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1.
Thorac Cancer ; 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31828980

RESUMO

BACKGROUND: The impact of adjuvant treatment for esophageal carcinoma with tumor-negative lymph nodes after upfront radical esophagectomy is still uncertain. This study investigated the effects of postoperative radiotherapy in pT1-3N0 esophageal carcinoma after radical resection. METHOD: We retrospectively identified pT1-3N0M0 esophageal carcinoma patients between 2000 and 2016 from the Surveillance, Epidemiology, and End Results database. Patients with upfront esophagectomy were categorized as having received surgery alone (SA) and surgical resection followed by adjuvant radiotherapy (SA + RT). Propensity score matching, univariate and multivariate analysis were performed to compare overall survival (OS) and cause-specific survival (CSS). RESULTS: A total of 2862 patients were identified, of whom 274 received SA + RT and 2588 received SA. The median follow-up was 60.4 months (95%CI, 58.7-62.1 months). The five-year OS and CSS were better for SA group compared with SA + RT group (P < 0.001, respectively). Furthermore, after matching, the OS and CSS were still significantly better for SA patients. For T subgroup analysis, postoperative radiotherapy was an independent prognostic factor only for pT1 patients with worse OS, without survival differences for pT2 and pT3 patients. However, after multivariate cox analysis, postoperative radiotherapy can provide significantly better OS for pT3 patients with tumor length ≥5 cm (P = 0.03; 95%CI, 0.29-0.94). CONCLUSIONS: Among pT1-3N0M0 esophageal carcinoma patients, postoperative radiotherapy can provide significantly better OS for pT3 patients with tumor length ≥5 cm. However, there are no survival benefits for pT1-2 patients after SA + RT procedure. This finding may have significant implications on the use of adjuvant radiation in patients with pN0 disease.

2.
Orthop Surg ; 11(1): 3-9, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30834704

RESUMO

Bowstring disease (BSD) is a new classification of spine disease caused by axial stretched lesion on nerve roots and the spinal cord, which is differentiated from disc herniation and canal stenosis in that it is caused by nerve compression lesions. BSD could be caused by mismatched growth rates between the spine and nerve roots (the juvenile type), or by imbalanced degenerative rates between the spine column and nerve roots (degenerative type). Here, we propose that there are several self-adjust mechanisms to relieve axial nerve tension: (i) nerve growth; (ii) posture adjustment and low back pain; (iii) autogenous degeneration of intervertebral disc; and (iv) idiopathic and degenerative scoliosis. Iatrogenic lesions could also result in BSD, which could be presented as adjacent segment degeneration, leading to adding-on effects and other neurological symptoms. The diagnosis criteria are proposed based on symptoms, physical examination, and radiological presentations. To remove axial tension on nerve roots, lumbar surgery should aim to restore the coordination of spine and cord units. Capsule surgery, shortening the spine column, could decompress cord and nerve roots 3-dimensionally.


Assuntos
Vértebras Lombares/cirurgia , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/cirurgia , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/cirurgia , Humanos , Degeneração do Disco Intervertebral/etiologia , Deslocamento do Disco Intervertebral/etiologia , Dor Lombar/etiologia , Síndromes de Compressão Nervosa/etiologia , Escoliose/etiologia , Compressão da Medula Espinal/etiologia , Raízes Nervosas Espinhais/fisiopatologia
3.
Clin Neurol Neurosurg ; 177: 86-91, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30634057

RESUMO

OBJECTIVES: To investigate the effect of computer-assisted virtual operation planning (CAVOP) on anterior controllable anterior-displacement and fusion (ACAF) surgery for ossification of the posterior longitudinal ligament (OPLL). PATIENTS AND METHODS: A total of 25 patients with OPLL were enrolled in the study from September 2017 to December 2017. Preoperative Computed tomography (CT) scanning data were input into Mimics software to reconstruct three-dimensional (3D) models of actual cervical OPLL.Preoperative simulation of each surgical procedure and measurement of main parameters for intraoperative decision were conducted. Postoperative CT were used to test the clinical value of the preoperative planning. Width of vertebrae-OPLL complex (VOC), thickness of resected vertebral body (VB), height of intervertebral spacer, and length of screws and anterior plate were analyzed. RESULTS: There were no significant differences between the length of screws, width of VOC, and thickness of anterior resection of vertebrae in preoperative CT and postoperative CT. Statistical differences were found between preoperative and postoperative height of intervertebral space and length of anterior plate. CONCLUSION: A virtual ACAF surgical procedure for OPLL is feasible and useful clinically in surgical planning. It may provide a valuable tool for surgeons in formulating an appropriate surgical plan.

4.
J Cell Biochem ; 2018 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-30556170

RESUMO

Osteogenic differentiation refers to the process of bone formation and remodeling, which is controlled by complex molecular mechanisms. Activin A receptor type I (ACVR1) is reported to be associated with osteogenic differentiation. However, the underlying molecular mechanism remains elusive. Therefore, this study evaluates the function of ACVR1 in osteogenic differentiation through the Wnt signaling pathway. The expression of osteocalcin (Oc) and osterix together with osteogenic differentiation and mineralization was examined in ACVR1-knockout (KO) mouse. Furthermore, the Wnt signaling pathway was inhibited in bone marrow stromal cells (BMSCs) of mice to explore the role of the Wnt signaling pathway in osteogenic differentiation by means of alkaline phosphatase (ALP) activity detection and evaluation of mineralized nodules and calcium content. Subsequently, the effect of ACVR1 on the Wnt signaling pathway was assessed by determining the expression of ACVR1, ß-catenin, glycogen synthase kinase 3 ß (GSK3ß), dickkopf-related protein 1 (DKK1), and frizzled class receptor 1 (FZD1). Both their effects on osteogenic differentiation were further evaluated by determination of Oc, osterix, and Runx2 expression. AVCR1 KO mice exhibited increased Oc and osterix expression and promoted bone resorption and formation. ACVR1-knockout was observed to activate the Wnt signaling pathway with an increase of ß-catenin and reductions in GSK3ß, DKK1, and FZD1. With the inhibited Wnt signaling pathway expression of Oc, osterix, and Runx2 was decreased, and ALP activity, mineralized nodule, and calcium content in cellular matrix were decreased as well, indicating that inactivation of the Wnt signaling pathway reduced the differentiation of BMSCs into osteoclasts. These findings indicate that ACVR1-knockout promotes osteogenic differentiation by activating the Wnt signaling pathway in mice.

5.
Onco Targets Ther ; 11: 2709-2723, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29785120

RESUMO

Background: Previous studies have reported that nuclear receptor subfamily 5, group A, member 2 (NR5A2) polymorphisms (rs3790843 G>A, rs3790844 T>C, rs12029406 C>T) are associated with the risk of pancreatic cancer. However, the results of epidemiological investigations are still controversial. In order to explore its potential attributing factors, we pooled the updated literatures to evaluate the association between NR5A2 polymorphism and the risk of pancreatic cancer in this meta-analysis. Materials and methods: Databases such as PubMed, Google Scholar and China National Knowledge Infrastructure were searched for eligible articles following strict inclusion and exclusion criteria (updated to November 18, 2017). Odds ratios (ORs) and 95% CIs were computed to assess the intensity of association. In addition, heterogeneity, sensitivity analysis and publication bias were explored. All statistical analyses were conducted by STATA 14.0. Results: Our results showed that the rs3790843 (GA vs GG: OR=0.86, CI=0.76-0.98, P=0.992; GA+AA vs GG: OR=0.83, CI=0.73-0.94, P=0.950; A vs G: OR=0.85, CI=0.78-0.93, P=0.802), rs3790844 (CC vs TT: OR=0.65, CI=0.54-0.78, P=0.617; CC vs TT+CT: OR=0.73, CI=0.62-0.85, P=0.742; C vs T: OR=0.78, CI=0.73-0.84, P=0.555) and rs12029406 (TT vs CC: OR=0.73, CI=0.61-0.89, P=0.483; TT vs CC+CT: OR=0.78, CI=0.66-0.92, P=0.648; T vs C: OR=0.87, CI=0.79-0.95, P=0.837) polymorphisms were associated statistically with the risk of pancreatic cancer. Furthermore, the results of subgroup analysis showed that rs3790843 and rs3790844 polymorphisms were especially related to the risk of pancreatic cancer in Caucasian population. Conclusion: Our results revealed that NR5A2 may have a protective effect on pancreatic cancer. However, more well-designed researches are needed to verify the relationship between NR5A2 polymorphisms and the risk of pancreatic cancer.

6.
World Neurosurg ; 113: e101-e107, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29421454

RESUMO

OBJECTIVE: This study used the uncinate process (UP) base as the landmark to measure the various distances of the interested anatomic structures to improve the practicality of anterior controllable antedisplacement and fusion (ACAF) for ossification of the posterior longitudinal ligament (OPLL). METHODS: Computed tomographic (CT) scan data of 20 OPLL patients were studied. We investigated the base distance of the UP, transverse foramen (TF) to UP base, pedicle to UP base, posterior to anterior UP, maximal width of OPLL, and width of the vertebrae-OPLL complex (VOC). RESULTS: Base distance of the UP shows an increasing trend from C3 to C7. The average base distance of the UP ranges from 14.6 mm at C3 to 22.7 mm at C7. The TF to UP distance ranges from 4.6 to 7.2 mm. The pedicle to UP distance is significantly shorter than upper levels at C7 and C6. The posterior to anterior UP ranges from -3.7 to -5.7 mm with an increasing trend from C3 to C7. The maximal width of OPLL is 13.2 mm on average. The mean width of the VOC in the ACAF cases is 16.8 mm on average. CONCLUSIONS: The results show that the UP can serve as a landmark for the location of longitudinal osteotomies in ACAF. However, preoperative measurement of CT images should be conducted for an individual dependent surgical planning of ACAF.


Assuntos
Pontos de Referência Anatômicos/anatomia & histologia , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Fusão Vertebral/métodos , Idoso , Pontos de Referência Anatômicos/diagnóstico por imagem , Antropometria , Vértebras Cervicais/diagnóstico por imagem , Discotomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Tomografia Computadorizada por Raios X
7.
Oncotarget ; 8(37): 62445-62453, 2017 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-28977958

RESUMO

Low molecular mass protein (LMP) gene performs a critical role in the foreign antigen processing machine via the major histocompatibility complex-I (MHC-I) complex CD8+ cytotoxic T lymphocytes (CTL) pathway. Recent studies have reported the association of LMP2-60 G>A (rs17587) and LMP7-145 C>A (rs2071543) polymorphisms with various types of cancers, but the outcomes remained inconsistent. To obtain a reliable conclusion, we summarized available data and conducted a meta-analysis involving a total of 19 published studies. Evidences were obtained from the PubMed, Google Scholar, Web of Science and Chinese National Knowledge Infrastructure (CNKI) databases. The results demonstrated that the rs17587 and rs2071543 polymorphisms were associated with an increased cancer risk in the recessive and homozygote models. Stratified analyses by ethnicity indicated a significant association only in Asian population. Furthermore, rs17587 showed a greater susceptibility to gynecological cancers, while rs2071543 increased the risk of gastrointestinal and gynecological cancers. Our results indicate that the LMP2 rs17587 and LMP7 rs2071543 polymorphisms may act as risk factors for cancer, especially for Asian populations. Additional larger-scale multicenter studies should be performed to validate our results.

8.
Cancer Lett ; 408: 144-154, 2017 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-28867247

RESUMO

The transcription regulator Yin Yang-1 (YY1) serves as a tumor suppressor in pancreatic ductal adenocarcinoma (PDAC). However, the function of YY1 in proliferation of PDAC cells remains to be clarified. In this study, we found that overexpression of YY1 suppressed proliferation and decreased the expression of long non-coding RNA (lncRNA) SOX2OT and its potential target gene SOX2 in PDAC cells. Luciferase reporter, electrophoretic mobility shift (EMSA), and chromatin immunoprecipitation (ChIP) assays revealed binding of YY1 to the SOX2OT promoter. Moreover, YY1 suppressed PDAC cell proliferation through SOX2OT transcriptional inhibition and subsequent decreased SOX2 expression. In addition, YY1 expression was statistically negatively correlated with SOX2OT and SOX2 expression in PDAC tissues and lower level expression of SOX2OT predicted better outcome in PDAC patients. These results confirmed the anti-proliferation effect of YY1 on PDAC cells, which was associated with SOX2 down-regulation in a SOX2OT-dependent mechanism. Although other undiscovered mechanisms may be involved in the YY1-mediated tumor suppression role, the present study suggests that SOX2OT may act as a tumor promotor in PDAC and may represent a valuable diagnostic and therapeutic target.


Assuntos
Carcinoma Ductal Pancreático/patologia , Proliferação de Células , Regulação Neoplásica da Expressão Gênica , Neoplasias Pancreáticas/patologia , RNA Longo não Codificante/metabolismo , Fatores de Transcrição SOXB1/metabolismo , Fator de Transcrição YY1/metabolismo , Animais , Apoptose , Biomarcadores Tumorais , Carcinoma Ductal Pancreático/genética , Carcinoma Ductal Pancreático/metabolismo , Imunoprecipitação da Cromatina , Feminino , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Estadiamento de Neoplasias , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/metabolismo , Prognóstico , Regiões Promotoras Genéticas , RNA Longo não Codificante/genética , Fatores de Transcrição SOXB1/genética , Taxa de Sobrevida , Células Tumorais Cultivadas , Ensaios Antitumorais Modelo de Xenoenxerto , Fator de Transcrição YY1/genética
9.
Oncotarget ; 8(30): 50124-50132, 2017 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-28223548

RESUMO

Single nucleotide polymorphisms (SNPs) of Excision repair cross-complementing group 2 (ERCC2) gene are suspected to affect the risk of pancreatic cancer. Many studies have reported the association between ERCC2 Lys751Gln polymorphism (rs13181) and the susceptibility to pancreatic cancer, but the outcomes remained controversial. To comprehensively determine this association, we conducted a meta-analysis based on a total of eight studies. Evidence for this association was obtained from the PubMed, EMBASE, Web of Science and Chinese National Knowledge Infrastructure (CNKI) databases. In general, a significant association was found between ERCC2 rs13181 polymorphism and the susceptibility to pancreatic cancer in four genetic models [CC vs. AA: OR = 1.56, (95% CI: 1.28-1.90), P = 0.470; AC/CC vs. AA: OR=1.20, (95% CI: 1.06-1.36), P = 0.396; CC vs. AC/CC: OR = 1.50; (95% CI: 1.24-1.81), P = 0.530; C vs. A: OR=1.22, (95%CI:1.11-1.34), P = 0.159]. Furthermore, stratified analyses by ethnicity indicated a significant association only in the Asian population. Our results indicate that the ERCC2 Lys751Gln polymorphism might be important in stimulating the development of pancreatic cancer, especially for Asians.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Neoplasias Pancreáticas/genética , Proteína Grupo D do Xeroderma Pigmentoso/genética , Predisposição Genética para Doença , Humanos , Neoplasias Pancreáticas/patologia , Polimorfismo de Nucleotídeo Único
10.
Spine (Phila Pa 1976) ; 41(4): E186-90, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26352744

RESUMO

STUDY DESIGN: Cadaveric study. OBJECTIVE: To provide anatomical basis for deciding the surgical approach and skin incision in thoracolumbar extreme lateral interbody fusion (XLIF) by delineating the attachment points of diaphragm. SUMMARY OF BACKGROUND DATA: Although the general anatomy of the thoracic diaphragm is well described, the specific attachment points of diaphragm concerned with the XLIF approach is yet to be elaborated. METHODS: Dissections were performed on 21 cases of formalin fixed specimens (12 males, 9 females, a total of 42 sets of data). Special attention was paid to the attachment points of diaphragm on both sides at the midaxillary line (MAL point) and the vertebral level parallel to the MAL point (VL-MAL). The attachment points of diaphragm on the front and back edge of the spinal column (FES point and BES point) were also described. RESULTS: The MAL point of diaphragm muscle lied between the inferior edge of the 10th rib and the superior edge of the 12th rib (20 out of 21 on left, 21 out of 21 on right). VL-MAL lied between L1 and L2 vertebrae level (20 out of 21 on left, 18 out of 21 on right). The attachments on both sides of the vertebral column mainly located between the upper edge of T12 vertebrae and L1-L2 disc (38 out of 42). CONCLUSION: A transthoracic approach should be considered when the target level was above T12 vertebrae, whereas a retroperitoneal approach should be chosen when target level was below L1-L2 disc. If the target level is located between T12 and L1-L2 disc, whether via transthoracic, retropleural, or retroperitoneal approach should be determined according to the conditions of patients and the skill and experience of the surgeon. Incision should be made above the 10th rib for the transthoracic approach and below the 12th rib for the retroperitoneal approach. LEVEL OF EVIDENCE: 4.


Assuntos
Diafragma/anatomia & histologia , Vértebras Lombares/anatomia & histologia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/anatomia & histologia , Vértebras Torácicas/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Int J Clin Exp Med ; 6(6): 431-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23844266

RESUMO

To determine the level of brain-derived neurotrophic factor (BDNF) in experimental dog model of severe acute cauda equina syndrome, which was induced by multiple cauda equina constrictions throughout the entire lumbar (L), sacral (S) and coccygeal (Co) spinal cord and their central processes of the dorsal root ganglia neurons. Adult male mongrel dogs were randomly divided into 2 groups. The experiment group (n=4) was subjected to multiple cauda equina constrictions. The control group (n=4) was subjected to cauda equina exposure without constrictions. Level of BDNF in the spinal cord and the dorsal root ganglion cells (L7, S1-S3) was assessed 48 hours after multiple constrictions by immunohistochemical and histopathological analyses. 48 hours after multiple constrictions of cauda equina, up-regulation of BDNF within lumbosacral (L7-S3) spinal cord and dorsal root ganglion was observed in experimental group as compared to control group. Our result suggests that BDNF might play a role in the inflammatory and neuropathic pain as a result of multiple cauda equina constrictions. Regulation of BDNF level could potentially provide a therapy for treating cauda equina syndrome.

12.
Chin Med J (Engl) ; 122(10): 1214-22, 2009 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-19493474

RESUMO

OBJECTIVE: To review the literature on the clinical progress in cauda equina syndrome (CES), including the epidemic history, pathogenesis, diagnosis, treatment policy and prognosis. Data sources All reports on CES in the literature were searched in PubMed, Ovid, Springer, Elsevier, and the Chinese Biomedical Literature Disk using the key terms "cauda equina syndrome", "diagnosis", "treatment", "prognosis" and "evidence-based medicine". Study selection Original milestone articles and critical reviews written by major pioneer investigators about the cauda equina syndrome were selected. RESULTS: CES is rare, both atraumatically and traumatically. Males and females are equally affected. The incidence of CES is variable, depending on the etiology of the syndrome. The most common cause of CES is herniation of a lumbar intervertebral disc. CES symptoms may have sudden onset and evolve rapidly or sometimes chronic ally. Each type of CES has different typical signs and symptoms. Low back pain may be the most significant symptoms, accompanied by sciatica, lower extremities weakness, saddle or perianal hypoesthesia, sexual impotence, and sphincter dysfunction. MRI is usually the preferred investigation approach. Patients who have had CES are difficult to return to a normal status. CONCLUSIONS: The diagnosis of CES is primarily based on a careful history inquiry and clinical examination, assisted by elective radiologic investigations. Early diagnosis and early surgical decompression are crucial for a favorable outcome in most CES cases.


Assuntos
Polirradiculopatia/diagnóstico , Medicina Baseada em Evidências/métodos , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Polirradiculopatia/etiologia , Polirradiculopatia/patologia
13.
Zhonghua Wai Ke Za Zhi ; 46(14): 1062-5, 2008 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-19094531

RESUMO

OBJECTIVE: To discuss Clinic feature and turnover of delayed hyperextension injury concomitance spinal cord injury of cervical spine. METHODS: The clinic data of 30 patients delayed hyperextension injury of cervical spine were reviewed and analyzed. Course of disease was from 3 months to 8 years. Thirty patients were divided into three groups according to course of disease. The first group, 3 - 6 months, 17 cases; the second group, 6 - 12 months, 8 cases; the third group, 12 months-8 years, 5 cases. Neurological function improvement rates were evaluated according to the JOA scores at preoperative, 3 months and 1 year post operation, and complications were observed in three groups. Twenty-six cases were treated with anterior decompression, bone graft and plate fixation. Four cases were treated with posterior decompression, bone graft and plate fixation. RESULTS: The patient number of the three group exist with statistical significance. Thirty patients were followed up for 18 - 39 months, 23 months on average. Neurological function recovery rates were 23.8% in the first group, 53.9% in the second group and 54.3% in the third group at 1 year post operation. JOA scores of the first group and the second group with statistical significance at 3 months and 1 year post operation. JOA scores of the first group and the third group with statistical significance at 3 months and 1 year post operation. JOA scores of the second group and the third group without statistical significance at 3 months and 1 year post operation. CONCLUSIONS: Incidence of hyperextension injury associated with spinal cord injury of cervical spine would degrade along with course of disease prolong. If delayed spinal cord injury occurred earlier, the patient's condition was severer and badly improvement rate.


Assuntos
Vértebras Cervicais/lesões , Traumatismos da Medula Espinal/cirurgia , Traumatismos em Chicotada/cirurgia , Adulto , Idoso , Transplante Ósseo , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Feminino , Seguimentos , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/patologia , Traumatismos em Chicotada/complicações , Traumatismos em Chicotada/patologia
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