The association between interleukin-28B gene polymorphisms as a potential biomarker and the risk of chronic Periodontitis in an Iranian population

Background

Chronic Periodontitis (CP) is a common inflammatory disease affects supporting tissues of the teeth and can lead to tooth loss. The objective of this study was to determine the relationship between polymorphisms in the IL-28B gene and chronic periodontitis in an Iranian population.

Methods

Two hundred and ten CP patients and one hundred healthy subjects were enrolled in the present case-control study. The rs12979860 and rs8099917 SNPs were identified using RFLP and T-ARMS-PCR methods respectively.

Results

SNP analysis revealed that the G allele of rs8099917 SNP and T allele of rs12979860 SNP increased susceptibility to CP compared to the A allele and C allele (p < 0.0001, OR = 2.712, CI = 1.783-4.126; p < 0.0001, OR = 2.538, CI = 1.784-3.613 respectively). In addition, the CT/GT, TT/GG and TT/GT haplotypes were predominant in CP patients and significantly associated with the increased risk of CP.

Conclusion

IL-28B polymorphisms may be useful predictive factors for chronic periodontitis and correlated to the susceptibility to CP infection in our population.

     

Incidence and predictive risk factors of postoperative sepsis in orthopedic trauma patients

Background

Postoperative sepsis is associated with high mortality and the national costs of septicemia exceed those of any other diagnosis. While numerous studies in the basic orthopedic science literature suggest that traumatic injuries facilitate the development of sepsis, it is currently unclear whether orthopedic trauma patients are at increased risk. The purpose of this study was thus to assess the incidence of sepsis and determine the risk factors that significantly predicted septicemia following orthopedic trauma surgery.

Materials and methods

56,336 orthopedic trauma patients treated between 2006 and 2013 were identified in the ACS-NSQIP database. Documentation of postoperative sepsis/septic shock, demographics, surgical variables, and preoperative comorbidities was collected. Chi-squared analyses were used to assess differences in the rates of sepsis between trauma and nontrauma groups. Binary multivariable regressions identified risk factors that significantly predicted the development of postoperative septicemia in orthopedic trauma patients.

Results

There was a significant difference in the overall rates of both sepsis and septic shock between orthopedic trauma (1.6%) and nontrauma (0.5%) patients (p < 0.001). For orthopedic trauma patients, ventilator use (OR = 15.1, p = 0.002), history of pain at rest (OR = 2.8, p = 0.036), and prior sepsis (OR = 2.6, p < 0.001) were significantly associated with septicemia. Statistically predictive, modifiable comorbidities included hypertension (OR = 2.1, p = 0.003) and the use of corticosteroids (OR = 2.1, p = 0.016).

Conclusions

There is a significantly greater incidence of postoperative sepsis in the trauma cohort. Clinicians should be aware of these predictive characteristics, may seek to counsel at-risk patients, and should consider addressing modifiable risk factors such as hypertension and corticosteroid use preoperatively. Level of evidence Level III.

     

Acute kidney injury after open ventral hernia repair: an analysis of the 2005–2012 ACS-NSQIP datasets

Purpose

Acute kidney injury (AKI) is a serious postoperative complication, negatively impacting mortality rates, extending length of stay, and raising hospital costs. The purpose of this study was to examine AKI following open ventral hernia repair (OVHR) using a large, heterogeneous database to determine the incidence and identify risk factors for this complication.

Methods

Using the 2005–2012 ACS-NSQIP database, patients undergoing open ventral hernia repair were identified by CPT codes. Patients with acute kidney injury within 30 days of surgery were compared to controls by multivariate logistic regression across preoperative and intraoperative characteristics.

Results

Of 48,629 open ventral hernia repair patients identified in the dataset, AKI developed in 1.4 % (681 patients). Multivariate logistic regression determined a number of factors associated with AKI. These include WHO Class III obesity (OR = 2.57, p < 0.001), history of cardiovascular disease (OR = 1.81, p < 0.001), diabetes (OR = 1.29, p = 0.028), hypoalbuminemia (OR = 1.42, p = 0.004), and chronic kidney disease (for a baseline GFR of 60?89 mL/min/1.73m2, OR = 1.62, p = 0.001; for 30?59 mL/min/1.73m2, OR = 2.25, p < 0.001; for 15?29 mL/min/1.73m2, OR = 4.96, p < 0.001). Intraoperative factors include prolonged operative time (for ≥1SD above the mean, OR = 1.68, p = 0.002; for ≥2SD above the mean, OR = 2.76, p < 0.001) and intraoperative transfusion (OR = 2.44, p < 0.001).

Conclusions

Patients with a history of obesity, chronic kidney disease, cardiovascular history, diabetes, and hypoalbuminemia are at increased risk for AKI when undergoing OVHR. Intraoperative variables such as prolonged operative times and blood transfusions may also suggest increased risk. Preoperative identification of patients with these characteristics and perioperative hemodynamic stabilization are important first steps to minimize this complication.

     

Vitamin D and prostate cancer prognosis: a Mendelian randomization study

Purpose

Decreased vitamin D levels have been associated with prostate cancer, but it is unclear whether this association is causal. A functional single-nucleotide polymorphism (SNP) in the group-specific component (GC) gene (T > G, rs2282679) has been associated with 25-hydroxy (25-OH) vitamin D and 1.25 dihydroxy (1.25-OH2) vitamin D levels.

Methods

To examine the hypothesized inverse relationship between vitamin D status and prostate cancer, we studied the association between this SNP and prostate cancer outcome in the prospective PROCAGENE study comprising 702 prostate cancer patients with a median follow-up of 82 months.

Results

GC rs2282679 genotypes were not associated with biochemical recurrence [hazard ratios (HR) 0.91, 95 % confidence interval (CI) 0.73–1.12; p = 0.36], development of metastases (HR 1.20, 95 % CI 0.88–1.63; p = 0.25) or overall survival (HR 1.10; 95 % CI 0.84–1.43; p = 0.50).

Conclusions

A causal role of vitamin D status, as reflected by GC rs2282679 genotype, in disease progression and mortality in prostate cancer patients is unlikely.

     

Risk Factors for Mortality and Morbidity in Elderly Patients Presenting with Digestive Surgical Emergencies

Background

Emergency digestive surgery is being increasingly performed in elderly patients. The aim of the present study was to identify the predictors of mortality and morbidity following emergency digestive surgery in patients aged 80 years and older.

Methods

A single-center retrospective review was performed of consecutive patients aged ≥65 years operated for a digestive surgical emergency between January 2011 and December 2013. Two groups were compared: group A (aged 65–79 years) and group B (aged ≥80 years).

Results

The study population included 185 patients: 76 patients in group A and 109 in group B. The mean age was 79.9 years (65–104 years). The overall 90-day mortality rate was 23.2 and 31.9% at 1 year, which was similar between groups. The overall morbidity was 28.6%. No differences were noted between the two groups in overall, minor (Dindo I–II) or major (Dindo III–IV) morbidity rates. Multivariate analysis identified pulmonary disease (odds ratio, OR = 6.43, p = 0.02), bowel ischemia (OR = 11.41, p = 0.01), postoperative ICU stay (OR = 7.37, p < 0.0001) and the occurrence of postoperative complications (OR = 2.66, p = 0.03) as predictors of 90-day mortality. Predictors of in-hospital morbidity were preoperative hemoglobin <12 g/dL (OR = 2.49, p = 0.02) and postoperative intensive care unit (ICU) stay (OR = 6.69, p < 0.0001). An age ≥80 year was not associated with mortality or morbidity in this study.

Conclusions

The decision to perform abdominal surgery in the emergency setting should be based on physiological status, which accounts for a patient’s comorbidities and health status, rather than on chronological age per se.

     

Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry

Background

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has dramatically improved the survival of patients with epithelioid peritoneal mesothelioma. It is unknown if CRS/HIPEC is indicated for the more aggressive biphasic mesothelioma variant.

Methods

A retrospective analysis of the Peritoneal Surface Oncology Group International (PSOGI) registry including data from 33 centers was performed. Survival was reviewed based on mesothelioma type, completion of cytoreduction, and volume of disease.

Results

Overall, 484 of 1165 (41.5%) CRS/HIPEC procedures with complete CC0 and CC1 cytoreductions were analyzed; 450 (93%) procedures were performed for epithelioid mesotheliomas, while 34 (7%) were performed for biphasic mesotheliomas. For patients with CC0 resection, 5-year survival was 64.5 and 50.2% (median 7.8 and 6.8 years; p = 0.015) for epithelioid and biphasic mesotheliomas, respectively, while inclusion of CC1 resections in the analysis resulted in inferior 5-year survival of 62.9% and 41.6% (median 7.8 and 2.8 years; p = 0.0012), respectively. Incomplete CC2 resections for biphasic primaries resulted in a median survival of 4.3 months. Univariate analysis of the biphasic cohort indicated Peritoneal Cancer Index (PCI; p = 0.015), CC status of resection (p < 0.0001), and Ki67 (p = 0.04) as predictors of survival. Systemic chemotherapy before (p = 0.55) or after (p = 0.7) CRS/HIPEC did not influence survival. In multivariate analysis, only PCI (p = 0.03) and CC (p = 0.04) remained significant.

Conclusions

Long-term survival is achievable in patients with low-volume biphasic mesothelioma after complete macroscopic cytoreduction. Biphasic peritoneal mesotheliomas should not be considered as an absolute contraindication for CRS/HIPEC if there is low-volume disease and if complete cytoreduction can be achieved.

     

Effect of interleukin 6 –174G&gt;C gene polymorphism on opioid requirements after total hip replacement

Objective

In recent years, increasing attention has been paid to the contribution of genetic factors to variability in patient pain threshold and the efficacy of pain management. One of the genes implicated in pain pathology and treatment response is interleukin 6 (IL6). The aim of the present study was to evaluate the association between IL6 (rs1800795: –174G>C) and opioid requirements in patients after total hip replacement (THR).

Methods

A total of 196 patients eligible for the study (126 women, 70 men) were subjected to THR. The THR procedure was performed using spinal anaesthesia after implementing routine peri-operative monitoring. After the procedure each patient was individually observed, and the patient-specific chart of dynamic changes in pain perception was recorded, using the five-level Verbal Rating Scale (VRS). The multimodal analgesic treatment after THR was defined by the operating surgeons after considering indications and contraindications to the use of different groups of drugs (opioid and non-opioid analgesics). Postoperative pain was controlled by the patient-controlled analgesia method and VRS during the day-time, as well as night-time nurse-controlled analgesia. All medication adjustments were recorded in the individual patient files. In the case of moderate pain intensity (VRS-assessed), a patient was administered the non-opioid analgesic drug, and for high intensity pain the opioid. The analysis of pain relief therapy included information on the drugs applied, mode of dosing (single or multiple), daily dose, route of administration, and drug refusal due to the absence of pain recorded each study day, i.e. on the day of surgery and recovery in the postoperative room (day 0), and then daily from day 1 to day 6. Polymorphism rs1800795:G>C in the promoter region of the IL6 gene (–174G>C) was determined using the PCR–RFLP method.

Results

The patients carrying at least one IL6 –174G allele (GG homozygote and GC heterozygote) were administered opioids significantly more often on days 0 (p = 0.0029), 3 (p = 0.019) and 4 (p = 0.031) after surgery compared with CC homozygous patients. Those patients also required a significantly higher opioid dose on days 3 (p = 0.029) and 4 (p = 0.030). Multivariate analysis demonstrated that the presence of the –174G allele was an independent factor predisposing patients to the administration of opioids during the first 24 h [p = 0.001, odds ratio (OR) 7.1, 95 % confidence interval (CI) 2.17–22.7], on day 3 (p = 0.01, OR 2.79, 95 % CI 1.25–6.26) and day 4 (p = 0.01, OR = 2.61, 95 % CI 1.17–5.79).

Conclusion

The presence of the G allele IL6 gene (–174G>C) polymorphism was found to be an independent factor predisposing to a higher dose and more frequent administration of opioids in the first days after total hip replacement.

     

Correlation between pelvic tilt and the sacro-femoral-pubic angle in patients with adolescent idiopathic scoliosis,patients with congenital scoliosis,and healthy individuals

Purpose

To examine whether the sacro-femoral-pubic (SFP) angle could estimate pelvic tilt (PT) in scoliotic and normal subjects.

Methods

One hundred nine subjects including 38 patients with adolescent idiopathic scoliosis (AIS), 35 patients with congenital scoliosis (CS), and 36 healthy individuals were studied. PT, as the angle between the lines connecting the midpoint of the sacral plate to the centroid of one acetabulum and the vertical plane, and the SFP angle, as the angle between the midpoint of the upper sacral endplate, the centroid of one acetabulum, and the upper midpoint of the pubic symphysis, were calculated on full-length lateral and anteroposterior radiographs, respectively. Correlations between PT and the SFP angle were investigated in each group.

Results

The three groups were comparable in terms of age, sex, and the mean SFP angle. The mean PT, however, was significantly lower in healthy subjects compared to that in patients with AIS and CS. Significant and reverse correlations were present between PT and the SFP angle in all three groups (AIS: r = ?0.32, p = 0.04, PT = 82.5???average SFP angle; CS: r = ?0.48, p = 0.003, PT = 95.41???average SFP angle; healthy: r = ?0.33, p = 0.04, PT = 88.95???average SFP angle).

Conclusions

Unlike two previous reports, the SFP angle correlated poorly to PT in this study, limiting its use as a suitable surrogate for PT in scoliotic and healthy subjects.

     

Prehospital intubation for isolated severe blunt traumatic brain injury: worse outcomes and higher mortality

Purpose

Prehospital endotracheal intubation (ETI) for traumatic brain injury (TBI) is a controversial issue. The aim of this study was to investigate the effect of prehospital ETI in patients with TBI.

Methods

Cohort-matched study using the US National Trauma Data Bank (NTDB) 2008–2012. Patients with isolated severe blunt TBI (AIS head ≥3, AIS chest/abdomen <3) and a field GCS ≤8 were extracted from NTDB. A 1:1 matching of patients with and without prehospital ETI was performed. Matching criteria were sex, age, exact field GCS, exact AIS head, field hypotension, field cardiac arrest, and the brain injury type (according PREDOT-code). The matched cohorts were compared with univariable and multivariable regression analysis.

Results

A total of 27,714 patients were included. Matching resulted in 8139 cases with and 8139 cases without prehospital ETI. Prehospital ETI was associated with significantly longer scene (median 9 vs. 8 min, p < 0.001) and transport times (median 26 vs. 19 min, p < 0.001), lower Emergency Department (ED) GCS scores (in patients without sedation; mean 3.7 vs. 3.9, p = 0.026), more ventilator days (mean 7.3 vs. 6.9, p = 0.006), longer ICU (median 6.0 vs. 5.0 days, p < 0.001) and total hospital length of stay (median 10.0 vs. 9.0 days, p < 0.001), and higher in-hospital mortality (31.4 vs. 27.5 %, p < 0.001). In regression analysis prehospital ETI was independently associated with lower ED GCS scores (RC ?4.213, CI ?4.562/?3.864, p < 0.001) and higher in-hospital mortality (OR 1.399, CI 1.205/1.624, p < 0.001).

Conclusion

In this large cohort-matched analysis, prehospital ETI in patients with isolated severe blunt TBI was independently associated with lower ED GCS scores and higher mortality.

     

Analysis of active surveillance uptake for low-risk localized prostate cancer in Canada: a Canadian multi-institutional study

Purpose

Although the uptake of active surveillance (AS) appears to be increasing in published series, the uptake in most geographic regions remains largely unknown. Our aim was to examine practice patterns around the use of AS in low-risk prostate cancer in Canada. In addition, we examined regional variations in AS uptake, predictors of AS uptake, and persistent use for 12 months.

Methods

This is a retrospective multicentre review of low-risk patients who underwent a prostate biopsy in 2010 in six centres in four provinces (BC, QC, MB and ON). AS was identified based on chart review and required a minimum of 6 months of follow-up after diagnosis without any active treatment.

Results

Of 986 patients, 781 patients (mean age 64 years) were incident cases and over three-quarters (77.3 %) chose AS at diagnosis. There were significant differences in uptake of AS by centre (range 65.0–98.0 %, p ≤ 0.05). Key multivariate predictors of pursuing AS included older age (OR 1.34, p = 0.044), centre (p = 0.021), lower number of cores (OR 1.09, p = 0.025), lower number of positive biopsy cores (OR 0.52, p < 0.001), and lower percent core involvement (OR 0.84, p < 0.001). In total, 516 (85.4 %) men remained on AS over 12 months. Maintenance with AS over 12 months differed by centre, ranging from 64.1 to 93.9 % (p = 0.001). Predictors of maintenance with AS over 12 months included older age, centre, and lower number of positive cores.

Conclusions

Active surveillance is widely practiced across Canada, but important regional differences were observed. Further analyses are required to understand the root causes of differences and to determine whether AS uptake is changing over time.

     

Comparison of combined anterior–posterior approach versus posterior-only approach in treating adolescent idiopathic scoliosis: a meta-analysis

Purpose

Choosing a surgical approach to treat adolescent idiopathic scoliosis (AIS) is still controversial. To compare the effectiveness and safety of combined anterior–posterior approach to posterior-only approach, we conducted a meta-analysis.

Methods

We searched electronic database for relevant studies that compared anterior–posterior approach with posterior approach in AIS. Then data extraction and quality assessment were conducted. We used RevMan 5.1 for data analysis. A random effects model was used for heterogeneous data, while a fixed effect model was used for homogeneous data.

Results

A total of ten non-randomized controlled studies involving 872 patients were included. There was no significant difference in Cobb angle (95 % CI ?0.33 to 4.91, P = 0.09) and percent-predicted FEV1 (95 % CI ?6.79 to 4.54, P = 0.70) between the two groups. In subgroup analysis, the kyphosis angle correction was significantly higher than posterior group in severe subgroup (95 % CI 0.72–6.50, P = 0.01), while no significant difference was found in no-restriction subgroup (95 % CI ?2.75 to 5.42, P = 0.52). Patients in posterior group obtained a better percent-predicted FVC than those in anterior–posterior group (95 % CI ?13.18 to ?4.74, P < 0.0001). Significant less complication rate (95 % CI 2.75–17.49, P < 0.0001), blood loss (95 % CI 363.28–658.91, P < 0.00001), operative time (95 % CI 2.65–3.45, P < 0.00001) and length of hospital stay (95 % CI 1.98–22.94, P = 0.02) were found in posterior group.

Conclusions

Posterior-only approach can achieve similar coronal plane correction and percent-predicted FEV1 compared to combined anterior–posterior approach. The posterior approach even does better in sagittal correction in severe AIS patients. Significantly less complication rate, blood loss, operative time, length of hospital stay and better percent-predicted FVC are also achieved by posterior-only approach. Posterior-only approach seems to be effective and safe in treating AIS for experienced surgeons.

     

Evaluation of motion sickness susceptibility by motion sickness susceptibility questionnaire in adolescents with idiopathic scoliosis: a case–control study

Purpose

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine, with unknown origin. Some studies have noted impaired postural balance in AIS, in particular, difficulty to manage situations with sensory conflict. The motion sickness susceptibility can be secondary to a sensory conflict, for example, between visual and vestibular information. Our hypothesis is: patients with AIS have difficulty in managing situations with sensory conflict and therefore have increased motion sickness susceptibility. The purpose of this study was to evaluate in AIS subjects by evaluating their susceptibility to motion sickness, as compared to a control group.

Methods

We conducted an analysis of data on motion sickness susceptibility collected prospectively from 2012, with the B score of motion sickness susceptibility questionnaire. This evaluation was completed for 65 adolescents (age 14.5 ± 1.6 year) with major right thoracic AIS (Cobb = 40.7° ± 13.1°) and 71 matched controls (14.6 ± 1.6 year).

Results

Adolescents with major right thoracic AIS were more susceptible to motion sickness (B score = 5.3 ± 5.8) than controls (B score = 3.4 ± 3.7) with significant difference (p = 0.025).

Conclusions

We interpret our results suggesting there is difficulty for patients with AIS to manage situations with sensory conflict. Previous studies focusing on situations with sensory conflict in AIS have required sophisticated technology. They are not accessible for routine patient management. Our research shows the same result with simple, non invasive, low-cost and quick method: B score of motion sickness susceptibility questionnaire.

     

A systematic review on the efficacy and safety of PA21 versus sevelamer in dialysis patients

Aim

To evaluate the efficacy and safety of PA21 versus sevelamer in dialysis patients.

Methods

We searched Medline, Embase, Science Citation Index, Cochrane Central Register of Controlled Trials, and Clinical Trial Registries for randomized controlled trials comparing PA21 and sevelamer in dialysis patients.

Results

Four studies were included. Compared with sevelamer group, PA21 needed fewer mean daily number of tablets (WMD, ? 7.97 pill; 95% CI, ? 11.28 to ? 4.65, p < 0.00001), developed fewer all adverse events (RR = 1.05; 95% CI, 1.00 to 1.11, p = 0.05), and developed fewer gastrointestinal adverse events (RR = 1.32; 95% CI, 1.15 to 1.53, p = 0.0001). There was no significant difference in serum phosphorus between two groups (WMD, ? 0.07 mmol/L; 95% CI, ? 0.15 to 0.02, p = 0.12). As for serum calcium, there was also no significant difference between two groups (WMD, 0.27 mmol/L; 95% CI, ? 0.63 to 1.17, p = 0.55).

Conclusion

PA21 can effectively control serum phosphorus with lower pill burden and less side effects than sevelamer. PA21 might be another valuable choice for dialysis patients with hyperphosphatemia when patients are unable to tolerate sevelamer.

     

Abnormal rib count in scoliosis surgery: impact on the reporting of spinal fusion levels

Purpose

Variation in rib numbering has been noted in adolescent idiopathic scoliosis (AIS), but its effect on the reporting of fusion levels has not been studied. We hypothesized that vertebral numbering variations can lead to differing documentation of fusion levels.

Methods

We examined the radiographs of 161 surgical AIS patients and 179 control patients without scoliosis. For AIS patients, the operative report of fusion levels was compared to conventional vertebral labeling from the first thoracic level and proceeding caudal. We defined normal counts as 12 thoracic (rib-bearing) and five lumbar (non-rib-bearing) vertebrae. We compared our counts with data from 181 anatomic specimens.

Results

Among AIS patients, 22 (14 %) had an abnormal number of ribs and 29 (18 %) had either abnormal rib or lumbar count. In 12/29 (41 %) patients, the operative report differed from conventional labeling by one level, versus 3/132 (2 %) patients with normal numbering (p < 0.001). However, there were no cases seen of wrong fusion levels based on curve pattern. Among controls, 11 % had abnormal rib count (p = 0.41) compared to the rate in AIS. Anatomic specimen data did not differ in abnormal rib count (p = 1.0) or thoracolumbar pattern (p = 0.59).

Conclusions

The rate of numerical variations in the thoracolumbar vertebrae of AIS patients is equivalent to that in the general population. When variations in rib count are present, differences in numbering levels can occur. In the treatment of scoliosis, no wrong fusion levels were noted. However, for both scoliosis patients and the general population, we suggest adherence to conventional labeling to enhance clarity.

     

Off-pump versus on-pump coronary surgery in patients with chronic kidney disease: a meta-analysis

Background

Patients with chronic kidney disease (CKD) have worse adverse cardiovascular outcomes after coronary artery bypass grafting (CABG). However, the adverse cardiovascular outcomes between off-pump coronary artery bypass grafting (OPCAB) versus on-pump coronary artery bypass grafting (ONCAB) in these patients have been a subject of debate.

Methods

We undertook a comprehensive literature search of PubMed, Embase, and the Cochrane Library database to identify all relevant studies comparing techniques between OPCAB and ONCAB in CKD patients. We pooled the odds ratios (ORs) and hazard ratios (HRs) from individual studies and conducted heterogeneity, quality assessment, and publication bias analyses.

Results

This meta-analysis includes 17 studies with 201,889 patients. In CKD patients, OPCAB was associated with significantly lower early mortality as compared to ONCAB (OR 0.88; 95% CI 0.82–0.93; p < 0.0001). OPCAB was associated with decreased risk of atrial fibrillation (OR 0.57; 95% CI 0.34–0.97; p = 0.04), cerebrovascular accident (OR 0.46; 95% CI 0.22–0.95; p = 0.04), blood transfusion (OR 0.20; 95% CI 0.08–0.49; p = 0.0005), pneumonia, prolonged ventilation, and shorter hospital stays. No difference was found regarding long-term survival (HR 1.08; 95% CI 0.86–1.36; p = 0.51) or myocardial infarction (OR 0.65; 95% CI 0.30–1.38; p = 0.26).

Conclusions

Compared with ONCAB, OPCAB is associated with superior postoperative morbidity and the early mortality in CKD patients. Long-term survival is comparable between the two surgical revascularizations.

     

Quantitative evaluation of the relationship between COMP promoter methylation and the susceptibility and curve progression of adolescent idiopathic scoliosis

Purpose

The cartilage oligomeric matrix protein (COMP) was reported to be down-regulated in adolescent idiopathic scoliosis (AIS). The purposes of the study were to evaluate the roles of COMP promoter methylation on the abnormal gene expression and the epigenetic phenotype in AIS.

Methods

DNA samples of 50 AIS patients and 50 healthy controls were analyzed. Five CpG sites of COMP gene were amplified and sequenced using the polymerase chain reaction (PCR) and the pyrophosphate sequencing technology, while the COMP gene expression was evaluated using real-time PCR. Comparisons were analyzed with the Chi-square test and independent t test. Pearson coefficients of correlation were used to evaluate the association between gene methylation and clinical phenotypes.

Results

The average COMP gene promoter methylation of the AIS and control groups was 12.26 ± 2.36 and 8.76 ± 1.94 (p < 0.0001), and correspondingly the relative expression of COMP gene expression was 0.52 ± 0.12 and 1.16 ± 0.52 (p < 0.001), respectively. The correlation analysis showed significantly negative correlation between methylation level and gene expression (p < 0.0001). The comparison analysis between AIS patients with positive and negative methylation showed significant difference in chronological age (p < 0.001) and Cobb angle of main curve (p = 0.011). The methylation level of the COMP promoters was significantly correlated with Cobb angle of main curve and age (p < 0.0001) among the five CpG sites.

Conclusions

AIS patients had significantly high COMP promoter methylation and low gene expression. Positive and high COMP promoter methylation was correlated with young age and high Cobb angle of main curve. Therefore, COMP gene promoter methylation may provide significant prognostic information in predicting the susceptibility and curve progression of AIS.

     

The validity and reliability of “Spinal Mouse” assessment of spinal curvatures in the frontal plane in pediatric adolescent idiopathic thoraco-lumbar curves

Purpose

Radiological measurement has been accepted as the gold standard for evaluating scoliosis for many years. However, exposure of children to X-ray constitutes a major limitation of the radiological methods. Spinal Mouse (SM) is a safe, practical and easy to perform measurement of curvature in scoliosis, but its validity and reliability have not been investigated. The aim of this study was to investigate the validity and reliability of Cobb angle and SM measurements in children with adolescent idiopathic scoliosis (AIS).

Methods

Fifty-one patients with AIS who were followed up conservatively were included in the study. The mean age of the patients was 14.4 years (9–18 years). Frontal plane curvatures were evaluated with SM by 2 physiotherapists and the results were compared with radiological measurements. Radiological measurements were performed by 2 orthopedists.

Results

All the measurements were of the thoraco-lumbar curve and the mean value was 35.08° according to Cobb angle measurement. There was no difference between the interobserver measurements of SM (p = 0.256) while the Cobb degrees measured by the 2 orthopedists was different (p = 0.0001). We did not find a statistically significant difference between Cobb measurements and the SM measurements of observer 1 and 2 (p = 0.505). The interobserver and intraobserver agreement of the Cobb and SM measurements was excellent (ICC = 0.872–0.962). When the differences between the evaluations were compared, the interobserver SM differences were seen to be lower than the interobserver Cobb angle differences (p = 0.003). The agreement between the Cobb and SM measurements was higher for curves over 40°. We found a strong or very strong relationship between measurements made with the Cobb and SM methods (p < 0.0001).

Conclusions

We conclude that SM can be used for research and patient follow-up in the clinic as a safe, reliable, quick, and easy to use method with no side effects although it cannot be the only factor to consider when determining the treatment plan of AIS patients.

     

One-port video-assisted thoracic surgery versus three-port video-assisted thoracic surgery for primary spontaneous pneumothorax: a meta-analysis

Objective

To further understand the effects of video-assisted thoracic surgery (VATS) with one-port versus three-port VATS for primary spontaneous pneumothorax (PSP).

Methods

In this study, we searched information from the PubMed, Cochrane Library, Embase, ScienceDirect, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Data databases from inception to September 2015 to collect data of randomized controlled trials (RCTs) and cohort studies about one-port VATS versus three-port VATS for PSP. Two independent authors were committed to screen literature, extract data, and assess the risk of bias of related studies. Then, we used the RevMan 5.20 software for a meta-analysis of one-port VATS versus three-port VATS for PSP.

Results

Six cohort studies involving 310 patients were finally selected in this meta-analysis. The results of our study indicate that one-port VATS had a shorter hospital stay (SMD = ?0.39, 95 % CI ?0.69 to 0.09, P = 0.01), lower VAS score of 24-h post-operative pain (SMD = ?0.78, 95 % CI ?1.40 to ?0.52, P < 0.00001), shorter chest drainage time (SMD = ?0.68, 95 % CI ?1.15 to ?0.22, P = 0.004), and lower incidence of post-operative paraesthesia (OR = 0.13, 95 % CI 0.06 to 0.29, P < 0.00001) compared with three-port VATS. However, one-port VATS had a lower patient satisfaction score at 24 h (SMD = ?0.65, 95 % CI ?0.95 to ?0.35, P < 0.0001) and 48 h (SMD = ?0.46, 95 % CI ?0.71 to ?0.21, P = 0.0002). No differences in the recurrence of pneumothorax (OR = 0.58, 95 % CI 0.20 to 1.67, P = 0.32), the operation time (SMD = 1.01, 95 % CI ?4.63 to 2.60, P = 0.58), and the satisfaction score at 72 h (SMD = ?0.11, 95 % CI ?0.44 to 0.22, P < 0.00001) were noted between the groups.

Conclusion

Current evidence suggests that one-port VATS may have certain advantages over three-port VATS for PSP. More large-scale and high-quality studies are needed for authentication.