Electrical impedance tomography (EIT) is a new non-invasive functional imaging technology, which has the advantages of non-invasion, non-radiation, low cost, fast response, portability and visualization. In recent years, more and more studies have shown that EIT has great potential in the detection of lung diseases and has been applied to early diagnosis and treatment of some diseases. This paper introduced the basic principle of EIT, discussed the research and clinical application of EIT in the detection of acute respiratory distress syndrome, chronic obstructive pulmonary disease, pneumothorax and pulmonary embolism, and focused on the summary and introduction of indicators and functional images of EIT related to the detection of lung diseases. This review will help medical workers understand and use EIT, and promote the further development of EIT in lung diseases as well as other fields.
Humans ; Electric Impedance ; Tomography/methods* ; Lung Diseases/diagnosis* ; Pulmonary Disease, Chronic Obstructive/diagnosis* ; Pulmonary Embolism/diagnosis* ; Respiratory Distress Syndrome/diagnosis*

Objective: To explore the clinical safety and efficacy of a single-position robot-assisted radical nephroureterectomy (RRUN) in the treatment of upper tract urothelial carcinoma (UTUC). Methods: A retrospective study was conducted on 136 UTUC patients who underwent RRUN (n=35) and laparoscopic radical nephroureterectomy (LRUN，n=101) in our hospital during Dec.2020 and Aug.2023.The perioperative and safety indicators of the two groups were compared.The intravesical recurrence-free survival (IVRFS)，recurrence-free survival (RFS)，and overall survival (OS) of the two groups were compared using Kaplan-Meier method. Results: There were no significant differences in the baseline data between the two groups (P>0.05).All surgeries were successfully completed without conversion to open surgery.RRUN demonstrated superior perioperative outcomes compared to LRUN in overall postoperative complication rate [37.1%(13/35) vs. 56.4%(57/101)]，postoperative hospital stay [6(5,7) days vs. 7(6,8) days]，and catheter indwelling time [3(2，4) days vs. 4(3，5) days]，with statistically significant differences (P<0.05).Safety indicators of both surgical approaches were similar (P>0.05).Survival analysis showed no significant difference in oncological outcomes between the two groups [IVRFS (1 year：92.1%，2 years：85.2%)，RFS (1 year:82.4%，2 years:74.9%)，OS (1 year:90.6%，2 years:84.2%)] (P>0.05). Conclusion: Compared with retroperitoneal LRUN，single-position RRUN for UTUC demonstrates comparable safety and oncological efficacy，while offering significant advantages in perioperative outcomes such as reducing postoperative complication rate and shortening hospital stay.

Replantation of traumatic amputation in children has its own characteristics. This consensus primarily focuses on the issues related to the treatment of traumatically amputated limb injuries in children. Organised along a timeline, the consensus summarises domestic and international clinical experiences in emergency care and injury assessment of traumatic limb amputation limbs, indications and contraindications for replantation surgery, principles and procedures of replantation surgery, postoperative medication and management, as well as rehabilitation in children. The aim of this consensus is to propose standardise the treatment protocols for limb replantation for children therefore to serve as a reference for clinical practitioners in medical practices, and further improve the treatment and care for the traumatic limb amputations in children.

The polyfoliate perforator flap is a new type of flap that was developed on the basis of the traditional polyfoliate myocutaneous flap, polyfoliate fascial flap and perforator flap. It overturns the traditional idea that the deep fascial vascular network is the fundamental for a survival of the flap, and enables the flaps to achieve the best profile and function of the recipient areas with minimal damage to the donor area. In order to improve the understanding of the polyfoliate perforator flap and further standardise its clinical application, this paper forms a consensus on the definition, classification, indications, operative points and precautions of the polyfoliate perforator flap, so as to provide references in diagnosis and treatment process and practical application for the surgeons.

The polyfoliate perforator flap is a new type of flap that was developed on the basis of the traditional polyfoliate myocutaneous flap, polyfoliate fascial flap and perforator flap. It overturns the traditional idea that the deep fascial vascular network is the fundamental for a survival of the flap, and enables the flaps to achieve the best profile and function of the recipient areas with minimal damage to the donor area. In order to improve the understanding of the polyfoliate perforator flap and further standardise its clinical application, this paper forms a consensus on the definition, classification, indications, operative points and precautions of the polyfoliate perforator flap, so as to provide references in diagnosis and treatment process and practical application for the surgeons.

Objective:To evaluate the feasibility of coronary artery calcium (CAC) detection, quantification and risk classification using ultra-low-dose chest CT (ULD-CT) combined with a calcium-aware algorithm.Methods:A total of 115 patients were prospectively enrolled from April to October 2022 at Zhejiang Provincial People′s Hospital, who underwent a standard calcium scoring CT (CACS-CT) scan followed by an additional ULD-CT scan. CACS-CT adopted a prospective ECG-triggered sequence scan with a tube voltage of 120 kVp, and the reconstruction algorithm with Qr36 (group CACS-CT Qr). ULD-CT adopted non-ECG-triggered high-pitch scan with a tube voltage of Sn 100 kVp, and the standard algorithm Qr36 (group ULD-CT Qr) and calcium-aware algorithm Sa36 (group ULD-CT Sa) were respectively used to reconstruct two groups of images. Taking the CAC detection of CACS-CT as a reference, the accuracy of ULD-CT for detecting CAC was calculated, and kappa was used to evaluate the agreement of CAC detection between scanning protocols. The agreement of CACS quantification between scanning protocols was assessed using intraclass correlation coefficients (ICC) and Bland-Altman plots, and the agreement of risk classification between scanning protocols was assessed using weighted kappa. Results:The CAC was found in 66.96% (77/115) of patients in CACS-CT Qr. Taking the CAC detection in CACS-CT Qr as a reference, the sensitivity of CAC detection in ULD-CT Qr and ULD-CT Sa was 96.1% and 97.4%, respectively, and the specificity was 94.73% (k= 0.902, 0.921). The CACS for ULD-CT Qr and ULD-CT Sa was lower than that for CACS-CT Qr (3.6, 6.2 vs. 8.5; P< 0.001), but strongly correlated with CACS for CACS-CT Qr ( r= 0.983, P< 0.001). The mean difference in CACS for ULD-CT Sa and CACS-CT Qr was smaller (12.33), and the agreement was better (ICC= 0.992). The agreement of risk classifications between ULD-CT Sa and CACS-CT Qr was relatively high (weighted k= 0.936), and the reclassification rate (6.08%) was relatively low. The effective radiation dose for ULD-CT was reduced by approximately 77.22% compared with that for CACS-CT. Conclusions:It is feasible to evaluate CACS using Non-ECG-triggered ULD-CT combined with a calcium-aware algorithm.

Objective To investigate the establishment of a six-gene-edited pig-to-non-human primate kidney xenotransplantation model. Methods The kidney of humanized genetically-edited pig (GTKO/β4GalNT2KO/CMAHKO/hCD55/hCD46/hTBM) was transplanted into a cynomolgus monkey. The survival of the recipient and kidney condition after blood perfusion were observed. The parenchymal echo, blood flow changes, and size of the kidney were monitored on a regular basis. Routine blood test, kidney function test and electrolyte assessment were carried out. Dynamic changes of urine, feces and body mass were monitored. At the end of life, the transplant kidney, heart, liver, spleen, lung, and cecum were collected for pathological examination. Results The recipient died at postoperative 7 d. After blood flow was restored, the kidney was properly perfused, the organ was soft and the color was normal. At the end of the recipient's life, a slight amount of purulent secretion was attached to the ventral side of the kidney, with evident congestion and swelling, showing the appearance of "red kidney". Postoperatively, the echo of renal parenchyma was increased, blood flow was decreased, the cortex was gradually thickened, and a slight amount of effusion surrounded the kidney and abdominal cavity over time. In the recipient, the amount of peripheral red blood cells, hemoglobin, albumin, and platelets was progressively decreased, and serum creatinine level was increased to 308 μmol/L at postoperative 7 d, whereas the K⁺ concentration did not significantly change. Light yellow urine was discharged immediately after surgery, diet and drinking water were resumed within postoperative 3 h, and light yellow and normal-shape stool was discharged. The reddish urine was gradually restored to normal color within postoperative 1 d, which were consistent with the results of the routine urine test. A large amount of brown bloody stool was discharged twice in the morning of 2 d after surgery. Omeprazole was given for acid suppression, and the stool returned to normal at postoperative 4 d. The β₂-microglobulin level was increased to 0.75 mg/L at postoperative 7 d. The body mass was increased by 1.7 kg. Autopsy pathological examination showed interstitial edema and bleeding of the transplant kidney, a large amount of infiltration of lymphocytes and macrophages, infiltration of lymphocytes in the arteriole wall and arterial cavity, accompanied by arteritis changes, lymphocyte infiltration in the cecal stroma and congestion in the spleen tissues. No significant abnormal changes were observed in other organs. Conclusions The humanized genetically-edited pig-to-non-human primate kidney xenotransplantation model is successfully established, and postoperative survival of the recipient is 1 week.

Objective:To explore the feasibility for taking weight and body mass index (BMI) to calculate the size-specific dose estimate (SSDE) in abdomen-pelvis CT examination.Methods:512 adult patients undergoing abdomen-pelvis CT examination were retrospectively analyzed. The in-house software based on MATLAB platform were used to calculate automatically water equivalent diameter ( dw), size-dependent conversion factor ( f), SSDE, together with their respective averaged values. The correlations between age, height, weight and BMI with dw were calculated by using Spearman correlation analysis. Two regression equations were established to calculate the SSDE (SSDE weight, SSDE BMI), one for the correlation of weight with dw based on first half of these cases and the other for that between BMI with dw based on another half as the cases to be verified. With reference of the SSDE derived from the in-house software, the averaged relative differences and root-mean-square errors in SSDE weightand SSDE BMI were calculated, respectively. Results:No statistically significant correlation between age and d w ( P>0.05) was shown, but weak correlation between height and dw( r=0.260, P<0.05), strong correlation between either weight or BMI with dw( r=0.879, 0.851, P<0.05). Two regression equations were described as dw=13.808+ 0.184×weight, dw=11.142+ 0.618×BMI. The mean SSDE, SSDE weight and SSDE BMI for the verified patients were (13.55±1.66) mGy, (13.84±2.03) mGy and (13.83±2.02) mGy, respectively. As compared to actual SSDE, the averaged relative differences in SSDE weight and SSDE BMI were 1.97% and 1.87%; 0.38% and 2.75% for male patients; 4.58% and 0.43% for female patients; 0.11% and 3.32% for patients with BMI<18.5 kg/m 2;1.92% and 2.06% for those with 18.5 kg/m 2≤BMI<24.0 kg/m 2;2.57% and 1.57% for those with 24 kg/m 2≤BMI<28.0 kg/m 2;3.28% and -1.36% for those with BMI≥28.0 kg/m 2. The averaged root-mean-square errors in SSDE weight and SSDE BMI were both 0.80 mGy; 0.65 and 0.67 mGy for male patients; 0.98 and 0.59 mGy for female patients; 0.73 and 1.03 mGy for underweight, 0.74 and 0.66 mGy for normal weight, 0.85 and 0.79 mGy for overweight, and 1.10 and 1.32 mGy for obesity. Conclusions:Weight and BMI can be used as the surrogate dw to compute SSDE in adult abdomen-pelvis CT examination. However, Weight rather than BMI is more applied to male patients, and BMI is more suitable for female patients.

Objective:To evaluate the clinical factors affecting the probability of malignant micro-sized (≤10 mm) solitary pulmonary nodules (≤10 mm, micro-sized SPN), and established a clinical prediction model. Methods:Medical records from 102 patients with a pathological diagnosis of micro-sized SPN (Group A), established between June 2012 and March 2014, were reviewed. Clinical data were collected to evaluate the independent predictors of malignant micro-sized SPN using single factor analysis and Logistic regression analysis. A clinical prediction model was subsequently created. Receiver-operating characteristic (ROC) curves were constructed using the prediction model. Between January 2015 and August 2017, data from an additional 10 patients enrolled from January 2015 to August 2017 from Jinhua Guangfu Hospital (Group B) with a pathological y diagnosed micro-sized SPN were used to validate this clinical prediction model. The model was also compared with the Mayo Clinic Model. Results:Median age of 102 patients (Group A) was 55.31±10.77 years old. There were 75.5％malignant nodules and 24.5％benign ones. Logistic regression analysis identified six clinical characteristics (no symptoms, upper lobe, diameter>5 mm, no clear border, not irregular round, no calcification) as independent predictors of malignancy in patients with micro-sized SPN. The area under the ROC curve for our model was 0.922 (95％CI:0.857-0.986). In our model, the diagnosis sensitivity and specificity were 88.3％and 84.0％, respectively. The test power of the model was better compared with the Mayo Clinic Model. Conclusions:In this study, we had found the independent predictors of malignant micro-sized SPN, and developed a prediction model that could accurately identify malignant micro-sized SPN in patients.

Objective: To explore the practical value of whole-body diffusion weighted imaging (WB-DWI) in the diagnosis and monitoring of newly diagnosed multiple myeloma (MM) patients. Methods: The clinical data of 107 newly diagnosed MM patients at hematology department of the first affiliated hospital of Soochow’s University from September 2012 to January 2016 were retrospectively analyzed. The results of all the 60 patients who were performed WB-DWI before treatment were analyzed. And the role of WB-DWI in the diagnosis and monitoring MM was discussed. Results: Of 60 patients, 57 were found to have more or less abnormal foci of osteoclasia by WB-DWI with the positive rate of 95.0% (57/60) . Myeloma related bone lesions occurred predominantly in the axial skeleton, which were commonly seen in ribs, spines and pelvis. There were 96.5% (55/57) patients who had osteolytic rib lesions. And the ribs were the most vulnerable organs. Thirteen patients who had no osteoclasia by computerized tomography (CT) examination were detected abnormal limited diffuse lesions by WB-DWI. Eight patients underwent more than one follow-up WB-DWI. The mean apparent diffusion coefficient (ADC) values of the maximal lesions from all eight patients before and after treatment were 0.984×10^-3mm²/s and 1.142×10^-3mm²/s, respectively. They were both higher than the normal range [ (0.516±0.180) ×10^-3mm²/s]. Mean ADC values of the maximal lesions after treatment were higher than that before treatment. The results of WB-DWI after the induction chemotherapy were consistent with clinical therapeutic effect. Conclusions WB-DWI has an important value in the diagnosis and monitoring of newly diagnosed MM. It has higher sensitivity than than that of CT. The results of WB-DWI after induction therapy has a nice correlation with treatment effect and it could monitor the disease.