OBJECTIVETo evaluate the local recurrence and 5-year survival of proximal fibular osteosarcoma.

METHODSFrom October 1997 to July 2005, 12 patients with proximal fibular osteosarcoma were treated. There were 9 males and 3 females. The mean age at diagnosis was 16 (9-23) years old. Histopathological diagnosis were obtained by trut-cut biopsy, Enneking surgical stages of 12 lesions were as follows: 11 grade II B and 1 grade III. Induction chemotherapy was applied to all patients except one who left the hospital after the biopsy. Of 11 patients, 8 were performed Malawer type I resection, and 3 type II. All patients continued to get postoperative chemotherapy.

RESULTSRegular follow-up was applied. Only 1 patient was found local recurrence one year after operation and received re-resection, the others did not. Four patients died of lung metastases, including the one who did not get treated, one stage III and two II B patients. The range of follow up was 6 to 117 months. The evaluated 5 year disease-free survival of 11 patients who got treated was 72.7% by using Kaplan Meier survival analysis.

CONCLUSIONSThe local recurrence is low, and 5 year disease-free survival is acceptable, in accordance with present point that marginal resection may not impact survival for fibular osteosarcoma. No knee instability is found in this group after great care is taken for proper reconstruction of lateral collateral ligament and reinsertion of biceps femoris tendon on the lateral condyle of tibia.

Adolescent ; Adult ; Bone Neoplasms ; surgery ; Child ; Female ; Fibula ; Follow-Up Studies ; Humans ; Male ; Neoplasm Recurrence, Local ; Osteosarcoma ; surgery ; Survival Analysis

Objective To observe the effects of exogenous interleukin (IL)-6 on survival time and regeneration of liver grafts in an orthotopic liver transplantation model in IL-6 knockout (KO) mice.Methods A model of liver transplantation in C57BL/6 wild type (WT) and IL-6 KO mice with C57BL/6 background was established. Grafts were preserved at 4 ℃ in UW solution before transplantation.Study was divided into 4 groups:IL-6 KO→IL-6 KO control group,IL-6 KO→C57BL/6 WT group,IL-6 KO→IL-6 KO+ rIL-6 group,and IL-6 KO→C57BL/6 WT+ rIL-6 group.Recipient animals were injected subcutaneously with human recombinant IL-6 (1 mg/kg body weight) 1 h before transplantation.Survival of liver grafts after transplantation was followed up.Hepatocyte replication with BrdU uptake after liver transplantation was examined by irnmunohistochemistry.Results A total of 48 liver transplantations were performed.Cold ischemic time was 50 min.The survival time of liver grafts in the control group was 2.2 days,and that was 1.9 days,＞17.6 days and ＞20.4 days in IL-6 KO→C57BL/6 WT group,IL-6 KO+ rIL-6 group and C57BL/6 WT+ rIL-6 group respectively with the the difference being statistically significant among the latter three groups (P＜0.01 ).The liver grafts transplanted in control group recipients showed patchy areas of necrosis and hepatocyte ballooning.Slight increase in BrdU uptake was found at 48 h post-transplantation.Minimal injury and no necrosis were observed in IL-6 treated groups.Mild increase of BrdU uptake was demonstrated at 48 h after liver transplantation. Conclusion Exogenous recombinant IL-6 appears to significantly prolong the survival time of IL-6 KO liver grafts after liver transplantation and enhance the regenerative response after liver transplantation in IL-6 KO mice.

Objective To explore the effect of different cold ischemia (CI)times on the patterns of intra-graft T cell activation gene-3 (TCA-3) expression early after isogeneic half liver transplantation (PLT)in mice. Methods The models of C57BL/6 full-size(FS) and PLT were established.The CI time was 1,4 and 8 h.Specimen were collected at 4 and 24 h post-reperfusion.Ribonuclease protection assays (RPA)was used to evaluate serial mRNA expression of the TCA-3 chemokine in all mice.Histopathology was used to examine cold ischemia injury in the liver grafts. Results A total of 45 control and 30 PLTs were performed.The survival rate at 7 day after control and PLT was 100％.Quantitative analysis demonstrated the levels of TCA-3 mRNA expression were low at 4 h after reperfusion in control group with 1,4,8 h CI.The levels of TCA-3 significandy increased at 4 h after reperfusion in PLT group with CI of 1,4,8 h and the difference between the two groups was statistically significant ( F =7.41,P ＜ 0.05 ). TCA-3 mRNA expression significantly decreased at 24 h after reperfusion in two groups. But the difference was not statistically significant ( P ＞ 0.05 ). Histopathology showed severer cold ischemia injury in PLT grafts compared with control grafts. Conclusions The expression of TCA-3 significandy increased early after PLT and played an important role in cold ischemia injury.TCA-3 could be used as the early therapeutic target for reducing ischemia injury in PLT grafts.

Abstract: Objective　To analyze the serotype distribution, drug resistance rate and drug resistance gene carrying of Streptococcus pneumoniae isolates in hospitalized patients, and evaluate the coverage of the vaccine to the serotype of Streptococcus pneumoniae in this area, so as to provide reference for the rational use of antibiotics in clinic. Methods　A total of 150 strains of non-repetitive Streptococcus pneumoniae isolated from inpatients from January 2015 to December 2019 were collected for serotyping and antimicrobial sensitivity test. The carrying rates of pbp2b, ermB and tetM were detected by PCR. Results　The PCR classification rate of 150 strains of Streptococcus pneumoniae was 93.1%, and the classification rate of capsular swelling test was 100%, and a total of 19 serotypes were divided, mainly 19F and 6B. Children's serotypes were predominantly 19F, 6B, and 15A; adult serotypes were predominantly 19F, 14, and 23F. The coverage rates of the PCV7, PCV10, PCV13 and PPV23 vaccines were 36.8%, 42.1%, 57.9% and 68.4%, respectively. Strains with serotypes of 19F, 6B, 3, and 23F had higher rates of resistance to antimicrobials. The sensitivity of Streptococcus pneumoniae to penicillin was greater than 96.0%. Antimicrobials with significant differences in resistance rates between invasive and non-invasive strains were penicillin, moxifloxacin, and levofloxacin. The percentage of strains carrying both ermB and tetM resistance genes was 96.0%, and the concordance rate between pbp2b, ermB and tetM resistance genes and the resistance phenotype was >98.0%. A total of 10 multi-resistance combinations were detected, with a multi-resistance rate of 62.6%, and the multi-drug resistance pattern of Streptococcus pneumoniae was mainly concentrated in the 19F and 6B serotypes. Conclusion　There are significant age differences in the serotypes of Streptococcus pneumoniae in this area. The vaccine currently used has low coverage in this region and therefore offer limited protection to the population. The drug resistance rates of Streptococcus pneumoniae varied significantly among serotypes. Erythromycin and tetracycline are not recommended for clinical treatment of Streptococcus pneumoniae. Penicillin can still be used as the first choice for clinical treatment of Streptococcus pneumoniae infection.

OBJECTIVETo observe initial radiographic manifestations and evaluate its value for the diagnosis and differential diagnosis in patients with severe acute respiratory syndrome (SARS).

METHODSInitial chest radiographs of 79 patients, 15 to 69 years old (mean age 34.1 years, 40 men and 39 women), were retrospectively reviewed in the study. For all patients, average temperature was 38.8 degrees C and mean time from onset of the fever to the time of initial radiographs taken was 5.8 days. Location, abnormal distribution, appearance of lung abnormalities, effusion of pericadiaum and pleura, and lymphadenopathy were observed. Abnormal distribution and associated findings were compared. Differences of mean age, temperature, and the time were statistically analyzed between patients with and without abnormal findings.

RESULTSInitial chest radiographs were normal in 36 of 79 patients (45.5%). Abnormal radiographs in 43 patients (81.3%) showed exudative changes. No significant difference of mean age and day (form onset of the fever to the time of initial radiographs taken) was found between the patients with and without abnormal initial chest radiographs (P > 0.05). No lymphadenopathy, effusion of pericadiaum and pleura were found on the initial chest radiographs.

CONCLUSIONSThe main abnormal radiographic appearance of lung in patients with SARS is exudative changes. SARS patients with normal initial chest radiographs are not uncommon and abnormal radiographic findings may appear to be late after onset of fever. Therefore, more attention should be paid in the clinical diagnosis of SARS.

Adolescent ; Adult ; Aged ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Severe Acute Respiratory Syndrome ; diagnostic imaging

Objective To detect the influence of fluoride on the expression TM9SF1 mRNA and Ras mRNA of osteoblasts. Methods The third generation of primary cultured osteoblasts were exposed to a series concentrations of 0,2.5,5.0, 10.0,20.0 mg/L fluoride for 10 days. The influence of different doses of fluorine on the expression of TM9SF1 mRNA and Ras mRNA of osteoblasts cultured in vitro was investigated by SYBR Green I methods. Results The osteoblasts of the control group and the 2.5 mg/L group were in the shape of long spindle, triangle or irregular polygon and had processes, and the cytoplasm was translucent, adjacent cells affixed to each other under light microscope. Those of the 20.0 mg/L group shaped as long spindle or irregular polygon, and some vacuolization and granular materials appeared in cytoplasm. The number of the cells decreased and the volume increased significantly. After exposed to fluoride for 10 days, osteoblasts of 2.5 mg/L group morphologically proliferated. There were statistical siguificances between each groups of TM9SF1 mRNA in human osteoblasts(F = 322.82, P < 0.01). The highest in the 2.5 mg/L group(9326.0 ± 115.97), the expression of TM9SF1 mRNA decreased along with the increasing dose of fluorine. There were statistical significances between 5.0, 10.0,20.0 mg/L groups(6495.0 ± 323.9, 4387.5 ± 545.2, 5962.5 ± 536.7) and control group(9221.0 ± 107.5, all P< 0.01). There was a statistical significance between each groups of Ras mRNA in human osteoblasts(F = 703.28, P < 0.01). The highest in the control group, the expression of Ras mRNA decreased along with the increasing of dose of fluorine. There were statistical significance between 2.5, 5.0, 10.0, 20.0 mg/L groups(6144.5 ± 270.82,5603.5 ± 88.39,3181.0 ± 159.81,4067.5 ± 37.4) and control group(6571.0 ± 196.58). Conclusion The influence on TM9SFI mRNA and Ras mRNA expression in osteoblasts correlates with the dose of fluorine.

Objective To explore the clinical significance of preoperative ultrasound-assisted drawings in location of thyroid micronodule resection .Methods A total of 88 patients ( 137 nodules ) who underwent thyroid micro-nodule resection were enrolled in the prospective randomized controlled study .All patients were randomly divided into two groups:46 patients (68 micronodules) in experimental group and 42 patients (69 micronodules) in control group.Inclusion criteria:the maximum diameter of nodule≤1.0 cm. Preoperative thyroid ultrasound was conducted .Patients in experimental group also underwent ultrasound-assisted location of thyroid micronodule .Results The diagnostic accuracy rate of US was 81.82%(69/88) in all patients .With the help of ultrasound-assisted location , all nodules in experimental group were found quickly and accurately.The resection rate of experimental group was 100%(46/46).Whereas 4 nodules (in 4 patients ) were missed in control group with a resection rate of 90.5% (38/42).The postoperative US examinations after 3 months showed that all nodules were completely removed in experimental group while 4 nodules retained in control group .Conclusions Preoperative ultrasound-assisted drawings in location of thyroid micronodule plays an important role in thyroid nodule resection .It is great value of clinical application .

Objective To investigate the treatment of biliary complications in perioperative stage of live transplantation. Methods From January 2007 to December 2009, 23 patients suffered from surgical biliary complications after liver transplantation. The clinical data including the types of biliary leakage,treatment, prognosis were analyzed retrospectively. Results Of 12 biliary leakage patients, 7 were anastomotic leakage, 3 with leakage of bile duct on the cutting surface of the graft of living ralated liver transplation, 1 with cystic duct leakage and 1 with leakage of aberrant biliary duct. Of 11 biliary stricture patients, 4 patients were anastomotic stenosis and 7 patients were no-anastomotic stenosis. The anastomotic biliary leakage of 7 patients was cured with biliary tract reconstruction in 2 patients, with cholangioenterostomy in 2 patients, with biliary reparation in 1 patient and peritoneal drainage in 1 patient but the patient with dual graft received re-transplantation. Three patients with biliary leakage on liver cut surface respectively receiving reparation or drainage were cured, of which 1 patient suffered from bile duct stricture and was finally cured by ERCP. One patient with biliary leakage of aberrant bile duct and 1 with biliary leakage of cystic duct were cured by salvage surgery. For the 4 patients with anastomotic stenosis, 3 patients were cured by ERCP and 1 patient recovered by biliary reconstruction. Among the patients with nonanastomotic stenosis, 3 cases were alleviated by ERCP or PTCD, another 3 patients had to receive retransplantation, of which 2 patients recovered well without surgery-related complications, one died of severe infection. Conclusions Biliary complications are common among liver transplant patients often causing significant mortality and morbidity necessitating comprehensive salvage procedures, though most of them are preventable.

OBJECTIVETo determine the independent prognostic factors of primary synovial sarcoma.

METHODSThe clinical data of 52 patients followed up from 66 patients with synovial sarcoma treated between September 1997 and September 2008 was analyzed retrospectively. There were 28 male and 24 female patients aged from 11 to 71 years old. Three and five-year overall survival (OS), recurrence rate and 9 prognostic factors were analyzed in this study. Univariate and multivariate analysis were performed to determine the prognostic factors of OS.

RESULTSFifty-two patients were followed up with the follow-up time ranged from 6 to 88 months (median 32 months). The 3-, 5-year overall survival rate and local recurrence rate were 52.8%, 30.3% and 32.7% respectively. Univariate showed tumor size < 5 cm, tumor located at extremities, adequate surgical margin and radical resection combined with radiotherapy had better survival rate (P < 0.05). Multivariate analysis demonstrated that tumor size, primary site and adequate surgical margin were independent prognostic factors for OS. Patients received radical resection combined with radiotherapy have longer median relapse time (25 months) compared with marginal resection combined with radiotherapy (18 months) and single radical resection (12 months). Thirty-five (67%) patients were treated with chemotherapy and seventeen (33%) patients received no chemotherapy for the primary tumor. Treatment with chemotherapy was not associated with an improved OS (P = 0.52).

CONCLUSIONSThe independent prognostic factors of synovial sarcoma are tumor size, primary site and adequate surgical margin. Doxorubicin and ifosfamide based chemotherapy was not associated with an improved OS in patients with synovial sarcoma. Radical resection combined with radiotherapy can best control local condition.

Adolescent ; Adult ; Aged ; Antineoplastic Agents ; therapeutic use ; Child ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local ; Prognosis ; Regression Analysis ; Retrospective Studies ; Sarcoma, Synovial ; diagnosis ; drug therapy ; radiotherapy ; surgery ; Young Adult

OBJECTIVESTo define the role of high transthoracic approach in the treatment of cervicothoracic and high thoracic tumor, and analyze the problem encountered during tumor resection and reconstruction of this technique and oncological results of patients who received this type of surgery.

METHODSTwenty-one patients with cervicothoracic and high thoracic tumor (T(1 - 4)) were treated with high transthoracic approach. This series included metastatic tumor 11 patients, eosinophilic granuloma of bone 2 patients, osteosarcoma 1 patient, Ewing's sarcoma 2 patients, chondrosarcoma 2 patients, giant cell tumor 2 patients, lymphoma 1 patient. High transthoracic approach was applied to these patients for tumor resection and spinal cord decompression. Reconstruction method included artificial vertebrae implantation or bone graft implantation combined with anterior internal fixation.

RESULTSChest-back pain of all patients relieved significantly after operation. Paraplegia of 3 patients was improved from grade A to grade D according to Frankel grading system, the other 2 patients recovered completely. Pulmonary infection and pulmonary atelectasis occurred in 2 patients; cerebrospinal fluid leakage happened in 1 patient; thoracic aorta rupture happened in 1 patient. The follow-up period was 11 - 58 months, 9 patients died, including 7 patients with metastatic cancer, 1 patient with Ewing's sarcoma, 1 patient with osteosarcoma.

CONCLUSIONSHigh transthoracic approach is a satisfactory method in dealing with the lesion of cervicothoracic and high thoracic vertebrae, especially with the lesion involving the vertebrae and single vertebral arch. The thoracic canal can be decompressed effectively by this approach.

Adolescent ; Adult ; Aged ; Child ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Scapula ; surgery ; Spinal Neoplasms ; surgery ; Thoracic Surgical Procedures ; Thoracic Vertebrae ; surgery ; Treatment Outcome