ObjectiveTo evaluate the effect on complication after esophagectomy by comparing the different methods of anastomosis (cervical versus thoracic anastomosis).
MethodsWe searched the following databases including PubMed, EMbase, The Cochrane Library, Web of Science, CBM, CNKI, VIP and Wanfang database to identify randomized controlled trials (RCTs) of cervical versus thoracic anastomosis for esophagectomy patients from establishment of each database to October 30, 2014. Quality of the included RCT was evaluated. Meta-analysis was conducted by using RevMan 5.2 software.
ResultsWe finally identified 4 RCTs involving 267 patients. In terms of the postoperative complication, the incidence of anastomotic leakage (RR=3.83, 95%CI 1.70 to 8.63, P=0.001) with cervical anastomosis was significantly higher than that of the patients with thoracic anastomosis. However, there was no statistical difference in incidence of anastomotic stricture (RR=1.04, 95%CI 0.62 to 1.76, P=0.87), pulmonary complication (RR=0.73, 95%CI 0.27 to 1.91, P=0.52), and mortality (RR=0.89, 95%CI 0.40 to 1.97, P=0.77) between cervical and thoracic anastomosis.
ConclusionCompared with thoracic anastomosis, the method of cervical anastomosis is associated with a higher incidence of anastomotic leakage. But there are many unclear factors about anastomotic stricture, pulmonary complication and mortality, further measurement should be taken.
ObjectiveTo systematically review the correlation between mTOR protein expression and different clinical pathological features as well as the response to radiotherapy and chemotherapy of cervical cancer.
MethodsWe electronically searched databases including The Cochrane Library (Issue 1, 2015), PubMed, EMbase, CNKI, CBM, VIP and WanFang Data from inception to April 2015 to collect case-control studies investigating the correlation between mTOR protein expression and different clinical pathological features as well as the response to radiotherapy and chemotherapy of cervical cancer. Two reviewers independently screened literature, extracted data and assessed the risk bias of the included studies. Then meta-analysis was performed using RevMan 5.2 software.
ResultsA total of 8 case-control studies involving 591 patients were included. Among these cases, 365 cases were in the cervical cancer group, 135 cases were in the cervical intraepithelial neoplasia (CIN) group, and 91 cases were in the normal cervix tissue group. The results of meta-analysis showed that:(1) Compared with the normal cervix tissue group, mTOR protein was overexpressed in the cervical cancer group (OR=24.14, 95%CI 4.47 to 130.35, P=0.000 2) and the CIN group (OR=4.71, 95%CI 2.15 to 10.33, P=0.000 1); Compared with the CIN group, mTOR protein was overexpressed in the cervical cancer group (OR=5.12, 95%CI 2.96 to 8.86, P<0.000 01). (2) Compared with the non-lymphnode-metastasis group, mTOR protein was overexpressed in the lymph node metastasis group (OR=3.29, 95%CI 1.61 to 6.69, P=0.001); Compared with the FIGO I group, mTOR protein was overexpressed in the FIGO Ⅱ group (OR=3.00, 95%CI 1.49 to 6.04, P=0.002); Compared with the radiotherapy and chemotherapy responsive group, mTOR protein was overexpressed in the non-response group (OR=15.64, 95%CI 3.17 to 77.15, P=0.000 7). In addition, there was no significant difference between the medium/high differentiation group and low differentiation group (OR=1.70, 95%CI 0.75 to 3.81, P=0.20).
ConclusionmTOR protein expression is associated with cervical cancer, and mTOR protein overexpression was associated with lymph node metastasis, higher FIGO and non-response to radiotherapy and chemotherapy. Due to the limited quantity and quality of the included studies, the above conclusion needs to be further verified by more high quality studies.
ObjectiveTo understand the cervical spine function, core stability and strength of fighter pilots, and to explore the difference of that between fighter pilots with and without neck pain.MethodsFrom October to December 2020, a double-blind design was used to test the cervical spine function, core stability and strength of fighter pilots of a certain part of the Air Force. At the same time, the area of deep cervical flexor and the thickness of transverse abdominis and multifidus muscles were measured. According to the presence or absence of neck pain in the last 3 months, they were divided into neck pain group and non-neck pain group. The cervical spine function, core stability and core strength, deep cervical flexor and transversus abdominis endurance of the two groups were compared and analyzed.ResultsA total of 38 pilots were included. There was no significant difference in age, body mass index, service life, flight time, total flight time and weekly flight time between the neck pain group and the non-neck pain group (P>0.05). There was no significant difference in cervical spine mobility between the two groups of pilots (P>0.05). The cervical flexor muscle strength [(15.5±4.9) vs. (12.1±3.0) N] and the ratio of cervical flexion/neck extension (0.6±0.1 vs. 0.5±0.1) in the non-neck pain group were higher than in the neck pain group (P<0.05). There was no significant difference in the muscle strength of other superficial cervical muscles between the two groups (P>0.05). The average value of deep neck flexor endurance in the neck pain group [25.36 mm Hg(1 mm Hg=0.133 kPa)] better than the non-neck pain group group (17.11 mm Hg) (P=0.026). There was no significant difference in test values of transverse abdominis endurance between the two groups (P>0.05). The left hip internal rotator strength [(11.9±2.6) vs. (10.0±2.1) N] and the left hip external rotator strength [(13.7±2.2) vs. (11.9±2.0) N] in the non-neck pain group were higher than in the neck pain group (P<0.05). There was no significant difference in the muscle strength of the other hip joint muscles between the two groups (P>0.05). The thickness of the right transversus abdominis in the neck pain group [(1.1±0.3) vs. (0.8±0.3) cm] was higher than that in the non-neck pain group (P<0.05). There was no significant difference in the thickness of the left transversus abdominis, the cross-sectional area of deep cervical flexor muscle and the thickness of lumbar multifidus muscle between the two groups (P>0.05).ConclusionsFighter pilots with neck pain have superficial cervical flexor muscle strength and decreased left hip internal and external rotation muscle strength, and the superficial cervical flexor and extensor muscle strength is unbalanced. Strengthening the superficial cervical flexor muscle strength, improving the balance between the superficial cervical flexor and extensor muscles, and enhancing the hip internal and external rotator muscle strength may help prevent neck pain.
【摘要】 目的 評價人乳頭狀瘤病毒(HPV)DNA檢測在宮頸癌篩查中的價值。 方法 采用第二代雜交捕獲(HCⅡ)技術和液基細胞學測試(LCT)2種方法,對1026例在婦科病中心就診的受檢者進行同步盲法檢測,同時進行陰道鏡檢查。以宮頸活檢組織病理學檢查結果為診斷標準。評價該方案在宮頸癌篩查中的應用價值。 結果 病理檢查結果顯示,宮頸上皮內瘤變(CIN)Ⅰ級152例,CINⅡ級108例,CINⅢ級109例,宮頸浸潤癌28例。篩查高危型HPV感染366例,陽性率3570%, 在不同宮頸病變中的陽性率分別是:宮頸癌9290%(26/28),CINⅢ900%(99/109),CINⅡ8890%(96/108),CINⅠ8750%(133/152)。高危HPV對宮頸高級別病變的敏感性、特異性、陽性預測值,陰性預測值分別是9860%、8610%、1480%和9980%;HPV與LCT聯合檢測(平行試驗)的以上各指標分別是10000%、8090%、1210%和10000%。 結論 高危型人乳頭狀瘤病毒檢測在宮頸癌前病變的篩查中有較高的敏感度和陰性預測值,聯合LCT檢測是目前宮頸癌篩查具有診斷價值的方法。【Abstract】 Objective To investigate the value of high risk human papillomavirus(HPV) DNA dectection for cervical cancer screening. Methods Hybrid capture Ⅱ(HCⅡ)human papillomavirus (HPV) test and liquid based cytology test (LCT) were performed in 1026 patients treaed in Xuzhou No.1 hospital from May 2008 to May 2009,and the abnomal cytological or HPV DNA findings were further biopsied under the colposcopeto to appraise the appicational importance of each approach for screening cervical cancer. Results Pathological results showed that cervical intraepithelial neoplasial(CIN)Ⅰin 152 patients,CIN Ⅱ in 108 patients,CIN Ⅲ 109 patients,invasive cervical cancer in 28 patients.HPV infected 366 patients in detection, with 3570% positive rate. The infection rate of HPV in cervical cancer was 929%(26/28),in CIN Ⅲ was 908%(99/109),in CIN Ⅱ was 889%(96/108),and in CIN Ⅰwas 875%(133/152).The pathological results treated as standard,the sensitivity, soecificiy, positive prevalue, negative prevalue of HCⅡ HPV for detecting highgrade cervical lesions were 986%,861%,148% and 998%.The values for HPVLCT parallel test were 1000%,809%,121% and 100%. Conclusion Highrisk HPV DNA test is of high sensitivity and negativepredictive value. The combination of HCⅡ HPV and LCT tests are of great value for screening cervical cancer at present.
OBJECTIVE: To discuss the value of anterior operation in fracture-dislocation of connect of cervical vertebrae and thoracic vertebrae. METHODS: From 1997, 21 patients with fracture-dislocation of connect of cervical vertebra and thoracic vertebrae were operated on. The interval between injury and operation was within 24 hours in 4 cases, 2-7 days in 9 cases, 8-14 days in 3 cases and within 4 weeks in 5 cases. The locations were C6,7 in 7 cases, C7 in 9 cases and T1 in 5 cases. The nerves function of spinal of all the cases have different degrees of injury. Classification of Frankel were the following: 3 cases of grade A, 6 cases of grade B, 9 cases of grade C, and 3 cases of grade D. The operative procedure included the following: anterior operation of cervical vertebrae; incision of most fracture vertebral body to decompress; transplantation of ilium bone grafting fusion; and internal fixation of anterior cervical vertebrae with locking-steel. RESULTS: In 21 patients, 1 died of accompanying by pulmonary infection; 20 were followed up 8 months to 3 years with an average of 21 months. All transplanted ilium had fused. The nerve function of spinal cord had recovered in different degrees(2 cases of grade A, 1 case of grade C, 9 cases of grade D and 8 cases of grade E); the turn of vertebral column was normal. No internal fixation failed. CONCLUSION: Anterior operation is a better way to treat fracture-dislocation of connect of cervical vertebrae and thoracic vertebrae with easy operation, less complications, satisfactory reduction of fracture and good stability.
Objective To evaluate the effectiveness of microplate fixation in open-door cervical expansive laminoplasty (ELP) by comparing with anchor fixation. Methods Between January 2005 and October 2008, 35 patients with multi-segment cervical spondylotic myelopathy were treated. Of them, 15 patients underwent ELP by microplate fixation (microplate group) and 20 patients underwent ELP by anchor fixation (anchor group). In microplate group, there were 10 malesand 5 females with the age of (51.2 ± 11.5) years; the disease duration ranged from 6 to 60 months (mean, 14 months); and the preoperative Japanese Orthopoaedic Association (JOA) score was 7.7 ± 2.5. In anchor group, there were 13 males and 7 females with the age of (50.7 ± 10.8) years; the disease duration ranged from 3 to 58 months (mean, 17 months); and the preoperative JOA score was 7.8 ± 2.9. There was no significant difference in the general data, such as gender, age, and JOA score between 2 groups (P gt; 0.05). Results All incisions healed by first intention. Thirty-five cases were followed up 24-68 months (mean, 32 months). The operation time was (113 ± 24) minutes in anchor group and (111 ± 27) minutes in microplate group, showing no significant difference (t=0.231 3, P=0.818 5). The rate of spinal canal expansion in microplate group (60% ± 24%) was significantly higher than that in anchor group (40% ± 18%) (t=2.820, P=0.008). The JOA scores of 2 groups at 3 months and 24 months after operation were significantly higher than the preoperative scores (P lt; 0.01). There was no significant difference in JOA score between 2 groups at 3 months after operation (t=1.620 5, P=0.114 6), but the JOA score of microplate group was significantly higher than that of anchor group at 24 months after operation (t=3.454 3, P=0.001 5). X-ray film, MRI, and CT scan at 3-6 months after operation displayed that door spindle reached bony fusion. There was no occurrence of ‘‘re-close of door’’ in 2 groups. The rate of compl ication in microplate group (13.3%, 2/15) was significantly lower than that in anchor group (25.0%, 5/20) (χ2=7.160 0, P=0.008 6). Conclusion ELP by microplate fixation can achieve the stabil ity quickly after operation, which can help patients to do functional exercises early, and has satisfactory effectiveness and less complications.
ObjectiveTo systematically review the efficacy and safety of radio-chemotherapy combined with thermotherapy for cervical cancer.
MethodsLiterature about the efficacy and safety of radio-chemotherapy combined with thermotherapy for patients with cervical cancer at mid-term/advanced stage was retrieved from digital databases of The Cochrane Library (Issue 7, 2013), PubMed, EMbase, CBM, VIP, CNKI, and WanFang Data, and from their established dates to July, 2013. Data extraction and quality assessment of included studies were conducted by two reviewers independently. RevMan 5.2 software was then used to perform meta-analysis.
ResultsA total of 9 randomized controlled trials involving 693 patients were included. The results of meta-analysis showed that, compared with the radio-chemotherapy alone group, the radio-chemotherapy combined with thermotherapy group had significant increased 1-year survival rates (OR=3.05, 95%CI 1.70 to 6.68, P=0.005), 2-year survival rates (OR=2.29, 95%CI 1.19 to 4.38, P=0.01), and overall effective rates (OR=3.66, 95%CI 2.31 to 5.81, P < 0.000 01). The incidence of adverse reactions was no statistically significant between the two groups.
ConclusionRadio-chemotherapy combined with thermotherapy improves long-term survival rates and short-term curative effects for patients with cervical cancer at mid-term/advanced stage. However, due to the limited quantity and quality of the included studies, more high quality studies with large sample size and long-term follow-up are still needed to verify the above conclusion.
Objective To investigate the imaging characteristics of cervical kyphosis and spinal cord compression in cervical spondylotic myelopathy (CSM) with cervical kyphosis and the influence on effectiveness. Methods The clinical data of 36 patients with single-segment CSM with cervical kyphosis who were admitted between January 2020 and December 2022 and met the selection criteria were retrospectively analyzed. The patients were divided into 3 groups according to the positional relationship between the kyphosis focal on cervical spine X-ray film and the spinal cord compression point on MRI: the same group (group A, 20 cases, both points were in the same position), the adjacent group (group B, 10 cases, both points were located adjacent to each other), and the separated group (group C, 6 cases, both points were located >1 vertebra away from each other). There was no significant difference between groups (P>0.05) in baseline data such as gender, age, body mass index, lesion segment, disease duration, and preoperative C2-7 angle, C2-7 sagittal vertical axis (C2-7 SVA), C7 slope (C7S), kyphotic Cobb angle, fusion segment height, and Japanese Orthopedic Association (JOA) score. The patients underwent single-segment anterior cervical discectomy with fusion (ACDF). The occurrence of postoperative complications was recorded; preoperatively and at last follow-up, the patients’ neurological function was evaluated using the JOA score, and the sagittal parameters (C2-7 angle, C2-7 SVA, C7S, kyphotic Cobb angle, and height of the fused segments) were measured on cervical spine X-ray films and MRI and the correction rate of the cervical kyphosis was calculated; the correlation between changes in cervical sagittal parameters before and after operation and the JOA score improvement rate was analyzed using Pearson correlation analysis. Results In 36 patients, only 1 case of dysphagia occurred in group A, and the dysphagia symptoms disappeared at 3 days after operation, and the remaining patients had no surgery-related complications during the hospitalization. All patients were followed up 12-42 months, with a mean of 20.1 months; the difference in follow-up time between the groups was not significant (P>0.05). At last follow-up, all the imaging indicators and JOA scores of patients in the 3 groups were significantly improved when compared with preoperative ones (P<0.05). The correction rate of cervical kyphosis in group A was significantly better than that in group C, and the improvement rate of JOA score was significantly better than that in groups B and C, all showing significant differences (P<0.05), and there was no significant difference between the other groups (P>0.05). The correlation analysis showed that the improvement rate of JOA score was negatively correlated with C2-7 angle and kyphotic Cobb angle at last follow-up (r=?0.424, P=0.010; r=?0.573, P<0.001), and positively correlated with the C7S and correction rate of cervical kyphosis at last follow-up (r=0.336, P=0.045; r=0.587, P<0.001), and no correlation with the remaining indicators (P>0.05). Conclusion There are three main positional relationships between the cervical kyphosis focal and the spinal cord compression point on imaging, and they have different impacts on the effectiveness and sagittal parameters after ACDF, and those with the same position cervical kyphosis focal and spinal cord compression point have the best improvement in effectiveness and sagittal parameters.
Objective To evaluate the biomechanical characteristicsof titanium mesh with anterior plate fixation or ilium autograft in anterior cervical decompression.Methods Six fresh cervical spine specimens(C3-7) of young cadaver were used in the biomechanical test. After C5, C5,6 and C4-6 were given vertebrectomy,ilium autograft and titanium mesh with anterior plate fixation were performed. Their stabilities of flexion,bilateral axial rotation,the lateral bending and the extension were tested. Intact cervical spine specimens served as control group. Results Ilium autograft improved the stability of the unstable cervical vertebrae and decreased the flexion, the lateral bending or the extension, showing a significant difference when compared with control group(Plt;0.05). Whereas, axial rotational motion was decreased insignificantly(Pgt;0.05). Titanium meshwith anterior plate fixation improved the stability of the unstable spine and decreased the flexion,the bilateral axial rotation,the lateral bending or the extension, showing a significant difference when compared with control group(Plt;0.05). Conclusion The vertebrectomy and anterior cervical fusion by ilium autograft was the least stable construct of all modes tested,and the titanium mesh implantation is stabler than the intact cervical sample.
Objective To investigate the correlation between cervical Modic change (MC) and blood lipid and glucose levels. Methods Patients hospitalized with neck and shoulder pain in the Affiliated Hospital of North Sichuan Medical College between January 2015 and January 2021 were selected and divided into MC group and non-MC group according to whether the signal changes of cervical vertebral endplate occurred on MRI. The general data (age, gender, smoking history, drinking history), blood lipid indicators (high-density lipoprotein, low-density lipoprotein, lipoprotein a, total cholesterol, triglyceride) and blood glucose indicators (glycosylated hemoglobin, fasting blood glucose) were compared between the two groups. Multivariate logistic regression analysis was used to explore the correlation between MC and various indicators. Results A total of 160 patients were included, including 48 patients in MC group and 112 patients in non-MC group. The age [(61.46±12.10) vs. (56.22±10.65) years], total cholesterol [(5.06±1.17) vs. (4.44±1.31) mmol/L], triglyceride [(1.61±0.64) vs. (1.38±0.58) mmol/L], glycosylated hemoglobin (6.78%±1.27% vs. 5.79%±0.85%), and fasting blood glucose [(7.84±1.51) vs. (6.93±1.47) mmol/L] of the patients in MC group were significantly higher than those in non-MC group (P<0.05). There was no significant difference in gender, smoking ratio, drinking ratio, high-density lipoprotein, low-density lipoprotein or lipoprotein a between the two groups (P>0.05). Logistic regression analysisshowed that age [odds ratio (OR)=1.064, 95% confidence interval (CI) (1.022, 1.109), P=0.003], total cholesterol [OR=1.788, 95%CI (1.187, 2.694), P=0.005], triglyceride [OR=2.624, 95%CI (1.257, 5.479), P=0.010] and glycosylated hemoglobin [OR=4.942, 95%CI (2.446, 9.987), P<0.001] were risk factors of cervical MC. Conclusions Age, total cholesterol, triglyceride and glycosylated hemoglobin are risk factors of cervical MC. Elderly patients with hyperlipidemia and hyperglycemia should be alert to the occurrence of cervical MC. Controlling the levels of blood lipid and glucose may reduce the risk of cervical MC.
