Efficacy of percutaneous cement-augmented screw fixation plus percutaneous kyphoplasty in the management of unstable osteoporotic vertebral compression fractures.

OBJECTIVE: The present study was performed to compare the efficacy of percutaneous kyphoplasty (PKP) vs. percutaneous cement-augmented screw fixation plus PKP in the management of unstable osteoporotic vertebral compression fractures (OVCF). PATIENTS AND METHODS: A total of 197 patients with unstable OVCF treated in the Department of Spine Surgery, Lianyungang First People's Hospital from September 2019 to September 2021 were recruited and assigned via random number table method 1:1 to receive either PKP (group A, n=106) or PKP plus percutaneous cement-augmented screw fixation (group B, n=91). The outcome measures for the evaluation of different surgical methods included visual analogue scale (VAS), the height of the anterior-posterior border of the injured spine, Cobb angle of the posterior convexity, Oswestry disability index (ODI) scores, and Japanese Orthopaedic Association (JOA) scores. RESULTS: PKP exhibited shorter operative time and length of hospital stay and less intraoperative blood loss vs. PKP plus percutaneous cement-augmented screw fixation (p<0.05). Patients with PKP plus percutaneous cement-augmented screw fixation experienced milder postoperative pain vs. those with PKP alone at 7 days postoperatively, as evidenced by the lower VAS scores (p<0.05). PKP plus percutaneous cement-augmented screw fixation provided more restoration of anterior margin height and posterior convexity Cobb angle vs. PKP alone (p<0.05). Patients with PKP only showed slightly higher Japanese Orthopaedic Association (JOA) scores than those with combined surgery, while the postoperative clinical signs between the two arms were similar (p>0.05). CONCLUSIONS: Single PKP features the benefits of minimal trauma, simple operation, and rapid postoperative recovery in the treatment of OVCF. PKP plus percutaneous cement-augmented screw fixation for severe OVCF provided distinctly better performance than PKP alone in terms of early pain relief, restoration of vertebral body height, correction of posterior convexity deformity, and firm spinal stability.

[Evaluation of effects of comprehensive intervention based on key persons on AIDS-related high-risk behaviors in male sex workers in entertainment venues].

Objective: To evaluate the effect of comprehensive intervention model based on key persons in entertainment venues on the incidence of AIDS-related high-risk behaviors in male sex workers (MSW). Data from this study thus can be used to provide compelling evidence for the wider implementation of the intervention model. Methods: In this randomized controlled trial, MSW were recruited and followed-up from May to December, 2021 in entertainment venues in Wuxi, Jiangsu Province, with an estimated sample size of 320. The MSW in the intervention group were provided with comprehensive interventions via key persons in entertainment venues compared with the control group receiving routine interventions. The effect of the intervention model was assessed by comparing the behavioral differences between these two groups and in the intervention group before and after intervention. Results: A total of 330 MSW were recruited at baseline survey, in which 168 were divided into intervention group and 162 into control group. There was no significant difference in socio-demographic characteristics between two groups (all P>0.05). After intervention for 6 months, the rate of consistent condom use in commercial homosexual activities in the intervention group was 79.5% (101/127), higher than 63.2% (74/117) in the control group, and in the intervention group, 90.1% (73/81) of MSW used condom consistently in heterosexual activities, higher than in the control group (59.6%, 59/99) . Compared with 30.8% (36/117) of MSW with drug abuse history in the control group, a lower proportion of 9.4% (12/127) was observed in the intervention group. Differences in all of aforementioned variables were significant (all P<0.05). After intervention, the incidence of group sex was 3.9% (5/127) in the intervention group and 9.4% (11/117) in the control group, the incidence of anal sex post-alcohol consumption was 40.2% (51/127) in the intervention group and 32.5% (38/117) in control group, the differences were not significant (all P>0.05). Conclusions: The intervention model based on key persons in entertainment venues could promote consistent condom use in MSW in both commercial homosexual and heterosexual activities and help them reduce drug abuse, but had no significant effect on decreasing group sex and anal sex after alcohol consumption. It is crucial to improve the intervention model according to the specific characteristics of MSW in order to enhance the effects of comprehensive intervention.

Efficacy of minimally invasive transforaminal lumbar interbody fusion plus cement-augmented pedicle screw fixation in the treatment of degenerative lumbar spine disease with osteoporosis in the elderly.

OBJECTIVE: The aim of this study was to evaluate the efficacy of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) plus cement-augmented pedicle screw fixation in the treatment of degenerative lumbar spine disease with osteoporosis in the elderly. PATIENTS AND METHODS: From February 2020 to January 2021, 40 elderly patients with degenerative lumbar spine disease with osteoporosis admitted to our hospital were randomly assigned (1:1) to receive either MIS-TLIF plus cement-augmented pedicle screw fixation (group A) or TLIF plus cement augmentation (group B), with 19 cases in group A and 21 cases in group B. Outcome measures included visual analogue scale (VAS), Oswestry Dysfunction Index (ODI) and Japanese Orthopedic Association Scores (JOA), operative duration, intraoperative bleeding, postoperative drainage volume, and the incidence of complications. Frontal and lateral radiographs of the lumbar spine and computed tomography (CT) were performed 3 days after surgery to observe the distribution of bone cement. At 12 months postoperatively, the fusion of the bone graft was evaluated according to the Bridwell intervertebral fusion criteria based on the lumbar frontal and lateral radiographs. RESULTS: All 40 cases completed the surgery successfully and were followed up for 12 months. The two groups did not differ significantly in terms of operative duration (p>0.05). MIS-TLIF plus cement-augmented pedicle screw fixation was associated with significantly less intraoperative bleeding volume (142.25±40.93 mL) and (76.25±17.54 mL) vs. TLIF plus cement augmentation (322.00±93.45 mL, 159.75±54.74 mL) (p<0.05). The difference in the VAS scores, ODI, and JOA scores between the two groups preoperatively and at the final follow-up showed no statistical significance (p>0.05). Patients receiving MIS-TLIF plus cement-augmented pedicle screw fixation had significantly lower VAS scores and ODI and higher JOA scores vs. TLIF plus cement augmentation (p<0.05). The lumbar frontal and lateral radiographs and CT of the two groups 3 days after surgery showed good cement distribution and no cement leakage. At the final follow-up, no complications were seen in group A, and there was one case of intervertebral cement leakage in group B. The intervertebral graft fusion was grade I in both groups. CONCLUSIONS: MIS-TLIF plus cement-augmented pedicle screw fixation shortens the operative time, alleviates postoperative pain, facilitates operative lumbar spine function restoration, and provides favorable intervertebral implant fusion.

Specific inhibition of delta antigen by in vitro system by antisense oligodeoxynucleotide: implications for translation mechanism and treatment.

Synthetic antisense oligodeoxynucleotides (ODNs) and a system containing transcription and translation coupled rabbit reticulocyte lysate were used to develop a new model modulating the synthesis of small delta antigen which, in turn, inhibits the replication of HDV (hepatitis D virus). The ODN was stable for at least 50 min in this system at 37 degrees C. Unmodified 15-mer antisense D3 and D4, complementary to translation initiation region and coding region, respectively, inhibit the synthesis of small delta antigen by 95% at a concentration of 5 microM, whereas antisenses complementary to 5' noncoding region, stop codon region and polyadenylation site were less effective. This system also showed a dose-dependent inhibitory effect of antisense D3 on the production of the target protein. However, the synthesis of E6 protein, an internal control, was not affected. These observations imply that this in vitro system is convenient for rapid screening of effective antisense compounds and offers a promising perspective for the investigation of translation mechanisms and for the inhibition of HDV replication by antisense strategy.

Prognostic factor analysis of fulminant and subfulminant hepatic failure in an area endemic for hepatitis B.

In order to determine the criteria in selecting candidates for orthotopic liver transplantation (OLT), we assessed the aetiology and prognostic indicators in 61 patients with fulminant or subfulminant hepatitis during the past 13 years. Several previously reported models of high risk predictors were not suitable for a large portion of our patients with different aetiological and ethnic backgrounds. In the present study, serological markers of various hepatitis viruses were tested and clinical parameters were compared between survivors and non-survivors. Multiple virus infection and multifactorial causes were important in the pathogenesis (48%) of acute liver failure. Among the 13 clinical parameters, six were considered significant on univariate analysis: prothrombin time prolongation (P < 0.001), total bilirubin, creatinine and alpha-fetoprotein (P < 0.01), age and cholesterol (P < 0.05). With stepwise logistic regression using most discriminatory cut-off values, an age of > 43 years (P = 0.0001), total bilirubin levels of > 23 mg/dL (P < 0.005) and prothrombin time prolongation > 19 s (P < 0.0001) were independent predictors of non-survival. When applied to determine the index of poor prognosis, the sensitivity, specificity, positive predictive value, negative predictive value and predictive accuracy were 100, 67, 95, 100 and 95%, respectively, in the presence of any one of these prognostic factors. We conclude that these indicators may be useful for selecting patients with acute liver failure indicated for OLT.

Ruptured hepatocellular carcinoma: treatment strategy and prognostic factor analysis.

BACKGROUND: The prognosis of ruptured hepatocellular carcinoma (HCC) is generally poor, but few studies have focused on the analysis of prognostic factors of this catastrophic event. METHODS: Eighty-four consecutive patients with ruptured HCC were included. Twenty-nine clinical and laboratory variables were correlated to prognosis by using uni- and multivariate analyses. RESULTS: Epigastralgia and/or right upper quadrant abdominal pain was the most common initial presentation (70%), followed by shock (42%), abdominal distension (27%) and others (17%). Of these 84 patients, 50 patients were treated by supportive measure, 21 by operation and 13 by transcatheter arterial embolization (TAE). The median survival was 13, 30 and 202 days in each group, respectively, and 24 days overall. TAE showed the lowest hemostatic failure rate (20%). Univariate analysis showed that active treatment (operation or TAE), group I tumor with a solitary nodule or single nodule with proliferation into surrounding area, serum creatinine (< or = 1.2 mg/ml), alkaline phosphatase (< or = 95 U/L), alanine aminotransferase (ALT, < or = 40 U/L), total bilirubin (< or = 1.6 mg/ml), initial systolic blood pressure (> or = 90 mmHg), and absence of main portal vein thrombosis were correlated with a survival longer than 90 days (p < 0.05) in univariate analysis. Active treatment, ALT level and initial systolic blood pressure were still significant in multivariate analysis (p < 0.05). CONCLUSIONS: TAE may help stop the tumor bleeding. Treatment regimen, ALT levels and initial blood pressure are correlated with the prognosis of ruptured HCC.

Prevalence and type of precore hepatitis B virus mutants in hepatitis D virus superinfection and its clinical implications.

To study the prevalence and type of the hepatitis B e antigen (HBeAg)-negative mutant in hepatitis D virus (HDV) superinfection, the precore region of hepatitis B virus (HBV) was analyzed by cycle sequencing. Of the 58 samples sequenced, 24 were wild type and 34 carried mutants. The precore stop mutation (TAG) at the 28th codon was found in 32 cases, other mutations were found in 7, and double mutations were found in 5. The absence of HBeAg showed a substantial agreement with the presence of mutants (kappa value, 0.74). Of the acute hepatitis patients, HDV replication and clinical manifestations were not significantly different between those with mutant and wild type virus, except that those with mutant virus were older (mean age, 48 vs. 28 years; P < .002). The absence of HBeAg in these patients is mainly due to HDV superinfection in older HBV carriers who already had precore mutant.

A method for screening antisense oligodeoxyribonucleotides effective for mRNA translation-arrest.

A transcription and translation coupled reticulocyte lysate system was established for rapid screening of antisense oligodeoxyribonucleotides (ODNs) to determine which are most effective for mRNA translation-arrest. A plasmid containing the target cDNA under the control of the T7 (or SP6) promoter was added to the lysate system in the presence of the T7 (or SP6) RNA polymerase, RNase H, and the antisense ODN under test. Transcription and translation were accomplished in a one-tube reaction. Translation-arrest caused by antisense ODN was evaluated in terms of the amounts of de novo-synthesized, [35S]-methionine or [35S]cysteine labeled target protein measured by gel electrophoresis and autoradiography. The properties of this system and optimal reaction conditions for use in antisense ODN screening were determined. Our method is simpler and more rapid than other in vitro screening methods.

Genotyping of hepatitis D virus by restriction-fragment length polymorphism and relation to outcome of hepatitis D.

The outcome of hepatitis D virus (HDV) superinfection varies among patients and in different geographical areas. To find out whether HDV genotype affects outcome, we used a simple genotyping method based on restriction-fragment length polymorphism with enzymes XhoI and SacII for cleavage of PCR products of the HDV genome. Of samples from 88 patients studied, the genotypes of 61 were confirmed by two methods--analysis with both enzymes or by combined restriction-enzyme and direct sequencing analyses--with consistent results. No genotype III HDV was detected among these patients. The majority of patients with acute HDV infection (35/41 [85%]) had genotype II HDV. Among the 41 patients with acute infection, four of six with genotype I had fulminant disease compared with two of 35 with genotype II. Among patients in chronic stage, cirrhosis or hepatocellular carcinoma were found in 12 of 18 with genotype I HDV and eight of 29 with genotype II. Thus genotype II was the predominant HDV genotype in this study in Taiwan. Genotype II HDV was less frequently associated with fulminant hepatitis at the acute stage or with an unfavourable long-term clinical outcome at the chronic stage than was genotype I.

Acute relapsing hepatitis A in Taiwan--a rare event not related to multiple viral infection: a report of two cases.

From 1981 to 1993, 40 cases of acute type A viral hepatitis were reviewed and 2 cases (5%) of relapsing hepatitis were reported here. One case relapsed two weeks after remission and the other relapsed three weeks after remission, both had benign courses and recovered within four months. They were negative for serum hepatitis B surface antigen and hepatitis B core IgM antibodies. The serum autoantibodies, hepatitis C antibodies and hepatitis E antibodies were all negative during relapse. In summary, relapsing hepatitis A is rare in Taiwan and it is not related to multiple viral infections.

Clinical and radiological pictures of hepatocellular carcinoma with intracranial metastasis.

Hepatocellular carcinoma (HCC) with extrahepatic spreading is not uncommon. In order to delineate the clinical and radiological pictures of HCC with intracranial metastasis, 33 documented cases were analysed. Eighteen had brain parenchymal metastasis without skull involvement; the other 15 cases disclosed skull metastasis with brain invasion. The underlying HCC are mainly of expanding (13/33, 39.4%) and multifocal (13/33, 39.4%) types. Eighteen cases (18/33, 54.5%) had mental changes not related to hypoglycaemia or hepatic encephalopathy. Eighteen cases (18/20, 90%) disclosed hyperdense mass lesions by non-contrast computed tomography (CT) scans and 17 cases showed homogeneous enhancement (17/22, 77.3%) by post-contrast CT images. In the non-skull involved group, five cases (5/12, 41.7%) disclosed ring-shape enhancement and 14 cases (14/16, 87.5%) had perifocal oedema, which were not seen in the skull involved group. Eight cases (8/33, 24.2%) presented as intracerebral haemorrhage. Twelve (12/33, 36.4%) died of brain herniation. Most (14/18, 77.8%) non-skull involved cases had simultaneous lung metastasis without bony metastasis, while the skull involved group often (10/15, 66.7%) disclosed extracranial bony metastasis without lung metastasis. The difference in extracranial metastasis was statistically significant (P < 0.05). The multivariate survival analysis disclosed that lower lactate dehydrogenase level (< or = 316 U/L, P = 0.029) and treatments (surgery or radiation, P = 0.001) were positively associated with longer survival. In conclusion, HCC with intracranial metastasis is symptomatic and life-threatening. Half the cases may come from pulmonary metastasis and the other half may be from bony metastasis. Brain irradiation or surgery can prolong their survival.

Injection with nondisposable needles as an important route for transmission of acute community-acquired hepatitis C virus infection in Taiwan.

A prospective case-controlled study was conducted in order to determine the transmission route of community-acquired hepatitis C virus (HCV) infection in Taiwan. Thirty-eight consecutive patients (25 men and 13 women) with acute community-acquired HCV infection and 76 age (within 3 years)- and sex-matched healthy control subjects without HCV infection were enrolled. Serum anti-HCV was tested by second generation immunoassay. The sera of 26 family members from 12 families of index patients were also tested for anti-HCV. A questionnaire covering the history of blood transfusion, surgery, intravenous drug abuse, prostitute contact, dental procedures, injection, acupuncture, tattooing, and ear-piercing was conducted among patients and control subjects. Univariate analysis revealed injection with nondisposable needles was an independent risk factor (P = 0.02, odds ratio = 4.17, 95% confidence interval = 1.24-14.47) associated with HCV infection. Other risk factors were not significant. Only 2 (7.7%) family members of index patients had an anti-HCV. In conclusion, more vigorous effort to prohibit the use of nondisposable needles should be promoted to interrupt the spread of community-acquired HCV infection in Taiwan. Of note, a significant number of patients (34.2%) contracted HCV infection without identifiable risk factors. Unidentified routes need to be investigated.

Transcatheter arterial embolization for hepatocellular carcinoma with portal vein thrombosis.

In order to evaluate the possible benefits of transcatheter arterial embolization (TAE) in hepatocellular carcinoma (HCC) patients with peripheral portal vein thrombosis, 96 consecutive HCC cases with peripheral portal vein thrombosis were analysed. Of them, 35 cases received TAE and 61 cases did not. Most (77.8%) of the TAE-treated cases showed decreased alpha-fetoprotein (AFP) levels after treatment, but 57.1% of them suffered another rise in AFP levels and subsequently died. One patient (2.8%) developed progressive jaundice after TAE and died within 1 month, while four of the non-TAE cases died within 1 month after diagnosis. In general, TAE is safe for HCC patients with peripheral portal vein thrombosis. In addition, using Cox's regression model for multivariate survival analysis, serum total bilirubin (< or =, > 2 mg/dL; P = 0.0254), AFP (< or = 3155 ng/mL, > 3155 ng/mL; P = 0.0002) and treatments (TAE, non-TAE; P = 0.0059) were found to affect their prognosis. There was significant difference in survival between TAE and non-TAE groups, the 6 month, 1 year and 2 year survival rates were 91.4 versus 62.3%, 51.4 versus 26.2% and 17.1 versus 4.9% (P = 0.0017). The median survival times of TAE and non-TAE groups were 10.3 versus 3.7 months, respectively. Though TAE only provided palliative treatment, it did prolong survival in HCC patients with peripheral portal vein thrombosis.

Natural history of hepatitis D viral superinfection: significance of viremia detected by polymerase chain reaction.

BACKGROUND/AIMS: Polymerase chain reaction (PCR) is very sensitive. The aim of the study was to reevaluate viral replication in hepatitis D virus (HDV) superinfection by PCR. METHODS: HDV and hepatitis B virus (HBV) were detected by PCR in 185 patients. RESULTS: The acute hepatitis group had the highest detection rate of HDV RNA compared with chronic hepatitis, cirrhosis, hepatocellular carcinoma, and remission groups (63 of 64 vs. 35 of 47, 17 of 23, 19 of 30, and 7 of 21) and the highest alanine aminotransferase (ALT) levels (mean, 1741 U/L vs. 266 to 27 U/L; P < 0.05). The detection rate of HBV DNA was the lowest in the acute group (41%) compared with 66%, 70%, 80%, and 57% in the remaining groups (P < 0.02). At the chronic stage, 13%-25% of cases had HDV RNA, and 30%-48% of cases had HBV DNA detected by PCR but not by traditional method. HDV RNA was associated with ALT levels in horizontal and longitudinal analyses. CONCLUSIONS: HDV superinfection may be divided into the following three phases: acute phase, active HDV replication and suppression of HBV with high ALT levels; chronic phase, decreasing HDV and reactivating HBV with moderate ALT levels; and late phase, development of cirrhosis and hepatocellular carcinoma caused by replication of either virus or remission resulting from marked reduction of both viruses.

[Influences of lipid peroxidative injury to endothelial cells on adherence and migration of monocyte].

The influences of lipid peroxidative injury to endothelial cells (EC) on adherence to EC and migration into subendothelial space of human monocytes were studied by using a modified vascular endothelial model in vitro. Lipid peroxidative injury to cultured human umbilical vein EC was initiated by treating the EC with diamide. The results showed that injury to EC could enhance adherence to EC and migration into subendothelial space of monocytes. Monocytes mainly adhered to the intercellular space and surface of injured EC. In the area of EC denudation, the number of monocytes which migrate into the subendothelial space was more than that in the area without denudation. These results suggested that enhanced adherence to EC and migration into subendothelial space of monocytes caused by lipid peroxidative injury to EC may play an important role in atherogenesis.

Multiple viral infection as the most common cause of fulminant and subfulminant viral hepatitis in an area endemic for hepatitis B: application and limitations of the polymerase chain reaction.

We tested serum samples from 25 fulminant hepatitis and 7 subfulminant hepatitis patients for hepatitis A, B, C, D and E viral markers and nucleic acids by means of polymerase chain reaction to determine the role of each virus on such catastrophic events in an area endemic for hepatitis B. Of these 32 patients, 14 (44%) were hepatitis B virus carriers with hepatitis D virus superinfection (1 with hepatitis C virus infection), 3 others had coexisting hepatitis B virus and hepatitis C virus infections, 6 had reactivation of underlying chronic hepatitis B, 4 had acute hepatitis B, 2 had acute hepatitis C and 1 had acute hepatitis E. Pathogenesis in the remaining two cases was unclear. Serum hepatitis B virus DNA was detectable in most carriers without superinfection and in one third of those with superinfection detected on polymerase chain reaction (6 of 7 vs. 6 of 16, p < 0.05). Of the polymerase chain reaction-positive samples, only 17% yielded positive results on spot hybridization. Hepatitis B virus DNA was the only marker to indicate coexisting hepatitis B virus infection in one patient positive for hepatitis C virus antibody. Only three of the six hepatitis C virus-infected cases were positive for hepatitis C virus antibody; diagnoses in the remaining three were established by means of detection of hepatitis C virus RNA. Of the hepatitis D virus-infected patients, infection in only half was diagnosed by means of total hepatitis D virus antibody assay. Twelve (86%) were positive for anti-hepatitis D virus IgM and nine (64%) had detectable hepatitis D virus RNA on reverse transcription-polymerase chain reaction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of lipid peroxidation injury to endothelial cells (EC) on adherence of monocytes].

Inducing lipid peroxidation injury to cultured EC from human umbilical vein was achieved by treating EC with diamide. When the concentration of diamide reached 0.1 x 10(-4) mol/l, intracellular accumulation of lipid peroxide and EC damage were induced and then increased adherence of monocyte to EC was observed. Monocytes appeared to prefer to adhere onto the surfaces and intercellular spaces of the injured EC. These results suggest that the increased adherence of monocytes to EC injured by lipid peroxidation may play an important role in atherogenesis.

Hepatitis D virus infection among prostitutes in Taiwan.

Two hundred and sixty-three adult licensed, 233 adult and 157 teenage unlicensed prostitutes from Taiwan were studied for prevalence and risk factors of hepatitis D virus (HDV) infection. The hepatitis B carrier rate among the three groups was 21, 15 and 20%, respectively, not significantly different from that of the general population in this area. However, the prevalence of HDV infection among carrier prostitutes was 55, 36 and 16%, respectively, much higher than that in general hepatitis B carriers. Univariate analysis revealed that the history of conducting paid sex for more than 12 months (P < 0.03), ear-piercing (P < 0.02), tattooing (P < 0.02), and gonorrhoea or syphilis (P < 0.005) were significant factors associated with HDV infection among these subjects. Multivariate analysis revealed that the history of ear-piercing and venereal diseases (P < 0.001) were still significant. In summary, genital ulcers caused by venereal diseases due to frequent sexual contact with multiple partners, and use of unsterilized needles in ear-piercing or tattooing play important roles in the high prevalence of HDV infection in prostitutes.

Heterosexual transmission as the most common route of acute hepatitis B virus infection among adults in Taiwan--the importance of extending vaccination to susceptible adults.

Sixty adult patients with acute viral hepatitis B (AVHB) and 93 controls were interviewed to assess potential risk factors of hepatitis B. Heterosexual contact was the only significant factor, and it was associated with 83% of cases. A history of having new sex partners or multiple sex partners within 6 months before the onset of AVHB or first sexual contact before 20 years of age were significantly associated with HBV infection (P < .005, respectively). There was a dose-response relationship between the number of sex partners and the risk of HBV infection. In multivariate analyses, a history of having new sex partners was the most important factor. Moreover, 18 of 24 sex partners of the patients were serum hepatitis B surface antigen- and HBV DNA-positive. Heterosexual contact is, therefore, the predominant route of HBV transmission among adults in Taiwan. Susceptible adults should receive vaccination.