Objective To investigate the imaging signs of osteoid osteoma(OO)of short tubular bone.Methods A retrospective analysis was conducted on clinical and imaging data from 19 cases pathologically confirmed of OO in short tubular bones,and a com-parision was made with the imaging findings of 67 cases of long tubular bones.Results Among the 19 cases of OO in short tubular bones,73.70%of cases were under 30 years old.There were 16 cases involved the hand's short tubular bones,with 14 cases in the phalanges(1 in the thumb,4 in the index finger,5 in the middle finger,2 in the ring finger,2 in the little finger)and 2 cases in the metacarpals.Three cases involved the short tubular bones of the foot,all in the metatarsals.Five cases reported increased pain at night,three cases experienced relief with nonsteroidal anti-inflammatory drugs,and two cases did not take any medication.All lesions were osteolytic,with mineralisation within the nidus and varying degrees of surrounding bone sclerosis,bone marrow edema,and soft tissue edema.Compared to OO in long tubular bones,OO in short tubular bones more frequently exhibited expansile and discontinu-ous cortical bone features,but the degree and extent of bone sclerosis were less pronounced.Conclusion Short tubular bones are a rare location for OO,often lacking typical clinical symptoms,which can easily lead to misdiagnosis.Therefore,close attention should be paid to its imaging characteristics.

Objective To analyze the imaging signs of chondromyxoid fibroma(CMF)and to improve the diagnostic accuracy of CMF.Methods The imaging data of 31 cases of CMF diagnosed by pathology were analyzed retrospectively and the characteristic imaging signs were analyzed.Results Among the 31 CMF patients,the male-to-female ratio was about 1.4∶1,and 75％of cases occurred before the age of 30;20 cases occurred in the long bones:15 cases in the tibia,4 cases in the femur,and 1 case in the fibula;15 cases occurred in the metaphyseal;7 cases occurred in the flat bones,and 4 cases occurred in the bones of the hands and feet.All lesions showed osteolysis with different degrees of expansion,lobulation,clear borders,and sclerotic margins on both X-ray plain film and CT.There was internal mineralization in 17 cases and internal bone ridge in 12 cases.All lesions showed T1 WI low-equal signal,T2WI medium-high signal in MRI,and enhanced scans were dominated by circumferential or nodular enhancement of the margins.Conclusion Multiple imaging examination methods can improve the diagnosis of CMF.

Objective To investigate the imaging signs of osteoid osteoma(OO)of short tubular bone.Methods A retrospective analysis was conducted on clinical and imaging data from 19 cases pathologically confirmed of OO in short tubular bones,and a com-parision was made with the imaging findings of 67 cases of long tubular bones.Results Among the 19 cases of OO in short tubular bones,73.70%of cases were under 30 years old.There were 16 cases involved the hand's short tubular bones,with 14 cases in the phalanges(1 in the thumb,4 in the index finger,5 in the middle finger,2 in the ring finger,2 in the little finger)and 2 cases in the metacarpals.Three cases involved the short tubular bones of the foot,all in the metatarsals.Five cases reported increased pain at night,three cases experienced relief with nonsteroidal anti-inflammatory drugs,and two cases did not take any medication.All lesions were osteolytic,with mineralisation within the nidus and varying degrees of surrounding bone sclerosis,bone marrow edema,and soft tissue edema.Compared to OO in long tubular bones,OO in short tubular bones more frequently exhibited expansile and discontinu-ous cortical bone features,but the degree and extent of bone sclerosis were less pronounced.Conclusion Short tubular bones are a rare location for OO,often lacking typical clinical symptoms,which can easily lead to misdiagnosis.Therefore,close attention should be paid to its imaging characteristics.

Objective To analyze the imaging signs of chondromyxoid fibroma(CMF)and to improve the diagnostic accuracy of CMF.Methods The imaging data of 31 cases of CMF diagnosed by pathology were analyzed retrospectively and the characteristic imaging signs were analyzed.Results Among the 31 CMF patients,the male-to-female ratio was about 1.4∶1,and 75％of cases occurred before the age of 30;20 cases occurred in the long bones:15 cases in the tibia,4 cases in the femur,and 1 case in the fibula;15 cases occurred in the metaphyseal;7 cases occurred in the flat bones,and 4 cases occurred in the bones of the hands and feet.All lesions showed osteolysis with different degrees of expansion,lobulation,clear borders,and sclerotic margins on both X-ray plain film and CT.There was internal mineralization in 17 cases and internal bone ridge in 12 cases.All lesions showed T1 WI low-equal signal,T2WI medium-high signal in MRI,and enhanced scans were dominated by circumferential or nodular enhancement of the margins.Conclusion Multiple imaging examination methods can improve the diagnosis of CMF.

Sarcopenia and physical deconditioning are common complications in patients with liver cancer,which are frequently caused by insufficient physical activity and poor nutritional status,resulting in physical frailty and a significant impact on the patient's physical fitness.Notably,sarcopenia,frailty,and poor cardiopulmonary endurance have all been linked to higher mortality rates among patients with liver cancer.Exercise intervention significantly improves various health parameters in liver cancer patients,including metabolic syndrome,muscle wasting,cardiorespiratory endurance,health-related quality of life,and reduction in hepatic venous pressure gradient.However,the link between physical exercise and liver cancer is commonly overlooked.In this article,we will examine the impact of exercise on liver cancer and present the most recent evidence on the best types of exercise for various stages of liver cancer.This article also summarizes and discusses the molecular mechanisms that control metabolism and systemic immune function in tumors.In brief,physical exercise should be considered an important intervention in the prevention and treatment of liver cancer and its complications.

This article reported a case of hypertrophic pyloric stenosis after neonatal esophageal atresia repair. The mother of the child did not have regular prenatal care. The child was born at a gestational age of 40 weeks and 2 days of gestation, with polyhydramnios at birth, and was diagnosed with esophageal atresia and cleft palate after birth and underwent thoracoscopic esophageal-esophageal end-to-end anastomosis and esophageal-tracheal fistula ligation and was given nasogastric feeding after surgery. At four months of age, the child vomited a lot of coffee-like material after nasogastric feeding, and the ultrasonographic and upper gastroenterography findings suggested hypertrophic pyloric stenosis, which was treated surgically with good results. This case suggests that hypertrophic pyloric stenosis should be considered in children with unexplained non-bilious vomiting/feeding difficulties after esophageal atresia repair. After definitive diagnosis, laparoscopic pyloromyotomy is feasible.

Objective:To explore the prognosis and treatment experience of fetal/neonatal ovarian cyst.Methods:Clinical data of 35 cases of fetal/neonatal ovarian cyst (38 ovarian cysts) admitted to Guangdong Women and Children Hospital from June 2014 to December 2019 were retrospectively collected, including the cyst size before and after birth, ultrasonic features, intraoperative conditions, and pathology. According to the ultrasonic features at the first prenatal detection, the ovarian cysts were divided into two groups: simple cyst group (25 cysts) and complex cyst group (13 cysts). Two independent samples t-test and Fisher exact test were used to compare the characteristics of cysts between the two groups. The outcomes and treatment experience were summarized. Results:(1) The ratio of intraoperative torsion in the complex cysts group was higher than that in the simple cysts group [10/13 vs 32% (8/25), Fisher exact test, P<0.05]. (2) Twenty-five simple cysts were found on the first prenatal ultrasound scan, and 32% (8/25) of them eventually transformed into complex cysts. Among these eight cysts, the maximum diameter of five cysts was >4 cm before the transformation. (3) Postnatal ultrasound found one cyst regressed spontaneously and among the remaining 37 cysts, simple and complex type cysts were accounted for 16 and 21, respectively. Among the complex type cysts, 90% (19/21) were consistent with prenatal ultrasound. (4) Out of the 21 complicated cysts, 19 were surgically removed; the remaining two cysts (maximum diameter <3 cm) were observed conservatively and disappeared spontaneously within one year. During the operation, 81% (17/21) of the complicated cysts were found with torsion and 24% (5/21) with ovarian loss. Conclusions:Simple cysts can transform into complex cysts, especially the biggest diameter >4 cm. Complex fetal/neonatal ovarian cysts indicated by ultrasonography were more prone to torsion, which required postnatal operation.

Objective:To investigate the clinical effect of lateral rectus abdominis approach combined with presacral decompression for surgical treatment of old Denis type II sacral fractures complicated with upper sacral plexus injury.Methods:A retrospective case series study was performed on the clinical data of 9 patients with old Denis type II sacral fractures complicated with upper sacral plexus injury (L 4-S 1) admitted to Zhongnan Hospital of Wuhan University from June 2010 to December 2016. There were 6 males and 3 females, aged (33.1±7.5)years (range, 15-58 years). Embolization of internal iliac artery and preimplantation of abdominal aortic balloon were performed 2 hours before operation under the guidance of digital subtraction angiography (DSA). Surgery was performed using a single lateral rectus abdominis approach combined with presacral decompression. The operation time, intraoperative blood loss and full weight-bearing time were recorded. The visual analogue scale (VAS) and European QOL Five Dimensional health scale (EQ-5D) were compared before and after operation. The Gibbons' impairment scale was used to assess neurological function. X-ray and CT scan were used to observe internal fixation and fracture healing. The complications during and after operation were recorded. Results:The patients were followed up for 24-52 months [(35.2±5.2)months]. The operation time was (2.9±0.6)hours. The intraoperative bleeding was (573±138)ml, and the full weight-bearing time was (11.6±1.2)weeks. X-ray and CT scan showed bone healing in all patients at the latest follow-up. The VAS and EQ-5D scale improved from preoperative (7.8±0.6)points and (0.34±0.07)points to the final follow-up of (0.8±0.3)points and (0.81±0.05)points ( P<0.05). According to Gibbons classification, 8 patients were grade I and 1 patient was grade II one year after operation ( P<0.01). Namely, the radiation pain of lower extremities was significantly improved in all patients, among which 8 patients showed pain disappeared and completely returned to normal and 1 patient showed residual numbness and hypoesthesia of the affected limbs. No major complications (eg, iatrogenic lumbosacral plexus injury, vital blood vessels or pelvic organs injury) occurred during the operation. During the follow-up period, only one patient developed traumatic hip arthritis and underwent total hip arthroplasty 6 months after operation. Fractures of the remaining patients were healed well without complications like infection, pressure ulcer or implant failure. Conclusions:For old Denis type II sacral fractures complicated with upper sacral plexus injury, lateral rectus abdominis approach combined with presacral decompression can fully decompress the upper sacral plexus nerve, relieve pain, and promote functional rehabilitation, with low incidence of complications. It is an alternative surgical method for the treatment of old Denis type II sacral fractures complicated with upper sacral plexus injury.

While the majority of all human cancers counteract telomere shortening by expressing telomerase, ~15% of all cancers maintain telomere length by a telomerase-independent mechanism known as alternative lengthening of telomeres (ALT). Here, we show that high load of intrinsic DNA damage is present in ALT cancer cells, leading to apoptosis stress by activating p53-independent, but JNK/c-Myc-dependent apoptotic pathway. Notably, ALT cells expressing wild-type p53 show much lower apoptosis than p53-deficient ALT cells. Mechanistically, we find that intrinsic DNA damage in ALT cells induces low level of p53 that is insufficient to initiate the transcription of apoptosis-related genes, but is sufficient to stimulate the expression of key components of mTORC2 (mTOR and Rictor), which in turn leads to phosphorylation of AKT. Activated AKT (p-AKT) thereby stimulates downstream anti-apoptotic events. Therefore, p53 and AKT are the key factors that suppress spontaneous apoptosis in ALT cells. Indeed, inhibition of p53 or AKT selectively induces rapid death of ALT cells in vitro, and p53 inhibitor severely suppresses the growth of ALT-cell xenograft tumors in mice. These findings reveal a previously unrecognized function of p53 in anti-apoptosis and identify that the inhibition of p53 or AKT has a potential as therapeutics for specifically targeting ALT cancers.

Objective The aim of our study was to establish an endoscopic endonasal transsphenoidal surgical training model, and to examine its application value. Methods The endoscopic endonasal transsphenoidal surgical training models were made.After assessments,the models was used for endoscopic operation training for 8 neurosurgeons with no experiences of endoscopic operation. Results The available operating space of this model is similar to the actual operating space in endoscopic endonasal transsphenoidal surgery. The egg fixed on the model has many layers of structure, such as eggshell, shell membrane, egg white and egg yolk, which constituted a good practice object. All students indicated that they could benefit from the training using this model. The skill in grinding the eggshell [(1.07 ± 0.221)cm2/min vs.(1.45±0.27)cm2/min, P<0.001]was significantly improved and the chance for shell membrane rupture (8 vs. 2, P=0.007) was significantly reduced in the last-time practice compared with the first-time practice (P<0.001). Conclusion The endoscopic endonasal transsphenoidal surgical training model is helpful for neurosurgeons to practice the basic operation of endoscopic surgery and to improve their surgical skills,and can be used repeatedly.It can be used in basic operation training before the training using cadaver cranium.