Does Microwave Ablation of the Tumor Edge Allow for Joint-sparing Surgery in Patients With Osteosarcoma of the Proximal Tibia?

Background

Joint-sparing surgery of a patient’s native joint for osteosarcoma likely affords better function and comparable survival. However, it sometimes is challenging to resect a juxtaarticular osteosarcoma in a way that preserves the affected epiphysis because wide margins are necessary to minimize the risk of local recurrence. If there was a method to resect a tumor close to the joint and treat a potentially positive margin to prevent recurrence, it might allow salvage of a joint that otherwise might be lost.

Questions/purposes

We therefore asked (1) whether joint-preserving tumor resection could be performed for juxtaarticular osteosarcoma after microwave ablation of the tumor edge under navigation without leading to local recurrences, (2) what is the resulting function, and (3) what are the complications associated with this procedure.

Methods

Between 2009 and 2011, we treated 11 patients who had juxtaarticular osteosarcoma of the proximal tibia (mean age, 12 years; range, 9–16 years) with joint-preserving surgery by transepiphysis tumor resection after navigation-assisted microwave ablation of the tumor edge; they were followed a minimum of 37 months (mean, 48 months; range 37–62 months), and none was lost to followup. Patients were considered eligible for this procedure if they had a distance from the tumor edge to the articular surface between 10 to 15 mm, good chemotherapy responses, no pathologic fracture and no tumor involvement of major neurovascular structures. Allograft in combination with a vascularized fibula flap was used for segmental reconstruction. We recorded local tumor control, complications, and functional outcomes using the Musculoskeletal Tumor Society score, which ranges from 0 to 30, with higher scores indicating better function.

Results

There were no local recurrences. Major complications included osteonecrosis of part of the epiphysis in two patients and deep infection in one. The Musculoskeletal Tumor Society score ranged from 26 to 30 with a mean of 29.

Conclusions

In selected patients with osteosarcoma invading the epiphysis, navigated resection facilitates performing joint-sparing surgery, and in our small series, the adjuvant microwave ablation seemed to provide adequate local tumor control. Although more experience and longer followup are needed, this approach may make it possible to salvage more native joints when performing limb salvage for osteosarcoma.

Level of Evidence

Level IV, therapeutic study.     

某三甲医院73名护士离职原因及再就业情况调查分析

目的分析某三甲医院73名护士离职原因及再就业情况,探讨提高护士工作满意度,减少护士离职的对策。方法对73名护士采取电话访谈方式了解离职原因及再就业情况。结果护士离职的主要原因依次为护理工作紧张压力大(87.67%)、工作环境不满意(50.69%),科室人际关系紧张(41.10%)及考取外单位在编编制(38.36%)等6项原因。再就业包括继续从事护理专业(56.16%)、非护理专业(10.96%)、暂时休息(20.55%)等。结论应合理配置护士人力资源,缓解工作压力,实施更为人性化的管理,做好护士职业生涯规划等,以提高护士工作满意度,降低离职率。     

延续护理对PCI术后患者抗血小板治疗依从性的影响

目的：探讨延续护理对PCI术后患者抗血小板治疗依从性的影响。方法将129例PCI术后患者采用随机数字表法分为对照组55例和观察组74例,对照组采用常规护理,观察组在常规护理的基础上实施延续护理,在 PCI 术后6个月和12个月分别评估两组患者的抗血小板治疗依从性。结果 PCI术后6个月,观察组抗血小板治疗依从性好者占97.1%,对照组为84.0%,两组比较差异有统计学意义(χ2=4.76,P<0.05);PCI术后12个月,观察组抗血小板治疗依从性好者占96.9%,对照组为82.6%,两组比较差异有统计学意义(χ2=4.98,P<0.05)。结论延续护理可以提高PCI术后患者抗血小板治疗的依从性。     

Microscopy illumination engineering using a low-cost liquid crystal display

Illumination engineering is critical for obtaining high-resolution, high-quality images in microscope settings. In a typical microscope, the condenser lens provides sample illumination that is uniform and free from glare. The associated condenser diaphragm can be manually adjusted to obtain the optimal illumination numerical aperture. In this paper, we report a programmable condenser lens for active illumination control. In our prototype setup, we used a $15 liquid crystal display as a transparent spatial light modulator and placed it at the back focal plane of the condenser lens. By setting different binary patterns on the display, we can actively control the illumination and the spatial coherence of the microscope platform. We demonstrated the use of such a simple scheme for multimodal imaging, including bright-field microscopy, darkfield microscopy, phase-contrast microscopy, polarization microscopy, 3D tomographic imaging, and super-resolution Fourier ptychographic imaging. The reported illumination engineering scheme is cost-effective and compatible with most existing platforms. It enables a turnkey solution with high flexibility for researchers in various communities. From the engineering point-of-view, the reported illumination scheme may also provide new insights for the development of multimodal microscopy and Fourier ptychographic imaging.OCIS codes: (170.2945) Illumination design, (170.0180) Microscopy, (170.3010) Image reconstruction techniques, (100.3190) Inverse problems