Nonsurgical intervention for neuroclaudication due to lumbar spinal stenosis:Interpretation of the 2021 American Association for the Study of Pain Guidelines

Lumbar Spinal Stenosis(LSS)is the major cause of Neurogenic Claudication(NC).It is common in the elderly and has an increasing incidence.In 2021,the United States Association for the Study of Pain published new evidence-based clinical practice guidelines to provide more effective nonsurgical treatment of LSS-induced NC.Based on a thorough reading of the latest guidelines,combined with new clinical developments,and in collaboration with the 2011 North American Spine Society,NASS guidelines(hereinafter referred to as the 2011 Guidelines)were compared with the 2019 Danish Health Authority(DHA)Guidelines(hereinafter referred to as the 2019 Guidelines),and the clinical diagnosis and treatment of NC caused by LSS were reviewed and suggestions were put forward.

Curcumin suppresses proliferation of MCF-7 breast cancer cells by modulating gap junction signaling

Curcumin, an agent isolated from turmeric, shows therapeutic potential against breast cancer. However, the mechanism underlying anticancer activity has not been fully expounded. In this research, bioinformatics was utilized to analyze molecular mechanism of curcumin and the results have been proved in breast cancer cells subsequently. In order to generate a breast cancer molecular network with which curcumin interacts, target proteins of curcumin from PubChem were combined with genes implicated in breast cancer in the NCBI within Ingenuity Pathway Analysis software. Predicted curcumin targets were verified by reverse transcription-quantitative polymerase chain reaction. Bioinformatics identified gap junction signaling and 14-3-3-mediated adherens junctions as the main canonical signaling pathways targeted by curcumin. Moreover, curcumin can substantially up-regulates the gap junction protein connexin in breast cancer cells. Our results suggest that curcumin through modulation of the gap junction signaling pathway to inhibit cell proliferation and differentiation in breast cancer cells.

The diagnosis and treatment of lumbar disc herniation with radiculopathy: interpretation of NASS guidelines for evidence-based medicine

Lumbar disc herniation with radiculopathy refers to a localized displacement of disc material beyond the normal margins of the intervertebral disc space resulting in pain,weakness or numbness in a myotomal or dermatomal distribution.North American Spine Society(NASS)released a new version of clinical guidelines for diagnosis and treatment of lumbar disc herniation with radiculopathy.For providing the best and effective diagnosis and treatment plan,this guidelines use a systematic review of literature and evidence-based medical evidence analysis to identify different recommended intensities,focus on the common problems of diagnosis and treatment.This article gives a brief explanation of guidelines with the clinical practice in China,so as to provide a reference for clinicians and researchers.

Evaluation of the quality of randomized controlled trials on exercise for cervical radiculopathy

Objective:To review and evaluate the quality of the randomized controlled trials of exercise for the treatment of cervical radiculopathy with the present internationally recognized CONSORT statement, which provides reference and basis for the improvement of clinical research on exercise for intervening cervical radiculopathy in the future.Methods: A computer-based search of large domestic databases, including CNKI, Wanfang database and VIP database screened out literature that meet the requirements and used CONSORT statement for quality assessment.Results: According to the prescribed inclusion and exclusion criteria, 30 articles were retrieved in accordance with the standard. No literature was referred to the randomized controlled trial, 2 documents clearly defined the type of test design, 1 documents carried out the calculation of sample size, 13 documents clearly randomly assigned, 1 literature implemented the blind method, in the 7 literature, baseline information was shown in tabular form, and no reference was made to trial registration, trial protocol and funding.Conclusion:There are some aspects of randomized controlled trials on exercise for the treatment of cervical radiculopathy. However, there are some aspects that need to be improved. In the future randomized controlled trial report, the CONSORT statement should be highly valued and carefully considered to improve the accuracy and credibility of the research.

Meta-analysis of percutaneous kyphoplasty for elderly osteoporotic vertebral compression fractures

Objective:To evaluate the clinical efficacy of percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral compression fractures(OVCF)in the elderly by meta-analysis,and to provide a basis for clinical application.Methods:CNKI,Wanfang,Weipu,CBM,PubMed,the Cochrane Library and EMbase were retrieved by computer from the date of establishment to January 2019.The literature on randomized controlled trials of PKP and conservative treatment of OVCF was collected and diagnosed as thoracolumbar vertebral compression fracture by X-ray,CT,and MRI.Osteoporosis of thoracolumbar vertebrae(T<2.5)was determined by bone mineral density measurements.Age(>50 years old)and course of the disease(<3 months).Postoperative outcome indicators included at least one of the following indicators:visual analogue scale.VAS and Oswestry Dysfunction Index(ODI),changes of Cobb angle of diseased vertebrae and height of the anterior edge of diseased vertebrae.The quality of the included literature was evaluated by referring to the evaluation criteria for randomized controlled trials provided in the Cochrane Systematic Evaluation Manual.Results:Six randomized controlled trials studies were included,all of which were Chinese literature.Five of them had 4 or more points in methodological quality evaluation and one had 3 points in methodology quality evaluation.There were 525 patients in the two groups,267 in the PKP group and 258 in the conservative treatment group.Meta-analysis showed that the pain visual analogue score in the PKP group was significantly higher than that in the conservative treatment group[MD=2.10,95%CI(-2.25,-1.95),P<0.00001].There were significant differences between the PKP group and the conservative treatment(CT)group[MD=8.90,95%CI(-9.86,-7.94),P<0.00001]in the changes of the Cobb angle of the diseased vertebrae after treatment.There were significant differences in the ODI and the height of the anterior edge of the diseased vertebrae(P<0.05).Conclusion:PKP treatment of OVCF can effectively reduce pain visual analogue score,improve dysfunction index(ODI)and improve the quality of life of patients.It can also effectively restore the height of vertebral loss,correct the Cobb angle of the diseased vertebrae,and reduce the risk of recurrent fracture of the adjacent vertebral body and serious complications.

Target prediction and mechanism of Shiyangning in treatment of perianal eczema

Objective:To explore the possible targets and signaling pathways of Chinese herbal compound"Shiyangning"in the treatment of perianal eczema(PE).Methods:The main active components and target proteins in Shiyangning were screened out by searching the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP).PE Targets were retrieved and collected from Disease Databases such as Therapeutic Target Database(TTD).The protein-protein interaction(PPI)network was constructed and analyzed by STRING online database,and the network topology results were analyzed by Cytoscape 3.7.1 software.The common gene names of target proteins were checked in Uniprot database,and KEGG pathway function enrichment analysis was carried out through David database to study the possible signaling pathway of Shiyangning in the treatment of PE.Results:There were 238 core compounds,152 targets and 233 PE disease targets.Six key targets(STAT3,IL6,TP53,EGFR,EGF and TNF)were obtained from the analysis of network topology.The results of pathway enrichment showed that PI3K-Akt signaling pathway and FoxO signaling pathway were the main pathways.Conclusion:Shiyangning treat PE mainly by regulating STAT3,IL-6 and other related inflammatory signaling pathways.

Effects of kidney-tonifying and blood circulation-promoting recipes and platelet-rich plasma on the activity and expression of type I collagen

Objective:To observe the effects of kidney-tonifying and blood circulation-promoting recipes and platelet-rich plasma(PRP)on the activity and expression of type I collagen in co-culture system.Methods:The subcutaneous adipose tissue and degenerative nucleus pulposus tissue of patients with nucleus pulposus removal under lumbar intervertebral disc degeneration were isolated and cultured by multiple enzyme digestion methods to establish a co-culture system of ADSCs/NPCs.Patients with lumbar intervertebral disc degeneration were enrolled for 2 weeks.The venous blood was taken 50mL before the first dose and one hour after the last dose.Platelet-rich plasma was prepared by secondary centrifugation and cultured with different plasma.The experiment was divided into five groups:platelet-rich plasma group(PRP),platelet-poor plasma group(PPP),drug-rich platelet-rich plasma group(M-PRP)and drug-poor platelet plasma group(M-PPP),fetal bovine serum group(FBS).The morphological changes of the cells in each group were observed under an inverted microscope.The changes of type I collagen activity were detected by immunofluorescence assay.The expression of CCOL1A1 gene was detected by RT-PCR two weeks after the intervention.Results:In this study,the results of kidney-tonifying and blood circulation-promoting recipes and PRP group intervention were shown.The results of the group intervention showed that the M-PRP group and the PRP group had clearer cell contours and better refractive index than the other groups,and there was no significant difference between the two groups.The results of immunofluorescence staining showed that the number of cells in PRP group and M-PRP group was higher,but the staining intensity of single cells was significantly lower than that in FBS group.RT-PCR results showed that the expression of COL1A1 mRNA in PPP group,PRP group,M-PRP group and M-PPP group was significantly down-regulated(P<0.05),respectively:0.343±0.040,0.294±0.018,0.310±0.022,0.430±0.020.Conclusions:Kidney-tonifying and blood circulation-promoting recipes combined with platelet-rich plasma can decrease the activity and exhibit a tendency to inhibit the expression of type I collagen.

Systematic evaluation and meta-analysis of acupuncture treatment for residual pain after lumbar disc herniation

Objective:To systematically evaluate the effectiveness and safety of acupuncture in the treatment of postoperative residual pain in lumbar disc herniation,and to provide evidence for its clinical treatment.Methods:A randomized controlled trial(RCT)of all acupuncture treatments for postoperative lumbar disc herniation in PubMed,CBM,CNKI,Wanfang,VIP,E mbase,and Cochrane libraries was published by May 2019,followed by RevMan5.3 software for meta-analysis.Results:11 randomized controlled trials were included in 855 patients,including 428 in the experimental group and 427 in the control group,with a ratio of 1:1.The results of the meta-analysis showed that the overall effective rate of the experimental group[RR=1.22,95%CI(1.15,1.29),P<0.00001],visual analogue pain(VAS)score[MD=1.59,95%CI(1.22,1.95),P<0.00001],Japanese Orthopaedic Association evaluation treatment score(JOA)[MD=5.66,95%CI(2.58,8.74),P=0.0003],the incidence of adverse hair loss[RR=0.35,95%CI(0.18,0.71),P=0.003]were significantly better than the control group,the difference was statistically significant.Conclusion:Acupuncture has obvious advantages in the treatment of residual pain after lumbar disc herniation,which can significantly relieve postoperative pain and improve quality of life.However,the conclusions of this study need to be further verified by the large sample and high quality literature.

On the prevention and treatment of cervical spondylosis^1

Cervical spondylosis is a kind of frequently occurring and refractory disease with high recurrence rate and tends to be younger. It has become a multiple refractory disease at home and abroad, and its mechanism research and clinical diagnosis and treatment are still controversial. This article will discuss the etiology, pathogenesis, mechanism and treatment of cervical spondylosis from ancient Chinese medicine and modern western medicine, and focus on the research progress of modern prevention and treatment of cervical spondylosis, in order to provide reference for modern clinical treatment of cervical spondylosis.

Effects of Kidney-tonifying and Blood Circulation-promoting Recipes and PRP on the Activity and Expression of Type I Collagen

Objective:To observe the effects of kidney-tonifying and blood circulation-promoting recipes and platelet-rich plasma (PRP) on the activity and expression of type I collagen in co-culture system.Methods:The subcutaneous adipose tissue and degenerative nucleus pulposus tissue of patients with nucleus pulposus removal under lumbar intervertebral disc degeneration were isolated and cultured by multiple enzyme digestion methods to establish a co-culture system of ADSCs/NPCs. Patients with lumbar intervertebral disc degeneration were enrolled for 2 weeks.The venous blood was taken 50mL before the first dose and one hour after the last dose. Platelet-rich plasma was prepared by secondary centrifugation and cultured with different plasma. The experiment was divided into five groups: platelet-rich plasma group (PRP), platelet-poor plasma group (PPP), drug-rich platelet-rich plasma group (M-PRP) and drug-poor platelet plasma group (M-PPP), fetal bovine serum group (FBS). The morphological changes of the cells in each group were observed under an inverted microscope. The changes of type I collagen activity were detected by immunofluorescence assay. The expression of CCOL1A1 gene was detected by RT-PCR two weeks after the intervention.Results:In this study, the results of kidney-tonifying and blood circulation-promoting recipes and PRP group intervention were shown. The results of the group intervention showed that the M-PRP group and the PRP group had clearer cell contours and better refractive index than the other groups, and there was no significant difference between the two groups. The results of immunofluorescence staining showed that the number of cells in PRP group and M-PRP group was higher, but the staining intensity of single cells was significantly lower than that in FBS group. RT-PCR results showed that the expression of COL1A1 mRNA in PPP group, PRP group, M-PRP group and M-PPP group was significantly down-regulated (P<0.05), respectively: 0.343±0.040, 0.294±0.018, 0.310±0.022, 0.430±0.020.Conclusion:Kidney-tonifying and blood circulation-promoting recipes combined with platelet-rich plasma can decrease the activity and exhibit a tendency to inhibit the expression of type I collagen.

Systematic evaluation and Meta-analysis 0f the improvement of pain and function after total knee replacement by percutaneous electrical stimulation

Objective:To systematically evaluate the effectiveness and safety of acupuncture in the treatment of postoperative residual pain in lumbar disc herniation, and to provide evidence for its clinical treatment. Methods A randomized controlled trial (RCT) of all acupuncture treatments for postoperative lumbar disc herniation in PubMed, CBM, CNKI, Wanfang, VIP, Embase and Cochrane libraries was published by May 2019, followed by RevMan5.3 software for meta-analysis. Results 11 randomized controlled trials were included in 855 patients, including 428 in the experimental group and 427 in the control group, with a ratio of 1:1. The results of the meta-analysis showed that the overall effective rate of the experimental group [RR=1.22, 95%CI(1.15, 1.29), P<0.00001], visual analogue pain (VAS) score [MD=1.59, 95%CI(1.22, 1.95), P<0.00001], Japanese Orthopaedic Association evaluation treatment score(JOA)[MD=5.66, 95%CI (2.58, 8.74), P=0.0003], the incidence of adverse hair loss [RR=0.35, 95%CI(0.18, 0.71), P=0.003]were significantly better than the control group, the difference was statistically significant. Conclusions Acupuncture has obvious advantages in the treatment of residual pain after lumbar disc herniation, which can significantly relieve postoperative pain and improve quality of life. However, the conclusions of this study need to be further verified by the large sample and high quality literature.