[Short-term clinical efficacy observation of lesion removal, bone graft fusion, and external brace treatment for late-stage wrist tuberculosis].

OBJECTIVE: To observe the clinical efficacy of lesion removal, bone grafting, fusion, and external fixation in the treatment of late-stage wrist tuberculosis. METHODS: From October 2015 to May 2019, 25 patients with late-stage wrist tuberculosis were treated using lesion removal, bone grafting, fusion, and external fixation. Among these patients, there were 14 males and 11 females, aged from 40 to 74 years old, with an average age of (60.72±8.45) years old. The duration of the disease ranged from 5 to 24 months, with an average of (11.52±7.61) months. There were 11 cases of left wrist tuberculosis and 14 cases of right wrist tuberculosis, with 5 cases accompanied by sinus formation. Postoperative regular anti-tuberculosis treatment was continued. Visual analogue score (VAS), inflammatory indicators, Gartland-Werley wrist function score, and upper limb function score were observed before and after treatment. RESULTS: All 25 patients were followed up for ranging from 12 to 36 months with an average of (19.7±6.3) months. At the latest follow-up, all wounds were healed satisfactorily, and there was no recurrence of tuberculosis or infection. VAS at one week before operation and three months after operation were (5.16±1.14) score and (1.68±0.80) score respectively. One week before operation and three months after operation, erythrocyte sedimentation rate (ESR) was (44.20±20.56) mm·h-1 and (14.44±1.14) mm·h-1, and C-reactive protein (CRP) was (12.37±7.95) mg·L-1 and (4.3±3.37) mg·L-1. The differences in all three data sets were statistically significant (P<0.01). According to Gartland-Werley wrist function scoring, the scores at one week before operation and one year after operation were (21.32±3.44) and (14.96±1.37) respectively, showed a statistically significant difference (P<0.01). According to the upper limb function score (disabilities of the arm, shoulder, and hand, DASH), the score was (70.52±7.95) at one week before operation and(28.84±2.30) at one year after operation. The difference was statistically significant (P<0.01). At the latest follow-up, no patient had a recurrence of tuberculosis. CONCLUSION: The short-term clinical efficacy of treating wrist tuberculosis with lesion removal, bone grafting, fusion, and external fixation is satisfactory.

C-arm Fluoroscopy-Guided Percutaneous Needle Biopsy for the Diagnosis of Spinal Infection: A Study of 203 Consecutive Patients.

C-arm fluoroscopy-guided percutaneous needle biopsy (PNB) is a commonly used biopsy method, which shows similar diagnostic outcomes to CT-guided biopsy. This study aimed to evaluate the diagnostic value of C-arm fluoroscopy-guided percutaneous needle biopsy (PNB) for spinal infection. A total of 30 male and 73 female patients with suspected spinal infection were enrolled. Among enrolled patients, the spinal lesion was mainly located in the thoracic (T3-T12, 48.28%) and lumbar vertebra (L1-L5, 46.80%), and T12 was the most frequently involved site. C-arm fluoroscopy-guided PNB was performed for the isolation of biopsy samples in these patients. The overall detection rate of pathological changes in bone tissues was 94.1% (191/203), including 92 granulomata with caseous necrosis, 81 inflammatory tissues, 18 tumor tissues, and 12 bone tissues without visible pathological changes. After excluding the tumors, the detection rate of pathogenic microorganisms in liquid tissues was 50.27% (93/185), including 68 Mycobacterium tuberculosis, and 25 other microorganisms. Spinal tuberculosis was diagnosed in 118 (58%) cases, and nonspecific spinal infection with microorganisms other than Mycobacterium tuberculosis was diagnosed in 25 (12.7%) cases. Definite diagnosis was not determined in the left 42 (20.5%) patients with neither positive pathological nor pathogenic results. C-arm fluoroscopy-guided PNB is effective in the detection of pathological changes and pathogenic microorganisms, which is a practical approach for the diagnosis of spinal infection with high accuracy.

Gallic acid inhibits osteoclastogenesis and prevents ovariectomy-induced bone loss.

Osteoporosis is a common metabolic bone disease with a rapidly increasing prevalence, characterized by massive bone loss because of excessive osteoclast formation. Gallic acid (GA), a phenolic acid isolated from Cornus officinalis, has anti-inflammatory and anti-oxidant effects, but its effect on osteoclast formation has not been confirmed. In our study, we demonstrated that GA significantly inhibited RANKL-induced osteoclast formation and function of osteoclast in bone marrow monocytes (BMMs) and RAW264.7 cells in a dose-dependent manner without cytotoxicity. For molecular mechanisms, GA repressed osteoclastogenesis by blocking Akt, ERK, and JNK pathways, and suppressed osteoclastogenesis-related marker expression, including nuclear factor of the activated T-cell cytoplasmic 1 (NFATc1), c-Fos, and cathepsin K (CTSK). In addition, we further assessed the effect of GA in an ovariectomized mouse model, which indicated that GA has a notable effect on preventing bone loss. In conclusion, GA exerts notable effects in inhibiting osteoclastogenesis and preventing ovariectomy-induced bone loss, suggesting that GA is a potential agent in osteoporosis treatment.

Mini-open anterior approach focal cleaning combined with posterior internal fixation for thoracolumbar tuberculosis: Follow-up of 149 cases.

OBJECTIVE: To investigate the clinical efficacy and safety of mini-open anterior approach focal cleaning combined with posterior internal fixation for thoracolumbar tuberculosis. METHODS: A total of 149 patients with thoracolumbar tuberculosis were reviewed retrospectively and divided into 3 groups: mini-open anterior approach (group A), conventional anterior extraperitoneal approach (group B), and posterior approach (group C). After the operation, drainage tubes were routinely placed and the draining fluid was collected on the 4th day for the PCR detection of Mycobacterium tuberculosis (MTB), Mycobacterium tuberculosis DNA test (MTD), and Roche culture. Patients' surgical information, Cobb's angles, and postoperative complications were also compared. RESULTS: There was no significant difference in operation time, blood loss, hospital stay, or preoperative Cobb's angle among three groups. There existed obvious differences in the postoperative Cobb's angle and incidence of postoperative complications between group A and group C, as well as group B and group C. There was no obvious difference in the positive rate of MTB among the three groups by rapid culture plus Roche culture test. However, statistically significant differences in the positive rate of MTB were found between group A and group C by PCR detection, and between group A and group B by MTD. CONCLUSION: Mini-open anterior approach focal cleaning combined with posterior internal fixation resulted in small Cobb's angles, low incidence of postoperative complications and low positive rates of MTB, without increasing operation time, blood loss and hospital stay, rendering it as a safe and effective method to treat patients with thoracolumbar tuberculosis.

Treatment for lumbar spinal stenosis in elderly patients using percutaneous endoscopic lumbar discectomy combined with postoperative three-dimensional traction.

BACKGROUND: There were few previous studies about the use of percutaneous endoscopic lumbar discectomy (PELD) combined with postoperative three-dimensional traction in elderly patients with stenosis. This study aimed to evaluate the clinical efficacy of PELD combined with postoperative three-dimensional traction in the treatment of lumbar spinal stenosis in elderly patients. METHODS: A total of 180 elderly patients with lumbar spinal stenosis were randomly divided into three groups: the traditional surgery group, PELD group (transforaminal approach), and PELD combined with postoperative three-dimensional traction group. The operation duration, intraoperative blood loss, hospital stay, and the imaging data for pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), thoracic kyphosis (TK), and lumbar lordosis (LL) were obtained. Visual Analog Scale for Pain (VAS) and Japanese Orthopaedic Association (JOA) Score were carried one year after the operation. RESULTS: The operation duration, intraoperative blood loss, and hospital stay in PELD combined with postoperative three-dimensional traction group were significantly lower than in the traditional group. There were better outcomes of the LL, SS, and PT changes before and after surgery, as well as the VAS and JOA scores after surgery, in the PELD combined with postoperative three-dimensional traction group than in the other two groups. CONCLUSION: PELD combined with postoperative three-dimensional traction reduced hospital stay, provided adequate decompression for the spine, and improved surgical outcomes.

Association between ACE gene I/D polymorphism and knee osteoarthritis in a Chinese population.

Osteoarthritis (OA) is a degenerative joint disease characterized by joint destruction with cartilage loss and occasional gross derangement of joint integrity. In recent years, several studies have reported the association between angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and knee OA. However, the results were conflicting. To determine the association between ACE gene I/D polymorphism and knee OA, we conducted a hospital-based case-control study with 282 knee OA cases and 316 controls to investigate the association between ACE gene I/D polymorphism and knee OA susceptibility in a Chinese Han population. The present study found that DD genotype or D allele carriers of ACE gene I/D polymorphism increased the risk of knee OA. Stratification analyses of sex, age, and body mass index (BMI) showed significant associations amongst the groups of females, ≥55 years, and abnormal BMI. In addition, the present study made analysis between ACE I/D polymorphism and some clinical features of OA, and found DD genotype of I/D polymorphism was associated with arthralgia. Furthermore, we undertook a meta-analysis together with the present study between this single nucleotide polymorphism (SNP) and knee OA risk. This meta-analysis found that ACE gene I/D polymorphism was associated with increased risk for OA. Stratification analysis of ethnicity in this meta-analysis indicated that I/D polymorphism increased the risk of knee OA amongst the Asians and Caucasians. In conclusion, this case-control study and meta-analysis suggest that ACE gene I/D polymorphism is associated with increased risk for knee OA.