Outcome of the modified Dunn procedure in severe slipped capital femoral epiphysis.

BACKGROUND: The modified Dunn procedure has rapidly gained popularity as a treatment for slipped capital femoral epiphysis (SCFE) during the past few years. However, there is limited information regarding its safety and efficacy in severe slips with this procedure. The purpose of this study is to present clinical results and incidence of complications associated with the modified Dunn osteotomy in a consecutive series of severe SCFE cohort. PATIENTS AND METHODS: We retrospectively assessed the outcomes of all twenty patients who had been treated with the modified Dunn procedure in our tertiary-care institution. According to the Loder and Fahey criteria, all cases were classified as severe slips; nineteen cases were stable, and one case was an unstable slip. All surgical procedures were performed by one senior orthopedic surgeon who had specific training in the modified Dunn procedure. Operative reports, outpatient records, follow-up radiographs, and the intraoperative findings were reviewed to determine the demographic information, type of fixation, final slip angle, presence of avascular necrosis (AVN), and any additional complications. The mean age of the patients was 13.2 ± 1.6 years (range, 10 to 17 years). Twenty patients (twenty-one hips) with a mean of 31.2 ± 14 months (range, 12 to 57 months) follow-up met the inclusion criteria. Pain and function were assessed by the modified Harris score and WOMAC score. Radiographic anatomy was measured using the slip angle and α-angle. The radiographic findings related to the anatomy of the femoral head-neck junction, as well as signs of early-onset of osteoarthritis (OA) and AVN, were evaluated pre- and postoperatively. RESULTS: Overall, nineteen patients had excellent clinical and radiographic outcomes with respect to hip function and radiographic parameters. One patient (5%) who developed implant failure at 3 months postoperatively had a poor outcome. The mean preoperative slip angle was corrected from 63.2 ± 8.1° (range, 51 to 84°) to a normal value of 7.5 ± 3.5° (range, 2 to 15°) (p < 0.01). The mean α-angle was improved from an average of 94.5 ± 21.1° (range, 61 to 123°) to postoperative 42 ± 6.4° (range, 25 to 55°) (p < 0.01). The mean modified Harris hip and WOMAC scores postoperatively were 96.7 ± 13.4 (range, 40 to 100) and 95.4 ± 10.6 (range, 38 to 100), respectively. There were no cases of the development of femoroacetabular impingement (FAI) and the progression of OA. We did not record any case of AVN, closure of the growth plate, heterotopic ossification (HO), trochanteric nonunion, or limb length discrepancy that occurred postoperatively either at the most recent follow-up. CONCLUSIONS: Our series of severe SCFEs treated with the modified Dunn osteotomy demonstrated that the procedure is safe and capable of restoring more normal proximal femoral anatomy by maximum correction of the slip angle, minimizing probability of secondary FAI and early onset of OA. However, despite its lower surgical complication rate compared with alternative treatment described in the literature for SCFE, AVN can and do occur postoperatively which should always be concerned in every hip.

Gremlin2 Suppression Increases the BMP-2-Induced Osteogenesis of Human Bone Marrow-Derived Mesenchymal Stem Cells Via the BMP-2/Smad/Runx2 Signaling Pathway.

Osteoblasts are essential for maintaining skeletal architecture and modulating bone microenvironment homeostasis. From numerous associated investigations, the BMP-2 pathway has been well-defined as a vital positive modulator of bone homeostasis. Gremlin2 (Grem2) is a bone morphogenetic protein (BMP) antagonists. However, the effect of Grem2 on the BMP-2-induced osteogenesis of human bone marrow-derived mesenchymal stem cells (hBMSCs) remains ambiguous. This study aimed to analyze the procedure in vitro and in vivo. The differentiation of hBMSCs was assessed by determining the expression levels of several osteoblastic genes, as well as the enzymatic activity and calcification of alkaline phosphatase. We found that Grem2 expression was upregulated by BMP-2 within the range of 0-1 µg/mL, and significant increases were evident at 48, 72, and 96 h after BMP-2 treatment. Si-Grem2 increased the BMP-2-induced osteogenic differentiation of hBMSCs, whereas overexpression of Grem2 had the opposite trend. The result was confirmed using a defective femur model. We also discovered that the BMP-2/Smad/Runx2 pathway played an important role in the process. This study showed that si-Grem2 increased the BMP-2-induced osteogenic differentiation of hBMSCs via the BMP-2/Smad/Runx2 pathway. J. Cell. Biochem. 118: 286-297, 2017. © 2016 Wiley Periodicals, Inc.

Influence of video-assisted thoracoscopic lobectomy on immunological functions in non-small cell lung cancer patients.

In this study, we compared the effects of video-assisted thoracic surgery (VATS) and traditional open surgery (TOS) on immune system functioning in non-small cell lung cancer (NSCLC) patients. We enrolled 122 NSCLC patients in this study. The patients were randomly divided into VATS group (n = 61) and TOS group (n = 61). Plasma DNA concentration was analyzed by fluorescence quantitative PCR. Automatic blood analyzer was used to measure WBC-C, and immune nephelometry was employed to assess hs-CRP concentrations. The number of CD3+T, CD4+T and CD8+T lymphocytes in peripheral blood was estimated by flow cytometry. ELISA was used to quantify the levels of IGFBP-3, VEGF and IL-6. Compared to the TOS group, surgery-related blood loss and pain score on day 1 after surgery were lower in VATS group. After surgery, the out-of-bed activity occurred earlier and in-hospital stays were shorter in the VATS group compared to the TOS group. Plasma free DNA concentration of VATS group patients at first, third and fifth days after surgery was lower than that of the TOS group. WBC-C and hs-CRP levels were lower in the VATS group at each time point after surgery. The number of CD3+T, CD4+T, CD8+T lymphocytes and CD4+/CD8+ was lower in the TOS group compared to VATS group. Plasma IGFBP-3, VEGF and IL-6 levels were significantly lower in VATS group compared to the TOS group. Finally, incidence of complications in the VATS group was dramatically lower than the TOS group (all P < 0.05). Based on our findings, compared to TOS, VATS significantly decreased the incidence of acute-phase reaction and lowered the inhibition of immune functions after surgery.