Hemilaminoplasty for the treatment of lumbar intraspinal synovial cysts (LISCs) and literature review

Purpose

The present report intended to introduce the hemilaminoplasty technique and evaluate the efficacy of our surgical procedure for LISCs.

Methods

This retrospective study was conducted to analyze the results in 24 LISCs who had undergone our hemilaminoplasty between 2000 and 2012 in two hospitals. All were confirmed by pathological histology and mid- to long-term follow-up had been performed in all cases with a mean of 4.9 years. Using the Japanese Orthopedic Association scoring system (JOA score) and visual analog scale (VAS), symptoms resulting from cyst compression were quantified at various stage for statistical analysis.

Results

The JOA score and VAS of back/leg pain following surgery were improved significantly (P < 0.01). At final follow-up, with normal aging there was a little decrease in JOA score and VAS of back/leg pain, but still significantly improved (P < 0.01). Similarly, mean improvement rate of JOA was 83.5 % at 1 year after surgery while 75.6 % at final visit. Successful bone healing was obtained at a mean of 3.8 months after surgery. No cyst reformation and recurrent back/leg pain were observed around the surgical sites.

Conclusions

These lesions could be regarded as a result of facet arthrosis/instability and repetitive facet minor trauma with herniation of synovium through the defective joint capsule. Improvement in lumbago and leg pain may be a consequence of complete cyst resection via hemilaminoplasty plus partial facetectomy with anatomical reconstruction of the posterior spinal elements.

     

Association of interleukin-10 gene promoter polymorphisms with recurrent pregnancy loss: a meta-analysis

Purpose

It has been reported single-nucleotide polymorphisms (SNPs) of the IL-10 promoter might be associated with the susceptibility to recurrent pregnancy loss (RPL). Owing to the inconclusive results, we conducted a meta-analysis to systematically summarize and clarify the association between the IL-10 promoter SNPs and RPL risk.

Methods

A systematic search of studies on the association of the three SNPs with RPL was conducted in PubMed and Embase. Odds ratios (ORs) and 95 % confidence intervals (95 % CIs) were used to pool the effect size.

Result

Eleven case–control studies on rs1800896, seven studies on rs1800871, and eight studies on rs1800872 were included. A significant association was identified between IL-10 rs1800896 with RPL risk (G versus A: OR?=?1.21, 95 % CI 1.09–1.35). No evidence of association was found between rs1800871 and RPL when restricted to those studies in Hardy–Weinberg equilibrium in controls (T versus C: OR?=?1.25, 95 % CI 0.76–2.06). No statistical association was demonstrated between rs1800872 and RPL (C versus A: OR?=?1.08, 95 % CI 0.83–1.42).

Conclusions

IL-10 rs1800896 significantly increases the risk of RPL, while rs1800872 is not correlated with RPL risk. No significant association is demonstrated between rs1800871 and RPL risk but this requires further investigation.

     

Mechanical Ventilation After Bidirectional Superior Cavopulmonary Anastomosis for Single-Ventricle Physiology: A Comparison of Pressure Support Ventilation and Neurally Adjusted Ventilatory Assist

We evaluated the effects of different respiratory assist modes on cerebral blood flow (CBF) and arterial oxygenation in single-ventricle patients after bidirectional superior cavopulmonary anastomosis (BCPA). We hypothesized that preserved auto-regulation of respiration during neurally adjusted ventilatory assist (NAVA) may have potential advantages for CBF and pulmonary blood flow regulation after the BCPA procedure. We enrolled 23 patients scheduled for BCPA, who underwent pressure-controlled ventilation (PCV), pressure support ventilation (PSV), and NAVA at two assist levels for all modes in a randomized order. PCV targeting large V _T (15 mL × kg^?1) resulted in lower CBF and oxygenation compared to targeting low V _T (10 mL × kg^?1). During PSV and NAVA, ventilation assist levels were titrated to reduce EAdi from baseline by 75 % (high assist) and 50 % (low assist). High assist levels during PSV (PSV_high) were associated with lower PaCO₂, PaO₂, and O₂SAT, lower CBF, and higher pulsatility index compared with those during NAVA_high. There were no differences in parameters when using low assist levels, except for slightly greater oxygenation in the NAVA_low group. Modifying assist levels during NAVA did not influence hemodynamics, cerebral perfusion, or gas exchange. Targeting the larger V _T during PCV resulted in hyperventilation, did not improve oxygenation, and was accompanied by reduced CBF. Similarly, high assist levels during PSV led to mild hyperventilation, resulting in reduced CBF. NAVA’s results were independent of the assist level chosen, causing normalized PaCO₂, improved oxygenation, and better CBF than did any other mode, with the exception of PSV at low assist levels.     

Natural History After Acute Necrotizing Pancreatitis: a Large US Tertiary Care Experience

Background

Most studies of acute necrotizing pancreatitis (ANP) focus on short-term outcomes. We evaluated long-term survival and outcomes following ANP.

Methods

Patients treated for ANP at the University of Pittsburgh Medical Center from 2001 to 2008 were studied. Data on presentation and course during initial hospitalization and follow-up (median 34 months) was extracted.

Results

Mean age of patients (n?=?167) was 53?±?16 years; 70 % were male, 94 % white, 71 % transfers, 52 % biliary etiology, and 78 % had first-attack of acute pancreatitis. Majority had severe disease with high Acute Physiology and Chronic Health Evaluation II (APACHE-II) score (median 11), length of stay (median 26 days), intensive care unit (ICU) admission (87 %), presence of systemic inflammatory response syndrome (SIRS) (90 %), persistent organ failure (60 %), and infected necrosis (50 %). Intervention was needed in 74 %. Eighteen (10.8 %) patients died during index hospitalization, 9 (5.4 %) during the first year, and 13 (7.8 %) after 1 year. Median survival was significantly shorter when compared with age- and sex-matched US general population (9.1 vs. 26.1 years, p?<?0.001). Increasing age (HR 1.05), persistent organ failure (HR 4.5), and >50 % necrosis (HR 3.8) were independent predictors of death at 1 year. In eligible patients, new-onset diabetes, oral pancreatic enzyme replacement therapy, and disability were noted in 45, 25, and 53 %, respectively.

Conclusion

ANP significantly impacts long-term survival. A high proportion of patients develop functional derangement and disability following ANP.

     

Multiplex crack smoking and sexual networks: associations between network members’ incarceration and HIV risks among high-risk MSM

This study examined HIV risks in the multiplex crack-smoking and sexual networks of incarcerated drug-using men who have sex with men (MSM) and their associates. We estimated the associations between the network members’ incarceration, self-reported HIV infection, and trading sex for money. Our analytic sample consisted of 508 crack-smoking or sexual partnerships of 273 high-risk MSM. Network members were specified by (1) crack smoking and sexual behavior or (2) crack smoking only. Longer incarceration of the crack-smoking and sexual network members was associated with self-reported HIV infection (AOR = 1.61, p < 0.05), which extended up to one’s partners’ partners’ partners (AOR = 1.63, p < 0.05). Similar results were found for trading sex (AOR = 2.77, p < 0.05). The findings of the study call for the development of a system-level HIV intervention among former incarcerated MSM and their associates.     

Fabrication and characterization of Mg-doped chitosan–gelatin nanocompound coatings for titanium surface functionalization

Titanium and its alloys have been widely used in clinic and achieved great success. Due to the bio-inertness of titanium surface, challenges still exit in some compromised conditions. The present study aimed to functionalize titanium surface with magnesium (Mg)-doped chitosan/gelatin (CS/G) nanocompound coatings via electrophoretic deposition (EPD). CS/G coatings loaded with different amount of magnesium were successfully prepared on titanium substrate via EPD. Physicochemical characterization of the coatings confirmed that magnesium ions were loaded into the coatings in a dose-dependent manner. XRD results demonstrated that co-deposition of magnesium influenced the crystallinity of the coatings, and a new crystalline substance presented, namely hydrated basic magnesium carbonate. Mechanical tests showed improved tensile and shear bond strength of the magnesium-doped coatings, while the excessively high magnesium concentration could eventually decrease the bonding strength. Sustained release of magnesium ion was detected by ICP-OES within 28 days. TEM images also displayed that nanoparticles could be released from the coatings. In vitro cellular response assays demonstrated that the Mg-doped nanocompound coatings could enhance the proliferation and osteogenic differentiation of MC3T3-E1 cells compared to CS/G coatings. Therefore, it could be concluded that Mg-doped CS/G nanocompound coatings were successfully fabricated on titanium substrates via EPD. It would be a promising candidate to functionalize titanium surface with such organic–inorganic nanocompound coatings.