BACKGROUND:Traditional surgery for lumbar disc herniation involves extensive excision of tissue surrounding the nerve for decompression and removal of protruding lumbar intervertebral discs,which poses various risks and complications such as nerve damage causing paralysis,lumbar instability,herniation recurrence,intervertebral space infection,and adjacent vertebral diseases. OBJECTIVE:To propose the symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous technique for lumbar spine symmetrically decompression,showing the induced resorption of herniated nucleus pulpous phenomenon and early clinical efficacy,and then analyze its decompression mechanism. METHODS:214 patients with lumbar disc herniation at Department of Orthopedics,First Affiliated Hospital of Zhengzhou University from March 2021 to May 2023 were enrolled in this study.Among them,81 patients received conservative treatment as the control group,and 133 patients received symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous treatment as the trial group.Before surgery,immediately after surgery(7-14 days),and early after surgery(over 1 year),MRI images were used to measure the volume changes of lumbar disc herniation.CT images were used to measure the posterior displacement distance of the lumbar spinous process ligament complex,as well as the width and height of the lateral recess.Japanese Orthopaedic Association scores were used to evaluate the patient's neurological function recovery. RESULTS AND CONCLUSION:(1)Control group:81 patients with lumbar disc herniation were treated conservatively,with a total of 171 herniated lumbar discs.The average follow-up time was(22.7±23.1)months.The first and second MRI measurements of 171 herniated lumbar discs showed herniated lumbar disc volumes of(551.6±257.9)mm3 and(792.2±330.4)mm3,respectively,with an average volume increase rate of(53.2±44.4)%,showing statistically significant differences(P<0.001).Out of 171 herniated lumbar discs,4 experienced natural shrinkage,with an absorption ratio of 2.3%(4/171)and an absorption rate of(24.5±9.9)%.(2)Trial group:133 patients with lumbar disc herniation had a total of 285 herniated lumbar discs.(1)Immediately after surgery:All patients were followed up immediately after surgery.229 out of 285 herniated lumbar discs experienced retraction,with an absorption ratio of 80.3%(229/285)and an average absorption rate of(21.5±20.9)%,with significant and complete absorption accounting for 6.5%.There were a total of 70 herniated lumbar discs in the upper lumbar spine,with an absorption ratio of 85.7%(60/70),an average absorption rate of(23.1±19.5)%,and a maximum absorption rate of 86.6%.There were 215 herniated lumbar discs in the lower lumbar spine,with an absorption ratio of 78.6%(169/215),an average absorption rate of(21.0±21.3)%,and a maximum absorption rate of 83.2%.Significant and complete absorption of the upper and lower lumbar vertebrae accounted for 5.7%and 6.5%,respectively,with no statistically significant difference(P>0.05).The average distance of posterior displacement of the spinous process ligament complex immediately after surgery was(5.2±2.8)mm.There were no significant differences in the width and height of the left and right lateral recess before and immediately after surgery(P>0.05).The Japanese Orthopaedic Association score immediately after surgery increased from(10.1±3.4)before surgery to(17.0±4.8),and the immediate effective rate after surgery reached 95.6%.(2)Early postoperative period:Among them,46 patients completed the early postoperative follow-up.There were 101 herniated lumbar discs,with an absorption ratio of 94%(95/101)and an average absorption rate of(36.9±23.7)%.Significant and complete absorption accounted for 30.6%,with a maximum absorption rate of 100%.Out of 101 herniated lumbar discs,3 remained unchanged in volume,with a volume invariance rate of 2.97%(3/101).Out of 101 herniated lumbar discs,3 had an increased volume of herniated lumbar discs,with an increase ratio of 2.97%(3/101)and an increase rate of(18.5±18.4)%.The Japanese Orthopaedic Association score increased from preoperative(9.3±5.1)to(23.5±4.0),with an excellent and good rate of 93.4%.(3)The early postoperative lumbar disc herniation absorption ratios of the control group and trial group were 2.3%and 85.9%,respectively,with statistically significant differences(P<0.001).(4)Complications:There were two cases of incision exudation and delayed healing in the trial group.After conservative treatment such as dressing change,no nerve injury or death occurred in the incision healing,and no cases underwent a second surgery.(5)It is concluded that symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous is a new method for treating lumbar disc herniation that can avoid extensive excision of the"ring"nerve and achieve satisfactory early clinical efficacy.It does not damage the lumbar facet joints or alter the basic anatomical structure of the lateral recess,fully preserves the herniated lumbar discs,and can induce significant or even complete induced resorption of herniated nucleus pulpous.Symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous provides a new basis and method for the clinical treatment of lumbar disc herniation.

Health technology assessment(HTA)is an important tool to inform health decision-making.Although highly related to ethical issues in the context of HTA,equity has attracted much attention from the academia,a consensus has not yet been reached on how to define and evaluate equity in China and abroad.It introduces the concept of equity,pointes out the necessity to realize health equity and the reflection of equity in healthcare sector,and further elaborates four ways to consider equity,and described the official practice of equity in HTA at home and abroad.It proposes several suggestions for China's HTA:considering equity in HTA and the discussion of equity should depend on specific decision-making scenarios;clarifying what health measurement perspective should be adopted before measuring health equity;paying attention to the value judgment of equity adopted by various stakeholders;conducting basic researches on the general population's preference for health measurement perspectives and value judgments of equity in China in a gesture to improve the evaluation system of equity in HTA.

The payment methods,such as Diagnosis Related Group(DRG)for hospitalization and capitation for outpatient treat-ment,have achieved positive results in protecting the rights and interests of insured persons and improving the efficiency of the use of medical insurance funds.However,for patients with chronic diseases and rehabilitation nursing,the hospitalization period is long and the conditions complicated,and the payment method of DRGs is not reasonable.It analyzes the experiences of paying for long-term hospital cases in the US.and Germany from the aspect of reform process,payment method and regulatory measures.In order to pro-vide references for the reform of per-diem payment in rehabilitation nursing and other long-term hospitalized cases,it puts forward suggestions from aspects of realizing value care,reflecting individual differences,exploring complex payment methods,improving data quality and establishing constraint mechanism.

Objective To investigate the correlation between uterine globulin associated protein 1(UGRP1)and Fas mediated apoptosis pathway in hashimoto thyroiditis(HT).Methods The expression of UGRP1 in thyroid cells of normal people and HT patients was detected by immunohistochemistry(IHC).FRTL-5 cells were transfect-ed by plasmids in vitro,and control group,UGRP1 group,Fas group were established respectively.Real-time fluo-rescent quantitative reverse transcription PCR(RT-qPCR)was used to detect the expression of Fas and UGRP1 mRNA in each group.Results UGRP1 expression was positive in thyroid cells of HT patients and negative in that of normal people.There were no significant differences between control group and UGRP1 group in Fas gene ex-pression(1.085 0±0.124 9 vs 1.021 0±0.113 9).Compared with the control group,the expression of UGRP1 gene increased significantly in Fas group(P＜0.000 1,5.807 0±0.323 2 vs 0.752 7±0.076 0).Conclusion The high expression of UGRP1 in HT may be related to apoptosis pathway mediated by Fas.

Objective To compare the efficacy of three different methods in the prevention of adhesion after the HEOS system for different degrees of intrauterine adhesions.Methods 284 patients with mild,moderate and severe intrauterine adhesions,who were treated with the HEOS system,were divided into three groups,the intrauterine device with sodium hyaluronate gel was placed in Group A,Foley water capsule tube with sodium hyaluronate gel was placed in Group B,and sodium hyaluronate gel was placed in Group C only.The recovery of uterine adhesion,improvement of menstruation,endometrial thickness,and adverse reactions were compared among the three groups.Results The mild intrauterine adhesions group showed statistical differences among the three groups(P<0.05).Group A had a higher menstrual improvement rate than Group C(P<0.017),and there was no significant difference in other therapeutic indicators(P>0.017).However,the adverse reaction rate in Group A was also higher than that in Group C(P<0.017).In the moderate intrauterine group,there was a significant difference in the improvement rate of intrauterine adhesions between Group B and the other two groups(P<0.017).Group A and B were higher than Group C in terms of menstrual status,endometrial thickness,and adverse reactions(P<0.017).In severe intrauterine adhesions,Group A had higher efficacy indicators than other groups(P<0.017).Conclusions The curative effect index and adverse reaction rate were analyzed,after operation.For the light,moderate,and severe intrauterine adhesions,sodium hyaluronate gel,Foley water capsule tube with sodium hyaluronate gel,and intrauterine device with sodium hyaluronate gel were the best choice for adhesion.Individual and hierarchical management can achieve good clinical effects,which is worth popularizing.

Objective To compare the safety and comfort of patients with or without postoperative gastric tube placement after esophageal cancer surgery, and analyze the cost and nursing time of gastric tube placement. Methods The patients with esophageal cancer undergoing minimally invasive surgery in West China Hospital of Sichuan University in 2021 were enrolled. The patients were divided into a gastric tube indwelling group and a non gastric tube indwelling group according to whether the gastric tube was indwelled after the operation. The safety and comfort indicators of the two groups were compared. Results A total of 130 patients were enrolled. There were 66 patients in the gastric tube indwelling group, including 53 males and 13 females, aged 61.80±9.05 years and 64 patients in the non gastric tube indwelling group, including 55 males and 9 females, aged 64.47±8.00 years. Six patients in the non gastric tube indwelling group needed to place gastric tube 1 to 3 days after the operation due to their condition. There was no statistical difference in the incidence of postoperative complications between the two groups (P>0.05). The subjective comfort of patients in the gastric tube indwelling group was significantly lower than that in the non gastric tube indwelling group (P<0.001), and the incidence of foreign body sensation in the throat of patients in the gastric tube indwelling group was higher than that in the non gastric tube indwelling group (P<0.001). The average nursing time in the gastric tube indwelling group was about 59.58 minutes, and the average cost of gastric tube materials and nursing was 378.24 yuan per patient. Conclusion No gastric tube used after operation for appropriate esophageal cancer patients will not increase the incidence of postoperative complications (pulmonary infection, anastomotic leakage, chylothorax), but can increase the comfort of patients, save cost and reduce nursing workload, which is safe, feasible and economical.

Objective To observe the clinical efficacy of Guishao Liujunzi Decoction combined with traditional Chinese medicine(TCM)mouthrinse in the treatment of helicobacter pylori(Hp)associated gastritis,and its effect on the Hp conversion rate.Methods Eighty patients with Hp-related gastritis were selected and randomly divided into the control group(standard quadruple therapy)and the treatment group(standard quadruple therapy combined with Guishao Liujunzi Decoction and TCM mouthrinse),with 40 patients in each group.The clinical efficacy,TCM syndrome scores,and Hp conversion rate of the two groups were observed.Results The total effective rate of the treatment group(95%)was higher than that of the control group(72.5%)(P<0.05).The Hp conversion rate in the treatment group(90%)was higher than that in the control group(72.5%)(P<0.05).After treatment,the main symptom scores and total scores of the two groups decreased compared to before treatment,and the treatment group was lower than the control group(P<0.05).Conclusion The combination of modified Guishao Liujunzi decoction and TCM mouthrinse in the treatment of Hp-related gastritis can significantly improve clinical efficacy and Hp negative conversion rate compared to conventional treatment.

BACKGROUND:Mechanical stimulation has been confirmed to promote osteogenic differentiation of bone marrow stromal stem cells,but the mechanism is unknown.Primary cilia are important mechanoreceptors and regulate various signaling pathways such as TGF-β1/BMP-2/SMAD.They are likely to be important targets for mechanical regulation of bone marrow stromal stem cells. OBJECTIVE:To investigate the effect and mechanism of fluid shear stress on osteogenic differentiation of bone marrow stromal stem cells. METHODS:Rat bone marrow stromal stem cells were divided into control group,mechanical stimulation group(fluid shear mechanics intervention by shaking table),mechanical stimulation + IFT88 silencing group(mechanical stimulation + silencing IFT88 expression with siRNA).After 24 hours of intervention,qRT-PCR was utilized to determine the expression of transforming growth factor β1 and bone morphogenetic protein 2.Western blot assay was used to detect the expression of phosphorylated SMAD2/3 protein.Immunofluorescent staining of primary cilia was conducted and morphology was analyzed. RESULTS AND CONCLUSION:Shear stress stimulation could promote the transcriptional activity of transforming growth factor β1 and bone morphogenetic protein 2 genes,and increase the expression of phosphorylated SMAD2/3 protein.After siRNA interfered with primary cilia,this mechanical response effect was significantly reduced.There was a Spearman correlation between the change ratio of the primary cilium area of bone marrow stromal stem cells and the increased ratio of transforming growth factor β1 and bone morphogenetic protein 2 gene transcription.These findings indicate that primary cilia/intraflagellar transport mediates the activation of fluid shear stress-responsive transforming growth factor β1/bone morphogenetic protein 2/SMAD signaling pathway and promotes osteogenic differentiation of bone marrow stromal stem cells.

Objective:To investigate the relationship between body mass index (BMI) and gestational hypertension using two-sample Mendelian randomization analysis.Methods:The summary level data for BMI and gestational hypertension were obtained from the genome-wide association study (the deadline for data inclusion was October 31, 2023). All data were analyzed by inverse variance weighting, MR-Egger regression, weighted median, simple model and weighted model methods. Cochrane Q test was used to evaluate heterogeneity, MR-Egger regression intercept test and funnel plot were used to assess horizontal pleiotropy. Results:Inverse variance weighting result under fixed effects and random effects models showed that the risk of gestational hypertension increased with the increase of BMI ( OR = 1.62 and 1.62, 95% CI 1.39 to 1.88 and 1.39 to 1.88, P<0.01). Sensitivity analysis results including MR-Egger regression, weighted median and weighted model methods showed that BMI increased the risk of gestational hypertension ( OR = 1.51, 1.56 and 1.71; 95% CI 1.01 to 2.26, 1.23 to 1.99 and 1.09 to 2.69; P<0.05 or <0.01). Although Cochrane Q test result showed evidence of heterogeneity ( P = 0.04), inverse variance weighting under a random model suggested that BMI increased the risk of gestational hypertension. Horizontal pleiotropy was not observed in the above analysis ( P = 0.73). Conclusions:Obesity may increase the risk of gestational hypertension. Pregnant women should pay attention to weight control to decrease the risk of gestational hypertension.

Objective To explore the efficacy and safety of evolocumab in elderly patients with high-risk cardiovascular diseases.Methods A total of 153 patients with poor lipid control after conventional statin therapy who were hospitalized in the cardiologic departments in the First,Sec-ond,Sixth and Eighth Medical Centers of Chinese PLA General Hospital from November 2019 to November 2022 were included,and divided into non-elderly group(＜60 years old,46 cases),eld-erly group(60-74 years old,66 case)and very elderly group(≥75 years old,41 cases).They were all given evolocumab treatment according to guidelines.Another 50 over-75-year-old patients with high-risk cardiovascular diseases and poor lipid control who were hospitalized in the above cardiologic departments during the same period were treated with a statin drug combined with ezetimibe,and served as conventional treatment group(control group).The baseline clinical data and the blood indicators at 4th and 12th week after drug administration,and the occurrence of ad-verse drug reactions and major adverse cardiovascular events(MACE)within 12 weeks were com-pared among the groups.Results The levels of LDL-C and TC were significantly decreased in the three evolocumab treatment groups at 4 and 12 weeks after medication when compared with the baseline values(P＜0.05,P＜0.01),but there were no obvious differences in the 2 levels among the 3 groups at 12 weeks(P＞0.05).At the time point,no statistical difference was observed in the incidence of adverse events in the three groups(2.2％vs 3.0％vs 2.4％,P＞0.05).The levels of LDL-C and TC were decreased significantly in the very elderly group and the conventional treatment group at the 12th week when compared with the baseline levels(P＜0.05,P＜0.01),and the LDL-C level at the week was notably lower in the very elderly group than the convention-al treatment group(1.36±0.44 mmol/L vs 1.87±0.56 mmol/L,P＜0.01).But no difference was seen in the incidence of MACE between the 2 groups(12.2％vs 16.0％,P＞0.05),either in sur-vival rate between them(P=0.576).Conclusion For patients of all ages,evolocumab has good short-term efficacy in lipid control,and for those over 75 years old,the drug also shows good effi-cacy and sound safety.