[Percutaneous pedicle screw fixation combined expandable tubular retractor in the treatment of spinal metastases]

OBJECTIVE

To investigate the effectiveness of percutaneous pedicle screw fixation combined expandable tubular retractor in the treatment of patients with spinal metastases.

METHODS

In the study, 12 patients of spinal metastases treated with percutaneous pedicle screw fixation combined expandable tubular retractor in our hospital were retrospectively reviewed between June 2017 and October 2019. Among the 12 patients, 9 were males and 3 were females; the median age was 62.5 years [(65.1±2.9) years]. The decompression segment of 7 patients was located at the lower thoracic spine (including 1 patient with incomplete paraplegia) and the decompression segment of 5 patients was located at the lumbar spine; Tomita score was 6.0±0.6. Perioperative data of the patients were reviewed. Visual analog scale (VAS score), Karnofsky score, and Eastern Cooperative Oncology Group (ECOG) score were compared before and after surgery. The patient's survival, adjuvant treatment, and internal fixation failure were observed in the follow-up period.

RESULTS

All the 12 patients had a successful operation with percuta-neous pedicle screw fixation combined expandable tubular retractor. The average operative time, blood loss, and blood transfused of the patients were (247.0±14.6) min, (804.2±222.3) mL and (500.0±100.0) mL, respectively. The average amount of drainage was (240.8±79.3) mL. Drainage tubes were pulled out early postoperative [(3.2±0.3) d], allowing early mobilization. The patients discharged (7.8±0.8) d postoperative. All the patients were followed up for 6-30 months, and the average overall survival time was (13.6±2.4) months. During the follow-up period, 2 patients experienced screw displacement, the internal fixation was stable after conservative treatment and no revision surgery was performed. The VAS of the patients was 7.1±0.2 before surgery, which decreased to 2.3±0.1 and 2.8±0.4 at 3 and 6 months after surgery (P < 0.05). The Karnofsky score of the patients was 59.2±1.9 before surgery, which increased to 75.0±1.9 and 74.2±3.1 at 3 and 6 months after surgery (P < 0.05). The ECOG of the patients was 2.3±0.2 before surgery, which decreased to 1.7±0.1 and 1.7±0.2 at 3 and 6 months after surgery (P < 0.05).

CONCLUSION

For selected patients with spinal metastases, minimally invasive surgical treatment of spinal metastases (percutaneous pedicle screw internal fixation combined with expandable tubular retractor) can effectively relieve the clinical symptoms and improve the quality of life, with satisfactory clinical outcome.

2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules: the C-TIRADS

Thyroid nodules are very common all over the world, and China is no exception. Ultrasound plays an important role in determining the risk stratification of thyroid nodules, which is critical for clinical management of thyroid nodules. For the past few years, many versions of TIRADS (Thyroid Imaging Reporting and Data System) have been put forward by several institutions with the aim to identify whether nodules require fine-needle biopsy or ultrasound follow-up. However, no version of TIRADS has been widely adopted worldwide till date. In China, as many as ten versions of TIRADS have been used in different hospitals nationwide, causing a lot of confusion. With the support of the Superficial Organ and Vascular Ultrasound Group of the Society of Ultrasound in Medicine of the Chinese Medical Association, the Chinese-TIRADS that is in line with China's national conditions and medical status was established based on literature review, expert consensus, and multicenter data provided by the Chinese Artificial Intelligence Alliance for Thyroid and Breast Ultrasound.

Experimental Demonstration of Hadron Beam Cooling Using Radio-Frequency Accelerated Electron Bunches

Cooling of beams of gold ions using electron bunches accelerated with radio-frequency systems was recently experimentally demonstrated in the Relativistic Heavy Ion Collider at Brookhaven National Laboratory. Such an approach is new and opens the possibility of using this technique at higher energies than possible with electrostatic acceleration of electron beams. The challenges of this approach include generation of electron beams suitable for cooling, delivery of electron bunches of the required quality to the cooling sections without degradation of beam angular divergence and energy spread, achieving the required small angles between electron and ion trajectories in the cooling sections, precise velocity matching between the two beams, high-current operation of the electron accelerator, as well as several physics effects related to bunched-beam cooling. Here we report on the first demonstration of cooling hadron beams using this new approach.

[Clinical characteristics and prognosis of cultured negative pyogenic spondylitis]

OBJECTIVE

There are limited data describing the clinical characteristics and prognosis of culture negative pyogenic spondylitis. The aim of this study was to investigate the treatment, prognosis and clinical characteristics of culture negative pyogenic spondylitis.

METHODS

A retrospective study reviewed 74 patients who were diagnosed with spondylitis in Peking University First Hospital from January 2010 to December 2015. A total of 27 patients suffered from pyogenic spondylitis. According to the pathogenic culture results, the patients were divided into two groups: culture negative group and culture positive group. The clinical characteristics and treatment outcomes between the two groups were compared.

RESULTS

The elder were more vulnerable to pyogenic spondylitis, and of the 27 patients, 12 patients were female and 15 male. All patients had no history of administration of antibiotics prior to obtaining culture samples. A causative germ was identified in 14/27 patients (51.9%) with Staphylococcus aureus being the most common pathogen. There was no significant difference between the two groups in the patient's age, gender, visual analogue score (VAS), predisposing factor, clinical symptom, sign and spinal segment (P>0.05). Erythrocyte sedimentation rate (ESR) (P=0.056) and C-reactive protein (CRP) (P=0.040) of culture negative group were lower in contrast to culture positive group. The incidence of vertebral abscess in culture negative group was higher than in culture positive group (P=0.046). After treatment, ESR dropped almost equally in both groups, and CRP dropped faster in the culture positive group (P=0.192). At last, there was no significant difference between the two groups in hospital stay, pain relief, open debridement operation rate, and recurrence rate of infection.

CONCLUSION

ESR and CRP of the culture negative patient were lower than those of the culture positive patient, and the incidence rate of paravertebral abscess was higher than that of the culture positive patient. After administration of antibiotics, there was no significant difference between the two groups in duration of antibiotics, open debridement operation rate and recurrence rate of infection. So, culture negative may not necessarily be a negative prognostic factor for pyogenic spondylitis. However, we should watch out for the drug resistant bacteria or double infection, due to the long term use of wide-spectrum antibiotic in culture negative patients.

[Separation and identification of thellungianin G from the root of Pimpinella thellungiana Wolff]

OBJECTIVE

To study the effective components in the root of Pimpinella thellungiana

METHOD

Column chromatography with silica gel and ODS was employed for the isolation and purification of ingredients. Their structures were elucidated by spectral analysis.

RESULT

Three compounds were obtained and identified as 2-(1',2'-epoxy)-4-methoxy pheryl-2-methyl-butyrate(I),4-(1'-propenyl) phenol(II) and 2-methyl butyric acid(III).

CONCLUSION

Compound I is a new compound and named thellungianin G. Compounds II and III were separated from P. Thellungiana for the first time.

[Chemical constituents of the root of Pimpinella thellungiana Wolff]

OBJECTIVE

To search for new effective hypotensive components from the Chinese folk drug, the root of Pimpinella thellungiana.

METHOD

A new compound was isolated from etheral extract of the drug by chromatographic method and identified by physical, chemical and spectroscopic methods.

RESULT

The compound has been identified as 2-(1',2'-dihydroxy)propyl-4-methoxy phenol.

CONCLUSION

The compound was obtained from the root of P. thellungiana for the first time.

[Studies on the chemical constituents of the root of Pimpinella thellungiana]

Four compounds were isolated from the roots of Pimpinella thellungiana Wolff., their structures were identified as palmitic acid(I), 4-propenylphenol(II), pinoresinol(III), 2-methyl-2-hydroxy-5-methoxy berzo(d) hydrofuran-3-one(IV) by physicochemical constants and spectral analysis (UV, IR, MS, 1HNMR, 13CNMR, 13C-1HCOSY, DEPT), IV of them is a new compound, Pharmacological tests showed IV has a hypotensive effect.

[An immunohistochemical and ultrastructural study of 20 chordomas]

Altogether 20 chordomas were reported. The site distribution included 9 cases at the sacrococcygeal region, another 9 cases at the spheno-occipital region, 1 at the cervical vertebra, and another 1 at the lumbar vertebra. Histologic examination revealed that characteristic "physaliphorous cells" were easily identified in all the 19 cases. Tissue for immunohistochemistry study was available in 18 cases. Among them, tumor cells were found strongly positive to EMA, but negative for CEA. 16/18 cases also showed positive for keratin and S-100 protein. Totally, 2 cases were studied ultrastructurally and there were abundant RER and microfilaments seen in the cytoplasm of the tumor cells but only few surface microvilli detected. The epithelial nature of chordoma is strongly supported by the ultrastructural and immunohistochemical findings of these 20 cases.

[Extraskeletal myxoid chondrosarcoma: a clinicopathological study of six cases]

The clinicopathologic, ultrastructural, and immunohistochemical features of six cases of extraskeletal myxoid chondrosarcoma are described. Light microscopic examination disclosed a lobulated neoplasm consisting of cells that tended to be round or polygonal with plenty of eosinophilic cytoplasm. The tumor cells were arranged in strands and small nests surrounded by abundant myxoid extracellular matrix. Ultrastructurally, these tumor cells displayed the signs of chondroblastic differentiation. The cytoplasm contained numerous rough endoplasmic reticulum, mitochondria and scattered glycogen granules. The intercellular matrix showed amorphous material and electronic dense and fine granules. The tumor cells in all these six cases showed diffuse immunostaining for S-100 protein but were negative for keratin. The data obtained tend to support the chondroblastic origin of this tumor.

[Clear cell sarcoma: a clinicopathological study of 11 cases]

The clinicopathologic, ultrastructural and immunohistochemical features of eleven cases of clear cell sarcoma are described. There were 6 males and 5 females with an average age of thirty-six (10-59 years). Tumors were found arising from the tendons, aponeuroses and fascial structures with a predilection for the lower and upper extremities. Follow-up data was available in 8 patients. Five of them are alive. Nevertheless, 3 of the five showed evidence of recurrence or metastasis. The other 3 patients died of tumor with metastasis. Microscopically, the tumors were composed of short fascicles of fusiform cells with a clear to eosinophilic cytoplasm and vesicular nuclei with prominent nucleoli. Melanin was demonstrated in 5 cases and S-100 was known present focally in all cases, but no positive keratin staining was obtained. Electron microscopic studies revealed cell attachments and mature melanosomes. The exact histogenesis remains obscure, but our ultrastructural and immunohistochemical findings support the idea of neural crest origin of this tumor.

[Clinicopathologic and immunohistochemical study on 8 cases of malignant mixed müllerian tumor]

The clinico-pathological features of eight cases of malignant mixed müllerian tumor, a rare neoplasm composed of an admixture of epithelial and stromal elements, are reported. Four of the tumors located in the endometrium, three in the cervix and one in the ovary. Microscopically, the epithelial elements ranged from poorly to well differentiated adenocarcinoma. Homologous stromal sarcoma cells were present in six tumors and heterologous elements were also seen in the other two tumors. Immunohistochemical studies showed diffuse cytoplasmic staining of keratin in the epithelial elements of all the eight cases. Sarcomatous cells were positive focally for keratin in four spindle cell sarcoma cases. Desmin immunoreaction was moderately positive in the sarcomatous element of four neoplasms. Follow-up result was available in 7 patients of whom 3 survived and 4 died from recurrence or metastasis. Immunohistochemical findings support the stem cell origin of this tumor.