Medicine
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Pedicle screws are commonly used to treat adolescent idiopathic scoliosis (AIS). Many studies have discussed the rates and effects of pedicle screw misplacement. In this study, to increase the accuracy rate, cannulated pedicle screws were inserted into the periapical vertebrae, highly rotated vertebrae, and vertebrae with very thin pedicles in a single patient group. We compared these results with those of a patient group who underwent conventional pedicle screw placement. ⋯ The use of cannulated screws to treat AIS decreases perforation and complication rates. Although it did not significantly lower the medial perforation rate, it dramatically reduced the lateral perforation rate. The use of cannulated screws enables intraoperative confirmation of placement accuracy. Our data suggest that cannulated pedicle screw use to treat AIS is safer and more efficient.
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Observational Study
Serum YKL-40 predicts long-term outcome in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
Serum YKL-40, a potential inflammatory marker, is greatly increased at the early stage of ST-segment elevation myocardial infarction (STEMI). Here, we hypothesized that YKL-40 levels at admission could predict the long-term outcomes after STEMI. A total of 324 patients with acute STEMI undergoing primary percutaneous coronary intervention (PCI) were consecutively enrolled and followed for 24 months. ⋯ Kaplan-Meier curve showed that elevated YKL-40 levels were associated with reduced MACE-free survivals (log-rank P < .001). In multivariate Cox regression analysis, we found that high serum YKL-40 level was an independent predictor of MACE after controlling for clinical and angiographic variables (hazard ratio: 1.65, 95% confidence interval: 1.14-2.39, P = .008). The results of our study indicate that serum YKL-40 may be used as a biomarker to predict the long-term outcome after PCI in patients with STEMI.
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Complex regional pain syndrome (CRPS) usually occurs after trauma and surgery but can also occur spontaneously. There are various known pathophysiology and treatment protocols for CRPS. However, there is no established treatment guideline. Although physical therapy is known as the first line treatment for CRPS, performing physical therapy is difficult due to severe pain. This case reports the first case with positive effect of physical therapy under sedation that allowed early physical therapy. ⋯ This case suggests that passive ROM exercise under sedation may be a successful alternative as a treatment when exercise, currently known as a treatment to CRPS, is impossible.
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Case Reports
Bacterial meningitis and cauda equina syndrome after trans-sacral epiduroscopic laser decompression: A case report.
Trans-sacral epiduroscopic laser decompression (SELD) is a noninvasive pain-relieving procedure for treatment of herniated lumbar disc (HLD), and is known to have positive effects in alleviating lower back pain or radicular leg pain after HLD. However, little is known about the possible complications of SELD. ⋯ In this study, we described a patient who had bacterial meningitis after SELD. During SELD, clinicians should keep in mind the possibility of infection.
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Meta Analysis Comparative Study
Continuous versus intermittent infusions of antibiotics for the treatment of infectious diseases: Meta-analysis and systematic review.
Severe sepsis and pneumonia are common problems in the intensive care units (ICUs) and cause high morbidity and mortality. Optimal doses and appropriate routes of antibiotics are critical to improve their efficacy, but their appropriate routes remain controversial. ⋯ The results of present meta-analysis were insufficient to recommend continuous infusion of intravenous antibiotics better than traditional intermittent infusions of antibiotics at routine clinical care. Hope large-scale RCT to provide more rebuts evidence for making recommendations to warrant continuous infusions of intravenous antibiotics at clinical practice.