Microwave-induced hyperthermia in situ in the treatment of tumors of proximal humerus: long-term results with functionary sparing surgery.

BACKGROUND: The present study aimed to evaluate the indications, feasibility, clinical effectiveness and complications of the treatment with microwave in situ inactivation followed by curettage and bone grafting assisted with internal fixation, for the proximal humerus tumors. METHODS: The clinical data of 49 patients with primary or metastatic tumor of the proximal humerus who received intraoperative microwave inactivation in situ with curettage and bone grafting in our hospital from May 2008 to April 2021 were retrospectively analyzed. RESULTS: There were 25 males and 24 females, with an average age of 57.6 ± 19.9 years (range, 20-81). All patients were followed up for 7 to 146 months, with an average period of 69.2 ± 39.8 months. Up to the last follow-up, 14 patients died. The 5-year overall survival was 67.3%, and 5-year tumor-specific survival was 71.4%. The 5-year tumor-specific survival rates were 100% for aggressive benign tumors or low potential malignancy tumors, 70.1% for primary malignancies, and 36.9% for metastatic tumors. The average preoperative MSTS, constant-Murley and VAS scores were 16.81 ± 3.85, 62.71 ± 12.56 and 6.75 ± 2.47, which were all significantly improved at 6 weeks after operation and at the final follow-up (P < 0.05). CONCLUSIONS: Microwave inactivation in situ and curettage and bone grafting are a feasible treatment for tumors of proximal humeral, especially for malignant tumors and metastases, without the necessity of the replacement of the shoulder, with little trauma and good upper limb function, and with low local recurrence and distant metastasis.

Effects of Chemical Sterilization and Gamma Irradiation on the Biochemical and Biomechanical Properties of Human Tendon Allografts In Vitro Study.

OBJECTIVE: Pre-implantation sterilization procedures for tendons are important measures to reduce the risk of disease transmission, however these procedures may compromise tendon microarchitecture and biomechanical properties to varying degrees. We explore the effects of different sterilization procedures on the micro-histology, biomechanical strength and biochemical properties of human tendon allografts in vitro study. METHODS: The tendon allografts were harvested from cadaveric donors after the donors were serologically screened by antibody or nucleic acid testing of infectious agents. All samples were divided into five groups, which were fresh-frozen group (control group), 15 kGy gamma irradiation group, 25 kGy gamma irradiation group, 70% ethanol group, and peracetic acid-ethanol group. Each group included 10 tendons for testing. Histological staining and transmission electron microscopy were applied to observe the internal structure and arrangement of tendon collagen fibers, while the machine learning classifier was trained to distinguish the darker cross-sections of collagen fibers and brighter backgrounds of the electron micrograph to detect the distribution of diameters of tendon collagen fibers. The viscoelasticity, mechanical properties and material properties of tendon allografts were examined to detect the influence of different intervention factors on the biomechanical properties of tendons. RESULTS: Histological staining and transmission electron microscopy showed that the structure of fresh-frozen tendons was similar to the structures of other experimental groups, and no obvious fiber disorder or delamination was observed. In the uniaxial cyclic test, the cyclic creep of 25 kGy irradiation group (1.5%) and peracetic acid-ethanol group (1.5%) were significantly lower than that of the control group (3.6%, F = 1.52, P = 0.039) while in the load-to-failure test, the maximum elongation and maximum strain of the peracetic acid-ethanol group were significantly higher than those of the control group (F = 4.60, P = 0.010), and there was no significant difference in other biomechanical indicators. According to the experimental results of denatured collagen, it could be seen that no matter which disinfection procedure was used, the denaturation of the tendon sample would be promoted (F = 1.97, P = 0.186), and high-dose irradiation seemed to cause more damage to collagen fibers than the other two disinfection procedures (296.2 vs 171.1 vs 212.9 µg/g). CONCLUSION: Biomechanical experiments and collagen denaturation tests showed that 15 kGy gamma irradiation and 70% ethanol can preserve the biomechanical strength and biochemical properties of tendons to the greatest extent, and these two sterilization methods are worthy of further promotion.

Efficacy of Jintiange Capsules in the Treatment of Osteoporosis: A Network Meta-analysis.

OBJECTIVE: To evaluate the efficacy of Jintiange capsules and Jintiange combined with other therapies in the treatment of osteoporosis. METHODS: A systematic review of the literature was conducted through databases including China National Knowledge Infrastructure (CNKI), the VIP Database for Chinese Technical Periodicals (VIP), Wanfang, and PubMed from inception to April 2018. Network meta-analysis was used to determine the relative efficacy of related treatments on osteoporosis. The primary outcome measures are the bone mineral density (BMD) of the lumbar and femoral neck, and the secondary outcome measures are visual analog pain score (VAS) and adverse events. Two reviewers independently selected the studies, extracted information, and assessed the quality of included trials. Data extracted from eligible studies was pooled and meta-analyzed, and the mean differences (MD) with their 95% confidence intervals were estimated as the effect size between treatments. RESULTS: Thirty-one studies were included in this study, containing 28 randomized controlled trials (RCT) and 3 non-randomized controlled trials (non-RCT), with a total of 14 regimens treating osteoporosis. According to the surface under the cumulative ranking (SUCRA) curves, Jintiange capsules combined with atorvastatin (89.9%) and Jintiange combined with bisphosphonates (88.2%) have the best efficacy in terms of the BMD of the lumbar and femoral neck, respectively. Based on the VAS, Jintiange combined with calcium has the best analgesic effect (83.4%). CONCLUSION: Jintiange capsules alone and combined with other therapies is a good choice for treating patients with osteoporosis in terms of improving BMD, relieving pain, and reducing adverse events. More large-scale and well-designed RCT are warranted to confirm the results of this study.

Intraoperative microwave inactivation in-situ of malignant tumors in the scapula.

OBJECTIVE: To explore the feasibility and effect of microwave in situ inactivation of malignant primary or metastatic tumors in the scapula. METHODS: Seventeen patients (12 men, 5 women, mean age 48 years [range, 13-59 years]) with malignant primary or metastatic tumors involving the scapula were treated by microwave inactivation between June 1998 and February 2008. There were 12 malignant primary bone and 5 metastatic tumors. In 14 cases Area Sl was involved and in 3 cases both Areas S1 and S2. All 17 cases were by making a dorsal arc- or "∩-" shaped incision to expose the tumor, protecting the surrounding soft tissues with a copper grid, and then heated the tumors locally with 2450 MHz microwave to 50°C for 20 min, after which all or some of the necrotic tumor tissue was removed, preserving the support role of the scapula. RESULTS: The operation time was 60-180 min (mean 120 min) and blood loss was 300-1000 mL (mean 460 mL). No serious intraoperative or postoperative complications occurred in any patient. The patients were followed up for 3 months to 10 years (mean 4.2 years). Three patients with Ewing's sarcoma in the scapula had pulmonary, cerebral and systemic multiple metastases and died 8~24 months after surgery. Three patients with malignant fibrous histiocytoma died of pulmonary and systemic multiple metastases 10~22 months after surgery; one patient had recurrence 6 months after surgery and survived with tumor. Five patients with metastatic tumor in the scapula died of non-scapular metastatic tumor 6~14 months after surgery. The other five patients with primary malignant bone tumors had no recurrence or metastasis during follow-up. Three cases had restricted extension of the shoulder joint with unrestricted protraction and retroflexion after surgery. CONCLUSION: In situ microwave inactivation features simple surgery, reliable effects and patient acceptability, making it an ideal surgical method for malignant tumors in the scapula.