A matched-pair comparison between bilateral intrafascial and interfascial nerve-sparing techniques in extraperitoneal laparoscopic radical prostatectomy

The aim of this study was to validate the advantages of the intrafascial nerve-sparing technique compared with the interfascial nerve-sparing technique in extraperitoneal laparoscopic radical prostatectomy. From March 2010 to August 2011, 65 patients with localized prostate cancer (PCa) underwent bilateral intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. These patients were matched in a 1∶2 ratio to 130 patients with localized PCa who had undergone bilateral interfascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy between January 2008 and August 2011. Operative data and oncological and functional results of both groups were compared. There was no difference in operative data, pathological stages and overall rates of positive surgical margins between the groups. There were 9 and 13 patients lost to follow-up in the intrafascial group and interfascial group, respectively. The intrafascial technique provided earlier recovery of continence at both 3 and 6 months than the interfascial technique. Equal results in terms of continence were found in both groups at 12 months. Better rates of potency at 6 months and 12 months were found in younger patients (age ≤65 years) and overall patients who had undergone the intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. Biochemical progression-free survival rates 1 year postoperatively were similar in both groups. Using strict indications, compared with the interfascial nerve-sparing technique, the intrafascial technique provided similar operative outcomes and short-term oncological results, quicker recovery of continence and better potency. The intrafascial nerve-sparing technique is recommended as a preferred approach for young PCa patients who are clinical stages cT1 to cT2a and have normal preoperative potency.     

关节镜技术和三柱锁定钢板固定治疗胫骨平台骨折

目的探讨关节镜技术和三柱锁定钢板治疗胫骨平台骨折的临床效果。方法采用关节镜技术和三柱锁定钢板固定治疗51例胫骨平台骨折,SehatzkerI～Ⅲ型35例,Ⅳ一Ⅵ型16例;其中,胫骨髁间嵴骨折并前交叉韧带损伤8例,后交叉韧带止点撕脱骨折8例,半月板损伤5例。结果本组随访12～24个月,平均13．6个月。膝关节功能参照Rasmussen评分：优24例,良20例,可6例,差1例,优良率达86．3％。无切口坏死,无固定失败及骨外露发生。有1例伤口感染。结论采用关节镜技术和三柱锁定钢板固定各种胫骨平台骨折是一种可靠方法。     

Anti‐fibrosis effect of BMP‐7 peptide functionalization on cobalt chromium alloy

Orthopedic metallic prosthetic implants are commonly made of cobalt chromium (CoCr) alloys. However, such metal‐based implants are susceptible to fibrous capsule formation on the implant surface after implantation. At the bone‐implant interface, this capsule can prevent implant integration, resulting in loosening and failure. Minimizing the development of such a capsule on the CoCr surface would improve direct bone‐implant bonding leading to long‐term implant functionality. We evaluated the anti‐fibrosis effect of bone morphogenic protein‐7 (BMP‐7) peptide covalently bonded to CoCr alloy. This peptide, a biomimetic derivation of the knuckle epitope of BMP‐7, was conjugated at the N‐terminus with a cysteine amino acid. X‐ray photoelectron spectroscopy (XPS) and probe binding assay were used to evaluate different stages of grafting and surface functionalization using polydopamine coating. Cellular functions were studied using fibroblast attachment, cell proliferation, and MTT assays. Fibroblasts were grown on functionalized and pristine CoCr substrates, and the efficacy of BMP‐7 peptide on anti‐fibrosis was analyzed via gene expression and protein expression of fibrosis markers ACTA2, Collagen 1A1, and fibronectin. The peptide functionalized substrates showed significant reduction of fibrosis markers expression after 1 week of incubation compared to controls. BMP‐7 signaling pathway activation was shown by the presence of phosphorylation of Smad1/5/8. These findings may contribute to the improvement of CoCr implants in orthopedic surgery applications. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 983–990, 2013     

Comparison of High Tibial Osteotomy and Unicompartmental Knee Arthroplasty in the Treatment of Unicompartmental Osteoarthritis : A Meta-Analysis

We conducted a systematic review of comparative clinical trials assessing the results of high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) in patients with strictly unilateral osteoarthritis of the knee. A literature search was conducted through Medline, Embase and Cochrane library. A total of 11 comparative studies were included. Pooled results showed: UKA showed significantly better results compared to HTO in terms of function results, however, no difference in specific knee score was observed; HTO got slightly better results of the range of motion; a trend towards an increased velocity was found in UKA without significant difference. Postoperative rate of revision and complications did not differ significantly between two groups. With the correct patient selection, both HTO and UKA show effective and reliable results.     

Prognostic study of sevoflurane-based general anesthesia on cognitive function in children

Purpose

It is unclear whether volatile general anesthetics have sustained adverse effects on the immature brains of children. We performed a self-controlled study to evaluate the effects of strabismus surgery under sevoflurane-based general anesthesia on the cognitive function of pediatric patients.

Methods

The study included 100 children of ages 4 to 7 years old scheduled to undergo strabismus correction under sevoflurane-based general anesthesia. Cognitive function was tested 1 day before the operation (T1), 1 month after the operation (T2), and 6 months after the operation by the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) (Third Edition) method, which consists of 150 items. The scores at T1 were compared with scores at T2 and T3.

Results

Seventy-two children completed the three tests. At T1, they were 66.1 ± 7.7 months old and had a mean body weight of 21.6 ± 4.0 kg. The mean anesthesia time was 67.3 ± 9.8 min. The mean interval between T1 and T2 was 25.4 ± 6.8 days, and that between T1 and T3 was 182.1 ± 27.7 days. No statistically significant decrease in WPPSI scores was observed between T1 and T2, or between T1 and T3.

Conclusion

These findings from our self-controlled study show that sevoflurane-based general anesthesia does not have significantly adverse effects on the cognitive function of 4- to 7-year-old children at 1 month and 6 months after strabismus surgery. Additional studies with a larger sample size are needed.     

Mid-term results of Bernese periacetabular osteotomy for developmental dysplasia of hip in middle aged patients

Purpose

To address the question, compared to having hip replacement with latent revision, does Bernese periacetabular osteotomy (PAO) before primary hip replacement occupy a preferable treatment strategy for middle aged (aged 35–54 years) hip dysplasia patients? We assessed the mid-term functional outcome and survivorship of PAO in those patients.

Methods

Forty-one hips in 36 patients at middle age at the time of surgery (mean age, 39.5 years; range, 35–47 years) were retrospectively identified out of a total PAO cohort of 315 patients. Eleven of the 41 PAO hips also underwent osteochondroplasty at the femoral head-neck junction. Radiographic parameters of lateral centre edge angle, anterior centre edge angle and hip joint medialisation were investigated using the Harris Hip Score (HHS).

Results

The average follow-up was 5.1 years (range, two to ten years). Radiographic parameters postoperatively improved into the normal range, whereas no progression was found from preoperative Tonnis osteoarthritis score. Forty hips survived at the last follow-up, with HHS Score improved from 63.7 to 88.4. Compared to the sole PAO group, both postoperative alpha angle and range of joint motion improved in the PAO combined with osteochondroplasty group. However, no difference in HHS score was found.

Conclusions

Good survivorship and improved joint function were identified in middle-aged Chinese patients following PAO with or without osteochondroplasty. We prudently suggest PAO as an alternative strategy for treating DDH in those patients.     

Neoadjuvant chemotherapy with gemcitabine/cisplatin vs. methotrexate/vinblastine/doxorubicin/cisplatin for muscle-invasive urothelial carcinoma of the bladder: A retrospective analysis from the University of Southern California

ObjectivesWe evaluated pathologic and survival outcomes of GC (gemcitabine/cisplatin) and methotrexate/vinblastine/doxorubicin/cisplatin (M-VAC) neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC).Materials and methodsA retrospective analysis of prospectively collected data on 116 patients who received NAC (GC: n = 58; M-VAC: n = 58) before radical cystectomy and superextended pelvic lymph node dissection for clinical stage T2-4N0M0 bladder cancer was performed. The outcomes were complete response rate (CRR; pT0N0), partial response rate (PRR; pT0N0, pTaN0, pT1N0, or pTisN0), overall mortality (OM), and recurrence. The Kaplan-Meier method and multivariable Cox regression analysis were used to analyze OM. The cumulative incidence method and Fine and Gray's competing risk regression analysis were used to analyze recurrence.ResultsThe median follow-up duration was 2.1 years for the GC group and 7.4 years for the M-VAC group (P < 0.001). There were no statistically significant differences between the GC and M-VAC groups with regard to CRR (27.3% vs. 17.1%, P = 0.419) or PRR (45.5% vs. 37.1%, P = 0.498). The predicted 5-year freedom from OM rate (P = 0.634) and cumulative incidence of recurrence rate (P = 0.891) did not differ between the GC and M-VAC groups. Multivariable analysis showed that there was no independent association between type of NAC and OM (P = 0.721) or recurrence (P = 0.065).ConclusionsPathologic and survival outcomes did not differ in patients who received GC and M-VAC NAC. These data support the use of the GC regimen in the neoadjuvant setting.     

Direct Bladder Stimulation with Percutaneous Electrodes and Impedance Monitoring of Volume in an SCI Animal Model

Abstract

Bladder responses to percutaneous electrodes were investigated with stimulation in three male spinal cats. The animals had been spinalized (T1 level lesion) 10 weeks prior to these studies and had been instrumented with chronic bladder wall electrodes and suprapubic bladder catheters for filling and pressure recording. Percutaneous stimulation in tethered animals was conducted with hook electrodes inserted with a needle in the abdomen bilaterally adjacent to the bladder trigone. Stimulation was conducted with 40 Hz pulse trains of 10 to 30 mA for three seconds. Stimulation with both percutaneous and chronic electrodes induced high bladder pressures and voiding. In addition, with chronically implanted electrodes, impedance monitoring of bladder volume was found to be an effective recording technique. (J Spinal Cord Med; 18:98–102)