Tick-borne encephalitis is a central nervous system disease caused by infections with tick-borne pathogens, which is characterized by severe clinical symptoms, multiple sequelae, and a high fatality rate. Currently, there is no cure for tick-borne encephalitis. Tick-borne encephalitis virus (TBEV) is the most common pathogen of tick-borne encephalitis. Therefore, rapid and accurate detection of TBEV contributes to reducing the mortality of tick-borne encephalitis, improving patients' prognosis, and reducing the risk of TBEV transmission. The currently available serological tests for detection of TBEV infections mainly include neutralization test, enzyme-linked immunosorbent assay (ELISA), immunofluorescence assay, and nucleic acid tests mainly include polymerase chain reaction (PCR), loop-mediated isothermal amplification (LAMP), reverse transcription polymerase spiral reaction, clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated proteins (Cas)-based assays. This review summarizes the progress of researches on serological and nucleic acid tests for detection of TBEV infections, so as to provide insights into prevention and control of tick-borne encephalitis.

OBJECTIVE: To precise classify sacral meningeal cysts, effective guide minimally invasive neurosurgery and postoperative personalized rehabilitation by multiple dimensions radiographic reconstruction MRI. METHODS: From March to December 2021, based on the original 3D-fast imaging employing steadystate acquisition (FIESTA) scanning sequence, 92 patients with sacral meningeal cysts were pre-operatively evaluated by multiple dimensional reconstruction MRI. The shape of nerve root and the leakage of cyst were reconstructed according to the direction of nerve root or leakage track showed on original MRI scans. Sacral canal cysts were accurately classified as including nerve root and without nerve root, so as to accurately design the incision of skin and formulate corresponding open range of the posterior wall of the sacral canal. Under the microscope intraoperation, the shape of the nerve roots inside cysts or leakage track of the cysts without nerve roots were verified and explored. After the reinforcement and shaping operation, several reexaminations of multiple dimensional reconstruction MRI were performed to understand the deformation of the nerve root and hydrops in the operation cavity, so as to formulate a persona-lized rehabilitation plan for the patients. RESULTS: Among the 92 patients with sacral mengingeal cyst, 58 (63.0%) cysts with nerve root cyst, 29 (31.5%) cysts without nerve root cyst, and 5 (5.4%) cysts with mixed sacral canal cyst. In 58 patients with nerve root cysts, the accuracy of preoperative clinical classification on MRI image reached 96.6% (56/58) through confirmation by operating microscope. Only 2 cases of large single cyst with nerve root on the head of cyst were mistaken for without nerve root type. In 29 patients with sacral cyst without nerve root, the accuracy of preoperative image reached 100% through confirmation by operating microscope. The accuracy of judging the internal nerve root and leakage of 12 cases with recurrent sacral cyst was also 100%. Two cases of delayed postoperative hydrops were found one month after operation. After rehabilitation treatment by moxibustion and bathing, the hydrops disappeared 4-6 months after operation. CONCLUSION Multiple dimensional reconstruction MRI can precisely make clinical classification of sacral meningeal cysts before operation, guide minimally invasive neurosurgery effectively, and improve the rehabilitation effect.
Humans ; Magnetic Resonance Imaging/methods* ; Male ; Female ; Sacrum/surgery* ; Adult ; Middle Aged ; Imaging, Three-Dimensional/methods* ; Cysts/rehabilitation* ; Aged ; Adolescent ; Young Adult ; Spinal Nerve Roots/diagnostic imaging* ; Minimally Invasive Surgical Procedures ; Neurosurgical Procedures/methods*

Objective : To explore the risk factors of biliary stricture after liver transplantation and to construct a nomogram prediction model. Methods : The clinical data of 208 liver transplant recipients in hospital were retrospectively analyzed, including 54 cases in the biliary stricture group and 154 cases in the non-biliary stricture group. Multivariate Logistic regression analysis was used to screen out independent predictors, fit the prediction model and construct a visual nomogram to evaluate the prediction model. Survival curves were drawn and multivariate Cox regression analysis was performed. Results : Autoimmune liver diseases(OR=6.610,95%CI: 1.410-30.99), alanine aminotransferase(ALT)(OR=1.007,95%CI: 1.003-1.011), warm ischemia time(OR=1.972,95%CI: 1.399-2.780), cold ischemia time(OR=1.016,95%CI: 1.010-1.022), cytomegalovirus infection(OR=6.037,95%CI: 1.480-24.63) and hepatic vascular stenosis(OR=7.784,95%CI: 2.312-26.20) were independent predictors of biliary stricture after liver transplantation. The area under the curve(AUC) of the nomogram prediction model was 0.921, the cut-off value was 0.238, the sensitivity was 0.889, and the specificity was 0.838. The model showed good discrimination. The Brier score was 0.092, Hosmer-Lemeshow goodness-of-fit testP=0.253, Calibration curve(B=1 000) was in good agreement, and the model showed good calibration. Decision curve analysis(DCA) showed that the application of the model could benefit liver transplant recipients. The postoperative follow-up time was 27-60 months. The cumulative survival rate of the non-biliary stricture group was better than that of the biliary stricture group(P=0.019), but multivariate Cox regression analysis showed that biliary stricture(HR=1.194, 95%CI: 0.624-2.285) was not an independent risk factor for survival after liver transplantation. Conclusion The nomogram model based on autoimmune liver diseases, ALT, warm ischemia time, cold ischemia time, cytomegalovirus infection and hepatic vascular stenosis performs well and can be used to predict the occurrence of biliary stricture after liver transplantation.

The contents recorded in the rotation registration manual is not only the quantitative indicators for evaluating the quality of residency training, but also the important basis for training assessment and issuance of training certificates. In order to solve the problems of data authenticity, information delay, and repeated entry in the rotation registration manual for residency training, Shanghai East Hospital, Tongji University, launched a project to dock the electronic rotation registration manual with the hospital information system. Through the establishment of the project team, the development of working mechanisms, and the implementation of the project, data analysis was used for process reformation and system optimization, so as to continuously improve management efficiency and medical safety while solving problems and form a set of implementation system with reference significance in practice.

Objective:To investigate the diagnostic value of machine learning model based on 18F-FDG PET/CT for polymyalgia rheumatica (PMR). Methods:From November 2014 to December 2022, 177 patients (119 males, 58 females; age: 67.0 ( 61.0, 72.0) years) admitted to the Department of Rheumatology and Immunology, the First People′s Hospital of Changzhou, with suspected PMR and undergoing 18F-FDG PET/CT examination were retrospectively analyzed. Patients were randomly divided into training set and validation set at the ratio of 7∶3. Three machine learning models, including classification and regression tree (CART), the least absolute shrinkage and selection operator (LASSO) algorithm, and logistic regression, were established based on the PET/CT imaging features to aid in the diagnosis of PMR. The diagnostic efficacy of each model was evaluated by ROC curve analysis and differences among AUCs were analyzed by Delong test. Results:There were 78(44.1%, 78/177) PMR patients and 99(55.9%, 99/177) non-PMR patients, and 124 patients in the training set and 53 patients in the validation set. The logistic regression model (training set: AUC=0.961; validation set: AUC=0.930) was superior to the CART (training set: AUC=0.902, z=2.96, P=0.003; validation set: AUC=0.844, z=2.46, P=0.014) in diagnosing PMR, and was similar to LASSO algorithm (training set: AUC=0.957, z=0.95, P=0.340; validation set: AUC=0.930, z=0.00, P=1.000), but with fewer sites evaluated. The simplified PMR-Logit score had the AUC of 0.951 in the overall population, with the sensitivity of 89.74%(70/78) and the specificity of 90.91%(90/99). Conclusion:Machine learning models based on 18F-FDG PET/CT imaging features are expected to be an effective diagnostic tool for PMR.

Objective To explore the feasibility of the multiplexed sensitivity encoding diffusion weighted imaging(MUSE-DWI)sequence in neck MRI,and to compare with traditional single-shot echo-planar imaging diffusion weighted imaging(SS-EPI-DWI)sequence.Methods Thirty healthy volunteers underwent MUSE-DWI and SS-EPI-DWI sequences scanning in neck.Two groups of images were independently scored by two radiologists for magnetic sensitivity artifact,chemical shift artifact,geometric distortion and overall image quality.The noise,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the regions of interest(ROI)of the two groups of images were measured and compared on the nasopharyngeal fossa layer,parotid gland layer,glottic layer and thyroid layer.Results Qualitative analysis showed that the image quality scores of MUSE-DWI sequence were significantly better than those of SS-EPI-DWI sequence in terms of magnetic sensitivity artifact,chemical shift artifact,geometric distortion and overall image quality(P<0.001).Quantitative analysis showed that the noise values of ROIs of MUSE-DWI sequence were significantly lower than those of SS-EPI-DWI sequence(P<0.001).The SNR and CNR of ROIs of MUSE-DWI sequence were higher than those of SS-EPI-DWI sequence(P<0.001).Conclusion MUSE-DWI sequence can significantly reduce geometric distortion,magnetic sensitivity artifact and chemical shift artifact,and SNR and CNR of images are significantly increased compared with SS-EPI-DWI sequence,which is more suitable for neck MRI scanning.

BACKGROUND:Umbilical cord mesenchymal stem cells(UMSCs)have been proven to have therapeutic effects on cartilage injury,and exosomes are the main carriers for UMSCs to exert therapeutic effects in vivo.Our research group previously found that lncRNA H19 is an important active molecule that mediates the activity of UMSCs-derived exosomes regulating chondrocytes.LncRNA H19 could adsorb miR-29b-3p to promote the proliferation and regeneration of chondrocytes,but its downstream mechanism is still unclear. OBJECTIVE:To reveal the specific mechanism of UMSCs in the treatment of cartilage injury from the perspective of exosomes and lncRNAs,so as to provide a new target for the treatment of cartilage injury. METHODS:UMSCs stably overexpressing lncRNA H19 were constructed.H19-Exos were extracted by ultra-centrifugation.The exosomes were identified by transmission electron microscopy,Nanosight,western blot assay and exosome uptake assay.The effect of miR-29b-3p overexpression and silencing on the TGF-β1/Smad3 pathway was detected by western blot assay,qPCR and dual luciferase reporter gene system.The biological effect of H19-Exos on cartilage regeneration was verified by the specific TGF-β1/Smad3 inhibitor in vitro and in vivo. RESULTS AND CONCLUSION:(1)H19-Exos showed a typical cup shape under an electron microscope,and the particle size was approximately 130 nm.H19-Exos expressed CD63,CD81 and TSG1010.(2)Overexpression of miR-29b-3p could down-regulate the mRNA and protein levels of TGF-β1 and Smad3,while silencing miR-29b-3p could up-regulate the mRNA and protein levels of TGF-β1/Smad3.(3)Dual-luciferase reporter gene system showed that miR-29b-3p had significant differences in the activities of downstream target genes TGF-β1 and Smad3.(4)The osteoarthritis models of rats were successfully established by injection of type II collagenase into the knee joint.H19-Exos significantly promoted cartilage regeneration.The specific TGF-β1/Smad3 inhibitor SB-431542 could block the biological effect of H19-Exos on cartilage regeneration in vitro and in vivo.(5)This study systematically demonstrated the promotion effect of UMSCs-derived exosomes highly expressing lncRNA H19 on cartilage regeneration,and the specific mechanism is that lncRNA H19 promotes cartilage regeneration by targeting miR-29b-3p/TGF-β1/Smad3 pathway.

BACKGROUND:The displacement change parameters of the bone structure of the first metatarsal bone at the two-dimensional level of hallux valgus deformity are of great significance for clinical diagnosis and treatment,while the quantitative analysis of the three-dimensional deformity index may have some influences on the postoperative efficacy. OBJECTIVE:To explore the quantitative change of the three-dimensional deformity index of the first metatarsal bone after routine osteotomy and orthosis for hallux valgus deformity and to provide reference for clinical work. METHODS:100 patients with hallux valgus deformity(foot)in Hengshui People's Hospital from October 2020 to April 2023 were selected and all of them underwent conventional osteotomy and orthosis.Foot function was assessed by the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale 6 months after surgery.Anterolateral X-rays of the foot in weight-bearing position and CT images in simulated weight-bearing position were taken before surgery and 6 months after surgery.The three-dimensional deformity indexes of the first metatarsal bone before and after surgery were quantitatively analyzed in patients with different ages,genders and therapeutic effects,including first-second intermetatarsal angle,hallux valgus angle,distal metatarsal articular angle,tibial sesamaid position,and first metatarsal rotation α angle.The value of the difference of three-dimensional deformity indexes of the first metatarsal bone before and after operation in evaluating the curative effect was analyzed. RESULTS AND CONCLUSION:(1)Six months after operation,the American Orthopedic Foot and Ankle Society score was 75-98(88.25±4.14)points,among which 56 cases were excellent,28 cases were good,14 cases were average,and 2 cases were poor.The excellent and good rate was 84%(84/100).(2)Compared with the preoperative results,first-second intermetatarsal angle,hallux valgus angle,distal metatarsal articular angle,tibial sesamaid position,and first metatarsal rotation α angle were significantly improved in patients of different ages and genders 6 months after surgery(P<0.05).First-second intermetatarsal angle,hallux valgus angle,distal metatarsal articular angle,tibial sesamaid position,and first metatarsal rotation α angle were all lower in patients with good curative effect 6 months after surgery than those with poor curative effect,and the difference before and after surgery was greater than those with poor curative effect(P<0.05).(3)The area under the curve of the difference evaluation of the first metatarsal three-dimensional deformity index before and after surgery was above 0.7,and the area under the curve of the combined evaluation of all indexes was the largest(0.902),which was significantly greater than the first metatarsal rotation α angle and distal metatarsal articular angle(P<0.05).(4)The quantitative analysis of the three-dimensional deformity index of the first metatarsal in patients with hallux valgus deformity is related to the postoperative effect,which has important guiding significance for improving the accuracy and comprehensiveness of preoperative evaluation and improving the treatment plan.

This article describes the experience of implementing the informatization construction of teaching supervision for standardized residency training in Shanghai East Hospital, Tongji University, and discusses the means to improve teaching activity supervision, such as management informatization and internet technology. This study aims to ensure the efficiency and work quality of supervision, optimize the process and resource allocation of supervision, and lay a solid foundation for improving the quality of residency training and teaching in the hospital (especially the key indicators for residency training and teaching quality, including the supervision rate of teaching activities and the completion rate of teaching activities) and establishing a sound system and the assets of teaching data in residency training.

Objective:To evaluate the effect of virtual reality arthroscopic simulation system combined with case-based learning (CBL) in orthopedic clinical teaching.Methods:From January 2021 to June 2022, a total of 36 residents who took the standardized residency training at Department of Articular Orthopedics in The Third Affiliated Hospital of Soochow University were enrolled in this study. They were randomized into an experimental group and a control group, with 18 trainees in each group. The experimental group adopted the virtual reality arthroscopic simulation system combined with CBL teaching mode, while the control group adopted simple endoscopic simulation training box with traditional teaching mode. Theoretical and practical tests and questionnaire survey were carried out to evaluate the teaching effects in two groups. SPSS 22.0 was performed to conduct t-test on the measurement data between the two groups. Results:The theoretical and practical test scores of the experimental group [(89.39±3.09) and (82.72±4.28)] were better than those of the control group [(86.22±4.43) and (76.61±5.65)], with statistically significant differences ( t= 2.49, P=0.018; t=3.66, P=0.001). The questionnaire survey showed that the experimental group was better than the control group in creating novel forms of courses [(4.94±0.24) vs. (4.11±0.58), t=5.62, P<0.001], simulating more real scenes [(4.83±0.38) vs. (3.78±0.43), t=7.80, P<0.001], inspiring learning interests [(4.78±0.43) vs. (4.00±0.59), t=4.51, P<0.001], improving practical skills [(4.83±0.38) vs. (3.83±0.51), t=6.61, P<0.001], and building career confidence [(4.50±0.62) vs. (3.06±0.54), t=7.47, P<0.001], with statistically significant differences (all P<0.001). Conclusions:The virtual reality arthroscopic simulation system combined with CBL teaching mode can better simulate the real clinical scenes, help inspire the interest of learning and quickly improve practical skills, thereby improving the effect of orthopedic clinical teaching.