Objective To explore the feasibility and safety of ultrasound-guided percutaneous microwave ablation for unresectable pancreatic cancer.Methods Totally 84 patients who underwent ultrasound-guided percutaneous microwave ablation for unresectable pancreatic cancer were enrolled,and the technical success rate,complete ablation rate,complication rate,pain relief rate and survival time,etc.were observed.Results The median age of 84 cases was 61.5 years.Totally 86 tumors,including 44.19％(38/86)at the head/neck and 55.81％(48/86)at the body/tail of pancreas were detected,and a total of 85 ablation sessions were performed with the median ablation energy applied per tumor of 9.90(1.08,21.60)kJ and the complete ablation rate of 42.86％(36/84).The technical success rate was 100％(85/85).Thirty-nine complication events occurred in 25 cases,no ablation-related death.Among 34 patients underwent ablation mainly for pain symptoms,the pain score decreased from(6.22±1.12)points before treatment to(1.94±1.64)points after treatment(P＜0.001).During 6.8(3.3,12.9)months' follow-up,the mean survival time was(8.5±6.7)months,and all 47 patients died due to tumor progression.Conclusion Ultrasound-guided percutaneous microwave ablation was safe and feasible for unresectable pancreatic cancer.

Objective:To explore the curative effect of abdominal flap carried with combined perforating vessels in reconstruction of extra large and complicated defect in extremities.Methods:A retrospective analysis was conducted on 16 patients who were admitted to the Department of Hand Surgery, the Affiliated Traditional Chinese Medicine Hospital for treatment of extra large and complex wounds in extremities, from January 2020 to December 2023. There were 6 defects in upper limbs and 10 in lower limbs. Fourteen patients had a combination of fracture and 6 of tendon defects. The defects were large and sized from 30.0 cm×9.0 cm to 35.0 cm×15.0 cm. The defects were reconstructed by large sized abdominal flaps at 32.0 cm×10.0 cm to 36.0 cm×16.0 cm. According to the size of the defect, perforators of different arteries carried by the abdominal flap were combined by anastomosis in a manner of internal and external supercharging in order to boost the blood supply of the flap. The supercharging vessel anastomosis was as follows: one superficial circumflex iliac artery (or superficial inferior epigastric artery) was anastomosed with the contralateral branch of the deep inferior epigastric artery, with the veins were anastomosed with the corresponding veins, and the main trunk of the deep inferior epigastric artery was anastomosed end-to-end or end-to-side with the main branch of the recipient artery. Alternatively, both of the left and right superficial iliac circumflex (or inferior epigastric) arteries were directly anastomosed end-to-side or end-to-end with the main trunk or its branches in the recipient site, and the veins were anastomosed end-to-side or end-to-end with the adjacent veins. The donor site was pulled and relaxed by a pull-rod wound expander and sutured layer by layer. After surgery, routine anti-infection, anti-vasospasm, anticoagulation, enhancement of blood circulation and other symptomatic treatment were given. Postoperative follow-ups were conducted at outpatient clinic and via telephone and WeChat interviews. The colour and the sign of capillary reflux of the flap were closely observed.Results:All patients were included in the postoperative follow-up for 6-26 months, with an average of 13 months. Fifteen flaps survived after surgery. One flap had partial necrosis and the necrosis was found being caused by a thrombosis at the vessel anastomotic site. The necrotic tissue was removed and the defect was reconstructed by a flap transfer. The abdominal donor sites healed by first intention, and the navel was normal in terms of location and shape. There was no muscle hernia, except a minor scar hyperplasia. The flaps healed well, with satisfactory appearance and soft texture, without obvious bloating. The donor site healed well with partial scar formation.Conclusion:When an abdominal flap is used to reconstruct an extremely large and complex defect in extremities, the perforating vessels of different source arteries carried by the flaps can be anastomosed in a manner of combination, hence the flap can be flexibly freed, with satisfactory treatment effects.

Objective:To explore the clinical value of multi-parameter combined monitoring in guiding low-molecular-weight heparin (LMWH) therapy for intensive care unit (ICU) patients.Methods:A retrospective case-control study was conducted. A total of 381 patients who received LMWH therapy with anti-Ⅹa activity monitoring in the ICU of West China Hospital, Sichuan University between January 31st, 2022, and November 30th, 2023, were enrolled in this study. The cohort comprised 264 males and 117 females, with the age of 58 (48, 71) years old. Clinical data and relevant laboratory parameters were collected, including anti-Ⅹa activity, antithrombin activity (AT), thrombin-antithrombin complex (TAT), plasmin-antiplasmin complex (PIC), conventional coagulation parameters such as activated partial thromboplastin time (APTT), and indicators of hepatic/renal impairment such as alanine aminotransferase (ALT) and creatinine( CREA). Patients were stratified into three groups based on thrombotic event: thrombosis-controlled, progressive thrombosis, and bleeding group. Single-factor and adjusted multifactorial Logistic regression analysis were used to identify independent predictors of anti-xa activity levels.Results:Among 381 patients, thrombosis was controlled in 213 (55.9%) patients, progressed in 81 (21.3%) patients , and bleeding events occurred in 87 (22.8%) patients. The patients whose anti-Ⅹa activity levels lay entirely within the target range(0.2-0.4 IU/ml): Only 35 (16.4%) cases in the thrombosis-controlled group, 16 (19.7%) cases in the progressive thrombosis group, and 16 (18.4%) in the bleeding group. No significant differences in anti-Ⅹ a levels activity among the three groups ( H=1.678, P=0.432). Both single-factor and adjusted multifactorial Logistic regression identified low AT activity as an independent risk factor for failure to achieve target anti-Ⅹ a activity levels (AT nadir, OR=1.031,95% CI 1.016-1.046, P<0.05). Compared with the progressive thrombosis and bleedinggroup, the thrombosis-controlled group exhibited significantly higher proportion of TAT values below the cut-off value ( H=8.519, P=0.014), and a higher proportion of TAT/PIC ratios below the cut-off ( H=15.56, P<0.001). Patients with bleeding demonstrated significantly lower AT activity ( H=14.968, P=0.001), prolonged APTT ( H=6.815, P=0.033), higher ALT ( H=13.774, P=0.001), and higher CREA ( H=14.068, P=0.001) compared with the thrombosis-controlled or progressive thrombosis group. Conclusion:Laboratory monitoring is required for low-molecular-weight heparin (LMWH) therapy in ICU patients. While anti-Ⅹa activity reflects the anticoagulant effect of LMWH, the utility of anti-Ⅹ a activity for predicting thrombotic or hemorrhagic risks in LMWH treated ICU patients is limited. Reductions in TAT levels and TAT/PIC ratios are associated with a lower risk of thrombotic progression. Furthermore, abnormalities in conventional coagulation tests and standard hepatic/renal function parameters occur more frequently in patients experiencing hemorrhagic events.

Objective To compare the image quality of readout-segmented diffusion weighted imaging(RESOLVE-DWI)and integrated slice-by-slice shimming diffusion weighted imaging(iShim-DWI)in patients with nasopharyngeal carcinoma.Methods A retrospective study was conducted on 26 patients with nasopharyngeal carcinoma confirmed by pathology.The imaging data included RESOLVE-DWI and iShim-DWI.The signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the two sequences were compared by one deputy chief imaging technician.And two experienced radiologists used the 5-point scoring scheme to compare the lesion clarity,image artifacts,and antideformation ability of the two sequences,repectively.Results The SNR and CNR of the iShim-DWI sequence were significantly higher than those of RESOLVE-DWI sequence(P＜0.01).While the subjective scores of lesion clarity,image artifacts,and antideformation ability on RESOLVE-DWI were significantly better than those of iShim-DWI,and the differences were statistically significant(P＜0.01).Conclusion Both RESOLVE-DWI and iShim-DWI obtained good images.With sufficient SNR and CNR,RESOLVE-DWI has clearer lesions and surrounding structures,higher image resolution,fewer artifacts,and better antideformation ability,thus providing clinical advantages in evaluating patients with good physical tolerance.

Objective To compare the image quality of readout-segmented diffusion weighted imaging(RESOLVE-DWI)and integrated slice-by-slice shimming diffusion weighted imaging(iShim-DWI)in patients with nasopharyngeal carcinoma.Methods A retrospective study was conducted on 26 patients with nasopharyngeal carcinoma confirmed by pathology.The imaging data included RESOLVE-DWI and iShim-DWI.The signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the two sequences were compared by one deputy chief imaging technician.And two experienced radiologists used the 5-point scoring scheme to compare the lesion clarity,image artifacts,and antideformation ability of the two sequences,repectively.Results The SNR and CNR of the iShim-DWI sequence were significantly higher than those of RESOLVE-DWI sequence(P＜0.01).While the subjective scores of lesion clarity,image artifacts,and antideformation ability on RESOLVE-DWI were significantly better than those of iShim-DWI,and the differences were statistically significant(P＜0.01).Conclusion Both RESOLVE-DWI and iShim-DWI obtained good images.With sufficient SNR and CNR,RESOLVE-DWI has clearer lesions and surrounding structures,higher image resolution,fewer artifacts,and better antideformation ability,thus providing clinical advantages in evaluating patients with good physical tolerance.

Objective To explore the feasibility and safety of ultrasound-guided percutaneous microwave ablation for unresectable pancreatic cancer.Methods Totally 84 patients who underwent ultrasound-guided percutaneous microwave ablation for unresectable pancreatic cancer were enrolled,and the technical success rate,complete ablation rate,complication rate,pain relief rate and survival time,etc.were observed.Results The median age of 84 cases was 61.5 years.Totally 86 tumors,including 44.19％(38/86)at the head/neck and 55.81％(48/86)at the body/tail of pancreas were detected,and a total of 85 ablation sessions were performed with the median ablation energy applied per tumor of 9.90(1.08,21.60)kJ and the complete ablation rate of 42.86％(36/84).The technical success rate was 100％(85/85).Thirty-nine complication events occurred in 25 cases,no ablation-related death.Among 34 patients underwent ablation mainly for pain symptoms,the pain score decreased from(6.22±1.12)points before treatment to(1.94±1.64)points after treatment(P＜0.001).During 6.8(3.3,12.9)months' follow-up,the mean survival time was(8.5±6.7)months,and all 47 patients died due to tumor progression.Conclusion Ultrasound-guided percutaneous microwave ablation was safe and feasible for unresectable pancreatic cancer.

Objective:To explore the curative effect of abdominal flap carried with combined perforating vessels in reconstruction of extra large and complicated defect in extremities.Methods:A retrospective analysis was conducted on 16 patients who were admitted to the Department of Hand Surgery, the Affiliated Traditional Chinese Medicine Hospital for treatment of extra large and complex wounds in extremities, from January 2020 to December 2023. There were 6 defects in upper limbs and 10 in lower limbs. Fourteen patients had a combination of fracture and 6 of tendon defects. The defects were large and sized from 30.0 cm×9.0 cm to 35.0 cm×15.0 cm. The defects were reconstructed by large sized abdominal flaps at 32.0 cm×10.0 cm to 36.0 cm×16.0 cm. According to the size of the defect, perforators of different arteries carried by the abdominal flap were combined by anastomosis in a manner of internal and external supercharging in order to boost the blood supply of the flap. The supercharging vessel anastomosis was as follows: one superficial circumflex iliac artery (or superficial inferior epigastric artery) was anastomosed with the contralateral branch of the deep inferior epigastric artery, with the veins were anastomosed with the corresponding veins, and the main trunk of the deep inferior epigastric artery was anastomosed end-to-end or end-to-side with the main branch of the recipient artery. Alternatively, both of the left and right superficial iliac circumflex (or inferior epigastric) arteries were directly anastomosed end-to-side or end-to-end with the main trunk or its branches in the recipient site, and the veins were anastomosed end-to-side or end-to-end with the adjacent veins. The donor site was pulled and relaxed by a pull-rod wound expander and sutured layer by layer. After surgery, routine anti-infection, anti-vasospasm, anticoagulation, enhancement of blood circulation and other symptomatic treatment were given. Postoperative follow-ups were conducted at outpatient clinic and via telephone and WeChat interviews. The colour and the sign of capillary reflux of the flap were closely observed.Results:All patients were included in the postoperative follow-up for 6-26 months, with an average of 13 months. Fifteen flaps survived after surgery. One flap had partial necrosis and the necrosis was found being caused by a thrombosis at the vessel anastomotic site. The necrotic tissue was removed and the defect was reconstructed by a flap transfer. The abdominal donor sites healed by first intention, and the navel was normal in terms of location and shape. There was no muscle hernia, except a minor scar hyperplasia. The flaps healed well, with satisfactory appearance and soft texture, without obvious bloating. The donor site healed well with partial scar formation.Conclusion:When an abdominal flap is used to reconstruct an extremely large and complex defect in extremities, the perforating vessels of different source arteries carried by the flaps can be anastomosed in a manner of combination, hence the flap can be flexibly freed, with satisfactory treatment effects.

Objective:To explore the clinical value of multi-parameter combined monitoring in guiding low-molecular-weight heparin (LMWH) therapy for intensive care unit (ICU) patients.Methods:A retrospective case-control study was conducted. A total of 381 patients who received LMWH therapy with anti-Ⅹa activity monitoring in the ICU of West China Hospital, Sichuan University between January 31st, 2022, and November 30th, 2023, were enrolled in this study. The cohort comprised 264 males and 117 females, with the age of 58 (48, 71) years old. Clinical data and relevant laboratory parameters were collected, including anti-Ⅹa activity, antithrombin activity (AT), thrombin-antithrombin complex (TAT), plasmin-antiplasmin complex (PIC), conventional coagulation parameters such as activated partial thromboplastin time (APTT), and indicators of hepatic/renal impairment such as alanine aminotransferase (ALT) and creatinine( CREA). Patients were stratified into three groups based on thrombotic event: thrombosis-controlled, progressive thrombosis, and bleeding group. Single-factor and adjusted multifactorial Logistic regression analysis were used to identify independent predictors of anti-xa activity levels.Results:Among 381 patients, thrombosis was controlled in 213 (55.9%) patients, progressed in 81 (21.3%) patients , and bleeding events occurred in 87 (22.8%) patients. The patients whose anti-Ⅹa activity levels lay entirely within the target range(0.2-0.4 IU/ml): Only 35 (16.4%) cases in the thrombosis-controlled group, 16 (19.7%) cases in the progressive thrombosis group, and 16 (18.4%) in the bleeding group. No significant differences in anti-Ⅹ a levels activity among the three groups ( H=1.678, P=0.432). Both single-factor and adjusted multifactorial Logistic regression identified low AT activity as an independent risk factor for failure to achieve target anti-Ⅹ a activity levels (AT nadir, OR=1.031,95% CI 1.016-1.046, P<0.05). Compared with the progressive thrombosis and bleedinggroup, the thrombosis-controlled group exhibited significantly higher proportion of TAT values below the cut-off value ( H=8.519, P=0.014), and a higher proportion of TAT/PIC ratios below the cut-off ( H=15.56, P<0.001). Patients with bleeding demonstrated significantly lower AT activity ( H=14.968, P=0.001), prolonged APTT ( H=6.815, P=0.033), higher ALT ( H=13.774, P=0.001), and higher CREA ( H=14.068, P=0.001) compared with the thrombosis-controlled or progressive thrombosis group. Conclusion:Laboratory monitoring is required for low-molecular-weight heparin (LMWH) therapy in ICU patients. While anti-Ⅹa activity reflects the anticoagulant effect of LMWH, the utility of anti-Ⅹ a activity for predicting thrombotic or hemorrhagic risks in LMWH treated ICU patients is limited. Reductions in TAT levels and TAT/PIC ratios are associated with a lower risk of thrombotic progression. Furthermore, abnormalities in conventional coagulation tests and standard hepatic/renal function parameters occur more frequently in patients experiencing hemorrhagic events.

Objective:To analyze the clinical presentations and diagnostic and treatment process of one patient with autoimmune encephalitis(AE)with double positive anti-N-methyl-D-aspartate receptor(NMDAR)and anti-γ-aminobutyric acid B receptor(GABABR)secondary to herpes simplex virus encephalitis(HSVE),and to improve the clinicians'awareness of this disease.Methods:The clinical data of one AE patient with double positive anti-NMDAR and anti-GABABR secondary to HSVE were collected,the diagnostic and therapeutic processes were summarized,and the relevant literatures were reviewed.Results:The patient,a 36-year-old male,developed a headache followed by limb convulsions,and progressed to disturbed consciousness.After admission,the routine biochemistry of the cerebrospinal fluid(CSF)was abnormal,and the herpes simplex virus-1(HSV-1)IgG antibody showed positive in the CSF;both CSF and serum tests for NMDAR antibodies were positive;the head magnetic resonance imaging(MRI)results showed abnormal signals in the right occipital white matter,leading to the diagnosis of HSVE secondary to anti-NMDAR encephalitis.Several months later,the patient experienced psychiatric behavior abnormalities,cognitive dysfunction,and sleep disorders,and both the serum NMDAR and GABABR antibodies showed positive results,prompting the diagnosis of HSVE secondary anti-NMDAR encephalitis and anti-GABABR encephalitis.After treatment with steroid pulse therapy and intravenous immunoglobulin(IVIG),the patient's condition was improved and the patient was discharged.At one-year follow-up,the patient's psychiatric symptoms had completely resolved,leaving mild cognitive impairment.Conclusion:If the clinical symptoms of the patients recovering from antiviral treatment for HSVE is worsened,secondary AE should be highly suspected;it is important to complete autoimmunity antibody testing as soon as possible for the early diagnosis and treatment to improve the prognosis of the patient.