Activity restrictions after posterior lumbar discectomy. A prospective study of outcomes in 152 cases with no postoperative restrictions

STUDY DESIGN: A prospective clinical trial was conducted. OBJECTIVES: To determine the feasibility of removing activity restrictions after surgery and encouraging early return to work; to ascertain the clinical and behavioral response to such a strategy; and to identify factors predictive of early return to work, preparatory to possible randomized clinical trials. SUMMARY OF BACKGROUND INFORMATION: Current practice usually entails several weeks to several months of restricted activities after lumbar discectomy to avoid disc "reinjury." Earlier work has suggested these restrictions may not be necessary. METHODS: One hundred fifty-two consecutive working patients undergoing limited open discectomy for herniated lumbar intervertebral disc were treated postoperatively with no activity restrictions. Patients were encouraged to return to full activities as soon as possible. The patients were followed for a minimum of 2 years (average follow-up time = 4.8 years). At follow-up, an independent examiner evaluated each patient and collected further postoperative data. RESULTS: One hundred forty-nine of the 152 patients (98%) returned to work. The average work loss was 1.2 weeks and 148 of 149 patients had returned to full duty by 8 weeks. Approximately one-third of the group returned to work within 1 week of surgery (32%), many the next day. Statistical analysis demonstrated very early return to work did not correlate with either recurrent sciatica, reoperation for reherniation, or ultimate clinical outcome. Seventeen patients (11.2%) had possible reherniations (recurrent sciatica) and eight underwent reoperation (5.3%). CONCLUSION: Lifting of postoperative activity restrictions after limited discectomy allowed shortened time to return to work relative to the 4 to 16 weeks commonly recommended. Complication rates appear comparable to those reported in the literature for patients under postoperative restrictions. Postoperative restrictions may not be necessary in most patients.     

游离骨膜与复合rhBMP2的异种骨联合移植修复骨缺损的实验研究

目的 探讨复合基因重组人ＢＭＰ２（ｒｈＢＭＰ２）的异种骨与游离骨膜（ＦＰ）联合移植修复节段性骨缺损的效果。方法 将ｒｈＢＭＰ２与去抗原牛松质骨载体（ＢＣＢ）复合,制成ｒｈＢＭＰ２／ＢＣＢ;选用新西兰大耳白兔２８只,制成烧骨干１５ｍｍ缺损动物模型,分别行ＦＰ和ｒｈＢＭＰ２／ＢＣＢ复合移植（ｎ＝６）、ｒｈＢＭ２／ＢＣＢ移植（ｎ＝６）和单纯ＢＣＢ移植（ｎ＝２）;术后４、８、１２、１６周取材,通过Ｘ线、生     

Tea preparations protect against DMBA-induced oral carcinogenesis in hamsters

The preventive effects of green tea, tea pigments, and mixed tea (a composite of whole water extract of green tea, tea polyphenols, and tea pigments) on 7,12-dimethyl-benz[a]anthracene (DMBA)-induced oral carcinogenesis in golden Syrian hamsters were studied. The right buccal pouches of animals were topically treated with 0.5% DMBA three times per week for 15 weeks. Animals were killed separately after 6, 10, and 15 weeks of DMBA treatment. Oral tumors were counted and measured, and mean tumor burden was calculated. The incidence of preneoplastic lesions and micronucleated cells, the number and volume of silver-stained nucleolar organizer regions (AgNOR), the labeling index of proliferating cell nuclear antigen, and the level of epidermal growth factor receptor expression were studied. The results showed that oral administration of 1.5% green tea, 0.1% tea pigments, and 0.5% mixed tea as the sole source of drinking water for two weeks before initiation of the DMBA treatment and until the end of the experiment significantly reduced the mean tumor burden and the incidence of dysplasia and oral carcinoma (p < 0.01). The frequency of micronucleated cells, the number of AgNOR, the total volume of AgNORs, the labeling index of proliferating cell nuclear antigen, and the level of epidermal growth factor receptor expression in the oral mucosal cells were also significantly reduced (p < 0.01). These results clearly indicated that tea preparations could effectively inhibit DMBA-induced oral carcinogenesis in hamsters. Protection from DNA damage and suppression of cell proliferation could be important mechanisms of the anticarcinogenic effects of the tea preparations.     

上海市居民吸烟与癌症及有关疾病十年前瞻性研究

目的探讨上海市民吸烟与癌症及有关疾病的关系。方法８０年代初在上海市区、市郊和郊县开展了居民吸烟状况的横断面调查。至１９９４年年底,市区研究对象随访了１２年,郊区研究对象随访了１１年。本次研究分析了４０岁以上研究对象的随访资料,并用Ｐｏｉｓｏｎ回归模型估计吸烟因素的年龄调整相对危险度及其９５％可信区间。结果市区分析结果表明,男女性吸烟者全死因的相对危险度分别为１．４８、１．６２。而所有癌症死亡的相对危险度男性为２．２０,女性为２．００。相对危险度有统计学意义的癌症部位是肺癌、肝癌、食管癌（男）、胃癌（男）、胰腺癌（男）、膀胱癌（男）。脑血管疾病、慢性支气管炎、肺气肿和肺心病的相对危险度也见显著升高。市郊和郊县的结果与市区类似。我们估计了三个地区吸烟对男性某些疾病的归因危险度（ＰＡＲ）,所有死因吸烟的ＰＡＲ（％）三地分别为２０．９、１８．９、１６．３,所有癌症三地吸烟的ＰＡＲ（％）分别为４０．０、３４．５、３４．２,肺癌三地吸烟的ＰＡＲ（％）分别为７１．７、５９．２、６４．７。结论吸烟与一些癌症、慢性阻塞性肺部疾病、肺原性心脏病及脑血管病等的死亡有关     

Performance of the Frameless IUD (Flexigard prototype inserter) and the TCu380A after six years as part of a WHO multicenter randomized comparative clinical trial in parous women

The clinical performance of the new Frameless IUD was compared with the TCu380A, the most widely used copper IUD in the world today. Insertions of the Frameless IUD were conducted with a prototype inserter (Flexigard). We report on the 6-year results from a randomized comparative clinical trial conducted at the Shanghai Institute of Planned Parenthood Research, as part of an international multicenter WHO clinical trial, involving 200 women, respectively recruited for use of each device. The cumulative 6-year pregnancy rates were 0.0 per 100 women for the Frameless IUD and 3.3 for TCu380A. Termination due to partial expulsion was significantly less for the Frameless IUD as compared with TCu380A (0.0 and 4.3 per hundred women, respectively). Complete expulsion, bleeding, pain, bleeding and pain and other medical reasons for termination did not differ significantly between the two devices. The net cumulative continuation rates at six years per 100 women were 80.8 for TCu380A, and 83.0 for the Frameless IUD.Both Frameless IUD and TCu380A are highly effective, safe and acceptable contraceptive devices, because of low pregnancy rates (per 100 women), and low termination rates due to expulsion, pain, bleeding, and bleeding and pain. Due to its anchoring, the Frameless IUD is significantly more effective than the TCu380A IUD as regards proper retention of the IUD in the uterine cavity. This may also explain its lower failure rate.     

叶酸拮抗乙酰水杨酸致大鼠卵黄囊毒性作用的研究

以全胚胎培养模型结合免疫组化和电镜技术等探讨了乙酰水杨酸和叶酸对大鼠卵黄囊及胚胎的影响。结果表明：培养基含乙酰水杨酸３００μｇ／ｍｌ组的卵黄囊直径和胚胎体长均显著低于阴性对照组,胚胎畸形率明显增高。组织学检查发现卵黄囊厚度变薄。间质层血岛、微血管数量明显减少,血管壁细胞不连续,血管发育不良。卵黄囊内皮层细胞顶端微绒毛少见。内皮层细胞的溶酶体、内质网及核蛋白体等结构和数量均有明显改变。而６０ｍｇ／ｋｇ叶酸灌胃鼠血清与乙酰水杨酸联合应用后,则卵黄囊的上述毒性作用明显减轻或消失,提示叶酸能明显拮抗乙酰水杨酸致大鼠卵黄囊的毒性作用。     

内燃机车乘务员和轮轴工外周血淋巴细胞微核观察

本文作者对５１名内燃机车乘务员和车辆维修车间的３０名轮轴工外周血淋巴细胞微核进行了分析。结果表明,机车乘务员和轮轴工微核阳性检出率、微核细胞率和微核率均明显高于对照组（Ｐ＜０．０１）,而且随着作业工龄的延长,微核细胞率和微核率有接近显著（０．０５＜Ｐ＜０．０１）或显著（Ｐ＜０．０５）意义的增高。对两类作业工作人员微核增高的原因进行了讨论     

疝环充填无张力疝修补术（附50例报道）

目的 观察疝环充填无张力疝修补术的临床应用效果。方法 疝囊做高位剥离而不做高位结扎,用美国Bard公司生产的锥形疝环充填 物充填内环,再用该公司生产的成型补片于精溃后方贴补腹肥肉沟管后壁,其它步骤同传统的手术方法。结果 本组50例,手术时间为30-770分钟,平均40分钟。随访1年效果良好,未见并发症。结论 疝环充填无张力疝修补术具有疼痛轻微、复发率低以及术后恢复快等优点。     

人体双侧对称经络电阻抗失衡与疾病的相关研究

通过实验装置．分别测量人体双侧对称经络对称两穴位之间的电流波形,计算其电阻抗值,探讨经络的导电特性。证明了正常人双侧经络电阻抗的对称性、经络循行线的低阻性及双侧经络电阻抗失衡与其络属脏器病变的相关性等问题。