[Analysis of factors influencing the efficacy and prognosis of surgical treatment for primary malignant pelvic bone tumors].

Objective: To analyze the prognostic factors and the influence of surgical margin to prognosis. Methods: A retrospective analysis was performed for 208 pelvic tumors who received surgical treatment from January 2000 to December 2017 in our instituition. Survival analysis was performed using the Kaplan-Meier method and Log rank test, and impact factor analysis was performed using Cox regression models. Results: There were 183 initial patients and 25 recurrent cases. According to Enneking staging, 110 cases were stage ⅠB and 98 cases were stage ⅡB. 19 lesions were in zone Ⅰ, 1 in zone Ⅱ, 15 in zone Ⅲ, 29 in zone Ⅰ+Ⅱ, 71 in zone Ⅱ+Ⅲ, 29 in zone Ⅰ+Ⅳ, 35 in zone Ⅰ+Ⅱ+Ⅲ, 3 in zone Ⅰ+Ⅱ+Ⅳ, and 6 in zone Ⅰ+Ⅱ+Ⅲ+Ⅳ. Surgical margins including Intralesional excision in 7 cases, contaminated margin in 21 cases, marginal resection in 67 cases, and wide resection in 113 cases. Local recurrence occurred in 37 cases (17.8%), 25 cases were performed by reoperation and 12 cases received amputation finally. The 5-year recurrence rate of marginal resection was higher than wide resection (P＜0.05), and the recurrence-free survival rate of marginal resection was lower than wide resection (P＜0.05). There was significant differences in recurrence rate and recurrence-free survival rate between R0 and R1 resection (P＜0.05). 92 cases were not reconstructed and 116 cases were reconstructed after pelvic surgery. At the last follow-up, 63 patients (30.3%) died, and the 5-year, 10-year and 15-year survival rates were 70.4%, 66.8% and 61.3%, respectively. The 5-year survival rate of stage ⅠB and ⅡB tumor was 90.4% and 46.8%, respectively. There were 29 cases had postoperative wound complications (13.8%), 1 case with pelvic organ injury. The final function was evaluated in 132 patients, with an average MSTS score of 25.1±3.6. Cox multivariate analysis showed that surgical staging, R0/R1 margin and metastasis were independent prognostic factors for pelvic tumors. Conclusions: The safe surgical margin is the key factor for recurrence-free of pelvic tumor. The survival rate of stage ⅡB pelvic tumors was significantly lower than that of stage ⅠB tumors. Wound infection is the main postoperative complication. Surgical staging, R0/R1 margin and metastasis were independent prognostic factors of pelvic tumors.

[Progress in the treatment of soft tissue sarcoma in the 2023 annual meeting of the American Society of Clinical Oncology].

Soft tissue sarcoma (STS) is a group of rare malignant tumors originating from mesenchymal tissue, with a high degree of malignancy and a wide range of pathological subtypes. The prognosis varies among different subtypes, and treatment increasingly relies on selecting appropriate treatment methods for different subtypes. Surgical treatment is still the main treatment method at present, and the development of immune and targeted therapy also brings new hope for the treatment of soft tissue sarcoma. Immune checkpoint inhibitors, oncolytic viruses and T cell therapy have shown well safety and efficacy in clinical trials. Targeted drugs such as trabectedin and lenvatinib have changed the treatment pattern of soft tissue sarcoma. Currently, chemotherapy based on doxorubicin and ifosfamide is still the first line treatment for patients with advanced soft tissue sarcoma who have distant metastasis. However, the adverse reactions of doxorubicin limit its application in elderly patients, and trofosfamide has shown good efficacy and safety as an alternative in clinical trials. The efficacy of postoperative radiotherapy has been confirmed, which can reduce the local recurrence rate after surgical resection of soft tissue sarcoma. In summary, multimodal comprehensive treatment has become the main strategy for the treatment of soft tissue sarcoma. The combination of different treatment methods can generate synergistic effects and help patients obtain more clinical benefits, such as the combination of doxorubicin and immune checkpoint inhibitors, and the combination of antiangiogenic drugs and chemotherapy drugs. At the 2023 annual meeting of the American Society of Clinical Oncology (ASCO), oncologists from all over the world reported many researches related to the treatment of soft tissue sarcoma. This article aims to review the new progress in the treatment of soft tissue sarcoma in the 2023 annual meeting of ASCO.

Association between Iodized Salt Intake and Cognitive Function in Older Adults in China.

OBJECTIVES: To investigate the association between iodized salt intake and cognitive function in older adults. DESIGN: A cross-sectional study. SETTINGS: Individuals from the Zhejiang Major Public Health Surveillance Program (ZPHS). PARTICIPANTS: Data of 10,217 participants (including 4,680 coastal residents and 5,537 inland residents) aged ≥ 60 years were analyzed. MEASUREMENTS: Salt intake was evaluated using a questionnaire, and participants were stratified into the following three groups: iodized salt, non-iodized salt, and mixed salt. Cognitive function was assessed through the Mini-Mental State Examination and defined using education-specific cut-off points. Logistic regression models controlling for an extensive range of potential confounders were generated to examine the association between salt intake and cognitive function among all participants. RESULTS: Data from 10,217 participants with a 16.1% prevalence of cognitive impairment were analyzed. Compared with non-iodized salt intake, consumption of iodized salt was inversely associated with cognitive impairment (odds ratio [OR], 0.410; 95% confidence interval [CI], 0.351-0.480; P < 0.001) in all participants after multivariable adjustment. An association between iodized salt intake and cognitive impairment was observed in coastal (OR, 0.441; 95% CI, 0.340-0.572; P < 0.001) and inland residents (OR, 0.569; 95% CI, 0.439-0.738; P < 0.001). Despite the insufficient sample size, the results for individuals consuming mixed salt suggested an inverse association between mixed salt intake and cognitive impairment among coastal residents (OR, 0.598; 95% CI, 0.405-0.885; P = 0.010) after multivariable adjustment. CONCLUSION: Our results indicate that iodized salt intake may reduce the risk of cognitive impairment in older adults living in coastal or inland areas, and the protective effect of iodized salt intake is greater in coastal areas than in inland areas.

[Radiation-associated sarcomas of bone and soft tissue: a clinicopathological analysis of 46 cases].

Objective: To investigate the clinical, imaging, histological, and molecular features and the differential diagnosis of radiation-associated sarcomas of bone and soft tissue. Methods: Forty-six cases of radiation-associated sarcomas of the bone and soft tissue in Beijing Jishuitan Hospital from January 2010 to January 2022 were retrospectively analyzed; and the imaging, histological features and immunophenotype were examined. Results: There were 33 females and 13 males, aged from 18 to 74 years, with a mean of 52 years. The most common site of radiation-associated sarcomas were the limbs and spine (15 cases), followed by the chest (9 cases). The primary diseases included epithelial tumors (15 breast cancer, 6 cervical cancer, and 5 bowel cancer), hematolymphoid tumors, bone and soft tissue tumors and infectious lesions. The latent period of radiation-associated sarcomas ranged from 2-22 years, with an average of 11.6 years. Histopathologically, the morphology was divergent from the primary tumor. The most common malignant tumor type was undifferentiated sarcoma (22 cases), followed by osteosarcoma (16 cases). The immunophenotype of radiation-related sarcoma was almost the same as the corresponding soft tissue sarcoma. Conclusions: Radiation-induced sarcoma has a wide range of primary tumor types and its imaging, morphology and immunohistochemical features are similar to those of the primary sarcoma of bone and soft tissue. Clinical correlation is often recommended for the differential diagnosis.

[Mutation characteristics of osteosarcoma: a single center study of 64 cases using next-generation sequencing].

Objective: To investigate the distribution and characteristics of gene mutations in osteosarcoma, and to analyze the frequency and types of detectable mutations, and to identify potential targets for individualized treatment of osteosarcoma. Methods: The fresh tissue or paraffin-embedded tissue samples of 64 cases of osteosarcoma that were surgically resected or biopsied and then subject to next generation sequencing, were collected from Beijing Jishuitan Hospital, China from November 2018 to December 2021. The tumor DNA was extracted to detect the somatic and germline mutations using targeted sequencing technology. Results: Among the 64 patients, 41 were males and 23 were females. The patient age ranged from 6 to 65 years with a median age of 17 years, including 36 children (under 18 years old) and 28 adults. There were 52 cases of conventional osteosarcoma, 3 cases of telangiectatic osteosarcoma, 7 cases of secondary osteosarcoma, and 2 cases of parosteosarcoma. The detection rate of gene mutations was overall 84.4% (54/64). There were 324 variations in 180 mutated genes, including 125 genes with copy number variations, 109 single nucleotide variants, 83 insertions or deletions, and 7 gene fusions. The most common mutated genes were TP53, VEGFA, CCND3, ATRX, MYC, RB1, PTEN, GLI1, CDK4 and PTPRD. Among them, TP53 had the highest mutation rate (21/64, 32.8%), single nucleotide variant was the main mutation type (14/23, 60.9%), and 2 cases carried the TP53 germline mutation. VEGFA and CCND3 showed copy number amplification simultaneously in 7 cases. Conclusions: The high-frequency mutation of TP53 suggests that it plays an important role in the pathogenesis and development of osteosarcoma. VEGFA, CCND3 and ATRX are mutated genes in osteosarcoma and worthy of further studies. Combination of pathologic diagnosis and next generation sequencing with clinical practice can guide individualized treatment for patients with refractory, recurrent and metastatic osteosarcoma.

[Analysis of chronic obstructive pulmonary disease screening questionnaire and pulmonary function test among migrant workers exposed to dust].

Objective: To analyze the application of Chronic Obstructive Pulmonary Disease (COPD) Screening Questionnaire and pulmonary function test in dust-exposed migrant workers. Methods: In May 2019, 149 cases of dust exposed migrant workers were selected as the research subjects through the free clinic in the countryside. COPD Screening Questionnaire and lung function test were carried out to analyze the high-risk groups and the influencing factors of positive pulmonary function test results. Results: Among 149 cases of dust-exposed migrant workers, 107 (71.8%) were positive for questionnaire screening, 73 (49.0%) were positive for pulmonary function test, 75 (50.3%) were diagnosed with coal worker's pneumoconiosis, and 101 (67.8%) were diagnosed with lung function injury. The positive rate of pulmonary function of migrant workers with positive questionnaire screening results was significantly higher than that of those with negative results (P<0.05) . The results of multivariate analysis showed that compared with non-pneumoconiosis, the risk of positive pulmonary function test results was higher in dust-exposed migrant workers with stage Ⅲ pneumoconiosis (OR=16.462, 95%CI: 3.390-79.946; P<0.01) . Compared with non-smoking, the risks of positive pulmonary function test results of dust-exposed migrant workers with smoking index of 11-20 package years and >20 package years were higher (OR=19.814, 95%CI: 3.854-101.883; OR=9.733, 95%CI: 2.310-41.008; P<0.01) . Conclusion: The risk of COPD in dust-exposed migrant workers is high, so we should strengthen the early examination of the high pneumoconiosis stage and smoking population. The screening questionnaire can better screen out the high-risk groups of COPD, and it can be used as a basic screening tool.

[Predictive value of sentinel lymph node biopsy in prognosis of acral melanoma].

Objective: To explore the application of sentinel lymph node biopsy (SLNB) and its prognostic value in the treatment of acral melanoma. Methods: We retrospective analyzed 118 patients who underwent sentinel lymph node biopsy from Mar 2012 to Jun 2019 with effective follow-up data available in our institute. We ruled out palpable regional lymph node metastasis with preoperative imaging of MRI and ultrasonography, used the (99)Tc(m)-Dextran (Dx) as a tracer, with intraoperative γ-ray probe positioning for SLN capture. Wide resection and reconstruction in primary lesion followed by complete lymph node dissection were underwent SLN positive patients. Cox regression model were used to analyze the prognostic factors. Results: The patients had an average disease history of 53.6 months (2-360 months), the primary lesion located at hands and feet in 84 cases, while 27 cases were subungual and 7 cases were cutaneous. The mean Breslow depth was 3.6 mm, and 72 cases (61.0%) combined with ulceration. The average number of SLN was 2.8, the SLN positive rate was 24.6% (29/118), and the false-negative rate was 2.5% (3/118). There were 24 cases (20.3%) developed clinically positive metastasis, including 7 cases displayed distant metastasis combined with lymph node metastasis (5.9%), 8 cases with clinically positive lymph node metastasis alone (6.8%), and 9 cases with distant metastasis (7.6%). There were 33 patients in stage Ⅰ, 56 patients in stage Ⅱ and 29 patients in stage Ⅲ, with a 5-years overall survival rate of 69.5%. The Breslow depth is an independent risk factor of SLN positive. While Breslow depth, SLN status, SLN positive number and clinically detectable metastasis are independent prognostic factors of the overall survival (P<0.05). Conclusions: Patients without clinically positive regional lymph node metastasis under imaging and physical examinations, SLNB can provide accurate pathologic staging and play an accurate prediction role in the prognostic evaluation. SLNB should be carried out routinely in clinical practice.

Effects of cottonseed meal on slaughter performance, meat quality, and meat chemical composition in Jiangnan White goslings.

Cottonseed meal (CSM), which is an unconventional protein material with abundant sources, high protein content, and a relatively cheap price, can be used in poultry diets. The aim of this study was to investigate the effects of CSM on slaughter performance, meat quality and meat chemical composition in Jiangnan White goslings. A total of 300 healthy 28-day-old male goslings were randomly divided into 5 treatments, with 6 pens containing 10 geese each. Five isonitrogenous and isocaloric experimental diets were formulated such that 0% (a corn-soybean meal basal diet, control), 25% (CSM25), 50% (CSM50), 75% (CSM75), and 100% (CSM100) protein from soybean meal was replaced with CSM (corresponding to 0, 6.73, 13.46, 20.18, and 26.91% CSM in the feed, respectively). On day 70, 1 goose from each pen (6 geese per treatment) was randomly selected and killed to measure the slaughter performance, meat quality, and the meat amino acid (AA) and fatty acid (FA) compositions. The results showed that dietary CSM did not affect the slaughter performance or meat quality of geese (P > 0.05). The fat content of breast muscle in the CSM100 group was higher than that in the control group (P < 0.05). A concentration of 13.46% or more dietary CSM increased the threonine content but decreased the cysteine content, and 20.18% dietary CSM also decreased the valine content (P < 0.05). Dietary CSM concentration had no effect on the content of total saturated FAs (SFAs, P > 0.05), but 20.18 and 26.91% dietary CSM increased the content of total monounsaturated FAs and decreased the content of total polyunsaturated FAs (PUFAs) and PUFA/SFA in the breast muscle of geese (P < 0.05). In conclusion, dietary CSM did not affect the slaughter performance or meat quality of geese, but the replacement of soybean meal with CSM in whole or high proportion altered the composition of AAs and FAs in breast muscle.

Meta-analysis of preoperative high-sensitivity cardiac troponin measurement in non-cardiac surgical patients at risk of cardiovascular complications.

BACKGROUND: Patients undergoing major non-cardiac surgery are at risk of cardiovascular complications. Raised levels of high-sensitivity troponin are frequently detected before operation among these patients. However, the prognostic value of high-sensitivity troponin in predicting postoperative outcomes remains unclear. METHODS: A systematic search of PubMed, Embase and Science Citation Index Expanded was undertaken for observational studies published before March 2018 that reported associations between raised preoperative levels of high-sensitivity troponin and postoperative major adverse cardiac events and/or mortality after non-cardiac surgery. Meta-analyses were performed, where possible, using random-effects models. RESULTS: Seven cohort studies with a total of 4836 patients were included. A raised preoperative high-sensitivity troponin level was associated with a higher risk of short-term major adverse cardiac events (risk ratio (RR) 2·92, 95 per cent c.i. 1·96 to 4·37; I2  = 82·6 per cent), short-term mortality (RR 5·39, 3·21 to 9·06; I2  = 0 per cent) and long-term mortality (RR 2·90, 1·83 to 4·59, I2  = 74·2 per cent). The addition of preoperative high-sensitivity troponin measurement provided improvements in cardiovascular risk discrimination (increase in C-index ranged from 0·058 to 0·109) and classification (quantified by continuous net reclassification improvement) compared with Lee's Revised Cardiac Risk Index alone. There was substantial heterogeneity and inadequate risk stratification analysis in the included studies. CONCLUSION: Raised preoperative levels of high-sensitivity troponin appear to represent a risk for postoperative major adverse cardiac events and mortality. Further study is required before high-sensitivity troponin can be used to predict risk stratification in routine clinical practice.

ANTECEDENTES: Los pacientes a los que se realiza una cirugía mayor no cardíaca tienen riesgo de presentar complicaciones cardiovasculares. En estos pacientes se observan con frecuencia niveles preoperatorios elevados de troponina de alta sensibilidad (high-sensitivity troponin, hs-cTn). Sin embargo, el valor pronóstico de la hs-cTn para predecir los resultados postoperatorios no está bien definido. MÉTODOS: Se realizó una búsqueda sistemática en las bases de datos PubMed, EMBASE y Science Citation Index Expanded de estudios observacionales publicados antes de marzo de 2018 que analizasen la posible relación de los niveles elevados preoperatorios de hs-cTn y los efectos adversos graves de tipo cardíaco (major adverse cardiac events, MACE) postoperatorios y/o la mortalidad después de la cirugía no cardíaca. Se realizó el metaanálisis utilizando modelos de efectos aleatorios siempre que fuera posible. RESULTADOS: Se incluyeron siete estudios de cohortes con un total de 4.836 pacientes. La elevación preoperatoria de hs-cTn se asoció con un mayor riesgo de MACE a corto plazo (tasa de riesgo, risk ratio, RR 2,92, i.c. del 95% 1,96-4,37, I2 = 82,6%) y con la mortalidad a corto plazo (RR 5,39, i.c. del 95 % 3,21-9,06, I2 = 0%) y a largo plazo (RR 2,90, i.c. del 95% 1,83-4,59, I2 = 74,2%). Añadir la medición preoperatoria de hs-cTn mejoró la capacidad discriminativa para el riesgo cardiovascular (aumento de 5,8% a 10,9% en el índice C) y también la clasificación de los pacientes (cuantificada mediante el índice de reclasificación neta continua) en comparación con el uso de solo el índice de riesgo cardíaco revisado de Lee. En los estudios incluidos, hubo gran heterogeneidad y análisis inadecuado de la estratificación del riesgo. CONCLUSIÓN: Los niveles preoperatorios elevados de troponina de alta sensibilidad parecen ser un marcador de riesgo de efectos adversos graves de tipo cardíaco en el postoperatorio y de mortalidad. Se requieren más estudios antes de utilizar la troponina de alta sensibilidad para la estratificación del riesgo en la práctica clínica rutinaria.

[Study on changes of pulmonary function in patients with pneumoconiosis in three years].

Objective: To investigate the characteristics of pulmonary function changes and its possible influencing factors in patients with pneumoconiosis. Methods: In December 2019, pneumoconiosis patients hospitalized in four departments of occupational diseases in Hunan Occupational Disease Prevention and Control Hospital from December 2015 to December 2016 were selected as subjects. Lung function including forced vital capacity (FVC) , FVC%, forced expiratory volume in one second (FEV1) , FEV1%, forced expiratory volume in one second / forced vital capacity (FEV1/FVC) , diffusion capacity of the lung foe carbon monoxide% (DLCO%) 、maximal expiratory rlow 75% (MEF75%) , maximal expiratory rlow 50% (MEF50%) and maximal expiratory rlow 25% (MEF25%) were tested, and collect their age, occupation history, smoking history and Chronic Obstructive Pulmonary Disease Self Rating Questionnaire (CAT) score. They were followed up after 3 years to analyze the 3-year decline rates of lung function indicators and their relationship with stage of pneumoconiosis, age, smoking index, baseline values of lung function and CAT score. Results: 265 cases were studied effectively. After 3 years, the values of 9 lung function indicators of pneumoconiosis patients were significantly lower than those of 3 years ago (P<0.05) . The decline rates of FEV1%, FEV1/FVC, MEF75%, MEF50% and MEF25% were positively correlated with the stage of pneumoconiosis (r=0.250, 0.290, 0.219, 0.280, 0.141, P<0.05) . The decline rates of FEV1% and MEF75% were positively correlated with smoking index (r=0.148, 0.152, P<0.05) . The decline rates of DLCO% and MEF25% were positively correlated with the baseline value of initial pulmonary function (r=0.276, 0.153, P<0.05) , while the decline rates of FEV1%, FEV1/FVC and MEF50% were negatively correlated with the baseline values of initial pulmonary function (r=-0.215, -0.146, -0.214, P<0.05) . The decline rates of FVC%, FEV1%, MEF75% and MEF50% were positively correlated with the changes of CAT scores (r=0.147, 0.208, 0.210, 0.196, P<0.05) . Logistic regression analysis showed that old age and high initial value of DLCO% were the risk factor for the decline of DLCO% (OR=1.105、1.078, P<0.05) .High smoking index was the risk factors for the decline of MEF75% (OR=1.016, P<0.05) . High stage and the increase of CAT score were the risk factors for the decline of MEF50% (OR=1.548, 1.162, P<0.05) . High initial value of MEF25% was the risk factor for the decline of MEF25% (OR=1.010, P<0.05) . Conclusion: The pulmonary function index of pneumoconiosis patients declined significantly in 3 years. The stage of pneumoconiosis, age, smoking index and degree of pulmonary function damage were related to the decline rate of pulmonary function.

[Synchronous multicentric osteosarcoma: treatment and prognostic factor analysis].

Objective: To identify the clinical outcome and prognostic factors of synchronous multicentric osteosarcoma (SMOS). Methods: The clinical data of 2 602 conventional osteosarcoma patients admitted to Beijing Jishuitan Hospital from January 1995 to June 2018 were retrospectively analyzed. Finally, 56 (2.1%) cases were confirmed as SMOS according to clinical and imaging database, medical record and pathological results.All epidemiological data of SMOS cases,initial diagnosis time, tumor site, number of lesions, chemotherapy, surgical treatment, alkline phosphatase (AKP),lactate dehydrogenase (LDH) and oncological results were collected in our institution. The Survival rate, comparison of various parameters, univariate analysis and multivariate Cox regression were performed with statistical software. Results: There were 41 males and 15 females enrolled in this research, the median and mean ages were 15 and 18 years (range, 8-50 years) respectively. All of them were multi-site involved, whereas the initial complaints of sites distribution were 32 cases of femur, 13 cases of tibia, 4 cases of humerus, 3 cases of fibula, 2 cases of spine, 1 case of sternum and 1 case of calcaneus. Forty-four of 56 cases performed adjuvant chemotherapy and 31 of them underwent surgical treatment. The mean follow-up time was 15.4 (range, 1-186) months. Thirty-five cases died of disease at the end of the follow-up. The 5-year survival rate was 10.4%. According to the number of lesions stratification, the 2-year survival rates in patients with low (<5 sites) and high (≥5 sites) tumor load was 33.6% and 0, respectively (χ(2)=6.697, P=0.010). The 2-year survival rate of chemotherapy and non-chemotherapy patients was 20.8% and 0, respectively (χ(2)=6.998, P=0.008), the value of AKP after chemotherapy(median: 272 IU/L) significantly decreased when compared with that at the initial diagnosis (median: 454 U/L) (Z=-3.274, P=0.001).The 2-year survival rate in patients with and without standard chemotherapy was 55.6% and 0, respectively (χ(2)=8.798, P=0.003). The 2-year survival rate was 25.0% in the surgical group and 0 in the non-surgical group, respectively (χ(2)=7.942, P=0.005). Multivariate cox regression analysis with the forward Wald method indicated that standard chemotherapy was the only variable contributor to survival and prognosis of multifocal osteosarcoma. Conclusions: SMOS has low survival rate and poor prognosis. Chemotherapy and surgery can improve the survival rate, standard chemotherapy is an independent prognostic factor.

[Research progress of sentinel lymph node biopsy and regional dissection in melanoma].

Melanoma is a malignant tumor derived from the skin and mucous membrane, the epidemiological data showed that the incidence of melanoma elevated rapidly in the last decade. Early lymph node metastasis is a distinguishing characteristic of melanoma. The assessment of regional lymph nodes is a vital factor for melanoma staging and comprehensive therapeutic strategies. The sentinel lymph node biopsy (SLNB) plays an important role in this comprehensive diagnosis and treatment system. Completion lymph node dissection (CLND) with positive sentinel lymph node was accepted by traditional theories. But it has recently been questioned via the latest global clinical trial. CLND limited the benefit for melanoma specific survival. However, SLNB is the reliable procedure for staging and prognostic evaluation of melanoma patients with positive sentinel lymph node, and CLND can significantly improve the local control and decrease the regional recurrence according to the evidence-based medicine. The authors summary the recently correlational research of SLNB and CLND in melanoma in this review.

[Investigation of medication compliance in patients with pneumoconiosis complicated with chronic obstructive pulmonary disease at stable stage].

Objective: To investigate the compliance of inhalation during stable phase of pneumoconiosis complicated with COPD and to explore the factors influencing compliance. Methods: The patients with pneumoconiosis complicated with COPD who were hospitalized in the four Department of occupational disease prevention and treatment in Hunan province from December 2016 to August 2017 were selected as the research subjects. The examination of Chest radiograph, HRCT and lung function was perfected, and CAT score and MRC score were carried out. The age, culture, smoking history, acute aggravation of 1 years, medical insurance and so on were collected, and follow-up was conducted after 6 months. Results: Of the 115 patients who had successfully followed up, 14 cases (12.17%) were persisted in medication, and 101 cases (87.83%) did not adhere to the medication. The smoking index median of the non adherence group was 30 (15, 40) , while that of the adherence group was 16 (6, 31) . The smoking index of the adherence group was lower than that of the non adherence group. The FEV1% in the unadhered group was 44.69+15.48, and the drug group was 37.12+16.98, the FEV(1)/FVC in the unadhered group was 52.43+9.19, and the drug group was 44.43+11.88, and the lung function of the drug group was worse than that of the unadhered group. The adherence rate of group COPD (group D) was higher than that of group A, B and C, and the difference between D group and B group was statistically significant. The adherence rate of pneumoconiosis stage Ⅲ was higher than that of pneumoconiosis stageⅡand pneumoconiosisⅠ. Conclusion: The compliance of long acting bronchodilator inhalation is low in stable phase of pneumoconiosis complicated with COPD. The poorer the lung function, the higher the compliance of inhalation. The compliance of pneumoconiosis patients with Medical insurance for industrial injury is higher than that of pneumoconiosis patients with New rural cooperative medical service.

[Complications and influencing factors of pneumoconiosis patients undergoing CT guided percutaneous lung biopsy].

Objective: To investigate the safety and influencing factors of ct-guided percutaneous lung biopsy in pneumoconiosis patients. Methods: The data of 63 patients with pneumoconiosis who underwent ct-guided percutaneous lung biopsy in our hospital were studied to analyze the incidence of complications and influencing factors of percutaneous lung biopsy. Results: 63 cases of pneumoconiosis patients received CT guided percutaneous lung biopsy. There were 29 cases of complications (46.03%) , including 20 pneumothorax (37.75%) , 12 bleeding (19.05%) , and 3 cases of liquid pneumothorax (4.76%) . The single factor chi square analysis showed that there were significant differences in age, depth of focus, puncture position and puncture times (P<0.05) , and there was significant difference between the occurrence of hemorrhage and age, type of focus, size of focus, and the location of puncture site (P<0.05) . The unconditional LogisticL multiple factor regression analysis showed that the depth of the lesion was an independent risk factor for concurrency pneumothorax, and the size of the lesion was an independent risk factor for bleeding. Conclusion: Complications of CT-guided percutaneous pulmonary biopsy are mainly pneumothorax and hemorrhage. Age, focus type, focus size, focus depth, puncture site, and puncture times are all the factors of complications.

[Surgical treatment of giant cell tumors with pathological fracture around the knee].

Objective: To compare the local recurrent rate, the persistence of reconstruction and functional recovery of Giant Cell Tumor (GCT) after the treatments of extensive curettage or resection. Methods: A retrospective review was conducted on the clinical data of 50 patients who had giant cell tumor with pathological tracture around the knee treated in our hospital from January 2001 to July 2014. There were 30 males and 20 females. The average age was 33.7 years respectively (range, 17 to 71 years). The fracture localizations of 45 cases were distal femur and of 5 cases were proximal tibia. According to AO fracture classification, 3 cases were in type A, 36 cases in type B and 11 cases in type C. In Campanicci system for image grading study, 5 cases were in grade Ⅱ and 45 cases in grade Ⅲ. Surgical treatment included 20 cases of extensive curettage and 30 cases of resection. The surgical reconstructive methods included 16 cases of cement reconstruction with internal fixation, 5 cases of unicompartmental arthroplasty with allograft, 1 case of segment osteoarticular allograft transplantation and 28 cases of prosthesis replacement. Final statistical analysis of surgery and therapeutic effect were carried out by SPSS, version 16.0 for Windows. Enrolling parameters collected gender, age, location, fracture type, surgical treatment, surgical margin, reconstruction, complications, local recurrence (LR) and functional evaluation. Categorical data were described by result frequencies.The comparison of the rate was performed by chi-square or Fisher's exact test. Between the two groups compared using independent t-test. The recurrence-free survival was estimated by the method of Kaplan-Meier. Results: The mean postoperative follow-up time was 66.9 months (range, 24-149 months). Four patients developed local recurrence (4/50, 8.0%)including 3 cases of curettage group (3/20, 15.0%)and 1 case of resection group (1/30, 3.3%), there was no significant difference between curettage and resection group (P=0.289). The comparison of local recurrence between this curettage group (3/20, 15.0%) and the GCT group without fracture published before(10/116, 8.6%) in our institution also had no significant difference (P=0.407). There was no significant difference among the three types of fracture regarding the rate of local recurrence (P=0.160), but there was significant difference in the choice of surgical procedures for different fracture types (P=0.006). The complications: 2 patients (2/20, 10.0%)had joint degeneration in curettage group. 15 cases (15/30, 50.0%) had complications in resection group, 1 case of unicompartmental arthroplasty allograft absorption, 2 cases of infection and 12 cases of aseptic loosening after prosthesis replacement (including 1 case with periprosthetic fracture and 1 case with prosthesis fracture). The postoperative complications in curettage group had a significant reduction (P=0.005) when compared with the resection group. The mean score of functional evaluation with Musculoskeletal Tumor Society (MSTS) for curettage and resection group were (93.5±6.5)% and (82.6±12.9)% (F=4.838, P=0.033). Conclusions: (1) Extensive curettage did not increase the risk of local recurrence of giant cell tumor with pathological fracture around the knee. (2)The different fracture type had no effect on the local recurrence rate, but affect the decision of surgical procedures options. (3)The reconstructive complications in resection group was significant higher than curettage group, and the postoperative function of curettage group was better than resection group.

[Dedifferentiated liposarcoma of extremities: a clinicopathologic analysis].

Objective: To study the clinicopathologic features of dedifferentiated liposarcoma of extremities. Methods: Nine cases of dedifferentiated liposarcoma of extremities diagnosed at Beijing Jishuitan Hospital from 2009 to 2017 were selected. The histological features of cases of dedifferentiated liposarcoma of extremities were evaluated by HE and immunohistochemistry, together with the clinical and radiological features. Flourescence in situ hybridization(FISH) was used to detect MDM2 amplification. Results: They were located in the thigh (6 cases), calf (2 cases) and buttock (1 case). There were six females and three males. Patients' age ranged from 61 to 79 years (mean 68 years). Histologically, there were two components, well-differentiated liposarcoma and dedifferentiated sarcoma with or without transitional lesions between them. The histology of dedifferentiated liposarcoma included undifferentiated sarcoma and fibrosarcoma. Heterologous elements such as bone and cartilage were present in two cases. Immunohistochemical study showed the tumor cells expressed vimentin, CDK4 and p16. MDM2 were positive in 6 cases (6/9) and p53 was positive in one case(1/9). CKpan was positive in the epithelioid differentiation area. S-100 protein was positive in the well-differentiated liposarcoma component. FISH showed the amplification of MDM2(6/9). Conclusions: Dedifferentiated liposarcoma of extremities is very rare. The diagnosis should be combined with the histological characteristics and immunohistochemical results and differentiated from the other tumors and tumor-like lesions.

[Clinical, radiologic and pathologic features of giant cell tumor of bone treated with denosumab].

Objective: To investigate the radiological and histopathological features of giant cell tumor of bone treated with RANKL inhibitor denosumab. Methods: Eleven cases were retrieved from the surgical pathology records between March 2015 and June 2017 in Beijing Jishuitan Hospital. Formalin fixed, paraffin embedded specimens were collected and the histological features were evaluated. The imaging features including X ray, magnetic resonance imaging, and computed tomography were also reviewed. Results: These 11 cases of giant cell tumor of bone were derived from five female and six male patients, with age ranged from 20 to 62 years (mean age, 35 years). The tumors were located in the sacrum (6 cases), femur (2 cases), radius (1 case), tibia (1 case) and patella (1 case), respectively. Histologically, all cases showed depletion of giant cells, proliferation of mononuclear cells and different degrees of ossification 3 to 6 months after denosumab therapy. Radiography showed marked osteosclerosis and sclerotic rim formation. Three cases of the sacrum recurred after 5, 6 and 11 months of surgery, and the remaining cases showed no recurrence within follow-up of 1 to 14 months. Conclusions: Denosumab treated giant cell tumors morphologically differ from untreated tumors. Careful attention to a history of denosumab administration is crucial to avoid misdiagnosis and to allow proper differentiation from other tumors and tumor-like lesions.

[Dedifferentiated chordoma of sacrococcygeal region: a clinicopathologic analysis and review of literature].

Objective: To study the clinicopathologic features of dedifferentiated chordoma. Methods: Four cases of dedifferentiated chordoma of sacrococcygeal region were collected at Beijing Jishuitan Hospital, from 2009 to 2014. HE and immunohistochemistry (EnVision method) were used to observe the clinical, radiological and histological features of dedifferentiated chordoma and to make the diagnosis and differential diagnosis. The literature was reviewed. Results: Four cases of dedifferentiated chordoma were all located in the sacrococcygeal region. The mean age at diagnosis was 57 years (range 49-64 years). There were 1 female and 3 males. Histologically, there were two components of conventional chordoma and dedifferentiated sarcoma with or without transitional area between them. The histology of dedifferentiated components includes undifferentiated sarcoma and fibrosarcoma. Immunohistochemical study showed that cytokeratin, epithelial membrane antigen, S-100, Brachyury were positive in the portion of chordoma while p53 were positive in the portion of undifferentiated sarcoma. INI1 and vimentin were both positive. Conclusions: The dedifferentiated chordoma is very rare. The diagnosis should combine the histological characters and immunohistochemical results and should be differentiated from the sarcomatoid chordoma, poorly differentiated chordoma and other high grade sarcoma. p53 may play a role in the malignant transformation mechanism of chordoma.