Objective:To explore the clinical efficacy and safety of unilateral biportal endoscopic (UBE) and percutaneous transforaminal endoscopic discectomy (PTED) techniques in treating recurrent lumbar disc herniation (RLDH).Methods:This study is a retrospective cohort study. The clinical data were retrospectively collected from 68 patients who underwent surgical treatment for RLDH at Department of Mini-invasive Spinal Surgery, the Third People′s Hospital of Henan Province from June 2020 to June 2023. The patients were divided into the UBE group (38 cases) and the PTED group (30 cases) based on the surgical technique used. The drainage volume, surgery duration, and postoperative complications for revision surgeries in both groups were recorded. Visual analogue scale(VAS) and Oswestry disability index (ODI) were used to assess back pain and leg pain degrees and improvements preoperatively, 3 days postoperatively, 3 months postoperatively, and at the final follow-up. The modified Macnab criteria were used to evaluate outcomes at the final follow-up. The data comparison was conducted using independent sample t-test, repeated measures analysis of variance, χ2 test or Fisher's exact test. Results:All surgeries were successfully completed. The surgery duration in the UBE group was significantly shorter than in the PTED group, with statistically significant differences ((50.9±10.5)minutes vs.(55.9±12.5)minutes, t=1.234, P=0.001). All patients were followed up for more than 1 year, with a follow-up period of (18.1±5.6) months (range: 12 to 29 months). Both groups showed a significant reduction in VAS and ODI for back and leg pain at all postoperative time points compared to preoperative scores (all P<0.05). However, there were no statistically significant differences in VAS of low back pain, lower limb pain score and ODI score over time between the groups (all P>0.05). At the final follow-up, the UBE group had an excellent and good rate of 92.1% (35/38); the PTED group had an excellent and good rate of 86.6% (26/30)( χ2=0.727, P=0.867). One patient in the UBE group and three in the PTED group experienced cerebrospinal fluid leaks, and one patient in the PTED group experienced postoperative leg numbness; all were discharged after conservative treatment. At the final follow-up, lumbar X-rays, CT, and MRI evaluations showed no recurrence or instability at the surgical segments. Conclusions:Both UBE and PTED can achieve good clinical outcomes in the treatment of RLDH through continuous visualization. The choice of surgical method for RLDH should be more precisely tailored to the individual.

Objective To explore the biomechanical difference between bilateral pedicle screws fixation and unilateral pedicle screw combined with contralateral translaminar facet screw fixation under two endo-scopic approaches(interlaminar approach and transforaminal approach)through finite element analysis.Meth-ods The fusion model of simple fusion device(CAGEF model),interlaminar approach and transforaminal ap-proach models for bilateral pedicle screw fixation(BPSP model and BPSL model),and interlaminar approach and transforaminal approach for unilateral pedicle screw fixation combined with contralateral translaminar fac-et screw fixation(TLFSP model and TLFSL model)were established.The peak value of spinal displacement,maximum stress of the intervertebral fusion device,maximum stress of the internal fixation device,and maxi-mum stress of the L3 and L4 intervertebral disc of each model under six motion states:forward flexion,back-ward extension,left/right flexion,and left/right rotation were compared among the models.Results Com-pared with the CAGEF model,the peak spinal displacement and the maximum stress of the interbody fusion cage in the other four models were significantly reduced,and the values of the four fixed models were close to each other.The maximum stress of the internal fixation device in the three motion states of left flexion,left rotation,and right rotation in the BPSP model was greater than that in the BPSL model,while the maximum stress of the internal fixation device in TLFSP model was less than that in the TLFSL model only under the forward flexion motion state.Compared with the TLFSP model and TLFSL model,the maximum stress of the internal fixation devices in the BPSP model and BPSL model was greater only in the two motion states of flex-ion and extension,while which in the other four cases was smaller.Except for the maximum stress on the L3 and L4 intervertebral disc during rotation in the CAGEF model was higher than the other 4 models,the maxi-mum stress on the L3 and L4 intervertebral disc was similar in all other models under other motion states.Conclusion Under both interlaminar and foraminal approaches,the bilateral pedicle screws fixation and uni-lateral pedicle screw combined with contralateral translaminar facet screw fixation are both effective minimally invasive spinal fusion operations,and their biomechanical conditions are satisfactory.If choosing the interlami-nar approach,it is recommended to perform bilateral pedicle screw fixation,meanwhile decreasing the forward flexion and backward extension movements.Alternatively,a unilateral pedicle screw combined with contralat-eral interlaminar screw fixation can also be considered,while reducing left/right flexion movements.Howev-er,the specific treatment choice still needs to consider the patient's personalized treatment and the surgical operation ability of the clinical physician.

Objective To evaluate the reliability and validity of the Chinese version of the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)in patients with maintenance hemodialysis(MHD).Methods The general information and medical history of 84 MHD patients were collected,and the Mini-Mental State Exam(MMSE),Montreal Cognitive Assessment Scale(MoCA),and RBANS were conducted.The reliability of the scale was assessed by Cronbach α and split-half reliability.The structure and convergent validity of the scale were assessed by confirmatory factor analysis,and the RBANS scores'correlation to MoCA and MMSE scores was analyzed by Spearman correlation analysis.The predictive value of the RBANS total score on cognitive impairment(CI)was analyzed by receiver operating characteristic(ROC)curve.Results The Cronbach's alpha coefficient of the RBANS total scale was 0.896,split-half reliability was 0.911,and reliability for the five dimensions of the RBANS ranged from 0.618 to 0.791.Confirmatory factor analysis indicated that the overall fit of the five-dimensional model of the RBANS scale was acceptable(χ2/df=1.587,root mean square error of approximation=0.084,comparative fit index=0.967,incremental fit index=0.968,Tucker-Lewis index=0.947,goodness of fit index=0.891).The average variance extracted(AVE)for the five dimensions of the RBANS ranged from 0.525 to 0.863,while the composite reliability(CR)ranged from 0.733 to 0.926,indicating good convergent validity of the scale.Furthermore,Spearman correlation analysis revealed that the total RBANS score was negatively correlated to the age of MHD patients and positively correlated to years of education,as well as the total scores of MMSE and MoCA(all P<0.01).The ROC curve analysis indicated that the area under the curve(AUC)for the total RBANS score in predicting CI was 0.891(P<0.01),suggesting a high predictive value.Conclusion The Chinese version of RBANS has good reliability and validity in MHD patients,and can be used as a measure of cognitive function in MHD patients.

Objective:To investigate the expression of mismatch repair protein 2(MSH2)in gastric cancer and its correlation with patient clinical characteristics,as well as its effects on malignant biological behaviors of gastric cancer cells and underlying mechanisms.Methods:Tumor tissues and matched adjacent tissues were collected from 40 gastric cancer patients admitted to Xingtai People's Hospital from May 2020 to July 2022,along with patient clinical data.Normal gastric mucosal epithelial cells(GES-1)and gastric cancer cell lines(AGS,MKN45,and BGC-823)were routinely cultured.The sh-NC(negative control),shMSH2-1,and shMSH2-2 lentiviral vectors were transfected into AGS and MKN45 cells,respectively,dividing the cells into sh-NC,shMSH2-1,and shMSH2-2 groups accordingly.The proliferation,migration,and invasion capabilities of AGS and MKN45 cells in each group were assessed using CCK-8 assay,colony formation assay,Edu staining,and Transwell chamber assay,respectively.A nude mouse MKN45 cell xenograft model was established to evaluate the effect of MSH2 knockdown on tumor growth.WB was performed to detect the expression of MSH2,PI3K/AKT/mTOR pathway-related proteins,and epithelial-mesenchymal transition(EMT)-related proteins in cells and xenograft tissues.Results:MSH2 was highly expressed in gastric cancer tissues and cell lines,and this elevated expression was associated with lymph node metastasis,advanced T stage,and poor histological differentiation(all P<0.001).Successful knockdown of MSH2 expression was achieved in AGS and MKN45 cells(P<0.001).MSH2 knockdown significantly inhibited cell viability,Edu-positive cell ratio,colony formation,migration,and invasion ability of AGS and MKN45 cells(all P<0.001),as well as xenograft tumor growth(P<0.001).It markedly suppressed the expression of MSH2 protein,PI3K/AKT/mTOR pathway-related proteins,and N-cadherin protein(all P<0.001),while promoting E-cadherin expression(P<0.001)in both AGS,MKN45 cells and MKN45 xenograft tissues.Conclusion:MSH2 is highly expressed in gastric cancer tissues and cell lines and is associated with lymph node metastasis,advanced T-stage progression,and poor histological differentiation.Knockdown of MSH2 expression suppresses the malignant biological behaviors of AGS and MKN45 cells by inhibiting the PI3K/AKT/mTOR pathway,positioning MSH2 as a potential therapeutic target for gastric cancer management.

Objective To evaluate the reliability and validity of the Chinese version of the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)in patients with maintenance hemodialysis(MHD).Methods The general information and medical history of 84 MHD patients were collected,and the Mini-Mental State Exam(MMSE),Montreal Cognitive Assessment Scale(MoCA),and RBANS were conducted.The reliability of the scale was assessed by Cronbach α and split-half reliability.The structure and convergent validity of the scale were assessed by confirmatory factor analysis,and the RBANS scores'correlation to MoCA and MMSE scores was analyzed by Spearman correlation analysis.The predictive value of the RBANS total score on cognitive impairment(CI)was analyzed by receiver operating characteristic(ROC)curve.Results The Cronbach's alpha coefficient of the RBANS total scale was 0.896,split-half reliability was 0.911,and reliability for the five dimensions of the RBANS ranged from 0.618 to 0.791.Confirmatory factor analysis indicated that the overall fit of the five-dimensional model of the RBANS scale was acceptable(χ2/df=1.587,root mean square error of approximation=0.084,comparative fit index=0.967,incremental fit index=0.968,Tucker-Lewis index=0.947,goodness of fit index=0.891).The average variance extracted(AVE)for the five dimensions of the RBANS ranged from 0.525 to 0.863,while the composite reliability(CR)ranged from 0.733 to 0.926,indicating good convergent validity of the scale.Furthermore,Spearman correlation analysis revealed that the total RBANS score was negatively correlated to the age of MHD patients and positively correlated to years of education,as well as the total scores of MMSE and MoCA(all P<0.01).The ROC curve analysis indicated that the area under the curve(AUC)for the total RBANS score in predicting CI was 0.891(P<0.01),suggesting a high predictive value.Conclusion The Chinese version of RBANS has good reliability and validity in MHD patients,and can be used as a measure of cognitive function in MHD patients.

Objective:To explore the clinical efficacy and safety of unilateral biportal endoscopic (UBE) and percutaneous transforaminal endoscopic discectomy (PTED) techniques in treating recurrent lumbar disc herniation (RLDH).Methods:This study is a retrospective cohort study. The clinical data were retrospectively collected from 68 patients who underwent surgical treatment for RLDH at Department of Mini-invasive Spinal Surgery, the Third People′s Hospital of Henan Province from June 2020 to June 2023. The patients were divided into the UBE group (38 cases) and the PTED group (30 cases) based on the surgical technique used. The drainage volume, surgery duration, and postoperative complications for revision surgeries in both groups were recorded. Visual analogue scale(VAS) and Oswestry disability index (ODI) were used to assess back pain and leg pain degrees and improvements preoperatively, 3 days postoperatively, 3 months postoperatively, and at the final follow-up. The modified Macnab criteria were used to evaluate outcomes at the final follow-up. The data comparison was conducted using independent sample t-test, repeated measures analysis of variance, χ2 test or Fisher's exact test. Results:All surgeries were successfully completed. The surgery duration in the UBE group was significantly shorter than in the PTED group, with statistically significant differences ((50.9±10.5)minutes vs.(55.9±12.5)minutes, t=1.234, P=0.001). All patients were followed up for more than 1 year, with a follow-up period of (18.1±5.6) months (range: 12 to 29 months). Both groups showed a significant reduction in VAS and ODI for back and leg pain at all postoperative time points compared to preoperative scores (all P<0.05). However, there were no statistically significant differences in VAS of low back pain, lower limb pain score and ODI score over time between the groups (all P>0.05). At the final follow-up, the UBE group had an excellent and good rate of 92.1% (35/38); the PTED group had an excellent and good rate of 86.6% (26/30)( χ2=0.727, P=0.867). One patient in the UBE group and three in the PTED group experienced cerebrospinal fluid leaks, and one patient in the PTED group experienced postoperative leg numbness; all were discharged after conservative treatment. At the final follow-up, lumbar X-rays, CT, and MRI evaluations showed no recurrence or instability at the surgical segments. Conclusions:Both UBE and PTED can achieve good clinical outcomes in the treatment of RLDH through continuous visualization. The choice of surgical method for RLDH should be more precisely tailored to the individual.

Objective:To investigate whether prophylactic use of metal clips is necessary after cold snare polypectomy (CSP) of colorectal polyps of 6-10 mm.Methods:A total of 200 patients with 6-10 mm polyps that met the criteria of cold snare resection in Chengdu Third People's Hospital from 15 February 2022 to 30 May 2022 were randomly divided into two groups: a group that received preventive metal clip treatment and an observation group. Age, gender, body mass index (BMI), Boston score, endoscopy entry time, wound size, operation time, intraoperative bleeding time, postoperative delayed bleeding rate and cost between the two groups were compared and analyzed.Results:Ninety-eight patients in the metal clip group had 122 polyps removed, and 97 patients in the observation group had 119 polyps removed. There was no significant difference in the age, gender, BMI, Boston score, endoscopy entry time or wound size between the two groups. There were significant differences in the operation time (171.03±90.78 s VS 69.81±43.26 s, t=2.266， P=0.010), intraoperative bleeding time (19.98±17.37 s VS 29.16±17.56 s, t=-2.875， P=0.006) and surgery cost (571.63±110.92 yuan VS 366.32±13.2 yuan, t=18.102， P<0.001) between the metal clip group and the observation group. There was no significant difference in the delayed bleeding incidence［0.0%（0/98）VS 1.0%（1/97）， P=0.497］between the two groups. Conclusion:For patients with continuous bleeding time <60 seconds after CSP of 6-10 mm colonic polyps, the prophylactic use of metal clips may reduce the bleeding time, but may increase the operation time and cost. Metal clips have little effect on preventing postoperative complications.

Clinicians need to focus on various points in the diagnosis and treatment of insomnia.This article prescribed the treatment protocol based on the unique features,such as insomnia in the elderly,women experiencing specific physiologi-cal periods,children insomnia,insomnia in sleep-breathing disorder patients,insomnia in patients with chronic liver and kidney dysfunction.It pro-vides some reference for clinicians while they make decision on diagnosis,differentiation and treat-ment methods.

Objective To investigate the diagnostic efficacy and clinical value of GNB4 and Riplet gene methylation alone and in combination in the diagnosis of primary liver cancer.Methods A total of 313 patients were selected,including 78 patients with primary liver cancer,41 patients with other digestive system tumors,17 patients with non-digestive system tumors,20 patients with postoperative liver cancer,and 157 patients with benign liver disea-ses.The levels of GNB4 and Riplet gene methylation in plasma were detected using quantitative methylation-specific PCR(qMSP).Serum alpha-fetoprotein(AFP)levels were measured by direct chemiluminescence.Results The sensitivity and specificity of AFP in diagnosis were 51.3％and 94.3％,respectively;the sensitivity and specificity of GNB4 gene methylation in diagnosis were 83.3％and 99.4％,respectively;the sensitivity and specificity of Riplet gene methylation in diagnosis were 73.1％and 99.4％,respectively.The sensitivity and specificity of GNB4 and Riplet gene methylation combined diagnosis were 92.3％and 98.7％,respectively;the sensitivity and specificity of AFP,GNB4 and Riplet gene methylation combined diagnosis were 92.3％and 98.7％,respectively;the sensitivity and specificity of combined diagnosis including age and gender were 93.6％and 97.5％,respective-ly.Conclusion The sensitivity and specificity of AFP in the diagnosis of primary liver cancer are limited,while the methylation levels of GNB4 and Riplet genes are higher,and the sensitivity and specificity of their combined de-tection are higher than those of AFP.The sensitivity and specificity of AFP,GNB4 and Riplet gene methylation combined diagnosis are significantly higher than those of AFP,GNB4 and Riplet gene methylation alone.

Objective: To examine the association between noise exposure in daily life and depressive symptoms, so as to provide the evidence for reducing the impact of noise in daily life on depressive symptoms. Methods: Based on the 2015 to 2020 database of National Health and Nutrition Examination Survey, demographic information and noise exposure in daily life were collected from people aged 18 years and over. Depressive symptoms were evaluated using the Patient Health Questionnaire-9. The relationship between noise exposure in daily life and depressive symptoms were analyzed using a multivariable logistic regression model. Results: A total of 3 216 individuals were enrolled, including 1 707 males (53.08%) and 1 509 females (46.92%). The mean age was (49.30±18.07) years. There were 491 individuals with noise exposure in daily life, accounting for 15.27%. There were 265 cases with depressive symptoms, accounting for 8.24%. There were 66 individuals exposed to noise in daily life in the group with depression symptoms (24.91%), and 425 individuals exposed to noise in daily life in the normal group (14.40%), with statistically significant difference in noise exposure in daily life between the two groups (P<0.05). Multivariable logistic regression analysis showed that after adjusting for gender, age, educational level, marital status, household income poverty ratio, sleep duration, alcohol consumption and hearing, individuals who had noise exposure in daily life (OR=1.743, 95%CI: 1.258-2.413) were more likely to have high risk of depressive symptoms. Conclusion Noise exposure in daily life was associated with an increased risk of depressive symptoms.