Objective:To evaluate the clinical outcome of all arthroscopic autogenous tendon suspended fixation for Myerson type III chronic noninsertional achilles tendon rupture in elderly patients.Methods:Data of 18 patients with Myerson type III chronic noninsertional Achilles tendon rupture who had performed all arthroscopic autogenous tendon suspended fixation from February 2016 to February 2019 in Department of Hand and Foot Microsurgery, Xuzhou Central Hospital were retrospectively analyzed. There were 12 males and 6 females (right side, 10 cases and left side, 8 cases) aged from 60 to 79 years with a median of 65.3 years. The mean injury-to-surgery time was 12 weeks (range, 6-32 weeks). All the patients were treated by all arthroscopic autogenous tendon suspended fixation. The function of the ankle and the foot was assessed using visual analogue scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) foot and ankle score and the achilles tendon total rupture score (ATRS), and the excellent and good rate was evaluated according to Arner-Lindholm score.Results:All patients healed at the first stage without any complications such as infection, sural nerve injury or tend re-rupture. The mean follow-up period was 18.6 months (range, 12-50 months). At the latest follow-up, all achilles tendons were healed with the VAS score reduced from 4 (1, 7) preoperatively to 0 (0, 1) postoperatively ( Z=2.334, P< 0.05); the AOFAS ankle and hindfoot score was improved from 60.3±9.7 (range, 40-83) preoperatively to 92.6±4.3 (range, 86-100) postoperatively ( t=34.541, P< 0.05); the ATRS score was improved from 55.7±10.6 (range, 42-80) preoperatively to 93.1±3.2 (range, 88-100) postoperatively ( t=64.773, P< 0.05); one patient was unable to stand on tiptoe of the single injured limb, because he could stand it, no further treatment was given; another patient complained of mild pain after a long time walking,which was alleviated by stretching the achilles tendon consistently. According to the score of Arner-Lindholm, 14 cases were excellent, 4 cases were good, and the excellent and good rate was 100% (18/18). Conclusion:All arthroscopic autogenous tendon suspended fixation for Myerson type III chronic noninsertional achilles tendon rupture in elderly patients is an effective method, which has the advantages of less trauma, faster recovery and fewer complications.

Objective To observe the changes of hepatic CT perfusion parameters and their correlation with serum aspartate transaminase( AST),alanine transaminase(ALT) and alkaline phosphatase (ALP) in a rabbit hepalic ischemia reperfusion injury (IRI) model.Methods Hepatic IRI was produced in rabbits by inducing left liver lobe ischemia (60 min) followed by 6 h,12 h and 24 h reperfusion (6 rabbits were used for each reperfusion interval ).Additional 6 rabbits were served as sham-operatedcontrols.All the rabbits were scanned with a dynamic iCT protocol.Blood samples were taken from the superior mesenteric vein to measure the levels of serum amylase (ALT,AST,and ALP) in various groups,and liver samples were taken for histological examinations after scanning.One-way analysis of variance (ANOVA) was used to determine differences between groups.The correlations of CT perfusion parameters with serum levels were analyzed using Pearson correlation coefficient.Results Heterogeneity of CT perfusion patterns appeared in the 6 h groups,which presented as low enhanced area [ ( 25.1 ± 9.3 ) ml · 1min-1 · 100mg-1].In reduced perfusion regions of IRI group,HAP of 12 h IRI group [ ( 19.5 ± 13.6) ml · min-1 · 100 mg-1],24 h IRI group [(8.0+2.7) ml · min-1 · 100 mg-1 ],HPP of 6 h IRI group [(10.8±5.5) ml · min-1 · 100 rng-1],12 h IRI group [(14.4±5.2) ml · min-1 · 100 mg-1],24 h IRI group [(7.8±3.3) ml · min-1 · 100 mg-1] and TLP of 6 h IRI group [(35.9 ±14.0) ml ·min-1 · 100 mg-1 ],12 h IRI group [ (33.9 ± 16.1) ml · min-1 · 100 mg-1 ],24 h IRI group [ (16.0 ±5.5) ml · min- 1 · 100 mg-1 ] were lower than those of sham group [ HAP (21.2 + 10.5 ) ml · min-1100mg-1,HPP(63.5±24.0) ml · min-1 · 100 mg-1,TLP (81.4±24.8) ml · min-1 · 100 mg-1](F=8.376,25.950,16.925,P＜0.01).However,HPI of 6 h IRI group [(65.9±3.9)％],12 h IRIgroup [ (54.2 ± 16.7)％ ],and 24 h IRI group [ (48.9 ± 10.0)％ ] were higher compared to sham group [ ( 24.1 ± 7.5 ) ％ ] ( F =43.664,P ＜ 0.01 ).But,the perfusion parameters in the relatively normal area of IRI groups showed decline compared with sham group.The levels of AST,ALT and ALP in IRI groups were significantly higher than those in the sham group ( P ＜0.05).In poorly enhancing tissues,TLP and HPP of IRI groups were inversely correlated with AST and ALP respectively ( P ＜ 0.01 ),and HPI was closely related to the increase of AST ( r =0.751,P ＜ 0.01 ).Conclusion These results demonstrate CT perfusion is sensitive to detect the hemodynamic changes.Perfusion parameters are closely correlated to the degree of liver injury in the rabbit IRI model.

Objective To characterize the effect of the ~1H-MRS scan parametem, including the type of coil, TE,NSA and VOI, on shimming, water suppression, spectral signal to noise ratio(SNR)and the stability of the baseline of liver in vivo. Methods ~1H-MRS of liver in vivo was performed prospectively on GE Signa Excite HD 3.0 T system in 46 volunteers. Point-resolred spectroscopy(PRESS)sequence with built-in body coil and eight-channel torso phased-array coils was applied. After the localized scan,the first PRESS sequence with a TR of 1500 ms,TE of 30 ms. VOI of 2 cm×2 cm×2 cm and NSA of 64 times was acquired using eight-channel torso phased-array coils.(The first PRESS sequence parametem was deemed as A).Then,the sequence was repeated with alteration of the three parameters including the type of coil,TE and size of VOI.(Changed parameters deem as B).The data were analyzed with the Wilcoxon matched pairs signed test.0 mark:A is similar to B,1 mark:A better than B,-1 mark:A worse than B.Results SNR(-1 mark 0 pair,0 mark 1 pair,1 mark 10 pair,Z=-3.162,P=0.002)was better in data(n=11)with eight-channel torso phased-array coils(A)than that with the built-in body coil(B),but the autoshimming line width with eight-channel torso phased-array coils were inferior to those with built-in body coil (-1 mark 8 pair,0 mark 2 pair,1 mark 1 pair,Z=-2.511,P=0.012).SNR was better in data(n=13)with TE of 30 ms(A)than that at the sequence with TE of 90 ms(B)(-1 mark 2 pair,0 mark 0 pair,1 mark 11 pair,Z=-2.496,P=0.013).whereas baseline stability was,poorer in the former(-1 mark 10 pair,0 mark 2 pair,1 mark 1 pair,Z=-2.333,P=0.020).SNR at the sequence(n=10)with VOI of 2 cm×2 cm×3 cm(B)was better(-1 mark 6 pair,0 mark 4 pair,1 mark 0 pair,Z=-2.449,P=0.014)than that at the sequence(n=29)with VOI of 2 cm ×2 cm × 2 cm(A),but poorer(-1 mark 0 pair,0 mark 5 pair,1 mark 5 pair,Z=-2.041,P=0.041)auto-shimming line width was shown. By comparison the sequences with NSA of 128 times(B)and NSA of 64 times(A),the former could provide better spectrum SNR(-1 mark 21 pair,0 mark 7 pair,1 mark 1 pair,Z=-4.264,P=0.000).Conclusion It is more easy to achieve a homogeneous bo magnetic field using a small size of VOI and builtin body coli.The sequence with VOI of 2 cm ×2 cm ×3 cm.NSA of 128 times is recommended for clinical use. Increase VOI and NSA are helpful to improve SNR. Longer TE is helpful to improve baseline stability.

ranches of portal vein were found in 3 cases. Conclusion The multi-slice spiral CT findings of eosinophilie hepatic infiltration are relatively specific, and three-phase dynamic CT studies can be a valuable tool for the diagnosis of this disease.

Objective To evaluate 3.0 T MR DWI techniques in detecting the lesions of pre and post-radiofrequency ablation of the rabbit liver VX2 tumors. Methods Twenty two New Zealand white rabbits were used in this experiment. Twenty tumor fragments were implanted into the livers of 20 rabbits respectively. Two normal rabbits were used as controls for radiofrequency ablation of the normal liver. 3.0 T MR DWI was performed 14 to 21 days after tumor implantation (mean, 17 days) in the tumor-bearing animals. Radiofrequency ablation was performed in the 18 tumor-bearing animals and in the two healthy animals. 3.0 T MRI and DWI were performed 7 to 10 days after radiofrequency ablation (mean, 8 days).Pathology was obtained immediately after the completion of post-radiofrequency ablation MR imaging. The MRI features and ADC values of pre- and post -radiofrequency ablation lesions in the liyers with VX2 tumors and normal rabbits were analyzed and correlation was made with histopathologic findings. Analysis of variance repeated measures were performed in analyzing the differences among the ADC values of different tissues with the same b value. Results All 20 rabbit liver models of VX2 tumors were constructed successfully. One rabbit died of anesthetic overdose, another one showed necrosis within the implanted tumor. All 18 untreated VX2 tumors had predominantly low or iso-signal intensity on T1 WI and high signal intensity on T2WI. All 18 VX2 tumors and 2 normal rabbits were treated by radiofrequency ablation successfully. Lesions treated by Radiofrequency ablation displayed low signal intensity on T1 WI, and high signal intensity on T2WI. Seven to 10 days after radiofrequency ablation, lesions varied from having low signal intensity to slightly increased signal intensity on T1 WI, with areas of mixed ( high, intermediate, and low) signal intensity. A peripheral rim of high signal intensity with varying thickness on T2WI correlated with granulation tissue, which exhibited intense enhancement on contrast-enhanced images. Areas of low to intermediate signal intensity within the lesion on T2WI corresponded to coagulation necrosis. The tumor tissue appeared as areas of peripheral nedularity, with intermediate to high signal intensity on T2-weighted images and DWI. The tumor specimen was gray, among the tumor tissue, there were hyperplastic vessels,and granulation tissue. When b value was 600 s/mm2 , the ADC value of viable tumor (9 cases), necrosis (18 cases), granulation tissue ( 18 cases), normal liver tissue ( 18 cases) were ( 1. 227 ±0. 140) × 10-3,(0. 702 ± 0. 050)×10-3, ( 1.918 ± 0.124) × 10-3, ( 1. 739 ± 0. 044 ) × 10-3 mm2/s, respectively, which were statistically significant (P ＜0. 01 ). When b =200,400,600,800,1000 s/mm2, the differences of ADC values among viable tumor, granulation tissue, necrosis,normal liver tissue were also statistically significant ( P ＜0. 01 ). Conclusion The rabbit liver VX2 tumor models and 3.0 T MR DWI are important tools in the basic and clinical researches of radiofrequency ablation.

Objective To explore the value of DWI ADC in the diagnosis of hepatic ischemia reperfusion injury (IRI) at 3.0 T and investigate the mechanism by comparison with liver enzyme and pathological findings. MethodsForty-two New Zealand white rabbits were divided randomly into ( n ＝ 6,each) six IRI groups by rank sum test. The IRI animals underwent left lobar ischemia for 60 min and were reperfused 0. 5 h, 2. 0 h, 6. 0 h, 12. 0 h, 24. 0 h and 48. 0 h later. One Sham operative group underwent laparotomy without liver ischemia. T2 WI, T1 WI, DWI and contrast-enhanced T, WI were performed with 3.0 T magnetic resonance imaging scanner in each group respectively. For DWI, b-values of 20, 50, 100,200,300,400,500 and 600 s/mm2 were used respectively. Blood samples were taken to detect the levels of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) at different time points. Liver samples were examined histologically after MRI scanning. One-way analysis of variance (ANOVA) was used to determine differences, followed by LSD-t test for multiple comparisons. ResultsOverall, ADC decreased markedly at the early IRI phase ( 0. 5 h), drastically increased in the 2.0 h group, and then ascended slightly from 6. 0 h to 48.0 h after reperfusion, except for a transient decrease at the time point of 24. 0 h. When b values were 20, 50, 100,200 and 300 s/mm2, the ADC values in the Sham group were (3.47 ±0.53) × 10-3, (3.11 ±0.39) ×10-3, (2.87 ±0.19) ×10-3, (2.56 ±0.37) × 10-3 and (1.95 ±0.33) ×10-3mm2/s, (2.63±0.31)±10-3, (2.47±0.32) ×10-3, (2.12±0.38) ×10-3, (2.01±0.51) ×10-3and (1.61 ±0.17) ×10-3mm2/s in the 0.5 h group, (2.72 ±0.09) ×10-3, (2.51±0. 11) ×10-3, (2.28 ±0.30) ± 10-3, (1.96 ±0. 14) × 10-3 and (1.58 ±0. 17) × 10-3mm2/s in the 24.0 h group, respectively. ADC of 0. 5 h and 24. 0 h groups were significantly lower than that of Sham group (P＜0.05) when b value was under 300 mm2/s.In the Sham, 0.5 h, 2.0 h, 6.0 h, 12.0 h,24.0 h and 48. 0 h IRI groups, they were (80±8), (181 ±34), (413 ±62), (474 ±83), (424 ±41 ),(332 ±41 )and(302 ±39) U/L for the levels of ALT,and (79 ± 10), (454 ±55), (547 ±72), (607±31 ), (649 ±79), (785 ±49) and ( 1526 ± 167) U/L for the AST respectively. The levels of AST and ALT in IRI groups were significantly higher than those in the Sham group ( P ＜ 0. 01 ).Histological findings showed diffuse hepatocytes swelling and erythrocytes depositing in the hepatic sinusoids, portal area, central venous and arterials at the initial phase.With the injury aggravated, inflammatory cell infiltration,hepatocyte nuclear condensation of apoptosis, sinusoidal dissociation and coagulation necrosis developed eventually. Conclusion 3.0 T DWI can monitor the pathological process of rabbit liver ischemia reperfusion injury dynamically, and provides a feasible imaging modality for clinical diagnosis and treatment.

Objective To assay the clinical effect of proximal dorsal digital artery pedicled island flap in treatment and sensory reconstruction of adjacent finger soft-tissue defect.Methods The study enrolled 21 cases of soft-tissue defect in 21 fingers treated from January 2013 to January 2014.All the defects were covered with the proximal dorsal artery pedicled island flaps raised from the adjacent finger.Index finger was injured in 7 patients,middle finger in 9 patients,ring finger in 4 patients,and little finger in 4 patients.Defect and flap dimensions varied from 1.9 cm × 1.5 cm to 4.3 cm × 2.3 cm and from 2.0 cm × 1.7 cm to 4.5 cm × 2.5 cm respectively.Donor site was resurfaced with a fullthickness skin harvested from medial side of the upper arm.Postoperative flap appearance and two-point discrimination were evaluated.Total active motion (TAM) of the finger was evaluated after operation.Results All the flaps and skin grafts survived after operation.Duration of the follow-up was 6-18 months (mean,14.7 months).Through the final follow-up,appearance and function of the flap were satisfactory,donor site healed well,and two-point discrimination was 5-9 mm (mean,6.3 mm).TAM evaluation was excellent in 19 patients and good in 2 patients with the excellent-good rate of 100％.Conclusion The proximal dorsal artery pedicled island flap raised from the adjacent finger is an ideal choice in finger soft-tissue reconstruction,for the technique has advantages of high survival rate,satisfactory appearance and sensory function as well as few complications.

Objective To investigate the clinical result of treating Tillaux-Chaput fractures using the full ankle arthroscopy technique.Methods A retrospective analysis was made on 21 patients with Tillaux-Chaput fractures followed up after treatment by the full ankle arthroscopy technique from May 2013 to May 2015.There were 16 males and 5 females,with the age range of 6-55 years [(25.5 ± 12.8)years].Right ankle was involved in 12 patients and left ankle in 4 patients.Sixteen patients had single TillauxChaput fractures and 5 patients had combined proximal fibular fractures.Diagnosis of Tillaux-Chaput fractures was confirmed by X-rays in 18 patients an CT in 3 patients.Ankle arthroscopy was used through the anterolateral and anteriormedal approaches for closed reduction and internal fixation using one or two Herbert screws.Wound healing,bone union and visual analogue score (VAS) were detected postoperatively.Function assessment was performed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scoring system.Results All incisions healed by first intention,without evidence of nerve,vessel and tendon injuries.Period of follow-up was (15.3 ± 7.1) months (range,12-25 months).Fracture healed within 12 to 36 weeks [(22.6 ±4.6)weeks] after operation.VAS was (0.8 ± 0.3) points after operation,obviously lower than preoperative (8.3 ± 1.3) points (P ＜ 0.05).At the final follow-up,all patients regained normal ankle function and normal walking gait,without the presence of ankle pain and weight-bearing walking pain.AOFAS score was improved from preoperative (51.2 ± 12.5) points to postoperative (92.7 ± 16.5) points (P ＜ 0.05).Based on the AOFAS score,the results were excellent in 19 patients and good in 2 patients,with the excellent-good rate of 100％.Conclsion Full ankle arthroscopy by the anterolateral and anterionnedal approaches provides a precise and effective method for closed reduction and internal fixation of Tillaux-Chaput fractures and deserves clinical application.

Objective To evaluate treatment effect of nodal lymphoma by using multiple b value diffusion-weighted MRI based on intravoxel incoherent motion (IVIM) model. Methods From November 2012 to November 2013, 22 patients with pathology confirmed lymphoma in Guangdong General Hospital were chosen. Patients were examined on a 1.5 T MR scanner with plain MRI scan and multiple b value diffusion-weighted MRI scan before and after cycle two of chemotherapy. According to chemotherapy response which evaluated after cycle 2 of chemotherapy, lymphoma nodes were divided into four groups:complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD). Kruskal-Wallis H test was used to compare prechemotherapy D value, f value among CR, PR, SD groups. Nemenyi test was used to compare prechemotherapy D value between the two of CR, PR, SD groups. One-way ANOVA was used to compare D*value among CR, PR, SD groups. Paired-sample t test was used to compare D, f, D*value between before and after chemotherapy in PR group. CR and PR group were ascribed to curative group, and SD group ascribed to poor response group. ROC curve was used to evaluate the predictive efficiency of parameters derived from IVIM. Results Twenty-two lymphoma patients were scanned before chemotherapy and 21 patients were scanned after cycle 2 of chemotherapy. There were 49 lesions in CR group, 17 lesions in PR group, 8 lesions in SD group and no lesions in PD group. Prechemotherapy D value of CR, PR, SD group were (0.63±0.26)×10-3, (0.57±0.10)×10-3,(0.42±0.04)×10-3 mm2/s, respectively. There was significant difference among the three groups (H=12.944,P=0.002). There was no statistically difference of prechemotherapy D value between CR and PR group (χ2=0.072,P=0.965). Prechemotherapy D value was lower in SD group than that in CR group (χ2=12.090,P=0.002) and PR group (χ2=10.684,P=0.005). There was no statistically difference of prechemotherapy f value among CR, PR, SD groups (χ2=2.312,P=0.315) or D*value (F=0.535,P=0.588). D value significantly increased after chemotherapy in PR group [(1.03±0.37)× 10-3 vs.(0.63 ± 0.26)× 10-3 mm2/s, t=-4.781, P=0.001]. f value significantly increased after chemotherapy in PR group [(9.39 ± 4.52)% vs.(6.44 ± 3.25)%, t=2.294, P=0.036]. D* value slightly increased after chemotherapy but with no statistical difference in PR group [(99.72 ± 42.12)× 10-3 vs.(90.37 ± 45.33)× 10-3 mm2/s, t=-0.579, P=0.570]. When a D value of 0.48 × 10-3 mm2/s was used as the threshold value for predicting chemotherapy response, the best results were obtained with sensitivity of 100.00%and specificity of 75.76%.Conclusions Prechemotherapy D value can predict chemotherapy response and D value can monitor chemotherapy response in lymphoma.

Objective To investigate the clinical outcomes of using modified antegrade digital artery island flap for the treatment of the severely flexion contracture of the burned finger.Methods Between August,2013 to August,2015,21 patients (21 fingers) with severely flexion contracture of the burned finger were hospitalized for treatment.According to the Stren classification standard for the interphalangeal joint flexion contracture,all the patients were rated as type Ⅲ.The volar soft-tissue defect with exposed tendons,nerves,vessels or bone ranged from 1.0 cm × 2.0 cm to 2.5 cm × 4.0 cm after scar relaxation.The artery and the nerve defect were 1.5 to 4.5 cm and 2.0 to 4.2 cm,respectively.The wound were reconstructed with the modified antegrade digital artery island flap.The dorsal branches of the proper digital nerve of the flap were anastomosised with the proper digital nerve of the wound.The flap donor site was resurfaced with full-thickness skin grafting from inner aspect of the forearm.All the cases were called back for postoperative follow-up.Results All the reconstructed fingers and flaps survived completely without vascular problems.The donor skin graft survived and wound healed by first intention.All the patients were followed up with 11.5 months (range,6-22 months).The finger appearance was satisfactory.The texture and color of flaps in all cases were good.There was no pigmentation and contraction relapse.The contracted fingers received no cold intolerance.At the final examination,the average values of static 2-point discrimination were 5.2 mm (range,4.3-6.5 mm) of the flap.In the series,based on the Michigan Hand Outcome Questionnaire,18 patients were strongly satisfied with the injured finger appearance and 3 patients satisfied with the appearance.Conclusion The modified antegrade digital artery island flap,which is easy to raise with large flap size and can result with the good finger appearance and function,is an ideal technique for reconstruction of the severe flexion contracture of the burned finger.