Objective: Try to get the information about the civil will of donation of cadaver in Wuhan. Method: Make stochastic visit to the dwellers in Wuchang district of Wuhan and then study the statistical data. Content: Legal system, sensibility, traditional ideas and public opinions etc. Result: The most notable factors are legal system and sensibility. Conclusion: In order to implement the new law,we should strengthen the dissemination of donation of cadaver.

Objective To study the clinical features and pathology of renal damage in patients with MPA. Method The clinical pathological changes of 23 MPA patients were analyzed and the patients with positive ANCA were compared with those with negative ANCA. Results Most MPA patients were senile and male with the symptoms of lung damage, pleuritis, arthritis and myalgia as well as extrarenal symptoms such as fever, weight-loss, and anorexia. 65.2% of the patients were ANCA (+). Symptoms of renal function damage were hematuria and proteinuria, which could be found in all the patients. Different degree of renal damage could be detected. Glomerular cresent formation, which were mostly fibrous, could be found in all of the 23 patients. Half of the patients have tuft necrosis and interstitial vessel vasculitis. Conclusion MPA patients often have extrarenal symptoms besides renal function damage. Patients with positive ANCA differs from patients with negative ANCA in both clinical manifestation and kidney pathology.

Objective To investigate the value of renal CT arteriography in the preoperation evaluation of patients with renal tumors.Methods From Jan 2007 to June 2012,372 patients with renal tumors took renal CT arteriography (with Philips Brilliance 16) to evaluate the variations of their renal arteries.We executed plain scan first,then artery phase,venous phase scan and delaying scan by turns after injections of Omnipaque.All images were delivered to imaging workstation and reconstructed to 3D views of renal arteries to supply imageological supports for surgeons.Results Tumors in solitary kidneys were detected in 21 patients,and masses in both kindneys were detected in 4 cases.We collected data of 376 kidneys finally.We found premature branching renal arteries on 46 kidneys (12.2％) and accessory renal arteries on 74 kidneys (19.7％).Double accessory renal arteries were seen on 10 kidneys (2.7％),and there were 84 accessory renal arteries in summary.7 accessory renal arteries (7.2％) came from arteria phrenica and 77 (91.7％) came from abdominal aorta (x2 =65.68,P ＜ 0.01).We found the regions where the accessory renal arteries entered kidneys:65.5％ (55/84) in upper poles,19.0％ (16/84) in central regions and 15.5％ (13/84)in inferior poles.Routine CT scans found 44 variations of renal arteries in 218 cases who underwent surgeries,and then renal CT arteriography found 63 variations in the same cases (20.2％ vs 28.9％,x2 =4.47,P ＜ 0.05).Finally,surgeons found 60 variations of renal artries in operations in the 63 cases with variations found by renal CT arteriography before surgeries.Conclusions There is limitations of routine CT scan (plain scan and with contrast medium) in detection of renal artery variations.Renal CT arteriography can supply reliable supports for establishment of surgical plans for renal tumors.

Objective To study the influence of combined spinal-epidural anesthesia on perioperative coagulation function,RAAS activity and postoperative analgesia effect in parturients with cesarean section.Methods One hundred and eighteen parturients of cesarean section in our hospital from June 2013 to January 2016 were collected and divided into the observation group and control group according to the random number table method,59 cases in each group.The observation group received the combined spinal-epidural anesthesia and the control group received epidural anesthesia.The coagulation function indicators on preoperative 1 d (T0),at 10 min before operation end(T1) and postoperative 6 h (T2) were detected by adopting the automatic blood coagulation analyzer,the renin angiotensin aldosterone system (RAAS) function indices were detectd by radioimmunoassay.The pain indicators at postoperative 6 h(T2),12 h (T3) were detected by the pain threshold test instrument.Results The levels of prothrombin time(PT),activated partial thromboplastin time (APTT) and thrombin time (TT) at T1 and T2 in the observation group were significantly higher than those in the control group,while the PTA level was lower than that in the control group(P<0.05);serum RAAS indices such as (renin),angiotensin Ⅱ(ANG II) aldosterone(ALD) in the observation group were lower than those in the control group(P<0.05).The VAS score at T2,T3 in the observation group was lower than that in the control group,while the pain threshold and pain tolerance threshold levels in the observation group were higher than those in the control group(P<0.05).Conclusion Combined spinal-epidural anesthesia can reduce the blood coagulation and RAAS activation caused by cesarean section trauma,and the effect of postoperative analgesia is more significant.

Objective To evaluate the dosimetric effects of target volume delineation with metal clip and seroma,alone or in combination,on external-beam partial breast irradiation (EB-PBI) based on four-dimensional computed tomography (4DCT).Methods Twenty female patients undergoing EB-PBI from 2009 to 2013 were enrolled as subjects.The gross tumor volumes (GTVs),GTVC,GTVS,and GTVC+S,were delineated on 4DCT images at 10 phases using metal clip,seroma,and both of them,respectively.The GTVS on 4DCT images at 10 phases were fused to generate the internal gross tumor volumes (IGTVS),IGTVC,IGTVS,and IGTVC+S.The planning target volumes (PTVS),PTVC,PTVS,and PTVC+S,were obtained via expansion of margin by 15 mm.The three-dimensional conformal radiotherapy plans were made by one physician based on PTVC,PTVS,and PTVC+S on end-inhalation images.The target volume,homogeneity index (HI),conformity index (CI),and doses to organs at risk were compared between the three groups.Results The C+S group had the largest IGTV,PTV,and the ratio of PTV to diseased breast volume,which was followed by the C group and the S group (all P＜ 0.05).The S group had significantly lower doses to the ipsilateral normal breast and lung than the C group and the C+S group (all P＜0.05).There were no significant differences in HI or CI between the three groups (all P＞ 0.05).Conclusions The volume variation caused by target volume dehneation on 4DCT images based on different references has little impact on dose distribution in target volume.However,it has substantial impact on radiation doses to the ipsilateral normal breast and lung.

Objective To investigate feedback regulation of close-loop muscle relaxant injection system on accuracy of cisatracurium besilate usage. Methods Two hundred patients undergoing laparoscopic cholecystectomy surgery, aged 20 to 40 years old, at ASA Ⅰ or Ⅱ, were randomly divided into two groups:control group and treatment group (n=100 each group).In the control group, the patients received injection of cisatracurium besilate with closed-loop muscle relaxant injection system at 1.5-2.0 μg·kg-1 ·min-1 , until 30 min before the end of surgery;if the muscle relaxant level could not meet the requirement of the operation, extra 0.05 mg·kg-1 was added.The treatment group was adopted closed-loop muscle relaxant monitoring under negative feedback regulation of infusion cisatracurium, and the close-loop control parameters were set to: drug was added when TOF was 8%, and injection speed was 2. 5 μg · kg-1 · min-1 , maintaining speed was 0. 33 μg · kg-1 · min-1 , the stimulus current for monitoring muscle relaxant was 60 mA , and the pulse width was 200μs.The Cooper score, cisatracurium dosage, and muscle recovery index, TOFr75 and TOFr90 of the two groups were compared. Prediction probability ( Pk ) of NI on awakening period of eye opening and directional force recovery of the two groups were detected, and regression equation was established to predict ED50 and ED95 related NI . Results Cooper score was significantly higher in the treatment group than in the control group ( P<0. 01 ) . Muscle recovery index, TOFr75 , TOFr90 , and cisatracurium dosage per unit time and body mass were significantly lower in the treatment group than in the control group(P<0.01). Pk of NI on awakening period of eye opening and directional force recovery of the two groups were higher than 0.5; and Pk of the treatment group were significantly higher than those of the control group ( P<0.01) . Regression equation predicted that ED95 was significantly lower in the treatment group than in the control group ( P<0.01) , while the ED50 between the two groups has no significant difference ( P>0.05) . Conclusion The accuracy of closed loop muscle relaxant injection system is higher than that of the traditional method, it provides better muscle relaxation effect for tracheal intubation, reduces recovery time, increases the Pk of NI on patient awakening.

Objective To evaluate the impact of respiratory motion for dose of target and organ at risk during external-beam partial breast irradiation (EB-PBI).Methods 4D-CT scan sets were acquired for 20 patients who underwent EB-PBI.The volume of the tumour bed (TB) was determined based on seroma or surgical clips on the ten sets of 4D-CT images.For each patient a conventional 3D conformal plan (3D-CRT) was generated based on the 4D-CT end inhalation phase images,then copied and applied to the other phases.The following parameters were calculated to analyse:mean dose (D),homogeneity index (HI),conformal index (CI),and the volumes that received ≥ x Gy (Vx).Results During free breathing,the TB centroid motion was 0.90,0.75 and 0.80 mm in the lateral,anteroposterior and superior-inferior directions,respectively.The medium spatial motion vector was 0.95 mm.In the superiorinferior direction,TB motion significantly correlated with D HI,and CI of PTV (r =-0.458,-0.451 and 0.462,P ＜ 0.05),as well as D V20 and V30 received by the ipsilateral normal breast (r=0.527,0.488 and0.526,P ＜0.05).And in the motion vector,the D V5,V10,V20 of the ipsilateral lung all correlated with TB motion (r =0.416,0.503,0.522 and 0.498,P ＜ 0.05).A correlation also existed between dose and percent volume of heart and volume variation of heart (Dmean,V5 and V10) (r =0.727,0.704 and 0.695,P ＜ 0.05).Conclusions Small TB motion caused by respiratory motion during free breathing result in dosimetric variation of the target and potential dosimetric off-target or suboptimal dose coverage for EB-PBI.The doses of lung during free breathing were relatively sensitive to TB motion and thorax expansion,while heart doses were not influenced notably.

BACKGROUND:Intertrochanteric fracture is one of the common fracture, and accompanied by osteoporosis and high energy injury. The fracture line often descended, and induced A3 intertrochanteric fracture. This type of fracture is difficult to treat. Common intramedulary fixation includes proximal femoral nail anti-rotation and InterTan, which have high stability, are minimaly invasive, and have been extensively used. OBJECTIVE: To compare the biomechanical stability of A3 intertrochanteric fracture fixed with proximal femoral nail anti-rotation and InterTan by finite element analysis. METHODS:Three three-dimensional finite element models of the AO3.1, AO3.2 and AO3.3 intertrochanteric fracture fixed with proximal femoral nail anti-rotation and InterTan were established. Fixation was completed according to the requirement of Department of Orthopedics. Stress distribution of femur and fixator of different models was observed. Stress peak at different areas was compared in femur and fixation models. Biomechanical stability was analyzed. RESULTS AND CONCLUSION: The maximum pressure concentration area in AO3.1 intertrochanteric fracture with proximal femoral nail anti-rotation was located in the lateral proximal femur, and with Intertan was located in the medial proximal femur. The AO3.2 had little differences between two types of nails. The AO3.3 intertrochanteric fracture with proximal femoral nail anti-rotation was located in the medial proximal femur and the medial distal implant. There was no significant pressure concentration with InterTan. The von Mises pressure of six models was concentrated in the medial distal implant, and higher maximum von Mises pressure was found in the proximal femoral nail anti-rotation. There was significant difference of von Mises distribution between the lateral and medial implant with proximal femoral nail anti-rotation. Except the AO3.3 intertrochanteric fracture with proximal femoral nail anti-rotation, the maximum pressures of remaining models were located in the main nail and interlocking nail infal. These results concluded that the fracture fixed with InterTan exhibited fine fixation stability in the AO3.1 and AO3.3 intertrochanteric fracture. There was no significant difference of fixation stability between proximal femoral nail anti-rotation and InterTan in AO3.2. The von Mises distribution of InterTan for intertrochanteric fracture is more reasonable.

Objective To investigate the differences in position and volume between planning target volumes (PTV) based on positron emission tomography?computed tomography (PET?CT) images with an standardized uptake value ( SUV) no less than 2?5, 20% of the maximum SUV ( SUVmax ), or 25% of SUVmax , three?dimensional ( 3D ) CT, and four?dimensional ( 4D ) CT in thoracic esophageal cancer. Methods Eighteen patients with thoracic esophageal cancer sequentially received chest 3DCT, 4DCT, and [18F]fluoro?2?deoxy?D?glucose (FDG) PET?CT scans. PTV3D was obtained by conventional expansion of 3DCT images;PTV4D was obtained by fusion of target volumes from 10 phases of 4DCT images. The internal gross tumor volumes ( IGTV) , IGTVPET2.5 , IGTVPET20%, and IGTVPET25%, were generated based on PET?CT images with an SUV no less than 2?5, 20% of SUVmax , and 25% of SUVmax , respectively. These IGTVs were expanded longitudinally by 3?5 cm and radically by 1 cm to make PTVPET2.5 , PTVPET20%, and PTVPET25%, respectively. Results PTV3D was significantly larger than both PTV4D and PTVPET(P=0?000 -0?044), while there was no significant difference between PTV4D and PTVPET ( P= 0?216 -0?633 ) . The mutual degrees of inclusion ( DIs ) between PTV3D and PTV4D were 0?70 and 0?95, respectively, which were negatively correlated with 3D?Vector ( P=0?039). The mutual DIs between PTVPET2.5, PTVPET20%, and PTVPET25% were 0?74, 0?72, 0?78, 0?73, 0?77, and 0?70, respectively, which showed no correlation with 3D?Vector (P=0?150 -0?822). The mutual DIs between PTV3D and PTVPET were 0?86, 0?84, 0?88, 0?63, 0?67, and 0?59, respectively. Conclusions It is difficult to achieve complete volumetric overlap of PTVs based on 3DCT, 4DCT and PET?CT in thoracic esophageal cancer due to different target volume information. PET scan during free breathing should be used with caution to generate PTVs in thoracic esophageal cancer.

Objective To evaluate the effect of propofol with different sedation depth on CERO 2 of elder patientsduring anesthesia. Method 60 case patients under cholecystotomywith laparoscope, ASA IorⅡgrading, 65-75 year old , 45-75 kg , were randomly divided into 3 groups ( n = 20 ) and were divided into group A (3 μg/mL), group B (4 μg/mL), group, C (5 μg/mL), according to TCI of propofol. TCI in different groups were modified after gereral anesthesia. Bloodgas was analyzed by blood samples taken from radial artery and Sjv ball, Da-jvO2 and CERO2 were calculated. Results The Da-jvO2 and CERO2 of group B and C were significantly lower thanthose of group A at T2,3, while CjvO2 were significantly higher thangroup A (P < 0.05). The Da-jvO2 and CERO2 of group B and C werenot significantly different (P > 0.05); NI value of group A in T1-3 was significantly higher thangroup B (P < 0.05), while. NI value of group B in T1-3 was significantly higher thangroup C (P < 0.05). Conclusion Propofol TCI 4 μg/mL, can improve cerebral oxygen metabolism of elder patients and decrease CERO2.