BACKGROUND:Traditional core decompression and al ograft fibula supporting can reduce the stress load within femoral head and improve mechanical properties of femoral head. However, it cannot provide supports for maintaining the stability of five pathological areas fol owing femoral head necrosis. OBJECTIVE:To observe the clinical effect of fan-shaped decompression and al ograft fibula supporting internal fixation in treatment of early femoral head necrosis in adults, taking al ograft fibula grants as the control. METHODS:Forty patients with early femoral head necrosis were randomly divided into treatment group and control group, receiving fan-shaped decompression plus al ograft fibula supporting internal fixation and traditional decompression plus al ograft fibula grafting, respectively. The therapeutic effects in two groups were observed and compared. After treatment, patients were detected by bilateral hip anteroposterior films, Harris scoring and X-ray ARCO staging to evaluate the col apse severity and restoration of necrosis. RESULTS AND CONCLUSION:At the last fol ow-up, Harris scores in the treatment group were significantly higher and the repairing effect was better than control group (P<0.05). In treatment group, 18 hips restored wel (72%) and 7 hips delayed or failed to restore (28%);in control group, 9 hips restored wel (60%) and 6 hips delayed or failed to restore (40%). Our findings indicate that, fan-shaped decompression plus al ograft fibula supporting internal fixation yields a more complete decompression, a higher stability of femoral head and a more reliable supporting, compared with traditional decompression plus al ograft fibula grafting.

Objective:To investigate the optimal time of coronary computed tomography angiography (CCTA) after taking nitroglycerine,and to provide basis for improving the image quantity of CCTA .Methods:43 patients underwent CCTA were scanned with coronary artery calcium score (CACS)after taking nitroglycerin 0,3,5 and 10 min.Then the diameters of the same coronary artery from the same anatomic location and the expanding rates were measured,and the change regular was analyzed with single factor analysis of variance of SPSS 17.0 software. Results:The average coronary artery expanding rate was 8% 3 min after taking nitroglycerin, and the difference was significant compared with 0 min (P<0.05);but there were 5 patients whose coronary artery didn’t expand. The coronary artery expanded obviously 5 and 10 min after taking nitroglycerin compared with 0 and 3 min (P<0.05);the maximum expanding rates at 5 and 10 min were both 38%.There were 13 and 28 patients whose coronary artery reached the maximum expanding rates (17% and 19%)5 and 10 min after taking nitroglycerin, respectively;the coronary artery of 2 patients expanded at a same level at 5 and 10 min.The average expanding rates of coronary artery had no significant differences between 5 and 10 min (P>0.05 ).Conclusion:Taking nitroglycerin can significantly expand the diameter of coronary arteries.It is necessary to perform CCTA during 5-1 0 min after taking nitroglycerine.

Objective To observe the effects of Tongluo-Jiedu-Huazhuo decoction on hemorheological indexes and gastric juice components in patients with chronic atrophic gastritis.Methods According to the inclusion criteria,84 patients with chronic atrophic gastritis were randomly divided into the observation group and the control group,with 42 cases in each group.The control group received the routine clinical treatment,and the observation group was treated with Tongluo-Jiedu-Huazhuo decoction on the basis of the control group.The clinical symptoms were scored before and after treatment.The blood viscosity,plasma viscosity,hematocrit,fibrinogen and erythrocyte aggregation index were measured bY automatic hemorheology instrument,and gastric juice pH,free acid,pepsin and nitrite levels were measured by serial gastric juice detection method.The clinical efficacy was evaluted.Results The total effective rate of the observation group was 90.5％ (38/42),and the total effective rate of the control group was 76.2％ (32/42),with statistically significant difference (Z=-2.683,P＜0.05).After treatment,the scores of epigastric pain,stomach swelling,nausea and vomiting,acid reflux and dietary deficiency in the observation group were significantly lower than those in the control group (t were 4.865,4.632,4.716,4.582,4.433,respectively,all Ps＜0.05),and the whole blood viscosity,plasma viscosity,hematocrit,fibrinogen and erythrocyte aggregation index were significantly lower than those in the control group (t were 5.044,4.462,5.274,4.231 and 4.485,respectively,all Ps＜0.05).The gastric juice pH (2.28 ± 0.33 vs.2.75 ± 0.38,t=4.825),nitrite (33.27 ± 4.45 mg/L vs.38.80 ± 4.93 mg/L,t=5.136) in the observation group were significantly lower than the control group (P＜0.05).The free acid (22.13 ± 3.36 mmol/L vs.18.65 ± 2.54 mmol/L,t=5.382),pepsin (144.56 ± 15.86 U vs.137.16 ± 14.63 U,t=5.736) in the observation group were significantly higher than the control group (P＜0.05).Conclusions The application of Tongluo-Jiedu-Huazhuo decoction in patients with chronic atrophic gastritis can improve the hemorrheology index and regulate the function of gastric secretion,which is helpful to protect the gastric mucosa and relieve the clinical symptoms.

Objective To explore the effects of acupoint application combined with modified Xiaoqinglong decoction on airway remodeling and serum C-reactive protein (CRP), interleukin-8 (IL-8) and eosinophil chemotactic factor (eotaxin) levels in patients with bronchial asthma. Methods A total of 78 patients with bronchial asthma were randomly divided into two groups, 39 cases each group. The control group was treated with conventional western medicine therapy, and the study group was treated with acupoints plus Xiaoqinglong decoction on the basis of the control group.The treatment effect,adverse reaction were observed, and airway remodeling associated indicators like Transforming growth factor-β1 (TGF-β1), vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and serum CRP, IL-8, Eotaxin levels were detected as well. Results After treatment, the clinical asthma control rate was 87.18% (34/39) in the study group and 58.97% (23/39) in the control group, and the difference was statistically significant (χ2=7.885,P<0.05).After treatment,the TGF-β1(6.74 ± 2.21 μmol/L vs.10.90 ± 2.24 μmol/L,t=8.256),VEGF(27.63 ± 5.14 ng/ml vs.35.76 ± 5.82 ng/ml,t=6.539),bFGF(7.15 ± 1.54 μmol/L vs.12.62 ± 2.23μmol/L,t=12.605)in the study group were significantly lower than those of the control group (P<0.05). After treatment, the CRP (9.16 ± 1.85 mg/L vs.16.74 ± 2.20 mg/L,t=16.468),IL-8(51.26 ± 17.25 pg/L vs.114.32 ± 20.15 pg/L,t=14.847),IL-8 (98.59 ± 34.12 pg/ml vs.159.62 ± 52.74 pg/ml,t=6.068)in the study group were significantly lower than those of the control group (P<0.05). There was no significant difference in the incidence of adverse reaction between the study group 20.5%(8/39) and the control group12.8%(5/39) during treatment (χ2=0.831, P>0.05). Conclusions The acupoint application combined with modified Xiaoqinglong decoction can significantly improve the clinical effect, inhibit airway remodeling, decrease the level of serum CRP, IL-8 and Eotaxin in patients with bronchial asthma, and its safety is high.

To establish diagnostic criteria for common traditional Chinese medicine (TCM) syndromes in osteoporosis.

To establish a quantitative estimate model for diagnosing traditional Chinese medicine (TCM) syndromes of patients with osteoporosis.

Objective:To evaluate the clinical application of virtual and simulation techniques to aid pre-operative design for precise screw placement into the sustentaculum tali in the treatment of intra-articular calcaneal fractures.Methods:From January 2016 to January 2019, 68 patients were treated at Department of Orthopaedics, Suqian Hospital Affiliated to Xuzhou Medical University for intra-articular calcaneal fractures of Sanders types Ⅱ-Ⅳ. According to different designs of screw placement into the sustentaculum tali, they were assigned into a control group (38 cases and 42 feet) and an observation group (30 cases and 33 feet). There were 24 males and 14 females with an age of 39.3 years±8.8 years in the control group. There were 17 males and 13 females with an age of 42.0 years ± 7.6 years in the observation group. The control group was given a routine placement design based on the X-ray and MSCT scanning images of the injured feet. In the observation group, a Mimics model was first constructed using the X-ray and MSCT scanning images of the normal or less injured feet for further virtual screw placement into the sustentaculum tali on a 3D printed model. The disparity was investigated between the parameters designed and the actual values in both groups. The 2 groups were compared in terms of average placements, screw distribution, placement accuracy, placement time and Maryland scores of foot function one year after operation.Results:There were no significant differences in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The design parameters and actual values in the control group were respectively as follows: 17.7°±3.2° versus 15.1°±5.9° in upward oblique angle, 20.3°±2.1° versus 16.2°±6.8° in backward oblique angle, and 47.9 mm ± 3.8 mm versus 45.4 mm ± 4.2 mm in length of screw path, showing significant differences ( P< 0.05). The design parameters and actual values in the observation group were as follows: 16.5°±3.5° versus 17.1°±3.9° in upward oblique angle, 20.9°±4.3° and 19.6°±3.8° in backward oblique angle, and 48.1 mm ± 3.1 mm versus 47.3 mm ± 3.8 mm in length of screw path, showing insignificant differences ( P>0.05). The average screw placements into the sustenta culum tali in the observation group (1.6±0.5) were significantly more than those in the control group (1.2±0.4). Compared with the control group, the observation group had a higher rate of placement of 2 screws[60.6 % (20/23) versus 16.7% (7/42)], higher accuracy of placement [94.3% (50/53) versus 77.6% (38/49)], less placement time for each screw (9.6 mm±3.9 min versus 13.2 mm±4.7 mm), less placement time for each foot (15.6 mm±4.8 min versus 20.5 mm±3.8 mm), and higher Maryland scores at one year after operation (94.2±6.5 versus 89.7±6.9). All the above comparisons were statistically significant ( P<0.05). Conclusions:Application of virtual and simulation techniques to aid pre-operative design for precise screw placement into the sustentaculum tali can improve the outcomes of intra-articular calcaneal fractures, because it increases the number of screws placed, enhances quality of screw placement, shortens operation time, and thus facilitates functional recovery of the injured foot.

Objective To analyse the memory function and MRI changes in local-advanced nasopharyngeal carcinoma patients before-and after-radiation.Methods Clinical data,dosimetric data,digital span score and MRI of 14 cases with nasopharyngeal carcinom treated in Zhejiang Cancer Hospital from November 2015 to August 2016 were retrospectively analysed.There were 1 case at T2 stage,7 cases at T3 and 6 at T4.They received IMRT or TOMO therapy concurrent with 2 cycles Nedaplatin after 2-3 cycles PF/TP induction chemotherapy.Results The IMRT dosimetric data of 9 cases were available.For hippocampus and temporal lobe,the mean volume was (15.17 ± 2.17) and (95.07 ± 12.26) cm3,respectively,while the mean dose was (1 154.06 ±771.63) and (1 306.61 ±603.69) Gy,and the max dose (3 797.61 ± 1 450.98) and (5 394.17 ± 982.28) Gy,respectively.The equivalent uniform dose (EUD) was (2 233.28 ±872.73) Gy for hippocampus and (3 113.11 ±603.69) Gy for temporal lobe.10 patients received digit span score before-and 3 months after-radiotherapy.The mean score of forward digit span was 8.8 ± 1.8 before radiation and 8.1 ± 1.59 at 3 months after radiation(P ＞ 0.05),while thatof backward digit span decreased from 6.2 ± 1.04 before radiation to 5.3 ± 2.36 at 3 months after radiation (t =3.25,P ＜ 0.05).9 patients' MRI were available.Volume reduction of temporal lobe was observed (t =4.57,P ＜ 0.01) by voxel-based morphometry (VBM).Conclusions Radiation-induced injury to hippocampus and temporal lobe is inevitable in local-advanced nasopharyngeal carcinoma patients.There might be some connection between memory loss and temporal lobe volume atrophy after radiotherapy.Enrollment of larger sample analysis is expected.

Objective:To evaluate our novel path based on anatomical division of the anterior lateral wall of calcaneus and the sustentaculum tali for precise sustentacular screw placement in the surgical treatment of calcaneal fractures of Sanders types Ⅱ and Ⅲ.Methods:The anterior lateral wall of the calcaneus was divided into the anterior-superior zone S 1, the anterior-inferior zone S 2, the posterior-superior zone S 3 and the posterior-inferior zone S 4 for demarcation of the screw insertion points by our method of Four Zones, and into the front, middle and rear sections by our method of Three Sections for demarcation of the screw target points. The specimens were scanned by CT and modeled by Mimics. On the 3D virtual model of the calcaneus, one screw was placed from each zone of the anterior lateral wall of the calcaneus to the sustentaculum tali body. The screw placement target for S 1 and S 2 was the medial intersection point P 1 of the front and middle sections of the sustentaculum tali, and that for S 3 and S 4 was the medial intersection point P 2 of the middle and rear sections of the sustentaculum tali. It was observed whether the screws were placed in the bone channel. A total of 72 patients were included who had been admitted to Department of Orthopaedics, Suqian Hospital Affiliated to Xuzhou Medical University for calcaneal fractures of Sanders types Ⅱ and Ⅲ from January 2017 to January 2021. They were divided into an anatomical division group and a 3D printing group according to their screw placement method for the sustentaculum tali. In the anatomical division group of 32 patients subjected to screw placement based on our anatomical division, there were 25 males and 7 females, aged from 24 to 60 years; in the 3D printing group of 40 patients subjected to screw placement assisted by 3D printing, there were 31 males and 9 females, aged from 25 to 58 years. The disparities between the parameters of sustentacular screw placement and the actual values were compared in the anatomical division group, and the total number of screws, screws on average, distribution of screws, and accuracy of screw placement were compared between the 2 groups. Results:All the screws which were virtually placed in the specimens of the calcaneus from S 1 and S 2 to P 1 and from S 3 and S 4 to P 2 passed through the bony channel, with no perforation into the tarsal sinus. There was no significant difference in the general date between the anatomical division group and the 3D printing group, showing they were comparable ( P > 0.05). In the anatomical division group, a total of 52 screws were placed to the sustentaculum tali with an average of (1.63 ± 0.48) screws per patient, and 2 screws were placed in 20 patients, yielding an accuracy rate of screw placement of 92.3% (48/52). There were no statistically significant differences between the parameters and the actual values of screw placement in the anatomical division group ( P > 0.05). In the 3D printing group, a total of 63 screws were placed to the sustentaculum tali with an average of (1.58 ± 0.49) screws per patient, and 2 screws were placed in 23 patients, yielding an accuracy rate of screw placement of 93.7% (59/63). There were no significant differences in the above comparisons between the anatomical division group and the 3D printing group ( P > 0.05). Conclusion:In the surgical treatment of calcaneal fractures of Sanders types Ⅱ and Ⅲ, the sustentacular screw placement based on our anatomical division of the anterior lateral wall of the calcaneus and the sustentaculum tali can lead to similar clinical accuracy as 3D printing-assisted screw placement does.

Objective To analyze the radiation doses to the head, body, and tail of the hippocampus in intensity-modulated radiotherapy(IMRT)for nasopharyngeal carcinoma(NPC). Methods Ten NPC patients treated with IMRT were selected,and the head, body, and tail of both hippocampi were delineated on T1-weighted images. The doses to the hippocampus were then analyzed. WAIS-CR speech test results were tested by paired sample t-test. Results The mean doses to left and right hippocampi were 1 147±976 cGy and 1 011±602 cGy, respectively. The mean doses to the head, body, and tail of the left hippocampus were 1 739± 1 317 cGy, 890± 982 cGy, and 547± 688 cGy, respectively(P=0.042);the mean doses to the head,body,and tail of the right hippocampus were 1 691±942 cGy,744±483 cGy,and 531±603 cGy,respectively(P=0.002).The dose to the hippocampus decreased from the head to the tail, and the irradiated volume also decreased as the dose varied. Conclusions The dose to hippocampus decreases from the head to the tail in NPC patients treated with IMRT,which is worthy of attention.