Publications by authors named "Zhi-Wei Wang"

266 Publications

Targeting cancer stem cells by nutraceuticals for cancer therapy.

Semin Cancer Biol 2021 Jul 14. Epub 2021 Jul 14.

Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China. Electronic address:

Accumulating evidence has demonstrated that cancer stem cells (CSCs) play an essential role in tumor progression and reoccurrence and drug resistance. Multiple signaling pathways have been revealed to be critically participated in CSC development and maintenance. Emerging evidence indicates that numerous chemopreventive compounds, also known as nutraceuticals, could eliminate CSCs in part via regulating several signaling pathways. Therefore, in this review, we will describe the some natural chemopreventive agents that target CSCs in a variety of human malignancies, including soy isoflavone, curcumin, resveratrol, tea polyphenols, sulforaphane, quercetin, indole-3-carbinol, 3,3'-diindolylmethane, withaferin A, apigenin, etc. Moreover, we discuss that eliminating CSCs by nutraceuticals might be a promising strategy for treating human cancer via overcoming drug resistance and reducing tumor reoccurrence.
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http://dx.doi.org/10.1016/j.semcancer.2021.07.008DOI Listing
July 2021

The emerging role of WWP1 in cancer development and progression.

Cell Death Discov 2021 Jun 21;7(1):163. Epub 2021 Jun 21.

Department of Hepatobiliary Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.

Emerging evidence demonstrates that WW domain-containing E3 ubiquitin protein ligase 1 (WWP1) participates into carcinogenesis and tumor progression. In this review article, we will describe the association between dysregulated WWP1 expression and clinical features of cancer patients. Moreover, we summarize the both oncogenic and tumor suppressive functions of WWP1 in a variety of human cancers. Furthermore, we briefly describe the downstream substrates of WWP1 and its upstream factors to regulate the expression of WWP1. Notably, targeting WWP1 by its inhibitors or natural compounds is potentially useful for treating human malignancies. Finally, we provide the perspectives regarding WWP1 in cancer development and therapies. We hope this review can stimulate the research to improve our understanding of WWP1-mediated tumorigenesis and accelerate the discovery of novel therapeutic strategies via targeting WWP1 expression in cancers.
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http://dx.doi.org/10.1038/s41420-021-00532-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8257788PMC
June 2021

Monoterpene indole alkaloids from the roots of Bousigonia mekongensis and their anti-diabetic nephropathy activity.

Fitoterapia 2021 Jun 17;153:104964. Epub 2021 Jun 17.

Institute of Materia Medica, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan 250000, China. Electronic address:

Four new monoterpene indole alkaloids (1-4) together with six known alkaloids (5-10) were isolated from the roots of Bousigonia mekongensis. Compounds 3 and 4 were the first examples of condylocarpan-adenine type alkaloids obtained from natural plant resource. Their structures were elucidated on the basis of spectroscopic data. All compounds were evaluated for their inhibiting glucose-induced mesanginal cell proliferation and protecting high glucose-evoked podocyte injury activities. (-)-demethoxycarbonyldihydrogambirtannine (5) can significantly antagonize glucose-induced podocyte injury with EC value of 6.5 ± 1.2 μM.
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http://dx.doi.org/10.1016/j.fitote.2021.104964DOI Listing
June 2021

Efficacy Analysis of Selection of Distal Reference Point for Tibial Coronal Plane Osteotomy during Total Knee Arthroplasty: A Literature Review.

Orthop Surg 2021 Jul 17;13(5):1682-1693. Epub 2021 Jun 17.

Department of Bone and Joint, The First Hospital of Jilin University, Changchun, China.

Total knee arthroplasty is an effective treatment for end-stage knee osteoarthritis. The tibial platform osteotomy must take full account of the coronal plane, the sagittal plane, and the rotational alignment of the tibial prosthesis. During surgery, individual differences in the coronal alignment of the tibia need to be taken into account as poor alignment after surgery can lead to rapid wear of the tibial platform, reducing the longevity of the prosthesis and adversely affecting quality of life. Intraoperative tibial osteotomies are often performed using extramedullary alignment. When an extramedullary alignment approach is used, the proximal tibial osteotomy guide is usually placed in the medial third of the tibial tuberosity. There is no consensus on the most reliable anatomical landmarks or axes for achieving distal tibial coronary alignment. Anatomical points or reference axes that are highly reproducible and precise need to be identified. From available data it appears that most surgeons use the extensor hallucis longus tendon, the second metatarsal, and the anterior tibial cortex to determine the distal localization point. However, its accuracy has not been confirmed in clinical and radiographic data, and the alignment concept and preoperative planning for total knee arthroplasty has paid more attention to rotational alignment, but there are few studies on the coronal alignment of the tibia. This article reviews the recent use of the distal tibial coronal osteotomy reference point in total knee arthroplasty. However, due to there being only a small number of studies available, the evidence collected is insufficient to prove that a certain reference axis has obvious advantages and a combination of different reference points is needed to achieve the ideal lower extremity force line angle.
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http://dx.doi.org/10.1111/os.13054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313145PMC
July 2021

Spino cranial angle as a predictor of loss of cervical lordosis after laminoplasty in patients with cervical myelopathy.

BMC Surg 2021 Jun 12;21(1):291. Epub 2021 Jun 12.

Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.

Background: To explore the relationship between spino cranial angle (SCA) and loss of cervical lordosis (LOCL), and to determine whether SCA has the ability to predict LOCL for patients with cervical myelopathy.

Methods: A total of 68 consecutive patients with cervical myelopathy who received laminoplasty (LAMP) were selected to the current study. C2-C7 lordosis was defined as a representation of the cervical alignment. Alignment change > 0° was considered LOCL. Multiple linear regression analysis was applied to evaluate the association between LOCL and various sagittal parameters at preoperative, such as SCA, CL, T1s and cSVA. Linear regression analysis was applied to evaluate the relationships between LOCL and preoperative SCA in each subgroup.

Results: Patients were assigned to three groups depending on the quartile of preoperative SCA. The first quarter of patients were defined as the low SCA group, the last quarter were defined as the high SCA group and the middle half were defined as the middle SCA group. There was no statistically significant difference in age, sex and the type of OPLL among the three groups. Patients in the low SCA group showed more cervical lordosis before surgery and more LOCL after LAMP (p < 0.001). After linear regression analysis for SCA and LOCL, preoperative SCA was negatively correlated with LOCL in the low SCA group (r = - 0.857, p < 0.001) and high SCA group (r = - 0.515, p = 0.034). However, there was no significant correlation between preoperative SCA and LOCL in the middle SCA group (r = 0.027, p = 0.881).

Conclusions: Patients with lower SCA had more lordosis preoperatively and performed more LOCL after LAMP at 2 years of follow-up. Both too high or low preoperative SCA were negatively correlated with the degree of LOCL, while when the SCA fluctuates in a suitable range, it is easier to compensate for the changes of cervical sagittal alignment.
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http://dx.doi.org/10.1186/s12893-021-01293-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199803PMC
June 2021

Repair of Delayed Meningeal Cyst after Spinal Surgery with Paraspinal Muscle Flap under Microscope.

J Invest Surg 2021 May 26:1-8. Epub 2021 May 26.

Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China.

Background: Delayed meningeal cyst (DMC) is a rare complication after spinal surgery that is often ignored by clinicians, and its in-depth research is infrequent. In particular, no consensus has been reached about its surgical treatment. We found that patients with a DMC failed after conservative treatment, epidural blood patch, subarachnoid drainage, and initial attempts to eliminate the meningeal cyst. Therefore, we introduce the application of a paraspinal muscle flap repair under a microscope for the treatment of DMC.

Methods: In this study, 13 patients who were repaired by a paraspinal muscle flap under a microscope for DMC from January 2007 to January 2017 were retrospectively reviewed. Their ages were 18-68 years old (mean age 48.7 years). The course of the disease ranged from 3 weeks to 28 months after the operation for the primary disease, with an average of 10.6 months. Length >5 cm was called a large DMC and length >8 was called a giant DMC. By analyzing the effect of surgical treatment, we summarized the treatment experience of DMC and evaluated the risk factors for the formation of DMC.

Results: All patients were treated with paraspinal muscle flap repair under a microscope, and they healed well after the operation. There was no cerebrospinal fluid leakage or other operation-related complication. The mean follow-up was 16.5 months. Reexamination of the spine MRI showed no recurrence of the DMC.

Conclusions: The application of paraspinal muscle flap under a microscope combined with glue, bedrest, and CSF drain, was an effective option for the patients with DMC.
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http://dx.doi.org/10.1080/08941939.2021.1924899DOI Listing
May 2021

Discovery of key genes as novel biomarkers specifically associated with HPV-negative cervical cancer.

Mol Ther Methods Clin Dev 2021 Jun 6;21:492-506. Epub 2021 Apr 6.

Center of Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China.

Cervical cancer is a common female malignancy that is mainly caused by human papillomavirus (HPV) infection. However, the incidence of HPV-negative cervical cancer has shown an increasing trend in recent years. Because the mechanism of HPV-negative cervical cancer development is unclear, this study aims to find the pattern of differential gene expression in HPV-negative cervical cancer and verify the underlying potential mechanism. Differentially expressed genes were compared among HPV-positive cervical cancer, HPV-negative cervical cancer, and normal cervical tissues retrieved from TCGA. Subsequently, dysregulated differentially expressed genes specifically existed in HPV-negative cervical cancer tissues and HPV-negative cell lines were validated by qRT-PCR, western blotting, and immunohistochemical staining. We found seventeen highly expressed genes that were particularly associated with HPV-negative cervical cancer from analysis of TCGA database. Among the 17 novel genes, 7 genes (preferentially expressed antigen in melanoma [PRAME], HMGA2, ETS variant 4 [ETV4], MEX3A, TM7SF2, SLC19A1, and tweety-homologs 3 [TTYH3]) displayed significantly elevated expression in HPV-negative cervical cancer cells and HPV-negative cervical cancer tissues. Additionally, higher expression of MEX3A and TTYH3 was associated with a shorter overall survival of patients with HPV-negative cervical cancer. Our study implies that these seven genes are more likely to provide novel insights into the occurrence and progression of HPV-negative cervical cancer.
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http://dx.doi.org/10.1016/j.omtm.2021.03.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8091489PMC
June 2021

Restoration of Joint Inclination in Total Knee Arthroplasty Offers Little Improvement in Joint Kinematics in Neutrally Aligned Extremities.

Front Bioeng Biotechnol 2021 29;9:673275. Epub 2021 Apr 29.

The Center of Diagnosis and Treatment for Joint Disease, China Rehabilitation Research Center, Capital Medical University, Beijing, China.

Kinematically aligned total knee replacements have been shown to better restore physiological kinematics than mechanical alignment and also offer good postoperative satisfaction. The purpose of this study is to evaluate the extent to which an inclined joint line in a kinematically aligned knee can alter the postoperative kinematics. A multi-body dynamic simulation was used to identify kinematic changes in the joint. To accurately compare mechanical alignment, kinematic alignment and a natural knee, a "standard" patient with neutral alignment of the lower extremities was selected for modeling from a joint database. The arthroplasty models in this study were implanted with a single conventional cruciate-retaining prosthesis. Each model was subjected to a flexion movement and the anteroposterior translation of the femoral condyles was collected for kinematic analysis. The results showed that the mechanical alignment model underwent typical paradoxical anterior translation of the femoral condyles. Incorporating an inclined joint line in the model did not prevent the paradoxical anterior translation, but a 3° varus joint line in the kinematic alignment model could reduce the peak value of this motion by about 1 mm. Moreover, the inclined joint line did not restore the motion curve back to within the range of the kinematic curve of the natural knee. The results of this study suggest that an inclined joint line, as in the kinematic alignment model, can slightly suppress paradoxical anterior translation of the femoral condyles, but cannot restore kinematic motions similar to the physiological knee. This finding implies that prostheses intended to be used for kinematic alignment should be designed to optimize knee kinematics with the intention of restoring a physiological motion curve.
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http://dx.doi.org/10.3389/fbioe.2021.673275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116507PMC
April 2021

Does cervical facet degeneration impact surgical outcomes and sagittal balance in patients with radiculopathy?

BMC Surg 2021 Apr 30;21(1):225. Epub 2021 Apr 30.

Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.

Purpose: In our present study, we aimed to investigate (1) whether cervical facet degeneration (FD) affects the clinical functional scores of patients with cervical radiculopathy after single-segment anterior cervical discectomy fusion (ACDF) and (2) whether FD affects the sagittal parameters of the cervical spine.

Methods: A total of 120 enrolled patients who underwent single-segment ACDF for radiculopathy with more than 2 years of follow-up were classified into two groups based on whether the preoperative mean FD was greater than or less than the mean FD grading score: mild FD group (mean score ≤ 2, n = 102) or severe FD group (mean score > 2, n = 48). Sagittal alignment changes and clinical functional scores were compared between the 2 groups. The relevant factors for FD were identified using multivariate logistic regression.

Results: Age, duration of symptoms, disc height and interfacet distance were independently associated with preoperative FD (age: P < 0.001; duration of symptoms: P = 0.020; disc height: P < 0.001; interfacet distance: P = 0.045). Compared with the mild FD group, the preoperative VAS (neck pain) score and NDI of the severe FD group were also higher, and the improvement of neck symptoms was better during the follow-up period. However, all clinical scores and radiographic parameters showed no significant differences during the 2-year follow-up. Additionally, no significant differences in the sagittal parameter changes were presented.

Conclusion: Patients with severe FD tended to experience more severe neck pain before surgery and greater improvement of neck symptoms at the follow-up visit. However, 2-year clinical efficacy and sagittal alignment after ACDF may not be markedly affected by preoperative FD severity. ACDF is considered to be a good choice for patients with radiculopathy, especially for patients with severe FD.
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http://dx.doi.org/10.1186/s12893-021-01227-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8091712PMC
April 2021

The roles of PD-1/PD-L1 in the prognosis and immunotherapy of prostate cancer.

Mol Ther 2021 06 29;29(6):1958-1969. Epub 2021 Apr 29.

Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; Center of Scientific Research, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China. Electronic address:

Multiple studies have confirmed that programmed cell death 1/programmed cell death ligand-1 (PD-1/PD-L1) and immune checkpoint inhibitors (ICIs) targeting PD-1/PD-L1 play pivotal roles in the treatment of numerous tumors. Patients suffering from cancer are provided hope in the form of immunotherapy. In this review, we discuss the finding that high PD-L1 expression is associated with poor clinical outcomes in prostate cancer patients. Some molecules exert their antitumor effects by downregulating PD-L1 expression in prostate cancer. Additionally, we discuss and summarize the important roles played by anti-PD-1/PD-L1 immunotherapy and its combination with other drugs, including chemotherapy and vaccines, in the treatment of prostate cancer.
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http://dx.doi.org/10.1016/j.ymthe.2021.04.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178461PMC
June 2021

Spino Cranial Angle and Degenerative Cervical Spondylolisthesis.

World Neurosurg 2021 Jul 24;151:e517-e522. Epub 2021 Apr 24.

Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China. Electronic address:

Objective: The purpose of our study was to analyze and compare the spino cranial angle (SCA) in patients with degenerative cervical spondylolisthesis (DCS) and asymptomatic controls and to determine whether SCA could help diagnose DCS.

Methods: We enrolled 50 patients diagnosed with DCS (4.3%) from among 1168 patients and the same number of asymptomatic participants as the control group by using cervical radiographs. Both groups underwent cervical radiographs and computed tomography at the same time. Various sagittal parameters were measured on computed tomography in a standardized supine position and compared with the asymptomatic control group. The Spearman correlation coefficient was applied to test the correlation among the sagittal parameters in the DCS group. Multivariate logistic regression analysis and receiver operating characteristic curve analysis were performed to determine whether SCA could help predict DCS.

Results: Fifty patients were enrolled in the DCS group, and 50 asymptomatic participants were included in the control group. The SCA was significantly lower for the DCS group than for the control group (76.84 ± 7.48 degrees vs. 82.47 ± 8.06 degrees, P < 0.001), and the T1 slope (T1s) was significantly greater for the DCS group than for the control group (27.29 ± 7.84 degrees vs. 22.28 ± 6.43 degrees, P = 0.001). Except for SCA and T1s, no other parameters showed significant differences. The SCA on the computed tomography scan was significantly correlated with the values of the T1s (r = -0.890, P < 0.001), cervical lordosis (r = -0.437, P = 0.002), C2-C7 sagittal vertical axis (r = 0.397, P = 0.004), and thoracic inlet angle (r = -0.565, P < 0.001). Multivariate logistic regression analysis and receiver operating characteristic curve analysis showed that both a lower SCA and a higher T1s could be risk factors for DCS, and an SCA of <79.1 degrees demonstrated significant diagnostic value for the detection of DCS.

Conclusions: Patients in the DCS group had a lower SCA and a higher T1s. Both a lower SCA and a higher T1s could be risk factors for DCS, and an SCA of <79.1 degrees demonstrated significant diagnostic value for the detection of DCS.
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http://dx.doi.org/10.1016/j.wneu.2021.04.071DOI Listing
July 2021

A prognostic dynamic model applicable to infectious diseases providing easily visualized guides: a case study of COVID-19 in the UK.

Sci Rep 2021 04 16;11(1):8412. Epub 2021 Apr 16.

Department of Pharmacology, University of Oxford, Oxford, OX1 3QT, UK.

A reasonable prediction of infectious diseases' transmission process under different disease control strategies is an important reference point for policy makers. Here we established a dynamic transmission model via Python and realized comprehensive regulation of disease control measures. We classified government interventions into three categories and introduced three parameters as descriptions for the key points in disease control, these being intraregional growth rate, interregional communication rate, and detection rate of infectors. Our simulation predicts the infection by COVID-19 in the UK would be out of control in 73 days without any interventions; at the same time, herd immunity acquisition will begin from the epicentre. After we introduced government interventions, a single intervention is effective in disease control but at huge expense, while combined interventions would be more efficient, among which, enhancing detection number is crucial in the control strategy for COVID-19. In addition, we calculated requirements for the most effective vaccination strategy based on infection numbers in a real situation. Our model was programmed with iterative algorithms, and visualized via cellular automata; it can be applied to similar epidemics in other regions if the basic parameters are inputted, and is able to synthetically mimic the effect of multiple factors in infectious disease control.
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http://dx.doi.org/10.1038/s41598-021-87882-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052322PMC
April 2021

Assessment of spino cranial angle of cervical spine sagittal balance system after multi-level anterior cervical discectomy and fusion.

J Orthop Surg Res 2021 Mar 17;16(1):194. Epub 2021 Mar 17.

Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, PR China.

Background: To analyze the impact of spino cranial angle (SCA) on alteration of cervical alignment after multi-level anterior cervical discectomy fusion (ACDF) and explore the relationship between SCA and health-related quality of life (HRQOL) scores.

Material And Methods: In total, 49 patients following multi-level ACDF for multi-level cervical spondylotic myelopathy (MCSM) with more than 2 years follow-up period were enrolled. Radiographic data including SCA were measured. Receiver operating characteristics (ROC) curve analysis was applied to confirm the optimal cut-off values of SCA for predicting sagittal balance. Patients were divided into two groups on the basis of the cut-off value of preoperative SCA. Correlation coefficients were analyzed between SCA and HRQOL scores.

Results: Optimal cut-off values for predicting sagittal balance was SCA of 88.6°. Patients with higher SCA, no matter preoperatively, postoperatively and at follow-up, got lower T1-Slope (T1s), C2-C7 lordosis angle (CA) and higher △SCA (pre vs post: p = 0.036, pre vs F/U: p = 0.022). Simultaneously, pre-SCA, post-SCA, and F/U-SCA in the high SCA group were positively correlated with the pre-NDI, post-NDI, and F/U-NDI scores respectively (pre: p < 0.001, post: p = 0.015, F/U: p = 0.003). However, no correlation was performed in the low SCA group.

Conclusion: An excessive SCA can be considered to cause poorer clinical outcomes at preoperative and better correction after surgery. The SCA could be used as a new reference value to determine sagittal balance parameters of the cervical spine and to assess the quality of life.
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http://dx.doi.org/10.1186/s13018-021-02353-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968356PMC
March 2021

Influence of SCA on clinical outcomes and cervical alignment after laminoplasty in patients with multilevel cervical spondylotic myelopathy.

J Orthop Surg Res 2021 Jan 12;16(1):49. Epub 2021 Jan 12.

Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.

Background: To study the impact of changes in spino-cranial angle (SCA) on sagittal alignment and to investigate the relationship between SCA and Neck Disability Index (NDI) scores after laminoplasty (LP) MATERIAL AND METHODS: In total, 72 patients with multilevel cervical spondylotic myelopathy (MCSM) after laminoplasty (LP) were retrospectively enrolled. Based on the optimal cut-off values of preoperative SCA, patients were classified into low SCA and high SCA groups. Radiographic data were measured, including spino-cranial angle (SCA), T1-slope (T1s), C2-7 lordosis (CA), T1s minus CA (T1sCA), and C2-7 sagittal vertical axis (cSVA). JOA and NDI scores were both applied to assess postoperative and follow-up clinical efficacy. Pearson correlation coefficient and linear regression analysis were respectively calculated between radiographic data and between SCA and NDI.

Results: The preoperative SCA was significantly correlated with T1s (r = - 0.795), CA (r = - 0.857), and cSVA (r = 0.915). A receiver operating characteristic (ROC) curve model predicted a threshold of SCA (value of 85.2°). At the follow-up period, patients with lower SCA had a higher T1s and CA and a lower cSVA, simultaneously accompanied by greater △T1s, △CA, and △cSVA. The linear regression model demonstrated that SCA in the higher group was positively correlated with NDI, and patients with higher SCA had worse NDI scores (pre: p < 0.001; post: p < 0.001; F/U: p = 0.003) and greater changes of NDI (post: p < 0.010; F/U: p = 0.002).

Conclusion: SCA may be a good predictor of evaluating sagittal balance and planning surgery. Changes in sagittal alignment in the low SCA group were affected more easily, and a higher SCA was associated with worse quality of life. Laminoplasty could be a good choice for patients with lower SCA.
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http://dx.doi.org/10.1186/s13018-021-02200-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802161PMC
January 2021

[Correlation between CT Texture Analysis and Synchronous Distant Metastasis in Patients with Lymph Node-negative Colorectal Cancer].

Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2020 Dec;42(6):781-788

Department of Radiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.

Objective To investigate the correlation between CT texture analysis and synchronous distant metastasis in patients with lymph node-negative colorectal cancer. Methods The preoperative CT images of 82 patients with lymph node-negative colorectal cancer were analyzed retrospectively.There were 12 patients with simultaneous distant metastasis and 70 patients without simultaneous distant metastasis.The maximum plane of the lesion on plain scan and portal CT images was analyzed by TexRAD software.When the spatial scaling factor(SSF)was 0 and 2-6,six texture parameters were obtained,and the differences of texture parameters between the two groups were compared.The counting data were analyzed by chi-square test and the measurement data by Mann-Whitney test. Results There was a significant difference in the skewness of SSF=3 between the simultaneous distant metastasis group and the non-synchronous metastasis group on plain CT scan(=0.031).On contrast-enhanced CT images,the entropy values of SSF=2,3,5,and 6 were statistically significant(=0.048,=0.027,=0.016,=0.017),and the peak values of SSF=2 were statistically significant(=0.026).According to the comprehensive analysis of the texture parameters of the six groups,when the boundary value was 0.636,the sensitivity and specificity for the diagnosis of simultaneous distant metastasis were 75% and 89%,respectively. Conclusion CT texture analysis is useful in the diagnosis of synchronous distant metastasis in patients with lymph node-negative colorectal cancer.
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http://dx.doi.org/10.3881/j.issn.1000-503X.11985DOI Listing
December 2020

CT Texture Analysis: A Potential Biomarker for Evaluating KRAS Mutational Status in Colorectal Cancer.

Chin Med Sci J 2020 Dec;35(4):306-314

Department of Radiology, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.

Objective Texture analysis is deemed to reflect intratumor heterogeneity invisible to the naked eyes. The aim of this study was to evaluate the feasibility of assessing the KRAS mutational status in colorectal cancer (CRC) patients using CT texture analysis. Methods This retrospective study included 92 patients who had histopathologically confirmed CRC and underwent preoperative contrast-enhanced CT examinations. The patients were assigned into a training cohort (=51) and a validation cohort (=41). We placed the region of interest in the tumour regions on the selected axial images using software of TexRad to extract a series of quantitative parameters based on the spatial scaling factors (SSFs), including mean, standard deviation (SD), entropy, mean of positive pixels (MPP), skewness, and kurtosis. The texture parameters and clinical characteristics (age, gender, tumour location, histopathology, tumour size, T, N, M stages) were compared between the mutated and wild-type KRAS patient groups in training cohort and validation cohort. Before building the multiple feature classifier, we calculated the correlations of the features using Pearson's correlation coefficient, and if any two features were significantly correlated, the one with lower AUC was removed. Ultimately, only the most discriminative isolated features were combined to train a supporting vector machine (SVM) classifier. The receiver operating characteristic (ROC) curve was processed for evaluating the diagnostic efficiency of texture parameters in differentiating CRC patients with mutated KRAS from those with wild-type KRAS. Results None of the clinical characteristics were significant different between CRC patients with wild-type KRAS and mutated KRAS in both cohorts. For predicting the expression of mutated KRAS in CRC patients, the perfect model which combined skewness on SSF 5 by unenhanced CT, entropy on SSF 2, skewness and kurtosis on SSF 0, and kurtosis and mean on SSF 3 by enhanced CT, showed a desirable AUC of 0.951 (95% : 0.895-1, <0.001), with a sensitivity of 88.9% and a specificity of 91.7%, when the cut-off value was 0.46 in the training cohort; while in the validation cohort, the AUC value was 0.995 (95% : 0.982-1, <0.001), the sensitivity was 100%, and the specificity was 93.7% when the cut-off value was 0.28. Conclusion It is feasible to evaluate the KRAS mutational status in CRC using CT texture analysis.
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http://dx.doi.org/10.24920/003770DOI Listing
December 2020

Emerging Role of Ubiquitination in the Regulation of PD-1/PD-L1 in Cancer Immunotherapy.

Mol Ther 2021 03 1;29(3):908-919. Epub 2021 Jan 1.

Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China. Electronic address:

A growing amount of evidence suggests that ubiquitination and deubiquitination of programmed death 1 (PD-1)/programmed death-ligand 1 (PD-L1) play crucial roles in the regulation of PD-1 and PD-L1 protein stabilization and dynamics. PD-1/PD-L1 is a major coinhibitory checkpoint pathway that modulates immune escape in cancer patients, and its engagement and inhibition has significantly reshaped the landscape of tumor clearance. The abnormal ubiquitination and deubiquitination of PD-1/PD-L1 influence PD-1/PD-L1-mediated immunosuppression. In this review, we describe the ubiquitination- and deubiquitination-mediated modulation of PD-1/PD-L1 signaling through a variety of E3 ligases and deubiquitinating enzymes (DUBs). Moreover, we briefly expound on the anticancer potential of some agents that target related E3 ligases, which further modulate the ubiquitination of PD-1/PD-L1 in cancers. Therefore, this review reveals the development of a highly promising therapeutic approach for cancer immunotherapy by targeting PD-1/PD-L1 ubiquitination.
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http://dx.doi.org/10.1016/j.ymthe.2020.12.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934629PMC
March 2021

Three new 3-formyl-2-arylbenzofurans from and their anti-hepatocellular carcinoma effects.

Nat Prod Res 2020 Dec 30:1-10. Epub 2020 Dec 30.

School of Pharmacy, Guizhou University of Traditional Chinese Medicine, Guiyang, People's Republic of China.

Five 3-formyl-2-arylbenzofuran derivatives, including three new compounds (-) and two known analogues (-), were identified from the 95% EtOH extract of . Extensive spectroscopic analyses were performed for the structure elucidation of all new benzofurans, and single-crystal X-ray diffraction analyses were further employed for the structure verification of iteafuranals C () and D (). In MTT assay, iteafuranal E () and iteafuranal A () displayed significant growth inhibition effect on SK-Hep-1 cells with IC values of 5.365 μM and 6.013 μM, respectively. The colony formation assay of and further confirmed their remarkable inhibitory effect on cell growth. Preliminary mechanism study demonstrated that remarkably down-regulated the phosphorylation level of ERK, which suggested could inhibit cell growth and induce apoptosis of SK-Hep-1 cells by blocking RAS/RAF/MEK/ERK signaling pathway. This study highlighted the potential of 3-fomyl-2-benzofuran derivatives as novel lead compounds to treat Hepatocellular carcinoma.
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http://dx.doi.org/10.1080/14786419.2020.1867130DOI Listing
December 2020

Cdc20 induces the radioresistance of bladder cancer cells by targeting FoxO1 degradation.

Cancer Lett 2021 03 5;500:172-181. Epub 2020 Dec 5.

Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China. Electronic address:

Ionizing radiation is a conventional therapy for cancer patients, but patients often experience distant metastasis and recurrence, which lead to a poor prognosis after the implementation of this treatment. Moreover, the underlying mechanisms by which radioresistance contributes to metastatic potential is still elusive. Here, we explored the molecular mechanisms that contribute to radioresistance in bladder cancer. To achieve this, we established two irradiation-resistant (IR) cell lines, T24R and 5637R, which were derived from parental bladder cancer cell lines. Cell viability was detected by CCK-8 assay, while migration and invasion abilities were examined by wound healing and Transwell chamber assays, respectively. Furthermore, the role of Cdc20 in the regulation of epithelial to mesenchymal transition (EMT) in IR cells was explored by Western blotting, immunoprecipitation and immunofluorescence staining. The IR cells exhibited EMT properties, and our data showed that Cdc20 expression was significantly elevated in IR cells. Remarkably, Cdc20 silencing reversed the EMT phenotype in IR cells. Mechanistically, Cdc20 governed IR-mediated EMT in part by governing forkhead box O1 (FoxO1) degradation. Taken together, our findings showed that the inactivation of Cdc20 or the activation of FoxO1 might be a potential strategy to overcome radioresistance in bladder cancer.
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http://dx.doi.org/10.1016/j.canlet.2020.11.052DOI Listing
March 2021

Emerging roles of long noncoding RNAs in chemoresistance of pancreatic cancer.

Semin Cancer Biol 2020 Nov 15. Epub 2020 Nov 15.

Center of Scientific Research, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China. Electronic address:

Pancreatic cancer is one of the most common causes of cancer death in the world due to the lack of early symptoms, metastasis occurrence and chemoresistance. Therefore, early diagnosis by detection of biomarkers, blockade of metastasis, and overcoming chemoresistance are the effective strategies to improve the survival of pancreatic cancer patients. Accumulating evidence has revealed that long noncoding RNA (lncRNA) and circular RNAs (circRNAs) play essential roles in modulating chemosensitivity in pancreatic cancer. In this review article, we will summarize the role of lncRNAs in drug resistance of pancreatic cancer cells, including HOTTIP, HOTAIR, PVT1, linc-ROR, GAS5, UCA1, DYNC2H1-4, MEG3, TUG1, HOST2, HCP5, SLC7A11-AS1 and CASC2. We also highlight the function of circRNAs, such as circHIPK3 and circ_0000284, in regulation of drug sensitivity of pancreatic cancer cells. Moreover, we describe a number of compounds, including curcumin, genistein, resveratrol, quercetin, and salinomycin, which may modulate the expression of lncRNAs and enhance chemosensitivity in pancreatic cancers. Therefore, targeting specific lncRNAs and cicrRNAs could contribute to reverse chemoresistance of pancreatic cancer cells. We hope this review might stimulate the studies of lncRNAs and cicrRNAs, and develop the new therapeutic strategy via modulating these noncoding RNAs to promote chemosensitivity of pancreatic cancer cells.
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http://dx.doi.org/10.1016/j.semcancer.2020.11.004DOI Listing
November 2020

Special issue: Targeting E3 ubiquitin ligases for cancer therapy.

Semin Cancer Biol 2020 Nov 13. Epub 2020 Nov 13.

Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA. Electronic address:

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http://dx.doi.org/10.1016/j.semcancer.2020.11.001DOI Listing
November 2020

Spontaneous resolution of idiopathic intestinal obstruction after pneumonia: A case report.

World J Clin Cases 2020 Oct;8(19):4512-4520

Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.

Background: Duodenal obstruction is a common clinical scenario that can either be mechanical or a pseudo-obstruction. Clinical management of intestinal obstruction starts from localization and proceeds to histological examination of the stenotic intestine. Systemic factors and dysfunction of distant organs might contribute to the development of intestinal obstruction. Here, we report a unique case of idiopathic mechanical duodenal obstruction, which resolved spontaneously after 3 mo of conservative treatment, but was followed by intestinal pseudo-obstruction.

Case Summary: An 84-year-old woman presented with worsened postprandial vomiting accompanied by prolonged pneumonia. Thorough noninvasive investigations revealed complete circumferential stenosis in the descending duodenum without known cause. Exploratory surgery was postponed due to septic shock and possible pulmonary fungal infection. Conservative treatment for 3 mo for ileus and control of pulmonary infection resolved the intestinal obstruction completely. Unfortunately, 2 wk later, she had regurgitation and postprandial vomiting again, complicated by deteriorating wheezing and dyspnea. Computed tomography revealed a dilated stomach and proximal duodenum without new intestinal stricture or pulmonary infiltration. The patient fully recovered after combined treatment with antireflux agents, enema, prokinetics, and bronchodilators.

Conclusion: This complicated case highlights the inter-relationship of local and systemic contributions to ileus and gut dysfunction, which requires multidisciplinary treatment.
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http://dx.doi.org/10.12998/wjcc.v8.i19.4512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559674PMC
October 2020

Calycosin induces apoptosis via p38‑MAPK pathway‑mediated activation of the mitochondrial apoptotic pathway in human osteosarcoma 143B cells.

Mol Med Rep 2020 Nov 1;22(5):3962-3968. Epub 2020 Sep 1.

Department of Orthopedics, Affiliated Hospital of Inner Mongolia University for The Nationalities, Tongliao, Inner Mongolia 028007, P.R. China.

Previous studies have demonstrated that calycosin is a natural phytoestrogen with a similar structure to estrogen, which can inhibit cell proliferation and induce apoptosis in a variety of tumors. Calycosin exerts potential pharmacological effects on osteosarcoma cells by inducing apoptosis. The aim of the present study was to elucidate the specific molecular mechanism of calycosin‑induced apoptosis in osteosarcoma cells. Cell proliferation was determined by an MTT assay. Annexin V/PI and JC‑1 staining were used to detect apoptosis and mitochondrial dysfunction, respectively, by flow cytometry. Western blot analysis was used to detect the expression of caspases or mitochondrial proteins. The results revealed that calycosin reduced the cell viability of human osteosarcoma 143B cells, induced apoptosis and increased the loss of mitochondrial membrane potential (MMP). In addition, calycosin increased the expression of the proapoptotic antiapoptotic proteins cleaved caspase‑3, cleaved caspase‑9, cleaved poly(ADP‑ribose) polymerase and Bcl‑2‑associated X protein (Bax), and decreased the expression of the antiapoptotic proapoptotic protein B‑cell lymphoma‑2 (Bcl‑2), thus altering the Bax/Bcl‑2 ratio. In addition, the expression levels of cytochrome c were markedly decreased in the mitochondria and increased in the cytoplasm following calycosin treatment. Furthermore, calycosin treatment induced p38‑mitogen‑activated protein kinase (MAPK) phosphorylation, whereas the p38‑MAPK inhibitor BIRB 796 markedly reversed cell viability, apoptosis and loss of MMP in 143B cells. These results suggested that calycosin inhibited osteosarcoma 143B cell growth via p38‑MAPK regulation of mitochondrial‑dependent intrinsic apoptotic pathways.
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http://dx.doi.org/10.3892/mmr.2020.11471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533496PMC
November 2020

PhotoPROTACs: A Novel Biotechnology for Cancer Treatment.

Trends Cell Biol 2020 10 24;30(10):749-751. Epub 2020 Aug 24.

Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China. Electronic address:

PROteolysis-TArgeting Chimeras (PROTACs) have been developed for targeting specific protein destruction. Two recent studies in Science Advances by Liu et al. and Reynders et al. reported a novel technology, PHOtochemically TArgeting Chimeras (PHOTACs) or opto-PROTAC, which is light-induced control of protein degradation. This new approach might lead to precision therapeutics in patients with cancer.
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http://dx.doi.org/10.1016/j.tcb.2020.08.003DOI Listing
October 2020

Magnetic covalent organic framework as a solid-phase extraction absorbent for sensitive determination of trace organophosphorus pesticides in fatty milk.

J Chromatogr A 2020 Sep 3;1627:461387. Epub 2020 Jul 3.

State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products, Institute of Quality and Standard of Agro-products, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, P. R. China; Key Laboratory of Detection for Pesticide Residues and Control of Zhejiang, Hangzhou 310021, P. R. China; Agricultural Ministry Key Laboratory for Pesticide Residue Detection, Hangzhou 310021, P. R. China. Electronic address:

A simple and efficient magnetic solid-phase extraction (MSPE) method was established with magnetic covalent organic framework (COF) as adsorbent to enrich organophosphorus pesticides from fatty milk samples, followed by the sensitive determination via LC-MS/MS. The key parameters influencing the MSPE efficiency were comprehensively investigated to afford an optimized procedure. All the target analytes could be captured directly by magnetic COF from milk without protein precipitation, making the pretreatment rapid and convenient. Systematic method validation demonstrated its satisfactory linearity, recoveries (80.0-105 %), and precision (RSDs <12.3 %). The method limits of quantification were 0.2-0.5 μg L. A comparison experiment to the reported solid-phase extraction fully verified the present MSPE more rapid, accurate, and environment-friendly. Furthermore, FT-IR and XPS analysis were performed to reveal the adsorption mechanisms of magnetic COF to organophosphorus pesticides, which could offer guidance on the rational design of COF adsorbent for various target analytes.
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http://dx.doi.org/10.1016/j.chroma.2020.461387DOI Listing
September 2020

Tracing nitrogenous byproducts during ozonation in the presence of bromide and ammonia using stable isotope labeling and high resolution mass spectrometry.

J Hazard Mater 2021 02 2;403:123612. Epub 2020 Aug 2.

Shenzhen Environmental Science and New Energy Technology Engineering Laboratory, Tsinghua-Berkeley Shenzhen Institute, Shenzhen 518055, PR China; Environmental Simulation and Pollution Control State Key Joint Laboratory, State Environmental Protection Key Laboratory of Microorganism Application and Risk Control (SMARC), School of Environment, Tsinghua University, Beijing 100084, PR China.

Ammonia has been widely used to inhibit bromate formation during ozonation. However, our recent study found that during ozonation in the presence of bromide and ammonia, toxicity increased under certain conditions that might be attributed to the formation of nitrogenous byproducts. Herein, a typical structural moiety of natural organic matter (NOM), hydroquinone, was evaluated for its potential to form nitrogenous byproducts. During ozonation of the hydroquinone solution containing bromide and ammonia, toxicity of organic byproducts increased significantly. As organic bromine was hardly detected, organic nitrogen was responsible for the increased toxicity. An effective method combining ultra-performance liquid chromatography in tandem with high resolution mass spectrometry (UPLC-HRMS) with an isotope labeling strategy was used to trace nitrogenous byproducts. Four newly formed nitrogenous byproducts were detected, two of which were also detected in Suwannee River natural organic matter (SRNOM) solution treated under the same ozonation condition. Furthermore, the molecular structures and formation pathways of these nitrogenous byproducts were proposed. This study highlights that, despite the widespread use, adding ammonia to inhibit bromate formation during ozonation might increase the toxicity posed by nitrogenous byproducts. During ozonation in the presence of bromide and ammonia, particular attention should be paid to nitrogenous byproducts.
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http://dx.doi.org/10.1016/j.jhazmat.2020.123612DOI Listing
February 2021

Precise Surgical Treatment of Thoracic Ossification of Ligamentum Flavum Assisted by O-Arm Computer Navigation: A Retrospective Study.

World Neurosurg 2020 11 1;143:e409-e418. Epub 2020 Aug 1.

Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China. Electronic address:

Objective: O-arm computer navigation-assisted technology (OACNAT) has been widely used in the treatment of thoracic ossification of ligamentum flavum (TOLF) in recent years, but there are few in-depth studies on the safety and effectiveness of this approach. The purpose of this study was to investigate the clinical effect of accurate surgical treatment for TOLF with OACNAT.

Methods: From January 2010 to January 2018, the clinical data of 64 patients with TOLF who underwent laminectomy and internal fixation in the Third Hospital of Hebei Medical University were retrospectively reviewed. The patients were divided into group A (with OACNAT, n = 33) and group B (without OACNAT, n = 31) according to the application of OACNAT during the operation. The possible operation-related variables, imaging results, and clinical effects were compared between the 2 groups.

Results: In terms of demographics, there were no significant differences between group A and group B in age, sex, body mass index, smoking, drinking, heart disease, hypertension and diabetes (P > 0.05). In terms of operation-related variables, imaging results, and clinical efficacy, there were significant differences in operation time, wound length, postoperative modified Japanese Orthopaedic Association (JOA) score, JOA score improvement rate, accuracy of screw placement, number of intraoperative fluoroscopy procedures, and cerebrospinal fluid leakage between group A and group B (P < 0.05). There were no significant differences in other variables between the 2 groups (P > 0.05). In contrast to group A, in group B, 2 patients had incorrect segmental localization, 3 patients had residual ossified ligamentum flavum after the operation, and 1 patient had postoperative neurologic impairment. On further analysis, compared with group B, group A had a shorter operation time, more accurate screw placement, fewer fluoroscopy procedures, higher JOA score improvement rate, and lower incidence of complications.

Conclusions: The use of OACNAT accurately located the position, size, shape, and boundary of ossification of the ligamentum flavum during the operation, which could guide accurate decompression and improve the accuracy of pedicle screw placement. This approach not only reduced the incidence of incorrect segmental localization and incomplete or excessive decompression but also reduced the risk of related complications and improved the accuracy, safety, and effectiveness of the operation.
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http://dx.doi.org/10.1016/j.wneu.2020.07.196DOI Listing
November 2020

Evolving roles of lysyl oxidase family in tumorigenesis and cancer therapy.

Pharmacol Ther 2020 11 18;215:107633. Epub 2020 Jul 18.

Departmant of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China. Electronic address:

The lysyl oxidase (LOX) family is comprised of LOX and four LOX-like proteins (LOXL1, LOXL2, LOXL3, and LOXL4), and mainly functions in the remodeling of extracellular matrix (ECM) and the cross-linking of collagen and elastic fibers. Recently, a growing body of research has demonstrated that LOX family is critically involved in the regulation of cancer cell proliferation, migration, invasion and metastasis. In this review, we discuss the roles of LOX family members in the development and progression of different types of human cancers. Furthermore, we also describe the potential inhibitors of LOX family proteins and highlight that LOX family might be an important therapeutic target for cancer therapy.
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http://dx.doi.org/10.1016/j.pharmthera.2020.107633DOI Listing
November 2020

FBXO45 is a potential therapeutic target for cancer therapy.

Cell Death Discov 2020 3;6:55. Epub 2020 Jul 3.

Departmant of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027 China.

FBXO protein 45 (FBXO45), a substrate-recognition subunit of E3 ligases, has been characterised to have pivotal roles in many human diseases, including nervous system diseases, inflammatory diseases and human malignancies. In this article, we describe the expression of FBXO45 in several types of human tumour specimens and highlight the downstream substrates of FBXO45. Moreover, the biological functions of FBXO45 in the regulation of proliferation, apoptosis, the cell cycle and metastasis are mentioned. Furthermore, we describe that the expression level of FBXO45 is regulated by several upstream factors such as miR-27a, Hey1, mA and the lncRNA RP11. As FBXO45 has a critical role in tumorigenesis and progression, FBXO45 might be a novel therapeutic target for cancer treatment.
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http://dx.doi.org/10.1038/s41420-020-0291-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335190PMC
July 2020

Cervical Flexion Osteotomy through One-Stage Posterior-Anterior-Posterior Approach for Cervical Extension Deformity in Ankylosing Spondylitis: A Novel Surgical Technique.

Orthop Surg 2020 Jun 3;12(3):1005-1009. Epub 2020 Jun 3.

Orthopedics Department, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

The present study was to introduce a new surgical technique of cervical flexionosteotomy, with an emphasis on the clinical and radiographic outcomes. Two male patients aged 45 and 21 years presented with cervical extension deformity in ankylosing spondylitis (AS). Both patients exhibited upward deviation of the forward gaze. The chin brow vertical angle (CBVA) were 15° upward and 5° downward, respectively; and the sagittal vertical axis (SVA) were-13.2mm and 195.7mm, respectively. Aposterior transverse release was performed at C -T , exposing the theca and C8 nerve roots to facilitate closure of theosteotomy site. Then, an anterior closing-wedgeosteotomy of C -T was performed followed with anterior internal fixation with a locking plate to prevent any translation. After closure and anterior fixation, patients were returned to the proneposition, and posterior screw-rod instrumentation was used for further stabilization. The follow-up periods were 20 and 10 months, respectively. At the last follow-up, CBVA and SVA of Patient 1 were 14° downwardand -12.6mm; and CBVA and SVA of Patient 2 were 1° downward and 75.6mm respectively, indicating the visual angle and sagittal balance were significantly improved. No intraoperative or postoperative complications were encountered. Full-spine radiographs of each patient at the last visit confirmed successfulbony union. The present study was the first report introducing a novel flexion osteotomy for cervical extension deformity in AS through a posterior-anterior-posterior approach inone-stage. The improved forward gaze and no complications demonstrated the effectiveness and safety of the novel technique, suggesting that it might provide a more feasible method for the correction of cervical extension deformity.
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http://dx.doi.org/10.1111/os.12670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7307245PMC
June 2020
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