Objective:To investigate the mid-to-long term therapeutic effects of allogeneic bone composite prosthesis reconstruction in patients with large bone defects after the resection of distal femoral tumors.Methods:From June 2013 to December 2018, a total of 19 patients with malignant tumors of the distal femur who underwent reconstruction with allogeneic bone composite prosthesis in the Department of Bone Tumor, Shanghai General Hospital were retrospectively collected. There were 10 males and 9 females, aged 22.3±11 years (range, 11-42 years). The mean body mass index was 19.3±3.4 kg/m 2 (range, 14-27 kg/m 2). There were 18 cases of osteosarcoma and 1 case of Ewing's sarcoma. According to Ennecking staging, there were 17 cases of stage IIB and 2 cases of stage III. The intraoperative blood loss and operation time were recorded, and the prosthesis and patient survival conditions and postoperative complications were observed. The limb function was evaluated by the Musculoskeletal Tumor Society (MSTS) 93 function score. Results:All patients successfully completed the operation. The operation time was 187.3±39.8 min (range, 110-260 min), the intraoperative blood loss was 284.9±87.0 ml (range, 200-500 ml), and the blood transfusion volume was 327±213 ml (range, 100-800 ml). The remaining length of the proximal femur was 153.7±26.6 mm (range, 93-190 mm), and the length of allogeneic bone was 84.1±24.6 mm (range, 39-134 mm). Among the 19 patients, 9 patients (47%) achieved bony union with an average healing time of 16.7±4.8 months (range, 10-25 months), and 7 patients had delayed healing with an average healing time of 18.4±4.0 months (range, 15-25 months). The remaining 10 cases were nonunion between allogeneic bone and host bone. All patients were followed up for 80.7±20.2 months (range, 56-121 months). During the follow-up, 3 cases died due to pulmonary metastasis of bone tumors, and the time of death was 57 months, 63 months, and 59 months after surgery, respectively. At the last follow-up, the patient survival rate was 84% (16/19), and the MSTS 93 function score of the 16 patients was (24.3±2.4) points (range, 21-28 points), with an excellent rate of 100% (16/16). Seven patients underwent revision surgery, 3 cases were aseptic loosening, 3 cases were prosthesis stem fracture at the junction of the allograft bone and the host bone, and 1 case was periprosthetic infection, among which the patient with periprosthetic infection had poor local soft tissue conditions due to preoperative radiotherapy, and the infection was controlled after two revision surgeries. Five cases were revised with allogeneic bone composite prosthesis, and 2 cases were revised with short-stem giant prosthesis with cortical steel plate or locking nail. After revision, the remaining length of the proximal femur was 143.4±31 mm (range, 91-175 mm), and the length of the allograft bone was 92.6±26.6 mm (range, 61-123 mm). The 7 revised patients were still in follow-up. There were no cases of pulmonary infection, nerve injury, deep vein thrombosis or other complications after surgery.Conclusion:The survival period of patients after the surgery to reconstruct large bone defects following the resection of malignant tumors at the distal end of the femur using allogeneic bone composite prosthesis is satisfactory, and the limb function is good. However, the incidence of prosthesis complications is high, which can be reconstructed through revision.

Objective:To explore the construction and application methods of multicenter bone tumor-specific database.Methods:Experts from multiple centers including Shanghai General Hospital, Shanghai Changzheng Hospital, Zhongshan Hospital, Shanghai Sixth People's Hospital, Ruijin Hospital, Fudan University Shanghai Cancer Center and Shanghai Ninth People's Hospital established a standard dataset for bone tumors through research and discussion. Clinical data will be automatically collected and standardized according to standard fields. A database will be built and a users' interface will be developed to ensure secure data storage, while providing services such as exporting raw data, visualizing statistical analysis, establishing clinical queue research projects, et al. Finally, the bone tumor database will be shared by integrating with the Shenkang's Big Data Platform to achieve multi-center data integration.Results:A standard data set for bone tumors containing 603 fields has been established and published. An automated data collection system for bone tumors has been established, including complete data collection, data collation and visualization functions. The data categories include modules such as patients' electronic case information, laboratory information on blood routine, biochemistry and tumor markers, imaging information, surgery information, pathology information and radiotherapy records. Personal information such as patients' names and ID numbers are desensitized and encrypted and can be exported for further research. From 2015 to 2023, the total number of bone tumor cases collected in the database was 10,789. From 2015 to 2019, 112 cases of the osteosarcoma cohort were retrospectively analyzed for admission, with a statistical 5-year survival rate of 68%.Conclusion:A regional bone tumor specialty big data network and data sharing platform has been established, along with data sharing mechanisms and standards including data standards, security standards, and quality evaluation standards. This provides data and efficient new solutions for the construction of China's bone tumor database, as well as a research and development platform for standardized diagnosis and treatment of bone tumors and new technologies.

To report the short-term clinical outcome of three cases of distal tibial osteosarcoma treated with a novel 3D-printed ankle fusion prosthesis for limb preservation. The patients were admitted to the Department of Bone Tumor, Shanghai General Hospital from January 2020 to June 2021, with one male and two female cases, aged 18, 12, and 14 years, respectively, all diagnosed with distal tibial osteosarcoma (Ennecking stage IIb). A new self-designed ankle fusion prosthesis was used to perform osteosarcoma resection and prosthetic reconstruction of the distal tibia. The operation time, blood loss, postoperative American Orthopedic Foot and Ankle Society Score (AOFAS) and ankle range of motion were recorded. All the 3 patients successfully completed the operation and were followed up for 22 months, 18 months and 12 months, respectively. The operation time was 140 min, 110 min and 200 min, and the blood loss was 200 ml, 200 ml and 350 ml, respectively. At the last follow-up, the AOFAS were 86, 90 and 95 points, and the range of motion of ankle flexion and extension were 30°, 15° and 30°. There was no local recurrence or lung metastasis at the last follow-up. The novel 3D-printed ankle fusion prosthesis in the distal tibia is safe and effective for the reconstruction of bone defects after resection of osteosarcoma in the distal tibia, and the early postoperative function is satisfactory.

Objective:Limb salvage treatment for osteosarcoma in the distal tibiais challenging and the incidence of postoperative complications is high. To prove that the use of autologous bone inactivation to replant the ankle joint has a satisfactory clinical effect.Methods:This study retrospectively studied 6 cases (4 males and 2 females) of the osteosarcoma of the distal tibia from June 2018 to April 2019 in our center. The average case age was 16.8 years. All cases were first diagnosed in the center, and classic osteosarcoma was confirmed by biopsy. Before the operation, he received 4 courses of neoadjuvant chemotherapy. The tumor was resected under general anesthesia, and the tumor bone was inactivated and replanted for internal fixation and reconstruction. During the operation, the tumor segment was completely removed, and after a series of treatments, it was immersed in hypertonic saline at 65 °C for 45 min. After removal, the bone defect was filled with bone cement, and internal fixation materials such as plate screws and anchors were placed. Finally, soft tissue was rebuilt after the inactivated bone internal fixation complex (autograft-fixation composite, AFC) was replanted. Patients were treated with plaster for 3 months after surgery. Chemotherapy continued 2 weeks after surgery. Follow-up X-ray of the lower tibia were taken at 3 months, 6 months, and 12 months after the operation to evaluate the MSTS score and ankle function score (AOFAS) to evaluate the ankle function.Results:The patients were followed up for an average of 20 months. At 12 months after operation, no complications such as deep infection, mechanical failure of internal fixation, or local tumor recurrence occurred. The MSTS score averaged 26.7±2.6 points. The AOFAS average was 82.3±8.5 points. The VAS average is 2.7 points. Boneunionwasobserved in 5 cases during follow-up. All cases were satisfied with the treatment results.Conclusion:Limb salvage treatment of distal tibia osteosarcoma is more difficult. This study proves that the use of tumor bone inactivation and internal fixation to reconstruct the ankle joint can not only cure the tumor, but also has satisfactory limb function. It is an ideal strategy for limb salvage reconstruction.

Objective To explore the related factors and clinical significance of the effect of irrigation on infant with dacryocystitis. Methods A total of 318 eyes of 262 infant were treated with dacryocystitis, and their overall curative effect was observed. Single factor correlation analysis and multivariate Logistic regression were used to analyze 8 factors related to efficacy, such as age of children, length of medical history, severity of symptoms, degree of operation of nurses, degree of parental cooperation, compliance with medication, massage therapy and treatment methods. The effect of each factor on the curative effect. Results It was found that the total effective rate was 90.56 percent of the lacrimal passage in children with 318 tear channel obstruction and dacryocystitis.Single factor analysis results show that the factors influencing the curative effect of single in treatment (χ2= 88.984, P < 0.01), symptom severity (χ2=14.185,P < 0.05) length of history (χ2=18.783, P < 0.05) difference and massage therapy (χ2=10.081, P < 0.05) was statistically significant, the three factors of multiariable Logistic regression analysis results showed that the treatment (P=0.000, OR=0.148,95％ CI 0.052- 0.419) and massage therapy (P=0.012, OR=3.390, 95％ CI 1.309- 8.777) affected infant lacrimal duct flushing out main factors influencing the efficacy of tong. Conclusions The main influencing factors are the different treatment modalities, severity of symptoms the length of medical history and massage therapy in the related factors that affect the effect of infantwith dacryocystitis.

Objective To explore the feasibility of novel nano-particle HIF-1 α@Fe3 O4 labeled pancreatic cancer PANC1 cells as well as the changes of signal intensity in 3.0T MRI scan.Methods Pancreatic cancer PANC1 cells were cultured in hypoxia condition,and hypoxia-inducible-factor-1 α(HIF-1 α) and stem cell markers CD133,Oct-4,Sox-2 were detected by Western blot assay.Cells cultured under hypoxia for 24 h were collected and then co-incubated with 5,15 and 45 μg/ml HIF-1α@Fe3O4 for 24 h.The number of HIF-1 α@Fe3O4 labeled PANC1 cells and cell survival rate were detected,and the signal intensity of T2 WI image for PANC1 cells was measured by a 3.0T MRI system.Results In hypoxia condition,HIF-1 α level was obviously increased compared with that of normoxic culture,which was further increased with the increase of hypoxia time(all P ＜ 0.05).Stem-cell markers CD133,Oct-4 and Sox-2 was positively correlated with HIF-1α level.Co-cultured with different concentrations of HIF-1α@Fe3O4 for 24 h,blue-stained iron particles in cytoplasm of PANC1 cells was dosage-dependently increased,and the peak was at the concentration of 45 μg/ml,which could reach 100％.The survival rate of the PANC1 cells cultured in normoxic condition,the unlabeled and labeled in hypoxic condition group were(87.0 ± 2.1) ％,(84.7 ± 2.7) ％ and (85 ± 3.8) ％,respectively,and the difference was not statistically significant (P ＞ 0.05).In 3.0T MRI scan,T2 WI signal intensity in unlabeled group and 5,15 and 45 μg/ml labeled group was 1.017 ± 0.046,0.793 ± 0.041,0.447 ± 0.032 and 0.240 ± 0.031,and the difference was not statistically significant (F =80.0,P ＞ 0.05).Conclusions Hypoxia condition could promote and maintain the stemness in PANC1 cells.HIF-1α@Fe3O4 probe could successfully label HIF-1α highly expressed PANC1 cells during hypoxia condition,and a significant decrease in T2WI signal intensity can be detected by a 3.0T MRI system.

OBJECTIVETo examine the impact of single nucleotide polymorphisms in obesity-related genes on risk of obesity and metabolic disorder in childhood.

METHODSA total of 3 503 Chinese children aged 6 to 18 years participated in the study, including 1 229 obese, 655 overweight and 1 619 normal weight children (diagnosed by the Chinese age- and sex- specific BMI cutoffs). Body size parameters were assessed and venipuncture blood samples were collected after a 12-hour overnight fast. Plasma glucose, insulin and serum lipid profiles were measured.Genomic DNA was isolated from peripheral blood white cells using the salt fractionation method. A total of 11 single nucleotide polymorphisms were genotyped by TaqMan allelic discrimination assays with the GeneAmp 7900 sequence detection system (Applied Biosystems, Foster City, CA, USA) (FTO rs9939609, MC4R rs17782313, GNPDA2 rs10938397, FAIM2 rs7138803, BDNF rs6265, NPC1 rs1805081, PCSK1 rs6235, KCTD15 rs29941, BAT2 rs2844479, SEC16B rs10913469 and SH2B1 rs4788102). Multiple factor analysis was performed to estimate the association between the variant and obesity-related traits. The false discovery rate (FDR) approach was used to correct for multiple comparisons.

RESULTSAfter sex, age and pubertal stage adjustment and correction for multiple testing, the rs9939609-A, rs17782313-C, rs10938397-G, and rs7138803-A alleles were associated with higher BMI (β = 0.352-0.747), fat mass percentage(β = 0.568-1.113), waist circumference (β = 0.885-1.649) and waist-to-height ratio(β = 0.005-0.010) (all P values < 0.01) in Chinese children. The rs6265-G allele increased BMI(β = 0.251, P = 0.020). The rs9939609-A, rs17782313-C, and rs10938397-G and rs6265-G alleles were also associated with risk of obesity (OR = 1.386, 95%CI:1.171-1.642; OR = 1.367, 95%CI:1.196-1.563; OR = 1.242, 95%CI:1.102-1.400; OR = 1.156, 95%CI:1.031-1.296).Rs7138803 was associated with risk of obesity only in boys (OR = 1.234, 95%CI:1.043-1.460). GNPDA2 rs10938397-G allele was associated with risk of insulin resistance(OR = 1.205, 95%CI:1.069-1.359), but there was no significance after adjusting for BMI.

CONCLUSIONThe association of FTO rs9939609-A, MC4R rs17782313-C, GNPDA2 rs10938397-G, and FAIM2 rs7138803-A with higher BMI, fat mass percentage, waist circumference, and waist-to height ratio and risk of obesity, and BDNF rs6265-G allele may increase BMI and obesity risk in Chinese children. GNPDA2 rs10938397-G may increase the risk of childhood insulin resistance depending on BMI.

Adolescent ; Alleles ; Asian Continental Ancestry Group ; Body Mass Index ; Child ; Genetic Predisposition to Disease ; Genotype ; Humans ; Male ; Metabolic Diseases ; Obesity ; Overweight ; Polymorphism, Single Nucleotide ; Risk Factors ; Waist Circumference

Objective To examine the impact of single nucleotide polymorphisms in obesity-related genes on risk of obesity and metabolic disorder in childhood.Methods A total of 3 503 Chinese children aged 6 to 18 years participated in the study , including 1 229 obese, 655 overweight and 1 619 normal weight children ( diagnosed by the Chinese age-and sex-specific BMI cutoffs ).Body size parameters were assessed and venipuncture blood samples were collected after a 12-hour overnight fast.Plasma glucose , insulin and serum lipid profiles were measured.Genomic DNA was isolated from peripheral blood white cells using the salt fractionation method.A total of 11 single nucleotide polymorphisms were genotyped by TaqMan allelic discrimination assays with the GeneAmp 7900 sequence detection system ( Applied Biosystems , Foster City , CA, USA ) ( FTO rs9939609, MC4R rs17782313, GNPDA2 rs10938397, FAIM2 rs7138803, BDNF rs6265, NPC1 rs1805081, PCSK1 rs6235, KCTD15 rs29941, BAT2 rs2844479, SEC16B rs10913469 and SH2B1 rs4788102).Multiple factor analysis was performed to estimate the association between the variant and obesity-related traits.The false discovery rate ( FDR ) approach was used to correct for multiple comparisons.Results After sex, age and pubertal stage adjustment and correction for multiple testing , the rs9939609-A,rs17782313-C,rs10938397-G, and rs7138803-A alleles were associated with higher BMI (β=0.352-0.747), fat mass percentage(β=0.568-1.113),waist circumference(β=0.885-1.649) and waist-to-height ratio(β=0.005-0.010)(all P values<0.01) in Chinese children.The rs6265-G allele increased BMI(β=0.251,P=0.020).The rs9939609-A, rs17782313-C, and rs10938397-G and rs6265-G alleles were also associated with risk of obesity ( OR=1.386,95%CI:1.171-1.642;OR=1.367,95%CI:1.196-1.563;OR=1.242,95%CI:1.102-1.400;OR=1.156,95%CI:1.031-1.296).Rs7138803 was associated with risk of obesity only in boys (OR=1.234,95%CI:1.043-1.460).GNPDA2 rs10938397-G allele was associated with risk of insulin resistance(OR=1.205,95%CI:1.069-1.359), but there was no significance after adjusting for BMI.Conclusion The association of FTO rs9939609-A, MC4R rs17782313-C, GNPDA2 rs10938397-G, and FAIM2 rs7138803-A with higher BMI , fat mass percentage , waist circumference , and waist-to height ratio and risk of obesity , and BDNF rs6265-G allele may increase BMI and obesity risk in Chinese children.GNPDA2 rs10938397-G may increase the risk of childhood insulin resistance depending on BMI.

Objective To examine the impact of single nucleotide polymorphisms in obesity-related genes on risk of obesity and metabolic disorder in childhood.Methods A total of 3 503 Chinese children aged 6 to 18 years participated in the study , including 1 229 obese, 655 overweight and 1 619 normal weight children ( diagnosed by the Chinese age-and sex-specific BMI cutoffs ).Body size parameters were assessed and venipuncture blood samples were collected after a 12-hour overnight fast.Plasma glucose , insulin and serum lipid profiles were measured.Genomic DNA was isolated from peripheral blood white cells using the salt fractionation method.A total of 11 single nucleotide polymorphisms were genotyped by TaqMan allelic discrimination assays with the GeneAmp 7900 sequence detection system ( Applied Biosystems , Foster City , CA, USA ) ( FTO rs9939609, MC4R rs17782313, GNPDA2 rs10938397, FAIM2 rs7138803, BDNF rs6265, NPC1 rs1805081, PCSK1 rs6235, KCTD15 rs29941, BAT2 rs2844479, SEC16B rs10913469 and SH2B1 rs4788102).Multiple factor analysis was performed to estimate the association between the variant and obesity-related traits.The false discovery rate ( FDR ) approach was used to correct for multiple comparisons.Results After sex, age and pubertal stage adjustment and correction for multiple testing , the rs9939609-A,rs17782313-C,rs10938397-G, and rs7138803-A alleles were associated with higher BMI (β=0.352-0.747), fat mass percentage(β=0.568-1.113),waist circumference(β=0.885-1.649) and waist-to-height ratio(β=0.005-0.010)(all P values<0.01) in Chinese children.The rs6265-G allele increased BMI(β=0.251,P=0.020).The rs9939609-A, rs17782313-C, and rs10938397-G and rs6265-G alleles were also associated with risk of obesity ( OR=1.386,95%CI:1.171-1.642;OR=1.367,95%CI:1.196-1.563;OR=1.242,95%CI:1.102-1.400;OR=1.156,95%CI:1.031-1.296).Rs7138803 was associated with risk of obesity only in boys (OR=1.234,95%CI:1.043-1.460).GNPDA2 rs10938397-G allele was associated with risk of insulin resistance(OR=1.205,95%CI:1.069-1.359), but there was no significance after adjusting for BMI.Conclusion The association of FTO rs9939609-A, MC4R rs17782313-C, GNPDA2 rs10938397-G, and FAIM2 rs7138803-A with higher BMI , fat mass percentage , waist circumference , and waist-to height ratio and risk of obesity , and BDNF rs6265-G allele may increase BMI and obesity risk in Chinese children.GNPDA2 rs10938397-G may increase the risk of childhood insulin resistance depending on BMI.

Objective To investigate the clinical values of loop electrosurgical excision procedure (LEEP) in diagnosis and treatment of cervical intraepithelial neoplasia(CIN). Methods Fifty-two patients with cervical intraepithelial neoplasia underwent LEEP following cytology, colposcopy and multiple biopsies, were treated by LEEP. The cure rate, the operative time, bleeding volume and patients reaction of LEEP to the cervical intraepithelial neoplasia were investigated during the follow-up. Results The effective rate was 98.07 % in the patients treated by LEEP. The effective rate was 100 % in the patients in grade CIN Ⅰ or CIN Ⅱ by LEEP. No patients in grade CIN Ⅰ and Ⅱ had recurrence during the follow-up 1 year. The mean operative time was 7.8 minutes. The mean bleeding volume was 10 ml. No secondary bleeding and post-operative infection occurred. All these surgical specimens were checked successfully for pathology diagnosis. Conclusion The advantages to use the LEEP to manage cervical intraepithelial neoplasia include its simpleness to handle, short operative time,less bleeding, less vaginal discharge, safety, and high cure rate. LEEP can offer intact sample for pathological diagnosis. LEEP electrotome is a very ideal therapy for the cervical intraepithelial neoplasia, and can block the development of precancerosis to infiltrating carcinoma effectively.