[Objective]To study the clinical matters of inactivated bone replantation with preservation of the epiphysis in children limb salvage with osteosarcoma.[Method]Eleven children(mean age 7.6 years old,5 male and 6 female)with osteosarcoma underwent inactivated bone replantation with preserving epiphysis following chemotherapy during 6 years.All lesions located in the distal femur.Seven were in Ⅰ type on MRI classification,4 in Ⅱ type.Two courses of the same protocol as preoperative chemotherapy were administered postoperatively.[Result]The operative time were 3~4 hours.The bleeding amount were about 300~500 ml.No complications occurred in operation and incisions healed well in all patients.Eleven patients were done follow-up from 10 to 72 months.Functions of the affected limbs were satisfatory.Local tumor recurrence was seen in one case and lung metastasis in two,3 patients died of the disease.Blot became flexible and inactivated bone fractured in one,respectively.[Conclusion]Inactivated bone replantation with preserving epiphysis for osteosarcoma in children is propitious to recover limb function and keep limb length.The main measures of preventing complications include no-touch technique in operation,incision drain completely,prolonging time of affected limb external fixation and safeguarding the affected limb during postoperative function exercise.

[Objective]To analyze the causes of revision for bone tumor salvage limb operations and to explore the therapies.[Method]There were 4 cases of male,1 of female and with the mean age of 41.2 years old.The time between the first operation and revision was from 3 to 29 years.The common reason for revision was aseptic loosening,2 patients with sinus and 1 with fracture of prosthesis.During revision,the old prosthesis were implanted in 2 cases,the new one were used in the others.[Result]All patients were followed up with the mean time of 28 months,no patient died.The mean score of limb function was 21.5.[Conclusion]Revision should be performed as soon as the prosthesis aseptic loosening has been determined,and the satisfactory limb function could be obtained.

Purpose: To explore the relationship between the amount of lymphocyte containing adhesion molecules(CD_(44)) and the development and postoperative metastasis of bone tumors. Method: The percentage of peripheral blood CD_(44) positive lymphocyte's(PB CD_(44) + L) in 45 patients with bone tumor and the tissue CD_(44) content in 7 malignant bone tumors were determined with the flow cytomentric immunological method. Results: The PB CD_(44) + L in benign tumor group(BG) and malignant tumor group(MG) were much higher than that of the control, and the PB CD_(44) + L in MG was higher than that in BG. No difference was found in the content of PB CD_(44) + L between the mahgnant non-metastatic group (MNG) and the malignant metastatic group(MMG). The postoperative PB CD_(44) + L in the BG and MNG was decreased, but CD_(44) was unchanged pre-and postoperatively in the MMG. The patients with high CD_(44) content in the tumor tissues were liable to postoperative lung metastasis. Conclusions: The determination of CD_(44) in PBL and tumor tissue can be helpful to determine the nature of the neoplasm and to predict its prognosis.

ObjectiveTo investigate whether the T1-weighted dynamic contrast-enhanced perfusion magnetic resonance imaging (DCEPMRI) technique can help to delineate the clinical target volume of brain glioma patients.MethodsThe DCE T1-weighted images from 28 glioma patients were collected after GdDTPA was injected.After the acquired images were processed and analyzed using modified Tofts-Kermode'two compartment analysis model and de-convolution method,the value and its pseudo mapping of quantitative parameter Ktrans related to microvascular permeability were obtained.The tumor size in the largest diameter slice measured both in routine enhanced MRI and Ktrans mapping of T1-weighted DCEPMRI were compared.ResultsThe vascular permeability and tumor infiltration was lower in low grade glioma,the difference of the tumor size between T1-weighted DCEPMRI and routine enhanced MRI reached 0.2％ -0.3％ there was significant difference of tumor size between T1 -weighted DCEPMRI and routine enhanced MRI ( grade Ⅰ and Ⅱ grade with 2.93 cm2∶2.46 cm2(t=6.90,P=0.000) and 4.18 cm2∶3.21 cm2(t=10.22,P=0.000) ).While in high grade glioma,the vascular permeability and the tumor infiltration were higher,the difference of the tumor size between T1-weighted DCEPMRI and routine enhanced MRI reached 25％ - 26％( the size of grade Ⅲ and Ⅳ were 6.46 cm2 vs 5.48 cm2 ( t =10.83,P =0.000) and 8.26 cm2 vs 6.52 cm2(t =18.53,P =0.000) ).ConclusionsThe pseudo mapping of quantitative parameter Ktrans related to microvascular permeability acquired by T1-weighted DCEPMRI reflect the infiltrating circumscription in glioma,T1-weighted DCEPMRI can provide more information in delineation the clinical target volume,and it can be used as a new method for tumor volume evaluation.

Objective To test and evaluate the geometric accuracy of delineation of organs at risk ( OARs) in head and neck cancer using an atlas?based autosegmentation ( ABAS) software. Methods The atlases for the ABAS software was generated using images from 40 patients with head and neck cancer undergoing intensity?modulated radiotherapy. The software was tested in 40 new patients. Automatic delineation of OARs was carried out on computed tomography images by single?( one to one ) and multi?template ( ten to one) approaches. In order to evaluate the feasibility of the automatic delineation in clinical application, differences in volume (ΔV%), position (Δx,Δy, andΔz), conformability (sensitivity ( Se ), specificity ( Sp ) , and dice similarity coefficient ( DSC) ) , and delineation time were assessed between the automatic and manual delineation. The comparison between the two automatic delineation approaches was made by paried t test. Results For all OARs, the multi?template automatic delineation achieved a significantly smaller mean ΔV% value and a significantly larger mean DSC value than the single?template automatic delineation (-0.02%± 0?29% vs. -0.16%± 0?41%, P<0?05;0.74± 0?16 vs. 0.68± 0?20, P<0?05);the position differences between two automatic delineation approaches were less than 0?4 cm in all three directions except for the temporal lobe, lower jaw, and spinal cord;in the receiver operating characteristic curve defined by Se versus 1-Sp , the data points were all within the first quadrant except for the optic nerve and chiasm;automatic delineation saved 42%?72% of time compared with manual delineation. Conclusions The ABAS software achieves satisfactory results of automatic delineation for most of OARs in patients with head and neck cancer. The multi?template automatic delineation, particularly, has better outcomes than the single?template one. In addition, it greatly shortens the time the clinicians spend on delineation of OARs.

BACKGROUND: Limb salvage operations with preservation of the epiphysis (LSPPE) had been used clinically in order to overcome discrepancy of affected limb and poorer limb function, but more post-operation complications existed, including infection, grafting bone resorption, fracture and internal fixation cinch.OBJECTIVE: To study the clinical related matters of inactivated bone replantation with preservation of the epiphysis in children limb salvage with osteosarcoma.DESIGN: Clinical observation regularly.SETTING: General Hospital of Jinan Military Area Command of Chinese PLA.MATERIALS: Eleven patients corresponded selected standard and accepted treatment from January 1999 to January distal metastasis was found with lung X-ray check and CT scanning, the patient would be excluded this study. There were 5 males, 6 females, and the mean age of (8±2) years old (4-11 years). The disease history was 1-6 months.FO) were adopted. After 2 weeks of chemotherapy, the operations of inactivated bone replantation with preservation of the epiphysis were performed. The operation was performed under epidural or general anesthesia. The patient lied on operating table. The knee anteriomedialis incision was adopted. Firstly, femur periosteum was opened beyond proximal end 2-3 cm from tumor, subperiosteum stripping was done to the proximal femur, descend femur with wire saw, separated and disconnected aboral periosteum, blunt dissecting femur aboral blood vessel and nerves to the popliteal fossa,deligating blood vessel around the tumor. Attachment of gastroenemius was cut off. Epiphyseal plate was identified carefully. According to pre-operation MR, the distal femur descend level was determined and the femur was descend with electro-saw. It was determined with cytology that no tumor cell existed in descend level, and reconstruction of bone de-fect with inactivated tumor-bone shell with 95% alcohol and bone cement containing ADR (20 g bone cement: 10 mg ADR), the diaphysis was fixed by intramedullary nail and screws were inserted in the residual epiphysis for the osteosynthesis of the distal osteotomy. One drainage tube was placed into and closed incision The affected limb was protected with plaster cast. Post-operative treatment: Regular usage of antibiotics was adopted to prevent infection. The drainage tube was pulled out when drainage amount ＜ 50 Ml/24 hours. The progressive passive exercise was initiated during the protection of affected limb with plaster cast for 8 weeks. Twelve to 14 days after operation, stitches were taken out. The postoperative chemotherapy then initiated, drug and dosage were identified on the response to the preoperative chemotherapy. Eight weeks after operation, patients were permitted to walk with the protection of double crutches and ery analysis: To observe ncision healing and existing of nerve and blood vessel injure, or not. During follow-up, patient recoveries were determined with affected knee function, limb length, distal metastasis, post-operative complications and dynamic imaging inspection of bone healing.imaging inspection of bone healing.MAIN OUTCOME MEASURES: ① The response to chemotherapy was evaluated with tumor cell necrosis rate. ② Post-operative recovery was determined with parameters such as knee function, limb length, distal metastasis, etc. ③ Dynamic imaging inspection of bone healing.MAIN OUTCOME MEASURES: ① The response to chemotherapy was evaluated with tumor cell necrosis rate. ② Post-operative recovery was determined with parameters such as knee function, limb length, distal metastasis, etc. ③ Dynamic imaging inspection of bone healing.RESULTS:All patients in this study were done follow-up.①The histological response of 11 patients to preoperative chemotherapy were classified as 7 in gradeⅣ,4 ingrade Ⅲ.②Post-operation recovery:No nerve and blood vessel injury existed and all incision healed well,there was not incision infection and healing.Eleven patients were followed-up from 10 to 72 months.Three patients could flexed affected knee joint ≥110,90-110 in 3 cases,60-90 in 4 cases,＜60 in one patient .The length of both lower extremity equaled in 4 cases,the length of affected limb was shorter than 2.0 cm in 5 cases,2.0-3.0 cm in 2 cases. One patient with recurrence,two with metastasis,three died.Screw cinch in one patient and one patient with inactivated bone fracture. ③Dynamic imaging inspection: No recurrence was found around epiphysis. Essential bone healing existed between the inactivated bone and epiphysis,callus formation between the inactivated bone and diaphysis at 2 months after operation; more callus formed and 4 months; 6 months after operation,bone complete healing was found between the inactivated bone and diaphysis.④Post-operation recovery:During follow-up, a screw cinch was found in one patient, and dislodged the screw because of bone healing well. One patient underwent open reduction, bone grafting and internal fixation with encircle device because of inactivated bone fracture.four months of the operation, grafting bone healed well. At post-operative 24 months, the length of both lower extremities equaled and the affected knee flexed to 110°.CONCLUSION: Inactivated bone replantation with preserving epiphysis for osteosarcoma in children was propitious to recover limb function and keep limb length.

Objective To compare the static intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) for mid and upper thoracic esophageal cancer.Method The data of twenty esophageal cancer patients were retrospectively re-planned with VMAT(single arc and double arcs) modality using Pinnacle treatment plan system.Five of these patients were selected again to simulate single arc plans with different segment intervals (4°,3°,2°) and re-planned on other treatment planning systems (Monaco and MasterPlan).Differences of dose distribution and treatment parameters were compared.Results In comparison to IMRT and single-VMAT (S-VMAT),Double-VMAT (D-VMAT) significantly improves the dosimetric parameters for targets(P ＜ 0.05),dose homogeneity(P ＜ 0.05) and conformity(P ＜ 0.05).Though VMAT plans were slightly better than IMRT in reducing the doses to the organs at risk (OARs),no advantage was observed in the low-dose protection of lung and E-P (P ＜ 0.05).For the VMAT plans with different segment intervals,lower OAR doses were observed using an interval of 2°(P ＜ 0.05),except for the mean dose of the heart.For the VMAT plans on different treatment planning systems,Monaco-based plans protected OARs better (P ＜ 0.05).The number of monitor units (MU) and treatment time were less in VMAT cases.Conclusions VMAT plans perform better in target coverage,dose homogeneity and conformity,and can reduce the radiation dose to the spinal cord,lungs,heart and other normal tissue than IMRT plans.The VMAT plan quality could be further improved by using double arcs and smaller segment interval.Monaco-based plans provide better OAR protections under the same conditions of physical and optimization parameters.

Objective To explore the psychological resilience of patients with AIDS and influencing factors during hospitalization period.Methods From January 2016 to January 2017, a cross-sectional study was carried out to 120 AIDS patients hospitalized in Department of Infectious Disease in West China School of Medicine/West China Hospital, Sichuan University, who were surveyed by a questionnaire on general information, Connor-Davidson resilience scale (CD-RISC), Perceived social support scale (PSSS), Self-esteem scale (SES) and General self-efficacy scale (GSES).Results Total average scores of AIDS patients in psychological resilience were (52.11±13.84) points, in a medium level; total average scores in social support, self-esteem and self-efficacy were (51.87±15.20), (21.89±5.63) and (2.71±0.47). There were significant differences in gender, age group, HIV stage, future beliefs and health care services (t=2.588, 3.595, 7.409, 14.293, 3.172;P<0.05). It was shown in multiple linear regression analysis that HIV stages, beliefs about the future, health care, self-esteem, social support and self-efficacy had an impact on total score of the patients' resilience.Conclusions Resilience of AIDS patients is generally inadequate. To develop the patients' resilience, it is of great importance to improve actively hospital medical service quality, to adjust unhealthy attitude of the patients, and to mobilize effectively social support.

Objective To evaluate the geometric and dosimetric accuracy of autosegmentation software for contouring the organ-at-risk ( OAR) of esophageal cancer, and discuss its clinical feasibility. Methods A total of 10 patients were enrolled, and single and multi-template were adopted respectively to auto-delineate corresponding OARs on target CT images based on image registration. The geometric consistency including volume difference (ΔV) , dice similarity ( DSC) and position difference (Δx, Δy,Δz) between the two autosegmentation method and manual were compared using Wilcoxon signed-rank test. And the correlation between DSC and OAR volume was analyzed. In addition, to evaluate the clinical feasibility of autosegmentation, the dose distributions of all OARs were compared using Friedman test. Results The average DSC of all OARs obtained by single and multi-template were 0.82 ± 0.17 and 0.92 ± 0.54, respectively, with statistically significant difference (Z= -2.803- -2.497, P<0.05). A positive correlation between DSC of the autosegmentation and OAR volume was found by spearman analysis, and the single-template was not good enough for the spinal cord with smaller volume. The positional deviations of multi-template group were less than 0.5 cm in three directions, which were better than single-template group. The main dosimetric indexes of single-template and multiple-template were similar to manual coutours. V20 of whole lung were 23.2％, 22.4％ and 22.1％, Dmeanof whole lung were (11.3 ±4.0), (11.1 ±4.5) and (11.0 ±4.3) Gy, Dmaxof spinal cord were (40.3 ±4.8), (38.2 ±6.7) and (39.4 ± 5.3) Gy, respectively, and V30 of heart were 16.0％, 15.8％ and 15.5％, respectively. There was no statistical difference between the three methods (P>0.05), and all of the dosimetric indexes were in line with the requirements of clinical dose limits. Conclusions The autosegmentation software can achieve satisfactory precision for the OARs of the esophageal cancer patients, and the multi-template method is better than the single-template, which is more suitable for clinical application.

Objective To simulate the possible systematic delivery errors introduced by monitor units ( MU) and multi-leaf collimator ( MLC) in radiotherapy plans for nasopharyngeal carcinoma ( NPC) , and to analyze the dosimetric sensitivity of static intensity-modulated radiotherapy ( IMRT ) and volumetric modulated arc therapy ( VMAT) with these errors. Methods Five IMRT plans were replanned using VMAT modality with the same physical parameters, and then MU errors of 125%, 250%, and 5. 00% were introduced into IMRT and VMAT plans. Meanwhile, to simulate leaf position errors during delivery, MLC position errors (025 mm, 050 mm, 100 mm, 150 mm, and 200 mm) were introduced by modifying the original plan documents. The types of MLC errors were as follows:( 1) the MLC banks moved in the same direction;( 2) the MLC banks moved in opposing directions ( expand or contract the MLC gaps ) . The differences in dosimetric sensitivity introduced by MU and MLC errors between IMRT and VMAT plans for NPC were calculated by linear regression analysis. Results With the increase in MU errors, the doses to target and organs at risk ( OARs) of IMRT and VMAT plans increased in a linear way, and met R2=0992-1000( P<005) . For MLC errors, the average dosimetric sensitivity for target and OARs of IMRT and VMAT were-026%/mm and-065%/mm in case of offset errors, 487%/mm and 868%/mm in case of expansion errors, and -604%/mm and -988%/mm in case of indentation errors. In addition, the dosimetric sensitivity with the three types of MLC errors was greater for VMAT plan than for IMRT plan. ConclusionsMU and MLC errors have a significant effect on the dose distribution of IMRT, and particularly VMAT, for NPC. It is important to execute routine quality assurance of MLC to ensure accurate radiotherapy.