The use of cortical bone trajectory (CBT) pedicle screws for circumferential interbody fusion represents a viable alternative for single-level procedure with reduced invasiveness and less tissue destruction than the traditional technique. In addition, CBT screws have a potentially stronger pullout strength because of the greater amount of cortical bone intercepted. Only few series exist evaluating clinical and radiological outcomes of CBT screws.
Methods
This is a retrospective cohort study. All patients that underwent circumferential lumbar interbody fusion with CBT screws in our institution from 2014 to 2017 were reviewed. Patient demographics, clinical outcome with visual analogue scale (VAS) and Oswestry Disability Index (ODI), radiological data such as fusion, lordosis and muscle trauma, operative blood loss, hospital stay and use of fluoroscopy were evaluated.
Results
A total of 101 patients undergoing CBT-arthrodesis for degenerative lumbo-sacral disease were reviewed. Mean procedural time was 187 min. The mean operative blood loss and X-ray dose per procedure was 383 ml and 1.60 mg cm2, respectively. The mean hospital stay was 3.47 days. The mean follow-up was 18.23 months. Mean lordosis increment at the treated level was 4.2°. When the follow-up was longer than 12 months (53% of patients), fusion was obtained in 94% of cases. Mean ODI and VAS index improved with statistical significance.
Conclusions
This is to our knowledge that the largest available study regarding CBT for circumferential arthrodesis. Results underlined the safety of this technique and the promising clinical and radiological outcomes that will need a longer follow-up.
Graphical abstract
These slides can be retrieved under Electronic Supplementary material.
Rituximab plus fludarabine and cyclophosphamide (RFC) is the standard of care for fit patients with untreated chronic lymphocytic leukemia (CLL); however, its use is limited in ‘unfit’ (co-morbid and/or full-dose F-ineligible) patients due to its toxicity profile. We conducted a systematic review and Bayesian network meta-analysis (NMA) to determine the relative efficacy of commercially available interventions for the first-line treatment of unfit CLL patients.
Methods
For inclusion in the NMA, studies had to be linked via common treatment comparators, report progression-free survival (PFS), and/or overall survival (OS), and meet at least one of the five inclusion criteria: median cumulative illness score >6, median creatinine clearance ≤70 mL/min, existing co-morbidities, median age ≥70 years, and no full-dose F in the comparator arm. A manual review, validated by external experts, of all studies that met at least one of these criteria was also performed to confirm that they evaluated first-line therapeutic options for unfit patients with CLL.
Results
In unfit patients, the main NMA (five studies for PFS and four for OS) demonstrated clear preference in terms of PFS for obinutuzumab + chlorambucil (G-Clb) versus rituximab + chlorambucil (R-Clb), ofatumumab + chlorambucil (O-Clb), fludarabine and chlorambucil (median hazard ratios [HRs] 0.43, 0.33, 0.20, and 0.19, respectively), and a trend for better efficacy versus rituximab + bendamustine (R-Benda) and RFC-Lite (median HR 0.81 and 0.88, respectively). OS results were generally consistent with PFS data, (median HR 0.48, 0.53, and 0.81, respectively) for G-Clb versus Clb, O-Clb, and R-Clb 0.35 and 0.81 versus F and R-Benda, respectively); however, the OS findings were associated with higher uncertainty. Treatment ranking reflected improved PFS and OS with G-Clb over other treatment strategies (median rank of one for both endpoints).
Conclusion
G-Clb is likely to show superior efficacy to other treatment options selected in our NMA for unfit treatment-naïve patients with CLL.
In somatic cells phosphoinositide 3-kinase (PI 3-kinase) is activated upon
interaction with both receptor tyrosine kinases (RTK) and G- proteins
resulting in the production of moieties involved in the inositol
phospholipid signalling pathway. As G proteins, RTK and the inositol
phospholipids have all been implicated in the human sperm acrosome
reaction, experiments were carried out to determine whether PI 3-kinase was
also involved in this phenomenon. Wortmannin is a selective inhibitor of PI
3-kinase and was shown to significantly inhibit the acrosome reaction
induced by both mannose-bovine serum albumin (mannose-BSA) (10, 50 and 100
nM) and a polyclonal antibody raised against an extracellular region of the
sperm zona receptor kinase (ZRK, at 100 nM only). Wortmannin did not
inhibit the A23187- or progesterone-induced acrosome reaction. These
results suggest that PI 3- kinase is involved in the human sperm acrosome
reaction. The levels of tyrosine phosphorylation of sperm proteins as
detected by Western blotting using antiphosphotyrosine antibodies was not
affected by wortmannin in agonist (A23187 and mannose-BSA)-stimulated
spermatozoa. This indicated that PI 3-kinase operates downstream of
tyrosine phosphorylation in the signal transduction cascade which leads to
the human sperm acrosome reaction.
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The objective of this study was to determine the impact of the learning
curve of one surgeon on the term delivery rate following laparoscopic
salpingostomy for tubal infertility. This was a retrospective audit of
ongoing clinical practice, undertaken in two tertiary level infertility
programmes. Subjects in this study were women undergoing surgery for total
occlusion of the distal Fallopian tube. The main outcome measure was
cumulative term delivery rates. On stepwise life-table analysis the length
of infertility, primary and secondary infertility, tubal diameter and
whether surgery was performed in the first or second half of the series
were significantly associated with outcome. These data suggest that there
is a learning curve in obtaining skills to perform laparoscopic
salpingostomy, that patient selection may improve with experience, and that
selection criteria should be emphasized during didactic teaching and the
preceptorship process.
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