Three-dimensional-printed custom-made patellar endoprosthesis for recurrent giant cell tumor of the patella: A case report and review of the literature.

BACKGROUND: Giant cell tumor (GCT) is a benign lesion and rarely involves the patella. This disease is characterized by a relatively high recurrence rate after primary treatment. En bloc resection has been a predominant option for recurrent GCT. However, total patellectomy can lead to disruption of the knee. Therefore, exploration of functional reconstruction of the extensor mechanism is worthwhile. CASE SUMMARY: A 54-year-old woman presented with right knee pain and swelling, and was diagnosed as having a GCT in the patella following curettage and autograft. Medical imaging revealed a lytic and expanded lesion involving the whole patella with focal cortical breaches and pathological fracture. Based on the combination of histological, radiological, and clinical features, a diagnosis of recurrent GCT in the patella was made (Campanacci grade III). After a multidisciplinary team discussion, three-dimensional (3D)-printed custom-made patellar endoprosthesis was performed following en bloc resection for reconstructing the extensor mechanism. The patient was followed for 35 mo postoperatively. No evidence of local recurrence, pulmonary metastasis, or osteoarthritis of the right knee was observed. The active flexion arc was 0°-120°, and no extension lag was detected. A favorable patellar tracking and height (Insall-Salvati ratio 0.93) were detected by radiography. CONCLUSION: We depict a case of a GCT at the right patella, which was successfully treated by patellectomy and 3D-printed custom-made endoprosthetic replacement. The patella normal reconstruction, the precise-fit articular design, and gastrocnemius flap augmentation could lead to satisfactory knee function and a low rate of complications in the short-term follow-up.

Prognostic value of the C-reactive protein to albumin ratio: a novel inflammation-based prognostic indicator in osteosarcoma.

The prognostic role of the C-reactive protein to albumin ratio (CRP/Alb ratio) in patients with osteosarcoma has not been investigated. A total of 216 osteosarcoma patients were enrolled in the study. Univariate and multivariate survival analyses between the groups were performed and Kaplan-Meier analysis was conducted to plot the survival curves. Receiver operating characteristic curves were generated and areas under the curve (AUCs) were compared to assess the discriminatory ability of the inflammation-based indicators, including CRP/Alb ratio, Glasgow prognostic score (GPS), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR). The optimal cutoff value was 0.210 for CRP/Alb ratio with a Youden index of 0.319. Higher values of CRP/Alb ratio were significantly associated with poorer overall survival in univariate (HR =2.62, 95% CI =1.70-4.03; P<0.001) and multivariate (HR =2.21, 95% CI =1.40-3.49; P=0.001) analyses. In addition, the CRP/Alb ratio had significantly higher AUC values compared with GPS (P=0.003), NLR (P<0.001), and PLR (P<0.001). The study demonstrated that the CRP/Alb ratio is an effective inflammation-based prognostic indicator in osteosarcoma, which potentially has a discriminatory ability superior to that of other inflammatory indicators including GPS, NLR, and PLR.

[Computer-aided mandibular repositioning system for efficacy prediction of oral appliance in patients with obstructive sleep apnea-hypopnea syndrome].

OBJECTIVE: To develop a computer-aided mandibular repositioning system (CAMRS) and investigate its preliminary application in efficacy prediction of oral appliance in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: CAMRS was mainly consisting of a step motor and a screw that was remote-controlled by a computer. This system could work with polysomnography (PSG). Fourteen OSAHS patients diagnosed by PSG were recruited. With CAMRS, six mandibular positions were titrated with PSG for every hour. RESULTS: Stable mandible positioning and little sleeping disturbance were observed. Apnea hypopnea index (AHI) was improved progressively with mandibular advancement. The extent of mandibular advancement was correlated with the severity of OSAHS (r = 0.72747). CONCLUSIONS: CAMRS could reproductively and effectively reposition mandible with little sleeping disturbance. Through CAMRS, an individualized optimal mandibular position could be obtained for each OSAHS patient treated with oral appliance.