Iatrogenic Abdominal Aortic Rupture During Transpedicular Bone Grafting for Thoracolumbar Burst Fractures Successfully Treated by Endovascular Stent Implantation.

PURPOSE: Vascular injury resulting from transpedicular bone grafting in the treatment of thoracolumbar burst fractures has not been reported but can be lethal. The management of patients with iatrogenic aortic injury remains a difficult clinical problem. This study describes a case of iatrogenic abdominal aortic rupture at the level of L2 during transpedicular bone grafting for the first time. CASE REPORT: A 55 year-old male patient suffered from a T12 vertebral body mild compression fracture and an L2 vertebral body burst fracture due to falling. This patient was treated with posterior open reduction and pedicle screw fixation combined with transpedicular bone grafting in the L2 vertebrae using a paravertebral approach. Unfortunately, during transpedicular bone grafting, the abdominal aorta was punctured by the tip of the graft funnel. The use of endovascular stent implantation successfully averted a clinical catastrophe. The patient had a good clinical outcome, and no complications associated with vascular trauma were apparent at a 1-year follow-up examination. CONCLUSION: For the repair of vascular injury caused by transpedicular bone grafting, endovascular techniques can provide a safe, minimally invasive, and effective treatment option. CLINICAL IMPACT: Surgeons should carefully evaluate the specificity of the patient's anatomical structures preoperatively and be more cautious during transpedicular bone grafting in the treatment of thoracolumbar burst fractures.

Spinal Metastatic Melanoma with Unknown Primary Lesions Presenting as Radiculopathy: Case Report and Literature Review.

BACKGROUND: Metastatic malignant melanoma of the spine is rare, while the spinal metastatic melanoma with unknown primary lesions presenting as radiculopathy is even rarer. Summarizing and analyzing this disease can provide insight into disease development and allow optimization of clinical management. CASE DESCRIPTION: A 55-year-old male patient was admitted to our institution presenting with lower back pain that had persisted for 3 years. It was aggravated, with radiating pain in bilateral lower extremities lasting 2 weeks. Neurologic examination revealed bilateral L5 motor deficit with paresis. Radiologic findings showed an irregularly destructive lesion of the L5 vertebral body, and the lesion extended dorsally, obstructing the spinal canal. The patient underwent complete resection of the L5 vertebral tumor with titanium mesh implantation and posterior fusion and instrumentation from L3-S2. The pathologic diagnosis after surgery was malignant melanoma. No obvious primary lesion was detected anywhere on the skin surface, mucosa, and retina. A postoperative positron emission tomography-computed tomography scan of the whole body displayed no abnormal uptake in other parts of the body. However, the patient didn't receive any chemotherapy or radiotherapy. Five months after operation, the tumor recurred and metastasis was detected in other sites. CONCLUSIONS: Although spinal metastatic melanoma with unknown primary lesions presenting as radiculopathy is rare, effective management and treatment of these patients remains an important challenge for surgeons. Surgical resection can alleviate patients' chief complaints and improve their quality of life. However, it may not prolong the survival period and improve the prognosis. Postoperative radiotherapy and/or chemotherapy may be needed.

Downregulation of hepatic lipase is associated with decreased CD133 expression and clone formation in HepG2 cells.

The drug resistance of cancer remains a major obstacle to successful chemotherapy. New strategies for improving chemotherapeutic efficacy are urgently required. Recent studies have indicated that LIPC plays a role in promoting the liver metastasis of colorectal cancer. In the present study, we aimed to investigate the effects of LIPC on theproliferation and clone formation of colorectal cancer-derived cells, and chemoresistance in hepatoblastoma-derived HepG2 cells. The activity and expression of LIPC were determined in the cell lines by RT-qPCR and western blot analysis. HepG2 cells in which LIPC was knocked down by LIPC short hairpin RNA (shRNA) and control cells [shRNA control (shCON)] were established and analyzed for cell proliferation and colony formation rates. FACS analysis was used to explore the association between LIPC and the tumor-derived cell biomarker, CD133, and the percentages of CD133-positive cells were assessed by FACS. Additionally, shLIPC- and shCON-transfected cells were treated with various concentrations of doxorubicin and 5-floxuridine (5-FU), and cell viability was determined by MTT assay. mRNA levels in the shLIPC- and shCON-transfected cells were compared by cDNA microarray and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. The results revealed that the HepG2 cells exhibited a relatively higher LIPC activity and expression levels compared to the other colon cancer cell lines. The downregulation of LIPC in the HepG2 cells was associated with the decreased expression of CD133, decreased cell proliferation and colony formation, as well as increased resistance to chemotherapy. KEGG analysis of the cDNA microarray data revealed increased levels in the cell adhesion molecule (CAM) pathway, including CLDN10 and CLDN1, indicating that CAMs may play a role in LIPC-mediated tumor progression. The present findings indicate a potential role of LIPC as a promising therapeutic target in cancer.

Meta-analysis: fecal calprotectin for assessment of inflammatory bowel disease activity.

BACKGROUND: Fecal calprotectin (FC) is a promising biomarker for diagnosis of inflammatory bowel disease (IBD). However, the utility of FC for assessment of IBD activity has yet to be clearly demonstrated. The aim of our study was to evaluate the diagnostic accuracy of FC for differentiating between patients with active IBD and those in remission. METHODS: We systematically searched the databases Medline, Web of Science, Cochrane Library, and EMBASE for eligible studies from December 2013 or earlier that evaluated activity in ulcerative colitis (UC) and Crohn's disease (CD). A hierarchical summary receiver operating characteristic model was performed to calculate the area under the curve to evaluate the overall diagnostic accuracy. The sensitivities and specificities of each commonly applied cutoff value were pooled using a random effects model. RESULTS: We included 13 studies (744 patients with UC and 727 with CD) in the final analysis. The area under the curve values were 0.89 (95% confidence interval, 0.86-0.92), 0.93 (0.89-0.97), and 0.88 (0.83-0.93) in the IBD, UC, and CD groups, respectively. For the IBD group at a cutoff value of 50 µg/g, the pooled sensitivity was 0.92 (0.90-0.94) and specificity 0.60 (0.52-0.67). For a cutoff value at 100 µg/g, the pooled sensitivity was 0.84 (0.80-0.88) and specificity was 0.66 (0.59-0.73). For a cutoff value at 250 µg/g, the pooled sensitivity was 0.80 (0.76-0.84) and specificity was 0.82 (0.77-0.86). CONCLUSIONS: The FC test is a reliable marker for assessing IBD disease activity and may have greater ability to evaluate disease activity in UC than CD.