Abstract The association between NLR and postoperative pneumonia (POP) in patients with aneurysmal subarachnoid hemorrhage (aSAH) who underwent endovascular treatment remains poorly understood. Patients with aSAH who underwent endovascular treatment between January 2019 and April 2023 were included. The follow-up endpoint was the presence of POP at 30 days postoperatively. Logistic regression analysis was conducted using POP as the dependent variable. NLR was calculated at admission (NLR1), 24 h after endovascular treatment (NLR2), and 3–7 days after endovascular treatment (NLR3). Four prediction models were constructed: Model 1 (variables with p < 0.05, except for the NLR); Model 2 (Model 1 plus NLR1); Model 3 (Model 1 plus NLR2); and Model 4 (Model 1 plus NLR3). Among the 154 patients with aSAH, POP occurred in 101 (65.6%) patients. Higher NLRs at admission (odds ratio [OR] = 1.08; 95% Confidence Interval [CI] 1.02, 1.16; p = 0.019), 24 h postoperatively (OR = 1.14; 95% CI 1.05, 1.25; p = 0.005) and 3-7days postoperatively (OR = 1.17; 95% CI 1.02, 1.38; p = 0.04) were independently associated with the occurrence of POP. Follow-up NLR may be an independent predictor of POP in aSAH patients treated endovascularly. Elevated NLR at admission, 24 h postoperatively and 3–7 days postoperatively correlated with a high risk for POP.
The Chinese expert consensus on thoracic lymph node (LN) dissection in radical esophagectomy (Chinese Criteria, 2017 edition) was newly promoted. This study examined the prognostic significance and role of thoracic LN metastasis based on the Chinese Criteria for esophageal cancer.Data of patients with thoracic esophageal squamous cell carcinoma (ESCC) who underwent curative esophagectomy in the West China Hospital from May 2005 to May 2015 were retrospectively analyzed. Patients' prognosis and clinicopathological features were compared to determine the role of Chinese Criteria and their relationship with Union for International Cancer Control (UICC)/American Joint Committee on Cancer (AJCC) 8th TNM staging.Overall, 2,285 qualified patients were divided into the no (n=1,148), skip (n=156), local (n=665), and mediastinal (n=316) metastasis groups according to the Chinese Criteria. Significant prognostic differences occurred among the four groups in all the thoracic and lower mediastinal ESCC patients (both P<0.001). The Chinese Criteria grouping was an independent prognostic factor for all thoracic [P<0.001; hazard ratio (HR) =1.261, 95% confidence interval (CI): 1.103-1.441], upper (P<0.001; HR =1.391, 95% CI: 1.264-1.530), lower mediastinal thoracic ESCC patients (P<0.001; HR =1.312, 95% CI: 1.257-1.370) and all thoracic ESCC after adjuvant therapy (P<0.001; HR =1.303, 95% CI: 1.221-1.390). Significant prognostic differences among Chinese Criteria groups occurred with N1 (P=0.014) and N2 (P=0.018) stages only. Significant differences in survival among N stages were found in local (P<0.001) and mediastinal (P=0.009) metastasis groups.Our study was the first to report the Chinese Criteria in measuring the degree of thoracic LN metastasis. Similar to N-stage, the Chinese Criteria were confirmed as an independent prognostic factor for thoracic ESCC. Further confirmation of our findings is warranted.
Abstract Background Mediastinoscope-assisted transhiatal esophagectomy (MATHE) is the most minimally invasive esophagectomy procedure. It is a more challenging procedure and more difficult to be popularized than thoracoscopic surgery. We developed a new MATHE operation mode that provides a clearer visual field and makes the procedures simpler. Methods A total of 48 patients with esophageal cancer were divided into a control group (n = 29) and a study group (n = 19). The control group underwent classic MATHE, while the study group received modified MATHE. We compared the two groups on operation time; intraoperative blood loss; blood transfusion amount; incidence rate of lung infection, recurrent laryngeal nerves (RLNs) injury, chylothorax, and anastomotic leakage; and upper mediastinal lymph node dissection. Results The study group was significantly better than the control group in operation time (273.94 min vs. 322.90 min, p < 0.05), intraoperative blood loss (46.84 mL vs. 68.97 mL, p < 0.05), and left paratracheal lymph node (No. 4 L) dissection rate (84.21% vs. 24.14%, p < 0.01). No significant differences were identified in the incidence rate of anastomotic leakage, lung complications, or RLNs injury between the two groups. Conclusion The modified MATHE is easier to perform. Modified MATHE is significantly superior to classic MATHE in operation time, intraoperative blood loss, and upper mediastinal lymph node dissection rate.
Objective To investigate the clinical outcome of modified large decompressive craniectomy in treatment of severe traumatic brain injury combined with acute subdural hematoma. Methods A retrospective analysis was carried out to compare the clinical outcome of large decompressive craniectomy (treatment group) for 81 patients with severe traumatic brain injury combined with acute subdural hematoma from July 2007 to June 2010 and that of standard large trauma decompressive craniectomy (control group) for 65 patients with same injuries from July 2004 to June 2007. Results According to the Glasgow outcome scale at the end of month 6 after injury, there were 21 patients (GCS 5 points) with good recovery, 19 (GCS4 points) with moderate deficit, 24 (GCS 3 points) with severe deficit, five (GCS 2 points) under persistent vegetative status and 12 (GCS 1 points) deaths in the treatment group,with good prognosis rate (good recovery and moderate deficit) of 49% (P ＜ 0.05) and poor prognosis rate of 51%. However, only 21 patients got favorable outcome, including 12 patients (GCS 5 points)with good recovery and nine (GCS 4 points) with moderate deficit; 44 patients got unfavorable outcome (68%), including 22 patients (GCS 3 points) with severe deficit, three (GCS 2 points) under persistent vegetative status and 19 (GCS 1 points) deaths in the control group (P ＜0.05). Furthermore, the incidences of delayed intracranial hematomas and subdural collection of fluid in the treatment group were significantly lower than those in the control group (P ＜ 0.05). Conclusion Modified large decompressive craniectomy can significantly improve the outcome and reduce complications of patients with severe traumatic brain injury combined with acute subdural hematoma.
Key words:
Craniocerebral trauma; Decompression, surgical; Modified large decompressive craniectomy
The lack of novel therapeutic targets poses the major challenge to prolong survival and improve the quality of life for esophageal squamous cell carcinoma (ESCC). Methylenetetrahydrofolate dehydrogenase 1-like (MTHFD1L) plays critical roles in folate cycle maintenance. However, little information is available concerning the role of MTHFD1L in cancer cells, and no studies have addressed such issues in esophageal cancer.Surgical cancer and adjacent normal esophageal tissues were obtained from patients with esophagectomy and esophagogastrostomy for ESCC. Western blot, immunohistochemistry and Quantitative RT-PCR were performed to evaluate protein and RNA expression levels of MTHFD1L. Knockdown of MTHFD1L expression was achieved by using short hairpin RNA. The effects of MTHFD1L silencing on ESCC cell proliferation and apoptosis were assessed by the MTT assay, Celigo assays, Annexin V FACS assay and Caspase-3/7 array in vitro.Twenty-three paired cancer and adjacent normal esophageal tissues from patients with ESCC were included in this study. MTHFD1L protein and RNA expression levels were significantly upregulated in ESCC tissue as compared with normal tissue. High expression of MTHFD1 was also detected in two esophageal cancer cell lines (TE-1 and EC109). Knockdown of MTHFD1L expression inhibited the proliferation of TE-1 cells, and the apoptosis was distinctly increased following shMTHFD1L infection.Our preliminary study highlighted for the first time that MTHFD1L might be involved in the development of ESCC, which may provide a new potential tumor-specific therapeutic targeting for anti-folate agents.
The interaction between tumor cells and inflammatory cells has not been systematically investigated in esophageal squamous cell carcinoma (ESCC). The aim of the present study was to evaluate whether preoperative lymphocyte-monocyte ratio (LMR), neutrophil-lymphocyte ratio (NLR), and neutrophil-monocyte ratio (NMR) could predict the prognosis of ESCC patients undergoing esophagectomy.A total of 1,883 patients with histologically diagnosed ESCC who underwent radical esophagectomy from May 2005 to May 2015 were retrospectively reviewed. Besides clinicopathological factors, "Survminer" package in R® was applied to determine the optimal cut-off point for LMR, NLR and NMR. Meanwhile, we evaluated the prognostic value of LMR, NLR, and PLR using Kaplan-Meier curves and Cox regression models.The median follow-up was 28.77 months (range, 1.60-247.90 months). The optimal cut-off point of LMR, NLR and NMR is 3.83, 2.06 and 7.21, respectively. Kaplan-Meier survival analysis of patients with low preoperative LMR demonstrated a significant worse prognosis for 5-year OS (P<0.001) than those with high preoperative LMR. The high NLR cohort had lower 5-year OS (P<0.001). No significant difference with 5-year OS was found in NMR (P=0.405). On multivariate analysis, preoperative LMR (P=0.018; HR =0.786, 95% CI: 0.645, 0.959) and NLR (P=0.028; HR =1.247, 95% CI: 1.024, 1.519) were the independent prognostic factors in ESCC patients. Integrating LMR and NLR, we divided the ESCC patients in four groups according to their cut-off points and we found the patients in LMR ≥3.83 and NLR <2.06 group received the best prognosis while the prognosis of patients in LMR<3.83 and NLR ≥2.06 group was the worst. The difference was statistically significant.Preoperative LMR and NLR better predicts cancer survival in patients with ESCC undergoing esophagectomy, especially under the circumstances of LMR ≥3.83 and NLR <2.06.
Objective
To investigate the effect of autophagy response on neurological functions and the role of mitogen-activated protein kinases (MAPKs) signaling pathway in rats after traumatic brain injury (TBI).
Methods
Fifty-four healthy male SD rats were randomly divided into sham-operated group, TBI group and TBI+autophagy inhibitor 3-methyladenine (3-MA) group (n=18). TBI animal models of the later two groups were established using Feeney's method. Rats in the sham-operated group were only performed bone window opening without knock; rats in the TBI+3-MA group were given intraperitoneal injection of 3-MA(5 mg/kg) 30 min after modeling and rats in the other two groups were given the same volume of normal saline. Three and 7 d after modeling, the protein levels of S100B and neuron specific enolase (NSE) in serum were tested with enzyme linked immunosorbent assay (ELISA); modified neurologic severity scale (mNSS) was used to detect the movement, sense and reflex functions; brain water content was measured with wet-dry weight method. The autophagy related factors (LC3-II and Beclin-1) and MAPKs signaling pathway related factors (c-Jun N-terminal kinase [JNK], phosphorylated [p]-JNK, extracellular signal-regulated kinase [ERK]1/2, p-ERK1/2, p38MAPK and p-p38MAPK) protein expressions in TBI cerebral cortex were determined by Western blotting.
Results
As compared with those in the sham-operated group, the brain edema level, mNSS scores, and S100B and NSE protein levels in the TBI group and TBI+3-MA group were significantly increased (P< 0.05); TBI+3-MA group had significantly lower brain edema level, mNSS scores, and S100B and NSE protein levels than TBI group (P<0.05). The expression levels of autophagy and MAPKs signaling pathway related factors in the TBI group and TBI+3-MA group were significantly higher as compared with those in the sham-operated group (P<0.05). As compared with the TBI group, TBI+3-MA group had significantly decreased levels of LC3-II, Beclin-1 and activation of JNK and p-p38MAPK signaling pathways (P<0.05).
Conclusion
Suppressing autophagy response markedly improves neurological outcomes after TBI, possibly mediated by inhibiting activation of JNK and p38MAPK signaling pathways.
Key words:
Traumatic brain injury; Neuroprotection; Autophagy; Mitogen-activated protein kinase signaling pathway
Gliomas are the most common malignant primary brain tumors with poor prognosis. The migration-inducing gene-7 (Mig-7) protein is a cysteine-rich protein. Vasculogenic mimicry can replace endothelium-dependent blood vessels and supply blood to tumors, thus promoting tumor invasion and metastasis. They have also been shown to play critical roles in the development and progression of various cancers. We attempted to explore the role of Mig-7 and vasculogenic mimicry in glioma progression. We demonstrated that Mig-7 and vasculogenic mimicry were not expressed in normal tissues. In glioma, Mig-7 expression was positively associated with vasculogenic mimicry formation, the expression of both increased with increasing glioma pathological grade. In-vitro, Mig-7 silencing may inhibit the in-vitro invasiveness and formation of vasculogenic mimicry in human glioma U87 cells by inhibiting the phosphatidylinositol 3-kinase/AKT/ matrix metalloproteinases 2 and matrix metalloproteinases 9 signaling pathway. The present study thus indicates a potential role for Mig-7 as a target in the treatment of glioma.
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