Objective To compare the value of 18 F-labeled deoxyglucose (FDG) PET or PET-CT with MRI in detecting local residue or recurrence of nasopharyngeal carcinoma after radiotherapy, by performing a meta-analysis of relevant trials.Methods A literature search was performed to English original articles about FDG PET or PET-CT and MRI in Medline, Embase and the Cochrane database from January 1995 to August 2009.The reference standard was histopathologic analysis and/or close clinical and imaging follow-up.Two reviewers searched articles and extracted data independently.Sensitivity, specificity,summary receiver operating characteristic curves (SROC), and the Q index for FDG PET or PET-CT and MRI were pooled, respectively.Results Seventeen studies about FDG PET or PET-CT and 10 studies about MRI were included in this meta-analysis.The pooled sensitivity of FDG PET or PET-CT and MRI were 0.935(95% CI= 0.901 -0.964) and 0.792 (95% CI= 0.731 -0.844), separately.The pooled specificity were 0.924 (95 % CI= 0.898 - 0.945) and 0.787 (95 % GI= 0.746 - 0.825), separately.Area under SROC curves of PET-CT or PET (0.966) was significantly larger than that of MRI (0.852) (z =2.29, P < 0.05).The Q * index estimates for PET-CT or PET (0.914) were significantly higher than for MRI (0.783)(z=2.94,P<0.05).Conclusions FDG-PET/PET-CT has higher accuracy than MRI in diagnosing local residue or recurrence of nasopharyngeal carcinoma after radiotherapy.

Objective To explore the clinical features and outcomes of defo rm ities correction of old bucket handle and tilt fractures of pelvis. Methods From October 1998 to October 2002, six patients treated with open reduction, osteoto my and internal fixation for old bucket handle and tilt fractures of pelvis were analyzed. There were 3 males and 3 females aging from 18 to 51 years (mean, 27. 5 years). According to Tile’s classification, all fractures were diagnosed as t ype B2 with longitudinal stability and rotational instability, which were caused by traumatic violence of lateral compression, and associated with anterior ring injuries of ipsilateral inferior and superior rami of pubis combined symphysis separation as well as contralateral posterior ring injury of innominate fracture , dislocation of sacraoiliac joint, or sacral fracture. The incidence of associa ted injury was 100% in the patients as injured. The mean interval from the prima ry injury to the operation was an average of 6.5 months ranging from 2 to 15 mon ths. The limb shortening of buckle handle side of pelvis ranged from 2 to 3.5 cm (mean, 2.5 cm), and the rotational deformity of pelvis was more than 30? in al l patients. The tilting proximal fragment of the superior ramus and disrupted sy mphysis projected inferiorly and posteriorly into the perineum. The surgical pro cedures consisted of: 1) osteotomy through the superior pubic ramus malunion in 6 cases to correct anterior ring deformity, and through innominate osteotomy in 3 cases, direct osteotomy of sacral malunion in 1 case , and sacraoiliac fusion in 2 cases to correct the posterior ring deformity; 2) reduction by manipulati on or assisted with instrumentation; 3) fixation with reconstruction plate in 3 , reconstruction plate combined with anterior pelvic frame in 2, and reconstruct ion plate combined with lag screws in 1. Results All the patients were followed up on an average of 15.6 months (range, 3 to 45 months). The limb discrepancy ha d been completely corrected following satisfactory fracture reduction and union. According to Mears’s evaluation, the anatomical reduction of the pelvis was fo und in 5 cases and satisfactory in 1 patient. According to Majeed’s radiography evaluation, 5 patients were classified as excellent, and 1 good. One patient wi th delayed sacral nerve injury recovered without any treatment after operation. Conclusion The combination of osteotomy through anterior and posterior pelvic ri ng to correct the entire deformities in one stage is an useful technique for imp rovement of the affected limb shortening and prevention of the related complicat ions.

Objective To study clinical effect after laparoscopic abdominal preperitoneal inguinal hernia repair methodwithout stapler. Methods 80 cases of inguinal hernia(hospitalized from February 2015 to January 2017)were divided into two groups according to the random number table method ,with 40 patients in each group. Traditional laparoscopic peritoneal inguinal hernia repair method was applied in the control group. Free stapler group received free stapler laparoscopic preperitoneal inguinal hernia repair treatment method. Operation time , amount of bleeding during surgery , the average hospitalization time after operation , the total cost of hospitalization,postoperative pain score,postoperative recovery activities time,patients′satisfaction,operation effusion after operation occurred scrotal hematoma and other complications were comparedbetween the two groups of patients. Results In free stapler group,patients′ satisfaction rate was significantly higher than the control group (P < 0.05). Area of effusion,scrotal hematoma and other complications infree stapler group after surgery were significantly lower than the control group (P < 0.05). Total cost of hospitalization,postoperative pain score, postoperative recovery time activities in free stapler group were significantly better than those in the control group (P<0.05). Operation time,bleeding amount during the operation,average hospitalization time difference between the two groups were not statistically significant(P > 0.05). Conclusion Operation time and amount of bleeding were similar between traditional laparoscopic transabdominal preperitoneal inguinal hernia repair method and free stapler in laparoscopic transabdominal preperitoneal inguinal hernia repair.Clinical effect of free stapler in laparoscopic transabdominal preperitoneal inguinal hernia repair proves to be effective with less complications ,less pain, faster postoperative recovery, and can reduce the cost of treatment.Free stapler in laparoscopic transabdominal preperitoneal inguinal hernia repair has satisfactory cosmetic results and was well received by patients,worthy of promotion.

Objective To investigate the diagnosis and treatment of primary hyperparathyroidism (PHPT) with urolithiasis.Methods The clinical data of 9 PHPT patients who were evaluated with simple metabolic evaluation in 881 urolithiasis from 2000 to 2005 were summarized and the references were reviewed.Results The level of serum calcium was (2.96±0.48)mmol/L before operation, (1.94±0.42) mmol/L after operation.The level of parathyroid hormone(PTH) was(1133.53±788.21)pmol/L before op-eration,(74.52±49.17)pmol/L after operation.The level of serum calcium and PTH changed significantly after the parathyroidectomy (P<0.01).Follow-up for 14 months to 6 years.the ureteral stones fragments with lithotripsy were clear after 3 months and followed without recurrence,although the renal stones without lithotripsy were followed with no significant change.Conclusions Increase of serum calcium or increase of PTH above double with normal serum calcium may be helpful for diagnosis of PHPT with urolithiasis.Ureteral stone with PHPT should be treated together.Renal stone with PHPT may be followed up after the parathv-roidectomy,and be treated until the complications were occurred.It suggests that the maidend diagnosed pa-tient with urolithiasis should be added with simple metabolic evaluation,including serum calcium, phospho-nium and PTH.

BACKGROUND:Stem cel transplantation has achieved good results in the treatment of cerebral ischemia, and how to reduce apoptosis of transplanted cel s has become the focus of the therapy.
OBJECTIVE:To investigate the injured effect of tumor necrosis factor alpha (TNF-α) on bone marrow mesenchymal stem cel s and its mechanism.
METHODS:Primary cultured bone marrow mesenchymal stem cel s from Sprague-Dawley rats were treated with 200μg/L TNF-αfor 6 hours. Cel vitality was assayed by MTT, and cel apoptosis was observed by Hoechst33342 staining. Apoptotic rate was detected by Annexin-V/PI double staining. Level of oxidative stress was evaluated by determination of malondialdehyde and superoxide dismutase levels. The protein expressions of phosphorylated-Akt, Akt, phosphorylated-FoxO1, FoxO1 were detected by western blot analysis.
RESULTS AND CONCLUSION:After treatment with TNF-α, the cel vitality of bone marrow mesenchymal stem cel s decreased, the apoptotic rate increased, and the cel s were arrested in the S phase. Moreover, the oxidative stress level was elevated, and the protein expression of phosphorylated-Akt and phosphorylated-FoxO1 was significantly reduced compared with the control group (P<0.05). These results suggest that TNF-αat high level contributes to the S-stage arrest, responsible for the apoptosis processes of bone marrow mesenchymal stem cel s via the Akt-FoxO1 pathway.

Objective:To investigate the therapeutic effect of reverse proximal segment dorsal flap of radial digital artery of the thumb in repairing thumb tip defects.Methods:A retrospective case series study was conducted to analyze the clinical data of 56 patients with thumb tip defects admitted to Renqiu People 's Hospital from February 2010 to October 2020. There were 37 males and 19 females，aged 17-66 years［（37.8±12.2）years］. The injury on the right side was observed in 35 patients and on the left side in 21 patients. All of them were thumb tip defects with exposed distal phalanx. Dimension of skin defects was 2.9 cm×1.8 cm-3.3 cm×2.6 cm.The reverse proximal segment dorsal flap of thumb radial digital artery was used，with the dorsal digital nerve sutured with the proper digital nerve. The donor site was repaired with free skin graft from the ulnar side of the affected forearm. The time of flap harvesting，operation time and healing of the flap were measured. At the last follow-up，the shape，texture，sensory recovery and complications of the flap were observed. One month after operation and at the latest follow-up，the upper limb function evaluation standard set up by hand surgery branch of Chinese Medical Association and Vancouver Scar Scale（VSS）score were used to evaluate the recovery of sensory function of the flap and scar formation of the donor sites，respectively. Results:All patients were followed up for 6-26 months［（13.2±6.4）months］. The time of flap harvesting ranged from 20 to 35 minutes［（26.0±5.3）minutes］. The operation time was 1-2 hours［（1.3±0.3）hours］. Blisters appeared at the distal end of the flap in 2 patients after operation，but they were not treated. After 7 days，the blisters subsided and the flaps survived. The other flaps survived successfully. The donor sites healed by first intention. At the last follow-up，the flaps showed relatively cosmetic appearance，similarities in texture，elasticity and color to the surrounding area and good sensory recovery，without scar contracture and dystrophy of interphalangeal joint. According to the upper limb function evaluation standard set up by hand surgery branch of Chinese Medical Association，56 patients exceeded S3 grade compared to none at postoperative 1 month（ P<0.01），and the VSS score was 3-7 points［（5.0±1.4）points］compared to 6-12 points［（8.8±1.5）points］at postoperative 1 month（ P<0.01）. The donor site left a linear scar，which had no significant effect on its shape and function. Conclusion:The reverse proximal segment dorsal flap of the radial digital artery of the thumb can be used to repair thumb tip defects，for it has advantages of easy operation，a high survival rate as well as good appearance and sensory function recovery，with less damage to the donor area.

Objective:To report our clinical efficacy of pedicled transplantation of proximal thumb dorsal transverse flap to repair tissue defects at thumb pulp and fingertip.Methods:From February 2010 to November 2020, 97 patients with tissue defects at thumb pulp and fingertip were treated by pedicled transplantation of proximal thumb dorsal transverse flap at Department of Orthopedics, People's Hospital of Renqiu. They were 55 men and 42 women, aged from 17 to 66 years (average, 41.3 years). Altogether 55 right and 42 left sides were affected. The size of soft tissue defects ranged from 2.8 cm×1.8 cm to 3.9 cm×2.8 cm. Postoperatively, flap survival, shape, color and sensory recovery at the recipient area were observed; wound healing, function and complications at the donor site were also observed.Results:All the 97 flaps survived and all the wounds healed at the first stage. Blisters appeared at the distal end of the flap in only 2 cases but subsided 7 days after operation with no special treatment and the flaps survived smoothly. All the skin grafts at the donor site survived uneventfully. The 97 patients were followed up for 6 to 26 months (average, 10.7 months). Their flaps were not swollen, finger abdomen was full, finger appearance satisfactory, and finger feeling recovered well. The two-point discrimination at the last follow-up ranged from 4 to 11 mm (average, 7.6 mm). By the trial criteria for assessment of upper limb function suggested by Hand Surgery Society of Chinese Medical Association, sensory function of the affected finger was assessed as S 4 in 21 cases and as S 3+ in 76 cases at the last follow-up. No scar contracture was observed at the donor site and no movement restriction at the interphalangeal joint. Conclusion:Proximal thumb dorsal transverse flap is a reliable choice for reconstruction of complex tissue defects at thumb pulp and fingertip because of the advantages of easy harvest, constant vascular anatomy, full appearance and good sensory function at the recipient site, and limited damage to the donor site.