Síndrome de Herlyn-Werner Wünderlich: reporte de dos casos / Herlyn-Werner-Wünderlich syndrome: Two case report

El síndrome de Herlyn-Werner Wünderlich, también llamado OHVIRA por sus siglas en inglés (obstructed hemivagina and ipsilateral renal anomaly), es una anomalía congénita mülleriana poco frecuente que se caracteriza por la asociación entre útero didelfo, hemivagina obstruida y agenesia renal ipsilateral. La presentación clínica más común es la masa abdominal secundaria a hematocolpos, dolor y dismenorrea. Se asocia a infertilidad, endometriosis, alteraciones menstruales y obstétricas. La ecografía es la técnica de elección para la evaluación inicial, mientras que la resonancia magnética sigue siendo el método más exacto para el diagnóstico. La septotomía vaginal es el tratamiento recomendado. Se describen 2 casos clínicos con el objetivo de destacar la importancia del diagnóstico temprano para evitar las posibles complicaciones futuras.

Herlyn-Werner-Wunderlich syndrome, also known as obstructed hemivagina and ipsilateral renal anomaly (OHVIRA), is a rare, congenital Müllerian duct anomaly characterized by the association of septate uterus, obstructed hemivagina, and ipsilateral renal agenesis. The most common clinical presentation is an abdominal mass secondary to hematocolpos, pain, and dysmenorrhea. It is associated with infertility, endometriosis, and menstrual and obstetric alterations. The ultrasound is the technique of choice for the initial assessment, while the magnetic resonance imaging remains the most accurate method for diagnosis. The resection of the vaginal septum is the recommended treatment. Here we describe 2 clinical cases to highlight the importance of an early diagnosis to prevent potential complications in the future.

Involvement of SIRT1 and SIRT3 in Effects of Hypoxic Hypobaric Preconditioning on Hippocampal Damage Induced by Chronic Cerebral Hypoperfusion in C57/6j and a7nAchRs(-/-) Mice / Participación de SIRT1 y SIRT3 en los Efectos del Precondicionamiento Hipobárico Hipóxico sobre el Daño del Hipocampo Inducido por Hipoperfusión Cerebral Crónica en Ratones C57/6j y a7nAchRs (-/-)

SUMMARY: Hypoxic preconditioning is known to induce neuroprotection, but its effects and pathways in chronic brain pathology still unknown. The aim was to establish an involvement of a7 subunit of nicotinic acetylcholine receptors (a7nAchRs), and sirtuins of 1 (SIRT1) and 3 (SIRT3) types in the effects of hypoxic hypobaric preconditioning on brain damage in mice with chronic cerebral hypoperfusion caused by the left common carotid artery occlusion. The male C57/6j (C57, wild type) and a7nAchRs(-/-) mice were divided to six experimental groups (10 mice per group): sham-operated C57, C57 with chronic cerebral hypoperfusion, C57 with hypoxic hypobaric preconditioning and chronic cerebral hypoperfusion, sham-operated a7nAchRs(-/-) mice, a7nAchRs(-/-) with chronic cerebral hypoperfusion, a7nAchRs(-/-) with hypoxic hypobaric preconditioning and chronic cerebral hypoperfusion. For preconditioning, mice were exposed to hypoxia by "lifting" in barochamber to simulated altitude of 5600 m a.s.l. for 1 h/day on 3 consecutive days before surgical manipulation. Expressions of SIRT1, SIRT3 in brain tissue, and histopathological changes of the hippocampi were examined. It was shown that 8-week chronic hypoperfusion of the brain, caused by unilateral occlusion of the common carotid artery, was accompanied by injury to the neurons of the hippocampi of both hemispheres, which was more pronounced on the side of the occlusion. This damage, as well as the mechanisms of neuroprotection induced by hypoxic preconditioning, were maintained for at least 8 weeks by mechanisms mediated through a7nAChRs. Deficite of a7nAChRs was accompanied with reduction of neuronal damage caused CCH in 8 weeks, as well as preconditioning effects, and lead to compensatory activation of regulatory and protective mechanisms mediated by SIRT1, in normal conditions and in CCH. In wild-type (C57) mice, protective mechanisms in CCH were realized to a greater extent by increased expression of SIRT3 in both hemispheres of the brain.

Se sabe que el precondicionamiento hipóxico induce neuroprotección, pero aún se desconocen sus efectos y vías en la patología cerebral crónica. El objetivo fue establecer la participación de la subunidad a7 de los receptores nicotínicos de acetilcolina (a7nAchR) y las sirtuinas de tipo 1 (SIRT1) y 3 (SIRT3) en los efectos del precondicionamiento hipóxico hipobárico sobre el daño cerebral en ratones con hipoperfusión cerebral crónica causada por la oclusión de la arteria carótida común izquierda. Los ratones macho C57/6j (C57, tipo salvaje) y a7nAchRs(-/-) se dividieron en seis grupos experimentales (10 ratones por grupo): C57 con operación simulada, C57 con hipoperfusión cerebral crónica, C57 con precondicionamiento hipobárico hipóxico y crónica. hipoperfusión cerebral, ratones a7nAchRs(-/-) operados de forma simulada, a7nAchRs(-/-) con hipoperfusión cerebral crónica, a7nAchRs(-/-) con precondicionamiento hipobárico hipóxico e hipoperfusión cerebral crónica. Para el preacondicionamiento, los ratones fueron expuestos a hipoxia "levantándolos" en una cámara de barro a una altitud simulada de 5600 m s.n.m. durante 1 h/día durante 3 días consecutivos antes de la manipulación quirúrgica. Se examinaron las expresiones de SIRT1, SIRT3 en tejido cerebral y los cambios histopatológicos de los hipocampos. Se demostró que la hipoperfusión cerebral crónica de 8 semanas, causada por la oclusión unilateral de la arteria carótida común, se acompañaba de lesión de las neuronas del hipocampo de ambos hemisferios y que era más pronunciada en el lado de la oclusión. Este daño, así como los mecanismos de neuroprotección inducidos por el precondicionamiento hipóxico, se mantuvieron durante al menos 8 semanas mediante mecanismos mediados por a7nAChR. El déficit de a7nAChR se acompañó de una reducción del daño neuronal causado por CCH en 8 semanas, así como de efectos de precondicionamiento, y condujo a una activación compensatoria de mecanismos reguladores y protectores mediados por SIRT1, en condiciones normales y en CCH. En ratones de tipo salvaje (C57), los mecanismos de protección en CCH se realizaron en mayor medida mediante una mayor expresión de SIRT3 en ambos hemisfe- rios del cerebro.

Continuous Unilateral Cephalalgia Due to Systemic Lupus Erythematosus: A Case Report / Cefaleia unilateral contínua por lúpus eritematoso sistêmico: relato de caso

BACKGROUND: Hemicrania continua is a rare form of cephalalgia featuring a chronic and persistent headache in only one side of the head. OBJECTIVES: In this report, we present a case of a patient with hemicrania continua and systemic lupus erythematosus (SLE). METHODS: We collected patient data through the electronic medical record. Afterward, we reviewed the literature regarding hemicrania continua and its pathophysiology and correlation with neurovascular alterations, inflammation, and SLE. RESULTS: A 42-year-old woman visited the emergency department due to worsening constant unilateral cephalalgia that had been present for the past 6 months. The patient reported a highly intense (10/10) headache in the entire left hemicrania that radiated to the left shoulder. During physical examination, she presented with nystagmus, vertigo, and aggravated cephalalgia associated to body movement and, despite having no optic nerve thickening. In addition, she had jaundice, tachycardia, and splenomegaly. Complimentary exams found deep anemia, depletion in complement system and anti-nuclear factors, suggesting a possible hemolytic anemia (AIHA) due to SLE. Treatment was initiated with hydrocortisone and prednisone, associated with amitriptyline, fluoxetine and diazepam, reaching full remission. CONCLUSION: These syndromes have aggravated each other, and possibly the explanation for the cephalalgia remission was the control of AIHA and SLE. It features a rare case in literature and thus warrants discussion.

INTRODUÇÃO: Hemicrania contínua é uma forma rara de cefaléia caracterizada por cefaleia crônica e persistente em apenas um lado da cabeça. OBJETIVOS: Neste relato apresentamos o caso de um paciente com hemicrania contínua e lúpus eritematoso sistêmico (LES). MÉTODOS: Coletamos dados dos pacientes por meio do prontuário eletrônico. Posteriormente, revisamos a literatura sobre a hemicrania contínua e sua fisiopatologia e correlação com alterações neurovasculares, inflamação e LES. RESULTADOS: Uma mulher de 42 anos recorreu ao serviço de urgência devido ao agravamento da cefaleia unilateral constante, presente nos últimos 6 meses. O paciente relatou cefaleia de alta intensidade (10/10) em toda a hemicrânia esquerda com irradiação para o ombro esquerdo. Ao exame físico apresentava nistagmo, vertigem e cefaléia agravada associada à movimentação corporal e, apesar de não apresentar espessamento do nervo óptico. Além disso, ela apresentava icterícia, taquicardia e esplenomegalia. Os exames complementares evidenciaram anemia profunda, depleção do sistema complemento e fatores antinucleares, sugerindo uma possível anemia hemolítica (AIHA) por LES. Iniciou-se tratamento com hidrocortisona e prednisona, associadas a amitriptilina, fluoxetina e diazepam, atingindo remissão completa. CONCLUSÃO: Essas síndromes agravaram-se mutuamente e possivelmente a explicação para a remissão da cefaléia foi o controle da AIHA e do LES. Apresenta um caso raro na literatura e, portanto, merece discussão.

Pathological types and clinical features of unilateral primary aldosteronism / 中华内分泌代谢杂志

Objective:To investigate the distribution of pathological types of unilateral primary aldosteronism, and to explore the clinical characteristics and prognosis of patients with different pathological types.Methods:A total of 241 patients with unilateral primary aldosteronism who underwent adrenal surgery were included in this study. The clinical data and postoperative follow-up data were collected, and the postoperative tissue sections were stained with HE and aldosterone synthase. According to the staining results, pathological types of 241 patients were classified, and the clinical characteristics and surgical prognosis of patients with unilateral primary aldosteronism were compared.Results:According to the international histopathology consensus for unilateral primary aldosteronism, among 241 patients with unilateral primary aldosteronism, 223 were classical(92.5%), 17 were non-classical(7.1%), and 1 was aldosterone producing carcinoma(0.4%). Among classical cases, 189 were aldosterone producing adenoma and 34 were aldosterone producing nodule. In the non-classical cases, 8 cases were multiple aldosterone producing nodule and 9 cases were multiple aldosterone producing nodule. Compared with the classical group, the non-classical group had a longer duration of hypertension(9.0 vs 5.0 years, P=0.062) and a lower baseline plasma aldosterone concentration(273 vs 305 pg/mL, P=0.147), but the difference was not significant. There was no significant difference between the two groups in the proportion of patients who achieved a complete biochemical response after surgery(98% vs 92.3%, P=0.281), but the proportion of patients who achieved a complete clinical response was significantly lower in the non-classical group(23.1% vs 52.9%, P=0.046). Conclusion:The pathological types of unilateral primary aldosteronism are predominantly classical, with aldosterone-producing adenoma being the most common. There were no significant differences in the clinical characteristics and postoperative biochemical remission rates between classical and non-classical patients, but the clinical prognosis of the latter was inferior to the former.

Surgical prognosis and influencing factors in 406 patients with primary aldosteronism / 中华内分泌代谢杂志

Objective:To evaluate postoperative biochemical and clinical remission rates in patients with unilateral primary aldosteronism and analyze related influencing factors.Methods:A total of 406 patients of primary aldosteronism with confirmed subtyping, who underwent adrenalectomy and completed follow-up in the Department of Endocrinology of the First Affiliated Hospital of Chongqing Medical University from November 2013 to March 2022 were retrospectively enrolled. Clinical and biochemical data were recorded. Postoperative clinical and biochemical outcomes were assessed according to Primary Aldosteronism Surgery Outcome(PASO) consensus.Results:Complete biochemical success was achieved in 391(96.31%) of 406 primary aldosteronism patients, while partial and absent biochemical success in only 4(0.99%) and 11(2.71%) primary aldosteronism patients; Complete clinical success was seen in 217(53.45%) patients, and partial clinical success in 189(46.55%) patients. Compared to the partial clinical success group, the complete clinical success group was younger, had a greater proportion of women, a smaller body mass index, a shorter duration of hypertension, a smaller daily defined dose value for antihypertensive medication, a higher estimated glomerular filtration rate(eGFR), and a lower proportion of family history of hypertension and diabetes mellitus. Multifactorial logistic regression analysis further showed that gender( OR=2.49, 95% CI 1.42-4.35, P=0.001), body mass index( OR=1.16, 95% CI 1.05-1.28, P=0.003), antihypertensive drug daily defined dose( OR=1.83, 95% CI 1.37-2.44, P<0.001), family history of hypertension( OR=2.16, 95% CI 1.22-3.83, P=0.008), history of diabetes( OR=2.47, 95% CI 1.15-5.29, P=0.021), and eGFR( OR=0.98, 95% CI 0.97-0.99, P=0.001) were independent factors influencing clinical prognosis of primary aldosteronism. Conclusion:The postoperative complete biochemical success is higher in patients with unilateral primary aldosteronism, but only about half of all patients achieve complete clinical success.

Pulmonary artery reconstruction to repair infant isolated unilateral absence of pulmonary artery: A retrospective cohort study in a single center / 中国胸心血管外科临床杂志

@#Objective To confirm the changes of pulmonary artery pressure, neo pulmonary artery stenosis and reoperation in children with unilateral absence of pulmonary artery (UAPA) undergoing pulmonary artery reconstruction. Methods The clinical data of the infants with UAPA undergoing pulmonary artery reconstruction in our hospital from February 19, 2019 to April 15, 2021 were analyzed. Changes in pulmonary artery pressure, neo pulmonary artery stenosis and reoperation were followed up. Results Finally 5 patients were collected, including 4 males and 1 female. The operation age ranged from 13 days to 2.7 years. Cardiac contrast-enhanced CT scans were performed in all children, and 2 patients underwent pulmonary vein wedge angiography to confirm the diagnosis and preoperative evaluation. Preoperative transthoracic echocardiography and intraoperative direct pulmonary arterial pressure measurement indicated that all 5 children had pulmonary hypertension, with a mean pulmonary arterial pressure of 31.3±16.0 mm Hg. Pulmonary arterial pressure decreased immediately after pulmonary artery reconstruction to 16.8±4.2 mm Hg. The mean follow-up time was 18.9±4.7 months. All 5 patients survived during the follow-up period, and 1 patient had neo pulmonary artery stenosis or even occlusion and was re-operated. Conclusion Pulmonary artery reconstruction can effectively alleviate the pulmonary hypertension in children with UAPA. The patency of the neo pulmonary artery should be closely followed up after surgery, and re-pulmonary angioplasty should be performed if necessary.

Post-COVID-19 unilateral upper lip numbness: A case report

@#This is a case of a 63-year-old female with post-COVID-19 unilateral upper lip pain and numbness. Neurologic examination did not reveal any deficits other than deficits on pinprick in the maxillary division (V2) of the left trigeminal nerve. Brain neuroimaging showed signs of acute inflammation of the left maxillary sinus. Neuropraxia of the infraorbital nerve, a branch of the trigeminal nerve, was the diagnosis considered. Reports on trigeminal neurosensory changes following acute sinusitis are few, and isolated trigeminal neuropathy is rare except in cases of dental disorders. Up to this writing, there have been no reports on post-COVID-19 unilateral upper lip numbness and pain. This study will also serve as a concise review on the correlative neuroanatomy of the trigeminal nerve.

Myricetin attenuates renal fibrosis by activating Nrf2/HO-1 pathway to inhibit oxidative stress / 药学学报

This paper investigates the effect of myricetin (MYR) on renal fibrosis induced by unilateral ureteral obstruction (UUO) and common bile duct ligation (CBDL) in mice and its mechanism. The animal experiment has been approved by the Ethics Committee of China Pharmaceutical University (NO: 2022-10-020). Thirty-five ICR mice were divided into control, UUO, UUO+MYR, CBDL and CBDL+MYR groups. H&E and Masson staining were used to detect pathological changes in kidney tissues. Western blot (WB) was used to detect the expression of fibrosis-related proteins in renal tissue, and total superoxide dismutase (SOD) activity detection kit (WST-8) was used to detect the changes of total SOD in renal tissue of CBDL mice. In vitro, HK-2 cells and transforming growth factor beta 1 (TGF-β1, 10 ng·mL-1) were used to induce fibrotic model, and high glucose (30 mmol·L-1) was used to induce oxidative stress model, and then treated with different concentrations of MYR, WB was used to detect the expression of fibrosis and oxidative stress-related proteins, while NIH/3T3 cells were treated with different concentrations of MYR, and their effects on cell proliferation were detected by 5-bromo-2′-deoxyuridine (Brdu). The results showed that the renal lesions in UUO group and CBDL group were severe, collagen deposition was obvious, the expression of collagen-Ⅰ (COL-Ⅰ), α-smooth muscle actin (α-SMA), fibronectin (FN), vimentin and plasminogen activator inhibitor-1 (PAI-1) protein was up-regulated, and the activity of SOD enzyme in CBDL group was significantly decreased. MYR partly reversed the above changes after treatment. MYR inhibited the proliferation of NIH/3T3 cells but had no effect on the proliferation of HK-2 cells, and decreased the upregulation of PAI-1, FN and vimentin in HK-2 cells stimulated by TGF-β1. MYR can also up-regulate the down-regulation of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) in HK-2 cells stimulated by high glucose. To sum up, MYR can improve renal fibrosis in vivo and in vitro, probably by inhibiting the proliferation of fibroblasts and activating Nrf2/HO-1 signal pathway to inhibit oxidative stress.

Clinical research of approach selection of extraction of maxillary embedded mesiodens / 安徽医科大学学报

Objective @#To explore the related factors for the unilateral flap and bilateral flap by changing the original operation plan in the extraction of maxillary impacted mesiodens. @*Methods @#81 patients with impacted mesiodens in the middle of the maxillary were retrospectively analyzed. The primary outcome variables were planned surgery (unilateral flap)and unplanned surgery (bilateral flap) . The secondary outcome variables consisted of operation time and postoperative swelling. The predictive variables were as follows:the differential value of the shortest distance from the supernumerary tooth to the labial and palatal bone plates , which was divided into≥1. 5 mm group and < 1. 5 mm group ; the ratio of the distance from the adjacent tooth apex to the nasal floor, compared to the length of the supernumerary teeth , was recorded as≥1 and < 1 . A statistical software SPSS 20 was used to complete the statistical analysis. @*Results @#When the differential value was less than 1. 5 mm , the possibility of unplanned surgery increased , and the probability of planned surgery was 0. 085 times than that of unplanned surgery. With age growing each 1 ⁃year, the probability of planned surgery gradually decreased , HR = 0. 745. The postoperative swelling of the palatal approach was only 0. 374 times than that of the labial approach. With age increasing , the operation time increased gradually , B = 1. 213. The ratio of the distance from the adjacent tooth apex to the nasal floor to the length of the supernumerary teeth did not affect the change of the surgical plan during the operation. @*Conclusion @#The shortest distance difference between the supernumerary teeth and the labial and palatal bone plates can be used as a reference for the selection of surgical approach for the extraction of maxillary impacted mesiodens.

Clinical application and perspectives of unilateral biportal endoscopic technique / 解放军医学杂志

Unilateral biportal endoscopic(UBE)technique is a minimally invasive spinal technique developed rapidly in recent years.Compared with traditional spinal endoscopy,the prominent feature of UBE is that it can open two channels on the same side of the spine,which can be used to provide visual field and insert operating instruments respectively,greatly expanding the operating space and reducing the difficulty of surgery.It has the advantages of less bleeding,little injury,quick recovery and mild pain,and has unique advantages in the treatment of lumbar spinal stenosis,lumbar disc herniation and other lumbar degenerative diseases.With the continuous in-depth exploration and development of the UBE technique,the field of diseases that can be treated by this technology has gradually expanded.It is not only limited to lumbar diseases,but also has made great progress in cervical and thoracic diseases,which has attracted the attention of many spinal surgeons.UBE technique has become one of the promising surgical methods for spinal-related diseases,but there are also complications such as incomplete decompression,nerve root and dural injury,epidural hematoma,relatively prolonged operation time,operation fatigue and other deficiencies.This paper summarizes the progress of the UBE technique,discusses its complications and deficiencies,proposes relevant solutions and possible future directions for its development,so as to provide reference for the clinical practice of UBE technique.

Research progress on complications of unilateral biportal endoscopic spinal surgery technique / 临床外科杂志

The unilateral biportal endoscopic spinal surgery(UBE)technique is an emerging endoscopic technique,mainly used as treatment for lumbar degenerative disease.The procedure is characterized by two working channels,one being endoscopic,the second to be employed as an operating channel.Through the use of such dual-channel-technology,it allows the operating instruments to be unrestricted in size.Therefore,it is a highly efficient surgical technique for minimally invasive spinal surgery(MISS).However,the clinical complications of UBE technology must be taken into consideration.Possible side effects include dural injury,epidural hematoma,occult blood loss,postoperative headache,nerve root injury and insufficient decompression.This article reviews the causes,prevention and management of UBE-related complications.

Clinical efficacy of UBE-LIF versus posterior lesion removal bone graft fusion fixation in the treatment of lumbar brucelli spondylitis / 西安交通大学学报(医学版)

Objective To compare the safety and clinical efficacy of lesion removal combined with percutaneous pedicle screw fixation with classical posterior lesion removal in the treatment of lumbar brucelli spondylitis(LBS)by unilateral biportal endoscopic technique with transforaminal lumbar interbody fusion(UBE-LIF)technique.Methods The clinical data of 32 patients with LBS admitted by the Department of Spine and Orthopedics of Gansu Provincial Hospital of Traditional Chinese Medicine from January 2020 to January 2022 were retrospectively analyzed,and the clinical data of the 32 LBS patients were divided into 15 cases in the UBE-LIF group and 17 cases in the posterior group.The general data,surgery-related indexes,and postoperative pathological HE staining of the two groups were recorded and analyzed.The patients'clinical recovery was assessed according to their erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP),low back pain visual analogue score(VAS),Japanese Orthopaedic Association(JOA)score,and Oswestry Dysfunction Index(ODI)preoperative,1 week after surgery,1,3,6 months and 1 year after surgery.Lumbar lordosis angle(LL)and intervertebral space height(DH)were measured by imaging before surgery and at the last follow-up,and intervertebral bone graft fusion was assessed using Suk grading criteria.Results Both groups successfully completed the operation and no serious postoperative complications occurred.There were no significant differences in gender,age,surgical segment,operation time,preoperative ESR and CRP,preoperative VAS,JOA score and ODI index,preoperative LL and DH(P＞0.05).The intraoperative blood loss,postoperative drainage,postoperative getting out of bed,and postoperative hospital stay in UBE-LIF group were significantly lower than those in the posterior group(P＜0.001).Pathological examination of diseased tissues was performed during surgery,all of which was consistent with brucellosis changes.Patients in both groups were followed up for 12-18 months,with an average of 14.8 months.The VAS,JOA score,and ODI index at all postoperative time points in the two groups were significantly improved compared with the preoperative period(P＜0.05).The difference between the two groups was significantly greater than that in the postoperative group:VAS score was lower in UBE-LIF group than in the posterior group(P＜0.01),CRP in both groups was higher than that in the preoperative group,and the elevation level was significantly lower in UBE-LIF group than in the posterior group(P＜0.001).There was no significant difference in ESR between the two groups compared with that before surgery(P＞0.05).There were no significant differences in VAS,JOA score,ODI index,CRP or ESR between the remaining time points after surgery(P＞0.05).At the last follow-up,imaging examination showed that the overall fusion rate of intervertebral bone graft in UBE-LIF group was 93.3％and 94.1％in the posterior group,without significant difference(x2=0.246,P=0.884).LL and DH were significantly improved in both groups compared with preoperative ones(P＜0.01),and the two groups did not significantly differ before and after surgery(P＞0.05).Conclusion Both surgical treatments for LBS are safe effect.Compared with posterior lesion removal bone graft fusion internal fixation,UBE-LIF technology combined with percutaneous pedicle screw internal fixation has the advantages of clear intraoperative vision,less blood loss,faster early postoperative recovery,and shorter postoperative hospital stay,and thus is a feasible surgical method for the minimally invasive treatment of LBS.

Robot-assisted minimally invasive transforaminal lumbar interbody fusion in treatment of lumbar degenerative diseases / 中国组织工程研究

BACKGROUND:Minimally invasive surgery is developing rapidly.Robot-assisted minimally invasive transforaminal lumbar interbody fusion and robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion are important posterior minimally invasive surgical approaches to treat lumbar degenerative diseases.However,it is worth discussing which operation method is more advantageous. OBJECTIVE:To compare the clinical efficacy and imaging examination between different operation groups,and discuss the clinical application value of robot-assisted minimally invasive lumbar posterior fusion technology to treat lumbar degenerative diseases. METHODS:Clinical data of 83 patients with lumbar degenerative diseases from January 2018 to June 2022 at the Department of Orthopedics,Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital were retrospectively analyzed.Of them,27 patients received robot-assisted minimally invasive transforaminal lumbar interbody fusion treatment(group A);30 patients received robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion treatment(group B),and 26 traditional minimally invasive transforaminal lumbar interbody fusion patients were selected as the control group(group C).There were no significant differences in gender,age,body mass index,surgical segment,preoperative visual analog scale score and Oswestry Disability Index among the three groups(P＞0.05).The operation time,intraoperative blood loss,complications,fluoroscopic dose,fluoroscopic time,and fluoroscopic frequency were compared among the three groups.Gertzbein-Robbins'classification was used to evaluate the accuracy of percutaneous pedicle screw.Visual analog scale and Oswestry Disability Index scores were evaluated after surgery.The excellent and good rate of the three surgical options was evaluated using Macnab's criteria. RESULTS AND CONCLUSION:(1)The operation time of group A was significantly shorter than that of groups B and C(P＜0.05),but there was no significant difference between group B and group C(P＞0.05).The intraoperative blood loss in group B was significantly less than that in group A,and that in group A was significantly less than that in group C(P＜0.05).(2)The fluoroscopic dose,fluoroscopic time,and fluoroscopic frequency of group C were significantly higher than those of groups A and B(P＜0.05).(3)Visual analog scale score and Oswestry Disability Index in the three groups significantly improved after operation when compared with that before operation(P＜0.05),but there was no significant difference among the three groups 1 day and 6 months after surgery(P＞0.05).(4)Postoperative imaging showed that the accuracy of percutaneous pedicle screw placement in groups A and B was better than that in group C(P＜0.05).(5)There was no significant difference in the excellent and good rate of MacNab criteria among the three groups(P＞0.05).(6)There was no significant difference in complications among the three groups(P＞0.05).(7)The results indicated that robot-assisted minimally invasive transforaminal lumbar interbody fusion and robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion are effective surgery methods for lumbar degenerative diseases.Compared with traditional minimally invasive transforaminal lumbar interbody fusion,robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery has higher efficiency,less intraoperative radiation and higher internal fixation accuracy,which has a good clinical application value.

Two lumbar fusion regimens in treatment of single-level lumbar degenerative diseases based on propensity score matching / 中国组织工程研究

BACKGROUND:Unilateral biportal endoscopic technique has been widely used in lumbar interbody fusion in recent years,but there is little comparison between its clinical efficacy and that of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of lumbar degenerative disease,whether the unilateral biportal endoscopic technique is a safe and effective lumbar fusion remains to be further demonstrated. OBJECTIVE:To compare the clinical efficacy of unilateral biportal endoscopic lumbar interbody fusion(UBE-LIF)and MIS-TLIF in the treatment of lumbar degenerative diseases and explore a more efficient lumbar fusion procedure. METHODS:Patients with single-level lumbar degenerative disease were enrolled in Affiliated Hospital of Guilin Medical College from October 2020 to February 2022,including 35 patients who underwent UBE-LIF and 286 patients who underwent MIS-TLIF.Propensity score matching was used to eliminate confounders.Four covariates including sex,age,disease type and surgical segment were matched 1:1(caliper value 0.01).After matching,29 patients from each group were included in the study.The perioperative operative time,hemoglobin loss and hospital stay were compared between the two groups.Visual analog scale score and Oswestry disability index were used to evaluate the functional recovery of the two groups before,1,6 months and 1 year after operation.The excellent and good rate of the two groups was evaluated by the modified MacNab standard at the last follow-up.The fusion of the two groups was evaluated by Lenke Dynamic X-ray film. RESULTS AND CONCLUSION:(1)The operative time in the MIS-TLIF group was shorter than that in the UBE-LIF group(P＜0.05).The amount of intraoperative hemoglobin loss in the MIS-TLIF group was higher than that in the UBE-LIF group.The hospital stay in the MIS-TLIF group was longer than that in the UBE-LIF group,and the differences were statistically significant(P＜0.05).(2)The visual analog scale scores for lumbago and leg pain,and Oswestry disability index were significantly reduced in both groups 1,6 months,and 1 year after surgery compared to before surgery(P＜0.05).Except for the visual analog scale score for lumbago at 1 month after surgery,there was no significant difference in the visual analog scale score for lumbago and leg pain,and Oswestry disability index between the two groups at the above time points(P＞0.05).(3)At the last follow-up,the modified MacNab standard efficacy evaluation showed that the excellent and good rates were 93%(27/29)in the UBE-LIF group and 90%(26/29)in the MIS-TLIF group;there was no significant difference between the two groups(P＞0.05).(4)Lenke dynamic radiographic evaluation system evaluation for lumbar fusion exhibited that the fusion rate was 90%(grade A,21 cases;grade B,5 cases;grade C,3 cases)in the UBE-LIF group;the fusion rate was 86%(grade A,20 cases;grade B,5 cases;grade C,4 cases)in the MIS-TLIF group;there was no significant difference between the two groups(P＞0.05).(5)It is indicated that UBE-LIF and MIS-TLIF have similar clinical effects in the treatment of single-level lumbar degenerative disease with the advantages of less trauma,less bleeding and shorter hospital stay.In addition,the early postoperative lumbago was relatively mild and the learning curve was relatively smooth.Although the operative time in the UBE-LIF group was longer than that in the MIS-TLIF group,it was still a safe and effective operation.

Constructing an animal model of temporomandibular joint osteoarthritis in Sprague-Dawley rats by digital technology / 中国组织工程研究

BACKGROUND:Temporomandibular joint osteoarthritis is a common oral disease with a high incidence.However,temporomandibular joint osteoarthritis is not easy to be detected in the early stage,and it is difficult to obtain clinical pathological specimens,so it is difficult to carry out related research.The application of digital 3D printing technology to animal models of Temporomandibular joint osteoarthritis increases the consistency of the animal models,thus promoting the study of temporomandibular joint osteoarthritis. OBJECTIVE:To establish a standardized animal model of temporomandibular joint osteoarthritis using novel digital technology. METHODS:According to the different modeling methods of unilateral anterior crossbite,30 female Sprague-Dawley rats were randomly divided into traditional model group,digital model group,and control group(n=10 per group).Cartilage specimens of the condyles were collected at 4 and 8 weeks after modeling.The apparent morphology was observed by stereoscopic microscope.The pathological morphology was observed by hematoxylin-eosin staining and Safranin O/fast green staining.Changes in the expression of interleukin-1β and tumor necrosis factor-α were observed by ELISA,and changes in the expression of aggrecan,type Ⅱ collagen and matrix metalloproteinase-13 were observed by immunohistochemical staining. RESULTS AND CONCLUSION:Different degrees of degeneration were observed in the digital and traditional model groups.The body mass of rats in both the model groups decreased during the 1st week after intervention and subsequently demonstrated growth trend and were significantly lower than that in the control group.The results of stereoscopic microscope showed that at 4 and 8 weeks after modeling,the deformation and defect degree of the digital model group was significantly higher than that of the traditional model group.At these two time points,the Osteoarthritis Research Society International scores of the digital model group and the traditional model group were higher than those of the control group,and the Osteoarthritis Research Society International score of the digital model group was higher than that of the traditional model group(P＜0.05).Histopathological observation showed that the modified Mankin score and Osteoarthritis Research Society International score of the two model groups were significantly higher than those of the control group of the same age at 4 and 8 weeks after modeling(P＜0.05).Immunohistochemical staining results showed that at two time points,compared with the control group of the same age,the expression of aggrecan and type Ⅱ collagen decreased in the traditional model group and the digital model group,while the expression of matrix metalloproteinase 13 increased(P＜0.05).ELISA results showed that the expression levels of inflammatory factors interleukin-1β and tumor necrosis factor-α in the traditional and digital model groups were higher than those in the control group at 8 weeks,and the expression levels of interleukin-1β and tumor necrosis factor-α in the digital model group were higher than those in the traditional model group(P＜0.05).To conclude,the personalized metal tube designed and produced by 3D printing technology can quickly guide the osteoarthritis-like lesions of the temporomandibular joint without repeated trial and adjustment,which is reproducible and suitable for promotion and application.

Efficacies of different correction methods on adolescents with low-to-moderate unilateral myopia / 局解手术学杂志

Objective To compare the prevention and control effects of binocular myopia after wearing orthokeratology lenses or glasses for correction in adolescents with low-to-moderate unilateral myopia.Methods The clinical data of 46 adolescents with unilateral myopia treated in First Affiliated Hospital of Army Medical University were retrospectively analyzed,the patients were divided into the orthokeratology lenses group and spectacles group according to the correction methods,with 23 cases in each group.The axial length(AL),changes in spherical diopter(SD)and anisometropia between the myopic eye and the control eye with orthokeratology lenses spectacles for unilateral myopia correction,and orthokeratology lenses for unilateral and binocular myopia were compared.Results There was no significant difference in baseline AL,SD or anisometropia between the two groups(P>0.05).One year after unilateral myopia correction,the increase of SD for the myopic eye in the orthokeratology lenses group was less than that in the spectacles group(P<0.05),and there was no significant difference in the AL elongation of myopic eyes between the two groups(P>0.05);the elongation of AL for the control eyes in the orthokeratology lenses group was more than that in the spectacles group;the increase of SD for the myopic eyes in the orthokeratology lens group was lower than that in the spectacles group(P<0.05),and there was no significant difference in the increase of SD for the control eyes between the two groups(P>0.05);the anisometropia of patients in the orthokeratology lenses group was less than that in the spectacles group(P<0.05).The biological parameters of the eyes before and after wearing orthokeratology lenses in the patients with monocular and binocular myopia in the orthokeratology lens group were compared,the elongation of AL for the myopic eyes with lens in one eye was less than that with lenses in both eyes(P<0.05),and the elongation of AL for the control eye was more than that with lenses in both eyes(P<0.05),the increases of SD in both myopic eyes and control eyes were more than those with lenses in both eyes(P<0.05),and the anisotropia was more than that with lenses in both eyes(P<0.05).Conclusion Orthokeratology lenses is better than spectacles in controlling the increase of myopia in low-to-moderate unilateral myopia,which can reduce anisometropia between eyes.However,the AL of the emmetropic eye increases rapidly during unilateral myopia correction by orthokeratology lenses,and the progression of binocular myopia can be significantly delayed after wearing orthokeratology lenses.

Clinical efficacy of unilateral biportal endoscopic decompression for lumbar disc herniation / 中国内镜杂志

Objective To observe the clinical effectiveness of unilateral biportal endoscopy(UBE)decompression in the treatment of lumbar disc herniation.Methods 80 patients with lumbar disc herniation who were treated with UBE decompression from January 2021 to March 2022 were collected,and the visual analogue scale(VAS)was applied to assess patient pain,Oswestry disability index(ODI)to assess limb function,and the Japanese Orthopaedic Association(JOA)score to evaluate patient vertebral body function at the preoperative and postoperative periods of 1 day,3 months,6 months,and 12 months,respectively.Results The mean VAS of the lumbar and back of patients before surgery was(5.72±2.18),(2.74±1.52),(1.92±1.26),(1.73±1.36),and(0.87±0.72)at the 1 day,3 months,6 months,and 12 months after surgery,respectively,with statistical significance(P<0.05).The VAS of the patient's leg decreased from(4.63±2.17)to(4.22±1.91)before and 1 day after surgery,with no significant difference(P>0.05),at 3 months(3.73±1.42),6 months(2.13±1.16),and 12 months(0.76±0.63)after surgery,with statistical significances(P<0.05);The preoperative ODI of the patients was(60.23±8.13)%,and decreased to(41.91±6.53)%,(12.82±4.24)%,(8.19±3.84)%,and(6.75±2.14)%after 1 day,3 months,6 months,and 12 months of follow-up,respectively,with statistical significances(P<0.05).The preoperative JOA scores was(9.08±1.34),1 day after surgery,the score was(10.89±0.88),3 months(13.34±1.25),6 months(15.75±1.24),and 12 months(18.12±1.86)after surgery,with significant improvement in lumbar function(P<0.05).Conclusion UBE decompression can achieve good clinical efficacy in the treatment of lumbar disc herniation,providing another option for the treatment of lumbar disc herniation,which is worth promoting.

Short-term curative effect evaluation of unilateral biportal endoscopy through Sublamina approach for lumbar intervertebral foramen stenosis combined with lumbar disc herniation / 中国内镜杂志

Objective To explore the efficacy of unilateral biportal endoscopy(UBE)for lumbar intervertebral foramen stenosis combined with lumbar disc herniation through Sublamina approach.Methods From October 2021 to June 2022,7 elderly patients with typical symptoms of lumbar disc herniation in the intervertebral foramen area accompanied by spinal stenosis were retrospectively analyzed.There were 6 patients with lumbar disc herniation and nerve root canal stenosis at L4/5 and 1 patient at L5/S1.The mean course of disease was(8.6±2.5)months.All the patients were treated by UBE through Sublamina approach.Results Postoperative limb radicular symptoms of 7 patients were relieved.The visual analogue scale(VAS)of limb pain was significantly decreased from preoperative(8.6±1.3)to(2.1±1.1)at 2 d after the surgery(P<0.05),the Japanese Orthopaedic Association(JOA)score was significantly increased from preoperative(10.1±2.4)to(17.3±1.8)at 2 d after the surgery(P<0.05).Conclusion UBE for lumbar intervertebral foramen stenosis combined with lumbar disc herniation through Sublamina approach has a satisfactory therapeutic effect,providing a new idea for the surgical treatment of this disease.

Application effect and safety analysis of unilateral laminectomy and bilateral decompression under unilateral biportal endoscopy and microendoscope in lumbar spinal stenosis / 中国内镜杂志

Objective To analyze the efficacy and safety of unilateral laminectomy and bilateral decompression under unilateral biportal endoscopy(UBE)and microendoscope(MED)in lumbar spinal stenosis.Methods 80 patients with lumbar spinal stenosis from January 2021 to December 2022 were selected and divided into two groups by numerical table method,the control group and the study group,and the number of cases was 40.The grouping method was random number table method.The control group was treated with unilateral laminectomy and bilateral decompression under MED,while the study group was treated with unilateral laminectomy and bilateral decompression under UBE.Operation time,intraoperative blood loss,Oswestry disability index(ODI)and visual analogue scale(VAS)of lumbago and leg pain were obtained before surgery,1,3 months after surgery and at the last follow-up,efficacy and complications were compared between the two groups.Result There were no significant differences in operative time and blood loss between the study group and the control group(P>0.05).1,3 months after surgery and at the last follow-up,ODI in both groups were lower than those before surgery(P<0.05),but there was no difference between the study group and the control group(P>0.05).The VAS of lumbago and leg pain in both groups were lower than those before surgery(P<0.05),at 1,3 months after surgery and the last follow-up,and the study group was significantly lower than the control group(P<0.05).The excellent and good rate of clinical treatment in the study group was 97.50%,and there was no difference compared with 92.50%in the control group(P>0.05).The complication rate of the study group was 2.50%,significantly lower than that of the control group(15.00%)(P<0.05).Conclusion Unilateral laminectomy and bilateral decompression under the UBE and MED have similar efficacy in the treatment of lumbar spinal stenosis,both of which can effectively promote functional recovery,but UBE can reduce pain more effectively and has fewer postoperative complications.

Analysis of risk factors for recurrence after unilateral biportal endoscopy in patients with lumbar disc herniation / 中国内镜杂志

Objective To explore the risk factors for recurrence after unilateral biportal endoscopy in patients with lumbar disc herniation.Methods Clinical data of 156 patients with lumbar disc herniation were retrospectively analyzed.All the patients underwent unilateral biportal endoscopy treatment.Follow up for 2 years after surgery,and the recurrence rate of all patients was recorded.The clinical characteristics of patients in the recurrent and non recurrent groups were compared,the factors influencing postoperative recurrence were analyzed by multivariate Logistic regression.Results After a 2-year follow-up,a total of 22 patients experienced recurrence,with a recurrence rate of 14.10%(22/156).The results of multivariate Logistic analysis showed that,the age>60 years old,fiber ring break>5 mm,incomplete nucleus pulposus removal,and postoperative intervertebral motion>10 ° were independent risk factors for recurrence after unilateral biportal endoscopy in patients with lumbar disc herniation(P<0.05).Conclusion Age>60 years old,fiber ring break>5 mm,incomplete removal of the nucleus pulposus,and postoperative intervertebral motion>10 ° were independent risk factors for recurrence after unilateral biportal endoscopy in patients with lumbar disc herniation,and prevention should be strengthened.