老年退变性腰椎侧凸并椎管狭窄长节段固定疗效

目的探讨腰椎后路长节段固定选择性减压治疗老年退变性腰椎侧凸(DLS)并椎管狭窄的临床效果。方法行选择性椎板减压长节段植骨融合内固定手术治疗的老年DLS合并腰椎管狭窄患者23例,术前、术后及随访时均采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、日本骨科学会腰椎功能评分(JOA)评价患者症状;对腰椎Cobb角、腰椎前凸角进行统计分析。结果术前、术后VAS、ODI及腰椎JOA有统计学差异(P<0.05);全部患者腰椎Cobb角、腰椎前凸角均有明显改善。结论腰椎后路长节段固定选择性减压治疗老年DLS并椎管狭窄可达到较好中期疗效。     

两种融合方案联合内固定术治疗老年峡部裂型腰椎滑脱症的临床疗效比较

目的探讨两种融合方案联合内固定术治疗老年峡部裂型腰椎滑脱症的临床疗效。方法 90例老年峡部裂型腰椎滑脱症患者,按融合方案分为两组,A组行腰椎后路椎板减压椎间盘切除腰椎椎体间融合器(Cage)植骨融合内固定术,B组行腰椎后路椎板减压后外侧植骨融和内固定术。比较患者的手术时间、术中出血量、滑脱复位率及丢失率、并发症、植骨融合率、椎间隙高度及日本骨科协会(JOA)评分。结果 A组患者的手术时间较B组患者手术时间长,且术中出血量明显高于B组,差异均有统计学意义(P0.01)。A组患者术后2 w的滑脱复位率高于B组,而术后1年的复位丢失率低于B组,术中A组的并发症发生率(31.11%)明显高于B组(8.89%),术后1年A组患者的植骨融合率和椎间隙高度明显高于B组(P0.05)。术后1年A组患者的JOA评分明显高于B组(P0.05)。结论腰椎后路椎板减压后外侧植骨融联合内固定术治疗老年峡部裂型腰椎滑脱症,可减少手术时间和术中出血量,有效复位椎体恢复腰椎曲度及椎间隙高度,植骨融合率较高,并发症发生率低,具有较好的临床疗效。     

椎间植骨融合椎弓根钉内固定治疗腰椎峡部裂滑脱（附35例报告）

目的观察后路椎间植骨融合椎弓根钉内固定治疗腰椎峡部裂滑脱的临床疗效。方法对35例腰椎峡部裂滑脱患者采用后路减压、椎间自体骨植骨融合、椎弓根钉内固定治疗,观察临床症状改善情况和椎间高度恢复及并发症情况。结果术后35例临床症状均得到不同程度改善,滑椎复位满意,椎间高度恢复好。发生断钉1例（1枚）,余未出现松动、断裂,植骨获得骨性愈合,未见假关节形成。结论后路椎间植骨椎弓根钉内固定术治疗腰椎峡部裂滑脱疗效好。彻底减压、适度复位、植骨融合是手术关键。     

保留刺突及部分椎板的椎管减压术治疗腰椎管狭窄症

目的：探讨一种既能充分减压又能维持腰椎稳定的治疗腰椎管狭窄的手术方法。方法：32例60岁以上的病人采用保留棘突和部分椎板的椎管减压术,根据术后症状改善程度来评价减压的彻底性。根据术前术后动态X片来评价腰椎稳定性。结果：手术后症状完全改善29例,优良率为90．6％,术后发生椎体滑脱3例,占9．3％,讨论：保留棘突和部分椎板的椎管减压术是一种既能充分减压,又能达到椎体稳定的治疗腰椎管狭窄的手术方法。     

后路椎弓根钉内固定联合椎间植骨融合治疗老年腰椎滑脱的效果

目的探讨应用脊柱后路联合使用椎弓根钉内固定与椎间植骨融合手术治疗腰椎滑脱症的临床效果。方法选择该院脊柱外科近3年内收治的49例腰椎滑脱症患者,应用后路椎弓根钉内固定联合椎间植骨融合手术治疗,并随访1年,拍摄患者术后1 w、3个月、1年时的腰椎X线片,并通过JOA评分方法评价手术治疗的满意度。结果 49例腰椎滑脱患者术后1 w、3个月、1年的腰椎滑脱率、滑脱角及椎间隙高度均与术前比较差异显著(P0.01);从临床JOA评分来看术后显著上升,术后1年平均改善率高达(98.9%±4.1)。结论后路应用椎弓根钉内固定联合椎间植骨融合技术治疗腰椎滑脱症疗效确切,值得推广。     

椎板及后韧带复合结构瓣回植治疗退行性腰椎管狭窄症的疗效

<正>退行性腰椎管狭窄症(DLSS)临床表现以腰腿疼痛、间歇性跛行为主〔1,2〕。目前对DLSS的手术治疗方法主要是椎管减压术,但如果手术切除减压范围太大可能会导致脊柱不稳,严重者可引起腰椎滑脱〔3,4〕。本研究观察保留椎板及后韧带复合结构瓣回植治疗DLSS的疗效。1临床资料1.1一般资料我科DLSS患者42例,男27例,女15例;年龄55~79(平均61.2)岁。纳入标准:1有典型的腰腿疼痛、间     

后路自体骨粒打压植骨椎间融合术治疗腰椎滑脱症（附38例报告）

目的观察后路自体骨粒打压植骨椎间融合术治疗腰椎滑脱症的临床疗效。方法 38例腰椎滑脱症患者中,退行性腰椎滑脱33例、峡部裂5例。均采用经后路自体骨粒打压植骨椎间融合术治疗。结果术后随访6个月～3 a,所有滑脱节段达骨性融合,无内固定松动、断裂等并发症发生。本组疗效优33例,良3例,可1例,优良率为94%。结论后路自体骨粒打压植骨椎间融合术治疗腰椎滑脱症疗效好、安全。     

椎管减压联合椎弓根钉加单枚cage植入融合治疗腰椎滑脱症（附37例报告）

目的探讨椎管减压联合椎弓根钉加单枚cage植入融合治疗腰椎滑脱症的疗效。方法采用椎板切除减压,椎弓根钉固定加单枚cage植入融合治疗腰椎滑脱患者37例,比较手术前后Taillard指数、腰骶关节角、椎间高度指数变化。结果37例均获随访,随访时间为1-4a（平均2a）,术后1周Taillard指数、椎间隙高度、滑脱角、腰椎生理前凸角与术前比较,P均〈0．05。手术疗效优良率为91．89％（34／37）,腰椎融合率为100％。无神经根损伤、内固定松动和断裂,cage融合器位置形态无改变。结论椎管减压椎弓根钉固定加单枚cage融合器治疗腰椎滑脱,复位满意,效果好。     

后路椎弓根钉固定分别联合两种融合手术治疗腰椎滑脱症的效果比较

目的比较后路椎弓根钉固定分别联合椎间自体椎板、棘突植骨融合术与椎间融合器融合术治疗腰椎滑脱症的临床效果。方法将72例腰椎滑脱患者随机分为观察组和对照组各36例,两组均行后路椎弓根钉固定,并分别联合椎间自体椎板、棘突植骨融合术与椎间融合器融合术治疗;术后随访8~40个月（平均11.3个月）,采用JOA评分评定两组疗效并记录植骨融合率。结果观察组和对照组疗效优良率分别为91.67%、88.57%,植骨融合率分别为94.44%、91.67%,组间比较P均〉0.05。结论后路椎弓根钉固定分别联合椎间自体椎板、棘突植骨植骨融合术与椎间融合器术融合治疗腰椎滑脱症效果相近,前者有望减少患者创伤和医疗费用。     

老年退行性腰椎管狭窄症的外科治疗

目的探讨外科治疗老年退行性腰椎管狭窄症的方法及疗效。方法回顾性分析2003年2月至2006年4月中山医院骨科收治的70岁及以上退行性腰椎管狭窄症患者137例,男92例,女45例;年龄70～81岁,平均75.6±6.2岁;病史3～8年,平均5.3±0.4年。41例患者术前合并一种或多种内科疾病,所有病人术前均经内科治疗,病情稳定3个月以上后方行手术。112例行单纯全椎板或部分椎板切除减压术;25例采用椎板减压＋椎弓根固定＋椎间植骨融合术。结果围手术期并发症12例,经对症处理及内科联合治疗后好转,无围手术期死亡病例。本组平均随访时间2年6个月,Oswestry评分术前为62.42±11.36,术后为17.25±5.62。所有患者术后神经受压症状均有改善,连续行走从术前不足15min到术后至少30min。结论手术治疗有助于老年退行性腰椎管狭窄症患者神经功能的恢复,术前积极治疗合并症可以降低围手术期风险。     

Advances in Retinal Tissue Engineering

Retinal degenerations cause permanent visual loss and affect millions world-wide. Current treatment strategies, such as gene therapy and anti-angiogenic drugs, merely delay disease progression. Research is underway which aims to regenerate the diseased retina by transplanting a variety of cell types, including embryonic stem cells, fetal cells, progenitor cells and induced pluripotent stem cells. Initial retinal transplantation studies injected stem and progenitor cells into the vitreous or subretinal space with the hope that these donor cells would migrate to the site of retinal degeneration, integrate within the host retina and restore functional vision. Despite promising outcomes, these studies showed that the bolus injection technique gave rise to poorly localized tissue grafts. Subsequently, retinal tissue engineers have drawn upon the success of bone, cartilage and vasculature tissue engineering by employing a polymeric tissue engineering approach. This review will describe the evolution of retinal tissue engineering to date, with particular emphasis on the types of polymers that have routinely been used in recent investigations. Further, this review will show that the field of retinal tissue engineering will require new types of materials and fabrication techniques that optimize the survival, differentiation and delivery of retinal transplant cells.     

同型半胱氨酸对血管内皮细胞合成蛋白聚糖的影响

为探讨同型半胱氨酸对血管内皮细胞合成蛋白聚糖的影响，采用400umol／L同型半胱氨酸作用于培养的人脐静脉内皮细胞，以^35S-Na2SO4为示踪物标记细胞合成的蛋白聚糖，通过离子交换层析，凝胶过滤层析分离蛋白聚糖。结果发现，实验组培养液中总蛋白聚糖降低，硫酸乙酰肝素蛋白聚糖及硫酸软骨素-硫酸皮肤素蛋白聚糖含量也降低，但其百分含量未见改变。细胞层中蛋白聚糖未见明显变化。     

International Hemoglobin Information Center Policies - Ihic

Abstract

The levels of the inactive hemoglobin (Hb) pigments [such as methemoglobin (metHb), carboxyhemoglobin (HbCO) and sulfohemoglobin (SHb)] and the active Hb [in the oxyhemoglobin (oxyHb) form] as well as the blood Hb concentration in healthy non pregnant female volunteers were determined using a newly developed multi-component spectrophotometric method. The results of this method revealed values of SHb% in the range (0.0727–0.370%), metHb% (0.43–1.0%), HbCO% (0.4–1.52%) and oxyHb% (97.06–98.62%). Furthermore, the results of this method revealed values of blood Hb concentration in the range (12.608–15.777?g/dL). The method is highly sensitive, accurate and reproducible.     

Efficacy of combination treatment with cyclosporin A and corticosteroids for acute interstitial pneumonitis associated with dermatomyositis

Interstitial pneumonitis (IP) associated with polymyositis and dermatomyositis (PM/DM) is a serious complication that affects prognosis. We therefore undertook a retrospective multicenter study to examine the efficacy of a combination treatment with cyclosporin A (CsA) and corticosteroids. Fifty-three IP patients with PM/DM (9 PM, 44 DM) were analyzed. Thirty-two patients treated with CsA plus corticosteroids (9 PM, 23 DM) were included in the study. Four parameters, i.e., subjective symptoms, ausculatory sound, chest radiographs, and respiratory index, were serially evaluated. A general evaluation was performed 4 weeks after the start of the combination treatment. All patients with PM and chronic IP with DM, and 52% of those with acute IP with DM were graded as better than partially effective in the general evaluation. In contrast, all patients graded as progressive in the general evaluation had acute IP with DM. It is of note that in acute IP with DM, the survival rate of the group primarily treated with CsA and corticosteroids from the early stage of their disease was significantly higher than that of the group initially treated with corticosteroids alone (P = 0.049). In conclusion, a combination treatment of CsA and corticosteroids from the early stage of disease may be advantageous for patients with IP with PM/DM, especially acute IP with DM.     

Efficacy of combination treatment with cyclosporin A and corticosteroids for acute interstitial pneumonitis associated with dermatomyositis

Abstract

Interstitial pneumonitis (IP) associated with polymyositis and dermatomyositis (PM/DM) is a serious complication that affects prognosis. We therefore undertook a retrospective multicenter study to examine the efficacy of a combination treatment with cyclosporin A (CsA) and corticosteroids. Fifty-three IP patients with PM/DM (9 PM, 44 DM) were analyzed. Thirty-two patients treated with CsA plus corticosteroids (9 PM, 23 DM) were included in the study. Four parameters, i.e., subjective symptoms, ausculatory sound, chest radiographs, and respiratory index, were serially evaluated. A general evaluation was performed 4 weeks after the start of the combination treatment. All patients with PM and chronic IP with DM, and 52% of those with acute IP with DM were graded as better than “partially effective” in the general evaluation. In contrast, all patients graded as “progressive” in the general evaluation had acute IP with DM. It is of note that in acute IP with DM, the survival rate of the group primarily treated with CsA and corticosteroids from the early stage of their disease was significantly higher than that of the group initially treated with corticosteroids alone (P = 0.049). In conclusion, a combination treatment of CsA and corticosteroids from the early stage of disease may be advantageous for patients with IP with PM/DM, especially acute IP with DM.     

Methemoglobin Forming Effect of Dimethyl Trisulfide in Mice

Abstract

Dimethyl trisulfide (DMTS) is a natural organic trisulfide that has been patented as a promising antidotal candidate against cyanide (CN). The primary mode of action of DMTS is as a sulfur donor that enables the conversion of CN to thiocyanate. Recently, it was discovered that DMTS is capable of oxidizing hemoglobin (Hb) to methemoglobin (MetHb) in vitro. The goal of these experiments was to measure the extent of DMTS-induced MetHb formation in vivo. In these experiments, intramuscular (IM) injections of formulated DMTS were administered to mice. Following the IM injection, blood was drawn and analyzed for MetHb using a rapid spectrophotometric method. Methemoglobin levels peaked in a dose-dependent manner between 20 and 30?min., and then began dropping. The highest MetHb levels measured for the 50, 100, 200 and 250?mg/kg doses of DMTS were respectively 3.28, 6.12, 9.69, and 10.76% MetHb. These experiments provide the first experimental evidence that IM administered DMTS generates MetHb in vivo and provide additional evidence for the presence of a secondary therapeutic pathway for DMTS - CN scavenging by DMTS-generated MetHb.     

Golimumab for moderate to severe ulcerative colitis

Introduction: Golimumab (GLM) is a subcutaneously administered human anti-tumor necrosis factor (TNF) agent that has been approved by the regulatory authorities for the treatment of moderate to severe ulcerative colitis (UC) in 2013.

Areas covered: Maintained clinical remission rates up to 50% have been shown in UC patients receiving GLM, and higher GLM serum concentrations have been associated with improved clinical outcomes. Approximately 50% of UC patients do not respond to induction therapy with GLM, and up to 40% of GLM responders will lose response over time. In most patients, loss of response is associated with low serum GLM concentrations, which suggests insufficient exposure to GLM. Low GLM serum concentrations may be avoided by therapeutic drug monitoring.

Expert commentary: So far, the therapeutic window for GLM has not yet been defined, but options to dose increase GLM based on therapeutic drug monitoring might result in improved clinical outcome and higher success rates.     

The Mitochondrial Permeability Transition: Role in Ischemia/Reperfusion Injury

The mitochondrial permeability transition (MPT) occurs when a non-specific pore opens in the inner mitochondrial membrane and converts the mitochondrion from an organelle whose ATP production sustains the normal function of the cell to an instrument of death. Conditions favouring the MPT including high [Ca2+], oxidative stress and adenine nucleotide depletion, all of which occur when a tissue is reperfused following a period of ischemia. Cyclosporin A (CsA) and low pH (<7.0) are potent inhibitors of the MPT. Methods have been devised to demonstrate directly that the MPT pores open upon reperfusion but not during ischemia. The mechanism of the MPT appears to involve binding of mitochondrial cyclophilin (CyP) to the adenine nucleotide translocase (ANT) followed by a calcium-mediated conformational change that converts the ANT into a non-specific pore. Understanding the molecular mechanism has assisted in devising strategies that can be used to protect tissues from damage caused by reperfusion injury. These might also be of benefit in the prevention of multiple organ failure for which reperfusion injury of the gut is thought to be the initial trigger. Protective regimes include the pretreatment of tissues prior to ischemia/reperfusion with CsA (binds to CyP), free radical scavengers that reduce oxidative stress (e.g., pyruvate and propofol) and agents that decrease pHi (e.g., pyruvate or amelioride derivatives). Reperfusion injury can produce both immediate cell death by necrosis or delayed apoptotic cell death and it appears that the mitochondria determine which route is taken. Prolonged opening leads to rapid cell death by necrosis, whilst transient opening leads to cytochrome c release and subsequent apoptosis hours or days later.     

Efficacy and safety of bucillamine, a d-penicillamine analogue, in patients with active rheumatoid arthritis

Japanese rheumatologists consider bucillamine (Buc) to be a useful disease-modifying antirheumatic drug (DMARD) and often give Buc to patients with rheumatoid arthritis (RA) prior to administering methotrexate (MTX). However, no large studies on the efficacy and safety of Buc in RA patients have been published in English to date. We therefore investigated the clinical course of RA patients treated with Buc and compared the results with those for patients treated with MTX to evaluate and confirm the place of Buc in therapeutic strategies for RA in Japan. Our results suggested that Buc should be given to patients with moderately active RA either before or after the administration of MTX because its efficacy can be judged within 3 months and because serious adverse events are rare. Issues like the ability of Buc to prevent joint destruction and its efficacy and safety when combined with agents like etanercept require future study.     

Papillomavirus Infectious Pathways: A Comparison of Systems

The HPV viral lifecycle is tightly linked to the host cell differentiation, causing difficulty in growing virions in culture. A system that bypasses the need for differentiating epithelium has allowed for generation of recombinant particles, such as virus-like particles (VLPs), pseudovirions (PsV), and quasivirions (QV). Much of the research looking at the HPV life cycle, infectivity, and structure has been generated utilizing recombinant particles. While recombinant particles have proven to be invaluable, allowing for a rapid progression of the HPV field, there are some significant differences between recombinant particles and native virions and very few comparative studies using native virions to confirm results are done. This review serves to address the conflicting data in the HPV field regarding native virions and recombinant particles.