BACKGROUND:At present,the treatment methods for necrotizing fasciitis mostly use negative pressure sealing suction after thorough debridement.This method requires repeated debridement to completely remove necrotic infected tissue,causing serious physical and economic burdens to patients. OBJECTIVE:To introduce a rare clinical case of calf compartment syndrome caused by diabetic foot necrotizing fasciitis,and summarize the clinical experience of using antibiotic-loaded bone cement for treatment and comprehensive management. METHODS:A total of 6 patients with calf compartment syndrome caused by diabetic necrotizing fasciitis admitted to Wuxi 9th Affiliated Hospital of Soochow University from August 2017 to August 2020 were selected,including 5 males and 1 female with an average age of 54 years.During the perioperative period,the patients'general condition was evaluated and systemic nutritional support treatment was given.In the first stage,all patients received complete debridement to control infection,antibiotic-loaded bone cement packing,and negative pressure sealed drainage.In the second stage,bone cement was removed and wound repair was performed.The wound healing,as well as the occurrence of redness,swelling,and exudation was observed during the follow-up. RESULTS AND CONCLUSION:(1)The wounds of four patients were fresh after twice antibiotic-loaded bone cement packing,and the membrane formation was good,and one patient was good after three times of antibiotic-loaded bone cement packing,and the wounds of all five patients healed well after the second stage of skin grafting.Due to the difficulty in maintaining intraoperative blood pressure and infection in all four compartments of the lower leg,a patient underwent emergency knee amputation.Meanwhile,the stump wound was placed with antibiotic-loaded bone cement.The wound was closed directly after the secondary bone cement was removed,and the wound healed in the first stage.(2)The six patients were followed up for 6-24 months after discharge.At the last follow-up,all six patients had good wound healing and no symptoms such as redness,swelling,and exudation.The quality of life of the patients was significantly improved,and all of them were satisfied with the curative effect.(3)The occurrence of calf compartment syndrome should be vigilant when diabetic foot necrotizing fasciitis is highly suspected.Early diagnosis and timely incision decompression are of great importance.Besides,the application of antibiotic-loaded bone cement in the treatment of calf compartment syndrome caused by diabetic necrotizing fasciitis has a good short-term effect.

Objective To evaluate the performance of magnetic resonance imaging(MRI)multi-sequence feature imputation and fusion mutual model based on sequence deletion in differentiating high-grade glioma(HGG)from low-grade glioma(LGG).Methods We retrospectively collected multi-sequence MR images from 305 glioma patients,including 189 HGG patients and 116 LGG patients.The region of interest(ROI)of T1-weighted images(T1WI),T2-weighted images(T2WI),T2 fluid attenuated inversion recovery(T2_FLAIR)and post-contrast enhancement T1WI(CE_T1WI)were delineated to extract the radiomics features.A mutual-aid model of MRI multi-sequence feature imputation and fusion based on sequence deletion was used for imputation and fusion of the feature matrix with missing data.The discriminative ability of the model was evaluated using 5-fold cross-validation method and by assessing the accuracy,balanced accuracy,area under the ROC curve(AUC),specificity,and sensitivity.The proposed model was quantitatively compared with other non-holonomic multimodal classification models for discriminating HGG and LGG.Class separability experiments were performed on the latent features learned by the proposed feature imputation and fusion methods to observe the classification effect of the samples in two-dimensional plane.Convergence experiments were used to verify the feasibility of the model.Results For differentiation of HGG from LGG with a missing rate of 10%,the proposed model achieved accuracy,balanced accuracy,AUC,specificity,and sensitivity of 0.777,0.768,0.826,0.754 and 0.780,respectively.The fused latent features showed excellent performance in the class separability experiment,and the algorithm could be iterated to convergence with superior classification performance over other methods at the missing rates of 30%and 50%.Conclusion The proposed model has excellent performance in classification task of HGG and LGG and outperforms other non-holonomic multimodal classification models,demonstrating its potential for efficient processing of non-holonomic multimodal data.

Objective To evaluate the performance of magnetic resonance imaging(MRI)multi-sequence feature imputation and fusion mutual model based on sequence deletion in differentiating high-grade glioma(HGG)from low-grade glioma(LGG).Methods We retrospectively collected multi-sequence MR images from 305 glioma patients,including 189 HGG patients and 116 LGG patients.The region of interest(ROI)of T1-weighted images(T1WI),T2-weighted images(T2WI),T2 fluid attenuated inversion recovery(T2_FLAIR)and post-contrast enhancement T1WI(CE_T1WI)were delineated to extract the radiomics features.A mutual-aid model of MRI multi-sequence feature imputation and fusion based on sequence deletion was used for imputation and fusion of the feature matrix with missing data.The discriminative ability of the model was evaluated using 5-fold cross-validation method and by assessing the accuracy,balanced accuracy,area under the ROC curve(AUC),specificity,and sensitivity.The proposed model was quantitatively compared with other non-holonomic multimodal classification models for discriminating HGG and LGG.Class separability experiments were performed on the latent features learned by the proposed feature imputation and fusion methods to observe the classification effect of the samples in two-dimensional plane.Convergence experiments were used to verify the feasibility of the model.Results For differentiation of HGG from LGG with a missing rate of 10%,the proposed model achieved accuracy,balanced accuracy,AUC,specificity,and sensitivity of 0.777,0.768,0.826,0.754 and 0.780,respectively.The fused latent features showed excellent performance in the class separability experiment,and the algorithm could be iterated to convergence with superior classification performance over other methods at the missing rates of 30%and 50%.Conclusion The proposed model has excellent performance in classification task of HGG and LGG and outperforms other non-holonomic multimodal classification models,demonstrating its potential for efficient processing of non-holonomic multimodal data.

Objective:To investigate the relationship between serum free triiodothyronine (FT 3) and the severity and prognosis of elderly patients with coronavirus disease 2019 (COVID-19). Methods:Clinical data of the elderly patients aged≥65 years old with COVID-19 who were admitted to the Ninth People′s Hospital of Wuxi from December 27, 2022 to January 18, 2023 were collected. The laboratory examinations of the non-severe and the severe/critical groups were compared. Patients were divided into group T1 (FT 3<2.51 pmol/L), group T2 (FT 3=2.51 to 2.95 pmol/L, ), and group T3 (FT 3>2.95 pmol/L) according to the FT 3 level. Independent sample t test was used for comparison between groups. Logistic regression analysis was performed to evaluate the risk factors for severe/critical disease, and to analyze the risk of severe/critical COVID-19 in elderly patients with different FT 3 levels. The receiver operator characteristic (ROC) curve was drawn to analyze the predictive value of FT 3 on the occurrence of severe/critical disease in patients. Kaplan-Meier survival curve and log-rank test were used to analyze the 30-day survival rate of elderly COVID-19 patients. Results:Among the 190 patients, the FT 3 level in the severe/critical group was (2.54±0.30) pmol/L, which was significantly lower than that in the non-severe group ((2.91±0.69) pmol/L), and the difference was statistically significant ( t=-3.42, P=0.001). Elevated serum FT 3 level was a protective factor for severe/critical disease in elderly COVID-19 patients (odds ratio ( OR)=0.139, 95% confidence interval ( CI) 0.034 to 0.577, P=0.007). There were 66 patients in the T1 group, 61 in the T2 group and 63 in the T3 group, respectively. After adjusted for sex, age, history of lung diseases, history of cardiac diseases, history of hypertension, history of diabetes mellitus, history of cerebral infarction, white blood cell count, lactate dehydrogenase, D-dimer, free thyroxine and thyrotropin, the risk of developing severe/critical disease in group T1 and group T2 were 10.982 folds and 3.695 folds of that in group T3, respectively (both P<0.05). The area under ROC curve of FT 3 of predicting severe/critical COVID-19 in the elderly patients was 0.731. The sensitivity and specificity were 0.733 and 0.659, respectively. The cut-off value was 2.53 pmol/L. The 30-day survival rate in patients with FT 3<2.53 pmol/L was significantly lower than that in patients with FT 3≥2.53 pmol/L ( χ2=13.49, P<0.001). Conclusions:The elevated level of FT 3 is a protective factor for progression to severe/critical disease in elderly patients with COVID-19. The evaluation of serum FT 3 could predict the severity and prognosis of elderly COVID-19 patients.

Objective To explore the values of metrics on intravoxel incoherent motion (IVIM) and gadoxetic acid enhanced T1ρ imaging for staging of non?alcoholic fatty liver disease activity scores (NAS) and inflammation in nonalcoholic steatohepatitis (NASH) rabbits model. Methods NASH rabbits model was established by feeding with a varied duration (4, 8, 12 weeks) of high?fat, high?cholesterol diet. IVIM and gadolinium?ethoxybenzyl?diethylenetriamine pentaacetic acid (Gd?EOB?DTPA) enhanced T1ρ images were performed by a 3.0 T MR scanner. The inter?class correlation coefficients (ICC) and Bland?Altman analysis were applied to evaluate the reproducibility of the IVIM and Gd?EOB?DTPA enhanced T1ρ mapping measurers. Spearman correlation analysis were used to assess the correlation between MR metrics, including ADC, D, D*, f, T1ρ, T1ρ (hepatobiliary phase, HBP), and NAS score and inflammation grades respectively with reference to histopathology. ROC curve analysis was used to evaluate the diagnostic performance of T1ρ and IVIM parameters for NASH, inflammation grade, and hepatic fibrosis. Multiple linear regression equations were used to analyze the independent influence factors of T1ρ (HBP). Results The f value was negatively correlated with the NAS score (r=-0.530, P<0.01). The f value of the fibrosis S1?2 was significantly lower than that of the S0 (P<0.01). There was no statistical difference in D, D*, ADC among NASH score, inflammation, and fibrosis stage. T1ρ and T1ρ (HBP) values were positively correlated with NAS scores and inflammation grades. The area under curve (AUC) for the diagnosis of NASH for T1ρ, T1ρ(HBP), ADC, D, D*, and f values were 0.849, 0.949, 0.728, 0.596, 0.522, and 0.871, respectively. The AUCs of T1ρ (HBP)+f in the diagnosis of NASH, G2?3 inflammation, and F1?2 fibrosis were 0.971, 0.935, and 0.903, respectively. Fibrosis (R2=0.624, P=0.002) and inflammation (R2=0.746, P=0.002) were major independent factors of T1ρ (HBP). Conclusion Gd?EOB?DTPA enhanced T1ρ imaging can reflect the severity of NASH and degree of inflammation. IVIM measurements are not accurate enough to stage liver inflammatory activity of NASH. T1ρ (HBP)+f might be a superior noninvasive imaging biomarker than either non?enhanced T1ρ or IVIM for NASH activity and inflammation assessments.

Objective: To explore the values of metrics on intravoxel incoherent motion (IVIM) and gadoxetic acid enhanced T₁ρ imaging for staging of non-alcoholic fatty liver disease activity scores (NAS) and inflammation in nonalcoholic steatohepatitis (NASH) rabbits model. Methods: NASH rabbits model was established by feeding with a varied duration (4, 8, 12 weeks) of high-fat, high-cholesterol diet. IVIM and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced T₁ρ images were performed by a 3.0 T MR scanner. The inter-class correlation coefficients (ICC) and Bland-Altman analysis were applied to evaluate the reproducibility of the IVIM and Gd-EOB-DTPA enhanced T₁ρ mapping measurers. Spearman correlation analysis were used to assess the correlation between MR metrics, including ADC, D, D^*, f, T₁ρ, T₁ρ (hepatobiliary phase, HBP), and NAS score and inflammation grades respectively with reference to histopathology. ROC curve analysis was used to evaluate the diagnostic performance of T₁ρ and IVIM parameters for NASH, inflammation grade, and hepatic fibrosis. Multiple linear regression equations were used to analyze the independent influence factors of T₁ρ (HBP). Results: The f value was negatively correlated with the NAS score (r=-0.530, P<0.01). The f value of the fibrosis S1-2 was significantly lower than that of the S0 (P<0.01). There was no statistical difference in D, D^*, ADC among NASH score, inflammation, and fibrosis stage. T₁ρ and T₁ρ (HBP) values were positively correlated with NAS scores and inflammation grades. The area under curve (AUC) for the diagnosis of NASH for T₁ρ, T₁ρ(HBP), ADC, D, D^*, and f values were 0.849, 0.949, 0.728, 0.596, 0.522, and 0.871, respectively. The AUCs of T₁ρ (HBP)+f in the diagnosis of NASH, G2-3 inflammation, and F1-2 fibrosis were 0.971, 0.935, and 0.903, respectively. Fibrosis (R²=0.624, P=0.002) and inflammation (R²=0.746, P=0.002) were major independent factors of T₁ρ (HBP). Conclusion Gd-EOB-DTPA enhanced T₁ρ imaging can reflect the severity of NASH and degree of inflammation. IVIM measurements are not accurate enough to stage liver inflammatory activity of NASH. T₁ρ (HBP)+f might be a superior noninvasive imaging biomarker than either non-enhanced T₁ρ or IVIM for NASH activity and inflammation assessments.

Objective To investigate the differences in GD-EOB-DTPA multi-modality MR images be-tween well-differentiated hepatocellular carcinoma(WHCC)and non well-differentiated HCC.Methods The clin-ical and MR images of 57 patients with pathologically proved HCC were retrospectively collected. All patients un-derwent abdominal enhancement MRI,including T1 weighted and T2 weighted imaging(T1WI and T2WI),diffu-sion weighted imaging(DWI),the apparent diffusion coefficient(ADC)map,and gadoxetic acid-enhanced multi-phase sequences. The patients were classified into well-differentiated HCC(WHCC)group and non-WHCC group which combined moderate HCC and poor differentiated HCC according to their histopathological differentiation.Dif-ferences of T1WI,T2WI,DWI,ADC map,the types of HCC on hepatobiliary phase(HBP)images,and enhance-ment patterns on dynamic images were compared. The chi-square test or Fisher exact was used for comparing the imaging signal differences between WHCC and non-WHCC. Multiple logistic regression analysis was performed to identify the independent predictors of WHCC. Results T1WI signal intensities,HBP signal types,enhancement patterns and ADC maps showed statistical significance between WHCC and non-WHCC(P<0.05).But,multiple logistic regression analysis showed that signal intensities on T1WI were independent risk factors for WHCC(P =0.001). In addition,hyperintense on T1WI showed higher statistical significance compared with isointense or hy-pointense on T1WI(P = 0.002). Conclusions Multi-modality of GD-EOB-DTPA MRI is useful for assessing WHCC. The signal intensities on T1WI are independent risk factors for evaluating WHCC. Moreover,WHCC are more likely in hyperintense T1WI signal intensity.

BACKGROUND:Anterior cruciate ligament (ACL) injury is a commonly sport-induced knee joint injury that does serious harm to the knee stability. ACL reconstruction is a commonly used treatment method, but researches on 1/2 peroneus longus tendon (PLT) graft are rarely reported. OBJECTIVE: To investigate the clinical outcomes of removing the autologous ipsilateral 1/2 PLT under arthroscopy for ACL reconstruction. METHODS:106 patients with complete ACL rupture in the Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University from December 2010 to December 2014 were enrolled, and autologous ipsilateral 1/2 PLT was removed under arthroscopy for ACL reconstruction. At baseline, 3, 6 and 12 months postoperatively, the knee stability was evaluated manually through the anterior drawer test, Lachman test, and pivot-shift test, and the knee function was evaluated by Tegner activity scale, Lysholm and International Knee Documentation Committee scores. RESULTS AND CONCLUSION: Postoperative anterior drawer test, Lachman test, and pivot-shift test tests were negative in all patients. In terms of Tegner activity scale, Lysholm and International Knee Documentation Committee scores, there were significant differences at baseline and postoperative 3 months as compared with postoperative 6 months (P < 0.05); the scores at baseline and postoperative 3 months showed significant differences compared with 12 months postoperatively (P < 0.05); the scores showed no significant difference between 6 and 12 months postoperatively (P > 0.05). These results indicate that autologous ipsilateral 1/2 PLT is a good choice for ACL reconstruction under arthroscopy, achieving rapid and satisfactory functional recovery of the knee joint, which is not only minimally invasive and easy to operate, but also exhibits good therapeutic efficacy.

Objective To investigate the MRI manifestations and diagnostic value of adenomatoid tumor (AT)of epididymis. Methods The MRI features of 5 patients with AT of epididymis were analyzed retrospectively,which were confirmed by histopathology,and some relevant medical literatures were reviewed.Results The epididymal tumor was manifested as moderate signal on T1 WI and T2 WI,similar to adjacent testicule,and as moderate signal with slightly high rim-enhancement on enhanced T1 WI in 4 cases.Secondary infarction and chronic granulomatous inflammation in 1 patient was found and presented unevenly moderate signal on T1 WI,slight hypointensity on T2 WI, hyperintensity on DWI and rim-enhancement on dynamic enhancement MRI.Few hydrocele was detected in all 5 patients.Conclusion AT of epididymis is a rare benign neoplasm with some characteristic MRI features which is helpful for the preoperative diagnosis.

Clinical practice teaching in out-patient department is an important part of general internal clinical teaching for medical students. From 2010, eight-year program medical students in Huazhong University of Science and Technology began their clinical rotation practice in the out-patient department of general internal medicine. The one-on-one tutoring style was used in clinical teaching. We combined teacher demonstration teaching method with teacher supervision teaching method in clinical practice, and carried out periodical case discussion. At the end of each rotation stage, regular teaching evaluation and examination was taken. It has been proved that our teaching mode can not only help the students improve their professional and practical levels of clinical skills, and also help them gain the clinical working abilities and the professional spirits, which is worthy of further promotion.