OBJECTIVE: To investigate the effectiveness of digital three-dimensional (3D) assisted unilateral biportal endoscopy (UBE) in the treatment of highly isolated lumbar disc herniation (LDH) with translaminar approach. METHODS: The clinical data of 59 patients who met the selection criteria and underwent UBE treatment due to highly isolated LDH between January 2022 and December 2023 were retrospectively analyzed. Among them, 25 cases were treated with digital 3D assisted translaminar approach (observation group) and 34 cases were treated with interlaminar approach (control group). There was no significant difference in gender, age, disease duration, surgical segment, and preoperative visual analogue scale (VAS) score and Oswestry disability index (ODI) between the two groups ( P>0.05). The operation time, intraoperative blood loss, and lateral articular surface preservation rate were recorded and compared between the two groups. VAS score and ODI were used to evaluate the improvements of pain and function before operation and at 3 and 6 months after operation. The modified MacNab criteria was used to evaluate the effectiveness at last follow-up. RESULTS: One patient in the control group had dural tear, and the other patients had no nerve injury, infection, dural tear, or other related complications. There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). Patients in both groups were followed up 6-13 months, with an average of 8.3 months. The lateral articular surface preservation rate in the observation group was significantly higher than that in the control group ( P<0.05). Three patients in the observation group and 2 patients in the control group had calf muscle venous thrombosis, which was cured after anticoagulant treatment with rivaroxaban and delayed exercise time. There was no recurrence or second operation during the follow-up period. The VAS score and ODI of the two groups at 3 and 6 months after operation significantly improved when compared with those before operation ( P<0.05). There was no significant difference between the two groups at each time point after operation ( P>0.05). At last follow-up, the effectiveness was evaluated according to the modified MacNab criteria, and there was no significant difference in the evaluation grade and excellent and good rate between the two groups ( P>0.05). CONCLUTION UBE via translaminar approach is safe and effective for the treatment of highly isolated LDH, which is beneficial to protect the facet joint, maintain spinal stability, and reduce soft tissue injury. With the assistance of digital 3D technique, preoperative planning can be performed accurately.
Humans ; Intervertebral Disc Displacement/diagnostic imaging* ; Lumbar Vertebrae/diagnostic imaging* ; Male ; Retrospective Studies ; Female ; Endoscopy/methods* ; Treatment Outcome ; Middle Aged ; Adult ; Imaging, Three-Dimensional ; Operative Time ; Pain Measurement

Objective This study aims to investigate the expression, phenotypic changes, and mechanisms of action of guanylate-binding protein 2 (GBP2) in the process of silica-induced pulmonary fibrosis. Methods The expression and localization of GBP2 in silicotic lung tissue were detected by immunohistochemical staining and immunofluorescence. An in vitro cell model was constructed, and methods such as Western blot and real-time quantitative reverse transcription polymerasechain reaction were utilized to investigate the function of GBP2 in different cell lines following silica stimulation. The mechanism of action of GBP2 in various cell lines was elucidated using Western blot analysis. Results GBP2 was highly expressed in the lung tissue of patients with silicosis. Immunohistochemical staining and immunofluorescence have revealed that GBP2 was localized in macrophages and epithelial cells. In vitro cell experiments demonstrated that silicon dioxide stimulated THP-1 cells to activate the c-Jun pathway through GBP2, promoting the secretion of inflammatory factors and facilitating the occurrence of M2 macrophage polarization. In epithelial cells, GBP2 promoted the occurrence of epithelial to mesenchymal transition (EMT) by upregulating Krueppel-like factor 8 (KLF8). Conclusion GBP2 not only activates c-Jun in macrophages to promote the production of inflammatory factors and the occurrence of M2 macrophage polarization, but also activates the transcription factor KLF8 in epithelial cells to induce EMT, collectively promoting the progression of silicosis.
Humans ; Silicosis/genetics* ; Macrophages/cytology* ; Epithelial Cells/pathology* ; GTP-Binding Proteins/physiology* ; Epithelial-Mesenchymal Transition ; Disease Progression ; Cell Line ; Male

BACKGROUND:As a leading technique in the treatment of primary stenosis by posterior spinal endoscopy through unilateral approach and bilateral decompression using single channel endoscopy,the long-term efficacy needs to be further observed.There are few reports on the scope of intraoperative resection and few relevant studies on biomechanics and finite element analysis. OBJECTIVE:A three-dimensional finite element model was established to evaluate the effects of bilateral lumbar canal decompression under a one-hole split endoscope on lumbar range of motion and intradiscal pressure,to provide suggestions for clinical operation and theoretical basis for further clinical research. METHODS:A complete L3-L5 vertebral body model was reconstructed by CT images of nine healthy volunteers,which was used as the preoperative model M1.The simulated surgical resection range of L4-L5 was performed,and 1/4,1/3 and 1/2 of bilateral facet joints were removed respectively to obtain models M2,M3 and M4.The range of motion and the maximum Von Mises stress of the four models were compared in the six directions of forward bending,backward extension,left and right bending,and left and right rotation. RESULTS AND CONCLUSION:(1)The L3-L5 finite element model established in this study was effective,and the range of motion was within the range of previous solid studies under six motion states.(2)Compared with the M1 model,the L4-L5 lumbar spine range of motion increased with the increase of resection range in M2 with M3 and M4 models under forward bending,left and right bending and left and right rotation loading,and the difference was significant(P＜0.05).Under posterior extension loading,there was no significant difference in lumbar range of motion between M1 and M2(P＞0.05),but there was a significant difference of M1,M3 and M4(P＜0.05).(3)The range of motion of the L3-L4 lumbar spine had no significant change with the increase of bilateral facet arthrotomy(P＞0.05).(4)There was a significant difference in the maximum value of L4-L5 Von Mises between M1 and M2(P＜0.05),and there was a significant difference in the maximum value of L4-L5 Von Mises between M1 and M3,M4(P＜0.01),and the maximum value of L4-L5 lumbar von Mises increased with the increasing range of bilateral facet joint resection.Resection of more than 1/3 was particularly obvious.(5)The maximum value of Von Mises in the L3-L4 lumbar spine was increased with the increase of the resection range under forward bending,left and right bending and left and right rotation loading and the difference was significant(P＜0.05).(6)The results exhibited that the L4-L5 lumbar motion and intervertebral disc pressure increased with the increase of the excision range.Intervertebral disc pressure at L3-L4 increased with the increased extent of excision,but the lumbar range of motion was not significantly affected.In conclusion,the stability of the operative segment may be affected by the increase in the scope of facet joint resection.Although the immediate stability of adjacent segments is not affected,it may accelerate disc degeneration.

Objective To systematically evaluate the clinical efficacy of treatment based on intestine in the sepsis induced acute lung injury/acute respiratory distress syndrome(ALI/ARDS)under the traditional Chinese medicine theory"interior and exterior relationship between the lung and large intestine",and to provide evidence-based reference for clinical practice.Methods A computerized search of CNKI,Wanfang database,VIP database,China Biology Medicine disc(CBMdisc),Embase database of Dutch medical abstracts,PubMed database,Cochrane library database was performed to identify randomized controlled trial(RCT)that used the Tongfu method as an intervention for the treatment of ALI/ARDS induced by sepsis,published from the database establishment until October 8,2020.The control group was treated with conventional western medicine,and the test group was treated with the combination of Tongfu method and conventional western medicine.Screening of the literature and data extraction for those that met the inclusion criteria were performed by 2 investigators.The modified Jadad scale was used for quality assessment,and RevMan 5.4 and Stata 16.0 software were used for Meta analysis of the data.Results Thirteen articles were finally included,all of which were single center RCT studies,including 7 articles with≥4 points and 6 articles with<4 points.A total of 579 patients were included,290 in the test group and 289 in the control group.Meta-analysis showed that combined Tongfu treatment significantly increased the ALI/ARDS patient caused by sepsis oxygenation index[PaO2/FiO2;mean difference(MD)= 62.55,95%confidence interval(95%CI)was 55.74 to 69.37,P<0.05],reduced the levels of interleukin-6(IL-6;MD =-29.70,95%CIwas-48.34 to-11.06,P<0.05),tumor necrosis factor-α(TNF-α;MD=-2.94,95%CIwas-5.28 to-0.59,P<0.05),procalcitonin(PCT;MD =-1.34,95%CI =-2.17 to-0.51,P<0.05)and C-reactive protein(CRP;MD =-22.41,95%CIwas-36.52 to-8.29,P<0.05),reduced mechanical ventilation time(MD=-2.26,95%CIwas-2.86 to-1.66,P<0.05)and hospitalization time in intensive care unit(ICU;MD=-4.15,95%CIwas-7.47 to-0.84,P<0.05),reduced the 28-day mortality[relative risk(RR)= 0.43,95%CI was 0.24 to 0.76,P<0.05]and acute physiology and chronic health status scoreⅡ(APACHEⅡ;MD =-3.53,95%CI was-5.41 to-1.64,P<0.05).Conclusion Treatment based on intestine is valuable for reducing the condition and improving the prognosis of ALI/ARDS patients caused by sepsis,but further high-quality RCT studies are still needed to verify its efficacy and provide more accurate evidence-based evidence for clinical treatment.

Tripartite motif-containing protein 28 is a kind of macromolecular protein with E3 ubiquitin ligase, which belongs to an important member of the TRIM protein family. As a new molecular biomarker, it has attracted wide attention. TRIM28 is highly expressed in many kinds of malignant tumors, which is closely related to clinicopathological features, and is also involved in biological behaviors such as proliferation, apoptosis, migration and invasion of tumor cells. TRIM28 may be a potential marker and therapeutic target for clinical diagnosis and prognosis of tumors. This study reviews the structure and biological function of TRIM28, its relationship with malignant tumors and the molecular mechanism of signal transduction pathway.

Objective: To construct nomogram to predict the risk of bone metastasis in patients with non-small cell lung cancer(NSCLC). Methods: The clinical data of NSCLC patients diagnosed in the hospital were retrospectively analyzed, including the occurrence of bone metastasis, age, gender, pathological type, smoking status, PS score, TN stage, metastasis of other sites before bone metastasis, carcinoembryonic antigen(CEA) level, alpha fetoprotein(AFP) level, serum calcium(Ca2+), serum phosphorus(P), alkaline phosphatase(ALP) level, which were determined by univariate and multivariate logistic regression analysis. Receiver operating characteristic curve(ROC) and decision curve analysis were used, DCA was used to verify the accuracy and clinical benefit of the model, and nomogram was used to visualize the model. Results: Area under the ROC curve(AUC) showed that in the modeling group(n=138) and the validation group(n=92), the AUC value predicted by combined indicators(age, gender, pathological type, CEA, ALP)(modeling group=0.792, validation group=0.629) was higher than that predicted by single indicator. Conclusion The prediction model constructed in this study has good effect and can provide reference for clinical screening of high-risk patients with bone metastasis of NSCLC.

Objective To explore the expression of cullin 4A (CUL4A) in cholangiocarcinoma tissues and its clinical significance.Methods Primary fresh cholangiocarcinoma tissues (n =35) and normal bile duct tissues (n =15) from patients who underwent curative surgery in Binzhou People's Hospital of Shandong Province from February 2011 to December 2013 were collected.The expressions of CUL4A mRNA were detected by quantitative real-time PCR (qRT-PCR).Then,cholangiocarcinoma tissues (n =72) and normal bile duct tissues (n =36) from patients who underwent curative surgery in Binzhou People's Hospital of Shandong Province from January 2008 to January 2014 were collected.The expressions of CUL4A protein were tested by immunohistochemistry.The relationships between the expression of CUL4A and the patients' clinicopathologic features and prognosis were analyzed.Results The expression of CUL4A mRNA in cholangiocarcinoma tissues was obviously higher than that in normal bile duct tissues (3.876 ±0.975 vs.1.216 ±0.265),and the difference was statistically significant (t =12.23,P ＜ 0.001).The positive rates of CUL4A protein in cholangiocarcinoma and normal bile duct tissues were 70.8％ (51/72) and 2.8％ (1/36) respectively,and the difference was statistically significant (x2 =44.524,P ＜ 0.001).The expression of CUL4A protein in cholangiocarcinoma was related to the differentiated degree (x2 =4.341,P =0.037),neural invasion (x2 =8.326,P =0.004),TNM stage (x2 =7.745,P =0.005),lymph node metastasis (x2 =3.869,P =0.049) and vascular invasion (x2 =5.555,P =0.018).Survival analysis results showed that the median survival time of CUL4A positive patients was significantly shorter than that of CUL4A negative patients (32.40 months vs.51.30 months),and the difference was statistically significant (x2 =6.561,P =0.011).Conclusion The expression of CUL4A in cholangiocarcinoma tissues is higher than that in normal bile tissues.CUL4A plays an important role in the process of tumor invasion and metastasis and indicates poor prognosis,which may become a potential target for the diagnosis and therapy of the cholangiocarcinoma.

Objective To investigate the expressions of TRIM59,Twist and E-cadherin in hepatocellular carcinoma and their clinical significance. Methods The expressions of TRIM59,Twist and E-cadherin protein were tested by immunohistochemistry in 80 cases of hepatocellular carcinomas and the adjacent paracancerous tissues. Results The positive rate of TRIM59 in hepatocellular carcinoma was significantly higher than that in the adjacent paracancerous tissue(76.3%vs. 8.0%,P<0.05). Significant difference was also observed in the expres-sion rate of Twist between the hepatocellular carcinomas and the paracancerous tissue(66.3%vs. 6.0%,P<0.05). The positive rate of E-cadherin in hepatocellular carcinoma was significantly lower than that in the adjacent para-cancerous tissue(27.5%vs. 90.0%,P<0.05). The differences of the expression of TRIM59 in hepatocellular carci-noma of pathological grading,tumor differentiation,vascular invasion and clinical TNM stage were significant(P<0.05). The differences of the expression of Twist in hepatocellular carcinoma of pathological grading ,differentia-tion,vascular invasion and clinical TNM stage was also significant(P<0.05,respectively). The differences of the expression of E-cadherin in hepatocellular carcinoma of pathological grading,differentiation,vascular invasion and clinical TNM stage were also significant(P<0.05,respectively). Significantly positive correlation was also found between TRIM59 and Twist by using spearman correlation analysis(P<0.05). Negative correlations were observed between TRIM59 and E-cadherin(P < 0.05),and between Twist and E-cadherin(P < 0.05). Survival analysis showed that TRIM59 expression was an independent prognostic factor in hepatocellular carcinoma. Conclusion TRIM59,Twist and E-cadherin protein expression might be associated with the development,invasion,and metas-tasis of hepatocellular carcinoma. TRIM59 may become a new target gene for the treatment of human hepatocellular carcinoma.

Objective To investigate the effect of point Zusanli acupuncture on serum creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) in high-intensity military training soldiers and explore its possible antifatigue mechanism.Methods Sixty healthy soldiers were randomly allocated to groups A and B, 30 each. Group A received acupuncture at point Zusanli and group B, no treatment. After two weeks of treatment, two groups of soldiers separately did 5 km high-intensity running training and fulfilled the requirement of army examination. CK and CK-MB were measured in two groups before and after training and five days after training.Results In the two groups, there were statistically significant differences in serum CK and CK-MB contents between before training and after or five days after training (P<0.05). After or five days after training, there were statistically significant differences in serum CK and CK-MB contents between groups A and B (P<0.05).ConclusionsAcupuncture at point Zusanli can effectively improve bodily antifatigue ability and reduce myocardial and skeletal muscle injury caused by high-intensity exercise in military training soldiers.

Objective To study the incidence and risk factors ofdefecatory dysfunction in acute minorischemic strokepatientsandexplore the influence of the risk factors onprognosis.Methods Clinical data of 274 patients with acute minor ischemic strokewere reviewed and analyzed retrospectively.According to the presence of poststroke defecatorydysfunction,they were divided into defecatory dysfunction group and non-defecatory dysfunction group.The factors associated withdefecatory dysfunctionwere analyzed by univariate analysis and multivariatelogisticanalysis respectively,followed by investigating their effects on the prognosis.Results 74 patients of them with acute minor ischemic stroke had defecatory dysfunction.The univariate analysis indicated that4 factors including baseline NIHSS scorewere the risk factors.Multivariate logistic analysis showed that female,age,diabetes mellitus and baseline NIHSS score were independent risk factors for defecatory dysfunction.The scores of modified Rankin Scale (mRS) after 3 months in minor stroke patients with defecatory dysfunction wassignificantly higher(P ＜ 0.05).Baseline NIHSS score was a predictive factor for the prognosis of post-stroke defecatorydysfunctionpatients.Conclusions Defecatory dysfunction in acute minor stroke patients may increase the risk of poor prognosis.The female,elderlypatients as well those with diabetes mellitus and serious neurologicalfunction deficits are more likely to suffer post-stroke defecatory dysfunction.