Thoracolumbar spinal tuberculosis in children with severe post-tubercular kyphotic deformities treated by single-stage closing–opening wedge osteotomy: preliminary report a 4-year follow-up of 12 patients

Purpose

The correction of severe post-tubercular kyphosis (PTK) is complex and has the disadvantage of being multistaged with a high morbidity. In this study, we evaluated the outcomes of children who underwent single-stage closing–opening wedge osteotomy as a surgical treatment of PTK of the thoracolumbar spine.

Method

Our study group included 12 children with thoracolumbar PTK (seven boys and five girls) with an average age of 9.4 years (range 6–12 years), who were treated at our institution from January 2004 to October 2009. The American Spinal Injury Association Impairment Scale and visual analog scale score were used to classify neurologic function. All patients underwent halo-pelvic traction before surgery and were treated with single-stage closing–opening wedge osteotomy.

Result

The duration of surgery averaged 99 min (range 70–150 min). Average blood loss was 782 ml (range 560–1,200 ml), and the average length of hospital stay was 12 days (range 8–16 days). The neurological function of all patients improved significantly after the procedure. The mean preoperative kyphotic angle was 83.3° (range 59–118°), which had reduced to 27.6° (range 20–38°) at the final follow-up visit. All patients had solid fusion, and no major complications were observed through the final follow-up visit.

Conclusion

Single-stage closing–opening wedge osteotomy is an effective method to correct severe thoracolumbar PTK. A main advantage of the procedure is that it is a posterior-only, single-staged surgery, allowing for significant correction with minimal complications.     

mir-300 Promotes Self-Renewal and Inhibits the Differentiation of Glioma Stem-Like Cells

MicroRNAs (miRNAs) are small noncoding RNAs that have been critically implicated in several human cancers. miRNAs are thought to participate in various biological processes, including proliferation, cell cycle, apoptosis, and even the regulation of the stemness properties of cancer stem cells. In this study, we explore the potential role of miR-300 in glioma stem-like cells (GSLCs). We isolated GSLCs from glioma biopsy specimens and identified the stemness properties of the cells through neurosphere formation assays, multilineage differentiation ability analysis, and immunofluorescence analysis of glioma stem cell markers. We found that miR-300 is commonly upregulated in glioma tissues, and the expression of miR-300 was higher in GSLCs. The results of functional experiments demonstrated that miR-300 can enhance the self-renewal of GSLCs and reduce differentiation toward both astrocyte and neural fates. In addition, LZTS2 is a direct target of miR-300. In conclusion, our results demonstrate the critical role of miR-300 in GSLCs and its functions in LZTS2 inhibition and describe a new approach for the molecular regulation of tumor stem cells.     

Is wound drainage necessary in hip arthroplasty? A meta-analysis of randomized controlled trials

Purpose

The use of closed suction drainage systems for hip arthroplasty (HA) is a common practice. However, the effectiveness and safety are still questionable. Thus, the aim of this meta-analysis was to review the advantages and adverse effects of closed suction drainage systems in hip arthroplasty.

Methods

All randomized or quasi-randomized trials comparing the use of closed suction drainage systems with no drainage systems for hip arthroplasty were searched in PubMed, Medicine, EMBASE and other internet databases. We assessed the methodological quality of the studies and abstracted the relevant data independently.

Results

Sixteen studies involving 1,663 participants with surgical wounds comparing HA with and without the use of drainage were included in our analysis. Our results demonstrated blood transfusion was required more frequently the same as the persistent discharge in those who received drains. No significant differences in the incidence of wound hematoma, dehiscence or deep vein thrombosis were found between those allocated to drains and the non-drained wounds. Wound infection and the range of movement of the joint after surgery were similar between the two groups.

Conclusions

Based on the current evidence, there is insufficient evidence to support the routine use of closed suction drainage in hip arthroplasty. At the same time, our meta-analysis study suggested that using of closed suction drainage in HA increased requirement for postoperative blood transfusion. However, there is a moderate possibility of selection bias and publication bias in this review. Because of the limited number of studies which may weaken the strength of the evidence of our results, more samples, high-quality randomized trials are needed to increase the reliability of evidences.

Level of evidence

II.     

全胃多发类癌一例

1 临床资料 患者女,46岁。因进食后腹胀小适1年余,期间无腹痛、恶心、呕吐、反酸、暖气、呕血、黑便等症状,于当地乡镇卫生院就诊,行上消化道钡餐造影检查,诊断为慢性萎缩性胃炎,给予促胃肠动力、抑酸、保护胃黏膜等保守治疗后症状缓解。此后反复发作腹胀不适,为求进一步诊断与治疗患者于2012年8月28日来我院普通外科就诊。患者自述慢性萎缩性胃炎病史10余年、体格检查：胸部和腹部均无阳性体征。     

脑卒中患者步行功能的恢复

目的：探讨康复治疗对脑卒中患者行步功能恢复的影响，方法：采用以Ｂｏｂａｔｈ和Ｂｒｕｎｎｓｔｒｏｍ方法为主的康复治疗技术，并配合传统按摩疗法和功能性电刺激，对急性脑卒中患者进行了临床对照性研究，对恢复期患者进行了临床观察。结果康复治疗后，病程在１个月的患者的独立步行恢复率为７２．００％，与对照组（１４．７１％）相比差异显著（Ｐ〈０．００１）；恢复早期（病后１～３月）患者的独立步行恢复率为７７．７８％     

家庭肠内营养对改善晚期胃癌患者生活质量的应用价值

目的研究家庭肠内营养（HEN）对晚期胃癌患者改善生活质量的意义。方法回顾性分析浙江省人民医院胃肠外科2010年6月1日至2012年6月1日连续收治的60例无法手术切除及复发转移的晚期胃癌患者的病历资料,根据是否进行HEN分为肠内营养（EN）组（25例）和对照组（35例）。EN组营养支持方式包括经空肠造瘘管EN、经鼻胃肠管完全或部分EN;对照组中存在胃癌伴梗阻的患者进行全肠外营养（TPN）,其余患者完全经口饮食。在持续1年的随访过程中,分别于第1、3、6和12月进行Kamofsky评分和Spitzer指数测定。第6月时行EORTCQLQ—c30评分。全组患者均接受FLOFOX4方案（奥沙利铂、四氢叶酸钙、氟尿嘧啶）静脉化疗。结果两组患者在基线资料方面差异无统计学意义。1年随访期间,两组共有53例患者死亡,其中EN组21例,对照组32例。KamoHky评分结果显示,EN组在第3、6、12月的评分结果分别为平均57．4、39．6和28．2,明显优于对照组的平均45．3、29．2和20．1（分别为P=0．041、P=0．012和P=0．015）。Spitzer评分结果显示,EN组在第3、6、12月的评分结果分别为5．12、4．04和2．54,也明显优于对照组的4．32、3．21和1．97（分别为P=0．048、P=0．035和P=0．024）。EROTCQLQ-30评分结果显示,EN组在功能量表方面同样均明显优于对照组（均P〈0．05）,“呼吸费力”、“疼痛”和“疲劳”阳性症状较对照组轻（分别为P=0．025、P=0．044和P=0．016）;但“腹泻”症状较对照组明显（P=0．047）。结论HEN作为一项营养干预措施,能在有限的生存期内改善晚期胃癌患者的生活质量。     

CD147-CD98hc Complex Contributes to Poor Prognosis of Non-Small Cell Lung Cancer Patients Through Promoting Cell Proliferation Via the PI3K/Akt Signaling Pathway

Background

It has been reported that CD147 and CD98 heavy chain (CD98hc) form a complex on the cell plasma membrane of several cancers; however, whether this complex exists in non-small cell lung cancer (NSCLC) cells and affects the prognosis of patients remains to be elucidated.

Methods

The expression of CD147 and CD98hc was assessed in tissue samples from 241 NSCLC patients and NSCLC cell lines. The correlation between CD147 and CD98hc expression and their association with the prognosis of NSCLC patients were analyzed. We also evaluated the impact of CD147 and CD98hc on the growth of NSCLC cells as well as Akt phosphorylation.

Results

Both CD147 and CD98hc were significantly upregulated in NSCLC cells, and their expression levels were significantly correlated (p < 0.001). Immunoflurenece staining and co-immunoprecipitation demonstrated that CD147 and CD98hc could form a complex on NSCLC cells. Compared with NSCLC patients with CD147?/CD98hc?, those with CD147+/CD98hc+ exhibited a significantly poor overall survival (OS) with a hazard ratio (HR) of 1.92 (p = 0.010), and a significantly increased risk of recurrence with a HR of 1.97 (p = 0.004). Also, we demonstrated that the proliferation of lung cancer cell lines was significantly affected by knockdown and force-expression of the CD147-CD98hc complex. Western blot analysis indicated that the phosphorylation of Akt in NSCLC cells was significantly affected by knockdown and overexpression of either or both CD147 and CD98hc.

Conclusions

Our findings indicate that the CD147-CD98hc complex significantly contributes to poor prognosis of NSCLC patients through promoting cell proliferation via the PI3K/Akt pathway.