Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up

This study is a prospective, consecutive, 3-year cohort study of women with back pain in an index pregnancy. The aim was to describe the physical status and disability among women with back pain 3 years after delivery. Pain was identified as lumbar back pain, posterior pelvic pain or combined lumbar as well as posterior pelvic pain. Previous studies have established that all three types of pain can be reduced by structured physiotherapy during pregnancy, and the beneficial effect may last for several years. Though it is known that some women have residual pain for a long time, the relative incidence of the three pain types and their degree of disability associated with each have never been reported. Neither has any study presented findings of a physical examination of women 3 years post partum with a focus on the type of pain. All women who were registered as having experienced back pain during an index pregnancy were interviewed by mail 3 years post partum. Women who had residual back pain filled in an additional questionnaire and were physically examined. Out of 799 pregnant women, 231 had some type of back pain during the index pregnancy, and 41 women had pain 3 years later. Women with combined lumbar and posterior pelvic pain were significantly more disabled ( P<0.05) and had significantly lower endurance in the lumbar back and hip abduction muscles ( P<0.01). Some 5% of all pregnant women, or 20% of all women with back pain during pregnancy, had pain 3 years later. The key problem may be poor muscle function in the back and pelvis.     

Percutaneous endoscopic lumbar discectomy for migrated disc herniation: classification of disc migration and surgical approaches

Percutaneous endoscopic lumbar discectomy (PELD) for migrated disc herniations is technically demanding due to the absence of the technical guideline. The purposes of this study were to propose a radiologic classification of disc migration and surgical approaches of PELD according to the classification. A prospective study of 116 consecutive patients undergoing single-level PELD was conducted. According to preoperative MRI findings, disc migration was classified into four zones based on the direction and distance from the disc space: zone 1 (far up), zone 2 (near up), zone 3 (near down), zone 4 (far down). Two surgical approaches were used according to this classification. Near-migrated discs were treated with "half-and-half" technique, which involved positioning a beveled working sheath across the disc space to the epidural space. Far-migrated discs were treated with "epiduroscopic" technique, which involved introducing the endoscope into the epidural space completely. The mean follow-up period was 14.5 (range 9-20) months. According to the Macnab criteria, satisfactory results were as follows: 91.6% (98/107) in the down-migrated discs; 88.9% (8/9) in the up-migrated discs; 97.4% (76/78) in the near-migrated discs; and 78.9% (30/38) in the far-migrated discs. The mean VAS score decreased from 7.5 +/- 1.7 preoperatively to 2.6 +/- 1.8 at the final follow-up (P < 0.0001). There were no recurrence and no approach-related complications during the follow-up period. The proposed classification and approaches will provide appropriate surgical guideline of PELD for migrated disc herniation. Based on our results, open surgery should be considered for far-migrated disc herniations.     

Effects of the bone morphogenetic protein binding protein spp24 (secreted phosphoprotein 24 kD) on the growth of human lung cancer cells

Bone morphogenetic proteins (BMPs) and transforming growth factor‐beta (TGF‐β) contribute to the growth of some skeletal metastases through autocrine stimulation. Secreted phosphoprotein 24 kDa (spp24) has been shown to bind to both BMP‐2 and TGF‐β and to markedly inhibit the osteogenic properties of rhBMP‐2. We hypothesized that the addition of spp24 would sequester autocrine growth factors (especially BMP‐2) and reduce tumor growth in a system (A549 human non‐small cell lung cancer cell line) where autocrine stimulation by BMP‐2 is known to be important. A549 cells were injected into two sites (subcutaneous and intraosseus) in SCID mice with and without the co‐injection of BMP‐2 and spp24. Tumor growth after 8 weeks was assessed through gross examination, radiological imaging, and histological analysis. Spp24 attenuated the tumor growth enhancing effects of rhBMP‐2 and reduced the tumor growth when added to tumor cells that were not treated with BMP‐2. We conclude that spp24 can reduce A549 cell tumor growth in both soft tissue and intraosseus environments. We hypothesize that the mechanism for this inhibition is interruption of autocrine stimulation through the sequestration of BMP‐2. Spp24 can be developed into a therapeutic agent that can be employed in clinical situations where the inhibitions of BMPs and related proteins is advantageous. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29:1712–1718, 2011     

Selective blocking laminoplasty in cervical laminectomy and fusion to prevent postoperative C5 palsy

BACKGROUND CONTEXT

Cervical laminectomy and fusion (CLF) is a common surgical option for multilevel cord compression. Postoperative C5 palsy occurrence after CLF has been a vexing problem for spine physicians. The posterior shift of the cord following laminectomy has been implicated as a major factor for postoperative C5 palsy, but attempts by spine surgeons to mitigate excessive shift while providing sufficient decompression have not been well reported.

Impact of the Reconstruction Material on the Patency of Middle Hepatic Vein in Living Donor Liver Transplantation Using the Right Liver

BackgroundA right liver graft with middle hepatic vein (MHV) reconstruction is the standard graft for adult-to-adult living donor liver transplantation (LDLT). The patency of reconstructed MHV affects the recovery and regeneration of graft. The aim of the study is to evaluate the patency rate of reconstructed MHV according to the reconstruction material in LDLT using the right liver.MethodsThe data was collected retrospectively on 521 patients who underwent LDLT with right liver graft form August 2003 to December 2012 at the Seoul St. Mary’s Hospital in Seoul. Two serial comparisons were performed. At first, patients were divided into 2 groups: biologic graft group (n = 252) and synthetic graft group (n = 177). Second, patients were divided into 6 groups: No MHV reconstruction (n = 92); MHV was reconstructed by greater saphenous vein (GSV) (n = 20); recipient’s portal vein (PV) (n = 219); cryopreserved iliac artery (CIA) (n = 2); cryopreserved iliac vein (CIV) (n = 11); polytetrafluoroethylene (PTFE) graft (n = 105); and polyethylene terephthalate (PETE) graft (n = 72). We compared the patency of reconstructed MHV among these groups by computed tomography angiography at 7 days, 20 days, 90 days, and 1 year.ResultsAt the first comparison, the patency rate of the biologic graft group on the seventh postoperative day was 61.9%, and the synthetic graft group was 72.4% (P = .029). At postoperative 1 year, the patency rate of the biologic graft group was 42.9%, and the synthetic graft group was 24.1% (P = .001). At the second comparison, the MHV patency of GSV, PV, CIA, CIV, PTFE, and PETE was 65.0%, 62.5%, 50%, 63.6%, 75%, 72% on the seventh postoperative days (P = .318); 60%, 57.1%, 50%, 54.5%, 69%, 55.6% on the 20th postoperative days (P = .444); 40%, 48.8%, 50%, 27.3%, 47%, 34.1% on the 90th postoperative days (P = .294); and 30%, 45.2%, 50%, 27.3%, 27%, 26.4% at 1 postoperative year (P = .008).ConclusionAlthough there was no statistical difference in comparison of each material, there were significant differences in MHV patency rates between the biologic and the synthetic group. Therefore, the synthetic graft could be considered in living donor liver transplantation with MHV reconstruction.     

Target Tracking Based on Biological-Like Vision Identity via Improved Sparse Representation and Particle Filtering

To effectively track targets under partial occlusion and illumination variation, an improved target tracking method based on combination of sparse representation and particle filtering is proposed in this paper. We regard the candidate target particle set as redundant dictionary and the target template as observation signal to reduce the computational complexity and enhance the real-time performance of target tracking. Besides, to enhance tracking robustness for better adaption to illumination and occlusion, the density histogram, local binary pattern feature fusion, trivial templates and energy control parameters are also utilized in this study. Finally, extensive simulation experiments under different circumstances show that the proposed method performs better compared with other methods, and the average computation time decreases greatly.     

AN EPIDEMIC OF PLEURISY AMONGST MILITARY RECRUITS

An epidemic amongst recruits who presented with acute viral exudative pleural effusion with lymphocytic pleocytosis is analysed. Histologic and bacteriologic proof of tuberculosis was lacking in majority. Most of them recovered without pleural thickening. Overcrowding, inadequate clothing protection, stress and strain of vigorous recruit training could be important precipitating factors. None reported with parenchymal tuberculosis in two year follow up.KEY WORDS: Pleural effussion, Viral     

慢性支气管炎性急性发作期危重病人外周血B和T细胞CD分子的检测

目的 对慢性支气管炎急性期和缓解期患者外周血B细胞和T细胞CD分子检测并了解其变化。方法 用荧光单抗CD19^ 、CD4^ 、CD8^ ／CD28^ 对B细胞和T细胞亚群进行标记和记数。结果 慢性支气管炎急性发作期患者与缓解期患者相比,体内辅助性T淋巴细胞无明显变化,抑制性T淋巴细胞增加,细胞毒性T淋巴细胞减少,B淋巴细胞二者间无差异。结论 因慢性支气管炎急性期危重病人T淋巴细胞亚群变化,造成免疫功能紊乱。因此,在治疗疾病过程中,除对症处理外,另须配合使用提高免疫功能的药物,改善免疫功能。