Retaining intradiscal pressure after annulotomy by different annular suture techniques, and their biomechanical evaluations

Background

The adverse effects of annulotomy during lumbar discectomy have been increasingly recognized, and methods are developing to repair the annular defect. Biomechanically, the repair should retain the intra-nuclear pressure, which is doubtful using the current suture techniques. Therefore, a new suture technique was designed and tested to close a simpler type of annular incision.

Methods

A new suture technique, the modified purse-string suture, was introduced into a re-validated nonlinear finite element human disk model after creating a standard transverse slit incision, as well as two other suture techniques: either two simple sutures, or a horizontal crossed suture, and compared their contact pressure on the cleft contact surface. Then, porcine lumbar endplate–disk–endplate complexes with transverse slit incisions were repaired using the three techniques. Quantitative discomanometry was then applied to compare their leakage pressure, as a parameter of disk integrity.

Findings

In finite element model, the new technique created the greatest contact pressure along the suture range (the outer annulus), and generated a minimum contact pressure at the critical point, which was 68% and 55% higher than the other two suture techniques. In quantitative discomanometry, the new suture technique also had an average leakage pressure of 85% and 49% higher than the other two suture techniques.

Interpretation

The modified purse-string suture can generate higher contact pressure than the other two techniques at finite element analysis and in realistic animal models, which aids in retaining intra-discal pressure, and should be encouraged in clinical practice.     

Altered age-related trajectories of amygdala-prefrontal circuitry in adolescents at clinical high risk for psychosis: a preliminary study

Emotion processing deficits are prominent in schizophrenia and exist prior to the onset of overt psychosis. However, developmental trajectories of neural circuitry subserving emotion regulation and the role that they may play in illness onset have not yet been examined in patients at risk for psychosis. The present study employed a cross-sectional analysis to examine age-related functional activation in amygdala and prefrontal cortex, as well as functional connectivity between these regions, in adolescents at clinical high risk (CHR) for psychosis relative to typically developing adolescents. Participants (n=34) performed an emotion processing fMRI task, including emotion labeling, emotion matching, and non-emotional control conditions. Regression analyses were used to predict activation in the amygdala and ventrolateral prefrontal cortex (vlPFC) based on age, group, sex, and the interaction of age by group. CHR adolescents exhibited altered age-related variation in amygdala and vlPFC activation, relative to controls. Controls displayed decreased amygdala and increased vlPFC activation with age, while patients exhibited the opposite pattern (increased amygdala and decreased vlPFC activation), suggesting a failure of prefrontal cortex to regulate amygdala reactivity. Moreover, a psychophysiological interaction analysis revealed decreased amygdala-prefrontal functional connectivity among CHR adolescents, consistent with disrupted brain connectivity as a vulnerability factor in schizophrenia. These results suggest that the at-risk syndrome is marked by abnormal development and functional connectivity of neural systems subserving emotion regulation. Longitudinal data are needed to confirm aberrant developmental trajectories intra-individually and to examine whether these abnormalities are predictive of conversion to psychosis, and of later deficits in socioemotional functioning.     

Morphological changes of the triceps surae muscle-tendon unit during passive extension: an in vivo rabbit model

Objective. To elucidate the morphological and biomechanical manifestation of the triceps surae muscle-tendon unit during passive extension.

Design. The instantaneous changes within the load-deformation curve of muscle-tendon unit were analyzed by an in vivo rabbit model.

Background. Although muscle strains occur more frequently than complete failures, the failure mechanism of these sub-failure injuries is rarely investigated. Monitoring of the instantaneous changes in the load-deformation curve allows correlation with the morphological changes that occur during passive extension.

Methods. After anesthesia, the triceps surae muscle of rabbit was dissected and then stretched to failure by a MTS Bionix 858 machine. The morphological changes in failure patterns were recorded by photographs.

Results. The morphological and biomechanical manifestations of the triceps surae muscle-tendon unit was divided into five different portions: first, the viscoelastic portion with minimal morphologic change; second, the portion of micro-failure with local ecchymosis; third and fourth, the portions of macrofailure with sequential rupture of the muscle fibers; and fifth, the portion of rupture and separation of muscle parenchyma.

Conclusions. A threshold for stretch-induced injury does exist. The threshold of the initiation of micro-failure in this model was 16.5% of the strain, which corresponded to 16.6% of the maximal sustainable force.     

Genome scan of schizophrenia families in a large Veterans Affairs Cooperative Study sample: evidence for linkage to 18p11.32 and for racial heterogeneity on chromosomes 6 and 14.

Genome-wide linkage analyses of schizophrenia have identified several regions that may harbor schizophrenia susceptibility genes but, given the complex etiology of the disorder, it is unlikely that all susceptibility regions have been detected. We report results from a genome scan of 166 schizophrenia families collected through the Department of Veterans Affairs Cooperative Studies Program. Our definition of affection status included schizophrenia and schizoaffective disorder, depressed type and we defined families as European American (EA) and African American (AA) based on the probands' and parents' races based on data collected by interviewing the probands. We also assessed evidence for racial heterogeneity in the regions most suggestive of linkage. The maximum LOD score across the genome was 2.96 for chromosome 18, at 0.5 cM in the combined race sample. Both racial groups showed LOD scores greater than 1.0 for chromosome 18. The empirical P-value associated with that LOD score is 0.04 assuming a single genome scan for the combined sample with race narrowly defined, and 0.06 for the combined sample allowing for broad and narrow definitions of race. The empirical P-value of observing a LOD score as large as 2.96 in the combined sample, and of at least 1.0 in each racial group, allowing for narrow and broad racial definitions, is 0.04. Evidence for the second and third largest linkage signals come solely from the AA sample on chromosomes 6 (LOD = 2.11 at 33.2 cM) and 14 (LOD = 2.13 at 51.0). The linkage evidence differed between the AA and EA samples (chromosome 6 P-value = 0.007 and chromosome 14 P-value = 0.004).     

Sintered dicalcium pyrophosphate increases bone mass in ovariectomized rats.

Bisphosphonates are synthetic pyrophosphate analogs that can be used for the treatment of osteoporosis. Sintered dicalcium pyrophosphate, as a pyrophosphate analog, may be useful in the clinical setting for osteoporosis. In this study, an ovariectomized rat model is used to evaluate the effects of orally administered sintered dicalcium pyrophosphate on bone mass. Thirty-six female rats were used in this study. They randomly were divided into six groups: a negative normal control group, a positive osteoporosis control group, and ovariectomized groups treated either with alendronate sodium (one group) or sintered dicalcium pyrophosphate (three groups, each at a different level). The animals were sacrificed at 4 weeks after treatment. For all the rats, whole blood samples were obtained for the biochemical study. Bone ashes of long bones were measured and studied and histologic studies of cancellous bone were carried out. The ingestion of either alendronate or sintered dicalcium pyrophosphate did not have any deleterious effect on the major visceral organs. Ingestion of alendronate or sintered pyrophosphate decreased the bony porosity and increased bone mineral contents in the long bones of ovariectomized rats. Thus sintered dicalcium pyrophosphate can increase bone mass in the ovariectomized rat.     

Sex differences in prefrontal cortical brain activity during fMRI of auditory verbal working memory

Functional imaging studies of sex effects in working memory (WMEM) are few, despite significant normal sex differences in brain regions implicated in WMEM. This functional MRI (fMRI) study tested for sex effects in an auditory verbal WMEM task in prefrontal, parietal, cingulate, and insula regions. Fourteen healthy, right-handed community subjects were comparable between the sexes, including on WMEM performance. Per statistical parametric mapping, women exhibited greater signal intensity changes in middle, inferior, and orbital prefrontal cortices than men (corrected for multiple comparisons). A test of mixed-sex groups, comparable on performance, showed no significant differences in the hypothesized regions, providing evidence for discriminant validity for significant sex differences. The findings suggest that combining men and women in fMRI studies of cognition may obscure or bias results.     

DRD2 -141C insertion/deletion polymorphism is not associated with schizophrenia: results of a meta-analysis.

The gene DRD2, which codes for dopamine receptor D2, has been considered a prime candidate for allelic association testing with schizophrenia based on the strong evidence for involvement of this protein in disease pathophysiology. Recent meta-analyses confirmed a small but reliable association between schizophrenia and the cysteine-coding allele of the Cys311Ser polymorphism of DRD2. In the present study, we sought to determine if another polymorphism (the -141C insertion/deletion) in the same gene, which has been reported to be associated with schizophrenia in several individual studies, would show a similar pattern of association with the disease in a pooled dataset. The pooled odds ratio for the insertion allele obtained from 10 case-control studies was 1.1, which was not significant (P = 0.580); however, there was marked heterogeneity among the findings of individual studies, suggesting that some underlying factor influenced the size of their observed effects. Yet, neither ethnicity, the age of the control group, nor the gender composition of the samples reliably influenced effect size. Because linkage disequilibrium patterns between various DRD2 polymorphisms are not yet known, it remains possible that divergent meta-analytic findings at both commonly examined mutation sites within DRD2 are accurate. Haplotype analysis within this gene would be useful for definitively specifying the role of this gene in the etiology of schizophrenia.