A Novel Transforaminal Approach to Presacral Abscess.

BACKGROUND: Presacral abscess is a common disease in the developing countries. Treatments include minimally invasive percutaneous drainage and open surgical debridement. Percutaneous drainage under computed tomography (CT) guidance has been recommended by the American College of Radiology as a good alternative to surgical drainage before elective surgical treatment. Because of the many anatomic obstacles, the presacral space can be one of the most difficult locations to access. There are several reported access routes like transabdominal, transgluteal, transvaginal, transperineal, transanal, precoccygeal, transpedicular, and so on. We introduce a novel approach, the trans-sacral-foramen approach, to drain presacral abscess under CT guidance. METHODS: A 47-year-old woman who had lumbar laminectomy debridement for epidural abscess was diagnosed with residual presacral abscess. She was placed in the prone position. One-step technique was applied. Intermittent CT scans were obtained during drainage catheter (8F) advancement into the sacral posterior foramen. The stylet was withdrawn and an approximately 60° angle for catheter trajectory was used to best reach the sacral anterior foramen due to the inherent pelvic tilt. When the catheter tip reached the presacral abscess, the abscess cavity was aspirated with a syringe, pus was drained, and catheter was fixed to skin. Sensitive antibiotics were administered. RESULTS: After 2 weeks magnetic resonance imaging (MRI) showed significant reduced abscess and the catheters were removed. At 18-month follow-up, MRI showed intervertebral fusion at the lumbosacral segment. CONCLUSIONS: Trans-sacral-foramen approach is the shortest path to reach the presacral abscess. The approach is easier and safer than the others for patients with indication.

Reactive arthritis after COVID-19 vaccination.

The severe acute respiratory syndrome coronavirus 2-induced coronavirus disease 2019 (COVID-19) has had a global spread. Vaccines play an essential role in preventing the spread. However, almost all types of vaccines have been reported to be associated with adverse events. Reactive arthritis (ReA) after vaccination has been reported; however, ReA after COVID-19 vaccination has not been reported. We reported a 23-year-old woman who suffered from an acute ReA on her left knee joint after COVID-19 vaccination and discussed the etiology and preventive strategy. She presented with swollen, painful left knee joint for 18 d. She had been inoculated 0.5 ml CoronaVac vaccine on 0 d and the 14th day with deltoid intramuscular injection. Finally, she was diagnosed as ReA after CoronaVac vaccination and was administered a single intra-articular injection of 1 ml compound betamethasone. The swelling and pain nearly disappeared after 2 d. On 1month follow-up, her condition was normal. ReA after COVID-19 vaccination is rare. The benefits of vaccination far outweigh its potential risks and vaccination should be administered according to the current recommendations. Further attentions should be put to determine which individual is at higher risk for developing autoimmune diseases after COVID-19 vaccination. More versatile and safer vaccines should be explored.

Targeted knockdown of IQGAP1 inhibits the progression of esophageal squamous cell carcinoma in vitro and in vivo.

IQGAP1 is a scaffolding protein that can regulate several distinct signaling pathways. The accumulating evidence has demonstrated that IQGAP1 plays an important role in tumorigenesis and tumor progression. However, the function of IQGAP1 in esophageal squamous cell carcinoma (ESCC) has not been thoroughly investigated. In the present study, we showed that IQGAP1 was overexpressed in ESCC tumor tissues, and its overexpression was correlated with the invasion depth of ESCC. Importantly, by using RNA interference (RNAi) technology we successfully silenced IQGAP1 gene in two ESCC cell lines, EC9706 and KYSE150, and for the first time found that suppressing IQGAP1 expression not only obviously reduced the tumor cell growth, migration and invasion in vitro but also markedly inhibited the tumor growth, invasion, lymph node and lung metastasis in xenograft mice. Furthermore, Knockdown of IQGAP1 expression in ESCC cell lines led to a reversion of epithelial to mesenchymal transition (EMT) progress. These results suggest that IQGAP1 plays crucial roles in regulating ESCC occurrence and progression. IQGAP1 silencing may therefore develop into a promising novel anticancer therapy.