OBJECTIVE: To investigate the diagnostic efficacy of ^99mTc-MDP three-phase bone scintigraphy (TPBS) combined with C-reactive protein (CRP) for periprosthetic joint infection (PJI). METHODS: The clinical data of 198 patients who underwent revision surgery of artificial joint between January 2017 and January 2024 and received TPBS examination before surgery were retrospectively analyzed. There were 77 males and 121 females with an average age of 63.74 years ranging from 24 to 92 years. There were 90 cases of hip arthroplasty and 108 cases of knee arthroplasty. PJI was diagnosed according to the 2013 American Musculoskeletal Infection Society (MSIS) standard diagnostic criteria. The sensitivity, specificity, accuracy, negative predictive value (NPV), and positive predict value (PPV) were calculated. The receiver operating characteristic (ROC) curve was used to compare the diagnostic performance of the three methods, and the area under curve (AUC) was used to evaluate the diagnostic performance. RESULTS: According to the 2013 MSIS criteria, 116 cases were diagnosed as PJI, and the remaining 82 cases were aseptic loosening. The cases of PJI diagnosed by TPBS, CRP, and TPBS-CRP were 125, 109, and 137 respectively, and the cases of aseptic loosening were 73, 89, and 61 respectively. The sensitivity, accuracy, NPV, and PPV of TPBS-CRP combination in the diagnosis of PJI were higher than those of TPBS and CRP, but the specificity was lower than that of TPBS and CRP. ROC curve analysis further showed that the AUC value of TPBS-CRP combination was better than that of TPBS and CRP. The severity of bone defect and the duration of symptoms in patients with false positive TPBS diagnosis were worse than those in patients with true negative TPBS diagnosis (P<0.05), but there was no significant difference in the survival time of prosthesis between the two groups (P>0.05). Among the patients diagnosed with PJI by TPBS, CRP, and TPBS-CRP, 49, 35, and 54 patients had received antibiotic treatment 2 weeks before diagnosis, respectively. There was no significant difference in the diagnostic accuracy of TPBS and TPBS-CRP before diagnosis between patients treated with and without antibiotics and those not treated (P>0.05). The diagnostic accuracy of antibiotic therapy before CRP diagnosis was significantly lower than that of untreated patients (P<0.05). CONCLUSION TPBS and CRP have limited specificity in differentiating PJI from aseptic loosening. The TPBS-CRP combination diagnostic method can synergize the local bone metabolic characteristics and systemic inflammatory response to achieve higher diagnostic accuracy, but caution should be exercised in patients with severe bone defects and longer symptom duration.
Humans ; Prosthesis-Related Infections/blood* ; Middle Aged ; Male ; Female ; Aged ; C-Reactive Protein/metabolism* ; Retrospective Studies ; Adult ; Radionuclide Imaging/methods* ; Arthroplasty, Replacement, Knee/adverse effects* ; Aged, 80 and over ; Technetium Tc 99m Medronate ; Arthroplasty, Replacement, Hip/adverse effects* ; Sensitivity and Specificity ; Knee Prosthesis/adverse effects* ; ROC Curve ; Reoperation ; Radiopharmaceuticals ; Young Adult

Radiotherapy is widely used in the treatment of primary and metastatic malignant tumors. It is traditionally believed that the killing effect of radiotherapy on tumor is based on the direct or indirect damage of ionizing radiation to DNA. In recent years, the anti-tumor role and mechanism of anti-tumor immune response induced by ionizing radiation have captivated widespread attention and achieved significant progress. Among them, Cyclic GMP-AMP synthase (cGAS)-stimulator of interference genes (STING) pathway is considered to be one of the key regulatory hubs. cGAS is a cytoplasmic DNA receptor that can bind to tumor-derived double-stranded DNA and activate the downstream STING, thereby activating anti-tumor immune response of the host. In view of the latest progress in this field, the important role and potential mechanism of cGAS-STING pathway in radiotherapy immune effect were mainly summarized, and the application prospect of targeting cGAS-STING pathway in radiotherapy sensitization was explored.

Two patients with eyelid defect were admitted to the Department of Plastic Surgery of the First Affiliated Hospital of Anhui Medical University.Case 1 was a 45-year-old male with full layer eyelid defect after operation of lower eyelid pigment basal cell carcinoma. And case 2, male, 84 years old, had full eyelid defect after operation of recurrent basal cell carcinoma. A 3.0 cm×3.5 cm mucoperiosteal composite flap was designed in the longitudinal radian of the anterior and posterior palatal respectively. The flap was cut obtuse and sharp under the periosteum, and trimmed according to the shape of the eyelid defect. The flap was transplanted to the defect area of the posterior layer to replace the tarsus, palpebral and bulbar conjunctiva. The superficial outlet point of the zygomatic orbital-buccal lateral perforator vessels was explored before surgery, and the perforator flap was designed. The length and width of the flap were adjusted according to the eyelid defect during surgery, and the pedicle fascia perforator vessels were retained. The lower eyelid was 90°, and the upper eyelid was transferred nearly 100° to cover the outer skin and soft tissue defects of the upper and lower eyelids. The perforator flap was completely survived 9-12 days after the operation. After 8 months to 2 years and 8 months of follow-up, the upper and lower eyelid function and appearance were good, the original vision was maintained, and the cancer did not recur.

Two patients with eyelid defect were admitted to the Department of Plastic Surgery of the First Affiliated Hospital of Anhui Medical University.Case 1 was a 45-year-old male with full layer eyelid defect after operation of lower eyelid pigment basal cell carcinoma. And case 2, male, 84 years old, had full eyelid defect after operation of recurrent basal cell carcinoma. A 3.0 cm×3.5 cm mucoperiosteal composite flap was designed in the longitudinal radian of the anterior and posterior palatal respectively. The flap was cut obtuse and sharp under the periosteum, and trimmed according to the shape of the eyelid defect. The flap was transplanted to the defect area of the posterior layer to replace the tarsus, palpebral and bulbar conjunctiva. The superficial outlet point of the zygomatic orbital-buccal lateral perforator vessels was explored before surgery, and the perforator flap was designed. The length and width of the flap were adjusted according to the eyelid defect during surgery, and the pedicle fascia perforator vessels were retained. The lower eyelid was 90°, and the upper eyelid was transferred nearly 100° to cover the outer skin and soft tissue defects of the upper and lower eyelids. The perforator flap was completely survived 9-12 days after the operation. After 8 months to 2 years and 8 months of follow-up, the upper and lower eyelid function and appearance were good, the original vision was maintained, and the cancer did not recur.

Objective To compare the transparency efficiency of six different optical clearing method on the rat brain tissues. Methods Brain tissue blocks of 14 SD rats were processed with iDISCO, SeeDB, CUBIC, SCALEVIEW-A2,CLARITY-CUBIC, Passive-CLARITY clearing method, respectively. Results The gray value of PBS group was 13.031 ± 0.586,that of iDISCO,SeeDB,CUBIC,SCALEVIEW-A2,CLARITY-CUBIC,passive-CLARITY clearing were 6.447 ± 0.574,11.690 ± 0.909,2.318 ± 0.986,8.118 ± 1.026,8.591 ± 0.384,4.198 ± 0.182, respectively. Except the SeeDB group(P=0.185),the rest groups showed significant differences compared with the PBS group(P< 0.01), and there were significant differences between CUBIC and other groups(P < 0.01). After the clearing treatment, the changes of tissue area ratio in the iDISCO, SeeDB, CUBIC, SCALEVIEW-A2, CLARITY-CUBIC, Passive-CLARITY method were(-30.02 ± 2.39)%,(19.74 ± 4.09)%,(14.7 ± 3.92)%,(10.7 ± 5.55)%,(23.01 ± 4.19)%,(66.51 ± 5.68)%,respectively. Each group showed a significant difference compared with the groups iDISCO and the Passive-CLARITY,P< 0.01. Conclusions Except the SeeDB method,all the clearing methods can achieve a transparent effect, while CUBIC is better than the other groups applied for rat brain tissues. The tissue block volume is shrunken after iDISCO clearing,and expanded after Passive-CLARITY processing.