Objective To report the treatment outcomes and repair methods for soft tissue defects at thumb using miniature flaps. Methods Six different kinds of surgical flaps were used for the repair on different thumb injuries. They were radial lateral thumb reverse island flap, dorsal ulnar thumb revers flap, first metacarpal dorsal reverse flap, first digital dorsal island flap, neurovessel pedicled V-Y advanced island flap, free nail flap first foot digital, and so on. The emergency repair using miniature flaps were studied on 132 different cases, all 137 flaps. Results The flaps survived expect 5 flaps had partial epidermis necorsis in the 137 flaps. But the 5 flaps survived too after disinfecting and changing dressing. The appearances and functions of thumbs were satisfactory for the 1 to 2 years post-operation follow-up. Conclusion It will gain better results if choosing appropriate emergency repair methods using miniature flaps on different cases.

Objective To investigate the influence of age on liver histopathological feature of patients infected with chronic hepatitis B. Methods Liver biopsies were performed on 114 patients with chronic hepatitis B. The biochemical tests were measured by routine automated techniques. Serum hepatitis markers including HBsAg, anti-HBs, HBeAg, anti-HBe, and anti-HBc were assayed by using a microparticle enzyme linked immunosorbent assay. HBV-DNA was measured with quantitative polymerase chain reaction assay. The grades of liver necrosis/inflammation and fibrosis were compared between four groups with different age: younger than 20years, 20 ～ 30, 31 ～40, and older than 40 years. Results All 114 patients had liver histological changes with different degree. 75.4 percent (89/114) of cases had 2/over 2 grades of liver necrosis/inflammation, and 47.4 percent (54/114) of cases had 2/over 2 stages of liver fibrosis.There was no significant relation between the level of ALT and age or between the level of ALT and the grades of liver necrosis/inflammation and fibrosis( P ＞0. 05 ). The significant difference in degrees of liver inflammation and fibrosis was found among three age groups ( x2 = 30. 86, P ＜ 0. 01; x2 = 21.17; P ＜0.05 ). The grades of 1 iver inflammation and fibrosis increased with the increased age of the patients. Conclusion These results suggested that age was an independent factor for the disease progression. It was very important to undertake liver biopsy for patients with CHB more than 30 years to reveal the liver histopathological characteristics and guide the treatment.

Objective To explore the efficacy and adverse effects of nimotuzumab combined with chemotherapy and radiotherapy in the treatment of locally advanced cervical cancer.Methods Sixty patients with stage Ⅲ cervical cancer by the histopathologic diagnosis were collected,and they were randomly divided into two groups using the random number table method.The control group (n =30)using intensity-modulated radiotherapy,intracavitary afterloading therapy and periodic chemotherapy,the observation group (n =30)in addition to the intensity-modulated radiotherapy,intracavitary afterloading therapy and periodic chemotherapy, the nimotuzumab (200 mg)was given to the patients before weekly radiotherapy.All patients were received 6 to 7 times of treatment.Results The curative effects of all the patients were evaluated after radiotherapy 3 months.In the observation group,there were 20 cases of CR,5 cases of PR,4 cases of SD,1 case of PD,the total effective rate (CR +PR)was 83.3%.In the control group,there were 1 8 cases of CR,3 cases of PR,6 cases of SD,3 cases of PD,the total effective rate was 70.0%.The difference was statistically significant (χ2 =8.356,P <0.05).The main adverse reactions in the observation group and control group included slight radioactive proctitis (1 6.7% vs 1 3.3%),radioactive cystitis (1 0.0% vs 1 0.0%),nausea and vomiting (50.0% vs 46.7%),reduction of white blood cells (40.0% vs 43.3%),with no significant differences (χ2 =3.357,P =0.71 9;χ2 =2.71 7,P =0.925;χ2 =5.882,P =0.623;χ2 =4.728,P =0.687).There were no skin rashes and allergic reactions.Conclusion Nimotuzumab can enhance the locally stage cervical cancer patients′sensitivity on radiotherapy,which can increase the efficacy and doesn′t increase adverse
reaction obviously.

Objective To compare the curative effect of conservative treatment and full thread hollow screw in the treatment of Ekrol 2 fracture of the fifth metatarsal bone.Methods From April 2013 to May 2015,42 patients with avulsion fractures of the fifth metatarsal basement of type 2 fractures in Ekrol division were treated in our hospital.23 patients underwent full thread hollow screw surgery (surgical treatment group),and there were 12 males and 11 females,with an average age of 43.4±9.2 years,and the fracture displacement length was 2.3±0.2 mm.19 patients treated with plaster fixation (conservative group),including 10 males and 9 females,with an average age of 45.7±8.9 years and fracture displacement length was 2.1±0.2 mm.During follow-up,X -ray examination was performed to evaluate the time of fracture healing and forefoot score of American Orthopaedic Foot and Ankle Society (AOFAS),visual analogue score (VAS) and quality of life questionnaire (SF-36) were compared between the two groups.Results All 42 patients were followed up for 12 to 24 months with an average of 18 months.At the latest follow-up,the fracture healing time of the surgical group was 9.3±2.0 weeks,with AOFAS score of 84.1±3.9,VAS score of 0.1±0.2,and the SF-36 score of 95.1±2.9 points,and the shortening of length after treatment was 2.1±2.5 mm;the average healing time of the conservative treatment group was 12.2±2.1 weeks,with the average AOFAS score of 84.2±4.2 points,and the average VAS score of 0.2±0.2 points,the average SF-36 score of 94.1 ±5.2 points,and the shortening of length after treatment was 0.4±2.5 mm.The results of each short-term score and the shortening of the length of the fracture after treatment was statistically significant.The results of the mid-and long-term scores showed no significant difference between the two groups;the fractures of both groups reached bone healing.3 cases of sural nerve stimulation occurred in the operation group,while 1 case occurred in the conservative group.Abnormal healing occurred in 2 cases of conservative treatment,and the fractures of the surgical treatment group were anatomic reduced.Conclusion Usingfull thread hollow screwfor the treatment of Ekrol 2 fracture of the fifth metatarsal bone is better than the conservative treatment in the short term,but there is no significant difference in the long-term effect.

Objective:To investigate the medicinal retention of different concentrations of melatonin in the bone tissue of type 2 diabetic osteoporosis (T2DOP) rats and explore to efficacy of improvement of the bone microstructure of T2DOP rats.Methods:A total of 95 SD rats were selected, 60 of which had intraperitoneal in jection of high-fat diet combined with low-dose streptozotocin establishing a T2DOP rat model. Two months later, 45 rats' model was determined to be successful by detecting blood glucose and insulin sensitivity index. 30 successful modelling and 30 normal SD rats were randomly selected for melatonin distribution experiment, and were divided into four groups according to the injected melatonin concentration, including modeling rat high concentration group (50 mg/kg), modeling rat low concentration group (10 mg/kg), normal rat high concentration group (50 mg/kg) and normal rat low concentration (10 mg/kg), and there were15 rats in each group. Each group was divided into 5 sub-groups according to the time point of sampling (5, 15, 30, 60, 120 min), 3 animals per group. The bone tissue of each group was pretreated, and then the melatonin drug distribution in the bone tissue was detected by high performance liquid chromatography (HPLC). Another 15 rats were successfully modeled, and were divided into T2DOP group, high melatonin group (50 mg/kg) and low melatonin group (10 mg/kg), 5 rats in each group. 5 normal SD rats were taken as controls (control group), and Micro-CT was used to detect changes in bone microstructure after 8 weeks of treatment with melatonin.Results:The results of the drug distribution experiment showed that after melatonin was injected intraperitoneally, there were drugs remaining in the bone tissues of the rats in each group. The drug concentration reached the highest after 30 min of administration, and significantly decreased after 120 min. Compared with the normal rat low concentration group, there was no significant difference in the drug concentration between the two groups at 5 time points. However, the drug concentration at the four time points of 5, 15, 30, and 60 min in the modeling rat high concentration group were 7.613±2.568 ng/ml, 13.983±2.262 ng/ml, 18.816±1.291 ng/ml, 6.172±1.962 ng/ml, 1.112±0.566 ng/ml, which were significantly different compared with normal rat high group. Micro-CT results showed that after 8 weeks of melatonin treatment, the bone density of the high concentration group was (205.72±28.41 g/cm 3) significantly lower than that in the low concentration group (223.63±35.41 g/cm 3), but both groups were significantly higher than the normal rat group (158.31±31.86 g/cm 3). Conclusion:Exogenous melatonin is distributed in bone tissue, and the drug absorption rate of T2DOP rats is higher. Meanwhile, there is no difference in the distribution of melatonin in bone tissue with different concentrations, and these two concentrations of melatonincan canimprove the bone microstructure of T2DOP rats.

Objective:To investigate the feasibility of applying the ArcherQA three-dimensional (3D) dosimetric verification system in intensity-modulated radiotherapy (IMRT) plans for nasopharyngeal carcinoma (NPC).Methods:A retrospective analysis was conducted for 105 NPC patients′ IMRT plans developed using the Eclipse treatment planning system (TPS). Dose verification was conducted using the ArcherQA system and through portal dosimetry (PD). Moreover, this study compared γ passing rates (criteria: 3 mm/3%, TH = 10%) between ArcherQA and PD and the doses delivered to the target volume ( Dmean, D90%) and organs at risk (OARs) ( Dmean) between ArcherQA and TPS, and analyzed the 3D γ passing rates of each organ at risk calculated by ArcherQA. Results:The average 3D γ passing rate calculated by ArcherQA was (99.04±1.01)%, and the average 2D γ passing rate measured by PD was (99.49±0.78)%, with statistically significant differences ( t=-3.35, P< 0.05). The dosimetric differences to the target volume between ArcherQA and TPS were as follows: the average difference in Dmean to the gross tumor volume (GTV) was (0.57±0.48)%, and the average difference in D90% was (0.65±0.56)%. For the target volume, the average γ passing rate was (97.67±3.43)% for GTV, (97.80±4.35)% for GTVnd-L, (97.82±4.07)% for GTVnd-R, (97.88±2.44)% for CTV1, and (96.64±4.32)% for CTV2. The mean dose difference of each target volume was CTV1 (0.57±0.46)%, GTVnd-L (0.85±0.55)%, GTVnd-R (0.73±0.55)%, and CTV2 (0.88±0.52)%. For OARs, the mean γ passing rate was (99.93±0.22)% for the brainstem, (99.17±2.82)% for the optic chiasm, (100±0)% for the lens, (99.56±1.05)% for the spinal cord, (99.00±2.06)% for the thyroid, and (87.86±10.42)% for the trachea. Statistically significant differences in the average doses to OARs were observed ( t=-14.62 to 4.82, P<0.05), except for those to the left optic nerve, the right hippocampus, and the right parotid gland. Conclusions:Based on the high-performance GPU platform and the Monte Carlo dose algorithm, ArcherQA can provide accurate 3D dose distribution and 3D γ passing rates inside patients according to CT images and provide the dose volume histogram (DVH) of various regions of interest (ROIs). Therefore, the ArcherQA three-dimensional dose verification system can be applied to IMRT plans for NPC. Moreover, it is inducive to improve the treatment efficiency since it does not occupy the accelerator operation time.

Objective:To investigate the impacts of electron streaming effect (ESE) on out-of-field dose distribution in 1.5 T MRI-guided radiotherapy.Methods:Firstly, the Monaco v5.40.1 (Elekta AB, Stockholm, Sweden) treatment planning system (TPS) was implemented to investigate the ESE in a square field (5 cm × 5 cm) at the entry and exit sides of a special homogeneous water phantom. Afterward, a retrospective investigation was conducted into one laryngeal cancer case and one breast cancer case who had been treated on a conventional linear particle accelerator (linac). Then doses were recalculated in the Monaco system using a Unity machine model. Meanwhile, the out-of-field skin dose enhancement induced by ESE was investigated.Results:ESE-induced dose variations were observed at both the entry and exit sides of the phantom surface in the presence of a magnetic field, with the ESE on the exit side notably stronger than that on the entry side. For the laryngeal cancer case, the ESE was not notable and had insignificant impacts on the out-of-field skin dose. In contrast, ESE-induced in-air high-dose region outside the body stretched to the chin area for the breast cancer case. This led to the skin dose escalation of the chin at D1 cm 3 454.6 cGy. After the application of 1 cm bolus, the corresponding skin dose of the chin D1 cm 3 reduced to as low as 113.6 cGy, which is almost equivalent to that in the absence of a magnetic field ( D1 cm 3=92.5 cGy). Conclusions:The ESE in a magnetic field can alter out-of-field dose and lead to local dose enhancement along the electron path. Although the ESE had insignificant impacts on the out-of-field dose of the laryngeal cancer case, it reached the chin area of the breast cancer case. ESE can be effectively shielded by adding protective bolus.