BACKGROUND:The incidence of complications folowing conventional repairing for the ruptured tendon is up to 73%, such as delayed healing, adhesion, secondary rupture. These complications severely affect ankle joint function of the patients. OBJECTIVE:To reduce the complications folowing the repair and investigate the role of hernia repair materials in the repairing of ruptured Achiles tendon. METHODS:Eleven patients who underwent repair of ruptured Achiles tendon were retrospectively studied. Among them there were eight males and three females with the mean age of 42 years (26-58 years). Three cases were injured in left side and eight cases were in right side; four cases were open injury by sickle-induced damage and seven cases were closed injury by exercise-induced damage. The hernia repair materials after pruning was applied with a “wrap” method to strengthen the anastomosis repair of Achiles tendon after the conventional repair surgery had been completed. At the time of folow-up, al patients were observed for postoperative local appearance and function recovery, and assessed with Arner Lindholm standards. RESULTS AND CONCLUSION:The folow-up interval was 6-45 months (average 24.5 months). Two cases were lost to folow-up. According to the Arner Lindholm standards, the effects were excelent in seven cases (78%) and good in two cases (22%). Local appearance and function recovered wel postoperatively, and no complications occurred such as wound infection, secondary rupture and so on. A “wrap” method with hernia repair materials is suggested to strengthen the anastomosis repair of ruptured Achiles tendon after the conventional repair surgery is completed, it can significantly promote the healing of Achiles tendon ruptured end anastomosis, prevent Achiles tendon recurrent ruptures, local adhesion and infection.

Objective To investigate the incidence of systemic inflammatory response syndrome(SIRS) after cardiopulmonary resuscitation(CPR) and to observe the effect of Ulinastain in inhibition of inflammatory mediator.Methods Forty patients surviving more than 48 hours after CPR were divided into Ulinastain and control groups randomly. Activity of nuclear factor kappa B(NF-?B), IL-6,TNF-? of the patients was detected .All patients were evaluated by SIRS diagnosis standard and their general organ function was examined. All data were compared between two groups.Results Activities of NF-?B, IL-6,TNF-? of patients after CPR was significantly higher than that of normal people (P

BACKGROUND: Tumor recurrence in liver transplant recipients greatly affects prognosis of liver transplantation with hepatocellular carcinoma (HCC). How to prevent tumor recurrence has aroused increasing attention. Arsenious acid chemotherapy is considered effective on treating moderate or advanced liver cancer, but its utilization following liver transplantation remains few. OBJECTIVE: To explore the role of arsenious acid on tumor recurrence in liver transplant patients with primary HCC extending Milan criteria. RESULTS AND CONCLUSION: All patients were routinely followed up for 3-32 months. Thirty recipients were presented with tumor recurrence, 16 in the chemotherapy group and 14 in the non-chemotherapy group. Tumor recurred in lung, liver graft and bones in most cases. The total recurrence rate was similar in these two groups, but chemotherapy could delay recurrence after transplantation (P=0.026). There was no significance in 6-month, 1-year survival rate between two groups, but the 2-year survival in the chemotherapy group was higher (P=0.037); 6-month tumor-free survival rates in the two groups had no significance, 1-year and 2-year tumor-free in the chemotherapy group were significantly higher than those in the non-chemotherapy group (P=0.030, 0.023). Intravenous arsenious acid chemotherapy can delay tumor recurrence and prolong survival in liver transplant patients with HCC extending Milan criteria.

Objective To explore the operative technique of liver retransplantation.Methods The clinical data of 24 patients who underwent liver retransplantation in the recent 4 years in our center were reviewed.In all of the patients a modified piggy-back liver transplantation was adopted.Extracorporeal venous bypass was used in 6 cases,and no bypass was used in 18 cases.We anastomosed the suprahepatic inferior vena cava to the annexed vena cava in a modified piggy-back figuration.The portal vein was reconstructed by end-to-end anastomosis.In 17 cases the hepaticy artery was anastomosed end-to-end,and in the other 7 cases was(anastomosed) to abdominal aorta by interposition graft.In 6 cases the biliary tract was reconstructed by(end-to-end) anastomosis,and in the others by choledochojejunostomy.All of the patients were routinely followed up after operation.Results Postoperative mortality of liver retransplantation was 41.6%(10/24).The cause of death was sepsis in 7 patients,intraoperative bleeding in 2,and cerebral hemorrhage in 1.The other patients(14/24,58.4%) successfully recovered after liver retransplantation.The complication rate in this group was 21.4%%(3/14),including biliary tract complications in 2 patients,and wound dehiscence in 1.Conclusions There was no significant difference in operative time and blood loss between liver(retransplantation) and primary transplantation.The key for success is to adopt individuation in selection of(methods) for liver retransplantation.The difficulty of liver retransplantation is exposure and mobilization of(inferior) vena cava. The probability of interposition graft from hepatic artery to abdominal aorta and(choledochojejunostomy) is higer than that of primary liver transplantation.

Objective To explore the feasibility using aluminum tripolyphosphate as the synthesis of aspirin model instead of sulfuric acid catalyst. Methods The thermodynamic functions of the reaction system of salicylic acid and acetic anhydride were calculated according to the Benson group contribution method and Joback group contribution method.The enthalpy change,entropy and Gibbs free energy along with the change of temperature as well as the influence of the molar rate of reactants on the equilibrium conversation rate were also studied.Results In the temperature range of 298.15 K to 358.15 K,the reaction enthalpy was less than zero,and was exothermic reaction,and increase of temperature was not conducive to the reaction.The improvement of mole ratio of salicylic acid and acetic anhydride was helpful to improve the equilibrium conversation rate.The theoretical conversion rate could reach 99.58% when the mole ratio of salicylic acid and acetic anhydride was 3.Conclusion From the viewpoint of thermodynamics, the reaction is practical and feasible.

Objective To investigate the feasibility of defining the radiotherapy target of primary liver cancer using four-dimensional computed tomography (4DCT) and T2-weighted magnetic resonance (MR-T2) deformable image registration.Methods Ten patients with hepatocellular carcinoma (HCC) who first received radiotherapy were included in this study.The 4DCT in free breathing and MR-T2 in deep breathing were acquired sequentially.4DCT were sorted into ten series of CT images according to the respiratory phase.MIM software was used for deformable image registration.The accuracy of deformable image registration was assessed by the maximal displacements in three-dimensional directions of the portal vein and the celiac trunk and the degree of liver overlapping (P-LIVER).Gross tumor volume (GTV) was delineated on different series of CT images and the internal GTV (IGTV) was merged by ten GTVs on 4DCT images in each phase.The MR-T2 image was deformably registered to 4DCT images in each phase to acquire ten GTVDR.The IGTVDRwas obtained by merging the ten GTVDR.The differences between different target volumes were compared by paired t-test.Results The maximal displacements in three-dimensional directions of the portal vein were 0.3±0.8 mm along the x-axis, 0.8±1.8 mm along the y-axis, and 0.5±1.5 mm along the z-axis.The maximal displacements in three-dimensional directions of the celiac trunk were 0.1±1.0 mm along the x-axis, 0.7±1.2 mm along the y-axis, and 0.6±2.0 mm along the z-axis.Overlapping degree was 115.4±13.8%.The volumes of GTVs obtained from 4DCT images in each phase after DR increased by an average of 8.18%(P<0.05), and were consistent with those delineated on MR-T2 images.The IGTV after DR increased by an average of 9.67%(P<0.05).Conclusions MRI image can show more information and have a higher contrast than CT image.MRI images should be combined with 4DCT images for delineating the GTV.It can better determine the scope and trajectory of the target and improve the delineation accuracy of HCC target.

Objective To investigate the characteristic of movement disorders,so as to improve their diagnosis and treatment. Methods The clini?cal data of patients with movement disorders that admitted in the dystonia and Botox outpatient department were analyzed. Results Cases of involun?tary movement were significantly more than the primary dystonia,and case of primary hemifacial spasm was dominant(163 cases,61.05%). Among the 66 cases of primary dystonia,blepharospasm was ranked the first(19 cases),the second was spasmodic torticollis(18 cases),and the third was Meige syndrome(12 cases).There was no statistical significance in the gender distribution among primary hemifacial spasm,blepharospasm,spas?modic torticollis and Meige syndrome. Instead,there was statistical significance in the treatment methods(P<0.05),and there was statistical signifi?cance in the mean treatment and onset age(P<0.05). Of the 163 cases with primary hemifacial spasm,the mean onset age was 44.22±12.22 years, and the ratio of men to women was 1∶2.4. There were statistical significances in the mean onset age and duration among the patients with different severity degrees(all P<0.05). Conclusion Primary hemifacial spasm,blepharospasm,spasmodic torticollis and Meige syndrome are the com?mon disease in outpatient department. The primary hemifacial spasm is dominant,women are more than men,and the onset age and/or duration are proportional to the severity degree.

Objective To compare and analyze the dosimetric characteristics of the intensity-modulated arc therapy (RapidArc) combined with active breathing coordinator (ABC) in the thoracic esophageal carcinoma radiation therapy. Methods Ten thoracic esophageal carcinoma patients undergoing radiotherapy were selected for this study.The CT simulations were performed under three breath patterns respectively:moderate deep inspiration breath-hold (mDIBH) with ABC aid; Set the trigger threshold to 80％ of the peak of the respiration curve; and free breathing (FB).Based on the corresponding CT image sets,three treatment plans were generated for each patient respectively:Arc-ABC( three small arcs),ArcFB (consisted of two coplanar full arcs) and IMRT-FB plan.The following dosimetric parameters were compared among different plans:D2％,D98％,V95,homogeneity index ( HI),conformal index ( CI ) the percentage of volume receiving dose of over x Gy (Vx),monitor unit (MU),control points and treatment time.Results The planning target volume ( PTV ) of FB was 376 cm3 which decreased to 260 cm3 after using ABC.For mDIBH and FB patients,the total lung volumes were 5964.6 cm3(35％ more than FB) and 3838.8 cm3 respectively; the heart volumes were 524.4 cm3 and 642.7 cm3 respectively. No significant difference was observed among Arc-ABC,IMRT-FB and Arc-FB in terms of D2,D98,V95,CI and HI.For Arc-ABC plans,there were significant decreases of radiation dose in total-lung's V10,V20,V30,V40 and mean lung dose ( F =4.38,5.34,4.07,3.89,4.28,P ＜0.05).Various dose decreases of heart V20,V3,V40,Dmean and spinal cord Dmax were observed,yet no statistically significant difference existed.The MUs and total control points of Arc-ABC plans were significantly lower than other plans ( F =26.86,12.56,P ＜ 0.05 ).Conclusions When thoracic esophageal carcinoma patients were treated with radiotherapy,the combined utilization of RapidArc and ABC can potentially decrease the volume of irradiated lung yet escalate the dose in target.

Objective To seauch the ideal management for gross hematuria in autosomal dominant polycystic kidney disease (ADPKD).Methods ADPKD patients who were ever hospitalized and followed up in our department since 1993 were enrolled in the study.Demographic and clinical data were colloected,such as gender,age of gross hematuria,level of renal function,causative factors,management strategies,duration of gross hematuria,blood platelet count,activated partial thromboplastin time,prothrombin time,international normalized ratio,size of kidney cyst and so on.ADPKD patients were divided into different groups according to causative factors or management.The clinical data were compared among groups.Results A total of 905 ADPKD patients were screened,among whom 279 patients ever had gross hematuria (male/female:150/129),One hundred and forty-six patients had integrated therapeutic process records,while only 101patients could provide relevant laboratory examination results.In these 101 patients,gross hematuria was found in any stage of chronic kidney disease (CKD); the average eGFR was (56.4±44.1) mml·min-1 ·(1.73 m2)-1; the duration of gross hematuria was (8.8±8.0) d; no significant difference between male and female in duration of gross hematuria existed [(8.2±7.3) d vs (9.5±8.8) d,P=0.426]; coagulation parameters were all normal.The platelet count was also normal in 91 patients.Duration of gross hematuria among groups divided according to different causative factors was significantly different (P＜0.05).The patients in bed rest group had significantly shorter duration of gross hematuria compared with other groups (P＜0.05).The platelet count,prothromhin time and international normalized ratio were all at similar level in different groups.Conclusions The causative factors in ADPKD patients with gross hematuria should be confirmed as the first step of management strategies.Bed rest is the key point in management.Antifibrinolytic agent is a proper choice in the cases receiving bemostatic drugs.It is unnecessary to use antibiotic agent for prevention.

Objective To investigate the motion characteristics of primary thoracic esophageal carcinoma with four-dimensional computed tomography(4DCT).Methods Sixteen patients with primary thoracic esophageal carcinoma received respiratory gated 4DCT imaging,mapping the GTV1-GTV10 on every patient's each subsequent CT image of 10 images in the full-respiratory phase,and measuring the displacement of each centre of GTV.These displacements and directions were analyzed on different segments of esophagus.Results The mean total lung volume and GTV volume was 2993.5 cm3,35.00 cm3 and 3362.12 cm3,34.84 cm'respectively on end-expiration and end-inspiration phases(t=12.36,P=0.000and t=-0.61,P=0.546).The total mean peak to peak displacement of GTV were 0.65 mm,0.55 mm,and 2.03 nnn in x,y-and z-axis direction,respectively(F=41.14,P=0.000).The motion in x-axis,y-axis and z-axis were 0.50 mm,0.48mm,1.23 mm in the upper segment(F=5.45,P=0.017),0.68 mm,0.62 mm,1.97 mm in the middle segment(F=27.74,P=0.000),0.72 mm,0.38 mm,3.05 mm in the lower segment,respectively(F=15.61,P=0.000).Conclusions The displacement of tumor in z axis is more notable than x-,y-axis in thoracic esophageal carcinoma.The displacement of tumor x-,y-and z-axis is different in different segment of thoracic esophageal carcinoma.