Discovery and Characterization of Intercondylar Transphyseal Complexes and their Oncological Significance in Transphyseal Extension of Pediatric Osteosarcoma.

OBJECTIVE: To explore whether there exist undiscovered transphyseal vasculature-canal compound structures in immature femurs and tibias, and reveal their potential oncological impact. METHODS: This investigation was divided into a morphological study and a clinical study. In the morphological part, a new-identified anatomic structure was investigated by using radiographical, anatomical, and histological methodologies. Twenty-eight 1-mm-slice thickness magnetic resonance images of pediatric knees were generated and 10 pediatric knees were dissected to verify the existence and universality, observe the radiographic and anatomic characteristics, and determined the located region of this structure. Hematoxylin-eosin staining, immunofluorescence, and angiography procedures were performed to illustrate its histological feature, molecular identification, and vascular origination, respectively. In the clinical part, 38 pediatric osteosarcoma patients were enrolled from January 2014 to December 2020. A descriptive clinical study including 13 typical participants was conducted to investigate the oncological significance of this new-identified structure. Meanwhile, the discrepancy in transphyseal osteosarcoma extension between different physeal regions was evaluated in a cross-sectional study. RESULTS: In the morphological study, we discovered a new-found vasculature-canal compound structure, intercondylar transphyseal complex (ITC), which originated from the middle genicular vessels, traversed the whole epiphysis, and breached the intact open physis in the immature proximal tibia or distal femur. The components of ITC included the juxta-articular, epiphyseal, and transphyseal segments of vessels, the canals that traverse the entire epiphysis and physis and enclosed the vessels, vascular foramina on articular facet and foramina-covered synovium. Depending on the location, ITCs can be divided into three types: femoral ITC, anterior tibial ITC, and posterior tibial ITC. Clinically, the ITC may facilitate intercondylar transphyseal sarcomatous dissemination without damaging the adjacent physeal cartilage. Compared to bilateral condylar physes, more osteosarcomas transgressed the open growth plates through intercondylar regions in which ITC was located (P = 0.022). CONCLUSION: As the "gap" on intact open physis, ITC, which is a new-identified compound structure in intercondylar regions of immature femur or tibia, may promote intercondylar transphyseal tumor extension. Moreover, the identification and characterization of ITC subvert some traditional comprehensions about physis and may provide novel perspectives for pediatric osteosarcomas.

[Study on plasma antibodies against heat shock protein 70 in the hypertensive patients with cerebral infarction].

OBJECTIVE: To determine the level of heat shock protein 70 (HSP70) antibody in the hypertensive patients with cerebral infarction and explore the role of plasma antibody against HSP70 in the pathogenesis of cerebral infarction and its relationship to the brain tissue damage. METHODS: One hundred patients with CT or MRI confirmed cerebral infarction were enrolled in the study, in whom 64 were male, and 36 female. Among them, 67 patients were having hypertension and 33 with normal blood pressure. One hundred healthy individuals, including 58 male and 42 female, served as the control group. The level of plasma HSP70 antibody was determined with Western blot-enzyme linked immunoadsorbent assay (ELISA) technique. RESULTS: Patients with cerebral infarction had a significantly higher incidence (69%) of antibodies to HSP70 compared to the low incidence (13%) of antibodies to HSP70 in the controls. Patients with hypertension had a high incidence (57%) of antibodies to HSP70 compared to the low incidence (12%) of antibodies to HSP70 in patients with normal blood pressure in cerebral infarction group. Patients with hypertension in the control group had a higher incidence (11%) of antibodies to HSP70 compared to the low incidence (2%) of antibodies to HSP70 in the same group. CONCLUSION: There is a significant difference in the level of antibodies to HSP70 between patients with cerebral infarction and controls. Elevation in the level of antibodies to HSP70 may reflect the degree of brain tissue damage.