Objective:To investigate the early clinical outcomes of anterior cervical discectomy and fusion (ACDF) in the treatment of two-segment cervical spondylotic myelopathy (CSM) using a cervical soft endoscopic minimally invasive system.Methods:A retrospective follow-up study was conducted on the medical records of 23 patients with two-segment cervical myelopathy who underwent ACDF using a soft endoscopic cervical spine minimally invasive system at the Third Affiliated Hospital of Southern Medical University between October 2022 and December 2023. The cohort included 15 males and 8 females, aged 37-79 years (58.52±11.77 years). The affected cervical segments included: C 3, 4 and C 4, 5 in 2 cases; C 3, 4 and C 5, 6 in 3 cases; C 4, 5 and C 5, 6 in 10 cases; C 5, 6 and C 6, 7 in 7 cases; and C 4, 5 and C 6, 7 in 1 case. Clinical outcomes were evaluated based on the Japanese Orthopaedic Association (JOA) scores and visual analog scale (VAS) for neck and shoulder pain, assessed preoperatively and at 1 week, 1 month, and 3 months postoperatively. Additional data recorded included incision length, intraoperative blood loss, operative time, postoperative complications, and the presence of prevertebral soft tissue edema. The improvement rate of JOA scores at the final follow-up was also calculated. Results:All patients successfully underwent surgery and completed follow-up, with follow-up durations ranging from 3 to 6 months (4.01±0.98 months). The mean operative time was 80.09±22.66 min (range: 53-127 min), and the mean incision length was 3.25±0.32 cm (range: 3-4 cm). Estimated blood loss ranged from 10 to 100 ml, with a mean of 34.78±24.1 ml. Postoperative drainage ranged from 0 to 80 ml (mean: 23.13±26.1 ml), and postoperative hospitalization durations ranged from 4 to 12 days (6.83±2.59 days). JOA scores improved significantly from a preoperative median of 9.00(8.00, 10.00) to 12.00(11.00, 14.00) at 1 week, 13.00(12.00, 14.00) at 1 month, and 15.00(15.00, 16.00) at 3 months postoperatively (χ 2=220.492, P<0.001). VAS scores for neck and shoulder pain also improved significantly from a preoperative median of 5.00(4.00, 6.00) to 3.00(2.00, 3.00) at 1 week, 2.00(2.00, 3.00) at 1 month, and 2.00(1.00, 2.00) at 3 months postoperatively (χ 2=170.869, P<0.001). No postoperative complications such as dysphagia, hoarseness, nerve injury, cerebrospinal fluid leakage, or intraspinal hematoma were observed. Imaging revealed no significant prevertebral soft tissue edema. At the final follow-up, the improvement rate of JOA scores resulted in 14 cases rated as excellent and 9 as good. Conclusions:ACDF using a cervical soft endoscopic minimally invasive system demonstrates satisfactory clinical outcomes for the treatment of two-segment CSM. This technique reduces the incidence of common complications associated with both open and traditional endoscopic surgeries.

Objective:To investigate the early clinical outcomes of anterior cervical discectomy and fusion (ACDF) in the treatment of two-segment cervical spondylotic myelopathy (CSM) using a cervical soft endoscopic minimally invasive system.Methods:A retrospective follow-up study was conducted on the medical records of 23 patients with two-segment cervical myelopathy who underwent ACDF using a soft endoscopic cervical spine minimally invasive system at the Third Affiliated Hospital of Southern Medical University between October 2022 and December 2023. The cohort included 15 males and 8 females, aged 37-79 years (58.52±11.77 years). The affected cervical segments included: C 3, 4 and C 4, 5 in 2 cases; C 3, 4 and C 5, 6 in 3 cases; C 4, 5 and C 5, 6 in 10 cases; C 5, 6 and C 6, 7 in 7 cases; and C 4, 5 and C 6, 7 in 1 case. Clinical outcomes were evaluated based on the Japanese Orthopaedic Association (JOA) scores and visual analog scale (VAS) for neck and shoulder pain, assessed preoperatively and at 1 week, 1 month, and 3 months postoperatively. Additional data recorded included incision length, intraoperative blood loss, operative time, postoperative complications, and the presence of prevertebral soft tissue edema. The improvement rate of JOA scores at the final follow-up was also calculated. Results:All patients successfully underwent surgery and completed follow-up, with follow-up durations ranging from 3 to 6 months (4.01±0.98 months). The mean operative time was 80.09±22.66 min (range: 53-127 min), and the mean incision length was 3.25±0.32 cm (range: 3-4 cm). Estimated blood loss ranged from 10 to 100 ml, with a mean of 34.78±24.1 ml. Postoperative drainage ranged from 0 to 80 ml (mean: 23.13±26.1 ml), and postoperative hospitalization durations ranged from 4 to 12 days (6.83±2.59 days). JOA scores improved significantly from a preoperative median of 9.00(8.00, 10.00) to 12.00(11.00, 14.00) at 1 week, 13.00(12.00, 14.00) at 1 month, and 15.00(15.00, 16.00) at 3 months postoperatively (χ 2=220.492, P<0.001). VAS scores for neck and shoulder pain also improved significantly from a preoperative median of 5.00(4.00, 6.00) to 3.00(2.00, 3.00) at 1 week, 2.00(2.00, 3.00) at 1 month, and 2.00(1.00, 2.00) at 3 months postoperatively (χ 2=170.869, P<0.001). No postoperative complications such as dysphagia, hoarseness, nerve injury, cerebrospinal fluid leakage, or intraspinal hematoma were observed. Imaging revealed no significant prevertebral soft tissue edema. At the final follow-up, the improvement rate of JOA scores resulted in 14 cases rated as excellent and 9 as good. Conclusions:ACDF using a cervical soft endoscopic minimally invasive system demonstrates satisfactory clinical outcomes for the treatment of two-segment CSM. This technique reduces the incidence of common complications associated with both open and traditional endoscopic surgeries.

Objective:To explore the clinical effects of endoscopic sinuvertebral nerves neurotomy for discogenic low back pain.Methods:Based on the anatomical research of sinuvertebral nerves, a total of 40 patients, including 9 males and 21 females aged 35±10 (24-55) years, with single-segment discogenic low back pain were treated with endoscopic sinuvertebral nerves neurotomy in our hospital from July 2018 to February 2019. The operating section included 4 cases of L 3,4 (10.0%, 4/40), 31 cases of L 4, 5 (77.5%, 31/40), and 5 cases of L 5S 1 (12.5%, 5/40). The preoperative visual analogue scale (VAS) score was 4.5±0.9 with the preoperative Oswestry disability index (ODI) score 49.7%±14.0%. For diagnostic nerves block, lidocaine (0.1-0.3 ml of 0.05 g/L) was successfully injected into the intersection of the lateral edge of the bilateral pedicle projection and the upper edge of the intervertebral disc projection. The initial segment of the sinuvertebral nerves was destroyed by a radiofrequency blade or a nerve dissector after bilateral percutaneous transforaminal endoscopic. All cases were followed up at 1, 3, 6 and 12 months after surgery, observing the changes in VAS and ODI. Results:Filamentous lumbar sinuvertebral nerve was observed under endoscope with its main trunk tranversed into the spinal canal against the intervertebral disc. The deputy trunk crossed at the posterolateral edge of the intervertebral disc and entered the intervertebral disc or the posterior edge of the vertebral body. By moving along with postcentral branches of spinal artery, the main trunk of sinuvertebral nerve was with tension and was capable of moving with the nerve root. In spite of moving the working channel along the main trunk of the sinuvertebral nerve laterally, the starting point of the sinuvertebral nerve at the ventral ganglion could be observed. All 40 patients successfully completed the sinuvertebral nerve destruction. The VAS was reduced to 1.7±0.9, 1.3±0.9, 1.2±0.8, 1.3±0.7 at 1, 3, 6 and 12 months after sugery respectively, which were significantly lower than those at pre-operation ( F=116.7, P=0.00). The improvement rate of VAS in 40 cases was 68.9%± 17.1% (33.3%-100.0%) at 12 months after operation. The VAS score in 6 cases was higher at 12 months after surgery than that preoperatively ( t=4.2, P=0.48), namely 1 case of L 3, 4, 2 cases of L 4, 5, and 3 cases of L 5S 1. In all cases, the ODI was reduced to 18.3%±5.2%, 14.5%±4.3%, 13.6%±3.7%, 12.8%±3.0% points at 1, 3, 6 and 12 months after surgery respectively, which were significantly lower than those before surgery ( F=237.7, P=0.00). The improvement rate of ODI was 72.0%±11.6% (33.3%-88.9%) at 12 months after surgery in all cases. Conclusion:The destruction of sinuvertebral nerve after transforaminal endoscope could improve the pain and function in patients with discogenic low back pain at L 3,4 and L 4, 5 segments within 12 months. For patients with discogenic low back pain at L 5S 1 segment, the clinical effects could be better within 6 months.

Objective To explore a method to prepare a model of renal ischemia-reperfusion injury, with mild injury to animals, simple and easy to operate and stable effectiveness. Methods Healthy SD male rats were randomly divided into normal group (group C), sham-operated group (group S) and experimental group (IR group). Rats in the experimental group received a median incision in the middle of the back skin. Through the muscle fascia of each side on the back into the bilateral retroperitoneal space, the bilateral renal pedicles were separated, and closed for 50 min with a mini artery clamp without injury, and then the blood perfusion of the bilateral renal pedicles was resumed by releasing the mini artery clamp. Except that the rats of sham operation group were not blocked the renal pedicle, the rest of the operating steps were consistent with the experimental group. The normal group rats were not treated except for anesthesia. To observe the condition of the rats, serum creatinine (SCr), blood urea nitrogen (BUN) and pathologyical changes in the kidney tissues at 24 h after operating. Results Skin incision was 2. 24 ± 0. 27 cm in the group IR, the right incision of lumbar dorsal fascia and muscle was 1. 36 ± 0. 21 cm, and the left incision was 1. 36 ± 0. 24 cm. The operation time was 3. 30 ± 0. 37 min from incising skin to clamping the bilateral kidney pedicles. The successful rate of model preparation reached 95% in the IR group. Compared with the groups C and S, the levels of SCr and BUN were remarkably increased in the IR group (P ＜0. 01), and renal tubular necrosis scores were also significantly increased (P＜ 0. 05). Conclusions The rat model of renal ischemia-reperfusion injury is established by clamping bilateral renal pedicles via dorsal retroperitoneal incision. This surgical procedure is stable and simple, with a high success rate and small incision, less bleeding, and minimal animal injury.

Objective To evaluate multi-slice CT (MSCT) features and pathological basis of lung cancer containing thin-walled airspace. Methods Thirty?five cases of pathologically confirmed lung cancer containing thin-walled airspace were retrospectively analysed with regard to clinical data, pathological types and MSCT features between 2012 and 2015.There were 35 cases(25 adenocarcinoma, 9 squamous carcinoma, 1 spindle cell tumor) in total. MSCT features were compared between the lesions with or without solid component .Fisher exact test was used for the statistical analysis. For dynamic follow-up CT scans, the lesion dynamic change was evaluated .Correlations between the pathological section and CT images of the 11 cases were analysed. Results These features accounted for more than 60% of all MSCT signs in 35 cases, including round shape in 28 cases(80.0%),lobulation in 32 cases(91.4%),multiple cysts in 27 cases(77.1%), irregular inner wall in 33 cases(94.3%)and septum in airspace in 31 cases(88.6%). Shape, spiculation, bronchus cut-off, blood vessel and bronchus passing through the airspace, and ground-glass opacity were significantly different between the lesions with or without solid component(P<0.05).The frequency of spiculation(11 cases) and bronchus cut-off(12 cases) in mixed solid lesions was higher than that in lesions without solid component(1 case, respectively).The frequency of irregular shape(6 cases),blood vessel passing through the airspace(12 cases),ground-glass opacity(13 cases)and bronchus passing through the airspace(7 cases) in lesions without solid were higher than that in solid mixed lesions(1, 1, 5, 3 cases respectively).The pathological basis of the formation of thin-walled airspace was obvious central necrosis in solid lesions and emphysematous change due to the tumor cells diffused along the inner airspace wall and the alveolar wall destruction.Five lesions were with progressive wall thickening and increased size of the airspace,and two lesions were with decreased size of the airspace and enlarged nodules in followed CT.One case of lung cancer with thin-walled airspace evolved from ground glass nodule. Conclusions The CT manifestation of lung cancer containing thin-walled airspace was characteristic.The pathological basis of the thin-walled airspace was various.

Objective To investigate the predictive value of the whole nodule size and solid component size of lung adenocarcinoma manifesting as subsolid nodule(SSN) in three different dimensions for pathologic grade.Methods We evaluated retrospectively preoperative chest HRCT data of 125 patients with 127 SSNs surgically resected and pathologically conformed lung adenocarcinomas.All specimens were divided into two groups: a total of 69 SSNs in group A, including 22 AIS and 47 MIA;a total of 58 SSNs in group B, only including IAC.Computer aided diagnosis software were used to measure the one dimension maximum diameter of solid component with lung window setting(1D-SCLW),two dimension maximum diameter of solid component with lung window setting(2D-SCLW),one dimension maximum diameter of solid component with mediastinal window setting(1D-SCMW),two dimension maximum diameter of solid component with mediastinal window setting(2D-SCMW),one dimension maximum diameter of whole nodule with lung window setting (1D-WNLW), two dimension maximum diameter of whole nodule with lung window setting (2D-WNLW), and volume of solid component with threshold of-300 HU (SCT) of all SSNs.Results 1D-SCLW, 2D-SCLW,1D-SCMW,2D-SCMW,1D-WNLW,2D-WNLW and SCT of the group B were significantly larger than those of the group A(P=0.000).ROC analyses indicated that the diagnostic efficiency of SCT for the pathologic grade was the highest among 7 CT features(AUC=0.887, sensitivity:81%,specificity:93%);The cut-off values of 1D-SCLW,2D-SCLW,1D-SCMW,2D-SCMW,1D-WNLW, 2D-WNLW and SCT were 17.50 mm,14.75 mm,9.50 mm,7.75 mm,0.50 mm,1.25 mm and 139.00 mm3.Multiple Logistic regression analysis revealed that SCT was the independent predictor of pathologic grade(OR=4.978,95%CI=1.430-17.331,P=0.012).SCT of 139.00 mm3 or greater was a significant indicator of IAC.Conclusion Among the whole nodule size and solid component size of SSN in three different dimensions on preoperative HRCT, SCT is found to be the independent predictor of pathologic grade, which may provide reference for surgery.

Objective To investigate the predictive value of whole nodule size and solid component size of pulmonary subsolid nodules (SSNs)with different window setting on preoperative HRCT for pathologic grade in lung adenocarcinoma.Methods We retrospectively evaluated preoperative chest HRCT and pathological data of 125 patients with 127 surgically resected lung adenocarcinoma manifesting as SSNs.All specimens were divided into two groups:a total of 69 SSNs in group A,including 22 adenocarcinomas in situ (AIS) and 47 minimally invasive adenocarcinoma (MIA);a total of 58 SSNs in group B,including invasive adenocarcinoma (IAC).Observer 1 used computer aided diagnosis software to measure the volume of whole nodule with lung window setting (WNLW),volume of solid component with lung window setting (SCLW),volume of solid component with mediastinal window setting (SCMW) and volume of solid component with threshold of-300 HU(SCT) of all SSNs.Observer 2 randomly selected 50 SSNs and repeated all the measurements.The interobserver agreement regarding quantitative measurements were evaluated by using intraclass correlation coefficient(ICC).The differences of all quantitative features between two groups were evaluated by Mann-Whitney U test.All the quantitative features were evaluated by using univariate logistic regression analysis,significant quantitative features identified by univariate logistic regression analysis were included in the multivariate logistic regression and independent predictors of pathological grade were obtained.Receiver operating characteristic analysis was conducted for the independent predictive factors that exhibited statistically significant differences in the multivariate logistic regression.Results The interobserver agreement regarding quantitative features were excellent (ICC＞ 0.75).The WNLW,SCLW,SCMW and SCT of group B were significantly larger than those of group A (P＜ 0.001).The univariate logistic regression analysis indicated that WNLW,SCLW,SCMW and SCT were significant (P＜0.001),the multivariate logistic regression analysis indicated that SCT was the independent predictive factor (OR=1.013,95％CI:1.006—1.020,P＜0.001).When SCT larger than 139.00 mm3,SSN was significantly associated with IACs (AUC=0.887,sensitivity=81％,specificity=93％).Conclusion SCT of SSNs on preoperative HRCT can be used to distinguish between AIS-MIA and IAC,which may provide information for choice of operation.

Objective To investigate the effect of raloxifene on ERα, ERβ and MT-1a expression in renal tubular epithelial cells contaminated with cadmium chloride,for exploring the protective effect and action mechanism of raloxifene in renal injury induced by cadmium. Methods Renal tubule cells were isolated from kidneys of new born SD rats and purified by Percoll. The cells of the second generation were selected for experiment. The cells were divided into 3 groups:blank control group,cadmium chloride group and raloxifene group. After 4 h,cell viability was detected by MTT,and after 24 h,mRNA and protein expression levels of ERα, ERβ and MT-1a in renal tissues were determined by RT-PCR and immunohistochemistry technology,respectively. Results Compared with the blank control group,morphology of plenty cells were changed in cadmium chloride group,a number of cells were dead,and the survival rate was only 55.3%;at the same time,mRNA and protein expression levels of ERβ and MT-1a significantly increased (P<0.05). Compared with cadmium chloride group,only a small part of cells underwent morphological changes,and the survival rate was 88.6% in raloxifene group,and the mRNA and protein expression levels of ERβand MT-1a were significantly decreased ( P<0.05) . The expression of ERαshowed no significant difference among the three groups ( P>0.05) . Conclusion Raloxifene can bond with ERβcompetively,down-regulate MT-1a and decrease Cd-MT synthesis,so as to reduce cadmium-induced damage of renal tubular epithelial cells.

Objective To evaluate the diagnostic value of CT target scanning combining with changing position for pulmonary nodules in special location .Methods CT target scanning combining with changing position was performed in 22 patients with pulmo‐nary nodules adjacent to heart or in posterior costophrenic angle ,which were found with routine spiral CT scanning .For objective analysis , the signal‐noise‐ratio (SNR) and contrast‐noise‐ratio (CNR) of lung were calculated .In terms of subjective assessment ,the image quality was rated on a 3‐point scale (0-2) for pulmonary inflation ,gravity‐dependent pulmonary perfusion and severity of artifacts , respectively .The CT features of pulmonary nodules were compared between different scanning techniques .Moreover ,the diagnostic confidence for pulmonary nodules was evaluated .The paired t test ,Wilcoxon signed‐rank test and Kappa test were used for statisti‐cal analysis .Results In comparison with conventional spiral CT scanning ,CT target scanning combining with changing position im‐proved the subjective image quality scores (P<0 .01) ,increased the signal‐to‐noise ratio (SNR) and contrast‐to‐noise ratio (CNR) , showed more detailed CT features (P<0 .05) ,and improved the confidence of diagnosis (P<0 .01) .Conclusion CT target scanning combining with changing position technique can show detailed features ,which should be recommended as the optimal scanning tech‐nique for pulmonary nodules adjacent to heart or in posterior costophrenic angle .

Objective To evaluate multi-detector computed tomography(MDCT)features of lung cancer associated with cystic airspace,and to improve diagnostic accuracy.Methods 21 pathologically or clinically confirmed lung cancer associated with cystic airspace were retrospectively analyzed with regard to clinical data,pathological types and TNM stage,SUMmax and MDCT features.For dynamic follow-up CT scans,the lesion dynamic change was evaluated.Results There were 21 cases (1 1 adenocarcinoma,6 squamous carcinoma)in total. The lesion was predominant cysts in 2 cases(9.52%),cysts with GGO mixed lesions in 3 cases(14.29%),cysts with solid mixed lesions in 14 cases(66.67%),cysts with GGO and solid mixed lesions in 2 cases(9.52%).Four morphological patterns,20 cases had solid nodules,solid nodule protruding externally from the cyst wall was in 5 cases (23.81%),solid nodule protruding internally from the cyst wall was in 1 case (4.76%),solid tissue intermixed within clusters of cysts was in 14 cases(66.67%),the lesion presenting as circumferential thickening of the cyst wall was in 1 case (4.76%).The frequency of following features accounted for more than 60% of all MDCT signs,including round shape (66.67%),lobulation (80.95%),blood vessel passing through the cyst (76.1 9%),pleural indentation (80.95%);while the frequency of multiple cysts,irregular inner wall and septum in cyst in 19 lesions(90.48%)was more than 90%.With respect to the relationship between lesion and bronchus,bronchus passing through the cyst was the most common sign,accounting for 38.10%(8/21).Average CT enhancement value was 28.27 HU±7.27 HU(range 14.2-40 HU).Average SUVmax was 6.05(range 4.5-9.8),indicating marked FDG uptake.Two lesions manifested as progressive wall thickening and increased size of the cyst,and one lesion showed decreased size of the cyst and enlarged nodules in follow up CT.Conclusion The irregular inner wall,septum in cyst and blood vessel passing through the cyst are the most three important signs for the diagnosis of malignant lesions.