Jianpi Peiyuan acupoint thread embedding therapy for perimenopausal obesity: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical efficacy and safety of Jianpi Peiyuan acupoint thread embedding therapy on perimenopausal obesity (PMO).@*METHODS@#Ninety-six patients of PMO were randomly divided into an observation group (48 cases) and a control group (48 cases). The control group received health education and lifestyle intervention. On the basis of the treatment in the control group, the observation group was treated with acupoint thread embedding at the main acupoints of Shangwan (CV 13), Zhongwan (CV 12), Xiawan (CV 10), Yinlingquan (SP 9) and Fenglong (ST 40), etc. as well as the supplementary acupoints in accordance with the syndrome differentiation, once every 2 weeks for 8 weeks (4 times in total). The indexes of obesity (body mass index [BMI], waist circumference, hip circumference and body mass), modified Kupperman score, insomnia severity index (ISI) score, self-rating anxiety scale (SAS) score, and self-rating depression scale (SDS) score of the two groups were observed before and after treatment, and the safety was evaluated.@*RESULTS@#After treatment, BMI, waist circumference, hip circumference and body mass in the two groups were lower than before treatment (P<0.05), and those in the observation group were lower than the control group (P<0.05). After treatment, Kupperman, ISI and SAS scores in the observation group were lower than before treatment (P<0.05), and ISI score in the control group was lower than before treatment (P<0.05). Kupperman, ISI and SAS scores in the observation group were lower than those in the control group (P<0.05). There was no significant difference in SDS between the two groups or within groups (P>0.05). No serious adverse reactions occurred during the experiment.@*CONCLUSION@#Jianpi Peiyuan acupoint thread embedding therapy can reduce the degree of obesity in PMO patients, and improve patients' the perimenopausal symptoms, insomnia and anxiety, with good safety.

Incidences and reasons of postoperative surgical site infection after lumbar spinal surgery: a large population study.

PURPOSE: The purpose of this study was to determine the incidences of postoperative acute surgical site infection (SSI) after lumbar spinal surgery and its possible reasons in our hospital during the past 9 years. METHODS: This is a retrospective study with a large sample size. The medical records of all included patients were reviewed, and patients with acute SSI were identified. The incidence and possible reasons of SSI were determined. RESULTS: A total of 7240 patients who underwent posterior lumbar spinal surgery were included in this study, and the total incidence of postoperative SSI was 1.53% (111/7240). Gram-negative bacteria were found to be dominant in postoperative wound infections after lumbar spinal surgery. And Escherichia coli were the most common pathogen in patients with SSI. The rate of postoperative SSI following lumbar spinal surgery was increased at first and then decreased during the past 9 years. Additionally, from 2011 to 2014, it was mainly deep infection in these patients, and then was mainly superficial infection from 2015 to 2019. Patients with lumbar spinal stenosis had the highest incidence of postoperative SSI (2.39%, P < 0.001). There was also a significant difference for the number of SSI cases among different surgeons. CONCLUSION: Based on a large population analysis, Gram-negative bacteria were the most common pathogen in postoperative SSI after lumbar spinal surgery. And patients with lumbar spinal stenosis had the highest incidence of SSI. Increasing the intervention of Gram-negative may be an important step to reduce the postoperative SSI after lumbar spinal surgery.

Clinical potentials of ginseng polysaccharide for treating gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) is the most common glucose metabolism complication or cause of potential impaired glucose tolerance that can occur either before or during pregnancy and lactation. The prevalence of GDM and its related complications in young women is increasing, and this condition may cause serious outcomes and health hazards to the foetus. However, traditional oral hypoglycaemic drugs have potential safety hazards; therefore, it is urgent to develop new, safe, effective, and easily administered agents and remedies. Ginseng polysaccharide (GPS), which is isolated from Panax (P.) ginseng C. A. Meyer, exhibits notably promising biological activities and effects; specifically, it has been shown to lower blood glucose with mild, safe, and nontoxic characteristics, and it can also improve human bodily functions. Hence, we hypothesise that GPS might be used as an additional therapy and candidate agent for treating GDM. This review innovatively summarizes the available reports and evidence from basic studies to analyze the potential for and feasibility of using GPS as a new therapeutic agent for treating GDM. Additionally, for the first time, this review provides a rationale for the use of GPS. Our summarized results show that GPS may be developed as a novel antidiabetic drug and a remedy for use in preventing and treating GDM, with great application prospects.

Using the lamina nutrient foramen as the entry point for posterior cervical pedicle screw placement.

STUDY DESIGN: A prospective study and technique description. OBJECTIVE: This study introduced a method for posterior cervical pedicle screw placement by using the bilateral posterior lamina nutrient foramens as the entry point. METHODS: Firstly, 30 dry C3-C7 vertebrae specimens were harvested for measurement. The lamina nutrient foramens were used as the entry points for posterior cervical pedicle screw placement and four linear and two angle parameters were obtained from a computed tomography scan(CT). Then, 60 patients who underwent C3-C7 pedicle screw fixation using this method were included, linear and angle parameters were obtained from a postoperative CT. RESULTS: The average incidences of lamina nutrient foramen on the C3-C7 specimens were 88.3%, 90.0%, 95.0%, 95.0%, and 96.7%, respectively. The distances from the entry point to the pedicle screw tip (OD), the pedicle transverse angles (α), and the pedicle sagittal angles (ß) measure for the entry points from C3-C7 were 28.74 ± 3.45-30.15 ± 2.01 mm, 26.88 ± 6.89° to 32.72 ± 5.91°, and 12.48 ± 9.31° to 19.71 ± 8.45°, respectively, with no significant differences between the left and right sides. In the 60 patients who underwent surgery, the lengths of the pedicle screws (PL) were 28.34 ± 2.25-30.15 ± 2.31 mm, the pedicle transverse angles (α) were 26.89 ± 6.86° to 32.36 ± 5.65°, and the pedicle sagittal angles (ß) were 12.49 ± 9.11° to 20.06 ± 8.91°. The new method had a 96.8% (454/469) success rate among these patients, with no screws penetrating the spinal canal or signs of vertebral artery injury. CONCLUSION: Entry at the bilateral lamina nutrient foramen represents an alternative posterior cervical pedicle screw placement technique that is feasible and safe.

Solving patient referral problems by using bat algorithm.

BACKGROUND: A two-hospital patient referral problem intends to calculate an optimal value of referral patients between two hospitals and to evaluate whether or not the current number of referral patients is too low. OBJECTIVE: The goal of this study is to develop a simulation-based optimization algorithm to find the optimal referral between two hospitals with the unfixed daily patient referral policy. METHODS: This study applied system simulation and a bat algorithm (BA) to build a simulation model in accordance with the status of the two hospitals case and to calculate an optimal value of daily referral patients. RESULTS: Based on the 20 test instances, we verified the stability of this algorithm. The results show that the average magnetic resonance imaging (MRI) patient wait time reduced from 16 days to eight days. The hospital should increase the average total monthly MRI referral patients to 370 under the limitation of the daily referral patients to 25. CONCLUSIONS: This research investigated the two-hospital patient referral problems. We conducted and analyzed a simulation model and improved the case hospital's conditions, enhancing the quality of its medical care. The findings of this study can extend to other departments or hospitals.

Diagnostic value of CA-153 and CYFRA 21-1 in predicting intraocular metastasis in patients with metastatic lung cancer.

Lung cancer is prone to metastasis to various organs. Although intraocular metastasis (IOM) occurs at a later stage than metastasis to other organs, it often adversely affects the quality of life and suggests a poor prognosis. In this study, we selected 1608 patients with lung cancer who had metastasis to at least one site and explored clinical differences between those with IOM and non-IOM (NIOM). An independent t test and chi-squared test were used to analyze the clinical features of the patients. The statistically significant parameters were analyzed by binary logistic regression to determine the risk factors for IOM. A receiver operating characteristic curve was constructed to assess their diagnostic value in IOM. The results showed that no significant differences were noted in age, gender, and pathological type between the IOM and NIOM groups. However, the IOM group had higher levels of alpha-fetoprotein, carcinoembryonic antigen, cancer antigen (CA)-125, CA-153, cytokeratin fragment 19 (CYFRA 21-1), and total prostate-specific antigen, compared with the NIOM group. Binary logistic regression indicated that CA-153 and CYFRA 21-1 were risk factors for IOM in patients with MLC (P < 0.05). Area under the curve of CA-153, CYFRA 21-1 and their combination were 0.791, 0.860, and 0.872 respectively. The cutoff values for CA-153 and CYFRA 21-1 were 22.2 U/mL and 6.785 ng/mL. In conclusion, both CA-153 and CYFRA 21-1 were independent risk factors for IOM in patients with metastatic lung cancer (MLC), whereas the combination of CA-153 and CYFRA 21-1 assessment yields the most value in the detection of IOM in patients with MLC.

Analysis on applications and funded projects in physiology and integrative biology of National Natural Science Foundation of China in the past decade / 生理学报

Here we perform a review on applications and funded projects at Division of Physiology and Integrative Biology in Department of Life Sciences sponsored by National Natural Science Foundation of China in the past ten years. Based on the research fields of applications and funded projects and the funding cost, we analyzed the sub-disciplines of the funded applications, key support areas, research frontiers and trends in the subjects of physiology and integrative biology, which gives us an insight into the future applications to optimize the layout of research areas in Division of Physiology and Integrative Biology.

Effects of the pestle needle therapy, a type of acupoint stimulation, on post-hemorrhoidectomy pain: A randomized controlled trial / 中西医结合学报

BACKGROUND@#Hemorrhoids are one of the most common conditions that lead to surgery, and until now surgical hemorrhoidectomy has been the major effective treatment. Post-operative pain from hemorrhoidectomy has been experienced by thousands of patients and remains a major inconvenience of the operation.@*OBJECTIVE@#This study evaluates the clinical efficacy of the pestle needle therapy, an acupoint stimulation method, for relief of post-hemorrhoidectomy pain.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS@#This was a single-center, patient-assessor-blinded and randomized controlled trial with 154 patients receiving Milligan hemorrhoidectomy surgery. Eligible patients were randomly assigned to either a treatment group or a control group at a ratio of 1:1. The treatment group received the pestle needle therapy, with manual stimulation at Yaoshu (DU2), Mingmen (DU4), Changqiang (DU1), Chengshan (BL57), Erbai (EX-UE2) and the perianal points (1, 3, 5, 7, 9, and 11o'clock around the lesion); while the control group received a sham treatment with very light pressure. Three sessions of treatment were performed at 30 min, 4 h and 12 h after the surgery, and each lasted for 15 min.@*MAIN OUTCOME MEASURES@#The primary outcome was post-operative pain measured with the visual analogue scale (VAS) at 12 h after surgery. The secondary outcomes included the VAS scores measured at 0.5, 2, 4, 6, 8, 24 and 48 h after surgery, the analgesic dose, the time and the VAS score of the patients' first defecation after surgery, as well as the Hamilton Rating Scale for Anxiety (HAMA) evaluated before discharge.@*RESULTS@#The mean pain score of the treatment group was significantly lower than that of the control group (3.10 ± 1.27 vs 4.82 ± 1.29; P < 0.001) at 12 h after surgery. Compared with the control group, patients in the treatment group needed a smaller dose of analgesic within the first 24 hours after surgery (P = 0.002); and their HAMA scores before discharge were lower (4.07 ± 2.40 vs 5.10 ± 2.45, P = 0.009). Compared to the treatment group, patients in the control group had a greater time to the first defecation after surgery ([52.34 ± 15.72] h vs [27.08 ± 13.68] h; P < 0.001), but there was no difference in their VAS scores at the first defecation (P = 0.092).@*CONCLUSION@#The pestle needle therapy was effective for relieving pain, reducing anxiety and improving bowel function after hemorrhoidectomy, and it is worthy of clinical application.

Effects of a nutritional complex on tumor growth and immune function in tumor-bearing mice / 预防医学

Objective@#To explore the effects of a complex made from lily,glutinous rice,black bean,red jujube,whey protein powder and spirulina on tumor growth and immune function in C57BL/6 tumor-bearing mice,so as to provide evidence for nutrition intervention on tumor sufferers. @*Methods@#Twenty-four C57BL/6 male tumor-bearing mice were divided into three dose groups and a control group. The mice in the low,medium and high dose group was fed with 8 g/kgbw,20 g/kgbw and 40 g/kgbw complex,respectively;the mice in the control group was fed with 0.5% CMC-Na. All mice were intragastrically administered for seven days,and the weight gain,tumor volume,tumor weight,tumor inhibition rate,thymus index,spleen index,T lymphocyte proliferation,NK cell killing rate and interleukin-2 expression were measured. @*Results@#The tumor weights of the mice in the three dose groups wereall less than that in the control group（P<0.05）. The numbers of CD3+ T cells in the three dose groups were more than that in the control group（P<0.05）. The tumor inhibition rates of the low,medium and high dose groupwere 32.46%,45.14% and 48.03%,respectively. The optical density,NK cell killing rates,IL-2 expression of spleen cells and the number of T lymphocyte subsets were dose-dependent（P<0.05）. Compared with the control group,the mice in the medium and high dose group had higher thymus indexes,NK cell killing rates,IL-2 expression of spleen cells,CD4+T cell levels and CD4+ to CD8+ ratios,but lower tumor volumes and CD8+ T cell levels（P<0.05）;the mice in the high dose group had higher optical density（P<0.05）.@*Conclusion@#This nutritional complex may play an anti-tumor role by regulating the immune function of tumor-bearing mice.

Risk Factors for Surgical Site Infection After Posterior Lumbar Spinal Surgery.

STUDY DESIGN: A retrospective study. OBJECTIVE: The purpose of this study was to identify the independent risk factors for postoperative surgical site infection (SSI) after posterior lumbar spinal surgery based on the perioperative factors analysis. SUMMARY OF BACKGROUND DATA: SSI is one of the most common complications after spinal surgery. Previous studies have identified different risk factors for postoperative SSI after lumbar spinal surgery. However, most of the studies were focused on the patient and procedure-related factors. Few studies reported the correlation between laboratory tests and postoperative SSI. METHODS: A retrospective study was carried out in a single institution. Patients who underwent posterior lumbar spinal surgery between January 2010 and August 2016 were included in this study. All patients' medical records were reviewed and patients with postoperative SSI were identified. Perioperative variables were included to determine the risk factors for SSI by univariate and multivariate regression analysis. RESULTS: A total of 2715 patients undergoing posterior lumbar spinal surgery were included in this study. Of these patients, 64 (2.4%) were detected with postoperative SSI, including 46 men and 18 women. Diabetes mellitus (P = 0.026), low preoperative serum level of calcium (P = 0.009), low preoperative and postoperative albumin (P = 0.025 and 0.035), high preoperative serum glucose (P = 0.029), multiple fusion segments (P < 0.001), increased surgical time and estimated blood loss (P = 0.023 and 0.005), decreased postoperative hemoglobin (P = 0.008), and prolonged drainage duration (P = 0.016) were found to be the independent risk factors for SSI. Multilevel fusion and a history of diabetes mellitus were the two strongest risk factors (odds ratio = 2.329 and 2.227) for SSI. CONCLUSION: Based on a large population analysis, previous reported risk factors for SSI were confirmed in this study while some new independent risk factors were identified significantly associated with SSI following lumbar spinal surgery, including preoperative low serum level of calcium, decreased preoperative and postoperative albumin, and decreased postoperative hemoglobin. LEVEL OF EVIDENCE: 4.

The risk factors for predicting or diagnosing bone metastases from urinary bladder neoplasms / 解放军医学杂志

Objective To explore the clinical significance of some risk factor,such as blood calcium serum alkaline phosphatase (ALP) and hemoglobin (Hb) for predicting or diagnosing bone metastases from urinary bladder neoplasms.Methods A total of 35 patients diagnosed as urinary bladder neoplasms and bone metastasis based on the histopathologic analysis (bone metastasis group,BM),and 105 cases of age-,sex-and follow-up time matched urinary bladder neoplasms patients without bone metastasis (non bone metastasis group,NBM) were included in present study.The correlations between clinical-pathological parameters (blood calcium,ALP,Hb) and bone metastases from urinary bladder neoplasms were analyzed and the risk factors for predicting or diagnosing bone metastases were identified.Results The levels of blood calcium,ALP and Hb were significantly higher at first diagnosis and follow-up period in BM group than in NBM group (P＜0.05).Multivariate logistic regression analysis indicated that the levels of calcium,ALP and Hb at first diagnosis were the independent risk factors for predicting the later incidence of bone metastases (P＜0.05).The levels of calcium,ALP and Hb in follow-up period were the independent risk factors for diagnosing bone metastases (P＜0.05).Receiver operating characteristic (ROC) curves analysis showed that the levels of calcium,ALP,Hb may give a more accurate prediction on bone metastases (AUC:0.615,0.704,0.692;cut-off:2.55mmol/L,97.0U/L,101.5g/L,respectively) or diagnosing bone metastases (AUC:0.706,0.776,0.829;cut-off:2.46mmol/L,112.5U/L,103.5g/L,respectively).Conclusion The levels of blood calcium,ALP and Hb may be used to predict the risk of bone metastases for patients firstly diagnosed as urinary bladder neoplasms,and predict whether the patients will be complicated with bone metastases during follow-up period.

Evaluation and analysis of cross-institutional collaboration models for chronic diseases serv-ices:A survey of medical personnel / 中国卫生政策研究

Objectives: To compare the changes in effectiveness of cross-institutional collaboration before and after intervention and non-intervention from medical personnel in order to empirically support promoting cross-institu-tional communication, coordination and cooperation modes for chronic diseases services. Methods: The typical sam-pling and multistage random sampling were used to conduct a questionnaire survey among medical personnel at villa-ges, townships and county levels. The Propensity ( Tendency) Scores were used to match the samples of the baseline and the following year of intervention, and the results were statistically analyzed. Results: After one-year of interven-tion, the county-level hospital doctors manifested higher participation while the sense of identity in work decreased;township medical personnel offered patient-centered provision of chronic disease services at higher level, but they re-ceived limited benefits from training attendance; and village medical institutions benefited a lot from the improved health care services and improved the clinic capability from cross-institutional collaboration on chronic diseases serv-ices. Suggestions: At the level of cross-institutional collaboration model policy development, attention should be paid on the work needs of county-level hospital doctors. It is also necessary to improve incentive mechanism and to work out definite and clear procedures and standards of promotion, establish a sound cross-institutional training mechanism and put knowledge into practice thereby encouraging individual development. For ultimate stand-straight, the roles and responsibilities of multi-level institutions in cross-institutional cooperation should be explored from the perspective of continuous chronic disease services.

Collaboration among health workers in multi-level health institutions from the perspective of health workers:A case study of three counties in Jiangsu province / 中国卫生政策研究

Objectives:This study aims to analyze the current status of the collaboration of medical staff among county,township,and village with comprehensive prevention and control of chronic diseases based on nine dimen-sions of DMIC integrated medical service development model,with a view to providing medical services collaboration on chronic diseases across the organization to provide direction for improvement. Methods:278 health workers sam-pled by the combination of typical sampling and multi-stage random sampling method received a questionnaire and the results were analyzed statistically. Results:According to the findings of this study,village doctors show higher partic-ipation in chronic care collaboration,but they are faced with the aging population and most of them are poorly educat-ed;the multi-institutional collaboration is of low efficiency in practice although it is well accepted by all health work-ers;there is no existing shared health information system among county,township and village. Conclusion:These re-sults suggest that the government should strengthen its leadership and promote primary health care management through medical staff collaboration;initiatives of health workers should be stimulated to promote the continuity of medical serv-ices;the shared health information system should be set up to facilitate the health workers' collaboration.

Effect of Electroacupuncture on Synaptic Plasticity and 5-Htt Protein In Hippocampal Ca1 Region of WKY Depression Model Rats / 世界科学技术-中医药现代化

Objective: To observe the effects of electroacupuncture (EA) on depressive-like behavior, synaptic plasticity and 5-HTT protein expression of hippocampal CA1 region in the WKY model rats. Methods In this experiment, 10 male Wistar rats were selected as the normal group (Control), and 30 male WKY rats were randomly divided into model group, electroacupuncture group (EA) and sham needle group (Sham EA) . Behavioral testing was performed by the Sour Water Preference Experiment (SPT), the Open Field Experiment (OFT), and the Forced Swimming Experiment (FST) . The electrophysiological field potential experiment was used to detect the effect of electroacupuncture on LTP in the hippocampal CA1 region of rats with depression, which is the effect on synaptic plasticity. The expression of 5-HTT protein in hippocampal CA1 region was detected by Western blot. Results In the SPT, compared to the Control group, the sucrose solution intake was significantly reduced in the Model group (P ＜ 0.01) . It was improved after EA treatment compared to Sham EA group (P ＜ 0.05) . In the OFT, compared with the Control group, the center time, total move time, center distance, total distance, rearing and grooming incidents were all decreased in the Model group. Compared with the Model group, the center time and total move time in the EA group increased significantly after 3 weeks of treatment (P ＜0.05) . In the FST, duration of immobility was significantly (P ＜ 0.05) longer in the Model group comparing with the Control group. Compared with Sham EA group and Model group, the immobile time of EA group was significantly shorter (P ＜ 0.05) . Compared with the Control group, the fEPSP slope of the Model group was significantly shorter (P ＜ 0.001) .Compared with the Sham EA group, the fEPSP slope of the EA group increased significantly (P ＜ 0.001) . And the LTP of Sham EA and Model groups induced failure in hippocampal CA1 region, the LTP induction was successful after EA treatment. Compared with the Control group, the expression of 5-HTT protein was significantly increased (P＜0.001) .Compared with Sham EA group, the expression of 5-HTT protein in EA group decreased (P ＜ 0.001) . Conclusion EA could alleviate depression-like behaviors in depression model rats and reverse the impairment of hippocampus synaptic plasticity by decrease the over-expression of 5-HTT protein in hippocampal CA1 region. It may be one of the mechanisms of EA on depression.

Risk factors for bone metastasis from renal cell cancer.

OBJECTIVE: The prognosis for renal cell carcinoma (RCC) is related to a high rate of metastasis, including 30% of bone metastasis. In this study, we investigate the correlation between diverse clinical factors and bone metastases secondary from renal cell cancer (RCC), and to identify potential risk factors for bone metastasis in newly diagnosed patients and those who have already received treatment. METHODS: The clinical data of 372 patients with RCC were reviewed from January 2000 to August 2016. The correlations between age, gender, histopathologic types, alkaline phosphotase (ALP), CEA, AFP, CA-125, CA-153, CA-199, calcium, hemoglobin (HB) and bone metastases were analyzed. And the risk factors for bone metastases in RCC were identified by multivariate logistic regression analysis. The cutoff value, sensitivity and specificity of the independent correlation factors were calculated by receiver operating characteristic (ROC) curve. RESULTS: The bone is the second to the lung as a distant metastasis target site in patients with RCC. Thirty eight individuals were identified with bone metastases. Of these patients, significantly higher levels of ALP, calcium, HB were found than those without bone metastasis (P < 0.05, respectively). No significant differences were detected in CEA, AFP, CA-125, CA-153, CA-199, age, gender and histopathologic types between patients with and without bone metastases (P > 0.05, respectively). Multivariate logistic regression analysis indicated that ALP, calcium and HB were independent risk factors correlated with bone metastasis (P < 0.05, respectively). ROC curves demonstrated these factors had comparable accuracy at predicting bone metastasis (AUC were 0.749, 0.633 and 0.665, respectively). The cutoff values of ALP, calcium and HB were 105.5 U/L, 2.615 mmol/L and 111.5 g/L, respectively. The sensitivities of them were 57.9%, 36.8% and 71.1% for predicting bone metastasis, with specificities of 83.5%, 95.2% and 65.3%, respectively. CONCLUSION: Based on our study, the concentrations of ALP, calcium and HB were potentially risk factors for bone metastasis in patients with RCC. For newly diagnosed patients, if the values of ALP>105.5 U/L, calcium>2.615 mmol/L and HB<111.5 g/L were detected, intensive monitoring and bone scanning are warranted for them.

Clinical characteristics and risk factors for developing bone metastases in patients with breast cancer.

The risk factors for predicting bone metastases in patients with breast cancer are still controversial. Here, a total of 2133 patients with breast cancer, including 327 with bone metastases (15.33%) and 1806 without bone metastases (84.67%) were retrospective reviewed from January 2005 to December 2015. The spine was found to be the most common site for bone metastases, followed by ribs (57.5%), pelvis (54.1%) and sternum (44.3%). The results indicated that axillary lymph node metastases and the concentrations of CA125, CA153, ALP and hemoglobin were the independent risk factors for bone metastases in patients with breast cancer. The receiver operating characteristics (ROC) curves showed that combined axillary lymph node metastases, high CA153 and ALP, with low hemoglobin were the most accurate biomarkers for predicting bone metastases in breast cancer [area under the curve = 0.900], and the sensitivity and specificity for the prediction were 78.5% and 87.8%, respectively. Therefore, breast cancer patients with more axillary lymph node metastases, high serum concentrations of CA125, CA153, ALP and low level of hemoglobin were closely related to bone metastases. Combined axillary lymph node metastases, CA153, ALP with hemoglobin have the highest predictive accuracy for bone metastases in breast cancer.

Incidence and risk factors for symptomatic spinal epidural haematoma following lumbar spinal surgery.

PURPOSE: Spinal epidural haematoma (SEH) is a common complication after lumbar spinal decompression surgery, and symptomatic SEH usually causes devastating neurological deficits. Although different risk factors for post-operative SEH have been reported, few studies focused on patients' laboratory tests. The purpose of this study was to analyze the incidence of symptomatic SEH following lumbar spinal surgery, as well as identify the risk factors for it. METHODS: Patients who underwent posterior lumbar spinal decompression surgery between January 2010 and August 2016 were included in this study and their medical records were retrospectively reviewed. Those who developed post-operative symptomatic SEH after the surgery were identified. The risk factors for SEH were analyzed by univariate and multivariate regression analysis. RESULTS: In total, 2715 patients were included in this study and 31 (1.14%) were identified with post-operative symptomatic SEH. Of these patients, 19 were males and 12 were females, with an average age of 59.39 ± 11.66 years. After multivariate logistic regression analysis, low serum calcium level (P = 0.025), blood type A (P = 0.04), increased estimated blood loss (P = 0.032), prolonged surgical duration (P = 0.018), and decreased post-operative globulin (P = 0.016) were identified as the independent risk factors for post-operative SEH following lumbar spinal surgery. Furthermore, prolonged surgical duration (odds ratio = 3.105) was the strongest risk factor for SEH. CONCLUSION: Based on a large population investigation, the incidence of symptomatic SEH following lumbar spinal decompression surgery was 1.14%. Blood type A, increased estimated blood loss, and prolonged surgical duration were identified as the independent risk factors for post-operative SEH while two new risk factors, including low serum calcium level and decreased post-operative globulin, were firstly identified in this study.

Serum Concentrations of Fibrinogen in Patients with Spinal Cord Injury and Its Relationship with Neurologic Function.

BACKGROUND: Many studies have focused on axon regeneration after spinal cord injury (SCI), and fibrinogen has been reported to be an inhibitory factor for axon regeneration. However, most of these studies were based on animal experiments and in vitro trials. Few studies reported serum concentrations of fibrinogen in patients with SCI. OBJECTIVE: We sought to investigate the circulating serum concentrations of fibrinogen in patients with SCI and determine the relationship between fibrinogen concentrations and patients' neurologic function. METHODS: A total of 306 patients who were diagnosed with acute SCI between January 2008 and March 2016 were included in this study. Patients with traumatic fractures of the extremities at the same period (220 of them with single fracture and 207 with multiple fractures) were enrolled as a control group. Additionally, 151 patients with no injury were involved as the normal group. The fibrinogen concentrations in each group were recorded and compared at different time points, and the correlation between fibrinogen serum concentrations and American Spinal Injury Association impairment scale in patients with SCI were analyzed. RESULTS: The mean serum concentrations of fibrinogen within 2 days after injury were 2.63 ± 0.76 g/L in the SCI group, 3.03 ± 0.82 g/L in the single-fracture group, and 2.86 ± 0.91 g/L in the multiple-fractures group, respectively, which were significant higher than those in the normal group (2.33 ± 0.43 g/L). Additionally, the concentrations of fibrinogen in SCI group were significantly lower compared with those in single- and multiple-fractures groups (P < 0.001 and P = 0.001). The positive rate of fibrinogen concentrations was 12.42% in the SCI group, which was significantly lower than that of the single-fracture group (25.45%) and multiple-fractures group (25.13%) (P < 0.01). In patients with SCI, Spearman correlation analysis revealed that a significant correlation was found between fibrinogen serum concentrations and patients' American Spinal Injury Association impairment scales (r = 0.17, P < 0.001). CONCLUSIONS: The serum concentrations of fibrinogen in patients with SCI were significantly increased after injury and were correlated with the severity of neurologic deficit in patients with SCI.

Blocking fatty acid synthase inhibits tumor progression of human osteosarcoma by regulating the human epidermal growth factor receptor 2/phosphoinositide 3-kinase/protein kinase B signaling pathway in xenograft models.

Previous studies have demonstrated that fatty acid synthase (FASN) is overexpressed in osteosarcoma (OS) cells and tissues and, therefore, knockdown of FASN may inhibit OS cell proliferation, migration and invasion via regulation of the human epidermal growth factor receptor 2 (HER2)/phosphoinositide 3-kinase (PI3K)/protein kinase B(Akt) signaling pathway in vitro. However, the tumor microenvironment has a crucial role in the determination of tumor malignant phenotype. The aim of the present study was to investigate the effect of knockdown of FASN on OS progression and the potential molecular mechanism in nude mice with orthotopic tumor implants in vivo. Results demonstrated that the knockdown of FASN markedly suppressed the growth and metastasis of OS, at least partially, by blocking the HER2/PI3K/Akt signal pathway in mice with intratibial 143B OS xenografts. These results suggest that the FASN/HER2/PI3K/Akt signaling pathway may be a potential therapeutic target for OS management.

Radiographic Evaluation of the Reliability of Neck Anatomic Structures as Anterior Cervical Surgical Landmarks.

BACKGROUND: Accurate location of the skin incision is helpful to decrease the technical difficulty and save the operative time in anterior cervical spine surgery. Spine surgeons usually use the traditional neck anatomic structures (the hyoid bone, thyroid cartilage, and cricoid cartilage) as landmarks during the surgery. However, the reliability of these landmarks has not been validated in actual practice. OBJECTIVE: To find out which landmark is the most accurate for identifying the cervical levels in anterior cervical spine surgery. METHODS: The lateral flexion and extension radiographs of cervical spine in standing position from 30 consecutive patients from January 2015 to February 2015 were obtained. The cervical vertebral bodies from C2 to C7 were divided equally into 2 segments. The cervical segments corresponding to each of the surface landmarks were recorded on the flexion and extension radiographs, respectively, and the displacement of corresponding cervical segments from the flexion to extension radiographs for each landmark was calculated. RESULTS: Based on the measurements, the main corresponding cervical levels for the mandibular angle were C2 on both of the flexion and extension films, for the hyoid bone were the C3-C4 interspace on flexion film and C3 on extension film, for the thyroid cartilage C5 on both of flexion and extension films, and for the cricoid cartilage C6 on flexion film and C5-C6 interspace on extension film, respectively. The ratios of displacement within 2 segments from flexion to extension were 83.3% (25/30) for mandibular angle, 56.7% (17/30) for hyoid bone, 66.7% (20/30) for thyroid cartilage, and 56.7% (17/30) for cricoid cartilage, respectively. The mean displacement from flexion to extension films were significantly less than 2 cervical segments for the mandibular angle but greater than 2 segments for the other landmarks. Significant differences were found between mandibular angle and the other 3 landmarks for the displacement from flexion to extension. CONCLUSIONS: The angle of mandible was found to be the most accurate landmark for identifying the cervical level, which corresponded to C2 and C2-C3 disc space. The hyoid bone, thyroid cartilage, and cricoid cartilage were not reliable to predict the cervical levels.