Use self-gravitation traction to treat lumbar disc herniation: Study protocol for a double-center, single-blind randomized controlled trial

BACKGROUND

Self-gravitation traction is 1 of the most popular treatments for lumbar disc herniation (LDH). This study aims to evaluate the effectiveness and safety of the self-gravitation traction device in the treatment of LDH and to confirm its positive treatment effect.

METHODOLOGY

This trial is designed as a pragmatic double-center, single-blind, and 3-arm (1:1:1 ratio) randomized controlled trial. The recruited patients with LDH will be randomly allocated to the intervention (traction weight is 40% or 60% of its body weight) or control (traction weight is 20% of its body weight) group. Traction will be completed within 6 consecutive weeks (3 times a week), with 10 minutes of traction for the first 3 weeks, 20 minutes of traction for the next 3 weeks. After the experiment is completed, we will establish an experiment-related database. The software of SPSS, version 21 (SPSS Inc. Chicago, IL) will be used for statistical analysis, and measurement data will be expressed via mean and standard deviation (mean ± SD).

DISCUSSION

Once the trial is completed, we will publish the study in journals in both Chinese and English to promote the dissemination and use of the results. In addition, we also plan to promote the research results at various academic conferences both domestically and internationally.

Effect of different attributes of the mimic human lumbar spine biomechanics material structure change by finite element analysis

In this study, we compared stress changes and quantity effect relationships from 3D finite element models of normal and degenerative lumbar segments. We further defined the mechanisms causing alterations in mechanical stability the control of normal and degenerative lumbar segments using traditional Chinese medicine. The characteristics of the stress change and the quantity effect relationships of the three-dimensional finite element model of normal and degenerative lumbar segments were compared. The mechanism(s) leading to changes in mechanical stability and the intervention and balance between normal and degenerative lumbar segments of the traditional Chinese medicine was analyzed. The change trend of stress and strain was compared with the three dimensional finite element model under different motion states of normal lumbar vertebrae. A 3D-FEM of degenerative lumbar segments L4 ~ 5 of the human spine was established to simulate the physiological and pathological changes of the lumbar spine in response to flexion, extension, lateral bending and torsion. The stress changes in the normal and degenerative lumbar vertebrae were assessed through external force interventions and the response to TCM. Stress in the degenerative lumbar vertebrae changed according the external load. Stress and strain were compared in the FEM model under a range of motion states. Components of the human lumbar vertebrae including the cortical vertebrae, cancellous bone, endplates, fibrous rings, and facet articular processes were investigated. The elastic modulus of the nerve roots and the posterior marginal structures of the vertebral body increased with lumbar degeneration. Under stress trends in normal lumbar and different degrees of degenerative lumbar structures including cortical bone, loose bone, terminal plate, fiber ring, nucleus, small articular processes, nerve roots and posterior structures. In normal lumbar spine, 20%, 50%, 70% lumbar degeneration, 106 different lumbar anterior flexion 30 and posterior extension with different external forces showed that ANOVA F was between 3.623 and 11.381 and P changed between 0.001 and 0.05.It is clear that in the lumbar movement segments under different pressure intervention, the changes in the degree of degeneration are significantly different from each constituent structure, among which the trend of expected change between the constituent structures of the lumbar anterior flexion 30 is particularly obvious. The stress distribution in the intervertebral discs were influenced by TCM, and the space in the spinal canal enlarged so that nerve root stress decreased, vertebral body stress increased, and facet processes and pedicle stress in the posterior regions exceeded those of the anterior flexion position. The internal stress of the intervertebral disc increased in the flexion compared to the extension position, gradually increasing from top to bottom. The stress concentration point of the degenerative lumbar disc is significantly greater than the stress in the normal lumbar disc stress distribution area, and increases with the degree of degeneration. Compared with the load capacity of normal lumbar and mild (15% reduction), moderate (40% reduction) lumbar disc protrusion model in bending, extension, axial rotation, lateral bending, the results found that the load transmission of lumbar disc degeneration model to different degrees has also changed, so its compression stiffness, strain distribution and size are also different. TCM can improve and treat lumbar disc disease through its ability to regulate the mechanical environment of degenerative lumbar vertebrae. Compared to the FEM models of the lumbar vertebrae, lumbar degenerative changes could be assessed in response to alterations in the biomechanical environment. These findings provide a scientific basis for the popularization and application of TCM to prevent and treat spinal degenerative disease.

[Peutz-Jeghers syndrome: report of 4 cases]

OBJECTIVE

Four patients with Peutz-Jeghers syndrome were consecutively observed according to their clinical manifestation, pathologic characteristic, family history.

METHODS

Four cases were analyzed according to their clinical observation, X-ray detection, pathological diagnosis and family history.

RESULTS

Peutz-Jeghers syndrome had characteristic of family inhereditary. Intestinal lesion was correlative to canceration of polypus.

CONCLUSION

Family inhereditary detection should be performed in Peutz-Jeghers syndrome patients. The patients whose intestinal lesion was located in colon were considered high risk patients. They should be intensively cared regularly in long-term.

[Effects of isoprenaline on apoptosis related gene expression in rat myocardium cells]

AIM

To study the relationship between acute myocardial ischemia rat induced by isoprenaline (Iso) and expression of some apoptosis related genes in myocardium.

METHODS

Acute myocardial ischemic rat model was induced by subcutaneous injection of large doses of Iso. The myocardial expression of apoptosis related genes, Fas, CPP32, Bcl-2 and Bax, were detected with RT-PCR method. The influences of aloperine (Alo, 20 mg.kg-1) and propranolol (Prop, 2 mg.kg-1) on apoptosis related genes were also investigated by the same method.

RESULTS

Myocardial expression of Fas, CPP32 and Bcl-2 were increased in acute myocardial ischemic rats, but no significance was detected in Bax expression. Both Alo and Prop were shown to decrease the expression of Fas and CPP32, and increase expression of Bcl-2. Prop also showed down regulated effect on expression of Bax.

CONCLUSION

Subcutaneous injection of large doses of Iso was shown to induce expressions of apoptosis related genes in rat myocardium, which were also influences by Alo and Prop.

[Protective effects of baicalin, mannitol and dexamethasone on infective brain edema in rats]

OBJECTIVE

To compare the therapeutic effects of baicalin, mannitol and dexamethasone on infective brain edema(IBE) in rats.

METHODS

Forty normal Sprague-Dawley(SD) rats (200 +/- 30) g by weight were divided into 5 groups randomly: (1) normal saline control group(NS, n = 8); (2) infective brain edema group (BE, n = 8); (3) mannitol treatment group(MAN, n = 8); (4) dexamethasone treatment group(DXM, n = 8); and (5) baicalin treatment group(BC, n = 8). Pertussis bacilli(PB, contained bacilli in 10.8 x 10(9), 0.2 ml-1.kg-1) were injected into the left carotid arteries through the left common carotid arteries by puncture to obtain BE models. The contents of brain water, sodium ion, potassium ion and Evans blue in brain tissues were observed too.

RESULTS

The contents of brain water, sodium ion, and EB in BE group were higher than those in BE group(P < 0.01), they decreased in MAN, DXM, BC groups and were lower than those in BE group(P < 0.01). In MAN, DXM, BC groups, there were no significant difference in the contents of brain water and sodium ion(P > 0.05). The EB content in BC group was higher than that in MAN and DXM groups(P < 0.01). The content of potassium ion in BE group was higher than that in MAN and DXM groups, the content of potassium ion was similar to that in NS group, but lower than that in BC group. Light microscope inspection in MAN, DXM and BC groups showed lessened brain edema, slight increase of perivascular space, and occasional nerve cell pyknotic nucleus. We found on nerve cell vacuolar degeneration in DXM group.

CONCLUSION

Baicalin, mannitol and dexamethasone all have similar protective effects on infective brain edema in rats.

Skeletal maturity of the hand and wrist in Chinese children in Changsha assessed by TW2 method

Skeletal maturity of 2122 normal children aged 2-20 years in the southern Chinese city of Changsha have been assessed by the TW2 score method. These mean bone ages are lower than the British standards up to puberty and thereafter higher than the British standards.