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.

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.

Liver metastasis from hepatoid adenocarcinoma of the stomach mimicking hepatocellular carcinoma: Dynamic computed tomography findings

AIM: To evaluate the dynamic computed tomography(CT) findings of liver metastasis from hepatoid adenocarcinoma of the stomach(HAS) and compared them with hepatocellular carcinoma(HCC).METHODS: Between January 2000 and January 2015, 8 patients with pathologically proven HAS and liver metastases were enrolled. Basic tumor status was evaluated for the primary tumor location and metastatic sites. The CT findings of the liver metastases were analyzed for tumor number and size, presence of tumor necrosis, hemorrhage, venous tumor thrombosis, and dynamic enhancing pattern.RESULTS: The body and antrum were the most common site for primary HAS(n = 7), and observed metastatic sites included the liver(n = 8), lymph nodes(n = 7), peritoneum(n = 4), and lung(n = 2). Most of the liver metastases exhibited tumor necrosis regardless of tumor size. By contrast, tumor hemorrhage was observed only in liver lesions larger than 5 cm(n = 4). Three patterns of venous tumor thrombosis were identified: direct venous invasion by the primary HAS(n = 1), direct venous invasion by the liver metastases(n = 7), and isolated portal vein tumor thrombosis(n = 2). Dynamic CT revealed arterial hyperattenuation and late phase washout in all the liver metastases.CONCLUSION: On dynamic CT, liver metastasis from HAS shared many imaging similarities with HCC. For liver nodules, the presence of isolated portal vein tumor thrombosis and a tendency for tumor necrosis are imaging clues that suggest the diagnosis of HAS.