[摘 要] 目的：探讨白蛋白结合型紫杉醇联合PD-1抑制剂用于治疗一线化疗失败的骨与软组织肉瘤的疗效及安全性。方法：回顾性分析北京积水潭医院骨肿瘤科2017年8月至2020年8月收治的一线化疗失败的晚期骨与软组织肉瘤患者。患者接受白蛋白结合型紫杉醇（125~140 mg/m2，第1天和第8天）与PD-1抑制剂（信迪利单抗或特瑞普利单抗，每21 d一次）联合治疗。每2个治疗周期评估1次疗效，按RECIST 1.1标准评估肿瘤疗效，按NCI-CTCAE5.0标准评估不良反应。结果：共20名患者纳入研究，完成1至8个治疗周期，中位治疗周期数为3个。所有患者均可评估疗效，完全缓解4例（20%），部分缓解0例，稳定9例（45%），疾病进展7例（35%）。客观缓解率（ORR）为20%，疾病控制率（DCR）为65%。中位无进展生存期（PFS）为3.0个月。治疗期间主要不良反应包括2级白细胞减少（40%）、1-2级神经毒性反应（20%），以及2级甲状腺功能减退（10%）。结论：白蛋白结合型紫杉醇联合PD-1抑制剂治疗为一线化疗失败的晚期骨与软组织肉瘤患者提供了一种潜在的治疗选择，其不良反应可控，值得开展更大样本的前瞻性研究进一步验证其疗效。

Objective:To investigate the clinical efficacy of liquid nitrogen cryopreservation and reimplantation versus allograft reconstruction in patients underwent resection of primary malignant bone tumors of the long bones of the extremities.Methods:A retrospective analysis was conducted on 144 patients who underwent resection of primary malignant bone tumors of the long bones of the extremities followed by either liquid nitrogen cryopreservation and reimplantation or massive allografts reconstruction at the Beijing Jishuitan Hospital affiliated with Capital Medical University from January 2012 to July 2023. The study included 82 males and 62 females, with an average age of 23.8±12.3 years (range, 6-64 years). Patients were divided into two groups based on the reconstruction method: the cryopreservation and reimplantation group (72 cases) and the allograft group (72 cases). The following outcomes were recorded during follow-up: local tumor recurrence, bone union, union time, graft survival, and reasons for graft removal. Graft-related complications were recorded using the modified Henderson classification system of the International Limb Salvage Association. Limb function was assessed at the last follow-up using the Musculoskeletal Tumor Society score (MSTS-93).Results:All patients completed surgery and were followed up for a mean of 60.2±32.1 months (range, 12-149 months). At the last follow-up, 24 patients were dead from the tumor, 16 patients survived with the tumor (2 cases of local recurrence and 14 cases of distant metastasis), and 104 patients survived without the tumor. The bone union rate and union time in cryopreservation and reimplantation group were 90% (65/72) and 9.6±4.8 months, respectively, which was significantly superior to those in allograft group [68% (49/72) and 15.9±6.7 months, P<0.05]. The 5-year overall graft survival rate was 86.8% [95% CI (80.1%, 95.7%)] in cryopreservation and reimplantation group, higher than 73.2% [95% CI(68.4%, 84.5%)] in allograft group significantly (χ 2=7.122, P=0.017). The rates of graft removal due to non-union and infection in the cryopreservation and reimplantation group were 0% (0/72) and 1.4% (1/72), respectively, which were significantly lower than those in the allograft group [5.6% (4/72) and 9.7% (7/72), P<0.05]. Overall, 48.6% (70/144) of patients experienced at least one graft-related complication, with a complication rate of 33.3% in cryopreservation and reimplantation group, lower than the 61.1% in allograft group significantly (χ 2=11.146, P<0.001). The complications with the highest incidence rate were nonunion (20.8%, 30/144), followed by structural failure (17.4%, 25/144), tumor progression (10.4%, 15/144), infection (10.4%, 15/144), and soft tissue failure (5.6%, 8/144). The incidence rates of the atrophic non-union and the structural failure of grafts were 9.7% (7/72) and 1.4% (1/72) respectively in the cryopreservation and reimplantation group, which were significantly lower compared to the allograft group [29.2% (21/72) and 13.9% (10/72), P<0.05]. At the last follow-up, the MSTS-93 score was 89.7%±8.3% in the cryopreservation and reimplantation group, and 87.6%±7.5% in the allograft group, with no statistically significant difference ( t=0.326, P=0.542). Conclusion:Compared with allograft reconstruction, autologous inactivated bone grafting demonstrated superior bone union efficiency and fewer complications, it may be considered for reconstruction in cases whose tumor bone is not severely osteolytic or pathologically fractured.

Objective:To analyze the distribution of human immunodeficiency virus 1（HIV-1）genotypes and antiretroviral drug resistance patterns among individuals infected with HIV and patients with acquired immunodeficiency syndrome（AIDS）in Fuyang，with the aim of informing the optimization of antiretroviral therapy strategies.Methods:Blood samples were collected from HIV/AIDS patients who failed antiviral treatment in Fuyang from 2023 to 2024，as well as newly reported HIV-infected individuals who were first diagnosed and did not receive antiviral treatment. The HIV-1 pol gene was amplified and sequenced. Genotypic resistance was assessed using the Stanford University HIV Drug Resistance Database，and analyses were conducted on HIV-1 subtypes and drug resistance-associated mutations.Results:A total of 571 HIV/AIDS patients were included in this study，comprising 320 newly reported HIV-infected individuals and 251 HIV/AIDS patients who failed antiviral treatment. Both groups were predominantly male，middle-aged and elderly individuals over 45 years old，and heterosexual contact was the primary transmission route. The most prevalent HIV-1 subtypes differed between groups：CRF07_BC（36.88%，118/320）dominated among newly reported HIV-infected patients，whereas subtype B（43.03%，108/251）was predominant in HIV/AIDS patients who failed antiviral treatment. The drug resistance rate was significantly lower in newly reported HIV-infected patients（15.63%，50/320）compared to the HIV/AIDS patients who failed antiviral treatment（38.25%，96/251； χ2=37.825， P<0.001）. Non-nucleoside reverse transcriptase inhibitors（NNRTIs）exhibited the highest resistance rates in both cohorts. Compared to newly reported HIV-infected patients，HIV/AIDS patients who failed antiviral treatment showed a significantly higher prevalence of drug resistance mutations（ P<0.001），with greater diversity in mutation patterns. Key resistance-associated mutation site demonstrated statistically significant differences in mutation rates between the two groups（ P<0.05）. The results of the molecular transmission network showed that the proportion of elderly people over 60 years old and patients with CRF07_BC and B subtypes was higher among the networked cases in the two groups of newly reported and antiviral treatment failure. Conclusion:The study revealed a diverse distribution of HIV-1 subtypes among HIV/AIDS patients in Fuyang. NNRTIs exhibited the most prominent resistance challenges，accompanied by diversified resistance mutation profiles. These findings highlight the need for enhanced surveillance of resistance to curb the spread of resistant strains and improve clinical outcomes.

Tenosynovial giant cell tumor (TGCT) is a rare mesenchymal tumor that clinically presents as nodular-type or diffuse-type (D-TGCT). D-TGCT is more aggressive, has a higher surgical recurrence rate, and can potentially lead to severe joint destruction. The traditional treatment is primarily through surgical intervention. Recent advancements in understanding the molecular mechanisms of the disease and the development of new drugs have significantly changed TGCT treatment strategies. Drug therapy and active surveillance have become important treatment options for unresectable or high-recurrence-risk TGCT. Imaging examinations and patient-reported outcome tools play a crucial role in evaluating efficacy and guiding treatment decisions. Comprehensive management by a multidisciplinary team and utilizing individualized treatment plans can significantly improve the quality of life and treatment outcomes of patients. Future research should explore the molecular mechanisms of TGCT, enhance multidisciplinary collaboration, and emphasize long-term management to improve treatment efficacy and patient prognosis.

Objective:To investigate the clinical efficacy of liquid nitrogen cryopreservation and reimplantation versus allograft reconstruction in patients underwent resection of primary malignant bone tumors of the long bones of the extremities.Methods:A retrospective analysis was conducted on 144 patients who underwent resection of primary malignant bone tumors of the long bones of the extremities followed by either liquid nitrogen cryopreservation and reimplantation or massive allografts reconstruction at the Beijing Jishuitan Hospital affiliated with Capital Medical University from January 2012 to July 2023. The study included 82 males and 62 females, with an average age of 23.8±12.3 years (range, 6-64 years). Patients were divided into two groups based on the reconstruction method: the cryopreservation and reimplantation group (72 cases) and the allograft group (72 cases). The following outcomes were recorded during follow-up: local tumor recurrence, bone union, union time, graft survival, and reasons for graft removal. Graft-related complications were recorded using the modified Henderson classification system of the International Limb Salvage Association. Limb function was assessed at the last follow-up using the Musculoskeletal Tumor Society score (MSTS-93).Results:All patients completed surgery and were followed up for a mean of 60.2±32.1 months (range, 12-149 months). At the last follow-up, 24 patients were dead from the tumor, 16 patients survived with the tumor (2 cases of local recurrence and 14 cases of distant metastasis), and 104 patients survived without the tumor. The bone union rate and union time in cryopreservation and reimplantation group were 90% (65/72) and 9.6±4.8 months, respectively, which was significantly superior to those in allograft group [68% (49/72) and 15.9±6.7 months, P<0.05]. The 5-year overall graft survival rate was 86.8% [95% CI (80.1%, 95.7%)] in cryopreservation and reimplantation group, higher than 73.2% [95% CI(68.4%, 84.5%)] in allograft group significantly (χ 2=7.122, P=0.017). The rates of graft removal due to non-union and infection in the cryopreservation and reimplantation group were 0% (0/72) and 1.4% (1/72), respectively, which were significantly lower than those in the allograft group [5.6% (4/72) and 9.7% (7/72), P<0.05]. Overall, 48.6% (70/144) of patients experienced at least one graft-related complication, with a complication rate of 33.3% in cryopreservation and reimplantation group, lower than the 61.1% in allograft group significantly (χ 2=11.146, P<0.001). The complications with the highest incidence rate were nonunion (20.8%, 30/144), followed by structural failure (17.4%, 25/144), tumor progression (10.4%, 15/144), infection (10.4%, 15/144), and soft tissue failure (5.6%, 8/144). The incidence rates of the atrophic non-union and the structural failure of grafts were 9.7% (7/72) and 1.4% (1/72) respectively in the cryopreservation and reimplantation group, which were significantly lower compared to the allograft group [29.2% (21/72) and 13.9% (10/72), P<0.05]. At the last follow-up, the MSTS-93 score was 89.7%±8.3% in the cryopreservation and reimplantation group, and 87.6%±7.5% in the allograft group, with no statistically significant difference ( t=0.326, P=0.542). Conclusion:Compared with allograft reconstruction, autologous inactivated bone grafting demonstrated superior bone union efficiency and fewer complications, it may be considered for reconstruction in cases whose tumor bone is not severely osteolytic or pathologically fractured.

Objective:To analyze the distribution of human immunodeficiency virus 1（HIV-1）genotypes and antiretroviral drug resistance patterns among individuals infected with HIV and patients with acquired immunodeficiency syndrome（AIDS）in Fuyang，with the aim of informing the optimization of antiretroviral therapy strategies.Methods:Blood samples were collected from HIV/AIDS patients who failed antiviral treatment in Fuyang from 2023 to 2024，as well as newly reported HIV-infected individuals who were first diagnosed and did not receive antiviral treatment. The HIV-1 pol gene was amplified and sequenced. Genotypic resistance was assessed using the Stanford University HIV Drug Resistance Database，and analyses were conducted on HIV-1 subtypes and drug resistance-associated mutations.Results:A total of 571 HIV/AIDS patients were included in this study，comprising 320 newly reported HIV-infected individuals and 251 HIV/AIDS patients who failed antiviral treatment. Both groups were predominantly male，middle-aged and elderly individuals over 45 years old，and heterosexual contact was the primary transmission route. The most prevalent HIV-1 subtypes differed between groups：CRF07_BC（36.88%，118/320）dominated among newly reported HIV-infected patients，whereas subtype B（43.03%，108/251）was predominant in HIV/AIDS patients who failed antiviral treatment. The drug resistance rate was significantly lower in newly reported HIV-infected patients（15.63%，50/320）compared to the HIV/AIDS patients who failed antiviral treatment（38.25%，96/251； χ2=37.825， P<0.001）. Non-nucleoside reverse transcriptase inhibitors（NNRTIs）exhibited the highest resistance rates in both cohorts. Compared to newly reported HIV-infected patients，HIV/AIDS patients who failed antiviral treatment showed a significantly higher prevalence of drug resistance mutations（ P<0.001），with greater diversity in mutation patterns. Key resistance-associated mutation site demonstrated statistically significant differences in mutation rates between the two groups（ P<0.05）. The results of the molecular transmission network showed that the proportion of elderly people over 60 years old and patients with CRF07_BC and B subtypes was higher among the networked cases in the two groups of newly reported and antiviral treatment failure. Conclusion:The study revealed a diverse distribution of HIV-1 subtypes among HIV/AIDS patients in Fuyang. NNRTIs exhibited the most prominent resistance challenges，accompanied by diversified resistance mutation profiles. These findings highlight the need for enhanced surveillance of resistance to curb the spread of resistant strains and improve clinical outcomes.

Objective:To explore the effects of computer-navigated surgery and traditional surgery on the functional and oncological outcomes of pelvic chondrosarcoma.Methods:Retrospective analysis of 136 cases of pelvic chondrosarcoma surgically treated at Beijing Jishuitan Hospital from January 2000 to December 2017. There were 65 males and 71 females with an average age of 46.07±13.37 years (range 13-73 years). There were 120 primary cases and 16 secondary cases, of which 109 cases were ordinary chondrosarcoma (7 cases with pathological differentiation grade I, 83 cases with grade II. There were 109 cases of common type chondrosarcoma (7 cases of pathological differentiation grade I, 83 cases of grade II, 19 cases of grade III), 21 cases of dedifferentiated chondrosarcoma, 3 cases of mesenchymal type, 2 cases of clear cell type, 1 case of mucinous type; 12 cases of malignant degeneration of multilocular chondrosarcoma of bone; 104 cases of Enneking staging stage IB, 32 cases of stage IIB. According to the pelvis zone classification, there were 14 cases of pelvic zone I, 1 case of zone II, 13 cases of zone III, 16 cases of zone I+II, 16 cases of zone I+IV, 47 cases of zone II+III, 25 cases of zone I+II+III, 25 cases of zone I+II+III, 4 cases of zone I + II + III + IV. All cases were classified as intracapsular, marginal, or wide resection according to the resection boundary classification. There were 45 cases in computer-navigated surgery (navigated group) and 91 cases in non-navigated surgery group. The demographic data, preoperative tumor staging, surgical characteristics, surgical boundary classification, oncological indexes, reconstruction methods, postoperative complications, and bone and soft tissue tumor function score (Musculoskeletal Tumor Society score, MSTS) were compared between the two groups.Results:No surgical complications related to the computerized navigation system occurred in the navigation group. The postoperative follow-up time was 68.56±37.82 months (range 6-197 months) and 76.85±52.60 months (range 5-225 months) for the navigation and non-navigation groups, respectively. The MSTS was 25.43±2.85 and 24.56±4.19 points in the navigation and non-navigation groups, respectively, with no significant difference ( t=1.191, P=0.237). There were 10 cases of marginal resection and 35 cases of wide resection in the navigation group, and 12 cases of intracapsular resection, 32 cases of marginal resection and 47 cases of wide resection in the non-navigation group with significant difference (χ 2=10.977, P=0.004). There were 4 cases (8.9%, 4/45) of local recurrence after surgery in the navigation group and 20 cases (21.9%, 20/91) in the non-navigation group, with significant difference (χ 2=4.040, P=0.046). There were 2 cases of final amputation and 2 cases of re-excision with recurrence in the navigation group and 6 cases of final amputation and 14 cases of re-excision in the non-navigation group. Distant metastases occurred in 3 cases (7%, 3/45) in the navigation group and 18 cases (20%, 18/91) in the non-navigation group wtih significant difference (χ 2=4.478, P=0.034). The five-year postoperative survival rates of the navigation and non-navigation groups were 93.3% and 72.6%, and the three- and five-year progression-free survival rates were 91.1% and 84.4% and 74.8% and 62.7%, respectively, with significant differences (χ 2=5.081, P=0.024; χ 2=6.800, P=0.009). The five-year survival rate of stage IB tumors was 96.7% in the navigation group and 84.5% in the non-navigation group with significant difference (χ 2=3.897, P=0.048); the five-year survival rate of stage IIB tumors was 75.0% in the navigation group and 35.0% in the non-navigation group with no significant difference ( P>0.05). Postoperative complications included 15 cases of postoperative infection, 16 cases of deep vein thrombosis, 14 cases of double lower limb inequality, 2 cases of prosthesis dislocation, 2 cases of lymphedema, 1 case of hernia and 1 case of allograft bone resorption. There was no significant difference of complication rates between the two groups ( P>0.05). Conclusion:Computer navigation-assisted resection of pelvic chondrosarcoma was better in obtaining a safe surgical border of the tumor compared with traditional surgery, reducing the rate of local recurrence of the tumor and thus effectively improved the survival and prognosis of patients.

To explore the method of constructing the first-class undergraduate course of Treatise on Febrile Diseases. The undergraduates majoring in traditional Chinese medicine were selected as the teaching subjects. Three combinations (combination of theory and clinics, combination of science and education, and combination of ideological/political education and professional education) were adopted as the starting point. A variety of teaching methods were used. The combination of in-class and after-class and the combination of theory and clinics were implemented. Course construction was carried out from the aspects of course objectives, course resource construction, course content, organization and implementation, and course evaluation methods. Emphasis was placed on the process evaluation and formative evaluation. Questionnaire survey and final examination were used to evaluate the teaching effect. The results showed that a total of 10 first and second prizes were awarded in the provincial and municipal innovation competitions related to the theory of cold disease in the past three years. During the same time, more than 70 medical records were collected and collated, 82 research papers and 155 learning experiences were documented, five communities were visited along with the affiliated hospital and the school hospital for providing healthcare services in rural areas, and more than 20 traditional Chinese diagnosis and treatment activities were performed in these communities. The average score of students in overall course evaluation was 87. More than 94.00% (141/150) students highly evaluated the course construction. They believed that the course construction was very helpful to the theoretical study and clinical application of Treatise on Febrile Diseases, and improved their levels and abilities in classic reading, medical case evaluation and analysis, and syndrome differentiation and treatment. Students' recognition of this course has been improved and phased results have been achieved.

Objective:To analyze the prognostic factors and the influence of surgical margin to prognosis.Methods:A retrospective analysis was performed for 208 pelvic tumors who received surgical treatment from January 2000 to December 2017 in our instituition. Survival analysis was performed using the Kaplan-Meier method and Log rank test, and impact factor analysis was performed using Cox regression models.Results:There were 183 initial patients and 25 recurrent cases. According to Enneking staging, 110 cases were stage ⅠB and 98 cases were stage ⅡB. 19 lesions were in zone Ⅰ, 1 in zone Ⅱ, 15 in zone Ⅲ, 29 in zone Ⅰ+Ⅱ, 71 in zone Ⅱ+Ⅲ, 29 in zone Ⅰ+Ⅳ, 35 in zone Ⅰ+Ⅱ+Ⅲ, 3 in zone Ⅰ+Ⅱ+Ⅳ, and 6 in zone Ⅰ+Ⅱ+Ⅲ+Ⅳ. Surgical margins including Intralesional excision in 7 cases, contaminated margin in 21 cases, marginal resection in 67 cases, and wide resection in 113 cases. Local recurrence occurred in 37 cases (17.8%), 25 cases were performed by reoperation and 12 cases received amputation finally. The 5-year recurrence rate of marginal resection was higher than wide resection ( P＜0.05), and the recurrence-free survival rate of marginal resection was lower than wide resection ( P＜0.05). There was significant differences in recurrence rate and recurrence-free survival rate between R0 and R1 resection ( P＜0.05). 92 cases were not reconstructed and 116 cases were reconstructed after pelvic surgery. At the last follow-up, 63 patients (30.3%) died, and the 5-year, 10-year and 15-year survival rates were 70.4%, 66.8% and 61.3%, respectively. The 5-year survival rate of stage ⅠB and ⅡB tumor was 90.4% and 46.8%, respectively. There were 29 cases had postoperative wound complications (13.8%), 1 case with pelvic organ injury. The final function was evaluated in 132 patients, with an average MSTS score of 25.1±3.6. Cox multivariate analysis showed that surgical staging, R0/R1 margin and metastasis were independent prognostic factors for pelvic tumors. Conclusions:The safe surgical margin is the key factor for recurrence-free of pelvic tumor. The survival rate of stage ⅡB pelvic tumors was significantly lower than that of stage ⅠB tumors. Wound infection is the main postoperative complication. Surgical staging, R0/R1 margin and metastasis were independent prognostic factors of pelvic tumors.

ObjectiveTo support intelligent clinical decision-making in traditional Chinese medicine（TCM）， this study utilized ontology and knowledge graph construction techniques to achieve the IT application of clinical practice guidelines. MethodBased on the principles of findability， accessibility， interoperability， and reusability （FAIR principles）， this study employed ontology techniques to construct an ontology for TCM clinical practice guidelines and built a knowledge graph using coronary heart disease as an example. Based on the Checklist for Reporting Practice Guidelines in Traditional Chinese Medicine and Recommendation Grading in TCM Clinical Guidelines/Consensus （T/CAS 530—2021），the ontology of TCM clinical practice guidelines was constructed using the seven-step ontology construction method. On this basis，the TCM diagnosis and treatment data from the Guidelines for the Diagnosis and Treatment of Stable Angina Pectoris in Coronary Heart Disease were stored in Neo4j in the form of triples through knowledge extraction，integration，and storage. ResultThe information in the clinical practice guidelines was divided into three categories： onset and prevention information， diagnosis information， and treatment information， and the TCM clinical practice guideline ontology was constructed. A total of 27 concepts related to TCM clinical diagnosis and treatment and 14 data attributes were obtained， and 12 conceptual relationships including hierarchical relationships and object attributes were established. By taking coronary heart disease as an example and the TCM clinical practice guideline ontology as the model layer， the knowledge map of TCM diagnosis and treatment guidelines for stable angina pectoris in coronary heart disease with 276 nodes and 336 relationships was constructed， realizing the visual display and query of the guideline content. ConclusionThe ontology of TCM clinical practice guidelines and the knowledge graph of stable angina pectoris in coronary heart disease constructed by combining the seven-step ontology construction method and Neo4j graph database technology are efficient and flexible，providing an intelligent TCM diagnosis and treatment scheme and promoting the standardization and objectification of TCM diagnosis and treatment.