Objective To explore the clinical effect of the treatment for fresh achilles tendon rupture by modified double Kessler suture with S type incision .Methods Totally 21 cases of fresh achilles tendon rupture were admitted into our hospital from January 2012 to Decem-ber 2015, and they were treated by S type incision modified double Kessler suture within 7 days (averagely 4.1 days).Observed the postop-erative complications and evaluated the efficacy with Arner-Lindholm.Results All the 21 patients were followed for 6 to 24 months ( aver-agely 12 months).There was no incision infection ,necrosis, re-fracture of achilles tendon and other complications .There were 16 cases of excellent and 5 cases of good , with the excellent and good rate of 100% through the Arner-Lindholm evaluation criteria .Conclusion Modified double Kessler suture with S incision for the treatment of fresh achilles tendon rupture is conducive to early functional exercise ,and it can obtain satisfactory clinical efficacy .

Objective To quantify the perfusion parameters of normal pancreas and pancreatic carcinoma with three-dimension (3D) fast spoiled gradient echo dynamic contrast enhanced (DCE) MRI on 3.0T MR system, and to assess the value of 3D DCE-MRI in the diagnosis of pancreatic carcinoma. Methods Thirty-four patients with pathology verified pancreatic carcinoma and 31 control subjects with normal pancreas (without pancreatic diseases) underwent DCE-MRI with 3D LAVA sequence of ten phases. The data were processed on ADW 4.2 workstation. The perfusion parameters of the head, body and tail of normal pancreas, together with lesion and non-lesion area of pancreatic carcinoma were measured and statistically analyzed, including signal enhancement ratio at 30 s after injection (SER_(30)), signal enhancement ratio at 90 s after injection(SER_(90)), positive enhancement integral (PEI), time to peak (TTP) and maximum slope of increase (MSI). Results There was no significant perfusion difference among head, body or tail of normal pancreas (P>0.05). The difference of SER_(30), PEI, TTP and MSI between lesion and non-lesion region of carcinous pancreas was significant (P<0.05). The TTP between normal pancreas and the non-lesion region of carcinous pancreas was significantly different (P<0.05). Conclusion Normal pancreas has no regional perfusion difference. The data from DCE-MRI provide reliable information for the diagnosis of pancreatic cancer, and for the assessment of the invasion of pancreatic carcinoma. The difference in TTP between the normal pancreas and non-lesion region of carcinous pancreas suggest the existing of potential lesions.

Objective To evaluate the ability of diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) value in diagnosis of pancreatic cancer at 3.0T MR. Methods The diffusion-weigted sequences with b=800 s/mm~2 were performed in 30 patients of pancreatic cancer confirmed pathology, and in 30 control subjects with normal pancreas as well. ADC value of the cancer, pericancerous tissue and normal pancreas were recorded and statistically analyzed with ANOVA and ROC analysis. Results The mean ADC value of cancer, pericancerous tissue and normal pancreas was(1.494±0.273)×10~(-3) mm~2/s, (1.631±0.281)×10~(-3) mm~2/s and (1.778±0.237)×10~(-3) mm~2/s, respectively. ADC value of pancreatic cancer was significant different from that of the normal pancreas, while there was no significant difference between pancreatic cancer and pericancerous tissue. The one-side upper limit of 95% confidence interval of mean ADCs (1.622×10~(-3)mm~2/s)was adopted as the point to diagnosis of pancreatitis. The area under ROC curve was Az=0.800. Conclusion ADC values are helpful to differential diagnosis of pancreatic cancer and normal pancreas. DWI may be do some contribution to the diagnosis of pancreatic cancer.

Objective To retrospectively compare CT and MR features of hepatocellular adenoma with pathologic findings.Methods Twelve patients with histopathologically proved hepatocellular adenoma were classified on the basis of pathologic and genotype phenotype findings into four groups:steatotic type,cytological abnormality type,telangiectatic adenoma with inflammatory infiltrates type and atypical adenoma type.The CT and MR features of each type were reviewed retrospectively compared with the pathological results.Results In this retrospective study,12 patients were examined with CT (8 patients) and MR (8 patients).Among 12 patients,4 patients showed a steatotic type.One patient showed hypo-density on the non-enhanced CT and 3 patients demonstrated hypo-density on all phases of the post-contrast scans.Two lesions showed iso-intense signal on the in-phase T1 WI with signal dropout on the out-of-phase T1WI,and hypo-intense signal on the T2 WI with fat suppression sequences.One lesion demonstrated moderate hypointense signal on all phases of the post-contrast MRI scans.Two patients with the telangiectatic adenoma irflammatory infiltrates type were found.One patient showed hypo-density on the non-enhanced CT scans and hyper-density on all phases of the post-contrast CT scans.One patient demonstrated iso-intense signal and the other hypo-intense signal on the T1 WI,and both displayed moderate hyper-intense signal on the T2WI with fat suppression sequences and hyper-intense signal with gradual enhancement on all phases of post-contrast MR scans.There were 3 patients with a cytological abnormality type.One patient appeared hypodensity and 1 patient showed uniform iso-density on non-enhanced CT scans.All patients who had undergone contrast-enhanced CT scans were found to have hyper-density on the hepatic arterial-dominant phase and became slightly lower on the portal venous phase.On the delay phase the density reduced further.One mass showed iso-intense signal on the T1WI and hyper-intense signal on the T2WI with fat suppression sequences.There were 3 patients with an atypical adenoma type.One patient appeared uniform hypo-density on the nonenhanced CT and hyper-density on the hepatic arterial-dominant phase and became iso-dense on the portal venous phase.On the delay phase,it was slightly hyper-dense.Two out of the three lesions showed isointense and one hypo-intense signal on the in-phase T1 WI,and hypo-intense,hyper-intense,and iso-intense signal on the T2WI with fat suppression sequences,respectively.Two patients examined on all phases of post-contrast MRI scans.The result was similar to the CT findings.Conclusion The imaging features of hepatocellular adenoma are closely associated with pathological characteristics.

Objective To evaluate the efficacy and safety of sublingual immunotherapy (SLIT) in patients with allergic asthma in order to provide reliable evidence for clinical application of SLIT.Methods To search published articles of randomized controlled trials (RCTs) in allergic asthma from CNKI,WANFANG,Pubmed and Medline databases.The methodological quality of trials was assessed by Jadadscale.The heterogeneity was examined by using Stata 11.0 software.Fixed effect model or random effect model was used to pool the data.The articles which could not be pooled were carried out by descriptive analysis.The Egger's and Begg's test were used to evaluate the publication bias.Results There were total 6 RCTs included in this text.Compared with control group,SLIT could significantly reduce asthma symptom scores (SMD =-0.89,95％ CI-1.36--0.43,P =0.000) and asthma medication scores (SMD =-4.53,95％CI-6.97--2.08,P =0.000),but not forced expiratory volume (FEV1) of lung function (SMD =0.19,95％ CI-0.02-0.41,P =0.078),neither serum sIgE levels (SMD =0.05,95％ CI -0.58-0.69,P =0.870).There were no obvious adverse events reported after treatment of SLIT.No publication bias were indicated by Egger's and Begg's tests.Conclusion SLIT significantly reduces asthma symptom scores and medication scores,suggesting that SLIT is a safe and effective approach of immunotherapy.However,it still needs more highly qualified studies of RCTs to prove.

OBJECTIVETo investigate the application and therapeutic effect of advanced orbicularis oculi muscle (OOM ) flap for eyelid defect.

METHODSUni-pedicle or bi-pedicle advanced OOM flaps were designed according to the location, depth and size of the eyelid defects. The resulted wounds in the donor sites were closed directly. The flap size ranged from 1.5 cm x 0.5 cm - 6.0 cm x 3.5 cm.

RESULTS120 cases were treated. All the flaps survived except for 3 flaps with epidermis necrosis at the end of flaps, which healed after dressing. The patients were followed up for 3 -36 months with inconspicious scar in donor sites. The flap color, texture had a good match with surrounding skin.

CONCLUSIONSThe OOM flap is ideal for eyelid defect with reliable blood supply, satisfied color and texture. The wound at donor site can be closed directly with less morbidity.

Blepharoplasty ; methods ; Cicatrix ; Eyelids ; surgery ; Facial Muscles ; transplantation ; Humans ; Surgical Flaps ; transplantation ; Transplant Donor Site ; surgery

Objective To prospectively evaluate the value of US,MSCT,EUS and MRI in the quantitative evaluation of the extent of pancreaticobiliary duct obstruction in pancreatic cancer.Methods Consecutive 68 patients with pancreatic carcinoma underwent US,MSCT,EUS and MRI before surgery.The diameter of extrahepatic bile duct and pancreatic duet were measured,and correlation analysis was performed with surgical specimens.Results Diameters of extrahepatic bile duct scaled by US.MSCT,EUS and MRI were(16.60±6.33)mm,(18.90±6.74)mm,(18.80±5.88)nun and(17.26±4.83)mm,and diameter measured from surgical specimens was(18.39±6.05)mm;the correlation among the four imaging examinations and the surgical evaluation were r=0.3839,P=0.1055;r=0.7113,P=0.0011; r=0.3759,P=0.0465;r=0.3376,P=0.2872,respectively. Kappa Values were 0.6285,0.7115,0.6661 and 0.7490,respectively.The diameter of pancreatic duct was(15.90±3.41)mm,(6.83 4-3.70)mm,(6.77±3.22)mm and(5.58±2.65)mm,and diameter measured from surgical specimens was(5.97±2.60)mm,the correlation among the four imaging examinations and the surgical evaluation were r=0.3584,P=0.2895;r=0.6148,P＜0.0001; r=0.7373,P＜0.0001;r=1.0746,P＜0.0001.Kappa values were 4.159,9.094,9.001 and 4.050.All of these parameters were in coherence with surgical findings.Condusions US could be used as the initial method in the assessment of extrahepatic and pancreatic duct obstruction.MRI and MSCT,combined with EUS if necessary,could be used to quantitatively evaluate the extent of pancreaticobiliary obstruction.

OBJECTIVETo analyze the imaging characteristics of hepatic epithelioid hemangioendothelioma (EHE) and their correlation with histopathological findings.

METHODSCT and MRI imaging and histopathological characteristics of five patients with hepatic EHE were retrospectively reviewed and the correlation of their imaging characteristics with pathological findings was analyzed.

RESULTSA total of 92 lesions were found in the 5 patients, all presenting with multiple nodules. All the 92 lesions were located within a 2-cm zone heneath the hepatic capsule, i.e., the shortest distance from the horder of lesions to the hepatic capsule. 28 of the 92 lesions showed the "capsular retraction" sign. 36 lesions were found in three patients receiving MRI. 77.8% of the 36 lesions demonstrated the "halo" sign on a fat-suppression T2- weighted image, while 91.7% after contrast enhancement. A peripheral dark rim was found in 91.7% of the lesions on a fat-suppression T2-weighted image. In addition, 36.1% of the lesions showed slight internal or edge enhancement at the hepatohiliary phase. In the two patients receiving CT examination, 7 of 56 lesions demonstrated the "halo" sign.

CONCLUSIONSHepatic EHE may manifest as nodular lesions with predilection of peripheral subcapsular growth and nodular confluence, together with "halo" sign and " capsular retraction". The peripheral dark rim on a fat-suppression T2-weighted image and slight enhancement at the hepatobiliary phase can help to improve the accuracy of diagnosis and differential diagnosis of this hepatic tumor. MRI is superior to CT imaging to denict their intra-lesional characteristics.

Hemangioendothelioma, Epithelioid ; diagnosis ; diagnostic imaging ; pathology ; Humans ; Liver Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Magnetic Resonance Imaging ; Neoplasms, Multiple Primary ; diagnosis ; diagnostic imaging ; pathology ; Physical Examination ; Retrospective Studies ; Tomography, X-Ray Computed

Objective To evaluate the in vitro effect on tumor cell uptake,tumor imaging and in vivo biodistribution of 99Tcm-epidermal growth factor receptor (EGFR) mRNA antisense PNA probe mediated by cationic liposome.Methods The oligonucleotide with sequence complementary to part of the EGFR mRNA antisense PNA was hybridized in an anti-parallel orientation targeted PNA.PNA hybridization complexes were labeled with 99Tcm by ligand exchange.The assembly of lipofectamine and 99Tcm-labeled heteroduplex was achieved by electrostatic interactions,and the radiolabeled purity was determined by reversedphase HPLC (RP-HPLC).The disparities of cell uptake in SKOV3 cells and the differences of biodistribution and molecular imaging in BALB/c nude mice bearing SKOV3 xenografts between lipofectanine-mediated 99Tcm-EGFR mRNA antisense PNA (group 1) and 99Tcm-EGFR mRNA antisense PNA (group 2) were analyzed.Two-sample t (or t') test and Wilcoxon rank sum test were used for statistical analysis.Results The labeling rates of both group 1 and group 2 were more than 95％ within 6 h.The cell uptake at 1,2,4,6,12,24 h after injection was (28.90±1.12)％,(32.76±1.20)％,(38.20±3.11)％,(41.23±1.60)％,(46.63±1.55)％ and (46.78±2.14)％ in group 1,and was (3.51±0.39)％,(3.90±0.40)％,(4.69±0.18)％,(5.91±0.26)％,(5.30±0.22)％ and (5.39±0.17)％ in group 2 respectively (t'=47.11-58.67,Z=2.80,all P＜0.05).The retention ratios showed significant difference between the two groups (t'=7.25-11.55,Z=2.80,all P＜0.05).The SKOV3 tumor could be visualized in both groups at 1 h post injection but much better visualized in group 1.The T/NT ratios were higher in group 1 at all time points (t =3.96,t'=12.65-14.69,Z=2.83-5.29,all P＜0.05).The T/NT ratios at uptake peak were 5.02 and 3.95,respectively.The probe accumulated mainly in tumor,kidneys and liver.Tumor uptake increased with time ((1.49±0.09) ％ID/g and (2.15±0.21) ％ID/g at 1 h,(3.90±0.65) ％ID/g and (5.00±0.10) ％ID/g at 6 h) after lipofectamine treatment.The ratios of tumor to contralateral muscle were also higher in group 1 (t =11.24,t' =3.96-11.94,all P＜0.05).Conclusions Lipofectamine-mediation can significantly improve the intracellular delivery of radionuclide molecular probe.Lipofectamine-mediated 99Tcm-EGFR mRNA antisense PNA can greatly improve imaging contrast and visualization of EGFR-over-expressing tumors.

Objective To prepare the 99Tcm-labeled human epidermal growth factor receptor type 2 (HER2) affibody molecule ZHER2:342 and evaluate its receptor binding specificity in vitro.Methods The molecular ZHERa:342 was labeled with 99Tcm using the ligand exchange method.The labeling efficiency and radiochemical purity were measured by HPLC.The major factors,such as the mass of SnC12 and NaOH and reaction time were analyzed,and the optimal method was summarized.Cell binding kinetics and cellular retention of the probe were investigated in HER2-expressing SKOV-3 cells and MDA-MB-231 cells with low HER2 expression respectively.HER2 binding specificity of 99Tcm-ZHER2:342 was analyzed by a pre-injection of excess unlabeled ZHER2:342 to saturate HER2 receptors.One-way analysis of variance and two-sample t test were used.Results The optimal labeling procedure was as follows:5 μg (1 g/L) of ZHER2:342 was mixed with 5 μg of NaOH (1 g/L),then 8.8 μg SnC12(1 g/L,solution) was added,followed by 150 μl (37 MBq) 99TcmO4-solution,and finally the mixture was slightly vortexed and incubated for 1 h at room temperature.99TcmZHER2:342 was stable in vitro with a high labeling efficiency of (98.10± 1.73)％.The radiochemical purity was ＞ 98％,and was more than 85％ after the incubation for 24 h in saline and fresh human serum.The cell binding of 99Tcm-ZHER2:342 with HER2-expressing SKOV-3 cells gradually increased over time with a peak of (9.95± 1.02)％ at 6 h.The binding of 99Tcm-ZHER2:342 in SKOV-3 cells was significantly higher than that in MDA-MB-231 cells at every time point (5.68-9.88 vs 0.56-2.11 ; t:from-34.50 to-13.14,all P＜0.01).The labeled molecular probe retained the capacity to bind specifically to HER2-expressing SKOV-3 cells since the cell binding decreased from (9.95 ± 1.02) ％ to (2.11 ±0.27) ％ after receptor saturation (t =-13.14,P＜0.01).Conclusions 99Tcm-ZHER2:342 has a high labeling efficiency,good stability and optimal binding specificity.These characteristics enable it to be a promising molecular probe for HER2-targeting imaging.