Surgical Treatment and Proposed Modified Classification for Harrington Class III Periacetabular Metastases

ObjectivesThis study aims to: (i) evaluate the outcome of patients with Harrington class III lesions who were treated according to Harrington classification; (ii) propose a modified surgical classification for Harrington class III lesions; and (iii) assess the efficiency of the proposed modified classification.MethodsThis study composes two phases. During phase 1 (2006 to 2011), the clinical data of 16 patients with Harrington class III lesions who were treated by intralesional excision followed by reconstruction of antegrade/retrograde Steinmann pins/screws with cemented total hip arthroplasty (Harrington/modified Harrington procedure) were retrospectively reviewed and further analyzed synthetically to design a modified surgical classification system. In phase 2 (2013 to 2019), 62 patients with Harrington class III lesions were classified and surgically treated according to our modified classification. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) 93 scoring system. The outcome of local control was described using 2‐year recurrence‐free survival (RFS). Owing to the limited sample size, we considered P < 0.1 as significant.ResultsIn phase 1, the mean surgical time was 273.1 (180 to 390) min and the mean intraoperative hemorrhage was 2425.0 (400.0 to 8000.0) mL, respectively. The mean follow‐up time was 18.5 (2 to 54) months. Recurrence was found in 4 patients and the 2‐year RFS rate was 62.4% (95% confidence interval [CI] 31.6% to 93.2%). The mean postoperative MSTS93 score was 56.5% (20% to 90%). Based on the periacetabular bone destruction, we categorized the lesions into two subgroups: with the bone destruction distal to or around the inferior border of the sacroiliac joint (IIIa) and the bone destruction extended proximal to inferior border of the sacroiliac joint (IIIb). Six patients with IIIb lesions had significant prolonged surgical time (313.3 vs 249.0 min, P = 0.022), massive intraoperative hemorrhage (3533.3 vs 1760.0 mL, P = 0.093), poor functional outcome (46.7% vs 62.3%, P = 0.093), and unfavorable local control (31.3% vs 80.0%, P = 0.037) compared to the 10 patients with IIIa lesions. We then modified the surgical strategy for two subgroup of class III lesions: Harrington/modified Harrington procedure for IIIa lesions and en bloc resection followed by modular hemipelvic endoprosthesis replacement for IIIb lesions. Using the proposed modified surgical classification, 62 patients in the phase 2 study demonstrated improved surgical time (245.3 min, P = 0.086), intraoperative hemorrhage (1466.0 mL, P = 0.092), postoperative MSTS 93 scores (65.3%, P = 0.067), and 2‐year RFS rate (91.3%, P = 0.002) during a mean follow‐up time of 19.9 (1 to 60) months compared to those in the phase 1 study.ConclusionThe Harrington surgical classification is insufficient for class III lesions. We proposed modification of the classification for Harrington class III lesions by adding two subgroups and corresponding surgical strategies according to the involvement of bone destruction. Our proposed modified classification showed significant improvement in functional outcome and local control, along with acceptable surgical complexity in surgical management for Harrington class III lesions.     

软骨组织工程种子细胞的基础和应用研究进展

软骨种子细胞的老化和缺乏是限制软骨组织工程在临床应用的瓶颈问题。本文概述了目前对软骨种子细胞研究的两个方面 :扩大种子细胞的来源及预防和延缓种子细胞功能老化 ,并展望软骨组织工程在监床的应用前景。     

不同机制大动脉粥样硬化型脑卒中基线特征和血管内治疗后结局比较

目的 本研究旨在比较颅内大血管伴/不伴同侧颈内动脉闭塞的大动脉粥样硬化型脑卒中患者基线特征以及行血管内治疗后结局的差异。方法 对DIRECT-MT亚组进行回顾性分析,以比较前循环大动脉粥样硬化（large-artery atherosclerosis,LAA）型卒中串联闭塞和颅内闭塞接受血管内治疗（endovascular treatment,EVT）的患者的基线特征和预后,分析不同机制学特征（动脉粥样硬化或动脉-动脉栓塞）对临床结局的影响。结果 LAA型卒中患者共108例,其中串联闭塞63例,颅内闭塞45例。颅内闭塞组患者高血压史率高于串联闭塞组（77.8% vs. 52.4%, P=0.007）。颅内闭塞组闭塞部位最常见于大脑中动脉M1段（88.6%）,而串联闭塞组颅内闭塞主要位于颈内动脉颅内段（49.2%）和大脑中动脉M1段（49.2%）（P＜0.001）。两组患者在年龄、性别、术前抗栓、他汀类药物的使用,卒中、房颤、吸烟史,基线mRS、NIHSS评分,是否静脉溶栓,侧枝循环,以及救治流程时间差异均无统计学意义（P均＞0.05）。90天mRS 0-2分的患者比例两组差异无统计学意义（53.3% vs. 41.9%, P=0.243）。颅内闭塞组术后成功再灌注率高于串联闭塞组（93.3% vs. 77.4%, P=0.026）,但术后24-72小时血管再通的比例前组低于后组（57.1% vs. 77.2%, P=0.034）。最终梗死体积,颅内闭塞组小于串联闭塞组（20.1 vs. 34.5, P=0.025）。术后NIHSS评分,90天EQ-5D-5L评分和BI指数等其他次要结局,两组间差异无统计学意义（P均＞0.05）。两组在90天内的死亡率,发生的无症状性和症状性颅内出血率,5-7天时在另外的血管区域新发脑梗死,以及新流域栓塞的患者百分比相似,差异无统计学意义（P均＞0.05）。结论 动脉粥样硬化导致的串联闭塞相较于孤立颅内闭塞,末次造影成功再灌注率较低,梗死体积更大,但术后24-72小时再通率更高,且神经功能良好预后率以及不良事件发生率均与颅内闭塞相仿。     

特瑞普利单抗联合舒尼替尼治疗晚期肾细胞癌的初步疗效分析

目的：评估特瑞普利单抗联合舒尼替尼治疗晚期肾细胞癌的疗效与安全性。方法：回顾性分析2020年1月—2022年3月海军军医大学第二附属医院接受特瑞普利单抗联合舒尼替尼治疗的25例晚期肾癌患者临床资料,其中男21例,女4例,中位年龄为59 (33~80)岁。25例患者病理类型均为透明细胞癌,其中2例为TFE3融合基因相关肾癌,1例部分肉瘤样变,25例患者均发生局部进展或远处转移。评价其生存获益和相关不良反应发生情况。结果：中位随访时间11.0(2.5～24)个月,25例患者均可评价疗效,总体人群ORR 36.0%,DCR 84.0%,9例患者部分缓解,12例患者病情稳定,4例患者疾病进展,中位PFS 12.7个月(95%置信区间：10.7～14.7),中位OS尚未达到。治疗总体不良反应发生率为88.0%,常见不良反应包括皮疹、腹泻、手足皮肤反应、高血压等,90%的不良反应为1~2级。     

Homer 1b/c通过内质网功能调节由谷氨酸诱发的HT22细胞自噬

目的　研究Homer1b/c蛋白在谷氨酸诱发的细胞自噬中的作用及机制。方法　选用小鼠海马细胞系HT22细胞,通过500 ?mol/L谷氨酸处理建立细胞损伤模型。用siRNA慢病毒转染方式下调Homer1b/c表达和10 ?mol/LBAPTA-AM（1,2-双(2-氨基苯氧基)乙烷-N,N,N`,N`-四乙酸四乙酸甲酯,钙离子螯合剂）、10 mmol/L4-PBA（4-苯基丁酸,内质网应激抑制剂）分别抑制细胞内钙离子释放和内质网应激后,使用蛋白质印迹法检测Homer1b/c,自噬蛋白Beclin-1、微管相关蛋白轻链3（LC3）,以及内质网应激标志蛋白CHOP（人内质网应激相关蛋白）、GRP-78(葡萄糖调节蛋白78)的表达水平。每组实验均进行3次,采用独立样本t检验和单因素方差分析进行统计学分析。结果　谷氨酸处理HT22细胞12 h后,Beclin-1表达和LC3-Ⅱ/LC3-Ⅰ比值均升高（P<0.05）,下调Homer1b/c表达可降低Beclin-1表达和LC3-Ⅱ/LC3-Ⅰ比值的升高程度（P<0.05）。抑制细胞内钙离子释放和抑制内质网应激均能降低Beclin-1表达和LC3-Ⅱ/LC3-Ⅰ比值的升高程度（P<0.05）。然而在下调Homer1b/c表达后,抑制细胞内钙离子释放和抑制内质网应激未能进一步降低Beclin-1表达和LC3-Ⅱ/LC3-Ⅰ比值的升高程度（P<0.05）。结论　Homer1b/c能够调节谷氨酸诱导的自噬,其调节作用可能与内质网功能有关。     

石蜡切片中BCL-6抗原失活机制及修复

目的　探讨石蜡切片中BCL 6抗原失活机制及修复的最佳方法 .方法　淋巴组织反应性增生 11例石蜡切片分别用二乙胺四乙酸 (EDTA)、柠檬酸、碳酸钠及去离子水 4种与钙离子结合力不同的修复液 ,结合高压、微波和煮沸 3种不同方法修复后 ,比较检出的BCL 6阳性率及强度 .结果　BCL 6阳性率由高至低依次为 :EDTA 0 .73>柠檬酸 0 .45 (P<0 .0 1) >碳酸钠 0 .12 (P <0 .0 1) ,去离子水组无 1例阳性 .高压修复阳性率 0 .5 5 >微波修复 0 .2 8和煮沸修复 0 .12 (P <0 .0 5 ) .不同修复液与高压结合修复检出BCL 6阳性率及强度 :EDTA与柠檬酸阳性率分别为 1,0 .82 (P >0 .0 5 ) ,高于碳酸钠组 (0 .36 )和去离子水组 (0 ) (P <0 .0 1) .EDTA组强阳性占 0 .82 ,显著高于其他各组 (P <0 .0 1) .结论　EDTA结合高压是修复BCL 6抗原的理想方法 ,钙离子的参与可能是甲醛固定后BCL 6抗原失活的原因之一     

恒温恒压电烫仪建立小鼠烫伤模型的实验研究

目的：寻求理想的建立小鼠不同深度烫伤模型的方法。方法：研制了恒温恒压电烫仪,分别以80度,0．5kg,2cm为统一的致伤温度,致伤压力,致伤直径,同时严格控制其他各个因素,以致伤时间为唯一可变因素,通过改变致伤时间,在小鼠背部建立不同深度的烫伤模型,并于烫伤后即时,4h,12,24h和48h取材病检。结果：建立浅II度,深II度及III度烫伤创面模型的致伤时间分别为5s,8s和12s;汤伤创面深度随病程逐渐加深,直至伤后24h才稳定,伤后48h的组织学改变类似伤后24h,结论：烫伤创面深度应以伤后24h创面深度稳定后的深度为诊断标准,本方法操作简单,所建模型稳定,重复性好,不失为一种建立小鼠不同深度烫伤模型的较为理想的方法。     

P~(53)蛋白在口腔扁平苔藓癌变诊断中的意义

目的 :探索口腔粘膜扁平苔藓 (OLP) P53蛋白的表达及其在癌变诊断中的应用价值。方法 :采用 S- P免疫组化方法 ,观察在 2 5例 OLP、2 0例鳞癌 (OSCC)中 P53蛋白的表达。结果 :1 P53蛋白的阳性表达在 OLP早期已出现 ,各组间 P53阳性表达率间有显著性差异。2在 OSCC中其阳性表达率高达 80 % ,随着细胞异常增生程度的增高而增高。结论 :1在 OSCC的形成过程中 ,抑癌基因 P53的失活可能参与调节作用 ;2 P53蛋白作为判断 OLP癌变的辅助性参考指标 ,具有一定的可行性     

卵巢恶性肿瘤VEGF mRNA和bFGF mRNA的表达及其意义

应用原位分子杂交技术研究卵巢恶性肿瘤组织中VEGFmRNA和bFGFmRNA的表达及其意义。结果发现 :浆液性腺癌和内胚窦癌两者表达阳性率高于粘液性腺癌和颗粒细胞瘤 ;临床分期Ⅰ期和未转移病例两者表达阳性率低于临床分期Ⅲ～Ⅳ期和转移病例。结果提示VEGFmRNA和bFGFmRNA表达与卵巢恶性肿瘤病理类型、临床分期和转移发生关系密切 ,阳性表达者可能预后较差。     

肝癌患者恶性疾病相关性DNA结合蛋白2的检测

The aim of this study was to assess the value of malignant disease-associated DNA-binding protein 2(MAD2) in the diagnosis of liver cancer. The concentration of plasma MAD2 was determined in 27 patients with primary liver cancer, 14 patients with metastatic liver cancer and 12 healthy subjects by ELISA assay. The primary tumors of all the patients with metastatic liver cancer were located in the gastrointestinal tract, which had been radically resected and had no signs of local recurrence. The concentrations of plasma MAD2 in the patients with primary liver cancer, with metastatic liver cancer, and the healthy subjects were 30.56 +/- 11.38 micrograms/ml, 9.27 +/- 5.58 micrograms/ml and 8.43 +/- 5.62 micrograms/ml, respectively. The concentration of MAD2 in patients with primary liver cancer was significantly higher than that in the patients with metastatic liver cancer and healthy subjects (P < 0.001). There was no significant difference between the healthy subjects and the patients with metastatic liver cancer(P > 0.05). These results suggest that MAD2 may be an useful marker for the diagnosis of primary liver cancer.