Objectives:To investigate the survival and tumor recurrence after en bloc spondylectomy of spinal tumor and analyze the risk factors of postoperative tumor recurrence.Methods:This is a retrospective case series study. Data of 101 patients undergoing en bloc spondylectomy of spinal tumors in the Musculoskeletal Tumor Center, Peking University People′s Hospital from December 2006 to June 2022 were analyzed. There were 58 males and 43 females, aged (38.2±15.8) years (range: 10 to 79 years) at the time of surgery; the follow-up time was(44.0±36.0) months (range: 12 to 171 months).Among them, there were 25 relapsed patients, with 7 females and 18 males; aged (34.8±16.3) years (range: 12 to 66 years) at the time of surgery. The types of tumors included 5 giant cell tumors of bone, 6 osteosarcomas, 1 chordoma, 5 chondrosarcomas, 1 undifferentiated sarcoma, 1 fibrosarcoma, 2 Ewing sarcomas, 3 metastases and 1 malignant giant cell tumor of bone. Survival analysis of overall and relapsed patients were performed using the Kaplan-Meier curves. A segmented regression model was used to fit the sequence of recurrence rate changes over time since admission and identify change points for further analysis on risk factors. Univariate and multivariate Logistic regression analysis were performed to assess risk factors associated with recurrence rate; results from multivariate regression analysis were presented using a forest plot.Results:The tumor recurrence rate after en bloc spondylectomy was 24.8% (25/101).The overall median recurrence-free survival after en bloc spondylectomy was 161 months (95% CI: 92 months to NA).The median recurrence-free survival of recurrent patients was 13 months (95% CI: 12 to 27 months).Regarding the classification based on tumor malignancy, and relapse-free survival of metastatic tumors was significantly shorter ( P=0.007); and among the surgical margin groups, relapse-free survival of R0 group was significantly better than the R1 and R2 groups ( P<0.01). According to the segmented regression model, the tumor recurrence rate for en bloc spondylectomy showed a significant downward trend over time, with relatively higher recurrence rates before 2009 and a relatively stable trend after 2014. The results of univariate analysis showed that surgical margin and time of admission were the influencing factors of patient recurrence. The results of multivariate analysis showed that the R1 resection( OR=13.453,95% CI:2.897 to 97.941, P=0.002) and R2 resection( OR=11.379,95% CI:2.658 to 79.429, P=0.003) were independent influencing factor affecting patient recurrence. Conclusions:The overall tumor recurrence rate after en bloc spondylectomy was high. The surgical margin of tumor resection is an independent risk factor affecting tumor recurrence. Specifically, R2 and R1 resections significantly increase the risk of tumor recurrence.

Objectives:To investigate the survival and tumor recurrence after en bloc spondylectomy of spinal tumor and analyze the risk factors of postoperative tumor recurrence.Methods:This is a retrospective case series study. Data of 101 patients undergoing en bloc spondylectomy of spinal tumors in the Musculoskeletal Tumor Center, Peking University People′s Hospital from December 2006 to June 2022 were analyzed. There were 58 males and 43 females, aged (38.2±15.8) years (range: 10 to 79 years) at the time of surgery; the follow-up time was(44.0±36.0) months (range: 12 to 171 months).Among them, there were 25 relapsed patients, with 7 females and 18 males; aged (34.8±16.3) years (range: 12 to 66 years) at the time of surgery. The types of tumors included 5 giant cell tumors of bone, 6 osteosarcomas, 1 chordoma, 5 chondrosarcomas, 1 undifferentiated sarcoma, 1 fibrosarcoma, 2 Ewing sarcomas, 3 metastases and 1 malignant giant cell tumor of bone. Survival analysis of overall and relapsed patients were performed using the Kaplan-Meier curves. A segmented regression model was used to fit the sequence of recurrence rate changes over time since admission and identify change points for further analysis on risk factors. Univariate and multivariate Logistic regression analysis were performed to assess risk factors associated with recurrence rate; results from multivariate regression analysis were presented using a forest plot.Results:The tumor recurrence rate after en bloc spondylectomy was 24.8% (25/101).The overall median recurrence-free survival after en bloc spondylectomy was 161 months (95% CI: 92 months to NA).The median recurrence-free survival of recurrent patients was 13 months (95% CI: 12 to 27 months).Regarding the classification based on tumor malignancy, and relapse-free survival of metastatic tumors was significantly shorter ( P=0.007); and among the surgical margin groups, relapse-free survival of R0 group was significantly better than the R1 and R2 groups ( P<0.01). According to the segmented regression model, the tumor recurrence rate for en bloc spondylectomy showed a significant downward trend over time, with relatively higher recurrence rates before 2009 and a relatively stable trend after 2014. The results of univariate analysis showed that surgical margin and time of admission were the influencing factors of patient recurrence. The results of multivariate analysis showed that the R1 resection( OR=13.453,95% CI:2.897 to 97.941, P=0.002) and R2 resection( OR=11.379,95% CI:2.658 to 79.429, P=0.003) were independent influencing factor affecting patient recurrence. Conclusions:The overall tumor recurrence rate after en bloc spondylectomy was high. The surgical margin of tumor resection is an independent risk factor affecting tumor recurrence. Specifically, R2 and R1 resections significantly increase the risk of tumor recurrence.

Objective:To assess the clinical outcome of patients with spinal tumors who received en bloc resection in our center and to provide theoretical basis for developing novel surgical technique in en bloc resection for spinal tumor.Methods:We retrospectively reviewed the clinical and follow-up data of 113 patients who received en bloc resection for spinal tumors in Musculoskeletal Tumor Center, Peking University People's Hospital from Jan. 2007 to Dec. 2021. There were 68 males and 45 females with an average age of 38.7±16.7 (10-79) years. Primary malignant spinal tumors, primary aggressive spinal tumors and solitary metastatic spinal tumors were diagnosed in 55, 27 and 31 patients, respectively. The surgeries were planned according to the surgical classification for en bloc resection for spinal tumors proposed by Boriani et al, which classified the en bloc resection for spinal tumor into 7 types. The general condition (gender, age, histological diagnosis, location of the lesion, number of involved vertebrae, pre-operative neurological function), surgical procedure (type of surgery, stage of surgery, reconstruction method for anterior structure, duration of surgery, intra-operative haemorrhage, surgical margin), peri- and post-operative complication (intra- and peri-operative complication, post-operative neurological function), and survival [overall survival (OS), recurrence-free survival (RFS) and implant survival (IS)] of patients were retrospectively analyzed.Results:All surgeries accomplished uneventfully except one intra-operative death owing to the haemorrhagic shock caused by injury of major blood vessel. Mean duration of surgery and volume of intra-operative haemorrhage was 517.6±267.4 min and 3802.7±3039.4 ml, respectively. R0 resection was achieved in 48 patients. Three patients died in peri-operative period. Intra- and peri-operative complications were identified in 44 patients (38.9%). 109 patients were followed up with a mean time of 39.4±35.2 months. 27 patients died during follow-up period. The average post-operative overall survival (OS) was 115.4[95% CI (97.9, 133.0)]months and the 5-year OS rate was 64.1%[95% CI (52.3%, 75.9%)]. In patients with primary malignant spinal tumors, the OS of patients with R2 resection was significantly poorer than that of patients with R0/R1 resection ( P=0.024); in patients with metastatic tumors, no difference of OS was observed in patients with different surgical margins ( P=0.612). There were 29 recurrences, and the mean RFS was 105.8 [95% CI (87.5, 124.1)] months. In patients with primary malignant and aggressive spinal tumors, the RFS of patients underwent R2 resection was significantly lower than that of patients underwent R0/R1 resection ( P=0.008, P=0.027); in patients with metastatic spinal tumors, no significant difference of RFS was found in patients with different surgical margin (P=0.707). Conclusion:Although en bloc resection for spinal tumors indicates high morbidity, it significantly improves the OS of patients with primary malignant spinal tumors and the local control of primary malignant and aggressive spinal tumors.

Objective:To investigate the clinical efficacy of cement-in-cement (CiC) technique for endoprosthetic revision surgeries of noninfectious causes around the knee.Methods:All of 128 patients who had received cement-in-cement technique for endoprosthetic revision from February 2002 to August 2020 including 71 males and 57 females, whose mean age was 33.5±15.4 years (range, 8-77 years). 128 patients included 73 cases of osteosarcoma, 38 cases of giant cell tumors, 8 cases of undifferentiated sarcoma, 4 cases of chondrosarcoma, 2 cases of Ewing sarcoma, 2 cases of fibrosarcoma and 1 case of synovial sarcoma, with 105 cases in distal femur and 23 cases in proximal tibia. The failure mode classification included 64 cases of aseptic loosening, 47 cases of structure failure and 17 cases of tumor progression. 16 out of the 19 endoprosthese failure after the first cement-in-cement procedure received a second cement-in-cement procedure. The survival of revised prostheses, duration of the operation, the amount of blood loss, epidemiological data, complications and limb function were enrolled and statistical analyzed.Results:The mean follow-up from CiC revision was 127±33 months (range, 6-326 months). There were 25 (19.5%) complications for the first CiC procedure and 19 (14.8%) of the 25 complications lead to the protheses failure including 5 (3.9%) structure failure, 6 (4.7%) aseptic loosening, 2 (1.6%) tumor recurrence and 6 (4.7%) infection. The other 6 cases included 5 poor superficial wound healing and 1 patellar ligament rupture. All were recovered after debridement and tendon repair. The cumulative survival rates of first CiC procedure were 85.0%, 76.6% and 70.7% at 5, 10 and 15 years, respectively. Limb salvage rate was 97.7%. Sixteen of the 19 cases received a second CiC revision. The mean operative time (206±51 min vs. 258±41 min, t=3.18, P=0.399), blood loss (596±217.99 ml vs. 621±245.84 ml, t=0.30, P=0.926) and the median MSTS 93 score (26.38±2.47 vs. 25.06±2.11, t=1.61, P=0.376) of the first and second CiC procedure for the 16 cases were similar. Conclusion:CiC technique is a repeatable, conservative and viable option for endoprosthetic revision surgeries of noninfectious causes around the knee, with acceptable prosthetic survival rate, complication rate and limb function.

Objective:To evaluate the clinical outcome of a special physeal sparing knee prosthesis for pediatric distal femoral osteosarcoma regarding the functional outcome, retention of the growth potential of the proximal tibia, and postoperative complications.Methods:A retrospective study was conducted to review 37 pediatric patients with osteosarcoma of distal femur who were treated in a single musculuskeletal tumor center between August 2015 and January 2019. Among them, 21 were boys and 16 were girls, aged from 5 to 12 years at the time of operation, with an average age of 9.1±2.1 years and the height of 115 to 160 cm, with an average of 140±10 cm. Tumor resection of distal femur was performed and the bone defect was reconstructed by a special hinged knee prosthesis which can preserve the proximal tibial epiphyseal plate. Demographic data was recorded. Overall leg length and tibial length was assessed by full-length standing anteroposterior radiographs of bilateral lower extremity with the patella pointing anteriorly preoperativelly and postoperativelly at each follow up. And the growth potential of the affected proximal tibia was calculated by comparing with the preoperative length of tibia. Meanwhile, the functional outcome was assessed by using the Musculoskeletal Tumor Society (MSTS) system, and the postoperative complications were analysed.Results:All patients underwent the tumor resection and reconstruction operation successfully. The average operation duration was 143±41 minutes, ranging 90 to 250 minutes. The average intraoperative blood loss was 314±397 ml, ranging 30 to 2 200 ml. The patients were followed up for 24 to 64 months, averaging 42.3±12.1 months. The postoperative knee range of motion was 100-130 degrees, with an average of 115.6±7.2 degrees. The postoperative MSTS score was 23-30, with an average of 26.7±1.6. To the last follow-up, the limb length discrepancy of the lower limb was 1.3 to 10 cm, and the length of the tibia was shortened from 0 to 3.8 cm compared with the opposite side, with an average of 1.3±1.0 cm. The growth percentage of the proximal tibial epiphysis on the affected side was 30% to 100%, with an average of 70%±17%. Totally, 13 patients suffered postoperative complication, the overall incidence of complications was 35% (13/37), and prosthesis-related complications were 16% (6/37). Three patients with wound dehiscence were managed by debridement and antibiotics. Radiographs revealed femoral stem loosening in a single patient 3 years after the initial operation and then the prosthesis was converted to an adult tumor knee endoprosthesis. Two cases experienced breakage of the femoral stem at 30 and 33 months, respectively, due to an accidental injury. They received revision surgery, and a new femoral prosthesis component was replaced. One patient developed femoral stem breakage at 10 months after surgery due to fatigue fracture, which treated with revision surgery. Tumor recurrence occurred in 6 patients. Among them, tumor recurrence in soft tissue occurred in 4 patients, and treated with regional resection without further recurrence. The other 2 patients experienced tumor recurrence at the distal femoral site, and treated with resection and prosthetic revision.Conclusion:The physeal sparing pediatric knee prosthesis can preserve the growth potential of the proximal tibial epiphyseal plate with good postoperative function and low incidence of prosthesis complications. Therefore, it can be an alternativeespecially for skeletally immature patients with distal femur osteosarcoma.

Objective:To explore the practical effect of nursing research group model in a training program for clinical nurses′ scientific research ability.Methods:From August 2020 to July 2021, 30 clinical nurses from the Fifth Affiliated Hospital of Sun Yat-sen University were trained by case teaching mode through the construction of a complete nursing scientific research training course system with the nursing research group as the carrier. The scores of nursing scientific research ability of clinical nurses before and after the training were compared, and the evaluation of teaching effect and the output of scientific research results were analyzed.Results:After the training, the total scores of clinical nurses′ scientific research ability, problem discovery ability, literature reading ability, scientific research design ability, data processing ability, scientific research practice ability and thesis writing ability were 78.33 ± 7.48, 8.83 ± 1.42, 14.47 ± 1.22, 13.27 ± 1.36, 11.07 ± 1.60, 14.73 ± 1.28, 15.97 ± 1.35 respectively. The scores were significantly higher than those before the training (59.00 ± 7.44, 6.53 ± 1.22, 11.80 ± 1.37, 9.53 ± 1.31, 8.10 ± 1.37, 11.30 ± 1.34, 11.73 ± 1.46), and the differences were statistically significant ( t values were -52.80 - -21.14, all P<0.05). The proportion of clinical nurses who believed that the training with nursing research group as the carrier could improve learning attitude, enhance clinical comprehensive ability and promote professional development was ≥90%. After the training, 8 papers were published, 3 projects were approved and 2 patents were approved, which were significantly higher than those before the training (2, 1 and 0), and the total scientific research and innovation achievements increased by 333.33% (10/3) compared with those before the training. Conclusions:Scientific research training with nursing research group as the carrier can improve the scientific research ability of clinical nurses and improve their innovative thinking.

Objective:To investigate the current status of emotional intelligence of standardized training nurses and explore the influencing factors.Methods:A total of 312 standardized training nurses from the Fifth Affiliated Hospital of Sun Yat-sen University and the First Affiliated Hospital of Nanchang University were investigated from May to June 2020 with general information questionnaire and Nurses′ Emotional Intelligence Scale, and analyze the influencing factors of nurses′ emotional intelligence during the standar dized training period.Results:The total score of standardized training nurses′ emotional intelligence was (59.01 ± 8.24), the scoring rate was 73.76%, and the total average score of items was (3.69 ± 0.52). The average scores of the four dimensions from low to high were: self emotion assessment (3.86 ± 0.66), self emotion management (3.67 ± 0.71), self emotion application (3.64 ± 0.67) and emotion assessment of others (3.58 ± 0.65). Multiple linear regression analysis showed that political outlook, whether it was an only child, and training time and willingness to engage in nursing work for a long time were the main influencing factors of standardized training nurses′ emotional intelligence, accounting for 32.6% of the variance.Conclusions:The emotional intelligence of standardized training nurses is at the medium level, which needs to be further improved. Hospital managers need to carry out positive intervention combined with relevant influencing factors to cultivate more excellent nursing talents for clinical practice.

Objective:To investigate the current status of emotional labor of nurses in standardized training period, and to analyze the relationship between emotional labor and emotional intelligence.Methods:From May to June 2020, 312 nurses in the standardized training period were selected as the research objects, which were investigated with general information questionnaire, Emotional Labor Scale and Emotional Intelligence Scale.Results:The total score of standardized training nurses' emotional labor was (52.27±10.18) points, and the total average score of items was (3.73±0.73) points. The average scores of the three dimensions from high to low: deep acting (4.62±0.86) points, expression of genuine emotion (3.62±0.99) points and surface acting (3.42±0.95) points. There was a correlation between emotional intelligence and emotional labor. Multiple linear regression analysis showed that the emotional evaluation of others ( β value was -0.189, P<0.05) ( β value was -0.255, P<0.01). Self emotional assessment ( β value was 0.297, P<0.01) ( β value was 0.177, P<0.05). Self emotional assessment ( β value was 0.269, P<0.05), which had a positive predictive effect on emotional expression requirements. Conclusions:The emotional labor of nurses in standardized training period is at the medium level, and the deep acting score is the highest between three dimensions. Hospital managers could promote nurses to use appropriate emotional labor strategies by strengthening the cultivation of emotional intelligence during standardized training period.

Objective:To investigate the risk factors of relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with t (8;21) acute myeloid leukemia (AML) .Methods:The clinical features of patients with t (8;21) AML who received allo-HSCT between January 2008 and October 2020 in the Hospital of Blood Disease and the Chinese Academy of Medical Sciences were retrospectively analyzed. Univariate and multivariate analyses were performed on the factors that might influence relapse.Results:A total of 73 patients were enrolled. The analysis revealed that, out of the 73 cases, 10 had relapses, with a 3-year cumulative incidence of relapse (CIR) of 15.7% (95% CI 7.3%-26.8%) . The median time of relapse was 9.2 (2.0-47.6) months. Furthermore, 19 cases died, with a 3-year overall survival (OS) of 68.9% (95% CI 56.4%-81.4%) . Compared with the RUNX1-RUNX1T1 at first diagnosis, a ≥ 3-log reduction within 3 months and/or 4-log reduction within 3-12 months can significantly decrease 3-year CIR after HSCT (13.3% vs 57.1%; 5.1% vs 25.0%, both P<0.001) . Cox multivariate analysis showed that high levels of RUNX1-RUNX1T1 (≥1.58%) on the day of transplantation (day 0) [ P=0.006; HR=28.849 (95% CI 2.68-310.524) ] and the flow cytometric analysis of blasts ratio in bone marrow ≥60% at first diagnosis [ P=0.015; HR=6.64 (95% CI 1.448-30.457) ] were independent risk factors for relapse. Furthermore, no significant difference in the effect of c-Kit and Flt3 gene mutations on relapse after transplantation was observed ( P=0.877 and P=0.773, resp) . The flow cytometric analysis of blasts ratio in bone marrow ≥60% at first diagnosis [ P<0.001; HR=8.925 (95% CI 2.702-29.476) ] and the number of courses to achieve complete remission ≥ 2[ P=0.013; HR=4.495 (95% CI 1.379-14.649) ] were independent risk factors for OS. Conclusion:Both high levels of RUNX1-RUNX1T1 (≥1.58%) on the day of transplantation (day 0) and the ratio of flow cytometric analysis of blasts in bone marrow at first diagnosis increase the chance of t (8;21) AML relapse after allo-HSCT. Detection of the transcription levels of RUNX1-RUNX1T1 after allo-HSCT at different times could help predict the hazard of relapse.

Objective:To explore the mediating role of occupational benefit in the emotional intelligence and emotional labor of nurses during the standardized training period, so as to provide references for enhancing the professional adaptation potential of nurses during the standardized training period.Methods:This study was a cross-sectional study. Using the convenient sampling method, a total of 318 standardized training nurses from the Fifth Affiliated Hospital of Sun Yat-sen University and the First Affiliated Hospital of Nanchang University were selected as research objects from May to June 2020. They were investigated by general data questionnaire, Emotional Intelligence Scale, Occupational Benefit Scale and Emotional Labor Scale. Structural equation model (SEM) was used to explore the mediating effect of occupational benefit on emotional intelligence and emotional labor.Results:A total of 318 questionnaires were collected in this study, among which 312 were valid. The mean scores of items of emotional intelligence and occupational benefits of 312 nurses were (3.69±0.52) and (3.97±0.54) , respectively. The average scores of the three dimensions of emotional labor were surface acting (3.42±0.95) , emotional expression requirements (3.62±0.99) and deep acting (4.62±0.86) . There were correlations between emotional intelligence, occupational benefit and emotional labor (all P<0.05) . The structural equation model showed that the emotional intelligence and occupational benefit of nurses in the standardized training period had direct predictive effects on emotional labor, and emotional intelligence also indirectly affected emotional labor with occupational benefit as an intermediary variable. The structural equation fitting index χ 2/ df was 1.731, the goodness of fit index was 0.949, the adjusted goodness of fit index was 0.912 and the root mean square error of approximation was 0.058. Conclusions:Occupational benefit has a partial mediating effect between the emotional intelligence and emotional labor of nurses during the standardized training period. Nursing managers can take effective measures to improve the emotional intelligence level of nurses during the standardized training period, enhance the sense of occupational benefit and optimize their emotional labor performance from individual factors.