Objective〓〖WTBZ〗To observe the clinical features of autoimmune optic neuropathy (AON). 〖WTHZ〗Methods〓 〖WTBZ〗The clinical data of 58 patients with AON from Jan. 2006 to Dec. 2007 were retrospectively analyzed. The patients had undergone routine ophthalmological, neurological examination, visual field test, all set of autoimmune antibody test, brain MRI. 〖WTHZ〗Results〓〖WTBZ〗In 93 eyes of 58 patients with AON, the lowest best corrected visual acuity (BCVA) was lt;01 in 68 eyes (731%), 10 patients (172%) had other symptoms of nervous system, 14 patients (241%) had lesions of nonneurological system. Positive antinuclear antibody was found in 43 patients (796%); other abnormal antibodies were also found, including antiSSA/SSB, antidsDNA, antihistonic, anticardiolipin, and antihuman leukocyte antigen B27 antibodies. Systematic connective tissue disease presented in 20 patients (345%), such as sicca syndrome, systemic lupus erythematosus, and Behcet disease. 32 patients (552%) had abnormal brain MRI, and the BCVA of 49 eyes (777%) improved significantly after hospitalization. 〖WTHZ〗Conclusion〓〖WTBZ〗Patients with AON always have poor visual function, some of whom associate with other systems, as well as damages to other parts of the nervous system. While some AON patients are secondary to systemic connective tissue disease involving the optic nerve, the majority of these patients are isolated autoimmune optic neuropathy.
Objective To investigate the effect of inhaled anticholinergics on heart rate recovery (HRR) in patients with stable chronic obstructive pulmonary disease (COPD). Methods Sixty clinically stable patients with stage Ⅱ-Ⅳ COPD according to the Global Initiative for Chronic Obstructive Lung Disease guidelines were recruited. HRR was analyzed in this study between 28 patients who had received tiotropium≥1 year and 32 patients who never used anticholinergics as control, so as to reflect parasympathetic reactivity of the heart. Results HRR was significantly lower in the subjects with tiotropium than that in the controls [(16±6) beats/min vs. (22±8) beats/min, P<0.05]. Multivariate regression analysis revealed that anticholinergics medication could be used as an independent predictor of HRR in the COPD patients. Conclusion Anticholinergics can affect cardiac autonomic function of stable COPD patients.
ObjectiveTo investigate the difference between four transforaminal endoscopic approaches in the treatment of serious lumbar disc herniation.MethodsBetween October 2010 and February 2015, a total of 122 patients with serious lumbar disc herniation were enrolled and treated with discectomy under transforaminal endoscope. The patients were divided into 4 groups according to the different approaches. The transforaminal endoscopic spine system (TESSYS) technology was used in group A (31 cases), Yeung endoscopic spine system (YESS) technology was used in group B (30 cases), improved transforaminal endoscopic access (ITEA) technology was used in group C (31 cases), and interlaminar dorsal access (IDA) technology was used in group D (30 cases). There was no significant difference in gender, age, disease duration, lesion segment, and preoperative visual analogue scale (VAS) score of low back pain, VAS score of bilateral lower extremities pain, Oswestry disability index (ODI), intervertebral height, lumbar curvature index (LCI), and disc degeneration grading between groups (P>0.05). The removal volume of nucleus pulposus was compared; after operation, VAS score, ODI score, LCI, intervertebral height, and disc degeneration grading were used to evaluate the effectiveness.ResultsThe removal volumes of nucleus pulposus in groups A, B, C, and D were (3.6±0.9), (3.5±0.7), (4.6±1.0), (3.1±1.1) cm3, respectively. There were significant differences between groups (P<0.05). All incisions healed by first intention, and no early postoperative complications was found. All cases were followed up 12-35 months, with an average of 24 months. During follow-up, there was no recurrence of nucleus pulposus herniation, infection of intervertebral space, cerebrospinal fluid leakage, epidural hematoma, or other complications. At last follow-up, the VAS scores of low back pain and bilateral lower extremities pain, and ODI scores in each group significantly improved when compared with those before operation (P<0.05); there was no significant difference in the scores and improvements between groups after operation (P>0.05). At last follow-up, the disc degeneration grading in group B significantly improved when compared with that before operation (P<0.05); there was no significant difference between groups (P>0.05). At last follow-up, there was no significant difference in LCI of each group when compared with that before operation (P>0.05); and there was no significant difference in LCI and loss value between groups (P>0.05). There was no significant difference in the intervertebral height of the 4 groups at immediate after operation and last follow-up when compared with preoperative value (P>0.05), and there was no significant difference between groups at immediate after operation and last follow-up (P>0.05).ConclusionApplication of transforaminal endoscope in the treatment of serious lumbar disc herniation has great clinical outcomes. The ITEA technology can obtain a wider field of view and be more convenient to find and remove the degenerative nucleus pulposus. However, the appropriate approach should be selected according to the symptoms and characteristics of lumbar disc herniation.
ObjectiveTo discuss the effect of three different ways of annulus fibrosus incision on the biomechanical strength of intervertebral disc. MethodsA total of 30 goats underwent intervertebral disc nucleus pulposus extraction at L3, 4 and L4, 5 by the working channel in group A (n=10), by circular incision in group B (n=10), and by square incision in group C (n=10). The body weight, male and female ratio, age, intraoperative blood loss, and wound healing time were recorded and compared among 3 groups. The survival rate and wound healing situation were observed after operation. At 24 weeks after operation, the goats were sacrificed, MRI images were taken to observe the signal intensity of nucleus pulposus. The disc height of L3, 4 and L4, 5 was measured to calculate the loss of disc height; biomechanical test was used to assess the strength of the disc and anulus. Histological staining was also conducted to observe the repair effect at L4, 5. ResultsThere was no significant difference in body weight, male to female ratio, age, intraoperative blood loss, and wound healing time among groups (P>0.05). All goats survived to the end of the experiment. MRI examination showed decreased signal intensity in 3 groups, indicating intervertebral disc degeneration. According to modified Thompson classification method, the degree of intervertebral disc degeneration of group A was significantly higher than that of groups B and C (P<0.05), but no significant difference was found between groups B and C (P>0.05). Difference was not significant in intervertebral space height before operation among 3 groups (P>0.05). But after 24 weeks, the intervertebral space height in group A was significantly higher than that in groups B and C (P<0.05), and the intervertebral space height loss in group A was significantly lower than that in groups B and C (P<0.05). The biomechanical strength in group A was also significantly higher than that in groups B and C (P<0.05), but no significant difference was found between group B and group C (P>0.05). HE and Masson staining showed good continuity of annulus fibrosus and clear layers in group A; poor continuity of annulus fibrosus and obvious scar tissues were observed in groups B and C. ConclusionApplication of working channel may have less destruction of annulus fibrosus, it plays a positive role in the maintenance of biomechanical strength and repair of annulus fibrosus.
This study is to investigate the inhibitory effect of different concentrations of zoledronic acid on the activity of osteoclasts, to obtain characteristics on inhibitory effect and to find the lowest effective concentration of zoledronic acid. Marrow cells of C57 mice (6 weeks) were cultured in vitro. Osteoclasts were induced by single nuclear cells. According to the concentration of zoledronic acid, we set up the experimental group with five different concentrations, i.e. 1×10–8 mol/L, 1×10–7 mol/L, 1×10–6 mol/L, 1×10–5 mol/L, and 1×10–4 mol/L. The control group did not contain any bisphosphonate. By tartrate resistant acid phosphatase staining, the number of multinuclear cells, cells through the filter and bone resorption lacune were counted. Five days after the cultivation, the number of multinuclear cells in the experimental group decreased with the increase of concentration of zoledronic acid. Inhibition on the formation of osteoclasts in vitro was effective at 1×10–6 mol/L. At the concentration of 1×10–5 mol/L, the effect of inhibition on migration of osteoclast and bone resorption was more obvious. The effect was further enhanced at concentration of 1×10–4 mol/L. However, the concentration and inhibition curves were gradually mild. The inhibitory effect on different concentrations of zoledronic acid on the activity of osteoclasts was different. The inhibition effect was obvious at 1×10–6 mol/L. We should pay attention to administrate appropriate concentration of zoledronic acid in the clinical applications.
ObjectiveTo investigate the effect and effectiveness analysis of different approaches of transforaminal endoscope on extirpation amount of nuclues pulposus.MethodsBetween August 2011 and December 2014, a total of 165 patients with lumbar disc herniation were retrospectively enrolled and were treated with nucleus pulposus discectomy through transforaminal endoscope. The patients were randomly divided into 4 groups according to different approach of transforaminal endoscope. The posterolateral approach (Yeung’s technology) was used in group A (42 cases), transforaminal endoscopic spine system (TESSYS) technology was used in group B (40 cases), improved transforaminal endoscopic access (ITEA) technology was used in group C (43 cases), and interlaminar approach (40 cases) was used in group D (40 cases). There was no significant difference in gender, age, disease duration, symptomatic side, and segments among 4 groups (P>0.05). The extirpation amount of nuclues pulposus was calculated and compared among 4 groups; the effectiveness was evaluated by pre- and post-operative visual analogue scale (VAS) score, Oswestry disability index (ODI), lumbar curvature index (LCI), and intervertebral height.ResultsThe discectomy amount of nucleus pulposus was (3.7±0.8), (3.6±0.7), (4.5±1.1), and (3.0±0.8) cm3 in groups A, B, C, and D, respectively. The amount of group C was significantly larger than that of the other 3 groups (P<0.05), and the amount of group D was significantly smaller than that of the other 3 groups (P<0.05); no significant difference was found between groups A and B (P>0.05). Cerebrospinal fluid leakage was found in 1 case; no other postoperative complications including intervertebral space infection and epidural hematoma was found. All the incisions healed by first intension. All the patients were followed up 12-24 months (mean, 18 months), and no typical symptoms of recurrence was found during the follow-up period. There was no significant difference in preoperative lower back pain VAS score, lower extremities VAS score, and ODI scores among 4 groups (P>0.05). The above scores at last follow-up were significantly improved when compared with preoperative ones in each group (P<0.05), but no significant difference of above scores and recovery values was found among 4 groups (P>0.05). The difference in LCI and intervertebral height at preoperation and at last follow-up were not significant between 4 groups (P>0.05). The difference in LCI and intervertebral height of each group between at preoperation and last follow-up were not significant (P>0.05). And the recovery value of LCI and the lost of height at last follow-up also showed no significant differences between 4 groups (P>0.05).ConclusionThe ITEA technology can give a wider field of view than other technologies. It is more convenient to find and remove the nucleus pulposus. However, the appropriate operative approaches should be chosen according to the symptoms and characteristics of lumbar disc herniation.
Objective To investigate the relationship between the volume of bone-graft and fusion efficacy in posterior lumbar interbody fusion and internal fixation of spondylolisthesis. Methods Between May 2004 and June 2007, 79 patients with spondylolisthesis were treated with posterior lumbar interbody fusion and internal fixation. The patients were randomly divided into 3 groups according to the volume of bone-graft for interbody fusion: group A (n=27), 5 bone granules/ cm3 on average; group B (n=26), 11 bone granules/cm3 on average; and group C (n=26), 25 bone granules/cm3 on average. There was no significant difference in gender, age, disease duration, affected segment, and the degree of vertebral slip among 3 groups (P gt; 0.05). The volume of bone-graft, the fusion rate, the loss of intervertebral height, and the incidence of internal fixation failure were compared among 3 groups. Results All cases were followed up 24-43 months (mean, 35 months). There were significant differences in volume of bone-graft among 3 groups (P lt; 0.05). There was no significant difference in total volume of bone-graft and Cage height among 3 groups (P gt; 0.05). The Oswestry disability index (ODI) and visual analogue scale (VAS) scores of low back pain and leg pain at last follow-up were significantly decreased when compared with preoperative scores in 3 groups (P lt; 0.05); but no significant difference was found among 3 groups (P gt; 0.05). The fusion rate was significantly higher in group B than in groups A and C, and in group A than in group C at 1 and 2 years after operation (P lt; 0.05). The change values of the intervertebral height were (2.2 ± 1.4), (0.8 ± 1.3), and (2.3 ± 1.6) mm respectively in groups A, B, and C; it was significantly lower in group B than in groups A and C (P lt; 0.05). The degree of vertebral slip at immediately after operation and last follow-up was significantly improved when compared with preoperative one in 3 groups (P lt; 0.05); the loss of vertebral slip in group B was significantly lower than that in groups A and C at last follow-up (P lt; 0.05). After operation, nail breaking occurred in 1 case (3.7%) of group C at 1 year, depinning in 1 case (3.8%) of group A at 2 years, and no nail breaking or depinning in group B. There was no significant difference in the incidence of internal fixation failure among 3 groups (χ2=3.950, P=0.604). Conclusion The application of bone-graft with middle volume (11 bone granules/cm3 on average) in internal fixation and posterior lumbar interbody fusion has a good imageology outcome, which can increase the fusion rate and decrease the loss of intervertebral height.