Tranexamic acid (TXA) is well-established as a versatile oral, intramuscular, and intravenous (IV) antifibrinolytic agent. However, the efficacy of IV TXA in reducing perioperative blood transfusion ...in spinal surgery is poorly documented.
We conducted a meta-analysis of randomized controlled trials (RCTs) and quasi-randomized (qi-RCTs) trials that included patients for various spinal surgeries, such as adolescent scoliosis surgery administered with perioperative IV TXA according to Cochrane Collaboration guidelines using electronic PubMed, Cochrane Central Register of Controlled Trials, and Embase databases. Additional journal articles and conference proceedings were manually located by two independent researchers.
Totally, nine studies were included, with a total sample size of 581 patients. Mean blood loss was decreased in patients treated with perioperative IV TXA by 128.28 ml intraoperatively (ranging from 33.84 to 222.73 ml), 98.49 ml postoperatively (ranging from 83.22 to 113.77 ml), and 389.21 ml combined (ranging from 177.83 to 600.60 ml). The mean volume of transfused packed cells were reduced by 134.55 ml (ranging 51.64 to 217.46) (95% CI; P = 0.0001). Overall, the number of patients treated with TXA who required blood transfusions was lower by 35% than that of patients treated with the comparator and who required blood transfusions (RR 0.65; 95% CI; 0.53 to 0.85; P<0.0001, I(2) = 0%). A dose-independent beneficial effect of TXA was observed, and confirmed in subgroup and sensitivity analyses. A total of seven studies reported DVT data. The study containing only a single DVT case was not combined.
The blood loss was reduced in spinal surgery patients with perioperative IV TXA treatment. Also the percentage of spinal surgery patients who required blood transfusion was significantly decreased. Further evaluation is required to confirm our findings before TXA can be safely used in patients undergoing spine surgery.
Traumatic neuromas are rare benign tumors, which are common in trauma or post-operation and accompanied with obvious symptoms of pain. This study will show the superficial peroneal nerve neuroma ...occurring after resection of hemangioma.
A 44-year-old male had an operation of the right leg cavernous hemangioma resection in 1995. Half a year after the operation, pain around the wound appeared and gradually aggravated. The patient had the lesion exploration resection in 2013, and the pathological result showed traumatic neuroma. Within half a year of the second operation, severe pain showed up again, so neuroma resection proceeded in May 2015. The postoperative pathological and immunohistochemical results showed traumatic neuroma. According to the postoperative follow-up, there were no symptoms of pain appearing again.
The pain is obvious, and B ultrasonography is the most efficient way to find neuromas. Both conservative and operative therapy have their advantages and disadvantages.
There remain many unanswered questions in relation to the treatment of traumatic neuromas, and further research is required, although we have already had adequate understanding of traumatic neuromas.
To compare the effectiveness between paratricipital approach and chevron olecranon V osteotomy approach for the treatment of type C3 (AO/OTA) distal humeral fractures and investigate the details of ...operation.
Between April 2010 and September 2016, 36 type C3 (AO/OTA) distal humeral fractures were treated with open reduction and bicolumnar orthogonal locking plating fixation by paratricipital approach and chevron olecranon V osteotomy approach respectively. The patients were divided into 2 groups by approach, there were 17 cases in paratricipital group (group A) and the bicolumns and distal humeral joint surface were exposed by traction of triceps and olecranon, and the distal humeral joint surface of the 19 cases in chevron olecranon V osteotomy group (group B) were exposed by osteotomy of the olecranon and reversing of triceps. There was no significant difference in gender, age, dominant side, interval between injury and surgery, causes of injury between 2 groups (
>0.05). Patients were followed up, the post
Mg-doped hydroxyapatite (MH) with oriented microchannels was prepared by hot-pressing sintering and pore-forming heat treatment using continuous carbon fibres (CFs) as the pore-forming agent to ...achieve balanced mechanical and biological properties. The proportion of MH and (Ca, Mg)3(PO4)2 in the microporous bioceramic with inter-microchannel spacing of 400 μm obtained by sintering at 900 °C (900-2P-MH) was 43.9/56.1 (wt%), which could promote degradation. The compressive strength of the MH bioceramics containing oriented microchannels with a suitable pore size (5–14 μm) did not decrease, but increased in comparison with that of a dense MH sample without microchannels. In particular, the compression strength of the MH bioceramic with oriented microchannels formed using single CF units was 53.31% higher than that of the dense ones. The fracture toughness of the MH bioceramics with oriented microchannels increased to 177.42% of that of the dense ones. The strengthening and toughening mechanism includes contributions from the combination of heating and pressing, uniform distribution of microchannels, and in situ formation of continuous micro/nano-MH ceramic tubes. Moreover, the microchannel-containing MH showed noticeably improved apatite mineralisation in simulated body fluid (SBF). Analysis of the rat tibial bone defect model revealed that the relative bone volumes in the cases of the dense MH without microchannels and the MH with microchannels increased by 23.18 and 40.14%, respectively, compared with that of hydroxyapatite. Furthermore, the MH bioceramics with oriented microchannels displayed a moderate reduction in strength owing to degradation after 8 weeks of implantation. The satisfactory osteogenic properties and degradability of the microporous bioceramic can be attributed to Mg2+ doping and oriented microchannels.
•A new and effective strengthening and toughening method was developed for ceramic-matrix composites.•Oriented-microchannel-containing Mg-doped hydroxyapatite (MH) with balanced mechanical and biological properties was constructed using continuous CFs as the pore-forming agent.•Continuous micro/nano ceramic tubes were formed in situ in the oriented microchannels of MH.•Compression strength of MH bioceramics with oriented microchannels was 53.31% higher than that of MH without microchannels.•Fracture toughness of MH bioceramics with oriented microchannels increased to 177.42% of that of MH without microchannels.
Transplantation of olfactory ensheathing cells (OEC) is a promising therapy in spinal cord injury (SCI) treatment. However, the therapeutic efficacy of this method is unstable due to unknown reasons. ...Considering the alterations in the culture environment that occur during OEC preparation for transplantation, we hypothesize that these changes may cause variations in the curative effects of this method. In this study, we compared OEC cultured in medium containing different types and concentrations of serum. After purification and passage, the OEC were cultured for 7 days in different media containing 5%, 10%, 15% or 20% fetal bovine serum (FBS) or rat serum (RS), or the cells were cultured in FBS-containing medium first, followed by medium containing RS. In another group, the OEC were first cultured in 10% FBS for 3 days and then cultured with rat spinal cord explants with 10% RS for another 4 days. An MTT assay and P75 neurotrophin receptor immunofluorescence staining were used to examine cell viability and OEC numbers, respectively. The concentration of neurotrophin-3 (NT-3), which is secreted by OEC into the culture supernatant, was detected using the enzyme-linked immunosorbent assay (ELISA). RT-PCR was applied to investigate the NT-3 gene expression in OEC according to different groups. Compared with FBS, RS reduced OEC proliferation in relation to OEC counts (χ2 = 166.279, df = 1, p < 0.01), the optical density (OD) value in the MTT assay (χ2 = 34.730, df = 1, p < 0.01), and NT-3 concentration in the supernatant (χ2 = 242.997, df = 1, p < 0.01). OEC cultured with spinal cord explants secreted less NT-3 than OEC cultured alone (F = 9.611, df = 5.139, p < 0.01). Meanwhile, the order of application of different sera was not influential. There was statistically significant difference in NT-3 gene expression among different groups when the serum concentration was 15% (χ2 = 64.347, df = 1, p < 0.01). In conclusion, different serum conditions may be responsible for the variations in OEC proliferation and function.
Purpose
We aimed to provide evidence for clinical choice of surgical approach in treating spinal tuberculosis, including anterior, posterior and combined approaches (combined anterior and posterior ...approach).
Methods
A literature search up to June 2015 was performed on PubMed, Embase, Cochrane library, CNKI, Wanfang and Weipu database. Weighted mean differences (WMDs) or risk radios (RRs) and their 95 % confidence intervals (CI) were calculated.
Results
Total 26 studies with 2345 spinal tuberculosis adults were analyzed. Results showed advantages of posterior approach compared with anterior approach in operation time (WMD = 20.91; 95 % CI: 9.05–32.76), blood loss (WMD = 72.32, 95 % CI: 13.87–130.78), correction of angle (WMD = −2.47; 95 % CI: −4.04 to −0.90) and complications (RR = 1.78; 95 % CI: 1.21–2.60), and compared with combined approach in operation time (WMD = −82.76; 95 % CI: −94.38 to −71.14), blood loss (WMD = −263.63; 95 % CI: −336.85 to −190.41), hospital stay (WMD = −4.60; 95 % CI: −5.10 to −4.10) and complications (RR = 0.36; 95 % CI: 0.23–0.58. Meanwhile, significantly larger correction of angle (WMD = −2.25; 95 % CI: −4.35 to −0.14;
P
= 0.04) and less loss of correction (WMD = 3.97; 95 % CI: 2.22–5.72) were found when compared combined approach with anterior approach. However, combined approach had significantly longer operation time (WMD = −41.92; 95 % CI: −52.45 to −31.38) and more blood loss (WMD = −102.18; 95 % CI: −160.45 to −43.91) than anterior approach.
Conclusion
Posterior approach has better clinical outcomes than anterior or combined approach for spinal tuberculosis. However, individual assessment of each case should be considered in the clinical application of these surgical approaches.
Accumulating evidence reveals that miR-449a is expressed at a low level in several tumors and cancer cell lines, and acts as a tumor suppressor in several cancers. However, its role in osteosarcoma ...(OS) is not well understood. In the present study, we found that miR-449a was significantly downregulated in both OS tissues and cell lines. Furthermore, low expression level of miR-449a was correlated with advanced tumor stage, metastasis, and predicted a poor overall survival in OS patients. Additionally, restoration of miR-449a in OS cell lines U2OS and Saos-2 reduced cell viability, promoted cell apoptosis in vitro, and suppressed tumorigenicity in vivo. Moreover, BCL2, an antiapoptotic molecule, was identified to be a direct target of miR-449a, and the proapoptotic function of miR-449a was mainly through targeting BCL2 expression. Taken together, our results demonstrated a tumor-suppressive role of miR-449a in OS progression and suggested a potential therapeutic target for OS.
Bone scaffolds designed based on the Voronoi-tessellation algorithm have been increasingly studied owing to their structural similarity with natural cancellous bone. The irregularity of pore ...morphology (IPM) influences the osteogenesis efficiency of Voronoi scaffolds since it may alter the static and hydromechanical microenvironments for the initial adhesion and mechano-regulated osteoblast differentiation (MrOD) of mesenchymal stem cells (MSCs). In this work, animal experiments were conducted to explore the relationship between IPM and osteogenesis efficiency in Voronoi scaffolds. A computational fluid dynamics (CFD) analysis based on discrete phase models was performed to predict the efficiency of MSC adhesion in different IPMs. Another combined finite element and CFD analysis based on the mechano-regulation algorithm was performed to predict the influence of IPM on the MrOD of the adhesive MSCs. The results showed that the osteogenesis efficiency of the Voronoi scaffolds increased as the IPM rose from low to moderate and then dropped as the IPM further rose. Same trends were also found in the MSC adhesion and MrOD, which caused by the changes of strain tensors on the strut surface and the tortuosity and fluid velocity of the fluid pathway. Moderate IPM induced the highest osteogenesis efficiency owing to its highest efficiencies of MSC adhesion and MrOD. This work identified the optimal IPM for the osteogenesis of Voronoi scaffolds and clarified its biomechanical mechanisms from the adhesion and mechano-regulated differentiation of MSCs, which is of great importance for guiding Voronoi scaffold design when it is used for bone defect repair.
Apart from its role in inflammation and immunity, chemerin is also involved in white adipocyte biology. To study the role of chemerin in adipocyte metabolism, we examined the function of chemerin in ...brown adipose tissue. Brown and white adipocyte precursors were differentiated into adipocytes in the presence of Chemerin siRNA. Chemerin‐deficient (Chem−/−) mice were compared to wild‐type mice when fed a high‐fat diet. Chemerin is expressed during brown adipocyte differentiation and knock down of chemerin mRNA results in decreased brown adipocyte differentiation with reduced fatty acid uptake in brown adipocytes. Chem−/− mice are leaner than wild‐type mice but gain more weight when challenged with high‐fat diet feeding, resulting in a larger increase in fat deposition. Chem−/− mice develop insulin resistance when on a high‐fat diet or due to age. Brown adipose depots in Chem−/− mice weigh more than in wild‐type mice, but with decreased mitochondrial content and function. Compared to wild‐type mice, male Chem−/− mice have decreased oxygen consumption, CO2 production, energy expenditure, and a lower respiratory exchange ratio. Additionally, body temperature of Chem−/− mice is lower than that of wild‐type mice. These results revealed that chemerin is expressed during brown adipocyte differentiation and has a pivotal role in energy metabolism through brown adipose tissue thermogenesis.
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