In vitro simulated digestion and fermentation characteristics of pectic polysaccharides from fresh passion fruit (Passiflora edulis f. flavicarpa L.) peel.

In this study, two pectic polysaccharides (PFP-T and PFP-UM) were extracted from fresh passion fruit peels using three-phase partitioning (TPP) and sequential ultrasound-microwave-assisted TPP methods, respectively, and their effects on the in vitro gastrointestinal digestion and fecal fermentation characteristics were examined. The results indicate that gastrointestinal digestion has a minimal effect on the physicochemical and structural characteristics of PFP-T and PFP-UM. However, during in vitro fecal fermentation, both undigested PFP-T and PFP-UM are significantly degraded and utilized by intestinal microorganisms, showing increased the total relative abundance of Firmicutes and Bacteroidota in the intestinal flora. Notably, compared with PFP-UM, PFP-T better promoted the reproduction of beneficial bacteria such as Prevotella, Megasphaera and Dialister, while suppressed the growth of harmful genera including Escherichia-Shigella, producing higher content of short-chain fatty acids. Therefore, our findings suggest that PFP-T derived from passion fruit peel has potential as a dietary supplement for promoting intestinal health.

Pay Attention to the Osteochondromas in Fibrodysplasia Ossificans Progressiva.

BACKGROUND: Fibrodysplasia ossificans progressiva (FOP) is an extremely rare disease characterized by malformation of the bilateral great toes and progressive heterotopic ossification. The clinical features of FOP occur due to dysfunction of the bone morphogenetic protein (BMP) signaling pathway induced by the mutant activin A type I receptor/activin-like kinase-2 (ACVR1/ALK2) which contributes to the clinical features in FOP. Dysregulation of the BMP signaling pathway causes the development of osteochondroma. Poor awareness of the association between FOP and osteochondromas always results in misdiagnosis and unnecessary invasive operation. CASE PRESENTATION: In this study, we present a case of classical FOP involving osteochondroma. An 18-year-old male adolescent, born with deformity of bilateral big toes, complained multiple masses on his back for 1 year. The mass initially emerged with a tough texture and did not cause pain. It was misdiagnosed as an osteochondroma. After two surgeries, the masses became hard and spread around the entire back region. Meanwhile, extensive heterotopic ossification was observed around the back, neck, hip, knee, ribs, and mandible during follow-up. Osteochondromas were observed around the bilateral knees. No abnormalities were observed in the laboratory blood test results. Whole exome sequencing revealed missense mutation of ACVR1/ALK2 (c.617G > A; p.R206H) in the patient and confirmed the diagnosis of FOP. CONCLUSION: In summary, classical FOP always behaves as a bilateral deformity of the big toes, as well as progressive ectopic ossification and osteochondromas in the distal femur and proximal tibia. An understanding of the association between osteochondromas and FOP aids in diagnosis and avoids unnecessary invasive management in patients.

The combination of baseline neutrophil to lymphocyte ratio and dynamic changes during treatment can better predict the survival of osteosarcoma patients.

Background: Osteosarcoma is a primary malignant bone tumor with a high metastatic potential that accounts for a significant proportion of all bone tumors. The prognosis for patients with metastatic or recurrence disease remains poor. The neutrophil-to-lymphocyte ratio (NLR) has become a potential prognostic biomarker for cancer. Recent evidence suggests that the dynamic changes in neutrophil-to-lymphocyte ratio (NLR) during treatment may be more informative in predicting patient prognosis, but the value of dynamic NLR in osteosarcoma has not yet been determined. Methods: This retrospective study retrospectively analyzed the clinical information of 251 osteosarcoma patients diagnosed and treated in West China Hospital of Sichuan University, explored the impact of baseline NLR and changes in NLR during treatment on the prognosis of osteosarcoma patients, and further combined baseline NLR with Delta NLR to build an NLR staging system. Results: The results showed that both baseline NLR and delta NLR had some predictive ability for the prognosis of osteosarcoma patients (P = 6.90e-4, P = 0.022). Patients with high baseline NLR were more likely to have a decrease in delta NLR (P = 1.24e-10). The NLR stage had a better predictive ability than baseline NLR and delta NLR, and was an independent prognostic factor for overall survival in osteosarcoma patients HR: 2.456 (1.625-3.710) (P = 1.97e-05). Conclusion: NLR has value in continuous monitoring, and continuous monitoring of NLR can better predict the survival of osteosarcoma patients compared to baseline NLR.

Effects of direct addition of curdlan on the gelling characteristics of thermally induced soy protein isolate gels.

In this study, the effects of the direct addition of curdlan on the physicochemical, structural, and functional properties of heat-induced soy protein isolate (SPI) gels were evaluated. Results demonstrated that the direct incorporation of curdlan enhanced the gel-forming performance, water-holding capacity, and gel strength of heat-induced SPI gels. The presence of curdlan reduced the free water molecules and α-helix content in the SPI structure and contributed to the construction of stable SPI gels with uniform and compact network structures, as visually proven by microstructure observations. Moreover, compared with the SPI gel alone, the curdlan-SPI composite gels presented a more pronounced viscoelastic property and thermal stability mainly due to the intermolecular hydrogen bonding interaction between curdlan and the SPI molecules. Our findings suggest that the direct incorporation of curdlan can effectively ameliorate the gelling characteristics of heat-induced SPI gels, indicating its potential application as a promising gel improver in the food industry.

Polysaccharide extracted from cultivated Sanghuangporous vaninii spores using three-phase partitioning with enzyme/ultrasound pretreatment: Physicochemical characteristics and its biological activity in vitro.

Sanghuangporous vaninii, as a valuable dietary supplement and medicinal ingredient, contains abundant bioactive polysaccharides that have health-promoting effects. In the present study, four polysaccharides (SVSPs-C, SVSPs-E, SVSPs-U, and SVSPs-E/U) were extracted for the first time from S. vaninii spores by three-phase partitioning (TPP), enzyme pretreatment before TPP (E-TPP), ultrasonic pretreatment before TPP (U-TPP), and enzyme pretreatment followed by ultrasonic before TPP (E/U-TPP) methods, respectively. Their physicochemical characteristics and in vitro pharmacological functions were determined and compared. Results showed that four TPP-based extraction methods had remarkable impacts on the extraction yield, chemical properties, monosaccharide compositions, and molecular weights (Mw) of SVSPs. Specifically, SVSPs-E/U obtained by E/U-TPP showed the highest extraction yield (25.40 %), carbohydrate content (88.50 %), and the lowest protein content (0.86 %). The four SVSPs had high-Mw (183.8-329.1 kDa) and low-Mw (23.0-156.4 kDa) fractions and mainly consisted of galactose, glucose, and mannose with different contents. In vitro bioactivities assays indicated that SVSPs-E/U possessed stronger antioxidant, hypoglycemic, hypouricemic, immunostimulatory, and antitumor activities than those of SVSPs-C, SVSPs-E, and SVSPs-U. Therefore, our results provide an efficient and promising extraction technique for bioactive polysaccharides from S. vaninii spores, as well as SVSPs had the potential to be applied in functional food, pharmaceutical, and cosmetics fields.

Surgical Treatment of Osteosarcoma Induced Distant Pre-Metastatic Niche in Lung to Facilitate the Colonization of Circulating Tumor Cells.

Recently, the major challenge in treating osteosarcoma patients is the metastatic disease, most commonly in the lungs. However, the underlying mechanism of recurrence and metastasis of osteosarcoma after surgical resection of primary tumor remains unclear. This study aims to investigate whether the pulmonary metastases characteristic of osteosarcoma is associated with surgical treatment and whether surgery contributes to the formation of pre-metastatic niche in the distant lung tissue. In the current study, the authors observe the presence of circulating tumor cells in patients undergoing surgical resection of osteosarcoma which is correlated to tumor recurrence. The pulmonary infiltrations of neutrophils and Gr-1+ myeloid cells are characterized to form a pre-metastatic niche upon the exposure of circulating tumor cells after surgical resection. It is found that mitochondrial damage-associated molecular patterns released from surgical resection contribute to the formation of pre-metastatic niche in lung through IL-1ß secretion. This study reveals that surgical management for osteosarcoma, irrespective of the primary tumor, might promote the formation of postoperative pre-metastatic niche in lung which is with important implications for developing rational therapies during peri-operative period.

The anti-hyperlipidemic effect and underlying mechanisms of barley (Hordeum vulgare L.) grass polysaccharides in mice induced by a high-fat diet.

Hyperlipidemia is a pathological disorder of lipid metabolism that can cause fatty liver, atherosclerosis, acute myocardial infarction, and other diseases, seriously endangering people's health. Polysaccharides have been shown to have lipid-lowering potential. In the current study, the anti-hyperlipidemia effect and potential mechanisms of a polysaccharide (BGP-Z31) obtained from barley grass harvested at the stem elongation stage in high-fat diet (HFD)-treated mice were investigated. Results showed that supplementation with BGP-Z31 (200 and 400 mg kg-1) not only suppressed obesity, organ enlargement, and fat accumulation caused by HFD, but also regulated dyslipidemia, relieved liver function injury, and ameliorated the oxidative stress level. Meanwhile, BGP-Z31 increased the concentrations of acetic acid, propionic acid, butyric acid, and isovaleric acid in HFD-induced mice. Gut microbiota analysis demonstrated that BGP-Z31 had no obvious effect on the gut microbiota diversity in mice treated with HFD, but it positively remodeled the intestinal flora structure by elevating the relative abundances of Bacteroides, Muribaculaceae, and Lachnospiraceae and lowering the Firmicutes/Bacteroides value and the relative abundance of Desulfovibrionaceae. Therefore, our data suggested that BGP-Z31 can be used as a promising nutritional supplement for dietary intervention in hyperlipidemia.

Preliminary Study of Preheated Decarburized Activated Coal Gangue-Based Cemented Paste Backfill Material.

This study proposes a novel idea of the use of coal gangue (CG) activation and preheated decarburized activated coal CG-based cemented paste backfill material (PCCPB) to realize green mining. PCCPB was prepared with preheated decarburized coal CG (PCG), FA, activator, low-dose cement, and water. This idea realized scale disposal and resource utilization of coal CG solid waste. Decarbonization and activation of CG crushed the material to less than 8 mm by preheated combustion technology at a combustion temperature of 900 °C and a decarbonization activation time of 4 min. The mechanism of the effect of different Na2SO4 dosages on the performance of PCCPB was investigated using comprehensive tests (including mechanical property tests, microscopic tests, and leaching toxicity tests). The results show that the uniaxial compressive strength (UCS) of C-S2, C-S3, and C-S4 can meet the requirements of backfill mining, among which the UCS of C-S3 with a curing time of 3 d and 28 d were 0.545 MPa and 4.312 MPa, respectively. Na2SO4 excites PCCPB at different curing time, and the UCS of PCCPB increases and then decreases with the increase in Na2SO4 dosage, and 3% of Na2SO4 had the best excitation effect on the late strength (28 d) of PCCPB. All groups' (control and CS1-CS4 groups) leachate heavy metal ions met the requirements of groundwater class III standard, and PCCPB had a positive effect on the stabilization/coagulation of heavy metal ions (Mn, Zn, As, Cd, Hg, Pb, Cr, Ba, Se, Mo, and Co). Finally, the microstructure of PCCPB was analyzed using FTIR, TG/DTG, XRD, and SEM. The research is of great significance to promote the resource utilization of coal CG residual carbon and realize the sustainable consumption of coal CG activation on a large scale.

Preparation and properties of a decarbonized coal gasification slag-fly ash filling material.

To promote the widespread use of fly ash (FA) and coal gasification slag (CGS) in mine filling, reducing the amount of cement and promoting the sustainable development of mining enterprises are essential. In this study, decarbonized CGS (DCGS) was prepared from CGS through decarbonization. A new DCGS-FA filling material was prepared using DCGS, FA, cement (3 wt.%), sodium sulfate (SS), and aeolian sand (AS). The effects of different mass ratios (1/9-5/5) of DCGS/FA on the properties of new filling materials were investigated. The results indicate that CGS can be used with FA to prepare filling materials after decarbonization. The flow performance of the DCGS-FA filling material is positively correlated with the mass ratio of DCGS/FA, while the mechanical properties are negatively correlated. The 28-day unconfined uniaxial compressive strength (UCS) of all specimens met the mechanical requirements (UCS ≥ 1.0 MPa). The types of hydration products were determined through X-ray diffraction, scanning electron microscopy, and energy-dispersive spectroscopy. The main hydration products of DCGS-FA filling materials are ettringite (AFt) and C-S-H gel. The results of the TG/DTG test of 28 days revealed that an increase in the DCGS/FA mass ratio would reduce the content of hydration products in filling materials. When the mass ratio increased from 1/9 to 5/5, the content of hydration products in the filling material decreased by 54.5%. This study provides a new concept for the resource utilization of CGS and FA in mine filling, which can significantly reduce the amount of cement in filling materials and promote the sustainable development of mine filling.

Structural characteristics and ameliorative effect of a polysaccharide from Corbicula fluminea industrial distillate against acute liver injury induced by CCl4 in mice.

Corbicula fluminea distillate as an important industrial by-product of C. fluminea during steaming process is rich in amino acids, proteins and polysaccharides, showing potential hepatoprotective effect. In this study, a polysaccharide (CFDP) was obtained from C. fluminea distillate by three-phase partitioning combined with (NH4)2SO4 precipitation at a saturation of 60 %. The structural characteristics, antioxidant activity in vitro, and hepatoprotection against mice CCl4-induced acute liver damage of CFDP were studied. Results demonstrated that CFDP was a water-soluble homogenous polysaccharide predominantly comprising glucose (>98 %), with a weight-average molecular weight of 1.4 × 107 Da, and exhibiting potent antioxidant benefits in vitro. CFDP had a backbone of (1 â†’ 4)-α-d-glucopyranosyl (Glcp) and a small amount of (1 â†’ 4, 6)-α-D-Glcp. The branch formed at C-6 comprised by (1→)-α-D-Glcp and (1→)-α-D-N-acetylglucosamine. CFDP possessed excellent hepatoprotective activity against acute liver damage caused by CCl4 in mice, mainly by ameliorating weight reduction and organ injures, alleviating hepatic function and serum lipid metabolism, suppressing oxidative stress and inflammatory responses, as directly verified by histopathological examination. Moreover, CFDP improved gut microbiota by up-regulating the relative abundance of total bacteria and probiotics such as Firmicutes, Bacteroidete, Rumminococcaceae, Lactobacillaceae, accompanied by promoting short chain fatty acid production. Therefore, our findings indicated that CFDP can be developed as a healthy food supplement for the prevention of chemical livery injury.

A pectic polysaccharide from fresh okra (Abelmoschus esculentus L.) beneficially ameliorates CCl4-induced acute liver injury in mice by antioxidation, inhibition of inflammation and modulation of gut microbiota.

Okra [Abelmoschus esculentus (Linn.) Moench], as a well-known medicinal and food plant, has important physiological activities and health benefits, and polysaccharide is its main bioactive component. In this study, a pectic polysaccharide (OPS-50) prepared from fresh okra pods by three-phase partitioning and gradient (NH4)2SO4 precipitation at a saturation of 50% was employed in carbon tetrachloride (CCl4)-caused acute liver damage in mice to evaluate the hepatoprotective potential. Results indicated that OPS-50 was mainly composed of a limited linear homogalacturonan backbone and abundant rhamnogalacturonan-I domains as side chains. OPS-50 exerted positively protective effects on acute liver damage induced by CCl4 in mice through relieving weight reduction and organ damage, ameliorating liver function and dyslipidemia, alleviating oxidative stress, suppressing pro-inflammatory cytokines, modulating gut microbiota, and promoting short-chain fatty acid secretion. Moreover, liver histopathology demonstrated the protective benefit of OPS-50 on CCl4-caused acute liver damage in mice. Therefore, our data suggested that the pectic OPS-50, as a dietary supplement, have great potential in preventing and treating chemical liver damages.

Three-dimensional printed customized uncemented unipolar prosthesis combined with ligament reconstruction for tumorous defect of the distal femur in children.

BACKGROUND: Hemiarthroplasty following tumor resection of the distal femur in children provides a chance to preserve the proximal tibial physis for limb elongation. Based on three-dimensional (3D) printing technology, the uncemented unipolar prosthesis with joint stability reinforced structures (JSRSs) was custom-designed for our cases. This study aimed to describe the design and assess the short-term outcomes of this refined prosthetic hemiarthroplasty. METHODS: Seven patients (four females and three males) received 3D-printed customized uncemented unipolar prosthesis for hemiarthroplasty after removal of the distal femur, from September 2019 to October 2020 at our Orthopedics department. The limb function, growth of the preserved proximal tibial physis, joint stability, and limb length discrepancy (LLD) were assessed. Complications were recorded. RESULTS: Six patients survived with no evidence of metastasis or local recurrence at the last follow-up, and one patient died of lung metastasis at 19 months postoperatively. Follow-up ranged from 19 to 32 months, with an average of 26 months. Elongation of the tibia was observed in all cases. At the last follow-up, four patients exhibited equal growth length compared with the healthy contralateral tibia. LLD ranged from 0.8 to 1.6 cm with a mean of 1.3 cm. The average knee range of motion was 95.3° of flexion and 4.5° of extension. All patients achieved satisfactory postoperative limb function with a mean MSTS score of 25.8. The results of the drawer, Lachman, and pivot shift tests were negative in all patients. During follow-up, painless joint space narrowing was observed in two patients. The screw for ligament fixation loosened in one of the seven patients at 17 months postoperatively. No subluxation of the joint, angular deformity, or breakage of the implant was detected in the remaining patients. CONCLUSIONS: 3D-printed customized uncemented unipolar prosthesis with JSRS would be a good choice for reconstructing tumorous defect in the distal femur in children.

Recent advances in the bioactive polysaccharides and other key components from Phellinus spp. and their pharmacological effects: A review.

Phellinus spp. is one of the largest genera of Hymenochaetaceae with approximately 220 species, such as P. vaninii, P. buamii, P. linteus, and P. igniarius, these species are considered as precious food supplements and medicinal ingredients in China, Korea, Japan, and other Asian countries for over 2000 years. Phellinus spp. contains abundant bioactive polysaccharides and other key components (e.g., phenolics, terpenes, steroids, etc.). Pharmacological investigations have confirmed that bioactive polysaccharides and other important secondary metabolites from Phellinus spp. possess multiple health-promoting benefits, including antitumor, immunomodulatory, anti-inflammatory, antidiabetic, antioxidant, and antimicrobial effects. However, comprehensive evaluations on the preparation and structural characteristics, bioactivities, and toxicology of these functional components (e.g., polysaccharides, phenolics, terpenes, steroids) from various Phellinus spp. species are very limited, which may restrict the practical application of Phellinus spp. This review summarizes the physicochemical characteristics, pharmacological activities, and possible mechanisms of bioactive components from Phellinus spp. according to published studies from 2017 to 2022. It also surveyed the toxicological assessment for safety and applications of different Phellinus spp. species. This review aims to provide useful references and promising directions for the comprehensive development and utilization of Phellinus spp. in functional foods, pharmaceuticals, and cosmetics.

Prognostic significance of modified lung immune prognostic index in osteosarcoma patients.

Purpose: Osteosarcoma is the most common primary malignancy of bone with a dismal prognosis for patients with pulmonary metastases. Evaluation of osteosarcoma prognosis would facilitate the prognosis consultation as well as the development of personalized treatment decisions. However, there is limited effective prognostic predictor at present. Lung Immune Prognostic Index (LIPI) is a novel prognostic factor in pulmonary cancers, whereas, the prognostic significance of LIPI in osteosarcoma has not yet been well clarified. In this study, we firstly explore the prognostic role of LIPI and further modify this predictive model in osteosarcoma. Patients and methods: A retrospectively study was conducted at Musculoskeletal Tumor Center of West China Hospital between January 2016 and January 2021. Hematological factors and clinical features of osteosarcoma patients were collected and analyzed. The area under curve (AUC) and optimal cuff-off of each single hematological factor was calculated. Results: In this study, lactate dehydrogenase (LDH), derived neurtrophil to lymphocyte ratio (dNLR), and Hydroxybutyrate dehydrogenase (HBDH) have higher AUC values. LIPI was composed of LDH and dNLR and was further modified by combing the HBDH, forming the osteosarcoma immune prognostic index (OIPI). OIPI divided 223 osteosarcoma patients divided into four groups, none, light, moderate, and severe (p < 0.0001). OIPI has a higher AUC value than LIPI and other hematological indexes in t-ROC curve. According to the univariate and multivariate analysis, pathological fracture, metastasis, NLR, platelet-lymphocyte ratio (PLR), and OIPI were associated with the prognosis; and metastasis and OIPI were independent prognostic factors of osteosarcoma patients. An OIPI-based nomogram was also established and could predict the 3-year and 5-year overall survival. In addition, OIPI was also revealed correlated with metastasis and pathological fracture in osteosarcoma. Conclusion: This study first explore the prognostic significance of LIPI in osteosarcoma patients. In addition, we developed a modified LIPI, the OIPI, for osteosarcoma patients. Both the LIPI and OIPI could predict the overall survival of osteosarcoma patients well, while OIPI may be more suitable for osteosarcoma patients. In particular, OIPI may have the ability to identify some high-risk patients from clinically low-risk patients.

The Experimental Investigation on Mechanics and Damage Characteristics of the Aeolian Sand Paste-like Backfill Materials Based on Acoustic Emission.

With the wide application of the filling mining method, it is necessary to consider the influence of rock activity on the filling body, reflected in the laboratory, that is, the influence of loading rate. Therefore, to explore the response characteristics of loading rate on the mechanical and damage characteristics of aeolian sand paste filling body, DNS100 electronic universal testing machine and DS5-16B acoustic emission (AE) monitoring system were used to monitor the stress-strain changes and AE characteristic parameters changes of aeolian sand paste filling body during uniaxial compression, and the theoretical model of filling sample damage considering loading rate was established based on AE parameters. The experimental results show that: (1) With the increase in loading rate, the uniaxial compressive strength and elastic modulus of aeolian sand paste-like materials (ASPM) specimens are significantly improved. ASPM specimens have ductile failure characteristics, and the failure mode is unidirectional shear failure → tensile failure → bidirectional shear failure. (2) When the loading rate is low, the AE event points of ASPM specimens are more dispersed, and the large energy points are less. At high loading rates, the AE large energy events are more concentrated in the upper part, and the lower part is more distributed. (3) The proportion of the initial active stage is negatively correlated with the loading rate, and the proportion of the active stage is positively correlated with the loading rate. The total number of AE cumulative ringing decreases with the increase in loading rate. (4) Taking time as an intermediate variable, the coupling relationship between ASPM strain considering loading rate and the AE cumulative ringing count is constructed, and the damage and stress coupling model of ASPM specimen considering loading rate is further deduced. Comparing the theoretical model with the experimental results shows that the model can effectively reflect the damage evolution process of ASPM specimens during loading, especially at high loading rates. The research results have significant reference value for subsequent strength design of filling material, selection of laboratory loading rate and quality monitoring, and early warning of filling body in goaf.

Hip reconstruction using a customized intercalary prosthesis with the rhino horn-designed uncemented stem for ultrashort proximal femur segments following tumor resection: a combined biomechanical and clinical study.

BACKGROUND: Hip-preserved reconstruction for patients with ultrashort proximal femur segments following extensive femoral diaphyseal tumor resection is a formidable undertaking. A customized intercalary prosthesis with a rhino horn-designed uncemented stem was developed for the reconstruction of these extensive skeletal defects. METHODS: This study was designed to analyze and compare the differences in the biomechanical behavior between the normal femur and the femur with diaphyseal defects reconstructed by an intercalary prosthesis with different stems. The biomechanical behavior under physiological loading conditions is analyzed using the healthy femur as the reference. Five three-dimensional finite element models (healthy, customized intercalary prosthesis with four different stems implemented, respectively) were developed, together with a clinical follow-up of 12 patients who underwent intercalary femoral replacement. RESULTS: The biomechanical results showed that normal-like stress and displacement distribution patterns were observed in the remaining proximal femur segments after reconstructions with the rhino horn-designed uncemented stems, compared with the straight stem. Stem A showed better biomechanical performance, whereas the fixation system with Stem B was relatively unstable. The clinical results were consistent with the FEA results. After a mean follow-up period of 32.33 ± 9.12 months, osteointegration and satisfactory clinical outcomes were observed in all patients. Aseptic loosening (asymptomatic) occurred in one patient reconstructed by Stem B; there were no other postoperative complications in the remaining 11 patients. CONCLUSION: The rhino horn-designed uncemented stem is outstanding in precise shape matching and osseointegration. This novel prosthesis design may be beneficial in decreasing the risk of mechanical failure and aseptic loosening, especially when Stem A is used. Therefore, the customized intercalary prosthesis with this rhino horn-designed uncemented stem might be a reasonable alternative for the reconstruction of SSPF following extensive tumor resection.

Osteosarcoma immune prognostic index can indicate the nature of indeterminate pulmonary nodules and predict the metachronous metastasis in osteosarcoma patients.

Purpose: The relationship between indeterminate pulmonary nodules (IPNs) and metastasis is difficult to determine. We expect to explore a predictive model that can assist in indicating the nature of IPNs, as well as predicting the probability of metachronous metastasis in osteosarcoma patients. Patients and methods: We conducted a retrospective study including 184 osteosarcoma patients at West China Hospital from January 2016 to January 2021. Hematological markers and clinical features of osteosarcoma patients were collected and analyzed. Results: In this study, we constructed an osteosarcoma immune prognostic index (OIPI) based on the lung immune prognostic index (LIPI). Compared to other hematological markers and clinical features, OIPI had a better ability to predict metastasis. OIPI divided 184 patients into four groups, with the no-OIPI group (34 patients), the light-OIPI group (35 patients), the moderate-OIPI group (75 patients), and the severe-OIPI group (40 patients) (P < 0.0001). Subgroup analysis showed that the OIPI could have a stable predictive effect in both the no-nodule group and the IPN group. Spearman's rank correlation test and Kruskal-Wallis test demonstrated that the OIPI was related to metastatic site and metastatic time, respectively. In addition, patients with IPNs in high-OIPI (moderate and severe) groups were more likely to develop metastasis than those in low-OIPI (none and light) groups. Furthermore, the combination of OIPI with IPNs can more accurately identify patients with metastasis, in which the high-OIPI group had a higher metastasis rate, and the severe-OIPI group tended to develop metastasis earlier than the no-OIPI group. Finally, we constructed an OIPI-based nomogram to predict 3- and 5-year metastasis rates. This nomogram could bring net benefits for more patients according to the decision curve analysis and clinical impact curve. Conclusion: This study is the first to assist chest CT in diagnosing the nature of IPNs in osteosarcoma based on hematological markers. Our findings suggested that the OIPI was superior to other hematological markers and that OIPI can act as an auxiliary tool to determine the malignant transformation tendency of IPNs. The combination of OIPI with IPNs can further improve the metastatic predictive ability in osteosarcoma patients.

Combined and Modified Gibson and Ilioinguinal Approaches in Type II + III Internal Hemipelvectomy for Periacetabular Tumors.

Background: The routine iliofemoral approach and its modifications in type II+III resection require extensive skin incision and massive periacetabular muscle detachment, leading to prolonged hospital stay, increased complication incidence, and impaired lower limb function. Under the management of an enhanced recovery after surgery (ERAS) protocol, a combined and modified Gibson and ilioinguinal (MGMII) approach was used to avoid unnecessary soft tissue trauma during tumor resection and therefore advantageous to patients' return to normal life. Methods: Twenty-five patients with type II + III (including type II) periacetabular tumors who underwent reconstruction with 3D printed customized endoprostheses at our center between January 2017 and March 2019 were included in this study. There were 13 cases using MGMII approach and 12 cases using iliofemoral approach. The operation duration and blood loss were assessed by chart review. The surgical margin was evaluated by the histopathological studies. The reconstruction accuracy, the abductor muscle strength, the 1993 version of the Musculoskeletal Tumor Society (MSTS-93), the Harris Hip scores (HHS), and the limp score were evaluated. Complications were recorded after reviewing the patients' records. Results: The operative duration and blood loss in MGMII group were shorter than those in the iliofemoral group, but the postoperative hemoglobin was slightly higher than that in the iliofemoral group. The MGMII group had stronger postoperative hip abductors, better functional restoration, and relatively fewer patients with higher limp scores. No complication was observed in the MGMII group. In the iliofemoral group, three patients encountered wound healing delay, and one patient suffered deep infection. Conclusions: The MGMII approach can better expose the posterior column of the acetabulum, especially the ischial tuberosity, which is beneficial for avoiding tumor rupture during resection. The MGMII approach also helps to preserve residual muscle function, such as the origin of the gluteus medius, while ensuring the extent of resection.

[Application of modified Gibson combined with modified ilioinguinal approach in treatment of Enneking â ¡+ â ¢ pelvic malignant tumors with three-dimensional printed hemipelvic prosthesis replacement].

Objective: To explore the surgical skills of modified Gibson combined with modified ilioinguinal (MGMII) approach in the treatment of Enneking Ⅱ+Ⅲ pelvic malignant tumors in the three-dimensional (3D) printed customized integrated hemipelvic prosthesis, and to evaluate the convenience and accuracy of the surgical approach and the short-term effectiveness. Methods: Between January 2017 and March 2019, 7 patients with Enneking Ⅱ+Ⅲ pelvic malignant tumors were treated with tumor resection and 3D printed hemipelvic prosthesis replacement via MGMII approach. There were 6 males and 1 female. The age ranged from 23 to 68 years, with an average of 43.7 years. There was 1 chondrosarcoma, 1 Ewing's sarcoma, 1 osteosarcoma, 1 malignant Schwannoma, 2 metastatic renal clear cell carcinoma, and 1 metastatic hepatocellular carcinoma. The Enneking stage of 4 cases of primary malignant tumor was stage ⅡB. The disease duration was 6-12 months, with an average of 9.5 months. The preoperative Harris hip score (HHS) was 82.1±1.4 and the Musculoskeletal Tumor Society (MSTS) score was 21.4±1.1. The tumor size by imaging examination was 5.1-9.1 cm, with an average of 6.9 cm. The operation time, intraoperative blood loss, postoperative blood transfusion volume, and postoperative complications were recorded. Postoperative pathological examination confirmed tumor residue according to R classification criteria. The lower limb length, acetabular height, acetabular eccentricity, abduction angle, and anteversion angle were measured and the bone integration was observed by imaging review. Bilateral abductor muscle strengths were measured, and joint function was evaluated by MSTS score and HHS score. Results: All operations were successfully completed. The operation time was 210-360 minutes (mean, 280.0 minutes); the intraoperative blood loss was 1 300-2 500 mL (mean, 1 785.7 mL); the postoperative blood transfusion volume was 0-11 U (mean, 6.1 U). Postoperative pathological examination confirmed R0 resection assisted by osteotomy guide plate. All incisions healed by first intention. All patients were followed up 30-48 months (mean, 41.3 months). At last follow-up, the imaging review showed the good osseointegration in all 7 cases. There was no significant difference in the lower limb length, acetabular height, acetabular eccentricity, abduction angle, and anteversion angle between the affected side and the healthy side ( P>0.05), all of which met the requirements of anatomical reconstruction. At 3 months after operation, the ratios of muscle strength between the affected side and the healthy side was 68.29%±7.41% at 3 months and 89.86%±2.79% at 12 months, showing a significant difference between the two time points ( t=8.242, P=0.000). At last follow-up, the MSTS score and HHS score were 27.3±0.8 and 96.6±1.4, respectively, which significantly improved when compared with those before operation ( P<0.05). None of the patients had assisted walking at last follow-up. There was no recurrence, death, or complications such as deep infection, dislocation of the prosthesis, or fracture of the prosthesis or screw. Conclusion: MGMII approach can expose the posterior column of the acetabulum, especially the ischial tubercle, which is helpful to avoid tumor rupture during tumor resection and preserve the muscle functions such as gluteus medius and iliac muscle while ensuring the resection scope.