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Objective:To evaluate the clinical outcome of a special physeal sparing knee prosthesis for pediatric distal femoral osteosarcoma regarding the functional outcome, retention of the growth potential of the proximal tibia, and postoperative complications.Methods:A retrospective study was conducted to review 37 pediatric patients with osteosarcoma of distal femur who were treated in a single musculuskeletal tumor center between August 2015 and January 2019. Among them, 21 were boys and 16 were girls, aged from 5 to 12 years at the time of operation, with an average age of 9.1±2.1 years and the height of 115 to 160 cm, with an average of 140±10 cm. Tumor resection of distal femur was performed and the bone defect was reconstructed by a special hinged knee prosthesis which can preserve the proximal tibial epiphyseal plate. Demographic data was recorded. Overall leg length and tibial length was assessed by full-length standing anteroposterior radiographs of bilateral lower extremity with the patella pointing anteriorly preoperativelly and postoperativelly at each follow up. And the growth potential of the affected proximal tibia was calculated by comparing with the preoperative length of tibia. Meanwhile, the functional outcome was assessed by using the Musculoskeletal Tumor Society (MSTS) system, and the postoperative complications were analysed.Results:All patients underwent the tumor resection and reconstruction operation successfully. The average operation duration was 143±41 minutes, ranging 90 to 250 minutes. The average intraoperative blood loss was 314±397 ml, ranging 30 to 2 200 ml. The patients were followed up for 24 to 64 months, averaging 42.3±12.1 months. The postoperative knee range of motion was 100-130 degrees, with an average of 115.6±7.2 degrees. The postoperative MSTS score was 23-30, with an average of 26.7±1.6. To the last follow-up, the limb length discrepancy of the lower limb was 1.3 to 10 cm, and the length of the tibia was shortened from 0 to 3.8 cm compared with the opposite side, with an average of 1.3±1.0 cm. The growth percentage of the proximal tibial epiphysis on the affected side was 30% to 100%, with an average of 70%±17%. Totally, 13 patients suffered postoperative complication, the overall incidence of complications was 35% (13/37), and prosthesis-related complications were 16% (6/37). Three patients with wound dehiscence were managed by debridement and antibiotics. Radiographs revealed femoral stem loosening in a single patient 3 years after the initial operation and then the prosthesis was converted to an adult tumor knee endoprosthesis. Two cases experienced breakage of the femoral stem at 30 and 33 months, respectively, due to an accidental injury. They received revision surgery, and a new femoral prosthesis component was replaced. One patient developed femoral stem breakage at 10 months after surgery due to fatigue fracture, which treated with revision surgery. Tumor recurrence occurred in 6 patients. Among them, tumor recurrence in soft tissue occurred in 4 patients, and treated with regional resection without further recurrence. The other 2 patients experienced tumor recurrence at the distal femoral site, and treated with resection and prosthetic revision.Conclusion:The physeal sparing pediatric knee prosthesis can preserve the growth potential of the proximal tibial epiphyseal plate with good postoperative function and low incidence of prosthesis complications. Therefore, it can be an alternativeespecially for skeletally immature patients with distal femur osteosarcoma.
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Objective:To investigate the clinical efficacy of cement-in-cement (CiC) technique for endoprosthetic revision surgeries of noninfectious causes around the knee.Methods:All of 128 patients who had received cement-in-cement technique for endoprosthetic revision from February 2002 to August 2020 including 71 males and 57 females, whose mean age was 33.5±15.4 years (range, 8-77 years). 128 patients included 73 cases of osteosarcoma, 38 cases of giant cell tumors, 8 cases of undifferentiated sarcoma, 4 cases of chondrosarcoma, 2 cases of Ewing sarcoma, 2 cases of fibrosarcoma and 1 case of synovial sarcoma, with 105 cases in distal femur and 23 cases in proximal tibia. The failure mode classification included 64 cases of aseptic loosening, 47 cases of structure failure and 17 cases of tumor progression. 16 out of the 19 endoprosthese failure after the first cement-in-cement procedure received a second cement-in-cement procedure. The survival of revised prostheses, duration of the operation, the amount of blood loss, epidemiological data, complications and limb function were enrolled and statistical analyzed.Results:The mean follow-up from CiC revision was 127±33 months (range, 6-326 months). There were 25 (19.5%) complications for the first CiC procedure and 19 (14.8%) of the 25 complications lead to the protheses failure including 5 (3.9%) structure failure, 6 (4.7%) aseptic loosening, 2 (1.6%) tumor recurrence and 6 (4.7%) infection. The other 6 cases included 5 poor superficial wound healing and 1 patellar ligament rupture. All were recovered after debridement and tendon repair. The cumulative survival rates of first CiC procedure were 85.0%, 76.6% and 70.7% at 5, 10 and 15 years, respectively. Limb salvage rate was 97.7%. Sixteen of the 19 cases received a second CiC revision. The mean operative time (206±51 min vs. 258±41 min, t=3.18, P=0.399), blood loss (596±217.99 ml vs. 621±245.84 ml, t=0.30, P=0.926) and the median MSTS 93 score (26.38±2.47 vs. 25.06±2.11, t=1.61, P=0.376) of the first and second CiC procedure for the 16 cases were similar. Conclusion:CiC technique is a repeatable, conservative and viable option for endoprosthetic revision surgeries of noninfectious causes around the knee, with acceptable prosthetic survival rate, complication rate and limb function.
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Objective:To assess the clinical outcome of patients with spinal tumors who received en bloc resection in our center and to provide theoretical basis for developing novel surgical technique in en bloc resection for spinal tumor.Methods:We retrospectively reviewed the clinical and follow-up data of 113 patients who received en bloc resection for spinal tumors in Musculoskeletal Tumor Center, Peking University People's Hospital from Jan. 2007 to Dec. 2021. There were 68 males and 45 females with an average age of 38.7±16.7 (10-79) years. Primary malignant spinal tumors, primary aggressive spinal tumors and solitary metastatic spinal tumors were diagnosed in 55, 27 and 31 patients, respectively. The surgeries were planned according to the surgical classification for en bloc resection for spinal tumors proposed by Boriani et al, which classified the en bloc resection for spinal tumor into 7 types. The general condition (gender, age, histological diagnosis, location of the lesion, number of involved vertebrae, pre-operative neurological function), surgical procedure (type of surgery, stage of surgery, reconstruction method for anterior structure, duration of surgery, intra-operative haemorrhage, surgical margin), peri- and post-operative complication (intra- and peri-operative complication, post-operative neurological function), and survival [overall survival (OS), recurrence-free survival (RFS) and implant survival (IS)] of patients were retrospectively analyzed.Results:All surgeries accomplished uneventfully except one intra-operative death owing to the haemorrhagic shock caused by injury of major blood vessel. Mean duration of surgery and volume of intra-operative haemorrhage was 517.6±267.4 min and 3802.7±3039.4 ml, respectively. R0 resection was achieved in 48 patients. Three patients died in peri-operative period. Intra- and peri-operative complications were identified in 44 patients (38.9%). 109 patients were followed up with a mean time of 39.4±35.2 months. 27 patients died during follow-up period. The average post-operative overall survival (OS) was 115.4[95% CI (97.9, 133.0)]months and the 5-year OS rate was 64.1%[95% CI (52.3%, 75.9%)]. In patients with primary malignant spinal tumors, the OS of patients with R2 resection was significantly poorer than that of patients with R0/R1 resection ( P=0.024); in patients with metastatic tumors, no difference of OS was observed in patients with different surgical margins ( P=0.612). There were 29 recurrences, and the mean RFS was 105.8 [95% CI (87.5, 124.1)] months. In patients with primary malignant and aggressive spinal tumors, the RFS of patients underwent R2 resection was significantly lower than that of patients underwent R0/R1 resection ( P=0.008, P=0.027); in patients with metastatic spinal tumors, no significant difference of RFS was found in patients with different surgical margin (P=0.707). Conclusion:Although en bloc resection for spinal tumors indicates high morbidity, it significantly improves the OS of patients with primary malignant spinal tumors and the local control of primary malignant and aggressive spinal tumors.
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Surgical treatment for bone and soft tumors of pelvis and sacrum presents a big challenge, because of the complex anatomy of sacropelvic region, large tumor volume at presentation, rich blood supply to the tumor and visceral involvemen, et al. Therefore, surgical excision and reconstruction are technically difficult for sacropelvic tumors. Extensive intraoperative haemorrhage could be life-threatening, and this issue remains a major concern. How to effectively control bleeding during surgery is critical for successful operation and patient's favorable prognosis. Some previous attempts, such as interventional selective internal iliac artery embolization or manual ligation through an additional anterior approach, were tested to be ineffective. Inspired by the success of resuscitative endovascular balloon occlusion of the aorta (REBOA) which resemble an endovascular tourniquet for traumatic hemorrhagic shock, some researchers have applied this techinique to control surgical bleeding during pelvic or sacral tumor resection.The authors have performed REBOA for more than 1 500 sacropelvic tumr surgeries since 2003 in Peking University People's Hospital. The patient age, the diameter of femoral artery and aorta, atherosclerosis, as well as tumor location, volume and expansion and blood suppy, have to be thoroughly evaluated prior to REBOA administration. Admittedly, the application of REBOA do reduce intraoperative bleeding, shorten the operation duration, improve the safety of surgery, yet some complications were observed including local hematoma at the puncture site, acute arterial thrombosis, femoral artery pseudoaneurysm or occlusio, et al. The purpose of this study is to review the literature on REBOA administration in pelvic and sacral tumors excision, with the focus on its indications, performing procedure, the safety and efficacy, and complications. Moreover, in order to popularize the clinical application of aortic balloon occlusion in the future, we summarize our experience of abdominal aortic balloon occlusion over 10 years.
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Objective:We designed and applied a novel, bionic megaprosthesis for distal femur, which substituted the hinged articulation with an artificial ligament and a constrained tibial insert in order to maintain articular stability and reduce stress and the risks of wearing, loosening and breakage.Methods:We reviewed the cases of distal femoral osteosarcoma in children population who were initially treated in our center during 2019. Twelve cases of bionic distal femoral prosthesis (bionic group) and 21 cases of fixed-hinge distal femoral prosthesis (control group) were included. In the bionic group, there were six female and six male with the mean age as 8.8±2.6 y. One patient had pathological fracture. Staging according to Enneking system included 1 case of stage IIA, 10 cases of stage IIB and 1 case of stage III. In the control group, there were seven female and fourteen male with the mean age as 8.6±2.2 y. Pathological fracture was seen in three cases. Staging included 15 cases of stage IIB and 6 cases of stage III.We investigated the peri-operative safety, oncological outcome, complication profiles and post-operative functional status of the bionic prosthesis by comparing the baseline data, operative data, and oncological and prosthetic outcomes between the two groups.Results:The two groups were comparable in terms of baseline data including gender, age, height, weight and onset duration, and operative data including duration of operation (126.7±27.9 min vs 143.3±38.9 min, P=0.203), intra-operative hemorrhage (162.5±212.3 ml vs 247.6±175.6 ml, P=0.224) and duration of wound drainage (6.3±2.4 d vs 6.4±3.4 d, P=0.908). The mean follow-up duration of bionic group was 16.0±4.7 months, during which time three patients had systemic progression and one of them died of disease. Another patient had local recurrence and subluxation of the prosthesis that was treated by amputation. Subluxation might be related to the huge tumor mass and excessive resection of the quadriceps femoris. As for the control group, the mean follow-up duration was 12.7±4.5 months. Three patients had systemic progression and all patients were still alive by last follow-up. Local recurrence was seen in two patients and was treated by excision. No prosthetic complications were seen in the control group. The averaged range of motion (ROM) was greater in the bionic group than that in the control group (120.6°±13.6° vs 92.0°±7.7°, P<0.05), but the MSTS 93 scores were similar between groups (29.1±0.9 vs 29.5±0.6, P=0.337). Conclusion:Compared with the fixed-hinge distal femoral prosthesis, the bionic prosthesis had good peri-operative safety, did not increase the risks of prosthetic complications, and could achieve a better range of motion and a similar functional status based on the results of short-term follow-up.
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Objective@#To explore the method of the blood return of continuous blood purification therapy for patients with heart failure.@*Methods@#A total of 69 patients with heart failure treated by continuous blood purification therapy in our ICU from January 2017 to January 2018 were randomly divided into experimental group (blood return with blood bag,35 patients) and the control group (blood return with machine,34 patients). The vital signs, clinical manifestations and hemodynamic indicators of each patient were collected during the blood return of the first CBP therapy, and the data were analyzed between the two groups.@*Results@#After blood return of the first CBP therapy, the exacerbation of New York Heart Association (NYHA) heart function grade, SpO2, CVP, HR of patients in the control group were 33.27% (11/31), 0.91 ± 0.06, (12.44 ± 1.43) cmH2O (1cmH2O=0.098 kPa), (118.17 ± 3.27) times per minute and those in the experimental group were 6.25% (2/32), 0.96±0.04, (8.98±1.36) cmH2O, (90.45 ± 3.35)times per minute, respectively. The difference was statistically significant between the two groups (χ2=3.786, t=2.861, -7.565, 3.792, P< 0.05). Subgroup analysis showed that for patients within 24 hours of CBP treatment, the exacerbation of NYHA heart function grade, SpO2, CVP, HR of the control group and the experimental group were respectively 76.92% (10/13), 0.86±0.01, (12.92±1.12) cmH2O, (111.38±2.96) times per minute and 8.33% (1/12), 0.94±0.01, (8.11±0.74) cmH2O, (90.34±1.32) times per minute, the difference was statistically significant (χ2 =9.345, t=-14.101, 2.894, 7.648, P < 0.05). For patients treated with CBP therapy over 24 hours, the difference of the exacerbation of NYHA heart function grade, SpO2, CVP, HR of the control group and the experimental group was not statistically significant (P>0.05).@*Conclusions@#In patients with heart failure treated with CBP, especially in those treated with CBP therapy within 24 hours, blood return with blood bag may avoid the recurrence of heart failure.
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Objective The purpose of this study was to investigate the preliminary clinical outcomes of total elbow arthroplasty (TEA) in the treatment of elbow deformity caused by tumor-like lesions.Methods Between September 2009 and June 2017,the technique of triceps facial tongue exposure was adopted for all 11 patients who underwent total elbow arthroplasty.There were 5 females and 6 males with the mean age of 56.7±14.7 years.There were 6patients with synovial chondromatosis and 5 with pathologic hypertrophy of synovium.Seven of 11 patients were performed by posterior approach only,while the other 4by combined posterior-anterior approach.A semi-constrained Coonrad-Morrey prosthesis which provides 7° varas/valgus laxity was used in 7 patients,and custom-made total constrained prosthesis which only allow flexion and extension on a single plane was used in 4 cases.Preoperative average flexion range of elbow was 50.5°±14.0° (range,20°-70°).The ulnar nerve compression and claw hand deformity was identified in 2patients preoperatively and the nerve was transposed during operation.According to Mayo elbow function score (MEPS score),the average preoperative MEPS score was 42.1±12.7 points (range,15-60).Results Perioperative complications were not found.None of patients lost in thefollow-up and all the patients were alive.There was no pain in the joints,no triceps fracture or weakening of muscle strength,and no recurrence of the lesions.All 11 patients were followed up for 7 to 63 months with an average of 36.3±19.5 months.The mean MEPS score was improved to 89±7.2 point after surgery (t=-11.993,P=0.000).The average flextion-extension arc improved from preoperative 50.5° to 105.9° postoperatively (t=-8.697,P=0.000).The average pronation-supination arc improvement from preoperative 105°-123.2° postoperatively (t=-6.901,P=0.000).For the two patients with ulnar nerve deficit before surgery,one patient recovered 6 months after operation,however,the other patient did not 2 years later.One Coonrad-Morrey prosthesis with deep infection was treated by removing the implant.Three of 4 custom-made total constrained prostheses experienced implant failure due to loosening or periprosthetic fracture.The incidence of complications of semi-constrained prosthesis was lower than that of total constrained prosthesis (14％ vs.75％),however,it did not reach a significant difference.Conclusion This study reveals an acceptable outcome with triceps facial tongue exposure for TEA in the treatment of tumor-like lesions of elbow.TEA is a viable good alternative treatment for selected patients with large mass around the elbow or with severe deformation.However,the failure rate of fully constrained prosthesis tends to be higher than semi-constrained one,possible due to its design flaw.
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We report a case of follicular variant papillary thyroid carcinoma with bone metastases as the initial symptom,and review the progression,management and short-term outcome of the case.The classification and characterization of follicular variant papillary thyroid carcinoma combined with a review of literature were discussed.We hope that the lessons learn will help better management of the disease.
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Objective To evaluate the safety and efficacy of denosumab in treatment of patients with pelvic giant cell tumor of bone (GCTB) during perioperative period. Methods This is a retrospective observational study. Twenty-three patients diagnosed with pelvic GCTB undergoing perioperative denosumab treatment in Musculoskeletal Tumor Center of Peking University People's Hospital from January 2014 to December 2016 were reviewed. The subjective adverse reactions and mandibular X-ray films were used to assess the drug safety. As for efficacy, imaging findings (including X-ray, CT, magnetic resonance imaging) were reviewed. MSTS-93 scoring system was applied in the postoperative functional assessment. Histological response rate, objective response rate, clinical benefit rate and event-free survival rate were all used to deficit the efficacy of denosumab in the treatment of pelvic GCTB combined with surgery. All the results of postoperative were compared statistically with pelvic GCTB patients who underwent surgery in the same hospital from 1999 to 2009. Results All the patients were firstly diagnosed as classic GCTB except for one case which was malignant pelvic GCTB. All patients received denosumab preoperatively and/or postoperatively, and the average number of medications was 8.43. According to the surgical patterns, patients were divided into intralesional surgery group (13 cases) and wide resection group (10 cases). The follow-up was 5-47 months(mean:27.30 months),recurrence was observed in 2 cases in the intralesional surgery group, none in the wide resection group. After drug administration, 13 cases were partial response, 7 cases were stable disease, the objective response rate was 65.0 % (13/20), and the histologically clearance rate of giant cells was 85.0 % (17/20). No case of osteonecrosis of the jaw was observed in this study, and all laboratory indicators were normal. The average postoperative MSTS-93 score was 26.87. Compared with pelvic GCTB patients who underwent surgical treatment from 1999 to 2009, in the intralesional surgery group, there was no significant difference in the recurrence rate [15.4 % (2/13) vs. 30.8 % (4/13), P = 0.514], but the limb function was significantly increased (P= 0.002). Conclusions Denosumab combined with surgery plays an important role in the multidisciplinary treatment of pelvic GCTB. The neoadjuvant strategy can reduce patient's intraoperative blood loss by shrinking the tumor size which makes the intralesional curettage surgery possible, and also diminishing the recurrence rate. But more attention should be paid to secondary malignant GCTB during the use of denousmab.
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Objective To discuss the effect of grade repositioning designed by our team on preventing the development of pressure ulcers in ICU patients and its influence on nursing workload of repositioning. Methods Eligible patients admitted to ICU were randomly divided into control group (traditional repositioning,219 cases)and experimental group(grade repositioning,230 cases).The patients in control group was routinely repositioned every 2 hours;the patients in experimental group was classified as"A""B""C"three levels according to Braden Scores and catecholamine scores,and their repositioning frequency was 1 hour,2 hours and 4 hours respectively.Number of pressure ulcers and nursing workload of repositioning were observed and compared between the two groups. Results At last,the data analysis was included in 201 patients in control group and 220 patients in experimental group.There was no significant difference in the rate of pressure ulcer occurrence between the experimental group(0)and the control group[0.1%(2/201)](P>0.05).But the rate of skin redness occurrence was significant less in the experimental group than in the control group[1.36%(3/220)vs.11.44%(23/201), χ2=13.20,P<0.05]. The mean repositioning times for each patient in the experimental group was significantly less than the control group[(7.22±1.81)times/day vs.(11.38±1.23)times/day],and turn over time was(42.09±1.68)min and(66.35±1.83)min which was also significantly different(t=6.563, 5.210, P<0.05). Conclusion Grade repositioning could effectively prevent critically illed patients from the occurrence of pressure ulcers,while reducing the overall nursing workload of repositioning in an ICU.
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Objective To evaluate the clinical benefits of denosumab in treatment of sacral giant cell tumor of bone(GCTB) when used preoperatively or postoperatively along with surgery, and to analysis the improvement of sacral nerve function. Methods Thirty patients diagnosed as sacral GCTB in Musculoskeletal Tumor Center of Peking University People's Hospital from April 2014 to July 2016 were divided into control group (10 cases), post-operative group (9 cases), and neoadjuvant group (11 cases). Patients in the post-operative and neoadjuvant group were treated with 120 mg of subcutaneous denosumab every 4 weeks with loading doses on days 8 and 15 of the first cycle. Results Three patients in the control cohort 1 had recurrence (3/10), no recurrence occurred in the post-operative group (0/9), and 3 patients in the neoadjuvant group had recurrence(3/11).There were no significant differences in event-free survival(EFS) among the three groups (P = 0.133). The objective response rate (OTR) was 63.6 % (7/11) in the neoadjuvant group based on the RECIST 1.1 criteria for evaluating the efficacy of solid tumors. Five cases had significant pain improvement (defined 2 points improved) and had much better bladder and bowel functions. Four patients were able to have their indwelling catheters removed after neoadjuvant denosumab treatment. Conclusions Neoadjuvant therapy with denosumab can relieve the symptoms and neurologic deficits caused by nerve compression and can diminish the intraoperative blood loss. Surgical removal of the tumor is still the basic treatment of sacral GCTB.
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There is increasing recognition of the importance of the quality of life (QOL) since it became an endpoint of clinical practices, a variety of disease-specific quality of life instruments have been developed and used as a means of assessing clinical interventions. Traditional evaluation was performed by researchers who generally ignore the subjective feeling from pa-tiens. At present, many evaluation criteria has paid more attention to the patient's subjective feelings into the scoring system, the assessment tool of patient-reported outcome (PRO) is usually the patient self-rating scale or questionnaire. As a common complica-tions of terminal stages of cancer, the treatment of bone metastases is usually conservative, improving or maintaining the quality of life of patients has been the consensus. Bone metastases trials have employed QLQ-C30 which raised by Europe Organization for Research and Treatment of Cancer (EORTC) or other generic health related QOL measurement, such as functional assessment of cancer therapy-general (FACT-G) and the MOS 36-item short from health survey (SF-36). But they lack specificity and accuracy in the assessment. EORTC QLQ-BM22 scale is considered as a bone metastases specific scale which was introducted in 2009, after the reliability, validity, cross-cultural adaptability verification, with the combination of EORTC QLQ-C 30 or used alone, has in-creasingly applied to clinical trials and practice for QOL assessment of bone metastatic cancer patients in recent years. It complete the EORTC evaluation system, which has significant value for assessing efficacy. EORTC QLQ-BM 22 has been translated into sim-plified Chinese and evaluated its utility, could be used in China as an effective questionnaire in evaluating the QOL for patients with bone metastases. In this study, current situation and progress of QOL measuring tools for bone metastases patients is re-viewed, in order to help researchers choose appropriate scale and better assess the efficacy, find the pros and cons to guide the clinical treatment decision.
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There is increasing recognition of the importance of the quality of life (QOL) since it became an endpoint of clinical practices, a variety of disease-specific quality of life instruments have been developed and used as a means of assessing clinical interventions. Traditional evaluation was performed by researchers who generally ignore the subjective feeling from pa-tiens. At present, many evaluation criteria has paid more attention to the patient's subjective feelings into the scoring system, the assessment tool of patient-reported outcome (PRO) is usually the patient self-rating scale or questionnaire. As a common complica-tions of terminal stages of cancer, the treatment of bone metastases is usually conservative, improving or maintaining the quality of life of patients has been the consensus. Bone metastases trials have employed QLQ-C30 which raised by Europe Organization for Research and Treatment of Cancer (EORTC) or other generic health related QOL measurement, such as functional assessment of cancer therapy-general (FACT-G) and the MOS 36-item short from health survey (SF-36). But they lack specificity and accuracy in the assessment. EORTC QLQ-BM22 scale is considered as a bone metastases specific scale which was introducted in 2009, after the reliability, validity, cross-cultural adaptability verification, with the combination of EORTC QLQ-C 30 or used alone, has in-creasingly applied to clinical trials and practice for QOL assessment of bone metastatic cancer patients in recent years. It complete the EORTC evaluation system, which has significant value for assessing efficacy. EORTC QLQ-BM 22 has been translated into sim-plified Chinese and evaluated its utility, could be used in China as an effective questionnaire in evaluating the QOL for patients with bone metastases. In this study, current situation and progress of QOL measuring tools for bone metastases patients is re-viewed, in order to help researchers choose appropriate scale and better assess the efficacy, find the pros and cons to guide the clinical treatment decision.
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Objective To investigate brachial artery endothelial function and carotid intima-media thickness (IMT) in patients with H-type hypertension.Methods One hundred and twenty patients with newly-diagnosed mild to moderate hypertension were enrolled in the study,including 58 cases with normal homocysteine (HCY) level (＜ 10 μmnol/L,non H-type group) and 62 cases with high HCY (≥10 μ moL/L,H-type group).Systolic pressure,diastolic pressure,blood lipid (TC,TG,LDL-C,HDL-C),fasting plasma glucose and two hours postprandial plasma glucose were measured in all patients.Brachial artery endothelial function and carotid IMT were determined with ultrasonography and compare between two groups.The factors related to brachial artery endothelium-dependent dilation (EDD) and carotid IMT were analyzed with multiple linear stepwise regression.Results Compared with non H-type group,the brachial artery EDD was reduced [(6.85 ± 0.77) ％ vs.(5.98 ± 0.85) ％,t =2.552,P =0.041] and carotid IMT was increased [(0.90±0.13)mm vs.(1.01 ±0.17)mm,t =2.426,P=0.048] in H-type group.The multiple linear stepwise regression analysis showed that EDD was negatively correlated to systolic pressure,diastolic pressure,fasting plasma glucose,two hours postprandial plasma glucose and HCY (r =-0.685,-0.654,-0.571,-0.627,-0.529,respectively,all P ＜ 0.05).IMT was positively related to systolic pressure,diastolic pressure,TC,TG,LDL-C and HCY (r =0.596,0.584,0.652,0.665,0.673,0.541,respectively,all P ＜ 0.05).Conclusion Patients with H-type hypertension are at a higher risk to arteriosclerosis than those with non H-type hypertension,which may be related to high HCY levels.
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Adaboost algorithm with improved K-nearest neighbor classifiers is proposed to predict protein subcellular locations. Improved K-nearest neighbor classifier uses three sequence feature vectors including amino acid composition, dipeptide and pseudo amino acid composition of protein sequence. K-nearest neighbor uses Blast in classification stage. The overall success rates by the jackknife test on two data sets of CH317 and Gram1253 are 92.4% and 93.1%. Adaboost algorithm with the novel K-nearest neighbor improved by Blast is an effective method for predicting subcellular locations of proteins.
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Objective To explore the recurrence rate, the complications and functional status of 25 patients with grade I chondrosarcoma of long bones treated by intralesional curettage and electrocauterization, and to determine the feasibility and effi?cacy of this method for grade IA chondrosarcoma of long bones. Methods Twenty?five eligible patients treated in our hospital from May 2003 to December 2011, were collected in this study with a mean age of 49 years (range, 28-72 years). According to En?neking staging system, all the lesions were staged as IA. Patients received surgery of the lesion before were excluded. The involved bones were femur (13 patients), tibia (4 patients), and humerus (8 patients). During the operation, a large elliptical cortical window about the size of the longest dimension of the lesion was made to ensure the thorough exposure of the lesion and avoid inadequate curettage. The lesion was curettaged thoroughly after the cortical window was made, then the high speed bur drill was applied to clear away a thin layer of the reactive bone shell. After a thorough lavage of the cavity, electrocauterization was done alongside the cavity wall slowly twice. Allograft or artificial bone was used to fill in the cavity to enhance bone healing. If mechanical property of the long bone was endangered by the cortical window and the surgical procedure, plate and screws were applied to strengthen the bone to avoid post?operative fracture. Results All the 25 patients were followed up regularly. The period of follow?up was from 38 months to 142 months, with a mean time of 80 months. Calcification was observed clearly in all the lesions. The length of the le?sions varied from 4 cm to 11 cm, with an average length of 7 cm. Nineteen patients received a plate and screws fixation because the mechanical property of the affected bone, while the rest received no internal fixation. Deep infection occurred in 1 patient (4%, 1/25) two months after operation. Thorough debridement and packing of bone cement with antibiotics was done to control the infec?tion. The infection has been controlled till the latest follow?up at 62 months after operation. Local recurrence occurred in one pa?tient thirteen months after the primary operation. Tumor resection, mega?prosthesis replacement was applied to the patient. The pa?tient has been disease free till now for 67 months. Mean Musculoskeletal Tumor Society (MSTS) 93 functional score of all patients was 93%(range, 83%-100%). The five?year survival rate of these twenty?five patients was 100%. Conclusion Intralesional cu? rettage together with the application of high?speed bur drill and electrocauterization is an applicable method for grade I chondrosar?coma of long bones. The excellent functional result and low recurrence rate make it a favorable option for the selected cohort of pa?tients.
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Objective: To determine the prognostic factors of primary osteosarcoma in adults . Methods:This is a review of 54 patients older than 40 years (24 men and 30 women) who were treated between 1998 and 2011 at the authors ’ institution .Demographic information and follow-up data were obtained and statistically analyzed .Results: Tumors involved the limbs in 30 patients ( 55 .5%) and axial skeleton in 17 patients (31.5%), and arose from soft tissue in 7 patients (13%).And 6 patients (11.1%) had synchronous metastasis .According to our review , tumors were treated surgically in 52 patients (96.3%).Local recurrence was documented in 14 patients (26.9%).Metastasis after diagno-sis appeared in 21 patients (38.9%).In the 52 patients who received the surgical treatment , the 5 year disease-free survival and overall survival rates were 43.7% and 50.4%, respectively.Conclusion:Adult patients with primary osteosarcoma had a poor clinical outcome .Inadequate surgical margins , more tumors in the axial location due to high recurrence rates , metastatic disease at presentation , and large tumor volumes were associated with significantly lower survival rates .Aggressive multi-agent treatment regimens might improve survival .
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Objective To evaluate the clinical and functional outcome of biological reconstruction by using pasteurized autograft and massive allograft after en-bloc resection of primary femoral diaphyseal sarcomas.Methods Retrospectively reviewed 19 consecutive patients with primary femoral diaphyseal sarcomas between Feb.2005 and Dec.2013.There were 11 males and 8 females with the mean age of 18 (2-38) years old.Thirteen patients were diagnosed as osteogenic sarcoma (OS),while five Ewing' s sarcoma (EWS) and one malignant fibrous histocytoma (MFH).All patients were treated with wide local excision,and 9patients were reconstructed by intercalary femur segmental allograft and 10 by pasteurized autograft.The median length of the resected bone was 16.9 (9-24) cm.15 segmental grafts were fixed by using plates including 10 intramedullary free vascularised fibular graft constructs,the other 4 segmental grafts were fixed by intramedullary nails.The average operation time for pasteurized autograft construct was 5.1 hours,while the time for intercalary allograft construct was 4.22 hours.Of 38 host-donor junctions,there are 28 diaphyseal junctions and 10 metaphyseal junctions.Results The average operation time for pausterized autograft construct tended to be longer than intercalary allograft (5.1h Vs 4.22h),although the difference did not reach the significance.Bone union occurred at a median of 10.3 months and 7.25 months at diaphyseal and metaphyseal junction for pasteurized autograft-host construct; 13.8 months at the diapyhseal junction and 11.5 months at the metaphyseal junction for allograft-host construct.Bone healing time of diaphyseal junction and metaphyseal junction between these two constructs were significant difference.Eight of 19patients (42.1％) developed complications:5 bone unnunion/fracture (including 1 subsequently developed local recurrence),1deep infection and 2 local recurrence (including 1 soft tissue recurrence).The mean overall follow-up was 33.5 months (3-107),five patients died of lung metastases,the cumulative patient survival was 76.5％ at 2 years and 61.2％ at 5 years determined by Kaplan-Meier method.All living patients except the MFH patients who received amputation,had a mean MSTS score of 83.7％ (70％-95％).Conclusion Although the reconstructive procedure with pasteurized autograft is more complicated and needs longer operation time than allograft reconstruction,the bone healing time with autograft is significant shorter than allograft.Our observations suggest the pausterized autograft shell with intramedullary free fibular graft is strongly recommeded.
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<p><b>OBJECTIVE</b>To analyze the clinical outcome of an operative technique using recycling bones to reconstruct pelvis after primary malignant pelvic tumor resection.</p><p><b>METHODS</b>Fifteen patients who presented with malignant pelvic tumors were treated by wide or marginal resection and reconstruction using recycling bone in our institute from January 2003 to December 2011. The median age was 31 (15-62) years, and the most common diagnosis was chondrosarcoma, followed by Ewing sarcoma. The operative technique consisted of en-bloc excision of the pelvic tumor, removal of soft tissue, curettage of the tumor, incubated in 65 °C 20% hypertonic saline for 30 minutes, reimplantation of recycling bone, and internal fixation with plates, screws and/or total hip replacement. Bone cement was used to augment bone strength when necessary. Bone healing features and function of lower limbs were evaluated with the International Society of Limb Salvage (ISOLS) graft evaluation method and Musculoskeletal Tumor Society (MSTS) score, respectively. Adjuvant therapies were used according to the type and extension of the primary tumor.</p><p><b>RESULTS</b>One patient died of severe peri-operative bleeding 2 days after operation, and the other patients were followed-up for 6 to 96 months (mean 40.4 months), and 5 patients died of local recurrence or metastasis. Eleven operations were followed by complications of any kind. Most mechanical complications were related to the use of hip arthroplasties, where implant breakdown and dislocation were the commonest.Infection was seen in 7 cases (superficial 4 cases and deep 3 cases). Healing and functional scores were fair. The median ISOLS score and MSTS score were 81.0% (range 30.0% to 95.0%) and 60.0% (range 23.0% to 93.0%), respectively.</p><p><b>CONCLUSIONS</b>Recycling reconstruction technique is valid for young patients with low-grade chondrosarcoma or other chemo-sensitive tumor in pelvis. Although many complications are seen, this method remains our treatment of choice.</p>
Subject(s)
Adolescent , Adult , Humans , Middle Aged , Young Adult , Arthroplasty, Replacement, Hip , Bone Neoplasms , General Surgery , Chondrosarcoma , General Surgery , Follow-Up Studies , Pelvic Neoplasms , General Surgery , Plastic Surgery Procedures , Methods , Replantation , Sarcoma, Ewing , General Surgery , Treatment OutcomeABSTRACT
Objective To investigate technique,effect,complications of limb salvage surgery for malignant tumors of the proximal tibia involving the fibula.Methods Between November 1998 and February 2010,32 patients with malignant tumors of the proximal tibia involving the fibula underwent limb salvage surgery in our institute.There were 21 males and 11 females,aged from 10 to 66 years (average,23.4years).There were 23 cases of osteosarcoma,5 cases of chondrosarcoma,1 case of malignant giant cell tumor,and 3 cases of soft tissue sarcoma.All patients received en bloc resection of tumor including proximal tibia and fibula.During operations,ligation of anterior tibial vessels was performed in 14 patients,anastomosis of posterior tibial vessels in 1 patient,both ligation of anterior tibial vessels and anastomosis or replacement of posterior tibial vessels in 5 patients.The common peroneal nerve was resected in 4 patients,and the deep peroneal nerve was resected in 5 patients.The reconstruction methods included prosthetic replacement in 24 patients,replacement with inactivated autograft-prosthesis composite in 5 patients,and replacement with inactivated autograft in 3 patients.The caput mediale musculi gastrocnemii flap was transferred to reconstruct soft tissue defect in 14 patients,while caput laterale musculi gastrocnemii flap was transferred in 1patient.Results All patients were followed up for 11 to 159 months (average,39.4 months).Local recurrence occurred in 6 patients (18.8％).The overall 5-year survival rate was 51.2％.Fourteen patients died of tumor metastasis,2 survived with tumor,and 16 patients survived without tumor.Variant complications occurred in 15 patients (46.9％).The complications included ischemia of the lower leg in 4 patients,peroneal nerve palsy in 12 patients (permanent palsy in 9 patients and temporary palsy in 3 patients),wound healing problem in 4 patients,deep infection in 1 patient,and periprosthetic fracture in 1 patient.The mean MSTS 93 score was 21.6 points (72％).Conculusion The indications of limb salvage surgery for malignant tumors of the proximal tibia involving the fibula should be restricted.Although complications are encountered frequently,most patients have acceptable postoperative function.