Objective:To compare the clinical effect of large-diameter metal-on-metal(L-MoM)total hip arthroplasty(THA)versus conventional metal on poly ethylene(MoPE)THA following posterolateral minimal incision.Methods:22 L-MoM THA in 20 patients were performed with posterolateral minimal incision.A matched group of 22 hips in 20 patients who had undergone a MoPE THA with posterolateral minimal incision were also performed by the same surgeon.The two groups of patients were evaluated clinically and radiographically respectively,including the length of the incision,surgical time,intra-operative blood loss,postoperative drainage volume,postoperative amount of decreasing hemoglobin(Hb),postoperative pain score,C-reactive rotein(CRP),erythrocyte sedimentation rate(ESR),the circumference difference of the operated thighs,length of stay,major complications and component positions.Results:There were no differences between the two groups with regard to the length of the skin incision,operating time,blood loss,postoperative amount of decreasing Hb,the visual analog scale(VAS)pain score at 24 hours after surgery,CRP,ESR,the circumference difference of the operated thighs,length of stay,major complications and component positions.Conclusion:L-MoM THA with posterolateral minimal incision can be effectively performed without increased risk of complications.The key is to master the surgical skills.

Objective:To evaluate the short-term results of total hip arthroplasty(THA)with entirely Corail hydroxyapatite(HA)-coated prosthesis in the treatment of femoral neck fractures in the elderly patients.Methods:A total of 21 cases of primary THA from Jan 2007 to Jun 2008 using Corail prosthesis in the treatment of the femoral neck fractures in elderly patients were reviewed.Their results were studied clinically and roentgen graphically to evaluate chiefly their Harris scores,complications and thigh pain.Results:All patients were in good condition during the operation.The mean operation time and average bleeding volume during operation was(52.6 ?7.17)min and(217.9?37.7)ml,respectively.Except 2 patients with deep venous thrombosis,2 patients with fat necrosis and 5 patients with cognitive impairment,there were no serious complications occurred.The postoperative X-ray films showed that the initial fixation was excellent or good in all the stems.A total of 19 cases were followed up for 9.5 months on average.No thigh pain was seen in these cases.Their mean Harris scores were improved from 37.2?6.7 preoperatively to 83.5?4.8 postoperatively.X-ray examination showed no radiolucent lines,osteolysis,or loosing of prosthesis.Subsidence of prosthesis was found in 2 cases,however,with a distance less than 2 mm.All the prostheses achieved bony stabilization according to the criteria proposed by Engh et al.Conclusion:The THA for elderly femoral neck fracture with Corail entirely HA-coated prosthesis has an excellent clinical and radiological short-term results and meanwhile is safe.

[Objective]To compare the short-term clinical effect of Corail entirely hydroxyapatite(HA)-coated versus cemented femoral stem prosthesis in total hip arthroplasty(THA) for elderly femoral neck fracture.[Method]Fifty-four cases of unilateral femoral neck fracture in patient over 75 were retrospectively analyzed from January 2007 to June 2008.In them,21cases underwent THA using Corail femoral prosthesis(HA group),and the other 33 were treated with cemented THA(cement group).The difference was compared in time of hospitalization,time of operation,blood loss,hemodynamic parameters,adverse effect,Harris scoring and radiological results.[Result](1)The average operation time were(52.6?7.2)minutes in HA group and(62.5?8.5)minutes in cement group,with significant difference(P

Objective To compare treatment response according to the PERCIST1.0,RECIST1.1,EORTC,and WHO criteria in patients with colorectal liver metastases (CLM) who received neoadjuvant chemotherapy.Methods A total of 41 CLM patients (27 males,average age 68.48 years;14 females,average age 62.43 years) from January 2010 to September 2013 were included in this retrospective study.PET/CT scan was performed before chemotherapy and after 4-6 cycles′ chemotherapy.The baseline and the sequential follow-up 18F-FDG PET/CT of each patient were evaluated according to the PERCIST1.0,RECIST1.1,EORTC,and WHO criteria.The response was categorized into 4 levels including CR,PR,SD,PD.PET/CT images were used for both metabolic and anatomic evaluation.The concurrent diagnostic CT or MRI images (performed within 1 week of PET/CT) were also utilized when needed.The agreements of criteria were analyzed using Kappa test.The response rate (RR) and disease control rate (DCR) were compared using χ2 test.Results The RR and DCR according to the PERCIST1.0,EORTC and RECIST1.1 criteria were 31.71％(13/41) and 63.41％(26/41),31.71％(13/41) and 60.98％(25/41),17.07％(7/41) and 68.29％(28/41),respectively.The general comparison of PERCIST1.0 and RECIST1.1,EORTC and RECIST1.1 criteria showed good agreements (κ values: 0.711,0.689).Significant difference was not found in the DCR(χ2=2.000,P>0.05) but found in the RR(χ2=6.000,P<0.05) between PERCIST1.0 and RECIST1.1.Difference of DCR between EORTC and RECIST1.1 was not significant(χ2=3.000,P>0.05),while the RR had significant difference(χ2=6.000,P<0.05).The RR and DCR according to WHO criterion were 12.20％(5/41) and 70.73％(29/41),which had a good consistency with those according to PERCIST1.0 criteria (κ=0.629).Significant statistical difference was not found in the DCR(χ2=3.000,P>0.05) but found in the RR(χ2=8.000,P<0.05) between PERCIST1.0 and WHO criteria.Conclusions In evaluating CLM treatment response,anatomical criteria and metabolic criteria have a good consistency.But metabolic criteria are more sensitive for RR evaluating.

Purpose: Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define the pathology, impacting the real evaluation of NAC. This research aimed to assess real NAC efficacy without interference from TURBT and apply combined modality therapies guided by NAC efficacy. Materials and Methods: Patients with cT2-4aN0M0 MIBC were confirmed by cystoscopic biopsy and imaging. NAC efficacy was assessed by imaging, urine cytology, and cystoscopy with multidisciplinary team discussion. Definite responders (≤ T1) underwent TURBT plus concurrent chemoradiotherapy. Incomplete responders underwent radical cystectomy or partial cystectomy if feasible. The primary endpoint was the bladder preservation rate. Results: Fifty-nine patients were enrolled, and the median age was 63 years. Patients with cT3-4 accounted for 75%. The median number of NAC cycles was three. Definite responders were 52.5%. The complete response (CR) was 10.2%, and 59.3% of patients received bladder-sparing treatments. With a median follow-up of 44.6 months, the 3-year overall survival (OS) was 72.8%. Three-year OS and relapse-free survival were 88.4% and 60.0% in the bladder-sparing group but only 74.3% and 37.5% in the cystectomy group. The evaluations of preserved bladder function were satisfactory. Conclusion After stratifying MIBC patients by NAC efficacy, definite responders achieved a satisfactory bladder-sparing rate, prognosis, and bladder function. The CR rate reflected the real NAC efficacy for MIBC. This therapy is worth verifying through multicenter research.

Objective:To investigate the long-term survival and safety in patients with muscle-invasive bladder cancer (MIBC) who experienced a noninvasive down-staging (≤pT 1)after transurethral resection of bladder tumor (TURBT) plus systemic chemotherapy and received bladder-sparing treatment. Methods:The records of patients with MIBC who underwent maximal TURBT plus systemic chemotherapy-guided bladder-sparing treatment were reviewed retrospectively from Dec 2013 to Dec 2020. Eventually, 22 patients who achieved noninvasive down-staging underwent conservative management. The total patient cohort contained 10 males and 12 females. A majority of patients had single lesion and stage T2 disease. The median age of the patients was 66 years and the median tumor size was 3.0 cm. All patients underwent maximal TURBT to resect all visible diseases and followed by 3-4 cycles platinum-based systemic chemotherapy. After achieving noninvasive down-staging, 14 patients received concurrent chemoradiotherapy, and the other 8 patients underwent surveillance. Overactive bladder symptom score (OABSS) was used to assess the bladder function after treatment.Results:Twelve patients achieved pT 0 and 10 patients were down-staged to cT a-T 1. At a median follow-up of 36.7 months, 90.9%(20/22) patients retained their bladder function successfully. Among the 14 patients who received concurrent chemoradiotherapy, 4 had grade 3 or 4 adverse events. Among the 8 patients who underwent surveillance, 3 had grade 3 or 4 adverse events after systemic chemotherapy.Nine patients experienced tumor recurrence in the bladder, and 2 patients died of bladder cancer. Seven (31.8%) patients experienced Ⅲ/Ⅳ grade complications. The 5-year recurrence-free survival (RFS) and overall survival (OS) in patients achieved pT0 were 66.7% and 100.0%, respectively. The 5-year RFS and OS in patients achieved cTa-T1 were 40% and 72%, respectively. The OABSS score of 20 patients who retained their bladder successfully was (1.00±1.03). Conclusions:MIBC patients who achieved noninvasive down-staging might be candidates for the bladder-sparing treatment with maximum TURBT followed by systemic chemotherapy.The patients who achieved pT 0 might have better prognosis with functional bladder.

Objective: To compare the recurrence rates between 755 nm Q-switched alexandrite laser (QSAL) treatment and surgical excision of oral melanotic macules (OMM). Methods: This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. A retrospective cohort study was designed to collect demographic and clinical characteristics and follow-up data from patients with OMM. Patients who received QSAL or surgical excision in the Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2019 to August 2021 were included. The one-year recurrence rate was investigated as the primary outcome. Long-term adverse reaction rates were investigated as safety indicators. Kaplan-Meier analyses were performed to analyze the recurrence-free rates between the groups. Results: A total of 57 patients were enrolled in this study. 16 patients underwent surgical excision, and 41 underwent QSAL. The baseline demographic and clinical characteristics between the groups were not significantly different. No recurrence (0%) of OMM was observed in the surgical excision group, while in the QSAL group, the macule recurred in 12 patients (29.27%). The average duration of recurrence was 6.08 months after treatment. Recurrence was not found to be associated with smoking (P = 1.000), gastrointestinal polyps (P = 1.000), longitudinal melanonychia (P = 0.187), family history (P = 0.552), treatment sessions (P = 0.567) or multiple macule lesions (P = 0.497). Compared with treatment with surgical excision, the odds ratio of recurrence for treatment with QSAL was 4.41, with a 95% confidence interval of 1.27-15.24 (P = 0.020). In the surgical excision group, 3 patients (18.75%) reported depressions and scars on the lesion, while no long-term adverse reactions (0%) were reported in the QSAL group (P = 0.019). Conclusion Compared with surgical excision, the advantage of QSAL is the low long-term adverse reaction rate, while the disadvantage is the relatively high one-year recurrence rate. It is necessary to communicate the advantages and disadvantages of the two methods with OMM patients to assist in clinical decision-making.