A 67-year-old male patient with intrahepatic bile duct carcinoma was treated with oxaliplatin (hepatic artery perfusion)+gemcitabine (hepatic artery perfusion)+camrelizumab (intravenous infusion)+apatinib (oral). Platelet count (PLT) decline (49×10 9/L) was observed after 2 months (apatinib had been discontinued by himself), which was improved after platelet elevating therapy. Due to multiple tumor metastases, bevacizumab (hepatic arterial perfusion, once per 30 days) was added. Before bevacizumab treatment, PLT and coagulation function of the patient were basically no abnormalities. After 2 cycles of treatments, the PLT was 101×10 9/L and prothrombin time was 14.1 s. Considering the high risk of bleeding in interventional therapy, oxaliplatin and gemcitabine were discontinued, and bevacizumab administration was changed to intravenous infusion. PLT and coagulation function were not improved. Six days after the 5th dose of bevacizumab, the patient had intermittent hematemesis twice (about 300 ml). Laboratory tests showed PLT 75×10 9/L and prothrombin time 15.8 s. The patient was diagnosed with digestive tract hemorrhage. Fasting and water restriction was performed, and gastric acid suppression, hemostasis, parenteral nutrition, etc. were given. The patient had no hematemesis but intermittent black stool. Gastroscopy indicated duodenal ulcer accompanied by bleeding. Rabeprazole and sucralfate were added. Fasting was stopped and liquid diet was given. The next day, the patient had blood in the stool, and the bleeding of the lower digestive tract was judged to be related to camrelizumab and bevacizumab. The bleeding symptoms were slightly improved after treatments with arterial embolization hemostasis and type A cryopprecipitation coagulation factor, etc. Later, the patient had repeated bleeding condition, and finally died despite of rescue efforts.

A 67-year-old male patient with intrahepatic bile duct carcinoma was treated with oxaliplatin (hepatic artery perfusion)+gemcitabine (hepatic artery perfusion)+camrelizumab (intravenous infusion)+apatinib (oral). Platelet count (PLT) decline (49×10 9/L) was observed after 2 months (apatinib had been discontinued by himself), which was improved after platelet elevating therapy. Due to multiple tumor metastases, bevacizumab (hepatic arterial perfusion, once per 30 days) was added. Before bevacizumab treatment, PLT and coagulation function of the patient were basically no abnormalities. After 2 cycles of treatments, the PLT was 101×10 9/L and prothrombin time was 14.1 s. Considering the high risk of bleeding in interventional therapy, oxaliplatin and gemcitabine were discontinued, and bevacizumab administration was changed to intravenous infusion. PLT and coagulation function were not improved. Six days after the 5th dose of bevacizumab, the patient had intermittent hematemesis twice (about 300 ml). Laboratory tests showed PLT 75×10 9/L and prothrombin time 15.8 s. The patient was diagnosed with digestive tract hemorrhage. Fasting and water restriction was performed, and gastric acid suppression, hemostasis, parenteral nutrition, etc. were given. The patient had no hematemesis but intermittent black stool. Gastroscopy indicated duodenal ulcer accompanied by bleeding. Rabeprazole and sucralfate were added. Fasting was stopped and liquid diet was given. The next day, the patient had blood in the stool, and the bleeding of the lower digestive tract was judged to be related to camrelizumab and bevacizumab. The bleeding symptoms were slightly improved after treatments with arterial embolization hemostasis and type A cryopprecipitation coagulation factor, etc. Later, the patient had repeated bleeding condition, and finally died despite of rescue efforts.

A 66-year-old female patient with infiltrating adenocarcinoma in left lung received anlotinib 12 mg orally once daily (2-week medication followed by 1-week discontinuation, 3 weeks was a cycle). After 14 months of regular medication, the patient developed palpitation and chest tightness. Laboratory tests showed that the N-Terminal pro-brain natriuretic peptid (NT-proBNP) was 1 698 ng/L; echocardiography showed decreased apical wall motion and left ventricular diastolic dysfunction. Heart failure was condsidered, which was suspected to be related to anlotinib. Anlotinib was stopped and symptomatic treatments were given. Eight days later, her symptoms above-mentioned were alleviated and NT-proBNP was 485 ng/L. Because of the illness condition, the patient took anlotinib again at original dose according to the doctor′s instructions. Three months later, the above symptoms recurred and ventricular fibrillation occurred suddenly. Considering that the heart failure in the patient might be caused by anlotinib. Anlotinib was stopped again. After 11 days of treatments with diuretics, cardiac function improvement, myocardial nutrition, and potassium supplement, the patient′s condition was improved obviously. After that, the patient did not take anlotinib again.

A 66-year-old female patient with infiltrating adenocarcinoma in left lung received anlotinib 12 mg orally once daily (2-week medication followed by 1-week discontinuation, 3 weeks was a cycle). After 14 months of regular medication, the patient developed palpitation and chest tightness. Laboratory tests showed that the N-Terminal pro-brain natriuretic peptid (NT-proBNP) was 1 698 ng/L; echocardiography showed decreased apical wall motion and left ventricular diastolic dysfunction. Heart failure was condsidered, which was suspected to be related to anlotinib. Anlotinib was stopped and symptomatic treatments were given. Eight days later, her symptoms above-mentioned were alleviated and NT-proBNP was 485 ng/L. Because of the illness condition, the patient took anlotinib again at original dose according to the doctor′s instructions. Three months later, the above symptoms recurred and ventricular fibrillation occurred suddenly. Considering that the heart failure in the patient might be caused by anlotinib. Anlotinib was stopped again. After 11 days of treatments with diuretics, cardiac function improvement, myocardial nutrition, and potassium supplement, the patient′s condition was improved obviously. After that, the patient did not take anlotinib again.

Objective To explore the change of serum thyroid hormone related indicators and the probability of occurrence of thyroid dysfunction abnormality in the patient with type 2 diabetes mellitus(T2DM).Methods 86 patients with T2DM and 61 age-matched and gender-matched individuals with healthy physical examination as controls were selected and detected serum FT3,FT4 and TSH by the electrochemiluminescence method Results The serum FT3,FT4 and TSH in the T2DM group were 5.09 pmol/L, 17.32 pmol/L and 2.81 mIU/L respectively;which in the normal control group were 4.99 pmol/L,17.24 pmol/L and 2.71 mIU/L respectively,the differences between the two groups had no statistical significance(P >0.05).Among 86 cases of T2DM,29 cases had the serum abnormal TSH with the abnormal rate of 33.7%,which in the control group was 14.8% with statistical difference between the two groups(P <0.05).Among T2DM patients,the TSH abnormal rate of in females was 42.1%,which was higher than 17.2% in males.Conclusion The serum thyroid hormone detection is necessary for the T2DM patients,especially female pa-tients,which is conducive to early screening,prevention and treatment.

Objective To study the mechanism of the hyperuricemia among the middle and elderly populations. Methods Serum uric acid, creatinine (Cr), blood urea nitrogen (BUN), fasting gluose (FG), total cholesterol (TC), triglyceride (TG) were detected in 1073 subjects with hyperuricemia and 1235 subjects with normal serum uric acid as control of middle and elder groups. Results The means of Cr, BUN, FG, TG ,TC in hyperuricemia were significantly higher than those in the control group,respectively (males: t′ =7. 508,P ＜0.05;t′ =9. 484,P ＜0.05;t=6.208,P＜0.05;t′ =7.055,P ＜0.05;t = 5. 097,P ＜0.05;females;t′ = 11.221,P ＜0.05;t′= 8.314,P ＜0.05 ;t =5. 641 ,P ＜0.05 ;t′ =8. 328 ,P ＜0.05 ;t =7. 227 ,P ＜ 0.05). In males,the mean of the BUN; FG and TG were significant different among the different age groups (the control group: F = 3. 500, P ＜ 0.05; F = 5. 607, P ＜0.05 ;F =3. 378,P ＜0.05 ;the hyperuricemia group: F= 15.400,P ＜0.05 ;F =5. 111 ,P ＜0.05 ;F = 11. 143 ,P ＜0.05), the positive rate of BUN, Cr, FG and TG were significant different among the different age groups (control group:χ2 = 17. 112,P ＜ 0.05;χ2 =7. 807,P ＜0.05 ;χ2 = 17. 829,P ＜0.05;χ2=8.433,P ＜0.05; hyperuricemia group:χ2 =35. 587,P ＜0.05 ;χ2 =83. 005 ,P ＜0.05 ;χ2 =41. 639,P ＜0.05 ;χ2 =31. 466,P ＜0.05). In the same age group,the mean and the positive rate of BUN and Cr were significantly higher in the hyperuricemia group than in the control group(P ＜ 0.05). The mean of TG was significantly higher in every age group of the hyperuricemia group than controls (P ＜ 0.05), but the positive rate had no significant differences in the age group of ≥ 70 years (P ＞0.05). The mean and the positive rate of FG and TC were significant differences in middle age group between the hyperuricemia and the control group (P ＜ 0.05), but were no differences in elder age group(P ＞ 0.05). In females,the mean and positive rate of Cr, BUN, FG,TG and TC were significant different in different age groups of the controls(BUN:F = 13. 759,P ＜0.05;χ2 = 19. 491 ,P ＜0.05; FG: F = 13. 554,P ＜0.05;χ2 = 33. 438,P ＜0.05;TG:F= 18. 160,P ＜0.05;χ2 = 16. 978,P ＜0.05;TC: F = 37. 647,P ＜0.05;χ2 =60.547,P ＜0.05) ,but in the hyperuricemia group that were only significant difference in BUN, Cr and TC (BUN:F = 5. 830, P ＜ 0.05; χ2 =11.941,P＜0.05;Cr:F=4.057,P ＜0.05;χ2 =20.097,P＜0.05;TC:F=7.934,P ＜0.05;χ2 = 16.405,P ＜0.05). In same age group compared of all the indices were similar with male. Conclusions The mechanism of serum uric acid increasing are different in middle age and elderly age. In middle age, it is metabolic disturbance. However,in elderly age it is descending of the kidney function.

BACKGROUND:Prosthesis selection for total hip replacement is determined by geometrical matching with femoral medullary cavity of patients and the optimal biodynamics.It is of great significance for elevating outcomes of total hip replacement.OBJECTIVE:To evaluate the biomechanics of four groups of femoral stem prostheses matched with a femar and to get a stem whose mechanics distribution is similar to the normal femur.DESIGN:Controlled observation.SETTING:Department of Orthopaedics of Oriental Hospital Affiliated to Tongji University,Department of Orthopaedics of Changhai Hospital of Second Military Medical University of Chinese PLA,and Department of Mechanical and Power Engineering of Shanghai Jiao Tong University.MATERIALS:Experiments were performed at the Laboratory of Life Quality and Machinery Engineering of Department of Mechanical and Power Engineering of Shanghai Jiao Tong University from December 2004 to October 2005.A male volunteer aged 40 years with the normal proximal ferout(175 cm height and 78 kg weight),free from hip disease,were selected.X-ray image of the eutopic femar was shot and wrote into memory in the format of DICOM.The volunteer signed an infonned consent.The experiment was approved by Hospital Ethical Committee.No.Ⅰ prosthesis,Zimmer versys Fiber Metal Taperl 1#,No.Ⅱ prosthesis,Plus APL 2#,No.Ⅲ prosthesis,Welink Ribbed system cementless01#,and No.Ⅳprosthesis,Lima F2L 1# were used in this study.METHODS:The ezDICOM software was used to read files with DICOM format of femoral X-ray image,which was converted into files with bmp format.The image files with bmp format of the proximal femar X ray were introduced with Matlab software after regulation,and the two-dimensional contour data of femar were extracted.Prosthesis matched with the template was set in PhotoShop 7.0 software.The two-dimensional contour data of prosthetic femar were extracted in MATLAB software.The ANSYS software was used to establish the model of geometrical and two-dimensional nonlinearity finite element ncluding femur and femur-femoral stem.Stress distribution in the proximal femur was analyzed and compared by loading.MAIN OUTCOME MEASURES:Stress istribution of the proximal femur.RESULTS:Stress value and distribution of No.Ⅰ prosthesis and No.Ⅳ prosthesis in proximal femur were similar to the normal femar.Moreover,No.Ⅰ prosthesis was better than No.Ⅳ prosthesis.CONCLUSION:The biomechanics of femoral stem prostheses has been evaluated by analyzing and comparing the two-dimensional biomechanics of the femoral stem prostheses based on X-ray and template,which can offer support in optimal rosthesis selection.

Objective To evaluate, the long-term results of pacemaker implantation in 122 elderly patients. Methods A long-term follow-up was carried out in 122 elderly patients (≥ 70 years old, elderly group)and 109 non-elderly patients (< 70 years old,non-elderly group)who received pacemaker implantation. The elinical characteristics, complications and quality of life were compared. Results The mean follow-up time was (8.22±6.01) years and (7.74±5.82) years respectively. The successful rate of the follow-up was 100%. The overall postoperative complications about pacemaker pocket and the prevalence of atrial fibrillation occurred in elderly group were higher than those in non-elderly group (4.10% vs 0, 21.31% vs 10.09%, P< 0.05).The heart function failure was the main cause of the death in elderly group. The stroke and uremia were the main causes of the death in non-elderly group. There was no significant difference in the improvement of the life quality in both groups (P>0.05). Conclusions The pacemaker implantation is a safe and effective therapy for treatment of elderly patients with bradyeardia, and can improve the quality of elderly patients' life. Optimal mode for elderly patients will be given according to the physiological characteristics and the types of bradycardia.

BACKGROUND: Fracture healing occurrs by two ways: healing by first intention and healing by second intention, with the latter one similar to natural healing process. It has been proved that only 37% tibial farcture can reach healing by first intention, even it is fixed with strong AO steel plate. Different materials for intramedullary fixation have different influences on callus formation and callus content in the process of fracture healing.OBJECTIVE: To explore the influences of different internal fixations on callus formation and content in the course of fracture healing analysis with X ray computer image.DESIGN: Randomized controlled trialSETTING: At the Department of Orthopeadics of Changhai Hospital Affiliated to the Second Millitary Medical University of Chinese PLA and the Experimental Animal Center of the Second Millitary Medical University of Chinese PLA.MATERIALS: This study was carried out at the Experimental Animal Center and Orthopeadic Laboratory of the Second Millitary Medical University of Chinese PLA between March 2000 and July 2001. Totally 51New Zealand rabbits were randomly selected without gender limitation and divided, accccording to intermeduallry nails, into three groups with 17 rabbits in each group: rectangle-shaped intramedullary nails (RIN), Ender's nails (END) and stainless steel plates (SPL) groupsMETHODS: Fracture models were succccesufly established on rabbits.And then intramedullary nails were fixed 2 mm below the border of left tibial and fibula without exopexy. Positve and lateral X-ray films of each operational tibia were obtained at postoperational 2,3,4,8,12 weeks.Three rabbits in each group were killed for callus observation with naked eyes, and the maximal callus diameter at different time points was measured. The X-ray films at different periods were read carefully and quanatatively analyzed with computor image analysis system (lAS). The difference was compared with the analysis of variance and SNK test.MAIN OUTCOME MEASURES: The maximal callus diameter was determined with X-ray image at different time points so as to calculate the corrssponding integral of callus grey level.RESULTS: Totally 51 rabbits were enrolled in this study, 6 missed the experiment because 4 died for diarrhea and other two has exposed bone due to local infection, and then two rabbits were derived from each group; thereby, data of 45 rabbits were subjecte to the final statistical to the epak at postoperational 8 weeks; it was the longest in RIN group of the same stage,followed by Ender group and SPL group [(11.24±0.38), (10.86±0.65), (8.12±0.36) mm at postoperatively 4 weeks; ( 13.56±0.88 ), (12.84±0.20), (10.52±0.68) mm at postoperatively 8 weeks; ( 12.66±0.65 ), ( 11.84±0.55 ), (9.68±0.27) mm at postoperatively 12 weeks]. The difference between RIN, Ender and SPL was statistically significant, but the difference between the former two was unobvigroup; at the same postoperational time point, the intergral of callus grey level was the highest in RIN group, followed by Ender group and SPL group (89.11 ± 1.05,86.42±3.12,47.28 ± 1.57 at postoperatively 4weeks;159.69 ±3.64,148.72 ±1.68,79.63 ±2.41 at postoperatively 8 weeks;192.46 ±4.96,186.53 ±1.84,107.34 ±2.37 at postoperatively 12 weeks),The difference between RIN, Ender and SPL was obvious and moreover,the difference between RIN and Ender was significant at 8th week.CONCLUSION: The callus content in RIN and Ender group were higher than that in SPL group at each postoperational time point, which benefited for fracture healing. Callus content examination is a traditional means for the judgement of fracture healing. It prossesses that properties of intuition and persicuity, reliability, simplicity and practicibility. Moreover, subjectivity could be avioided if used in combination with X-ray image analysis system, since the digital management can help judging not only callus content but also callus quality, which may provide guidance for clinical treatment.

Objective To investigate the effects of continuous passive motion (CPM) protocols on outcomes of total knee arthroplasty. Methods Seventy-two patients who underwent total knee arthroplasty were divided into 2 groups and treated with different CPM protocols: group 1 with CPM from 0 degree to 40 degrees and increased by 10 degrees per day, while group 2 with CPM from 90 degrees to 50 degrees (early flexion) and gradually progressed to full extension over a 4-day period. The CPM was administered twice a day for 1 hour over a 7-day period. All the patients participated in the same postoperative physiotherapy program. Results Group 2 (the early flexion group) had significantly more range of motion than group 1. Conclusion The early flexion can help achieve favorable functional gain after total knee arthroplasty.