The beginnings and evolution of a pancreatic surgeon: a technical morphological analysis in first 5 years / 中华外科杂志

Objective: To explore the development of the pancreatic surgeon technique in a high-volume center. Methods: A total of 284 cases receiving pancreatic surgery by a single surgeon from June 2015 to December 2020 were retrospectively included in this study. The clinical characteristics and perioperative medical history were extracted from the medical record system of Zhongshan Hospital,Fudan University. Among these patients,there were 140 males and 144 females with an age (M (IQR)) of 61.0 (16.8) years(range: 15 to 85 years). The "back-to-back" pancreatic- jejunal anastomosis procedure was used to anastomose the end of the pancreas stump and the jejunal wall. Thirty days after discharge,the patients were followed by outpatient follow-up or telephone interviews. The difference between categorical variables was analyzed by the Chi-square test or the CMH chi-square test. The statistical differences for the quantitative data were analyzed using one-way analysis of variance or Kruskal-Wallis H test and further analyzed using the LSD test or the Nemenyi test,respectively. Results: Intraoperative blood loss in pancreaticoduodenectomy between 2015 and 2020 were 300,100(100),100(100),100(0),100(200) and 150 (200) ml,respectively. Intraoperative blood loss in distal pancreatectomy was 250 (375),100 (50),50 (65), 50 (80),50 (50),and 50 (100) ml,respectively. Intraoperative blood loss did not show statistical differences in the same operative procedure between each year. The operative time for pancreaticoduodenectomy was respectively 4.5,5.0(2.0),5.5(0.8),5.0(1.3),5.0(3.3) and 5.0(1.0) hours in each year from 2015 to 2020,no statistical differences were found between each group. The operating time of the distal pancreatectomy was 3.8 (0.9),3.0 (1.5),3.0 (1.8),2.0 (1.1),2.0 (1.5) and 3.0(2.0) hours in each year,the operating time was obviously shorter in 2018 compared to 2015 (P=0.026) and 2020 (P=0.041). The median hospital stay in 2020 for distal pancreatectomy was 3 days shorter than that in 2019. The overall incidence of postoperative pancreatic fistula gradually decreased,with a incident rate of 50.0%,36.8%,31.0%,25.9%,21.1% and 14.8% in each year. During this period,in a total of 3,6,4,2,0 and 20 cases received laparoscopic operations in each year. The incidence of clinically relevant pancreatic fistula (grade B and C) gradually decreased,the incident rates were 0,4.8%,7.1%,3.4%,4.3% and 1.4%,respectively. Two cases had postoperative abdominal bleeding and received unscheduled reoperation. The overall rate of unscheduled reoperation was 0.7%. A patient died within 30 days after the operation and the overall perioperative mortality was 0.4%. Conclusion: The surgical training of a high-volume center can ensure a high starting point in the initial stage and steady progress of pancreatic surgeons,to ensure the safety of pancreatic surgery.

Analysis of factors affecting intraoperative blood loss in patients with spinal tumors undergoing preoperative selective arterial embolization / 肿瘤研究与临床

Objective:To investigate the related factors affecting intraoperative blood loss in patients with spinal tumors undergoing preoperative selective arterial embolization.Methods:The clinical data of 90 patients with spinal tumors who underwent preoperative selective arterial embolization in the Affiliated Hospital of Jining Medical College and the Second Affiliated Hospital of Shanxi Medical University from January 2017 to December 2020 were retrospectively analyzed. The influencing factors of intraoperative bleeding were analyzed by using multiple linear regression.Results:There were statistically significant differences in intraoperative blood loss of spinal tumor patients undergoing preoperative selective arterial embolization with different blood supply abundance and the number of tumors involving vertebral body (all P < 0.05). There were no significant differences in age, gender, body mass index, interval after embolization, operation time, pathological type, tumor site, embolization degree, the number of embolized vessels, preoperative Frankel grade among different groups (all P > 0.05). Multiple linear regression analysis showed that the number of tumors involving vertebral body and tumor blood supply abundance were factors affecting intraoperative blood loss, and vertebra number and tumor blood supply were positively correlated with intraoperative blood loss (all P < 0.05). Conclusion:For patients with spinal tumors undergoing preoperative selective arterial embolization, the number of tumors involving vertebral body and the abundance of the tumor blood supply are factors affecting the amount of intraoperative bleeding.

3D printed personalized lumbar spinal fusion device design and biomechanical performance analysis / 中国骨伤

OBJECTIVE@#The finite element analysis method was used to compare the biomechanical performance of the individualized interbody fusion cage, the clinically common double bullet type fusion cage and the healthy lumbar spine model under different working conditions.@*METHODS@#According to the CT scan data of the lumbar spine of a real healthy human body, a finite element model of the lumbar spine of a healthy human body was designed using finite element software as a normal control group. On this basis, the individualized lumbar fusion cage model and the clinical standard bullet type fusion cage lumbar spine model were further established. These three finite element models were applied with different loads such as vertical compression, forward flexion, extension, and lateral bending to observethe changes in the stress distribution and stress magnitude of each component of the lumbar spine.@*RESULTS@#The maximum stress values of the vertebral body and the fusion cage under the extension condition in the clinical standard bullet type fusion cage lumbar spine model were 45.81 MPa and 97.07 MPa, respectively. The stress of the vertebral body and the fusion cage in the individualized lumbar fusion cage model was closer to the stress of the vertebral body and the intervertebral disc in the healthy lumbar spine model. From the perspective of displacement, the displacement of each component of the lumbar spine models of the two fusion cages was smaller than that of the healthy lumbar spine model, indicated that the internal fixation of the fusion cage limited the range of motion of the vertebral body. On the other hand, it also confirmed the validity of the finite element model established in the study. The displacement of the fusion cage and the vertebral body in the individualized model under different working conditions was generally smaller thanthat of the standard model fusion cage and the vertebral body.@*CONCLUSION@#The fusion cage can replace the diseased intervertebral disc to a certain extent, so as to reduce the patient's pain and restore the lumbar function. The personalized design of the fusion cage can better meet the needs of individual patients, which has the great significance to the recovery of the patient's lumbar spine function, the service life of the fusion cage and the protection of the contact vertebral body, and provides certain guidance for actual clinical treatment.

Study on the mechanical differences between single-row belt rivets and double-row suture bridge in repairing rotator cuff injury / 中国骨伤

OBJECTIVE@#To compare and analyze the mechanical differences between single-row suture anchor fixation for repairing rotator cuff injuries and double-row suture bridges for repairing rotator cuff injuries from a biomechanical perspective.@*METHODS@#The CT scan data of healthy adult shoulder joint were imported into Mimics, Geomagics and Hypermesh to carry out reverse reconstruction of two repair models, material assignment and mesh division, and the tearing of supraspinatus muscle was designed. After treatments, the load and boundary conditions were applied to the shoulder joint in ABAQUS software. The shoulder joint was fixed with four working conditions including flexion 15 °, flexion 30 °, internal rotation 15 ° and internal rotation 30 ° after anchor fixationand repair. The stress changes of the upper rotator cuff muscle and the anchor with thread were compared under these four conditions.@*RESULTS@#Under the two flexion conditions, the stress of the supraspinatus in the double row suture bridge fixation model was 8.3% and 12% less than that in the single-row suture anchor fixation, respectively. Under the two internal rotation conditions, the stress of supraspinatus in the double row suture bridge fixation model was 47% and 48% less than that in the single row fixation repair model, respectively.@*CONCLUSION@#The "load sharing" effect between the two rows of four anchors makes the stress distribution more dispersed, increases the contact area between the supraspinatus muscle and the humerus, reduces the stress of the anchor, avoids the serious stress concentration phenomenon, and explains the advantages of the fixation method of the double row suture bridge from the biomechanical angle.

Clinicopathological features and survival analysis of gastric cancer patients with neuroendocrine differentiation after radical resection / 中华胃肠外科杂志

Objective: To compare the clinicopathological characteristics and the prognosis of gastric adenocarcinoma patients with and without neuroendocrine differentiation (NED) after radical gastrectomy plus D2 lymph node dissection. Methods: A retrospective cohort study was performed. The inclusion criteria were as follows: (1) patients who underwent radical resection of gastric cancer plus D2 lymph node dissection and were confirmed as gastric adenocarcinoma by postoperative pathology and received immunohistochemical examination of neuroendocrine markers Syn and/or CgA; (2) patients aged 20 to 75 years with normal organ function; (3) patients who did not receive neoadjuvant chemotherapy or radiotherapy before operation; (4) patients with postoperative pathological stage I to III according to the 8th edition of tumor staging system of American Joint Committee on Cancer (AJCC); and (5) patients who completed adjuvant chemotherapy according to the postoperative pathological stage. Those who had other malignant tumors in the past 5 years and who could not be followed up according to the required rules were excluded. According to the above criteria, the clinicopathological characteristics of gastric cancer patients who underwent radical resection plus D2 lymph node dissection in Zhongshan Hospital of Fudan University from January 2010 to June 2017 were collected and compared. All patients were followed up till June 2020. The disease-free survival (DFS) and overall survival (OS) between the patients with and without NED were compared, and the effect of NED on the prognosis was corrected by Cox proportional hazards model. The propensity score matching method was used for sensitivity analysis. Results: A total of 539 patients were enrolled in this study, including 35 with NED and 504 without NED. Compared with the patients without NED, the patients with NED were older [(65.0±7.5) years vs. (54.5±11.3) years, t=-7.681, P<0.001], had higher proportion of undergoing proximal gastrectomy [22.9% (8/35) vs. 7.6% (36/504), χ(2)=10.335, P=0.006], higher proportion of intestinal-type based on Lauren classification [77.1% (27/35) vs. 42.5% (214/504), χ(2)=14.553, P<0.001], and higher proportion of pathologic stage III [65.7% (23/35) vs. 27.6% (139/504), χ(2)=25.653, P<0.001]. The 3-year DFS of patients with NED and those without NED was 48.9% (95% CI: 33.8%-70.8%) and 37.4% (95% CI: 32.9%-42.5%) respectively, and no significant difference was found (P=0.44). The 3-year OS was 56.1% (95% CI: 39.9%-79.1%) and 64.3% (95% CI: 59.3%-69.7%) respectively, and no significant difference was found as well (P=0.32). Univariate and multivariate analyses showed that NED was not an independent risk factor for DFS and OS (all P>0.05). Sensitivity analysis showed that there was no significant difference in DFS and OS between the two groups after propensity score matching. Conclusion: Compared with patients without NED, patients with NED were older at onset, had a higher proportion of proximal gastrectomy, intestinal-type, and later diagnostic stage, but the survival prognosis had no significant difference with that of patients without NED.

Effect and prognosis of tumor-type artificial knee prosthesis replacement for treatment of malignant bone tumors around the knee / 肿瘤研究与临床

Objective:To investigate the effects, complications and survival of patients tumor-type artificial knee prosthesis replacement for treatment of malignant bone tumors around the knee.Methods:The data of 47 patients undergoing tumor-type knee prosthesis replacement in Shanxi Medical University from January 2010 to April 2018 was retrospectively analyzed. There were 21 males and 26 females, with a median age of 21 years (7-70 years). There were 39 cases of osteosarcomas, 3 cases of chondrosarcomas, 2 cases of malignant fibrous histiocytomas, 2 cases of giant cell bone tumors, and 1 case of fibrosarcoma. The involved locations were the distal femur in 35 cases and proximal tibia in 12 cases. Patients with osteosarcoma and malignant fibrous histiocytomas received chemotherapy for 2 courses before operation and 4-6 courses after operation. The data included the survival time, prosthesis survival time, complications, limb function, tumor recurrence and lung metastasis of patients.Results:Patients were followed up for a median time of 25 months (5-102 months). The 1-year, 3-year and 5-year overall survival rates were 95.74%, 71.29% and 58.06%, respectively. The 1-year, 3-year and 5-year disease-free survival rates were 86.42%, 55.49% and 50.86%, respectively. Local tumor recurrence occurred in 10 patients (21.28%) within 3 years after operation. Of the 10 patients, 8 cases had a recurrence of the soft tissue tumor and then they received the resection surgery; the other 2 patients underwent amputation of the diseased limb. The pulmonary metastasis occurred in 15 patients (31.91%). The 5-year survival rate of prosthesis was 82.33%, and the 5-year survival rate of prosthesis in patients with tumor in the distal femur was higher than that in patients with tumor in the proximal tibia [86.96% vs. 75.00%, P = 0.338]. The periprosthetic infection occurred in 3 patients (6.38%), and 1 case (2.13%) received revision after prosthesis loosening, 1 case (2.13%) received revision after prosthesis breakage. At the patient's last follow-up, the Musculoskeletal Tumor Society (MSTS) score was 21 points (15 points, 24 points), and the excellent rate was 61.70% (29/47). The incidence of extensor lag in patients with tumor in the proximal tibia was higher than that in patients with tumor in the distal femur, and the difference was statistically significant [33.33% (4/12) vs. 2.86% (1/35), P = 0.016]. Conclusions:Tumor-type artificial knee prosthesis replacement can effectively treat malignant bone tumors around the knee and maintain satisfactory limb function and patients' survival rate. However, the postoperative complications may lead to limb salvage failure. It is necessary to reduce the occurrence of complications through standardized chemoradiotherapy, extensive and strict tumor resection and proper rehabilitation exercises.

Comparison of different reconstruction methods after resection of malignant tumors around the ilium / 肿瘤研究与临床

Objective:To observe the clinical effects of resection and different reconstruction methods of malignant tumors around the ilium (Ⅰ region, Ⅰ+Ⅱ region and Ⅰ+Ⅳ region).Methods:The clinical data of 23 patients with resection and reconstruction of malignant tumors around the ilium in the Second Hospital of Shanxi Medical University from January 2012 to December 2017 was retrospectively analyzed. All patients received pelvic tumor resection and screw-rod system fixation, and some patients received bone graft or cement reinforcement at the same time. The clinical effect, survival rate, complications and limb function score were statistically analyzed.Results:All cases were followed up for 10-79 months (median 42 months). Eleven patients survived, the 1-year overall survival (OS) rate was 82.6% (19/23), the 3-year OS rate was 65.2% (15/23), and the 5-year OS rate was 52.2% (12/23). The 3-year OS rate was 70.6% for the patients without acetabulum involvement, and 57.1% for those with acetabulum involvement, and the difference between the two groups was statistically significant (χ 2 = 4.182, P = 0.041). Seven cases complicated with wound nonunion, dislocation and other complications. The postoperative functional score of patients with pedicle screw-rod fixation and reconstruction was (23.6±1.3) points, and the postoperative functional score of patients with ordinary semi-pelvis and nail-rod semi-pelvic reconstruction was (18.1±1.4) points, and the difference between the two groups was statistically significant (t = 9.42, P < 0.01). Conclusion:For the bone defect after resection of tumors around the ilium, the clinical effect of pedicle screw-rod fixation is better than that of nail-rod semi-pelvic reconstruction.

A case report of simultaneous multiple osteosarcoma and a review of systematic literature / 中华骨科杂志

Synchronous multifocal osteosarcoma (SMOS) was analyzed for its predisposing age, sex, location, oncology characteristics, and survival time with different treatment. The key words about "multifocal osteosarcoma" had been used to search articles which includ Synchronous multifocal osteosarcoma patients databases from 1949 to 2020. The articles have been filtratedby title, abstract and full text. There were 80 articles used for thisstudy. All the patients were objects of thisstudy. Butthe same patients' data in different articles had not been used repeatedly. The patients' data had been collected as much aspossible, including age, location, treatment, survival timeand so on. All the patients' data had been used forsystematic analysis. All of the 80 articles and 264 patients had been studied. The mean onset age was 16.17 years old and the peak age of onset was 10-20 years old. The gender difference had been uncovered and the sex ratio was 1.76∶1. The incidence site of 188 patients (92.16%) was located in the extremities. Alkaline phosphatase was elevated in 135 patients (95.10%). The pathological type was osteoblastic osteosarcoma in 134 patients (76.14%). There were 3 patients with hypocalcemia and 2 patients with anemia. The mean survival time of 15 patients (15/58) who gave up treatment was 4.51 months. The mean survival time of 23 patients with chemotherapy was 8.97 months. The mean survival time was 16.17 months in 11 patients with preoperative chemotherapy and surgical treatment. Nine patients with neoadjuvant chemotherapy, surgery and postoperative chemotherapy had an average survival time of 23.28 months. Multiple osteosarcoma of the same type was rare, with high degree of malignancy and poor prognosis. The age of high incidence was 10-20 years old. Currently, the most effective treatment was neoadjuvant chemotherapy, surgery and postoperative chemotherapy.

Prognosis analysis of 44 patients with extremity osteosarcoma / 肿瘤研究与临床

Objective@#To investigate the survival of patients with osteosarcoma treated in a single institute.@*Methods@#A total of 44 patients with osteosarcoma who had undergone surgical treatment in the Second Hospital of Shanxi Medical University from January 2013 to January 2018 were enrolled in this retrospective study. After the diagnosis of osteosarcoma, patients received cisplatin plus doxorubicin neoadjuvant chemotherapy. The patient's basic data, auxiliary examination results, surgical methods, pathological reports, prognosis and other information were reviewed and recorded, and the Kaplan-Meier method, Cox regression model were used to analyze the relationship between various factors and prognosis of patients.@*Results@#Among 44 patients, there were 23 males and 21 females, aged from 7 to 62 years old (average 27.2 years old); the tumor site of 5 cases was located at the upper limbs and 39 was located at the lower limbs; the diameter of the tumor was < 10 cm in 30 cases, ≥10 cm in 14 cases. All patients underwent extensive resection, including 35 cases of limb salvage surgery and 9 cases of amputation. At the end of follow-up, the 3-year overall survival rate was 65.5%. The 3-year overall survival rates in patients with or without local recurrence were 40.0% and 72.4%, respectively (P = 0.037). The 3-year overall survival rates in patients with or without lung metastasis were 32.0% and 84.5%, respectively (P < 0.01). The 3-year overall survival rates in patients with tumor's diameter≥10 cm or <10 cm were 40.2% and 78.1%, respectively (P = 0.003). The 3-year overall survival rates in patients with or without standard chemotherapy were 74.9% and 35.8%, respectively (P = 0.048). The 3-year overall survival rates in patients with high or normal lactate dehydrogenase at the time of diagnosis were 38.1% and 72.3%, respectively (P = 0.010). Multivariate analysis showed that standard chemotherapy (P = 0.005) and lung metastasis (P = 0.003) were independent prognostic factors affecting the survival of patients with osteosarcoma.@*Conclusions@#Neoadjuvant chemotherapy combined with surgical methods can improve the survival rate of patients with osteosarcoma of the extremities. Nonstandard chemotherapy and lung metastasis during or after treatment affect the survival of patients with osteosarcoma.

Prognosis analysis of 44 patients with extremity osteosarcoma / 肿瘤研究与临床

Objective To investigate the survival of patients with osteosarcoma treated in a single institute. Methods A total of 44 patients with osteosarcoma who had undergone surgical treatment in the Second Hospital of Shanxi Medical University from January 2013 to January 2018 were enrolled in this retrospective study. After the diagnosis of osteosarcoma, patients received cisplatin plus doxorubicin neoadjuvant chemotherapy. The patient 's basic data, auxiliary examination results, surgical methods, pathological reports, prognosis and other information were reviewed and recorded, and the Kaplan-Meier method, Cox regression model were used to analyze the relationship between various factors and prognosis of patients. Results Among 44 patients, there were 23 males and 21 females, aged from 7 to 62 years old (average 27.2 years old); the tumor site of 5 cases was located at the upper limbs and 39 was located at the lower limbs;the diameter of the tumor was<10 cm in 30 cases, ≥10 cm in 14 cases. All patients underwent extensive resection, including 35 cases of limb salvage surgery and 9 cases of amputation. At the end of follow-up, the 3-year overall survival rate was 65.5％. The 3-year overall survival rates in patients with or without local recurrence were 40.0％and 72.4％, respectively (P=0.037). The 3-year overall survival rates in patients with or without lung metastasis were 32.0％and 84.5％, respectively (P<0.01). The 3-year overall survival rates in patients with tumor's diameter≥10 cm or<10 cm were 40.2％and 78.1％, respectively (P=0.003). The 3-year overall survival rates in patients with or without standard chemotherapy were 74.9％ and 35.8％, respectively (P= 0.048). The 3-year overall survival rates in patients with high or normal lactate dehydrogenase at the time of diagnosis were 38.1％and 72.3％, respectively (P=0.010). Multivariate analysisshowed that standard chemotherapy (P= 0.005) and lung metastasis (P= 0.003) were independent prognostic factors affecting the survival of patients with osteosarcoma. Conclusions Neoadjuvant chemotherapy combined with surgical methods can improve the survival rate of patients with osteosarcoma of the extremities. Nonstandard chemotherapy and lung metastasis during or after treatment affect the survival of patients with osteosarcoma.

Analysis of oncological prognosis and survival of prosthesis after surgery for distal femoral malignant tumors / 肿瘤研究与临床

Objective To investigate the oncological prognosis, prosthesis survival rate and other related factors after limb salvage surgery for distal femoral malignant bone tumors. Methods A total of 42 patients who received the surgery of resection of malignant bone tumor of distal femur and prosthesis replacement of knee joint tumor in the Second Hospital of Shanxi Medical University from January 2008 to December 2013 were retrospectively analyzed. The patient's oncological prognosis, prosthesis survival rate and related influencing factors were analyzed. Results The follow-up period was 18-97 months. Of 42 patients with malignant bone tumors, 21 cases (50％) survived without tumor, 7 cases (16％) survived with tumor, and the 5-year overall survival rate was 66％. The overall survival rate of patients with Enneking stage ⅡB tumor was 55.4％, and that of patients with stage ⅡA tumor was 75.0％, and the difference was statistically significant (χ2= 4.350, P= 0.037). The survival rate of artificial prosthesis was 78.6％ (22/28), the different length of osteotomy affected the survival rate of prosthesis (χ2= 4.248, P= 0.039), but the different types of prosthesis did not affect the survival rate of prosthesis (χ2= 2.177, P= 0.140). Conclusions The distal femoral malignant bone tumor has a good oncological prognosis after limb salvage surgery, Enneking staging is an important factor affecting the oncological prognosis. The different length of osteotomy at the distal femur affects the survival rate of the prosthesis, the longer the prosthesis, the lower the survival rate of the prosthesis.

Efficacy observation of prosthetic replacement for bone tumors and devitalization and replantation after resection of tumor segment for treatment of extremity osteosarcoma / 肿瘤研究与临床

Objective To evaluate the efficacy of prosthetic replacement for bone tumors and devitalization and replantation after resection of tumor segment for the treatment of patients with extremity osteosarcoma. Methods A total of 54 patients with Enneking stage Ⅱ extremity osteosarcoma who underwent limb-salvaging surgery in the Second Hospital of Shanxi Medical University from December 2010 to June 2017 were analyzed. Kaplan-Meier survival analysis was performed on the prosthetic replacement for bone tumors group and devitalization and replantation after resection of tumor segment group, the 5-year survival rate and distant metastasis rate between the two groups were compared. The χ 2 test and t test were used to compare the local recurrence rate, occurrence of local infection, and postoperative functional recovery between the two groups. Results Forty-six patients were followed up with the period ranging from 3 to 84 months. The prosthetic replacement for bone tumors group had 35 cases and the devitalization and replantation after resection of tumor segment group had 11 cases. The postoperative 5-year survival rate and 5-year distant metastasis rate were compared between the prosthetic replacement for bone tumors group and devitalization and replantation after resection of tumor segment group by using the Kaplan-Meier method (52.5％ vs. 59.4％, 38.5％ vs. 35.7％), and the differences were not statistically significant (χ 2 values were 0.084 and 0.013, both P > 0.05). For local recurrence rate and the risk of postoperative infection, the patients in devitalization and replantation after resection of tumor segment group showed higher results than those in prostheticreplacement for bone tumors group [36.4％ (4/11) vs. 8.6％ (3/35), 36.4％ (4/11) vs. 11.4％ (4/35)], and the differences were statistically significant (χ 2 values were 4.181 and 5.020, both P < 0.05). For 6 months postoperative functional reconstruction score, the patients in devitalization and replantation after resection of tumor segment group showed worse result than that in prosthetic replacement for bone tumors group [(17.4± 2.5) points vs. (24.3±4.8) points], and the difference was statistically significant (t = -4.911, P < 0.05); but this index tended to show better result at 18 months after surgery as compared with prosthetic replacement for bone tumors group [(27.3±2.7) points vs.(24.8±4.6) points], but the difference was not statistically significant (t= 1.811, P > 0.05). Conclusion The efficacy of prosthetic replacement for bone tumors is considered better than that of devitalization and replantation after resection of tumor segment, and it could be used as the preferred surgical option for limb-salvaging treatment in patients with extremity osteosarcoma at present.

Detection and surveillance of west nile virus infection in southern Xinjiang, China, 2012 / 中华实验和临床病毒学杂志

Objective@#To investigate the west nile virus (WNV) infection in Xinjiang, China.@*Methods@#Serum samples were collected from patients with fever and chicken in southern Xinjiang, 2012. The presence of WNV-specific immunoglobulin M (IgM) antibodies and neutralizing antibodies was examined through enzyme-linked immunosorbent assay (ELISA) and plaque reduction neutraization test (PRNT90).@*Results@#A total of 1 712 serum samples of outpatients and inpatients were collected in 8 counties in southern Xinjiang. As a result , 22 samples were positive for WNV IgM antibody and 48 samples were positive for WNV neutralization antibody, among which 21 WNV IgM antibody positive samples and 42 WNV neutralization antibody positive samples were from Jiashi county. Of 383 chicken serum samples collected in 4 counties in southern Xinjiang, only 28 samples were positive for WNV neutralizing antibody, interestingly, all positive chicken serum samples were collected from Jiashi county.@*Conclusions@#This study revealed that WNV infection occurred in human and poultry in southern Xinjiang, 2012, mainly in Jiashi county.

Evaluation of the efficacy of pelvic malignant bone tumor resection and function reconstruction / 肿瘤研究与临床

Objective@#To discuss the efficacy of pelvic region Ⅰ-Ⅲ malignant bone tumor resection and function reconstruction.@*Methods@#A retrospective study was performed on 23 patients with pelvic malignant bone tumors who underwent limb salvage surgery in the Second Hospital of Shanxi Medical University from January 2010 to December 2018, including 12 males and 11 females, aged 19-78 years old. There were 22 cases of primary tumors, and 1 case of metastatic carcinoma. The tumor of 13 cases located in region Ⅰ, 2 cases in region Ⅱ, 5 cases in region Ⅲ, 1 case in region Ⅱ+Ⅲ, and 2 cases in region Ⅰ+Ⅱ. The surgical methods included resection + allograft, resection + pedicle screw reconstruction, resection + ipsilateral iliac bone graft reconstruction, and artificial hemipelvic replacement. The complications, outcomes, survival, and function recovery of patients were analyzed.@*Results@#None of the 23 patients died in the perioperative period. Five patients with tumor invasion region Ⅱ underwent hemipelvic replacement, and no serious complications occurred after operation; 15 patients underwent allogeneic bone graft or autologous bone graft after tumor resection, 2 of them had milder wound infection, and no serious complications were found in the others; 3 cases underwent pedicle screw reconstruction after tumor resection, and no obvious complications occurred after operation. By the end of follow-up, 12 patients died of local recurrence or lung metastases after surgery, including 4 patients who underwent hemipelvic replacement. The gait of 23 patients was changed to some extent, most of them were claudication; One patient needed to walk with two crutches.@*Conclusions@#The malignant bone tumors in the pelvic region Ⅰ and Ⅲ can achieve satisfactory postoperative results after extensive resection in the boundary of security. For pelvic region Ⅱ malignant bone tumors, the postoperative curative effect of half pelvic prosthesis reconstruction after resection in the boundary of security is acceptable.

Saikosaponin-b2 alleviates CCL4-induced acute liver injury in mice by inhibiting endoplasmic reticulum stress signal pathway / 中国药理学与毒理学杂志

OBJECTIVE To investigate the protective effect of saikosaponin-b2 (SS-b2) on acute liver injury induced by carbon tetrachloride (CCI4) and its inhibition on endoplasmic reticulum stress pathway in mice. METHODS Sixty male BALB/c mice were randomly divided into normal control, model, SS-b2 (5, 10 and 20 mg·kg-1) and silymarin (10 mg·kg-1) groups. Mice were ig given different drugs or saline for 7 d. Two hours after the last administration, mice were IP given 5% CCI4 to induce acute liver injury, except those in normal control group. The activities of glutamic-pyruvic transaminase (GPT), glutamic-oxaloacetic transaminase (GOT) and superoxide dismutase (SOD) and the content of malondialdehyde (MDA) in mouse serum were detected by colorimetric method. Pathological changes in liver tissue were detected by HE staining. The expression levels of protein kinase R-like ER kinase (PERK), phospho-eukaryotic initiation factory 2a (p-elF2α), activating transcrIPtion factor-4(ATF4), glucose regulated protein 78 (GRP78) and CCAAT/enhancer-binding protein homologous protein (CHOP) were detected by immuno-histochemistry and Western blotting. RESULTS Compared with the normal control group, the activities of GPT and GOT and the content of MDA in mouse serum in model group were significantly increased (P<0.05, P<0.01), but the activity of SOD was significantly decreased (P<0.01). Meanwhile, the expression levels of PERK, p-elF2α, ATF4, GRP78 and CHOP in the liver tissue were significantly increased in the model group (P<0.01). Compared with the model group, SS-b2 groups significantly reduced the activity of GPT, GOT and the content of MDA in the serum of acute liver injury mice (P<0.05, P<0.01), but increased the activity of SOD (P<0.01), and the expression levels of endoplasmic reticulum stress pathway proteins mentioned above were significantly reduced (P<0.05, P<0.01). HE staining results showed that different concentrations of SS-b2 could significantly improve the swelling of hepatocytes, the dissolution of nuclei around hepatic lobules, and the arrangement disorder of hepatic cords induced by CCI4 in mice. The cell morphology was obviously improved. CONCLUSION SS-b2 has a significant protective effect on CCL-induced acute liver injury in mice. The mechanism may be related to the inhibition of oxidative stress and down-requlation of the expressions of ERS related protein.

Application of PVP puncture needle as saw guide in total en bloc spondylectomy of thoracic and lumbar neoplasms through single posterior approach / 中华骨科杂志

Objective To explore the practicability and safety of the application of Percutaneous Vertebroplasty puncture (PVP) needle as a saw guide in the Total En-bloc Spondylectomy (TES) of thoracic and lumbar tumor through single posterior approach.Methods From June 2017 to March 2018,four patients with thoracic and lumbar vertebral neoplasms were analyzed retrospectively.They included 2 males and 2 females,which aged 50-77 years with an average age of 63.75 years.There were 1 case of Tomita 5 grade T7 lymphoma,1 case of Tomita 3 grade T5 metastasis of lung cancer,1 case of Tomita 5 grade T9 metastasis of prostate cancer and 1 case of Tomita 4 grade L2 metastasis of renal cancer.The PVP needle combined with the modified "3-step" method was applied in TES for 4 cases through posterior approach.The operative time and intraoperative blood loss were recorded.The integrity of excised vertebra and postoperative complications were observed.The visual analogue score (VAS) was evaluated to assess the pain improvement.The ASIA classification was evaluated for the assessment of neurological function of thoracic vertebral tumor cases and the muscle strength grades was evaluated for the assessment of neurological function of lumbar vertebral tumor cases.Results In all 4 cases,the vertebra was removed entirely.The average operation time was 4.9 h (4.0-6.5 h)and average blood loss was 3 200 ml (800-9 000 ml).No pachymeninx injury,cerebrospinal fluid leakage,iatrogenic spinal cord injury or vascular injury occurred.During the surgery,the saw-cutting plane is firmly located in the intervertebral disc and no slippage of the cutting plane was observed.Postoperatively,the pain was significantly alleviated.The VAS score decreased to average 1.75 points (1-2 points) after surgery,average reduction of 5.75 points (5-7 points).The neurological deficit was not aggravated in all patients.The neurological improvement of one grade was observed in 3 patients.Two cases of thoracic vertebral tumor had a grade of ASIA classification improved from grade B to grade C.One case of lumbar vertebral tumor had a grade of lower limb muscle strength improved from grade 3 to grade 4.No recurrence of tumor was observed at average 8.1 months (3.5-12 months) followup and 1 case of bone metastasis of lung cancer had intermittent intercostal neuralgia.Conclusion It is feasible and safe to apply PVP puncture needle as a saw guide in TES of thoracic and lumbar tumor through single posterior approach,on the basis of this,the "3-step" intervertebral disc truncation technique is developed,which has good practicability and high safety.

Comparative analysis of Epstein-Barr virus nucleic acid loads in peripheral blood mononuclear cells and plasma / 中华检验医学杂志

Objective To find the rational selection of specimens for the detection of Epstein-Barr virus ( EBV ) DNA.Methods A total of 117 patients were diagnosed with EBV infection at Beijing Friendship Hospital from January to June 2017, including 44 patients with infectious mononucleosis (IM), 36 patients with EBV-associated hemophagocyticlymphohistiocytosis ( HLH ) and 37 patients with post-transplant lymphoproliferative disorders (PTLD).Patients were aged from 6 months to 28 years.EBV DNA loads (median and quartile) in peripheral blood mononuclear cells (PBMC) and plasmawere detected by real-time quantitative PCR.The viral loads of different specimen types were compared by nonparametric rank sum test ( Mann-Whitney test, M-W test) .Spearman correlation analysis was performed for correlation analysis.Results TheEBV DNA loads in PBMC of IM and PTLD were 53600 (7875,626500) copies/ml and 114000 (3396,590500) copies/ml, which were significantly higher than those in plasma [4500 (675, 8600)copies/ml and 0(0, 0)copies/ml, respectively].The M-W values were 372.5 and 30.5 respectively (both P<0.001), which indicated statistically significant differences .However, the EBV DNA loads in PBMC and plasma of HLH were 5100 (1425, 170000) copies/ml and 13500 (1303, 152500) copies/ml.The M-W value was 646.5 (P=0.991), which indicated no statistically significant difference . Spearman correlation analysis showed good correlations of EBV DNA loads between PBMC and plasmain IM and HLH, and the r values were 0.548 and 0.400, respectively (both P<0.05), while the correlation of EBV DNA loads between PBMC and plasma in PTLD was poor , and the r value was 0.308 ( P>0.05 ) . Conclusions For the diagnosis and monitoring of EBV infection , the types of specimens recommended by different diseases are different .Plasma or serum specimens are recommended for quantitative detection of EBV DNA in IM and HLH, while PBMC and plasma specimens are recommended in PTLD .Clinically, the type of specimen should be chosen reasonably according to the type of disease .

Effect of Matrigel on the establishment of human osteosarcoma animal model / 肿瘤研究与临床

Objective To investigate the effects of cell suspension including Matrigel, normal culture medium and phosphate buffer saline (PBS) on the xenograft model establishment of human osteosarcoma. The function of Matrigel on regulating human osteosarcoma cell differentiation and proliferation was analyzed. Methods Twenty-four BALB/c-nu/nu nude mice were randomly divided into three groups with 8 animals in every group: Matrigel and RPMI 1640 suspension (group M), RPMI 1640 culture medium (group R), PBS (group P). Human osteosarcoma cell-SaOS-2 was suspended in the three groups respectively. 1×106/ml equivalent cell counts were injected into the back of each anesthetized nude mouse (400 μl per mouse). Xenograft tumors were measured at regular intervals and the tumor volume was calculated. After 5 weeks of inoculation, the tumor parts were dissected. Paraffin-embedded sections from xenograft tumor tissues were fixed in 4 % paraformaldehyde and pathological study was made after paraffin embedding and cutting under microscope by HE stains. Results Eight nude mice formed tumor lumps at 0 day in group M and were gradually increased over time. Xenograft tumors of group R and group P disappeared in 2-4 days and some appeared again after 1 week with an increase of tumor size. After 5 weeks, the tumor volume in the group M was significantly larger than that in the group P and group R [(3 185 ± 488), (598 ± 189), (512 ± 109) mm3 respectively,F=85.7,P<0.001].After 5 weeks,tumor body was dissected.The tumor weight in the group M was significantly larger than that in the group P and group R[tumor weight:(2.22 ± 0.18),(1.48 ± 0.13),(1.47 ± 0.17) g respectively, F= 37.07, P< 0.001]. There was no difference between group R and group P in tumor volume and weight(P>0.05).Histopathological analysis showed that cells in the group M could keep original degrees of pathological differentiation in osteosarcoma cells. Besides, cells suspension of culture medium or PBS in the group P and group R were poorly differentiated. Conclusions Matrigel can promote high tumor growth rate and good uniformity of human osteosarcoma cells in experimental animals. The histological state is similar to original structure,which conforms to the occurrence and development of human osteosarcoma.

Investigation of mosquitoes and arboviruses in the border areas of Yunnan province, 2012 / 中华实验和临床病毒学杂志

Objective@#To investigate the distribution patterns of arboviruses in Yunnan province near the China-Laos-Myanmar border, China, and to provide evidence for prevention and control of arboviruses diseases.@*Methods@#Mosquito samples were collected in Daluo county of Xishuangbanna Dai Autonomous Prefecture and Zhengdong county of Pu’er city in Yunnan province, 2012. Viruses were isolated from the samples by tissue culture, positive isolates were identified by RT-PCR with arbovirus species-specific primers, for further sequencing and phylogenetic analysis.@*Results@#A total of 17 species of mosquitoes from 6 genera were collected. A total of 24 strains of viruses were isolated from the mosquito pools and identified as Tembusu virus (TMUV) (2 strains), Japanese encephalitis virus (JEV) (3 strains), Getah virus (GETV) (2 strains), Banna virus (BAV) (4 strains), Densovirus (DNV) (9 strains) and Nam Dinh virus (NDiV) (3 strains).@*Conclusions@#The China-Laos-Myanmar border of Yunnan province is rich in species of mosquitoes and arboviruses.

Phylogenctics of Getah virus and its migration / 中国人兽共患病学报

In order to investigate the molecular evolution and spatio-temporal migration of Getah viruses (GETV) isolated around the world,the nucleotide and deduced amino acid sequence of GETVs were analyzed and phylogenetic trees were constructed by using informatics software including ClustalX1.83,MegaAlign,GeneDOC and Mega6.0.The Bayesian Stochastic Search Variable Selection (BSSVS) program in the BEAST v 1.8.1 software package was used to analyze the spatial dynamics of the Getah virus.Results showed that the full-length of Getah virus E2 gene consists of 1 266 nueleotides,encoding 422 amino acids.And the homology of nucleotide and amino acid were 94.5％ 100％ and 96.4％ 100％ respectively.The molecular evolution analysis revealed that there were no species and geographical distribution difference existing among GETV host animals (e.g.horses and pigs) and vectors (e.g.mosquitoes).Bioinformatics analysis showed that GETV originated in Malaysia,then it was spread to Japan,China,South Korea,Mongolia,Russia,etc.GETV E2 gene was relatively stable since GETV was first isolated in 1955.The differences of species and geographical distribution did not exist among GETV host animals and vectors,and the virus has spread from tropical regions to Eurasian continent.Thus,strengthening the detection and monitoring of GETV and its infections in humans and livestock is critical.