Objectives:To investigate the clinical outcomes of unilateral biportal endoscopy assisted unilateral laminotomy for bilateral decompression(ULBD)in the treatment of lumbar spinal stenosis under local anesthe-sia,and to compare the anesthetic effects of single-stage and two-stage local anesthesia.Methods:A retro-spective analysis was conducted on the data of 106 patients with lumbar spinal stenosis who underwent uni-lateral biportal endoscopy assisted ULBD treatment under local anesthesia in our hospital from January 2022 to June 2023.There were 51 males and 55 females,aged 55-83(66.7±14.5)years old,with the following le-sion segments:17 cases at L3-4,36 cases at L4-5,and 53 cases at L5-S1.Schizas classification:25 cases of grade B,36 cases of grade C,and 45 cases of grade D.Among them,52 patients underwent single-stage local anesthesia and were included in the single anesthesia group(Group A),while 54 patients received two-stage local anesthesia and were included in the two-stage local anesthesia group(Group B).There were no statistically significant differences in age,gender ratio,body mass index(BMI),surgical segments,Schizas classification and American Society of Anesthesiologists(ASA)classification between the two groups of patients.The perioperative complications,operative time,as well as the visual analogue scale(VAS)score,oxygen saturation,mean arterial pressure,heart rate in both groups before surgery(T1),during exposure(T2),during traction of the nerve root(T3),and immediately after surgery(T4)were recorded;The VAS scores for low back pain and leg pain,as well as the Oswestry disability index(ODI),were compared between the two groups before and after surgery.The MacNab assessment criteria were used to evaluate the overall postoperative efficacy of the patients at the final follow-up.Results:All patients successfully completed the operation.Two cases had dural tear,but no dural repair was performed;Five cases had mild headache,which disappeared after symptomatic treatment;Four cases had increased lower limb pain and numbness compared to pre-operative conditions,which were treated with symptomatic treatment for swelling reduction,and the symptoms alleviated or disappeared 3-5d after surgery;All incisions healed in stage Ⅰ.During the operation,the vital signs remained stable throughout and no unexpected incidents occurred.There was no statistical difference between group A and group B in operative time(101.9±17.3min vs.103.6±15.9min,P＞0.05).No statistically significant difference was observed in VAS scores,mean arterial pressure and heart rate between the two groups at T1 and T2(P＞0.05).At T3 and T4,the VAS scores,mean arterial pressure and heart rate of group A were significantly higher than those of group B(P＜0.05).At each time point after surgery,the VAS scores and ODI of the two groups improved significantly compared with those before surgery(P＜0.05),but there was no statistically significant difference between the two groups at the same time point(P＞0.05).At the final follow-up,31 cases in group A were excellent,14 cases were good,and 7 cases were fair,with an excellent and good rate of 86.5％;36 cases in group B were excellent,13 cases were good,and 5 cases were fair,with an excellent and good rate of 90.7％.There was no statistically significant difference in the excellent and good rate between the two groups(P＞0.05).Conclusions:The unilateral biportal endoscopy technique under local anesthesia for ULBD in the treatment of lumbar spinal canal stenosis can achieve good clinical efficacy,and two-stage local anesthesia provides a superior analgesic effect compared to single-stage local anesthesia.This method holds significant clinical application value,particularly for patients with lumbar spinal canal stenosis accompanied by complex comorbidities and at high risk for general anesthesia.

This study aims to explore the synergistic effects of the main components in salvianolic acids for Injection(SAFI) on key pathological events in cerebral ischemia, elucidating the pharmacological characteristics of SAFI in neuroprotection. Two major pathological gene modules related to endothelial injury and neuroinflammation in cerebral ischemia were mined from single-cell data. According to the topological distance calculated in network medicine, potential synergistic component combinations of SAFI were screened out. The results showed that the combination of caffeic acid and salvianolic acid B scored the highest in addressing both endothelial injury and neuroinflammation, demonstrating potential synergistic effects. The cell experiments confirmed that the combination of these two components at a ratio of 1∶1 significantly protected brain microvascular endothelial cells(bEnd.3) from oxygen-glucose deprivation/reoxygenation(OGD/R)-induced reperfusion injury and effectively suppressed lipopolysaccharide(LPS)-induced neuroinflammatory responses in microglial cells(BV-2). This study provides a new method for uncovering synergistic effects among active components in traditional Chinese medicine(TCM) and offers novel insights into the multi-component, multi-target acting mechanisms of TCM.
Brain Ischemia/metabolism* ; Neuroprotective Agents/pharmacology* ; Animals ; Drugs, Chinese Herbal/administration & dosage* ; Benzofurans/pharmacology* ; Mice ; Drug Synergism ; Caffeic Acids/pharmacology* ; Polyphenols/pharmacology* ; Humans ; Alkenes/pharmacology* ; Endothelial Cells/drug effects* ; Depsides

This study aims to explore the role and mechanism of berberine in promoting the expression of aquaporin 4(AQP4) in astrocytes by regulating the expression of miR-383-5p in HepG2 cell-derived exosomes under insulin resistance(IR). The IR-HepG2 cell model was established with 1×10~(-6) mol·L~(-1) insulin. With metformin as the positive control, the safe concentrations of berberine and metformin were screened by cell counting kit-8(CCK-8) and lactate dehydrogenase(LDH) leakage assays, and the effect of berberine on the IR of HepG2 cells was evaluated by glucose consumption. NanoSight was used to measure the particle size and concentration of exosomes secreted by HepG2 cells in each group. HepG2 cell-derived exosomes in each group were incubated with astrocytes for 24 h, and the protein and mRNA levels of AQP4 in HA1800 cells were determined by Western blot and qRT-PCR, respectively. qRT-PCR was performed to determine the expression of miR-383-5p in HepG2 cell-derived exosomes and HA1800 cells after co-incubation. Western blotting was employed to determine the expression levels of miRNAs and proteins associated with exosome production and release in HepG2 cells. The results showed that 10 μmol·L~(-1) berberine and 1 mmol·L~(-1) metformin significantly alleviated the IR of HepG2 cells and reduced the concentration of exosomes in HepG2 cells. The exosomes of HepG2 cells treated with berberine and metformin significantly up-regulated the protein and mRNA levels of AQP4 in HA1800 cells. The mRNA level of miR-383-5p in HepG2 cell exosomes and HA1800 cells co-incubated with berberine and metformin decreased significantly. The intervention with berberine and metformin significantly down-regulated the expression of proteins associated with the production of miRNAs(Dicer, Drosha) as well as the production(Alix, Vps4A) and release(Rab35, VAMP3) of exosomes in IR-HepG2 cells. In conclusion, berberine can promote the expression of AQP4 in astrocytes by inhibiting the production and release of miR-383-5p in HepG2-derived exosomes under IR.
Humans ; MicroRNAs/metabolism* ; Berberine/pharmacology* ; Hep G2 Cells ; Exosomes/genetics* ; Aquaporin 4/metabolism* ; Insulin Resistance ; Astrocytes/drug effects*

Background The high work intensity and possible subsequently increased susceptibility to occupational hazards of calcium carbide plants may lead to hypertension in workers, but there are few studies on the relationship between occupational hazard exposure and hypertension in workers involving the production process of calcium carbide. Objective To explore the influence of occupational hazards on the incidence of hypertension in calcium carbide plants. Methods Using historical cohort design, the employees of a calcium carbide factory in the western part of Inner Mongolia Autonomous Region were selected as research subjects. According to the pre-determined inclusion and exclusion criteria, the study population comprised an exposure group of 377 employees (including furnace workers, inspection workers, and maintenance workers) exposed to dust, noise & carbon monoxide, and a control group of 388 employees (including central control workers, electricians, and administrative personnel) without above-mentioned exposure. The total sample size was 765 participants. The follow-up period was from April 2011 to October 2022, and the study endpoint was defined as the conclusion of the follow-up period or diagnosed hypertension in annual occupational health examination. Information on general demographic characteristics, living habits, and work status was collected from all study subjects. Cox proportional hazards regression model was used to analyze the association between occupational hazard exposure and the risk of hypertension among the calcium carbide plant employees. Results The average age, mean systolic and diastolic blood pressure, proportion of males, smoking rate, and alcohol consumption rate in the exposure group were higher than those in the control group (P<0.05). Compared to baseline, both systolic and diastolic blood pressure levels increased in the exposure group and the control group at the end of the follow-up (P<0.05). At the end of the follow-up, the average differences between systolic/ diastolic blood pressure and baseline values in the exposure group were higher than those in the control group (P<0.05). During the follow-up period, a total of 223 cases of hypertension occurred, with a total follow-up of 2785 person-years, resulting in an incidence density of 8007.18 per 100000 person-years, an average age of onset of (35.90±8.22) years, and an average working age of onset of (2.69±1.97) years. The incidence density in the exposure group was 128.71% higher than that in the control group, and the risk of hypertension in the exposure group was 2.115 times that of the control group. The risk of hypertension was 2.199 times higher for men than for women, 1.344 times higher for those aged 30 and above than for those under 30, 1.546 times higher for smokers than for non-smokers, and 1.750 times higher for drinking workers than for non-drinking ones. The results of Cox proportional hazards regression modeling indicated that the hazard ratio (95%CI) of hypertension among the employees exposed to dust, noise, and carbon monoxide was 2.254 (1.703, 2.982), 1.594 (1.107, 2.295), and 1.567 (1.079, 2.274), respectively, when different covariates (gender, age, smoking, and alcohol consumption) were included. The results of Log-rank test showed that there were statistically significant differences in the distribution of disease-free survival between the exposure group and the control group (P<0.05). Conclusion Occupational exposures to dust, noise, and carbon monoxide may increase the risk of hypertension among calcium carbide plant workers.

Diabetic encephalopathy(DE)is a complication of the central nervous system induced by diabetes,characterized by insidious onset and complex pathological mechanisms.Recent research has revealed that the pathological mechanisms of DE are closely associated with the imbalance of intercellular communica-tion across multiple organs.Exosomes,serving as vital media-tors of intercellular communication,are involved in the patholog-ical progression of DE and hold promise as diagnostic biomarkers and therapeutic targets for DE.Traditional Chinese medicine(TCM)can improve communication between brain cells and be-tween peripheral and brain tissues by regulating exosomes and their contents,thereby preventing and treating DE.Meanwhile,exosomes,as targeted delivery carriers of active molecules,can carry TCM monomers more easily across the blood-brain barrier to prevent and treat DE.In light of this,this review summarizes the regulatory role of exosomes in the pathological progression of DE and explores the enormous potential of TCM in the preven-tion and treatment of DE by regulating exosomes and using exo-somes as traditional Chinese medicine carriers,aiming to pro-vide new evidence for the prevention and treatment of DE with TCM.

The glymphatic system(GS)is a unique toxic sub-stance clearance system in brain,which is very important for maintaining the microenvironment stability of the central nervous system.The polarization distribution of aquaporin 4(AQP4)lo-cated in the terminal foot of astrocytes affects the function of GS and participates in the pathological progress of many neurodegen-erative diseases,but the detailed regulation mechanism of AQP4 polarization distribution has not been systematically summarized.Therefore,this paper systematically combs the mechanism of reg-ulating the polarization distribution of AQP4 from the perspective of the composition integrity of dystrophin-glycoprotein complex(DGC)and basement membrane foot complex,and summarizes the potential drug and non-drug therapies for targeted regulation of AQP4 polarization distribution at present,aiming at providing new target reference and theoretical basis for targeted regulation of AQP4 polarization to prevent and treat neurodegenerative dis-eases.

Diabetic encephalopathy(DE)is a complication of the central nervous system induced by diabetes,characterized by insidious onset and complex pathological mechanisms.Recent research has revealed that the pathological mechanisms of DE are closely associated with the imbalance of intercellular communica-tion across multiple organs.Exosomes,serving as vital media-tors of intercellular communication,are involved in the patholog-ical progression of DE and hold promise as diagnostic biomarkers and therapeutic targets for DE.Traditional Chinese medicine(TCM)can improve communication between brain cells and be-tween peripheral and brain tissues by regulating exosomes and their contents,thereby preventing and treating DE.Meanwhile,exosomes,as targeted delivery carriers of active molecules,can carry TCM monomers more easily across the blood-brain barrier to prevent and treat DE.In light of this,this review summarizes the regulatory role of exosomes in the pathological progression of DE and explores the enormous potential of TCM in the preven-tion and treatment of DE by regulating exosomes and using exo-somes as traditional Chinese medicine carriers,aiming to pro-vide new evidence for the prevention and treatment of DE with TCM.

The glymphatic system(GS)is a unique toxic sub-stance clearance system in brain,which is very important for maintaining the microenvironment stability of the central nervous system.The polarization distribution of aquaporin 4(AQP4)lo-cated in the terminal foot of astrocytes affects the function of GS and participates in the pathological progress of many neurodegen-erative diseases,but the detailed regulation mechanism of AQP4 polarization distribution has not been systematically summarized.Therefore,this paper systematically combs the mechanism of reg-ulating the polarization distribution of AQP4 from the perspective of the composition integrity of dystrophin-glycoprotein complex(DGC)and basement membrane foot complex,and summarizes the potential drug and non-drug therapies for targeted regulation of AQP4 polarization distribution at present,aiming at providing new target reference and theoretical basis for targeted regulation of AQP4 polarization to prevent and treat neurodegenerative dis-eases.

Objectives:To investigate the clinical outcomes of unilateral biportal endoscopy assisted unilateral laminotomy for bilateral decompression(ULBD)in the treatment of lumbar spinal stenosis under local anesthe-sia,and to compare the anesthetic effects of single-stage and two-stage local anesthesia.Methods:A retro-spective analysis was conducted on the data of 106 patients with lumbar spinal stenosis who underwent uni-lateral biportal endoscopy assisted ULBD treatment under local anesthesia in our hospital from January 2022 to June 2023.There were 51 males and 55 females,aged 55-83(66.7±14.5)years old,with the following le-sion segments:17 cases at L3-4,36 cases at L4-5,and 53 cases at L5-S1.Schizas classification:25 cases of grade B,36 cases of grade C,and 45 cases of grade D.Among them,52 patients underwent single-stage local anesthesia and were included in the single anesthesia group(Group A),while 54 patients received two-stage local anesthesia and were included in the two-stage local anesthesia group(Group B).There were no statistically significant differences in age,gender ratio,body mass index(BMI),surgical segments,Schizas classification and American Society of Anesthesiologists(ASA)classification between the two groups of patients.The perioperative complications,operative time,as well as the visual analogue scale(VAS)score,oxygen saturation,mean arterial pressure,heart rate in both groups before surgery(T1),during exposure(T2),during traction of the nerve root(T3),and immediately after surgery(T4)were recorded;The VAS scores for low back pain and leg pain,as well as the Oswestry disability index(ODI),were compared between the two groups before and after surgery.The MacNab assessment criteria were used to evaluate the overall postoperative efficacy of the patients at the final follow-up.Results:All patients successfully completed the operation.Two cases had dural tear,but no dural repair was performed;Five cases had mild headache,which disappeared after symptomatic treatment;Four cases had increased lower limb pain and numbness compared to pre-operative conditions,which were treated with symptomatic treatment for swelling reduction,and the symptoms alleviated or disappeared 3-5d after surgery;All incisions healed in stage Ⅰ.During the operation,the vital signs remained stable throughout and no unexpected incidents occurred.There was no statistical difference between group A and group B in operative time(101.9±17.3min vs.103.6±15.9min,P＞0.05).No statistically significant difference was observed in VAS scores,mean arterial pressure and heart rate between the two groups at T1 and T2(P＞0.05).At T3 and T4,the VAS scores,mean arterial pressure and heart rate of group A were significantly higher than those of group B(P＜0.05).At each time point after surgery,the VAS scores and ODI of the two groups improved significantly compared with those before surgery(P＜0.05),but there was no statistically significant difference between the two groups at the same time point(P＞0.05).At the final follow-up,31 cases in group A were excellent,14 cases were good,and 7 cases were fair,with an excellent and good rate of 86.5％;36 cases in group B were excellent,13 cases were good,and 5 cases were fair,with an excellent and good rate of 90.7％.There was no statistically significant difference in the excellent and good rate between the two groups(P＞0.05).Conclusions:The unilateral biportal endoscopy technique under local anesthesia for ULBD in the treatment of lumbar spinal canal stenosis can achieve good clinical efficacy,and two-stage local anesthesia provides a superior analgesic effect compared to single-stage local anesthesia.This method holds significant clinical application value,particularly for patients with lumbar spinal canal stenosis accompanied by complex comorbidities and at high risk for general anesthesia.