BACKGROUND:Traditional surgery for lumbar disc herniation involves extensive excision of tissue surrounding the nerve for decompression and removal of protruding lumbar intervertebral discs,which poses various risks and complications such as nerve damage causing paralysis,lumbar instability,herniation recurrence,intervertebral space infection,and adjacent vertebral diseases. OBJECTIVE:To propose the symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous technique for lumbar spine symmetrically decompression,showing the induced resorption of herniated nucleus pulpous phenomenon and early clinical efficacy,and then analyze its decompression mechanism. METHODS:214 patients with lumbar disc herniation at Department of Orthopedics,First Affiliated Hospital of Zhengzhou University from March 2021 to May 2023 were enrolled in this study.Among them,81 patients received conservative treatment as the control group,and 133 patients received symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous treatment as the trial group.Before surgery,immediately after surgery(7-14 days),and early after surgery(over 1 year),MRI images were used to measure the volume changes of lumbar disc herniation.CT images were used to measure the posterior displacement distance of the lumbar spinous process ligament complex,as well as the width and height of the lateral recess.Japanese Orthopaedic Association scores were used to evaluate the patient's neurological function recovery. RESULTS AND CONCLUSION:(1)Control group:81 patients with lumbar disc herniation were treated conservatively,with a total of 171 herniated lumbar discs.The average follow-up time was(22.7±23.1)months.The first and second MRI measurements of 171 herniated lumbar discs showed herniated lumbar disc volumes of(551.6±257.9)mm3 and(792.2±330.4)mm3,respectively,with an average volume increase rate of(53.2±44.4)%,showing statistically significant differences(P<0.001).Out of 171 herniated lumbar discs,4 experienced natural shrinkage,with an absorption ratio of 2.3%(4/171)and an absorption rate of(24.5±9.9)%.(2)Trial group:133 patients with lumbar disc herniation had a total of 285 herniated lumbar discs.(1)Immediately after surgery:All patients were followed up immediately after surgery.229 out of 285 herniated lumbar discs experienced retraction,with an absorption ratio of 80.3%(229/285)and an average absorption rate of(21.5±20.9)%,with significant and complete absorption accounting for 6.5%.There were a total of 70 herniated lumbar discs in the upper lumbar spine,with an absorption ratio of 85.7%(60/70),an average absorption rate of(23.1±19.5)%,and a maximum absorption rate of 86.6%.There were 215 herniated lumbar discs in the lower lumbar spine,with an absorption ratio of 78.6%(169/215),an average absorption rate of(21.0±21.3)%,and a maximum absorption rate of 83.2%.Significant and complete absorption of the upper and lower lumbar vertebrae accounted for 5.7%and 6.5%,respectively,with no statistically significant difference(P>0.05).The average distance of posterior displacement of the spinous process ligament complex immediately after surgery was(5.2±2.8)mm.There were no significant differences in the width and height of the left and right lateral recess before and immediately after surgery(P>0.05).The Japanese Orthopaedic Association score immediately after surgery increased from(10.1±3.4)before surgery to(17.0±4.8),and the immediate effective rate after surgery reached 95.6%.(2)Early postoperative period:Among them,46 patients completed the early postoperative follow-up.There were 101 herniated lumbar discs,with an absorption ratio of 94%(95/101)and an average absorption rate of(36.9±23.7)%.Significant and complete absorption accounted for 30.6%,with a maximum absorption rate of 100%.Out of 101 herniated lumbar discs,3 remained unchanged in volume,with a volume invariance rate of 2.97%(3/101).Out of 101 herniated lumbar discs,3 had an increased volume of herniated lumbar discs,with an increase ratio of 2.97%(3/101)and an increase rate of(18.5±18.4)%.The Japanese Orthopaedic Association score increased from preoperative(9.3±5.1)to(23.5±4.0),with an excellent and good rate of 93.4%.(3)The early postoperative lumbar disc herniation absorption ratios of the control group and trial group were 2.3%and 85.9%,respectively,with statistically significant differences(P<0.001).(4)Complications:There were two cases of incision exudation and delayed healing in the trial group.After conservative treatment such as dressing change,no nerve injury or death occurred in the incision healing,and no cases underwent a second surgery.(5)It is concluded that symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous is a new method for treating lumbar disc herniation that can avoid extensive excision of the"ring"nerve and achieve satisfactory early clinical efficacy.It does not damage the lumbar facet joints or alter the basic anatomical structure of the lateral recess,fully preserves the herniated lumbar discs,and can induce significant or even complete induced resorption of herniated nucleus pulpous.Symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous provides a new basis and method for the clinical treatment of lumbar disc herniation.

Objective To compare the efficacy of three different methods in the prevention of adhesion after the HEOS system for different degrees of intrauterine adhesions.Methods 284 patients with mild,moderate and severe intrauterine adhesions,who were treated with the HEOS system,were divided into three groups,the intrauterine device with sodium hyaluronate gel was placed in Group A,Foley water capsule tube with sodium hyaluronate gel was placed in Group B,and sodium hyaluronate gel was placed in Group C only.The recovery of uterine adhesion,improvement of menstruation,endometrial thickness,and adverse reactions were compared among the three groups.Results The mild intrauterine adhesions group showed statistical differences among the three groups(P<0.05).Group A had a higher menstrual improvement rate than Group C(P<0.017),and there was no significant difference in other therapeutic indicators(P>0.017).However,the adverse reaction rate in Group A was also higher than that in Group C(P<0.017).In the moderate intrauterine group,there was a significant difference in the improvement rate of intrauterine adhesions between Group B and the other two groups(P<0.017).Group A and B were higher than Group C in terms of menstrual status,endometrial thickness,and adverse reactions(P<0.017).In severe intrauterine adhesions,Group A had higher efficacy indicators than other groups(P<0.017).Conclusions The curative effect index and adverse reaction rate were analyzed,after operation.For the light,moderate,and severe intrauterine adhesions,sodium hyaluronate gel,Foley water capsule tube with sodium hyaluronate gel,and intrauterine device with sodium hyaluronate gel were the best choice for adhesion.Individual and hierarchical management can achieve good clinical effects,which is worth popularizing.

BACKGROUND:Mechanical stimulation has been confirmed to promote osteogenic differentiation of bone marrow stromal stem cells,but the mechanism is unknown.Primary cilia are important mechanoreceptors and regulate various signaling pathways such as TGF-β1/BMP-2/SMAD.They are likely to be important targets for mechanical regulation of bone marrow stromal stem cells. OBJECTIVE:To investigate the effect and mechanism of fluid shear stress on osteogenic differentiation of bone marrow stromal stem cells. METHODS:Rat bone marrow stromal stem cells were divided into control group,mechanical stimulation group(fluid shear mechanics intervention by shaking table),mechanical stimulation + IFT88 silencing group(mechanical stimulation + silencing IFT88 expression with siRNA).After 24 hours of intervention,qRT-PCR was utilized to determine the expression of transforming growth factor β1 and bone morphogenetic protein 2.Western blot assay was used to detect the expression of phosphorylated SMAD2/3 protein.Immunofluorescent staining of primary cilia was conducted and morphology was analyzed. RESULTS AND CONCLUSION:Shear stress stimulation could promote the transcriptional activity of transforming growth factor β1 and bone morphogenetic protein 2 genes,and increase the expression of phosphorylated SMAD2/3 protein.After siRNA interfered with primary cilia,this mechanical response effect was significantly reduced.There was a Spearman correlation between the change ratio of the primary cilium area of bone marrow stromal stem cells and the increased ratio of transforming growth factor β1 and bone morphogenetic protein 2 gene transcription.These findings indicate that primary cilia/intraflagellar transport mediates the activation of fluid shear stress-responsive transforming growth factor β1/bone morphogenetic protein 2/SMAD signaling pathway and promotes osteogenic differentiation of bone marrow stromal stem cells.

BACKGROUND:Cervical neutral position magnetic resonance imaging is widely used for the diagnosis and treatment of cervical spondylotic myelopathy.However,it is not possible for patients to maintain the exact same position of the head and neck during repeated cervical magnetic resonance imaging examinations.The cervical spine undergoes minor flexion and extension movements in the sagittal plane,and the head may have a certain degree of variation in flexion and extension.Whether these changes in the neutral position of the cervical spine affect the volume of cervical discs herniation and cervical curvature is unclear. OBJECTIVE:Using artificial intelligence-assisted measurement,this study aimed to analyze the accuracy and reliability of magnetic resonance imaging examinations for measuring the volume of cervical discs herniation and cervical curvature in patients with cervical spondylotic myelopathy undergoing two consecutive cervical neutral positions in the short term. METHODS:A retrospective study was conducted on patients with cervical spondylotic myelopathy who underwent conservative treatment and underwent two consecutive cervical magnetic resonance imaging examinations within three months between June 2012 and June 2023.We proposed the use of occipital-thoracic distance and occipital-thoracic angle to evaluate the variation in flexion and extension of the head in the neutral position of the cervical spine.Based on the changes in occipital-thoracic angle,patients were divided into occipital-thoracic angle increase group and occipital-thoracic angle decrease group.Cervical discs herniation volume,C2-6 Cobb angle,and cervical(C3-C7)curvature were measured using artificial intelligence-assisted measurement software.Normal distribution data were represented by mean±SD,while non-normal distribution data were represented by the median(interquartile range).Spearman's rank correlation coefficient was used to analyze the correlation between changes in Cobb angle,cervical(C3-C7)curvature,and cervical discs herniation volume. RESULTS AND CONCLUSION:(1)A total of 104 patients and 326 cervical discs herniation were included in the study.There were 47 patients in the occipital-thoracic angle increase group and 57 patients in the occipital-thoracic angle decrease group.(2)Extension and flexion index of the head:There were no significant differences in occipital-thoracic distance and occipital-thoracic angle during the initial diagnosis and follow-up examination.The variation of occipital-thoracic distance was 0.035(3.23)mm,and the variation of occipital-thoracic angle was-0.31(3.28)°.The deviation range of occipital-thoracic distance and occipital-thoracic angle was small,and there was no significant correlation.(3)Cervical curvature index:There were no significant differences in C2-6 Cobb angle and C3-C7 curvature during the initial diagnosis and follow-up examination.There were no significant differences in C2-6 Cobb angle and C3-C7 curvature between the occipital-thoracic angle increase group and occipital-thoracic angle decrease group.(4)There was no significant difference in volume of cervical discs herniation during the initial diagnosis and follow-up examination.There was no significant difference in volume of cervical discs herniation between the occipital-thoracic angle increase group and occipital-thoracic angle decrease group.There was no significant correlation between the change of cervical discs herniation volume and the change of C2-6 Cobb angle and the cervical(C3-C7)curvature.(5)These results indicate that in the neutral position of the cervical spine,there were negligible minor flexion and extension movements in the sagittal plane,and the head was limited to a specific position.Although the head has a certain range of flexion and extension variation,it does not affect the accuracy and reliability of parameters including cervical discs herniation volume,C2-6 Cobb angle,and cervical(C3-C7)curvature.

Objective:To investigate the clinical characteristics and management status of children with Turner syndrome (TS) in China.Methods:As a cross-sectional study, 1 089 TS patients were included in the database of the National Collaborative Alliance for the Diagnosis and Treatment of Turner Syndrome from August 2019 to November 2023. Clinical characteristics (growth development, sexual development, organ anomalies, etc.), karyotypes, auxiliary examinations, and treatments were collected and analyzed.Results:Among the 1 089 TS cases, 809 were recorded karyotypes. The karyotype distribution was as follows: 45, X in 317 cases (39.2%), X chromosome structural variants (including partial deletions of p or q arm, ring chromosome, and marker chromosome) in 89 cases (11.0%), 45, X/46, XX mosaicism in 158 cases (19.5%), mosaicism with X chromosome structural variants in 209 cases (25.8%), and presence of Y chromosome material in 36 cases (4.4%). Among the 824 TS cases, the age of diagnosis was 9.7(6.4, 12.2) years, with a height standard deviation score (HtSDS) of -3.1±1.2. Five hundred and fifty three cases underwent growth hormone (GH) stimulation test, and 352 cases (63.7%) had GH peak values <10 μg/L and 75.9% (577/760) had low IGF1 levels, with IGF1 SDS ≤-2 accounting for 38.2% (290 cases). Among 471 cases aged ≥8 years, 132 cases (28.0%) showed spontaneous sexual development (mean bone age (11.0±1.7) years), 10 cases had spontaneous menarche (mean bone age (12.0±2.2) years), and 2 cases had regular menstrual cycles. Common physical features included cubitus valgus (311 cases (28.5%)), neck webbing (188 cases (17.2%)), low posterior hairline (185 cases (17.0%)), shield chest (153 cases (14.0%)), high arched palate (127 cases (11.6%)), short fourth metacarpal (43 cases (3.9%)), and spinal abnormalities (38 cases (3.5%)). Congenital cardiovascular and urogenital anomalies occurred in 91 cases (19.4%) and 66 cases (12.0%)respectively. Abdominal ultrasound in 33 cases (7.2%) indicated fatty liver, hepatomegaly, intrahepatic bile duct stones, and splenomegaly. Among 23 cases undergoing oral glucose tolerance test (OGTT) test, 2 were diagnosed with diabetes mellitus and 4 with impaired glucose tolerance. Following diagnosis, 669 cases (80.7%) received rhGH treatment at a chronological age of (9±4) years and bone age of (8.3±3.2) years. Additionally, 112 cases (19.4%) received sex hormone replacement therapy starting at the age of (14±4) years and bone age of (12.6±1.2) years.Conclusions:The karyotypes of 45, X and mosaicism were most common in Chinese children with TS. The clinical manifestations were mainly short stature and gonadal dysplasia. However, a few TS children could be in the normal range of height, and some cases among those aged of ≥8 years old had spontaneous sexual development. Some exhibited physical features, congenital cardiovascular and urogenital anomalies, and dysfunction of the hypothalamic-pituitary-IGF1 axis. Moreover, a few of them developed impaired glucose tolerance and diabetes mellitus. Following diagnosis, most of the patients received rhGH treatment, and a few of them received sex hormone replacement therapy.

Objective To observe the effects of minimally invasive puncture and drainage combined with urokinase on the severity of cerebral edema,serum malondialdehyde(MDA),matrix metalloproteinase-9(MMP-9)and intercellular adhesion molecule-1(ICAM-1)after cerebral hemorrhage.Methods A total of 82 patients with hypertensive intracerebral hemorrhage(HICH)admitted to our hospital were retrospectively enrolled between January 2020 and September 2022.According to different treatment methods,they were divided into two groups:observation group(44 cases,control group combined with UK)and control group(38 cases,control treatment).The cerebral edema volume,nerve function[National Institutes of Health Stroke Scale(NIHSS)]and serological indexes(MDA,MMP-9,ICAM-1)in both groups were observed.The occurrence of postoperative complications was recorded.The prognosis[scores of Glasgow Outcome Scale(GOS)and activity of daily living scale(ADL),death]in the two groups was compared at 3 months after surgery.Results At 14d after surgery,peripheral cerebral edema volume in the observation group was smaller than that in the control group[(14.76±2.39)ml vs(16.87±2.24)ml,P＜0.05],NIHSS score was lower than that in the control group[(11.12±1.96)points vs(11.96±1.65)points,P＜0.05].The levels of serum MDA,MMP-9 and ICAM-1 in the observation group were(8.65±1.16)nmol/ml,(96.17±19.34)ng/ml and(624.31±32.76)μg/ml,respectively,which were lower than those in the control group[(16.14±2.16)nmol/ml,(120.47±21.32)ng/ml,(661.24±35.21)μg/ml,P＜0.05].There was no significant difference in incidence of postoperative complications between the observation group and the control group(9.09％vs 18.42％,P＞0.05).There was no death in either group within 3 months after surgery.At 3 months after surgery,GOS and ADL scores in the observation group were(4.03±0.92)points and(71.21±12.65)points,which were higher than those in the control group[(3.52±1.12)points,(62.98±15.58)points,P＜0.05].Conclusion The control combined with UK can effectively control cerebral edema,down-regulate MDA,MMP-9 and ICAM-1 levels,protect nerve function and improve prognosis in HICH patients.

Objective:To retrospectively analyze the clinical characteristics of 193 Chinese patients with McCune-Albright syndrome (MAS).Methods:By using keywords " McCune-Albright syndrome", " Albright syndrome", or " fibrous dysplasia " as the search terms, 193 cases of MAS reported in China from January 1990 to November 2022 from the Wanfang data, CNKI, VIP, PubMed, and Embase databases were obtained, and their clinical data was retrospectively analyzed. Intergroup comparisons were carried out by using t test, Mann-Whitney U test, and χ2 test. Results:The 193 MAS patients had included 42 males and 151 females, with the median first-visit age of females being younger than males. The typical triad group had accounted for 46.1% of patients, and the middle first-visit and diagnosis age was younger than the atypical group. The primary reason for first-visit in males of MAS was fibrous dysplasia (FD), whilst that in females of MAS was peripheral precocious puberty (PPP). FD has occurred in 84.5% of the patients, with an average age of onset age being 6.1 years old, and 90% was ≤ 16 years of age. Endocrine hyperfunction was found in 79.3% of the patients, with a higher proportion in females compared with males ( P<0.05). Pituitary involvement was seen in 21.8% of the patients, and the incidence of craniofacial FD and cranial nerve compression was significantly higher in those with elevated growth hormone (GH) than without ( P<0.05). Café-au-Lait Spots were noted in 86.5% of the patients, and 28.3% (28/99) had located on the different side of FD. Conclusion:Most MAS patients had atypical manifestations and multi-systemic involvement. It is more common and occurs earlier in females. The most common reasons for initial diagnosis in male and female patients were FD and PPP, respectively. Patients with elevated GH should be examined for cranial nerve compression.

Objective:To investigate the risk factors for the occurrence and poor in-hospital prognosis in patients with peripartum cardiomyopathy (PPCM).Methods:The clinical data of 35 patients with PPCM and 35 healthy pregnant women in Xuanwu Hospital, Capital Medical University and Beijing Friendship Hospital Affiliated to Capital Medical University from January 2003 to January 2022 were retrospectively analyzed. The personal histories, laboratory examination, imaging examination, cardiac function outcome, etc were collected. According to the left ventricular ejection fraction (LVEF) at discharge, the patients with PPCM were divided into in-hospital recovery group (LVEF≥50%, 18 cases) and prolonged disease group (LVEF<50%, 17 cases). Multivariate Logistic regression analysis was used to analyze independent risk factors of poor in-hospital prognosis in patients with PPCM.Results:Among 35 patients with PPCM, the age was (29.81 ± 5.37) years old, 17 cases (48.57%) complicated with gestational hypertension, 6 cases (17.14%) complicated with gestational diabetes mellitus, 24 cases (68.57%) of New York Heart Association (NYHA) cardiac function classification was Ⅲ to Ⅳ class, and 4 cases died (11.43%). The gestational age in patients with PPCM was significantly shorter than that in healthy pregnant women: (36.26 ± 4.27) weeks vs. (38.54 ± 4.59) weeks, the rates of multiple pregnancy and gestational hypertension were significantly higher than those in healthy pregnant women: 17.14% (6/35) vs. 2.86% (1/35) and 48.57% (17/35) vs. 11.43% (4/35), and there were statistical differences ( P<0.05 or <0.01). Compared with hospital recovery group, the patients in protracted disease group had shorter gestational age, larger left ventricular end-diastolic diameter, higher serum creatinine, C-reactive protein and amino-terminal pro-brain natriuretic peptide (NT-proBNP), worse NYHA cardiac function classification, and there were statistical differences ( P<0.05 or <0.01); but there were no statistical difference in LVEF at the first diagnosis and troponin I between two groups ( P>0.05). Multivariate Logistic regression analysis result showed that elevated creatinine was an independent risk factor for poor in-hospital prognosis in patients with PPCM ( OR = 4.554, 95% CI 1.536 to 13.684, P = 0.018). Conclusions:The gestational hypertension may be a risk factor for PPCM. The gestational hypertension, earlier onset time, enlarged left ventricular end-diastolic diameter, high NT-proBNP, high C-reactive protein, high creatinine and high cardiac function NYHA classification may be risk factors for poor in-hospital prognosis in patients with PPCM; and elevated creatinine is an independent risk factor for poor in-hospital prognosis in patients with PPCM.

Objective:To observe the characteristics and outcomes of hospital-acquired venous thromboembolism (HA-VTE), and to guide the clinic to take preventive measures for high-risk patients to reduce the incidence of HA-VTE.Methods:The clinical data of 1 570 hospitalized patients with HA-VTE from December 2013 to December 2019 in Xuanwu Hospital, Capital Medical University were retrospectively analyzed, including the basic information, department, risk factor evaluation of venous thromboembolism (VTE), prevention and outcomes, etc.Results:During the period, the total incidence of HA-VTE was 0.50% (1 570/317 047). The annual incidence of HA-VTE increased year by year, from 0.19% (85/44 737) in 2014 to 0.82% (564/68 780) in 2019. The incidence of HA-VTE in elderly patients (age ≥65 years old) was significantly higher than that in young and middle-aged patients (age form 18 to 64 years old): 0.96% (970/100 768) vs. 0.28% (600/216 279), and there was statistical difference ( χ2 = 654.96, P<0.01). There was no statistical difference in the incidence of HA-VTE between male and female: 0.51% (780/151 617) vs. 0.48% (790/165 430), χ2 = 2.19, P>0.05. HA-VTE patients were mainly distributed in the neurology department, emergency department, neurosurgery department, orthopedics department, vascular surgery department, general surgery department, etc, with the highest proportion of 27.83% (437/1 570) in neurology department. The departments with high incidence of HA-VTE were intensive care unit, emergency department, stroke center, orthopedics department, rehabilitation department and neurology department, with the highest incidence of 7.69% (7/91) in intensive care unit. The hospital stay in patients with HA-VTE was significantly longer than that in patients without HA-VTE: 14 (9, 20) d vs. 7 (3, 11) d, and there was statistical difference ( Z = - 39.75, P<0.01). During hospitalization, 94 patients died, and 7 cases (0.45%, 7/1 570) were directly caused by HA-VTE. Only 0.13% (2/1 570) of the patients underwent the risk factor evaluation of VTE. Conclusions:The annual incidence of HA-VTE has a clear upward trend, and the incidence of critical illness and elderly patients is the highest. HA-VTE significantly prolonged the average hospital stay of patients and increased the risk of death. Screening and evaluation should be strengthened, high-risk groups should be identified, and active preventive measures should be taken to reduce the risk of HA-VTE.

Objective:To investigate the relationship between glycemic variability and glycosylated hemoglobin (HbA1c) level during follow-up in elderly male patients with type 2 diabetes.Methods:Retrospective cohort study. A total of 200 elderly male patients who received continuous glucose monitoring from January 2007 to January 2011 were recruited in the Second Medical Center of PLA General Hospital. The subjects were divided into two groups according to baseline mean amplitude of glycaemic excursion (MAGE) level, including MAGE <3.9 mmol/L group ( n=114) and MAGE ≥3.9 mmol/L group ( n=86). The correlation between baseline MAGE and mean HbA1c during follow-up were evaluated by univariate Pearson correlation analysis and multivariate linear regression analysis. Results:Baseline characteristics including age, body mass index, waist circumference, smoking, drinking, fasting blood glucose, blood lipid and blood pressure were comparable between MAGE <3.9 mmol/L group and MAGE ≥3.9 mmol/L group. The average follow-up period was 12.5 years. The mean HbA1c during follow-up in MAGE ≥3.9 mmol/L group was significantly higher than that in MAGE <3.9 mmol/L group (7.23%±0.72% vs. 6.91%±0.77%, t=-2.94, P=0.004). The proportion of mean HbA1c <7.0% during follow-up in MAGE ≥3.9 mmol/L group was 44.2% (38/86), which was significantly lower than that in MAGE <3.9 mmol/L group [60.5% (69/114), χ 2=5.26, P=0.022]. In univariate analysis, MAGE at baseline was correlated with the mean HbA1c during follow-up ( r=0.306, P<0.001). Multivariate linear regression analysis suggested that the baseline MAGE remained an independent influential factor of mean HbA1c ( β=0.09, 95% CI: 0.03 to 0.15, P=0.006, R2=0.31) after several confounding factors were adjusted. Conclusions:With the increased glycemic variability at baseline, mean HbA1c level during follow-up is accordingly elevated. The glycemic variability at baseline is independently related to mean HbA1c level during follow-up in elderly male patients with type 2 diabetes.