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Background: Glucocorticoids have been widely used in perioperative period for postoperative pain relief and the prevention of postoperative nausea and vomiting after total knee arthroplasty (TKA). However, the optimal administration protocols of glucocorticoids remain controversial. The purpose of this study is to compare the efficacy of glucocorticoids between intravenous and periarticular injection on clinical outcomes.Methods: A total of 114 patients were randomly assigned, and 46 patients in intravenous (IV) group and 47 patients in periarticular injection (PI) group were included in the final statistical analysis. The IV group received 10 mg dexamethasone intravenously, and the PI group received periarticular injection of cocktail including 10 mg dexamethasone during the procedure. The clinical outcomes were assessed using a visual analogue scale (VAS), the knee society score (KSS), range of motion (ROM), knee swelling, inflammation markers and complications for all patients after TKA.Results: Patients in the IV group had similar VAS score at rest and during walking at 6 hours, 1st, 2nd, 3rd, 4th days, 2 weeks and 3 months postoperatively when compared to the PI group. The ROM of knee in the affected leg at post- operative 3 months was less in the IV group compared with the PI group (110.1°± 11.9°vs 115.4°± 13.5°, P = 0.047), but without a statistically significant difference at 3rd days and 2 weeks postoperatively. The knee swelling and KSS function score were not statistically different. The level of IL-6, CRP and ESR at postoperative 1st days and 3rd days were also similar in two groups. Vomiting and other complications occurrence were not significantly different between the two groups.Conclusion: The intraoperative intravenous and periarticular injection of glucocorticoids have similar clinical outcomes, including postoperative pain management, prevention of PONV, inflammation, knee swelling, knee function recovery and the incidence of complications following primary TKA.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000033490. Date of registration: June 2, 2020.

Patients that present with multiple primary malignant neoplasms are increasingly encountered, but the treatment of such patients presents specific challenges and long-term survival is rare. The present study reports the case of a 45-year-old female diagnosed with three rare, distinct primary malignant neoplasms, including epithelioid hemangioendothelioma (EHE) of the brain, Ewing’s sarcoma of the lumbar 2 vertebra and a malignant solitary fibrous tumour (SFT) of the liver, at different time points. The patient underwent multidisciplinary treatment according to the diagnoses, including radial resection of all primary lesions, chemotherapy (consisting of vincristine, dactinomycin, cyclophosphamide and adriamycin) and radiotherapy, to treat Ewing’s sarcoma and metastases of EHE and malignant SFT. Following these treatments, the patient survived for >14 years. Multidisciplinary treatment regimens based on surgery can lead to long-term survival of patients with multiple asynchronous rare primary malignant neoplasms. The present study reported that multidisciplinary treatment regimens based on surgery can lead to the long-term survival of patients with multiple asynchronous rare primary malignant neoplasms.

To evaluate the short-term clinical results of a new approach of lumbar-pelvic fixation for lumbosacral reconstruction after resection of sacral tumors.Fifteen patients with sacral tumors underwent lumbar-pelvic fixation using TSRH-3D, CDH-M8 or ISOLA with iliac screws. The lumbosacral stability was evaluated according to the X-ray result to assess the feasibility and therapeutic effect of this approach.X-ray showed that high lumbosacral stability was achieved in all the 15 cases after the operation, and satisfactory therapeutic effect was obtained.Lumbar-pelvic fixation with iliac screw is feasible for lumbosacral reconstruction after resection of the sacral tumors, which provides strong internal fixation and produce good clinical outcomes.

Cell-based gene therapy is an alternative to viral and non-viral gene therapy. Emerging evidence suggests that mesenchymal stem cells (MSC) are able to migrate to sites of tissue injury and have immunosuppressive properties that may be useful in targeted gene therapy for sustained specific tissue engraftment.In this study, we injected intravenously (i.v.) 1x10(6) MSC, isolated from green fluorescent protein (GFP) transgenic rats, into Rif-1 fibrosarcoma-bearing C3H/HeN mice. The MSC had been infected using a lentiviral vector to express stably the luciferase reporter gene (MSC-GFP-luci). An in vivo imaging system (IVIS 200) and Western blotting techniques were used to detect the distribution of MSC-GFP-luci in tumor-bearing animals.We observed that xenogenic MSC selectively migrated to the tumor site, proliferated and expressed the exogenous gene in subcutaneous fibrosarcoma transplants. No MSC distribution was detected in other organs, such as the liver, spleen, colon and kidney. We further showed that the FGF2/FGFR pathways may play a role in the directional movement of MSC to the Rif-1 fibrosarcoma. We performed in vitro co-culture and in vivo tumor growth analysis, showing that MSC did not affect the proliferation of Rif-1 cells and fibrosarcoma growth compared with an untreated control group. Finally, we demonstrated that the xenogenic MSC stably expressing inducible nitric oxide synthase (iNOS) protein transferred by a lentivirus-based system had a significant inhibitory effect on the growth of Rif-1 tumors compared with MSC alone and the non-treatment control group.iNOS delivered by genetically modified iNOS-MSC showed a significant anti-tumor effect both in vitro and in vivo. MSC may be used as a target gene delivery vehicle for the treatment of fibrosarcoma and other tumors.