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BACKGROUND: For benign bone tumor patients, the life cycle is long. To reduce the incidence of complications and improve the quality of life after surgery through surgery is the common goal of physicians. The quality of life of patients can be increased through discussing the operation mode and prognosis of benign tumor patients, choosing the reasonable operation mode, predicting and reducing the risk of secondary fracture. OBJECTIVE: To analyze the femoral neck force after different surgical methods using finite element technique in the analysis of benign proximal femoral lesions, and to assess the stability of the femoral neck and the risk of fracture after different surgical procedures for cases with a wide range of lesions. METHODS: According to preoperative CT data of lesion sites in 10 subjects with benign tumor of proximal femur, three-dimensional model of internal fixation with bone cement and steel plate after focal curettage (group A) and three-dimensional model of treating with bone cement after focal curettage (group B) were set in this study. Finite element technique was used to simulate the maximum force of the femoral neck when walking. The stress peaks of the femoral neck were compared after surgery between the two groups. The risk of fracture at this location was assessed. Patients signed the informed consent. This study was approved by the Ethics Committee of Chengde Medical College. RESULTS AND CONCLUSION: (1) The stress was significantly lower in the group A than in the group B (P=0.007 < 0.05). (2) The local stress of the model was reasonable in the group A. Ten patients were operated with the protocol of the group A. An additional 17 patients with proximal femur benign lesions who met the requirements but refused to enter the finite element experiment were treated with the surgical program of the group A. (3) The patients were followed up for 14-42 months. During the follow-up, no new fracture was found in the operation area, and the internal fixation device was firm without fracture. At 12 months postoperatively, the mean Musculoskeletal Tumor Society score of all patients was (26.12±2.28). (4) The finite element technology for simulating the stress evaluation and postoperative follow-up verified that the treatment of proximal femur benign tumor with bone cement and steel plate internal fixation after curettage is more reasonable and effective. The scheme can effectively reduce the risk of secondary fracture and enhance the stability in the surgical area.
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BACKGROUND: For the patients with benign osteopathy, the patients usually get a good life cycle after surgical treatment. Through continuous improvement of the operation mode, the stress of the proximal femur after the operation of benign osteopathy is studied by using the finite element analysis. The risk of pathological fracture and secondary fracture is predicted and reduced. To explore the best operation and prognosis is of great significance for prolonging and improving the quality of life of patients. OBJECTIVE: Three-dimensional finite element technique was used to analyze the different surgical models of benign proximal femoral lesions. The differences of different surgical models were compared and the rationality and effectiveness of internal fixation were verified. The reliability of the finite element model was verified in the follow-up of patients after operation. METHODS: Preoperative CT examination was conducted in 10 patients with benign proximal femoral lesions who met the inclusion criteria. Three models of limbs scraping (group A), cavity internal nail re-infusion bone cement (group B) and intracavitary bone cement joint plate screw (group C) were established by MIMICS. The maximum stress values of the left and right side windows of the cortical model of group A, B and C were measured under simulated conditions, and the stress values of the three groups were compared. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. RESULTS AND CONCLUSION: (1) The comparison of the maximum stress values of the anterior and posterior sides of the cortical fenestration in the three groups of models was group A > group B > group C (P < 0.05). The risk of fracture was high in group A, and the risk of fracture in group B was large. The stress in group C was controlled within a reasonable range, and the risk of fracture was low. (2) Therefore, 10 subjects underwent the treatment in group C. The prognosis was good and there were no secondary fractures. The Musculoskeletal Tumor Society score was 27-30 points 1 year after surgery. (3) The model stress is prone to increase the local stress after opening the window. After adding bone cement and steel plate, the stress value of the model window is significantly reduced. After the benign lesions of the proximal femur are scraped, the stress of the fenestration can be effectively reduced by placing the bone cement and the steel plate, and the fracture probability at the surgical site is significantly reduced. Steel plate placement is reasonable.
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Objective:The aim of the study is analyze the recurrence, metastasis and prognosis of early breast cancer patients and evaluate the long-term safety of tracer sentinel lymph node biopsy (SLNB) using indocyanine green (ICG) and methylene blue (MB) in early breast cancer.Methods:A total of 394 breast cancer patients were enrolled from January 1, 2014 to December 31, 2014 in Affiliated Hospital of Chengde Medical University. The baseline data and clinical characteristics of 222 patients who met the inclusion criteria were analyzed.Results:The median follow-up time of 222 patients was 57 months. The detection rate of sentinel lymph nodes (SLNs) using ICG or MB alone was 96.4% and 84.7% ( P=0.02); the number of SLNs detected was 740 and 604 ( P<0.001); the positive SLN detection rates were 100% and 91% ( P=0.014), and the positive SLNs were 221 and 195 ( P<0.001). The local recurrence rates were 0.7% in patients without axillary lymph node dissection (ALND) and 1.4% ( P=0.57) in patients with ALND, and the distant metastasis rates were 5.3% and 15.7% ( P=0.01), respectively. The 5-year overall survival (OS) was 4.7% and 91.7% ( P=0.421), and the disease-free survival (DFS) was 90.5% and 85.9% ( P=0.285). The OS and DFS of the 222 patients were 100%, 96.8%, 94.1% and 100%, 96.4% and 89.2% respectively at 1, 3 and 5 years after operation. Multivariate COX regression model showed that age ≤50 years old, triple negative molecular classification and primary tumor >2 cm were independent risk factors for prognosis, and HR were 3.254, 7.321 and 3.507, respectively (all P<0.05). Conclusions:Sentinel lymph node biopsy with indocyanine green combined with methylene blue is a safe and reliable method for axillary staging of breast cancer. The COX regression models showed that patients with younger age, three-negative molecular type and larger primary tumor were more likely to have adverse events.
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Objective To establish a BALB/c mouse model of total hysterectomy and to investigate and analyze its characteristics and formation mechanism. Methods The control group was fed conventionally without any treatment. The mice in the model group were anesthetized and performed hysterectomy. The animals in the sham-operated group had abdominal cavity opened and only exposing the uterus. The changes of body weight were observed dynamically,and at the end of the fourth weeks. The concentration of serum estradiol was determined and histological structure of the ovaries was examined. Results The general status of all the mice after operation was good without obvious inflammation, and the incision healed completely. There was no significant difference in the body weight before operation among the mice, whereas the weight of model group mice was higher than the control group and sham-operation group at the end of the second,third and forth weeks(P< 0.05). The estradiol contents of the model group was significantly lower than that in control group and sham operation group(P< 0.01). The histological structure of ovaries in the control group and sham-operation group was normal,however the model group showed differences,such as irregular shape of the ovaries,changed number of mature follicles, loosely distributed granulosa cells, and apoptosis. Conclusions The mouse model of total hysterectomy established in our study can well simulate the clinical manifestations of ovarian dysfunction after operation, and is an ideal model for the study of complications after ovariectomy and screening of drugs.
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Objective To investigate the feasibility of 3-D printing technology in the application of proxi-mal tibial epiphyseal injury fracture surgery for teenagers. Methods Clinical materials of the 8 patients with proxi-mal tibial epiphyseal injury fracture who were admitted to our hospital from January 2014 to March 2016 were retro-spectively analyzed. CT data of all patients was collected before the surgery and was used for fracture 3-D recon-struction with Minics software to print out the 1:1 physical model. Meanwhile,surgical simulation was carried out on the 3-D model to design the internal fixation scheme,and all intraoperative operations were implemented in line with the preoperative planning. Postoperative brace immobilization and the early-stage function exercise were taken and growth situation of the affected limbs and fracture healing were observed and recorded. In line with the modified Hohl and Luck knee score standards,knee functional score was taken 12 months after the surgery. Results All pa-tients received postoperative follow-up service for 12 to 18 months,with the average of 15.3 months. All patients were bony union,with the excellent knee score rate of 100%. The full-length axis of two limbs was compared be-tween the postoperative reexamination and no premature skeleton closure. Pronation and supination of the knee,un-stable joints and other complications were investigated. No obvious differences were found among the activity of the affected limbs and 12-month growth length after the surgery and that of the uninjured side. Conclusions 3-D printing technology is a strong clinical guidance to the treatment of proximal tibial epiphyseal injury fracture surgery for teenagers.
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Objective To study the influence of different routes of keyhole limpet hemocyanin ( KLH) immuniza-tion on the T-cell-dependent antibody response in mice.Methods SPF Kunming mice were divided into four groups: the intravenous injection group, subcutaneous injection group, intraperitoneal injection group and control group.Each mouse was injected 200 μg KLH intravenously, subcutaneously or intraperitoneally daily for consecutive 10 days, respectively. Mice in the control group were given solvent injection only.Serum concentration of IgG stimulated by KLH antigen was measured 7 days after the last dosing.Spleen was isolated to calculate the organ coefficient and examined by pathology u-sing hematoxylin and eosin staining.Results Intravenously, subcutaneously and intraperitoneally administered KLH stimu-lated the generation of secondary lymphoid follicles and germinal center to varying degrees, B cell apoptosis, increased a-mount of cells in the marginal zone and other pathological changes were observed in the spleen.Intravenous and intraperito-neal administration of KLH led to more pronounced pathological changes compared with that in the subcutaneous injection group.All of the three administration routes of KLH induced generation of IgG antibody, significantly higher than that in the control group (P<0.05).Intravenous injection of KLH generated the highest concentration of IgG and organ coefficient among the three administration routes ( P<0.05) .Conclusions Different immunization routes do affect the production of IgG antibody, organ coefficient and pathological changes in the spleen, and these differences should be taken into consider-ation when analyzing the T cell dependent antibody response in mice.
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Objective To compare coagulation data measured with domestic produced and imported coagulation testing solutions on SD rat and human by testing prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time(TT), fibrinogen(FIB).Methods Blood samples were obtained from SPF SD rat and human .Domestic produced and imported coagulation testing solutions were applied to test PT , APTT, TT, and FIB.Results Compared to rat data measured with imported coagulation testing solution , data measured with domestic produced coagulation testing solution of PT, APTT, FIB was significantly higher (P<0.05), while, data of TT was statistically lower(P<0.05), and there was no obvious difference in human blood coagulation .Conclusion The data measured with different coagulation testing solution varies on SD rat , so the laboratories are required to establish reference data according to different products .
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Objective To investigate the feasibility in screening of normal ovarian tissues by evaluating the expressions of tumor-associated genes in tissues adjacent to human epithelial ovarian cancer of orthotopic implantation in nude mice.Methods Human epithelial ovarian cancer cell lines OVCAR3 were grown in subcutaneous tissues,and the tumor tissues were orthotopic implanted.The expressions of CK-7,CA125,P53,survivin,MMP-2,and TIMP-2 were detected by immunohistochemical staining in proximal tissues,middle tissues,distal tissues adjacent to tumor,tumor tissues,and normal ovarian tissues of nude mice.Results 35 samples ovarian tissues with normal biopsy were gained from 40 cases of human epithelial ovarian cancers of orthotopic implantation model in nude mice.The expression rate of CK-7,CA125,P53,survivin,MMP-2,and TIMP-2 were 95.0％ (38/40),95.0％ (38/40),75.0％ (30/40),85.0％ (34/40),77.5％ (31/40),and 77.5％ (31/40) in tumor tissues,respectively; 71.4％ (25/35),68.6％(24/35),57.1％ (20/35),62.9％ (22/35),60.0％ (21/35),and 57.1％ (20/35) in proximal tissues adjacent to tumor,respectively; 34.3％ (12/35),31.4％ (11/35),31.4％ (11/35),31.4％ (11/35),34.3％ (12/35),and 31.4％ (11/35) in middle tissues adjacent to tumor,respectively; and 25.7％ (9/35),22.9％ (8/35),25.7％ (9/35),25.7％ (9/35),28.6％(10/35),and 31.4％ (11/35) in distal tissues adjacent to tumor,re respectively.The expressions of CK-7,CA125,P53,survivin,MMP-2,and TIMP-2 were all negative in 23 samples normal ovarian tissues adjacent to tumor.The expressions of CK-7,CA125,P53,survivin,MMP-2 and TIMP-2 in proximal tissues adjacent to tumor were lower than those in tumor tissues(P＜0.05),and higher than those in middle tissues and in distal tissues adjacent to tumor(P＜0.01).There were no expression difference between in middle tissues and in distal tissues (P＞0.05).The strong positive expressions of CK-7,CA125,and survivin were higher than those of P53,MMP-2,and TIMP-2 (P＜0.01).No significant difference was found in those expressions in the normal ovarian tissues adjacent to tumor gained from orthotopic implantation model with different severity.The expressions of CK-7,CA125,P53,survivin,MMP-2,and TIMP-2 were all negative in 20 normal ovarian tissues of nude mice.Conclusions The expression of CK-7,CA125,P53,survivin,MMP-2,and TIMP-2 showed decreasing trend to non-cancer direction.Negative expressions of these tumor-associated genes can be used as standard in screening of normal ovarian tissues adjacent to tumor.Relative safe normal ovarian tissues can be obtained from the tissues adjacent to tumor.