Correlation of multifidus degeneration with sex, age and side of herniation in patients with lumbar disc herniation.

OBJECTIVE: The aim of this study was to determine the relationship between multifidus degeneration and sex, age and side of protrusion in patients with lumbar disc herniation(LDH). METHODS: Data were collected from September 2015 to September 2022 from patients with L4/5 and L5/S1 LDH. A total of 104 patients (62 males and 42 females) were included in this study, and there were 35 and 69 cases of L4/5 and L5/S1 LDH, respectively. Patients were divided into 4 groups according to age: group 1 (20-29), group 2 (30-39), group 3 (40-49) and group 4 (50-59). Magnetic resonance spectroscopy analysis was used to observe the fat fraction (FF) and functional cross-sectional area (f-CSA) of the defatted multifidus muscle of the protruding side (affected side) and the nonprotruding side (healthy side) of the L4/5 and L5/S1 gaps to evaluate the relationship between multifidus degeneration and sex, age and protruding side in patients with LDH. RESULTS: Between sexes, the FF of the multifidus muscle was significantly greater in women than in men, regardless of whether it was on the affected or healthy side of the L4/5 segment or on the affected or healthy side of the L5/S1 segment (P < 0.05). Between age groups, there was a significantly positive relationship between the change in FF (%) of the multifidus muscle in patients with LDH and age, with increasing fatty infiltration of the multifidus increasing with age (P < 0.05); notably, there was a significant difference between group 4 and the remaining three groups but no significant difference between groups 1, 2 and 3. The f-CSA of the multifidus (cm2) was negatively correlated with age, with the f-CSA of the multifidus becoming more atrophic with increasing age; specifically, there was a significant difference between group 1 and the other three groups (P < 0.05) but not between groups 2, 3 and 4. Regarding the side of the herniated disc, (1) the differences in FF and f-CSA at the L4/5 and L5/S1 levels were not statistically significant between the affected side and the healthy side in patients with lumbar disc herniation at the L4/5 segment (P > 0.05); (2) the differences in FF and f-CSA at the L5/S1 level were not statistically significant between the affected side and the healthy side in patients with LDH at the L5/S1 segment (P > 0.05); (3) the difference between FF at the L4/5 level and f-CSA and FF at the L5/S1 level was not statistically significant (P > 0.05); and (4) the f-CSA at the L5/S1 level was significantly greater on the healthy side than on the affected side (P < 0.05). CONCLUSION: The proportion of lipoatrophy in female patients with L4/5 and L5/S1 disc herniations was greater than that in male patients. Lipoatrophy of the multifidus muscle increased with age and was significantly worse in patients over 50 years of age. The f-CSA of the multifidus muscle was negatively related to age, and the f-CSA of the multifidus muscle became more atrophic with increasing age. A comparison of degeneration showed no significant difference between the L4/5 patients and the L5/S1 patients in terms of f-CSA atrophy on the affected side of the herniated disc compared to the healthy side.

Pediatric lumbar disc herniation: a report of two cases and review of the literature.

BACKGROUND: Lumbar disc herniation (LDH) is not a common condition in children. Most reports on pediatric LDH concern the outcomes of surgeries performed in children in whom nonsurgical treatment failed while the outcome of nonsurgical treatment of LDH in children was rarely reported. CASES PRESENTATION: Case 1: a 10-year-old girl presented with back pain and sciatica in her left leg for over 3 months. The physical examination revealed exacerbation of back pain by waist extension or flexion, and a positive Lasegue's sign was revealed in her left leg. Magnetic resonance imaging (MRI) revealed lumbar disc herniation at the L5/S1 level. She was diagnosed with LDH. After receiving nonsurgical treatment of traditional Chinese medicine (TCM) for 30 days, the girl had mild low back pain and sciatica and the symptoms had resolved completely at the 3-month follow-up. There was no recurrence within the following 2 years. MRI performed 30 months later revealed that the herniated disc did not shrink significantly. However, she was totally asymptomatic at the follow-up performed 30 months later. Case 2: a 13-year-old boy presented with sciatica in his left leg for over 3 months. The physical examination revealed that Lasegue's sign was positive in the left leg, the level of muscle strength in the left ankle plantar flexors was grade 4. MRI revealed a lumbar disc herniation at the L5/S1 level. He was diagnosed with LDH. The boy underwent 2 weeks of TCM treatment, and exhibited a favorable outcome: only mild pain was noticed in his left buttocks after walking for more than 15 min. He was asymptomatic at the 3-month follow-up and there was no recurrence within the next 3 years. MRI scan performed at 40 months later showed no significant resorption of the herniated disc. However, he was totally asymptomatic at the follow-up performed 40 months later. CONCLUSIONS: For the nonsurgical treatment of pediatric LDH, resorption of herniated discs is not necessary for favorable long-term outcomes, and children with symptomatic LDH may become asymptomatic without resorption.

[Characteristics and Significance of Gene Expression Changes in Peripheral Blood of Lumbar Disc Extrusion Patients before and after Nonoperative Treatment].

OBJECTIVE: To define the gene expression characteristics in the peripheral blood of patients with lumbar disc extrusion (LDE) and the effect of nonoperative treatment on the gene expression. METHODS: DNA microarray was used to identify semi-quantitatively the differentially expressed genes (DEGs) in the peripheral blood of patients with LDE and that of the healthy controls and the variation trend of these DEGs after nonoperative treatment. Enrichment analysis was done to reveal the functional characteristics of these DEGs, and network analysis was done to identify key genes that contribute to gene dysregulation. The levels of these key genes were measured by qRT-PCR to examine their expression in LDE patients and the controls, and the effect of nonoperative treatment on the expression level. RESULTS: We identified 153 DEGs in the peripheral blood of LDE patients and healthy controls, including 131 upregulated genes and 22 downregulated genes. Enrichment analysis revealed that most of the DEGs were related to immunity and the inflammatory response. Network analysis revealed that toll-like receptor 4 ( TLR4 ), matrix metallopeptidase 9 ( MMP9) and myeloperoxidase ( MPO), cathelicidin antimicrobial peptide ( CAMP), resistin ( RETN), toll-like receptor 5 ( TLR5) were the key genes in the protein-protein interaction network. These key genes were all enriched into the terms releated to immunity and the inflammatory response. The patients experienced pain relief after nonoperative treatment. Among the 153 DEGs, TLR5 , interleukin 1 receptor antagonist ( IL1 RN) and solute carrier family 8 member A1 ( SLC8 A1) were downregulated after nonoperative treatment. qRT-PCR revealed that the levels of TLR4, MMP9 , MPO, CAMP, RETN, TLR5, IL1 RN and SLC8 A1 in the peripheral blood of the LDE patients were higher than those of the healthy control group ( P<0.05). In addition, TLR5 , IL1 RN and SLC8 A1 expression levels decreased after treatmentin in comparison with the levels before treatment ( P<0.05). CONCLUSION: Gene expression in the peripheral blood of LDE patients was characterized by the dysregulation of immune and inflammatory response-related genes, among which, TLR4, MMP9, MPO, CAMP, RETN and TLR5, the genes relevant to immune and inflammatory response, played a key role in the dysregulation of gene expression in the peripheral blood of LDE patients. The outcome of non-operative treatment may be related to the downregulation of the overexpressed TLR5, IL1 RN and SLC8 A1 in the peripheral blood of patients.

Integrated traditional Chinese medicine alleviates sciatica while regulating gene expression in peripheral blood.

BACKGROUND: Although integrated traditional Chinese medicine (TCM) has long been indicated to be effective in the treatment of sciatica and is widely used in the management of this condition, the mechanism by which integrated TCM alleviates sciatica has not yet been fully defined, and the effect of integrated TCM on gene expression in the peripheral blood of patients with sciatica is still unknown. We performed this study to investigate the effect of integrated TCM on peripheral blood gene expression in patients with sciatica and to explore new clues for studying the mechanism of integrated TCM in alleviating sciatica. METHODS: We used a microarray to identify differentially expressed genes (DEGs) in the peripheral blood of patients with sciatica and healthy controls (DEGs-baseline), bioinformatic analysis to reveal the characteristics of DEGs-baseline, and the key genes that contribute to the gene dysregulation. A microarray was also used to identify DEGs in the peripheral blood of patients with sciatica after integrated TCM treatment compared with those at baseline, and the expression levels of DEGs were validated by qRT-PCR. RESULTS: We identified 153 DEGs-baseline, which included 131 upregulated genes and 22 downregulated genes. Bioinformatic analysis revealed that most of the DEGs-baseline were related to immunity and the inflammatory response and that TLR4, MMP9, MPO, CAMP, RETN, TLR5, and IL1RN were key genes involved in the dysregulation of genes in the peripheral blood of patients with sciatica. The expression levels of TLR5, IL1RN, SLC8A1, RBM20, GPER1, IL27, SOCS1, and GRTP1-AS1 were decreased in the peripheral blood of patients after integrated TCM treatment compared with that at baseline, which was accompanied by relief of pain. CONCLUSION: Integrated TCM treatment relieved pain while regulating the gene expression of TLR5, IL1RN, SLC8A1, RBM20, GPER1, IL27, SOCS1, and GRTP1-AS1 in the peripheral blood of patients with sciatica. Our study provides new clues for studying the mechanism of TCM in treating sciatica.

Astrocyte contributes to pain development via MMP2-JNK1/2 signaling in a mouse model of complex regional pain syndrome.

BACKGROUND: The activation of spinal glial cells (astrocyte and microglia) is reported in patient with complex regional pain syndrome (CRPS). However, the roles of spinal glial activities in the pathophysiology of CRPS are unclear. Here, we explored the roles of spinal astrocyte and microglia and the molecular mechanisms underlying CRPS using a mouse model of chronic post-ischemia pain (CPIP). RESULTS: CPIP injury increased the level of glial fibrillary acidic protein (GFAP, reactive astrocyte biomarker), but had no significant impact on ionized calcium binding adaptor molecule 1 (IBA1, reactive microglia biomarker), in the ipsilateral dorsal horn on post-injury day (PID) 3 when the pain threshold started to reduce significantly. Astrocytic inhibition with fluorocitrate but not microglial inhibition with minocycline attenuated the development of allodynia in CPIP-injured mice, which was concomitant with increased spinal levels of phosphorylated c-jun N-terminal kinase 1/2 (pJNK1/2) on PID 3. Furthermore, the intrathecal administration of SP600125 (JNK inhibitor) prevented the development of allodynia in CPIP-injured mice. Double immunofluorescence staining showed that pJNK1/2 was mainly co-localized with GFAP. Subsequently, increased levels of pJNK1/2 were reversed by intrathecal fluorocitrate. Furthermore, the level of spinal matrix metalloproteinase-2 (MMP2) was increased and mainly expressed in NeuN (neuron biomarker) on PID 3 in the CPIP-injured mice, while intrathecal APR 100 (MMP2 inhibitor) delayed the development of allodynia and decreased spinal levels of GFAP and pJNK1/2 on PID 3. CONCLUSION: This study shows that activation of astrocyte MMP2/JNK1/2 signaling pathway contributes to the pathogenesis of pain hypersensitivity in the CPIP model.

Captopril Pretreatment Produces an Additive Cardioprotection to Isoflurane Preconditioning in Attenuating Myocardial Ischemia Reperfusion Injury in Rabbits and in Humans.

BACKGROUND: Pretreatment with the angiotensin-converting inhibitor captopril or volatile anesthetic isoflurane has, respectively, been shown to attenuate myocardial ischemia reperfusion (MI/R) injury in rodents and in patients. It is unknown whether or not captopril pretreatment and isoflurane preconditioning (Iso) may additively or synergistically attenuate MI/R injury. METHODS AND RESULTS: Patients selected for heart valve replacement surgery were randomly assigned to five groups: untreated control (Control), captopril pretreatment for 3 days (Cap3d), or single dose captopril (Cap1hr, 1 hour) before surgery with or without Iso (Cap3d+Iso and Cap1hr+Iso). Rabbit MI/R model was induced by occluding coronary artery for 30 min followed by 2-hour reperfusion. Rabbits were randomized to receive sham operation (Sham), MI/R (I/R), captopril (Cap, 24 hours before MI/R), Iso, or the combination of captopril and Iso (Iso+Cap). In patients, Cap3d+Iso but not Cap1hr+Iso additively reduced postischemic myocardial injury and attenuated postischemic myocardial inflammation. In rabbits, Cap or Iso significantly reduced postischemic myocardial infarction. Iso+Cap additively reduced cellular injury that was associated with improved postischemic myocardial functional recovery and reduced myocardial apoptosis and attenuated oxidative stress. CONCLUSION: A joint use of 3-day captopril treatment and isoflurane preconditioning additively attenuated MI/R by reducing oxidative stress and inflammation.

Effect of ulinastatin combined rivaroxaban on deep vein thrombosis in major orthopedic surgery.

OBJECTIVE: To explore the effect of ulinastatin (UTI) continuous infusion combined Rivaroxaban on the deep vein thrombosis in patients undergoing major orthopedic surgery. METHODS: Forty-five patients undergoing major orthopedic surgery were randomly divided into three groups:ulinastatin continuous infusion (Uc) group, ulinastatin single injection (Us) group and control (C) group. All patients received patient-controlled intravenous analgesia (PCIA) after operation, and took Rivaroxaban 10 mg orally 12 hours after operation. Ulinastatin (5 000 U/kg) was given intravenously to both Uc and Us groups preoperatively. Group C was given isometric normal saline, group Uc was pumped UTI continuous intravenously at the end of surgery (10 000 U/kg) to 48 hours through PCIA pump. The values of hematocrit (HCT), thrombomodulin (TM), Interleukin (IL-6), thrombin-antithrombin complex (TAT), D-Dimer (D-D) were normally tested before surgery (T1), at the end of the surgery (T2), 12 hours (T3), 24 hours (T4) and 48 hours (T5) after surgery. RESULTS: Compared with T1, there was an upward tendency in TM, IL-6, TAT, and D-D after operation in group C group (P<0.05). The values of them were significantly increased from nearly 24-hour after surgery in Us group (P<0.05). In group Uc, there were no significant changes in these indices after operation (P>0.05). CONCLUSIONS: During the perioperative period, ulinastatin continuous infusion combined Rivaroxaban can correct blood hypercoagulability through different approaches in patients undergoing major orthopedic surgery.