Risk factors and functional evaluation of recurrence after resection of thigh soft tissue malignant tumor / 中华骨科杂志

Objective:To explore the risk factors of recurrence after resection of thigh soft tissue malignant tumors and the evaluation of the postoperative lower limb function.Methods:A total of 211 patients who underwent thigh soft tissue malignant tumor resection in the Department of Orthopaedics of the second affiliated Hospital of Medical College of Zhejiang University from May 2011 to May 2021 were retrospectively analyzed, including 117 males and 94 females, aged 53 (43, 65) years. There were 59 cases of atypical/well-differentiated liposarcoma, 30 cases of other types of liposarcoma, 33 cases of malignant fibrous histiocytoma, 19 cases of fibrosarcoma, 12 cases of rhabdomyosarcoma, 12 cases of leiomyosarcoma, 9 cases of synovial sarcoma, and 37 cases of others. The tumor involvement of muscle, bone, blood vessel, nerve tissue and intermuscular compartment, postoperative Musculoskeletal Tumor Society (MSTS) functional score and recurrence were recorded. The relationship between anatomical structure and postoperative recurrence was analyzed by Cox logistic regression to determine risk factors; the cumulative recurrence rate of different compartment groups (medial compartment, anterior compartment, and posterior compartment) were compared; The Box plot was used to compare the postoperative function of patients with resection of different anatomical structures (e.g., vastus lateralis, biceps femoris, femur, etc.).Results:A total of 34 out of 211 patients relapsed, with a recurrence rate of 16.1%. The recurrence time ranged from 2.6 months to 91.6 months after operation, with a median recurrence time of 37.0 (18.2, 52.8) months. Three independent risk factors were found to be associated with recurrence, namely: pathological grade [ HR=3.86, 95% CI(1.75, 8.51)], involvement of vastus intermedius [ HR=3.05, 95% CI(1.53, 6.06)], and involvement of vastus medialis [ HR=3.17, 95% CI(1.56, 6.41)]. The recurrence rate of patients with anterior chamber tumor resection was 35.3%, which was higher than that of patients without tumor resection (16.2%), and the difference was statistically significant ( P=0.020). There was no significant difference in recurrence rate between patients with medial chamber tumor resection and patients without tumor resection ( P>0.05). The recurrence rate of patients with posterior compartment tumor resection was 12.3%, which was lower than that of unresectable patients (37.6%), and the difference was statistically significant ( P=0.002).The postoperative MSTS score of 167 patients averaged 26±3.2 points (9-30 points). After intraoperative resection of part of the femur, vastus intermedius, vastus medialis, and rectus femoris, the patient's function was relatively poor [corresponding median MSTS score: 25 (23, 28), 26 (24 28), 26 (24,28), 26(24, 27)]. Conclusion:The risk factors for local recurrence after resection of thigh soft tissue malignant tumors include: pathological grade of the tumor, and whether the vastus intermedius or vastus medialis is involved. Anterior compartment tumors have a higher recurrence rate after surgery. If the tumor involves the above-mentioned anatomical structures, more attention should be paid to the risk of local recurrence after surgery.

Mini-open excision of osteoid osteoma using burrs with the guidance of O-arm navigation / 中华骨科杂志

Objective:To investigate the surgical method and clinical effect of O-arm navigation mini-open burring for osteoid osteoma.Methods:Eighteen patients with osteoid osteoma were treated with O-arm guided grinding drill from June 2021 to May 2022, including 15 males and 3 females, the age was (18.4 ±10.9) years (range 2 to 44 years), and the course of disease ranged from 1 week to 3 years (mean 14.2 months). The lesions sites included 6 cases of proximal femur, 3 cases of distal femur, 4 cases of proximal tibia, 1 case of distal tibia, 2 cases of proximal fibula and 1 case of distal and proximal humerus. During the operation, the O-arm navigation was used to determine the location of the focus, the muscle and soft tissue was peeled off to the bone surface through a 1-4 cm small incision, the channel retractor was placed, and the burr was registered as a navigation recognition device to gradually remove the bone on the surface of the tumor nest, and the tumor nest was scraped with a curette for pathological examination; according to the navigation image, the focus was enlarged removed with burr and the grinding range was confirmed by the O-arm X-ray machine before the end of the operation. The patients were followed up for 6 to 15 months (mean 9.5 months). CT scans were performed before and after surgery for imaging comparison in order to figure out whether it had residual lesions or recurrence. The visual analogue score (VAS) of pain was used as a parameter for evaluating the clinical efficacy.Results:The operation time of 18 cases was 40-175 min, with an average of 89.3 min. The time required to establish navigation image was 18.0 ±4.1 min (range 13 ~ 22 min). The length of the incision was 2.7±1.1 cm (range 1-4 cm). All patients achieved complete curettage of the lesions, and osteoid osteoma was confirmed by pathology after operation. All the patients could move to the ground 24 hours after operation, and the pain was significantly relieved from 3 to 7 d after operation, and the pain almost disappeared 3 months after operation. The VAS score of 18 cases was 5.33±1.24 before surgery, 2.79±1.32 on the 3rd day, 1.86±1.21 on the 7th day, 0.86±0.93 on the 1st month, 0.33±0.48 on the 3rd month, and 0.09±0.29 on the 6th month after operation, and the difference was statistically significant ( F=58.50, P<0.001). There were no serious complications during and after operation, and the success rate of treatment (no recurrence of symptoms, no residual recurrence of imaging lesions, no serious complications after operation) was 100%. Conclusion:Treatment of osteoid osteoma with mini-open excision using burrs under the navigation of O-arm is a simple, safe, minimally invasive and efficient technique. Intraoperative precise positioning and the use of burr with navigation to remove a larger area than the tumor nest are the keys to successful treatment.

Clinical features and prevention of dislocation after resection and reconstruction of tumors involving pelvic area II / 中华骨科杂志

Objective:To explore the clinical characteristics of dislocation after resection and reconstruction of tumors involving pelvic area II, and to try to propose intraoperative and postoperative techniques to prevent its occurrence.Methods:From March 2011 to March 2021, 122 patients with resection and reconstruction involving pelvic area II were retrospectively analyzed. Among them, 17 had postoperative dislocation, 32 had pelvic area II, and 31 had pelvic area I+II. There were 40 cases in the pelvic area II+III, and 19 cases in the pelvic area I+II+III. There were 49 female patients and 73 male patients; the mean age was 47 years (9-73 years). The Musculoskeletal Tumor Society (MSTS) score of lower extremity patients after reduction was evaluated, and the clinical characteristics of dislocation, such as dislocation direction, dislocation time and reduction method, were counted and analyzed, and feasible prevention measures were analyzed based on the imaging characteristics after resection and reconstruction. dislocation method.Results:Among the 122 patients, there were 17 cases of dislocation, and the dislocation rate was 13.7%. Among them, 12 cases were anterior dislocation, accounting for 70.6% of anterior dislocation; 5 cases were posterior dislocation, and the proportion of posterior dislocation was 29.4%, difference (χ 2=4.52, P=0.033). There were 12 cases of dislocation within 3 months after operation, accounting for 70.6%; 1 case of dislocation occurred in 5 months after operation, and the other 4 cases of dislocation occurred for more than one year. The MSTS score of the dislocation patients after reduction was 56.1±15.6% (20%-80%). Combined with postoperative imaging examinations, the feasible methods for preventing dislocation include: The anteversion angle of the acetabular cup can be appropriately reduced (0°-10°); The acetabular cup can be appropriately shifted to the rear of the rotation center; Appropriately reducing the anteversion angle of the femoral neck prosthesis, the combination of the three can reduce the occurrence of femoral-acetabular prosthesis impingement; at the same time, the affected limb is controlled in a neutral position with strict nail shoes after surgery to avoid the occurrence of external rotation. Conclusion:The dislocation after tumor resection and reconstruction in pelvic area II is mostly anterior dislocation. Postoperative CT scan of the pelvis shows that the space between the neck of the femoral stem prosthesis and the lower edge of the acetabulum is small, which is prone to impingement. If the anteversion angle of the acetabular cup is appropriately reduced, the acetabular prosthesis is appropriately displaced posteriorly, and the anteversion angle of the femoral neck is reduced by 5°, the possibility of femoral-acetabular impingement can be reduced, thereby reducing the risk of postoperative dislocation.

Prosthesis-preserving sequential method for treatment of peripheral prosthesis infection after bone tumor limb salvage / 中华骨科杂志

Objective:To explore the curative effect of the "domino" sequential method with prosthesis preservation in the treatment of infection around the prosthesis after limb salvage surgery for bone tumors.Methods:A retrospective analysis of 11 patients with peripheral prosthetic infections after limb salvage surgery with prosthesis preserving "domino" from January 2016 to January 2020 was retrospectively analyzed, including 8 males and 3 females; age 21-74 years old, with an average of 51.8 years old. There were 6 cases of knee prosthesis for distal femoral tumor, 2 cases of proximal tibia knee prosthesis, 2 cases of pelvic prosthesis infection, and 1 case of middle femoral prosthesis. Before the operation, 8 cases had fever, and 2 cases had sinus. Sequential treatment failure is defined as: recurrence of infection. The treatment method is the debridement and lavage of the prosthesis and the systemic combined local application of drug-sensitive antibiotics to evaluate the patient's blood routine, C-reflective protein, erythrocyte sedimentation rate and other indicators, X-ray and CT of the surgical site, and the Musculoskeletal Tumor Society (MSTS) score.Results:The positive rate of microorganism culture was 72.7% (8/11), including 2 cases of Staphylococcus aureus, 1 case of Staphylococcus epidermidis, 1 case of methicillin-resistant Staphylococcus epidermidis, 1 case of methicillin-resistant Staphylococcus aureus, abalone There were 2 cases of Acinetobacter mannifolia and 1 case of Streptococcus degalactiae. The MSTS score before treatment and at the last follow-up after treatment increased from 10.91±2.31 points to 20.73±3.52 points, the difference was statistically significant ( t=7.162, P<0.05). A total of 3 cases of sequential treatment failed to control infection, and the operation success rate was 72.7% (8/11). One case was amputation, one case was long-term replacement of wound dressing, and one case was switched to antibiotic bone cement combined with intramedullary nail reverse double insertion technique to control infection. Conclusion:For bone tumors with clinical infection symptoms less than one month after limb salvage surgery, the use of prosthesis-preserving "domino" sequential method for treatment of prosthetic infections is desirable for early and mid-term clinical efficacy.

3D printed hemipelvic prosthesis for treatment of pelvic malignant tumors resected via sacroiliac joint / 中华骨科杂志

Objective:To analyze the surgical techniques, surgical indications and early clinical effects of 3D printed hemipelvic prostheses in the reconstruction of pelvic malignant tumors resected by the sacroiliac joint.Methods:From January 2016 to March 2020, a retrospective analysis of 9 patients with malignant tumors involving pelvis I+II or I+II+III region were treated with sacroiliac joint osteotomy and 3D printed pelvic prosthesis reconstruction. There were 7 males and 2 females; their age was 51.1±10.5 years (range 27-66 years). Among them, 5 cases were chondrosarcoma, 1 case was pleomorphic undifferentiated sarcoma, 2 cases were metastatic renal cell carcinoma, and 1 case was metastatic primitive neuroectodermal tumor. Resection of pelvic area I+II or I+II+III were according to the extent of tumor involvement. During the resection of pelvic I region, osteotomy was done through sacroiliac joint surface, and 3D printed hemipelvic prosthesis that fits the sacral auricular surface was used for reconstruction. Postoperative imaging examination was used to evaluate the acetabular rotation center deviation of the pelvic prosthesis; the International Bone Tumor Society (Musculoskeletal Tumor Society, MSTS) function score was used for functional evaluation; the patient's oncology outcome and postoperative complications were evaluated.Results:All 9 patients successfully completed the operation. The operation time was 3.5-6 hours, with an average of 4.5 hours. The intraoperative blood loss was 800-3 000 ml, with an average of 1 400 ml. 3 patients underwent resection and reconstruction of pelvis I+II area, 4 patients underwent pelvic resection and reconstruction of I+II+III area, 2 patients underwent pelvic I+II+III area combined with proximal femur resection and reconstruction; all patients were followed up. The follow-up time was 6-50 months, with an average of 16 months. At the last follow-up of 9 patients, the MSTS score was 12-26, with an average of 20.2; the postoperative rotation center horizontal displacement distance was 10.67±7.12 mm, and the vertical displacement was 8.56±4.22 mm. One case of metastatic cancer was found to have multiple metastases throughout the body during chemotherapy 3 months after surgery, and died in 7 months after surgery; 1 case of pelvic metastatic renal cell carcinoma developed multiple metastases within one and a half years after surgery, controlled by targeted drugs, and survived with the tumor; the rest seven cases had no recurrence at the surgical site and no distant metastasis was found.Conclusion:The semipelvic prosthesis with 3D printed auricular surface has potential advantages in reconstructing the bone defect of the pelvis I+II or I+II+III area after the sacroiliac joint osteotomy. The short-term efficacy is relatively satisfactory, and the long-term efficacy remains to be further observed.

The immune microenvironment of giant cell tumor of bone and its role as an indicator to denosumab administration / 中华骨科杂志

Objective:To investigate the alteration of immune microenvironment in giant cell tumor of bone (GCTB) after denosumab treatment from the aspect of immune cellsat single-cell level.Methods:During Nov 2018 and May 2020, fresh tumor excision tissues from GCTB cases were collected and received CyTOF analyses. CyTOF datasets were analyzed and visualized by t-distributed stochastic neighbor embedding (TSNE) method of reduction dimension. The compositions of immune cells in GCTB with or without denosumab treatment were compared. The supernatant of culture medium of ex vivo inoculated primary tumor tissues was harvested to clarify if the culturing supernatant could affect cell growth.Results:A total of 15 primary GCTB cases and three denosumab-treated samples were included in this study and were sent for CyTOF and multicolor FACS assay. GCTB was featured of T-cell and macrophage-like myeloid cell-dominant immune microenvironment. After denosumab treatment, the percentage of T-cells was significantly elevated, while the number of macrophage-like myeloid cells were reduced. Furthermore, the ratio of macrophage-like myeloid cells in total live cells was associated with the treatment period of denosumab. The multinuclear osteoclast like giant cells were characterized by the expression of γδTCR, while most of the intratumoral CD8+ T-cells were activated PD-1+CD69+T-cells. The culturing supernatant of denosumab treatment-free GCTB tissues reinforced cell proliferation in vitro, while this phenomenon was not seen when using denosumab treated tissues.Conclusion:Illustrated the immune cell atlas of GCTB, and preliminarily investigated the potential effects of immune cells on tumor progression in GCTB, providing some theoretical clues for prolonged use of denosumab in unresectable GCTB cases.

Early functional result of modular reverse shoulder tumor prosthesis in the treatment of proximal humerus tumor / 中华骨科杂志

Objective:To summarize the indications, early functional outcome, complications and precautions of modular reverse shoulder tumor prosthesis in the treatment of proximal humerus tumor.Methods:From September 2018 to October 2019, there were 7 patients with proximal humeral tumor underwent tumor resection and modular reverse shoulder tumor prosthesis replacement in our hospital, including 6 males and 1 female. The average age of the patients was 32 years (14-59 years), including 3 cases of giant cell tumors, 2 cases of osteosarcomas, one case of myeloma and one case of renal cancer metastasis. The prosthesis reconstruction was performed after the removal of the proximal humerus tumor according to malawer type I. Postoperative outpatient follow-up included X-ray of shoulder joint, measurement of shoulder joint activity, functional evaluation using Constant-Murley function score and Musculoskeletal Tumor Society (MSTS) function score.Results:All the 7 patients successfully completed the operation, the operation times were ranged from 125 to 215 min, averaged 158 min; the intraoperative hemorrhage were ranged from 100 to 500 ml, the averaged 257 ml; the length of resected proximal humerus were ranged from 10 to 16 cm, averaged 12 cm. All patients were followed up for 4-17 months, with an average of 8 months. At the last follow-up, the average active abduction of shoulder was 108° (80°-175°), and the average active flexion was 124° (90°-175°). Three patients complained of mild discomfort in the shoulder, the rest of the patients had no pain in the shoulder. Sleep was not affected in all patients, and the hands of seven patients could go over the top of head, and they could live and work normally. In 7 patients, the rotation of shoulder joint was limited, the abduction force of shoulder joint was decreased, the Constant-Murley function score was 72% (59%-78%), and the MSTS function score was 84% (67%-93%). None of the 7 patients had incision infection, hematoma and other related complications. There was one dislocation occurred one month after the operation because the humeral adhesion of deltoid was resected. After open reduction, a larger glenoid ball was used and tension of deltoid muscle was tightened, and no dislocation was found.Conclusion:The combined tumor prosthesis of reverse shoulder has the advantages of simple installation, lower operative requirements compared with the common reverse shoulder prosthesis compounded with allograft, easy to control the length of the prosthesis, and also can achieve satisfactory results.

Effectiveness of tranexamic acid in reducing bleeding in limb salvage around knee joints / 中华骨科杂志

Objective:To evaluate the effectiveness and safety of intravenous infusion of tranexamic acid combined with local infiltration in reducing the perioperative bleeding of prosthetic replacement surgery after massive tumor resection around the knee joint.Methods:Retrospective analysethe patients treated in our hospital from December 2014 to November 2018 underwent tumor resection and prothesis replacement surgery for tumors around the knee, according to whether intravenous infusion of tranexamic acid combined local infiltration of tranexamic acid in the incision was divided into tranexamic acid group and control group. Statistical analysis of postoperative drainage volume, total blood loss, number of blood transfusion, hemoglobin and fibrinogen level in 3 days after surgery, drug-related side effects, wound complications. The differences between the measurement data of the two groups used independent sample t test to compare; the comparison between the count data groups was by χ2 test. Results:In all 116 patients, preoperative intravenous infusion of tranexamic acid combined with intraoperative local infiltration of tranexamic acid in 26 patients, 90 cases in control group; 39 of the replacement required preoperative chemotherapy, There were 8 cases in the tranexamic acid group. In the tranexamic acid group, there were 23 cases (88.46%) in the distal femur and 3 cases (11.54%) in the proximal tibia, and 59 cases (65.56%) in the proximal femur in control group, and 31 cases (34.44%) of the proximal tibia. The length of the osteotomy is similar, the control group is 14.01±3.26 cm, and the tranexamic acid group is 15.21±4.69 cm. The operation time in control group was 2.57 h, and the tranexamic acid group was 2.34 h. Bleeding volume: the bleeding in control group was 613.33±212.76 ml, and the tranexamic acid group was 440.39±208.48 ml ( t=3.636, P=0.002). There were 54 patients (60%) had blood transfusion in control group, and 15 patients (57.69%) in the tranexamic acid group. There was a significant difference between two groups ( χ2=4.771, P=0.029). The total drainage volume was 623.92±316.87 ml in control group, 468.08±220.74 ml in tranexamic acid group ( t=2.328, P=0.022); estimated total blood loss index: 440.47±194.23 ml in control group, tranexamic acid group: 236.75±116.56 ml ( t=5.046, P=0.000); hemoglobin level in 3 d after surgery, control group: 84.29±11.21 g/L, tranexamic acid group: 92.12±13.66 g/L ( t=-2.951, P=0.004), perioperative blood loss: 866.14±418.68 ml in control group, 586.75±409.93 ml in the tranexamic acid group ( t=2.985, P=0.003). There were significant differences between two groups. All patients were rechecked for coagulation function within 3 days after surgery. The PT time of the patients in the tranexamic acid group was 15.01±1.01 s at 3 d, which is 14.88±0.85 s in control group, and the APTT was 41.18±4.61 s in tranexamic acid group, but approximately 40.77±4.63 s in control group, fibrinogen was 3.26±0.66 g/L and 3.31±1.20 g/L in control group, there is no significant difference between two groups. Conclusion:Local infiltration of tranexamic acid intravenous infusion of tranexamic acid during surgery can significantly reduce the perioperative bleeding volume of limb salvage surgery aroundknee joint and reduce allogeneic blood transfusion.

Muscle group excision is an effective and safe surgical treatment for soft tissue sarcoma of thigh / 中华骨科杂志

Objective To evaluate the local recurrence rate,limb function and complications of soft tissue sarcoma of thigh after muscle group resection.Methods Between January 2009 and August 2016,twenty-threepatients who were diagnosed as soft tissue sarcoma for the first time in our hospital,receiving thigh quadriceps muscle group resection,adductor muscle group resection or posterior compartment of the thigh resection were incorporated into this study.Patients who had received surgery of this lesion before,suffered from recurrent soft tissue tumor,had tumor involved multiple muscle groups which could not be resected completely,had sciatic nerve or femoral artery or vein affected by tumor or had distal metastasis were excluded.This retrospective study consisted of 12 male and 11 female.The age ranged from 20-80 with the average of 52.All the patients received CT and MRI of thigh to figure out the size of tumor,the invaded extension of the lesion and the specific muscle group involved.Chest CT scan and ultrasound of bilateral inguinal lymph nodes were arranged to exclude the tumor metastases.After all these examinations were done,needle biopsy with the guidance of CT scan was performed for the pathological diagnosis.The pathology included undifferentiated pleomorphic sarcoma (7 cases),rhabdomyosarcoma (2 cases),primitive neurotodermal tumor (1 case),synovial sarcoma (1 case),leiomyosarcoma (3 cases),fibrosarcoma (5 cases) and liposarcoma (4 cases).Sixpatients received quadriceps muscle group resection,eightpatients received adductor muscle group resection and the other 9 patients received posterior compartment of the thigh resection.Patients with undifferentiated pleomorphic sarcoma,leiomyosarcoma,primitive neurotodermal tumor and synovial sarcoma received postoperative adjuvant chemotherapy.None of patients received radiotherapy.After surgery,drainage tube of negative pressure was placed until the volume of drainage was less than 50 ml within 24 h.The affected thigh was bound up tightly.Intravenous antibiotics were used for 3 days to prevent from postoperative infections.Patients received quadriceps muscle group resection stayed in the bed for 4 weeks.After that they could walk with the protection of orthosis with unbending position.Other patients got out of bed after 2 weeks.All the complications after surgery were recorded.Reexaminations were arranged in 3,6,12 and 24 months after surgery separately.After that,reexamination was arranged every half a year.Chest CT scan was used to detect lung metastasis and ultrasound or MRI was arranged for local recurrence.Lower limb function after surgery was evaluated by MSTS scores.Results All the surgeries of muscle group excision were successfully completed.The duration of surgery ranged 1.5-3.5 h with the average of 2.2 h.The bleeding volume during surgery ranged 100-1 100 mL with the average of 313 mL.The follow-up was a mean of 41 months (range,17-108 months).None was lost to follow-up.The local recurrence rate was 4.3％ (1/23).One patient with undifferentiated pleomorphic sarcoma had positive surgical margin,who received posterior compartment of the thigh resection.Local recurrence occurred 6 months after surgery.Then he received expanded resection.Six patients had distant metastases,five patients for lung metastases,one patient for lung and inguinal lymph node metastases.Of these,five patients had died and one lived with the metastasis.The median MSTS score was 26.3 points (range,14-30 points).Specifically,the median musculoskeletal tumor society (MSTS) score was 28 points (range,21-30 points) for 9 patients with posterior compartment of the thigh resection,twenty-nine points (range,27-30 points) for 8 patients with adductor muscle group resection,and 20.3 points (range,14-24 points) for 6 patients with quadriceps muscle group resection.Five patients had complications,including local recurrence (1 case),hematoma (2 cases) and cutaneous necrosis (2 cases),all of which were settled by reoperation.The rate of complication was 21.7％.Conclusion Muscle group resection is an effective surgical treatment for soft tissue sarcoma of thigh,which could reduce the risk of local recurrence,apart from quadriceps muscle group resection,the other two muscle group resections have limited impact on lower limb function,additionally,thigh muscle group resection is a safe procedure with few complications.

Personalized treatment options and clinical results of giant cell tumor of the long bone——A retrospective analysis of 281 patients from one institution / 中华骨科杂志

Objective To explore the personalized treatment options and clinical results obtained by our hospital for different parts of bone destruction of different degrees of bone giant cell tumor.Methods Retrospective analysis from January 2005 to December 2014,according to the giant bone cell tumor diagnosis and treatment procedures used in thehospital to take wide resection or intralesional curettage and adjuvant therapy for the treatment of primary limb long bone giant cell tumor 281 cases.There were 150 males and 131 females,with overall age from 14 to 71 years and an average of 35.10 yearsold.The distal ulna was 9 cases.The distal radiuswas 26 cases.The proximal humerus was 19 cases.The distal humerus was 2 cases.The proximal femur was 38 cases.The distal femur was 95 cases.The proximal tibiawas 59 cases.The distal tibiawas 10 cases.There were 19 proximal fibula cases,3 distal fibula cases and 1 case of multiple giant cell tumor of bone.We chose curettage and/or adjuvant therapy or wide resection,then with bone cement,allograft or autograft,prostheses to reconstructionaccording to tumor site,the degree of destruction,pathological fractures.The x2 test and Cox regression analysis were used to detect the statistic differences.The KaplanMeier survival analysis was used to count the disease-free survival.The relationship between tumor location,destruction degree,Campanacci grading,pathological fractures,treatment methods at different stages and recurrence were analyzed.Results A total of 281 patients with long bone giant cell tumor were included in the follow-up study,including 37 pathological fracture and 244 non-fracture.According to the author's giant cell tumor diagnosis and treatment process,122 patients received a wide resection,159 cases were treated with curettage ± adjuvant therapy.23 patients had postoperative recurrence,the recurrence rate was 8.19％.The recurrence time after operation ranged from 9 to 75 months (average 30.95 months).There was no significant difference between the recurrence rate of lesions around the knee and other parts (x2=0.370,P=0.240).In the non-pathologic fracture group,the recurrence rate was significantly lower in the large section compared with curettage surgery (x2=9.393,P=0.002).Of the patients with intralesional surgery,126 patients reconstructed with cement and 28 patients reconstructed with autograft/allograft bone to rebuild mechanical stability.There were 14 recurrence cases (14/126,11.11％) in the bone cement group and 8 recurrence cases (8/28,28.57％) in the bone graft group.The recurrence rate in the bone cement group was significantly lower than that in the simple bone graft group (x2=5.846,P=0.017).The patients with lesion less than 50％,4 had recurrences (4/55,7.27％),12 recurrences occurred (12/76,15.79％) in more than 50％ and less than 75％ of the cross-sections,and if the lesion was more than 75％ cross-sectional area,4 cases of recurrence (4/113,3.54％).There was no significant difference in the proportion of bone destruction between different cross-sections in affecting tumor recurrence.The recurrence rate of Campanacci Grade Ⅲ patients was significantly higher than that of Campanacci Grade Ⅱ patients with curettage surgery (x2=9.909,P=0.002).Only 1 of the patients with pathological fracture had recurrence (1/37,2.70％),the recurrence rate was significantly lower than that the curettage group (x2=11.972,P=0.001).Among the early patients,79 cases (63.71％) were cured by surgery and 17 cases were relapsed,while in the last 5 years 80 cases (50.96％) were cured by surgery and 6 cases were relapsed,In two different periods,the curettage recurrence rate was significantly decreased (x2=9.246,P=0.003).Conclusion By selecting personalized treatment options for different patients,it is possible to increase the proportion of patients who maintain their knee joints while reducing the local recurrence rate,providing doctors and patients with a choice of treatment options.

Diagnosis and surgical treatment of spinal osteoblastoma / 中华骨科杂志

Objective To investigate the clinical charactistics,diagnosis,treatment options and surgical efficacy of spinal osteoblastoma.Methods From May 2007 to May 2016,the clinical manifestations,imaging data,diagnosis,treatment and prognosis of 11 patients with spinal osteoblastoma were retrospectively reviewed.There were 7 males and 4 females.The age ranged from 15 to 44 years old with the average of 27.5 years.Two lesions were involved in cervical spine and 6 lesions were located in thoracic spine.The other 3 cases was in lumbar spine.All patients suffered from local pain.Four patients had neurological deficiency,with 3 suffering radicular pain and 1 suffering incomplete paraplegia (Frankel C).Four patients were staged as Enneking 2 and treated by intralesional curettage.Seven patients were staged as Enneking 3.Accordingly,4 patients were treated by expanded excision with single posterior approach and 1 patient was treated by expanded excision with combined anterior and posterior approach.The other 2 patients were treated by piecemeal total vertebrectomy with single posterior approach.The pain release,neurological recovery and tumor recurrence were evaluated by postoperative follow-up.Results The mean operation time was 3.5 h (range,1.5-7 h) and the average intraoperative blood loss was 800 ml (range,100-3 000 ml).1 patient had cerebrospinal fluid leakage and 2 patients had pleural effusion.No surgical infection was detected in any patient.After surgery,the pain was dramatically relieved in all patients.The radicular pain in 3 patients were relieved and the incomplete paraplegia in 1 patient was recovered to Frankel E.The mean follow-up period was 45.8 months (range,12-117 months).Recurrence occurred in 1 case of cervical 7 and thoracic 1 spine leison 4 years after the surgery.Another expanded excision of the tumor was conducted for this patient and no recurrence was detected till now.No other cases of recurrence were observed.No loosing or breakage of implantation was detected during the follow-up.Conclusion For Enneking 2 leisons,intralesional curettage was effective.For Enneking 3 leisons,the expanded excision or piecemeal total vertebrectomy were recommended.No matter the excision was intralesional or not,the satisfactory results could be achieved if complete tumor excision could be conducted.

Health information service for patients in hospital library / 中华医学图书情报杂志

Objective To provide reference and ideas for information service in hospital library by analyzing the influencing factors for its service satisfaction.Methods The satisfaction of hospitalized patients for information service was investigated.The characteristics of patients,their requirements for information service and the influencing factors for their satisfaction were analyzed by logistic regression analysis.Their satisfaction for information service was assessed according to the IPA method and analyzed using the SPSS19.0.P0.05).The importance of information service and the satisfaction of patients for information service were rather high.IPA analysis showed that the patients considered high the importance of library-provided personal bibliography and departments-provided health pamphlets with a low satisfaction,which should thus be solved.Conclusion The satisfaction of patients for information service is good.However,the importance of library-provided personal bibliography and departments-provided health pamphlets is high and the satisfaction for them is low.It is thus necessary for librarians to improve their service and encourage more medical staff to participate in information service for patients.

Blood pressure variability and ischemic stroke / 国际脑血管病杂志

Hypertension is the most important risk factor for ischemic stroke and other cardiocerebrovascular diseases.However,the mean blood pressure can not completely explain the target organ damage caused by hypertension and the benefits of antihypertensive treatment.A series of studies have demonstrated that blood pressure variability (BPV) is the risk factor for ischemic stroke independent of the mean blood pressure,and there was also a significant correlation between BPV and ischemic stroke.In recent years,the research of BPV has gradually become a hot spot in the field of prevention and treatment of ischemic stroke.However,the specific relevance between BPV and ischemic stroke is not entirely clear.This article briefly reviews the relationship between BPV and ischemic stroke.

The short-term function of reverse shoulder arthroplasty after resection of the proximal humerus bone tumour / 中华骨科杂志

Objective To explore the short?term functional outcomes of the reconstruction of the proximal humerus by re?verse shoulder arthroplasty after tumor rescetion. Methods 8 patients who underwent reverse shoulder arthroplasty after tumor resection between January 2013 and December 2014. 5 were female and 3 were male, mean aged was 38 years old (25-61). 2 chon?drosarcomas and 6 giant cell tumors. Enneking stageing of 2 cases with chondrosarcoma were stageⅠB and stageⅡB. 6 giant cell tumors were Campanacci stage 3, meanwhile 3 cases had pathological fractures. The deltoid and axillary nerve were intact in all patients by image analysis before the operation. The proximal humerus was resected according to Malawer typeⅠresection. Then reverse shoulder arthroplasty reconstruction and bone graft was performed. The follow?up was scheduled, and the patient received X?ray examination of the shoulder. The range of motion of the shoulder was measured, the Constant?Murley score and musculoskel?etal tumor society(MSTS) score was recorded. Results The mean duration of the operation was 2.7 h (2-3.5 h). The bleeding in the operation was 510 ml (300-850 ml). The mean length of humerus resection was 8 cm (6-10 cm). The allografts were used in 7 cases and reimplantation after tumor bone deactivation was used in one. The latissimus dorsi transfer were performed in 2 cases. The rotator cuff were resected 1-1.5 cm from the great and lesser tubercles. The follow?up was 13 months (3-26 months). No infec?tion, dislocation, or loosening of prosthesis was found by the last follow?up. The X?ray showed the case who received reimplanta?tion after tumor bone deactivation had achieved bone union 1 year postoperation,7 cases received allograft had still nonunion at the host?graft junction. Bone resorption were found in all cases in different extent but the prosthesis were stable. No local recur?rence of the tumor was found. At last follow?up, active abduction was 155° (100°-175° ) and active forward elevation was 150° (115°-170°) and Constant?Murley score was 76%(68%-87%). The MSTS score was 92%(87%-97%). Conclusion The func?tional outcomes of the reconstruction of the proximal humerus by reverse shoulder arthroplasty after tumor rescetion was satisfied in early period. The reverse shoulder arthroplasty can be used in younger patient, but long?term results need further study.

A troponin detection-combined study of rabbit experiment for evaluating cardiac fatigue / 生物医学工程学杂志

The objective of this study is to combine troponin and indicators of cardiac acoustics for synthetically evaluating cardiac fatigue of rabbits, analyzing exercise-induced cardiac fatigue (EICF) and exercise-induced cardiac damage (EICD). New Zealand white rabbits were used to conduct a multi-step swimming experiments with load, reaching an exhaustive state for evaluating if the amplitude ratio of the first to second heart sound (S1/S2) and heart rate (HR) during the exhaustive exercise would decrease or not and if they would be recovered 24-48 h after exhaustive exercise. The experimental end point was to complete 3 times of exhaustions or death from exhaustion. Circulating troponin I (cTnI) were detected from all of the experimental rabbits at rest [(0. 02±0. 01) ng/mL], which, in general, indicated that there existed a physiological release of troponin. After the first exhaustive swim, cTnI of the rabbits increased. However, with 24-hour rest, S1/S2, HR, and cTnI of the tested rabbits all returned toward baseline levels, which meant that the experimental rabbits experienced a cardiac fatigue process. After repeated exhaustion, overloading phenomena were observed, which led to death in 3 out of 11 rabbits, indicating their cardiac damage; the troponin elevation under this condition could be interpreted by pathological release. Evaluation of myocardial damage can not be based on the troponin levels alone, but can only be based on a comprehensive analysis.

Preliminary study of rabbit experiment modality for evaluating cardiac fatigue / 生物医学工程学杂志

This paper presents a preliminary study of rabbit experiment modality incorporating a new indicator for evaluating cardiac function changes, providing a basis for subsequent study of cardiac fatigue. Using only biochemical indicators, such as troponins, is difficult to make a distinction between exercise-induced cardiac fatigue (EICF) and exercise-induced cardiac damage (EICD). Therefore, some new indicators are needed to evaluate cardiac fatigue synthetically. In our study, we used New Zealand white rabbits to conduct a multi-step swimming experiments with load. We made the rabbits reach an exhaustive state to evaluate whether the amplitude ratio of the first to second heart sound (S1/S2) and heart rate (HR) during the exhaustive exercise would be decreased and whether they would be able to recover after the exhaustive exercise for 24 hours. During the first phase of swimming, S1/S2 and HR were increased, and then decreased at exhaustive state. They were recovered after the exhaustive exercise for 24 hours. Overloading led to deaths of three rabbis, and new phenomena from overloading and related to this kind of death were observed. The experiments proved that Multi-steps swimming experiments with loads by using New Zealand white rabbit is useful for studying cardiac fatigue and premonition of sudden cardiac death.

Investigation on the methods to prevent radiotherapy-induced oral mucositis / 中国实用护理杂志

Objective To investigate effective methods for preventing radiotherapy - induced oral mucositis among patients with cephalocervical malignant tumors. Methods 92 patients with cephalocer-vical malignant tumors treated with radiotherapy were randomly divided into group A (31 cases),group B (31 cases) and group C (30 cases). Mixture of 20 ml heartleaf houttuynia herb injection,20 ml salvia injection and 30 ml distilled water were given to patients in group A by means of nebulization inhalation one hour before and after every radiotherapy treatment, the inhalation lasted 20 minutes each time up to the end of radiotherapy. Mixture of 2 ml Kang-fu-xin injection,0.5 mg vitamin B|2 injection and SO ml normal saline were given to patients in group B by the same means as group A. Yangyin Qingfei decoction were given to patients in group C by means of selecting its 500 ml juice for oral use. Half of the 500 ml decoction were separately given 1 hour before and after each radiotherapy treatment up to the end of radiotherapy. Results The incidence rates of oral mucositis were obviously lower among patients in group A than in group B and C. Conclusions Nebulization inhalation of mixture of heartleaf houttuynia herb and salvia injections has significant clinical effects on oral mucositis after radiotherapy.

Caspase-8 dependent osteosarcoma cell apoptosis induced by proteasome inhibitor MG132 / 中国病理生理杂志

AIM: To investigate the effects of proteasome inhibitor Z-LLL-CHO(MG132) on human osteosarcoma cell line MG-63 and its possibly mechanism.METHODS: After treated with different concentration of MG132,the morphological change,ultrastructral morphology,cell viability,cell apoptosis,gene transcription and protein expression in MG-63 cells were accessed by fluorescence microscope,electron microscope,MTT assay,agrose gel electrophoresis,FCM,RT-PCR and Western blotting.RESULTS: Proteasome inhibitor MG132 was an effective inducer of apoptosis in human osteosarcoma MG-63 cells.Not only apoptotic changes,but also cell arrest at G2-M-phase,the accumulation of p27kip1,the accumulation of activated caspase-8 and increased ratio of Bax∶Bcl-2 were observed.However,to normal human diploid fibroblast cells,MG132 did not show apoptosis-inducing effect.CONCLUSION: Apoptosis induced by MG132 may be caspase-8,p27kip1and bcl-2-related.