Objective To investigate the clinical effects of treating traumatic lesions of the popliteal artery by staged stretching.Methods From July 2011 to March 2016,29 patients with traumatic lesion of the popliteal artery underwent staged stretching after direct end to end anastomosis at Department of Orthopaedics,The 9th People's Hospital of Wuxi.They were 19 males and 10 females,with a mean age of 38.3 years (range,from 16 to 61 years).The average length of popliteal artery lesions was 3.7 cm (range,from 2 to 5 cm).After the keen joint was immobilized at flexion by external fixation,direct end to end anastomosis was performed with a proper segmental vascular freedom.From 4 weeks after operation,the popliteal artery was stretched stage by stage to its original length by gradual adjustment of the external fixation till the knee joint was fully extended.The color,skin temperature,pulp tension and capillary reaction of the toes were closely observed after surgery.CT angiography (CTA) was performed 6 months after surgery.The active range of motion was assessed at 12 months after surgery for the knee and ankle joints on the injured limb.Results All the patients were available for an average follow-up of 2 years (range,from 1 to 3 years).Blood supply was good for all the affected limbs.The staged stretching of the popliteal artery resulted in no rupture of any anastomotic stoma or no thrombus.CTA at 6 months after surgery showed fine patency of the popliteal artery and no formation of false aneurysm or arteriovenous fistula.At 12 months after surgery,the knee function was excellent in 15 cases,good in 10 and fair in 4;the ankle function was excellent in 18 cases,good in 8 and fair in 3.Conclusion Staged stretching is a safe,convenient and effective treatment of traumatic lesions of the popliteal artery.

Objective To investigate the clinical application and effect of autogenous costal car-tilage in rhinoplasty repair surgery .Methods From July 2015 to June 2018 ,112 cosmetic patients were treated with costal cartilage nasal tip prosthesis in the Department of Cosmetic Surgery ,Shang-hai Yixing Medical and Beauty Hospital .By using the straight part of the ribs ,the nasal columella was made with mortise groove and then septal expanded graft prepared by using two pieces of expanded grafts .The cap-like ,shield-like cartilage and perichondrium were combined for completing nasal tip prosthesis .Results A total of 112 patients were treated after rhinoplasty repair surgery .After 6-24 months of follow-up ,100 (accounting for 89 .3％ ) cosmetic seekers were satisfied with the shape of the nasal tip ,5 (accounting for 4 .5％ ) of those patients were not being satisfied due to unexpected na-sal tip point ,3 (accounting for 2 .7％ ) surgical infection cases after rhinoplasty and underwent pros-thesis removal ,2 (accounting for 1 .8％ ) had slight deviation of nasal tip and 2 had partial necrosis of nasal septum mucosa .No pneumothorax or chest wall deformities were found .Conclusions Rib carti-lage is an excellent material for nasal tip formation in rhinoplasty .The use of autogenous costal carti-lage to repair aesthetic defects in the lower nose can achieve a more effective ,safe and lasting effect .

Objective To compare the effects of bone transport versus induced membrane technique for large segmental tibial defects.Methods The clinical data were analyzed retrospectively of 89 patients with large segmental tibial defect who had been treated at Department of Orthopaedics,Wuxi No.9 People's Hospital from June 2005 to February 2017 using bone transport or induced membrane technique.They were 58males and 31 females,aged from 13 to 74 years (average,38.0 years).The bone transport group had 59cases and the induced membrane technique group 30 cases.The 2 groups were compared in terms of preoperative general data and postoperative bone nonunion,bone healing time,complications and functional recovery of the adjacent joint.Results There were no statistically significant differences between the 2groups in terms of age,gender,cause or type of defects,associated injury,course of disease,functionary scores of the adjacent joint or number of operations,showing compatibility between the 2 groups (P ＞ 0.05).All the patients were followed up for 12 to 48 months (average,20 months).The bone transport group had significandy longer clinical healing time (14.7 ± 5.4 months) and significantly higher incidences of major complications (50.8％),minor complications (57.6％) and overall complications (83.1％) than the induced membrane technique group (11.2 ± 2.8 months,16.7％,26.7％ and 30.0％,respectively) (P ＜ O.05),but significantly lower functionary scores of the adjacent joint (86.4 ± 5.0 points) than the induced membrane technique group (88.8 ± 4.9 points) (P ＜ 0.05).Conclusions Both bone transport and induced membrane technique are effective repairs for large segmental tibial defects.However,induced membrane technique may be superior to bone transport in terms of bone healing,complications and functional recovery.

Objective To evaluate recurrence risk factors in postoperative breast cancer patients after 5-year adjuvant endocrine therapy.Methods From Jan 2006 to Dec 2011,a total of 327 patients were enrolled for this study.Kaplan-Meier curves were applied to estimate survival rates and COX's proportional hazards model to identify prognostic variables.Results Among these 327 eligible patients,42 (12.8％) patients suffered from distant metastasis and 34 (10.4％) patients experienced locoregional recurrence after 5-year adjuvant endocrine therapy.Survival analysis showed that patients with histologic grade 3 disease,lymph node metastasis,Ki-67 high expression,high TNM stage and radiotherapy were statistically significant with poorer relapse-free survival (RFS,P =0.000,0.003,0.000,0.003,0.034)and poorer distant metastasis-free survival (DMFS,P =0.000,0.002,0.000,0.002,0.023),respectively.In multivariate analysis,patients with histological grade 3 disease (P =0.002) and more than 3 positive nodes (P =0.032) were risk factors for lower RFS.However,only histological grade 3 (P =0.015) was risk factor for DMFS.Conclusions Late relapse after completion of 5-year adjuvant endocrine therapy was still common,patients with grade 3 disease and more than 3 positive nodes may benefit from extended endocrine therapy.

Objective To observe and discuss the application and clinical effect of different forms of ear cartilage in nasal tip plasty.Methods Auricular cartilage was used to prune it as "halberd" shape at first,and then the extended transplantation and the cartilage fornix reconstruction were carried out by using single or combined septum cartilage.Meanwhile,nasal tip plasty was performed by using "cap shape" or "shield shape" cartilage grafting.Results 136 patients were followed up for 6 to 24 months after operation.119 cases were satisfied,accounting for 87.5％,of which 11 cases (ear cartilage weakness) were not improved obviously,accounting for 8％.However,there were only 6 cases with the unsatisfactory feedback as the nasal tip that was decreased by 1～2 mm one year after the operation,accounting for 4.41％.Conclusions The auricular cartilage is pruned as "halberd" shape singly or combined with septal cartilage as an extended graft,reconstructing the cartilage fornix in the meantime,which is the way better than the traditional way of making nasal tip plasty to obtain the ideal nasal tip protrusion.

Objective To compare the effect of fluoroscopic triggering method and empirical delay method on image quality in the liver Gd-EOB-DTPA dynamic enhanced MRI,and to investigate the value of fluoroscopic triggering method in Gd-EOB-DTPA dynamic enhanced MRI.Methods The patients underwent Gd-EOB-DTPA dynamic enhanced MRI were randomly divided into two groups according to the starting modes in the artery phase.Group A used fluoroscopic triggering method and group B used empirical delay method.Eliminating the images with severe respiratory motion artifacts,the quality of the remaining images in 78 cases of group A and 85 cases of group B were assessed in scores (excellent=5 scores;good=4 scores).Data was statistically analyzed with Mann-whitney tests,and P<0.05 was considered statistically significant.Results The excellent rate of the images in group A was 96.15% (75/78).The excellent rate of the images in group B was 67.06% (57/85).There were significant differences between the two groups in the excellent rate (χ2=27.889, P<0.001)and the image quality scores (Z=-4.747,P<0.001).Conclusion For the liver Gd-EOB-DTPA dynamic enhanced MRI, fluoroscopic triggering method is more likely to get better image quality and higher success rate in artery phase than empirical delay method,which indicates that fluoroscopic triggering method have obviously advantages in clinical applications.

Objective To prospectively evaluate the short-term test-retest reproducibility of intravoxel incoherent motion (IVIM) parameters for lung cancer,and to investigate its impact factors.Methods Thirty-eight lung cancer patients underwent twice free breathing IVIM scanning (0.5-1.0 h interval).Two radiologists independently analyzed IVIM images to obtain true diffusion coefficient (D),pseudo-diffusion coefficient (D*) and perfusion fraction (f).All the parameters were compared between repeated measurements and scans.Intra-and inter-observer,test-retest reproducibility was assessed with interclass correlation coefficients (ICCs).The impact of lung cancer type (peripheral and central),size (the largest diameter ≥2 cm and ＜2 cm) and location (upper,mid,and lower lung field) on short-term reproducibility were compared by using coefficient of variations (WCVs).Results There was no significant difference between repeated measurements for all parameters (all P＞ 0.05).All the parameters showed good intra-and inter-observer agreement.WCVsof D* and f (19.88％-36.83％) were higher than those of D (2.97％-4.62％).WCVs of D were higher for central lung cancer and the largest diameter ＜2 cm,and increasing from apical to lower zone.WCV of f was larger in the central lung cancer and the largest diameter ≥2 cm,while D* was greatly influenced by type,size and location of lung cancer.Conclusion The test retest reproducibility of D is good,while of D* and f are poor in lung cancer.The type,size and location of lung cancers are the impact factors of IVIM parameters.

OBJECTIVE: To predict the incidence of lung cancer in Jiashan county from 2017 to 2019 on the basis of the incidence rates of lung cancer during 1987-2016. METHODS: Lung cancer incident cases were derived from cancer registry system of Jiashan. Crude incidence, age-standardized incidence rate by the Chinese standard population (ASR China) and the world standard population (ASR world) were calculated. Annual percent change (APC) was used to examine the temporal trend, and the autoregressive integrated moving average method (ARIMA) of time series model was used to predict the incidence rates from 2017 to 2019. RESULTS: There were 6103 lung cancer incident cases during 1987-2016 in Jiashan county. Averagely, the crude incidence rate, ASR China and ASR world were 53.77/10, 25.24/10 and 34.15/10, respectively. The crude incidence rate, ASR China and ASR world in male were 78.30/10, 34.77/10 and 51.87/10, which were higher than those in female (29.15/10, 14.31/10 and 17.99/10). Crude incidence rate increased from 27.58/10 in 1987 to 111.24/10 in 2016, and the APC was 5.28%. Crude incidence rate predicted by ARIMA model from 2017 to 2019 would be 135.64/10, 145.97/10 and 152.63/10, and the predicted crude incidence rate for 2017 was close to the real incidence rate in 2017 (135.95/10). CONCLUSIONS The incidence of lung cancer in Jiashan has been increased dramatically over the past 30 years and will continue to increase in the future.
China ; epidemiology ; Female ; Humans ; Incidence ; Lung Neoplasms ; epidemiology ; Male ; Registries

Background Retinal vascular caliber changes can reflect the development status of cardiovascular disease and diabetes-associated vascular diseases,so it is very important to quantitatively measure retinal vascular caliber in the study of systemic diseases and retinal vascular disease.However,the methodology study is rately seen in China within our knowledge.Objective The present study was to investigate the repeatability and reproducibility of IVAN software in measuring retinal vascular caliber.Methods This study was approved by Ethic Committee of Affiliated Hospital of Inner Mongolia Medical University,and written informed consent was obtained from each subject prior to medical examination.A prospectively diagnostic trail was performed.The digitized fundus color photograph centered on the disc from 192 eyes of 96 healthy volunteers were collected in Affiliated Hospital of Inner Mongolia Medical University from January,2013 to December,2014,and central retinal arteriolar equivalent (CRAE),central retinal venular equivalent (CRVE) and arteriovenous ratio (AVR) were analyzed by IVAN measurement software.The repeatability and reproducibility of IVAN software for random repeat measurement of retinal vessel caliber from consecutive 85 right eyes of 85 volunteers were evaluation by interobserver and intraobserver measurement with interclass correlation coefficient (ICC).The correlations of measuring results between two observers or two-time measuring were analyzed with Pearson linear correlation analysis.Bland-Altman agreeement analysis was employed to assess the agreeement of the outcomes.Results No significant differences were found in CRAE,CRVE and AVR between the right eyes and the left eyes (t=-1.009,1.090,-1.259,all at P＞0.05).The CRAE,CRVE and AVR values from observer 1 were (145.02±12.94) μm,(400.72±9.12) μm and 0.36±0.03,and those from observer 2 were (145.10 ± 11.86) μm,(401.17 ± 9.85) μm and 0.36 ± 0..03,with no significant differences between observer 1 and observer 2 (t =-0.074,-0.913,0.116,all at P＞0.05).The repeat CRAE,CRVE and AVR values from observer 1 were (145.02 ± 12.94) μm,(400.72 ±9.12) μm and 0.36 ±0.03,which were significantly different from the initial values (t =-0.777,-0.048,-0.745,all at P＞0.05).In two-time measurements of intraobserver,all ICC were ≥0.738 and showed good correlations (all at r≥0.739).The two measurements of interobserver,showed good correlations (r≥ 0.662),with all ICC ≥ 0.657.Bland-Altman plots showed good agreements in CRAE and CRVE measurement with 95％ limits of agreement(LoA) ranged from-18.5 μm to 17.3 μm and-9.8 μm to 9.6 μm in intraobserver,and from-19.3 μm to 20.0 μm and-10.2 μm to 9.0 μm in interobserver,respectively.Conclusions IVAN measurement software yields good repeatability and reproducibility in the quantitative measurement of retinal vascular caliber.

Objective To analyze the therapeutic effect of Masquelet technique in the treatment of bone defects.Methods From January 2008 to December 2014,20 patients with bone defects were treated by Masquelet technique.There were 15 males and 5 females,from 18 to 69 years of age (average,38.4 years).Four cases had open bone defects and 16 infectious ones.At the first stage,radical debridement of the bone defects and soft tissue was conducted via conventional approaches.The bone defects ranged from 2 to 9 cm,averaging 6.1 cm.At the second stage,internal fixation was applied in 18 cases and external fixation in 2.The interval from the second stage to the first stage operation ranged from 6 to 23 weeks (average,11.5 weeks).The healing of bone defects and the functional recovery of adjacent joint were evaluated by Paley scoring at the last follow-up.Results The 20 patients were followed up for 12 to 50 months (average,19.7 months) after the second stage operation.All the patients obtained uneventful wound healing and control of infection after the first stage operation except the one with infectious defects who had to receive 2 operations to control the infection at the first stage operation.At the second stage operation,obvious injury and defect of the induced membrane occurred in 4 cases.All the patients achieved clinical healing of bone defects after 3 to 6 months (average,4.8 months).The bone defect healing was graded as excellent in all.After bone healing,all the patients resumed weight-bearing activities,with no breakage or infection of fixators,or recurrence of infection.By the Paley scoring at the last follow-up,the functional recovery of the adjacent joint was excellent in 8 cases,good in 10 and fair in 2,yielding an excellent and good rate of 90.0％.Conclusion As a kind of modified free bone grafting,Masquelet technique has advantages of simplicity,limited complications,a high rate of healing,and good control of bone infection.