Objective:To investigate the clinical value of integrated traditional Chinese and Western medicine based on the concept of enhanced recovery after surgery (ERAS) in the perioperative period of total knee arthroplasty.Methods:Sixty patients who underwent primary unilateral total knee arthroplasty in Tonglu Hospital of Traditional Chinese Medicine from July 2018 to June 2019 were included in this study. They were randomized as odd numbers to the control group ( n = 30) and even numbers to the observation group ( n = 30). The control group was treated with conventional rehabilitation treatment, while the observation group was subjected to integrated traditional Chinese and Western medicine based on the concept of ERAS in the perioperative period of total knee arthroplasty. The perioperative pain, related complications, hospitalization expenses and length of hospital stay were recorded in each group. The Visual Analogue Scale (VAS) was used to evaluate the degree of pain and range of motion of the knee joint. The Hospital for Special Surgery (HSS) knee score was also measured to evaluate the curative effects. Results:At 3 and 7 days, 2 and 6 weeks after surgery, knee range of motion score was (63.40 ± 2.80) points, (86.20 ± 4.40) points, (90.30 ± 6.48) points, (100.5 ± 3.39) points, respectively, and at 6 weeks after surgery, HSS knee score was (89.40 ± 5.18) points, in the observation group, which were significantly higher those in the control group [(48.50 ± 4.20) points, (55.40 ± 3.58) points, (77.50 ± 4.38) points, (87.60 ± 4.58) points, (70.50 ± 6.44) points, t = 0.029, 0.013, 0.032, 0.039, 0.042, all P < 0.05]. In the observation group, the VAS score in resting state at 6, 12, 24 and 48 hours after surgery were (3.62 ± 0.40) points, (2.41± 0.52) points, (2.05 ± 0.62) points, (1.93 ± 0.28) points respectively, and the VAS score in active state at 24 and 48 hours were (2.15 ± 0.21) points and (1.71 ± 0.39) points, respectively, which were significantly lower than those in the control group [(5.71 ± 0.63) points, (4.60 ± 0.31) points, (3.84 ± 0.22) points, (3.30 ± 0.21) points, (5.50 ± 0.49) points, (4.80 ± 0.21) points, t = 0.040, 0.035, 0.046, 0.042, 0.027, 0.024, all P < 0.05]. The proportions of patients experiencing postoperative urinary retention, mental disorder, or blood transfusion, length of hospital stay, and hospitalization expenses in the observation group were lower or shorter than those in the control group ( χ2 = 0.003, 0.005, 0.017, t = 0.040, 0.048, all P < 0.05). Conclusion:Integrated traditional Chinese and Western medicine based on the concept of ERAS can mitigate postoperative pain, reduce perioperative complications, and promote the recovery of knee joint function, and thereby deserves clinical application.

Objective:To investigate the relationship between gastric filling status and intra-or inter-fractional tumor displacement in patients with adenocarcinoma of the esophagogastric junction (AEG) undergoing preoperative radiotherapy.Methods:From October 2018 to June 2019, 10 patients with locally advanced AEG who received totally neoadjuvant therapy were enrolled in this prospective study. Patients received two markers implanted at the cranial and caudal borders of the tumors under gastroscope and a total of 20 fiducial markers were implanted finally. All patients underwent 4DCT scan under the gastric fasting and filling status. Ten images of 0% to 90% respiratory phase were automatically reconstructed by the system (Pinnacle 3, version 9.1, Philips Medical Systems, Eindhoven, The Netherland). Each patient obtained one hundred sets of images. Results:In the tumors proximal to the chest, gastric filling did not significantly affect intrafractional or interfractional tumor displacements. Nevertheless, in the tumors distal to the chest, the interfractional displacement in the cranio-caudal (CC) direction under the gastric fasting status was significantly larger compared with that under the gastric filling status (6.22±4.67 mm vs. 4.13±3.68 mm, P=0.013). To ensure 95% of the prescribed dose irradiated to at least 90% of the tumor volume during the radiotherapy, the margins of tumors proximal to the chest in the left-right (LR), antero-posterior (AP) and CC directions were 9 mm, 8.5 mm, 12.1 mm under gastric filling status with 300 ml semi-fluid. Six patients diagnosed with gastric cancer with proximal thoracic fiducial markers treated by preoperative radiotherapy were included in the validation group, revealing that the fiducial markers of 93% patients were covered in this margin. Conclusion:During the preoperative radiotherapy in AEG patient, the approach of quantitative gastric filling can be considered.

Objective:To evaluate the safety and preliminary efficacy of total neoadjuvant therapy (TNT) model of" neoadjuvant chemoradiotherapy plus consolidation neoadjuvant chemotherapy (CNCT) followed by surgery" for locally advanced gastric cancer.Methods:From 2018 to 2020, 28 patients clinically diagnosed with locally advanced gastric adenocarcinoma or Siewert Ⅱ/Ⅲ adenocarcinoma gastroesophageal junction cancer were prospectively enrolled. The neoadjuvant chemoradiotherapy (NCRT) was delivered with a total dose of 45 Gy, 1.8 Gy/f. Concurrent chemotherapy was S-1 at a dose of 40-60 mg twice daily. Then, patients received four to six cycles of CNCT of SOX regimen at three weeks after neoadjuvant chemoradiotherapy. D 2 lymphadenectomy was performed at 4-6 weeks after CNCT. Results:A total of 28 patients completed the whole therapy. Grade 3 or above adverse events occurred in 3 cases (11%) during CCRT, including thrombocytopenia, leukopenia and anorexia; 2 cases (7%) developed leukopenia and 3 cases (11%) of thrombocytopenia during CNCT. Twenty patients (71%) completed the surgery. The proportion of patients with pathological complete remission (pCR) was 50%. Three patients experienced surgical complications including anastomotic leak, anastomotic stenosis and intra-abdominal sepsis. All were recovered after symptomatic treatment.Conclusion:Interim analysis results demonstrate that TNT can yield significant down-staging for patients with locally advanced gastric cancer, which causes tolerable adverse events and postoperative complications.

Objective:To explore the motion and influencing factors of implanted gold markers in guiding liver stereotactic body radiation therapy (SBRT) using abdominal compression.Methods:Twenty patients with oligometastatic colorectal cancer or primary hepatocellular carcinoma from January 2016 to December 2019 were included. All patients were treated with SBRT under abdominal compression, with 1-3 gold markers were implanted within 2 cm from the lesion before positioning. Four-dimensional computed tomography (4DCT) scan was used for treatment planning. The respiratory cycle was divided into 0-90% respiratory phase images based on the respiratory signal, which were reconstructed by the system (Pinnacle 3 version 9.1; Philips Medical System, Madison, WI, USA), and cone beam CT validation images before radiation exposure were obtained. The liver volume was divided into 3 parts: within 2 cm from the main hepatic portal vein, 2-5 cm from the main hepatic portal vein, and>5 cm from the main hepatic portal vein. The motion of different tumor locations was evaluated. Results:The average intrafractional motion amplitude was (2.63±2.81) mm in the cranial-caudal (CC) direction, (1.35±1.23) mm in the anterior-posterior (AP) direction, and (0.76±0.88) mm in the left-right (LR) direction, respectively. The average interfractional motion amplitude was (3.45±3.06) mm, (2.64±2.60) mm, and (2.23±2.07) mm, respectively. Both the intra-or inter-fractional motion amplitudes in the CC direction were the highest, followed by those in the AP and LR direction (all P<0.001). The motion varied at different tumor locations. The longer distance from the main hepatic portal vein, the larger the intrafractional motion (all P<0.05). To cover the 95% population-based confidence interval, the internal target volume (ITV) was suggested to include the expansion of 3.9 mm, 5.2 mm and 7.9 mm in the LR, AP and CC direction. The expansion of 4.3 mm, 4.4 mm and 6.1 mm was delivered within 2 cm from the main hepatic portal vein, and 3.5 mm, 7.3 mm and 9.7 mm>5 cm from the main hepatic portal vein, respectively. The expansion varied significantly depending on the tumor location, whereas the motion in the CC direction was the largest regardless of the tumor location. The longer distance of the tumor from the main portal vein, the larger expansion in the CC direction. The expansion of tumor > 5 cm from the main portal vein in the AP direction was larger than that of inner parts. Conclusion:Liver tumors at different locations require individual external expansion of ITV.

Objective:To investigate the relationship between MRI parameters and clinical prognosis before and after chemoradiotherapy in patients with locally advanced rectal cancer.Methods:Clinical and follow-up data of 96 patients with locally advanced rectal cancer who were initially treated in the Cancer Hospital of Chinese Academy of Medical Sciences from 2015 to 2017 were retrospectively analyzed. All patients received preoperative chemoradiotherapy, followed by delayed radical surgery at 6-13 weeks after radiotherapy. MRI assessment was performed twice around radiotherapy which were within 4 weeks before the treatment and 4-8 weeks after it. Correlation analysis was utilized to determine the association between MRI assessment and 3-year disease-free survival (DFS).Results:Of the all patients, 80 (83%) had T 3 stage, 16(17%) had T 4 stage, 14 (15%) had N 0 stage, and 82 (86%) had N 1-2 stage. Among them, 69(72%) and 58(60%) patients were positive for MRF and EMVI. The median dose of radiotherapy was 50 Gy, and all patients were sensitized by simultaneous capecitabine. After chemoradiotherapy, T-downstage rate of the whole group was 24%, and 50% for the N-downstage rate. The MRF-and EMVI-positive rates were significantly decreased to 37% and 27% after chemoradiotherapy (both P<0.001). Univariate and multivariate analyses showed that N staging and EMVI status change were significantly correlated with the 3-year DFS. Conclusion:MRI after concurrent chemoradiotherapy reveals that positive EMVI throughout the treatment and N 1-N 2 staing are poor prognostic factors of DFS, suggesting the need for improving the treatment.

Objective To label human VEGF targeted bevacizumab (avastin) with 111In and to evaluate the application of 111 In?DTPA?avastin SPECT imaging for tumor diagnosis. Methods DTPA?avastin was prepared by coupling with a bifunctional chelating agent, and then labeled with 111 In to obtain 111 In?DTPA?avastin. The stability and molecular integrity of the labeled radiotracer were studied. Human hepatoma cell ( BEL7404) bearing nude mice tumor model was employed for tumor targeting evaluation. Gamma imaging was acquired after intravenous injection of 18.5 MBq probe. At the end of the observation, animals were sac?rificed for bio?distribution study. Results 111 In?DTPA?avastin tracer was synthesized and purified to a?chieve a radiochemical purity yield above 98% and specific activity up to 185 GBq/nmol. Its stability in 5%BSA was optimal, and the radiochemical purity after incubation for 96 h was over 90%. Gamma imaging re?sults showed that the tracer possessed definite tumor targeting property. Its biodistribution was consistent with that of normal in vivo antibody metabolism while possessing a good tumor?targeting property with a relatively high uptake of (3.8±0.8) %ID/g in tumor tissues 96 h after injection. Conclusions 111 In?DTPA?avastin tracer has good physicochemical properties, in vivo stability and good VEGF targeted binding. 111 In?DTPA?avastin has potential to be a new molecular probe for SPECT imaging.

Objective To evaluate the clinical outcomes of periprosthetic femoral fractures (PFF) following hip arthroplasty utilizing locking compression plates (LCP) in regard to tips and tricks on the construction of LCP augmented with locking attachment plate (LAP) and titanium cables (TC).Methods A total of 41 cases of PFF follow hip arthroplasty (THA 3,Hemi-arthroplasty 2) between May 2008 to April 2016 have been retrospectively analyzed.There were 13 males and 28 females with an average age of 70.5±8.6 years,including 11 case of Unified Classification System (UCS) type Ⅳ.3B1.1,21 cases of B2.1 and 9 cases of type C.All were closed fractures caused by simple fall in terms of low-energy injury.Surgical options depended on individual configuration of the fractures with the combination of LCP and LAP or TC.In respect of reduction techniques,minimally invasive plate osteosynthesis (MIPO) was used in 5 cases for type B1.1 and 8 cases for type C,Mini-open in 6 cases for type B1.1 and 1 case for type C.Posterolateral approach with open reduction internal fixation were selected for type B2.1.The patients were followed up periodically.Harris score,Mukundan criteria and complications were recorded.Results Five cases died of the comorbidities (heart failure 3,pulmonary infection 1,multiple organs failure 1) within 1 year postoperatively.The follow-up rate was 78.0％ (32 out of 41 cases) and the average follow-up time was 41 months (ranging 11 to 71 months).No malunion,no reduction lost,no hardware failure,no hip dislocation and revision surgery following PFF care found.All cases showed the signs of fracture healing from 8 to 12 (average 10 weeks) postoperatively except 2 cases of delay union.The postoperative complications shown in 11 cases,including 2 cases of superficial infection of the wound,6 cases of deep vein thrombosis (popliteal vein 2,intramural gastrocnemius vein 4) and 3 cases of the prosthetic loosening.Harris score at the latest follow-up were 91.5±2.1 for group B1.1,77.5±4.2 for group B2.1 and 83.5±3.8 for group C.The LCP lengths were 248.9±24.3 mm,258.6±25.2 mm,280.4±24.0 mm for group B1.1,B2.1 and C respectively.The LCP length of group B1.1 was short than that of group C (P＜0.05).The screw numbers for the proximal fragments were 6.1±1.8,6.5±0.7 and 3.8±0.7 for group B1.1,B2.1 and C respectively.The number of screws used in B1.1 and B2.1 were more than that in C (P＜0.05).The screw numbers for the distal fragments were 3.5±0.5,3.9±0.5 and 5.1±0.8 for group B1.1,B2.1 and C respectively,indicating less screws used in B1.1 and B2.1 than that in C (P＜0.05).The cable numbers were 1.9±1.3,2.5±0.9 and 3.7±0.7 respectively for group B1.1,B2.1 and C (P＜0.05).The LAP used in 2,12 and 6 cases for type B 1.1,B2.1 and C respectively without significant difference statistically (P＞0.05).Conclusion Utilizing LCP for PFF following hip arthroplasty can achieve satisfactory short and mid-term clinical outcomes with the prerequisites of precise and individualized preoperative planning.LCP augmented by LAP and TC is a reliable option with low complication rate.However,type C PFF needs longer plate with more screws at distal fragment and more titanium cables.

OBJECTIVETo compare the difference of the clinical efficacy in treatment of nervous tinnitus of kidney deficiency between the combined therapy of Zhuang medicine at Qineihuan point combined with the conventional acupuncture and simple conventional acupancture.

METHODSSixty patients were randomized into an observation group and a control group, 30 cases in each one. In the control group, the conventional acupuncture was applied to Taixi (KI 3), Zhaohai (KI 6), Tinggong (SI 19) and Waiguan (TE 5), etc. and the needles were retained for 30 min. In the observation group, on the basic treatment as the control group, Zhuang medicine acupuncture at Qineihuan point was added. The treatment was given once every day, 10 treatments made one session and there were 2 days of interval between the sessions. In 3 sessions of treatment, the changes of tinnitus were observed and the clinical efficacy was evaluated.

RESULTSAfter treatment, tinnitus score and tinnitus grade were all improved as compared with those before treatment in the two groups (all P<0. 05) and the results in the observation group were better than those in the control group (all P<0. 05). The curative and remarkably effective rate was 63. 3% (19/30) and the total effective rate was 93. 3% (28/30) in the observation group, better than 30. 0% (9/30) and 73. 3% (22/30) in the control group (both P<0. 05).

CONCLUSIONThe combined therapy of Zhuang medicine at Qineihuan point and conventional acupuncture achieves the better efficacy on nervous tinnitus of kidney deficiency as compared with the simple conventional acupuncture.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Female ; Humans ; Kidney ; physiopathology ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Tinnitus ; physiopathology ; therapy ; Treatment Outcome ; Yin Deficiency ; physiopathology ; therapy

Objective To establish a novel direct radio-labeling method for 99Tcm-IgG and evaluate the biologic distribution of 99Tcm-IgG.Methods IgG protein was modified with 2-mercaptoethanol.Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE),UV-vis spectrophotometer,matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) were used to identify the concentration,integrity of the modified protein.Then radiolabeled IgG-SH with 99TcmO4-was analyzed with radio-HPLC.The product was prepared as frozen kits.The distribution and metabolic process of 99Tcm-IgG were observed in New Zealand white rabbits.Results The relative molecular mass of IgG-SH and IgG measured by SDA-PAGE were similar.The relative molecular mass measured by MALDI-TOF was 1.47× 105.The radiolabeling yield was over 95％,the specific activity was 1.7× 105 GBq/mmol.All the radioactive conjugates of 99Tcm-IgG showed excellent stability in vitro.And more than 95％ conjugates retained their original structures for 6 h in 5％ BAS.Gamma imaging in New Zealand white rabbits showed blood retention in first 4 h after injection,and prominent uptake of radiotracers in the liver,kidneys,and urinary bladder at 24 h after injection,which indicated that 99Tcm-IgG was excreted mainly through the renal route.99Tcm-IgG kept its original biological activity after the modification.Conclusions Direct radio-labeling of 99Tcm-IgG was successfully established.The methods may be useful for radio-modification of monoclonal antibody.