Palliative radiotherapy for bone metastases from lung cancer: Evidence-based medicine?

To review current recommendations for palliative radiotherapy for bone metastases secondary to lung cancer, and to analyze surveys to examine whether global practice is evidence-based, English language publications related to best practice palliative external beam radiotherapy(EBRT) for bone metastases(BM) from lung cancer were sought via literature search(2003-2013). Additional clinical practice guidelines and consensus documents were obtained from the online Standards and Guidelines Evidence Directory. Eligible survey studies contained hypothetical case scenarios which required participants to declare whether or not they would administer palliative EBRT and if so, to specify what dose fractionation schedule they would use. There is no convincing evidence of differential outcomes based on histology or for spine vs non-spine uncomplicated BM. For uncomplicated BM, 8Gy/1 is widely recommended as current best practice; this schedule would be used by up to 39.6% of respondents to treat a painful spinal lesion. Either 8Gy/1 or 20Gy/5 could be considered standard palliative RT for BM-related neuropathic pain; 0%-13.2% would use the former and 5.8%-52.8% of respondents the latter(range 3Gy/1-45Gy/18). A multifraction schedule is the approach of choice for irradiation of impendingpathologic fracture or spinal cord compression and 54% would use either 20Gy/5 or 30Gy/10. Survey results regarding management of complicated and uncomplicated BM secondary to lung cancer continue to show a large discrepancy between published literature and patterns of practice.

Development and Characterization of Calcium Based Biocomposites Using Waste Material (Calcite Stones) for Biomedical Applications

Calcium-based biocomposite materials have a pivotal role in the biomedical field with their diverse properties and applications in combating challenging medical problems. The study states the development and characterization of Calcium-based biocomposites: Hydroxyapatite (HAP), and PVA-Gelatin-HAP films. For the preparation of Calcium-based biocomposites, an unconventional source, the waste material calcite stone, was used as calcium raw material, and by the process of calcination, calcium oxide was synthesized. From calcium oxide, HAP was prepared by chemical precipitation method, which was later added in different proportions to PVA-Gelatin solution and finally dried to form biocomposite films. Then the different properties of PVA/Gelatin/HAP composite, for instance, chemical, mechanical, thermal, and swelling properties due to the incorporation of various proportions of HAP in PVA-Gelatin solution, were investigated. The characterization of the HAP was conducted by X-ray Diffraction Analysis, and the characterization of HAP-PVA-Gelatin composites was done by Fourier Transform Infrared Spectroscopy, Thermomechanical Analysis, Tensile test, Thermogravimetric Differential Thermal Analysis, and Swelling Test. The produced biocomposite films might have applications in orthopedic implants, drug delivery, bone tissue engineering, and wound healing.

可降解锌基合金在骨缺损修复重建中的应用及研究热点和不足

背景:锌基合金医用植入材料有优异的力学性能、完全可降解性、良好的生物相容性,主要用于骨科植入物、心血管支架、胆管支架、气管支架、神经导管等。目的:综述可降解锌基合金应用于骨缺损修复的研究进展,展望锌基材料可期研究方向与成果。方法:检索PubMed、Web of Science、万方及中国知网数据库,选择各数据库建库至2023年6月收录的各类可降解锌基合金用于骨植入材料研究的相关文献,对生物可降解锌基合金的基本特性进行概述,对锌基合金促进骨组织修复作用进行梳理和归纳总结,讨论当前的研究热点与不足。结果与结论:①锌基合金具备良好的生物相容性,以锌基合金为基体材料,借助支架结构构建技术和涂层优化工艺将有效提高锌基合金的骨传导性,并且使其降解产物具备高效骨诱导性,以调控成骨、破骨细胞的基因表达,促进骨缺损后的修复重建;②然而在锌基合金优化的研究中,涂层工艺相对不足,增材负载技术尚缺乏;③锌基合金拥有良好的机械、生物特性,通过特殊工艺可增加材料的骨传导性、骨诱导性以有效提高其促进骨修复重建能力,并有望进一步实现个性化移植材料的研发。优化涂层与增材负载等技术融合于锌基合金的研究有待进一步探讨。

Incidence and mortality of primary bone cancers in China, 2014

Objective: In this study, we aimed to estimate the updated incidence and mortality of primary bone cancers based on population-based cancer registration data in 2014, collected by the National Central Cancer Registry of China(NCCRC).Methods: In 2017, 339 registries' data were qualified based on data quality criteria set down by the NCCRC.Cases of primary bone cancers were retrieved from the national database. We estimated numbers of primary bone cancer cases and deaths in China using age-specific rates and corresponding national population stratified by area,sex, age-group(0, 1-4, 5-9, 10-14, …, 85+). Chinese standard population in 2000 and Segi's World population were applied for the calculation of age-standardized incidence and mortality rates.Results: In 2014, 24,000 primary bone cancer cases and 17,200 deaths attributable to primary bone cancers were estimated to have occurred in China. The crude incidence rate of primary bone cancers was 1.76/100,000, with agestandardized incidence rate by Chinese standard population(ASIRC) and by World standard population(ASIRW)being 1.35/100,000 and 1.32/100,000, respectively. The crude mortality rate of primary bone cancers was1.26/100,000, with age-standardized mortality rate by Chinese standard population(ASMRC) and by World standard population(ASMRW) being 0.88/100,000 and 0.86/100,000, respectively. Age-specific incidence curve was bimodally distributed with age, with the first peak occurring in the second decade of the life and the second peak in the elderly. Males had higher crude and age-standardized rates for both incidence and mortality compared with females. Both crude and age-standardized incidence rates were higher in rural areas than in urban areas, so were the crude and age-standardized mortality rates.Conclusions: This population-based study presents the most recently available estimates on primary bone cancers in China, revealing that the males are 1.34 times as much as females suffering from primary bone cancers and the adolescents in puberty and the elderly are predominantly affected groups by these cancers. High-quality cancer registration data are a prerequisite for undertaking further study for gaining insight into the causes and risk factors for primary bone cancers in China.

In vivo testing of a bone graft containing chitosan, calcium sulfate and osteoblasts in a paste form in a critical size defect model in rats

Bone loss associated with musculoskeletal trauma or metabolic diseases often require bone grafting. The supply of allograft and auto-graft bones is limited. Hence, development of synthetic bone grafting materials is an active area of research. Chitosan, extracted from chitin present in crawfish shells, was tested as a de-livery vehicle for osteoblasts in a 2-3 mm size defect model in rats. Twenty-seven male Lewis rats, divided into three groups with sacrifice intervals of 3, 6 &9 months were used. In the experimental samples, a critical size defect was filled with chitosan bone graft paste and fixed with a plate, while in the operated control group, a critical size defect was repaired only by a plate (no paste was applied). An unoperated control group was also included. Bone growth was evaluated histologically by examining undecal-cified and decalcified stained sections. The fe-murs were also examined non-destructively by micro-computed tomography (礐T). Defects filled with chitosan bone graft paste demon-strated superior healing across all time periods compared to unfilled defects as examined by histology and micro-computed tomography. Crawfish chitosan has successfully been used as a cell delivery system for osteoblasts for use as a synthetic bone graft material.

Synthesis and manufacture of photocrosslinkable poly(caprolactone)-based three-dimensional scaffolds for tissue engineering applications

It is known that the body can efficiently repair hard tissue (bone) micro fractures by suturing the defect through the deposition of minerals resulting in an area that is stronger post-injury. Larger defects, however, generally cause more trouble since the body is incapable of repairing them. Bone defects can occur as a result of congenital abnormalities, trauma, or disease. Traditional methods for addressing these defects have involved the use of acellular cadaverous bone or autologous bone. Both contain innate prob- lems associated with them;the former method can result in disease transmission, as well as very low integration with the host due to the lack of viable cells while the latter is associated with two surgical sites and morbidity at the donor site. Alternative methods have been developed, but no method has yet provided a satisfactory solution. As a result, resear- chers and the medical community are turning toward the promising fields of biomaterial development and tissue engineering to develop new materials and me- thods of bone regeneration. In this work, a design of experiments (DOE) approach was performed to ren- der commercially available biodegradable polymers (Poly(caprolactone)-diol/triol) photocrosslinkable and resultantly manufacturable using stereolithography (SL), a rapid prototyping technology. To perform the investigations, a commercial SL system (Viper HA, 3D Systems, Valencia, CA) equipped with a solid state laser system (355 nm wavelength) was used to manu-facture synthesized poly(caprolactone) trifuma- rate (PCLtF) 3D porous constructs. Results of the work conducted produced constructs which provided pro- mising chemical and biological results for the in- tended application.

Screening and early diagnosis of osteoporosis through X-ray and ultrasound based techniques

Effective prevention and management of osteoporosis would require suitable methods for population screenings and early diagnosis. Current clinicallyavailable diagnostic methods are mainly based on the use of either X-rays or ultrasound(US). All X-ray based methods provide a measure of bone mineral density(BMD), but it has been demonstrated that other structural aspects of the bone are important in determining fracture risk, such as mechanical features and elastic properties, which cannot be assessed using densitometric techniques. Among the most commonly used techniques, dual X-ray absorptiometry(DXA) is considered the current 'gold standard' for osteoporosis diagnosis and fracture risk prediction. Unfortunately, as other X-ray based techniques, DXA has specific limitations(e.g., use of ionizing radiation, large size of the equipment, high costs, limited availability) that hinder its application for population screenings and primary care diagnosis. This has resulted in an increasing interest in developing reliable pre-screening tools for osteoporosis such as quantitative ultrasound(QUS) scanners, which do not involve ionizing radiation exposure and represent a cheaper solution exploiting portable and widely available devices. Furthermore, the usefulness of QUS techniques in fracture risk prediction has been proven and, with the last developments, they are also becoming a more and more reliable approach for assessing bone quality. However, the US assessment of osteoporosis is currently used only as a pre-screening tool, requiring a subsequent diagnosis confirmation by means of a DXA evaluation. Here we illustrate the state of art in the early diagnosis of this 'silent disease' and show up recent advances for its prevention and improved management through early diagnosis.

3D打印技术在住院医师规范化培训骨肿瘤案例式学习法中的应用

目的:分析评价3D打印技术在住院医师规范化培训骨肿瘤案例式学习法(case-based learning,CBL)中的应用效果。方法:纳入我院骨科住培基地学员60名,随机分为试验组(3D打印+CBL组)和对照组(床边带教组),通过考试和问卷调查评价3D打印技术在住培骨肿瘤CBL教学中的应用效果。结果:试验组学员理论知识考核成绩和实践能力考核成绩均高于对照组(P<0.05)。试验组学员在总体满意程度、学习兴趣、教学吸引力、知识掌握程度、临床沟通交流能力和治疗方案理解程度方面的评分均高于对照组(P<0.05)。结论:3D打印技术联合CBL教学以案例为基础,突出骨肿瘤专业学习的重点和难点,提高了住培学员的学习兴趣和临床综合能力,值得在住培工作中推广应用。

骨组织工程镁基支架的制备研究进展

骨组织工程为受损骨、病变骨的治疗提供了重要的途径。如何获得易于骨修复、高强度且具有良好生物相容性的支架,是当前骨组织工程支架应用的技术难点和研究热点之一。支架材料的种类及制备方法是影响骨组织工程结构及性能的主要因素。镁基合金因在生物相容性、降解行为等方面具有突出表现而受到了普遍的关注,被认为是一种前景广阔的骨组织工程支架材料。常见的骨组织工程镁基支架制备方法有熔体发泡法、渗流铸造法、固/气共晶定向凝固法和增材制造法等,然而现有制备方法在孔隙结构精细控制及造孔残留物对镁基支架生物相容性的影响等方面仍需进一步研究。本文综述了骨组织工程镁基支架的制备方法,分析了影响镁基支架孔隙结构和性能的因素,总结了每种制备方法的优缺点,并对未来的研究方向进行了展望。

颅底动脉瘤样骨囊肿1例并文献复习

目的 总结颅底动脉瘤样骨囊肿(ABC)的临床特征并复习颅底特殊部位病变相关手术技巧。方法 回顾性分析兰州大学第二医院2021年12月收治的1例颅底ABC患者的临床资料,并结合相关文献对颅底ABC及相关手术技巧进行复习。结果 行额颞开颅硬膜外入路全切肿瘤,术后病理诊断为ABC。随访期间未见肿瘤复发。结论 ABC位于颅底的发病部位少见,诊断难度较高,首选治疗方案为手术完整切除。

鼻咽癌颅底骨转移瘤SPECT/CT影像特征变化及诊断价值分析

目的分析单光子发射计算机体层成像CT(SPECT/CT)在诊断鼻咽癌(NPC)颅底骨转移瘤中的应用价值。方法选取2019年1月-2021年6月期间于我院拟接受手术治疗的60例NPC患者,全部患者术前均接受SPECT/CT及核磁共振成像(MRI)检查,以随访作为“金标准”,对比分析患者SPECT/CT、MRI检查影像特征以及SPECT/CT、MRI检查对NPC颅底骨转移的诊断结果和诊断效能。结果经SPECT/CT检查评估NPC的准确度、灵敏度、特异度、阳性预测值、阴性预测值分别为81.66%、86.04%、70.58%、88.09%、66.66%,经MRI检查准确度、灵敏度、特异度、阳性预测值、阴性预测值分别为63.33%、67.44%、52.94%、78.37%、39.13%(P<0.05);经SPECT/CT检查评估NPC颅底骨转移的准确度、灵敏度、特异度、阳性预测值、阴性预测值分别为76.66%、73.60%、81.81%、87.50%、64.28%,经MRI检查准确度、灵敏度、特异度、阳性预测值、阴性预测值分别为56.66%、50.00%、68.18%、73.07%、44.11%(P<0.05)。结论SPECT/CT在NPC颅底骨转移瘤中有较高的诊断价值,临床在放射治疗前参照SPECT/CT影像特征,可全面掌握病灶情况,提高诊断的准确率。

可降解镁基金属引导骨再生膜的研究现状与展望

可降解镁基金属引导骨再生(GBR)膜具有良好的机械性能、生物降解性和生物促成骨性能,是治疗颌面部骨缺损的理想植入物。本文对镁基金属引导骨再生膜的现状和未来的研究趋势进行阐述。首先介绍了镁基金属的研究历史及应用领域,随后从镁基金属GBR膜的机械性能、生物相容性和促成骨性能及其机制方面介绍了镁基金属制备GBR膜的应用优势,最后对当前镁基金属GBR膜的局限性及在口腔医学中的应用和展望进行介绍。镁基金属GBR膜在基础和转化研究方面都取得了重要的进展,为治疗口腔颌面部的骨缺损奠定了重要的基础。

案例教学法在儿科住院医师规范化培训骨髓穿刺术教学中的应用

目的 探讨案例教学法(case based learning,CBL)在儿科住院医师规范化培训(简称住培)骨髓穿刺术教学中的应用及教学效果。方法 选取32名儿科住院医师为对照组采用传统教学法进行儿童骨髓穿刺术培训,选取40名儿科住院医师为观察组采用案例教学法培训时采取组队刻意练习方法教学。通过模拟操作考核、上海市住培出站考试操作考核和问卷调查的方法进行教学效果的评价比较。结果 对照组与观察组儿科住院医师骨髓穿刺术模拟考核平均分70.5分比79.0分,通过率为93.75%比97.50%(P> 0.05),差异无统计学意义。对照组与观察组儿科住院医师在上海市住培出站考试操作考核通过率为96.88%比100.00%(P> 0.05),差异无统计学意义。问卷调查结果显示对照组与观察组培训满意度78.10%比82.50%,大多数儿科住院医师认为案例教学法比以往传统的操作培训收获更大。结论 案例教学法能够提高儿科住培骨髓穿刺术的临床操作能力,联结基础知识和临床技能,组队练习能够提高团队合作意识,值得在其他临床操作培训中推广。

3D打印模型结合案例教学法在骨肿瘤临床教学中的应用

目的探索3D打印模型结合案例教学法(CBL)在骨肿瘤临床教学中的应用效果及意义。方法选取2023年7月至2023年9月在空军军医大学西京医院骨肿瘤科参加临床实习的五年制本科学生148人,随机分为2组,每组74人,接受相同的病例教学课程,分别采用CBL方法和3D打印模型结合CBL方法进行授课,课程结束采用随堂测试和课后问卷对授课效果进行评估。结果随堂测试结果显示,CBL结合3D打印组在肿瘤毗邻结构辨识、手术入路选择、肿瘤切除范围评估方面的优良率分别为93.2%、90.5%和87.8%,均高于CBL组的81.1%、78.4%和74.3%,差异具有统计学意义(P<0.05)。课后评估显示,在课程趣味性、激发临床兴趣、理解手术过程和提高临床思维能力方面,CBL结合3D打印组的优良率分别为100%、95.9%、97.3%与95.9%,均优于CBL组的86.5%、83.8%、83.8%和81.1%,差异具有统计学意义(P<0.05)。结论3D打印模型结合CBL对于骨肿瘤这种少见复杂疾病的临床诊疗教学有积极意义,教学效果良好。

“小骨片”支架成形术修补额窦大缺损的初步探讨

目的探究“小骨片”支架成形术在修补额窦(FS)大缺损的应用。方法回顾性研究哈尔滨医科大学附属第一医院神经外科2021年5月—2023年8月间收治的10例行前额底入路并使用“小骨片”支架进行FS重建的患者。结果10例患者中,2例颅咽管瘤、1例垂体瘤、1例胶质瘤、1例动脉瘤、5例脑膜瘤;4例患者彻底清除FS黏膜,6例患者黏膜无特殊处理,术后随访1~26个月,平均10.3个月,随访显示所有患者均无脑脊液漏、术后感染或粘液囊肿。结论“小骨片”支架成形术简单、有效,可以恢复FS的形态,保留生理功能,避免术后并发症。

鼻翼基底对称性骨修复对单侧唇裂术后鼻畸形的疗效研究

目的比较鼻翼基底对称性骨修复联合鼻唇畸形整复术与仅行鼻唇畸形整复术对单侧唇裂伴牙槽突裂患者鼻畸形的改善效果。方法研究共纳入50例单侧唇裂伴牙槽突裂患者,其中20例仅行鼻唇畸形整复术(不植骨组),30例行骨修复联合鼻唇畸形整复术(骨修复组)。收集患者术前、术后1年面部观照片,参照Farkas人体测量学标准,进行鼻部解剖标志点的定位,测量10个鼻畸形指标,比较2组的手术效果。结果与不植骨组相比,骨修复组患者术后1年的鼻畸形获得了明显改善,其中鼻小柱对称参数更接近1,鼻小柱倾斜角更接近90°,鼻翼基脚内倾角及鼻翼基底倾斜角更小(P<0.05)。结论鼻翼基底对称性骨修复有助于改善单侧唇裂伴牙槽突裂患者唇裂术后鼻畸形,对鼻部对称性、鼻翼形态及鼻底畸形的改善效果明显。

鼻咽癌颅底骨质侵犯临床诊断中MRI与CT检查的作用对比

目的:探讨MRI与CT检查鼻咽癌颅底骨质侵犯的临床诊断价值。方法:选取2022年2月—2023年4月武威市人民医院收治的72例鼻咽癌疑似颅底骨质侵犯患者作为研究对象。患者均在手术及活检前完成MRI和CT检查,对比两者对颅底骨质侵犯的诊断效能。结果:72例鼻咽癌疑似颅底骨质侵犯患者经术后病理组织学诊断确诊为颅底骨质侵犯58例(80.56%),无颅底骨质侵犯患者14例(19.44%)。CT检出阳性40例,阴性32例;MRI检出阳性49例,阴性23例;MRI检查对颅底骨质侵犯诊断灵敏度81.03%和准确率81.94%均显著高于CT检查的62.07%、63.89%(P<0.05);两者联合诊断颅底骨质侵犯灵敏度96.55%和准确率95.83%均显著高于CT和MRI单一检查(P<0.05);MRI检查对各位置颅底骨质侵犯检出总准确率高于CT检查,差异有统计学意义(P<0.05)。结论:鼻咽癌患者经MRI扫描,可更为敏感地检出颅底骨质侵犯,与CT检查相比,检出率相对较高,有助于明确骨质侵犯位置,联合检测能进一步提高诊断准确性。

生物可降解镁基材料在颅颌面外科的应用及其研究进展

作为一种新型骨植入材料,生物可降解镁基材料在颅颌面外科显示出广阔的应用前景。与传统骨植入材料相比,镁具有良好的降解特性、生物相容性、力学特性和成骨特性,其降解产物镁离子具有抗凋亡、抗炎的作用,能够促进骨折和骨缺损部位的愈合。多项研究将生物可降解镁基材料应用于颅颌面部骨内固定、引导骨再生技术、骨替代材料、药物负载、种植体表面涂层等领域,其结果显示该类材料能够为骨愈合提供稳定的支持,并发挥出良好的促进成骨作用。此外,镁在口腔其他领域,如牙组织工程、促进软组织愈合等方面也表现出应用潜能,显示出生物可降解镁基材料具有重要的研究价值。