Desplazamiento de Tercer Molar Inferior a Espacio Submandibular: Reporte de Caso y Revisión de Literatura / Lower Third Molar Displacement to Submandibular Space: Case Report and Literature Review

El desplazamiento de un tercer molar a un espacio anatómico adyacente, ya sea en su totalidad o un fragmento de este, se encuentra descrito como una complicación rara pero posible de las exodoncias de terceros molares. En este reporte se aborda específicamente el desplazamiento accidental de un tercer molar inferior hacia el espacio submandibular izquierdo, el cual fue resuelto quirúrgicamente mediante un abordaje intraoral bajo anestesia general por el equipo de cirugía maxilofacial del Hospital de Urgencia Asistencia Pública, Santiago, Chile. Se realizó una revisión de literatura en la plataforma PubMed con las palabras claves "third molar - submandibular - displacement" obteniendo un total de 17 artículos en los cuales se reportan 15 casos. El propósito del presente escrito fue presentar recomendaciones sobre el manejo actual de esta complicación en base a la literatura disponible.

The displacement of a third molar into an adjacent anatomical space, either in its entirety or a fragment of it, has been described as a rare but posible complication of third molar extractions. This report will specifically address the accidental displacement of a lower third molar into the left submandibular space, which was surgically removed through an intraoral approach under general anesthesia, by the maxillofacial surgeon team of "Hospital de Urgencia Asistencia Pública", Santiago, Chile. An literature review was carried out on PubMed platform with the keywords ""third molar - submandibular - displacement"", obtaining a total of 17 articles where are reported 15 cases. The purpose of this paper is to present recommendations on the current management of this complication based on the available literature.

Taquicardia ventricular polimórfica tipo Torsadess de Pointes secundaria a estimulación por marcapasos

La taquicardia ventricular polimórfica se origina en los ventrículos, cuyos complejos QRS son de morfología, amplitud y dirección variable, con frecuencias que oscilan entre 200 y 250 lpm, pudiendo ser autolimitadas o degenerar en una fibrilación ventricular. La TdP es un tipo de taquicardia ventricular polimórfica caracterizada por complejos con un eje eléctrico que gira alrededor de la línea isoeléctrica y que está asociada a QT largo. Se presenta el caso de una paciente portadora de marcapaso que presenta episodios de taquicardia ventricular polimórfica, con una morfología típica de TdP, sin documentación de QT prolongado previo ni actual, generada por la estimulación ventricular sobre onda T, de forma accidental por desplazamiento del electrodo auricular a Ventrículo Derecho (VD).

Polymorphic ventricular tachycardia is a tachycardia originating in the ventricles, where the QRS complexes have variable morphology, amplitude, and direction, with frequencies ranging between 200 and 250 bpm; it may be self-limited or degenerate into ventricular fibrillation. Torsades de Pointes (TdP) is a type of polymorphic ventricular tachycardia characterized by complexes with an electrical axis that rotates around the isoelectric line and that is associated with long QT interval. We present the case of a patient with a pacemaker who presents episodes of polymorphic ventricular tachycardia, with a typical morphology of TdP, without documentation of previous or current prolonged QT, generated by ventricular stimulation on the T wave, accidentally due to displacement of the atrial electrode to the Right Ventricle (RV).

Narrativas escolares de las estudiantes desplazadas por el conflicto armado en Colombia

(analítico) El desplazamiento forzado en Colombia ha sido una realidad compleja que ha generado la vulneración sistemática de los derechos de niños, niñas y adolescentes. Este estudio, enmarcado en el paradigma cualitativo, analizó el currículo vivenciado a partir de las narrativas construidas con 14 estudiantes desplazadas por el conflicto armado, pertenecientes a una institución educativa de Medellín (Colombia). Los métodos de recolección empleados fueron entrevistas semi-estructuradas, diarios personales y fotografías. Se presentan las inter-secciones que se establecen con la escuela, entendida como escenario de y para la construcción de paz, concluyendo en la pertinencia de las propuestas educativas flexibles. Este análisis, hilado desde una perspectiva de género, visibiliza otros modos de existir en la escuela, contribuyendo a la resignificación del currículo para la permanencia de las estudiantes que fueron desplazadas.

(analytical) Forced displacement in Colombia has been a complex reality that has led to the systematic violation of the rights of children and adolescents. This is a qualitative study that analyzed the curriculum in school in Medellin (Colombia) through the narratives constructed with 14 female students displaced by the armed conflict. Semi-structured interviews, personal diaries and photographs were used to gather data. The intersections established with the school as a scenario of and for peace building are presented and the relevance of flexible educational proposals is highlighted. This analysis, carried out using a gender perspective, highlights other modes of existence in the school and also contributes to the re-definition of the school curriculum as a determinant in the permanence of displaced students.

(analítico) A deslocação forçada na Colômbia tem sido uma realidade complexa que tem conduzido à violação sistemática dos direitos das crianças e dos adolescentes. Este estudo, estruturado no paradigma qualitativo, analisou o currículo vivido a partir das narrativas construídas com 14 estudantes desloca-das pelo conflito armado, pertencentes a uma instituição educacional em Medellín (Colômbia). Os métodos de coleta utilizados foram entrevistas semi-estruturadas, diários pessoais e fotografias. São expostas às interseções estabelecidas com a escola, entendidas como um cenário de e para a cons-trução da paz, concluindo sobre a relevância de propostas educacionais flexíveis. Esta análise, fiada a partir de uma perspectiva de gênero, torna visíveis outras formas de existir na escola, contribuindo para a re-significação do currículo para a permanência das alunas que foram deslocadas.

Trastornos de salud mental en población desplazada por el conflicto en Colombia: análisis comparado frente a la Encuesta Nacional de Salud Mental 2015

Introducción y objetivos: Colombia es uno de los países del mundo con mayor volumen de desplazamiento interno a causa de un conflicto armado interno. Esta población tiene mayores posibilidades de sufrir un trastorno de salud mental, sobre todo en territorios afectados históricamente por el conflicto. El objetivo es comparar la prevalencia de posibles trastornos de la salud mental entre las personas en condición de desplazamiento en Meta, departamento de Colombia históricamente afectado por el conflicto armado, frente a población desplazada en todo el país según la Encuesta Nacional de Salud Mental (ENSM) de 2015. Métodos: Análisis de datos recolectados en la ENSM 2015, estudio a escala nacional, y la encuesta Conflicto, Salud y Paz (CONPAS) de 2014, estudio representativo del grado de afectación por el conflicto en el municipio, realizado en el departamento del Meta. Para medir un posible trastorno de la salud mental, se utiliza el Self Report Questionnaire-25 (SRQ-25). La condición de desplazamiento fue declarada por los encuestados en ambos estudios. Se hizo un análisis descriptivo sobre el posible trastorno de la salud mental en la población desplazada de la ENSM 2015 y la CONPAS 2014. Resultados: Se encuestó a 1.089 adultos en la CONPAS 2014 y 10.870 adultos en la ENSM 2015. El 42,9% (468) y el 8,7% (943) de las personas reportaron estar en condición de desplazamiento en la CONPAS 2014 y la ENSM 2015 respectivamente. En ambos estudios, la población desplazada tiene mayores posibilidades de sufrir cualquier trastorno de la salud mental que la población no desplazada. En la CONPAS 2014, el 21,8% (intervalo de confianza del 95% [IC95%], 18,1-25,8) de esta población tenía un posible trastorno de la salud mental (SRQ+) frente al 14,0% (IC95%, 11,8-16,3) en la ENSM 2015. Los encuestados en condición de desplazamiento de la CONPAS 2014 tuvieron mayor probabilidad que los de la ENSM 2015 en depresión -el 12,4% (IC95%, 9,5-15,7) frente al 5,7% (IC95%, 4,3-7,4)-, ansiedad -el 21,4% (IC95%, 17,7-25,3) frente al 16,5% (IC95%, 14,2-19,1)-y trastornos psicosomáticos -el 52,4% (IC95%, 47,5-56,7) frente al 42,2% (IC95%, 39,0-45,4)-. Los desplazados de la ENSM 2015 tenían mayor probabilidad de ideación suicida, el 11,9% (IC95%, 9,3-14,1) frente al 7,3% (IC95%, 5,0-10,0) en la CONPAS 2014, y trastorno bipolar, el 56,5% (IC95%, 53,2-59,7) frente al 39,3% (IC95%, 34,8-43,9). Conclusiones: La mayor probabilidad de trastornos de la salud mental (SRQ+) de la población regional en condición de desplazamiento frente a toda la población nacional en esa condición puede representar una mayor necesidad de servicios de atención en salud mental en los territorios afectados por el conflicto. Así pues, y dada la necesidad de facilitar el acceso y la atención médica en salud mental a poblaciones especialmente afectadas por el conflicto armado, es importante el diseño de políticas de atención en salud que faciliten la recuperación de poblaciones afectadas por la guerra y, simultáneamente, reducir inequidades y promover el cumplimiento de uno de los objetivos en salud más importantes y, a la vez, usualmente menos priorizados en el desarrollo internacional: la salud mental. © 2021 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. Todos los derechos reservados.

Background and objectives: Colombia is one of the countries with the highest levels of internal displacement resulting from armed conflict. This population has greater chances of experiencing a mental health disorder, especially in territories historically affected by armed conflict. Our objective was to compare the levels of possible mental health disorder in people experiencing internal displacement in Meta, Colombia, a department historically affected by armed conflict, compared to the internally displaced population in the National Mental Health Survey of 2015. Methods: Analysis of data collected in the National Mental Health Survey (ENSM) of 2015, study with representative data at national level and the Conflict, Peace and Health survey (CONPAS) of 2014, representative study of the degree of impact of the conflict on the municipality, conducted in the department of Meta, Colombia. To measure possible mental health disorder, the Self-Report Questionnaire - 25 (SRQ-25) was used. Internal displacement is self-reported by people surveyed in both studies. An exploratory analysis is used to measure possible mental health disorders in the displaced population in the ENSM 2015 and CONPAS 2014. Results: 1,089 adults were surveyed in CONPAS 2014 and 10,870 adults were surveyed in the ENSM 2015. 42.9% (468) and 8.7% (943) of people reported being internally displaced in CONPAS 2014 and ENSM 2015, respectively. In both studies, internally displaced populations have greater chances of experiencing any mental health disorder compared to non-displaced populations. For CONPAS 2014, 21.8% (95%CI, 18.1-25.8) of this population had a possible mental health disorder (SRQ+) compared to 14.0% (95%CI, 11.8-16.3) in the ENSM 2015. Compared with the ENSM 2015, at the regional level (CONPAS 2014), displaced people had a greater chance of presenting depression by 12.4% (95%CI, 9.5-15.7) compared to 5.7% (95%CI, 4.3-7.4) in the ENSM 2015, anxiety in 21.4% (95%CI, 17.7-25.3) compared to 16.5% (95%CI, 14.2-19.1) in the ENSM 2015, and psychosomatic disorders in 52.4% (95%CI, 47.5-56.7) in CONPAS 2014 compared to 42.2% (95%CI, 39.0-45.4) in the ENSM 2015. At the national level (ENSM 2015), displaced people had greater possibilities of presenting, compared to the regional level, suicidal ideation in 11.9% (95%CI, 9.3-14.1) compared to 7.3% (95%CI, 5.0-10.0) in CONPAS 2014 and bipolar disorder in 56.5% (95%CI, 53.2-59.7) compared to 39.3% (95%CI, 34.8-43.9) in CONPAS 2014. Conclusions: The greater possibilities of displaced populations at the regional level of experiencing a mental health disorder, compared to this same population at the national level, may represent and indicate greater needs in mental health care services in territories affected by conflict. Therefore, and given the need to facilitate access to health services in mental health for populations especially affected by armed conflict, there is a need to design health care policies that facilitate the recovery of populations affected by war and, simultaneously, that reduce inequities and promote the fulfilment of one of the most important and, at the same time, least prioritised health objectives in international development: mental health.

Repercussion Of Cultural Clashes In Manju Kapur's The Immigrant

Manju Kapur primarily writes about the plight and repression of Indian women as well as their resistance to it. Marriage, families, complexities in relationships and separation are some of the most pervasive themes in her fiction. Manju Kapur's The Immigrant is a story of dislocation and cultural conflict. The novel revolves around a thirty-one-year-old spinster, Nina, who lived with her widowed mother in Delhi. She marries Ananda, an NRI, dentist and she flies to Canada to start her new life. The paper discusses how the novelist brings up the life of a married woman, with only her husband to talk to, all alone in a foreign land where Indian culture and individualism have often remained alien ideas. This paper delves into the issues of alienation and the search for cultural identity, as well as transformation of Nina and Ananda as a result of becoming an immigrant.

Neighborhood Walkability Index and Its Association With Indices of Childhood Obesity in Bengaluru, Karnataka

Background: The prevalence of childhood obesity is increasing in low-middle income countries like India. Built environment features such as walkability can influence weight-related outcomes but data from developing countries are scanty. Objective: To develop population level walkability index in urban Bengaluru, and examine its association with indices of childhood obesity in school children. Study Design: Nested cross-sectional study based on a cohort. Participants: Normal healthy children aged 6 to 15 years from urban schools in Bengaluru. The children were stratified into different land use classification such as residential, commercial and open space based on residential address. Methods: Anthropometric data, body composition data, measured using air displacement plethysmography. Outcomes: Walkability index derived using residential density, street connectivity and land-use mix environment variables. Results: The mean (SD) of age, body mass index (BMI), BMI zscore and percentage body fat (% Body fat) of 292 (50% boys) children were 10.8 (2.9) year, 17.4 (3.3) kg/m2, -0.27 (1.35) and 20.9% (8.8), respectively. The mean (SD) walkability index was 16.5, which was negatively associated with BMI (slope -0.25 and -0.08) and percentage body fat (slope -0.47 and -0.21) for age 5 and 10 years, respectively in children, but the effects decreased with increasing age. Conclusions: The findings of this pilot study suggest that the neighborhood walkability may be associated with the obesity indices in younger children. Future longitudinal studies are needed to understand how built environment affects health and body composition of children in India and other low-middle income countries.

The application of unilateral biportal endoscopy through extraforaminal approach in the treatment of extra canal lumbosacral nerve root entrapment / 中华骨科杂志

Objective:To investigate the effect of unilateral biportal endoscopy (UBE) through extraforaminal approach in the treatment of extra canal lumbosacral nerve entrapment.Methods:Seventeen patients with extra canal lumbosacral nerve root entrapment were treated by UBE through extraforaminal approach in Tianjin Hospital from January 2020 to March 2022, including 9 males and 8 females with an average age of 59.2 years (range 45-71 years). All 17 patients had lower limb radiation pain, numbness, and weakness with or without intermittent claudication. MRI imaging examination showed L 4, 5 foramen stenosis with far lateral disc herniation in 2 case, and L 5S 1 foramen stenosis with far lateral disc herniation in 15 cases, and the height of intervertebral space decreased, resulting in the compression of exiting nerve root and ganglion. Among them, far-out syndrome was diagnosed in 7 cases and transitional lumbarsacral vertebrae was found in 12 cases. The incisions were designed 2 cm away form the projection of adjacent pedicles, while incision at S 1 was designed at the inner edge of the iliac bone due to the shielding of the ilium, taking the outer edge of the isthmus at the outer opening of the intervertebral foramen as the target of channels. The ventral and apical part of superior articular process (SAP) was gradually removed with high-speed burr from its outer edge and isthmus, and the occluded sacral ala and the lower edge of transverse process were removed when necessary. The hyperplastic ligament was removed to expose the exiting nerve root. The protruding intervertebral disc was removed at the ventral side of the nerve root. The far-out syndrome was decompressed laterally along the exiting nerve root until it is completely released. The results and stability were evaluated with visual analogue scale (VAS), Oswestry disability index (ODI), Macnab scores and dynamic X-ray film during follow-up. Results:The operation time was 45-85 min, with an average of 60 min. After remove of the SAP tip and enlarge of the intervertebral foramen, the exiting nerve root and disc protrusion were fully exposed, the exiting nerve root was exposed and released laterally until totally release without entrapment in far out syndrome, and the nerve could be decompressed completely. The symptoms were significantly relieved after operation, and imaging examination showed that facet joints were preserved. During follow-up, the pain and function improved continuously. At final follow-up, the improve rate of VAS and ODI were 85.2% and 86.2%, respectively, and the results were excellent in 15 cases and good in 2 case according to Macnab score, and there was no lumbar instability on dynamic lumbar X-ray film.Conclusion:Extra canal lumbosacral nerve entrapment can be treated by UBE through extraforaminal approach, with sufficient exposure, complete decompression and better preservation of lumbar stability.

Progress in diagnosis and treatment of percutaneous endoscopic lumbar discectomy / 中国医师杂志

Lumbar disc herniation is one of the common orthopedic diseases. Percutaneous endoscopic lumbar discectomy (PELD) has gradually become a first-line surgical approach. Compared with open discectomy and open lumbar microdiscectomy, PELD has shorter operation time, less bleeding and lower complication rate, but the postoperative recurrence rate is relatively high and the learning curve is steep. Unilateral biportal endoscopic discectomy and full endoscopic transforaminal lumbar interbody fusion may be effective supplements to PELD. New technologies such as the combination of navigation and 3D printing technology, multi-mode nonlinear optical microscope, the combination of nuclear magnetic resonance imaging and artificial intelligence (such as deep learning and convolution neural network) will help to improve the accuracy of positioning and tissue discrimination of PELD, predict the surgical difficulty and postoperative recurrence, shorten the learning curve, and promote the popularization and application of PELD.

Efficacy of radiofrequency ablation combined with ozone therapy under CT guidance in the treatment of lumbar disc herniation / 中国基层医药

Objective:To investigate the efficacy of radiofrequency ablation combined with ozone therapy under CT guidance in the treatment of lumbar disc herniation.Methods:A total of 93 patients with lumbar disc herniation who were admitted to The First Hospital of Jiaxing from January 2019 to May 2022 were included in this study. They were randomly divided into an observation group ( n = 47) and a control group ( n = 46). The control group was treated with radiofrequency ablation and the observation group was treated with radiofrequency ablation combined with ozone therapy. Efficacy was compared between the two groups at 3 months after surgery. The pain was compared between the two groups before and 7 days and 3 months after surgery. Inflammatory factors were compared between the two groups before and 7 days after surgery. The lumbar spine function was compared between the two groups before and 3 months after surgery. Results:At 3 months after surgery, the excellent and good rate in the observation group was significantly higher than that in the control group [89.36% (42/47) vs. 71.74% (33/47), χ2 = 4.63, P < 0.05). At 7 days and 3 months after surgery, Visual Analogue Scale scores in the observation group were (2.91 ± 0.54) points and (1.32 ± 0.31) points, respectively, which were significantly lower than (3.76 ± 0.62) points and (2.08 ± 0.47) points in the control group ( t = 7.06, 9.22, both P < 0.001). At 7 days after surgery, serum interleukin-1β, interleukin-6, and tumor necrosis factor-α in the observation group were (0.24 ± 0.05) μg/L, (18.49 ± 3.47) ng/L, and (97.94 ± 17.43) ng/L, respectively, which were significantly lower than (0.37 ± 0.09) μg/L, (24.31 ± 4.12) ng/L, and (148.87 ± 20.13) ng/L, respectively in the control group ( t = 8.63, 7.37, 13.05, all P < 0.05). At 3 months after surgery, the Japanese Orthopedic Association score in the observation group was significantly higher than that in the control group [(25.68 ± 2.28) points vs. (21.17 ± 3.24) points, t = -7.78, P < 0.001], and the Oswestry Disability Index in the observation group was significantly lower than that in the control group [(9.84 ± 1.43) points vs. (13.46 ± 2.18) points, t = 9.49, P < 0.001]. Conclusion:Radiofrequency ablation combined with ozone therapy under CT guidance is highly effective on lumbar disc herniation. The combined therapy can reduce pain and inflammatory reactions in patients and improve lumbar function.

Effects of surgery with the YESS technique on lumbar range of motion and limb function in patients with lumbar disc herniation / 中国基层医药

Objective:To investigate the effects of surgery with the Yeung endoscopic spine system (YESS) technique on lumbar range of motion and limb function in patients with lumbar disc herniation.Methods:A total of 148 patients with lumbar intervertebral disc herniation admitted to Liaocheng Second Hospital Affiliated to Shandong First Medical University from April 2018 to April 2021 were included in this study. They were randomly divided into control and observation groups ( n = 74/group). The control group was treated with laminectomy, and the observation group was treated with an intervertebral foramen mirror YESS. The lumbar range of motion, Oswestry disability index score, and incidence of surgical complications were compared between the two groups. Results:At postoperative 7 days, ranges of motion in lumbar flexion, lumbar extension, left lumbar lateral flexion, and right lumbar lateral flexion in the observation group were (87.45 ± 7.38)°, (26.87 ± 3.41)°, (28.58 ± 3.41)°, (28.39 ± 3.41)°, which were significantly higher than (68.98 ± 6.51)°, (15.69 ± 3.23)°, (18.69 ± 2.32)°, (14.56 ± 2.96)° in the control group ( t = 16.15, 20.48, 20.63, 26.35, all P < 0.001). At postoperative 7 days, the Oswestry Disability Index in each group was significantly decreased compared with before treatment (both P < 0.05). At postoperative 7 days, the score of each dimension of the Oswestry Disability Index in the observation group was significantly lower compared with the control group ( t = 49.13, 50.20, 54.78, 37.79, 32.04, 36.68, 43.69, 28.92, 39.31, 64.12, all P < 0.001). There were no significant differences in the incidences of perioperative incision infection, nerve injury, cerebrospinal fluid leaks, lumbar spondylolisthesis, and foot drop between the two groups (all P > 0.05). Conclusion:Treatment of lumbar intervertebral disc herniation with the YESS technique is helpful to improve lumbar mobility and reduce lumbar dysfunction and is highly safe.

Feasibility, reliability and validity of a 3D scanning volume measurement for distal upper limb volume / 中国康复理论与实践

ObjectiveTo clarify the feasibility of the 3D scanning volume method for distal upper limb volume measurement, and to analyze its scorer reliability and criterion-related validity. MethodsFrom January to March, 2022, a therapist (operator A) who had not been exposed to 3D scanning volume method and water displacement method was trained to use a handheld 3D laser scanner and a spilt cup to measure the volume of a PVC distal upper limb model. The operation time of 30 operations of each method was recorded. The learning curves of the two methods were plotted using cumulative sum (CUSUM) analysis. The curve was cut into the learning stage and the mastery stage by the vertex of peak. The times required to reach the mastery stage and the operation time of the mastery stage for the two methods were recorded. A total of 20 healthy subjects were recruited from Huashan Hospital of Fudan University. Two trained therapists (operator A and operator B) measured the bilateral distal upper limb volume using a handheld 3D laser scanner, and operator A measured the bilateral distal upper limb volume using a spilt cup. ResultsThe fitting learning curve of the 3D scanning volume method (R² = 0.984) reached its peak after eight times of operation; while that of the water displacement method (R² = 0.494) reached its peak after five times of operation. At mastery stage, the operator spent less time using 3D scanning volume method than using water displacement method (P < 0.05). The intraclass correlation coefficient between the two operators were both 0.979 for bilateral distal upper limb volume measure (P < 0.001). The Pearson coefficients was above 0.979 between 3D scanning volume method and water displacement method (P < 0.001). ConclusionA therapist can master the use of the 3D scanning volume method after eight times of operation, and the operation time of 3D scanning volume method is shorter than that of water displacement method at mastery stage. The 3D scanning volume method is well reliable and valid, that can be used as an alternative to the water displacement method for distal upper limb volumetric measurement.

Fluorine-thiol displacement probes for acetaminophen's hepatotoxicity

Chemicals possessing reactive electrophiles can denature innate proteins leading to undesired toxicity, and the overdose-induced liver injury by drugs containing electrophiles has been one of the major causes of non-approval and withdraw by the US Food and Drug Administration (FDA). Elucidating the associated proteins could guide the future development of therapeutics to circumvent these drugs' toxicities, but was largely limited by the current probing tools due to the steric hindrance of chemical tags including the common "click chemistry" labels. Taking the widely used non-steroidal anti-inflammatory drug acetaminophen (APAP) as an example, we hereby designed and synthesized an APAP analogue using fluorine as a steric-free label. Cell toxicity studies indicated our analogue has similar activity to the parent drug. This analogue was applied to the mouse hepatocellular proteome together with the corresponding desthiobiotin-SH probe for subsequent fluorine-thiol displacement reactions (FTDRs). This set of probes has enabled the labeling and pull-down of hepatocellular target proteins of the APAP metabolite as validated by Western blotting. Our preliminary validation results supported the interaction of APAP with the thioredoxin protein, which is an important redox protein for normal liver function. These results demonstrated that our probes confer minimal steric perturbation and mimic the compounds of interest, allowing for global profiling of interacting proteins. The fluorine-thiol displacement probing system could emerge as a powerful tool to enable the investigation of drug-protein interactions in complex biological environments.

Clinical study of warming needle moxibustion of Jiaji and TCM fumigation combined for acute inflammatory period of lumbar disc herniation / 国际中医中药杂志

Objective:To evaluate the clinical efficacy of lumbar spine warming needle moxibustion of Jiaji and Traditional Chinese Medicine (TCM) fumigation combined with conventional western medicine therapy on patients with acute inflammatory period of lumbar disc herniation (LDH).Methods:Randomized controlled trial. A total of 140 patients with acute inflammation of LDH in our hospital from December 2019 to December 2021 were selected as observational objects, and the patients meeting the inclusion criteria were divided into 2 groups with 70 patients in each group by random number table method. The control group was treated with conventional western medicine therapy, and the observational group was treated with warming needle moxibustion of Jiaji combined with TCM fumigation on the basis of control group treatment. Both groups received continuous treatment for 1 month. TCM syndrome scores were performed before and after treatment, the degree of lumbar pain was assessed by VAS, the degree of lumbar dysfunction was assessed by Japanese Orthopaedic Association Evaluation Treatment (JOA score), and serum CRP, IL-6 and TNF-α levels were measured by ELISA.Results:The total effective rate was 95.71% (67/70) in the observation group and 82.86% (58/70) in the control group, and there was significant difference between the two groups ( χ2=6.05, P=0.014). After treatment, TCM syndrome score [(4.45±1.09) vs. (10.67±2.82), t=16.85], VAS score [(1.54±0.43) vs. (3.28±1.04), t=12.94] lower than those in the control group ( P<0.01), subjective feeling [(7.54±2.87) vs. (6.24±1.76), t=5.72], physical signs [(6.76±2.00) vs. (4.34±1.67), t=7.77], limited daily activities [(9.56±3.27) vs. (7.89±2.97), t=3.16], bladder function score [(2.88±0.84) vs. (2.63±0.64), t=2.89] and the total score [(25.04±7.44) vs. (20.35±6.87), t=4.63] were higher than those in the control group ( P<0.01). After treatment, serum IL-6 [(18.12±4.23) μg/L vs. (26.46±4.58) μg/L, t=11.19], CRP [(18.87±6.07) mg/L vs. (25.89±5.72) mg/L, t=7.04] and TNF-α levels [(24.42±5.37) ng/L vs. (29.45±5.44) ng/L, t=5.51] were lower than those in the control group ( P<0.01). Conclusion:The warming needle moxibustion of Jiaji and TCM fumigation combined with conventional western medicine therapy can improve the lumbar pain of LDH patients in acute inflammatory stage, reduce the level of inflammatory factors, improve clinical efficacy.

Clinical study of modified Shishi Niubangzi Decoction combined with strengthening tendons-waist exercise on lumbar disc herniation / 国际中医中药杂志

Objective:To observe the clinical effect of modified Shishi Niubangzi Decoction combined with strengthening muscle-waist exercise on lumbar disc herniation (LDH).Methods:Randomized controlled trial. A total of 60 patients with LDH admitted to the Pinggu Hospital, Beijing Traditional Chinese Medicine Hospital, were enrolled as the research objects between September 2020 and September 2021. According to the random number table, they were randomly divided into the treatment group and control group, 30 in each group. Both groups were given routine basic treatments (strengthening tendons-waist exercise and three-position six-step manipulation). On this basis, the treatment group was treated with modified Shishi Niubangzi Decoction, while the control group was treated with non-steroidal anti-inflammatory drugs (ibuprofen codeine sustained-release tablets). Both groups were treated for 4 weeks. The responsive rates, back pain intensity, leg pain and numbness by Visual Analogue Scale (VAS) and lumbar function by Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) were compared between the two groups.Results:The response rate of treatment group was significantly higher than that of control group (93.3% vs. 73.3%; χ2=4.32, P=0.038). After treatment, scores of JOA (subjective symptoms, signs, activities of daily living) in the treatment group were significantly higher than those in the control group ( t=3.86, 2.71, 2.21, P<0.05). After treatment, scores of back pain (2.12±0.21 vs. 3.02±0.32, t=12.88), leg pain (2.04±0.64 vs. 2.64±0.66, t=3.58), lower limb numbness (1.75±0.24 vs. 2.41±0.70, t=4.89) in the treatment group were significantly lower than those in the control group ( P<0.01). At 1 week and 1 month after treatment, ODI scores in treatment group were significantly lower than those in control group ( t=10.22, 5.59; P<0.05). Conclusion:The modified Shishi Niubangzi Decoction combined with strengthening tendons-waist exercise can improve responsive rates, improve lumbar pain and function in LDH patients.

Stress Distributions Affected by Different Filling Blocks in Medial Opening Wedge High Tibial Osteotomy / 医用生物力学

Objective To analyze the influence from material and size of the filling block on stress distributions of the tibial osteotomy model. Methods The filling blocks with three different materials (iliac bone, cancellous bone and polyetheretherketone (PEEK)) and five different sizes were established and implanted to the tibial osteotomy models, respectively. The mechanical loads were applied on the model, the stress distribution and edge displacement of the model were analyzed. Results For three kinds of materials, the stress at proximal end of the tibia and the plate, as well as edge displacement in the model implanted with filling block by iliac bone material were lower than those of the cancellous bone and PEEK, but the filling block by iliac bone material had the highest stress. When the filling blocks with different sizes were implanted in osteotomy space, the stress distribution on each part of the tibial osteotomy and edge displacement were different. Especially when the width of the filling block was reduced from 30 mm to 10 mm, the peak stress of the proximal tibia, steel plate and filling block was increased by 49. 3% , 92. 7% and 54. 4% on average. Conclusions Different filling block parameters will affect the stress distribution in different parts of the tibial osteotomy. The research results provide the theoretical basis for parameter selection of the tibial osteotomy filling block in clinic.

Progress in self-expanding metallic ureteral stent in the treatment of ureteral stricture in renal allografts / 器官移植

Ureteral stricture in renal allografts is one of the common postoperative complications in kidney transplant recipients. Due to short ureter in renal allografts, endovascular treatment should be adopted before reconstruction surgery to avoid irreversible injury. Alleviating renal allograft injury, easing obstruction or establishing drainage channel are the key measures to treat ureteral stricture. In endovascular treatment, balloon dilatation and internal incision yield high recurrence rate, and long-term indwelling of self-expanding metallic ureteral stents may be a better option. Compared with traditional stents, metallic stents may maintain urinary tract patency for a long time and mitigate the irritation of lower urinary tract symptoms,with different indications and efficacy. Although all metallic stents may be displaced and occluded, it still plays a positive role in the treatment of ureteral stricture in renal allografts. In this article, the application of self-expanding metallic ureteral stent in ureteral stricture of renal allografts was mainly illustrated, aiming to provide reference for optimizing the treatment of ureteral stricture in renal allografts.

Influential factors related to functional status after full-endoscopic lumbar discectomy / 北京大学学报(医学版)

OBJECTIVE@#To explore the influential factors associated with functional status of those patients who undertook a full-endoscopic lumbar discectomy operation.@*METHODS@#A prospective study was conducted. A total of 96 patients who undertook a full-endoscopic lumbar discectomy operation and met inclusive criteria were enrolled in the study. The postoperative follow-up was held 1 month, 3 months and 6 months after operation. The self-developed record file was used to collect the patient's information and medical history. Visual analogue scale (VAS) score, Oswestry disability index (ODI) score, Gene-ralised anxiety disorder-7 (GAD-7) scale score and patient health questionnaire-9 (PHQ-9) scale score were applied to measure pain intensity, functional status, anxiety status and depression status. Repeated measurement analysis of variance was used to explore the ODI score 1 month, 3 months and 6 months after operation. Multiple linear regression was recruited to illuminate the influential factors associated with functional status after the operation. Logistic regression was employed to explore the independent risk factors related to return to work 6 months after operation.@*RESULTS@#The postoperative functional status of the patients improved gradually. The functional status of the patients 1 month, 3 months and 6 months after operation were highly positively correlated with the current average pain intensity. The factors influencing the postoperative functional status of the patients were different according to the recovery stage. One month and 3 months after operation, the factors influencing the postoperative functional status were the current average pain intensity; 6 months after operation, the factors influencing the postoperative functional status included the current average pain intensity, preoperative average pain intensity, gender and educational level. The risk factors influencing return to work 6 months after operation included women, young age, preoperative depression status and high average pain intensity 3 months after operation.@*CONCLUSION@#It is feasible to treat chronic low back pain with full-endoscopic lumbar discectomy operation. In the process of postoperative functional status recovery, medical staffs should not only take analgesic mea-sures to reduce the pain intensity experienced by the patients, but also pay attention to the impact of psychosocial factors on the recovery. Women, young age, preoperative depression status, and high average pain intensity 3 months after operation may delay return to work after the operation.

Analysis of the effect of midazolam on pain in a rat model of lumbar disc herniation based on the p38 MAPK signaling pathway / 中国骨伤

OBJECTIVE@#To investigate the effect of midazolam on pain in lumbar disc herniation model rats based on p38 MAPK signaling pathway.@*METHODS@#Fifty SPF-grade Sprague-Dawley healthy rats, half male and half female, were selected and randomly divided into normal group, model group, and low-dose, medium-dose, high-dose groups. Model group and low-dose, medium-dose, high-dose groups were initially modeled for lumbar disc herniation. Intraperitoneal injection of saline was performed in rats of normal and model groups; and in the low-dose, medium-dose, and high-dose groups, intraperitoneal injection of midazolam was performed with doses of 30, 60, and 90 mg/kg, respectively. Interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), 5-hydroxytryptamine (5-HT), β-endorphin (β-EP), substance P (SP), neuropeptide Y (NPY) were detected in the serum of rats by enzyme-linked immunoassay. The expression of p38 MAPK and matrix metalloproteinase-3(MMP-3) protein were detected by Western blot in the tissues of rats of each group.@*RESULTS@#The levels of TNF-α, IL-1β and β-EP were higher and the level of 5-HT was lower in the model group than in the normal group(P<0.05);the levels of TNF-α, IL-1β and β-EP were lower and the level of 5-HT was higher in the low-dose, medium-dose and high-dose groups than in the model group(P<0.05). The levels of SP and NPY increased in the model group compared with the normal group (P<0.05) and the levels of SP and NPY decreased in the low-dose, medium-dose and high-dose groups compared with the model group (P<0.05). The expression of p38 MAPK and MMP-3 increased in the model group compared with the normal group (P<0.05); the expression of p38 MAPK and MMP-3 decreased in the low-dose, medium-dose and high-dose compared with the model group(P<0.05).@*CONCLUSION@#Midazolam may ameliorate the immune inflammatory response in rats with a model of lumbar disc herniation, possibly regulated through the p38MAPK signaling pathway.

Feasibility of enlarging the ventral space by using a drill under spinal endoscopy in the treatment of severe free lumbar disc herniation / 中国骨伤

OBJECTIVE@#To evaluate the clinical efficacy of spinal endoscopy in the treatment of severe free lumbar disc herniation and explore the feasibility and application of microscopic drills to expand ventral space.@*METHODS@#Thirty patients with severe free lumbar intervertebral disc herniation treated by spinal endoscopic technique from April 2019 to March 2021 were collected, including 19 males and 11 females;aged from 19 to 76 years with an average of (44.03±16.92) years old. All patients had a single segmental lesion with prolapse of the nucleus pulposus. Among them, there were 3 cases on L2,3, 3 cases on L3,4, 15 cases on L4,5, and 9 cases on L5S1. During operation, posterior bone of vertebral body and pedicle notch were removed by a drill under the endoscope to enlarge the ventral space. And the free nucleus pulposus was exposed and completely removed. The intraoperative blood loss, operation time, hospital stay and postoperative neurological complications were recorded, and Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI) and visual analogue scale (VAS) were compared before operation, 2 days, 3 months and 1 year after operation, and Macnab standard was used to evaluate clinical efficacy.@*RESULTS@#All operations were successful and the free nucleus pulposus was completely removed. Pain in the lower back and legs was significantly relieved on the day after operation. Two patients experienced transient pain and numbness in lower limbs after operation, and no serious nerve injury complications occurred. ODI and VAS at each time point after surgery were significantly lower than those before surgery (P<0.01), and JOA score was significantly higher than before surgery (P<0.01). The excellent and good rates of Macnab were 66.67% (20/30), 83.33% (25/30) and 90.00% (27/30) on 2 days, 3 months and 1 year after operation, respectively.@*CONCLUSION@#For severe free lumbar intervertebral disc herniation, using of a drill under endoscope to expand the ventral space can smoothly remove the free nucleus pulposus and avoid nerve damage.

Comparison of clinical efficacy between percutaneous endoscopic transforaminal discectomy and coblation nucleoplasty in the treatment of inclusive lumbar disc herniation / 中国骨伤

OBJECTIVE@#To observe clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) and target radioffrequency thermal coblation nucleoplasty(CN) on inclusive lumbar disc herniation(LDH) in different age groups, and provide a basis for clinical formulation of precise and individualized treatments.@*METHODS@#A retrospective analysis of 219 patients with lumbar disc herniation treated with PETD and CN between January 2018 and June 2021 was performed, in which 107 patients were treated with PETD and 112 with CN. Patients were stratified by age into young group(≤45 years old), middle-aged group(>45 years old and <60 years old) and older group(≥60 years old). Before treatment, 3 days, 1 month and 6 months after treatment, visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, infrared thermal imaging temperature difference (△T) and lumbar range of motion (ROM) were evaluated and clinical efficacy were compared in the different age groups between two treatment methods.@*RESULTS@#①VAS and JOA score outcomes, in the same age group and the same treatment method, the VAS and JOA scores at different time points postoperatively were obviously improved (P<0.05). For the same age group and the different treatment methods, the older group had lower VAS and higher JOA scores after PETD than after CN (P<0.05), and there was no significant difference between the young group and middle-aged group (P>0.05). There was no significant difference in VAS and JOA scores at the same time between age groups by PETD treatment (P>0.05). The VAS was higher and the JOA score was lower in older group than in young group and middle-aged group at 1, 6 months after CN treatment(P<0.05). ②△T and ROM outcomes, in the same age group and same treatment method, postoperative △T and ROM at different time points were obviously improved(P<0.05). There was no significant difference in △T between two methods of PETD and CN at the same age(P>0.05), there was no significant difference in ROM between young group and middle-aged group(P>0.05), ROM was higher after PETD treatment than after CN treatment(P<0.05). There was no significant difference in △T and ROM at the same time between age groups by PETD treatment(P>0.05). There was no significant difference in △T between age groups by CN treatment, but the ROM was smaller in older group than in young group and middle-aged group after CN treatment(P<0.05).@*CONCLUSION@#Both PETD and CN for inclusive LDH have good efficacy, the curative benefit for older patients receiving PETD within 6 months after surgery more than CN, and CN is more appropriate for young and middle-aged patients.