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Purpose: This study investigated the outcome of elderly patients (≥65 years) with thoracic esophageal squamous cell carcinoma (TESCC) treated with esophagectomy and postoperative radiotherapy (PORT) or definitive radiotherapy (DRT). Patients and Methods: One hundred and ninety patients (median age of 72 years) who received PORT (n = 68) or DRT (n = 122) for TESCC were analyzed. Majority of them showed locally advanced disease (T3/4: 70.5%, N+: 70.5%, Stage III: 51.6%). Compared to patients who received DRT, those who received PORT had lower Age-Adjusted Charlson Comorbidity Index (AACCI) scores (2.49 ± 0.61 vs. 3.73 ± 1.28, χ2 = 7.283; P = 0.000) and higher Karnofsky Performance Scale (KPS) (χ2 = 9.016; P = 0.003) and were of younger ages (68.90 ± 3.00 vs. 75.17 ± 5.71, χ2 = 9.925; P = 0.000). Results: Overall survival (OS) was significantly higher in the PORT group (median, 61.2 months; 95% confidence interval [CI], 46.04–76.36) than in the DRT group (median, 24.37 months; 95% CI, 15.43–33.31). Multivariate analysis showed that treatment method (hazard ratio [HR]: 2.38, 95% CI, 1.46–3.90; P = 0.001), clinical T stage (HR: 0.57, 95% CI, 0.34–0.95; P = 0.031), and lymph node metastasis (HR: 0.51, 95% CI, 0.31–0.84; P = 0.008) were independent prognostic factors. Regarding subgroup analysis, OS of patients receiving PORT was significantly higher than that of DRT in the T3–4 group (HR: 2.98, 95% CI, 1.80–4.92; P = 0.000) and the N+ group (HR: 2.20, 95% CI, 1.26–3.83; P = 0.006). Conclusions: The efficacy of PORT for the treatment of elderly TESCC patients was superior to DRT. With regard to AACCI, KPS, and age, DRT is still a treatment option for elderly TESCC patients, especially for those >75 years of age
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Objective To discuss the treatment efficacy and radiotherapy side effects of the preoperative long-course radiochemotherapy and preoperative short-course radiotherapy.Methods 64 patients with local advanced middle and low rectal cancer who got the treatment from April 2004 to April 2010 were analyzed retrospectively.40 patients got the preoperative long-course radiochemotherapy under the dose of DT 45-50 Gy/25 F,1.8-2.0 Gy/F,5 F/W,combining with the synchronous capecitabine chemotherapy (1 650 mg/m2,2 F/d,d1-14/d21-35),and accepted operation 4-6 weeks after the radiotherapy.The rest 24 patients underwent the preoperative short-course radiotherapy under the dose of DT 25 Gy/5 F,5 Gy/F,5 F/W,and got the operation in 2 weeks after the radiotherapy.Results The radical and anus reservation rates in preoperative long-course radiochemotherapy group [85.0 ％ (34/40),65.0 ％ (26/40)] were higher than those in preoperative short-course radiotherapy group [58.3 ％ (14/24),33.3 ％ (8/24)] (x2 =5.689,P =0.019;x2 =6.040,P =0.041).There were no significant differences between the two groups on the index of remission rates,radiation injury,surgical complications,and overall survival rate of 1,3,5 years (all P ＞ 0.05).Conclusions The remission rate and overall survival time between the preoperative long-course radiochemotherapy group and preoperative short-course radiotherapy have no significant difference.But the preoperative long-course radiochemotherapy may improve the anus reservation rate and the radical resection rate,without increasing the radiation injury and surgical complications.
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BACKGROUND: In vivo and in vitro experiments have demonstrated that polyetheretherketone (PEEK) polymer is the best cervical fusion cage material due to its good biocompatibility, elastic modulus similar to human bone, and satisfactory plasticity and hardness.OBJECTIVE: To assess the outcomes of polyetheretherketone (PEEK) cage filled with nano-artificial bone following anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylotic myelopathy.METHODS: In total 17 patients with cervical spondylotic myelopathy were collected from the Department of Orthopedics, First Affiliated Hospital of Harbin Medical University between May 2007 and September 2009. There were 12 males and 5 females,averaging 55 (range 42-67) years of age. All patients underwent ACDF using PEEK cage filled with nano-artificial bone. Patients'neurological functions were assessed on the basis of Japanese Orthopaedic Association (JOA) scoring system. The distance between the midpoint of the upper end plate and lower end plate was measured as interboby height. Radiographs with the neck in lateral flexion and extension were obtained to evaluate fusion results.RESULTS AND CONCLUSIONS: Seventeen patients with cervical spondylotic myelopathy participated in the final analysis.Almost all patients had symptomatic improvement. Within postoperative several days, muscle strength of lower limb was increased, and limb was more flexible after surgery than prior to surgery. At 3 months after surgery, JOA scores were significantly increased compared to prior to surgery, the operated segments were stable and disc space height was satisfactory. In addition, no complications were found, and all cases achieved solid fusion, as confirmed by radiographs. These findings suggest that the immediate stability of the operated segments can be obtained by anchoring PEEK cage, and the nano-artificial bone-filled PEEK cage is safe, simple, and with relatively few complications. It is therefore a good choice for patients with cervical spondylotic myelopathy.
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BACKGROUND: In the process of limb allograft, apoptosis of target cell is one of the main mechanisms of dysfunction of allograft, which might lead to the failure of allotransplantation. It is assumed that immunosuppressant may relate with cell apoptosis. OBJECTIVE: To investigate effects of FK506 on Bcl-2 mRNA and Bax mRNA expressions and cell apoptosis in rat limb allograft. DESIGN, TIME AND SETTING: The randomized controlled animal trial was performed at the Animal Experimental Center of First Hospital of Harbin Medical University from June 2005 to November 2006. MATERIALS: Fifty-six clean-grade healthy male SD recipient rats and 56 Wistar donor rats were selected. FK506 was product of Fujisawa, Japan (No. 100143G). METHODS: Right hind limb was separated from the upper segment of thigh of SD rat (donor), and washed using heparin saline. The recipient rates underwent limb allotransplantation from allogenetic Wistar to establish injury model. The recipients were randomly divided into two groups (n=28): immunosuppressant group was injected with FK506 1 mg/kg per day, and the control group was not given any immunosuppressant. The right hind limb including skin, subcutaneous tissues, muscles and femoral arteriolar-venular tissue mass were harvested on postoperative days 1, 3, 5, and 7. MAIN OUTCOME MEASURES: Bcl-2 Mrna and Bax mRNA expression were detected using reverse transcription polymerase chain reaction (RT-PCR), and cell apoptosis was detected using in situ terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate nick end labeling technique. RESULTS: Fifty-six model rats were included in final analysis. On the 3, 5, and 7 days after FK506 injection, Bcl-2 mRNA expression in immunosuppressant group was significantly higher than the control group (t=7.18-21.20, P
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Bone marrow mesenchymal stem cells(BMSCs) have the ability of multi-directional differentiation.In different environments,it can be induced into various blastodermic layer cells,such as osteoblast,chondrocyte and so on.Intervertebral disc degeneration(IDD) is mainly the change of nucleus pulposus cells and extracellular matrix.Nucleus pulposus cell is a chondrocyte-like cell.With the progress of cell bioengineering and molecular biology,the tissue engineering nucleus pulposus cells can be regenerated by BMSCs combined with cell carrier.It can be implanted into intervertebral disc to prevent and reverse IDD.It will be a new way for treating IDD.
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BACKGROUND: Limb allograft is a sort of composite tissues allotrans plantation(CTA), some researches showed that the apoptosis of target cell is one of the main mechanism of the dysfunction of allograft.OBJECTIVE: To investigate the characteristic of cell apoptosis in acute rejection of limb allograft in rats based on limb allograft model.DESIGN: A randomized controlled trial using the experimental animals as the objects.SETTING: Experimental animal center Laboratory of a hospital of a medical university MATERIALS: The experiment was done in the Experimental Animal Central Laboratory of the First Affiliated Hospital of Harbin Medical University from November 2003 to May 2004. Totally 56 healthy and male SD rats and 28 Wister rats were involved with body mass of 200 to 250 g. The rats were provided by the Experimental Animal Center of the First Affiliated Hospital of Harbin Medical University. They were randomly divided into two groups:transplantation group with 28 Wistar rats and 28 SD rats and control group with 28 SD rats.INTERVENTIONS: The transplantation group of SD rats underwent limb allotransplantation from allogenetic Wistar. The control group of SD rats underwent limb replantation. The expression of acute rejected in limb allografts was observed. The limb grafts were harvested atday 1, 3, 5 or 7 after transplantation. Histopathological rejection grade of each tissue rejection was performed with hematoxylin-eosin staining. Apoptotic cells were detected by TUNEL (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling) and apoptotic index(AI) was calculated.MAIN OUTCOME MEASURES: Primary results: ① istopathological grade of acute rejection in limb allografts ② The relationship between apoptosis and acute rejection in limb allograft in rats; Secondary results:General condition of rats in each group.RESULTS: The limb grafts showed edema and erythema and the skin became red at day(3.43 ±0.79) after transplantation. The average survival time was(7.42 ± 1.72) days. The acute rejection in skin was the strongest. On the day 3, 5 and 7 after operation, the histopathological rejection grades of skins in the transplantation group were(1.14±0.38) ,(2.28 ±0.48) and(2.86 ±0.38) grades respectively. They were significantly different from that of muscle and nerve( P ＜ 0.05 ) . The apoptotic cells in allografts were mainly infiltrating lymphocytes in subcutaneous tissues and then the muscle cells. All was positively correlated with acute rejection grade in limb allograft .CONCLUSION: Apoptosis was involved in acute rejection of limb allograft in rat. The apoptotic index can be used as a quantitative index to estimate the injury of grafts.