Objective:To investigate the clinical experience of different types of femoral perforator flaps in the reconstruction of oral and maxillofacial head and neck defects.Methods:From January 2018 to January 2021, 573 patients with oral and maxillofacial head and neck defects reconstructed by femoral perforator flap were collected in the Department of Maxillofacial Oncology, the Third Affiliated Hospital of Air Force Military Medical University (age range of 21-76 years, with a male to female ratio of 1.23∶1). According to the type of perforator flap, the patients were divided into ALT group, AMT group, TFL flap group and free muscle flap group. The incidence of postoperative complications, wound healing time and drainage volume in femoral area were compared among the 4 groups.Results:The ALT flap was used in 527 cases: 22 flaps had vascular crisis, 14 flaps had infection, 8 flaps had necrosis, 519 flaps survived; the mean healing time of the wound was (14.50±3.19) days, and the mean drainage volume was (49.9±21.3) ml. 28 cases were repaired with AMT flap: 2 flaps had vascular crisis and 1 had infection. All the flaps survived; the mean healing time of the wound was (14.18±2.75) days, and the mean drainage volume was (50.3±23.0) ml. 11 cases were repaired by TFL flap: 1 flap had vascular crisis and 1 had infection. All the flaps survived. The mean healing time of the wound was (14.09±2.66) days, and the mean drainage volume was (54.1±25.0) ml. 7 cases were repaired by free muscle flap survived without vascular crisis, infection and other postoperative complications; the mean healing time of the wound was 14.14±1.86, and the mean postoperative drainage volume was (49.9±21.1) ml. There was no significant difference in complication rate (flap necrosis, vascular crisis, infection, etc.) and repair effect among 573 patients with different flap types. The postoperative follow-up was conducted for 6-24 months, and the donor area was smooth and good in appearance, without obvious scar or functional influence. The repair effect of the affected area was satisfactory.Conclusions:Although there is a certain proportion of perforator vessel variation in the femoral perforator flap, the flap can be designed freely according to different types of variation. The thigh perforator flap has an essential application value in the repair of oral and maxillofacial head and neck defects.

Real-world study is increasingly becoming an important source of evidence for changing clinical practice, especially for clinical problems that can′t be randomized. In recent years, real-world research in the field of breast cancer has gradually became a boom. Existing research results have begun to assist in the epidemiological analysis of breast cancer, promote the approval of rare diseases diagnosis and indication, and promote the analysis of real-world treatment status and evaluation of curative effects. Chinese scholars have also established databases and carried out relevant real-world research, providing real-world evidence for clinical practice in China. But domestic research is still in its infancy. The number of real-world research literature published by domestic scholars is relatively small, and there is a lack of pragmatic randomized clinical trial and real-world research for decision-making. In the future, we need to take advantage of the abundant diagnosis and treatment resources, further improve the database, and carry out real-world study on drug development based on population data in China.

Objective:To explore whether gray matter and white matter presented abnormalities in neural circuit in patients with OCD by using multimodal imaging strategies.Methods:Magnetic resonance imaging (MRI) scans from 54 OCD patients and 54 healthy controls (HC) were acquired. Gray matter volume was compared using the voxel-based morphometry (VBM) approach based on the SPM software. Fractional anisotropy (FA) difference was also evaluated using tract based spatial statistics (TBSS) based on the FSL software.Results:Compared with the HC, Patients with OCD showed decreased gray matter volume in the left middle frontal gyrus, left anterior cingulate and paracingulate gyri, left precental gyrus and right inferior temporal gyrus ( P<0.05, Alphasim corrected); meanwhile, decreased FA values in the body and genu of corpus callosum were found. Conclusions:Patients with OCD demonstrated widespread gray matter and white matter alterations especially in the incortico-striatal-thalamic-cortical (CSTC)circuit. Therefore, Patients with OCD might present altered gray and white matter structures simultaneously.

Objective:To explore whether gray matter and white matter presented abnormalities in neural circuit in patients with OCD by using multimodal imaging strategies.Methods:Magnetic resonance imaging (MRI) scans from 54 OCD patients and 54 healthy controls (HC) were acquired. Gray matter volume was compared using the voxel-based morphometry (VBM) approach based on the SPM software. Fractional anisotropy (FA) difference was also evaluated using tract based spatial statistics (TBSS) based on the FSL software.Results:Compared with the HC, Patients with OCD showed decreased gray matter volume in the left middle frontal gyrus, left anterior cingulate and paracingulate gyri, left precental gyrus and right inferior temporal gyrus ( P<0.05, Alphasim corrected); meanwhile, decreased FA values in the body and genu of corpus callosum were found. Conclusions:Patients with OCD demonstrated widespread gray matter and white matter alterations especially in the incortico-striatal-thalamic-cortical (CSTC)circuit. Therefore, Patients with OCD might present altered gray and white matter structures simultaneously.

Artificial intelligence clinical decision-support system is an important direction of artificial intelligence in the medical field. Both international and domestic researchers are exploring the application value of intelligent decision-making system in the field of cancer. But at the same time of the craze, there are still some problems in the intelligent decision-making system. Combining the work of the research groups in this field, this paper explores the current confusions and solutions, and hopes to help clinicians better understand intelligent decision-making. It is believed that with the deepening of the concept and the advancement of technology, intelligent decision-making will become a good help for doctors in the future.

OBJECTIVE： To establish HPLC fingerprint of Nüjin pills， and to conduct cluster analysis and principal component analysis. METHODS： HPLC method was adopted. The determination was carried out on Agilent ZORBAX Eclipse Plus C18 column with mobile phase consisted of acetonitrile-0.2％ formic acid solution （gradient elution） at the flow rate of 1.0 mL/min. The detection wavelength was set at 270 nm， and column temperature was 30 ℃. The sample size was 10 μL. Using baicalin as reference， HPLC fingerprints of 10 batches of samples were determined. The similarity of 10 batches of samples was evaluated by TCM Chromatographic Fingerprint Similarity Evaluation System （2012 edition） to confirm common peak. Cluster analysis and principal component analysis were performed by using SPSS 22.0 software. RESULTS： There were 21 common peaks in HPLC chromatograms of 10 batches of samples， the similarity of which was all over 0.95， which indicated that in 10 batches of samples， the chemical composition was consistent， but the contents of these components were different. When euclidean distance was equal to 25，10 batches of sample were divided into two categories； S3 was included in the first category， and others were included in the second category. When euclidean distance was equal to 5， the second category could be divided into three sub-categories， one sub-category was S2， S4， S6 and S10； one sub-category was S5， S9； one sub-category was S1， S7， S8. Through the principal component analysis， the cumulative contribution rate of three main component factors was 90.642％， and comprehensive score of S3 was the highest with the best quality. CONCLUSIONS： Established HPLC fingerprint， the results of cluster analysis and principal component analysis can provide reference for quality evaluation of Nüjin pills.

In the past two years, researchers have been exploring the precision medicine. Thanks to the development of sequence industry and clinical study, the big data about the precision medicine have been more and more sufficient. However, how to deal with the precision data is still a question for clinicians. We focus on the hot issues that disturb clinicians most, wanting to help them to make suitable decisions between the traditional and precision medicine of breast cancer. We believe the precision medicine is on the way.

Objective To determine the independent risk factors for sepsis in patients with large area burns.Methods The study enrolled 307 patients with large area burns treated from June 2014 to June 2015.Related variables included age,gender,visit time,emergency eschar open,burn index,tangential excision of eschar during shock stage,delayed resuscitation during shock stage,oxygen pressure(PaO2),carbon dioxide pressure (PaCO2),assisted ventilation mode,mechanical ventilation time,inhalation injury,prophylactic tracheotomy,continuous lactic acid rise,refractory hypernatremia,heart-lung disease history,and diabetes history.Correlation of the variables with the incidence of sepsis was observed.Independent predictors of sepsis in patients with large burns were differentiated using the Logistic regression analysis.Results Delayed resuscitation during shock period (OR =1.747,95％ CI 1.822-7.431,P ＜ 0.05),continuous lactic acid rise (OR =1.758,95％ CI 1.137-4.002,P ＜ 0.05),refractory hypernatremia (OR =2.985,95％ CI 1.074-6.782,P ＜ 0.05),moderate and severe inhalation injury(OR =14.764,95％ CI 0.892-47.323,P ＜ 0.05) and burn index (OR =5.017,95％ CI 1.075-23.572,P ＜ 0.05) were found be independently associated with sepsis in patients with large burns.Conclusions These independent risk factors for sepsis in large area burn patients deserve more attention.Early and timely treatment measures may reduce the incidence of sepsis.

Objective To investigate the feasibility and necessity of escharectomy and skin graft in sepsis shock stage in burn patients.Methods Fifty-two patients with large area burns coupled with sepsis, hospitalized for treatment from September, 2008 to December, 2014 in our hospital were selected for the study.When the patients displayed signs of shock, they were given anti-shock treatment and at the same time received escharectomy and skin grafting.Collection of medical data was made in 25 severe burn patients, who had delayed escharectomy during sepsis stage and received surgery when the state of illness became stable.Comparisons were made between the 2 groups in the indices of postoperative organ function ( creatinine, ALT) , blood analysis, postoperative plasma PCT ( Pro-calcitonin) and interleukin 6 ( IL-6) levels, as well as wound healing rate and postoperative blood lactic acid level, incidence of multi-ple organ dysfunction syndrome ( MOD) and mortality rate.Results The levels of PCT and IL-6 after surgery for the escharectomy group were decreased, and the state of illness was stable.Incidence of MODS after surgery and mortality were significantly lower than those of the delayed escharectomy group, and the indices of organ functions as well as wound healing rate were all significantly superior to those of the delayed escharectomy group.Conclusion To the burn patients at sepsis shock stage, active anti-shock measures coupled with escharectomy and skin grafting, removal of the necrotic tissue could not only decrease mortality, increase cure rate, decrease inva-sive wound infection, but shorten the course of disease, reduce incidence of MODS and mortality, thus increasing cure rate.

Objective To explore white matter abnormalities in obsessive-compulsive disorder (OCD) and the relationship between such abnormalities and clinical features. Methods Forty patients with OCD and 40 healthy controls matched for sex-, age-and education underwent diffusion tensor imaging (DTI ) scans. Voxel-based analysis was used to compared fractional anisotropy (FA) map between groups. Correlations between white matter abnormalities, illness duration and clinical symptoms measured by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) were performed. Results Compared with healthy controls, OCD patients showed overall decreased FA in white matter of the body of the right corpus callosum (MNI(x,y,z):18,16,16;t=4.00), right thalamus(MNI(x,y,z):10,-22,-22;t=5.31) , left anterior cingulate gyrus (MNI(x,y,z):-14,26,24;t=3.95), right posterior cingulate(MNI(x,y,z):0,-34,16;t=3.77), bilateral middle and inferior temporal gyri(left middle temporal gyrus MNI(x,y,z):-44,-24,-8;t=4.45; right middle temporal gyrus MNI(x,y,z):48,-34,-10;t=4.34),left inferior temporal gyrus MNI(x,y,z):-46,12,-30;t=3.91; right inferior temporal gyrus MNI(x,y,z):46,-20,-12;t=4.11), bilateral parahippocampal gyri(left parahippocampal gyrus MNI(x,y,z):-28,-24,-26;t=4.40;right parahippocampal gyrus MNI(x,y,z):20,-32,-20;t=4.21), right precuneus(MNI(x,y,z):26,-42,14;t=4.22), left lingual gyrus (MNI(x,y,z):-28,-72,-2;t=4.30)and bilateral cerebella(left cerebella MNI(x,y,z):-6,-42,-36;t=4.46; right cerebella MNI(x,y,z):10,-48,-36;t=4.16). Similar but more extensive abnormailities were observed in drug-naive patients compared to healthy controls(all P<0.001). Correlational analyses revealed that the total score of Y-BOCS was positively correlated with the FA value in white matter of the right frontal lobe, right cingulated, left superior temporal gyrus, right precuneus, left inferior parietal lobe. There was a negative correlation between the right inferior parietal lobe FA and the duration of illness. Conclusions There are extensive microstructural abnormalities in white matter of patients with OCD. Impaired axonal integrity within the white matter may be associated with the pathophysiology of OCD. Similar white matter abnormalities found in drug-naive patients may imply the diathesis of OCD.