Mid-thoracic Segments Research Articles

Clinico-pathological study of esophageal mucoepidermoid carcinoma: a 10-year survival from a single center

BackgroundMucoepidermoid Carcinoma of the Esophagus (MECE) is a relatively rare tumor type, with most of the current data derived from case reports or small sample studies. This retrospective study reports on the 10-year survival data and detailed clinicopathological characteristics of 48 patients with esophageal MEC.MethodsData were collected from 48 patients who underwent curative surgery for esophageal MEC at the Fourth Hospital of Hebei Medical University between January 1, 2004, and December 31, 2020. These were compared with contemporaneous cases of Esophageal Squamous Cell Carcinoma (ESCC) and Esophageal Adenocarcinoma (EAC). Using the Kaplan-Meier method and multivariate Cox regression analysis, we investigated the clinicopathological factors affecting the survival of patients with MEC.ResultsThe incidence of MECE was predominantly higher in males, with a male-to-female ratio of approximately 7:1. The mid-thoracic segment emerged as the most common site of occurrence. A mere 6.3% of cases were correctly diagnosed preoperatively. The lymph node metastasis rate stood at 35.4%. The overall 1-year, 3-year, 5-year, and 10-year survival rates for all patients were 85.4%, 52.1%, 37.0%, and 31.0%, respectively. Post 1:1 propensity score matching, no significant statistical difference was observed in the Overall Survival (OS) between MEC patients and those with Esophageal Squamous Cell Carcinoma (ESCC) and Esophageal Adenocarcinoma (EAC) (P = 0.119, P = 0.669). Univariate analysis indicated that T staging and N staging were the primary factors influencing the prognosis of esophageal MEC.ConclusionsMECE occurs more frequently in males than females, with the mid-thoracic segment being the most common site of occurrence. The rate of accurate preoperative endoscopic diagnosis is low. The characteristic of having a short lesion length yet exhibiting significant extramural invasion may be a crucial clinicopathological feature of MECE. The OS of patients with MEC does not appear to significantly differ from those with esophageal squamous carcinoma and adenocarcinoma.

Predicting clinical entry point for thoracic epidural catheter insertion during paramedian approach: A prospective observational study.

Thoracic epidural insertion has high failure rates in the mid-thoracic region due to steep angulation of oblique bending of spinous processes. The preferred skin puncture point for epidural needle insertion in the paramedian sagittal plane with respect to the superior/inferior tip of spinous process or inter-spinous cleft in the mid-thoracic region (T5-8) is not standard. The primary objective of this prospective observational study was to find the skin puncture point which had the best success rate for a successful epidural catheterization. Secondary objectives were to study the number of attempts and passes required to locate epidural space, incidence of failed epidural, and its relationship with patient characteristics and demographics. After informed consent, 155 patients planned for general anesthesia with epidural analgesia in the mid-thoracic region were included in the trial. Patient demographics, the details of epidural attempts with respect to anatomical landmarks, distance from the midline, and number of passes in each attempt were noted. Epidural catheterization was considered successful after demonstrating dermatomal band of sensory blockade. The success rate at different skin puncture sites was not statistically significant (P = 0.58). We found a failure rate of 12.9%. Failed epidural catheterization was significantly high in the age group >56 years (n = 62 and P = 0.007). In our study, none of the skin puncture points had a significant association with successful epidural insertion in mid-thoracic segments using a para-median approach.

The multisystem deformities features of Klippel-Feil syndrome patients combined with congenital scoliosis

Objective: To summarize the characteristics of multisystem deformities in patients with Klippel-Feil syndrome (KFS) combined with congenital scoliosis (CS). Methods: Within the framework of the "Deciphering Disorders Involving Scoliosis and Comorbidities (DISCO)" research collaboration, a retrospective analysis was conducted on patients diagnosed with KFS and CS at Peking Union Medical College Hospital between April 2005 and August 2022. Patient data, including imaging examinations and medical records, were collected to summarize the spinal and associated deformities. Results: A total of 82 KFS patients with concurrent CS were included, comprising 42 males and 40 females. The average age was (12.8±8.9) years. Among the KFS patients, there were 31 cases of Type Ⅰ, 12 cases of Type Ⅱ, and 39 cases of Type Ⅲ. The most common location for the major curve of scoliosis was the mid-thoracic segment (42 cases, 51.2%). Hemivertebrae deformities were most frequently observed in the upper thoracic segment (31 cases, 60.8%). There were no statistically significant differences in age, gender, major curve Cobb angle, or region of hemivertebrae occurrence among the different types of KFS (all P>0.05). Apart from spinal vertebral deformities, intraspinal deformities had the highest comorbidity rate (33 cases, 40.2%). The subjects were divided into two groups based on the presence or absence of intraspinal deformity (absence as group G0, presence as group G1), there was a statistically significant difference in the main Cobb angle [M(Q1, Q3)] between the two groups, which was 45.0° (27.5°, 62.0°) and 60.0° (37.5°, 83.5°), respectively (P=0.044). Additionally, a portion of the patients had concurrent cardiovascular system abnormalities (13 cases, 15.9%), craniofacial-ocular-auricular abnormalities (8 cases, 9.8%), genitourinary system abnormalities (7 cases, 8.5%), and gastrointestinal abnormalities (2 cases, 2.4%). Conclusions: Patients with KFS combined with CS commonly present with a major curve of spinal deformity in the mid-thoracic segment and often have comorbidities involving multiple systems. When combined with intraspinal anomalies, the major curve exhibits a greater degree of curvature.

Usefulness of Distal Access Catheter in Endovascular Embolization for Spinal Dural Arteriovenous Fistulae in the Mid-Thoracic Segment.

We report a case of mid-thoracic spinal dural arteriovenous fistula (SDAVF) that was successfully treated by transarterial embolization using a distal access catheter (DAC). A 75-year-old male presented with about a 2-year history of slowly progressive bilateral lower extremity weakness and numbness. Spinal MRI revealed significant spinal cord lesions and flow voids below Th4. Spinal angiography revealed a mid-thoracic SDAVF. We performed a transarterial selective embolization using a 4.2Fr DAC combined with a 6Fr guiding catheter to obtain a stronger support. The fistula was completely occluded. For endovascular embolization of SDAVF, especially in the case of mid-thoracic SDAVF, using a DAC can be one of the most powerful options to obtain a stronger support.

The Evolution of Sagittal Spinal Alignment in Sitting Position During Childhood.

This is a cross-sectional descriptive study. The purposes of this study are to describe normative data of the sagittal plane in the sitting position within the pediatric population and document the evolution of sagittal alignment during the growth. Surgical procedures addressing the deformity aim to make the maximal correction on the coronal and transverse planes and to restore the physiological curves on the sagittal plane. Prerequisite for sagittal plane reconstruction is to know the physiological values. Children between 3 and 17 years of age, followed by pediatrics unit for nonskeleton disease with lateral radiographs of the entire spine and pelvis on sitting positions, were included to the study. Children with history of surgery or disease that may affect spine development were excluded. Children were evaluated in 4 age groups (3-6, 7-9, 10-12, and 13-17 yr) in terms of spinal sagittal alignment on sitting position. Of the screened, 124 children (49 girls, 75 boys) were included. Descriptive statistics of all possible segmental angles were summarized. Thoracic kyphosis and lumbar lordosis values were lower on sitting position than on standing position. Thoracic segmental angulations steadily increased from T1-T2 to midthoracic segments and then decreased in caudal direction. Moreover, lumbar segmental angulations steadily increased in cephalocaudal direction. Sacral slope, L4-S1 angulation, and T1-T12 and T1-S1 distance tend to increase as the age increases. Sagittal spinal alignment in the sitting position is different than that in the standing position and it changes as the child grows. There is a statistically significant difference between different age groups, especially at the cervicothoracic, thoracolumbar, and lumbosacral junctions. These findings should be taken into consideration for young nonambulatory patients who require spinal instrumentation and/or fusion. 2.

Dense distributed processing in a hindlimb scratch motor network.

In reduced preparations, hindlimb movements can be generated by a minimal network of neurons in the limb innervating spinal segments. The network of neurons that generates real movements is less well delineated. In an ex vivo carapace-spinal cord preparation from adult turtles (Trachemys scripta elegans), we show that ventral horn interneurons in mid-thoracic spinal segments are functionally integrated in the hindlimb scratch network. First, mid-thoracic interneurons receive intense synaptic input during scratching and behave like neurons in the hindlimb enlargement. Second, some mid-thoracic interneurons activated during scratching project descending axons toward the hindlimb enlargement. Third, elimination of mid-thoracic segments leads to a weakening of scratch rhythmicity. We conclude that densely innervated interneurons in mid-thoracic segments contribute to hindlimb scratching and may be part of a distributed motor network that secures motor coherence.

Disuse muscle atrophy exacerbates motor neuronal degeneration caudal to the site of spinal cord injury

Spinal cord injury is often followed by disuse muscle atrophy. The effect of disuse muscle atrophy on motor neurons below the level of spinal cord lesions is not fully understood. We produced spinal contusions in the mid-thoracic segment (Th7/8) of rats. To promote disuse muscle atrophy, their hind limbs were immobilized. Alpha-motor neurons in L4/5 at 3 weeks postinjury showed signs of degeneration associated with disuse muscle atrophy. Muscle atrophy alone did not produce a significant α-motor neuronal degeneration. Our results demonstrate that disuse muscle atrophy within the context of spinal cord injury exacerbates motor neuronal degeneration in caudal regions remote from the injury.

Evaluation of thoracic pedicle morphometry in a Chinese population using 3D reformatted CT

The aim of this study was to investigate the detailed three-dimensional morphology of the pedicles from T1 to T12 in 120 Chinese patients using a light-speed Vct CT (General Electric). After reformatting the original images, the following parameters were studied: outer pedicle width (OPW), outer pedicle height (OPH), pedicle chord length (PCL), pedicle cortical thickness (PCT) of the isthmus, and transverse pedicle angle (TPA). The mean outer pedicle width, outer pedicle height, and pedicle chord length were significantly smaller in females than in males at all levels (P < 0.01). The percentage of outer pedicle width ≤ 5.0 mm and ≤ 4.5 mm was high at mid-thoracic pedicles. No significant differences were found in transverse pedicle angle and pedicle cortical thickness in males and females. Pedicle cortical thickness was significantly thinner in patients over 50 years old compared with patients below 50 years old at most levels. The results showed that a screw of larger than 4.5 mm would be too large for mid-thoracic segments in Chinese population, especially for female patients. Considering the amount of variation between individuals and the complicated structure of the thoracic pedicles, the use of the transpedicular screw fixation must be individualized for each patient and based on detailed preoperative assessment. Reformatted CT assessment is essential before this procedure is performed.

Autonomic dysreflexia after spinal cord transection or compression in 129Sv, C57BL, and Wallerian degeneration slow mutant mice

To study plasticity of central autonomic circuits that develops after spinal cord injury (SCI), we have characterized a mouse model of autonomic dysreflexia. Autonomic dysreflexia is a condition in which episodic hypertension occurs after injuries above the midthoracic segments of the spinal cord. As synaptic plasticity may be triggered by axonal degeneration, we investigated whether autonomic dysreflexia is reduced in mice when axonal degeneration is delayed after SCI. We subjected three strains of mice, WldS, C57BL, and 129Sv, to either spinal cord transection (SCT) or severe clip-compression injury (CCI). The WldS mouse is a well-characterized mutant that exhibits delayed Wallerian degeneration. The CCI model is an injury paradigm in which significant the axonal degeneration is due to secondary events and therefore delayed relative to the time of the initial injury. We herein demonstrate that the incidence of autonomic dysreflexia is reduced in WldS mice after SCT and in all mice after CCI. To determine if differences in afferent arbor sprouting could explain our observations, we assessed changes in the afferent arbor in each mouse strain after both SCT and CCI. We show that independent of the type of injury, 129Sv mice but not C57BL or WldS mice demonstrated an increased small-diameter CGRP-immunoreactive afferent arbor after SCI. Our work thus suggests a role for Wallerian degeneration in the development of autonomic dysreflexia and demonstrates that the choice of mouse strain and injury model has important consequences to the generalizations that may be drawn from studies of SCI in mice.

Autonomic dysreflexia in a mouse model of spinal cord injury

Most experimental studies of spinal cord injury have centered on the rat as an experimental model. A shift toward a mouse model has occurred in recent years because of its usefulness as a genetic tool. While many studies have concentrated on motor function and the inflammatory response following spinal cord injury in the mouse, the development of autonomic dysreflexia after injury has yet to be described. Autonomic dysreflexia is a condition in which episodic hypertension develops after injuries above the mid-thoracic segment of the spinal cord. In this study 129Sv mice received a spinal cord transection at the second thoracic segment. The presence of autonomic dysreflexia was assessed 2 weeks later. Blood pressure responses to stimulation were as follows: moderate cutaneous pinch caudal to the injury (35±6 mm Hg), tail pinch (25±7 mm Hg), and a 0.3 ml balloon distension of the colon (37±4 mm Hg). Previous reports have suggested that small diameter primary afferent fiber sprouting after spinal cord injury may be responsible for the development of autonomic dysreflexia. In order to determine whether autonomic dysreflexia in the mouse may be caused by a similar mechanism, the size of the small diameter primary afferent arbor in spinal cord-injured and sham-operated animals was assessed by measuring the area occupied by calcitonin gene-related peptide-immunoreactive fibers. The percentage increase in the area of the small diameter primary afferent arbor in transected over sham-operated spinal cords was 46%, 45% and 80% at spinal segments thoracic T5–8, thoracic T9–12 and thoracic T13–lumbar L2 respectively. This study demonstrates the development of autonomic dysfunction in a mouse model of spinal cord injury that is associated with sprouting of calcitonin gene-related peptide fibers. These results provide strong support for the use of this mouse model of spinal cord injury in the study of autonomic dysreflexia.

Continuous Caudal Epidural Analgesia for Congenital Lobar Emphysema: A Report Of Three Cases

Continuous Caudal Epidural Analgesia for Congenital Lobar Emphysema: A Report Of Three Cases

The relative influence of vertebral body and intervertebral disc shape on thoracic kyphosis

Objective. The aim of this study was to quantify the morphology or shape of thoracic vertebral bodies and intervertebral discs, and to examine the ex vivo association of thoracic kyphosis with these shape parameters. Design. A quantitative, retrospective study design was applied to define vertebral body and disc influences on thoracic kyphosis. Background. Age-related progression of thoracic kyphosis is a well-defined process that is influenced by the morphology of vertebral bodies. However, little is known about the contribution of intervertebral disc shape to the thoracic curvature. Methods. Vertebral and disc morphology, as represented by antero-posterior height ratios, were quantified in 93 lateral spine radiographs and midsagittal computed tomography films of ex vivo spines. Kyphosis was indicated by the Cobb angle. Linear and stepwise regression were applied to examine relationships for cumulative (T1–T12) and regional (T4–T9) analyses. Results. Vertebral morphology was highly predictive of thoracic curvature, while a poorer association was noted for disc morphology. The combined influence of both accounted for >85% of the variability in kyphosis. There was a trend for a more pronounced anterior wedge configuration of the midthoracic vertebral bodies and discs. Higher associations between variables were also noted in this region. Conclusions. The normal kyphosis of the thoracic spine reflects the morphological adaptation of both the vertebral bodies and intervertebral discs. Relevance This study contributes new data on the thoracic spine, particularly the characteristics of thoracic discs and their contribution to kyphosis genesis. Future directions for morphology studies should encompass more detailed examination of the thoracic discs and greater emphasis on the midthoracic segments, considering the prevalence of osteoporosis related fractures and subsequent deformity at these levels.

Spreading pattern of epidurally administered contrast medium in rabbits.

The aim of this study was to examine the precise spreading pattern of epidurally administered contrast medium with small increments of injection volume for determining both the exact volume of the dose required and the site of epidural injection according to different target segments of the spinal cord in a rabbit epidural model. Following pentobarbital anesthesia, the epidural puncture was done surgically with a round-tipped blunt hook. The tip of the epidural catheter was located at either the mid-portion of T7 (T7 group, n = 7) or T12 (T12 group, n = 8). Injection of the contrast medium was started at 0.1 ml/kg and increased by 0.1 ml/kg up to a maximum of 0.6 ml/kg. In both groups, the extent of spread increased continuously with increasing injected volume (T7 group: r2 = 0.91, P = 0.0001; T12 group: r2 = 0.86, P = 0.0001) and the total spread of contrast medium was similar. However, the spread was not linearly volume dependent. The total number of segments (y) through which the contrast medium spread during changes in its volume (x) in the T7 and T12 groups was calculated as y = 4.0 + 41.8x - 28.1x2 and y = 0.2 + 57.7x - 43.5x2, respectively. The contrast medium spread in both rostral and caudal directions, equally from the catheter tip in the T7 group, whereas it spread rostrally about twice as far as it spread caudally in the T12 group (P < 0.05). In rabbits, it is recommended that at the lower thoracic or lumbar segments the tip of the epidural catheter should be located 1-3 segments below the target segment because of more rostral spread. In the case of mid-thoracic segments, however, placement at the target segment is recommended. In addition, a small titration of volume to achieve a particular range of epidural spread should be required.

Segment-specific pattern of sympathetic preganglionic projections in the chicken embryo spinal cord is altered by retinoids.

Sympathetic preganglionic neurons exhibit segment-specific projections. Preganglionic neurons located in rostral spinal segments project rostrally within the sympathetic chain, those located in caudal spinal segments project caudally, and those in midthoracic segments project either rostrally or caudally in segmentally graded proportions. Moreover, rostrally and caudally projecting preganglionic neurons are skewed toward the rostral and caudal regions, respectively, of each midthoracic segment. The mechanisms that establish these segment-specific projections are unknown. Here we show that experimental manipulation of retinoid signaling in the chicken embryo alters the segment-specific pattern of sympathetic preganglionic projections and that this effect is mediated by the somitic mesoderm. Application of exogenous retinoic acid to a single rostral thoracic somite decreases the number of rostrally projecting preganglionic neurons at that level. Conversely, disrupting endogenous synthesis of retinoic acid in a single caudal thoracic somite increases the number of rostrally projecting preganglionic neurons at that level. The number of caudally projecting neurons does not change in either case, indicating that the effect is specific for rostrally projecting preganglionic neurons. These results indicate that the sizes of the rostrally and caudally projecting populations may be independently regulated by different factors. Opposing gradients of such factors along the longitudinal axis of the thoracic region of the embryo could be sufficient, in combination, to determine the segment-specific identity of preganglionic projections.

Galanin immunoreactivity in rat spinal lamina IX: Emphasis on sexually dimorphic regions

Fibers and puncta that contained galanin-like immunoreactivity (GAL-LI) were distributed within lamina IX in a heterogeneous fashion. In cervical spinal segments, GAL-LI was almost absent except for the phrenic nucleus, which received the most robust GAL-LI innervation in lamina IX. In high and mid-thoracic segments, GAL-LI was found in moderate amounts, but the number of GAL-LI fibers gradually diminished in a caudal fashion, so that in low thoracic segments GAL-LI was sparse. Throughout all thoracic segments, GAL-LI fibers surrounded some clusters of motoneurons, while other groups of motoneurons were devoid of GAL-LI fibers. In lumbar segments, three sexually dimorphic nuclei received sparse to moderate amounts of GAL-LI, while GAL-LI in the remainder of lumbar lamina IX was very sparse. In sacral spinal segments, GAL-LI was very sparse. These data indicate that fibers and puncta that contain GAL-LI preferentially surround motoneurons that innervate muscles associated with the axial skeleton, while motoneurons that innervate appendicular or tail-associated skeletal muscles only have an occasional GAL-LI fiber associated with them.

Aneurysmal enlargement of the aorta during regression of experimental atherosclerosis

We explored the relationship between regression of diet-induced atherosclerosis and aneurysmal enlargement of the aorta in cynomolgus monkeys. Atherosclerotic plaques were induced in 17 monkeys by feeding them a diet containing 2% cholesterol and 25% peanut oil for 6 months (group I, n = 6; group III, n = 6) or 12 months (group II, n = 5). Regression was induced in group III by feeding a regression diet consisting of 0.25% cholesterol and 15% corn oil in a standard chow diet, for 6 months after the 6-month induction period. Serum cholesterol was 788 +/- 80 mg/dl after 6 months of induction, 508 +/- 53 mg/dl after the 12-month induction period, and 198 +/- 15 mg/dl in the regression group at 12 months. Aortas were fixed in situ under conditions of controlled pressure perfusion, and transverse sections of the unopened vessels were taken at standard levels in the midthoracic and abdominal aortic segments. The area encompassed by the internal elastic lamina was taken as a measure of artery size. Plaques were abundant in abdominal and thoracic sections after the 6- and 12-month induction periods, and no significant difference was observed in lumen area or artery size between the groups. The ratio of abdominal to thoracic aortic plaque area was markedly reduced in the regression group (0.3 +/- 0.2 for regression compared with 0.6 +/- 0.3 for 6-month induction and 1.3 +/- 0.2 for 12-month induction animals; p less than 0.05 for both). A twofold increase was observed in abdominal aortic lumen area in the regression group (10.0 +/- 1.5 mm2 for regression compared with 5.6 +/- 0.7 mm2 for the 6-month and 4.2 +/- 0.7 mm2 for the 12-month induction groups; p less than 0.05 for both) as well as a twofold increase in internal elastic lamina area (10.5 +/- 1.5 mm2 compared with 6.0 +/- 0.7 mm2 for the 6-month and 5.9 +/- 0.8 mm2 for the 12-month induction group; p less than 0.05 for both). Aortic enlargement in the regression group was accompanied by a reduction in media thickness in the abdominal aorta. No significant vessel enlargement or alteration in media thickness occurred in the thoracic aorta. One of six regression animals (17%) had a threefold enlargement of the abdominal aorta and was thought to have a manifest aneurysm.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of methyl prednisolone, dimethyl sulphoxide and naloxone in experimental spinal cord injuries in rats.

The effects of methyl prednisolone (MPD), dimethyl sulphoxide (DMSO), and naloxone were examined in 38 albino rats after making an impact spinal cord injury on the midthoracic segments with a modified Allen's weight dropping trauma method. Somatosensorial evoked potentials (SEPs) were recorded before and 12 h and 14 d after the injury from epidurally inserted electrodes on the parietal cortex with sciatic nerve stimulations. Lower extremity motor functions of the animals were also examined. It may be concluded that in this study model, DMSO has a moderate effect which can be demonstrated clinically and through SEPs. Naloxone has no effect on the clinical outcome but causes reasonable improvement electrophysiologically.

EFFECTS OF POSTURE AND BARICITY ON SPINAL ANAESTHESIA WITH 0.5% BUPIVACAINE 5 ML: A Double-Blind Study

In four groups of 10 patients, 0.5% bupivacaine 5 ml was used in spinal anaesthesia for gynaecological surgery. Group 1 received plain solution in the sitting position, group 2 plain solution in the lateral position, group 3 hyperbaric solution in the sitting position and group 4 hyperbaric solution in the lateral position. All patients were returned to the horizontal supine position, the sitting subjects 2 min after, and the lateral subjects immediately after, spinal injection. In each group the mean height of block was to the mid-thoracic segments, but there was no significant difference between the groups. There was, however, considerable scatter within each group. Posture had some effect on the speed of onset of the analgesia, but no significant effect on the final outcome. The use of 0.5% bupivacaine as a test dose in extradural blockade is discussed.

Caustic burns and carcinoma of the esophagus.

A history of caustic injury was obtained in 12 of 846 patients with squamous cell carcinoma of the esophagus. The average age was 52.8 years; the interval from injury to development of carcinoma was 45.8 years. Nine of the 12 carcinomas were in the midthoracic segment. Resection was possible in nine patients, with two surviving over ten years. A survey of reported series with this association confirms the increased resection rate and probability of long survival compared with the usual carcinoma of the esophagus.

Distribution of protein I, a synapse-specific phosphoprotein, and adenylate cyclase in the rat spinal cord.

The longitudinal and transverse distributions of the synapse-specific phosphoprotein Protein I and adenylate cyclase in the rat spinal cord were studied. Protein I was found to be enriched in all cervical and midlumbar (L3-L5) segments, and sparse in midthoracic and sacral segments. Adenylate cyclase activity was high in all cervical and lumbosacral segments, and low in mid-thoracic segments. Cross sectionally, both Protein I and adenylate cyclase were more enriched in the dorsal half than in the ventral half in the various segments studied. The similar topographical distributions of Protein I and adenylate cyclase in the spinal cord support the idea that adenylate cyclase may be intimately associated with Protein I in the nervous system, and could thereby regulate the state of in vivo phosphorylation of Protein I through formation of cyclic AMP.