Impact of computed tomography/magnetic resonance imaging registration on rehabilitation after percutaneous endoscopic decompression for lumbar stenosis: Retrospective study

BACKGROUND Percutaneous endoscopic lumbar decompression(PELD)shows promise for lumbar spinal stenosis(LSS)treatment,but its use is limited by the disease's complexity and procedural challenges.AIM In this study,the effects of preoperative planning and intraoperative guidance with computed tomography(CT)/magnetic resonance imaging(MRI)registration techniques on PELD for LSS and postoperative rehabilitation outcomes were evaluated.METHODS This retrospective study was conducted with data from patients who underwent PELD for LSS between January 2021 and December 2023.Patients were assigned to preoperative CT/MRI registration and control groups.Data collected included the operative time,length of hospital stay,visual analog scale(VAS)scores for low back and leg pain,and the Japanese Orthopaedic Association(JOA)lumbar spine score.Differences between groups were assessed using Student’s t test.RESULTS Data from 135 patients(71 in the CT/MRI registration group,64 in the control group)were analyzed.The operative time was significantly shorter in the CT/MRI registration group(P=0.007).At 2 months postoperatively,both groups showed significant reductions in VAS leg and low back pain scores(all P<0.001)and improvements in the JOA score(both P<0.001).No complication or death occurred.Preoperatively,pain and JOA scores were similar between groups(P=0.830,P=0.470,and P=0.287,respectively).At 2 months postoperatively,patients in the CT/MRI registration group reported lower leg and low back pain levels(P<0.001 and P=0.001,respectively)and had higher JOA scores(P=0.004)than did patients in the control group.CONCLUSION Preoperative CT/MRI registration for PELD for LSS reduced the operative time and VAS pain scores at 2 months and improved JOA scores,demonstrating enhanced effectiveness and safety.

Simulation of crowd dynamics in pedestrian evacuation concerning panic contagion:A cellular automaton approach

The study of the panic evacuation process is of great significance to emergency management.Panic not only causes negative emotions such as irritability and anxiety,but also affects the pedestrians decision-making process,thereby inducing the abnormal crowd behavior.Prompted by the epidemiological SIR model,an extended floor field cellular automaton model was proposed to investigate the pedestrian dynamics under the threat of hazard resulting from the panic contagion.In the model,the conception of panic transmission status(PTS)was put forward to describe pedestrians’behavior who could transmit panic emotions to others.The model also indicated the pedestrian movement was governed by the static and hazard threat floor field.Then rules that panic could influence decision-making process were set up based on the floor field theory.The simulation results show that the stronger the pedestrian panic,the more sensitive pedestrians are to hazards,and the less able to rationally find safe exits.However,when the crowd density is high,the panic contagion has a less impact on the evacuation process of pedestrians.It is also found that when the hazard position is closer to the exit,the panic will propagate for a longer time and have a greater impact on the evacuation.The results also suggest that as the extent of pedestrian’s familiarity with the environment increases,pedestrians spend less time to escape from the room and are less sensitive to the hazard.In addition,it is essential to point out that,compared with the impact of panic contagion,the pedestrian’s familiarity with environment has a more significant influence on the evacuation.

The Denver Tube Combined with Antiviral Drugs In the Treatment of HBV-related Cirrhosis with Refractory Ascites: A Report of Three Cases

Treatment of nucleos(t)ide antiviral drugs for decompensated HBV-related cirrhosis can significantly improve the prognosis. But those patients with refractory ascites possibly deteriorate due to the complications of ascites before any benefit from anti-viral drugs could be observed. Therefore, it is important to find a way to help the patients with HBV-related cirrhosis and refractory ascites to receive the full benefits from antiviral therapy. Peritoneovenous shunt(PVS) using Denver tube enables ascites to continuously bypass into systemic circulation, thereby reducing ascites and albumin input and improving quality of life. We report herein 3 cases of decompensated HBV-related cirrhosis with refractory ascites, PVS using Denver tube was combined with lamivudine for antiviral treatment before and after. Then, ascites was alleviated significantly or disapeared and viral responsed well. All patients achieved a satisfactory long-term survival from 6.7 to 14.7 years. It was suggested that the Denver shunt could be used as an adjuvant method to antiviral drugs for decompensated HBV-related cirrhosis with refractory ascites to help the patients reap the full benefits and maximize efficacy of antiviral treatment.

Anti-cyclic citrullinated peptide antibody predicts the development of rheumatoid arthritis in patients with undifferentiated arthritis

Background:Clinical outcomes of undifferentiated arthritis(UA)are diverse,and only 40%of patients with UA develop rheumatoid arthritis(RA)after 3 years.Discovering predictive markers at disease onset for further intervention is critical.Therefore,our objective was to analyze the clinical outcomes of UA and ascertain the predictors for RA development.Methods:We performed a prospective,multi-center study from January 2013 to October 2016 among Chinese patients diagnosed with UA in 22 tertiary-care hospitals.Clinical and serological parameters were obtained at recruitment.Follow-up was undertaken in all patients every 12 weeks for 2 years.Predictive factors of disease progression were identified using multivariate Cox proportional hazards regression.Results:A total of 234 patients were recruited in this study,and 17(7.3%)patients failed to follow up during the study.Among the 217 patients who completed the study,83(38.2%)patients went into remission.UA patients who developed RA had a higher rheumatoid factor(RF)-positivity(42.9%vs.16.8%,χ^2=8.228,P=0.008),anti-cyclic citrullinated peptide(CCP)antibodypositivity(66.7%vs.10.7%,χ^2=43.897,P<0.001),and double-positivity rate of RF and anti-CCP antibody(38.1%vs.4.1%,χ^2=32.131,P<0.001)than those who did not.Anti-CCP antibody but not RF was an independent predictor for RA development(hazard ratio 18.017,95%confidence interval:5.803–55.938;P<0.001).Conclusion:As an independent predictor of RA,anti-CCP antibody should be tested at disease onset in all patients with UA.

Infliximab treatment in two Chinese patients with psoriatic arthritis

Psoriatic arthritis(PsA) is a rheumatoid factor(RF)-seronegative systemic inflammatory disorder associated with psoriasis.Current treatment for PsA in China is still focused on disease modifying anti-rheumatic drugs(DMARDs).In this paper,we report two Chinese patients with active longstanding PsA treated with infliximab,a human-mouse chimeric monoclonal antibody against tumor necrosis factor alpha(TNF-α).The results show that infliximab acted quickly and effectively in relieving peripheral and axial symptoms and refractory skin lesions,even in recombinant human TNF-α receptor(rhTNFR)-resistant case.The take-home message from our cases is that infliximab is a useful therapeutic option for refractory PsA,especially when a patient has a combination of psoriasis and psoriatic arthritis.Further local evidence and experience must be accumulated in order to make anti-TNF-α therapy more accessible to PsA patients in China.