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Objective:To investigate the risk factors for 1-year survival rate in patients with spinal metastasis secondary to lung cancer.Methods:The data of 343 patients with spinal metastases secondary to lung cancer from January 2011 to December 2018 were retrospectively studied. There were 188 males (54.8%) and 155 females (45.2%) with an average age of 59.47±10.21 years old (range 23-91 years). The patients were divided into operation group (150 cases, 43.7%) and non operation group (193 cases, 56.3%). The demographics, types of primary tumor, non spinal metastasis, visceral metastasis, spinal metastasis and segments, pathological fractures of vertebra, Frankel classification, physical function status (Karnofsky performance scale, KPS), visual analogue score (VAS), the spinal instability neoplastic score (SINS) were recorded and analyzed. The impact of different treatments on the survival prognosis of patients with spinal metastasis was evaluated. The independent factors affecting survival in those patients were analyzed by Cox proportional hazards regression model.Results:The peak incidence of spinal metastases was found in the age group of 46-60 years (43.7%, 150/343). 38.5% (132/343) of the patients had pathological fractures of the involved vertebral body. 58.3% (200/343) of the patients had extraspinal bone metastasis. 36.2% (124/343) of the patients had visceral metastasis. Among the primary tumors, adenocarcinoma was the most common tpye (61.5%, 211/343), followed by large cell lung cancer (12.5%, 43/343), small cell lung cancer (6.4%, 22/343), squamous cell cancer (6.1%, 21/343) and mixed cell lung cancer (5.3%, 18/343). The type of lung cancer cells in about 8.2 (28/343) patients was unknown. Among the surgical patients, 21 patients underwent minimally invasive surgery (14.0%), 28 patients underwent simple decompression surgery (18.7%), 76 patients underwent separation surgery (50.7%), and 25 patients underwent radical surgery (16.6%). 59.3% (89/150) of the patients had a better neurological function than before surgery. The average survival time of all patients was 9.88 months with the median survival time of 8 (5,14) months. The survival rates were 62.1% (213/343), 30.0% (103/343), and 3.8% (13/343) at 6, 12, and 24 months, respectively. The average survival time of patients in the operation group was 10.24 months with the median survival time of 9 (5, 15) months, and the average survival time of patients in the non operation group was 9.41 months with the median survival time of 7 (5, 13) months with no significant difference between the groups (χ 2=0.300, P=0.584). Multivariate Cox proportional hazard regression model analysis showed that radiotherapy [ HR=1.913, 95% CI(1.471, 2.488), P<0.001], chemotherapy [ HR=1.313, 95% CI(1.040, 1.658), P=0.022], targeted drug therapy [ HR=1.683, 95% CI(1.221, 2.319), P=0.001], KPS [ HR=1.593, 95% CI(1.140, 2.225), P=0.006] and pathological type (non-small cell lung cancer) were independent factors affecting the 1-year survival rate of patients with spinal metastasis secondary to lung cancer [ HR=0.322, 95% CI(0.225, 0.460), P<0.001] with significant difference. Conclusion:Surgical treatment can improve both the neurological function and general status of patients with spinal metastasis. Treatments of radiotherapy, chemotherapy, and targeted drug therapy can significantly improve 1-year survival rate, while a KPS less than 50 points and a primary lung cancer other than adenocarcinoma were independent risk factors reducing 1-year survival rate.
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Objective To analyze the characteristics of hepatitis B infection time in Baqiao Distract of Xian City, predict the incidence trend of hepatitis B in the next years with ARIMA model, and provide theoretical guidance for the adjustment of hepatitis B prevention and control strategies. Methods A total of 7173 cases of hepatitis B in our hospital from 2018 to 2023 were collected as subjects,the annual percentage of change (APC) was used to analyze the characteristics of time of hepatitis B infection in the next years, and the ARIMA optimal model was used to predict the incidence rate in 2024. Results The gross incidence of hepatitis B in Baqiao Distract of Xian City from 2018 to 2023 was 51.30 per 100 000, and the standardized incidence rate was 42.11 per 100 000. The six-year incidence rate showed an upward trend (APC=8.71%,95% CI：3.29% -9.61% , P<0.05). Chi square results showed that the standardized incidence rate of hepatitis B in men is 1.51 times than women, and the incidence rate of hepatitis B in the 30-45 age group was the highest. The prediction results showed that the number of hepatitis B cases in 2024 was 1590, which was 1.91% lower than that in 2023 (1621 cases). Conclusion The infection of hepatitis B is on the rise in Baqiao Distract of Xian City, ARIMA can be used to predict this kind of infectious disease and provide scientific guidance for the prevention of this disease.
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Objective To perform finite element analysis on a novel motion mode hinged knee prosthesis, and investigate the method of wear simulation on hinged prosthesis and the influence of motion mode on wear of the prosthesis. Methods Based on the finite element model of contact stress on spherical axis prosthesis, the finite element model of wear was established according to Archard wear theory. The kinematics data during different motions were input as loading condition to simulate mechanical environment of the knee arthroplasty in physiological activities. The wear results of spherical axis prosthesis were studied. Results For tibial insert, the average and maximum contact stresses during upstairs and downstairs climbing were higher than those during walking, and the cumulative wear volume during upstairs climbing was larger than that during downstairs climbing and walking. The wear mainly occurred on lower surface of tibial insert during all 3 motions. For rotating bushing, there was only a short period of contact and wear during walking, and the cumulative wear was 0. 19 mm3. Conclusions The spherical axis motion of hinged knee prosthesis can improve the mechanical environment of knee, reduce the wear of rotating bushing, and prolong the prosthesis survival. The finite element simulation can predict the wear of hinged prosthesis effectively, and provide the theoretical basis for design and improvement of the prosthesis.
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Objective:To explore the relationship between the occurrence and development of colorectal cancer and the risk of BRCA1 and BRCA2 gene mutations. Methods:Sixty-one patients with colorectal adenocarcinoma admitted to Beijing Friendship Hospital Affiliated to Capital Medical University from January 2022 to March 2022 were tested by second-generation sequencing. Information such as age of onset, gender, histological grade and TNM stage were collected. According to whether the BRCA1 and BRCA2 gene had systemic mutation, the patients were divided into BRCA1 and BRCA2 gene system mutation group and unmutated group. There were 8 cases in the BRCA1 and BRCA2 gene system mutant group and 53 cases in the non-mutant group. The main outcome measures were the relationship between pathogenic or likely pathogenic germline mutations in colorectal cancer and clinicopathological data of patients, including age of onset, gender, tumor location, TNM stage, histological differentiation, and family history. The secondary outcome was the relationship between BRCA1 and BRCA2 gene system mutations and clinicopathological data. Measurement data with normal distribution were expressed as mean±standard deviation ( ± s), and comparison between groups was analyzed using the t-test. Measurement data with non-normal distribution were represented as M ( Q1, Q3), and comparison between groups was analyzed using the Mann-Whitney U test. Measurement data were expressed as the number of cases or percentage (%), and Chi-square test was used for comparison between groups. Results:Among 61 colorectal adenocarcinoma patients, the frequency of pathogenic or potentially pathogenic germ line mutations in colorectal cancer was 13.1% (8/61), and the frequency of BRCA1 and BRCA2 mutations was 3.3% (2/61). The frequency of BRCA1 and BRCA2 mutations was 13.1% (8/61). Women with BRCA1 and BRCA2 mutations (75.0% vs 37.7%, χ2=3.947, P=0.047) and right colon cancer (75.0% vs 26.4%, χ2=7.889, P=0.019) were significantly higher than those without mutation. Conclusions:The frequency of BRCA1 and BRCA2 gene mutation is higher in colorectal cancer patients. BRCA1 and BRCA2 gene mutations are recommended for colorectal cancer patients with a family history of breast or ovarian cancer.
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Objective:To investigate the association between cancer fatalism and optimistic attitudes among colorectal cancer patients, and how the above linkage is moderated by the involvement of patients′ opinions, the family members′ opinions and the physicians′ opinions in treatment decision-making.Methods:A cross-sectional survey was conducted on 64 patients diagnosed with colorectal cancer and awaiting radical colorectal cancer surgery in the Department of General Surgery of Beijing Friendship Hospital Affiliated to Capital Medical University, from January 2021 to December 2021. There were 38 males and 26 females, aged (61.2±13.0) years from 30 to 84 years. Cancer fatalism, optimism attitudes, and the involvement of patients′ opinions, the family members′ opinions and the physicians′ opinions in treatment decision-making were assessed. The patients′ cancer fatalism beliefs were measured by the " Chance" subscale of the Form C of the Multidimensional Health Locus of Control (MHLC-C), optimism attitudes were assessed by the Chinese version of the revised Life Orientation Test (CLOT-R), and the influence of patients′, family members′, and physicians′ opinions in the medical decision-making process was measured by a self-designed single factor scale. Measurement data of normal distribution were expressed as mean±standard deviation ( ± s). Measurement data of skewed distribution were expressed as M( Q1, Q3). Spearman correlation analysis and Chi-square test was used to examine the association between the main outcome variable (patients′ optimistic attitudes) and demographic and clinical characteristics. Interaction was examined by hierarchical linear regression analysis combined with simple slope tests. Results:Cancer fatalism was negatively associated with patients′ optimistic attitudes ( r=-0.35, P<0.01). Optimistic attitude of patients was significantly and negatively correlated with the influence of family members′ opinions on medical decision-making ( r=-0.25, P<0.05). There were significant positive correlations between the influence of patients′ and family members′ opinions ( r=0.50, P<0.01), family members′ and physicians′ opinions ( r=0.67, P<0.01), and physicians′ and patients′ opinions ( r=0.38, P<0.01) in medical decision making. Hierarchical linear regression analysis showed a negative association between cancer fatalism and optimism ( β=-0.32, P=0.01). This association was further moderated by the involvement of family members′ opinions ( β=-0.56, P<0.01) and the involvement of physicians′ opinions ( β=-0.36, P=0.04) in medical decision-making. Simple slope tests revealed that the negative impact of fatalistic attitudes on patients′ optimism attitudes may be potentiated when family members′ opinions have high influence on medical decision-making, while the negative impact may be buffered to some extent when physicians′ opinions have high influence on medical decision-making. Conclusions:Cancer fatalism had a negative effect on patients′ optimism. The high influence of physicians in treatment decision-making buffered the negative effect of cancer fatalism on optimism; the high influence of family members in treatment decision-making potentiated the negative effect of cancer fatalism on optimism. In the process of doctor-patient communication and shared decision-making, for patients with strong fatalistic attitudes, consideration should be given to appropriately increasing direct informational communication between physicians and patients and reducing excessive family intervention in medical decision-making, so as to enhance patients′ autonomy for treatment, promote optimism, and reduce the negative effects of cancer fatalism.
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Objective:To analyze the incidence of gallstone formation after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) by meta-analysis.Methods:English terms for this meta-analysis included "bariatric surgery, gastric bypass, Roux-n-Y gastric bypass, RYGB, sleeve gastrectomy, SG, cholelithiasis, cholecystectomy, gallstone". Researched articles in Pubmed, Medline and Embase databases were searched up to February 2023 and retrieved for further analysis. The quality of each article was evaluated with Newcastle-Ottawa Scale (NOS). Generated data were analyzed with Revman 5.4.Results:Nine relevant cohort studies were retrieved for this meta-analysis, including a total of 24 255 RYGB patients and 4 500 SG patients. All articles met the requirements after the quality evaluation of NOS. The meta-analysis results showed that the incidence of postoperative gallstones in RYGB group was higher than that in SG group ( P<0.001). In subgroup analysis, by administering ursodeoxycholic acid (UDCA) for gallstone prevention, the incidence had no difference between the two groups ( P=0.090), while in the study without UDCA, the incidence of gallstones after RYGB was higher than SG ( P=0.005). In the studies with follow-up time no more than 24 months, the incidence of postoperative gallstones in RYGB group was higher than that in SG group ( P=0.050), but there was no statistical difference when following-up beyond 24 months ( P=0.240). Conclusions:Within 2 years after surgery, RYGB patients have more chances to develop gallstones than SG patients. However, beyond 2-year follow-up, there is no difference between the two procedures. Prophylactical utilization of UDCA after RYGB can effectively reduce the incidence of gallstone formation.
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Objective:To investigate the feasibility and early clinical efficacy of spherical motion axis hinge knee prosthesis to reconstruct distal femoral bone defects.Methods:A retrospective analysis was performed on 16 patients admitted to PLA 960th Hospital and Tianjin Hospital from October 2019 to November 2021, including 8 males and 8 females, with an average age of 43.3±17.8 years (range, 15-71 years). There were 13 patients of primary tumors of the distal femur and 3 patients of postoperative revision of knee joint prostheses. Among the 13 patients with distal femur tumors, there were 6 cases of osteosarcoma, 5 cases of giant cell tumor of bone, 1 case of leiomyosarcoma and 1 case of chondrosarcoma. The reasons for revision after prosthesis replacement in 3 cases were: 2 cases of aseptic loosening after tumor-type prosthesis and 1 case of periphery fracture of surface artificial knee prosthesis. A spherical shaft rotary hinged knee prosthesis was designed and fabricated to reconstruct postoperative femoral defects in 16 patients. Follow up regularly after the operation, recheck the X-ray film to evaluate the lower limb force line, evaluate the quality of life after the operation with the Chinese version of 36-item short-form (SF-36), and evaluate the postoperative limb function with the Musculoskeletal Tumor Society (MSTS) 93 evaluation system.Results:All 16 patients were successfully placed with prostheses, and except for 2 patients undergoing total femoral replacement, the length of bone defects was 18.2±11.7 cm (range, 8.6-47.1 cm) in other 14 patients, and the operation time was 138±19 min (range, 110-170 min), the intraoperative blood loss was 211±118 ml (range, 100-500 ml). The postoperative full length orthostatic X-ray film of the lower limbs showed that the distance between the mechanical axis of the lower limb and the center of the knee joint was 0.1 (0, 0.7) cm in 16 patients, and the hip-knee ankle angle was 179.0°±2.3°(range, 173.3°-182.2°). The patients were followed up for 12-36 months. No prosthesis complications were found in 16 patients. The SF-36 score was 56.7±7.0 (range, 42.7-67.4) for physiological function and 54.1±7.6 (range, 40.5-66.3) for psychological function. The maximum knee flexion angle was 120.0°±15.6° (range, 95°-130°). The MSTS 93 score of 15 patients with tumor was 25.0±1.7 (range, 22-28), including 7 excellent and 8 good. One patient developed liver and lung metastases 10 months after surgery and died 18 months after surgery. The remaining patients, as of the last follow-up, were alive and had no local recurrence or distant metastases. Tumor-free survival time was 25.8±8.4 months (range, 12-36 months).Conclusion:The spherical motion axis hinge knee prosthesis reconstruction for distal femoral bone defects is simple and fast in intraoperative prosthesis installation, and there are no prosthetic related complications during short-term follow-up. The clinical efficacy is satisfactory.
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AIM: To investigate the effect of autophagy on cell ferroptosis in intestinal ischemia-reperfusion injury. METHODS: Twenty-four SPF grade Wistar rats weighing 200-220 g were divided into 4 groups (n = 6): sham operation group (sham group), ischemia group (I group), ischemia-reperfusion group (I/R group),and ischemia-reperfusion + autophagy inhibitor group (I/R + 3-MA group). The ischemia model was established by clamping the superior mesenteric artery for 1 hour, and the intestinal ischemia-reperfusion injury model was established by reperfusion for 2 hours. HE staining was used to observe the pathological changes of intestinal mucosa and Chiu score under light microscope. Fe
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Bone defects caused by trauma, infection, tumor and other factors is a thorny problem in orthopedic clinic, and promoting bone repair and regeneration is the key and difficult point of treatment. In addition to autologous bone grafting, artificial bone materials are often used for large bone defects. β-tricalcium phosphate has good biocompatibility, bone conduction and bone induction properties, and has been studied deeply because of its excellent drug delivery performance and has shown broad application prospects. In this paper, the author will summarize the research progress of β-tricalcium phosphate composites loaded with different drugs in the treatment of bone defects caused by trauma, infection and tumor.
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Objective:To evaluate the clinical value of the New England spinal metastasis score (NESMS) in predicting the prognosis of patients with spinal metastases by retrospectively analyzing the medical records of multicenter spinal metastases in China.Methods:The data of 179 patients with spinal metastases from January 2008 to December 2018 were retrospectively collected. There were 108 males (60.3%) and 71 females (39.7%) with an average age of 59.79±10.88 years old (range 27-84 years). The patient demographic characteristics, primary tumor type, spinal metastases and segments, vertebral pathological fractures, neurological Frankel classification, physical function status, Karnofsky performance scale (KPS), visual analogue score (VAS), the spinal instability neoplastic score (SINS), modified Bauer score, NESMS score, Tomita score and modified Tokuhashi score were collected. The clinical value of NESMS score, Tomita score and modified Tokuhashi score in predicting the survival of patients with spinal metastases were compared. The independent factors affecting survival in these patients were analyzed by Cox proportional hazards regression model.Results:Among the 179 patients, the peak incidence of spinal metastases was in the age group of 61-75 years (45.3%, 81/179) of all patients. Lung cancer was the most common primary tumor (46.9%, 84/179). 40.8% (73/179) of patients had multi-segment metastasisand thoracic spine was the most common site with single-site metastasis (26.3%, 47/179). 28.5% (51/179) of the patients had visceral metastases and 52.0% (93/179) of the patients had extraspinal bone metastases. 31.3% (56/179) of the patients had pathological fractures of the involved vertebral bodies.114 patients received surgical treatment (63.4%). The mortality rates in 3-months, 6-months and 1-year were 22.4% (40/179), 51.4% (92/179) and 77.1% (138/179), respectively. The median survival time of patients with NESMS score of 0-3 was 3, 4, 8, and 10 months respectively with the mean survival time was 3.60±2.10, 6.77±3.39, 9.69±5.71 and 10.53±6.25 months. The 1-year mortality rates were 100% (13/13), 87.5% (42/48), 71.6% (63/88) and 66.7% (20/30) respectively. The consistency of NESMS score, Tomita score and modified Tokuhashi score in predicting survival of all patients was 0.63, 0.58 and 0.55, respectively. For patients with spinal metastases, the NESMS score was better than the Tomita score and modified Tokuhashi score in predicting survival at 3-months (AUC=1.00, 0.63, 0.42) and 6-months (AUC=0.71, 0.63, 0.45). But the accuracy of Tomita score was best in predicting survival at 1-year (AUC=0.66, 0.61, 0.38). Multivariate Cox proportional hazards regression model analysis showed that growth rate of primary tumor, neurological function Frankel score, albumin level and surgical treatment were independent factors affecting the survival time of patients with spinal metastases ( P<0.05). Conclusion:The consistency and accuracy of NESMS score in predicting survival of patients with spinal metastases are better than Tomita score and modified Tokuhashi score, especially in predicting 3- and 6-month survival. The growth rate of primary tumor, Frankel classification, albumin level and surgical treatment were independent factors affecting the survival time of patients with spinal metastases.
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Objective:To summarize the technical points of microwave ablation for inactivating the preserved bone in situ combined with hip prosthesis for proximal femoral malignancy and analyze its clinical efficacy.Methods:A total of 28 patients with proximal femoral malignancy who were treated in Tianjin Hospital from January 2018 to December 2021 were included in the study. There were 12 males and 16 females, aged 65.3±10.9 years (range 39-85 years); 26 metastatic bone tumors and 2 patients with proximal femoral primary tumors accompanying marrow cavity jumping focus in the study. According to whether the tumor bone mass was preserved in situ during microwave ablation, the patients were divided into the bone mass preservation group (18 cases) and conventional surgery group (10 cases). In the bone mass preservation group, according to the evaluation of preoperative CT and MRI, part of the tumor bone was preserved in situ and hip arthroplasty was performed after microwave inactivation. In the conventional surgery group, total resection of the tumor and microwave inactivation were performed firstly, and then hip prosthesis replacement was performed. Clinical efficacy was evaluated by comparing the length of osteotomy, the postoperative prosthesis stability and Musculoskeletal Tumor Society (MSTS) score.Results:The follow-up time of 28 patients was 11.9±5.9 months (range 4 to 24 months). The intraoperative length of osteotomy was 9.2±2.5 cm in the bone mass preservation group and the intraoperative length of osteotomy was 15.4±3.6 cm in the conventional surgery group, and the difference between the two groups was statistically significant ( t=5.40, P=0.002). There were 5 common hip prosthesises and 13 modular hip prosthesises in the bone mass preservation group. In 2 patients with common prosthesis, X-ray showed partial bone resorption at the osteotomy interface 3 and 8 months after operation, no loosening or fracture at the prosthesis-bone interface, and no pain or limitation of walking. There were 10 modular hip prosthesises in the conventional surgery group, with one patient suffered pain while walking at 19 months after surgery, and the X-ray suggested loosening between the prosthesis-bone interface. MSTS score of bone mass preservation group at 3 months post-operation was 16.6±1.9 points, including good 6 cases and moderate 12 case, and the excellent and good rate was 33%, meanwhile MSTS score of conventional surgery group was 15.5±3.6 points, including good 3 cases, moderate 5 cases and poor 2 cases, and the excellent and good rate was 30% at 3 months post-operation, and the difference between the two groups was not statistically significant ( t=0.94, P=0.366). MSTS score of bone mass preservation group at 6 months post-operation was 21.7±3.2 points, including excellent 3 cases, good 9 cases, moderate 1 case and poor 1 case, and the excellent and good rate was 86% (12/14), meanwhile MSTS score of conventional surgery group at 6 months post-operation was 16.5±4.9 points, including excellent 1 case, good 3 cases, moderate 3 cases and poor 2 cases, and the excellent and good rate was 44% at 6 months post-operation, and the difference between the two groups was statistically significant ( t=3.03, P=0.006). MSTS score of bone mass preservation group at 12 months post-operation was 22.3±7.6 points, including excellent 8 cases, good 2 cases, moderate 1 case and poor 1 case, and the excellent and good rate was 83% (10/12), meanwhile conventional surgery group at 12 months post-operation was 22.1±6.6 points, including excellent 3 case, good 3 cases, moderate 1 cases and poor 1 cases, and the excellent and good rate was 75%(6/8), and the difference was not statistically significant ( t=0.06, P=0.957). The MSTS scores of 6 months after operation, including movement function, acceptance degree, brace assistance and walking ability, were significantly improved in the bone mass preservation group compared with the conventional surgery group, and the differences were statistically significant ( t=2.33, P=0.030; t=2.74, P=0.012; t=2.80, P=0.011; t=2.59, P=0.026). Conclusion:Preserved bone mass in situ inactivated by microwave ablation combined with tumor hip prosthesis is an alternative surgical method for the treatment of proximal femoral malignancy, which can increase the stability of the prosthesis, facilitate the biological reconstruction of soft tissues and early functional recovery.
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Objective:To explore the reasons for revision of tumor prosthesis of knee joint and summarize the experience of revision surgery.Methods:We conducted a retrospective study of 33 patients who underwent revision surgery for tumor prosthesis of knee joint in Tianjin Hospital and the 960th Hospital of the People's Liberation Army Hospital from June 2004 to June 2018. There were 25 male and 8 female patients, the mean age was 45±13.1 years (range 19-64 years) at the time of revision. Histological diagnosis was giant cell tumor in 17 patients, osteosarcoma in 9 patients, malignant fibrous histiocytoma in 3 patients and one for each of chondrosarcoma, peripheral schwannoma, ligamentoid fibroma and bone metastases. The reasons for revision were aseptic loosening in 23 cases, dislocation, stem breakage and periprosthetic fracture in 2 cases, infection in 3 cases, and local recurrence in 1 case. The general outcome, oncological outcome, reasons for prosthesis revision, postoperative limb function, and complications were summarized.Results:The median follow-up of the 33 patients was 48.0 (24.0, 107.0) months. The most common reason for revision was aseptic loosening (88%, 29/33), followed by infection (9%, 3/33) and local recurrence (3%, 1/33). The MSTS of 32 patients with survival more than 1 year was 24.28±4.74 points (range 9-30 points), which was statistically different from preoperative 11.78±5.23 points (range 4-21 points) ( t=10.02, P<0.001). The postoperative median TESS score of 32 patients with survival more than 1 year was 86.67(80.00, 91.67) points, and the preoperative median score was 56.0(43.17, 65.33) points, which was statistically significant ( Z=6.78, P<0.001). Postoperative complications occurred in 12 patients, most commonly mechanical problems (15%, 5/33) and infection (15%, 5/33), followed by local recurrence (6%, 2/33), with an overall complication rate of 36% (12/33). Conclusion:The main reason for revision of tumor prosthesis of knee joint is aseptic loosening. Revision surgery can achieve ideal postoperative function and should be the first choice for failure of prosthesis after initial replacement.
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Objective:To explore the clinical features and treatment efficiencies of pediatric giant posterior fossa tumors.Methods:A retrospective analysis was performed. The clinical data of 18 children with giant posterior fossa tumors, whose maximum diameter of any section was over 5 cm, admitted to our hospital from January 2015 to June 2020, were collected. The surgical treatment results were analyzed.Results:The tumor volume of 18 children was (63.9±20.7) mL (33.2-116.2 mL). Sixteen children had different degrees of preoperative obstructive hydrocephalus; ommaya capsule implantation was performed in 2, ventriculoperitoneal shunt was performed in one, and external ventricular drainage was performed in one before surgery; intraoperative external ventricle drainage was performed in 5; and the left 7 had postoperative self-healing. Tumor resection was performed in 17 children, including 10 with total resection and 7 with subtotal resection. The postoperative pathological results indicated medulloblastoma in 10 patients, ependymoma in 3 patients, pilocytic astrocytoma in 2 patients, oligodendroglioma in 1 patient, and yolk sac tumor in 1 patient;12 patients were treated with chemotherapy and 9 with radiotherapy. Postoperative persistent hydrocephalus was noted in 2 patients, cerebellar mutism in 2 patients, and subarachnoid hemorrhage combined with ventricular hematocele in 1 patient. The follow-up period ranged from 3 to 67 months: 13 children survived for more than one year (10 lived without tumor recurrence); 8 of the 10 patients with total tumor resection had progression-free survival for more than 1 year (the other 2 patients were lost of follow-up), while 3 of the 7 patients with subtotal resection had progression-free survival for more than 1 year.Conclusion:Pediatric giant posterior fossa tumors have high complication rate, high recurrence rate and poor prognosis; symptomatic treatment, total resection of the tumors, and adjuvant radiotherapy/ chemotherapy are effective treatment methods.
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Traumatic brain injury（TBI）in combination with its sequelae is currently a public health problem that seriously endangers human health. Accumulating studies have deeply investigated the pathological processes of TBI to find possible therapeutic targets. In recent years，the relationship between TBI pathogenesis and gut-brain axis changes in aspects of microflora，metabolites，inflammatory factors and neurohumoral changes has drawn widespread attention，which not only provides a better understanding how TBI affects gut-brain axis，but also provides new therapeutic targets in improving cure rate and recovery level after TBI. However，due to the existence of complicated gut-brain axis self-regulation as well as the individual differences of TBI patients，the recognition and transformation for the latest experimental research are largely limited. In this review，the authors summarize how TBI event influences gut-brain axis balance，as well as how gut-brain axis regulates TBI pathogenesis mutually，so as to provide a better understanding of the interaction between gut-brain axis and TBI.
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Objective:To compare the safety and therapeutic effect of bridging therapy versus direct endovascular treatment in patients with acute ischemic stroke(AIS)aged 80 years and over, who received the therapy within 4.5 h of onset.Methods:A total of 89 AIS patients aged 80 years and over receiving the endovascular therapy at our hospital from January 2016 to June 2019 were studied with versus without intravenous thrombolysis before endovascular therapy(the former as bridging therapy group, n=49; the latter as the direct endovascular treatment group, n=40). Baseline information including gender, the modified Rankin scale(mRS)score, medical history, smoking history, preoperative national institute of health stroke scale(NIHSS)score were collected.Clinical data related to the operation including the times from onset to hospital, door-to-puncture and door-to-recanalization, complications(symptomatic cerebral hemorrhage, mortality)and mRS at 90 d after treatment were compared between the two groups.Multiple logistic regression analysis was used to determine whether or not bridging therapy with intravenous thrombolysis was a prognostic factor.Results:There was no significant difference in baseline information between the two groups( P>0.05). The times from onset to hospital, door-to-puncture, door-to-recanalization had no significant difference between the two groups( P>0.05). There was no significant difference in the incidence of symptomatic cerebral hemorrhage and mortality within 90 d between the two groups(26.5% or 13 cases vs. 17.5% or 7 cases, 14.3% or 7 cases vs.7.5% or 3 cases, χ2=1.031 and 1.017, P=0.310 and 0.313). With different clinical outcomes as dependent variables, after adjusting factors such as gender, admission NIHSS and medical history, Logistic regression analysis showed that the bridging therapy with intravenous thrombolysis was not a prognostic factor( OR=0.795, 95% CI: 0.280~2.258, P=0.666). Conclusions:The bridging therapy is as safe and effective as the direct intravascular therapy for AIS patients aged 80 and over within 4.5 hours of onset.The intravenous thrombolysis should be given as soon as possible within time window.
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Objective:To evaluate the effect of astaxanthin on neuropathic pain in rats and the role of spinal heme oxygenase-1 (HO-1).Methods:Seventy-two SPF-grade healthy adult male Sprague-Dawley rats, weighing 200-250 g, in which intrathecal catheters were successfully implanted, were divided into 6 groups ( n=12 each) by a random number table method: blank control group (group C), sham operation group (Sham group), neuropathic pain (NP) group, NP plus dimethyl sulfoxide (DMSO) group (NP + DMSO group), NP plus astaxanthin group (NP + AST group) and NP plus zinc protoporphyrin plus astaxanthin group (NP+ ZnPP+ AST group). NP was induced by chronic constriction injury in anesthetized rats.In Sham group, the sciatic nerve was only isolated without ligation.At 5 days after establishing the model, 0.5% DMSO 10 μl was intrathecally injected in NP+ DMSO group, astaxanthin 1 μg (dissolved in 10 μl DMSO) was intrathecally injected in NP+ AST group, HO-1 inhibitor zinc protoporphyrin 24 μg (dissolved in 10 μl DMSO) was intrathecally injected, and 3 h later astaxanthin 1 μg (dissolved in 10 μl DMSO) was intrathecally injected in NP+ ZnPP+ AST group.Injection was given once a day for 10 consecutive days in the 3 groups mentioned above.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before establishing the model and 3, 7 and 14 days after establishing the model.The rats were sacrificed at 14 days after establishing the model, and the L 4-6 lumbar segments of the spinal cord were removed for determination of the contents of tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β), superoxide dismutase (SOD) and glutathione peroxidase (GHS-PX)(by enzyme-linked immunosorbent assay) and expression of HO-1 (by Western blot). Results:Compared with group C and group Sham, the MWT was significantly decreased and TWL was shortened at each time point after establishing the model, the contents of TNF-α and IL-1β were increased, and the expression of HO-1 was up-regulated in the other four groups, the SOD and GSH-PX contents were significantly decreased in NP group, NP+ DMSO group and NP+ ZnPP+ AST group, and the SOD and GSH-PX contents were significantly increased in NP+ AST group ( P<0.05). Compared with NP group, the MWT was significantly increased and TWL was prolonged at 7 and 14 days after establishing the model, the contents of TNF-α and IL-1β were decreased, and the expression of HO-1 was up-regulated in NP+ AST group, the expression of HO-1 was down-regulated in NP+ ZnPP+ AST group ( P<0.05), and no significant change was found in the parameters mentioned above in NP+ DMSO group ( P>0.05). Compared with NP+ AST group, the MWT was significantly decreased and TWL was shortened at 7 and 14 days after establishing the model, the contents of SOD and GSH-PX were decreased, the contents of TNF-α and IL-1β were increased, and the expression of HO-1 was down-regulated in NP+ ZnPP+ AST group ( P<0.05). Conclusion:Astaxanthin can reduce NP in rats, and the mechanism is related to up-regulating the expression of HO-1 in the spinal cord and inhibiting oxidative stress and inflammatory responses.
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Objective:To construct and confirm a predictive model for the risks of cardiovascular diseases (CVD) with metabolic syndrome (MS) and its factors in Xinjiang Kazakh population.Methods:A total of 2 286 Kazakh individuals were followed for 5 years from 2010 to 2012 as baseline survey. They were recruited in Xinyuan county, Yili city, Xinjiang. CVD cases were identified via medical records of the local hospitals in 2013, 2016 and 2017, respectively. Factor analysis was performed on 706 MS patients at baseline, and main factors, age, and sex were extracted from 18 medical examination indexs to construct a predictive model of CVD risk. After excluding the subjects with CVD at baseline and incomplete data, 2007 were used as internal validation, and 219 Kazakhs in Halabra Township were used as external validation. Logistic regression discriminations were used for internal validation and external validation, as well as to calculate the probability of CVD for each participant and receiver operating characteristic curves.Results:The prevalence of MS in Kazakh was 30.88%. Seven main factors were extracted from the Kazakh MS population, namely obesity factor, blood lipid and blood glucose factor, liver function factor, blood lipid factor, renal metabolic factor, blood pressure factor, and liver enzyme factor. The area under the curve (AUC) for predicting CVD in the internal validation was 0.773 (95% CI 0.754-0.792). In the external validation, the AUC for predicting CVD was 0.858 (95% CI 0.805-0.901). Conclusions:The CVD risk prediction model constructed by 7 main factors extracted from Kazakh MS patients has high validation efficiency and can be used for risk assessment of CVD in Xinjiang Kazakh population.
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Objective@#To construct and confirm a predictive model for the risks of cardiovascular diseases (CVD) with metabolic syndrome (MS) and its factors in Xinjiang Kazakh population.@*Methods@#A total of 2 286 Kazakh individuals were followed for 5 years from 2010 to 2012 as baseline survey. They were recruited in Xinyuan county, Yili city, Xinjiang. CVD cases were identified via medical records of the local hospitals in 2013, 2016 and 2017, respectively. Factor analysis was performed on 706 MS patients at baseline, and main factors, age, and sex were extracted from 18 medical examination indexs to construct a predictive model of CVD risk. After excluding the subjects with CVD at baseline and incomplete data, 2007 were used as internal validation, and 219 Kazakhs in Halabra Township were used as external validation. Logistic regression discriminations were used for internal validation and external validation, as well as to calculate the probability of CVD for each participant and receiver operating characteristic curves.@*Results@#The prevalence of MS in Kazakh was 30.88%. Seven main factors were extracted from the Kazakh MS population, namely obesity factor, blood lipid and blood glucose factor, liver function factor, blood lipid factor, renal metabolic factor, blood pressure factor, and liver enzyme factor. The area under the curve (AUC) for predicting CVD in the internal validation was 0.773 (95%CI 0.754-0.792). In the external validation, the AUC for predicting CVD was 0.858 (95%CI 0.805-0.901).@*Conclusions@#The CVD risk prediction model constructed by 7 main factors extracted from Kazakh MS patients has high validation efficiency and can be used for risk assessment of CVD in Xinjiang Kazakh population.
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Objective@#To compare metabolic syndrome(MS)with Framingham risk score as predictors of cardiovascular disease(CVD)among Kazakhs population.@*Methods@#The participants were the residents who had been followed up for more than 5 years in representative areas of Kazakhs in Xinjiang. We assigned MS a continuous risk score for predicting the development of CVD based on the weights of MS components. MS and Framingham risk score were compared in terms of their ability in predicting years in representative areas of Kazakhs in Xinjiang. We assigned MS a continuous risk score for predicting the development of CVD based on the weights of MS components. MS and Framingham risk score were compared in terms of their ability in predicting development of CVD using Cox regression and receiver operating characteristic curve.@*Results@#The incidence of CVD was 13.87%. The incidence of CVD was higher in the MS group than it in the non-MS group(21.59% vs 11.10%, P<0.001). The area under the receiver operating characteristic(ROC)curve of MS risk score was significantly larger than that of MS classification(0.727 vs 0.585, P<0.001); the area under the curve of MS risk score was close to that of Framingham risk score(0.732 vs 0.727, P=0.673). The association between CVD and each quintile of MS risk score was more significant than that between Framingham risk score and CVD under the same exposed condition(4.61, 9.33, 14.15, 22.29 vs 3.69, 6.36, 8.47, 16.99).@*Conclusion@#MS risk score that included age may be a better predictor of CVD among Kazakhs population.
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Objective To compare metabolic syndrome(MS)with Framingham risk score as predictors of cardiovascular disease( CVD) among Kazakhs. Methods The participants were the residents who had been followed up for more than 5 years in representative areas of Kazakhs in Xinjiang. We assigned MS a continuous risk score for predicting the development of CVD based on the weights of MS components. MS and Framingham risk score were compared in terms of their ability in predicting years in representative areas of Kazakhs in Xinjiang. We assigned MS a continuous risk score for predicting the development of CVD based on the weights of MS components. MS and Framingham risk score were compared in terms of their ability in predicting development of CVD using Cox regression and receiver operating characteristic curve. Results The incidence of CVD was 13.87％. The incidence of CVD was higher in the MS group than it in the non-MS group(21.59％ vs 11.10％, P<0.001). The area under the receiver operating characteristic(ROC)curve of MS risk score was significantly larger than that of MS classification(0.727 vs 0.585, P<0.001);the area under the curve of MS risk score was close to that of Framingham risk score ( 0. 732 vs 0.727, P=0.673). The association between CVD and each quintile of MS risk score was more significant than that between Framingham risk score and CVD under the same exposed condition(4.61、9.33、14.15、22.29对3.69、6.36、8.47、16.99) . Conclusion MS risk score that included age may be a better predictor of CVD among Kazakhs.