Objective To summarize the clinical effects of one stop hybrid approach for treating the tetralogy of fallot complicated with aorta pulmonary collateral arteries. Methods From Janu 2008 to June 2013, 79 cases of tetralogy of fallot were complicated with aorta pulmonary collateral arteries with mean age (5.4±3.9) years and weight (18.2±5.7) kg. All patients were diagnosed by echocardiography examination and accepted 64-row CT for demonstration of no dysplasia in pulmonary ressels, McGoon index was (1.7±0.6) and Nakata index was (176.7±7.3). 76 cases had aorta pulmonary collateral arteries for preliminary screening, and accepted cardiovascular angiography before operation. 3 cases were misdiagnosed before surgery and were confirmed by cardiovascular angiography after operation. Results There were 4 deceased cases with an operative mortality of 5.1%. 1 case died of lung infection and 3 cases died of refractory heart failure. In all aorta pulmonary collateral arteries, the smallest diameter was 2.5 mm, the largest was 9.4 mm, average (5.3±2.1) mm. 2 to 21 coils were implanted in respective case with an average of 10.2 coils per case. The maximum number of coils implanted in 1 single ressel was 9. The average number of ressels occluded was 3.7 (range from 1 to 11 ressels) in each case. One case received second closure due to re-open of collateral arteries on neo-vasculanigation. 14 cases had lung infection and 3 cases had pulmonary edema post operation. 75 cases were followed up for 3-72 months. 4 cases with post operative heart function of NYHA gradeⅢtoⅣand all other cases with gradeⅡon higher. Conclusions Peri-operative hybrid management for aorta-pulmonary collateral arteries can increase the operative success rates and reduce complications.

Objective To investigate the expressions and functions of the fusion gene SYT-SSX1 and SYT-SSX2 in synovial sarcoma.Methods The synovial sarcoma tissue samples and clinical data of 22 synovial sarcoma patients were collected.The expressions of fusion genes were detected by RT-PCR.The relationships between fusion gene and clinicopathologic factors were statistically analyzed.The abilities of proliferation,migration and invasion of 3T3 cells transfected with tusion gene plasmids were detected by MTT,migration and invasion assays.Results There were 11 cases with expression of SYT-SSX1 gene and 9 cases with that of SYT-SSX2 genes.The ratio of SYT-SSX1 and SYT-SSX2 was about 1:1.The SYT-SSX1 positive tumors were most biphasic SS and the tumor volumes of patients with SYT-SSX1 positive were larger than that of patients with SYT-SSX2 positive (P =0.028).The SYT-SSX1 positive NIH3T3 cells exhibited higher abilities of proliferation,migration and invasion than SYT-SSX2 positive.Conclusions The ratio of expression of SYT-SSX1 and SYT-SSX2 in synovial sarcoma was about 1∶1.Both SYT-SSX1 and SYT-SSX2 can promote the growth and migration in NIH3T3 cell.The abilities of proliferation and migration of SYT-SS1 were more potent than that of SYT-SSX2.

Objective To investigate technique of reservation and reconstruction of the extensor mechanism in extraarticular total knee resection.Methods There were 6 cases of fresh total knee joint specimen for anatomical observation.After meglumine diatrizoate was injected into the joint capsule and the deep infrapatellar bursa,the CT examination of the knee specimen was performed.The specimens were detached according to the requirement of extraarticular knee resection,after methylene blue was injected into the joints capsule.The relationships between articular capsule,infrapatellar fat pad and deep infrapatellar bursa were observed,as well as feasibility of extraarticular total knee resection.Four patients with malignant bone tumor around the knee were performed extraarticalar total knee resection.The patellar ligament was reserved completely in 2 patients whose infrapatellar fat pads were not be involved by tumor confirmed by deep infrapatellar bursa radiography.However,the patellar ligament was split along the coronal plane in 2patients who had not undergone deep infrapatellar bursa radiography.The patients were followed up to observe results of tumor control and function of the affected knees.Results Through anatomical observation,some bursas around the knee joints,such as the suprapatellar bursa and popliteal bursa,communicated with the joint cavity,while the deep infrapatellar bursa did not.Furthermore,the infrapatellar fat pad located between the patellar tendon and joint cavity to form a good barrier to tumor invasion.So the patellar tendon could be reserved completely if the infrapatellar fat pad was not involved.Four patients were followed up for 10 to 28 months (average,19 months).At final follow-up,there was no local recurrence and metastasis in all 4 patients.The range of flexion of the affected knees ranged from 95° to 118 ° (average,105 °),and the average extension lag was 22 ° (range,10° to 40 °).The MSTS score was 72.5％.Conclusion For patients with malignant bone tumor involving the knee,the deep infrapatellar bursa radiography should be performed routinely.The patellar ligament could be reserved completely in the extraarticular total knee resection when the deep infrapatellar bursa doesn't communicate with the joint cavity combined with presence of the infrapatellar fat pad.Sometimes,only reserving the superficial half of the patellar ligament also could meet the need of extension.The short-term result of tumor control and function of the affected knee are satisfactory.

ObjectiveTo investigate the effect of arsenic trioxide (As2O3) on the metastasis capability of Ewing's sarcoma ceils. MethodsMTT assays were performed to choose appropriate concentrations of As2O3 (＜ 2 μmol/L) for the experiments.Migration and invasion assays were performed to assess the effect of As2O3 on the metastasis of Ewing's sarcoma cells. Changes in matrix metalloproteinase(MMP)-9 expressions were detected by gel zymography assay and the phosphoinositide 3-kinase/AKT(PI3K-AKT)pathway was investigated using Western blot. ResultsThe amount of Ewing's sarcoma cells across basal membrane of Transwell in migration and invasion assay decreased gradually with the increase in As2O3 concentration. The average quantities of A-673 across the membrane after treatment by gradual concentrations accounted for 54.3 ％,49.0 ％ and 17.0 ％ of that of untreated group respectively in migration assay (F=112.78,P ＜ 0.01), while 52.7 ％, 32.3 ％ and 10.3 ％ in invasion assay(F =183.76, P ＜ 0.01). Similarly, the percentage of RD-ES was 46.0 ％,39.0 ％ and 8.0 ％ in migration assay (F =408.25,P ＜ 0.01) and 58.7 ％,22.3 ％ and 9.0 ％ in invasion assay (F =373.25, P ＜ 0.01)respectively. The difference had statistics significance.The expression of MMP-9 was suppressed by As2O3 treatment according to gel zymography assay.Western blot assay showed that PI3K-AKT pathway was inhibited and nuclear factor kappa B(NF-κB)was inactivated.ConclusionLow-concentration As2O3 may inhibit metastasis capability of Ewing's sarcoma cells.

Objective To investigate the spinal stability reconstruction and related complications after total spondylectomy for thoracolumbar tumors. Methods From January 1997 to December 2009, 34 cases with thoracolumbar tumors treated with total spondylectomy, including 20 males and 14 females with an average age of 43 years. The tumors were located in thoracic vertebra in 27 cases and lumbar vertebra in 7, including 6 spinal metastases and 28 primary tumors. The total spondylectomy was piecemeal in 23 cases and en bloc in 11. The reconstruction methods included posterior short-segment fixation in 19 cases, multi-segmental fixation in 13, anterior intervertebral fixation in 2, titanium mesh with auto-bone graft in 20 cases, titanium mesh with bone cement in 7, bone cement filling in 2, auto-bone strut graft in 2, titanium mesh with strengthened rings in 1, artificial vertebral body replacement in 2, posterior massive bone bridging graft in 8 and bone particles graft in 26. Results The mean follow-up time was 43 months. Seven patients died, 5 suffered recurrence. Poor grafted bone fusion was found in 5 cases. The intervertebral sagittal Cobb angle of adjacent vertebra was ??after operation, 9.3?at the end of follow-up or before revision operation. The average lost angle was 14.1?for cases with multi-segmental fixation, and 21.5?with short-segment fixation. Complications included internal fixation broken (5) and loosening (2), titanium mesh subsidence (6) and displacement (3). There were 5 revision surgeries. Conclusion There are relative more complications about spinal stability reconstruction after total spondylectomy. To achieve temporary stiff fixation and long-term fusion, the posterior multi-segment fixation and massive bone bridging graft combined with the anterior artificial vertebral body replacement are effective.