At present, the C-arm structure accelerators commonly used in radiotherapy equipment are complex in operation and have potential safety hazards when realizing non-coplanar treatment. By combining with medical robotic arm technology, a spherical radiotherapy accelerator motion system is designed. The beam module is clamped by the medical robotic arm structure to achieve three-dimensional multi-angle irradiation treatment within the non-coplanar angle range. Firstly, the rotating mechanism, beam module, and MLC module of the spherical radiotherapy equipment are designed. Then, the double-plane counterweight method is used to calculate the dynamic balance of the equipment, ensuring that the beam center point does not rotate during the treatment process. Finally, the strength check and reliability analysis of the transmission component gear are conducted. The results show that the designed spherical radiotherapy accelerator motion system can meet the requirements of stable, accurate, and fast precision radiotherapy, which is conducive to improving the treatment efficiency.
Particle Accelerators/instrumentation* ; Equipment Design ; Reproducibility of Results ; Radiotherapy/instrumentation*

Objective:To explore the clinical value of the three-dimensional fat suppression fast spoiled gradient echo (3D-FS-FSPGR) MRI sequence in the preoperative evaluation of congenital radial polydactyly.Methods:The data of children with congenital radial polydactyly who underwent surgical treatment in the Department of Orthopedics at Shanxi Children’s Hospital from May 2021 to April 2022 were retrospectively analyzed. Preoperative X-ray examinations and MRI 3D-FS-FSPGR sequence scans were performed on the children. Radiologists first described the morphological characteristics of the articular cartilage, and then orthopedic surgeons performed the Wassel classification based on the X-ray and MRI imaging result, focusing on the bifurcation level, morphology, and articular surface of the phalangeal and metacarpal cartilage. The corresponding surgical method was selected according to the Wassel classification, and intraoperative incision exploration was used as the gold standard. Six months after surgery, the surgical outcome was evaluated using the modified Tada scoring system [with a total score of 0-7, and classified as excellent: >5 points, good: 3-5 points, and poor: <3 points; the excellent and good rate = (excellent + good) cases/total number of cases × 100%]. The appearance, function and recurrence of the operated finger were evaluated 1 year after surgery. Descriptive statistics were performed using SPSS 26.0 software, and the Kappa coefficient was used to evaluate the consistency of the Wassel classification result between radiographs, MRI 3D-FS-FSPGR sequences and intraoperative exploration respectively.Results:A total of 45 children (55 fingers) with congenital radial polydactyly were enrolled, including 25 males and 20 females, aged 5 to 60 months, with the median age of 9 months. Unilateral findings were seen in 35 cases and bilateral findings in 10 cases. MRI 3D-FS-FSPGR imaging sequences clearly demonstrated the level of cartilage bifurcation and bone tissue growth and development, which were consistent with intraoperative exploration findings. The accuracy of the MRI 3D-FS-FSPGR Wassel classification was 100% (55/55), and the accuracy of the X-ray Wassel classification was 81.8% (45/55). Disagreements were found in the classifications of five fingers: three with X-ray classifications of Wassel type Ⅳ but actually classified as type Ⅲ, and two with X-ray classifications of Wassel type Ⅳ but actually classified as type Ⅴ. The Kappa coefficients were all >0.85. All patients were followed up for 1 year. The modified Tada score showed excellent in 41 fingers, good in 6 fingers, and poor in 8 fingers, for an excellent and good rate of 85.5% (47/55). At final follow-up, the reconstructed thumbs showed significant improvement in appearance, with normal bone axis restoration, no deviation of the digits, and normal nail appearance. There was no significant scarring or contracture. Functions of thumb flexion, extension, grasping, and opposition were good. There was no postoperative deformity or recurrence.Conclusion:MRI 3D-FS-FSPGR sequences can accurately classify congenital radial polydactyly preoperatively, optimize the surgical incision and osteotomy alignment, and achieve excellent surgical outcomes.

Objective:To investigate the function and mechanism of exosomes in bladder cancer cell growth and metastasis regulating by NETs.Methods:The exosomes secreted by SV-HUC-1,MGH-U3 and 253J cells were extracted.PBS and the above exo-somes incubated with PMN,recorded as PBS group,SV-HUC-1 exo group,MGH-U3 exo group,253J exo group.The generation of NETs was detected by Sytox green staining,and the expressions of NETs marker proteins CIT-H3,NE and MPO were detected by Western blot.MGH-U3 and 253J cells were divided into Control group,PMN group,MGH-U3 exo group,253J exo group MGH-U3 exo+PMN group,253J exo+PMN group.The PMN culture supernatant of MGH-U3 exo group and 253J exo group were added with 1.5 U/ml DNAse,after incubation for 30 min,the collected mixture to co-incubate with MGH-U3 and 253J cells,recorded as MGH-U3 exo+PMN+DNAse group and 253J exo+PMN+DNAse group.The proliferation ability of MGH-U3 and 253J cells were detected by CCK8,the migration and invasion of cells were detected by Transwell,and the phosphorylation levels of PI3K and AKT were detected by Western blot.Results:Compared with PBS group,the formation of NETs and the expressions of CIT-H3,NE and MPO in MGH-U3 exo group and 253J exo group increased significantly(P<0.001).There was no significant change of the above indexes in SV-HUC-1 exo group.Compared with Control group,MGH-U3 exo+PMN group and 253J exo+PMN group had significantly increased cell prolifer-ation,migration and invasion ability(P<0.05),the phosphorylation levels of PI3K and AKT increased significantly(P<0.001).Com-pared with MGH-U3 exo+PMN group,MGH-U3 exo+PMN+DNAse group had significantly decreased cell proliferation,migration and invasion ability(P<0.05),the phosphorylation levels of PI3K and AKT decreased significantly(P<0.001).Compared with 293J exo+PMN group,293J exo+PMN+DNAse group had significantly decreased cell proliferation,migration and invasion ability,the phosphor-ylation levels of PI3K and AKT decreased significantly(P<0.001).Conclusion:The exosomes of bladder cancer cells can promote the proliferation,migration and invasion of tumor cells by inducing the generation of NETs.

Objective:To explore the clinical value of the three-dimensional fat suppression fast spoiled gradient echo (3D-FS-FSPGR) MRI sequence in the preoperative evaluation of congenital radial polydactyly.Methods:The data of children with congenital radial polydactyly who underwent surgical treatment in the Department of Orthopedics at Shanxi Children’s Hospital from May 2021 to April 2022 were retrospectively analyzed. Preoperative X-ray examinations and MRI 3D-FS-FSPGR sequence scans were performed on the children. Radiologists first described the morphological characteristics of the articular cartilage, and then orthopedic surgeons performed the Wassel classification based on the X-ray and MRI imaging result, focusing on the bifurcation level, morphology, and articular surface of the phalangeal and metacarpal cartilage. The corresponding surgical method was selected according to the Wassel classification, and intraoperative incision exploration was used as the gold standard. Six months after surgery, the surgical outcome was evaluated using the modified Tada scoring system [with a total score of 0-7, and classified as excellent: >5 points, good: 3-5 points, and poor: <3 points; the excellent and good rate = (excellent + good) cases/total number of cases × 100%]. The appearance, function and recurrence of the operated finger were evaluated 1 year after surgery. Descriptive statistics were performed using SPSS 26.0 software, and the Kappa coefficient was used to evaluate the consistency of the Wassel classification result between radiographs, MRI 3D-FS-FSPGR sequences and intraoperative exploration respectively.Results:A total of 45 children (55 fingers) with congenital radial polydactyly were enrolled, including 25 males and 20 females, aged 5 to 60 months, with the median age of 9 months. Unilateral findings were seen in 35 cases and bilateral findings in 10 cases. MRI 3D-FS-FSPGR imaging sequences clearly demonstrated the level of cartilage bifurcation and bone tissue growth and development, which were consistent with intraoperative exploration findings. The accuracy of the MRI 3D-FS-FSPGR Wassel classification was 100% (55/55), and the accuracy of the X-ray Wassel classification was 81.8% (45/55). Disagreements were found in the classifications of five fingers: three with X-ray classifications of Wassel type Ⅳ but actually classified as type Ⅲ, and two with X-ray classifications of Wassel type Ⅳ but actually classified as type Ⅴ. The Kappa coefficients were all >0.85. All patients were followed up for 1 year. The modified Tada score showed excellent in 41 fingers, good in 6 fingers, and poor in 8 fingers, for an excellent and good rate of 85.5% (47/55). At final follow-up, the reconstructed thumbs showed significant improvement in appearance, with normal bone axis restoration, no deviation of the digits, and normal nail appearance. There was no significant scarring or contracture. Functions of thumb flexion, extension, grasping, and opposition were good. There was no postoperative deformity or recurrence.Conclusion:MRI 3D-FS-FSPGR sequences can accurately classify congenital radial polydactyly preoperatively, optimize the surgical incision and osteotomy alignment, and achieve excellent surgical outcomes.

Objective:To investigate the function and mechanism of exosomes in bladder cancer cell growth and metastasis regulating by NETs.Methods:The exosomes secreted by SV-HUC-1,MGH-U3 and 253J cells were extracted.PBS and the above exo-somes incubated with PMN,recorded as PBS group,SV-HUC-1 exo group,MGH-U3 exo group,253J exo group.The generation of NETs was detected by Sytox green staining,and the expressions of NETs marker proteins CIT-H3,NE and MPO were detected by Western blot.MGH-U3 and 253J cells were divided into Control group,PMN group,MGH-U3 exo group,253J exo group MGH-U3 exo+PMN group,253J exo+PMN group.The PMN culture supernatant of MGH-U3 exo group and 253J exo group were added with 1.5 U/ml DNAse,after incubation for 30 min,the collected mixture to co-incubate with MGH-U3 and 253J cells,recorded as MGH-U3 exo+PMN+DNAse group and 253J exo+PMN+DNAse group.The proliferation ability of MGH-U3 and 253J cells were detected by CCK8,the migration and invasion of cells were detected by Transwell,and the phosphorylation levels of PI3K and AKT were detected by Western blot.Results:Compared with PBS group,the formation of NETs and the expressions of CIT-H3,NE and MPO in MGH-U3 exo group and 253J exo group increased significantly(P<0.001).There was no significant change of the above indexes in SV-HUC-1 exo group.Compared with Control group,MGH-U3 exo+PMN group and 253J exo+PMN group had significantly increased cell prolifer-ation,migration and invasion ability(P<0.05),the phosphorylation levels of PI3K and AKT increased significantly(P<0.001).Com-pared with MGH-U3 exo+PMN group,MGH-U3 exo+PMN+DNAse group had significantly decreased cell proliferation,migration and invasion ability(P<0.05),the phosphorylation levels of PI3K and AKT decreased significantly(P<0.001).Compared with 293J exo+PMN group,293J exo+PMN+DNAse group had significantly decreased cell proliferation,migration and invasion ability,the phosphor-ylation levels of PI3K and AKT decreased significantly(P<0.001).Conclusion:The exosomes of bladder cancer cells can promote the proliferation,migration and invasion of tumor cells by inducing the generation of NETs.

Objective To evaluate clinical efficacy and safety of Bizheng Granules combined with basic therapy in the treatment of liver and kidney insufficiency and phlegm-dampness cross-blocking syndrome of nerve root type cervical spondylosis radiculopathy.Methods Totally 108 patients with nerve root type cervical spondylosis radiculopathy were selected and divided into Bizheng Granules group,Jingfukang Granules group,and Bizheng Granules placebo group according to random number table method,with 36 cases in each group.The three groups were treated with the basic treatment(oral methylcobalamin tablets of 0.5 mg,three times a day,and cervical spine intermittent traction once a day,each time for 15 min),and Bizheng Granules were given in the Bizheng Granules group,and Jingfukang Granules in the Jingfukang Granules group,and Bizheng Granules placebo in the Bizheng Granules placebo group,twice a day after meals.All three groups were treated continuously for 2 weeks and followed up at 4 and 12 weeks after treatment.Visual analog scale(VAS),cervical dysfunction index(NDI),and 36-items short form survey(SF-36)score were recorded in the 3 groups before and after treatment and 4 and 12 weeks after treatment,respectively.Adverse reactions during treatment and follow-up were recorded in the 3 groups.Results 3 cases lost in the Bizheng Granules group,3 cases in the Jingfukang Granules group,and 1 case in the Bizheng Granules placebo group.Compared with the pre-treatment period,the differences in VAS score,NDI score,and SF-36 score among the three groups of patients at all time points of treatment and follow-up were statistically significant(P<0.05).At 12 weeks after treatment,the VAS score and NDI score of the Bizheng Granules group and the Jingfukang Granules group were lower than those of the Bizheng Granules placebo group,but the differences in VAS score and NDI score between Bizheng Granules group and Jingfukang Granules group were not statistically significant(P>0.05).12 weeks after treatment,the SF-36 score of Bizheng Granules group were higher than those of Bizheng Granules placebo group,but the difference in SF-36 score between Bizheng Granules group and Jingfukang Granules group was not statistically significant(P>0.05).The total effective rate of Bizheng Granules group was better than that of the Jingfukang Granules group and Bizheng Granules placebo group(P<0.05).The incidence of adverse reactions in the three groups was not statistically significant(P>0.05).There were no serious adverse events in the three groups.Conclusion Bizheng Granules combined with basic therapy has a definite therapeutic effect in improving pain,restoring cervical dysfunction,and improving quality of life in the treatment of liver and kidney insufficiency and phlegm-dampness cross-blocking syndrome of nerve root type cervical spondylosis radiculopathy,with good safety.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the application of CT image omics model in the differential diagnosis of ganglioneuroblastoma (GNB) and neuroblastoma (NB) in childhood.Methods:A retrospective case series study was performed. The clinical and imaging data of 23 NB and 23 GNB pediatric patients confirmed by surgery and pathology in Shanxi Children's Hospital from January 2013 to December 2013 were collected. The original CT images in the normal scan phase, arterial phase and venous phase of all the children before operation were extracted from the PACS system in DICOM format. ITK-SNAP (ver.3.4.0) software was applied to manually outline and extract the image omics features layer by layer of the lesions in the normal scan phase, arterial phase and venous phase of each patient before surgery. The minimum absolute contraction selection operator and stepwise multi-factor logistic regression method were used to screen out effective features in different scan phases. The corresponding phase image omics model was established by using logistic model. The diagnostic efficiency of each phase of the image omics model was evaluated by using the receiver operating characteristic curve, calibration curve and decision curve.Results:A total of 1 361 image omics features were extracted from the original CT images in the 3 phases. The model was established by using multi-factor logistic regression to extract 4 features in the normal scan phase, 2 features in the arterial phase, 3 features in the venous phase and 7 features in the combination of the 3 phases. The area under the curve (AUC) of the model in the normal scan phase was 0.940, the accuracy was 89.1%, the sensitivity was 91.3% and the specificity was 87.0%; the AUC of the model in the arterial phase was 0.923, the accuracy was 84.8%, the sensitivity was 82.6%, and the specificity was 87.0%; the AUC of the model in the venous phase was 0.949, the accuracy was 87.8%, the sensitivity was 83.3%, and the specificity was 91.3%; the AUC of 3 phases combined model was 0.964, the accuracy was 95.1%, the sensitivity was 94.7%, and the specificity was 95.5%. The results showed that the single-phase image omics model was effective in the differential diagnosis of NB and GNB in childhood; the AUC, accuracy, sensitivity and specificity of the 3 phases combined imaging model were higher than those of the single-phase imaging model. The calibration curve and decision curve showed that the probability of differential diagnosis of NB and GNB in childhood by the 3 phases combined model had a high consistency with the observed value, and a good net benefit could be achieved.Conclusions:CT-based image omics model has a high clinical value in the differential diagnosis of NB and GNB in childhood.

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.

To investigate the molecular mechanism of modified Yigong powder(MYG)in the treat-ment of spleen deficiency syndrome based on network pharmacology and analyzed the effect of MYG on gastrointestinal simulated intestinal flora of spleen deficiency dogs and mucosal barrier of Caco-2 cells,as well as the interaction between intestinal flora and mucosal barrier.The molecular mechanism of MYG in the treatment of spleen deficiency syndrome was predicted by network pharmacology.The fecal samples of three canines(12±1)years old with spleen deficiency were collected to establish an in vitro gastrointestinal simulation system,which was divided into the o-riginal fecal sample group,the gastrointestinal simulation group and the gastrointestinal simulation treated by MYG group.The structural changes of the flora in each group were detected by 16S rD-NA sequencing.The metabolites were extracted from the gastrointestinal simulation system trea-ted by MYG group to study its effect on LPS-induced Caco-2 cell mucosal barrier injury model.The cell experiments included the blank control group,LPS model group,modified Yigong metabolite group.The permeability of mucosal was determined by fluorescein sodium,and then relative ex-pression levels of Claudin-1,Occludin and ZO-1 mRNA were determined by qPCR.The correlation between intestinal flora and Caco-2 cell mucosal barrier index after MYG intervention was further analyzed.The results showed that MYG had 76 active ingredients and 45 potential targets for the treatment of spleen deficiency syndrome.Forty key targets were obtained through protein interac-tion analysis,34 items were obtained by GO enrichment analysis,and 16 pathways were obtained by KEGG enrichment analysis.In the gastrointestinal simulation system,compared with the gas-trointestinal simulation group,at the phylum level,the abundance of Firmicutes,Bacteroides and Actinobacteriota increased significantly(P＜0.05),and the abundance of Proteobacteria decreased significantly(P＜0.05).At the genus level,the abundance of Fusobacterium,[Ruminococcus]gna-vus group and Blautia increased significantly(P＜0.05),while the abundance of Escherichia-Shi-gella and Citrobacter decreased significantly(P＜0.05).The diversity index of intestinal flora in the gastrointestinal simulation treated by MYG group was significantly increased(P＜0.05).In cell experiments,compared with the LPS model group,the mucosal permeability of Caco-2 cells in the modified Yigong metabolite group was significantly reduced(P＜0.01),and the expression levels of Claudin-1,Occludin and ZO-1 mRNA were significantly increased(P＜0.01).Correlation analysis showed that there was a certain correlation between bacterial community structure and mucosal barrier indexes.In summary,MYG may act on 40 key targets such as TNF,IL6,IL18,CX-CL8 and AKT1 through 76 active ingredients such as quercetin,arachidonic acid and naringin,and treat spleen deficiency syndrome in dogs through 16 signaling pathways such as AGE-RAGE,FoxO and HIF-l.In addition,the gastrointestinal metabolites of MYG up-regulate tight junction protein mRNA expression,reduce mucosal permeability,and repair mucosal barrier,which may be related to MYG's regulation of flora structure.