Objective To determine whether the use of 18F-FDG PET/CT alters staging and management of nasopharyngeal carcinoma (NPC) when compared with MRI staging practice;and to explore the relation of standard uptake value (SUV) of 18F-FDG PET/CT and the pathological classification and T staging of NPC. Methods The study was performed retrospectively on a group of 41 patients with a new diagnosis of NPC. All the patients underwent whole body PET/CT scanning and head & neck MRI scanning within 3 weeks of each other. The AJCC protocol was introduced to stage NPC and the results of the PET/CT were compared with MRI based on pathologic diagnosis. Results ①Primary tumor:the accuracy of T staging of PET/CT was significantly higher than MRI (85.37% vs 60.98%,U=2.49,P

Objective To evaluate the radioprotective effects of Quercetin (QN) on 6 Gy X-ray irradiation-induced immune dysfunction and toxicity in hepatic tissue in rats. Methods 40 adult rats were randomly divided into 4 groups. Group Ⅰ was injected intraperitoneally with saline solution for 7 consecutive day sand served as control group. Group Ⅱ was daily injected with QN (40 mg/kg) for 7 consecutive days. Group Ⅲ was irradiated with a single dose of 6 Gy X-ray. Group Ⅳ received a daily injection of QN (40 mg/kg) for 7 consecutive days, and 1 h after the last injection rats were irradiated with a single dose (6 Gy) X-ray irradiation.The animals were sacrificed after 24 h. Lymphocyte transforming rate was measured with MTT method, and CD+4 T, CD+4 T and CD+8/CD+8 T were measured with flow cytometry method. Oxidative conditions in liver were measured with malondialdehyde (MDA), reduced glutathione hormone (GSH), supernxide dismutase (SOD) andglutathione peroxidase (GSH-Px) activities kits. HE staining was used to observe the general condition of rat's liver. Results Lymphocyte transforming rate, CD+4 T, CD+8 T and CD+8/CD+8 T in rats of Group Ⅳ were all higher than those in rats of Group Ⅲ ( F = 8.455,22.644, 18.911, P < 0.01 ). MDA content in the Group Ⅳ rat's liver was lower than that in the Group Ⅲ ( F = 10.059, P < 0.01 ) and antioxidant enzymes SOD, GSH-Px activities were higher than those in Group Ⅲ (F = 23.688,186.046,19.788, P < 0.01 ). The capillary of the hepatic lobules dilated and congested obviously in portal area, involving infiltration of polymorphonuclear leukocytes in the Group Ⅲ, while QN improved this change apparendy. Conclusions Pretreatment with Quercetin improved the irradiated rat's immune functions and protected the irradiated rats from oxidative stress to some extent.

Objective To explore the effects of 75 mGy irradiation on the apoptosis of spermatogenic cells and antioxidant capacity of serum and testis and hormone levels in male rats with diabetes mellitus(DM).Methods Rats were injected intraperitoneally with streptozotocin(STZ)to develop diabetes.The diabetic rats were irradiated with 75 mGy X-rays every other day for 4 weeks.Their survival rate and body weight were recorded 12 weeks after development of diabetes.The apeptosis percentage of germ cells was measured with flow cytometry and TUNEL method.The changes of anti-oxidation and gonadal hormone levels in serum and testis were measured with kits.Results After the rats suffered from diabetes for 12 weeks,the survival rate in DM group was 25%(6/24),100% in normal control group(16116).The survival rate in 75 mGy + DM group(9/16,56.25%)was obviously higher than that in the DM group(X2= 4.00,P < 0.05).Meanwhile,the percentage of apaptotic spermatogenic cells in the diabetic rats was significantly larger than those in the normal control and irradiation groups(F = 5.496,P < 0.05).MDA and NO levels in serum and testis of diabetic rats were higher in varying degrees than that in the normal control,while the serum and testis MDA content in the 75 mGy + DM group were lower than those in the DM group especially in the testis(F = 10.644,P < 0.01).75 mGy X-ray irradiation decreased NO content in the diabetic rats serum significantly(F = 14.379,P < 0.05)and increased NOS activity and TS,FSH level(F = 9.676,43.194 and 5.282,respectively,P < 0.05 and P < 0.01).Conclusions LDR could decrease the MDA level and NO content,and increase the antioxidant enzyme activity and TS and FSH levels in testis and serum of diabetic rats.

Objective To construct the pshuttle-Egr-1-hSmac plasmid and transfect human breast cancer MDA-MB-435 cells,and to observe its radiotherapy enhancing effect on tumor cells.Methods The empty vector pshuttle and pshuttle-Egr-1-hSmac plasmid were transfected into MDA-MB-435 cells by liposomal.At different time(4,8,12,24 and 48 h)after irradiation with 2.0 Gy X-ray and 24 h after irradiation with 0.5 -5.0 Gy,the total RNA and protein were collected and extracted from these cells to analyze the Smac mRNA and protein expression levels with RT-PCR and Western blotting methods. The cells were divided into control, pshuttle, pshuttle-Egr-1-hSmac,2.0 Gy irradiation group, pshuttle + 2.0 Gy irradiation and pshuttle-Egr-1-hSmac+2.0 Gy irradiation groups.MTT method was used to evaluate cell proliferation,and the cell survival ability was measured with clone formation assay;Annexin Ⅴ/PI double staining and PI single staining were used to examine the apoptosis and cell cycle of MDA-MB-435 cells. Results There was no Smac mRNA expression in MDA-MB-435 cells in control and pshuttle groups,but the Smac mRNA expression levels in MDA-MB-435 cells in pshuttle-Egr-1-hSmac plasmid group were gradually increased with the time prolongation, and reached the maximum at 24 and 48 h;the Smac mRNA expression levels in MDA-MB-435 cells were increased gradually 24 h after irradiation of 0.5 - 5.0 Gy X-ray with the increasing of irradiation doses, and reached the maximum after 2.0 and 5.0 Gy irradiation. The Smac protein expression levels in pshuttle-Egr-1-hSmac plasmid group were increased gradually with the time prolongation,and reached the maximum at 24 h.The Smac protein expression lervels were increased 24 h afer irradiation of 0,0.5,1.0,2.0 and 5.0 Gy X-ray,especially in 5.0 Gy group. The MTT results showed that the A490 values in 2.0 Gy,pshuttle+2.0 Gy and pshuttle-Egr-1-hSmac groups 24, 48,and 72 h after irradiation were lower than those in control group(P<0.01);the A490 values of MDA-MB-435 cells in pshuttle-Egr-1-hSmac group after 1.0-5.0 Gy X-ray irradiation were lower than those in 0 Gy group (P<0.05 or P<0.01);the survival fraction(SF)in pshuttle-Egr-1-hSmac group was lower than those in control group (P<0.01).The percentages of the cells at G0/G1 and S phase in pshuttle-Egr-1-hSmac group were lower than those in 2.0 Gy group(P<0.01),the percentage of the cells at G2/M phase was higher than that in 2.0 Gy group (P<0.01);the apoptotic rate of the cells in pshuttle-Egr-1-hSmac group was higher than that in 2.0 Gy group (P<0.01).Conclusion X-ray irradiation can significantly increase the Smac mRNA and protein expression levels in MDA-MB-435 cells transfected with pshuttle-Egr-1-hSmac plasmid,inhibit the cell survival rate,and induce G2/M arrest and apoptotic increasing;Smac gene combined with radiotherapy could significantly increase the radiosensitivity of breast cancer cells.

Objective To investigate the association between tumor necrosis factor-α(TNF-α)and lymphotoxin α(LTα) gene single nucleotide polymorphisms (SNPs) and susceptibility to extremity post-traumatic osteomyelitis in Chinese population.Methods We used SNaPshot genotyping method to detect genotypes of 6 TNF-α gene SNP sites (rs1799964,rs1800630,rs1799724,rs1800750,rs1800629 and rs361525) and 1 LT α gene SNP site of rs909253 in 189 patients with post-traunatic osteomyelitis and 200 healthy controls.Genetic models were applied to investigate the potential links between the above-mentioned SNPs and risks of developing post-traumatic osteomyelitis.Results Outcomes revealed that the frequency of mutant allele C of rs909253 in the patient group was statistically higher than that in healthy controls (54.23％ versus 45.00％,P =0.010,OR =1.448,95％ CI 1.092 ～ 1.921).Significant correlations were found between rs909253 and risk of developing post-traumatic osteomyelitis by recessive model (CC versus CT+TT,P=0.012,OR=1.868,95％CI1.150～3.035) and homozygote model (CCversusTT,P=0.021,OR=2.016,95％ CI 1.111～3.658).The frequency of CC (29.63％) in the patient group was higher than that in the control group (17.50％).With regard to rs1800629 site of TNF-oα gene,we only found that the frequency of mutant allele A (4.23％) in the patient group was statistically lower than that(7.75％) in the control group (P=0.040,OR=0.526,95％ CI 0.283 ～0.978).Conclusions LTαgeneSNP site rs909253 may be linked with elevated risk of developing post-traumatic osteomyelitis in Chinese population.Mutant allele C may be a risk factor and people with genotype of CC may be a group at a higher risk of developing post-traumatic osteomyelitis in China.

Objective To investigate the design,incisional method and clinical experiences of using the mi cro-dissected polyfoliate anterolateral thigh perforator flap to repair of complex soft tissue defect in extremities.Methods From June,2017 to September,2018,12 cases of different kinds of complex soft tissue defect in extremities were repaired by micro-dissected free polyfoliate anterolateral thigh perforator flap.Each flap was divided into two cutaneous perforators to give two separate flap with a common vascular supply.The flaps were cut from the superficial layer of the deep cervical fesciae and without fascia lata.The donor sites were treated by subcutaneous cosmetic suture.Patients were followed-up by outpatient service,telephone and WeChat video to observe and record the flap's appearance,sensory recovery,extremities function and the scars of the donor site to evaluate its clinical efficacy.Results All flaps survived without vascular crisis happened except one-leaf necrosis occurred,which healed with local flap transferring.The donor sites remained linear scars.The mean flap thickness of this group after micro-dissection was (4.5±0.5) mm.All the patients were followed-up for 5-15 months.The 2 point discrimination ranged between 0.5-2.0 cm.Sensory restoration ranking was S3-S3+.The range of montion of wrist joint was 65°-90°,and that of ankle joint was 40°-60°.Conclusion The micro-dissected polyfoliate anterolateral thigh perforator flap is an ideal method for complex and irregular multiple sites soft tissue defect in extremities as it can keep good economic benefit and minimal damage to the donor site.

Objective:To compare the clinical effects on new bone formation and foot-ankle function between proximal tibial bone transport and distal tibial bone transport in the treatment of massive bone defects after tibial osteomyelitis debridement.Methods:From July 2012 to July 2017, 42 patients with chronic tibial osteomyelitis received bone transport surgery at Department of Orthopaedics, Nanfang Hospital.According to the Cierny-Mader classification for chronic osteomyelitis, all of them belonged to diffusive tibial osteomyelitis (type IV).Of them, 32 were treated by proximal tibial bone transport after tibial osteomyelitis debridement.In the proximal group, there were 27 males and 5 females, aged from 17 to 65 years and involving 20 left and 12 right sides. The other 10 cases received distal tibial bone transport. In the distal group, all of them were male, aged from 25 to 63 years and involving 6 left and 4 right sides. The 2 groups were compared in terms of external fixation index (EFI) and American Orthopaedic Foot & Ankle Society(AOFAS) Ankle and Hindfoot Scale.Results:There were no significant differences between the 2 groups in the preoperative general data such as gender, age or osteomyelitis site, indicating the 2 groups were comparable ( P>0.05). Both groups obtained complete follow-up. The proximal group was followed up for 590.1 d ± 287.3 d and the distal group for 615.6 d ± 130.6 d, showing no significant difference between groups ( P>0.05). In the proximal group 2 cases developed talipes equinovalgus after bone transport while in the distal group 3 cases did, and surgical intervention was needed for them. Surgical intervention was also carried out for16 cases of non-union at the docking site in the proximal group and for 2 ones in the distal group. The EFI was 76.2 d/cm±50.0 d/cm for the proximal group and 84.3 d/cm ± 59.9 d/cm for the distal group, showing no significant difference between groups ( P>0.05). The AOFAS scores were 81.4±10.1 for the proximal group and 60.0±5.9 for the distal group, showing a significant difference ( P<0.05). Conclusion:In the treatment of massive bone defects after tibial osteomyelitis debridement, no significant difference has been observed in the effect on bone formation between proximal tibial bone transport and distal tibial bone transport, but the former transport may have a less adverse effect on foot-ankle function.

Objective:To discuss the clinical results of treatment for congenital muscular torticollis with different injection points of botulinum toxin type A and traditional conservative method, and to expound the safety and effectiveness of this way.Methods:From January 2018 to December 2018, 60 cases aged from one month to six months with congenital muscular torticollis who visited the outpatient clinic of plastic surgery in Children＇s Hospital of Quanzhou, a teaching hospital of FuJian Medical University, and there were 38 males and 22 females. The treatment groups were divided into two groups according to random number method that were treated with botulinum toxin type A: the single point group was given one point injection, and the three-point group was injected with three points, while the control group was treated with traditional conservative treatment (mainly manual stretching exercises). The number of cases in each group was 20.Results:The differences of muscle thickness and muscle length were repeatedly measured at different time points in the same group and variance analysis conducted. The results showed that there were statistical significances among the two indicators at different time points in each group ( P<0.05). Least significant difference (LSD) was further adopted for pairwise comparison between indicators at different time points in each group and the differences were statistically significant ( P<0.05). In the comparison of treatment effect of different groups after twelve months follow-up, the cure rate was 85% (17 cases) in the single point group, 95 % (19 cases) in the three-point group, and 80 % (16 cases) in the control group, there was no significant difference among three groups ( P>0.05). Conclusions:Local injection of botulinum toxin type A is a safe and effective treatment option for congenital muscular torticollis, which can achieve the same clinical effect as traditional conservative treatment.

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.