[Manual therapy combined with posterior percutaneous endoscopic cervical decompression for the treatment of cervical spondylotic radiculopathy].

OBJECTIVE: To explore the clinical efficacy and safety of manual therapy combined with posterior percutaneous endoscopic cervical decompression(PECD) in the treatment of intractable cervical spondylotic radiculopathy. METHODS: From May 2016 to May 2018, 23 CSR patients who responded poorly to conservative treatment for at least 6 weeks underwent the combination management. Firstly, the patients received the posterior percutaneous endoscopic cervical decompression routine care for the following 4 weeks and manual therapy for another 4 weeks. A total of 23 patients were followed up, including 14 males and 9 females, the age ranged from 29 to 78 years old with an average of (50.30±12.28) years, the course of disease was 3 to 24 months with an average of (9.74±5.76) months. The lesion segment involved C4,5 in 4 cases, C5,6 in 13 cases, C6,7 in 6 cases. The visual analogue scale (VAS), neck disability index (NDI), changes of cervical physiological curvature and interbody stability, adverse events were observed before and after operation. The follow-up time points were before operation, 1 day after operation and 1, 3 and 6 months after operation. RESULTS: All patients successfully completed the operation and manual treatment for 4 to 8 times. Among the 29 cases, 23 patients were followed up for more than 6 months. There was no spinal cord and nerve root injury during the treatment and follow-up. Operation time was from 80 to 120 min with a median of 90 min;intraoperative blood loss was from 35 to 80 ml with a median of 50 ml. NDI, VAS of neck, shoulder and arm each period after operation were significantly lower than those before PECD(P<0.05), while there were no significant improvement in cervical physiological curvature and target segment intervertebral space height(P>0.05);there was no significant change in interbody stability (P>0.05). After received the manual therapy, NDI significantly decreased (P<0.05), however, there was no significant difference in VAS of neck, shoulder and arm, physiological curvature of cervical spine and intervertebral space height of target segment compared with that before manual treatment (P>0.05);there was no significant change in interbody stability (P>0.05). CONCLUSION: Manual therapy combined with PECD in the treatment of intractable cervical spondylotic radiculopathy can not only quickly improve the symptoms, but also alleviate the residual symptoms after PECD safely and effectively, and can not cause obvious signs of accelerated instability of cervical adjacent segments in the short term.

[Research on community promotion and application of single acupoint electroacupuncture therapy for lumbar intervertebral disc herniation].

OBJECTIVE: To observe the clinical effect of single acupoint [Yaotu (extra)] electroacupuncture (EA) therapy on lumbar intervertebral disc herniation (LIDH) and its promotion and application in community medical institutions. METHODS: This research adopted a three-level promotion model, and used multi-center collaboration topics as a platform. A total of 240 patients with LIDH were divided into a group A (top three hospital, 80 cases, 3 cases dropped off), a group B (secondary hospital, 80 cases, 8 cases dropped off), and a group C (community health center, 80 cases, 7 cases dropped off). All groups were treated with EA at a single acupoint [Yaotu (extra)] under the guidance of a unified experimental protocol. The EA was given 60 min each time and performed 3 times a week for a total of 2 weeks. The changes of visual analogue scale (VAS) scores of three groups before and after each treatment were compared, and the clinical efficacy was evaluated. RESULTS: Compared with before each treatment, the VAS scores of three groups after each treatment decreased (P<0.05). Except for the second and fifth treatments, the immediate effect in the group A was higher than that in the group B and C (P<0.05). The total effective rate of group A, group B, and group C respectively was 90.9% (70/77), 93.1% (67/72), 86.3% (63/73), and there was no statistically significant difference among the three groups (P>0.05). CONCLUSION: The single acupoint EA therapy has a significant effect in the treatment of LIDH, can quickly relieve the pain symptoms, and has the characteristics of simple operation and easy control, suitable for promotion and application in primary hospitals.

Knockdown of galectin-1 suppresses the growth and invasion of osteosarcoma cells through inhibition of the MAPK/ERK pathway.

Galectin-1 (GAL1), a widely expressed ß­galacto-side-binding protein, exerts pleiotropic biological functions. GAL1 has been found to be upregulated in many malignancies; yet the role of GAL1 in the pathophysiology of human osteosarcoma (OS) remains uncertain. The present study was carried out to investigate the expression of GAL1 in human OS tissues and to explore its effects on the growth and invasion of OS cells. OS and corresponding adjacent non-cancerous tissues (ANCT) were collected from 30 consecutive cases. The expression of GAL1 was detected by immunohistochemical assay through tissue microarray procedure. Using small hairpin RNA (shRNA)-mediated GAL1 knockdown (Lv-shGAL1) in OS (MG-63 and U-2 OS) cells, we observed the changes in the malignant phenotype in OS cells in vitro and in vivo. As a consequence, the positive expression of GAL1 was significantly higher in OS tissues than that in the ANCT (63.3 vs. 36.7%, P=0.029), and was positively correlated with distant metastasis in the OS patients (P=0.022). Knockdown of GAL1 suppressed cell proliferative activities and invasive potential and induced apoptosis in OS cells with decreased expression of p38MAPK, p-ERK, Ki-67 and matrix metallopeptidase-9 (MMP-9) and increased expression of caspase-3. In addition, the tumor volume in the MG-63 subcutaneous tumor models treated with Lv-shGAL1 was significantly smaller than that in the negative control (NC) group (P<0.01). Altogether, our findings indicate that high expression of GAL1 is associated with distant metastasis of OS patients, and knockdown of GAL1 inhibits growth and invasion of OS cells possibly through inhibition of the MAPK/ERK pathway, suggesting that GAL1 may represent a potential target for the treatment of cancer.

Clinical efficacy of semi-laminectomy and posterior stabilization for treatment of thoracolumbar burst fracture.

OBJECTIVE: The purpose of the present study was to investigate the efficacy of posterior semi-laminectomy, restoration of bony fragments and short-segment pedicle screw fixation for treatment of thoracolumbar burst fractures. METHODS: From January 2008 to April 2011, 21 patients (19 males and 2 females) who suffered single-level thoracolumbar burst fractures were enrolled in this study. Fractures at T11, T12, L1, L2 and L3 level occurred in 3, 5, 8, 4 cases and 1 case, respectively. The patients enrolled were presented with 30%-50% encroachment of spinal canal, partial neurological function deficits and intact pedicles, and underwent semi-laminectomy on the fractured thoracolumbar spine, restoration of the fractured bony fragments with special bone punch beneath dural sac, as well as pedicle screw fixation of the fractured thoracolumbar spine and the two vertical neighboring segments. RESULTS: All patients were followed up for 12-48 months, with a mean of 17 months. The mean kyphotic deformity was reduced from (17.3 ± 5.3)° preoperatively to (9.2 ± 4.1)° at follow-up within 12 months. The mean spinal canal diameter increased from (9.7 ± 2.7) mm before surgery to (13.3 ± 1.4) mm at follow-up. Neurological improvement occurred in all subjects after average 2.5 months (range, 1-7 months). Only postoperative wound dehiscence was observed in 1 case, which was caused by implant reaction of calcium phosphate and healed after debridement. CONCLUSION: Semi-laminectomy and restoration of bony fragments is a safe and effective therapeutic measure for thoracolumbar burst fractures with spinal canal encroachment of less than 50%.

[Case-control studies on debridement combined with external application of Mangxiao for the treatment of severe open injuries of limbs].

OBJECTIVE: To investigate simple and convenient methods for the treatment of severe open injuries of limbs. METHODS: From 2005.1 to 2008.3, 31 patients got limb salvage in 33 cases (Gustilo III B) from emergency, which were divided into two groups(A and B). The 16 patients in Group A (14 male and 2 female) were treated with emergency debridement, sequential dressing change, and finally with skin grafting or free flap. The 15 patients in Group B (11 male and 4 female) were treated with radical debridement (skin and muscle), decompression of fascial compartment routinely and repair of periosteal avulsion lesion. The patients in Group B were also treated with external application of Mangxiao postoperatively and dressing change for first time one week later. The clinical effects were assessed by the skin survival rate of degloving injury, the number of operative procedures (using free flap or not), the number of dressing changes in the first two weeks, body temperature and white cell count (48 h after the first debridement ). Statistical analysis was done with SPSS software. Chi-square analyses was used to compare the enumeration data, and compare means with independent samples T test for measurement data. RESULTS: All the patients in Group A got limb salvage (10 patients were upper limb, 6 patients were lower limb), and the mean skin survival rate of degloving injury was (77.88 +/- 4.21)%. Five patients in Group A were finally treated with free flap. All the patients in Group B got limb salvage (10 patients were upper limb, 5 patients were lower limb) by a few secondary skin grafting, and the mean skin survival rate of degloving injury was (97.53 +/- 3.09)%. The mean skin survival rate of Group B was obviously better than that of Group A (P<0.01). The number of dressing changes in the first two weeks in Group B was absolutely less than that of Group A (P<0.01). Also, infection rate and the number of operative procedures of Group B was significantly less than that of Group A (P<0.01). All the patients were followed up for at least 3 months. CONCLUSION: Radical debridement combined with external application of Mangxiao for the treatment of severe open fractures is simple, convenient and effective. It is better for a lot of people injured simultaneously in accident.