ABSTRACT
Objective:To compare the efficacies of posterior long segment instrumentation combined with transpedicular impaction bone grafting or with bone cement augmentation in treating stage III Kümmell disease.Methods:A retrospective cohort study was conducted to analyze the clinical data of 38 patients with stage III Kümmell disease who were admitted to Zhengzhou Orthopedic Hospital between January 2016 and December 2020. The study included 8 male and 30 female patients, with ages ranging from 59 to 81 years [(68.9±4.9)years]. The vertebral fractures occurred at T 8 in 1 patient, T 11 in 9 patients, T 12 in 10 patients, and L 2 in 10 patients. Seventeen patients underwent posterior long segment instrumentation combined with transpedicular impaction bone grafting (impaction bone grafting group), and 21 patients underwent posterior long segment instrumentation combined with bone cement augmentation (bone cement group). The surgical duration, intraoperative blood loss, and incidences of postoperative complications were compared between the two groups. Additionally, the visual analogue score (VAS), Japanese orthopedic association (JOA) score, and Cobb angle were compared before the operation, at 1 week and 3 months post-operation, and at the final follow-up for both groups. The study also compared bone healing at the last follow-up and postoperative complication rates between the two groups. Results:All the patients were followed up for 24-35 months [(28.7±2.9)months]. The impaction bone grafting group had a surgical duration of (150.7±25.4)minutes and intraoperative blood loss of (285.3±48.6)ml, significantly different from those in the bone cement group [(132.0±21.1)minutes, (251.4±44.8)ml] (all P<0.05). Before the operation, there were no significant differences in the VAS, JOA score, or Cobb angle between the two groups (all P>0.05).The VAS was (3.2±0.8)points, (2.7±0.5)points and (2.2±0.7)points in the impaction bone grafting group and was (2.7±0.6)points, (2.6±0.7)points and (2.4±0.8)points in the bone cement group at 1 week and 3 months post-operation and at the final follow-up, respectively. The VAS in the impaction bone grafting group was significantly higher than that in the bone cement group at 1 week post-operation ( P<0.05); however, no significant differences were found at 3 months post-operation or at the last follow-up (all P>0.05). There was no significant difference in the JOA score between the two groups at 1 week or 3 months post-operation, or at the final follow-up (all P>0.05). The Cobb angle in the impaction bone grafting group was (5.1±1.3)°, (5.9±1.8)° and (6.5±2.5)° at 1 week and 3 months post-operation, and at the final follow-up, significantly lower than that in the bone cement group [(8.4±1.6)°, (12.6±2.1)°, and (14.5±3.3)°] (all P<0.01). All the patients in the impaction bone grafting group achieved bone healing at the last follow-up. One patient in the impaction bone grafting group experienced delayed incision healing, whereas two patients in the bone cement group had poor bone healing. The complication rate was 5.9% (1/17) in the impaction bone grafting group and 9.5% (2/21) in the bone cement group ( P>0.05). Conclusions:Posterior long segment instrumentation combined with transpedicular impaction bone grafting or with bone cement augmentation are both effective in alleviating pain and improving the spinal function for stage III Kümmell disease. The former procedure is associated with longer surgical duration and increased intraoperative blood loss, but it can provide superior correction and maintenance of kyphosis deformity, promoting the healing of the injured vertebrae.
ABSTRACT
Objective:To compare the clinical efficacies of precision targeted and traditional percutaneous vertebroplasty (PVP) in the treatment of refracture of injured vertebra after operation for Kümmell disease.Methods:A retrospective cohort study was conducted to analyze the clinical data of 23 Kümmell disease patients suffering from refracture of injured vertebra after PVP in Zhengzhou Orthopedic Hospital from October 2014 to October 2018. The patients included 7 males and 16 females, aged 53-89 years [(69.3±3.5)years]. There were 11 patients of stage I Kümmell disease and 12 patients of stage II Kümmell disease. The vertebral distribution of fracture was T 11 (3 patients), T 12 (9 patients), L 1 (8 patients) and L 2 (3 patients). Eleven patients received traditional PVP treatment (traditional PVP group) and 12 patients received precision targeted PVP treatment (targeted PVP group). The operation time, amount of bone cement injection and filling of bone cement in the fracture space were compared between the two groups. The visual analogue score (VAS) and Oswestry disability index (ODI) were also compared before operation, at 2 days, 1 month, 3 months, 6 months after operation, and at the last follow-up. The rates of bone cement leakage and re-collapse of injured vertebra were observed in the two groups. Results:The patients were followed up for 12-36 months [(24.2±2.6)months]. There were no significant differences in the operation time or amount of bone cement injection between the two groups (all P>0.05). All the fracture spaces in the targeted PVP group were fully filled with bone cement, while 4 patients in the traditional PVP group showed inadequate filling of the fracture area ( P<0.05). The VAS values in the targeted PVP group were (8.9±0.5)points, (1.6±0.2)points, (1.7±0.1)points, (1.8±0.1)points, (1.9±0.3)points, and (1.8±0.4)points before operation, at 2 days, 1 month, 3 months, 6 months after operation and at the last follow-up; and those in the traditional PVP group were (9.1±0.9)points, (1.8±0.4)points, (1.8±0.2)points, (2.0±0.4)points, (2.1±0.2)points, and (2.4±0.3)points, respectively. The VAS values of both groups were significantly decreased at 2 days, 1 month, 3 months, 6 months after operation, and at the last follow-up compared with those before operation (all P<0.05), but there was no significant difference between different time points after operation (all P>0.05). No significant differences were found in the VAS values between the two groups before operation and at 2 days, 1 month, 3 months and 6 months after operation (all P>0.05). However, the VAS value in the targeted PVP group was significantly lower than that in the traditional PVP group at the last follow-up ( P<0.05). The ODI values in the targeted PVP group were 38.5±4.3, 7.2±2.3, 7.3±2.0, 7.2±1.8, 7.3±2.4, and 7.4±2.5 before operation and at 2 days, 1 month, 3 months, 6 months after operation, and at last follow-up; and those in the traditional PVP group were 37.8±4.1, 7.5±2.5, 7.7±1.9, 7.9±2.4, 8.1±2.6, and 9.6±2.4, respectively. The ODI values of both groups were significantly decreased at 2 days, 1 month, 3 months, 6 months after operation and at the last follow-up compared with those before operation (all P<0.05), but there were no significant differences between different time points after operation (all P>0.05). The ODI values were not significantly different between the two groups before operation and at 2 days, 1 month, 3 months, 6 months after operation (all P>0.05), but the ODI value in the targeted PVP group was significantly lower than that in the traditional PVP group at the last follow-up ( P<0.05). There were no significant differences in the rates of bone cement leakage or re-collapse of injured vertebra between the two groups (all P>0.05). Conclusion:Compared with traditional PVP treatment for refracture of injured vertebra after operation for Kümmell disease, targeted PVP can make bone cement injection fully dispersed, greatly reduce pain and promote functional recovery.
ABSTRACT
Objective:To investigate the efficacy of the classified reduction based on CT two-dimensional images for the surgical treatment of single segment facet joint dislocation in subaxial cervical spine.Methods:A retrospective case series study was made on 105 patients with single segment facet joint dislocation in subaxial cervical spine admitted to Zhengzhou Orthopedic Hospital from January 2015 to October 2022. There were 63 males and 42 females, with the age range of 22-78 years [(47.5±3.6)years]. Preoperative American Spinal Cord Injury Association (ASIA) classification was grade A in 23 patients, grade B in 45, grade C in 22, grade D in 15 and grade E in 0. The classification of surgical approach was based on the presence or not of continuity between anterior and posterior subaxial cervical structures and the movability of the posterior cervical facet joint on CT two-dimensional images, including anterior cervical surgery if both were presented and posterior facet joint resection plus anterior cervical surgery if there was discontinuity between anterior and posterior subaxial cervical structures or posterior facet joint fusion. Reduction procedures were applied in accordance with the type of facet joint dislocation classified based on the position of the lower upper corner of facet joint, including skull traction or manipulative reduction for the dislocation locating at the dorsal side (type A), intraoperative skull traction and leverage technique for the dislocation locating at the top (type B) and intraoperative skull traction and leverage technique with boosting for the dislocation locating at the ventral side (type C). If the dislocation of two facet joints in the same patient was different, the priority of management followed the order of type C, type B and type A. The reduction success rate, operation time and intraoperative blood loss were recorded. The cervical physiological curvature was evaluated by comparing the intervertebral space height and Cobb angle before operation, at 3 months after operation and at the last follow-up. The fusion rate of intervertebral bone grafting was evaluated by Lenke grading at 3 months after operation. The spinal cord nerve injury was assessed with ASIA classification before operation and at 3 months after operation. Japanese Orthopedic Association (JOA) score was applied to measure the degree of cervical spinal cord dysfunction before operation and at 3 months after operation, and the final follow-up score was used to calculate the rate of spinal cord functional recovery. The occurrence of complications was observed.Results:All patients were followed up for 3-9 months [(6.0±2.5)months]. The reduction success rate was 100%. The operation time was 40-95 minutes [(58.6±9.3)minutes]. The intraoperative blood loss was 40 to 120 ml [(55.7±6.8)ml]. The intervertebral space height was (4.7±0.3)mm and (4.7±0.2)mm at 3 months after operation and at the last follow-up, significantly decreased from preoperative (3.1±0.5)mm (all P<0.01), but there was no significant difference in intervertebral space height at 3 months after operation and at the last follow-up ( P>0.05). The Cobb angle was (6.5±1.3)° and (6.3±1.2)° at 3 months after operation and at the last follow-up, significantly increased from preoperative (-5.4±2.2)° (all P<0.01), but there was no significant difference in Cobb angle at 3 months after operation and at the last follow-up ( P>0.05). The fusion rate of intervertebral bone grafting evaluated by Lenke grading was 100% at 3 months after operation. The ASIA grading was grade A in 15 patients, grade B in 42, grade C in 29, grade D in 12 and grade E in 7 at 3 months after operation. The patients showed varying degrees of improvement in postoperative ASIA grade except that 15 patients with preoperative ASIA grade A had partial recovery of limb sensation but no improvement in ASIA grade. The JOA score was (13.3±0.6)points and (13.1±0.6)points at 3 months after operation and at the last follow-up, significantly improved from preoperative (6.8±1.4)points (all P<0.01), but there was no significant difference in JOA score at 3 months after operation and at the last follow-up ( P>0.05). The rate of spinal cord functional recovery was (66.3±2.5)% at the last follow-up. All patients had no complications such as increased nerve damage or vascular damage. Conclusion:The classified reduction based on CT two-dimensional images for the surgical treatment of single segment facet joint dislocation in subaxial cervical spine has advantages of reduced facet joint dislocation, recovered intervertebral space height and physiological curvature, good intervertebral fusion and improved spinal cord function.
ABSTRACT
Objective:To compare the clinical effect of transpedicular impaction and grafting of allogeneic bone containing enriched bone marrow combined with posterior internal fixation and posterior subtotal vertebrectomy combined with posterior internal fixation in the treatment of stage III Kümmell′s disease.Methods:A retrospective cohort study was made on clinical data of 40 patients with stage III Kümmell′s disease admitted to Zhengzhou Orthopedic Hospital from June 2015 to December 2018. There were 10 males and 30 females, at age range of 57-79 years［(67.7±6.1)years］. A total of 19 patients were treated by transpedicular impaction and grafting of allogeneic bone containing enriched bone marrow combined with posterior internal fixation (impaction bone graft group), and 21 patients by posterior subtotal vertebrectomy combined with posterior internal fixation (subtotal vertebrectomy group). Operation time and intraoperative blood loss were compared between the two groups. Degree of pain, lumbar dysfunction and degree of kyphosis were evaluated by visual analogue scale (VAS), Japanese Orthopedic Association (JOA) score and kyphotic Cobb angle before operation, at 1 week after operation and at the last follow-up. Bone healing time was compared between the two groups. The complications of the two groups were observed.Results:All patients were followed up for 25-64 months［(40.6±10.4)months］. Operation time and intraoperative blood loss were (130.0±10.1)minutes and (284.5±43.5)ml in impaction bone graft group, lower than those in subtotal vertebrectomy group［(253.8±33.2)minutes, (889.1±95.7)ml］(both P<0.01). There were no significant differences in VAS, JOA score or kyphotic Cobb angle between the two groups before operation, at 1 week after operation and at the last follow-up (all P>0.05). Both VAS and JOA score showed significant differences within each group at any time point (all P<0.01). In both groups, the kyphotic Cobb angle reduced significantly at 1 week after operation when compared with that before operation (all P<0.01), and the angle showed a slight increase at the last follow-up, but remained significantly lower than that before operation (all P<0.01). There were no relapse of pain or aggravation of kyphosis. Bone healing time in impaction bone graft group［4.4(4.0, 5.0)months］was significantly shorter than that in subtotal vertebrectomy group［6.4(5.2, 8.1)months］( P<0.01). There were 2 patients with delayed healing of surgical incision in impaction bone graft group, with the complication rate of 11%. There were 2 patients with dural tear and 3 patients with delayed healing of surgical incision in subtotal vertebrectomy group, with the complication rate of 24%. The complication rate was not statistically significant between the two groups ( P>0.05). No loosening or breakage of internal fixation was observed during the follow-up. Conclusions:Transpedicular impaction and grafting of allogeneic bone containing enriched bone marrow combined with posterior internal fixation and posterior subtotal vertebrectomy combined with posterior internal fixation are effective in the treatment of stage III Kümmell disease. However, the former can shorten the operation time, reduce the intraoperative blood loss and accelerate the healing of injured vertebral bone, suggesting a relatively minimally invasive surgical method for reconstruction and maintenance of spinal biomechanical stability.
ABSTRACT
Objective:To investigate the efficacy of stage I anterior cervical reduction, decompression, interbody fusion and internal fixation of single-segment lower cervical injury of AO type C subtype F4.Methods:A retrospective case series study was made on 45 patients with single-segment lower cervical injury of AO C type F4 subtype admitted to Zhengzhou Orthopedic Hospital from January 2012 to December 2019. The study included 31 males and 14 females with the age of (48.5±3.7)years (range, 23-78 years). Segment of injury was located at C 4/5 in 11 patients, at C 5/6 in 19, and at C 6/7 in 15. Under general anesthesia, all patients (16 unilateral injury and 29 bilateral injury) underwent stage I anterior cervical reduction, decompression, interbody fusion and internal fixation within 24 hours after injury. The interbody fusion methods included autogenous iliac bone in 28 patients and cervical fusion cage in 17. The operation time, blood loss, reduction time and correction rate of zygapophysial joints, postoperative complications and incision healing were analyzed. The height of cervical intervertebral space and Cobb angle were measured through X-ray of lateral cervical vertebrae before operation and3 months after operation to assess the cervical physiological curvature. The type of injury was clarified according to Lenke classification through coronal and sagittal CT scanning to determine the intervertebral bone graft fusion rate. The intraspinal spinal cord decompression was observed through MRI. The nerve function was assessed before operation and 3 months after operation using American Spinal Injury Association (ASIA) scale and Japanese Orthopedic Association (JOA) score, and the improvement rate was measured. Results:All the patients were followed up for (6.1±3.6)months (range, 3-9 months). The operation time was (55.1±8.2)minutes (range, 40-75 minutes), and intraoperative blood loss was (45.2±5.3)ml (range, 40-80 ml). The Zygapophysial joint reduction took (2.1±0.5)minutes (range, 1.5-3.0 minutes), with a success rate of 100%. Surgical procedures were performed with no postoperative complications such as aggravated spinal cord injury, large vascular injury or esophageal lesion. All the patients obtained Class I incision healing at first stage. The height of cervical intervertebral space was improved from preoperative (3.3±0.6)mm to (4.9±0.8)mm at postoperative 3 months ( P<0.05). The Cobb angle was increased from preoperative (-4.6±3.6)° to (6.5±2.1)° at postoperative 3 months ( P<0.01). According to Lenke classification, the intervertebral body fusion was good at postoperative 3 months, including Grade A in 41 patients and Grade B in 4. The rest of the patients showed varying degrees of neurological recovery according to ASIA scale, except for 6 patients with ASIA Grade A. The JOA score was improved from preoperative (7.4±2.3)points to (15.0±3.2)points at postoperative 3 months ( P<0.05), with the improvement rate of (73.3±17.6)%. Conclusion:For stage I anterior cervical reduction, decompression, interbody fusion and internal fixation of single-segment lower cervical injury of AO type C subtype F4, early surgical decompression is needed so as to reduce the perched facet or dislocated zygapophyseal joints and effectively improve the cervical spinal cord function.
ABSTRACT
Objective:To compare the clinical efficacy of long/short segment posterior instrumentation combined with transpedicular impaction bone grafting for stage III Kümmell's disease.Methods:A retrospective case control study was conducted to analyze the clinical data of 45 patients with stage III Kümmell's disease admitted to Zhengzhou Orthopaedics Hospital from June 2012 to June 2019, There were 8 males and 37 females, aged 58-84 years [(68.8±3.5)years]. Segment of injury was T 11 in 5 patients, T 12 in 18, L 1 in 15, and L 2 in 7. A total of 24 patients were treated with posterior long segment pedicle screw fixation combined with pedicle screw compression and bone grafting (long segment group), and 21 patients were treated with posterior short segment pedicle screw fixation combined with pedicle screw compression and bone grafting (short segment group). For patients with severe osteoporosis, pedicle screws were augmented with bone cement. The operation time and blood loss were compared between the two groups. The visual analogue scale (VAS) was used to evaluate the degree of low back pain, and the Japanese Orthopaedic Association (JOA) score was used to evaluate the lumbar function at postoperative 2 weeks and 1 year. According to X-ray film and CT examination, the bone healing of the grafted vertebral body and the changes of Cobb angle of injured vertebrae were further evaluated. The complications were observed. Results:All patients were followed up for 15-48 months[(31.2±2.3)months]. There were no significant differences between the two groups in operation time and intraoperative blood loss ( P>0.05). The bone grafts in the vertebrae healed well in both groups at 1 year after operation. The Cobb angle, VAS and JOA score in both groups improved at 2 weeks and 1 year after operation ( P<0.01). There was no significant difference in Cobb angle, VAS and JOA score between the two groups at 2 weeks after operation ( P>0.05). The Cobb angle in short segment group [(14.8±6.3)°] was significantly higher than that in long segment group [(8.5±3.3)°] at 1 year after operation ( P<0.01), but there was no significant difference in VAS and JOA scores between the two groups ( P>0.05). There was no loosening or breakage of internal fixation in both groups. Conclusions:For stage III Kümmell's disease, both long and short segment posterior instrumentation combined with transpedicular impaction bone grafting can effectively restore the vertebral height, improve kyphosis and reduce dysfunction. However, long segment can better maintain spine stability, prevent vertebral collapse and progression of local kyphosis Cobb angle when compared with short segment fixation.
ABSTRACT
Objective From the economic point of view,this study was to systematically assess the status quo on lung cancer screening in the world and to provide reference for further research and implementation of the programs,in China.Methods PubMed,EMbase,The Cochrane Library,CNKI and Wanfang Data were searched to gather papers on studies related to economic evaluation regarding lung cancer screening worldwide,from the inception of studies to June 30th,2018.Basic characteristics,methods and main results were extracted.Quality of studies was assessed.Cost were converted to Chinese Yuan under the exchange rates from the World Bank.The ratio of incremental cost-effectiveness ratio (ICER) to local GDP per capita were calculated.Results A total of 23 studies (only 1 randomized controlled trial) were included and the overall quality was accepted.22 studies were from the developed countries.Nearly half of the studies (11 studies) took 55 years old as the starting age of the screening program.Smoking history was widely applied for the selection of criteria on target populations (18).Low-dose computed tomography (LDCT) was involved in every study used to evaluate the economic effectiveness.Annual (17) and once-life time (7) screening were more common frequencies.22 studies reported ICERs for LDCT screening,compared to no screening,of which 17 were less than 3 times local GDP per capita,and were considered as cost-effectiveness,according to the WHO's recommendation.15 and 7 studies reported ICERs for annual and once-life time screening,of which 12 and 7 studies were in favor the results of their cost-effectiveness,respectively.Additionally,the cost-effectiveness of once-lifetime screening was likely to be superior to the annual screening.Differences of cost-effectiveness among the subgroups,by starting age or by the smoking history,might exist.Conclusions Based on the studies,evidence from the developed countries demonstrated that LDCT screening programs on lung cancer,implemented among populations selected by age and smoking history,generally appeared more cost-effective.Combined with the local situation of health resource,the findings could provide direction for less developed regions/countries lacking of local evidence.Low frequency of LDCT screening for lung cancer could be adopted when budget was limited.Data on starting ages,smoking history and other important components related to the strategy of screening programs,needs to be precisely evaluated under the situation of local population.
ABSTRACT
Objective From the economic point of view,this study was to systematically assess the status quo on lung cancer screening in the world and to provide reference for further research and implementation of the programs,in China.Methods PubMed,EMbase,The Cochrane Library,CNKI and Wanfang Data were searched to gather papers on studies related to economic evaluation regarding lung cancer screening worldwide,from the inception of studies to June 30th,2018.Basic characteristics,methods and main results were extracted.Quality of studies was assessed.Cost were converted to Chinese Yuan under the exchange rates from the World Bank.The ratio of incremental cost-effectiveness ratio (ICER) to local GDP per capita were calculated.Results A total of 23 studies (only 1 randomized controlled trial) were included and the overall quality was accepted.22 studies were from the developed countries.Nearly half of the studies (11 studies) took 55 years old as the starting age of the screening program.Smoking history was widely applied for the selection of criteria on target populations (18).Low-dose computed tomography (LDCT) was involved in every study used to evaluate the economic effectiveness.Annual (17) and once-life time (7) screening were more common frequencies.22 studies reported ICERs for LDCT screening,compared to no screening,of which 17 were less than 3 times local GDP per capita,and were considered as cost-effectiveness,according to the WHO's recommendation.15 and 7 studies reported ICERs for annual and once-life time screening,of which 12 and 7 studies were in favor the results of their cost-effectiveness,respectively.Additionally,the cost-effectiveness of once-lifetime screening was likely to be superior to the annual screening.Differences of cost-effectiveness among the subgroups,by starting age or by the smoking history,might exist.Conclusions Based on the studies,evidence from the developed countries demonstrated that LDCT screening programs on lung cancer,implemented among populations selected by age and smoking history,generally appeared more cost-effective.Combined with the local situation of health resource,the findings could provide direction for less developed regions/countries lacking of local evidence.Low frequency of LDCT screening for lung cancer could be adopted when budget was limited.Data on starting ages,smoking history and other important components related to the strategy of screening programs,needs to be precisely evaluated under the situation of local population.
ABSTRACT
Objective To investigate the application value of enhanced recovery after surgery with no gastrointestinal decompression tube and with early postoperative oral feeding in minimally invasive radical resectionof esophageal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 126 patients who underwent minimally invasive McKeown surgery in the General Hospital of Southern Theatre Command of PLA between March 2016 and October 2017 were collected.There were 80 males and 46 females,aged from 52 to 82 years,with an average age of 64 years.Of 126 patients,82 undergoing "li's anastomosis" with no gastrointestinal decompression tube and receiving early postoperative oral feeding were allocated into non-tube no fasting group,and 44 undergoing end-to-side gastroesophageal anastomosis with tubular stapler,conventionally indwelling gastrointestinal decompression tube,and beginning oral feeding at 1 week after surgery were allocated into traditional treatment group.Observation indicators:(1) surgical and postoperative recovery situations;(2) results of pathological examination;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative tumor recurrence and metastasis up to October 2018.Measurement data with normal distribution were represented as Mean ± SD,and comparison between groups was analyzed using independent sample t test.Measurement data with skewed distribution were expressed as M (range),and comparison between groups was analyzed by rank sum test.Count data were described as absolute number or percentage,and comparison between groups was analyzed using chi-square test.Ordinal data were analyzed by rank sum test.Results (1) Surgical and postoperative recovery situations:patients in the two groups underwent minimally invasive McKeown surgery successfully.Operation time,volume of intraoperative blood loss,incidence of anastomotic fistula,incidence of pulmonary complications,and duration of postoperative hospital stay were respectively (326±41) minutes,(225±96) ml,7.3 ％ (6/82),24.4％ (20/82),and 10 days (range,6-90 days) in the non-tube no fasting group and (317± 37) minutes,(214 ± 66) mL,9.1％ (4/44),20.5％ (9/44),and 14 days (range,10-42 days) in the traditional treatment group;there was a statistically significant difference in duration of postoperative hospital stay between the two groups (Z =-7.129,P ＜ 0.05) and no statistically significant difference in operation time,volume of intraoperative blood loss,incidence of anastomotic fistula,and incidence of pulmonary complications between the two groups (t =1.311,0.703,x2 =0.000,0.077,P＞0.05).(2) Results of pathological examination:the number of lymph node dissected,cases in postoperative TNM stage Ⅰ,Ⅱ and Ⅲ were respectively 27±5,12,55,15 in the non-tube no fasting group and 26±5,9,28,7 in the traditional treatment group,with no statistically significant difference between the two groups (t =0.549,Z =-0.747,P＞0.05).(3) Follow-up:of 126 patients,116 were followed up for 12-31 months,with a median time of 20 months,including 76 in the non-tube no fasting group and 40 in the traditional treatment group.During the follow-up,no tumor recurrence or metastasis was found in the 116 patients.Conclusion The enhanced recovery after surgery with no gastrointestinal decompression tube and with early postoperative oral feeding is safe and feasible in the McKeown surgery,which can significantly shorten the postoperative hospitalization time compared with the traditional treatment.
ABSTRACT
Objective@#To investigate whether elevated levels of C-reactive protein (CRP) and neutrophil (NE) in the blood is associated with an increased risk of lung cancer incidence.@*Methods@#From 2006 to 2007, all employees and retirees from Kailuan (Group) Limited liability Corporation were included in this Kailuan Cohort study. The last follow-up date was December 2015. Data on new cases of lung cancer were collected, and multivariable Cox proportional hazards regression models were used to the relationship between baseline CRP and NE at baseline and risk of lung cancer.@*Results@#A total of 92 735 participants were enrolled in this study. During the follow-up, 850 new cases of lung cancer were identified. All subjects were divided into four groups according to the combination level of CRP and NE at baseline: CRP≤3 mg/L and NE≤4×109/L(Group A), CRP≤3 mg/L and NE>4×109/L(Group B), CRP>3 mg/L and NE≤4×109/L(Group C), CRP>3 mg/L and NE>4×109/L(Group D). The cumulative incidence of lung cancer were 950/100 000, 1 030/100 000, 1 081/100 000 and 1 596/100 000 in these four groups, respectively (P<0.001). Multivariate Cox proportional risk model showed that participants from Group D had an significantly increased 72% risks of lung cancer when compared to Group A (95% CI: 1.40~2.12, P<0.001). Stratified analyses gender showed that males in Group D had higher risk of lung cancer when compared with participants in Group A (HR=1.73, 95% CI: 1.40~2.15, P<0.001).@*Conclusion@#Elevated levels of CRP and NE might increase the risk of lung cancer.
ABSTRACT
To construct CRISPR/Cas9 vectors for the editing of SmPAL1 in the phenylpropane metabolic pathway of Salvia miltiorrhiza, CIRSPR/Cas9 target sites of SmPAL1 were designed by online software. Its target efficiencies were detected in vitro by enzyme digestion and sequences with highly efficiency were constructed into CRISPR/Cas9 vectors. Three possible CRISPR target sequences (SmPAL1-g1, SmPAL1-g2, SmPAL1-g3) were designed and the enzyme digestion efficiencies were 53.3%, 76.6% and 10.0%. SmPAL1-g1 and SmPAL1-g2 were constructed into vector VK005-03 named as VK005-03-g1 and VK005-03-g2. The results of sequencing showed that the two CRISPR/Cas target sequences were all constructed into VK005-03. Here we first laid the foundation for the study of SmPAL1 and provided an effective strategy for the screening of sgRNA.
Subject(s)
CRISPR-Cas Systems , Clustered Regularly Interspaced Short Palindromic Repeats , Metabolic Networks and Pathways , Genetics , Salvia miltiorrhiza , Chemistry , GeneticsABSTRACT
Objective To investigate the association between alcohol consumption and lung cancer risk in Chinese males.Methods Information on alcohol consumption and outcomes were collected on a biennial basis among males in Kailuan Cohort (2006-2015).In addition,electronic databases of hospitals affiliated to Kailuan Community,Insurance Systems of Kailuan Community and Tangshan were also used for supplementary information retrieval.Cox proportional hazards regression models were used to evaluate the hazard ratio (HR) and 95％ CI of baseline frequency and type of alcohol consumption associated with lung cancer risk in males.Non-drinkers were used as control group.Results A total of 101 751 males were included and 913 new lung cancer cases were identified in the Kailuan male cohort study,with a total follow-up time of 808 146.56 person-years and a median follow-up time of 8.88 years by 31 December 2015.After adjusting for potential confounding factors,the HR of former drinkers,occasional drinkers (＜ 1/day) and drinkers (≥ 1/day) were 1.30 (95％CI:0.90-1.88),0.80 (95％CI:0.64-1.01) and 1.04 (95％CI:0.85-1.27),respectively,compared with non-drinkers.In addition,drinking beer/red wine (HR=0.91,95％CI:0.69-1.20) and white wine (HR=0.99,95％ CI:0.83-1.19) showed no significant association with lung cancer.The results were similar when stratified analysis were conducted.Conclusion Our study results don't support the hypothesis that alcohol consumption is significantly associated with the risk of lung cancer in males.
ABSTRACT
Objective To assess the association and intensity of baseline TC level with the incidence of lung cancer in men in China.Methods Since May 2006,all the male workers,including the employees and the retirees in Kailuan Group were recruited in the Kailuan male dynamic cohort study.Information about demographics,medical history,anthropometry and TC level were collected at the baseline interview,as well as the information of newly-diagnosed lung cancer cases during the follow-up period.According to guidelines for blood lipids in Chinese adults and the distribution in the population,TC level was classified into five groups as followed:＜ 160,160-,180-,200-and ≥240 mg/dl,with the second quintile group (160-mg/dl) serving as the referent category.Cox proportional hazards regression model and restricted cubic spline (RCS) model were used to evaluate the association and the nonlinear association between baseline TC level and the risk of lung cancer in the men.Results By December 31,2014,for the 109 884 men,a follow up of 763 819.25 person-years was made with a median follow-up period of 7.88 years.During the follow up,808 lung cancer cases were identified.After adjustment for age,education level,income level,smoking status,alcohol consumption level,history of dust exposure,FPG level and BMI,HR (95％CD of lung cancer for men with lower TC level (＜160 mg/dl) and higher TC level (≥240 mg/dl) were 1.34 (1.04-1.72) and 1.45 (1.09-1.92),respectively,compared with men with normal TC level (160-mg/dl).The results didn't change significantly after exclusion of newly diagnosed cancer cases within 2 years of follow up and subjects with the history of hyperlipidemia.Conclusion Our results showed that TC might be associated with higher risk of lung cancer.Men with lower TC level or higher TC level had higher risk for lung cancer.Keep moderate TC level might be one of the effective precaution for the prevention of lung cancer.
ABSTRACT
Objective To investigate the association between alcohol consumption and lung cancer risk in Chinese males.Methods Information on alcohol consumption and outcomes were collected on a biennial basis among males in Kailuan Cohort (2006-2015).In addition,electronic databases of hospitals affiliated to Kailuan Community,Insurance Systems of Kailuan Community and Tangshan were also used for supplementary information retrieval.Cox proportional hazards regression models were used to evaluate the hazard ratio (HR) and 95％ CI of baseline frequency and type of alcohol consumption associated with lung cancer risk in males.Non-drinkers were used as control group.Results A total of 101 751 males were included and 913 new lung cancer cases were identified in the Kailuan male cohort study,with a total follow-up time of 808 146.56 person-years and a median follow-up time of 8.88 years by 31 December 2015.After adjusting for potential confounding factors,the HR of former drinkers,occasional drinkers (＜ 1/day) and drinkers (≥ 1/day) were 1.30 (95％CI:0.90-1.88),0.80 (95％CI:0.64-1.01) and 1.04 (95％CI:0.85-1.27),respectively,compared with non-drinkers.In addition,drinking beer/red wine (HR=0.91,95％CI:0.69-1.20) and white wine (HR=0.99,95％ CI:0.83-1.19) showed no significant association with lung cancer.The results were similar when stratified analysis were conducted.Conclusion Our study results don't support the hypothesis that alcohol consumption is significantly associated with the risk of lung cancer in males.
ABSTRACT
Objective To assess the association and intensity of baseline TC level with the incidence of lung cancer in men in China.Methods Since May 2006,all the male workers,including the employees and the retirees in Kailuan Group were recruited in the Kailuan male dynamic cohort study.Information about demographics,medical history,anthropometry and TC level were collected at the baseline interview,as well as the information of newly-diagnosed lung cancer cases during the follow-up period.According to guidelines for blood lipids in Chinese adults and the distribution in the population,TC level was classified into five groups as followed:＜ 160,160-,180-,200-and ≥240 mg/dl,with the second quintile group (160-mg/dl) serving as the referent category.Cox proportional hazards regression model and restricted cubic spline (RCS) model were used to evaluate the association and the nonlinear association between baseline TC level and the risk of lung cancer in the men.Results By December 31,2014,for the 109 884 men,a follow up of 763 819.25 person-years was made with a median follow-up period of 7.88 years.During the follow up,808 lung cancer cases were identified.After adjustment for age,education level,income level,smoking status,alcohol consumption level,history of dust exposure,FPG level and BMI,HR (95％CD of lung cancer for men with lower TC level (＜160 mg/dl) and higher TC level (≥240 mg/dl) were 1.34 (1.04-1.72) and 1.45 (1.09-1.92),respectively,compared with men with normal TC level (160-mg/dl).The results didn't change significantly after exclusion of newly diagnosed cancer cases within 2 years of follow up and subjects with the history of hyperlipidemia.Conclusion Our results showed that TC might be associated with higher risk of lung cancer.Men with lower TC level or higher TC level had higher risk for lung cancer.Keep moderate TC level might be one of the effective precaution for the prevention of lung cancer.
ABSTRACT
Objective@#To investigate the association between tea consumption and lung cancer risk in Chinese males.@*Methods@#Tea consumption and incident lung cancer cases were collected on a biennial basis among males in Kailuan Cohort during 2006-2015. Up to 31st December 2015, a total of 103 010 male candidates from the Chinese Kailuan Male Cohort Study were enrolled in the present study. Cox proportional hazards regression model was used to evaluate the association between tea consumption and risk of lung cancer in males.@*Results@#The age of male candidates was (51.3±13.4)years old. There were 828 810.74 person-years of follow-up and 8.91 years of median follow-up period. During the follow-up, 964 lung cancer cases were identified. In male, the rate of never cosumers, tea drinkers (<4/week) and tea drinkers (≥4/week) were 58.17%(n=59 926), 24.04%(n=24 765) and 17.78%(n=18 319), respectively. After adjustment for potential confounding factors, HR (95%CI) of lung cancer for subjects with tea drinkers (<4/week) and tea drinkers (≥4/week) were 0.80 (0.63-1.02) and 1.02 (0.80-1.30), respectively, as compared with never cosumers. The results showed no significant association with lung cancer. Stratification analysis and sensitivity analysis showed no significant changes.@*Conclusion@#Our study has not found that tea consumption is significantly associated with the risk of male lung cancer.
ABSTRACT
Objective To systematically evaluate the association between protein C and Legg -Calve -Perthes disease.Methods A literature research was performed through PubMed,Embase,Cochrane library,Web of Science,Chinese Biomedical Literature Database(CBM),China National Knowledge Infrastructure(CNKI)and Wan-fang Database from inception to February 201 6 on the association between protein C and Legg -Calve -Perthes disease.According to the Newcastle -Ottawa Scale(NOS)criteria,the quality of studies was evaluated and data were extracted.Meta -analysis was performed with Stata 1 1 .0 software.Results A total of 1 4 articles were included.Twelve articles on protein C and Legg -Calve -Perthes disease in the study group and the control group were compared.The results of Meta -analysis showed that there was no significant difference in protein C levels between the study group and the control group[odds radio(OR)=1 .41 ,95% confidence interval(CI)(0.87,2.28),P =0.1 47];five articles on protein C and the white race of Legg -Calve -Perthes disease between the study group and the control group were com-pared,The results of Meta -analysis showed that there was no significant difference in protein C levels between the whiteskin patients′group and the control group[OR =0.61 2,95%CI(1 .83,7.29),P =0.61 2];three articles on pro-tein C and the yellow race of Legg -Calve -Perthes disease between the study group and the control group were com-pared,and the results of Meta -analysis showed that there was no significant difference in protein C levels between the yellow skin patients group and the control group[OR =0.59,95%CI(0.05,6.72),P =0.080].Conclusion There is no significant correlation between protein C and Legg -Calve -Perthes disease.
ABSTRACT
<p><b>BACKGROUND</b>Both uniportal and triportal thoracoscopic lobectomy and sublobectomy are feasible for early-stage non-small cell lung cancer (NSCLC). The aim of this study was to compare the perioperative outcomes of uniportal and triportal thoracoscopic lobectomy and sublobectomy for early-stage NSCLC.</p><p><b>METHODS</b>A total of 405 patients with lung lesions underwent thoracoscopic lobectomy or sublobectomy through a uniportal or triportal procedure in approximately 7-month period (From November 2014 to May 2015). A propensity-matched analysis, incorporating preoperative variables, was used to compare the short-term outcomes of patients who received uniportal or triportal thoracoscopic lobectomy and sublobectomy.</p><p><b>RESULTS</b>Fifty-eight patients underwent uniportal and 347 patients underwent triportal pulmonary resection. The conversion rate for uniportal and triportal procedure was 3.4% (2/58) and 2.3% (8/347), respectively. The complication rate for uniportal and triportal procedure was 10.3% and 9.5%, respectively. There was no perioperative death in either group. Most patients had early-stage NSCLC in both groups (uniportal: 45/47, 96%; triportal: 313/343, 91%). Propensity score-matching analysis demonstrated no significant differences in operation time, intraoperative blood loss, numbers of dissected lymph nodes, number of stations of lymph node dissected, duration of chest tube, and complication rate between uniportal and triportal group for early-stage NSCLC. However, the duration of postoperative hospitalization was longer in the uniportal group (6.83 ± 4.17 vs. 5.42 ± 1.86 d, P = 0.036) compared with the triportal group.</p><p><b>CONCLUSIONS</b>Uniportal thoracoscopic lobectomy and sublobectomy is safe and feasible, with comparable short-term outcomes with triportal thoracoscopic pulmonary resection. Uniportal lobectomy and sublobectomy lead to similar cure rate as triportal lobectomy and sublobectomy for early NSCLC.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Blood Loss, Surgical , Carcinoma, Non-Small-Cell Lung , Pathology , General Surgery , Length of Stay , Lung , Pathology , General Surgery , Lung Neoplasms , Pathology , General Surgery , Operative Time , Pneumonectomy , Methods , Prospective Studies , Thoracic Surgery, Video-Assisted , Methods , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To evaluate the association between high sensitivity C-reactive protein (hsCRP) and breast cancer incidence among the non-diabetic females in a large-scale cohort study in Kailuan group.</p><p><b>METHODS</b>The Kailuan cohort was established on May 1, 2006. Baseline information on demography, lifestyle, medical history, and anthropometry, i.e., body height and weight, were collected during the baseline interview, and breast cancer incidence, mortality and other related outcome information were obtained by follow-up every two years and the related health condition database information were collected every year. Multivariable Cox proportional-hazards regression model was used to calculate the hazard ratios (HRs) and 95%CI (confidence interval) between the level of hsCRP at baseline interview and breast cancer incidence adjusted for age group, body mass index (BMI), marital status (married and single) and tobacco smoking (smokers and non-smokers) when appropriate.</p><p><b>RESULTS</b>By Dec 31, 2011, a total of 17 402 females were enrolled in the cohort. There were 85 286 person-years of follow-up with a mean follow-up period of (58.81 ± 4.52) months. A total of 75 incident breast cancer cases were collected. Subjects with the highest level (>3 mg/L) of hsCRP at baseline interview were associated with a significantly increased risk of breast cancer (adjusted HR = 1.80, 95%CI = 1.03-3.15) compared with those with the lowest level (<1 mg/L).</p><p><b>CONCLUSIONS</b>Elevated levels of hsCRP at baseline interview may be associated with an increased risk of breast cancer among non-diabetic females. Further follow-up and etiological exploration will help to evaluate the association between the hsCRP level and the risk of breast cancer more reliably.</p>
Subject(s)
Female , Humans , Middle Aged , Body Mass Index , Breast Neoplasms , Diagnosis , Epidemiology , Metabolism , C-Reactive Protein , Metabolism , Cohort Studies , Diabetes Mellitus , Incidence , Proportional Hazards Models , Prospective Studies , Risk , Risk Factors , SmokingABSTRACT
<p><b>OBJECTIVE</b>To evaluate the association and its strength between body mass index (BMI, kg/m(2)) and cancer incidence in a large-scale population-based cohort study.</p><p><b>METHODS</b>A dynamic cohort was established on May 1, 2006. Baseline information on demography, lifestyle, anthropometry such as body height and weight, were collected during the first interview, and cancer incidence, mortality and other related outcome information were obtained through active follow-up every two years and passive follow-up every year. Cancer cases diagnosed within 1 year follow-up period were excluded. Multivariable Cox proportional-hazards regression model was used to calculate the hazard ratios (HRs)and 95% confidence interval (CI) between BMI and cancer incidence after adjusted for age group, education level, tobacco smoking (smokers and non-smokers), alcohol consumption (drinkers or non-drinkers) and HBsAg status (positive or negative, for liver cancer only) when appropriate. Repeated analysis was carried out on male lung cancer, male liver cancer and female breast cancer, stratified by tobacco smoking, HBsAg status and menopausal status respectively.</p><p><b>RESULTS</b>By December 31, 2011, a total of 133 273 subjects, including 106 630 (80.01%)males and 26 643(19.99%)females were enrolled in the cohort. There were 570 531.02 person-years of follow-up and 4.28-year of average follow-up period. According to the Guidelines for Prevention and Control of Overweight and Obesity in Chinese Adults, study subjects were divided into groups as: underweight (BMI<18.5 kg/m(2)), normal weight (BMI 18.5 kg/m(2)-23.9 kg/m(2)), overweight (BMI 24.0 kg/m(2)-27.9 kg/m(2)) and obese(BMI≥28.0 kg/m(2)). In males, 2 387 (2.24%) were underweight, 45 090(42.29%)were normal weight, 43 774 (41.05%) were overweight and 15 379 (14.42%) were obese. Meanwhile, in females, 858 (3.22%)were underweight, 14 037 (52.69%) were normal weight, 8 507 (31.93%) were overweight and 3 241 (12.16%) were obese. A total of 1 647 incident cancer cases among different cancers were collected during the follow-up, including 1 348 in men and 299 in women. Results from Multivariate Cox proportional-hazards regression model showed that 'underweight' increased the risk on both gastric cancer incidence (adjusted HR = 3.82, 95% CI: 1.97-7.38) and liver cancer incidence (adjusted HR = 3.00, 95% CI:1.36-6.65) in males, while both 'overweight' (adjusted HR = 1.98, 95% CI:1.03-3.82) and 'obesity' (adjusted HR = 2.75, 95% CI: 1.25-6.06) increased the risk of colon cancer incidence in males. But for bladder cancer incidence in males, overweight seemed being protective (adjusted HR = 0.44, 95%CI:0.23-0.84). And for lung cancer incidence in males, both overweight and obesity were protective as well (adjusted overweight vs. normal weight, HR = 0.59, 95%CI: 0.46-0.76;adjusted obese vs. normal weight, HR = 0.64, 95%CI: 0.44-0.92). In females, obesity increased the risk of breast cancer incidence(adjusted HR = 1.86, 95%CI:1.05-3.31). Further analysis for lung cancer cases stratified by tobacco smoking, data showed that overweight decreased the risk of lung cancer in both male non-smokers (adjusted HR = 0.50, 95%CI:0.35-0.72) and male smokers (adjusted HR = 0.70, 95%CI:0.50-0.98) while obesity decreased the risk of lung cancer in male non-smokers(adjusted HR = 0.57, 95% CI:0.33-0.97), but not in smokers (adjusted HR = 0.72, 95%CI:0.43-1.21). Stratified analysis in females by menopausal status, data showed that obesity increased the incidence of breast cancer in postmenopausal subjects (adjusted HR = 1.97, 95% CI:1.01-3.82), but not in premenopausal subjects.</p><p><b>CONCLUSION</b>The association between BMI and cancer incidence varied by cancer site. Underweight increased the risk of gastric cancer and liver cancer in males, and obesity increased the risk of colon cancer in males, breast cancer and ovarian cancer in females. However, overweight might played a protective role in lung cancer incidence and bladder cancer incidence in males and obesity might play a protective role in lung cancer incidence in male non-smokers.</p>