扶正泄浊保肾汤对CRF大鼠血浆ET-1、Scr、BUN及肾组织病理的影响

目的：观察扶正泄浊保肾汤对慢性肾衰竭（CRF）大鼠血浆内皮素-1（ET-1）、血肌酐（Scr）、尿素氮（BUN）及肾组织病理的影响,探讨其作用机制.方法：采用5/6肾切除的方法制造CRF模型.将60只雄性SD大鼠随机分为6组：假手术组、模型组、尿毒清组及扶正泄浊保肾汤大、中、小剂量组;分别按一定比例予大、中、小剂量组大鼠灌胃,假手术组及模型组同时间予等体积的生理盐水灌胃.所得数据均采用（±s）表示,组间比较用t检验,采用SPSS 18.0进行统计学处理.结果：各治疗组与模型组间比较,血浆ET-1及Scr、BUN水平显著下降,差异有统计学意义（P＜0.05）,且肾脏病理改变较轻;大、中剂量组与小剂量、尿毒清组间差异有统计学意义（P＜0.05）;大、中剂量组间差异无统计学意义（P＞0.05）;小剂量组与尿毒清组间差异无统计学意义（P＞0.05）.结论：扶正泄浊保肾汤具有降低大鼠血清ET-1、Scr、BUN水平,减轻肾脏病理表现的作用.     

Reduced quality of life in living kidney donors: association with fatigue, societal participation and pre-donation variables

Health related quality of life (HRQoL) of living kidney donors on average is good, but some donors experience a low HRQoL after donation. This study assessed the prevalence of reduced HRQoL and explored associations with pre‐ and post‐donation variables. 316 donors (response rate 74%) who donated a kidney between 1997 and 2009 filled in a questionnaire. HRQoL was measured using the Short‐Form 36; fatigue using the Multidimensional Fatigue Inventory; societal participation using the Utrecht Scale for Evaluation of Rehabilitation‐Participation. Donors on average had better HRQoL than the general population. However, 12% had a reduced physical (PCS) and 18% a reduced mental (MCS) HRQoL. Donors with reduced HRQoL reported greater fatigue (P < 0.01), lower societal participation (P < 0.01) and showed a trend towards statistical significance in experiencing more donor–recipient relationship changes (P = 0.07). Prior to donation, donors with reduced PCS had a higher BMI (P < 0.05) and more often smoked (P < 0.05). Donors with reduced MCS had higher expectations (P < 0.05). Reduced HRQoL is associated with higher BMI, smoking and higher expectations prior to donation. These results may be used to develop a screening instrument to select donors at high risk for reduced HRQoL.     

Prediction of extraprostatic cancer by prostate specific antigen density,endorectal MRI,and biopsy Gleason score in clinically localized prostate cancer

BACKGROUNDS: The present study was designed to identify the preoperative parameters, including PSA-based parameters, and endorectal MRI, predictive of pathological stage in males who underwent radical prostatectomy. METHODS: We studied 114 patients who underwent radical retropubic prostatectomy and pelvic lymphadenectomy for clinically localized prostate cancer. Clinical stage was assessed by DRE, pelvic CT scan, endorectal MRI, and bone scan. The correlation between the preoperative parameters, including PSA-based parameters, clinical stage, and histological findings of biopsy specimens, and the pathological stage was analyzed. Logistic regression analysis was performed to identify a significant set of independent predictors for local extent of disease. RESULTS: Seventy-six (66.6%) patients had organ confined cancer and 38 (33.4%) patients had extraprostatic cancer. Of the 38 patients with extraprostatic cancer, four had seminal vesicle involvement, while, none had pelvic lymph node involvement. Biopsy Gleason score, PSA, PSA-alpha1-antichymotrypsin (PSA-ACT), PSA-density (PSAD), PSA-transition zone density, PSA-ACT density, and PSA-ACT transition zone (TZ) density were significantly higher and percent free PSA was lower in the patients with organ confined cancer than those with extraprostatic cancer (P < 0.01). PSAD showed the largest area under the ROC curve (AUC) among those parameters (AUC = 0.732). Sixty-eight (74.7%) of 91 patients with T2 on endorectal MRI had organ confined cancer, while 15 (65.2%) of 23 patients with T3 had extraprostatic cancer (P < 0.01). Multivariate logistic regression analysis indicated that Gleason score (> or =7 vs. < or =6), endorectal MRI findings, and PSAD were significant predictors of extraprostatic cancer (P < 0.01). CONCLUSIONS: The present study demonstrated that preoperative PSAD was the most valuable predictor among PSA-based parameters for extraprostatic disease in patients with clinically localized prostate cancer. The combination of PSAD, endorectal MRI findings, and biopsy Gleason score can provide additional information for selecting appropriate candidates for radical prostatectomy.     

Histopathological perspective on bone marrow oedema, reactive bone change and haemorrhage

This article presents a systematic review of the current biomedical literature surrounding the aetiopathogenesis and histopathological features of bone marrow oedema, reactive bone change and haemorrhage. Bone marrow oedema is generally demonstrated as a non-specific finding on magnetic resonance imaging in association with infections, tumours and avascular necrosis. When it occurs in isolation as a primary event not triggered by any obvious bony pathology in the clinical setting of debilitating joint pain, it constitutes the "bone marrow oedema syndrome". Although the latter diagnosis is based on magnetic resonance (MR) imaging, showing the lesion as areas of signal hyperintensity within the marrow, recent radiology-histology correlational studies have shown variably interstitial marrow oedema, necrosis, fibrosis and trabecular bone abnormalities. In light of these facts, the use of the term bone marrow oedema syndrome in a radiological context might be considered questionable, but histopathological techniques are not sensitive in detecting increased extracellular fluid. Reactive bone changes may be focal or diffuse and usually amount to increased bone formation. Bone marrow haemorrhage, due to trauma, results in bone bruising, a condition in which the size of the bruise and associated osteochondral injury determines the outcome, although the natural history of these lesions is still being researched.     

MRI上腰椎终板信号改变的影响因素分析———性别、体重、劳动量及吸烟与Modic改变的相关性

目的:探讨腰腿痛患者腰椎MRI上终板Modic改变的分布特点及其相关因素。方法:回顾性分析我院2009年2月～2010年10月收治的210例腰腿痛患者腰椎MRI中Modic改变的发生率及类型,并评估Modic改变与性别、体重、劳动量及吸烟等因素的相关性。结果:47例患者共58个椎间盘邻近椎板存在Modic改变,占入选患者的22.4%。其中男16例;女31例,ModicⅠ型、Ⅱ型和Ⅲ型的人数分别为16例、25例、6例,出现Modic改变的节段为L5/S1(28个)、L4/5(17个)、L3/4(9个)、L2/3(4个)。在肥胖人群中Modic改变的发生率高于正常体重和超重人群(P<0.05),重体力劳动者的发生率高于一般劳动者(P<0.05),劳动量和体重与ModicⅢ型改变有相关性(P<0.05),与其他分型无明显相关性(P>0.05)。吸烟与Modic改变无明显相关性(P>0.05)。结论:患者的性别、体重及劳动量等因素与Modic改变的发生具有相关性,生物力学损伤可能在Modic改变中发挥着重要作用。     

斜外侧椎间融合在Modic改变伴终板硬化腰椎间盘退变治疗中的应用CSCD

目的:探讨Stand-alone斜外侧椎间融合(oblique lateral interbody fusion,OLIF)应用于Modic改变伴终板硬化的腰椎间盘退变治疗的可行性和临床效果。方法:回顾性分析2015年1月至2018年12月3家医疗中心收治的16例Modic改变伴终板硬化的腰椎间盘退变患者。其中男6例,女10例;年龄45~67(55.48±8.07)岁;病史36~240(82.40±47.68)个月。病变部位:L2,32例,L3,45例,L4,59例;均表现为慢性腰痛,伴下肢神经症状3例。采用单纯斜外侧腰椎椎间融合术治疗,术后对临床和影像学结果,以及并发症情况进行观察。结果:术中无血管、终板损伤和椎体骨折。切口长度(4.06±0.42)cm,手术时间(45.12±5.43)min,术中出血量(33.40±7.29)ml;术后72 h切口疼痛视觉模拟评分(visual analogue scale,VAS)为1.14±0.47。所有患者无切口皮肤坏死、愈合不良或感染;出现交感链损伤1例、左大腿前外侧疼痛并麻木2例、左侧髂腰肌无力1例,均为一过性损伤,并发症发生率为25%(4/16)。16例患者均获得随访,时间12~36(20.80±5.46)个月。术后椎间隙高度获得明显的恢复,随访过程中有轻度丢失。末次随访时腰椎冠状面和矢状面平衡均获得良好的改善。融合器无明显沉降或移位,均获得椎间融合。末次随访时日本骨科协会(Japanese Orthop-aedic Association,JOA)评分和Oswestry功能障碍指数(Oswestry disability index,ODI)明显改善。结论:只要严格病例选择,充分的术前检查,采用Stand-alone OLIF治疗Modic改变伴终板硬化的腰椎间盘退变效果良好,临床优势明显,是较好的手术选择。     

The neoadjuvant rectal score and a novel magnetic resonance imaging based neoadjuvant rectal score are stage independent predictors of long-term outcome in locally advanced rectal cancer

Aim

Neoadjuvant rectal (NAR) score is an early surrogate for longer-term outcomes in rectal cancer undergoing radiotherapy and resection. In an era of increasing organ preservation, resection specimens are not always available to calculate the NAR score. Post-treatment magnetic resonance imaging (MRI) re-staging of regression is subjective, limiting reproducibility. We explored the potential for a novel MRI-based NAR score (mrNAR) adapted from the NAR formula.

Methods

Locally advanced rectal cancer patients undergoing neoadjuvant therapy (nCRT) and surgery were retrospectively identified between 2008 and 2020 in a single cancer network. mrNAR was calculated by adapting the NAR formula, replacing pathological (p) stages with post-nCRT MR stages (ymr). Cox regression assessed relationships between clinicopathological characteristics, NAR and mrNAR with overall survival (OS) and recurrence-free survival (RFS).

Results

In total, 381 NAR and 177 mrNAR scores were calculated. On univariate analysis NAR related to OS (hazard ratio [HR] 2.05, 95% confidence interval [CI] 1.33–3.14, p = 0.001) and RFS (HR 2.52, 95% CI 1.77–3.59, p = 0.001). NAR 3-year OS <8 was 95.3%, 8–16 was 88.6% and >16 was 80%. mrNAR related to OS (HR 2.96, 95% CI 1.38–6.34, p = 0.005) and RFS (HR 2.99, 95% CI 1.49–6.00, p = 0.002). 3-year OS for mrNAR <8 was 96.2%, 8–16 was 92.4% and >16 was 78%. On multivariate analysis, mrNAR was a stage-independent predictor of OS and RFS. mrNAR corresponded to NAR score category in only 15% (positive predictive value 0.23) and 47.5% (positive predictive value 0.48) of cases for categories <8 and >16, respectively.

Conclusions

Neoadjuvant rectal score is validated as a surrogate end-point for long-term outcomes. mrNAR categories do not correlate with NAR but have stage-independent prognostic value. mrNAR may represent a novel surrogate end-point for future neoadjuvant treatments that focus on organ preservation.     

Selective use of intraoperative sentinel lymph node pathological evaluation in breast cancer

Background

In breast cancer staging, the need for intraoperative sentinel lymph (SLN) evaluation is not well established. This study compares intraoperative use of touch preparation (TP), frozen section (FS), and factors that may influence the selective use of intraoperative SLN analysis.

Methods

Breast cancer patients (1998-2007) undergoing SLN evaluation were retrospectively reviewed.

Results

Of 205 SLN procedures, 157 cases underwent intraoperative evaluation, 43% (FS) and 57% (TP) with positive pathology in 21% and 20%, respectively. The false negative case rate was 16% for TP versus 12% for FS. Of T1, low-grade tumors, 9% were intraoperatively positive, versus 43% of T2-3, moderate- to high-grade tumors (P = .006). Additional positive axillary nodes were found in 43% of the higher risk patients versus 0% in the lower risk groups.

Conclusions

Both TP and FS are accurate for intraoperative SLN evaluation and can be selectively applied to breast cancer staging in low- and high-risk groups.     

Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain

The prevalence of “vertebral endplate signal changes” (VESC) and its association with low back pain (LBP) varies greatly between studies. This wide range in reported prevalence rates and associations with LBP could be explained by differences in the definitions of VESC, LBP, or study sample. The objectives of this systematic critical review were to investigate the current literature in relation to the prevalence of VESC (including Modic changes) and the association with non-specific low back pain (LBP). The MEDLINE, EMBASE, and SveMED databases were searched for the period 1984 to November 2007. Included were the articles that reported the prevalence of VESC in non-LBP, general, working, and clinical populations. Included were also articles that investigated the association between VESC and LBP. Articles on specific LBP conditions were excluded. A checklist including items related to the research questions and overall quality of the articles was used for data collection and quality assessment. The reported prevalence rates were studied in relation to mean age, gender, study sample, year of publication, country of study, and quality score. To estimate the association between VESC and LBP, 2 × 2 tables were created to calculate the exact odds ratio (OR) with 95% confidence intervals. Eighty-two study samples from 77 original articles were identified and included in the analysis. The median of the reported prevalence rates for any type of VESC was 43% in patients with non-specific LBP and/or sciatica and 6% in non-clinical populations. The prevalence was positively associated with age and was negatively associated with the overall quality of the studies. A positive association between VESC and non-specific LBP was found in seven of ten studies from the general, working, and clinical populations with ORs from 2.0 to 19.9. This systematic review shows that VESC is a common MRI-finding in patients with non-specific LBP and is associated with pain. However, it should be noted that VESC may be present in individuals without LBP.