BACKGROUND Due to mechanical imbalance in the spine,elderly scoliosis patients tend to develop vertebral fracture nonunion,i.e.,Kümmell disease,when osteoporotic vertebral compression fractures occur.However,acco...BACKGROUND Due to mechanical imbalance in the spine,elderly scoliosis patients tend to develop vertebral fracture nonunion,i.e.,Kümmell disease,when osteoporotic vertebral compression fractures occur.However,accompanying vertebral rotational deformities make surgical procedures challenging risky.Such patients are usually compelled to undergo conservative treatment and there are very few reports on minimally invasive surgeries for them.We first-time report a patient with Kümmell disease and lumbar scoliosis treated with percutaneous kyphoplasty(PKP)under O-arm guidance.CASE SUMMARY An 89-year-old female was admitted to the hospital due to delayed low back pain after a fall.She was diagnosed with Kümmell disease based on physical and radiologic examinations.The patient experienced severe scoliosis and subsequently underwent O-arm-guided kyphoplasty,resulting in a significant alleviation of low back pain.CONCLUSION PKP has good efficacy in treating Kümmell disease.However,surgical risks are elevated in scoliosis patients with Kümmell disease due to the abnormal anatomical structure of the spine.O-arm assisted operations play a crucial role in decreasing surgical risks.展开更多
BACKGROUND Primary vaginal cancer is rare and most vaginal tumors are metastatic,often arising from adjacent gynecologic structures.Primary vaginal cancers are also more common among postmenopausal women and most of t...BACKGROUND Primary vaginal cancer is rare and most vaginal tumors are metastatic,often arising from adjacent gynecologic structures.Primary vaginal cancers are also more common among postmenopausal women and most of these are squamous cell carcinomas,with adenocarcinomas being relatively rare.Vaginal bleeding is the most common clinical manifestation of vaginal adenocarcinoma.About 70%of vaginal adenocarcinomas are stage I lesions at the time of diagnosis,for which radical surgery is recommended.However,more advanced vaginal cancers are not amenable to radical surgical treatment and have poor clinical outcomes.Optimal treatments modes are still being explored.Here,we report a rare case of stage IIb primary vaginal adenocarcinoma for which an individually designed vaginal applicator for after-loading radiotherapy was used to achieve good tumor control.CASE SUMMARY A 62-year-old woman presented to our clinic after 3 months of abnormal postmenopausal vaginal bleeding.Gynecological examination,computed tomography(CT),and positron emission tomography-CT showed a large mass(about 5 cm)on the anterior vaginal wall.Colposcopy biopsy confirmed adenocarcinoma of vaginal origin.After three cycles of carboplatin plus paclitaxel chemotherapy,the lesion partially shrunk.The patient then received external irradiation of 45 gray(gy)in 25 fractions,which further reduced the vaginal lesion,followed by after-loading radiotherapy of 30 gy in 5 fractions with an individually designed vaginal applicator.Three months later,magnetic resonance imaging showed a slight thickening CONCLUSION Primary vaginal adenocarcinoma is rare,and prognosis is poor in most vaginal cancers of locally advanced stages,which cannot be treated with radical surgery.Better tumor control can be achieved with an individualized vaginal applicator that allows administration of a higher radical dose to the tumor area while protecting normal tissues.展开更多
Spinal cord injury that results in severe neurological disability is often incurable.The poor clinical outcome of spinal cord injury is mainly caused by the failure to reconstruct the injured neural circuits.Several i...Spinal cord injury that results in severe neurological disability is often incurable.The poor clinical outcome of spinal cord injury is mainly caused by the failure to reconstruct the injured neural circuits.Several intrinsic and extrinsic determinants contribute to this inability to reconnect.Epigenetic regulation acts as the driving force for multiple pathological and physiological processes in the central nervous system by modulating the expression of certain critical genes.Recent studies have demonstrated that post-SCI alteration of epigenetic landmarks is strongly associated with axon regeneration,glial activation and neurogenesis.These findings not only establish a theoretical foundation for further exploration of spinal cord injury,but also provide new avenues for the clinical treatment of spinal cord injury.This review focuses on the epigenetic regulation in axon regeneration and secondary spinal cord injury.Together,these discoveries are a selection of epigenetic-based prognosis biomarkers and attractive therapeutic targets in the treatment of spinal cord injury.展开更多
Following nerve injury,axonal disconnection in neurons usually results in persistent functional deficits,such as paralysis.However,axons in the adult mammalian central nervous system (CNS) have very limited regenerati...Following nerve injury,axonal disconnection in neurons usually results in persistent functional deficits,such as paralysis.However,axons in the adult mammalian central nervous system (CNS) have very limited regenerative ability.Understanding the molecular mechanism of controlling axon regeneration can provide idea for the design of effective therapeutic interventions for CNS injury,such as spinal cord injuries.Efficient axonal regeneration is achieved via gene expression in the neuronal soma,axonal transport of raw materials along the shaft,and membrane and cytoskeleton assembly at the nerve growth cone.Each process is delicately regulated by spatial-temporal controlled signaling pathways that target distinct effectors.Gene expression in the neuronal soma,especially of transcription factors,is often activated immediately following nerve injury.Injury signals at distal axons are interpreted and transmitted back to the soma,initiating a stream of gene expression events which positively regulate subsequent axonal regeneration.Over the past few decades,extensive studies have identified many regeneration-associated genes,including CREB,nuclear factor of activated T-cells,protein 53,Sprr1a,c-Jun,Smad1,activating transcription factor 3,signal transducer and activator of transcription 3,SRF,Sox11,and Kruppel-like factors.However,we know far less about how the coordinated expression of these regeneration-associated genes is regulated during axonal regeneration.Indeed,it is possible that they are regulated by a single common upstream regulator.If so,identification of this upstream regulator will provide us with an invaluable target for the development of more effective treatments for traumatic nerve injuries.Adult dorsal root ganglion (DRG) neurons represent a favorable medium in which to study the molecular mechanisms controlling intrinsic neuronal axon growth ability.Axotomy of the peripheral branch of a DRG neuron,known as a “conditioning lesion”,has been well-documented to greatly accelerate axonal growth both in vivo and in vitro,by enhancing the neuronal intrinsic growth potential.Enhancement of the growth state is thought to be mediated by a transcription-dependent axonal growth system that controls the expression of a number of regeneration-associated genes.展开更多
Axonal regeneration plays an important role in functional recovery after nervous system damage.However,after axonal injury in mammals,regeneration is often poor.The deletion of Krüppel-like factor-4(Klf4)has been...Axonal regeneration plays an important role in functional recovery after nervous system damage.However,after axonal injury in mammals,regeneration is often poor.The deletion of Krüppel-like factor-4(Klf4)has been shown to promote axonal regeneration in retinal ganglion cells.However,the effects of Klf4 deletion on the corticospinal tract and peripheral nervous system are unknown.In this study,using a mouse model of sciatic nerve injury,we show that the expression of Klf4 in dorsal root ganglion sensory neurons was significantly reduced after peripheral axotomy,suggesting that the regeneration of the sciatic nerve is associated with Klf4.In vitro,dorsal root ganglion sensory neurons with Klf4 knockout exhibited significantly enhanced axonal regeneration.Furthermore,the regeneration of the sciatic nerve was enhanced in vivo following Klf4 knockout.Finally,AAV-Cre virus was used to knockout the Klf4 gene in the cortex.The deletion of Klf4 enhanced regeneration of the corticospinal tract in mice with spinal cord injury.Together,our findings suggest that regulating KLF4 activity in neurons is a potential strategy for promoting axonal regeneration and functional recovery after nervous system injury.This study was approved by the Animal Ethics Committee at Soochow University,China(approval No.SUDA20200316A01).展开更多
BACKGROUND Stress fractures of the femoral neck are not common in clinical practice,and simultaneous stress fractures of the femoral neck and proximal femur of the unilateral femur are even more rare.We introduce a ca...BACKGROUND Stress fractures of the femoral neck are not common in clinical practice,and simultaneous stress fractures of the femoral neck and proximal femur of the unilateral femur are even more rare.We introduce a case of this type of fracture that was treated in our department,analyze the causes,and review similar stress fractures reported in the literature to provide references for the diagnosis and treatment of such conditions.CASE SUMMARY A 62-year-old female,with a free medical history,was admitted to the hospital mainly due to pain in the right hip and worsening pain in the right thigh.The patient had no obvious history of trauma.X-ray and computed tomography showed fracture of the femoral neck and proximal femur.The patient had undergone surgery 1 year prior to address a fracture of the left proximal femur that had occurred in a traffic accident.Our first consideration was stress fracture of the femoral neck;however,simultaneous stress fractures of the femoral neck and proximal femur of the unilateral femur were seen.The femoral neck stress fracture was a tension fracture,with obvious displacement and varus deformity of the hip.Considering that the patient was an elderly female,we performed total hip arthroplasty.Follow-up X-rays showed that the stress fracture of the proximal femur had mostly healed after 3 mo.CONCLUSION Muscle fatigue and hip varus deformity provide an anatomical basis for the occurrence of femoral neck stress fractures.展开更多
BACKGROUND The accessory bones are common bone variations around the feet and ankles,which usually originate from nonunion of the secondary ossification center adjacent to the main bone mass,and most of them remain as...BACKGROUND The accessory bones are common bone variations around the feet and ankles,which usually originate from nonunion of the secondary ossification center adjacent to the main bone mass,and most of them remain asymptomatic.Os subcalcis is an accessory bone at the plantar aspect of the calcaneus,which is located just posterior to the insertion of the plantar fascia.Focal bone formation at the calcaneal plantar pole with heel pain has rarely been reported.CASE SUMMARY A 55-year-old man presented to our clinic with left plantar heel pain and a progressive swelling for 8 years.X-ray,computer tomography and magnetic resonance imaging showed a large os subcalcison the plantar side of the calcaneus,located at the insertion of the plantar fascia.He underwent surgical excision of the lesion.Microscopically the bony trabeculae were intermingled with fat and covered with cartilage.CONCLUSION This is a rare case with accessory os subcalcis leading to heel pain.It highlights the awareness of os subcalcis and helps avoid future misdiagnosis of heel pain.展开更多
Neurons in the mammalian central nervous system (CNS) cannot regenerate axons after injury. In contrast, neurons in the mammalian peripheral nervous system and in some non-mammalian models, such as C. elegans and Dr...Neurons in the mammalian central nervous system (CNS) cannot regenerate axons after injury. In contrast, neurons in the mammalian peripheral nervous system and in some non-mammalian models, such as C. elegans and Drosophila, are able to regrow axons. Understanding the molecular mechanisms by which these neurons support axon regeneration will help us find ways to enhance mammalian CNS axon regeneration. Here, recent studies in which signaling pathways regulating naturally-occurring axon regeneration that have been identified are reviewed, focusing on how these pathways control gene expression and growth-cone function during axon regeneration.展开更多
基金Supported by The Innovation and Entrepreneurship Program of Jiangsu Province,No.(2015)-159。
文摘BACKGROUND Due to mechanical imbalance in the spine,elderly scoliosis patients tend to develop vertebral fracture nonunion,i.e.,Kümmell disease,when osteoporotic vertebral compression fractures occur.However,accompanying vertebral rotational deformities make surgical procedures challenging risky.Such patients are usually compelled to undergo conservative treatment and there are very few reports on minimally invasive surgeries for them.We first-time report a patient with Kümmell disease and lumbar scoliosis treated with percutaneous kyphoplasty(PKP)under O-arm guidance.CASE SUMMARY An 89-year-old female was admitted to the hospital due to delayed low back pain after a fall.She was diagnosed with Kümmell disease based on physical and radiologic examinations.The patient experienced severe scoliosis and subsequently underwent O-arm-guided kyphoplasty,resulting in a significant alleviation of low back pain.CONCLUSION PKP has good efficacy in treating Kümmell disease.However,surgical risks are elevated in scoliosis patients with Kümmell disease due to the abnormal anatomical structure of the spine.O-arm assisted operations play a crucial role in decreasing surgical risks.
文摘BACKGROUND Primary vaginal cancer is rare and most vaginal tumors are metastatic,often arising from adjacent gynecologic structures.Primary vaginal cancers are also more common among postmenopausal women and most of these are squamous cell carcinomas,with adenocarcinomas being relatively rare.Vaginal bleeding is the most common clinical manifestation of vaginal adenocarcinoma.About 70%of vaginal adenocarcinomas are stage I lesions at the time of diagnosis,for which radical surgery is recommended.However,more advanced vaginal cancers are not amenable to radical surgical treatment and have poor clinical outcomes.Optimal treatments modes are still being explored.Here,we report a rare case of stage IIb primary vaginal adenocarcinoma for which an individually designed vaginal applicator for after-loading radiotherapy was used to achieve good tumor control.CASE SUMMARY A 62-year-old woman presented to our clinic after 3 months of abnormal postmenopausal vaginal bleeding.Gynecological examination,computed tomography(CT),and positron emission tomography-CT showed a large mass(about 5 cm)on the anterior vaginal wall.Colposcopy biopsy confirmed adenocarcinoma of vaginal origin.After three cycles of carboplatin plus paclitaxel chemotherapy,the lesion partially shrunk.The patient then received external irradiation of 45 gray(gy)in 25 fractions,which further reduced the vaginal lesion,followed by after-loading radiotherapy of 30 gy in 5 fractions with an individually designed vaginal applicator.Three months later,magnetic resonance imaging showed a slight thickening CONCLUSION Primary vaginal adenocarcinoma is rare,and prognosis is poor in most vaginal cancers of locally advanced stages,which cannot be treated with radical surgery.Better tumor control can be achieved with an individualized vaginal applicator that allows administration of a higher radical dose to the tumor area while protecting normal tissues.
基金supported by the National Natural Science Foundation of China,Nos.81701225(to BYZ),81874254(to PYC),81571189 and 81772353(to Saijilafu)the Excellent Youth Grant of Science and Technology Department of Jilin Province of China,No.20190103077JH(to BYZ)the Bethune Project of Jilin University of China,No.2015312(to BYZ)
文摘Spinal cord injury that results in severe neurological disability is often incurable.The poor clinical outcome of spinal cord injury is mainly caused by the failure to reconstruct the injured neural circuits.Several intrinsic and extrinsic determinants contribute to this inability to reconnect.Epigenetic regulation acts as the driving force for multiple pathological and physiological processes in the central nervous system by modulating the expression of certain critical genes.Recent studies have demonstrated that post-SCI alteration of epigenetic landmarks is strongly associated with axon regeneration,glial activation and neurogenesis.These findings not only establish a theoretical foundation for further exploration of spinal cord injury,but also provide new avenues for the clinical treatment of spinal cord injury.This review focuses on the epigenetic regulation in axon regeneration and secondary spinal cord injury.Together,these discoveries are a selection of epigenetic-based prognosis biomarkers and attractive therapeutic targets in the treatment of spinal cord injury.
基金supported by the National Natural Science Foundation of China (Nos.81772353 and 81571189)the National Key Research and Development Program (No.2016YFC 1100203)the Priority Academic Program Development of Jiangsu Higher Education Institutions,and Innovation and Entrepreneurship Program of Jiangsu Province of China.
文摘Following nerve injury,axonal disconnection in neurons usually results in persistent functional deficits,such as paralysis.However,axons in the adult mammalian central nervous system (CNS) have very limited regenerative ability.Understanding the molecular mechanism of controlling axon regeneration can provide idea for the design of effective therapeutic interventions for CNS injury,such as spinal cord injuries.Efficient axonal regeneration is achieved via gene expression in the neuronal soma,axonal transport of raw materials along the shaft,and membrane and cytoskeleton assembly at the nerve growth cone.Each process is delicately regulated by spatial-temporal controlled signaling pathways that target distinct effectors.Gene expression in the neuronal soma,especially of transcription factors,is often activated immediately following nerve injury.Injury signals at distal axons are interpreted and transmitted back to the soma,initiating a stream of gene expression events which positively regulate subsequent axonal regeneration.Over the past few decades,extensive studies have identified many regeneration-associated genes,including CREB,nuclear factor of activated T-cells,protein 53,Sprr1a,c-Jun,Smad1,activating transcription factor 3,signal transducer and activator of transcription 3,SRF,Sox11,and Kruppel-like factors.However,we know far less about how the coordinated expression of these regeneration-associated genes is regulated during axonal regeneration.Indeed,it is possible that they are regulated by a single common upstream regulator.If so,identification of this upstream regulator will provide us with an invaluable target for the development of more effective treatments for traumatic nerve injuries.Adult dorsal root ganglion (DRG) neurons represent a favorable medium in which to study the molecular mechanisms controlling intrinsic neuronal axon growth ability.Axotomy of the peripheral branch of a DRG neuron,known as a “conditioning lesion”,has been well-documented to greatly accelerate axonal growth both in vivo and in vitro,by enhancing the neuronal intrinsic growth potential.Enhancement of the growth state is thought to be mediated by a transcription-dependent axonal growth system that controls the expression of a number of regeneration-associated genes.
基金This study was supported by the National Natural Science Foundation of China,Nos.81571189,81772353(to Saijilafu).
文摘Axonal regeneration plays an important role in functional recovery after nervous system damage.However,after axonal injury in mammals,regeneration is often poor.The deletion of Krüppel-like factor-4(Klf4)has been shown to promote axonal regeneration in retinal ganglion cells.However,the effects of Klf4 deletion on the corticospinal tract and peripheral nervous system are unknown.In this study,using a mouse model of sciatic nerve injury,we show that the expression of Klf4 in dorsal root ganglion sensory neurons was significantly reduced after peripheral axotomy,suggesting that the regeneration of the sciatic nerve is associated with Klf4.In vitro,dorsal root ganglion sensory neurons with Klf4 knockout exhibited significantly enhanced axonal regeneration.Furthermore,the regeneration of the sciatic nerve was enhanced in vivo following Klf4 knockout.Finally,AAV-Cre virus was used to knockout the Klf4 gene in the cortex.The deletion of Klf4 enhanced regeneration of the corticospinal tract in mice with spinal cord injury.Together,our findings suggest that regulating KLF4 activity in neurons is a potential strategy for promoting axonal regeneration and functional recovery after nervous system injury.This study was approved by the Animal Ethics Committee at Soochow University,China(approval No.SUDA20200316A01).
基金Supported by Suzhou Gusu Health Talent Program Training Program,No.GSWS2020121。
文摘BACKGROUND Stress fractures of the femoral neck are not common in clinical practice,and simultaneous stress fractures of the femoral neck and proximal femur of the unilateral femur are even more rare.We introduce a case of this type of fracture that was treated in our department,analyze the causes,and review similar stress fractures reported in the literature to provide references for the diagnosis and treatment of such conditions.CASE SUMMARY A 62-year-old female,with a free medical history,was admitted to the hospital mainly due to pain in the right hip and worsening pain in the right thigh.The patient had no obvious history of trauma.X-ray and computed tomography showed fracture of the femoral neck and proximal femur.The patient had undergone surgery 1 year prior to address a fracture of the left proximal femur that had occurred in a traffic accident.Our first consideration was stress fracture of the femoral neck;however,simultaneous stress fractures of the femoral neck and proximal femur of the unilateral femur were seen.The femoral neck stress fracture was a tension fracture,with obvious displacement and varus deformity of the hip.Considering that the patient was an elderly female,we performed total hip arthroplasty.Follow-up X-rays showed that the stress fracture of the proximal femur had mostly healed after 3 mo.CONCLUSION Muscle fatigue and hip varus deformity provide an anatomical basis for the occurrence of femoral neck stress fractures.
基金Supported by The Gusu Talents Project,No.GSWS2020069.
文摘BACKGROUND The accessory bones are common bone variations around the feet and ankles,which usually originate from nonunion of the secondary ossification center adjacent to the main bone mass,and most of them remain asymptomatic.Os subcalcis is an accessory bone at the plantar aspect of the calcaneus,which is located just posterior to the insertion of the plantar fascia.Focal bone formation at the calcaneal plantar pole with heel pain has rarely been reported.CASE SUMMARY A 55-year-old man presented to our clinic with left plantar heel pain and a progressive swelling for 8 years.X-ray,computer tomography and magnetic resonance imaging showed a large os subcalcison the plantar side of the calcaneus,located at the insertion of the plantar fascia.He underwent surgical excision of the lesion.Microscopically the bony trabeculae were intermingled with fat and covered with cartilage.CONCLUSION This is a rare case with accessory os subcalcis leading to heel pain.It highlights the awareness of os subcalcis and helps avoid future misdiagnosis of heel pain.
基金supported by grants from the NiH (R01NS064288)The Craig H. Neilsen Foundation
文摘Neurons in the mammalian central nervous system (CNS) cannot regenerate axons after injury. In contrast, neurons in the mammalian peripheral nervous system and in some non-mammalian models, such as C. elegans and Drosophila, are able to regrow axons. Understanding the molecular mechanisms by which these neurons support axon regeneration will help us find ways to enhance mammalian CNS axon regeneration. Here, recent studies in which signaling pathways regulating naturally-occurring axon regeneration that have been identified are reviewed, focusing on how these pathways control gene expression and growth-cone function during axon regeneration.