Restoration of thoracic kyphosis by simultaneous translation on two rods for adolescent idiopathic scoliosis

Introduction

Sagittal and axial corrections of the three-dimensional deformity characteristic of scoliosis remain challenging.

Materials and Method

The author developed a new technique for scoliosis correction consisting of the translation of vertebrae simultaneously towards two rods, which are pre-bent to the correct sagittal profile. Using two rods ensures both reduction and stabilization of the curve. The system includes stable anchorages with polyaxial-threaded extensions that connect to the rods. Deformity reduction is done by tightening nuts simultaneously and progressively on the two rods. Results demonstrate the efficiency of this technique to achieve normal thoracic kyphosis (>20°) in all 99 patients, with a mean gain of 19° of thoracic kyphosis in hypokyphotic cases. Coronal correction was 70−80 % with a vertebral rotation gain of 40 % where derotation connectors were used.

Conclusions

In a large consecutive series of patients, this new technique allows to achieve a good 3D correction of the scoliosis.

     

French Spine Surgery Society guidelines for management of spinal surgeries during COVID-19 pandemic

Since the outbreak of coronavirus disease 2019 (COVID-19) in December 2019 in China, various measures have been adopted in order to attenuate the impact of the virus on the population. With regard to spine surgery, French physicians are devoted to take place in the national plan against COVID-19, the French Spine Surgery Society therefore decided to elaborate specific guidelines for management of spinal disorders during COVID-19 pandemic in order to prioritize management of patients. A three levels stratification was elaborated with Level I: Urgent surgical indications, Level II: Surgical indications associated to a potential loss of chance for the patient and Level III: Non-urgent surgical indications. We also report French experience in a COVID-19 cluster region illustrated by two clinical cases. We hope that the guidelines formulated by the French Spine Surgery Society and the experience of spine surgeons from a cluster region will be helpful in order optimizing the management of patients with urgent spinal conditions during the pandemic.     

Colorimetric capnography to ensure correct nasogastric tube position

Purpose

We evaluate a procedure, combining colorimetric capnography with epigastric auscultation, to ensure nasogastric (NG) feeding tube correct position without any radiograph.

Methods

We first evaluated the accuracy of colorimetric capnography in detecting tracheal positioning in a control group of 100 mechanically ventilated patients. The procedure was thereafter evaluated in a study group including patients requiring an NG tube. The NG tube was first inserted 30 cm and connected to a colorimetric capnograph (first step). If the capnograph did not detect carbon dioxide, insertion was completed to a total distance of 50 cm. An epigastric auscultation after air insufflation and a second capnography (second step) were performed. A radiograph evaluated correct tube position.

Results

In the control group, colorimetric capnograph sensitivity to detect tracheal placement was 100%. In the study group, negative predictive value of first-step capnography to rule out tracheobronchial insertion was 100%. The association of a first-step negative capnography with a positive epigastric auscultation correctly identified all but one gastric insertions, yielding a sensitivity of 98.5% (95% confidence interval, 95.7-100). The positive predictive value of this association to detect gastric placement was 100%.

Conclusion

Colorimetric capnography combined with epigastric auscultation is safe and accurate in ensuring correct gastric tube insertion.     

Broad and specific caspase inhibitor-induced acute repression of apoptosis in atherosclerotic lesions evaluated by radiolabeled annexin A5 imaging.

OBJECTIVES: The purpose of this study was to evaluate the role of caspase inhibitors on acute resolution of apoptosis in atherosclerotic lesions as evaluated by imaging with annexin A5. BACKGROUND: Extensive apoptosis of macrophages has been reported at the site of plaque rupture in patients dying of acute coronary syndrome. METHODS: Of 31 New Zealand White atherosclerotic rabbits, 6 received broad caspase, 3 received caspase-1, 3 received caspase-3, 3 received caspase-8, and 4 received caspase-9 inhibitors; 12 animals did not receive any caspase inhibitors (treatment control group). Six unmanipulated rabbits were used for comparison (disease control group). Technetium-99m-labeled annexin A5 was used for imaging atherosclerotic lesions; 6 of the 12 uninhibited atherosclerotic rabbits received (99m)Tc-labeled mutant annexin A5 (radiotracer control group). Gamma images were obtained, and quantitative radiotracer uptake was compared with pathologic findings. RESULTS: Atherosclerotic lesions were best visible in untreated atherosclerotic rabbits. Quantitative annexin uptake, defined as the percent of injected dose per g of abdominal aorta tissue, was significantly higher in untreated atherosclerotic animals (mean +/- SD = 0.0515 +/- 0.0099) compared with the normal rabbits (0.0065 +/- 0.0008; p < 0.0001) or atherosclerotic rabbits receiving mutant annexin (0.014 +/- 0.0024; p < 0.0001). Among all caspase inhibitor-treated rabbits, uptake was 39% lower (0.0314 +/- 0.0151) than in untreated atherosclerotic animals (p < 0.01). Uptake was also significantly lower in rabbits receiving broad caspase (0.0206 +/- 0.0058; p < 0.0001) or caspase-1, -3, or -9 (0.0272 +/- 0.0088, p < 0.01; 0.0286 +/- 0.0095, p < 0.01; 0.0300 +/- 0.0021, p < 0.01, respectively) inhibitors. Caspase-8 inhibitor did not affect apoptosis (0.0618 +/- 0.0047; p = NS). Upon histologic characterization, a substantial decrease in macrophage apoptosis was observed in caspase-inhibited animals. CONCLUSIONS: Molecular imaging, using radiolabeled annexin A5, allows the detection of acute resolution of apoptosis as a result of caspase inhibition in experimental atherosclerosis. If proven clinically, this may allow development of novel intervention strategies in acute vascular events.