Exercise therapy versus surgery for lumbar spinal stenosis: A systematic review and meta-analysis

Objective: To compare the effectiveness of exercise therapy with surgery for lumbar spinal stenosis

Methods: Five English databases PubMed, the Cochrane Library, Web of science, OVID and PEDro database were searched for randomized controlled trials comparing surgical procedures with exercise therapy for lumbar spinal stenosis. Information on patients, study design, inclusion criteria, intervention and followup, outcomes, treatment details and adverse events were extracted. Meta-analysis was performed using Review Manager Version 5.3

Results: Two randomized controlled trials and one mixed design trial with a total of 897 patients were included. The pooled results showed a significant difference between exercise and surgery in Oswestry Disability Index at two years [MD= 3.85, 95%CI: 0.48 to 7.22; P=0.03], but no significant difference at six months [MD= 2.18, 95%CI: -2.80 to 7.17; P=0.39] and one year [MD= 4.26, 95%CI: -1.79 to 10.32; P=0.17]. In terms of physical function of 36 Items Short Form Health Survey, there were no significant differences between exercise and surgery at six months [MD= -2.23, 95% CI: -7.46 to 2.99; P=0.40], one year [MD= -2.17, 95% CI: -7.44 to 3.10; P=0.42] and two years [MD= -0.67, 95% CI: -6.16 to 4.82; P=0.81]

Conclusion: In brief, the current evidence demonstrated a trend that exercise therapy had a similar effect for lumbar spinal stenosis compared with decompressive laminectomies. However, for the small sample size and low methodology quality of the included trials, some rigorously designed and large-scaled RCTs need to be performed to confirm the conclusion

Comparison of two types of exercises in the treatment of lumbar spinal stenosis

Objective: To evaluate the efficacy of core stability exercise versus conventional exercise in the treatment of lumbar spinal stenosis

Methods: Between January 2014 and May 2017, patients with lumbar spinal stenosis were recruited and divided into group of core stability exercise or conventional exercise randomly. All the patients were treated using middle frequency electrotherapy, in addition to that, the patients in group of core stability exercise were treated using core stability exercise. The patients in group of conventional exercise were treated using conventional exercise. The outcome was evaluated using Japanese Orthopedic Association [JOA] score, self-reported walking capacity and lumbar lordosis angle at baseline and after treatment

Results: In the current study, sixty-two patients with lumbar spinal stenosis met the inclusion and exclusion criteria, in which 33 patients were included in group of core stability exercise and 29 in group of conventional exercise. After treatment, both Japanese Orthopedic Association scores [p<0.05] and self-reported walking capacity [p<0.05] increased significantly in each group when compared with baseline. The self-reported walking capacity and JOA scores in the group of core stability exercise were significantly higher than those in the conventional exercise group [p<0.05]. However, both the intragroup and intergroup comparison of lumbar lordosis presented with no significance [p>0.05]

Conclusion: Core stability exercise presents with better efficacy than conventional exercise in the treatment of lumbar spinal stenosis.

Clinical Observation of Meglumine Adenosine Cyclophosphate in the Treatment of Acute Myocardium In-farction / 中国药房

OBJECTIVE:To investigate clinical efficacy and safety of meglumine adenosine cyclophosphate in the treatment of acute myocardium infarction. METHODS:A total of 80 patients with acute myocardium infarction in our hospital during May 2015-Jan. 2016 were selected and divided into control group and observation group according to random number table,40 cases in each group. Control group was given conventional treatment. Observation group was additionally given Meglumine adenosine cyclo-phosphate injection 120 mg added into 5% Glucose injection 250 mL,ivgtt,qd,on the basis of control group. Both groups re-ceived treatment for 7 d. Clinical efficacies as well as the levels of serum hs-CRP and NT-proBNP before and after treatment were observed in 2 groups,and the occurrence of ADR was compared between 2 groups. RESULTS:Total response rate of observation group(92.50%)was significantly higher than that of control group(75.00%),with statistical significance(P0.05). After treat-ment,the serum levels of hs-CRP and NT-proBNP in 2 groups were decreased significantly,and the observation group was signifi-cantly lower than the control group,with statistical significance(P0.05). CONCLUSIONS:Meglumine adenosine cyclophosphate shows significant therapeutic efficacy for acute myocardium infarction,reduces serum levels of hs-CRP and NT-proBNP significantly with good safety.

Does the effectiveness of core stability exercises correlate with the severity of spinal stenosis in patients with lumbar spinal stenosis?

Objective: To determine whether the effectiveness of core stability exercises correlates with the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis

Methods: Forty-two patients with degenerative lumbar spinal stenosis treated in the department of orthopedics of our hospital between May 2013 and January 2016 were included in the study. All the patients performed core stability exercises once daily for six weeks, and the clinical outcomes were evaluated using Japanese Orthopaedic Association [JOA] score and self-reported walking capacity. The anteroposterior osseous spinal canal diameter was measured to evaluate the severity of spinal stenosis. The correlation between the stenosis degree and the differences of Japanese Orthopaedic Association score or self-reported walking capacity at baseline and after treatment were analyzed

Results: The patients were divided into three groups according to the spinal stenosis degree. In the three groups, there was no significant difference in JOA or self-reported walking distance at baseline [p>0.05] and after treatment [p>0.05]. The JOA scores and self-reported walking distance were significantly increased after treatment [p<0.05] in any of the three groups when compared to the baseline. Also, there was no significant correlation between the stenosis degree and the difference of JOA [p>0.05] or self-reported walking distance [p>0.05]

Conclusion: There was no significant correlation between the effectiveness of core stability exercises and the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis

Influence of lumbar disc degeneration on the efficacy of lumbar fixed-point rotation manipulation in sitting position：a finite element study / 针灸推拿医学（英文版）

Objective:To investigate the influence of lumbar disc degeneration on the efficacy of lumbar fixed-point rotation manipulation in sitting position in treating lumbar intervertebral disc herniation (LIDH). Methods:We simulated lumbar fixed-point rotation manipulation of sitting position using three finite element models including a normal model, a mild degeneration model and a moderate degeneration model of L3-5, in which the herniated disc was assumed at the left rear of L4 disc and the rotation manipulation was carried out on the right side. The displacement and stress at the left rear of L4 disc of the three models were analyzed. Results:When lumbar fixed-point rotation manipulation in sitting position was carried out, a displacement and stress were generated at the left rear of L4 intervertebral disc of the three models directing forward. The displacement and stress in degeneration models were less than those in the normal model, and the smallest values were found in the moderate degeneration model. From normal model to mild and then to the moderate degeneration model, the displacement decreased by 36% and 59%, and the stress decreased by 22.3% and 45.2%, respectively. Conclusion:The lumbar disc degeneration affects adversely the effectiveness of lumbar fixed-point rotation manipulation in sitting position in the treatment of LIDH. The severer the lumbar degeneration, the greater the influence.

Discussion on the theory of paying equal attention to sinew and bone in China osteosynthesis / 针灸推拿医学（英文版）

‘Paying equal attention to sinew and bone’ is an important principle in China osteosynthesis (CO). Traditional bone-setting manipulations not only pay high attention to fracture reduction, but also to sinew-regulating and soft tissues protection. The advantage of this principle has also been confirmed by modern medicine. To understand the principle better, it is essential to learn its historical origin, its important role in traumatology and its significant influence on modern orthopedics. In addition, we should inherit and further develop its theory, innovate and promote the development of CO constantly.

HPV 16/18 infection affect p53 expression in invasive ductal carcinoma? An experimental study

To determine the relations between human papilloma viruses type 16 and type 18 infection and the expression of p53 protein in invasive ductal carcinoma. We detected the expression of HPV 16/18 DNA and p53 protein in invasive ductal carcinoma in 45 cases, breast fibroadenoma in 20 cases and normal breast tissues in 20 cases. HPV detection was performed on paraffin sections using biotin-labeled probes by in situ hybridization and p53 protein expression was evaluated by immunohistochemistry. The expression rate of HPV 16/18 DNA and p53 protein in invasive ductal carcinoma is significantly higher than those in breast fibroadenoma and normal breast tissues [p < 0.05]; the expression in cases with axillary lymph node metastasis is dramatically higher than those without [p < 0.05]; the expression of p53 protein increases with TMN staging advance. The expression of HPV16/18 DNA was significantly correlated with the expression of p53 protein [p < 0.05]. Both HPV16/18 infection and p53 mutation participate the occurrence and progress of invasive ductal carcinoma, and HPV 16/18 infection may be the major factor to cause p53 mutation

Traumatic lumbar spondylolisthesis

Traumatic lumbar spondylolisthesis is a rare lesion and frequently noted in patients with multiple traumatic injuries. We report one case of L5 traumatic spondylolisthesis, which obtained successful decompression, reduction, interbody fusion and fixation by posterior lumbar interbody fusion, and got satisfactory outcome. We recommend early decompression, reduction, interbody fusion and fixation with posterior instrumentation to obtain the recovery of neurological function and stability of the spine

Experimental research on biomechanical stability about L_5S_1 ALIF / 中国矫形外科杂志

[Objective] To evaluate the biomechanical stability of lumbar intact specimen,anterior lumbar interbody fixation(ALIF)specimen,ALIF specimen fixed with pedicle screw and ALIF specimen fixed with translaminar facets screw.[Method]Each of eight adult fresh cadaver specimen of lumbarsacral segmcnts was analyzed in four states(groups):intact,L5S1 ALIF,L5S1 ALIF fixed with pedicle screw or fixed with translaminar facets screw,test and compare its range of motion(ROM)in flexion,extension,lateral bending and axial rotation.[Result]The ROM of ALIF specimen in extension was larger than that of intact specimen(P