Expression of ANGPTL4 in Nucleus Pulposus Tissues Is Associated with Intervertebral Disc Degeneration

Objective. Angiopoietin-like protein 4 (ANGPTL4), encoding a glycosylated secreted protein, has been reported to be closely related to many kinds of diseases, including diabetes, tumor, and some musculoskeletal pathologies, such as rheumatoid arthritis, osteoarthritis, and osteoporosis. The aim of the current study is to investigate the role of ANGPTL4 in intervertebral disc degeneration and analyze the association of ANGPTL4 expression with Pfirrmann grades. Methods. A total of 162 nucleus pulposus tissues were collected from lumbar intervertebral disc herniation patients undergoing interforaminal endoscopic surgery. Real-time quantitative PCR and western blot were performed to determine the mRNA and protein expression of ANGPTL4 in nucleus pulposus samples. Statistical analysis was performed to analyze the association of ANGPTL4 expression with Pfirrmann grades. Results. Based on the clinical data of 162 patients, results showed that Pfirrmann grades were significantly associated with patients’ age ( r = 0.162 , P = 0.047 ) and were not significantly associated with patients’ gender ( P > 0.05 ). RT-qPCR and western blot results showed that the mRNA ( r = 0.287 , P < 0.05 ) and protein ( r = 0.356 , P < 0.05 ) expressions of ANGPTL4 were both closely associated with Pfirrmann grades. The expression of ANGPTL4 was remarkably increased in the groups of high IVDD Pfirrmann grades. Conclusion. The results demonstrated that ANGPTL4 expression was positively associated with the Pfirrmann grades and the severity of intervertebral disc degeneration. ANGPTL4 may be served as a candidate biomarker for intervertebral disc degeneration.

Cervical Spondylopathy and Lumbar Intervertebral Disc Herniation Coexist in Free Radical Metabolism and Focus Separation in the Body

Lumbar disc herniation is a common lumbar disease in clinics, which is related to improper use of lumbar vertebrae and osteoporosis. Surgical removal of nucleus pulposus and maintenance of lumbar structural stability are important for the treatment of lumbar disc herniation. At present, in clinical percutaneous intervertebral foramen endoscopic surgery for lumbar disc herniation, interlaminar and intervertebral foramen approaches can be selected. Different approaches have different degrees of difficulty in the treatment of lumbar disc herniation, and the clinical effects that may be obtained are different. In this study, we observed the influencing factors of plasma nitric oxide (NO) and free radical metabolism in patients with lumbar disc herniation and the correlation between the effects of focus separation. The organic combination of local and total illness differentiation and dialectics, conventional acupuncture, and electrical stimulation was highlighted in this study, which linked local acupoints squeezed by nerve roots with distant acupoints along meridians. The use of authoritative quantitative standards and a multifactor assessment of the disease can accurately represent the disease's severity. The patient's condition changes in each period may be expressed more accurately, thoroughly, and objectively through the rise or reduction of the score, making self-evaluation easier for the patient. Electroacupuncture at point may be one of the most important strategies to minimize free radical damage, based on changes in plasma levels.

A CLINICO-OPERATIVE STUDY OF LUMBAR INTERVERTEBRAL DISC HERNIATION

Background: Herniation is a greater threat in younger individuals between the ages of 30 and 50 years, in whom the nucleusmaterial has good turgor, in contrast to older individuals in whom the nucleus is desiccated and fibrotic. Open discectomy is the gold standard for operative intervention in patients with herniated disc where conservative treatment has failed. Aim of objective: To study the reliability of clinical signs in diagnosing lumbar disc herniation. Material and Methods: This study was done collecting data of patients presenting to, JLNMCH, Bhagalpur. During this period there were 46 patients with a history of low back pain and at least one symptom suggesting root compression (Radiating pain, numbness,weakness or loss of sensation) who underwent surgery. Conclusion: Commonest presentation is that of, long histories of back pain with superimposed syndrome of sciatica. Patients with predominant leg pain or only leg pain have high incidences of ruptured herniations. Keywords: Herniation, Sciatica, Numbness, loss of sensation.

Criteria for selection of patients with lumbar intervertebral disc herniation complicated by spinal canal stenosis

Aim – to evaluate clinical and instrumental correlation (MRI data) in patients with lumbar intervertebral disc herniation complicated by spinal canal stenosis for optimizing the indications for differentiated surgical treatment. Materials and methods. Clinical and neurological manifestations and MRI data in 80 patients (men – 36, women – 44), aged 27 to 72 years with a diagnosis of intervertebral disc herniation complicated by spinal canal stenosis were retrospectively analyzed. Depending on the size of the spinal canal, there were 2 groups: the first – with relative spinal canal stenosis (n = 20) – 75–100 mm2, and the second group – with absolute spinal canal stenosis (n = 60) – less than 75 mm2. We examined the correlation between the clinical and neurological presentations and MRI findings. Results. Our retrospective analysis has found that the first group consisted mainly of younger patients (46 years) and with a mean intervertebral disc herniation of 8.35 mm, while the second group included older patients (51.7 years) and the mean size of intervertebral disc herniation was 7.3 mm. The group of relative spinal canal stenosis was dominated by patients with radiculopathy syndrome (70 %) and pain in one lower limb (85 %). Radiculoischemia syndrome (50 %), pain in both lower extremities (33 %), neurogenic intermittent claudication syndrome (46.6 %), knee reflex disorders (58.3 %), pelvic organ dysfunction (11.6 %) were more common in the second group of patients. In addition, the longest disease duration (more than 24 months) was observed among patients of this group. We have found a relationship between pain syndrome (according to VAS), muscle strength, the disease duration and the spinal canal area. Conclusions. The correlation of clinical and instrumental methods of examination in patients with intervertebral disc herniation complicated by spinal canal stenosis allows the indications for differentiated surgery to be optimized.

Ectopic bronchogenic cyst in the retroperitoneal region: a case report and literature review of adult patients

Background Bronchogenic cyst is congenital aberration of bronchopulmonary malformation, which is rarely encountered in the abdomen and retroperitoneum. We present a case report and literature review of retroperitoneal bronchogenic cyst. Case presentation A 53-year-old female presented to outpatient clinic for a routine checkup of lumbar intervertebral disc herniation. She received a contrast computed tomography scan of the abdomen which revealed a retroperitoneal cystic lesion below the left crura of diaphragm. Afterward, the patient underwent a laparoscopic excision of the cystic lesion and was discharged uneventfully at postoperative day 4. Histopathological findings confirmed the diagnosis of retroperitoneal bronchogenic cyst. Our literature review identified 55 adult cases in recent two decades. The average age at diagnosis was 43.2 (range 17–69) years. 44 (80%) cases had a retroperitoneal cyst on the left side, and 52 (94.5%) cases underwent curative excision through open or laparoscopic surgery. In the available follow up of cases, there was no recurrence after surgery. Conclusions Bronchogenic cyst is rare in the retroperitoneal region. It should be considered as one of the differential diagnoses of a retroperitoneal neoplasm.