RESUMO
BACKGROUND: Femoral head necrosis is a multifactorial disease, and has the youth oriented tendency. It often results in femoral head collapse and leads to total hip arthroplasty. Thus, finding a secure and effective treatment is of clinical benefits to relieve patients' suffering and to reduce social economic burden. Bone marrow mesenchymal stem cells (BMSCs) transplantation has been used in the clinical practice of femoral head necrosis. However, the conclusion remains controversial. OBJECTIVE: To access the safety and efficacy of the core decompression combined with autologous BMSCs transplantation in patients with femoral head necrosis by using meta-analysis approach. METHODS: Randomized clinical controlled trials (RCTs) which compared the therapeutic effects between core decompression combined with autologous BMSCs and core decompression were systematically retrieved from inception to June 20, 2017 in PubMed, The Cochrane Library (Issue 5, 2017), Embase, CNKI, CBM, VIP and WanFang databases. After extraction of the information and evaluation of the study quality, a meta-analysis was performed by RevMan software. RESULTS AND CONCLUSION: Eight RCTs with 323 patients (395 hips), 193 hips in BMSCs group and 202 in conventional therapeutic group, were ultimately included. The revisit time was 12-60 months. The overall quality of the trials was considered moderate-high. The results of meta-analysis show that compared with core decompression alone, autologous BMSCs transplantation combined with core decompression could alleviate the pain [Visual Analogue Scale: mean difference ( MD)=-0.39, 95% confidence interval (CI) (-0.76,-0.01)], enhance the joint function [Harris score: 12 months MD=7.16, 95%CI (3.88, 10.44) and 24 months MD=11.16, 95%CI (8.32, 14.00)], decrease the rate of disease progression in radiography [odds ratio=0.23, 95%CI (0.09, 0.55)]. Although there was no statistical significance between two groups, BMSCs transplantation had trend to reduce the rate of total hip arthroplasty [risk ratio=0.44, 95%CI (0.19, 1.03)]. No obvious complications were found in the course of BMSCs therapy. Given the above, autologous BMSCs transplantation combined with core decompression is a secure and effective therapeutic method for femoral head necrosis.
RESUMO
Objective: To investigate the clinical features, pathogenesis and the effect of surgical and medical treatment of patients with moyamoya disease complicating hyperthyroidism. Methods: The clinical data of 11 patients with moyamoya disease complicating hyperthyroidism were analyzed retrospectively, 10 of them were diagnosed by digital substraction angiography (DSA), and 1 was diagnosed by magnetic resonance angiography. All the patients met the diagnostic criteria of hyperthyroidism. After controlling hyperthyroidism, 8 patients underwent encephalo-duro-arterio-synangiosis, the other 3 were only given drugs to control hyperthyroidism. Results: Circled digit oneTen of the 11 patients (8 females) showed thyroid dysfunction, with increased 3,5,3′- triiodothyronine (T3) and thyroxine (T4), and the decreased thyroid stimulating hormone (TSH). Circled digit twoNine of the 11 patients showed cerebral infarction, 1 showed intraventricular hemorrhage and 1 did not found any abnormality in imaging findings. Ten patients had bilateral lesions and 1 had unilateral lesions. Circled digit threeEleven patients were followed-up for 11-102 months. Except 1 patient left mental decline and slow reaction, the symptoms of others were relieved or disappeared after the treatment. After encephalo-duro-arterio-synangiosis, 8 patients did not have any surgical complications, 6 of them conducted postoperative angiography (10-26 months) and all showed a great deal of compensatory blood supply from extracranial to intracranial arteries. Conclusion: Moyamoya disease complicating hyperthyroidism is mostly occured in female patients and their clinical symptoms are mainly cerebral infarction. The pathogenesis of moyamoya disease complicating hyperthyroidism remains unclear. It may be associated with a variety of genetic and immune factors. After controlling hyperthyroidism, surgical treatment can establish effective collateral circulation and reduce the risk of recurrence of stroke.
RESUMO
<p><b>OBJECTIVE</b>To analyze the radiogenic distribution in the sacrum in whole-body bone scanning.</p><p><b>METHODS</b>A total of 212 patients receiving whole-body bone scanning without any explicit bone metastases were divided into different age and gender groups. The radioactive distribution in the sacrum in whole-body bone scanning was analyzed statistically.</p><p><b>RESULTS</b>Of these cases, 31.1% presented with thin radioactive distribution in the sacrum and 11.3% exhibited increased radioactive distribution. Normal radioactive distribution in the sacrum was found in 57.6% of the cases. In both male and female elderly patients (>70 years), the rate of normal radioactive distribution in the sacrum was obviously reduced with increased rate of thin radioactive distribution. The female elderly patients showed higher rate of increased radioactive distribution in the sacrum than male elderly patients.</p><p><b>CONCLUSION</b>The radioactive distribution in the sacrum is similar between female and male patients. Elderly male patients over 70 years have generally thin radioactive distribution in the sacrum due to the presence of osteoporosis, which is also associated with latent fracture of the sacrum to result in increased radioactive distribution in the sacrum in whole-body bone scanning.</p>