Objective To evaluate the curative effect of percutaneous compression plating system in treatment of intertrochanteric fractures of the elderly patients.Methods The clinical data of 18 elderly patients(aged 68-89 years)with intertrochanteric fractures were retrospectively analyzed.According to Evans classification,there were seven patients with type Ⅰ fractures,nine with type Ⅱ fractures and two with type Ⅲa fractures.Percutaneous compression plating system was applied to all patients from June 2007 to June 2009,and the therapeutic effect was evaluated by Harris hip function evaluation criteria.Results All the fractures were healed,with excellent results in 15 patients and good results in the rest three patients.Conclusions The percutaneous compression plating system is easy to manipulate with minimal invasion,has minor side effect and is beneficial to reducing surgical complications in the elderly patients with intertrochanteric fractures.

Based on the histories of moxibustion and moxibustion apparatus, this paper studies two basic patterns and the problem of categorizing about moxibustion instrument, and summarizes and experimentalizes its mechanism. Its developing way is brought up.

Objective To investigate the relationship between chronic atrophic antral gastritis and the decrease of somatostatin levels in blood and pyloric glands and adaptable protection ability of gastric mucosa.Methods Gastric mucosa biopsy specimen and blood samples were collected to determine the levels of somatostatin(SST)using radioimmunoassay.Histological changes between pre-and post-treatment were observed under light microscope as well as the changes of uhramicrostrucuture under transmission electron microscope.Distribution of SST in gastric mucosa was studied by immunohistochemical staining and then quantified.Results The quantities of gastric antral D cells of chronic atrophic antral gastritis decrease obviously.SST was mainly distributed in D cells of mucosa pyloric gland crypt.The nucleus of mucus epithelial cells in atrophic gastric antral crypt had SST negative staining.Mitochodria swellen,crista broken,rough endoplasmic reticulum distension,mucus secretory granules decreasing,the nuclear membranes disappearing as well as ehromatin integrating could have been seen in the intracytoplasm of mucus epitheliun cells of chronic atrophic gastric antral gastritis.The average level of SST in blood,epithelium and crypt were obviously reduced comparing to that of in the control group.By immunochemistry staining,the SST level in crypt of atrophic gastric antral gastritis Was significantly reduced comparing to that of in control group.With the level of SST in blood＜10 pg/100μl,the probability ratio of emerging atrophy Was 67.7%.Conclusions In case of no systemic inflammatory reaction state,the decreased ability of human pyloric gland D cell in producing SST not only rehtes obviously with human chronic atrophic antral gastritis but also with the weakened adaptable protection ability of gastric mucosa.

BACKGROUND: Expectant treatment for intertrochanteric fractures in elderly patients with osteoporosis and other chronic diseases can easily lead to complications of lying in bed.OBJECTIVE: To evaluate the results of percutaneous compression plating system (PCCP) for intertrochanteric fractures in elderly patients. METHODS: Thirty-two cases of elderly intertrochanteric fractures treated with PCCP admitted from June 2007 to June 2009 and 40 cases of elderly intertrochanteric fractures treated with dynamic hip screw system (DHS) were reviewed. The operative bleeding, operative time and curative effect were compared.RESULTS AND CONCLUSION: The operative bleeding and operative time in the patients receiving PCCP were significantly lower than those in the patients receiving DHS. There was not statistical significance between the curative effects about the two methods. PCCP applied in elderly patients with intertrochanteric fracture can get satisfactory effects, and the system is operated simply with minimally invasive surgery, which is beneficial to reduce surgical complications.

BACKGROUND:Discectomy is an important therapy for lumbar disc herniation, but a smal number of patients undergoing discectomy wil relapse.
OBJECTIVE:To investigate the spinal stability fol owing posterior pedicle screw fixation combined with interbody fusion cage for treatment of recurrent lumbar disc herniation.
METHODS:Twenty-six patients with recurrent lumbar disc herniation from January 2007 to December 2011 were enrol ed and subjected to posterior pedicle screw fixation combined with interbody fusion cage. Pain relief and lumbar stability were observed postoperatively. We analyzed the spinal stability in recurrent lumbar disc herniation patients after posterior pedicle screw fixation combined with interbody fusion cage depending on literature search.
RESULTS AND CONCLUSION:Al the 26 patients were fol owed up for 12-36 months. After treatment, al patients effectively al eviated the symptoms of low back pain, and lumbar interbody fusion was good, with a good rate of 96.2%. There was no pedicle screw loosening, broken, non-fusion phenomenon. Posterior decompression and interbody fusion cage combined with posterior pedicle screw fixation for recurrent lumbar disc herniation, characterized as fast symptom relief, strong fixation, exact interbody fusion exact, is an ideal treatment for recurrent lumbar disc herniation.

Objective:To develop and validate a visualized computed tomography nomogram for differentiating focal-type autoimmune pancreatitis (fAIP) from pancreatic ductal adenocarcinoma (PDAC).Methods:This retrospective review included 42 consecutive patients with fAIP diagnosed according to the International Consensus Diagnostic Criteria and 242 consecutive patients with PDAC confirmed by pathology between January 2011 and December 2018 in the First Affiliated Hospital of Naval Medical University. Among them, 209 consecutive patients (25 fAIP and 184 PDAC) were enrolled in the development cohort; Seventy-five consecutive patients (17 fAIP and 58 PDAC) were enrolled in the validation cohort. CT image characteristics, including lesion location, size, enhancement mode and degree of mass enhancement in portal vein phase, pancreatic parenchymal atrophy, main pancreatic duct dilation, common bile duct dilation, cyst, acute obstructive pancreatitis, and vascular invasion were compared. Univariate and multivariate analysis were used to screen the independent predictive factors for fAIP and PDAC, based on which the nomogram was constructed and visualized. The receiver operating characteristic curve (ROC) was drawn and area under the curve (AUC) was calculated to evaluate the differential efficacy of the nomogram. The clinical usefulness of the nomogram was evaluated by decision curve analysis.Results:There were statistically significant differences on common bile duct dilation and the mode and degree of enhancement in portal phase between fAIP group and PDAC group in training set and validation set ( P<0.05). Univariate regression analysis showed that common bile duct dilation and degree of mass enhancement in portal vein were closely correlated with fAIP and PDAC phase between the two groups in training set and validation set; mass enhancement mode in portal vein phase and main pancreatic duct dilation were closely correlated with fAIP and PDAC in training set. Multivariate logistic regression analysis showed that common biliary duct dilatation ( OR=0.26, 95% CI 0.06-1.10, P=0.07), main pancreatic duct dilation ( OR=9.46, 95% CI 1.60-56.04, P<0.01) and mass mild hyper-enhancing in portal vein phase ( OR=0.003, 95% CI 0.0003-0.0278, P<0.0001) were the three independent predictors for fAIP and PDAC. Thus, the equation for predicting the probability of PDAC was 4.51-1.33× no dilatation of the common bile duct+ 2.25× the main pancreatic duct dilated-5.84× mass mild hyper-enhancing during the portal phase. The individualized prediction nomogram using these predictors of the fAIP achieved an AUC of 0.97 (95% CI 0.95-0.99) in the development set and 0.97(95% CI0.94-1.00) in the validation set. The sensitivity, specificity and accuracy of the model were 87.5%, 100% and 89% in the training set; and 94.83%, 94.12% and 94.67% in the validation set, respectively. The decision curve analysis demonstrated that the nomogram was clinically useful when the nomogram differentiated fAIP and PDAC at a rate of >0.2. Conclusions:The nomogram based on common bile duct dilation, main pancreatic duct dilation and mass enhancement in portal vein phase can be used as a useful tool for predicting fAIP and PDAC and provide valuable evidence for clinical decision.

Objective To study the value of reduced field-of-view (rFOV DWI) in differentiating patients with solid pancreatic focal lesions.Methods 139 patients with solid pancreatic mass were enrolled,including 105 patients with pancreatic ductal acinar carcinoma (PDAC),16 patients with neuroendocrine neoplasms,7 patients with mass forming chronic pancreatitis (MFCP) and 11 patients with solid papillary tumor (SPT).38 healthy adult volunteers served as controls,and underwent single stimulated echo planar imaging (ss-EPI) DWI and rFOV DWI(b value =0 and 600 s/mm2) MRI examination.Quartation method was used to evaluate the image quality of ss-EPI) DWI and rFOV DWI in the three terms of the visibility of anatomical structure,contrast of pancreatic lesions,motion and the susceptibility artifacts during MRI.Work station self-carried software was used to measure the ADC value of the region of interest (ROI).The image quality and ADC values of different pancreatic diseases and normal pancreas were compared.ROC curve for ADC value was drawn to evaluate the difference among PDAC,other benign pancreatic masses and normal pancreas.Results At b value of 0 and 600 s/mm2,rFOV DWI was superior to ss-EPI DWI in terms of showing pancreatic anatomic structure,the contrast of the lesion and the score evaluation for susceptibility artifacts(b =0 s/mm22.99 ±0.51 vs 2.79 ±0.64,2.37±0.48 vs 1.81 ±0.63,3.17 ±0.56 vs 2.91 ±0.60;b =600 s/mm23.63 ±0.50 vs 3.32 ±0.56,3.45 ±0.50 vs 3.01 ±0.49,3.74 ±0.44 vs 3.12 ±0.37),and the differences were statistically significant (P＜0.001).ADC values of PDAC,NET,MFCP,SPT and normal pancreas were (1.38 ± 0.17) × 10-3,(1.22 ± 0.35) × 10-3,(1.29 ± 0.13) × 10-3,(1.04 ± 0.38) ×10-3and(1.86±0.15) ×10-3mm2/sforrFOV DWI,and (1.73 ± 0.24) ×10-3,(1.63±0.39) ×10-3,(1.58±0.19) × 10-3,(1.25±0.26) × 10-3 and(2.04±0.20) × 10-3mm2/s for ss-EPI DWI.The difference on ADC values among different groups and within one group were all statistically significant (P ＜0.001).There were no statistical significant differences on ADC values between MFCP and PDAC,between MFCP and SPT as well as on ss-EPI DWI ADC values between PDAC and NET,but statistical differences were found between other two groups (P ＜ 0.05).The area under the ROC curve of rFOV and ssEPI DWI was 0.983 (95％ CI 0.944-0.998) and 0.889 (95％ CI 0.822-0.936),respectively,and the difference was statistically significant (P =0.0004),but rFOV DWI and ss-EPI DWI ADC values for PDAC and all benign solid diseases were 0.799 (95％ CI 0.719-0.864) and 0.755 (95％ CI 0.672-0.827),and the difference was not statistically significant.Conclusions rFOV DWI could significantly enhance the quality of DWI images,and its diagnostic efficacy was much better than ss-EPI DWI.

Objective:To investigate the MRI features of intraductal papillary mucinous tumor (IPMN) of the pancreas and establish a prediction model for predicting the malignancy risk.Methods:The clinical data of 260 IPMN patients who underwent MRI and pathological confirmed in the First Affiliated Hospital of Naval Medical University from October 2012 to April 2020 were retrospectively analyzed. According to the pathological results, all patients were divided into benign group (including IPMN with low-grade dysplasia) and malignant group (including IPMN with high grade dysplasia and invasive carcinoma). According to international consensus of prediction model modeling, patients were divided into training set and validation set in chronological order. A prediction model was developed based on a training set consisting of 193 patients (including 117 patients with benign IPMN and 76 patients with malignant IPMN) between October 2012 and April 2019, and the model was validated in 67 patients (including 40 patients with benign IPMN and 27 patients with malignant IPMN) between May 2019 and April 2020. The multivariable logistic regression model was adopted to identify the independent predictive factors for IPMN malignancy and establish and visualized a nomogram. The ROC was drawn and AUC was calculated. The decision curve analysis was used to evaluate its clinical usefulness.Results:The IPMN type, cyst size, thickened cyst wall, mural nodule size, diameter of main pancreatic duct (MPD) and the abrupt change in the caliber of the MPD with distal pancreatic atrophy in the training set and validation set, and jaundice and lymphadenopathy in the training set were significantly different between benign group and malignant group ( P<0.05). The multivariable logistic regression model of characteristics included the jaundice, cyst size, mural nodule size ≥5 mm, the abrupt change in caliber of the MPD with distal pancreatic atrophy were independent risk factors for IPMN maligancy. The model for predicting IPMN malignancy was -0.35+ 2.28×(jaundice)+ 1.57×(mural nodule size ≥5 mm)+ 2.92×(the abrupt change in caliber of the MPD with distal pancreatic atrophy)-1.95×(cyst <3 cm)-1.05×(cyst≥3 cm). The individualized prediction nomogram using these predictors of the malignant IPMN achieved an AUC of 0.85 (95% CI 0.79-0.91) in the training set and 0.84 (95% CI 0.74-0.94) in the validation set. The sensitivity, specificity and accuracy of the training set were 72.37%, 85.47% and 80.31%, respectively. The sensitivity, specificity and accuracy of the validation set were 81.48%, 75.00% and 77.61%, respectively. The decision curve analysis demonstrated that when the IPMN malignancy rate was >0.16, the nomogram diagnosing IPMN could benefit patients more than the strategy of considering all the patients as malignancy or non-malignancy. Conclusions:The nomogram based on MRI features can accurately predict the risk of malignant IPMN, and can be used as an effective predictive tool to provide more accurate information for personalized diagnosis and treatment of patients.

Objective:To develop and verify a predictive model based on CT characteristics for predicting infected walled-off necrosis (IWON) in MSAP and SAP patients.Methods:The clinical and CT data of 1 322 patients diagnosed as MSAP and SAP according to the 2012 Atlanta revised diagnostic criteria in the First Affiliated Hospital of Naval Medical University from January 2015 to December 2020 were continuously collected. Finally, 126 patients who underwent enhanced CT scans within 3 days after admission and percutaneous catheter drainage of WON during hospitalization were enrolled. Among them, there were 63 MSAP and 63 SAP patients. According to the results of the culture from drainage fluid, the patients were divided into sterile walled-off necrosis group (SWON group, n=31) and infected walled-off necrosis group (IWON group, n=95). Patients were divided into training set (18 patients with SWON and 74 patients with IWON from January 2015 to December 2018) and validation set (13 patients with SWON and 21 patients with IWON from January 2019 to December 2020). Univariate and multivariate logistic regression analysis were performed to establish a model for predicting IWON. The model was visualized as a nomogram. The receiver operating characteristic curve (ROC) was drawn. The predictive efficacy of the model was evaluated by the area under the curve (AUC), sensitivity, specificity and accuracy, and the clinical application value was judged by decision curve analysis (DCA). Results:Univariate regression analysis showed that age, etiology, WON with bubble sign and the lowest CT value of WON were significantly associated with IWON. Multivariate logistic regression analysis showed that older age, biliary acute pancreatitis, WON with bubble sign, and the greater minimum CT value of WON were independent predictors for IWON. The formula for the prediction model was 0.12+ 0.01 age-0.75 hyperlipidemia-1.62 alcoholic-2.62 other causes+ 19.18 WON bubble sign+ 0.10 minimum CT value of WON. The AUC, sensitivity, specificity, and accuracy of the model were 0.85 (95% CI 0.76-0.94), 67.57%, 88.89%, and 71.74% in the training set and 0.78(95% CI0.62-0.94), 66.67%, 84.62%, and 73.53% in the validation set, respectively. The decision analysis curve showed that when the nomogram differentiated IWON from SWON at a rate greater than 0.38, using the nomogram could benefit the patients. Conclusions:The prediction model established based on CT characteristics might non-invasively and accurately predict the presence or absence of IWON in MSAP and SAP patients, and provide a basis for guiding treatment and evaluating prognosis.

Objective:To investigate the value of machine learning model based on MRI in predicting the abundance of tumor infiltrating CD 8+ T cell and prognosis of pancreatic cancer patients. Methods:The clinical data of 156 patients with pathological confirmed pancreatic cancer who underwent pre-operative MRI within 7 days before surgery in the First Affiliated Hospital of Naval Medical University from January 2017 to April 2018 was retrospectively analyzed. According to the international consensus on the predictive model, a total of 116 patients from January to December 2017 were included in the training set, and a total of 40 patients from January to April 2018 were included in the validation set. With the overall survival of patients as the outcome variable, X-Tile software was used to obtain cut-off values of the percentage of CD 8+ T cells, and all patients were divided into CD 8+ T-high and -low groups. The clinical, pathological and radiological features were compared between two groups. 3D slicer software was used to draw the region of interest in each layer of the primary MR T 1- and T 2-weighted imaging, arterial phase, portal venous phase, and delayed phase images for tumor segmentation. Python package was applied to extract the radiomics features of pancreatic tumors after segmentation and the extracted features were reduced and chosen using the least absolute shrinkage and selection operator (Lasso) logistic regression algorithm. Lasso logistic regression formula was applied to calculate the rad-score. The extreme gradient boosting (XGBoost) were used to construct the machine learning predicted model. The models′ performances were determined by area under the ROC curve (AUC), sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Results:The cut-off value of the CD 8+ T-cell level was 19.09% as determined by the X-tile program. Patients in the high CD 8+ T cell group had a longer median survival than those in the low CD 8+ T cell group (25.51 month vs 22.92 month, P=0.007). The T stage in the training set and tumor size in the validation set significantly differed between the groups (all P value <0.05). A total of 1 409 radiomics features were obtained, and 19-selected features associated with the level of CD 8+ T cell were determined after being reduced by the Lasso logistic regression algorithm. The rad-score was significantly lower in the CD 8- high group (median: -0.43; range: -1.55 to 0.65) than the CD 8- low group (median: 0.22; range: -0.68 to 2.54, P<0.001). The prediction model combined the radiomics features and tumor size. In the training set, the AUC, sensitivity, specificity, accuracy, and positive and negative predictive value were 0.90 (95% CI 0.85-0.95), 75.47%, 90.48%, 0.84, 0.87, and 0.81. In the validation set, the AUC, sensitivity, specificity, accuracy, and positive and negative predictive value were 0.79 (95% CI 0.63-0.96), 90.00%, 80.00%, 0.85, 0.82, and 0.89. The predictive model can accurately distinguish patients with high and low CD 8+ T cells in pancreatic cancer. Conclusions:The radiomics-based machine learning model is valuable in predicting the CD 8+ T cells infiltrating level in pancreatic cancer patients, which could be useful in identifying potential patients who can benefit from immunotherapies.