This paper introduces Professor SUN Shentian's clinical experience in the treatment of refractory facial paralysis with acupuncture and moxibustion. Professor SUN believes that the etiology of refractory facial paralysis is complex. Acupuncture and moxibustion treatment should be based on cortical localization, Baihui (GV20), lower 1/5 of motor area and brainstem area are selected, and repetitive transcranial acupuncture is applied. Under the ultrasonic positioning, acupuncture is performed on the starting and ending points of the mimetic muscles in different lesion sites. Combined with the TCM pathogenesis of refractory facial paralysis with deficiency of healthy qi and retention of pathogenic factors, acupuncture and moxibustion treatment takes strengthening the healthy qi and eliminating pathogenic factors as the core, and reuses the acupoints of yangming meridians (Yingxiang [LI20], Sibai [ST2], Dicang [ST4], Hegu [LI4], Zusanli [ST36], etc.) as the main acupoints to dredge the meridians. The main facial mimetic muscles and related collateral points are selected for cluster needling to dredge the collaterals. Acupuncture at Yangbai (GB14)-toward-Tongziliao (GB1), Sibai (ST2)-toward-Dicang (ST4), Dicang (ST4)-toward-Jiache (ST6) is applied and combined with the needle-sticking and lifting technique to nourishing tendons. Qihai (CV6) and Guanyuan (CV4) are selected for acupuncture before moxibustion. In addition, Professor SUN emphasizes that the three methods of kneading, acupuncture and moxibustion should be used in Yifeng (TE17), Qianzheng (Extra) and Xiaguan (ST7). Professor SUN combines TCM syndrome differentiation with modern technology, which has the advantages of accurate positioning and diverse techniques, and provides a new idea for the treatment of refractory facial paralysis.
Humans ; Moxibustion ; Acupuncture Therapy ; Facial Paralysis/therapy* ; Female ; Male ; Acupuncture Points ; Middle Aged ; Adult

OBJECTIVES: To investigate the medium- and long-term efficacy of percutaneous mechanical thrombectomy (PMT) combined with stent implantation for treatment of iliac vein stenosis with lower extremity deep venous thrombosis (LEDVT). METHODS: Clinical and follow-up data of 125 patients with iliac vein stenosis and LEDVT who underwent PMT and stent implantation at five hospitals in northern Zhejiang province from January 2017 to June 2021 were collected. The thrombus clearance rate, thrombus recurrence rate, patency rate of iliac vein stents and post-thrombotic syndrome (PTS) occurrence rate were documented, and safety indicators such as bleeding, death, pulmonary embolism, stent fracture and displacement were assessed. RESULTS: Among 125 patients, for clearance of limb thrombosis, there were 8 cases of grade I (6.4%), 10 cases of grade II (8.0%), and 107 cases of grade III (85.6%). Patients were followed up for a median period of 74 months. According to the Villalta score, the recurrence rates of limb thrombosis at 12, 24 and 36 months were 8.48%, 8.93% and 10.91%; the iliac vein patency rates were 91.52%, 91.07%, and 89.09%; and the incidences of PTS were 5.08%, 5.36% and 6.36%, respectively. There were no major adverse events such as death, massive pulmonary embolism or severe hepatic and renal insufficiency, and no readmission intervention events due to stent fracture or other incidence were found. CONCLUSIONS PMT combined with iliac vein stent implantation is effective for patients with iliac vein stenosis complicated by LEDVT with good medium- and long-term efficacy and safety, which is worthy of clinical application.
Humans ; Stents ; Iliac Vein/pathology* ; Venous Thrombosis/surgery* ; Thrombectomy/methods* ; Female ; Male ; Middle Aged ; Aged ; Adult ; Constriction, Pathologic/surgery* ; Treatment Outcome ; Follow-Up Studies

Objective To explore the diagnostic value of amide proton transfer weighted imaging(APTWI)in conjunction with prostate-specific antigen density(PSAD)for detecting clinically significant prostate cancer(csPCa)within prostate imaging reporting and data system(PI-RADS)v2.13-5 grade lesions.Methods A retrospective analysis was conducted on the clinical and imaging data of 88 patients diagnosed with PI-RADS 3-5 grade prostate lesions.There were 59 patients with prostate cancer(PCa)and 29 with benign prostate lesion(BPL).The PCa group was divided into csPCa group(44 cases)and clinically insignificant prostate cancer(ciPCa)group(15 cases)according to Gleason score(GS).Spearman rank correlation analysis was used to analyze the correlation between APTWI-related parameters and GS in PCa.Comparative analyses were conducted to identify statistical discrepancies in APTWI and prostate-specific antigen(PSA)-related parameters across various groups.Subsequently,both solitary and combined diagnostic models were developed,and the receiver operating characteristic(ROC)curve were utilized to evaluate the diagnostic efficacy.Results APTmax and APTmean were moderately positively correlated with GS(r=0.683,r=0.705,respectively),and APTmin was weakly positively correlated with GS(r=0.547).APTWI and PSA-related parameters were significantly higher in the PCa group than in the BPL group,and APTmin had the highest efficacy in diagnosing PCa[area under the curve(AUC)=0.855].APTWI and PSA-related parameters differed among the BPL,ciPCa and csPCa groups(P＜0.05).Among the groups,statistically significant differences were observed in each parameter of APTWI and PSA-related indices between the BPL group and the csPCa group,as well as between the ciPCa group and the csPCa group(P＜0.05).In contrast,only APTmin and PSAD exhibited significant differ-ences between the BPL group and the ciPCa group(P＜0.05).The results of the combined diagnosis showed that APTmin+PSAD had the highest diagnostic efficacy for diagnosing PCa(AUC=0.899),and APTmean+PSAD had the highest diagnostic efficacy for diagnosing csPCa(AUC=0.838).Conclusion In PI-RADS 3-5 grade prostate lesions,APTWI and PSA-related parameters are statisti-cally different in the BPL,ciPCa,and csPCa groups.Notably,the combination of APTmean and PSAD exhibit the highest diagnostic efficacy for csPCa.

Agenesis of the dorsal pancreas(ADP)is an extremely rare congenital pancreatic malformation characterized by the absence or hypoplasia of the pancreatic body and tail.Its pathogenesis is closely related to abnormal embryonic development of the ventral and dorsal pancreatic buds,governed by a complex network of transcription factors,including HLXB9,HNF1B,PDX1,PTF1A,GATA4,and GATA6.The clinical spectrum of ADP is highly variable,ranging from asymptomatic cases to manifestations such as abdominal pain,diabetes mellitus,or pancreatitis.Imaging modalities-including ultrasonography,CT,magnetic resonance cholangiopancreatography,and endoscopic retrograde cholangio-pancreatography-serve as the main diagnostic tools,with characteristic findings of absent pancreatic body and tail accompanied by compensatory enlargement of the pancreatic head.ADP is frequently associated with congenital anomalies of the kidney,biliary tract,cardiovascular system,or genital organs.Management is primarily symptomatic,with insulin replacement for diabetes and pancreatic enzyme supplementation for exocrine insufficiency.Advances in genetic sequencing and stem cell research have deepened understanding of the pathogenesis,genetic background,and potential therapeutic strategies of ADP.This review summarizes current progress in embryology,genetics,clinical features,diagnosis,and treatment of ADP,aiming to improve clinical recognition and guide future investigations.

Agenesis of the dorsal pancreas(ADP)is an extremely rare congenital pancreatic malformation characterized by the absence or hypoplasia of the pancreatic body and tail.Its pathogenesis is closely related to abnormal embryonic development of the ventral and dorsal pancreatic buds,governed by a complex network of transcription factors,including HLXB9,HNF1B,PDX1,PTF1A,GATA4,and GATA6.The clinical spectrum of ADP is highly variable,ranging from asymptomatic cases to manifestations such as abdominal pain,diabetes mellitus,or pancreatitis.Imaging modalities-including ultrasonography,CT,magnetic resonance cholangiopancreatography,and endoscopic retrograde cholangio-pancreatography-serve as the main diagnostic tools,with characteristic findings of absent pancreatic body and tail accompanied by compensatory enlargement of the pancreatic head.ADP is frequently associated with congenital anomalies of the kidney,biliary tract,cardiovascular system,or genital organs.Management is primarily symptomatic,with insulin replacement for diabetes and pancreatic enzyme supplementation for exocrine insufficiency.Advances in genetic sequencing and stem cell research have deepened understanding of the pathogenesis,genetic background,and potential therapeutic strategies of ADP.This review summarizes current progress in embryology,genetics,clinical features,diagnosis,and treatment of ADP,aiming to improve clinical recognition and guide future investigations.

Objective To explore the diagnostic value of amide proton transfer weighted imaging(APTWI)in conjunction with prostate-specific antigen density(PSAD)for detecting clinically significant prostate cancer(csPCa)within prostate imaging reporting and data system(PI-RADS)v2.13-5 grade lesions.Methods A retrospective analysis was conducted on the clinical and imaging data of 88 patients diagnosed with PI-RADS 3-5 grade prostate lesions.There were 59 patients with prostate cancer(PCa)and 29 with benign prostate lesion(BPL).The PCa group was divided into csPCa group(44 cases)and clinically insignificant prostate cancer(ciPCa)group(15 cases)according to Gleason score(GS).Spearman rank correlation analysis was used to analyze the correlation between APTWI-related parameters and GS in PCa.Comparative analyses were conducted to identify statistical discrepancies in APTWI and prostate-specific antigen(PSA)-related parameters across various groups.Subsequently,both solitary and combined diagnostic models were developed,and the receiver operating characteristic(ROC)curve were utilized to evaluate the diagnostic efficacy.Results APTmax and APTmean were moderately positively correlated with GS(r=0.683,r=0.705,respectively),and APTmin was weakly positively correlated with GS(r=0.547).APTWI and PSA-related parameters were significantly higher in the PCa group than in the BPL group,and APTmin had the highest efficacy in diagnosing PCa[area under the curve(AUC)=0.855].APTWI and PSA-related parameters differed among the BPL,ciPCa and csPCa groups(P＜0.05).Among the groups,statistically significant differences were observed in each parameter of APTWI and PSA-related indices between the BPL group and the csPCa group,as well as between the ciPCa group and the csPCa group(P＜0.05).In contrast,only APTmin and PSAD exhibited significant differ-ences between the BPL group and the ciPCa group(P＜0.05).The results of the combined diagnosis showed that APTmin+PSAD had the highest diagnostic efficacy for diagnosing PCa(AUC=0.899),and APTmean+PSAD had the highest diagnostic efficacy for diagnosing csPCa(AUC=0.838).Conclusion In PI-RADS 3-5 grade prostate lesions,APTWI and PSA-related parameters are statisti-cally different in the BPL,ciPCa,and csPCa groups.Notably,the combination of APTmean and PSAD exhibit the highest diagnostic efficacy for csPCa.

Objective:To investigate the predictive value of clinical factor model, deep learning model based on baseline plain CT images, and combination of both for predicting hematoma expansion in cerebral hemorrhage.Methods:The study was cross-sectional. Totally 471 cerebral hemorrhage patients who were firstly diagnosed in the Second Affiliated Hospital of Soochow University from January 2017 to December 2021 were collected retrospectively. These patients were randomly divided into a training dataset ( n=330) and a validation dataset ( n=141) at a ratio of 7∶3 by using the random function. All patients underwent two noncontrast CT examinations within 24 h and an increase in hematoma volume of >33% or an absolute increase in hematoma volume of >6 ml was considered hematoma enlargement. According to the presence or absence of hematoma enlargement, all patients were divided into hematoma enlargement group and hematoma non-enlargement group.Two-sample t test, Mann-Whitney U test or χ2 test were used for univariate analysis. The factors with statistically significant differences were included in multivariate logistic regression analysis, and independent influences related to hematoma enlargement were screened out to establish a clinical factor model. ITK-SNAP software was applied to manually label and segment the cerebral hemorrhage lesions on plain CT images to train and build a deep learning model based on ResNet50 architecture. A combination model for predicting hematoma expansion in cerebral hemorrhage was established by combining independent clinical influences with deep learning scores. The value of the clinical factor model, the deep learning model, and the combination model for predicting hematoma expansion in cerebral hemorrhage was evaluated using receiver operating characteristic (ROC) curves and decision curves in the training and validation datasets. Results:Among 471 cerebral hemorrhage patients, 136 cases were in the hematoma enlargement group and 335 cases were in the hematoma non-enlargement group. Regression analyses showed that male ( OR=1.790, 95% CI 1.136-2.819, P=0.012), time of occurrence ( OR=0.812, 95% CI 0.702-0.939, P=0.005), history of oral anticoagulants ( OR=2.157, 95% CI 1.100-4.229, P=0.025), admission Glasgow Coma Scale score ( OR=0.866, 95% CI 0.807-0.929, P<0.001) and red blood cell distribution width ( OR=1.045, 95% CI 1.010-1.081, P=0.011) were the independent factors for predicting hematoma expansion in cerebral hemorrhage. ROC curve analysis showed that in the training dataset, the area under the curve (AUC) of clinical factor model, deep learning model and combination model were 0.688 (95% CI 0.635-0.738), 0.695 (95% CI 0.642-0.744) and 0.747 (95% CI 0.697-0.793) respectively. The AUC of the combination model was better than that of the clinical model ( Z=0.54, P=0.011) and the deep learning model ( Z=2.44, P=0.015). In the validation dataset, the AUC of clinical factor model, deep learning model and combination model were 0.687 (95% CI 0.604-0.763), 0.683 (95% CI 0.599-0.759) and 0.736 (95% CI 0.655-0.806) respectively, with no statistical significance. Decision curves showed that the combination model had the highest net benefit rate and strong clinical practicability. Conclusions:Both the deep learning model and the clinical factor model established in this study have some predictive value for hematoma expansion in cerebral hemorrhage; the combination model established by the two together has the highest predictive value and can be applied to predict hematoma expansion.

Objective To analyze and compare the strength of titanium alloy crystalline porous scaffolds and porous scaffolds with a triply periodic minimal surface(TPMS)structure and explore the effect of porosity on the equivalent elastic modulus and permeability.Methods Crystalline porous scaffolds(cell 1-4)and TPMS porous scaffolds(P-,G-,D-,and FKS-type)with the same porosity were constructed,and the equivalent elastic modulus,equivalent yield strength,and permeability of the scaffolds were calculated using finite element simulation.Results The elastic modulus of eight scaffolds was in the range of 5.1-10.4 GPa,the yield strength was in the range of 69-110 MPa,and the permeability of 4 crystalline scaffolds was in the range of 0.015-0.030 mm2.Conclusions With an increase in porosity,the elastic modulus and yield strength of the scaffold gradually decreased,and the permeability gradually increased.The cell 2-type scaffold is suitable for repairing defects at load-bearing bone sites because of its high elastic modulus and yield strength.The cell 3-type scaffold with a uniform stress distribution and a longer linear elasticity phase may be suitable for designing porous tibial platforms for knee joint prostheses.

Objective To explore the changes in serum creatine kinase(CK)and myoglobin(Mb)levels in benign acute childhood myositis(BACM)and their clinical significance.Methods The clinical data of 78 children with BACM treated in our hospital from January 2011 to December 2023 were collected,and the dynamic changes and clinical performance of serum CK and Mb levels were re-trospectively analyzed.Results The CK levels of the 78 patients ranged from 432 U/L to 18 440 U/L,with the mean level being 2 178.8 U/L.The levels exceeded the upper reference limit(310 U/L)in all the patients.They were 2 and 10 times the upper reference limit in 72(92.31％)and 15(19.23％)patients,respectively,and were greater than 5 000 U/L in 5(6.41％)patients and greater than 10 000 U/L in 1 patient.The CK level usually peaked in the first 3 days of BACM onset before decreasing gradually.By the 7th day,CK levels in 73％of the cases decreased to the normal reference range,which was consistent with the change in clinical symptoms.Serum Mb samples were col-lected from 66 patients,and the levels ranged from 13.3 ng/mL to 2 603.8 ng/mL,with the mean level being 260.17 ng/mL.In 34 patients(51.52％),the Mb levels were higher than the upper reference limit(116.3 ng/mL).Among these patients,20(30.30％),7(10.61％),and 3(4.55％)patients had Mb levels 2,5,and 10 times higher than the upper reference limit,respectively.Serum Mb levels peaked in the first 3 days of BACM onset and then decreased quickly.Furthermore,in 84.38％of the total cases,serum Mb levels decreased to the normal reference range by the 5th day of onset.Conclusion Serum CK levels in children with BACM are significantly increased,consistent with the changes in clinical symptoms,and therefore,could be regarded as an important basis for BACM diagnosis.Furthermore,serum Mb levels increase to varying extents,indicating a great reference value in BACM diagnosis,and should be tested simultaneously with serum CK.Testing for serum CK and Mb is of great significance for understanding the clinical conditions and guiding the treatment of BACM.

Endodontic diseases are a kind of chronic infectious oral disease.Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha.However,it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT).Recent research,encompassing bacterial etiology and advanced imaging techniques,contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT.Success in RCT hinges on factors like patients,infection severity,root canal anatomy,and treatment techniques.Therefore,improving disease management is a key issue to combat endodontic diseases and cure periapical lesions.The clinical difficulty assessment system of RCT is established based on patient conditions,tooth conditions,root canal configuration,and root canal needing retreatment,and emphasizes pre-treatment risk assessment for optimal outcomes.The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT.These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.