To study the influence of the number of metastatic lymph nodes (LNs) on survival and International Union Against Cancer tumor-node-metastasis (TNM) classification for esophageal carcinoma. The clinicopathological data on 1146 patients with esophageal squamous cell carcinoma who had undergone an esophagectomy were retrospectively studied. Survival was analyzed by the Kaplan-Meier method. By subclassifying the nodes (N) category according to the number of metastatic LNs as: N0 for no LN metastases; N1(1) for only one positive node; and N1(2) for >or=2 positive nodes. TNM staging was refined as stage IIa (T2-3N0M0), stage IIb (T1N1M0 and T2N1(1)M0), stage IIIa (T2N1(2)M0 and T3N1(1)M0), and stage IIIb (T3N1(2)M0 and T4NanyM0), and the survival was analyzed. LN metastases was found in 380 of 1146 (33.2%) treated esophageal cancer patients. In 4270 LNs harvested, metastases was detected in 807 (18.9%). The 5-year survival rates of the patients with 0, 1, and >or=2 positive nodes were 59.8, 33.4, and 9.4%, respectively. There was statistically significant difference among these three groups. The 5-year survival of the patients in stages T2N1M0 and T3N1M0 was significantly higher in the N1(1) group than in the N1(2) group (41.5 vs 24.1%, and 31.2 vs 6.8%, P<0.001). The 5-year survival rates of the patients in refined stage IIa, IIb, IIIa, and IIIb were 57.1, 42.2, 28.6, and 8.5%, with significant difference existing in each stage groups. The number of positive LNs significantly influenced survival of the patients with esophageal cancer. Three grade classification (0, 1, >or=2 positive nodes) could quite well demonstrate the effect of the number of LN metastases and the survival. The refined TNM classification based on the number of LN metastases could better reflect the prognosis of esophageal cancer. Our results offer a strong rationale for refining the International Union Against Cancer TNM classification for esophageal carcinoma.
Introduction Earlier work has suggested that the p38 MAPK, JNK1/2, and ERK1/2 signal pathway existed in nucleus pulposus cells and the cell growth, differentiation, and apoptosis were regulated by them. Because osmotic fluctuations are inevitable in the physicochemical environment of intervertebral disc cells, high osmolality could activate p38 MAPK, JNK1/2, and ERK1/2 signal pathway. The effects of high osmolality on the catabolic program and proliferation of nucleus pulposus cells are still not clear. Materials and Methods Rabbit nucleus pulposus cells were cultured and divided into different group at random. The cells were pretreated with inhibitor for p38 MAPK, JNK1/2, and ERK1/2 signal pathway, respectively. In next step, the cells were cultured in different osmolality environment for different time at 37°C in 5% carbon dioxide incubator. After treatments, ratio of apoptosis was measured by flow cytometry, and Western blotting was performed to quantify the expression of the activated forms of p38 MAPK, JNK1/2, and ERK1/2. Furthermore, immunofluorescence analysis with confocal microscopy was performed to confirm the hyperosmolality effects on activation of p38 MAPK, JNK1/2, and ERK1/2 signal pathways in nucleus pulposus cells. Results Our results show that in 500 and 600 mOsm/kg medium, rabbit nucleus pulposus cell apoptosis increased, and a persistent phosphorylation of p38 MAPK, JNK1/2, and ERK1/2 proteins were observed. In the same condition, the apoptotic cells death remarkably decreased when the p38 MAPK and JNK1/2 signal pathways were blocked by their inhibitors SB203580 and SP600125, respectively. On the other side, the apoptotic cells death rate reraised greatly when the ERK1/2 signal pathways were blocked by its inhibitor PD98059. Conclusion High osmolality activated p38MAPK, JNK1/2, and ERK1/2 in rabbit nucleus pulposus cell, and the activated p38 MAPK and JNK1/2 induced cell apoptosis, on the contrary, the activated ERK1/2 made the cell survived. Disclosure of Interest None declared References Freemont AJ. The cellular pathobiology of the degenerate intervertebral disc and discogenic back pain. Rheumatology (Oxford) 2009;48(1):5–10 Urban JP, McMullin JF. Swelling pressure of the inervertebral disc: influence of proteoglycan and collagen contents. Biorheology 1985;22(2):145–157 Wilke HJ, Neef P, Caimi M, Hoogland T, Claes LE. New in vivo measurements of pressures in the intervertebral disc in daily life. Spine 1999;24(8):755–762 Takeno K, Kobayashi S, Negoro K, et al. Physical limitations to tissue engineering of intervertebral disc cells: effect of extracellular osmotic change on glycosaminoglycan production and cell metabolism. Laboratory investigation. J Neurosurg Spine 2007;7(6):637–644 Boyd LM, Richardson WJ, Chen J, Kraus VB, Tewari A, Setton LA. Osmolarity regulates gene expression in intervertebral disc cells determined by gene array and real-time quantitative RT-PCR. Ann Biomed Eng 2005;33(8):1071–1077 Wuertz K, Urban JP, Klasen J, et al. Influence of extracellular osmolarity and mec...
In 4 7 a nima ls (rats, rab bits) the cardiac side effects of prolonged (3 to 6 hours) abdomi nal aortic cross-clamping and unc lam ping (3 to 6 ho urs) were in vestigated. T he rela tive insta ntaneous ventricu lar vascular vo lume (IVVV), a factor refl ect ing myoca rd ial b lood supply and t he rate p ressure product lAPP) represe nti ng myocardia l oxyge n dema nd were used as para mete rs. Fo llowing cross-clampi ng the IVVV showed an initia l dec rease while the myocar dial oxygen demand revealed a sudde n increase. Afte r unclamping, the myoca rdial oxygen demand dec reased and IVVV improved. Minimal levels of both IVVV and RPP occu rred at 6 hours following unc lamping. This may be an effect of a myocardial inhib iting substance, released by ischemia and necrosis of the lower e xtremity. Keyword s: Abdomi nal ao rtic cross-clampi ng-Myocardia l oxygen dema nd-Instan taneous ventricular vascu lar volume-Ra te pressure product
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