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Objective:To investigate the relationship between microsatellite instability (MSI) , and clinicopathological features ,prognosis in patients with stage Ⅱ and Ⅲ colon cancer.Methods:Patients undergoing surgical resection for stage Ⅱ and Ⅲ colonic tumor in the Affiliated Hospital of Qingdao University from Dec 2016 to Nov 2018 were enrolled. All the 292 patients were with stage Ⅱ and Ⅲ colon cancer and MSI status. Propensity score matching method was used to match the two groups of patients according to 1:1. χ 2 analysis, Logistic Regression and COX regression was used to analyse the relationship between MSI status, the clinicopathological features and prognosis. Results:The risk of MSI-H in young patients ( OR=0.340, 95% CI: 0.126~0.921, P=0.034), right-sided colon cancer ( OR=7.985, 95% CI: 3.040-20.973, P<0.001), mucinous adenocarcinoma ( OR=4.285, 95% CI: 1.495-12.284, P=0.007), poorer differentiation ( OR=4.848, 95% CI: 1.597-14.716, P=0.005), N0 staging ( OR=0.235 , 95% CI: 0.077-0.719, P=0.011) increased . The total OS of colon cancer patients in the MSS group (66.7%) and the MSI-H group (86.9%) were statistically different( P=0.003). The MSI status ( HR=0.367, 95% CI: 0.151-0.891, P=0.027) is an independent factor affecting the prognosis of patients. Conclusions:In stage Ⅱ and Ⅲ colon cancer, patients with MSI-H have a better prognosis. MSI status is prognosis relevant factor for colon cancer patients.
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Objective To explore the correlations relating functional MRI ( fMRI) and diffusion tensor imaging ( DTI) parameters with pre-operative neurological status and post-operative outcomes for patients with cervi-cal spondylotic myelopathy ( CSM ) . Methods Eighty-seven CSM patients treated with surgical decompression and 38 healthy counterparts were enrolled as the CSM and control groups respectively. DTI and fMRI of the cervical spine were performed while the subjects performed a finger-tapping task with their right hands before the operation and 6 months later. The control group was evaluated only when they were enrolled. All of the patients were given systematic rehabilitation treatment after the surgery. The Japanese Orthopaedic Association ( JOA) scoring system for CSM was used to evaluate neurological status, and a JOA recovery rate <50％ was defined as a poor recovery. Results Compared with the healthy controls, the pre-operative patients showed significantly higher volume of acti-vation ( VOA) in the left precentral gyrus ( PrCG) , but that had decreased significantly 6 months after the surgery. Before the surgery, the patients' fractional isotropy ( FA) was significantly less than that of the controls, but it had increased significantly 6 months after the operation. There was no difference in VOA in the left postcentral gyrus (PoCG) between the CSM patients and the controls before the surgery. The VOA ratio (PrCG/PoCG), VOA-PrCG, VOA-PoCG and FA were significantly correlated with both the JOA scores and recovery rates. Receiver oper-ating characteristic ( ROC) curve analyses were performed for the predictive ability with respect to surgical out-comes. The largest area under the ROC curve was observed for the VOA ratio (0.805), followed by FA (0.740), and the VOA-PrCG (0.715). The fMRI and DTI showed better potential for predicting functional outcomes than with standard MRI parameters. Multivariate logistic regression revealed that the VOA ratio and FA were independ-ently associated with poor outcomes. Conclusions fMRI and DTI parameters may be more valuable than conven-tional MRI results for neurological assessment and prognosis with CSM patients. They can also provide references for making up rehabilitation plans.
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Objective@#To observe the clinical effect of hyperbaric oxygen therapy on cervical spondylotic myelopathy (CSM) in the peri-operative period, and to explore its neural mechanism.@*Methods@#Eighty patients who underwent surgical decompression for CSM were randomly divided into a hyperbaric oxygen group (n=40) and a control group (n=40). Both groups received cervical laminoplasty and systematic rehabilitation treatment after the surgery, while the hyperbaric oxygen group was additionally provided with hyperbaric oxygen therapy in the peri-operative period. The patients′ neurological status was evaluated using Japanese Orthopaedic Association (JOA) scores. Both groups received conventional MRI and diffusion tensor imaging (DTI) before and 6 months after the surgery.@*Results@#After the surgery, both groups gained significant improvement in their average JOA score, with the improvement of the hyperbaric oxygen group significantly greater than in the control group. Pearson correlation analysis showed that the average pre-operative JOA score was significantly correlated with the anisotropic fraction (FA) and the apparent dispersion coefficient (ADC) of the compressed spinal cord. Six months after the surgery such correlation still persisted. During the six months, significant increase was observed in the average FA and significant decrease in the average ADC in both groups, with the average FA of the hyperbaric oxygen group (0.726±0.087) significantly higher at the end of the 6 months than that in the control group. The average ADC (1.148±0.079)×10-3 mm2/s) was significantly lower.@*Conclusions@#DTI′s quantitative indicators can objectively show changes in the microstructure and pathological state of spinal cords. Exposure to hyperbaric oxygen may relieve ischemia and hypoxia of the spinal cord, promoting the repair of injured neurons and accelerating the regeneration of nerve fibers.
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Objective@#To explore the correlations relating functional MRI (fMRI) and diffusion tensor imaging (DTI) parameters with pre-operative neurological status and post-operative outcomes for patients with cervical spondylotic myelopathy (CSM).@*Methods@#Eighty-seven CSM patients treated with surgical decompression and 38 healthy counterparts were enrolled as the CSM and control groups respectively. DTI and fMRI of the cervical spine were performed while the subjects performed a finger-tapping task with their right hands before the operation and 6 months later. The control group was evaluated only when they were enrolled. All of the patients were given systematic rehabilitation treatment after the surgery. The Japanese Orthopaedic Association (JOA) scoring system for CSM was used to evaluate neurological status, and a JOA recovery rate <50% was defined as a poor recovery.@*Results@#Compared with the healthy controls, the pre-operative patients showed significantly higher volume of activation (VOA) in the left precentral gyrus (PrCG), but that had decreased significantly 6 months after the surgery. Before the surgery, the patients′ fractional isotropy (FA) was significantly less than that of the controls, but it had increased significantly 6 months after the operation. There was no difference in VOA in the left postcentral gyrus (PoCG) between the CSM patients and the controls before the surgery. The VOA ratio (PrCG/PoCG), VOA-PrCG, VOA-PoCG and FA were significantly correlated with both the JOA scores and recovery rates. Receiver operating characteristic (ROC) curve analyses were performed for the predictive ability with respect to surgical outcomes. The largest area under the ROC curve was observed for the VOA ratio (0.805), followed by FA (0.740), and the VOA-PrCG (0.715). The fMRI and DTI showed better potential for predicting functional outcomes than with standard MRI parameters. Multivariate logistic regression revealed that the VOA ratio and FA were independently associated with poor outcomes.@*Conclusions@#fMRI and DTI parameters may be more valuable than conventional MRI results for neurological assessment and prognosis with CSM patients. They can also provide references for making up rehabilitation plans.
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Objective To compare the effect of clustered acupuncture of the scalp combined with constraint induced movement therapy (CIMT) with that of conventional acupuncture of the body points plus conventional rehabilitation intervention after cerebral infarction using blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI).Methods Thirty acute cerebral infarction patients with hemiplegia were equally divided into two groups at random.The test group received the clustered acupuncture of the scalp combined with CIMT,while the control group received the body point acupuncture plus conventional rehabilitation intervention.Before and after two weeks of treatment,blood oxygenation level-dependent functional magnetic resonance imaging at 3.0 T was performed during a passive digital opposition movement.The volume and intensity of the activated areas were compared.Fugl-Meyer assessment (FMA) was carried out as well.Results The most pronounced activation appeared in the contralateral somatosensory motor cortex for both groups.There was no significant difference in average FMA scores between the two groups before the treatment,but after the treatment the averages were significantly different.An increase in activated volume and intensity in the contralateral SMC was observed in both groups after the treatment,but the test group showed a much larger change in both activated volume and intensity.Conclusion The clustered acupuncture of the scalp combined with CIMT can achieve a more significant improvement in functional recovery after acute cerebral infarction than conventional acupuncture of the body points plus conventional rehabilitation intervention.Such combined therapy is worthy of application in clinical practice.
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Objective To explore surgical opportunity and management of high-energy Pilon fractures.Methods Twenty-five cases of the high-energy Pilon fractures were treated with anatomic type plate one-staged or ses of type III fractures.8 cases were open fractures and 17 cases were close fractures.8 cases open fractures and 6 cases close fractures were treated with anatomic type plate one-staged.11 cases close fractures with serious soft tissue swell were treated two-staged delayed.The combined fibular fractures were fixed accordingly.All cases were followed up for 32 months after operation in average( range 17 to 76 months).Results According to Mazur's criteria,the surgical result was evaluated as excellent in 10 patients,goed in 11 ,fair in 3 and poor in 1.Postoperative complication ineluded infection in 2 cases,necrosis of skin in 1 case and traumatic arthritis of the ankle joint in 2 cases.Conclusion In order to get a satisfactory result,it is important to choose the right timing of surgery and correct procedure in high-energy Pilon fracture.
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[Objective] To study the clinical significance of the changes of 100 cases C-reactive protein(CRP)values and erythrocyte sedimentation rates(ESR)in patients with primary osteoarthritis before and after total hip and total knee replacement.[Method] A prospective study was designed to observe the changes of CRP leves and ESR in patients with primary osteoarthritis before and at 1~7 days,2 weeks,1,2,3,6,12 months after total hip and total knee arthroplasty.Ninty-two cases received follow-up.There are 35 males and 57 females with average of 64.7 years,ranging from 37 to 92 years.Sixteen had cementless total hip replacement(THR),32 had hybrid THR,7 had cemented THR and 37 underwent cemented to tal knee replacement(TKR).[Result]In both groups serum CRP level increased rapidly after surgery,peaking at day 2(THR 216.7 mg/L,TKR 257.3 mg/L),and dropping gradually to pre-operative values at the end of the first month in THR patients and at the end of the second month in TKR patients.ESR peaked at day 5 and 6 respectively after operation in THR and TKR patients(THR 93.2 mm/h,TKR 95.7 mm/h),dropping to pre-operative values at the end of the third month in THR patients and at the end of the ninth month in TKR patients.[Conclusion]Serum CRP levels changed more rapidly than ESR and returned to normal more rapidly.CRP and ESR values tended to be higher in TKR than in THR patients.CRP can reflect the status of inflammation.Dynamic observation can help diagnoze early infection.
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[Objective]To determine the incidence and factors associated with pyrexia after total knee replacement(TKR).[Method]A retrospective review of 200 patients in departments of orthopaedics of our hospital and West China hospital who underwent TKRs from August 1998 and April 2006 was performed.The clinical,surgical and follow-up data were abstracted from the patients' records and were analyzed with SPSS 12.0.[Result]There was a statistically significant increase of the mean temperature post-operations,which remained significant throughout the first 7 days after surgeries(P
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[Objective]To retrospectively analyze the therapy comparison between the unilateral hinged external fixator assisting the internal fixation, soft tissue repair and reconstruction and routine surgery for elbow instability of fracture dislocation.[Method]A total of 117 cases of elbow fracture dislocation were collected from Jan. 2001 to Jun. 2005. Some patients were treated by unilateral hinged external fixator, and others were treated by routine surgery and casting external fixation.The JOA assessment was applied for the pain, function, arc of motion, articular instability and deformity of elbow joint before surgery and after operational follow-up. [Result]Eighty-six cases were followed up by telephone and mail appointment.The average follow-up time was 18.6 months (from the range of 8 months to 30 months).The function and arc of motion of two group patients were assessed by JOA in post-operational follow-up, showing statistical significant difference (P0.05). The total assessment score between two groups indicates statistical significant difference.[Conclusion]The operation in combination with unilateral hinged external fixator for treating elbow instability of fracture dislocation will enhance lateral stability of elbows, guaranteen early safe elbow function exercises, facilitate stable environment for ligaments healing,suggesting a good subsidiary operational method.