A comparative study between local bone graft with a cage and with no cage in single posterior lumbar interbody fusion (PLIF): a multicenter study

Objective

A retrospective study was performed to compare the clinical and radiological results between local bone graft with a cage and without using a cage in patients treated with posterior lumbar interbody fusion surgery.

Methods

A total of 115 consecutive patients who underwent PLIF in three institutions were evaluated from December 2005 to December 2010. 53 patients received PLIF with local bone graft combined with using one PEEK cage, and 62 patients received the PLIF with local bone graft without using a cage. The clinical data and perioperative complications of the patients in the two groups were recorded. Preoperative and postoperative radiographs were taken to calculate the disc height and the interbody bony fusion rate. Functional outcome was assessed using the Kirkaldy-Willis criteria at the follow-up time. The results between the cage group and no cage group were compared.

Results

The mean follow-up time was 19 months in no cage group and 18.5 months in cage group (P = 0.716). 20.9 % of patients (13 cases) in no cage group and 20.7 % of patients (11 cases) in cage group developed surgical complications perioperatively (P = 0.978). 51.6 % patients in no cage group got excellent functional outcome at the final follow-up while 54.7 % patients in cage group (P = 0.944). The mean interbody bony fusion time was 7.5 ± 4.5 months in no cage group and 8 ± 3.5 months in cage group (P = 0.841). According to the radiographs measurement, no significant difference was found for the disc height at each level between the two groups at the final follow-up.

Conclusion

Local bone graft without a cage is as beneficial as that with a cage for PLIF. Comparing with local bone graft using a single cage, we believe that the purely local bone graft is a more ideal way in single PLIF.     

Epsilon-aminocaproic Acid Improves Postrecirculation Hemodynamics by Reducing Intraliver Activated Protein C Consumption in Orthotopic Liver Transplantation

Background

Activated protein C (APC) is related to regulating the inflammatory response and hemodynamic stability upon reperfusion in cardiac operations and orthotopic liver transplantation (OLT). Epsilon-aminocaproic acid (EACA) is frequently used to treat fibrinolysis during OLT. It also has inhibitory effects related to the inflammatory response. However, it remains to be determined whether EACA can attenuate intraliver APC consumption and improve hemodynamic stability after reperfusion during OLT.

Methods

Fifty-nine recipients were randomized to receive either EACA (150 mg kg^?1 given intravenously prior to incision, followed by 15 mg kg^?1 h^?1 infusion until 2 h after the graft reperfusion) or the same volume of saline. Blood samples to assess plasma APC and protein C were obtained immediately before and after reperfusion from the inferior caval effluent or the portal veins for calculation of transliver differences (Δ). Hemodynamics and vasoactive medication use during the reperfusion period were observed in both groups.

Results

No transhepatic changes in protein C were found in either group. Immediately after reperfusion, a marked intraliver consumption of APC was noted in all recipients (P < 0.001), and intraliver consumption of APC in the control group was greater than that in the EACA-treated group (P < 0.05). Fewer requirements for vasoactive medication use after reperfusion and better initial graft function were noted in the EACA-treated group (P < 0.05).

Conclusions

EACA can attenuate intraliver APC consumption and improve hemodynamic stability after reperfusion and initial graft function during OLT.     

Lymph Node Counts and Ratio in Axillary Dissections Following Neoadjuvant Chemotherapy for Breast Cancer: A Better Alternative to Traditional pN Staging

Background

Neoadjuvant chemotherapy (NCT) for breast cancer might change the number of involved and detected nodes in axillary lymph node dissections (ALND). In this study, we analyzed whether the number of dissected nodes and the lymph node ratio (LNR, defined as the proportion of involved nodes in dissected nodes) would have a better prognostic value than traditional pN staging.

Methods

A total of 569 patients with stage II, III breast cancer were included in this retrospective study. All patients underwent a median of three cycles of NCT followed by mastectomy and ALND. Clinical and pathological variables were investigated using univariate and multivariate survival analyses.

Results

In post-NCT node-negative (LN?) patients, those with 4–9 dissected nodes experienced a significantly lower relapse-free survival (RFS) compared with those with 10 or more dissected nodes (hazard ratio = 0.19, 0.41, for 10–19 nodes, 20+ nodes, respectively; 4–9 nodes as the reference; P = 0.002). In post-NCT node-positive (LN+) patients, a lower LNR was correlated with a better RFS on multivariate analysis, and pN staging failed to show independent prognostic significance when the LNR was included in the Cox regression model (hazard ratio = 4.2, 2.97, 2.24, and 1.68 for LNR 81–100, 61–80, 41–60; and 21–40 %, respectively; LNR 0–20 % as the reference. P < 0.001). In addition, there were significant differences in the estimated 5-year RFS for pN1 (P = 0.043) and pN3 patients (P = 0.03) among the different LNR subgroups.

Conclusions

Our study has provided new evidence that the number of dissected nodes (in LN? patients) and the LNR (in LN+ patients) might be a complementary or alternative method to traditional pN staging when evaluating disease after primary treatment.     

Significance of the mass-compression effect of postlaminectomy/laminotomy fibrosis on histological changes on the dura mater and nerve root of the cauda equina: an experimental study in rats

Purpose The precise mechanism and pathological role of postlaminectomy/laminotomy fibrosis (PLF) in postoperative neurological deficits have not been established. Many studies use magnetic resonance imaging (MRI) to prove that there is no consistent correlation between PLF and postoperative neurological deficits and back pain (PNDBP). Therefore, we assumed that the direct-compression effect may not be the only factor but that other neurological deficits associated with pathological mechanisms should exist and need more investigation. The purpose of this study was to compare over time the differences and changes in histopathological properties of PLF in rats.Methods We used a rat model with walking-track analysis for neurologic evaluation, grading scale to evaluate PLF, histomorphometric measurements of dura sac diameter, and histological tissue reactions (dura mater and spinal rootlets) juxtaposed to the postlaminectomy/laminotomy defect. The 54 adult Sprague–Dawley rats were divided into laminotomy (n = 18), laminectomy (n = 18), and sham-operation groups (n = 18). All groups were subdivided into three equal subgroups based on different postoperative time points (1, 2, and 3 months). All sections of vertebral column were stained with hematoxylin and eosin and with Masson’s trichrome.Results The results showed that only a slight compression effect reflected by nonsignificant changes in the maximum anterior-posterior diameters within the dura sac, in the walking tract test, and increased grades of PLF over time. In addition, significant pathological inflammatory changes, such as thickening of the dura mater, axonal swelling, and neovascularization, were found in the post-laminectomy/laminotomy groups at each time point.Conclusion Laminectomy-/laminotomy-related inflammation may lead to PLF, and these pathological changes may be the main cause of postoperative neurological deficits. These findings show that research on preventing PLF should include perioperative modulation of inflammatory reactions induced by laminectomy/laminotomy.     

模拟高空跳伞着陆状态下踝关节动态角速度与垂直反作用力的测定

 目的 通过模拟高空跳伞着陆训练环境测定不同高度半蹲式跳伞着陆状态下的踝关节角速度、地面垂直反作用力,为预防跳伞着陆踝部损伤提供生物力学依据。方法 募集18名健康志愿者,包括空军地勤人员9名、职业跳伞人员9名。两组受试者身高、体重的差异无统计学意义。受试者分别从30 cm和60 cm高的跳台以半蹲式跳伞着陆并腿姿势跳落到测力台上。高速摄像机记录着陆过程,测定踝关节跖屈角位移及时间、地面垂直反作用力,计算角速度,分析踝关节动态角位移、角速度、垂直作用力与不同高度的相关性。结果 30 cm高度：地勤人员组与跳伞运动员组踝关节角位移分别为25.73°±8.13°、20.05°±12.27°,垂直反作用力分别为（3 372.4±748.6） N、（5 181.5±1 726.2） N,受力时间分别为（0.049±0.015） s、（0.012±0.004） s,缓冲时间分别为（1.397±0.746） s、（1.737±0.451） s,差异均有统计学意义。60 cm高度：地勤人员组与跳伞运动员组踝关节角速度分别为（25.45±15.01） °/s、（16.51±4.18） °/s,垂直反作用力分别为（4 616.0±1124.7） N、（7 119.5±2 307.4） N,受力时间分别为（0.048±0.013） s、（0.015±0.006） s,缓冲时间分别为（0.922±0.347） s、（1.617±0.547） s,差异均有统计学意义。结论 从不同的测试高度跳下,跳伞运动员组的地面垂直反作用力大于地勤人员组,但角速度及角位移小于地勤人员组。对比地勤人员组,跳伞运动员组的受力时间短而缓冲时间更长。     

内镜额部除皱术结合传统切开法除皱的效果

目的探讨内镜除皱术与传统除皱术相结合的治疗方式及效果。方法仅存在额部皱纹、眉间纹及眉下垂者采用内镜额部除皱术,切除或切断皱眉肌、降眉肌和额肌,必要时结合额部皮瓣上提悬吊技术即可;如同时存在中下面部皮肤老化、松弛下垂,则内镜额部除皱术尚需结合传统切开法的中面部或中下面部除皱术,做浅表肌腱膜系统（sMAs）筋膜的折叠或切除缝合,以及多余皮肤的切除剪裁。结果104例采用额部内镜除皱术,均取得良好的除皱和眉提升效果。并发症较少而轻微,包括表情肌去除部位的轻度凹陷、额部皮肤麻木、发际线轻微后移、皱纹去除不彻底等。无面神经颞支损伤等严重并发症发生。其中84例存在中下面部皮肤松弛下垂,在做内镜额部除皱的同时行耳前切口的传统除皱术,明显改善中下面部的皮肤老化,并使面部上下的年轻化协调一致。结论内镜额部除皱术设计合理、操作安全、效果明确,是一项切口小、损伤轻的微创技术,符合整形外科的发展趋势。对于同时存在有中下面部皮肤松弛者,如能结合传统切开法除皱术,面部年轻化的整体效果可进一步优化。     

IL-1β对ATDC5成软骨分化细胞miR-455-3p的影响

目的：检测IL-1β对ATDC5成软骨分化细胞miR-455-3p表达的影响,探索miR-455-3p在骨关节炎中的作用。方法诱导ATDC5细胞成软骨分化后,予10 ng/ml的IL-1β刺激,在刺激4、12、24、48 h时应用实时荧光定量PCR检测miR-455-3p、C/EBPβ和软骨特征性标记物的表达情况;并利用抑制剂IKK-NBD阻断NF-κB通路后,应用实时荧光定量PCR检测IL-1β作用下miR-455-3p的表达水平。结果在IL-1β作用下的ATDC5成软骨分化细胞中miR-455-3p、C/EBPβ和软骨退变标记物（ MMP13、ADAMTS5）均上调,而软骨基质合成标记物（ ACAN、COL2A1、SOX9）则下调,且后期更为明显;而IKK-NBD可抑制IL-1β诱导的miR-455-3p表达。结论 IL-1β可上调ATDC5成软骨分化细胞miR-455-3p的表达水平,且受NF-κB通路的调节。     

分析不同部位的胃癌肿瘤术式选择与预后

目的：分析不同部位的胃癌肿瘤术式选择与预后。方法采用回顾性方法分析,选取自2008年10月至2012年10月以来收治的100例行手术治疗的胃癌患者的临床资料,根据患者实际病症选择相宜手术,其手术方式分别为全胃切除术、联合脏器切除术、姑息切除术。分析手术结果及术后恢复情况。采用SPSS20．0软件分析统计学差异,P＜0．05表示差异有统计学意义。结果本组100例患者自2008年随访至今,47例死亡,8例失访,随访率92．0％。5年总生存率48．9％。上1/3部位、中1/3部位和下1/3部位胃癌患者的中位生存时间分别为30个月、36个月和39个月（χ2＝1．853, P＝0．396）,差异无统计学意义。上1/3、中1/3、下1/3部位胃癌患者的术后并发症发生率分别为16．0％、7．0％、9．4％,上1/3部位胃癌患者的术后并发症发生率明显比中1/3、下1/3部位胃癌患者高,差异具有统计学意义（χ2＝14．692, P＝0．031）。全胃切除术患者的中位生存时间（42．12个月）和联合脏器切除术组（30．80个月）明显高于姑息术组（11．21个月）,差异具有统计学意义（χ2＝8．223, P＝0．016）。全胃切除术组与联合脏器切除术组比较差异不具有统计学意义（χ2＝0．008, P＝0．927）。结论手术的选择还应根据患者实际病症选择适宜的手术方式,全胃切除术其生存时间较长,病死率较低,并发症发生率低。     

CT扫描对复杂性肾结石经皮肾镜取石术后疗效的预测价值

目的探讨cT扫描对复杂性肾结石经皮肾镜取石术（PCNL）后疗效的预测价值。方法对296例接受PCNL治疗复杂性肾结石患者的临床资料进行回顾性研究,分析术前CT扫描相关指标,如HU值、结石大小、结石位置、结石x线通透性等与术后结石清除率的关系,同时对HU值预测复杂性肾结石术后临床疗效进行评价及总结。结果根据结石清除率分组,多因素方差分析发现结石X线通透性、结石位置、HU值以及结石大小等指标均为影响结石清除率的因素（P〈0．05）。利用ROC曲线确定HU值诊断结石完全清除与否的阈值,发现最佳诊断点为688．4,低于此值,结石清除率明显降低。对结石成分与结石清除率的关系进行了探讨,发现含钙结石清除率高于其他成分的结石,但两组之间无统计学差异（P〉0．05）;同时发现HU值与术中出血量之间存在明显的正相关关系（P〈0．05）。结论术前CT扫描明确结石大小、结石位置以及HU值测定对复杂性肾结石PCNL术后临床疗效具有预测价值;术前明确结石的CT表现,采取恰当的手术方式能进一步提高碎石效率。     

腹腔镜下开放鞘状突环扎技术在小儿隐睾手术中的应用：附视频

目的探讨腹腔镜下开放鞘状突（PPV）环扎技术在小儿隐睾手术中的作用。方法回顾分析2008年8月至2012年2月腹腔镜治疗42例小儿隐睾的病例资料,统计PPV和对侧开放鞘状突（CCPV）发生率并予以关闭。观察手术时间、并发症、住院日数等。结果患儿年龄中位数3岁（1-14岁）,术前诊断左侧23例（54．8％）,右侧12例（28．6％）,双侧7例（16．6％）。术中探查PPV发生率73．8％（31／42）,CPPV发生率35．7％（15／42）。术前诊断为单侧隐睾的病例既往有手术史占5．7％（2／35）。腹腔镜下行PPV／CPPV环扎,或缩小患侧内环开口。腹股沟不可触及隐睾超声术前诊断与术中探查结果符合比率64％（29／45）,CT诊断符合比率69．2％（9／13）。手术时间（109．9±51．4）min。住院时间（6．3±3．6）d。术后随访时间为1个月。4年半,中位数时间3年,超声复查无睾丸萎缩、异时疝,无切口疝、肠粘连等。结论腹腔镜下PPV环扎技术应用于小儿隐睾手术,能最大限度保留腹股沟管壁完整性,手术微创、安全、有效。