Objective:To explore the clinical effect of perforator pedicled propeller flap (PPPF) in reconstruction of soft tissue defect in ankle and foot, as well as the role of preoperative ultrasonography in assistance of the location of perforators in donor site.Methods:From January 2017 to June 2023, the Department of Microorthopedics of the Second Affiliated Hospital of Luohe Medical College of Higher Education applied PPPF to reconstruct small and medium-sized soft tissue defects in the ankle and foot for 26 patients. The patients were 17 males, 9 females, aged 18 to 68 years old with 46 years old in average. The defect sites were 3 in forefoot and 6 in midfoot and combined with different degrees of tendon and bone exposure, 17 in ankle and heel and combined with various degrees of bone exposure, 12 with ankle open injury and 5 with Achilles tendon exposure. The area of soft tissue defects ranged from 2.5 cm×1.5 cm to 16.0 cm × 6.5 cm. The width of injury was measured before surgery, and a HHD was used to detect the perforators proximal to the defect site, and then high-frequency CDU was used to locate and confirm the location of the perforator and its alignment, blood flow and diameter. The line drawn between the 2 perforators was set as the axis of flap. The donor site was assessed by a "pinching and lifting" method to determine a direct closure of donor site or to have it closed by a flap transfer. The sizes of flap were from 2.8 cm×1.5 cm to 24.0 cm×7.5 cm. Twenty-two donor sites were directly closed and 4 received flap transfers. Four flaps had sutures with the skin nerves in the recipient site. Masquelet technique was performed in 6 patients with bone defects in the surgery. Patients received outpatient reviews with 1-2 weeks of intervals in the first 2 months after surgery, and X-ray reviews per 1-2 months for those with bone implants until bone healing.Results:All flaps survived successfully without any special treatment after surgery, except 1 flap that had blood vessel congestion and showed swelling and poor blood supply to the distal flap at 24 hours after surgery. The blood vessel congestion was revised by removal of part of the suture at the tip of flap pedicle. One week later, the tip of the flap remained with a small area of necrosis, which was then healed after dressing changes. A total of 21 patients were included in postoperative follow-up with 4 months to 3 years. All of the flaps had satisfactory appearance, colour and texture, and without any ulceration. Three cases of nerve suture were also included in follow-up. According to the assessment criteria of British Medical Research Council (BMRC), the sensory recovery of the flaps was found of S 2 in 1 flap and S 3 in 2 flaps. According to the American Orthopaedic Foot and Ankle Society (AOFAS), the ankle-hindfoot function scores, there were excellent in 16 patient and good in 5 patients. Conclusion:With the assistance of ultrasound, the PPPF can be effectively used in reconstruction of soft tissue defects in ankle and foot.

Objective:To explore the influence of body mass index (BMI) changes on the doses to normal tissues and adverse reactions of the lower digestive system and urinary system in the brachytherapy for cervical cancer.Methods:Clinical data of 80 cervical cancer patients who received radical radiotherapy in our hospital from January 2020 to February 2021 were retrospectively analyzed. All patients received external beam radiation ± chemotherapy + brachytherapy. The delineation method of target areas and organs at risk (OAR) was determined based on the recommended scheme of GEC-ESTRO. The target areas included high risk (HR)-CTV and intermediate risk (IR)-CTV, and OAR consisted of rectum, sigmoid colon, bladder, and small intestine. The target area dose was evaluated by D 90% of the HR-CTV. The OAR volume dose was evaluated by using D2cm3. Correlation analysis was used to compare the dosimetric relationship between BMI and D2cm3, D1cm3 and D0.1cm3 in bladder, rectum, colon and small intestine. Logistic regression analysis was adopted to analyze the risk factors of acute and late adverse reactions in the lower gastrointestinal system and urinary system. Whether BMI was a risk factor was validated. Results:BMI was negatively correlated with the D2cm3, D1cm3 and D0.1cm3 of the small intestine ( P=0.034, 0.024, 0.034), and the correlation coefficients were -0.240, -0.255, and -0.241, respectively. Logistic regression analysis showed that BMI was not a risk factor for the occurrence of acute and late adverse reactions in the lower gastrointestinal system and urinary system. For every 1 Gy increase of D2cm3, D1cm3 and D0.1cm3 in the small intestine, the relative risk of acute adverse reactions in the lower gastrointestinal system was increased by 16.6%, 15.1%,and 12.7%, respectively. Conclusions:In brachytherapy for cervical cancer, there is a negative correlation between BMI and D2cm3, D1cm3 and D0.1cm3 of the small intestine. As the BMI of patients declines, the radiation dose to the small intestine shows an increasing trend, which may increase the risk of acute adverse reactions in the lower gastrointestinal system.

"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions.
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Objective:To discuss the dosimetric contribution of the ovoid in the cervical cancer brachytherapy through the intracavity combined with interstitial(IC/IS)technique.Methods:The data on 20 patients with FIGO(2009)stageⅡ A, Ⅱ B or Ⅲ Bcervical cancer treated with radical radiotherapy in China-Japan Union Hospital of Jilin University during 2015-2017 was collected. External irradiation treatment was 45 Gy/1.8 Gy× 25 fractions. Brachytherapy was MRI-guided IC/IS brachytherapy with a prescription of 28 Gy/7 Gy× 4 fractions. All of 20 patients developed two kinds of plans, the ovoid group and the non-ovoid group. The original MRI-guided brachytherapy treatment plan was set(80 fractions)to the ovoid group. As contrast model that removed the ovoid and consisted of tandem combined with needles set to the non-ovoid group was built, and the same physicist designed the plan to make the dose of D90% for high-risk clinical target volume(HR-CTV)similar to the ovoid group. The dosimetric differences of the D90% and D98% for HR-CTV, D90% and D98% for intermediate-risk clinical target volume(IR-CTV)and D2 cm 3 for the bladder, rectum, sigmoid colon and small intestines between two groups of plans were analyze by paired t-test. Results:Compared with the ovoid group, the non-ovoid group showed no significant difference on HR-CTV D90%( P>0.05), but the HR-CTV D98%(6.99±0.60 vs. 6.78±0.76), IR-CTV D90%(4.71±0.58 vs. 4.26±0.57) and D98%(3.77±0.58 vs. 3.26±0.59) of the non-ovoid group decreased significantly( t=3.906, 9.860, 8.636, P<0.05). The sigmoid colon showed no significant difference( P>0.05), while the bladder (5.29±0.67 vs. 4.92±0.74), rectum (3.72±0.69 vs. 3.35±0.92) and small intestines (3.05±1.37 vs. 2.98±1.34) D2 cm 3of the non-ovoid group decreased significantly( t=8.758, 7.543, 8.059, P<0.05). Conclusions:Ovoid is very important for IC/IS technique in cervical cancer brachytherapy. Reasonable optimization of the dose weight ratio of the ovoid and the needle can bring better clinical benefits.

Objective:To explore the application of 3D printing technology-assisted standardized applicator in the image-guided adaptive brachytherapy (IGABT) for cervical cancer.Methods:Twenty-three patients with stage Ⅲ B cervical cancer with extensive paracervical invasion after external irradiation (45 Gy/25f) were treated with IGABT, and the prescription dose was 7 Gy/f×4f. According to the regression of tumor on MRI before and after external irradiation, the range of brachytherapy was determined, and the under dose area of standard intracavitary/interstitial applicator (IC+ IS) was estimated. The virtual transperineal needle channel was inserted in the under dose area, the angle, spacing and depth of implantation were optimized. The auxiliary templates were designed with graphic design software, and 3D printing technology was utilized to print the auxiliary templates. The auxiliary templates were closely combined with the standardized applicator. Under the anesthesia condition, ultrasound-guided applicator was completed, and patients were scanned with MRI image after operation. The MRI images were introduced into treatment planning system (TPS) to delineate the target area and organs at risk, and the treatment plans were optimized to complete the plan evaluation and treatment. Results:The average printing time of templates was (3.5±1.0) h, 382 implant needles were inserted guided by auxiliary templates, (4.2±1.5) template-guided implant needles were used in each fraction and the weight ratio was (16.49±9.50)%. The total dose of HR-CTV D 90% EQD 2Gy, α/ β=10 was (90.45±3.03) Gy, and IR-CTV D 90% EQD 2Gy, α/ β=10 was (66.46±3.68) Gy. The D 2cm 3 EQD 2Gy, α/ β=3 of the bladder, rectum, small intestine and sigmoid colon were (82.69±2.60) Gy, (73.20±2.52) Gy, (69.35±3.32) Gy and (69.39±3.27) Gy, respectively, all of which met the clinical dose requirements. The 1-and 2-year local control rates were 96% and 87%, 87% and 70% for the distant metastasis-free survival rates, and 96% and 78% for thea overall survival rates, respectively. Conclusion:The auxiliary applicators made by 3D printing technology can effectively compensate for the dose insufficiency of the standard applicator in the paracervical and other areas during the clinical brachytherapy in patients with stage Ⅲ B cervical cancer, providing an effective method for the brachytherapy of advanced cervical cancer.

In China, COVID-19 epidemic is currently showing a sporadic state, and the task of epidemic prevention is still arduous. Brachytherapy (BT) plays a critical role in the treatment of cancer. For some cancer receiving radiotherapy, use of BT can not be replaced or excessively delayed. Nevertheless, the recommendations or guidelines regarding the application of BT during COVID-19 epidemic have been rarely reported. In this article, a few recommendations on the application of BT during COVID-19 epidemic were retrieved and the work experience of Department of Radiation Oncology, China-Japan Union Hospital of Jilin University in the early epidemic period was summarized, aiming to provide relevant reference for the use of high-dose-rate BT for malignant tumor patients during COVID-19 epidemic.

Objective: To analysis the effect of nonoperative periodontal treatment on morphological changes of the schneiderian membrane of maxillary sinus in the chronic periodontitis patients by using oro-maxillaofacial cone-beam CT (CBCT) in order to provide the foundation in the diagnosis and treatment of maxillary sinusitis caused by chronic periodontitis. Methods: Totally 30 chronic periodontitis patients with schneiderian membrane thickening [(40.0±5.6) years old (ranged 26-55 years old), 18 males and 12 females] were randomly recruited in Department of Periodontics, School of Stomatology, China Medical University from June 2014 to December 2016. All patients were scanned by CBCT. The probing depth (PD), clinical attachment loss (CAL), plaque index (PLI) and bleeding index (BI) of the maxillary first and second premolars and molars were recorded. All patients received systematic nonoperative periodontal treatment. After six months, patients were reviewed, periodontal indexes and CBCT scanning were recorded. The thickness of the schneiderian membrane of maxillary sinus were analyzed by the software of CBCT. The changes of clinical parameters, parameter dimensional values of membrane thickness before and after treatment were statistically compared by t test. Results: In 30 chronic periodontitis patients, there was no statistically significant difference in the dimension and length of the maxillary sinus mucosa between the right and the left (P>0.05). The dimension of the mucosal thickening was positively correlated with PD and CAL values, and the correlation was statistically significant (P<0.05). Totally 58 maxillary sinus showed mucosal thickening. There were 20 mild thickening cases, and the dimension of mucosal thickening 6 months after treatment [(1.1±0.6) mm] was significantly lower than that before treatment [(2.5±0.7) mm] (P<0.05). There were 30 moderate thickening cases and the dimension of mucosal thickening 6 months after treatment [(2.3±0.6) mm] was significantly lower than that before treatment [(5.8±0.5) mm] (P<0.01). There were 8 severe thickening cases and the dimension of mucosal thickening 6 months after treatment [(4.2±0.4) mm] was also significantly lower than that before treatment [(11.2±1.8) mm] (P<0.01). The periodontal indexes of patients with mild, moderate and severe mucosal thickening in maxillary sinus showed statistically significant difference after treatment compared with before treatment (P<0.05). Conclusions Nonoperative periodontal treatment has a positive therapeutic significance for improving the schneiderian membrane thickening of maxillary sinus.

OBJECTIVE： To provide reference for pharmaceutical manufacturers improving the quality system of GMP and drug regulatory departments improving their supervision level. METHODS： Through analyzing and summarizing the problems existing in the 28 pharmaceutical enterprises which had been published on the website in the National Medical Products Administration from February 6th， 2018 to January 25th， 2019， the common problems were found and their causes were analyzed， then the regulatory countermeasures were put forward. RESULTS & CONCLUSIONS： Pharmaceutical enterprises have some problems of inadequate implementation of GMP， such as the inadequate performance of personnel in key positions and the unsatisfactory training effect of relevant personnel， the inconsistency between actual production technology and approved legal technology， the non-standard management of enterprise materials， the incomplete batch production records and the inability to effectively monitor the production cycle. However， there are also some problems in the supervision department， such as the large difference in the scale of inspectors’ on-site inspection， the need to strengthen the inspectors’ inspection ability and level， and the lack of innovation in the means of supervision. It is suggested that pharmaceutical manufacturers should improve the construction of GMP quality management system and strengthen the training of relevant personnel； the regulatory authorities should continue to promote the reform of “release， control and service”， strictly enforce the access conditions of inspectors， strengthen the training of inspectors and ideological construction of the inspector team，further strengthen the construction of supervision system and enhance the innovation of supervision means， so as to jointly maintain the safety， effectiveness and quality controllability of medicines.

OBJECTIVE: To analysis the acoustic characteristics in patients with unilateral arytenoid dislocation and unilateral vocal fold paralysis, and evaluate the application value of acoustic analysis technique in these two diseases. METHOD: The voice signals of sustained vowel /a/ were measured using the software MDVP in 50 healthy adults and 67 patients with unilateral vocal cord movement disorders. The acoustic parameters (jitter, shimmer, NHR and F₀) were analyzed. All patients were divided into arytenoid dislocation group (36 cases) and vocal fold paralysis group (31 cases) through the laryngeal electromyography. All groups were divided into male and female group again. The acoustic characteristics between the two experimental groups and normal control groups were observed and compared. Results were analyzed using Rank sum test. RESULT: (1) In both male or female groups, there were significant differences in jitter and shimmer between two experimental group and control group. In both male or female groups, there were significant differences in NHR between arytenoid dislocation group and control group. There were no significant differences in NHR between vocal fold paralysis group and control group. Except for the male vocal fold paralysis group, there were significant differences in F between the other experimental groups and control groups. (2) In both male or female groups, there were no significant differences in jitter and shimmer between vocal fold paralysis group and arytenoid dislocation group. There were significant differences in NHR. CONCLUSION The acoustic parameters are effective parameters to measure the voice quality of patients with unilateral arytenoid dislocation and unilateral vocal fold paralysis. NHR is the most sensitive parameter in the distinction of vocal cord paralysis and arytenoid dislocation.
Acoustics ; Adult ; Arytenoid Cartilage ; physiopathology ; Case-Control Studies ; Electromyography ; Female ; Humans ; Male ; Software ; Vocal Cord Paralysis ; diagnosis ; Vocal Cords ; physiopathology ; Voice Quality

Objective To compare the acoustic signal,mucosal wave and aerodynamic parameter (phonation threshold pressure,PTP) under different sub-glottal pressure (SGP) on the excised canine models with different extent of glottal incompetence.Methods Perturbation measures and nonlinear dynamic measures were applied to analyze the acoustic signal (jitter,shimmer),mucosal wave [frequency (F),amplitude (A),phase (P)] and PTP from our study including 11 excised canine larynges with different extent of glottal incompetence (0 mm,1 mm,2 mm,3 mm,n =11,respectively) under 1-4 kPa sub-glottal pressure.Results There were significant differences between different groups in jitter,shimmer,amplitude,frequency and PTP under various SGPs and extent of glottal incompetence (all P ＜ 0.05),inversely,there was no significant difference in P between groups (P ＞ 0.05).Jitter and shimmer changed obviously when the SGP increased to 3 kPa in the control group and GI 1 mm group.Jitter and shimmer changed obviously when the SGP increased to 2 kPa in the GI 2 mm and 3 mm groups.The F and A of mucosal wave increased with increasing SGP,decreased with increasing GI,and the P changed irregularly.There was statistically significant difference of PTP between different GI groups.Conclusions The SGP and the extent of GI had obvious affection on the the acoustic signal,mucosal wave and aerodynamic parameters.