Objective To study the CT and MR imaging feature of adult sphenoid spontaneous cerebrospinal fluid (CSF) rhinorrhea and accompanying intracranial hypertension. Methods Thirty consecutive patients including 11 males and 19 females with mean age of (50 ± 8) years (range, 31 to 64 years) were retrospectively reviewed. Imaging findings in 30 patients with adult sphenoid spontaneous CSF rhinorrhea (CT in 26 patients, MR in 29 patients, and both CT and MR in 25 patients) were analyzed. The MR imaging and CT features were evaluated by two experienced head and neck radiologists. The CT and MR imaging parameters of 30 fistulas were evaluated, including side, location, size, amount, bony change, and the adjacent structures change. Results Of the 30 patients of adult sphenoid spontaneous CSF rhinorrhea lesions, the site of the CSF fistula confirmed by endoscopy surgery was at the junction of the roof of the inferolateral recess and the floor of the middle cranial in 25 (83%, 25/30) patients, the roof of the inferolateral recess in 3 (10%,3/30) patients, and the lateral wall of the sphenoid sinus in 2 (7%,2/30). CT images revealed the osseous defects of the sphenoid sinus walls in 21 patients (80.7%, 21/26) patients, excessive pneumatization of the inferolateral recess of the sphenoid sinuses in 25 cases (96.1%, 25/26). MRI demonstrated the linear hyperintensity communicating subarachnoid space and sphenoid cavity, accompanying meningoencephalocele in 26 (89.6%, 26/29) patients, sphenoid sinus filled with CSF in 24 (82.7%,24/29) patients and air-fluid level in the sphenoid sinus in 8 cases (27.6%, 8/29), excessive expansion of adjoining lateral fissure cistern in 22 cases (75.9%,22/29), adjoining sulcus in one case (3.4%, 1/29), adjoining lateral ventricle in one case (3.4%,1/29). The imaging feature of accompanying intracranial hypertension included empty sella in 29 cases (100%, 29/29), augmentation of the complex of the optic sheath in 27 cases (93.1%, 27/29), the arachnoid pits in the middle cranial fossa in 30 cases (100%). Conclusions The spontaneous CSF fistula coexists with intracranial hypertension. The combined application of CT and MRI can accurately identify the fistula with accompanying symptom and the intracranial hypertension.

Objective To explore the MRI features of solitary fibrous tumor(SFT)in the orbit.Methods The MRI findings of 7 patients with SFT in the orbit confirmed by histopathology were analyzed retrospectively.Re sults Of the 7 lesions,5 occurred in the right orbit and 2 in the left orbit.Six lesions were located in the extraconal space near the lacrimal gland fossa,including 5 in the superomedial region and 1 in the inferolateral region.The other one was located in the retrobulbar intraconal space.The lesions with well-defined margin showed elliptic shape in 6 cases and lobulated configuration in 1.The maximum diameter of the lesions ranged from 18 to 40 mm(mean,31 mm).The lesions showed homogeneous isointense relative to gray matter on T1-weighted images in 6 patients.On T2-weighted images,the lesions showed heterogeneous hypointense in 5 patients,isointense and hyperintense in one patient respectively.SFT demonstrated markedly homogeneous enhancement in 6 patients and inhomogeneous enhancement in one patient The time-intensity curves(TIC)of 7 patients exhibited a rapidly enhancing and rapid washout pattern on dynamic contrast-enhanced(DCE)MRI.Conclusion Hypointense signal on T2WI,marked enhancement on contrast-enhanced T1 WI,and a rapidly enhancing and rapid washout pattern TIC on DCE MRI are the typical MRI features of orbital SFT.

Objective:To explore the method and effect of free thining anterolateral thigh perforator flap (ALTP) in repairing soft tissue defect of scar contracture deformity after hand trauma.Methods:From March, 2015 to August, 2019, 12 patients who suffered scar contracture after hand trauma were repaired with thin ALTP. First, completely resected the scar contracture tissue from the hands and restored the normal bone structure and force line of the hand. The area of hand wound defects were 5.0 cm×6.0 cm-8.0 cm×10.0 cm. The wound was repaired by free ALTP, and the flap was micro-thinned for the first time. The flaps did not carry broad fascia, and the donor sites were directly sutured. The wound healing, the flap appearance, texture, sensation, scarring of the donor area, and functional recovery of the affected hand were observed regularly after surgery. The patients were followed-up by outpatient review and WeChat.Results:All the flaps survived well after the operation. Two cases suffered crisis because hematoma entraps vein cause by bleeding from perforator branch. After surgical exploration, the flaps survived successfully. All 12 flaps were followed-up successfully, including 6 cases reviewed in outpatient clinic, 4 cases followed by WeChat video and 2 cases by telephone consultation. The follow-up time was 3-20 months, with an average of 11 months. The flaps were not bloated, soft, non-pigmented, and beautiful in appearance. Only linear scars remained in the donor sites. The gripp function, palm function, thumb opposition function and finger function of the affected hand were largely restored. According to the TAM method of Upper Limb Function Evaluation of the Chinese Medical Association: 7 cases were excellent, 4 cases were good, and 1 case was fair.Conclusion:The thinning ALTP can be used to repair the scar contracture deformity after hand trauma. It can carry different tissues for 3-dimensional repair. After operation, the flap has a beautiful appearance, the donor site can be closed directly, and the damage of donor site can be reduced. It is an effective method to repair the hand contracture deformity.

Objective:To evaluate the clinical effectiveness of the reconstruction of multiple digit-tip defects with transfer of polyfoliate perforator flaps of the fibular hallux.Methods:From January 2019 to June 2022, 15 patients had undergone reconstruction surgery for multiple digit-tip defects using polyfoliate perforator flaps of ipsilateral fibular hallux, with the first dorsal metatarsal artery as the pedicle, in the Department of Upper Limb Repair and Reconstruction Surgery, Guizhou Hospital of Beijing Jishuitan Hospital. The patients were 10 males and 5 females and aged 20 to 45 years old. Eight patients had the defects of thumbs and index fingers, 4 of thumbs and middle fingers, 2 of thumb, index and middle fingers and 1 of thumb, index and ring fingers. All the 15 digit injuries had nail bed defects to which reconstructive surgery were required. For the flaps of dorsal artery, flaps were 1.8 cm×2.0 cm-2.0 cm×3.1 cm in size and for those of plantar artery, the flaps sized 1.5 cm×2.0 cm-2.5 cm×3.0 cm. Donor site defects in the hallux were reconstructed with free superficial circumflex iliac perforator flaps. Postoperative follow-up lasted until 30th June 2023 and included visits to the outpatient clinic, WeChat and telephone reviews to assess the appearance, function and sensation recovery of the digits.Results:All the 15 flaps survived. During the 6 to 24 months (16 months in average) of postoperative follow-up, the appearance and texture of all flaps were found close to the healthy digits, with good nail growth and without deformity. TPD were found between 8.0 mm and 12.0 mm. The donor sites on the great toes that reconstructed with superficial circumflex iliac artery flaps were all survived well, and the incisions were satisfactorily healed without the functions of walking, running or jumping being significantly affected.Conclusion:The use of polyfoliate perforator flaps of fibular hallux for reconstruction of multiple digit-tip defects is an ideal surgical method due to the consistency of vascular anatomy, ease with flap harvest, similarity in the normal digital skin texture, and the capability to include a nail bed with the flap. A single donor from the hallux can simultaneously reconstruct two defects of digit-tip, making it an excellent treatment in the reconstruction of small-to medium-sized composite tissue defects in multiple digits.

Gitelman syndrome is characterized by hypokalemia, metabolic alkalosis, hypocalciuria, and hypomagnesemia. The clinical course of Gitelman syndrome in pregnant women remains unclear, but it is thought to be benign. We report here the first Korean case of atypical eclampsia in a 31-year-old who was diagnosed with Gitelman syndrome incidentally during an antenatal screening test. The patient did well during pregnancy despite significant hypokalemia. At 33 weeks’ gestation, the patient exhibited eclampsia, hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, and renal insufficiency without significant hypertension or proteinuria. We explain this unusual clinical course through a review of the relevant literature.
Adult ; Alkalosis ; Eclampsia ; Female ; Gitelman Syndrome* ; HELLP Syndrome* ; Hemolysis ; Humans ; Hypertension ; Hypokalemia ; Liver ; Pregnancy ; Pregnant Women ; Prenatal Diagnosis ; Proteinuria ; Renal Insufficiency

Objective:To explore the causes and precaution procedures of olfactory dysfunction after transsphenoidal surgery for pituitary lesions.Methods:The clinical data of 72 patients underwent transsphenoidal surgery for pituitary lesions in our hospital from November 2016 to May 2018 were summarized. Resection under microscope was performed in 27 patients and resection under endoscope in 45 patients. The olfactory function of patients with postoperative olfactory disorders was evaluated one and 6 months after surgery. Bilateral nasal passages were examined by nasal endoscopy 3-6 months after surgery. Whether intraoperative operations were related to olfactory impairment was analyzed.Results:There were seven hyposmic/anosmic patients; three patients (6.7%) were operated via endoscopic approach and four patients (14.8%) were operated via microscopic transsphenoidal approach; incidence of olfactory dysfunction between the two groups showed no statistical difference ( P>0.05). One month after operation, two patients had a slight decrease in olfactory function, 4 had a severe decrease in olfactory function and one had anosmia. Six months after the operation, two patients with severe hypoxia got improvment, but failed to return to normal level; and the rest of the patients showed no significant improvement. Three-6 months after operation, nasal endoscopic examination found that all patients had healed nasal wound, two patients had large volume of nasal mucus secretion, and 3 patients had postoperative nasal mucosa adhesion. In these 72 patients,cauterization of the mucosa around the sphenoid ostium was performed in 6 patients, placement of the speculum above the sphenoid ostium was performed in 2 patients, and olfactory damage was noted in all the 8 patients. Conclusions:Olfactory dysfunction after transsphenoidal surgery for pituitary lesions is common, and attention should be paid.Placement of the speculum above the sphenoid ostium and cauterization of the mucosa around the sphenoid ostium might be the main reasons for olfactory damage.

Objective:To explore the clinical characteristics and experiences in diagnosis and treatment of severe hand injuries caused by chaff cutters.Methods:A retrospective analysis was conducted on 60 patients (193 digits) who had mangled hand injuries caused by chaff cutters and admitted to the Department of Upper Limb Repair and Reconstruction, Beijing Jishuitan Hospital Guizhou Hospital between January 2015 and June 2022. The patients were 39 males and 21 females, with 10 to 72 (mean 42.6) years old of age. The injuries involved 41 right hands and 19 left hands. The extent of hand injuries of soft tissue and bones varied from digit-tips to wrist. Among them, 5 digits were completely destroyed in 8 cases, 3 digits including thumb were destroyed in 12 cases, 4 digits including thumb were destroyed in 10 cases, 3 or more fingers without thumb were destroyed in 8 cases, simple hand destroyed in 8 cases, digits and palm destroyed in 8 cases, and total hand destroyed in 6 cases. The sizes of wound ranged from 1.8 cm×2.0 cm to 6.8 cm×15.6 cm. Based on the wound contamination and conditions of tissue damage, surgical treatment included debridement, stump trimming, in-situ replantation, transpositional replantation, venous bridging flap transfer and emergency or phased free second toe and free flap transfers. The flap sizes were 3.0 cm×5.0 cm-7.0 cm×16.0 cm. Both the reconstructed and flap donor sites were primarily closed in one stage. Postoperative follow-ups were conducted through regular visits of outpatient clinic or via WeChat interviews. The survival and functional recovery of flap and finger were observed.Results:Of the 60 patients, emergency orthotopic replantation of 112 digits were performed with survival of 96 digits; 16 digits transposition replantation were carried out with 12 survived; 5 digits received venous bridging flap transfer with 4 survived; all 5 Flow-through anteriolateral thigh perforator flaps (ALTPFs) were survived; all of 12 phase II digit reconstructions with free second toe transfer survived; and all 18 phase II free flap transfers survived [10 ALTPFs and 8 superficial circumflex iliac artery perforator flaps(SCIAPFs)]. Postoperative complications such as wound exudation and fever happened in 8 patients, and all were rectified after debridement and symptomatic anti-infection treatment. The follow-up ranged 6 to 18 months, with 12 months in average. Hand functions were assessed using the Michigan Hand Outcomes Questionnaire (MHQ), and the scores achieved at 20.3 to 72.8 points, with 42.6 points ± 16.6 points in average.Conclusion:Severe hand injuries caused by chaff cutters are severe and complicated. A thorough assessment of wound contamination and residual digits and tissues are required. Successful surgical outcomes can be achieved through emergency and elective surgery with multiple microsurgical techniques and multi-phased surgical reconstructions, although overall functional recovery of the injured hand is often not quite realistic.

As the backbone force of China's social and economic construction, the health status of workers is closely related to the nation's productivity and social development. Currently, cancers have become one of the major diseases threatening the health of workers. However, there are still many shortcomings in the cancer screening services for the workers. To standardize cancer screening services for workers, ensure the quality of screening services, and improve the overall screening effectiveness, 19 institutions, including Peking Union Medical College Hospital of the Chinese Academy of Medical Sciences, have jointly formulated the Group Standard "Specification for service of cancer screening for workers (T/CHAA 023-2023)". This standard follows the principles of "legality, scientific rigor, advancement, and feasibility" and combines the frontier scientific advances in cancer screening. It clarifies the relevant requirements for service principles, service design, service delivery, service management, service evaluation, and improving worker cancer screening. Implementing this group standard will help connect the common screening needs of workers, employers, and cancer screening service providers, standardize the screening process, improve screening quality, and ultimately increase the early diagnosis rate and survival rate of cancer patients. Consequently, this group standard will help safeguard workers' health rights and interests, ensure the labor force resources, promote the comprehensive coordinated and sustainable development of society, and contribute to realizing the "Healthy China 2030" strategic policy.

A novel protein encoded by the open reading frame 4 (ORF4) was recently discovered in porcine circovirus type 2 (PCV2). However, little is known about the interaction proteins of ORF4 which hindered better understanding the biological functions of ORF4 in the life cycle of PCV2. In the present study, the ORF4 was inserted into the multiple cloning site of pCMV-N-Flag-GST, yielding recombinant plasmid pCMV-N-Flag-GST-ORF4. The recombinant plasmid was transfected into 293T cells and the intracellular interaction complex of ORF4 were enriched and separated by GST pull-down and SDS-PAGE, sequentially. The potential interacting proteins of PCV2 ORF4 were stained with silver and identified by mass spectrometry (MS). Finally, five candidate ORF4-interacting proteins, including Serine/threonine-protein phosphatase 6 catalytic subunit, alpha cardiac muscle 1, actin, SEC14-like protein 5 and myosin 9 were identified. These results would benefit a better understanding of the biological function of ORF4 in PCV2 infected cells.
Animals ; Circoviridae Infections ; Circovirus ; HEK293 Cells ; Humans ; Mass Spectrometry ; Open Reading Frames ; Swine ; Viral Proteins

Objective: To understand the consciousness of the cancer early detection among urban residents and identify the influencing factors from 2015 to 2017. Methods: A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. Self-designed questionnaires were used to collect population, socioeconomic indicators, self-cancer risk assessment, regular participation in physical examination and other information. The multivariate logistic regression model was used to identify the factors of people who had not regularly participated in the regular physical examination in the past five years. Results: The self-assessment results of 32 357 residents showed that there were 27.54% (8 882) of total study population with self-reported cancer risk, 45.48% (14 671) without cancer risk and 26.98% (8 704) with unclear judgement on their own cancer risk. Among population with cancer risk, 79.84% (7 091) considered physical examination accounted. In the past five years, there were 21 105 (65.43%) residents participated in regular physical examination and 11 148 (34.56%) participated in non-scheduled one, respectively. The multivariate logistic regression analysis showed that compared with unmarried and western region residents, divorced, middle and eastern region residents had a stronger consciousness to participate in the regular physical examination (P<0.05). Compare with residents with annual household income less than 20 000 CNY in 2014, cancer risk assessment/screening intervention population, and self-assessment with cancer risk, residents with annual household income between 20 000 CNY and 59 000 CNY in 2014, occupational population, community residents, cancer patients, self-reported cancer-free risk, and self-assessment with unclear judgement of cancer risk were less likely to participate in the regular physical examination (all P values <0.05). Conclusion From 2015 to 2017, the Chinese urban residents had a acceptable consciousness of the cancer early detection. The marital status, annual household income, population group and self-assessment of cancer risk were related to the consciousness of the cancer early detection of people who had not participated in the regular physical examination in the past five years.