Adult ; Bone Neoplasms ; pathology ; surgery ; Female ; Giant Cell Tumor of Bone ; pathology ; surgery ; Humans ; Patella

Objective To study and evaluate the therapeutic efficacy of CT-guided radioactive 125Iseeds implantation combined with percutaneous vertebroplasty for spinal vertebra metastases.Methods Fifteen patients and 21 lesions were enrolled in this study.Based on the CT images,a computer-based treatment planning system (TPS) was used to determine the optimal seeds distribution.Under CT-guided,radioactive 125I seeds were implanted into the lesions.Based on the X-ray and CT image after the implantation,quality check was carried out with TPS.The ostalgia-relieving degree and the image alterations of the spinal vertebra metastases lesions were observed.Two months later,15 patients underwent percutaneous vertebroplasty with DSA guidance,bone cement was made according to the ratio methyl acrylic resin polymer/liquid methyl acrylic resin monomer/contrast as 3 ∶ 2 ∶ 1 in injecting paste form.The puncturation through pedicle of vertebral arch and lateral posterior body of vertebra was both adopted in thoracic and lumbosacral vertebrae site.After making sure that the puncturation was completed and there was no leakage in vertebral body,the bone cement was injected into vertebral body quickly.Results Accepted radioactive 125I seeds plantation,relief of pain was obtained.Among 15 patients,8 patients were powerful,6 patients were effective and 1 patient was inefficiency.After treatment,the pain grading significantly decreased.After treatment for 2 months,CT was used to recheck,7 lesions were local controlled,12 lesions had no changes,2 lesions were progress.The responsive rate was 90.5％ (19/21).No serious side-effect happened.Conclusions Radioactive 125I seeds implantation can be a safe and effective method in treating spinal vertebra metastases and obtaining good clinical effects with minimal damage and few complications.Percutaneous vertebroplasty can strengthen the target and relief pain quickly.CT-guided radioactive 125I seeds implantation combined with percutaneous vertebroplasty for the treatment of spinal vertebra metastases has complementary advantages.

OBJECTIVETo investigate the mothod and therapeutic efficacy of total hip anthroplasties (THA) for osteoarthritis secondary to Crowe type IV developmental dysplasia of hip in adults.

METHODSFrom May 2006 to December 2013, THA was performed on 15 adult patients (17 hips) with Growe type IV acetabular dysplasia, including 13 females and 2 males, with a mean age of 30.9 years old (22 to 58 years old) and an average preoperative Harris score of (34.0 ± 6.5) points. Traction of the affected limb was not performed before surgery. After extensive release and lengthening of soft tissues, sub-trochanteric osteotomy of the femur was performed, hip joint center was rebuilt and the abduction function was restored.

RESULTSThe patients were followed up with a mean period of 33 months (ranged from 6 months to 5 years). The postoperative Harris score was 85.0 ± 7.3,higher than the preoperative score. The extended length of limb ranged from 1.6 to 5.4 cm, with a mean of (3.42 ± 0.65) cm. The shortening and malformation of the affected limb were corrected in the most patients,with the difference in length of the two legs less than 1.5 cm. After surgery, 1 patient experienced partial sciatic nerve injury, which was largely recovered after 3 months of conservative treatment. One patient experienced complete sciatic nerve injury, which was partially recovered after 6 months of conservative treatment; a foot-drop varus deformity was formed in the distal end of the affected limb, which was improved after tendon transposition and transplantation. Joint pain was relieved, and the joint function was restored significantly. Over the follow-up period, no severe complications such as dislocation, infection, prosthesis loosening, or subsiding occurred.

CONCLUSIONSatisfactory efficacy can be achieved for adult Growe type IV acetabular dysplasia associated with osteoarthritis by THA, with proper soft tissue release and lengthening, sub-trochanteric osteotomy of femur, joint functional restoration, appropriate choice of prosthesis, and careful protection of nerves and vessels.

Adult ; Arthroplasty, Replacement, Hip ; methods ; Female ; Hip Dislocation, Congenital ; complications ; Humans ; Leg Length Inequality ; therapy ; Male ; Middle Aged ; Osteoarthritis, Hip ; surgery

Objective To observe the clinical effects of ornithine aspartate (OA) and lactulose on the prevention and treatment of hepatic encephalopathy for patients with portal hypertension after modified transjugular intrahepatic portosystemic shunt (TIPS).Methods Fifty-six patients with portal hypertension were treated by modified TIPS,OA and lactulose after the operation were given,the incidence of postoperative hepatic encephalopathy and the changes of blood ammonia were observed.Patients with hepatic encephalopathy after modified TIPS accepted therapeutic dosage of OA and lactulose,and the clinical effects of combined OA and lactulose on treatment of the hepatic encephalopathy after modified TIPS and changs of blood ammonia were evaluated as well.Results Prophylactic use of combined OA and lactulose after modified TIPS,there was no hepatic encephalopathy happened in 56 patients.Hepatic encephalopathy was seen in 5 patients after discontinuation of combined OA and lactulose,the incidence rate of hepatic encephalopathy was 8.93％ (5/56).The level of blood ammonia in patients after modified TIPS was significanby higher than that before treatment [(88.2 ± 23.0) μ mol/L vs.(43.1 ± 19.2) μ mol/L,P ＜ 0.05].Five patients with hepatic encephalopathy was improved quickly after given therapeutic dosage of OA and lactulose (the average treatment time was 7 d),and the level of blood ammonia was significantly lower than before treatment [(69.1 ± 14.1) p mol/L vs.(139.2 ± 15.8) μ mol/L,P＜ 0.05].Conclusion Combined OA and lactulose can effectively prevent and treat the hepatic encephalopathy after modified TIPS,its mechanism may be associated with reduction of blood ammonia level.

Objective To evaluate the outcome of super-selective embolization of renal artery for severe hemorrhage after minimally invasive percutaneous nephrohthotomy (MPCNL) and its effect on renal function.Methods Super-selective embolization of renal artery were performed in 9 patients with kidney hemorrhage followed by MPCNL.Results Seven patients were cured after the first time of embolization and 2 patients were treated successful after the second time.The main renal function was reserved.There was no serious complication after intervention.Condusiom Super-selective embolization of renal artery is reliable and effective in the diagnosis and treatment of kidney hemorrhage followed by MPCNL and in keeping main function of the kidney.It' s a safe and effective method in the treatment of severe hemorrhage after MPCNL.

Adult ; Aged ; Cervical Vertebrae ; diagnostic imaging ; Female ; Humans ; Magnetic Resonance Imaging ; instrumentation ; methods ; Male ; Middle Aged ; Radiography ; Spinal Osteophytosis ; diagnosis ; diagnostic imaging ; Young Adult

OBJECTIVETo evaluate the effect and safety of L-carnitine in the treatment of idiopathic oligoasthenozoospermia based on current clinical evidence.

METHODSWe searched the Cochrane Library, PubMed, MEDLINE, EMBASE, CNKI, VIP, CBM and Wanfang Database from the establishment to April 2014 for the published literature on the treatment of idiopathic oligoasthenozoospermia with L-carnitine. We conducted literature screening, data extraction, and assessment of the methodological quality of the included trials according to the inclusion and exclusion criteria, followed by statistical analysis with the RevMan 5. 2 software.

RESULTSSeven randomized controlled trials involving 751 patients with idiopathic oligoasthenozoospermia met the inclusion criteria, and 678 of them were included in the meta-analysis. L-carnitine treatment achieved a significantly increased rate of spontaneous pregnancy as compared with the control group (RR = 3.2, 95% CI 1.74 to 5.87, P = 0.0002). After 12-16 and 24-26 weeks of medication, total sperm motility (WMD = 5.21, 95% CI 2.78 to 7.64, P < 0.0001 and WMD = 9.29, 95% CI 1.28 to 17.29, P = 0.02) and the percentage of progressively motile sperm (WMD = 12.44, 95% CI 4.58 to 20.31, P = 0.002 and WMD = 9.76, 95% CI 3.56 to 15.97, P = 0.002) were remarkably higher than those in the control group, but no statistically significant differences were observed in sperm concentration between the two groups (WMD = 4.91, 95% CI -2.63 to 12.45, P = 0.2 and WMD = 0.93, 95% CI -3.48 to 5.34, P = 0.68). After 12-16 weeks of treatment, the percentage of morphologically abnormal sperm was markedly decreased in the L-carnitine group as compared with the control (WMD = -2.48, 95% CI -4.35 to -0.61, P = 0.009), but showed no significant difference from the latter group after 24-26 weeks (WMD = -4.38, 95% CI -9.66 to 0.89, P = 0.1). No statistically significant difference was found in the semen volume between the two groups after 12-16 or 24-26 weeks of medication (WMD = -0.13, 95% CI -0.43 to 0.18, P = 0.42 and WMD = 0.28, 95% CI -0.02 to 0.58, P = 0.07). No serious L-carnitine-related adverse events were reported in 4 of the randomniized controlled trials.

CONCLUSIONThe current evidence indicates that L-carnitine can improve spontaneous pregnancy and semen parameters in the treatment of idiopathic oligoasthenozoospermia, with no serious adverse reactions.

Asthenozoospermia ; drug therapy ; Carnitine ; adverse effects ; pharmacology ; Female ; Humans ; Male ; Pregnancy ; Pregnancy Rate ; Randomized Controlled Trials as Topic ; Semen Analysis ; Sperm Count ; Sperm Motility

OBJECTIVETo observe the clinical effects of combined type external fixator in treating complex tibial metaphyseal fractures.

METHODSFrom January 2007 to July 2012, 34 patients with complex tibial metaphyseal fractures were treated with combined type external fixator in different stagings. There were 23 males and 11 females, with a mean age of 41.3 years (ranged, 16 to 63), and the course of disease were from 1 h to 8 d. In the patients, 31 cases were open fractures, 11 cases with type II, 13 cases with type III A, 7 cases with type III B according with Gustilo classification; 19 cases were tibia plateau fractures, 6 cases with type II, 1 case with type IV, 5 cases with type V, 7 cases with type VI according to Schatzker classification; 15 cases were distal tibial fractures (one were bilateral fractures), 2 fractures with type A2, 1 fracture with type A3, 1 fracture with type C1, 5 fractures with type C2, 7 fractures with type C3 according to AO classification. Rasmussensn scoring system and AOFAS Ankle Hind-foot Scale were respectively used to assess the joint function of knee and hip.

RESULTSWound surface of 19 patients obtained at phase I healing and 15 patients obtained at phase III healing. Superficial wound infections occurred in 2 cases and bone non-union necessitated reoperation occurred in 2 cases (final fractures obtained bone healing after the second operation). All patients were followed up from 6 to 38 months with a mean of 14.3 months. At the final follow-up,according to Rasmussensn scoring system, 5 fractures got excellent results, 11 good, 3 fair, the mean Rasmussen score was 23.58 +/- 3.98; according to AOFAS Ankle Hind-foot Scale, 5 fractures got excellent results, 8 good, 3 fair, the mean AOFAS Ankle Hind -foot Scale was 80.75 +/- 14.21.

CONCLUSIONCombined type external fixator can well maintain the stability of the fractures, had advantages of low incidences of soft tissue complications and less influence to joint motion in treatment of complicated tibial metaphyseal fractures. However there were some limitations in long-term use.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Fracture Fixation ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Radiography ; Recovery of Function ; Tibial Fractures ; diagnostic imaging ; physiopathology ; surgery ; Treatment Outcome ; Young Adult

In 2011, the FDA approved ipilimumab, the first immune checkpoint inhibitor(ICI), targeting CTLA-4, opening the field of immune checkpoint therapy (ICT). ICIs can induce durable clinical responses and improve survival in selected population. However, significant challenges still remain, including mechanisms of resistance, patient selection, management of serious immune-related adverse events, and rational therapeutic combinations. This review surveys the current understanding of response and resistance to ICIs and proposes a path forward to improving efficacy and minimizing toxicities.