Objective:To investigate the risk factors for 1-year survival rate in patients with spinal metastasis secondary to lung cancer.Methods:The data of 343 patients with spinal metastases secondary to lung cancer from January 2011 to December 2018 were retrospectively studied. There were 188 males (54.8%) and 155 females (45.2%) with an average age of 59.47±10.21 years old (range 23-91 years). The patients were divided into operation group (150 cases, 43.7%) and non operation group (193 cases, 56.3%). The demographics, types of primary tumor, non spinal metastasis, visceral metastasis, spinal metastasis and segments, pathological fractures of vertebra, Frankel classification, physical function status (Karnofsky performance scale, KPS), visual analogue score (VAS), the spinal instability neoplastic score (SINS) were recorded and analyzed. The impact of different treatments on the survival prognosis of patients with spinal metastasis was evaluated. The independent factors affecting survival in those patients were analyzed by Cox proportional hazards regression model.Results:The peak incidence of spinal metastases was found in the age group of 46-60 years (43.7%, 150/343). 38.5% (132/343) of the patients had pathological fractures of the involved vertebral body. 58.3% (200/343) of the patients had extraspinal bone metastasis. 36.2% (124/343) of the patients had visceral metastasis. Among the primary tumors, adenocarcinoma was the most common tpye (61.5%, 211/343), followed by large cell lung cancer (12.5%, 43/343), small cell lung cancer (6.4%, 22/343), squamous cell cancer (6.1%, 21/343) and mixed cell lung cancer (5.3%, 18/343). The type of lung cancer cells in about 8.2 (28/343) patients was unknown. Among the surgical patients, 21 patients underwent minimally invasive surgery (14.0%), 28 patients underwent simple decompression surgery (18.7%), 76 patients underwent separation surgery (50.7%), and 25 patients underwent radical surgery (16.6%). 59.3% (89/150) of the patients had a better neurological function than before surgery. The average survival time of all patients was 9.88 months with the median survival time of 8 (5,14) months. The survival rates were 62.1% (213/343), 30.0% (103/343), and 3.8% (13/343) at 6, 12, and 24 months, respectively. The average survival time of patients in the operation group was 10.24 months with the median survival time of 9 (5, 15) months, and the average survival time of patients in the non operation group was 9.41 months with the median survival time of 7 (5, 13) months with no significant difference between the groups (χ 2=0.300, P=0.584). Multivariate Cox proportional hazard regression model analysis showed that radiotherapy [ HR=1.913, 95% CI(1.471, 2.488), P<0.001], chemotherapy [ HR=1.313, 95% CI(1.040, 1.658), P=0.022], targeted drug therapy [ HR=1.683, 95% CI(1.221, 2.319), P=0.001], KPS [ HR=1.593, 95% CI(1.140, 2.225), P=0.006] and pathological type (non-small cell lung cancer) were independent factors affecting the 1-year survival rate of patients with spinal metastasis secondary to lung cancer [ HR=0.322, 95% CI(0.225, 0.460), P<0.001] with significant difference. Conclusion:Surgical treatment can improve both the neurological function and general status of patients with spinal metastasis. Treatments of radiotherapy, chemotherapy, and targeted drug therapy can significantly improve 1-year survival rate, while a KPS less than 50 points and a primary lung cancer other than adenocarcinoma were independent risk factors reducing 1-year survival rate.

Background The contradiction between science and operability has always existed in the model of classified occupational health supervision and management. Comprehensive risk assessment method for occupational disease hazards of employers provides risk grading and classification for occupational health management, and it's a new attempt to explore classification supervision and law enforcement. Objective To apply a comprehensive risk assessment method for occupational disease hazards of employers to estimate health risk level of wood furniture enterprises, discuss its advantages and disadvantages, and provide a basis for improving the classified management of occupational health. Methods Seven typical factories were selected in counties with highly concentrated wooden furniture manufacturing. Occupational health field investigation and testing were carried out to estimate occupational disease hazard risk level (Ⅰ, Ⅱ, and Ⅲ). A self-rated checklist was applied to score occupational health management status by interviewing employers, one by one, and to determine occupational health management status grade (A, B, and C) by the score. Thus, a comprehensive risk level (Class A, Class B, and Class C) of a specific factory was obtained from a matrix of occupational disease hazard risk level and management status grade. Risk verification was carried out based on any abnormality reported by regular occupational physical examination in past 3 years. Results Defects in occupational health management were identified in all 7 factories, among which 6 were grade C with key nonconformities (poor), and 1 was grade B (medium). Disqualified occupational disease hazards were found in 6 of 7 factories, and the workstation-specific disqualified rates were 26.09% (12/46) for noise, 14.71% (5/34) for wood dust (hard), and 12.50% (1/8) for xylene. Level Ⅱ (medium) of occupational disease hazard risk was estimated in 5 of 7 factories, while level Ⅲ (high) in 2 factories. All 7 factories were class C (high risk) accessed by the comprehensive risk assessment method for occupational disease hazards. The occupational health surveillance documents showed 636 batches of regular occupational physical examination were ordered by the 7 employers, and a total of 37 workers from 5 factories reported abnormalities in physical examination, among which 3 workers reported dust exposure and 34 workers reported noise exposure. Conclusion The comprehensive risk assessment method for occupational disease hazards of employers is not able to perform with satisfaction in occupational health classification of wooden furniture manufacturing factories yet. It is necessary to expand the pilot to improve this assessment method and develop an efficient supervision mechanism to ensure the authenticity of the data before it is popularized and applied in classified occupational health management.

OBJECTIVE To establish a comprehensive and rapid m ethod for the a nalysis of chemical constituents as phthalides and organic acids in Angelica sinensis ，and to provide scientific reference for the quality evaluation and pharmacodynamic substance research of A. sinensis . METHODS The 70％ ethanol extract of A. sinensis was analyzed by ultra high performance liquid chromatography-quadrupole-time of flight tandem mass spectrometry （UPLC-Q-TOF/MS）. The determination was performed on ACQUITY UPLC BEH-C 18 column with mobile phase consisted of 0.1％ formic acid solution- acetonitrile（gradient elution ）at the flow rate of 0.3 mL/min. The column temperature was set at 30 ℃，and sample size was 2 µL. The ion source was an electrospray ion source ，using positive ion scanning mode ，and the mass scanning range was m/z 50-1 000. Capillary voltage was 4 000 V； atomizer pressure was 35 psi；cracking voltage was 135 V and the taper hole voltage was 65 V；the temperature of dry gas was 320 ℃；the flow of dry gas was 10 L/min and the flow of sheath gas was 11 L/min；collision energy were 20 and 40 V. Qualitative Analysis 10.0 software was used to obtain the retention time of compounds ，the accurate mass number of excimer ion peaks and secondary fragments. The compounds were analyzed by comparing with the mass spectra of the reference substance ，combined with relevant literature ，mass spectrometry cleavage law and database such as Chemspider ，MassBank，PubChem. RESULTS A total of 72 compounds were identified or deduced from A. sinensis ，including 55 phthalides，13 organic acids and 4 other constituents. CONCLUSIONS The established method is rapid and accurate for the identification of chemical constituents from A. sinensis ，such as organic acids and phthalides ，which provides an efficient and rapid analytical method for the comprehensive characterization of its chemical constituents.

Objective:To retrospectively analyze the patients with spinal metastases who received surgical intervention and summarize the evolution of their clinical and pathological characteristics and surgical methods.Methods:The data of 703 patients with spinal metastases from January 2007 to December 2018 were collected retrospectively. There were 395 males (56.19%, 395/703) and 308 females (43.81%, 308/703) with an average age of 58.14±11.46 years (range 13-84 years). According to the degree of invasion and thoroughness of tumor resection, the surgical methods could be divided into minimally invasive surgery, decompression surgery, separation surgery, piecemeal resection and total en-bloc spondylectomy surgery. The operative methods were minimally invasive surgery in 89 cases (12.66%), decompression surgery in 96 cases (13.66%), separation surgery in 303 cases (43.10%), piecemeal resection in 182 cases (25.89%) and total en-bloc spondylectomy in 33 cases (4.69%). To analyze the trend of the clinical, pathological types and surgical treatment of patients with spinal metastases over the years, and determine the relevant factors affecting the decision-making of surgical methods by multivariate logistic regression.Results:The ratio of male to female was 1.28:1. 39.54% (278/703) of patients with single-segment involvement in 703 patients, 24.04% (169/703) of patients with double-segment metastasis and 36.42% (256/703) of patients with multi-segment metastasis. The most common type of primary tumor was lung cancer (34.57%, 243/703), followed by breast cancer (8.25%, 58/703), myeloma (8.11%, 57/703), gastrointestinal tumor (6.82%, 48/703) and renal malignant tumor (6.40%, 45/703). From 2007 to 2018, there was no significant difference in the percentage change of different age, gender and primary tumor source composition (age: χ 2=14.01, P=0.233; gender: χ 2=35.73, P=0.341; primary tumor: χ 2=120.09, P=0.074). The percentage of patients with sacrococcygeal metastasis decreased from 20.00% in 2008 to 1.89% in 2017 and the difference was statistically significant (χ 2=8.09, P=0.005). The percentage of patients with multi-level metastasis increased from 26.67% in 2008 to 52.83% in 2017, and the difference was statistically significant (χ 2=7.23, P=0.007). The percentage of patients with minimally invasive surgery decreased from 25.00% in 2007 to 5.88% in 2018, and the percentage of patients with segmented resection decreased from 53.33% in 2008 to 10.29% in 2018. The proportion of the two surgical methods showed a significant downward trend, and the differences were statistically significant (minimally invasive surgery: χ 2=1.46, P=0.026; segmented resection surgery: χ 2=19.56, P<0.001). The percentage of patients undergoing separation surgery increased from 13.33% in 2008 to 64.71% in 2018, and the proportion of patients undergoing total en-bloc spondylectomy increased from 0 in 2007 to 10.29% in 2018. Both surgical methods showed a significant growth trend and the differences were statistically significant (separation surgery: χ 2=27.09, P<0.001; χ 2=4.16, P=0.042). Multivariate Logistic regression analysis showed that age, metastatic site, number of metastatic segments, pathological vertebral fractures, Frankel grade, SINS score and VAS score were independent factors influencing surgical decision-making ( P<0.05). Conclusion:With different time and age, the invasiveness and thoroughness of surgery are increasing, which shows that the percentage of patients who underwent separation surgery and to-tal en-bloc spondylectomy is significantly increasing. Age, metastatic site, number of metastatic segments, pathological vertebral fractures, Frankel grade, SINS score and VAS score are independent factors affecting surgical decision-making.

Objective:To evaluate the clinical value of the New England spinal metastasis score (NESMS) in predicting the prognosis of patients with spinal metastases by retrospectively analyzing the medical records of multicenter spinal metastases in China.Methods:The data of 179 patients with spinal metastases from January 2008 to December 2018 were retrospectively collected. There were 108 males (60.3%) and 71 females (39.7%) with an average age of 59.79±10.88 years old (range 27-84 years). The patient demographic characteristics, primary tumor type, spinal metastases and segments, vertebral pathological fractures, neurological Frankel classification, physical function status, Karnofsky performance scale (KPS), visual analogue score (VAS), the spinal instability neoplastic score (SINS), modified Bauer score, NESMS score, Tomita score and modified Tokuhashi score were collected. The clinical value of NESMS score, Tomita score and modified Tokuhashi score in predicting the survival of patients with spinal metastases were compared. The independent factors affecting survival in these patients were analyzed by Cox proportional hazards regression model.Results:Among the 179 patients, the peak incidence of spinal metastases was in the age group of 61-75 years (45.3%, 81/179) of all patients. Lung cancer was the most common primary tumor (46.9%, 84/179). 40.8% (73/179) of patients had multi-segment metastasisand thoracic spine was the most common site with single-site metastasis (26.3%, 47/179). 28.5% (51/179) of the patients had visceral metastases and 52.0% (93/179) of the patients had extraspinal bone metastases. 31.3% (56/179) of the patients had pathological fractures of the involved vertebral bodies.114 patients received surgical treatment (63.4%). The mortality rates in 3-months, 6-months and 1-year were 22.4% (40/179), 51.4% (92/179) and 77.1% (138/179), respectively. The median survival time of patients with NESMS score of 0-3 was 3, 4, 8, and 10 months respectively with the mean survival time was 3.60±2.10, 6.77±3.39, 9.69±5.71 and 10.53±6.25 months. The 1-year mortality rates were 100% (13/13), 87.5% (42/48), 71.6% (63/88) and 66.7% (20/30) respectively. The consistency of NESMS score, Tomita score and modified Tokuhashi score in predicting survival of all patients was 0.63, 0.58 and 0.55, respectively. For patients with spinal metastases, the NESMS score was better than the Tomita score and modified Tokuhashi score in predicting survival at 3-months (AUC=1.00, 0.63, 0.42) and 6-months (AUC=0.71, 0.63, 0.45). But the accuracy of Tomita score was best in predicting survival at 1-year (AUC=0.66, 0.61, 0.38). Multivariate Cox proportional hazards regression model analysis showed that growth rate of primary tumor, neurological function Frankel score, albumin level and surgical treatment were independent factors affecting the survival time of patients with spinal metastases ( P<0.05). Conclusion:The consistency and accuracy of NESMS score in predicting survival of patients with spinal metastases are better than Tomita score and modified Tokuhashi score, especially in predicting 3- and 6-month survival. The growth rate of primary tumor, Frankel classification, albumin level and surgical treatment were independent factors affecting the survival time of patients with spinal metastases.

Objective: To analyze the occupational health surveillance data of toxic and harmful workers in Ningbo, and provide scientific basis for making protective measures. Methods: To export the occupational health surveillance data of toxic and harmful workers reported by occupational health examination institutions in Ningbo during the January 1, 2011 to December 31, 2017 from the China Information System for Disease Control and Prevention, and analyze the trend of the suspected occupational disease and occupational contraindication detection rate, and compare the the health status of workers in different industry nature, economic type, enterprise scale and occupational hazards. Results: From 2011 to 2017, the number of occupational health surveillance of toxic and harmful workers in Ningbo was increasing year by year. The detection rates of suspected occupational diseases and occupational contraindications generally showed a downward trend (P<0.05) . In 2017, the distribution of occupational health care for toxic and harmful workers in Ningbo was mainly based on manufacturing (187 681/220 895, 84.96%) , private economic enterprises (103 960/220 895, 47.06%) and small enterprises (100 357/220 895, 45.43%) , Workers exposed to chemical poisons had the largest number of physical examinations (101 813/220 895, 46.09%) . The highest detection rates of suspected occupational diseases were mining industry (2/1225, 0.16%) , collective economic enterprises (4/2622, 0.15%) and small enterprises (88/100 357, 0.09%) . The highest detection rates of occupational contraindications were rental and business services (16/1 320, 1.21%) , private economic enterprises (1 190/103 960, 1.14%) and small enterprises (995/100 357, 0.99%) . In addition, workers exposed to dust had the highest detection rate of suspected occupational diseases (57/46 740, 0.12%) and workers exposed to physical factors had the highest detection rate of occupational contraindications (1207/69 567, 1.74%) . There were significant differences between the detection rate of suspected occupational disease and occupational contraindication in different industries, economic types, enterprise scale and occupational hazards (P<0.05) . Conclusion The occupational health surveillance of toxic and harmful workers in Ningbo has been strengthened year by year, attention should be paid to small, private enterprises, and strengthen the supervision of occupational health and further standardize the work of occupational health examination so as to effectively protect the health of the occupational population.

Objective To analyze clinical efficacy of artificial prosthesis in giant cell tumor in distal femur,and to investigate risk factors affecting prosthesis failure and functional outcomes.Methods 42 patients with giant cell tumor of bone in distal femur,who had undergo prosthesis replacement from January 2002 to May 2015,were enrolled in this study.There were 24 males and 18 females,with an average age of 38.53± 12.87 years.There were 28 primary patients and 14 relapsed patients,including 11 cases of recurrence once and 3 cases of twice.Three-dimensional finite element model was used to analyze the effect of different angles of deviation of the spinal needle on the deformation of the bone wall.The correlations between the factors such as age,sex,occupation,prosthesis type,and other factors on prosthesis loosening were compared.Biomechanical effect of lower limbs caused by prosthesis offset angle was analyzed through gait analysis.Analyzed the effects of primary tumor or recurrence,prosthesis service status,and length of surgical osteotomy on joint function.Results A total of 42 patients were followed up by 20-158 months,with an average of 68.7 months.The 3 year survival rate of prosthesis was 83.33％ for 3 years and 57.14％ for 5 years.The major reason of prosthesis failure was loose (18/42,42.8％).X-ray films showed 19 cases of prosthetic intramedullary nail and sagittal bias of medullary force line angle ＞ 3° in the first follow-up.Osteotomy length (OR=0.132,P=0.0027) and offset angle of needle (OR=25.000,P=0.000) were significantly correlated to prosthesis loose.A length more than 12 cm and angle more than 3° were easier to result in prosthesis loose.There were no significant correlation between prosthesis failure and patients age,gender,occupation and prosthesis type.Gait analysis shows that the unsuitable bias angle of the prosthesis can significantly change the joint force of the prosthesis.The average score of MSTS 93 function evaluation was 25.43±4.256,excellent in 33 cases,good in 7 cases and poor in 2 cases.Function of patients with primary GCT were better than that of recurrent ones.Patients with one 1 times recurrence were better than that of recurrence twice (P=0.003).Patients without prosthesis loosening and revision were better than that with loosening (P=0.001).Patients with an osteotomy length less than 12 cm had a poorer function than that with more than 12 cm (P=0.002).Conclusion The main factors affecting distal femoral prosthesis replacement therapy of GCT is loosening,which was caused by broach and medullary cavity mismatch,osteotomy length,prosthesis rotation,prosthesis position.The function of the prosthesis is mainly affected by operation times,prosthesis status,osteotomy length and low patella.

Objective To investigate the factors related to the local recurrence of spine giant cell tumor (GCT) after surgical treatment and provide a reference for the treatment.Methods A retrospective analysis of GCT of the spine from January 2000 to June 2016 was conducted.A total of 73 patients with GCT of the spine who underwent surgical treatment in Giant Cell Tumor Team of China (GTOC) were collected,including 29 males and 44 females.The average age was 33.73±11.34 years (range:13-60 years).Clinical characteristics including gender,age,history of recurrence,tumor position,Ennecking stage,Frankel score,clinical symptoms,surgery procedures,surgical approach,preoperative selective artery embolism (PAE),radiotherapy and bisphosphonate treatment history are collected.The correlation between the factors and tumor recurrence were analyzed by single factor analysis and multiple-factor logistic regression.Results The mean follow-up time was 61.81 ±53.21 months (range:4-210 months).Surgical procedures,bisphosphonate treatment,history of recurrence and radiotherapy were found significant correlation with tumor recurrence by single factor analysis.The result of multiple-factor logistic regression showed that surgical procedures (P=0.026) and bisphosphonate treatment (P=0.017) were independent risk factors for tumor recurrence.Conclusion Total spondylectomy and bisphosphonate treatment could significantly reduce the recurrence rate of GCT of the spine.

Objective To retrospective analysis the onset characteristics and outcome of surgical management in patients with giant cell tumor (GCT) of distal tibia,explore the operation indication and the risk factors for recurrence and limb function.Methods From October 2000 to June 2014,Fifteen patients with GCT in the distal tibia from domestic three bone tumor centers were involved in this study.They included 8 males and 7 females,with an average age of 35.9± 10.4 years.There were 11 cases of Campanacci Ⅱ and 4 cases of Campanacci Ⅲ.Two cases of Campanacci Ⅱ occurred pathologic fracture.Expanded curettage surgery was performed in 11 cases and tumor resection with revascularization was performed in 4 cases.Factors influencing the choice of surgery,recurrence and limb function were analyzed.These included tumor size,ankle condition,Campanacci grade,pathological fracture.Results A1l patients were followed up with a mean duration of 62.3±25.2 months,ranging from 26 to 60 months.One of 11 patients treated with extended curettage underwent local recurrence.One of 4 patients treated with marginal excision underwent local recurrence.The effect of Campanacci classification and pathological fracture on selection of operation scheme was analyzed.The effects of pathological fractures,Campanacci classification,surgical methods and postoperative functional score (MSTS score) on postoperative recurrence rate were analyzed.Single factor analysis showed that the pathological fractures did not affect the selection of GCT surgical treatment plan (P=1.000).Campanacci classification affected the selection of GCT surgical treatment plan (P=0.001).Pathological fractures,Campanacci classification and surgical methods were not related to the local recurrence rate (P ＞ 0.05).Expanded curettage of Campanacci grade Ⅱ patients with better postoperative MSTS score than tumor segment resected Campanacci grade Ⅲ patients (t=3.385,P=0.005).There was no significant relationship between pathological fracture and postoperative MSTS score.Conclusion Distal tibia GCT Campanacci classification and whether combined with pathological fracture or not affects the choice of surgical procedure and postoperative functional recovery.

Objective To evaluate the prognostic factors of spinal metastases by recursive partitioning analysis (RPA)and establish a decision tree model that can guide clinicians to select individualized treatment.Methods Between January 2011 and December 2015,three institutional databases were searched to identify 169 patients with metastatic spinal tumors underwent surgery.The ratio of male and female was 1.48:1 (102 males and 67 females).The average age was 59.2±11.1 years.One-hundred eighteen cases of patients were randomly selected as training samples and the remaining 51 cases were verified samples.Preoperative factors were collected and analyzed by RPA methods,including primary tumor,KPS score,Frankel grade,gender,age,visceral metastasis,bone metastasis,spinal metastasis,blood glucose,blood pressure,surgery site,symptoms,surgery interval,serum albumin level and other risk factors.Pearson's Chi-square test was performed to judge the segmentation point of the decision tree model.The decision tree model is built using the Chi-square automatic interaction detector (CHIAD) algorithm and sensitivity and specificity was automatically calculated.Results The median postoperative survival time was 12.6±1.2 months [95％CI(10.1,15.0)].70％ were randomly selected as the experimental group (118 cases),and 30％ were the verification group (51 cases).The sensitivity was 96.9％.The specificity was 89.8％.The Kappa coefficient was 0.874 in the experimental group.The sensitivity was 95.4％.The specificity was 90.8％.The Kappa coefficient was 0.810 in the test group.The prognostic factors (weight from high to low) based on RPA were Frankel grade (F=8.132,P=0.005),the primary tumor and the KPS score (Equal,F=9.871,P=0.000 and F=1 1.945,P=0.003),serum albumin and movement time (Equal,F=7.566,P=0.018 and F=9.966,P=0.008).The decision tree model consists of 7 types.Survival time was 51 months,18 months,13 months,8 months,4 months,5 months,9 months in the class Ⅰ～Ⅶ,respectively.According to the difference of RPA survival time,the operation was classified as 3 grade.Total spinal resection was regarded as grade 1,including class Ⅰ and class Ⅱ,with an average survival time of over 18 months.Limited operation was regarded as grade 2,including class Ⅲ,Ⅴ and Ⅶ with survival time in 6-18 months.The conservative treatment was regarded as grade 3,including class Ⅳ and Ⅵ with the survival time was less than 6 months.Conclusion The decision tree model based on RPA for predicting the survival time of spinal metastases can not only identify the prognostic factors,but also classify and grade various prognostic factors;the decision tree model is simple and can guide clinicians to choose the best surgical plan by predicting the survival time.