BACKGROUND:Common therapies for damage to the central tendon of finger extensor tendon include Matev, Carrol, Fowler methods as wel as residual central tendon flipping repair, but the therapeutic effects are no satisfied with bloated appearance, tendon adhesions, limited joint function. OBJECTIVE:To investigate the clinical effects of dorsal longitudinal driling and segmental tendon graft to repair old central tendon injury. METHODS:Eighty patients with old central tendon injury were randomized into treatment group and control group, with 40 cases in each group. In the treatment group, dorsal longitudinal driling and segmental tendon transplantation were given; while in the control group, Carrol, Matev, Fowler methods were chosen according to the individual conditions. Then, the therapeutic outcomes were compared between two groups. RESULTS AND CONCLUSION:The excelent and good rate was 85% in the treatment group and 65% in the control group, and there was a significant difference between the two groups (P < 0.05). Results from Valpar Component Work Samples showed that the number of cases adapting to the original work was 30 cases (75%) in the treatment group and 16 (40%) in the control group, and there was also a significant difference between the two groups (P < 0.05). The degree of proximal interphalangeal joint flexion was increased gradualy in the two groups at admission, at 15 days after hospitalization, at 1 day before discharge and at 4 months after discharge, and meanwhile, the degree of proximal interphalangeal joint dorsiflexion was reduced gradualy (P < 0.05). There were significant differences in the degree of proximal interphalangeal joint flexion and degree of proximal interphalangeal joint dorsiflexion between the two groups at 15 days after hospitalization, 1 day before discharge, and 4 months after discharge (P < 0.05). These findings indicate that the dorsal longitudinal driling and segmental tendon graft for repair of old central tendon injury can play an effective role in the recovery of articular flexion and extension function.

Objective To investigate the surgical indications and repair methods for the treatment of electrical bums in the limbs.Methods Thirty-eight cases since May,1997 to June,2014 who underwent flap treatment in 7-14 days after electrical bums was summarized.Among these patients,4 cases were treated by local flaps,1 case was treated by thenar flap,2 cases were treated by dorsal island skin flap of the index finger,1 case was treated by cross-leg flap,1 case was treated by medial plantar skin flap;2 cases were treated by pedicle latissimus dorsi flaps,4 cases were treated by antebrachial flap with a pedicle of the posterior interosseous artery,4 cases were treated by metacarpal artery reversed island flaps,10 cases were treated by groin flaps;1 case was treated by free radial artery flap,1 case was treated by free latissimus dorsi flap,3 cases were treated by free anterolateral thigh flaps;1 case was treated by reverse island forearm posterior interosseous flap,2 cases were treated by posterior perforator reversed island flaps of the lower leg,1 case was treated by anterolateral perforator reversed island flaps of the lower leg.The area of flap was from 42.0 cm × 13.0 cm to 6.0 cm × 3.0 cm.The survival rate of the flap,the appearance and function of limb were observed.Results All these patients were followed up from 4 months to 3 years 6 months,the mean time was 6 months and 20 days.Thirty-five flaps survived completely,accounting for 92.1％,and 3 cases suffered partial necrosis at the distal end,accounting for 7.9％.Secondary healing was achieved by dress changing.The appearance of the limbs was satisfactory.Among the 28 cases whose bums were on the hands,the total number of excellent and good was 15,medium was 8,and 5 poor cases.The excellent and good rate was 57.1％.Conclusion Early repairing of the electrical burns with flaps is the effective method for protecting the deep structures of the limb,preventing and control the secondary infections and preserve the function of the limbs.

Objective To explore the diagnostic value of magnetization transfer imaging (MTI) and DWI for detecting intestinal wall property of crohn's disease (CD). Methods Forty four patients with CD were prospectively enrolled in the study, and MR enterography (MRE), MTI and DWI were performed. According to MRE findings, patients were divided into three subgroups:acute inflammatory group, chronic fibrotic group and combined inflammatory with fibrotic group. Intestinal wall T2WI signal, magnetization transmisson rate (MTR) and ADC value were measured on MRE, MRI and DWI imagings, respectively. The differences of MTR and ADC among the three groups were analyzed by one-way ANOVA;the differences of T2WI scores were analysed by Kruskal Wallis;the differences of MTR and ADC values between normal and pathological intestinal wall were analyzed by paired t test;ROC curve were used to evaluate the CD fibrosis and inflammation diagnostic efficiency of MTI ana DWI based on MRE signs. Results Among the 44 cases, 11 cases were in the acute inflammatory group, 18 cases were in the chronic fibrotic group and other 15 cases were in the combination group. The T2WI score, MTR and ADC among the three groups showed significant differences (all P<0.01).The mean MTR and ADC of pathological intestinal wall of the 44 cases were (40.77±6.05)%and (1.04±0.18)× 10-3mm2/s, and the adjacent normal bowel were (21.75±4.17)%and (1.97 ± 0.23) × 10- 3mm2/s, respectively. Moreover, the difference of the above values showed significant differences (t=19.12,-21.80 respectively, all P<0.01). There was a negative correlation between MTR and T2WI score (r=-0.71,P<0.01). While ADC value was positively correlated with T2WI score (r=0.80, P<0.01). Using ROC curve analysis to differentiate the CD fibrosis from acute inflammation, the area under the curve (AUC) of MTR and ADC were 0.97 and 0.96 ,respectively. Conclusions Both MTI and DWI can be used to assess the properties of intestinal wall, which has the same diagnostic efficacy to identify the acute inflammation and fibrosis.

Objective To analysis the clinical diagnosis and treatment of the scaphoid and lunate bone fracture with (or) wrist dislocation.Methods A retrospective analysis of the clinical data included 77 cases,which got admitted according to the inclusion and exclusion criteria and followed up completely from 2005 to 2013.In this group,there were 64 males and 13 females whose age arranged from 15 to 73 with a mean age of 31.9.There were 41 cases of simple fracture,32 cases of bone fracture with dislocation and 4 cases of simple dislocation.Treatment of cases was divided into the conservative treatment group (9 cases) and the surgery group (68 cases).The surgery group was further divided into four subgroups according to surgical method (i.e.compression screw fixation,Kirschner wire fixation,proximal row of carpal resection,and lunate excision head shaped bone transposition).Clinical outcome was evaluated based on modified Mayo wrist score and X-ray.Results All of 77 patients were followed up completely.Follow-up time arranged from 6 months to 8 years,with an average follow-up time of 3 years and 5 months.9 cases were treated conservatively.In the surgical treatment group,there were 36 cases of compression screw fixation,34 cases of Kirschner wire fixation,1 case of proximal row of carpal resection and 1 case of the lunate bone resection heads transposition.The average healing time of compression screw group was 6.1 weeks and the Kirschner group was 7 weeks.According to the modified Mayo wrist score,excellent:51 cases (66.2％),good:11 cases (14.3％),fair:9 cases,and poor:6 cases.The rate of excellent and good was 80.5％.The cure rate of compression screw treatment was 97％,and 85％ of Kirschner.The difference of cure rate was statistically significant.After surgery,there were four cases that got scaphoid malunion.The degree of deformity was not serious with only one case happened in the dominant hand,and the wrist pain got better after symptomatic treatment.1 case of scaphoid fracture with dislocation had the problem of wrist instability.18 weeks later,with ligament tightening surgery,postoperative Mayo score went back to excellent.Conclusion Lateral X-ray film of wrist is a preferred method for the examination of scaphoid and lunate fractures with (or) dislocation.Since it's easy to misdiagnose,films of special position are needed to be added.Surgery is preferred for treatment,and the selecting of surgical methods are based on the situation of fracture and dislocation.The advantages of screw fixation are obvious.

Objective To explore the diagnostic values of combined detection of serum procalcitonin (PCT) and β2 microglobulin (β2MG) in tsutsugamushi disease.Methods Serum PCT and β2MG were compared in cases of tsutsugamushi disease and fever patients at the same time,who were hospitalized at Fourth Affiliated Hospital of Guangxi Medical University from June 2014 to May 2017.The best diagnosis cut-off value of tsutsugamushi disease was calculated by receiver operating characteristic (ROC) curve.Results A total of 57 cases of tsutsugamushi disease,40 cases of sepsis,17 cases of acquired immunodeficiency syndrome (AIDS),17 cases of severe community-acquired pneumonia (SCAP),63 cases of common community-acquired pneumonia (CCAP),14 cases of pulmonary tuberculosis (PTB),20 cases of upper respiratory tract infection,13 cases of other infectious fever and 28 cases of non-infectious fever patients were selected.The level of serum PCT in tsutsugamushi disease [0.87 (0.68-1.34) μg/L] was higher than those in AIDS [0.47 (0.20-1.12) μg/L],CCAP [0.17 (0.09-0.51) μg/L],PTB [0.13 (0.05-0.18) μg/L],upper respiratory tract infection [0.23 (0.05-0.48) μg/L] and non-infectious fever [0.09 (0.06-0.13) μg/L],but was lower than those in sepsis [5.00 (1.04-18.78) μg/L] and SCAP [3.35 (0.76-14.41) p,g/L,P ＜ 0.05],while the difference was not significant compared with other infectious fever [0.76 (0.13-1.99) μg/L,P ＞ 0.05].The level of serum β2MG in tsutsugamushi disease [(5.67 (4.47-7.90) mg/L] was higher than those in sepsis [2.83 (2.10-4.54) mg/L],AIDS [3.85 (3.19-5.22) mg/L],SCAP [3.83 (2.98-5.58) mg/L],CCAP [1.99 (1.51-2.75) mg/L],PTB [1.92 (1.37-3.00) mg/L],upper respiratory tract infection [2.02 (1.25-2.74) mg/L],other infectious fever [2.45 (1.51-4.12) mg/L] and non-infectious fever [2.99 (2.06-4.30) mg/L,P ＜ 0.05].ROC curve showed that the most suitable diagnosis cut-off value of serum PCT in tsutsugamushi disease was 0.53 μg/L,the sensitivity was 94.7％,and the specificity was 60.4％.The critical value of serum β2MG was 3.74 mg/L in diagnosis of tsutsugamushi disease,its corresponding sensitivity and specificity were 91.2％ and 75.9％,respectively.The sensitivity and specificity of combined serum PCT and β2MG in diagnosis of tsutsugamushi disease was 87.7％ and 86.3％,respectively.Conclusion Combined detection with serum PCT and β2MG can improve early diagnosis of tsutsugamushi disease.

OBJECTIVETo assess the value of MDCT with vessel probe(VP) in the diagnosis and treatment of isolated superior mesenteric artery dissection (ISMAD).

METHODSClinical and imaging data of 15 patients with ISMAD admitted to the First Affiliated Hospital of Sun Yat-Sen University from June 2008 to May 2013 were retrospectively reviewed. Relationship among radiograpic features, clinical symptoms and therapeutic options of ISMAD was examined based on the imaging of 64-MDCT with VP.

RESULTSThe dissection crevasse of all the 15 patients located in anterior arterial wall, and the distance was(24.3±9.7) mm from the origin of SMA. Meanwhile dissection crevasse of 73.3%(11/15) patients located in the zone within 1 cm of proximal end and 1 cm of distal end of the proximal SMA curvature. There were significant differences between patients without abdominal pain(8 cases) and those with abdominal pain(7 cases) in dissection length, minor diameter ratio of true lumen to false lumen, major diameter ratio of true lumen to false lumen(all P<0.01). According to classification of Yun, there were 5 patients of typeI( and 3 type II(a, whose conservative treatment were successful. In other 7 patients of type II(b, 3 patients received successful conservative treatment, and 4 patients had symptom remission after turning to interventional treatment or surgery.

CONCLUSIONS64-MDCT with VP can clearly depict the image manifestation of ISMAD, which provides evidence for the diagnosis and therapeutic options of ISMAD.

Objective To assess the value of MDCT with vessel probe (VP) in the diagnosis and treatment of isolated superior mesenteric artery dissection (ISMAD). Methods Clinical and imaging data of 15 patients with ISMAD admitted to the First Affiliated Hospital of Sun Yat-Sen University from June 2008 to May 2013 were retrospectively reviewed. Relationship among radiograpic features, clinical symptoms and therapeutic options of ISMAD was examined based on the imaging of 64-MDCT with VP. Results The dissection crevasse of all the 15 patients located in anterior arterial wall, and the distance was (24.3 ±9.7) mm from the origin of SMA. Meanwhile dissection crevasse of 73.3%(11/15) patients located in the zone within 1 cm of proximal end and 1 cm of distal end of the proximal SMA curvature . There were significant differences between patients without abdominal pain (8 cases) and those with abdominal pain (7 cases) in dissection length, minor diameter ratio of true lumen to false lumen, major diameter ratio of true lumen to false lumen (all P<0.01). According to classification of Yun, there were 5 patients of typeⅠand 3 typeⅡa, whose conservative treatment were successful. In other 7 patients of typeⅡb, 3 patients received successful conservative treatment, and 4 patients had symptom remission after turning to interventional treatment or surgery. Conclusions 64-MDCT with VP can clearly depict the image manifestation of ISMAD , which provides evidence for the diagnosis and therapeutic options of ISMAD.

Objective To assess the value of MDCT with vessel probe (VP) in the diagnosis and treatment of isolated superior mesenteric artery dissection (ISMAD). Methods Clinical and imaging data of 15 patients with ISMAD admitted to the First Affiliated Hospital of Sun Yat-Sen University from June 2008 to May 2013 were retrospectively reviewed. Relationship among radiograpic features, clinical symptoms and therapeutic options of ISMAD was examined based on the imaging of 64-MDCT with VP. Results The dissection crevasse of all the 15 patients located in anterior arterial wall, and the distance was (24.3 ±9.7) mm from the origin of SMA. Meanwhile dissection crevasse of 73.3%(11/15) patients located in the zone within 1 cm of proximal end and 1 cm of distal end of the proximal SMA curvature . There were significant differences between patients without abdominal pain (8 cases) and those with abdominal pain (7 cases) in dissection length, minor diameter ratio of true lumen to false lumen, major diameter ratio of true lumen to false lumen (all P<0.01). According to classification of Yun, there were 5 patients of typeⅠand 3 typeⅡa, whose conservative treatment were successful. In other 7 patients of typeⅡb, 3 patients received successful conservative treatment, and 4 patients had symptom remission after turning to interventional treatment or surgery. Conclusions 64-MDCT with VP can clearly depict the image manifestation of ISMAD , which provides evidence for the diagnosis and therapeutic options of ISMAD.

OBJECTIVETo compare the CT image of gastrointestinal schwannomas (GIS) and gastrointestinal stromal tumors(GIST), and to find the CT features to be helpful for differentiation of GIS from GIST.

METHODSClinical and iconography data of 15 GIS patients and 50 GIST patients who underwent stomach CT scan with postoperatively confirmed histopathology between January 2000 and July 2014 in our department were collected retrospectively. CT findings of these two tumors were compared. Then the ROC curve was drawn based on the significant CT findings and area under the curve (AUC) was calculated to assess the sensibility and specificity for the differential diagnosis of GIS and GIST.

RESULTCT findings, such as the tumor size, shape, cystic change, perilesional lymph nodes, vessel seeding, enhancement pattern and degree, absolute and standardized CT value were significantly different between GIS and GIST(all P<0.05). Among the CT findings, tumor size, cystic change, perilesional lymph nodes, enhancement pattern and arterial phase standardized CT value (Sa) were better differential than others (all AUC>0.7). Tumor size showed the highest sensibility(90%), and cystic change and Sa showed the highest specificity(87%).

CONCLUSIONSGIS seems to show a homogeneous tumor more frequently, presenting light and moderate enhancement pattern and obvious enhancement of perilesional lymph nodes, while GIST seems to reveal malignant features, such as abundant blood supply, larger volume, frequent necrosis and cystic change. Cystic change and Sa value possess the better differential ability in diagnosis of these two tumors.

Objective To assess the diagnostic value of magnetization transfer MRI (MTI) for bowel inflammation and fibrosis in humans with Crohn disease (CD). Methods From July 2014 through April 2017, 31 patients with a confirmed diagnosis of CD were prospectively recruited from the First Affiliated Hospital of Sun Yat Sen University. They were scheduled for elective surgery due to bowel obstruction and other complications, and underwent preoperative MR enterography (MRE) and MTI within 15 days of surgery. All cases had available intestinal specimens identified on MRE and resected bowel segments for region by region matching. All patients underwent breath hold conventional MRE and MTI examinations, and then the magnetization transfer ratios (MTRs) of pathological bowel segments were measured. Using region by region correlation between MTI and surgical specimen, the bowel segments were resected to stain with HE for evaluating bowel inflammation, Masson for bowel fibrosis, and typeⅠcollagen staining for the deposition of typeⅠcollagen within the bowel walls. The histologic sections from the most severe areas were scored as 0 (normal), 1 (mild), 2 (moderate) and 3 (severe). The correlations between MTR and histologic scores were analyzed by using Spearman rank correlation or partial correlation. The differences in MTR among different grades of bowel fibrosis were analyzed by one way ANOVA. The efficacy of MTR for predicting bowel fibrosis was evaluated by receiver operating characteristic curves analysis. The difference in MTRs between purely inflammatory bowel walls and mixed fibrotic and inflammatory bowel walls was analyzed by Student s t test. Results Sixty two resected bowel specimens from 31 patients including 9 purely inflammatory bowel walls and 53 mixed fibrotic and inflammatory bowel walls were obtained in this study. There were significant differences in MTR among non fibrotic [(21.45 ± 2.65)%], mildly [(30.88 ± 6.14)%], moderately [(35.14 ± 4.31)%] and severely [(35.14 ± 4.31)%] fibrotic walls (F=38.397,P<0.01). MTRs strongly correlated with fibrosis scores (r=0.681, P<0.01). High accuracy of MTRs was shown (curve under area=0.905, P<0.01) for differentiating moderately severely fibrotic from non fibrotic and mildly fibrotic bowel walls. Using MTR of 31.50% as a cutoff value, the sensitivity and specificity were 93.6% and 80.0%, respectively. The MTRs of purely inflammatory bowel walls [(21.45 ± 2.65)%] were significantly higher than that of mixed fibrotic and inflammatory [(36.28±5.21)%] bowel walls (t=-13.052,P<0.01). MTRs correlated with the scores of type Ⅰ collagen (r=0.325, P=0.044) but did not correlate with inflammation scores (r=-0.024, P=0.857). Conclusions MTI enables quantitative evaluation of bowel fibrosis in patients with CD and can be used to differentiate purely inflammatory CD from mixed fibrotic and inflammatory CD.