Fixator-assisted nailing of tibial fractures: New surgical technique and presentation of first 30 cases

Background

Intramedullary nailing is considered a “gold standard” for treatment of tibial shaft fractures. However, some types of fractures are typically considered as “difficult for nailing”. This group includes the periarticular fractures, fractures of both bones at the same level, comminuted and segmental fractures of the tibia. Fixator-assisted nailing (FAN) is an effective method treatment of these types of fractures. The main requirements for the ideal reduction device are an ease of its installation and an ability of multiplanar fracture reduction. Fixator-assisted nailing (FAN) with the use of two perpendicular to each other monolateral tubular frames perfectly meets these requirements. In this study we present this new surgical technique and the analysis of first 30 cases.

Correlation of Molecular Markers in High Grade Gliomas with Response to Chemo-Radiation

Background: The standard of care in high grade glioma (HGG) is maximal safe surgical resection followed by adjuvant radiotherapy (RT) with/without chemotherapy. For anaplastic gliomas, studies have shown use of procarbazine, lomustine, vincristine (PCV) improves overall survival (OS) and progression free survival (PFS). Currently, there is substantial evidence that molecular markers strongly predict prognosis and response to treatment. Methods: Between January 2016 to January 2018, 42 patients were accrued and followed up till April 2019. The primary end points were to correlate molecular markers with response to therapy in terms of OS and PFS in HGG. The secondary end point was to evaluate frequency of 1p/19q codeletion, IDH 1 mutation, ATRX deletion and p53 in HGG patients. Results: The median age was 46 years (range 18-67) with M:F ratio 30:12. The frequency of IDH1 mutation,1p/19q codeletion, p53 mutation and ATRX mutation were 42.8%, 16.6%, 42.8% and 14.2% respectively. All the seven patients with 1p/19q codeletion had IDH1 mutation. Median follow up was 22 months. The 20-months PFS for different mutations were as follows; IDH1-mutated vs wild type: 53.6% vs 29.8%; p-0.035, 1p/19q codeleted vs non-codeleted: 85.7% vs 62.3%; p-0.011, p53 wild type vs mutated 32.1% vs 35.6%; p-0.035 and ATRX lost vs retained: 55.6% vs 53.3%; p- 0.369. The 20-months OS for IDH1 mutated vs wild type: 82.4% vs 30.6%; p-0.014, 1p/19q codeleted vs non-codeleted: 85.7% vs 65.8%; p-0.104, p53 wild-type vs mutated 45.5% vs 73.9%; p-0.036 and ATRX lost vs retained: 100% vs 60.3%; p-0.087. Conclusion: Codeletion of 1p/19q with IDH1 mutation in HGG is associated with a significantly favourable PFS. However, larger studies with longer follow up are required to evaluate OS and PFS in all the molecular subgroups.     

Clinicopathological analysis of immunohistochemical expression of CD47 and SIRPα in adult T-cell leukemia/lymphoma

The interaction of CD47 and signal-regulatory protein alpha (SIRPα) induces “don't eat me signal”, leading suppression of phagocytosis. This signal can affect the clinical course of malignant disease. Although CD47 and SIRPα expression are associated with clinicopathological features in several neoplasms, the investigation for adult T-cell leukemia/lymphoma (ATLL) has not been well-documented. This study aimed to declare the association between CD47 and SIRPα expression and clinicopathological features in ATLL. We performed immunostaining on 73 biopsy samples and found that CD47 is primarily expressed in tumor cells, while SIRPα is expressed in non-neoplastic stromal cells. CD47 positive cases showed significantly higher FoxP3 (P = .0232) and lower CCR4 (P = .0214). SIRPα positive cases presented significantly better overall survival than SIRPα negative cases (P = .0132). SIRPα positive cases showed significantly HLA class I (P = .0062), HLA class II (P = .0133), microenvironment PD-L1 (miPD-L1) (P = .0032), and FoxP3 (P = .0229) positivity. In univariate analysis, SIRPα expression was significantly related to prognosis (Hazard ratio [HR] 0.470; 95% confidence interval [CI] 0.253-0.870; P = .0167], although multivariate analysis did not show SIPRα as an independent prognostic factor. The expression of SIRPα on stromal cells reflects activated immune surveillance mechanism in tumor microenvironment and induce good prognosis in ATLL. More detailed studies for gene expression or genomic abnormalities will disclose clinical and biological significance of the CD47 and SIRPα in ATLL.     

Congenital high airway obstruction syndrome (CHAOS): Natural history,prenatal management strategies,and outcomes at a single comprehensive fetal center

PurposeCongenital high airway obstruction syndrome (CHAOS) is a devastating fetal condition of complete airway discontinuity resulting in significant hydrops and extreme lung hyperplasia. It is universally fatal with survival reported only in the rare spontaneous fistulization or EXIT intervention (Ex Utero Intrapartum Treatment). Even in these cases, mortality remains high, and current investigations are targeting prenatal interventions. This report describes our experience with management and fetal interventions for CHAOS, including laser laryngotomy.MethodsWe retrospectively reviewed all patients diagnosed with CHAOS at a single academic institution between 2006 and 2017.ResultsFifteen patients were identified. Eight had obstruction at the trachea and seven at the larynx. In the laryngeal obstructions, three expired shortly after birth, and one survived after spontaneous fistulization and subsequent EXIT to tracheostomy. The remaining three underwent in-utero treatment with laser laryngotomy. One had preterm premature rupture of membranes (PPROM), delivered 3 days post-operatively, and died. Two underwent EXIT to tracheostomy with one surviving to discharge and is currently 2 years old.ConclusionOur study demonstrates the outcomes of a large series of patients diagnosed with CHAOS. While mortality remains high, options for fetal intervention are being explored to allow alterations in the prenatal natural history and improve postnatal outcomes.Type of StudyRetrospective Treatment Study.Level of EvidenceLevel IV.     

高流量吸氧与面罩吸氧在胸腔镜辅助食管癌根治术后氧疗效果对比

目的观察高流量湿化吸氧与常规面罩吸氧在食管癌患者行胸腔镜辅助食管癌根治术后治疗的临床效果。方法将36例择期行胸腔镜辅助下食管癌根治术后患者随机分为常规面罩吸氧对照组(A组)和高流量湿化吸氧治疗组(B组),对两组患者治疗2 h、6 h和24 h后的呼吸频率、动脉血气分析等指标进行比较,了解两种吸氧方式在食管癌患者行胸腔镜辅助食管癌根治术后治疗上的优劣。结果两组患者治疗2 h、6 h和24 h的呼吸频率、动脉血气分析发现,A组动脉氧饱和度、动脉血氧分压较B组降低,动脉血二氧化碳分压、呼吸频率较B组增高,两组比较差异有统计学意义(均P0.01)。结论与常规面罩吸氧比较,高流量湿化面罩吸氧可以使胸腔镜辅助食管癌根治术后患者有更满意的氧合效果,值得在临床上推广。     

高海拔地区精神分裂症患考临床特征分析

目的:了解高海拔环境对精神分裂症的影响。方法:对106例高海拔地区精神分裂症患者(高海拔组)的临床特征、疗效、药物副作用进行调查,与同期106例平原精神分裂症患者(平原组)对照。结果:高海拔组临床症状以幻觉、疑病妄想、夸大妄想、紧张冲动行为及焦虑、抑郁等精神症状出现频率较高,而对照组以被害妄想、情感淡漠等精神症状出现频率较高(P<0.01或P<0.05);入院时高海拔组总体病情较重(P<0.01);两组间疗效无显著性差异;高海拔组药物不良反应多于平原组。结论:高海拔地区精神分裂症患者临床特征、总体病情严重程度、药物不良反应与平原地区有一定区别,可能与高海拔环境有关。     

脑心通对脑缺血再灌注损伤细胞外信号调节激酶活化的影响

目的:观察大鼠局灶性脑缺血/再灌注((ischemia/reperfusion,I/R)后信号转导介质细胞外信号调节激酶(extracellular signal-regulated kinase,ERK)的活化情况以及脑心通对其影响。方法:雄性成年Wistar大鼠90只,随机分成3组:假手术组、对照组和脑心通组(每组30只),分别于缺血前6日每日用生理盐水4mL、生理盐水4mL和脑心通0.48g/kg(脑心通用4mL生理盐水溶解)灌胃。采用线栓法致大脑中动脉栓塞(middle cerebral artery occlusion,MCAO)模型,在脑缺血再灌注后的3h、6h、24h、48h和72h分别处死大鼠(各组每个时间点6只),将脑组织进行免疫组织化学、TTC染色,TUNEL法观察细胞凋亡。结果:脑缺血诱导ERK活化,第6h达高峰,并持续到72h。脑心通组ERKs活化明显较对照组增强,而且各时间点ERK免疫反应阳性细胞数脑心通组显著较对照组增多(P<0.01)。脑心通组TTC染色梗死体积及凋亡细胞数较对照组明显较少(P<0.01)。结论:局灶性脑缺血再灌注可诱导缺血脑细胞部分ERK活化,脑心通干预可使缺血大脑海马ERK活化增强,减轻细胞的缺血性损伤。     

髓内钉在矫治儿童成骨不全严重肢体畸形中的应用

[目的]探讨用髓内钉治疗儿童成骨不全严重肢体畸形中的矫形和防止再骨折的作用。[方法]2000年1月-2004年8月期间，共治疗8例，男3例，女5例。术中均将弯曲股骨或胫骨行多段截骨后髓内钉固定。其中2．0mm克氏针置入2例，Ender钉3例，Nancy弹性髓内钉3例。[结果]术后8例畸形改善明显，随访9个月．5a，平均2．4a，随访中肢体未再发骨折，未见髓内针合并感染、骨不连等并发症。1例术前轮椅患儿术后可扶拐行走；1例发生克氏针骨外部分断裂。[结论]多段截骨矫形后内置髓内钉治疗儿童成骨不全，对矫正肢体畸形、减少再次骨折机会，效果确实可靠。     

Steroid pulse therapy impaired endothelial function while increasing plasma high molecule adiponectin concentration in patients with IgA nephropathy.

BACKGROUND: Decreased plasma adiponectin is associated with impaired endothelial function and, thereby, increased risk for cardiovascular events. Glucocorticoid (GC) affects vascular endothelial cells either favourably or harmfully depending upon the dosages and duration. We examined the effect of GC pulse therapy on vascular endothelial function. METHODS: Fourteen young patients with IgA nephropathy were evaluated for flow-mediated vasodilation (FMD), plasma levels of adiponectin both in high molecular weight (HMW adiponectin) form and in single molecular form (total adiponectin), hepatocyte growth factor (HGF), asymmetric dimethylarginine (ADMA), and high-sensitive C-reactive protein, before and after a course of GC pulse therapy. RESULTS: GC pulse therapy significantly decreased FMD (from 7.2 +/- 2.6 to 5.7 +/- 2.5%, P < 0.01). Meanwhile, plasma adiponectin levels were significantly augmented (total adiponectin: from 10.2 +/- 4.0 to 12.1 +/- 6.3 microg/ml, P < 0.05; HMW: from 6.5 +/- 3.2 to 7.7 +/- 3.3 microg/ml, P < 0.05). In parallel, elevated concentrations of serum HGF (from 0.28 +/- 0.12 to 0.63 +/- 0.38 ng/ml, P < 0.01) and plasma ADMA (from 0.45 +/- 0.07 to 0.53 +/- 0.04 nmol/ml, P < 0.05) were observed. CONCLUSIONS: GC pulse therapy impaired endothelial function while increasing plasma adiponectin levels, which may in turn restore the endothelial function in patients with IgA nephropathy.