Unilateral or Bilateral Percutaneous Endoscopic Debridement and Drainage for Thoracolumbar Infections: A Systemic Review and Meta-analysis.

BACKGROUND: Unilateral percutaneous endoscopic debridement and drainage (UPEDD) and bilateral PEDD (BPEDD) are commonly implemented, and have consistently yielded favorable clinical outcomes. Nevertheless, there is a scarcity of literature contrasting the advantages and disadvantages between these 2 procedures. OBJECTIVE: The goal of this research was to conduct a meta-analysis to compare the clinical effects of UPEDD and BPEDD. STUDY DESIGN: A systematic review and meta-analysis. METHODS: A systematic review of studies reporting outcomes following UPEDD and/or BPEDD procedures was performed. The extracted data were used for meta-analysis. Pooled event rates for positive bacteria culture, pain control satisfaction, reoperation, and complications were estimated. The pooled operation time and blood loss were also calculated. RESULTS: Among 764 retrieved articles, 28 studies with 661 patients met the inclusion criteria and were used for our meta-analysis. A total of 21 studies (462 patients) investigated UPEDD outcomes and 7 studies (199 patients) investigated BPEDD outcomes. For the UPEDD group, the pooled event rates for positive bacteria culture, pain control satisfaction, reoperation, and complications were 72%, 91%, 9% and 4%, respectively; the pooled operation time and blood loss were 89.90 minutes and 59.77 mL. For the BPEDD group, these were 79%, 92%, 4%, 8%, 93.23 minutes and 64.93 mL, respectively. LIMITATIONS: First, all included studies were retrospective series, limiting our study design to a single-arm meta-analysis. Second, there was a limited amount of studies that were determined to be fitting, particularly on BPEDD; the sample size was also small. Third, the clinical effects of UPEDD and BPEDD needed to be compared in greater detail, such as the time it took for inflammatory markers to return to normal, the incidence of local kyphosis, and whether the duration of antibiotic use could be shortened after adequate debridement with BPEDD. Lastly, further studies are necessary to compare the clinical outcome of PEDD and percutaneous endoscopic interbody debridement and fusion. CONCLUSIONS: Both UPEDD and BPEDD can provide a relatively reliable causative-pathogen identification and satisfactory clinical outcome. The 2 techniques are not significantly different in terms of positive bacteria culture rate, pain control satisfaction rate, complication rate, and reoperation rate.

Expression of miR-625 and Fas in cervical vertebral cartilage endplate.

The aim of the present study was to assess miR-625 and Fas expression in normal and degenerative cervical cartilage endplate (CEP) tissues. Following biof-informatics analysis, the Fas gene was predicted to be one of the targets of miR-625. Quantitative PCR (qPCR) and western blotting were used to detect miR-625 and Fas expression in normal and degenerative CEP. A luciferase reporter assay was used to identify whether miR-625 could directly target the 3' untranslated region (3'-UTR) of Fas. Lentiviral overexpression and/or inhibition vectors of miR-625 (pre-miR-625)/antigomiR-625 were constructed to determine whether overexpression or inhibition of miR-625 could affect Fas and B-cell lymphoma 2 (Bcl-2) expression in cartilaginous endplate cells (CECs) and tissues. qPCR analysis demonstrated that miR-625 expression in degenerative CEP was significantly lower than in normal CEP tissue, while the production of Fas in degenerated CEP was significantly higher. Results from western blotting also showed a significant increase in Fas expression in degenerative CEP. miR-625 can bind directly to the 3'-UTR of the Fas gene. However, this inhibition was attenuated by a target mutation in the miR-625-binding site of the 3'-UTR of Fas mRNA. In addition, following transfection of CECs with pre-miR-625 and antigomiR-625, expression of Fas significantly decreased and increased, respectively, and Bcl-2 expression was upregulated and downregulated, respectively. Upregulation of miR-625 can inhibit Fas expression and further affect Bcl-2 expression in CEP degeneration, suggesting that miR-625-mediated inhibition of the Fas gene is important in cervical degeneration.

[Application of vacuum sealing drainage in treating large avulsion injuries of limbs].

OBJECTIVE: To investigate the therapeutic effectes of vacuum sealing drainage (VSD) technique and reattachment of avulsed skin in treating avulsion injuries of limbs. METHODS: A retrospective analysis was done on 25 patients suffering from avulsion injuries of limbs, who were treated with vacuum sealing drainage and reattachment of the avulsed skin. Among the patients, 19 patients were male and 6 patients were female, ranging in age from 21 years to 57 years, with an average of 41 years. After debridement, the patients got reattachment of skin graft with subdermal vascular network or split-thickness skin graft, and the wound surface was covered with polyvinyl sponge. VSD was removed after 7 to 14 days. The color, survival rate and sensory function of the skin were observed after operation. RESULTS: All the wounds infection was controlled with VSD. The skin survival rate was more than 96% in 16 cases, more than 90% in 7 cases, and skin edge of 2 cases had little necrosis but rehabilitated after dress-changing. The reattached skins had almost normal skin color, soft and abrasion resistant, satisfactory sensory function, and no compression ulcer was observed after 4 weeks. CONCLUSION: VSD combined with graft with subdermal vascular network or split-thickness skin graft helps to promote wound drainage, reattachment of skin, and decrease infection. It is an effective method in treating avulsion injuries of limbs.

[Use of vacuum sealing drainage and mesh grafting in treating defects of skin and soft tissue in foot].

OBJECTIVE: To explore the therapeutic effectiveness of vacuum sealing drainage (VSD) technique and mesh grafting in treating defects of skin and soft tissues in foot. METHODS: A retrospective analysis was done on 17 cases (11 male and 6 female) suffering from defects of skin and soft tissues in foot, which were treated by vacuum sealing drainage and mesh grafting. The age of patients was from 18 to 67 years with an average of 43 years. The wound surface was filled with polyvinyl alcohol gelatin sponge after debridement and continuous negative pressure drainage was taken for 24 h. After 7 days, granulation tissue growing mesh grafting was performed and to observe the skin colour, survival rate and feet function. RESULTS: All the infection of wounds was controlled with VSD for 1 to 3 times. Skin survival rate of 14 cases more than 98%, 2 cases more than 95%; skin edge of 1 case had little necrosis, but foot function obtained rehabilitation after dress-changing. CONCLUSION: Vacuum sealing drainage (VSD) technique and mesh grafting is effective methods for the treatment of defects of skin and soft tissues in foot and is worthy generalization and application.