[The clinical analysis of instrumentation failure after corrective surgery for thoracolumbar focal kyphosis]

OBJECTIVE

To analyze the etiology of instrumentation failure after corrective surgery for thoracolumbar focal kyphosis, and make suggestion for treatment.

METHODS

Retrospective study for 8 patients with thoracolumbar focal kyphosis who underwent surgical treatment and suffered instrumentation failure from June 2005 to December 2011 was made. The surgical procedures included pedicle subtraction osteotomy (PSO), anterior opening-posterior closing osteotomy and correction (AOPC), and posterior vertebral column resection (VCR). The reasons of instrumentation failure were analyzed and revision surgeries were performed.

RESULTS

The incidence of instrumentation failure was 6.3%. The average occurrence time was 22.5 months after surgery. Except one had failure in 3 months after surgery, all cases happened after 1 year. In this series, there were 5 cases with post-tuberculosis, 2 cases with post-traumatic kyphosis and 1 case with congenital kyphosis. For the surgical procedure, 7 cases underwent VCR and 1 case AOPC. After the instrumentation failure, all cases had back pain, and 3 of them had combined neurological symptoms. The reasons or risk factors of instrumentation failure included non-fusion of bone graft, VCR procedure, sink of the titanium mesh, insufficiency of anchor sites, and more severe kyphosis. All the 8 cases were treated with revision surgery and got good results.

CONCLUSIONS

The instrumentation failure of thoracolumbar focal kyphosis is relatively late occurred, and can develop with various reasons. Positive revision surgery is suggested for the instrumentation failure, and good results can be expected.

Breast cancer incidence and mortality: trends over 40 years among women in Shanghai, China

BACKGROUND

Breast cancer incidence rates are increasing among Asian women, likely due to the changes in risk factors caused by globalization. Trends in breast cancer rates among Chinese women may differ from other Asian regions due to the implementation of a nationwide family planning program and resulting changes in women's reproductive practices. Appraisal of cancer trends can direct cancer control and public health planning, but relevant studies in China are scarce due to a lack of long-term data. We sought to evaluate secular time trends in breast cancer incidence and mortality using 40 years of cancer registry data for women in urban Shanghai.

MATERIALS AND METHODS

Data on invasive breast cancer incidence and mortality were collected by the Shanghai Cancer Registry. Age-standardized rates (ASRs) for incidence and mortality were calculated using the Segi/Doll 1960 world standard population. Age, period, and birth cohort effects were evaluated using age-period-cohort (APC) Poisson regression models. Overall linear trends, interpreted as the estimated annual percentage change (EAPC), were derived from the net drift in age-drift models.

RESULTS

A total of 53 885 breast cancer cases and 17 235 breast cancer-specific deaths were documented among women in urban Shanghai between 1 January 1973 and 31 December 2012. Breast cancer incidence and mortality ASRs increased by 141.2% and 26.6%, respectively. Significant age, cohort, and period effects were identified in both incidence and mortality APC models; cohort effects were pronounced. Overall, a substantial increase in breast cancer incidence (EAPC = 2.96%/year) and a moderate increase in breast cancer mortality (EAPC = 0.87%/year) was observed. A notable downward trend in mortality was identified among younger women born after 1960.

CONCLUSIONS

Forty years of cancer registry data document a tremendous increase in incidence and a slight increase in mortality for breast cancer among women in Shanghai. Effective, appropriate, and affordable breast cancer prevention and control strategies are urgently needed in China.

Knockdown of linc-UFC1 suppresses proliferation and induces apoptosis of colorectal cancer

Long intergenic noncoding RNAs (lincRNAs) have important roles in biological functions, molecular mechanisms and prognostic values in colorectal cancer (CRC). In this context, the roles of linc-UFC1 remain to be elucidated. In this study, linc-UFC1 was overexpressed in CRC patient tissues and positively correlated with tumor grade, N stage and M stage. Inhibition of linc-UFC1 resulted in cell proliferation inhibition and G1 cell cycle arrest, which was mediated by cyclin D1, CDK4, Rb and phosphorylated Rb. In addition, inhibition of linc-UFC1 induced cell apoptosis through the intrinsic apoptosis signaling pathway, as evidenced by the activation of caspase-9 and caspase-3. An investigation of the signaling pathway revealed that the effects on proliferation and apoptosis following linc-UFC1 knockdown were mediated by suppression of β-catenin and activation of phosphorylated P38. Furthermore, the P38 inhibitor SB203580 could attenuate the apoptotic effect achieved by linc-UFC1 knockdown, confirming the involvement of P38 signaling in the induced apoptosis. Taken together, linc-UFC1 might have a critical role in pro-proliferation and anti-apoptosis in CRC by regulating the cell cycle, intrinsic apoptosis, and β-catenin and P38 signaling. Thus, linc-UFC1 could be a potential therapeutic target and novel molecular biomarker for CRC.

In kidney transplant recipients with BK polyomavirus infection, early BK nephropathy, microvascular inflammation, and serum creatinine are risk factors for graft loss

BACKGROUND

Little information is available on the risk factors for graft loss in kidney transplant recipients with BK polyomavirus (BKPyV) nephropathy (BKVN) in the presence or absence of antibody-mediated rejection (AMR).

METHODS

We examined the risk factors for graft loss in consecutive kidney allograft recipients with biopsy-confirmed BKVN, with or without concomitant AMR.

RESULTS

A total of 1904 kidney transplants were performed at our institution during 2005-2011. Of these, 330 (17.33%) were diagnosed with BKPyV viremia, and 69 were diagnosed with BKVN (3.6%). Eleven patients had a concomitant diagnosis of AMR. Patients with AMR were characterized by significantly higher peak panel-reactive antibody, retransplant rates, and desensitization preconditioning at the time of transplantation, as well as microvascular inflammation (MVI = glomerulitis + peritubular capillaritis), C4d score, and donor-specific antibody at the time of diagnosis (P ≤ 0.01). Treatment with plasma exchange, intravenous immunoglobulin, and cidofovir was more prevalent in this group (P ≤ 0.02). Univariate analyses assessing the risk factors for graft loss in all patients with BKVN, identified an independent association of African-American race, deceased-donor transplantation, serum creatinine (Scr), MVI, and early disease (BKVN within 6 months of transplant) with poor outcomes. Multivariate analyses retained only 3 variables: Scr >2 mg/dL (hazard ratio [HR] = 4.3, 95% confidence interval [CI] 1.9-9.7, P = 0.0004), early BKVN (HR = 2.7, 95% CI 1.3-5.3, P = 0.004), and MVI (HR = 1.8, 95% CI 1.2-2.8, P = 0.008).

CONCLUSIONS

These observations suggest that, in patients with BK infection, early BKVN, Scr >2, and MVI are predictors of poor outcomes. Further studies are needed to determine effective treatment strategies for BKVN, with or without AMR.

Expression of transforming growth factor-β1 in neonatal rats with hyperoxia-induced bronchopulmonary dysplasia and its relationship with lung development

The aim of this study was to detect the expression of transforming growth factor-ß1 (TGF-ß1) in neonatal rats with hyperoxia-induced bronchopulmonary dysplasia (BPD) and to explore its relationship with lung development. Forty-eight rats (2-3 days old) were randomly divided into a hyperoxia group and a control group (N = 24) which were then fed in ≥95% oxygen atmosphere and air, respectively. On the 1st, 3rd and 7th days of hyperoxia exposure, morphological changes of lung tissues were observed under an optical microscope. TGF-ß1 mRNA and protein levels in lung tissues were detected by real-time quantitative polymerase chain reaction and western blot, respectively. With increasing time of hyperoxia exposure, the hyperoxia group gradually suffered from pathological changes such as poor development of lung tissues, alveolar simplification, decrease in the number of alveoli, and hindered pulmonary microvascular development. On the 7th day of hyperoxia exposure, TGF-ß1 mRNA and protein levels (relative to b-actin) of the hyperoxia group (0.34 ± 0.19 and 0.21 ± 0.09, respectively) were significantly lower than those of the control group (0.83 ± 0.45 and 0.57 ± 0.45, respectively; P < 0.05). TGF-ß1 participates in the pathogenesis of BPD as an important regulatory factor during pulmonary vascular development.

The role of middle calyx puncture in percutaneous nephrolithotomy: relative factors and choice considerations

Percutaneous nephrolithotomy (PCNL) is a well established procedure for management of renal calculi. It is generally believed that the access to the renal pelvic system via the desired calyx is the most crucial step during the whole procedure. The adequacy of the access directly influences the success and complication rates of PCNL. Traditionally, a lower pole access was routinely performed for less complication. Upper calices are also preferred for access in a given condition with large and complex calculi. However, the middle calices access is seldom selected. In aim to provide the reader some advantages of middle pole approach and a broaden horizon in determining the strategy of renal puncture, the present review describes the anatomical basis of the percutaneous tract. It provides a literature review of the success rate and efficiency of middle calyx access alone with the advantage of this approach, especially in dealing with large and complex stones.

Large-Scale and Selective Synthesis of Carbon Nanofiber Bundles, Curved Carbon Nanofibers and Helical Carbon Nanofibers

Through the pyrolysis of acetylene at 250 °C, large quantities of carbon nanofiber bundles (CNFBs), curved carbon nanofibers (CCNFs) and helical carbon nanofibers (HCNFs) can be synthesized selectively by controlling the Fe:Cu molar ratio of Fe-Cu nanoparticles. In this study, the systematic experimental results indicated that the Cu content in the Fe-Cu nanoparticles and pyrolysis temperature had great impact on the yield and structure of the final samples. Moreover, the transmission electron microscopic observation indicated that the catalyst nanoparticles were enwrapped tightly by graphite layers, and the obtained HCNFs show good magnetic property. Compared to the methods reported in the literature, the approach described herein has the advantages of being simple, low-cost, and environment-friendly. It is suitable for the controllable and mass production of CNFBs, CCNFs and HCNFs.

Mussel-inspired nanofibrous sheet for suture-less stomach incision surgery

We report a dopamine-based crosslinker-conjugated gelatin/polycaprolactone nanofibrous sheet. The nanosheet was then employed to treat stomach incisions without sutures during surgery.

Effect of HGF on the apoptosis of rat corpus cavernosum smooth muscle cells induced by TGFβ1

Corpus cavernosum smooth muscle cells (CCSMCs) are important functional cells for penile erection. We evaluated the effect of transforming growth factor β1 (TGFβ1) and hepatocyte growth factor (HGF) on the viability and apoptosis of CCSMCs in vitro. CCSMCs from healthy male Sprague Dawley rats were randomly divided into four groups: a negative control group, a TGFβ1 group, a HGF group and a HGF+ TGFβ1 group. Differences in cell viability and apoptosis among groups were observed by 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay and flow cytometry. Western blot was used to detect the change of apoptosis-related proteins. The level of reactive oxygen species (ROS) was detected by colorimetry. In the TGFβ1 group, the MTT values were obviously decreased at 12 h, 24 h, 48 h-0.320, 0.383 and 0.432 respectively. However, compared with the normal group, the apoptosis index was markedly increased, reaching 26.86% at the 48-h time point. After TGFβ1 treatment, the levels of cleaved caspase-3 and p-Smad2 were increased in the cells, but the levels of Bcl-xL, Bcl-2 and p-Akt were significantly lower. However, HGF co-treatment partially reversed these changes and could decrease the intracellular ROS level while increasing the Akt phosphorylation level. These results indicate that TGFβ1 might induce apoptosis of CCSMCs in vitro and that HGF could interfere with the above process through downregulation of apoptosis signalling and oxidative stress reaction.

Effect of supplementation of organic manganese on reproductive performance of female Ussuri raccoon dogs (Nyctereutes procyonoides) during the breeding season

The study was conducted to investigate the effect of dietary manganese (Mn) on reproductive performance of female Ussuri raccoon dogs (Nyctereutes procyonoides) during the breeding season. Healthy female Ussuri raccoon dogs (n=72) were randomly divided into six groups of twelve each. The six experimental diets were formulated to contain graded amounts of Mn (0, 40, 80, 120, 200 and 400mg/kg of diet; Groups A through F, respectively). Litter size of Group D was greater than that of Groups A, B, C and E (P<0.05), with Group E having the smallest litter size. Values of number born alive were affected by different amounts of organic Mn. Number of pups born alive in Group D was greater than that of Groups B, C, E and F (P<0.05). Number of pups weaned alive for Group D was greater than that of Groups A, B, C and E (P<0.05). Mn supplementation of the control diet (containing 24.32 mg/kg from raw materials) with 120 mg/kg of Mn was adequate for female Ussuri raccoon dogs during the breeding season, based on positive effects of reproduction performance.

Characterization of transfusion-elicited acute antibody-mediated rejection in a rat model of kidney transplantation

Animal models of antibody-mediated rejection (ABMR) may provide important evidence supporting proof of concept. We elicited donor-specific antibodies (DSA) by transfusion of donor blood (Brown Norway RT1(n) ) into a complete mismatch recipient (Lewis RT1(l) ) 3 weeks prior to kidney transplantation. Sensitized recipients had increased anti-donor splenocyte IgG1, IgG2b and IgG2c DSA 1 week after transplantation. Histopathology was consistent with ABMR characterized by diffuse peritubular capillary C4d and moderate microvascular inflammation with peritubular capillaritis + glomerulitis > 2. Immunofluorescence studies of kidney allograft tissue demonstrated a greater CD68/CD3 ratio in sensitized animals, primarily of the M1 (pro-inflammatory) phenotype, consistent with cytokine gene analyses that demonstrated a predominant T helper (TH )1 (interferon-γ, IL-2) profile. Immunoblot analyses confirmed the activation of the M1 macrophage phenotype as interferon regulatory factor 5, inducible nitric oxide synthase and phagocytic NADPH oxidase 2 were significantly up-regulated. Clinical biopsy samples in sensitized patients with acute ABMR confirmed the dominance of M1 macrophage phenotype in humans. Despite the absence of tubulitis, we were unable to exclude the effects of T cell-mediated rejection. These studies suggest that M1 macrophages and TH 1 cytokines play an important role in the pathogenesis of acute mixed rejection in sensitized allograft recipients.

The expression and significance of TIPE2 in peripheral blood mononuclear cells from asthmatic children

Tumour necrosis factor-α-induced protein-8 like-2 (TIPE2) is a newly identified immune negative regulator. The abnormal expression of TIPE2 has been found in several human inflammatory diseases. However, the expression level and clinical significance of TIPE2 in childhood asthma remain unclear. In this study, we detected TIPE2 expression in peripheral blood mononuclear cells (PBMC) from 42 children with asthma and 39 healthy controls by RT-PCR, qRT-PCR and Western blot. We also detected the levels of serum total immunoglobulin E (IgE), eosinophil (EO), interleukin-4 (IL-4) and interferon-γ (IFN-γ) and analysed the correlations of TIPE2 expression with IgE, EO, IL-4 and IFN-γ. The results showed that TIPE2 mRNA and protein expression were decreased in children with asthma compared with healthy controls. The levels of IgE, EO and IL-4 in the children with asthma were obviously higher than those in normal controls, while the level of IFN-γ in patients with asthma was significantly lower than that in healthy subjects. Furthermore, the expression level of TIPE2 mRNA was negatively correlated with IgE, EO and IL-4. However, no statistically significant correlation was found between TIPE2 mRNA expression and serum IFN-γ level. In conclusion, our data suggest that reduced TIPE2 expression may contribute to the pathogenesis of childhood asthma.

Diagnosis and management of antibody-mediated rejection: current status and novel approaches

Advances in multimodal immunotherapy have significantly reduced acute rejection rates and substantially improved 1-year graft survival following renal transplantation. However, long-term (10-year) survival rates have stagnated over the past decade. Recent studies indicate that antibody-mediated rejection (ABMR) is among the most important barriers to improving long-term outcomes. Improved understanding of the roles of acute and chronic ABMR has evolved in recent years following major progress in the technical ability to detect and quantify recipient anti-HLA antibody production. Additionally, new knowledge of the immunobiology of B cells and plasma cells that pertains to allograft rejection and tolerance has emerged. Still, questions regarding the classification of ABMR, the precision of diagnostic approaches, and the efficacy of various strategies for managing affected patients abound. This review article provides an overview of current thinking and research surrounding the pathophysiology and diagnosis of ABMR, ABMR-related outcomes, ABMR prevention and treatment, as well as possible future directions in treatment.

Effects of Different Treatment Options on the Prognosis of Wasp Stings

Introduction

Severe wasp sting injuries often threaten patient's life. We compared the effects of three different therapies on the prognosis of wasp stung patients.

Methods

We conducted a randomised single-blind controlled trial. Patients stung by wasp were randomly assigned to one of the three treatment groups: group A received symptomatic treatment; those complicated with acute renal failure and haemolysis also received haemoperfusion combined with haemodialysis; for patients with severe haemolytic anaemia, plasmapheresis were applied; for patients with haemodynamic instability, continuous renal replacement therapy was used. Group B received intravenous methylprednisolone injection, 80 mg/d for continuous 3 days in addition to the symptomatic therapy; for patients with haemolysis, methylprednisolone 0.5 g/d was injected intravenously for 3-5 days. For group C, in addition to all treatments administrated to group B patients, subcutaneous injection of 0.5 ml 0.1% epinephrine was given immediately after admission. Primary endpoint was mortality. Major complications (gastrointestinal haemorrhage, toxic encephalopathy, haemolysis, and acute left ventricular failure) and serum enzyme spectrum elevate (alanine aminotransferase [ALT], creatine kinase [CK] isoenzyme and serum creatinine) were secondary endpoints.

Results

Of 134 patients recruited, 45, 44 and 45 patients were assigned to group A, B or C respectively. Therapy in group C reduced mortality compared with group A and B (respectively 24.4%, 9.09%, 0.00% for group A, B, C respectively; p<0.001); there was no significant effects on major complications among three groups (p >0.1). The incidence of elevated ALT was significantly lower in group B and group C than in group A (p<0.001). The incidence of elevated CK isoenzyme was significantly lower in group C than in group A and group B (p<0.001).

Conclusions

For patients with concurrent organ impairment by wasp sting, early combination of epinephrine and methylprednisolone with supportive treatment with renal replacement therapy can effectively reduce the incidence of organ damage and mortality. (Hong Kong j.emerg.med. 2013;20:270-275)

1,25(OH)2D3 suppresses COX-2 up-regulation and thromboxane production in placental trophoblast cells in response to hypoxic stimulation

In this study, we determined if vitamin D could inhibit oxidative stress-induced thromboxane production by placental trophoblasts. Trophoblast isolated from normal placentas were stimulated with CoCl2, a hypoxic mimicking agent, with or without pretreatment of 1,25(OH)2D3. Soluble phospholipase-A2, metabolites of thromboxane-A2 and prostacyclin, and 8-isoprostane were measured. Expression of cyclooxygenase-1 (COX-1), COX-2, and heme oxygenase-1 (HO-1) were determined. We found that pretreatment of trophoblasts with 1,25(OH)2D3 significantly reduced 8-isoprostane and the ratio of thromboxane-A2 to prostacyclin production, and blocked COX-2 expression induced by CoCl2. These results provide evidence of the beneficial effects of vitamin D on placental trophoblasts.

Asymmetric dimethylarginine attenuates serum starvation-induced apoptosis via suppression of the Fas (APO-1/CD95)/JNK (SAPK) pathway

Asymmetric dimethylarginine (ADMA) is synthesized by protein arginine methyltransferases during methylation of protein arginine residues and released into blood upon proteolysis. Higher concentrations of ADMA in blood have been observed in patients with metabolic diseases and certain cancers. However, the role of ADMA in colon cancer has not been well investigated. ADMA serum levels in human patients diagnosed with colon cancer were found to be higher than those present in healthy subjects. ADMA treatment of LoVo cells, a human colon adenocarcinoma cell line, attenuated serum starvation-induced apoptosis and suppressed the activation of the Fas (APO-1/CD95)/JNK (SAPK) (c-Jun N terminal protein kinase/stress-activated protein kinase)pathway. ADMA also suppressed the activation of JNK triggered by death receptor ligand anti-Fas mAb and exogenous C₂-ceramide. Moreover, we demonstrated that ADMA pretreatment protected LoVo cells from doxorubicin hydrochloride-induced cell death and activation of the Fas/JNK pathway. In summary, our results suggest that the elevated ADMA in colon cancer patients may contribute to the blocking of apoptosis of cancer cells in response to stress and chemotherapy.