Somatic mutations of KIT are frequently found in mastocytosis and gastrointestinal stromal tumor (GIST), while germline mutations of KIT are rare, and only found in few cases of familial GIST and mastocytosis. Although ligand-independent activation is the common feature of KIT mutations, the phenotypes mediated by various germline KIT mutations are different. Germline KIT mutations affect different tissues such as interstitial cells of Cajal (ICC), mast cells or melanocytes, and thereby lead to GIST, mastocytosis, or abnormal pigmentation. In this review, we summarize germline KIT mutations in familial mastocytosis and GIST and discuss the possible cellular context dependent transforming activity of KIT mutations.

Questions whether to continue or discontinue aspirin administration in the perioperative period of spinal surgery has not been systematically evaluated. The present systematic review is carried out to assess the impact of continuing aspirin administration on the bleeding and cardiovascular events in perispinal surgery period. Studies were retrieved through MEDLINE, EMBASE, and Springer Link Databases (search terms, aspirin, continue or discontinue, and spinal fusion), bibliographies of the articles retrieved, and the authors’ reference files. We included studies that enrolled patients who underwent spinal surgery who were anticoagulated with aspirin alone and that reported bleeding or cardiovascular events as an outcome. Study quality was assessed using a validated form. 95% confidence interval (95% CI) was pooled to give summary estimates of bleeding and cardiovascular risk. We identified 4 studies assessing bleeding risk associated with aspirin continuation or cardiovascular risk with aspirin discontinuation during spinal surgery. The continuation of aspirin will not increase the risk of blood loss during the spinal surgery (95% CI, −111.72 to −0.59; P = .05). Also, there was no observed increase in the operative time (95% CI, −33.29 to −3.89; P = .01) and postoperative blood transfusion (95% CI, 0.00–0.27; P = .05). But as for the cardiovascular risk without aspirin continuation and mean hospital length of stay with aspirin continuation, we did not get enough samples to make an accurate decision about their relations with aspirin. Patients undergoing spinal surgery with continued aspirin administration do not have an increased risk for bleeding. In addition, there is no observed increase in the operation time and postoperative blood transfusion.

Purpose: Choosing an optimal distal fusion level for adult spinal deformity (ASD) is still controversial. To compare the radiographic and clinical outcomes of distal fusion to L5 versus the sacrum in ASD, we conducted a meta-analysis. Methods: Relevant studies on long fusion terminating at L5 or the sacrum in ASD were retrieved from the PubMed, Embase, Cochrane, and Google Scholar databases. Then, studies were manually selected for inclusion based on predefined criteria. The meta-analysis was performed by RevMan 5.3. Results: Eleven retrospective studies with 1211 patients were included in meta-analysis. No significant difference was found in overall complication rate (95% CI 0.60 to 1.30) and revision rate (95% CI 0.59 to 1.99) between fusion to L5 group (L group) and fusion to the sacrum group (S group). Significant lower rate of pseudarthrosis and implant-related complications (95% CI 0.29 to 0.64) as well as proximal adjacent segment disease (95% CI 0.35 to 0.92) was found in L group. Patients in S group obtained a better correction of lumbar lordosis (95% CI − 7.85 to − 0.38) and less loss of sagittal balance (95% CI − 1.80 to − 0.50). Conclusion: Our meta-analysis suggested that long fusion terminating at L5 or the sacrum was similar in scoliosis correction, overall complication rate, revision rate, and improvement in pain and disability. However, fusion to L5 had advantages in lower rate of pseudarthrosis, implant-related complications, and proximal adjacent segment disease, while fusion to the sacrum had advantages in the restoration of lumbar lordosis, maintenance of sagittal balance, and absence of distal adjacent segment disease. Graphic These slides can be retrieved under Electronic Supplementary Material.

Albeit it is rare, the authors report a stage 3 Kummell disease case. It is diagnosed by dynamic thoracic magnetic resonance imaging (MRI). Because there is no established strategy on stage 3 Kummell disease, we performed percutaneous kyphoplasty at first, but unfortunately made a revision surgery to remove the polymethylmethacrylate (PMMA) cement after the failure of percutaneous kyphoplasty. A 73-year-old lady with severe back pain due to osteoporosis vertebral fracture was admitted to our hospital on June 23, 2016. She underwent percutaneous kyphoplasty with the back pain improved shortly. Unfortunately, she went back to our hospital due to aggravated back pain and partial paralysis on July 25, 2016. Kummell disease, lumbar stenosis, lacunar infarction. Specially, the compression of spinal cord was obvious in the hyperflexion position on dynamic MRI. Even though there was no improvement in muscle strength, the patient was satisfied with the back pain relief after percutaneous kyphoplasty. But, the same back pain reappeared after about 1 month. Then, we took out the PMMA cement and performed posterior vertebral column resection. At last, the back pain was relieved again but the muscle strength was improved not obviously after operation. At the same time, the kyphosis was corrected and the intravertebral stability was achieved. Dynamic MRI is helpful in Kummell disease with neurologic symptoms, even if there is no obvious compression in the neutral position. Furthermore, the intravertebral instability is probably the main reason of the neurologic symptoms in this case. Percutaneous kyphoplasty could not reconstruct the intravertebral stability. Stage 3 Kummell disease with obvious intravertebral instability should be treated by open surgery.