Objective To explore the feasibility and clinical efficacy of long-segmental bone defects after en bloc tumor resection of lower limb segment with composite of titanium alloy 3D printed prosthesis and vascularized fibular autograft and bioceramics.Methods 5 patients with lower extremity tumor (1 high grade chondrosarcoma,1 Ewing sarcoma,1 single metastatic tumor and 2 osteosarcoma) were treated by en bloc resection and precise reconstruction with segmental 3D-printed,custom-made prosthesis from August 2015 to November 2016,which composed of 1 male and 4 females,ranged from 16 to 56 years old,the average was 32± 19.3 years old.Three-dimensional computed tomography reconstructed images of patients' tumors were built before surgery.Custom-made prostheses were manufactured based on the patients' reconstructed images with micro-pores on the surface.After en bloc tumor resection with the help of osteotomy guide plate,the defects were reconstructed with 3D-printed,custom-made prostheses.Vascularized fibular autografts were put inside the prostheses,and the interval space among them was filled with bioceramics.Results All the 5 cases were performed surgical planning before the surgery with prosthesis and guide plate were designed at the same time.After verification of the finite element analysis SLM (2 cases) and the EBM (3 cases) were used to process prosthesis,and were designed into porous sharp with 210.98±66.16 mm in length and 26 901.76±12 903.96 mm3 in volume.Then the prosthesis would be cleaned and sterilized.All 5 operation were proceeded according to the plan of preoperative.The intra-operative guide plate were installed on the bone surface stably.The bone cutting was guided according to the plan of preoperative.By intra-operative frozen pathological examination,there were no malignant tissues in near and far marrow cavity.Unfolded fibular flap with 168.75±49.07 mm in length and porous tricalcium phosphate particle composite implants with 10±4.08 g were used in 4 cases and bone cement was used in 1 cases of metastatic tumor.The average operation time was 261±85 min and average blood loss was 540±182 ml.After a mean follow-up time of 6.4 months (1-15 months),all 5 cases survived with no local recurrence and pulmonary metastasis tumor.2 cases with vascular pedicle fibular transplant confirmed the survival of fibula via bone scan 3 months after operation.All cases were no infection,fractures,prosthesis loosening,except broken screw in 1 case.The Musculoskeletal Tumor Society (MSTS) 93 score was 17-26.Conclusion Long segment tubular titanium alloy 3D printed prosthesis with vascularized fibular autograft and bioceramics could reconstruct the segmental defects caused by tumor resection.

Objective To discuss the correlations amongst the count,molecular and clinicopathological characteristics of circulating tumor cells (CTCs),and the feasibility of using CTC as an aid to judge the metastasis of osteosarcoma,evaluate the therapeutic effect,and predict the prognosis of patients.Methods Retrospective analysis of 30 patients with newly diagnosed osteosarcoma diagnosed from January 2015 to June 2016,there were 17 males and 13 females.The average age was 13.77±4.31 years old (ranged from 7 to 21 years).There were 21 cases of Ennecking stage Ⅱ,including 2 cases of ⅡA,19 cases of ⅡB,and 9 cases of Ennecking Ⅲ.Peripheral blood of all patients was obtained and processed using CanPatrolTM System at baseline,pre-and post-operation.Multiplex RNA-in situ hybridization (RNA-ISH) assay was used to characterize the molecular markers.Combined with clinical data,the relationship between peripheral blood CTC counts,count changes,molecular characteristics,tumor metastasis,chemotherapy effects,and prognosis of patients with osteosarcoma was analyzed and compared.Results The CTC count in peripheral blood was 10.44±5.70 in Ennecking stage Ⅲ patients and 4.76±3.56 in stage Ⅱ patients.The increase or decrease in CTC counts was associated with good or poor neoadjuvant chemotherapy (P=0.002).In patients with good chemotherapy effect,the CTC count in peripheral blood was decreased after chemotherapy.The mean progression-free survival time was 11.85±4.93 months for patients with CTC number ≥7,and the average progression-free survival time was 15.53±4.09 months for patients with CTC number ＜ 7 (P=0.012).The proportion of interstitial CTC in Ennecking stage Ⅲ was 40.42％,which was higher than that of Ennecking ⅡB stage 23.00％.The difference was statistically significant (P=0.010).The positive rate of metastasis-associated gene 1 (MTA1) in interstitial CTC was 85.50％,and the positive rate of other types of CTC was 66.67％.The difference was statistically significant (P=0.000).Conclusion The counting and typing of peripheral blood CTC in osteosarcoma patients can be used as a complement to the commonly used imaging examinations,and they can play an auxiliary role in judging tumor metastasis,curative effect observation and prediction of poor prognosis.

Objective To investigate the epidemic of severe acute respiratory symdrome(SARS) in Beijing blood donors and make guidance for assuring blood safety during SARS epidemic.Methods Using SARSCoV Ab ELISA Kits, specimens from 2357 donors from Beijing during SARS epidemic phase,1079 preserved samples from Beijing donors collected well before the SARS epidemic,1183 donors from Shandong and Hunan provinces where no SARS had been reported were screed for IgG,IgM,and total antibodies against SARS coronavirus.Donors with reactive samples were followed up,RT PCR were performed to detect the SARS CoV RNA.Results There was no significant difference between the 3 groups of specimens and there was no SARS epidemic or subclinical SARS infections among Beijing blood donors.Conclusion Instead of blood SARS CoV Ab screening, we should focus on the donors inquiry,physical examination and education to prevent SARS transmission by transfusion.

OBJECTIVESTo perform GIS spatial analysis on malaria transmission patterns in Jiangsu after setting up a malaria database and developing GIS model of malaria transmission in Jiangsu province.

METHODSThe epidemiological GIS database of malaria in Jiangsu province was established using ArcView 3.0a software. The climate data covering Jiangsu province and its peripheral area were extracted from the FAOCLIM database, the total growing degree days (TGDD) for Plasmodium vivax were calculated, and spatial distribution for TGDD was analyzed by ArcVeiw 3.0a.

RESULTSThe predicted malaria distribution map based on TGDD was created, which showed that the transmission of malaria decreased gradually from west to east, which can be divided into three belts according to the degree of transmission. The 14-year mean morbidity distribution map of malaria in Jiangsu showed that the middle and west parts of Jiangsu is the most serious endemic area. The morbidity in the areas along the Taihu valley, such as Suzhou, Wuxi and Changzhou, as well as Nantong and a few of northern counties are the lowest. The morbidity of other places is at the middle level. The 14-year mean morbidity distribution map of malaria is correlated with predicted malaria distribution map for TGDD.

CONCLUSIONIt is possible to monitor the malaria transmission by GIS predicted model based on TGDD.

China ; epidemiology ; Databases, Bibliographic ; Geographic Information Systems ; Humans ; Malaria ; epidemiology ; transmission ; Models, Biological

Programmed death-1 and programmed death-ligand 1(PD-1/PD-L1)are regulatory immune checkpoint molecules that inhibit T cell activation and,therefore,play an important role in tumor immunotherapy.In recent years,increasing numbers of targeted therapeutic agents have been developed,but single immune checkpoint blockers cannot completely inhibit tumor occurrence,and tumor escape sporadically occurs.Consequently,combination therapy of targeted drugs is considered a useful method to inhibit tumorigenesis and tumor development.T cell immunoglobulin and immunoreceptor tyrosine-based inhibition motif(ITIM)domain(TIGIT)is an inhibitory type 1 poliovirus receptor that has recently been a hotspot of targeted drug therapy research.It has been shown that the combination therapy of TIGIT plus PD-1/PD-L1 can reduce tumor escape and inhibit tumorigenesis more effectively.Therefore,this review summarizes and discusses the progress on the dual blockade of TIGIT and PD-1/PD-L1 pathways in tumor immunotherapy to provide a theoretical basis for tumor im-munotherapy.