Percutaneous endoscopic laser annuloplasty for discogenic low back pain

BackgroundLaser-assisted spinal endoscopy (LASE) kit has been used for percutaneous intradiscal decompression to evaporate and shrink the posterior and central nucleus for improvement of leg and radicular pain due to contained disc herniation. Percutaneous endoscopic laser annuloplasty (PELA), a new minimally invasive technique, uses LASE to directly coagulate the inflamed disc granulation tissue associated with annular tears. The small diameter of the endoscope including Ho:YAG laser, irrigation, and light, plus the extreme posterolateral approach into the posterior annulus, enables one to minimize damage to normal nuclear tissue. The authors sought to demonstrate the safety and efficacy of PELA for controlling discogenic low back pain (DLBP) due to abnormal disc tissues, new vessels, and nerves in the central torn posterior annulus.MethodsClinical outcomes of PELA were investigated in patients having DLBP with an annulus-torn degenerative disc or contained disc herniation. Thirty patients treated at a single level and achieving a mean follow-up of 9.7 months were analyzed. Outcomes were assessed using the visual analog scale (VAS) for back pain, the Korean Oswestry Disability Index (KODI), and the modified Macnab's criteria.ResultsThe mean back pain VAS score improved from 8.0 to 2.4, and the mean KODI score improved from 79.0 to 22.4 (P < .001). Results by the modified Macnab's criteria also showed a good outcome, with a success rate of 90.0%. There were no serious complications observed during follow-up.ConclusionsPercutaneous endoscopic laser annuloplasty using the Ho:YAG laser provides favorable outcomes for carefully selected groups of patients with DLBP.     

Impact of recurrent disease and chronic allograft nephropathy on the long‐term allograft outcome in patients with IgA nephropathy

Although recurrent IgA nephropathy (IgAN) may lead to graft dysfunction after transplantation, donation from living related donor (LRD), with whom the risk of recurrence may be higher, is not a contraindication. Herein, we evaluated the natural history of allograft in recipients with IgAN and the risk factors influencing long‐term allograft outcome. Recurrence rate and graft survival were assessed retrospectively in 221 IgAN patients, including transplants from 139 LRDs (62.9%). Ten‐year cumulative rate for recurrent IgAN was 30.8%. The operation at younger age and donation from LRD were significant for the recurrence by multivariate analysis. Ten‐year graft survival was affected by recurrent IgAN (61.0% in recurrent IgAN group vs. 85.1% in nonrecurrent, P < 0.01). However, transplants from LRDs did not show poor graft survival when compared with those from other types of donors. In transplants from LRDs, the incidence of chronic allograft nephropathy (CAN) was lower than those in grafts from deceased donors (10.8% vs. 19.5%, P < 0.05). When CAN was considered in addition to recurrence, the variance of graft survival was affected significantly by the development of CAN than by the recurrence. These results suggest that the detection and adequate management of CAN could improve graft outcome in transplant recipients with IgAN.     

BsmI,TaqI, ApaI and FokI polymorphisms in the vitamin D receptor (VDR) gene and risk of fracture in Caucasians: A meta-analysis

ContextVitamin D receptor (VDR) gene polymorphisms have been strongly associated with bone mineral density in some studies. However, in a recent meta-analysis, no relationship of the VDR BsmI or TaqI polymorphism and fracture risk was found in the meta-analysis of published data.Objective and designOur meta-analysis studied whether a relationship exists between BsmI, TaqI, ApaI and FokI polymorphisms in the VDR gene and risk of fracture.Data sourcesRelevant studies were identified from the following electronic databases: MEDLINE, EMBASE and Current Contents before January 2010.Data synthesisThis meta-analysis included 17 studies with a total of 21 eligible comparisons, which included 2112 fracture cases and 4521 controls. All of these studies reported on Caucasians. The combined results based on all studies showed that fracture cases had a significantly lower frequency of bb genotype of BsmI [odds ratio (OR) = 0.87, 95% confidence interval (CI) = 0.76, 0.98]. When stratifying by fracture type, we found that (1) hip fracture cases had a significantly lower frequency of bb genotype of BsmI (OR = 0.82, 95% CI = 0.70, 0.97); (2) hip fracture cases had a significantly lower frequency of Tt genotype of TaqI (OR = 0.65, 95% CI = 0.43, 0.97); (3) hip fracture cases had a significantly higher frequency of tt genotype of TaqI (OR = 1.74, 95% CI = 1.05, 2.91); (4) vertebral fracture cases had a significantly higher frequency of Aa genotype of ApaI (OR = 1.63, 95% CI = 1.03, 2.59). No significant difference was found in any genotype of FokI.ConclusionOur meta-analysis suggests that there is a modest but statistically significant association between the BsmI bb genotypes and fracture.     

两种内固定方法治疗髌骨下极粉碎性骨折的病例对照研究

目的:对比研究张力带联合髌骨环扎、记忆合金聚髌器固定两种方法治疗髌骨下极粉碎性骨折疗效。方法:2015年7月至2019年7月收治60例髌骨下极骨折患者,根据手术方式的不同分为两组,A组30例采用记忆合金聚髌器(NiTi-PC)固定,男17例,女13例,年龄20～71(39.4±9.9)岁,其中摔伤19例,交通伤9例,运动伤2例,受伤至手术时间10～75(33.1±7.8)h;B组30例采用张力带加环扎固定,男15例,女15例,年龄21～76(38.6±10.2)岁,其中摔伤17例,交通伤12例,砸伤1例,受伤至手术时间10～91(34.5±9.1) h。观察对比两组患者的疗效。结果:60例患者均获随访,随访时间9～30个月。两组术中出血量、手术时间、随访时间及骨折愈合时间比较差异无统计学意义。术后6个月按照膝关节Bostman功能评分:A组30例(28.6±4.7)分,其中优26例,良4例;B组30例(25.5±4.4)分,其中优20例,良8例,差2例;两组Bostman总评分和疗效评价结果比较差异均有统计学意义(P0.05),A组评分明显优于B组。B组有1例出现克氏针退针,2例关节僵硬,3例出现内固定激惹。结论:记忆合金聚髌器治疗髌骨下极骨折内固定坚强可靠,术后能早期行康复功能锻炼,关节功能及活动度恢复好,并发症少。     

VEGF基因体外转染大鼠骨髓间充质干细胞的实验研究

目的:探讨脂质体介导血管内皮细胞生长因子(VEGF)基因转染大鼠骨髓间充质干细胞(MSCS)应用于基因治疗的可行性、安全性。方法:体外分离、培养、鉴定MSCs,PcDNA3.1(-)/VEGF165质粒转染MSCs,转染后用免疫荧光和ELISA检测MSCs表达VEGF蛋白的情况,MTT检测MSCs对VEGF质粒转染的敏感性。结果:骨髓中分离得到MSCs,流式细胞检测显示MSCs不表达CD34和CD45,但表达CD90。透射电镜观察可见细胞浆中含大量粗面内质网和分泌颗粒。VEGF基因转染MSCs后第5天抗VEGF免疫荧光染色约90%的MSCs呈阳性,ELISA检测结果显示PcDNA3.1(-)/VEGF165质粒转染组细胞培养上清液中VEGF含量明显高于对照组,并于转染后第5天达到峰值。MTT检测结果显示VEGF质粒转染对MSCs增殖无影响。结论:MSC可作为VEGF基因转染的靶细胞用于基因治疗。     

磁共振成像在肝移植术后并发症诊断中的应用

目的探讨磁共振成像在肝移植并发症诊断中的价值。方法回顾分析11例肝移植术后发生并发症者的磁共振检查影像资料。结果11例患者术后出现皮肤和巩膜黄染、发热以及尿黄等症状，丙氨酸转氨酶、天冬氨酸转氨酶、γ-谷氨酰转移酶和胆红素升高．经B型超声波检查不能明确原因，采用磁共振（MRI、MRA和MRCP）检查，明确肝动脉吻合口狭窄1例；肝动脉闭塞2例；下腔静脉吻合口狭窄及血栓形成各1例；胆管吻合口狭窄4例，其中1例伴胆汁瘤形成；肝门水平非吻合口狭窄6例；肝坏死2例；肝包膜下血肿及右肾上腺出血各1例；均显示不等量的右侧胸腔积液、腹腔积液及肝门部水肿。结论磁共振一次检查可显示肝内外的多种结构，能为肝移植术后并发症的诊断提供丰富的肝脏、血管、胆道以及肝外结构的图像信息。     

转化生长因子-β1对肌腱腱鞘、腱外膜和腱内膜细胞增殖和胶原产生的影响

目的 探讨兔屈趾肌腱腱鞘、腱外膜和腱内膜细胞增殖、胶原产生和转化生长因子（TGF）-β1对细胞的增殖和胶原产生的影响。方法 从兔屈趾肌腱分离腱鞘、腱外膜和腱内膜细胞并培养，在使用TGF-β1培养后，细胞的数量和胶原产生量被测量，并与不使用TGF-β1培养的对照组比较。另外，通过逆转录-聚合酶链反应（RT-PCR）测定使用TGF-β1前后各种细胞Ⅰ型胶原基因的表达。结果 所有3种细胞均可以产生Ⅰ、Ⅱ、Ⅲ型胶原组织，TGF-β1使培养的细胞数量降低，但能显著性地增加Ⅰ、Ⅱ、Ⅲ型胶原组织产生和Ⅰ型胶原基因的表达（P〈0．05）。结论 调节TGF-β1的水平能调节胶原组织的产生，可能为临床上防止肌腱粘连提供新的途径。     

APCDD1在直肠癌及结直肠腺瘤中的定量表达

目的建立荧光定量逆转录-聚合酶链反应（RT—PCR）方法检测APCDD1 mRNA基因表达的方法，了解直肠癌及结直肠腺瘤组织中APCDD1 mRNA的表达水平。方法用荧光定量PCR方法检测86例直肠癌及癌旁组织、20例结直肠腺瘤及配对的正常黏膜组织APCDD1 mRNA相对表达水平并比较其差异。结果75％的结直肠腺瘤和65％的直肠癌表达上调，86例直肠癌APCDD1 mRNA平均相对表达水平为正常黏膜组的4．712倍，20例结直肠腺瘤中APCDD1 mRNA平均相对表达水平为正常黏膜组的3．872倍，直肠癌组和结直肠腺瘤组均较正常黏膜组织上调，差异有统计学意义（P〈0．05）。结论APCDD1 mRNA表达在腺瘤和直肠癌中表达上调，但在直肠癌中与病理分级无明显相关。     

中央型颈脊髓损伤保守与手术治疗的对比研究

目的对比研究手术与非手术治疗中央型颈脊髓损伤的临床疗效。方法中央型颈脊髓损伤患者120例,手术治疗72例,其中前路手术28例,后路手术44例;非手术治疗48例。详细记录患者ASIA运动功能评分(AMS),对治疗前及治疗后6个月、2年时的AMS评分进行比较。结果96例获随访,时间6个月~5年,21例失访,3例死亡。两组治疗后6个月、2年时AMS评分之间差异有显著性(P<0.05)。治疗后6个月内非手术组6例出现并发症(6/48,12.5%),手术组4例出现并发症(4/72,5.6%),两组之间差异无显著性(P>0.05)。结论手术治疗中央型颈脊髓损伤疗效可靠。早期手术能够解除脊髓压迫,稳定颈椎,促进脊髓功能恢复。     

Hamstring腱在体内重塑与转归的组织学研究

目的探讨游离Hamstring腱作为替代腱重建前十字韧带（anterior cruciate ligament，ACL）后在体内的重塑与转归过程，初步确定其术后在体内成熟的时间。方法33例关节镜下自体同侧游离4-5股Hamstring腱重建ACL的患者在行关节镜下再视手术时，于移植腱体中下段取活检组织进行组织学观察。重建术至再视手术的平均时间为11．9个月。替代腱依据重建术至再视手术的时段分为1月～、4月～、7月～、10月～、13月～、18月～和25月～组。将替代腱与正常ACL和半腱肌腱组织进行对比。结果重建ACL的Hamstring腱随植入时间延长，组织结构呈现其胶原纤维由不规则排列逐步向同向排列，排列不规则的菱形成纤维细胞逐步向较规则排列的椭圆形类纤维细胞转变，且细胞数目逐渐减少，血管腔数目也不断减少。上述的重塑变化主要发现在7月～组以前，其后各组重塑变化过程缓慢。结论自体游离Hamstring腱重建ACL术后具有良好的早期存活、加快再血管化和重塑过程的组织特性。其术后的重塑与成熟过程与自体髌腱相似，自体Hamstring腱在体成熟的时间为7-9个月。