BACKGROUND:One-hole split endoscope as a new type of endoscopic technique is suitable for the treatment of far lateral lumbar disc disease.However,there are few research data on L5/S1,which has a very low incidence of far lateral lumbar disc herniation at home and abroad,and there is no detailed image anatomical data describing the one-hole split endoscope treatment of L5/S1 far lateral lumbar disc herniation. OBJECTIVE:Through the three-dimensional image reconstruction,the bony landmarks were determined to accurately locate the positional relationship between the L5 outlet nerve root,the L5/S1 intervertebral space and other structures.One-hole split endoscope via posterolateral approach was used to accurately,safely and effectively decompress the L5 outlet nerve root and treat the L5/S1 far lateral lumbar disc herniation. METHODS:Twenty-nine patients with L5/S1 unilateral far lateral lumbar disc herniation who met the inclusion and exclusion criteria were selected,including 12 males and 17 females at the age of 48-74 years.The lumbar CT data of the patients were imported into Mimics 21.0 software to reconstruct the three-dimensional lumbar model.Measurement of L5/S1 related parameters:(1)Measurement on the sagittal plane at the intersection(H)of the lower edge of the transverse process and the lateral edge of the isthmus:The vertical distance between H and the upper and lower edges of L5 outlet nerve root(a1,a2);the vertical distance between H and the lower endplate of L5 and the upper endplate of S1(b1,b2);vertical distance from the lower edge of the pedicle from H to L5(c).(2)Horizontal distance between the left and right sides of the sagittal surface where the medial wall of the pedicle was located from H to L5(d).(3)The horizontal distance from H to the left and right side of the sagittal plane where the lateral margin of the dura was located(e).(4)Horizontal distance(f)between the left and right sides of the sagittal plane at the outermost edge of the lower endplate from H to L5.(5)Measurements were made on the sagittal plane where the outermost edge of the lower endplate of L5:The vertical distance between the cross section of H and the upper and lower edges of L5 outlet nerve root(g1,g2);vertical distance(h1,h2)between the transverse section of H and the lower endplate of L5 and the upper endplate of S1,respectively;(6)anteroposterior horizontal distance from H to L5 in the coronal plane where the last edge of the nerve root exits(i);(7)anteroposterior horizontal distance from the highest point of the posterior margin of the sacral wing to the last margin of the inferior endplate of L5 in the coronal plane(j). RESULTS AND CONCLUSION:(1)There was no significant difference in the relevant measurement parameters between men and women(P>0.05).(2)a1,a2,b1,b2,c,d,e,f,h1,h2,g1,g2,i,and j on the affected side were not significantly different from the healthy side(P>0.05).(3)There was no significant difference between a1 and c(P>0.05),indicating that the lower edge of the pedicle was the upper edge of the L5 outlet nerve root;the L5 outlet nerve root was close to the lower edge of the pedicle and ran anterolateral behind the L5 vertebral body,and H was located above the L5 outlet nerve root.(4)With H as the bony marker point,it was not necessary to probe upward or to remove the isthmus,but only to grind part of the bone downward and laterally to reveal the L5 outlet nerve root and vertebral space,and to have enough safe distance to avoid damage to the dural membrane to complete exploration and decompression of the lateral recess and foraminal region.(5)The surgeon could operate in the sagittal plane where the most lateral edge of the L5 inferior endplate was located,and in the"rectangular area"formed by the L5 transverse process and the sacral wing.The closer to the medial and inferior area(Kambin triangle),the safer the operation was.(6)It is suggested that using H as the bony landmark point to locate the L5 outlet nerve root and intervertebral space through one-hole split endoscope via posterolateral approach can achieve accurate,safe and effective decompression of L5/S1 far lateral lumbar disc herniation.

BACKGROUND:One-hole split endoscope technique has been widely used in the treatment of lumbar degenerative diseases,but there is no relevant literature on the safety analysis of this technique in the treatment of upper lumbar disc herniation. OBJECTIVE:To observe the position relationship of nerve roots,intervertebral space and bone landmarks in the upper lumbar spine by three-dimensional lumbar CT reconstruction technology,and to provide a basis for the clinical operation of one-hole split endoscope surgery. METHODS:Twenty-six patients with upper lumbar disc herniation underwent a lumbar CT scan.Mimics 17.0 software was imported to measure the related imaging parameters of L1/2 to L3/4 segments:(1)Measurement of vertical distance:In coronal view,the distance(a)from the intersection point of the medial facet of the superior articular process and the superior endplate(N)to the apex of the articular process(S);in the coronal view,the distance(b)from the sagittal intersection(M)of N and the inferior endplate to the apex of the inferior articular process(X).(2)Measured horizontal distance:the distance(c)between the cross-section of N and the lower edge of the outlet nerve root(N2);distance(d)between the cross-section of N and the intersection point of neural tissue(N1);N1 to N2 distance(e);distance(f)between the cross-section of M and the lateral edge of the nerve tissue(M1);M to M cross-section and exit nerve root intersection(M2)distance(g);distance(h)from M1 to M2;distance(i)from M2 to N1;distance(j)from the posterior edge of the articular surface(R)to M2 in sagittal view of the superior articular process. RESULTS AND CONCLUSION:(1)With the decrease of the segment,the distances a and b gradually increased,and the distance j gradually decreased.There was no significant difference between L1/2 and L2/3 segments(P>0.05).(2)With the decrease of the segment,distance d first decreased and then increased;distance f gradually decreased;distances c,e,g,h and i gradually increased;and there was no significant difference between L2/3 and L3/4 segments(P>0.05).(3)Distance i was the shortest distance without pulling nerve roots in the natural state,and the area of the safety zone was between four points M1,M2,N1,and N2.The bone was removed to the upper and lower endplates by biting the bone downward and upward through S and X,respectively,to expose the intervertebral space,and the window of distance g to M2 could be opened outward to avoid injury of the outlet nerve roots.(4)In conclusion,the upper lumbar vertebrae have unique anatomical characteristics.Based on the relevant measurements of nerve roots,spinal dura and intervertebral space,the parameters of the one-hole split endoscope technique are more accurate and safe during operation.

OBJECTIVE: To compare the effectiveness of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope (OSE) and traditional posterior lumbar interbody fusion (PLIF) in the treatment of L_{4, 5} degenerative lumbar spondylolisthesis (DLS). METHODS: The clinical data of 58 patients with DLS who met the selection criteria admitted between February 2020 and March 2022 were retrospectively analyzed, of which 26 were treated with OSE-assisted posterolateral approach lumbar interbody fusion (OSE group) and 32 were treated with PLIF (PLIF group). There was no significant difference between the two groups in terms of gender, age, body mass index, Meyerding grade, lower limb symptom side, decompression side, stenosis type, and preoperative low back pain visual analogue scale (VAS) score, leg pain VAS score, Oswestry disability index (ODI), and the height of the anterior and posterior margins of the intervertebral space (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were compared between the two groups. The low back pain and leg pain VAS scores and ODI before operation, at 1 month, 6 months after operation, and last follow-up, the height of anterior and posterior margins of the intervertebral space before operation, at 6 months after operation, and last follow-up, the modified MacNab criteria at last follow-up after operation were used to evaluate the effectiveness; and the Bridwell method at last follow-up was used to evaluate the interbody fusion. RESULTS: Both groups successfully completed the operation. Compared with the PLIF group, the OSE group showed a decrease in intraoperative blood loss and postoperative hospital stay, but an increase in operation time, with significant differences (P<0.05). In the OSE group, no complication such as nerve root injury and thecal sac tear occurred; in the PLIF group, there were 1 case of thecal sac tear and 1 case of epidural hematoma, which were cured after conservative management. Both groups of patients were followed up 13-20 months with an average of 15.5 months. There was no complication such as loosening, sinking, or displacement of the fusion cage. The low back pain and leg pain VAS scores, ODI, and the height of anterior and posterior margins of the intervertebral space at each time point after operation in both groups were significantly improved when compared with those before operation (P<0.05). Except for the VAS score of lower back pain in the OSE group being significantly better than that in the PLIF group at 1 month after operation (P<0.05), there was no significant difference in all indicators between the two groups at all other time points (P>0.05). At last follow-up, both groups achieved bone fusion, and there was no significant difference in Bridwell interbody fusion and modified MacNab standard evaluation between the two groups (P>0.05). CONCLUSION OSE-assisted posterolateral approach lumbar interbody fusion for L_{4, 5} DLS, although the operation time is relatively long, but the postoperative hospitalization stay is short, the complications are few, the operation is safe and effective, and the early effectiveness is satisfactory.
Humans ; Spondylolisthesis/surgery* ; Low Back Pain/surgery* ; Retrospective Studies ; Lumbosacral Region ; Blood Loss, Surgical ; Endoscopes

OBJECTIVE: To explore the effect of telmisartan on the expression of metadherin in the kidney of mice with unilateral ureter obstruction. METHODS: Eighteen male C57 mice were randomized into sham-operated group, model group and telmisartan treatment group. In the latter two groups, renal interstitial fibrosis as the result of unilateral ureter obstruction (UUO) was induced by unilateral ureteral ligation with or without telmisartan intervention. Renal pathological changes of the mice were assessed using Masson staining, and immunohistochemistry and Western blotting were used to detect the expression of extracellular matrix proteins and metadherin in the kidney of the mice. In the experiment, cultured mouse renal tubular epithelial cells (mTECs) were stimulated with transforming growth factor-β1 (TGF-β1) and transfected with a siRNA targeting metadherin, and the changes in the expressions of extracellular matrix proteins and metadherin were detected using Western blotting. RESULTS: The expressions of extracellular matrix proteins and metadherin increased significantly in the kidney of mice with UUO ( < 0.05). Intervention with telmisartan significantly lowered the expressions of extracellular matrix proteins and metadherin and alleviated the pathology of renal fibrosis in mice with UUO ( < 0.05). In cultured mTECs, siRNA-mediated knockdown of metadherin obviously reversed TGF-β1-induced increase in the expressions of extracellular matrix proteins and metadherin. CONCLUSIONS Telmisartan can suppress the production of extracellular matrix proteins and the expression of metadhein to attenuate UUO-induced renal fibrosis in mice.
Angiotensin II Type 1 Receptor Blockers ; Animals ; Antihypertensive Agents ; Extracellular Matrix Proteins ; metabolism ; Fibrosis ; Kidney ; drug effects ; metabolism ; pathology ; Male ; Membrane Proteins ; genetics ; metabolism ; Mice ; Mice, Inbred C57BL ; RNA, Small Interfering ; Random Allocation ; Telmisartan ; pharmacology ; Transforming Growth Factor beta1 ; pharmacology ; Ureteral Obstruction ; complications ; metabolism

OBJECTIVE:To excavate the drug use rules of type 2 diabetes,and to provide reference for clinical treatment. METHODS:Clinical data of 807 patients with type 2 diabetes were collected from our hospital during Jan. 2012-Jun. 2017. Complex network and subnetworks for drug compatibility and their visual chromatograms were established by Gephi 0.9.1 software. MATLAB R2014a software was used for topic model mining. The complex network,subnetworks and the overlapping structures of community were analyzed in respects of node distance and degree centrality. Core drugs for type 2 diabetes were screened. RESULTS & CONCLUSIONS:The drug complication complex network established in the study included 119 nodes and 24 412 edges with maximum edge weight of 378. Drugs with high frequency included Insulin aspart injection,Fluvastatin sodium extended release tablets,Metformin hydrochloride tablets,Acarbose tablets,etc. Average distance of network was 1.89,and maximum distance was 4. The distance of 89.90% drugs was 1 or 2,and the links between the various drugs were close. Insulin aspart injection(0.914),Metformin hydrochloride tablets(0.887)and Voglibose tablets(0.866)were core drugs of the network. Totally 4 typical topics were excavated, including peripheral neuropathy, peripheral vascular disease, abnormal lipid metabolism and microangiopathy. Results of subnetwork analysis showed that typical topics were based on hypoglycemic therapy and supplemented by neurotrophic drugs,antihypertensive drugs,lipid regulating drugs and drugs for improvement of retinopathy. Complex network analysis showed that drug use regularity was in line with related guideline of type 2 diabetes and clinical practice. The method has practical significance of data mining in clinic.

Methotrexate (MTX)has dual effects of anti-inflam-matory and immune suppression,and its pharmacological mecha-nism is complex,diverse and synergistic.This paper summari-zes the main anti-inflammatory mechanism of low-dose MTX,in-cluding inhibition of JAK/STAT pathway,inhibition of inflam-matory reaction and immune response,increasing the accumula-tion of adenosine and the function of intracellular metabolites (methotrexate polyglutamate).In addition,low-dose MTX can inhibit oxidation by decreasing the level of lipid peroxidation, suppress the inflammatory response to secondary spinal cord in-jury,reduce spinal cord ischemia reperfusion injury and neuro-pathic pain,thus playing a neuroprotective role by a series of pharmacological mechanism.The anti-inflammatory mechanism of low-dose MTX and its application in spinal cord injury were reviewed,to guide the further research on the anti-inflammatory effect of MTX,and provide a theoretical basis for new drugs for clinical treatment of spinal cord injury.

OBJECTIVE:To observe therapeutic efficacy and safety of applying dexamethasone+docetaxel+cisplatin+fluoroura-cil(DCF)regimen induction chemotherapy before Ⅲ-Ⅳ stage oral squamous cell carcinoma resection. METHODS:A total of 120 patients with Ⅲ-Ⅳ stage oral squamous cell carcinoma were randomly divided into control group(60 cases)and observation group (60 cases). Both groups were given oral cancer resection,control group received radiotherapy 4-6 weeks after surgery,observation group was additionally given Dexamethasone acetate tablets 0.75 mg orally once a day,d1-7+Docetaxel injection 80 mg/m2 added in-to 0.9% Sodium chloride solution 250 mL intravenously for 2 h,d2+Cisplatin injection 80 mg/m2 added into 0.9% Sodium chloride solution 250 mL intravenously for 1 h,d2+Fluorouracil injection 750 mg/m2 added into 0.9% Sodium chloride solution 500 mL in-travenously,d2-5. Treatment course of 2 groups lasted for 7 d. Clinical efficacies of 2 groups were observed as well as EORTC QLQ-C30 score before and after treatment,recurrence rate 12,24,36 months and the occurrence of ADR. RESULTS:The short-term total response rate of observation group was significantly higher than that of control group;12,24,36 months fol-low-up recurrence rate of observation group were significant lower than those of control group;the incidence ofⅠ-Ⅱ degree nausea and vomiting,leucopenia in observation group were significantly higher than control group,with statistical significance (P<0.05);there was no statistical significance in the incidence of Ⅲ-Ⅳ degree nausea and vomiting,leucopenia andⅠ-Ⅱ,Ⅲ-Ⅳ de-gree diarrhea between 2 groups (P>0.05). Before treatment,there was no statistical significance in EORTC QLQ-C30 score be-tween 2 groups(P>0.05). After treatment,EORTC QLQ-C30 score of 2 groups were significantly lower than before,with statisti-cal significance (P<0.05),but there was no statistical significance between 2 groups (P>0.05). CONCLUSIONS:The applying of DCF regimen induction chemotherapy can improve short-term efficacy before Ⅲ-Ⅳ stage oral squamous cell carcinoma resec-tion,reduce reoccurrence risk but induce high incidence ofⅠ-Ⅱ degree nausea and vomiting,leucopenia.

OBJECTIVE:To explore the application of topic model in the study of type 2 diabetes treatment plan. METHODS:Clinical data of 650 inpatients with type 2 diabetes in our hospital during Jan. 2012-Jun. 2016 were analyzed retrospectively. The data of clinical diagnosis,lab indexes and clinical drug use were exchanged,summarized and merged by MATLAB R2014a software. Latent Dirichlet allocation and author topic model were adopted to extract the typical topics with topic probability value>0.1,and the topics was described by the complications with cumulative probability value>0.5. RESULTS:A total of 62 complications words,16 abnormal laboratory indexes groups and 20 treatment plans were obtained. A total of 4 typical topics were excavated(cumulative probability values for the first few complications were 0.8786,0.8247,0.8215,0.7536;topic probability value were 0.3364,0.2773,0.2035,0.1176,respectively) and were mainly characterized by peripheral neuropathy,peripheral vascular disease,abnormal lipid metabolism and microvascular lesions;abnormal lab indexes groups met the above characteristics. The complications with high distribution rate included diabetic peripheral neuropathy (0.5787), hypertension (0.3631),atherosclerosis (0.2789),hyperlipidemia (0.4578) and diabetic retinopathy (0.3143);main drugs included Insulin aspart injection,Insulin injection,Methylcobalamin dispersible tablets,etc. CONCLUSIONS:The complications of type 2 diabetes are characterized by peripheral neuropathy,peripheral vascular disease,abnormal lipid metabolism and microvascular lesions. The medication rules with clinical significance can be extracted from the clinical data by topic model.

4-Hydroxybenzoate (4HBA) is an important chemical compound used for synthesis of liquid crystal. Production of 4HBA from renewable resources is an effective mean to solve problems such as environmental pollution and petroleum shortage. This review briefly introduces the chemical synthesis of 4HBA from oil compounds, and mainly describes the progress in 4HBA biosynthesis from renewable resources by plants and microorganisms. In most intriguing aspect of plant-based synthesis of 4HBA is the appeal of directly synthesizing a chemical from CO2. However, the glucosylation system in plant cells converting 4HBA to glucose conjugates, causing the post treatment a problem. The recombinant microorganisms produce pure 4HBA, but less efficient. A new strain of Microbulbifer has ability to naturally accumulate 4HBA from glucose. Elucidation of the metabolic pathways and regulation systems would improve 4HBA synthesis efficiency.
Alteromonadaceae ; metabolism ; Glucose ; chemistry ; Glycosylation ; Industrial Microbiology ; Metabolic Networks and Pathways ; Parabens ; metabolism ; Plants ; metabolism

BACKGROUND:Studies have shown that umbilical cord blood stem cel transplantation promote the recovery of spinal cord injury, and electroacupuncture also can inhibit the proliferation of astrocytes to reduce damage to scar formation, suggesting that a combination of umbilical cord blood stem cel transplantation and electroacupuncture may play an important role in the treatment of acute spinal cord injuries. OBJECTIVE:To observe the influence of transplantation of human umbilical cord blood stem cels combined with electroacupuncture at theDu channel on expression of nerve growth factor and neurotrophin 3 in rats with spinal cord injuries. METHODS: Seventy-two female Sprague-Dawlay rats were randomly divided into control group, injury group, transplantation group and combined therapy group. In the control group, only an incision on the back was sutured;in the injury group, a piece of saline-infiltrated gelatin sponge, 1 mm×2 mm×2 mm, was placed into the transected spinal cord at T10 level; in the transplantation group and combined therapy group, a piece of gelatin sponged infiltrated in the suspension of human umbilical cord blood stem cels was placed into the transected spinal cord, respectively, and then, electroacupuncture stimulation at the Duchannel was performed in the combined therapy group at 1 hour after modeling. Specimens were taken at 7, 14, 28 days after modeling in each group, and then immunohistochemistry, western blot and real time-PCR methods were used to detect the expression of nerve growth factor and neurotrophin 3. RESULTS AND CONCLUSION:Compared with the transplantation group, the expression of nerve growth factor and neurotrophin 3 was lower in the injury group but higher in the combined therapy group at 7, 14, 28 days after modeling (P < 0.05). The results of western blot and real time-PCR were consistent with those of immunohistochemical detection. Findings show that human umbilical cord blood stem cel transplantation combined with electroacupuncture has a remarkable synergistic effect in the treatment of spinal cord injury that can significantly up-regulate the expression of nerve growth factor and neurotrophin 3, and contribute to injured spinal cord repair, regeneration and functional recovery after spinal cord injury.