Objective To analyze the feasibility and practicality of the navigational template for antegrade lag screw fixation of the fractures in the posterior column of acetabulum.Methods Spiral CT scan data of 40 normal adult pelvis was collected.3D CT scans of pelvics were performed.Virtual 3D pelvic models were reconstructed with software Mimics 10.01.Virtual cylindrical implants were placed along the longitudinal axis of the acetabular posterior column via the ischial tuberosity among the ipsilateral hemipelvis and some anatomical parameters were measured.To adjust cylinder position to determine the best projection point,the shortest distance of the point to the linea terminalis and the anterior border of the auricular surface,the angle between the cylindrical and the coronal plane (α),and the angle between the quadrilateral district and iliac fossa plane (β) were measured respectively.The 3D models were imported into software UG 6.0.The models of navigational templates were designed according to the anatomic features of the acetabulums and the measured parameters.16 cases of dry left side of pelvis specimens were collected.Simulate acetabular posterior column screw fixation from different screw holes and verify the accuracy of navigation template assisted in the nail.Results The navigational templates was designed and manufactured successfully which was more consistent with the anatomical features of the quadrilateral plane.Placement of lag screw from the first hole:6.3％ achieved accurate positioning,75％ well positioning,and 18.7％ loose.From the second hole:81.3％ had accurate positioning,18.7％ well positioning.From the third hole:37.5％ had accurate positioning,62.5％ loose.Conclusion The navigational template designed according to the anatomic features of acetabulum and the measured parameters can accurately assist lag screw placement.

Objective Study the apply of diffusional kurtosis imaging(DKI) value to assess liver cancer and tumoral cell invasion of peritumoral liver zone. Methods This research belonging to prospective study which included 24 patients with liver cancer and confirmed by clinical history and imaging features(liver cancer group), 10 healthy volunteers as control group. The liver cancer group underwent MRI plain and contrast enhanced scan, and DKI examination, while control group underwent MRI plain scan and DKI scan. The signal features of liver parenchyma and liver cancer lesion could be observed from the routine MRI and DKI. Fractional anisotropy (FA), mean diffusion (MD), axial diffusivity (Da), radial diffusivity (Dr), fractional anisotropy kurtosis (Fak), mean kurtosis (MK), kurtosis anisotropy (Ka) and radial kurtosis (Kr) value of four groups, the distant liver parenchyma(far away from the tumor>2 cm), peritumoral liver parenchyma(the distance≤2 cm around the tumor) and liver cancer were recorded. The differences of DKI parameters were evaluated using one-way analysis of variance (ANOVA). Results The signal of liver cancer in MR plain scan showed mild long T1 and mild long T2 signal, fast in and fast out enhanced feature of the neoplasms could be observed from the enhanced MRI and signal of liver cancer would not lower in DKI with b value up to top. The difference of DKI parameters including FA, MD, Da, Dr and Ka value had statistical significance in these four groups excepted for MK and Kr value. MD, Da and Dr value of normal parenchyma were higher than that of peritumoral parenchyma and liver cancer,while the Ka value was reverse. The differences of MD, Da, Dr and Ka value only had no statistical significance between the distant liver parenchyma and peritumoral liver parenchyma(P>0.05),and the differences of them had statistical significance among the rest group(P<0.05). Conclusion The DKI quantitative parameters can reflect the differences of different tissue, meaning that they can provide molecular imaging information for evaluating liver cancer and peritumoral zone.

Objective To investigate the clinical effect of distal radioulnar ligament reconstruction by autologous tendon pal‐maris longus transplantation under arthroscopic assistance in treating chronic instability of the distal radioulnar joint .Methods Seven patients with chronic instability of the distal radioulnar joint after failure of conservation therapy were definitely diagnosed by the wrist joint exploration .Then the autologous tendon palmaris longus was taken for conducting the anatomical reconstruction of distal radioulnar ligament ;the average follow up was 12 months .The preoperative and postoperative grip strength and the motion of wrist joint were recorded ;the pain status of the wrist joint was evaluated by using the visual analogue scale (VAS) ,and the wrist function status was evaluated by using the Disabilities of the Arm ,Shoulder and Hand(DASH) and the Modified Mayo Wrist Score (MMWS) .Results The average VAS score of the rist joint motion was recovered from (7 ± 2) points before operation to (3 ± 3) points after operation ,the MMWS score was improved from preoperative (50 ± 9) points to postoperative (83 ± 11) points ,the DASH score was decreased significantly from preoperative (37 ± 15) points to postoperative (16 ± 10) points ,the grip strength was improved from preoperative 84 .5 ± 16 .0 to postoperative 93 .4 ± 11 .0 ,the differences were statistically significant .The mean range of motion(ROM ) in flexion/extension of the wrist was increased from preoperative 93 .5% ± 6 .0% to postoperative 96 .4% ± 3 .0% ,the ROM in pronation/supination of the forearm was increased from preoperative 92 .6% ± 7 .0% to postoperative 97 .2% ± 5 .0% ,but the differences were not statistically significant .Conclusion Under arthroscopic assistance ,the anatomical reconstruc‐tion of the distal radioulnar ligaments is an effective treatment method for treating chronic distal radioulnar joint instability ,its short term follow up has satisfactory effect .

Objective To explore the effect of nimodipine combined with minimally invasive puncture on neurological function,hemodynamics,and serum inflammatory factor levels in patients with hypertensive intracerebral hemorrhage(HICH).Methods A total of 108 patients with HICH treated at the Second Affiliated Hospital of Hebei North University from June 2019 to May 2022 were selected as the research subjects.They were divided into an observation group(n=55)and a control group(n=53)according to the treatment method.All patients in the two groups received minimally invasive puncture;on this basis,the patients in the observation group were treated with nimodipine for one month.The neurological deficit of patients in the two groups was evaluated by the National Institute of Health Stroke Scale(NIHSS)score before and after treatment.Before and after treatment,5 mL of fasting venous blood was taken from patients in the morning,and the serum was obtained by centrifugation.The serum levels of brain-derived neurotrophic factor(BDNF),neuron-specific enolase(NSE),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were detected by enzyme-linked immunosorbent assay.Ultrasonic transcranial Doppler blood flow analyzer was used to monitor the hemodynamic indexes such as mean blood flow velocity(Vm),resistance index(RI)and pulsitility index(PI)of patients in the two groups before and after treatment.The adverse reactions such as headache,dizziness,infection and rebleeding were recorded in the two groups after treatment.Results There was no statistically significant difference in the NIHSS score and serum NSE and BDNF levels between the two groups before treatment(P＞0.05).After treatment,the NIHSS score and serum NSE level of patients in the two groups were significantly lower than those before treatment,while the serum BDNF level was significantly higher than that before treatment(P＜0.05).After treatment,the NIHSS score and serum NSE level of patients in the observation group were significantly lower than those in the control group,while the serum BDNF level was significantly higher than that in the control group(P＜0.05).There was no statistically significant difference in the Vm,PI and RI between the two groups before treatment(P＞0.05).After treatment,the Vm and PI of patients in the two groups were significantly higher than those before treatment,while the RI was significantly lower than that before treatment(P＜0.05).After treatment,the Vm and PI of patients in the observa-tion group were significantly higher than those in the control group,while the RI was significantly lower than that in the control group(P＜0.05).There was no statistically significant difference in serum TNF-α,IL-6,and CRP levels between the two groups before treatment(P＞0.05).The levels of serum TNF-α,IL-6,and CRP of patients in the two groups after treatment were significantly lower than those before treatment(P＜0.05).After treatment,serum TNF-α,IL-6,and CRP levels of patients in the observation group were significantly lower than those in the control group(P＜0.05).The incidence of adverse reactions in patients in the control group and observation group was 7.55％(4/53)and 9.09％(5/55),respectively,and the difference in the incidence of adverse reactions between the two groups was not statistically significant(P＞0.05).Conclusion Nimodipine combined with minimally invasive puncture can effectively improve the blood perfusion rate of HICH patients,reduce the degree of inflammatory response,and alleviate the patients'neurological function damage.

Objective:To investigate whether the real-world marital status is a factor affecting the survival of patients with early stage breast cancer.Methods:According to the data of 62 845 patients with early stage (T 1-2N 0M 0) breast cancer who received treatment from January 2012 to December 2015 in the Surveillance, Epidemiology and End Results (SEER) database, univariate survival analysis for 7 factors including age, race, surgery, T stage, tumor differentiation, molecular type and marital status was performed by Kaplan-Meier method. The 5-year cancer specific survival (5-CSS) rate was calculated. Multivariate Cox proportional hazards model was used to analyze the death risk of patients with different marital status (married, unmarried and bad marriage). Results:Univariate analysis showed that 7 factors were correlated with the survival of patients with early stage breast cancer (all P < 0.001). Multivariate analysis showed that marital status was an independent factor affecting the survival of patients, and the death risk of unmarried patients and patients with bad marriage was 2.014 times (95% CI 1.714-2.367, P < 0.001) and 2.559 times (95% CI 2.254-2.905, P < 0.001) higher than that of married patients, respectively. In tumor differentiation, molecular type, T stage and race subgroups, univariate analysis showed that the rates of 5-CSS in married patients were higher than those in unmarried patients and patients with bad marriage (all P < 0.001); multivariate analysis showed that the risk of death in patients with bad marriage (except undifferentiated type) was higher than that in married patients (all P < 0.001), and the risk of death in unmarried patients (except undifferentiation, Luminal B type, black and other races) was also higher than that in married patients (all P < 0.01). Conclusions:Marital status is one of the factors influencing the survival of patients with early stage breast cancer.

Objective : To explore the risk factors of fever after hysterectomy in patients with uterine fibroids，and establish a nomogram prediction model to provide theoretical guidance for clinical diagnosis and treatment． Methods : The data of patients who underwent hysterectomy due to uterine fibroids were collected and randomly divided into training group and validation group at 6 ∶ 4．Univariate and multivariate analyses were performed by χ2 test and Lo- gistic regression model analysis．The nomogram was established based on the results of multivariate analysis，the calibration curve and receiver operating characteristic，curve were used to evaluate the prediction ability and accura- cy of the nomogram．The decision curve reflected the clinical application value of the model. Results : Among 264 patients in the training group，33 patients had fever，and the postoperative disease rate was 12. 5%．The results of univariate and multivariate analysis showed that anemia，preoperative curettage，operation scope and operation time were independent risk factors for fever after hysterectomy in patients with uterine fibroids．The internal and external calibration curves had a good fit with the actual observation results，with an average error of 0. 031 and 0. 025，re- spectively．The area under receiver operating characteristic curve of the internal and external verification of the no- mogramare 0. 788 and 0. 712，respectively，reflecting the good predictive ability of the model．The decision curve showed that the model had good clinical benefit in a certain threshold range． Conclusion Based on multivariate a- nalysis，the independent risk factors of fever after hysterectomy in patients with uterine fibroids，including anemia， preoperative curettage，operation scope and operation time．In addition，we established a nomogram with good pre- dictive ability and accuracy，which is helpful for clinicians to timely manage fever after hysterectomy in patients with uterine fibroids and guide clinical individualized treatment.

Objective:To compare the dosimetric difference between intensity-modulated photon radiaotherapy (IMRT) planning and intensity-modulated proton radiotherapy (IMPT) planning for glioma.Methods:The clinical data of 15 glioma patients who underwent IMRT in ion medical center of the First Affiliated Hospital of USTC from November 2020 to April 2022 were retrospectively analyzed. IMRT planning and IMPT planning were designed for the image of each patient in the therapy planning system. Main dosimetric parameters were compared including plan target volume (PTV), coverage index (CI), dose homogeneity index (HI), and maximal dose (D max) and mean dose (D mean) of organs at risk between both plans. Results:There were no significant differences between IMRT planning and IMPT planning in terms of D max and D mean of PTV1 and PTV2, CI and HI (all P > 0.05). Compared with IMRT planning, brainstem D mean [6.92 GyE (0.09 GyE, 12.58 GyE) vs. 24.41 GyE (2.59 GyE, 34.18 GyE)], left optic nerve D max [0.78 GyE (0.04 GyE, 25.18 GyE) vs. 20.42 GyE (6.38 GyE, 37.17 GyE)], left optic nerve D mean [0.10 GyE (0.01 GyE, 11.63 GyE) vs. 9.74 GyE (2.99 GyE, 20.87 GyE)], right optic nerve D mean [1.57 GyE (0.13 GyE, 14.90 GyE) vs. 14.08 GyE (2.66 GyE, 23.67 GyE)], left len D max [0 GyE (0 GyE, 2.91 GyE) vs. 4.84 GyE (1.42 GyE, 5.48 GyE)], left len D mean [0 GyE (0 GyE, 1.73 GyE) vs. 3.84 GyE (1.25 GyE, 4.30 GyE)], right len D max [0.25 GyE (0.04 GyE, 4.55 GyE) vs. 4.28 GyE (1.58 GyE, 5.84 GyE)], right len D mean [0.16 GyE (0.01 GyE, 1.95 GyE) vs. 3.73 GyE (1.04 GyE, 4.86 GyE)], pituitary D max [6.97 GyE (0.18 GyE, 39.70 GyE) vs. 36.60 GyE (2.74 GyE, 45.19 GyE)], pituitary D mean [1.36 GyE (0.06 GyE, 13.85 GyE) vs. 24.74 GyE (2.42 GyE, 32.80 GyE)], hippocampus D max [5.10 GyE (0.24 GyE, 26.52 GyE) vs. 35.83 GyE (5.03 GyE, 46.11 GyE)], hippocampus D mean [0.36 GyE (0.04 GyE, 25.65 GyE) vs. 18.79 GyE (2.37 GyE, 28.10 GyE)] in IMPT planning were lower, and the differences were statistically significant (all P < 0.05). There were no statistical differences in brainstem D max [51.98 GyE (0.66 GyE, 53.43 GyE) vs. 53.29 GyE (3.87 GyE, 53.48 GyE)], right optic nerve D max [9.60 GyE (0.01 GyE, 43.32 GyE) vs. 25.37 GyE (3.45 GyE, 41.25 GyE)] of both plans (all P > 0.05). Conclusion:In the radiotherapy for glioma, IMRT and IMPT can meet the dose demand in clinic. Furthermore, IMPT planning can protect organs at risk and reduce radiation dose in hippocampus, brainstem, optic nerve, lens and pituitary.

Objective:To investigate the difference of dose distribution between intensity-modulated photon radiotherapy (IMRT) and intensity-modulated proton radiotherapy (IMPT) in patients with non-small cell lung cancer.Methods:The clinical data of 8 patients with stage Ⅱ-Ⅲ non-small cell lung cancer who received radiotherapy in Ion Medical center of the First Affiliated Hospital of University of Science and Technology of China from November 2020 to April 2022 were retrospectively analyzed. IMRT and IMPT radiotherapy plans were created for each patient separately, the main evaluation indicators were targeted area dose distribution parameters [homogeneity index (HI), conformity index (CI) and the percent volume of volume wrapped by 95% and 100% of prescription dose profile in the targeted area (V 95% and V 100%)], and the average dose (D mean) to the organ at risk and the percent volume of a certain relative biological effect (RBE) dose exposure [D mean, V 5 Gy(RBE) and V 20 Gy(RBE) of ipsilateral lung, D mean, V 5 Gy(RBE) and V 20 Gy(RBE) of bilateral lung, D mean, V 30 Gy(RBE) and V 40 Gy(RBE) of heart, maximum dose (D max) of spinal cord, and D mean of esophageal]. Results:In comparison with IMRT, IMPT reduced the levels of dose parameters in bilateral lung, ipsilateral lung, spinal cord, esophagus, and heart with statistically significant differences (all P < 0.05), especially in D mean of bilateral lung [(4.1±1.8) Gy (RBE) vs. (6.9±1.9) Gy (RBE)], V 5 Gy(RBE) [(15.9±7.1) % vs. (28.5±8.6)%], V 20 Gy(RBE) [(7.4±3.5)% vs. (10.1±3.5)%], and D mean of ipsilateral lung [(9.1±4.5) Gy (RBE) vs. (11.9±3.3) Gy (RBE)], all decreased significantly (all P < 0.001), but the differences in the levels of targeted area dose distribution parameters between them were not statistically significant (all P > 0.05). Conclusions:For patients with non-small cell lung cancer, IMPT is superior to IMRT in the protection of bilateral lung, ipsilateral lung, spinal cord, esophagus and heart.

Objective:To explore the degradation property of novel magnesium alloy stents in Bama mini-pig models of carotid artery stenosis, and evaluate the feasibility of observing their dynamic and continuous process by high-resolution C-arm CT.Methods:Twelve Bama mini-pigs were selected; carotid artery stenosis models were established by large balloon over-dilation and high-fat and high-salt diet in Bama pigs; 24 weeks after that, self-made braided degradable magnesium alloy stents were inserted into the carotid artery stenosis models (confirmed by DSA) by balloon dilation. Degrees of stent patency and in-stent restenosis were examined by DSA immediately after procedure and on the 30 th, 60 th and 90 th d of procedure. Four experimental pigs were sacrificed on the 30 th, 60 th and 90 th d of procedure, respectively; the degradation property of the novel magnesium alloy stents was observed according to results of high-resolution C-arm CT in the inserted-stent areas and staining results of specimens in the stenosis areas, and stent imaging features during degradation were summarized. Results:Twelve Bama mini-pig models of carotid artery stenosis were established and 12 magnesium alloy stents were successfully inserted with a technical success rate of 100%. Both immediate postoperative and follow-up angiography showed patency of the vascular lumens without obvious in-stent restenosis. High-resolution C-arm CT and pathological examination showed homogeneous stent lumens and clear delineation of the stent meshes, with slightly degraded stent on the 30 th d of procedure; the stent lumen was blurred and some magnesium alloy wires were fractured with developed degradation of the stent on the 60 th d of procedure; and the stent meshes and stent strut could not be visualized due to severe degradation of the stent on the 90 th d of procedure. Conclusion:Magnesium alloy degradable stent is almost completely degraded within 90 th d of procedure in Bama mini-pig models of carotid artery stenosis, and high-resolution C-arm CT can be used to dynamically monitor the degradation of the stent in vivo.

Objective:To explore the stent apposition and safety of Neuroform EZ and Enterprise 2 stents in treatment of symptomatic intracranial atherosclerotic stenosis (sICAS), and their influencing factors for in-stent restenosis.Methods:A total of 143 sICAS patients treated by Enterprise 2 stents (implanted 143 Enterprise 2 stents, E2 group) and 202 patients treated by Neuroform EZ stents (implanted 202 Neuroform EZ stents, EZ group) were selected from Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University from January 2017 to January 2022. Stent apposition was evaluated based on reconstructive images of high-resolution flat detector CT. The complications 30 d after surgery and during 6-24 months of follow-up were recorded. Based on DSA or CTA 6 months after surgery, the patency of the two stents was evaluated. Univariate analysis and multivariate Logistic regression analysis were used to determine the independent risk factors for in-stent restenosis.Results:(1) Forty-nine patients had incomplete stent apposition (ISA) after stent release: 24 patients with ISA in E2 group (16.8%, 24/143; 15 of type I and 9 of type II) and 25 with ISA in the EZ group (12.4%, 25/202, 11 of type I and 14 of type II) were found, without statistical difference ( χ 2=1.334, P=0.248); however, ISA incidence in the EZ group (19.0% and 10.3%) was significantly lower than that in the E2 group (41.4% and 25.6%) when the diameter ratio of anterior and posterior vessels of the stenosis lesions≥1.30 or the angle of stent≥75° ( χ 2=4.228, P=0.040; χ 2=4.531, P=0.033). (2) Within 30 d of stenting, 17 patients developed neurological dysfunction-related complications: 8 patients in EZ group and 9 in E2 group were noted, without significant difference ( P=0.324). Clinical follow-up was obtained in 317 patients, and 20 patients developed long-term stroke associated with responsible lesion vessels: 12 patients in EZ group and 8 in E2 group were noted, without significant difference ( P=0.995). (3) Totally, 298 patients received imaging follow-up 6 months after surgery, and 65 patients developed in-stent restenosis: 36 patients in EZ group and 29 in E2 group were noted, without significant difference ( χ 2=0.309, P=0.578). Multivariate Logistic regression analysis showed that diabetes ( OR=2.714, 95% CI: 1.437-5.126, P=0.002), stent apposition ( OR=3.435, 95% CI: 1.223-9.652, P=0.019), lesion stenosis length ( OR=1.176, 95% CI: 1.065-1.300, P=0.001) and immediate postoperative residual stenosis ( OR=1.038, 95% CI: 1.004-1.074, P=0.029) were independent influencing factors for in-stent restenosis. Conclusions:Enterprise 2 and Neuroform EZ stents have high stent apposition and safety in sICAS treatment, but in cases with large diameter ratio of the anterior and posterior vessels of the stenosis lesions (diameter ratio≥1.30) or large angle of the stent (≥75°), Neuroform EZ stent has better stent apposition. Patients with diabetes, ISA, long lesion stenosis or high residual stenosis may trend to have in-stent restenosis.