Prevalent vertebral deformities: Relationship to bone mineral density and spinal osteophytosis in elderly men and women

The aims of this study were to ascertain vertebral deformity prevalence in elderly men and women and to describe the association between bone mineral density (BMD) at the lumbar spine and femoral neck, severity of spinal degenerative disease and vertebral deformity prevalence. We performed standardized spinal radiographs in a random sample of 300 elderly men and women participating in the Dubbo Osteoporosis Epidemiology Study, a population-based study of fracture risk factors. Radiographs were read independently by masked observers for the prevalence of vertebral deformity and severity of osteophytosis. BMD was measured by dual-energy X-ray absorptiometry. The prevalence of vertebral deformities was critically dependent on the criterion used. The less strict criteria seemed to overestimate deformities at either end of the spine region analysed. However, irrespective of the criterion used, prevalence of deformity was higher in men than in women (25% vs 20% for the 3 SD criterion, 17% vs 12% for the 4 SD criterion and 27% vs 25% for the 25% criterion). Femoral neck BMD was more strongly associated with vertebral deformities than spinal BMD for the 25% criterion (OR/SD change in BMD 1.39 (p=0.02) vs 1.20 (p=0.19)), 3 SD criterion (OR/SD change in BMD 1.45 (p=0.01) vs 1.10 (p=0.34)) and 4 SD criterion (OR/SD change in BMD 1.98 (p=0.0002) vs 1.68 (p=0.008)). BMD was also more strongly associated with biconcave deformities than either wedge or crush deformities and more so in men than in women. Severity of spinal osteophytosis was not associated with vertebral deformity. In conclusion, femoral neck BMD is at least equivalent to the lumbar spine BMD in strength of association with prevalent vertebral fractures. Spinal osteophytosis falsely elevates BMD without a concomitant decrease in fracture risk, indicating that any interpretation of spinal BMD needs to be adjusted for osteophytosis. These findings support the use of femoral neck bone densitometry in older men and women. Moreover, these data indicate that current criteria for radiological assessment of vertebral deformity are sufficiently loose to include a substantial proportion of non-fractures in the elderly, with important implications for the design of clinical trials. However, irrespective of the criterion used, vertebral deformities in men are at least as common, if not more so, than in women, suggesting that vertebral osteoporotic fractures are overlooked in men.     

爱母分娩工程初探——产程系列服务模式

爱母分娩工程的核心是产时分娩的管理，除医疗技术水平为重要因素外，改善产科系列服务模式，加强孕妇夫妇有关培训与健康教育，加强保健与临床的结合，对爱母分娩工程的作用亦是举足轻重的。广东省妇幼保健院试运行产时分娩管理新模式、产科系列服务新模式，提高了产科质量和社会效益及经济效益。     

左旋多巴对弱视眼视诱发电位影响的研究

目的:探讨左旋多巴治疗弱视的效果。方法:正常眼和弱视眼服用单次剂量左旋多巴前后进行图形视诱发电位(pattem visual evoked poten-tial,PVEP)检测。结果:正常眼服药后中空间频率PVEP的N_1P_1振幅和高空间频率PVEP的P_1N_2振幅增大,弱视眼服药后低空间频率PVEP的N_1波潜伏期和中空间频率PVEP的P_1波潜伏期缩短。结论:左旋多巴可改善弱视眼的视功能,可作为弱视的一种新的治疗方法。眼科学报1997;13:182—185。     

Synthesis of polymers containing pseudohalide groups by cationic polymerization, 13. “Living” polymerization of 2-methylpropene initiated by the system 1,4-bis(1-azido-1-methylethyl)benzene/BCl3/dimethyl sulfoxide

Polymerizations of 2-methylpropene (MP) initiated by the system 1,4-bis(1-azido-1-methylethyl)benzene (DAMEB)/BCl₃ in the presence of DMSO were carried out by “all monomer in” (AMI) technique at ?70°C in CH₂Cl₂ solution. FT-IR, ¹H NMR and SEC analyses of polymers (PMP) showed that the M _n versus weight of PMP plot is a straight line without intercept and azide F_n3 and aromatic ring F_? functionalities are close to the theoretical values of 2 and 1, respectively. A polymerization of MP initiated by the system α,ω-diazido-PMP/BCl₃/DMSO led to a final poly(2-methylpropene) (PMP) with an increase of M _n corresponding to the amount of MP introduced and presenting the same functionalities F_N3 and F_? as the starting PMP. These results indicate that the polymerization system MP/DAMEB/BCl₃/DMSO is a “living” one, because in an acceptably large range of molecular weight (M _n < 50000) the Mayo plot 1/DP versus 1/DP ₀ is a straight line. The intercept gives k_trM/k_p = 4 · 10^?5, showing the transfer reaction proceeds at very low rate.     

IEC-18, a nontransformed small intestinal cell line for studying epithelial permeability.

Small intestinal epithelium is leaky and allows permeation of hydrophilic molecules of various sizes. Passively absorbed hydrophilic permeability probes have been shown to permeate across intestinal epithelium mainly through the paracellular pathways. In this study we introduce microporous filter-grown IEC-18 epithelial cells, a nontransformed small intestinal cell line, as a in vitro model of intestinal epithelium for the study of epithelial permeability. IEC-18 cells, originally derived from native rat ileal crypts, form confluent epithelium when grown on hydrated collagen-coated Millicell-CM permeable inserts (Millipore Corp., Bedford, Mass.). With scanning and transmission electron microscopy, the presence of tight junctions and desmosomes between cells and the development of microvilli at the apical surface were confirmed. Immunofluorescent labeling of ZO-1 proteins and desmoplakins verified the presence of tight-junctional proteins (ZO-1) and desmosomes in the intercellular junctions of confluent IEC-18 epithelium. The net electrical resistance of IEC-18 epithelium (28 omega-cm2) was similar to resistance values obtained from small intestinal tissue with (50 to 100 omega-cm2) or without (20 to 45 omega-cm2) muscularis and serosal layers. Assessment of mannitol and dextran permeation revealed early "maturation" of paracellular pathway, with increasing restriction of permeation to both probes through day 4. Resistance across IEC-18 epithelium also reached plateau levels between 4 and 7 days. Permeability studies with various probes indicate that cross-sectional diameter rather than molecular weight of the probe is the important determinant of permeation rate. IEC-18 epithelium selectively restricted the permeation of probes proportional to probe size; permeation of larger probes such as albumin was negligible. We conclude that cultured IEC-18 epithelial cells, because of their native crypt origin, similarity in resistance to small intestinal epithelia, retention of ability to differentiate into villus-like enterocytes, and permeability characteristics, are a useful model of intestinal epithelium for the study of permeability and paracellular transport.     

Acute localized diverticulitis: Optimum management requires accurate staging

Between 1977 and 1989, 151 patients were treated in our institution for acute sigmoid diverticulitis. Thirty-one patients were operated on for diffuse peritonitis, and were excluded from the study. One hundred twenty patients had localized disease. There were 59 men and 61 women, with a mean age of 60 years (range, 30 to 87 years). Thirteen were under 40 years of age. A phlegmonous diverticulitis (no pericolic abscess) was diagnosed in 78 cases (group I). A pericolic abscess was identified in 42 cases (group II). The medical treatment was successful in 97% of the patients of the group I. Only 15 patients required a delayed elective resection for recurrence or chronic complications, within the next 24 months. There were no operative deaths. All the other patients were doing well after a mean follow-up of 5 years (9–144 months), without any disease-related death. Patients presenting with a localized pericolic abscess (group II,n=42) were initially treated either conservatively (n=22) or by a more or less extensive drainage (n=20). There were two deaths in the conservative group. Primary or delayed colonic resection was indicated in 34 cases because of uncontrolled sepsis, recurrence or secondary chronic complications. It is concluded that accurate classification of the disease is essential. If no peritonitis has developed, the presence of an abscess is the main determinant in both prognosis and treatment. Most patients who develop an acute phlegmonous diverticulitis do well with conservative treatment, and prophylactic resection is not indicated. Curative colectomy is reserved for patients developing persistent complications over the next few months. On the other hand, high rates of recurrence and complication are observed among the patients with a pericolic abscess. Drainage of the abscess, possibly followed by a secondary elective colectomy, could be the appropriate treatment.

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Résumé Entre 1977 et 1989 151 malades ont été traités dans notre institution pour une diverticulite aigue du sigmoide. 31 malades ont été opérés pour une péritonite diffuse et ont été exclus de cette étude. 120 malades avaient une maladie localisée. Il y a avait 59 hommes et 61 femmes d'un âge moyen de 60 ans (30–87 ans). 13 étaient âgés de 40 ans ou moins. Une diverticulite phlegmoneuse (sans abcès péricolique) fut diagnostiquée dans 78 cas (groupe I). Un abcès péricolique a été identifié dans 42 cas (groupe II). Le traitement médical fut couronné de succès chez 97 % des patients du groupe I.15 patients seulement ont nécessité une résection élective retardée pour récidive ou complication chronique dans les 24 mois suivants. Il n'y a pas eu décès opératoire. Tous les autres patients allaient bien après une surveillance moyenne de 5 ans (9–144 mois) sans aucune cause de mort en relation avec la maladie. Les patients présentant un abcès péricolique localisé (groupe II,n=42) furent initialement traités soit conservativement (n=22), soit par un drainage plus ou moins extensif (n=20). Il y eut 2 morts dans le groupe conservatif. Une résection colique d'emblée ou retardée fut indiquée dans 34 cas en raison d'une suppuration incontrôlée, d'une récidive ou de complications chroniques secondaires. On conclut qu'une classification appropriée de la maladie est essentielle. Si il n'y a pas de péritonite, la présence d'un abcès est le principal facteur à la fois de pronostic et de traitement. La plupart des patients qui developpent une diverticulite phegmoneuse aigue vont bien avec un traitement conservateur et la résection prophylactique n'est pas indiquée. La colectomie curative est réservée aux patients qui développent des complications chroniques dans les quelques mois suivants. D'autre part, un pourcentage de récidives et de complications élevé fut observé chez les patients qui avaient un abcès péricolique. Le drainage de l'abcès, eventuellement suivi d'une colectomie élective secondaire, pourrait être le traitement approprié.

     

Transsynaptic degeneration of motoneurones caudal to spinal cord lesions

We studied the effects of complete transversal section of the spinal cord, at T8-10, in adult rats, upon the number and morphology of identified motoneurones in lumbar segments L4 and L5. In observations by light and electron microscopy many lumbar motoneurones had structural abnormalities when the interval between surgery and perfusion ranged between a few hours and one week. We found also that as many as 25% of the motoneurones distal to a cord transection disappeared as a consequence of the lesions. We did not find comparable changes in the spinal cord at C6 after transection at T8-10. Complete removal of the cerebellum did not reduce the lumbar motoneurone counts. Bilateral ablation of the "motor" cortex did cause a reduction of motoneurone counts at L4-5; these animals showed normal or near normal spontaneous locomotor activity beginning a few days after the lesion was placed. Motoneurone counts were significantly reduced after partial cord lesions that spared the dorsal funiculi (where the corticospinal tract travels in the rat), but in this case the rats were paraplegic as a result of the lesion. Cord transection at 7 days of postnatal age resulted in reduced motoneurone counts when the rats reached adulthood. Intraspinal or subarachnoid administration of colchicine led to reduced motoneurone counts. Prolonged infusion of a GABA agonist, muscimol, into the lumbar CSF did not prevent the loss of motoneurones produced by cord transection. Pretreatment of animals with a Ca2+ channel blocker (nimodipine) did not prevent the effects of cord transection.(ABSTRACT TRUNCATED AT 250 WORDS)     

The retinal nerve fiber layer in normal and glaucomatous eyes. II. Correlations

The retinal nerve fiber layer is different in normal and glaucomatous eyes. We correlated semi-quantitative data of the retinal nerve fiber layer of 398 eyes with chronic primary open-angle glaucoma and of 234 normal eyes with the intra- and parapapillary morphometric signs and with the perimetric indices. The three parameters "sequence of the fundus sectors concerning the best visibility of the retinal nerve fiber bundles", "visibility of the nerve fiber bundles", and "localized defects" were significantly (p less than 0.001) correlated to 1) area of the neuroretinal rim as a whole and in four different optic disc sectors, 2) neuroretinal rim width determined every 30 degrees, 3) optic cup area, diameters and form, 4) horizontal and vertical cup/disc ratios and the quotient of the horizontal to vertical cup/disc ratio, 5) area and width of zone "Alpha", zone "Beta", and the total parapapillary chorio-retinal atrophy, 6) diameter of the retinal vessels, 7) grade of a "tesselated fundus", and 8) the visual field loss. If only the inferior temporal and the superior temporal sectors were considered, the retinal nerve fiber bundles were less visible in that sector with the largest notch in the neuroretinal rim, the smaller neuroretinal rim area and width, the thinner retinal vessels, and the larger zone "Alpha", zone "Beta", and total parapapillary chorio-retinal atrophy. The glaucomatous changes in the retinal nerve fiber layer are correlated in time and location with the intra- and parapapillary and the perimetric alterations. Evaluation of the retinal nerve fiber layer is a useful method to detect a glaucomatous optic nerve damage.(ABSTRACT TRUNCATED AT 250 WORDS)