Objective:To investigate the clinical significance and inducing factors of abnormal intraoperative neurophysiological monitoring (IONM) signals during surgery for cervical degenerative diseases.Methods:A retrospective analysis was performed on 586 patients who underwent cervical degenerative disease surgery with IONM at the Department of Orthopedics, The First Affiliated Hospital of Soochow University, from April 2015 to April 2024. Surgical approaches included 380 anterior spinal canal decompression and fusion procedures, 154 posterior spinal canal decompression and fusion procedures (including single-door laminoplasty, total laminectomy, and hemilaminectomy), and 52 combined anterior-posterior surgeries. The multimodal IONM protocol employed transcranial electrical stimulation motor evoked potentials (TES-MEP) and cortical somatosensory evoked potentials (CSEP), combined with electromyography (EMG). Bilateral deltoid muscles, thenar/hypothenar muscles and abductor hallucis muscles were monitored in all patients. Intraoperative MEP, SEP, and EMG results were recorded to analyze the causes of abnormal signals, intraoperative response strategies, and postoperative neurological function and outcomes. Fourfold table chi-square tests were used to analyze factors possibly associated with IONM alerts.Results:Among the 586 cervical surgeries, 17 cases (2.9%) exhibited abnormal IONM signals. These included 4 cases of anterior cervical discectomy and fusion (ACDF), 4 cases of anterior cervical corpectomy and fusion (ACCF), and 2 cases of combined anterior-posterior surgeries for cervical spondylotic myelopathy; and 5 posterior surgeries and 2 anterior ACCF procedures for ossification of the posterior longitudinal ligament (OPLL). The rate of abnormal IONM signals was significantly higher in patients with maximum spinal cord compression (MSCC)>60% (5.8%, 12/208) than in those with MSCC≤60% (χ 2=9.417, P=0.002); in patients with intraoperative hypotension during posterior surgery (mean arterial pressure reduction>20% from baseline, cumulative duration>20 min), the abnormal IONM rate was 22.2% (6/27), which was significantly higher than that in patients without intraoperative hypotension (χ 2=33.542, P<0.001); in patients who underwent calcified tissue removal during anterior surgery, the abnormal IONM rate was 9.3% (5/54), which was significantly higher than that in patients without calcified tissue removal (χ 2=13.162, P=0.003). Thus, MSCC>60%, intraoperative hypotension during posterior surgery, and calcified tissue removal during anterior surgery may be inducing factors for abnormal IONM signals. Among the 17 patients with monitoring abnormalities, 8 cases showed no significant improvement after corresponding intraoperative treatments, and 7 of these 8 cases experienced varying degrees of muscle strength decline and sensory numbness immediately after surgery; 9 cases showed partial or complete recovery of signals, among which 8 cases had no new-onset neurological impairment after surgery, and 1 case developed unilateral upper limb grip strength decline. IONM demonstrated a sensitivity of 0.8750 and specificity of 0.8889. Conclusions:Multimodal IONM can detect electrophysiological abnormalities of spinal cord nerve function during cervical degenerative disease surgery, providing real-time warning of potential nerve damage during the operation. The proportion of abnormal IONM signals is relatively high in cases with MSCC>60%, intraoperative hypotension during posterior cervical surgery, or calcified tissue removal during anterior cervical surgery.

Objective:To investigate the clinical significance and inducing factors of abnormal intraoperative neurophysiological monitoring (IONM) signals during surgery for cervical degenerative diseases.Methods:A retrospective analysis was performed on 586 patients who underwent cervical degenerative disease surgery with IONM at the Department of Orthopedics, The First Affiliated Hospital of Soochow University, from April 2015 to April 2024. Surgical approaches included 380 anterior spinal canal decompression and fusion procedures, 154 posterior spinal canal decompression and fusion procedures (including single-door laminoplasty, total laminectomy, and hemilaminectomy), and 52 combined anterior-posterior surgeries. The multimodal IONM protocol employed transcranial electrical stimulation motor evoked potentials (TES-MEP) and cortical somatosensory evoked potentials (CSEP), combined with electromyography (EMG). Bilateral deltoid muscles, thenar/hypothenar muscles and abductor hallucis muscles were monitored in all patients. Intraoperative MEP, SEP, and EMG results were recorded to analyze the causes of abnormal signals, intraoperative response strategies, and postoperative neurological function and outcomes. Fourfold table chi-square tests were used to analyze factors possibly associated with IONM alerts.Results:Among the 586 cervical surgeries, 17 cases (2.9%) exhibited abnormal IONM signals. These included 4 cases of anterior cervical discectomy and fusion (ACDF), 4 cases of anterior cervical corpectomy and fusion (ACCF), and 2 cases of combined anterior-posterior surgeries for cervical spondylotic myelopathy; and 5 posterior surgeries and 2 anterior ACCF procedures for ossification of the posterior longitudinal ligament (OPLL). The rate of abnormal IONM signals was significantly higher in patients with maximum spinal cord compression (MSCC)>60% (5.8%, 12/208) than in those with MSCC≤60% (χ 2=9.417, P=0.002); in patients with intraoperative hypotension during posterior surgery (mean arterial pressure reduction>20% from baseline, cumulative duration>20 min), the abnormal IONM rate was 22.2% (6/27), which was significantly higher than that in patients without intraoperative hypotension (χ 2=33.542, P<0.001); in patients who underwent calcified tissue removal during anterior surgery, the abnormal IONM rate was 9.3% (5/54), which was significantly higher than that in patients without calcified tissue removal (χ 2=13.162, P=0.003). Thus, MSCC>60%, intraoperative hypotension during posterior surgery, and calcified tissue removal during anterior surgery may be inducing factors for abnormal IONM signals. Among the 17 patients with monitoring abnormalities, 8 cases showed no significant improvement after corresponding intraoperative treatments, and 7 of these 8 cases experienced varying degrees of muscle strength decline and sensory numbness immediately after surgery; 9 cases showed partial or complete recovery of signals, among which 8 cases had no new-onset neurological impairment after surgery, and 1 case developed unilateral upper limb grip strength decline. IONM demonstrated a sensitivity of 0.8750 and specificity of 0.8889. Conclusions:Multimodal IONM can detect electrophysiological abnormalities of spinal cord nerve function during cervical degenerative disease surgery, providing real-time warning of potential nerve damage during the operation. The proportion of abnormal IONM signals is relatively high in cases with MSCC>60%, intraoperative hypotension during posterior cervical surgery, or calcified tissue removal during anterior cervical surgery.

Objective To observe the effect of Bupiyichang pills combined with levocetirizine in the treatment of 56 patients with chronic urticaria,so as to provide clinical guidance and basis.Methods 118 patients with chronic urticaria were selected for our study,and after informed consent they were randomly divided into observation group and control group.The observation group were was treated by Bupiyichang pills combined with levocetirizine,and the control group were was treated by levocetirizine.When they were curingAfter treatment for 10,20,and 30 days,the effective rates in the two groups were calculated and compared with each other.And at the day before treating and the day after treating for 20 days,the serum IgE levels in each group was detected and compared.The falling ranges between the two groups were calculated and compared.Results When they were curing treated for 10,20,and 30 days,the effective rates in the observation group were 76.79％,94.64 ％,85.71％,respectively,which in those of the control group were 59.68％,74.19％,64.52％,respectively,the differences between the two groups were statistically significance significant (x2 =3.94,9.11,6.97,all P ＜ 0.05).At the day before treating and the day after treating for 20 days,the serum IgE levels in the observation group were (384.71 ± 65.62) U/mL and (214.59 ±40.71) U/mL respectively,the difference was statistically significance significant (t =10.93,P ＜ 0.05);and the serum IgE levels in the control group were (380.25 ± 67.81)U/mL and (256.99 ± 53.21)U/mL respectively,the difference was statistically significancesignificant (t =9.37,P ＜ 0.05).The falling ranges in the observation group and the control group were (170.12 ± 35.59) U/mL and (123.26 ± 53.31) U/mL respectively,the difference was statistically significance significant between the two groups (t =7.82,P ＜ 0.05).Conclusion Bupiyichang pills combined with levocetirizine is more effective than single medication of levocetirizine.

Objective To explore the clinical effects of the packet therapy combined with Chinese prescrip-tion soaking in the treatment of patients with verruca plantaris,so as to provide clinical guidance and basis.Methods 101 patients with verruca plantaris were chosen as study objects,and they were divided into two groups,namely obser-vation group and control group.Observation group was treated by the packet therapy combined with Chinese prescrip-tion soaking,and control group was treated by Chinese prescription soaking.When they were cured for 4 weeks,the main symptoms and effective rate in the two groups were calculated and compared.For the recovery patients,when their drugs were withdrew for 8 weeks,the recurrence rate between the observation group and control group was compared.Results After being treated for 4 weeks,both of the skin lesion and pain degree between the observation group and control group had significant differences (Z=4.48,P<0.05;Z=4.18,P<0.05).The effective rates in the observation group and control group were 85.71% and 48.08%,respectively,and the difference between the two groups was statistically significant (χ2 =16.00,P<0.001).The recurrence rates in the observation group and control group were 13.33% and 27.27%,respectively,and the difference between the two groups was no statistically signifi-cant (P>0.05).Conclusion The packet therapy combined with Chinese prescription soaking is more effective than Chinese prescription soaking.