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1.
Sci Rep ; 14(1): 14993, 2024 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-38951574

RESUMO

Spinal magnetic resonance (MR) scans are a vital tool for diagnosing the cause of back pain for many diseases and conditions. However, interpreting clinically useful information from these scans can be challenging, time-consuming and hard to reproduce across different radiologists. In this paper, we alleviate these problems by introducing a multi-stage automated pipeline for analysing spinal MR scans. This pipeline first detects and labels vertebral bodies across several commonly used sequences (e.g. T1w, T2w and STIR) and fields of view (e.g. lumbar, cervical, whole spine). Using these detections it then performs automated diagnosis for several spinal disorders, including intervertebral disc degenerative changes in T1w and T2w lumbar scans, and spinal metastases, cord compression and vertebral fractures. To achieve this, we propose a new method of vertebrae detection and labelling, using vector fields to group together detected vertebral landmarks and a language-modelling inspired beam search to determine the corresponding levels of the detections. We also employ a new transformer-based architecture to perform radiological grading which incorporates context from multiple vertebrae and sequences, as a real radiologist would. The performance of each stage of the pipeline is tested in isolation on several clinical datasets, each consisting of 66 to 421 scans. The outputs are compared to manual annotations of expert radiologists, demonstrating accurate vertebrae detection across a range of scan parameters. Similarly, the model's grading predictions for various types of disc degeneration and detection of spinal metastases closely match those of an expert radiologist. To aid future research, our code and trained models are made publicly available.


Assuntos
Imageamento por Ressonância Magnética , Humanos , Imageamento por Ressonância Magnética/métodos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/patologia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/patologia , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/patologia , Processamento de Imagem Assistida por Computador/métodos , Interpretação de Imagem Assistida por Computador/métodos
2.
Proc Biol Sci ; 291(2026): 20240820, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38981526

RESUMO

Unravelling the functional steps that underlie major transitions in the fossil record is a significant challenge for biologists owing to the difficulties of interpreting functional capabilities of extinct organisms. New computational modelling approaches provide exciting avenues for testing function in the fossil record. Here, we conduct digital bending experiments to reconstruct vertebral function in non-mammalian synapsids, the extinct forerunners of mammals, to provide insights into the functional underpinnings of the synapsid-mammal transition. We estimate range of motion and stiffness of intervertebral joints in eight non-mammalian synapsid species alongside a comparative sample of extant tetrapods, including salamanders, reptiles and mammals. We show that several key aspects of mammalian vertebral function evolved outside crown Mammalia. Compared to early diverging non-mammalian synapsids, cynodonts stabilized the posterior trunk against lateroflexion, while evolving axial rotation in the anterior trunk. This was later accompanied by posterior sagittal bending in crown mammals, and perhaps even therians specifically. Our data also support the prior hypothesis that functional diversification of the mammalian trunk occurred via co-option of existing morphological regions in response to changing selective demands. Thus, multiple functional and evolutionary steps underlie the origin of remarkable complexity in the mammalian backbone.


Assuntos
Evolução Biológica , Fósseis , Mamíferos , Coluna Vertebral , Animais , Mamíferos/fisiologia , Fósseis/anatomia & histologia , Coluna Vertebral/anatomia & histologia , Coluna Vertebral/fisiologia , Fenômenos Biomecânicos , Amplitude de Movimento Articular , Répteis/fisiologia , Répteis/anatomia & histologia
3.
BMC Ecol Evol ; 24(1): 96, 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38982364

RESUMO

The Portezuelo Formation preserves an outstanding record of the upper Turonian - lower Coniacian. Despite the discovery of a significant quantity of sauropod fossil material from the formation, only two species have been formally described to date: Malarguesaurus florenciae and Futalognkosaurus dukei. Here we present new sauropod material mostly composed of non-articulated caudal vertebrae (MCF-PVPH 916 and 917) that belong to two titanosauriforms on the basis of the following features: anterior caudal vertebrae with procoelous-opisthoplatyan articulations, transverse processes that reach the posterior articular face of the centrum and neural spines with a transverse width of around 50% of their anteroposterior length; anterior and middle caudal vertebrae with the neural arch restricted to the anterior half of the centrum; middle caudal centra with circular cross-section. Phylogenetic analysis recovers the new material in close relation to Malarguesaurus within a monophyletic clade at the base of Somphospondyli. This clade shares large pedicel height with a vertical anterior border on the middle caudal vertebrae, a vertical orientation of the neural spines on the distalmost middle caudal vertebrae and proximalmost posterior caudal vertebrae, and subequal relative lengths of the proximal ulnar condylar processes. The specimens presented here are distinct not only from Futalognkosaurus, but also from other indeterminate titanosaurian remains from the same formation. However, there are no significant differences between the specimen MCF-PVPH 917 and Malarguesaurus, but there are differences between the posterior caudal vertebrae of MCF-PVPH 916 and Malarguesaurus, so they could be considered different species. Whilst we err on the side of caution in not naming new taxa here, the two specimens significantly expand what we know about sauropods in the Turonian-Coniacian ecosystems of Patagonia, which will continue to do so as more material is discovered.


Assuntos
Dinossauros , Fósseis , Filogenia , Animais , Dinossauros/anatomia & histologia , Argentina , Coluna Vertebral/anatomia & histologia , Biodiversidade
4.
Pediatr Surg Int ; 40(1): 178, 2024 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-38970642

RESUMO

PURPOSE: The study aimed to compare spinal posture, mobility, and position sense in adolescents with pectus excavatum (PE), pectus carinatum (PC), and healthy control (HC). METHODS: 22 with PE, 22 with PC, and 21 HC were included in the study. The spinal posture (thoracic kyphosis, lumbar lordosis, pelvic tilt, thoracic, lumbar, pelvic lateral tilt angles) and mobility (thoracic, lumbar, hip/sacral, and overall, in the sagittal and frontal plane) with the spinal mouse, and spinal position sense (repositing errors) with the inclinometer were assessed. RESULTS: The thoracic kyphosis angle of PE and PC was higher than in HC (p < 0.001; p = 0.001). Hip/sacral mobility in the sagittal plane was lower in the PE and PC than control, respectively (p < 0.001; p < 0.001). Overall sagittal spinal mobility (p:0.007) and hip/sacral mobility in the frontal plane (p:0.002) were lower in the PC than in HC. Overall frontal spinal mobility was lower in the PE and PC than in HC (p:0.002; p:0.014). The PE and PC repositing errors were higher (p < 0.001; p:0.014). CONCLUSION: The study found that adolescents with PE and PC had decreased spinal mobility, spinal alignment disorders, and a decline in spinal position sense. It is important not to overlook the spine during physical examinations of adolescents with chest wall deformities. In clinical practice, we suggest that adolescents with chest deformities should undergo a spine evaluation and be referred for physical therapy to manage spinal disorders.


Assuntos
Tórax em Funil , Pectus Carinatum , Postura , Humanos , Adolescente , Tórax em Funil/fisiopatologia , Tórax em Funil/complicações , Masculino , Pectus Carinatum/fisiopatologia , Feminino , Postura/fisiologia , Coluna Vertebral/anormalidades , Coluna Vertebral/fisiopatologia , Parede Torácica/anormalidades , Parede Torácica/fisiopatologia , Criança , Propriocepção/fisiologia , Estudos de Casos e Controles
5.
J Med Internet Res ; 26: e48535, 2024 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-38995678

RESUMO

BACKGROUND: With the progressive increase in aging populations, the use of opportunistic computed tomography (CT) scanning is increasing, which could be a valuable method for acquiring information on both muscles and bones of aging populations. OBJECTIVE: The aim of this study was to develop and externally validate opportunistic CT-based fracture prediction models by using images of vertebral bones and paravertebral muscles. METHODS: The models were developed based on a retrospective longitudinal cohort study of 1214 patients with abdominal CT images between 2010 and 2019. The models were externally validated in 495 patients. The primary outcome of this study was defined as the predictive accuracy for identifying vertebral fracture events within a 5-year follow-up. The image models were developed using an attention convolutional neural network-recurrent neural network model from images of the vertebral bone and paravertebral muscles. RESULTS: The mean ages of the patients in the development and validation sets were 73 years and 68 years, and 69.1% (839/1214) and 78.8% (390/495) of them were females, respectively. The areas under the receiver operator curve (AUROCs) for predicting vertebral fractures were superior in images of the vertebral bone and paravertebral muscles than those in the bone-only images in the external validation cohort (0.827, 95% CI 0.821-0.833 vs 0.815, 95% CI 0.806-0.824, respectively; P<.001). The AUROCs of these image models were higher than those of the fracture risk assessment models (0.810 for major osteoporotic risk, 0.780 for hip fracture risk). For the clinical model using age, sex, BMI, use of steroids, smoking, possible secondary osteoporosis, type 2 diabetes mellitus, HIV, hepatitis C, and renal failure, the AUROC value in the external validation cohort was 0.749 (95% CI 0.736-0.762), which was lower than that of the image model using vertebral bones and muscles (P<.001). CONCLUSIONS: The model using the images of the vertebral bone and paravertebral muscle showed better performance than that using the images of the bone-only or clinical variables. Opportunistic CT screening may contribute to identifying patients with a high fracture risk in the future.


Assuntos
Aprendizado Profundo , Fraturas da Coluna Vertebral , Tomografia Computadorizada por Raios X , Humanos , Feminino , Masculino , Tomografia Computadorizada por Raios X/métodos , Idoso , Fraturas da Coluna Vertebral/diagnóstico por imagem , Estudos Retrospectivos , Pessoa de Meia-Idade , Estudos Longitudinais , Coluna Vertebral/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/lesões
6.
JBJS Rev ; 12(7)2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38968370

RESUMO

BACKGROUND: A composite endpoint (CEP) is a measure comprising 2 or more separate component outcomes. The use of these constructs is increasing. We sought to conduct a systematic review on the usage, quality of reporting, and appropriate use of CEPs in spine surgery research. METHODS: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Articles reporting randomized controlled trials of a spine surgery intervention using a CEP as a primary outcome were included. We assessed the quality of CEP reporting, appropriateness of CEP use, and correspondence between CEP treatment effect and component outcome treatment effect in the included trials. RESULTS: Of 2,321 initial titles, 43 citations were included for analysis, which reported on 20 unique trials. All trials reported the CEP construct well. In 85% of trials, the CEP design was driven by US Food and Drug Administration guidance. In the majority of trials, the reporting of CEP results did not adhere to published recommendations: 43% of tests that reported statistically significant results on component outcomes were not statistically significant when adjusted for multiple testing. 67% of trials did not meet appropriateness criteria for CEP use. In addition, CEP treatment effect tended to be 6% higher than the median treatment effect for component outcomes. CONCLUSION: Given that CEP analysis was not appropriate for the majority of spine surgery trials and the inherent challenges in the reporting and interpretation of CEP analysis, CEP use should not be mandated by regulatory bodies in spine surgery trials. LEVEL OF EVIDENCE: Level I. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Coluna Vertebral , Humanos , Coluna Vertebral/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Sci Rep ; 14(1): 15241, 2024 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-38956140

RESUMO

Stegosaurs are a minor but iconic clade of ornithischian dinosaurs, yet due to a poor fossil record, their early evolution is poorly understood. Here, we describe a new stegosaur, Baiyinosaurus baojiensis, gen. et sp. nov. from the Middle Jurassic Wangjiashan Formation of the Pingchuan District, Baiyin City, Gansu Province, China. The frontal of Baiyinosaurus possesses a unique characteristic among Stegosauria: it is wider than long and contributes to both the medial and anterior margins of the supratemporal fenestra. The character combinations of dorsal vertebrae of Baiyinosaurus are also different to other stegosaurs: its neural arches are not greatly elongated, its parapophyses are well developed, and its neural spines are axially expanded in lateral. The features of the frontal and vertebrae of Baiyinosaurus are reminiscent of basally branching thyreophorans, indicating that Baiyinosaurus is transitional in morphology between early thyreophorans and early-diverging stegosaurs. Systematic analysis shows that Baiyinosaurus is an early-diverging stegosaur.


Assuntos
Dinossauros , Fósseis , Dinossauros/anatomia & histologia , Dinossauros/classificação , Animais , China , Fósseis/anatomia & histologia , Filogenia , Coluna Vertebral/anatomia & histologia , Evolução Biológica
8.
Sensors (Basel) ; 24(11)2024 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-38894318

RESUMO

Multiple myeloma (MM) patients complain of pain and stiffness limiting motility. To determine if patients can benefit from vertebroplasty, we assessed muscle activation and co-activation before and after surgery. Five patients with MM and five healthy controls performed sitting-to-standing and lifting tasks. Patients performed the task before and one month after surgery. Surface electromyography (sEMG) was recorded bilaterally over the erector spinae longissimus and rectus abdominis superior muscles to evaluate the trunk muscle activation and co-activation and their mean, maximum, and full width at half maximum were evaluated. Statistical analyses were performed to compare MM patients before and after the surgery, MM and healthy controls and to investigate any correlations between the muscle's parameters and the severity of pain in patients. The results reveal increased activations and co-activations after vertebroplasty as well as in comparison with healthy controls suggesting how MM patients try to control the trunk before and after vertebroplasty surgery. The findings confirm the beneficial effects of vertebral consolidation on the pain experienced by the patient, despite an overall increase in trunk muscle activation and co-activation. Therefore, it is important to provide patients with rehabilitation treatment early after surgery to facilitate the CNS to correctly stabilize the spine without overloading it with excessive co-activations.


Assuntos
Eletromiografia , Mieloma Múltiplo , Humanos , Mieloma Múltiplo/fisiopatologia , Mieloma Múltiplo/cirurgia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Vertebroplastia/métodos , Músculo Esquelético/fisiopatologia , Músculo Esquelético/cirurgia , Coluna Vertebral/cirurgia , Coluna Vertebral/fisiopatologia , Tronco/fisiopatologia , Tronco/cirurgia , Tronco/fisiologia
9.
J Strength Cond Res ; 38(7): e341-e348, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38900182

RESUMO

ABSTRACT: Scott, KM, Kreisel, BR, Florkiewicz, EM, Crowell, MS, Morris, JB, McHenry, PA, and Benedict, TM. The effect of cautionary versus resiliency spine education on maximum deadlift performance and back beliefs: A randomized control trial. J Strength Cond Res 38(7): e341-e348, 2024-The purpose of this study was to determine the effect of cautionary information about the spine vs. a message of spine resiliency on maximum deadlift (MDL) performance and beliefs regarding the vulnerability of the spine. This cluster randomized control trial involved 903 military new cadets (n = 903) during their mandatory fitness test in cadet basic training (mean age 18.3 years, body mass index 23.8 kg·m-2, 22% female). Subjects were cluster randomized to 3 groups. The cautionary group received a message warning them to protect their backs while deadlifting, the resiliency group received a message encouraging confidence while deadlifting, and the control group received the standardized Army deadlift education only. The outcome measures were MDL weight lifted and perceived spine vulnerability. Significance was set at alpha ≤0.05. There were no between-group differences in weight lifted (p=0.40). Most subjects believed that the spine is vulnerable to injury. Three times as many subjects who received the resiliency education improved their beliefs about the vulnerability of their spines compared with those receiving the cautionary education (p<0.001). This study demonstrated the potential for brief resiliency education to positively influence beliefs about spine vulnerability, whereas cautionary education did not impair performance.


Assuntos
Militares , Humanos , Feminino , Masculino , Militares/psicologia , Adolescente , Adulto Jovem , Levantamento de Peso/fisiologia , Levantamento de Peso/psicologia , Lesões nas Costas/prevenção & controle , Coluna Vertebral/fisiologia , Adulto
10.
J Neuroeng Rehabil ; 21(1): 96, 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38845000

RESUMO

BACKGROUND: Telerehabilitation is a promising avenue for improving patient outcomes and expanding accessibility. However, there is currently no spine-related assessment for telerehabilitation that covers multiple exercises. METHODS: We propose a wearable system with two inertial measurement units (IMUs) to identify IMU locations and estimate spine angles for ten commonly prescribed spinal degeneration rehabilitation exercises (supine chin tuck head lift rotation, dead bug unilateral isometric hold, pilates saw, catcow full spine, wall angel, quadruped neck flexion/extension, adductor open book, side plank hip dip, bird dog hip spinal flexion, and windmill single leg). Twelve healthy subjects performed these spine-related exercises, and wearable IMU data were collected for spine angle estimation and IMU location identification. RESULTS: Results demonstrated average mean absolute spinal angle estimation errors of 2.59 ∘ and average classification accuracy of 92.97%. The proposed system effectively identified IMU locations and assessed spine-related rehabilitation exercises while demonstrating robustness to individual differences and exercise variations. CONCLUSION: This inexpensive, convenient, and user-friendly approach to spine degeneration rehabilitation could potentially be implemented at home or provide remote assessment, offering a promising avenue to enhance patient outcomes and improve accessibility for spine-related rehabilitation. TRIAL REGISTRATION:  No. E2021013P in Shanghai Jiao Tong University.


Assuntos
Terapia por Exercício , Coluna Vertebral , Telerreabilitação , Humanos , Masculino , Telerreabilitação/instrumentação , Adulto , Feminino , Coluna Vertebral/fisiologia , Terapia por Exercício/métodos , Terapia por Exercício/instrumentação , Dispositivos Eletrônicos Vestíveis , Adulto Jovem , Acelerometria/instrumentação , Acelerometria/métodos , Fenômenos Biomecânicos
11.
Trials ; 25(1): 362, 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38840210

RESUMO

BACKGROUND: Flash visual evoked potentials (FVEPs) are a reliable method for protecting visual function during spine surgery in prone position. However, the popularization and application of FVEPs remain limited due to the unclear influence of various anesthetics on FVEPs. Exploring the effects of anesthetic drugs on FVEP and establishing appropriate anesthesia maintenance methods are particularly important for promoting and applying FVEP. According to the conventional concept, inhaled narcotic drugs significantly affect the success of FVEP monitoring, FVEP extraction, and interpretation. Nonetheless, our previous study demonstrated that sevoflurane-propofol balanced anesthesia was a practicable regimen for FVEPs. Desflurane is widely used in general anesthesia for its rapid recovery properties. As the effect of desflurane on FVEP remains unclear, this trial will investigate the effect of different inhaled concentrations of desflurane anesthesia on amplitude of FVEPs during spine surgery, aiming to identify more feasible anesthesia schemes for the clinical application of FVEP. METHODS/ DESIGN: A total of 70 patients undergoing elective spinal surgery will be enrolled in this prospective, randomized controlled, open-label, patient-assessor-blinded, superiority trial and randomly assigned to the low inhaled concentration of desflurane group (LD group) maintained with desflurane-propofolremifentanil-balanced anesthesia or high inhaled concentration of desflurane group (HD group) maintained with desflurane-remifentanil anesthesia maintenance group at a ratio of 1:1. All patients will be monitored for intraoperative FVEPs, and the baseline will be measured half an hour after induction under total intravenous anesthesia (TIVA). After that, patients will receive 0.5 minimum alveolar concentration (MAC) of desflurane combined with propofol and remifentanil for anesthesia maintenance in the LD group, while 0.7-1.0 MAC of desflurane and remifentanil will be maintained in the HD group. The primary outcome is the N75-P100 amplitude 1 h after the induction of anesthesia. We intend to use the dual measure evaluation, dual data entry, and statistical analysis by double trained assessors to ensure the reliability and accuracy of the results. DISCUSSION: This randomized controlled trial aims to explore the superiority effect of low inhaled concentration of desflurane combined with propofolremifentanil-balanced anesthesia versus high inhaled concentration of desflurane combined with remifentanil anesthesia on amplitude of FVEPs. The study is meant to be published in a peer-reviewed journal and might guide the anesthetic regimen for FVEPs. The conclusion is expected to provide high-quality evidence for the effect of desflurane on FVEPs and aim to explore more feasible anesthesia schemes for the clinical application of FVEPs and visual function protection. TRIAL REGISTRATION: This study was registered on clinicaltrials.gov on July 15, 2022. CLINICALTRIALS: gov Identifier: NCT05465330.


Assuntos
Anestésicos Inalatórios , Desflurano , Potenciais Evocados Visuais , Monitorização Neurofisiológica Intraoperatória , Ensaios Clínicos Controlados Aleatórios como Assunto , Remifentanil , Coluna Vertebral , Humanos , Desflurano/administração & dosagem , Potenciais Evocados Visuais/efeitos dos fármacos , Anestésicos Inalatórios/administração & dosagem , Estudos Prospectivos , Coluna Vertebral/cirurgia , Pessoa de Meia-Idade , Monitorização Neurofisiológica Intraoperatória/métodos , Adulto , Masculino , Remifentanil/administração & dosagem , Feminino , Propofol/administração & dosagem , Adulto Jovem , Idoso , Anestésicos Intravenosos/administração & dosagem , Adolescente , Fatores de Tempo , Procedimentos Ortopédicos , Estimulação Luminosa
12.
Neurosurg Rev ; 47(1): 265, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38856859

RESUMO

The provision of specialized spine care in Nigeria presents a pressing challenge amid limited resources and geographical disparities. This correspondence offers a comprehensive roadmap for improving spine surgery and care within the country. We examine the current state of spinal health infrastructure, highlighting barriers such as limited access to specialists and facilities, particularly in rural areas, and financial constraints for patients. Innovations in spinal treatment, including the adoption of minimally invasive techniques and advancements in surgical modalities, are discussed alongside persistent challenges such as disparities in access and equipment costs. Training and education of spine surgeons emerge as critical areas requiring attention, with a shortage of qualified professionals exacerbated by inadequate training programs and resource constraints. We advocate for fostering local and international collaborations to address these gaps, emphasizing the role of partnerships in capacity building and knowledge exchange. Additionally, we explore the potential of public-private partnerships and investments to enhance the Nigerian spine healthcare system, calling for strategic initiatives to modernize infrastructure and improve accessibility. Finally, we propose a strategic blueprint encompassing infrastructure enhancement, training programs, research initiatives, policy advocacy, and public awareness campaigns. Through concerted efforts from local stakeholders and international partners, we envision a future where spine care in Nigeria is comprehensive, accessible, and of high quality, leading to improved health outcomes and a higher quality of life for those affected by spinal conditions.


Assuntos
Doenças da Coluna Vertebral , Humanos , Nigéria , Doenças da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Acessibilidade aos Serviços de Saúde , Procedimentos Neurocirúrgicos , Atenção à Saúde
13.
Med Sci Monit ; 30: e944427, 2024 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-38851875

RESUMO

BACKGROUND Emergence agitation, or delirium, occurs during early recovery from general anesthesia and involves disorientation, excitation, and uncontrolled physical movements. Dexmedetomidine is an alpha agonist that has sedative, anxiolytic, analgesic, and sympatholytic activities and is used as a continuous infusion to prevent emergence agitation. This study aimed to evaluate patients aged 65 years and older undergoing general anesthesia to determine the 90% effective dose (ED90) of dexmedetomidine continuous intraoperative infusion to prevent emergence agitation. MATERIAL AND METHODS We enrolled 44 patients aged 65 years and older undergoing spinal surgery under general anesthesia. Dexmedetomidine administration commenced 30 minutes before surgery completion, with a predetermined infusion dose (µg/kg/h), without a loading dose. The initial dose was 0.2 µg/kg/h, and subsequent step size was ±0.05 µg/kg/h. We tried to find ED90 of dexmedetomidine using the biased-coin design. Vital signs, extubation quality scores, extubation-related complications, and postoperative outcomes were monitored. RESULTS Dexmedetomidine ED90 for smooth emergence in older patients was 0.34 µg/kg/h. Peri-extubation vital signs remained within 20% of baseline values, without requiring pharmacological intervention. No hypoxia, hypoventilation, or post-extubation agitation occurred. In the recovery room, 1 patient briefly exhibited excitement but quickly calmed. Nine patients initially unresponsive in the recovery room fully awoke and were promptly discharged. CONCLUSIONS For older patients who are vulnerable to adverse effects of anesthetics and opioids, dexmedetomidine enables gentle awakening without adverse vital sign changes, respiratory depression, excessive sedation, or emergence agitation (ED90=0.34 µg/kg/h). Further studies should involve a larger patient cohort, considering diverse medical conditions in older individuals.


Assuntos
Período de Recuperação da Anestesia , Dexmedetomidina , Hipnóticos e Sedativos , Humanos , Dexmedetomidina/administração & dosagem , Dexmedetomidina/farmacologia , Idoso , Masculino , Feminino , Hipnóticos e Sedativos/administração & dosagem , Anestesia Geral/métodos , Coluna Vertebral/cirurgia , Idoso de 80 Anos ou mais , Relação Dose-Resposta a Droga , Delírio do Despertar/prevenção & controle
14.
J Orthop Surg Res ; 19(1): 337, 2024 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-38849873

RESUMO

BACKGROUND: Limited research has examined the impact of lower limb length discrepancy (LLLD) alteration on spinopelvic compensation in individuals with developmental dysplasia of the hip (DDH). This study aimed to investigate the effects of LLLD on spinopelvic compensation following total hip arthroplasty (THA) and elucidate the complex biomechanical adaptations in the spinopelvic structures. METHODS: A retrospective review of DDH patients undergoing THA from January 2014 to December 2021 categorized individuals with Crowe type I and II into the low dislocation group (LDG, n = 94) and those with Crowe type III and IV into the high dislocation group (HDG, n = 43). Demographic data, as well as preoperative, postoperative, and last follow-up imaging data, including lower limb length (LLL), sacral obliquity (SO), iliac obliquity (IO), hip obliquity (HO), Cobb angle, apical vertebral translation (AVT), and coronal decompensation (CD), were collected for analysis. RESULTS: Patients in the LDG had a significantly higher surgical age and shorter disease duration (P<0.05). In LDG, patients exhibited substantial postoperative reductions in LLLD, SO, IO, and HO (P<0.05), while Cobb Angle, AVT, and CD showed no statistically significant changes (P>0.05). The variation in LLLD correlated significantly with the variations in SO, IO, and HO (P<0.05). Postoperative outcomes in the HDG demonstrated marked decreases in LLLD, SO, IO, HO, and CD (P<0.05), with no significant change in Cobb angle and AVT (P>0.05). The variation in LLLD correlated significantly with the variations in SO, IO, HO, and CD (P<0.05). CONCLUSIONS: THA effectively reduces LLLD in patients with DDH, and the variation in LLLD correlates meaningfully with the recovery of spinopelvic compensatory mechanisms.


Assuntos
Artroplastia de Quadril , Displasia do Desenvolvimento do Quadril , Desigualdade de Membros Inferiores , Humanos , Artroplastia de Quadril/métodos , Feminino , Masculino , Estudos Retrospectivos , Desigualdade de Membros Inferiores/etiologia , Desigualdade de Membros Inferiores/diagnóstico por imagem , Pessoa de Meia-Idade , Displasia do Desenvolvimento do Quadril/cirurgia , Displasia do Desenvolvimento do Quadril/diagnóstico por imagem , Idoso , Adulto , Pelve/diagnóstico por imagem , Fenômenos Biomecânicos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia
15.
Minerva Anestesiol ; 90(6): 482-490, 2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38869262

RESUMO

BACKGROUND: Major spine surgery is associated with severe postoperative pain and increased opioid consumption. Opioid-free anesthesia (OFA) is thought to provide adequate intraoperative analgesia with reduced postoperative opioid consumption. The aim of this study is to compare the impact of intraoperative OFA approach to the conventional opioid-based anesthesia (OBA) on postoperative pain, opioid consumption, and related side effects in patients undergoing multilevel spinal fusion surgery. METHODS: Forty-eight patients undergoing elective major spine surgery were randomly allocated to either receive intraoperative dexmedetomidine and lidocaine (OFA group) or fentanyl during induction and intraoperative remifentanil (OBA group). All patients received intraoperative sevoflurane, propofol, rocuronium, ketamine, dexamethasone, ondansetron and postoperative paracetamol and patient-controlled analgesia device set to deliver intravenous morphine for 48 hours after surgery. Postoperative pain was measured using numerical rating scale. Opioid side effects were documented, when present. RESULTS: OFA group required less morphine in the first 24 hours post-surgery (17.28±12.25 mg versus 27.96±19.75 mg, P<0.05). The incidence of postoperative nausea and vomiting (PONV) was significantly lower in the OFA group. More patients in the OFA group required antihypertensive medications compared to patients in the OBA group (P<0.05). In the post anesthesia care unit, OFA patients had a significantly longer stay than OBA patients (114.1±49.33 min versus 89.96±30.71 min, P<0.05). CONCLUSIONS: OFA can be an alternative to OBA in patients undergoing multilevel spine fusion surgery. OFA reduces opioids consumption in the first 24 hours and PONV.


Assuntos
Analgésicos Opioides , Dor Pós-Operatória , Humanos , Masculino , Feminino , Analgésicos Opioides/uso terapêutico , Analgésicos Opioides/administração & dosagem , Pessoa de Meia-Idade , Estudos Prospectivos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Adulto , Coluna Vertebral/cirurgia , Dexmedetomidina/uso terapêutico , Dexmedetomidina/administração & dosagem , Idoso , Fusão Vertebral , Náusea e Vômito Pós-Operatórios/epidemiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Remifentanil/administração & dosagem , Remifentanil/uso terapêutico , Anestesia/métodos
16.
Neurosurg Rev ; 47(1): 264, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38856823

RESUMO

OBJECTIVE: This international survey investigated Evidence-Based Medicine (EBM) in spine surgery by measuring its acceptance among spine surgeons. It assessed their understanding of EBM and how they apply it in practice by analyzing responses to various clinical scenarios.. MATERIALS AND METHODS: Following the CHERRIES guidelines, an e-survey was distributed to multiple social media forums for neurosurgeons and orthopedic surgeons on Facebook, LinkedIn, and Telegram and circulated further through email via the authors' network. Three hundred participants from Africa, Asia, Europe, North America, and Oceania completed the survey. RESULTS: Our study revealed that 67.7% (n = 203) of respondents used EBM in their practice, and 97.3% (n = 292) believed training in research methodology and EBM was necessary for the practice of spine surgery. Despite this endorsement of using EBM in spine surgery, we observed varied responses to how EBM is applied in practice based on example scenarios. The responders who had additional training tended to obey EBM guidelines more than those who had no additional training. Most surgeons responded as always or sometimes prescribing methylprednisolone to patients with acute spinal cord injury. Other significant differences were identified between geographical regions, training, practice settings, and other factors. CONCLUSIONS: Most respondents used EBM in practice and believed training in research methodology and EBM is necessary for spine surgery; however, there were significant variations on how to use them per case. Thus, the appropriate application of EBM in clinical settings for spinal surgery must be further studied.


Assuntos
Medicina Baseada em Evidências , Coluna Vertebral , Humanos , Inquéritos e Questionários , Coluna Vertebral/cirurgia , Neurocirurgiões , Procedimentos Neurocirúrgicos , Masculino , Feminino
19.
Chiropr Man Therap ; 32(1): 23, 2024 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-38909258

RESUMO

BACKGROUND: Radiography is commonly used in the assessment of spinal disorders, despite a lack of high-quality evidence demonstrating improved clinical outcomes or additional benefit to the patient. There is disagreement amongst chiropractors regarding the appropriate use of radiography for clinical management. This study aims to qualitatively explore chiropractors' perceptions on the use of spinal radiographs in clinical practice with respect to how they determine when to order radiographs; and how they use radiographs to inform clinical management. METHODS: Online qualitative semi-structured interviews were conducted with 17 Australian chiropractors who currently manage patients with spinal disorders. Convienence, snowball, and purposive sampling strategies were used to ensure an appropriate breadth and depth of participant characterisitcs and beliefs. Interview data were recorded, transcribed and analysed using framework analysis. RESULTS: Three themes were developed to describe how chiropractors determined when to order radiographs. These themes included specific findings from the clinical encounter that may inform clinical management, their perceptions of radiation risk, and the influence of clinical experience/intuition. Three themes and four subthemes were developed for how chiropractors use radiographs to inform their management. These themes explored the use of radiography for the application of chiropractic technique, as well as the role of radiographs in predicting patient prognosis, and as an educational tool to provide reassurance. CONCLUSION: Australian chiropractors' decision-making around spinal radiography is diverse and can be influenced by a number of clinical and external factors. Previously unexplored uses of spinal radiography in clinical practice were highlighted. Some chiropractors reported potential benefits of radiography that are currently not supported by research evidence. Future research should address how radiographic findings are reported to patients with spinal disorders and how this could be optimised to improve patient outcomes.


Assuntos
Quiroprática , Pesquisa Qualitativa , Radiografia , Humanos , Feminino , Masculino , Austrália , Adulto , Pessoa de Meia-Idade , Atitude do Pessoal de Saúde , Doenças da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem
20.
Int J Mol Sci ; 25(11)2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38891790

RESUMO

Derived from axial structures, Sonic Hedgehog (Shh) is secreted into the paraxial mesoderm, where it plays crucial roles in sclerotome induction and myotome differentiation. Through conditional loss-of-function in quail embryos, we investigate the timing and impact of Shh activity during early formation of sclerotome-derived vertebrae and ribs, and of lateral mesoderm-derived sternum. To this end, Hedgehog interacting protein (Hhip) was electroporated at various times between days 2 and 5. While the vertebral body and rib primordium showed consistent size reduction, rib expansion into the somatopleura remained unaffected, and the sternal bud developed normally. Additionally, we compared these effects with those of locally inhibiting BMP activity. Transfection of Noggin in the lateral mesoderm hindered sternal bud formation. Unlike Hhip, BMP inhibition via Noggin or Smad6 induced myogenic differentiation of the lateral dermomyotome lip, while impeding the growth of the myotome/rib complex into the somatic mesoderm, thus affirming the role of the lateral dermomyotome epithelium in rib guidance. Overall, these findings underscore the continuous requirement for opposing gradients of Shh and BMP activity in the morphogenesis of proximal and distal flank skeletal structures, respectively. Future research should address the implications of these early interactions to the later morphogenesis and function of the musculo-skeletal system and of possible associated malformations.


Assuntos
Proteínas Hedgehog , Costelas , Coluna Vertebral , Animais , Proteínas Hedgehog/metabolismo , Proteínas Hedgehog/genética , Costelas/metabolismo , Costelas/embriologia , Coluna Vertebral/metabolismo , Coluna Vertebral/embriologia , Regulação da Expressão Gênica no Desenvolvimento , Mesoderma/metabolismo , Mesoderma/embriologia , Codorniz , Somitos/metabolismo , Somitos/embriologia , Proteínas Morfogenéticas Ósseas/metabolismo , Proteínas Morfogenéticas Ósseas/genética , Proteínas de Transporte
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