Volume 100 ·  Issue 04 ·  2020

At the 18th academic conference of the Neurosurgery Branch of the Chinese Medical Association in 2019, the Neurosurgery Branch of the Chinese Medical Association innovatively put forward the concept of spine (column) and (spine) marrow win-win (referred to as spine and marrow win-win), focusing on promoting multidisciplinary cooperation, building a comprehensive, systematic and standardized treatment system, in line with the development trend of international neurosurgery, promoting the rapid development of disciplines, comprehensively improving the quality of spinal cord prevention and treatment, and fully demonstrating the determination and confidence of the Neurosurgery Society to vigorously promote the development of spinal cord discipline. There is a big gap between the development status of spinal cord of neurosurgery in China and the international neurosurgery, and the business volume and influence of spinal cord of orthopedics in China. Colleagues of spinal cord of neurosurgery in China should learn from their brother departments, catch up with the international advanced spinal cord of neurosurgery, strengthen discipline construction and talent training, strengthen scientific research innovation, highlight the concept of microscopic technology, neuroprotection and minimally invasive precision of neurosurgery, popularize the health knowledge of cervical spondylosis and low back pain, and strive to promote the development of the discipline.

As an important component of minimally invasive spinal surgery technology, channel technology includes microscopy (microscope) under percutaneous channel, endoscopy technology and microchannel robot technology under development. These channel spinal surgery techniques have their own advantages and disadvantages. Microscopy and endoscopy techniques learn from each other's strengths and weaknesses, and even the "dual-scope combination" technique can be applied to treat complex disc herniation, spinal stenosis and tumors inside and outside the spinal canal. Channel spinal surgery technology will be a trend and trend. Doctors in neurosurgery, orthopedics and pain departments should abandon their stereotypes, bravely face challenges, actively master all kinds of new knowledge and technologies, and work together for the benefit of spinal cord patients.

Diabetic nephropathy (DKD), one of the common chronic complications in diabetic patients, refers to chronic kidney disease (CKD) caused by diabetes and manifests as elevated urinary protein levels (urinary albumin-creatinine ratio ≥30 mg/g) and/or estimated glomerular filtration rate (eGFR)<60 ml·min^-1· (1.73 m²）^-1And continued for more than 3 months, while excluding the clinical diagnosis of other etiologic CKD. A large-sample cohort study of diabetes in Europe and America reported that 20% ~40% of diabetic patients can develop DKD^[1,2]。 China lacks a national representative diabetes cohort, and the prevalence of DKD reported by some regional studies is similar to that of European and American countries^[3,4,5]。 Globally, DKD is the leading cause of CKD, including end-stage kidney disease (ESKD), and an important risk factor for cardiovascular disease and early mortality in diabetic patients^[6,7]。

To analysis of the efficacy of tubular paraspinal approach and conventional semi-laminar approach in treating lumbar stenosis.

Retrospective research of clinical data of 56 lumbar stenosis cases who were operated in neurosurgery department of first center of PLA general hospital from May 2015 to June 2018. Collecting the information of sex, age, operating time, intraoperative blood loss, postoperative duration in bed, as well as length of hospital stay of those patients. The 2 groups of cases, tubular paraspinal approach group (n=35)and semi-laminal approachgroup (n=21), compared by Japanese orthopedic association (JOA) score and visual analogue scale to assess the functional situation of the patients before operation, 1 week after operation, 1 month after operation, 6 months after operation, and the last follow up.

The operating time(83.1±7.3 vs 86.1±9.6 min), intraoperative blood loss(18.2±3.9 vs 40.5±13.3 ml), postoperative duration in bed(37.4±7.8 vs 63.7±15.8 h), as well as length of hospital stay (3.8±1.1 vs 6.5±2.0 d)were all obviously better in tubular paraspinal approach group than in traditional semi-laminar approach group(P<0.05). The postoperative 1 week, 1month, and 6 months JOA score (21.8±3.4, 23.6±2.4, 24.2±2.4 vs 19.9±3.7, 21.6±2.8, 22.4±2.1)and VAS (2.2±1.0, 2.0±1.1, 0.4±0.1 vs 3.1±1.2, 2.6±1.3, 0.5±0.1) were better in tubular paraspinal approach group than semi-laminar approach group (P<0.05). While at the last follow up, the JOA score and VAS were similar in the 2 groups (P>0.05) .

In non-fusion techniques for treating lumbar stenosis, tubular paraspinal approach demonstrated less blood loss, shorter stay in bed as well as in hospital, and better symptom relief in early postoperative period than traditional semi-laminal approach. While at long term follow up, both approaches achieved satisfactory outcome.

To compare and analyze the effect of minimally invasive surgery and traditional open surgery in patients with spinal canal tumors, including intraspinal and extraspinal communication tumors.

From 2017 to 2019, 31 patients (minimally invasive channel group) were included in the neurosurgery department of Huashan Hospital Affiliated to Fudan University, and 38 patients (open operation group) were selected as the control group. From the aspects of intraoperative condition, operative effect, postoperative muscle injury, postoperative complications, postoperative spinal stability, the minimally invasive access group and the open operation group were compared and analyzed.

The bleeding volume (70.2 ml±4.9 ml), operation time (164.7 min±16.0 min) and hospitalization days (9.5±2.5) in the minimally invasive access group were significantly lower than those in the open operation group (P<0.001). The creatine kinase CK (363.9 U/L±51.6 U/L) in the minimally invasive group was significantly lower than that in the open group (514.2 U/L±68.3 U/L) (P<0.001). According to Panjabi standard, the effect of spinal cord stability in minimally invasive group was significantly lower than that in open operation group (P<0.001), and the symptom improvement rate in minimally invasive group was significantly higher than that in open hand group (P<0.05).

Compared with the open surgery, the amount of bleeding, the length of incision, the time of operation and the days of hospitalization were significantly shorter, the degree of muscle damage was also significantly reduced, the incidence of complications was lower, the impact of spinal stability was smaller, and the overall advantage was obvious.

To evaluate the clinical results of percutaneous endoscopic transforaminal discectomy (PETD) for L5~S1 lumbar disc herniation (LDH).

One hundred and two cases of L5~S1 LDH from April 2016 to June 2018 were retrospectively analyzed, including 13 patients with high iliac crest. Pre-and postoperative pain was measured by Visual Analog Scale (VAS) and functional status was assessed by Oswestry Disability Index (ODI).

All the operations were successful and no severe complications occurred such as hemorrhages, infections, injury of nerves. The operation time was (87.6±21.0) min; the frequencies of intraoperative fluoroscopy were 29.1±11.7; the postoperative bedridden time was (4.6±1.1) hours and the hospital stay was (3.6±0.5) days. The mean VAS and ODI scores were significantly improved (P<0.01) postoperatively. The efficiency of 102 cases were excellent in 89 cases (87.3%), good in 8 cases (7.8%), fair in 4 cases (3.9%) and poor in 1 cases (1.0%). One patient (1.0%) relapsed at 6 months after surgery.

PETD is a safe and effective method for treatment of L5~S1 LDH. The "transverse process localization method" might be an effective technique for patient with high iliac crest and/or hypertrophic transverse process.

To explore the application, advantages and disadvantages of minimally invasive surgery for lumbar schwannoma.

this study was a prospective, non-randomized controlled study with a trial group (minimally invasive surgery group) and a control group (traditional laminectomy group).For the patients with lumbar schwannoma hospitalized in the neurosurgical spinal ward of Beijing Tian Tan hospital, the surgeon communicated with them one-on-one to inform the patients of the advantages and disadvantages of minimally invasive surgery through channels and traditional laminectomy. After the surgical risks and their respective advantages and disadvantages were identified, patients who underwent minimally invasive surgery to remove tumors through the channel were admitted to the channel surgery group according to the wishes of the patients; otherwise, patients who underwent traditional laminectomy were included in the control group. From December 2017 to March 2019, a total of 15 patients (experimental group) were treated with minimally invasive surgery. A total of 15 patients with tumors similar in size and location to those in the experimental group were selected from the control group who were hospitalized during the same period for traditional laminectomy. Relevant clinical data of the two groups of patients were collected and analyzed, including preoperative lesion imaging characteristics, intraoperative blood loss, operation time, postoperative hospital stay, postoperative complications, symptom improvement, etc.

the operating time of the experimental group and the control group was (157±27) min and (158±29) min, respectively (P=0.897). Intraoperative blood loss was (66±27) ml and (110±43) ml, respectively (P=0.020). The mean hospital stay was (7.60±1.29) days and (11.67±1.23) days, respectively (P=0.000). Postoperative JOA scores were 26.73±2.84 and 26.60±2.41, respectively (P=0.891). Postoperative VAS scores were 0.40±1.12 and 0.27±0.71, respectively (P=0.699).The mean blood loss and hospital stay in the experimental group were significantly lower than those in the control group, the difference in operation time between the two groups was not significant, and there was no difference in neurological function results.

In certain types of lumbar schwannoma tumors (non-giant tumors), minimally invasive resection through channels has the advantages of less surgical trauma, less bleeding, faster recovery and definite curative effect, which is a safe and effective surgical treatment.

To study the technical notes and clinical efficacy of full-endoscopic thoracic intervertebral discectomy via transforaminal approach.

We included 16 patients with thoracic disc herniation treated by full-endoscopic thoracic discectomy via transforaminal approach between January 2017 and September 2018 in ours department of orthopedics. The average age is 53.7 years. The compressionare classified by nature: 5 cases of soft thoracic disc herniation, 7 cases of calcified or ossified thoracic disc herniation, and 4 cases of osteophyte protrusion of the posterior edge of the adjacent vertebral body of the diseased disc. All patients had symptoms of thoracic myelopathy before operation, and 7 of them had radiculopathy. Via transforaminal approach under local anesthesia, enlarged foraminoplasty and full-endoscopic thoracic discectomy were used for treatment. Observe the changes of postoperative imaging, pain symptoms and recovery of spinal cord function at 1 week, 3 months, 6 months and 1 year after operation. Back pain and radicular pain were scored with VAS, neurological function was assessed with Nurick score and mJOA score, and thoracic spine function was assessed with Oswestry disability index (ODI).

All operations were successfully completed, and no intraoperative conversion of surgical methods occurred. Postoperative thoracic MRI and CT examinations of all patients showed that the spinal cord was fully decompressed without any residual compression. Back pain and radicular pain were all relieved obviously in all patients, and spinal cord function was obviously restored. Transient intercostal neuralgia occurred in 2 cases after operation, and no other surgical complications occurred.

Full-endoscopic or fluoroscopic foraminoplasty and full-endoscopic thoracic discectomyvia transforaminal approach under local anesthesia is a safe and effective treatment for soft and hard thoracic disc herniation located on the ventral side of the spinal cord.

To investigate the novel application and effectof Percutaneous Full-Endoscopic transforaminal approach for lumbar dumbbell tumors.

A retrospective analysis of 12 cases of lumbar dumbbell tumors was conducted by Percutaneous full-endoscopic transforaminal approach in the Department of Neurosurgery, Fujian Medical University Union Hospital from Feb, 2018 to Jul, 2019. According to Eden classification, 5 cases in type Ⅲ and 7 cases in type Ⅳ. The Japanese Orthopaedic Association (JOA) score and Pain Visual analogue Scale (VAS) were used to compare the recovery of neurological function before and after surgery.

All the 12 tumors were completely removed in one stage. The pathological reports were all schwannomas (WHO grade Ⅰ). The VAS scores were significantly decreased compared with preoperative ones (P<0.001). The JOA scores were significantly improved without obvious complications and spinal instability. Median length of follow-up was 14 months with a range of 4 months to 20 months, there is no tumor recurrence and spinal instability.

In the treatment of lumbar dumbbell spinal tumor, the full endoscopic transforaminal approach is a novel, safe and effective surgical procedure which removes the tumors intra-foramen and extra-foramen with less damage of spine, smaller possibility of instability and faster recovery.

To investigate the incidence and risk factors of lower extremities deep venous thrombosis (DVT) in patients with chronic refractory wounds (chronic wounds).

A retrospective analysis of 722 cases of chronic wounds admitted to the First People′s Hospital of Zhengzhou from January 1, 2015 to December 31, 2018 was carried out, and clinical data such as gender, age, wound involves the lower extremities, wound type, duration of wound, D-dimer level and complicated diabetes, hypertension, coronary heart disease, cerebral infarction, pneumonia and sepsis/septic shock were collected. The patients were divided into DVT group and non-DVT group according to the color ultrasound test. Multivariate binary logistic regression analysis was used to screen the independent risk factors of DVT in patients with chronic wounds.

There were 55 (7.6%) patients in DVT group, of which 44(80.0%) were diagnosed as chronic DVT by conventional lower extremities venous color ultrasound screening at admission, and the remaining 11(20.0%) were newly diagnosed during hospitalization. There were no significant differences in gender, wound involves the lower extremities, duration of wound, complicated diabetes and hypertension between DVT group and non-DVT group (all P>0.05); and the differences were statistically significant in age, wound type, D-dimer level, complicated coronary heart disease, cerebral infarction, pneumonia and sepsis/septic shock (all P<0.05). Multivariate binary logistic regression analysis showed age [OR=2.260 (95%CI: 1.584-3.224)], D-dimer level [OR=14.201 (95%CI: 6.101-33.055)], complicated coronary heart disease [OR=2.731 (95%CI: 1.210-6.162)] and sepsis/septic shock [OR=3.170 (95%CI: 1.115-9.016)] were independent risk factors for DVT (all P<0.05).

Chronic wounds patients have a higher incidence of DVT, most of which are chronic DVT, and age, D-dimer level, complicated coronary heart disease and sepsis/septic shock are independent risk factors for DVT in chronic wounds.

To investigate the immune function of myeloid-derived suppressor cells (MDSC) and its mechanism in obstructive sleep apnea syndrome (OSAS).

Twenty OSAS patients who were diagnosed by polysomnography (Apnea Hyponea Index>30 events/h) from Sleep Disorders Center at First Affiliated Hospital between January 2015 and December 2016 were selected. The percent of CD14⁺ low expression or lack of human leukocyte antigen DR (HLA-DR^-/low) MDSC in the CD14⁺ monocyte from both OSAS patients and healthy people were analyzed by flow cytometry. In vitro assay, MDSC from OSAS patients and health people were sorted by flow cytometry and T cells were sorted with negative isolation kit. For T-cell proliferation assays, the carboxyfluorescein diacetate succinimidyl ester (CFSE)-labeled T cells were respectively incubated with autologous MDSC. CFSE fluorescence intensity of T cells was detected by flow cytometry. Enzyme-linked immunosorbent assay (ELISA) and Western blot analysis were used to evaluate the concentrations of interleukin (IL)-6, tumor necrosis factor-α (TNF-α), IL-10, transforming growth factor-β₁ (TGF-β₁), positive rate of programmed death ligand-L1 (PD-L1), relative transcript level of Arginase 1 (Arg1), inducible nitric oxide synthase (iNOS), hypoxic inducible factor-1α (HIF-1α) expressed by MDSC.

Comparing to healthy people, the percentage of CD14⁺HLA-DR^-/low MDSC in CD14⁺ monocyte was significantly elevated [(12.5±1.5)% vs (3.5±0.4)%, P<0.05]. In vitro, OSAS patient-derived MDSC exhibited a stronger suppressive effect on T-cell proliferation [(23.2±1.1)% vs (53.7±3.2)%, P<0.05]. Further analysis revealed that OSAS patient-derived MDSC secreted much higher concentrations of IL-6, TNF-α, IL-10 and TGF-β₁ [(1 316±163) vs (642±72) ng/L, (316±35) vs (167±18) ng/L, (385±42) vs (108±26) ng/L and (44 276±4 589) vs (9 557±1 124) ng/L] (all P<0.05). The percentage of membrane molecule PD-L1-positive cells in OSAS patient-derived MDSC was obviously higher than that in healthy people-derived MDSC [(75.6±7.9)% vs (30.6±2.5)%, P<0.05]. Compared with healthy people-derived MDSC, the relative transcript level of Arg1, iNOS and HIF-1α in OSAS patient-derived MDSC was also increased by (4.6±0.5), (2.8±0.3) and (4.3±0.4) fold, respectively (allP<0.05).

OSAS may be capable of inducing the proliferation of MDSC and its expression of immunosuppressive molecules by activating HIF-1α signal, thereby enhancing the immunosuppressive ability of MDSC.

To investigate the clinicopathological characteristics, MSI and K-ras mutation of double primary malignancies (DPM) associated with colorectal cancer (CRC).

From January 2015 to December 2016, the clinicopathological data of CRC patients treated by surgery in the Affiliated Drum Tower Hospital of Nanjing University Medical School were collected, and the clinical data was analyzed. Multiplex real-time fluorescence quantitative PCR and amplification refractory mutation was performed to identify MSI and K-ras gene mutations.

Of all patients with CRC, 5.2% (55/1 066) were DPM. There was no significant difference in the male and female ratio, age, colorectal cancer site, T stage, N stage composition ratio between DPM patients with CRC and patients with single CRC (P>0.05). There were significant difference of TNM stage between the two group (P<0.05). The most frequent location of CRC was the colon in both DPM patients with CRC and patients with single CRC[35.5% (359/1 011) and 41.8% (23/55), respectively]. Of 55 DPM patients with CRC, 48 were metachronous DPM patients, 7 were synchronous DPM patients and 41 were colorectal cancer first. In extracolonic organ, digestive system (23/55) was the most commonly occurring system and stomach (11/55) was the most common lesion. DPM patients with CRC had higher incidence of MSI-H than patients with single CRC (P<0.05). There was no significant difference of K-ras gene mutation between DPM patients with CRC and patients with single CRC (P>0.05). MSI-H and K-ras mutation were present in only 2 patients of DPM patients with CRC.

The rectum is the most common lesion site in CRC patients. The stomach is the most common extracolonic organ of DPM patients with CRC. DPM patients with CRC has high risk of MSI-H, but no significant difference in the incidence of K-ras mutation.

Hyperthyroidism syndrome in pregnancy is closely related to hyperemesis gravidarum. Severe vomiting can lead to severe electrolyte disorder, hypovolemic shock, organ function damage, etc. In severe cases, it may induce hyperthyroidism crisis, thus endangering the life of pregnant women and fetuses. This paper discusses a case of early pregnant young woman with abnormal thyroid function, hyperemesis gravidarum, severe dehydration, severe electrolyte disorder, hyperthyroidism crisis and fetal arrest. It is suggested that the thyroid function should be screened in time for hyperemesis gravidarum, and the symptomatic and supportive treatment should be strengthened to prevent and treat serious complications.

This article reports a patient admitted to hospital after intraspinal hematoma evacuation due to "low back pain, weakness of lower limbs for 3 months, swelling and pain of testis for 2 months, swelling and pain of buttocks and both lower limbs for 1 month". It was finally diagnosed as idiopathic acquired coagulation factor VIII deficiency with epididymitis, and no new hematoma occurred after rituximab treatment.

This article reports the experience of treating a case of rectal duplication malformation and ectopic pancreas. The pelvic mass resection and partial rectal resection were performed under general anesthesia and laparoscopy. During the operation, the tumor was located between the rectum and the bladder, and the texture was tough. The lower part of the tumor was closely related to the rectum and could not be separated from the rectum. The rectum was cut about 2.0 cm below the tumor, and the tumor was completely dissociated. The tumor and proximal rectal stump were raised into the abdominal cavity, and the rectum was cut about 2.0 cm above the tumor.

The pathology of aplastic anemia shows that the red pulp with hematopoietic function gradually decreases, the bone marrow granules are empty, and the hematopoietic tissue is replaced by adipocytes. This process of bone marrow adipose tissue replacing hematopoietic tissue is called bone marrow adipotization. Bone marrow fat is an important component of hematopoietic microenvironment. Bone marrow fat and adipokines secreted by it have a biphasic effect of promoting/inhibiting hematopoiesis. Exploring the mechanism of bone marrow adipogenesis in aplastic anemia will help to understand the pathogenesis of bone marrow hematopoietic failure.

In recent years, the incidence of pulmonary cryptococcosis has increased year by year. It is the third major type of pulmonary mycosis after Candida and Aspergillus. It can occur in both normal and low immune function. Its clinical manifestations and imaging lack specificity, which easily leads to misdiagnosis and missed diagnosis. Deep understanding of its imaging features is helpful for early recognition and diagnosis. Pathogenic smear and culture, histopathological examination are the "gold standard" of diagnosis; The detection of serum cryptococcal capsular polysaccharide antigen has high rapid diagnostic value. Triazole antifungal drugs are the first choice for treatment, and sufficient dosage and sufficient course of treatment are required.