Comparison between Minimally Invasive Transforaminal Lumbar Interbody Fusion and Conventional Open Transforaminal Lumbar Interbody Fusion： An Updated Meta-analysis

Background： The previous studies agree that minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） has better function outcomes, less blood loss, and shorter hospital stay, when compared to open-TLIF. However, there are no significance differences on operative time, complication, and reoperation rate between the two procedures. This could be from less relative literatures and lower grade evidence. The further meta-analysis is needed with more and higher grade evidences to compare the above two TLIF procedures. Methods： Prospective and retrospective studies that compared open-TLIF and MIS-TLIF were identified by searching the Medline, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP database （the literature search comprised Medical Subject Heading terms and key words or Emtree term）. The retrieval time ranged from the date when the database was founded to January 2015. Pooled risk ratios （RRs） and weighted mean differences （WMDs） with 95% confidence intervals were calculated for the clinical outcomes and perioperative data. Results： Twenty-four studies （n =1967 patients） were included in this review （n =951, open-TLIF, n 1016, MIS-TLIF）. MIS-TLIF was associated with a significant decrease in the visual analog score （VAS）-back pain score （WMD 0.44; P= 0.001）, Oswestry Disabilities Index （WMD 1.57; P =0.005）, early ambulation （WMD = -1.77; P = 0.0001）, less blood loss （WMD = -265.59; P 〈 0.00001）, and a shorter hospital stay （WMD =-1.89; P 〈 0.0001）. However, there were no significant differences in the fusion rate （RR =0.99; P = 0.34）, VAS-leg pain （WMD = -0.10; P = 0.26）, complication rate （RR = 0.84; P = 0.35）, operation time （WMD = 5.23; P = 0.82）, or reoperation rate （RR = 0.73; P = 0.32）. Conclusions： MIS-TLIF resulted in a similar fusion rate with better functional outcome, less blood loss, shorter ambulation, and hospital stay; furthermore, it did not increase the complication or reoperation rate based on the existing evidence.

Minimally Invasive Reduction and Fixation in Orthopedic Trauma

In China,approximately,4.41 million individuals sustain fractures every year.With the rapid development of economy,industrialization,and urbanization as well as the aging of the Chinese population,it is predictable that the number of traumatic fractures will inevitably increase dramatically in the near future.According to the nation-wide data on the clinical epidemiology of orthopedic trauma during 2010-2011,

Recent Advances in Technique and Clinical Outcomes of Minimally Invasive Spine Surgery in Adult Scoliosis

Objective： Conventional open spinal surgery of adult scoliosis can be performed from anterior, posterior, or combined approach. Minimally invasive spine surgery （MISS） was developed for the purpose of reducing the undesirable effects and complications. This review aimed to make a brief summary of recent studies of the approach and clinical outcomes of MISS in adult scoliosis. Data Sources： We conducted a systematic search from PubMed, Medline, EMBASE, and other literature databases to collect reports of surgical methods and clinical outcomes of MISS in treatment of adult scoliosis. Those reports were published up to March 2017 with the following key terms： ＆quot;minimally invasive,＆quot; ＆quot;spine,＆quot; ＆quot;surgery,＆quot; and ＆quot;scoliosis.＆quot;Study Selection： The inclusion criteria of the articles were as followings： diagnosed with adult degenerative scoliosis （DS） or adult idiopathic scoliosis; underwent MISS or open surgery; with follow-up data. The articles involving patients with congenital scoliosis or unknown type were excluded and those without any follow-up data were also excluded from the study. The initial search yielded 233 articles. After title and abstract extraction, 29 English articles were selected for full-text review. Of those, 20 studies with 831 patients diagnosed with adult DS or adult idiopathic scoliosis were reviewed. Seventeen were retrospective studies, and three were prospective studies. Results： The surgical technique reported in these articles was direct or extreme lateral interbody fusion, axial lumbar interbody fusion, and transforaminal lumbar interbody fusion. Among the clinical outcomes of these studies, the operated levels was 3–7, operative time was 2.3–8.5 h. Both the Cobb angle of coronal major curve and evaluation of Oswestry Disability Index and Visual Analog Scale decreased after surgery. There were 323 complications reported in the 831 （38.9%） patients, including 150 （18.1%） motor or sensory deficits, and 111 （13.4%） implant-related complications. Conclusions： MISS can provide good radiological and self-evaluation improvement in treatment of adult scoliosis. More prospective studies will be needed before it is widely used.

Long-term Prognosis of Patients with Acute non-ST-segment Elevation Myocardial Infarction undergoing Different Treatment Strategies

Background： In cardiology, it is controversial whether different therapy strategies influence prognosis after acute coronary syndrome. We examined and compared the long-term outcomes of invasive and conservative strategies in patients with non-ST-segment elevation myocardial infarction （NSTEMI） and characterized the patients selected for an invasive approach. Methods： A total of 976 patients with acute NSTEMI were collected from December 2006 to October 2012 in the First Affiliated Hospital of Dalian Medical University Hospital. They are divided into conservative strategy （586 patients） and invasive strategy （390 patients） group. Unified tbllow-up questionnaire was performed by telephone contact （cut-off date was November, 2013）. The long-term clinical events were analyzed and related to the different treatment strategies. Results： The median follow-up time was 29 months. Mortality was 28.7% （n = 168） in the conservative group and 2.1% （n = 8） in the invasive management at long-term clinical follow-up. The secondary endpoint （the composite endpoint） was 59.0% （n = 346） in the conservative group and 30.3% （n = 118） in the invasive management. Multivariate analysis showed that patients in the conservative group had higher all-cause mortality rates than those who had the invasive management （adjusted risk ratio [RR] = 7.795; 95% confidence interval [CI]： 3.796 16.006, P 〈 0.001）, and the similar result was also seen in tile secondary endpoint （adjusted RR ： 2.102; 95% （7： 1.694-2.610, P 〈 0.001 ）. In the subgroup analysis according to each Thrombolysis in Myocardial Infarction risk score （TRS）, log-rank analysis showed lower mortality and secondary endpoint rates in the invasive group with the intermediate and high-risk patients （TRS 3-7）. Conclusions： An invasive strategy could improve long-term outcomes for NSTEMI patients, especially for intermediate and high-risk ones （TRS 3- 7）.

Clinical and Molecular Epidemiology of Invasive Staphylococcus aureus Infections in Chinese Children： A Single-center Experience

Staphylococcus aureus is associated with a variety of invasive infection; typically, these infections occur as sepsis, osteomyelitis, endocarditis, and arthritis. China has a relatively high incidence of invasive S. aureus disease in children.[1] The present study aimed to provide the demographics, clones, and the antimicrobial susceptibility of S. aureus that cause invasive infection in Chinese children.

Comparison of the Outcomes of Modified Artificial Chordae Technique for Mitral Regurgitation through Right Minithoracotomy or Median Sternotomy

Background： Right minithoracotomy （RM） has been proven to be a sate and effective approach for mitral valve surgery, but the differences of artificial chordae technique between RM and median sternotomy （MS） were seldom reported. Here, we compared the outcomes of modified artificial chordae technique for mitral regurgitation （MR） through RM or MS approaches. Methods： One hundred and eighteen consecutive adult patients who received mitral valve repair with artificial chordae and annuloplasty for MR through RM （n = 58） or MS （n = 60） from January 2006 to January 2015 were analyzed. Results： All of the selected patients underwent mitral valve repair successfully without any complication during the surgery. There was no significant difference between RM group and MS group in cardiopuhnonary bypass time, aortic cross-clamp time, and early postoperative complications. However, compared with the MS group, the RM group had shorter hospital stay and taster surgical recovery. At a mean follow-up of 44.8 ± 25.0 months, the freedom from more than moderate MR was 93.9% ± 3.5% in RM group and 94.8% ± 2.9% in MS group at 3 years postoperatively. Log-rank test showed that there was no significant difference in the freedom from recurrent significant MR between the two groups （Х^2= 0.247, P = 0.619）. Multivariate analysis revealed that the presence of mild MR at discharge was the independent risk factor for the recurrent significant MR. Conclusion： Right minithoracotomy can achieve the similar therapeutic effects with MS for the patients who received modified artificial chordae technique for treating MR.

Does Quadriceps-sparing Total Knee Arthroplasty Increase the Risk of Lower Limb and Component Malalignment？ A Minimum 5-year Follow-up Study

The conventional total knee arthroplasty （TKA） is the most successful surgical procedure for relieving pain and improving poor function in patients with advanced arthritis. However, postoperative pain and delayed rehabilitation are the greatest complaints for the conventional approach. Recently, various minimally invasive surgery （MIS） TKA-techniques have been developed to address the concern. MIS-TKAs have shown less postoperative pain, shorter hospital stays, and quicker recovery after surgery.