Use of immunohistochemical biomarkers as independent predictor of neoplastic progression in Barrett's oesophagus surveillance: A systematic review and meta-analysis.

INTRODUCTION: The low incidence of oesophageal adenocarcinoma (EAC) in Barrett's oesophagus (BE) patients reinforces the need for risk stratification tools to make BE surveillance more effective. Therefore, we have undertaken a systematic review and meta-analysis of published studies on immunohistochemical (IHC) biomarkers in BE to determine the value of IHC biomarkers as neoplastic predictors in BE surveillance. MATERIALS AND METHODS: We searched MEDLINE, EMBASE, Web of Science, CENTRAL, Pubmed publisher, and Google scholar. All studies on IHC biomarkers in BE surveillance were included. ORs were extracted and meta-analyses performed with a random effects model. RESULTS: 16 different IHC biomarkers were studied in 36 studies. These studies included 425 cases and 1835 controls. A meta- analysis was performed for p53, aspergillus oryzae lectin (AOL), Cyclin A, Cyclin D and alpha-methylacyl-CoA racemase. Aberrant p53 expression was significantly associated with an increased risk of neoplastic progression with an OR of 3.18 (95% CI 1.68 to 6.03). This association was confirmed for both non-dysplastic BE and BE with low-grade dysplasia (LGD). Another promising biomarker to predict neoplastic progression was AOL, with an OR of 3.04 (95% CI 2.05 to 4.49). DISCUSSION: Use of p53 IHC staining may improve risk stratification in BE surveillance. Aberrant p53 expression in BE patients appeared to be associated with a significantly increased risk of neoplastic progression for both non-dysplastic and LGD BE patients.

Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of severe scoliosis (>100 degrees).

STUDY DESIGN: Retrospective clinical study. OBJECTIVE: To report the results of surgical correction achieved by intraoperative halo-femoral traction and posterior only pedicle screw instrumentation in severe scoliosis (scoliosis greater than 100 degrees ). SUMMARY OF BACKGROUND DATA: Although previous reports show the effectiveness of preoperative halo traction in the treatment of severe spinal deformity, the intraoperative use of halo-femoral traction in conjunction with posterior pedicle screw instrumentation has never been reported in patients with severe spinal deformity. METHODS: A total of 15 consecutive patients with severe (>100 degrees) thoracic idiopathic scoliosis and/or kyphoscoliosis operated by using intraoperative halo-femoral traction and posterior only pedicle screw instrumentation were included in the study. Subjects were analyzed by age at date of examination, gender, major coronal curve magnitude, major compensatory coronal curve magnitude, major sagittal curve magnitude, shoulder imbalance, and preoperative vital capacity of the lungs. Halo-traction related complications and short- and long-term complications were noted in each case. RESULTS: The average age at the time of surgery was 17.8 years (range, 16-19). There were 4 males and 11 females. The average improvement was 51% in the major thoracic curve, 33% in the compensatory lumbar curve, and 53% in the major sagittal curve. The average follow-up was 56 (range, 24-96) months. Loss of correction averaged 4 degrees for major thoracic curves and 2 degrees for thoracic kyphosis based on measurements at the final follow-up date. CONCLUSION: The use of intraoperative halo-femoral traction together with the wide facet resection and posterior release gradually provide a good correction and balance maintained by pedicle screw instrumentation. Intraoperative halo-femoral traction not only elongates spinal column but also elongates the thoracic cavity improving the compromised pulmonary function.