Hypermetabolism associated with worse prognosis of amyotrophic lateral sclerosis

Journal of Neurology - Exploration of hypermetabolism in amyotrophic lateral sclerosis (ALS) with different ethnicities is needed to understand its metabolic implications for clinical management....     

全程管理在神经源性膀胱患者骶神经调节治疗的疗效评价

目的评价基于多学科团队协作的骶神经调节治疗神经源性膀胱患者全程管理方案的实践效果。 方法收集2018年1月至2019年12月中山大学孙逸仙纪念医院收治的36例神经源性膀胱行骶神经调节治疗患者的病例资料。将36例患者按入院时间分为对照组15例（2018年1~ 12月）和干预组21例（2019年1~12月）。对照组给予常规管理,干预组实施全程护理模式。比较两组骶神经调节二期手术转化率,两组患者一期术后3个月时膀胱功能管理效果、尿路感染发生率、患者满意度和生活质量的差异。 结果两组患者在骶神经调节二期手术转化率、平衡膀胱达标率、膀胱容量、患者满意度和生活质量的差异有统计学意义（P<0.05）,干预组均高于对照组。 结论多学科团队协作的全程管理实现了骶神经调节治疗神经源性膀胱患者连续的全程化、个性化管理,协调多学科团队协作,改善了患者的临床疗效,提高了患者满意度,是一种有效的患者管理照护模式。     

低气腹压在老年患者腹腔镜完全腹膜外疝修补术中的应用

目的探讨6mmHg（1 mmHg=0.133 kPa）气腹压在腹腔镜完全腹膜外疝修补术（TEP）中的应用。 方法第一阶段将60例心肺功能良好、年龄<75岁的非高龄单侧腹股沟斜疝患者随机分为A、B组,每组30例。A组气腹压力设定为14 mmHg,B组气腹压力设定6 mmHg,比较2组手术医师的手术视野满意度、手术时间、气腹时间、手术麻醉期不同时间点的气道压及呼气末二氧化碳分压（P_ETCO₂）、出院时间、手术并发症发生率。 结果3组患者住院时间差异无统计学意义（P>0.05）。在手术时间和气腹时间方面,与A组相比,B组和C组均略长,差异有统计学意义（P<0.05）,B组和C组之间差异无统计学意义（P>0.05）。A组手术视野满意度（4.30±0.65）分优于B组（4.28±0.63）分、C组（4.42±0.64）分,差异均有统计学意义（P<0.05）;B组与C组手术视野满意度差异无统计学意义（P>0.05）。3组患者术后并发症发生率比较,差异均无统计学意义（P>0.05）。3组患者T1、T2及T3的Paw及P_ETCO₂与同组T0比较,差异均有统计学意义（P<0.05）。B组和C组T1、T2及T3的Paw及P_ETCO₂与A组比较,差异均有统计学意义（P<0.05）;其余指标比较,差异均无统计学意义（P>0.05）。 结论6 mmHg低气腹压TEP手术用于部分高龄以及心肺功能较差的患者,可以确切降低术中气道压及P_ETCO₂,增加手术安全性及耐受性,虽轻度影响手术的操作视野及空间,但并不影响手术的顺利完成,术后并发症的发生率及出院时间未受明显影响。     

GOKIO KUMBU/AMADABLAM TREK 2012: stabilometric adaptation in women to exercise training at low and high altitude

Purpose

Balance is the essential ability to maintain posture during physical activity and daily life. Exercise can have acute and chronic effects on postural stability. Individual exercise sessions can decrease postural stability, while long-term training improves balance and postural sway. Consequently, athletes and people undergoing training have better postural sway than more sedentary subjects. Hypobaric hypoxia has also been suggested to cause stress and adaptation of balance abilities. Thus, the aim of this study was to determine the effects of exercise training under normoxia and hypobaric hypoxia on postural sway.

Methods

Seven adult females participated in this study. They underwent assessments of posture before and after 12 days of low-to-moderate exercise training at low altitude, and the same 4 months later, after 12 days of exercise training at high altitude. The data collected included: centre of pressure, average speed oscillation, and Romberg Quotient. This generated a total of 56 posture tests for these seven subjects.

Results and conclusions

The results of this research suggest that comparing the each period of activity (pre-exercise) and after the end of each period (post-exercise), both at low and at high altitudes, did not influence the postural stability.

     

Local delivery of mutant CCL2 protein‐reduced orthopaedic implant wear particle‐induced osteolysis and inflammation in vivo

Total joint replacement (TJR) has been widely used as a standard treatment for late‐stage arthritis. One challenge for long‐term efficacy of TJR is the generation of ultra‐high molecular weight polyethylene wear particles from the implant surface that activates an inflammatory cascade which may lead to bone loss, prosthetic loosening and eventual failure of the procedure. Here, we investigate the efficacy of local administration of mutant CCL2 proteins, such as 7ND, on reducing wear particle‐induced inflammation and osteolysis in vivo using a mouse calvarial model. Mice were treated with local injection of 7ND or phosphate buffered saline (PBS) every other day for up to 14 days. Wear particle‐induced osteolysis and the effects of 7ND treatment were evaluated using micro‐CT, histology, and immunofluorescence staining. Compared with the PBS control, 7ND treatment significantly decreased wear particle‐induced osteolysis, which led to a higher bone volume fraction and bone mineral density. Furthermore, immunofluorescence staining showed 7ND treatment decreased the number of recruited inflammatory cells and osteoclasts. Together, our results support the feasibility of local delivery of 7ND for mitigating wear particle‐induced inflammation and osteolysis, which may offer a promising strategy for extending the life time of TJRs. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:58–64, 2016.     

Aggravation of spinal cord compromise following new osteoporotic vertebral compression fracture prevented by teriparatide in patients with surgical contraindications

Summary

Patients with spinal cord deficits following new unstable osteoporotic compression fracture and surgical contraindications were considered to receive conservative treatment. Teriparatide was better than alendronate at improving bone mineral density and bone turnover parameters, as well as preventing aggravation of spinal cord compromise.

Introduction

This study compared the preventive effects of teriparatide and alendronate on aggravation of spinal cord compromise following new unstable osteoporotic vertebral compression fracture (OVCF) in patients with surgical contraindications.

Methods

This was a 12-month, randomized, open-label study of teriparatide versus alendronate in 49 patients with new unstable OVCF and surgical contraindications. Neurological function was evaluated using modified Japanese Orthopedic Association (mJOA) score (11-point scale, the maximum score of 11 implies normalcy). Visual analog scale (VAS) scores, kyphotic angles, anterior-border heights and diameters of the spinal canal of the fractured vertebrae, any incident of new OVCFs (onset of OVCF during follow-up), spine bone mineral density (BMD), and serum markers of bone resorption and bone formation were also examined at baseline and 1, 3, 6, and 12 months after initiation of the medication regimen.

Results

At 12 months, mean mJOA score had improved in the teriparatide group and decreased in the alendronate group. Mean concentrations of bone formation and bone resorption biomarkers, mean spine BMD, and mean anterior-border height and spinal canal diameter of the fractured vertebrae were significantly greater in the teriparatide group than in the alendronate group. Mean VAS score, mean kyphotic angle of the fractured vertebrae, and incidence of new OVCFs were significantly smaller in the teriparatide group than in the alendronate group.

Conclusions

In patients with neurological deficits following new unstable OVCF and with surgical contraindications, teriparatide was better than alendronate at improving the BMD and the bone turnover parameters, as well as preventing aggravation of spinal cord compromise.

     

Surgical management of spinal liposarcoma: a case series of 7 patients and literature review

European Spine Journal - Liposarcoma, one of the most common soft tissue sarcomas originates from primitive mesenchymal cells. But spinal involvement of either primary or metastatic liposarcoma is...