percutaneous laser nucleotomy for lumbar disc herniation: Preliminary report of early results and MRI findings

Early therapeutic results and magnetic resonance imaging (MRI) findings were serially evaluated for 34 consecutive patients with lumbar disc herniation treated by percutaneous laser nucleotomy (PLN), a minimally invasive technique for reducing intradiscal pressure, in which a neodymium: yttrium-aluminum-garnet (Nd:YAG) laser was used. At the mean follow up 13.8 months after PLN, successful results were obtained in 20 patients (58.8%). No serious complications were encountered. In patients with contained discherniation, the improvement rate was significantly higher than that in patients with non-contained dise herniation (P<0.05). Sagittal magnetic resonance (MR) images obtained during the time sequence after PLN demonstrated a relationship between MR signal intensity patterns and clinical recovery. No measurable change in the size of the herniated mass was confirmed on axial images immediately after PLN, while, in contrast, reduced signal intensity inside the disc was observed in 12 of 20 patients with successful results in the early postoperative period. Postoperative T2-weighted MRI can be used to predict the prognosis of patients treated with PLN. This work was presented, in part, at the 68th Annual Meeting of the Japanese Orthopaedic Association, Yokohama, 9–11 April, 1995     

Role of angiotensin II type 1 (AT1) and type 2 (AT2) receptors in airway reactivity and inflammation in an allergic mouse model of asthma

Objective: Angiotensin II (Ang II) exerts its effects through two G-protein coupled receptors: angiotensin II type 1 receptors (AT1) and type 2 receptors (AT2). Both these receptor subtypes are poorly understood in asthma. In this study, we investigated effects of AT1 receptor antagonist losartan, novel AT2 receptor agonist novokinin and AT2 receptor antagonist PD 123319 in a mouse model of asthma.

Methods: Mice were divided into control (CON) and allergen sensitized (SEN) groups. SEN was sensitized with ovalbumin (OVA) on days 1 and 6 (30?μg; i.p.), followed by 5% OVA aerosol challenge (days 11–13). Treatments included (a) losartan (SEN?+?LOS; 20?mg/kg i.p., day 14), (b) novokinin (SEN?+?NOV; 0.3?mg/kg i.p., day 14), and (c) PD 123319 (SEN?+?PD; 5?mg/kg i.p., day 14). Experiments for airway responsiveness, bronchoalveolar lavage, and tracheal ring reactivity using isolated organ bath were performed.

Results: Airway responsiveness to methacholine (MCh) (48?mg/mL) was significantly higher in SEN (563.71?±?40% vs. 294.3?±?123.84 in CON). This response was potentiated in SEN?+?PD group (757?±?30%; p?<?.05 compared to SEN). SEN?+?LOS (247.61?±?86.85%) and SEN?+?NOV (352?±?11%) had significantly lower response compared to SEN. SEN?+?LOS (26.22?±?0.29%) and SEN?+?NOV (46.20?±?0.76%) treatment significantly (p?<?.001) attenuated total cell count and eosinophils compared to SEN group (69.38?±?1.5%), while SEN?+?PD (73.04?±?0.69%) had highest number of eosinophils. Tracheal response to MCh was significantly higher in SEN group compared to controls, and this response was significantly lowered with the losartan and novokinin treatments.

Conclusions: These data suggest that AT1 and AT2 receptors have opposite effects in modulating airway hyperresponsiveness and inflammation in asthma.     

Can we do better? Bridging the research to practice gap in patient blood management–optimizing ‘audit & feedback’ and the challenges of undertaking a national cluster‐randomized controlled trial

Audit and Feedback (A&F) is a frequently used quality improvement strategy, which aims to improve patient care and outcomes. The impact of A&F has been subjected to research scrutiny; systematic reviews document only modest and variable effects, despite the likely high costs of A&F programmes, such as those undertaken nationally. To understand and enhance A&F, a programme of research termed AFFINITIE ‘Development & Evaluation of A udit and F eedback IN terventions to I ncrease evidence‐based T ransfusion practice'; http://www.ccf.nihr.ac.uk/ PGfAR/about/Pages/Abstract.aspx?ID=12588) has been completed. AFFINITIE adopted a multidisciplinary approach that applied behavioural theory and evidence to optimize the design and delivery of feedback on transfusion practice. These interventions were then tested by embedding them in the context of transfusion national audits in two national randomized cluster trials. The audit topics were preoperative surgery management and use of blood in patients with haematological malignancies. Emerging findings included the scope to improve the design of feedback reports by the inclusion of additional behaviour change techniques and increasing the specificity and relevance of feedback (i.e. clarity around who the feedback is targeted at, providing feedback only on behaviours relevant to audit standards, selecting fewer, more concrete, and relevant standards). Other findings recognized the importance of robust data collection based on agreed and clearly stated standards. Also, given wide variation in how hospitals received, shared and responded to feedback, a consequent need was identified to better support hospitals to plan their response to feedback, including disseminating the reports to all relevant stakeholders with agreement on selecting local goals and plans.