The immune cell infiltration-associated molecular subtypes and gene signature predict prognosis for osteosarcoma patients.

Host immune dysregulation involves in the initiation and development of osteosarcoma (OS). However, the exact role of immune cells in OS remains unknown. We aimed to distinguish the molecular subtypes and establish a prognostic model in OS patients based on immunocyte infiltration. The gene expression profile and corresponding clinical feature of OS patients were obtained from TARGET and GSE21257 datasets. MCP-counter and univariate Cox regression analyses were applied to identify immune cell infiltration-related molecular subgroups. Functional enrichment analysis and immunocyte infiltration analysis were performed between two subgroups. Furthermore, Cox regression and LASSO analyses were performed to establish the prognostic model for the prediction of prognosis and metastasis in OS patients. The subgroup with low infiltration of monocytic lineage (ML) was related to bad prognosis in OS patients. 435 DEGs were screened between the two subgroups. Functional enrichment analysis revealed these DEGs were involved in immune- and inflammation-related pathways. Three important genes (including TERT, CCDC26, and IL2RA) were identified to establish the prognostic model. The risk model had good prognostic performance for the prediction of metastasis and overall survival in OS patients. A novel stratification system was established based on ML-related signature. The risk model could predict the metastasis and prognosis in OS patients. Our findings offered a novel sight for the prognosis and development of OS.

Silk fibroin based wearable electrochemical sensors with biomimetic enzyme-like activity constructed for durable and on-site health monitoring.

Flexible biomimetic sensors have encountered a bottleneck of sensitivity and durability, as the sensors must directly work within complex body fluid with ultra-trace biomarkers. In this work, a wearable electrochemical sensor on a modified silk fibroin substrate is developed using gold nanoparticles hosted into N-doped porous carbonizated silk fibroin (AuNPs@CSF) as active materials. Taking advantage of the inherent biocompatibility and flexibility of CSF, and the high stability and enzyme-like catalytic activity of AuNPs, AuNPs@CSF-based sensor exhibits durable stability and superior sensitivity to monitor H2O2 released from cancer cell (4T1) and glucose in sweat. The detection limits for H2O2 and glucose are low to be 1.88 µM and 23 µM respectively, and the sensor can be applied in succession within 30 days at room temperature. Further, physical cross-linking of polyurethane (PU) with SF well matches with the skin tissue mechanically and provides a flexible, robust and stable electrode-tissue interface. AuNPs@CSF is applied successfully for wearable electrochemical monitoring of glucose in human sweat.The present AuNPs@CSF will possess a potential application in clinical diagnosing of H2O2- or glucose-related diseases in future.

Oriented Crystallization of Hydroxyapatite in Self-Assembled Peptide Fibrils as a Bonelike Material.

Controlling oriented crystallization is key to producing bonelike composite materials with a well-organized structure. However, producing this type of composite material using synthetic biopolymers as scaffolds is challenging. Inspired by the molecular structure of collagen-I, a collagenlike peptide─(Pro-Hyp-Gly)10 (POG10)─was designed to produce self-assembled fibrils that resemble the structure of collagen-I fibrils. In addition, the oriented mineralization of HAP crystals is formed in the fibrils that reproduces a bonelike material similar to collagen-I fibril mineralization. Unlike collagen-I fibrils, POG10 fibrils do not contain gap spaces. The molecular simulation results indicate that in addition to space confinement, the molecular field generated by POG10 can also confine the orientation of HAP, enriching our understanding of physical confinement and shedding light on the design of synthetic biopolymer scaffolds for bonelike material fabrication.

Biomimetic synthesis of 2D ultra-small copper sulfide nanoflakes based on reconfiguration of the keratin secondary structure for cancer theranostics in the NIR-II region.

Two-dimensional transition metal dichalcogenides have attracted widespread attention in cancer theranostics due to their high specific surface area and excellent photothermal conversion properties. However, their dimensions and biodegradability have limited the exploration of the therapeutic properties of transition metal dichalcogenides. Herein, we explore the mechanism of the keratin α-helix-to-random coil transition, as an actuation mechanism for the controllable design and precise synthesis of two-dimension copper sulfide nanoflakes (CuS NFs) with high absorption in the NIR-II window. Upon mixing keratin and Cu2+, the hydrogen bonds that maintain the α-helix are broken by copper ions to form biuret coordination, while the structure of the α-helix is transformed into a random coil, providing a more scalable space for the growth of CuS NFs. The CuS NFs prepared in this way possess the great advantages of outstanding uniformity, size controllability, and biodegradability. Importantly, the CuS NFs in the NIR-II window show an excellent photothermal conversion efficiency (32.9%) and extraordinary photoacoustic signal. This work updates the fabrication of two-dimensional transition metal dichalcogenides and greatly enhances their competitiveness in the area of cancer theranostics in the NIR-II region, and provides significant theoretical and practical opportunities for the development of keratin using biomimetic synthesis.

Phycocyanin - carbon dots nanoprobe for the ratiometric fluorescence determination of peroxynitrite.

As a kind of reactive oxygen species, peroxynitrite is related to various diseases closely such as cancer and neurodegenerative diseases. Constructing probes with highly specific ability and a wide linear detection range for peroxynitrite detection is crucial for understanding the pathogenesis of related diseases and optimizing treatments. In this work, we developed a novel luminescent ratiometric fluorescence nanoprobe (PC-CDs) based on carbon dots and phycocyanin. PC-CDs are constructed by amidation reaction between carbon dots and phycocyanin. The nanoprobe we obtained has a good ability of distinguishing peroxynitrite from other reactive oxygen species and interfering substances. Moreover, the linear range of the nanoprobe is 0.5-100 µM and the limit of detection is 0.5 µM when detecting peroxynitrite. In the spiked recovery experiments under phosphate buffered saline (PBS) environment, our nanoprobe has a good recovery performance and the recovery is 99% - 104%, which will be beneficial to the further development of peroxynitrite testing and the research progress of related diseases. Finally, we discuss the quenching mechanism of peroxynitrite for nanoprobe, and found that there is the combination of dynamic and static quenching in the quenching process.

Band-Edge Engineering To Eliminate Radiation-Induced Defect States in Perovskite Scintillators.

Under radiative environments such as extended hard X- or γ-rays, degradation of scintillation performance is often due to irradiation-induced defects. To overcome the effect of deleterious defects, novel design mitigation strategies are needed to identify and design more resilient materials. The potential for band-edge engineering to eliminate the effect of radiation-induced defect states in rare-earth-doped perovskite scintillators is explored, taking Ce3+-doped LuAlO3 as a model material system, using density functional theory (DFT)-based DFT + U and hybrid Heyd-Scuseria-Ernzerhof (HSE) calculations. From spin-polarized hybrid HSE calculations, the Ce3+ activator ground-state 4f position is determined to be 2.81 eV above the valence band maximum in LuAlO3. Except for the oxygen vacancies which have a deep level inside the band gap, all other radiation-induced defects in LuAlO3 have shallow defect states or are outside the band gap, that is, relatively far away from either the 5d1 or the 4f Ce3+ levels. Finally, we examine the role of Ga doping at the Al site and found that LuGaO3 has a band gap that is more than 2 eV smaller than that of LuAlO3. Specifically, the lowered conduction band edge envelopes the defect gap states, eliminating their potential impact on scintillation performance and providing direct theoretical evidence for how band-edge engineering could be applied to rare-earth-doped perovskite scintillators.

Selenium substitution effects on excited-state properties and photophysics of uracil: a MS-CASPT2 study.

The photophysics of selenium-substituted nucleobases has attracted recent experimental attention because they could serve as potential photosensitizers in photodynamic therapy. Herein, we present a comprehensive MS-CASPT2 study on the spectroscopic and excited-state properties, and photophysics of 2-selenouracil (2SeU), 4-selenouracil (4SeU), and 2,4-selenouracil (24SeU). Relevant minima, conical intersections, crossing points, and excited-state relaxation paths in the lowest five electronic states (i.e., S0, S1, S2, T2, and T1) are explored. On the basis of these results, their photophysical mechanisms are proposed. Upon photoirradiation to the bright S2 state, 2SeU quickly relaxes to its S2 minimum and then moves in an essentially barrierless way to a nearby S2/S1 conical intersection near which the S1 state is populated. Next, the S1 system arrives at an S1/T2/T1 intersection where a large S1/T1 spin-orbit coupling of 430.8 cm-1 makes the T1 state populated. In this state, a barrier of 6.8 kcal mol-1 will trap 2SeU for a while. In parallel, for 4SeU or 24SeU, the system first relaxes to the S2 minimum and then overcomes a small barrier to approach an S2/S1 conical intersection. Once hopping to the S1 state, there exists an extended region with very close S1, T2, and T1 energies. Similarly, a large S1/T1 spin-orbit coupling of 426.8 cm-1 drives the S1→ T1 intersystem crossing process thereby making the T1 state populated. Similarly, an energy barrier heavily suppresses electronic transition to the S0 state. The present work manifests that different selenium substitutions on uracil can lead to a certain extent of different vertical and adiabatic excitation energies, excited-state properties, and relaxation pathways. These insights could help understand the photophysics of selenium-substituted nucleobases.

Topical Injection of Tranexamic Acid via a Drain Plus Drain-Clamping to Reduce Blood Loss in Degenerative Lumbar Scoliosis Surgery.

OBJECTIVE: The aim of the present study was to investigate whether an innovative way of administering tranexamic acid (TXA), that is, injecting it retrogradely through the drain and clamping it for 1 h, can reduce postoperative bleeding after degenerative lumbar scoliosis surgery. METHODS: Sixty degenerative lumbar scoliosis patients who underwent posterior lumbar decompression with fusion of three or more levels were retrospectively enrolled and categorized into three groups (TXA, Gelfoam, and control groups). The demographic distribution, operative parameters, length and amount of Hemovac drainage, blood transfusion rate, length of stay, laboratory results (complete blood count and coagulogram), and the postoperative complications were collected and analyzed. RESULTS: The age of patients in the Gelfoam group was significantly younger than in the TXA and control groups (59.75 ± 6.95 vs 66.10 ± 8.80, P = 0.016 and 59.75 ± 6.95 vs 67.90 ± 5.33, P = 0.000, respectively). There were no significant differences in sex, body mass index, comorbid medical status, and operation level between each of the two groups. The three groups did not differ significantly in estimated blood loss during surgery, the mean red blood cell transfusion requirement during hospitalization, and the entire perioperative allogenic blood transfusion rate. The postoperative total blood loss and total drainage were lower in the TXA group than in the control group (1027.14 ± 466.56 vs 1390.07 ± 314.85 mL, P = 0.006; 322.20 ± 187.32 vs 605.50 ± 184.70 mL, P = 0.000, respectively). The length of drainage retention in the TXA group was significantly shorter than in the Gelfoam and control groups (46.10 ± 9.00 vs 68.00 ± 12.31 h, P = 0.000 and 46.10 ± 9.00 vs 76.40 ± 10.97 h, P = 0.000, respectively). The TXA and Gelfoam groups also had significantly shorter hospital stays than the control group (7.50 ± 0.95 vs 9.80 ± 2.44 days, P = 0.000, and 7.90 ± 1.16 vs 9.80 ± 2.44 days, P = 0.003, respectively). At discharge, the mean hemoglobin and hematocrit level were significantly higher in the TXA group compared with the control group (11.77 ± 1.78 g/dL vs 10.67 ± 0.94 g/dL, P = 0.002; 34.82 ± 3.57% vs 31.79 ± 3.85%, P = 0.014). No significant difference was identified with respect to prothrombin time, activated partial thromboplastin time, and D-dimmer among groups (P > 0.05). The three groups were comparable in wound problem incidences. Symptomatic deep vein thrombosis and pulmonary embolism were not observed in this study. CONCLUSION: Topical injection of TXA retrogradely via a drain at the end of a degenerative lumbar scoliosis operation and clamping the drain for an hour can effectively decrease the postoperative blood loss and the length of hospitalization without increasing the complication rate.

Long-term survival of the middle and lower thoracic esophageal cancer patients after surgical treatment through left or right thoracic approach.

BACKGROUND: Esophageal cancer is one of the most prevalent malignancies with a high incidence and mortality in China, the main treatment for esophageal cancer at present is still surgery-based multimodality treatment, and surgery is still the most effective measure. However, the modes of surgical treatment for esophageal cancer have been diverse. The surgical approaches can be mainly divided into the left thoracic approach and right thoracic approach in China. The long-term survival of the patients treated through right approach was reported better than that through left thoracic approach, but until now no statistically significant difference was found between two approaches, especially, for those with middle and lower thoracic esophageal cancer without suspected upper mediastinal lymph node metastasis in preoperative examinations, no definite conclusion have been made on selection of the approach, therefore, this studies try to compare the long-term survival between two approaches . METHODS: The data of 402 cases with complete resection and two-field lymph node dissection from January, 2011 to December, 2011 in the Cancer Hospital, Chinese Academy of Medical Sciences was retrospectively reviewed and analyzed. Propensity score matching (PSM) analysis and life-table in SPSS 22.0 and Stata 14.0 were used to analyze the survival. RESULTS: Totally, 402 cases were surgically treated either via left or right thoracic approach. The overall 5-year survival rate of this series was 38%, it was 37% in 281 cases surgically treated through left approach, and 39% in 121 cases through right approach (P=0.908). The 5-year survival of 256 patients without suspected lymph node metastasis in the upper mediastinum based on the preoperative examinations surgically treated through left approach was 38% versus 43% of 88 cases through right approach (P=0.404). After PSM, the 5-year survival of 110 cases surgically treated through left approach was 32% versus 40% of another matched 110 cases through right approach (P=0.146). for the patients without suspected lymph node metastasis in the upper mediastinum based on preoperative examinations, the 5-year survival of 88 surgically treated through left approach was 33% versus 44% of another matched 88 cases through right approach (P=0.239). CONCLUSIONS: For the middle and lower thoracic esophageal cancer patients, whether or not who has suspected lymph node metastasis in the upper mediastinum based on preoperative CT and EUS, the surgical treatment through right thoracic approach can achieve better but not significantly better overall survival than that through left thoracic approach. Further prospective randomized clinical trials are still needed to verify this disputed issue on approach selection.

Perfect Strain Relaxation in Metamorphic Epitaxial Aluminum on Silicon through Primary and Secondary Interface Misfit Dislocation Arrays.

Understanding the atomically precise arrangement of atoms at epitaxial interfaces is important for emerging technologies such as quantum materials that have function and performance dictated by bonds and defects that are energetically active on the micro-electronvolt scale. A combination of atomistic modeling and dislocation theory analysis describes both primary and secondary dislocation networks at the metamorphic Al/Si (111) interface, which is experimentally validated by atomic resolution scanning transmission electron microscopy. The electron microscopy images show primary misfit dislocations for the majority of the strain relief and evidence of a secondary structure allowing for complete relaxation of the Al-Si misfit strain. This study demonstrates the equilibrium interface that represents the lowest energy structure of a highly mismatched and semicoherent single-crystal interface with complete strain relief in an atomically abrupt structure.

A Hydrogel of Ultrathin Pure Polyaniline Nanofibers: Oxidant-Templating Preparation and Supercapacitor Application.

Although challenging, fabrication of porous conducting polymeric materials with excellent electronic properties is crucial for many applications. We developed a fast in situ polymerization approach to pure polyaniline (PANI) hydrogels, with vanadium pentoxide hydrate nanowires as both the oxidant and sacrifice template. A network comprised of ultrathin PANI nanofibers was generated during the in situ polymerization, and the large aspect ratio of these PANI nanofibers allowed the formation of hydrogels at a low solid content of 1.03 wt %. Owing to the ultrathin fibril structure, PANI hydrogels functioning as a supercapacitor electrode display a high specific capacitance of 636 F g-1, a rate capability, and good cycling stability (∼83% capacitance retention after 10,000 cycles). This method was also extended to the preparation of polypyrrole and poly(3,4-ethylenedioxythiophene) hydrogels. This template polymerization method represents a rational strategy for design of conducing polymer networks, which can be readily integrated in high-performance devices or a further platform for functional composites.

Seeded Mineralization Leads to Hierarchical CaCO3 Thin Coatings on Fibers for Oil/Water Separation Applications.

Like their biogenic counterparts, synthetic minerals with hierarchical architectures should exhibit multiple structural functions, which nicely bridge the boundaries between engineering and functional materials. Nevertheless, design of bioinspired mineralization approaches to thin coatings with distinct micro/nanotextures remains challenging in the realm of materials chemistry. Herein, a general morphosynthetic method based on seeded mineralization was extended to achieve prismatic-type thin CaCO3 coatings on fibrous substrates for oil/water separation applications. Distinct micro/nanotextures of the overlayers could be obtained in mineralization processes in the presence of different soluble (bio)macromolecules. These hierarchical thin coatings therefore exhibit multiple structural functions including underwater superoleophobicity, ultralow adhesion force of oil in water, and comparable stiffness/strength to the prismatic-type biominerals found in mollusk shells. Moreover, this controllable approach could proceed on fibrous substrates to obtain robust thin coatings, so that a modified nylon mesh could be employed for oil/water separation driven by gravity. Our bioinspired approach based on seeded mineralization opens the door for the deposition of hierarchical mineralized thin coatings exhibiting multiple structural functions on planar and fibrous substrates. This bottom-up strategy could be readily extended for the syntheses of advanced thin coatings with a broad spectrum of engineering and functional constituents.

Graphical analysis of mammalian cell adhesion in vitro.

Short-term (<2h) cell adhesion kinetics of 3 different mammalian cell types: MDCK (epithelioid), MC3T3-E1 (osteoblastic), and MDA-MB-231 (cancerous) on 7 different substratum surface chemistries spanning the experimentally-observable range of water wettability (surface energy) are graphically analyzed to qualitatively elucidate commonalities and differences among cell/surface/suspending media combinations. We find that short-term mammalian cell attachment/adhesion in vitro correlates with substratum surface energy as measured by water adhesion tension, τ≡γlvcosθ, where γlv is water liquid-vapor interfacial energy (72.8 mJ/m2) and cosθ is the cosine of the advancing contact angle subtended by a water droplet on the substratum surface. No definitive functional relationships among cell-adhesion kinetic parameters and τ were observed as in previous work, but previously-observed general trends were reproduced, especially including a sharp transition in the magnitude of kinetic parameters from relatively low-to-high near τ=0mJ/m2, although the exact adhesion tension at which this transition occurs is difficult to accurately estimate from the current data set. We note, however, that the transition is within the hydrophobic range based on the τ=30mJ/m2 surface-energetic dividing line that has been proposed to differentiate "hydrophobic" surfaces from "hydrophilic". Thus, a rather sharp hydrophobic/hydrophilic contrast is observed for cell adhesion for disparate cell/surface combinations.

Removal of organic micro-pollutants (phenol, aniline and nitrobenzene) via forward osmosis (FO) process: Evaluation of FO as an alternative method to reverse osmosis (RO).

In this study, we have explored and compared the effectiveness of using (1) lab-fabricated forward osmosis (FO) membranes under both FO and reverse osmosis (RO) modes and (2) commercially available RO membranes under the RO mode for the removal of organic micro-pollutants. The lab-fabricated FO membranes are thin film composite (TFC) membranes consisting of a polyamide layer and a porous substrate cast from three different materials; namely, Matrimid, polyethersulfone (PESU) and sulfonated polyphenylene sulfone (sPPSU). The results show that the FO mode is superior to the RO mode in the removal of phenol, aniline and nitrobenzene from wastewater. The rejections of all three TFC membranes to all the three organic micro-pollutants under the FO processes are higher than 72% and can be even higher than 90% for aniline when a 1000 ppm aromatic aqueous solution and 1 M NaCl are employed as feeds. These performances outperform the results obtained from themselves and commercially available RO membranes under the RO mode. In addition, the rejection can be maintained even when treating a more concentrated feed solution (2000 ppm). The removal performance can be further enhanced by using a more concentrated draw solution (2 M). The water flux is almost doubled, and the rejection increment can reach up to 17%. Moreover, it was observed that annealing as a post-treatment would help compact the membrane selective layer and further enhance the separating efficiency. The obtained organic micro-pollutant rejections and water fluxes under various feasible operating conditions indicate that the FO process has potential to be a viable treatment for wastewater containing organic micro-pollutants.

Surgical repair of lacerated anterior cerebral artery presented with massive intracerebral hemorrhage.

OBJECTIVE AND IMPORTANCE: Traumatic intracranial aneurysms present diagnostic and therapeutic challenges. Owing to their fragile nature, endovascular intervention has become the first-line treatment; however, direct surgery has an advantage in certain cases. CLINICAL PRESENTATION: A 34-year-old man in coma was admitted after a motor vehicle accident. Brain computed tomographic scans revealed deep bifrontal, left intraventricular, and subarachnoid hemorrhages. Three-dimensional computed tomographic angiography and digital subtraction angiography revealed an aneurysm arising from the left pericallosal artery. INTERVENTION: A massive intracerebral hematoma prompted us to perform emergency surgical intervention. We immediately removed the hematoma and extirpated the aneurysm. After hematoma evacuation via the interhemispheric approach, a pulsating red sphere projecting from the pericallosal artery, with no obvious solid wall or neck, was encountered. While retracting the frontal lobe, it suddenly ruptured. Under temporary trapping of the parent artery, the point of bleeding was identified. No aneurysm wall or fibrous tissue was present, whereas a 1.5-mm laceration was observed at the pericallosal artery close to its branching point. The laceration was sutured with 10-0 nylon. Postoperative digital subtraction angiography confirmed patency of the pericallosal artery. CONCLUSIONS: Although recent technologic advances of intravascular surgery have enabled successful treatment of traumatic pseudoaneurysms, open surgical intervention still has some advantages of providing definitive hemostasis, allowing for parent artery reconstruction, and facilitating mass reduction. The case in the current study was quite unusual in that angiographic aneurysm had disrupted easily, leaving arterial laceration. This finding implies the probability of unavoidable parent artery occlusion when endovascular treatment is applied.

Liraglutide ameliorates renal injury in streptozotocin­induced diabetic rats by activating endothelial nitric oxide synthase activity via the downregulation of the nuclear factor­κB pathway.

Accumulating evidence has implicated that liraglutide, one of the human glucagon­like peptide­1 (GLP­1) analogues, elicits protective effects on diabetic nephropathy; however, the mechanism has yet to be fully elucidated. The present study aimed to assess the effect and underlying mechanisms of liraglutide in diabetic nephropathy. Wistar rats with streptozotocin­induced diabetes mellitus were subcutaneously injected with liraglutide or phosphate buffer for 12 weeks at a dose of 0.3 mg/kg/12 h. The biochemical parameters were determined, renal histological examination was performed by hematoxylin and eosin and periodic acid Schiff base staining, and the mRNA levels of nuclear factor κB (NF­κB) and endothelial nitric oxide synthase (eNOS) were assessed by quantitative polymerase chain reaction. Furthermore, the protein expression of NF­κB and eNOS as well as eNOS phosphorylation were examined by western blot analysis and the levels of inflammatory cytokines downstream of NF­κB were evaluated by fluorescence-assisted cell sorting and finally, the eNOS activity and nitric oxide (NO) production were evaluated by ELISA. Liraglutide decreased the levels of total cholesterol, urine, 24-h urinary albumin, blood urea nitrogen, serum creatinine and histological damage. Liraglutide also reduced the expression of NF­κB at mRNA and protein levels; the expression of tumor necrosis factor­α, interferon­Î³, interleukin­6 and monocyte chemoattractant protein­1 were also reduced. By contrast, eNOS phosphorylation, eNOS activity and NO production appeared to have increased. Liraglutide may have a direct beneficial effect on diabetic nephropathy by improving eNOS activity by inhibiting the NF­κB pathway without eliciting a glucose lowering effect.

[Three-column reconstruction via posterior approach for the treatment of unstable thoracolumbar fracture accompanied by posterior column injury].

OBJECTIVE: To investigate clinical effects of three-column reconstruction via single posterior approach for the treatment of unstable thoracolumbar fractures accompanied by posterior column injury. METHODS: From December 2008 to May 2010,three-column reconstruction via posterior approach was implemented to 21 patients with unstable thoracolumbar fractures accompanied by posterior column injuries. There were 13 males and 8 females, ranging in age from 23 to 54 years old(averaged,35.5 years old). Injured vertebrae: 1 patient had injury in T11, 4 patients had injuries in T12, 8 patients had injuries in L1, 5 patients had injuries in L2, 3 patients had injuries in L3. The Cobb angle was (25.34 +/- 3.42) degrees. The operation time,blood loss during operation, Cobb angle and the bony fusion were observed. RESULTS: Twenty-one patients were followed up, and the duration ranged from 24 to 27 years old, with an average of 25.6 months. The operation time ranged from 135 to 275 min, with a mean of 185 min. The blood loss during operation ranged from 700 to 1 650 ml (averaged, 870 ml). All the patients had complete decompression. Postoperative Cobb angle was (4.01 +/- 2.03) degrees, and (4.34 +/- 2.38) degrees at the latest follow-up. All the patients got bony fusion. CONCLUSION: To the patients with unstable thoracolumbar fractures accompanied by posterior column injuries, three-column reconstruction via single posterior approach has both anterior approach and posterior approach advantages, which can obtain excellent clinical outcomes.

Significance of nonmucinous lepidic component with mild nuclear atypia in the discrimination of multiple primary lung cancers from intrapulmonary metastases.

The distinguishing of intrapulmonary metastases from multiple primaries is of great clinical importance. Although comprehensive histological assessment (CHA) was recommended for addressing this problem, the limitations of CHA have been addressed. We hypothesized that a nonmucinous lepidic component with mild nuclear atypia (NLCMA) may be one of the important sign suggesting primary lesions. In this study, we measured the value of NLCMA in distinguishing multiple primaries from intrapulmonary metastases. We retrospectively analyzed a cohort of 54 patients with 116 lesions (70 comparisons). Intrapulmonary metastases and multiple primaries were differentiated on the basis of CHA (Method I) and CHA combined with the assessment of NLCMA (Method II), respectively. Then, the results of two methods were compared with survival analysis. 33 cases were defined as multiple primaries and 21 cases as metastases by Method I, while 41 cases as multiple primaries and 13 cases as metastases by Method II. On univariate analysis, there was a better DFS in patients with a tumor ≤ 3 cm (P=0.012), female gender (P=0.011), highest N0 (P=0.002), absent micropapillary (P=0.013), multiple primaries (P=0.008 by method I, P < 0.001 by method II). A multivariate analysis adjusting for gender, tumor size, micropapillary and multiple primaries/metastases (by methodI and method II, respectively) indicated that multiple primaries (by method II) was an independent predictors for DFS. The presence of NLCMA may indicate that a lesion should be defined as primary in multifocal adenocarcinoma.

Clinical analysis of 19 cases of adult primary mediastinal liposarcoma.

OBJECTIVE: To explore the pathoclinical features of adult primary mediastinal liposarcoma and their correlation with the prognosis. METHODS: The clinical data of 19 patients with adult primary mediastinal liposarcoma who were treated in our hospital between 1970 and 2011 were retrospectively analyzed. Eighteen patients underwent open thoracic tumor excisions for at least one time, and the remaining one patient only received biopsy surgery. Histopathological results after surgery revealed that 6 well-differentiated type tumors, 6 myxoid type tumors, 3 pleomorphic type tumors, 2 mixed type tumors, and 2 un-classified tumors. RESULTS: Among 6 patients with well-differentiated type tumors, 1 died after having been survived for 10 years; 5 were still alive, with a mean duration of 126.2 months,the 5-year survival rate was 100%. Among 6 patients with myxoid type tumors, 5 patients had follow-up data, with a mean survival of 26.2 months. Among 3 patients with pleomorphic type tumors, only one patient had follow-up data: the patient finally died, with a survival of 34 months. Of 2 patients with mixed type tumors, only one patient had follow-up data: the patient survived 8 months and died. Of 2 patients with un-classified type tumors, one had follow-up data: the patient lived for 24 months and died. CONCLUSIONS: Mediastinal liposarcoma is a rare disease. Surgery is the primary therapeutic modality. Different pathological subtypes have different epidemiological features, biological behaviors, and malignant potentials. Pathological subtype is an important prognosis factor. Patients with well-differentiated tumors have much better prognosis than those with other subtypes.

[Surgical treatment of sternal tumors: resection of the tumors and reconstruction of the chest wall defects].

OBJECTIVE: To investigate the efficacy of surgical treatment of sternal tumors and repairing methods of the chest wall defects. METHODS: Fifteen patients with sternal tumors were diagnosed and underwent resection of the sternal tumors according to the en-bolck principle and repair of the chest wall defects using various materials from January 1968 to December 2010 in our hospital. RESULTS: Of 6 patients with sternal manubrim tumors, one patient had reconstruction only with steel wire, other 5 patients healed completely after repair with soft materials. Of 7 patients with sternal body tumors, one patient recovered quickly without reconstruction because he had only partial resection; four patients had chest wall repair with soft materials, but they breathed hardly; and two patients had chest wall reconstruction with rigid materials. One patient had ventilatory support, another patient recovered quickly. Ventilatory support was needed in two patients treated by subtotal sternectomy because they had chest wall repair with soft materials. CONCLUSIONS: In surgical treatment of sternal tumors by manubrim sternetomy, the chest wall defects can be constructed with soft materials. After resection of sternal body tumors and subtotal sternectomy, the thoracic wall defects need to be reconstructed with rigid materials.