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BACKGROUND:As a leading technique in the treatment of primary stenosis by posterior spinal endoscopy through unilateral approach and bilateral decompression using single channel endoscopy,the long-term efficacy needs to be further observed.There are few reports on the scope of intraoperative resection and few relevant studies on biomechanics and finite element analysis. OBJECTIVE:A three-dimensional finite element model was established to evaluate the effects of bilateral lumbar canal decompression under a one-hole split endoscope on lumbar range of motion and intradiscal pressure,to provide suggestions for clinical operation and theoretical basis for further clinical research. METHODS:A complete L3-L5 vertebral body model was reconstructed by CT images of nine healthy volunteers,which was used as the preoperative model M1.The simulated surgical resection range of L4-L5 was performed,and 1/4,1/3 and 1/2 of bilateral facet joints were removed respectively to obtain models M2,M3 and M4.The range of motion and the maximum Von Mises stress of the four models were compared in the six directions of forward bending,backward extension,left and right bending,and left and right rotation. RESULTS AND CONCLUSION:(1)The L3-L5 finite element model established in this study was effective,and the range of motion was within the range of previous solid studies under six motion states.(2)Compared with the M1 model,the L4-L5 lumbar spine range of motion increased with the increase of resection range in M2 with M3 and M4 models under forward bending,left and right bending and left and right rotation loading,and the difference was significant(P＜0.05).Under posterior extension loading,there was no significant difference in lumbar range of motion between M1 and M2(P＞0.05),but there was a significant difference of M1,M3 and M4(P＜0.05).(3)The range of motion of the L3-L4 lumbar spine had no significant change with the increase of bilateral facet arthrotomy(P＞0.05).(4)There was a significant difference in the maximum value of L4-L5 Von Mises between M1 and M2(P＜0.05),and there was a significant difference in the maximum value of L4-L5 Von Mises between M1 and M3,M4(P＜0.01),and the maximum value of L4-L5 lumbar von Mises increased with the increasing range of bilateral facet joint resection.Resection of more than 1/3 was particularly obvious.(5)The maximum value of Von Mises in the L3-L4 lumbar spine was increased with the increase of the resection range under forward bending,left and right bending and left and right rotation loading and the difference was significant(P＜0.05).(6)The results exhibited that the L4-L5 lumbar motion and intervertebral disc pressure increased with the increase of the excision range.Intervertebral disc pressure at L3-L4 increased with the increased extent of excision,but the lumbar range of motion was not significantly affected.In conclusion,the stability of the operative segment may be affected by the increase in the scope of facet joint resection.Although the immediate stability of adjacent segments is not affected,it may accelerate disc degeneration.
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Objective To build a knowledge graph;To visualize the knowledge structure relationships and clinical thinking in the treatment of coronary heart disease by renowned TCM doctors;To provide methodological reference for the inheritance of experience of renowned TCM doctors.Methods Medical records about treatment of coronary heart disease by renowned TCM doctors were retrieved from CNKI from the establishment of the database to 30th,Nov.2022.The characteristics of TCM diagnosis and treatment and the characteristics of the theoretical system of syndrome differentiation and treatment in TCM were analyzed.Concept types and relationships between concepts were sorted out and extracted to form a pattern layer of knowledge graph;based on the characteristics of the pattern layer,Python 3.11(PyCharm 2022.3.2)was used to write rules,and knowledge extraction and data import were implemented through the Pandas library,Openpyxl library and Py2neo library,which were stored in the graph database Neo4j-Community-5.2.0 to complete the construction of the knowledge graph.Implementing query application was realized through Cypher language.Results The data of 643 medical cases of 144 renowned TCM doctors were included,which were entered into the Neo4j graph database,forming a knowledge graph consisting of 2 744 nodes and 23 795 relationships under 8 concepts and 10 relationships,to achieve visual presentation and query application of the diagnosis and treatment process of coronary heart disease by renowned TCM doctors.Conclusion The knowledge graph can intuitively display the relationship of diseases-symptoms-syndromes-treatments-prescriptions-medicine in medical records,develop a knowledge system that is easy to retrieve,and improve the accessibility of domain knowledge,which can provide methodological reference for the inheritance of experience of renowned TCM doctors.
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Objectives:To explore the early clinical efficacies of unilateral decompression and bilateral decompression by one-hole split endoscope(OSE)technique for moderate-severe lumbar spinal stenosis(LSS)with unilateral symptoms amongst middle aged and elderly people.Methods:A retrospective analysis was performed on the patients with moderate-severe LSS who underwent unilateral decompression and bilateral decompression using OSE technique between January 2021 and December 2021.According to the inclusion and exclusion criteria,a total of 120 patients were enrolled in this study,with 60 patients in the unilateral decompression group(group A)and 60 patients in the bilateral decompression group(group B).The length of hospitalization,operative time,incision length and intraoperative blood loss were counted and compared between group A and group B.Moreover,range of motion(ROM)and sagittal translation(ST)on lumbar dynamic X-ray,facet preservation rate on the approach side,and cross-sectional area of the canal(CAC)of the surgical segment before and after operation were recorded and compared.The visual analogue scale(VAS)of back and leg pain was used before surgery,and at 7 days,3 months and 18 months after surgery,the Oswestry disability index(ODI)was used to evaluate the functional improvement,and the clinical efficacy was evaluated by modified Macnab criteria at the last follow-up.All the clinical scores of both groups were analyzed and compared between before and after surgery.Results:All the patients underwent surgical inter-vention successfully.There was no statistical significance in the length of hospitalization between groups A and B(P＞0.05),but group B was longer in operative time,bigger in incision,and more in blood loss than group A,with statistical significance(P＜0.05).The VAS for back and leg pain and the ODI after operation in both groups were all significantly lower than those before surgery,respectively(P＜0.05),and the values at each postoperative time point within group were significantly different when compared pairwise(P＜0.05);There was no significant difference between the two groups before surgery(P＞0.05),but group B had more significant improvement than group A at 7 days,3 months and 18 months after surgery(P＜0.05).There was no statistical significance in ST and ROM of surgical segment before and after surgery between the two groups(P＞0.05).The postoperative facet preservation rate was higher in group B than in group A(P＜0.05).There was no sig-nificant difference in the CAC of the surgery segment before operation between the two groups(P＞0.05),how-ever,the CAC of the surgical segment in group B was larger than that in group A(P＜0.05).The rate of im-provement in CAC was higher in group B than in group A(P＜0.05).The CAC of the surgical segment postop-eratively in both groups were significantly larger than before surgery,with statistical significance(P＜0.05).Ex-cellent-good rate at 18 months after surgery was 86.7％in group A and 91.7％in group B.There was no significant difference in the number of excellent and good cases between the two groups at 18 months after operation(P＞0.05).One patient in group A had numbness and discomfort in the lower limb on the healthy side after surgery,and one case with mild dural tear in group B.Conclusions:Both unilateral decompression and bilateral decompression under OSE are safe and effective in the treatment of moderate and severe central canal and bilateral lateral recess stenosis with unilateral symptoms in the middle-aged and elderly people,with definite early clinical efficacy.Bilateral decompression is more complete and better in clinical efficacy than unilateral decompression,but further follow-up is required in the long term.
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Objectives: Our study was to evaluate the effect of Qishen Yiqi Dropping Pills(QSYQ) on the prognosis of chronic ischemic heart failure(CIHF) and its safety. Methods: Databases including CNKI, Wanfang, VIP, CBM, PubMed, Web of Science, The Cochrane Library and EMbase were searched from their inception to April 2023 to screen relevant randomized controlled trials (RCTs). Primary indicators included readmission rates, rates of major adverse cardiovascular events (MACE), and all-cause mortality rates. The quality of the literature was assessed according to the Cochrane Reviewers' Handbook 5.0 and the Modified Jadad Scale (with a score of 4-7 rated as high quality). Meta-analysis was performed using the meta-package created by R software version 4.2.3, continuous data were compared using SMDs, and dichotomous and ordered data were compared using ORs; and the I2 test was used to assess the heterogeneity. Results: Fifty-nine studies out of 1,745 publications were finally included, totalling 6,248 patients. Most studies were poorly designed and had some publication bias, with only 26 high-quality papers (Jadad score ≥4). Meta-analysis showed that the combined application of QSYQ was able to reduce the readmission rate [OR = 0.42, 95% CI (0.33, 0.53), P < 0.001], all-cause mortality rate [OR = 0.43, 95% CI (0.27, 0.68), P < 0.001], and the incidence of MACE [OR = 0.42, 95% CI (0.31, 0.56), P < 0.001]. Also, the treatment method can improve clinical effectiveness [OR = 2.25, 95% CI (1.97, 2.58), P < 0.001], increase 6-min walking distance (6MWD) [SMD = 1.87, 95% CI (1.33, 2.41), P < 0.0001] and left ventricular ejection fraction (LVEF) [SMD = 1.08, 95% CI (0.83, 1.33), P < 0.0001], and decrease the Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores [SMD = -2.03, 95% CI (-3.0, -1.07), P < 0.0001], BNP levels [SMD = -2.07, 95% CI (-2.81, -1.33), P < 0.0001] and NT-ProBNP levels [SMD = -2.77, 95% CI (-4.90, -0.63), P < 0.05]. A total of 21 studies (n = 2,742) evaluated their adverse effects, of which 13 studies reported no adverse effects and 8 studies reported minor adverse effects. Conclusion: Our results suggest that the combined application of QSYQ can further improve patients' cardiac function and exercise tolerance, improve their quality of life, and ultimately improve patients' prognosis with a favorable safety profile. Nonetheless, limited by the quality and high heterogeneity of the literature, we must be conservative and cautious about the present results. Systematic Review Registration: PROSPERO (CRD42023449251).
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<p><b>OBJECTIVE</b>To explore the role of microRNA on the myocardial microvascular endothelial cells (CMECs) of ischemic heart rats in the process of angiogenesis and related regulation mechanism.</p><p><b>METHODS</b>Myocardial ischemic rats model was established by coronary ligation.Seven days after operation, the ischemic CMECs were cultured by the method of planting myocardium tissue and identified by immunocytochemistry to observe the biological characteristics of ischemic CMECs angiogenesis, to determine the window period of migration, proliferation, tube formation in the process of its angiogenesis. Dynamic expression changes of microRNA in the process of ischemic CMECs angiogenesis was detected using microRNA chip and further verified by real-time PCR, the core microRNA of the ischemic CMECs was defined and the predicted target genes of core microRNA were determined by bioinformatics methods and real-time PCR. At the same time, the protein expression of target gene and angiogenesis related genes of p38MAPK, PI3K,Akt,VEGF were measured by Western blot.</p><p><b>RESULTS</b>The CMECs of rats presented typical characteristics of microvascular endothelial cells, and factor VIII, CD31 related antigens were all positively stained by immunocytochemical analysis. The migration window period was on the first day, and the tube formation window period was on the second day of both control and ischemic groups, while the proliferation window period was on the third day for the normal group, and the sixth day for ischemic group. According to the expressional difference and their relationship with angiogenesis, miRNA-223-3p was ultimately determined as the core microRNA in the process of ischemic CMECs angiogenesis, real-time PCR verified this hypothesis. Bioinformatics methods predicted that Rps6kb1 is the target genes of miRNA-223-3p, the pathway analysis showed that Rps6kb1 could regulate angiogenesis via HIF-1α signal pathway. Moreover, the mRNA and protein expression of VEGF, p38MAPK, PI3K,Akt, which were the downstream molecules of Rps6kb1/HIF-1α signal pathway, were also significantly downregulated in ischemic CMECs from migration and proliferation stage.</p><p><b>CONCLUSION</b>Our results show that the miRNA-223-3p is the core microRNA of ischemic CMECs angiogenesis. MiRNA-223-3p could regulate Rps6kb1/HIF-1α signal pathway, inhibit the process of migration and proliferation of ischemic CMECs angiogenesis. MiRNA-223-3p is thus likely to be a core target for enhancing angiogenesis of ischemic heart disease.</p>
Subject(s)
Animals , Rats , Blotting, Western , Endothelial Cells , Physiology , Endothelium, Vascular , Hypoxia-Inducible Factor 1, alpha Subunit , MicroRNAs , Pharmacology , Myocardial Ischemia , Myocardium , Myocytes, Cardiac , Neovascularization, Pathologic , Phosphatidylinositol 3-Kinases , Platelet Endothelial Cell Adhesion Molecule-1 , RNA, Messenger , Ribosomal Protein S6 Kinases, 70-kDa , Signal TransductionABSTRACT
Abstract: Large-scale clinical trial is an important measure of clinical evaluation on drugs. This paper introduces the concept and features of large-scale clinical trial, the possibility and necessity of large-scale clinical trial of traditional Chinese medicine, as well as its administration and quality control, with Myocardial Infarction Secondary Prevention Study in Traditional Chinese Medicine (MISPS-TCM), a National Program Subject, as an example.
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Case recruitment of large-scale clinical trials should be strictly checked in quality and quantity for it is the key to clinical trial. This study discusses the main difficulties and countermeasures in the case recruitment of large sample, multi-center clinical trials according to the national research project "Myocardial Infarction Secondary Prevention Study in Traditional Chinese Medicine".
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Background Traditional Chinese medicine (TCM), especially herbal medicine, has been widely used in China and now is also being increasingly used in other countries for the treatment of cardiovascular diseases. Although many studies have demonstrated that certain Chinese herbal products are effective and safe for the treatment of cardiovascular diseases, most of these lack sufficient quality. Therefore, large randomized clinical trials and further scientific research to determine its safety, effectiveness are necessary.QiShen YiQi Dripping Pills (QSYQDP) is a herbal preparation clinically used in the treatment and prevention of coronary artery disease. Preliminary observations have shown its safety and effectiveness. Methods/Design This randomized, controlled trial will recruit 3600 patients with a history of myocardial infarction. Patients will be randomized into two groups by a Centr-Randomized System. One group receives QSYQDP, the other group receive aspirin. This trial protocol will describe eligibility criteria, detailed information on the treatment definition, blinding, endpoints, statistical methods, sample size determination, data management, legal aspects, and the current status of the trial. Discussion This trial is one of the first randomized, controlled clinical trial to evaluate the efficacy and safety of traditional Chinese herbal medicine in the treatment and secondary prevention of coronary artery disease. The results of this study should help to define the role of TCM in modern medical care, as well as to provide the management strategy for CAD patients in China and other countries.
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AIM： To investigate the effects of 6， 7－ dimethoxycoumarins on the proliferation and the cell cycle of human lung carcinoma cell（ PA） in vitro METHODS： The effects of 6， 7－ dimethoxycoumarins on the cytomorphology， growth and cell cycle of PA cells were evaluated by MTT assay and flow cytometry in vitro RESULTS： 6， 7－ dimethoxycoumarins could inhibit the proliferation of PA cells in a dose－ dependent manner The inhibition action of 6， 7－ dimethoxycoumarins plateaued at 160μ g/ml(52 4％ inhibition) The agent in dose of 80μ g/ml led to a decline in the proportion of cells to those in G2/M phase， made the cells remain in G0/G1 phase and reduced the proliferation index(PI) of PA cells CONCLUSION： In vitro， 6， 7－ dimethoxycoumarins can inhibit the proliferation of PA cells， which leads to arrest of the cells in G0/G1 phase by way of inhibiting DNA synthesis
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AIM:To investigate the effects of 6,7-dimethoxycoumarins on the proliferation and the cell cycle of human lung carcinoma cell(PA)in vitro METHODS:The effects of 6,7-dimethoxycoumarins on the cytomorphology,growth and cell cycle of PA cells were evaluated by MTT assay and flow cytometry in vitro RESULTS:6,7-dimethoxycoumarins could inhibit the proliferation of PA cells in a dose-dependent manner The inhibition action of 6,7-dimethoxycoumarins plateaued at 160?g/ml(52 4% inhibition) The agent in dose of 80?g/ml led to a decline in the proportion of cells to those in G2/M phase,made the cells remain in G0/G1 phase and reduced the proliferation index(PI) of PA cells CONCLUSION:In vitro,6,7-dimethoxycoumarins can inhibit the proliferation of PA cells,which leads to arrest of the cells in G0/G1 phase by way of inhibiting DNA synthesis
