Objective To summarize the key point of application of acellular dermal matrix(ADM)in operative cooperation of pharyngeal tissue repair.Methods In order to rebuild the air-tight cavity,ADM was sewn to the anterior vertebrae fascia in 7 patients with pharyngeal malignant tumor undergoing total laryngectomy or pharyngolaryngectomy to rebuild the posterior wall of the laryngopharynx.Meanwhile the muscular flap of the pectoralis major Was used to rebuild the anterior and lateral walls of the laryngopharynx.Results There was no reject reaction or pharyngeal fistula in these 7 cases and the wound surface were all mucous membranized.All the incisions reached the primary healing.Conclusions ADM is easy to get and possesses good histocompatibility and compatible thickness.It is easy to be managed during operation and can modify the peripharyngeal defect with the combination of muscular flap of the pectoralis major or any other neck tissue.Strict nursing preparation before operation and perfect cooperation during operation are key steps to complete the surgery successfully.

Sixty-eight cases undergoing living related renal transplantation in First Hospital of Sun Yat-sen University between April 2004 and August 2007 were selected.The informed consent was obtained from the donors and recipients.The clinical data about operation assistance were retrospectively analyzed,including the pre-operation air sterilization in operation room,preparation of apparatus,one-off utensils and medicine,donor position fixation,assistance in kidney perfusion and preparation,management and usage of medicines,and steps of assistance during operation by instrument nurse.The results show the operational apparatus and utensils were prepared well,and the nurses knew well operation process and worked in harmony with the surgeons.For the 68 donor kidneys,the warm ischemic time was 1-6 minutes,and cold ischemic time was 10-118 minutes.The operations for both donors and recipients ran smoothly and lasted for 2.5-4 hours.Blood loss was less than 200 mL.Vital signs were stable during operation,and no complications happened.Good pre-operative preparation,strict management of personnel participating in operation,and training of assistant techniques are the preconditions for operation assistance.Rigorous aseptic management and correct preservation of organs are the keys for assistance for living donor kidney transplantation.Short warm and cold ischemic time of the donor kidneys are of great importance for the success of operation and the long-term survival of transplanted patients.

Objective To explore risk factors of unintentional injury among left-behind children in a rural poverty county and to provide evidence for injury intervention.Methods 2 909 students,including 1 630 left-behind children,were recruited from a poor counties of five schools by Multi-stage stratified cluster random sampling method,and were surveyed applying designed questionnaire,interview method and observation method to collect the data of the injury accidents and related factors in the last one year.Results The incidence of unintentional injury among the left-behind children in rural area was 34.0％,higher than the rate of 27.7％ among non-left-behind children and the difference was statistically significant (c2 =13.541,P＜0.05);in the top five injury type were falling injury (14.0％),burus (5.6％) and sharp instrument injury (3.6％),bite (3.0％),parts (1.6％) among left-behind children.Low age,often miss my mother,fighting in school,outdoor activities,road and traffic state were risk factors for injury of left-behind children.Corcltsion The unintentional injury of left-behind children has become a social problem that can not be ignored,and targeted intervention should be carried out.

Objective To explore the effect of the self-designed cotton-padded covering for a modified lithotomy position on preventing complications in the lower limbs in patients undergoing gynecological laparscopic surgery.Methods A total of 320 patients undergoing radical hysterectomy or deep invasive endometriosis were selected and randomly divided into an observation group(n=160) and a control group(n=160).The patients in the control group were placed on the routine lithotomy position,the lower extremity and popliteal space protected with oasis outline cushion in the control group,while the patients in the observation group were placed on the same pads,the lower extremity and popliteal space protected with the self-designed cotton-padded coverings.Results The average temperature of the lower limbs of patients after operation in the observation group was significantly higher than that in the control group (P<0.01).The incidences of complications in the observation group were significantly lower than those in the control group(all P<0.05). Conclusion The self-designed cotton-padded covering for modified lithotomy position can effectively prevent the complications of the lower limbs and improve the comfort of patients.

Objective:To investigate the role and possible molecular mechanisms of m6A methyltransferase METTL3 and demethylase FTO in H7N9 virus infection.Methods:Western blot(WB) was used to detect the expression of METTL3 and FTO after H7N9 virus infected A549 cells. After knocking down and over-expressing METTL3 and FTO, H7N9 virus infection was tested by WB and TCID 50 for its effect on virus replication. Transcriptome sequencing method were used to analyze differentially expressed genes at the transcriptome level in METTL3 or FTO knockdown and wild-type control cells, and preliminary analysis of potential targets was performed. Results:After 24 h of H7N9 virus infection in A549 cells, METTL3 expression was up-regulated, and FTO did not significantly change. After knocking down METTL3 and FTO, the virus nucleoprotein (NP) expression level and virus titer decreased significantly. Consistent with the result of the knockdown experiments, we found that the viral titer was increased by METTL3 and FTO overexpression. Transcriptome sequencing result showed that 314 and 555 differentially expressed genes were found between the METTL3 or FTO knockdown group and the control group, respectively. GO functional enrichment analysis and KEGG pathway enrichment analysis showed that these genes were related to the host immune response.Conclusions:METTL3 and FTO may play a key role in H7N9 virus infection by regulating host-virus interactions.

Objective: To clarify the role of cytochrome P450 in nonalcoholic fatty liver disease (NAFLD) by RNA-Seq and bioinformatics analysis. Methods: A total of 20 male C57BL/6 mice were used. Ten mice were fed with high-fat diet (D12492, 60% kcal fat) for 16 weeks to establish a mouse model of NAFLD, and the other 10 mice were fed with low-fat diet (D12450B, 10% kcal fat) as control group. At the end of the experiment, the body weight, liver weight, and hepatic triglyceride (TG) content were measured. Meanwhile, HE staining and RNA-Seq analysis were performed for the liver tissues. The differentially expressed genes were screened out and subjected to bioinformatics analysis, including KEGG and GO BP enrichment analyses and interaction network analysis. Comparison of means between the two groups was made using t-test. Results: Compared with the control group, the mice in the model group were obviously obese, with significantly increased body weight (41.41 ± 6.01 g vs 28.78 ± 1.79 g, t = 6.04, P < 0.01) and liver weight (1.38 ± 0.30 g vs 1.08 ± 0.10 g, t = 2.89, P < 0.01). The mice in the model group showed obvious steatosis, accompanied by a small amount of inflammatory cell infiltration, but with no obvious fibrosis, according to the results of HE staining. In addition, the hepatic TG content in the model group was significantly increased compared with that in the control group (0.64 ± 0.01 mg/mg vs 0.29 ± 0.06 mg/mg, t = 10.11, P = 0.04). Compared with the control group, a total of 367 differentially expressed genes, including 211 down-regulated and 156 up-regulated ones, were identified in the model group according to the RNA-seq results. Meanwhile, 19 CYP450 subtypes, accounting for 5% of the differentially expressed genes, were identified, and CYP2E1, CYP2C70, CYP3A11, CYP3A25, CYP2D26, CYP4A10, CYP17A1, CYP2B10, and CYP2C38 were involved in oxidative stress, steroid hormone metabolism, fatty acid metabolism, arachidonic acid metabolism, and the PPAR signaling pathway. An interaction network was constructed with 30 nodes, and CYP2E1 and CYP2C70 were identified as key nodes. RT-PCR validation results showed that the expression changes of CYP450 subtypes and lipid metabolism-related genes were consistent with the findings of sequencing. Conclusion The CYP450 family plays a vital role in the pathogenesis of fatty liver by regulating lipid metabolism-related pathways, including oxidative stress, arachidonic acid metabolism, steroid hormone metabolism , and fatty acid metabolism.

Objective To observe the value of quantitative CT(QCT)abdominal body fat parameters combined with clinical-imaging model for predicting recurrent acute pancreatitis(RAP).Methods Data of 468 patients with acute pancreatitis(AP),including 207 cases of RAP(RAP group)and 261 cases of non-RAP(non-RAP group)were retrospectively analyzed.Clinical information,conventional CT manifestations and QCT parameters such as abdominal subcutaneous fat area(SFA),visceral fat area(VFA),total abdominal fat area(TFA),hepatic fat content and pancreatic fat content at the first visit were recorded or measured.Clinical characteristics,CT manifestations and QCT parameter values were compared between groups,and the independent factors for predicting RAP were selected with multivariate logistic regression analysis.Then a clinical-imaging model and a comprehensive model combining with QCT parameters were constructed,and their efficacies for predicting RAP were evaluated with receiver operating characteristic(ROC)curves,and the area under the curves(AUC)were calculated.Results Compared with non-RAP group,patients in RAP group were younger,had higher percentage of alcohol consumption,biliary stones and hyperlipidemia,as well as of distinct pancreatic margins on CT images,also higher VFA,TFA,liver fat content and pancreatic fat content(all P＜0.05).Alcohol consumption,hyperlipidemia,biliary stones,pancreatic margins and pancreatic fat content were all independent predictors of RAP,and the comprehensive model constructed based on these five had higher AUC(0.860)than clinical-imaging model constructed based on the previous 4 factors(0.701)and pancreatic fat content alone(0.770)(both P＜0.001).Conclusion QCT abdominal body fat parameters combined with clinical-imaging comprehensive model was effective for predicting the risk of RAP.

Objective To investigate the value of quantitative CT(QCT)parameters related to abdominal and dorsal fat content for predicting early postoperative complications of esophageal cancer.Methods A total of 184 patients who underwent radical esophageal cancer surgery were retrospectively collected and divided into complication group(n=76)and control group(n=108)according to whether early postoperation complication(within 30 days after surgery)occurred or not.QCT was used to obtain parameters related to abdominal and dorsal fat content,including visceral fat area(VFA),subcutaneous fat area(SFA),VFA/SFA and the degree of muscle fat infiltration(MFI)of posterior vertebral muscles based on L3 central-level CT images.Univariate analysis and multivariate logistic regression were used to analyze clinical and pathological data as well as QCT parameters related to abdominal and dorsal fat content to screen independent risk factors for early postoperative complications of esophageal cancer.Then receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficacy of each independent risk factor alone and their combination for predicting early postoperative complications of esophageal cancer.Results VFA/SFA and MFI degree of posterior vertebral muscles were both independent risk factors for early postoperative complications of esophageal cancer(OR=5.121,1.110,both P＜0.05).The AUC of VFA/SFA and MFI degree of posterior vertebral muscle was 0.81 and 0.77,respectively,while of their combination was 0.84.Conclusion QCT parameters related to abdominal and dorsal fat content could be used to effectively predict early complications of esophageal cancer after surgery.

Objective To explore the feasibility and convenience of automatic registration ultrasound-CT/MR fusion imaging based on hepatic vessel trees. Methods The PercuNav fusion imaging system of Philips Epiq 7 was used to perform ultrasound-CT/MR fusion imaging on 22 patients with focal liver lesions detected by contrast-enhanced CT or MR.Both automatic registration ultrasound-CT/MR fusion imaging based on hepatic vessel trees and the conventional ultrasound-CT/MR fusion imaging based on internal anatomic landmarks were employed for alignment in these patients.The results including the success rate of registration,duration time of initial registration,error of initial registration,number of times of fine-tuning, duration time of fine-tuning and the overall duration time of registration were compared between these two methods.Results The success rates of registration,duration time of initial registration,errors of initial registration,numbers of times of fine-tuning,duration time of fine-tuning and the overall duration time of registration for automatic registration ultrasound-CT/MR fusion imaging based on hepatic vessel trees and the conventional ultrasound-CT/MR fusion imaging based on internal anatomic landmarks were 72.73% and 95.45%,16.5 s (10~30 s) and 13 s (8~24 s),3 mm (1~14 mm) and 14 mm (2~43 mm),0 time (0 to 2 times) and 1 time (0~3 times),0 s(0~46 s) and 30 s (0~88 s),and 20 s (12~61 s) and 42 s (9~102 s),successively and respectively. There was no statistically significant difference in the success rates between these two methods ( P >0.05).The duration time of initial registration of conventional method was less than that of automatic registration method( P <0.05).The error of initial registration,number of times of fine-tuning,duration time of fine-tuning and the overall duration time of registration of automatic registration method were superior to those of conventional method ( P < 0.05).Conclusions Automatic registration ultrasound-CT/MR fusion imaging based on hepatic vessel trees is feasible. It is also more convenient than conventional ultrasound-CT/MR fusion imaging based on internal anatomic landmarks.

Background/Aims: The accuracy of endosonographers in diagnosing gastric subepithelial lesions (SELs) using endoscopic ultrasonography (EUS) is influenced by experience and subjectivity. Artificial intelligence (AI) has achieved remarkable development in this field. This study aimed to develop an AI-based EUS diagnostic model for the diagnosis of SELs, and evaluated its efficacy with external validation. Methods: We developed the EUS-AI model with ResNeSt50 using EUS images from two hospitals to predict the histopathology of the gastric SELs originating from muscularis propria. The diagnostic performance of the model was also validated using EUS images obtained from four other hospitals. Results: A total of 2,057 images from 367 patients (375 SELs) were chosen to build the models, and 914 images from 106 patients (108 SELs) were chosen for external validation. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the model for differentiating gastrointestinal stromal tumors (GISTs) and non-GISTs in the external validation sets by images were 82.01%, 68.22%, 86.77%, 59.86%, and 78.12%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in the external validation set by tumors were 83.75%, 71.43%, 89.33%, 60.61%, and 80.56%, respectively. The EUS-AI model showed better performance (especially specificity) than some endosonographers.The model helped improve the sensitivity, specificity, and accuracy of certain endosonographers. Conclusions We developed an EUS-AI model to classify gastric SELs originating from muscularis propria into GISTs and non-GISTs with good accuracy. The model may help improve the diagnostic performance of endosonographers. Further work is required to develop a multi-modal EUS-AI system.