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David JJ, Kannan B, Pandi C, Jayaseelan VP, Vasagam JM, Arumugam P. Increased SEC14L2 expression is associated with clinicopathological features and worse prognosis in oral squamous cell carcinoma. Odontology 2024; 112:1326-1334. [PMID: 38575815 DOI: 10.1007/s10266-024-00929-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
Abnormal expression of SEC14L2 has been implicated in many human cancers. However, the role of SEC14L2 in oral squamous cell carcinoma (OSCC) remains unclear. Therefore, this study aimed to evaluate the expression and prognostic roles of SEC14L2 in OSCC. OSCC tumors and adjacent non-tumors were collected from OSCC patients and used for SEC14L2 mRNA expression by quantitative reverse transcription PCR (RT-qPCR). Additionally, the expression of SEC14L2 was further analyzed using The Cancer Genome Atlas-Head Neck Squamous Cell Carcinoma (TCGA-HNSCC) dataset to identify its relationship with HNSCC clinical characteristics. The Kaplan-Meier plot was used to assess survival rates, and the Tumor Immune Estimation Resource (TIMER) database was used to examine the correlation between SEC14L2 expression and tumor immune cell infiltration. In silico tools also looked at SEC14L2 involvement in cancer pathways through its protein network. The mRNA and protein levels of SEC14L2 are notably higher in both OSCC and HNSCC tissues compared to adjacent normal tissues. Upregulation of SEC14L2 was associated with advanced tumor stages, grades, metastasis, HPV-negative, and TP53 mutations in cancer patients. In addition, the high expression of SEC14L2 was negatively correlated with the poor survival of cancer patients and the infiltration of diverse immune cells in cancer patients. According to the findings of this investigation, SEC14L2 is significantly elevated in OSCC/HNSCC patients and associated with a worse prognosis. More investigation and clinical studies are required to completely understand the therapeutic potential of SEC14L2 in HNSCC and convert these findings into better patient outcomes.
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Affiliation(s)
- Jonah Justin David
- Department of Periodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
| | - Balachander Kannan
- Molecular Biology Laboratory, Centre for Cellular and Molecular Research, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, 600077, India
| | - Chandra Pandi
- Molecular Biology Laboratory, Centre for Cellular and Molecular Research, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, 600077, India
| | - Vijayashree Priyadharsini Jayaseelan
- Clinical Genetics Laboratory, Centre for Cellular and Molecular Research, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
| | - Jeevitha Manicka Vasagam
- Department of Periodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
| | - Paramasivam Arumugam
- Molecular Biology Laboratory, Centre for Cellular and Molecular Research, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, 600077, India.
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Chen W, Zhang R, Jia S, Cui Y, Zhao K, Wang T, Lv H, Zhu Y, Tian H, Wang B, Li J, Wang T, Lyu SR, Wang J, Zhang Y. Proximal tibia osteotomy with absorbable spacer combined with fibular osteotomy versus high tibial osteotomy for medial compartmental knee osteoarthritis. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05808-8. [PMID: 37074375 DOI: 10.1007/s00264-023-05808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 03/30/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE The study aimed to compare the perioperative complications, short-term clinical outcomes, patient-reported outcomes, and radiographic parameters of tibiofibular proximal osteotomy combined with absorbable spacer insertion (TPOASI) and open-wedge high tibial osteotomy (OWHTO) in a two year postoperative time period. METHODS A total of 160 patients with Kellgren-Lawrence classification grade 3 medial compartmental knee OA were randomized to receive either TPOASI (n = 82) or OWHTO (n = 78). The primary and secondary outcomes were measured preoperatively, postoperatively, and at each follow-up examination. The primary outcomes were the between-group change in the Western Ontario and McMaster Universities Global score (WOMAC). Secondary measures included visual analog scale (VAS), radiographic parameters, American Knee Society Score (KSS), operation time, blood loss, length of incision, hospital stay, and relevant complications. Postoperative radiographic parameters, including the femorotibial angle (FTA), varus angle (VA), and joint line convergence angle (JLCA), were measured to evaluate the correction of varus deformity. RESULTS No significant differences were found in the baseline data between the two groups. Both methods improved functional status and pain postoperatively. For primary outcomes of both groups, statistical difference was observed in WOMAC scores at the 6-month follow-up (P < 0.001). For secondary outcomes, no statistical difference was observed between the groups during the 2-year follow-up (P > 0.05). For TPOASI vs. OWHTO, the mean hospital stay (6.6 ± 1.3 days vs. 7.8 ± 2.1 days) was shorter (P < 0.001), and both blood loss (70.56 ± 35.58 vs. 174.00 ± 66.33 mL) and complication rate (3.7% vs. 12.8%) were significantly lower (P < 0.005 for both). CONCLUSIONS Both approaches showed satisfactory functional outcomes and alleviated pain. However, TPOASI is a simple, feasible method with few complications, and it could be widely used.
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Affiliation(s)
- Wei Chen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- NHC Key Laboratory of Intelligent Orthopedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Ruipeng Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- NHC Key Laboratory of Intelligent Orthopedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Siming Jia
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- NHC Key Laboratory of Intelligent Orthopedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Yunwei Cui
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- NHC Key Laboratory of Intelligent Orthopedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Kuo Zhao
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- NHC Key Laboratory of Intelligent Orthopedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Tianrui Wang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- NHC Key Laboratory of Intelligent Orthopedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
- Department of Orthopedic Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, 266003, Shandong, People's Republic of China
| | - Hongzhi Lv
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- NHC Key Laboratory of Intelligent Orthopedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- NHC Key Laboratory of Intelligent Orthopedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Hongtao Tian
- Department of Orthopedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Bo Wang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- NHC Key Laboratory of Intelligent Orthopedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Jidong Li
- Department of Orthopedic Surgery, Jingxing Xian Hospital, No. 20 Jianshe South Road, Jingxing, 050300, China
| | - Tonglin Wang
- Department of Orthopedic Surgery, Lincheng People's Hospital, No. 86 Linquan Road, Lincheng, 054399, China
| | - Shaw-Ruey Lyu
- International Health Promotion Center of the Knee Tzu-Chi Dalin General Hospital, Min-Shen Road, Dalin, Chiayi, Taiwan, 222
| | - Juan Wang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
- NHC Key Laboratory of Intelligent Orthopedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China.
| | - Yingze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
- NHC Key Laboratory of Intelligent Orthopedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China.
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Lyu SR, Hsu CC, Hung JP. Medial abrasion syndrome: a neglected cause of persistent pain after knee arthroplasty. J Orthop Surg Res 2021; 16:61. [PMID: 33468201 PMCID: PMC7814453 DOI: 10.1186/s13018-020-02191-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/28/2020] [Indexed: 12/27/2022] Open
Abstract
Introduction Persistent post-operative pain (PPOP) has detracted from some otherwise successful knee arthroplasties. This study investigated medial abrasion syndrome (MAS) as a cause of PPOP after knee arthroplasty. The surgical techniques and outcomes of incorporating this concept into the management of both primary arthroplasty cases and patients suffering from unknown causes of PPOP after arthroplasties were presented. Materials and methods In a 1-year period, the author performed unicompartmental or total knee arthroplasty (the UKA or TKA group) that also eliminated medial abrasion phenomenon (MAP) on 196 knees of 150 patients at advanced stages of knee osteoarthritis (OA). During the same year, 16 knees of 16 patients with unknown causes of PPOP after knee arthroplasties were referred to the author for the arthroscopic medial release procedure (the AMR group) after being diagnosed as MAS. Subjective satisfaction, Knee Society Score (KSS), and Knee injury and Osteoarthritis Outcome Score (KOOS) evaluations were used for outcome study. Results All 166 patients were followed for more than 3 years (mean 3.7 years, 3.1–4.2) for the outcome study. All knees receiving arthroplasty showed medial plicae with MAP at the time of surgery. Only 2 of them suffered from PPOP: one was a neglected tibial plateau fracture with residual varus deformity after UKA, and the other was a late infection after TKA and received revision. The satisfactory rate was 98.8% in the UKA group, 99.1% in the TKA group, and 100% in the AMR group. The Knee Society Scores and all subscales of KOOS were statistically improved in all groups. Conclusions MAS is a cause of pain in patients who have received knee arthroplasties, and MAP should be eliminated to ensure a successful knee arthroplasty. PPOP after knee arthroplasty can be caused by MAS, which can be managed by AMR. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-020-02191-7.
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Affiliation(s)
- Shaw-Ruey Lyu
- Joint Center, Dalin Tzu Chi General Hospital, Chiayi, Taiwan. .,Tzu Chi University, Hualien City, Taiwan.
| | - Chia-Chen Hsu
- Joint Center, Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Jung-Pin Hung
- Joint Center, Dalin Tzu Chi General Hospital, Chiayi, Taiwan
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Miyoshi Y, Kondo Y, Suzuki H, Fukuda T, Yasuda H, Yokobori S. Effects of hypertonic saline versus mannitol in patients with traumatic brain injury in prehospital, emergency department, and intensive care unit settings: a systematic review and meta-analysis. J Intensive Care 2020; 8:61. [PMID: 32817796 PMCID: PMC7425012 DOI: 10.1186/s40560-020-00476-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/28/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Intracranial pressure control has long been recognized as an important requirement for patients with severe traumatic brain injury. Hypertonic saline has drawn attention as an alternative to mannitol in this setting. The aim of this study was to assess the effects of hypertonic saline versus mannitol on clinical outcomes in patients with traumatic brain injury in prehospital, emergency department, and intensive care unit settings by systematically reviewing the literature and synthesizing the evidence from randomized controlled trials. METHODS We searched the MEDLINE database, the Cochrane Central Register of Controlled Trials, and the Igaku Chuo Zasshi (ICHUSHI) Web database with no date restrictions. We selected randomized controlled trials in which the clinical outcomes of adult patients with traumatic brain injury were compared between hypertonic saline and mannitol strategies. Two investigators independently screened the search results and conducted the data extraction. The primary outcome was all-cause mortality. The secondary outcomes were 90-day and 180-day mortality, good neurological outcomes, reduction in intracranial pressure, and serum sodium level. Random effects estimators with weights calculated by the inverse variance method were used to determine the pooled risk ratios. RESULTS A total of 125 patients from four randomized trials were included, and all the studies were conducted in the intensive care unit. Among 105 patients from three trials that evaluated the primary outcome, 50 patients were assigned to the hypertonic saline group and 55 patients were assigned to the mannitol group. During the observation period, death was observed for 16 patients in the hypertonic saline group (32.0%) and 21 patients in the mannitol group (38.2%). The risks were not significant between the two infusion strategies (pooled risk ratio, 0.82; 95% confidence interval, 0.49-1.37). There were also no significant differences between the two groups in the other secondary outcomes. However, the certainty of the evidence was rated very low for all outcomes. CONCLUSIONS Our findings revealed no significant difference in the all-cause mortality rates between patients receiving hypertonic saline or mannitol to control intracranial pressure. Further investigation is warranted because we only included a limited number of studies.
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Affiliation(s)
- Yukari Miyoshi
- Department of Emergency and Critical care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021 Japan
| | - Yutaka Kondo
- Department of Emergency and Critical care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021 Japan
| | - Hidetaka Suzuki
- Emergency and Critical Care Center, Japanese Red Cross Musashino Hospital, Musashino, Japan
| | - Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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Zusman BE, Kochanek PM, Jha RM. Cerebral Edema in Traumatic Brain Injury: a Historical Framework for Current Therapy. Curr Treat Options Neurol 2020; 22:9. [PMID: 34177248 PMCID: PMC8223756 DOI: 10.1007/s11940-020-0614-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE OF REVIEW The purposes of this narrative review are to (1) summarize a contemporary view of cerebral edema pathophysiology, (2) present a synopsis of current management strategies in the context of their historical roots (many of which date back multiple centuries), and (3) discuss contributions of key molecular pathways to overlapping edema endophenotypes. This may facilitate identification of important therapeutic targets. RECENT FINDINGS Cerebral edema and resultant intracranial hypertension are major contributors to morbidity and mortality following traumatic brain injury. Although Starling forces are physical drivers of edema based on differences in intravascular vs extracellular hydrostatic and oncotic pressures, the molecular pathophysiology underlying cerebral edema is complex and remains incompletely understood. Current management protocols are guided by intracranial pressure measurements, an imperfect proxy for cerebral edema. These include decompressive craniectomy, external ventricular drainage, hyperosmolar therapy, hypothermia, and sedation. Results of contemporary clinical trials assessing these treatments are summarized, with an emphasis on the gap between intermediate measures of edema and meaningful clinical outcomes. This is followed by a brief statement summarizing the most recent guidelines from the Brain Trauma Foundation (4th edition). While many molecular mechanisms and networks contributing to cerebral edema after TBI are still being elucidated, we highlight some promising molecular mechanism-based targets based on recent research including SUR1-TRPM4, NKCC1, AQP4, and AVP1. SUMMARY This review outlines the origins of our understanding of cerebral edema, chronicles the history behind many current treatment approaches, and discusses promising molecular mechanism-based targeted treatments.
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Affiliation(s)
- Benjamin E. Zusman
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Institute for Clinical Research Education, University of Pittsburgh, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Patrick M. Kochanek
- Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Children’s Hospital of Pittsburgh, UPMC, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, John G. Rangos Research Center, Pittsburgh, PA, USA
| | - Ruchira M. Jha
- Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, John G. Rangos Research Center, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Zhang R, Li S, Yin Y, Guo J, Chen W, Hou Z, Zhang Y. Open-Wedge HTO with Absorbable β-TCP/PLGA Spacer Implantation and Proximal Fibular Osteotomy for Medial Compartmental Knee Osteoarthritis: New Technique Presentation. J INVEST SURG 2019; 34:653-661. [PMID: 31588821 DOI: 10.1080/08941939.2019.1670296] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Ruipeng Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Shilun Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Yingchao Yin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Jialiang Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Wei Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
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Gu J, Huang H, Huang Y, Sun H, Xu H. Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomized controlled trials. Neurosurg Rev 2019; 42:499-509. [PMID: 29905883 DOI: 10.1007/s10143-018-0991-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/05/2018] [Accepted: 06/04/2018] [Indexed: 02/05/2023]
Abstract
Hyperosmolar therapy is regarded as the mainstay for treatment of elevated intracranial pressure (ICP) in traumatic brain injury (TBI). This still has been disputed as application of hypertonic saline (HS) or mannitol for treating patients with severe TBI. Thus, this meta-analysis was performed to further compare the advantages and disadvantages of mannitol with HS for treating elevated ICP after TBI. We conducted a systematic search on PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Wan Fang Data, VIP Data, SinoMed, and China National Knowledge Infrastructure (CNKI) databases. Studies were included or not based on the quality assessment by the Jadad scale and selection criteria. Twelve RCTs with 438 patients were enrolled for the meta-analysis. The comparison of HS and mannitol indicated that they were close in field of improving function outcome (RR = 1.17, 95% CI 0.89 to 1.54, p = 0.258) and reducing intracranial pressure (MD = - 0.16, 95% CI: - 0.59 to 0.27, p = 0.473) and mortality (RR = 0.78, 95% CI 0.53 to 1.16, p = 0.216). The pooled relative risk of successful ICP control was 1.06 (95% CI: 1.00 to 1.13, p = 0.044), demonstrating that HS was more effective than mannitol in ICP management. Both serum sodium (WMD = 5.30, 95% CI: 4.37 to 6.22, p < 0.001) and osmolality (WMD = 3.03, 95% CI: 0.18 to 5.88, p = 0.037) were increased after injection of hypertonic saline. The results do not lend a specific recommendation to select hypertonic saline or mannitol as a first-line for the patients with elevated ICP caused by TBI. However, for the refractory intracranial hypertension, hypertonic saline seems to be preferred.
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Affiliation(s)
- Jiajie Gu
- College of Medicine, Shantou University, Shantou, Guangdong, China
| | - Haoping Huang
- College of Medicine, Shantou University, Shantou, Guangdong, China
| | - Yuejun Huang
- Transforming Medical Center, Second Affiliated Hospital of Medical College of Shantou University, North Dongxia Rd, Shantou, 515041, Guangdong, China
| | - Haitao Sun
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Hongwu Xu
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Changping Rd, Shantou, 515041, Guangdong, China.
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WU TSUNGCHIAO, YEN CHUANHSIN, LYU SHAWRUEY, HUNG SHUOSUEI. MODIFICATION IN FOOT PRESSURE AND GAIT PATTERN AFTER ARTHROSCOPIC CARTILAGE REGENERATION FACILITATING PROCEDURES (ACRFP) IN PATIENTS WITH OSTEOARTHRITIS OF KNEE. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419400268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Arthroscopic cartilage regeneration facilitating procedure (ACRFP) has been reported with satisfactory results, yet there is limited research on the biomechanics in these patients. The purpose of this study is to assess the change on the biomechanics after ACRFP, in terms of foot pressure and gait pattern. Patients with chronic knee pain due to osteoarthritis and received ACRFP were recruited, and the knee joints in each patient were divided into either study or control group according to radiographical or symptomatic severity. Assessments were done with Knee injury and Osteoarthritis Outcome Score (KOOS) and dynamic foot pressure at the time before surgery, three months and six months postoperatively. A total of 24 patients completed the study. Significant improvement was found of KOOS, at both three and six months postoperatively. No much change in the gait parameters was noted, but there was a significant decrease of foot pressure over lateral side of hindfoot at six months postoperatively. In conclusion, significant clinical improvements could be achieved with surgical results of ACRFP, and shifting of the foot pressure medially may be related to decrease in the knee adduction moment, which is more favorable for the knee joints.
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Affiliation(s)
- TSUNG-CHIAO WU
- Department of Orthopedics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd, Xindian Dist. New Taipei City 23142, Taiwan
| | - CHUAN-HSIN YEN
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei, 112 Taiwan
| | - SHAW-RUEY LYU
- Joint Center, Dalin Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation Road, Dalin Town, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, No. 701, Sec. 3, Jhongyang Rd. Hualien 97004, Taiwan
| | - SHUO-SUEI HUNG
- Department of Orthopedics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd, Xindian Dist. New Taipei City 23142, Taiwan
- School of Medicine, Tzu Chi University, No. 701, Sec. 3, Jhongyang Rd. Hualien 97004, Taiwan
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Medical image analysis of knee joint lipoma arborescens and arthroscopic treatment. Comput Med Imaging Graph 2018; 66:66-72. [PMID: 29567561 DOI: 10.1016/j.compmedimag.2018.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/03/2018] [Accepted: 01/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Arthroscopy is a minimally invasive surgical procedure on a joint in which examination and treatment of knee damage is performed using a surgical device known as the arthroscope. Lipoma arborescens (LA), an infrequent intra-articular lesion, originates from mature adipose cells under subsynovial tissue. The synovial membrane is pale yellow with large villous projections. It is caused by various underlying factors. We found many patients with LA and processed them appropriately.The research was implemented to investigate therapeutic effect of semi-automated arthroscopic diagnosis and treatment for knee joint. METHODS We used the Stryker arthroscopic in surgery that is 4 mm in diameter with angle at 30°. Patients were chosen by biomechanical analysis and scanning mode. All of the patients underwent radiographic imaging examination, Magnetic Resonance Imaging (MRI), Lysholm Score and Visual Analogue Scale (VAS). Arthroscopic limited synovectomy was carried out on these patients. RESULTS The wound of all patients healed up. The content of follow-up includes: chief complaints, range of motion of knee joint, Visual Analogue Scale (VAS) and Lysholm score. No swollen nor effusion of the infected knee was found in all patients during the follow-up. The postoperative symptom was markedly alleviated in fourteen patients and partially alleviated in one. All patients were satisfied with the therapeutic effect. CONCLUSION We performed biomechanical analysis based on knee slight flexion and extension. Arthroscopy is an endoscope for the diagnosis and treatment of joint diseases. Semi-automated arthroscopic debridement is good for early and mid-term osteoarthritis with Lipoma arborescens.
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Abstract
Noise in the knee joint is a common symptom that often leads to outpatient clinic visits. However, there have been no previous review articles regarding noise around the knee despite its high prevalence. We will review the noise characteristics according to sound nature and onset as well as factors for differentiation between physiological and pathological noises. In addition, we will describe causes of the physiological and pathological noises and management of noise in the knee. An appropriate review of the characteristics of noise, its pathophysiology, and factors for differentiation between physiological and pathological noises can facilitate patient guidance. It is important to differentiate between physiological noise and pathologic noise. In most cases, noise after surgery is simply the perception of noise that had been present previously due to emotional concerns. Minor problems associated with surgery, such as postoperative noise, can decrease patient satisfaction, especially among patients with high expectations. Following surgical principles and providing accurate information about physiological noise can decrease the risk of both pathological noise and patient dissatisfaction. In total knee arthroplasty, every attempt should be made to avoid patellar crepitus and clunk by using modern prostheses with proper patellofemoral conformity and by avoiding surgical errors.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Cheol Hee Park
- Department of Orthopedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hu Liang
- Department of Orthopedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sang Jun Kim
- Department of Orthopedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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Da Dalt L, Parri N, Amigoni A, Nocerino A, Selmin F, Manara R, Perretta P, Vardeu MP, Bressan S. Italian guidelines on the assessment and management of pediatric head injury in the emergency department. Ital J Pediatr 2018; 44:7. [PMID: 29334996 PMCID: PMC5769508 DOI: 10.1186/s13052-017-0442-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/18/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE We aim to formulate evidence-based recommendations to assist physicians decision-making in the assessment and management of children younger than 16 years presenting to the emergency department (ED) following a blunt head trauma with no suspicion of non-accidental injury. METHODS These guidelines were commissioned by the Italian Society of Pediatric Emergency Medicine and include a systematic review and analysis of the literature published since 2005. Physicians with expertise and experience in the fields of pediatrics, pediatric emergency medicine, pediatric intensive care, neurosurgery and neuroradiology, as well as an experienced pediatric nurse and a parent representative were the components of the guidelines working group. Areas of direct interest included 1) initial assessment and stabilization in the ED, 2) diagnosis of clinically important traumatic brain injury in the ED, 3) management and disposition in the ED. The guidelines do not provide specific guidance on the identification and management of possible associated cervical spine injuries. Other exclusions are noted in the full text. CONCLUSIONS Recommendations to guide physicians practice when assessing children presenting to the ED following blunt head trauma are reported in both summary and extensive format in the guideline document.
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Affiliation(s)
- Liviana Da Dalt
- Pediatric Emergency Department-Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Niccolo' Parri
- Department of Pediatric Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Angela Amigoni
- Pediatric Emergency Department-Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Agostino Nocerino
- Department of Pediatrics, S. Maria della Misericordia University Hospital, University of Udine, Udine, Italy
| | - Francesca Selmin
- Pediatric Emergency Department-Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Renzo Manara
- Department of Radiology, Neuroradiology Unit, University of Salerno, Salerno, Italy
| | - Paola Perretta
- Neurosurgery Unit, Regina Margherita Pediatric Hospital, Torino, Italy
| | - Maria Paola Vardeu
- Pediatric Emergency Department, Regina Margherita Pediatric Hospital, Torino, Italy
| | - Silvia Bressan
- Pediatric Emergency Department-Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
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Boutonnet M, Laemmel E, Vicaut E, Duranteau J, Soubeyrand M. Combinatorial therapy with two pro-coagulants and one osmotic agent reduces the extent of the lesion in the acute phase of spinal cord injury in the rat. Intensive Care Med Exp 2017; 5:51. [PMID: 29230608 PMCID: PMC5725399 DOI: 10.1186/s40635-017-0164-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 11/30/2017] [Indexed: 12/31/2022] Open
Abstract
Background Spinal cord injury (SCI) is a complex disease that leads to a motor, sensitive, and vegetative impairment. So far, single therapies are ineffective for treating SCI in humans and a multifactorial therapeutic approach may be required. The aim of this work was to assess the effect of a triple therapy (TT) associating two pro-coagulant therapies (tranexamic acid and fibrinogen) with an anti-edema therapy (hypertonic saline solution), on the extent of the lesion 24 h post-injury. Methods The design of this study is a randomized controlled study. The setting of this study is an experimental study. Male Wistar rats were assigned to receive saline solution for the control group or one of the treatment, or a combination of two treatments or the three treatments (triple therapy group (TT)). Animals were anesthetized and received a weight-drop SCI induced at the level of the 12th thoracic vertebra (Th12). They were treated by single therapies, double therapies, or TT started 5 min after the SCI. Results The extent of the lesion was assessed 24 h after injury by spectrophotometry (quantification of parenchymal hemorrhage and blood-spinal cord barrier disruption) and by histology (quantification of spared neuronal tissue). As compared with the control group, the TT significantly reduced parenchymal hemorrhage (p < 0.05) and improved the total amount of intact neural tissue, measured 24 h later (p = 0.003). Conclusions Combinatorial therapy associating two pro-coagulants (tranexamic acid and fibrinogen) with an anti-edema therapy (hypertonic saline solution) reduces the extent of the lesion in the acute phase of spinal cord injury in the rat.
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Affiliation(s)
- Mathieu Boutonnet
- Service de Réanimation, Hôpital d'Instruction des Armées Percy, Clamart, France. .,INSERM U942, Equipe universitaire 3509 Paris VII-Paris XI-Paris XIII, Microcirculation, Bioénergétique, Inflammation et Insuffisance circulatoire aiguë, Paris Diderot-Paris VII, Paris, France.
| | - Elisabeth Laemmel
- INSERM U942, Equipe universitaire 3509 Paris VII-Paris XI-Paris XIII, Microcirculation, Bioénergétique, Inflammation et Insuffisance circulatoire aiguë, Paris Diderot-Paris VII, Paris, France
| | - Eric Vicaut
- INSERM U942, Equipe universitaire 3509 Paris VII-Paris XI-Paris XIII, Microcirculation, Bioénergétique, Inflammation et Insuffisance circulatoire aiguë, Paris Diderot-Paris VII, Paris, France
| | - Jacques Duranteau
- INSERM U942, Equipe universitaire 3509 Paris VII-Paris XI-Paris XIII, Microcirculation, Bioénergétique, Inflammation et Insuffisance circulatoire aiguë, Paris Diderot-Paris VII, Paris, France.,Département d'Anesthésie Réanimation, Service de Réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Marc Soubeyrand
- INSERM U942, Equipe universitaire 3509 Paris VII-Paris XI-Paris XIII, Microcirculation, Bioénergétique, Inflammation et Insuffisance circulatoire aiguë, Paris Diderot-Paris VII, Paris, France.,Service de Chirurgie Orthopédique, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
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Treatment of medial compartment knee osteoarthritis by arthroscopic 'L' medial release procedure. INTERNATIONAL ORTHOPAEDICS 2017; 41:2025-2035. [PMID: 28600698 DOI: 10.1007/s00264-017-3508-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 05/07/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of an arthroscopic 'L' medial release (ALMR) procedure for the treatment of medial compartment knee osteoarthritis (MCKOA). METHODS Between January 2012 and December 2013, 372 patients with MCKOA of Kellgren's radiographic grade I-III were diagnosed. Among them, 252 patients with MCKOA received ALMR performed by a single surgeon. The other 120 patients received supportive treatment and were regarded as the control group. The Knee Society Score (KSS) at baseline and 2 years, and the subjective visual analogue scale (VAS) at baseline and 1st, 2nd, 6th, 12th, and 24th months were used for outcome studies. RESULTS There were 286 patients available for follow-up for more than 2 years and the mean follow-up period was 28 months. There were 202 patients with unilateral MCKOA in the ALMR group and 84 in the control group. The mean subjective VAS showed a statistically significant improvement after 6 months, and then remained relatively stable between the 6th and 24th month. The mean KSS for pain and function improved statistically at 2 years of follow-up. CONCLUSIONS This ALMR appears to be an effective and safe treatment for mild and moderate MCKOA.
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Burgess S, Abu-Laban RB, Slavik RS, Vu EN, Zed PJ. A Systematic Review of Randomized Controlled Trials Comparing Hypertonic Sodium Solutions and Mannitol for Traumatic Brain Injury. Ann Pharmacother 2016; 50:291-300. [DOI: 10.1177/1060028016628893] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To comparatively evaluate hypertonic sodium (HTS) and mannitol in patients following acute traumatic brain injury (TBI) on the outcomes of all-cause mortality, neurological disability, intracranial pressure (ICP) change from baseline, ICP treatment failure, and serious adverse events. Data Sources: PubMed, EMBASE, CENTRAL, Cochrane Database of Systematic Reviews, ClinicalTrials.gov, and WHO ICTRP (World Health Organization International Clinical Trials Registry Platform) were searched (inception to November 2015) using hypertonic saline solutions, sodium chloride, mannitol, osmotic diuretic, traumatic brain injury, brain injuries, and head injury. Searches were limited to humans. Clinical practice guidelines and bibliographies were reviewed. Study Selection and Data Extraction: Prospective, randomized trials comparing HTS and mannitol in adults (≥16 years) with severe TBI (Glasgow Coma Scale score ≤8) and elevated ICP were included. ICP elevation, ICP reduction, and treatment failure were defined using study definitions. Data Synthesis: Of 326 articles screened, 7 trials enrolling a total of 191 patients met inclusion criteria. Studies were underpowered to detect a significant difference in mortality or neurological outcomes. Due to significant heterogeneity and differences in reporting ICP change from baseline, this outcome was not meta-analyzed. No difference between HTS and mannitol was observed for mean ICP reduction; however, risk of ICP treatment failure favored HTS (risk ratio [RR] = 0.39; 95% CI = 0.18-0.81). Serious adverse events were not reported. Conclusions: Based on limited data, clinically important differences in mortality, neurological outcomes, and ICP reduction were not observed between HTS or mannitol in the management of severe TBI. HTS appears to lead to fewer ICP treatment failures.
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Affiliation(s)
- Sarah Burgess
- University of British Columbia, Vancouver, BC, Canada
| | - Riyad B. Abu-Laban
- University of British Columbia, Vancouver, BC, Canada
- VCHRI Centre for Clinical Epidemiology and Evaluation, Vancouver, BC, Canada
| | - Richard S. Slavik
- University of British Columbia, Vancouver, BC, Canada
- Interior Health, Kelowna, BC, Canada
| | - Erik N. Vu
- University of British Columbia, Vancouver, BC, Canada
- British Columbia Emergency Health Services, Vancouver, BC, Canada
| | - Peter J. Zed
- University of British Columbia, Vancouver, BC, Canada
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Abstract
"Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear" published in the New England Journal of Medicine on December 26, 2013 draws the conclusion that arthroscopic partial medial meniscectomy provides no significant benefit over sham surgery in patients with a degenerative meniscal tear and no knee osteoarthritis. This result argues against the current practice of performing arthroscopic partial meniscectomy (APM) in patients with a degenerative meniscal tear. Since the number of APM performed has been increasing, the information provided by this study should lead to a change in clinical care of patients with a degenerative meniscus tear.
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Affiliation(s)
- Shaw-Ruey Lyu
- 1 Joint Center, Dalin Tzu-Chi General Hospital, Chiayi, Taiwan ; 2 School of Medicine, Tzu-Chi University, Hualien, Taiwan
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