Development and validation of a robust multigene signature as an aid to predict early relapse in stage I-III clear cell and papillary renal cell cancer.

Background and objectives: Multi-gene signature can be used as prognostic indicator in many types of cancer, but the association with early-relapse in patients with stage I-III clear cell and papillary renal cell cancer (RCC) is unknown. We aim to establish a mRNAs signature for improving prediction of early-relapse in patients with stage I-III clear cell and papillary RCC. Methods: The data of 610 patients with stage I-III RCC from The Cancer Genome Atlas (TCGA) and 270 patients from Fudan University Shanghai Cancer Center (FUSCC) were extracted. Propensity score matching analysis, linear models for microarray data VOOM method, least absolute shrinkage and selection operation Cox regression modeling analysis was conducted in turn for selecting multi-mRNA signature. Survival differences were assessed by Kaplan-Meier estimate and compared using log-rank test. Multivariable Cox regression and time-dependent receiver operating characteristic curves were used to evaluate the association of mRNAs signature with relapse-free survival (RFS). Results: Seventeen mRNAs were identified to constitute the early-relapse signature. Among patients with stage I-III RCC, those with high-risk score calculated from 17 mRNAs signature showed shorter RFS than those with low-risk score, both in TCGA discovery and internal validation sets, and in FUSCC discovery and internal validation sets (all p < 0.05). In multivariable Cox regression analysis, the 17 mRNAs signature remained an independent prognostic factor both in TCGA discovery (HR 2.43, 95%CI 1.98-2.96) and internal validation sets (HR 1.66, 95%CI 1.19-2.30), and FUSCC discovery (HR 1.28, 95%CI 1.13-1.43) and internal validation sets (HR 1.65, 95%CI 1.11-2.48). Additionally, the 17 mRNAs signature achieved a higher accuracy for RFS estimation beyond clinical indicator. Conclusion: The 17 mRNAs signature could classify stage I-III RCC patients into low- or high-risk of early-relapse, and will help to guide interventions to optimize survival outcomes.

Retropharyngeal hematoma following anterior cervical spine surgery: Lessons from a case report (CARE-compliant).

RATIONALE: Retropharyngeal hematoma (RH) is an infrequent but potentially life-threatening complication of anterior cervical spine surgeries (ACSS). Challenging situations might be confronted and catastrophic events or even deaths still occurred occasionally during the treatment. Currently, no widely accepted protocol has been developed. PATIENT CONCERNS: A 55 years old male underwent ACSS due to cervical myelopathy. Thirty-three hours after surgery the patient presented cervical swelling and obstructive dysphagia. Conservative treatment resulted in no recovery and cervical swelling progressed. DIAGNOSES: Emergent magnetic resonance imaging and plain radiograph established massive incisional and RHs. RH was shown to extend from the base of the skull to T1. INTERVENTIONS: An emergent surgery was performed under local anesthesia and cervical hematoma was evacuated. Nonetheless, evacuation of the blood clots in the vision field resulted into incomplete recovery of throat blockage. A gloved finger was used to explore the retropharyngeal space and some hidden blood clots were found and evacuated, then the patient obtained complete relief of the symptoms. OUTCOMES: Normal respiration and swallowing functions were obtained after the surgery. Obviously, recovery of motor function was noted while no other complication was found at 3-month follow-up LESSONS:: Our case illustrated that dysphagia was an early symptom of RH. Posterior compression from RH could cause obstruction of the pharyngeal airway and lead to difficulty of intubation. Hematoma could spread through the retropharyngeal space, a hematoma exploration beyond the visual range might be necessary in some cases for fear of the hidden hematoma.

Adverse Effect of Lymph Node Dissection in Metastatic Renal Cell Cancer Patients Treated with Cytoreductive Nephrectomy: A Contemporary Analysis of Survival.

Background and objectives: In patients with metastatic renal cell cancer (mRCC), cytoreductive nephrectomy (CN) may occasionally be performed. However, the role of lymph node dissection (LND) for such cases is unknown in era of target therapy. To test the effect of LND at CN on cancer-specific survival (CSS), overall survival (OS) in era of target therapy compared with no LND in patients with mRCC. Methods: A total of 4690 mRCC patients treated with CN were identified within the Surveillance, Epidemiology, and End Result (SEER) database (2006-2015). Survival differences were assessed by Kaplan-Meier estimate and compared using log-rank test. Multivariable Cox regression analysis (MCR) was used to evaluate the effect of LND on CSS and OS. Results: Within the SEER database, 1902 (40.6%) of 4690 mRCC patients underwent LND at CN. MCR analysis showed that LND at CN exhibited lower CSS (hazard ratio [HR] 1.18, 95% confidence interval (CI) 1.09-1.27; p < 0.01) and OS (HR 1.13, 95% CI 1.05-1.21; p < 0.01) compared with non-LND in mRCC patients. The adverse effect of LND on CSS and OS were also detected in metastatic patients with clear cell RCC (ccRCC) and non-ccRCC (all p<0.0001). Additionally, the association of number of resected node with CSS (HR 0.98, 95% CI 0.88-1.10; p = 0.68) and OS (HR 1.00, 95% CI 0.89-1.11; p = 0.93) were not observed in MCR analysis. Conclusion: We are the first to demonstrate that LND at CN is associated with poor CSS and OS in metastatic patients with ccRCC and non-ccRCC. Considering that the current study is retrospective, these findings' impact on clinical practice needs to be further verified in future validation studies.

Effects of annulus defects and implantation of poly(lactic-co-glycolic acid) (PLGA)/fibrin gel scaffolds on nerves ingrowth in a rabbit model of annular injury disc degeneration.

BACKGROUND: Growth of nerve fibers has been shown to occur in a rabbit model of intravertebral disc degeneration (IVD) induced by needle puncture. As nerve growth may underlie the process of chronic pain in humans affected by disc degeneration, we sought to investigate the factors underlying nerve ingrowth in a minimally invasive annulotomy rabbit model of IVD by comparing the effects of empty disc defects with those of defects filled with poly(lactic-co-glycolic acid)/fibrin gel (PLGA) plugs. METHODS: New Zealand white rabbits (n = 24) received annular injuries at three lumbar levels (L3/4, L4/5, and L5/6). The discs were randomly assigned to four groups: (a) annular defect (1.8-mm diameter; 4-mm depth) by mini-trephine, (b) annular defect implanted with a PLGA scaffold containing a fibrin gel, (c) annular puncture by a 16G needle (5-mm depth), and (d) uninjured L2/3 disc (control). Disc degeneration was evaluated by radiography, MRI, histology, real-time PCR, and analysis of proteoglycan (PG) content. Nerve ingrowth into the discs was assessed by immunostaining with the nerve marker protein gene product 9.5. RESULTS: Injured discs showed a progressive disc space narrowing with significant disc degeneration and proteoglycan loss, as confirmed by imaging results, molecular and compositional analysis, and histological examinations. In 16G punctured discs, nerve ingrowth was observed on the surface of scar tissue. In annular defects, nerve fibers were found to be distributed along small fissures within the fibrocartilaginous-like tissue that filled the AF. In discs filled with PLGA/ fibrin gel, more nerve fibers were observed growing deeper into the inner AF along the open annular track.  In addition, innervations scores showed significantly higher than those of punctured discs and empty defects. A limited vascular proliferation was found in the injured sites and regenerated tissues. CONCLUSIONS: Nerve ingrowth was significantly higher in PLGA/fibrin-filled discs than in empty defects. Possible explanations include (i) annular fissures along the defect and early loss of proteoglycan may facilitate the ingrowth process and (ii) biodegradable PLGA/fibrin gel may promote adverse growth of nerves and blood vessels into deeper parts of injured disc. The rabbit annular defect model of disc degeneration appears suitable to investigate the effects of nerve ingrowth in relation to pain generation.

[Application of Jintian'ge capsule in treatment of vertebral compression fracture in senile osteoporosis patients].

To study the clinical application of Jintian'ge capsule in treatment of vertebral compression fracture in senile osteoporosis patients. In the study, 69 senile osteoporotic vertebral compression fracture patients hospitalized in our hospital between January 2012 and June 2014 were selected and randomly divided into the control group and the treatment group. Patients in the control group were treated by percutaneous kyphoplasty (PKP), while those in the treatment group were given Jintian'ge capsule in addition to PKP. Efforts were made to visit the patients before the surgery and in three month after that, observe and compared the vertebral height, Cobb's angle, bone density, visual analogue scale (VAS) and Oswestry disability index between patients in the two groups. According to the findings, compared with before the treatment, patients in the two groups showed significant improvements in the vertebral height, Cobb's angle, bone density, VAS and Oswestry disability index three months after the surgery (P < 0.05); During the visit three months after the treatment, compared with the control group, the treatment group showed notable increases in all parameters (P < 0.05), particularly in the vertebral height, VAS and Oswestry disability index (P < 0.05). Based on the above findings, Jintian'ge capsule is applicable in adjuvant therapy after the osteoporotic vertebral compression facture PKP surgery.

[Analysis of correlative factors of non-surgical vertebral fractures after percutaneous vertebroplasty for osteoporotic vertebral compression fractures].

OBJECTIVE: To investigate the correlative factors of non-surgical vertebral fractures after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures(OVCFs). METHODS: From August 2009 to September 2011, 126 patients who underwent single-level PVP for OVCFs were included in this study. They were followed up with an average time of 13.6 months,divided into the refracture group and non-refracture group according to the onset of non-surgical vertebral fractures or not. In refracture group,there were 14 males and 18 females with an average age of (67.63+/-7.28) years(ranged, 54 to 82); and in non-refracture group,there were 40 males and 54 females with an average age of (66.26+/-6.79) years (ranged, 55 to 76). The refracture group wps divided again into adjacent vertebral fracture (AVF) group (7 males and 13 females) and remote vertebral fracture(RVF) group (4 males and 8 females). The age, sex, bone mineral density(BMD), injecting bone cement volume, the recovery rate of vertebral body height,kyphosis corrected degree were recorded and the correlative factors of non-surgical vertebral fractures were analyzed. RESULTS: There was no statistically significant differences in age, sex, BMD, injecting bone cement volume and kyphosis corrected degree between refracture group and non-refracture group (P>0.05), and there was statistically significant difference in the recovery rate of vertebral body height (P<0.05). There was no statistically significant difference in BMD, kyphosis corrected degree between adjacent vertebral fracture group and non-refracture group (P>0.05); and there was statistically significant difference in injecting bone cement volume,recovery rate of vertebral body height(P<0.05). There was no statistically significant difference in BMD,injecting bone cement volume,recovery rate of vertebral body height, kyphosis corrected degree between remote vertebral fracture group and non-refracture group (P>0.05). CONCLUSION: Recovery of vertebral body height may prefigure increasing risk of refracture in non-surgical vertebral body for the patient with OVCFs after PVP, and the adjacent vertebral fracture maybe concerned with injecting bone cement volume and recovery rate of vertebral body height.

[Minimally invasive trochanteric antegrade nail fixation for the treatment of intertrochanteric fractures of femur in elder].

OBJECTIVE: To evaluate the clinical effect of minimally invasive Trochanteric Antegrade Nail (TAN) for the treatment of intertrochanteric fractures of femur in elder. METHODS: From January 2005 to June 2008, 80 patients with intertrochanteric fractures of femur were treated with minimally invasive fixation of Trochanteric Antegrade Nail. There were 16 males and 64 females with an average age of 75 years ranging from 65 to 93 years. According to Evans classification, there were 8 cases of type I, 32 of type II, 30 of type III, 6 of type IV and 4 of type V. After the operation of minimally invasive Trochanteric Antegrade Nail fixation,patients begun to do the continuous passive motion (CPM) and active motion of the injured hip joint and knee joint. RESULTS: All patients were followed from 5 to 18 months with an average of 10 months. All factures were healing in time from 10 to 14 weeks with none screw breakage. Proximal screw exiting out about 0.5 cm occurred in 3 patients without obvert symptom. Three patients appeared lower limb deep venous thrombosis and were cured with medicine. According to the scales of Sanders, pain score was 9.08 +/- 1.19, ambulation score 8.85l +/- 1.09, function score 9.10 +/- 1.27, muscle strength score 9.13 +/- 1.18, daily life score 8.91 +/- l.07, X-ray evaluation score 9.34 +/- 1.09, so as the results were excellent in 56 cases, good in 20, poor in 4. CONCLUSION: With the advantage of mini-invasion, operative convenience and stable fixation, minimally invasive TAN fixation is an effective method for intertrochanteric fractures in elder.

[Analysis of curative effect of discectomy for lumbar intervertebral disc herniation].

OBJECTIVE: To evaluate the short and long term results of discectomy for lumbar intervertebral disc herniation. METHODS: From 2000 to 2007, 400 patients (male 220 and female 180, the age was from 16 to 73 years old with an average of 42.3 years) with lumbar intervertebral disc herniation underwent discectomy by posterior mini-incision less than 5 cm and vertebrae plate was ectomized in 2 cm x 2 cm winder,and nerve root was compressied. The short and long term clinical result were analyzed with SPSS 10.0 software. RESULTS: Three hundred and eighty patients were followed up in the short term (less than 2 years after operation), 308 cases obtained excellent result, 48 good, fair 24, the excellent and good rate was 93.7%. Three hundred and forty-eight patients were followed up in the long term (more than 3 years after operation), 244 cases obtained excellent result, 48 good, fair 56,the excellent and good rate was 83.9%. There was significant difference in follow-up between the short and long term (P < 0.05). CONCLUSION: The clinical effect of discectomy for lumbar intervertebral disc herniation decreased with time lapse.