Objective To compare microendoscopic discectomy (MED) with open discectomy (OD) for degenerative lumbar spinal stenosis in terms of cl inical outcomes, and provide experience and therapeutic evidence for cl inical appl ication.Methods From May 2002 to October 2007, 215 patients with lumbar spinal stenosis were randomized into two groups, and underwent either MED or OD. In group A, 105 patients underwent MED, including 56 males and 49 females aged 34 to 83 years old (average 45 years old); the duration of the disease ranged from 9 months to 26 years (average 50 months); the spinal stenosis involved one segment in 76 cases, two segments in 27 cases, and three segments in 2 cases. In group B, 110 patients received OD, including 57 males and 53 females aged 35 to 85 years old (average 47 years old); the duration of the disease ranged from 8 months to 25 years (average 48 months); the spinal stenosis involved one segment in 78 cases, two segments in 29 cases, and three segments in 3 cases. No significant difference was evident between two groups in terms of the general information(P gt; 0.05). Results Operation was successfully performed in all cases. Volume of intraoperative blood loss was (82.14 ± 6.18) mL in group A and (149.24 ± 11.17) mL in group B. Length of hospital stay was (7.0 ± 2.1) days in group A and (12.0 ± 2.6) days in group B. Significant difference was noted between two groups in terms of the above parameters (P lt; 0.01). All the wounds healed by first intention. The patients were followed up for 13-54 months (average 27 months) in group A and 12-55 months (average29 months) in group B. Four patients in each group suffered from spinal dural rupture during operation and recovered after corresponding treatment. Three patients in group B had lumbar instabil ity 3 years after operation and recovered using lumbar interbody fusion combined with general spine system internal fixation. No such compl ications as wrong orientation, nerve root injury, cauda equina injury and infection occurred in each group, and radiology exam showed no relapse. Therapeutic effect was evaluated by Nakai standard, 52 cases in group A were graded as excellent, 45 as good, 7 as fair, 1 as poor, and the excellent and good rate was 92.4%; 53 cases in group B were graded as excellent, 48 as good, 8 as fair, 1 as poor, and the excellent and good rate was 91.8%; there was no significant difference between two groups (P gt; 0.05). Conclusion Two methods have the similar therapeutic effect, but MED el iminates the shortcomings of traditional OD, so it is one of ideal minimally invasive operative approaches for degenerative lumbar spinal stenosis.
Objective To compare microsurgery lumbar discectomy (MSLD) via posterior approach with traditional open discectomy by fenestration for single-level lumbar disc protrusion in terms of methodology and therapeutic effect. Methods From January 2001 to January 2008, 230 patients with single-level lumbar disc protrusion were randomized into two groups. In group A, 114 patients underwent MSLD, including 77 males and 37 females aged 15-76 years old (average 41 years old); the duration of the disease ranged from 6 months to 28 years (average 51 months); the lumbar disc protrusion involved L4,5 level in 52 cases, and L5 - S1 level in 62 cases; there were 50 cases of lumbar disc protrusion on the left side, 54 onthe right side, and 10 of the central type; preoperative JOA score was 6-18 points (average 11.8 points). In group B, 116 patients underwent traditional posterior open discectomy by fenestration, including 78 males and 38 females aged 14-78 years old (average 42 years old); the duration of the disease ranged from 8 months to 26 years (average 52 months); the lumbar disc protrusion involved L4,5 level in 56 cases, and L5 - S1 level in 60 cases; there were 53 cases of lumbar disc protrusion on the left side, 52 on the right side, and 11 of the central type; preoperative JOA score was 5-19 points (average 12.3 points). No significant difference was evident between two groups in terms of general information (P gt; 0.01). Parameters of operative time, volume of blood loss during operation, length of operative incision, length of hospital stay after operation, and total medical cost of single disease were analyzed. Therapeutic effect was assessed by postoperative JOA score during follow-up period. Results The operative time was (40 ± 9) minutes in group A and (47 ± 11) minutes in group B. The volume of blood loss during operation was (26 ± 5) mL in group A and (60 ± 6) mL in group B. The length of operative incision was (2.6 ± 0.8) cm in group A and (5.6 ± 0.5) cm in group B. The length of hospital stay after operation was (4.0 ± 2.6) days in group A and (8.0 ± 2.9) days in group B. The total medical cost of single disease was (5 500 ± 1 800) ￥ in group A and (6 300 ± 1 500) ￥ in group B. Significant difference was evident between two groups in terms of the above parameters (P lt; 0.01). The incisions in two groups all healed by first intention.No compl ications such as wrong orientation, nerve root injury, cauda equina injury, and infection occurred. The follow-upperiod was 12-37 months (average 26 months) for 102 patients of group A and 12-35 months (average 24 months) for 98 patients of group B. The JOA score 12 months after operation was 21-28 points (average 24.8 points) in group A and 22-27 points (average 25.2 points) in group B, showing a significant difference when compared with preoperative score (P lt; 0.01), and no significant difference between two groups (P gt; 0.01). Conclusion Two methods have similar cl inical outcomes, but MSLD has merits of minimal invasion, less blood loss, shorter operative time, shorter length of hospital stay, and lower medical cost. It is one of ideal minimally invasive operations for single-level lumbar disc protrusion．
Objective To explore the feasibility and the effectiveness of the accurate placement of lumbar pedicle screws using three-dimensional (3D) printing navigational templates in Quadrant minimally invasive system. Methods The L1-5 spines of 12 adult cadavers were scanned using CT. The 3D models of the lumbar spines were established. The screw trajectory was designed to pass through the central axis of the pedicle by using Mimics software. The navigational template was designed and 3D-printed according to the bony surface where the soft tissues could be removed. The placed screws were scanned using CT to create the 3D model again after operation. The 3D models of the designed trajectory and the placed screws were registered to evaluate the placed screws coincidence rate. Between November 2014 and November 2015, 31 patients with lumbar instability accepted surgery assisted with 3D-printing navigation module under Quadrant minimally invasive system. There were 14 males and 17 females, aged from 42 to 60 years, with an average of 45.2 years. The disease duration was 6-13 months (mean, 8.8 months). Single segment was involved in 15 cases, two segments in 13 cases, and three segments in 3 cases. Preoperative visual analogue scale (VAS) was 7.59±1.04; Oswestry disability index (ODI) was 76.21±5.82; and the Japanese Orthopaedic Association (JOA) score was 9.21±1.64. Results A total of 120 screws were placed in 12 cadavers specimens. The coincidence rate of placed screw was 100%. A total of 162 screws were implanted in 31 patients. The operation time was 65-147 minutes (mean, 102.23 minutes); the intraoperative blood loss was 50-116 mL (mean, 78.20 mL); and the intraoperative radiation exposure time was 8-54 seconds (mean, 42 seconds). At 3-7 days after operation, CT showed that the coincidence rate of the placed screws was 98.15% (159/162). At 4 weeks after operation, VAS, ODI, and JOA score were 2.24±0.80, 29.17±2.50, and 23.43±1.14 respectively, showing significant differences when compared with preoperative ones (t=14.842,P=0.006;t=36.927,P=0.002;t=–36.031,P=0.001). Thirty-one patients were followed up 8-24 months (mean, 18.7 months). All incision healed by first intention, and no complication occurred. During the follow-up, X-ray film and CT showed that pedicle screw was accurately placed without loosening or breakage, and with good fusion of intervertebral bone graft. Conclusion 3D-printing navigational templates in Quadrant minimally invasive system can help lumbar surgery gain minimal invasion, less radiation, and accurate placement.
ObjectiveTo identify prognostic factors for patients with non-small cell lung cancer (NSCLC) in pathologic stage ⅠA after operation. MethodsWe retrospectively analyzed the clinical data of 138 patients, who underwent surgical resection at our institution for stage ⅠA NSCLC. There were 81 males and 57 females with a median age of 61 years (ranged from 37 to 80 years). The in-hospital data and follow-up results were collected. Survival curve was generated by Kaplan-Meier method. Univariate and multivariate analyses of disease-free survival (DFS) were performed. ResultsThe follow-up time was from 9 to 90 months with a median of 59 months. During the follow-up, recurrence and metastasis occurred in 14 patients, local relapse in 8 patients, bone and ipsilateral lymph node metastasis occurred in one patient. Univariate analysis showed that DFS of patients was related with blood vessel or lymphatic invasion (P=0.017), poor histological differentiation (P=0.043), and tumor diameter ≥2 cm (P=0.017), respectively. Multivariate analysis demonstrated that tumor diameter ≥2 cm (P=0.026) and blood vessel or lymphatic invasion (P=0.011) were independent prognostic factors for DFS of stage ⅠA NSCLC patients after operation. ConclusionOur analyses indicate vessel involvement and the tumor diameter are independent indicators of DFS in patients with pathologic stage ⅠA NSCLC after operation.
Objective To investigate the effect s of T lymphoma invasion and metastasis inducing factor 1 ( Tiam 1) antisense oligonucleotides (ASODN) on morphological remodeling of gast ric cancer cells. Methods The high-invasive and metastastic subgroup (MH ) was separated f rom human gast ric cancer cell line MKN245 (M0 ) by laminin adhesion method in vi t ro. And they were divided into four group s according to different further t reatment s : no t ransfection group (cont rol group ) , liposome t ransfection group , sense oligonucleotides2liposome t ransfection group ( SODN t ransfection with liposome group ) and antisense oligonucleotides2liposome t ransfection group (ASODN t ransfection with liposome group) . Then the expressions of Tiam 1 mRNA and protein were detected by RT-PCR and flowcytomet ry , respectively. The morphology changes between Tima 1 ASODN t ransfected MH cells and no t ransfected cells were observed by using HE stain , cytoskeletal protein stain and scanning elect ronic microscope (SEM) . Results Compared with the other group s , the expressions of Tiam 1 mRNA and protein in MH cells were significantly decreased af ter the cells were t ransfected with 0. 43 μmol/ L Tiam 1 ASODN ( P lt; 0. 01) . Additionally , it was observed that the t ransfected MH cells had less membrane surface projections , fewer or shortener pseudopodia , less irregular cytoskeletal network and less spotted-like actin bodys than no t ransfected MH cells did. Conclusion ASODN t ransfection could effectively suppress the expression of Tiam 1 and the remodeling in gast ric cancer cells , which may play an important role in the invasion and metastasis of gast ric cancer cells.
Objective To study the feasibility of radical resection of gallbladder cancer with extensive invasion. Methods A patient of the gallbladder cancer with invasion of liver, gastric antrum, duodenum, caput pancreatis and colon transversum, was received radical resection (including pancreatoduodenectomy, hepatectomy and colectomy). Results Seven months later, the value of CEA and Hb were normal and cancer recurrence was not observed. Conclusion The radical resection of gallbladder cancer with extensive invasion, can improve survival quality and extent survival time.
ObjectiveTo explore the risk factors that affect the long-term prognosis of liver cancer after liver transplantation, and to evaluate the clinical value of the Chinese Medical Association’s new microvascular invasion pathological classification.MethodsThe clinical pathology and follow-up data of 112 patients with liver cancer who underwent liver transplantation from January 2015 to December 2018 were retrospectively analyzed. Prognostic risk factors were analyzed by Cox proportional hazard regression model.ResultsAll of the 112 patients were followed up. The postoperative follow-up period was 12 to 60 months [(28.3±13.5) months], and the median overall survival time was 38-month. The results of the Cox proportional hazard regression model suggested that the preoperative Child classification and microvascular invasion pathological classification were independent factors affecting the prognosis of patients (P<0.05), the higher microvascular invasion pathological classification and Child grade, the worse the prognosis.ConclusionThe Chinese Medical Association’s new microvascular invasion pathological classification can predict the prognosis of patients with liver cancer after liver transplantation and has a good predictive value.
ObjectiveTo establish a model of chronic rotator cuff injury by inducing subacromial impingement syndrome in rats, so as to lay a foundation for further study on the mechanism and treatment of chronic rotator cuff injury. MethodsThe polyether-ether-ketone implants were designed and made with three-dimensional printing technique. In 48 male Sprague Dawley rats[weighing, (277.25±22.03) g], one shoulder joint was selected randomly as the experimental group; in the experimental group, the implant was pierced into shoulder joint close tothe acromion medial side and was pierced out under acromion close to the deltoid trailing edge; the penetratingpartof implant was cut off after the implanting part was fixed with 4# braided silk suture. No any treatment was performed on the contralateral shoulder of 24 rats as control group; and the implants were immediately removed after they were pierced into the contralateral shoulder joint of the other 24 rats as sham-operation group. All the rats were exposed to 30 minutes of downhill running at 17 m/minute (-13.5°) every day at 4 days after operation and the general condition of rats was observed. At 2, 4, 6, and 8 weeks after operation, 12 rats were sacrificed to collect shoulder joint samples. The hardtissueslices was used for VanGieson staining and histological observation of the supraspinatus tendon. ResultsAll ratssurvived to the end of experiment, without infection.The rats suffered limp at 2-3 daysafter operation, and the gait of most rats returned to normal at 4 days after operation.The histological results showed that the supraspinatus tendon had smooth edge, without split layers or breakage in the control group and sham-operation group. In the experimental group, the implants were positioned accurately without dislocation; 4 kinds of typical pathological changes were observed. Partial-thickness tear on bursal side appeared at 2 weeks (5 rats) and 4 weeks (2 rats), showing no significant difference between at 2 and 4 weeks (P > 0.05); intratendinous gap formed mainly at 4 weeks (10 rats) and 6 weeks (11 rats), showing significant differences when compared with that at 2 weeks (2 rats) (P < 0.05) and 8 weeks (2 rats) (P < 0.05); partial-thickness tear on articular side mainly appeared at 6 weeks (8 rats), showing significant difference when compared with that at other time points (P < 0.05); full-thickness tear was found mainly at 8 weeks (10 rats), showing significant differences when compared with that at other time points (P < 0.05). ConclusionA model of chronic rotator cuff injury is successfully established in rats through microinvasive implantation of subacromial impingement syndrome inducing implants and the pathological changes in this model are highly similar to the clinical pathological progress.
ObjectiveTo investigate the effects of pipecolic acid oxidase (PIPOX) on the proliferation, apoptosis, migration and invasion of primary liver cancer cells. MethodsImmunohistochemical staining and analysis of The Cancer Genome Atlas (TCGA) database were used to examine the PIPOX expression levels in liver cancer tissues and paired adjacent normal tissues, and studied their relationship with patient prognosis. Liver cancer cell lines stably overexpressing or knocking out PIPOX were constructed to explore PIPOX’s impact on liver cancer cell proliferation, apoptosis, migration and invasion by conducting in vitro functional experiments such as CCK-8, EdU, apoptosis detection, and Transwell assays. In vivo, nude mice subcutaneous tumor models and lung metastasis models were used to verify PIPOX’s effect on liver cancer growth and metastasis. Real-time quantitative polymerase chain reaction (RT-qPCR) and western blot were both employed to detect the expression of epithelial-mesenchymal transition (EMT) markers in liver cancer cells. ResultsImmunohistochemical staining and TCGA database analysis revealed that PIPOX expression was significantly lower in liver cancer tissues compared to paired adjacent normal tissues (P<0.05). Prognostic analysis indicated shorter overall survival and disease-free survival in PIPOX low expression group (P<0.05). In vitro gain- and loss-of-function experiments showed that PIPOX significantly inhibited liver cancer cell migration and invasion (P<0.05), while having no significant effects on their proliferation and apoptosis (P>0.05). Animal experiments also confirmed that PIPOX significantly inhibited liver cancer lung metastasis (P<0.05), but had no significant effects on tumor growth (P>0.05). Finally, RT-qPCR and western blot results revealed that PIPOX promoted the expression of the epithelial marker E-cadherin (P<0.05) and inhibited the expression of mesenchymal markers (N-cadherin, vimentin, Snail) (P<0.05). ConclusionsPIPOX significantly inhibits liver cancer cell migration and invasion, potentially via suppressing the EMT process. However, PIPOX does not significantly affect liver cancer cell proliferation and apoptosis.
Objective To investigate the relationship between skin/pectoral muscle invasion and the prognosis of male breast cancer. Methods Clinical data and follow-up information of 79 male breast cancer patients who received treatment between September 2008 to April 2020 in West China Hospital were retrospectively reviewed, to analyze the clinicopathological features of male breast cancer and prognostic value of skin/pectoral muscle invasion. Results Among 79 male breast cancer patients, a total of 23 patients (29.1%) were with skin/pectoral muscle invasion at diagnosis. All the patients were followed up, with a median follow-up period of 63.3 months (1.0–204.5 months). Within follow-up period, 8 patients (10.1%) suffered from relapse, 19 patients (24.7%, 19/77) suffered from metastasis, and 4 patients (5.1%) died. Multivariate Cox proportional risk regression model suggested that patients with skin/pectoral muscle invaded had poor disease free survival [RR=4.48, 95%CI (1.08, 18.52), P=0.038]. Conclusions Skinor pectoral muscle invasion might be a valuable prognostic factor for male breast cancer patients. However, limited by sample size, the conclusion should be proved by further high-level studies.