BACKGROUND:It has been proved clinically that adhesion of fibrous scar with the dura mater or nerve root after lumbar operation is an important factor for postoperative symptoms,such as postoperative pain and numbness. OBJECTIVE:To verify the inhibitory effect of autologous ligamentum flavum on the formation of epidural fibrous scar after lumbar surgery and explore the possible molecular biological mechanism. METHODS:Forty-eight Japanese white rabbits(6-8 months old)were randomly divided into three groups:a ligamentum flavum preservation group,a ligamentum flavum non-preservation group,and an autologous fat reposition group.A lumbar laminectomy model was established in all the three groups of rabbits,and rabbit epidural tissues were collected at 3 and 6 weeks after modeling.Hematoxylin-eosin staining was used to observe histological changes and the number and density of fibroblasts,VG staining was used to observe the percentage of collagen fiber area,and immunohistochemistry was used to observe the expression of transforming growth factor β1 and Smad3 proteins. RESULTS AND CONCLUSION:Hematoxylin-eosin staining results revealed that fibroblasts in the ligamentum flavum preservation group were few and loosely arranged,while the cells in the ligamentum flavum non-preservation and autologous fat reposition groups were more numerous and closely arranged.The number density of fibroblasts in the ligamentum flavum preservation group was lower than that in the ligamentum flavum non-preservation and autologous fat reposition groups at 3 and 6 weeks after surgery(P＜0.05);however,there was no significant difference between the latter two groups.VG staining results showed that the collagen fibers in the ligamentum flavum preservation group were sparse and distributed unevenly,while a lot of red collagen fibers were gathered in the ligamentum flavum non-preservation and autologous fat reposition groups.The area percentage of collagen fibers in the ligamentum flavum preservation group was lower than that in the ligamentum flavum non-preservation and autologous fat reposition groups at 3 and 6 weeks after surgery(P＜0.05),but there was no significant difference between the latter two groups.The results of immunohistochemistry showed that the degree of positive staining of retained histone the ligamentum flavum preservation group was significantly lower than that of the other two groups.The absorbance value of transforming growth factor β1 and Smad3 in the ligamentum flavum preservation group was significantly lower than that in the other two groups at 3 and 6 weeks after surgery(P＜0.05),but there was no significant difference between the latter two groups.To conclude,there are different degrees of epidural fibrous scar formation after lumbar surgery.If the ligamentum flavum is preserved,it can help to reduce the number of epidural fibroblasts as well as the formation of collagen fibers,thus reducing the adhesion of the fibrous scar tissue to the dural sac and nerve root.The mechanism is not only a purely mechanical blockade,but also to reduce the formation of epidural fibrous scar by interfering with the transforming growth factor β1/Smad3 signaling pathway.

Tiepishihu(Dendrobii officinalis Caulis)is a medicinal and food source herbal medicine with the effect of benefiting stomach and promoting fluid,nourishing Yin and clearing heat.It has rich chemical components and pharmacological activities,with anti-inflammatory,anti-bacterial,anti-oxidation,anti-tumor,immunomodulatory,blood press regulation,hypoglycemic effects.It is not only used as medicinal food and health care products,but also widely used in medicine,such as Shihu Yeguang Wan,Compound fresh dendrobium granules and other drugs,with high medicinal and economic value.This paper summarized the resource distribution,chemical composition,pharmacological activities,and medicine and food of Dendrobii officinalis Caulis,and analyzed its application status,laying a theoretical foundation for the sustainable development,medicinal and food homologous development and comprehensive utilization of Dendrobii officinalis Caulis.

Objective: To evaluate the differences of serum total light chain(sTLC), urine total light chain(uTLC) and serum free light chain(sFLC) in different stages of chronic kidney disease(CKD) and their correlation with renal function indexes. To investigate the predictive value of light chain indexes in CKD staging. Methods: 292 patients with CKD were analyzed retrospectively, and plasma cell diseases, acute kidney injury and tumor diseases were excluded. According to the estimated glomerular filtration rate(eGFR), CKD patients were divided into five groups from CKD 1 stage to CKD 5 stage. The levels of sTLC, uTLC, sFLC and corresponding biochemical indexes of CKD patients were detected, and the differences and correlations among the indexes of each group were compared. The receiver operating curve(ROC curve) was used to analyze the predictive value of each light chain index in CKD stage, with CKD1-2 stage combined as control group and CKD3-5 stage combined as case group. Results: There was no significant difference in sTLC κ, sTLC λ, sTLC κ/λ and sFLC κ/λ among CKD1-5 stage(P>0.05). There were significant differences between sFLC κ, sFLC λ and uTLC κ, uTLC λ among CKD1-5 stage(P<0.05), which increased with the increase of CKD staging. The correlation between sFLC κ, sFLC λ and serum creatinine(Scr), blood urea nitrogen(BUN), eGFR were better than uTLC κ, uTLC λ(P<0.001). The sTLC κ, sTLC λ, sTLC κ/λ and sFLC κ/λ had no correlation with renal function indexes(P>0.05). The best critical points of sFLC κ and sFLC λ for predicting CKD3-5 stage were 35.4 mg/L and 52.8 mg/L, and AUC was 0.916(0.883-0.949) and 0.915(0.881-0.949), which were higher than uTLC κ and uTLC λ,AUC was 0.811(0.754-0.869) and 0.787(0.728-0.846), respectively. Conclusion With the increase of CKD staging, the levels of sFLC and uTLC gradually increase. The sFLC and uTLC can effectively predict patients with CKD3 and above, which has an important reference value in stratified management of patients with CKD.

Objective:To study whether the excitability of facial nerve motor nucleus is increased in patients with facial spasm to further study the mechanism of facial spasm.Methods:Thirty patients with HFS underwent MVD in our hospital from April 2018 and March 2019 were chosen in our study. The amplitude and threshold voltage of facial nerve motor evoked potential (FNMEP) of the affected side and healthy side were monitored and compared by using monopulse stimulation and multi-pulse stimulation. The changes of FNMEP amplitude in patients before and after sevoflurane inhalation were monitored.Results:Stable facial motor evoked potential could be stimulated by monopulse in 26 patients (89.7%) on the affected side, while only 5 patients (17.2%) on the healthy side, showing statistical difference between the two sides ( P<0.05); there was no significant difference in FNMEP amplitude between the affected side and the healthy side ([207.2±62.1] μV vs. [180.2±55.0] μV, P>0.05); the average threshold voltage of neuromotor evoked potential on the affected side was (140.3±26.8) V, which was significantly lower than that in the healthy side ([177.0±23.2] V, P<0.05). The amplitude of FNMEP on the affected side was (207.2±62.1) μV, (133.0±36.5) μV, and (70.4±40.2) μV, respectively, before sevoflurane inhalation, and at 0.5 fold of minimun alveolar concentration (MAC) and 1.0 fold of MAC concentrations, with significant differences ( P<0.05). Conclusion:In patients with hemifacial spasm, there is increased excitability of facial nerve motor nucleus on the affected side, which to a certain extent supports the central theory of hemifacial spasm pathogenesis.

Objective To evaluate the efficacy and safety of nerve combing for trigeminal neuralgia without neurovascular decompression.Methods A retrospective review of clinical data of 281 patients with trigeminal neuralgia,admitted to our hospital from January 2008 to January 2016,was performed.The patients were divided into two groups:patients from group A were treated by nerve combing (n=32),and patients from group B were treated by microvascular decompression (n=249).The two groups were compared in terms of surgical outcomes and postoperative complications.Results The pain was completely relieved in 90.6％ patients of group A (29/32) and 94.4％ patients of group B (235/249),respectively;the mean follow-up duration was 62.5 months in group A,and 78.1％ patients (25/32) were completely relieved;the mean follow-up duration was 59.8 months in group B,and 84.1％ patients (201/239)were completely relieved;no statistically significant differences existed in the surgical outcomes and long-term outcomes between the two groups (P＞0.05).No complications related to severe disability or death were noted in the two groups.The rate of facial numbness in patients from group A (71.9％) was significant higher than that in group B (2.5％,P＜0.05).Conclusions Nerve combing is a safe and effective treatment for trigeminal neuralgia without neurovascular decompression.Most patients treated with nerve combing experienced some degrees of facial numbness.

This paper aimed to review the recent literature on the TCM treatment for stroke sequelae. The content summarized and discussed the definition of stroke sequelae, herbalmedicine, TCM patents, acupuncture and so on. Sequelae of stroke’s pathogenesis was mainly caused by deficiency generating stasis, so the treatment principles were to tonifying Qi and blood and promote circulation and remove stasis with the common prescriptions, such asBuyang-Huanwudecoction,Xuefu-Zhuyu decoction andDihuang-Yinzi. Meanwhile, Chinese medicine patents and acupuncture treatment canimprove the brain function and ADL.

Objective To observe the effect of swallowing training exercise for promoting rehabilitation of swallowing dysfunction after skull base tumor surgery. Methods We averagedly divided 86 patients with swallowing dysfunction into experimental group and control randomly, and the patinets of control group received routine treatment and care, the patients of experimental group not only on the basis of routine treatment and but also received a self-designed swallowing training exercise. Results The effective rate of swallowing function rehabilitation was 100. 0% in the experimental group while it was 65. 1% in the control group (U=360. 5,P<0. 01). The length of hospitalization in the experimental group was lower than that of the control group. Conclusions Swallowing training exercise can promote functional recovery, shorten hospital stay and improve the quality of life of patients.

Objective To investigate the role and value of the biliary stent in the treatment of large common bile duct stones. Methods Thirty-two patients with large common bile duct stones were underwent plastic biliary stenting after endoscopic stone extraction with oddi sphincterotomy, and were followed up for 6 months. Results Thirty-two patients were successfully placed biliary stents. The postoperative jaundice, abdominal pain and other symptoms were alleviated. The secondary endoscopic retragrade cholang iopancreatography (ERCP) was performed six months after surgery. Large stones disappeared in 3 cases, 25 cases were reduced to varying degrees, 4 cases showed no obvious narrowing in 32 patients with biliary stones. Twenty-nine patients with residual stones were taken stone again. The operation was successful in 25 cases . Four cases continued to be observed the drainage of biliary since the difficulties for taking stone. The success rate of treatment of large common bile duct stones by biliary stent was 87.5%. Conclusion The therapy of large common bile duct stones by biliary stent is of simple, short operation time, fewer complications, satisfactory results, safe and effective advantages.

Objective To investigate the Effects of thyroxine on the level of serum homocysteine and urinary albumin excretion rate in elderly patients with early diabetic nephropathy and subclinical hypothyroidism.Methods Seventy-five patients with early diabetic nephropathy and subclinical hypothyroidism were randomly divided into levothyroxine treatment group and conventional treatment group.Urinary albumin excretion rate (UAER),serum levels of homocysteine,creatinine,and lipids were measured at both pre-and post-treatment of 48 weeks.Results After treatment,serum total cholesterol,low density lipoprotein-cholesterol,triglyceride,thyrotropin,homocysteine,UAER,and serum creatinine in the levothyroxine treatment group were significantly lower than those in the conventional treatment group [(-0.52 ± 0.12 vs 0.31 ± 0.40) mmol/L,(-0.33 ± 0.22 vs 0.24 ± 0.36) mmol/L,(-0.16±0.18 vs0.19±0.29)mmol/L,(-4.4 ± 1.2 vs 1.2 ±0.8)mIU/L,(-1.4 ±2.0 vs0.9± 1.0)mmol/L,(-13 ± 13 vs 10 ± 7) pg/ml,(-2 ± 2 vs 3 ± 2) μmoL/L,respectively,all P＜0.01].Conclusions Treatment with levothyroxine could significantly improve serum lipid profiles and reduce homocysteine,UAER,and creatinine,and exert a protective effect on the kidney in the elderly patients with early diabetic nephropathy and subclinical hypothyroidism.

Sixty patients with early diabetic nephropathy (DN) and normal blood pressure were randomly divided into telmisartan treatment and control groups.And the blood biochemical parameters,urinary albumin excretion rate (UAER),the serum levels of homocysteine (HCY) and transforming growth factor-β1 (TGF-β1) were measured at both pre- and post-treatment of 24 weeks.After treatment,the levels ofUAER,HCY [(61 ±26) vs.(98±38) mg/L,(11.70 ±2.86) vs.(14.4±2.8) μmol/L (P＜ 0.01 ) ]and homeostasis model of insulin resistance index,TGF-β1 [ ( 3.17 ± 0.66) vs.( 3.60 ± 0.87 ),(66 ± 14) vs.(77 ± 17 )U/L respectively (P ＜ 0.05 )]in the telmisartan group were significantly lower than those in the control group.It indicated that telmisartan could improve the insulin sensitivity,significantly decrease the serum levels of HCY and TGF-β1,reduce UAER and exert kidney protection effects in the patients with early DN.