ABSTRACT
Objective To explore the efficiency of prophylactic intravesical chemotherapy after nephroureterectomy for primary upper tract urothelial carcinoma.Methods Forty-seven patients with primary upper tract urothelial carcinoma who underwent nephroureterectomy were retrospectively analyzed.There were 25 male and 22 female patients with mean age of 68 years.Patients were divided into intravesical chemotherapy group (n =32) and non-intravesical chemotherapy group (n =15).In the intravesical chemotherapy group, there were 14 male and 18 female patients with mean age of 70.3 years;20 cases located at left side while 12 at the right side.In non-intravesical chemotherapy group, There were 11 male and 4 female patients with mean age of 65.0 years;10 cases located at left side while 5 at the right side.The age, gender, side of the two groups were not statistical different.The two groups were followed up, and the tumor stage, grade, recurrence rate, cancer-free survival time were compared.Results The pathology results of all cases were urothelial carcinoma.In the intravesical chemotherapy group, 23 cases were high grade tumors with 9 low grade tumors.There were 15 cases of Ta-T1 stage, 8 cases of T2 stage and 9 cases of T3 stage;the tumor of 19 cases located at pelvis, 12 located at ureter, 1 located at pelvis and ureter;the mean size of the tumors was (2.75 ± 1.49) cm;8 cases were multiple while 24 were single.In the non-intravesical chemotherapy group, 12 cases were high grade tumors with 3 low grade tumors, there were 6 cases of Ta-T1 stage, 4 cases of T2 stage and 5 cases of T3 stage;the tumor of 11 cases located at pelvis, 3 located at ureter, 1 located at pelvis and ureter;the mean size of the tumors was (3.11 ± 1.48) cm;6 cases were multiple while 9 were single.The items mentioned above did not reach statistical difference between the two groups(P ＞0.05).6 patients relapsed in intravesical chemotherapy group while 7 in non-intravesical chemotherapy group.The recurrence rate of bladder cancer of intravesical chemotherapy group was lower than that of non-intravesical chemotherapy group (18.75％ vs.46.67％, χ2 =3.978, P =0.046).Compared with non-intravesical chemotherapy group, intravesical chemotherapy group had longer cancer-free survival, but it did not reach statistical difference (36.5months vs.29.6months, t =1.079, P =0.286).The age and tumor grade were risk factors of bladder cancer recurrence, meanwhile the gender, tumor side, tumor stage, voided urine cytology, tumor size, and location were not.Conclusion Prophylactic intravesical chemotherapy after nephroureterectomy for primary upper tract urothelial carcinoma could reduce the recurrence rate of bladder cancer.
ABSTRACT
In this paper the latest studies on the role of estrogen for the development of osteoarthritis and osteoporosis in postmenopausal women are reviewed.Estrogen can influence the pathophysiology of osteoarthritis through its interactions with the estrogen receptors,type Ⅱ collagen,cytokines and reactive oxygen species.While in the process of osteoporosis,estrogen can not only influence the estrogen receptors,cytokmes,reactive oxygen species,but also affect the sex hormone binding globulin and estrogen receptor-related receptor.
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In the field of biomechanics, there have been many discoveries concerning the cervical spine injuries in recent years. With the help of biomechanical knowledge, we can not only judge the stability of the cervical spine and have a clear idea of the factors that may affect the stability but also conduct an appropriate classification of the injuries. In this article, we summarize the effects of the stiffness and preinjury biomechanical characteristics of the cervical spine (such as alignment, mass, inertial properties) on the injury, changes of the spinal canal during injury, and the rapidly developing research on finite element models of cervical spine injuries in the past few years.
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<p><b>OBJECTIVE</b>To investigate the mechanism associated with thoracolumbar burst fractures.</p><p><b>METHODS</b>Stress distribution of the spine in the upright, flexion and extension positions was analyzed using a three-dimensional finite element model of the spinal motion segment.</p><p><b>RESULTS</b>Stress concentration was noted at the pedicle and posterosuperior part of the vertebral body near the pedicle.</p><p><b>CONCLUSION</b>Stress concentration of the spine may be implicated in the biomechanical mechanism underlying thoracolumbar burst fractures.</p>
Subject(s)
Biomechanical Phenomena , Imaging, Three-Dimensional , Lumbar Vertebrae , Wounds and Injuries , Models, Biological , Spinal Fractures , Thoracic Vertebrae , Wounds and InjuriesABSTRACT
Fractures of the odontoid process in children are rare but account for the majority of all the cervical spine injuries in the infantile and young juvenile groups. The initial radiographic evaluation is often difficult so that the diagnosis-making is delayed or the fractures are missed. The management of the odontoid fractures of adults has long been controversial and varies with different spinal surgeons. By contrast, the diagnosis and treatment of odontoid fractures in skeletally immature children have not been frequently documented and not in details. This paper reviews the clinical characteristics, diagnosis, treatment principles, and long-term outcome of the odontoid fractures in a consecutive series of patients aged 14 years or younger.
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The lumber ligaments play an important role in spinal bsomechanics. The results of three-dimensional finite element analysis showed that one of functions of lumbar ligaments is transmission of the tensile load between the lumbar vertebrae. The anterior longitudinal ligament is loaded in extension of lumbar spine and the resistance to the tensile load in flexion is provided by other ligaments. These ligaments are subject to much more tension with degsneration of the intervertebral disc so that a series of pathological changes occur. Relevant significance in clinical aspect is also discussed.
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In order to analyse the effects of flexion-extension motion of lumbar spine on the position and shape of lumbosacral dural sac, measurements were performed on 10 flexion/extension lateral myelograms of cadaver specimens of normal lumbar spine.It could be seen that from flexion to extension both sagittal diameter and length of the dural sac increased significantly, the dural sac moved caudally, and the sagittal diameter of the anterior epidural space decreased in the mid-vertebral level but increased in the inter vertebral level.The dynamic changes of the dural sac, the influence factors and the clinical relevances were discussed.
ABSTRACT
A mechanical model was constructed with three-dimensional finite element method to analyse the statusof stress distribution in the isthmus of the neural arch. It was found that the stress concentrate significantlyin the isthmus with spine upright. flexed and extended, and most obviously in extension position. The auth-ors conclude that spondylolysis is mainly the fatigue fracture due to locally increased stress and is contribut-ing most by backward extension of lumbar spine.