Isthmic spondylolisthesis: Interpretation of NASS guidelines for evidence-based medicine

Isthmic spondylolisthesis in adults is a common clinical disease that causes lower back pain. In order to provide the best and effective diagnosis and treatment plan, in 2014, the North American Spine Association (NASS) formulated the guidelines for the diagnosis and treatment of isthmic spondylolisthesis in adult (hereinafter referred to as the guideline). Through the systematic review of literature, evidence-based medical evidence analysis was conducted to identify different recommended intensities, to discuss the clinical diagnosis and treatment plan mainly from two aspects of diagnosis and treatment. This article gives a brief explanation of the guidelines and discusses them in combination with the clinical practice in China, so as to provide a reference for clinicians.

Research progress on therapeutic mechanism of spinal diseases caused by nerve root compression

Manipulation of traditional Chinese medicine(TCM), which has been proved effective in clinical already, has been used widely in clinical treatment as a significant method to treat the Orthopedics degenerative diseases. At present, plenty of researches on intervention mechanism of manipulation have been carried out, but it has not been completely elucidated. This paper attempts to sort out relevant articles about manipulation therapy of the spinal disease caused by nerve root compressed systematically and classify and expound some confirmed mechanism of these therapy, so as to help other clinical doctors when they select the treatment plan and promote the standardization process of manipulation therapy.

An overview of the latest international guidelines on evidence-based knee osteoarthritis

Knee osteoarthritis(KOA)is the highest incidence of osteoarthritis,which seriously affects the quality of life of patients.In order to update the understanding of the disease,clear diagnostic criteria and appropriate treatment were proposed.In 2018 and 2019,the European Society for Clinical and Economic Aspects of Osteoporosis,Osteoarthritis and Musculoskeletal Diseases(ESCEO),the Association of the Scientific Medical Societies in Germany(AWMF)and Brazil successively formulated guidelines for knee osteoarthritis,which determined different guidance suggestions through systematic evaluation of a large number of literatures and evidence-based medical evidence analysis.This paper compares and interprets the guidelines,and discusses them according to the actual situation of our country for the reference of clinicians.

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.

A Systematic Review and Meta-analysis for Duhuo Jisheng Decoction Combined with Manipulation in Treatment of Lumbar Disc Herniation

Objective:To systematically evaluate the efficacy and safety of Duhuo Jisheng decoction combined with manipulation in the treatment of lumbar disc herniation.Method:We systematically searched 8 databases at home and abroad.Literature quality of the included studies was evaluated by the bias risk assessment tool of Cochrane collaboration network,and the Meta-analysis was performed by RevMan 5.3 software.Result:A total of 427 related literature were retrieved,and 12 studies were eventually included,involving 1153 patients.All studies were in Chinese.Meta-analysis results showed that the total effective rate of Duhuo Jisheng decoction combined with manipulation in the treatment of LDH was better than that of the control group(RR=1.23,95%CI[1.17,1.29],P<0.00001).Subgroup analysis showed that Duhuo Jisheng decoction combined with manipulation had a more significant effect than conventional treatment(RR=1.34,95%CI[1.20,1.50],P<0.00001),nonsteroidal anti-inflammatory drugs(RR=1.24,95%CI[1.12,1.37],P<0.0001),and Yaotongning capsules(RR=1.19,95%CI[1.10,1.29],P<0.0001).It has obvious advantages in improving VAS scores(MD=-1.19,95%CI-1.19[-1.87,-0.51],P=0.0006),but it has no obvious advantages in improving JOA scores(MD=2.6595%CI[0.06,5.24],P=0.05).In terms of safety,Duhuo Jisheng decoction combined with manipulation treatment reported fewer adverse events.Conclusion:The Duhuo Jisheng decoction combined with manipulation treatment can effectively relieve the clinical symptoms of patients with lumbar disc herniation,with obvious clinical efficacy,and fewer adverse events.But in view of the limitations of clinical studies,there are some limitations in this study,and more studies with high quality of evidence are needed to further confirm its efficacy and safety.

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.

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.