Massive acroosteolysis in adult T-cell leukemia/lymphoma

Adult T-cell leukemia/lymphoma is a relatively uncommon disease, most often found in Japan, the Caribbean, the southeastern United States, and South America. To date there have been few reports of its skeletal manifestations. A case is reported in a 44-year-old man in which a short history of swelling of the hands and feet and painful motion in the fingers was followed by the rapid development of severe acroosteolysis.     

羟基磷灰石溶解度等温线的测定

目的：应用微量添加固体滴定和激光散射法测定HA(37℃)溶解度等温线。方法：滴定物为HA。半导体二极管激光为发射光源，散射光源探测器用于监测超过溶解平衡点出现的沉淀。微量添加固体滴定所引发的沉淀引起散射光源显著且恒定地高于基线，由此判断溶液已处于过饱和状态，该固体滴定总量用于代表溶解度等温线的数据点。结果：HA溶解度等温线(37℃)由6次滴定合共50个滴定终点构成。与传统方法所得结果比较，本实验所得HA的溶解度约为过往结果的百份之一。结论：微量添加固体滴定和激光散射法利于研究HA的溶解平衡且能得到准确的HA溶解度等温线。     

前路与后路腰椎间盘切除后Cage植入治疗与射频治疗改善椎间盘源性下腰痛的效果比较

目的:比较采用射频疗法与前路和后路椎体间融合术治疗椎间盘源性下腰痛疗效差别。方法:①于1999-01/2005-08在解放军总医院骨科、北京大学第三医院骨科有完整临床资料的椎间盘源性腰痛患者53例,男33例,女20例;年龄33～58岁。纳入对象影像学检查显示无明显神经根受压、腰椎不稳等其他腰椎疾病;符合国际疼痛学会1988年制定的椎间盘造影阳性标准;均对治疗方案知情同意。②所有入选病例依据治疗方法不同分为3组:射频组21例:行经皮穿刺射频汽化成型术;前路椎体间融合组14例:行腹膜外椎间盘切除、Cage植入、结合后路经椎板关节突螺钉固定、髂骨取骨植骨融合术;后路椎体间融合组18例:行后路椎间盘切除、椎间Cage植入结合椎弓根螺钉内固定后外侧植骨融合术。③统计手术时间和出血量,术后1年进行放射学评估融合情况。采用目测类比评分评估患者疼痛程度(无痛为0分,腰痛到无法忍受的最大程度为10分)。参照Oswestry功能障碍指数评估患者腰部功能恢复程度(分值越高表示功能受限程度越重)。分别于术前、术后1年进行评分。改善率=[(术前评分-术后评分)/术前评分]×100%。分级标准,优:改善率≥75%。良:改善率50%～75%;可:改善率25%～50%;差:改善率<25%。④计量资料差异比较采用连续型重复测量资料的方差分析。结果:椎间盘性下腰痛患者53例均进入结果分析。①手术时间和出血量比较:后路椎体间融合组手术时间和手术出血量明显长于/高于其他2组(P<0.05),射频组明显短于/小于前路椎体间融合组(P<0.05)。②术后疼痛改善情况:射频组良9例,可10例,差2例;前路椎体间融合组和后路椎体间融合组疼痛评分改善均为优。射频组目测类比评分改善率明显低于其他2组(P<0.05)。③术后功能改善情况:射频组良5例,可13例,差3例;前路椎体间融合组优12例,良2例;后路椎体间融合组优6例,良12例。射频组Oswestry功能障碍指数改善率明显低于前、后路椎体间融合组(P<0.05),前路椎体间融合组Oswestry功能障碍指数改善率明显高于后路椎体间融合组(P<0.05)。④椎体融合情况:前、后路椎体间融合组术后1年椎体融合率均为100%。结论:射频治疗创伤小但疗效差,前路椎间盘切除Cage植入结合后路经椎板关节突螺钉固定与后路椎间盘切除椎间融合结合椎弓根固定可明显改善疼痛,前者创伤相对小,功能恢复更好,是治疗椎间盘源性腰痛的最佳选择。     

自体骨髓间充质干细胞治疗脊髓损伤疗效观察

目的:观察自体骨髓间充质干细胞移植治疗脊髓损伤患者的近期疗效及其安全性。方法:选择2005-04/2006-02在山东省残疾人康复中心住院的脊髓损伤患者24例,采用随机表法分为治疗组和对照组。患者知情同意并签署知情同意书。治疗组11例,对照组13例,均经CT或MRI确诊并行手术治疗。两组在年龄、病程、损伤程度(ASIA分级)等方面均具有可比性(P>0.05)。治疗组在综合康复治疗的基础上给予自体骨髓间充质干细胞治疗,经髂骨穿刺采集自体骨髓156～180mL,分离提取骨髓间充质干细胞后经静脉途径和/或蛛网膜下腔1次性或分次注射。对照组仅给予综合康复治疗。两组均于入院当天、治疗后7,15,30,60,90d进行运动与感觉、日常生活能力、膀胱功能评定。结果:24例患者均进入结果分析。①治疗组11例患者均有不同程度的感觉、运动和自主神经功能改善,与对照组比较,差异不显著。②治疗组ASIA分级A级8例,有2例在第60天、1例在第90天评估中恢复为B级。C级1例,在第30天评估中恢复为D级,第90天评估中恢复为E级,能独立行走,生活完全自理。D级2例,其中1例在第90天评估中恢复为E级。对照组A级9例,1例在第90天评估中恢复为B级。B级1例,治疗后无变化。C级2例,1例在第90天评估中恢复为D级。③骨髓间充质干细胞移植常见的不良反应包括低热(7/11例)、头痛(2/11例)、腹胀(1/11例),其中1例于蛛网膜下腔注射后出现双下肢麻木和脑膜刺激征,均于两三天内自行消失。结论:骨髓间充质干细胞移植治疗脊髓损伤近期有一定疗效而且安全,但远期疗效有待于进一步观察。     

Dutch Physiotherapy Guidelines for Low Back Pain

Many guidelines for the management of low back pain in primary care have been published during recent years, but guidelines for physiotherapy do not yet exist. Therefore, physiotherapy guidelines have been developed, reflecting the consequences of the current state of knowledge of effective and appropriate physiotherapy for low back pain. They aim to improve the efficiency and effectiveness of physiotherapeutic care for patients with low back pain.The guidelines were constructed on the basis of the phases of the physiotherapy process, using the Dutch method of developing physiotherapy guidelines. Scientific evidence of systematic reviews was used as the basis for the recommendations. A computerised literature search of Medline, Cinahl, the Cochrane Database of Systematic Reviews and the Database of the Dutch National Institute of Allied Health Professions was conducted to identify relevant systematic reviews. If no evidence was available, consensus between experts was obtained.The guidelines were pilot tested among one hundred physiotherapists and reviewed by an external multi-disciplinary panel.The guidelines recommend that the diagnostic process should focus on disability and participation problems resulting from back pain. The treatment should consist of an active approach, in which the patients learn to take control over their back pain. For patients with a normal course, where activities and participation gradually increase, reassurance, adequate information and advice to stay active are the most important recommendations. For patients with an abnormal course, where activities and participation do not increase, exercise therapy should also be provided, with a behavioural approach if necessary.These are the first national physiotherapy guidelines for low back pain. The recommendations are largely in line with other primary care guidelines for low back pain. Implementation will be a major challenge for the near future.     

Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births

Objective  To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care.
Design  A nationwide cohort study.
Setting  The entire Netherlands.
Population  A total of 529 688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321 307 (60.7%) intended to give birth at home, 163 261 (30.8%) planned to give birth in hospital and for 45 120 (8.5%), the intended place of birth was unknown.
Methods  Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics.
Main outcome measures  Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit.
Results  No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16).
Conclusions  This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.     

人骨关节炎滑膜组织cDNA文库的构建及分析

目的:构建骨关节炎滑膜组织的cDNA文库,为筛选与骨关节炎的发生特异相关的基因及探讨骨关节炎发病机制奠定基础。方法:实验于2006-01/10在深圳市人民医院骨关节科完成,选取骨关节炎患者滑膜,以Trizol一步法从骨关节炎滑膜组织中提取总RNA,分离纯化mRNA,反转录合成双链cDNA,以pBlueScriptII为载体,构建关节炎滑膜组织cDNA文库,对随机挑取的克隆进行鉴定。结果:①总RNA及mRNA的质量:总RNA经分光光度计测定,测得mRNA的A260nm吸光度值为0.245,平均得率为0.45g/L,A260nm/A280nm=1.84,无DNA、蛋白质及小分子污染。符合建库要求。②cDNA的合成及分析:10μg mRNA反转录合成cDNA,合成的cDNA大小为0.5￣9.0kb,且主要集中在1.0￣2.0kb之间。③文库的鉴定:将50ng的cDNA与质粒载体pBlueScriptII连接过夜,采用电转化法转化受体菌DH5A,经稀释铺板测定原始文库的滴度为1.45×109pfu/L,总克隆数为4.6×105,重组率为96.2%,扩增后文库总滴度为6.4×1012pfu/L,插入片段多分布在0.5～2.6kb之间。结论:构建关节炎滑膜组织cDNA文库具有较好的库容量、较高的重组率以及较大的插入片段,为克隆关节炎相关功能基因的研究奠定了基础。