Pyogenic spondylitis caused by Escherichia coli: A case report and literature review

BACKGROUND

Pyogenic spondylitis is often manifested as atypical low back pain and fever, which makes it easy to be confused with other diseases. Here we report a case of pyogenic spondylitis and describe the diagnosis and treatment based on the related literature.

CASE SUMMARY

The reported case suffered from pyogenic spondylitis caused by Escherichia coli and complicated with bacteremia and psoas abscess. Acute pyelonephritis was initially diagnosed due to atypical symptoms. Symptoms were improved from antibiotic treatment while developing progressive lower limb dysfunction. One month post the admission, the patient underwent anterior lumbar debridement + autogenous iliac bone graft fusion + posterior percutaneous screw-rod internal fixation, and received 6 wk of antibiotic treatment after the operation. Reexamination 4 mo post the operation showed that the patient had no evident pain in the waist, and walked well with no evident dysfunction of lower limbs.

CONCLUSION

Here we describe the application value of several imaging examinations, such as X-ray, computed tomography and magnetic resonance imaging, and certain tests like erythrocyte sedimentation rate and C-reactive protein in the clinical treatment of pyogenic spondylitis. This disease requires early diagnosis and treatment. Sensitive antibiotics should be used in early stages and surgical intervention should be taken if necessary, which may help for a speedy recovery and prevent the occurrence of severe complications.

Loss of Reduction after Cephalomedullary Nail Fixation of Intertrochanteric Femoral Fracture: A Brief Report

Objective

At present, cephalomedullary nail is the most frequently used implant in the management of intertrochanteric fractures around the world. The implant design and fixation techniques of the cephalomedullary nail have been continuously improved to ensure uncomplicated bone union during the past decade. However, a degree of reduction loss during bone healing is still not rare in clinical work. Many attributed this complication to misoperation during the surgery and hold that a series of techniques and tips could help to avoid the loss of reduction. However, until now there has been no research to explore whether the reduction loss after the operation can be fully prevented in the best cases. The purposes of the study are as follows: (i) to evaluate the efficiency of the current established CMN techniques; (ii) to quantify the loss of reduction under an appropriately implanted CMN to anatomically realigned intertrochanteric fractures; and (iii) to explore the possible underlying causes for the inevitable loss of reduction.

Methods

In the retrospective study, 163 consecutive cases with the intertrochanteric fractures fixed with standard cephalomedullary nail technique were reviewed. The anatomical reduction and optimal positioning of the nail were confirmed by postoperative imaging. The fracture types ranged from 31‐A1.1–2.3 according to the OTA/AO fracture classification. One hundred and fifteen cases with stable fracture types (31A1.1–2.1) were allocated to Group A, and 48 cases with unstable 31A2.2–2.3 fracture types were allocated to Group B. The radiological measurements included femoral neck shortening, loss of the neck‐shaft angle, cutout, and cut‐through of the blade. The outcomes between postoperative and 1 year after the operation were evaluated and compared.

Results

The patients consisted of 66 males and 97 females with an average age of 69.4 (range: 46–78, SD: 14.6) years. At the 1‐year follow‐up, no fixation failure or nonunion was observed in each group. The mean femoral neck shortening and loss of the neck‐shaft angle were 4.47 mm (range: 0.43–17.68, SD: 3.71) and 5.4° (range: 0.51–19.10, SD: 3.58) separately. The mean cutout and cut‐through were 1.84 mm (range: 0.24–11.30, SD: 2.33) and 1.25 mm (range: 0.51–10.29, SD: 1.74). The average femoral neck shortening and loss of the neck‐shaft angle were higher in Group B than Group A. Among the 23 cases with the femoral neck shortening more than 10 mm, 19 cases (16.5%) were from Group A and four cases (8.3%) were from Group B. There were nine (7.8%) cases with the loss of the neck‐shaft angle more than 10° in Group A and six (12.5%) cases in Group B.

Conclusions

Current established CMN techniques are efficient in treating intertrochanteric femoral fracture. However, even with currently consensual techniques of cephalomedullary nail, the process of fracture healing still risks the loss of reduction, although the migration of the blade could be minimized. This situation may associate with the intrinsic design of the CMN and further improvement is still needed.

Giant Cell Tumor of Tendon Sheath with Tarsal Bones and Intertarsal Joint Invasion: A Case Report

The giant cell tumor of tendon sheath (GCTTS) is a benign lesion most commonly attached to the tendons and bones of the fingers, hands, and wrists. The involvement of GCTTS to the foot is uncommon. The GCTTS invading tarsal bones and intertarsal joints is not described yet, and the appropriate diagnosis and treatment remain unclear. We report a case of GCTTS with the involvement of tarsal bones and intertarsal joint. Computed tomography scan and magnetic resonance imaging were used to further diagnose and evaluate the quality and range of tumor. The patient was treated with surgical excision of the tumor without application of bone graft. After adequate clearance of the tumor, the patient returned to an asymptomatic walk in 3 months. No malfunction, fracture, or tumor recurrence was found in 2-years follow-up. This report includes clinical, radiologic, histologic diagnostic, and surgical challenges in an unexpected lesion and a review of the literature.

[Effect of lumbar dorsal muscle injuries on lumbar vertebral bone quality of rat]

Objective: To explored the effects of lumbar dorsal muscle damage on local lumbar vertebral bone quality. Methods: Thirty SD female rats, at age of 20 weeks, were randomly divided into three groups: control group, or say pseudo surgery group, an incision in the back were performed as CNT; bilateral erector spinal muscle group in which group bilateral lumbar erector spinal muscle were removed as RESM; castration group in which bilateral ovaries were resected as OVX.After three months, bone mineral density, microscopic CT and vertebral compression test were taken in lumbar vertebral (L4-6) in turn. Results: After three months bone mineral density in RESM group was obviously lower than the control group [(0.211±0.028) g/cm² vs(0.253±0.021) g/cm², P<0.01], however, there was no significant difference between OVX and RESM[(0.197±0.015) g/cm² vs(0.211±0.028) g/cm², P>0.05]. In microscopic CT three-dimensional reconstruction and bone histomorphometry analysis, compared with control group CNT , in the experimental groups OVX and RESM, bone trabecula of vertebral bodies were more sparse, the overall number and interconnection of trabecula were less.Especially in the OVX, osteoporotic trend of trabecular network trend is more obvious.In vertebral compression test, the maximum load, energy absorption, the maximum stress and elastic modulus in both OVX and RESM were significantly reduced (P<0.01). In the RESM the above four biomechanical parameters were significantly higher than those of OVX (P<0.05). Conclusion: Integrity and vigor of paravertebral muscles would be of great significance to maintain adjacent vertebral bone quality.Resection of lumbar dorsal muscles could lead to a significant decrease of local vertebral bone quality.Damage and atrophy of lumbar dorsal muscle could cause osteoporosis of vertebral bodies.

Comparative study on electrochemical 4-chlorophenol degradation in different diaphragm systems with combined reduction and oxidation properties

Two diaphragm electrolysis systems, two-electrode (anode-cathode) and three-electrode (cathode-anode-cathode), were compared for the electrochemical degradation of 4-chlorophenol. The performance of these systems was improved by feeding with hydrogen gas and then with air, in aid of the combined processes of reduction and oxidation. The 4-chlorophenol degradation, dechlorination, and total organic carbon removal were monitored to characterize the difference between the two systems. The results indicated that the three-electrode system exhibited higher degradation percentages for 4-chlorophenol compared with that of the two-electrode system. The dechlorination property of the three-electrode system was stronger than that of the two-electrode system. In addition, the total organic carbon removal percentage of the anodic compartment in the three-electrode system was higher than that of the two-electrode system. The three-electrode system showed excellent treatment properties for 4-chlorophenol.

Electrocatalytic degradation kinetic of 4-chlorophenol by the Pd/C gas-diffusion electrode system

A Pd/C gas-diffusion cathode which generated H2O2 through a two-electron reduction process of fed oxygen molecule was used to degrade 4-chlorophenol in an undivided electrolysis device. The kinetics of 4-chlorophenol degradation has been investigated by the electrochemical oxidation processes. By inspecting the relationship between the rate constants (k) and influencing factors, using first-order kinetics to describe the electrochemical oxidation process of 4-chlorophenol, a kinetic model of 4-chlorophenol degradation process was proposed to calculate the 4-chlorophenol effluent concentration: C = C0 exp( -3:76 × 10(-6) C(-0.5)0 J(2) M(-0.7) Q(0.17) Dt). It was found that the electrocatalytic degradation rate of 4-chlorophenol was affected by current density, electrode distance, air-feeding rate, electrolyte concentration and initial 4-chlorophenol concentration. The kinetics obtained from the experiments under corresponding electrochemical conditions could provide an accurate estimation of 4-chlorophenol effluent concentration and lead to better design of the electrochemical reactor.

The CREB-Smad6-Runx2 axis contributes to the impaired osteogenesis potential of bone marrow stromal cells in fibrous dysplasia of bone

Fibrous dysplasia (FD) is characterized by the replacement of normal bone with abnormal fibro-osseous tissue. This disorder is due to activating missense mutations in the GNAS gene and resultant over-production of cAMP. However, the signalling pathways that contribute to FD pathogenesis remain unknown. In the current study, bone marrow stromal cells (BMSCs) carrying GNAS R201H mutation were isolated from lesion site of FD patients. cAMP accumulation, enhanced proliferation and impaired osteogenesis potential were observed. Two cell models, BMSCs treated with excess exogenous cAMP and BMSCs infected with lentivirus GNAS R201H, were established to model the pathological conditions of FD and used to investigate its pathogenesis. The results suggest that the CREB-Smad6-Runx2 axis is involved in osteogenesis dysfunction of BMSCs with the FD phenotype. We confirmed the results in FD lesion-derived BMSCs and observed that the impaired osteogenesis potential of BMSCs infected with lentivirus GNAS (R201H) was recovered in vitro through modulation of the CREB-Smad6-Runx2 axis. This study provides useful insight into the signalling pathways involved in the FD phenotype and facilitates dissection of the molecular pathogenesis of FD and testing of novel therapies.

Degradation of 4-chlorophenol by the anodic-cathodic cooperative effect with a Pd/MWNT gas-diffusion electrode

Pd/multi-walled carbon nanotubes (MWNTs) catalyst used for the gas-diffusion electrode was prepared by ethylene glycol (EG) reduction and characterized by the X-ray diffraction (XRD) and scanning electron microscope (SEM). The results indicated that Pd particles with an average size of 8.0 nm were highly dispersed in the MWNTs with amorphous structure. In a diaphragm electrolysis system with a Ti/RuO(2)/IrO(2) anode and the Pd/MWNT gas diffusion cathode, the degradation of 4-chlorophenol was performed by a combination of electrochemical reduction and oxidation. The combined process was in favor of improving 4-chlorophenol degradation efficiency. The optimum reaction conditions were as following: initial pH 7, aeration with hydrogen and air. Under the optimized electrolysis conditions the removal of 4-chlorophenol in the anodic and cathodic compartments were 98.5 and 90.5%, respectively. Additionally, based on the analysis of electrolysis intermediates using high performance liquid chromatography (HPLC) and ion chromatography (IC), the electrolysis degradation of 4-chlorophenol was proposed containing the intermediates, such as phenol, hydroquinone, benzoquinone, maleic acid, fumaric acid, succinic acid, malonic acid, oxalic acid, acetic acid and formic acid.

Degradation mechanism of 4-chlorophenol with electrogenerated hydrogen peroxide on a Pd/C gas-diffusion electrode

Using a self-made Pd/C gas-diffusion electrode as the cathode and a Ti/IrO2/RuO2 anode, the degradation of 4-chlorophenol has been investigated in an undivided electrolysis device by the electrochemical oxidation processes. The result indicated that the neutral aqueous solutions can accelerate 4-chlorophenol degradation during electrolysis. The removal efficiency of 4-chlorophenol and COD reached about 89.6% and 62.0% after 120 min electrolysis, respectively. It suggested that most of 4-chlorophenol was oxidised to intermediates using the Pd/C gas-diffusion electrode. Furthermore, the biodegradation ability of the solution was increased significantly during the electrolysis. The degradation of 4-chlorophenol was attributed to the cooperative oxidation processes including electrochemical oxidation at the anode and H2O2 and hydroxyl radical (HO·) produced by the reduction of oxygen at the cathode. Finally, main aromatic intermediates (e.g., hydroquinone and benzoquinone) and main aliphatic carboxylic intermediates (e.g., oxalic, malonic, maleic, succinic, fumaric, and dodecanoic acids) were identified by GC-MS. Moreover, a reaction scheme involving all these intermediates was proposed.

Human mesenchymal stem cells promote growth of osteosarcoma: involvement of interleukin-6 in the interaction between human mesenchymal stem cells and Saos-2

Our previous study showed that exogenous human mesenchymal stem cells (hMSCs) targeted established osteosarcoma and promoted its growth and pulmonary metastasis in vivo. As a follow-up, the present study aimed to investigate how hMSCs would interact with Saos-2 through autocrine/paracrine communication. The results showed that co-injection of hMSCs with Saos-2 into the proximal tibia of nude mice could promote tumor growth and progression. In vitro, the proliferation of Saos-2 and hMSCs was promoted by each other's conditioned medium, in which interleukin-6 (IL-6) played an important role. Osteogenic differentiation of hMSCs could be inhibited by conditioned medium of Saos-2, in which IL-6 was also involved. Furthermore, decreased IL-6 secretion by hMSCs during its osteogenesis and increased IL-6 secretion in response to conditioned medium of Saos-2 were observed. Based on these data, we suggest that there was a positive feedback loop of IL-6 in the interaction between hMSCs and Saos-2.

Increased number of mesenchymal stem cell-like cells in peripheral blood of patients with bone sarcomas

BACKGROUND AND AIMS

The number of peripheral blood mesenchymal stem cells (PBMSCs) may increase under pathological conditions. We sought to compare the number of MSC-like cells in the peripheral blood of patients with bone sarcomas with healthy controls and to analyze related cytokines in the peripheral blood plasma.

METHODS

Peripheral blood mononuclear cells (PBMNs) of patients with bone sarcomas and control subjects were isolated for culture and analyzed by flow cytometry for MSC phenotype. Cytokines in the plasma obtained after cell separation were analyzed using enzyme-linked immunosorbent assay (ELISA). Annexin-V and beta-galactosidase staining were used to investigate whether the cells died from apoptosis or senescence.

RESULTS

Flow cytometric analysis demonstrated an >9-fold increase in the number of cells with MSC-like phenotypes (CD34(-), CD45(-), CD105(+)) in patients with bone sarcomas compared with control subjects (p<0.05). ELISA results showed that concentrations of hepatocyte growth factor (HGF) and vascular endothelial growth factor (VEGF) in patients with bone sarcomas were statistically higher than those in the control subjects (p<0.05), whereas there was no significant difference in plasma concentrations of leptin and stromal cell-derived factor 1 between the two groups. A significant, positive correlation between the percentages of PBMSC-like cells and concentrations of HGF in all samples (R=0.618; p=0.011). Annexin-V staining of MSC-like cells was positive, whereas beta-galactosidase staining was negative.

CONCLUSIONS

Peripheral blood of patients with bone sarcomas has more cells with MSC phenotypes than blood of healthy persons. The increased number is accompanied by increased HGF and VEGF in the plasma.