Therapeutic potential of melatonin in the intervertebral disc degeneration through inhibiting the ferroptosis of nucleus pulpous cells.

Ferroptosis, a novel type of cell death mediated by the iron-dependent lipid peroxidation, contributes to the pathogenesis of the intervertebral disc degeneration (IDD). Increasing evidence demonstrated that melatonin (MLT) displayed the therapeutic potential to prevent the development of IDD. Current mechanistic study aims to explore whether the downregulation of ferroptosis contributes to the therapeutic capability of MLT in IDD. Current studies demonstrated that conditioned medium (CM) from the lipopolysaccharide (LPS)-stimulated macrophages caused a series of changes about IDD, including increased intracellular oxidative stress (increased reactive oxygen species and malondialdehyde levels, but decreased glutathione levels), upregulated expression of inflammation-associated factors (IL-1ß, COX-2 and iNOS), increased expression of key matrix catabolic molecules (MMP-13, ADAMTS4 and ADAMTS5), reduced the expression of major matrix anabolic molecules (COL2A1 and ACAN), and increased ferroptosis (downregulated GPX4 and SLC7A11 levels, but upregulated ACSL4 and LPCAT3 levels) in nucleus pulposus (NP) cells. MLT could alleviate CM-induced NP cell injury in a dose-dependent manner. Moreover, the data substantiated that intercellular iron overload was involved in CM-induced ferroptosis in NP cells, and MLT treatment alleviated intercellular iron overload and protected NP cells against ferroptosis, and those protective effects of MLT in NP cells further attenuated with erastin and enhanced with ferrostatin-1(Fer-1). This study demonstrated that CM from the LPS-stimulated RAW264.7 macrophages promoted the NP cell injury. MLT alleviated the CM-induced NP cell injury partly through inhibiting ferroptosis. The findings support the role of ferroptosis in the pathogenesis of IDD, and suggest that MLT may serve as a potential therapeutic approach for clinical treatment of IDD.

Dual Passivation of CsPbI3 Perovskite Nanocrystals with Amino Acid Ligands for Efficient Quantum Dot Solar Cells.

Inorganic CsPbI3 perovskite quantum dot (PQD) receives increasing attention for the application in the new generation solar cells, but the defects on the surface of PQDs significantly affect the photovoltaic performance and stability of solar cells. Herein, the amino acids are used as dual-passivation ligands to passivate the surface defects of CsPbI3 PQDs using a facile single-step ligand exchange strategy. The PQD surface properties are investigated in depth by combining experimental studies and theoretical calculation approaches. The PQD solid films with amino acids as dual-passivation ligands on the PQD surface are thoroughly characterized using extensive techniques, which reveal that the glycine ligand can significantly improve defect passivation of PQDs and therefore diminish charge carrier recombination in the PQD solid. The power conversion efficiency (PCE) of the glycine-based PQD solar cell (PQDSC) is improved by 16.9% compared with that of the traditional PQDSC fabricated with Pb(NO3 )2 treating the PQD surface, owning to improved charge carrier extraction. Theoretical calculations are carried out to comprehensively understand the thermodynamic feasibility and favorable charge density distribution on the PQD surface with a dual-passivation ligand.

Suppression of reverberations at fiber tips for optical ultrasound sensing.

Fabry-Perot-based ultrasound sensors at fiber tips have performed high sensitivity and immunity of electromagnetic interference with a relatively compact size. Nevertheless, the reverberation at fiber tips causes a strong noise that degrades the sensing capability. Here we propose a fiber optical-based ultrasound sensor with three design approaches to reduce the reverberation, including designs with an eccentric core, absorptive shield, and arc edge. The effect was experimentally validated with a photoacoustic signal excitation. Compared with bare single-mode fibers in simulation, the low-reverberation design increased the signal-to-noise ratio by 32.1 dB with identical excitation. The experimental results demonstrated the "clean" response with almost invisible reverberations, which was validated by a commercial hydrophone. This research solved the reverberation problems and provided a low-noise design for fiber optic ultrasound sensing.

[Effect of laparoscopic surgery under total intravenous anesthesia on postoperative pregnancy outcomes of heterotopic pregnancies].

OBJECTIVE: To evaluate the effects of laparoscopic surgery under total intravenous anesthesia (TIVA) on outcomes of heterotopic pregnancies which need to receive laparoscopic procedures. METHODS: The data of 108 cases of pregnant women in Center of Reproductive Medicine, Peking University Third Hospital were retrospectively analyzed, and divided into two groups according to whether received surgery. Surgery group : 48 pregnant women after in vitro fertilization-embryo transfer (IVF-ET) were diagnosed as heterotopic pregnancies and received laparoscopic procedures under TIVA. CONTROL GROUP: 60 normal pregnant women after IVF-ET. The miscarriage rate, pregnant complications rate, premature birth rate, live birth rate, delivery weeks and cesarean section rate of two groups were compared. Meanwhile, the newborn's weight, male rate, birth defect rate and Apgar score in 1 min and 5 min of the two groups were compared. RESULTS: The miscarriage rate, pregnant complications rate, premature birth rate, cesarean section rate, male rate of surgery group were 14.6%, 16.7%, 4.2%, 82.9%, 51.2% respectively, which were 15.0%, 18.3%, 6.7%, 84.3%, 52.9% in control group respectively. There were no significant difference between the two groups (χ(2)=-0.072, -0.241, -0.569, -0.442, -0.163, P>0.05). The delivery weeks and newborn's weight of surgery group were (38.3±1.7)weeks and(3 394.9±460.7)g respectively , which were (37.9±1.5) weeks and (3 406.3±512.6 )g in control group. There were no significant difference between the two groups (t=1.083, -0.111, P>0.05). The 1 min Apgar score and 5 min Apgar score of surgery group were 9.6(9.0-10.0), 10(10-10) scores and were 9.5(9.0-10.0), 10(10-10) scores in control group.There were no significant difference between the two groups (Z=-0.418, 0.000, P>0.05). The live birth rate of two groups were both 100%, and the birth defect rate were both 0. CONCLUSION: Laparoscopic surgery under TIVA has no effect on the outcome of heterotopic pregnancies.

Rejuvenating Aged Perovskite Quantum Dots for Efficient Solar Cells.

Perovskite quantum dots (PQDs) have emerged as one of the most promising candidates for next-generation solar cells owing to its remarkable optoelectronic properties and solution processability. However, the optoelectronic properties of PQDs suffer from severe degradation in storage due to the dynamically binding ligands, predominantly affecting photovoltaic applications. Herein, an in situ defect healing treatment (DHT) is reported to effectively rejuvenate aged PQDs. Systematically, experimental studies and theoretical calculations are performed to fundamentally understand the causes leading to the recovered optoelectronic properties of aged PQDs. The results reveal that the I3 - anions produced from tetra-n-octylammonium iodide and iodine could strongly anchor on the surface matrix defects of aged PQDs, substantially diminishing the nonradiative recombination of photogenerated charge carriers. Meanwhile, an DHT could also renovate the morphology of aged PQDs and thus improve the stacking orientation of PQD solids, substantially ameliorating charge carrier transport within PQD solids. Consequently, by using a DHT, the PQD solar cell (PQDSC) yields a high efficiency of up to 15.88%, which is comparable with the PQDSCs fabricated using fresh PQDs. Meanwhile, the stability of PQDSCs fabricated using the rejuvenated PQDs is also largely improved.

Utilization of a novel patient-specific 3D-printing template for percutaneous endoscopic transforaminal discectomy: results from a randomized controlled trial.

Background: The learning curve for percutaneous endoscopic transforaminal discectomy (PETD) is steep, especially for the puncturing and localization procedures. The implementation of 3D printing technology may solve this problem. Methods: A novel individualized 3D-printing template (3D-PT) was designed and utilized in PETD. A prospective randomized controlled trial was performed. A total of 28 patients with lumbar disc herniation treated with PETD were analyzed. Of these, 14 patients were treated with the assistance of 3D printing technology (3D-PT group) in conjunction with fluoroscopy, while the remaining 14 patients were treated exclusively under the guidance of C-arm fluoroscopy (control group). Results: The number of puncture attempts in the 3D-PT group was significantly less than in the control group (1.36 ± 0.63 vs. 6.07 ± 3.08, p = 0.000). The 3D-PT group exhibited a significant reduction in both intraoperative puncture fluoroscopies (2.71 ± 1.27 vs. 12.14 ± 6.15, p = 0.000) and the overall number of fluoroscopies (2.71 ± 1.27 vs. 17.43 ± 6.27, p = 0.000). In the 3D-PT group, there was a significant reduction in both the puncture time (5.77 ± 1.82 vs. 13.99 ± 4.36, p = 0.000) and the total operation time (60.39 ± 9.78 vs. 76.25 ± 17.78, p = 0.007). Complications were not observed in either group. Conclusion: The application of the novel individualized 3D-PT for PETD is effective and safe. The technique has substantial potential and is worth widely promoting.

Melatonin premedication attenuates isoflurane anesthesia-induced ß-amyloid generation and cholinergic dysfunction in the hippocampus of aged rats.

Melatonin plays an important role in aging and relevant neurodegeneration as an antioxidant and neuroprotector. It can interact with ß-amyloid (Aß) generation, inhibit formation of ß-sheet and amyloid fibrils, modulate apoptosis, and protect cholinergic system function in Alzheimer's disease animal model. Recently, its effects on anesthetic-induced neurodegeneration have received more attention, and in this investigation, we explored whether melatonin can attenuate Aß(1-40) generation and cholinergic dysfunction in the hippocampus of aged rats induced by isoflurane through enzyme-linked immunosorbent assay, Western blot, immunohistochemistry, and immunofluorescence. The results showed that isoflurane increased Aß(1-40) generation and caused cholinergic dysfunction through decreasing choline acetyltransferase (ChAT) expression in the hippocampus in a dose-dependent way, and intraperitoneal melatonin premedication attenuated the neurodegeneration through inhibiting Aß(1-40) generation and increasing ChAT expression, and its effects were more obvious in high-concentration isoflurane group. Collectively, our results provide evidence for the therapeutic value of melatonin on isoflurane-induced neurodegeneration, including Aß(1-40) generation and cholinergic dysfunction, and further work is necessary to clarify its target sites and detailed mechanisms.

Comparison of intra-articular low-dose sufentanil, ropivacaine, and combined sufentanil and ropivacaine on post-operative analgesia of isolated anterior cruciate ligament reconstruction.

PURPOSE: To evaluate the effect of combined local anaesthetic and opioid in post-operative analgesia, the effect of intra-articular injection of local anaesthetic (ropivacaine), opioid (sufentanil) and combination of these two (ropivacaine combined with sufentanil) after the single-bundle anterior cruciate ligament reconstruction were compared. METHODS: In a prospective randomized double-blind design, 80 patients who underwent isolated anterior cruciate ligament reconstruction under epidural analgesia were randomly allocated to 4 groups, group A (n = 20) received 30 mL of 0.9% saline as the control group, group B (n = 20) received 10 mg ropivacaine and 2 µg sufentanil in 30 mL 0.9% saline, group C (n = 20) received 10 mg ropivacaine in 30 mL 0.9% saline, group D (n = 20) received 2 µg sufentanil in 30 mL 0.9% saline at the end of the operation. Pain was assessed by use of a 100-mm visual analogue scale (VAS) which was evaluated at 6 and 24 h post-operation. The pain VAS score in active straight leg raising exercise, sleep quality and the status of the administered supplementary analgesia drugs during the first 24 h were also collected. RESULTS: Pain scores of each of the three experiment groups were significantly lower than the control group in every aspect. Group B (ropivacaine with sufentanil) had significant lower pain score than group C (ropivacaine) and group D (sufentanil) both at 6 and 24 h after the operation. Patients in group B, C or D showed significant better sleep qualities than group A. Significantly more patients in group A received supplementary analgesia than group B, C or D. In group B, no patient needed to receive intramuscular dolantin as supplementary analgesia. CONCLUSIONS: Intra-articular injection of opioid (sufentanil), local anaesthetic (ropivacaine) or combination of these two kinds of agents could significantly reduce the pain following the reconstruction of anterior cruciate ligament. The combined intra-articular injection of opioid and local anaesthetic provided better analgesia effect than using sufentanil or ropivacaine alone. LEVEL OF EVIDENCE: Randomized controlled trial, Level I.

[Influence of inhaled anesthesia on bispectral index of elderly patients with cognitive decline].

OBJECTIVE: To investigate the influence of inhaled anesthesia on bispectral index (BIS) of elderly patients with cognitive decline at loss of consciousness and regain of consciousness, and on deepening of sedation. METHODS: The patients aged more than 65 years undergoing elective operations from January 2012 to September 2012 were recruited, then 60 cognitive intact patients and 60 cognitive decline patients were screened by mini-mental state examinations. Inhaled anesthesia was administered using sevoflurane. BIS's of the two groups at loss of consciousness and regain of consciousness, and during end-tidal concentration of sevoflurane (CETSev) changing from 0.7% to 2.8% were recorded. The data were compared with independent-samples t test and repeated-measures general linear model of ANOVA. RESULTS: In the study, 117 patients finshed the investigation, The BIS's of the cognitive decline group at loss of consciousness were significantly higher than those of the cognitive intact group (P<0.01). There were no significant differences at regain of consciousness between the two groups (P>0.05). The BIS's of the cognitive decline group during CETSev changing from 0.7% to 2.8% were significantly lower than those of the cognitive intact group (P<0.05). The BIS's of the cognitive decline group at CETSev 0.7%, 1.05%, 1.4% and 1.75% were significantly lower than those of the cognitive intact group (P<0.05), but there were no significant differences at CETSev 2.1%, 2.45% and 2.8% between the two groups (P>0.05). CONCLUSION: During inhaled anesthesia, the BIS of the elderly patients with cognitive decline at loss of consciousness is higher than that of the patients with cognitive intact, The BIS of elderly patients with cognitive decline on deepening of anesthesia is lower than that of the patients with cognitive intact, especially during light anesthesia, and its mechanisms may attribute to cognitive decline related neurodegeneration and neurotransmitter system dysfunction.

Antisolvent-Assisted In Situ Cation Exchange of Perovskite Quantum Dots for Efficient Solar Cells.

Cesium-formamidinium lead iodide perovskite quantum dots (FAx Cs1- x PbI3 PQDs) show high potential for next-generation photovoltaics due to their outstanding optoelectronic properties. However, achieving composition-tunable hybrid PQDs with desirable charge transport remains a significant challenge. Herein, by leveraging an antisolvent-assisted in situ cation exchange of PQDs, homogeneous FAx Cs1- x PbI3 PQDs with controllable stoichiometries and surface ligand chemistry are realized. Meanwhile, the crystallographic stability of PQDs is substantially improved by substituting the cations of the PQDs mediated by surface vacancies. Consequently, PQD solar cell delivers an efficiency of 17.29%, the highest value among the homostructured PQD solar cells. The high photovoltaic performance is attributed to the broadened light harvesting spectra, flattened energy landscape, and rationalized energy levels of highly oriented PQD solids, leading to efficient charge carrier extraction. This work provides a feasible approach for the stoichiometry regulation of PQDs to finely tailor the optoelectronic properties and tolerance factors of PQDs toward high-performing photovoltaics.

Effects of glial cell line-derived neurotrophic factor intrathecal injection on spinal dorsal horn glial fibrillary acidic protein expression in a rat model of neuropathic pain.

Glial fibrillary acidic protein (GFAP) is a specific astrocytic marker in the central nervous system. Few studies on the effects of glial cell line-derived neurotrophic factor (GDNF) intrathecal injection on GFAP expression exist in the literature. The present study determined GFAP expression in rat spinal dorsal horn following a spinal nerve ligation (SNL). The effects of GDNF intrathecal injection on GFAP expression were examined to gather experimental evidence on the mechanisms underlying neuropathic pain. Following L5-6 SNL, male Sprague-Dawley rats were randomly divided into four groups: normal control, sham-operated, SNL, and GDNF. Each group was further divided into three subgroups (n = 10) according to the times of sacrifice: 3, 7, and 14 days after surgery. Compared with the normal control and the sham-operated groups, GFAP expression in the SNL group increased at day 3 after surgery and lasted until 14 days after. GFAP expression was significantly less in the GDNF group compared with the SNL group which lasted until 14 days after surgery, suggesting that rat spinal dorsal horn GFAP expression contributes to SNL-induced neuropathic pain. The mechanisms underlying GDNF alleviation of neuropathic pain were shown to be related to the GDNF inhibition of GFAP expression in the spinal dorsal horn.

Highly Orientated Perovskite Quantum Dot Solids for Efficient Solar Cells.

Perovskite quantum dots (PQDs) have emerged as competitive optoelectronic materials for photovoltaic applications due to their ideal bandgap energy, high defect tolerance, and solution processability. However, the highly dynamic surface and imperfect cubic structure of PQDs generally result in unfavorable charge-carrier transport within the PQD solids and serious nonradiative recombination. Herein, a highly orientated PQD solid is demonstrated using precursor engineering accompanied by a chemical stripping treatment (CST). A combination of systematic experimental studies and theoretical calculations is conducted to fundamentally understand the resurfacing of PQDs using the CST approach. The results reveal that the highly ordered PQDs can result in a high orientation of PQD solids, significantly promoting charge-carrier transport within the PQD solids. Meanwhile, the ideal cubic-structured PQD with an iodine-rich surface dramatically decreases surface trap states, thereby substantially diminishing trap-assisted nonradiative recombination. Consequently, the inorganic PQD solar cell delivers a power conversion efficiency of up to 16.25%. This work provides a feasible avenue to construct highly orientated PQD solids with improved photophysical properties for high-performance optoelectronic devices.

Ligand exchange engineering of FAPbI3 perovskite quantum dots for solar cells.

Formamidinium lead triiodide (FAPbI3) perovskite quantum dots (PQDs) show great advantages in photovoltaic applications due to their ideal bandgap energy, high stability and solution processability. The anti-solvent used for the post-treatment of FAPbI3 PQD solid films significantly affects the surface chemistry of the PQDs, and thus the vacancies caused by surface ligand removal inhibit the optoelectronic properties and stability of PQDs. Here, we study the effects of different anti-solvents with different polarities on FAPbI3 PQDs and select a series of organic molecules for surface passivation of PQDs. The results show that methyl acetate could effectively remove surface ligands from the PQD surface without destroying its crystal structure during the post-treatment. The benzamidine hydrochloride (PhFACl) applied as short ligands of PQDs during the post-treatment could fill the A-site and X-site vacancies of PQDs and thus improve the electronic coupling of PQDs. Finally, the PhFACl-based PQD solar cell (PQDSC) achieves a power conversion efficiency of 6.4%, compared to that of 4.63% for the conventional PQDSC. This work provides a reference for insights into the surface passivation of PQDs and the improvement in device performance of PQDSCs.

Clinical efficacy of ultrasound-guided pulsed radiofrequency combined with ganglion impar block for treatment of perineal pain.

BACKGROUND: Ganglion impar block alone or pulsed radiofrequency alone are effective options for treating perineal pain. However, ganglion impar block combined with pulsed radiofrequency (GIB-PRF) for treating perineal pain is rare and the puncture is usually performed with X-ray or computed tomography guidance. AIM: To evaluate the safety and clinical efficacy of real-time ultrasound-guided GIB-PRF in treating perineal pain. METHODS: Thirty patients with perineal pain were included and were treated by GIB-PRF guided by real-time ultrasound imaging between January 2015 and December 2016. Complications were recorded to observe the safety of the ultrasound-guided GIB-PRF procedure, and visual analogue scale (VAS) scores at 24 h before and after treatment and 1, 3, and 6 mo later were analyzed to evaluate clinical efficacy. RESULTS: Ultrasound-guided GIB-PRF was performed successfully in all patients, and no complications occurred. Compared with pretreatment scores, the VAS scores were significantly lower (P < 0.05) at the four time points after treatment. The VAS scores at 1 and 3 mo were slightly lower than those at 24 h (P > 0.05) and were significantly lower at 6 mo after treatment (P < 0.05). There was a tendency toward lower VAS scores at 6 mo after treatment compared with those at 1 and 3 mo (P > 0.05). CONCLUSION: Ultrasound-guided GIB-PRF was a safe and effective way to treat perineal pain. The 6-mo short-term clinical efficacy was favorable, but the long-term outcomes need future study.

Insight into the Interface Engineering of a SnO2/FAPbI3 Perovskite Using Lead Halide as an Interlayer: A First-Principles Study.

The interfacial properties of the perovskite photovoltaic layer and electron transport layer (ETL) are critical to minimize energy losses of perovskite solar cells (PSCs) induced by interfacial recombination. Herein, the interface engineering of the SnO2/FAPbI3 perovskite using PbX2 (X = Cl, Br, or I) as an interlayer is extensively studied using first-principles calculations. The results reveal that the thickness of the PbI2 interlayer needs to be finely controlled, which may limit charge transport if there is a large amount of PbI2 precipitation at the interface. The high lattice mismatch of the PbBr2 with the SnO2/FAPbI3 interface makes PbBr2 an unfavorable passivation material. Due to the strong coupling of the PbCl2 with both SnO2 and FAPbI3, an efficient electron transport pathway could be built after applying PbCl2 as an interlayer. Meanwhile, the PbCl2 interlayer could also effectively passivate interface defects, therefore lowering the energy losses of PSCs.

Exploration on the effect of predeposit autotransfusion on bone marrow hematopoiesis after femoral shaft fracture.

OBJECTIVE: By observing the changes in the number and activity of CD34+ cells in bone marrow after predeposit autotransfusion (PAT) to patients with femoral shaft fracture (FSF), to evaluate the effects of PAT on hematopoietic function and hematopoietic stem cells in bone marrow. METHODS: Selected FSF patients were randomly divided into 2 groups: the control group (patients did not receive blood transfusion after surgery) and PAT group (patients received PAT after surgery). The content of RBC and Plt in blood samples were counted by blood routine. The cell cycle and proportion of CD34+ myelinated cells in blood samples was analyzed by flow cytometry. The telomere DNA length of hematopoietic stem cells (HSCs) in the control groups and PAT group at postoperation 24 was analyzed by southern blot. RESULTS: The content of RBC and Plt in postoperation 6h and 24h in the control group was evidently higher compared to that in PAT group, while Hb content in control group was significantly lower compared to that in PAT group. The proportion of CD34+ myelinated cells in post-transfusion 6h and postoperation 24h in PAT group was evidently higher compared to that in the control group. In PAT group, S phase at postoperation 24h was significantly larger compared to that at post-transfusion 6h. The telomere DNA length of HSCs in PAT group was longer than that in the control group. CONCLUSION: PAT can increase the number of HSC, while does not cause the abnormal aging of HSCs. PAT is suitable for postoperative blood transfusion of patients with FSF.

To Research the Effects of Storage Time on Autotransfusion based on Erythrocyte Oxygen-Carrying Capacity and Oxidative Damage Characteristics.

Autotransfusion refers to a blood transfusion method in which the blood or blood components of the patient are collected under certain conditions, returned to himself when the patient needs surgery or emergency after a series of storing and processing. Although autotransfusion can avoid blood-borne diseases and adverse reactions related to allogeneic blood transfusion, a series of structural and functional changes of erythrocytes will occur during extension of storage time, thus affecting the efficacy of clinical blood transfusion. Our research was aimed to explore the change of erythrocyte oxygen-carrying capacity in different storage time, such as effective oxygen uptake (Q), P50, 2,3-DPG, Na+-K+-ATPase, to detect membrane potential, the change of Ca2+, and reactive oxygen species (ROS) change of erythrocytes. At the same time, Western blot was used to detect the expression of Mitofusin 1 (Mfn1) and Mitofusin 2 (Mfn2) proteins on the cytomembrane, from the perspective of oxidative stress to explore the function change of erythrocytes after different storage time. This study is expected to provide experimental data for further clarifying the functional status of erythrocytes with different preservation time in patients with autotransfusion, achieving accurate infusion of erythrocytes and improving the therapeutic effect of autologous blood transfusion, which has important clinical application value.

Expert consensus on the diagnosis and treatment of myofascial pain syndrome.

Myofascial pain syndrome (MPS) is characterized by myofascial trigger points and fascial constrictions. At present, domestic and foreign scholars have not reached a consensus on the etiology and pathogenesis of MPS. Due to the lack of specific laboratory indicators and imaging evidence, there is no unified diagnostic criteria for MPS, making it easy to confuse with other diseases. The Chinese Association for the Study of Pain organized domestic experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of MPS. This article reviews relevant domestic and foreign literature on the definition, epidemiology, pathogenesis, clinical manifestation, diagnostic criteria and treatments of MPS. The consensus is intended to normalize the diagnosis and treatment of MPS and be used by first-line doctors, including pain physicians to manage patients with MPS.

[Anesthesia for cesarean section in pregnancy complicated with severe scoliosis: a case report].

Scoliosis refers to a complex three-dimensional spine deformity. Onset of scoliosis can occur in an infantile, juvenile, adolescent, or adult period. Severe scoliosis not only affects the appearance of the patient, but also impairs the functions of circulation and respiratory systems. Significant changes of the cardiopulmonary function can occur during pregnancy. In this report, general anesthesia was needed for emergent cesarean section of the puerperant complicated with severe scoliosis. The puerperant had already suffered type II respiratory failure preoperatively. There might be managements of difficult airway, depression with circulation and respiration of the neonate, and the risk for inhibition of the uterine contraction and awareness. Facing the challenges, the anesthesiologists must work out a detail anesthesia plan quickly, and make sure the safety of the puerperant and the neonate.

Combination of Gluteal Trigger Points Dry Needling and Percutaneous Endoscopic Lumbar Discectomy for Complex Low Back-Related Leg Pain.

PURPOSE: Causes of low back-related leg pain (LBLP) can be complex and diverse. A detailed medical history, physical examination, laboratory tests, and imaging are necessary to accurately distinguish the pathomechanisms of LBLP and determine the most appropriate treatment. CASE: In this study, we report the first documented case in which the combination of dry needling (DN) and percutaneous endoscopic lumbar discectomy (PELD) was used for a patient with active myofascial trigger points (MTrPs) in the gluteus minimus muscle as well as L3-4 lumbar disc herniation (LDH). This 63-year-old woman complained of LBLP for 3 months. After careful examination and analysis, we determined this pain originated from two active MTrPs in the gluteal region and not LDH in L3-4. We first performed MTrPs DN, and the patient's LBLP was relieved completely. We then performed PELD at the L3-4 level for residual numbness on the medial and anterior aspect of the left lower limb. Finally, the patient received a satisfactory result. CONCLUSION: The gluteal MTrPs test may be used as a routine examination for patients with LBLP, especially when clinical findings are discordant with imaging results.