Evaluation Of Clinical Effects Research Articles

Clinical evaluation of the effect of bladder-sparing therapy combined with gemcitabine and cisplatin for muscle invasive bladder cancer

Objectives To investigate clinical efficacy and adverse reactions of bladder-sparing therapy combined with emcitabine and cisplatin (GC) for muscle invasive bladder cancer (MIBC) . Methods 30 patients with MIBC underwent transurethral resection of the bladder tumor(TURBT) in our hospital from January 2008 to December 2010 were collected. The tumor staging was T2aN0M0~T3aN0M0 , and maximum tumor diameter was less than 4cm, single or multiple. The GC chemotherapy was given by gemcitabine (1000mg/m2 ) on day 1 and day 8, cisplatin (30mg/m2 ) on day 2 and day 4. The regimen was repeated every 21 days, Results 30 patients were followed up for average 36 months, 20 patients remained recurrence and metastasis free, 10 cases recurred, 2 cases recurred after 2 cycles of chemotherapy, and again underwent TURBT after four cycles of chemotherapy, without recurrence during follow-up.4 patients received radical cystectomy, 4 patients received radiotherapy after TURBT, and 2 patients died of tumor recurrence.No patients with serious side effects of chemotherapy were included and well tolerable. Conclusions Bladder-sparing therapy combined with gemcitabine and cisplatin in treatment of patients with muscle invasive bladder cancer who underwent TURBT, which would significantly improve the curative effect and reduce recurrence of tumor, compared with total cystectomy, which could be easily accepted by the patients, improve the quality of life of patients and provide a new way for the patients who unable or unwilling to underwent radical cystectomy. Key words: Urinary Bladder Neoplasms; Cystectomy; Cisplatin

Evaluation of clinical practice effect in master of nursing specialist

Objective To explore the effect of clinical practice on clinical practice ability in master of nursing specialist and evaluation measures of the clinical practice ability. Methods A total of 17 masters of nursing specialist engaged in clinical practice were selected in the First Affiliated Hospital of Xinjiang Medical University from March 2014 to February 2016. They were cultivated with two-level management methods of instruction between tutors and clinical teachers along with following up the requirements of Nursing Postgraduates Clinical Practice Handbook . The clinical practice ability evaluation form of master of nursing specialist was used to evaluate the clinical practice ability of 17 postgraduates from 4 aspects including graduate teachers, clinical teachers, classmates, self evaluation from 360° feedback. Results After clinical practice, the score of 4 aspects and the total score of clinical practice ability were higher than those before clinical practice with significant differences (P 0.05). Besides, the results revealed that there were statistically significant differences in the evaluation of practice ability of nursing and teaching management ability (P<0.05). In addition, the score of practice ability of nursing care and management capacity of teaching evaluated by classmates were higher than those evaluated by other subjects (P<0.05). Conclusions Scientific clinical practice teaching mode of master of nursing specialist can effectively improve clinical practice ability of postgraduates. Besides, the 360°feedback can be seen as an effective tool to objectively and fairly evaluate clinical practice ability of high-quality and utility-type nursing talents. Key words: Master of nursing; Professional degree; 360° feedback; Clinical practice ability

Evaluation of the clinical effect of ropivacaine on caesarean operation

Objective To explore the toxic effect and application safety of ropivacaine after transversus abdominis plane block for caesarean section. Methods Sixty cases puerperas who were suffered with transversus abdominis plane block for caesarean section in the People’s Hospital of Yan’an were retrospectively analyzed.Blood sample was collected after TAP block at different times and at the same time asked if they had neurotoxicity.The collected blood was measured for the concentration of ropivacaine.The ages, weight, height, BMI and total doses of ropivacaine were compared, and the mean total peak ropivacaine concentrations and the mean time to the maximum concentration in symptomatic and asymptomatic puerperas were compared to assess the reasonable threshold for clinical in symptomatic puerperas and suitable ropivacaine concentration. Results The BMI and total doses of ropivacaine of symptomatic group was (70.30±7.90) kg, (225.80±17.60) mg, significantly higher than the asymptomatic group((62.60±12.40) kg, (189.00±22.40) mg), the differences were significant(t=4.613, 7.143, P<0.05). The mean total peak ropivacaine concentrations in symptomatic group was increased compared with asymptomatic group((2.82±0.55) mg/L vs. (1.33±0.47) mg/L, t=0.779, P<0.05), and the mean time to the maximum concentration in symptomatic group was decreased compared with asymptomatic group((26.80±5.40) min vs. (39.20±6.30) min, t=4.158, P<0.05). Conclusion There is a certain neurotoxicity when applying ropivacaine after transversus abdominis plane block for caesarean section.Ropivacaine concentration 2.2 kg/ml as a reasonable threshold for clinical toxicity in puerperas undergoing TAP block, and 2.5 mg/L ropivacaine is fit for puerperal on lean body mass, and further reduction may be required as puerperal weight increases. Key words: Caesarean; Ropivacaine; Transversus abdominis plane

Application of three-dimensional digital technology in the diagnosis and treatment planning in orthodontics

Three-dimensional(3D)digital technology has been widely used in the field of orthodontics in clinical examination, diagnosis, treatment and curative effect evaluation. 3D digital technology greatly improves the accuracy of diagnosis and treatment, and provides effective means for personalized orthodontic treatment. This review focuses on the application of 3D digital technology in the field of orthodontics.

Clinical and radiographic evaluation of effect of risedronate 5 mg as an adjunct to treatment of chronic periodontitis in postmenopausal women (12-month study)

Bisphosphonates are beneficial to women, after menopause, in treatment of gum diseases. In this study, significant improvement in the disease condition was found and that no further progress was noted, and no side effects were reported. Bisphosphonates can be safely and successfully be used to support oral health procedures. The purpose of this study was to evaluate host modulating effect of bisphosphonate adjunct with the treatment of chronic periodontitis in osteopenic and osteoporotic postmenopausal women. Twenty-two osteopenic and osteoporotic postmenopausal women with moderate to severe chronic periodontitis were selected for the study. On intraoral examination, periodontal parameters like probing depth (PD), clinical attachment level (CAL), Plaque Index (PI) and Gingival Index (GI) were recorded. Scaling and root planing were done. Intraoral periapical X-rays were taken, and alveolar bone density (ABD) was measured with cone beam computed tomography (CBCT), and then, medications (risedronate 5mg once daily (OD), calcium citrate 250mg OD, vitamin D 400IU OD) were given. Patients were recalled for follow-up at 3, 6 and 12months. Intraoral periapical (IOPA) X-rays were taken at 6 and 12months and ABD was measured at baseline and 12months. There was a significant improvement in all the parameters. There was an increase of 0.02 ± 0.001cm on CT scan and 0.38 ± 0.005mm on IOPA in bone height over 12months from baseline. Bone density increased by 118.56 ± 3.251 Hounsfield units (HU). There was no progress in the disease, and further bone loss was not noticed. This is in correlation with clinical parameters which showed highly significant gain in CAL (3.57 ± 0.234mm) and reduction in PD (2.20 ± 0.229mm) Bisphosphonate therapy as an adjunct to scaling and root planing may have significant beneficial clinical effects on the periodontium of postmenopausal women with moderate to severe chronic periodontitis.

Clinical Evaluation of Effects of Chronic Resveratrol Supplementation on Cerebrovascular Function, Cognition, Mood, Physical Function and General Well-Being in Postmenopausal Women-Rationale and Study Design.

Background: This methodological paper presents both a scientific rationale and a methodological approach for investigating the effects of resveratrol supplementation on mood and cognitive performance in postmenopausal women. Postmenopausal women have an increased risk of cognitive decline and dementia, which may be at least partly due to loss of beneficial effects of estrogen on the cerebrovasculature. We hypothesise that resveratrol, a phytoestrogen, may counteract this risk by enhancing cerebrovascular function and improving regional blood flow in response to cognitive demands. A clinical trial was designed to test this hypothesis. Method: Healthy postmenopausal women were recruited to participate in a randomised, double-blind, placebo-controlled (parallel comparison) dietary intervention trial to evaluate the effects of resveratrol supplementation (75 mg twice daily) on cognition, cerebrovascular responsiveness to cognitive tasks and overall well-being. They performed the following tests at baseline and after 14 weeks of supplementation: Rey Auditory Verbal Learning Test, Cambridge Semantic Memory Battery, the Double Span and the Trail Making Task. Cerebrovascular function was assessed simultaneously by monitoring blood flow velocity in the middle cerebral arteries using transcranial Doppler ultrasound. Conclusion: This trial provides a model approach to demonstrate that, by optimising circulatory function in the brain, resveratrol and other vasoactive nutrients may enhance mood and cognition and ameliorate the risk of developing dementia in postmenopausal women and other at-risk populations.

Progress in research of pragmatic-explanatory continuum indicator summary

Randomized controlled trial (RCT) can be designed as explanatory trial and pragmatic/practical trial (PCT) for clinical effect evaluation. The pragmatic/practical trial reflects the intervention effect under actual clinical condition, which has relatively good extrapolation, but its internal validity is relatively poor. In contrast, explanatory trials conducted under ideal conditions have better inner validity but inferior external validity. However, in the design of RCT, PCT and explanatory trials are not always opposite. Many RCTs have the properties of the two designs at the same time, Pragmatic-explanatory continuum indicator summary (PRECIS) can be used in the design of RCT for the balance between internal validity and external validity. There are few available reports about the application of PRECIS in China at present, so this paper summarizes the basic principles, characteristics of PRECIS and the application of PRECIS in order to provide reference for the clinical trial design in China.

Pharmacogenetic Testing for Analgesic Adverse Effects: Pediatric Case Series.

Genetic variants in pharmacokinetic genes can alter the effectiveness and increase the risks of using analgesics to treat pain. The purpose of this retrospective study is to describe the clinical experiences that led to pharmacogenetic testing of pediatric pain management program patients for alterations in the CYP2D6, CYP2C19, and CYP2C9 genes and correlate the analgesic efficacy and adverse analgesic effects with the gene-specific findings and Metabolic Reserve (MR) index. Nineteen patients were referred for pharmacogenetic testing between February 2010 and December 2013 due to analgesic ineffectiveness or adverse analgesic effects. CYP2D6, CYP2C19, and CYP2C9 functional status was inferred from genotyping; and MR calculated. Data from the available inpatient and outpatient medical records from January 2007 to May 2014 for these patients were reviewed and extracted to characterize patient analgesic response phenotype. Significant CYP2D6 genetic variants were identified in 16 of the 19 (84%) patients: 4 were ultra-rapid metabolizers, 8 were deficient, 3 were poor metabolizers, and 1 was CYP2D6 null metabolizer. Of the 3 patients with functional CYP2D6 status, 2 were CYP2C19 null metabolizers. The MR scores ranged from 3.0 to 7.0, with a bimodal distribution with high frequencies corresponding to 4.0/4.5 and 7.0. Clinical evaluation of analgesic ineffectiveness and adverse effects led to the high likelihood of identifying patients with CYP2D6, CYP2C19, and CYP2C9 alleles associated with alterations in analgesic metabolism. Further research is needed to integrate pharmacogenetic and clinical information into anticipatory guidance for pharmacogenetic testing and analgesic prescribing to children with pain.

Evaluation of clinical effects of Jiawei Tongxie Yaofang decoction in treatment of irritable bowel syndrome based on brain-intestinal axis theory

Evaluation of clinical effects of Jiawei Tongxie Yaofang decoction in treatment of irritable bowel syndrome based on brain-intestinal axis theory

Evaluation of Clinical and Electrophysiological Effects of Electrical Stimulation on Spasticity of Plantar Flexor Muscles in Patients with Stroke

Evaluation of Clinical and Electrophysiological Effects of Electrical Stimulation on Spasticity of Plantar Flexor Muscles in Patients with Stroke

Adjunctive use of interferon γ inducer for treatment of patients with schizophrenia

The present paper is devoted to evaluation of clinical and immunomodulatory effect of ultra-high dilutions of antibodies to human interferon γ, included in the complex therapy of patients with schizophrenia. Materials and methods The study was carried out at the Mental Health Research Institute, Tomsk, Russian Federation. This double-blind, placebo-controlled randomised in parallel-group study enrolled 40 patients. As a part of complex therapy, patients from the main group (n=20) received anaferon, a drug containing ultra-high dilutions of affinity-purified antibodies to human interferon γ as the active pharmaceutical ingredient; patients from the comparative group (n=20) received placebo. Duration of the therapy was 30±5 days. Assessment of severity of symptoms and changes in them were made using clinical scales: Positive and Negative Syndrome Scale, Clinical Global Impression, Abnormal Involuntary Movements Scale. Spontaneous and phytohemagglutinin-induced production of interferon γ by immunocompetent cells in supernatants of 48 h whole blood culture of patients was measured by enzyme-linked immunosorbent assay (ELISA) method. The reduction of interferon-producing potential by immunocompetent cells in comparison with reference normal value was shown in total group of patients (n=40) before combined therapy. During the treatment, increase of spontaneous interferon γ production and favourable changes in psychopathological symptoms as compared with placebo were shown in subjects receiving anaferon. It was found that favourable changes in clinical symptoms assessed using clinical scales with a high degree of confidence correlated with high level of spontaneous interferon γ production. Anaferon as a part of complex therapy of patients with schizophrenia contributes to enhancement of its efficacy acting via mechanism of psychoimmunomodulation.

A clinical evaluation of bleeding patterns, adverse effects, and satisfaction with the subdermal etonogestrel implant among postpartum and non-postpartum users.

The etonogestrel implant (Implanon; Merck Sharp and Dohme, Kenilworth, NJ, USA) is an effective contraceptive with a good safety profile for up to 3 years [1]. However, its adverse effects include irregular vaginal bleeding (affecting 68.0% of users), weight gain (20.7%), acne (15.3%), breast pain (9.1%), and headache (8.5%) [2]. To provide further information about contraception options for women in the postpartum period, the aim of the present study was to investigate the bleeding patterns and adverse effects reported by women who underwent Implanon insertion within 8 weeks of delivery and compare them with those experienced by non-postpartum women. A prospective study was undertaken at Hospital Tengku Ampuan Afzan, Pahang, Malaysia, between July 1, 2010, and June 30, 2012. Women attending the postnatal clinic or family planning/gynecology clinic who met WHO medical eligibility criteria 1 and 2 (no medical restriction for use of contraception or advantages of using contraception outweigh the risks) [3] were enrolled. Nulliparous women and women who had last delivered 8 weeks to 6 months previously were excluded. The institutional ethical committee approved the study and informed consent was obtained from participants. Participants were divided into two groups. Women in the postpartum group had delivered up to 8 weeks previously and underwent Implanon insertion 4–8 weeks after delivery. Women in the non-postpartum group had last delivered at least 6 months previously and underwent Implanon insertion between day 1 and day 5 of menses. Baseline body weight was recorded for each participant. Follow-up visits were scheduled at 3 and 6 months. Bleeding patterns were categorized using the WHO 90-day reference period [4]. Non-menstrual adverse effects and satisfaction were recorded at 6 months. Data were analyzed using SPSS version 20.0 (IBM, Armonk, NY, USA). The Student t test and Fisher exact test were used to compare variables. P < 0.05 was considered statistically significant. A total of 110 women were included in the study, 60 in the postpartum group and 50 in the non-postpartum group. There were no differences in bleeding patterns between the groups at 3 months (Table 1). However, at 6 months, amenorrhea was significantly more common in the postpartum group than in the non-postpartum group (P = 0.005), and infrequent bleeding was more common in the non-postpartum group (P = 0.024) (Table 1). With regard to non-menstrual adverse effects, headache and acne were significantly more common in the non-postpartum group than in the postpartum group (P = 0.001 and P = 0.040, respectively) (Table 1). There were no significant differences for other adverse effects. Weight gain was the most frequent adverse effect, but there was no significant difference between groups (Table 1). Most users from both groups were satisfied with Implanon, with no difference in terms of satisfaction between groups ( Table 1). This finding implies that most women who experienced adverse effects were able to tolerate them. In conclusion, the present study has shown that bleeding patterns and non-menstrual adverse effects can differ according to timing of Implanon insertion after delivery. However, despite menstrual irregularities and other adverse effects, Implanon was well accepted in both groups.

Clinical effect and safety evaluation of elective surgery applying in obstructive colon cancer

Objective To investigate the clinical effect and safety of elective surgery applying in obstructive colon cancer, to provide a reference for clinical surgery. Methods 70 patients with obstructive colon cancer were selected, they were divided into control group and observe group, 35 cases in each group.Surgery was used right after patients were diagnosed in the control group, conservative treatment was used in the observation group before surgery.The clinical effect and safety were compared between the two groups. Results The rate of colon cancer excisionⅠperiod anastomosis in the observation group was 91.43%(32/35), which was higher than the control group(54.29%), the difference was statistically significant(χ2=9.456, P=0.001). The incidence rates of ileocolic anastomosis and colostomy of the observation group were 2.86%, 5.71%, which were lower than those of the control group, the differences were statistically significant(χ2=12.328, P=0.000; χ2=7.983, P=0.003).5 patients of the observation group had 6 complications, the incidence rate of complication was 14.29%, 20 patients of the control group had 25 complications, the incidence rate of complication was 57.14%, the difference was statistically significant(χ2=8.885, P=0.002). Conclusion Elective surgical disposable eradication rate is higher applying in obstructive colon cancer patients with good safety, which could be a priority in clinical application. Key words: Colon cancer; Surgical operation

Clinical Characteristics and Treatment of Trigeminal Neuralgia Following Herpes Zoster.

The aim of this study was to illustrate the clinical characteristics and treatment of trigeminal neuralgia following herpes zoster. From August 1, 2011 to August 1, 2013, 23 consecutive patients with trigeminal neuralgia following herpes zoster underwent microvascular decompression (MVD) at our cranial nerve disease center. All patients underwent preoperative MRI evaluation, intraoperative observation, and clinical effect evaluation. Clinical data were collected and analyzed in our center. V2 division was the most commonly affected branch. Unlike pretrigeminal neuralgia (PTN), trigger zone was only found in a small part of patients (21.7%). Unlike PTN, the adhesions and compressions between trigeminal nerve and offending vessels were usually not serious; trigeminal nerve usually is atrophic; superior cerebellar artery was the most common offending vessels (65.2%). Of 23 patients, 19 experienced pain relief (82.6%), 1 patient suffered from hearing loss, and another one suffered from cerebrospinal fluid leak; no severe complications were found. During follow-up period, no recurrence was found (3 lost). For patients who suffered from trigeminal neuralgia following herpes zoster, trigger zone was only found in a small part of patients. The trigeminal nerve usually is atrophic; microvascular decompression was equally applied to these patients if vessel compression was confirmed.

Effect of partial foraminotomy after laminoplasty surgery on preventing C5 nerve root palsy

Objective To investigate clinical curative effect of partial foraminotomy after C4,5 ossification of posterior longitudinal ligament (OPLL) on preventing C5 nerve root palsy. Methods A total of 155 patients with OPLL were treated with expansion open-door laminoplasty (EOLP) between January 2008 and October 2012, including 75 male patients and 80 female patients, with average age of 54.5 (ranging from 38 to 75). Among them, 90 cases took EOLP (open team), and 65 cases took EOLP and C4,5 partial foraminotomy (incision team). Clinical curative effect and imaging evaluation were used in 8 weeks and 12 months after operation. JOA scores, JOA scores improvement rate, C5 nerve root palsy occurrence rate, neurological function of patients with C5 nerve root palsy and the prognosis, cervical curvature index, opening angular variation, backward drift distance of anterior margin and posterior margin of the spinal cord were evaluated after 8 weeks and 1 year after the surgery. Results The operation time was 90-140 min, with the average time of 110±14 min; mean bleeding volume was 160±45 ml (ranging from 100 to 250 ml); follow-up visit time was 15.4 months on average (ranging from 12 to 18 months). JOA score and improvement rate after 8 weeks and 1 year of the operation have no statistical significance. The C5 nerve root palsy occurrence rate in open team was 8.89% (8/90), while that in incision team was 4.62% (3/65). The difference of two groups has statistical significance. C5 nerve root palsy all happened in laminar opening side. Comparison of cervical curvature index of two groups before the operation and after 8 weeks of the operation and inter-group comparison have no statistical significance. The difference between laminar opening angle after 1 year of the operation and laminar opening angle after 8 weeks has no statistical significance. The difference of backward drift distance of anterior margin of the spinal cord at different time after the operation and inter-group difference have no statistical significance. The difference in backward drift distance of posterior margin of the spinal cord between 1 year after the operation and 8 weeks after the operation has no statistical significance. Conclusion Treating OPLL with EOLP and C4,5 partial foraminotomy can reduce occurrence rate of C5 nerve root palsy, but has no significant influence on JOA score improvement rate. Key words: Cervical vertebrae; Foraminotomy; Decompression, surgical; Comparative study

Effects of Tiaozhi-Tongluo decoction combined with atorvastatin tablets on type 2 diabetes mellitus and lipid metabolism in patients with hyperlipidemia

Objective To observe the effects of Tiaozhi-Tongluo decoction combined with atorvastatin tablets on type 2 diabetes mellitus and lipid metabolism in patients with hyperlipidemia. Methods All patients were recruited into a control group and an observation group. Patients in both groups were performed diet control, reasonable exercise, and routine oral sulfonylureas and biguanides to make glucose level in a normal range. The control group was treated with atorvastatin tablets, 20 mg/d. While the observation group was treated with atorvastatin tablets plus Tiaozhi-Tongluo decoction. After both groups were treated for 6 months, the blood glucose and blood lipid level were detected for the evaluation of clinical curative effect. Results The total effective rates in the observation group and the control group were 87.5% (56/64)and 73.0% (46/63), respectively, the difference was statistically significant (χ2=4.213, P=0.040). The serum levels of total cholesterol (4.31 ± 1.11 mmol/L vs. 5.62 ± 1.34 mmol/L, t =6.004) and triglyceride (1.73 ± 0.53 mmol/L vs. 2.57 ± 1.01 mmol/L, t =5.855) in the observation group were significant lower than those in the control group. The levels of fasting plasma glucose (6.31 ± 1.64 mmol/L vs. 7.21 ± 1.71 mmol/L, t =3.027) , 2-h postchallenge plasma glucose (8.81 ± 1.39 mmol/L vs. 9.69 ± 1.55 mmol/L, t =3.370), and glycosylated hemoglobin (6.79% ± 1.61% vs. 7.96% ± 1.72%, t=3.958) in the observation group after treatment were significantly decreased than the control group (P<0.01). Conclusion Tiaozhi-Tongluo decoction combined with atorvastatin can reduce serum total cholesterol and triacylglycerol, and it is superior to atorvastatin alone in reducing lipidemia in type 2 diabetes mellitus patients with hyperlipidemia. Key words: Diabetes mellitus, type 2; Hyperlipidemias; Anticholesteremic agents; Treatment outcome; Atorvastatin; Tiaozhi-Tongluo decoction

Evaluation of clinical bradycardiac effect and respiratory adverse effect of β-blocking agents in coronary computed tomography angiography based on theoretical analysis.

β-blocking agents are used for patients with tachycardia to improve the image quality of coronary computed tomography angiography (CCTA). In this study, we analyzed the clinical bradycardiac effects and the adverse respiratory effects of five β-blocking agents (landiolol, esmolol, propranolol, metoprolol and atenolol) used for CCTA. The changes of the occupancy binding to β1 or β2 receptor of these drugs were calculated based on the receptor occupancy theory. Thereafter, we predicted both the rate of heart rate decline (▲HR) as a clinical effect and the rate of decrease in forced expiratory volume in 1s (▲FEV1) as an adverse effect, by using the ternary complex model. The results showed that the drugs with ▲HR greater than 10%, necessary for CCTA, were as follows: landiolol at 13.5%, propranolol at 11.0%, and atenolol at 22.6%. The ▲HR values at the end of CCTA for those three drugs were 0.3, 6.7, and 22.9%, respectively. It is desirable for the bradycardiac effect to disappear at the end of CCTA. Therefore, landiolol is thought to be a preferable drug. On the other hand, ▲FEV1 at start and end of CCTA for those three drugs was 0.04-2.5, 34.9-40.3, and 6.0-6.1%, respectively. Our results suggested that landiolol has the most appropriate effect and safety for patients with tachycardia who are undergoing a CCTA procedure.

Lead-DBS: A toolbox for deep brain stimulation electrode localizations and visualizations

To determine placement of electrodes after deep brain stimulation (DBS) surgery, a novel toolbox that facilitates both reconstruction of the lead electrode trajectory and the contact placement is introduced. Using the toolbox, electrode placement can be reconstructed and visualized based on the electrode-induced artifacts on post-operative magnetic resonance (MR) or computed tomography (CT) images.Correct electrode placement is essential for efficacious treatment with DBS. Post-operative knowledge about the placement of DBS electrode contacts and trajectories is a promising tool for clinical evaluation of DBS effects and adverse effects. It may help clinicians in identifying the best stimulation contacts based on anatomical target areas and may even shorten test stimulation protocols in the future.Fifty patients that underwent DBS surgery were analyzed in this study. After normalizing the post-operative MR/CT volumes into standard Montreal Neurological Institute (MNI)-stereotactic space, electrode leads (n=104) were detected by a novel algorithm that iteratively thresholds each axial slice and isolates the centroids of the electrode artifacts within the MR/CT-images (MR only n=32, CT only n=10, MR and CT n=8). Two patients received four, the others received two quadripolar DBS leads bilaterally, summing up to a total of 120 lead localizations. In a second reconstruction step, electrode contacts along the lead trajectories were reconstructed by using templates of electrode tips that had been manually created beforehand. Reconstructions that were made by the algorithm were finally compared to manual surveys of contact localizations.The algorithm was able to robustly accomplish lead reconstructions in an automated manner in 98% of electrodes and contact reconstructions in 69% of electrodes. Using additional subsequent manual refinement of the reconstructed contact positions, 118 of 120 electrode lead and contact reconstructions could be localized using the toolbox.Taken together, the toolbox presented here allows for a precise and fast reconstruction of DBS contacts by proposing a semi-automated procedure. Reconstruction results can be directly exported to two- and three-dimensional views that show the relationship between DBS contacts and anatomical target regions. The toolbox is made available to the public in form of an open-source MATLAB repository.

Evaluation of clinical effects on biological reconstruction for large femoral diaphyseal defect after primary bone sarcoma en-bloc resection

Objective To evaluate the clinical and functional outcome of biological reconstruction by using pasteurized autograft and massive allograft after en-bloc resection of primary femoral diaphyseal sarcomas.Methods Retrospectively reviewed 19 consecutive patients with primary femoral diaphyseal sarcomas between Feb.2005 and Dec.2013.There were 11 males and 8 females with the mean age of 18 (2-38) years old.Thirteen patients were diagnosed as osteogenic sarcoma (OS),while five Ewing' s sarcoma (EWS) and one malignant fibrous histocytoma (MFH).All patients were treated with wide local excision,and 9patients were reconstructed by intercalary femur segmental allograft and 10 by pasteurized autograft.The median length of the resected bone was 16.9 (9-24) cm.15 segmental grafts were fixed by using plates including 10 intramedullary free vascularised fibular graft constructs,the other 4 segmental grafts were fixed by intramedullary nails.The average operation time for pasteurized autograft construct was 5.1 hours,while the time for intercalary allograft construct was 4.22 hours.Of 38 host-donor junctions,there are 28 diaphyseal junctions and 10 metaphyseal junctions.Results The average operation time for pausterized autograft construct tended to be longer than intercalary allograft (5.1h Vs 4.22h),although the difference did not reach the significance.Bone union occurred at a median of 10.3 months and 7.25 months at diaphyseal and metaphyseal junction for pasteurized autograft-host construct; 13.8 months at the diapyhseal junction and 11.5 months at the metaphyseal junction for allograft-host construct.Bone healing time of diaphyseal junction and metaphyseal junction between these two constructs were significant difference.Eight of 19patients (42.1％) developed complications:5 bone unnunion/fracture (including 1 subsequently developed local recurrence),1deep infection and 2 local recurrence (including 1 soft tissue recurrence).The mean overall follow-up was 33.5 months (3-107),five patients died of lung metastases,the cumulative patient survival was 76.5％ at 2 years and 61.2％ at 5 years determined by Kaplan-Meier method.All living patients except the MFH patients who received amputation,had a mean MSTS score of 83.7％ (70％-95％).Conclusion Although the reconstructive procedure with pasteurized autograft is more complicated and needs longer operation time than allograft reconstruction,the bone healing time with autograft is significant shorter than allograft.Our observations suggest the pausterized autograft shell with intramedullary free fibular graft is strongly recommeded. Key words: Femoral neoplasms; Reconstructive surgical procedures; Comparative effectiveness research

Clinical effect evaluation of percutaneous vertebroplasty combined with the spinal external fixator for the treatment of osteoporotic compressive fractures with posterior vertebral defect.

The purpose of this study is to report a new technique and assess clinical outcome of compressive fractures with posterior vertebral defect treated by percutaneous vertebroplasty combined with the spinal external fixator. 80 patients (32 males and 48 females), ranging from 62 to 88 years old with the mean age of 71.5 years, underwent surgery for the compressive fractures with posterior vertebral defect by percutaneous vertebroplasty combined with the spinal external fixator. All patients were diagnosed to have fresh compressive fractures with osteoporosis and posterior vertebral defect shown on roentgenograms, computed tomography scans or magnetic resonance imaging preoperatively. They underwent spinal external fixation firstly to be fixed and restored, then to be carried out percutaneous vertebroplasty. The mean follow-up was 24 months (16-42 months). Spinal canal encroachment, spinal cobb angle and vertebral body height loss were measured to assess clinical outcome before and after surgery, at the final follow-up. The Visual Analogue Scale and Oswestry Disability Index were used for pain and functional assessment. In all cases, preoperative and postoperative radiographs and magnetic resonance imaging were obtained. The average time of surgery was 88 min (75-115 min). The mean blood loss was 10 ml (6-12 ml) during surgery. The anterior height loss of vertebral body decreased significantly from 79.3 ± 11% before surgery to 8.0 ± 5.2% after surgery, and 7.6 ± 6.0% at the final follow-up. The spinal canal encroachment significantly reduced from 19.9 ± 2.6 % preoperatively to 4.0 ± 0.7% postoperatively, 4.1 ± 0.7% at the final follow-up. The Cobb angle was corrected from 25.8 ± 7.9° primarily to 8.2 ± 4.1° postoperatively, 7.8 ± 3.1° at the final follow-up. There were significant differences (p < 0.05) among them before and after the surgery. Postoperative VAS and Oswestry scores were both significantly different from the preoperative and follow-up (p < 0.05). The preliminary results are encouraging, showing that the spinal external fixator combined with percutaneous vertebroplasty was a safe and effective method to treat the osteoporotic compressive fractures with posterior vertebral defect.