The great majority of malignant peripheral nerve sheath tumors (MPNSTs) exhibit Schwann differentiation. Few MPNSTs with perineurial differentiation are also named malignant perineuriomas. Benign perineurioms were classified as intraneural, extraneural (soft tissue), sclerosing, and reticular variant. Histopathological features of intraneural perineurioma are individual nerve axons surrounded by whorls of spindle-shaped cells arranged in an onion bulb-like pattern. However, intraneural malignant perineurioma is uncommon, its characteristic histological features were not clearly described yet. Positive for epithelial membrane antigen (EMA), glut-1 and claudin-1, is characteristic of malignant perineurioma. Herein, we report an intraneural malignant perineurioma in median nerve of a 13-year-old girl. The clinicopathological features were summarized and the related literatures were reviewed.

cral TB were subjected to anterior radical debridement and strut grafting and instrumentation, while cases with a large paraspinal abscess, especially lumbar TB, were given the surgical treatment of posterior instrumentation. The differential selection of the patients in each group may itself have influenced the results. In group B (posterior approach), either a titanium cage filled with morcelized rib bone or large autoilliac or costal grafting were used. What were the criteria for choosing either of them? One hundred and eighty-one patients with spinal TB were included in the study. Of these, only 25 patients had a neurological deficit. What was the indication for surgery in the other patients? They could very well have been managed conservatively or with a middle-path regimen [5] . The development of anti-TB drugs has revolutionized the treatment of patients with spinal TB, as most patients do not have extensive destruction of bone, and sequestration can be successfully treated conservatively with chemotherapy, external bracing and prolonged rest [6] . Spinal TB with the lesion situated in the thoracic spine is more prone to develop kyphosis. In their study [1] , the majority of patients in group A had TB in the dorsal spine while those in group B mostly had lesions in the lumbar spine. The poor results in group A cannot be attributed to instrumentation alone. The surgical time and blood loss which are critically important parameters for the choice of approach were not mentioned. Although the mean age was mentioned, the age range in each group was not. In children and young adults, vertebral destruction is more severe because most bone is cartilaginous. In addition, angulation is more significant due to the growth retardation of the anterior column and unrestricted growth of the posterior column. We read the article entitled ‘Outcomes of different surgical procedures in the treatment of spinal tuberculosis in adults’ by Cui et al. [1] with great interest. Despite being an age old disease debate still surrounds the choice of approach. The authors concluded that posterior approach was superior to anterior approach for correcting deformity and maintaining correction. However, this conclusion is drawn from study groups that were not comparable from the beginning. There were statistically significant differences in the preoperative kyphosis angle in the anterior and posterior groups. Hence, the conclusion may not be appropriate. The anterior approach popularized by Hodgson et al. [2] in 1960 is currently considered the gold standard for debridement and decompression in Pott’s spine [3] . Advocates of the traditional anterior approach cite the ability to directly access the disease pathology and perform decompression, the fact that there is less muscle dissection and the ability to place a large graft under compressive load for fusion [2, 4] . In the study of Cui et al. [1] , anterior instrumentation was found to be inferior to posterior instrumentation. One of the reasons given by the authors was that the screws in the vertebral body cannot provide the same strength as the pedicle screws due to osteoporosis of the vertebral body caused by spinal TB. We disagree with the authors, as the screws were put into the normal healthy vertebral body and the affected vertebrae were removed. If there were osteoporosis of the vertebral body, then the hold of the posterior screw would also be poor. The vertebra level operated on and the range of kyphosis angle in each group have not been mentioned. The anterior approach should be avoided in patients with lesions above T5 (as instrumentation above T4 body is difficult), in patients with kyphosis of more than 60° (anterior-only correction causes spinal lengthening), in patients with disease involving the posterior elements and in patients with a bad preoperative chest condition. It would be interesting to know how the authors managed the 28 patients with a kyphosis angle of between 61 and 70°. The size of paraspinal abscess decided the choice of approach. The cases lacking a large paraspinal abscess and without lumbosaPublished online: August 21, 2013

Objective To summarize clinical characteristics and explore operative strategy of elderly patients with spinal tuberculosis.Methods From December 2005 to December 2010,151 aged patients with spinal tuberculosis were treated with six different surgical procedures.Among 69 patients were followed,including 36 males and 33 females,with the average age of 68.3 (60 to 83) years.62 patients were complicated by other diseases.The clinical manifestations,locations and images of these patients were analyzed.The occurrence of misdiagnosis and mistreatment was counted.The visual analogue scale (VAS) scoring was applied to evaluate the local pain,and the Frankel classification was used to evaluate the improvement of neurological function.The criterion of cure of spinal tuberculosis was used to assess the clinical cure of these patients.Results All patients had different levels of local pain.The preoperative VAS was 8.2±1.4,with 42 (60.9) cases of more than 7.72.5％ patients didn't have obvious toxic symptoms and 43.5％ didn't have paravertebral or psoas abscess,while 68.1％ had spinal nerve damage.Lumbar spine was the most commonly affected area and 2 vertebrae TB got the highest incidence.The Cobb's angle was 20.4°±4.3° preoperatively.The misdiagnose rate was 30.4％ (21/69) and the mistreatment rate was 13.0％ (9/69).The average follow-up period was 27 months.Sixty-seven patients were clinically cured.The average union segments were 4.1 ±0.6 and the average time of union was 5.9± 1.7 months.The correction of kyphosis was 9.5°±3.6° after surgery but lost 7.2°±2.3° at the last follow-up time.5 patients with neurological deficits were clinically improved at least one grade after surgery,according to the Frankel grading system.One patient died from pulmonary infection.Other complications included cardiac dysfunction in 5 patients,pulmonary infection in 4 patients,cerebral infarction in 2 patients,internal fixation loosening in 2 patients,sinus formation in 5 patients,drug-induced liver dysfunction in 5 patients,drug rash in 6 patients and aggravation of neurological function in 1 patient.Conclusion Spinal tuberculosis in elderly patients usually concealed onset and combined with other diseases,which could lead to misdiagnosis and mistreatment.Surgical procedures should be chosen individually and in minimal-invasive way.The segments should be fixed longer to avoid loosening.

Objective To investigate operative approach,immobilization manner,and surgical effect of multiple-level contiguous thoracic spinal tuberculosis.Methods Between January 2001 and December 2010,112 patients with thoracic spinal tuberculosis were treated with 5 different surgical procedures.Among them,81 adults with multiple-level contiguous thoracic spinal tuberculosis were followed up for 17 to 75 months (average,39 months).Twenty three patients suffered from spinal cord dysfunction; according to the Frankel classification,there were 3 cases of type A,4 cases of type B,7 cases of type C,and 9 cases of type D.The double vertebral bodies were commonly affected areas,especially T10 and T11-Results Local symptoms of all patients were relieved significantly 1 to 3 weeks postoperatively.Erythrocyte sedimentation rates (ESR) returned to normal level in all patients 8 to 12 weeks postoperatively.Three sinuses were found 0.5 month,1 month and 1.5 months postoperatively,respectively,which were cured by changing dressing for 1 to 2 months.The average correction of kyphotic deformity was 10.2°±2.1° in anterior fixation group,while 12.6°±2.7° in posterior fixation group.At final follow-up,the average loss of correction was 6.9°±1.9° in anterior fixation group,while 5.8°±1.4° in posterior fixation group.At least one Frankel grade improvement was observed in 23 patients.Conclusion The surgical methods should be chosen according to the location and degree of the lesion.Correct surgical procedures can obtain good results in correction and maintenance of the deformity,clearance of the foci,decompression of the spinal cord and pain relief for thoracic spinal tuberculosis.The posterior fixation is better than the anterior fixation with regard to correction and maintenance of the kyphotic deformity.

用气相色谱仪氢火焰离子化检测器（GC-FID）对宠物饲料中的添加剂丙三醇、丙二醇、二甘醇的检测方法进行了研究,考查了提取试剂、提取方法、提取时间等因素对检测结果的影响,建立了宠物食品中添加剂丙三醇、丙二醇、二甘醇的检测方法,方法的检出限分别为0.05、0.01、0.02 g/kg.实验结果表明,本检测方法具有简便、快速、准确、成本低的特点.

OBJECTIVE:To investigate surgical methods and outcomes in the treatment of spinal tuberculosis (TB) in adults.SUBJECTS AND METHODS:One hundred and eighty-one patients (average age 39 years) without multiple-level noncontiguous spinal TB were followed up for 22-72 months. The patients were divided into four groups according to surgical procedure on the basis of the position and extension of the foci: group A (74 cases): anterior radical debridement and strut grafting with instrumentation; group B (83 cases): posterior instrumentation and bone grafting with anterior radical debridement and strut grafting in a single- or two-stage procedure; group C (10 cases): extrapleural anterolateral decompression and strut grafting with posterior instrumentation in thoracic or thoracolumbar spine, and group D (27 cases): single-stage transforaminal decompression and posterior instrumentation and fusion.RESULTS:There was a significant decrease (p < 0.05) in mean preoperative (81%) Oswestry's Disability Index. Except for 24 patients with lumbosacral TB who were only instrumented posteriorly, kyphosis degrees were corrected by a mean of 11.5° in the anterior instrumentation group and 12.6° in the posterior instrumentation group (p < 0.01). The correction loss was 6.8° in the anterior instrumentation group and 6.1° in the posterior instrumentation group at the last follow-up (p < 0.01).CONCLUSION:The four surgical procedures obtained good results for correction and maintenance of the correction, clearance of the foci, decompression of the spinal cord and pain relief in the treatment of spinal TB in adults, providing that the operative indication is accurately identified. However, the posterior approach was superior to anterior instrumentation for correcting deformity and maintaining the correction.

There are few articles in the literature comparing outcomes between anterior and posterior instrumentation in the management of thoracic and lumbar spinal tuberculosis (TB).

OBJECTIVE:To compare the outcomes of anterior verus posterior instrumentation under different surgical procedures in the surgical management of thoracolumbar spinal tuberculosis (TB). METHODS:Between January 2004 and December 2009, 241 adult patients with thoracolumbar spinal TB underwent radical debridement and strut grafting plus anterior or posterior instrumentation in single-stage or two-stages. The mean age was 39 years (range: 16 - 67). The mean follow-up period for 189 patients was 37 months (range: 22 - 72). Among them, 157 cases underwent > 3 weeks of chemotherapeutic regimen of isoniazid, rifampin, pyrazinamide and ethambutol and the remaining 32 were operated for neurological impairment after 6-18 h with the same chemotherapeutic regimen. Except for 8 patients with skip lesions undergoing hybrid anteroposterior instrumentation, anterior instrumentation was utilized in 74 patients (Group A) and posterior instrumentation in 107 patients (Group B). RESULTS:In both groups, local symptoms of all patients were relieved significantly 1-3 weeks postoperatively. And 10/14 cases (71%) in Group A and 14/19 cases (74%) in Group B with neurological deficits had excellent or good clinical outcomes (P > 0.05). The levels of erythrocyte sedimentation rates (ESR) returned from 43.6 mm/h and 42.4 mm/h preoperatively to normal at 8-12 weeks postoperatively. Kyphosis degrees were corrected by a mean of 11.5° in Group A and 12.6° in Group B (P < 0.01). The correction loss was 6.8° in Group A and 6.1° in Group B at the last follow-up (P < 0.01). Fusion rates of the grafting bone were 92.5% and 91.8% respectively at the final follow-up (P > 0.05). Severe complications did not occur. CONCLUSION:Either anterior or posterior instrumentation can obtain good results in correction and maintenance of deformity, clearance of foci, decompression of spinal cord and pain relief in the treatment of thoracolumbar spinal TB as long as the surgical indications are properly selected. Posterior instrumentation may be superior to anterior instrumentation in the correction and maintenance of deformity.

The perivascular epithelioid cell family of tumors includes angiomyolipoma, clear cell "sugar" tumor of the lung, lymphangioleiomyomatosis, and clear cell myomelanocytic tumor of the falciform ligament/ligamentum teres. Less frequently, perivascular epithelioid cell tumors arise in various other locations throughout the body including soft tissue, bone, and visceral organs. We report a case of a 23-year-old man who presented with 2-month history of frequent micturition and odynuria. Based on clinical examination, ultrasound computed tomography imaging, surgical operation, and histopathologic studies, a definitive diagnosis was made. Further characteristic images and pathology of this disease are discussed.

OBJECTIVE:To evaluate the surgical indications and clinical effectiveness of different operative procedures in the treatment of lower lumbar tuberculosis.METHODS:From June 2001 to Oct 2008, 72 patients with lower lumbar tuberculosis were treated by different operative procedures. Including 38 males and 34 females, with an average age of 38.5 years old ranging from 16 to 70 years. The average duration of symptom was 6.8 months (ranging from 4 months to 2 years). A single vertebrae was involved in 10 patients,two contiguous vertebrae in 50 cases and three vertebrae in 12 cases. The average preoperative lordotic angle was 13.1 degree (ranging from -5.0 degrees to 34.0 degrees). Three different operative procedures included: (1) posterior debridement and posterolateral fusion and posterior instrumentation in 28 patients; (2) anterior radical debridement and anterior fusion and anterior instrumentation in 32 patients; (3) image-guided percutaneous drainage (PCD) of tuberculous abscesses in 12 patients. The selection of the procedure was made according to the degree of the lesions. The resolution of inflammatory process, bony fusion, correction of sagittal angles and JOA scores were used for evaluating the result of the surgery and the complications were analyzed.RESULTS:All patients were followed up from 1.5 to 8.0 years (means 3.6 years). PCD was an effective treatment in 11 out of the 12 patients, one required surgical debridement and fusion. Among them, 57 (95%, 57/60) patients were treated by open operation showed successful bony fusion. The complications maily included common iliac vein injury in 3 patients, dural tear in 2 patients, they were all cured by intro-or postoperative treatment. The average immediate post-operative lordotic angle was 27.3 degree (35.0 degrees to 16.0 degrees), the average lordotic angle was 25.6 degree (33.0 degrees to 15.0 degrees) at final follow-up. Preoperatively and at final follow-up, JOA scores were respectively (15.2 +/- 3.4), (25.6 +/- 2.4) (P<0.01).CONCLUSION:Different operative procedures should be selected to treat lower lumbar tuberculosis according to the degree of lesions. Aggressive surgical treatment was found helpful in the resolution of inflammatory process and correcting the loss of lordosis, preventing progression of kyphosis.

OBJECTIVE:To explore the surgical measurements and principles in the treatment of thoracic and thoracolumbar spinal tuberculosis. METHODS:A total of 232 cases of previously treated thoracic or thoracolumbar spinal tuberculosis in recent 7 years were retrospective analyzed. Preoperative assessments were as follows: Cobb angles of kyphosis: < 30° (n = 65), 30 - 60° (n = 147) and > 60° (n = 20); Frankel B (n = 13), C (n = 12), D (n = 41) and E (n = 166). Forty-eight cases were performed with one-stage transpedicular screw system and anterolateral debridement by single incision, 184 cases with one-stage anterior approach (debridement, fusion and plate-screw fixation) routinely. The tissues and liquor paris debrided from focus were sent for pathology, Bacillus tuberculosis detection and culture, and drug sensitivity test. The patients were given anti-tuberculosis therapy according to the results of drug sensitivity test for 1 - 1.5 years. The follow-up parameters included relapse rate, fusion of bone graft, the status of neurological restoring and kyphosis correction. RESULTS:All 232 cases recovered from perioperation and 230 cases achieved primary wound healing. Two cases undergoing single incision one-stage posterior instrumentation and anterolateral debridement were complicated with wound healing and sinus formation. There was delayed healed by changing dressings. The complications included intercostals neuralgia (n = 135) and pneumothorax or hydrothorax requiring no special measure (n = 13). The follow-up period ranged from 1.0 to 4.5 years old (mean: 2.6). There was no recurrence within the follow-up period and bone union was found in all cases. All 66 cases with neurological deficits recovered partially or totally. Kyphosis correction was achieved by 27.5° on average postoperatively and showed a mild loss of 4.2° on average during the follow-up period. All cases were confirmed pathologically as Bacillus tuberculosis infection. Bacillus tuberculosis was detected and cultured successfully in 107 cases (46.1%). Forty strains (37.4%) were drug resistant among which 8 strains (7.5%) was multi-drug resistant. CONCLUSION:For the patients with thoracic and thoracolumbar spinal tuberculosis, directional chemotherapy, one-stage anterior approach with thorough debridement, auto-rib or Ti-mesh fusion and plate-screw fixation may be the first-line therapy.

OBJECTIVE To investigate the clinical significance of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in the treatment of spinal tuberculosis. METHODS Sixty-seven patients (41 males and 26 females, ranging in age from 23 to 61 years) with active spinal tuberculosis in our hospital (from Mar. 2004 to Mar. 2007) were included in this study. The tuberculosis focus were located either in cervical spine, thoracic spine or in lumbar spine. After 4 to 6 weeks anti-tuberculosis chemotherapy, all the patients underwent one-stage operation (focus debridment) and auto-bone graft combined with internal fixation. Blood test for ESR and CRP were carried out at different times before and after operation. RESULTS The average ESR was (79.4 +/- 35.6) mm/h, and the average CRP was (44.3 +/- 17.5) mg/L before chemotherapy, indicating active tuberculosis focus. After 4 to 6 weeks chemotherapy, the average ESR was (45.3 +/- 21.0) mm/h,and the average CRP was (26.7 +/- 11.8) mg/L, the differences were statistically (P < 0.05), and the clinical symptoms of spinal tuberculosis relieved in all patients. Four weeks after operation, the average ESR dropped to (42.8 +/- 16.5)mm/h, the average CRP dropped to (23.8 +/- 10.0) mg/L statistically (P < 0.05). Eight weeks after operation, the average value of ESR and CRP were at normal level in 47 cases, indicating inactive tuberculosis focus. Focus healing was achieved in 65 patients after short-term chemotherapy. CONCLUSION The level of ESR and CRP are high in active spinal tuberculosis and low when focus controlled. ESR and CRP are reliable parameters in evaluation the treatment and prognosis of spinal tuberculosis.

OBJECTIVE:To evaluate the exploratory development of bone graft by titanium mesh with bone allograft in treatment of cervical spinal tuberculosis. METHODS:Thirty two cases of cervical spinal tuberculosis treated with anterior radical debridement, decompression and inter fixation from January 2002 to January 2007 were included (at least two years follow-up). 18 male and 14 female, age from 18 to 72, mean 41.3 years old. 0.5 - 15.0 months before visit, mean 6.9 months. There were 13 cases in initial treatment group and 19 cases in retreatment group. All cases were divided into two groups (group A and group B) by resource of bone graft. Group A, titanium mesh with bone allograft, 17 cases. Group B, autograft with ilium, 15 cases. Operation time, blood loss, curing conditions, cervical curvature (absolute rotation angle, ARA), function of spinal cord and the rate for bone graft fusions in two groups were compared. The mean follow-up was 3.5 years (range 2 - 5 years). RESULTS:The primary healing rate of incisions was 93.8% (30/32), and total healing rate was 96.9% (31/32). There were no significant differences in operation time or in blood loss between two groups (P > 0.05). Operation time and blood loss, 72 min/121 ml in group A and 90 min/198 ml in group B, there were significant differences between two groups (P < 0.05). In each group, there were significant differences in the function of spinal cord between preoperative and immediately post operative, between preoperative and follow-up, and between immediately post operative and follow-up (P < 0.05), and there were significant differences in ARA between preoperative and immediately post operative, and between preoperative and follow-up (P < 0.05), and there were no significant differences between immediately post operative and follow-up (P > 0.05). On preoperative, immediately post operative and follow-up, there were no significant differences in the function of spinal cord or in ARA between two groups (P > 0.05). CONCLUSION:For cervical spinal tuberculosis followed by effective individual chemotherapy, a good effect can be obtained by treated with radical debridement and bone allograft with titanium mesh.

OBJECTIVE:To study the clinical application of anchoring cervical intervertebral fusion cage (ACIFC) in anterior cervical discectomy with fusion. METHODS:From November 2006 to June 2007, 21 cases of degenerative cervical disease were treated with anterior cervical discectomy, bone graft by ACIFC and anchoring stators, and 28 ACIFCs were implanted. There were 12 males and 9 females aged 25-68 years old (average 47.9 years old). The course of disease ranged from 3 days to 15 years (median 2.3 years). There were 7 patients with single-segment cervical spondylosis, 3 with two-segment cervical spondylosis, 2 with single-segment lower cervical spine instability, 4 with single-segment cervical spondylosis and lower cervical spine instability, and 5 with cervical disc herniation. Postoperatively, X-ray films were taken regularly to detect the fusion of bone graft and the intervertebral height of fused segment was measured. The symptoms, signs and cervical functions of patient before operation, shortly after operation and during the follow-up period were evaluated by "40 score" system. And the occurrence of postoperative axial symptom (AS) was assessed with the standard set by Zeng Yan et al. RESULTS:All incisions healed by first intention. AS occurred in 1 case 48 hours after operation and was improved from poor to good after symptomatic treatment. No other kind of complication was identified or reported during intra-operative and postoperative period. All the cases were followed up for 16-24 months (average 20.5 months), and fusion was reached in all the intervertebral discs. Evaluated by "40 score" system, the average score for the cervical spinal cord function before operation, shortly after operation and during the final follow-up period was 26.2, 30.6, and 35.5 points, respectively, indicating there were significant differences between different time points (P < 0.05). During the follow-up period of above 1 year, the average improvement rate was 67.4%. The average intervertebral height before operation, shortly after operation and during the last follow-up period were 1.9, 4.4 and 4.3 mm, respectively, showing there were significant differences between the preoperation and the immediate postoperative and last follow-up periods (P < 0.05). No degeneration of adjacent segment was observed during the follow-up period. CONCLUSION:Using ACIFC in bone graft fusion and internal fixation for degenerative cervical disease is convenient and fast, has wide range of indications with satisfying clinical effect, and can achieve obvious therapeutic effect in restoring and maintaining cervical intervertebral height.

OBJECTIVE:To evaluate the mid- or long-term clinical results and the factors that influence the outcomes of prosthetic disc nucleus (PDN) replacement in the treatment of lumbar disc disease.METHODS:Thirty-four patients who underwent the PDN replacement from March 2002 to October 2003 were followed for an average of 52.6 months (range from 48 to 66 months). Twenty patients were discogenic low back pain, 14 patients were lumbar disc herniation. The follow-up results were evaluated by using the Oswestry disability index (ODI) and the visual analogue scales (VAS) through direct examinations and questionnaires. ODI was 58.4% preoperatively, and VAS was 7.4. Radiography was also used to measure the range of motion (ROM) and disc height of the operative segment, and findings were compared with those on preoperative radiographs.RESULTS:Twelve months after operation, a significant proportion of patients recovered from low back pain or leg pain, ODI decreased to averaged 18.2%. VAS decreased to 1.8, the average increase of the postoperative disc height was 17.6%, ROM was 9.2 degrees. At the final followup, all patients with deteriorated leg radicular symptoms improved, ODI increased from 18.2% 12 months after operation to averaged 31.2%. Low back pain became more serious in 18 patients. VAS increased from 1.8 to 3.1, the average decrease of the postoperative to preoperative disc height was 13.5%, ROM decreased to 6.8 degrees. The rate of degeneration or breakages of the end plates was 64.7% (22/34), implant device migrations were observed in 25 patients.CONCLUSIONS:The mid- or long-term outcome of PDN replacement in the treatment of degenerative lumbar disc disease is not as encouraging as that of the short-term follow-up. It is neither effective in term of restoration of the intervertebral disc height nor increase of the ROM of the operative segment, complication rates are significantly higher, and inferior results are to be expected. The selection of suitable surgical candidates and determination of valid indications for operative treatment are very important.

某部运输分队于2004年12月赴利比里亚执行为期7个月的维和运输任务.利比里亚地处西非,气候炎热潮湿,加上连年内战,卫生条件极差,疟疾、伤寒、阿米巴病等传染病广泛流行,霍乱、肝炎、出血热及黄热病也时有发生.我们分析了我维和运输分队官兵2005年1～6月执行任务期间的发病情况,旨在为执行类似任务部队提供参考.

与一般的软组织不同,骨组织石蜡切片在脱水、透明等制片前需要使用脱钙剂除去骨组织中的钙盐才能制备成4～5μm厚的切片.为了更好地了解脱钙技术对骨组织免疫组织化学染色质量的影响,本文根据骨组织及其免疫组织化学染色的特点,结合文献对影响骨组织免疫组织化学染色质量的组织的固定、常用的脱钙方法及脱钙液、低温-微波快速脱钙技术及注意事项等方面进展进行了综合分析.