BJECTIVE: To explore the effect of different convergent conditions on accuracy of simulation results from a three dimensional finite element model of the pelvic ring.METHODS: A first-order linear load of 600 was applied on the S_1 vertebral endplate in an established three-dimensional finite element model. The step length was set to 0.1 s. The boundary condition was set as constraint of 6 degrees of freedom in the proximal femur. Static and dynamic explicit convergences with 6 different weight scale factors were calculated retrospectively,and all the simulated results were compared with the experimental results in order to verify the accuracy. RESULTS: The static convergence predicted most accurate with the linear regression coefficient 0.88. With the increase of weight scale factor, the time cost decreased. However, the accuracy of the predicted results decreased. There was statistically difference between the simulation results and experimental results when the weight scale factor achieved 3 000 (P<0.05) and the coefficient of linear regression was lower than 0.8.CONCLUSION: It suggested that as for the complex finite element model, especially when the model contains complex contact conditions, dynamic explicit convergence can be an alternative solution to static convergence if the latter failed. Also proper weight scale factor should be used to decrease the time cost under the condition that the error was in the limited.

Background and purpose: Alveolar soft part sarcoma (ASPS) is a rare malignant neoplasm characterized by slow growth and indolent behavior, and most of the patients had metastases in diagnoses. This study was to define clinical features and assess prognostic factors of ASTS. Methods: Between January 2003 and December 2008, there were 15 patients with ASTS who received treatment and were followed up in the Department of Orthopedic Ontology of Peking University People's Hospital. We retrospectively analyzed the clinical factors of the disease related to prognosis: gender, age, tumor size, primary tumor site, metastatic sites, local recurrence, the roles of postoperative radiotherapy and postoperative chemotherapy. Resnlts: At a follow-up from 7 to 76 months, only 2 patients had local recurrences after excision, but there was a high incidence of pulmonary metastases. Only 6 patients achieved disease free survival, 5 patients died of metastases or other complications. The five-year overall survival rates was 41.7%, and the median survival time was 42.0 months. Univariate analysis and Cox regression analysis revealed that tumor size, tumor primary site and metastases at diagnoses were prognostic factors, but not gender and age, Conclusion: Alveolar soft part sarcoma is a high grade malignant soft tissue neoplasm with frequent metastases to lung, bone or brain. Tumor size, primary tumor site and metastases at diagnoses are some of the prognostic factors. Chemotherapy or radiotherapy after surgery have no benefit to the survival in our analysis. Further prospective studies are needed to clarify the best strategy for the treatment of ASPS.

Objective To investigate technique,effect,complications of limb salvage surgery for malignant tumors of the proximal tibia involving the fibula.Methods Between November 1998 and February 2010,32 patients with malignant tumors of the proximal tibia involving the fibula underwent limb salvage surgery in our institute.There were 21 males and 11 females,aged from 10 to 66 years (average,23.4years).There were 23 cases of osteosarcoma,5 cases of chondrosarcoma,1 case of malignant giant cell tumor,and 3 cases of soft tissue sarcoma.All patients received en bloc resection of tumor including proximal tibia and fibula.During operations,ligation of anterior tibial vessels was performed in 14 patients,anastomosis of posterior tibial vessels in 1 patient,both ligation of anterior tibial vessels and anastomosis or replacement of posterior tibial vessels in 5 patients.The common peroneal nerve was resected in 4 patients,and the deep peroneal nerve was resected in 5 patients.The reconstruction methods included prosthetic replacement in 24 patients,replacement with inactivated autograft-prosthesis composite in 5 patients,and replacement with inactivated autograft in 3 patients.The caput mediale musculi gastrocnemii flap was transferred to reconstruct soft tissue defect in 14 patients,while caput laterale musculi gastrocnemii flap was transferred in 1patient.Results All patients were followed up for 11 to 159 months (average,39.4 months).Local recurrence occurred in 6 patients (18.8％).The overall 5-year survival rate was 51.2％.Fourteen patients died of tumor metastasis,2 survived with tumor,and 16 patients survived without tumor.Variant complications occurred in 15 patients (46.9％).The complications included ischemia of the lower leg in 4 patients,peroneal nerve palsy in 12 patients (permanent palsy in 9 patients and temporary palsy in 3 patients),wound healing problem in 4 patients,deep infection in 1 patient,and periprosthetic fracture in 1 patient.The mean MSTS 93 score was 21.6 points (72％).Conculusion The indications of limb salvage surgery for malignant tumors of the proximal tibia involving the fibula should be restricted.Although complications are encountered frequently,most patients have acceptable postoperative function.

Child, Preschool ; Diagnosis, Differential ; Female ; Humans ; Lead Poisoning, Nervous System, Childhood ; diagnosis ; therapy ; Male

Objective To determine the feasibility of limb salvage with major vascular reconstruction for sarcomas of extremities, focusing on the early complications, oncological and functional outcomes.Methods Between August 2004 and June 2009, 13 patients (mean age 38 years, range 14-63 years) underwent wide resection of upper and lower extremity sarcomas to include the involved arterial and venous segments. 4 patients had bone sarcomas and 9 soft tissue sarcomas, 6 patients only had underwent artery replacement and the other 7 had underwent both artery and vein. 8 resected vessels were reconstructed with vascular graft and 5 with ipsilateral or contralateral saphenous vein. Results No patient suffered from reperfusion injury and infection. The patient with osteosarcoma in proximal humerus had suffered acute arterial graft thrombosis at first day postoperatively; however, the limb was salvaged after successful thrombectomy. 5 of 8 patients with synthetic graft developed minor delayed wound healing and hematoma, but the other 5 patients with autologous saphenous vein replacement did not. The mean follow-up was 19.4 months (7-45months). One patient died of pulmonary metastasis; the patient with osteosarcoma in proximal humerus had developed local recurrence, but refused amputation and was alive with metastasis. No arterial occlusion was observed at final follow-up or at the time of death, but the patency of artery and vein was 100% and 28.6%respectively. One patient who has pulmonary metastases before operation died of metastases 7.5 months after operation. Four patients developed pulmonary metastases, therefore, Kaplan-Meier survival analysis showed that 2-year overall and metastasis-free survival rate was 90.9% and 63.6% respectively. Functional status were judged as good or excellent (mean MSTS score 72%) in 12 of 13 patients. Conclusion The study indicate that malignant involvement of major vessels is not a contraindication for limb-salvage. Vascular reconstruction is a feasible option in limb salvage surgery. Wide resection with vascular reconstruction provide acceptable oncological and functional outcome of limb salvage.

Fluid therapy has been the focus of attention and dispute. In this paper, there are three aspects including postoperative bowel function, surgical prognosis, and acute diffuse peritonitis. Colloidal supplement and appropriate crystal/colloid ratio should be noted in low perfusion conditions. The different types of fluid in recent studies did not show a significant difference in the long term. The new evidence will be noted in fluid therapy among 2012 SSC Severe Sepsis and Septic Shock Guideline update (unpublished).
Digestive System Surgical Procedures ; Fluid Therapy ; Humans ; Perioperative Care ; Peritonitis ; therapy ; Prognosis ; Shock, Septic ; therapy

Objective: To determine the prognostic factors of primary osteosarcoma in adults . Methods:This is a review of 54 patients older than 40 years (24 men and 30 women) who were treated between 1998 and 2011 at the authors ’ institution .Demographic information and follow-up data were obtained and statistically analyzed .Results: Tumors involved the limbs in 30 patients ( 55 .5%) and axial skeleton in 17 patients (31.5%), and arose from soft tissue in 7 patients (13%).And 6 patients (11.1%) had synchronous metastasis .According to our review , tumors were treated surgically in 52 patients (96.3%).Local recurrence was documented in 14 patients (26.9%).Metastasis after diagno-sis appeared in 21 patients (38.9%).In the 52 patients who received the surgical treatment , the 5 year disease-free survival and overall survival rates were 43.7% and 50.4%, respectively.Conclusion:Adult patients with primary osteosarcoma had a poor clinical outcome .Inadequate surgical margins , more tumors in the axial location due to high recurrence rates , metastatic disease at presentation , and large tumor volumes were associated with significantly lower survival rates .Aggressive multi-agent treatment regimens might improve survival .

Objective To evaluate the clinical and functional outcome of biological reconstruction by using pasteurized autograft and massive allograft after en-bloc resection of primary femoral diaphyseal sarcomas.Methods Retrospectively reviewed 19 consecutive patients with primary femoral diaphyseal sarcomas between Feb.2005 and Dec.2013.There were 11 males and 8 females with the mean age of 18 (2-38) years old.Thirteen patients were diagnosed as osteogenic sarcoma (OS),while five Ewing' s sarcoma (EWS) and one malignant fibrous histocytoma (MFH).All patients were treated with wide local excision,and 9patients were reconstructed by intercalary femur segmental allograft and 10 by pasteurized autograft.The median length of the resected bone was 16.9 (9-24) cm.15 segmental grafts were fixed by using plates including 10 intramedullary free vascularised fibular graft constructs,the other 4 segmental grafts were fixed by intramedullary nails.The average operation time for pasteurized autograft construct was 5.1 hours,while the time for intercalary allograft construct was 4.22 hours.Of 38 host-donor junctions,there are 28 diaphyseal junctions and 10 metaphyseal junctions.Results The average operation time for pausterized autograft construct tended to be longer than intercalary allograft (5.1h Vs 4.22h),although the difference did not reach the significance.Bone union occurred at a median of 10.3 months and 7.25 months at diaphyseal and metaphyseal junction for pasteurized autograft-host construct; 13.8 months at the diapyhseal junction and 11.5 months at the metaphyseal junction for allograft-host construct.Bone healing time of diaphyseal junction and metaphyseal junction between these two constructs were significant difference.Eight of 19patients (42.1％) developed complications:5 bone unnunion/fracture (including 1 subsequently developed local recurrence),1deep infection and 2 local recurrence (including 1 soft tissue recurrence).The mean overall follow-up was 33.5 months (3-107),five patients died of lung metastases,the cumulative patient survival was 76.5％ at 2 years and 61.2％ at 5 years determined by Kaplan-Meier method.All living patients except the MFH patients who received amputation,had a mean MSTS score of 83.7％ (70％-95％).Conclusion Although the reconstructive procedure with pasteurized autograft is more complicated and needs longer operation time than allograft reconstruction,the bone healing time with autograft is significant shorter than allograft.Our observations suggest the pausterized autograft shell with intramedullary free fibular graft is strongly recommeded.

Objective To investigate the mechanism of anti-epileptic effect of the curcumin .Methods The SD rats were injected intraperitoneally with pentylenetetrazol kindling 25 .0 mg/kg to induce a rat epilepsy model .All of the treatments were performed once a day continuously for 28 days .The rats in blank group and model group received 5 ml of normal saline .The rats in the high and low curcumin group were given 200 mg/kg and 100 mg/kg of curcumin once a day ,respectively .The rats in the sodium valproate (VPA) group were given 400 mg/kg of VPA once a day by gavage .After treatment ,the seizures level was recorded by using the Racine′s six point grading scale ,and the expression of IL-2 and IL-6 of hippocampus were detected by the enzyme linked immunoassay (ELISA) .Results The seizures level was reduced by curcumin in epileptic rats .The ex-pressions of IL-2 and IL-6 of the model group were significantly higher than those of the blank group (P<0 .05) ,while those rats of the anti-epileptic groups ,including high dose group and low dose group ,were lower than those rats of the model group (P<0 .05) .When compared with the curcumin low dose group ,the expression of IL-2 and IL-6 of curcumin high dose group is lower (P< 0 .05) .There was no significant difference between the high dose curcumin group and VPA group (P>0 .05) . Conclusion The curcumin can reduce the seizure level in rats ,it shows some anti-epileptic effets and dose-dependently ,which may be through down-regulating the expression of IL-2 and IL-6 in hippocampus .

Objective To investigate the situations of close contacting with MDR-TB in family and analysis the necessity and urgency of family protection.Methods Nine typical primary MDR-TB cases in our hospital that close contacted with family pulmonary TB patients.their relatives contacted with them and their treatment prognosis were retrospectively analyzed.Results All of the 9 cases were transmitted by lineal MDR-TB relatives.In one case,3 generations were pumonary TB patients.All of 4 family members were pulmonary TBpatients in another case.3 cases were treated with operations:2 cases with pulmonary lobectomy and 1 case with intestinal resection.Treatment prognosis:3 cases cured,2 cases not cured,4 cases dead.Conclusions Family close contacting with MDR-TB patients should be intervened earlier:including health education,effective protection and health examination regularly et al.