Objective To evaluate gray matter volume,white matter volume and FA value changes in amyatrophic lateral sclerosis(ALS)patients by voxel-based morphometry(VBM)and voxel-based diffusion tensor analysis(VBDTA).Methods Thirty-nine definite or probable ALS patients diagnosed by El Escorial standard and 39 healthy controls were recruited and underwent conventional MR scans and the neuropsychological evaluation.The 3D FSPGR T_1WI and DTI data were collected on GE Medical 3.0 T MRI system.The 3D T_1 structural images were normalized,segmented and smoothed,and then VBM analysis was performed.DTI data were acquired from 76 healthy controls,and FA map template was made.FA maps generated from the DTI data of ALS patients and healthy controls were normalized to the FA map template for voxel-based analysis.ANCOVA was applied,controlling with age and total intracranial volume for VBM and age for VBDTA.A statistical threshold of P＜0.01(uncorrected)and cluster level of more than continuous 20 voxels determined significance.Results Statistical results showed no significant difference in the global volumes of gray matter and white matter,total intracranial volumes and gray matter fraction between ALS patients and healthy controls,but the white matter fraction of ALS patients(0.29±0.02)was significantly less than that of healthy controls(0.30±0.02)statistically(P=0.003).There was significant reduction of gray matter volumes in bilateral superior frontal gyri and precentral gyri,right middle frontal gyrus,right middle and inferior temporal gyrus,left superior occipital gyms and cuneus and left insula in ALS patients when compared with healthy controls;and the regional reduction of white matter volumes in ALS patients mainly located in genu of corpus callosum,bilateral medial frontal gyri,paracentral lobule and insula,right superior and middle frontal gyrus and left postcentral gyrus.VBDTA showed decrease in FA values in bilateral parahipocampal gyri and cingulate gyri in ALS patients compared with healthy controls.Conclusions VBM and VBDTA analysis results suggest that ALS is not simply a motor neuron disease but a multisystem disorder;and VBDTA has a potential value for the detection of FA value changes of cingulate and parahippocampal gyral white matter in suspected cognitive impairment of ALS patients.

Objective:To study the bone regeneration capacity of the complex of bone marrow mesenchymal stem cells(BMSCs) and platelet rich plasma (PRP) with decellularized cartilage matrix (DCM).Methods:BMSCs were isolated from young rabbit and cultured;PRP were prepared from the fresh blood of rabbit and the DCM were come from the fresh ears of rabbits and processed into a mixture of BMSCs-PRP-DCM.The mixture was injected subcutaneously into nude mice,8 weeks after injection bone regeneration was examine by HE staining and Massons staining decellularization.Results:The BMSCs show good differentiation capacity in vitro and the cartilage fragments were well decellularized.Excellent endochondral ossification ability of the complex was observed by in vivo experiment.Conclusion:The BMSCs-PRP-DCM complex has good capacity of endochondral ossification.

Objective To investigate the effect of integrated traditional Chinese ( TCM ) and western medicine fast-track surgery ( FTS) in the perioperative management of laparoscopic cholecystectomy ( LC) .Methods One hundred and fifty patients with acute cholecysititis undergoing LC from June 2012 to January 2015, were recruited and divided randomly into 3 groups.Patients in group A (n=30) were treated with routine method in perioperative period, patients in group B ( n=60) were treated with western medicine FTS, and patients in group C (n=60) were treated with integrated TCM and western medicine FTS.The first exhaust time after operation, length of stay, times of clinic visit, symptoms, levels of IL-6, CRP and ALB, postoperative complications, readmission rate, reoperation rate, and patient satisfaction were evaluated in three groups.Results The first exhaust time after operation of group B and group C was earlier than that of group A [(25.16 ±8.36)h and (21.61 ±6.52)h vs.(36.06 ±10.88)h, P<0.05], and the first exhaust time of group C was earlier than that of group B (P<0.05).The length of stay of group B and group C were shorter than that of group A [(4.30 ±1.07)d and (3.98 ±1.16)d vs.(6.11 ±1.26)d, P<0.05].The nausea and vomiting, and abdominal distension of group C were lighter than those of group B [(0.27 ±0.08) vs.( 0.31 ±0.09); (0.35 ±0.09 ) vs.(0.40 ±0.13), respectively].There were no difference of the level of IL-6, CRP and ALB between group B and group C [(57.12 ±16.29) ng/L vs. (53.91 ±17.15) ng/L, (53.93 ±17.18) mg/L vs.(51.16 ±16.67) mg/L,(40.50 ±4.65) g/L vs. (41.01 ±4.60)g/L, respectively, all P<0.05].There was no difference among the three groups in the complication rate, readmission rate and reoperation rate(all P>0.05).Conclusion Integrated traditional Chinese and western medicine FTS in the perioperative period of LC can promote recovery, reduce symptoms and operation stress and maintain albumin level.

ObjectiveTo study the clinical value of prenatal ultrasound in diagnosis of fetal ductus arteriosus stenosis and the guiding significance for clinical delivery.Methods Ultrasound images and perinatal outcome of 12 cases of ductus arteriosus stenosis diagnosed by prenatal ultrasound were retrospectively analysed,the sonographic features were summarized.Results Fetal ductus arteriosus was thin in 12 cases with inner diameter of 1.6 - 2.1 mm.Color Doppler flow imaging showed multicolored blood flow in ductus arteriosus,spectral Doppler showed single peak continuous decreasing high-speed shunt spectrum,peak systolic velocity 256- 404 cm/s,end diastolic velocity 90 - 205 cm/s.Twelve fetuses were associated with right atrial and ventricular dilatation,pulmonary artery widened and moderate to severe tricuspid regurgitation,maximum reflux velocity 324 - 515 cm/s,maximum transvalvular pressure gradient 41 - 106 mmHg.There were 7 cases of emergency cesarean section delivery and 5 cases of oxytocin induced labor delivery,11 cases were full-term infants and 1 case was premature infant.12 fetuses were followed-up after birth by 1 to 3 months of echocardiography until the cardiac structure and function returned to normal,ConclusionsPrenatal ultrasound has important clinical value in diagnosis of fetal ductus arteriosus stenosis,it is helpful to assess the fetal right heart function and guide the clinical delivery.

Objective:We designed and applied a novel, bionic megaprosthesis for distal femur, which substituted the hinged articulation with an artificial ligament and a constrained tibial insert in order to maintain articular stability and reduce stress and the risks of wearing, loosening and breakage.Methods:We reviewed the cases of distal femoral osteosarcoma in children population who were initially treated in our center during 2019. Twelve cases of bionic distal femoral prosthesis (bionic group) and 21 cases of fixed-hinge distal femoral prosthesis (control group) were included. In the bionic group, there were six female and six male with the mean age as 8.8±2.6 y. One patient had pathological fracture. Staging according to Enneking system included 1 case of stage IIA, 10 cases of stage IIB and 1 case of stage III. In the control group, there were seven female and fourteen male with the mean age as 8.6±2.2 y. Pathological fracture was seen in three cases. Staging included 15 cases of stage IIB and 6 cases of stage III.We investigated the peri-operative safety, oncological outcome, complication profiles and post-operative functional status of the bionic prosthesis by comparing the baseline data, operative data, and oncological and prosthetic outcomes between the two groups.Results:The two groups were comparable in terms of baseline data including gender, age, height, weight and onset duration, and operative data including duration of operation (126.7±27.9 min vs 143.3±38.9 min, P=0.203), intra-operative hemorrhage (162.5±212.3 ml vs 247.6±175.6 ml, P=0.224) and duration of wound drainage (6.3±2.4 d vs 6.4±3.4 d, P=0.908). The mean follow-up duration of bionic group was 16.0±4.7 months, during which time three patients had systemic progression and one of them died of disease. Another patient had local recurrence and subluxation of the prosthesis that was treated by amputation. Subluxation might be related to the huge tumor mass and excessive resection of the quadriceps femoris. As for the control group, the mean follow-up duration was 12.7±4.5 months. Three patients had systemic progression and all patients were still alive by last follow-up. Local recurrence was seen in two patients and was treated by excision. No prosthetic complications were seen in the control group. The averaged range of motion (ROM) was greater in the bionic group than that in the control group (120.6°±13.6° vs 92.0°±7.7°, P<0.05), but the MSTS 93 scores were similar between groups (29.1±0.9 vs 29.5±0.6, P=0.337). Conclusion:Compared with the fixed-hinge distal femoral prosthesis, the bionic prosthesis had good peri-operative safety, did not increase the risks of prosthetic complications, and could achieve a better range of motion and a similar functional status based on the results of short-term follow-up.

Obiective:To investigate the design, the key points of surgery and the outcome of short-term follow-up of hemi-elbow-arthroplastic bionic total humeral prosthesis by using 3D-print.Methods:The clinical data of 8 patients with humerus malignant tumor who underwent total humerus resection and a 3D-printed auxiliary hemi-elbow-arthroplastic total humeral prosthesis replacement from March 2018 to March 2020 at Peking University People's Hospital were retrospectively analyzed. The operative data, oncological outcome, complication profiles of prosthesis and functional status of all 8 patients were also analyzed. There were 3 males and 5 females with a mean age of 5-37 years. Histological diagnosis included 5 cases of osteosarcoma, 2 cases of Ewing's sarcoma and 1 case of chondrosarcoma.Results:The time for production of the prosthesis was (9.8±2.7) d, the operation time was (209±23) min and intraoperative hemorrhage was (569±173) ml. All the prostheses were implanted successfully and no patients experienced intraoperative complications. While 2 patients had postoperative complications, 1 case of temporary palsy of radial nerve and 1 case of local recurrence. LARS artificial ligament or hernia patch was used to reconstruct joint capsule and tendon-ligament attached around the elbow and shoulder joint. The flexion and extension of the elbow was (118±15)° (100-140°) and (11±9)° (0-25°), and the abduction and anteflexion of the shoulder was (28±12)° (15-50°) and (26±9)° (15-40°), respectively. The postoperative Musculoskeletal Tumor Society (MSTS)-93 scale score was (24.1±1.5) scores. The median follow-up time was 17 months (12-32 months), 7 patients had disease-free survival and 1 patient survived with tumor.Conclusions:The novel 3D-printed total humeral prosthesis with hemi-elbow-arthroplasty has a good perioperative safety, which is effective in restoring the function of elbow joint, solving the problem of stress concentration of ulnar marrow lever of total elbow joint prosthesis and lowering long-term wear rate and loosening rate of prosthesis.

Mass spectrometry imaging (MSI), a label-free molecular imaging technique, has been applied widely in the spatial localization of small molecule metabolites, lipids, peptides, and proteins, with its unique advantage of high spatial resolving power compared to traditional liquid chromatography-mass spectrometry (LC-MS).With the nonstop advancement of its achievable sensitivity and spatial resolution, MSI technique has been providing novel perspectives into the preclinical studies of drugs, such as in vivo localization of drugs and their metabolites, visualization of drug metabolism, and drug delivery tracking.This review introduces the basics of MSI techniques, including basic principles, key features, technical advantages, and limitations, with particular highlight of the recent applications of MSI in drug efficacy and safety evaluation, drug distribution research, drug delivery research, and analysis of Chinese medicine from recent publications, aiming to promote the utilization and further expansion of MSI in the research and development of drugs.

Objective:To evaluation the performance of a total of 40 clinical biochemical reagents from three domestic manufacturers and two foreign manufacturers, and evaluate their clinical application value.Methods:The Beckman AU5400 automatic biochemical analyzer was used to verify the performance of 40 kinds of commonly used clinical biochemical reagents from three domestic manufacturers of Sichuan Maccura, Ningbo Medical System, and Shanghai Fosun Long March, and two foreign imported manufacturers of Roche and Japan′s Hitachi. The analysis samples were selected from the serum of patients who underwent clinical testing in Nanjing Drum Tower Hospital hospital from December 2021 to June 2022. Refer to China′s national health industry standards, China′s national pharmaceutical industry standards, the US Clinical Laboratory Standards Institute (CLSI) for the performance evaluation standards of in vitro diagnostic reagents, and the methods recommended in the relevant regulations of China′s State Food and Drug Administration on the management of in vitro diagnostic reagents. The precision, linear range, open bottle stability, interchangeability of calibrators and accuracy from different batches of 40 reagents were evaluated and validated. Simple linear regression analysis was used for linear regression, and P<0.05 indicated that the regression was statistically significant. Results:The overall precisions of 40 reagents were fine, except for one domestic reagent with low-level intra-batch coefficient of variation ( CV) exceeding the range declared in the specification. The intra-and inter-batch CVs of the remaining reagents were all smaller than those declared in their respective specifications. The linear ranges of domestic reagents and imported ones have achieved the linear ranges declared by each manufacturer. There were no statistical differences on the measurements between the reagents from open bottle of 30 days and the corresponding new ones for 40 reagents( P>0.05). The test values of domestic reagents and imported reagents after exchange of different batches of calibrators were within the ranges declared by each manufacturer. Both domestic reagents and imported reagents have passed the accuracy verification. Conclusions:The performance index of 27 biochemical detection indicators of the three domestic manufacturers are basically consistent with those of imported reagents, meeting the requirements of clinical biochemical laboratories. However, the bottle opening stability and anti-interference performance of some detection reagents needs to be improved.