椎弓根固定系统在腰椎退行性疾病治疗中的应用

目的 研究椎弓根固定器械在腰椎退行性疾病的应用指征、疗效和安全性。方法对121例应用椎弓根器械进行治疗的腰椎退行性疾病的患者进行随访。随访时间0．5～6．1年，平均3．1年。应用Suk标准进行影像学融合情况评估；VAS进行疼痛评估；以Oswestry功能丢失指数进行临床疗效评价。结果V AS(0～10分)评分：术前9．5～6．8(平均8．5)，术后0～5．3(平均4．1)；()swestrv：术前30～80(平均64)，术后0～72(平均38．5)。融合率：91．740A，；临床有效率：87．60％。结论 椎弓根器械在腰椎退行性疾病的手术治疗中具有提高融合率，促进症状改善，缩短康复时间的作用。同时应关注椎弓根器械的性能一价格比，严格掌握临床应用指征。     

一氧化氮合酶抑制剂对延缓腰椎间盘退变的影响

目的　探讨一氧化氮合酶(NOS)抑制剂L N6 亚氨乙基 赖氨酸(L NIL)和S 甲基异硫脲(SMT)对退变腰椎间盘组织代谢的影响。方法　无菌条件下,取2 0例腰椎间盘突出症患者的椎间盘组织体外培养,分别加入1mmol/L浓度的SMT和L NIL ,培养72h后,通过检测硝酸盐和亚硝酸盐的含量来观察椎间盘NO的释放量及NOS的活性;原位杂交法检测椎间盘组织iNOSmRNA和MMP3mRNA的表达。培养10d后,化学比色法观察椎间盘蛋白多糖含量和羟脯氨酸释放量的变化。结果　L NIL组髓核和纤维环NO释放量(65 .6±4.5 ,68.8±5 .7) μmol/L和SMT组髓核和纤维环NO释放量(69.5±6.5 ,69.1±6.1) μmol/L较对照组NO释放量(10 7.9±4.4,93 .1±5 .9) μmol/L明显减少(P <0 .0 1)。L NIL组和SMT组髓核组织中蛋白多糖含量(5 1.3±9.6,48.2±8.5 )kg/L ,比对照组(3 2 .1±6.4)kg/L明显增加(P <0 .0 1) ,羟脯氨酸释放量(1.1±0 .4,1.2±0 .5 )kg/L比对照组(3 .4±0 .8)kg/L显著减少(P <0 .0 1) ;同时,原位杂交法未检测到iNOSmRNA和MMP3mRNA的表达。结论　NOS抑制剂L NIL和SMT能抑制过量NO的释放,对延缓椎间盘退变具有积极的作用     

Kinetic magnetic resonance imaging analysis of lumbar segmental mobility in patients without significant spondylosis

Purpose

The purpose of this study was to examine lumbar segmental mobility using kinetic magnetic resonance imaging (MRI) in patients with minimal lumbar spondylosis.

Methods

Mid-sagittal images of patients who underwent weight-bearing, multi-position kinetic MRI for symptomatic low back pain or radiculopathy were reviewed. Only patients with a Pfirrmann grade of I or II, indicating minimal disc disease, in all lumbar discs from L1–2 to L5–S1 were included for further analysis. Translational and angular motion was measured at each motion segment.

Results

The mean translational motion of the lumbar spine at each level was 1.38 mm at L1–L2, 1.41 mm at L2–L3, 1.14 mm at L3–L4, 1.10 mm at L4–L5 and 1.01 mm at L5–S1. Translational motion at L1–L2 and L2–L3 was significantly greater than L3–4, L4–L5 and L5–S1 levels (P < 0.007). The mean angular motion at each level was 7.34° at L1–L2, 8.56° at L2–L3, 8.34° at L3–L4, 8.87° at L4–L5, and 5.87° at L5–S1. The L5–S1 segment had significantly less angular motion when compared to all other levels (P < 0.006). The mean percentage contribution of each level to the total angular mobility of the lumbar spine was highest at L2–L3 (22.45 %) and least at L5/S1 (14.71 %) (P < 0.001).

Conclusion

In the current study, we evaluated lumbar segmental mobility in patients without significant degenerative disc disease and found that translational motion was greatest in the proximal lumbar levels whereas angular motion was similar in the mid-lumbar levels but decreased at L1–L2 and L5–S1.     

Morphological changes in disc herniation in the lower cervical spine: an ultrastructural study

Introduction

The basis of disc degeneration is still unknown, but is believed to be a cell-mediated process. Apoptosis might play a major role in degenerative disc disease (DDD). The aim of this study was to correlate the viability of disc cells with the radiological degeneration grades (rDG) in disc herniation.

Materials and methods

Forty anterior IVD’s (C4–C7) from 39 patients with DDD were studied histologically and ultrastructurally to quantify healthy, “balloon”, chondroptotic, apoptotic and necrotic cells. Patients were classified to their rDG, as having either prolapse (P: DGII + III) and/or osteochondrosis (O: DGIV + V). Similar studies were undertaken on eight control discs.

Results

Cell death by necrosis (mean 35%) was common but differed not significantly in both groups. All patients with a disc prolapse DGII + III revealed balloon cells (iAF: mean 32%). All appeared alive and sometimes were hypertrophic. However, significantly less balloon cells were found in the O-Group. Control samples revealed no evidence of “balloon” cells in DGII and only a minor rate in DGIII.

Conclusion

According to the different rDG, quantitative changes were obvious in healthy and “balloon” cells, but not for cell death. At the moment it can only be hypothesized if “balloon” cells are part of a repair strategy and/or cause of disc herniation.     

Long-term outcomes of phacoemulsification cataract surgery performed by trainees and consultants in an Australian cohort

Background: It is unclear whether differences exist in surgical complication rates and long‐term visual acuity outcomes between patients whose phacoemulsification cataract surgery was performed by ophthalmological trainees and those performed by consultants. Design: Prospective clinical cohort study. Participants: 1851 participants of the Cataract Surgery and Age‐related Macular Degeneration study, aged ≥64 years, had cataract surgery performed at Westmead Hospital, Sydney. Methods: Surgical complication rates and visual acuity at 24‐month postoperative visits were compared between patients who were operated on by trainees and those operated on by consultants. Main Outcome Measures: Surgical outcomes included operative complications recorded in surgical audit forms and 24‐month postoperative visual acuity. Results: Of 1851 patients, 1274 (68.8%) were reviewed 24 months after surgery. Of these, 976 had data on the type of surgeon who performed the operation. After excluding 152 challenging cases and three cases operated on by first‐year trainees at the beginning of their training, 821 patients were included in this study, of those, 498 were operated on by trainees and 323 by consultants. Habitual visual acuity ≥6/12 was achieved in 77.3% (n = 385/498) and 74.3% (n = 240/323), respectively, of the two groups of patients 24 months postoperatively. Of 514 patients who had surgical audit data, the major complication rate was numerically greater, but not significantly different for the 330 trainee‐operated (6.1%) patients, compared with the 184 consultant‐operated patients (2.7%, P = 0.091). Conclusions: We found relatively comparable complication rates and visual outcomes after 2 years between patients operated on by ophthalmological trainees and those by consultants, in a cataract surgical cohort at Westmead Hospital.     

Visual outcomes 12 months after phacoemulsification cataract surgery in patients with diabetes

Purpose: To assess cataract surgery visual outcomes 12 months postoperatively in patients with diabetes, with or without diabetic retinopathy (DR), compared to patients without diabetes. Methods: We followed 1192 cataract surgical patients aged ≥65 for 12 months postoperatively. Standardised pre‐ and postoperative pinhole LogMAR visual acuity (VA) measurements were taken. Mean VA improvement was determined by comparing VA after 12 months to preoperative VA. Results: Of 1192 surgical patients, 324 (27.2%) had diabetes, of whom, 136 (42.0%) had DR. After adjusting for age, gender, diabetes duration and preoperative pinhole VA, the average VA gained 12 months after surgery was 10.8 letters among 868 patients without diabetes, 10.6 letters among 188 patients with diabetes but no DR, 10.0 letters among 95 patients with DR but no past laser treatment, and no letters among 41 patients with DR plus past laser treatment (p < 0.0001, compared to the other three groups). Diabetes duration ≥20 years was associated with mean VA gain of 3 fewer letters than duration <10 years (7 versus 10 letters, p = 0.023), after adjusting for age, gender, DR and preoperative pinhole VA. Conclusion: Cataract surgery improved VA by an average two lines for patients both with and without diabetes, or with DR but no past laser treatment. No significant VA improvement was evident for patients who had preoperative DR and laser therapy.     

软骨终板通透性对兔退变腰椎间盘Ⅱ型胶原表达的影响

目的探讨软骨终板通透性对兔退变腰椎间盘Ⅱ型胶原表达的影响。方法 6月龄新西兰大白兔14只,建立退变腰椎间盘模型后饲养8周。8周后处死并手术切取腰段椎间盘每只6个,随机分为A组和B组,其中A组为对照组,B组骨蜡封闭上下软骨终板。两组兔退变椎间盘在体外进行整体器官培养。在培养前以及培养7 d和14 d时分别用Mitotracker Green荧光探针、免疫组化SP法和RT-PCR方法对椎间盘中髓核的细胞活力、Ⅱ型胶原及Ⅱ型胶原mRNA的表达情况进行评估。结果经过7 d的体外培养之后,两组的荧光强度、Ⅱ型胶原的灰度值与培养前比较降低不显著(P0.05),而椎间盘髓核Ⅱ型胶原的mRNA表达与与培养前比较差异显著(P0.05),两组间荧光强度、Ⅱ型胶原的灰度值及椎间盘髓核Ⅱ型胶原的mRNA表达对比差异均无统计学意义(P0.05)。经过14 d的培养,两组的荧光强度分别降低了18.6%与31.3%,与培养之前的荧光强度相比以及两组之间相比差异均具有统计学意义(P0.05);两组的Ⅱ型胶原的灰度值均有提升,与培养之前的Ⅱ型胶原的灰度值相比差异具有统计学意义(P0.01),两组间Ⅱ型胶原的灰度值经比较差异显著,具有统计学意义(P0.01);两组Ⅱ型胶原mRNA的表达比培养前以及培养7 d时明显下降(P0.05),两组之间比较差异显著具有统计学意义(P0.05)。结论降低软骨终板的通透性可以在短时间内(14 d)降低细胞活力和Ⅱ型胶原及其mRNA的表达,加速兔腰椎间盘的退变。     

Konzept und Wirksamkeit eines Behandlungsprogrammes für Demenzkranke und deren Angehörige Ergebnisse aus dem Alzheimer Therapiezentrum Bad Aibling

A short-term residential treatment programme designed to prepare patients with dementia and caregivers for life with a progressive disease was evaluated in a pre-treatment post-treatment design. The multicomponent programme included: 1) intensive rehabilitation for patients, based on the concept of Self-Maintenance Therapy, and 2) an intervention programme for caregivers. Based on the concept of Self-Maintenance Therapy, it was hypothesised that experiences which are in accordance with patients' self-system would support patients' well-being, reduce psychopathological symptoms and facilitate social participation. In this study treatment effects in FTLD are analysed and compared with treatment effects in AD. The results for both groups show a consistent improvement in patients' depression and in other psychopathological symptoms, which can be seen as directly beneficial for patients. Following treatment, caregivers also felt less depressed, less mentally fatigued and restless, and more relaxed. It was predicted that FTLD patients challenge caregivers in a different way compared to patients with AD due to the particular profile of cognitive and psychiatric problems but there are no significant differences between groups. Further controlled follow-up studies are needed to evaluate the effects of the intervention as dementia progresses and to address hypotheses about factors responsible for benefits as well as for treatment resistance.     

Imaging Evaluation of Fat Infiltration in Paraspinal Muscles on MRI: A Systematic Review with a Focus on Methodology

PurposeNumerous studies have applied a variety of methods to assess paraspinal muscle degeneration. However, the methodological differences in imaging evaluation may lead to imprecise or inconsistent results. This article aimed to provide a pragmatic summary review of the current imaging modalities, measurement protocols, and imaging parameters in the evaluation of paraspinal muscle fat infiltration (FI) in MRI studies.MethodsWeb of Science, EMBASE, and PubMed were searched from January 2005 to March 2020 to identify studies that examined the FI of paraspinal muscles on MRI among patients with lumbar degenerative diseases.ResultsIntramyocellular lipids measured by magnetic resonance spectroscopy and FI measured by chemical‐shift MRI were both correlated to low back pain and several degenerative lumbar diseases, whereas results on the relationship between FI and degenerative lumbar pathologies using conventional MRI were conflicting. Multi‐segment measurement of FI at the lesion segment and adjacent segments could be a prognostic indicator for lumbar surgery. Most studies adopted the center of the intervertebral disc or endplate as the level of slice to evaluate the FI. Compared with visual semiquantitative assessment, quantitative parameters appeared to be precise for eliminating individual or modality differences. It has been demonstrated that fat CSA/total CSA (based on area) and muscle–fat index (based on signal intensity) as quantitative FI parameters are associated with multiple lumbar diseases and clinical outcomes after surgery.ConclusionHaving a good command of the methodology of paraspinal muscle FI on MRI was effective for diagnosis and prognosis in clinical practice.     

Multiplex ARMS PCR to Detect 8 Common Mutations of ATP7B Gene in Patients With Wilson Disease

Background

Wilson disease is a rare disorder of copper metabolism due to mutation in ATP7B gene. Proper counseling of patients with Wilson disease, and their families necessitates finding mutation in ATP7B gene. Finding mutations in ATP7B gene with 21 exons, and more than 500 mutations is expensive and time-consuming.

Objectives

The aim of this study was to provide a simple multiplex amplification refractory mutation system PCR (M-ARMS-PCR) for screening eight common mutations in ATP7B gene.

Patients and Methods

Two sets of ARMS mutant and normal specific primer pairs were designed for genotyping of p.R778L, p.R969Q, p.H1069Q, and p.3400delC mutations as Set 1 and p.W779G, c.3061-1G > A, p.I1102T, and p.N1270S mutations as Set 2. The Multiplex ARMS assay was then subsequently tested in 65 patients with Wilson disease with known and unknown ATP7B mutations.

Results

Using these two sets, we identified H1069Q mutation in four patients, c.2335T > G mutation in three, c.3061-1G > A splice site mutation in five, c.3305T > C mutation in one, and c.3809A > G mutation in two patients.

Conclusions

The Multiplex ARMS assay used in this study can be an efficient, reliable, and cost effective method as a primary screen for patients with Wilson disease.