A methodological systematic review of early versus late stabilization of thoracolumbar spine fractures.

OBJECTIVE: The optimal timing of stabilization in patients with traumatic thoracolumbar fractures remains controversial. There is currently a lack of consensus on the timing of surgical stabilization, which is limited by the reality that a randomized controlled trial to evaluate early versus late stabilization is difficult to perform. Therefore, the objective of this study was to determine the benefits, safety and costs of early stabilization compared with late stabilization using data available in the current literature. METHODS: An electronic literature search was performed in Medline, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials for relevant studies evaluating the timing of surgery in patients with thoracolumbar fractures. Two reviewers independently analyzed and selected each study on the basis of the eligibility criteria. The quality of the included studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system (GRADE). Any disagreements were resolved by consensus. RESULTS: Ten studies involving 2,512 subjects were identified. These studies demonstrated that early stabilization shortened the hospital length of stay, intensive care unit length of stay, ventilator days and reduced morbidity and hospital expenses for patients with thoracic fractures. However, reduced morbidity and hospital expenses were not observed with stabilization of lumbar fractures. Owing to the very low level of evidence, no conclusion could be made regarding the effect of early stabilization on mortality. CONCLUSIONS: We could adhere to the recommendation that patients with traumatic thoracolumbar fractures should undergo early stabilization, which may reduce the hospital length of stay, intensive care unit length of stay, ventilator days, morbidity and hospital expenses, particularly when the thoracic spine is involved. Individual patient characteristics should be concerned carefully. However, the definite conclusion cannot be made due to the heterogeneity of the included studies and low level of evidence. Further prospective studies are required to confirm whether there are benefits to early stabilization compared with late stabilization.

A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery.

OBJECTIVE: To identify the independent risk factors, based on available evidence in the literature, for patients developing surgical site infections (SSI) after spinal surgery. METHODS: Non-interventional studies evaluating the independent risk factors for patients developing SSI following spinal surgery were searched in Medline, Embase, Sciencedirect and OVID. The quality of the included studies was assessed by a modified quality assessment tool that had been previously designed for observational studies. The effects of studies were combined with the study quality score using a best-evidence synthesis model. RESULTS: Thirty-six observational studies involving 2,439 patients with SSI after spinal surgery were identified. The included studies covered a wide range of indications and surgical procedures. These articles were published between 1998 and 2012. According to the quality assessment criteria for included studies, 15 studies were deemed to be high-quality studies, 5 were moderate-quality studies, and 16 were low-quality studies. A total of 46 independent factors were evaluated for risk of SSI. There was strong evidence for six factors, including obesity/BMI, longer operation times, diabetes, smoking, history of previous SSI and type of surgical procedure. We also identified 8 moderate-evidence, 31 limited-evidence and 1 conflicting-evidence factors. CONCLUSION: Although there is no conclusive evidence for why postoperative SSI occurs, these data provide evidence to guide clinicians in admitting patients who will have spinal operations and to choose an optimal prophylactic strategy. Further research is still required to evaluate the effects of these above risk factors.

[Study on the correlation between combined detection of RACK1 and M2/M1 in oral squamous cell carcinoma and prognosis of the patients].

PURPOSE: To explore the relationship between combined detection of tissue active protein kinase C receptor 1 (RACK1) and M2/M1 and the prognosis of oral squamous cell carcinoma (OSCC). METHODS: 129 OSCC patients admitted to the Affiliated Hospital of Nantong University were selected as the research subjects from February 2017 to May 2018. RACK1 and M2/M1 in cancer tissues and adjacent tissues of patients were detected and compared. The relationship between RACK1 expression, M2/M1 and clinicopathological factors, and relationship between RACK1 expression, M2/M1 and prognosis in cancer tissue were analyzed. SPSS 18.0 software package was used for data analysis. RESULTS: The positive expression rate of RACK1 and the value of M2/M1 in cancer tissues were significantly higher than those in adjacent tissues (P<0.05). The positive expression rate of RACK1 in cancer tissues of patients with stage Ⅲ-Ⅳ, cervical lymph node metastasis, and vascular involvement were significantly higher than those with stage Ⅰ-Ⅱ, no lymph node metastasis, and no vascular involvement(P<0.05). M2/M1 values in cancer tissues of patients with stage Ⅲ-Ⅳ, poor differentiation, and cervical lymph node metastasis were significantly higher than those with stage Ⅰ-Ⅱ, moderate differentiation, and no cervical lymph node metastasis(P<0.05). Cox regression analysis showed that the stage of tumor, cervical lymph node metastasis, positive expression rate of RACK1, and M2/M1 were independent prognostic factors affecting overall survival (P<0.05). ROC curve showed that AUC of cancer tissue RACK1, M2/M1 and combination of the two to predict the prognosis of OSCC patients were 0.743, 0.718 and 0.875, respectively. The survival rate of patients with positive expression of RACK1 was 62.24%, and the survival rate of patients with negative expression of RACK1 was 92.31%. The overall survival rate of patients with positive expression of RACK1 and patients with negative expression were compared, and the difference was statistically significant(P<0.05). The survival rate of patients with M2/M1≥2.06 was 61.70%, the survival rate of patients with M2/M1<2.06 was 88.24%, and the overall survival curve of patients with M2/M1≥2.06 was compared with that of patients with M2/M1<2.06, and the difference was statistically significant(P<0.05). CONCLUSIONS: The expression of RACK1 and M2/M1 is abnormally high in cancer tissues of OSCC patients. The expression of RACK1 and M2/M1 is related to the patient's pathology and prognosis. The combination of the two has certain efficacy in predicting the prognosis of OSCC patients.

A meta-analysis of balloon kyphoplasty compared to percutaneous vertebroplasty for treating osteoporotic vertebral compression fractures.

A meta-analysis was conducted to assess the safety and efficacy of balloon kyphoplasty (KP) compared to percutaneous vertebroplasty (VP) in the treatment of osteoporotic vertebral compression fractures (OVCF). Ten studies, encompassing 783 patients, met the inclusion criteria. Overall, the results of the meta-analysis indicated that there were significant differences between the two groups in the long-term kyphosis angle (mean difference [MD] = -2.64, 95% confidence interval [CI] = -4.66 to -0.61; p = 0.01), the anterior height of the vertebral body (MD = 3.67, 95% CI = 1.40 to 5.94; p = 0.002), and the cement leakage rates (risk ratio [RR] = 0.70, 95% CI = 0.52 to 0.95; p = 0.02). However, there were no significant differences in the short-term visual analog scale (VAS) scores (MD = -0.57, 95% CI -1.33 to 0.20; p = 0.15), the long-term VAS scores (MD = -0.99, 95% CI = -2.29 to 0.31; p = 0.14), the short-term Oswestry Disability Index (ODI) scores (MD = -6.54, 95% CI = -14.57 to 1.48; p = 0.11), the long-term ODI scores (MD=-2.01, 95% CI = -11.75 to 7.73; p = 0.69), the operation time (MD = 4.47, 95% CI = -0.22 to 9.17; p = 0.06), the short-term kyphosis angle (MD = -2.25, 95% CI = -5.14 to 0.65; p = 0.13), or the adjacent-level fracture rates (RR = 1.52, 95% CI = 0.76 to 3.03; p = 0.24). This meta-analysis demonstrates that KP and VP are both safe and effective surgical procedures for treating OVCF. Compared with VP, KP can significantly relieve a long-term kyphosis angle, improve the height of the vertebral body, and reduce the incidence of bone cement leakage. However, because of the limitations of this meta-analysis, a large randomized controlled trial is required to confirm our findings.

[Clinical efficiency of computer-assisted pedicle screw placement versus conventional method: a meta-analysis].

OBJECTIVE: To compare the clinical efficacy of computer-assisted pedicle screw placement and conventional placement in the treatment of spinal disease. METHODS: A systematic search of studies published between Jan. 1990 and Feb. 2012 was conducted using Medline, Embase, OVID, ScienceDirect and Cochrane Review databases. Randomized controlled trials (RCTs) and prospective controlled trials of comparing computer-assisted pedicle screw placement to conventional method performed at one center or multi-centers providing data on accuracy of placement and clinical effects were identified. Two study authors independently reviewed the 93 articles originally identified and selected 10 for analysis. Study title,demographic characteristics,number of pedicle screw,anatomical area and outcomes were extracted manually from all selected studies. RevMan 5.1 software was used for meta-analysis. RESULTS: Ten studies encompassing 2813 pedicle screws met the inclusion criteria. Overall,the result of meta-analysis indicated that there were significant differences between two groups in accuracy in placement of pedicle screw [OR = 2.58, 95% CI (1.18, 5.63)], insertion time [WMD = -2.15, 95% CI (-2.36, -1.94)]. However, there was only one study reported preparation time of pedicle screw of navigation group was longer than conventional group. No neurological complication in navigation group was reported. CONCLUSION: As a safety supplementary measure, computer navigation provide better accuracy in placement of pedicle screw and insertion time. The preparation time of pedicle screw may prolong due to the complexity of navigation system. Further reseach should include randomized controlled trials with well-planned methodology to limit bias.

[Studies on relationship between the expression of hTNF-alpha gene and photosynthesis in Anabaena sp. IB02].

The effects of illumination on growth of Anabaena sp. IB02 and hTNF-alpha expression were studied. Photosynthetic activity, PS I and PS II activity of Anabaena sp. IB02 were assayed. Illumination enhanced the growth of Anabaena sp. IB02 and hTNF-a expression. Some relations were observed between hTNF-alpha expression and ture photosynthesis activity, PS I, PS II activity of Anabaena sp. IB02. Significant differences of the photosynthetic activity of host were detected simultaneously when hTNF-a expressed: the respiration rate increased (-68%), the light saturation point descended (+66%), all these suggested that the metabolic charge of host were increased and grow faster than wild type under low illumination.