The arterial supply of the human metatarsals in 90 lower limbs,ranging in age from newborn to87 years,was studied by perfusion method. The blood supply of the metatarsals is derived from the nutrient artery,the periosteal arteries,the epiphyseo-metaphyseal arteries and the pseudoepiphyseal arteries. The proximal and distal branches of the nutrient artery supply the inner two-thirds or three-fourths of the cortex. The periosteal arteries give off a few twigs penetrating into the cortex and supplying the outer one-third or one-fourth of the cortex. The radiate form epiphyseo-metaphyseal arteries derived from superficial plexuses in continuity with the periosteal networks on the shafts, supply the base of the first metatarsal, and the heads of the other four. The pseudoepiphyseal arteries, penetrating the non-articular areas of the bones, supply the bases of the second, third, fourth and fifth metatarsals and the head of the first. The sources of the nutrient arteries to the metatarsal vary with the different bone . The nutrient arteries to first metatarsal bone usually originate from the ramus plantaris profundus and the first plantar metatarsal artery, while the nutrient arteries to the other metatarsal bones mainly derive from the plantar metatarsal arteries, the plantar arch and its perforating branches. The clinical significance of the arterial distribution to the metatarsals is discussed.

BACKGROUND: There have been some prospective, randomized, controlled studies regarding the feasibility and safety of laparoscopic gastrectomy for gastric cancer, but controversy exists.OBJECTIVE: To systemically assess the feasibility and safety of laparoscopic gastrectomy for gastric cancer.METHODS: A computer-based online research of prospective, randomized, controlled studies addressing laparoscopic gastrectomy versus open gastrectomy published between January 1994 and December 2009 was performed in PubMed, Ovid Medline, Web of Knowledge, EMbase, Chinese Journal Full-text Database and Wanfang Database. Meta analysis of acquired data was performed through the use of RevMan 5.0 software. The inverse variance method was used to test the significance of continous data, while the Mantel-Haenszel method was used for dichotomous data. The chi-square test was used for evaluation of data heterogeneity. Homogenous data was calculated using the fixed effect model, and heterogeneous data was calculated using freedom model. Statistical data was expressed as 95% confidence interval. Funnel plot was used for sensitivity analysis to show potential publication bias.RESULTS AND CONCLUSION: Five papers that corresponded to inclusion criteria were included in this study. Among 326 cases included, 164 underwent laparoscopic gastrectomy and 162 received open gastrectomy. Meta analysis revealed that laparoscopic gastrectomy took longer operating time and removed fewer lymph nodes than open gastrectomy (both P ＜ 0.01), but for early-stage gastric cancer, laparoscopic gastrectomy was superior to open gastrectomy in terms of blood loss and hospital stay (P ＜ 0.01). But there was no significant difference in terms of time to resumption of oral intake, postoperative complications,postoperative morbidity rate, and tumor recurrence. Sensitive analysis demonstrated that publication bias existed in all indices to different extents with the exception of lymph node. The five papers adopted two different modes to remove lymph nodes, so subgroup analysis was also used. Results showed that for D1 lymph node dissection, laparoscopic gastrectomy took significantly reduced blood loss than open gastrectomy. All these findings indicate that laparoscopic gastrectomy for early stage gastric cancer is feasible and safe.

Objective To observe the effects of diabetic health education on improving the diabetic knowledge score(DKS) and glucose metabolism.Methods 119 diabetic patients were randomly divided into two groups,in addition to conventional therapy,the experimental group of 64 cases received one month diabetic health education,however,the control group of 55 cases was only treated with conventional therapy.Drug therapy of all patients was not changed during the observation.The changes of fasting blood glucose(FBG),post-prandial two-hour blood glucose(PBG),glycosylated hemoglobin(HbA 1c),diabetic knowledge score were detected.Results FBG,PGB,diabetic knowledge score were significantly improved after diabetic health education in experimental group(P0 05).Conclusion Diabetic health education can improve the DKS and glucose metabolism in diabetic patients.

Objective Tyrphostin AG1024(3-Bromo-5-t-butyl-4-hydroxybenzylidenemalonitrile) is a specific insulin like growth factor type Ⅰ receptor tyrosine kinase blocker,this study is to investigate the effect of AG1024 on the proliferation and apoptosis of hepatocellular carcinoma cell lines.Methods Treated with AG1024 on vailed concentrations(0～40 μmol/L),human hepatocellular carcinoma cel lines HepG2 and SMMC-7721 were observed for morphological and molecular biology changes,the effect of AG1024 on the cell lines proliferation invasion ability as well as apoptosis was evaluated. Results MTT showed that AG1024 dose-dependently inhibited the proliferation of hepatocellular carcinoma cells,flow cytometry suggested that AG1024 significantly promoted cell lines apoptosis,the cell invasion assay indieated that AG1024 significantly inhibited cell's invasion ability.RT-PCR showed over-expression of IGF-IR in liver cancer cells.and AG1024 dose-dependently increasedtheexpressionofcytochreme C. According totheresultsof Western, blotting,the phosphor-ERK and procaspase-3 were down-regulated while the total ERK remained unchanged. Conclusion AG1024 as a specific IGF-IR blocker blocks the downstream signaling cascade and thus inhibits the proliferation of hepatocellular carcinoma cells and induces cell's apoptosis.

Objective To investigate whether oral administration of probiotics can reduce complications induced by interventional therapy in patients with primary hepatic carcinoma and liver cirrosis.Methods Two hundred and sixty four patients with primary hepatic carcinoma and liver cirrhosis who underwent transarterial chemoembolization(TACE) were randomly divided into two groups.and patients in experimental group were given probiotics but not in control group.Shoa-term clinical manifestations.liver functions,blood routine and pain scores were compared between two groups.Results On the day 3 after therapy,the incidence of abdominal distension and constipation in experimental group were less than that in control group(x2=18.22 and 55.22,P=0.000);On the day 7 after therapy,the incidence of abdominal distension,constipation and infection in experimental group were less than that in control group(x2=5.35,13.5 and 19.14,P=0.021,0.000 and 0.000).There were no significant difference in other clinical manifestations,liver function,blood routine and pain scores between the two groups. Conclusion Oral administration of probiotics can reduce the incidence of some short-term complication induced by interventional therapy in patients with hepatic carcinoma and liver cirrhosis.

Objective To explore the clinical effect of Weifuchun tablet combined with chemotherapy on patients with advanced non-small cell lung cancer (NSCLC).Methods Sixty-eight patients with advanced NSCLC was randomly divided into control group (n =34) treated with cisplatin + gemcitabine and treatment group (n =34) treated with Weifuchun tablet (1.436g × 2/d) and cisplatin + gemcitabine.After two treatment cycles,the clinical effect in both groups were evaluated.Results The clinical efficacy in the treatment group was 52.94％ (18/34),which in the control group was 41.18％ (14/34),there was no statistically significant difference between the two groups(x2 =0.94,P ＞ 0.05).The quality of life and the level of T lymphocytes were markedly improved,and the reduction of hemoglobin,leucocyte,and platelet,and nausea reaction were all significantly inhibited in treatment group compared with that in control group after two treatment cycles (x2 =4.12,4.66,5.96,4.12,5.90,all P ＜ 0.05).Conclusion Weifuchun tablet combined with chemotherapy effectively ameliorates the clinical symptoms of the patient with advanced NSCLC,reduces the toxic and side effects caused by chemotherapy,and improves the quality of life,which is worthy in the clinic.

BACKGROUND: Minimally invasive percutaneous pedicle screw fixation possesses the advantages of less blood loss, less muscle and soft tissue dissection, and rapid recovery; however, accuracy of the screw positioning is the key to be successful.OBJECTIVE: To explore the application value of self-designed spinal localizer in the screw positioning for minimally invasive percutaneous pedicle screw fixation.METHODS: 428 patients with thoracolumber disorders were subjected to minimally invasive percutaneous pedicle screw fixation at the First Affiliated Hospital of University of South China, from March 2009 to March 2015, and randomly underwent the preoperative screw positioning by self-designed spinal localizer or one of traditional localizing methods (iliac crest, ribs, symptomatic vertebral appearance, skin marker, Kirscher wire, puncture needle localizations). The location accuracy, positioning time and radiographic times were compared among methods.RESULTS AND CONCLUSION: (1) Compared with the traditional localization methods, the self-designed spinal localizer was superior in accurate rate (P < 0.05), cost less positioning time (P < 0.05) and received less radiation (P < 0.05). (2) To conclude, the self-designed localizer exhibits a certain application value, which is an ideal method in preoperative localization for minimally invasive percutaneous pedicle screw fixation.

Objective To evaluate the accuracy, of different threshold segmentation of 18FDG PET for target volume delineation of non-small cell lung cancer(NSCLC) and the potential influence on radiotherapy treatment planning. Methods Eight NSCLC patients who had tumor with clear margin on CT scan and the amplitude of tumor movements not more than 5 mm were enrolled. PET scans were carried out at 1 h after intravenous injection of 18FDG with CT image for attenuation revisement. Gross target volume (GTV) delineated on CT image ( GTVCT ) was used as the standard. Then, GTVs were delineated on PET image with three different threshold segmentation of 42% Imax(total) (42% of maximum voxel intensity within the tumor) ,Iback + 20% Imax-back(max) (mean background intensity + 20% of normalized background-subtracted maximum voxel intensity within the tumor) and Iback -20% Imax-back(slice) (mean background intensity + 20% of normalized background-subtracted maximum voxel intensity of each slice within the tumor) ,the corresponding GTV was named as GTV42%, GTV20%max and GTV20%slice. Both the size of GTV42%, GTV20%max, GTV20%slice and GTVCT,and the coverage over GTVCT for each GTV were compared. A three dimensional margin of 1 cm were added to GTVCT, GTV42%, GTV20%max and GTV20%slice to form corresponding PTVCT, PTV42%, PTV20%max and PTV20%slic e. Three dimensional conformal radiotherapy treatment plans were designed based on PTVCT,PTV42% , PTV20%max and PTV20%slice respectively for each patient. The prescription dose of all PTVs was 66 Gy in 33 fractions in 6.6 weeks. Both the volume accepting dose less than 95% of prescription dose within PTVCT ( VPTV ) and the lung V20 were compared among the four plans based on different PTVs. Tumor control probability(TCP) as well as lung normal tissue complication probability (NTCP) were also compared. Resuits Eight patients were enrolled in this study. Median deviation of volume between GTVPET and GTVCT were -54.1% , -21.5 % and 5.3 % for GTV42% , GTV20%max and GTV20%slice, respectively. Median coverage over GTVCT of GTV42% , GTV20%max and GTV20%slice was 45.9% ,78.0% and 95.3% respectively( F = 57.50,P＜0.01). Median 7.5% of VPTV was observed for radiotherapy treatment plan based on PTV42% ,which meant that it might induce median 1% decrease of TCP comparing with that of radiotherapy treatment plan based on PTVCT. Whereas,there were only 1.3% and 0.0% of VPTV for treatment plans based on PTV20%max and PTV20%slice respectively. As far as TCP was concemed, both PTV20%max group and PTV20%slice group were superior to PTV42% group,there was no significant difference among PTV20%max group, PTV20%slice group and PTVCT group. Lung V20 and lung NTCP showed no significant difference among all groups. Conclusions The threshold segmentation of Iback + 20% Imax-back(slice) , being slice specialized, might be an optimal threshold segmentation for target volume delineation of lung caner. Independent of information of target volume provided by CT scan in advance,it is recommended to use for the target volume delineation of NSCLC with atelectasis.

Objective To establish a new rat model of biliary atresia by pure ethanol injection into the common bile duct.Methods A catheter was inserted and fixed in the common bile duct in male SD rats .Saline (8 rats) or pure ethanol (16 rats) was injected through the catheter ,respectively, and the biochemical and pathological changes in the rats were examined .Results SD rats in the experimental group were divided into a persistent injury and a restoration of liver dysfunction groups according to pathological and biochemical detection .In the persistent injury group , biochemical impair-ments were significantly higher at 8 weeks after ethanol injection than those in the control group and restoration group .Dis-tinct pathological changes in the liver were observed using HE , SMA, and Masson staining .Conclusions It is a reliable animal model of biliary atresia induced by injection of pure ethanol into the common bile duct in the rat .It will provide a useful tool in future studies of biliary atresia .

Objective To investigate the clinical value of indwelling hepatic arterial catheter in splitting fullfilling of lipiodol treatment for giant primary hepatic carcinomas. Methods Sixteen patients with giant primary hepatic carcinomas under DSA guidance,splitting lipiodol embolizations were carried out through indwelling hepatic arterial catheter everyday until the lipiodol with fulfilling the tumors. Total forty times (average 2.5 individually)of interventional treatment were accomplished in these patients. Liver function and short-term effect after interventional therapy were observed. Results None of these 16 patients had serious liver function damage and recovered uneventfully after general protective care. PR and SD were achieved in 9 and 7 cases respectively,3 months after this interventional procedure. PD was not found. Conclusions Indwelling hepatic arterial catheter in fulfilling of lipiodol treatment for giant primary hepatic carcinomas is not only unlikely to cause serious liver function damage,but also can completely embolize the tumor quickly,therefore worthy to be recommended clinically.