Objective:To investigate surgical methods and clinical effects of tibial pseudarthrosis due to neurofibromatosis type I (NF1) in adult using Ilizarov technique combined with intramedullary nail.Methods:A total of 12 adult with tibial pseudarthrosis due to NF1 treated by Ilizarov technique combined with intramedullary nail from October 2009 to December 2017 were retrospectively included. There were 6 males and 6 females with an average age of 27±8.3 years (range 17-44). All cases presented severe anterior arch in varus or valgus deformity with shortening in an average of 10.8±3.7 cm (range 5.6-16.5 cm). The in-volved levels were at the middle and lower part of tibia. All cases suffered from more than one treatment with failed surgery. One male patient with 5 times of unsuccessful operations. There were 4 cases with severe limping gait and 8 cases with walking with the help of brace (or single crutch) preoperatively. Regarding the family history, seven cases were inherited by father and 5 cases by mother. During surgery, the part of tibial pseudarthrosis and thickened fibrous tissue surroundings like periosteal were removed. The contracture achilles tendon was elongated in open way, and intramedullary nailing cross the ankle joint was applied when the tibial medullary cavity opened. Further, iliac bone grafting and proximal tibial osteotomy were performed with Ilizarov fixator application finally. The tibia was lengthened at a rate of 0.5-1 mm/d at 7 days postoperatively. The healing rate of pseudarthrosis and the length and alignment of limb were evaluated by X-ray routinely. The lower limb function and complications were assessed by self-made table for lower limb deformity correction and functional reconstruction.Results:All patients were followed up for 31-80 months with an average of 47.6±14.7 months. Bone union of pseudarthrosis in all cases was eventually achieved. The tibia was lengthened 5-12 cm with an average of 8.4±2.5 cm. There were 9 cases underwent second surgeries to promote bone healing and to correct residual deformities. The external fixator was used for 25-37 months with an average of 31.5±3.7 months. There was no complication, including neurovascular injury, severe soft tissue or bone infection affecting the clinical effects. All intramedullary nails were not removed finally. The limb function and gait in full weight bearing in 12 patients recovered at the latest follow-up. The evaluation score was 2.4±0.3 (range 2.1-2.8), of which 9 cases were excellent 3 were good. Thus, the excellent and good rate was 100%.Conclusion:The satisfactory clinical effects, including angular deformity correction, pseudarthrosis healing and short limb lengthening, can be achieved in adult with tibial pseudarthrosis due to NF1 by using the combination method of Ilizarov technique and intramedullary nail. However, the treatment duration could be longer.

Objective To evaluate the efficacy and toxicities of gemcitabine plus oxaliplatin with R-GemOx or without (GemOx) rituximab regimen in the treatment of relapsed or refractory diffuse large B-cell lymphoma in elderly patients.Methods A total of 39 patients with relapsed or refractory diffuse large B-cell lymphoma received R-GemOx or GemOx chemotherapy.There were 16 patients in R-GemOx and 23 patients in GemOx group.Patients in both groups received gemcitabine 1000 mg/m2,d1,at land 8 day and oxaliplatin 130 mg/m2,d1 at lday.Patients in R-GemOx additionally received rituximab 375 mg/m2.Every 21-28 days was 1 cycle.The toxicities were evaluated after 1 cycle of chemotherapy.The efficacy was evaluated after 2 cycles of chemotherapy.Results In R-GemOx group,the total response rate was 62.5％,and the clinical benefit rate was 87.5％.In GemOx group,the total response rate was 47.8％,and the clinical benefit rate was 73.9％ There was no significant differences between the two groups.There was a significant difference in the median time-to-progression (TTP) between R-GemOx group (6.4 months) and GemOx group (5.0 months) (P ＜ 0.05).The major toxicities were marrow suppression and gastrointestinal reaction,which had no significant differences between the two groups.Conclusions R-GemOx and GemOx regimen are effective and safe for the elderly patients with relapsed or refractory diffuse large B-cell lymphoma(DLBCL).But the patients with relapsed/refractory DLBCL treated with R-GemOx had a longer median time-to-progression than with GemOx regimen.

Aim To select a potential biomarker for early lung cancer diagnosis and targeted therapy by using the cancer specific bounded peptide ZS-6 which had already been obtained from the laboratory.Methods The peptide ZS-6 marked by biotin was used as a probe to pan out the human lung cancer cDNA phage display library,after 4 rounds of subtraction panning,the specific binding clones of ZS-6 were identified.After amplification and purification,then those DNA sequences were identified and analyzed with bioinformatics.Results 18 phage clones were identified to the specific peptide ZS-6 and the DNA sequence showed one of them was an unknown new gene while the others were known tumor related genes.Conclusion A tumor biomarker selected from human lung cancer cDNA library provides a potential tool for early lung cancer diagnosis and therapy.

Objective To develop a kind of rapid decompression equipment replacing the toughened glass simulating the state of aircraft cabin glass bursting on the fly.Methods The metallic membrane was used to isolate both chambers with different air pressures.The areas of decompression membrane and path were determined by calculating on the basis of aircraft decompression altitude,cabin pressure differential and decompression time.The structural strength was determined according to enduring force of the metallic membrane.The membrane was ejected by high pressure air using the ejection launch technology of aircraft missile.The result of simulating aircraft cabin glass bursting on the fly was achieved.Results The rapid decompression equipment ejected by air pressure in low-pressure chamber could achieve the state of simulating aircraft cabin glass bursting on the fly,and the best decompression time was 0.16 s.Conclusion The rapid decompression equipment ejected by air pressure accomplishes the decompression preparative in short time with easy operation,and can satisfy the desired requirements for the performance and precision.

Objective Head and neck cancer radiotherapy patients often appear a series of oral complications including mucositis, xerostomia, pain, dysphagia.The purpose of this study was to investigate whether personalization customized positioning oral stent was able to push normal tissue off the high dose target area and maintain accurate repeatable stable positions, thus protecting the normal tissue during radiotherapy of the nasopharyngeal carcinoma patients.Methods 15 newly diagnosed nasopharyngeal carcinoma patients were collected from March to August 2016 in Department of Radiation Oncology, Nanjing General Hospital of Nanjing Military Region and randomly divided into trial group and control group.Two groups of patients were treated with intensity modulated radiation therapy (IMRT).Trial group patients wear personalization customized oral positioning stents during radiotherapy while the control group did not wear.After radiotherapy, we compared the exposure doses of clinical target area(CTV) and normal oral tissue in two groups.ResultsThe left parotid gland radiotherapy doses of the trail group and the control group were 2223.557±294.549 cGy and 2900.563±374.660 cGy, the difference was statistically significant(t=3.847, P=0.002);the right parotid gland radiotherapy doses of the trail group and control group were 2284.957±256.673 cGy and 2994.670±339.264 cGy, the difference was statistically significant(t=4.512, P=0.001).The mean exposure doses of CTV in two groups were no statistically significant difference (6142.829±135.986 cGy vs 173.306±6221.825 cGy, t=0.971, P=0.349.Conclusion During the intensity modulated radiation therapy, patients with personalization customized oral positioning stents can keep the mandible in a precise repeatable stable position.And it can reduce the exposure dose of bilateral parotid without affect the radiotherapy effect of the clinical target area.

Reactive oxygen species (ROS),produced by the body cause the normal state turning into cancerous state,is one of the main reasons of malignant tumor.In addition,ROS is one of the main therapeutic mechanisms of most chemotherapy and radiotherapy for malignant tumor.This bidirectional regulation is achieved through different signaling pathways and mechanisms.Exogenous ROS during anti-cancer treatment,as appropriate,could contribute to the research and development of new anti cancer agents.In this paper,we summarize the carcinogenic/anticancer effect of ROS through the different mechanism,providing new ideas for prevention,control and the treatment of malignant tumors.

BACKGROUNDCoflex, a type of interspinous process implant, can provide intervertebral dynamic stability for surgical segments and effectively relieve lumbocrural pain. However, few studies have described therapeutic strategies and the avoidance of Coflex implant complications.

METHODSCoflex implant complications in this study included intraoperative or postoperative spinous process fracture, aggravated postoperative lumbocrural pain, dislodgment and malposition. The complications were analyzed, and therapeutic strategies were applied according to the specific complication. The Visual Analogue Scale and Oswestry Disability Index scores were evaluated by using the paired-samples test from SPSS 12.0.

RESULTSConservative treatment was provided to seven patients who experienced aggravated lumbocrural pain even though their devices remained in the correct position, and pedicle screw treatment was used as an alternative in four cases. The Visual Analogue Scale and Oswestry Disability Index scores showed evident improvement in these patients. The Visual Analogue Scale and Oswestry Disability Index scores of two patients who underwent revision were also improved.

CONCLUSIONSCoflex implants should be avoided in patients with osteoporosis, a narrow interspinous space and intervertebral coronal spondylolysis, or sagittal instability. Furthermore the device choice, depth of implantation, and clamping intensity should be appropriate. Conservative treatment can be provided to patients with symptoms if the device remains in the correct position; however, revisions and salvages should be undertaken with internal fixation of pedicle screws for patients with device malposition, intraoperative implantation failure, or device intolerance.

Adult ; Aged ; Aged, 80 and over ; Bone Screws ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Prostheses and Implants ; adverse effects ; Visual Analog Scale

Objective: To explore the expression of CD45 in newly diagnosed multiple myeloma (MM) and its relationship with clinical efficacy and prognosis. Methods: This study retrospectively analyzed expression and distribution of CD45 in 130 cases of newly diagnosed MM, comparing clinical efficacy and prognosis in CD45⁺/CD45^- groups. Results: ①The CD45⁺ group was 33 cases (25.38%) , and CD45^- group was 97 cases (74.62%) . ②The objective remission rate (ORR) of CD45⁺ and CD45^-group was 33.33% and 64.95%, respectively. The difference was statistically significant (P=0.002) . For patients in Bortezomib regimen, the ORR of CD45⁺ and CD45^- group was 35.71% and 66.25%, respectively. The difference was statistically significant (P=0.005) . ③The median progress free survival (PFS) of CD45⁺ group and CD45^- group was 29.8 (95%CI 10.0-59.0) months vs 34.5 (95%CI 6.0-69.0) months (χ²=14.59, P<0.001) and the median overall survival (OS) was 32.5 (95%CI 10.0-68.0) months vs 37.6 (95%CI 6.0-78.0) months (χ²=11.42, P=0.001) , respectively. Among the patients in bortezomib regimen, The median PFS and median OS of CD45 ⁺ group and CD45^- group were 30.3 (95%CI 10.0-59.0) months vs 36.3 (95%CI 6.0-69.0) months (χ²=14.75, P=0.001) and 34.0 (95%CI 10.0-68.0) months vs 39.5 (95%CI 6.0-78.0) months (χ²=10.62, P=0.001) . ④Cox risk regression model analysis showed that serum creatinine≥176.8 μmol/L (HR=5.078, 95%CI 1.744-14.723, P=0.001) , CD45 positive (HR=14.504, 95%CI 0.168-0.42, P=0.001) , LDH≥220 IU/L (HR=1.308, 95%CI 1.16-2.417, P=0.015) were independent risk prognostic factors. Conclusion CD45 expression is a risk prognostic factor of MM patients. Bortezomib did not improve the poor prognosis of CD45⁺ MM patients.

OBJECTIVETo investigate the value of the HCT-CI score in chemotherapy risk assessment and prognosis of elderly patients with acute myeloid leukemia (AML).

METHODSThe clinical data of 116 AML patients older than 60 years in the department of Hematology, Henan Provincial People's Hospital from January 2000 to December 2010 were analyzed retrospectively. All patients received cytarabine-based regimens, including protocol DA, MA, IA, AA or CAG, followed by cytarabine-based postremission treatment. (1) Comorbidities were evaluated by using HCT-CI score, the early death rates and median survival time were compared among these different groups. (2) These prognostic factors were analyzed by univariate and multivariate analyses.

RESULTS(1) All 116 cases were followed-up. The patient cohort was divided into those with HCT-CI scores of 0, 1 or 2, or ≥ 3. Early death rates were 3.7%, 12.1% and 23.21% in above three groups, respectively (P < 0.01). Overall survival were 345, 225 and 113 days, respectively (P < 0.01). (2) HCT-CI score ≥ 3 (P < 0.01), antecedent MDS history (P = 0.035), high-risk karyotype (P = 0.018), white blood cells at diagnosis ≥ 100×10(9)/L (P = 0.041) were independent adverse prognostic factors with multivariate analysis.

CONCLUSION(1) The HCT-CI score can objectively assess elderly AML patients with comorbidities and predict chemotherapy risk in older patients receiving AML induction therapy. (2) Antecedent MDS history, high-risk karyotype, high white blood cell, and HCT-CI score ≥ 3 are independent adverse prognostic factors of elderly AML patients.

Aged ; Aged, 80 and over ; Female ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Leukemia, Myeloid, Acute ; diagnosis ; Male ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment ; Treatment Outcome

OBJECTIVETo investigate device implanted complications and corresponding therapeutic strategies of Coflex interspinous dynamic stabilization system for lumbar spine intraoperatively and postoperatively.

METHODSFrom September 2008 to August 2010, 133 cases of degenerative disease of lumbar spine including 62 males and 71 females, ranging from 35 to 81 years of age (mean 60.8 years), underwent or planed to be underwent decompression with Coflex interspinous dynamic stabilization system were reviewed retrospectively, and 13 cases including 6 males and 7 females, ranging from 41 to 71 years of age (mean 58.6 years), occurred device implanted complications. The Coflex implanted complications were analyzed, and therapeutic strategies according to different character were carried out, scores of visual analogue scale (VAS), Oswestry disability index(ODI) and effect-related data preoperatively, postoperatively, after conservative treatment and in final follow-up were evaluated with paired-samples t test.

RESULTSThirteen cases of Coflex implanted complications and treatment applied included: 3 cases occurred fracture of spinous processes intraoperatively were treated by pedicle screws instead; 2 cases occurred fracture of spinous processes postoperatively or during follow-up, including 1 case underwent revision with pedicle screws, another 1 case treated with conservative treatment; 4 cases with degenerative coronal spondylolysis in surgical segments, 1 case with sagittal instability preoperatively, and 1 case with device dislodgment in follow-up all suffered aggravated pain and received conservative treatment; 1 case suffered implanted malposition intraoperatively was underwent internal fixation with pedicle screws instead; at length, 1 case with aggravated pain postoperatively and without definite reason received revision with internal fixation of pedicle screws demolishing the Coflex. The follow-up time of 13 cases ranged from 20 to 38 months (mean 27.6 months); and 7 cases implanted Coflex with aggravated pain of lumbar and lower limb, but the position of device can still maintained, were received conservative treatment, and whose score of VAS and ODI in the final follow-up were 1.9 ± 0.7 and 23.2 ± 3.4, and comparing to 6.1 ± 1.1 and 58.1 ± 3.0 preoperatively, evident improvement was got finally (t = 8.2 and 18.2, P < 0.01). Scores of VAS and ODI of 2 cases with Coflex implanted complications underwent revision with pedicle screws were also improved correspondingly.

CONCLUSIONSCoflex interspinous dynamic stabilization system implanted should be avoided to cases who suffered with osteoporosis, too narrow interspinous space and intervertebral coronal spondylolysis or sagittal instability; and choice of device, depth of implantation and intensity of clumping should be appropriate. For patients with symptom but device still in right position, conservative treatment can be carried out; but for patients subjected to malposition of device, failure of implantation intraoperatively or intolerance to device, revisions and salvages should be underwent with internal fixation of pedicle screws.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Internal Fixators ; adverse effects ; Intervertebral Disc Degeneration ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Spinal Fusion ; adverse effects ; instrumentation ; methods ; Treatment Outcome