Noninvasive in vivo multispectral optoacoustic imaging of apoptosis in triple negative breast cancer using indocyanine green conjugated phosphatidylserine monoclonal antibody.

Noninvasive and nonradioactive imaging modality to track and image apoptosis during chemotherapy of triple negative breast cancer is much needed for an effective treatment plan. Phosphatidylserine (PS) is a biomarker transiently exposed on the outer surface of the cells during apoptosis. Its externalization occurs within a few hours of an apoptotic stimulus by a chemotherapy drug and leads to presentation of millions of phospholipid molecules per apoptotic cell on the cell surface. This makes PS an abundant and accessible target for apoptosis imaging. In the current work, we show that PS monoclonal antibody tagged with indocyanine green (ICG) can help to track and image apoptosis using multispectral optoacoustic tomography

Fusion may not be a necessary procedure for surgically treated burst fractures of the thoracolumbar and lumbar spines: a follow-up of at least ten years.

BACKGROUND: The surgical results of treating thoracolumbar and lumbar burst fractures were reported to be comparable between patients with and without fusion in an intermediate-term follow-up. To our knowledge, no prior report has compared the results of fusion and non-fusion with long-term follow-up. METHODS: This study was designed to provide long-term evaluation of patients with a burst fracture of the thoracolumbar and lumbar spine treated with short-segment fixation who were randomly assigned to a fusion or non-fusion group. Patients older than sixty years of age at the time of injury and those who were lost to follow-up were excluded. Functional outcomes were evaluated using the Greenough Low-Back Outcome Score and the visual analog scale for back pain. Radiographic outcomes were focused on the vertebral body height of the injured vertebra, the kyphotic angle, and the regional segmental motion. RESULTS: Twenty-two patients were enrolled in the non-fusion group, and twenty-four patients were enrolled in the fusion group. The average follow-up period was 134 months (range, 121 to 161 months). The average preoperative kyphotic angle was 16.4° for the non-fusion group and 19.5° for the fusion group. The average postoperative kyphotic angle was 1.5° for the non-fusion group and 4.0° for the fusion group. At the time of the latest follow-up, the average kyphotic angle was 13.8° for the non-fusion group and 14.7° for the fusion group. The average kyphotic angle between the two groups was similar at all follow-up times. A progressive decrease of the kyphotic angle was significant (p < 0.05) with time, regardless of fusion. The radiographic outcomes were similar between these two groups at all follow-up times, as were functional outcomes. More patients in the non-fusion group underwent additional surgery to remove implants. Regional segmental motion was preserved in the non-fusion group, with a mean motion (and standard deviation) of 4.2° ± 1.9°. CONCLUSIONS: The long-term results of short segmental fixation with and without fusion for burst fractures of the thoracolumbar and lumbar spine were comparable. Regional segmental motion could be preserved without fusion, and bone graft donor site complications could be eliminated. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Does the size of the rod affect the surgical results in adolescent idiopathic scoliosis? 5.5-mm versus 6.35-mm rod.

BACKGROUND CONTEXT: Favorable clinical outcomes of surgical treatment with Cotrel-Dubousset instrumentation (CDI) or instrumentations that follow the principles of CDI, for adolescent idiopathic scoliosis (AIS) have been reported. However, there are few studies concerning the results with rods of different sizes. PURPOSE: To find out whether the rod size affects the surgical results for AIS. STUDY DESIGN: A retrospective cohort study based on the same spinal system with different sizes of rod. PATIENT SAMPLE: A consecutive series of 93 patients, who underwent posterior correction with posterior instrumentation and fusion for AIS, were included and retrospectively analyzed. OUTCOME MEASURES: Postoperative radiologic outcomes were evaluated using coronal curves, percentage of curve correction, and coronal global balance. METHODS: Ninety-three patients treated during the period January 2000 to December 2008 were included in this study; 48 patients were treated with the Cotrel-Dubousset Horizon (CDH) M10 system with a 6.35-mm rod from January 2000 through December 2004, and a CDH M8 was used with a 5.5-mm rod in another 45 patients from January 2005 through December 2008. The Cobb angle, Risser grade, coronal curves, flexibility of curve, percentage of curve correction, coronal global balance, operative time, and estimated blood loss were measured and analyzed. The same parameters were used when the patient was followed at the OPD. All of the patients underwent regular follow-up for at least 2 years. RESULTS: No statistical significance was observed in the demographic data, including age, sex, BMI, and Risser grade, between these 2 groups. The overall average percentage of correction was 60.0%±12.7%: 60.7%±12.5% for the CDH M10 group, and 59%±13.1% for the CDH M8 group. At the final follow-up, the overall average loss of correction was 4.8±3.9° for the CDH M10 group, and 4.3±4.0° for the CDH M8 group. The average percentage of correction at the final follow-up was 50.9%±15.1% for the CDH M10 group, and 51.1%±16.1% for the M8 group. No statistical significance could be observed in the radiologic parameters between these 2 groups. CONCLUSION: The radiologic results for the 5.5-mm rod and the 6.35-mm rod were comparable in terms of correction, loss of correction, and coronal global balance.

Surgical results of long posterior fixation with short fusion in the treatment of pyogenic spondylodiscitis of the thoracic and lumbar spine: a retrospective study.

STUDY DESIGN: A single-institution, single-surgeon retrospective review. OBJECTIVE: To evaluate the clinical results of long posterior instrumentation with short posterior or posterolateral fusion for pyogenic spondylodiscitis of the thoracic and lumbar spine retrospectively. SUMMARY OF BACKGROUND DATA: There are controversies concerning the optimal treatment for pyogenic spondylodiscitis, in terms of approach, grafting, and instrumentation. Reports of long posterior fixation with short fusion without debridement of infected tissue for pyogenic spondylodiscitis are rare. METHODS: From June 1997 to June 2007, 48 patients with pyogenic spondylodiscitis were treated. The indications for surgery were neurological compromise, significant vertebral body destruction with kyphosis and segmental instability, failure of medical treatment, and the need for tissue diagnosis. All patients received long posterior instrumentation with or without posterior decompression, depending on whether the patients had neurological deficit. During operation, no debridement of infected tissue was done. Clinical outcomes were assessed using the criteria of Kirkaldy-Willis and the visual analogue scale for pain. The neurological outcome was graded using Frankel grading system. Segmental kyphotic angle and fusion were recorded and analyzed. RESULTS: The average follow-up time was 64 months. The visual analogue scale scores improved from an average of 7.2 before surgery to 2.2 after surgery. Twenty-eight patients with initial neurological impairment had an average improvement of 1.03 grades, using the Frankel grading system, at the final follow-up. The segmental kyphotic deformity improved by an average of 8.5° immediately after operation and lost an average correction of 3.0° at the final follow-up. No relapse of infection was found among these 48 patients. CONCLUSION: The posterior approach with long segmental fixation and short posterior or posterolateral fusion without debridement of the infected tissue was effective for pyogenic spondylodiscitis of the thoracic and lumbar spine.

Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine?: a prospective, randomized study.

STUDY DESIGN: A prospective clinical trial was conducted. OBJECTIVES: To compare the results of fusion versus nonfusion for surgically treated burst fractures of the thoracolumbar and lumbar spine. SUMMARY OF BACKGROUND DATA: The operative results of surgically treated burst fractures with short segmental fixation have been well documented. There is no report comparing the results of fusion and nonfusion. METHODS: Fifty-eight patients were included in this study, with the inclusion criteria as follows: neurologically intact spine with a kyphotic angle > or = 20 degrees, decreased vertebral body height > or = 50% or a canal compromise > or = 50%, incomplete neurologic deficit with a canal compromise 50%, complete neurologic deficit, and multilevel spinal injury or multiple traumas. All patients were randomly assigned to fusion or nonfusion groups, and operative treatment with posterior reduction and instrumentation was carried out. Posterior fusion with autogenous bone graft was performed for the fusion group (n = 30), and no fusion procedure was done for the nonfusion group (n = 28). The average follow-up period was 41 months (range, 24-71 months). RESULTS: The average loss of kyphotic angle was not statistically significant between these 2 groups. The radiographic parameters were statistically significantly better in the nonfusion group, including angular change in the flexion-extension lateral view (4.8 degrees vs. 1.0 degrees), lost correction of decreased vertebral body height (3.6% vs. 8.3%), intraoperative estimated blood loss (303 mL vs. 572 mL), and operative time (162 minutes vs. 224 minutes). The scores on the low back outcome scale were not statistically significant for these 2 groups. CONCLUSIONS: The short-term results of short segmental fixation without fusion for surgically treated burst fractures of the thoracolumbar spine were satisfactory. The advantages of instrumentation without fusion are the elimination of donor site complications, saving more motion segments, and reducing blood loss and operative time.

The measurement of liver blood flow: a review of experimental and clinical methods.

Changes in hepatic blood flow reflect adaptive responses of the liver to injury, regeneration, and the development of disease states. The measurement of hepatic blood flow is, however, technically challenging and although theoretically useful has not become routine in clinical work. The different techniques that have been developed for quantitative measurement of hepatic blood flow require careful interpretation of the results obtained but are frequently applied without careful considerations of their technical limitations. In particular, many noninvasive techniques depend on good hepatocellular function and are thus irrelevant under most clinical conditions. Many other potentially useful techniques are poorly validated and standardized and there is a need for further research into smethodology. This review summarizes the salient technical features of the different techniques for quantitative measurement of hepatic blood flow. The techniques are divided into invasive, minimally invasive, and noninvasive categories and the relevance of each technique to both routine clinical application or research is discussed.

Surgical treatment of adult idiopathic scoliosis - comparison of two instrumentations.

In this study, 22 women patients with adult idiopathic scoliosis treated surgically with Cotrel-Dubousset instrumentation (CDI) or Texas Scottish Rite Hospital instrumentation (TSRHI) were followed up for 56.2+/-4.0 months. The overall immediate and final corrections were respectively 21.5+/-40 (58%) and 26.6+/-2.90 (48%), giving a loss of correction of 5.1+/-1.00 (10%). No significant differences were found in these two parameters between the two groups. The functional outcomes were good in 21 patients. There was no difference between CDI and TSRHI in deformity correction.