BACKGROUNDTo detect quantitatively HCMV DNA in peripheral blood leukocytes to monitor the status of HCMV infection, evaluate the effectiveness of antiviral treatment with ganciclovir (GCV) combined with intravenous immunoglobulin (IVIG) and find out the relationship among the HCMV DNA levels, the state of infection and the clinical outcome.The long-term goal of the study was to establish a molecular diagnostic standard for HCMV infection in children.

METHODS45 cases of suspected HCMV-infected children were examined by PCR, ELISA and fluorescent quantitative (FQ)-PCR, respectively. Twenty five HCMV hepatitis cases of the 45 were randomly assigned to a treated group or a control group. Both groups were treated with prednisone, glucurone, Luminal and Xiaoyanlidanpian. But the treated group was given with GCV+IVIG in addition. Each infant of the two groups was checked with FQ-PCR at the five time points.

RESULTSThe positive rates of PCR, ELISA and FQ-PCR were 60.00%, 33.33% and 66.67%,their sensitivities were 84.38%, 46.88% and 93.75%, respectively. There was no significant difference in viral DNA copy numbers between the two groups before being treated (P>0.05), but there was significant difference between HCMV hepatitis and normal infants (P<0.001). Although viral load of both groups decreased in both groups, the viral load of the treated group decreased more significantly. The level of HCMV DNA fell to 103 copies/ml at second time point while that of the control group fell to the same level after third time point. The differences between the two groups at each time point were statistically significant (P<0.001). The results of 135 person times testing indicated that 103 copies/ml of FQ-PCR can be taken as a critical value for prediction of active HCMV infection.

CONCLUSIONSFQ-PCR may be one of the effective methods for diagnosis of HCMV disease; it can offer a key index in the diagnosis of HCMV active infection; dynamic detection of HCMV viral load can play a role not only in monitoring antiviral therapy, but also in evaluating the development and prognosis of HCMV disease.

Antiviral Agents ; therapeutic use ; Cytomegalovirus ; isolation & purification ; Cytomegalovirus Infections ; diagnosis ; drug therapy ; DNA, Viral ; blood ; Ganciclovir ; therapeutic use ; Humans ; Infant ; Infant, Newborn ; Polymerase Chain Reaction ; methods ; Sensitivity and Specificity ; Treatment Outcome

Objective:To investigate the efficacy of endovascular embolization in the treatment of traumatic carotid cavernous fistula (TCCF) and the influencing factors of outcomes.Methods:Patients with Barrow A type TCCF underwent intravascular embolization in the Department of Neurosurgery, General Hospital of Ningxia Medical University from January 2009 to November 2019 were enrolled. They were treated with detachable balloons or Onyx-18 combined with coils via transarterial approach, and clinical and imaging follow-up were performed after operation. Recurrence was defined as a lesion that was completely embolized immediately, but the original fistula was redeveloped during imaging follow-up. The clinical recovery was defined as the disappearance of intracranial vascular murmur, pulsatile exophthalmos, conjunctival hyperemia and edema, the movement of eyeball without disorder and the restoration of vision loss. Multivariate logistic regression analysis was used to determine the independent risk factors for affecting imaging recurrence and clinical recovery. Results:A total of 54 patients with Barrow A type TCCF were enrolled. Their age was 42.5±10.6 years (range, 28-70 years); 36 were male (66.7%). Clinical manifestations: 40 patients (74.1%) had ocular symptoms (exophthalmos, conjunctival congestion, etc.), 35 (64.8%) had intracranial vascular murmur, 36 (66.7%) had visual impairment (decreased vision, visual field defect), 32 (59.3%) had headache, 15 (28.3%) had abducens nerve palsy, and 4 (9.1%) had epistaxis. Fourty-seven patients (87.0%) had superior ophthalmic vein drainage, 19 (35.2%) had superior and inferior petrosal sinus drainage, and 9 (16.7%) had cortical vein drainage. Twenty-eight patients (51.9%) were treated with Onyx-18 combined with coils, and 26 (48.1%) were treated with detachable balloons. After operation, 47 patients (87.0%) were immediately totally embobilized, 4 of them were totally embolized with Onyx-18 and coils after the failure of balloon embolization; 7 patients (13.0%) achieved subtotal embolization. Forty-seven patients (87.0%) recovered after surgery, and the symptoms of 4 patients were better than before admission but the vision did not fully recover (among them, 3 had the symptoms of abducens nerve palsy), 2 had mild hemiplegia, and no patients died after surgery. At postoperative follow-up, 5 (9.3%) recurred, and then they achieved total embolization with Onyx-18 combined with coils. Multivariate logistic regression analysis showed that subtotal embolization was an independent risk factor for postoperative imaging recurrence (odds ratio 16.63, 95% confidence interval 1.74-159.33; P=0.015), and the presence of cortical venous drainage was an independent risk factor for affecting postoperative clinical recovery (odds ratio 19.08, 95% confidence interval 1.61-226.58; P=0.020). Conclusion:Both of Onyx-18 combined with coils and detachable balloons are safe and effective for the treatment of TCCF. Subtotal embolization is associated with imaging recurrence, and the presence of cortical venous drainage is an independent influencing factor of clinical recovery.

Objective To provide anatomical information and clinical application of periosteal perforator bone-skin flap of proximal lateral tibia. Methods From March, 2015 to March, 2017, 15 fresh cadavers who underwent injected with imaging technology and dissected with layer by layer. The origins, branches, distribution and anastomosis of periosteal perforator vessels in the proximal lateral tibial were observed. Sixteen patients of composite tissue defect in hands and feet were repaired with the method of free transplantation of this flap from March, 2015 to March, 2017. Injured area was from 3.0 cm × 0.8 cm to 6.0 cm × 5.5 cm. Bony defect size was from 1.7 cm × 1.5 cm × 1.0 cm to 5.0 cm × 1.0 cm × 1.0 cm. The bone-skin flap size ranged respectively from 3.0 cm × 0.8 cm to 6.0 cm × 5.5 cm and 1.6 cm ×1.0 cm × 0.8 cm to 5.0 cm×1.0 cm × 1.0 cm. Postoperative followed-up was done termly. Results The diameter and superficial length of the main perforators respectively were 0.5 to 1.2 mm and from 2.5 to 4.3 cm. The followed-up time was from 6 to 24 months in 14 cases, with the results of the bone-skin flaps presented favourable contours and good functions. The healing time of bone flap was 2 to 4 months. The function of shank was normal. Conclusion The periosteal perforator of proximal lateral tibia has favourable appearance, constant vascular pedi-cle, reliable blood supply and large diameter. The free transplantation of this flap offers a satisfactory alternative for repairing the small and medium-sized area of composite tissue defects of hands and feet.

Objective:The respiratory waveform of lung cancer patients based on 4D-CT respiratory gating was analyzed to evaluate the accuracy of gating during radiotherapy, and to explore the off-target in the 4D-CT respiratory gating radiotherapy.Methods:Clinical data of 18 patients with lung cancer admitted to Radiotherapy Department of Jiangsu Cancer Hospital were collected to obtain the respiratory waveform data during 4D-CT respiratory gating radiotherapy. The waveform in each treatment working cycle was compared with the waveform in 4D-CT scan to study whether there was a possibility of the off-target in the treatment of lung cancer patients.Results:There were 154 treatment sessions and 20,790 treatment breathing cycles in 18 patients, among which the threshold of gated opening beam miss amplitude (Δm-en) was greater than 0 in 95 treatment breathing cycles in 7 patients, accounting for 0.46% of all breathing cycles, and the threshold of gated closing beam miss amplitude (Δm-dis) was greater than 0 in 1419 treatment breathing cycles in 13 patients, accounting for 6.83% of all cycles. Among the 13 patients withΔm-dis greater than 0, actual tumor range of motion (R G) was greater than the sum of the value of target margin (M) and the value of plan tumor range of motion (R T) in 7 patients, R G was more than 1.5 times of M+R T in 7 patients, and there were also 7 patients in the phase of rapid rise and fall of respiratory curve. The correlation efficients between R G-M-R T and the percentage of beam on miss phase (T en%) and the percentage of beam closing off phase (T dis%) were 0.41 and 0.57, respectively. Conclusion:When R G is more than 1.5 times of M+R T value and the gating beam on phase contains the phases in the rapid rise and fall of the respiratory curve, the possibility of the off-target during radiotherapy is significantly increased.

Objective: To report the clinical effect of skin grafting in small wounds with exposed vascular anastomosis. Methods: From January, 2011 to May, 2018, 16 small wounds with anastomotic vascular exposure were treated by full-thickness skin grafting. Of which, 4 performed after replantation, 9 after reconstruction and 3 after flap transplantation. Thirteen wounds were on hand and 3 in foot. After anastomosing the vessels, 3 arterial anastomoses, 9 venous anastomoses and 4 arterial-and-venous anastomoses were left exposure in wounds. Sizes of artery exposed in wound were 0.8 to 2.3 mm with an average of 1.0 mm. Sizes of vein exposed in wound were 0.8 to 2.5 mm with an average of 1.2 mm. The areas of soft tissue defect were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm, and the areas of grafted skins were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm. Grafted skin were covered without package nor pressurization. Donor areas were directly sutured. Postoperative follow-up was conducted to observe the postoperative effect. Results: Fourteen grafted skin completely survived, one partially survived and healed after immobilization of the limb and change of dressing, and one developed necrosis. All patients were followed-up for 6-24 months (mean 14.4 months). CDU, HHD or CTA were used at the final follow-up. Vascular anastomoses were patency in 15 patients, and 1 patient had embolism developed. No pigmentation was found on the grafted skin. All grafted skin was soft and wearable with two point discrimination at 7-10 mm. The pulse of anastomotic artery could be felt on the grafted skins. Only linear scars were left in the donor sites. Conclusion The operation of full-thickness skin grafting in small wounds with exposed vascular anastomosis was easy to perform and with high survival rate. The effect of operation is satisfactory. The exposure of anastomosed vessels does not affect the patency of anastomotic vessels, and has considerable clinical values.

Objective:To investigate the influences of age-adjusted Charlson comorbidity index (ACCI) on prognosis of patients undergoing laparoscopic radical gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 242 gastric cancer patients who underwent laparoscopic radical gastrectomy in 19 hospitals of the Chinese Laparoscopic Gastrointestinal Surgery Study Group-04 study, including 54 patients in Fujian Medical University Union Hospital, 32 patients in the First Hospital of Putian City, 32 patients in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 31 patients in Zhangzhou Affiliated Hospital of Fujian Medical University, 17 patients in Nanfang Hospital of Southern Medical University, 11 patients in the First Affiliated Hospital with Nanjing Medical University, 8 patients in Qinghai University Affiliated Hospital, 8 patients in Meizhou People′s Hospital, 7 patients in Fujian Provincial Hospital, 6 patients in Zhongshan Hospital of Fudan University, 6 patients in Longyan First Hospital, 5 patients in the First Affiliated Hospital of Xinjiang Medical University, 5 patients in the First Hospital Affiliated to Army Medical University, 4 patients in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, 4 patients in West China Hospital of Sichuan University, 4 patients in Beijing University Cancer Hospital, 3 patients in the First Affiliated Hospital of Xiamen University, 3 patients in Guangdong Provincial People′s Hospital, 2 patients in the First Affiliated Hospital of Xi′an Jiaotong University, from September 2016 to October 2017 were collected. There were 193 males and 49 females, aged 62(range, 23?74)years. Observation indicators: (1) age distribution, comorbidities and ACCI status of patients; (2) the grouping of ACCI and comparison of clinicopathological characteristics of patients in each group; (3) incidence of postoperative early complications and analysis of factors affecting postoperative early complications; (4) follow-up; (5) analysis of factors affecting the 3-year recurrence-free survival rate of patients. Follow-up was conducted using outpatient examination or telephone interview to detect postoperative survival of patients up to December 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the nonparametric rank sum test. The X-Tile software (version 3.6.1) was used to analyze the best ACCI grouping threshold. The Kaplan-Meier method was used to calculate survival rates and draw survival curves. The Log-Rank test was used for survival analysis. The Logistic regression model was used to analyze the factors affecting postoperative early complications. The COX proportional hazard model was used for univariate and multivariate analyses of factors affecting the 3-year recurrence-free survival rate of patients. Multivariate analysis used stepwise regression to include variables with P<0.05 in univariate analysis and variables clinically closely related to prognosis. Results:(1) Age distribution, comor-bidities and ACCI status of patients. Of the 242 patients, there were 28 cases with age <50 years, 68 cases with age of 50 to 59 years, 113 cases with age of 60 to 69 years, 33 cases with age of 70 to 79 years. There was 1 patient combined with mild liver disease, 1 patient combined with diabetes of end-organ damage, 2 patients combined with peripheral vascular diseases, 2 patients combined with peptic ulcer, 6 patients combined with congestive heart failure, 8 patients combined with chronic pulmonary diseases, 9 patients with diabetes without end-organ damage. The ACCI of 242 patients was 2 (range, 0-4). (2) The grouping of ACCI and comparison of clinicopathological characteristics of patients in each group. Results of X-Tile software analysis showed that ACCI=3 was the best grouping threshold. Of the 242 patients, 194 cases with ACCI <3 were set as the low ACCI group and 48 cases with ACCI ≥3 were set as the high ACCI group, respectively. Age, body mass index, cases with preoperative comorbidities, cases of American Society of Anesthesiologists classification as stage Ⅰ, stage Ⅱ, stage Ⅲ, tumor diameter, cases with tumor histological type as signet ring cell or poorly differentiated adenocarcinoma and cases with tumor type as moderately or well differentiated adenocarcinoma, cases with tumor pathological T staging as stage T1, stage T2, stage T3, stage T4, chemotherapy cycles were (58±9)years, (22.6±2.9)kg/m 2, 31, 106, 85, 3, (4.0±1.9)cm, 104, 90, 16, 29, 72, 77, 6(4,6) in the low ACCI group, versus (70±4) years, (21.7±2.7)kg/m 2, 23, 14, 33, 1, (5.4±3.1)cm, 36, 12, 3, 4, 13, 28, 4(2,5) in the high ACCI group, showing significant differences in the above indicators between the two groups ( t=-14.37, 1.98, χ2=22.64, Z=-3.11, t=-2.91, χ2=7.22, Z=-2.21, -3.61, P<0.05). (3) Incidence of postoperative early complications and analysis of factors affecting postoperative early complications. Of the 242 patients, 33 cases had postoperative early complications, including 20 cases with local complications and 16 cases with systemic complica-tions. Some patients had multiple complications at the same time. Of the 20 patients with local complications, 12 cases had abdominal infection, 7 cases had anastomotic leakage, 2 cases had incision infection, 2 cases had abdominal hemorrhage, 2 cases had anastomotic hemorrhage and 1 case had lymphatic leakage. Of the 16 patients with systemic complications, 11 cases had pulmonary infection, 2 cases had arrhythmias, 2 cases had sepsis, 1 case had liver failure, 1 case had renal failure, 1 case had pulmonary embolism, 1 case had deep vein thrombosis, 1 case had urinary infection and 1 case had urine retention. Of the 33 cases with postoperative early complications, there were 3 cases with grade Ⅰ complications, 22 cases with grade Ⅱ complications, 5 cases with grade Ⅲa complications, 2 cases with grade Ⅲb complications and 1 case with grade Ⅳ complica-tions of Clavien-Dindo classification. Cases with postoperative early complications, cases with local complications, cases with systemic complications were 22, 13, 9 in the low ACCI group, versus 11, 7, 7 in the high ACCI group, respectively. There were significant differences in cases with postoperative early complications and cases with systemic complications between the two groups ( χ2=4.38, 4.66, P<0.05), and there was no significant difference in cases with local complications between the two groups ( χ2=2.20, P>0.05). Results of Logistic regression analysis showed that ACCI was a related factor for postoperative early complications of gastric cancer patients undergoing laparoscopic radical gastrectomy [ odds ratio=2.32, 95% confidence interval ( CI) as 1.04-5.21, P<0.05]. (4) Follow-up. All the 242 patients were followed up for 36(range,1?46)months. During the follow-up, 53 patients died and 13 patients survived with tumor. The 3-year recurrence-free survival rate of the 242 patients was 73.5%. The follow-up time, cases died and cases survived with tumor during follow-up, the 3-year recurrence-free survival rate were 36(range, 2-46)months, 29, 10, 80.0% for the low ACCI group, versus 35(range, 1-42)months, 24, 3, 47.4% for the high ACCI group. There was a significant difference in the 3-year recurrence-free survival rate between the two groups ( χ2=30.49, P<0.05). (5) Analysis of factors affecting the 3-year recurrence-free survival rate of patients. Results of univariate analysis showed that preoperative comorbidities, ACCI, tumor diameter, histological type, vascular invasion, lymphatic invasion, neural invasion, tumor pathological TNM staging, postoperative early complications were related factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy [ hazard ratio ( HR)=2.52, 3.64, 2.62, 0.47, 2.87, 1.90, 1.86, 21.77, 1.97, 95% CI as 1.52-4.17, 2.22-5.95, 1.54-4.46, 0.27-0.80, 1.76-4.70, 1.15-3.12, 1.10-3.14, 3.01-157.52, 1.11-3.50, P<0.05]. Results of multivariate analysis showed that ACCI, tumor pathological TNM staging, adjuvant chemotherapy were indepen-dent influencing factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy ( HR=3.65, 11.00, 40.66, 0.39, 95% CI as 2.21-6.02, 1.40-86.73, 5.41-305.69, 0.22-0.68, P<0.05). Conclusions:ACCI is a related factor for post-operative early complications of gastric cancer patients undergoing laparos-copic radical gastrectomy. ACCI, tumor pathological TNM staging, adjuvant chemotherapy are indepen-dent influencing factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy.

When nanoparticles were introduced into the biological media, the protein corona would be formed, which endowed the nanoparticles with new bio-identities. Thus, controlling protein corona formation is critical to