The Clinical Results of Percutaneous Endoscopic Interlaminar Discectomy (PEID) in the Treatment of Calcified Lumbar Disc Herniation: A Case-Control Study.

BACKGROUND: Percutaneous endoscopic interlaminar discectomy (PEID), which poses advantages for certain types of herniated disc, is gaining wider acceptance in clinical practice. We retrospectively analyzed the efficacy of the PEID technique in treatment of calcified lumbar disc herniation. STUDY DESIGN: A retrospective case-control study. SETTING: University hospital in China. OBJECTIVE: To evaluate the efficacy of the PEID technique in treatment of calcified lumbar disc herniation, and a comparison between calcified and noncalcified disc herniation was drawn to analyze the causes of herniated disc calcification. METHODS: Data from patients who underwent full-endoscopic lumbar discectomy in our department between March 2011 and May 2013 were collected. Thirty cases with calcified lumbar disc herniation were included in the study group, and 30 age-, gender-, and body mass index (BMI)-matched cases with noncalcified lumbar disc herniation served as controls. Perioperative data, preoperative and postoperative Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) values, MacNab scores, and postoperative low-extremity dysesthesia among patients in the 2 groups were collected. RESULTS: The values of computed tomography (CT) in the calcified group were significantly higher than those in the noncalcified group (P < 0.01). The preoperative disease courses in the 2 groups were similar. However, there was a statistically significant difference in the duration of traditional Chinese medicines (TCM) administration (P < 0.01). VAS and ODI scores improved significantly after surgery, but there were no significant differences between the 2 groups (P > 0.05). Three months after surgery, the rate of low-extremity dysesthesia in the calcified group was significantly higher than that in the control group (P = 0.03) but became similar at 6 months. By applying MacNab criteria the proportions of good and excellent were greater than 90% in both groups, and there was no difference between groups (P > 0.05). LIMITATIONS: The sample size was small in this retrospective study. CONCLUSION: The PEID technique is an effective method in the treatment of calcified lumber disc herniation, although the rate of postoperative dysesthesia is higher in this group during the early postoperative period. Long-term TCM administration may be related to the calcification of herniated lumbar discs.

Changhai fulcrum bending radiographic technique to assess curve flexibility in patients with adolescent idiopathic scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the role and value of Changhai fulcrum bending radiograph(CH-FBR) in curve flexibility assessment of adolescent idiopathic scoliosis(AIS) patients.</p><p><b>METHODS</b>Thirty-seven AIS patients treated between June 2012 and August 2013 were enrolled, including 31 female and 6 male patients whose age ranged from 10 to 19 years, averaged of 15.0 years. The assessment of radiographs included preoperative standing posterior-anterior radiograph, supine side-bending radiograph, traditional fulcrum bending radiograph, Changhai fulcrum bending radiograph and postoperative standing posterior-anterior radiograph. Postoperatively, radiographs were assessed at one week. The CH-FBR was performed at the lowest height and the optimized height which means the weight on the fulcrum touch the maximum. All measurements of angle were made with use of the Cobb method. The flexibility of the curve as well as the correction rate and fulcrum bending correction index (FBCI) were calculated for all patients. The maximum height of CH-FBR, basic weight and maximum weight were measured for all AIS. Paired t-tests were used to assess differences between preoperative and postoperative curves within group samples. The Pearson correlation coefficients were calculated using bivariate analysis between CH-FBR flexibility rate and correction rate, the maximum height of CH-FBR and maximum weight, the height changes of CH-FBR and weight changes.</p><p><b>RESULTS</b>A total of 46 curves were involved in this study, including 28 thoracic and 18 thoracolumbar/lumbar curves. Preoperatively, the mean Cobb angle of the 46 structural curves was 47° ± 11°. Postoperatively, the mean Cobb angle was 11° ± 5°. Cobb's angle in supine side-bending(t = 7.2, P = 0.001), traditional fulcrum bending (t = 7.1, P = 0.001) and lowest height of Changhai fulcrum bending (t = 6.5, P = 0.001) were significantly different from the postoperative Cobb angle; Cobb's angle in traditional FBR (t = 11.0, P = 0.001) and lowest height of Changhai fulcrum bending (t = 13.6, P = 0.001) were significantly different from the optimized height CH-FBR Cobb angle. There was no significant difference found between traditional FBR Cobb angle and lowest height CH-FBR Cobb angle (t = 2.0, P = 0.051), optimized height CH-FBR Cobb angle and postoperative Cobb angle (t = 0.9, P = 0.36), lowest height CH-FBR Cobb angle and traditional FBR Cobb angle(t = 2.0, P = 0.051). The maximum height of CH-FBR, basic weight and maximum weight were (29.6 ± 1.4)cm,(20 ± 6)kg, and (40 ± 6) kg. Preoperatively, the mean Cobb angle of the 28 structural curves(main thoracic curves) was 46° ± 11°. Postoperatively, the mean Cobb angle was 12° ± 6°. Preoperatively, the mean Cobb angle of the 18 structural curves(thoracolumbar/lumbar curves) was 49° ± 12°. Postoperatively, the mean Cobb angle was 10° ± 5°. The results were same in 28 structural curves, 18 structural curves as well as 46 curves. Correlation analysis of 46 curves indicated that the maximum height of CH-FBR positively correlated with maximum weight (r = 0.69, r(2) = 0.47, P = 0.001), the height changes of CH-FBR positively correlated with weight changes on CH-FBR (r = 0.62, r(2) = 0.38, P = 0.001).</p><p><b>CONCLUSIONS</b>CH-FBR is a more reliable and effective method than traditional FBR and supine side-bending for curve flexibility evaluation in AIS patients. Moreover, compared to the traditional FBR and side-bending radiograph, the flexibility suggested by the optimized height CH-FBR more closely approximates the postoperative result made by pedicle screws fixation and fusion.</p>

ACUTE AND CHRONIC EFFECT OF R-hGH ON PLASM AFREE AMINO ACIDS IN DWARFS WITH GROWTH HORMONE DEFICIENCY / 中华内分泌代谢杂志

The plasma free amino acids (FAA) of 10 dwarfs with growth hormone deficiency (GHD) were analysed at the beginning of and 3 months after R-hGH treatment in order to observe the acute and chronic effect of R-hGH on plasma FAA.At the beginning of and after 3-month treatment, the levels of more than half of the essential amino acids(EAA) and most of the non-essential amino acids (NEAA) decreased dramatically 4 hours after R-hGH injection, denoting that the amino acids were consumed in protein synthesis, gluconeogenesis, and ketogenesis. The magnitudes of relevant results after 3-month treatment were not as much as those at the beginning (although still statistically significant), suggesting a mild metabolic adaptation of body to long-term R-hGH treament.The significant low value of FAA and urea in fasting blood after 3-month treatment bespeaks a nitrogen retention. The striking decrease in glycine, proline, glutamic acid etc., proposes an increased need of amino acids for bone growth after long-term R-hGH treatment. To meet the demand of body development, an increase in protein nutrition during GH therapy is recommended.

Reliability and validity of adapted simplified Chinese version of the Scoliosis Research Society-22 (SRS-22) Questionnaire / 第二军医大学学报

Objective:To evaluate the validity and reliability of adapted simplified Chinese Version of the Scoliosis Research Society-22(SRS-22)questionnaire.Methods:The English version of the SRS-22 was translated into simplified Chinese and was subjected to cross-culture adaptation;the final version of the simplified Chinese SRS-22 questionnaire was a consensus reached by an expert committee.Then the simplified Chinese version SRS-22 questionnaire and 36-Item Short Form Health Survey(MOS SF-36)questionnaire were used to survey 87 patients with adolescent idiopathic scoliosis who had been surgically treated;63 patients(72.4%)responded to the SRS-22 questionnaire.The average age of these patients(6 male,57 female)was(17.7?3.1)years(range,14.3-23.8 years).Fifty-six of the 63 patients returned the MOS SF-36 questionnaire.The 2 indicators of reliability were Cronbach's ? of internal consistency and intraclass correlation coefficient(ICC).Concurrent validity of the SRS-22 questionnaire was measured by comparing with domains of the SF-36 questionnaire,which was reflected by Pearson correlation coefficient(r).Results:The Cronbach ? values for 4 domains(function/activity,pain,self-image/appearance,and mental health)were all higher than 0.7;and the Cronbach ? value for satisfaction of management domain was acceptable.The intraclass correlation coefficients for function/activity,pain,self-image/appearance,mental health,and satisfaction domain were 0.74,0.78,0.86,0.81 and 0.84,respectively,demonstrating a satisfactory reproducibility.For the concurrent validity,3 domains had excellent correlation,10 had good correlation,and 21 had moderate correlation.Conclusion:The adapted simplified Chinese Version of the SRS-22 questionnaire has satisfactory reliability and concurrent validity,and might be suitable for post-operation clinical evaluation of Chinese adolescent patients with scoliosis.

THE GC ANALYSIS OF FATTY ACID IN HUMAN ADIPOSE TISSUE AND PLASMA / 营养学报

The total fatty acid in adipose tissue and total and free fatty acid in plasma, using tridecanoic (Cl3:0) and heptadecanoic acid (Cl7:0) as the internal standard (IS) respectively, were analysed by GC. In analysing total fatty acid, the esterification rate was 103.53% (IS Cl3:0) and 102.86% (IS C17:0); the recovery of lauric, myristic, stearic and arachidic acid was 101.0-103,3%, 102,1-494.1%, 103,1-104.5% and 100,0-105.0%; the CV of individual fatty acid were within the range of 2.24-8.46%. In analysing free fatty acid, the esterification rate in use of C17: 0 as the IS was 102.99%; the recovery of lauric, myristic, stearic and arachidic acid was 83.5-87.3%, 96.4-99.6%, 94.3-101.9%, and 82.0-105.0% respectively, the CV of individual fatty acid were within the range of 1.41-6.21%. The procedure analysing total fatty acid is especially simple, speedy, and reliable.