KẾT QUẢ PHẪU THUẬT GIẢI CHÈN ÉP ỐNG SỐNG QUA ỐNG BANH ĐIỀU TRỊ HẸP ỐNG SỐNG THẮT LƯNG DO THOÁI HÓA

Mục tiêu: Đánh giá kết quả phẫu thuật giải phóng chèn ép qua ống banh điều trị hẹp ống sống thắt lưng (HOSTL) do thoái hóa. Đối tượng và phương pháp: Nghiên cứu tiến cứu 62 bệnh nhân (BN) được chẩn đoán HOSTL do thoái hóa được phẫu thuật (PT) giải chèn ép ống sống qua ống banh thuật tại khoa CTCH cột sống - BVTWQĐ108 từ tháng 3/2015- 09/2016. Kết quả: 62 BN (25 nam, 37 nữ), tuổi trung bình là 57,61 ± 9,6 (từ 32 tới 81) đã được PT mở của sổ xương một bên giải chèn ép hai bên qua ống banh. Thời gian giải phóng chèn ép trung bình cho 1 mức đốt sống là 65,00 ±10,97 phút, 02 mức là 85,88 ± 18,04 phút. Kết quả xa sau PT được đánh giá theo thang điểm JOA (Japanese Orthopaedic Association score) tại thời điểm khám lại cuối cùng sau mổ trên 12 tháng 58/62 BN khám (93,5%) Thời gian kiểm tra trung bình: 33,47 ± 16,89 tháng (12-60). Rất tốt: 22 (37,9%), tốt: 31 (53,4%), trung bình: 3 (5,1%), kém: 2 (3,6%). Đánh giá cải thiện triệu chứng lâm sàng sau can thiệp tại thời điểm khám cuối cùng: điểm đau lưng VAS (Visual Analogue Scale) trước mổ 5,03 ± 1,24 khi khám lại là 0,67 ± 1,09, điểm đau chân VAS trước mổ là 7,23 ± 0,98 khi khám lại là 0,95 ±1,42, ODI (Oswestry Disability Index 2.0) trước mổ 66,32 ± 5,39 khi khám lại là 17,47±11,77, điểm JOA trước phẫu thuật là 11,29 ± 1,35 khi khám lại là 24,39 ± 2,70. Đánh giá sự gia tăng kích thước của ống sống trên phim cộng hưởng từ (CHT) sau PT giải chèn ép tại thời điểm khám cuối cùng 35/62 BN với sự thay đổi có ý nghĩa thống kê (p < 0,001): đường kính trước sau ống sống (ĐKTS) là 4,82 ± 1,65 mm (trước PT: 6,43 ± 1,34 mm, sau PT:11,25 ± 1,59 mm) và diện tích ống sống (DTOS) 73,06 ± 18,80 mm² (trước PT: 49,29 ± 15,09, sau PT: 122,35 ± 25,79). Biến chứng trong mổ: rách màng cứng: 02 (3,2%), tụ máu ngoài màng cứng 01(1,6%). Kết luận: Phẫu thuật giải chèn ép ống sống qua ống banh dưới kính vi phẫu thuật là phương pháp can thiệp ít xâm lấn, hiệu quả và an toàn trong điều trị bệnh lý HOSTL do thoái hóa.

Association of Recurrent Tear After Arthroscopic Rotator Cuff Repair and Superoxide-Induced Oxidative Stress

Background: Recurrent tears after arthroscopic rotator cuff repair (ARCR) remain a significant clinical problem. Oxidative stress contributes to the degeneration of the rotator cuff, and a degenerative rotator cuff can lead to recurrent tear after ARCR. However, the correlation between oxidative stress and retear after ARCR is unclear. Purpose: To investigate the correlation between superoxide-induced oxidative stress and recurrent tear after ARCR. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 68 patients who underwent ARCR using a suture-bridge technique participated in this study. Specimens were collected from the edge of the torn tendon during surgery. The modified Bonar score was used to evaluate degeneration of the rotator cuff on histological specimens, and fluorescence intensity on dihydroethidium (DHE) staining was used to detect oxidative stress. Superoxide dismutase (SOD) enzyme activity was also measured. The following were used for clinical evaluation: age, tear size on magnetic resonance imaging (MRI) before surgery, Goutallier classification on MRI before surgery, and Japanese Orthopaedic Association score before and 6 months after surgery. After the repaired rotator cuffs were evaluated on MRI 6 months after surgery, the patients were divided into groups: those with a healed rotator cuff (healed group; n = 46) and those with a recurrent tear (retear group; n = 22). The significant differences between the groups were determined with regard to clinical evaluation, modified Bonar score, DHE intensity, and SOD activity. In addition, multivariate logistic regression analysis was performed to investigate risk factors for recurrent tear. Results: Age, tear size, Goutallier classification, modified Bonar score, DHE intensity, and SOD activity were significantly greater in the retear group than in the healed group, although the Japanese Orthopaedic Association score was not significantly different. Multiple logistic regression analysis demonstrated that age, tear size, and SOD activity were significantly correlated with recurrent tear. Conclusion: In addition to tear size and age, superoxide-induced oxidative stress may be an exacerbating factor for retear after ARCR.

Do ‘Videos’ sections of Internet search engines provide accurate and adequate information about totally implantable venous access ports?

Objective: After cancer diagnosis, patients often look to Internet to learn more about totally implantable venous access ports which improve compliance with systemic anticancer therapy, as they do not get enough information from healthcare professionals. The aim of this study was to evaluate the video quality on Internet about totally implantable venous access ports using the most used three Internet search engines worldwide. Methods: ‘Videos’ sections of the most used three Internet search engines were queried using ‘Chemotherapy Port’, ‘Port Catheter’ and ‘Totally Implantable Venous Access Ports’ keywords. First, 50 results of each keyword in each search engine were analysed and evaluated according to a novel scoring system created by authors (totally implantable venous access port video evaluation score), Journal of the American Medical Association score and modified DISCERN score by independent reviewers. Obtained data were analysed by descriptive statistics, Kruskal–Wallis and chi-square tests. Results: Of the 450 videos, 229 were evaluated. The total video length was 1394.38 min. The mean video length was 6.08 ± 5.39 min, and the mean video view count was 32,553.71 ± 83,524.23. Mean Journal of the American Medical Association score, modified DISCERN score and totally implantable venous access port video evaluation score were 2.33 ± 0.90, 2.43 ± 1.59 and 3.54 ± 3.47, respectively. According to totally implantable venous access port video evaluation score, of the videos, 1.3% were remarkable, 5.2% were useful, 25.8% were poor and 67.7% were useless. Of the videos, 36.7% have been presented by healthcare professionals. Mean Journal of the American Medical Association score, modified DISCERN score and totally implantable venous access port video evaluation score of these videos were 3.11 ± 0.68, 3.97 ± 0.93 and 4.69 ± 4.25, respectively (p = 0.000, p = 0.000 and p = 0.003, respectively). Conclusion: Internet search engines’ ‘Videos’ sections have the potential of providing information about totally implantable venous access ports. However, they are vulnerable to providing unreliable information. This study has showed that videos about totally implantable venous access ports are insufficient in terms of reliability and integrity and may mislead patients.

Contingency learning and perfective morpheme productivity in L2 Italian: A study on lexeme–morpheme associations with ΔP

This study utilized unidirectional association score ΔP to track perfective morpheme productivity in longitudinal spoken L2 Italian data. Research questions concerned whether early L2 perfectives were contingent upon telicity of predicates, whether lexeme–morpheme association changed as proficiency increased, and whether distribution of perfectives in the L1 input affected the patterns of morpheme emergence. Results showed that (i) the productive use of the perfective was contingent upon a few, infrequent telic predicates but also upon some actionally underspecified, very frequent general-purpose ones; (ii) a generalized decrease in association scores over time accompanied the productivity of the perfective morpheme; (iii) distribution of perfectives in L2 data did not reflect distribution in the L1 input. The statistical analysis adopted in this study is replicable to other domains where contingency of stem-affix alternations may provide cues for observing the developing L2 grammar