Analysis of the bond of users from different basic health units with possible diagnosis of non-communicable chronic diseases during the covid-19 pandemic in a city in southern Brazil / Análisis del vínculo de Usuarios de distintas unidades básicas de salud con posible diagnóstico de Enfermedades Crónicas no transmisibles frente a la pandemia del Covid-19 en el en una ciudad del sur de Brasil / Análise do vínculo de usuários de diferentes unidades básicas de saúde com possível diagnóstico de doenças crônicas não transmissíveis frente à pandemia da covid-19 em uma cidade no sul do Brasil

Non-communicable chronic diseases (NCDs) are considered one of the leading causes of death worldwide. During the COVID-19 pandemic, these diseases have been neglected due to the Brazilian Unified National Health System (BHUS) overload. In this context, this study aimed to analyze the bond between patients with NCDs and primary care during the COVID-19 pandemic while also seeking to identify the population's level of knowledge about health parameters and their relationship with the healthcare system. A cross-sectional and observational study was conducted, in which an online questionnaire was administered to collect socioeconomic information from patients and their bond with BHUS in the metropolitan region of Maringa, Parana, Brazil, encompassing individuals over 18 years of age. The survey was promoted on social media, and interested participants responded to the questionnaire, which addressed topics such as identification, medication use, disease information, knowledge about NCDs, and general data related to COVID-19. The obtained and analyzed responses revealed a low bond level between this population and primary care and a lack of knowledge about NCDs and their health during the pandemic. There was a notable decrease in seeking healthcare services during this period, which may be explained by the fear of contracting the novel coronavirus. This study is essential to understand patients' responses to public health challenges during the pandemic. It can become a valuable ally in dealing with future pandemics and endemic crises, enabling improvements in care and raising awareness among the population about NCDs and the healthcare system.

Las enfermedades crónicas no transmisibles (ENT) son consideradas una de las principales causas de muerte a nivel mundial. Durante la pandemia de COVID-19, estas enfermedades han sido desatendidas debido a la sobrecarga de las Unidades Básicas de Salud (UBS). En ese contexto, el objetivo de este estudio es analizar el vínculo entre los pacientes con enfermedades crónicas no transmisibles (ECNT) y la atención primaria durante la pandemia de COVID-19, buscando identificar el nivel de conocimiento de la población sobre los parámetros de salud y la relación con el sistema de salud. Se realizó un estudio transversal y observacional, en el que se aplicó un cuestionario en línea para recolectar información socioeconómica de los pacientes y su vínculo con las BHU en la región metropolitana de Maringá/PR, abarcando personas mayores de 18 años. La divulgación se realizó en las redes sociales y los interesados respondieron el cuestionario que abordó temas como identificación, uso de medicamentos, información sobre enfermedades, conocimientos sobre ECNT y datos generales relacionados con el COVID-19. Las respuestas obtenidas y analizadas revelaron un bajo nivel de vinculación de esta población con la atención primaria, así como un desconocimiento sobre las ECNT y su propia salud durante la pandemia. Hubo una notable reducción en la demanda de servicios de salud durante este período, lo que puede explicarse por el temor a la contaminación por el nuevo coronavirus. Este estudio se presenta como una herramienta importante para comprender la respuesta de los pacientes a los desafíos de salud pública durante la pandemia. Puede convertirse en un valioso aliado para enfrentar futuras pandemias y crisis endémicas, posibilitando mejoras en la atención y concientización de la población sobre las ECNT y el sistema de salud.

As doenças crônicas não transmissíveis (DCNTs) são consideradas uma das principais causas de morte em todo o mundo. Durante a pandemia da COVID-19, essas doenças têm sido negligenciadas devido à sobrecarga das Unidades Básicas de Saúde (BHU). Neste contexto, o objetivo deste estudo é analisar o vínculo dos pacientes com DCNTs com a atenção primária durante a pandemia da COVID-19, ao mesmo tempo em que busca identificar o nível de conhecimento da população sobre os parâmetros de saúde e o relacionamento com o sistema de saúde. Realizou-se um estudo transversal e observacional, no qual foi aplicado um questionário online para coletar informações socioeconômicas dos pacientes e seu vínculo com as BHUs na região metropolitana de Maringá/PR, abrangendo indivíduos maiores de 18 anos. A divulgação foi realizada em mídias sociais e os interessados responderam ao questionário que abordou tópicos como identificação, uso de medicações, informações sobre doenças, conhecimento acerca das DCNTs e dados gerais relacionados à COVID-19. As respostas obtidas e analisadas revelaram um baixo nível de vínculo dessa população com a atenção primária, assim como uma falta de conhecimento sobre as DCNTs e a própria saúde durante a pandemia. Observou-se uma notável redução na procura por serviços de saúde durante esse período, o que pode ser explicado pelo receio da contaminação pelo novo coronavírus. Este estudo se apresenta como uma ferramenta importante para compreender a resposta dos pacientes frente aos desafios da saúde pública durante a pandemia. Ele pode se tornar um aliado valioso para lidar com futuras pandemias e crises endêmicas, possibilitando melhorias nos cuidados e na conscientização da população sobre as DCNTs e o sistema de saúde.

Remyelination Regulated by microRNAs in Neurodegenerative Diseases： A Review / 中国实验方剂学杂志

Demyelination of the central nervous system often occurs in neurodegenerative diseases， such as multiple sclerosis （MS）. The myelin sheath， a layer of myelin membrane wrapping the axon， plays a role in the rapid conduction and metabolic coupling of impulses for neurons. The exposure of the axon will lead to axonal degeneratio， and further neuronal degeneration， which is the main cause of dysfunction and even disability in patients with demyelinating neurodegenerative diseases. In addition to the demyelination of mature myelin sheath， remyelination disorder is also one of the major reasons leading to the development of the diseases. The myelin sheath is composed of oligodendrocytes （OLs） derived from oligodendrocyte progenitor cells （OPCs） which are differentiated from neural stem cells （NSCs）. The process of myelin regeneration， i.e.， remyelination， is the differentiation of NSCs into OLs. Recent studies have shown that this process is regulated by a variety of genes. MicroRNAs， as important regulators of neurodegenerative diseases， form a complex regulatory network in the process of myelin regeneration. This review summarizes the main molecular pathways of myelin regeneration and microRNAs involved in this process and classifies the mechanisms and targets. This review is expected to provide a theoretical reference for the future research on the treatment of demyelinating diseases by targeting the regulation of microRNAs.

The interplay between brain lesions and painter´s creative transformations / A interação entre lesões cerebrais e transformações criativas do pintor

This narrative review addresses the complex relationship between neurological diseases and artistic expression, which can have a profound impact on a painter´s works. This exploration highlights the dynamic and ever-evolving connection between neuroscience and art, offering insights into the extraordinary ways in which the human brain and artistic expression intersect and evolve. Following brain damage, there may be the emergence of sudden artistic talents, intriguing changes in the styles of established artists, the paradoxical facilitation of artistic abilities despite the cognitive decline consequent to these injuries, besides coping strategies that artists adopt in response to the challenges of health. Therefore, this article investigates different scenarios where brain injuries and disorders have had a profound impact on artists, leading to the emergence of new talents, changes in artistic styles, and unexpected improvements in their work, as well as adaptations in their artistic practices, as represented by some painters such as Tommy McHugh (1949 -2012), Francisco Goya (1746-1828), Otto Dix (1891-1969), Willem de Kooning (1904-1997), William Charles Utermohlen (1933-2007) and Charles Meryon (1821-1868). Consequently, works of art can be valuable but understudied tools for understanding brain dysfunction, although they must be interpreted with great care.

Esta revisão narrativa aborda a complexa relação entre doenças neurológicas e expressão artística, que pode ter um impacto profundo na obra de um pintor. Esta exploração destaca a conexão dinâmica e em constante evolução entre a neurociência e a arte, oferecendo insights sobre as formas extraordinárias pelas quais o cérebro humano e a expressão artística se cruzam e evoluem. Após danos cerebrais, pode haver o surgimento de talentos artísticos repentinos, mudanças intrigantes nos estilos de artistas estabelecidos, a facilitação paradoxal de habilidades artísticas, apesar do declínio cognitivo consequente a essas lesões, além de estratégias de enfrentamento que os artistas adotam em resposta aos desafios de saúde. Portanto, este artigo investiga diferentes cenários onde lesões e distúrbios cerebrais tiveram um impacto profundo nos artistas, levando ao surgimento de novos talentos, mudanças nos estilos artísticos e melhorias inesperadas em seu trabalho, bem como adaptações em suas práticas artísticas, bem como representado por alguns pintores como Tommy McHugh (1949 -2012), Francisco Goya (1746-1828), Otto Dix (1891-1969), Willem de Kooning (1904-1997), William Charles Utermohlen (1933-2007) e Charles Meryon (1821-1868). Consequentemente, as obras de arte podem ser ferramentas valiosas, mas pouco estudadas, para a compreensão da disfunção cerebral, embora devam ser interpretadas com muito cuidado.

Analysis of Animal Models of Cervical Spondylotic Radiculopathy Based on Characteristics of Clinical Symptoms of Chinese and Western Medicine / 中国实验方剂学杂志

With the acceleration of social rhythm， the progress of science and technology， and the increase of the number of phubbers， the incidence of cervical degenerative diseases is also increasing year by year. Cervical spondylotic radiculopathy（CSR）， as one of the diseases induced by cervical degeneration， has seriously affected people's quality of life and physical and mental health. Traditional Chinese medicine（TCM） is effective in the treatment of CSR， but the theoretical and basic experimental evidence is not sufficient， and the current formulation standard of animal model is not unified. Therefore， based on the clinical guidelines of Chinese and Western medicine for CSR and the characteristics of the disease and syndrome， the author systematically summarized and analyzed the existing animal models， and found that the existing models of microvascular clamp nerve root compression method had a poor agreement with the the Chinese and Western medical guidelines， while the modeling methods of spinal canal insertion， autologous bone insertion compression， stainless steel column compression， and fixed frame cervical degeneration reflected a high degree of agreement in the Western medical guidelines. However， the Chinese medical diagnostic criteria were poorly matched. This indicates that the existing animal models of this disease show few TCM syndrome elements， and lack information collection and evaluation in animal behavioral evaluation similar to the four diagnoses of TCM. In conclusion， this paper aims to systematically evaluate the current status of animal model establishment of CSR based on the concept of combination of disease and syndrome， so as to provide a theoretical basis for the model establishment of CSR that is more consistent with clinical characteristics and symptoms of Chinese and Western medicine.

Advances in the role of microglia polarization in the pathogenesis of retinal degenerative diseases / 眼科新进展

Microglia is involved in the occurrence and development of retinal degenerative diseases,thus its activation is a marker for retinal degenerative diseases.Microglia can be activated by different external stimulating factors and polar-ized into two phenotypes with different functional states and surface markers.The classical activation pathway produces M1 phenotype microglia,which mainly exerts pro-inflammatory and neurotoxic effects;the selective activation pathway pro-duces M2 phenotype microglia,which mainly exerts anti-inflammatory and neuroprotective effects.Precise modulation of microglia polarization is a promising approach for treating retinal degenerative diseases.This paper reviews the role of mi-croglia polarization in the pathogenesis of retinal degenerative diseases,aiming to pioneer new avenues and research ideas for treating retinal degenerative diseases.

Effect of sleep on brain clearing metabolites: thinking based on lymphoid system / 中华神经科杂志

Disruption of the structure of regular sleep is a common cause of neurodegenerative diseases such as Alzheimer′s disease and Parkinson′s disease, and its pathogenesis may be related to the deposition of waste products in the central nervous system. The glymphatic pathway, which is essentially a periarterial cerebrospinal fluid inflow pathway and peripheral venous clearance pathway, is functionally dependent on interstitial bulk flow coupling supported by aquaporin-4 on the astrocyte end-foot, also known as the lymphoid glial system. The glymphatic pathway, which removes waste proteins from the brain, is active primarily during sleep, and sleep quality declines with age, while the glymphatic pathway system also deteriorates with age, suggesting a relationship between sleep disturbances and symptom progression in neurodegeneration, and glymphatic system as a link closely links the two. The interaction of sleep, aging, metabolic waste and glymphatic pathway reticulation provides new clues to the pathogenesis of central nervous system degenerative diseases, and the glymphatic pathway may constitute a new target on treatment. The recent research progress on the effects of sleep and sleep disorders on the circulation of the glymphatic system, and proposes the possibility of sleep intervention to slow down the impairment of the lymphoid system function or even restore the function of the lymphoid system and thus improve the disease development process were reviewed in this paper.

Nuevo panorama para las enfermedades reumáticas pediátricas / New landscape for pediatric rheumatic diseases

Introducción: Las enfermedades reumáticas no se limitan a la edad adulta. Afectan a personas de todas las edades, incluidos los niños, y a menudo afectan a adultos jóvenes. En consecuencia, las enfermedades reumáticas pediátricas necesitan una evaluación y un seguimiento minuciosos y cuidadoso. Pueden ser debilitantes y, si no se tratan adecuadamente, pueden poner en peligro la vida. Objetivos: En este artículo se comentará sobre avances en el diagnóstico y tratamiento de las enfermedades reumáticas pediátricas, destacando las ventajas del empleo de determinados medios diagnósticos. Desarrollo: Para ello se ha realizado una revisión bibliográfica que permite aportar elementos importantes a considerar. Conclusiones: Se ha avanzado mucho en las últimas décadas en el campo de la reumatología pediátrica, que incluyen, entre otros, la patogenia, los criterios de clasificación y las terapias. Los reumatólogos pediátricos deben mantenerse al día con el progreso para aumentar la precisión del diagnóstico y mejorar el pronóstico de los pacientes(AU)

ABSTRACT Introduction: The effective treatment of postoperative pain is today a challenge for anesthetists, rheumatologists, orthopedic surgeons, surgeons and researchers of various specialties, who constantly propose protocols based on scientific evidence. Objective: Reflect and open the debate regarding the role of anesthesia in the relief of pain of rheumatological origin. Development: In Rheumatology, it is recommended, in all patients with chronic rheumatic pain, to calculate the intensity of the pain, both for the first choice of the analgesic treatment and for the measurement of the response. And, for this, several methods of quantification have been proposed. Conclusions: Diagnostic management and multidisciplinary treatment preside when this type of case is examined, since it is the only way to identify the origin of pain and provide prudent relief. In general, patients respond to conservative treatment and only a small group will need invasive anesthetic techniques(AU)

Factores relacionados con osteoartritis en trabajadores informales del centro de Medellín, Colombia / Related factors with Osteoarthritis in informal workers in Medellin downtown, Colombia

Resumen Introducción: Se hace una correlación entre la osteoatrosis y las condiciones laborales, hábitos y estilos de vida de los trabajadores informales del centro de Medellín, Colombia. Objetivo: Identificar la relación de la osteoartritis y la prevalencia de enfermedades crónicas y degenerativas con las condiciones sociodemográficas, laborales, hábitos y estilos de vida en un grupo de trabajadores informales de Medellín, Colombia. Materiales y métodos: Estudio transversal, con fuente primaria de información de 686 trabajadores informales. Se realizó una encuesta asistida, previa toma de consentimiento. Se seleccionaron 289 trabajadores con diagnóstico de enfermedad crónica o degenerativa, ≥18 años, con ≥5 años en su oficio. Se realizaron análisis exploratorios y de asociación con prueba Chi2, y cálculo de RP con IC del 95%. Resultados: el 79,9% de la población padecía alguna enfermedad crónica. El 3,46% presentaba diagnóstico de osteoartritis, siendo significativamente mayor (p<0,05) en quienes tenían entre 21 y 30 años en su oficio (RP=5,62. IC:1,20;26,34). También fue mayor la prevalencia de osteoartritis en; >45 años (RP=2,26), mujeres (RP:4,44), trabajadores sedentarios (RP=1,71), obesos (RP=3,40), así como en quienes habían sido obreros (RP=1,30), en aquellos que tenían puestos de venta semiestacionaria (RP=2,21), vendían productos de cosecha y perecederos (RP=1,78), en quienes trabajaban >8 horas diarias (RP:2,77), ≤5días a la semana (RP=3,10), no tenían espacio suficiente para moverse (RP=2,08), y en quienes tenían posturas o movimientos forzados (RP=2,72). Conclusión: En la población de vendedores informales del centro de Medellín, los factores sociodemográficos, laborales, hábitos y estilos de vida modificables se relacionan con una mayor prevalencia de osteoartritis.

Abstract Introduction: A correlation is made regarding osteoarthrosis and working conditions and lifestyles of informal workers in Medellin downtown. Objective: To identify the prevalence of chronic and degenerative diseases, and the relationship of osteoarthritis with sociodemographic and work conditions, habits and lifestyles, in a group of informal workers from Medellín, Colombia. Materials and methods: Cross-sectional study, with a primary source of information, with 686 workers. An assisted survey was applied, after obtaining consent. 289 workers with a diagnosis of chronic or degenerative disease, ≥18 years old, with ≥5 years in their profession were included. Exploratory and association analysis with Chi2 test, and calculation of PR with 95% CI. Results: 79.9% of them suffered from a chronic disease. 3.46% had a diagnosis of osteoarthrosis, being significantly higher (p <0.05) in those who had spent between 21 and 30 years performing their profession (PR=5,62.CI:1,20;26,34). The prevalence of osteoarthrosis was also higher in; >45 years (PR=2.26), women (PR=4,44), sedentary workers (PR=1,71), obese (PR=3,40), as well as those who had been brick-layers (PR=1,30), in those who had semi-stationary sales positions (PR=2,21), they sold harvest and perishable products (PR=1,78), in those who worked> 8 hours a day (PR:2,77), ≤ 5 days a week (PR=3,10), they did not have enough space to move (PR = 2.08), and in those who had forced postures or movements (PR=2,72). Conclusion: sociodemographic and work factors, habits and modifiable lifestyles are related to a higher prevalence of osteoarthrosis in this working population.

Research advances of chemokine receptor CX3CR1 and microglia in retinal degenerative diseases / 国际眼科杂志(Guoji Yanke Zazhi)

@#Retinal degenerative diseases such as retinitis pigmentosa and age-related macular degeneration are the main clinical blinding eye diseases with complex etiology and irreversible damage to vision. CX3CR1 is a specific receptor of the chemokine CX3CL1. Both of them participate in various physiological functions and pathological changes of the whole body through regulating the immune system of the body. In recent years, studies have pointed out that CX3CR1 regulates the activity and function of retinal microglia, which play an important role in the process of retinal degenerative diseases. In this paper, the structure and function of the chemokine receptor CX3CR1 and the role of microglia in retinal degenerative diseases were reviewed, so as to provide ideas and directions for future research and treatment of such diseases.

Current research of microinflammation on retinal degenerative diseases / 国际眼科杂志(Guoji Yanke Zazhi)

@#Retinal degenerative diseases are kinds of leading cause of blindness characterized by photoreceptor apoptosis and progressive neuronal degeneration. A large body of research has shown the evidence of inflammation reaction in such diseases. Retinal neuroinflammation may be a main factor resulting in apoptosis of photoreceptors and neurodegeneration of retina. In addition, the inflammatory response is not only detected in the retina, but also in aqueous humor, vitreous and even in blood, which forms a persistently very low degree, and chronic inflammatory environment. In this review, we focus on the development of microinflammatory response and its predictor for disease outcomes.

Research progress of photoreceptor transplantation in retinal degenerative diseases / 国际眼科杂志(Guoji Yanke Zazhi)

@#Retinal degenerative disease is a major disease that affects human vision. It damages human photoreceptor cells and damages human vision. And the mammalian retina does not have the ability to regenerate, once the disease will seriously affect people's normal life. At present, there is no clear way to prevent and alleviate these diseases, but the transplantation of photoreceptors to supplement the damaged photoreceptors in the retina can treat retinal diseases. In this paper, we will discuss the current situation and techniques of photoreceptor transplantation to restore vision in retinal degenerative diseases.

Clinical observation on the treatment of cervical degenerative diseases with Hybrid surgery / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of anterior cervical Hybrid surgery in the treatment of cervical degenerative diseases (CDD) and observe the incidence of heterotopic ossification of disc replacement segment at 1 year after surgery.@*METHODS@#From January 2015 to April 2018, 35 patients who received anterior cervical hybrid surgery met the inclusion and exclusion criteria and the complete clinical follow up data were analyzed retrospectively. Complete imaging follow-up data were obtained from 24 patients. There were 15 males and 20 females, aged from 39 to 70(55.57±7.73) years old. The amount of bleeding was for 20 to 100 (40.29±18.39) ml, and the hospitalstay was for 4 to 28(11.03±4.63) days, and the follow-up time was(12.97±1.36) months. Clinical outcomes were assessed by the Tanaka Yasushi cervical spondylitis symptom scale 20 score (YT20), and Japanese Orthopaedic Association (JOA) score. The occurrence of heterotopic ossification after Hybrid surgery was evaluated by X-ray according to McAfee standard one year after operation. Patients with or without heterotopic ossificationwere divided into two groups and their clinical effects were compared.@*RESULTS@#At the final follow up, the mean YT20 score and JOA score were significantly higher than those before operation (P <0.05), and the average improvement rate of JOA was (70.66 ±0.44)%. One year after operation, the heterotopic ossification occurred in 10 of 24 segments, with incidence of 41.70%(10/24), including 29.20% in gradeⅠand 12.50% in gradeⅡ. The results of clinical efficacy comparison between patients with and without heterotopic ossification were as follows:there was no significant difference in JOA score before and after operation (@*CONCLUSION@#The short-term clinical effect of Hybrid surgery is satisfactory for cervical degenerative diseases, and the cause of heterotopic ossification still needs tobe further explored.

Efficacy of Hybrid anterior cervical spine surgery on range of motion and curvature in the treatment of cervical degenerative diseases / 中国骨伤

OBJECTIVE@#To observe the change of cervical curvature and range of motion (ROM) on imaging at 6 months after Hybrid surgery.@*METHODS@#A total of 29 patients with cervical degenerative disease who underwent Hybrid surgery from January 2017 to July 2018 were retrospectively analyzed. Also, they all met the inclusion criteria and had complete preoperative and 6 months postoperative imaging data. There were 11 males and 18 females, aged from 34 to 76 (55.86±10.69) years, and the operation time was from 2 to 4(3.03±0.51) hours. The Cobb angle method was used to measure the changes of cervical curvature and ROM of C@*RESULTS@#There was no statistically significant difference in C@*CONCLUSION@#Hybrid surgery reconstructs the lordotic curvature of the entire cervical spine and the responsible segment, retains the ROM of the cervical replacement segment, and restores the biomechanical function of cervical spine.

Development of a lumbosacral intervertebral cage prototype for dogs / Desenvolvimento de um protótipo de cage intervertebral lombossacro para cães

Several surgical procedures aim to decompress and/or stabilize the lumbosacral (LS) joint of dogs; however, the lumbar interbody fusion technique, by using a cage combined with a bone graft, is the most indicated and used in human medicine. No specific implant is available for application to the canine lumbosacral joint. Thus, this study measured lumbosacral discs in large dogs, determined whether a human cage model could fit the dogs' L7-S1 intervertebral space, and developed a LS cage prototype for dogs. Ten cadaveric lumbosacral spines from adult dog weighing 20-35kg were used. The dogs had died for reasons unrelated to this study. The vertebral body dimensions and the L7-S1 intervertebral space occupied by the intervertebral disc were measured by lateral and ventrodorsal radiographs and by computed tomography in the dorsal, sagittal, and transverse views. Measurements were also taken of the anatomical specimens in the sagittal and transverse planes. After measuring the intervertebral discs, the following mean measures were obtained for L7-S1 discs: height 12.23mm, dorsal thickness 3.3mm, central thickness 4mm, ventral thickness 5.5mm, and width 24.74mm. The human lumbar cage models from brands LDR, Baumer Orthopedics, Stryker, Synthes, and Vertebral Technologies, Inc. and cervical stabilization cages from the brands B-Braun and Stryker were evaluated and were found to be unsuitable for large dogs. Cervical human cages had measurements similar to those found in this study; however, due to their quadrangular shape, the possibility of being introduced surgically through the surgical accesses available for the articulation between L7-S1 in dogs without injuring the cauda equina or the L7 root is small. A cage model was then developed using 3D modelling software. It was designed for insertion via dorsal laminectomy in the lateral portions of the intervertebral space. To avoid cauda equina lesion, the implant model was developed to be placed laterally to the midline. The cage surface is serrated to prevent using the locking screw to fix it, thus avoiding further injury to nerve structures. The serrated surfaces are also designed to avoid cage migration and promote stability. The prototype allows graft placement in the surrounding intervertebral space, which is fundamental for fusion through integration between the cage and the endplates as well as for bone growth between and around the cage. It was also considered studies on humans showing that the lateral regions of the endplates support a more considerable load. Biomechanical and in vivo studies on the developed model are necessary to evaluate the actual degree of distraction, mobility and the long-term rate of fusion between L7 and S1 and its possible impact on the adjacent motor units, combined or not with dorsal fixation techniques.(AU)

Vários procedimentos cirúrgicos visam descomprimir e/ou estabilizar a articulação lombossacra (LS) de cães; no entanto, a técnica de fusão lombar, usando um cage intersomático combinado com um enxerto ósseo, é a mais indicada e utilizada na medicina humana. Não há implante específico disponível para aplicação na articulação lombossacra canina. Assim, neste estudo foi realizada a mensuração do espaço do disco intervertebral lombossacro de cães de raças grandes, para verificar se algum modelo de cage usado na medicina humana poderia ser usado no espaço intervertebral L7-S1 de cães. O segundo objetivo foi desenvolver um protótipo de cage lombossacro para cães. Foram utilizadas dez colunas lombossacras provenientes de cadáveres de cães adultos com peso entre 20 e 35kg. Os cães vieram a óbito por razões não relacionadas a este estudo. As dimensões do corpo vertebral e o espaço intervertebral L7-S1 ocupado pelo disco intervertebral foram medidos por radiografias laterais e ventrodorsais e por tomografia computadorizada nos cortes dorsal, sagital e transversal. Também foram realizadas mensurações das peças anatômicas nos planos sagital e transversal. Após a mensuração dos discos intervertebrais, foram obtidas as seguintes medidas médias dos discos L7-S1: altura 12,23mm, espessura dorsal 3,3mm, espessura central 4mm, espessura ventral 5,5mm e largura 24,74mm. Os modelos de cage lombar humano das marcas LDR, Baumer Orthopaedics, Stryker, Synthes e Vertebral Technologies, Inc. não possuíam dimensões adequadas para os cães. Cages de estabilização cervical das marcas B-Braun e Stryker também foram avaliados e apresentaram medidas semelhantes às encontradas neste estudo; no entanto, devido à sua forma quadrangular, a possibilidade de serem introduzidos cirurgicamente através das abordagens disponíveis para a articulação entre L7-S1 em cães sem lesionar a cauda equina ou a raiz L7 é pequena. Um modelo de cage foi então desenvolvido usando-se o software de modelagem 3D. Foi projetado para inserção via laminectomia dorsal nas porções laterais do espaço intervertebral. Para evitar a lesão da cauda equina, o modelo de implante foi desenvolvido para ser colocado lateralmente à linha média. A superfície do cage é serrilhada para evitar o uso do parafuso de travamento, evitando-se lesões adicionais às estruturas nervosas. As superfícies serrilhadas também foram projetadas para evitar a migração do cage e promover estabilidade. O protótipo permite a colocação do enxerto no espaço intervertebral circundante, fundamental para a fusão através da integração entre o cage e as placas vertebrais terminais, bem como para o crescimento ósseo entre e ao redor do implante. Também foram considerados estudos em seres humanos que mostraram que as regiões laterais das placas vertebrais terminais suportam uma carga maior. São necessários estudos biomecânicos e in vivo do modelo desenvolvido para avaliar o grau real de distração, mobilidade e a taxa de fusão a longo prazo entre L7 e S1 e seu possível impacto nas unidades motoras adjacentes, quando combinado ou não com técnicas de fixação dorsal.(AU)

Inner-heating acupuncture of lumbar degenerative lesions based on β-catenin signaling pathway / 中国骨伤

OBJECTIVE@#By observing the effect of inner-heating acupuncture on the expression of Wnt1, Axin and β-catenin in the intervertebral disc of rats with lumbar degenerative disease and to explore the regulatory mechanism of inner-heating acupuncture on the apoptosis of annulus fibrosus cells in rats with lumbar degenerative disease.@*METHODS@#Forty SD rats were randomly divided into normal group, model group, inner heating acupuncture group and acupuncture group with 10 rats in each group. Except for normal group, all rats were modeled. Bilateral were selected for inner-heating acupuncture and acupuncture treatment. Western-bolt assay was used to detect the expression of Wnt1, Axin and β-catenin in rat intervertebral discs.@*RESULTS@#Compared with the model group, Wnt1 and β-catenin expression in annulus fibrosus cells of rats in the inner heating acupuncture group and the acupuncture group were significantly decreased(0.05).@*CONCLUSION@#Inner heating acupuncture can down regulate the expression of Wnt1 and β-catenin and up regulate the expression of Axin in annulus fibrosus of rats with lumbar degenerative desease. It is suggested that the mechanism may be to regulate the expression of related factors in the β-catenin signaling pathway, so as to achieve the goal of treating lumbar degenerative diseases.

Culture methods of inducing embryonic stem cells to differentiate into retinal pigment epithelial cells / 国际眼科杂志(Guoji Yanke Zazhi)

@#Retinal degenerative disease can lead to decreased vision, which is a blinding ophthalmopathy caused by irreversible damage or apoptosis of retinal pigment epithelium(RPE)cells or photoreceptor cells, often resulting in visual impairment or even blindness. Human embryonic stem cells(hESCs)are a kind of multi-directional differentiation cells. By appropriate methods, hESCs can be differentiated into various retinal cells. Since human PRE cells cannot be regenerated, studies have shown that the clinical treatment of retinopathy with stem cell derived RPE cell transplantation has practical prospects and has made a breakthrough in recent years. Due to the limitations of multiple factors, the selection of methods and the complexity of induction conditions, the efficiency of induced differentiation of RPE and the survival rate after transplantation vary greatly and are unstable. Therefore, the current researches should focus on how to integrate different culture methods, take advantages and eliminate disadvantages, so as to improve the directed differentiation efficiency of hESCs, as well as the number and quality of induced cells, thus reducing culture pollution and immune rejection and so on. Here, we will summarize the current examples of various culture methods and give a review from different perspectives.

Cementing the apical and terminal pedicle screw applied in osteoporotic spine with lumbosacral degenerative disease: A finite element analysis / 中国组织工程研究

BACKGROUND: Cement-augmented pedicle screw is an effective fixation for osteoporotic spine, and it is important to reduce the rate of cement leakage. OBJECTIVE: To evaluate the stability of cementing the apical and terminal pedicle screw applied in osteoporotic spine with lumbosacral degenerative disease by finite element analysis. METHODS: An intact finite element model of L2-5 segment was established by using CT scan data of one normal male volunteer. After verifying the validity of the intact model, the cementing apical and terminal pedicle screw and cement-augmented pedicle screw models of double/multi-level segment fixation were established, respectively. A 150 N vertical axial pre-load was imposed on the superior surface and a 10 N·m moment was applied on the superior surface along the radial direction to simulate six different physiological motions: flexion, extension, left bending, right bending, left rotation, and right rotation. The different of range of motion, cage stress, and pedicle screw stress on fixed segments were compared between models. RESULTS AND CONCLUSION: (1) The validity showed that the range of motion of the intact model was similar to cadaveric studies in all directions. (2) The range of motion of cementing the apical and terminal pedicle screw group was slightly larger than that of cement-augmented pedicle screw group and the difference between the two groups was less than 0.15°. The two fixation methods could maintain the similar stability of the operation segment. (3) The difference of the cage stress and instrument stress was also small between the two groups. (4) These results suggest that compare with cement-augmented pedicle screw, cementing the apical and terminal pedicle screw can increase the approximate stability in double-level and multi-level segment fusion. The cementing the apical and terminal pedicle screw procedure may reduce the risk of cement leakage and patient costs, and offer a useful alternative to the cement-augmented pedicle screw procedure.

Focus on stem cell-based therapy for retinal degenerative diseases / 中华实验眼科杂志

Retinal degenerative diseases are the common cause of blindness for all ages.Cell replacement therapy is the main strategy for treating retinal degenerative diseases.Recently, several retinal pigment epithelium(RPE) transplantation clinical trials have taken place worldwide and greatly enhanced the visual function of patients.However, irreversible loss of photoreceptors has been found in the late stage of diseases.Thus, photoreceptor transplantation is essential for the treatment of late-stage retinal degenerative diseases.How to obtain the clinical-grade amount of human cone photoreceptors remains to be one of the technical obstacles.This review introduced the present clinical trials of RPE transplantation and research achievements of photoreceptor transplantation.Furthermore, we will focus on the studies of stem cell-derived human photoreceptor differentiation.Lastly, the difficulties and future directions of stem cell-based therapy for retinal degenerative diseases will be discussed.

Progress of retinal organoids in treatment of retinal degenerative diseases / 国际眼科杂志(Guoji Yanke Zazhi)

@#Retinal degeneration is the primary cause of visual impairment and blindness. However, in advanced stage of the disease, the majority or all photoreceptors are lost, effective therapeutics has not been established. In recent years, a large number of studies have provided new ways for the replacement of photoreceptors and three-dimensional retinal culture has emerged to produce retinal photoreceptors and tissues of both fetal mouse and human, providing the cell source of photoreceptors replacement therapy for treating retinal degenerative diseases. This review focuses on the development of three-dimensional retinal culture techniques and photoreceptors transplantation experiments, and the existing application strategies and limitations of retinal organoids in the replacement therapy of retinal degeneration, which provide a theoretical reference for the optimization of 3D retina in photoreceptors replacement therapy.

As dificuldades no atendimento aos indivíduos com doenças neurodegenerativas: o fonoaudiólogo e a equipe multiprofissional / The difficulties in the care of the patient with neurodegenerative diseases: the speech-language therapist and the multi-professional team

RESUMO Objetivo Analisar as dificuldades de fonoaudiólogos quanto à intervenção fonoaudiológica em indivíduos com doenças neurodegenerativas. Métodos Trata-se de um estudo transversal com 74 fonoaudiólogos brasileiros. Os profissionais foram convidados, por meio de redes sociais, a responder um questionário online com perguntas sobre sua atuação profissional com indivíduos com doenças neurodegenerativas. Foram incluídos apenas fonoaudiólogos que atuavam no território brasileiro e que atendiam, ou já haviam atendido, indivíduos com doenças neurodegenerativas. Para verificar a existência de associação entre aspectos da experiência dos fonoaudiólogos e as dificuldades referidas, utilizaram-se os testes estatísticos Mann-Whitney U, Qui-quadrado e Exato de Fisher. Resultados As maiores dificuldades encontradas quanto ao atendimento de indivíduos com doenças neurodegenerativas foram: dificuldade de adesão do cuidador às orientações fonoaudiológicas (52,7%), insuficiência na comunicação entre os profissionais da equipe para um cuidado interdisciplinar (52,7%) e chegada tardia para avaliação (50%). A dificuldade de adesão do paciente às orientações fonoaudiológicas (p=0,015) e a dificuldade relacionada à insuficiência na comunicação entre os profissionais para um cuidado interdisciplinar (p=0,036) foram associadas ao menor tempo de formação profissional. Já a dificuldade de adesão do cuidador às orientações fonoaudiológicas, foi associada a equipes não interdisciplinares (p=0,014). Conclusão A falta de comunicação eficiente na equipe multiprofissional, a não adesão dos cuidadores e a chegada tardia do indivíduo para avaliação fonoaudiológica, junto ao desconhecimento das possibilidades de atuação da fonoaudiologia, foram os principais obstáculos enfrentados pelos profissionais. O tempo de formação profissional foi um dos aspectos mais associados às dificuldades no trabalho de fonoaudiólogos que atendem indivíduos com doenças neurodegenerativas.

ABSTRACT Purpose To analyze the difficulties of speech-language therapists regarding speech-language intervention in patients with neurodegenerative diseases. Methods This is a cross-sectional study with 74 Brazilian speech-language therapists. The professionals were invited through the social networks to respond an online questionnaire with open and closed questions about their professional performance with patients with neurodegenerative diseases. We included only speech-language therapists who work within the Brazilian territory and who attend, or have attended, individuals with neurodegenerative diseases. Descriptive and inferential analysis of the data was performed. Mann-Whitney U, Chi-square and Fisher Exact tests were used. Results The greatest difficulties encountered in the care of patients with neurodegenerative diseases were: difficulty in caregiver adhering to orientations (52.7%), lack of communication among professionals of the team for interdisciplinary care (52.7%), and late arrival for evaluation (50%). The difficulty of patient adherence to speech-language therapist's orientations (p=0.015) and difficulty related to communication failure among professionals for interdisciplinary care (p=0.036) were associated with shorter time of profession. However, the difficulty of adherence of the caregiver to orientations was associated with non-interdisciplinary teams (p=0.014). Conclusion The lack of efficient communication in multiprofessional team, the non-adherence of the caregivers and the late arrival of the individual for speech-language assessment, together with the lack of knowledge about the possibilities of speech-language therapy, were the main obstacles faced by professionals. The time of profession was the main variable associated with difficulties in the work of the speech-language therapists that attend patients with neurodegenerative diseases.