Is there a chance for regeneration of intervertebral discs? A preliminary study / Van-e esély az intervertebralis discusok regenerációjára? Elozetes tanulmány

Introduction: Segmental instability of the spine caused by the decreased height of intervertebral discs is one of the major causes of chronic low back pain affecting 70-80% of the adult population. The decrease in height is due to degenerative lesions induced by vertical compression overload of the disc. Objective: A preliminary study was performed to determine if disc degeneration due to overload could be stopped. We hypothesized that disc distraction during fission surgery from posterior approach could reduce the pressure on the discs, degeneration could be stopped, and perhaps the function could be restored. Methods: To characterize the condition of the discus, we used the determination glycosaminoglycan content, which is responsible for the disc-bound water content and thus for ensuring its elasticity. The use of gadolinium contrast agent in MRI (dGEMRIC) is an accepted method for determining the glycosaminoglycan content of the intervertebral disc, as the concentration of absorbed contrast agent is inversely proportional to the number of glycosaminoglycans in the intervertebral discs. In addition to pre- and postoperative dGEMRIC data, we examined disc height, lumbar lordosis, visual analog pain scale, and the Oswestry Disability Index. Results: All patients underwent monosegmental fusion Mowing posterior distraction of the affected segment due to segmental instability. During the surgeries, lumbar lordosis did not decrease despite posterior distraction. The heights of the discus increased by an average of 3 mm, the pain decreased, and the Oswestry Disability Index improved. In the dGEMRIC studies, an average of 309.18 units/cm(2) of gadolinium accumulated in the discs before surgery, which decreased postoperatively to 174.43 units/cm(2). All changes were significant at the p = 0.05 significance level. Conclusion: The trend of our preliminary results suggests that increasing the height of the discs can reduce the hydrostatic pressure in the discs, resulting in an increase in the amount of glycosaminoglycans, which can stop the degeneration of the discs and also initiate regeneration processes.

The hip replacement type choice: presentation of difficulty and responsibility about a case / A csípoprotézis-választás nehézségeinek és felelosségének bemutatása egy eset kapcsán.

Összefoglaló. A felszínpótló, fém a fémen csípoízületi protézisek reneszánszukat élték a 2000-es években. Elsosorban fiatal, aktív betegek esetében javasolták használni a remélt elméleti elonyök, mint a combfej csontállományának megorzése, a csípoízület biomechanikájának fenntartása, a luxatio kockázatának csökkentése, a polietilén törmelékek és kopástermékek hiánya miatt. Bemutatunk egy beteget, akinél 19 éves korában kétszeri vesetranszplantációt követo, hosszan tartó szteroidkezelés következtében kialakult kétoldali combfejnekrózis miatt került sor felszínpótló, fém a fémen csípoprotézis beültetésére. A harmadik posztoperatív évtol mindkét csípot érinto, fokozatosan súlyosbodó fájdalom, pszichés tünetek, valamint ismételt veseelégtelenség alakult ki. A tünetek hátterében kifejezetten magas Co-Cr szérumszintet, a csípoízület környezetében pszeudotumor-kialakulást, kiterjedt acetabularis cystákat, a combnyakak jelentos elvékonyodását találtuk, mely jobb oldalon periprotetikus combnyaktörést okozott. A revíziós mutétek során talált kiterjedt szöveti metallosis eltávolítását követoen a felszínpótló protéziseket cement nélküli kerámia-kerámia totális protézisekre cseréltük. A revíziókat követoen a lokális és pszichés tünetek megszuntek, a szérum Co-Cr szintje normalizálódott, ami lehetové tette a harmadik vesetranszplantáció elvégzését is. Páciensünk csíporevíziókat követo gyors javulása közvetett bizonyítékként szolgál a Co-Cr ionok negatív szerepére mind a helyi, mind a szisztémás szöveti reakciókban, így a transzplantált vese károsodásában. Esetünk tanulságai, hogy szervtranszplantációt követoen kerülni kell a fém a fémen protézisek használatát, valamint hogy nem elég a csípoízületi protézis indikációjának felállítása és a legmodernebbnek tartott protézis használata. Különös gonddal és elmélyülten kell elemezni a beteg járulékos körülményeit, gyógyszerelését, társbetegségeit is ahhoz, hogy a legmegfelelobb típusú protézist tudjuk kiválasztani, ami nem megkerülheto felelossége az ortopéd sebészeknek. Orv Hetil. 2021; 162(20): 800-805. Summary. The surface replacement, metal on metal hip prostheses, experienced a renaissance in the 2000s. It has been recommended for use primarily in young, active patients due to expected theoretical benefits such as preserving femoral bone stock, maintaining hip joint biomechanics, reducing the risk of dislocation, and lacking polyethylene debris abrasion products. We present a patient who had resurfacing prosthesis because of bilateral femoral head necrosis due to long-term steroid treatment following double kidney transplantation at the age of 19. In the third postoperative year, progressive pain in both hips, psychiatric symptoms, and recurrent renal failure developed. We found extremely high serum Co-Cr levels, pseudotumor formation of the hip joint, extensive acetabular cysts, and significant thinning of the femoral neck, followed by a periprosthetic femoral neck fracture on one side. After removing the extensive tissue metallosis found during the revision surgeries, the surface replacement prostheses were replaced with cementless ceramic-ceramic total prostheses. Following the revisions, local and psychiatric symptoms resolved, and serum Co-Cr levels normalized, allowing a third kidney transplant to be performed. The rapid improvement of our patient after prosthesis revisions serves as indirect evidence for the negative role of Co-Cr ions in both local and systemic tissue reactions, including damage to the transplanted kidney. Our case report shows that the use of metal on metal prostheses after organ transplantation should be avoided and simply setting up an indication for hip prosthesis and use the most modern type of prosthesis is inadequate. Depth analysis of the patient's ancillary conditions, medications, co-morbidities are required to select the most appropriate prosthesis type, which is an unavoidable responsibility of orthopedic surgeons. Orv Hetil. 2021; 162(20): 800-805.

Early onset of inflammation during ontogeny of bipolar disorder: the NLRP2 inflammasome gene distinctly differentiates between patients and healthy controls in the transition between iPS cell and neural stem cell stages.

Neuro-inflammation and neuronal communication are considered as mis-regulated processes in the aetiology and pathology of bipolar disorder (BD). Which and when specific signal pathways become abnormal during the ontogeny of bipolar disorder patients is unknown. To address this question, we applied induced pluripotent stem cell (iPSC) technology followed by cortical neural differentiation on adipocyte-derived cells from BD type I patients (with psychotic episodes in psychiatric history) and healthy volunteers (controls). RNA sequencing in iPSC and cortical neural stem cell (NSC) lines were used to examine alterations between the transcriptomes from BD I and control samples during transition from the pluripotent stage towards the neural developmental stage. At the iPSC stage, the most highly significant differentially expressed gene (DEG) was the NLRP2 inflammasome (P=2.66 × 10-10). Also among 42 DEGs at the NSC stage, NLRP2 showed the strongest statistical significance (P=3.07 × 10-19). In addition, we have also identified several cytoskeleton-associated genes as DEGs from the NSC stage, such as TMP2, TAGLN and ACTA2; the former two genes are recognised for the first time to be associated with BD. Our results also suggest that iPSC-derived BD-cortical NSCs carry several abnormalities in dopamine and GABA receptor canonical pathways, underlining that our in vitro BD model reflects pathology in the central nervous system. This would indicate that mis-regulated gene expression of inflammatory, neurotransmitter and cytoskeletal signalling occurs during early fetal brain development of BD I patients.

[The future of hospitals and the hospitals in the future]. / A kórházak jövoje, a jövo kórházai.

By the end of the 20th century the vertically organized hospitals formed into a closed hierarchical system, in which the healthcare supply significantly fragmented. The existing hospitals in the current organization are not prepared for the increase in longevity, nor for the high growth in the number of chronic and long-term illnesses and the multi-morbidity since they were not designed for extended carry treatments. The fast incorporation of high-tech and very expensive technologies into healthcare generates an economic crisis. Solving the supply and economic crisis at the same time cannot be achieved without changing the structure of hospitals. Future hospitals will be organized in a network, conducting special treatments according to disease profiles. According to present knowledge, this is the only structure that allows for economies in scale, the proper spending of the ever-shrinking resources, and to ensure the effective patient care required after the changing of disorder structures and patient corporate identities. Orv. Hetil., 2016, 157(28), 1099-1104.

[Low back pain: when and what to do]. / A derékfájás: mikor és mit tegyünk?

The low back pain has become one of the greatest public health problems worldwide. The author based on the current international standards summarizes the knowledge necessary for every day treatment of low back pain. In acute low back pain the author underlines the necessity of the rapid, accurate diagnosis and separation for specific and non-specific low back pain. In specific acute low back pain the treatment should focus on to eliminate the root causes. In non-specific cases pain killing treatment and early active mobilization is the choice for the therapeutic process. Beside analgesia, the primary goal of the treatment is to prevent becoming chronic the symptomatology. Objectives of the management of chronic low back pain are effective pain reduction, continuous maintainance of physical activity, prevention of permanent disability, and restoration of working ability. Analgesics, non steroid anti-inflammatory drugs, and muscle relaxants reduce pain, while multidisciplinary management programs, personalized and guided physiotherapy, cognitive behavioral therapy, as well as short training programs will help to restore function. Surgical treatment is only indicated in degenerative cases and only after the failure of conservative therapy.

[Reckoning: Assessment of 21 years' work in spinal surgery]. / Számvetés: 21 éves gerincsebészeti tevékenység mérlege.

INTRODUCTION: Of the world-wide used Cotrel-Dubousset instrumentation and surgical technique providing breakthrough for the three-dimensional correction and multi-segmental fixation of spinal deformity surgery in Hungary is linked to the author's name, who carried out 1655 spine deformity surgeries in the last 21 years. AIM: The aim of the author was to discuss his own results in the field of spine surgery and compare his own data to those published in the international literature. METHOD: At the beginning hooks, followed by hybrid instrumentation with hooks in thoracic area and transpedicular screws in lumbar spine have been used for the segmental fixation. During the correction process, initially the classic derotation maneuver was used, followed by the translation and then the in situ bending techniques and, finally, a combination of the above three techniques have been applied. RESULTS: In addition to the restoration of normal sagittal balance, an average of 40.8° (SD, 25.9), a 65.5% correction was achieved in the frontal plane, which partly exceeds and partly consistent with the published international results. The incidence of inflammation (3.9%), and mechanical complications (1.7%) was similar to the international average, while the incidence of neurological complications (0.48%) was slightly lower than the average of international data. CONCLUSIONS: The author believes that the better correction results as compared to the international average could be due to the always consistent application of the Cotrel-Dubousset instrumentation correction philosophy based on the meticulous segmental analysis of spine deformities.

Receptor protein tyrosine phosphatases are expressed by cycling retinal progenitor cells and involved in neuronal development of mouse retina.

Receptor protein tyrosine phosphatases (RPTPs) appear to coordinate many aspects of neural development, including cell proliferation, migration and differentiation. Here we investigated potential roles of RPTPs in the developing mouse retina. Using a degenerate oligonucleotide-based reverse transcription polymerase chain reaction approach, we identified 11 different RPTPs in the retina at embryonic stage 13 (E13). Subsequently, the expression patterns of RPTPkappa, RPTPJ, RPTPRR, RPTPsigma, RPTPepsilon and RPTPgamma in the retina from embryonic stages to adult were analyzed in detail using quantitative real-time-PCR, in situ hybridization, immunohistochemistry and Western blotting. At E13, all six RPTPs are expressed in actively cycling retinal progenitor cells and postmitotic newborn retinal neurons. With ongoing maturation, RPTPkappa, RPTPJ, RPTPRR, RPTPsigma, RPTPepsilon and RPTPgamma display a different spatiotemporal regulation of mRNAs and proteins in the pre- and postnatal retina. Finally, in adulthood these six RPTPs localize to distinct cellular compartments of multiple retinal neurons. Additional studies in RPTPgamma(-/-) and RPTPbeta/zeta(-/-) (also known as PTPRZ1, RPTPbeta or RPTPzeta) mice at postnatal stage P1 reveal no apparent differences in retinal laminar organization or in the expression pattern of specific retinal cell-type markers when compared with wild type. However, in RPTPbeta/zeta(-/-) retinas, immunoreactivity of vimentin, a marker of Müller glial cells, is selectively reduced and the morphology of vimentin-immunoreactive radial processes of Müller cells is considerably disturbed. Our results suggest distinct roles of RPTPs in cell proliferation and establishing phenotypes of different retinal cells during retinogenesis as well as later in the maintenance of mature retina.

Spasmogenic effect of a Solanummelongena leaf extract on guinea pig tracheal chains and its possible mechanism(s).

The methanol extract of fresh leaves of Solanum melongena L. (Solanaceae) was evaluated for its capacity to alter the tone of isolated, pre-contracted guinea pig tracheal chains, as well as for its possible mechanism(s) of action. Using serial dilutions between 0.0025 and 2.5 mg/mL, the extract was found to cause a dose-dependent increase in the force of muscle contraction. The EC(50) value was 0.46 +/- 0.01 mg/mL. The concomitant use of acetylcholine 10(-5) M did not significantly affect the force of contraction induced by the extract. Histamine 10(-5) M added at about 40% to, and salbutamol 10(-6) M antagonized by about 30% its constrictive effect. Chlorpheniramine 10(-6) M, propanolol 10(-5) M, and nifedipine 10(-6) M did not significantly influence the extract-induced force of contraction, but atropine 3 x 10(-7) M reduced it by approximately 60%. These data suggest that the Solanum melongena extract exerted a bronchospasmogenic rather than a bronchospasmolytic effect, probably through muscarinic receptor stimulation.

A portable data-logging system for industrial hygiene personal chlorine monitoring.

The combination of suitable portable sensors or instruments with small microprocessor-based data-logger units has made it possible to obtain detailed monitoring data for many health and environmental applications. Following data acquisition in field use, the logged data may be transferred to a desk-top personal computer for complete flexibility in manipulation of data and formating of results. A system has been assembled from commercial components and demonstrated for chlorine personal monitoring applications. The system consists of personal chlorine sensors, a Metrosonics data-logger and reader unit, and an Apple II Plus personal computer. The computer software was developed to handle sensor calibration, data evaluation and reduction, report formating and long-term storage of raw data on a disk. This system makes it possible to generate time-concentration profiles, evaluate dose above a threshold, quantitate short-term excursions and summarize time-weighted average (TWA) results. Field data from plant trials demonstrated feasibility of use, ruggedness and reliability. No significant differences were found between the time-weighted average chlorine concentrations determined by the sensor/logger system and two other methods: the sulfamic acid bubbler reference method and the 3M Poroplastic diffusional dosimeter. The sensor/data-logger system, however, provided far more information than the other two methods in terms of peak excursions, TWAs and exposure doses. For industrial hygiene applications, the system allows better definition of employee exposures, particularly for chemicals with acute as well as chronic health effects.(ABSTRACT TRUNCATED AT 250 WORDS)