GPBAR1 is associated with asynchronous bone metastasis and poor prognosis of hepatocellular carcinoma

BackgroundHepatocellular carcinoma (HCC) is the second leading cause of cancer-related death in China. Asynchronous metastasis is the main reason for HCC recurrence, but the current assessment of HCC metastasis and prognosis is far from clinically satisfactory.MaterialsIn our study, we investigated the expression of G-protein-coupled bile acid receptor (GPBAR1) in HCC tissues and tumor-adjacent tissues by qRT-PCR and immunohistochemistry. The associations between GPBAR1 expression, clinicopathological factors, and asynchronous metastases were assessed by the Chi-square test. The overall survival curves of different variables were plotted with the Kaplan–Meier method, and the statistical significance between different subgroups was analyzed with the log-rank test. The independent prognostic factors were identified by the Cox regression hazard model.ResultsGPBAR1 was more highly expressed in HCC tissues than in tumor-adjacent tissues. GPBAR1 expression in HCC was significantly higher than that in liver cirrhosis, followed by normal liver tissues. GPBAR1 was significantly associated with poor prognosis in HCC and can be regarded as an independent prognostic biomarker. Interestingly, GPBAR1 expression in HCC was significantly correlated with asynchronous metastasis to the bone but not to the liver or lung.ConclusionsGPBAR1 was found to be an independent, unfavorable prognostic factor of HCC, as well as an indicator of asynchronous bone metastasis but not liver or lung metastases. Our results could provide a new aspect for HCC metastasis studies and help identify high-risk HCC patients, which helps ameliorate the prognostic assessment of HCC

Bilateral C1 laminar hooks combined with C2 pedicle screws fixation for treatment of C1–C2 instability not suitable for placement of transarticular screws

The study design described here is a posterior C1–C2 fusion technique composed of bilateral C1 hooks and C2 pedicle screws. In addition, the clinical results of using this method on 13 patients with C1–C2 instability are reported. The objectives are to introduce a new technique for posterior C1–C2 fusion and to evaluate the clinical outcome of using it to treat C1–C2 instability. From October 2006 to August 2008, 13 patients (9 men and 4 women) with C1–C2 instability were included in this study: 3 had acute odontoid fractures, 4 had obsolete odontoid fractures, 4 had os odontoideum and 2 had traumatic rupture of the transverse ligament. All patients underwent posterior atlantoaxial fixation with bilateral C1 hooks and C2 pedicle screws. The mean follow-up duration was 25 months (range 13–30 months). Each patient underwent a complete cervical radiograph series, including anterior–posterior, lateral, and flexion–extension views, and a computed tomographic scan. The clinical course was evaluated according to the Frankel grading system. No clinically manifested injury of the nerve structures or the vertebral artery was observed in any of these cases. Five patients with neurological symptoms showed significant improvement in neurological function postoperatively. Bony fusion and construction stability were observed in all 13 patients (100%) on their follow-up radiographs, and no instrument failure was observed. Bilateral C1 hooks combined with C2 pedicle screws can be used as an alternative treatment method for C1–C2 dislocation, especially in cases not suitable for the use of transarticular screws. The clinical follow-up shows that this technique is a safe and effective method of treatment

Simultaneous ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum causing upper thoracic myelopathy in DISH: case report and literature review

A rare case of a 44-year-old Chinese male with diffuse idiopathic skeletal hyperostosis (DISH) and simultaneous ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) at T1–2 causing thoracic myelopathy is reported herein. Posterior decompression without extirpating the OPLL was performed at T1–2. Postoperatively, symptoms were greatly improved, with remaining hyperreflexia and Grade 4/5 muscle strength in the lower extremities. The Japanese Orthopedic Association score improved from 5 preoperatively to 9 at final follow-up. The presence of a cyst due to leakage of cerebrospinal fluid was confirmed by MRI at day 27, but it resolved after conservative management. The clinical manifestation of DISH, the relationship among DISH, OPLL, and OLF, and management of thoracic myelopathy due to OPLL and OLF were reviewed