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Objective:To evaluate the curative effects of Masquelet technique and 3D printing in repair of Cierny-Mader type Ⅳ long bone osteomyelitis.Methods:A retrospective study was conducted of the 8 patients who had been treated at Department of Orthopaedics, The Third Affiliated Hospital to Peking University for Cierny-Mader type Ⅳ osteomyelitis of the lower extremity from June 2017 to December 2019. They were 6 males and 2 females, aged from 27 to 79 years (average, 54.6 years). The defects involved femoral shaft in 5 cases, femoral metaphysis in one, tibia shaft in one, and tibial metaphysis in one. The defect lengths ranged from 7.7 to 15.5 cm, averaging 10.2 cm. Stage one was local infection control and temporary stability reconstruction using Masquelet technique, stage two design and 3D printing of the prosthesis and stable pattern design, and stage three prosthesis implantation and rehabilitation. The ranges of motion of the knee and ankle were recoded postoperatively and the functions evaluated using the Johner-Wruhs scores.Results:The average follow-up time for the 8 patients was 12.6 months (from 6 to 18 months). The total treatment time from the first admission to the last discharge ranged from 62 to 125 days (average, 91.0 days), the time for stage one from 13 to 57 days (average, 28.7 days), that for stage two from 30 to 87 days(average, 48.3 d), and that for stage three from 28 to 84 days (average, 63.0 days). The infection was controlled and there was no recurrence, implant loosening or breakage. Seven patients were capable of full weight-bearing at 14.7 days (from 4 to 42 days) after surgery. One patient recovered full weight-bearing 6 months after surgery due to severe osteoporosis. Fine functional recovery was achieved in the 8 patients, with a range of motion from 0° to 100° for the knee and a range from 35° dorsal flexion to 40° toe flexion for the ankle. The Johner-Wruhs scores at the last follow-up showed 2 excellent, 5 good and one moderate cases.Conclusion:In repair of Cierny-Mader type Ⅳ long bone osteomyelitis, Masquelet technique and 3D printing can shorten the treatment process and allow for early recovery.

Objective: To analyze the expression and clinical significance of solute carrier family 5 member 5 (SLC5A5), the coding gene of sodium/iodide symporter (NIS), in thyroid carcinoma. Methods: The messenger RNA (mRNA) expression of SLC5A5 in thyroid carcinoma and normal thyroid tissues from The Cancer Genome Atlas (TCGA) was compared using independent-sample t test and results were shown in one scatter plot. The relation between clinical features of thyroid carcinoma and the changes of SLC5A5 mRNA was analyzed on LinkedOmics using Kruskal-Wallis test or Wilcoxon test. Results: Data from TCGA showed that the SLC5A5 mRNA expression in thyroid carcinoma (1.419±0.049) was significantly reduced compared with that in normal thyroid tissues (3.301±0.087; t=12.66, P<0.01). The expression of SLC5A5 mRNA in thyroid carcinoma is affected by ethnicity (χ²=0.300, P<0.05). Moreover, the expression of SLC5A5 mRNA were decreased with the increase of pathologic grading (Ⅰ, Ⅱ, Ⅲ, Ⅳ) and T, N, M stages (χ² values: 0.114, 0.215, z values: -0.345, -0.102, all P<0.05). Conclusions The expression level of SLC5A5 mRNA is associated with clinical characteristic of thyroid carcinoma. SLC5A5 mRNA has the potential to become one candidate biomarker to assess disease and predict the development of thyroid carcinoma.

Objective To explore the correlation between thyroid nodules and uric acid levels and to find their gender differences.Methods A total of 68 056 subjects in a regional medical physical examination center of Shanxi Province from January 2013 to June 2015 were enrolled in this study.All the participants′ general information and parameters were recorded.Thyroid nodules were detected by color Doppler ultrasonography.Results The total prevalence of thyroid nodule was 35.5%, 30.7% in males and 40.0% in females.The prevalence of single nodule was 50.1%, and multiple 49.9%.Compared with no nodule group, thyroid nodule group tended to be older, with higher BMI, and with a worse metabolic status(all P<0.01).The uric acid levels were lower[(352.37±78.14 vs 357.70±77.51) μmol/L, P<0.01] in thyroid nodule group in male and higher[(260.22±61.91 vs 253.91±59.18) μmol/L, P<0.01] in female.Conclusion Thyroid nodules may be associated with metabolism and inflammation.In males, hyperuricemia group had lower, while in females, hyperuricemia ones were with a higher prevalence of thyroid nodules.

Cervical and mediastinal lymph nodes ( CMLN) are usually close to some important ves-sels, nerves and organs, which brings much difficult for surgical and radiotherapy. CT-guided 125 I seed im-plantation is becoming an effective, safe and reliable treatment. CT could be used to observe the distribution of seeds, complication and therapeutic effect after the implantation. This paper focuses on the advances of CT-guided 125 I seed implantation on residual or relapsing metastatic CMLN.

Objective: To identify the risk factors for failure of internal fixation with proximal femoral nail antirotation (PFNA) for reverse intertrochanteric hip fractures. Methods: A retrospective study was conducted of the 45 patients with reverse intertrochanteric hip fracture who had been treated with PFNA fixation from January 2006 through January 2018 at the Department of Traumatic Orthopaedics, The Third Affiliated Hospital to Peking University. They were 19 males and 26 females, aged from 19 to 97 years (average, 71.9 years). According to the AO/OTA classification, there were 7 cases of type 31-A3.1, 4 cases of type 31-A3.2 and 34 cases of type 31-A3.3. Fracture healing was judged according to the X-ray at the time of last follow-up. The patients were assigned into a healed group and a failed group. The 2 groups were compared in terms of gender, age, body mass index (BMI), mechanism of injury, AO classification, type of main fracture line, reduction method, reduction quality, status of lateral femoral wall and tip-apex distance. A multivariate logistic regression model was designed to analyse the dependent variable 'implant failure’ with a set of independent variables as risk factors. Results: The 45 patients were followed up for 12 to 62 months (average, 28.4 months). Implant failure was observed in a total of 6 patients (13.3%), 3 of whom had helical blade perforation, 2 main screw breakage, and one cut-out of helical blade. The single factor analysis revealed significant differences in reduction quality and type of main fracture line between the patients with successful fixation and those with failed fixation (P<0.05). The multiple logistic regression analysis identified poor reduction quality (OR=30.809, 95%CI: 1.052~902.298, P=0.047) and a transverse fracture line (OR=25.639, 95%CI: 1.636~401.917, P=0.021) as risk factors for implant failure. Conclusion Poor reduction quality and a transverse fracture line may be predictors of implant failure in reverse intertrochanteric hip fractures treated with PFNA fixation.

Objective To investigate the unmet needs of thyroid cancer patients undergoing 131Itreatment and their relationship with psychological distress and quality of life.Methods From October 2014 to March 2016,a total of 338 patients (106 males,232 females,average age (35.50±9.98) years) with thyroid cancer who were receiving 131I treatment were enrolled.The 34 items of Supportive Care Needs Survey Short Form (SNCS-SF34) were used to investigate the unmet care needs of patients.Patients' perceptions of distress and main causes of distress were measured by Distress Thermometers (DT) and issue list.The 12-item Short-Form Health Survey (SF-12) was used to measure patients' quality of life.Pearson correlation analysis was used to analyze the data.Results The degrees of patients' unmet care needs from high to low were as following:health information needs (65.38％,221/338),psychological needs (47.93％,162/338),patients' care and support needs (44.08％,149/338),physical and daily needs (36.09％,122/338) and sexual needs (34.32％,116/338).There were 47.93％(162/388) patients with DT score ＞ 4.The top three causes of patients' distress were fears,fatigue and memory deterioration.Degree of unmet needs for patients had positive correlation with the degree of psychological distress (r values:0.232-0.462,all P＜0.01).The unmet physiological and daily needs and psychological needs of patients had negative correlations with several dimensions of quality of life (r values:from-0.367 to-0.202,all P＜ 0.05).Conclusions The unmet care needs of patients with thyroid cancer have correlations with their psychological distress and quality of life.Evaluation of the unmet care needs of patients with thyroid cancer could be beneficial for providing the targeted care.

The liver reserve function refers to the compensatory ability to maintain liver function after damage, providing implication for the resection of hepatic malignant tumor. Hepatobiliary scintigraphy imaging can provide quantitative evaluation of liver blood perfusion, and has advantages on the evaluation of liver reserve function and the prediction of postoperative complications. 99Tc m-galactosyl serum albumin (GSA) and 99Tc m-mebrofenin are commonly used imaging agents for hepatobiliary scintigraphy imaging assessment of liver reserve function. This article reviews the application and progress of hepatobiliary scintigraphy in liver reserve function assessment.

Iodine is an essential trace element in the human body, and the gastrointestinal tract is the main way for the body to intake iodine. The intestinal tract contains trillions of microorganisms that have important impacts on the substance-energy metabolism and the genetic information processing in the human body. Gut microbiota or their metabolites can act on the thyroid through the circulatory system (namely the " gut-thyroid axis" ), thus potentially regulating iodine metabolism in thyroid. This article reviews the effects of gut microbiota on intestinal iodine uptake, as well as the effects of gut microbiota and their metabolites on the expression and activity of sodium iodide symporter (NIS) in thyroid cells, thus exploring the potential regulatory mechanisms of gut microbiota that involved in thyroid iodine metabolism. Potential factors affecting thyroid iodine metabolism by gut microbiota include the direct and the indirect factors. The direct factors include lipopolysaccharides, short-chain fatty acids, microbial peptides, and microbial proteins, which may affect the expression or activity of NIS in thyroid by regulating the nuclear factor kappa-B pathway, histone acetylation modifications, or antigen-antibody reactions. The indirect factors include the altered cellular environment that effected by gut microbiota which can further affect the transport of iodine ions in thyroid cells by manners like regulating the levels of thyroid-specific transcription factors and regulating the signal pathways mediated by thyroid-stimulating hormone and its receptor.

Objective:To investigate the differential diagnostic value of 18F-FDG PET/CT in multiple myeloma (MM) and unknown osteolytic metastasis (UOM). Methods:A retrospective study was performed on 18F-FDG PET/CT imaging of 43 patients (29 males, 14 females, age: (61.5±12.9) years) with multiple bone destructions and without extraosseous primary malignant tumor between June 2017 and March 2020 in Tenth People′s Hospital of Tongji University. Through follow-up, 20 patients (13 males, 7 females, age: (61.1±12.2) years) were pathologically confirmed as MM and 23 patients (16 males, 7 females, age: (61.4±13.9) years) were pathologically confirmed as UOM. The whole body skeleton was categorized to 8 sites including skull, spine, ribs, pelvis, sternum, clavicle, scapula and limb bone. The differences of the cross-sectional length of the lesion, cortical bone damage, SUV max and the distribution of imaging agent were compared between the two groups in different parts. Independent-sample t test and Mann-Whitney U test were used to analyze data. Results:The UOM group was invisible on clavicles, and spine and pelvis were the most predilection sites in both MM and UOM groups (spine: 41.30%(299/724) and 49.37%(117/237); pelvis: 24.45%(177/724) and 26.58%(63/237)). The cross-sectional length of lesions in the skull, spine, ribs, pelvis and limb bone in MM group were significantly shorter than those in UOM group (5.45(4.30, 8.06) vs (13.89±11.66) mm, 6.15(3.89, 10.06) vs 11.48(7.73, 16.90) mm, 7.01(4.59, 10.56) vs (24.61±16.22) mm, 8.20(5.14, 13.71) vs (21.12±13.31) mm, (8.48±5.75) vs (19.13±14.26) mm; z values: from -8.88 to -2.52, t=-2.76, P<0.001 or P<0.05) and SUV max of above lesions and scapula in MM group were significantly lower than those in UOM group (1.50(1.00, 2.20) vs 17.15±11.40, 2.60(2.00, 4.10) vs 8.20(5.65, 11.90), 2.30(1.40, 5.28) vs 10.58±5.52, 2.50(1.80, 3.90) vs 9.34±6.01, 3.08±2.41 vs 11.38±6.38, 2.45(1.50, 4.43) vs 6.90(4.63, 17.80); z values: from -13.87 to -2.41, t=-4.85, P<0.001 or P<0.05). The imaging agents in lesions on the skull, spine, ribs, pelvis, scapula and limb bone were more evenly distributed in MM group, while the imaging agents in lesions were more unevenly distributed in UOM group. On the skull, spine and ribs sites, the MM group was more likely to show no cortical bone damage; however, the UOM group showed cortical bone damage in the above sites. Conclusion:It is helpful for doctors to distinguish MM and UOM by comparing the cross-sectional length of the lesion, cortical bone damage, SUV max and the distribution of imaging agent in 18F-FDG PET/CT imaging before getting pathologic results.