Open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases

Purpose Posterior multilevel fixation of traumatic instability in ankylosing spinal disease (ASD) can be performed by open surgery (OS) or minimally invasive surgery (MIS). We investigated whether both methods differ based on the reduction results and perioperative parameters. Methods In this retrospective cohort study, OS and MIS groups were investigated. The bisegmental Cobb angles and dislocation angles were measured using pre- and postoperative CT images, and the initial malalignment and achieved reduction were calculated. Cut-seam time, calculated blood loss, transfusion number, fluoroscopy time, pedicle screw placement accuracy, duration of ICU stay, in-patient stay, and complications (bleeding, postoperative thrombosis and embolism, and postoperative mortality) were recorded. Results Seventy-five ASD patients with spine fractures (Ø 75 ± 11 years, male: 52, female: 23) (MIS: 48; OS: 27) were included in this study. The extent of reduction did not differ in the OS and MIS groups (p = 0.465; MIS:− 1 ± 3°, OS:−2 ± 6°). The residual postoperative malalignment angle was not significantly different (p = 0.283). Seventy-eight of the implanted screws (11%) showed malpositioning. No difference was found between OS and MIS (MIS, 37 [7%]; OS, 41 [16%]; p = 0.095). MIS was associated with less blood loss (OS: 1.28 ± 0.78 l, MIS: 0.71 ± 0.57 l, p = 0.001), cut-seam time (MIS: 98 ± 44 min, OS: 166 ± 69 min, p < 0.001), and hospital stay (MIS: Ø14 ± 16 d, OS: Ø38 ± 49 d, p = 0.02) than OS. Conclusion OS and MIS show equally limited performance in terms of the fracture reduction achieved. The MIS technique was superior to OS based on the perioperative outcome. Therefore, MIS should be preferred over OS for unstable spinal injuries, excluding C-type fractures, in ASD patients without neurological impairment.

Tissue-engineered patch modified by vascular endothelial growth factor for reconstruction of vascular wall

<p><strong>Background.</strong> Commercially available synthetic and animal-derived vascular patches used in patch angioplasty during carotid endarterectomy have several disadvantages, such as postoperative thrombosis or occlusion and restenosis. This problem may be resolved by the development of biologically active materials that are biodegradable and can stimulate tissue regeneration.<br />Aim. To evaluate the properties and efficacy of a biodegradable patch based on poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) and poly(ε-caprolactone) (PCL) into which vascular endothelial growth factor (VEGF) is incorporated, in comparison with unmodified PHBV/PCL and commercial vascular patches.</p><p><strong>Methods.</strong> Porous patches were fabricated by emulsion electrospinning from a mixture of PHBV and PCL, into which VEGF was incorporated. The morphological and mechanical properties of these patches were tested, and they were implanted into the wall of rat abdominal aortas for 1, 3, 6 and 12 months. Histological and immunofluorescence examinations were performed to evaluate endothelisation, cellular composition and calcification.</p><p><strong>Results.</strong> PHBV / PCL patches with VEGF had a highly porous structure and demonstrated tensile strength similar to that of the aorta in rats and the internal thoracic artery in humans. After 3 months of implantation, an endothelial monolayer was formed on the inner surface of these patches. The patches were populated by cells that secreted the extracellular matrix faster than did cells of patches from the xenopericardium. Remodelling with PHBV / PCL patches was not accompanied by chronic inflammation; in contrast, inflammation was observed with long-term implantation of unmodified PHBV / PCL samples.</p><p><strong>Conclusion.</strong> VEGF incorporated into biodegradable PHBV / PCL patches stimulated their endothelisation, increased their biocompatibility and promoted remodelling and formation of the components of the blood vessel. PHBV / PCL / VEGF patches thus have a high potential for use in tissue engineering of the vascular wall.</p><p>Received 2 June 2020. Revised 27 June 2020. Accepted 16 July 2020.</p><p><strong>Funding:</strong> This study was supported by the Complex Program of Basic Research under the Siberian Branch of the Russian Academy of Sciences within the Basic Research Topic of Research Institute for Complex Issues of Cardiovascular Diseases № 0546-2019-0002 “Pathogenetic basis for the development of cardiovascular implants from biocompatible materials using patient-oriented approach, mathematical modeling, tissue engineering, and genomic predictors”.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: V.V. Sevostianova, A.V. Mironov, L.V. Antonova, R.S. Tarasov, L.S. Barbarash<br />Data collection and analysis: V.V. Sevostianova, A.V. Mironov, L.V. Antonova, E.O. Krivkina, V.G. Matveeva, E.A. Velikanova, T.V. Glushkova<br />Statistical analysis: V.V. Sevostianova, T.V. Glushkova<br />Drafting the article: V.V. Sevostianova, A.V. Mironov <br />Critical revision of the article: L.V. Antonova, R.S. Tarasov, L.S. Barbarash<br />Final approval of the version to be published: V.V. Sevostianova, A.V. Mironov, L.V. Antonova, E.O. Krivkina, V.G. Matveeva, E.A. Velikanova, R.S. Tarasov, T.V. Glushkova, L.S. Barbarash</p>

Effect of Perioperative Coagulation Monitoring by Sonoclot on Short-Term Thrombosis in Pediatric Liver Transplantation

Background Sonoclot devices are used to monitor coagulation function in transplant patients. However, the appropriate value of Sonoclot parameters for reducing postoperative thrombosis in pediatric liver transplantation is not clear. Therefore, the aim of the study was to investigate the effect of coagulation monitoring by Sonoclot devices on early postoperative thrombosis after liver transplantation in children. Method The clinical data of 200 children with elective liver transplantation were collected. The effects of coagulation function monitoring by Sonoclot devices 1 h after ischemia-reperfusion on early thrombosis were analyzed. Receiver operating characteristic (ROC) analysis was used to obtain the sensitivity and cutoff value of Sonoclot parameters for the diagnosis of thrombosis. Results A total of 38 (19%) patients had thrombosis complications. 23 cases (11.5%) had postoperative hepatic artery thrombosis and 15 cases (7.5%) had portal vein and hepatic vein thrombosis. Sonoclot coagulation parameters included the following: for the thrombosis group & non-thrombosis group, whole blood activated clotting time (ACT): 178.5 ± 33.2 & 280.4 ± 58.6 (p < 0.05), clotting rate (CR): 12.4 ± 5.4 & 11.5 ± 5.7 (p > 0.05), and platelet function (PF): 3.0±1.4 & 2.6±1.1 (p>0.05). Univariate and multivariate analyses showed that ACT was an independent risk factor for postoperative thrombosis. ROC analysis found that the sensitivity of ACT for the diagnosis of postoperative thrombosis was 94.7%, and the ACT cutoff value to predict early postoperative thrombosis was 228.5 s. Conclusion ACT after ischemia-reperfusion was a risk factor for early postoperative thrombosis. It is recommended that ACT be maintained above 228.5 s to reduce postoperative thrombosis.Trial registrationApproval was obtained from the Ethics Committee of Tianjin First Center Hospital in China (Approval Number: 2016N0039KY), and written informed consent was obtained from eligible guardians. This study has been registered in clinical trial (ClinicalTrials.gov ID: ChiCTR1900026125). All processes were ethical.

Preventive Effect of Albumin Nano TPA Gene Plasmid Ultrasound Microbubble Carrier System on Thrombosis after Cardiac Valve Replacement

After cardiac valve replacement, most patients will have different degrees of thrombosis, different parts of the thrombus, and even more frequent occurrence of postoperative thrombosis; therefore, the prevention of postoperative thrombosis is particularly important. The purpose of this study was to investigate the preventive effect of albumin nano tPA gene plasmid ultrasound microbubble carrier system on thrombosis, especially in cardiac valve. The experimental control method was used. Firstly, 11 dogs meeting the experimental requirements were selected. Secondly, the data of albumin nanoparticles and microbubbles were analyzed. The average size of albumin particles was 132.0 nm, the average size of microbubbles was 3.1 ± 1.6 μm, and the zeta potential was 13.70 ± 1.95 MV. The concentration of microbubbles was 4.2 ± 1.3 × 10/ml. Finally, 11 dogs were divided into two groups. The experimental group was treated with albumin nanoparticles ultrasound microbubble, and the others were the control group. It was found that the levels of tPA and D-dimer in the experimental group were significantly increased and maintained at a high level at 1 week after operation, and the prothrombin time was detected and the international normalized ratio was calculated at the same time. No significant changes were found in the experimental group.

Impaired contraction of blood clots precedes and predicts postoperative venous thromboembolism

Deep vein thrombosis (DVT) is a common but unpredictable complication of surgical interventions. To reveal an association between the blood clot contraction (retraction) and the incidence of postoperative venous thrombosis, 78 patients with brain tumors that were operated on were studied, of which 23 (29%) were diagnosed with postoperative DVT. A clot contraction assay, along with other hemostatic and hematologic tests, was performed 1–3 days before the surgery and on the 1st day and 5–7th days after the surgery. On the 1st postoperative day, clot contraction was significantly suppressed in patients who subsequently developed DVT, compared to the patients without DVT. Importantly, this difference was observed at least 5 days before DVT had developed. The weakening of contraction on the 1st postoperative day was more pronounced in the DVT patients with malignant versus benign brain tumors, atherosclerosis, hypertension, as well as in patients receiving steroids before and during the operation. These results indicate that impaired clot contraction in the postoperative period is associated with imminent DVT, suggesting that it is a prothrombotic risk factor and promotional mechanism. The clot contraction assay has a predictive value in assessing the threat of postoperative thrombosis in patients with benign and malignant brain tumors.