[Study on feasibility of enhanced recovery after surgery combined with mobile microendoscopic discectomy-transforaminal lumbar interbody fusion in the treatment of lumbar spondylolisthesis].

Objective: To explore the feasibility of enhanced recovery after surgery (ERAS) combined with mobile microendoscopic discectomy-transforaminal lumbar interbody fusion (MMED-TLIF) in the treatment of lumbar spondylolisthesis and its influence on postoperative rehabilitation. Methods: From October 1 2014 to July 1 2016 , a cohort of 52 patients with lumbar spondylolisthesis who received the program of ERAS-MMED-TLIF were retrospectively reviewed in Department of Minimally Invasive Spine Surgery, Tianjin Hospital.The primary outcomes include the operation time, intraoperative blood loss, length of hospital stay, VAS score (low back pain and leg pain) and Oswestry Disability Index (ODI) at different follow-up time and complication.The height of intervertebral space and fusion rate were also recorded as radiographic indicators. Results: All cases had an average follow-up of 12 months. The mean operative time was (115±30) min with a mean blood loss of (100±35) ml.Compared with preoperative condition, VAS score of low back pain (6.3±3.3 vs 3.5±2.3, P<0.05), VAS score of leg pain (7.1 ± 4.2 vs 3.1 ± 2.6, P<0.05) and the ODI disability index score (43.5±9.6 vs 20.9±7.3, P<0.05) at the postoperative 24 h were decreased and the difference was statistically significant.The mean hospitalized time were (4.9±1.3) days with mean postoperative hospital stay (2.1±1.2) days.Fusion rate was 92.31% (48/52) at the last follow-up time. Conclusion: ERAS combined with MMED-TLIF is feasible in the treatment of lumbar spondylolisthesis, which can significantly reduce intraoperative bleeding, shorten the total length of stay and postoperative hospital stay, improve postoperative pain and promote rapid rehabilitation of patients after operation without increasing the operation time and influencing the long-term effect, it can be applied in clinical practice.

Maggot debridement therapy for the treatment of diabetic foot ulcers: a meta-analysis.

OBJECTIVE: To assess the potential efficacy of maggot debridement therapy (MDT) compared with standard care for diabetic foot ulcers (DFUs). METHOD: A meta-analysis was performed on the evidence for MDT for DFUs. Databases, including PubMed, Web of Science, the Cochrane Library, EMbase, EBSCOhost, Springer Link, ScienceDirect and Ovid-Medline, were electronically searched for randomised controlled trials, case-control studies and controlled clinical trials, up to 31 December 2012, and relevant references of the included articles were also manually searched. The literature was screened, the data were extracted and the methodological quality of the included studies was assessed. Meta-analyses were performed on the included data, for the outcomes healing rate, time to healing, incidence of infection, amputation rate and antibiotic-free days or antibiotics usage. RESULTS: Overall, four studies comparing MDT with standard therapy on a total of 356 participants were included. The results of meta-analyses suggested that the MDT group was significantly superior to the control group in the percentage of DFUs to achieve full healing (RR=1.8, 95%CI=1.07; 3.02; p=0.03), amputation rate (RR=0.41, 95%CI=0.20; 0.85; p=0.02), time to healing (RR=-3.70, 95%CI=-5.76; -1.64; p=0.0004) and number of antibiotic-free days (126.8 ± 30.3 days vs 81.9 ± 42.1 days; p=0.001); however, collated differences in incidence of infection after intervention revealed no evidence of a difference between the MDT and control groups (RR=0.82, 95%CI=0.65; 1.04, p=0.10). CONCLUSION: Although MDT may be a scientific and effective therapy in treatment of DFUs, the evidence is too weak to routinely recommend it for treatment. Large studies and sample sizes are needed to assess the efficacy and safety of MDT in the treatment of DFUs. DECLARATION OF INTEREST: There were no external sources of funding for this study. The authors have no conflicts of interest to declare with regard to this work or its contents. X. Tian and X.M. Liang contributed equally to this work.

Ultrasonic effect on fracture repair and prostaglandin E2 production.

Ultrasound has been recently recognized of its potential in promoting fracture healing. However, its effects on bone healing remain unclarified. The present study was initiated to compare the effects of frequency on fracture healing and the possible role of endogenous prostaglandin E2 in fracture healing stimulated by ultrasound. Histologic evaluation of callus formation with labelled fluorochromes indicated that the use of ultrasound at 1.5 MHz was most effective in accelerating bone healing. In addition, at this frequency, the endogenous PGE2 level was significantly elevated, which paralleled the accelerated bone healing. It is suggested that bone healing stimulated by ultrasound may be mediated via the production of PGE2.

Ultrasound can affect bone healing both locally and systemically.

Bone formation of fractured fibulae stimulated by ultrasound was evaluated with roentgenography and fluorochromes labelling. The fibulae of male New Zealand rabbits were fractured to create a 3 mm-gap. A pilot study was performed to determine the treatment interval for fracture healing of the fibula. Ultrasonic treatment at 1.0 W/cm2, 1.5 MHz for 15 min/day significantly accelerated bone formation at the fracture site of the un-treated fibula, but suppressed the bone formation of the directly treated fractured fibula. Subsequent treatments with these specificities showed that ultrasonic treatment on the unoperated fibula also significantly accelerated the bone formation of the contralateral fractured fibula. It was suggested that locally applied ultrasound at the intensity of 1.0 W/cm2 was deleterious to the treated fracture or intact fibula, but simultaneously would stimulate bone formation of the contralateral fibula.

[Preliminary studies on transaminase of Oncomelania snail].

By paper chromatography, the tissue homogenate of Oncomelania snails was shown to form glutamic acid at the expense of alpha-ketoglutarate plus aspartic acid, alanine or arginine respectively. The existence of alanine-glutamate, aspartate-glutamate and arginine-glutamate transaminase in Oncomelania snail was demonstrated. By using colorimetric method, the activity of aspartate-glutamate transaminase (GOT) and alanine-glutamate transaminase (GPT) of Oncomelania snail was 1.64 +/- 0.01 and 0.99 +/- 0.01 mumol/h.mg protein respectively. GOT and GPT were not inhibited by 2 ppm bromoacetamide, but the activity of GPT was suppressed (40%) by 2 ppm nicotinanilide. A combination of 0.5 ppm bromoacetamide and 0.5 ppm nicotinanilide had no synergitic molluscicidal effect.

[Oxidative phosphorylation of liver mitochondria in Oncomelania snail].

Oxidative phosphorylation of liver mitochondria in Oncomelania snail was separately detected by using oxygen electrode and spectrophotometer. ADP increased oxidative reaction of liver mitochondria from 0.187 to 0.318 mumol O2/mg protein.20 min. When certain substrates of citric acid cycle were added to liver mitochondria of Oncomelania snail, we found that oxidative phosphorylation increased to 0.353-0.444 mumol O2/mg protein.20 min. ATPase was detected in the liver of Oncomelania snail. The oxidative phosphorylation of mitochondria in Oncomelania snail could be markedly inhibited by DNP and molluscicide bromoacetamide, but the latter didn't show the inhibition of ATPase. (Figs. 1,2).

Small interfering RNA targeting nuclear factor kappa B to prevent vein graft stenosis in rat models.

BACKGROUND: Intimal hyperplasia plays an important role in vein graft stenosis. Inflammatory injury, especially nuclear factor kappaB (NF-κB) gene activation, is highly involved in stenosis progression. We examined whether neointimal hyperplasia and vein graft stenosis could be inhibited by silencing the NF-κB gene with small interference RNA (siRNA). METHODS: Sixty adult male Sprague-Dawley rats were randomly divided into a normal vein group, a vein graft group, a scrambled siRNA group, and an NF-κB siRNA group. We performed reverse interpositional grafting of the autologous external jugular vein to the abdominal aorta. Vein grafts were treated with liposome and gel complexes containing NF-κB siRNA or scrambled siRNA. The levels of monocyte chemoattractant protein -1, tumor necrosis factor-α, and NF-κB p65 in vessel tissues were evaluated after surgery for content of proliferating cell nuclear antigen (PCNA) and vascular wall thickness. RESULTS: NF-κB siRNA treated vein graft showed less neointimal formation and fewer positive PCNA cells (P < .05). In addition there were lower levels of, NF-κB p65 protein and of inflammatory mediators (P < .05) compared with the vein graft group. CONCLUSION: Our study suggested that siRNA transfection suppressed NF-κB expression, reduced inflammatory factors, lessened neointimal proliferation, and suppressed PCNA.

Mode of action of the molluscicide bromoacetamide.

1. Uptake of bromoacetamide was found to be upgraded with exposure time (6, 12, 24 hr) and drug concentration (0.1, 0.5, 1.0 ppm). 2. Bromoacetamide was also absorbed by carp and mice, but drug concentration was markedly lower than in snails. Drug clearance from carp as well as from mice is more rapid than that of snails. 3. The ultrastructure of hepatopancreas cells are markedly influenced by bromoacetamide, including swelling of mitochondria and splitting of cristae. This finding is correlative in a decrease in action of enzymes located in mitochondria (ornithine carbamyl-transferase, citric acid synthase). 4. Oxygen uptake and glucose uptake, as well as urea excretion, are reduced and glycogen reserve are decreased.

[Distribution of bromo[methylene-3H]acetamide in Oncomelania snails, carps, and mice].

Bromoacetamide show a high molluscicidal effect, low toxicity to fish and good solubility in water. It is a promising molluscicide. The present paper reported the distribution of bromo[methylene-3H]acetamide in Oncomelania snails, carps, and mice. Radioactivity in animals was measured by liquid scintillation counting. In Oncomelania snails the radioactivity gradually increased with exposure time and drug concentration. The highest level was found in the head-foot, reaching 12.5 x 10(3) dpm.mg-1 after exposure to the drug for 24 h, whereas the levels in liver and other tissue were 3.0 x 10(3) and 3.8 x 10(3) dpm.mg-1 respectively. Carps absorbed bromo[methylene-3H] acetamide similarly as in Oncomelania snails, but the levels in tissues were less than those in Oncomelania snails. Bromo[methylene-3H]acetamide 0.5 ml (1.4 mumol.L-1) was given ig to mice. Blood samples of 3 mice were collected at 0.5, 1, 3, 6, 12, 24 and 96 h after ig. The peak levels was found within 12 h and then declined gradually.