Targeted fully endoscopic visualized laminar trepanning approach under local anaesthesia for resection of highly migrated lumbar disc herniation.

PURPOSE: To introduce a new fully endoscopic visualized laminar trepanning approach with a periendoscopic trephine under local anesthesia for resection of highly migrated lumbar disc herniation (LDH) and report the clinical outcomes of one year follow-up. METHODS: Twenty-one patients with highly migrated LDH who underwent percutaneous endoscopic lumbar discectomy via the laminar trepanning approach from June 2019 to August 2020 were retrospectively reviewed. Patient-Reported Outcomes Measurement Information System (PROMIS) Short Forms-Pain Interference (PI) and Physical Function (PF) were selected as outcome measures. The operating duration and complication were documented. RESULTS: The average age of the 21 patients (15 males, 6 females) was 37.8 ± 6.0 years (29-52 years). Disc migration originated from L4/5 in 19 patients, L5/S1 in two patients. The mean operative duration was 54.1 ± 9.0 minutes (42-79 min). All patients were followed up to 12 months after the operation. PROMIS PI T-scores decreased significantly from pre-operatively mean 68.6 ± 2.4 to 54.4 ± 1.9 (P < 0.001) and 47.1 ± 4.3 (P < 0.001) at six weeks and 12 months, respectively. PROMIS PF T-scores improved significantly from pre-operatively mean 26.7 ± 4.7 to 44.3 ± 4.2(P < 0.001) and 58.4 ± 4.0 (P < 0.001) at six weeks and 12 months, respectively. No complications and disc herniation recurrences occurred. CONCLUSION: The targeted full endoscopic laminar trepanning under local anesthesia with a visualized periendoscopic trephine offers a safe, efficient and cost-effective option for the resection of highly migrated LDH.

[Acupoint puncture combined with Ilizarov technique for the treatment of elderly paitents with knee osteoarthritis].

OBJECTIVE: To explore the clinical effect of acupoint puncture combined with Ilizarov technique in the treatment of knee osteoarthritis in the elderly. METHODS: From March 2015 to February 2016, 76 patients with primary knee osteoarthritis were treated with tibial osteotomy acupoint puncture grouop and Ilizarov technique anatomical puncture group, including 24 males and 52 females, aged 56 to 75 years old with an average of 61.4 years old, and a course of 3 to 17 years with an average of 5.2 years. Among them, 38 cases were treated with external fixation of acupoint puncture needle and 38 cases were treated with external fixation of anatomical puncture needle. Preoperative full-length X-ray of both lower limbs showed tibial varus deformity, narrowing of medial knee joint space and enlargement of lateral knee joint space. The force line of the affected knee and lower limb was moved inward by body surface measurement, and the KSS knee function score was decreased. Symptoms included medial knee pain, flexion and extension, and conservative treatment for more than 2 years. RESULTS: The lower limb force lines of both groups were corrected and the osteotomy ends healed well. No nonunion of osteotomy, inadequate correction of lower limbs or recurrence of deformity were found. Seventy-five patients were followed up for 3, 6, 12 and 24 months after operation. There was no significant difference in knee joint mobility between the two groups before operation and on 6, 12, 24 months after operation(F=1.346, P>0.05). There were significant difference in KSS pain and total score between the two groups at 3 months after operation, acupoint puncture group was better than anatomical puncture group(P<0.05); there was no significant difference in KSS score at 12 months after operation(P>0.05). CONCLUSIONS: The acupoint puncture group formed a potential acupuncture effect in the acupoint area by continuously tightening the steel needle on Ilizarov ring external fixator during the post-operative adjustment. Within three months after wearing external fixator, the knee pain symptoms of knee osteoarthritis were relieved rapidly, continuously and effectively, which was significantly better than that of the anatomical puncture group.

Antitumoural hydroxyapatite nanoparticles-mediated hepatoma-targeted trans-arterial embolization gene therapy: in vitro and in vivo studies.

BACKGROUND/AIMS: Absence of curative treatment creates urgent need for new strategies for unresectable hepatoma. Based on former discoveries of good liver cell compatibility, safety and tumour-specific inhibition of hydroxyapatite nanoparticles (nHAP), this work tries to make nHAP serve as gene vector in the hepatoma-targeted trans-arterial embolization (TAE) gene therapy to elevate and synergize the therapeutic efficacy of TAE and target gene therapy. METHOD: Following dosage and ratio optimization, polypolex formed by surface modified nHAP and p53 expressing plasmid was applied in vitro for human hepatoma HePG2 cell, and then in vivo for rabbit hepatic VX2 tumour by injection of polypolex/lipodoil emulsion to the hepatic artery in a tumour-target manner. RESULTS: In vitro, the polypolex transfected only about 5% HepG2 cells, but can elevate the inhibition of its growth and apoptosis in a much more degree while keeping safe to the normal hepatocyte line, L02. In vivo, the emulsion, with better dispersion than the polypolex and more specific tumour-target than lipiodol, mediated specific 4% p53 expression and antitumoural nanoparticle retention in the target tumour site, also significantly reduced tumour growth and prolonged the animal survival times more than the lipiodol (P < 0.05). CONCLUSIONS: In all, this new treatment based on nHAP can enhance therapeutic effect of HCC safely both in vitro and in vivo.

Effectiveness of the immunofecal occult blood test for colorectal cancer screening in a large population.

BACKGROUND: Guaiac tests are the most widely used tests to detect colorectal cancer (CRC). However, their sensitivity is relatively low and results may be affected by various factors. Immunofecal occult blood test (IFOBT) is specific for human hemoglobin and does not require dietary restrictions. AIMS: The aim of this study was to evaluate the effectiveness of IFOBT for the screening of precancerous lesions and CRC. METHODS: From July 2006 to June 2007, IFOBT was performed on 5,919 adults who received periodic health examinations in our hospital. The positive cases were examined by colonoscopy and a double-contrast barium enema. Diagnosis was confirmed by histopathological analysis. RESULTS: Positive IFOBT was detected in 314 of 5,919 cases (5.30%). Further examinations were made in 264 IFOBT-positive cases. Of these, 116 cases with colorectal cancer (16 cases) or precancerous lesions (94 cases with colorectal adenomatous polyps and 6 cases with active ulcerative colitis) were detected. The total detection rate of CRC and precancerous lesions was 43.94% (116/264). TNM classification of 16 CRC cases was as follows: TNM I in eight cases (50.00%), TNM II in seven cases (43.75%) and TNM III in one case (6.25%), indicating IFOBT can detect CRC in the early stages. CONCLUSION: Regular IFOBT can detect precancerous lesions and CRC in early stages and can thus reduce mortality from CRC.

[Advances in biomechanical studies on functional training for the treatment of fractures].

Functional training is put a very high position in the treatment of fractures by Western Medicine and Traditional Chinese Medicine. The influences of functional training during fracture healing are very important. Functional training will begin after reduction and fixation and it represents the principle of the combination of functional training and fixation in the fracture treatment by TCM. Functional training makes kinds of favourable stress, which can accelerate the healing of fracture, but the incorrect functional training makes shear strength or torsion and so on, which may make interfere fracture healing. So, the biomechanical studies on functional training of the fracture are becoming a focus of fracture treatment.

[The effect of immunofecal occult blood test on colorectal cancer screening].

OBJECTIVE: To discuss the clinical value of immunofecal occult blood test in screening of colorectal cancer and its precancerous lesions in a large series of health checkup population. METHODS: Colorectal cancer and its precancerous lesions in 5919 subjects undergoing health checkup in our hospital were screened out by using immunofecal occult blood test from July 2006 to June 2007; positive cases with the test were subjected to colorectal endoscopy or X-ray barium enema examination. Relevant results were analyzed in combination with clinical and pathological data. RESULTS: Positive result was obtained in 314 out of the 5919 subjects undergoing health checkup with immunofecal occult blood test; the positive rate was 5.30%. 241 cases (76.75%) of them accepted colorectal endoscopic examination and 23 cases (7.32%) accepted X-ray barium enema examination. The total follow up rate was 84.08% with 50 cases out of contact. After excluding the cases out of contact, 16 cases of colorectal cancer were found morbidity 2.37 per thousand including 8 (50.00%) cases of Dukes A, 7 cases (43.75%) of Dukes B and 1 case of Dukes C (6.25%). The detection rate of colorectal cancer with positive immunofecal occult blood test was 6.06% (16/264). 94 cases (16.01 per thousand) of adenomatous polyps were found including 55 cases (58.51%) of tubular adenoma, 23 cases (24.47%) of villiform-tubular adenoma and 16 cases (17.02%) of villiform adenoma. Among these cases 55 (58.51%) were solitary and 39 (41.49%) multiple. In addition, 6 cases of ulcerative colitis in active phase were found. Altogether 116 (43.94%) of the 264 cases with positive immunofecal blood test and not out of contact were found to have colorectal cancer or its precancerous lesions. CONCLUSION: Immunofecal occult blood test is suitable for screening of colorectal cancer and its precancerous lesions in large series of population. Colorectal cancer and its precancerous lesions may be found in relatively early phase and be eradicated in curable stage, thus to reduce the morbidity and mortality.