Research progress of artificial intelligence in the diagnosis and treatment of bone tumors / 中华骨科杂志

Artificial intelligence (AI) has a broad application prospect in the field of bone tumor. By utilizing deep learning models and AI technology, it can provide effective assistance in pathological diagnosis of bone tumors, molecular biology diagnosis, imaging diagnosis and clinical data processing, providing patients with more accurate and personalized medical services. In terms of pathological diagnosis, AI can assist doctors to accurately identify and classify tumor types by automatically analyzing and reading a large number of pathological tissue section images. In terms of molecular biology diagnosis, AI discovers key genes and signaling pathways associated with bone tumors by analyzing large-scale genomics and transcriptomics data, which provides the basis for prognostic assessment and individualized treatment development. In terms of imaging diagnosis, AI can assist doctors to quickly and accurately analyze the image characteristics of bone tumors, automatically mark the location, size and morphology of tumors, guide treatment and predict prognosis. AI can also process large-scale clinical data to identify potential clinical features and patterns to assist in risk assessment, treatment decisions, and predicting prognosis. This paper reviews recent studies on the application of AI in the field of bone tumor diagnosis and treatment, with a view to improving the accuracy of bone tumor diagnosis, improving clinical prognosis, and providing a theoretical basis for the integrated development and innovation in the cross-field of medicine and industry.

Mid-term follow-up of reconstruction with liquid nitrogen-inactivated autologous bone graft in patients with diaphyseal malignant tumours / 中华骨科杂志

Objective:To explore the mid-term efficacy of liquid nitrogen-inactivated autologous tumor segment bone replantation for repairing bone defects after resection of malignant tumors in the long bone shaft.Methods:A retrospective analysis was performed on the clinical data of 16 patients treated with liquid nitrogen-inactivated autologous bone graft at Beijing Jishuitan Hospital from July 2015 to June 2017 to repair defects caused by malignant tumour resection of the diaphysis. There were 10 males and 6 females with a mean age of 23.4±11.6 years (range, 8-44 years), including 8 classic osteosarcoma, 2 high-grade surface osteosarcoma, 4 Ewing's sarcoma, 1 periosteal osteosarcoma, and 1 undifferentiated pleomorphic sarcoma. Tumors were located in the humerus in 2 cases, in the femur in 8 cases and in the tibia in 6 cases. The mean length of tumor was 12.4±4.8 cm (range, 5.5-26 cm). Postoperative imaging examination was performed every 6 months, and the healing status of the transplanted bone-host bone was evaluated based on the imaging assessment method of the International Society of Limb Salvage (ISOLS) imaging assessment after allogeneic bone transplantation, and the complications were assessed using the Henderson classification. The five-year survival rate for patients and grafted bone was calculated using the Kaplan-Meier survival curve.Results:The median follow-up was 64 (60.3, 69.8) months. At the end of follow-up, 13 patients were tumour free and 3 patients died of multiple metastases at 19, 20 and 33 months after surgery. There were 32 osteotomy ends in 16 patients, of which 30 healed, including 11 metaphyseal osteotomy ends, and the healing time was 9 (6, 12) months after replantation of the tumour segment with liquid nitrogen-inactivated autologous bone; 19 osteotomy ends in the diaphysis took 13 (9, 21) months to heal, with a statistically significant difference in healing time between different sites ( Z=-2.25, P=0.025). Sixteen patients had six complications, including two cases of non-union at the diaphyseal site, one case of failure of internal fixation due to non-union, three cases of recurrence, and no soft tissue complications or infections. One patient with failed internal fixation was treated with a vascularized tip iliac bone graft that healed 6 months after surgery. Another patient died of multiple metastases with 1 unhealed diaphysis left. Three cases of recurrence were all located in the extracranial soft tissue of the autologous tumor segment inactivated by liquid nitrogen. Among them, one case underwent reoperation and local radiotherapy, and there was still no tumor survival after 65 months of surgery, and two cases died due to multiple metastases. The five-year survival rate of patients was 81% as calculated using the Kaplan-Meier survival curve, and the graft survival rate was 100%. There was no amputation and the limb salvage rate was 100%. Conclusion:The use of liquid nitrogen-inactivated autologous tumor segment bone replantation for reconstruction of bone defects after resection of malignant tumors in the shaft has advantages of higher healing rate, shorter healing time at the metaphyseal end compared to the osteotomy end, fewer complications, and higher survival rate of the replanted bone.

Analysis of the application of orthopedic robot assisted technology in bone tumor surgery / 中华骨科杂志

Intellectualization and precision are important directions of development and research highlights of orthopaedic surgery at present. The orthopaedic robot-assisted technology is gradually applied to various orthopaedic specialties. However the application of robot-assisted technology in bone tumor surgery started relatively late and the scenarios suitable for clinical application are relatively limited. By searching PubMed, Embase, ScienceDirect, CNKI and Wanfang database about the application of orthopaedic robot-assisted technology in the field of bone tumor surgery, we analyzed its intelligence and precision requirements, sorted and analyzed the current clinical application of orthopaedic robot in bone tumor surgery. The robot-assisted puncture biopsy of bone tumor could improve the accuracy and positive rate, especially for tumors with small size, deep location and complex local anatomical structure. For robot-assisted precise osteotomy for bone tumors, the accuracy and error analysis of manual osteotomy and robot-assisted osteotomy in the literatures were compared. The robot-assisted technology has the potential to improve the accuracy of tumor resection at complex anatomical structures such as sacrum and pelvic tumors. For the application of robot-assisted technology in spinal tumor surgery, literature reports suggested that it can improve the accuracy of pedicle screw placement and the safety of minimally invasive vertebroplasty, and can be used for minimally invasive precise surgical resection of spinal tumors. At the same time, the existing problems and development directions were analyzed, such as cost-effectiveness, accuracy of registration, soft tissue recognition and feedback, error superposition and error correction, so as to provide reference basis for further clinical application and study.

Early numerical rating scale and Oswestry disability index in postmenopausal osteoporosis treated with denosumab / 中华骨科杂志

Objective:To compare the numerical rating scales (NRS) and Oswestry disability index (ODI) of denosumab in Chinese postmenopausal osteoporosis patients after 3 months, and analyze the early adverse reactions to provide reference for clinical diagnosis and treatment.Methods:Using a prospective study method, 260 patients with postmenopausal osteoporosis who were outpatients and inpatients in the Second Affiliated Hospital of Soochow University from September 2020 to October 2021 were selected, and general information, including age, height, weight, bone mineral density, history of fragility fractures, and use of anti-osteoporosis drugs. All subjects received denosumab 60 mg subcutaneously, and were given calcium and vitamin D at the same time. Pain was scored by NRS before treatment and 3 months after treatment, and functional improvement was assessed by ODI.Results:After 3 months of denosumab treatment in postmenopausal women with osteoporosis, among patients with different age groups, different degrees of osteoporosis, history of fragility fractures, and history of use of anti-osteoporosis drugs, NRS score and ODI score were lower than those before treatment, and the difference was statistically significant ( P<0.05). In addition, in patients with a history of fragility fractures (mainly vertebral fractures), the NRS scores and the ODI score decreased more significantly, and the difference was statistically significant ( P<0.05); the NRS score and ODI score decreased more significantly in patients with severe osteoporosis than in patients with osteoporosis, and the difference was statistically significant ( P<0.05); the BMD value of lumbar spine was negatively correlated with the reduction of NRS score before and after treatment ( P=0.042). In this study, 260 patients had musculoskeletal pain in 6 (2.3%), fatigue in 5 (1.9%), rash in 4 (1.5%), urinary tract infection in 2 (0.7%), and dizziness in 2 (0.7%), 2 case of fever (0.7%), 1 case of hypocalcemia (0.4%), a total of 22 cases of adverse reactions were reported, and the overall adverse reaction rate was 8.5%. Conclusion:Denosumab can improve pain symptoms and functional disability early in the clinical application of Chinese postmenopausal women with osteoporosis, and the incidence of adverse reactions is low. Especially for postmenopausal female osteoporosis patients with severe osteoporosis, low lumbar spine bone density, and a history of fragility fractures (mainly vertebral fractures), the application effect is more significant.

Construction of squalene producing cell factories and screening, cloning and expression of key genes / 生物工程学报

Squalene is widely used in pharmaceutical, nutraceutical, cosmetics and other fields because of its strong antioxidative, antibacterial and anti-tumor activities. In order to produce squalene, a gene ispA encoding farnesyl pyrophosphate synthase was overexpressed in a previously engineered Escherichia coli strain capable of efficiently producing terpenoids, resulting in a chassis strain that efficiently synthesizes triterpenoids. Through phylogenetic analysis, screening, cloning and expression of squalene synthase derived from different prokaryotes, engineered E. coli strains capable of efficiently producing squalene were obtained. Among them, squalene produced by strains harboring squalene synthase derived from Thermosynechococcus elongatus and Synechococcus lividus reached (16.5±1.4) mg/g DCW ((167.1±14.3) mg/L broth) and (12.0±1.9) mg/g DCW ((121.8±19.5) mg/L broth), respectively. Compared with the first-generation strains harboring the human-derived squalene synthase, the squalene synthase derived from T. elongatus and S. lividus remarkably increased the squalene production by 3.3 times and 2.4 times, respectively, making progress toward the cost-effective heterologous production of squalene.

Evaluation of total elbow arthroplasty for bone tumor around the elbow / 中华骨科杂志

Objective:To investigate the oncological efficacy and functional evaluation of total elbow arthroplasty (TEA) for the reconstruction of tumor around elbow joint.Methods:A retrospective case series study was made on the clinical data of 26 patients who underwent total elbow joint replacement after tumor resection in Beijing Jishuitan Hospital from June 1988 to June 2019. According to the inclusion and exclusion criteria, 23 patients were enrolled in the final study, there were 14 males and 9 females, the mean and median age was 37.6±19.9 and 35.0 years respectively. 23 patients included 3 cases of giant cell tumor, 4 cases of metastatic cancer, 4 cases of Ewing's sarcoma, 2 cases of osteosarcoma, 2 cases of aneurysmal bone cyst, 1 angiosarcoma, 1 primary malignacy in giant cell tumor, 1 low-grade central osteosarcoma, 1 parosteosarcoma, 1 synovial sarcoma, 1 plasma cell myeloma, 1 tendon sheath giant cell tumor and 1 case of mixed tumor. There were 6 cases of benign tumor, 4 cases of low grade sarcoma and 13 cases of high grade malignancy. With 19 cases of distal humerus, 3 cases of proximal ulna and 1 case of elbow. Each patient underwent tumor resection followed by restrictive tumor prosthesis and semi-restrictive of coonrad-morrey prosthesis were used for reconstruction.The duration of the operation, the amount of blood loss, epidemiological data, reconstruction length, oncology parameter, complications and functional evaluation were enrolled and statistical analyzed.Results:The mean length of the osteotomy followed by reconstruction was 12.5±3.9 cm, the mean operative time was 154.1±50.1 minutes, and the mean bleeding was 262.2±100.9 ml. Thirteen patients were treated with customized tumor limited prosthesis while 10 patients with Coonrad-Morrey semi-limited prosthesis. The 5-year survival rates of 23 patients was 64.3%, benign tumors, low-grade and high-grade malignancies were 100%, 100% and 39.7%, respectively. Three cases of lung cancer and three cases of Ewing's sarcoma died during the follow-up period (6/23, 26.1%), one case of giant cell tumor and one case of synovial sarcoma developed local recurrence (2/23, 8.7%). The median range of motion for the elbow increased from 35 to 85 degrees ( t=-13.787, P<0.05), the median NRS score decreased from 5.0 to 0.5 ( t=14.391, P<0.05). Postoperative complications occurred in 9 cases (9/23, 39.1%), the recent complications were nerve injury in 4 cases and infection in 1 case, late complications were prosthesis loosening and failure in 4 cases, the 5 year survival rate of prosthesis was 82.0%. The mean and median MSTS 93 score was 84.5%±11.0% and 88.3% respectively. Conclusion:The local control around the elbow is satisfactory after tumor resection. Total elbow arthroplasty can relieve pain and significantly improve function.

Expression and correlation of LC3-Ⅱ and ATF3 in hepatocellular carcinoma / 国际生物医学工程杂志

Objective:To analyze the expression of LC3-Ⅱ and ATF3 in hepatocellular carcinoma (HCC) , to explore the relationship between their expression and the prognosis of patients with HCC, and to analyze the expression correlation betweenLC3-Ⅱ and ATF3 in HCC tissues.Methods:Immunohistochemical method was used to detect the expression of LC3-Ⅱ and ATF3 protein in HCC tissue and corresponding paracancerous tissue specimens, to analyze the relationship between these two proteins and the patient's clinicopathological characteristics as well as survival time. Western blot was used to detect the expression of LC3-Ⅱ and ATF3 proteins in fresh HCC tissues and corresponding paracancerous tissue.Results:The expression of LC3-Ⅱ and ATF3 inparacancerous tissues was significantly higher than that in HCC tissues. The expression levels of were related to HCC histopathological grade and venous tumor thrombus (all P<0.05), but were not related to age, gender, and serum alpha-fetoprotein, tumor diameter, HBsAg, etc (all P>0.05) . The low expression of LC3-Ⅱ and ATF3 was significantly related to the poor prognosis of patients with HCC (both P<0.05). Conclusions:Both LC3-Ⅱ and ATF3 protein expression are related to the occurrence and development of HCC. The combined detection of LC3-Ⅱ and ATF3 is helpful for the assessment of the malignant degree of HCC and it is expected to become an important indicator for judging the prognosis of patients.

Research progress of sentinel lymph node biopsy and regional dissection in melanoma / 中华肿瘤杂志

Melanoma is a malignant tumor derived from the skin and mucous membrane, the epidemiological data showed that the incidence of melanoma elevated rapidly in the last decade. Early lymph node metastasis is a distinguishing characteristic of melanoma. The assessment of regional lymph nodes is a vital factor for melanoma staging and comprehensive therapeutic strategies. The sentinel lymph node biopsy (SLNB) plays an important role in this comprehensive diagnosis and treatment system. Completion lymph node dissection (CLND) with positive sentinel lymph node was accepted by traditional theories. But it has recently been questioned via the latest global clinical trial. CLND limited the benefit for melanoma specific survival. However, SLNB is the reliable procedure for staging and prognostic evaluation of melanoma patients with positive sentinel lymph node, and CLND can significantly improve the local control and decrease the regional recurrence according to the evidence-based medicine. The authors summary the recently correlational research of SLNB and CLND in melanoma in this review.

Surgical treatment of giant cell tumors with pathological fracture around the knee / 中华外科杂志

Objective@#To compare the local recurrent rate, the persistence of reconstruction and functional recovery of Giant Cell Tumor (GCT) after the treatments of extensive curettage or resection.@*Methods@#A retrospective review was conducted on the clinical data of 50 patients who had giant cell tumor with pathological tracture around the knee treated in our hospital from January 2001 to July 2014. There were 30 males and 20 females. The average age was 33.7 years respectively (range, 17 to 71 years). The fracture localizations of 45 cases were distal femur and of 5 cases were proximal tibia. According to AO fracture classification, 3 cases were in type A, 36 cases in type B and 11 cases in type C. In Campanicci system for image grading study, 5 cases were in grade Ⅱ and 45 cases in grade Ⅲ. Surgical treatment included 20 cases of extensive curettage and 30 cases of resection. The surgical reconstructive methods included 16 cases of cement reconstruction with internal fixation, 5 cases of unicompartmental arthroplasty with allograft, 1 case of segment osteoarticular allograft transplantation and 28 cases of prosthesis replacement. Final statistical analysis of surgery and therapeutic effect were carried out by SPSS, version 16.0 for Windows. Enrolling parameters collected gender, age, location, fracture type, surgical treatment, surgical margin, reconstruction, complications, local recurrence (LR) and functional evaluation. Categorical data were described by result frequencies.The comparison of the rate was performed by chi-square or Fisher′s exact test. Between the two groups compared using independent t-test. The recurrence-free survival was estimated by the method of Kaplan-Meier.@*Results@#The mean postoperative follow-up time was 66.9 months (range, 24-149 months). Four patients developed local recurrence (4/50, 8.0%)including 3 cases of curettage group (3/20, 15.0%)and 1 case of resection group (1/30, 3.3%), there was no significant difference between curettage and resection group (P=0.289). The comparison of local recurrence between this curettage group (3/20, 15.0%) and the GCT group without fracture published before(10/116, 8.6%) in our institution also had no significant difference (P=0.407). There was no significant difference among the three types of fracture regarding the rate of local recurrence (P=0.160), but there was significant difference in the choice of surgical procedures for different fracture types (P=0.006). The complications: 2 patients (2/20, 10.0%)had joint degeneration in curettage group. 15 cases (15/30, 50.0%) had complications in resection group, 1 case of unicompartmental arthroplasty allograft absorption, 2 cases of infection and 12 cases of aseptic loosening after prosthesis replacement (including 1 case with periprosthetic fracture and 1 case with prosthesis fracture). The postoperative complications in curettage group had a significant reduction (P=0.005) when compared with the resection group. The mean score of functional evaluation with Musculoskeletal Tumor Society (MSTS) for curettage and resection group were (93.5±6.5)% and (82.6±12.9)% (F=4.838, P=0.033).@*Conclusions@#(1) Extensive curettage did not increase the risk of local recurrence of giant cell tumor with pathological fracture around the knee. (2)The different fracture type had no effect on the local recurrence rate, but affect the decision of surgical procedures options. (3)The reconstructive complications in resection group was significant higher than curettage group, and the postoperative function of curettage group was better than resection group.

Clinical, radiologic and pathologic features of giant cell tumor of bone treated with denosumab / 中华病理学杂志

Objective@#To investigate the radiological and histopathological features of giant cell tumor of bone treated with RANKL inhibitor denosumab.@*Methods@#Eleven cases were retrieved from the surgical pathology records between March 2015 and June 2017 in Beijing Jishuitan Hospital. Formalin fixed, paraffin embedded specimens were collected and the histological features were evaluated. The imaging features including X ray, magnetic resonance imaging, and computed tomography were also reviewed.@*Results@#These 11 cases of giant cell tumor of bone were derived from five female and six male patients, with age ranged from 20 to 62 years (mean age, 35 years). The tumors were located in the sacrum (6 cases), femur (2 cases), radius (1 case), tibia (1 case) and patella (1 case), respectively. Histologically, all cases showed depletion of giant cells, proliferation of mononuclear cells and different degrees of ossification 3 to 6 months after denosumab therapy. Radiography showed marked osteosclerosis and sclerotic rim formation. Three cases of the sacrum recurred after 5, 6 and 11 months of surgery, and the remaining cases showed no recurrence within follow-up of 1 to 14 months.@*Conclusions@#Denosumab treated giant cell tumors morphologically differ from untreated tumors. Careful attention to a history of denosumab administration is crucial to avoid misdiagnosis and to allow proper differentiation from other tumors and tumor-like lesions.

Dedifferentiated chordoma of sacrococcygeal region: a clinicopathologic analysis and review of literature / 中华病理学杂志

Objective@#To study the clinicopathologic features of dedifferentiated chordoma.@*Methods@#Four cases of dedifferentiated chordoma of sacrococcygeal region were collected at Beijing Jishuitan Hospital, from 2009 to 2014. HE and immunohistochemistry (EnVision method) were used to observe the clinical, radiological and histological features of dedifferentiated chordoma and to make the diagnosis and differential diagnosis. The literature was reviewed.@*Results@#Four cases of dedifferentiated chordoma were all located in the sacrococcygeal region. The mean age at diagnosis was 57 years (range 49-64 years). There were 1 female and 3 males. Histologically, there were two components of conventional chordoma and dedifferentiated sarcoma with or without transitional area between them. The histology of dedifferentiated components includes undifferentiated sarcoma and fibrosarcoma. Immunohistochemical study showed that cytokeratin, epithelial membrane antigen, S-100, Brachyury were positive in the portion of chordoma while p53 were positive in the portion of undifferentiated sarcoma. INI1 and vimentin were both positive.@*Conclusions@#The dedifferentiated chordoma is very rare. The diagnosis should combine the histological characters and immunohistochemical results and should be differentiated from the sarcomatoid chordoma, poorly differentiated chordoma and other high grade sarcoma. p53 may play a role in the malignant transformation mechanism of chordoma.

Case-control study on malignant transformation of fibrous dysplasia / 中国肿瘤临床

Objective: To elucidate the biological behavior of malignant transformation (MT) of fibrous dysplasia (FD) and investigate its risk factors for diagnostic identification. Methods: A retrospective analysis of 394 FD cases from March 2006 to March 2017 in Beijing Ji Shui Tan Hospital was performed. Seven cases had been histopathologically confirmed as malignant (study group). According to age, location, and other epidemiological data, we performed a 1:2 case-matched comparison between the patients with malignant FD and 14 patients with benign disease (control group). Clinical features, visual analog scale (VAS) score, tumor volume, imaging characteris-tics, alkaline phosphatase (AKP) levels, lactate dehydrogenase (LDH) levels, oncologic results, and function data were analyzed. Re-sults: The 7 MT cases included 3 males and 4 females. Mean follow-up time was 175 (3-396) months, and mean and median follow-up time were 25 (3-51) months after MT. Mean and median age were 45.6 and 47 (24-60) years, respectively. Among the 7 cases, 6 in-volved the femur and 1 involved the tibia. Two cases involved a single lesion whereas the remaining 5 involved multiple lesions. There were 5 recurrent cases and 2 initial cases. The mean MT period from initial surgery were 207 (37-377) months. VAS scores in the study group were significantly higher than that in the control group (Z=-3.317, P=0.001); the VAS scores decreased significantly after opera-tion (Z=-2.384, P=0.017). Preoperative AKP levels were different between the study and control group; the levels were significantly higher in the former group than in the latter (Z=2.314, P=0.021). However, postoperative AKP levels were similar in both groups (Z=0.821, P=0.821). LDH levels were not significantly different between the two groups, either preoperatively (Z=1.269, P=0.205) or post-operatively (Z=0.075, P=0.940). As for the study group, AKP levels decreased significantly after surgery (Z=-2.366, P=0.018); LDH levels were also lower after surgery than before (Z=-2.028, P=0.043). CT enhancement values were higher in the study group than in the con-trol group (Z=-3.659, P<0.001). Univariate analysis indicated that preoperative VAS score, AKP level, cortical damage, presence of soft tissue mass, and CT enhancement value were clinical risk factors for determination of MT of FD. Histopathological analysis revealed 4 cases of osteosarcoma, 2 of low-grade spindle cell sarcoma, and 1 of undifferentiated pleomorphic sarcoma. Three patients had re-ceived adjuvant chemotherapy, 2 cases involved pulmonary metastasis, and 1 patient had died. The mean Musculoskeletal Tumor Soci-ety (MSTS) scores for the study and control groups were (95.0±3.9)% and (86.0±10.9)%, respectively (F=5.689, P=0.029). Conclusions:Malignant transformation of fibrous dysplasia is rare. The preoperative VAS score, AKP level, cortical damage, presence of soft tissue mass, and CT enhancement value may be helpful for clinical screening of malignant transformation. An adequate surgical margin is re-quired for treatment of this lesion.

Dedifferentiated liposarcoma of extremities: a clinicopathologic analysis / 中华病理学杂志

Objective@#To study the clinicopathologic features of dedifferentiated liposarcoma of extremities.@*Methods@#Nine cases of dedifferentiated liposarcoma of extremities diagnosed at Beijing Jishuitan Hospital from 2009 to 2017 were selected. The histological features of cases of dedifferentiated liposarcoma of extremities were evaluated by HE and immunohistochemistry, together with the clinical and radiological features. Flourescence in situ hybridization(FISH) was used to detect MDM2 amplification.@*Results@#They were located in the thigh (6 cases), calf (2 cases) and buttock (1 case). There were six females and three males. Patients′ age ranged from 61 to 79 years (mean 68 years). Histologically, there were two components, well-differentiated liposarcoma and dedifferentiated sarcoma with or without transitional lesions between them. The histology of dedifferentiated liposarcoma included undifferentiated sarcoma and fibrosarcoma. Heterologous elements such as bone and cartilage were present in two cases. Immunohistochemical study showed the tumor cells expressed vimentin, CDK4 and p16. MDM2 were positive in 6 cases (6/9) and p53 was positive in one case(1/9). CKpan was positive in the epithelioid differentiation area. S-100 protein was positive in the well-differentiated liposarcoma component. FISH showed the amplification of MDM2(6/9).@*Conclusions@#Dedifferentiated liposarcoma of extremities is very rare. The diagnosis should be combined with the histological characteristics and immunohistochemical results and differentiated from the other tumors and tumor-like lesions.

Outcome and prognosis of spinal myeloma surgery / 中华肿瘤杂志

Objective@#To evaluate the impact of surgery in pain relief, quality of life, neurological function, survival status and prognosis of spinal myeloma patients.@*Methods@#Twenty spinal myeloma patients from January 1990 to June 2016 who underwent surgery were reviewed. Compare the preoperative and postoperative neurological function and quality of life, via visual analogue scale (VAS), Eastern Cooperative Oncology Group (ECOG) score and Frankel classification, survival rate based follow-up were statistical analyzed by Wilcoxon and Kaplan-Meier respectively, univariate and multivariate analysis with Cox regression model.@*Results@#There were 12 males and 8 females enrolled with average age of 53.3 (range from 31 to 75 years). Lesions location distribution: cervical spine 1 case, 12 in thoracic spine, 6 in lumbar and 1 in sacral tumor. The majority of symptom was pain in 20 cases and 5 cases had incomplete paraplegia with spinal cord compression. Single posterior approach in 15 cases, single anterior in 3 cases, anterior and posterior combined approach in 2 cases. The average operation time was 225 min, average blood loss was 2 320 ml. The patients with postoperative median VAS score and ECOG score were 2.00 and 1 respectively, it is significantly decreased (P<0.001) compared with the preoperative score (7.50 and 3), the median Frankel classification was level 5 in postoperative patients and increased significantly (P<0.001) than preoperative patients (level 4). One patient had local recurrence, 2 patients had complications. The overall 5 and 10 year survival rate was 61.7% and 42.3%, respectively. The 3 years survival rate between surgery combine chemotherapy and without chemotherapy group was 87.1% and 25.0%, 5 years survival rate was 79.1% and 0 respectively (P<0.01). LDH, ALB and chemotherapy were independent prognostic factors of survival from Cox regression. The odds ratio (OR) was 1.037 (P=0.006), 0.746 (P=0.009) and 0.077 (P=0.012) respectively.@*Conclusion@#Surgical strategy is effective to improve quality of life for spinal myeloma patients. Combine chemotherapy could improve the survival.

The progress pattern and natural courses of myopic macularpathy / 中华眼底病杂志

Myopic macularpathy is the main cause of the decline of visual function in high myopia,which including tigroid fundus,lacquer cracks,diffuse retinal choroid atrophy,plaque retinal choroid atrophy,choroidal neovascularization (CNV),Fuchs spot and posterior staphyloma.The tigroid fundus is the initial myopic retinopathy.The lacquer cracks is a special lesion in the posterior pole of high myopia.When the lacquer cracksen enlarge or lacquer cracks progress to plaque retinal choroid atrophy should be paid to monitoring the occurrence of CNV.Myopic macularpathy progression include two mode.One is from tigroid fundus——lacquer cracks——plaque retinal choroid atrophy——CNV to macular atrophy.And the other is from tigroid fundus——diffuse retinal choroid atrophy——atrophy enlarge to diffuse retinal choroid atrophy with plaque retinal choroid atrophy or plaque retinal choroid atrophy occurence on the border of posterior staphyloma.Understanding the progression patterns and natural course of these lesions will help the clinic to further understand the course of high myoipa.

Surgical Treatment and Prognosis of Multiple Myeloma Bone Disease / 中华骨科杂志

Objective To evaluate the effect of surgical treatment for pain relief,quality of life,survival status of patients and analyze prognostic factors with multiple myeloma bone disease.Methods Retrospective analyzed 43 consecutive patients from June 1992 to June 2016 who underwent surgery in our department.Twenty five males and 15 females were enrolled with average age of 56.8 (ranged:28-81 years).Lesions location distribution:upper limb in 13 cases,lower extremity in 26 cases,pelvic 3 cases and trunk 2 cases.One patient had two lesions in humerus and femur.The main symptoms manifested 35 cases of pain (81.4％) and 22 cases (51.2％) of pathological fractures,including 11 cases of upper and lower limbs.Limbs surgical included curettage and fixation in 22 cases,segment resection and prosthesis replacement in 11 cases,allograft replacement in 1 case,internal fixation without removal the tumor in 3 cases and resection without reconstruction in 2 cases.Pelvic surgical included 1 curettage,1 resection with Iliofemoral fusion and 1 resection with acetabular reconstruction of total hip replacement.Trunk surgery included scapulectomy 1 case and rib resection 1 case.The postoperative pain relief,via visual analogue scale (VAS) and Eastern Cooperative Oncology Group (ECOG) score were analyzed by Wilcoxon.MSTS score was analyzed by paired-samples t-test.Survival rate and local recurrence were analyzed by Kaplan-Meier and Chi-square respectively.We collected gender,age,number of lesions,laboratory test (HB,CRP,ALB,Cre,LDH),chemotherapy and surgical marginal for multivariate analysis with Cox regression model.Results The average time and blood loss were 164 mins (40-290 mins) and 883ml (50-7 000 ml) respectively.The Mirels score for limb tumor patients averaged 9.97 and the median score was 10 (8-12).The quality of life ECOG (Z=-5.622,P=0.000),pain relief VAS (Z=-5.671,P=0.000) and MSTS score (t=-18.520,P=0.000) were improved significantly.Four patients occurred local recurrences (4/43,9.3％) and there was no significant difference between curettage and resection cases (x2=3.175,P=0.127).Four patients occurred complications (4/43,9.3％).The overall survival rate at 1 year,3 years,5 years and 10 years was 90.7％,76.8％,63％ and 57.7％ respectively.The 5-year survival rate of pathological fracture cases was lower than others (x2=7.734,P=0.005).The survival rate was significant difference between patients with and without chemotherapy (x2=12.043,P=0.001).The survival rate was significantly influenced by ALB,CRP,LDH,pathological fracture and chemotherapy indicated by univariate analysis.CRP,pathological fracture and chemotherapy were independent prognostic factors as Cox regression showed.Conclusion Our surgical strategy is effective to relieve pain and improve myeloma patients' living with minor complications;Chemotherapy could improve the postoperative survival rate significantly.CRP and pathological fracture were independent prognostic factors.

Construction of high-yield strain by optimizing lycopene cyclase for β-carotene production / 生物工程学报

To optimize key enzymes, such as to explore the gene resources and to modify the expression level, can maximize metabolic pathways of target products. β-carotene is a terpenoid compound with important application value. Lycopene cyclase (CrtY) is the key enzyme in β-carotene biosynthesis pathway, catalyzing flavin adenine dinucleotide (FAD)-dependent cyclization reaction and β-carotene synthesis from lycopene precursor. We optimized lycopene cyclase (CrtY) to improve the synthesis of β-carotene and determined the effect of CrtY expression on metabolic pathways. Frist, we developed a β-carotene synthesis module by coexpressing the lycopene β-cyclase gene crtY with crtEBI module in Escherichia coli. Then we simultaneously optimized the ribosome-binding site (RBS) intensity and the species of crtY using oligo-linker mediated DNA assembly method (OLMA). Five strains with high β-carotene production capacity were screened out from the OLMA library. The β-carotene yields of these strains were up to 15.79-18.90 mg/g DCW (Dry cell weight), 65% higher than that of the original strain at shake flask level. The optimal strain CP12 was further identified and evaluated for β-carotene production at 5 L fermentation level. After process optimization, the final β-carotene yield could reach to 1.9 g/L. The results of RBS strength and metabolic intermediate analysis indicated that an appropriate expression level of CrtY could be beneficial for the function of the β-carotene synthesis module. The results of this study provide important insight into the optimization of β-carotene synthesis pathway in metabolic engineering.

Clinical application of Tacrolimus to infant steroid-resistant nephrotic syndrome / 中华实用儿科临床杂志

Objective To analyze the peculiarity of infants steroid-resistant nephrotic syndrome (SRNS) and to assess the efficacy,side-effect and relapse of various of Tacrolimus prescribed in infants SRNS.Methods A total of 76 case of infant SRNS from August 2012 to August 2015 in Guangzhou Weman and Children's Medical Center grouped into oral Tacrolimus (TAC group),Methyprenisolone pulse therapy (MP group) and Methyprenisolong combined Cyclophosphamide(CTX) pulse therapy(MP + CTX group),were observed for 1 year,and the urine protein excretion,renal function (CCr),blood glucose (B G),urine retinal-binding-protein (URBP),lymphocyte count etc.were recorded and the situation of infection and relapse regularly were monitored regularly.The data were retrospectively analyzed by the statistical method.Results All SRNS children underwent kidney biopsy,and 36 cases of minimal change disease,32 cases of mesangial proliferative glomerulonephritis and 8 cases of focal segmental glome-rulosclerosis were contained in the patients.The pathological constituent ratios were not obviously different among these 3 groups.By 6-month follow-up,the complete remission ratio of TAC group was 63.64％,the total remission ratio was 95.45％,which were remarkably higher than those of MP group (26.09％,60.87％) and MP + CTX group (41.94％,74.19％);the urine protein excretion of TAC group [(7.8 ± 8.6) mg/(kg · d)] was distinctly lower than that of pretreatment and lower than that of MP group [(144.2 ± 118.3) mg/(kg · d)],and lower than that of MP + CTX group [(91.3 ± 87.4) mg/(kg · d)],and the difference was significant (F =22.69,P ＜ 0.05).The remission time of TAC group was about 2 months,that of other two groups was about 3 months.By 1-year follow-up,the lymphocyte counts including total T-cell (CD3 +),the helper T-cell (CD4 +) and the inhibited T-cell (CD8 +) of TAC group decreased obviously(all P ＜ 0.01),which were extremely lower than those of the M P group and MP + CTX group,and there were significant differences (all P ＜ 0.05).By 1-year follow-up,the person-time of infection existed superior to the other 2 groups,TAC group was compared with MP plus group,the rank sum was 348.5 (U =-3.69,P ＜ 0.01);compared with MP + CTX plus group,the rank sum was 369.5 (U =-4.18,P ＜ 0.01).During the observation the URBP of TAC group was distinctly higher than that of the MP group and the MP + CTX group [(13.77 ± 19.19) mg/L vs.(2.50 ± 1.77) mg/L,(2.06 ±3.63) mg/L],and the differences were significant(t =3.16,2.99,all P ＜0.05);the TAC group with BG and CCr maintained stably.Conclusions Tacrolimus shows its own advantages of more reliable effect and less side-effect in the infants with SRNS over MP therapy and MP combined CTX therapy,but it could not lessen the recurrence of the disease,and its long-term prognosis is still not very clear.

Inflammatory myofibroblastic tumor of long bone:a clinicopathologic analysis and review of literatures / 临床与实验病理学杂志

Purpose To study the clinicopathologic features of inflammatory myofibroblastic tumor (IMT) of long bone.Methods HE and immunohistochemistry of EnVision two-step were used to observe the clinical,radiological,histological and immunophenotype features of IMT of bone.The literatures were reviewed.Results 4 cases of IMT of bone were respectively located in the tibia (2 cases) and femur (2 cases).Histologically,the lesions were characterized by collagen-rich and spindled to plump myofibroblast-like cells and a variable admixture of inflammatory cells.Immunohistochemical study showed that the vimentin,SMA,actin,H-caldesmon and CD34 were positive.Conclusion The IMT is a rare and locally aggressive tumor.The diagnosis should combine the histological characters with immunohistochemical results and should be differentiated from the other tumors and tumor-like lesions.

The thickness of the retina, choroid and sclera in different posterior sclera shape in high myopia / 中华眼底病杂志

Objective To observe the thickness of the retina,retinal nerve fiber layer (RNFL),choroid and sclera among the difference posterior sclera shape (PSS) in high myopia (HM).Methods Sixty HM patients (96 eyes) were enrolled in this study.There were 18 males (25 eyes) and 42 females (71 eyes).The mean age was (51.32±10.06) years.The mean spherical equivalent was (-14.38±6.31) DS.The mean axial length was (29.49±2.44) mm.The eyes were evaluated from deep range imaging optical coherent tomography (DRI-OCT) Atlantis 3D model,and divided as four groups include PSS-Ⅰ (27 eyes),PSS-Ⅱ (46 eyes),PSS-Ⅲ (11 eyes) and PSS-Ⅸ (12 eyes) according to the Curtin classification method.The thickness of the retina,RNFL,choroid and sclera were measured in the EDTRS Grid area.Results There were statistically significant differences in the thickness of retina of the central,first circle,second circle in the EDTRS Grid area among PSS-Ⅰ,PSS-Ⅱ,PSS-Ⅲ and PSS-Ⅸ groups (F=4.48,5.03,4.98;P＜0.01).There was no statistically significant differences in the thickness of RNFL among four groups (F=0.13,P=0.93).There was no statistically significant differences in the central choroidal thickness (F=0.3 1,P=0.81).There were statistically significant differences in the first circle,second circle choroidal thickness among four groups (F=2.86,2.96;P=0.04,0.04).There was no statistically significant differences in the thickness of sclera under macular fovea among four groups (F=0.80,P=0.49).Conlusions There are changes of thickness of the retina,choroid present in the difference EDTRS Grid area among the difference PSS in HM,and changes in PSS-Ⅸ is most obvious.