Function after spinal treatment,exercise and rehabilitation (FASTER): improving the functional outcome of spinal surgery

Background  

The life-time incidence of low back pain is high and diagnoses of spinal stenosis and disc prolapse are increasing. Consequently, there is a steady rise in surgical interventions for these conditions. Current evidence suggests that while the success of surgery is incomplete, it is superior to conservative interventions. A recent survey indicates that there are large differences in the type and intensity of rehabilitation, if any, provided after spinal surgery as well as in the restrictions and advice given to patients in the post-operative period.     

Endometrial perfusion across the normal human menstrual cycle assessed by laser Doppler fluxmetry

This study investigated variations in microvascular perfusion of human endometrium across the menstrual cycle, using a laser Doppler technique to assess red blood cell (RBC) flux. Endometrial RBC flux was monitored by laser Doppler fluxmetry via a fibre optic probe inserted transvaginally into the uteri of 19 conscious normal volunteer women, on four occasions at weekly intervals over one menstrual cycle. Regional variation in RBC flux was investigated in 16 surgical patients under general anaesthesia and in five excised uteri. Endometrial perfusion exhibited short-term temporal variations consistent with the cardiac cycle and often also showed vasomotion (5-12 cycles/min). Mean endometrial perfusion differed between phases of the menstrual cycle in conscious women, being highest during early proliferative and early follicular phases. There were no significant regional differences in local mean endometrial perfusion in anaesthetized patients. No evidence of endometrial ischaemia/reperfusion episodes was found in any subject using this technique. This study provides benchmark data of variations in RBC flux per unit volume of tissue in the luminal approximately 1 mm of endometrium, across the normal human menstrual cycle. Flux values were highest at times associated with endometrial growth and preparation for implantation, indicating that RBC flux may be a useful parameter for assessment of endometrial physiology.      

Intravascular local gene transfer mediated by protein- coated metallic stent

Objective To assess the feasibility, efficiency and selectivity of adenovirus- mediated ge ne transfer to local arterial wall by protein- coated metallic stent. Methods A replication- defective recombinant adenovirus carrying the Lac Z reporter gene for nuclear- specific β- galactosidase (Ad- βgal) was used in this study. Th e coating for metallic stent was made by immersing it in a gelatin solution cont aining crosslinker. The coated stents were mounted on a 4. 0 or3. 0mmpe rcutaneous transluminal coronary angioplasty (PTCA) balloon and submersed into a high- titer Ad- βgal viral stock (2×10(10)pfu/ml) for 3 min, and then im planted into the carotid arteries in 4 mini- swines and into the left anterior d escending branch of the coronary artery in 2 mini- swines via 8F large lumen gui ding catheters. The animals were sacrificed7 (n=4), 14 (n=1) and 21 (n=1) days after implantation, respectively. The β- galactosidase expression was as sessed by X- gal staining. Results The results showed that the expression of transgene was detected in all animal. In 1 of carotid artery with an intact intima, the β- gal expression was l imited to endothelial cells. In vessels with denuded endothelium, gene expressi on was found in the sub- intima, media and adventitia. The transfection efficie ncy of medial smooth muscle cells was 38. 6%. In 2 animals sacrificed 7 days af ter transfection, a microscopic examination of X- gal- stained samples did not s how evidence oftransfection in remote organs and arterial segments adjacent to the treated arterial site.Conclusions Adenovirus- mediated arterial gene transfer to endothelial, smooth muscle cells and adventitia by protein- coated metallic stent is feasible. The transfection efficiency is higher. The coated stent may act as a good carrier of adenovirus - mediated gene transfer and have a potential to prevent restenosis following PT CA.