Objective To investigate the clinical effect of mini -plate and kuntscher pin fixation in the treatment of metacarpus and phalange fracture.Methods 113 FMB and FPB patients were divided into OSG (58 patients)and CTG(585patients)group according to random number table.Statistics of postoperative recovery and complications in the two groups were collected and analyzed after research.Results In 58 patients of OSG group,the total active bending from 2 -5 metacarpophalangeal joints to phalangeal joints of 28 cases(48.28%,χ2 =8.562,P =0.035 )were beyond 220°,19 cases (32.76%,χ2 =8.935,P =0.024)were between 180 -220°, 11 cases (51.72%,χ2 =9.365,P =0.012)were less than 180°.The total active bending fromthumb metacarpopha-langeal articulation to interphalangeal joint of 30 cases (51.72%,χ2 =9.365,P =0.012)were beyond 220°, 18 cases (31.03%,χ2 =8.747,P =0.009)were between 180 -220°,10 cases (17.24%,χ2 =8.932,P =0.041) were less than 180°(P <0.05).Conclusion AO Mini -plates surgical method has advantage of parking position accuracy,dissection stable fixation,functional recovery soon and less complication in the treatment of FMB and FPB patients,which is worthy of promotion.

This study aims to investigate the change of plasma concentration of digoxin (DIG) in rats with ovariectomy. Twelve female SD rats were randomly assigned into ovariectomized group and sham group (n = 6). All rats plasma was collected after a single dose of 2 mg x kg(-1) DIG administrated orally, serum DIG concentration was determined by LC-MS/MS. The level of P-gp in the intestinal was analyzed by Western blotting. Pharmacokinetic calculations were performed on each individual using DAS 2.0 practical pharmacokinetic software. Compared with the sham group, C(max) of ovariectomized group decreased significantly (P < 0.01). There was no significant difference of AUC(0-t), and the level of P-gp was elevated in ovariectomized group. It was found that C(max) of DIG was significantly reduced after ovariectomy, and the change was associated with the decreased level of estrogen, which contributes to the increased level of P-gp.

Objective To evaluate the role of postmastectomy radiotherapy in four subgroups of high-risk breast cancer patients, who were grouped by the status of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 (Her-2). Methods A total of 437 invasive breast cancer patients with T3-4N1 or N2-3 and available immunohistochemistry results of ER, PR and Her-2 were retrospectively analyzed. Patients were classified into 4 subgroups according to hormone receptors (ER or PR, Rec) and Her-2 status:Rec-/Her-2-(triple negative), Rec-/Her-2 +, Rec +/Her-2 + and Rec +/Her-2-. Rec-was defined as ER-and PR-. Rec + was defined as ER + and/or PR +. Her-2 positive was defined as Her-2 + + or Her-2 + + +. End points were isolated locoregional recurrence (LRR), distant metastasis (DM), disease-free survival (DFS) and overall survival (OS). Results The median follow up time was 48 months. Sixty-nine (15. 8%) patients were Rec-/Her-2-, 62 (14. 2%) Rec-/Her-2 +, 89 (20.4%) Rec +/Her-2 + and 217 (49.7%) Rec +/Her-2-. 480(93.4%) patients received chemotherapy and 352(80. 5%) received radiotherapy. Radiotherapy significantly reduced the 5-year LRR rates of all the four subgroups (Rec-/Her-2-: 13.1% vs. 33. 3%, Rec-/Her-2 + :9. 3% vs. 21.2%, Rec + /Her-2 + :9. 7% vs. 47.0%, Rec +/Her-2-:3. 2% vs. 15.4%). Radiotherapy significantly lowered the 5-year DM rates (26. 7% vs. 49.4%, 27.6% vs. 67. 5%, 18.4% vs. 100%) and improved the 5-year DFS rate (66. 7% vs. 33. 3% , 67.7% vs. 33. 3% , 72. 6% vs. 0%) as well as OS (73.9% vs. 25.2% ,69. 8% vs.41.5%, 91.0% vs. 32. 8%) of patients with Rec-/Her-2-, Rec-/Her-2 + and Rec +/Her-2 +. Conclusions In high-risk breast cancer patients, all subgroups of patients grouped by ER, PR and Her-2 status can benefit from postmastectomy radiotherapy.

Objective To investigate epidemiological and clinical features of human ehrlichiosis.Methods The epidemiological, clinical, laboratory, therapeutic and prognostic data of 21 clinically diagnosed cases of human ehrlichiosis were retrospectively analyzed. Results The epidemic regions where the ticks' activity was high located at the boundary between Hubei and Henan Provinces. All cases were farmers. The median age was 50 years ranged from 19 to 69 years. The male female ratio evident history of tick bite 1 week before the onset. The common symptoms included fever, diarrhea,cough, nausea and vomiting, abdominal pain and expectoration. The complications included hemorrhage, toxic encephalopathy, acute renal insufficiency, secondary infection and respiratory failure. The common abnormalities of routine lab data were thrombocytopenia, hypoeosinophilia,elevated lactate dehydrogenase, creatine kinase and aminotransferases, leucopenia and proteinuria.Nine cases were tested with peripheral blood smear and intracytoplasmic inclusions in neutrophils were found in one case. Seventeen cases were tested with serological assay and antibodies against Ehrlichia were positive in five cases. After doxycycline, symptomatic and supportive treatments, 14 cases were recovered and seven died. The average age of the deaths was 56 years. Conclusions Human ehrlichiosis is an acute tick-borne zoonosis and multiorgan could be involved. The older cases prone to develop complications and the prognosis is poor.

ObjectiveTo evaluate the inter-and intra-fractional clinical target volume (CTV) positioning errors of patients receiving postoperative simplified intensity-modulated radiotherapy (SIMRT) using cone beam computed tomography (CBCT).MethodsTwelve patients with liver tumors underwent postoperative SIMRT.CBCT images were acquired before and after the treatment.The clipbox volume for registration included the fiducial markers in the tumor bed and excluded the ribs and vertebral bodies.If any translational parameter of setup error before treatment exceeded 3 mm or rotational parameter exceeded 3°,the treatment couch was adjusted and a verification CBCT was acquired to assess residual setup error.Automatic bone match was used.A total of 214 acquisitions of CBCTs in 111 groups were analyzed.Inter-fractional translational CTV positioning errors in left-right (x),superior-inferior (y) and anterior-posterior (z) axis were calculated in 111 groups,and intra-fractional translational CTV positioning errors in 70 groups.Clinical to planning target volume (PTV) margins were calculated according to the formula:margin =2.0 ∑ + 0.7σ ( ∑ is systematic error,σ is random error).ResultsInter-fractional translational CTV positioning errors in x,y and z axis were -0.03 mm,-0.43 mm,1.02 mm,with systematic error ( ∑ ) of 1.50 mm,5.89 mm,1.97 mm,and random error (σ) of 1.76 mm,4.13 mm,2.42 mm,respectively.Intra-fractional translational CTV positioning errors in the x,y,z axis were 0.04 mm,0.86 mm,- 0.46mm,with systematic error (∑) of 0.46 mm,1.14 mm,0.31 mm,and random error (σ) of 0.95 mm,1.38 mm,0.91 mm,respectively.The calculate CTV to PTV margins were 4.5 mm,15.0 mm,5.8 mm in the x,y,z axis,respectively.ConclusionsThe CTV errors were inevitable when patients with liver tumors received SIMRT.Fiducial markers placed in tumor bed during operation were helpful for accurate positioning error analysis.

Objective To investigate the treatment outcome and failure in patients with primary mediastinal large B-cell lymphoma(PMBL). Methods Between Jan. 1992 and Oct. 2006, a total of 46 patients with pathologically confirmed PMBL were reviewed, including 14 with Ann Arbor Stage I disease, 23 with Stage Ⅱ disease,3 with Stage Ⅲ disease and 6 with Stage Ⅳ disease. Stage Ⅰ+Ⅱ disease was present in 80% of the patients. All patients were treated with chemotherapy ,and 29 also received radiotherapy. Twenty-seven patients(59%) were treated with first generation regimen(CHOP),9(20%) with third generation regimens (MACOP-B, ProMACE/CytaBOM, m-BACOD, or ProMACE-MOPP), and 10(22%) with high-dose chemotherapy (HDCT/APBSCT). Rituximab was administered to 16 patients (35%). For most patients who received radiotherapy,an involved field was used with a median dose of 45 Gy in 23 fractions.Results The rate of complete remission, partial remission and progression disease was 41%, 30% and 24% ,respectively. The 5-year overall survival rate(OS) for all patients was 35%. The 2- and 5-year OS was 79% and 63% for stage Ⅰ+Ⅱ and 51% and 0 for stage Ⅲ+Ⅳ ,respectively(X2=4.35 ,P=0. 037).The 2-year progression free survival rate was 63 % and 11%, respectively (X2=17.77, P=0.1300). The 5-year OS was 80% for the patients with CR,50% for those with PR,and 0 for those with progression disease(X2= 19.58 ,P=0.003 ). With a median follow-up of 22 months, progression disease and relapse occurred in 19 patients. Conclusions Survival of patients with advanced stage PMBL is poor. Further studies areneeded to confirm the optimal treatment. Radiotherapy often plays a pivotal role in local control.

Objective A phase Ⅰ study was conducted to determine the maximal tolerated dose (MTD) and the dose-limiting toxicity(DLT) of chemotherapy of oral doxifluridine(5-dFUR) and leucovorin with concurrent standard radiotherapy(RT) as adjuvant treatment in patients with rectal cancer. Methods Patients aged 18-75 years old, Karnofsky scored ≥70%, stage Ⅱ/Ⅲ rectal cancer after curative surgery were eligible. Total RT dose was delivered as DT 50 Gy in the fraction of 2.0 Gy per day for 5 weeks to the pelvic area. 5-dFUR was administered concurrently with radiotherapy in escalating doses, and oral leucovorin was The DLTs included grade 3 or grade 4 hematologic and nonhematologic toxicity. Results From Aug. 2005 the most common side effects although all neutropenia was less grade 3. The DLT was observed in 1 patient of RT. In the following 3 enrolled patients, one suffered grade 3 abdominal cramp pain, diarrhea, fatigue, nausea/vomit and grade 2 neutropinea and fever. Grade 3 diarrhea was also observed in all the additional 3 papatients didn't complete the scheduled concurrent chemoradiotherapy due to severe side effects,including 1 at grade 3 abdominal cramp pain,fatigue and nausea/vomit. Conclusions Diarrhea is the most common and severe side effect in this phase Ⅰ study. The MTD of doxifluridine, concurrently with RT and fixed dose of oral cramp pain is often accompanied with diarrhea and nauser/vomit when the dose of doxifluridine exceeds 550 mg/( m2 · d) or 900 mg/d,patients need to be observed carefully.

Objective The benefit of adjuvant chemoradiotherapy remains controversial for gastric cancer patients treated with more than D1 dissection. This retrospective analysis is to distinguish the first site of recurrence in patients treated with curative resection and more than D1 dissection and to find any feasible adjuvant concurrent chemoradiotherapy recommendation for them. Methods All patients treated between January 2002 and December 2004 who met the following criteria were analyzed: primary gastric or gastroesophageal cancer, underwent curative gastrectomy ( UICC R0 ) and more than D1 lymphadenectomy,pathologically staged as T3-4N0-1 M0, or any Tx N2-3M0. There were 297 patients analyzed and 19.5%,52. 2%, 17. 8% , 10. 4% of patients had stage Ⅱ ( T3 N0 M0, T1 N2 M0 ), Ⅲa, Ⅲb and Ⅳ ( M0 ) diseases,respectively. 76. 1% of patients received adjuvant chemotherapy, while Only 2 patients underwent adjuvant radiotherapy. Failure patterns and the prognostic factors for locoregional recurrence were analyzed. Results The median follow-up time was 61 months and the follow-up rate was 92. 3%. 145 patients developed recurrence with a median recurrent time of 26 months. Locoregional recurrence was observed in 82 patients and distant metastasis in 79 patients. Gastric stump, anastomosis, intra-abdominal lymph nodes were the most common sites of locoregional recurrence. Liver and lung were the most frequent sites of distant metastasis. Prognostic variables for locoregional recurrence were identified after univariate analysis,including pathologic type ( χ2 = 11.50, P = 0. 009 ), total number of dissected lymph nodes ( χ2 = 6. 65,P =0. 010), the number of positive lymph node ( χ2 =5. 80,P =0. 016), lymph node capsular invasion ( χ2 =pathologic type, total number of dissected lymph nodes, lymph node capsular invation, AJCC TNM stage and Borrmann type were independent prognostic factors for locoregional recurrence ( χ2 = 6. 77,19. 33,17. 84 and 6. 02,P =0. 009,0. 000,0. 000 and 0. 014). ConclusionsLocoregional recurrence remains the main cause of failure for locally advanced gastric or gastroesophageal cancer patients even though the patients have had more than D1 lymphadenectomy. The role of adjuvant concurrent hemoradiotheray for those patients is warranted.

Objective To investigate the influence of endorectal balloon on normal tissue dosimetry in prostate cancer patients treated with intensity-modulated radiation therapy (IMRT). Methods Ten patients with prostate cancer were included and each had two sets of planning CT-scans:one with and one without an air-filled endorectal balloon. Target volumes and organs at risk ( rectum, bladder,femoral heads)were contoured on the 20 CT scans and IMRT plannings were performed. The prescription dose was 78 Gy to 95％ of planning target volume. The percentage of volume of organs at risk ( without or with endorectal balloon) receiving more than 10 Gy, 20 Gy, 30 Gy, 40 Gy, 50 Gy, 60 Gy, 70 Gy and 75 Cy (V10 - V70 ,in increments of 10 Gy, and V75 ) were analyzed. Results The V1o - V60 0f rectum with endorectal balloon were 75. 5％ , 52. 6％ , 35. 3％ , 26. 1％, 19. 6％ , 14. 2％ , and those without endorectal balloon were 82. 2％ , 62. 8％ , 43. 9％ , 31. 4％ , 24. 0％ , 17. 1％ , respectively ( X2 = g. 46, P< 0. 01 ). Use of endorectal balloon significantly reduced the dose to the rectum ( v10 - V60 ) . The V70 and V75 of rectum with endorectal balloon were 9. 1％ and 8. 2％; and those without endorectal balloon were 9. 9％ and 6. 2％ respectively ( X2 = 1. 82,P＞0. 05) . The difference was not significant. There were no significant differences in the dose to bladder,left and right femoral head between patients with and without endorectal balloon.Conclusions Endorectal balloon can significantly decrease the medium and low dose volume of rectum for prostate cancer patients treated with IMRT, which may reduce the rectal toxicity.

Objective To analyze the prognostic factors and the role of postmastectomy radiotherapy (PMRT) in skin-involved breast cancer.Methods Fifty-three skin-involved breast cancer patients treated with mastectomy and axillary dissection were retrospectively analyzed.Ten patients had inflammatory breast cancer (IBC).Of the 43 non-inflammatory breast cancer (NIBC) patients, 19(36%) had clinical signs of skin involvement and 24(45%) had pathological skin infiltration without clinical signs.Thirty-three patients (62%) received PMRT with a median dose of 50 Gy, 45 received chemotherapy and 27 received hormone therapy.Results The median follow up time for alive patients was 42 (7 -83) months.The overall 5-year locoregional recurrence (LRR),disease-free survival (DFS) and overall survival (OS) rates were 18%,45% and 64%.Patients with NIBC had a significantly better 5-year DFS (49% vs.30% ,χ2=4.29,P=0.038) and OS (71% vs.37% ,χ2=5.92,P=0.015) than those with IBC.In patients with NIBC, those with primary tumor ≤5 cm had a lower 5-year LRR (11% vs.33% ,χ2= 3.75 ,P =0.053) and a higher 5-year OS (90% vs.38% ,χ2=4.44,P=0.035) as compared to those >5 cm.No significant difference in terms of LRR, DFS or OS was observed between patients with clinical signs of skin involvement and those without.Patients with 0 - 3 positive nodes had an improved 5-year DFS (80% vs.29%, χ2= 6.71, P =0.010) and OS (93% vs.52% ,χ2=6.00,P=0.014) than those with ≥4 positive nodes.Patients with Rec + / Her2 - had a lower5 - year LRR (7 % vs.3 4 % , χ2= 5.70, P= 0.017) and a higher DFS (54% vs.32% ,χ2=8.82 ,P =0.003) than those with triple-negative or Her2 +.There was no significant difference in 5-year LRR (12% vs.30%, χ2= 2.45, P = 0.118) between patients with PMRT and without PMRT.However, the 5-year chest wall recurrence rate was 0% and 50% (χ2= 9.15 ,P =0.002) for patients with chest wall bolus dose > 20 Gy and 20 Gy.Conclusions Skin-involved breast cancer is a heterogeneous group of diseases.Patients with NIBC, small tumor (≤5 cm), less positive nodes (0 -3) or rec +/Her2-have favorable prognosis.Patients with pathologically proven skin involvement without clinical signs have similar prognosis to those with clinical signs.PMRT with chest wall bolus dose >20 Gy is recommended.