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Objective:To investigate the relationship between lymph node metastases and the prognosis of uterine cervical cancer patients diagnosed at Ⅲ C1p after abdominal surgery. Methods:The clinical data of 350 uterine cervical cancer patients preoperatively confirmed as 2018 International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰ B-Ⅱ A who underwent abdominal hysterectomy followed by postoperative concurrent chemoradiotherapy between January 2012 and December 2019 at Subei People's Hospital of Jiangsu Province were retrospectively analyzed, and there were 81 patients postoperatively diagnosed at stage Ⅲ C1p. Kaplan-Meier method was used to analyze the survival of patients stratified by different factors, and multivariate Cox proportional risk model was used to analyze the factors affecting the prognosis of patients. Results:Among 81 uterine cervical cancer patients diagnosed at stage Ⅲ C1p after abdominal surgery, 79 cases were successfully followed up. Kaplan-Meier analysis showed that patients with parametrial infiltration, the number of metastatic lymph nodes > 2, metastatic lymph node rate > 20 and common iliac lymph node metastasis had worse disease-free survival (DFS) and the overall survival (OS) (all P < 0.05). Multivariate Cox proportional analysis showed that the number of metastatic lymph nodes > 2 ( HR = 5.38,95% CI 1.30-22.20, P = 0.020) was an independent risk factor for OS; the number of metastatic lymph nodes >2 ( HR = 5.99, 95% CI 1.45-24.77, P = 0.013), common iliac lymph node metastasis ( HR = 4.91, 95% CI 1.17-20.55, P = 0.029) were independent risk factors for DFS. Conclusion:Lymph node metastasis may be associated with the prognosis of uterine cervical cancer patients diagnosed at stage Ⅲ C1p after abdominal surgery. The number of metastatic lymph nodes > 2 is a adverse influencing factor for OS and DFS.
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Objective:To evaluate the effect of microvascular invasion (MVI) on postoperative prognosis of microhepatocellular carcinoma by a meta-analysis system.Methods:Relevant literatures in PubMed, Cochrane Library, Embase, CNKI, VIP and Wanfang databases were systematically searched. The search period was from January 2012 to January 2022. The Chinese search terms were "liver cancer" , "hepatocellular carcinoma" , "2 cm" , "microvascular invasion" , and "prognosis" . The English search terms were "small" , "solitary small" , "up to 2 cm" , "< 2 cm" , "liver" , "hepatocellular carcinoma" , "microvascular invasion" . The differences in prognosis of patients with microhepatocellular carcinoma in MVI(+ ) group and MVI(-) group were compared. Meta-analysis was performed using Review Manager 5.4 software.Results:Finally, 7 articles were included in the systematic review, with a total of 1 319 patients. All included literatures were scored ≥7 on the modified Newcastle-Ottawa scale. The results of meta-analysis showed that there were no significant differences in 1-year overall survival (OS) between MVI(+ ) group and MVI(-) group ( OR=3.14, 95% CI: 0.92-10.72, P=0.068). The 5-year OS time of patients in the MVI(+ ) group was shorter than that in the MVI(-) group, and the differences were statistically significant ( OR=2.34, 95% CI: 1.62-3.36, P<0.001). The 1-year and 5-year disease-free survival of the MVI(-) group were better than those of the MVI(+ ) group, and the difference was statistically significant (1-year: OR=3.09, 95% CI: 1.75-5.44, P<0.001; 5 years: OR=1.76, 95% CI: 1.24-2.51, P=0.002). Conclusion:The 5-year and long-term survival of MVI(+ ) patients with microhepatocellular carcinoma was poor, and the postoperative recurrence rate was high.
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Objective:To evaluate the short-term effect of robotic pancreaticoduodenectomy (RPD) and laparoscopic pancreaticoduodenectomy (LPD) in the treatment of ampullary and periampullary tumor systematically.Methods:A systematic search of the PubMed, Embase and Cochrane library database using the key words "pancreaticoduodenectomy, duodenopanreatectpmy, whipple, laparoscopic, robotic, Da Vinci" . A systematic search of the Sinomed, Wangfang, VIP and CNKI databases including the key words "胰十二指肠切除" , "腹腔镜" , "机器人" , "达芬奇" . To investigate the differences of the conversion rate of laparotomy, incidence of postoperative complications, and the postoperative hospital stay between the RPD group and the LPD group. The software RevMan5.3 was used in this meta-analysis.Results:A total of 4 retrospective cohort studies and 1 001 patients were included in this meta-analysis, including 451 patients in the RPD group and 550 patients in the LPD group. The results of the meta-analysis showed that there were significant differences between RPD group and LPD group for the conversion rate laparotomy ( OR=0.35, 95% CI: 0.24-0.50, P<0.05). There were no significant differences between RPD group and LPD group for the incidence rate of overall complication( OR=1.23, 95% CI: 0.95-1.58, P>0.05), hemorrhage ( OR=0.71, 95% CI: 0.50-1.00, P>0.05), pancreatic fistula ( OR=1.09, 95% CI: 0.80-1.49, P>0.05), delayed gastric empty ( OR=0.81, 95%CI: 0.57-1.14, P>0.05) and hospital stay after surgery ( WMD=-2.87, 95% CI: -1.44-1.70, P>0.05). Conclusions:RPD is as safe as LPD, with the same complication rate. Therefor it is worthy for further application in medical institutions with relevant conditions.
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Objective To study the impact of adjuvant transarterial chemoembolization (TACE)after curative resection for patients with hepatocellular carcinoma (HCC) and microvascular invasion (MVI).Methods PubMed,Cochrane library,Embase,Web of Science,CNKI,VIP,Wanfang were searched for randomized or non-randomized studies which compared recurrence-free survival and overall survival rates with or without postoperative adjuvant TACE after curative resection for patients with HCC and MVI.The limited search time was from January 1st,1999 to May 1st,2019.Statistical analyses were performed with software programs using Stata (version 15.0) and Review Manage (version 5.3).Results Eight studies which included 1 809 patients were studied.There were 815 patients who received and 994 patients who did not receive postoperative adjuvant TACE after radical hepatectomy.Postoperative adjuvant TACE significantly improved recurrence-free survival and overall survival rates in patients with HCC and MVI when compared with the patients who required no adjuvant TACE (HR =0.74,95％ CI:0.65-0.85,P ＜0.05;HR =0.74,95％ CI:0.62-0.89,P ＜ 0.05,respectively).Subgroup analysis demonstrated that patients with tumor diameter ＞ 5 cm benefited from postoperative adjuvant TACE only in recurrence-free survival rate (HR =0.72,95％ CI:0.58-0.90,P ＜ 0.05),but not in overall survival rate.Conclusion Postoperative adjuvant TACE delayed recurrence of microvascular invasion of HCC and improved long-term prognosis,but not for tumors with diameter ＞5 cm.These results need to be validated in further clinical trials.
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Objective To investigate the impact of combined postoperative transcatheter arterial chemoembolization (TACE) with antiviral therapy in hepatitis B-related hepatocellular carcinoma (HBV-HCC) patients with high risks of recurrence.Methods Fifty-three consecutive patients who underwent curative resection of HBV-HCC between January 2014 to February 2016 were enrolled.These patients were assigned to either the adjuvant antiviral therapy combined with TACE group (n =32),the treatment group or the no adjuvant treatment group (n =21,the control group).The recurrence-free survival (RFS) and overall survival (OS) were analyzed.Results There was no significant difference between the two groups in clinical characteristics (P＞0.05).The recurrence-free survival (RFS) (mean±S.D.) was (20.1 ± 1.8) months in the treatment group and (18.7±2.4) months in the control group (P=0.752).The 1-,2-and 3-year RFS rates of the treatment group and the control group were 65.6％ vs.57.1％,31.3％ vs.28.6％ and 15.6％ vs.14.3％,respectively (P＞0.05).The overall survival (OS) (mean±S.D.) was (26.8± 1.7) months in the treatment group and (21.1±2.2) months in the control group (P=0.037).The 1-,2-and 3-year RFS rates were 65.6％ vs.57.1％,31.3％ vs.28.6％ and 15.6％ vs.14.3％ in the treatment group and the control group,respectively.The 1-,2-,and 3-year OS rates were 87.5％ vs.66.7％,59.4％ vs.38.1％ and 43.8％ vs.19.0％ in the treatment group and the control group,respectively.Conclusion Antiviral therapy in combination with TACE did not decrease the RFS rate,but it improved the OS rate in HCC patients with high risks of recurrence.
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Objective To explore the relationship between MTHFR gene polymorphism and lung cancer in Han population of Heilongjiang Province.Methods Two hundred and twenty-five lung cancer patients were selected as the experimental group and the healthy subjects in the outpatient physical examination as the control group,A case-control study was used to analyze the association of MTHFR gene 677C/T,1298A/C SNP and lung cancer,and the gene typing was detected by Sanger double deoxidization chain termination method.Results In the control group,the frequencies of wild-type CC,mutant heterozygote CT,and homozygous TT genotypes of the MTHFR gene C677T were 34.2％,55.1％,and 10.7％,respectively.The frequencies of the three genotypes in the experimental group were 26.7％,50.2％,23.1％,respectively.The difference in the distribution of C677T SNP genotype frequencies of the experimental group and the control group was statistically significant (P =0.002),in which the mutation homozygous TT carriers were 2.78 times more likely to develop lung cancer than wild-type CC (OR(95％CI):2.78 (1.54 ～ 5.02),P =0.001);AA,AC and CC genotype frequencies ofthe A1298C locus of the MTHFR gene were 34.2％,55.1％,and 10.7％,respectively,and the control group was 64.0％.32.0％,4.0％,there was no significant difference between the two groups (P =0.247).The frequencies of AA,AC and CC genotypes in the A1298C locus of the MTHFR gene were 34.2％,55.1％,and 10.7％,respectively,and 64.0.％,32.0％,and 4.0％ in the control group,respectively.There was no significant difference between the two groups (P).=0.247).The haploid analysis showed that the distribution frequency of TA haplotype in the experimental group was significantly higher than that in the control group (43.1％ vs.35.3％).There was a statistically significant difference between the two groups (OR(95％CI):1.39 (1.06-1.81),P=0.016);while the frequencies of CC haplotypes in the experimental group and the control group were 10.6％ and 17.1％,respectively.The difference was statistically significant (OR(95％CI):0.58 (0.39-0.85).P=0.005).There was a linkage disequilibrium between the two points of MTHFR gene 677 and 1298 (D'=0.48,P=0.003).The gene-environment interaction analysis of the MTHFR gene C677T polymorphism showed that based on the comparison between TT and CC genotype,age over 60 (OR(95％CI):4.0(1.78-9.32),P =0.001),male (OR (95％CI):5.55 (2.10-14.67),P=0.000),smoking (OR(95％CI):8.13 (2.29-28.85),P=0.000) and small cell lung cancer (OR (95％CI):1.28 (1.10-1.44),P=0.000) can increase the risk of lung cancer;based on the comparison between CT and CC genotype,women (OR(95％CI):2.09 (1.05-4.16),P=0.030),non-smoking population (OR(95％CI):2.43 (1.25-4.74),P=0.008) and small cell lung cancer (OR (95％ CI):0.31 (1.16-1.59),P =0.000) can increase the risk of lung cancer.Conclusion MTHFR gene C677T is a genetic susceptibility gene for lung cancer and is associated with the risk of lung cancer.
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The high incidence of postoperative recurrence of hepatocellular carcinoma ( HCC) is a most difficult obstacle for improving the prognosis of patients.Several adjuvant modalities have been developed to prevent recurrence in patients after surgery; nevertheless , there is no consensus regarding the standardized adjuvant therapy in terms of indications , clinical efficacy and interactions.In this article we review the currently available evidence in the medical literature on adjuvant therapy in HCC after radical resection.
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Objective To investigate the clinical application of Glissonean pedicle transection method in hepatocellular carcinoma. Methods We analyzed the clinical data of 232 cases of hepatocellular carcinoma underwent hepatic resection in our department from April 2009 to April 2013. Eighty-nine cases underwent hepatic resection by Glissonean pedicle transection method, and 143 cases underwent Pringle maneuver. Results There was no significant differences in the operation time and blood loss between the two groups (P > 0.05). However, the postoperative hospital stay time and the postoperative complications in group A were better than those in group B(P0.05). Conclusion Glissonean pedicle transection method has many advantages including effectively preventing the intraoperative bleeding, maximally reserving the remaining of liver function, decreasing the rate of tumor spread and metastasis. Meanwhile, it is a safe and effective technique for hepatectomy without dissection of the hepatic artery, portal vein and bile duct in the hepatoduodenal ligament.
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<p><b>OBJECTIVE</b>To establish subcutaneous xenograft models of gastric cancer in nude mice and to screen the predictive biomarkers of bevacizumab effectiveness.</p><p><b>METHODS</b>Subcutaneous xenograft models were established using BGC823 gastric cancer cell line in 20 male 4-week old BALB/C-nu/nu nude mice and were randomly divided into four groups, bevacizumab group(15 mg/kg), 5-FU group(15 mg/kg), combined group and control group, with 5 mice in each group. Bevacizumab and 5-FU were administered intraperitoneally every other day for three weeks. After treatment, tumor size and inhibition rate were calculated. Expression of CD31 was examined by immunohistochemistry for evaluation of microvascular density(MVD). Levels of human vascular endothelial growth factor(VEGF), basic fibroblast growth factor (bFGF), placental growth factor (PIGF) and interleukin 8(IL-8) were tested by enzyme linked immunosorbent assay(ELISA).</p><p><b>RESULTS</b>Compared to the control group, bevacizumab group and combined group had a significantly lower MVD(5.2±1.0 and 4.3±1.2 vs. 13.8±1.6, P<0.05), a smaller tumor volume [(305.6±184.1) mm(3) and (242.2±71.4) mm(3) vs.(1535.2±625.1) mm(3), P<0.05], and lower levels of VEGF and IL-8 in tumor tissues [VEGF:(351.6±84.1) ng/L and (242.2±71.4) ng/L vs. (1256.7±702.1) ng/L, P<0.05); IL-8:(20 903±1485) ng/L and (27 489±6772) ng/L vs. (57 032±2437) ng/L, P<0.05]. The above parameters were not significantly different between 5-FU group and control group(all P>0.05). Levels of bFGF and IGF were not significantly different among four groups as well(all P>0.05).</p><p><b>CONCLUSION</b>VEGF and IL-8 may be used to be biomarkers candidates to predict bevacizumab effectiveness on human gastric cancer.</p>
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Animales , Humanos , Masculino , Ratones , Anticuerpos Monoclonales Humanizados , Bevacizumab , Biomarcadores , Línea Celular Tumoral , Fluorouracilo , Xenoinjertos , Inmunohistoquímica , Ratones Endogámicos BALB C , Ratones Desnudos , Neoplasias Gástricas , Factor A de Crecimiento Endotelial Vascular , Ensayos Antitumor por Modelo de XenoinjertoRESUMEN
<p><b>OBJECTIVE</b>To review the clinical features of duodenal gastrointestinal stromal tumors(GISTs), and to compare the clinical efficacy among different surgical treatments for duodenal GISTs.</p><p><b>METHODS</b>Clinicalpathological data of 36 cases of duodenal GISTs undergoing operation in The First Affiliated Hospital of Sun Yat-sen University from January 2000 to July 2013 were retrospectively analyzed. All the patients received surgical treatments, including 15 cases with regional resection, 8 cases with segmental resection, 12 cases with pancreaticoduodenectomy (PD), and 1 case with liver biopsy, respectively. Clinical efficacy between pancreaticoduodenectomy (PD) and non-PD (NPD) was compared.</p><p><b>RESULTS</b>Nine of 36 cases (25%) developed postoperative complications who were all in the PD group. Eight patients recovered and healed finally after active treatment, and 1 case was complicated with acute pancreatitis, pancreatic fistula and intra-abdominal infection. The median follow-up time was 54 months and the 5-year overall survival (OS) rate and 5-year recurrence-free survival (RFS) rate were 78.1% and 72.1%, respectively. The 5-year OS rate in the PD group and the NPD group was 61.1% and 61.1% respectively. The 5-year RFS rate in the PD group and the NPD group was 85.8% and 78.8% respectively. Statistical analysis showed no significant difference between the both groups (P=0.71 and P=0.89).</p><p><b>CONCLUSIONS</b>For duodenal GISTs patients, regional resection and segmental resection have similar clinical outcomes to pancreaticoduodenectomy while the former two can obviously decrease the incidence of postoperative complications. Based on the premise of R0 resection guaranteed, regional sectional and segmental resection with less injury should be the surgical treatment of choice.</p>
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Humanos , Neoplasias Duodenales , Tumores del Estroma Gastrointestinal , Infecciones Intraabdominales , Fístula Pancreática , Pancreaticoduodenectomía , Complicaciones Posoperatorias , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
<p><b>OBJECTIVE</b>To evaluate the rationality of T staging of gastric cancer with transverse mesocolon invasion.</p><p><b>METHODS</b>Data of 808 patients with primary gastric cancer undergoing surgical treatment was screened from the Data base of Gastric Cancer of Sun Yat-sen University, from April 1996 to October 2009. According to the information of transverse mesocolon invasion, all cases were divided into groups NOI (T4a stage, non organ invasion, n = 638), NTMI (T4b stage, non transverse mesolon invasion, with organ invasion, n = 126), and TMI (transverse mesocolon invasion, n = 44). The clinicopathological features, surgical procedure and prognosis were compared among the three groups.</p><p><b>RESULTS</b>No significant difference was found in gender, age, lymph node metastasis, hepatic metastasis, tumor's Borrmann type, histological type, differentiation degree, value of serum CEA among the 3 groups (all P > 0.05). In the groups NOI, NTMI and TMI, the ratio of mean tumor diameter ≥ 5 cm was 39.0% (249/638), 61.1% (77/126) and 54.5% (24/44), respectively; the ratio of distal metastasis was 11.9% (76/638), 30.2% (38/126) and 43.2% (19/44), respectively; the ratio of peritoneal metastasis was 8.2% (52/638), 26.2% (33/126) and 38.6% (17/44), respectively; the ratio of TNM IV stage was 25.4% (162/638), 84.7% (107/126) and 93.7% (41/44), respectively; and the ratio of radical resection was 92.0% (587/638), 69.8% (88/126) and 77.3% (34/44), respectively; all with significant differences (P < 0.01), and the results of pairwise comparisons (Bonferroni correction, significant level α = 0.05/3 = 0.0167) showed that these parameters were significantly different between groups NOI and TMI (P < 0.0167), but non-significant between groups NTMI and TMI (P > 0.0167). The median survival time was 42.0, 16.4 and 19.0 months in the groups NOI, NTMI and TMI, respectively (P < 0.01), and the results of pairwise comparison showed that the prognosis were significant different between the groups NOI and TMI (P < 0.01), but non-significant between the groups NTMI and TMI (P > 0.05). In the cases who received radical resection, the median survival time was 47.9, 23.5 and 21.4 months in the groups NOI, NTMI and TMI, respectively (P < 0.01), and the results of pairwise comparison showed that the prognosis was significantly different between the groups NOI and TMI (P < 0.05), but not significant between groups NTMI and TMI (P > 0.05).</p><p><b>CONCLUSIONS</b>The tumor size, distal meatastasis, peritoneal metastasis, TNM stage, surgical procedure and prognosis of gastric cancer with transverse mesocolon invasion are similar to that of T4b gastric cancer, but are significantly different from that of T4a gastric cancer. Gastric cancer with transverse mesocolon invasion should be reclassified as T4b stage.</p>
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Humanos , Neoplasias del Colon , Patología , Mesocolon , Patología , Estadificación de Neoplasias , Estómago , Patología , Neoplasias Gástricas , PatologíaRESUMEN
Objective To assess the efficacy of postoperative adjuvant interferon (IFN) therapy on patients with hepatitis B virus (HBV) related hepatocellular carcinoma (HCC).Methods An electronic search for articles published from January 2000 to January 2013 was conducted to identify English language comparative studies evaluating IFN therapy on recurrence and survival after surgical treatment of HCC.Results A total of five trials consisting of 694 patients were included in the Meta-analysis.The estimated odds ratios (OR) for the 1-,2-,3-,and 5-year overall survival rates of HBV-related HCC were 3.37 (95％CI:1.18-6.27,P=0.000),2.36 (95％ CI:1.45-3.83,P=0.001),1.81 (95％ CI:1.21-2.72,P=0.004),and 1.93 (95％ CI:1.35-2.75,P=0.000),respectively.The OR for the 1-,2-,3-,and 5-year recurrence rates were 0.63 (95％ CI:0.44-0.91,P=0.014),0.84 (95％ CI:0.60-1.18,P=0.322),0.88 (95％ CI:0.63-1.22,P=0.431),and 0.78 (95％ CI:0.56-1.07,P=0.120),respectively.Conclusion This Meta-analysis shows that IFN therapy had a significant clinical effect in improving overall survival rates but not in decreasing recurrence rates of HBV infected HCC patients postoperatively.
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ObjectiveTo analyze the clinicopathological features and prognosis of gastric cancer patients with metastatic nodules of perigastric soft tissue. MethodsIn this study,1025 cases of gastric cancer received radical resection.According to the metastasis of perigastric soft tissue,patients were divided into metastatic group ( group MP,n =334 ),non-metastatic group ( group NMP,n =691 ).The clinicopathological features and prognosis were compared between the two groups. ResultsIn group MP,the ratio of upper,middle,lower,total gastric cancer was 25.8％,22.0％,51.4％,0.9％ and the ratio in group NMP was 33.2％,21.3％,41.3％,4.2％ respectively,showing significant higher ratio of upper and total gastric cancer in MP group(P =0.000). In group MP 47.3％ cases with tumor size ≥5 cm,significantly higher than that in NMP group(27％ ) (P =0.000).Lymph node metastatic ratio between 21％ -40％ and 41％ -100％ was found in 24.4％ and 37.3％ in MP group respectively,significantly higher than that of 12.9％,10.8％ in NMP group(P =0.000).20.1％ cases had distal metastasis in group MP,significantly higher than that of 4.1％ in group NMP(P=0.000).In group MP and NMP group,the ratio of Borrmann infiltration typing was 82.1％ vs.64.6％,the ratio of positive CEA was 21.2％ vs.11.4％,the ratio of lower or undifferentiation typing was 78.7％ vs.64.2％,all with significant difference (P =0.000 ). COX regression analysis showed the infiltration depth,organic invasion,lymph node metastatic ratio,M staging,Borrmann typing,metastatic nodules was the independent prognostic factors.Prognosis was significantly poorer in the cases with perigastric soft tissues than without ( P =0.000 ).Stratified analysis showed that irrespective of tumor size,infiltration depth,lymph node metastatic ratio,CEA value,Borrmann typing,differentiation degree,the mean survival time was significantly shorter in MP group than that in group NMP(P ＜ 0.005).In cases without distal metastasis,the prognosis was significant poorer in group MP than that in group NMP ( P =0.000 ),however,there was no significant difference between two groups in cases without distal metastasis ( P =0.076).ConclusionsPerigastric soft tissue metastasis was common in gastric cancer,more frequently seen in tumor ≥5 cm,or with organic invasion,lymph nodemetastaticration ≥ 21％, distalmetastasis, Borrmanninfiltrationtyping, loweror undifferentiation typing,positive CEA. Perigastric soft tissues metastasis was the independent prognotic factor for gastric cancer.
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Objective To develop a rapid detection method of flow cytometry for antifungal susceptibility testing.Methods The experiment conditions of flow cytometry were optimized and the minimum inhibitory concentrations (M1Cs) of 230 strains of Candida spp to flucytosin,fluconazol,itraconazole,amphotericin B were detected.The MIC results obtained by flow cytometry were compared with M27-A2 reference assay.Results The agreement of MIC results between flow cytometry and M27-A2method was 85.0％ - 100％.Conclusion Flow cytometry can be used as a rapid and reliable method for antifungal susceptibility testing.
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6 cases(2 males to 4 females) who have received mandibula reconstruction with free vascularized fibular flaps in our hospital were studied retrospectively.The average length of the fibula grafts was 8.0 cm(range from 7.0 to 14 cm). 3 cases received primary insertion of osteointegrated dental implants into the free fibula flap. The mean follow-up of six cases of patients was 3 months to 1 year. The success rate was 100%. All patients spoke clearly. 4 patients could eat normally, the other two could eat soft food. 5/6 of patients with the recovery of facial appearance was satisfied. All patients were able to walk normally. No ankle unstability was reported. Vascularized free fibula flap is confirmed to be one of the optimal methods for mandible reconstruction by our study.
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Cancer metastasis is multi-step process that requires cancer cells to jump through many hoops.The low-molecule-weight beparin (LMWH) has been reported effective for the treatment of metastasis to some extent, the mechanisms are proposed as anticoagulation, inhibition of heparanase, selectins, adhesion, angiogenesis mediated by the tumor cells, and the effects on cell cycle and apoptosis.
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To investigate the effect of semi-joint prosthesis replacement in treating osteosarcoma around the knee joint,15 children with osteosarcoma around the knee joint underwent semi-joint prostheses replacement and removal of the section with tumor from October 1998 to July 2006.Imageology showed that tumor of 9 children was located at the distal femur,and 6 cases at the proximal tibia.The pathologic changes involved the upper segment of the tibia 9-11 cm in length.All the children had been diagnosed with osteosarcoma by pathological examination,which was graded as stage Ⅱ a according to Enneking staging system.All the patients underwent neoadjuvant chemotherapy preoperatively for 1-2 courses.The size of prosthesis was determined based on preoperative X-ray,CT and MRI.The length of the prosthesis should be 1.0-2.0 cm longer than that of the excised bone.Patellar and collateral ligaments were reconstructed in the artificial semi-knee joint prosthesis.All the 15 patients had a successful semi-joint prosthesis replacement.During the follow-up of 2 to 6 years,body height of the children increases by 4-6 cm,and the affected limbs shortened 1-3 cm.All children could live and study normally.There were 7 excellent,5 good,2 fine and 1 poor according to Enneking evaluation system.The semi-joint prosthesis replacement in the limb salvage surgery for child osteosarcoma around the knee joint can reconstruct knee joint function,remain normal osteoepiphysis,minimize affected limb crispation after operation,and create the condition for total knee replacement in adults.
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BACKGROUND: In recent years, the progression of transplantation of allografts has put forward to a new way to repair massive bone and joint defect caused by various reasons, which was a difficult subject in the past.OBJECTIVE: To probe into the effect of massive allograft and interlocking intramedullary nail on rebuilding bone and joint after bone tumor resection.DESIGN: Self-control observation SETTING: Department of Orthopaedics, Yunnan Provincial Tumor Hospital PARTICIPANTS: From April 1998 to January 2003, totally 18 patients with 15 cases of malignant bone tumor and 3 of osteoma-like disease, accepted bone tumor focus removal followed by intrmedullary nailing and allogenic bone transplantation, consented to join the study, were recruited.INTERVENTIONS: Allografts were taken from fresh cadaveric bone (Prepared and stored in Yunnan Provincial Tumor). The bone segment of osteoma was cut completely and the allografts were transplanted at the bone defects. The proximal and distal intrmedullary nailing were inserted in order. Auto cancellous bone particles were transplanted at the bone joint to promote the healing at bone end. The upper part of shoulder bone was transplanted to perform reconstruct of retotar and triangular muscle; half knee joint was transplanted to attach important muscle and ligament. After external fixation of 4 to 6 weeks following operation, the functional exercise was conducted in order sequence. Evaluating the curative effect of functional recovery of the limbs at postoperative 3,6 and 12 months as well as follow-up was carried out according to the criteria of Mankin(excellent ,good , moderate , unsatisfied).MAIN OUTCOME MEASURES: ①Functional recovery of limb of the patients. ② Adverse and side effectRESULTS: Date of totally 18 patients was entered result analysis. ①Functional recovery result of the limbs: According to evaluated criteria put forward by Mankin. In this group, 7 cases of excellent, 6 of good, 4 of moderate and 1 of unsatisfied. Bony callus and the concentration of nuclide were increased gradually in the examination at month 6 and 12. About 10-14 months after operation, the osteotylus would cover the end of allograft, substituted the allograft gradually. ② Adverse events and side effect:In this group, no tumor was survived in 16 cases, two cases died of primary lesion and pulmonary metastasis at postoperative 12 months and 18 months respectively. No infection, bone nonunion, flexible internal fixation or ruptures were found in the limbs of other patients. No one was found with shortened limbs. The patient with part joint transplantation has limitation in joint move, but the joint was stable.CONCLUSION: This operation has the highest stabilization .The patients can do exercise earlier to recover function, and injury arthritis could be prevented. It is suitable to rebuild the bone after bone tumor resection.
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Objective To observe the difference of lung injury between toll-like receptor 4 (TLR4) mutant mice and wild type mice in a model of lipopolysaccharide (LPS) induced acute lung injury (ALI),discuss the role of TLR4 in ALI.Methods Different doses of LPS solution (1,5mg?kg~(-1)) were injected in vein tail to reproduce ALI model in both TLR4 mutant (TLR4~(-/-)) and wild type (WT,TLR4~+(/+)) mice.Lung tissues were collected for gross and micrographic histological injury analysis and for assessment of lung edema.Meanwhile,the levels of myeloperoxidase (MPO) in lung tissues in both strains were assessed to evaluate the extent of polymorphological neutrophils (PMN) infiltration.Results The gross and micrographic injury of lung was milder in TLR4 mutant mice than that in wild type mice.The extent of lung edema (W/D) was also reduced compared with wild type mice,especially in 5 mg?kg~(-1) group [(4.08?0.1)vs.(4.55+0.2),n=10,t=12.71,P＜0.01].With high dosage of LPS,the value of W/D in both mice strains was higher than that in sham operation group (P＜0.01).The extent of PMN infiltration in lung tissues in TLR4 mutant mice was reduced compared with wild type mice.But they were higher than sham operated mice (P＜0.01).Conclusion TLR4 May involve in the development of ALI,by sequestration of PMN into lung tissues.
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Robots are being more and more used in surgery. High Intensity Focused Ultrasound is newly used in tumor treatment and it is non invasive. In this paper, we introduced a Robot integrated HIFU surgery system and its general flow. Also introduced is an 8 DOF surgical platform, its design, its mechanism and its kinematic analysis. In the end, we give out two spatial working areas individually. Each is the combination of 5 dimensional motions. Compared with other platforms available, this surgery platform is more flexible and accurate and its treatment area is larger. All these advantages make the treatment design easier.