Experimental Study of Multi-slice Spiral CT Perfusion Imaging in VX_ 2 Soft-tissue Tumor of Rabbits

An experimental animal model of malignant soft-tissue tumor was established to investigate the applied value of multi-slice spiral CT perfusion imaging preliminarily. Ten New Zealand white rabbits which were implanted with VX2 tumor in either proximal thigh were subjected to CT plain scan and perfusion scan two weeks later respectively, then the original perfusion images were transmitted to AW4.0 Workstation. The functional maps and perfusion parameters including blood flow （BF）, blood volume （BV）, mean transit time （MTT） and permeability surface （PS） were computed and analyzed. All the values of BF, BV and PS in VX2 soft-tissue tumors were obviously higher while the MTT-values were lower than those in the normal muscular tissues significantly. It was suggested that multi-slice spiral CT perfusion imaging is an accurate, convenient and relatively safe functional imaging technique, and can give a quantitative assessment to angiogenesis and blood perfusion of soft-tissue tumors.

Magnetic resonance imaging of soft-tissue tumors of the extremities: A practical approach

Diagnosis of extremity soft-tissue tumors can be challenging.Characteristics of tumor margins can help precisely identify locally aggressive or non-aggressive behavior for surgical planning,but cannot differentiate benign from malignant lesions.Most malignant tumors can have inhomogeneous signals on T2-weighted images.Although a uniform signal on T2-weighted images can be a reliable indication of a benign lesion,a well-defined mass with homogeneous internal signal intensity does not definitively identify a benign lesion.Some common and distinctive soft-tissue lesions can have specific clinical and imaging features allowing a diagnosis without biopsy.These are known as determinate lesions.This illustrative report presents a diagnostic guide for extremity soft-tissue tumors based on tissue signal and morphological characteristics on magnetic resonance images.It is important for clinicians to be familiar with the imaging characteristics of common determinate lesions.

Multimodality Treatment in Adult Patients with High-risk Soft-tissue Sarcomas

Objective： We enrolled retrospective data to determine the efficacy of combined chemotherapy and surgery for local tumour control and survival in patients with high-risk soft-tissue sarcomas. Methods： We collected data from 25 patients with high-risk soft-tissue sarcomas treated with four cycles of etoposide, ifosfamide and doxorubicin （EIA） followed by definitive surgery with or without postoperative radiotherapy and adjuvant chemotherapy. 21 patients received chemotherapy in a neoadjuvant/adjuvant clinical setting; eighteen of them completed adjuvant chemotherapy. Four patients received chemotherapy in an adjuvant setting only. Results： The objective response rate of neoadjuvant chemotherapy assessable in 21 patients was 43%. Including NED （n=7） and partial remissions （n=3）, the radiographic response rate was 47.6% with additional 42.9% stable diseases （n=9）. Surgery was performed in two patients before completing four neoadjuvant chemotherapy cycles because of disease progression. Median overall survival for all patients was 21.6＋ months. After completion of chemotherapy, in 62% of patients R0-resection could be performed. Conclusion： High proportion of R0-resections supports the idea of tumour down-staging after neoadjuvant treatment. Response to neoadjuvant chemotherapy is predictive for improved local tumour control resulting in long-term survival benefit.

Anterior glenohumeral instability:Current review with technical pearls and pitfalls of arthroscopic soft-tissue stabilization

The glenohumeral joint(GHJ)allows for a wide range of motion,but is also particularly vulnerable to episodes of instability.Anterior GHJ instability is especially frequent among young,athletic populations during contact sporting events.Many first time dislocators can be managed non-operatively with a period of immobilization and rehabilitation,however certain patient populations are at higher risk for recurrent instability and may require surgical intervention for adequate stabilization.Determination of the optimal treatment strategy should be made on a case-by-case basis while weighing both patient specific factors and injury patterns(i.e.,bone loss).The purpose of this review is to describe the relevant anatomical stabilizers of the GHJ,risk factors for recurrent instability including bony lesions,indications for arthroscopic vs open surgical management,clinical history and physical examination techniques,imaging modalities,and pearls/pitfalls of arthroscopic soft-tissue stabilization for anterior glenohumeral instability.

Contrast investigation of multi-slice spiral CT perfusion imaging and pathological findings in VX2 soft-tissue tumor of rabbits

Objective: To perform a contrast investigation of multi-slice spiral CT (MSCT) perfusion imaging and pathological findings in VX2 soft-tissue tumor of rabbits, and discuss the applicative value of multi-slice spiral CT perfusion imaging in soft-tissue tumors. Methods: 8 Newzealand white rabbits were implanted with 0.1 ml VX2 tumor tissue suspension in bilateral proximal thighs. 14 days and 21 days later, CT plain scan and perfusion scan were performed on these rabbits respectively, then the images were transmitted to AW4.0 workstation, the functional maps and perfusion parameters including blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface (PS) were computed and analyzed. Subsequently, the rabbits were sacrificed, the tumors of which were taken out for pathological examination. The correlation between MSCT functional parametric images and pathological findings was analyzed. Results: All the values of BF, BV and PS of VX2 soft-tissue tumors were obviously higher while the MTT-values were lower than those of the normal muscular tissues significantly (P<0.001). Conclusion: Multi-slice spiral CT perfusion imaging is an accurate, convenient and relatively safe functional imaging technique, which can give a quantitative assessment to blood perfusion and angiogenesis of soft-tissue tumors.

The Importance of the Multidisciplinary Approach to Surgical Treatment of Extremity Soft-Tissue Sarcomas

Soft tissue sarcomas (STS) are rare neoplasm with frequencies around 1% of all neoplasms. Although it consists of a high heterogeneous group of tumors, surgery is the mean treatment. The STS surgery is still challenging and complex procedure is usually required: this is because STS requires different types of resection and reconstruction due to various tissue-commitments (nerve, arteries, skin and muscle). So, a multidisciplinary team must be prepared for STS approach to obtain the maximum local control and a limited extremity functional impairment. We, here, showing our experience, wish to introduce some technical contrivances in STS surgery, with special reference to tissue reconstruction. This may illustrate the necessity of a multidisciplinary team approach in this surgery.

软组织恶性纤维组织细胞瘤的MRI特征与病理分析

目的探讨软组织内恶性纤维组织细胞瘤的MRI表现及病理特征,以提高影像诊断水平。方法回顾性分析经手术病理证实的12例软组织内恶性纤维组织细胞瘤患者的MRI影像及病理资料。结果 12例肿瘤形态多变,以梭形、类圆形及分叶状多见。12例中8例T1WI呈稍低信号或等信号,4例呈混杂信号;T2WI均呈混杂高信号,7例肿瘤内可见低信号分隔影,5例肿瘤可见假包膜,6例肿瘤边界不清,可见瘤周水肿。MRI增强后肿瘤呈明显不均匀强化。病理上肿瘤组织成分复杂,主要由纤维母细胞和组织细胞组成,质软,境界较清,可有假包膜。9例可见坏死或黏液样变,4例伴出血。结论恶性纤维组织细胞瘤的MRI表现与病理特征密切相关。该肿瘤的组织学成分复杂,因此MRI信号多变,其中MRI在病灶定位、出血及坏死囊变方面更具优势,对软组织恶性纤维组织细胞瘤的诊断具有重要价值。

蚯蚓提取物抗肿瘤作用的实验研究

目的:探讨蚯蚓提取物对Eca-109细胞生长抑制作用及机制。方法:应用四甲基偶氮唑盐(MTT)比色分析,流式细胞仪测定细胞凋亡,细胞周期及检测小鼠体内肿瘤质量。结果:蚯蚓提取物成分Ⅰ、Ⅱ、Ⅲ中,只有大、中剂量(900,450 mg.L-1)成分Ⅱ对Eca-109细胞有明显的抑制作用,300,600 mg.L-1灌胃对小鼠肿瘤有明显的抑制作用。细胞检测有凋亡细胞出现,细胞被阻滞在G0-G1期,DNA合成受阻故使肿瘤细胞受抑制,肿瘤体积缩小。结论:蚯蚓提取物成分Ⅱ对肿瘤细胞增殖有明显的抑制作用,主要通过细胞凋亡和肿瘤细胞受阻于G0-G1期,使DNA合成减少。

舌鳞状细胞癌P16蛋白表达的临床意义

目的 了解P16蛋白与舌鳞状细胞癌的发生发展、生物学行为和预后之间的关系。 方法 对67例舌鳞癌标本 ,58例癌旁组织标本用免疫组化法进行P16蛋白的检测。 结果 在细胞分化程度、临床分期、预后和癌与癌旁组织P16的阳性和阴性率有显著差异 ,在颈淋巴结转移上无显著性差异。 结论 P16蛋白的表达与舌鳞癌的发生发展有关 ,并能为预后提供更多的信息。

参芪抑瘤方联合顺铂对MFC荷瘤小鼠瘤组织 XIAP、PTEN表达的影响

目的:研究参芪抑瘤方联合顺铂对MFC荷瘤小鼠瘤组织连锁凋亡抑制蛋(XIAP)及磷酸酶和张力蛋白同源缺失性基因(PTEN)表达的影响。方法:建立MFC荷瘤小鼠模型进行体内抗肿瘤试验,将50只荷瘤小鼠随机分为模型组、顺铂组、参芪抑瘤方低剂量组(中药低组)、参芪抑瘤方高剂量组(中药高组)、参芪抑瘤方低剂量联合顺铂组(联合低组)、参芪抑瘤方高剂量联合顺铂组(联合高组),连续灌胃给药15 d,观察肿瘤生长情况以及小鼠一般情况,15 d后处死小鼠,剥取瘤组织称重,计算抑瘤率;实时荧光定量PCR技术(qRT-PCR)和免疫组织化学技术(IHC)分别检测肿瘤组织中XIAP、PTEN mRNA和蛋白的表达情况。结果:不同剂量组抑瘤率依次为顺铂组55.25%,参芪抑瘤方低、高剂量组分别为27.7%和30.58%,芪抑瘤方低、高剂参量联合顺铂组分别为66.3%和67.78%。联合用药组优于单纯用药组,差异具有统计学意义(P<0.01)。与模型组相比,顺铂组、中药组、联合组中XIAP mRNA及蛋白的表达均降低,PTEN mRNA及蛋白的表达升高,差异有统计学意义(P<0.01)。与顺铂组、中药低组和中药高组相比,联合低组和联合高组中XIAP mRNA及蛋白的表达均降低,PTEN mRNA及蛋白的表达升高,差异有统计学意义(P<0.01)。结论:参芪抑瘤方具有一定的抗MFC胃癌移植瘤作用,并与顺铂联用具有减毒增效作用。其作用可能是通过下调瘤组织中XIAP的表达,上调PTEN的表达有关。

牛蒡根提取物不同组分体外肿瘤细胞毒作用

采用硅胶柱层析法对有抗肿瘤活性的牛蒡根石油醚和氯仿提取物进一步提取分离,得到S-1、S-2、S-3和L-1、L-2、L-3、L-4等7个洗脱组分,MTT法比色法对这些洗脱组分进行体外抗肿瘤活性的测定。实验结果表明L1、L2对MCF-7、Hep A和S180细胞,表现出较好的细胞毒活性,在测定浓度范围内呈现出良好剂量依赖性。其IC50分别为:131.31、8.56、9.33和147.01、17.42、23.55 g/mL。

Analgesic Effect of Sinew Acupuncture for Patients with Soft-Tissue Injuries: A Pilot Trial

Objective: To investigate the immediate analgesic effect of sinew acupuncture for patients with soft-tissue injuries (STIs). Methods: Two hundreds eligible adult patients suffering from STIs were recruited and received sinew acupuncture with flexible treatment schedules. The number of treatment sessions was pragmatically decided by each patient on the basis of their pain relief. The outcome measurement was the change of pain rating in the Visual Analogue Scale (VAS) during the first 5 sessions. The adverse effect was also observed. Results: Of the 200 patients recruited, 7 were excluded due to incomplete data. In total, 888 sinew acupuncture treatments were administered to patients at 14 injury sites (including head, neck, shoulder, arm, chest, elbow, wrist, hand, waist and hip, knee, thigh, calf, ankle, and foot) where pain was felt. Compared with the baseline, the VAS rating after the first and last treatments were both significantly reduced at all the injury sites (P<0.01). The VAS rating was also significantly reduced after each session of treatment in the first five sessions (P<0.01). No serious adverse effect was observed. Conclusion: Sinew acupuncture had not only an immediate analgesic effect for STIs, but also an accumulated analgesic effect during the first 5 treatment sessions.

First line anlotinib plus liposomal doxorubicin for locally advanced or metastatic soft tissue sarcoma:A prospective,single-arm trial

Objective:To examine the efficacy and safety of anlotinib as first-line therapy to treat locally advanced or metastatic soft-tissue sarcoma.Methods:This is a single-arm trial.Treatment-naïve patients(≥14 years)with locally advanced or metastatic soft tissue sarcoma were eligible.Each treatment cycle lasted for 3 weeks,and included liposomal doxorubicin(40-50 mg/m^(2))on day 1 and anlotinib(12 mg)on days 8-21.Starting from the 9th cycle,treatment consisted of only anlotinib.Treatment continued until disease progression or intolerable toxicities.The primary efficacy end point was progression-free survival(PFS).Results:Eight patients were enrolled between July 25,2019 and January 8,2020.The median number of treatment cycles was 5.5.Within 5.9 months median follow-up,PFS events occurred in 4(4/8,50%)patients.The median PFS was 11.3 months and the 6-month PFS rate was 56%.No patients attained complete response and 2 patients(fibrosarcoma,1 patient and undifferentiated pleomorphic sarcoma,1 patient)achieved partial response.Three patients(fibrosarcoma,2 patients and synovial sarcoma,1 patient)had stable disease.The objective response rate was 25%(2/8)for the study population,and the disease control rate was 75%(6/8).No new safety concerns emerged.Conclusions:Anlotinib plus liposomal doxorubicin demonstrated antitumor activities in previously untreated locally advanced or metastatic soft tissue sarcomas.Due to the small sample size,further investigations with a larger population should be undertaken to confirm the study findings.

Clinicopathological and Immunohistochemical Study of Low-Grade Myofibroblastic Sarcoma of the Liver One Case Report

Low-grade myofibroblastic sarcoma is a recently characterized tumor showing features of myofibroblastic differen-tiation that is part of the spectrum of malignant mesenchymal tumors. This extremely rare type of tumor occurs most commonly in superficial locations. The case we describe herein is that of a 60- year-old man with two large hepatic masses. The patient＇s tumor was removed radically through an incision due to the inconclusive imaging findings. Follow-up computed tomography showed no recurrence and metastasis after 37 months, suggesting that enucleation was adequate for tumor eradication. To our knowl-edge, this is the first reported case of low-grade myofibroblastic sarcoma in the liver in the English language literature.

Metastatic melanoma misdiagnosed as lipoma manifesting as a subcutaneous soft-tissue mass

To the Editor:Metastatic melanoma is a fatal disease with rapid systemic dissemination and a 5-year survival rate of about 1 7%.[1] More than half of primary metastases involve the skin as nodal,subcutaneous,or distant metastasis.[2] Cutaneous metastases of melanoma occur relatively frequently and can arise in early-or late-stage disease,with a variable clinical appearance and pattern distribution.[3] We describe herein a patient with a large subcutaneous nodule on the arm that we initially diagnosed as a lipoma.After obtaining further clinical history and reviewing the pathologic findings after excision,the nodule was determined to represent metastatic melanoma.

A Polydisperse Sphere Model Describing the Propagation of Light in Biological Tissue

A polydisperse sphere model with the complex refractive index is employed to describe the propagation of light in biological tissue. The scattering coefficient, absorption coefficient and scattering phase function are calculated. At the same time, the inverse problem on retrieving the particles size distribution, imaginary part of the refractive index and number density of scatterers is investigated. The result shows that the retrieval scheme together with the Chahine algorithm is effective in dealing with such an inverse problem. It is also clarified that a group of parameters including the scattering coefficient, absorption coefficient and phase function are associated with another group including the refractive index, particle size distribution and number density of scatterers, which is a problem described in two different ways and the anisotropy factor is not an independent variable, but is determined by the phase function.

Total knee arthroplasty in Ranawat Ⅱ valgus deformity with enlarged femoral valgus cut angle:A new technique to achieve balanced gap

BACKGROUND Nearly 10%of patients undergoing primary total knee arthroplasty(TKA)have valgus deformity(VD)of the knee.For severe VD of the knee,a more lateral structural release is needed to achieve balance between medial and lateral space and neutral femorotibial mechanical axis(FTMA),which is challenging and technical.AIM To introduce a new surgical technique of resection,soft tissue release,and FTMA for Ranawat type-Ⅱ VD with a 5-year follow-up.METHODS A retrospective study was conducted on patients who underwent TKA from December 2011 to December 2014.Hip-knee-ankle(HKA),range of motion(ROM),Oxford knee score(OKS),and knee society score(KSS)were used to assess the joint activity of patients in the new theory TKA group(NT-TKA)and were compared with those of the conventional TKA group(C-TKA).RESULTS A total of 103 people(103 knees)were included in this study,including 42 patients with an average follow-up period of 83 mo in the C-TKA group and 61 patients with an average follow-up period of 76 mo in the NT-TKA group.Six patients had constrained prosthesis,one had common peroneal nerve injury,and two had joint instability in the C-TKA group,but none of these occurred in the NT-TKA group.There were significant statistical differences in constrained prosthesis usage and complications between the groups(P=0.002 and P=0.034,respectively).The KSS at 1 mo post-operation for the C-TKA and NT-TKA groups were 11.2±3.8 and 13.3±2.9,respectively,with a significant difference(P=0.007).However,the data of HKA,ROM,OKS KSS,and prosthesis survival rate were insignificant(P>0.05)in both the preoperative and follow-up periods.CONCLUSION Adopting 5°-7°valgus cut angle for VD and sacrificing 2°neutral FTMA for severe VD which cannot be completely corrected during TKA can reduce the need for soft tissue release,maintain early joint stability,reduce the use of constrained prostheses,and minimize postoperative complications.

Soft-tissue management and reconstruction of lower-extremity trauma

Soft-tissue management and subsequent salvage of the lower extremity following trauma has long presented difficult challenges to the plastic surgeon.Trauma to the lower extremity can produce long-term sequelae consisting of psychological trauma,functional deficits,and increased costs to the healthcare system.Avoiding incorrect management is important,and is compounded by the fact that few guidelines exist on appropriate treatment and patient counseling.This study aims to describe the authors’experience at a large limb salvage center in order to further delineate management strategies.

An Extensively Drug Resistant Acinetobacter baumannii from Soft Tissue Isolated in a Hospital in Senegal

Emerging and rapidly spreading multidrug resistant bacteria constitute a rising public health concern worldwide. Acinetobacter baumannii is one of these bacteria that cause different infections including pneumonia, bacteremia, meningitis, soft-tissue, and urinary tract infections, and are associated with high mortality and economic burden. We present a case of a 43-year-old woman, admitted at the department of orthopedics, regional hospital of Ourossogui, North-East of Senegal for soft-tissue injuries. Initially diagnosed with Yersinia pestis infection, the patient was well managed before being released. Supplementary sampling for confirmatory tests allowed the detection of an extensively drug-resistant Acinetobacter baumannii clone.

Development and accuracy of artificial intelligence-generated prediction of facial changes in orthodontic treatment:a scoping review

Artificial intelligence(AI)has been utilized in soft-tissue analysis and prediction in orthodontic treatment planning,although its reliability has not been systematically assessed.This scoping review was conducted to outline the development of AI in terms of predicting soft-tissue changes after orthodontic treatment,as well as to comprehensively evaluate its prediction accuracy.Six electronic databases(PubMed,EBSCOhost,Web of Science,Embase,Cochrane Library,and Scopus)were searched up to March 14,2023.Clinical studies investigating the performance of AI-based systems in predicting post-orthodontic soft-tissue alterations were included.The Quality Assessment of Diagnostic Accuracy Studies-2(QUADAS-2)and Joanna Briggs Institute(JBI)appraisal checklist for diagnostic test accuracy studies were applied to assess risk of bias,while the Grading of Recommendation,Assessment,Development,and Evaluation(GRADE)assessment was conducted to evaluate the certainty of outcomes.After screening 2500 studies,four non-randomized clinical trials were finally included for full-text evaluation.We found a low level of evidence indicating an estimated high overall accuracy of AI-generated prediction,whereas the lower lip and chin seemed to be the least predictable regions.Furthermore,the facial morphology simulated by AI via the fusion of multimodality images was considered to be reasonably true.Since all of the included studies that were not randomized clinical trials(non-RCTs)showed a moderate to high risk of bias,more well-designed clinical trials with sufficient sample size are needed in future work.