot or patchy hypointense whose diameter was about 2 ～ 5mm on GRE-T2 * WI.Another case of headache with hemiplegia and the side of the limb didnt show abnormalities on the CT, but showed a low signal in ambient cistern on T2 * WI and was proved to be subarachnoid hemorrhage.Conclusion After acute stroke,multi-sequence MRI enables the "one-stop shopping" imaging of cerebral hemorrhage,cerebral infarction and TIA in a shorter time,makes the state of micro-bleeding clear,determines ischemic penumbra,and even guides for thrombolytic treatment.

This study evaluated the effects of early treatment with β-adrenergic blocker metoprolol on ventricular remodeling and function after acute myocardial infarction (AMI) by using high frequency ultrasound. The relationship between the efficacy and the expression level of cardiac myocardial inflammatory cytokine was examined in rats. The rat model of AMI was induced by ligating the left anterior descending artery. The surviving rats were randomly assigned to two experimental groups: MI control (MI) group and MI metoprolol (MI-B) group, with the rats undergoing sham operation serving as normal control (Sham). MI-B group was given metoprolol for 4 weeks (refer to the CCS-2 protocol) and the other two groups received equal volume of saline via intragastric (i.g.) administration. The ventricular remodeling and function were evaluated by high frequency ultrasound 4 weeks after the treatment. Then all rats were sacrificed for pathological examination and immunohistochemistrical detection of inflammatory cytokines, including IL-1β, IL-6, IL-10 and TNF-α. Compared with the MI group, the left ventricular end-systolic dimension, end-diastolic dimension, end-systolic volume and end-diastolic volume of the MI-B group were significantly decreased (P<0.01), while the left ventricular anterior wall end-diastolic thickness, ejection fraction and fractional shortening were obviously increased (P<0.01). The conspicuous improvement in the left ventricular morphology and function was coincident with the markedly reduced TNF-α and IL-1β expression and the increased IL-10 expression. We are led to conclude that early metoprolol treatment for AMI can regulate myocardial inflammatory cytokine expression to improve cardiac function and the underlying mechanism might be that it decreases the level of pro-inflammatory cytokines and increases the level of its anti-inflammatory counterparts in cardiac myocytes. Our study also showed that echocardiography is a useful technique for the structural and functional assessment of left ventricle after acute myocardial infarction.
Animals ; Cytokines ; metabolism ; Inflammation ; drug therapy ; metabolism ; Male ; Metoprolol ; pharmacology ; Myocardial Infarction ; drug therapy ; Myocardium ; metabolism ; Rats ; Rats, Sprague-Dawley ; Ultrasonography ; methods

OBJECTIVE: To discuss the quality of reporting in randomized controlled trials (RCTs) of Chinese herbal medicine (CHM), and to provide suggestions for improving the reporting of future clinical studies in this therapeutic area. METHODS: A search of the Cochrane Library was conducted to identify RCTs of CHM. A revised CONSORT checklist designed for CHM clinical studies was implemented. The revised CONSORT checklist contained 63 items, including the following new items added specifically for CHM: (1) "syndrome of disease" based on Chinese medicine theories; (2) rationale of CHM formula; (3) formula composition; (4) preparation form of CHM; (5) quality control of CHM. RESULTS: The overall reporting quality of the RCTs as assessed with the revised CONSORT checklist varied between 19% and 44%, with a median score of 32% (standard deviation 8%). CONCLUSION: The overall quality of reporting of RCTs of CHM evaluated with a revised CONSORT checklist was poor, reflecting the need for improvements in reporting future clinical trials in this area. RECOMMENDATIONS: To improve the quality of reporting of RCTs of CHM, we recommend adopting a revised CONSORT checklist that includes items specific to CHM. We also recommend that editors of CHM journals require authors to use a structured approach to presenting their trials as a condition of publication.

OBJECTIVE:To compare the effects of equilibrium amino acid and it rich in branched chain amino acid on nutrition metabolism after surgery and prognosis of severe abdominal trauma patients. METHODS:A total of 60 severe abdominal trauma patients selected from our hospital during Sept. 2016-Jun. 2017 were divided into group A and B according to block randomization,with 30 cases in each group. Both groups were all given iso nitrogenous and iso caloric parenteral nutrition support on the basis of surgery and routine treatment after surgery;group A was additionally given 8.5％ Compound amino acid injection (18AA-Ⅱ)1.2 g/(kg·d)for 12 h each day at least;group B was additionally given 10％ Compound amino acid injection(20AA) 1.2 g/(kg·d)for 12 h each day at least. Both groups were treated for 7 d. The levels of nitrogen balance and serum protein(total protein,albumin,prealbumin and transferrin),plasma amino spectrum were observed in 2 groups before and after treatment. Hospitalization time,survival rate,the occurrence of complication and ADR were compared between 2 groups. RESULTS:Two patients of group A and one patient of group B were discharged,and totally of 57 patients completed the study. Before treatment, there was no statistical significance in the levels of nitrogen balance,serum protein or plasma amino spectrum (P>0.05). After treatment,the cumulative nitrogen balance of group B was significantly better than that of group A. The level of nitrogen balance was increased significantly in observation group 3-7 d after treatment and control group 5-7 d after treatment. Since 4 d after treatment,the level of nitrogen balance in group B was significantly better than control group,with statistical significance (P<0.05). The levels of albumin,prealbumin and transferring in group A were decreased significantly,and were significantly lower than group B, with statistical significance (P<0.05). The levels of glycine and threonine in 2 groups were increased significantly. The level of arginine in group B was decreased significantly, while the levels of valine and branched chainaimino acid were increased significantly;those indexes of group B were significantly lower or higher than those of group A respectively,with statistical significance(P<0.05). The incidence of gastrointestinal complications and disruption of wound,total incidence of complications in group B were significantly lower than group A,with statistical significance(P<0.05). There was no statistical significance in hospitalization time,survival rate or the incidence of infection between 2 groups (P>0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Compared to equilibrium amino acid,equilibrium amino acid rich in branched chain amino acid can further improve and maintain the nitrogen balance,the levels of serum protein and plasma amino acid of severe abdominal trauma patients after surgery with low incidence of complication.

Objective To evaluate the effects of dexmedetomidine on perioperative inflammatory response and cellular immune function in patients undergoing posterior lumbar interbody fusion. Methods Eighty American Society of Anesthesiologists physical statusⅠorⅡpatients of either sex, aged 40-60 yr, scheduled for elective posterior lumbar interbody fusion, were divided into dexmedetomidine group(group Dex)and control group(group C)using a random number table with 40 patients in each group. In group D, dexmedetomidine at a loading dose of 0.5 μg∕kg was intravenously infused starting from 10 min before anesthesia induction, followed by continuous infusion of 0.5 μg·kg-1·h-1until 15 min before the end of operation. The equal volume of normal saline was given at the same time points in group C. Before induc?tion, at 30 min after beginning of operation and at 1 h and 1, 3 and 5 days after the end of operation (T1?6), arterial blood samples were collected for determination of the plasma CD42a+∕CD14+ratio, HLA?DR+∕CD14+ratio, concentration of C?reactive protein(CRP)and white blood cell(WBC)count. Re?sults Compared with the baseline at T1, the plasma CD42a+∕CD14+ratio was significantly increased at T2?6, the HLA?DR+∕CD14+ratio was decreased at T3?6, the plasma CRP concentrations were increased at T4?6, and the WBC count was increased at T3?5in group C, and the plasma CD42a+∕CD14+ratio was signifi?cantly increased at T6, the HLA?DR+∕CD14+ratio was decreased at T3?5, and the plasma CRP concentra?tions were increased at T2?5in group D(P<0.05). Compared with group C, the plasma CD42a+∕CD14+ra?tio was significantly decreased at T2?4, the HLA?DR+∕CD14+ratio was increased at T4?5, and the plasma CRP concentrations and WBC count were decreased at T2?5in group D(P<0.05). Conclusion Dexme?detomidine can decrease perioperative inflammatory response and improve cellular immune function in the patients undergoing posterior lumbar interbody fusion.