Surgical treatment of scoliosis in a rare disease: arthrogryposis

Background

The reported incidence of scoliosis in arthrogryposis varies from 30% to 67% and, in most cases, the curves progress rapidly and become stiff from early age. The authors report six cases of scoliosis in arthrogryposis to assess the role of surgical treatment.

Methods

Six cases (3 males, 3 females; mean age at surgery 13.2 years) with arthrogryposis multiplex congenita associated with the characteristic amyoplasia were reviewed: they were operated on for scoliosis at the authors' Spine Surgery Department between 1987 and 2008. Surgery was performed using the Harrington-Luque instrumentation (2 cases), the Luque system (1), a hybrid segmental technique with hooks and screws (1) and spinal anchoring with pedicle screws (2).

Results

The patients were clinically and radiologically reviewed at a mean follow-up of 4.2 years, ± 2.7 (range, 1 to 9 years). Three minor postoperative complications were encountered; a long-term pulmonary complication was seen in one case after reintervention and was successfully resolved after 10 days. Surgery was successful in the other 5 cases, where solid arthrodesis was achieved and no significant curve progression was observed at follow-up.

Conclusions

The experience acquired with the present case series leads the authors to assert that prompt action should be taken when treating such aggressive forms of scoliosis. In case of mild spinal deformities in arthrogryposis, brace treatment should be attempted, the evolution of the curves being unpredictable; however, when the curve exceeds 40° and presents with marked hyperkyphosis, hyperlordosis or pelvic obliquity, surgery should not be delayed.     

Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review

Background

Studies on adolescent idiopathic scoliosis have well documented the differences between natural history of male and female patients. There are also differences in responses to nonoperative treatment, but the results of operative treatment in male patients compared with females have not been widely reported. Only few studies had compared the outcomes of operative treatment between male and female patients with different results.

Methods

We retrospectively reviewed the outcome of 150 (112 girls and 38 boys) consecutive patients with diagnosis of adolescent idiopathic scoliosis who were managed surgically between May 1996 and September 2005. Next, male radiographic parameters were compared with female ones pre- and postoperatively. Then, a subgroup of 38 matched girls was compared regarding the age, curve type, curve magnitude, and the instrumentation we used.

Results

In comparing male patients with unmatched girls, the boys had greater mean age (17.3 ± 2.3 vs. 16.3 ± 2.9; p = 0.049), greater primary curve (71.4 ± 21.3° vs. 62.7 ± 17.5°; p = 0.013), less flexibility (30.1 ± 13.5% vs. 40.3 ± 17.8%; p = 0.01), and less correction percentage (51.3 ± 12.9% vs. 58.8 ± 16.5%; p = 0/013). The loss of correction was comparable between the two groups. In the matched comparison, the flexibility in boys was less than girls (30.1 ± 13.5% vs. 38.1 ± 17.5%; p = 0.027). Also, the boys had a smaller correction percentage compared to the girls, but this finding was not statistically significant.

Conclusion

There was similar distribution curve pattern between male and female patients with AIS. Males had more rigid primary curves compared to females but a similar degree of postoperative scoliosis correction. Male AIS patients were older at the time of surgery. These preoperative gender differences, however; did not compromise the radiological outcomes of surgical treatment and the results were comparable between the genders.     

成人退行性腰椎侧弯合并滑脱的手术治疗

目的:探讨退行性腰椎侧弯合并滑脱的手术方法和临床疗效.方法:25例适应证患者行后路椎弓根螺钉内固定复位矫形后,采用椎管减压、神经根松解,行椎间植骨和后外侧植骨融合术,术后测量退变性脊柱侧弯的矫正效果,依照日本整形外科学会(JOA)下腰痛评分,观察腰腿疼痛改善情况.结果:全部病例获得随访,随访时间6月～3年,平均20个月,术后平均侧弯矫正率58.7%,疼痛改善优良率80%.结论:椎弓根固定系统结合椎间及后外侧植骨融合术是治疗退行性腰椎侧弯合并滑脱的有效方法.应重视术中神经根减压,矫正腰椎侧弯,恢复腰椎力学平衡,有助于提高远期疗效.     

Surgical treatment of the nasal deformities of leprosy: a 16-year review.

We present a retrospective review (from 1959 to 1975) of 86 patients who were treated surgically for nasal leprosy deformities at the Tata Department of Plastic Surgery. The postnasal skin graft inlay was the most frequent procedure, and it seems best suited for these repairs in developing countries where the patients often present late with major deformities. For minor and early nasal deformities, the insertion of a bone graft or a silicone rubber implant is recommended.     

Surgical treatment of osteoarthritis of the carpometacarpal joint of the thumb: a systematic review

In most cases of basal joint osteoarthritis, surgery becomes an option at stages II, III, and IV, as classified by Eaton. Controversy exists regarding which technique achieves the best outcome. This systematic review was undertaken to address the question of which technique, if any, offers the best outcome to patients with osteoarthritis of the first carpometacarpal joint greater than stage II. A thorough search of the electronic databases Cochrane, Cinahl, Healthstar, and MEDLINE/PubMed was undertaken to identify reviews and articles on primary comparative studies of the different surgical options. The methodological quality of the retrieved articles was assessed on the basis of specific criteria. Inclusion criteria were applied to 44 of 254 possibly relevant articles. Eight reviews and 18 comparative studies met the criteria and were reviewed. Each of the techniques, arthrodesis, trapeziectomy with or without biological/synthetic interposition, osteotomy, and joint replacement, was associated with unique benefits and risks. There was great variability in outcome measurements. The majority of retrieved review articles claim that ligamentous reconstruction and tendon interposition may represent the best option; however, validity assessment of these studies revealed methodological flaws. Furthermore, results from the articles on comparative studies indicate that ligamentous reconstruction and tendon interposition may provide no additional benefit when compared with arthrodesis and trapeziectomy alone or with tendon interposition. There is no consensus as to which clinical outcomes are most important in thumb basal joint surgery and how these should be measured. This renders the appraisal and comparison of such studies a challenging task. Until large randomized controlled trials that compare techniques in similar populations with respect to staging and prognostic factors are undertaken and the clinical outcomes are clearly defined, surgeons will continue to claim superiority of one technique over another without supporting evidence.     

Age-grading adult insects: a review of techniques

Abstract.The range of techniques available for age-grading adult insects is reviewed, with particular emphasis on species of medical and veterinary importance. Chronological and physiological age-grading are discussed, considering the relative merits of each approach. The techniques described include those based on changes to the reproductive system, those relying on somatic changes and those dependent on cuticular degradation. The advantages and problems of each technique and the use of a number of techniques in combination are discussed.     

Automated neuron model optimization techniques: a review

The increase in complexity of computational neuron models makes the hand tuning of model parameters more difficult than ever. Fortunately, the parallel increase in computer power allows scientists to automate this tuning. Optimization algorithms need two essential components. The first one is a function that measures the difference between the output of the model with a given set of parameter and the data. This error function or fitness function makes the ranking of different parameter sets possible. The second component is a search algorithm that explores the parameter space to find the best parameter set in a minimal amount of time. In this review we distinguish three types of error functions: feature-based ones, point-by-point comparison of voltage traces and multi-objective functions. We then detail several popular search algorithms, including brute-force methods, simulated annealing, genetic algorithms, evolution strategies, differential evolution and particle-swarm optimization. Last, we shortly describe Neurofitter, a free software package that combines a phase–plane trajectory density fitness function with several search algorithms.     

Supercritical methodologies applied to the production of biopesticides: a review

Supercritical technologies are new, environmentally friendly, advanced separation techniques that have attracted the attention of both industry and academy in their aspirations of producing safer products with cleaner processes. In the field of biopesticides, supercritical fluids are being used in different stages, from the extraction of active ingredients from natural matrices to the encapsulation of blends during the formulation of the final commercial pesticide. This review summarizes different supercritical processes that arise in literature comprising supercritical fluid extraction, supercritical antisolvent fractionation or extraction, supercritical assisted atomization, particle from gas saturated solutions and supercritical solvent impregnation among others. The aim of this work is to give a general view of supercritical fluids in the field of biopesticides production, optimization and formulation, emphasizing in the extraction, fractionation and encapsulation and highlighting their importance when green, solvent free processes have to be designed.     

Auto-scaling techniques for IoT-based cloud applications: a review

Cluster Computing - Cloud and IoT applications have inquiring effects that can strongly influence today’s ever-growing internet life along with necessity to resolve numerous challenges for...     

Progress of new label-free techniques for biosensors: a review

The detection techniques used in biosensors can be broadly classified into label-based and label-free. Label-based detection relies on the specific properties of labels for detecting a particular target. In contrast, label-free detection is suitable for the target molecules that are not labeled or the screening of analytes which are not easy to tag. Also, more types of label-free biosensors have emerged with developments in biotechnology. The latest developed techniques in label-free biosensors, such as field-effect transistors-based biosensors including carbon nanotube field-effect transistor biosensors, graphene field-effect transistor biosensors and silicon nanowire field-effect transistor biosensors, magnetoelastic biosensors, optical-based biosensors, surface stress-based biosensors and other type of biosensors based on the nanotechnology are discussed. The sensing principles, configurations, sensing performance, applications, advantages and restriction of different label-free based biosensors are considered and discussed in this review. Most concepts included in this survey could certainly be applied to the development of this kind of biosensor in the future.     

Elimination of electrocardiogram contamination from electromyogram signals: An evaluation of currently used removal techniques.

Trunk electromyographic signals (EMG) are often contaminated with heart muscle electrical activity (ECG) due to the proximity of the collection sites to the heart and the volume conduction characteristics of the ECG through the torso. Few studies have quantified ECG removal techniques relative to an uncontaminated EMG signal (gold standard or criterion measure), or made direct comparisons between different methods for a given set of data. Understanding the impacts of both untreated contaminated EMG and ECG elimination techniques on the amplitude and frequency parameters is vital given the widespread use of EMG. The purpose of this study was to evaluate four groups of current and commonly used techniques for the removal of ECG contamination from EMG signals. ECG recordings at two intensity levels (rest and 50% maximum predicted heart rate) were superimposed on 11 uncontaminated biceps brachii EMG signals (rest, 7 isometric and 3 isoinertial levels). The 23 removal methods used were high pass digital filtering (finite impulse response (FIR) using a Hamming window, and fourth-order Butterworth (BW) filter) at five cutoff frequencies (20, 30, 40, 50, and 60 Hz), template techniques (template subtraction and an amplitude gating template), combinations of the subtraction template and high pass digital filtering, and a frequency subtraction/signal reconstruction method. For muscle activation levels between 10% and 25% of maximum voluntary contraction, the template subtraction and BW filter with a 30 Hz cutoff were the two best methods for maximal ECG removal with minimal EMG distortion. The BW filter with a 30 Hz cutoff provided the optimal balance between ease of implementation, time investment, and performance across all contractions and heart rate levels for the EMG levels evaluated in this study.     

The random amplified polymorphic DNA (RAPD) assay and related techniques applied to genotoxicity and carcinogenesis studies: a critical review

More than 9000 papers using the random amplified polymorphic DNA (RAPD) or related techniques (e.g. the arbitrarily primed polymerase chain reaction (AP-PCR)) have been published from 1990 to 2005. The RAPD method has been initially used to detect polymorphism in genetic mapping, taxonomy and phylogenetic studies and later in genotoxicity and carcinogenesis studies. Despite their extensive use, these techniques have also attracted some criticisms, mainly for lack of reproducibility. In the light of their widespread applications, the objectives of this review are to (1) identify the potential factors affecting the optimisation of the RAPD and AP-PCR assays, (2) critically describe and analyse these techniques in genotoxicity and carcinogenesis studies, (3) compare the RAPD assay with other well used methodologies, (4) further elucidate the impact of DNA damage and mutations on the RAPD profiles, and finally (5) provide some recommendations/guidelines to further improve the applications of the assays and to help the identification of the factors responsible for the RAPD changes. It is suggested that after proper optimisation, the RAPD is a reliable, sensitive and reproducible assay, has the potential to detect a wide range of DNA damage (e.g. DNA adducts, DNA breakage) as well as mutations (point mutations and large rearrangements) and therefore can be applied to genotoxicity and carcinogenesis studies. Nevertheless, the interpretation of the changes in RAPD profiles is difficult since many factors can affect the generation of RAPD profiles. It is therefore important that these factors are identified and taken into account while using these assays. On the other hand, further analyses of the relevant bands generated in RAPD profile allow not only to identify some of the molecular events implicated in the genomic instability but also to discover genes playing key roles, particularly in the initiation and development of malignancy. Finally, to elucidate the potential genotoxic effects of environmental contaminants, a powerful strategy could be firstly to use the RAPD assay as a screening method and secondly to apply more specific methods measuring for instance DNA adducts, gene mutations or cytogenetic effects. It is also envisaged that these assays (i.e. RAPD and related techniques), which reflect effects at whole genome level, would continue to complement the use of emerging technologies (e.g. microarrays which aim to quantify expression of individual genes).     

The utility of superficial abdominal reflex in the initial diagnosis of scoliosis: a retrospective review of clinical characteristics of scoliosis with syringomyelia

Background

The incidence of spinal deformity in children with Prader-Willi syndrome (PWS) is high, with 86% of these patients found to have a significant structural scoliosis; however, there are very few case reports describing surgical treatment for this deformity.

Methods

The authors reviewed a case series consisting of 6 patients who underwent spine surgery for scoliosis. Children's mean age at index surgery was 12 years and 10 months (range, 10 to 15 yrs). Clinical evaluation revealed the typical phenotypic features of the PWS in all of the patients; 4 subjects had a karyotype confirmation of PWS. Major structural curves showed preoperative mean Cobb angles of 80.8° (range, 65° to 96°). Hybrid instrumentation with sublaminar wires, hooks and screws was used in the first 2 patients, while the remaining 4 were treated with titanium pedicle screw constructs.

Results

The mean clinical and radiological follow-up was 3 years and 10 months (range, 2 years to 9 years). Major complication rate was 50%. One patient who developed a major intraoperative complication (paraparesis) prevented spinal fusion to be obtained: the neurologic deficit resolved completely after instrumentation removal. Solid arthrodesis and deformity correction in both coronal and sagittal plane was, however, achieved in the other 5 cases and no significant curve progression was observed at follow-up. Another major short-term complication was encountered 3 months after surgery in a patient who experienced the detachment of a distally located rod and required correction through revision surgery and caudal extension by one level. Cervico-thoracic kyphosis was seen in 1 patient who did not require revision surgery.

Conclusions

Spine reconstructive surgery in patients with PWS is rare and highly demanding. The best method of reconstruction is posterior multilevel pedicle screw fixation. Moreover, even with modern techniques, the risk of complications is still high. These new techniques, however, have shown to improve the postoperative course by allowing for immediate mobilization without any brace or cast. The use of the growing rod techniques, requiring repeated surgeries, should be carefully evaluated in each single case.     

Angiographic assessment of coronary stenoses: a review of the techniques

This article reviews the fundamental techniques to quantify the physiological severity of (coronary) stenoses. Although a wide survey of different techniques and applications is provided, the focus of this review is on: 1) the assessment of the immediate effect of the stenoses on blood flow (i.e., the hemodynamic severity), and not on the assessment of the pathology of the vessel itself; 2) the flow reserve methods to defining the physiological severity of stenoses; and 3) the determination of blood flow and tissue perfusion by X-ray angiography (a short survey of other imaging modalities is provided as well). Although the practical implementation of the techniques is illustrated by applying them to coronary stenoses, most of the issues involved are of interest in other application areas (using other imaging modalities) as well. This review consists of four parts. The first part deals with the definition of stenoses severity; the second part with tracer kinetic theory necessary to determine flows by imaging; the third part focusses on (cardiac) imaging modalities, with an emphasis on X-ray angiography; and the last part illustrates the practical implementation of the techniques in cardiology.