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.
Objective To simplify surgical technique andincrease postoperative survival rate, sleeve anastomosis technique combined cuff technique was used in developing the model of cervical heart transplantation in rats. Methods In this model, the hearts from 25 male SD rats were transplanted into the neck of Wistar rats by anastomosing the donor innominate artery to the recipient right common carotid artery by use of sleeve technique, and the donor pulmonary artery to the recipient right external jugular vein by use of cuff technique. After operation,the rats were treated with cyclosporine A (1.5mg/kg, q.d.), transplanted hearts were followed by daily inspection or palpation and the allograft survival time was more than 3 days as the standard of successful operation. Results The mean operative time was (48.7±3.4) min, with a successful rate of 88%(22/25). Complications were anastomotic hemorrhage( 1 case) and thrombosis(2 cases). During the followup period, 6 rats died of pulmonary infection, abscess in the neck,liver or bladder tumor. The remaining 16 transplanted hearts survived more than3 months. Conclusion The modified operation have advantages ofless operative procedure, shorter operation and ischemia time and easier monitoring of graft function.
ObjectiveTo systematically review the efficacy and safety of hyperthermia in combination with radiation, chemotherapy or both for middle/advanced cervical cancer patients (LACC). MethodsThe databases such as PubMed, The Cochrane Library (Issue 6, 2013), CNKI, WanFang Data and VIP were searched from inception to July 1st, 2013 for randomized controlled trials (RCTs) that investigated hyperthermia in combination with radiation, chemotherapy or both for LACC for cervical cancer at middle/advanced stage. Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data, and evaluated methodological quality of included studies. Meta-analysis was then performed using RevMan 5.2.6 software. ResultsSix RCTs were included. A descriptive analysis was conducted due to significant heterogeneities among the results of studies. Out of 6 studies, the results of 4 studies showed that hyperthermia increased complete remission rate; the results of 3 studies reported objective effectiveness; while only one study showed statistical significance. Overall survival was reported in all studies, while only one study showed that hyperthermia significantly improved overall survival. Only one study reported 3-year progression-free survival with statistical significance. Two studies reported disease-free survival but only one showed statistical significance. Only two studies reported adverse events, and the data in one study showed acute toxicities of Grade 2-3 were higher for hyperthermia with unclear long-term reaction. ConclusionCurrent evidence is insufficient to confirm the efficacy and safety of hyperthermia for cervical cancer, and large-scale well-designed RCTs are further needed to verify the efficacy and safety of hyperthermia in the combined treatment of cervical cancer.
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.
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 evaluate the effectiveness of posterior cervical decompressive laminectomy and lateral mass screw fixation combined with foraminotomy for treating cervical radiculo-myelopathy. MethodsBetween January 2010 and January 2012, 58 patients with cervical radiculo-myelopathy were treated by posterior cervical decompressive laminectomy and lateral mass screw fixation combined with foraminotomy. There were 31 males and 27 females, with an average age of 52.7 years (range, 41-72 years). The mean disease course was 5.4 years (range, 3-15 years). The preoperative Japanese Orthopaedic Association (JOA) score was 7.8±1.3, and visual analogue scale (VAS) score was 6.8±1.7. There were 37 cases of inter-vertebral disc herniation and ligamentum flavum hypertrophy, 11 cases of vertebral osteophyte formation with the osteophyte spinal canal occupational ratio of 51.7%±18.1%, and 10 cases of inter-vertebral disc herination with cervical instability. Preoperative cervical curvature was (-5.5±12.5)°. The fixed segments included C3-7 in 29 cases, C4-7 in 19 cases, and C3-6 in 10 cases. Foraminotomy was performed in 135 nerve foramina (mean, 2.33 foramina). ResultsThe mean operation time was 204 minutes (range, 167-260 minutes), and the mean blood loss was 273 mL (range, 210-378 mL). No injury of vertebral artery or nerve root occurred during operation. Postoperative subcutaneous hematoma and cervical axial pain occurred in 1 case and 8 cases, respectively; and no nerve root palsy was observed. The patients were followed up 2.1-4.3 years (mean, 3.4 years). The postoperative JOA score was significantly increased to 14.1±1.7 (t=-27.672, P=0.000), with an improvement rate of 68.5%±21.9%. Postoperative VAS score was significantly decreased to 2.1±1.1 (t=15.168, P=0.000). The imaging examination showed adjacent segmental degeneration in 1 patient, who had no clinical symptom. There was no screw loosening or pseudoarthrosis formation during follow-up. The cervical curvature was (13.6±5.1)° at 5 days and was (13.2±4.8)° at 2 years, showing significant difference when compared with preoperative one (P < 0.05). The osteophyte spinal canal occupational ratio was 36.5%±10.4% at 2 years, showing significant difference when compared with preoperative one (t=6.921, P=0.000). ConclusionThe procedure of posterior cervical decompressive laminectomy and lateral mass screw fixation combined with foraminotomy is effect in treating cervical radiculo-myelopathy. The spinal cord and nerve root can be adequately decompressed by laminectomy and foraminotomy. The lateral mass screw fixation can correct the cervical curvature and further reduce the tension to spinal cord.
ObjectiveTo review the definition and possible etiologies for C5 palsy. MethodsThe literature on C5 palsy at home and abroad in recent years was extensively reviewed, and the possible etiologies were analyzed based on clinical practice experience. ResultsThere are two main theories (nerve root tether and spinal cord injury) accounting for the occurrence of C5 palsy, but both have certain limitations. The former can not explain the occurrence of C5 palsy after anterior cervical spine surgery, and the latter can not explain that the clinical symptoms of C5 palsy is often the motor dysfunction of the upper limb muscles. Based on the previous reports, combining our clinical experience and research, we propose that the occurrence of C5 palsy is mainly due to the instrumental injury of anterior horn of cervical spinal cord during anterior cervical decompression. In addition, the C5 palsy following surgery via posterior approach may be related to the nerve root tether caused by the spinal cord drift after decompression. ConclusionIn view of the main cause of C5 palsy after cervical decompression, it is recommended to reduce the compression of the spinal cord by surgical instruments to reduce the risk of this complication.
In the context of accelerated rehabilitation, nutritional support for patients with orthopedic cervical spondylosis is an important condition for lessening postoperative stress response, reducing postoperative complications, shortening patient’s length of hospital stay, lowering medical expenses, and promoting early recovery of patients. Based on this, West China Hospital of Sichuan University explored and established the West China Hospital program for nutritional management in cervical spondylosis from the aspects of team building, nutritional assessment and monitoring, and nutritional intervention.
ObjectiveTo investigate the expression of β-catenin and Galectin-3 protein in human cervical carcinoma and its clinical pathological significance. MethodsEighty-three cervical specimens were collected from January 2010 to June 2013. By immunohistochemical method, β-catenin and Galectin-3 expression of the 83 cases of cervical carcinoma, 45 cases of intraepithelial neoplasia (CIN) and 25 normal cervix tissue (control) were detected. ResultsThe positive expression rate in cervical carcinoma of β-catenin and Galectin-3 was respectively 74.70% and 81.93%, which was significantly higher than that in intraepithelial neoplasia (ⅠandⅡ) and normal cervical tissue (P<0.05). Compared with cervical cancer, the expression of β-catenin and Galectin-3 in CINⅢ had no statistical significance (P>0.05). The positive expression of β-catenin was significantly correlated with histological grade of cervical cancer tissue, International Federation of Gynecology and Obstetrics grade and lymph node metastasis (P<0.05). The positive expression of Galectin-3 was closely related to histological grade of cervical cancer tissue and lymph node metastasis (P>0.05). Both β-catenin and Galectin-3 expression had no relationship with other clinical pathological parameters, such as age of patients, tumor size and pathological pattern of tumor (P>0.05). β-catenin expression had significant positive correlation with that of Galectin-3 (r=0.327, P=0.002). ConclusionThe expression of Galectin-3 and β-catenin increases obviously and is associated with abnormal clinical parameters (invasion or metastasis) in patients with cervical cancer. Galectin-3 and β-catenin may act as cancer metastasis and prognostic indicators in these patients.
Objective To compare the effectiveness of a zero-profile three-dimensiaonal (3D)-printed microporous titanium alloy Cage and a conventional titanium plate combined with a polyether-ether-ketone (PEEK)-Cage in the treatment of single-segment cervical spondylotic myelopathy (CSM) by anterior cervical discectomy and fusion (ACDF). Methods The clinical data of 83 patients with single-segment CSM treated with ACDF between January 2022 and January 2023 were retrospectively analyzed, and they were divided into 3D-ZP group (35 cases, using zero-profile 3D-printed microporous titanium alloy Cage) and CP group (48 cases, using titanium plate in combination with PEEK-Cage). There was no significant difference in gender, age, disease duration, surgical intervertebral space, and preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, neck disability index (NDI), vertebral height at the fusion segment, Cobb angle, and other baseline data between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, complications, interbody fusion, and prosthesis subsidence were recorded and compared between the two groups. VAS score, NDI, and JOA score were used to evaluate the improvement of pain and function before operation, at 3 months after operation, and at last follow-up, and the vertebral height at the fusion segment and Cobb angle were measured by imaging. The degree of dysphagia was assessed by the Bazaz dysphagia scale at 1 week and at last follow-up. Results The operation was successfully completed in all the 83 patients. There was no significant difference in intraoperative blood loss and hospital stay between the two groups (P>0.05), but the operation time in the 3D-ZP group was significantly shorter than that in the CP group (P<0.05). Patients in both groups were followed up 24-35 months, with an average of 25.3 months, and there was no significant difference in the follow-up time between the two groups (P>0.05). The incidence and grade of dysphagia in CP group were significantly higher than those in 3D-ZP group at 1 week after operation and at last follow-up (P<0.05). There was no dysphagia in 3D-ZP group at last follow-up. There was no complication such as implant breakage or displacement in both groups. The intervertebral fusion rates of 3D-ZP group and CP group were 65.71% (23/35) and 60.42% (29/48) respectively at 3 months after operation, and there was no significant difference between the two groups [OR (95%CI)=1.256 (0.507, 3.109), P=0.622]. The JOA score, VAS score, and NDI significantly improved in the 3D-ZP group at 3 months and at last follow-up when compared with preoperative ones (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no significant difference in the improvement rate of JOA between the two groups at last follow-up (P>0.05). At 3 months after operation and at last follow-up, the vertebral height at the fusion segment and Cobb angle significantly improved in both groups, and the two indexes in 3D-ZP group were significantly better than those in CP group (P<0.05). At last follow-up, the incidence of prosthesis subsidence in 3D-ZP group (8.57%) was significantly lower than that in CP group (29.16%) (P<0.05). ConclusionThe application of zero-profile 3D-printed Cage and titanium plate combined with PEEK-Cage in single-segment ACDF can both reconstruct the stability of cervical spine and achieve good effectiveness. Compared with the latter, the application of the former in ACDF can shorten the operation time, reduce the incidence of prosthesis subsidence, and reduce the incidence of dysphagia.