RESUMEN
STUDY DESIGN: This was a retrospective study. OBJECTIVE: To describe a novel reconstruction strategy using a T-shaped titanium mesh cage with posterior cervical screw-rod fixation after total spondylectomy of axis tumors. SUMMARY OF BACKGROUND DATA: Instability of the upper cervical spine because of tumors in axis (C2) often results in devastating complications. Surgical resection and reconstruction after spondylectomy of C2 remain a technical challenge because of the intricate anatomies, vital adjacent tissues, and the unique spinal biomechanics in this special region. MATERIALS AND METHODS: The novel reconstruction mode included the construction of the anterior aspect conducted with a specially made titanium mesh cage and the posterior cervical fixation only. Patients who received total C2 tumors spondylectomy and reconstruction with this novel mode in our center between January 2009 and December 2017 were retrospectively analyzed to evaluate the efficacy of this novel reconstruction method. RESULTS: A total of 24 patients with C2 tumor received total spondylectomy and the new mode of local reconstruction. The neurological deficits recovered well and local pain relieved significantly (P<0.001) during the mean follow-up time of 22 months. Perioperative complications were rare and controllable. No internal fixation failure occurred. The mobility of the occipital-cervical junction was largely preserved in all patients. CONCLUSIONS: This novel reconstruction mode using an anterior "T-shaped" mesh cage with posterior screw-rod fixation provides satisfactory stability and motion of occipital-cervical junction with limited complications, and therefore may prove to be an ideal option for management of C2 tumors. LEVEL OF EVIDENCE: Level IV.
Asunto(s)
Vértebras Cervicales/cirugía , Neoplasias de la Columna Vertebral/cirugía , Adolescente , Adulto , Tornillos Óseos , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prótesis e Implantes , Rango del Movimiento Articular , Procedimientos de Cirugía Plástica , Estudios Retrospectivos , Titanio , Resultado del Tratamiento , Adulto JovenRESUMEN
Giant cell tumor of the bone (GCTB) is a locally aggressive tumor with a certain distant metastatic rate. For sacral GCT (SGCT) and pelvic GCT (PGCT), surgery has its limitations, especially for unresectable or recurrent tumors. Selective arterial embolization (SAE) is reported to be an option for treatment in several cases, but there are few systematic reviews on the effects of SAE on SGCT and/or PGCT. Medline and Embase databases were searched for eligible English articles. Inclusion and exclusion criteria were conducted before searching. All the clinical factors were measured by SPSS software, with P-values ≤0.05 considered statistically significant. A total of 9 articles were retrieved, including 44 patients receiving SAE ranging from 1 to 10 times. During the mean follow-up period of 85.8 months, the radiographic response rate was 81.8%, with a local control and overall survival rate of 75% and 81.8%, respectively. No bowel, bladder, or sexual dysfunction was observed. Three patients developed distant metastases and finally died. Patients with primary tumors tended to have better prognosis than those with recurrence (P = 0.039). The favorable outcomes of SAE suggest that it may be an alternative treatment for SGCT and PGCT patients for whom surgery is not appropriate.
Asunto(s)
Neoplasias Óseas/terapia , Embolización Terapéutica/métodos , Tumor Óseo de Células Gigantes/terapia , Neoplasias Pélvicas/terapia , Neoplasias de la Columna Vertebral/terapia , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Huesos Pélvicos , Sacro , Resultado del Tratamiento , Adulto JovenRESUMEN
Glycolysis is a typical conduit for energy metabolism in pancreatic cancer (PC) due to the hypoxic microenviroment. Lactate dehydrogenase A (LDHA) catalyzes the conversion of pyruvate to lactate and is considered to be a key checkpoint of anaerobic glycolysis. The aim of the present study was to explore the mechanism of interactions between hypoxia, HIF-1/2α and LDHA, and the function of LDHA on PC cells by analyzing 244 PC and paratumor specimens. It was found that LDHA was over-expressed and related to tumor stages. The result of in vitro study demonstrated that hypoxia induced LDHA expression. To explore the relationship between HIF and LDHA, chromatin immunoprecipitation assay and luciferase assay were performed. The result showed that HIF-1/2α bound to LDHA at 89bp under the hypoxic condition. Furthermore, knockdown of endogenous HIF-1α and HIF-2α decreased the LDHA expression even in the hypoxic condition, which was accompanied with a significant decrease in lactate production and glucose utilization (p < 0.01). Immunofluorescence in the 244 specimens showed that HIF-1/2α was over-expressed and associated with LDHA over-expression (p < 0.0001). Forced expression of LDHA promoted the growth and migration of PC cells, while knocking down the expression of LDHA inhibited the cell growth and migration markedly. In summary, the present study proved that HIF1/2α could activate LDHA expression in human PC cells, and high expression of LDHA promoted the growth and migration of PC cells.