Objective To investigate and compare the plasma concentrations of adenosine in patients taking ticagrelor versus clopidogrel after percutaneous coronary intervention (PCI) and its influence on occurrence of adverse clinical events.Methods The study enrolled 180 patients who had received PCI in the Tianjin First Center Hospital between June 2014 to July 2016.The patients were divided into 2 groups as the ticagrelor group (n=90, patients given ticagrelor 90 mg twice daily) and the clopidogrel group (n=90, patients given clopidogrel 75 mg daily).The plasma concentration of adenosine was taken at 30 days and 90 days after PCI.The adenosine levels and clinical events were compared between the 2 groups.Results The adenosine concentration were higher in the ticagrelor group both at 30 days [(1.65±0.16) μmol/L vs.(0.71±0.08) μmol/L, P<0.01] and 90 days [(1.65±0.14) μmol/L vs.(0.72±0.06) μmol/L, P<0.01] than in the clopidogrel group.The rates of major adverse cardiocerebral events were lower in the ticagrelor group both at 30 days (3.3% vs.13.3%, P<0.05) and at 90 days (6.7% vs.15.6%, P<0.05) than in the clopidogrel group.No significant difference in bleeding complication between the 2 groups.Conclusions Ticagrelor increases the concentration of adenosine in patients after PCI which may have beneficial effect on reduction of clinical adverse events.

Objective To investigate feasibility and effect of external fixator plus steel plate in treatment of open tibiofibular fractures combined with tibial defect.Methods The study involved 21 patients with open fractures of tibia and fibula (15 patients with type Gastilo ⅢA,five with type Gastilo ⅢB and one with type Gastilo ⅢC) with concurrent tibial defect of 2-6 cm.External fixator plus fibular steel plate was performed at the first stage,followed by iliac bone grafting for bone defect at the second stage.Results All patients showed successful reconstruction of the tibial defects with length difference between affected and healthy extremities less than 2 cm in follow-up for (14.0 ± 10.5) months (range,8-24 months).Meanwhile,no talipes equinovarus existed.Conclusions External fixator plus steel plate is an effective method for treating open tibiofibular fractures combined with tibial defect.The length and function of the extremities of patients with open tibiofibular fractures combined with tibial defect of less than 6 cm can be successfully restored.

Objective To evaluate the value of ultrasonography in diagnosing tendon xanthoma.Methods The ultrasonographic images of 17 patients with tendon xanthomas confirmed by surgery and pathology were retrospectively analyzed.The ultrasonographic features were summarized.Results The ultrasonographic images showed the location,number,size,shape,boundary,internal echo,involvement and blood supply of tendon xanthomas clearly.Tendon xanthomas showed hypoechoic masses within the tendons,mostly located on the extensor aspect of the hands,feet or bilateral Achilles tendons,symmetric growth,irregular-shaped and inhomogeneous,with loss of the normal fibrillar pattern in longitudinal plane.The abundant blood flow inside the tendon can be detected by color Doppler examination.Conclusions High frequency sonography is the preferred imaging method for diagnosis of tendon xanthomas.

Objective:To investigate the value of ultrasound in the diagnosis of hourglass-like fascicular constrictions of the anterior interosseous nerve.Methods:From July 2010 to July 2020, 12 patients with hourglass-like fascicular constrictions of the anterior interosseous nerve diagnosed in Shandong Medical Imaging Research Institute Affiliated to Shandong University were retrospectively analyzed. The characteristics of the high-frequency ultrasonographic images were summarized and compared with clinical surgery.Results:The hourglass-like fascicular constrictions of the anterior interosseous nerve were all located in the median nerve of the distal upper arm in 12 patients, including 9 cases of single hourglass change and 3 cases of multiple hourglass like changes. High-frequency ultrasound can accurately locate the location of the hourglass-like fascicular constrictions of the anterior interosseous nerve and the extent of neuropathy. The sonogram of hourglass-like fascicular constrictions of the anterior interosseous nerve showed single or multiple hourglass-like changes in the median nerve of the distal upper arm. The nerve fasciculars on both sides of hourglass-like changes were thickened. There was significant difference between the diameter of the affected fascicular and the corresponding position of the contralateral fascicular[(0.20±0.04)cm vs (0.11±0.03)cm, P<0.01]. There was significant difference between the cross-sectional area of the median nerve at the widest part of the lesion side and the corresponding position of the contralateral side[(0.14±0.03)cm 2 vs (0.09±0.03)cm 2, P<0.01]. Conclusions:High-frequency ultrasound is the preferred image method for the diagnosis of hourglass-like fascicular constrictions of the anterior interosseous nerve.

To evaluate the value of ultrasonography in diagnosing peripheral intraneural vascular anomalies . Methods The ultrasonographic images of 10 patients with peripheral intraneural vascular anomalies confirmed by surgery or pathology were retrospectively analyzed . T he ultrasonographic features were summarized . Results T he ultrasonographic images could not only clearly show the location , involvement and blood supply of peripheral intraneural vascular anomalies , but also determined the classification of them . Ultrasonography showed enlarging nerves ,within w hich tubular structures could be observed ,and the boundary between the vascular malformations and the perineurium was not clear . Abundant arteriovenous blood flow ( arteriovenous malformation) or low velocity venous blood flow ( venous malformation) within the vascular anomalies could be detected by color Doppler examination . Conclusions Ultrasonography is the preferred imaging method for diagnosis of peripheral intraneural vascular anomalies .

Objective:To evaluate the role of high frequency ultrasonography in diagnosis of closed volar plate injury of proximal interphalangeal joint.Methods:From May 2015 to may 2021, 41 patients with acute closed volar plate injury confirmed by Department of Hand and Foot Surgery of the Provincial Hospital Affiliated to Shandong First Medical University were examined by high frequency ultrasonography. The sonographic features were analyzed and classified.Results:High frequency ultrasonography could not only clearly show the thickness, shape and echo of volar plate, but also the degree of injury and avulsion fracture of volar plate, according to which the closed volar plate injury could be divided into three types: A, B and C. Type A(13 cases): Avulsion fracture of the middle phalangeal base was found with volar plate rupture, the sonogram showed that the continuity of the volar plate attachment of the middle phalangeal base was interrupted, and avulsion fracture was found at the distal end of the volar plate. Type B(11 cases): Complete rupture of the volar plate attachment of the middle phalangeal base was found without avulsion fracture, the sonogram showed that the continuity of the volar plate attachment of the middle phalangeal base was interrupted, and the end of the volar plate contracted and thickened. Type C(17 cases): Tear of the volar plate was found, the sonogram showed enlarging volar plates, heterogeneous internal echo, and liquid dark area was visible in some cases. The average thickness of the three types of closed volar plate injury of the proximal interphalangeal joint measured by ultrasound was (0.33±0.05)cm, and the average thickness of the volar plate at the same position of the corresponding finger on the opposite side was (0.22±0.03)cm. There was significant difference between the two groups ( t=7.864, P=0.006). Conclusions:High frequency ultrasonography is the preferred imaging examination method for the diagnosis of closed volar plate injury in proximal interphalangeal joint, which has an important guiding significance for the selection of clinical treatment.

T cells engineered with chimeric antigen receptor (CAR) have been successfully applied to treat advanced refractory B cell malignancy.However,many challenges remain in extending its application toward the treatment of solid tumors.The immunosuppressive nature of tumor microenvironment is considered one of the key factors limiting CAR-T efficacy.One negative regulator of T cell activity is lymphocyte activation gene-3 (LAG-3).We successfully generated LAG-3 knockout T and CAR-T cells with high efficiency using CRISPR-Cas9 mediated gene editing and found that the viability and immune phenotype were not dramatically changed during in vitro culture.LAG-3 knockout CAR-T cells displayed robust antigen-specific antitumor activity in cell culture and in murine xenograft model,which is comparable to standard CAR-T cells.Our study demonstrates an efficient approach to silence immune checkpoint in CAR-T cells via gene editing.

Objective To evaluate the value of ultrasonography in diagnosing intraneural ganglion cysts . Methods The ultrasonographic images of 12 patients with intraneural ganglion cysts confirmed by surgery and pathology were retrospectively analyzed . The ultrasonographic features were summarized . Results The ultrasonographic images showed the location ,number ,size ,shape ,boundary ,internal echo , involvement extent and blood supply in intraneural ganglion cysts clearly . Intraneural ganglion cysts showed cystic masses within peripheral nerve ,boundary clear ,irregular-shaped ,ill-acoustic transmissibility ,and separations are common ,color Doppler examination showed no blood flow inside the cysts . Conclusions High frequency sonography is the preferred imaging method for diagnosis of intraneural ganglion cysts .

Objective To evaluate the value of color Doppler ultrasonography in diagnosing cystic adventitial disease of the popliteal artery . Methods The ultrasonographic images of 12 patients with cystic adventitial disease of the popliteal artery confirmed by surgery and pathology were retrospectivly analyzed . The ultrasonographic features were summarized . Results The ultrasonographic images showed the location ,number ,size and the compression of popliteal artery . Cystic adventitial disease of the popliteal artery showed cystic masses within popliteal artery wall . The tunica media and tunica externa were separated . Slender separations could be found in some cysts . Color Doppler ultrasonography showed no blood flow inside the cysts . When the popliteal artery was compressed ,the velocity of blood flow increased significantly . The affected popliteal artery diameter was less than that of the contralateral side [ ( 2 .858 ± 1 .256)mm vs (5 .500 ± 0 .095)mm , t ＝7 .531 , P ＜0 .01] ,the peak flow velocity of the affected popliteal artery was higher than that of the contralateral side[(213.750±119.464)cm/svs(57.417±4.209)cm/s, t ＝4 .465 , P ＜0 .01] ,the peak flow velocity of the affected posterior tibial artery was lower than that of the contralateralside[(32.417±14.569)cm/svs(47.250±4.115)cm/s,t ＝4.318,P ＜0.01] .Conclusions Color Doppler ultrasonography is the preferred imaging method for diagnosis of cystic adventitial disease of the popliteal artery .

Objective:To investigate the diagnostic value of ultrasonography in Poland′s syndrome.Methods:From February 2016 to December 2020, the ultrasonographic images of 15 patients with Poland′s syndrome diagnosed by Provincial Hospital Affiliated to Shandong First Medical University were retrospectively analyzed, and the ultrasonographic features were summarized.Results:High-frequency ultrasound could clearly show the anatomical structures of each layer of the chest wall of the patients with Poland′s syndrome. The sonogram of Poland′s syndrome mainly showed the absence of all or part of the pectoralis major on the affected side, some of which were combined with the absence of pectoralis minor. The difference between the thickness of the affected chest wall and the healthy side was statistically significant ( P<0.01). Among the 15 cases of Poland′s syndrome, 11 cases had brachydactyly or syndactyly. Ultrasound showed that the bifurcation position of the common palmar digital artery of the middle finger was lower than that of the healthy side. Conclusions:The ultrasonography is an effective imaging method for diagnosis of Poland′s syndrome.