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OBJECTIVE: The aim of this study is to explore the related factors affecting infection risk caused by peripherally inserted central catheter (PICC) for bone tumor patients. METHOD: A retrospective analysis was performed for 223 bone tumor patients who received PICC and were admitted to our hospital from 2004 to 2017. A total of 18 cases (infection group) with PICC catheter-related infections and 205 cases without infection (noninfection group) were studied. First, factor analysis of variance or Chi-square test was applied to compare independent risk factors for PICC catheter-related infections, between bone tumor patients with catheter-related infections and those without catheter-related infections. RESULTS: This retrospective analysis involved a total of 18 patients with PICC infections and 205 patients without infections. The infection rate was 8.07%. Factor analysis of variance showed that many factors were related to PICC catheter-related infections, including experience of operator (χ2 = 3.48, P < 0.05), catheter retention time (χ2 = 7.478, P < 0.05), receiving chemotherapy or not (χ2 = 2.43, P < 0.05), Karnofsky Performance Scale scores (χ2 = 2.19, P < 0.05) and the frequency of replacing pad pasting on the point of puncture (χ2 = 2.23). Logistic regression analysis showed that PICC catheter retention time (odds ratio [OR] = 4.21, P < 0.05) and operator experience (OR = 2.80, P < 0.05) were independent factors affected PICC catheter-related infections. CONCLUSION: Catheter-related infections were related to experience of PICC operatorand length of catheter retention time.

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OBJECTIVE: The objective of this study is to investigate the clinical efficacy and safety of electroacupuncture and multiple acupoint stimulation in relieving cancer pain in patients with advanced hepatocellular carcinoma. METHODS: Sixty-five cases of advanced hepatocellular carcinoma with cancer pain were selected in our hospital and were divided into electroacupuncture multiple acupoint stimulation group (electroacupuncture group) (n = 32) and fentanyl transdermal patch analgesia group (control group) (n = 33) according to analgesic methods and intentions. In the electroacupuncture group, electric acupuncture treatment was administered at different acupoints, including Baihui, Quchi, Neiguan, Xuehai, Zusanli, and Sanyinjiao acupoint, once a day for 7 days. In the control group, a fentanyl transdermal patch was placed on the upper left arm every 3 days and replaced with a continuous external paste once for 7 days. Pain scores in the two groups before and during the treatment were evaluated with a visual analog scale (VAS), and adverse reactions during the treatment were recorded. RESULTS: The VAS pain score of the electroacupuncture group was significantly decreased on day 3 (P < 0.05), but the pain scores were not significantly different (P > 0.05) between the two groups 4 days after treatment. For treatment-related side effects, there were 3 cases of subcutaneous hemorrhage in the electroacupuncture group; 1 case of skin rashes and 3 cases of nausea and vomiting in the control group. The incidences of adverse reactions in the two groups were 9.4% and 12.1%, respectively, without significant difference (P > 0.05). CONCLUSION: Cancer pain in patients with advanced hepatocellular carcinoma can be alleviated with electroacupuncture and multiple acupoint stimulation, but the onset pain relief was slow. To improve the analgesic effects of this technique, the combination of various analgesic methods should be necessary in early stage of the treatment.

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Reports have indicated that warfarin is the most widely prescribed anticoagulant. However, traditionally prescribed doses for each patient may be too low or too high. The therapeutic effect is often hindered by a lack of evidence-based medical information. Herein, our aim is to provide this information. To accomplish this challenge, we report the development of a novel assay based on biotinylated tetrahedral DNA as a capture probe and fullerene (C60)-based nanomaterial as a redox probe using an ultrasensitivity assay with the Vitamin K epoxide reductase complex, subunit 1 (VKORC1). Platinum porous nanoparticles (PtPNPs) were modified on amino-terminated polyamidoamine (PAMAM)-functionalized C60 nanoparticles (C60NPs). The resultant C60NPs-PAMAM-PtPNPs were used as a redox probe. In this design, C60 exhibited excellent redox activity that was triggered by tetraoctylammonium bromide (TOAB). To improve the immobilization of the tetrahedral DNA capture probe, avidin was introduced during the fabrication of the biosensor because it can provide more active sites for the immobilization capture probe. The free-standing probe on top of the tetrahedral DNA served as a receptor to hybridize with target DNA directly. Different pulse voltammetry (DPV) was applied to record the electrochemical signals, which increased linearly with the target DNA. Under optimal conditions, the prepared biosensor showed a wide linear relationship, from 1 pM to 10 nM, with detection limits of 0.33 pM. This strategy demonstrates a new avenue for the determination of tumour-related mutated nucleotides in biosamples.

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Osteoporosis is one of the most prevalent age-related diseases worldwide, of which vertebral fracture is by far the most common osteoporotic fracture. Reduced bone formation caused by senescence is a main cause for senile osteoporosis, however, how to improve the osteogenic differentiation of osteoporotic bone marrow mesenchymal stem cells (BMSCs) remains a challenge. This study aimed to investigate the autophagic level changes in osteoporotic BMSCs derived from human vertebral body, and then influence osteogenesis through the regulation of autophagy. We found that hBMSCs from osteoporotic patients displayed the senescence-associated phenotypes and significantly reduced autophagic level compared to those derived from healthy ones. Meanwhile, the osteogenic potential remarkably decreased in osteoporotic hBMSCs, suggesting an inherent relationship between autophagy and osteogenic differentiation. Furthermore, rapymycin (RAP) significantly improved osteogenic differentiation through autophagy activatoin. However, the osteogenesis of hBMSCs was reversed by the autophagy inhibitor 3-methyladenine (3-MA). To provide more solid evidence, the hBMSCs pretreated with osteogenesis induction medium in the presence of 3-MA or RAP were implanted into nude mice. In vivo analysis showed that RAP treatment induced larger ectopic bone mass and more osteoid tissues, however, this restored ability of osteogenic potential was significantly inhibited by 3-MA pretreatment. In conclusion, our study indicated the pivotal role of autophagy for the osteo-differentiation hBMSCs, and offered novel therapeutic target for osteoporosis treatment.

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OBJECTIVE: To observe the effectiveness of digital customized plate in the treatment of complex limb fracture. METHODS: Between January 2012 and May 2013, CT raw data of complex limb fracture were used to establish the fracture three-dimensional simulation model after reduction, and a customized personalized anatomic plate was designed and used for internal fixation after open reduction in 42 cases. There were 22 males and 20 females, aged 16-53 years (average, 37.4 years). The causes of injury were traffic accident in 21 cases, falling from height in 18 cases, crush by heavy objects in 3 cases, including 26 cases of fresh closed fracture and 16 cases of open fracture (9 cases of type I and 7 cases of type II according to Gustilo classification). According to AO classification, there were 15 cases of humerus comminuted fracture, 4 cases of radial comminuted fracture, 8 cases of femoral comminuted fracture, and 15 cases of tibia comminuted fracture. The interval of injury and operation was 6-28 days (mean, 10 days). RESULTS: Reduction and internal fixation of fracture were successfully performed on 42 patients. The length and position of digital customized plate, direction and length of screw implant, number of screw were basically identical with preoperative design. The operation time was 35-120 minutes (mean, 70 minutes); the blood loss volume was 30-500 mL (mean, 180 mL); and X ray fluoroscopy frequency was 2-6 times (mean, 3 times). Superficial infection occurred in 2 cases, and was cured after dressing change; primary healing of incision was obtained in the other patients. Forty-two cases were followed up 6-24 months with an average of 11.5 months. The fracture healing time was 8-19 weeks (mean, 14 weeks) in 41 cases; delayed union occurred in 1 case at 44 weeks after operation. The fracture anatomical reduction was achieved in 19 cases, malunion in 3 cases, and functional reduction in the other patients. At last follow-up, no plate and screw loosening and breakage was observed. CONCLUSION: Digital customized plate in treatment of complex fractures of limbs, especially for the multiple comminuted fracture of long bones of the limbs has the advantages of convenient operation, less trauma, fewer complications, and good effectiveness.

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OBJECTIVE: To evaluate the effectiveness of comprehensive management for early stage avascular necrosis of the femoral head (ANFH) by arthroscopic minimally invasive surgery by comparing with closed core decompression. METHODS: Between January 2007 and March 2010, 28 patients (33 hips) with early stage ANFH were treated with the procedure of arthroscopic core decompression combined with autogenous cancellous bone graft and bone morphogenetic protein (BMP) in 18 cases (21 hips, trial group) or with simple closed core decompression in 10 cases (12 hips, control group). No significant difference was found in gender, age, disease duration, etiology, and staging between 2 groups (P > 0.05). RESULTS: Incision healed primarily in all patients, and no infection occurred. All patients were followed up 2.5 years on average (range, 1-3 years). Pain relief and improvement of hip function were obtained in all patients at 6 months after operation. At last follow-up, the Harris scores were 85.67 +/- 4.78 in trial group and 81.33 +/- 7.03 in control group, showing significant difference between 2 groups (t = -2.10, P = 0.04). Collapse of the femoral head was observed in 1 hip (Ficat stage II) of trial group, and in 2 hips (Ficat stage I) and 2 hips (Ficat stage II) of control group; hip arthroplasty was performed. Significant difference in total effective rate was found between trial group and control group (95.24% vs. 66.67%; chi2 = 4.85, P = 0.03). CONCLUSION: Arthroscopic core decompression combined with autogenous cancellous bone graft and BMP is more effective than traditional closed core decompression for treatment of early stage ANFH in pain relief, improvement of hip function, slowing-down the process of femoral head necrosis, reduction of hip joint replacement by accurate location of the lesions, and thoroughly debridement of necrotic bone.

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OBJECTIVE: To evaluate the effectiveness of artificial humeral head replacement in treatment of complicated fractures of the proximal humerus. METHOD: Between January 2005 and January 2011, 18 patients with proximal humerus fracture were treated with artificial humeral head replacement. There were 8 males and 10 females with a mean age of 71 years (range, 52-84 years). Fractures were caused by falling in 11 cases, by traffic accident in 3 cases, and by bruise in 4 cases. The time between injury and admission was 2 hours to 3 days (mean, 1.5 days). According to Neer classification, 8 cases had three-part fracture, 7 four-part fracture, and 3 cleavage fracture of humeral head; 5 cases complicated by shoulder joint subluxation, 2 cases by femoral fracture, 1 case by radial fracture, and 11 cases by osteoporosis. All the patients were treated with modular cemented prostheses. RESULTS: The operation time was 60-180 minutes with an average of 80 minutes; the blood loss was 100-400 mL with an average of 200 mL. All incisions healed by first intention without infection or neurovascular injury. Sixteen patients were followed up 3 years on average (range, 1-6 years). No loosening, dislocation of prosthesis or heterotopic ossification occurred. According to the Neer scores, the results were excellent in 5 cases, good in 8 cases, moderate in 2 cases, and poor in 1 case at 1 year after operation. The excellent and good rate was 81.2%. CONCLUSION: Artificial humeral head replacement is a good therapy for patients with complicated fractures of the proximal humerus, especially for elderly patients.

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OBJECTIVE: To evaluate the effectiveness of tumor-segmental resection and autologous iliac bone graft reconstruction combined with internal fixation in treating hand-foot-giant cell tumor of bone. METHODS: Between August 1997 and April 2008, 8 cases of hand-foot-giant cell tumor of bone were treated, including 3 males and 5 females with an average age of 28.5 years (range, 16-42 years). The locations were metacarpal bones in 3 cases, metatarsal bones in 4 cases, and phalanges of toes in 1 case. According to Campanacci's gradation of X-ray films, there were 1 case of grade I and 7 cases of grade II; according to pathological examination before operation, there were 3 cases of grade I to II, 4 cases of grade II, and 1 case of grade II to III; and according to TNM staging, there were 1 case of TisN0M0, 4 cases of T1N0M0, and 3 cases of T2N0M0. There were 2 cases of recurrence, the time from the first operation to recurrence were 11 and 14 months, respectively. The tumor size was 1.8 cm x 1.0 cm to 6.0 cm x 2.0 cm, the cortical bone became thinner, and the boundary between tumor and periosteum was clear. All patients underwent tumor-segmental resection combined with autologous iliac bone graft reconstruction, and miniplate internal fixation by lumbar anesthesia or trachea cannula anesthesia. RESULTS: All incision healed by first intention. Eight patients were followed up 10 to 84 months with an average of 46 months. Radiographs showed that fracture union was achieved at 3 to 9 months (mean, 5 months). No significant rotation, angular, and shortening deformity occurred in iliac bone graft. The function of iliac bone donor site recovered excellently. The pathological examination showed giant cell tumor of bone in all cases, including 2 case of grade I-II, 5 cases of grade II, and 1 case of grade II-III. The hand or foot function recovered excellently. No tumor recurrence or lung metastasis occurred during follow-up. CONCLUSION: Tumor-segmental resection combined with autologous iliac bone graft reconstruction plus internal fixation has excellent effectiveness for hand-foot-giant cell tumor of bone.

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