Exploring the mechanism of Buyang Huanwu decoction in the treatment of lumbar disc herniation based on network pharmacology and molecular docking

Buyang Huanwu decoction (BYHWD), as one of the traditional Chinese medicine formulas, is widely used in the clinical treatment of lumbar disc herniation (LDH) with curative effect. It has the characteristics of multi-component, multi-target, and mutual synergy, but the mechanism of action is often unclear. It needs some research to explore the molecular mechanism of BYHWD in the treatment of LDH based on network pharmacology and molecular docking. Screen the active compounds of BYHWD and predict drug-related gene/protein targets, which could determine the specific target of BYHWD in the treatment of LDH. Construct the “Drugs-Compounds-Targets” network and search for the core targets. Use Gene Ontology functional enrichment analysis, Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis, and molecular docking verification to explore the possible molecular mechanism. Eighty-two effective compounds and 666 targets of BYHWD, 187 targets for LDH treatment, and 20 core candidate targets were excavated. A total of 3414 entries were identified by Gene Ontology enrichment analysis, 173 related signal pathways were identified by Kyoto Encyclopedia of Genes and Genomes enrichment analysis, and 5 core compounds were identified by molecular docking, which had a good affinity with core genes STAT3, JUN, AKT1, MAPK1, RELA, and PIK3CA. BYHWD may play the role of analgesic and improving function by synergistic anti-inflammatory and analgesic compounds, regulating cell metabolic differentiation, regulating immunity, and anticoagulation. BYHWD in the treatment of LDH may play a role in analgesia and improve function through multiple signaling pathways, including PI3K-Akt, mitogen-activated protein kinase, tumor necrosis factor, and interleukin-17. The PI3K-Akt signaling may be one of the key mechanisms.     

经方治疗腰椎间盘突出症临床研究

本文阐述了经方治疗腰椎间盘突出症的临床特点,针对病因病机,用辛热辛温药物,如肉桂、细辛、地龙、当归、川芎、牛膝、桃仁、红花等,以补助阳气,驱除寒邪,温通经络,养血活血,化瘀止痛,用药规律,疗效独特。     

Full-Endoscopic versus Minimally Invasive Lumbar Interbody Fusion for Lumbar Degenerative Diseases : A Systematic Review and Meta-Analysis

ObjectiveAlthough full-endoscopic lumbar interbody fusion (Endo-LIF) has been tried as the latest alternative technique to minimally invasive transforaminal lumbar interobody fusion (MIS-TLIF) since mid-2010, the evidence is still lacking. We compared the clinical outcome and safety of Endo-LIF to MIS-TLIF for lumbar degenerative disease. MethodsWe systematically searched electronic databases, including PubMed, EMBASE, and Cochrane Library to find literature comparing Endo-LIF to MIS-TLIF. The results retrieved were last updated on December 11, 2020. The perioperative outcome included the operation time, blood loss, complication, and hospital stay. The clinical outcomes included Visual analog scale (VAS) of low back pain and leg pain and Oswestry disability index (ODI), and the radiological outcome included pseudoarthosis rate with 12-month minimum follow-up. ResultsFour retrospective observational studies and one prospective observational study comprising 423 patients (183 Endo-LIF and 241 MIS-TLIF) were included, and the pooled data analysis revealed low heterogeneity between studies in our review. Baseline characteristics including age and sex were not different between the two groups. Operation time was significantly longer in Endo-LIF (mean difference [MD], 23.220 minutes; 95% confidence interval [CI], 10.669–35.771; p=0.001). However, Endo-LIF resulted in less perioperative blood loss (MD, -144.710 mL; 95% CI, 247.941–41.478; p=0.023). Although VAS back pain at final (MD, -0.120; p=0.586), leg pain within 2 weeks (MD, 0.005; p=0.293), VAS leg pain at final (MD, 0.099; p=0.099), ODI at final (MD, 0.141; p=0.093) were not different, VAS back pain within 2 weeks was more favorable in the Endo-LIF (MD, -1.538; 95% CI, -2.044 to -1.032; p<0.001). On the other hand, no statistically significant group difference in complication rate (relative risk [RR], 0.709; p=0.774), hospital stay (MD, -2.399; p=0.151), and pseudoarthrosis rate (RR, 1.284; p=0.736) were found. ConclusionRelative to MIS-TLIF, immediate outcomes were favorable in Endo-LIF in terms of blood loss and immediate VAS back pain, although complication rate, mid-term clinical outcomes, and fusion rate were not different. However, the challenges for Endo-LIF include longer operation time which means a difficult learning curve and limited surgical indication which means patient selection bias. Larger-scale, well-designed study with long-term follow-up and randomized controlled trials are needed to confirm and update the results of this systematic review.     

Vertical split fracture of the vertebral body following oblique lumbar interbody fusion: A case report

Rationale:Oblique lumbar interbody fusion (OLIF) is an effective and safe surgical technique widely used for treating spondylolisthesis; however, its use is controversial because of several associated complications, including endplate injury. We report a rare vertebral body fracture following OLIF in a patient with poor bone quality.Patient concerns:A 72-year-old male patient visited our clinic for 2 years with lower back pain, leg radiating pain, and intermittent neurogenic claudication.Diagnoses:Lumbar magnetic resonance imaging revealed L4-5 stenosis.Intervention:We performed OLIF with percutaneous pedicle screw fixation and L4 subtotal decompressive laminectomy. We resected the anterior longitudinal ligament partially for anterior column release and inserted a huge cage to maximize segmental lordosis. No complications during and after the operation were observed. Further, the radiating pain and back pain improved, and the patient was discharged. Two weeks after the operation, the patient visited the outpatient department complaining of sudden recurred pain, which occurred while going to the bathroom. Radiography and computed tomography revealed a split fracture of the L5 body and an anterior cage displacement. In revision of OLIF, we removed the dislocated cage and filled the bone cement between the anterior longitudinal ligament and empty disc space. Further, we performed posterior lumbar interbody fusion L4-5, and the screw was extended to S1.Outcomes:After the second surgery, back pain and radiating pain in the left leg improved, and he was discharged without complications.Lesson:In this case, owing to insufficient intervertebral space during L4-5 OLIF, a huge cage was used to achieve sufficient segmental lordosis after anterior column release, but a vertebral body coronal fracture occurred. In patients with poor bone quality and less flexibility, a huge cage and over-distraction could cause a vertebral fracture; hence, selecting an appropriate cage or considering a posterior approach is recommended.     

椎间盘镜下手术治疗椎间盘突出症临床研究

目的探讨显微内镜椎间盘摘术治疗腰椎间盘突出症的疗效。方法回顾性分析50例经MED治疗腰椎间盘突出症效果。结果 50例完成镜下操作,随访6个月～6年,优32例,良11例;术中出血40～150ml,平均80ml。结论 MED具有手术切口小、创伤小、出血少、神经根减压彻底、不影响脊柱稳定性、术后恢复快等优点。     

原发性慢性闭角型青光眼与正常眼HRT-Ⅱ视盘形态结构的对比研究

目的 比较慢性闭角型青光眼（chronic angle-closure glaucoma,CACG）和正常眼视盘形态结构参数之间的差异,评价HRT-Ⅱ在原发性慢性闭角型青光眼早期诊断中的意义方法 用Heidelberg视网膜断层扫描仪（Heidelberg retina tomograph,HRT）对早期、进展期CACG 36例（60只眼）及正常人30例（60只眼）的视盘进行断层扫描,获得视盘平均地形图像和视盘结构诸参数.结果 CACG与正常人视盘结构各参数中视杯面积、杯盘面积比、盘沿面积、视杯容积、盘沿容积、视杯形态测量、平均视神经纤维层厚度及视神经纤维层横截面积存在明显差异.结论 HRT-Ⅱ能够反映慢性闭角型青光眼视盘改变,为临床早期诊断CACG提供依据.     

Optic Disc Cupping in Arteritic Anterior Ischemic Optic Neuropathy Resembles Glaucomatous Cupping

Five cases of anterior ischemic optic neuropathy secondary to biopsy-proven giant cell arteritis are presented. In each case, cupping of the optic disc, which closely resembled glaucomatous cupping, was observed in the affected eye. The presence of glaucoma was ruled out on the basis of normal intraocular pressures and normal tonographic measurements of facility of outflow. These cases indicate that arteritic ischemic optic neuropathy can result in optic disc cupping, which closely resembles glaucomatous cupping. The similarities in the appearance of cupping of these discs with that seen in eyes with glaucoma suggest that the pathogenesis of cupping in glaucoma and in arteritic ischemic optic neuropathy may share some common mechanisms.     

天灸治疗腰椎退行性骨关节炎30例

目的观察天灸治疗腰椎退行性骨关节炎的疗效。方法将60例腰椎退行性骨关节炎患者随机分为治疗组和对照组,分别采用天灸疗法或假天灸疗法。观察治疗前后Oswestry功能障碍指数(Oswestrydisability index,ODI)、视觉模拟评分(visual analogue scale,VAS)。结果治疗组在降低ODI和VAS方面显著优于对照组(P0.01)。结论天灸能改善腰椎退行性骨关节炎的功能障碍及缓解疼痛,简便易行。     

后路椎间融合器结合新型椎弓根钉系统治疗腰椎滑脱症

目的 探讨纯钛多孔涂层后路椎间融合器结合新型椎弓根钉系统对腰椎滑脱症的治疗效果。方法 33例腰椎滑脱症病人,采用后路全椎板切除减压、纯钛多孔涂层后路椎间融合器行椎间融合、新型椎弓根钉系统内固定治疗。结果 33例术后均随访,时间6~36个月,平均18.6个月。本组患者术后无神经损伤和切口感染,动态摄片观察无融合器移位、椎弓根螺钉松脱、断裂等并发症。按Brantigan评价标准评定结果:优21例、良10例、可2例、差0例。结论 纯钛多孔涂层后路椎间融合器结合新型椎弓根钉系统治疗腰椎滑脱症,具有椎管减压充分、椎体复位好、术后能立即改善疼痛症状、立即稳定椎体、病人可早期下床等优点,是一种治疗腰椎滑脱症较理想的方法。