Objective:To investigate the causes and management strategies of anesthetic complications during percutaneous spinal endoscopic surgery under local anesthesia.Methods:A total of 16 800 patients (8 625 males and 8 175 females) who underwent percutaneous spinal endoscopic surgery under local anesthesia (including intravenous basic anesthesia) in Tianjin Hospital, Shandong Public Health Clinical Center and Hebei General Hospital from February 2012 to February 2023 were retrospectively analyzed. The average age was 45.3±21.6 years (range, 12-84 years). There were 220 cases of posterior cervical keyhole endoscopic surgery, 50 cases of thoracic transforaminal endoscopic surgery, 70 cases of thoracic posterior interlaminar endoscopic surgery, 11 670 cases of lumbar transforaminal endoscopic surgery, and 4 790 cases of lumbar posterior interlaminar endoscopic surgery. The occurrence time, clinical manifestations, management of intraoperative anesthesia complications were recorded, as well as surgical segments, puncture sites, complication symptoms, signs, outcome and prognosis.Results:All patients received percutaneous water-mediated uniaxial spinal endoscopic surgery under local anesthesia. There were 9 patients experienced anesthesia complications, including 6 cases of epidural diffusion of anesthetics and 3 cases of anesthetics mistakenly entering the subarachnoid space. There were 4 males and 5 females, aged 48.4±18.2 years (range, 28-84 years). There were 1 case of T 12L 1 disc herniation, 1 case of C 5-6 disc herniation, 3 cases of L 4-5 disc herniation and 4 cases of L 5S 1 disc herniation. Surgical segments and procedures: 1 case of C 5-6 posterior Keyhole endoscopic surgery, 1 case of T 12L 1 transforaminal endoscopic surgery, 2 cases of L 4-5 transforaminal endoscopic surgery, 1 case of L 4-5 interlaminar endoscopic surgery, and 4 cases of L 5S 1 interlaminar endoscopic surgery. Anesthesia complications all appeared 5-10 min after injection of local anesthetics, with symptoms of decreased oxygen saturation, decreased blood pressure, altered consciousness, and sensory and motor dysfunction of limbs. 6 patients with epidural diffusion of anesthetics recovered completely after symptomatic treatment in 5 cases, and 1 case was left with foot drop. Three patients with anesthetics mistakenly entering the subarachnoid space were immediately converted to the supine position, of which one recovered by mask oxygenation; 1 patient improved after emergency tracheal intubation, rehydration, and application of vasoconstrictive medications; and 1 patient developed multiple complications such as multiorgan failure, rhabdomyolysis, and sepsis after tracheal intubation, and recovered at 3 months after surgery with symptomatic treatment. Conclusions:Epidural diffusion and entering into subarachnoid space of anesthetics are serious complications of local anesthesia in percutaneous spinal endoscopic surgery. In addition to sensory and motor dysfunction of the limbs, the functions of the respiratory and circulatory systems can also be affected. It is necessary to be alert to the occurrence of anesthesia-related complications during operation and early identification and treatment.

AIM:This study aims to investigate the potential mechanism of cell division cycle protein 42(Cdc42)in acute lung injury(ALI).METHODS:(1)The levels of Cdc42 and IQ motif-containing GTPase-activating protein 1(IQGAP1)in ALI were analyzed using the Gene Expression Omnibus(GEO)database.(2)The plasma samples were collected from 30 patients diagnosed with ALI and 30 healthy controls between January 2022 and December 2023.The bronchoalveolar lavage fluid(BALF)from ALI patients was also collected.Eighteen male C57BL/6 mice were ran-domly divided into control(CON)group,lipopolysaccharide(LPS)group,and LPS+ML141(Cdc42 inhibitor)group,with 6 mice in each group.After 72 h,the mice were euthanized,and the BALF was collected for analysis,including cell enumeration and protein concentration determination using the bicinchoninic acid method.Enzyme-linked immunosorbent assay was used to measure the levels of Cdc42 and inflammatory cytokines[interleukin-6(IL-6),IL-1β and tumor necro-sis factor α(TNF-α)]in human plasma and mouse BALF.Lung damage in mouse tissue sections was evaluated by HE staining.(3)Mouse pulmonary microvascular endothelial cells(PMVECs)were isolated by magnetic bead-based cell sorting and were divided into CON,LPS and LPS+ML141 groups.Vascular ring formation assay was conducted to assess the an-giogenic potential of PMVECs,and calcium ion imaging technology was employed to measure calcium ion concentrations in PMVECs.The levels of reactive oxygen species(ROS)were assessed using a ROS detection kit.Western blot was uti-lized to analyze the protein levels of Cdc42,VE-cadherin,intercellular adhesion molecule-1(ICAM-1),myosin light chain(MLC),phosphorylated MLC(p-MLC)and IQGAP1 in PMVECs.RESULTS:(1)The GEO database analysis re-vealed significant up-regulation of Cdc42 expression in ALI model(P<0.01).(2)Clinical assessments showed markedly elevated plasma levels of Cdc42 and pro-inflammatory cytokines(IL-6,IL-1β and TNF-α)in ALI patients(P<0.01),with subsequent reductions after treatment(P<0.05).Neutrophil counts in the BALF of ALI patients were significantly in-creased.In ALI animal models,cell count,protein concentration and inflammatory mediator levels in BALF,and lung tis-sue damage scores were significantly elevated(P<0.01),all of which were notably reduced after treatment with Cdc42 in-hibitor ML141(P<0.05).(3)The PMVECs in LPS group exhibited significant increases in Cdc42,ICAM-1,p-MLC,IQGAP1,ROS,and calcium ion concentrations(P<0.01),alongside significant decreases in VE-cadherin expression and angiogenic capacity(P<0.01).All parameters were significantly improved after ML141 treatment(P<0.05).CON-CLUSION:The Cdc42 may influence IQGAP1 by modulating calcium levels in PMVECs,playing a critical role in pulmo-nary vascular barrier injury during ALI.

Objective:To investigate the causes and management strategies of anesthetic complications during percutaneous spinal endoscopic surgery under local anesthesia.Methods:A total of 16 800 patients (8 625 males and 8 175 females) who underwent percutaneous spinal endoscopic surgery under local anesthesia (including intravenous basic anesthesia) in Tianjin Hospital, Shandong Public Health Clinical Center and Hebei General Hospital from February 2012 to February 2023 were retrospectively analyzed. The average age was 45.3±21.6 years (range, 12-84 years). There were 220 cases of posterior cervical keyhole endoscopic surgery, 50 cases of thoracic transforaminal endoscopic surgery, 70 cases of thoracic posterior interlaminar endoscopic surgery, 11 670 cases of lumbar transforaminal endoscopic surgery, and 4 790 cases of lumbar posterior interlaminar endoscopic surgery. The occurrence time, clinical manifestations, management of intraoperative anesthesia complications were recorded, as well as surgical segments, puncture sites, complication symptoms, signs, outcome and prognosis.Results:All patients received percutaneous water-mediated uniaxial spinal endoscopic surgery under local anesthesia. There were 9 patients experienced anesthesia complications, including 6 cases of epidural diffusion of anesthetics and 3 cases of anesthetics mistakenly entering the subarachnoid space. There were 4 males and 5 females, aged 48.4±18.2 years (range, 28-84 years). There were 1 case of T 12L 1 disc herniation, 1 case of C 5-6 disc herniation, 3 cases of L 4-5 disc herniation and 4 cases of L 5S 1 disc herniation. Surgical segments and procedures: 1 case of C 5-6 posterior Keyhole endoscopic surgery, 1 case of T 12L 1 transforaminal endoscopic surgery, 2 cases of L 4-5 transforaminal endoscopic surgery, 1 case of L 4-5 interlaminar endoscopic surgery, and 4 cases of L 5S 1 interlaminar endoscopic surgery. Anesthesia complications all appeared 5-10 min after injection of local anesthetics, with symptoms of decreased oxygen saturation, decreased blood pressure, altered consciousness, and sensory and motor dysfunction of limbs. 6 patients with epidural diffusion of anesthetics recovered completely after symptomatic treatment in 5 cases, and 1 case was left with foot drop. Three patients with anesthetics mistakenly entering the subarachnoid space were immediately converted to the supine position, of which one recovered by mask oxygenation; 1 patient improved after emergency tracheal intubation, rehydration, and application of vasoconstrictive medications; and 1 patient developed multiple complications such as multiorgan failure, rhabdomyolysis, and sepsis after tracheal intubation, and recovered at 3 months after surgery with symptomatic treatment. Conclusions:Epidural diffusion and entering into subarachnoid space of anesthetics are serious complications of local anesthesia in percutaneous spinal endoscopic surgery. In addition to sensory and motor dysfunction of the limbs, the functions of the respiratory and circulatory systems can also be affected. It is necessary to be alert to the occurrence of anesthesia-related complications during operation and early identification and treatment.

AIM:This study aims to investigate the potential mechanism of cell division cycle protein 42(Cdc42)in acute lung injury(ALI).METHODS:(1)The levels of Cdc42 and IQ motif-containing GTPase-activating protein 1(IQGAP1)in ALI were analyzed using the Gene Expression Omnibus(GEO)database.(2)The plasma samples were collected from 30 patients diagnosed with ALI and 30 healthy controls between January 2022 and December 2023.The bronchoalveolar lavage fluid(BALF)from ALI patients was also collected.Eighteen male C57BL/6 mice were ran-domly divided into control(CON)group,lipopolysaccharide(LPS)group,and LPS+ML141(Cdc42 inhibitor)group,with 6 mice in each group.After 72 h,the mice were euthanized,and the BALF was collected for analysis,including cell enumeration and protein concentration determination using the bicinchoninic acid method.Enzyme-linked immunosorbent assay was used to measure the levels of Cdc42 and inflammatory cytokines[interleukin-6(IL-6),IL-1β and tumor necro-sis factor α(TNF-α)]in human plasma and mouse BALF.Lung damage in mouse tissue sections was evaluated by HE staining.(3)Mouse pulmonary microvascular endothelial cells(PMVECs)were isolated by magnetic bead-based cell sorting and were divided into CON,LPS and LPS+ML141 groups.Vascular ring formation assay was conducted to assess the an-giogenic potential of PMVECs,and calcium ion imaging technology was employed to measure calcium ion concentrations in PMVECs.The levels of reactive oxygen species(ROS)were assessed using a ROS detection kit.Western blot was uti-lized to analyze the protein levels of Cdc42,VE-cadherin,intercellular adhesion molecule-1(ICAM-1),myosin light chain(MLC),phosphorylated MLC(p-MLC)and IQGAP1 in PMVECs.RESULTS:(1)The GEO database analysis re-vealed significant up-regulation of Cdc42 expression in ALI model(P<0.01).(2)Clinical assessments showed markedly elevated plasma levels of Cdc42 and pro-inflammatory cytokines(IL-6,IL-1β and TNF-α)in ALI patients(P<0.01),with subsequent reductions after treatment(P<0.05).Neutrophil counts in the BALF of ALI patients were significantly in-creased.In ALI animal models,cell count,protein concentration and inflammatory mediator levels in BALF,and lung tis-sue damage scores were significantly elevated(P<0.01),all of which were notably reduced after treatment with Cdc42 in-hibitor ML141(P<0.05).(3)The PMVECs in LPS group exhibited significant increases in Cdc42,ICAM-1,p-MLC,IQGAP1,ROS,and calcium ion concentrations(P<0.01),alongside significant decreases in VE-cadherin expression and angiogenic capacity(P<0.01).All parameters were significantly improved after ML141 treatment(P<0.05).CON-CLUSION:The Cdc42 may influence IQGAP1 by modulating calcium levels in PMVECs,playing a critical role in pulmo-nary vascular barrier injury during ALI.

Objective To explore the gene expression profile in paraspinal muscle degeneration(PMD)and identify key ferroptosis genes.Methods RNA sequencing was performed on paraspinal muscle tissue of 3 normal and 3 PMD patients respectively to obtain differentially expressed genes.Through protein-protein interaction(PPI)and gene functional enrichment analysis,the intersection of ferroptosis genes was identified to identify key hub genes associated with ferroptosis.The diagnostic value for PMD disease was analyzed by receiver operating characteristic(ROC)curves.Results A total of 292 differentially expressed genes were identified in PMD.Among them,125 genes were significantly downregulated and 167 genes were significantly upregulated.Bioinformatics analysis revealed that 14 differentially expressed genes were associated with ferroptosis.Among them,ferroptosis genes MUC1,ATF3 and CDKN1A were key hub genes with good specificity and sensitivity for diagnosing PMD.Functional enrichment analysis revealed that they may mediate the occurrence and progression of PMD by regulating cell apoptosis,ferroptosis and skeletal muscle tissue development and differentiation.Conclusion Ferroptosis genes MUC1,ATF3 and CDKN1A can serve as biomarkers for diagnosing PMD,providing theoretical basis for decoding the pathological mechanism of PMD and developing new drugs.

Objective:To establish a lumbosacral triangle (composed of L 5 transverse process, S 1 superior articular process, sacral ala and iliac crest) classification and to guide L 5S 1 endoscopic surgery. Methods:A total of 647 patients with low back pain who admitted to Tianjin Hospital from January 2016 to October 2018 were retrospectively analyzed, including 315 males and 332 females, aged 42.9±15.1 years (range, 19-74 years). The L 5 transverse process sacral distance (TSD), inter trans-verse process length (ITL), interlaminar width (ILW), interlaminar height (ILH), iliosacral angle (ISA), iliac crest height (IH), intervertebral space height (ISH), intervertebral foramen height (IFH), and intervertebral foramen width (IFW) were measured based on lumbar spine anterior-posterior and lateral radiographs. Spearman correlation analysis and hierarchical cluster analysis were used to establish the lumbosacral triangle classification. A total of 822 patients underwent endoscopic L 5S 1 surgery based on lumbosacral triangle classification guidance and verification in Tianjin Hospital from January 2020 to December 2022, including 421 males and 401 females, aged 45.1±16.7 years (range, 15-79 years). The visual analogue scale (VAS) and Oswestry disability index (ODI) were compared before and after surgery, and the Macnab criteria were used to assess surgical outcomes. Results:Spearman correlation analysis showed positive correlations between IH and ISA ( r=0.75, P<0.001), IFH and IFW ( r=0.60, P<0.001), TSD and IFH ( r=0.53, P<0.001), and TSD and IFW ( r=0.40, P<0.001). There was a negative correlation between TSD and IH ( r=-0.46, P<0.001), TSD and ISA ( r=-0.42, P<0.001), IFW and ISA ( r=-0.41, P<0.001), IFW and IH ( r=-0.50, P<0.001), IFH and IH ( r=-0.42, P<0.001). According to Spearman correlation analysis, hierarchical cluster analysis and receiver operating characteristic curve, lumbosacral angle was divided into three types: Type 1, L5 transverse process overlapped with sacral alar; Type 2, 07 mm. Based on lumbosacral triangle classification, different endoscopic techniques were used at L5S1 in 822 patients, including interlaminar approach single-axis endoscopy, trans-foraminal approach single-axis endoscopy, trans-foraminal fenestration approach mobile microendoscopy and unilateral biportal endoscopy, the VAS and ODI of all the patients decreased than those preoperative in immediate postoperative period, half a year postoperative period and the final follow up, and the difference was statistically significant ( P<0.05). At the last follow-up, the Macnab score was excellent in 278 cases, good in 475 cases, and fair in 69 cases, with an excellent and good rate of 91.6% (753/822). Conclusion:Lumbosacral triangle classification is simple and practical, and can effectively guide L5S1 endoscopic surgery.

Objective:To establish an artificial intelligence-based surgical selection system utilizing deep learning to assist in the decision-making process for lumbar endoscopic surgery.Methods:General data of 1,110 patients who underwent percutaneous transforaminal endoscopic discectomy, 804 patients who underwent percutaneous interlaminar endoscopic discectomy, 923 patients who underwent mobile microendoscopic discectomy and 623 patients who underwent unilateral biportal endoscopic in Tianjin Hospital from January 2018 to June 2023 were included in the study. Clinical outcomes were assessed using the visual analogue scale (VAS) for leg and back pain, the Oswestry disability index (ODI), and MacNab criteria both before surgery and 12 months postoperatively. Using a random number table method, patients were divided into a training dataset (2,768 cases) and a test dataset (692 cases) at a ratio of 4∶1. Patient clinical symptoms, physical signs, and multi-modal imaging data were input into a deep learning model. This model was structured into three main modules: intervertebral disc detection, surgical necessity identification, and surgical recommendation. The final surgical method was determined using a convolutional neural network incorporating U-Net for segmentation and ResNet for classification. The accuracy and recall rates of each module were evaluated using the test dataset.Results:Compared to preoperative values, all patients showed significant improvements at the 12-month postoperative follow-up. For patients who underwent percutaneous transforaminal endoscopic discectomy, percutaneous interlaminar endoscopic discectomy, mobile microendoscopic discectomy, and unilateral biportal endoscopic surgery, the VAS scores for leg pain decreased from 7.69±0.80, 7.82±0.88, 7.62±0.69, and 7.56±1.00 preoperatively to 1.44±1.09, 1.35±0.82, 1.51±1.08, and 1.43±0.91 postoperatively. Similarly, the VAS scores for back pain decreased from 5.73±0.83, 6.17±0.99, 6.11±0.88, and 6.46±0.95 to 0.93±0.75, 1.01±0.67, 1.40±0.72, and 1.27±0.70, respectively. Additionally, the ODI significantly decreased from 39.91%±4.50%, 40.05%±8.05%, 47.08%±9.50%, and 44.43%±4.71% preoperatively to 5.77%±2.22%, 6.05%±2.31%, 8.51%±2.16%, and 9.51%±3.70% postoperatively, with all differences being statistically significant ( P<0.05). The excellent rate according to the MacNab criteria was 93.12% (3,222/3,460). In the deep learning model, the multi-modal data of 2,768 patients were input in the training set for deep learning to form a surgical identification and operation recommendation system, and the preoperative data of 692 patients were input in the test set to compare with the final operation method. In the intervertebral disc location module, the accuracy of location and designation of the five lumbar intervertebral discs was 97.1%(672/692). In the module of intervertebral disc need for surgery, the accuracy was 94.8%(3,280/3,460) and the recall rate was 91.9%(636/692). As for patients, the accuracy rate was 91.9%(636/692). In the operation recommendation module, the accuracy rate of operation recommendation based on intervertebral disc was 89.5%(569/636), and the accuracy rate of surgical recommendation based on patient was 82.2%(569/692). Conclusion:In this study, an artificial intelligent surgical procedures selection system based on deep learning was established, which could effectively integrate relevant data and accurately guide the selection of lumbar endoscopic surgery.

The diagnostic technology of acute stroke by microwave imaging has the advantages of being non-ionizing, fast, small, and low-cost. Therefore, this technology is expected to become an auxiliary or alternative means to CT and MRI technology. As the signal transmitting and receiving device of the microwave imaging system, the antenna has an important influence on the performance of the imaging system. At present, there are many antennas with different performances used in imaging systems, but there is a lack of clear evaluation criteria for them. In this paper, several typical antennas were introduced, their advantages and disadvantages from the perspective of bandwidth and near-field were analyzed, and the common requirements of imaging systems for antennas and the performance indicators of various types of imaging systems were summarized. Moreover, the development trend of antenna technology for microwave imaging was pointed out to provide a reference for the study of stroke microwave imaging technology.

Low back pain (LBP) is a common clinical condition, and non-specific LBP is believed to be associated with lumbar instability caused by paraspinal muscle (PSM) degeneration. Therefore, MRI evaluation of PSM degeneration can help predict the progression of low back pain-related diseases. At present, the most commonly used MRI parameters are the cross-sectional area (CSA) and fat infiltration (FI) of PSM. In order to assess the degree of PSM degeneration more accurately, modified parameters including functional CSA, relative CSA and muscle-fat infiltration index (MFI), have been designed. Advancements in MRI technology,such as the application of IDEAL-IQ, allow for early detection of changes in fat infiltration. Additionally, the proton density fat fraction (PDFF) derived from chemical shift encoding based water-fat MRI (CSE-MRI), also shows promise in studying PSM. Numerous MRI studies, both domestically and internationally, have aimed to establish the relationship between PSM degeneration and non-specific LBP, lumbar degenerative diseases, degenerative lumbar scoliosis, and osteoporosis. It has been found that PSM degeneration is affected by other factors such as intervertebral disc, articular process and endplate degeneration. Furthermore, PSM degeneration and scoliosis/kyphosis are also reciprocal causation. Higher fat content in the vertebral body and PSM is associated with increased bone fragility, while vertebroplasty following osteoporotic vertebral fracture can delay PSM degeneration and improve quality of life.

Objective:To evaluate the value and efficacy of microscope-assisted minimally invasive anterior lumbar discectomy and zero-profile fusion (ALDF) for lumbar degenerative diseases.Methods:Anterior lumbar distractors were designed to maintain the distraction of intervertebral space and expose the posterior edge of the intervertebral space. From June 2018 to December 2020, 41 cases of lumbar degenerative diseases were treated with this operation, including 19 men and 22 women, aged 29-71 years old (average 42.1 years old). All patients had intractable low back pain. Imaging examination showed lumbar disc degeneration with narrow intervertebral space, including disc herniation with Modic changes in 7 cases, spinal stenosis with instability in 16 cases and spondylolisthesis in 18 cases. The involved levels included L 2,3 in 1 case, L 3,4 in 3 cases, L 2-L 4 in 1 case, L 4,5 in 17 cases and L 5S 1 in 19 cases. An incision was taken that was pararectus for L 2-L 4 and transverse for L 4-S 1, with the intervertebral disc exposed via extraperitoneal approach. The intervertebral space was released and distracted after discectomy in intervertebral space, and self-made distractors were used to maintain the space. Under microscope, the herniation, posterior annulus and osteophyte were removed for sufficient decompression, with a suitable self-anchoring cage implanted into the intervertebral space. The visual analogue score (VAS), Oswestry dysfunction index (ODI), intervertebral space height, lordosis angle and spondylolisthesis rate were evaluated. Results:Operations were performed successfully in all the patients. The operation time was 70-120 min with an average of 90 min, and the intraoperative blood loss was 15-70 ml with an average of 30 ml. No severe complication such as nerve or blood vessel injury occurred. The patients were followed up for 12 to 36 months, with an average of 18 months. At the last follow-up, VAS decreased from 6.4±2.3 to 1.1±0.9, and ODI decreased from 44.9%±16.9% to 5.8%±4.7%. Intervertebral space height recovered from 7.2±2.8 mm to 12.1±2.1 mm and lordosis angle recovered from 6.9°±4.8° to 10.1°±4.6°. X-ray showed significant recovery of intervertebral space height, lordosis angle and spondylolisthesis rate, with obvious interbody fusion and no displacement of cage. For 18 patients of spondylolisthesis, the slippage recovered from 16.6%±9.3% to 7.6%±5.3%, with an average improvement of 54.2%.Conclusion:Microscope-assisted minimally invasive ALDF can provide sufficient decompression and zero-profile fusion for lumbar degenerative diseases with satisfactory results during short-term follow-up.