Wedge Research Articles

Application of ultrasonography in diagnosis and treatment of intrauterine pregnancy complicated with cornual pregnancy after in-vitro fertilization embryo transfer

The clinical data of 39 cases of intrauterine pregnancy complicated with cornual pregnancy after in-vitro fertilization embryo transfer(IVF-ET) were analyzed retrospectively.All the patients were diagnosed by transvaginal ultrasound in early pregnancy, and the position of the gestational sac and its external process were determined by transvaginal ultrasound. According to the location and size of the gestational sac, the patients were divided into two groups: in group A (n=29) the gestational sac was located close to the interstitial tube and the gestational sac was larger, prominent out of the corners of the uterus; in group B (n=10) the gestational sac was located towards the uterine cavity, gestational sac was smaller and the embryo was not active. The laparoscopic angle wedge resection for group A and ultrasound-guided embryo reduction for group B were performed respectively. After treatment, 38 cases were stable to term delivery with intrauterine pregnancy; abortion occurred in 1 case of group A 2 weeks after operation. The early diagnosis and treatment is very important for intrauterine pregnancy complicated with cornual pregnancy. Ultrasonography provides an accurate preoperative assessment and intraoperative real-time monitoring during embryo reduction, which provides an alternative approach for the treatment of intrauterine pregnancy combined with cornual pregnancy. Key words: Ultrasonography, prenatal, three-dimensional; Pregnancy, ectopic; Embryo transfer

Towards the restoration of the liquid crystal surface anchoring potential using Grandgean-Cano wedge

GRAPHICAL ABSTRACT

Effect of nano carbon tattooing on the lesion localization in the early colon cancer for additional surgical procedure after endoscopic resection

To explore the effect of nano carbon tattooing on the lesion localization in the early colon cancer for additional surgical procedure after endoscopic resection. Thirty-five patients with early colon cancer accepted additional surgical procedures after endoscopic resection in Fuzhou General Hospital of PLA from May 2014 to November 2016. All the patients underwent nano carbon tattooing before the end of endoscopic resection: 0.1 ml carbon nanoparticles suspension was respectively injected into the normal intestinal submucosa from 1 cm outside the 4 sites (upper, lower, left and right) of the lesion border by colonoscopy, marking the original lesion location and guiding the subsequent additional surgery. Data of these 35 cases were summarized. All the 35 cases, including 22 males and 13 females, with a mean age of 46.5 years(range 35-70), completed the endoscopic disposable carbon nano marking, and the mean operative time was 7.5 minutes(range 5-10). No bleeding, no perforation and no adverse reaction occurred. Four to 21(10±3.5) days after endoscopic resection, the patients received the additional surgery as a result of pathological specimens of endoscopic resection in 10 cases of vascular invasion, 7 cases of severe submucosal infiltration, 7 cases of more than grade G2 in tumor budding, 6 cases of poorly differentiated adenocarcinoma and undifferentiated carcinoma, and 5 cases of positive margin. All the patients underwent laparoscopic surgery. The mean time of intraoperative detection and lesion location was 3.0 minutes(range 1-5). All tattooings were clearly visible under the naked eye. The colon wedge resection were performed in 5 cases, colon segment resection in 14 cases, and radical resection of colon cancer in 16 cases. The operative time was 45 to 180(120±30) min, and the blood loss was 50 ~ 200(50±15) ml. There was no intraoperative complications. The first gas passage time was 12 to 48(24±8) h. The postoperative hospital stay was 10 to 3(6.5±2.5) d. There was no postoperative complication and no perioperative mortality. Nano carbon tattooing is helpful for the accurate location of primary lesions in the additional surgical operation after endoscopic resection of early colon cancer, and it can improve the safety and precision of surgical procedures, especially for laparoscopic surgery.

Associated risk factors for cemented vertebral body re-wedge after percutaneous kyphoplasty

Objective To investigate the related risk factors of the previous cemented vertebral body re-wedge after percutaneous kyphoplasty (PKP). Methods In this retrospective case-control study, clinical data of 617 patients treated by PKP from December 2008 to November 2014 were analyzed. According to whether the cemented vertebra wedged again, the patients were divided into cemented vertebral re-wedge group (n=12) and non-cemented vertebral re-wedge group (n=605). The data of age, preoperative bone density, preoperative vertebral osteonecrosis, intraoperative bone cement injection amount, postoperative bone cement leakage, postoperative bone cement filling, postoperative recovery rate of vertebral wedge angle, and presence or absence of adjacent old vertebral wedging were recorded in two groups. All patients were followed up for one year, and the data were summarized and statistically analyzed. Results Single factor analysis showed the factors of whether there were adjacent old vertebral wedge, preoperative vertebral osteonecrosis, cystic bone cement filling, different wedge angle recovery rate, and emergence of previous cemented vertebral body re-wedge after PKP were statistically significant between two groups (P 0.05). Multivariate Logistic stepwise regression analysis showed cystic bone cement filling, preoperative vertebral osteonecrosis, adjacent old vertebral wedging, and higher recovery rate of vertebral wedge angle were prone to appear previous cemented vertebral body re-wedge (P<0.05). Conclusions Relatively higher recovery rate of vertebral wedge angle, previous adjacent old vertebral wedge, vertebral osteonecrosis, and cystic bone cement filling are risk factors closely related to cemented vertebral re-wedge after PKP, which gives a good reference to assess surgical risk, avoid risk factors and choose right surgical techniques. Key words: Fractures, compression; Thoracic vertebrae; Lumbar vertebrae; Percutaneous kyphoplasty

Tibial osteotomy combined with arthroscopic condylar notch plasty to treat flexion deformity of knee varus osteoarthri-tis

Objective To explore the medial open wedge high tibial osteotomy (OWHTO) combined with arthroscopic condyle plasty with clinical flexion deformity in patients with osteoarthritis of knee varus. Methods From January 2014 to July 2015, 11 cases (11 knees) of varus knee joint flexion deformity were applied the procedure of OWHTO combined with arthroscopic condyle plasty, including 4 male and 7 female; the average age was 52.1 years old (ranged from 48 to 58 years). OWHTO could ad-just the line of force of the lower limbs in coronal plane (the connection line between femoral head center point and the center point of ankle joint) through lateral tibial plateau 62.5% position, and implant allogeneic bone to support posterior inclination an-gle, underwent arthroscopic condyle plasty to improve flexion deformity at the same time. Results 11 patients in this group were all followed up, and the follow-up time was 1-2.5 years, average 1.5 years. No case of fracture nonunion or delayed healing was found. Imaging data was measured to evaluate the mechanical axis of lower extremity by the relative position of tibial plateau, femo-ral tibial angle,femoral notch width index, tibial plateau posterior angle before operation and one year after the operation. The rela-tive position of the mechanical axis of the lower limb through the tibial plateau was 17.4% ± 4.9% preoperatively, and 58.9% ± 3.1% after operation, femoral tibial angle changed from 181.6°±1.2° to 170.3°±1.3°, tibial plateau posterior inclination angle: pre-operative 7.7°±2.2°, postoperative 7.9°±1.9°, femoral notch width index was increased from 0.221±0.007 to 0.272±0.009 after op-eration, flexion deformity angle of preoperative was 11.1°±3.1°, and 1.4°±1.5° one years after operation, VAS score was (6.5±1.1) points before surgery, and (2.5±0.8) points of postoperative, Lysholm score was (50.72±6.57) points before operation, and (75.72±7.41) points one year after operation, and the differences were all statistically significant. Conclusion OWHTO combined with arthroscopic condyle plasty can significantly improve the lower limb line and flexion deformity, and also maintain the posterior in-clination angle of tibial plateau,and can get a good short-term efficacy. Key words: Osteoarthritis, knee; Osteotomy; Genu varum; Treatment outcome

Correlation between disc injury and parameters of vertebral body damage in patients with neurologically intact thoracolumbar bust fractures

Objective To assess the disc injury in neurologically intact thoracolumbar bust fractures and to evaluate the correlation between the severity of disc injury and the parameters of vertebral body damage as as to formulate radiologic index for further MRI examination. Methods A retrospective case series review was made on 22 patients (44 discs) with thoracolumbar burst fractures without neurologic deficit treated from January 2015 to December 2015. Vertebral level involved was from T11-L2. There were 12 males and 10 females, with the mean age of 47.9 years (range, 43-60 years). MRI were used to evaluate the severity of disc injury. Among the 44 discs, 18 were Grade 0, 11 were Grade 1, 12 were Grade 2, and three were Grade 3. Then patients with Grade 0 and 1 were taken as disc intact group and other 12 patients disc rupture group. Vertebral wedge angle, local kyphosis angle, anterior and posterior vertebral body height and canal compromise were measured on CT to determine the damage of fracture. Spearman correlation coefficient was used to analyze the correlation between the severity of disc injury and the parameters of vertebral body damage, and receiver operative curve (ROC) was used to assess the effectiveness of these indexes in predicting disc injury. Results Vertebral wedge angle and anterior/posterior vertebral body height ratio were correlated with the severity of superadjacent disc injury (P 0.05). Threshold of canal compromise, vertebral wedge angle and anterior/posterior vertebral body height ratio were 21%, 15.4°, and 0.69 respectively. Conclusions Vertebral wedge angle and anterior/posterior vertebral body hight ratio are correlated with the severity of superadjacent disc injury. Canal compromise>21%, VWA>15°and anterior/posterior vertebral body height ratio > 0.69 may be the practice preferences of indications for ordering a MRI in patients with neurologically intact thoracolumbar bust fractures. Key words: Thoracic vertebrae; Lumbar vertebrae; Intervertebral disc; Magnetic resonance imaging; Neurologically intact

Erratum to: Experimental Study on Wedge Slamming Considering Water Fluid-Structure Interaction

Erratum to: Experimental Study on Wedge Slamming Considering Water Fluid-Structure Interaction

High-frequency ultrasound imaging-guided wedge resection for the treatment of paraurethral duct dilatation following gonococcal paraurethral duct infection in 11 male patients

Objective To evaluate therapeutic effects of wedge resection on male paraurethral duct dilatation following gonococcal paraurethral duct infection. Methods With the aid of high-frequency ultrasound images, 11 male patients with paraurethral duct dilatation following gonococcal paraurethral duct infection were treated with wedge resection. The data were collected, including the surgical duration, amount of bleeding during the surgery, period of wound healing and complications. If the ostium beside the external urethral orifice disappeared within 4 weeks after the surgery, there was no discharge from the ostium with pressure, and no tubular echoic area was observed by high-frequency ultrasound imaging, the patient was considered to be recovered. If none of the above three conditions could be met, the surgical treatment was considered to be ineffective. Results The average surgical duration was 19.19 ± 2.71 minutes (range, 14-23 minutes) , the average amount of bleeding during the surgery was 11.09 ± 2.07 ml (range, 8-14 ml) , and the average period of wound healing was 14.91 ± 1.45 days (range, 13-17 days) . Of the 11 patients, 10 were cured, and 1 showed no response. No complications were observed in any of the 11 patients, and no defects formed in the glans penis. Conclusion Wedge resection is a kind of effective therapy for paraurethral duct dilatation following gonococcal paraurethral duct infection in males. Key words: Neisseria gonorrhoeae; Male; Treatment outcome; Wedge resection; Paraurethral duct dilatation; High frequency ultrasound

Intervertebral wedge osteotomy to treat scoliosis and kyphosis

Objective To compare the feasibility and efficacy of intervertebral wedge osteotomy and pedicle subtraction osteotomy (PSO), vertebral column resection (VCR), Smith-Petersen osteotomy (SPO) for the treatment of severe kyphosis and scoli-osis. Methods The data of 38 cases of severe kyphosis and kyphoscoliosis were retrospectively analyzed from January 2010 to February 2016, including 22 males and 16 females. According to the osteotomy mode, PSO, SPO, VCR and intervertebral disc wedge osteotomy were used to collect the average number of fixed phases, volume of bleeding, length of stay, length of hospital stay, improvement of main cobb angle, improvement of ODI score, and Frankel classification to evaluate the efficacy. Results There were no significant differences in the overall operative time between the four groups. The average number of fixation in 18 patients with SPO was (9.4±3.9) segments, the blood loss was (3 000±410) ml, the average Cobb angle was improved by 55.3%± 9.5%, the average postoperative hospitalization was (14.6±4.9) days, the improvement rate of ODI was 42.1%±7.4%, all the pa-tients were improved to Frankel E; The average number of fixation in 5 patients with PSO was (7.6±1.5) segments, the blood loss was (4 360±1 161) ml, the average Cobb angle was improved by 58.9%±15.1%, the average postoperative hospitalization was (18.2±7.0) days, the improvement rate of ODI was 41.3%±9.6%. One Frankel C patient was improved to Frankel D, others re-mained to be Frankel E as the same as pre-operation; The average number of fixation in 4 patients with VCR was (6.2±2.6) seg-ments, the blood loss was (3 750+1 848) ml, the average Cobb angle was improved by 83.9%±10.9%, the average postoperative hospitalization was (21±7.2) days, the improvement rate of ODI was 39.6%±18.1%. Three Frankel D patients were improved to Frankel E and one Frankel C patient was improved to Frankel D; The average number of fixation in 11 patients with IWO was (7.1±2.7) segments, the blood loss was (2855±1046) ml, the average Cobb angle was improved by 59.6%±22.05%, the average postoper-ative hospitalization was (13.5±2.7) days, the improvement rate of ODI was 51.3%±8.3%. One Frankel C patient was improved to Frankel D, eight Frankel D patients were improved to Frankel E, other patients remained to be Frankel E; The mean follow-up time was 25.2 months in 11 patients underwent intervertebral wedge osteotomy. All the patients had successful spinal fusion and no failure of internal fixation. Conclusion Intervertebral wedge osteotomy for the treatment of scoliosis and kyphosis could re-duce surgical injury to obtain good biomechanics and surgical result. Key words: Scoliosis; Kyphosis; Osteotomy; Spinal fusion

The effect of desflurane on hemodynamics and myocardial protection in patients undergoing off-pump coronary artery bypass grafting surgery

Objective To evaluate the effect of desflurane on hemodynamics and myocardial protection in patients undergoing off-pump coronary artery bypass grafting surgery (OPCABG). Methods Fifty patients, scheduled for OPCABG, were randomly assigned to two groups: the desflurane group (D group, n=25) and the propofol group (P group, n=25). For all patients, 10 mg morphine and 3-5 mg midazolam were intramuscularly injected before anesthesia. 0.1-0.2 mg/kg etomidate was used for anesthesia induction followed by rocuronium 0.6 mg/kg and sufentanil 1-2 μg/kg for all patients. For all patients, sufentanil 0.5-1.0 μg/(kg·h) and Cisatr-curium 0.5- 1.0 mg/(kg·h) were maintained. Desflurane 0.7-1.5 MAC was maintained in D group. Propofol 2-8 mg/kg was maintained in P group. Manometry was conducted through puncture in radial artery and right internal jugular vein for all patiens. The changes in cardiac index (CI), heart rate (HR), blood pressure (ABP), right atrial pressure (CVP), pulmonary arterial pressure (PAP) and pulmonary artery wedge pressure (PAWP) were monitored perioperatively. Bispectral index (BIS) was maintained at 40- 60. Temperature and urine were monitorred routinely. Before and 6, 12, 24 and 36 h after operation, blood samples were collected to measure troponin Ⅰ (cTnⅠ) and creatine kinase isoenzyme (CK-MB). Results Plasma cTnⅠ and CK-MB levels in postoperative period were higher than the preoperative baseline in both groups. cTnⅠ and CK-MB level were significantly higher in P group than in D group [(0.77±0.38) vs. (0.96±0.42), P=0.034; (23.79±5.96) vs. (28.13±7.51), P=0.042]. Conclusion Our results suggest that desflurane combined sufentanil anesthesia provides better management of reduced myocardial injury and less intropic agents usage in OPCABG. Key words: Desflurane; Off-pump coronary artery bypass; Hemodynamic; Myocardial protection

Balloon vertebroplasty reinforced by injectable calcium sulfate cement versus posterolateral fusion for treatment of thoracolumbar burst fractures

Objective To compare the clinical curative effects of balloon vertebroplasty reinforced by injectable calcium sulfate cement(CSC) and posterolateral fusion after short-segment pedicle screw fixation through the fractured vertebra in treatment of thoracolumbar bumt fractures. Methods From February 2012 to May 2015, 68 cases patients with single thoracolumbar burst fracture were admitted in Orthopaedics and Traumatology Department of Traditional Chinese Medicine Hospital of Gaozhou, and were randomly divided into two observation group and control group, each group with 34 cases.Observation group were treated by short-segment pedicle screw fixation through the fractured vertebra followed by transpedicular balloon reduction of the endplate and CSC injection, the control group were underwent posterolateral fusion in addition to short-segment pedicle screw fixation through the fractured vertebra.The 2 groups were compared at preoperation, and the last follow-up in terms of visual analog pain score(VAS), Oswestry disability index(ODI), anterior height ratio of the injured vertebra, middle height ratio of the injured vertebra, the vertebral wedge angle and the sagittal Cobb angle. Results The patients were followed up from 12 to 54 months.All the measure indexes at the last follow-up were significantly improved than those at preoperation in all the patients(P 0.05). At the last follow-up, the observation group showed a significantly less loss than the control group regarding the corrections of anterior height ratio of the injured vertebra((93.6±3.4) vs.(81.8±4.8)), middle height ratio of the injured vertebra((90.7±3.8) vs.(78.9±5.1)), the veaebral wedge angle((5.7±1.9) ° vs.(8.8±3.0) °) and the sagittal Cobb angle((5.2±2.1) ° vs.(7.9±2.4) °)(t=4.143, 5.786, 4.819, 4.465, P<0.05). Conclusion In treatment of thoracolumbar burst fractures, compared with posterolateral fusion, balloon vertebroplasty reinforced by injectable CSC can better restore the shape of injured vertebral body and stability of the anterior and middle columns in the early period, can also reduce losses of corrections, and keep the function of the spinal motion segment. Key words: Spinal Fractures; Fracture fixation; Calcium sulfate; Bone cement

Analysis of curative effect of kyphosis cancellous ossification osteotomy for ankylosing spondylitis

Objective To investigate the efficacy to cancellous ossification of spinal osteotomy for the treatment of ankylosing spondylitis kyphosis deformity and. Methods 34 patients with ankylosing spondylitis kyphosis in our Department from Jan 2014 January to Fab 2016 were selected and randomly divided into the observation group and the control group, the observation group used to cancellous ossification of spinal osteotomy combined with pedicle screw internal fixation for the treatment, control group using spinal wedge osteotomy combined with pedicle screw internal fixation for the treatment of bleeding, and deformity correction the extent of operation time, operation measure and comparison of two kinds of operation, and postoperative complications. Results In the observation group, the kyphotic angle of the thoracic vertebra was corrected from (37.4±10.0) ° to (1.8±0.5) °and then to (1.9±0.9) °, laparoscopic angle was corrected from (-13.7±17.3)° to (27.0±7.2) ° and then to (27.3±6.8) °, the sagittal plane balance was calculated from preoperative (35.8±10.6) ° to (12.7±4.2) ° andthen to (12.9±4.4) °, the maxillary angle was corrected from (63.5±11.1) ° to (12.8±3.1) °and then to (12.6±3.6)° at the second week and the third month, respectively, there was no significant difference compared with the control group (P= 0.077). While the sixth month after the end of follow-up, the difference was statistically significant (P=0.035); In the observation group, the fusion rate of bone graft was 100.0% higher than that of the control group (83.4%) (P=0.007). The observation group of spine function also had a significant difference in the follow-up period Higher than the control group (P=0.041). Conclusion The spine to cancellous ossification osteotomy used in ankylosing spondylitis kyphosis has good curative effect, can effectively restore the spinal height, prevent orthopedic excessive or loss, improve the fusion rate of bone graft, is worth the clinical promotion. Key words: To cancellous ossification; Osteotomy; Ankylosing spondylitis; Kyphosis

Pulmonary hypertension associated with left-sided heart disease.

Pulmonary hypertension associated with left-sided heart disease (PH-LHD) is the most common type of pulmonary hypertension. In patients with left-sided heart disease, the presence of pulmonary hypertension is typically a marker of more advanced disease, more severe symptoms, and worse prognosis. In contrast to pulmonary arterial hypertension, PH-LHD is characterised by an elevated pulmonary artery wedge pressure (postcapillary pulmonary hypertension) without or with an additional precapillary component (isolated postcapillary versus combined postcapillary and precapillary pulmonary hypertension). Transthoracic echocardiography is the primary nonin-vasive imaging tool to estimate the probability of pulmonary hypertension and to establish a working diagnosis on the mechanism of pulmonary hyperten-sion. However, right heart catheterisation is always required if significant pulmonary hypertension is sus-pected and exact knowledge of the haemodynamic constellation is necessary. The haemodynamic con-stellation (mean pulmonary artery pressure, mean pulmonary artery wedge pressure, left ventricular end-diastolic pressure) in combination with clinical infor-mation and imaging findings (mainly echocardiog-raphy, coronary angiography and cardiac magnetic resonance imaging) will usually allow the exact mech-anism underlying PH-LHD to be defined, which is a prerequisite for appropriate treatment. The general principle for the management of PH-LHD is to treat the underlying left-sided heart disease in an optimal man-ner using drugs and/or interventional or surgical ther-apy. There is currently no established indication for pulmonary arterial hypertension-specific therapies in PH-LHD, and specific therapies may even cause harm in patients with PH-LHD.

Precision in Wedge Off-axis Using Independent Dose Verification.

It is essential for quality assurance to verify the safety of each individual patient's plan in radiation therapy. The tolerance level for independent verification of monitor unit calculations for non-IMRT clinical radiotherapy has been shown in the AAPM TG114. Thus, we investigated the precision of independent MU (dose) verification considering a wedge off-axis calculation and we conducted a study at twelve institutes for independent verification with the wedge off-axis calculation. The results obtained with the wedge off-axis calculation showed better agreement with the treatment planning system calculation results than those without the former calculation in a phantom study and in the patient retrospective study. The confidence limits with the wedge off-axis calculation were 2.2±3.4% and 2.0±4.3% for the plans with a physical wedge and a non-physical wedge in the patient study, respectively. However, the confidence limits were over 5% without the off-axis calculation. From our multi-institutional study, the results suggested that the tolerance level for the wedge off-axis plan would be 5% when considering the wedge off-axis calculation and the level was similar to that of the treatment planning system using other conventional irradiation techniques.

Current status of surgical treatment of gastric gastrointestinal tumors: a national multi-center retrospective study

To retrospectively analyze the clinicopathology of patients with gastric gastrointestinal stromal tumor(gGIST) who underwent radical excision within 18 years in 10 domestic medical centers in order to understand the status of domestic surgical treatment of gGIST. Clinicopathological data of gGIST patients undergoing radical excision in 10 medical centers from January 1998 to January 2016 were collected, and their operational conditions, postoperative adjuvant therapy, gene detection and survival were analyzed retrospectively. A total of 1 846 cases were recruited in this study, including 246 cases from Guangdong General Hospital, 331 cases from Sun Yat-sen University Cancer Center, 374 cases from Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, 342 cases from Nanfang Hospital of Southern Medical University, 265 cases from Fujian Medical University Union Hospital, 148 cases from Fudan University Shanghai Cancer Center, 49 cases from West China Hospital of Sichuan University, 43 cases from Peking University Cancer Hospital and Institute, 28 cases from the 81st Hospital of Pepole's Liberation Army(PLA), 20 cases from Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute. There were 918 male (49.7%) and 928 female patients (50.3%) with median onset age of 59(18 to 95) years old. Fundus(735 cases, 39.8%) and body (781 cases, 42.3%) of stomach were the common sites of lesions. The average size of tumor was (5.3±4.6) cm. There were 1 421 cases with mitotic count ≤5(77.0%). According to the operation procedure, 924 cases (50.1%) underwent laparoscopic surgery, 759 cases (41.1%) laparotomy, 120 cases (6.5%) endoscopic surgery, and 20 cases (1.1%) laparoscopic combined with endoscopic surgery, 6 cases (0.3%) laparoscopic excision surgery through gastric wall and cavity, and 17 cases (0.9%) laparoscopy and then were transferred to laparotomy. Wedge excision were performed in 1 308 cases (70.9%), proximal gastric excision in 226 cases(12.2%), distal gastric excision in 92 cases (5.0%), total gastrectomy in 94 cases (5.1%), and local gastrectomy in 126 cases(6.8%). Multi-visceral excision was performed in 138 cases, and the splenectomy was performed in 83 cases(60.1%)with the highest ratio. According to modified NIH classification, 399 cases(21.6%) were extreme low risk, 580 cases(31.4%) were low risk, 424 cases(23.0%) were moderate risk, 443 cases (24.0%) were high risk. A total of 461 cases received postoperative imatinib adjuvant therapy, accounting for 53.2%(461/867) of patients with moderate and high risk. Among 1 846 cases, 1 402 cases (75.9%) had complete follow-up data and the median follow-up time was 33.6 (0.1 to 158) months. The 5-year survival rates of extreme low risk, low risk, moderate risk and high risk were 100%, 98.5%, 92.5%, and 79.2% with significant difference(P=0.000). Gastric GIST occurs mostly in fundus and body of stomach in China. Wedge excision is the main operational procedure and laparoscopic operation is over 50%. General prognosis of gastric GIST is quite good.

A Chinese multi-center study on the significance of monitoring imatinib plasma concentration in patients with gastrointestinal stromal tumor before and after administration

To investigate the factors which may influence the imatinib plasma concentration in Chinese patients with gastrointestinal stromal tumor(GIST), and to illuminate the significance of monitoring imatinib plasma concentration in adjuvant therapy for patients with GIST. A cross-sectional study with 60 GIST patients who accepted the imatinib therapy after surgery was conducted. They were respectively administrated in 10 domestic hospitals from December 2014 to April 2016, including The First Affiliated Hospital of Nanjing Medical University(n=28), The Affiliated Hospital of Nantong University(n=9), The Affiliated Hospital of Xuzhou Medical College(n=6), Nanjing Drum Tower Hospital(n=5), The Second Affiliated Hospital of Nanjing Medical University (n=2), Jingling Hospital (n=2), The Second People's Hospital of Lianyungang(n=2), Shandong Provincial Hospital(n=2), Jiangsu Province Tumor Hospital(n=2), and The First Affiliated Hospital of Zhejiang University(n=2). Some specific time points for collecting blood sample before and after taking imatinib were determined, then liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was used for monitoring imatinib plasma concentration in patients with GIST. Linear regression analysis was used for the correlation analysis of imatinib plasma concentration with dosage, clinicopathologic feature and side effect. Patients who could not tolerate 400 mg imatinib per day(n=3) received 300 mg per day. There was no significant difference in imatinib plasma concentration between patients with 300 mg and those with 400 mg imatinib(n=53)(P=0.527). However, the imatinib plasma concentration in patients with 600 mg imatinib per day (n=4) was significantly higher as compared to those with 400 mg(P=0.000). Linear regression analysis indicated a negative correlation between the imatinib plasma concentration in patients with 400mg imatinib per day for 90 days continuously and body surface area(R2=0.074, P=0.035), but no significant correlations of with age, creatinine clearance and serum albumin concentration were observed (all P>0.05). The differences in imatinib plasma concentration were not statistically significant between patients of different gender and those taking proton-pump inhibitor (PPI) or not (both P>0.05). Difference in imatinib plasma concentration between patients with different surgery was significant (P=0.026). Compared to patients who underwent wedge resection, enterectomy and other surgeries, the imatinib plasma concentration of patients with subtotal gastrectomy or total gastrectomy decreased significantly (all P<0.05). After 90 days of taking imatinib continuously, linear regression analysis revealed a negative correlation between imatinib plasma concentration in patients with 400 mg imatinib per day and white blood cell count (R2=0.103, P=0.013), and a positive correlation with serum alanine aminotransferase (ALT) concentration (R2=0.076, P=0.033). The imatinib plasma concentration in patients with larger body surface area, subtotal gastrectomy or total gastrectomy may be lower. For these patients, dosage of imatinib should be considered to increase in order to achieve effective plasma concentration. Excessive imatinib plasma concentration can result in some side effects, such as decrease of white blood cells and liver damage. Therefore, it is significant for receiving optimal clinical therapeutic efficacy to monitor imatinib plasma concentration, adjust imatinib dosage timely and keep imatinib plasma concentration in effective and safe range.

Total hip arthroplasty for post-traumatic hip fusion ankylosis secondary to operation in acetabular combined with femoral head fracture

Objective To investigate the technique and clinical results of total hip arthroplasty in treating post-traumatic hip fusion ankylosis secondary to operation in acetabular combined with femoral head fracture. Methods From October 2009 to January 2015, 7 patients (7 hips) with post-traumatic hip fusion ankylosis underwent total hip arthroplasty. There were 6 males and 1 female with an average age of 38 years (range, 25-51 years). There were 4 hips on the left side, 3 hips on the right side. Open reduction and internal fixation were performed on all patients. One patient had a postoperative deep infection and 6 patients under-went implant removal. The hip bony fusion ankylosis was developed secondary to post-traumatic arthritis after the surgery of ipsilateral acetabular combined with femoral head facture. The interval between internal fixation and total hip arthroplasty was 37.6 months on average (range, 21-67 months). The hip bony fusion ankylosis was relieved by wedge shape osteotomy at femoral neck level. The cementless prostheses were implanted in suitable places based on the accuracy position of acetabular center. One infection case was treated via surgical debridement, removal of all the screws, and antibiotic-loaded cement spacer implantation in the first stage. The cementless prostheses were implanted in the second stage. Results The average operation time and blood loss was 108 min (90-150 min) and 320 ml (280-450 ml) respectively. The internal fixation devices were explanted completely, including plate and screw in 5 cases, only screw in 1 case, intramedullary nail and screw in 1 case. The mean fallow-up period was 32.5 months (range, 15-48 months). The average Harris hip score improved from 48.8±6.5 points preoperatively to 92.6±5.1 points post-operatively (t=22.82, P=0.001). Osseointegration was developed in all of the acetabular and femoral components at 3 months post-operatively. Radiograph analysis showed satisfied position of acetabular cup and no evidence of implant migration or center of rotation change. Stem subsidence (<1.0 mm) occurred in 2 cases and heterotopic ossification in 2 cases (Brooker typeⅠ and typeⅡin 1 case, respectively) at one year postoperatively. No complication occurred, such as damages of vessels and nerve, dislocation, component loosening or infection. Conclusion The wedge shape osteotomy of femoral neck is a safe and reliable method in treating hip fusion ankylosis. Total hip arthroplasty can be achieved by reconstruction of acetabular center, suitable components implanted in anatomical position and ideal reconstruction of soft tissue around hip. Key words: Acetabulum; Femur head; Fractures, bone; Ankylosis; Arthroplasty, replacement, hip

Efficacy of laparoscopic or open surgery for gastrointestinal stromal tumors and effects of different risk level on prognosis

Objective To compare the efficacy of laparoscopic or open surgery for gastrointestinal stromal tumors (GISTs) and investigate effects of different risk level on prognosis. Methods The retrospective cohort study was adopted. The clinical data of 192 patients with GISTs who were admitted to Zhongshan Hospital of Fudan University from January 2008 to December 2013 were collected. Among the 192 patients, 88 undergoing laparoscopic surgeries were allocated into the laparoscopic surgery group, 104 patients undergoing open surgeries were allocated into the open surgery group. The following indicators were observed: (1) operative status: surgical procedure, operation time, volume of intraoperative blood loss. (2) Status of postoperative recovery: time of gastrointestinal function recovery, time of drainage tube removal, complications and duration of hospital stay. (3) Follow-up status. (4) Prognosis of patients in different risk level. The follow-up using outpatient examination and telephone interview was performed to assess patients′ survival, tumor recurrence and metastasis until June 2015. Measurement data with normal distribution were presented as ±s and comparison between groups was evaluated by the t test. Comparison of count data was analyzed by the chi-square test. The Kaplan-Meier method was used to draw survival curve and calculate the overall survival rate and relapse-free survival rate. Results (1) Operative status: of the 88 patients in the laparoscopic surgery group, 1 underwent laparoscopic wedge gastrectomy+ cholecystectomy+ appendectomy, 6 underwent laparoscopic wedge gastrectomy+ cholecystectomy, 14 underwent laparoscopic assisted partial gastrectomy, 67 underwent laparoscopic wedge gastrectomy. Of the 104 patients in the open surgery group, 1 underwent partial gastrectomy+ splenectomy, 2 underwent partial gastrectomy combined with distal pancreatectomy+ splenectomy, 2 underwent total gastrectomy, 7 underwent distal subtotal gastrectomy, 7 underwent wedge gastrectomy+ partial or total adjacent organ resection, 8 underwent proximal subtotal gastrectomy, 8 underwent wedge gastrectomy+ cholecystectomy, 69 underwent wedge gastrectomy. The operation time and volume of intraoperative blood loss were (105±33)minutes and (43±16)mL in the laparoscopic surgery group, (121±52)minutes and (199±81) mL in the open group, respectively, with statistically significant differences between the 2 groups (t=-2.104, 2.632, P 0.05). (3) Follow-up status: Of the 192 patients, 149 received follow-ups. Of 88 patients in the laparoscopic surgery group, 68 were followed up for an average time of 39 months. Of 104 patients in the open surgery group, 81 were followed up for an average time of 51 months. During the follow-up, tumor recurrence rate in the laparoscopic surgery group and open surgery group was respectively 8.8%(6/68) and 21.0%(17/81), with no statistically significant difference between the 2 groups (χ2=1.888, P>0.05 ). Postoperative 1-, 3-, 5 year survival rates were 98.5%, 92.9%, 87.4% and 91.7%, 85.2%, 76.9% in the laparoscopic surgery group and open surgery group, respectively, with no statistically significant difference between the 2 groups (χ2=1.967, P>0.05). (4) Prognosis of patients in different risk level: of the 149 who received the follow-up, the tumor recurrence rate of patients in low, intermediate and high recurrence risk was 7.0%(5/71), 13.6%(6/44) and 35.3%(12/34), respectively, with a statistically significant difference among the above indexes (χ2=14.637, P 0.05). Five-year relapse-free survival rate of low, intermediate and high risk patients was 94.2%, 80.0% and 61.8% respectively, with a statistically significant difference (χ2=13.547, P 0.05). Conclusions Compared to open resection, laparoscopic GISTs resection offers better short-term outcomes, however, the two surgical techniques offer equal long-term outcomes. Patients of high risk have poor prognosis. Key words: Gastrointestinal stromal tumors; Gastrectomy; Open surgery; Laparoscopy; Prognosis

ASSOCIATION OF MORB AND SSZ OPHIOLITES ALONG THE SHEAR ZONE BETWEEN COLOURED MÉLANGE AND BAJGAN COMPLEXES (NORTH MAKRAN, IRAN): EVIDENCE FROM THE SORKHBAND AREA

One of the largest worldwide accretionary wedges is exposed in the Makran region (SE Iran). The backstop of this accretionary wedge consists of an imbricate stack of continental and oceanic units, referred as North Makran domain. This domain is characterized by a km-thick shear zone, along which the metamorphic Bajgan Complex is thrust onto the Coloured Melange Complex. Along this shear zone two slices of ophiolites have been identified in the Sorkhband area. The upper tectonic slice consists of gabbros, whereas the lower tectonic one consists of mantle peridotites associated with dunites and chromitite ore deposits. Petrography and geochemistry of gabbros clearly indicate an N-MORB-type affinity, suggesting that they were generated at mid-ocean ridge setting. In contrast, mantle peridotites consist of harzburgites and depleted harzburgites, both showing geochemical features suggesting their genesis in a SSZ setting. The new data presented in this paper indicate that the slices of ophiolites from Sorkhband area derived from two different oceanic domains representing two different geodynamic settings. This occurrence provide new evidence that the boundary between the Coloured Melange and the Bajgan Complexes represents a first-order tectonic structure that played an important role in the geodynamic evolution of the Makran area.

Diagnosis and treatment of autoimmune pancreatitis

Diagnosis and treatment of autoimmune pancreatitis