Objective To compare treatment response according to the PERCIST1.0,RECIST1.1,EORTC,and WHO criteria in patients with colorectal liver metastases (CLM) who received neoadjuvant chemotherapy.Methods A total of 41 CLM patients (27 males,average age 68.48 years;14 females,average age 62.43 years) from January 2010 to September 2013 were included in this retrospective study.PET/CT scan was performed before chemotherapy and after 4-6 cycles′ chemotherapy.The baseline and the sequential follow-up 18F-FDG PET/CT of each patient were evaluated according to the PERCIST1.0,RECIST1.1,EORTC,and WHO criteria.The response was categorized into 4 levels including CR,PR,SD,PD.PET/CT images were used for both metabolic and anatomic evaluation.The concurrent diagnostic CT or MRI images (performed within 1 week of PET/CT) were also utilized when needed.The agreements of criteria were analyzed using Kappa test.The response rate (RR) and disease control rate (DCR) were compared using χ2 test.Results The RR and DCR according to the PERCIST1.0,EORTC and RECIST1.1 criteria were 31.71％(13/41) and 63.41％(26/41),31.71％(13/41) and 60.98％(25/41),17.07％(7/41) and 68.29％(28/41),respectively.The general comparison of PERCIST1.0 and RECIST1.1,EORTC and RECIST1.1 criteria showed good agreements (κ values: 0.711,0.689).Significant difference was not found in the DCR(χ2=2.000,P>0.05) but found in the RR(χ2=6.000,P<0.05) between PERCIST1.0 and RECIST1.1.Difference of DCR between EORTC and RECIST1.1 was not significant(χ2=3.000,P>0.05),while the RR had significant difference(χ2=6.000,P<0.05).The RR and DCR according to WHO criterion were 12.20％(5/41) and 70.73％(29/41),which had a good consistency with those according to PERCIST1.0 criteria (κ=0.629).Significant statistical difference was not found in the DCR(χ2=3.000,P>0.05) but found in the RR(χ2=8.000,P<0.05) between PERCIST1.0 and WHO criteria.Conclusions In evaluating CLM treatment response,anatomical criteria and metabolic criteria have a good consistency.But metabolic criteria are more sensitive for RR evaluating.

Objective:To explore the application and clinical efficacy of an innervated arterialised venous flap of the first dorsal metacarpal in reconstruction of thumb and finger pulp defects.Methods:From December 2021 to August 2022, 17 patients received surgery for reconstruction of thumb and finger pulp defects in the Department of Hand Surgery of Sichuan Modern Hospital. All were carried out in emergency surgery. The affected digits included: 3 thumbs, 4 index fingers, 6 middle fingers, 1 ring finger and 3 little fingers. After emergency debridement, a flap of the first dorsal metacarpal carrying superficial radial nerve and arterialised vein was taken for reconstruction of the defect. Donor site of the flap was directly closed with sutures. The survival and functional recovery of the digits and flaps were evaluated through postoperative follow-ups via outpatient visit and telephone and WeChat interviews.Results:Seven flaps developed blisters after surgery, which gradually subsided and healed after dressing change. The rest of 10 flaps survived smoothly, without any vascular compromise. All of the 17 patients(17 digits) had postoperative follow-up for 3-15 months, with 8 months in average. Appearance of thumb and finger pulps were good, with sensation restored to S 1-S 3+, according to the sensory function evaluation criteria of the British Medical Research Council(BMRC). According to Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, all 17 patientswere in excellent of total active movement(TAM). Conclusion:Innervated arterialised venous flap of the first dorsal metacarpal is reliable in reconstruction of the defects of digit pulps with good function and appearance. The flap is easy to take and with a satisfactory recovery of sensation.

Objective:To investigate the feasibility, clinical efficacy and donor site impact of the deep inferior epigastric artery perforator flap (DIEPF) with transverse symmetrical design in reconstruction of soft tissue defects in limbs.Methods:From September 2020 to August 2023, 12 patients with soft tissue defects of limbs who agreed to flap donor site in the lower abdominal wall were treated in the Department of Hand Surgery and Microsurgery, Sichuan Modern Hospital. There were 10 females and 2 males with an average age of 58.42 years old. Defect sites: 3 in upper limbs and 9 in lower limbs. Sizes of the soft tissue defect were 8.0 cm×15.0 cm-13.0 cm×40.0 cm. CTA or CDU was used to detect the perforators of deep inferior epigastric artery and appropriate perforators were selected. The width and length of redundant skin and subcutaneous tissues in the lower abdomen were evaluated according to the "pinch and lift test". Taking into account the requirements of abdominoplasty, symmetrical bilateral DIEPFs were designed in the transverse direction on the lower abdominal wall. The sizes of the flaps were 7.5 cm×24.0 cm-13.0 cm ×42.0 cm. The harvested flaps were firstly thinned under the microscope, trimmed and shaped properly to match the profile of the wounds. Blood circulation was reconstructed with various forms of vascular anastomoses, such as internal pressurisation, connection in series and Flow-through, etc. Lower abdominal wall wound should be gradually reduced in tension according to the requirements of abdominal wall plastic surgery, and cosmetic suturing should be performed.Results:All 12 DIEPFs survived. The lower abdominal donor site healed primarily. All patients were included in postoperative follow-up for 6 to 42 (average 18.31) months. All flaps were normal in colour and soft in texture. The appearance of abdominal walls were improved, and the function was not affected, except 1 patient who underwent debulking procedure 3 months after the surgery.Conclusion:The transverse symmetrical design of a DIEPF is an ideal method for reconstruction of soft tissue defects in limbs after appropriate flap modification. It is a win-win solution for an aesthetic appearance of donor and recipient sites of the flap.

Objective:To compare and analyze the clinical characteristics between acute fatty liver of pregnancy (AFLP) and the hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome.Methods:This is a retrospective cohort study. The clinical data of 13 cases with AFLP and 34 cases with HELLP syndrome were collected from three tertiary referral centers in Yunnan (the First Affiliated Hospital of Kunming Medical University, the Second Affiliated Hospital of Kunming Medical University, and Yan'an Hospital of Kunming City) from January 2016 to December 2021. The patients were diagnosed to AFLP and HELLP syndrome according to the Swansea criteria and the Tennessee classification system. The general characteristics, clinical features, laboratory results within 24 hours after admission, complications, maternal and neonatal outcomes were compared to analysis the differences between the two groups.Results:① Maternal characteristics: compared with HELLP syndrome group, AFLP group had lower body mass index (BMI) and blood pressure at admission (both P < 0.01). ②Clinical features: the most common symptoms in AFLP patients were skin jaundice, abdominal pain, nausea and vomiting, edema. The main manifestations of patients with HELLP syndrome were albuminuria, hypertension, edema, headache. Some patients had multiple symptoms concurrently. ③ Laboratory results: compared with HELLP syndrome group, the levels of platelet count (PLT), total bilirubin (TBil), direct bilirubin (DBil), γ-glutamyl transferase (γ-GGT), alkaline phosphatase (ALP), total bile acid (TBA), serum creatinine (SCr) and international standardized ratio (INR) in AFLP group were significantly increased within 24 hours after admission [PLT (×10 9/L): 107.69±51.13 vs.76.71±43.25, TBil (μmol/L): 121.60 (83.20, 170.00) vs.15.25 (7.22, 29.05), DBil (μmol/L): 86.50 (58.60, 104.00) vs. 4.30 (2.22, 10.10), γ-GGT (U/L): 87.00 (37.00, 127.00) vs. 41.00 (19.00, 64.42), ALP (U/L): 199.10 (109.00, 349.20) vs. 125.50 (90.50, 155.25), TBA (μmol/L): 51.50 (16.20, 117.40) vs. 4.15 (2.02, 6.95), SCr (μmol/L): 155.80 (129.00, 237.00) vs. 79.00 (65.43, 113.70), INR: 1.28 (1.17, 1.63) vs. 0.94 (0.88, 1.08), all P < 0.05], prothrombin time (PT) was significantly prolonged [seconds: 16.10 (14.50, 19.20) vs. 12.40 (11.43, 13.40), P < 0.05]. The level of blood glucose (GLU), fibrinogen (FIB) and the activity of antithrombin Ⅲ (ATⅢ) decreased significantly [GLU (mmol/L): 5.18±1.33 vs. 6.33±1.19, FIB (g/L): 1.96±1.46 vs. 3.81±1.58, ATⅢ (%): 40.61±25.84 vs. 66.39±24.11, all P < 0.05]; ④ Complications: compared with HELLP syndrome group, the incidence of patients with hypoglycemia [30.77% (4/13) vs. 0% (0/34)], acute liver failure [53.85% (7/13) vs. 5.88% (2/34)], acute renal insufficiency [69.23% (9/13) vs. 8.82% (3/34)], coagulopathy [76.92% (10/13) vs. 38.24% (13/34)], disseminated intravascular coagulation (DIC) [53.85% (7/13) vs. 5.88% (2/34)], and multiple organ dysfunction syndrome (MODS) [53.85% (7/13) vs. 5.88% (2/34)] were significantly higher in AFLP group (all P < 0.05). ⑤ Maternal and neonatal outcome: all patients delivered after admission. The total length of hospital and intensive care unit stay were significantly longer in the AFLP group than in the HELLP syndrome group [days: 17.00 (11.00, 25.00) vs. 9.00 (7.00, 12.00), 12.00 (4.00, 22.00) vs. 3.91 (0, 7.00), both P < 0.01]. Two AFLP patients died, including one due to intracranial venous thrombosis and one due to multiple organ failure and cardiopulmonary arrest. There were no deaths in the HELLP syndrome group. Conclusions:There are significant differences in maternal characteristics, laboratory results and complications between AFLP and HELLP syndrome. TBil, γ-GGT, SCr, FIB, INR and ATⅢ activity may help to distinguish the two diseases.

Objective·To explore the correlation between the quantitative results of autofluorescence imaging under computer assistance and the grade of epithelial dysplasia in oral leukoplakia.Methods·From April 2016 to January 2024,357 patients with oral leukoplakia who visited the Department of Oral Mucosal Diseases at Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,were included.Autofluorescence images of the lesions were obtained using a handheld autofluorescence device.These images were converted to grayscale images to obtain quantitative metrics.An ordered multinomial Logistic regression model was fitted in Python,and cumulative probability plots were generated.The dataset was divided into training and testing sets,and a decision tree was generated.Different hyperparameters were adjusted to achieve optimal model performance.Accuracy,precision,and F1 scores were calculated.The model performance was visualized using a confusion matrix.Results·As the degree of epithelial dysplasia increased,the relative mean color level showed a declining trend.In the binary classification of epithelial dysplasia,there was no overlap between the cumulative probability curves of different categories.In the four-category classification,only severe epithelial dysplasia overlapped with other category curves,indicating good discriminative ability of the model.In binary pathological grading,when the training and testing set ratio was 4∶1 and the maximum depth was 2,the accuracy,precision,and F1 scores were 0.792,0.801,and 0.795,respectively.In the four-category pathological grading,when the training and testing set ratio was 9∶1 and the maximum depth was 4,the accuracy,precision,and F1 scores were 0.611,0.537,and 0.569,respectively.Conclusion·Computer-assisted quantitative analysis of autofluorescence images can be used by oral mucosal specialists as a reference to predict the degree of epithelial dysplasia in patients with oral leukoplakia and to monitor their risk of cancer.