Objective:To evaluate the effect of the free anterolateral thigh flap with nerve and the sural neurocutaneous flap on ankle and foot tissue defect, and to provide guidance for clinical selection.Methods:From May 2016 to May 2019, we reviewed and analyzed the data of patients with soft tissue injury of ankle and foot repaired by flap from Microsurgery Repair and Reconstruction Center, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University. According to the surgical method, they were divided into the free anterolateral thigh flap with nerve group and the sural neurocutaneous flap group. The survival rate of the 2 groups of skin flaps were calculated. According to the trial standard for evaluation of upper limb function in Chinese Medical Association Hand Surgery Society, the flaps were rated as excellent, good, and acceptable. And the excellent and good rates were counted. The incidence of regional complications of the 2 groups were counted. SPSS 26.0 software was used for analysis, the measurement data were subjected to t-test, expressed as mean±standard deviation; the categorical variables were subjected to chi-square test or Fisher’s exact probability method, and P<0.05 indicated that the difference was statistically significant. Results:A total of 59 patients with soft tissue defects in the foot and ankle were included. Among them, 21 cases were repaired with free anterolateral thigh flaps with nerve (group A), 12 males and 9 females, with an average age of 42.1 years, and the defect area was 4 cm×6 cm-11 cm ×16 cm, followed up for an average of 12.3 months after surgery; 17 cases of sural neurocutaneous flap repair (group B), 11 males and 6 females, average age 45.3 years, defect area 5 cm×5 cm-10 cm× 14 cm, the average follow-up was 11.3 months. There were no statistically significant differences in age, gender and cause of injury between the two groups ( P<0.05). The area of the flaps in group A and group B were (53.0±12.2) cm 2 and (46.4±9.62) cm 2, respectively. There was no significant difference between the two groups ( t=1.824, P=0.076). The flaps were all survived in both groups. Among them, 2 cases of group A had partial necrosis at the distal end of the flaps and healed after post-treatment; 1 case of group B had vascular crisis after operation, and the flaps survived after exploratory decompression. The first-stage survival rate of skin flaps in group A was 90.5% (19/21), and the first-stage survival rate of skin flaps in group B was 94.1% (16/17). The difference was not statistically significant ( P=1.000). According to the trial standard of upper limb function evaluation of the Chinese Medical Association Hand Surgery Society, the skin flaps in group A were excellent in 10 cases, good in 7 cases, and fair in 4 cases, with an excellent and good rate of 81.0% (17/21). In group B, skin flaps were excellent in 3 cases and good in 3 cases. Of the 11 cases, the excellent and good rate was 35.3% (6/17), and the difference was statistically significant ( P=0.007). The flap donor area in group A healed well without related complications. In group B, 2 patients (11.8%) developed scar contracture deformity after the flap donor area, which affected calf function, and the function recovered after the second-stage scar was released. The incidence of complications in the region was not statistically significant ( P=0.193). Conclusions:Both the free anterolateral thigh flap with nerve and the sural neurocutaneous flap can repair the soft tissue defect of foot and ankle with high survival rate. But the sural neurocutaneous flap has a higher good rate than the free anterolateral thigh flap with nerve, and the donor site is affected smaller.

Objective:To evaluate the effect of the free anterolateral thigh flap with nerve and the sural neurocutaneous flap on ankle and foot tissue defect, and to provide guidance for clinical selection.Methods:From May 2016 to May 2019, we reviewed and analyzed the data of patients with soft tissue injury of ankle and foot repaired by flap from Microsurgery Repair and Reconstruction Center, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University. According to the surgical method, they were divided into the free anterolateral thigh flap with nerve group and the sural neurocutaneous flap group. The survival rate of the 2 groups of skin flaps were calculated. According to the trial standard for evaluation of upper limb function in Chinese Medical Association Hand Surgery Society, the flaps were rated as excellent, good, and acceptable. And the excellent and good rates were counted. The incidence of regional complications of the 2 groups were counted. SPSS 26.0 software was used for analysis, the measurement data were subjected to t-test, expressed as mean±standard deviation; the categorical variables were subjected to chi-square test or Fisher’s exact probability method, and P<0.05 indicated that the difference was statistically significant. Results:A total of 59 patients with soft tissue defects in the foot and ankle were included. Among them, 21 cases were repaired with free anterolateral thigh flaps with nerve (group A), 12 males and 9 females, with an average age of 42.1 years, and the defect area was 4 cm×6 cm-11 cm ×16 cm, followed up for an average of 12.3 months after surgery; 17 cases of sural neurocutaneous flap repair (group B), 11 males and 6 females, average age 45.3 years, defect area 5 cm×5 cm-10 cm× 14 cm, the average follow-up was 11.3 months. There were no statistically significant differences in age, gender and cause of injury between the two groups ( P<0.05). The area of the flaps in group A and group B were (53.0±12.2) cm 2 and (46.4±9.62) cm 2, respectively. There was no significant difference between the two groups ( t=1.824, P=0.076). The flaps were all survived in both groups. Among them, 2 cases of group A had partial necrosis at the distal end of the flaps and healed after post-treatment; 1 case of group B had vascular crisis after operation, and the flaps survived after exploratory decompression. The first-stage survival rate of skin flaps in group A was 90.5% (19/21), and the first-stage survival rate of skin flaps in group B was 94.1% (16/17). The difference was not statistically significant ( P=1.000). According to the trial standard of upper limb function evaluation of the Chinese Medical Association Hand Surgery Society, the skin flaps in group A were excellent in 10 cases, good in 7 cases, and fair in 4 cases, with an excellent and good rate of 81.0% (17/21). In group B, skin flaps were excellent in 3 cases and good in 3 cases. Of the 11 cases, the excellent and good rate was 35.3% (6/17), and the difference was statistically significant ( P=0.007). The flap donor area in group A healed well without related complications. In group B, 2 patients (11.8%) developed scar contracture deformity after the flap donor area, which affected calf function, and the function recovered after the second-stage scar was released. The incidence of complications in the region was not statistically significant ( P=0.193). Conclusions:Both the free anterolateral thigh flap with nerve and the sural neurocutaneous flap can repair the soft tissue defect of foot and ankle with high survival rate. But the sural neurocutaneous flap has a higher good rate than the free anterolateral thigh flap with nerve, and the donor site is affected smaller.

With the development of image-guided surgery and radiotherapy, the demand for medical image registration is stronger and the challenge is greater. In recent years, deep learning, especially deep convolution neural networks, has made excellent achievements in medical image processing, and its research in registration has developed rapidly. In this paper, the research progress of medical image registration based on deep learning at home and abroad is reviewed according to the category of technical methods, which include similarity measurement with an iterative optimization strategy, direct estimation of transform parameters, etc. Then, the challenge of deep learning in medical image registration is analyzed, and the possible solutions and open research are proposed.
Deep Learning ; Diagnostic Imaging ; Image Processing, Computer-Assisted ; Neural Networks (Computer) ; Research

The role of three-dimensional brachytherapy (3D-BT) in the radical treatment of cervical cancer has been widely recognized. Obtaining the image information through simulated positioning is a key step of 3D-BT.Currently, MRI/CT positioning has been commonly applied in clinical practice, which has respective limitations when applied in radiosurgery. Consequently, it is of necessity to explore an accurate, highly efficient and convenient positioning approach. Besides MRI and CT, ultrasound is a novel positioning method in clinical settings. Through literature review, the application of ultrasound in 3D-BT was summarized, aiming to provide reliable reference for clinicians.

Primary Sj(o)gren's syndrome (pSS) is a chronic autoimmune disease characterized by lymphoplasmacytic infiltration of the exocrine glands that results in multiple organs and systems damage.Renal injury affects 0.3％-27.0％ patients,The most frequent form of nephropathy in pSS is tubulointerstitial nephritis.The main clinical manifestation is renal tubular acidosis.The renal prognosis in patients with pSS is usually favorable,but renal failure may occur.At present,it still lacks of strict consensus or guideline for the treatment.

Objective To retrospectively compare the efficacy of Serva NB1 collagenase with Vitacyte GOLD collagenase on islet isolation of pancreas.Methods All the human pancreata were obtained from Chinese organ donors.In GMP laboratory,the pancreata were trimmed and distended with Serva NB1 collagenase (Serva NB1,n =12) or Vitacyte GOLD collagenase (Vitacyte GOLD,n =5) and digested according to a modified Ricordi semi-automatic protocol,and the digestion duration was recorded.The digested islets were then collected and washed,followed by the continuous density purification in a Cobe 2991 cell separator.The islet yield,purity,viability and glucose-stimulated insulin release (GSI) were determined each time after purification.Quantity and quality of isolated islets were determined by digestion efficacy.Results The digestion duration in Vitacyte GOLD collagenase group was significantly shorter than in Serva NB1 collagenase group to achieve the same digestion endpoint (P＜ 0.05).The islets yields of different sizes were variable between the two groups.The Vitacyte GOLD collagenase digestion produced more islets with a diameter range of 50-100 μm than the ServaNB1 collagenase digestion (P＜0.05),but the latter yielded more islets with a diameter range of 251-300 μm and 301-350μm (P＜0.05).There was no significant difference in total islets yields,viability,and GSI between two collagenase digestions (P＞0.05).Conclusion Both Vitacyte GOLD collagenase and Serva NB1 collagenase can be used for the clinical islet isolation in China.

Objective To study the effect of gastrodin on arterial blood gas and brain injury of rats under simulated high altitude hypoxia environment. Methods A total of 60 adult healthy male Wistar rats were randomly divided into normal (N) group, hypoxia model (M) group, rhodiola crenulata (RC) group, low dose of gastrodin (GAS-L) group, medium dose of gastrodin (GAS-M) group and high dose of gastrodin (GAS-H) group (10 for each group). The intragastric administration on rats was continued for 7 days timely in each day. Under simulated 8000m altitude using low pressure oxygen cabin, the arterial blood gas of each group were tested, pathological changes of brain tissues were observed and related indexes of brain were detected after 12h hypoxia. Results Comparing with group N, the blood oxygen partial pressure (PO2), value of blood oxygen saturation (SO2), oxygenation index (PO2/FIO2), Na+ concentration (Na+), actual bicarbonate radical (HCO3–) significantly decreased (P<0.01), lactic acid (Lac), hemoglobin concentration (Hb) significantly increased (P<0.01) and pathological damage was inflicted in group M; and contents of malondialdehyde (MDA), hydrogen peroxide (H2O2) in brain tissue significantly increased (P<0.01), content of glutathione(GSH) and activity of glutathione peroxidase (GSH-Px) in brain tissue significantly decreased (P<0.01) in group M. Compared with group M, PO2, SO2 and PO2/FIO2 significantly increased (P<0.01, P<0.05) in group GAS-L; Na+ and HCO3– significantly increased (P<0.01, P<0.05) in three dose groups of GAS; Lac significantly decreased (P<0.01, P<0.05) in group GAS-L and GAS-H. Hb significantly increased (P<0.01) in group GAS-H, a rising trend appeared in group GAS-L but with no statistical significance. Damages of brain tissue were alleviated in group RC and three dose groups of GAS comparing with group M. Compared with group M, MDA significantly decreased (P<0.01) in three dose groups of GAS; there was a decreasing trend of H2O2 but with no statistical significance in three dose groups of GAS; GSH and GSH-Px significantly increased (P<0.01, P<0.05) in three dose groups of GAS. However, three groups of GAS has no dose dependent. Conclusion There was an protective effect of gastrodin on arterial blood gas and brain injury of rats under simulated high altitude hypoxia environment.

Objectives To investigate the delivery mode and perinatal outcomes of low birth weight infants in mainland China, and to explore the appropriate delivery mode and timing of delivery. Methods Clinical data of 103 678 babies delivered from Jan 1st to Dec 31th, 2011 in 39 hospitals in mainland China were analyzed retrospectively. The 39 hospitals located in 7 administrative regions, including Northeast, Northwest, North, Central, East, South and Southwest China. Result (1) The average birth weight of the newborns was (3 263 ± 540) g. Among them, 7 474 cases were diagnosed low birth weight infants, with the incidence of 7.209%(7 474/103 678). There were 2.328%(2 214/95 116 ) full-term low birth weight infants and 61.434% (5 260/8 562 ) preterm low birth weight infants. (2) From week 28 to week 36, the cesarean section rate of low birth weight infants increased with the increasing of gestational weeks. The cesarean section rate of full-term low birth weight infants were 61.14%(1 139/1 863) , which was higher than that of normal birth weight infants (52.947%, 45 108/85 195). The differences were statistically significant (P<0.01). (3) The constitution of the indication of cesarean section showed that social factor and maternal factor were 10.73%(443/4 128) and 48.91%(2 019/4 128) for low birth weight infants, respectively. While for the normal birth weight infants, they were 27.70%(12 495/45 108) and 38.60%(17 412/45 108), respectively. There was statistically significant difference(P<0.01). (4) The emergency cesarean section rate of full-term low birth weight infants was 41.09%(468/1 139), which was higher than that of normal birth weight infants (31.09%, 14 024/45 108). The difference was statistically significant (P<0.01). (5) The rates of stillbirth, neonatal asphyxia and the mortality of full-term low birth weight infants were 2.36%(44/1 863), 6.12%(114/1 863), and 3.17%(59/1 863), respectively. Those of normal birth weight infants were 0.11%(94/85 195), 1.41%(1 201/85 195), and 0.14%(119/85 195), respectively. The differences were statistically significant (P<0.01). (6) The stillbirth rate and mortality of low birth weight infants born by cesarean delivery were significantly lower than those born by vaginal delivery. The rate of neonatal asphyxia (17.95%) and other morbidity (3.61%) among low birth weight infants born by cesarean section in week 28 to week 33+6 were significantly lower than those born by vaginal delivery (30.09%, 6.62%, respectively). (7) With the increase of gestational age, the incidence of neonatal asphyxia and stillbirth decreased. The incidence of neonatal asphyxia(39.22%) and stillbirth(23.28%) was most seen in 28 to 29 gestational weeks, which decreased to 9.08% and 2.88% in 34 gestation weeks. Conclusions Low birth weight is one of the leading causes of adverse perinatal outcomes and cesarean section. To decrease the incidence of low birth weight, individualized management should be performed according to the gestational age and fetal condition. Extending the gestational age to at least 34 weeks may avoid iatrogenic preterm labor and improve the neonatal survival rate.

Objective To investigate the influencing factors of low birth weight infants (LBWI) in China in order to provide evidence for lowering the incidence of LBWI and improving the perinatal outcomes.Methods Clinical data were obtained from 14 different provinces, municipalities or autonomous regions in Northeastern, Northwestern, Northern, Central, Eastern, Southern and Southwestern of China, covering 39 hospitals of different levels.A total of 112 441 newborns were collected from January 1 to December 31 in 2011.After exclusion of those cases with incomplete information, miscarriage before 28 weeks of gestation, induction due to fetal malformation or intrauterine fetal death, 103 678 cases were restrospectively analyzed.Questionnaires were filled out and all data were recorded in computer network databases.Clinical data included maternal age, education background, height, weight, parity, histories of abnormal pregancy and comorbidities and complication.Independent sample t-test, Chi-square test, unvariate and ultivariate unconditional Logistics regression analysis were performed.Results The incidence of LBWI in mainland China was 7.21％ (7 474/103 678), 61.43％ (5 260/8 562) for preterm babies, and 2.33％ (2 214/95 116) for full-term babies.Univariate analysis showed that LBWI were associated with maternal age, education background, height, pregestational body mass index (BMI), weight gain during pregnancy, cord length, smoking, parity, histories of abnormal pregancy, gestational diabetes mellitus (GDM), preterm birth, hypertensive disorders in pregnancy, anemia, premature rupture of membranes and abnormal amniotic fluid volume.The following unconditional binary logistic regression analysis for those factors with P ＜ 0.3 in unvariate analysis showed that preterm birth (OR=46.246, 95％CI: 41.484-51.555), hypertensive disorders during pregnancy (OR=5.031, 95％CI: 4.325-5.853), histories of intrauterine fetal death ≥ 1 times (OR=2.446, 95％CI: 1.479-4.044), oligohydramnios (OR=2.068, 95％CI:1.659-2.578), pregestational BMI ＜ 18.5 (OR=1.637, 95％CI: 1.415-1.893), spontaneous abortion ≥ 1 times (OR=1.362, 95％CI: 1.043-1.777), age ≤ 20 (OR=1.332, 95％CI: 1.046 1.695), anemia (OR=1.230, 95％CI: 1.017-1.488) and premature rupture of membranes (OR=1.154, 95％CI:1.016-1.311) were risk factors for LBWI.The higher the maternal education level, weight gain, BMI and height, the lower the LBWI incidence.The risk factors of LBWI in premature small for gestational age (SGA) infants were hypertensive disorders during pregnancy and histories of intrauterine fetal death ≥ 1 times.The higher the maternal height and weight gain during pregnancy, the lower the incidence of LBWI in premature SGA infants.Conclusions The main influencing factors for LBWI are preterm birth and hypertensive disorders during pregnancy.In addition, LBWI is also associated with socioeconomic and genetic factors.