Objective:To investigate the influencing factors for early tumor recurrence and the efficacy of adjuvant chemotherapy in gallbladder carcinoma (GBC) patients after curative-intent resection.Methods:The retrospective case-control study was conducted. The clinicopathological data of 506 patients with GBC in 11 medical centers, including The First Affiliated Hospital of Xi'an Jiaotong University et al, from January 2016 to December 2020 were collected. There were 168 males and 338 females, aged (62±11)years. All patients underwent curative-intent resection of GBC, and they were divided into patients with and without early recurrence based on time to postoperative recurrence. Observation indicators: (1) treatment; (2) follow-up and survival of patients; (3) analysis of influencing factors for early tumor recurrence after curative-intent resection of GBC; (4) efficacy of postoperative adjuvant chemotherapy. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the Mann-Whitney U test. Univariate analysis was conducted using the corresponding statistical methods based on data type. Multivariate analysis was conducted using the Logistic regression model with forward method. The Kaplan-Meier method was used to draw survival curve and calculate survival rate, and Log-Rank test was used for survival analysis. Results:(1) Treatment. Of 506 patients, there were 112 cases with postoperative adjuvant chemotherapy, and 394 cases without postopera-tive adjuvant chemotherapy. They underwent 5(range, 3-9)cycles of postoperative adjuvant chemo-therapy. (2) Follow-up and survival of patients. All 506 patients underwent postoperative follow-up, with the follow-up time of 55(range, 34-93)months. During the follow-up, there were 248 patients with tumor recurrence, including 158 cases of early recurrence and 90 cases of late recurrence, and there were 258 patients without tumor recurrence. Of 506 patients, 275 cases survived, and 231 cases died of multiple organ failure caused by tumor recurrence and metastasis. The postoperative recurr-ence-free survival time, overall survival time were 52(range,1-93)months, 62(range, 2-93)months. The 1-, 3-, 5-year disease-free survival rates and 1-, 3-, 5-year overall survival rates of the 506 pati-ents were 68.8%, 53.8%, 47.9% and 78.3%, 58.7%, 51.6%, respectively. Results of survival analysis showed that the median overall survival time of 158 patients with postoperative early recurrence and 348 patients without postoperative early recurrence (including 90 cases of late recurrence and 258 cases of no tumor recurrence) were 9(range, 2-73)months and unreached, showing a significant difference between them ( χ2=456.15, P<0.05). (3) Analysis of influencing factors for early tumor recurrence after curative-intent resection of GBC. Results of multivariate analysis showed that carcinoembryonic antigen (CEA) >5.0 μg/L, poorly differentiated tumor, liver invasion, and tumor N staging as stage N1-N2 were independent risk factors influencing early tumor recurrence after cura-tive-intent resection of GBC ( odds ratio=2.74, 6.20, 1.81, 2.93, 4.82, 95% confidence interval as 1.62-4.64, 1.82-21.12, 1.15-3.08, 1.68-5.09, 1.91-12.18, P<0.05), while postoperative adjuvant chemo-therapy was an independent protect factor ( odds ratio=0.39, 95% confidence interval as 0.21-0.71, P<0.05). (4) Efficacy of postoperative adjuvant chemotherapy. The median overall survival time of 394 patients without postoperative adjuvant chemotherapy and 112 patients with postoperative adjuvant chemotherapy were 57(range, 2-93)months and unreached, showing a significant differ-ence between them ( χ2=9.38, P<0.05). Of the 158 patients with postoperative early recurrence after curative-intent resection of GBC, 135 cases didn't receive adjuvant chemotherapy and 23 cases received adjuvant chemotherapy, with the overall survival time of 8(range, 2-73)months and 17(range, 8-61)months, respectively, showing a significant difference between them ( χ2=7.68, P<0.05). Conclusions:CEA >5.0 μg/L, poorly differentiated tumor, liver invasion, and tumor N staging as stage N1-N2 are independent risk factors influencing early tumor recurrence after curative-intent resection of GBC, while postoperative adjuvant chemotherapy is an independent protect factor. Postoperative adjuvant chemotherapy can prolong the overall survival time of patients with post-operative tumor early recurrence.

Objective:To investigate the influence of curative-intent resection with textbook outcomes of liver surgery (TOLS) on long-term prognosis of gallbladder carcinoma (GBC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 824 patients with GBC in the national multicenter database of Biliary Surgery Group of Elite Group of Chinese Journal of Digestive Surgery, who were admitted to 15 medical centers from January 2014 to January 2021, were collected. There were 285 males and 539 females, aged (62±11)years. According to the evalua-tion criteria of TOLS, patients were divided into those who achieved TOLS and those who did not achieve TOLS. Measurement data with normal distribution were represented as Mean± SD, and com-parison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data were conduc-ted using the Mann-Whitney U test. The Kaplan-Meier method was used to calculate survival rate and draw survival curve, and the Log-rank test was used for survival analysis. The COX stepwise regression model with backward Wald method was used for univariate and multivariate analyses. Results:(1) Achievement of TOLS. Of the 824 patients undergoing curative-intent resection for GBC, there were 510 cases achieving TOLS and 314 cases not achieving TOLS. (2) Follow-up. Of the 824 patients undergoing curative-intent resection for GBC, after excluding 112 deaths within 90 days after discharge, 712 cases were included for the survival analysis. The median follow-up time, median overall survival time and 5-year overall survival rate of the 510 patients achieving TOLS were 22.1(11.4,30.1)months, 47.6(30.6,64.6)months and 47.5%. The median follow-up time, median overall survival time and 5-year overall survival rate of the 202 patients not achieving TOLS were 14.0(6.8,25.5)months, 24.3(20.0,28.6)months and 21.0%. There was a significant difference in overall survival between patients achieving TOLS and patients not achieving TOLS ( χ2=58.491, P<0.05). (3) Analysis of factors influencing prognosis of patients. Results of multivariate analysis showed that TOLS, carcinoembryonic antigen (CEA), CA19-9, poorly differentiation of tumor, T2 stage of eighth edition of American Joint Committee on Cancer (AJCC) staging, T3 and T4 stage of eighth edition of AJCC staging, N1 stage of the eighth edition of AJCC staging, N2 stage of the eighth edition of AJCC staging, adjuvant therapy were independent factors influencing overall survival time of patients undergoing curative-intent resection for GBC ( hazard ratio=0.452, 1.479, 1.373, 1.612, 1.455, 1.481, 1.835, 1.978, 0.538, 95% c onfidence interval as 0.352-0.581, 1.141-1.964, 1.052-1.791, 1.259-2.063, 1.102-1.920, 1.022-2.147, 1.380-2.441, 1.342-2.915, 0.382-0.758, P<0.05). Conclusion:Patients under-going curative-intent resection for GBC with TOLS can achieve better long-term prognosis.

Objective:To investigate the influencing factors of textbook outcomes in liver surgery (TOLS) after radical resection of gallbladder carcinoma.Methods:The retrospective case-control study was conducted. The clinicopathological data of 530 patients who underwent radical resection of gallbladder carcinoma in 15 medical centers, including the First Affiliated Hospital of Army Medical University et al, from January 2014 to January 2020 were collected. There were 209 males and 321 females, aged (61±10)years. Patients underwent radical resection of gallbladder carcinoma, including cholecystectomy, hepatectomy, invasive bile duct resection, and lymph node dissection. Observation indicators: (1) situations of TOLS; (2) influencing factors of TOLS. Measure-ment data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the Mann-Whitney U test. The univariate analysis was conducted using the corresponding statistical methods based on data type, and variables with P<0.10 were included in multivariate analysis. Multivariate analysis was conducted using the Logistic stepwise regression model. Results:(1) Situations of TOLS. All 530 patients underwent radical resection of gallbladder carcinoma, and there were 498 cases achieving R 0 resection, 508 cases without ≥grade 2 intra-operative adverse events, 456 cases without postoperative grade B and grade C biliary leakage, 513 cases without postoperative grade B and grade C liver failure, 395 cases without severe com-plications within postoperative 90 days, 501 cases did not being re-admission caused by severe com-plications within postoperative 90 days. Of the 530 patients, 54.53%(289/530) of patients achieved postoperative TOLS, while 45.47%(241/530) of patients did not achieve postoperative TOLS. (2) Influencing factors of TOLS. Results of multivariate analysis showed that American Society of Anesthesiologists classification >grade Ⅱ, preoperative jaundice, T staging as T3?T4 stage, N staging as N2 stage, liver resection as right hemi-hepatectomy, and neoadjuvant therapy were independent factors influencing TOLS in patients undergoing radical resection of gallbladder carcinoma ( odds ratio=2.65, 1.87, 5.67, 5.65, 2.55, 3.34, 95% confidence interval as 1.22?5.72, 1.18?2.95, 2.51?12.82, 2.83?11.27, 1.41?4.63, 1.88?5.92, P<0.05). Conclusion:American Society of Anesthesiologists classification >grade Ⅱ, preoperative jaundice, T staging as T3?T4 stage, N staging as N2 stage, liver resection as right hemi-hepatectomy, and neoadjuvant therapy are independent factors influencing TOLS in patients undergoing radical resection of gallbladder carcinoma.

Objective:To investigate the effect of O-arm navigation assisted posterior pedicle screw reduction and internal fixation of atlantoaxial fractures.Methods:A retrospective case-control study was conducted to analyze 37 patients with atlantoaxial fractures admitted to Third Hospital of Hebei Medical University from January 2016 to June 2018, including 22 males and 15 females, aged from 29 to 68 years [(50.9±9.8)years]. The posterior pedicle screw reduction and internal fixation was performed under O-arm navigation system (navigation group, n=24), and using free-hand technique (free-hand group, n=13). The operation time and blood loss were compared between the two groups. The Japanese Orthopaedic Association (JOA) score and neck disability index (NDI) were used to evaluate the clinical efficacy before operation, 7 days operation and at the last follow-up. The complications were detected. A total of 86 screws were placed in navigation group (Neo grade 0: 83 screws, grade 1: 2 screws, grade 2: 1 screw ), and 44 screws were inserted in free-hand group (Neo grade 0: 36 screws, grade 1: 5 screws, grade 2: 2 screws, grade 3: 1 screw)( P<0.05). Classification of screw positions proposed by Neo et al was used to evaluate the position relationship between the screw and the bone cortex and the incidence of screw penetration. Results:All patients were followed up 24-38 months [(27.7±4.0)months]. The operation time in navigation group was (189.8±35.4)minutes, significantly shorter than (221.5±48.6)minutes in free-hand group ( P<0.05). The bleeding volume in navigation group was 300.0 (250.0, 537.5)ml , significantly less than 500.0 (425.0, 625.0)ml in free-hand group ( P<0.05). Both groups showed significantly enhanced JOA and decreased NDI after operation and at last follow-up, compared with those before operation ( P<0.05). However, there was no significant difference in JOA and NDI between the two groups ( P>0.05). No severe complications such as neurovascular injury occurred during operation. The incidence of cortical penetration was 3% (3/86) in navigation group and 18% (8/44) in free-hand group ( P<0.05). Conclusions:In the process of posterior atlantoaxial pedicle screw placement, the application of O-arm navigation can significantly reduce the operation time and amount of bleeding, and enhance the accuracy of pedicle screw implantation.

Oblique lateral interbody fusion (OLIF) was minimally invasiveprocedure for lumbar interbody fusion (LIF) through the space between anterior margin of retroperitoneal psoas major muscle and the vessels (ATP). Although OLIF had many advantages over other approaches, there were also various kinds of surgical complications, the incidence of which was 3.69%-81.82%. Most of the complications were relieved by conservative or symptomatic treatment. Only a small number of complications were difficult to recover, if so, revision surgery was needed and might remain persistent symptoms. OLIF complications included intraoperative and postoperative complications. Major vascular injury was a dangerous complication during operation, which requires immediate compression or suture to prevent bleeding. The incidence of nerve injury could be reduced by avoiding violent traction and tissue separation and reducing the operation time. When injury of thorax and peritoneum occurs, suture should be done as soon as possible. Transient hip flexion weakness and transient thigh/groin sensory disturbance was the most common post-operative complication, most of which would disappear after several months. Intestinal obstruction is caused by the pulling of peritoneum during operation, most of which was incomplete and would be relieved after some time. Postoperative infection was mostly superficial and would be cured by dressing change and antibiotic application. Subsidence of cage and collapse of intervertebral space were the most common complications related to instrumentations which might not lead to related clinical symptoms; however the severe cases need to be repaired. The incidence of pseudarthrosis is relatively low and a few patients with clinical symptoms need revision surgery. The sample size of most studies was small and follow-up period was short. In the future, large samples and multi-center studies are needed to improve our understanding of OLIF complications in the future.

Objective To compare the clinical efficacy of pedicle subtraction osteotomy(PSO)and posterior unilateral vertebral column resection(PUVCR)for old thoracolumbar compressive fracture accompanied with kyphotic deformity.Methods A retrospective case control study was conducted to analyze the clinical data of 51 patients with old thoracolumbar fracture accompanied with kyphotic deformity admitted to the Third Hospital of Hebei Medical University from January 2010 to January 2016.There were 29 males and 22 females,aged 46-69 years,with an average age of 54.9 years.In terms of the injured segments,there were 11 patients with T11,10 with T12,17 with L1,and 13 with L2.A total of 22 patients were treated with traditional PSO(PSO group),and 29 patients PUVCR(PUVCR group).The operation time,intraoperative blood loss,hospital stay,Cobb angle improvement 2 weeks after operation and postoperative 1 year,visual analogue scale(VAS) 1 year after operation and Japanese Orthopedic Association(JOA)scores were compared between the two groups.Intraoperative and postoperative complications were recorded.Results All patients were followed up for 3-18 months,with an average of 13.5 months.There were no significant differences between PSO group and PUVCR group in hospital stay[(13.8±1.1)days vs.(14.1±1.2)days],thoracolumbar Cobb angle 2 weeks after operation[(8.3±1.5)°vs.(9.1±2.0).]and JOA scores[(26.2±1.2)points vs(25.5±1.5)points](P＞0.05).Significant differences were found between PUVCR group and PSO group in operation time[(184.9±22.9)minutes vs.(219.9±17.1)minutes],intraoperative blood loss[(911.5±70.2)ml vs.(1136.1±92.0)ml],Cobb angle 1 year after operation[(10.0±1.6)°vs.(12.7±1.9)°],and VAS 1 year after operation[(2.3±0.5)points vs.(2.9±0_ 7)points](P＜0.05).No serious complications occurred during operation and follow-up.Conclusions For old thoracolumbar compressive fracture accompanied with kyphotic deformity,PSO and PUVCR can both effectively improve kyphosis and relieve dysfunction.But PUVCR has the advantages of shorter operation time,less intraoperative blood loss,better-improved kyphosis,and lower incidence of spinal nerve injury.

Objective To analyze the influencing factors of extra uterine growth retardation (EUGR) in premature very low birth weight infants.Methods A total of 61 EUGR premature very low birth weight infants survived in intensive care unit of our hospital were enrolled into EUGR group,and at the same time another 50 non-EUGR premature very low birth weight infants were selected into non-EUGR group.The clinical related medical records in the two groups were compared and analyzed,and the influencing factors of EUGR was analyzed by Logistic regression analysis.Results The birth gestational age of EUGR group was (31.29±1.56)weeks,which was significantly lower than (33.98±1.35)weeks of the non-EUGR group (t=9.60,P<0.05).The birth weight of the EUGR group was (1 206.76±212.14)g,which was significantly lower than (1 341.55±103.26)g of the non-EUGR group (t=4.11,P<0.05).The hospital stay,return to birth weight time,start enteral nutrition time and total parenteral nutrition time in the EUGR group were (27.77±5.00)d,(15.36±5.91)d,(3.36±1.91)d,(16.93±4.02)d respectively,which were significantly longer than those in the non-EUGR group[22.69±3.97)d,(10.61±4.57)d,(2.61±1.37)d,(9.43±3.11)d](t=3.53,4.65,2.33,10.80,all P<0.05).The incidence rates of complications such as respiratory system,digestive system and metabolic disorder in the EUGR group were 26.23%,19.67% and 67.21%,respectively,which were significantly higher than those of the non-EUGR group(8.00%,6.00% and 40.00%)(x2=6.18,4.39,8.22,all P<0.05).Logistic regression analysis showed that low birth gestational age and birth weight,long hospital stay,later return to birth weight and total parenteral nutrition time,intrauterine growth retardation,and respiratory system,digestive system and metabolic disorder were independent risk factors for the occurrence of EUGR(all P<0.05).Conclusion The influencing factors of EUGR in very low birth weight infants were mainly low gestational age and birth weight,long hospital stay,later return to birth weight and total parenteral nutrition time,intrauterine growth retardation,and respiratory system,digestive system and metabolic disorder.Therefore,in order to prevent EUGR,active symptomatic measures should be given in clinic.

BACKGROUND:O-arm navigation integrates CT image quality and the flexible mobility of the C-arm. Surgery for severe spinal deformity is very difficult, with high incidence of nerve injury, so it is a chalenging surgery for spinal surgery. The role of O-arm in the correction of spinal deformity is particularly important. OBJECTIVE:To explore the effect and safety of pedicle screw placement in severe spinal deformity under the guidance of O-arm navigation system. METHODS:Clinical data of 25 patients with severe spinal deformity with the aid of O-arm navigation were retrospectively analyzed. We observed pedicle screw insertion, operation time, intraoperative blood loss, correction of scoliosis and correction of kyphosis, and assessed the safety of screw insertion. RESULTS AND CONCLUSION:(1) Totaly 326 pedicle screws were implanted in 25 patients. According to NEO classification, 280 pedicle screws (92%) belonged to grade 0 (no perforation of pedicle cortex). Grade 1: perforation of pedicle cortex, < 2 mm, including 44 screws (8%); grade 2: perforation of pedicle cortex, > 2 mm, < 4 mm, including 0 screw (0%); grade 3: perforation of pedicle cortex, > 4 mm, including 0 screw (0%). (2) Operation time was (272.3±17.3) minutes. Intraoperative blood loss was (1 710.0±229.1) mL. (3) Cobb angle of scoliosis was changed from (70.5±6.0)° preoperatively to (22.8±4.8)° postoperatively. Cobb angle of kyphosis was changed from (72.0±5.2)° preoperatively to (28.1±5.7)° postoperatively. Significant differences were detected (P< 0.05). (4) These findings verify that with the guide of the O-arm navigation system, the accuracy of screw insertion is high. The risk of intraoperative nerve injury was reduced. The scoliosis and kyphosis deformity were improved effectively.

OBJECTIVESTo compare the paravertebral muscle (such as multifidus, erector spinae, psoas muscle) changes between the patients with degenerative lumbar instability and normal person by MRI and to observe the degeneration of paravertebral muscles. To analyze the relationship between paravertebral muscle degeneration and lumbar curvature of degenerative lumbar instability.

METHODSSixty patients with degenerative lumbar instability were retrospectively enrolled from December 2011 to July 2013 as degeneration group, meanwhile 60 health persons with no degenerative lumbar instability were selected as control group. No significant differences were found in the gender, age and body mass index between the two groups. The cross-sectional area(CSA) and percentage of fat infiltration area (FIA) of the paravertebral muscles at the L4-S1 levels were measured using T2-weighted axial MRI and Image J soft ware. And the lumbar curvature(expressed as lumbar lordosis angle) of all the patients in lumbar X-ray were measured in the two groups. The measured data were analyzed with independent samples t-test.

RESULTSThe difference of multifidus cross-sectional area and the percentage of fat infiltration in the patients of degenerative lumbar instability at the L4-L5, L5-S1 level, compared with the control group, was statistically significant (t = 2.768, t = 6.216, P < 0.05). Between the two groups, the percentage of fatty infiltration in erector spinae showed significant differences (t = 5.862, P < 0.05). The cross-sectional area of erector spinae and the degeneration of the psoas muscle between the two groups was not statistically significant. The lumbar lordsis angle in the patients with degenerative lumbar instability was (43.9 ± 15.6)°, which was higher than the (39.3 ± 14.2)° in control group (t = 2.915, P < 0.05).

CONCLUSIONSCompared with the control group, patients with degenerative lumbar instability exists erector spinae and multifidus muscle degeneration, and erector spinae is more obvious. The degeneration among psoas muscle, erector spinae and multifidus muscle are inconsistent, which may be related to the increasing of the lumbar lordosis angle in the patients with degenerative lumbar instability.

Aged ; Case-Control Studies ; Female ; Humans ; Joint Instability ; diagnosis ; etiology ; pathology ; Lumbosacral Region ; physiopathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle, Skeletal ; pathology ; Muscular Atrophy ; complications ; diagnosis ; pathology

OBJECTIVETo evaluate the clinical results and the value of the posterior approach 360° vertebral canal decompression and transfacet discectomy combined with interbody fusion and pedicle screw internal fixation for the treatment of ossifying thoracic disc herniation.

METHODSThirty nine cases of ossifying thoracic disc herniation who accepted the posterior approach 360° vertebral canal decompression and transfacet discectomy combined with interbody fusion and pedicle screw internal fixation were included in this study. There were 21 male and 18 female patients. The age ranged from 33 to 69 years, with an average of 53 years. The course of disease ranged from 1 month to 18 months, with an average of 6.5 months. The lesion locations were T7-8 for 1 case, T8-9 for 4 cases, T9-10 for 9 cases, T10-11 for 7 cases, T11-12 for 10 cases, T12-L1 for 6 cases, and both T11-12 and T12-L1 for 2 cases. The clinical results were evaluated by Otani scored system.

RESULTSThe operative time was from 2.5 to 5.0 hours, with average of 3.3 hours. The blood loss was from 400 to 2 000 ml, with average of 850 ml. All patients were successfully operated without neurological symptoms aggravation and accidents. The followed-up period was 24 to 60 months, mean 40.5 months. According to Otani scored system, there were excellent results in 16 cases and good results in 18 cases. The clinical satisfaction rate was 87.2%. All obtained bony fusion without instrument failure.

CONCLUSIONPosterior approach 360° vertebral canal decompression and transfacet discectomy combined with interbody fusion and pedicle screw internal fixation is a safe and effective surgical procedure for the treatment of ossifying thoracic disc herniation.

Adult ; Aged ; Decompression, Surgical ; methods ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; surgery ; Male ; Middle Aged ; Spinal Fusion ; methods ; Thoracic Vertebrae ; Treatment Outcome