ObjectiveTo evaluate early effectiveness of posterior 180-degree decompression via unilateral biportal endoscopy (UBE) in the treatment of lumbar spinal stenosis (LSS) combined with Michigan State University (MSU) grade 1 lumbar disc herniation (LDH). MethodsA retrospective analysis was conducted on clinical data from 33 patients with LSS combined with MSU grade 1 LDH who met selection criteria and were treated between March 2022 and January 2024. All patients underwent UBE-assisted 180-degree spinal canal decompression. The cohort comprised 17 males and 16 females, aged 37-82 years (mean 67.1 years). Preoperative presentations included bilateral lower limb intermittent claudication and radiating pain, with disease duration ranging from 5 to 13 months (mean, 8.5 months). Affected segments included L3, 4 in 4 cases, L4, 5 in 28 cases, and L5、S1 in 1 case. LSS was rated as Schizas grade A in 4 cases, grade B in 5 cases, grade C in 13 cases, and grade D in 11 cases. LDH was categorized as MSU-1A in 24 cases, MSU-1B in 2 cases, and MSU-1AB in 7 cases. Intraoperative parameters (operation time, blood loss) and postoperative hospitalization length were recorded. The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were used to assess the lower limb pain and functional outcomes after operation. Clinical efficacy was evaluated at last follow-up via modified MacNab criteria. Quantitative radiological assessments included dural sac cross-sectional area (DSCA) measurements and spinal stenosis grading on lumbar MRI. Morphological classification of lumbar canal stenosis was determined by calculating the nerve root-to-cerebrospinal fluid ratio, categorized into four grades. Results The operation time was 60.4-90.8 minutes (mean, 80.3 minutes) and intraoperative blood loss was 13-47 mL (mean, 29.9 mL). The postoperative hospitalization length was 3-5 days (mean, 3.8 days). All patients were followed up 12-16 months (mean, 13.8 months). The VAS scores and ODI improved at immediate and 3, 6, and 12 months after operation compared to before operation, and the differences between different time points were significant (P<0.05). At last follow-up, the clinical efficacy assessed by the modified MacNab criteria were graded as excellent in 23 cases, good in 9 cases, and poor in 1 case, with an excellent and good rate of 96.97%. Postoperative lumbar MRI revealed significant decompression of the dural sac in 32 cases, with 1 case showing inadequate dural expansion. DSCA measurements confirmed progressive enlargement and stenosis reduction over time. The differences were significant (P<0.05) before operation, immediately after operation, and at 6 months after operation. At 6 month after operation, Schizas grading of spinal stenosis improved to grade A in 27 cases and grade B in 6 cases. ConclusionPosterior 180-degree decompression via UBE is a safe and feasible strategy for treating LSS combined with MSU grade 1 LDH, achieving effective neural decompression while preserving intervertebral disc integrity.
ObjectiveTo overview the systematic reviews/meta-analyses (SRs/MAs) of efficacy and safety of dipeptidyl peptidase-4 inhibitors (DPP-4) in treatment of type 2 diabetes mellitus (T2DM).MethodsDatabase including The Cochrane Library, PubMed, EMbase, CBM, WanFang Data and CNKI were searched from inception to December 2016 to collect SRs/MAs of randomized controlled trials (RCTs) of DPP-4 for the treatment of T2DM. Two reviewers independently screened literature, extracted data, and evaluated the reporting and methodological qualities using the PRISMA checklist and the AMSTAR tool.ResultsTwenty-seven SRs/MAs of DPP-4 for the treatment of T2DM were included in this overview. The average score of AMSTAR was 7.04. The worst score were the item 1 (26 studies didn't provide an ‘a priori’ design), item 4 (10 studies didn't provide whether the status of publication used as an inclusion criterion?), item 10 and item 11 (15 studies didn't assess the likelihood of publication bias and the potential conflicts of interest). The PRISMA score ranged from 17.0 to 24.5. The main problems of reporting were protocol and registration, search, additional analyses and funding.ConclusionThe evidence shows that the reporting and methodological quality of the SRs/MAs of DPP-4 inhibitors for type 2 diabetes are not high.
ObjectiveTo overview the systematic reviews of dominant diseases of acupuncture in clinical efficacy.MethodsPubMed, The Cochrane Library, Web of Science, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect systematic reviews or meta-analyses of dominant diseases of acupuncture in clinical efficacy from inception to December 2020. Two reviewers independently screened literature, extracted data and assessed the quality of the included studies. Then, Excel 2010 and VOS viewer were used for data analysis.ResultsA total of 263 systematic reviews were included. Acupuncture techniques involved electroacupuncture (n=29), point thread-embedding (n=25), dermal needle (n=15), acupoint injection (n=12), spoon needle (n=12), fire needle (n=8), laser (n=8), intradermal needle (n=5), filiform needle (n=4), pricking blood therapy (n=2) and round-sharp needle (n=1). A total of 94 kinds of diseases were identified, and their total effective rate ranged from 4% (bladder cancer) to 98% (bladder stones, renal colic), 72 kinds of which were above 85%.ConclusionsAcupuncture is currently widely used in clinical practice. Based on the clinical effectiveness evidence, this study finally identifies 94 types of dominant diseases. However, the total sample size and total effective rate vary considerably, and the types of acupuncture are not yet specified in this study, which requires to be focused in future research.