Objective To study retrospectively the efficacy and complications of different surgery approaches used to treat primary spinal tumors and to discuss the surgical strategy in treating them. Methods 135 patients with primary spinal tumors had been treated between July 1998 and July 2005. The following diagnoses were made based on histopathological findings: multiple myeloma in 25 patients, giant cell tumor in 17, neurofibroma or neurilemmoma in 23, chondrosarcoma in 7, osteoblastoma in 6, aneurysmal bone cyst in 4, lymphoma in 9, eosinophilic granuloma in 6, hemangioma in 15, osteosarcoma in 3, Ewing sarcoma in 5, and other different tumors in 15. Anterior approach and posterior approach was used in 73 cases and 31 cases respectively. Posterolateral approach was used in 13 cases and combination of anterior and posterior approach was used in 18 cases. Results Pain relief was obtained in 126 of the 135 patients(93.3%). Improved neurological function was seen in 86 of 92 patients who had suffered from impaired neurological function. No severe complications were found in the follow-up period. Cerebrospinal fluid leakage was observed in 11 patients, and which was successfully treated using antibiotics therapy and raising the foot of the bed. 3 patients suffered from stress ulcer after operation, but they recovered soon after blood transfusion and anti-acid treatment. Other complications included subcutaneous emphysema (in 3 patients), superficial wound infection (in 3 patients),nerve root injury (in 2 patients), implant loosening (in 2 patients), and neurological morbidity due to surgery (in 1 patient). Conclusion When single or two adjacent vertebrae are involved by spinal tumors such as giant cell tumor and chondrosarcoma, tumor resection should be performed through combination of anterior and posterior approach. Aggressive resection based on the Tomita or WBB staging system is the treatment most likely to achieve long-term local control.

Objective To analyze the differences of coagulation parameters between patients with advanced schistosomiasis cirrhosis and hepatitis B cirrhosis under different degrees of liver function,so as to provide the evidence for further guidance of judging clinical condition and prognosis. Methods Sixty?three patients with advanced schistosomiasis cirrhosis and eighty pa?tients with hepatitis B induced cirrhosis hospitalized in Jingzhou Central Hospital from January 2014 to June 2016 were served as an advanced schistosomiasis cirrhosis group and a hepatitis B cirrhosis group,respectively,and ninety?six gastropathy pa?tients excluded from other diseases that might affect coagulation in the same period were served as a control group. The levels of PT,INR,Fib,TT,APTT,and PLT of the patients among the above 3 groups and the cirrhosis patients with different Child?Pugh classes were detected and compared. Results The differences of the levels of PT,INR,Fib,TT,APTT,and PLT among the 3 groups were statistically significant(F=84.512,81.672,37.612,104.475,52.497,102.233;all P<0.05). The further analysis showed that PT,INR,TT,and APTT of both the advanced schistosomiasis cirrhosis and hepatitis B induced cirrhosis groups were longer than those of the control group,and the PLT levels of both the former 2 groups were lower than that of the con?trol group(all P<0.05). Compared with the advanced schistosomiasis cirrhosis group,PT,INR,TT,and APTT of the hepati?tis B induced cirrhosis group were longer,and the levels of Fib and PLT were lower(all P<0.05). Among those with the liver function of Grade A,the reduced degree of PLT in the patients with hepatitis B induced cirrhosis was more serious,while for those with the liver function of Grade B and C,the difference between the patients with advanced schistosomiasis cirrhosis and hepatitis B induced cirrhosis was not statistically significant(both P > 0.05). Under all the grades of liver function,TT and APTT of the hepatitis B induced cirrhosis group was longer than those of the advanced schistosomiasis cirrhosis group ,and the Fib level of the former was lower than that of the latter. Among those with the liver function of Grade A and B ,PT and INR of the hepatitis B induced cirrhosis group were longer than those of the advanced schistosomiasis cirrhosis group;while for those with the liver function of Grade C,the difference between the two groups was not statistically significant(all P > 0.05). Conclu?sions There exist differences of the damage degrees of coagulation function between the patients with advanced schistosomiasis cirrhosis and hepatitis B cirrhosis. When the damage degree of the liver function is lighter,the coagulation function in the pa?tients with hepatitis B cirrhosis decreases more significantly;when the damage degree becomes more severe,APPT in the pa?tients with hepatitis B cirrhosis extends more significantly,while the differences of PLT and PT between them are little.

Objective To investigate technique,effect,complications of limb salvage surgery for malignant tumors of the proximal tibia involving the fibula.Methods Between November 1998 and February 2010,32 patients with malignant tumors of the proximal tibia involving the fibula underwent limb salvage surgery in our institute.There were 21 males and 11 females,aged from 10 to 66 years (average,23.4years).There were 23 cases of osteosarcoma,5 cases of chondrosarcoma,1 case of malignant giant cell tumor,and 3 cases of soft tissue sarcoma.All patients received en bloc resection of tumor including proximal tibia and fibula.During operations,ligation of anterior tibial vessels was performed in 14 patients,anastomosis of posterior tibial vessels in 1 patient,both ligation of anterior tibial vessels and anastomosis or replacement of posterior tibial vessels in 5 patients.The common peroneal nerve was resected in 4 patients,and the deep peroneal nerve was resected in 5 patients.The reconstruction methods included prosthetic replacement in 24 patients,replacement with inactivated autograft-prosthesis composite in 5 patients,and replacement with inactivated autograft in 3 patients.The caput mediale musculi gastrocnemii flap was transferred to reconstruct soft tissue defect in 14 patients,while caput laterale musculi gastrocnemii flap was transferred in 1patient.Results All patients were followed up for 11 to 159 months (average,39.4 months).Local recurrence occurred in 6 patients (18.8％).The overall 5-year survival rate was 51.2％.Fourteen patients died of tumor metastasis,2 survived with tumor,and 16 patients survived without tumor.Variant complications occurred in 15 patients (46.9％).The complications included ischemia of the lower leg in 4 patients,peroneal nerve palsy in 12 patients (permanent palsy in 9 patients and temporary palsy in 3 patients),wound healing problem in 4 patients,deep infection in 1 patient,and periprosthetic fracture in 1 patient.The mean MSTS 93 score was 21.6 points (72％).Conculusion The indications of limb salvage surgery for malignant tumors of the proximal tibia involving the fibula should be restricted.Although complications are encountered frequently,most patients have acceptable postoperative function.

Objective:To assess the surgical outcome of patients with mesenchymal chondrosarcoma (MCS) treated in our insti-tute. This study was also designed to describe the clinical characteristics, treatment, and outcome of MCS to provide a better understand-ing of its clinical management. Methods:A total of 27 patients with MCS were treated in Peking University People's Hospital, Beijing, China from October 1997 to March 2011. Demographic information and follow-up data were obtained and statistically analyzed. Re-sults:Among the 27 patients, 9 were males and 18 were females with a mean age of 30.4 years (ranging from 14 years to 51 years). The median follow-up time was 42.6 months (ranging from 6 months to 104 months). Among the total number of tumor cases, 22 and 5 were detected in bone tissues and extra-skeletal sites, respectively. A total of 25 patients underwent surgery, but only 17 achieved the standard surgical margin of wide excision. Among these patients, 16 and 13 were subjected to chemotherapy and irradiation. The three-and five-year survival rates were 65%and 49.5%, respectively. Conclusion:MCS is a rare tumor resulting in morbidity with local recur-rences and long-term metastases. In this study, standard multimodal regimens were proposed to treat MCS. The results recommended wide resection with suitable surgical margins as the preferred treatment. However, further studies should be conducted because the infor-mation about the benefits of chemotherapy and radiotherapy for the control of local or systemic symptoms of MCS remains insufficient.

BJECTIVE: To explore the effect of different convergent conditions on accuracy of simulation results from a three dimensional finite element model of the pelvic ring.METHODS: A first-order linear load of 600 was applied on the S_1 vertebral endplate in an established three-dimensional finite element model. The step length was set to 0.1 s. The boundary condition was set as constraint of 6 degrees of freedom in the proximal femur. Static and dynamic explicit convergences with 6 different weight scale factors were calculated retrospectively,and all the simulated results were compared with the experimental results in order to verify the accuracy. RESULTS: The static convergence predicted most accurate with the linear regression coefficient 0.88. With the increase of weight scale factor, the time cost decreased. However, the accuracy of the predicted results decreased. There was statistically difference between the simulation results and experimental results when the weight scale factor achieved 3 000 (P<0.05) and the coefficient of linear regression was lower than 0.8.CONCLUSION: It suggested that as for the complex finite element model, especially when the model contains complex contact conditions, dynamic explicit convergence can be an alternative solution to static convergence if the latter failed. Also proper weight scale factor should be used to decrease the time cost under the condition that the error was in the limited.

Background and purpose: Alveolar soft part sarcoma (ASPS) is a rare malignant neoplasm characterized by slow growth and indolent behavior, and most of the patients had metastases in diagnoses. This study was to define clinical features and assess prognostic factors of ASTS. Methods: Between January 2003 and December 2008, there were 15 patients with ASTS who received treatment and were followed up in the Department of Orthopedic Ontology of Peking University People's Hospital. We retrospectively analyzed the clinical factors of the disease related to prognosis: gender, age, tumor size, primary tumor site, metastatic sites, local recurrence, the roles of postoperative radiotherapy and postoperative chemotherapy. Resnlts: At a follow-up from 7 to 76 months, only 2 patients had local recurrences after excision, but there was a high incidence of pulmonary metastases. Only 6 patients achieved disease free survival, 5 patients died of metastases or other complications. The five-year overall survival rates was 41.7%, and the median survival time was 42.0 months. Univariate analysis and Cox regression analysis revealed that tumor size, tumor primary site and metastases at diagnoses were prognostic factors, but not gender and age, Conclusion: Alveolar soft part sarcoma is a high grade malignant soft tissue neoplasm with frequent metastases to lung, bone or brain. Tumor size, primary tumor site and metastases at diagnoses are some of the prognostic factors. Chemotherapy or radiotherapy after surgery have no benefit to the survival in our analysis. Further prospective studies are needed to clarify the best strategy for the treatment of ASPS.

Objective:To investigate the breakthrough points and methods of pharmaceutical care performed by clinical pharma-cists for chemotherapy-induced Ⅳ degree myelosuppression. Methods: One advanced lung adenocarcinoma patient suffering from IV degree myolosuppression after being treated with pemetrexed combined with nedaplatin was selected as the example, and the chemother-apy regimen, the cause and treatment of IV degree myolosuppression and the pharmaceutical service could be carried out were ana-lyzed. Results: With the help of clinical pharmacists, the patient conquered chemotherapy-induced myelosuppression, and clinical pharmacists enhanced the awareness of pharmaceutical care and played a positive role in the safe and effective drug use. Conclusion:The participation of clinical pharmacists in clinical pharmaceutical care through providing pharmaceutical service is beneficial to safer and more effective drug therapy.

Objective To investigate the allergic reaction of Shuanghuanglian Injection(SI)and chlorogenic acid.Meth- ods The sensitization of SI was evaluated by observed the systemic active allergic reaction on guinea pigs.The homogeneous and heterogenic passive skin allergic reactions in rats,mice and guinea pigs were observed to compare the sensitationz of SI and chlorogenic acid.Results The possibility of SI causing allergic reaction was higher than that of chlorogenic acid.Con- clusion It is suggested that the possibility of SI as a compound arising adverse reactions be higher than that of chlorogenic acid.

Objective To investigate the expression of glioma-associated oncogene 2 (Gli2) in giant cell tumor of bone, and analyze the differential expression in the different classification of imaging and pathology and the recurrent diseases, to discuss its role and significance in the pathogenesis and prognosis of giant cell tumor of bone. Methods 46 cases of giant cell tumor of bone who received the primary treatment in Peking University Peopleˊs Hospital during Jan 2009 and Dec 2012 and had the full data of treatment and could be follow-up were collected. Among which there were 40 benign cases and 6 malignant cases. The expression of Gli2 in the different cases of giant cell tumor of bone were detected by immunohistochemistry and real-time PCR, and its effect on the prognosis of giant cell tumor of bone was analyzed. Results Immunohistochemistry revealed positive expression of Gli2 in giant cell tumor of bone. The positive rate of Gli2 in malignant cases was significantly higher than that in benign cases [100.0 % (6/6) vs 55.0 % (22/40), P=0.035], and only found increasing trend but no significant difference among recurrent cases (P=0.204). Results of real-time PCR indicated that Gli2 highly expressed in giant cell tumor of bone, and the increasing trend of expression in different pathological types, different image classifications and recurrent cases, but no statistical different were found (all P>0.05). The expression correlation analysis showed that the expression of Gli2 and PTHrP, and the expression of RANKL and OPG either had a significant correlation (both P< 0.05). Additionally the expression of PTHrP and RANKL had a moderate correlation (P<0.05). Conclusions The expression level of Gli2 is high in giant cell tumor of bone, and Gli2 may be involved in recurrence,metastasis and malignant transformation. Gli2 may effect the osteolytic process of giant cell tumor of bone by the regulation mechanism of Gli2-PTHrP-RANKL pathway.

Objective: To determine the prognostic factors of primary osteosarcoma in adults . Methods:This is a review of 54 patients older than 40 years (24 men and 30 women) who were treated between 1998 and 2011 at the authors ’ institution .Demographic information and follow-up data were obtained and statistically analyzed .Results: Tumors involved the limbs in 30 patients ( 55 .5%) and axial skeleton in 17 patients (31.5%), and arose from soft tissue in 7 patients (13%).And 6 patients (11.1%) had synchronous metastasis .According to our review , tumors were treated surgically in 52 patients (96.3%).Local recurrence was documented in 14 patients (26.9%).Metastasis after diagno-sis appeared in 21 patients (38.9%).In the 52 patients who received the surgical treatment , the 5 year disease-free survival and overall survival rates were 43.7% and 50.4%, respectively.Conclusion:Adult patients with primary osteosarcoma had a poor clinical outcome .Inadequate surgical margins , more tumors in the axial location due to high recurrence rates , metastatic disease at presentation , and large tumor volumes were associated with significantly lower survival rates .Aggressive multi-agent treatment regimens might improve survival .