ORIGINAL ARTICLE: Long-term outcomes of vertebroplasty for osteoporotic compression fractures

Introduction: This study aimed to determine outcomes of percutaneous vertebroplasty for osteoporotic vertebral compression fractures (VCFs). Methods: Prospective assessment of short-term (≤6 weeks), medium-term (6 months) and long-term (29 months) outcomes of vertebroplasty, followed by a retrospective long-term follow-up of patients treated with vertebroplasty compared with conservative therapy. Outcomes measured were visual analogue scale pain scores, analgesic use, disability scores using the Roland Morris Disability questionnaire and a number of new VCFs. Results: In 27 patients with acute VCFs followed prospectively, vertebroplasty resulted in significant reductions in pain levels (56-mm reduction on a 100-mm scale) and disability scores (11.8-point reduction on a 24-point scale) at all follow-up points up to a mean of 29 months compared with pre-vertebroplasty levels (P < 0.001). Analgesic use was significantly less intense in the short and medium term after vertebroplasty (P < 0.005). In 25 patients who had vertebroplasty for VCF, a sustained reduction in all outcomes was demonstrated at a mean follow-up of 30 months, with less pain, significantly lower disability scores (P < 0.05) and less analgesic use (P < 0.05) compared with nine conservatively treated subjects. During the follow-up period, six new VCFs occurred in 4/25 vertebroplasty patients compared with four new VCFs in 2/9 control subjects. Conclusions: Vertebroplasty provides significant and clinically meaningful reductions in pain, analgesic use, and disability in the short, medium and long term. Compared with conservative therapy, vertebroplasty provides significantly greater functional improvement and reduction in analgesic use. The procedure is relatively safe with no clearly increased risk of new vertebral fractures.     

高位腰椎间盘突出症9例

1 临床资料高位腰椎间盘突出9(男7,女2)例,年龄18～72(平均49)岁,病程8～36(平均15) mo. 均有腰背痛,但无明确压痛点. 伴有大腿前方痛、股四头肌肌力减退、膝反射减弱5例,坐骨神经痛、足拇背伸肌力减退、跟腱反射减弱3例,直腿抬高试验阳性4例,2例跟臀试验阳性. 均经腰椎正侧位X线平片及CT,MRI检查、腰椎管造影而确诊.     

豆豉多糖对实验性糖尿病小鼠血糖的活性作用

目的:观察豆豉中的多糖类成分对正常小鼠和糖尿病小鼠血糖的影响,探讨其降血糖的活性作用。方法:实验于2006-03/06在华北煤炭医学院药学系实验室完成。选用雄性小白鼠130只,分为3部分进行实验。①治疗性给予豆豉多糖:取30只小鼠制作糖尿病模型。造模成功后随机平均分为模型组、低剂量给药组和高剂量给药组,另取10只作为空白对照组。低剂量和高剂量给药组小鼠分别灌胃豆豉多糖200mg/(kg·d)和400mg/(kg·d),模型组灌胃等体积的生理盐水,空白对照组不采取任何措施。给药4d和7d后测定各组小鼠的血糖水平。②豆豉多糖对正常小鼠血糖的影响:取30只小鼠随机平均分为对照组、低剂量给药组和高剂量给药组。低剂量和高剂量给药组小鼠分别灌胃豆豉多糖200mg/(kg·d)和400mg/(kg·d),对照组灌胃等体积的生理盐水,连续7d。末次给药2h后测定各组小鼠血糖水平。③预防性给予豆豉多糖:取30只小鼠随机平均分为对照组、低剂量给药组和高剂量给药组。低剂量和高剂量给药组小鼠分别灌胃豆豉多糖200mg/(kg·d)和400mg/(kg·d),对照组灌胃等体积的生理盐水,连续4d。灌胃结束后,腹腔注射四氧嘧啶200mg/(kg·d),3d后测定各组小鼠血糖及血清超氧化物歧化酶活性。结果:实验共纳入130只小鼠全部进入结果分析。①治疗性给予豆豉多糖对糖尿病模型小鼠血糖的影响:豆豉多糖灌胃后,模型组小鼠的血糖水平明显高于空白对照组(P<0.01)。给药4d时,高剂量和低剂量给药组与模型组比较,差异有显著性意义(P<0.01,0.05)。在给药7d后,随着多糖浓度的提高,血糖下降越明显,并呈现一定剂量-效应关系。②豆豉多糖对正常小鼠血糖的影响:豆豉多糖可明显降低正常小鼠的血糖水平(P<0.01)。③预防性给予豆豉多糖对糖尿病小鼠血糖及超氧化物歧化酶活性的影响:预防性给予小鼠豆豉多糖有明显的降血糖作用(P<0.01),说明豆豉多糖对糖尿病有一定的预防作用。与对照组比较,豆豉多糖可明显增加小鼠血清超氧化物歧化酶含量,提高超氧化物歧化酶活性。结论:豆豉多糖具有一定的降血糖作用。     

Benzodiazepines inhibit the rate of neutrophil apoptosis

Background Benzodiazepines, which are commonly administered perioperatively, can depress immune function. Neutrophil apoptosis plays a central role in the regulation of inflammation. This is particularly important during and after surgery. Aim To examine the effects of benzodiazepines (midazolam and diazepam) on neutrophil apoptosis. Methods Venous blood samples were withdrawn from patients scheduled to undergo elective surgery, (a) immediately prior to, and 10 minutes after administration of midazolam 0.2mg/kg intravenously (n=11) and (b) immediately prior to, and 60 minutes after administration of diazepam 10mg po (n=10). Neutrophil apoptosis was measured by Annexin VFITC after 1 and 12 hours in culture. Results The percentage of apoptotic cells was significantly less after midazolam at 12% (11.9) hours in culture compared to pre-midazolam 29.7% (13.3) (p<0.05). After diazepam, the rates of neutrophil apoptosis were also significantly less after 12 hours in culture (p<0.05). Conclusion Administration of benzodiazepines in clinically relevant doses inhibits neutrophil apoptosis. In the perioperative period, this may influence the inflammatory response to surgery.     

Antitrust aspects of exclusive contracts in medical imaging

Exclusive contracts between radiologists and hospitals may be more frequently scrutinized for antitrust violations because of the Hyde v Jefferson Parish Hospital District No. 2 case. In the Hyde case, the lower court decided antitrust law had been violated, and it was the first antitrust case about exclusive medical contracts to be reviewed by the U.S. Supreme Court. The case is a precedent for considering similar circumstances according to traditional business antitrust analyses such as per se violations, tying arrangements, group boycott, and market foreclosure. Areas that may be scrutinized for anticompetitiveness include hospital privileges when radiologists have exclusive contracts with the community's only hospital or provide services unique within an area, and physicians' access to scarce resources (e.g., computed tomography [CT], magnetic resonance [MR] imaging). Radiologists must understand antitrust implications of their hospital contracts; examine the terms of staff appointment, bylaws, and rights; and be able to guide their attorneys through contract negotiations.     

A proposed UVR protection factor for sunglasses

Solar ultraviolet radiation (UVR) has been long suspected as a causative factor in the aetiology of cataracts and recent scientific evidence has reinforced this viewpoint. The public and, in particular, outdoor workers need to take positive action to protect their eyes and the wearing of sunglasses can provide this protection. The Standards Association of Australia (SAA) has issued a standard covering the transmission requirements of sunglasses¹ (AS 1067 – 1990) and sunglasses complying with this standard offer substantial protection against ambient solar UVR. However, many sunglasses offer additional protection above that required by the standard. A UVR protection factor for sunglasses, analogous to the sun protection factor (SPF) for sunscreens, would allow the public to make an informed choice when purchasing sunglasses. Measurements of the transmittance of more than 250 pairs of sunglasses and protective eye wear have been made at the Australian Radiation Laboratory. Convolution of the spectral effectiveness of UVR on the eye (action spectrum) with the solar spectrum and the sunglass transmittance can give an estimate of the amount of protection different sunglasses offer. This method provides the means for rating sunglasses and producing the relevant protection factors. Calculations show that the concept of protection factor is viable for the different sunglass types.