Objective To evaluate the local recurrence rate,limb function and complications of soft tissue sarcoma of thigh after muscle group resection.Methods Between January 2009 and August 2016,twenty-threepatients who were diagnosed as soft tissue sarcoma for the first time in our hospital,receiving thigh quadriceps muscle group resection,adductor muscle group resection or posterior compartment of the thigh resection were incorporated into this study.Patients who had received surgery of this lesion before,suffered from recurrent soft tissue tumor,had tumor involved multiple muscle groups which could not be resected completely,had sciatic nerve or femoral artery or vein affected by tumor or had distal metastasis were excluded.This retrospective study consisted of 12 male and 11 female.The age ranged from 20-80 with the average of 52.All the patients received CT and MRI of thigh to figure out the size of tumor,the invaded extension of the lesion and the specific muscle group involved.Chest CT scan and ultrasound of bilateral inguinal lymph nodes were arranged to exclude the tumor metastases.After all these examinations were done,needle biopsy with the guidance of CT scan was performed for the pathological diagnosis.The pathology included undifferentiated pleomorphic sarcoma (7 cases),rhabdomyosarcoma (2 cases),primitive neurotodermal tumor (1 case),synovial sarcoma (1 case),leiomyosarcoma (3 cases),fibrosarcoma (5 cases) and liposarcoma (4 cases).Sixpatients received quadriceps muscle group resection,eightpatients received adductor muscle group resection and the other 9 patients received posterior compartment of the thigh resection.Patients with undifferentiated pleomorphic sarcoma,leiomyosarcoma,primitive neurotodermal tumor and synovial sarcoma received postoperative adjuvant chemotherapy.None of patients received radiotherapy.After surgery,drainage tube of negative pressure was placed until the volume of drainage was less than 50 ml within 24 h.The affected thigh was bound up tightly.Intravenous antibiotics were used for 3 days to prevent from postoperative infections.Patients received quadriceps muscle group resection stayed in the bed for 4 weeks.After that they could walk with the protection of orthosis with unbending position.Other patients got out of bed after 2 weeks.All the complications after surgery were recorded.Reexaminations were arranged in 3,6,12 and 24 months after surgery separately.After that,reexamination was arranged every half a year.Chest CT scan was used to detect lung metastasis and ultrasound or MRI was arranged for local recurrence.Lower limb function after surgery was evaluated by MSTS scores.Results All the surgeries of muscle group excision were successfully completed.The duration of surgery ranged 1.5-3.5 h with the average of 2.2 h.The bleeding volume during surgery ranged 100-1 100 mL with the average of 313 mL.The follow-up was a mean of 41 months (range,17-108 months).None was lost to follow-up.The local recurrence rate was 4.3％ (1/23).One patient with undifferentiated pleomorphic sarcoma had positive surgical margin,who received posterior compartment of the thigh resection.Local recurrence occurred 6 months after surgery.Then he received expanded resection.Six patients had distant metastases,five patients for lung metastases,one patient for lung and inguinal lymph node metastases.Of these,five patients had died and one lived with the metastasis.The median MSTS score was 26.3 points (range,14-30 points).Specifically,the median musculoskeletal tumor society (MSTS) score was 28 points (range,21-30 points) for 9 patients with posterior compartment of the thigh resection,twenty-nine points (range,27-30 points) for 8 patients with adductor muscle group resection,and 20.3 points (range,14-24 points) for 6 patients with quadriceps muscle group resection.Five patients had complications,including local recurrence (1 case),hematoma (2 cases) and cutaneous necrosis (2 cases),all of which were settled by reoperation.The rate of complication was 21.7％.Conclusion Muscle group resection is an effective surgical treatment for soft tissue sarcoma of thigh,which could reduce the risk of local recurrence,apart from quadriceps muscle group resection,the other two muscle group resections have limited impact on lower limb function,additionally,thigh muscle group resection is a safe procedure with few complications.

Local and/or regional recurrence is a common cause of the failure of primary radical radiotherapy for nasopharyn-geal carcinoma,and it is also a clinically existing treatment problem. Re-radiation therapy is one of main effective means of treatment for recurrent nasopharyngeal carcinoma. The article summarizes the recent domestic and abroad literatures on radiotherapy in vitro(in-cluding conventional two-dimensional,three-dimensional conformal,intensity-modulated radiotherapy),stereotactic radiotherapy, brachytherapy,proton beam and heavy ion therapy for recurrent nasopharyngeal carcinoma,and summarized the advantages and disad-vantages of different radiotherapies as well as their efficacies.

Cervical cancer is an important global public health problem,and its incidence tends to be younger in China.Compared with stage ⅡB cervical cancer,concurrent chemoradiotherapy has obvious advantages in reducing local recurrence rate,improving progression free survival rate,overall survival rate,and improving prognosis.Concurrent chemoradiotherapy and surgical treatment can effectively reduce local lesions and increase the opportunity for surgical resection.Synchronous radiotherapy and chemotherapy do not increase the difficulty of operation and postoperative complications.At the same time,all kinds of short-term and long-term complications caused by radical radiotherapy are avoided.The new adjuvant chemotherapy will strive for radical surgery,using radical surgery to eliminate the focus of radiotherapy and chemotherapy,improve the patient's survival time and improve the patient's quality of life.Preoperative radiotherapy can also maintain the physiological function of the vagina and avoid various complications caused by the amount of radical radiotherapy.

Objective To explore the impact of antiplatelet agents on the occurrence of hemorrhage after percutaneous nephrostomy (PCN).Methods Totally 197 patients (244 kidneys) underwent PCN were enrolled and divided into postoperative hemorrhage group and without postoperative hemorrhage group.The possible factors of the postoperative hemorrhage were analyzed.Results Post-operative hemorrhage occurred in 23 patients with 27 kidneys (27/244,11.07％).Univariate analysis showed that except for antiplatelet drugs,the other factors had no statistical difference between the two groups (P＞0.05).Logistic regression analysis showed that taking dual-antiplatelet was the risk factor of hemorrhage after PCN (OR=12.381,P =0.002).Conclusion Single aspirin therapy can not increase the risk of hemorrhage after PCN,while taking dual-antiplatelet might increase the risk of hemorrhage.Normal clotting function is also a guarantee of preventing hemorrhage after PCN.

Objective To investigate the clinical charactistics,diagnosis,treatment options and surgical efficacy of spinal osteoblastoma.Methods From May 2007 to May 2016,the clinical manifestations,imaging data,diagnosis,treatment and prognosis of 11 patients with spinal osteoblastoma were retrospectively reviewed.There were 7 males and 4 females.The age ranged from 15 to 44 years old with the average of 27.5 years.Two lesions were involved in cervical spine and 6 lesions were located in thoracic spine.The other 3 cases was in lumbar spine.All patients suffered from local pain.Four patients had neurological deficiency,with 3 suffering radicular pain and 1 suffering incomplete paraplegia (Frankel C).Four patients were staged as Enneking 2 and treated by intralesional curettage.Seven patients were staged as Enneking 3.Accordingly,4 patients were treated by expanded excision with single posterior approach and 1 patient was treated by expanded excision with combined anterior and posterior approach.The other 2 patients were treated by piecemeal total vertebrectomy with single posterior approach.The pain release,neurological recovery and tumor recurrence were evaluated by postoperative follow-up.Results The mean operation time was 3.5 h (range,1.5-7 h) and the average intraoperative blood loss was 800 ml (range,100-3 000 ml).1 patient had cerebrospinal fluid leakage and 2 patients had pleural effusion.No surgical infection was detected in any patient.After surgery,the pain was dramatically relieved in all patients.The radicular pain in 3 patients were relieved and the incomplete paraplegia in 1 patient was recovered to Frankel E.The mean follow-up period was 45.8 months (range,12-117 months).Recurrence occurred in 1 case of cervical 7 and thoracic 1 spine leison 4 years after the surgery.Another expanded excision of the tumor was conducted for this patient and no recurrence was detected till now.No other cases of recurrence were observed.No loosing or breakage of implantation was detected during the follow-up.Conclusion For Enneking 2 leisons,intralesional curettage was effective.For Enneking 3 leisons,the expanded excision or piecemeal total vertebrectomy were recommended.No matter the excision was intralesional or not,the satisfactory results could be achieved if complete tumor excision could be conducted.

Objective To explore the personalized treatment options and clinical results obtained by our hospital for different parts of bone destruction of different degrees of bone giant cell tumor.Methods Retrospective analysis from January 2005 to December 2014,according to the giant bone cell tumor diagnosis and treatment procedures used in thehospital to take wide resection or intralesional curettage and adjuvant therapy for the treatment of primary limb long bone giant cell tumor 281 cases.There were 150 males and 131 females,with overall age from 14 to 71 years and an average of 35.10 yearsold.The distal ulna was 9 cases.The distal radiuswas 26 cases.The proximal humerus was 19 cases.The distal humerus was 2 cases.The proximal femur was 38 cases.The distal femur was 95 cases.The proximal tibiawas 59 cases.The distal tibiawas 10 cases.There were 19 proximal fibula cases,3 distal fibula cases and 1 case of multiple giant cell tumor of bone.We chose curettage and/or adjuvant therapy or wide resection,then with bone cement,allograft or autograft,prostheses to reconstructionaccording to tumor site,the degree of destruction,pathological fractures.The x2 test and Cox regression analysis were used to detect the statistic differences.The KaplanMeier survival analysis was used to count the disease-free survival.The relationship between tumor location,destruction degree,Campanacci grading,pathological fractures,treatment methods at different stages and recurrence were analyzed.Results A total of 281 patients with long bone giant cell tumor were included in the follow-up study,including 37 pathological fracture and 244 non-fracture.According to the author's giant cell tumor diagnosis and treatment process,122 patients received a wide resection,159 cases were treated with curettage ± adjuvant therapy.23 patients had postoperative recurrence,the recurrence rate was 8.19％.The recurrence time after operation ranged from 9 to 75 months (average 30.95 months).There was no significant difference between the recurrence rate of lesions around the knee and other parts (x2=0.370,P=0.240).In the non-pathologic fracture group,the recurrence rate was significantly lower in the large section compared with curettage surgery (x2=9.393,P=0.002).Of the patients with intralesional surgery,126 patients reconstructed with cement and 28 patients reconstructed with autograft/allograft bone to rebuild mechanical stability.There were 14 recurrence cases (14/126,11.11％) in the bone cement group and 8 recurrence cases (8/28,28.57％) in the bone graft group.The recurrence rate in the bone cement group was significantly lower than that in the simple bone graft group (x2=5.846,P=0.017).The patients with lesion less than 50％,4 had recurrences (4/55,7.27％),12 recurrences occurred (12/76,15.79％) in more than 50％ and less than 75％ of the cross-sections,and if the lesion was more than 75％ cross-sectional area,4 cases of recurrence (4/113,3.54％).There was no significant difference in the proportion of bone destruction between different cross-sections in affecting tumor recurrence.The recurrence rate of Campanacci Grade Ⅲ patients was significantly higher than that of Campanacci Grade Ⅱ patients with curettage surgery (x2=9.909,P=0.002).Only 1 of the patients with pathological fracture had recurrence (1/37,2.70％),the recurrence rate was significantly lower than that the curettage group (x2=11.972,P=0.001).Among the early patients,79 cases (63.71％) were cured by surgery and 17 cases were relapsed,while in the last 5 years 80 cases (50.96％) were cured by surgery and 6 cases were relapsed,In two different periods,the curettage recurrence rate was significantly decreased (x2=9.246,P=0.003).Conclusion By selecting personalized treatment options for different patients,it is possible to increase the proportion of patients who maintain their knee joints while reducing the local recurrence rate,providing doctors and patients with a choice of treatment options.

Objective: To investigate the effect of auricle deformity corrector in non-surgical treatment of congenital auricular deformity. Methods: The auricular deformity correctors were applied for non-surgical treatment of congenital auricular deformities. The patients were divided into three groups according to the treatment starting age (<1 month old, 1-3 months old, 3-6 months old), followed up for every month respectively after treatment. According to the improvement of auricle morphology, the treatment results were divided into four levels (e, g, f, p) and the effective rate (e+ g)% was calculated. Results: From January 2014 to December 2016, there were 140 ears of congenital malformations in children aged less than 6 months who were treated and followed up. Among them, 33 ears had helical rim abnormalities, 29 with cup-shaped ears, 12 with prominent ears, 4 with Stahl′s ears, and 62 with cryptotia ears. The therapeutic efficacies (<1 month old, 1-3 months old, 3-6 months) of these ear malformations were: cryptotia ear (100%, 100%, 87.5%), helical rim abnormality (100%, 90.47%, 66.67 %), prominent ear (-, 100%, 50%), cup ear (100%, 78.57%, 53.33%), Stahl′s ear (-, 100%, 33.33%). Follow-up more than 6 months after treatment, up to a year and a half, no recurrence was found. Conclusions The auricular deformity corrector can be used as an effective approach for achieving natural outcomes and correcting cosmetic abnormalities. Rate of satisfaction is dependent on types of deformity, the neonatal age in which treatment started and also parents′ compliance to treatment methods and principals. The method is noninvasive, easy to wear and works well. Early proper treatment can avoid future operations and save social medical resources.

Objective: To explore the curative effect of ultra-delicate split-thickness skin graft in continuity with full-thickness skin flap combined with Z-plasty for correction of cryptotia. Methods: Four cases (six ears) were corrected by ultra-delicate split-thickness skin graft in continuity with full-thickness skin flap combined with Z-plasty method from 2016 to 2017. Following ear release, the flap is rotated into the defect and donor site covered by a razor-thin graft raised in continuity with the flap, the posterior flap was advanced and sutured with Z-plasty. Results: All corrected auricles four cases (six ears) were followed up from 3 months to 1 year and abtained satisfactory and stable appearance. Conclusions The shape of auricle is natural and satisfactory after operation. The method is simple and no skin grafting is needed. The adhesion of the hidden muscles and cartilages were sufficiently released.

Objective To investigate the clinical effect of treatment of severe carbon monoxide poisoning with Naoxingjing injection combined with naloxone.Methods Emergency department of affiliated theorem clinical college, hospital 70 patients diagnosed with severe carbon monoxide poisoning from emergency department in June 2014 to December 2016, were randomly divided into observation group and control group 35 cases.In the control group were treated with naloxone treatment, observation group were treated based on the use Naoxingjing injection treatment.The two groups were observed and recorded recovery time, mortality, the incidence of delayed encephalopathy, Glasgow Coma Score(GCS)and serum levels of IL-1β.Results The patients in the observation group total effective rate of 97.14% was significantly higher than 77.14%, and the difference was statistically significant(P<0.05);the recovery time was observed in patients(2.25 ± 0.88)h, significantly shorter than the control group(3.46 ± 1.10)h, and the difference was statistically significant(P<0.05);and follow-up observation group mortality rates were delayed encephalopathy(1.43%, 8.57%)than the control group(17.14%, 25.71%), and the difference was statistically significant(P<0.05);④ observation group were GCS score was (12.77±1.89), significantly better than the control group, and the difference was statistically significant(P<0.05);⑤ observed in patients IL-1β is(65.41±9.93)ng / L was significantly lower than the control group(89.86±10.74)ng / L, and the difference was statistically significant(P<0.05).Conclusion Naoxingjing injection combined with naloxone treatment of severe carbon monoxide poisoning exact clinical effect, can effectively reduce patient recovery time, reduce mortality and morbidity.

Objective To investigate the situation of drug resistance and nosocomial infection of multi-drug resistant bacteria (MDR),guidance for clinical rational use of antibiotics.Methods A total of 1521 strains of MDR was isolated from January 2015 to December in Beijing Tongren Hospital,using matrixassisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) identification of bacteria,VITEK-2 Compact and Kirby Bauer (KB) method for drug sensitivity test.Results In 1 521 strains of MDR,Acinetobacter Baumanii were 589 strains (38.7％),nosocomial infection rate were 16.6％;350 strains of Escherichia coli (23.0％),nosocomial infection rate were 9.0％;249 strains of Staphylococcus aureus (16.4％),nosocomial infection rate were 2.7％;171 strains of Klebsiella pneumoniae (11.2％),nosocomial infection rate were 14.3％;150 strains of pseudomonas aeruginosa (9.9％),nosocomial infection rate were 64.7％;12 strains of Enterococcus faecium (0.8％),nosocomial infection rate were 16.7％.MDR Acinetobacter Baumanii,MDR Pseudomonas aeruginosa,extended-spectrumβ-lactamase (ESBL) + Escherichia coli and ESBL + Klebsiella pneumoniae resistance rate to Imipenem were 100％,91.5％,0.6％ and 55.6％.Conclusions MDR pseudomonas aeruginosa (MDR-PAE),MDR acinetobacter baumanii (MDR-AB) and ESBL + Klebsiella pneumoniae were highly resistant,and the nosocomial infection rate were higher.