OBJECTIVEThis study investigated the thrombolitic effect of Tianma Xinnao capsule and its preliminary mechanism, as well as the effect on coagulation system.

METHODCharlton's and Tomihisa's methods were modified to investigate the thrombolytic effect of Tianma Xinnao capsule. The activities of type 1 plasminogen activator inhibitor (PAI-1) and tissue-type plasminogen activator (tPA) in rabbit plasma were assayed by use of ELISA. The effects of Tianma Xinnao capsule were also evaluated on euglobulin lysis time (ELT), prothrombin time (PT), kaolin partial thromboplastin time (KPTT), thrombin time (TT), fibrinogen (Fib) and hemorheology.

RESULTThe results showed that Tianma Xinnao capsule had a dose-dependent thrombolytic effect in rats. Tianma Xinnao capsule at 0.6 and 1.2 g x kg(-1) produced 40% and 50% of reperfusion rate, while obtained 50% and 40% of reocclusion rate; 0.3 g x kg(-1) of Tianma Xinnao capsule, however, had no effect on the reperfusion or reocclusion rate. Tianma Xinnao capsule significantly inhibited PAI-1 activity, while elevated tPA activity in rabbit plasma. Tianma Xinnao capsule markedly prolonged ELT, PT, and KPTT, and decreased Fib level. Tianma Xinnao capsule showed no significant influence on TT or high, medium, or low sheering viscosity.

CONCLUSIONIt is indicated that Tianma Xinnao capsule inhibited PAI-1 activity and increased tPA activity, and this property of Tianma Xinnao capsule is assigned to be responsible for the thrombolytic effect.

Animals ; Blood Coagulation ; drug effects ; Blood Viscosity ; drug effects ; Capsules ; Dose-Response Relationship, Drug ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Male ; Plasminogen Activator Inhibitor 1 ; metabolism ; Rabbits ; Rats ; Thrombosis ; blood ; drug therapy ; metabolism ; Tissue Plasminogen Activator ; metabolism

Objective:To compare the clinical efficacy of two-dimensional (2D) fluoroscopic guided robot-assisted and conventional TESSYS surgery in the treatment of lumbar disc herniation, the feasibility and precautions of 2D fluoroscopic guided robot-assisted TESSYS surgery were discussed.Methods:A retrospective analysis was performed on 34 male and 36 female patients aged 44.57±6.10 years (range 27 to 60 years) who received 2D guided robot-assisted TESSYS surgery and conventional TESSYS surgery from July 2019 to April 2020. 2D guided robot assisted TESSYS surgery group (the robot group) 32 cases, conventional TESSYS surgery (the conventional group) 38 cases. The number of puncture, number of fluoroscopy, puncture-channel time, operation time, visual analogue scale (VAS) and Oswestry disability index (ODI) before and after surgery and at the last follow-up were compared between the two groups to verify the clinical efficacy, and the complications were analyzed.Results:There were no significant differences in age, gender, body mass index, surgical level, Michigan State University (MSU) grading and average follow-up time between the robot group and the conventional group (all P>0.05). All patients completed surgery. The number of puncture times was 1.22±0.79 in the robot group and 4.66±1.86 in the conventional group, and the difference was statistically significant ( t=10.320, P<0.001). The number of fluoroscopy in the robot group was 10.97±1.96 times, and that in the conventional group was 17.45±4.30 times, the difference was statistically significant ( t=8.313, P<0.001). The puncture-channel time of the robot group was 10.66±3.62 min and that of the conventional group was 20.21±5.47 min, and the difference was statistically significant ( t=8.446, P<0.001). The operation time of the robot group was 62.25±6.68 min, and that of the conventional group was 72.89±10.48 min, the difference was statistically significant ( t=4.956, P<0.001). VAS scores of the robot group were 6.91±0.93 points before surgery, 2.97±0.65 points 1 d after surgery, and 1.53±0.51 points at the last follow-up, while those of the conventional group were 7.29±1.14 points before surgery, 2.89±0.56 points 1 d after surgery, and 1.42±0.50 points at the last follow-up. The ODI index of the robot group was 40.13%±1.54% before surgery, 17.28%±1.69% 1 day after surgery, and 10.84%±1.25% at the last follow-up, while that of the conventional group was 40.03%±1.46% before surgery, 17.42%±2.45% 1 day after surgery, and 10.92%±1.17% at the last follow-up. There were no statistically significant differences (all P>0.05). Two patients (6.3%) in the robot group and four (10.5%) in the conventional group had residual disc, there was no significant difference ( P>0.05). Conclusion:2D guided robot assisted TESSYS surgical treatment of lumbar disc herniation, which can plan puncture path in the stage of percutaneous target puncture, rigid guidance and accurate puncture target, and has obvious advantages in reducing puncture times and fluoroscopy times.