Percutaneous Endoscopic Interlaminar Discectomy via Laminoplasty Technique for L5 -S1 Lumbar Disc Herniation with a Narrow Interlaminar Window.

OBJECTIVE: To improve the treatment effect of patients with L5 S1 lumber disc herniation (LDH) with a narrow interlaminar window, we proposed an alternative approach to percutaneous endoscopic interlaminar discectomy (PEID) via the laminoplasty technique. METHODS: Fifteen L5 S1 LDH patients (7 men and 8 women; age range, 22 to 56 years; median age, 34 years; 9 left, 6 right) were enrolled in the present study retrospectively. The interlaminar windows of all patients were narrow (the transverse diameter of the L5 S1 interlaminar window is equal to or less than that of L4-5 ). Percutaneous laminoplasty and endoscopic interlaminar discectomy surgery were undergone by all patients from July 2018 to July 2019. All operations were completed under local anesthesia. The target laminoplasty area was the safety zone, use of which avoids both transverse and exit nerve roots. Under fluoroscopic guidance or clear endoscopic visualization, the trephines were used to enlarge the interlaminar window, which allowed the working cannula to enter the spinal canal but avoid nerve roots and the dural sac. The preoperative/postoperative visual analogue scale (VAS) scores and Oswestry disability index (ODI) were statistically analyzed. The modified MacNab criterion was used to assess the clinical effects. The radiological outcomes were evaluated by MRI and CT. SPSS 19.0 software was used for the statistical evaluation. RESULTS: The operative time ranged from 70 to 120 min, with a median time of 92 min, and the fluoroscopy times ranged from 8 to 12, with a median of 9.7 times. The body mass index (BMI) of patients ranged from 18.10 to 26.06, with a median of 22.04. All patients were followed up in the outpatient department for at least 12 months after surgery. At the last follow up, the average VAS-Back score of the study patients was reduced from 5.33 ± 2.09 to 2.00 ± 1.20 (P < 0.001) and the average VAS-Leg score was reduced from 7.53 ± 1.69 to 1.47 ± 0.92 (P < 0.001). The average ODI scores improved from 47.87 ± 11.41 to 12.93 ± 3.24 (P < 0.01). According to the modified MacNab criteria, 11 cases achieved excellent results and 4 cases achieved good results. All of the operations were successful. There wertr no nerve root injuries, dural tears, or other complications. CONCLUSION: The laminoplasty approach for PEID provides a safe and useful alternative for the treatment of L5-S1 LDH patients with a narrow interlaminar window.

Meta-analysis of the operative treatment of lumbar disc herniation via transforaminal percutaneous endoscopic discectomy versus interlaminar percutaneous endoscopic discectomy in randomized trials.

BACKGROUNDS: Transforaminal percutaneous endoscopic discectomy (TF-PELD) and interlaminar percutaneous endoscopic discectomy (IL-PELD) are the most common alternative treatments of lumbar disc herniation. The aim of this study was to compare the operation time duration and X-ray exposure as well as outcomes of TF-PELD and IL-PELD as indicated by the published clinical evidences within randomized trials. METHODS: We included randomized, controlled studies reporting operation duration and X-ray exposure as well as clinical outcome evaluations, comparing TF-PELD to IL-PELD with a minimum of 10 patients per group. The included data measures were operation duration, X-ray exposure and postoperation evaluations. Data were synthesized and analyzed using ReviewManager version 5.3. Publication bias was evaluated via funnel plot. The Cochran Q test and the degree of inconsistency (I2) were used to assess heterogeneity. Lowly biased and heterogenous dichotomous data were calculated by odds ratio and continuous data were calculated by mean difference (MD) with 95% confidence intervals (CI). RESULTS: Thirteen studies published from January 1970 to March 2018, with a total of 770 lumbar disc herniation patients, including 361 cases of TF-PELD and 409 cases of IL-PELD, were finally included. Meta-analysis of data extracted from these studies revealed that the postoperation outcomes of both surgery methods did not differ significantly, but the surgery duration was significantly shorter in the IL-PELD group than in the TF-PELD group (MD 21.69; 95% CI 12.94-30.27; P = .00001), and the fluoroscopy times demanded in the IL-PELD group was significantly fewer than those in the TF-PELD group (MD 7.57; 95% CI 6.22-8.93; P = .00001). CONCLUSION: The main finding of the study is that IL-PELD approach can decrease radiation exposure as their demanded duration of operation and fluoroscopy times were significantly shorter and fewer in the IL-PELD group, which they achieve similar outcomes comparing to TF-PELD. The study is limited at a lack of samples with lumbar disc herniation levels out of L5/S1. The findings implicate selection of IL-PELD approach over TF-PELD at applicable circumstances for lower lumbar disc herniation. Physicians should consider this data when choosing between TF-PELD and IL-PELD.

[Water Quality and Bacterial Population Driving Mechanism of Algae Vertical Succession in Stratified Reservoir].

Phytoplankton and bacteria are important components of the aquatic food web, and play a critical role in substance circulation and energy exchange in freshwater ecosystems. The succession of algae is closely related to the metabolism and structural succession of bacterial populations in the water column. Thus, in this study, the vertical succession characteristics of phytoplankton and bacteria community structure and their coupling with water quality were investigated during an algal bloom in the Lijiahe Reservoir using high-throughput DNA sequencing and Biolog technologies. The results showed that the Lijiahe Reservoir was in the thermal stratification stage in August, and the pH, dissolved oxygen, and NH4+-N of the water column gradually decreased with depth (P<0.001). Algal cell concentration and chlorophyll a exhibited a simultaneous trend (P<0.001), and the maximum values in the surface layer were 3363.33×104 cells·L-1 and 7.03 µg·L-1, respectively. The algal community structure was dominated by Microcystis at water depths of 0 m and 3 m, and at 6 m water depth, Cyclotella replaced Microcystis as the most dominant algae, with a relative abundance of 57.28%. Biolog analysis indicated that the outbreak of Microcystis had a significant impact on bacterial metabolic activity and its relative abundance, but the diversity of bacterial population metabolic activity varied less. A total of 1420 operational taxonomic units were found by high-throughput sequencing, belonging to 10 bacterial phyla. Of these, Actinobacteria and Proteobacteria dominated in all water layers, and their relative abundances were more than 50%. The relative abundance of Chlorobi and Planctomycetes varied significantly with water depth, reaching their maxima at a depth of 6 m with values of 10.29% and 6.78%, respectively, which were both negatively correlated with algal density (P<0.05). Firmicutes and Gemmatimonadetes were positively correlated with algal density (P<0.05). A heat map fingerprint showed that the vertical distribution of the bacterial community structure of the Lijiahe Reservoir varied significantly, and with the increase in water depth, the bacterial community was more uniformly distributed and tended to diversify. Redundancy analysis (RDA) showed that the vertical distribution of the bacterial and algal community structure was regulated by different water qualities, and the difference was significant. This study investigated the coupling mechanism of algal and bacterial communities during the algal bloom in the Lijiahe Reservoir, and the results provided a scientific basis for the investigation of the molecular microecological driving mechanism of water-source algal blooms.

A typical 22q11.2 deletion syndrome and pseudohypoparathyroidism: A CARE compliant case report.

RATIONALE: It is rare to find 22q11.2 deletion syndrome with pseudohypoparathyroidism in children. Furthermore, the phenotypic spectrum of this disorder varies widely. PATIENT CONCERNS: A patient was diagnosed with pseudohypoparathyroidism at age 14 years because of convulsions, hypocalcemia, hyperphosphatemia, normal parathyroid hormone levels, and basal ganglia calcifications. Thereafter, the child presented with symptoms of nephrotic syndrome; subsequently, he was diagnosed with nephrotic syndrome at the local hospital. DIAGNOSIS: At our hospital, multiplex ligation-dependent probe amplification confirmed that the patient had 22q11.2 deletion syndrome. INTERVENTIONS: The patient continued to be treated with calcium supplements. OUTCOMES: Seizure activity and proteinuria ceased. LESSONS: Signs of this syndrome include delayed speech development due to velofacial dysfunction, recurrent croup attacks during early childhood due to latent hypocalcemia, and mild dysmorphic features. The findings of this patient indicated that 22q11.2 deletion syndrome may include a wide spectrum of clinical findings and that this diagnosis needs to be considered for all patients presenting with hypocalcemia, regardless of age.

[Denitrification Characteristics and Community Structure of Aerobic Denitrifiers from Lake and Reservoir Sediments].

The effect of aerobic denitrifying bacteria is a hot topic in the field of water environment bioremediation. Aerobic denitrifier communities, H-30, X-10, and C-30, enriched by intermittent aeration, screened with screening culture media, and treated by ultrasonic waves, could perform high denitrification performance at the higher dissolved oxygen concentration of (7.2±0.6) mg ·L-1. The total nitrogen (TN) removal rate of aerobic denitrifier communities, H-30, X-10, and C-30, reached 83.04%, 83.40%, and 82.68%, respectively. There is lower nitrite accumulation during the process of denitrification. Illumina high-throughput DNA sequencing revealed that aerobic denitrifier compositions were significantly different among the three communities. The predominant strains of aerobic denitrifier communities, H-30, X-10, and C-30, were Bacillus subtilis, Paracoccus pantotrophus, and Pseudomonas stutzeri, respectively. The proportion of P. stutzeri in aerobic denitrifier communities H-30 and X-10 was almost the same, while Pseudomonas xiamenensis was only detected in H-30. These three efficient aerobic denitrifier communities provide a bacterium source guarantee for polluted water bioremediation of lakes and reservoirs in cities.

[Water Quality and Diversity of Denitrifier Community Structure of Typical Scenic Water Bodies in Xi'an].

Six micro-polluted landscape water bodies were selected to explore the relationship between water quality and the nirS-Type denitrifier community structure and diversity with an Illumina high-throughput sequencing technique. The results of a physico-chemical analysis of the water bodies showed that the Fengqing Park (FQ) and Laodong Park (LD) water bodies were classified as inferior Ⅴ water quality, the Qujiang Park (QJ), Mutasi Park (MTS), and Xinjiyuan Park (XJY) water bodies were classified as Ⅴ water quality, and the Yongyang Park (YY) water quality was classified as Ⅳ. The TN values varied from 1.21 mg·L-1 to 6.50 mg·L-1, with the lowest value found in YY and the highest in FQ (P<0.05). TP was significantly higher in LD (0.10 mg·L-1) and significantly lower in QJ[0.02 mg·L-1 (P<0.05)]. The NH4+-N in LD was 4.44 times higher than that in QJ and FQ (P<0.01). Illumina high-throughput sequencing revealed that the denitrifier community composition was significantly different among the six water bodies, and Paracoccus sp., Pseudomonas sp., and Rubrivivax sp. were the dominant genus species. A principle component analysis (PCA) indicated that the nirS-Type denitrifier communities of XJY and MTS were mainly regulated by NH4+-N and the permanganate index, LD and FQ were significantly influenced by NO3--N, NO2--N, TN, TP, and DO, and YY was significantly influenced by pH value. Our results showed that nirS-Type denitrifier communities were regulated by different water quality indicators.

Nontraumatic posterior atlantooccipital dislocation associated with atlantoaxial instability.

INTRODUCTION: Nontraumatic posterior atlantooccipital dislocation has only been rarely reported. In the current study, the authors reported an extremely rare case of nontraumatic posterior atlantooccipital dislocation associated with atlantoaxial instability. MATERIALS AND METHODS: A 47-year-old female was referred with a history of neck pain for 5 years. The patient had no history of trauma. The axial rotation of range of motion of the cervical spine was severely restricted. Posterior atlantooccipital dislocation with atlantoaxial instability was confirmed through conventional radiography, computed tomography and magnetic resonance imaging. We performed realignment of the dislocation and posterior occipitocervical (C0-C2) fusion. After the surgery, the patient's symptoms improved significantly and she manifested neurological improvement. CONCLUSION: To our knowledge, this lesion has not been reported previously. Anomalies of upper cervical spine may have induced this instability.

Does dynamic immobilization reduce chondrocyte apoptosis and disturbance to the femoral head perfusion?

The purpose of this study is to investigate whether the dynamic hip immobilization is more favourable for lessening ischemic injury to the immature femoral head than a static immobilization. 152 Japanese white rabbits were divided into four groups randomly, and the hips were immobilized into "human" position (group A), "frog leg" position (group B) and "dynamic frog leg" position (group C). Group D was used as control. Ten rabbits in each group were killed, and the hip specimens were harvested at 1, 2, and 3 weeks after immobilization. Bcl-2/Bax expression balance and chondrocytes apoptosis were analyzed. The remaining eight rabbits in each group were used to measure the blood supply of capital femoral epiphysis by selective vascular perfusion with Indian ink. The Bcl-2/Bax expression ratio in group C was significantly increased than that in group A and B (p<0.001), while that was not significantly different from control group (p=0.0592). At three weeks after immobilization, the average apoptotic ratio was 36.7%, 45.8%, and 26.7% in group A, B and C, respectively (p<0.01). There was no significant difference between group C and normal control (p=0.0597). The perfusion ratio was 0.03±0.03, 0.03±0.02, and 0.08±0.03 in group A, B and C respectively, and 0.12±0.04 in control group (p<0.05). Thus, the dynamic immobilization model exhibited a relatively less chondrocytes apoptosis and disturbance to the femoral head perfusion than other immobilizations in vivo, which therefore may be useful for reducing avascular necrosis following the treatment of developmental dysplasia of the hip.