Objective To investigate the value of dual-phase 18F-FDG PET/CT for differentiating pancreatic cancer from pancreatitis.Methods Dual-phase 18F-FDG PET/CT scanning was prospectively performed on patients with suspicious pancreatic lesions.Patients with solid focal pancreatic lesions proved by histopathology or clinical follow-up were enrolled and divided into 3 groups according to the maximum diameter of the focus: ≤2.0 cm (group A), >2.0 cm and ≤ 4.0 cm (group B), >4.0 cm (group C).SUVmax at (60±10) min and (120±15) min after FDG injection was defined as early and delayed SUVmax (SUVearly and SUVdelayed), respectively, and retention index (RI) was calculated.The differences of SUVearly, SUVdelayed and RI between pancreatic cancer and pancreatitis were analyzed with Mann-Whitney u test.ROC curve was used to determine the optimal cutoff values of the above three parameters and corresponding diagnostic efficiencies were obtained.The AUC was compared with MedCalc software.Results A total of 196 patients (152 pancreatic cancers and 44 pancreatic inflammatory lesions) with solid focal pancreatic lesions were enrolled.The AUC of SUVdelayed was significantly larger than that of SUVearly (0.83 vs 0.79, z=3.64, P<0.01).Numbers of patients in group A, B and C were 45, 96 and 55 respectively.There was no significant difference of the maximum diameter between pancreatic cancers and pancreatitis lesions in all three groups (z values:-0.39,-1.52,-1.41, all P>0.05).The SUVearly, SUVdelayed and RI of pancreatic cancers were all higher than those of pancreatitis in group A and B (z values: from-4.59 to-3.00, all P<0.01).The diagnostic sensitivity and accuracy of SUVearly > 3.6 combined with RI > 0 for diagnosing pancreatic cancer were higher than those of SUVearly > 3.6: 96.4%(27/28) vs 75.0%(21/28), 95.6%(43/45) vs 82.2%(37/45).The AUC of SUVdelayed was significantly larger than that of SUVearly in group B (0.81 vs 0.77, z=2.06, P<0.05).The optimal cutoff value of SUVdelayed in group B was 5.3, with the corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.4%(65/77), 13/19, 91.5%(65/71), 52.0%(13/25) and 81.2%(78/96), respectively.RI of pancreatic cancers was significantly higher than that of pancreatitis (25.0%(15.8%-35.7%) vs 14.4%(4.6%-18.7%), z=-2.39, P<0.05) in group C.The optimal cutoff value of RI in group C was 19.0%, with the corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 68.1%(32/47), 7/8, 97.0%(32/33), 31.8%(7/22) and 70.9%(39/55).Conclusions The SUVdelayed and RI of dual-phase 18F-FDG PET/CT might be useful for diagnosis of pancreatic tumors.SUVearly > 3.6 combined with RI >0 could be helpful to improve the diagnostic sensitivity and accuracy in patients with the maximum diameter of lesions ≤2.0 cm.The diagnostic value of SUVdelayed might be better than that of SUVearly in patients with the maximum tumor diameter of >2.0 cm and ≤4.0 cm.Only RI could be used for diagnosing pancreatic tumors in patients with the maximum tumor diameter > 4.0 cm.

A case of a 3-year-old child suffered with severe crush injury to the right forearm and right hand on June, 2017. A comprehensive treatment was conducted with limb salvage, free flap repair and the repair of nerve, vessel and tendon for functional reconstructions followed by rehabilitation therapies. The function and appearance of the injured limb and hand recovered well 3 years after surgery.

We had applied methods of stratified sampling and simple random sampling and collected 1704 questionnaires in 21 various hospitals, 18 provinces, then analyzed them. The conclusion showed that 78.4 percent experts presumed that the dosage rang of some traditional Chinese medicine should be revised. The dosages in the pharmacopoeia are not coincided with the practical dosages, and demand to revise. This paper will offer the consummate data for formulating the new dosage standard.
Dose-Response Relationship, Drug ; Drug Dosage Calculations ; Drug Therapy ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Surveys and Questionnaires

Objective: To investigate the value of ¹⁸F-fluorodeoxyglucose (FDG) PET/CT in differentiation of noninvasive and malignant pancreatic cystic lesions (PCL). Methods: A total of 125 PCL patients (66 males, 59 females, age range: 13-83 years), who had pathology or typical imaging performance with ≥12 months follow-up between August 2010 and December 2015, were enrolled in this retrospective study. The diagnostic effects of ¹⁸F-FDG PET/CT were calculated. The size, maximum standardized uptake value (SUV_max), delayed SUV_max and retention index (RI) of noninvasive and malignant PCL were analyzed. The results of pathological examination and follow-up were used as the gold standard, and Mann-Whitney u test was used to analyze the data. Receiver operating characteristic (ROC) curves of SUV_max, delayed SUV_max and RI were drawn and compared. Results: A total of 132 PCL were found in 125 patients, including 71 malignant PCL and 61 noninvasive PCL. The size, SUV_max, delayed SUV_max, RI of noninvasive and malignant PLC were 2.2 (1.4, 3.8) cm vs 3.9 (3.0, 5.0) cm, 1.5 (1.2, 1.8) vs 6.4 (4.4, 9.3), 1.5 (1.2, 1.9) vs 6.4 (5.4, 11.7), -6.3%(-19.4%, 5.6%) vs 17.5%(7.6%, 29.4%), respectively. All parameters were significantly different between 2 groups (z values: from -9.267 to -4.904, all P<0.05). The area under curve (AUC) and cut-off value of SUV_max were 0.969 and 2.5, and the corresponding accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were 92.4%(122/132), 93.0%(66/71), 91.8%(56/61), 93.0%(66/71), 91.8%(56/61), respectively. The AUC and cut-off value of delayed SUV_max were 0.969 and 2.7, and the accuracy, sensitivity, specificity, PPV, NPV were 94.3%(99/105), 96.7%(58/60), 91.1%(41/45), 93.5%(58/62), 95.3%(41/43), respectively. ROC curves of SUV_max and delayed SUV_max were not significantly different (z=1.799, P>0.05). Conclusion ¹⁸F-FDG PET/CT has good performance in differentiation of noninvasive and malignant PCL, but the delayed scan cannot further improve the efficacy of differential diagnosis.

This article reports a case, happened in July 2019, of 9 severed segments of 2nd-5th fingers in left hand treated in the Department of Repair and Microsurgery, Zhengzhou Renji Hospital. Through the unified management before surgery, team surgery, three or four fixed-point mattress eversion suture and close observation after surgery. It can effectively prevent the occurrence of vascular compromise. All the replanted fingers survived after the surgery. And the function of the fingers recovered well at 2 years after surgery through early and continuous rehabilitation exercise.

Objective:To observe the clinical efficacy of Heweishupiyin decoction in the treatment of functional dyspepsia (FD) in elderly patients with liver stagnation and spleen deficiency.Methods:A randomized controlled method was performed in this study, and 70 FD patients were selected from February 2018 to June 2019 in accordance with the inclusion criteria.The patients were divided into the observation group and the control group according to the random digital table method, with 35 cases in each group.The observation group was treated with Heweishupiyin decoction, the control group was given mosapride citrate tablets.The period of treatment was 4 weeks.The changes of total symptom scores, TCM syndrome evaluation, electrogastrogram (EGG) parameters, serum serotonin, and Hamilton depression scale (HAMD) scores before and after treatment were recorded.The statistical analysis was performed to evaluate the clinical efficacy of Heweishupiyin decoction.Results:After treatment, the overall symptom scores in both two groups were decreased.The overall symptom score of the observation group after treatment[(8.03±4.23)points] was lower than that of the control group[(10.36±4.67)points], and the difference was statistically significant( t=2.145, P<0.05). The overall efficacy of TCM symptoms of the observation group was 88.2% (30/35), which was significantly higher than 72.8% (24/35) of the control group ( Z=-2.473, P<0.05). After treatment, the EGG parameters of two groups had different degrees of increase, the main frequency of the observation group after meal[(3.39±0.34)cpm] was higher than that of the control group[(3.18±0.36)cpm], the difference was statistically significant( t=-2.202, P<0.05). The percentage of normal slow wave in the observation group[(68.91±4.79)%] was higher than that in the control group[(66.33±3.00)%], and the difference was statistically significant( t=-2.549, P<0.05). The reaction area of the observation group[(99.09±13.58)μV/s] was higher than that of the control group[(90.27±14.70)μV/s], and the difference was statistically significant( t=-2.390, P<0.05). After 4 weeks of treatment, the HAMD score of the observation group[(14.94±2.42)points] was lower than that of the control group[(16.94±4.29)points], and the difference was statistically significant( t=2.355, P<0.05). The serum level of serotonin after treatment in the observation group[(110.46±16.69)μmol/L] was higher than that in the control group[(99.04±19.86)μmol/L], the difference was statistically significant( t=-2.551, P<0.05). Conclusion:Heweishupiyin decoction is superior to mosapride citrate tablets in improving the overall symptomatic efficacy and TCM syndrome efficacy of FD patients with liver stagnation and spleen deficiency.Heweishupiyin not only can improve the depression state of FD in the elderly, but also has the effect of improving the gastric electrical rhythm disorder, which may be related to the regulation of serum serotonin levels.

Objective: The objective of this study was to analyze the different brain oxygen metabolism statuses in preeclampsia using magnetic resonance imaging and investigate the factors that affect cerebral oxygen metabolism in preeclampsia. Materials and Methods: Forty-nine women with preeclampsia (mean age 32.4 years; range, 18–44 years), 22 pregnant healthy controls (PHCs) (mean age 30.7 years; range, 23–40 years), and 40 non-pregnant healthy controls (NPHCs) (mean age 32.5 years; range, 20–42 years) were included in this study. Brain oxygen extraction fraction (OEF) values were computed using quantitative susceptibility mapping (QSM) plus quantitative blood oxygen level-dependent magnitude-based OEF mapping (QSM + quantitative blood oxygen level-dependent imaging or QQ) obtained with a 1.5-T scanner. Voxel-based morphometry (VBM) was used to investigate the differences in OEF values in the brain regions among the groups. Results: Among the three groups, the average OEF values were significantly different in multiple brain areas, including the parahippocampus, multiple gyri of the frontal lobe, calcarine, cuneus, and precuneus (all P-values were less than 0.05, after correcting for multiple comparisons). The average OEF values of the preeclampsia group were higher than those of the PHC and NPHC groups. The bilateral superior frontal gyrus/bilateral medial superior frontal gyrus had the largest size of the aforementioned brain regions, and the OEF values in this area were 24.2 ± 4.6, 21.3 ± 2.4, and 20.6 ± 2.8 in the preeclampsia, PHC, and NPHC groups, respectively. In addition, the OEF values showed no significant differences between NPHC and PHC. Correlation analysis revealed that the OEF values of some brain regions (mainly involving the frontal, occipital, and temporal gyrus) were positively correlated with age, gestational week, body mass index, and mean blood pressure in the preeclampsia group (r = 0.361–0.812). Conclusion Using whole-brain VBM analysis, we found that patients with preeclampsia had higher OEF values than controls.

Objective:To analyze the clinical efficacy of two-stage total hip arthroplasty in the treatment of chronic septic hip arthritis.Methods:From January 2008 to March 2020, 17 patients with chronic septic hip arthritis (17 hips) received two-stage total hip arthroplasty at Department of Orthopaedic Surgery, The First Affiliated Hospital to of Fujian Medical University. They were 11 males and 6 females, with an average age of 54.5 years (from 19 to 77 years) and 9 left and 8 right hips affected. There were 10 cases of primary septic hip and 7 cases of secondary infection after hip surgery. Three patients had undergone debridement in other hospitals and one patient had developed a sinus tract. In the first stage operation, the diseased femoral head and neck were resected to implant an articulating spacer after thorough debridement; in the second stage operation, the spacer was removed to implant a uncemented artificial hip prosthesis in 16 cases or a cemented artificial hip prosthesis in one case. Recorded were the results of microbial culture, operation time, intraoperative blood loss, and therapeutic outcomes of the patients.Results:Pathogenic data were available in 13 patients and the culture was negative in 4. The pathogens were detected by metagenomic next-generation sequencing in 2 patients with culture negative. In the first stage operation, operation time averaged 140.6 min (from 90 to 176 min) and intraoperative blood loss 361.8 mL(from 100 to 1 000 mL); in the second stage operation, operation time averaged 130.3 min (from 91 to 166 min)and blood loss 291.2 mL(from 50 to 700 mL). The average interval between the first and the second stage operations was 115.0 days(from 66 to 227 d). During the interval, spacer fracture occurred in one case, spacer dislocation in one case and lower extremity deep venous thrombosis in one case. All the patients were followed up for 12 to 82 months (average, 36.7 months) after second stage operation. The inflammatory indexes decreased to normal in all the 17 patients and infection recurrence was observed in none of them.Conclusions:Two-stage total hip arthroplasty may result in a high rate of successful treatment of chronic septic hip arthritis. Specific use of sensitive antibiotics after identification of specific pathogenic microorganisms by multiple methods is the key to a successful treatment.

Objective:To explore whether MRI WARP sequence can provide clearer musculoskeletal images to guide the operation for patients with periprosthetic joint infection (PJI) by comparing MRI WARP sequence images with conventional sequence images.Methods:The data were analyzed retrospectively of 23 PJI patients who had been diagnosed and treated at Department of Orthopedics, The First Affiliated Hospital to Fujian Medical University from January 2020 to February 2021. They were 13 females and 10 males, with an average age of 62.8 years (from 32 to 88 years). According to the MRI sequences, they were divided into a WARP group ( n=14) subjected to MRI scanning by WARP sequence and a conventional group ( n=9) subjected to MRI scanning by conventional sequence. The gender, age, erythrocyte sedimentation rate (ESR) and C-reaction protein (CRP) were recorded for both groups. The signal-to-noise ratios were compared between the 2 sequences and 2 experts evaluated the clarity and surgical guidance of the images. Results:There was no significant difference in gender, age, CRP or ESR between the 2 groups, showing comparability ( P>0.05). The 2 experts showed consistency in evaluation of image sharpness and surgical guidance ( P<0.05). The WARP group was significantly better than the conventional group in image sharpness score [2.25(2.0, 2.6) versus 1.00 (0.5, 1.0)], surgical guidance score [2.00(1.5, 2.5) versus 0.50(0, 0.8)], and signal-to-noise ratio [47.28 (32.8, 74.3) versus 21.67(13.5, 31.4)] ( P<0.05). Conclusion:MRI WARP sequence can provide clearer musculoskeletal images than conventional MRI sequence to better guide the operation for PJI patients.

Objective To investigate the regulatory mechanism of apurnic/apyrimidinic endonuclease 1(APE1)in the transformation of chronic intestinal inflammation to colitis-associated colorectal cancer(CAC).Methods C64S mutant(APE1C64S)mice and APE1 wild type(APE1WT)mice were randomly divided into experimental group and control group.In vivo CAC model was established by azoxymethane(AOM)and dextran sulfate sodium salt(DSS)solution.Immunohistochemistry(IHC)and multiple IHC(mIHC)assays were used to observe the expression of APE1 and immune cell infiltration in colon tissues of each group.A mouse colon cancer cell line MC38 with stable knockdown of APE1 was constructed by lentivirus transfection,and subcutaneous tumor bearing experiments were performed in APE1WT and APE1C64S mice to confirm that tumor cell-derived APE1 caused immunosuppressive tumor microenvironment.The expression of APE1 and CXCL1[chemokine(C-X-C motif)ligand 1]and the infiltration of immune cells in tumor-bearing specimens were analyzed by IHC and mIHC assays.The tumor specimens of a 28-year-old female patient with CAC from Army Medical Center of PLA were analyzed for the expression of APE1 and CXCL1 and the infiltration of immune cells in the tumor and adjacent inflammatory tissues by IHC and mIHC assays.Results Compared with the control group and APE1WT erperimental group,APE1C64S erperimental group had significantly reduced disease activity index and tumor formation,polymorphonuclear myeloid-derived suppressor cells(PMN-MDSCs)infiltration,and CD4+and CD8+T cells(P＜0.05).No significant differences were observed in tumor growth and immune cells between APE1WT and APE 1C64S mice bearing subcutaneous tumors.However,in the tumor-bearing experiment using tumor cells with knockdown of APE1,the tumor growth was significantly lower and the number of infiltrated PMN-MDSCs was reduced,while those of CD4+and CD8+T cells were significantly increased(P＜0.05).Furthermore,high expression of APE1 and increased infiltration of PMN-MDSCs were found in the tumor tissues of the young CAC patient,and CD8+T cells were significantly reduced in the tumor tissues compared with the inflammatory tissues(P＜0.05).Conclusion APE1-redox in tumor cells can promote the infiltration of PMN-MDSCs and reduce the number of T cells,thereby forming an immunosuppressive tumor microenvironment and mediating the occurrence and development of CAC.