BACKGROUND: Limb salvage operations with preservation of the epiphysis (LSPPE) had been used clinically in order to overcome discrepancy of affected limb and poorer limb function, but more post-operation complications existed, including infection, grafting bone resorption, fracture and internal fixation cinch.OBJECTIVE: To study the clinical related matters of inactivated bone replantation with preservation of the epiphysis in children limb salvage with osteosarcoma.DESIGN: Clinical observation regularly.SETTING: General Hospital of Jinan Military Area Command of Chinese PLA.MATERIALS: Eleven patients corresponded selected standard and accepted treatment from January 1999 to January distal metastasis was found with lung X-ray check and CT scanning, the patient would be excluded this study. There were 5 males, 6 females, and the mean age of (8±2) years old (4-11 years). The disease history was 1-6 months.FO) were adopted. After 2 weeks of chemotherapy, the operations of inactivated bone replantation with preservation of the epiphysis were performed. The operation was performed under epidural or general anesthesia. The patient lied on operating table. The knee anteriomedialis incision was adopted. Firstly, femur periosteum was opened beyond proximal end 2-3 cm from tumor, subperiosteum stripping was done to the proximal femur, descend femur with wire saw, separated and disconnected aboral periosteum, blunt dissecting femur aboral blood vessel and nerves to the popliteal fossa,deligating blood vessel around the tumor. Attachment of gastroenemius was cut off. Epiphyseal plate was identified carefully. According to pre-operation MR, the distal femur descend level was determined and the femur was descend with electro-saw. It was determined with cytology that no tumor cell existed in descend level, and reconstruction of bone de-fect with inactivated tumor-bone shell with 95% alcohol and bone cement containing ADR (20 g bone cement: 10 mg ADR), the diaphysis was fixed by intramedullary nail and screws were inserted in the residual epiphysis for the osteosynthesis of the distal osteotomy. One drainage tube was placed into and closed incision The affected limb was protected with plaster cast. Post-operative treatment: Regular usage of antibiotics was adopted to prevent infection. The drainage tube was pulled out when drainage amount ＜ 50 Ml/24 hours. The progressive passive exercise was initiated during the protection of affected limb with plaster cast for 8 weeks. Twelve to 14 days after operation, stitches were taken out. The postoperative chemotherapy then initiated, drug and dosage were identified on the response to the preoperative chemotherapy. Eight weeks after operation, patients were permitted to walk with the protection of double crutches and ery analysis: To observe ncision healing and existing of nerve and blood vessel injure, or not. During follow-up, patient recoveries were determined with affected knee function, limb length, distal metastasis, post-operative complications and dynamic imaging inspection of bone healing.imaging inspection of bone healing.MAIN OUTCOME MEASURES: ① The response to chemotherapy was evaluated with tumor cell necrosis rate. ② Post-operative recovery was determined with parameters such as knee function, limb length, distal metastasis, etc. ③ Dynamic imaging inspection of bone healing.MAIN OUTCOME MEASURES: ① The response to chemotherapy was evaluated with tumor cell necrosis rate. ② Post-operative recovery was determined with parameters such as knee function, limb length, distal metastasis, etc. ③ Dynamic imaging inspection of bone healing.RESULTS:All patients in this study were done follow-up.①The histological response of 11 patients to preoperative chemotherapy were classified as 7 in gradeⅣ,4 ingrade Ⅲ.②Post-operation recovery:No nerve and blood vessel injury existed and all incision healed well,there was not incision infection and healing.Eleven patients were followed-up from 10 to 72 months.Three patients could flexed affected knee joint ≥110,90-110 in 3 cases,60-90 in 4 cases,＜60 in one patient .The length of both lower extremity equaled in 4 cases,the length of affected limb was shorter than 2.0 cm in 5 cases,2.0-3.0 cm in 2 cases. One patient with recurrence,two with metastasis,three died.Screw cinch in one patient and one patient with inactivated bone fracture. ③Dynamic imaging inspection: No recurrence was found around epiphysis. Essential bone healing existed between the inactivated bone and epiphysis,callus formation between the inactivated bone and diaphysis at 2 months after operation; more callus formed and 4 months; 6 months after operation,bone complete healing was found between the inactivated bone and diaphysis.④Post-operation recovery:During follow-up, a screw cinch was found in one patient, and dislodged the screw because of bone healing well. One patient underwent open reduction, bone grafting and internal fixation with encircle device because of inactivated bone fracture.four months of the operation, grafting bone healed well. At post-operative 24 months, the length of both lower extremities equaled and the affected knee flexed to 110°.CONCLUSION: Inactivated bone replantation with preserving epiphysis for osteosarcoma in children was propitious to recover limb function and keep limb length.

Objective:To investigate the efficacy and safety of video assisted thoracic surgery and thoracic surgery in the treatment of myasthenia gravis.Methods:60 patients with myasthenia gravis were selected and randomly divided into two groups.The observation group(32 cases) received video assisted thoracic surgery.The control group(28 cases) received thoracic surgery.The efficacy and safety of video assisted thoracic surgery and thoracic surgery in the treatment of myasthenia gravis was evaluated by perioperative indexes,QMG scores before operation,after 3 months,6 months operation and complications during 6 months follow-up.Results:During the perioperative period,there was no statistical significance in the operation time between two groups(P＞0.05).The bleeding volume of observation group was less than that of the control group (P＜0.05).The drainage time,hospitalization and incision length of observation group were shorter than those of the control group (P＜0.05).Before operation,there was no statistical significance in the QMG scores.At 3 months,6 months after operation,the QMG scores were decreased in both groups.The QMG score of observation group was lower than that of the control group (P＜0.05).During 6 months' follow-up,complications were observed in 7 cases of the observation group and 17 cases of the control group,the major complication was pulmonary infection.The incidence of complications in the control group was higher than that of the observation group (P＜0.05).Conclusion:Video assisted thoracic surgery had advantages of smaller surgical incision,faster recovery and higher safety in the treatment of myasthenia gravis.

Objective: To investigate the clinical treatment results of combined Tretinoin-chemotherapy protocol and kinetics of PML-RAR ? fusion gene in childhood acute promyelocytic leukemia(APL). Methods: Ten children with APL were involved in this study. Induction therapy was Tretinoin alone(6 cases),Tretinoin plus chemotherapy(3 cases) and arsenic trixode(1 case). Postremission therapy consisted of three consolidation courses with DA,MA or HA and a monthly maintenance therapy over 4-5 years. Monitoring of minimal residual disease was performed regularly by RT-PCR assay for PML-RAR ? at differential clinical stages. Results: Clinical complete remission(CR) was obtained in 9 cases (90%).After a median follow-up of 42 months(14-156 months), the estimated 5-year event-free survival was (56? 16.5)%.Four cases relapsed at 14-42 months after achieving CR and 5 cases remained continuing CR. PML-RAR ? fusion gene was positive in all cases at CR and turned negative gradually during consolidation and maintenance treatment. The duration of conversion to RT-PCR negative status varied from 6 to 42 months.Four patients who were persistent positive(2 cases) or converted to positive(2 cases) for PML-RAR ? relapsed. Conclusion: Continuous negative RT-PCR results are associated with long-term disease-free survival and may be considered as potentially curative. RT-PCR assay for detection of PML-RAR ?should be performed regularly during post-remission period. The hematological relapse could potentially be averted through treatment modification according to molecular monitoring results of PML-RAR ?.

Objective To investigate the application of neurophysiological monitoring and microsurgi-eal technique in acoustic neurinoma resection, exploring the significance of neurophysiological monitoring in facial and auditory nerve reservation of acoustic neuronma microsurgery. Methods Accompanied with EMG and BAEP nerve monitoring, 113 patients harboring acoustic neuroma were treated surgically by the subocipi-tal retrosigmoid approach for reserving facial and auditory nerve. The facial nerve was stimulated to evaluate its function during late-operation. Postoperative facial and auditory nerve function were valuated in all the postop-erative following up. Results All of them were treated microsurgically via the suboccipitai retrosigmoid ap-proach. Total tumors resection was achieved in 102 cases (90.3%), subtotal resection in 6 cases(5.3%) and partial resection in 5 case (4.4%). The facial nerve was preserved anatomically in 98 cases (86.7%), the functional valuation of facial nerve according to the House-Brakman (H-B) postoperatively: 86 cases (76.1%) in class Ⅰ -Ⅱ , 12 cases(lO.6%) in class Ⅲ-Ⅳ and 15 cases (13.3%) in class Ⅴ-Ⅵ. The acoustic nerve was preserved anatomically in 40 cases (35.4%). It denoted the good function of facial nerve responsing sensi-tively to electrostimulation ≤ 4mA at the end of operation. Conclusion Assisted with the intraoperative electrophysiological monitoring techniques, it would be greatly facilitate the preservation of facial and auditory nerve in acoustic neuroma resection. Simultaneously, it would valuate the functional convalescence by late-op-erative electrostimulation in the postoperation.

Objective To explore the effects of astragalus (AST),total flavone of astragalus (TFA),total saponins of astragalus (TSA) and astragalus polysaccharides (APS) on ischemia/reperfusion (40 min/60 min) injury in isolated guinea-pig heart.Methods Isolated guinea-pig hearts underwent ischemia,then followed by K-H perfusion (I/R group),AST (60 mg/L),AST (60 mg/L),TFA (60mg/L),TSA (60 mg/L) and APS (60 mg/L) perfusion (n =6 each).Isolated hearts without ischemia serve as control group (n =6).Activity of lactate dehydrogenas (LDH) and creatine kinase (CK) in effluent were measured.Infarct size,myocardial superoxide dismutase (SOD) activity and malondiadehyde (MDA) contents were also determined.Results Compared to control hearts,heart rate,coronary flow and myocardial superoxide dismutase (SOD) activity were significantly reduced,while LDH and CK in effluent as well as myocardial MDA were significantly increased in the I/R hearts during reperfusion (all P ＜ 0.05),these changes could be partly reversed by AST and TFA perfusion.Infarct size was also significantly reduced in AST (11.9 ± 2.03) ％ and TFA (13.31 ± 1.17) ％ treated hearts compared to that in I/R group(18.9 ±2.27) ％ (all P ＜ 0.01).Conclusions The findings indicate that AST and TFA could attenuate I/R injury in isolated guinea-pig heart possibly through enhancing the activity of SOD and reducing lipid peroxidation.

Objective:To analyze the bacteria spectrum and antimicrobial resistance profile of bacterial meningitis among children in Baoji.Methods:Based on the acute meningeal and encephalitis syndrome surveillance project, cerebrospinal fluid samples were collected from 774 cases of bacterial meningitis in Baoji Municipal Maternal and Health Hospital from January 2016 to December 2023. Bacterial culture and drug sensitivity test were carried out.Results:A total of 105 positive strains were isolated with the detection rate of 13.57% (105/774). Among them, gram-positive strains accounted for 80.00% (84/105), mainly including Staphylococcus epidermidis, Staphylococcus hominis, and Streptococcus pneumoniae. Gram-negative bacteria accounted for 20.00% (21/105), and the predominant strain was Escherichia coli. Pathogenic bacteria were detected in every month of the year, with two peaks in March and September (26.67%, 28/105). The youngest was infected 20 min after birth, and the oldest was nine years old. There were statistical differences in the detection rates among different age groups (χ 2=35.91, P<0.05). The positive rate in the toddler group was lower than that in the infant group, the pre-school age group and the school age group, respectively (χ 2=15.01, 7.09, and 10.08; all P<0.05). There was no statistical difference between the toddler group and the neonate group (χ 2=1.60, P>0.05). The strains detected in the neonate group accounted for 44.76% (47/105), mainly including Escherichia coli and Staphylococcus epidermidis; the strains in the infant group accounted for 26.67% (28/105), mainly including Streptococcus pneumoniae; the strains in the toddler group accounted for 3.81% (4/105), mainly including Staphylococcus epidermidis; the strains in the pre-school age accounted for 11.43% (12/105), mainly including Staphylococcus epidermidis; the strains in the school age group accounted for 13.33% (14/105), mainly including Streptococcus pneumoniae. The results of drug sensitivity test showed that the resistance rates of Staphylococcus epidermidis to ampicillin/sulbactam, clindamycin, and levofloxacin were 47.06% (8/17), 41.18% (7/17), and 23.53% (4/17), respectively. Staphylococcus epidermidis strains were sensitive to vancomycin and linezolid. All of the Streptococcus pneumoniae strains were resistant to erythromycin and clindamycin, but sensitive to vancomycin and linezolid. The resistance rate of Streptococcus pneumoniae to penicillin was 69.23% (9/13). The resistance rates of Escherichia coli to ampicillin, levofloxacin, ceftriaxone, and cefotaxime were 66.67% (8/12), 41.67% (5/12), 33.33% (4/12), and 41.67% (5/12), respectively, but they were sensitive to ampicillin/sulbactam, cefoperazone/sulbactam, amikacin, and meropenem. Streptococcus agalactis strains were sensitive to penicillin, linezolid, and vancomycin, but resistant to erythromycin, clindamycin, ampicillin, and levofloxacin. Conclusions:The main pathogens causing bacterial meningitis in Baoji city are Staphylococcus epidermidis, Streptococcus pneumoniae, and Escherichia coli. The distribution of bacteria is varied in different age groups. The diagnosis and treatment of bacterial meningitis should be made based on the bacterial spectrum characteristics and the results of antimicrobial resistance profile.

【Objective】 To understand the current situation of blood components distribution in domestic prefecture-level blood stations through analyzing the components distribution data of 24 prefecture-level blood stations in China. 【Methods】 The data of components distribution of 24 blood stations from 2017 to 2020 as well as the data of blood deployment of 24 blood stations from 2019 to 2020 were collected and analyzed. 【Results】 From 2017 to 2020, positive annual growth in red blood cells, plasma and cryoprecipitate was observed in 22, 19 and 15 out of the 24 blood stations, and the annual growth median rate of above three components was 5.24%, 3.80% and 3.25%, respectively. Among the 24 prefecture-level blood stations, 23 carried out the preparation of cryoprecipitate. 【Conclusion】 The distribution of red blood cells, cryoprecipitate and plasma in prefecture-level blood stations is increasing year by year. However, there is a overstock of plasma, and most blood stations need blood employment.