Volume 99 ·  Issue 37 ·  2019

The primary treatment for most malignant bone tumors is surgical treatment, and the core of surgical treatment is the surgical boundary. This article starts with the surgical staging of malignant bone tumors, and expounds the concept of surgical boundary and important issues related to it, such as recurrence, metastasis and prognosis.

This article discusses the role of digital orthopedic technology in precision surgical treatment of pelvic tumors, and discusses the innovative treatment mode of precision and individualization of pelvic tumors.

Soft tissue sarcoma is a kind of malignant tumor originating from mesenchymal tissue. Surgery is the main treatment for early soft tissue sarcoma. For patients who cannot be surgically resected or have distant metastases, medical drug therapy is more prominent as a systemic treatment. This article reviews and reviews the main drugs for the treatment of soft tissue sarcoma in recent years.

Osteosarcoma is a highly malignant tumor that occurs in adolescents and is prone to lung metastasis. In addition to standard surgical procedures, standardized medical treatment is crucial. However, due to the low incidence rate, the lack of guidelines and literature on medical treatment, and the exploratory progress of targeted therapy and immunotherapy in addition to traditional chemotherapy in recent years, this article will systematically introduce the drug treatment of osteosarcoma, so as to facilitate the standardization of clinical treatment decision-making.

To identify the clinical outcome and prognostic factors of synchronous multicentric osteosarcoma (SMOS).

The clinical data of 2 602 conventional osteosarcoma patients admitted to Beijing Jishuitan Hospital from January 1995 to June 2018 were retrospectively analyzed. Finally, 56 (2.1%) cases were confirmed as SMOS according to clinical and imaging database, medical record and pathological results.All epidemiological data of SMOS cases,initial diagnosis time, tumor site, number of lesions, chemotherapy, surgical treatment, alkline phosphatase (AKP),lactate dehydrogenase (LDH) and oncological results were collected in our institution. The Survival rate, comparison of various parameters, univariate analysis and multivariate Cox regression were performed with statistical software.

There were 41 males and 15 females enrolled in this research, the median and mean ages were 15 and 18 years (range, 8-50 years) respectively. All of them were multi-site involved, whereas the initial complaints of sites distribution were 32 cases of femur, 13 cases of tibia, 4 cases of humerus, 3 cases of fibula, 2 cases of spine, 1 case of sternum and 1 case of calcaneus. Forty-four of 56 cases performed adjuvant chemotherapy and 31 of them underwent surgical treatment. The mean follow-up time was 15.4 (range, 1-186) months. Thirty-five cases died of disease at the end of the follow-up. The 5-year survival rate was 10.4%. According to the number of lesions stratification, the 2-year survival rates in patients with low (<5 sites) and high (≥5 sites) tumor load was 33.6% and 0, respectively (χ²=6.697, P=0.010). The 2-year survival rate of chemotherapy and non-chemotherapy patients was 20.8% and 0, respectively (χ²=6.998, P=0.008), the value of AKP after chemotherapy(median: 272 IU/L) significantly decreased when compared with that at the initial diagnosis (median: 454 U/L) (Z=-3.274, P=0.001).The 2-year survival rate in patients with and without standard chemotherapy was 55.6% and 0, respectively (χ²=8.798, P=0.003). The 2-year survival rate was 25.0% in the surgical group and 0 in the non-surgical group, respectively (χ²=7.942, P=0.005). Multivariate cox regression analysis with the forward Wald method indicated that standard chemotherapy was the only variable contributor to survival and prognosis of multifocal osteosarcoma.

SMOS has low survival rate and poor prognosis. Chemotherapy and surgery can improve the survival rate, standard chemotherapy is an independent prognostic factor.

To analyze and summarize the clinical-pathological features of dermatosis papulosa nigra of Han Chinese people.

We collected 71 cases of dermatosis papulosa nigra in the Third people′s Hospital of Hangzhou Affiliated to Zhejiang Chinese Medical University of Department of Dermatology from January 2010 to January 2019 which were confirmed clinically and pathologically. The clinical and histopathological data of all patients were analyzed and summarized, and relevant literature were reviewed.

Among the 71 patients, 51 were female and 25 were male, their average age was (44±13) years, the average age of onset was (39±14) years, and the average time of diagnosis was (65±51) months. The lesions were multiple dark brown papules with smooth surface, and mostly distributed in the chest and abdomen, 46 cases (64.8%), followed by the back and neck. The mean diameter of the lesions was (1.76±0.99) mm. Meanwhile, the initial onset of pruritus was observed in 15 patients. The pathological features of all lesions were similar to seborrheic keratosis. According to pathological classification, there were 49 (69.0%) cases of the acanthotic type, 11(15.5%) cases of the hyperkeratotic type, 6 (8.5%) cases of spiroid type, 4 (5.6%) cases of irritated type, and 1 (1.4%) case of clonal type. Epidermal pigmentation and/or dermal papillary pigmented granules were observed in 56 cases (78.9%), of which 46 cases (64.8%) had basal layer pigmentation. In addition, inflammatory cell infiltration was found in the superficial dermis of lesions of 10 patients (14.1%) with symptom of itching.

Dermatosis papulosa nigra of Han Chinese people has some unique clinical and pathological features.

To analyze the clinical effect of ultrasound-guided erector spinae block combined with pregabalin on post-herpetic neuralgia (PHN) in the elderly.

Sixty patients with post-herpetic neuralgia from January 2018 to January 2019 in the Department of Pain, First Affiliated Hospital of Bengbu Medical College were selected. The patients were divided into two groups according to the random number table (n=30): group C and ultrasound-guided erector spinae block (ESPB) group. Group C was treated with the oral drug pregabalin. ESPB group was treated with ultrasound-guided erector spinae block combined with oral drug pregabalin. The digital rating scale (NRS) score, sleep quality score (QS), total pregabalin dosage, and correlation during treatment were recorded before and after treatment at 1, 2, 3, 4, 6, and 8 weeks after treatment.

Four weeks after treatment, the scores of NRS and QS in ESPB group were 2.00(2.00-3.00) and 1.00(1.00-2.00) respectively, which were significantly lower than those in group C 3.00(3.00-4.00) and 2.00(2.00-3.00). The differences were statistically significant (Z=-2.318,-2.533, all P<0.05). The dosage of pregabalin in ESBP group was 1.73(1.65-1.99)g, less than that in group C 7.28(7.28-7.28)g, and the difference was statistically significant (Z=-4.916, P<0.05). The NRS score and QS score of ESPB group at the 8th week of follow-up were 2.50(2.00-4.00) and 1.00(0.00-2.00), respectively, which were significantly lower than those of group C 4.00(3.00-4.00) and 1.00(1.00-2.00). The difference was statistically significant (Z=-2.426,-2.691, all P<0.05). The significant effective rate of ESPB group was 70.0%, which was significantly better than that of group C (36.7%). The difference was statistically significant (χ²=6.694, P<0.05). Adverse reactions were mild in both groups.

Ultrasound-guided erector spinae block can effectively alleviate the pain of elderly patients with PHN in the chest, significantly reduce the dosage of oral drugs, improve the sleep quality of patients, and have higher safety.

To study the effect and safety of vertebral artery stent implantation via femoral artery and radial artery.

Twenty-four patients with vertebral artery stent implantation from December, 2017 to August, 2018 in Beijing Anzhen Hospital were randomized into 2 groups, one was research group with 12 patients, the other was control group with 12 patients. The research group underwent vertebral artery stent implantation via radial artery, the control group underwent vertebral artery stent implantation via femoral artery. The follow-up results of the two groups were analyzed.

The success rate of the first puncture in the research group was 100%, significantly higher than 83.33% of the control group, there was no statistical difference (χ²=2.528, P>0.05).The implantation time of sheath tube in the research group was (3.2±0.3) min, significantly longer than that in the control group (2.4±0.2) min, the difference was statistically significant (t=7.713, P<0.001). The time from sheath insertion to balloon dilation and bed rest time after operation in the research group were 17.3 (16.2-17.9) min, significantly less than the control group (27.1(26.1-28.3) min), the difference was statistically significant (Z=-4.157, P<0.001). The time of bed rest in the research group was 2.1 (2.0-2.2)h, significantly less than the control group (27.1(25.3- 28.9)h), the difference was statistically significant(Z=-4.167,P<0.001). No cerebrovascular events occurred during the follow-up period. One patient in the control group developed complications of vagal reflex, no patient in the research group developed complications.

Vertebral artery stent implantation via radial artery can significantly improve the success rate and safety of the operation. Radial artery approach is a better choice for vertebral artery stent implantation.

To summarize the experience and effectivity of brain protection in 25 patients who suffered from chronic thromboembolic pulmonary hypertension (CTEPH) and received pulmonary thromboendarterectomy (PTE) under deep hypothermic circulatory arrest.

Retrospective analysis of 25 PTE surgeries in our center from December 2016 to August 2018. All cases were completed underdeep hypothermic circulatory arrest. Standard brain protections were strictly executed, including: balanced and controlled extracorporeal circulation cooling, cerebral oxygen saturation (rSO₂) monitoring, strictly control of circulatory arrest time, and etc. The neurological adverse events during the perioperative period were recorded and statistically analyzed, and the intelligence level and cognitive function of the patients were evaluated by MMSE scale and MoCA scale before surgery and discharge.

All the 25 patients successfully completed the surgery, and 1 patient (4%) died of postoperative infection. The mean pulmonary arterial pressure decreased from (52.9±16.7) mmHg before surgery to (23.6±8.1) mmHg immediately after surgery (t=10.01, P<0.01), and(20.7±7.9) mmHg at 3 months follow-up (t=10.73, P<0.01). Pulmonary vascular resistance decreased from 975.4 (788.6-1 292.8) dyn·s·cm^-5 to 376.1 (283.6-565.5) dyn·s·cm^-5 (Z=5.34, P<0.01). Neurological complications occurred in 3 patients during the perioperative period, including 2 patients with hypoxic encephalopathy, and 1 patient with cerebral hemorrhage. All 3 patients fully recovered before discharge. Univariate analysis showed that the duration of rSO₂<40% and the maximum decrease rate of rSO₂ from baseline were significantly correlated with postoperative neurological damage. Multivariate analysis showed only time of rSO₂<40% was significantly correlated with postoperative neurological damage. There was no significant difference in MMSE and MoCA score before and after surgery (P>0.05).

Adequate brain protection measures are essential to reduce the neurological complications of PTE surgery. Real-time intraoperative monitoring of rSO₂ and strict control of circulatory arrest time can further reduce the occurrence of neurological damage.

To describe baseline characteristics of patients with primary Sjogren′s syndrome (pSS) with right heart catheterization (RHC)-confirmed pulmonary arterial hypertension (PAH).

This retrospective study included consecutive patients hospitalized with pSS-PAH from Jan.2013 to June.2019 in Tianjin Medical University General Hospital. All patients fulfilled the 2002 revised criteria for pSS proposed by the American-European Consensus Group. PAH was defined according to RHC-based European Society of Cardiology/European Respiratory Society guidelines. Associated variables were described and analyzed. Predictive factors for achieving treatment goals were explored. Sub-groups(based on Anti-SSB antibody positive/negative) were analyzed.

Twenty patients with RHC-confirmed pSS-PAH were included (median age at onset, 54.5 years; median PAH duration, 12 months).PAH was the initial manifestation of pSS in 5 patients(26.3%), and shortness of breath was the most common symptom (17/20,85%). Mean pulmonary arterialpressure (mPAP) was 48(38, 55.75)mmHg, pulmonary vascularresistance (PVR) was 11.23 (6.17,14.69)IU, and mean cardiac index was 2.59(2.04,2.98)L·min^-1·m^-2 in this group. In addition, right ventricular diameter≤40 mm[P=0.009, HR=5.92, 95%CI(1.55, 22.59)] was predictive factor for achieving the treatment goal. Furthermore, compared with Anti-SSB antibody negative patients, patients with Anti-SSB antibody positive had a higher PVR(IU) [14.1(11.23, 22.63)vs 6.4(6.15, 12.36),P=0.025], a higher mPAP(mmHg)[5(48.5,59)vs 39(32.5,50.75),P=0.013], and a lower cardiac index (L·min^-1·m^-2) [2.1(1.6,2.5)vs 2.9(2.56,3.41),P=0.002].

pSS-PAH patients are mainly middle-aged women with the most common symptom shortness of breath. And PAH can be the first manifestation of pSS. More attention should be paid to patients with Anti-La/SSB antibody positive and right ventricular diameter ≤40 mm because of higher mPAP, PVR, worse cardiac function and prognosis.

To explore the clinical features and analyze the chromosome 19 open reading frame 12(C19ORF12) gene mutation of a family with mitochondrial membrane protein-associated neurodegeneration (MPAN).

The pedigree diagnosed as neurodegeneration with brain iron accumulation (NBIA) in Henan Provincial People′s Hospital in May 2018 was collected, and clinical data of the patients in this family was further analyzed. Furthermore, whole exome sequencing (WES) was employed to identify the disease-causing genes. Subsequently, the pathogenic mutation was validated by Sanger sequencing.

We identified 3 brothers, born of consanguineous Chinese parents. These patients were thought to carry autosomal recessive genes. The age of the onset ranged from 8 to 10 years old. All of the patients exhibited a chronic course, then got worse progressively. Parkinsonism was the first symptom. Other clinical features included cognitive decline, ataxia, gait abnormality, dysarthria and spastic paraplegia. All cases showed hypo-intensity in bilateral substantia nigra and globus pallidus on T₂WI, FLAIR and SWI of MRI. However, the "eye-of-the-tiger sign" , which was commonly found in pantothenate kinase-associated neurodegeneration (PKAN), was absent. Further findings included cerebellar atrophy (all 3 patients) and the atrophy of temporal lobe (only one brother of the proband). The homozygous mutation c.52G>T (p.Asp18Tyr) was found through WES and Sanger sequencing. The proband′s mother was heterozygous. This novel mutation was not reported in mutation database. Consequently, the pathogenic mutation in C19ORF12 gene (exon2, c.2327C>T, p.P776L) was identified from the patients according to the American College of Medical Genetics and Genomics (ACMG) guideline. The final diagnosis of the family was MPAN.

We successfully identify a novel p.Asp18Tyr mutation in a family with MPAN. Our finding enriches the known MPAN mutation types and provides evidence for further research.

To explore the value of CT quantitative features of peritumoral nodules in predicting invasiveness of thymoma.

A retrospective study of 110 patients (65 males and 45 females, with a median age of 45 years) of thymoma with complete clinical, imaging and pathological data in Peking University Third Hospital from March 2013 to October 2018. Patients were divided into high risk (23 males and 15 females, with a median age of 52 years) and low risk groups (42 males and 30 females, with a median age of 42 years) according to the 2004 WHO criteria of thymoma. The major diameter, dual phase contrast CT values, ΔCT values and distance to main tumor of peritumoral nodule were analyzed. The predictive value of CT quantitative parameters were examined with Mann-Whitney U test and ROC curves.

Among 110 cases of thymoma, 28 cases had peritumoral nodules.The pathological classification of thymoma were type B1 (12 cases), type B2 (7 cases), type B3 (6 cases) and type C(3 cases). No peritumoral nodules were found in type A and AB.Sixteen patients were categorized into the high risk group whereas the other 12 patients were considered low risk. For high risk group, the major diameter, dual phase contrast CT values, ΔCT values and distance to main tumor of peritumoral nodule were (9.8±3.7) mm, (48±27)HU, (51±21)HU, (17±10)HU and (6.3±6.5)mm, respectively; and for low risk group, the major diameter, dual phase contrast CT values, ΔCT values and the distance to main tumor of peritumoral nodules were (5.5±1.6)mm, (55±18)HU,(52±19)HU, (14±10)HU and (3.9±2.2)mm, respectively. Compared with the low risk group, the major diameter was significantly higher in high risk group ( P<0.05). In contrast, dual phase contrast CT values, ΔCT values and the distance to main tumor only changed slightly (allP>0.05). The ROC curve analysis indicated that, the cutoff of the major diameter of peritumoral nodule predicting tumor′s high risk was 6.9 mm, and the corresponding AUC, sensitivity, and specificity was 0.862, 75.0% and 75.0%, respectively.

The major diameter of peritumoral nodule can potentially predict the invasiveness to thymoma.

To analyze the MRI characteristics of Brucellosis spondylitis (BS) and evaluate the clinical value of MRI in the diagnosis of BS.

A total of 47 patients clinically diagnosed as BS from General Hospital of Jizhong Energy Xingtai Mining Industry Bloc and Xingtai Second Hospital from January 2015 to December 2017 were collected, including 32 males and 15 females, aged 24-77 years, with an average age of (57±11) years, and the course of disease was 1 month-2 years. Routine spinal MRI sequence were acquired for patients. Images were assessed by two senior imaging diagnostic physician independently. The evaluation included signal changes in the affected area of the vertebral body, vertebral body and intervertebral disc, the signal of paravertebral soft tissue, the signal of abscess around the vertebral body, whether the dural sac, spinal cord and nerve root were compressed or not, and its signal changes.

(1) Spinal involvement, in 47 patients with BS, 112 vertebral bodies were involved, including 11 cervical vertebrae (9.8%), 5 thoracic vertebrae (4.5%), 91 lumbar vertebrae (81.2%), and 5 sacral vertebrae (4.5%), the lumbar vertebrae was dominant. (2) MRI features, 112 vertebral bodies were involved, including 105 (93.8%) vertebral bodies morphology showed no significant changes, only 7 (6.2%) vertebral bodies showed mild collapse changes; 71 vertebral bodies showed diffuse destruction (63.4%), and 41 vertebral bodies showed localized destruction (36.6%). Among the 47 cases, 40 cases were continuous destruction of adjacent vertebral bodies, 6 cases showed non-adjacent damage; 37 cases of intervertebral disc involvement; 29 cases of narrowing of intervertebral space; 11 cases of paravertebral soft tissue swelling and 28 cases showed paravertebral abscess.

MRI has certain characteristics in the diagnosis of Brucella spondylitis and has a high clinical value in the differential diagnosis of spinal disease.

To observe the relationship between early renal damage markers and renal ultrasonic manifestations in gout patients, and whether early renal damage is reversible after uric acid-reducing treatment.

The gout patients from the Department of Rheumatology of Beijing Haidian Hospital and Peking University People′s Hospital between July 2016 and December 2017 were recruited in this study. According to the results of renal ultrasonography, the patients were divided into the following three groups. Group A was normal. Group B was punctate crystallization. Group C was renal calculi. Each group included 30 patients. The patients in group B and group C who could insist on regular uric acid-reducing treatment for one year were selected. The levels of urinary RBP, β ₂-MG and NAG were measured in different groups and one year before and after uric acid-reducing treatment.

The urinary concentration of β ₂-MG in group A, group B and group C were (128.59±107.32), (316.08±207.41) and (311.25±162.85)mg/L, respectively. There were significant differences among the three groups (P<0.001). The urinary concentration of NAG were (13.41±5.12)U/L,(17.88±6.19)U/L and (18.48±9.84)U/L, respectively. There were differences among the three groups (P<0.01).There was no significant difference in urinary RBP concentration among the three groups (P=0.188). After one year of uric acid-reducing treatment, the levels of urinary RBP, β ₂-MG and NAG were lower than that before treatment. There were significant differences before and after treatment in each group (P<0.05). Compared with group C, the levels of urinary β ₂-MG and NAG were decreased in group B after uric acid-reducing treatment (all P<0.05).

Renal ultrasonography is helpful for the diagnosis of early renal damage in gout patients. Early renal damage markers in gout patients decreased after uric acid-reducing treatment, suggesting that early renal damage can be reversible if early diagnosis and timely treatment can be made in gout patients.

To acquire the signal of neuron excitability and blood oxygen in mouse cortex after ischemic stroke, and to clarify the relationship between the change of neurovascular function and the degree of cerebral infarction.

The male C57BL/6 mouse(n=20) about 6-8 weeks and 20 g weight were produced the embolic stroke modal by photochemical injury. The mouse cortex was scanned by the multispectral optical imaging while using electric stimulation in 1, 3 and 7 d after operation. Then several data around the infarction were acquired including neuron excitability, the total hemoglobin concentration and deoxygenated hemoglobin concentration. The ischemic cerebral infarction size was analyzed by TTC staining. Plasma TNF-α concentration was measured by enzyme-linked immunosorbent assay(ELISA). And modified neurological severity score (mNSS) was recorded after ischemic stroke(n=30). Then correlativity analysis was used between the optical signals and three indicators of cerebral infarction degree.

The changes of neuron excitability signals were 1.15%±0.28%, 2.84%±1.06%, 2.21%±0.55%. The total hemoglobin concentration signals were 3.71%±2.76%,3.19%±2.70%,4.27%±3.05%. The deoxygenated hemoglobin concentration signals were 2.93%±2.33%, 3.60%±1.74%, 2.08%±1.28%. The neural signal was correlated to cerebral infarction size, plasma TNF-α concentration and mNSS(r=-0.441, -0.449,-0.404, all P<0.05), and mNSS had a great effect on neuron excitability(β=-0.169,P<0.05). Meanwhile, the total hemoglobin concentration was correlated to cerebral infarction size(r=0.440,P<0.05).

The signal of neuron and blood oxygen is able to represent the change of neurovascular function and evaluate the progression of ischemic stroke.

Mills syndrome is a motor neuron disease prominently characterized by hemilateral superior motor neuron damage, which usually progresses slowly. Two patients with Mills syndrome were reported, both with weakness onset in the left foot, gradually progressing upward involving the ipsilateral upper limb, with clear signs of pyramidal tract on the affected side, no paresthesia, and no evidence of lower motor neuron damage on electromyography.

Malignant melanoma is a rare epithelial tumor with a high degree of malignancy. It is extremely rare to occur in the vulva. The primary lesion is easily confused with other glands or skin lesions of the vulva such as Barr gland cyst, which is easy to misdiagnose and delay treatment. Malignant melanoma is very easy to metastasize, and the incidence of postoperative metastasis is also high. Among them, gastrointestinal metastasis is the main one, but it also occurs in organs outside the gastrointestinal tract. There are some differences in the imaging manifestations of extragastrointestinal organ metastases in malignant melanoma and gastrointestinal metastases, and there may be some differences in the imaging manifestations of metastases in different organs, and there is some overlap with the imaging manifestations of primary tumors in this organ, so the diagnosis is quite difficult. This article presents and analyzes the imaging and clinical data of pancreatic and left ovarian metastases before and 21.8 months after surgery in a patient with a rare malignant melanoma of the vulva, with the aim of improving the understanding of this disease.

Acute cardiovascular and cerebrovascular events have a clear and stable disease definition, and the International Classification of Diseases coding is an important basis for event registration. The publication of the eleventh revision of the International Statistical Classification of Diseases and Related Health Issues (ICD-11) provides an important opportunity for the standardization and standardization of registries. This paper starts with the definition of acute cardiovascular and cerebrovascular events, systematically explains the evolution of ICD coding from the 9th to 11th editions, compares the similarities and differences between clinical diagnosis and disease definition and ICD coding, and discusses the design of event registration around the problems of misreporting, misreporting and re-reporting.

Obesity is an independent risk factor for arrhythmias. Obesity can cause abnormalities of cardiac calcium channels and calcium processing proteins, lead to imbalance of cardiomyocyte calcium homeostasis, change the action potential of cardiomyocytes and even cardiac electrophysiology, thus inducing arrhythmia. This paper emphasizes the mechanism of cardiac calcium homeostasis imbalance in the progression of obesity-induced arrhythmia, which brings inspiration to find new therapeutic targets for diseases.

Forced air heating (FAW) is currently the most commonly used and widely studied device to prevent perioperative hypothermia in clinic. At present, the clinical controversy over the use of forced air heating mainly focuses on two aspects: the destruction of clean air by thermal vortex and the direct pollution of the exhausted air by using forced air heating. In this paper, the relationship between these two aspects and surgical site infection is systematically reviewed in order to provide clinical reference.