Is extra-pleura Nuss procedure more secure and effective?

PURPOSE: To compare total extra-pleura Nuss procedure with classical Nuss, and evaluate the efficacies and safety of thoracoscopic total extra-pleural approach of Nuss procedure for correction of pectus excavatum in children. METHODS: We managed 69 patients with pectus excavatum from July 2006 to October 2012. Of the 69 patients, 40 underwent thoracoscopic total extra-pleural approach of Nuss (group A), and 29 underwent classical Nuss procedure (group B). In group A, there were 29 boys and 11 girls, and the mean age was 6.4 (ranged from 3.5 to 14.5). Under thoracoscopic guidance, an extra-pleural tunnel was created using a blunt dissector via a right thoracic incision. A steel bar was inserted in the entirely extra-pleural tunnel. The bar was turned and fixed as in standard Nuss procedure. In group B, there were 20 boys and 9 girls, and the mean age was 5.9 (ranged from 4 to 11) years. Under thoracoscopic guidance, a blunt dissector was inserted into pleura cavity directly via a right thoracic incision. It was a standard Nuss procedure. RESULTS: The operations were completed successfully in all patients. None of the children developed pneumothorax or injuries to the pericardium, heart or lungs. The operating time was 42.0 ± 5.3 and 43.4 ± 6.0 min in group A and B, respectively, and the difference was not significant (p = 0.306). Compared to group B, the postoperative hospital stay of group A was shorter (4.0 ± 1.1 vs 5.2 ± 1.2 days, p = 0.001). The outcomes of both groups were similar (97.5% in group A vs 93.8% in group B, p = 0.377) but pain time was shorter, and time of taking painkiller was less than those of group B (2.6 ± 0.8 vs 4.1 ± 1.0 days, p = 0.001; 1.1 ± 0.6 vs 1.8 ± 0.9 time, p = 0.008). No patients in group A developed subcutaneous emphysema or pleural irritation, while 5 patients in group B showed the symptoms (p = 0.004). All patients were followed-up for 4-30 months (mean 20.2). During the follow-up, none of the children had pulmonary infection or dislocation of the steel board or fixation instruments before the bar was removed. 69 patients removed their bar after a 24-month period on average. According to Nuss' postoperative assessment criteria, one patient in group B was fair. The other patients were all excellent or good. CONCLUSIONS: Extra-pleura Nuss procedure under thoracoscopic guidance is a safe and less traumatic procedure for the correction of pectus excavatum. It is not only superior in postoperative recovery and pleural cavity protection, but also results in fewer complications than the intrapleural procedures.

AMI, an Indazole Derivative, Improves Parkinson's Disease by Inhibiting Tau Phosphorylation.

Dopaminergic neuronal loss is the main pathological character of Parkinson's disease (PD). Abnormal tau hyperphosphorylation will lead to dopaminergic neuronal loss. An indazole derivative 6-amino-1-methyl-indazole (AMI) successfully synthesized to inhibit tau hyperphosphorylation may exert a neuroprotective effect. The in vitro study showed that AMI effectively increased cell viability and alleviated the apoptosis induced by MPP+ in SH-SY5Y cells. In addition, AMI treatment significantly decreased the expression of p-tau and upstream kinases GSK-3ß. In the MPTP-induced PD mice models, we found AMI apparently preserved dopaminergic neurons in the substantia nigra and improved the PD behavioral symptoms. Our results demonstrate that AMI exerts a neuroprotective effect by inhibiting tau hyperphosphorylation, representing a promising new candidate for PD treatment.

Protective role of 6-Hydroxy-1-H-Indazole in an MPTP-induced mouse model of Parkinson's disease.

This study aimed to explore the neuroprotective role of 6-hydroxy-1H-indazole on dopaminergic neurons in a 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP) mouse model of Parkinson's disease (PD). Forty 12-week-old C57BL/6 male mice were were randomized divided into 4 groups. Mice were treated with 2mg/kg and 4mg/kg 6-hydroxy-1H-indazole (i.p.) 1d before the initiation of MPTP administration (30mg/kg), and the 6-hydroxy-1H-indazole were daily injected half an hour before MPTP treatment in the following 5 days. The MPTP group was given normal saline on day 1 (i.p.), followed by 30mg/kg MPTP treatment in the following 5 days. Control group received an equivalent volume of normal saline. Ten days after the final injection of MPTP, the mice were killed. The results showed that MPTP decreased the dopaminergic neurons in the substantia nigra and dopamine in the striatum, downregulated the expression of tyrosine hydroxylase (TH), induced the impairment of behavior and hyperphosphorylation of tau, However, 6-hydroxy-1-H-indazole decreased the loss of dopaminergic neurons, increased dopamine concentration and TH expression, alleviated the behavioral damage and level of phosphor-tau in the MPTP-induced model of PD in C57BL/6 mice. These findings showed that 6-hydroxy-1-H-indazole-mediated neuroprotection was related to the inactivation of tau. In addition, 6-hydroxy-1-H-indazole may be a potential drug candidate for PD.