As the development of functional and molecular imaging,PET/CT gradually becomes one of methods in optimizing cancer radiotherapy treatment planning.Currently,numerous hospitals routinely use 18F-FDG PET/CT for the delineation of target volume in esophageal carcinoma (EC).However,the validity of 18F-FDG PET/CT in the delineation of target volume for EC is limited and needs further clinical validation.This review focuses on the value and validity of 18F-FDG PET/CT in the delineation of gross tumor target volume of EC primary lesions and regional lymph nodes.

Objective To explore the diagnosis, treatment strategies and clinical outcomes of spontaneous subarachnoid hemorrhage in elderly patients. Methods A total of 68 patients aged over 60 years presenting with spontaneous subarachnoid hemorrhage underwent cerebral angiography. And 72 intracranial aneurysms were detected in 60 patients, among whom 47 patients with 59 aneurysms underwent endovascular coil embolization, 6 aneurysms in 6 patients were clipped in microneurosurgery operation, and 7 patients chose conservative treatment. Results A total of 57 aneurysms (96.6%) were embolized successfully, among which 40 aneurysms (70.2%) reached dense occlusion and 17 aneurysms (29.8%) reached incomplete occlusion. Among 47 patients undergoing endovascular treatment, 39 patients (83.0%) were evaluated as good, 7 patients (14.9%) were moderately to seriously disabled according to Glasgow Outcome Scale when they were discharged, and one patient died. Conclusions Active treatment such as endovascular coil embolization can acquire good outcome in elderly patients with spontaneous subarachnoid hemorrhage, especially in elderly patients detected with aneurysms.

Objective To retrospectively analyze pulmonary function changes after growing rod surgery for progressive early-onset scoliosis.Methods Ten cases of progressive early-onset scoliosis treated with growing rod technique from September 2002 to July 2011 were enrolled in the study.There were 3males and 7 females,aged from 6 to 9 years (average,7.0±1.1 years).Four patients had finished the final fusion surgery (Group fusion),and 6 patients (Group non-fusion) were in the process of periodic lengthening.Forced vital capacity (FVC),FVC/predicted FVC ratio,forced expiratory volume in one second (FEV1),FEV1/predicted FEV1 ratio,Cobb’s angle,and C7-S1 distance before each surgery were recorded.Lung function changes and correlations between lung function changes and radiographic changes (Cobb’s angle and C7-S1 distance) were analyzed.Results In Group fusion,both FVC and FEV1 increased,and FVC showed a significant difference.In Group non-fusion,FVC and FEV1 also increased and both showed a significant difference.FVC/predicted FVC ratio and FEV1/predicted FEV1 ratio both changed similarly and did not show statistical differences in the two groups.There were no significant correlations between lung function changes and radiographic changes (Cobb’s angle and C7-S1 distance).Conclusion Pulmonary function improves after growing rod surgery for progressive early-onset scoliosis.The pulmonary function changes do not correlate with changes of Cobb’s angle and C7-S1 distance.

Objective To investigate the outcome between endoscopically assisted and routine anterior transposition of the ulnar nerve for treatment of cubital tunnel syndrome.Methods From Februray 2008 to June 2010, forty-four patients with cubital tunnel syndrome were treated with routine anterior subcutaneous transposition (routine group,28 cases) and endoscopically assisted anterior subcutaneous transposition (endoscope group,16 cases).The operate time,drug administration,scar and postoperative hospital stay were compared.The patients were followed 1-12 month postoperatively,postoperative time back to work and function of ulner nerve were recorded.Results The results of endoscope group were as follows: operative time was (67.20 ± 19.69)min; postoperative scar length was (1.5％ ± 0.58) cm; rate of administration of anodyne was 6.3％; postoperative hospital stay was (2.4％ ± 1.42) days; postoperative time back to work,(14.6 ± 4.69)days; the results of open surgery group were as follows:operative time (62.8％ ± 11.06) min; postoperative scar length was (8.7％ ± 1.42) cm; rate of administration of anodyne was 42.8％; postoperative hospital stay was (5.7％ ± 2.53) days; postoperative time back to work was (29.40 ± 8.75) days; all differences of the results were significant between two groups (P ＜ 0.05).According to function of ulner nerve scoring system,one year postoperatively, excellent or good results were 82.14％ in routine group and 81.25％ in endoscope group,no significant difference between two groups (P ＞ 0.05). Conclusion Compared with routine anterior transposition of the ulnar nerve,endoscopically assisted anterior transposition has the following advantages: smaller incision and less tissue damage,less postoperative pain and sooner returning to work.And similar outcome was achieved from the two group.

Objective To investigate the effect of basic fibroblast growth factor (bFGF) on the synthesis of extracellular matrixc (ECM)and expression of chondromodulin in human intervertebral disc cells. Methods 4 intervertebral discs (IVDs) obtained from patients in thetreatment of disc degenerative disease were used for cell culture. The secondary generation of intervertebral disc cells were cultured for 7days, then different concentration of bFGF (0, 0.1 ng/ml, 1 ng/ml, 10 ng/ml)were added to the medium and treated for 72 hours. Real-timeRT-PCR was used to detect the change of Aggrecan and type Ⅱ collagen mRNA expression. The effect of FGF on the expression of ChM-1,a cartilage derived anti-angiogenic factor, was also used by means of Real-time RT-PCR and Western blot. Results Real-time RT-PCRshowed that bFGF can significantly inhibit the expression of Aggrecan and type Ⅱ collagen mRNA. Both Real-time RT-PCR and Westernblot showed that the expression of ChM-1 was down-regulated by administration of bFGF with dose-dependent way. Conclusion bFGFserves primarily as a catabolic factor and induce the angiogenesis in the process of intervertebral disc degeneration.

Objective To evaluate the efficacy and safety of thromboprophylaxis with low molecular weight heparin after lumbar decompressive surgery.Methods Between January 2004 and April 2011,patients who had undergone lumbar decompressive surgery and had high or very high risk of venous thrombosis were selected.All patients received subcutaneous injection of low molecular weight heparin (Fraxiparine),starting at 6 hours after surgery with a half dose and subsequently once every 24 hours with full dose until discharge.When 24-hour drainage volume was less than 50 ml,the drainage tube was removed 2 hours prior to low molecular weight heparin administration.The occurrences of deep venous thrombosis (DVT),pulmonary embolism (PE),bleeding complications and side effects were recorded.Results Seventy eight patients were enrolled in the study.The average time of drug use was 8.5 days.No symptomatic DVT,PE and major bleeding events occurred.Drainage tube was placed in all patients except 3 patients with lumbar disc herniation.The mean total drainage volume was (319.5±218.5) ml,and the average time from operation to removal of drainage tube was (43.2±14.4) hours.Incision site ecchymosis occurred in 1 patient,incision bleeding in 1 patient,mild elevation in hepatic aminotransferase levels in 4 patients,and mild anaphylaxis in 1 patient.Conclusion It is effective and safe to prevent VTE with low molecular weight heparin for patients with high or very high risk of venous thrombosis after lumbar decompressive surgery.

Objective To investigate the clinical effect and feasibility of interventional treatment of cervical artery stenosis in the elderly patients aged 75 years and over. Methods The data of 60cases aged 75 years or over who underwent interventional treatment of the cervical arteriostenosis involving carotid artery (CA), vertebral artery (VA) or proximal segment of the subclavian artery (SCA) were analyzed retrospectively. The clinical manifestations, imaging characteristics,interventional managements and follow-up results were recorded. Results In this cohort, the mean age was (78. 9±3.7) years (range from 75 to 89). The 50 patients (93.3%) complained of cerebral ischemic symptoms, and all the patients had concurrent diseases or risk factors, including hypertension, diabetes mellitus, coronary heart disease (CHD), stroke history, and so on. Digital subtraction angiography (DSA) data showed 55 cases (91.7%) had 2 or more cerebral arteries with a stenosis exceeding 30%. Among all cases, 84 lesions were treated with 84 stents, with a technical success rate of 98.8%. After stenting, the percent diameter stenosis of lesions decreased from a mean of (80.8 ± 12.9) % to (7.1 ± 9.5 ) %. The periprocedural and 30-day postoperative neurological complication rate was 8. 3 %, resulting in a permanent complication rate of 5 %. Clinical improvement rate was 87.5%. During a follow-up period of (36.7±26. 3) months (range from 5 to 99), there were 4 deaths: 2 died from myocardial infarction, 1 died from brain metastases of lung cancer and 1 died from cerebral hemorrhage. Cerebral infarction recurred in 3 cases. Imaging follow-up in 78. 3% of patients for 66 stents, including ultrasound, CTA, MRA or DSA, showed that the general in-stent restenosis rate was 9. 1%, and the restenosis rate of VA, CA and SCA was 21.7% (5/23), 2.6%and 0, respectively. Conclusions The results of this series suggest that interventional treatment ofcervical artery stenosis in the elderly patients aged 75 years and over is effective and feasible. In our experience, clinical comprehensive management and skillful technique of the operator are equally important for the elderly patients aged 75 years and over with high incidence of concurrent diseases or risk factors.

Objective To retrospectively analyze the application of single and dual growing rod techniques in treatment of early onset scoliosis,and compare the early results of two techniques.Methods Retrospective study was done on 18 cases of early onset scoliosis treated with growing rod technique from November 2002 to March 2009.Single growing rod group included 5 cases and dual growing rod group included 13 cases.We compared the operation time,intra-operative bleeding,correction rate,changes in distance between C7-S1 and incidence of complications of the first operation between two techniques.Results The average post-operative follow-up duration was 39.9 months (14-89).There was no difference in operation time,intra-operative bleeding and incidence of complications between two techniques.There was no difference in preoperative coronal Cobb angle and preoperative sagittal Cobb angle between single growing rod group and dual growing rod group.Correction rate of dual growing rod group was significantly superior to single growing rod group in coronal plane (P＜0.01),but not in sagittal plane.Increase of the distance between C7-S1 dual growing rod group was significantly larger than the single growing rod group (P＜0.05).Conclusion Growing rod technique is an effective option for early onset scoliosis.Dual growing rod technique is relatively superior to single growing rod technique in correction outcomes.

Objective:To study the correlation between non-contact anterior cruciate ligament (ACL) injury and functional ankle instability (FAI) in young patients.Methods:A retrospective analysis was conducted of the 102 patients with non-contact ACL injury[61 males and 41 females, with an age of (31.9±6.1) years and a Tegner activity score of (6.1±1.9) points] who had been treated at Department of Orthopedics, Sun Yat-sen Memorial Hospital from January 2017 to March 2020 (injury group). Another 102 citizens without ACL injury from Guangzhou [56 males and 46 females, with an age of (30.3±7.2) years and a Tegner activity score of (6.0±2.1) points] were recruited as a control group. The Cumberland ankle instability tool (CAIT) and the Ankle Joint Functional Assessment Tool (AJFAT) were used to assess whether the subjects had self-conscious FAI or not. A correlation analysis was conducted using the data collected.Results:The 2 groups were comparable because there were no significant differences between them in general data ( P>0.05). By the CAIT score, the incidence of FAI in the injury group [52.9% (54/102)] was significantly higher than that in the control group [32.4% (33/102)] ( P<0.05); by the AJFAT score, the incidence of FAI in the injury group [59.8% (61/102) ] was significantly higher than that in the control group [39.2% (40/102)] ( P<0.05). Pearson correlation analysis showed that diagnoses of FAI by CAIT and by AJFAT were respectively correlated with ACL injury ( r=-0.159, P=0.023; r=-0.215, P=0.002). Conclusions:The incidence of FAI may be high in patients with ACL injury and there is a correlation between FAI and ACL injury.

Concurrent chemoradiotherapy (CCRT) refers to the simultaneous treatment of chemotherapy and radiotherapy, and the effect of radiotherapy is enhanced with low-dose chemotherapy, which can reduce tumor recurrence and metastasis and improve clinical prognosis of patients. At present, the main factors for the increase of radiosensitivity of concurrent chemotherapy is that concurrent chemotherapy prevents the repair of tumor cells, and chemotherapy and radiotherapy act on different cell cycles and have synergistic effects. However, even for patients with locally advanced cervical cancer (LACC) who have undergone CCRT, the 5-year survival rate is only 60%, which is still not ideal. In order to improve the efficacy, researchers have conducted a series of exploratory studies, which consist of the combination of targeted drugs and immunodrugs, and neoadjuvant regimens before CCRT, etc. Although targeted or immunologic drugs are effective treatment of LACC, in view of the lack of large-scale evidence-based medical evidence, multi-center prospective and randomized phase III clinical trials and high-level articles are needed to improve the level of evidence-based medicine. This consensus summarizes several key evidence-based medical studies published recently, especially the clinical research progress in targeted and immunological therapies, providing reference for domestic peers.