RESUMEN
Objective:To systematically evaluate whether the early use of bracing after posterior lumbar fusion has advantages in terms of the improvement of clinical outcomes such as pain, functional disability, fusion rate, and complication rate in patients with lumbar degenerative diseases.Methods:All randomized controlled trials of bracing performed after posterior lumbar fusion in patients with lumbar degenerative diseases were searched in Pubmed, Web of Science, Embase, China national knowledge infrastructure (CNKI) and Wanfang database from January 1990 to May 2022. The data extracted were authors, year of publication, nationality, subject characteristics, sample size, surgical protocol, type and time of bracing, follow-up duration, preoperative and postoperative Oswestry disability index (ODI) and visual analogue scale (VAS), postoperative fusion rate and complication rate. The Cochrane Risk of Bias tool was used to evaluate the risk of bias. The use of fix- or random-effect models was depended on the magnitude of heterogeneity. Data analysis was performed using Stata 17.0 statistical software for meta analysis.Results:A total of five randomized controlled trials were included, all in English, with a total of 362 patients (male 144, female 218). The results of meta-analysis showed that there was no statistically significant difference in the improvement of ODI scores [ MD=1.25, 95% CI(-2.39, 4.88), P=0.501]and VAS scores[ MD=0.21, 95% CI(-0.22, 0.63), P=0.340]between the brace group and the control group after operation. In terms of fusion rate, there was no significant difference between the brace group and the control group[ OR=0.59, 95% CI(0.25, 1.38), P=0.224]. In addition, there was also no significant difference in the incidence of postoperative complications between two groups[ OR=1.12, 95% CI(0.58, 2.15), P=0.735]. Conclusion:The early use of bracing after lumbar fusion has no significant advantages in improving symptoms and functional recovery, fusion rate and surgical complications. The necessity of postoperative bracing after posterior lumbar fusion requires further high-quality research to prove.
RESUMEN
Objective:To explore the predictive value of vertebral trabecular and endplate HU values on cage subsidence after posterior lumbar interbody fusion (PLIF), hope to provide reference for surgical planning.Methods:All of 72 patients with lumbar disc herniation that underwent PLIF were retrospectively reviewed, who were divided into two groups according to the occurrence of cage subsidence at one-year follow up. Cage subsidence was defined as more than 4 mm subsidence into the vertebrae valuated by CT at one-year follow up. There were 18 patients enrolled into Subsidence group and 54 patients enrolled into N-Subsidence group. The lumbar lordosis, segmental lordosis, intervertebral height, off-bed time, hospital stay, complications, the trabecular and endplate HU values of upper instrumented vertebrae (UIV) and lower instrumented vertebrae (LIV) were compared between the two groups. ROC was used to explore the thresholds of HU values.Results:There were 14 patients presented cage subsidence into the L4, 4 patients presented cage subsidence into the L5. There was no significant difference in lumbar lordosis, segmental lordosis, intervertebral height, off-bed time, hospital stay, or complications between the two groups. Both UIV and LIV trabecular and endplate showed a lower HU value in Subsidence group than those in N-Subsidence group. The most appropriate thresholds of HU value were 146, 172, 307, 254 for trabecular of UIV, trabecular of LIV, lower endplate of UIV, and upper endplate of LIV, respectively.Conclusion:Vertebral trabecular and endplate HU values could effectively predict the cage subsidence after PLIF, patients should be completely informed the risk of cage subsidence and larger cage should be recommended if they presented HU values under the certain threshold.
RESUMEN
BACKGROUND:Currently, there is no explicit evidence-based medicine evidence to prove the merits or demerits of absorbable materials in the treatment of fractures of the lateral humeral condyle in children. OBJECTIVE:To evaluate the clinical efficacies of open reduction with absorbable material versus open reduction with Kirschner wire fixation for lateral condylar fracture of the humerus in children.METHODS:WanFang, VIP, CNKI, CBMdisc, EMbase, PubMed were retrieved for controlled trials concerning open reduction with absorbable material versus open reduction with Kirschner wire fixation for treating lateral condylar fracture of the humerus in children. After data extraction and quality evaluations, RevMan 5.3 software was used for systematic review. Postoperative functional recovery of the elbow joint, average hospitalization expenses, adverse events, delayed union, postoperative infection, nerve injury and deformity of the elbow were compared in patients undergoing different treatments. RESULTS AND CONCLUSION:A total of seven articles, involving 449 children with lateral condylar fracture of the humerus, were included for this Meta-analysis. Children in test group received open reduction with absorbable material, while those in control group were subjected to open reduction with Kirschner wire fixation. For treating lateral condylar fracture of the humerus in children, no significant inter-group difference existed in the aspects of postoperative functional recovery of the elbow joint [odds ratio (OR)=0.72, 95％ confidence interval (CI) (0.37, 1.41),P=0.34]; postoperative delayed union [OR=0.46, 95％CI(0.16, 1.30),P=0.14]; deformity of the elbow [OR=0.70, 95％CI (0.24, 2.10),P=0.53]. Less adverse events and postoperative infections were observed in the test group compared with the control group [OR=0.17, 95％CI (0.08, 0.38),P < 0.0001;OR=0.09, 95％CI (0.02, 0.38),P=0.001]. However, up to now, we knew of no comparable data concerning average hospitalization expenses and indicators for nerve injury between the two groups. To conclude, compared with Kirschner wire fixation, open reduction with absorbable material can achieve similar effects on lateral condylar fractures of the humerus, but has better effects to prevent adverse events and postoperative infection. Further investigation on large-scale, double-blind, high-quality randomized controlled trials is warranted for confirming our results.
RESUMEN
AIM:To investigate the protein expression of mitogen-activated protein kinase-interacting kinase-2 (Mnk2) and its prognostic effect in the patients with resected esophageal squamous cell carcinoma (ESCC).METHODS:A total of 86 informative patients with surgically resected ESCC and 54 normal esophageal tissues were enrolled .Western blot and immunohistochemistry (IHC) were utilized to assess the protein expression of Mnk 2, and its correlation with prog-nosis was statistically analyzed by the methods of Kaplan-Meier curve and Cox proportional hazard mode .RESULTS:The protein expression of Mnk 2 was elevated in most of tumor tissues compared with the adjacent tissues .Clinicopathologic analysis showed that Mnk2 expression was significantly correlated with the TNM stage (P<0.05).Both disease-free sur-vival ( DFS) and overall survival ( OS) of Mnk2 over-expression patients were shorter than those in Mnk 2 negative expres-sion group.Multivariate analysis confirmed that Mnk2 expression, as an independent and significant factor for both DFS and OS, predicted a poor prognosis of the patients with resected ESCC (P<0.05).CONCLUSION: The expression of Mnk2 was significantly related to the TNM stages , and might be a novel predictor for prognosis in ESCC .
RESUMEN
AIM:To investigate the protein expression of mitogen-activated protein kinase-interacting kinase-2 (Mnk2) and its prognostic effect in the patients with resected esophageal squamous cell carcinoma (ESCC).METHODS:A total of 86 informative patients with surgically resected ESCC and 54 normal esophageal tissues were enrolled .Western blot and immunohistochemistry (IHC) were utilized to assess the protein expression of Mnk 2, and its correlation with prog-nosis was statistically analyzed by the methods of Kaplan-Meier curve and Cox proportional hazard mode .RESULTS:The protein expression of Mnk 2 was elevated in most of tumor tissues compared with the adjacent tissues .Clinicopathologic analysis showed that Mnk2 expression was significantly correlated with the TNM stage (P<0.05).Both disease-free sur-vival ( DFS) and overall survival ( OS) of Mnk2 over-expression patients were shorter than those in Mnk 2 negative expres-sion group.Multivariate analysis confirmed that Mnk2 expression, as an independent and significant factor for both DFS and OS, predicted a poor prognosis of the patients with resected ESCC (P<0.05).CONCLUSION: The expression of Mnk2 was significantly related to the TNM stages , and might be a novel predictor for prognosis in ESCC .
RESUMEN
Objective: To analyze the efficiency of ureteroscope and biopsy in the diagnosis of tumor grade, muscle-invasiveness and multifocality in suspected upper tract urinary carcinoma (UTUC) patients in order to find out whether it can be used in the risk stratification of UTUC patients.Methods: A retrospective study of 76 UTUC patients who underwent preoperative ureteroscope and/or biopsy and received radical nephroureterectomy in Peking University Third Hospital during January 2014 to December 2016 was undertaken.Results: In this study, 76 patients were included.There were 31 males (40.8%), and 45 females (59.2%).The median age was 64.5 years (31-88), and 51 patients had the symptom of hematuresis.The tumor was located in renal pelvis in 39 patients, and in ureter in 37 patients.Post-operative pathology confirmed that all the 76 patients included in this study suffered from UTUC, of whom 21 (21.6%) were of low-grade, 51 (67.1%) were of high-grade, 4 (5.3%) were undetermined, and 47 (61.9%) patients were muscle-invasive, and 27 (35.5%) were not, and 2 (2.6%) were undetermined.Among the 50 patients, in whom the grade of the tumor could be diagnosed by biopsy, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value for low-grade tumor was 88.2%, 69.7%, 76.0%, 60.0% and 92.0%, respectively.Among the 27 patients, in whom the muscle-invasiveness could be diagnosed by biopsy, 5 patients were diagnosed with muscle-invasiveness, all confirmed by pathology after surgery and 22 patients were diagnosed with none muscle-invasiveness, turned out to be 50% muscle-invasive and 50% none-muscle invasive after surgery.The accuracy was 59.3%.The accuracy of ureteroscopic biopsy to diagnosis multifocality was 61.0%.On univariate ana-lysis, biopsy grade was associated with postoperative pathology (P=0.001), while gender, age, side, body mass index (BMI), hematuresis, preoperative estimated glomerular filtration rate (eGFR), hydronephrosis, tumor size, location, multifocality and sessile were not associated with postoperative pathology grade.Biopsy grade (P=0.02), preoperative eGFR<90 mL/(min·1.73 m2)(P=0.025) and tumor located in pelvis (P=0.049) were associated with muscle invasiveness.Gender, age, side, BMI, hematuresis, hydronephrosis, tumor size, multifocality and sessile were not significantly associated with muscle invasiveness.Conclusion: Ureteroscope and biopsy can assist risk stratification in upper tract urothelial carcinoma patients.