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Objective:To investigate the prognostic value of Onodera's prognostic nutrition index (PNI) before treatment in patients with cervical and upper thoracic esophageal squamous cell carcinoma (CUTESCC) undergoing definitive chemoradiotherapy (dCRT) and its predictive value in the occurrence of ≥ grade 2 radiation esophagitis (RE).Methods:The data of 163 CUTESCC patients eligible for inclusion criteria admitted to the Fourth Hospital of Hebei Medical University from January 2012 to December 2017 were retrospectively analyzed. The receiver operating characteristic (ROC) curve was used to calculate the best cut-off value of PNI for predicting the prognosis of patients. The prognosis of patients was analyzed by univariate and Cox multivariate analyses. Logistics binary regression model was adopted to analyze the risk factors of ≥ grade 2 RE in univariate and multivariate analyses. The significant factors in logistic multivariate analysis were used to construct nomogram for predicting ≥ grade 2 RE.Results:The optimal cut-off value of PNI was 48.57 [area under the curve (AUC): 0.653, P<0.001]. The median overall survival (OS) and progression-free survival (PFS) were 26.1 and 19.4 months, respectively. The OS ( χ2=6.900, P=0.009) and PFS ( χ2=9.902, P=0.003) of patients in the PNI ≥ 48.57 group ( n=47) were significantly better than those in the PNI < 48.57 group ( n=116). Cox multivariate analysis showed that cTNM stage and PNI were the independent predictors of OS ( HR=1.513, 95% CI: 1.193-1.920, P=0.001; HR=1.807, 95% CI: 1.164-2.807, P=0.008) and PFS ( HR=1.595, 95% CI: 1.247-2.039, P<0.001; HR=2.260, 95% CI: 1.439-3.550, P<0.001). Short-term efficacy was another independent index affecting PFS ( HR=2.072, 95% CI: 1.072-4.003, P=0.030). Logistic multivariate analysis showed that the maximum transverse diameter of the lesion ( OR=3.026, 95% CI: 1.266-7.229, P=0.013), gross tumor volume (GTV) ( OR=3.456, 95% CI: 1.373-8.699, P=0.008), prescription dose ( OR=3.124, 95% CI: 1.346-7.246, P=0.009) and PNI ( OR=2.072, 95% CI: 1.072-4.003, P=0.030) were the independent factors affecting the occurrence of ≥ grade 2 RE. These four indicators were included in the nomogram model, and ROC curve analysis showed that the model could properly predict the occurrence of ≥ grade 2 RE (AUC=0.686, 95% CI: 0.585-0.787). The calibration curve indicated that the actually observed values were in good agreement with the predicted RE. Decision curve analysis (DCA) demonstrated satisfactory nomogram positive net returns in most threshold probabilities. Conclusions:PNI before treatment is an independent prognostic factor for patients with CUTESCC who received definitive chemoradiotherapy. The maximum transverse diameter of the lesion, GTV, prescription dose and PNI are the risk factors for ≥ grade 2 RE in this cohort. Establishing a prediction model including these factors has greater predictive value.
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Objective:To analyze the local recurrence patterns after concurrent chemoradiotherapy (CCRT) for thoracic esophageal squamous cell carcinoma (ESCC) through image fusion, and to explore the risk factors of local recurrence and its relationships with dosimetric indices.Methods:A retrospective analysis was conducted for 209 thoracic ESCC patients who received radical CCRT in Fourth Hospital of Hebei Medical University during 2016-2019. For the patients diagnosed as the local recurrence of esophageal lesions, their CT images were fused with the original planning CT images using image registration software to identify the recurrence sites. Through 1∶1 propensity score matching (PSM) of the clinal data of patients with local recurrence (the recurrence group, nbefore = 81, nafter = 62) and those without local recurrence (the recurrence-free group, nbefore = 128, nafter=62), the dose and volume parameters of the treatment plans for the two groups were compared. Univariate and multivariate analyses were conducted using the Kaplan-Meier method and the Cox regression model to analyze the factors affecting the overall survival (OS), progression-free survival (PFS), and recurrence-free survival (RFS). Results:All patients had 1-, 3-, and 5-year OS rates of 80.9%, 42.6%, and 33.0%, respectively, 1-, 3-, and 5-year PFS rates of 67.9%, 34.0%, and 27.9%, respectively, and 1-, 3-, and 5-year RFS rates of 71.3%, 39.2%, and 30.5%, respectively. T stage, N stage, and radiation dose were independent prognostic factors for the OS, PFS, and RFS ( HR = 1.42-1.87, P < 0.05) of the patients, respectively. Among 68 patients with local recurrence, 62 cases (91.2%) suffered recurrence within the gross tumor volume (GTV). The dose and volume parameters of patients with local recurrence, such as GTV- D95%, clinical target volume (CTV)- D95%, GTV- D50%, CTV- D50%, and planning target volume (PTV)- D50%, GTV- V60, CTV- V60, and PTV- V60, were significantly lower than those of patients free from the local recurrence ( t=1.90-2.15, P < 0.05). Conclusions:Local recurrence of patients with thoracic ESCC after radical CCRT occurs mainly within the GTV. Increasing radiation doses may contribute to their survival benefits. The D50% for each target volume in the radiotherapy plan may be related to local recurrence, and it is necessary to conduct further research.
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Objective:To investigate the relationship between systemic immune-inflammation index (SII) and the prognosis of esophageal cancer patients treated with radical radiotherapy and to predict the prognosis of the patients using the SII combined with clinical staging.Methods:A retrospective analysis was conducted for 248 patients with esophageal cancer who were admitted to the Department of Radiotherapy in the Fourth Hospital of Hebei Medical University between 2014 and 2016. These patients included 146 males and 102 females, with a median age of 67 years. Among them, 134 patients received concurrent chemotherapy and 114 patients received radiotherapy alone. The SII before radiotherapy was defined as platelet count × neutrophil count/lymphocyte count. The patients were divided into a low-SII group and a high-SII group according to the optimal cutoff value of pretreatment SII determined by the receiver operating characteristics (ROC) curve. Survival analysis was calculated using the Kaplan-Meier method, and the Cox proportional hazards model was used for multivariate analysis. For these patients, the prognosis effects and the predictive value for survival of different SII levels combined with TNM staging were compared.Results:According to the ROC curves, the optimal cutoff value of SII before radiotherapy was 740.80. Based on this number, the patients were divided into a low-SII group (< 740.80, 150 cases) and a high-SII group (≥ 740.80, 98 cases). The objective response rate of the low-SII group was significantly higher than that of the high-SII group (86.0% vs 75.5%, χ2=4.39, P=0.036). The 1-, 3-, and 5-year overall survival (OS) rates of the low-SII group were 78.6%, 45.6%, and 32.3%, respectively. These rates were significantly higher than the corresponding rates of the high-SII group, which were 71.0%, 28.3%, and 16.4% ( χ2=11.22, P=0.001), respectively. Moreover, the 1-, 3- and 5-year progression-free survival (PFS) rates of the low-SII group were 67.0%, 36.9%, and 32.0%, respectively. Again, these rates were significantly higher than those of the high-SII group, which were 45.5%, 17.5%, and 12.5% ( χ2=15.38, P < 0.001), respectively. Multivariate analysis showed that TNM staging, treatment method, and SII were independent prognostic factors for OS and PFS ( HR=1.39-1.60, P<0.05). Patients with low SII and early clinical staging had a better prognosis than other subgroups ( χ2=13.68, 13.43, P=0.001). The area under curve (AUC) of SII combined with TNM staging (0.70) was higher than that of SII (0.63) and TNM staging (0.62) ( Z=2.48, 2.57, P < 0.05). Conclusions:Pretreatment SII has a high predictive value for the prognosis of esophageal cancer after radiotherapy, and higher SII indicates a worse prognosis. Thus, combining SII with TNM staging can improve the prediction accuracy of the prognosis of esophageal cancer patients.
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The technique of prenatal diagnosis before embryo implantation has been greatly developed in assisted reproduction, especially for the people with abnormal genetic material to provide the technical possibility of eugenics and eugenics. As an emerging sequencing technology, single-cell sequencing can analyze the genome and transcriptome of cells from the level of a single cell, and reflect the heterogeneity between cells, thus helping to reveal the mechanism of the occurrence and development of diseases. Through prenatal diagnosis before embryo implantation and high-throughput sequencing of single cells obtained from embryo biopsy, euploidy of embryonic chromosomes can be effectively detected, and SNPs and chromosomal copy number variation, insertion, deletion and other variations can also be better detected. It can conduct the comprehensive detection and research of genomic polymorphism and mutation of individual and other species. In this paper, the single-cell sequencing technology and relevant methods was introduced, and the application scenarios of single-cell sequencing in genetic reproduction diagnosis were summarized. The applications of the technology in the field of genetic reproduction were described, and the future directions of the technology were discussed.
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Objective:To compare the minimally invasive transforaminal lumbar interbody fusion (MTLIF) with open transforaminal lumbar interbody fusion (OTLIF) in treatment of lumbar degenerative disease.Methods:Clinical data of 63 patients with single segment lumbar degenerative disease treated in Department of Orthopedics of Beijing Hospital from November 2015 to September 2016 were retrospectively analyzed, among whom 30 cases received MTLIF and 33 cases received OTLIF. The operative time, intraoperative X-ray exposure times, intraoperative blood lose, postoperative drainage,perioperative fever, adjacent segment degeneration, loosening of internal fixation and cage collapse were observed in two groups 4 years after operation, and the visual analog scale (VAS) score of the lower back and the leg, the Oswestry disability index (ODI) score were compared between two groups.Results:The operation time [(191.6±50.5) min] and radiation exposure times [(15.5±6.4) times] in MTLIF group were significantly more than those in OTLIF group [(105.8±23.1) min, (7.2±1.4)times, t=17.210, t=10.850,all P<0.01]. The intraoperative blood loss [(150.4±70.4) ml], postoperative drainage [(90.4±30.7)ml], VAS score (2.4±0.7) and ODI score (24.5±3.7) 2 weeks after surgery in MTLIF group were significantly lower than those in OTLIF group [(250.7±43.9)ml,(216.3±67.8)ml,(4.5±1.6),(30.6±4.6), t=-12.830, t=-14.070, t=-6.890, t=-5.805,all P<0.01]. There were no significant differences in the incidence of fever [1 case(3.3%) vs. 4 cases(12.1%),χ2=-1.661, P=0.20], VAS score[(1.2±0.7) vs. (1.3±0.6), t=-0.628, P=0.53], ODI score[(14.2±2.7) vs. (14.7±2.5), t=-0.756, P=0.45], fusion rate of Bridwell grade Ⅰ [86.7%(26/30) vs. 84.8%(28/33),χ2=0.042, P=0.84] 1 year after surgery; and the adjacent segment degeneration [0 case(0) vs. 1 case(3.0%),χ2=0.924, P=0.34], internal fixation loosening [1 case(3.3%) vs. 1 case(3.0%),χ2=0.005, P= 0.95] and cage collapse 4 years after surgery [1 case(3.3%) vs. 1case(3.0%),χ2=0.005, P=0.95] between MTLIF group and OTLIF group. Conclusion:Compared with OTLIF, MTLIF has longer operation time and more radiation exposure, but it can achieve full decompression, the same fusion rate, less bleeding, less trauma, faster recovery, fewer complications and satisfactory long-term effect.
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Objective:To investigate the relationship between Onodera′s prognostic nutritional index (PNI) and prognosis of patients with esophageal squamous cell carcinoma (ESCC) after definitive chemoradiotherapy or radiotherapy, aiming to provide a convenient, effective and accurate predictive indicator for evaluating the long-term survival of patients after treatment.Methods:Clinical data of 231 ESCC patients treated with definitive chemoradiotherapy or radiotherapy at the Fourth Hospital of Hebei Medical University from 2013 to 2015 were retrospectively analyzed. The PNI values of each patient at different radiotherapy periods were calculated and the ROC curve was used to determine the optimal cutoff value of PNI before radiotherapy, 231 patients were divided into the better-nourishment group ( n=86) and worse-nourishment group ( n=145). Kaplan- Meier method was used for survival analysis. Cox proportional hazards model was utilized to analyze the relationship between different nutritional status and prognosis. The short-term clinical efficacy and incidence of acute toxicities were statistically compared between two groups. Results:The mean values of PNI before, at week 3, week 6 and 1 month after radiotherapy were48.68±5.08, 39.68±4.87, 43.74±4.89 and48.31±4.92, respectively. The optimal cutoff value of pretreatment PNI was 49.25, the area under the curve (AUC) was 0.655, the sensitivity and specificity were 68.6% and 60.9%, respectively. The 5-year overall survival (OS) and progression-free survival (PFS) rates in the better-nourishment group (PNI≥49.25) were 36.0% and 31.3%, significantly better than 19.3% and 18.6% in the worse-nourishment group (PNI<49.25)( P=0.001, P=0.039). Multivariate analysis showed PNI before the therapy was an independent prognostic factor for OS ( P=0.021). Stratified analysis demonstrated that Stage Ⅰ/Ⅱ and concurrent chemotherapy patients in the better-nourishment group all obtained significantly better OS than their counterparts in the worse-nourishment group ( P=0.007, P=0.004). In addition, the objective response rate in the better-nourishment group was significantly higher than that in the worse-nourishment group ( P=0.047), whereas the incidence of ≥3 grade radiation esophagitis was lower than that in the worse-nourishment group ( P=0.060). Conclusions:Pretreatment PNI is a convenient and reliable indicator for predicting the long-term survival of ESCC patients after definitive chemoradiotherapy or radiotherapy. Patients with higher PNI have relatively better prognosis and radiotherapy tolerance, especially in those with early stage or concurrent chemotherapy.
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Objective:To investigate the impact of osteoporosis on clinical outcomes in elderly patients treated with short segment transforaminal lumbar interbody fusion.Methods:From May 2016 to May 2018, elderly patients who had undergone transforaminal lumbar interbody fusion(TLIF)in our hospital were retrospectively analyzed.Based on bone mineral density(BMD), patients were divided into the osteoporosis group(the OP group, n=75, T≤-2.5 in BMD)and the control group(the CO group, n=103, T>-1.0 in BMD). General patient information, clinical data and postoperative follow-up clinical results were compared between the two groups.Results:Eventually 178 cases were enrolled, including 68 with lumbar disc herniation and 110 with lumbar spinal stenosis.Preoperative Visual Analogue Scale(VAS)scores were 7.35±1.30 in the lower back and 7.32±1.30 in the leg for the OP group and 7.35±1.33 and 7.22±1.40, respectively, for the CO group, and there was no significant difference between the two groups( t=0.140 and 0.468, P=0.989 and 0.640). The proportions of cage collapse and internal fixation loosening were 70.7%(53/75)and 37.3%(28/75)in the OP group, which were higher than 22.3%(23/103)and 14.6%(15/103)in the CO group( χ2=41.440 and 12.280, both P=0.000). However, there was no significant difference between the OP group and the CO group in 1-and 2-year postoperative interbody fusion rates(postoperative 1-year rate: 89.3% or 67/75 vs.91.3% or 94/103, χ2=0.187, P=0.666; postoperative 2 year rate: 94.6% or 71/75 vs.95.1% or 98/103), χ2=0.021, P=0.885). There was no significant difference in VAS score and Oswestry disability index(ODI) between the OP group and the CO group at 6 months, 1 year and 2 years after surgery(all P>0.05). Conclusions:Although there are some osteoporosis-related complications such as cage subsidence and screw loosening, short-segment TLIF can still achieve good clinical results in elderly patients with osteoporosis.
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Objective:To explore the application of high-throughput sequencing (HTS) technology in pathogens detection for spinal infection.Methods:From January 2019 to May 2020, a total of 41 patients including 31 males and 10 females with an average age of 59.7±11.9 years (29-75 years) were suspected of spinal infections. There were 37 patients with local pain, 15 with fever (≥38 ℃) and 18 with neurological dysfunction. The infected sites were as follows, 4 cases of cervical spine, 8 cases of thoracic spine and 29 cases of lumbar spine. There were 36 patients met the surgical indications and underwent open debridement, bone grafting, fusion and internal fixation, while the other 5 patients underwent conservative treatment (three received drug therapy and two were transferred to the internal department for chemotherapy). Lesions obtained from open surgery patients were underwent pathology and HTS examination. In 5 cases with conservative treatment, two of them underwent CT guided percutaneous puncture for samples, while one case underwent ultrasound guided percutaneous puncture for pus, one case for venous blood, and one case received lumbar puncture for cerebrospinal fluid. The samples were sent for pathological and HTS examination, while liquid specimens were sent for bacterial culture and HTS. The sensitivity and specificity of HTS results were determined according to pathological examination which was regarded as the "gold standard". Based on HTS results combined with the clinical manifestations, imaging examination and pathological results of the patients, targeted antibiotics or anti-tuberculosis drugs were selected for postoperative drug therapy. Patients with bacterial infection received anti-infection treatment for 3 months after operation. For tuberculosis patients, "tetrad" (isoniazid+rifampicin+pyrazinamide+ethambutanol) anti-tuberculosis treatments were underwent for one year. Inflammation indicators from the blood samples were observed before and after treatment, including white blood cell count (WBC), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). These indicators were used to monitor disease progression and the curative effects. All patients were followed up for at least 3 months after surgery.Results:A total of 41 patients with suspected spinal infection were included in this study. The HTS pathogen detection results were obtained within 48 h. For the initial 5 patients, first-generation sequencing verification was conducted with coincidence rate 100%. Further, no further verification was conducted in the rest patients. Among the 41 cases, a total of 26 cases had positive results with a positive rate of 63.4%(26/41). Among them, thirteen cases were with mycobacterium tuberculosis (31.7%) and 6 cases with staphylococcus (14.6%). Fungi and Brucellosis were diagnosed in 2 cases respectively, accounting for 4.9% respectively. The test were negative in 15 patients (36.6%), including 2 patients with tumor or tumor-like lesions (1 hematologic tumor and 1 eosinophilic granuloma). A total of 38 patients underwent pathological examination, which confirmed 7 cases of suppurative infection, 12 cases of tuberculosis, 2 cases of tumor or tumor-like lesions and the remaining 17 cases of inflammatory lesions. The sensitivity and specificity of HTS were 80%(16/20) and 55.6% (10/18) with positive predictive value (PPV) 66.7% (16/24) and negative predictive value (NPV) 71.4% (10/14). All patients were followed up for 3 months. The inflammation indicators of blood at 3 months were all lower than that at admission. WBC decreased from (7.50±3.26)×10 9/L at admission to (6.22±2.53)×10 9/L at 3 months after treatment without statistically significant difference ( t=1.082, P=0.290). The CRP decreased from (32.2±34.1) mg/L to (4.5±10.5) mg/L, and ESR from (44.2±26.5) mm/1 h to (18.6±12.1) mm/1 h with statistically significant difference ( t=8.963, P<0.001; t=5.421, P<0.001). Conclusion:High-throughput sequencing technology can be used in detection of spinal infection pathogens, due to its relatively high positive rate, satisfied sensitivity and good diagnostic value.
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The parahippocampal gyrus-orbitofrontal cortex (PHG-OFC) circuit in humans is homologous to the postrhinal cortex (POR)-ventral lateral orbitofrontal cortex (vlOFC) circuit in rodents. Both are associated with visuospatial malfunctions in Alzheimer's disease (AD). However, the underlying mechanisms remain to be elucidated. In this study, we explored the relationship between an impaired POR-vlOFC circuit and visuospatial memory deficits through retrograde tracing and in vivo local field potential recordings in 5XFAD mice, and investigated alterations of the PHG-OFC circuit by multi-domain magnetic resonance imaging (MRI) in patients on the AD spectrum. We demonstrated that an impaired glutamatergic POR-vlOFC circuit resulted in deficient visuospatial memory in 5XFAD mice. Moreover, MRI measurements of the PHG-OFC circuit had an accuracy of 77.33% for the classification of amnestic mild cognitive impairment converters versus non-converters. Thus, the PHG-OFC circuit explains the neuroanatomical basis of visuospatial memory deficits in AD, thereby providing a potential predictor for AD progression and a promising interventional approach for AD.
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Objective To investigate the expression and significance of microtubule-associated protein 1 light chain 3 (LC3), an autophagy marker protein, in ameloblastomas. Methods Immunohistochemical methods were employed to evaluate the expression of LC3 in104 cases of ameloblastomas and 20 cases of normal oral mucosal tissues. The results were analyzed by a semiquantitative analysis method. Results The reactivity of LC3 in the epithelial cells of ameloblastomas was positive, and the positivity rate was significantly higher than that in normal oral mucosal tissues (P ＜ 0.05). There were no significant differences between the LC3 expression levels with respect to age, gender, or recurrence (P ＜ 0.05). The positivity rate in mandible ameloblastomas was significantly higher than that in maxilla and gingiva ameloblastomas (P ＜ 0.05). The reactivity for LC3 was significantly higher in solid ameloblastomas than that in the other three tissue types (P ＜ 0.05). Conclusion Autophagic activity in ameloblastomas was higher than that in normal oral mucosal tissues. This suggests that autophagy plays an important role during tumorigenesis, and contributes to the local invasion of ameloblastomas.
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BACKGROUND: Recent studies have shown that Taohong Siwu Decoction can alleviate the damage of vascular endothelial cells and maintain their normal secretory function, and endothelial progenitor cells can promote the repair of endothelial injury. Therefore, it is assumed that Taohong Siwu Decoction may protect endothelial function by improving the functional activity and increasing the number of endothelial progenitor cells. OBJECTIVE: To investigate whether Taohong Siwu Decoction can augment the number and functional activity of peripheral blood endothelial progenitor cells. METHODS: Endothelial progenitor cells were isolated from the peripheral blood of healthy subjects, and divided into control, low-, moderateand high-concentration Taohong Siwu Decoction groups. Cells were then cultured to observe the dose-effect relationship within 24 hours. Meanwhile, the high-concentration Taohong Siwu Decoction group was cultured for respective time points (6, 12, 24 and 48 hours) for observing the time-effect relationship. The number of endothelial progenitor cells was counted under inverted phase contrast microscope. Proliferation, adhesion and migration of endothelial progenitor cells were detected by MTT chromatometry, adhesion activity assay and modified Boyden chamber assay, respectively. RESULTS AND CONCLUSION: (1) The proliferation, adhesion and migration abilities of endothelial progenitor cells in the Taohong Siwu Decoction groups were significantly higher than those in the control group and showed a certain dose-effect relationship. (2) The proliferation, adhesion and migration abilities of endothelial progenitor cells in the Taohong Siwu Decoction groups were enhanced in a time-dependent manner, especially at 24 hours after intervention (P < 0.01). To conclude, the Taohong Siwu Decoction can increase the number of endothelial progenitor cells and promote cell functions. High-concentration Taohong Siwu Decoction exhibits the best interventional effect at 24 hours after intervention.
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BACKGROUND: Recent studies have shown that Taohong Siwu Decoction can alleviate the damage of vascular endothelial cells and maintain their normal secretory function, and endothelial progenitor cells can promote the repair of endothelial injury. Therefore, it is assumed that Taohong Siwu Decoction may protect endothelial function by improving the functional activity and increasing the number of endothelial progenitor cells. OBJECTIVE: To investigate whether Taohong Siwu Decoction can augment the number and functional activity of peripheral blood endothelial progenitor cells. METHODS: Endothelial progenitor cells were isolated from the peripheral blood of healthy subjects, and divided into control, low-, moderateand high-concentration Taohong Siwu Decoction groups. Cells were then cultured to observe the dose-effect relationship within 24 hours. Meanwhile, the high-concentration Taohong Siwu Decoction group was cultured for respective time points (6, 12, 24 and 48 hours) for observing the time-effect relationship. The number of endothelial progenitor cells was counted under inverted phase contrast microscope. Proliferation, adhesion and migration of endothelial progenitor cells were detected by MTT chromatometry, adhesion activity assay and modified Boyden chamber assay, respectively. RESULTS AND CONCLUSION: (1) The proliferation, adhesion and migration abilities of endothelial progenitor cells in the Taohong Siwu Decoction groups were significantly higher than those in the control group and showed a certain dose-effect relationship. (2) The proliferation, adhesion and migration abilities of endothelial progenitor cells in the Taohong Siwu Decoction groups were enhanced in a time-dependent manner, especially at 24 hours after intervention (P < 0.01). To conclude, the Taohong Siwu Decoction can increase the number of endothelial progenitor cells and promote cell functions. High-concentration Taohong Siwu Decoction exhibits the best interventional effect at 24 hours after intervention.
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Objective@#To investigate the long-term outcomes of posterior long segment instrumentation and fusion in adult degenerative scoliosis (ADS), and to explore the correlative factors of sagittal imbalance after long segment instrumentation and fusion, and to summarize the impacts of different lowest instrumented vertebra (LIV) on sagittal complication rates.@*Methods@#ADS patients who underwent long segment instrumentation and fusion between January 2008 and January 2014 were retrospectively reviewed and divided into two groups depended on LIV (L 5 group and S1 group). The follow-up time was at least five years. Radiographic parameters, Visual Analogue Score (VAS), Oswestry Disability Indexscore(ODI), the 12-item Short Form Health Survey-Physical Component Summary (SF-12 PCS)and sagittal complications were analyzed. And the correlation between sagittal imbalance and sagittal complications were calculated. Patients were divided into two groups(sagittal imbalance group and sagittal balance group) to explore the correlative factors of sagittal imbalance.@*Results@#All of 56 patients were included and evaluated in this study, and 35 cases stopped at L 5, 21 cases at S1. The mean follow-up time was 6.6±1.6 years. No significant difference were found in age, gender, follow-up time and surgery method (P>0.05) between two groups. No significant differences were found in Cobb angle(11.8°±7.3° vs 12.6°±6.4°), coronal balance distance(CBD) (0.7±0.6 cm vs 1.0±0.5 cm), sagittal vertebral axis(SVA)(3.0±3.1 cm vs 2.6±5.6 cm), thoracic kyphosis(TK) (21.4°±9.6° vs 22.5°±6.9°), lumbar lordosis(LL) (-32.7°±7.3° vs-34.8°±9.1°), pelvic tilt (PT) (23.4°±9.8° vs 23.3°±8.1°), VAS score(2.0±1.2 vs. 2.2±0.9), ODI score(18.5%±6.4% vs 19.3%±5.2%) and SF-12 PCSscore(45.5±5.2 vs 42.4±7.0) between two groups at final follow-up time(P>0.05). Radiographic parameters including Cobb angle, CBD, SVA and health related quality of life scores including VAS score, ODI score and SF-12 PCS scores were improved significantly at two weeks postoperatively, two-year follow-up time andfinal follow-up time in two groupscompared with those preoperatively (P<0.05). And no significant difference were found in radiographic parameters and health related quality of life scores between those at two years follow-up time and those at final follow-up time; Sagittal complication rates at final follow-up were higher than these at two years follow-up (82.1% vs 33.9%, P=0.000). Sagittal imbalance was related to internal fixation failure in L 5 group (r=0.691, P=0.011), internal fixation failure in S1 group (r=0.691, P=0.001) and pseudoarticulation formation (r=0.499, P=0.021). 10 patients in the sagittal imbalance group were with preoperative sagittal imbalance, 9 with preoperative coronal imbalance, 6 with internal fixation failure, 5 with proximal junctional kyphosis (PJK), 4 with adjacent segment degeneration during the follow-up periods, the incidence rates of which were higher than those in the sagittal balance group. LL in the sagittal imbalance group was lower than that in the sagittal balance group at two years follow-up time and final follow-up time. Compared with the sagittal imbalance group, the sagittal balance group achieved a higher SF-12 PCS (45.4±5.1 vs 41.6±7.4, P<0.05) and lower ODI scores (17.8%±6.1% vs 21.5±4.6%, P<0.05), and no significant difference was found in VAS scores between two groups (1.9±1.2 vs 2.4±0.8, P>0.05). The incidence of adjacent segment degeneration in L 5 group was higher than that in S1 group (P<0.05) at final follow-up time, and the incidence of pseudojoint in S1 group was higher than that in L 5 group (P=0.002) at final follow-up time.@*Conclusion@#Posterior long segment instrumentation and fusion for adult degenerative spinal deformity can obtain satisfying long-term clinical outcomes, and postoperative sagittal imbalance was related to preoperative sagittal/coronal imbalance, postoperativeinternal fixation failure, PJK, pseudoarticulation formation and adjacent segment degeneration. Distal fusion at L 5 or S1 may lead to high risk of adjacent segment degeneration or pseudoarticulation formation respectively.
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Objective To investigate the long?term outcomes of posterior long segment instrumentation and fusion in adult degenerative scoliosis (ADS), and to explore the correlative factors of sagittal imbalance after long segment instrumentation and fusion, and to summarize the impacts of different lowest instrumented vertebra (LIV) on sagittal complication rates. Meth?ods ADS patients who underwent long segment instrumentation and fusion between January 2008 and January 2014 were retro?spectively reviewed and divided into two groups depended on LIV (L 5 group and S1 group). The follow?up time was at least five years. Radiographic parameters, Visual Analogue Score (VAS),Oswestry Disability Indexscore(ODI), the 12?item Short Form Health Survey?Physical Component Summary (SF?12 PCS)and sagittal complications were analyzed.And the correlation between sagittal imbalance and sagittal complications were calculated. Patients were divided into two groups(sagittal imbalance group and sagittal balance group) to explore the correlative factors of sagittal imbalance. Results All of 56 patients were included and evaluat? ed in this study, and 35 cases stopped at L 5, 21 cases at S1. The mean follow?up time was 6.6±1.6 years. No significant difference were found in age, gender, follow?up time and surgery method (P>0.05) between two groups.No significant differences were found in Cobb angle(11.8°±7.3°vs 12.6°±6.4°), coronal balance distance(CBD) (0.7±0.6 cm vs 1.0±0.5 cm), sagittal vertebral axis (SVA)(3.0±3.1 cm vs 2.6±5.6 cm), thoracic kyphosis(TK) (21.4°±9.6°vs 22.5°±6.9°), lumbar lordosis(LL) (-32.7°±7.3°vs -34.8°± 9.1°), pelvic tilt (PT) (23.4°±9.8°vs 23.3°±8.1°), VAS score(2.0±1.2 vs. 2.2±0.9), ODI score(18.5%±6.4% vs 19.3%±5.2%) and SF?12 PCSscore(45.5±5.2 vs 42.4±7.0) between two groups at final follow?up time( P>0.05). Radiographic parameters including Cobb angle, CBD, SVA and health related quality of life scores including VAS score, ODI score and SF?12 PCS scores were improved significantly at two weeks postoperatively, two?year follow?up time andfinal follow?up time in two groupscompared with those preop?eratively (P<0.05). And no significant difference were found in radiographic parameters and health related quality of life scores be?tween those at two years follow?up time and those at final follow?up time; Sagittal complication rates at final follow?up were higher than these at two years follow?up (82.1% vs 33.9%, P=0.000). Sagittal imbalance was related to internal fixation failure in L 5 group (r=0.691, P=0.011), internal fixation failure in S1 group (r=0.691, P=0.001) and pseudoarticulation formation (r=0.499, P=0.021). 10 patients in the sagittal imbalance group were with preoperative sagittal imbalance, 9 with preoperative coronal imbalance, 6 with internal fixation failure, 5 with proximal junctional kyphosis (PJK), 4 with adjacent segment degeneration during the follow?up periods, the incidence rates of which were higher than those in the sagittal balance group. LL in the sagittal imbalance group was lower than that in the sagittal balance group at two years follow?up time and final follow?up time. Compared with the sagittal imbal?ance group, the sagittal balance group achieved a higher SF?12 PCS (45.4 ± 5.1 vs 41.6 ± 7.4, P<0.05) and lower ODI scores (17.8%±6.1% vs 21.5±4.6%, P<0.05), and no significant difference was found in VAS scores between two groups (1.9±1.2 vs 2.4± 0.8, P>0.05). The incidence of adjacent segment degeneration in L 5 group was higher than that in S1 group (P<0.05) at final follow?up time, and the incidence of pseudojoint in S1 group was higher than that in L 5 group (P=0.002) at final follow?up time. Conclu?sion Posterior long segment instrumentation and fusion for adult degenerative spinal deformity can obtain satisfying long?term clinical outcomes, and postoperative sagittal imbalance was related to preoperative sagittal/coronal imbalance, postoperativein?ternal fixation failure, PJK, pseudoarticulation formation and adjacent segment degeneration. Distal fusion at L 5 or S1 may lead to high risk of adjacent segment degeneration or pseudoarticulation formation respectively.
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Objective To investigate the effectiveness of open-door laminoplasty with lateral mass screw fusion in the treatment of multisegmental cervical spondylotic myelopathy (CSM)with segmental instability.Methods Forty-one patients with multisegmental cervical spondylotic myelopathy combined with instability underwent open-door laminoplasty with lateral mass screw fusion.The JOA(Japanese Orthopaedic Association)scoring system and Neck Disability Index(NDI) were applied to evaluate neurological function and axial neck/shoulder pain before and after surgery,respectively.In addition,the Ishihara method was used to measure the cervical curvature index(CCI),and spinal cord expansion was calculated with MRI.Results After 43 months of postoperative follow-up,there were significant differences in JOA scores[(7.12±0.91) vs.(14.73± 1.12),t =35.28,P＜0.001],areas of the dural sac at the level of maximum stenosis in MRI[(0.22±0.05)]cm2 vs.(0.62±0.09)cm2,t=14.15,P＜0.001],and NDI scores[(24.46±6.61) vs.(12.90±3.46),t=15.59,P ＜ 0.001],compared with those before treatment.However,there were no significant differences in pre-and post-operation CCI[(10.36±1.69) vs.(10.87±2.05),t=1.11,P＞0.05].Conclusions Open-door laminoplasty with lateral mass screw fusion can improve neurological function and maintain the normal cervical curvature.Therefore,it is effective in the treatment of multisegmental cervical spondylotic myelopathy with segmental instability.
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Objective To evaluate the role of different nicotinic acetylcholine receptor ( nAChR) subtypes in skeletal muscles in sepsis-related nerve-muscle dysfunction in septic rats by neuroelectrophysiol-ogy. Methods SPF adult male Sprague-Dawley rats, weighing 200-220 g, aged 2-3 months, were stud-ied. Sepsis was induced by cecal ligation and puncture in chloral hydrate-anesthetized rats. Twelve portions of sciatic nerve-tibialis anterior muscles taken at day 3 after successful establishment of the sepsis modelserved as group S. Another 12 portions of sciatic nerve-tibialis anterior muscles of normal rats served as group C. The endplate potential ( EPP ) was monitored by intracellular microelectrode recording. Six por-tions of nerve-muscle samples were incubated with the adult nAChR (ε-nAChR ) specific antagonist wa-glerin-1 at a concentration of 1 μmol∕L, the fetal nAChR (γ-nAChR) specific antagonist αA-OIVA at a concentration of 250 nmol∕L and neuronal nAChR (α7-nAChR) antagonist methyllycaconitine ( MLA) at a final concentration of 6 nmol∕L. The amplitude of EPP was recorded at 15 min of incubation, and the differ-ence in the amplitude of EPP (ΔEPP) and changing rate of EPP (ΔEPP％) were calculated. Another 6 portions of samples were incubated for 15 min with the Kreb mixture of waglerin-1 and 250 nmol∕LαA-OIVA at a final concentration of 1 μmol∕L, the Kreb mixture of waglerin-1 and 6 nmol∕L MLA at a final concen-tration of 1 μmol∕L, and the Kreb mixture of αA-OIVA and 6 nmol∕L MLA at a final concentration of 250 nmol∕L, and then the amplitude of EPP was recorded. Washout was performed with antagonist free Kreb so-lution for 15 min between treatments with different blockers. Results Compared with group C, ΔEPP andΔEPP％ were significantly decreased after antagonizing ε-nAChR, ΔEPP％ was decreased after antagoni-zing γ-nAChR, ΔEPP and ΔEPP％ were increased after antagonizing α7-nAChR, the amplitude of EPP was increased after antagonizingε-nAChR+γ-nAChR andε-nAChR+α7-nAChR, and the amplitude of EPP was decreased after antagonizing γ-nAChR+α7-nAChR (P<0. 05). ΔEPP and ΔEPP％ were significantly higher after antagonizing α7-nAChR than after antagonizingγ-nAChR in group S ( P<0. 05) . The EPP was significantly lower after antagonizingε-nAChR+α7-nAChR than after antagonizingε-nAChR+γ-nAChR ( P<0. 05) . Conclusion Weakened function of ε-nAChR and enhanced function of α7-nAChR in the mem-brane of the end-plate in skeletal muscle are the main reasons for sepsis-related nerve-muscle dysfunction in septic rats, and the role is comparable between them.
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Objective To evaluate the clinical efficacy of ventricle -peritoneal or ventricle-atrial shunt in the treatment of skull defect with craniocerebral trauma combined with hydrocephalus in the same period. Methods Sixty-four patients with skull defect after craniocerebral trauma combined with hydrocephalus were randomly divided into observation group (n=32) and control group (n=32) The ventricle-peritoneal or ventricle-atrial shunt and skull repair were conducted simultaneously following surgical operation in observation group whereas ventricle-peritoneal or ventricle-atrial shunt and the skull defect were performed within 3 months and after 3 months following operation, respectively. The hydrocephalus symptoms, prognosis after three months ,clinical outcomes and the postoperative complications were evaluated. Results There was no significant difference in hydrocephalus symptoms between the observation group and control group (χ2=0.005,P>0.05). The GCS score, GOS score and neurological function score after three months were better than those before the treatment in these two groups (P<0.05). These functional parameters were significantly better in the observation group than in control group (P<0.05). The good rate in three months was significantly higher in the observation group than in control group (59.38％vs 31.25％,χ2=7.23, P<0.05). The incidence of complication was 6.25％(2/32) in the observation group, which was significantly lower than that in the control group (31.25％, 10/32) (χ2=7.13, P<0.05).Conclusion Cranioplasty combined with shunt in the treatment of skull defect complicated with craniocerebral trauma-associated hydrocephalus has low postoperative complications, good clinical prognosis and reliable efficacy, which is worthy of clinical application.
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Objective To observe the effect of ketamine at low dose on inflammatory mediators during one lung ventilation and postoperative depression-like mood in patients with esophageal cancer radical surgery. Methods 60 patients who underwent esophageal cancer radical surgery were randomly divided into ketamine group(K)and control group(C). The patients in group K was injected with ketamine at a dose of 0.5 mg/kg at the time of anesthesia induction,then continuous infused with ketamine at a dose of 0.25 mg/(kg · h)for 30 minutes. Patients in group C:saline was given .Then concentrations of TNF-α,IL-6,IL-10 and PHQ-9 scores at different time points were evaluated. Results The PHQ-9 scores of the patients in K group at the 5 d after operation was significantly lower than that at the 1d before operation(P<0.05);The PHQ-9 scores in group K were decreased ob-viously than that those in group C(P<0.05). The concentration of serum TNF-α,IL-6 and IL-10 were significantly increased after T1 time of the two groups(P<0.05);Compared with group C,there was no statistical difference in the levels of TNF-α,IL-6 and IL-10 in group K at T2 and T3 time(P<0.05).Conclusion Low dose ketamine has no obvious effect on the concentration of blood TNF-α,IL-6 and IL -10 during one lung ventilation in patients with esophageal cancer radical surgery ,but it may alleviate postoperative depression-like mood.
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Objective To explore the risk factors of postoperative liver dysfunction in cirrhotic patients with Child-Pugh A liver function after splenorenal shunt and esophagogastric devascularization.Methods 128 Child-Pugh A cirrhotics undergoing splenorenal shunt and portal-azygous disconnection in our hospital from February,2014 to February,2016 were evaluated for risk factors of postoperative liver dysfunction.Results 22 cases (17.2％) developed postoperative liver dysfunction.By single factor analysis,age,history of upper gastrointestinal hemorrhage,ascites,serum prealbumin,serum albumin,mechanical ventilation time after surgery,postoperative serum albumin were associated with postoperative liver dysfunction.Non-conditional Logistic regression showed that age ＞ 60,serum prealbumin ＜ 170 g/L and serum albumin ＜ 30 g/L was independent risk factors for postoperative liver dysfunction.Conclusion Patients' age ＞ 60,serum prealbumin ＜ 170 g/L and serum albumin ＜ 30 g/L was independent risk factors for postoperative liver dysfunction after splenorenal shunt and portal-azygous disconnection.
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<p><b>OBJECTIVE</b>To explore the genetic etiology for fetuses featuring intrauterine growth anomalies using array-based comparative genomic hybridization (aCGH).</p><p><b>METHODS</b>Forty-nine fetuses were enrolled in this study. Genomic DNA of the abortive tissues was analyzed with aCGH.</p><p><b>RESULTS</b>Fourteen (28.6%) samples were found with chromosomal aberrations, which included 8 chromosomal aneuploidies and 6 micro-aberrations (4 with known clinical pathogenecity and 2 with unknown clinical significance).</p><p><b>CONCLUSION</b>Numerical and structural chromosomal aberrations underlie a significant proportion of fetal growth anomalies. aCGH has provided an effective method for delineating their genetic cause.</p>