Radiological and clinical comparisons of the patients with rheumatoid arthritis operated with rigid and dynamic instrumentation systems due to lumbar degenerative spinal diseases

BackgroundIt is extremely difficult to treat spine disorders with stabilization in patients with rheumatoid arthritis. Because revision rates are significantly higher in rigid stabilization. To date, there is no data about patients with rheumatoid arthritis treated with dynamic stabilization. Our aim was to compare the radiological and clinical results of patients with rheumatoid arthritis who underwent lumbar rigid stabilization or dynamic stabilization with Polyetheretherketone rod (PEEK).MethodsPatients with degenerative lumbar spine disease with rheumatoid arthritis who underwent dynamic stabilization between 2013 and 2015 and rigid stabilization between 2010 and 2012 were evaluated radiologically for adjacent segment disease, proximal junctional kyphosis, system problem (nonunion, screw loosening, instrumentation failure, pull out). It was also compared according to both the revision rates and the Visual Analog Scale and Oswestry Disability Index scores at the 12th month and 24th month.ResultsThe difference of decrease in Visual Analog Scale and Oswestry Disability Index scores from preoperative to 12th month between patients who underwent dynamic stabilization and rigid stabilization was statistically insignificant. However, there was a significant difference of increase in Visual Analog Scale and Oswestry Disability Index scores between the 12th month and 24th month of patients who underwent rigid stabilization, compared with patients with dynamic stabilization. In patients with dynamic stabilization, the problems of instrumentation were seen less frequently. Revision rates were high in patients with rigid stabilization when compared the patients with dynamic stabilization.ConclusionRadiological and clinical outcomes in patients with rheumatoid arthritis operated with dynamic stabilization are more significant when compared to rigid stabilization. These patients have lower pain and disability scores in their follow up periods. Revision rates are lower in patients with dynamic stabilization.     

Endoscopic therapy of weight regain after bariatric surgery

Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological, anatomical and metabolic factors. Surgical revision of these patients has significant risks and limited benefits. Endoscopic revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective, safe, less invasive and even reproducible treatment. We herein discuss the indication, selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric surgery. Future research could optimize a personalized approach not only in the endoscopic management but also in combination with other therapeutic modalities for weight regain after bariatric surgery.     

The impact of the health-care sector on national economies in selected European countries

Policy-makers face pressures to improve lives and safeguard public finances sustainably. In this analysis, we estimate the economic importance of the health-care sector in 19 European national economies.We use input–output tables for the year 2010 and sectoral data to estimate a set of multipliers: simple, total, truncated, type I and type II multipliers for output, income, value-added, employment and import multiplier.The analysis reveals similarities in the economic importance of the health-care sector for the national economies of the observed countries. Results suggest prevailing positive effects on national economies (value-added, employment and household income) when spending on health-care sector products and services increases, especially in comparison to the effects of increases in spending in other sectors. The importance of the health-care sector is connected to countries’ levels of development; the benefits are especially promising in countries with lower levels of gross domestic product (GDP) per capita, where changes in the health-care sector have a larger impact on employment in the national economy than similar changes in more developed countries. The health-care sector therefore can play an important role as an instrument of economic policy.     

Concentrating stroke care provision in the Czech Republic: The establishment of Stroke Centres in 2011 has led to improved outcomes

This article describes policy processes that have led to the re-organisation of stroke care in the Czech Republic since 2011, which has been part of a broader process of care concentration in several medical fields. Currently, stroke care is provided by 13 Comprehensive and 32 Primary Stroke Centres. The paper explains factors that supported the reform implementation, reviews implications, and discusses future challenges.Mandatory reporting of quality indicators, the introduction of a benchmarking system, integration with pre-hospital emergency care, and the introduction of countrywide patient triage have supported more timely treatment for stroke patients and better quality of care. Data from the Stroke Care Quality Indicators of the Czech Stroke Society show positive trends in many areas: the number of patients treated with intravenous thrombolysis quadrupled in eight years, with 26.4 % of all acute stroke patients receiving thrombolysis in 2018. Czech Republic now ranks third in Europe in the number of thrombolysis per population and second in the number of mechanical thrombectomies per population. The Czech experience provides an example of positive outcomes of concentrated stroke care, while highlighting the importance of proper implementation processes. In particular, it is essential to involve stakeholders and to provide reputational incentives through continuous benchmarking.     

Voltage clamp of a small muscle membrane area by means of a circular sucrose gap arrangement

Summary A new method is described which permits the measurement of membrane currents of thick muscle fibres (diameter 300 m or more) ofAstacus fluviatilis orBalanus balanus under voltage clamp conditions.The potential difference across a small patch of membrane (60–100 m in diameter) is controlled by connecting a voltage source across it with two external electrodes. One of them is connected to the fluid bathing the muscle fibre. The other, tubular one is in touch with the test area. The current flowing through the electrodes represents the sum of the membrane current flowing across the test area and the leak current flowing in the external fluid between the electrodes. In the first version of the method the leak current is limited by a circular sucrose gap around the test area. In the second, more elaborate method, the leak current is eliminated by a system of two concentric sucrose rings with a guard ring electrode between them. This method permits in addition the measurement of full sized action potentials in the test area.This work has been briefly reported in Cs. fysiol.17, 48 (1968).     

Action potentials of the rat diaphragm and their sensitivity to tetrodotoxin during postnatal development and old age

Summary Using the microelectrode technique, parameters of action potentials obtained from the diaphragm muscle fibres were studied at 3, 7, 14, 30 and 90 days of age and on 28–30 month old rats. The maximum rate of rise was always greater at the end-plate zone than at the extrajunctional parts of muscle fibre at all ages examined. A maximum difference of 40% was found in animals aged 7–30 days. Sensitivity to tetrodotoxin (TTX) was maximal 3 days after birth at the extrajunctiona zone (5×10^–8 M) and minimal at the end-plate zone (5×10^–6 M). This difference declined during the postnatal life until it had disappeared in old rats. The greater resistance of the end-plate zone action potentials to TTX and their greater maximum rate of rise is not apparently connected with the presence of acetylcholine sensitivity.