13例髓内高分化骨肉瘤的临床、影像及病理学观察

背景与目的:髓内高分化骨肉瘤发病率低,临床影像及病理检查均易误诊,而因误诊导致的不当治疗对患者预后影响极大。本文旨在探讨髓内高分化骨肉瘤的临床、影像及病理学特点,随访观察其临床规律。方法:收集2000年1月—2012年6月在河北医科大学第三医院就诊并最终经组织学诊断为髓内高分化骨肉瘤的11例病例,另外2例为26年前确诊的病例。回顾性分析该组13例髓内高分化骨肉瘤的临床、影像及病理学资料,并随访患者的预后。随访时间2例为26年,11例为6～101个月,平均37.5个月。结果:13例中男性10例,女性3例。初诊年龄19～52岁,平均32岁。12例病变位于长骨,1例位于髋臼Ⅱ区。除2例病变相对局限,其他病变范围广泛,长骨病变全部涉及干骺端区,可向骨干或骨端延伸。其影像表现虽有一些规律,但缺乏特征性,总体发展缓慢,部分有恶性的征象。该组病变多边界不清,全部有骨皮质破坏、中断,粗大骨嵴常见,骨膜反应和软组织肿块较少见。组织学主要为梭形细胞成分,仅有轻度异型。随访发现,采用截肢及段切治疗者均无复发及转移;采用病灶搔刮治疗者4例,随访过程中3例死亡,其中2例死于肿瘤复发、转移。结论:髓内高分化骨肉瘤好发于长骨干骺端,以股骨远端最为多见。影像表现缺乏特征性。组织学诊断要密切结合临床及影像。病变切除完全者预后良好,病灶刮除或切除不彻底将导致反复复发,并促其转化为高度恶性肿瘤。

DNACDS:Cloud IoE big data security and accessing scheme based on DNA cryptography

The Internet of Everything(IoE)based cloud computing is one of the most prominent areas in the digital big data world.This approach allows efficient infrastructure to store and access big real-time data and smart IoE services from the cloud.The IoE-based cloud computing services are located at remote locations without the control of the data owner.The data owners mostly depend on the untrusted Cloud Service Provider(CSP)and do not know the implemented security capabilities.The lack of knowledge about security capabilities and control over data raises several security issues.Deoxyribonucleic Acid(DNA)computing is a biological concept that can improve the security of IoE big data.The IoE big data security scheme consists of the Station-to-Station Key Agreement Protocol(StS KAP)and Feistel cipher algorithms.This paper proposed a DNA-based cryptographic scheme and access control model(DNACDS)to solve IoE big data security and access issues.The experimental results illustrated that DNACDS performs better than other DNA-based security schemes.The theoretical security analysis of the DNACDS shows better resistance capabilities.

Management and outcome of pancreatic trauma:a 6-year experience at a level I trauma center

Background: Pancreatic trauma (PT) accounts for less than 1% of all trauma admissions. Occasionally, PT is undetected during theprimary survey and becomes apparent only when complications arise. It occurs in up to 5% of blunt abdominal trauma cases and 12%of individuals with penetrating abdominal injuries. Management is determined by the status of the main pancreatic duct and associatedinjuries.Methods: This was an ambispective study conducted at the Jai Prakash Narayan Apex Trauma Center, All India Institute ofMedical Sciences,New Delhi, from January 2015 to December 2017 (retrospective), and January 2019 to December 2020 (prospective). In total, 113patients with PT were included in this study.Results:We analyzed the data of 113 patients with PT included in this study, of whichmales predominated (93.7%). Blunt PT was presentin 101 patients (89.4%) and penetrating PT in 12 patients (10.6%). Half of the patients (51.3%) had the American Association for theSurgery of Trauma grade III PT, followed by grade II (18.6%), and grade I (15%). Of the total 113 patients, 68 (60.2%) were treated withoperative management, and 45 (39.8%) with nonoperative management. Distal pancreatectomy, with or without splenectomy, was themost common procedure performed in our study, followed by drainage. There were 27 mortalities (23.8%) during the study period, ofwhich 7 were directly related to PT and 20 were due to other organ-related sepsis and hemorrhagic shock.Conclusion: Pancreatic trauma is rare but challenging for trauma surgeons, with persistent management controversies. Early diagnosisis important for favorable results;however, a delay in diagnosis has been associated with higher morbidity and mortality. Low-grade pancreaticinjuries can be successfully managed nonoperatively, whereas high-grade pancreatic injuries require surgical intervention.

高龄患者锁骨下静脉位置的解剖学差异

目的观察不同年龄右锁骨下静脉在X线下解剖学位置的变化,为临床提供参考。方法随机测量220例经右肘静脉穿刺中心静脉置管(peripherally inserted central catheter,PICC)的患者,按年龄不同分为:A组(<65岁);B组(≥65岁),每组110例。在仰卧位X线胸片下测量PICC管顶端纵向与横向在第一肋圈中的位置分布情况。结果 A组68例(62%)PICC管顶点通过第一肋圈中1/3;B组70例(64%)通过第一肋圈下1/3,两组间差异有统计学意义(P<0.01)。A、B组PICC管顶点距第一肋弓距离差异无统计学意义。结论 65岁以上高龄患者右锁骨下静脉的顶点位置较成年患者偏下,可为临床高龄患者锁骨下静脉穿刺提供参考。

Varied presentations, magnitude, and outcome of traumatic neck injuries at a level I trauma center

Introduction:Traumatic neck injuries(TNIs)constitute 5%–10%of all trauma cases.These injuries can be caused by either penetrating or blunt trauma.Patients can have a varied presentation like cut injury over the neck,bleeding,neck swelling,breathing difficulty,dysphagia,etc.Methods:This was a retrospective observational study conducted at a level I trauma center in India from January 2016 to March 2020.One hundred thirty patients who required admission and intervention due to TNIs were included in this study.Results:One hundred thirty patients with neck injuries were included in this study.Males were predominant(91.5%)with the age ranging from 10 to 70years.The most common mechanism of injury was physical assault(40.7%),followed by road traffic injury(23.8%)and self-inflicted injuries(18.4%).Penetrating trauma was predominant.Open neck wound with bleeding was the most common presenting symptom.Zone II injuries were more common(83.8%)followed by zone I(12.3%)and zone III(3.8%).Soft tissue injury including skin,platysma breach,and strap muscle injury was present in 46.9% of patients.Laryngopharyngeal injury was present in 13.8%,tracheal injury in 28.5%,vascular injury in 13.8%,and esophageal injury in 4.6% of patients.Conclusion:Penetrating neck trauma is more common than blunt in developing countries like India.Advanced Trauma Life Support(ATLS)protocol guides the initial management.The definitive management depends on the type and mechanism of injury,anatomical level,severity,and the organ injured.