Unilateral interlaminar approach 270° circular spinal canal decompression under the iLESSYS Delta for the treatment of lumbar spinal stenosis in the elderly / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of unilateral interlaminar approach 270° circular spinal canal decompression under the Interlaminar Endoscopic Surgical System(iLESSYS) Delta for the treatment of lumbar spinal stenosis (LSS) in the elderly.@*METHODS@#Total of 29 patients with LSS treated with the iLESSYS Delta from December 2018 to January 2021 were retrospectively analyzed, including 12 males and 17 females with an average age of (71.52±10.82) years old ranging from 63 to 83 years old. All patients had definite intermittent claudication, mainly neurogenic symptoms of both lower limbs. All patients had single-level spinal stenosis, including L3,4 5 cases, L4,5 21 cases, and L5S1 3 cases. Visual analogue scale (VAS), Oswestry Disability Index (ODI) and modified Macnab assessment criteria were used to evaluate pain, low back pain dysfunction index and clinical efficacy, respectively.@*RESULTS@#All 29 cases were successfully completed. The operation time was (73.45±5.89) min, the intraoperative blood loss was (9.93±0.83) ml, the hospital stay was (4.03±0.41) days, and the follow-up was more than 12 months. The VAS scores of low back pain before surgery and 1 day, 1 month, 3 months, 1 year after surgery were 2.31±0.88, 1.45±0.62, 1.21±0.61, 1.10±0.55, 1.03±0.49;VAS of leg pain were 6.48±0.49 0.56, 1.97±0.61, 1.31±0.59, 1.17±0.59, 1.10±0.55;ODI scores were 38.41±2.74, 18.14±1.17, 5.17±0.53, 5.07±0.45, 4.90±0.48;low back and leg pain VAS score and ODI score have statistically significant differences between preoperative and postoperative follow-up time points (P<0.05). The MacNab efficacy evaluation at 1-year follow-up:excellent in 22 cases, good in 5 cases and fair in 2 cases.@*CONCLUSION@#The clinical effect of unilateral interlaminar approach 270° circular spinal canal decompression under the iLESSYS Delta for the treatment of lumbar spinal stenosis in the elderly is satisfactory, with the advantages of less trauma and less bleeding, large microscopic operation space, sufficient decompression, and ideal post-operative recovery, and at the same time, it can minimize the damage to the stable structure of the lumbar spine, which is an ideal surgical method for the treatment of elderly lumbar spinal stenosis.

Xuesaitong injection (lyophilized) combined with aspirin and clopidogrel protect against focal cerebral ischemic/reperfusion injury in rats by suppressing oxidative stress and inflammation and regulating the NOX2/IL-6/STAT3 pathway.

BACKGROUND: Combination of aspirin (ASA) and clopidogrel (CLP) [dual antiplatelet therapy (DAPT)] has been limited in reducing early recurrent stroke events. Xuesaitong injection (lyophilized) (XST) made of total saponins from P. notoginseng, which significantly improves cerebral circulation and has been widely used in clinical applications for decades to treat and prevent ischemic stroke. Here, we confirmed the protective effect and mechanism of XST combined with DAPT (XST+ASA+CLP) on cerebral ischemia/reperfusion injury, exploring their better pharmacological action for clinical patients. METHODS: Sprague-Dawley rats (SD rats) (n=9 in each group) were randomly assigned to three groups and pretreated with XST, ASA+CLP, or XST+ASA+CLP for 7 days. Then rats were subjected to 2 h of middle cerebral artery occlusion (MCAO) followed by reperfusion for 24 h. Therapeutic effect of XST+ASA+CLP was measured by infarct volume, neurological behavior and regional cerebral blood flow (rCBF). Inhibition of neuronal apoptosis and glial cells was determined by immunofluorescent staining. We studied the protein levels of neurotrophic factors, neuroplasticity-related factors, oxidative stress indicators and inflammatory factors by ELISA assay. RESULTS: XST+ASA+CLP group showed significant reduction in infarct volumes and neurological deficit scores. XST+ASA+CLP group also had higher levels in rCBF and synaptic growth, and showed remarkable inhibition of microglia and astrocytes activation and the neuronal apoptosis. In addition, XST+ASA+CLP group had lower levels of NADPH, protein carbonyl, 4-hydroxynonenal (4-HNE), 8-hydroxydeoxyguanosine (8-OHdG) and several inflammatory cytokines. Moreover, XST+ASA+CLP group also had lower levels of NOX2, inducible nitric oxide synthase (iNOS), interleukin (IL)-6, and p-STAT3/STAT3. CONCLUSIONS: These results demonstrate that a combination of XST, ASA, and CLP effectively protected rats against middle cerebral artery occlusion/reperfusion (MCAO/R) injury by suppressing the NOX2/IL-6/ STAT3 pathway. These novel findings provide theoretical basis and experimental evidence for the rationality of clinical combined use of drugs in the treatment of ischemic stroke.

Development of shear force-induced intervertebral disc degeneration model / 医用生物力学

Objective To develop a shear force-induced intervertebral disc degeneration (IDD) in vivo animal model, and investigate the relationship between shear stress and IDD. Methods A total of 20 Japanese white rabbits were randomly divided into two groups. In loading group (n=10), shear force of 50 N was applied on the disc of L4/5 for 4 weeks by a custom-made external shear force loading device. In control group (n=10), the animals underwent a sham operation with the external loading device situated, but their discs remained unloaded. After 4 weeks, all the intervertebral discs of L4/5 were executed for the pathologic examination. Results The postoperative radiographic examination showed a perfect position of the loading device, and the operation process and implanted loading device had no effect on daily activities and diet of the experiment animals. The pathological examination showed an irregular arrangement of annulus fibrosus and a significant decrease of normal nucleus pulposus cells in loading group. Conclusions The new custom made device greatly reduced the wounds on animal vertebra and provided a reliable shear force. The development of in vivo animal model indicates that IDD can be induced by shear force, which is of significance to further study the relationship between loading and IDD.

Morphologic characteristics and clinical significance of Neiguan (PC 6) / 中国针灸

<p><b>OBJECTIVE</b>To provide appropriate needling angle and depth for the acupuncture and acupoint injection at Neiguan (PC 6), and to avoid damaging nerves and vessels so as to produce its maximum effect.</p><p><b>METHODS</b>Thirty adults' upper-limb samples were used to dissect and observe the referred hierarchical structure and adjoining crucially nerves and vessels in needling Neiguan (PC 6) according to the national standard Acupoint Location (GB 12346-90).</p><p><b>RESULTS</b>In this punctuation region, there are three parts rich in connective tissues containing the nerves and blood vessels. The surface part is between the skin and the musculus flexor digitorum superficialis and it is the tissue which contains medial and lateral antebrachial cutaneous nerve and its nutrient artery. The middle part is between the musculus flexor digitorum superficialis and the flexor digitorum profundus muscle and contains the median nerve, its palmar branch of and artery. The deep part is between the pronator quadratus muscle and the interosseous membrane and contains the anterior interosseous nerve. When perpendicular needling, the depth of needling the body from skin to the superficial surface of the musculus flexor digitorum superficialis and to the superficial surface of the flexor digitorum profundus muscle is (6.68 +/- 0.64) mm and (12.37 +/- 0.87) mm respectively. The depth of needling the body from skin to the superficial surface of the pronator quadratus muscle and to the superficial surface of the anterior interosseous terminal branch of the nerves is (17.83 +/- 1.00) mm and (30.87 +/- 1.85) mm respectively, and the proportional cun is (2.20 +/- 0.14) cm. The ulnaris cord of median nerves are located at the radial of the needle. The deep layers could touch the anterior interosseous nerve ending.</p><p><b>CONCLUSION</b>Perpendicularly needling Neiguan (PC 6) for 3 fen (6.68 mm), 5 fen (12.37 mm) and 1.4 cun (30.87 mm) will stimulate the nervus vascularis of the rich part of surface, middle and deep connective tissues respectively and produce the acupuncture effect. During the acupoint injection, perforating the needle perpendicularly at the middle point of the two tendons or deviating slightly to the direction of tendon of palmaris longus can avoid the damage of the median nerve cord.</p>