Hemoperfusion plus continuous veno-venous hemofiltration in the treatment of patients with multiple organ failure after wasp stings.

PURPOSE: This study aimed to evaluate the clinical effects of hemoperfusion plus continuous veno-venous hemofiltration in the treatment of patients with multiple organ failure after wasp stings and investigate its impacts on cytokines. METHODS: A total of 12 patients with multiple organ failure after wasp stings admitted to Xijing Hospital were included in the present study between January 2017 and January 2019. All patients received hemoperfusion plus continuous veno-venous hemofiltration treatment in addition to conventional treatment after admission. Procedure of treatment was conducted as the following: hemoperfusion (2 h/day) and followed by continuous veno-venous hemofiltration (22 h/day) for at least 5 days. Patients' clinical features, serum laboratory tests, and hemodynamic variables were monitored. The blood samples were taken to measure the changes of plasma cytokines. RESULTS: All 12 patients survived in the observation period. After hemoperfusion plus continuous veno-venous hemofiltration treatment, there were significant improvements in indicators of liver function, renal function, state of consciousness, and mediators in blood circulation, including alanine transaminase, aspartate transaminase, creatine kinase, blood urea nitrogen, serum creatinine, myoglobin, C-reactive protein, and so on. In these patients, acid-base metabolism returned to normal levels; Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II score, and Sequential Organ Failure Assessment score lowered markedly. Furthermore, the plasma levels of interleukin 1ß, interleukin 4, interleukin 6, interleukin 8, and interleukin 10 in these patients were significantly decreased; no significant change was shown in the level of tumor necrosis factor α. CONCLUSION: Our results revealed that hemoperfusion plus continuous veno-venous hemofiltration was effective in the management of patients with multiple organ failure after wasp sting via the non-specific removal of the wasp venom and inflammatory cytokines.

Blockade of glutamate receptor ameliorates lipopolysaccharide-induced sepsis through regulation of neuropeptides.

Glutamate receptors (N-methyl-d-aspartate receptor (NMDAR)) are expressed mainly in the central nervous system (CNS), but several potentially important exceptions are worth mentioning. Recently, NMDAR, a glutamate receptor, has been reported to be found in the lungs. NMDAR is activated in acute lung injury (ALI). Here, the present experiment was designed to examine whether NMDAR blockade (MK-801) ameliorates ALI through affecting neuropeptides in LPS-induced sepsis animal models. Male Kunming mice were divided into control group, LPS group, control + MK-801 group, and LPS + MK-801 group. Bronchoalveolar lavage fluid (BALF) was collected and evaluated. The lung histological pathology was assayed by immunocytochemistry staining. Western blot was used to measure PGP9.5, substance P (SP), and vasoactive intestinal polypeptide (VIP). Results showed that LPS-induced mice animal models were ameliorated by co-treatment with the MK-801, an uncompetitive NMDAR antagonist. Moreover, the protective effects of MK-801 attributed to the increased secretion of VIP and decreased secretion of SP. The results of the present study indicated that the blockade of NMDAR may represent a promising therapeutic strategy for the treatment of sepsis-associated ALI through regulation of neuropeptides.

Management and Outcomes of Cerebrospinal Fluid Leak Associated With Anterior Decompression for Cervical Ossification of the Posterior Longitudinal Ligament With or Without Dural Ossification.

STUDY DESIGN: A retrospective clinical study. OBJECTIVE: To analyze and evaluate the clinical outcomes of cerebrospinal fluid (CSF) leak after anterior decompression for cervical ossification of the posterior longitudinal ligament (OPLL) with or without dural ossification (DO). SUMMARY OF BACKGROUND DATA: Anterior decompression can be highly efficacious in the treatment of OPLL. However, in some cases of OPLL, there often exists DO and fusion with the posterior longitudinal ligament, which may increase the chance for CSF leak during an anterior decompression surgery. MATERIALS AND METHODS: A retrospective analysis was performed on 126 OPLL patients (89 men and 37 women) treated with anterior decompression surgery between January 2008 and January 2012. The mean age at operation was 61 years (ranging from 46 to 72 y) and the average duration of diagnosis was 4.2 years (ranging from 3 d to 7 y). DO was present in 11 patients, of whom 7 developed dural tear or defect. Among the 115 patients without DO, only 4 developed dural tear. Intraoperative dural repair was performed with gelatin foam onlay and fibrin glue seal. Postoperative care for CSF leak involved bed rest, CSF drainage, nutritional support, and antibiotics. RESULTS: A total of 11 cases associated with dural tear or defect developed postoperative CSF leak (an overall incidence of 8.7%). There was a statistically significant difference (P<0.001) in the incidence of CSF leak between the DO group (63.6%) and the non-DO group (3.5%). While leakage in 3 patients resolved spontaneously within 5 days of surgery, intermittent CSF cysts developed in 8 patients. These were treated with circular pressure bandages, repeated aspiration, and lumbar drainage. All 8 cases resolved 14-30 days after surgery. These 11 patients were followed up for an average of 12.8 months (range of 1 to 36 mo) with an average Japanese Orthopedic Association score of 51.2% and no significant neurological deficit or persistent headaches were recorded. CONCLUSIONS: Patients with DO are at increased risk for dural injury while undergoing anterior decompression for the treatment of OPLL. This is associated with a high incidence of CSF leak. However, the majority of patients with CSF leak could be managed conservatively.

Dysphagia after anterior cervical discectomy and fusion: a prospective study comparing two anterior surgical approaches.

BACKGROUND: The Smith-Robinson approach is commonly used to expose the vertebrae in anterior cervical discectomy and fusion (ACDF). Postoperative dysphagia has been frequently reported following this procedure. In this approach, surgical dissection can be carried out either lateral (LEO) or medial (MEO) to the omohyoid muscle. The purpose of this study was to compare the degree of dysphagia between the LEO and MEO groups. METHODS: In this randomized, prospective study, 80 patients were enrolled and evenly divided into the MEO and LEO groups. Patients underwent two-level ACDF using a right-sided Smith-Robinson approach. Follow-up was obtained 1, 3, 6, 12 week and 6 months after surgery. The degree of dysphagia was assessed using a 14-item questionnaire from the SWAL-QOL survey. RESULTS: There were no differences between the MEO and LEO groups with respect to age, gender, body mass index, or length of surgery. Overall, the SWAL-QOL scores were not different between the two groups at any of the follow-up time points. However, when the level of surgery was taken into consideration, the early postoperative SWAL-QOL scores were significantly lower in the C3-C4 subgroup when the MEO approach was used. Conversely, the SWAL-QOL scores were significantly lower in the C6-C7 subgroup when the LEO approach was used. Two patients with C6-C7 surgery in the MEO group also developed dysphonia that resolved spontaneously within 3 months. CONCLUSION: The findings from this study suggest that the LEO approach should be selected if the level of surgery involves C3-C4. For C6-C7 surgery, however, a left-sided MEO approach should be used. Depending on surgeon's preference, either approach can be used if both cervical levels are involved.

Trauma-induced spinal cord injury in cervical spondylotic myelopathy with or without lower cervical instability.

Dynamic factors are important contributors to neurologic deficits in cervical spondylotic myelopathy (CSM) patients. Between 2005 and 2009, we retrospectively investigated 72 patients with CSM with or without lower cervical instability for their neurologic status after low-energy trauma and surgery. Patients were divided into two groups: the instability group and the stability group. The neurologic status was evaluated using the Japanese Orthopaedic Association (JOA) scoring system. The incidence of neurologic deterioration after trauma was higher in patients with lower cervical instability than in those without (p<0.05). Patients in the instability group had a lower preoperative JOA score (p<0.05) and experienced less post-surgery improvement in neurologic function than those in the stability group (p<0.01). Even a minor trauma to the neck can lead to irreversible spinal cord injury for patients with CSM with cervical instability. Eliminating local instability through surgical and non-surgical methods is necessary for such patients before decompression and fusion surgery.

A pilot study on the feasibility of real-time calculation of three-dimensional dose distribution for (153)Sm-EDTMP radionuclide therapy based on the voxel S-values.

OBJECTIVE: Using (153)Sm-EDTMP therapy for bone metastases from nasopharyngeal cancer (NPC), we attempted a real-time three-dimensional (3D) dose calculation based on the S-value for voxels. The 3D radionuclide uptake data on SPECT images were factored into the precalculations by the Monte Carlo (MC) method. METHODS: For the nuclide (153)Sm, the S-value for voxels of size 3.45 x 3.45 x 3.45 mm(3) in a soft tissue phantom was precalculated on a self-developed program built from the MC program EGS4. Based on the SPECT/CT image of the patient, the 3D dose rate distributions were calculated with the S-value method and compared with the direct MC calculation results. The total volume of the whole calculation region and the bone were chosen as the regions of interest (ROIs); additionally, the dose rate volume histograms (DVHs) for the ROIs were also calculated. RESULTS: The iso-dose was administered based on the scan images obtained at 6 hours following injection with the nuclide. In the calculation region, the maximum dose rate was 5.98 x 10(-5) and 6.26 x 10(-5) mGy/(MBq S) for S-value and direct MC calculations, respectively. Once the dose rate was normalized to the maximum dose rate point, the iso-dose curves for both methods of calculation were similar in most regions and reasonably matched the functional image as well. The DVHs of the ROIs indicated that the dose rate distributions were nonuniform, that is, approximately 30% of the bone-ROI volume received 10% of the maximum dose rate; however, only 3.8% volume received 50% of the maximum dose rate. CONCLUSIONS: Using (153)Sm-EDTMP therapy for bone metastases from NPC, we attempted to supplement the current dosimetry work at the image-level by a pragmatic and real-time dosimetry calculation based on S-value and functional imaging. More accurate dose calculations for patients undergoing radionuclide therapy will depend on the development of higher image resolution in nuclear medicine and warrant further studies to optimize the pharmacokinetics model.