Objective To investigate the value of amide proton transfer(APT)imaging in evaluating lymph-vascular space inva-sion(LVSI)of cervical cancer.Methods A retrospective analysis was conducted on the data of cervical cancer patients with patho-logically confirmed LVSI status.Based on the presence of LVSI,the patients were divided into LVSI positive group and LVSI nega-tive group.All patients underwent diffusion weighted imaging(DWI)and APT imaging before treatment,and the apparent diffusion coefficient(ADC)and APT values of the lesions were measured.An independent sample t-test was used to compare the differences in ADC and APT values between the two groups.The sensitivity,specificity and area under the curve(AUC)of ADC,APT and ADC+APT in predicting LVSI were observed by receiver operating characteristic(ROC)curve,and the diagnostic performance of the three was compared by DeLong test.Results A total of 78 patients were included,of which 54 were LVSI negative and 24 were LVSI positive.The ADC values in the LVSI positive group were significantly lower than those in the LVSI negative group(P＜0.001),while the APT values in the LVSI positive group were significantly higher than those in the LVSI negative group(P＜0.001).The sensitivities of ADC,APT and ADC+APT in predicting LVSI were 79.17％,83.33％ and 87.50％,respectively,the specificities were 75.93％,55.56％ and 77.78％,respectively,and the AUC were 0.828,0.759 and 0.868,respectively,indicating that the diag-nostic performance of ADC+APT was better than that of ADC and APT alone(P＜0.001).Conclusion APT imaging can preop-eratively predict the presence of LVSI status in cervical cancer.When combined with ADC,its diagnostic accuracy is higher than that of APT alone,providing a new approach for evaluating LVSI in cervical cancer.

Objective:To evaluate whether the mechanism by which high glucose attenuated the cardioprotective effect of sevoflurane postconditioning was associated with the hypoxia-inducible factor-1α (HIF-1α)/monocarboxylate transporter 4 (MCT4) signaling pathway in rat cardiomyocytes.Methods:H9C2 cardiomyocytes were cultured at a 1∶4 ratio and then divided into 8 groups ( n=21 each) using a table of random numbers: control group (N+ Con group), hypoxia-reoxygenation (H/R) group (N+ H/R group), sevoflurane postconditioning group (N+ SPostC group), high glucose control group (H+ Con group), high glucose-H/R group (H+ H/R group), high glucose sevoflurane postconditioning group (H+ SPostC group), high glucose sevoflurane postconditioning + HIF-1α agonist group (H+ SPostC+ D group), and high glucose sevoflurane postconditioning + HIF-1α agonist + MCT4 inhibitor group (H+ SPostC+ D+ A group). N+ Con, N+ H/R and N+ SPostC groups were cultured in conventional culture dishes, while high-glucose group was incubated in high-glucose (35 mmol/L) DMEM. Cells were subjected to 3 h of hypoxia in serum-free and glucose-free DMEM using a three-gas incubator, followed by 3 h of reoxygenation in fresh DMEM in a CO 2 incubator. Sevoflurane postconditioning was performed as follows: Cells were incubated at 37 ℃ in a three-gas incubator filled with sevoflurane (2.4%) for 15 min. At 2 h before hypoxia, H+ SPostC+ D group was incubated in medium containing 1 mmol/L DMOG (HIF-1α agonist), and H+ SPostC+ D+ A group was incubated in medium containing 1 mmol/L DMOG and 10 μmol/L AZD0095 (MCT4 inhibitor). The viability of cardiomyocytes (by CCK8 assay), levels of LDH in culture medium (by microplate assay), levels of lactate (by WST-8 assay), levels of ATP (by chemiluminescence assay), apoptosis rate of cells (by flow cytometry), mitochondrial membrane potential (by fluorescence probe assay), and expression of HIF-1α and MCT4 (by Western blot) were measured. Results:Compared with N+ H/R group, the cell viability, levels of lactate, levels of ATP and mitochondrial membrane potential were significantly increased, the levels of LDH in culture medium and apoptosis rate of cells were decreased, and the expression of HIF-1α and MCT4 was up-regulated in N+ SPostC group ( P<0.05). There were no significant differences in each parameter between H+ H/R group and H+ SPostC group ( P>0.05). Compared with H+ SPostC group, the cell viability, levels of lactate, levels of ATP and mitochondrial membrane potential were significantly increased, the levels of LDH in culture medium and apoptosis rate of cells were decreased, and the expression of HIF-1α and MCT4 was up-regulated in H+ SPostC+ D group ( P<0.05). Compared with H+ SPostC+ D group, the cell viability, levels of lactate, levels of ATP and mitochondrial membrane potential were significantly decreased, the levels of LDH in culture medium and apoptosis rates of cells were increased, and the expression of HIF-1α and MCT4 was down-regulated in H+ SPostC+ D+ A group ( P<0.05). Conclusions:The mechanism by which high glucose attenuates the cardioprotective effect of sevoflurane postconditioning may be related to the inhibition of the HIF-1α/MCT4 signaling pathway in rat cardiomyocytes.

Objective:To evaluate whether the mechanism by which high glucose attenuated the cardioprotective effect of sevoflurane postconditioning was associated with the hypoxia-inducible factor-1α (HIF-1α)/monocarboxylate transporter 4 (MCT4) signaling pathway in rat cardiomyocytes.Methods:H9C2 cardiomyocytes were cultured at a 1∶4 ratio and then divided into 8 groups ( n=21 each) using a table of random numbers: control group (N+ Con group), hypoxia-reoxygenation (H/R) group (N+ H/R group), sevoflurane postconditioning group (N+ SPostC group), high glucose control group (H+ Con group), high glucose-H/R group (H+ H/R group), high glucose sevoflurane postconditioning group (H+ SPostC group), high glucose sevoflurane postconditioning + HIF-1α agonist group (H+ SPostC+ D group), and high glucose sevoflurane postconditioning + HIF-1α agonist + MCT4 inhibitor group (H+ SPostC+ D+ A group). N+ Con, N+ H/R and N+ SPostC groups were cultured in conventional culture dishes, while high-glucose group was incubated in high-glucose (35 mmol/L) DMEM. Cells were subjected to 3 h of hypoxia in serum-free and glucose-free DMEM using a three-gas incubator, followed by 3 h of reoxygenation in fresh DMEM in a CO 2 incubator. Sevoflurane postconditioning was performed as follows: Cells were incubated at 37 ℃ in a three-gas incubator filled with sevoflurane (2.4%) for 15 min. At 2 h before hypoxia, H+ SPostC+ D group was incubated in medium containing 1 mmol/L DMOG (HIF-1α agonist), and H+ SPostC+ D+ A group was incubated in medium containing 1 mmol/L DMOG and 10 μmol/L AZD0095 (MCT4 inhibitor). The viability of cardiomyocytes (by CCK8 assay), levels of LDH in culture medium (by microplate assay), levels of lactate (by WST-8 assay), levels of ATP (by chemiluminescence assay), apoptosis rate of cells (by flow cytometry), mitochondrial membrane potential (by fluorescence probe assay), and expression of HIF-1α and MCT4 (by Western blot) were measured. Results:Compared with N+ H/R group, the cell viability, levels of lactate, levels of ATP and mitochondrial membrane potential were significantly increased, the levels of LDH in culture medium and apoptosis rate of cells were decreased, and the expression of HIF-1α and MCT4 was up-regulated in N+ SPostC group ( P<0.05). There were no significant differences in each parameter between H+ H/R group and H+ SPostC group ( P>0.05). Compared with H+ SPostC group, the cell viability, levels of lactate, levels of ATP and mitochondrial membrane potential were significantly increased, the levels of LDH in culture medium and apoptosis rate of cells were decreased, and the expression of HIF-1α and MCT4 was up-regulated in H+ SPostC+ D group ( P<0.05). Compared with H+ SPostC+ D group, the cell viability, levels of lactate, levels of ATP and mitochondrial membrane potential were significantly decreased, the levels of LDH in culture medium and apoptosis rates of cells were increased, and the expression of HIF-1α and MCT4 was down-regulated in H+ SPostC+ D+ A group ( P<0.05). Conclusions:The mechanism by which high glucose attenuates the cardioprotective effect of sevoflurane postconditioning may be related to the inhibition of the HIF-1α/MCT4 signaling pathway in rat cardiomyocytes.

Objective To investigate the value of amide proton transfer(APT)imaging in evaluating lymph-vascular space inva-sion(LVSI)of cervical cancer.Methods A retrospective analysis was conducted on the data of cervical cancer patients with patho-logically confirmed LVSI status.Based on the presence of LVSI,the patients were divided into LVSI positive group and LVSI nega-tive group.All patients underwent diffusion weighted imaging(DWI)and APT imaging before treatment,and the apparent diffusion coefficient(ADC)and APT values of the lesions were measured.An independent sample t-test was used to compare the differences in ADC and APT values between the two groups.The sensitivity,specificity and area under the curve(AUC)of ADC,APT and ADC+APT in predicting LVSI were observed by receiver operating characteristic(ROC)curve,and the diagnostic performance of the three was compared by DeLong test.Results A total of 78 patients were included,of which 54 were LVSI negative and 24 were LVSI positive.The ADC values in the LVSI positive group were significantly lower than those in the LVSI negative group(P＜0.001),while the APT values in the LVSI positive group were significantly higher than those in the LVSI negative group(P＜0.001).The sensitivities of ADC,APT and ADC+APT in predicting LVSI were 79.17％,83.33％ and 87.50％,respectively,the specificities were 75.93％,55.56％ and 77.78％,respectively,and the AUC were 0.828,0.759 and 0.868,respectively,indicating that the diag-nostic performance of ADC+APT was better than that of ADC and APT alone(P＜0.001).Conclusion APT imaging can preop-eratively predict the presence of LVSI status in cervical cancer.When combined with ADC,its diagnostic accuracy is higher than that of APT alone,providing a new approach for evaluating LVSI in cervical cancer.

BACKGROUND:Three-point mechanics is an effective method for ankle foot orthosis correction and prevention of various foot diseases.At present,the clinical application research on 3D printing ankle foot orthosis has been widespread;however,there are relatively few reports on numerical simulation and finite element analysis involving three-point mechanical correction.There is a lack of relevant biomechanical experimental verification. OBJECTIVE:Three-point force was loaded to analyze the composite model of ankle foot orthosis and foot by finite element method,observing the effect of foot correction with ankle foot orthosis under three-point force intervention,verifying the effectiveness of three-point force and the reliability of ankle foot orthosis. METHODS:A three-dimensional foot and ankle model of a healthy volunteer was constructed based on the medical image processing software Mimics.Rodin 4D and Geomagic reverse engineering software were used to optimize the models and design personalized ankle foot orthosis models.Solidworks software was utilized to turn the ankle model inside for 10° to simulate the foot varus disease.Static loading was carried out on the foot force application area by ANSYS software combined with the three-point mechanics principle.The deformation and stress changes of the foot and ankle tissues were analyzed when the human foot pain threshold was met.The display dynamics was used to further verify the effectiveness of the three-point force applied by the ankle foot orthosis. RESULTS AND CONCLUSION:(1)The personalized ankle foot orthosis designed in this paper had the effect of preventing and fixing foot and ankle varus.The ankle varus was 1.81 mm after being loaded with 1 N·m of varus when not wearing ankle foot orthosis,while it was only 0.44 mm after wearing ankle foot orthosis,the deformation rate was reduced by 75.7%,and the effect of preventing varus was significantly enhanced.(2)When only coronal correction was performed,the low calcaneal force would aggravate the varus angle of the front foot.After adjusting the correction force on the inside of the heel and above the medial malleolus,the varus angle of the front foot and the calcaneus position were improved;however,the medial phalangeal region of the foot still had different degrees of adduction and displacement,which would aggravate the adduction deformity of the patient's front foot.(3)The correction effect of the coronal plane and horizontal plane was better than that of the single coronal plane.There was no adduction and displacement of the medial phalanges of the front foot and the varus angle of the front foot decreased under the force(25,10,10,20 N)of the medial heel,the medial shaft of the first metatarsal,below the lateral malleolus and above the medial malleolus,and the valgus along the X-axis was corrected by 1.395 mm,the calcaneus valgus was corrected by 1.227 mm.The calcaneus varus angle was corrected from 10.21° to 7.25°,and the varus angle was improved by 28.9%.(4)The lateral plantar metatarsal load decreased,the medial plantar metatarsal load increased under the action of a two-plane three-point force,and the plantar bone stress was significantly improved after correction.Thus,the reliability of the three-point force principle was further verified.This study provides an important theoretical support for the implementation of ankle foot orthosis in the treatment of varus in clinical practice.

Objective:To discuss the effect of fingertip reconstruction with V-Y advancement flap and nailbed suture treating Allen’s type Ⅲ amputations unsuitable for vascular anastomosis.Methods:From September 2018 to December 2020, clinical data of patients with Allen’s type Ⅲ fingertip amputations treated in Northern Jiangsu People’s Hospital were analyzed retrospectively. The fingertips were reconstructed with V-Y advancement flap and nailbed suture. The infeasibility of vascular anastomosis was checked under the microscope. Following fixation of the distal phalanx, the nailbed was stretched as flat as possible and sutured. If the nail plate was missing, a manual nail plate made from a plastic transfusion pipe would be fixed to cover the exposed nailbed. The palmar soft tissue of the amputated fingertip was excised, and periosteum, hyponychium, nailbed, and dorsal soft tissue were retained. The proximal volar skin was incised until the subcutaneous adipose layer to get a V-Y advancement flap. The volar defect was repaired with the V-Y advancement flap distally sutured with the pre-retained hyponychium. Postoperatively, burn cream was smeared on the nail for moisturizing, without lamp heating, and intravenous antibiotics was administered routinely. The main indexes were collected including nail appearance, pulp plumpness, static two-point discrimination, motion loss of the distal interphalangeal joint, and patients’ self-evaluation of the appearance. Chinese Medical Association trial standard of upper limb partial function assessment (CMA evaluation) was used to evaluate finger function.Results:A total of 16 patients with 18 fingertips were included. There were 9 males and 7 females, aged (31.5±6.1) years (21-52 years). There were 14 cases of single fingertips injury and 2 cases of multiple fingertips injury. Damaged finger: 2 of thumb, 3 of indicator finger, 6 of middle finger, 5 of ring finger, 2 of little finger. All 18 fingertips survived postoperatively and followed up for 7-16 months (median 12 months). One case underwent a second surgery due to infection and mild bone exposure followed by good healing. One case had a slightly hooked nail. The fingertip appearance was satisfying or acceptable by all the patients except the above two. Good results were got for all patients such as bone healing, smooth nail, plump pulp, and flexible distal interphalangeal joint. At the latest follow-up, motion loss of the distal interphalangeal joint was 0°-3.6° (mean 2.4°) for extension and 2.0°-12.0° (mean 7.6°) for flexion. The static two-point discrimination was 2.5-4.6 mm (mean 3.8 mm). Respectively, the functional evaluation of the affected finger was excellent in 11 cases, good in 3 cases and fair in 2 cases according to the CMA evaluation.Conclusion:Fingertip reconstruction with V-Y advancement flap and nailbed suture is a good technique to treat Allen’s type Ⅲ amputations, with advantages of preserved fingertip length, smooth nail, plump pulp, good sensory and flexible distal interphalangeal joint. The technique is simple with a high success rate and good results.

The setting and adjustment of ventilator parameters need to rely on a large amount of clinical data and rich experience. This paper explored the problem of difficult decision-making of ventilator parameters due to the time-varying and sudden changes of clinical patient's state, and proposed an expert knowledge-based strategies for ventilator parameter setting and stepless adaptive adjustment based on fuzzy control rule and neural network. Based on the method and the real-time physiological state of clinical patients, we generated a mechanical ventilation decision-making solution set with continuity and smoothness, and automatically provided explicit parameter adjustment suggestions to medical personnel. This method can solve the problems of low control precision and poor dynamic quality of the ventilator's stepwise adjustment, handle multi-input control decision problems more rationally, and improve ventilation comfort for patients.
Humans ; Ventilators, Mechanical ; Respiration, Artificial ; Neural Networks, Computer

Objective:To discuss the effect of fingertip reconstruction with V-Y advancement flap and nailbed suture treating Allen’s type Ⅲ amputations unsuitable for vascular anastomosis.Methods:From September 2018 to December 2020, clinical data of patients with Allen’s type Ⅲ fingertip amputations treated in Northern Jiangsu People’s Hospital were analyzed retrospectively. The fingertips were reconstructed with V-Y advancement flap and nailbed suture. The infeasibility of vascular anastomosis was checked under the microscope. Following fixation of the distal phalanx, the nailbed was stretched as flat as possible and sutured. If the nail plate was missing, a manual nail plate made from a plastic transfusion pipe would be fixed to cover the exposed nailbed. The palmar soft tissue of the amputated fingertip was excised, and periosteum, hyponychium, nailbed, and dorsal soft tissue were retained. The proximal volar skin was incised until the subcutaneous adipose layer to get a V-Y advancement flap. The volar defect was repaired with the V-Y advancement flap distally sutured with the pre-retained hyponychium. Postoperatively, burn cream was smeared on the nail for moisturizing, without lamp heating, and intravenous antibiotics was administered routinely. The main indexes were collected including nail appearance, pulp plumpness, static two-point discrimination, motion loss of the distal interphalangeal joint, and patients’ self-evaluation of the appearance. Chinese Medical Association trial standard of upper limb partial function assessment (CMA evaluation) was used to evaluate finger function.Results:A total of 16 patients with 18 fingertips were included. There were 9 males and 7 females, aged (31.5±6.1) years (21-52 years). There were 14 cases of single fingertips injury and 2 cases of multiple fingertips injury. Damaged finger: 2 of thumb, 3 of indicator finger, 6 of middle finger, 5 of ring finger, 2 of little finger. All 18 fingertips survived postoperatively and followed up for 7-16 months (median 12 months). One case underwent a second surgery due to infection and mild bone exposure followed by good healing. One case had a slightly hooked nail. The fingertip appearance was satisfying or acceptable by all the patients except the above two. Good results were got for all patients such as bone healing, smooth nail, plump pulp, and flexible distal interphalangeal joint. At the latest follow-up, motion loss of the distal interphalangeal joint was 0°-3.6° (mean 2.4°) for extension and 2.0°-12.0° (mean 7.6°) for flexion. The static two-point discrimination was 2.5-4.6 mm (mean 3.8 mm). Respectively, the functional evaluation of the affected finger was excellent in 11 cases, good in 3 cases and fair in 2 cases according to the CMA evaluation.Conclusion:Fingertip reconstruction with V-Y advancement flap and nailbed suture is a good technique to treat Allen’s type Ⅲ amputations, with advantages of preserved fingertip length, smooth nail, plump pulp, good sensory and flexible distal interphalangeal joint. The technique is simple with a high success rate and good results.

Objective:To describe the distribution of volumetric breast density(VBD) in different ages of Chinese women based on X-ray mammograms.Methods:Based on mammographic images of 1 140 patients from January 2010 to December 2016 in a hospital in Beijing, the VBD of women was assessed by Volpara 1.5.1 and graded according to breast imaging reporting and data system published by American College of Radiology. The patients were divided into two groups according to the median age, and the two independent samples t-test was used to compare them. The patients were also divided into four groups according to age ( <40 years, 40-49 years, 50-59 years, ≥ 60 years), and the breast thickness, breast volume, glandular volume, and VBD were compared using a One-way ANOVA analysis. Results:The median age was 50 years. The compressed breast thickness and breast volume in patients over 50 years were significantly higher than those in patients below 50 years ( t= -8.99, -7.92, P<0.001), while glandular volume and VBD were significantly lower than those below 50 years ( t= 8.11, 18.49, P<0.001). The compressed breast thickness, breast volume, glandular volume, and VBD were statistically significant different among four groups ( F=27.10, 22.34, 25.70, 122.03, P<0.001). Patients over 60 years had the lowest VBD ( t=-12.56, -15.27, -4.57, P<0.001). VBD was negatively correlated with ages ( r=0.47, P<0.001). Conclusions:The compressed breast thickness and breast volume increased with ages, while the glandular volume and VBD decreased with ages.

Objective:To investigate the feasibility of the application of low tube potential scanning in dacryocystography CT.Methods:The mixture of iohexol and saline with the ration of 1∶3 as the dacryocyst was set on the nose wing of the head-neck phantom. The phantom was scanned at 80, 100, 120, 140 kV with appropriate mAs to set the volume CT dose index(CTDI vol)at 10, 15, 20, 25, 30, 35 or 40 mGy. All the images were objectively evaluated to find out the optimal scanning parameters of 80 kV/240 mAs with the same contrast-to-noise ratio(CNR)of conventional scanning condition of 120 kV/180 mAs. A total of 62 patients who conducted dacryocystography CT in Beijing Tongren Hospital from November 2019 to July 2020 were prospectively selected. They were randomly divided equally into conventional scanning group with 120 kV/180 mAs and low tube potential group with 80 kV/240 mAs. The CT number, noise (SD) and contrast-to-noise ratio (CNR) of the two groups were measured as the objective evaluation indicators of image quality. The subjective evaluation was performed by two senior radiologists using a double-blind method and a 5-scale system evaluation. Results:For the phantom study, the CNR was positively correlated with CTDI vol under the same tube potential ( r=0.985, 0.965, 0.971, 0.972, P < 0.05). With the same CNR, the radiation dose decreased with lower tube potential. Under the conventional scanning parameters of 120 kV/180 mAs, the CNR was 27.8. At the same CNR, the optimal scanning parameters were 80 kV/240 mAs. For the clinical study, the CTDI vol of conventional scanning group and low tube potential group were 31.2 and 12.8 mGy respectively, 59% decreased in low tube potential group. There were statistically significant differences in CT number of dacryocyst area, CT number of orbital fat area and noise between the two groups ( t=-3.476, 2.601, -5.704, P < 0.05). There was no statistically significante difference in CNR between 2 groups( P>0.05). Two observers had a good consistency ( Kappa >0.75). There was no statistically significante difference in subjective rating between 2 groups( P>0.05). Conclusions:Low tube potential scanning could obtain satisfactory image quality in dacryocystography CT at much lower radiation dose.