Effects of dexamethasone and gamma globulin combined with prednisone on the therapeutic effect and immune function of Henoch-Schonlein purpura nephritis in children.

BACKGROUND: Henoch-Schonlein purpura nephritis (HSPN) is a serious complication of Henoch-Schonlein purpura (HSP), which is usually treated with immunosuppressant and glucocorticoid. This study was designed to explore the effect of dexamethasone and gamma globulin combined with prednisone in the treatment of pediatric HSPN. METHODS: According to the treatment plan, 60 children treated with dexamethasone and gamma globulin were included in the control group, and the rest 55 children treated with dexamethasone and gamma globulin combined with prednisone were selected as the research group. The clinical manifestations, therapeutic effect, immune function, serum inflammatory factors, blood coagulation function, urine routine, renal function, and adverse reactions were compared between the two groups. RESULTS: The clinical manifestations of children in the research group were significantly better than those in the control group after treatment (P < .05). The total effective rate in the research group (94.55%) was markedly higher than that in the control group (76.67%) (P < .05). CD3+, CD4+, CD8+, IL-10, PT, and APTT increased while CD4+/CD8+, IgA, IL-8, TNF-α, FIB, urine protein, urine red blood cell, Scr, and BUN decreased in both groups after treatment, and the changes of all the above indexes in the research group were significant than those in the control group (P < .05). The incidence of adverse reactions in the research group was remarkably superior to that in the control group (P < .05). CONCLUSION: Dexamethasone and gamma globulin combined with prednisone can improve the immune function of children with HSPN and promote the recovery of renal function.

The "slide technique"-a novel free-hand method of subaxial cervical pedicle screw placement.

BACKGROUND: Cervical Pedicle Screw (CPS) placement is a challenging work due to the high risk of neurovascular complications. Although there have been several different free-hand or navigation assisted techniques for CPS placement, perforations may occur during screw insertion, especially lateral perforation. The objective of this manuscript is to describe a novel free-hand technique for subaxial CPS placement (C3-C7) and to evaluate if it decreases the chances of perforation. METHODS: Thirty-two patients undergoing surgery with CPS instrumentation (C3-C7) at our institute between June 2017 and December 2018 were included in this study. All the patients had cervical trauma, and pedicle screw insertion was performed according to the free-hand "slide technique". The lamina, lateral mass and facet joint of the target area were exposed and the optimal entry point was found on the lateral mass posterior surface. A pedicular probe was then inserted and gently advanced. During the pedicle probe insertion, the cortex of the medial margin of the pedicle acted as a slide to permit the safe insertion of the screw. If the pedicle screw pathway was intact, the screw of the appropriate size was carefully placed. Three-dimensional (3D) CT imaging reconstruction was performed in all the patients after surgery, and screw perforations were graded with the Gertzbein-Robbins classification. RESULTS: Thirty-two patients who met the inclusion criteria were included in this study. A total of 257 CPSs (C3-7) were inserted, of which 41 CPSs were in C3, 61 CPSs were in C4, 55 CPSs were in C5, 53 CPSs were in C6, and 47 CPSs were in C7. The diameter and length of CPSs were 3.5 mm and 22-26 mm respectively. According to the Gertzbein-Robbins classification, grade 0, 231 screws; grade 1, 19 screws; and grade 2, 7 screws. No neurovascular complications occurred stemming from malpositioning of pedicle screws. Among perforated screws (26 screws), there were 16 lateral perforations, 5 medical perforations, and 4 inferior perforations. CONCLUSIONS: The initial usage result shows the "slide technique" is a safe, effective and cost-effective technique for pedicle screw placement in the cervical spine. This is the first report of such a technique, and further studies are needed.

Effects of SGLT2 inhibitors on fractures and bone mineral density in type 2 diabetes: An updated meta-analysis.

BACKGROUND: The aim of the study is to update and determine the effects of sodium glucose cotransporter 2 (SGLT2) inhibitor therapy on fracture and bone mineral density (BMD) in patients with type 2 diabetes mellitus (T2DM). METHODS: We identified 27 eligible randomized controlled trials (RCTs) that compared the efficacy and safety of SGLT2 inhibitors to a placebo in 20 895 T2DM participants, with an average duration of 64.22 weeks. The relative risk (RR) of bone fracture and weighted mean difference (WMD) of changes in the BMD from baseline were determined to evaluate the risk of fracture. The degree of heterogeneity was evaluated by the I2 statistic, and publication bias was estimated using a funnel plot and Egger test. RESULTS: The pooled RR was 1.02 (95% CI [0.81, 1.28]) with low heterogeneity, indicating that SGLT2 inhibitor treatment was not correlated with a higher risk of fracture. Additionally, no increased risk was found for patients with different ages, sexes, and levels of HbA1c and some biochemical indicators. Three trials with 1303 patients reported a change in the BMD from baseline. SGLT2 inhibitor treatment did not decrease the BMD at four skeletal sites (lumbar spine, femoral neck, total hip, and distal forearm), and the overall WMD was 0.08 (95% CI [-0.09, 0.26]). No significant publication bias was detected. CONCLUSIONS: No increased risk for bone fracture was detected in patients with T2DM treated with SGLT2 inhibitors in this meta-analysis. SGLT2 inhibitor therapy did not appear to affect bone health, but more long-term detailed data are needed to validate this conclusion.

Surgical treatments for degenerative lumbar scoliosis: a meta analysis.

PURPOSE: Degenerative lumbar scoliosis (DLS) is a spinal deformity that typically develops in adults over 50 years old. Although its etiology is unclear, asymmetric degeneration of the spine is the main cause. Individuals with DLS may experience no symptoms of the deformity, mild symptoms, or severe disability. Most patients with DLS receive conservative treatment, while a small number of patients receive surgery for severe DLS with back pain and/or progressive neurological symptoms. A variety of surgical procedures have emerged. However, a systemic comparison of these surgical procedures is currently unavailable. This study reviews the main outcomes and complications of surgical treatments. METHODS: A meta analysis of main outcomes and complications of surgical treatments of DLS was conducted through searching PubMed and EMbase databases. RESULTS: A total of 45 studies were included in this study, which were classified into four surgical categories. Nine studies utilized isolated decompression, 12 used short interbody fusion, 17 used long interbody fusion, and 11 studies included patients using short or long interbody fusion or surgery other than fusion, respectively. Decompression surgery is used to release the symptoms of neurogenic claudication. Spine fusion is widely utilized to prevent worsening of the curve. Instrumentation has been used together with fusion to straighten the spine, correct sagittal imbalance, and repair rotational defects. Decompression is commonly combined with fusion surgery when treating an individual with DLS. CONCLUSION: Despite a high rate of complications, this review demonstrates that surgery is an effective and reasonable treatment intervention for severe DLS and ultimately improves spine function and deformity. This review also suggests that large scale, high quality studies with long term follow-up are needed to provide more reliable evidence for future evaluation.

Which is the better choice for open tibial shaft fracture in overweight adolescent with open physis: A comparative study of external fixator plus elastic stable intramedullary nail versus external fixator alone.

PURPOSE: To compare the clinical outcomes of external fixator + elastic stable intramedullary nail (EF+ESIN) vs. external fixator (EF) in the treatment for open tibial shaft fracture in overweight adolescents. METHODS: Patients of open tibial shaft fractures younger than 14 years old with body weight over 50 Kg treated with EF + ESIN or EF at our institute from 2010 to 2018 were reviewed. Patients with Gustilo Type III open fractures, pathological fractures, previous fracture or instrumentation in the operative leg were excluded. Baseline information and clinical data were collected from the hospital database and during out-patient visits. RESULTS: Forty-six patients, including 27 males and 19 females, were included in the EF group, whereas 35 patients, including 18 males and 17 females, were included in the EF + ESIN group (p = 0.527). The incidence of superficial infection was higher in the EF group (26/46, 56.5%) than the EF + ESIN group (12/35, 34.3%), p < 0.001. The frontal and sagittal angulation was higher in the EF group (p < 0.001), but the degrees in both groups were within the acceptable range. The union time was longer in the EF group (68.0 ± 12.7, d) than the EF + ESIN group (61.9 ± 11.9), p < 0.001. The retaining of EF (11.9 ± 3.2, w) was longer in the EF group than the EF +ESIN group (5.7 ± 1.2, w), p < 0.001. CONCLUSION: EF+ESIN is a safe and alternative choice for selected overweight adolescents with open tibial shaft fracture.

Single-stage posterior-only approach treating single-segment thoracic tubercular spondylitis.

There are quite a few controversies on surgical management of single-segment thoracic spinal tuberculosis (STB) with neurological deficits. The present study was to compare single-stage posterior-only transpedicular debridement, interbody fusion and posterior instrumentation (posterior-only surgery) with a combined posterior-anterior surgical approach for treatment of single-segment thoracic STB with neurological deficits and to determine the clinical feasibility and effectiveness of posterior-only surgical treatment. Sixty patients with single-segment thoracic STB with neurological deficits were treated with one of two surgical procedures in our center from January 2003 to January 2013. Thirty patients were treated with posterior-only surgery (Group A) and thirty were treated with combined posterior-anterior surgery (Group B). The American Spinal Injury Association (ASIA) score system to evaluate the neurological deficits, the visual analogue scale (VAS) to assess the degree of pain, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to judge the activity of tuberculosis (TB), surgery duration, intraoperative blood loss, length of hospitalization, bony fusion rates, and kyphosis correction of the two groups were compared. The average follow-up period was 36.5 ± 9.2 months for Group A and 34.6 ± 10.2 months for Group B. Under the ASIA score system, all patients improved with treatment. STB was completely cured and grafted bones were fused within 5-11 months in all patients. There were no persistent or recurrent infections or obvious differences in radiological results between the groups. The kyphosis deformity was significantly corrected after surgical management. The average operative duration, blood loss, length of hospital stay, and postoperative complication rate of Group A were lower than those of Group B. In conclusions, posterior-only surgery is feasible and effective, resulting in better clinical outcomes than combined posterior-anterior surgeries, especially in surgical time, blood loss, hospital stay, and complications.