Optimizing the management of patients with spinal myeloma disease

Myeloma is one of the most common malignancies that results in osteolytic lesions of the spine. Complications, including pathological fractures of the vertebrae and spinal cord compression, may cause severe pain, deformity and neurological sequelae. They may also have significant consequences for quality of life and prognosis for patients. For patients with known or newly diagnosed myeloma presenting with persistent back or radicular pain/weakness, early diagnosis of spinal myeloma disease is therefore essential to treat and prevent further deterioration. Magnetic resonance imaging is the initial imaging modality of choice for the evaluation of spinal disease. Treatment of the underlying malignancy with systemic chemotherapy together with supportive bisphosphonate treatment reduces further vertebral damage. Additional interventions such as cement augmentation, radiotherapy, or surgery are often necessary to prevent, treat and control spinal complications. However, optimal management is dependent on the individual nature of the spinal involvement and requires careful assessment and appropriate intervention throughout. This article reviews the treatment and management options for spinal myeloma disease and highlights the value of defined pathways to enable the proper management of patients affected by it.     

Cervical curvature, spinal cord MRIT2 signal, and occupying ratio impact surgical approach selection in patients with ossification of the posterior longitudinal ligament

Objective

Factors impacting surgical options and outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL) were explored.

Methods

A retrospective analysis was conducted of 127 eligible cervical OPLL patients (61 males, 66 females) aged 41–70 years (mean 55.2 years) selected from 152 total OPLL patients treated from 2002 to 2006, with 5–10-year (mean 6.8 years) follow-up. Patients underwent anterior subtotal corpectomy with ossification ligament resection (anterior surgery, n = 68) or posterior cervical double-door laminoplasty (posterior surgery, n = 59). Radiographic assessments of cervical curvature, T2-weighted MRI (MRIT2) signal, and OPLL occupying ratio were correlated with surgical strategy before surgery and at 1, 5 weeks, and 5 years.

Results

Lordosis increased following anterior surgery, though kyphosis improved by 10.3 %. The canal stenosis occupying ratio was >50 %, and short-term improvement following anterior surgery was significantly higher than posterior surgery (P > 0.0001). Superior neurological function was observed in patients with unchanged versus high spinal MRIT2 signals (P = 0.0434). No significant differences were observed in short-term outcomes between anterior and posterior surgeries in high spinal MRIT2 signal patients, but anterior surgery produced significantly better long-term outcomes at 1 week (P = 0.7564) and 1 year (P = 0.0071). Complications occurred in five anterior and three posterior surgeries.

Conclusion

Preoperative assessment of cervical curvature, MRIT2 signal, and occupying ratio can be used to guide clinical surgical approach selection to potentially produce better long-term outcomes in patients with OPLL.     

中国人肠道产甲酸草酸杆菌甲酰辅酶A转移酶基因的分离、克隆和鉴定

目的 克隆产甲酸草酸杆菌甲酰辅酶A转移酶基因（frc），检测其在真核细胞中的表达。方法 用聚合酶链式反应技术从产甲酸草酸杆菌基因组DNA中扩增frc基因片段并插入真核表达载体获取重组质粒pEGFP-frc，通过限制性内切酶酶切电泳和测序鉴定重组质粒。重组质粒转染人胚。肾293细胞，检测frc基因在mRNA和蛋白水平上的表达。被转染细胞在含草酸培养液中培养，检测0～72h培养液中草酸浓度的变化。结果 frc基因的真核表达载体构建成功。转染293细胞后24～72h，可观察到明亮的绿色荧光，在mRNA和蛋白水平上可检测到frc基因在真核细胞中的表达。转染pEGFP-frc细胞12～72h培养液中草酸浓度明显低于转染空载体的细胞（P〈0．05）。结论 中国人肠道产甲酸草酸杆菌中可分离出frc基因；frc基因可在真核细胞293细胞中表达并使293细胞获得代谢草酸的能力。     

21羟化酶缺乏致女性假两性畸形的内外科联合治疗

目的　为了诊断和治疗 2 1羟化酶缺乏导致的女性假两性畸形。方法　 1990年以来 ,对 4例患者进行了外科手术和内科糖皮质激素的综合治疗。结果　 4例均得到了一个较完善的女性外阴 ,补充治疗了由于 2 1羟化酶先天缺乏引起的一系列全身症状。结论　综合治疗使该病在临床上获得了满意结果。     

辛伐他汀对颈椎异体骨移植融合过程的影响

目的 研究辛伐他汀对颈椎异体骨皮质移植融合过程的影响. 方法 健康成年雄性Wistar大鼠44只,随机分为对照组、辛伐他汀组、重组人骨形态发生蛋白-2(rhBMP-2)组及空白对照组,前3组行颈椎前路间盘切除异体骨皮质椎间移植融合术.分别在手术后2、4、8和12周将动物处死,取出颈椎后拍摄X线片,观察融合情况,双能量骨密度仪测量颈椎椎体骨密度;颈椎标本组织化学染色观察椎体骨小梁同植骨块表面融合,及植骨内部的血管新生和骨形成的情况. 结果 颈椎骨密度对照组较空白对照组明显降低(P<0.01),而辛伐他汀组和rhBMP-2组颈椎椎体骨密度同空白对照组无明显差别.病理显示,对照组炎性纤维组织长期存在,术后3月植骨界面有少量的软骨内成骨;而辛伐他汀组术后炎性纤维组织形成少,存在时间短;在术后第8周辛伐他汀组及rh BMP-2组异体骨表面均可与椎体骨小梁发生骨性融合;植骨12周,rhBMP-2组植骨内部的血管侵入和骨质形成较少,而辛伐他汀组植骨内部可见较多的新生血管形成,新生血管周围可形成环形骨质沉积. 结论 辛伐他汀可促进异体骨皮质移植后同颈椎椎体的融合.     

Downregulation of the spinal NMDA receptor NR2B subunit during electro-acupuncture relief of chronic visceral hyperalgesia

The involvement of spinal NR2B, a N-methyl-D-aspartate (NMDA) receptor subunit, in the therapeutic effect of electro-acupuncture (EA) on chronic visceral hyperalgesia was investigated. Chronic visceral hyperalgesia was induced using an irritable bowel syndrome (IBS) model in rats. Graded colorectal distention (CRD) stimuli at strengths of 20, 40, 60 and 80 mmHg were applied, and behavioral tests were performed to measure the abdominal withdrawal reflex (AWR) in response to the CRD stimuli and assess the severity of the visceral hyperalgesia. Rats were randomly divided into four groups: normal intact (control) group, IBS model (model) group, EA-treated IBS rats (EA) group and sham EA-treated IBS rats (sham EA) group. For the EA treatment, electric stimuli were applied through needles inserted into two acupoints [Zu-san-li (ST-36) and Shang-ju-xu (ST-37)] in both hind limbs, while the sham EA treatment consisted of only the insertion of needles into these same acupoints without an application of electric stimuli. Our results showed that AWR scores of the model group responding to CRD stimuli of 20, 40, 60 and 80 mmHg were significantly increased. These increased scores subsequently decreased following EA treatment (P < 0.05) compared with those for the other groups. The expression of NR2B in the superficial laminae (SDH, laminae I and II), nucleus proprius (NP, laminae III and IV), neck of the dorsal horn (NECK, laminae V and VI) and central canal region (lamina X) at thoracolumbar (T13-L2) and lumbosacral (L6-S2) segmental level significantly increased in the model group versus the control group (P < 0.05) and significantly decreased after EA treatment (P < 0.05). There were no significant changes in neither AWR scores nor expression of the NR2B subunit in these spinal regions after the sham EA treatment. These results confirm that EA can relieve chronic visceral hyperalgesia in IBS model rats and suggest that such an effect is possibly mediated through the downregulation of the NR2B subunits of NMDA at the spinal level.     

Borosilicate Glass-Ceramics Containing Zirconolite and Powellite for RE- and Mo-Rich Nuclear Waste Immobilization

In order to increase the loading of rare earth- and molybdenum-rich high-level waste in the waste forms, zirconolite- and powellite-based multi-phase borosilicate glass-ceramics were synthesized via an in-situ heat treatment method. The effects of the CTZ (CaO, TiO₂ and ZrO₂) content on the crystallization, microstructure and aqueous durability of the multi-phase borosilicate glass-ceramics were studied. The results indicate that the increase of CTZ content can promote crystallization. The glass-ceramics presented even structures when the CTZ content was ≥ 40 wt%. For the glass-ceramic with 40 wt% CTZ, only zirconolite and powellite crystals were detected and powellite crystals were mainly distributed around zirconolite, whereas for the glass-ceramics with 50 wt% CTZ, perovskite was detected. Furthermore, the leaching rates of Na, Ca, Mo and Nd were in the ×10⁻³, ×10⁻⁴, ×10⁻³ and ×10⁻⁵ g·m⁻²·d·⁻¹ orders of magnitude on the 28th leaching day, respectively.     

Postoperative treatment of the patient with obstructive sleep apnea.

OBJECTIVE: The postoperative management of patients with obstructive sleep apnea syndrome (OSAS) has been based primarily on the potential loss of the airway. Our hypothesis is that not all patients with OSAS require placement in the intensive care unit after surgery. METHODS: We undertook a prospective, nonrandomized study (N = 38). Data included demographics, polysomnograms, body mass index (BMI), and postoperative course, including any complications within 72 hours. RESULTS: The average respiratory disturbance index was 66, and the average BMI was 29. The average preoperative and postoperative maximal arterial oxygen desaturation values were 82% and 94%, respectively. Patients with BMIs less than 35 did not have desaturation values below 90%. No complications occurred. DISCUSSION: Within the first 72 hours after surgery, no complications were observed in our study groups. Patients with BMIs greater than 35 were at increased risk for postoperative desaturations. The uncomplicated OSAS patient, one without significant comorbid factors, can be treated in a safe and prudent fashion outside of an intensive care unit.     

不同厚度普玛黏结剂对冠固位力的影响

目的:探讨不同厚度普玛黏结剂对冠固位力的影响。方法:收集50颗正畸拔除的上颌前磨牙,选取其中30颗牙体按照在代型上涂布间隙剂层数的不同分为A、B、C3组制作金属冠,用普玛黏结剂黏结制成试件,于人工唾液浸泡1个月,循环加载10000次后进行冠固位力的测试。20颗牙体利用CAD/CAM系统制作全瓷冠,依黏结剂厚度分为50μm组和75μm组,分别采用自固化和光固化2种形式黏结制成试件,于人工唾液浸泡1个月后进行冠固位力的测试。结果:A组和B组的固位力明显强于C组的固位力,差异均有统计学意义(P<0.01),但A、B组的固位力差异无统计学意义(P>0.05)。全瓷冠的50μm组的固位力要大于75μm组的固位力,差异有统计学意义(P<0.05)。相同黏结厚度时,光固化和自固化黏结后冠的固位力差异均无统计学意义(P>0.05)。结论:在一定黏结厚度范围内,随着黏结厚度的增加,冠的固位力减小。