50 g/ml by MIC. Nine isolates contained the qacA/B, and 1 isolate contained the smr gene. No qacG,qacH and qacE?1 was detected. Conclusion The disinfect resistance of Staphylococcu spp isolated from hospital disinfectant environment is markedly high. Resistance monitoring should be strengthened,and the rational use of disinfect should be emphasized.

BACKGROUND: Clinical evidence have proved that heterotopic ossification is easily present in bony callus of patients with fracture combined with head injury, and the healing of bone fracture is accelerated obviously. OBJECTIVE: To study the expression and distribution of vascular endothelial growth factor (VEGF) in bony callus among the patients with fracture combined with head injury and simple fracture patients, and to investigate its clinical significance and action mechanism.DESIGN, TIME AND SETTING: Grouping controlled observation was performed in the Xijing Hospital, the Fourth Military Medical University of Chinese PLA between February 2006 and July 2007.PARTICIPANTS: The patients comprised two groups those who had fracture combined with head injury and those who had simple fracture. Each group had 50 patients. The fracture combined head injury group included 41 males and 9 females, aged 19-55 years; simple fracture group included 36 males and 14 females, aged 17-52 years. METHODS: The bony callus specimens were harvested at 7-10, 11-15, 16-20, 21-27 and 28-35 days post-injury. The content of VEGF in bony callus was measured at different phase by using immunohistochemistry methods, and the speed of fracture healing was also observed.MAIN OUTCOME MEASURES: ①X-ray results; ②immunohistochemical image analysis. RESULTS: In different phase of bone healing, the VEGF of the two groups were homogenous, the early expression of VEGF in osteoprogenitor cell, osteoblast and cartilage cell in the fracture combined with head injury group was significantly higher than those in simple fracture group. The osteoprogenitor cell proliferated, and the differentiations of osteoblast and cartilage cell were enhanced obviously. The VEGF level reached the peak at 7-10 days, and kept at the high level for 30 days and then gradually decreased. The peak of VEGF level in simple fracture group came at 11-15 days, kept in the high level for 20 days and then gradually decreased. The peak value in simple fracture group was significantly lower than the fracture combined with head injury group. There was statistical significance in the expression of VEGF between two groups by the paired t-test (P < 0.05). A large mount of osteotylus could be detected at 4 weeks after injury by X-ray in patients with fracture combined, with head injury, but at 7-9 weeks in patients of those who had simple fracture.CONCLUSION: The expression of VEGF in the bony callus in the group of fracture combined with head injury is significantly greater than that in simple fracture patients, and the expression lasts for a longer time. The proliferation and differentiation of osteogenitor call, osteoblast and cartilage cell are also significantly faster in the group of fracture combined with head injury, which might be one of the bone healing mechanisms.

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

Objective To investigate the safety and efficacy of mechanical thrombectomy (MT) compared with In?tra-arterial Thrombolysis (IAT) treatment in patients with severe acute ischemic stroke (AIS) caused by large cerebral ar?tery occlusion. Method The patients with AIS caused by large cerebral artery occlusion and underwent MT or IAT from 2005 May to 2014 May was included. A retrospective analysis was conducted on the onset to emergency(OTE)time, emergency to acupuncture(ETA)time, acupuncture to recanalization (ATR) time, stroke severity as measured by the Na?tional Institutes of Health Stroke Scale (NIHSS) score, and site of arterial occlusion on magnetic resonance angiography (MRA). A comparison was made between MT and IAT patients in rates of recanalization, symptomatic intracranial bleed?ing (SIB), mortality, and functional outcome. Three-month favourable outcome was defined as a modified Rankin Scale (mRS) score≤2. Result One hundred and two AIS patients were treated with MT and 50 with IAT. There was no differ?ence between MT and IAT groups with regard to demographics, onset NIHSS score (13.37±6.95 vs. 12.70±6.11;P=0.572) and discharge NIHSS score (8.40 ± 6.69 vs. 7.53 ± 7.28, P= 0.522) and the change of NIHSS score (3.87 ± 7.14 vs. 4.26 ± 5.42, P=0.766). There were significantly differences between MT and IAT groups in the OTE time (Median 300 min vs. 120 min,Z=-5.704,P=0.000) , ATR time (Median 30 min vs. 65 min,Z=-5.011,P=0.001) ,recanalization (91.2%vs. 60.0%,P =0.01),the rate of AIB(21.7% vs. 36.0%,P =0.046),3-month mortality (16.6% vs. 26.0%,P =0.043). The above parameters were better in MT group than in the IAT group. There were no significant differences between MT and IAT groups in the rate of SIB (12% vs. 16%,P =0.055), the NIHSS change(Median 3 vs. 4,Z =-0.236,P =0.823) and mRS score on 90d ( 48.2%vs. 46.0%, P=0.823). MT patients had significantly higher percentages of stent use (22.5%vs. 8%,P=0.018) . The Recanalization for ICA(81.8%vs. 55.6%,P=0.048),BA(93.1%vs. 55.6%,P=0.032)and MCA( 97.5% vs. 60.0%,P =0.026)was higher in MT group than in IAT group .The SIB rate for ICA(13.8% vs. 33.3%,P =0.000),BA(13.8%vs. 33.3%,P=0.000)was lower in MT group than in IAT group . The mortality rate of was significant?ly lower in MT than in IAT group for MCA (2.5%vs. 20.0%,P=0.000) . the good outcome rate for BA was higher in MT group than in IAT group(41.3%vs. 22.2%,P﹤0.01). Conclusions Compared to IAT,MT can provide broader time win?dow,higher recanalization rate and better outcome in patients with severe acute ischemic stroke (AIS) caused by large ce?rebral artery occlusion.

Objective To investigate the clinical feasibility and effectiveness of 3-D printing (3DP) combined with 3-D laparoscopic nephron-sparing surgery (LNSS) for partial endogenous renal cell carcinoma.Methods A retrospective analysis was made of the clinical data of 79 patients with partial endogenous renal cell carcinoma who were admitted to our department from July 2015 to October 2018.There were 46 males and 33 females.Their average age was (50.9 ± 7.9) years old,ranged from 33 to 68 years old.Tumor stages were T1aN0M0 in 53 cases and T1bN0M0 in 26 cases.The preoperative serum creatinine ranged from 40 to 107 μmol/L,with an average of (72.4 ± 14.2) μmol/L.The preoperative GFR ranged from 19 to 54 ml/min,with an average of (40.2 ± 6.2) ml/min.Thirty-four patients underwent 2-D laparoscopic nephron-sparing surgery (2DLNSS) based on preoperative enhanced CT scans.Forty-five patients underwent 3-D printing (3DP) based on three-dimensional reconstruction of renal CT scans.Seventeen patients underwent 2-D laparoscopic nephron-sparing surgery guided by 3-D printing model(3DP-2DLNSS),and 28 patients underwent 3-D laparoscopic nephron-sparing surgery guided by 3-D printing (3DP-3DLNSS).Serum creatinine levels ranged from 42 to 122 μmol/L with an average of (86.3 ± 14.8) μmol/L,and creatinine levels ranged from 8 to 66 μmol/L with an average of (19.1 ± 14.1) μmol/L.Six months after operation,the GFR of the kidney was 9-36 ml/min with an average of (21.4 ± 6.4)ml/min,and the fluctuation range was 6-40 ml/min with an average of (19.2 ± 8.8) ml/min.There was no statistical difference in the incidence of complications and pathological types after operation.Results There was no statistical difference in general data of preoperative patients.In intraoperative and post-operative statistics,the time of exploring renal artery was shorter than that of 2DLNSS (33.7 ± 7.5) min in 3DP-2DLNSS (28.3 ± 8.2,P =0.015) min and 3DP-3DLNSS (27.8 ± 6.5,P =0.002) min.In tumor detection time,3 DP-2DLNSS was shorter than 2DLNSS group (41.2 ± 6.6 vs.46.5 ± 6.9 min,P =0.012),and 3 DP-3DLNSS was shorter than 3DP-2DLNSS (35.4 ± 7.3 vs.41.2 ± 6.6 min,P =0.009).In warm ischemia time,3DP-2DLNSS min was shorter than 2DLNSS (23.5 ±9.7 vs.33.9 ±7.5 min P ＜0.001),and 3DP-3DLNSS was shorter than 3DP-2DLNSS (18.3 ± 4.6 vs.23.5 ± 9.7,P =0.023).In surgical time,3DP-2DLNSS (115.7 ± 23.0) min and 3DP-3DLNSS (103.3 ± 22.8) min were shorter than 2DLNSS (132.4 ± 28.9) min (P =0.031,P ＜ 0.001).In intraoperative bleeding volume,3 DP-3 DLNSS was less than 2DLNSS (117.9 ± 17.9 vs.130.6 ± 16.8,P =0.009) ml.Fasting for 1 to 4 days after operation,with an average of (1.7 ± 0.8) days.The indwelling catheterization ranged from 1 to 8 days after operation,with an average of (3.9 ± 1.3) days.Negative pressure drainage was removed 2-9 days after operation,with an average of (4.9 ± 1.4) days.And the hospitalization 5-11 days after operation,with an average of (7.3 ± 1.5) days.Conclusions Preoperative 3D printing combined with intraoperative 3D laparoscopic nephron sparing surgery for partial endogenous renal tumors is safe and effective,which is superior to the previous CT scan alone and intraoperative 2D laparoscopic treatment.

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

Objective:To explore the application of sentinel lymph node biopsy (SLNB) and its prognostic value in the treatment of acral melanoma.Methods:We retrospective analyzed 118 patients who underwent sentinel lymph node biopsy from Mar 2012 to Jun 2019 with effective follow-up data available in our institute. We ruled out palpable regional lymph node metastasis with preoperative imaging of MRI and ultrasonography, used the 99Tc m-Dextran (Dx) as a tracer, with intraoperative γ-ray probe positioning for SLN capture. Wide resection and reconstruction in primary lesion followed by complete lymph node dissection were underwent SLN positive patients. Cox regression model were used to analyze the prognostic factors. Results:The patients had an average disease history of 53.6 months (2-360 months), the primary lesion located at hands and feet in 84 cases, while 27 cases were subungual and 7 cases were cutaneous. The mean Breslow depth was 3.6 mm, and 72 cases (61.0%) combined with ulceration. The average number of SLN was 2.8, the SLN positive rate was 24.6% (29/118), and the false-negative rate was 2.5% (3/118). There were 24 cases (20.3%) developed clinically positive metastasis, including 7 cases displayed distant metastasis combined with lymph node metastasis (5.9%), 8 cases with clinically positive lymph node metastasis alone (6.8%), and 9 cases with distant metastasis (7.6%). There were 33 patients in stage Ⅰ, 56 patients in stage Ⅱ and 29 patients in stage Ⅲ, with a 5-years overall survival rate of 69.5%. The Breslow depth is an independent risk factor of SLN positive. While Breslow depth, SLN status, SLN positive number and clinically detectable metastasis are independent prognostic factors of the overall survival ( P<0.05). Conclusions:Patients without clinically positive regional lymph node metastasis under imaging and physical examinations, SLNB can provide accurate pathologic staging and play an accurate prediction role in the prognostic evaluation. SLNB should be carried out routinely in clinical practice.

Objective:To explore the application of sentinel lymph node biopsy (SLNB) and its prognostic value in the treatment of acral melanoma.Methods:We retrospective analyzed 118 patients who underwent sentinel lymph node biopsy from Mar 2012 to Jun 2019 with effective follow-up data available in our institute. We ruled out palpable regional lymph node metastasis with preoperative imaging of MRI and ultrasonography, used the 99Tc m-Dextran (Dx) as a tracer, with intraoperative γ-ray probe positioning for SLN capture. Wide resection and reconstruction in primary lesion followed by complete lymph node dissection were underwent SLN positive patients. Cox regression model were used to analyze the prognostic factors. Results:The patients had an average disease history of 53.6 months (2-360 months), the primary lesion located at hands and feet in 84 cases, while 27 cases were subungual and 7 cases were cutaneous. The mean Breslow depth was 3.6 mm, and 72 cases (61.0%) combined with ulceration. The average number of SLN was 2.8, the SLN positive rate was 24.6% (29/118), and the false-negative rate was 2.5% (3/118). There were 24 cases (20.3%) developed clinically positive metastasis, including 7 cases displayed distant metastasis combined with lymph node metastasis (5.9%), 8 cases with clinically positive lymph node metastasis alone (6.8%), and 9 cases with distant metastasis (7.6%). There were 33 patients in stage Ⅰ, 56 patients in stage Ⅱ and 29 patients in stage Ⅲ, with a 5-years overall survival rate of 69.5%. The Breslow depth is an independent risk factor of SLN positive. While Breslow depth, SLN status, SLN positive number and clinically detectable metastasis are independent prognostic factors of the overall survival ( P<0.05). Conclusions:Patients without clinically positive regional lymph node metastasis under imaging and physical examinations, SLNB can provide accurate pathologic staging and play an accurate prediction role in the prognostic evaluation. SLNB should be carried out routinely in clinical practice.

Objective:To analyze the prognostic factors and the influence of surgical margin to prognosis.Methods:A retrospective analysis was performed for 208 pelvic tumors who received surgical treatment from January 2000 to December 2017 in our instituition. Survival analysis was performed using the Kaplan-Meier method and Log rank test, and impact factor analysis was performed using Cox regression models.Results:There were 183 initial patients and 25 recurrent cases. According to Enneking staging, 110 cases were stage ⅠB and 98 cases were stage ⅡB. 19 lesions were in zone Ⅰ, 1 in zone Ⅱ, 15 in zone Ⅲ, 29 in zone Ⅰ+Ⅱ, 71 in zone Ⅱ+Ⅲ, 29 in zone Ⅰ+Ⅳ, 35 in zone Ⅰ+Ⅱ+Ⅲ, 3 in zone Ⅰ+Ⅱ+Ⅳ, and 6 in zone Ⅰ+Ⅱ+Ⅲ+Ⅳ. Surgical margins including Intralesional excision in 7 cases, contaminated margin in 21 cases, marginal resection in 67 cases, and wide resection in 113 cases. Local recurrence occurred in 37 cases (17.8%), 25 cases were performed by reoperation and 12 cases received amputation finally. The 5-year recurrence rate of marginal resection was higher than wide resection ( P＜0.05), and the recurrence-free survival rate of marginal resection was lower than wide resection ( P＜0.05). There was significant differences in recurrence rate and recurrence-free survival rate between R0 and R1 resection ( P＜0.05). 92 cases were not reconstructed and 116 cases were reconstructed after pelvic surgery. At the last follow-up, 63 patients (30.3%) died, and the 5-year, 10-year and 15-year survival rates were 70.4%, 66.8% and 61.3%, respectively. The 5-year survival rate of stage ⅠB and ⅡB tumor was 90.4% and 46.8%, respectively. There were 29 cases had postoperative wound complications (13.8%), 1 case with pelvic organ injury. The final function was evaluated in 132 patients, with an average MSTS score of 25.1±3.6. Cox multivariate analysis showed that surgical staging, R0/R1 margin and metastasis were independent prognostic factors for pelvic tumors. Conclusions:The safe surgical margin is the key factor for recurrence-free of pelvic tumor. The survival rate of stage ⅡB pelvic tumors was significantly lower than that of stage ⅠB tumors. Wound infection is the main postoperative complication. Surgical staging, R0/R1 margin and metastasis were independent prognostic factors of pelvic tumors.

Objective:To analyze the prognostic factors and the influence of surgical margin to prognosis.Methods:A retrospective analysis was performed for 208 pelvic tumors who received surgical treatment from January 2000 to December 2017 in our instituition. Survival analysis was performed using the Kaplan-Meier method and Log rank test, and impact factor analysis was performed using Cox regression models.Results:There were 183 initial patients and 25 recurrent cases. According to Enneking staging, 110 cases were stage ⅠB and 98 cases were stage ⅡB. 19 lesions were in zone Ⅰ, 1 in zone Ⅱ, 15 in zone Ⅲ, 29 in zone Ⅰ+Ⅱ, 71 in zone Ⅱ+Ⅲ, 29 in zone Ⅰ+Ⅳ, 35 in zone Ⅰ+Ⅱ+Ⅲ, 3 in zone Ⅰ+Ⅱ+Ⅳ, and 6 in zone Ⅰ+Ⅱ+Ⅲ+Ⅳ. Surgical margins including Intralesional excision in 7 cases, contaminated margin in 21 cases, marginal resection in 67 cases, and wide resection in 113 cases. Local recurrence occurred in 37 cases (17.8%), 25 cases were performed by reoperation and 12 cases received amputation finally. The 5-year recurrence rate of marginal resection was higher than wide resection ( P＜0.05), and the recurrence-free survival rate of marginal resection was lower than wide resection ( P＜0.05). There was significant differences in recurrence rate and recurrence-free survival rate between R0 and R1 resection ( P＜0.05). 92 cases were not reconstructed and 116 cases were reconstructed after pelvic surgery. At the last follow-up, 63 patients (30.3%) died, and the 5-year, 10-year and 15-year survival rates were 70.4%, 66.8% and 61.3%, respectively. The 5-year survival rate of stage ⅠB and ⅡB tumor was 90.4% and 46.8%, respectively. There were 29 cases had postoperative wound complications (13.8%), 1 case with pelvic organ injury. The final function was evaluated in 132 patients, with an average MSTS score of 25.1±3.6. Cox multivariate analysis showed that surgical staging, R0/R1 margin and metastasis were independent prognostic factors for pelvic tumors. Conclusions:The safe surgical margin is the key factor for recurrence-free of pelvic tumor. The survival rate of stage ⅡB pelvic tumors was significantly lower than that of stage ⅠB tumors. Wound infection is the main postoperative complication. Surgical staging, R0/R1 margin and metastasis were independent prognostic factors of pelvic tumors.