Conservative surgery with microwave ablation for recurrent bone tumor in the extremities: a single-center study.

BACKGROUND: Surgical treatment for recurrent bone tumors in the extremities still presents a challenge. This study was designed to evaluate the clinical value of microwave ablation in the treatment of recurrent bone tumors. METHODS: We present 15 patients who underwent microwave ablation for recurrent bone tumors during the last 7 years. The following parameters were analyzed for outcome evaluation: general condition, surgical complications, local disease control, overall survival, and functional score measured using the Musculoskeletal Tumor Society (MSTS) 93 scoring system. RESULTS: Percutaneous microwave ablation in one patient with osteoid osteoma and another with bone metastasis resulted in postoperative pain relief. Thirteen patients received intraoperative microwave ablation before curettage or resection, including those with giant cell tumors of bone (6), chondroblastoma (2), osteosarcoma (2), undifferentiated sarcoma (1), and bone metastases (2). All patients achieved reasonable local tumor control in the mean follow-up of 29.9 months. The functional score was 24.1 for the 15 patients 6 months after the operation. Four patients had tumor metastasis and died, whereas 3 patients with tumors survived, and the remaining 8 patients without the disease survived. CONCLUSIONS: Microwave ablation represents an optional method for local control in treating recurrent bone tumors in the extremities.

Positioning thoracic pedicle screw entry point using a new landmark: a study based on 3-dimensional computed tomographic scan.

STUDY DESIGN: A novel method to identify the entry point. OBJECTIVE: To quantify the position of thoracic pedicle screw entry points on the lamina at various segments of the thoracic vertebrae in normal subjects and patients with adolescent idiopathic scoliosis and propose a new technique to select entry points using a new landmark. SUMMARY OF BACKGROUND DATA: Thoracic pedicle screws have been widely used in thoracic surgery, and the placement of pedicle screws has been studied extensively. However, there are only qualitative studies on selecting the entry point, and no study has quantified the position of entry points. METHODS: A retrospective study using 3-dimensional computed tomographic reconstruction techniques were used to study the morphology of thoracic vertebrae in 110 adolescents (56 cases of adolescent idiopathic scoliosis and 54 normal subjects). A quantitative area was used to select the entry point. Thoracic pedicle screw entry point was determined using the new landmark as reference and thoracic pedicle screws were placed in 21 patients. Postoperative computed tomographic scanning was performed to assess the safety and effectiveness of this entry point selection technique. RESULTS: We determined that the accuracy of pedicle screw placing after positioning entry point using the quantitative area was significantly superior to that after positioning entry point using the traditional method (P < 0.05). CONCLUSION: The new technique quantifies the position of each thoracic pedicle screw entry point and it is convenient, easy to operate, and has relatively high accuracy of screw placement. This positioning technique can provide safe and accurate clinical guidance for selecting thoracic pedicle screw entry point.

Inhibition of cancer cell migration and invasion through suppressing the Wnt1-mediating signal pathway by G-quadruplex structure stabilizers.

WNT1 encodes a multifunctional signaling glycoprotein that is highly expressed in several malignant tumors. Patients with Wnt1-positive cancer are usually related to advanced metastasis. Here, we found that a stretch of G-rich sequences located at the WNT1 promoter region is capable of forming G-quadruplex structures. The addition of G-quadruplex structure stabilizers, BMVC and BMVC4, raises the melting temperature of the oligonucleotide formed by the WNT1 promoter G-rich sequences. Significantly, the expression of WNT1 was repressed by BMVC or BMVC4 in a G-quadruplex-dependent manner, suggesting that they can be used to modulate WNT1 expression. The role of G-quadruplex stabilizers on Wnt1-mediated cancer migration and invasion was further analyzed. The protein levels of ß-catenin, a mediator of the Wnt-mediated signaling pathway, and the downstream targets MMP7 and survivin were down-regulated upon BMVC or BMVC4 treatments. Moreover, the migration and invasion activities of cancer cells were inhibited by BMVC and BMVC4, and the inhibitory effects can be reversed by WNT1-overexpression. Thus the Wnt1 expression and its downstream signaling pathways can be regulated through the G-quadruplex sequences located at its promoter region. These findings provide a novel approach for future drug development to inhibit migration and invasion of cancer cells.

The meaningful use of EMR in Chinese hospitals: a case study on curbing antibiotic abuse.

Comprehensive electronic medical records (EMR) have proven to be an effective tool for improving the safety and quality of healthcare. In particular, EMR has resulted in a significant reduction in antibiotic consumption and an improvement in rational antibiotic use. This study focused on evaluating the effectiveness of using a comprehensive EMR system to curb antibiotic abuse. A retrospective "before/after" investigation was conducted in an 850-bed nonprofit hospital. A comprehensive EMR was implemented to improve the management of medical practices during treatment and to track antibiotic prescriptions. Patient records on antibiotic use were identified by searching the hospital database from April 1 to October 30, 2011 (post-implementation) and compared with those of patients from April 1 to October 30, 2010 (pre-implementation). Outcome measures were defined daily doses (DDDs) of antibiotics per 1,000 patient-days and factors that influenced antibiotic consumption. Antibiotic consumption during the seven months with EMR management decreased from 727 DDDs to 480 DDDs per 1,000 patient-days (p < 0.001). The decreases in cefminox, cefoperazone combinations, cefixime, and gentamicin were notably significant. The type of medical insurance, patient age, and ordering department (importance coefficients of 0.1935, 0.1818 and 0.1756, respectively) were the most significant factors that influenced antibiotic consumption. An improvement in the rational antibiotic use was also observed in the length of antibiotic therapy, selection of appropriate antibiotic level, route of administration, and so on. Rational antibiotic use resulted in a lower mortality of 0.0644 % during the post-implementation period compared to 0.179 % during the pre-implementation period (p = 0.018). The comprehensive EMR system contributed to a significant reduction in antibiotic consumption and an improvement in rational antibiotic use.

Ameloblastic fibroma: a review of published studies with special reference to its nature and biological behavior.

To further elucidate confusions with respect to the nature and biological behavior of ameloblastic fibroma (AF), available English-language literature since its first description in 1891 was reviewed. A total number of 123 cases with well-documented follow-up data were retrieved to evaluate various clinical, pathological and behavioral aspects of this tumor. AF tends to occur in the first two decades (89/123; 72.4%), but patients older than 22 years are not uncommon (30 cases). An overall recurrence rate of 33.3% (41 cases) is identified in reported cases who were treated by conservative (91.5%) and radical (8.5%) methods. Malignant transformation is evident in 14 recurrent tumors with an overall transformation rate of 11.4%. These data support the view that majority of AFs are true neoplasms. However, a small number of AFs occurring in childhood may represent the primitive stage of a developing odontoma, as three of the reported recurrent AFs do show further maturation with formation of dental hard tissues. A significantly longer recurrence-free survival was noted in patients treated by radical procedures in comparison to those treated by conservative methods and the age of patients at the first presentation was significantly related to malignant transformation of AF. As we are unable, at present, to differentiate a hamartomatous lesion from a neoplasm among this group of lesions merely on histologic grounds, age of the patients should be an important consideration when choosing therapeutic methods. Radical surgery should not be employed for the treatment of AFs in young people.

[Study on the characteristic of assimilating nitrogenous phosphorous fertilizer and the accumulation disciplinarian of total tanshinons of Salvia miltiorrhiza].

OBJECTIVE: To confirm the amount of fertilizer and the ration of fertilizer. METHOD: Through the experiment of planting Salvia miltiorrhiza in pot and in field were carried out. RESULT: When N:P = 1:1, The production was 1.8 times more than the contrast group in plotting experiment, and in field the production of the highest fertilizer plot were 2.5 times more than the contrast and the higher and high fertilizer plot is 2.25 and 1.2 times respective were than those in the contrast group. CONCLUSION: The proper ration of nitrogenous fertilizer and phosphorous fertilizer is 1:1. Nitrogen shows negative effects to the accumulation of tanshinon IIA, the more the nitrogen ous fertilizer, The less the content of tanshinon IIA. In contrast, phosphor ous fertilizer shows good effects on the accumulation of tanshinon IIA. Phosphorous fertilizer could alleviate the decline of the content of tanshinon IIA by using nitrogenous fertilizer. The accumulation peak of the tanshinon IIA emerge in the period of 150 d.