Objective:To evaluate the clinical outcomes of 2 kinds of osteocutaneous flap in the treatment of mandibular osteoradione-crosis.Methods:35 cases with mandibular osteoradionecrosis were treated by partial mandibulectomy and bone graft according to de-fect size and patients'requirements.The defects in 7 patients were reconstructed with iliac osteocutaneous flap and 28 with fibular os-teocutaneous flap.All flaps and wounds were monitored regularly.Results:One flap with venin crisis was observed in the patients treated with iliac osteocutaneous flap,its skin island was failed but the bone graft was survived.In the fibular osteocutaneous flap group,3 flaps with vein crisis were observed.2 of them were failed and 1 was rescued after second surgery.The most common compli-cations were infection,delayed wound healing and scar.The appearance and function were all satisfied and limitation of mouth opening was improved after surgery.Conclusion:Both of fibular osteocutaneous flap and iliac osteocutaneous flap can be applied in the defect reconstruction of patients with mandibular osteoradionecrosis.Fibular osteocutaneous flap is a good choice for huge mandibular defect and iliac osteocutaneous flap seems more esthetical.

Objective To investigate the risk factors in children with hand-foot-mouth disease(HFMD)hospitalized after the second visit to outpatient department(OPD),and to evaluate their predictive value.Method In May 2008,180 of 343 pediatric patients with HFMD were repatriated to family or community after preliminary diagnosis in Bering Ditan Hospital.The ill children hospitalized after revisit(RVH)were compared with the remaining children(control group)for seeking the differences in age,HFMD contagion,temperattLre,interval between onset and visit,WBC count,skin lesion and comphcating risk symptoms by respective analysis.Logistic regression analysis was performed to find the risk factors involved in patients with RVH and diagnostic evaluation was introducted to predict the probability of RVH.Results Of 180 ill children,17(9.44%)ones returned to family or community requested admission into hospital for further consultation because who symptoms urtremitted or complications developed.The average duration between the preliminary visit and second visit was 3.26 days(0.5～14 days).No significant differences were found between RVH group and control group in age(P=0.669),ratio of gender(P=0.101),conttagion with HFMD(P=0.104),and typing of vires(P=0.475).Compared with control groups,the significant prolongation of interval between onset and visist(3.71±1.10)d,significant eleva-tion of temperature(38.74±0.57)℃ and WBC counls(10.99±3.67)×109 were noticed in ill children of RVH(P<0.05).According to logistic regression,interval between onset and visit nlore than 3 days,body tem-perature at the first visit higher than 38.5℃,WBC count over 10.0×109,and the accompaniment of serious symptoms were confirmed to be independent risk factors involved in RVH.Of them,67.85%(11/16)ill children with three or more risk factors of RVH showed diagnosis sensitivity and specificity reach to 64.53%and 97.14%,respectively.Conclusions Risk factors confirmed are the interval between onset and the visist more than 3 days,bodv temperature higher than 38.5℃ at the first visit,WBC count more than 10.0×109,and the accompaniment of severe symptoms.The ill children with three or more risk factors are in great request of more closely monitoring and should not be the candidates for repatriation to family or community after preliminary diagnosis.

Objective To assess the effect of ultrasound-guided multiple-spot sector stereotaxis in unipolar cooling cycle radiofrequency ablation of hepatic carcinomas. Methods Ninety-six patients with 112 liver malignancies were treated with ultrasound-guided percutaneous radiofrequency ablation using multiple-spot sector stereotaxis method. Conventional multi-section ultrasound scanning was performed to determine the exact location of tumors. Contrast enhanced ultrasound (CEUS) was performed 15 minutes after treatment to determine whether the tumors were completely inactivated. Contrast enhanced CT (CECT) and CEUS were performed 1 month after treatment to evaluate the therapeutic effect. Results A total of 293 punctures were performed for 112 tumors, technical successful rate with a successful rate of puncture was 91.81% (269/293). CEUS showed no blood flow signals in the tumors 15 minutes after therapy. One month after therapy, CT showed the volume of tumors shrunk, no enhancement was found in 100 tumors (100/112, 89.29%), while partial reinforcement was noticed in 12 tumors (10.71%). Meanwhile, CEUS showed no enhancement in 90 tumors (90/103, 87.38%), when partial reinforcement was noticed in 13 tumors (13/103, 12.62%). Conclusion Ultrasound-guided multiple-spot sector stereotaxis unipolar cooling cycle radiofrequency ablation is an effective and reliable method to treat hepatic carcinomas.

Acute basilar artery occlusion (ABAO) has a high rate of disability and mortality, and the key to its treatment is to start reperfusion therapy as early as possible. A number of retrospective studies have found that the good prognosis rate of endovascular treatment of ABAO is related to number of infarction locus, extent of ABAO, vascular occlusion and collateral circulation. Screening patients through imaging evaluation before endovascular treatment may further improve the rate of favorable outcome. This article reviews research progress on the correlation between imaging evaluation before endovascular treatment of ABAO and clinical prognoses.

Mandibular defects in adolescents are mostly caused by surgical resection of benign and malignant tumors, trauma and jaw inflammation. The reconstruction of mandibular defects in adolescents is challenging. In addition to solving the problem of jaw reconstruction in adults, some clinical factors, including the influence of surgery on the growth of donor and recipient areas, the long-term effects of reconstruction, and the outcome of bone grafts, must also be considered. At present, the main reconstructive methods include autogenous bone grafts and distraction osteogenesis. Autogenous bone grafts are still the gold standard due to their long-term effects. Favorable growth potential after repair was shown in adolescent cases of mandibular reconstruction with fibula flap. Normal occlusion was restored, and a long-term stable effect was achieved in cases of condylar reconstruction with costal cartilage. The safety and clinical effects of distraction osteogenesis have been confirmed, but the long-term effects of large-scale mandibular defects are still uncertain. In addition, other tissue engineering techniques also have good application prospects for the repair and reconstruction of adolescent mandible defects, but more in-depth basic research and more extensive clinical trials should be performed to verify the efficacy.

Objective To investigate the efficacy and safety of endovascular recanalization 6-24 h after onset in patients with acute basilar artery occlusion,and explore the related factors for their prognoses.Methods Clinical data of 37 patients with acute basilar artery occlusion,received endovascular recanalization in our hospital from January 2016 to July 2019,were retrospectively collected;23 patients were into group of onset-to-puncture time (OPT)＞6 h (6-24 h),and 14 patients were into group of OPT ≤ 6 h (0-6 h).Statistical methods were used to compare the postoperative symptomatic intracranial hemorrhage rate,good prognosis rate (modified Rankin scale [mRS] scores ≤ 3) and mortality 3 months after onset between the two groups;clinical data between the subgroups with good and poor prognoses in patients of group of OPT＞6 h were compared.Results The postoperative symptomatic intracranial hemorrhage rate,and good prognosis rate and mortality of patients from group of OPT＞6 h were 30.4％,47.8％ and 43.5％,respectively;and there were no statistically significant differences as compared with those in patients from group of OPT≤6 h (35.7％,35.7％,and 42.9％,P＞0.05).Scores of scales based on preoperative CTA images (posterior circulation-Alberta stroke program early CT scale [pc-ASPECTS],scale of posterior circulation on CTA [pc-CTA],and scale of basilar artery on CTA [BATMAN]) showed significant differences between the good prognosis subgroup and poor prognosis subgroup in patients fiom group of OPT＞6 h (P＜0.05).Conclusion Endovascular recanalization 6-24 h after onset is effective in patients with acute basilar artery occlusion,and the safety does not obviously decrease;scores of pc-ASPECTS,pc-CTA and BATMAN may be related to the clinical prognoses.

BACKGROUNDTo evaluate and compare the effects and toxicity of the domestic product of nrhTNF combined with chemotherapy in the trial group and chemotherapy alone in the control group in the treatment of patients with non-small cell lung cancer (NSCLC).

METHODSNinety patients with NSCLC in multicenter were randomly devided into trial group and control group. Each group had 45 patients. Chemotherapy with CAP regimen was given for the patients in the trial group. Meanwhile, nrhTNF injection of 4×10⁶U/m ² was also given from the 1st to 7th days, the 11th to 17th days on the chemotherapy course. Twenty-one days were as a cycle, 2 cycles were given each patients. Chemotherapy alone with CAP regimen was given in the control group. The chemothepeutic effects and toxicity were observed and compared between the two groups after the therapy.

RESULTSOf the 90 patients, 3 cases in each group were out of the trial because of economy. The other 84 cases (each group had 42 patients) could be used to analyze and evaluate the clinical effects and toxicity. The response rate of chemotherapy was 47.62% (20/42) in the trial group and 19.05% (8/42) in the control group (P=0.002) respectively. The KPS was 85.02±10.74 in the trial group, and 81.35±9.63 in the control group (P=0.038). No significant difference of degree III+IV toxicity was observed between the trial group and control group (P > 0.05). The side effects related to nrhTNF included slight fever, cold like symptoms, pain, and red and swelling in injection site. All of them were mild and didn't need any treatment and disappeared after the therapy.

CONCLUSIONSThe results demonstrate that the effects of domestic nrhTNF combined with chemotherapy can remarkably higher than that of chemotherapy alone in the treatment of NSCLC. It is able to increase the sensitivity to chemotherapy and improve the quality of life of the patients. The toxicity is also slight and is worth to expand clinical use, so as to further evaluate its effect and toxicity.