Reoperation rates and risk factors for revision 4 years after dynamic stabilization of the lumbar spine

Background Context

The concept of dynamic stabilization (DS) of the lumbar spine for treatment of degenerative instability has been introduced almost two decades ago. Dynamic stabilization follows the principle of controlling movement in the coronal plane by providing load transfer of the spinal segment without fusion and, at the same time, reducing side effects such as adjacent segment disease (ASD). So far, only little is known about revision rates after DS due to ASD and screw loosening (SL).

Boosting treatment stabilization in patients of amphetamine-type stimulant use disorder

BackgroundTo investigate boosting effects on treatment stabilization in the mandatory treatment modality for patients of amphetamine-type stimulant use disorder.MethodsThis is a retrospective follow-up study over a period from January 2013 to December 2018. We analyzed 425 patients of amphetamine-type stimulant use disorder under mandating treatments. Treatment stabilization for a given patient was defined once 4 negative urinalysis had been observed. We developed a dynamic monitoring model of boosting effects informed by the available data, specifically the number of negative urine samples required to reach stabilization, the sum of urinalyses done at the time when the given number of negative urine samples had been observed and who the patient was. To represent the simulated population, a Monte Carlo method was used to generate p-values from 1000 experiments conducted on a computer.ResultsIn the observed samples, the probability of 4 negative results in urinalysis from 4 outpatient visits was 75.5%. In comparison, the probability for achieving 4th negative results in urinalysis over 4 visits from negative binominal distribution was 57.3%, and from the computer simulation, 49.8%. The observed samples had significantly higher probability of achieving 4 negative results in urinalysis over 4 outpatient visits (p < 0.001).ConclusionsThe mandatory treatment modality boosted treatment stabilization for patients of amphetamine-type stimulant use disorder. The major benefit of using the monitoring model is the ability to monitor boosting effects of stabilization. Results supported the effectiveness of this mandatory treatment modality and can be implemented in deferred-prosecution based treatment modality.     

Psychosocial mechanisms of a behavioral treatment for urinary incontinence of prostate cancer survivors

Abstract

Purpose: We examined underlying psychosocial processes of a behavioral treatment for urinary incontinence (UI) of prostate cancer survivors.

Design: Secondary analysis of data collected from a clinical trial.

Sample: Two hundred forty-four prostate cancer survivors who participated in a clinical trial of behavioral intervention to UI as intervention or control subjects.

Methods: The participants had a 3-month behavioral intervention or usual care and were followed up for an additional 3?months. They were assessed at baseline, 3, and 6?months. Latent growth curve models were performed to examine trajectories of each study variable and relationships among the variables.

Findings: Increasing self-efficacy and social support were significantly and independently associated with more reduction of urinary leakage frequency over time.

Implications for psychosocial oncology: Providing problem-solving skills and social support, including peer support, are essential for empowering patients to reduce UI.     

螺旋CT三维重建成像在先天性高肩胛症手术方式选择中的作用

[目的]探讨螺旋CT三维重建技术在先天性高肩胛症分度和手术方式选择中的作用。[方法]22例先天性高肩胛症术前应用螺旋CT对病变部位进行扫描并三维重建，测量以肩胛骨肩胛冈内侧缘为参照点，两侧肩胛骨高度差。根据测量结果依据Cavendish分度将其分类，并根据三维重建成像选择不同的矫形手术术式。[结果]本组22例病人，随访2—4年，外观及功能均有不同程度的改善，未出现神经、血管和椎体等的损伤。[结论]根据螺旋CT扫描和三维重建检查结果，术前即可直观的明确先天性高肩胛症的病变程度，相互关系，伴发畸形，患侧肩胛骨与正常对侧肩胛骨的外观差异等，便于手术操作方案的制定，避免了手术操作的盲目性，减少医源性并发症的发生。     

FEEDBACK CONTROL OF A HEAT DIFFUSION SYSTEM WITH TIME-DEPENDENT SPATIAL DOMAIN

The problem of controlling the temperature distribution in a solid cylinder whose length varies with time and with one end in contact with a constant temperature medium is considered. This problem is motivated from that of controlling the temperature and thermal gradient inside a crystal pulled from a melt by the Czochralski method. Boundary feedback controls are derived by considering the time rate of change of a cost functional involving the deviations of both the solid temperature and its gradient from their desired values. The derived feedback controls consist of spatially distributed proportional-plus-rate and lag compensators and a non-linear feedback control involving the temperature gradient at the cylinder surface and the velocity of the spatial domain boundary. The resulting feedback-controlled system has the property that the cost functional along any motion decreases monotonically to zero with time. A numerical scheme for solving the partial differential equation of the feedback-controlled system is proposed. Typical numerical results on the dynamic behaviour of the feedback-controlled system obtained by means of the proposed scheme are presented.     

Arthroscopic Shoulder Stabilization: Is There Ever a Need to Open?

Recent studies show comparable results of arthroscopic shoulder stabilization techniques compared with the gold standard open Bankart reconstruction. Great technical advances and ever-increasing surgeon experience have rendered pathology once deemed an indication for open surgery as treatable by arthroscopic means. With this movement toward a more universal application of all-arthroscopic techniques, we might consider the following question: Is there ever a need to open? To answer this question, we must first consider normal anatomy and then appreciate the contribution of deranged pathoanatomy to recurrent instability in each individual case. The surgeon must then determine whether this is best addressed via an arthroscopic or open technique. Arthroscopy, as compared with open stabilization procedures, holds the potential benefits of decreased morbidity rates, early functional rehabilitation, and improved range of motion. Despite potential advantages, arthroscopic stabilization is clearly contraindicated when a significant pathologic lesion contributing to recurrent instability cannot be adequately addressed as a result of the limitations of current techniques or instrumentation. On the basis of this principle, we believe that sizable glenohumeral bone defects remain the only absolute contraindication to an all-arthroscopic approach. Many complicating issues, such as attenuated capsule, humeral avulsion of the glenohumeral ligament lesions, cases of revision surgery, and collision or contact athletes, exist and warrant close attention. We prefer to think of these situations as “challenges” for which both arthroscopic and open surgery should be considered, rather than as true contraindications to arthroscopic shoulder stabilization. We are, by no means, advocating arthroscopic treatment in all cases of shoulder instability, because this would represent a gross oversimplification of the issues at hand. However, we do acknowledge that the steadfast contraindications to arthroscopic shoulder stabilization are decreasing every day.     

The role of mast cells and histamine in leukocyte-endothelium interactions in four rat strains

 The objective of the present study was to determine the role of mast cells and histamine in leukocyte-endothelium interactions in mesenteric venules of four rat strains: Brown Norway, Lewis, Sprague-Dawley and Wistar. Intravital microscopy showed that the mast cell stabilizer cromoglycate (5 mg/kg i.v. just before exteriorization of the mesentery) did not affect the baseline level and velocity of leukocyte rolling in any of the four strains. This finding is in agreement with the observation that cromoglycate pretreatment only slightly influenced mast cell degranulation in all strains except the Brown Norway. After mast cell stabilization, only in Sprague-Dawley did topical administration of histamine (10^–4 M) result in a significant increase in the level of leukocyte rolling and a decrease in the rolling velocity compared with the time control. Histamine induced leukocyte adhesion only in the Brown Norway strain. In conclusion, the hypothesis presented in other studies, that degranulation of mast cells, and more specifically the release of histamine, is of major importance for the induction of leukocyte-endothelium interactions in rat mesenteric venules is not generally applicable; the present study shows a clear strain dependency. Received: 18 July 1997 / Received after revision: 17 November 1997 / Accepted: 13 March 1998     

联合肩胛/肩胛旁分叶皮瓣修复严重颌颈部瘢痕挛缩

目的探讨临床应用联合肩胛/肩胛旁分叶皮瓣显微修复严重颌颈部瘢痕挛缩畸形,并重建颈部三维活动功能及轮廓外观的方法和疗效。方法2003年1月~2004年11月,收治9例严重颌颈部瘢痕挛缩畸形患者,年龄9~32岁。病程2~18年。瘢痕挛缩程度为3~4度。行瘢痕切除,对颈部挛缩组织松解复位所致软组织缺损创面采用联合肩胛/肩胛旁分叶皮瓣进行解剖分区的显微修复。分叶皮瓣范围最大分叶皮瓣为20cm×8cm~20cm×11cm,最小分叶皮瓣为15cm×4cm~15cm×6cm。结果9例患者有8例分叶皮瓣成活,1例肩胛皮瓣远端发紫,经换药加压包扎后成活。其中8例术后获3~9个月随访,畸形无复发,颌颈角恢复至90~105°;3例行二期皮瓣臃肿修整手术。患者对术后颌颈部外观和功能均满意。结论对于严重颌颈部瘢痕挛缩畸形,联合肩胛/肩胛旁分叶皮瓣可提供足够的组织覆盖,有可靠的血管蒂,对于重建颌颈部功能和外形,是一种较好的手术选择。