Objective To explore the effect of the meteorologic factors on air pollution in the summer in Xian, China. Methods The data of SO2?NO2 and PM10 concentrations in the air and the related meteorologic factors [maximum temperature(tmax), minimum temperature(tmin), average air pressure(P) and relative humidity(H)) from April 1st to June 30th in 2005 were collected. The correlation between the air pollutant level and related meteorologic factors was analyzed by the elements time diagram and multiple regression models with SPSS 11.0 software. Results A significant correlations between the meteorological elements and air pollutants was seen, the regression models for air pollutants were as follows, lnSO2=-3.352+0.019 tmax-0.026 tmin, lnNO2=-3.448-0.003H+0.012 tmax-0.015 tmin and lnPM10=-2.197+0.011 tmax-0.021 tmin. Conclusion The meteorologic factors have some effects on the air pollution levels and then impact human health in some degree.

Objective To investigate the methods and the therapeutic effects of groin flap and stylus recurrent branch of radial artery flap for the repair of severely contracture of the first web space. Methods From March 2007 to six 2009,45 patients with severely contracture of the first web space received treatment of groin flaps and stylus recurrent branch of radial artery flaps, with 6 to 12 months clinical observation. Among then, 33 patients received treatment of groin flaps, 12 patients received treatment of stylus recurrent branch of radial artery flaps, and 28 patients received the first web space widening as well as functional reconstruction of thumb abduction. Results Most of the flaps healed by first intention but also with distal necrosis for 3 stylus recurrent branch of radial artery flaps and 1 groin flap. And the weth of the first web space of all patients were more than 90% of comparison. From clinical observation,function of opposition recovered well. While some groinflaps got a litte fat and clumsy .The color of most flaps was as similar as normal besides, some groin flaps occurrenced pigmentation. Conclusion Children and adults below 50 yesrs should choose the groin flap, and aged people and adults more than 50yesrs shuould choose the stylus recurrent branch of radial artery flap firstly.

Objective:To investigate the correlation of serum pro-gastrin-releasing peptide (ProGRP), sugar chain antigen 242(CA242), procalcitonin(PCT) levels in patients with chronic atrophic gastritis (CAG) with intestinal metaplasia and Helicobacter pylori(Hp) infection and prognosis.Methods:One hundred patients with CAG intestinal metaplasia in Emergency General Hospital were selected as the research objects, and they were divided into infection group (75 cases) and non-infected group (25 cases) according to whether they had Hp infection. The clinical data, levels of serum ProGRP, CA242, and PCT were compared between the two groups, and the diagnostic value of the combination of serum indicators in the diagnosis of Hp infection in CAG intestinal metaplasia patients and their correlation with prognosis were analyzed.Results:The degree of atrophy and intestinal metaplasia in the infected group were higher than those in the non-infected group ( P<0.05). The levels of serum ProGRP, CA242 and PCT in the infected group were higher than those in the non-infected group: (159.41 ± 42.38) ng/L vs. (105.84 ± 18.29) ng/L, (7.24 ± 2.28) kU/L vs. (4.12 ± 1.30) kU/L, (3.84 ± 1.12)μg/L vs. (2.57 ± 0.82) μg/L, there were statistical differences ( P<0.05). The results of Spearman analysis showed that the levels of ProGRP, CA242, PCT had positive correlation with atrophy degree ( r = 0.614, 0.629, 0.672, P<0.05), and had positive correlation with intestinal metaplasia degree ( r = 0.574, 0.591, 0.603, P<0.05). The area under the curve (AUC) for the combined diagnosis of Hp infection in patients with CAG intestinal metaplasia by serum ProGRP, CA242, and PCT was 0.874 (95% CI 0.793 - 0.932), the diagnostic sensitivity and specificity were 76.00% and 92.00%, respectively. The incidence of gastric neoplasms in patients with Hp positive combined diagnosis of serum ProGRP, CA242, and PCT within 2 years (11.86%) was higher than that of negative patients (0), but the difference was not statistically significant ( P>0.05). Conclusions:The levels of serum ProGRP, CA242 and PCT in patients with CAG intestinal metaplasia are closely related to Hp infection. The combination of various indicators has high application value in the diagnosis of Hp infection.

Stitching skin wounds is one of the essential skills of a surgeon. Whether it is a traumatic wound or a surgical incision, choosing the most appropriate closure technique according to its characteristics is an important factor for good healing. Various skin wounds suturing techniques have been created and improved over the years, which have advantages of simple operation, precise alignment, reducing tension of the wound edges, and reducing scar formation, etc. Although these techniques provide more options for wound suture, they also put forward requirements for the judgment and operation ability of the operators. This article summarizes the advantages and disadvantages of the different skin wounds suturing techniques and their clinical application.

Female ; Humans ; Infant, Newborn ; Thoracic Surgical Procedures ; methods ; Twins, Conjoined ; surgery

Objective To study the values of change of diameter (ΔD%)on DCE-MRI and ΔD% combined with ADC for the therapeutic effect evaluation in the neoadjuvant chemotherapy(NAC)of each subtype of breast cancer.Methods 121 women with invasive breast cancer were enrolled in this study,including 56 cases of Luminal A type,42 cases of Luminal B type,13 cases of Her-2 type and 10 cases of triple negative type.Results Imaging evaluation results obtained by single applying DCE-MRI was analyzed with the pathological results after surgery for the consistency,and the Kappa values of Luminal A,Luminal B,Her-2 and triple negative type were 0.594,0.617,0.401,0.690,0.800,respectively.When combining ΔD% with ΔADC%,the Kappa values were 0.844,0.792,0.854, 0.847 and 0.800,respectively.The sensitivity of combined parameters in evaluating pCR after NAC was significantly increased in Luminal type cancers,however,with a slightly increasing in Her-2 type,and constant in triple negative type.Conclusion ΔD% combining with ΔADC% is better than single parameter in evaluating pCR for Luminal and Her-2 types cancer,but not for triple negative type.

Objective:To evaluate the diagnostic performance of a radiomics model based on dynamic contrast-enhanced MRI (DCE-MRI) and diffusion weighted imaging (DWI) in small breast cancer (≤ 20 mm in greatest dimension), and to compare the results with those of an experienced radiologist’s interpretation.Methods:A total of 205 small breast lesions in 192 consecutive female patients from June 2016 to January 2018 at Renji Hospital, School of Medicine, Shanghai Jiaotong University, were retrospectively enrolled in the study. All lesions (≤ 20 mm in greatest dimension) were confirmed by surgical pathological results. The lesions were divided into a training set (116 lesions) and an independent test set (89 lesions). Based on preoperative breast DCE-MRI and DWI data, a radiomics model was built using gradient boosting decision tree (GBDT). The GBDT model was applied to the test set for differentiation between malignant and benign small breast lesions. Cases of the test set were also evaluated by an experienced radiologist for benign and malignant diseases differentiation. ROC curve was used to assess the diagnostic performance for the GBDT model and the radiologist evaluation, respectively. Differences in the area under the ROC curve (AUC) were analyzed by the DeLong test. Differences in sensitivity, specificity and accuracy were evaluated by the McNemar test. Kappa values were used to assess the agreement between different evaluation methods.Results:The AUC of the GBDT model (0.950) showed no significant difference from that of the radiologist’s evaluation based on DCE-MRI combing DWI data (0.935) ( Z=0.499, P=0.618). However, it showed the AUC of GBDT model was significantly higher than that of evaluation based on DCE-MRI (0.874) or DWI (0.832) alone ( Z=2.024， P=0.043； Z=2.772， P=0.006). The sensitivity, specificity and accuracy of the best cutoff point of GBDT model were 90.0%, 89.8% and 89.9% respectively. The sensitivity, specificity and accuracy of evaluation based on DCE-MRI combined with DWI were 97.5%, 79.6% and 87.6% respectively. There was no significant difference in diagnostic performance between the two methods (χ 2=0.800,2.286 and 0.083, P>0.05). Conclusions:A radiomics model based on DCE-MRI and DWI images provided good diagnostic performance in small breast cancer. The results of radiomics were favorably comparable with those of experienced radiologist evaluation based on the combination of DCE-MRI and DWI data.

Objective:To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation for the treatment of combined immunodeficiency (CID) and explore prognostic risk factors.Methods:In this retrospective cohort study, clinical characteristics, laboratory tests and prognosis of 73 CID children who underwent allogeneic hematopoietic stem cell transplantation from February 2014 to April 2022 in the Children′s Hospital of Fudan University were analyzed. Based on the subtypes of diseases, all patients were divided into severe combined immunodeficiency disease (SCID) group and other CID group. Based on the types of donors, all patients were divided into matched sibling donor group, matched unrelated donor group, unrelated cord blood group, and haploidentical donor group. Kaplan-Meier method and Log-Rank test were used to analyze the survival data. Cox regression was used to analyze prognostic factors.Results:Among the 73 patients, there were 61 (84%) males and 12 (16%) females. Fifty-five (75%) patients were SCID, and 18 (25%) patients were other CID. Donor source included 2 (3%) matched sibling donors (MSD), 3 (4%) matched unrelated donors (MUD), 64 (88%) unrelated cord blood (UCB), and 4 (5%) haploidentical donors. The age at transplant was 10.7 (5.9, 27.5) months, and the follow-up time was 36.2 (2.5, 62.9) months. The 3-year overall survival rate of 73 patients with CID was (67±6) %. No significant difference was found in the 3-year overall survival rates between patients with SCID (55 cases) and other CID (18 cases) ((64±7) % vs. (78±10) %, χ2=1.31, P=0.252). And no significant difference was found in the 3-year overall survival rates among patients who received MSD or MUD (5 cases), UCB (64 cases), and haploidentical donor (4 cases) transplant (100% vs. (66±6)% vs. (50±25) %, χ2=2.30, P=0.317). Cox regression analysis showed that the medical history of sepsis ( HR=2.55, 95% CI 1.05-6.20, P=0.039) and hypoalbuminemia at transplant ( HR=2.96, 95% CI 1.14-7.68, P=0.026) were independent risk factors for the prognosis of allogeneic hematopoietic stem cell transplantation in pediatric patients with CID. Conclusions:Allogeneic hematopoietic stem cell transplantation is an effective treatment for CID. The medical history of sepsis and hypoalbuminemia at transplant were risk factors for prognosis. Enhancing infection prevention and nutritional intervention before transplant can improve patient prognosis.

Objective : To compare the disinfection effect of 3% (v/v) hydrogen peroxide and 500 mg/L chlorine-containing disinfectants in the independent waterway of a periodontal ultrasonic scaler to provide a reference for clinical waterway disinfection management in stomatology departments. Methods : The 18 ultrasonic scalers were randomly divided into 3 groups of 6 units: the control group, experimental group 1 (3% hydrogen peroxide disinfectant group), and experimental group 2 (500 mg/L chlorine-containing disinfectant group). The replaceable parts of the independent waterway pipes of the 3 groups of ultrasonic scalers were replaced, and the water supply was supplied with sterile distilled water (DW). In the control group, special treatment was not applied to the nonreplaceable pipe part. In experimental group 1, the 3% hydrogen peroxide was used to disinfect nonreplaceable pipelines. In experimental group 2, the nonreplaceable part was disinfected with the 500 mg/L chlorine-containing disinfectant. The water sample was taken from the outlet of the scaler working part in the three groups for monitoring before disinfection, immediately after disinfection and 10 consecutive days after disinfection. Bacteria in the water samples were cultured for the colony counts. Then, the bacterial culture data were compared between groups. The qualified criterion of the water sample was that the number of bacterial colonies was less than or equal to 100 CFU/mL. After disinfection, a bacterial species mass spectrometry identification analysis was carried out when the number of bacterial colonies in each group exceeded the standard for the first time. Biofilms from the inner wall of the tube in the three groups were observed under an electron microscope on the 10th day after disinfection. Results : There were no significant differences between the three groups before disinfection (F = 2.549, P = 0.111). The number of bacterial colonies in the spout of 6 scalers in the control group all exceeded the standard, and three kinds of bacteria were cultured: Sphingomonas melonis, Herbaspirillum huttiense, and Ralstonia pickettii. Compared with those in the control group, the number of bacterial colonies in experimental group 1 decreased significantly for 1-2 days after disinfection (P<0.05) and reached the standard. On the 3rd day after disinfection, the number of bacterial colonies of group 1 increased rapidly and exceeded the standard, and three kinds of bacteria were cultured: Sphingomonas, Herbaspirillum huttiense, and Ralstonia pickettii. For experimental group 2, the number of bacterial colonies decreased significantly compared to the control group on Days 1 to 6 after disinfection, but the number of bacterial colonies increased slightly from the 7th day after disinfection and exceeded the standard. Two kinds of bacteria were cultured: Herbaspirillum huttiense and Ralstonia pickettii. The average number of bacterial colonies 10-day after disinfection in experimental group 2 was lower than that in experimental group 1(P<0.001). Under an electron microscope, the biofilm thickness of the two experimental groups was significantly lower than that of the control group. Conclusion There is water pollution in the independent waterway of a periodontal ultrasound scaler. Three percent hydrogen peroxide and 500 mg/L chlorine disinfectant both have effective disinfection effects on the outlet water of scalers, and the effect of 500 mg/L chlorine disinfectant is better than that of 3% hydrogen peroxide. The use of 3% hydrogen peroxide to disinfect periodontal ultrasound scaler-independent waterways is recommended for disinfection every other day, and disinfection once a week is recommended for the use of 500 mg/L chlorine disinfectant.

Objective To investigate the clinical characteristics of 8 immunodeficiency cases caused by human recombination activating gene 1 (RAG1) mutations,and to explore the relationship among genotypes,clinical manifestations and immunophenotypes.Methods Clinical data were collected and analyzed from patients with RAG1 mutations who visited the Department of Clinical Immunology,Children's Hospital of Fudan University between October 2013 and June 2017.The data included clinical manifestations,immunophenotypes and genotypes.Results A total of 8 patients were diagnosed with RAG1 deficiency (6 boys and 2 girls).The minimum age of onset was 2 months,and the maximum age was 4 months.The minimum age of diagnosis was 2 months,and the maximum age was 13 years.Four patients had a family history of infant death due to severe infections.Two cases were born to the same consanguineous parents.All cases had recurrent infections,including involvement of respiratory tract (8 cases),digestive tract (6 cases),urinary tract (1 case),and central nervous system (1 case).The pathogens of infection included bacteria,viruses and fungi.Rotavirus was found in 3 cases,cytomegalovirus (CMV) in 5 cases,bacillus Calmette-Guérin adverse reaction in 2 cases (1 of whom had a positive acid-fast smear from lymph node puncture fluid),fungal infection in 3 cases.One case had multiple nodular space-occupying lesions in lungs and abdominal cavity complicated with multiple bone destruction.The peripheral blood lymphocyte counts of all patients ranged between 0.1 × 109/L and 3.3 × 109/L (median,0.65 × 109/L).Eosinophilia was found in 3 cases (range,(0.48-1.69) x 109/L).The patients were classified according to immunophenotype as severe combined immunodeficiency phenotype (4 cases),leaky severe combined immunodeficiency (2 cases),Omenn syndrome (1 case) and combined immunodeficiency(1 case).Decreased serum IgG levels were found in 3 cases,increased serum IgM levels in 3 cases,increased serum IgE levels in 5 cases.RAG1 homozygous mutations were detected in 5 cases and RAG1 compound heterozygous mutations in 3 cases.Two novel mutations and six previously reported mutations were identified.Three cases were successfully treated with hematopoietic stem cell transplantation.Four cases died due to infections,and the 13 year-old patient was still under follow-up in the outpatient clinic.Conclusions Different RAG1 gene mutations can lead to diverse clinical presentations and immune phenotypes.Clinicians should pay attention to the family history of infant death with severe infection.In that situation,immunological evaluation and gene detection should be performed as early as possible.