Stent-assisted coiling of intracranial carotid ophthalmic segment aneurysm segment aneurysms:Long-term follow-up from a single center

Background:To evaluate the efficacy of stent-assisted coiling(SAC)for the treatment of carotid ophthalmic segment aneurysm segment aneurysms(OSAs)of the internal carotid artery(ICA)through detailed long-term follow-up of a large patient cohort.Methods:We retrospectively analyzed 88 consecutive patients with OSAs between January 2009 and January 2020 at our center.Angiographic results were evaluated using the modified Raymond grading system and clinical outcomes were evaluated using the mRS scale.The primary endpoints were major aneurysm recurrence and poor clinical outcomes for at least 18 months of follow-up.The patients were asked to attend clinical follow-up assessments and possibly undergo DSA or MR via telephone.Results:We enrolled 88 patients with 99 OSAs treated with coiling,of whom 76 were treated with SAC.The coiling procedures were successful in all 88 patients.Overall,complications occurred in 8 patients(9.1%).No procedure-related mortality was observed.67(76.1%)experienced immediate aneurysm occlusion at the end of the procedure.Long-term angiographic follow-up(18 months)was available in 45/88 aneurysms(51%)(average 18.7±5.2 months).Four patients continued their follow-up for 5 years after initial aneurysm treatment.After a clinical follow-up time of 28.7 months(range,12-51 months),85 patients(95.5%)achieved favorable clinical outcomes(mRS scores of 0-2).Conclusions:This study indicates that SAC treatment is a safe and effective therapeutic alternative for ruptured and unruptured OSAs.The procedural risks are low with relatively long-term effectiveness.

Pseudoaneurysm formation following transarterial embolization of traumatic carotid-cavernous fistula with detachable balloon:An institutional cohort long-term study

BACKGROUND The goal of therapy for traumatic carotid-cavernous fistula(TCCF)is the elimination of fistula while maintaining patency of the parent artery.The treatment for TCCF has evolved from surgery to endovascular management using detachable balloons,coils,liquid embolic agents,covered stents,or flow-diverter stent through arterial or venous approaches.Despite the withdrawal of detachable balloons from the market in the United States since 2004,transarterial embolization with detachable balloons has currently remained the best initial treatment for TCCF in several countries.However,the pseudoaneurysm formation following transarterial detachable balloon embolization has rarely been observed in long-term follow-up.AIM To determine the occurrence and long-term follow-up of pseudoaneurysm after transarterial detachable balloon for TCCF.METHODS Between January 2009 and December 2019,79 patients diagnosed with TCCF were treated using detachable latex balloons(GOLDBAL)of four sizes.Pseudoaneurysm sizes were stratified into five grades for analysis.Initial and follow-up assessments involved computed tomography angiography at 1 month,6 month,1 year,and longer intervals for significant cases.Clinical follow-ups occurred semi-annually for 2 years,then annually.Factors analyzed included sex,age,fistula size and location,and balloon size.RESULTS In our cohort of 79 patients treated for TCCF,pseudoaneurysms formed in 67.1%,with classifications ranging from grade 0 to grade 3;no grade 4 or giant pseudoaneurysms were observed.The majority of pseudoaneurysms did not progress in size,and some regressed spontaneously.Calcifications developed in most large pseudoaneurysms over 5-10 years.Parent artery occlusion occurred in 7.6%and recurrent fistulas in 16.5%.The primary risk factors for pseudoaneurysm formation were identified as the use of specific balloon sizes,with balloon SP and No.6 significantly associated with its occurrence(P=0.005 and P=0.002,respectively),whereas sex,age,fistula size,location,and the number of balloons used were not significant predictors.CONCLUSION Pseudoaneurysm formation following detachable balloon embolization for TCCF is common,primarily influenced by the size of the balloon used.Despite this,all patients with pseudoaneurysms remained asymptomatic during long-term follow-up.

Chronic exercise training versus acute endurance exercise in reducing neurotoxicity in rats exposed to lead acetate

After intraperitoneal injection of 20 mg/kg lead acetate, rats received 8 weeks of treadmill exercise （15-22 m/min, 25-64 minutes） and/or treadmill exercise at 1.6 km/h until exhaustion. The markers related to neurotoxicity were measured by enzyme-linked immunosorbent assay method. 8 weeks of treadmill exercise significantly increased brain-derived neurotrophic factor level in the hippocampus （P = 0.04） and plasma level of total antioxidant capacity of rats exposed to lead acetate （P 〈 0.001）, and significantly decreased plasma level of malondialdehyde （P 〈 0.001）. Acute exercise only decreased the hippocampal malondialdehyde level （P = 0.09） and increased brain-derived neurotrophic factor level in the hippocampus （P = 0.66）. Acute exercise also enhanced the total antioxidant capacity in rats exposed to lead acetate, insignificantly （P = 0.99）, These findings suggest that chronic treadmill exercise can significantly decrease neurotoxicity and alleviate oxidative stress in rats exposed to lead acetate. However, acute endurance exercise was not associated with these beneficial effects.

Gastric endoscopic submucosal dissection in Western countries:Indications,applications,efficacy and training perspective

Endoscopic submucosal dissection was introduced in Japan for the mini-invasive treatment of early gastric cancer,as part of national screening program considering high prevalence of disease in these latitudes.This technique allows en-bloc curative oncological excision and to obtain in a single step R0-resection,characterization,histological staging and potential cure of the tumor with a very high cost-benefit balance.Over the years,Western endoscopists have adopted endoscopic submucosal dissection,achieving good rates of efficacy,long-term improved outcomes and safety,with low risk of local recurrence comparable to those obtained in Asian institutes.However,according to some authors,the excellent outcomes from East country could not be representative of the Western experience.Despite epidemiological differences of early gastric cancer,scant volume data and limitations in training opportunities between Western and Eastern countries,European Society of Gastrointestinal Endoscopy have adopted Japanese guidelines and developed a European core curriculum for endoscopic submucosal dissection training.Endoscopists should be able to estimate the probability of performing a curative resection by considering the benefit/risk relationship case-by-case in order to implement a correct decision-making process.

Effects of Aerobic Exercise Combined with Resistance Training on Patients with Myocardial Ischemia Caused by Coronary Heart Disease

Objective:To explore the clinical effect of long-term aerobic exercise combined with resistance training in patients with myocardial ischemia caused by coronary heart disease and its influence on cardiac function, exercise endurance and quality of life. Methods:100 patients with myocardial ischemia caused by coronary heart disease from January 2017 to January 2019 were randomly divided into control group (n = 50 cases) and observation group (n = 50 cases). The control group was given resistance training, while the observation group was combined with long-term aerobic exercise on the basis of the control group. The two groups were treated for 3 months. The cardiac function, exercise endurance and quality of life were compared between the two groups. Results:The levels of IVST (8.20+1.32) mm, LVDD (46.43+4.13) mm and LVSD (32.59+3.15) mm in the observation group were lower than those in the control group at 3 months after treatment. The level of LVEF (67.49+5.77)% in the observation group was higher than that in the control group at 3 months after treatment. The difference between the two groups was significant (P<0.05). The ET (55.42+2.9) in the observation group was higher than that in the control group (P<0.05). 2) The levels of ng/L and TXB2 (93.23 + 6.26) ng/L were significantly lower than those of the control group, and the difference between the two groups was statistically significant (P<0.05). The 6-minute walking distance (561.25 +43.64) m and the quality of life score (95.31 +6.39) in the observation group were higher than those in the control group 3 months after treatment, and the difference between the two groups was statistically significant (P<0.05). Conclusions:Long-term aerobic exercise combined with resistance training can improve cardiac function, exercise tolerance and quality of life in patients with myocardial ischemia caused by coronary heart disease, which is worthy of popularization and application.

Isolated mitral valve replacement with Guangdong-Ⅰ porcine bioprostheses in rheumatic heart valve disease: analysis of 166 cases with long-term follow-up

Objective To study the long-term effects of mitral valve replacement with bioprostheses in rheumatic heart valve disease. Methods 166 patients with rheumatic heart valve disease underwent isolated mitral valve replacement from Jan. 1978 to Dec. 1985. 79 Patients were male and 87 female. Patients’ age ranged from 11 to 53 years [mean (29.4 ± 9.9) years]. The patients were classified into two groups: group 1 (age【 30 years) included 84 patients, group 2 (age≥30 years) 82 cases. Mean CTR is 0.68 *0.08. Most patients were in NYHA function class Ⅲ-Ⅳ. 76. 3% of patients had atrial fibrillation. 6 patients had pre-operative cerebral vascular accidents. Postoperative deaths were excluded. Follow-up extended from 0.4 year to 19.4 years. Results Actuarial estimate of survival rate at 14 years is (52.5 ± 7.0)%. Heart function was improved to class Ⅰ - Ⅱ in most of patients. Late structural valve deterioration occurred in 89 patients. Among them, 59 were re-operated. Actuarial estimate of freedom from

Adult Congenital Lumbar Kyphosis Requiring Anteroposterior Correction and Fusion: A Case Report with 32-Year Follow-Up

Congenital pure kyphosis due to failure of vertebral body segmentation is a relatively rare entity, and surgical intervention is infrequent compared to that for failure of vertebral body formation [1] [2]. There are very few reports of long-term follow-up of surgical treatment in patients with congenital pure kyphosis, and all the reported cases were diagnosed as failure of formation and had an age at the time of surgery of less than 18 years. It is important for orthopedic surgeons to follow the postoperative course of rare cases over 30 years. Here, we present a surgically treated case with ultra-long term follow-up of a 50-year-old patient with congenital pure kyphosis of the lumbar spine. Imaging of the lumbar spine showed six vertebrae and an unsegmented bar at L3-4 causing a pure kyphosis of 54°. The wedge-shaped block vertebra had 4 pedicles with the neural foramen between the pedicles without concomitant disc space, with compensatory thoracic hypokyphosis and lower lumbar hyperlordosis. One-stage correction and fusion surgery using anterior opening and posterior closing osteotomy was successfully performed. Both clinical and radiographic results were excellent and have been maintained for over 30 years postoperatively. The basic principle in the surgical treatment of adult spinal deformity is to achieve and maintain a good global sagittal balance over time. This case reaffirms the importance of spinopelvic harmony.

Long-term follow-up of Ta transitional cell carcinoma of bladder after treatment of TURBt plus intravesical therapy

To stduy the association between the prognosis of Ta transitional cell carcinoma (TCC) of the bladder and risk-related factors.Methods A total of 88 cases (62 males and 26 females;mean age,61 years;age range,41-81 years) of initial T.TCC of the bladder treated with transurethral resection of bladder tumor (TURBt) plus intravesical chemotherapy or immunotherapy were enrolled.Among them,there were 26 cases of G1,61 cases of G2 and 1 case of G3.For tumor site,62 cases (16 cases of G1,45 of G2,1 of G3) had single tumor and 26 cases (10 cases of G1,16 of G2) had multi-site tumors.The mean follow-up was 113 months (range,56-168 months).The tumor grade,original tumor number and their association with the recurrence and progression of this type of TCC were retrospectively analyzed.Results The overall recurrence rate (RR) was 60% (53/88).In single tumor group,RR of G1 cases was 25% (4/16);RR of G2 cases was 62% (28/45) and the total RR was 52% (32/62).In multi-site tumor group,RR of G1 cases was 80% (8/10),RR of G2 cases was 75% (12/16) and the total RR was 77% (20/26).The RR of multi-site tumor group was significantly higher than that of single tumor group (P<0.01).In single tumor group,RR of G2 cases was significantly higher than that of G1 cases (P<0.001).In multi-site tumor group,there was no association of RR with tumor grade.There was no progression in G1 tumor cases.The progression rate was 42.5% (17/40) in G2 tumor cases;among them,30% (12/40) progressed to T1G2 tumors and 12.5% (5/40) progressed to T2G2 tumors.The RR of cases who received thiotepa,mitomycin and BCG were 75% (12/16),68% (30/44) and 40% (11/27),respectively.Tumor specific mortality was 1.14% (1/88,a T2G3 case).Conclusion The multi-site Ta TCC of the bladder has relatively higher RR and greater chance of progression after the treatment of TURBt plus intravesical chemotherapy or immunotherapy,especially in the poor differentiated tumors,thus active treatment and close follow-up are essential in clinical practice.9 refs.

Chronic effects of stretching on range of motion with consideration of potential moderating variables:A systematic review with meta-analysis

Background:It is well known that stretch training can induce prolonged increases in joint range of motion(ROM).However,to date more information is needed regarding which training variables might have greater influence on improvements in flexibility.Thus,the purpose of this metaanalysis was to investigate the effects of stretch training on ROM in healthy participants by considering potential moderating variables,such as stretching technique,intensity,duration,frequency,and muscles stretched,as well as sex-specific,age-specific,and/or trained state-specific adaptations to stretch training.Methods:We searched through PubMed,Scopus,Web of Science,and SportDiscus to find eligible studies and,finally,assessed the results from 77 studies and 186 effect sizes by applying a random-effect meta-analysis.Moreover,by applying a mixed-effect model,we performed the respective subgroup analyses.To find potential relationships between stretch duration or age and effect sizes,we performed a meta-regression.Results:We found a significant overall effect,indicating that stretch training can increase ROM with a moderate effect compared to the controls(effect size=-1.002;Z=-12.074;95%confidence interval:-1.165 to-0.840;p<0.001;I^(2)=74.97).Subgroup analysis showed a significant difference between the stretching techniques(p=0.01)indicating that proprioceptive neuromuscular facilitation and static stretching produced greater ROM than did ballistic/dynamic stretching.Moreover,there was a significant effect between the sexes(p=0.04),indicating that females showed higher gains in ROM compared to males.However,further moderating analysis showed no significant relation or difference.Conclusion:When the goal is to maximize ROM in the long term,proprioceptive neuromuscular facilitation or static stretching,rather than ballistic/dynamic stretching,should be applied.Something to consider in future research as well as sports practice is that neither volume,intensity,nor frequency of stretching were found to play a significant role in ROM yields.

Pulp health and calcific healing of a complicated crown–root fracture with additional root fracture in a maxillary incisor: A case report

BACKGROUND Complicated crown–root fracture (CRF) involves severe injury to the crown, root,and pulp, and may be accompanied by multiple root fractures. The loss of a toothhas lifelong consequences for children and teenagers, but the maintenance of pulphealth and the calcific healing of multiple root fractures are rarely reported in theliterature.CASE SUMMARY This case reports healing of a permanent tooth with complicated crown–root andadditional root fractures, in which pulp health was maintained. A 10-year-old girlfell and fractured the root of her maxillary left central incisor at the cervical level.After the coronal fragment was repositioned, the tooth was splinted until thetooth was no longer mobile, 2 years later. Eight years after treatment, the toothhas remained asymptomatic with vital pulp and localized gingival overgrowth.Cone-beam computed tomography revealed not only calcified healing of the CRFbut also spontaneous healing in an additional undiagnosed root fracture. Thefracture line on the enamel could not be healed by hard tissue and formed agroove in the cervical crown. It was speculated that the groove was related to thelocalized gingival overgrowth.CONCLUSION This case provides a clinical perspective of the treatment of a tooth with acomplicated CRF and an additional root fracture.

Long-term results of laparoscopic fenestration for patients with congenital liver cysts

BACKGROUND: The feasibility and immediate outcome of laparoscopic fenestration for patients with congenital liver cysts have been generally recognized. The aim of the present study was to assess the long-term results after laparoscopic fenestration. METHODS: A retrospective study was performed on 44 patients with congenital liver cysts who had undergone laparoscopic fenestration between June 1998 and December 2004. Among them, 30 were women and 14 men, aged 57 years on average (range 18-76 years). While 14 patients had solitary cysts, 20 had multiple cysts, and 10 had polycystic liver disease. The results of laparoscopic fenestration, including mortality, morbidity, mean postoperative hospital stay, and recurrences of cysts were evaluated. RESULTS: There was no perioperative death and the morbidity rate was 11% (5/44). All complications were treated conservatively. The mean postoperative hospital stay was 4 days. A mean follow-up of 57 months showed that the rates of cyst recurrence and symptom recurrence were 9% and 4.5%, respectively. CONCLUSION: Laparoscopic fenestration as a feasible and safe treatment procedure for patients with congenital liver cysts can yield very good long-term results.

Long-term survival after enucleation of a giant esophagea gastrointestinal stromal tumor

Gastrointestinal stromal tumors(GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract. Less than 1% occurs in the esophagus. Surgery is the primary treatment for patients with GISTs. We report a29-year-old male was admitted after the detection of a posterior mediastinal mass during work-up with routine examination. He did not have any disease-related symptoms. The physical examination was unremarkable. Chest computed tomographic scan, the barium esophagogram and endoscopic esophageal ultrasound showed benign neoplasm. The patient was performed an enucleation surgery through the right posterolateral thoracotomy. The pathology revealed a 13.0 cm × 12.0cm × 5.0 cm mass. The tumor was CD117(C-kit), PDGFRA and DOG1 positive. These findings were consistent with a GIST of the esophagus. So the diagnosis of GIST of esophagus was confirmed. The pathological diagnosis of low grade of GIST of esophagus was confirmed. The patient has no evidence of recurrence and is in good clinical conditions up-to date, five years after surgery.

Long-term results of Ahmed glaucoma valve implantation in Egyptian population

AIM： To evaluate the long-term results and complications of Ahmed glaucoma valve （AGV） implantation in a cohort of Egyptian patients. METHODS： A retrospective study of 124 eyes of 99 patients with refractory glaucoma who underwent AGV implantation and had a minimum follow-up of 5y was performed. All patients underwent complete ophthalmic examination and intraocular pressure （lOP） measurement before surgery and at ld, weekly for the 1st month, 3, 6mo, and ly after surgery and yearly afterward for 5y. lOP was measured by Goldmann applanation tonometry and/or Tono-Pen. Complications and the number of anti-glaucoma medications needed were recorded. Success was defined as lOP less than 21 mm Hg with or without anti-glaucoma medication and without additional glaucoma surgery. RESULTS： Mean age was 23.1±19.9y. All eyes had at least one prior glaucoma surgery, lOP was reduced from a mean of 37.2±6.8 to 19.2±5.2 mm Hg after 5y follow-up with a reduced number of medications from 2.64±0.59 to 1.81±0.4. Complete and qualified success rates were 31.5% and 46.0% respectively at the end of follow-up. The most common complications were encapsulated cyst formation in 51 eyes （41.1%）, complicated cataract in 9 eyes （7.25%）, recessed tube in 8 eyes （6.45%）, tube exposure in 6 eyes （4.8%） and corneal touch in 6 eyes （4.8%）. Other complications included extruded AGV, endophthalmitis and persistent hypotony. Each of them was recorded in only 2 eyes （1.6%）. ~ CONCLUSION： Although refractory glaucoma is a difficult problem to manage, AGV is effective and relatively safe procedure in treating refractory glaucoma in Egyptian patients with long-term follow-up. Encapsulated cyst formation was the most common complication, which limits successful lOP control after AGV implantation. However, effective complications management can improve the rate of success.

Long-term results of an anatomically implanted hip arthroplasty with a short stem prosthesis (MiniHip^(TM))

AIM To evaluate the clinical and radiological outcome nineand ten years after short-stemmed, bone preserving and anatomical hip arthroplasty with the MiniHip^(TM) system. METHODS In a prospective study, 186 patients underwent hip arthroplasty with a partial neck preserving short stem(MiniHip^(TM), Corin). Elderly patients were not excluded from this study, thus the mean age at the time of surgery was 59.3 years(range 32 to 82 years). Surgery and the follow-up assessments were performed at two Centers. Up until now, the mean follow-up was 112.5 ± 8.2 mo. The Oxford Hip Score(OHS) and the Hip Dysfunction Osteoarthritis and Outcome Score(HOOS) was assessed pre-and each year after surgery. The clinical follow-up was accompanied by standardized a.p. and axial radiological examinations. Periprosthetic lucencies, hypertrophies within the Gruen zones one to fourteen were assessed. A subsidence of the stem was investigated according to Morray and heterotopic ossifications were assessed according to Brooker.RESULTS The OHS and HOOS improved from 18 ± 3.3 to 46 ± 2.0 and from 30 ± 8.3 to 95 ± 4.6 points, P < 0.001 respectively. There were no differences regarding age, etiology, friction pairings, etc.,(P > 0.05). Two stems were revised due to a symptomatic subsidence four and twelve months postoperatively. Thus, the survivorship for aseptic loosening at nine to ten years was 98.66%. Including one stem revision due to a symptomatic exostosis, bursitis and thigh pain as well as one revision because of a septic stem loosening, the overall survival for the stem with revision for any reason was 97.32%. Besides one asymptomatic patient, radiological signs of a proximal stress-shielding, such as bone resorptions within the proximal Gruen zones, were not noticed. Findings suggesting a distal loading, e.g., bony hypertrophies or bone appositions of more than 2 mm, were also not detected. CONCLUSION Regarding these first long-term results on the MiniHip^(TM), the implant performed exceedingly well with a high rate of survivorship for aseptic loosening. Our radiological results within the Gruen zones support the design rationale of the Minihip to provide a reliable metaphyseal anchoring with the expected proximal, more physiological load transfer. This might minimize or exclude a stress shielding which might be associated with thigh pain, proximal bone loss and an increased risk of aseptic loosening. The MiniHip^(TM) is a reliable partial-neck retaining prosthesis with good a clinical long-term outcome in younger as well as elderly patients.

Survivors of COVID-19 exhibit altered amplitudes of low frequency fluctuation in the brain: a resting-state functional magnetic resonance imaging study at 1-year follow-up

Although some short-term follow-up studies have found that individuals recovering from coronavirus disease 2019(COVID-19)exhibit anxiety,depression,and altered brain microstructure,their long-term physical problems,neuropsychiatric sequelae,and changes in brain function remain unknown.This observational cohort study collected 1-year follow-up data from 22 patients who had been hospitalized with COVID-19(8 males and 11 females,aged 54.2±8.7 years).Fatigue and myalgia were persistent symptoms at the 1-year follow-up.The resting state functional magnetic resonance imaging revealed that compared with 29 healthy controls(7 males and 18 females,aged 50.5±11.6 years),COVID-19 survivors had greatly increased amplitude of low-frequency fluctuation(ALFF)values in the left precentral gyrus,middle frontal gyrus,inferior frontal gyrus of operculum,inferior frontal gyrus of triangle,insula,hippocampus,parahippocampal gyrus,fusiform gyrus,postcentral gyrus,inferior parietal angular gyrus,supramarginal gyrus,angular gyrus,thalamus,middle temporal gyrus,inferior temporal gyrus,caudate,and putamen.ALFF values in the left caudate of the COVID-19 survivors were positively correlated with their Athens Insomnia Scale scores,and those in the left precentral gyrus were positively correlated with neutrophil count during hospitalization.The long-term follow-up results suggest that the ALFF in brain regions related to mood and sleep regulation were altered in COVID-19 survivors.This can help us understand the neurobiological mechanisms of COVID-19-related neuropsychiatric sequelae.This study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University(approval No.2020 S004)on March 19,2020.

Restenosis after recanalization for Budd-Chiari syndrome: Management and long-term results of 60 patients

BACKGROUND Budd-Chiari syndrome is defined as hepatic venous outflow tract obstruction.For Asian Budd-Chiari syndrome patients,the major treatment modality is recanalization(percutaneous transluminal angioplasty with or without stent implantation).The cumulative 1-,5-,and 10-year primary patency rates and survival rates are reported to be excellent or satisfactory,but the long-term outcome of patients with restenosis(the most common complication after recanalization)is unknown.AIM To explore the treatment strategy for restenosis in patients with Budd-Chiari syndrome after interventional therapy and to evaluate the long-term follow-up results.METHODS The clinical data and follow-up results of 60 patients with restenosis after interventional therapy from November 1983 to December 2013 were retrospectively analyzed.RESULTS Sixty patients with restenosis were retrospectively divided into a percutaneous transluminal angioplasty(PTA)group(40 patients)and a PTA+stent group(20 patients)according to the primary recanalization method.For the patients with restenosis in the PTA group,13 refused treatment,and 27 received further treatment;among these patients,five had a second restenosis,two had a third restenosis,and one had a fourth restenosis.For the patients with restenosis in the PTA+stent group,nine refused treatment,ten received PTA alone,and the other received PTA+stent implantation.Among the patients who received further treatment,five had a second restenosis,three had a third restenosis,and one had a fourth restenosis.The 1-,5-,10-,20-,and 25-year cumulative survival rates of the 38 patients who received further treatment after restenosis were 100%,78.3%,78.3%,70.5%,and 70.5%,respectively;however,for the 22 patients who refused treatment,the survival rates were 72.7%,45.9%,30.6%,10.2%,and unavailable,respectively(P<0.001).CONCLUSION Long-term follow-up after interventional therapy is very important.Active treatment for patients with restenosis can improve prognosis,and minimally invasive treatment strategies for restenosis allows to obtain satisfactory results.

Total femur replacement with 18 years of follow-up:A case report

BACKGROUND Osteosarcoma is one of the most common primary malignant bone tumors and is more common in adolescents.The femur is the most common site of osteosarcoma,and many patients require total femur replacement.We reviewed the relevant literature and case findings,summarized and analyzed this case in combination with relevant literature,and in doing so improved the understanding of the technology.CASE SUMMARY The case we report was a 15-year-old patient who was admitted to the hospital 15 days after the discovery of a right thigh mass.The diagnosis was osteosarcoma of the right femoral shaft.After completion of neoadjuvant chemotherapy and preoperative preparation,total right femoral resection+artificial total femoral replacement was performed.Then,chemotherapy was continued after surgery.The patient recovered well after treatment,and the function of the affected limb was good.No recurrence,metastasis,prosthesis loosening,dislocation,fracture or other complications were found during 18 years of follow-up.At present,the patient can still work and lives normally.The results of the medium-and longterm follow-up were satisfactory.CONCLUSION Artificial total femur replacement is a feasible limb salvage operation for patients with femoral malignant tumors,and the results of medium-and long-term follow-up are satisfactory.

A Long-Term Study of Efficacy of Patients with Macular Edema Secondary to BRVO Treated with Ranibizumab Combined with Compound Salvia

Purpose: To study the long-term efficacy of intravitreal ranibizumab injection combined with in-travenous compound salvia injection drip in the treatment of patients with macular edema sec-ondary to branch retinal vein occlusion(BRVO). Methods: Sixty-five patients of branch retinal vein occlusion with macular edema were analyzed retrospectively. Thirty-seven patients in the treat-ment group were treated with ranibizumab injection combined with intravenous compound salvia injection drip, twenty-eight patients in the control group were treated with ranibizumab injection only. All patients were recorded and analyzed changes of clinical efficacy after 3 months, 6 months after a course of treatment of 6 months. Results: During 3 months after 6 months’ treatment, there were 5 patients having recurrence in the treatment group, while there were 9 in control group, the rate of recurrence between the two groups had significant difference (P < 0.05);during 3 - 6 months after a course of treatment, there were 2 patients having recurrence in the treatment group, while there were 4 in control group, the rate of recurrence between the two groups had significant difference (P < 0.05);however, the treatment group’s BCVA was better than control group, and the difference between the two groups had significance (P < 0.05). Conclusion: Ranibizumab injection combined with intravenous compound salvia injection drip could effectively reduce the impossibility of recurrence, improve the visual activity and bring better therapeutic efficacy in patients with macular edema secondary to branch retinal vein occlusion. The treatment showed great potential in the clinical use.

Fifty-Year-Follow-up Results Compared with Shorter Follow-up of Breast Cancer Patients Undergoing Radical Mastectomy with or without Adjuvant Radiotherapy

Background: To evaluate the effect of follow-up length on the outcome of breast cancer patients, we compared the 50- and 25-year follow-up results in terms of cure rate, overall mortality and mortalities from breast cancer, second cancer, and benign diseases. Methods: 763 patients treated for breast cancer between February 1953 and September 1976, were followed up until December 2014. They were divided into two cohorts;earlier cohort exclusively underwent radical mastectomy plus adjuvant radiotherapy, while later cohort had radical mastectomy alone. Assuming that in all patients follow-up was terminated at 50 or 25 years after diagnosis, likelihood ratio test and stratified Log-rank tests were performed to evaluate the differences in cure rate and overall survival between the two cohorts. Results: During the 50 years, radical mastectomy alone compared with radical mastectomy plus adjuvant radiotherapy is associated with a significantly higher cure rate, and higher survivals regardless of whether the death was from breast cancer, second cancer, benign causes or any causes. However, if follow-up information is limited to 25 years, the advantage of radical mastectomy alone is partly offset and the survival difference between the two cohorts becomes less significant. Conclusion: Radiotherapy to breast cancer may adversely affect not only mortality from breast cancer, but mortalities unrelated to breast cancer. Since such deaths occur later, they may fail to be detected unless follow-up is long enough. Thus, deleterious effects of radiotherapy may be underestimated. Exceedingly long follow-up is required to accurately estimate the cure rate and the long-term effect of radiotherapy.

Modeling the Long-term Antibody Response and Duration of Immune Protection Induced by an Inactivated,Preservative-free Hepatitis A Vaccine(Healive)in Children

Objective Long-term seroprotection via the hepatitis A vaccine is essential for the prevention of disease from the hepatitis A virus(HAV).Due to documented difficulties during decade-long follow-ups after receiving vaccines,statistical-modeling approaches have been applied to predict the duration of immune protection.Methods Based on five-year follow-up data from a randomized positive-controlled trial among Chinese children(1–8 years old)following a 0,6 months vaccination schedule,a power-law model accounting for the kinetics of B-cell turnover,as well as a modified power-law model considering a memory-B-cell subpopulation,were fitted to predict the long-term immune responses induced by HAV vaccination(Healive or Havrix).Anti-HAV levels of each individual and seroconversion rates up to 30 years after vaccination were predicted.Results A total of 375 participants who completed the two-dose vaccination were included in the analysis.Both models predicted that,over a life-long period,participants vaccinated with Healive would have close but slightly higher antibody titers than those of participants vaccinated with Havrix.Additionally,consistent with previous studies,more than 90%of participants were predicted to maintain seroconversion for at least 30 years.Moreover,the modified power-law model predicted that the antibody titers would reach a plateau level after nearly 15 years post-vaccination.Conclusions Based on the results of our modeling,Healive may adequately induce long-term immune responses following a 0,6 months vaccination schedule in children via induction of memory B cells to provide stable and durable immune protection.