Clinical analysis of selective tracheostomy necessary for patients undergoing head and neck surgery with free flap reconstruction / 北京大学学报(医学版)

OBJECTIVE@#To discover the factors that may affect the use of selective tracheostomy among patients who have undergone head and neck surgeries with free flap reconstruction, so that the patients will not need tracheostomy nor receive the unnecessary treatment.@*METHODS@#Five hundred and thirty-three patients who had undergone head and neck surgery with free flap reconstruction operated by the same team of surgery at Department of Oral and Maxillofacial Surgery at Peking University School of Stomatology from 2015 to 2016 were reviewed. Three hundred and twenty-one (60.2%) of these patients underwent selective tracheostomy. All the patients' demographic information, operation-related information, prior treatments, comorbidities and complications were recorded and analyzed.@*RESULTS@#The patients with defects of the tongue, mouth floor, oropharynx and bilateral mandible, who underwent neck dissection and with previous radiotherapy and smoking habit were more likely to get selective tracheostomy. Usage of bulky soft tissue flap might also add to the risk of airway obstruction and the need of selective tracheostomy, while other factors were not significantly related to the risk of postoperative airway obstruction and the patients could be kept safe without selective tracheostomy. Most cases without tracheostomy were kept safe except one case, while 8.39% of the patients with tracheostomy suffered from tracheostomy related complications, mainly pneumonia and hemorrhage of the tracheostomy wound, yet none led to serious consequences or even death.@*CONCLUSION@#Selective tracheostomy is not necessary for patients who have undergone head and neck surgeries with free flap reconstruction except that there are defects at the tongue, oropharynx and mandible. Neck dissection, bulky soft tissue flap reconstruction, previous radiotherapy and smoking habit may also add to the risk of postoperative airway obstruction, while a favorable decision would involve a combination of all the above factors to assure the safety of the postoperative airway for the patients undergone head and neck surgeries with free flap reconstruction.

Clinicopathologic analysis of micro and mini parotid gland tumors / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinicopathological characteristics of micro and mini parotid gland tumors and to provide reference for their clinical diagnosis and treatment.@*METHODS@#Patients with parotid gland tumors treated in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from December 2012 to April 2020 were selected. Relevant clinical data of the patients with tumor diameter ≤20 mm detected by preoperative CT were collected to analyze the clinicopathological characteristics and prognosis of micro and mini parotid gland tumors. And the collected data were divided into two groups with diameter 11-20 mm and diameter ≤10 mm according to tumor diameter measured by preoperative CT. The clinicopathological differences between the two groups were statistically analyzed.@*RESULTS@#A total of 2 067 patients with primary epithelial parotid gland tumors were collected, and 685 patients with tumor diameter ≤20 mm were examined by CT, accounting for 33.1%. The ratio of male to female patients with micro and mini parotid gland tumors was 1 ∶1.93, the average age was (45.3±13.8) years (12-83 years), and the median course of disease was 12 months (1 week to 30 years). Among them, 635 cases (92.7%) were benign tumors, 50 cases (7.3%) were malignant tumors, and the ratio of benign to malignant was 12.7 ∶1. The most common benign tumor was pleomorphic adenoma, and the most common malignant tumor was mucoepidermoid carcinoma. The micro and mini parotid gland tumors were divided into 11-20 mm group (n=611) and ≤10 mm group (n=74), the clinical characteristics comparison of the two groups of gender ratio, average age, course of di-sease had no statistical difference (P>0.05). In the 11-20 mm diameter group, the percentage of benign and malignant tumor was 92.8% (567/611) and 7.2% (44/611) respectively, and the ratio of benign to malignant tumors was 12.9 ∶1. In the ≤10 mm diameter group, the percentage of benign and malignant tumor was 91.9% (68/74) and 8.1% (6/74) respectively, and the ratio of benign to malignant tumors was 11.3 ∶1. There was no significant difference between the two groups (P>0.05). Fifty patients with malignant tumor were followed up for the median follow-up period of 39.5 months (1-91 months). Local recurrence occurred in 2 patients with one death. The overall 2-year survival rate was 93.7% and the 5-year survival rate was 89.3%.@*CONCLUSION@#The majority of micro and mini parotid gland tumors was benign lesion. There was a good prognosis for micro and mini parotid gland carcinoma. Early surgical treatment was recommended for micro and mini parotid gland tumors.

Association between short-term exposure to ambient nitrogen dioxide and the risk of heart failure hospitalization / 中华预防医学杂志

Objective: To assess the association between short-term exposure level of nitrogen dioxide and the hospitalization risk of heart failure. Methods: Based on China-PEACE Retrospective Heart Failure Study, 117 364 hospitalized patients with heart failure were recruited from 92 hospitals in 62 cities throughout China between January 1, 2015 and December 31, 2015. The daily exposure level of nitrogen dioxide, temperature, and humidity in the same cities during the same period were also collected. We applied the generalized additive model and Bayesian hierarchical model to quantify the lagged effect and cumulative effect of short-term (0-3 days) exposure to ambient nitrogen dioxide on the hospitalization risk of heart failure. We further conducted stratified analyses by age, region, and season to identify any difference in the associations between short-term nitrogen dioxide exposure and heart failure among subgroups. Results: The mean age for participants in the analysis was (70.32±12.22) years. The median, minimum and maximum of daily nitrogen dioxide concentration in 62 cities from January 1, 2015 to December 31, 2015 was 26.4 μg/m3, 2.33 μg/m3 and 150.25 μg/m3, respectively. The exposure level of nitrogen dioxide at the same day was associated with the hospitalization risk of heart failure (OR=1.022, 95%CI: 1.012, 1.031). Significant effects were also observed in the moving average concentrations from lag 0-1 to lag 0-3 day (OR=1.020, 95%CI: 1.009, 1.030; OR=1.016, 95%CI: 1.004, 1.028; OR=1.013, 95%CI: 1.001, 1.026). Moreover, all of the associations between short-term exposure to nitrogen dioxide and the risk of heart failure hospitalization were statistically significant, with no significant difference in all subgroups stratified by age, region, and season. Conclusion: A higher level of short-term exposure to nitrogen dioxide could trigger more hospitalizations with heart failure.

Application of mixed reality technique for the surgery of oral and maxillofacial tumors / 北京大学学报(医学版)

OBJECTIVE@#To explore the application of mixed reality technique for the surgery of oral and maxillofacial tumors.@*METHODS@#In this study, patients with a diagnosis of an oral and maxillofacial tumor who were referred to Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from December 2018 to January 2020 were selected. The preoperative contrast-enhanced computed tomography data of the patients were imported into StarAtlas Holographic Medical Imaging System (Visual 3D Corp., Beijing, China). Three-dimensional (3D) model of tumor and key structures, such as skeleton and vessels were reconstructed to three-dimensionally present the spatial relationship between them, followed with the key structures delineation and preoperative virtual surgical planning. By using mixed reality technique, the real-time 3D model was displayed stereotactically in the surgical site. While keeping sterile during operation, the surgeon could use simple gestures to adjust the 3D model, and observed the location, range, and size of tumor and the key structures adjacent to the tumor. Mixed reality technique was used to assist the operation: 3D model registration was performed for guidance before tumor excision; intraoperative real-time verification was performed during tumor exposure and after excision of the tumor. The Likert scale was used to evaluate the application of mixed reality technique after the operation.@*RESULTS@#Eight patients underwent mixed reality assisted tumor resection, and all of them successfully completed the operation. The average time of the 3D model registration was 12.0 minutes. In all the cases, the surgeon could intuitively and three-dimensionally observe the 3D model of the tumor and the surrounding anatomical structures, and could adjust the model during the operation. The results of the Likert scale showed that mixed reality technique got high scores in terms of perceptual accuracy, helping to locate the anatomical parts, the role of model guidance during surgery, and the potential for improving surgical safety (4.22, 4.19, 4.16, and 4.28 points respectively). Eight patients healed well without perioperative complications.@*CONCLUSION@#By providing real-time stereotactic visualization of anatomy of surgical site and guiding the operation process through 3D model, mixed reality technique could improve the accuracy and safety of the excision of oral and maxillofacial tumors.

Application of computer-assisted design for anterolateral thigh flap in oral and maxillofacial reconstruction / 北京大学学报(医学版)

OBJECTIVE@#To investigate the feasibility and accuracy of using digital technology to design anterolateral thigh flap (ALTF) in oral and maxillofacial defect reconstruction.@*METHODS@#Ten cases underwent oral and maxillofacial defects reconstruction with ALTFs in Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from June 2019 to Oct. 2019 were enrolled. There were 7 males and 3 females with the mean age of 47.1 years. Preoperative high frequency color Doppler ultrasound examination was performed to detect the perforators of ALTF. CT data of the thigh was imported in DICOM (digital imaging and communications in medicine) format to the Proplan CMF 3.0 software (Materalise, Belgium), then virtual harvest of ALTF was performed according to the points of perforators detected by high frequency color Doppler ultrasound and the virtual flap volume was calculated by Proplan CMF 3.0 software. ALTF was harvested followed by preoperative virtual design, and the actual flap volume of ALTF was measured by the draining method during the surgery. Finally, the accuracy rate of using high frequency color Doppler ultrasound to detect perforators of ALTFs was calculated, and the differences between the virtual flap volume measured by Propaln CMF 3.0 software and the actual volume of ALTF by the draining method were compared using paired samples T test.@*RESULTS@#Fifteen perforators in the flaps area of 10 patients who underwent oral and maxillofacial defects reconstruction with ALTFs were detected by high frequency color Doppler ultrasound, and 16 perforators were identified during the surgery, with the accuracy rate of 87.5%. The flaps size ranged from 5 cm×7 cm to 8 cm×15 cm, all the 10 flaps survived. The donor sites were primarily closed without skin graft, and no surgery complication was found on the donor site. The mean flap volume measured by Propaln CMF 3.0 software was 71.4 cm³ (range: 36.1-188.4 cm³), and the mean volume measured by the draining method was 70.7 cm³ (range: 38.3-172.5 cm³). There was no significant difference between the virtual flap volume measured by Propaln CMF 3.0 software and the actual volume measured by draining method (t=0.318; P=0.758).@*CONCLUSION@#Preoperative virtual design of ALTF has good feasibility and accuracy and can be used to guide the harvest of ALTF during operation.

Effect of Jiawei Changfengyin with Retention Enema Therapy on Th1/Th2 in Patients with Acute Radiation Proctitis / 中国实验方剂学杂志

Objective: To discuss the efficacy of Jiawei Changfengyin with retention enema therapy for acute radiation proctitis and investigate its influence on regulating levels of helper T cell(Th)1/Th2. Method: One hundred and twenty-eight patients were randomly divided into control group and observation group by random number table. Patients in control group (64 cases) got montmorillonite powder (3.0 g), dexamethasone (10 mg) and normal saline (100 mL), with retention enema therapy. Patients in observation group (64 cases) got Jiawei Changfengyin(Changfengyin+Xileisan+pearl powder), with retention enema therapy. Both groups of patients received enema once every night, and the treatment course was 4 weeks in both groups. Before and after treatment, scores of main symptoms, proctoscopy, routine examination of stool+occult blood, and KPS scores of quality of life were graded. Levels of Th1 cell factors[interleukin(IL)-1β, IL-8 and interferon-γ(IFN-γ)], Th2 cell factors (IL-4 and IL-10) were detected. Result: The total effective rate for comprehensive clinical efficacy was 95.31% in observation group, higher than 82.81% in control group (χ2=5.132, PPZ=2.764, PPPβ, IL-8 and IFN-γ in observation group were lower than those in control group, while levels of IL-4 and IL-10 were higher than those in control group (PConclusion: Jiawei Changfengyin can relieve symptoms of acute radiation proctitis, promote healing of rectal mucosa, improve quality of life, and regulate Th1/Th2 cytokines, with good repairing effect for intestinal mucosa.

Fungal endocarditis after heart prosthetic valve surgery:two case report and literature review on treatment strategies / 中国感染控制杂志

Objective To evaluate treatment strategies for fungal endocarditis after heart prosthetic valve surgery. Methods Two cases of severe fungal infection after heart prosthetic valves surgery were analyzed retrospectively, related literatures were reviewed.Results Two patients had fungal endocarditis after surgery,the valve function was affected,patients were hospitalized repeatedly after surgery.In case 1 ,fever occurred 45 days after cardiac sur-gery and patient was returned to the hospital for re-examination,emergency mitral valve replacement was performed under cardiopulmonary bypass,the postoperative vegetation culture suggested Aspergillus flavus.In case 2,the aortic wall vegetation was removed 5 months after heart surgery under cardiopulmonary bypass,pathology of post-operative vegetation suggested mucor.Two patients were promptly removed infection foci through surgery and trea-ted with standard antifungal agents,patient with Aspergillus infection died after rescue,and patient with mucor in-fection was cured,the latter was more powerful in antifungal therapy.Conclusion Prevention is the key to fungal endocarditis after heart prosthetic valve surgery,treatment should be prompt and effective,antifungal agents should be given in sufficient dose and course.

Expression of long non-coding RNA DGCR5 in gastric cancer and its clinical significance / 医学研究生学报

Objective Recent evidence points towards a close relationship between dysregulation of long non-coding RNA (lncRNA) and carcinogenesis and progression of various tumors including gastric cancer. The aim of this study was to investigate the expression of lncRNA DGCR5 in the gastric cancer tissue and plasma and its influence on the biological behavior of gastric cancer cells. Methods We collected tumorous and adjacent normal tissues from 96 gastric adenocarcinoma patients as well as plasma samples from 34 gastric cancer patients and another 34 healthy controls. We deter-mined the expression of DGCR5 by real-time fluorescent quantitative PCR,analyzed its correlation with the clinicopathological features of gastric cancer,observed the apoptosis, proliferation and invasiveness of the gastric cancer cells after overexpressing DGCR5, and detected the expressions of epithelial-mesenchymal transition (EMT)-associat-ed genes and proteins by Western blot. Results The expression of DGCR5 was significantly decreased in tumor tissue of the gastric canc-er patients as compared with that in the adjacent normal tissue,which was correlated with the advanced TNM stage and lymph node metastasis, and so was it in the plasma of the patients, which was also correlated with the TNM stage. The area under the ROC curve for the diagnosis of gastric cancer by the expression level of plasma DGCR5 was 0.722. Overexpressed DGCR5 induced significant apoptosis and inhibited the proliferation and invasion of gastric cancer cells,markedly promoted the expression of E-cadherin,and suppressed the expressions of N-cadherin,vimentin and Twist. Conclu-sion The expression of DGCR5 is significantly decreased in the tumor tissue and plasma of gastric cancer patients. The DGCR5 level in the plasma has a certain diagnostic value for gastric cancer. Overexpressed DGCR5 can reduce the proliferation and invasiveness of gastric cancer cells,increase their apoptosis,and inhibit EMT.

Surgical reconstruction of maxillary defects using computer-assisted techniques / 北京大学学报(医学版)

The maxilla is the most important bony support of the mid-face skeleton and is critical for both esthetics and function.Maxillary defects,resulting from tumor resection,can cause severe functional and cosmetic deformities.Furthermore,maxillary reconstruction presents a great challenge for oral and maxillofacial surgeons.Nowadays,vascularized composite bone flap transfer has been widely used for functional maxillary reconstruction.In the last decade,we have performed a comprehensive research on functional maxillary reconstruction with free fibula flap and reported excellent functional and acceptable esthetic results.However,this experience based clinical procedure still remainssome problems in accuracy and efficiency.In recent years,computer assisted techniques are now widely used in oral and maxillofacial surgery.We have performed a series of study on maxillary reconstruction with computer assisted techniques.The computer assisted techniques used for maxillary reconstruction mainly include:(1) Three dimensional (3 D) reconstruction and tumor mapping:providing a 3 D view of maxillary tumor and adjacent structures and helping to make the diagnosis of maxillary tumor accurate and objective;(2) Virtual planning:simulating tumor resection and maxillectomy as well as fibula reconstruction on the computer,so that to make an ideal surgical plan;(3) 3D printing:producing a 3D stereo model for prebending individualized titanium mesh and also providing template or cutting guide for the surgery;(4) Surgical navigation:the bridge between virtual plan and real surgery,confirming the virtual plan during the surgery and guarantee the accuracy;(5) Computer assisted analyzing and evaluating:making a quantitative and objective of the final result and evaluating the outcome.We also performed a series of studies to evaluate the application of computer assisted techniques used for maxillary reconstruction,including:(1)3D tumor mapping technique for accurate diagnosis and treatment of maxillary tumor;(2) Maxillary reconstruction with free fibula flap used computer assisted techniques;(3) Computer assisted orbital floor reconstruction after maxillectomy.The results suggested that computer assisted techniques could significantly improve the clinical outcome of maxillary reconstruction.

NOTCH signaling of the vascular niche prompts differentiation of functional HSCs from hPSCs / 军事医学

Objective To generate hemogenic endothelial cells(HECs)from human induced pluripotent stem cells (hiPSCs)in vitro in order to learn more about the mechanism by which the vascular niche affects HECs production and self -renewal.Methods hiPSCs with reporter gene runx1c were differentiated to hematopoietic cells by spinEB method.The CD34 positive cells were sorted by magnetic-activated cell sorting(MACS)at day 10 after hematopoietic differentiation. Afterwards,these CD34 positive cells were co-cultured with DLL4 overexpressed vascular niche cells VeraVec to further differentiate to HECs.The HECs derived from the hiPSCs were characterized by FACS.Results We first established an hiPSCs single cell culture method for spinEB differentiation.Single cell cultured hiPSCs with reporter gene runx 1c were differentiated to form embryonic bodies(EBs)by spinEB method.The HECs were enriched from the day 10.Meanwhile, we cultured the E4ORF1 transfected human umbilical vein endothelial cell(HUVEC)line(VeraVec)and examined the expression of NOTCH signaling pathway related genes.According to the results, VeraVec had a high expression level of NOTCH ligand DLL4 at both mRNA and protein levels.And the CD34 positive HECs were co-cultured with DLL4 overexpressed VeraVec cells,which promoted the expression of tdTomato during hematopoitic differentiation and increased HSCs production.Conclusion A method of inducing hiPSCs differentiation by spinEB has been established, which can enrich HECs.This model can be applied to study the mechanism by which the vascular niche promotes hematopoietic differentiation from hPSCs.The generated functional HSCs are of great social and military values for HSCs transplantation and battlefield radiation injury treatment.

Application of the microprobe dredging operation in the treatment of the meibomian gland dysfunction (MGD) / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To evaluate the function of the microprobe dredging technology in the treatment of meibomian gland dysfunction ( MGD ) and to provide fast, efficient, economical and practical method of treatment for meibomian gland dysfunction ( MGD) . METHODS:The 100μm diameter stainless steel wire was made as the microprobe with the total length of 3cm, which the needle was about 5mm and hand shank was about 2. 5cm. Selected 140 cases with dry eyes of meibomian gland dysfunction ( MGD ) , patients were divided into two groups and made them have comparability. Observation group ( n = 70 ) used microprobe to dredge meibomian gland pipe accompanied with drugs, hot compress and meibomian gland massage treatment. The control group (n=70) was given conventional drugs, hot compress and meibomian massage treatment. To compare the tear break-up time ( BUT) , efficient rate and the cure rate of the two groups after treatment of 1d, 1wk, 2wk, 1 mo, 2mo and 3mo. RESULTS: BUT were significantly prolonged in observation group and control group after treatment, and the observation group improved more obviously; the efficient rate and cure rate of the observation group were significantly higher than that of the control group after 1d, 1wk, 2wk, 1mo, 2mo and 3mo treatment. CONCLUSlON: Using microprobe to unclog the meibomian gland tube can provide the fast and efficient, economical and practical treatment for meibomian gland dysfunction ( MGD ) , which can be promoted in the clinical practice.

Preoperative 3T high field blood oxygen level dependent functional magnetic resonance imaging for glioma involving sensory cortical areas / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Localization of sensory cortical areas during the operation is essential to preserve the sensory function. Intraoperative direct electrostimulation under awake anesthesia is the golden standard but time-consuming. We applied 3T high field blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) to identify the relationship between glioma and cortical sensory areas preoperatively and to guide intraoperative direct electrostimulation for quick and precise localization.</p><p><b>METHODS</b>Five glioma patients with sensory cortex involvement by or next to the lesion had preoperative BOLD fMRI to determine the spatial relationship of cortical sensory areas to the tumours. Bilateral hand opposite movement was performed by these patients for fMRI. Precentral and postcentral gyri were identified by electrical stimulation during the operation. Karnofsky Performance Status scores of the patients' pre- and postoperative and the role of BOLD fMRI were evaluated.</p><p><b>RESULTS</b>The cortical sensory areas were all activated in five glioma patients involving postcentral gyrus areas by BOLD fMRI with bilateral hand opposite movement. The detected activation areas corresponded with the results from cortical electrical stimulation.</p><p><b>CONCLUSIONS</b>The relationship between cortical sensory areas and tumour can be accurately shown by BOLD fMRI before operation. And the information used to make the tumour resection could obtain good clinical results.</p>

Application of abdominal packing in non-trauma patients with severe abdominal hemorrhage / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the efficacy and safety of damage control surgery with abdominal packing in non-trauma patients with severe abdominal hemorrhage.</p><p><b>METHODS</b>A retrospective review of consecutive non-trauma patients who underwent abdominal packing to control severe abdominal hemorrhage between February 2002 and February 2007 were performed. The demographics, physiological parameters, surgical indications and procedures, mortality, morbidity and volumes of resuscitation were retrieved. The observed mortality was compared to those calculated from the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) and Portsmouth Predictor Equation (P-POSSUM) scores.</p><p><b>RESULTS</b>A total of 26 non-trauma patients were included in this study, with a mean age of (42.6 +/- 15.8) years (range, 18 - 72 years). The most common etiologies associated with the severe hemorrhage was necrotizing pancreatitis (11 cases), intestinal fistula (5 cases) and tumor (4 cases). Of the patients, 24 cases (92.4%) achieved hemostasis by simple packing, 1 achieved hemostasis by using packing and angiographic embolization, and the other one failed and died. The mean intra-operative blood loss during the initial procedure was 1253.8 ml. The physiological parameters which improved significantly after rewarming and resuscitation in ICU phase included: body temperature, systolic blood pressure, heart rate, arterial pH, base excess, hemoglobin, hematocrit, prothrombin time, and international normalized ratio. The mean duration of packing was 4.3 days. The mean length of SICU stay and hospital stay was 40.5 and 67.4 days, respectively. Mortality rate predicted by POSSUM and P-POSSUM was 77.7% and 63.4%, respectively. Seven patients (26.9%) died after operation, brought an observed mortality rate significantly lower than predicted (P = 0.001 and 0.025, respectively). The most common complications included pneumonia (57.7%), bacteremia (50.0%), and re-bleeding (26.9%).</p><p><b>CONCLUSIONS</b>Damage control laparotomy with packing is an effective procedure in the management of severe non-trauma abdominal hemorrhage, it can prevent the aggravation of "lethal triad" characterized by hypothermia, coagulopathy and acidosis. Appropriate application of the technique in strictly selected patients can result in a lower mortality rate.</p>

The observe of clinical effect of treating lumbar intervertebral disc herniation by bone setting manipulation of different directions / 中国骨伤

<p><b>OBJECTIVE</b>To compare the effect between lumbar backwards flexion manipulation and rotating manipulation for treating lumbar intervertebral disc herniation.</p><p><b>METHODS</b>Two hundred and nine patients of lumbar intervertebral disc herniation, male 131, female 78, the age from 20 to 79 years old, 58 cases of all these patients age above 50. According to diagnosis the ladder of the 92 cases bulging type, 69 hernia type, 48 cases free type. The patients were randomly divided into treatment group (107 cases) and control group (102 cases). All the patients were treated with the three-dimensional computer-controlled traction therapeutic apparatus, with continued traction for 30 minutes. After traction, lumbar backwards flexion manipulation and rotating manipulation were respectively adopted in treatment group and control group (on alternate days one time, 3 times as a course of treatment). The symptoms and signs (including back pain and discomfort, lower limb pain and numbness, powerless urination and defecation, numbness in perineum, straight-leg raising degree, ability of lower extremity walking, work and live) of patients were observed after treatment.</p><p><b>RESULTS</b>All the patients were followed up from 1 to 6 months with an average of 3.2 months. After treatment, the symptoms and signs of patients have markedly improved (P < 0.01), but the lower back pain and discomfort, lower limb walking ability in treatment group were better than control group (P < 0.05). According therapeutic criteria, the effect of treatment group was better than of control group (P < 0.01). In cases with bulging type, 47 in treatment group and 45 in control group, the effect of treatment group was better than of control group (P < 0.05); in cases with hernia type, 35 in treatment group and 34 in control group, there was no significantly difference in effect between two groups (P > 0.05); in cases of free type, 25 in treatment group and 23 in control group, there was no significantly difference in effect between two groups (P > 0.05).</p><p><b>CONCLUSION</b>The global effect of lumbar backwards flexion manipulation was satisfactory than rotating manipulation for treating lumbar intervertebral disc herniation. But rotating manipulation suited to free type.</p>

Activation of nuclear factor kappaB and induction of inducible nitric oxide synthase by lipid-associated membrane proteins isolated from Mycoplasma penetrans / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>This study was designed to investigate the potential pathogenicity of Mycoplasma penetrans (M. penetrans) and its molecular mechanisms responsible for the induction of iNOS gene expression in mouse macrophages stimulated by lipid-associated membrane proteins (LAMPs) prepared from M. penetrans.</p><p><b>METHODS</b>Mouse macrophages were stimulated with M. penetrans LAMPs to assay the production of nitric oxide (NO). The expression of inducible nitric oxide synthase (iNOS) was detected by RT-PCR and Western blotting. The activity of nuclear factor kappaB (NF-kappaB) and the effects of pyrrolidine dithiocarbamate (PDTC), an inhibitor of NF-kappaB, on the production of nitric oxide and the expression of iNOS were also assessed in mouse macrophages treated with M. penetrans LAMPs by indirect immunofluorescence and Western blotting.</p><p><b>RESULTS</b>M. penetrans LAMPs stimulated mouse macrophages to produce nitric oxide in a dose- and time-dependent manner. The mRNA and protein levels of iNOS were also upregulated in response to LAMP stimulation and inhibited by PDTC treatment. M. penetrans LAMPs were found to trigger NF-kappaB activation, a possible mechanism for the induction of iNOS expression.</p><p><b>CONCLUSION</b>This study demonstrated that M. penetrans may be an important etiological factor of certain diseases due to the ability of M. penetrans LAMPs to stimulate the expression of iNOS, which is probably mediated through the activation of NF-kappaB.</p>