Objective To explore the feasibility and reference value of allogeneic lung transplantation and postoperative monitoring in miniature pigs for lung transplantation research. Methods Two miniature pigs (R1 and R2) underwent left lung allogeneic transplantation. Complement-dependent cytotoxicity tests and blood cross-matching were performed before surgery. The main operative times and partial pressure of arterial oxygen (PaO₂) after opening the pulmonary artery were recorded during surgery. Postoperatively, routine blood tests, biochemical blood indicators and inflammatory factors were detected, and pathological examinations of multiple organs were conducted. Results The complement-dependent cytotoxicity test showed that the survival rate of lymphocytes between donors and recipients was 42.5%-47.3%, and no agglutination reaction occurred in the cross-matching. The first warm ischemia times of D1 and D2 were 17 min and 10 min, respectively, and the cold ischemia times were 246 min and 216 min, respectively. Ultimately, R1 and R2 survived for 1.5 h and 104 h, respectively. Postoperatively, in R1, albumin (ALB) and globulin (GLB) decreased, and alanine aminotransferase increased; in R2, ALB, GLB and aspartate aminotransferase all increased. Urea nitrogen and serum creatinine increased in both recipients. Pathological results showed that in R1, the transplanted lung had partial consolidation with inflammatory cell infiltration, and multiple organs were congested and damaged. In R2, the transplanted lung had severe necrosis with fibrosis, and multiple organs had mild to moderate damage. The expression levels of interleukin-1β and interleukin-6 increased in the transplanted lungs. Conclusions The allogeneic lung transplantation model in miniature pigs may systematically evaluate immunological compatibility, intraoperative function and postoperative organ damage. The data obtained may provide technical references for subsequent lung transplantation research.

Lung transplantation is the ultimate therapeutic option for end-stage pulmonary diseases such as interstitial pneumonia, chronic obstructive pulmonary disease and pneumoconiosis. Currently, the shortage of allogeneic lung donors significantly limits the opportunity for end-stage lung disease patients to receive lung transplantation. In recent years, with the rapid development of biomedical engineering technologies, especially the major breakthroughs in genetic modification and cloning, xenogeneic lung transplantation has shown important potential for clinical translation. Among them, genetically modified pigs have become the most promising xenogeneic lung source due to the close similarity of organ size and physiological characteristics to humans, and the ability to perform targeted gene knockouts (such as α-Gal antigen knockout) to reduce the occurrence of hyperacute rejection. This article focuses on the research progress of porcine xenogeneic lung transplantation, systematically reviews the latest achievements and challenges in animal experiments and human trials, and introduces the technical experience accumulated by Shenzhen Third People's Hospital in the porcine-to-monkey xenogeneic lung transplantation model, in the hope of providing practical references for future research in this field.

Objective:To explore the efficacy of using drug combination and sublingual immunotherapy（SLIT） for pediatric obstructive sleep apnea（OSA） and allergic rhinitis（AR） after adenotonsillectomy, in order to provide a more optimized treatment plan after the surgery. Methods:A total of 95 pediatric OSA combined with AR were selected. According to the treatment plan, they were divided into the SLIT group（postoperative medication combined with SLIT） and the control group（postoperative medication treatment only）. The comparisons were made between the two groups regarding the scores of the 18-item Quality of Life Questionnaire for Obstructive Sleep Apnea（OSA-18） and the Visual Analogue Scale（VAS） before and at 1 month, 3 months, 6 months, 1 year, and 2 years after treatment; the monthly total medication scores（TMS） from 1 month to 3 months, 4 months to 6 months, 7 months to 1 year, and 1 year to 2 years after treatment, as well as the number of acute attacks of AR in the 1st year and 2nd year after treatment; and the Lund-Kennedy scores and nasal resistance grading of nasal endoscopy before and at 1 month, 3 months, 6 months, 1 year, and 2 years after treatment. The effectiveness and safety were also analyzed. Results:After one year of treatment, the OSA-18 score, VAS score, TMS and Lund-Kennedy score in the SLIT group were significantly better than those in the control group. The nasal resistance was significantly reduced（P<0.05）, and the frequency of AR attacks was significantly lower than that in the control group（P<0.05）. After 2 years of treatment, the VAS score, Lund-Kennedy score and nasal resistance classification in the SLIT group tended to stabilize, while the OSA-18 score continued to decline. Conclusion:After surgery for pediatric OSA combined with AR, the use of drugs combined with SLIT can effectively alleviate AR symptoms, further improve OSA-related symptoms and quality of life, reduce drug dependence, decrease the frequency of AR attacks, and enhance the long-term efficacy of the surgery.
Humans ; Sleep Apnea, Obstructive/surgery* ; Rhinitis, Allergic/therapy* ; Quality of Life ; Child ; Tonsillectomy ; Treatment Outcome ; Adenoidectomy ; Sublingual Immunotherapy ; Drug Therapy, Combination ; Male ; Female

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Objective:To automatically synthesize Al 18F-fibroblast activation protein inhibitor (FAPI)-74, and explore its value of clinical application. Methods:Al 18F-FAPI-74 was synthesized automatically by the commercial synthesis module CFN-MPS-100, and its yield, radiochemical purity and stability were determined. Sixteen normal Kunming (KM) mice were randomly divided into 4 groups and euthanized at 10, 30, 60 and 90 min after Al 18F-FAPI-74 injection, and the biodistribution was measured. MicroPET/CT dynamic scanning (60 min) was performed in 5 rat pancreatic tumor-bearing BALB/c nude mice to observe the tumor uptake. Al 18F-FAPI-74 PET/CT imaging was performed on 3 volunteers (1 male, 2 females; age: 37, 41, 43 years) to evaluate the clinical application value of Al 18F-FAPI-74. Results:The automated synthesis time of Al 18F-FAPI-74 was about 35 min, with the synthesis yield of (21.34±3.86)% (without attenuation correction, n=5) and the radiochemical purity more than 99%. The radiochemical purity was still more than 96% after placement at 37 ℃ for 6 h. Biodistribution in normal mice and microPET/CT dynamic scanning in tumor-bearing nude mice showed that consistently high uptake in the kidneys and bladder, and the tumor uptake was the highest at 20 min, and the maximum tumor-to-muscle ratio was 3.16±0.01 at 60 min. PET/CT imaging on volunteers showed that there was a small amount of uptake in myocardium, most organs such as the liver and lung had background uptake, and the maximum SUV max of persistent high uptake of tumor was 17.08. Conclusions:Al 18F-FAPI-74 has the advantages of simple synthesis, high yield, stable quality and good imaging performance in mice and volunteers. It is a kind of imaging agent that meets the requirements of clinical diagnosis.

Objective:To evaluate the laparoscopic sleeve gastrectomy combined with hiatal hernia repair surgery for weight loss and antireflux.Methods:This study included 21 obese patients with gastroesophageal reflux who underwent laparoscopic sleeve gastrectomy at the Weight Loss Metabolism Center of the Department of Hepatobiliary and Pancreatic Surgery of Zhejiang Provincial People's Hospital from Dec 2019 to Dec 2020. Patients were divided into simple bariatric surgery group (9 cases) and simultaneous combined surgery group (12 cases).Results:In the combined surgery group, 1 case had postoperative gastric leakage. The postoperative body weight, waist circumference, and BMI indexes of the two groups showed a downward trend ( F=5.154, P=0.013; F=14.319, P<0.001; F=6.725, P=0.004). There was a statistically significant difference in the excess weight loss in both the two groups at 6 months after the operation compared to 1 month after the operation ( t=8.927, P<0.001; t=8.926, P<0.001). There was no statistically significant difference in postoperative lower esophageal sphincter resting pressure and Gerd symptom score in the bariatric surgery group compared with preoperative ( t=-0.891, P=0.507; t=0.629, P=0.298). The postoperative Gerd symptom score of the patients in the combined surgery group was significantly lower than that before the operation, and the resting pressure of the lower esophageal sphincter was significantly higher than that before the operation, ( t=-10.539, P<0.001; t=5.066, P=0.038). Conclusion:Combined surgery have the same weight loss effect as in simple bariatric surgery in obese patients with gastroesophageal reflux, in addition to stronger anti-reflux effect.

Fiber photometry is a recently-developed method that indirectly measures neural activity by monitoring Ca

Objective:To analyze variant patterns and characteristics of focal physiological uptake (FPU) in the tongue on 18F-fluorodeoxyglucose (FDG) PET/CT imaging in patients without a history of oral tumor surgery and radiotherapy. Methods:A total of 6 233 consecutive patients who underwent routine whole-body PET/CT scan between January 2013 and December 2017 in the First Hospital of Shanxi Medical University were investigated retrospectively, and 324 patients with a history of oral surgery and radiotherapy were excluded, the remaining 5 909 patients (3 418 males, 2 491 females, age range: 2-95 (average: 58) years) were enrolled. A part of the patients underwent local PET/CT scan and CT scan with diagnostic dose, covering the oral cavity on mouth-opening position. The morphological characteristics of FPU patterns were analyzed, and the maximum standardized uptake value (SUV max) was measured. Results:Seventy-six FPUs in 76 patients (49 males, 27 females, age range: 40-83 (average 64) years) identified by routine whole-body PET/CT scan were confirmed by clinical examination from a specialist in stomatology or follow-up for more than 6 months. Forty-one of the 76 patients subsequently underwent local PET/CT scan and diagnostic CT scan on mouth-opening position. The incidence of FPU in the tongue was 1.29%(76/5 909). The FPU patterns could be classified into three types: type Ⅰ with FDG uptake involved only anterior part of the tongue body in the midline (near the tip of the tongue), which showed as a " dotted" shape( n=68; 1.15%, 68/5 909); type Ⅱ with FDG uptake involved mainly middle part of the genioglossus muscle, which showed as a " bar-shorted" shape ( n=5; 0.08%, 5/5 909); type Ⅲ with FDG uptake involved large part of the tongue body and the genioglossus, which showed as a " T" shape( n=3; 0.05%, 3/5 909). The SUV max in patients with type Ⅰ and type Ⅱ were 5.53(4.53, 7.30), 19.50(17.10, 22.74) respectively. The SUV max in 3 patients with type Ⅲ were 23.34, 27.50 and 35.14, respectively. Conclusion:In patients without a history of oral tumor surgery and radiotherapy, the FPU in the tongue has its specific pattern, and PET/CT scan on mouth-opening position helps to reveal the detailed features.

Objective: To explore the diagnostic efficacy of by ¹⁸F-FDG PET-CT for hypermetabolic thyroid nodules. Methods: To retrospectively analyze the clinical data of 3 192 patients underwent ¹⁸F-FDG PET-CT in our hospital from May 2012 to October 2014. Among them, 98 patients were diagnosed with focal hypermetabolic thyroid nodules. 61 of the 98 patients were diagnosed with malignant or benign thyroid nodules using histopathological or clinical follow-up (22 malignant nodules, 39 benign nodules). The average age of these 61 patients was 61.6±12.5 years. Results: The lgSUVmax of malignant group (0.69±0.31) was significantly higher than that in benign group (0.43±0.27) (P=0.001). There was no significant difference in age, gender, nodule size, minimum diameter of nodule, lgCT, calcification, the boundary definition, density uniformity, and history of malignancy between the two groups (P>0.05). Binary Logistic regression indicated the AUC of Logistic regressive model(AUC) was 0.866±0.049 (95% CI: 0.769-0.963), and the malignant AUCs of ROC curve was 0.747±0.068 (95%CI: 0.614-0.880) which was only determined by lgSUVmax. The difference was statistically significant (P<0.01). Conclusion ¹⁸F-FDG PET-CT imaging can not only detect hypermetabolic thyroid nodules, but also have a certain clinical value for the identification of benign and malignant nodules.

Objective To establish radiation-induced heart disease ( RIHD) Beagle models, in-vestigate the efficacy of 18 F-FDG PET/CT in the detection of RIHD and observe the pathological changes. Methods The ventricular anterior wall of 12 Beagle dogs were X-ray irradiated locally with a single dose of 20 Gy. 18 F-FDG PET/CT and echocardiography were performed at baseline and 3 months after radiation. ROI was drawn on the irradiation field and the non-irradiation field ( the posterior wall of left ventricle) to obtain the SUVmax . Then the SUVmax ratio of the irradiation field to the non-irradiation field ( INR) was cal-culated. The left ventricular function parameters before and after radiation were obtained by echocardio-graphy. Within 1 week after the imaging examinations were finished, the dogs were sacrificed, and hearts were taken out to perform pathological observation. Paired t test was used to analyze the data. Results High 18 F-FDG uptake in the irradiation field was shown 3 months after radiation. The average INRs before and after radiation were 0.99±0.15 and 2.54±0.43 respectively (t=7.021, P=0.001). No significant difference was ob-served on cardiac function parameters between baseline and 3 months after radiation( t values:from-1.253 to-0.786, all P>0.05) . The pathological results showed a few degenerated myocytes, increased thickness of myocardial vascular walls in irradiated myocardium. Conclusions 18 F-FDG PET/CT can detect early RIHD before abnormal cardiac function. Increased 18 F-FDG uptake in irradiated field may be related to myocardial ischemia which results from microvascular damage by radiation.