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

Objecttve To compare the positional and volumetric differences of planning target volumes(PTVs)based on axial three-dimensional CT(3D-CT)and four-dimensional CT(4D-CT)for the primary tumor of non-small cell lung cancer(NSCLC).Methods Sixteen NSCLC patients with lesions located in the upper lobe and 12 patients with lesions in middle and lower lobes,totally 28 patients, initially underwent three-dimensional CT scans followed by 4D-CT scans of the thorax under normal free breathing.PTVvector was defined on gross tumor volume (GTV) contoured on 3D-CT and its motion vector. The clinical target volumes(CTVs)were created by adding 7 mm to GTVs,then, internal target volume (ITVs)were produced by enlarging CTVs isotropically based on the individually measured amount of motion in the 4D-CT,lastly,PTVs were created by adding 3 mm setup margin to ITVs. PTV4D was defined on the fusion of CTVs on all phases of the 4D data.The CTV wag generated by adding7 mm to the GTV on each phase.then,PIVs were produced by fusing CTVs on 10 phases and adding 3 mm setup margin.The position of the target center,the volume of target and the degree of inclusion(DI)were compared reciprocally between the PTVvector and the PTV 4D The difference of the position,volume and degree of inclusion of the targets between PTVvecter and PTV4D were compared,and the relevance between the relative characters of the targets and the three-dimensional vector was analyzed based on the groups of the patients. Results The median of the 3 D motion vector for the lesions in the upper lobe was 2.8 mm, significantly lower than that for the lesions in the middle and lower lobe ( 7.0 mm, z = - 3. 485, P < 0. 05 ). In the upper lobe group there was only significant spatial difference between the PTVvector and PTV4D targets in the center coordinate at the x axe (z = -2. 010, P < 0. 05 ), while in the middle and lower lobes there was only significant spatial difference between the PTVvector and PTV4D targets in the center coordinates at the z axe (z = -2. 136,P <0.05). The median of ratio of PTV4D and PTVvector, of the upper lobe group was 0. 75, significantly higher than that of the middle and lower lobes group (0. 52, z = - 2. 949, P < 0. 05 ).A significant correlation was found for the motion vector and the ratio of PTV and PTV4D in both groups ( r = - 0. 638, - 0. 850, P < 0. 05 ). For all patients, the median of D[ of PTV4D in PTVvector was 66. 39% ,while the median of DI of PTVvector, in PTV4D was 99. 55% , both showed a positive significant correlation with the motion vector (r = -0. 814,0. 613 ,P < 0. 05). Conclusions PTV4D defined based on 4D-CT simulation images is obviously less than PTV defined based on 3D-CT simulation images. The ratio and DI of both targets are related with the three-dimensional motion vector of the tumor.

Objective To compare positional and volumetric differences of internal gross tumor volume (IGTV) delineated separately by three approaches based on four-dimensional CT (4DCT) for the primary tumor of non-small cell lung cancer (NLCLC). Methods Twenty-one patients with NLCLC underwent big bore 4DCT simulation scan of the thorax. IGTVs of the primary tumor of NSCLC were tumor on the MIP images were delineated to produce IGTVMIP. The position of the target center, the volume of target, the degree of inclusion (DI) and the matching index (MI) were compared reciprocally between IGTV10, IGTVEI+EE and IGTVMIP. Results Average differences between the position of the center of IGTVs on direction of x,y and z axes were less than 1 mm, with no statistically significant difference. The volume of IGTV10 was larger than that of IGTVEI+EE, the difference was statistically significant (t=2.37,P=0.028);the volume of IGTV10 was larger than that of IGTVMIP, but the difference was not statistically significant(t=1.95 ,P=0.065). The ratio of IGTVEI+EE with IGTV10, IGTVMIP with IGTV10 were 0.85±0.08 and 0.92±0.11, respectively. DI of IGTVEI+EE in IGTV10, IGTVMIP in IGTV10 were 84.78% ± 8. 95% and 88.47% ±9.04%. MI between IGTV10 and IGTVEI+EE, IGTV10 and IGTVMIP were 0.85 ±0.09, 0.86±0. 09, respectively. Conclusions The center displacement of the IGTVs delineated separately by the three different techniques based on 4DCT images are not obvious; IGTVEI+EE and IGTVMIP can not replace IGTV10 , however , IGTVMIP is more close to IGTV10 comparing to IGTVEI+EE . The ratio of GTVEI+EE with IGTV10 is correlated to the tumor motion vector. As the vector increases, the ratio of GTVEI+EE with IGTV10decreases, especially for small tumors.

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.

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 research the feasibility of using three-dimensional CT (3DCT) associated with active breathing control (ABC) in determination of the individual internal tumor volume (ITV) for hepatocellular carcinoma (HCC) comparing the four-dimensional CT (4DCT).Methods After 4DCT scans of 15 HCC patients who had accepted TACE,completed the 3DCT scans associated with ABC in three ways of breathing:free breathing ( FB),end inspiration hold ( EIH),end expiration hold (EEH).4DCT images were sorted into 10 phases and the maximum intensity projection (MIP) images were constructed.The GTVs were manually contoured on 4DCT and 3DCT images (labeled as GTV0,GTV10.….GTV90,GTVMIP,,GTVFB,GTVEIH and GTVEEH).GTV0…GTV90,GTV0 and GTV50,GTV0,GTV20 and GTV50,GTVEIH and GTVEEH were respectively merged into IGTV1,IGTV2,IGTV3,IGTV4.The volume and geometry displacement of GTVs and IGTVs were compared.Results All patients were compatible with the ABC technique and completed the CT scans in two ways.The motion of diaphragm measured between 4DCT and 3DCT images was not significantly different ( 1.39 cm and 1.39 cm,t =-0.02,P =0.983 ),it was similar to the volume difference among GTV0,GTV20,GTV50,GTVEIH,GTVEEH and GTVFB (56.4,54.6,55.5,55.6,55.2,59.7 cm3,F =0.01,P =1.000 ).The comparison result of volume difference among IGTV1,IGTV2,IGTV3,IGTV4 and GTVMIP (77.9,71.4,73.4,72.3 and 66.3 cm3,F =0.02,P =1.000)were similar to the differences of geometry displacement in x,y and z axial among them (F =0.48,0.04,0.02,P =0.750,0.997,0.999,respectively).Conclusion The application of 3DCT associated with ABC in determination of the individual IGTV for HCC is feasible and safe comparing to 4DCT.

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 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.