Pneumococcal vaccine plays a key role in preventing diseases such as pneumonia and meningitis caused by Streptococcus pneumoniae(S.pneumoniae).Capsular polysaccharide,C-polysaccharide and phosphorus content are important indicators for quality control of polysaccharide antigens in vaccine development and production.In this study,a quantitative 1H NMR and 31P NMR method based on a single internal standard hexamethylphosphoramide(HMPA)was developed to achieve simultaneous determination of capsular polysaccharide,C-polysaccharide and phosphorus content in 6A,6B,18C,19A,19F and 23F S.pneumoniae polysaccharide antigens.Using the internal reference comparison method,the effect of solubility of polysaccharide on quantitative 1H NMR determination was investigated.It was found that the determination results of quantitative 1H NMR were affected by the viscosity and concentration of polysaccharide solution.It was found that high viscosity polysaccharides at 3-15 mg/mL and low viscosity polysaccharides at 5-25 mg/mL were the optimal detection solution concentration range.This"one internal standard three quantitative"NMR method has good precision,specificity and accuracy,and provides a valuable new strategy for the quality control of pneumococcal vaccine.

The training of orthopedic residents in Taiwan, China includes post graduate year and specialist training, which contain continuous orthopedic specialist training, humanistic training, and holistic education to ensure the high post competency of orthopedic residents. The training process is oriented towards competency and outcome, emphasizing the cultivation of core competencies. Comprehensive quantitative standards have been established to comprehensively evaluate the post competency of residents through theoretical, technical, and clinical work assessments. In this paper, the literature on medical education and resident training in Taiwan was reviewed. The overall training system, assessment requirements, and humanistic training of orthopedic residents in Taiwan were introduced. In addition, the models of training orthopedic specialists were compared between Taiwan and Mainland of China represented by Peking University Medical Department to provide reference for the training program of orthopedic residents.

Objective:To study the genetic profile of neonatal hyperbilirubinemia with unknown etiology in Guangdong Province and the clinical significance of jaundice-related genetic screening.Methods:From July to September, 2021, neonates with hyperbilirubinemia of unknown etiology born in different hospitals in Guangdong Province were studied. 24 neonatal jaundice-related exons were sequenced using targeted capture and high-throughput sequencing technology. The pathogenic variants were analyzed.Results:A total of 331 cases, 139 (42.0%) cases showed positive screening results with five diseases, including 65 (19.6%) cases of Gilbert syndrome, 48 (14.5%) cases of glucose-6-phosphate dehydrogenase (G6PD) deficiency,18 (5.4%) cases of sodium taurocholate cotransporting polypeptide deficiency, 4 (1.2%) cases of Citrin deficiency and 4 (1.2%) cases of Dubin-Johnson syndrome. 149 (45.0%) cases carried one or more genetic variants and 43 (13.0%) cases showed no clinically significant variants. The 8 high-frequency mutation loci (carrier rate >1%) are UGT1A1 gene c.211G>A and c.1091C>T, G6PD gene c.1466G>T and c.1478G>A, SLC10A1 gene c.800C>T, SLC25A13 gene c.852_855del TATG, HBB gene c.126_129delCTTT and c.316-197C>T.Conclusions:Genetic factors are important for neonatal hyperbilirubinemia with unknown etiology in Guangdong. The common pathogenic genes are UGT1A1, G6PD, SLC10A1, and SLC25A13 and the population carries high-frequency mutation loci. Therefore, genetic screening in neonates with hyperbilirubinemia of unknown etiology has important clinical significance.

Objective:To explore the significance of 99Tc m-sulfur colloid lymphoscintigraphy in the diagnosis of lower limb lymphedema after gynecological tumor surgery. Methods:The clinical data of patients with lower limb lymphedema after gynecological tumor surgery in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from May 2015 to October 2019 were retrospectively analyzed. 99Tc m-sulfur colloid lymphoscintigraphy was performed in all patients. The results of lymphatic vessel imaging, lymph node imaging and their combination in the diagnosis of lower limb lymphedema were analyzed. The diagnostic efficacy of lymphatic vessel imaging alone, lymph node imaging alone and their combination was evaluated by the receiver operating characteristic (ROC) curve and the area under the curve (AUC), and the Youden index, sensitivity and specificity were calculated. Results:Among the 100 lower limbs of 50 patients, 56 limbs had lymphedema and 44 limbs had no obvious edema. When diagnosis was based on abnormal lymphatic vessel imaging alone, among 56 lower limbs with lymphedema, lower limbs lymphatic vessel imaging was positive in 38 (67.9%) and negative in 18 (32.1%); among 44 lower limbs without obvious edema, lower limbs lymphatic vessel imaging was positive in 6 (13.6%) and negative in 38 (86.4%); the sensitivity was 67.9%, the specificity was 86.4%, and the Youden index was 0.543. When diagnosis was based on abnormal lymph node imaging alone, among 56 lower limbs with lymphedema, lower limbs lymph node imaging was positive in 42 (75.0%) and negative in 14 (25.0%); among 44 lower limbs without obvious edema, lower limbs lymph node imaging was positive in 13 (29.5%) and negative in 31 (70.5%); the sensitivity was 75.0%, the specificity was 70.5%, and the Youden index was 0.455. When diagnosis was based on the combination of lymphatic vessel imaging and lymph node imaging, among 56 lower limbs with lymphedema, lymphatic vessel imaging and lymph node imaging were positive in 48 (85.7%) and negative in 8 (14.3%); among 44 lower limbs without obvious edema, lymphatic vessel imaging and lymph node imaging were positive in 14 (31.8%) and negative in 30 (68.2%); the sensitivity was 85.7%, the specificity was 68.2%, and the Youden index was 0.539. The AUC for the combined diagnosis of lymphatic vessel imaging and lymph node imaging was 0.781, the AUC for the diagnosis of abnormal lymphatic vessel imaging was 0.771, and the AUC for the diagnosis of abnormal lymph node imaging was 0.739 (all P < 0.01). Conclusions:99Tc m-sulfur colloid lymphoscintigraphy is of great help in the diagnosis of lower limb lymphedema after operation of gynecological tumors. The combination of lymph node imaging and lymphatic vessel imaging is more effective in the diagnosis of lower limb lymphedema.

Objective:To investigate the changes of default network functional connectivity (FC) in resting state of patients with insomnia disorder (ID).Methods:Fifty-six patients with insomnia disorder and fifty healthy controls were recruited. All subjects were assessed with Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), Epworth sleepiness score (ESS) and Hamilton depression scale (HAMD-17). All subjects were scanned with resting state functional magnetic resonance imaging (rs-fMRI). SPM12 and CONN18b were used to preprocess rs-fMRI data on MATLAB (R2013b).The medial superior frontal gyrus was defined as the seed point, and the differences in the functional connection strength of the two groups of subjects were compared. Pearson correlation analysis was performed between the FC value of the brain area with statistical significance and scores of PSQI and ISI.Results:(1)FC analysis showed that compared with the control group, patients with ID had abnormal default mode network (DMN) connection, as follows: FC of left medial superior frontal gyrus and left central anterior gyrus (MNI: x, y, z=-30, -15, 51) and anterior cingulate gyrus (MNI: x, y, z=-6, 24, 36), FC of right medial forehead between the last gyrus and the left central anterior gyrus (MNI: x, y, z=-48, -6, 48), FC of left anterior cuneiform and the left central back (MNI: x, y, z=-54, -18, 54) and left superior occipital gyrus (MNI: x, y, z=-21, -69, 30), FC of right precuneus and left central posterior gyrus (MNI: x, y, z=-60, -21, 48) was enhanced. The FC of left anterior cuneiform lobe and the right middle frontal gyrus (MNI: x, y, z=42, 33, 42) and the right angular gyrus (MNI: x, y, z=54, -51, 45), FC of right precuneus and left inferior temporal gyrus (MNI: x, y, z=-51, -12, -42) was weakened. (2)With the left medial superior frontal gyrus as the seed point, FC values in anterior cingulate gyrus ( r=0.451, 0.338, both P<0.01) and left anterior central gyrus ( r=0.324, 0.402, both P<0.05) were positively correlated with PSQI and ISI scores. With the right precuneus as the seed point, FC value of left posterior central gyrus was positively correlated with PSQI( r=0.333, P=0.013) and ISI scores( r=0.418, P=0.008), while FC value of left inferior temporal gyrus was negatively correlated with PSQI( r=-0.662, P=0.001) and ISI scores( r=-0.402, P<0.01).With the left precuneus as the seed point, FC value of left superior occipital gyrus was positively correlated with PSQI( r=0.438, P=0.001) and ISI scores( r=0.495, P=0.011). Conclusion:Patients with ID may have changes in the functional connection of multiple networks. The decrease of FC in DMN may be one of the potential causes of insomnia. The increase in FC between DMN and the visuospatial attention network may be the core of the mechanism of damage to the brain function network of insomnia link.

At the end of December 2019, acute respiratory infectious diseases caused by a new type of coronavirus were prevalent in Wuhan and other cities of China. Different from radiology examinations, the protocols of nuclear medical imaging examinations are complicated, in which more workplaces and staff are needed, resulting more complex management of patients and higher protection requirements. Combined with the characteristics of SPECT and PET imaging procedures, this paper puts forward some suggestions on the protective process of imaging examinations for patients with confirmed or suspected novel coronavirus infection. The main purpose is to protect medical staff from virus infection, effectively reduce the risk of virus transmission during the examination process, and ensure the medical quality and safety.

At the end of December 2019, acute respiratory infectious diseases caused by a new type of coronavirus were prevalent in Wuhan and other cities of China. Different from radiology examinations, the protocols of nuclear medical imaging examinations are complicated, in which more workplaces and staff are needed, resulting more complex management of patients and higher protection requirements. Combined with the characteristics of SPECT and PET imaging procedures, this paper puts forward some suggestions on the protective process of imaging examinations for patients with confirmed or suspected noval coronavirus infec- tion. The main purpose is to protect medical staff from virus infection, effectively reduce the risk of virus transmission during the examination process, and ensure the medical quality and safety.

Objective To evaluate the influences of FBP and OSEM (with different iteration numbers or subset numbers) on cardiac function parameters with MPI,and to identify a suitable clinical method.Methods The MPI of 66 patients (33 males,33 females,age range: 18-77 years) from January 2012 to December 2014 were retrospectively analyzed.The imaging data was reconstructed with FBP and 5 different OSEM (4-16 subsets and 2-4 iterations) in order to evaluate if there was any difference of cardiac function parameters calculated by QGS between the different image processing methods.In addition,the results were compared with those of cardiac ultrasonography.One-way analysis of variance was used for data analysis.Results The statistical differences of LVEF,EDV,and ESV(F values: 10.73,4.89 and 5.97,all P<0.05) were found among 6 reconstructed methods.The values of LVEF were (66.14±11.12)％,(75.05±12.10)％,(70.09±11.27)％,(66.88±10.38)％,(64.97±10.25)％,and (62.58±9.84)％.Those of EDV were (77.32±27.58),(67.97±27.56),(75.10±27.89),(81.03±28.11),(84.94±29.07),and (89.98±29.71) ml,and the ESV values were (28.71±10.04),(19.71±16.51),(25.13±17.66),(29.01±18.47),(32.10±19.63),and (35.83±20.41) ml respectively.The cardiac function parameters measured by OSEM (with 2 iterations,12 subsets) were much similar to that measured by cardiac ultrasonography.Conclusion Compared with other 5 processing methods of MPI,the OSEM (with 2 iterations,12 subsets) method may be more suitable for practical clinical application.

Objective: To analyze the risk factors for metastasis of lymph nodes between sternocleidomastoid and sternohyoid muscle (LNSS) in papillary thyroid cancer (PTC). Methods: Papillary thyroid cancer patients with clinically positive lateral lymph node metastasis (cN1) who underwent surgery including LNSS dissection between May 1, 2013 and May 31, 2016 at the Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center were retrospectively studied. Logistic regression analysis was performed to evaluate possible clinicopathological factors related to LNSS metastasis. Results: In 85 patients, 54 patients (63.5%) showed LNSS in their surgical specimen, and 20 patients (23.5%) had pathologically positive LNSS metastasis. Patients with LNSS showed preoperatively higher levels of serum thyroid stimulating hormone (TSH) and thyroid peroxidase antibody (TPO-Ab) compared to patients only with fibrofatty tissues between sternocleidomastoid and sternohyoid muscle (P<0.05), and they also displayed a higher proportion of multifocality in ipsilateral thyroid lobe (P<0.05). Multi-factor analysis indicated that LNSS metastasis was correlated with original tumor size (OR=1.819, 95%CI 1.050-3.850, P=0.002) and Level Ⅳ lymph node metastasis (OR=2.190, 95%CI 1.132-2.334, P=0.005). Furthermore, the number of positive LNSS was tightly correlated to that of level Ⅳ lymph node metastasis(P<0.05). Conclusion LNSS metastasis is occult but not quite rare in PTC. Patients with extensive lymph node metastasis in Level Ⅳhave a higher risk for metastasis of LNSS.

Objective To prepare a kind of 99Tcm-labeled estrogen receptor (ER) SPECT imaging agent,and evaluate its binding characteristics with ER by in vitro and in vivo studies.Methods EDL was prepared from estrone and then reacted with GAP to synthesize GAP-EDL.Then,GAP-EDL was labeled with 99Tcm to obtain 99Tcm-GAP-EDL.Cell uptake and blocking assays were performed in vitro on MCF-7and MDA-MB-231 cells.The biodistribution study of 99Tcm-GAP-EDL was performed on normal BALB/c mice at 30,60,120,180 and 240 min post injection.Nude mice bearing either MCF-7 or MDA-MB-231derived tumors were injected with 99Tcm-GAP-EDL,and subjected to γimaging at 1,2,4 h post injection.The mice injected with excess unlabeled GAP-EDL or estradiol were used as the blocking control.Two-sample t test was used for data analysis.Results The radiolabeling yield of 99Tcm-GAP-EDL was (98.8 ±0.5) ％ and the radiochemical purity after 24 h was over 90％.The cell uptake rate of MCF-7 cells at 240min was (4.84± 0.21) ％,which was significantly higher than that of MDA-MB-231 cells ((2.11±0.21) ％;t =15.96,P＜0.05).99 Tcm-GAP-EDL uptake rate of MCF-7 cells in blocking groups ((2.31 ± 0.28) ％ and (2.05±0.35) ％) decreased significantly compared to that of non-blocking group(t=11.52,11.16,both P＜0.05).Biodistribution studies showed that 99Tcm-GAP-EDL was mainly metabolized by the liver and kidneys,and exhibited quick blood clearance.Gamma imaging showed high uptake in MCF-7 tumors 1 h post injection and the uptake reached the highest at 4 h,while there was little 99Tcm-GAP-EDL uptake in MDA-MB231 tumors and blocked MCF-7 tumors.Conclusions 99Tcm-GAP-EDL may be prepared under mild conditions with high labeling purity and stability.The in vitro and in vivo characteristics of 99Tcm-GAP-EDL suggest that it may be a promising probe for ER positive tumor imaging.