A systematic review and meta-analysis for Chinese herbal medicine Duhuo Jisheng decoction in treatment of lumbar disc herniation: A protocol for a systematic review

Clinical efficacy of exercise therapy for lumbar disc herniation: a systematic review and meta-analysis of randomized controlled trials

Background

Lumbar disc herniation (LDH) is mainly characterized by pain and neurological dysfunction resulting from rupture of the fibrous ring of the lumbar disc. The incidence of LDH is increasing year by year, mainly owing to long-term sitting and immobility, improper posture, and reduced physical activity during study and work. The incidence of LDH in young people aged 18-35 years has shown a significant upward trend. LDH is one of the most common causes of back pain, affecting approximately 1-3% of the global population, and it is mainly concentrated in people aged 30-50 years. Exercise therapy, as an economically effective treatment method, can enhance the strength of core muscle groups and effectively alleviate the symptoms of LDH. However, strong evidence that proves the effectiveness of exercise therapy for LDH is still lacking. We conducted a meta-analysis of relevant clinical studies and used statistical methods to scientifically explore the effectiveness of exercise therapy for LDH.

Methods

Four databases were searched, including PubMed, Embase, Web of Science, and Ovid. The search period ended on August 24, 2024. Comparisons were made between the group that used exercise therapy (treatment group) and the group that did not (control group). If heterogeneity among the studies was strong, sensitivity analysis was performed.

Results

Of the 580 articles initially identified, eight (encompassing 611 patients with LDH) were included in the analysis. The results of the meta-analysis demonstrated that the treatment group exhibited superior outcomes in terms of Visual Analog Scale score, Oswestry Disability Index, range of motion, McSensory score, McTotal score, and Short Form-36 score compared with the control group.

Conclusion

Exercise therapy is an economical, effective, and simple adjuvant therapy for patients with LDH. Exercise therapy enhances core muscle strength and lumbar stability, relieves lower back and leg pain, and improves patients' quality of life. However, no consensus on the use of exercise therapy for LDH currently exists, and there are no specific recommendations for exercise intensity, frequency, and activity that are suitable for patients with LDH. More high-quality clinical studies are needed to validate the application of exercise therapy as a treatment for LDH.

Systematic Review Registration

The protocol was registered on PROSPERO (CRD42024586775).

Integrated metagenomic and metabonomic mechanisms for the therapeutic effects of Duhuo Jisheng decoction on intervertebral disc degeneration

Intervertebral disc degeneration (IVDD) is a prevalent orthopedic condition with lower back pain as the predominant clinical presentation that challenges clinical treatment with few therapeutic options. Duhuo Jisheng Decoction (DHJSD) has been proven effective in the therapy of IVDD, but the precise underlying mechanisms remain not fully elucidated. The current study was designed to test our hypothesis that DHJSD may systematically correct the phenotypic disruption of the gut microbiota and changes in the serum metabolome linked to IVDD. Analysis of the active ingredients of DHJSD by ultra high performance liquid chromatography. An integrated metagenomic and metabonomic approach was used to analyze feces and blood samples from normal and IVDD rats. Compared to the control group, fiber ring pinning on the caudal 3 to caudal 5 segments of the rats caused IVDD and significantly altered the compositions of the intestinal microbiota and serum metabolites. Integrated analysis revealed commonly-altered metabolic pathways shared by both intestinal microbiota and serum metabolome of the IVDD rats. DHJSD inhibited the degenerative process and restored the compositions of the perturbed gut microbiota, particularly the relative abundance of commensal microbes of the Prevotellaceae family. DHJSD also corrected the altered metabolic pathways involved in the metabolism of glycine, serine, threonine, valine, the citric acid cycle, and biosynthesis of leucine and isoleucine. DHJSD inhibited the disc degeneration process by an integrated metagenomic and metabonomic mechanism to restore the microbiome profile and normalize the metabonomic pathways.

Early efficacy of postoperative rehabilitation training for lumbar disc herniation

OBJECTIVE

To investigate the early clinical efficacy of rehabilitation training after unilateral biportal endoscopy for lumbar disc herniation and to analyze the prognostic factors.

METHODS

A total of 100 patients with lumbar disc herniation who underwent unilateral biportal endoscopy at The Sixth Affiliated Hospital of Nantong University from January 2019 to January 2021 were retrospectively analyzed. The control group was given a standard home-based exercise program, while the intervention group was given a substituted rehabilitation training opposed to a standard home-based exercise program. The early postoperative pain relief and quality of life values were compared between the two groups, and the independent risk factors affecting the prognosis of patients were analyzed.

RESULTS

There were no significant differences in sex, age, smoking, drinking, BMI, course of disease, type of disc herniation, preoperative VAS, ODI or SF-36 between the two groups (P > 0.05). There was no significant difference in preoperative and postoperative VAS and ODI scores at 3 months between the two groups (P > 0.05), yet there were significant differences in postoperative VAS and ODI at 12 months (P < 0.05). The SF-36 score of the intervention group was lower than that of the control group at 12 months, and the difference was statistically significant (P < 0.05). The excellent rate of the Macnab standard modification used in the intervention group was 88.00% at 12 months, and that in the control group was 62.00%. The difference between the two groups was considered to indicate a statistically significant (P < 0.05). The results of logistic multivariate regression model analysis showed that rehabilitation training (95% CI: 1.360-12.122, P = 0.012), the type of intervertebral disc (95% CI: 0.010-0.676, P = 0.020), and age (95% CI: 1.056-8.244, P = 0.039) were independent risk factors affecting the prognosis of patients.

CONCLUSION

Postoperative rehabilitation training can effectively relieve pain and improve quality of life; thus, it is highly recommended in the clinic. Postoperative rehabilitation training, intervertebral disc type and age are independent risk factors for the postoperative prognosis of lumbar intervertebral disc herniation.

A Study Based on Network Pharmacology Decoding the Multi-Target Mechanism of Duhuo Jisheng Decoction for the Treatment of Intervertebral Disc Degeneration

Intervertebral disc degeneration (IDD) poses a grim public health impact. Duhuo Jisheng Decoction (DJD), a traditional Chinese medicine formula, has recently received significant attention for its efficacy and safety in treating IDD. However, the pathological processes of IDD in which DJD interferes and molecular mechanism involved are poorly understood, which brings difficulties to the clinical practice of DJD for the treatment of IDD. This study systematically investigated the underlying mechanism of DJD treatment of IDD. Network pharmacology approaches were employed, integrating molecular docking and random walk with restart (RWR) algorithm, to identify key compounds and targets for DJD in the treatment of IDD. Bioinformatics approaches were used to further explore the biological insights in DJD treatment of IDD. The analysis identifies AKT1, PIK3R1, CHUK, ALB, TP53, MYC, NR3C1, IL1B, ERBB2, CAV1, CTNNB1, AR, IGF2, and ESR1 as key targets. Responses to mechanical stress, oxidative stress, cellular inflammatory responses, autophagy, and apoptosis are identified as the critical biological processes involved in DJD treatment of IDD. The regulation of DJD targets in extracellular matrix components, ion channel regulation, transcriptional regulation, synthesis and metabolic regulation of reactive oxygen products in the respiratory chain and mitochondria, fatty acid oxidation, the metabolism of Arachidonic acid, and regulation of Rho and Ras protein activation are found to be potential mechanisms in disc tissue response to mechanical stress and oxidative stress. MAPK, PI3K/AKT, and NF-κB signaling pathways are identified as vital signaling pathways for DJD to treat IDD. Quercetin and Kaempferol are assigned a central position in the treatment of IDD. This study contributes to a more comprehensive understanding of the mechanism of DJD in treating IDD. It provides a reference for applying natural products to delay the pathological process of IDD.

Study on Anti-Inflammatory Mechanism of Angelica pubescens Based on Network Pharmacology and Molecular Docking

References and data show that AP has a certain effect on alleviating inflammation. Based on the methods of network pharmacology and molecular docking, this paper predicts the potential mechanism of anti-inflammatory effect of the effective components. Methods: Active components and target genes of AP were screened out by SymMap, an associated database of TCM syndromes. First, screen out the active components according to the setting conditions, and its molecular structure file was obtained from the PubChem database. The target genes of anti-inflammatory effect were obtained from GeneCards database with “anti-inflammation effect” as the keyword, and then the common gene targets between AP and anti-inflammatory effect were screened. The PPI network diagram was constructed with Cytoscape 3.80 software to screen the core genes. The GO function and KEGG pathway of the core genes were enriched and analyzed by David database; 3D view of proteins encoded by the core gene from the PDB database, conduct molecular docking between the active components and the core proteins in Auto Dock Vina software, and made a heat map with binding free energy. Results: The main anti-inflammatory components were O-Acetylcolumbianetin, isoindigo, Nodakenetin, Marmesin, Diphencyprone; The core targets are TNF, VEGFA, IL6, TP53, IL1B, ESR1, MMP9, PPARG, Jun, CASP3, PTGS2. AP participated in cytokine-mediated signaling pathway, response to drug, positive regulation of gene expression, and other processes by regulating the combination of extracellular space, cell surface with protein and enzyme, and then exert anti-inflammatory activity. The signal pathways mainly involved IL-17 signaling pathway, hepatitis B, TNF signaling pathway, inflammatory bowel disease, rheumatoid arthritis, etc.; Through molecular docking, it was found that the key targets were MMP9, TNF, PTGS2, ESR1, JUN, and PPARG, while the active components which ha,d a strong effect on these genes were O-Acetylcolumbianetin, isoindigo, Nodakenetin, Marmesin, Diphencyprone. Conclusion: This study used network pharmacology and molecular docking methods to predict the potential active components, target genes, and signal pathways of the anti-inflammatory effect of AP, so as to provide a theoretical reference for the follow-up experimental research and clinical treatment of AP.

Discussion on the molecular mechanism of Duhuo Jisheng decoction in treating osteoarthritis based on network pharmacology and molecular docking

In this study, network pharmacology and molecular docking technology were used to explore the molecular mechanisms of the Duhuo Jisheng decoction in the treatment of osteoarthritis (OA). The chemical composition of the prescriptions was obtained from the traditional Chinese medicine systems pharmacology database and analysis platform (TCMSP) database and the retrieved literature. Targets for the active ingredients were obtained using TCMSP and the Swiss Target Prediction Database. Disease targets were obtained from GeneCards and DisGeNET databases. The online tool, Venny, was used to obtain common targets for drugs and diseases. Protein-protein interactions (PPI) between common targets were analyzed using the search tool for the retrieval of interacting genes/proteins (STRING) database. Common targets were analyzed for gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment using the database for annotation, visualization and integrated discovery (DAVID) database. Molecular docking of the first 10 targets and first 10 components was verified using AutoDock Tools software, and the docking diagram was visualized using PyMOL software. After screening, 210 chemical components of the Duhuo Jisheng decoction (DHJSD) were identified. The 253 common targets of drugs and diseases were combined by eliminating repeat values. Based on PPI network analysis, the top ten targets were SRC, STAT3, MAPK3, MAPK1, RELA, PIK3R1, HSP90AA1, TP53, EP300, and AKT1. KEGG analysis showed that DHJSD could regulate the HIF-1, PI3K-Akt, and JAK-STAT signaling pathways. The biological processes involved include inflammatory reactions, the negative regulation of apoptosis, and the positive regulation of cell proliferation. Molecular docking results showed that all targets, except the RELA protein, showed good binding to the compounds, indicating that the 10 components might exert therapeutic effects by binding to the above targets. DHJSD can treat OA by regulating the HIF-1, PI3K-Akt, and JAK-STAT signaling pathways. The proteins involved were SRC, STAT3, MAPK3, MAPK1, and PIK3R1. In this study, network pharmacology was used to predict the mechanism of DHJSD in OA treatment, which was verified by molecular docking to provide experimental research ideas and scientific basis for OA treatment.

Characteristics and mechanisms of resorption in lumbar disc herniation

Lumbar disc herniation (LDH) can be spontaneously absorbed without surgical treatment. However, the pathogenesis and physiological indications for predicting protrusion reabsorption are still unclear, which prevents clinicians from preferentially choosing conservative treatment options for LDH patients with reabsorption effects. The purpose of this review was to summarize previous reports on LDH reabsorption and to discuss the clinical and imaging features that favor natural absorption. We highlighted the biological mechanisms involved in the phenomenon of LDH reabsorption, including macrophage infiltration, inflammatory responses, matrix remodeling, and neovascularization. In addition, we summarized and discussed potential clinical treatments for promoting reabsorption. Current evidence suggests that macrophage regulation of inflammatory mediators, matrix metalloproteinases, and specific cytokines in intervertebral disc is essential for the spontaneous reabsorption of LDH.

Diagnosis experience and literature review of patients with cervical, thoracic and lumbar multi-segment spinal stenosis: A case report

BACKGROUND

The incidence of cervical, thoracic and lumbar spinal canal stenosis is low. It is difficult to identify the main focus and responsible segment, and it is also difficult to select the sequence of staging surgery. We report a patient with triple stenosis.

CASE PRESENTATION

In this paper, we introduced a 61-year-old female patient with cervical, thoracic and lumbar spinal canal stenosis who had previously undergone "lumbar discectomy" in the outer hospital. The postoperative effect was not good and the symptoms were poor. The diagnosis was "cervical spinal stenosis and lumbar spine surgery." The staged spinal canal decompression operation and Duhuo Jisheng Decoction (DHJSD) treatment were conducted in our hospital. After 3 months of follow-up, the functional and imaging results were satisfactory.

CONCLUSION

We should pay enough attention to the patients with spinal degenerative diseases who need surgery, and must pursue the unity of medical history, signs and images. In case of difficult patients, more comprehensive examination is required, and the main focus and responsible segment are determined through comprehensive analysis. The more important diseases that may exist cannot be covered up by focal lesion manifestations, so as to avoid unnecessary surgical trauma for patients. In addition, surgery combined with Chinese herbal medicine DHJSD therapy may be an effective treatment for this kind of disease.