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2.
Eur Spine J ; 2022 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-35972554

RESUMO

PURPOSE: To report the clinical characteristics and surgical outcomes of scoliosis in patients with spinal muscular atrophy (SMA) from Mainland China. METHODS: Nineteen patients were retrospectively analyzed. Demographic, anthropometric and respiratory parameters were collected preoperatively. Surgical program was analyzed. Radiographic data were measured perioperatively. Motor status, ventilation support, sitting ability and respiratory symptoms were evaluated preoperatively and at final follow-up. RESULTS: Age at surgery was 17.08 (12.83, 20.08) years. More than 40% of patients were diagnosed with low weight. Pulmonary dysfunction was observed in all patients. All patients received posterior spinal fusion (PSF). Sacroiliac fixation with sacral-2 alar iliac technique was used in 16 patients. Major curve correction rate was 54.87 ± 16.14%. Pelvic obliquity correction rate was 63.84 ± 23.70%. T1-T12 height, space-available-for-lung ratio and thoracic transverse diameter were increased (p < 0.001). Percentage of patients capable of sitting independently increased from 26.32% preoperatively to 73.68% at final follow-up. Cumulative scores of sitting-related items in muscular dystrophy spine questionnaire improved from 19.11 ± 5.40 preoperatively to 26.21 ± 5.20 at final follow-up. Total scores of symptomatic domains in St. George's Respiratory Questionnaire decreased from 4 (2, 12) preoperatively to 1 (0, 3) at final follow-up. CONCLUSIONS: SMA patients in China always present severe scoliosis at late adolescence, accompanied with high proportion of low weight and pulmonary dysfunction. PSF is effective for the correction of scoliosis and pelvic obliquity and the improvement of thoracic morphology. Sitting ability and respiratory symptoms were improved postoperatively.

3.
Front Surg ; 9: 841680, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35937609

RESUMO

This study aims to analyze the potential association between the preoperative coagulation status and perioperative blood loss in spinal deformity correction surgery. The preoperative coagulation status and estimated blood loss (EBL) during operation, postoperative wound drainage, and allogeneic transfusion during and after operation were recorded and analyzed. Among the 164 patients, 26 had a longer prothrombin time (PT), 13 had a lower fibrinogen level, 55 had a longer activated partial thromboplastin time (APTT), and 2 had a longer thrombin time (TT), and the platelet count (PLT) was all normal or higher than the normal level. The mean EBL per surgical level was 77.8 ml (range, 22-267 ml), and the mean drainage per surgical level was 52.7 ml (range, 7-168 ml). Fifty-five patients and 12 patients underwent allogeneic transfusion during and after the operation, respectively. The differences in EBL per surgical level, mean drainage per surgical level, the occurrences of allogeneic transfusion during and after operation between the patients with a longer PT, lower fibrinogen level, longer APTT or longer TT, and the normal controls were not significant (all P's > 0.05). The Spearman correlation analysis showed that there was no correlation between PT, fibrinogen, APTT, TT or PLT with EBL per surgical level, mean drainage per surgical level, or allogeneic transfusion during and after the operation (all P's > 0.05). The abnormal preoperative coagulation status but not hemophilia does not lead to more perioperative blood loss or a higher rate of perioperative allogeneic transfusion in spinal deformity correction surgery.

4.
BMC Musculoskelet Disord ; 23(1): 775, 2022 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-35964038

RESUMO

BACKGROUND: The treatment of severe and rigid scoliosis is challenging. We developed a surgical strategy for severe and rigid scoliosis since 2014. This study aimed to retrospectively analyze the safety and efficacy of apical region correction and global balance with 3 rods as a surgical strategy for the treatment of severe and rigid scoliosis. METHODS: A retrospective study was performed for patients with severe and rigid scoliosis who underwent one-stage posterior corrective operation using the apical region correction and global balance with 3 rods surgical strategy between February 2014 and April 2020. The inclusion criteria were as follows: [1] Cobb angle > 90°; [2] flexibility < 30%; [3] a minimum 2-year follow-up. Patients were excluded if they had a history of traction or spinal surgery. Coronal and sagittal parameters, including Cobb angle, flexibility, apex vertebra translation, trunk shift (TS), thoracic kyphosis, lumbar lordosis, and sagittal vertical axis (SVA) were measured preoperatively, postoperatively and at the final follow-up. The Scoliosis Research Society 22-item questionnaire was administered preoperatively and at the final follow-up. During the operation, one slightly-bent short rod was placed into the concave side of apical region and correction was achieved by rod-rotation and distraction. Two pre-bent long rods were placed into both sides of the scoliosis and global balance was improved by leveling the proximal thoracic vertebrae and distal lumbar vertebrae. RESULTS: A total of 41 patients were included, with an average age of 20 years (range, 12-49 years) and follow-up of 34 months (range, 24-58 months). Postoperative correction rate was 53% for scoliosis. There were 14 patients with normal kyphosis before surgery, and 28 patients with normal kyphosis at the last follow-up. 88% of the patients (23/26) with preoperative coronal imbalance (TS > 20 mm) restored coronal balance at the final follow-up. 87% of the patients (14/16) with preoperative sagittal imbalance (SVA > 40 mm) restored sagittal balance at the final follow-up. The mean operation time and blood loss were 286 min and 941 mL, respectively. No patients had neurological complications or implant failure. CONCLUSION: The surgical strategy of apical region correction and global balance with 3 rods is a safe and effective alternative for the surgical treatment of severe and rigid scoliosis.


Assuntos
Cifose , Escoliose , Fusão Vertebral , Adulto , Humanos , Cifose/diagnóstico por imagem , Cifose/cirurgia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Adulto Jovem
6.
BMC Musculoskelet Disord ; 23(1): 89, 2022 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-35081918

RESUMO

BACKGROUND: Postoperative pulmonary complications are common and associated with morbidity and mortality. Congenital scoliosis is a failure of vertebral formation and/or segmentation arising from abnormal vertebral development. Posterior fusion and osteotomy are necessary for these patients to prevent deterioration of spine deformity. The incidence of postoperative pulmonary complications in this specific group of patients, especially young children were unknown. METHODS: A retrospective study was conducted and electronic medical records of early-onset scoliosis patients who had primary posterior fusion and hemivertebra resection at our institution from January 2014 to September 2019 were reviewed. The demographic characteristics, the intraoperative and postoperative parameters were collected to identify the predictors of postoperative pulmonary complications. RESULTS: A total of 174 patients (57.5% boys) with a median age of 3 years old were included for analysis. Eighteen patients (10.3%) developed perioperative pulmonary complications and pneumonia (n=13) was the most common. History of recent upper respiratory infection was not related to postoperative pulmonary complications. Multifactorial regression analysis showed thoracoplasty was the only predictive risk factor of postoperative pulmonary complications. CONCLUSIONS: For congenital scoliosis patients younger than 10 years old, thoracoplasty determine the occurrence of postoperative pulmonary complications. Both surgeons and anesthesiologists should pay attention to patients undergoing thoracoplasty and preventive measures are necessary.


Assuntos
Escoliose , Fusão Vertebral , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Escoliose/epidemiologia , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
7.
Spine (Phila Pa 1976) ; 47(3): E107-E115, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34265810

RESUMO

STUDY DESIGN: A prospective study. OBJECTIVE: The aim of this study was to investigate the factors associated with cardiopulmonary exercise testing (CPET) measurements in patients with adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: Patients with AIS display restrictive pulmonary dysfunction on pulmonary function testing (PFT). It remains unknown whether thoracic spinal deformity affects exercise performance. METHODS: One hundred and sixty-eight patients with AIS from January 2014 to December 2019 were included. They underwent preoperative spinal radiological assessment, PFT, and CPET. The effects of the thoracic curve magnitude, body mass index, physical activity level and history of bracing on pulmonary function and exercise performance were analyzed. The Student t test and two-tailed Pearson test were used in data analysis. RESULTS: We found significantly reduced forced expiratory volume in 1second (FEV1) in patients with a larger magnitude of the proximal thoracic curve (P < 0.001) and the main thoracic curve (P < 0.001). There was a negative correlation between forced vital capacity (FVC) and the magnitude of the main thoracic curve (P < 0.001) and thoracic hypokyphosis (P < 0.001). In CPET, exercise capacity indicators such as the work rate, peak oxygen intake, and heart rate were not affected by the thoracic curve magnitude. Patients with moderate or severe pulmonary dysfunction had decreased tidal volume (P = 0.01) and ventilatory reserve (P < 0.001), as well as increased respiratory frequency at maximal exercise (P = 0.01). Patients with a moderate or high physical activity level had better exercise capacity, which was reflected by a higher work rate (P = 0.009) and oxygen intake (P < 0.001). CONCLUSION: There was no significant correlation between radiographic parameters and exercise capacity indicators. When the thoracic curve increased, patients had restrictive ventilatory dysfunction, which led to a tachypneic breathing pattern and reduction of ventilatory reserve during exercise. A physiological change of improved peak oxygen intake was demonstrated in patients with a moderate or high physical activity level.Level of Evidence: 3.


Assuntos
Cifose , Escoliose , Adolescente , Exercício Físico , Volume Expiratório Forçado , Humanos , Pulmão/diagnóstico por imagem , Estudos Prospectivos , Escoliose/diagnóstico por imagem , Capacidade Vital
8.
Global Spine J ; 12(5): 922-930, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33203246

RESUMO

STUDY DESIGN: Retrospective case series. OBJECTIVES: To present outcomes concerning patients with early-onset mixed-type congenital scoliosis (EOMTCS) treated with the traditional single growing rod (TSGR), focusing on the growth of unsegmented levels (USLs). METHODS: Patients with EOMTCS who underwent TSGR and had a minimum of 4 USLs, 4 distractions, and 3-year follow-up were enrolled. Spine radiographs before and after index surgery and at the latest follow-up were evaluated. The length of the concave and convex side of USLs and thoracic parameters were measured. The absolute value and percentage of growth were calculated. RESULTS: Fourteen patients (mean age, 7.3 ± 2.8 years) were enrolled. The average follow-up duration was 4.9 ± 1.2 years, during which time 84 distractions and 8 final fusions were performed. The average number of USLs was 6.3 ± 2.2. The total and annual percent growth of concave side of USLs was significantly higher than convex side (32.2 ± 13.3% vs. 23.9 ± 9.5%, p = 0.007; 6.8 ± 2.7%/year vs. 5.1% ± 2.2%/year, p = 0.007, respectively). The concave-to-convex ratio of USLs increased from 58.6 ± 6.4 ± 7.6% at baseline to 68.8 ± 9.3% at the latest follow-up (p < 0.001). The Campbell's space available for lung ratio increased from 74.9 ± 11.1% at baseline to 89.6 ± 7.0% at the latest follow-up (p < 0.001). CONCLUSIONS: In patients with EOMTCS, unilateral repetitive lengthening with TSGR can accelerate the growth of the concave side of USLs and improve the symmetry of the thorax.

9.
Front Mol Biosci ; 8: 789087, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34957218

RESUMO

As the principal reason for low back pain, intervertebral disc degeneration (IDD) affects the health of people around the world regardless of race or region. Degenerative discs display a series of characteristic pathological changes, including cell apoptosis, senescence, remodeling of extracellular matrix, oxidative stress and inflammatory local microenvironment. As a serine/threonine-protein kinase in eukaryocytes, AMP-activated protein kinase (AMPK) is involved in various cellular processes through the modulation of cell metabolism and energy balance. Recent studies have shown the abnormal activity of AMPK in degenerative disc cells. Besides, AMPK regulates multiple crucial biological behaviors in IDD. In this review, we summarize the pathophysiologic changes of IDD and activation process of AMPK. We also attempt to generalize the role of AMPK in the pathogenesis of IDD. Moreover, therapies targeting AMPK in alleviating IDD are analyzed, for better insight into the potential of AMPK as a therapeutic target.

10.
BMC Musculoskelet Disord ; 22(1): 779, 2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511086

RESUMO

BACKGROUND: Contradictory opinions about whether early correction and fusion surgeries should be performed for congenital scoliosis (CS) patients at a young age exist. The objectives of this study were to analyze the association between patient characteristics and fusion-surgery outcomes in CS patients treated with spinal correction and fusion surgeries and to report risk factors for extended length of stay (LOS), more estimated blood loss (EBL), longer fused segments and higher medical costs. METHODS: We analyzed data of 1,207 CS inpatients treated with fusion surgeries in our institute from January 2010 - December 2019. All patients underwent spinal X-ray, CT, MRI, echocardiogram and urogenital ultrasound. We analyzed demographic and clinical information and outcome measures, including LOS, EBL, fused segments and medical costs. RESULTS: Age at fusion (OR = 1.053; p < 0.001), musculoskeletal defects (OR = 1.670; p = 0.004) and thoracic deformity (OR = 1.519; p = 0.03) were risk factors for extended LOS. Age at fusion (OR = 1.117; p < 0.001), male sex (OR = 1.813; p < 0.001), mixed defects (OR = 1.662; p = 0.027) and failure of formation (OR = 1.718; p = 0.021) were risk factors for more EBL. Age at fusion (OR = 1.213; p < 0.001) was a risk factor for longer fused segments. Age at fusion (OR = 1.091; p < 0.001) and thoracic deformity (OR = 1.853; p = 0.004) were risk factors for higher medical costs. CONCLUSIONS: We found that older age at fusion in CS patients is a risk factor for extended LOS, more EBL, longer fused segments and higher medical costs with the risk increasing by 5-21 % for each year of age. Other identified risk factors include thoracic deformity for extended LOS; longer fused segments, higher medical costs, and musculoskeletal defects for extended LOS; and CS type (FF and MD) and sex (male) for more EBL.


Assuntos
Escoliose , Fusão Vertebral , Idoso , Humanos , Tempo de Internação , Masculino , Estudos Retrospectivos , Fatores de Risco , Escoliose/diagnóstico por imagem , Escoliose/epidemiologia , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
11.
BMC Musculoskelet Disord ; 22(1): 663, 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372818

RESUMO

BACKGROUND: To indicate whether combined topical and intravenous (IV) administration of tranexamic acid (TXA) could further reduce the blood loss after surgery for adolescent idiopathic scoliosis (AIS) compared with IV-TXA alone. METHODS: Ninety AIS patients who underwent posterior spinal fusion were prospectively randomized to combined group (IV + topical- TXA group) and IV-TXA alone group. TXA was infused at a loading dose of 1 g from the beginning of the surgery with a maintenance dose of 10 mg/kg/h until the wound was closed. In the combined group, 2 g TXA was injected retrogradely through a drain, while an equivalent amount of normal saline was injected in the IV-TXA alone group. The drain tube was clamped for 2 h in both groups. The amount of wound drainage and transfusion rates were analyzed. RESULTS: The drainage volume and duration of drain were significantly lower in the combined group compared with that in the IV-TXA alone group (372.0 ± 129.7 mL vs. 545.2 ± 207.7 mL, P < 0.001;64.7 ± 13.9 h vs. 82.0 ± 12.5 h, P < 0.001). Postoperative length of hospital stay was also significantly shorter in the combined group (6.5 ± 1.51 days vs. 7.95 ± 1.44 days, P < 0.05). Transfusion and complication rates were comparable between the two groups . CONCLUSIONS: IV injection of TXA combined with retrograde injection of TXA into a drain and clamping it for 2 h could further reduce the total volume of drainage in AIS patients who underwent spinal fusion surgery. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR1900024177 , Registered 29 June 2019, http://www.chictr.org.cn/showproj.aspx?proj=40214.


Assuntos
Antifibrinolíticos , Escoliose , Fusão Vertebral , Ácido Tranexâmico , Administração Intravenosa , Administração Tópica , Adolescente , Antifibrinolíticos/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Humanos , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/prevenção & controle , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Ácido Tranexâmico/efeitos adversos
12.
Eur Spine J ; 30(12): 3577-3584, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34235574

RESUMO

PURPOSE: This study systematically analyzed and assessed the interrelationships among vertebral anomaly location, congenital scoliosis (CS) type and associated abnormality prevalence. METHODS: We retrospectively extracted medical records of 1289 CS inpatients surgically treated in our institute from January 2010-December 2019. All patients underwent spinal X-ray, CT, MRI, echocardiogram, urogenital ultrasound and systemic physical examination. We analyzed information on demographics, CS type, associated anomalies and vertebral anomaly location. RESULTS: Cervical, thoracic and lumbar vertebral anomalies were found in 5.7%, 78.1% and 33.6% of patients, respectively. 82.7% had one region involved. 59.5% with cervical malformations had mixed defects and 61.1% with lumbar malformations exhibited failure of formation. The musculoskeletal defect prevalence was 28.4%, 19.1% and 9.0% in patients with cervical, thoracic and lumbar anomalies. The intraspinal defect prevalence was 33.4% and 20.7% for thoracic and lumbar anomalies. 86.5% of patients with cervical anomalies had more than one region involved, while 78.1% and 62.2% with thoracic and lumbar anomalies, respectively, had only one region involved. CONCLUSIONS: Cervical malformations had higher prevalence of mixed defects, musculoskeletal and intraspinal defects and multi-region involved. Thoracic malformations had higher prevalence of intraspinal and musculoskeletal defects and more involvement of only one vertebral region. Lumbar vertebral malformation patients had much lower prevalence of intraspinal and musculoskeletal defects and more involvement of only one vertebral region. Cervical malformation was a risk factor for more associated anomalies and more severe vertebral anomalies, which deserves more attention from surgeons in outpatient clinic.


Assuntos
Anormalidades Musculoesqueléticas , Escoliose , Estudos Transversais , Humanos , Vértebras Lombares , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/epidemiologia , Escoliose/cirurgia
13.
Ann Palliat Med ; 10(6): 6220-6227, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34118854

RESUMO

BACKGROUND: There have been no report about the association between physical capacity and health-related quality of life in patients with adolescent idiopathic structural scoliosis (AIS). This study aims to investigate the correlation between dynamic cardiopulmonary capacity and quality of life in AIS patients. METHODS: This retrospective study involved 63 patients. Correlations between cardiopulmonary exercise test parameters and Scoliosis Research Society (SRS)-22 scores were evaluated using Spearman's correlation test. RESULTS: Fifty-four female patients [mean age: 14.1 (range, 10-19) years] and 9 male patients [15.9 (range, 14-19) years] with AIS (Cobb angle: 28°-86°) were included. Significant correlations were found between the peak oxygen uptake normalized by body weight and the SRS-22 scores in female patients, as reflected by the function (r=0.511, P<0.001), pain (r=0.418, P=0.002), mental health (r=0.536, P<0.001) and subtotal (r=0.618, P<0.001) scores. Significant correlations were also found between oxygen uptake at anaerobic threshold normalized by body weight and the SRS-22 scores in female patients, as reflected by the function (r=0.404, P=0.002), pain (r=0.455, P=0.001), and subtotal (r=0.501, P<0.001) scores, along with respiratory exchange ratio reflected by subtotal (r=0.464, P<0.001) score. CONCLUSIONS: The physical capacity and capacity for the exercise intensity and endurance correlated with quality of life among patients with AIS. Exercise may better the quality of life of patients with AIS.


Assuntos
Qualidade de Vida , Escoliose , Adolescente , Feminino , Humanos , Masculino , Saúde Mental , Dor , Estudos Retrospectivos
14.
Int Orthop ; 45(8): 2049-2059, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34059967

RESUMO

PURPOSE: The objective of this article is to report associated anomaly incidences of a large CS cohort and analyze interrelationships among vertebral anomaly types and associated abnormalities. METHODS: We retrospectively searched and extracted medical records of 1289 CS inpatients surgically treated in our institute from January 2010 to December 2019. All patients have taken spine X-ray, CT, MRI, echocardiogram, urogenital ultrasound, and systemic physical examination. We analyzed information on demographics, CS types, and associated anomalies. RESULTS: CS type was found to be 49.1% for failure of formation (FF), 19.5% for failure of segmentation (FS), and 31.4% for mixed defects (MD). Intraspinal defects were found in 29.4% patients (16.0% for FF, 45.4% for FS, 40.5% for MD), cardiac in 13.7% (12.3% for FF, 14.3% for FS, 15.6% for MD), genitourinary in 5.8% (4.1% for FF, 6.0% for FS, 8.4% for MD), gastrointestinal in 3.6% (4.7% for FF, 1.6% for FS, 3.0% for MD), and musculoskeletal in 16.4% (10.3% for FF, 19.9% for FS, 23.7% for MD). The intraspinal and musculoskeletal defect incidences were significantly higher in patients with failure of segmentation and mixed defects. We also observed a decreasing trend for intraspinal and musculoskeletal defect incidences as well as a tendency for more failure of formation and less failure of segmentation from 2010 to 2019. CONCLUSIONS: The intraspinal and musculoskeletal defect incidences were higher in patients with failure of segmentation and mixed defects. Strong interrelationships were found between intraspinal and musculoskeletal defects and among cardiovascular, genitourinary, and gastrointestinal defects. From 2010 to 2019, the proportion of patients with failure of formation increased significantly, causing a decrease in the intraspinal and musculoskeletal defect incidences over time. Female sex, failure of segmentation, and mixed defects could be considered risk factors for more associated anomalies in CS individuals, which would help surgeons in medical management and prenatal consultation.


Assuntos
Escoliose , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/epidemiologia , Escoliose/cirurgia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia
15.
BMC Musculoskelet Disord ; 22(1): 483, 2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34034738

RESUMO

INTRODUCTION: Adult non-degenerative scoliosis accounts for 90% of spinal deformities in young adults. However, perioperative complications and related risk factors of long posterior instrumentation and fusion for the treatment of adult non-degenerative scoliosis have not been adequately studied. METHODS: We evaluated clinical and radiographical results from 146 patients with adult non-degenerative scoliosis who underwent long posterior instrumentation and fusion. Preoperative clinical data, intraoperative variables, and perioperative radiographic parameters were collected to analyze the risk factors for perioperative complications. Potential and independent risk factors for perioperative complications were evaluated by univariate analysis and logistic regression analysis. RESULTS: One hundred forty-six adult non-degenerative scoliosis patients were included in our study. There were 23 perioperative complications for 21 (14.4%) patients, eight of which were cardiopulmonary complications, two of which were infection, six of which were neurological complications, three of which were gastrointestinal complications, and four of which were incision-related complication. The independent risk factors for development of total perioperative complications included change in Cobb angle (odds ratio [OR] = 1.085, 95% CI = 1.035 ~ 1.137, P = 0.001) and spinal osteotomy (OR = 3.565, 95% CI = 1.039 ~ 12.236, P = 0.043). The independent risk factor for minor perioperative complications is change in Cobb angle (OR = 1.092, 95% CI = 1.023 ~ 1.165, P = 0.008). The independent risk factors for major perioperative complications are spinal osteotomy (OR = 4.475, 95% CI = 1.960 ~ 20.861, P = 0.036) and change in Cobb angle (OR = 1.106, 95% CI = 1.035 ~ 1.182, P = 0.003). CONCLUSIONS: Our study indicate that change in Cobb angle and spinal osteotomy are independent risk factors for total perioperative complications after long-segment posterior instrumentation and fusion in adult non-degenerative scoliosis patients. Change in Cobb angle is an independent risk factor for minor perioperative complications. Change in Cobb angle and spinal osteotomy are independent risk factors for major perioperative complications.


Assuntos
Escoliose , Fusão Vertebral , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Radiografia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/epidemiologia , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Resultado do Tratamento , Adulto Jovem
16.
Global Spine J ; : 21925682211007116, 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33823627

RESUMO

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To evaluate whether pre-existing adjacent spinal canal stenosis (SCS) is associated with short-term outcomes after lumbar fusion surgery. METHODS: We included patients with lumbar spinal stenosis treated surgically between July 2015 and December 2017 at 4 centers. All patients had the same pathology, with L4-S1 as the culprit sections. Patients were divided into 2 groups based on the cerebrospinal fluid occlusion sign on MRI at the adjacent L3/4 level. Patients without SCS (grade 0) and with mild SCS (grade 1) were classified into the non-stenosis (NS) and mild stenosis (MS) groups, respectively. All patients underwent PLIF and completed at least 1-year follow-up. The incidence of adjacent segment degeneration (ASDeg) and clinical outcomes were compared between the 2 groups. RESULTS: A total of 308 patients (NS, 156; MS, 152) met the inclusion criteria. The incidence of ASDeg in the NS group (n = 40, 25.6%) was significantly lower than that in the MS group (n = 74, 48.7%; P < .001). The most frequent type of ASDeg in the 2 groups was the SCS-aggravated type. No significant difference was observed in adjacent segment disease incidence between the 2 groups (P = .243). The NS group had better outcomes according to the clinical function scores (P < .05). CONCLUSIONS: The cerebrospinal fluid occlusion sign on MRI is valuable for evaluating the adjacent segment with pre-existing degeneration. Patients with mild SCS in adjacent segments were more likely to have ASDeg, and the most frequent type of ASDeg was the SCS-aggravated type at early follow-up.

17.
Environ Sci Pollut Res Int ; 28(17): 20939-20944, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33677662

RESUMO

Recently, during the pandemic infection of the novel SARS-CoV-2, some cases of Miller Fisher syndrome (MFS) have been reported. We want to summarize the main features of patients with MFS and COVID-19. A PubMed search was performed on 8 October to identify references reporting cases with MFS associated with COVID-19 from the first report of COVID-19 to 8 October 2020 using the following keywords: "Miller Fisher syndrome" AND "COVID-19" OR "SARS-CoV-2". A systematic review from the first report of coronavirus disease 2019 (COVID-19) to 8 October 2020 revealed 7 cases with Miller Fisher syndrome (MFS) associated with COVID-19. The 7 cases came from 5 countries but most of these patients were from Europe (85.7%), especially Spain. There are 5 cases of MFS diagnosed after the laboratory confirmation of SARS-CoV-2 infection. The mean onset time of MFS-associated neurological symptoms was 14.75 days after the diagnosis of COVID-19. However, the two remaining cases presented initially with MFS-associated neurological symptoms followed by the diagnosis of COVID-19. The most common symptoms of COVID-19-associated MFS were perioral paresthesias (57.1%), ataxia (57.1%), blurred vision (42.9), ophthalmoplegia (42.9), and generalized areflexia (42.9). However, more cohort and case-control studies are required to establish the epidemiological linkage.


Assuntos
COVID-19 , Síndrome de Miller Fisher , Europa (Continente) , Humanos , SARS-CoV-2 , Espanha
18.
Brief Bioinform ; 22(5)2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-33783485

RESUMO

Tumor suppressor genes (TSGs) exhibit distinct evolutionary features. We speculated that TSG promoters could have evolved specific features that facilitate their tumor-suppressing functions. We found that the promoter CpG dinucleotide frequencies of TSGs are significantly higher than that of non-cancer genes across vertebrate genomes, and positively correlated with gene expression across tissue types. The promoter CpG dinucleotide frequencies of all genes gradually increase with gene age, for which young TSGs have been subject to a stronger evolutionary pressure. Transcription-related features, namely chromatin accessibility, methylation and ZNF263-, SP1-, E2F4- and SP2-binding elements, are associated with gene expression. Moreover, higher promoter CpG dinucleotide frequencies and chromatin accessibility are positively associated with the ability of TSGs to resist downregulation during tumorigenesis. These results were successfully validated with independent datasets. In conclusion, TSGs evolved specific promoter features that optimized cancer resistance through achieving high expression in normal tissues and resistance to downregulation during tumorigenesis.


Assuntos
Cromatina/metabolismo , Biologia Computacional/métodos , Resistencia a Medicamentos Antineoplásicos/genética , Evolução Molecular , Genes Supressores de Tumor , Neoplasias/genética , Regiões Promotoras Genéticas , Antineoplásicos/uso terapêutico , Carcinogênese/genética , Carcinogênese/metabolismo , Carcinogênese/patologia , Linhagem Celular Tumoral , Cromatina/ultraestrutura , Ilhas de CpG , Metilação de DNA , Conjuntos de Dados como Assunto , Regulação Neoplásica da Expressão Gênica , Ontologia Genética , Humanos , Anotação de Sequência Molecular , Neoplasias/tratamento farmacológico , Neoplasias/metabolismo , Neoplasias/patologia , Domínios e Motivos de Interação entre Proteínas , Transcrição Genética
19.
BMC Surg ; 21(1): 106, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33648467

RESUMO

BACKGROUND: Early onset scoliosis (EOS) may cause malnutrition in affected patients. Growing-rod treatment has been an effective protocol for treating EOS. The objective of this study is to demonstrate whether growing-rod treatment improves nutritional status of EOS patients. METHODS: Fifty-two EOS patients who had dual growing-rod surgery was enrolled. The minimum follow-up was 3-years. Their body weights were normalized based on the data of two National Population Census of China. Z-scores were used to indicate the standard deviation from the median body weight-for-age. RESULTS: The median follow-up time was 6 years. Preoperatively, the prevalence of malnutrition (Z < - 2) was 21.2%, and reduced to 9.6% at the end of the follow-up. Preoperatively, the average Z-score was - 0.94, and it increased to - 0.65 at the latest follow-up (p < 0.05). Patients with preoperative Z-score below - 1 had more significant increase of Z-scores (- 2.15 vs - 1.26, p < 0.001). A significant negative correlation between the change of Z-score and the preoperative Z-score (correlation coefficient - 0.65, p < 0.001). CONCLUSIONS: The growing rod surgery and lengthening procedures significantly improves the nutrition status of EOS patients. The body weight gains are more significant in patients with lower body weights.


Assuntos
Estado Nutricional , Escoliose , China , Seguimentos , Humanos , Escoliose/cirurgia , Resultado do Tratamento
20.
Cell Prolif ; 54(5): e13024, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33751722

RESUMO

OBJECTIVES: Guillain-Barré syndrome (GBS) results from autoimmune attack on the peripheral nerves, causing sensory, motor and autonomic abnormalities. Emerging evidence suggests that there might be an association between COVID-19 and GBS. Nevertheless, the underlying pathophysiological mechanism remains unclear. MATERIALS AND METHODS: We performed bioinformatic analyses to delineate the potential genetic crosstalk between COVID-19 and GBS. RESULTS: COVID-19 and GBS were associated with a similar subset of immune/inflammation regulatory genes, including TNF, CSF2, IL2RA, IL1B, IL4, IL6 and IL10. Protein-protein interaction network analysis revealed that the combined gene set showed an increased connectivity as compared to COVID-19 or GBS alone, particularly the potentiated interactions with CD86, IL23A, IL27, ISG20, PTGS2, HLA-DRB1, HLA-DQB1 and ITGAM, and these genes are related to Th17 cell differentiation. Transcriptome analysis of peripheral blood mononuclear cells from patients with COVID-19 and GBS further demonstrated the activation of interleukin-17 signalling in both conditions. CONCLUSIONS: Augmented Th17 cell differentiation and cytokine response was identified in both COVID-19 and GBS. PBMC transcriptome analysis also suggested the pivotal involvement of Th17 signalling pathway. In conclusion, our data suggested aberrant Th17 cell differentiation as a possible mechanism by which COVID-19 can increase the risk of GBS.


Assuntos
COVID-19/patologia , Biologia Computacional/métodos , Citocinas/metabolismo , Síndrome de Guillain-Barré/patologia , Células Th17/imunologia , Antígeno B7-2/metabolismo , COVID-19/complicações , COVID-19/virologia , Diferenciação Celular , Redes Reguladoras de Genes , Síndrome de Guillain-Barré/etiologia , Síndrome de Guillain-Barré/metabolismo , Humanos , Subunidade p19 da Interleucina-23/metabolismo , Leucócitos Mononucleares/citologia , Leucócitos Mononucleares/metabolismo , Mapas de Interação de Proteínas , SARS-CoV-2/isolamento & purificação , Transdução de Sinais , Células Th17/citologia , Células Th17/metabolismo
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