Yuan Y.,Changzheng Hospital |
Chen X.-S.,Shanghai JiaoTong University |
Liu S.-Y.,Changzheng Hospital |
Shen K.-W.,Shanghai JiaoTong University
American Journal of Roentgenology | Year: 2010
OBJECTIVE. Prediction of pathologic complete remission in breast cancer after preoperative therapy presents difficulties. We performed a meta-analysis to determine the ability of MRI to predict pathologic complete remission in patients with breast cancer after preoperative therapy. MATERIALS AND METHODS. Medical subject heading terms ("MRI" and "Breast Neoplasm") and key words ("neoadjuvant" or "primary systemic" or "preoperative" or "presurgery") were used for a literature search in the MEDLINE database. A meta-analysis of pooled data from eligible studies was performed to estimate the accuracy of MRI in predicting pathologic complete remission after preoperative therapy in patients with breast cancer. RESULTS. Twenty-five studies were included in this meta-analysis. Pooled weighted estimates of sensitivity and specificity were 0.63 (range, 0.56-0.70) and 0.91 (range, 90.89-0.92), respectively. Heterogeneity between studies was highly influenced by the pathologic complete remission rate, with a regression coefficient of -6.160 (p = 0.020). Subgroup analysis showed that the specificity of MRI in studies with a pathologic complete remission rate of ≥ 20% was lower than that in studies with a pathologic complete remission rate of < 20% (p = 0.0003). CONCLUSION. This meta-analysis indicates that MRI has high specificity and relatively lower sensitivity in predicting pathologic complete remission after preoperative therapy in patients with breast cancer. The pathologic complete remission rate may influence the performance of MRI accuracy in this setting, which deserves further investigation. © American Roentgen Ray Society.
Liu Z.-T.,Shanghai JiaoTong University |
Fu P.-L.,Changzheng Hospital |
Wu H.-S.,Changzheng Hospital |
Zhu Y.,Changzheng Hospital
Knee | Year: 2012
Objective: To compare the results of primary total knee arthroplasty with patellar reshaping or resurfacing. Methods: One hundred thirty-three patients were randomized into patellar reshaping group and patellar resurfacing group. Patellar reshaping includes resecting the partial lateral facet of the patella and the osteophytes surrounding the patella, trimming the patella to match the trochlea of the femoral component. The minimum follow-up time was 7. years. The outcome was measured by anterior knee pain rate, Knee Society clinical score, and radiographs. Results: Eight patients in the reshaping group (12.5%) and 10 patients in the resurfacing group (14.7%) complained of anterior knee pain (P= 0.712). Meanwhile, there were no significant differences between the two groups in terms of total Knee Society score, Knee Society pain score, Knee Society function score, as well as anterior knee pain rate. Conclusions: With the numbers available, there was no significant difference between the groups treated with patellar reshaping or patellar resurfacing with regard to the KSS, anterior knee pain rate and radiographs. We prefer reshaping the patella to resurfacing the patella because the former preserves sufficient patellar bone stock and can easily be converted to patellar replacement if patients complain of recurrent anterior knee pain. © 2011 Elsevier B.V.
Sun A.,Jiangsu University |
Yu G.,Changzheng Hospital |
Dou X.,Jiangsu University |
Yan X.,Center for Health Research |
And 2 more authors.
Molecular Cancer | Year: 2015
Background: Gastric cardia adenocarcinoma (GCA) is the most aggressive subtype of gastric carcinoma. New molecular markers and therapeutic targets are needed for diagnosis, prognosis and treatment of GCA. This study is to establish the E3 ubiquitin ligase Nedd4-1 as a prognostic biomarker to predict the survival and guide the treatment of GCA patients. Methods: Expression of Nedd4-1 in 214 GCA tumor samples was detected by immunohistochemistry staining (IHC) using tissue microarray assay (TMA). Association of Nedd4-1 with cumulative survival of the TNM stages I-III patients and clinicopathological characteristics was statistically analyzed. The role of Nedd4-1 in gastric cancer cell migration and invasion were determined by transwell and wound healing assays. Results: Nedd4-1 is overexpressed in 83% of the GCA tumors. The 5-year survival rate in Nedd4-1 negative GCA patients is as high as 96%. Log-rank analysis indicated that overexpression of Nedd4-1 is inversely correlated with cumulative survival (χ 2 = 21.885, p <0.001). Multivariate logistic regression analysis showed that overexpression of Nedd4-1 is associated with an extremely low GCA survival rate with a hazard ratio (HR) = 0.068 (p = 0.008) in TNM stages I-III patients. Statistical analysis of association of Nedd4-1 overexpression with clinicopathological characteristics revealed that overexpression of Nedd4-1 is tightly associated with TNM stage (p < 0.001). Knockdown of Nedd4-1 in gastric cancer cell lines AGS and N87 dramatically inhibited the gastric cancer cell migration and invasion. Conclusions: Our results indicate that Nedd4-1 is an exceptional prognostic biomarker for GCA and suggest that Nedd4-1 may play an essential role in GCA metastasis. © 2014 Sun et al.; licensee BioMed Central Ltd.
Yu X.,Southwest University |
Li C.,Southwest University |
Hong W.,Southwest University |
Pan W.,Changzheng Hospital |
Xie J.,Southwest University
Cellular Signalling | Year: 2013
Autophagy is a cellular homeostasis mechanism to eliminate unwanted or excessive organelles, or for the turnover of long-life cytosolic macromolecules. During Mycobacterium tuberculosis infection, autophagy represents not only an antimicrobial mechanism for the clearance of the intracellular pathogen, but also prevents excessive inflammation, avoiding the adverse effects on host. Here we focus on the anti-tuberculosis autophagy and signal pathways involved, and attempt to depict an integrative map of the interaction between autophagy and cytokine, ROS production, vitamin D, and inflammatory response. Novel autophagy-based therapy is also summarized. This integrative insight might add some novel thoughts for better tuberculosis medications. © 2013 Elsevier Inc.
Ren D.,Changzheng Hospital |
Hu Z.,Changzheng Hospital |
Yuan W.,Changzheng Hospital
Spine | Year: 2016
Study Design. A kinematic study of cervical spine. Objective. The aim of the study was to confirm the interesting manifestation observed in the dynamic images of the cervical spine movement from full-extension to full-flexion. To further explore the fine motion of total process of cervical spine movement with the new concept of Cobb angular velocity (CAV). Summary of Background Data. Traditionally range of motion (ROM) is used to describe the cervical spine movement from extension to flexion. It is performed with only end position radiographs. However, these radiographs fail to explain how the elaborate movement happens. Methods. The dynamic images of the cervical spine movement from full-extension to full-flexion of 12 asymptomatic subjects were collected. After transforming these dynamic images to static lateral radiographs, we overlapped C7 cervical vertebrae of each subject and divided the total process of cervical spine movement into five equal partitions. Finally, CAV values from C2/3 to C6/7 were measured and analyzed. Results. A broken line graph was created based on the data of CAV values. A simple motion process was observed in C2/3 and C3/4 segments. The motion processes of C4/5 and C5/6 segments exhibited a more complex track of "N" and "W" than the other segments. The peak CAV values of C4/5 and C5/6 were significantly greater than the other segments. From C2/3 to C6/7, the peak CAV value appeared in sequence. Conclusion. The intervertebral movements of cervical spine did not take a uniform motion form when the cervical spine moved from full-extension to full-flexion. From C2/3 to C6/7, the peak CAV value appeared in order. The C4/5 and C5/6 segments exhibited more complex kinematic characteristics in sagittal movement. This leads to C4/5 and C5/6 more vulnerable to injury and degeneration. We had a hypothesis that there was a positive correlation between injury/degeneration and complexity of intervertebral movement in the view of CAV. © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Fang W.,Changzheng Hospital |
Fa Z.,Changzheng Hospital |
Liao W.,Changzheng Hospital
Fungal Genetics and Biology | Year: 2015
Cryptococcosis is a significant invasive fungal infection with noteworthy morbidity and mortality, primarily caused by Cryptococcus neoformans and Cryptococcus gattii. In China, C. neoformans var. grubii (especially molecular type VNI) is the most common variety in the environment and responsible for the majority of cryptococcal infections. C. gattii infections are quite rare in China and the primary molecular type is VGI, which is closely related to C. gattii isolates in Australia. Interestingly, the majority of cryptococcosis in China were reported in the HIV-uninfected patients (especially immunocompetent hosts). This unique phenomenon may be attributed to multiple polymorphisms in the genes encoding mannose-binding lectin (MBL) and Fc-gamma receptor 2B (. FCGR2B) in the Han population, the major ethnic group in China. Compared to immunocompromised patients, immunocompetent patients with cryptococcal meningitis often presented with more intense inflammatory responses and more severe neurological complications, but less fungal burdens and disseminated infection. The overall prognosis, which is independently associated with amphotericin B-based initial therapy, is similar between immunocompetent and immunocompromised patients. In addition, intrathecal administration of amphotericin B has been proved to be an effective adjunctive treatment for cryptococcosis in China. © 2014 The Authors.
Wang X.,Changzheng Hospital |
Dong Y.,Changzheng Hospital |
Qi X.-Q.,Changzheng Hospital |
Li Y.-M.,Changzheng Hospital |
And 2 more authors.
Critical Care | Year: 2013
To assess the efficacy of antimicrobial-impregnated catheters in preventing catheter-related infections during external ventricular drainage (EVD), we performed a meta-analysis and systematic review. We systematically searched Medline, Embase, and the Cochrane Library. All randomized controlled trials (RCTs) and nonrandomized prospective studies (NPSs) related to antimicrobial-impregnated EVD catheters were included. The primary outcome was the rate of cerebrospinal fluid infection (CFI). The secondary outcomes included the rate of time-dependent CFI and catheter bacterial colonization. We further performed subgroup analysis, meta-regression analysis, and microbial spectrum analysis. Four RCTs and four NPSs were included. The overall rate of CFIs was 3.6% in the antimicrobial-impregnated catheter group and 13.7% in the standard catheter group. The pooled data demonstrated that antimicrobial-impregnated catheters were superior to standard catheters in lowering the rate of CFIs (odds ratio (OR) = 0.25, 95% confidence interval (CI) = 0.12 to 0.52, P <0.05). In survival analysis, the 20-day infection rate was significantly reduced with the use of antimicrobial-impregnated catheters (hazard ratio = 0.52, 95% CI = 0.29 to 0.95, P <0.05). Furthermore, a significantly decreased rate of catheter bacterial colonization was noticed for antimicrobial-impregnated catheters (OR = 0.37, 95% CI = 0.21 to 0.64, P <0.05). In subgroup analyses, although significant results remained for RCTs and NPSs, a subgroup difference was revealed (P <0.05). Compared with standard catheters, a significantly lower rate of CFIs was noticed for clindamycin/rifampin-impregnated catheters (OR = 0.27, 95% CI = 0.10 to 0.73, P <0.05) and for minocycline/rifampin-impregnated catheters (OR = 0.11, 95% CI = 0.06 to 0.21, P <0.05). However, no statistical significance was found when compared with silver-impregnated catheters (OR = 0.33, 95% CI = 0.07 to 1.69, P = 0.18). In microbial spectrum analysis, antimicrobial-impregnated catheters were shown to have a lower rate of Gram-positive bacterial infection, particularly the coagulase-negative Staphylococcus. In conclusion, the use of antimicrobial-impregnated EVD catheters could be beneficial for the prevention of CFI and catheter bacterial colonization. Although antibiotic-coated catheters seem to be effective, no sufficient evidence supports the efficacy of silver-impregnated catheters. © 2013 BioMed Central Ltd.
Chen J.,Changzheng Hospital |
Xu T.,Changzheng Hospital
Frontiers in Bioscience | Year: 2013
Despite recent therapeutic advances, most patients with glioblastoma multiforme (GBM) experience disease recurrence, with very poor prognosis. Much work still needs to done to improve the treatment efficacy. The optimal management of patients with recurrent GBM is still controversial. This article summarizes the current status of therapeutic strategies in recurrent glioblastoma patients, with an emphasis on more novel approaches and important recent progress. The clinical evidence of current treatment strategies were collected and reviewed. Patients still need comprehensive treatment for recurrent GBM. Surgery may be useful as adjuvant treatment for patients with symptoms due to the effect of the mass or for patients requiring definitive histopathology, but it generally should be combined with another treatment modality; high-precision re-irradiation such as stereotactic radiosurgery or gamma knife is another option. Chemotherapy like fotemustine, or a metronomic schedule of temozolomide regimens and anti-angiogenic agents like bevacizumab could also be considered. Other targeted molecular inhibitors or antiangiogenic therapies, and immunotherapies are still under investigation and their efficacy needs to be evaluated further in the future.
Hou Y.,Changzheng Hospital |
Yuan W.,Changzheng Hospital |
Wang X.,Changzheng Hospital
Journal of Spinal Disorders and Techniques | Year: 2011
STUDY DESIGN: A retrospective study of elderly patients who underwent anterior screw fixation for type II odontoid fractures between 2000 and 2009 was conducted. OBJECTIVE: To evaluate the clinical outcome of anterior screw fixation for type II odontoid fractures in elderly people and to provide valuable information for spinal surgeon reference. SUMMARY OF BACKGROUND DATA: Odontoid fractures are the most common fractures of the cervical spine in patients above 70 years of age, and patients above 80 years of age form the majority of spinal fractures. However, the optimum treatment of type II odontoid fractures in the geriatric population remains controversial. METHODS: A retrospective analysis was performed in 43 patients (19 women; mean age, 80.6 y; range, 65 to 92 y) with type II odontoid fractures who were consecutively admitted to a single medical center between January 2000 and October 2009. Twenty-eight patients had posteriorly displaced odontoid fractures and the remaining 15 had anteriorly displaced odontoid fractures according to the radiographical presentation. Neurological symptoms were present in 4 patients including 3 Frankel D and 1 Frankel C and always occurred in patients with posteriorly displaced odontoid process. The medical records, plain x-rays, and computed tomographic scans of all patients were reviewed. After surgery, patients were discharged with rigid cervical immobilization and clinical follow-ups were between 18 and 24 months (average, 21.3 mo). RESULTS: The mean displacement of odontoid process revealed by preoperative radiologic evaluation was 4.9 mm (ranged from 1 to 10 mm). Anterior screw fixation was performed successfully in 42 cases except 1 in which posterior C1-C2 fusion had to be undertaken to replace the original operation scheme because of technical difficulty. According to postoperative radiologic evaluation, 36 of 42 type II odontoid fracture cases treated with anterior screw fixation achieved fusion within 6 months. The fusion rate was 85.7% (36 of 42). Thirty-four patients regained normal cervical movement, 5 patients had about 25%, and 3 had >25% limited cervical motion. Sixteen patients achieved clinically excellent outcomes, 24 good, and 2 fair outcomes. CONCLUSIONS: Anterior screw fixation can be performed safely in elderly patients with type II odontoid fracture, and the clinical outcomes of this procedure were satisfactory. High fusion rates, low postoperative complications, and maintenance of cervical motion were acquired. The anterior screw fixation can be a reliable and reasonable treatment for type II odontoid fractures in the elderly patients. Copyright © 2011 by Lippincott Williams & Wilkins.
Zhao Q.,Changzheng Hospital
Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi | Year: 2013
To investigate the relationship between the clinical features, pathogenesis, immunophenotype, different classification models and prognosis in Chinese patients with diffuse large B-cell lymphoma (DLBCL). A total of 147 patients with DLBCL who were treated with CHOP-like or R-CHOP were subjected to analysis. Standard two-step Envision method of immunohistochemical staining was used to assess the expression of CD10, Bcl-6, MUM1, FOXP1, GCET1, CD5, Bcl-2, Ki-67, then according to Hans algorithm, Choi algorithm and Molecular markers, we compared the differences of their prognoses. (1) Kaplan-Meier univariate analysis of the clinical data of 147 DLBCL patients found that the 3-year overall survival (OS) rates were better in early stage (P=0.032), low IPI score (P=0.001), less than one extranodal involvement (P=0.014), and complete remission (P<0.01). The prognoses had no significant difference in terms of gender, age, LDH, B symptoms and treatment options (P value> 0.05). (2 )For Hans model, GCB group had 42 cases, the ABC group 85 cases; GCB were 47 cases, ABC 80 cases (according to Choi model). Choi model suggested GCB subtype showed much better prognosis than ABC subtype (P=0.047), while Hans model shed no statistically significant difference (P=0.285). (3) Ki-67 of 75% was found to significantly discriminate patients with good or bad prognosis. In R-CHOP group at the same time, low Ki-67 (P=0.017) and CD5-negative groups (P=0.012) were better. Cox proportional hazards regression model showed that IPI score (P=0.002) and Ki-67 (P=0.019) were independent adverse prognostic factors. The Ann Arbor stage, IPI score, extranodal involvement status and Ki-67 were significantly associated with prognosis .Compared to Hans algorithm, Choi had an advantage to predict the different prognosis between subtypes, and ABC group had poor outcome. Finally, both Ki-67 and IPI score were independent adverse prognostic factors.