Objective To explore the feasibility of predicting expression level of Ki-67 in lung adenocarcinoma via multi-parameter of spectral CT.Methods The data of 226 patients with lung adenocarcinoma confirmed by pathology were analyzed retrospectively.The conventional and spectral CT parameters of the lesions were analyzed.According to Ki-67 expression level,all patients were divided into low expression group and high expression group.The parameters with statistical significance were identified as independent variables for multivariate logistic regression analysis to establish a logistic regression model for predicting the expression level of Ki-67.Receiver operating characteristic(ROC)curve was used to assess the diagnostic performance for each model,respectively.Results There were significant differences in the clinical factors of gender,smoking and chest pain between high and low Ki-67 expression groups.In spectral CT parameters,CT40 keV,CT100 keV,Z-effective(Zeff)and iodine concentration(IC)in the high expression group in arterial phase were significantly higher than those in the low expression group.Logistic regression analysis showed that CT100 keV was the independent risk factor for Ki-67 expression level.Both the spectral CT model and the combined model had high value in predicting the expression level of Ki-67 in lung adenocarcinoma,and the combined model had better diagnostic efficacy.Conclusion Spectral CT parameters combined with clinical factors have a certain value in predicting the expression level of Ki-67 in lung adenocarcinoma.

Objective:To evaluate the clinical effects of adjustable traction skin stretchers used in repair of wounds at the lower leg, foot and ankle.Methods:A retrospective study was performed to analyze the clinical data of 56 patients who had been treated for skin defects at the lower leg, foot and ankle from August 2016 to September 2022 at The First Affiliated Hospital of Zhengzhou University, Honghui Hospital, Affiliated to Xi'an Jiaotong University Medical College, The First Affiliated Hospital of Henan Polytechnic University, and Yunnan Zhongde Orthopedic Hospital. There were 35 males and 21 females, aged (39.9±18.7) years. There were 43 traumatic wounds, 3 burns, 6 inflammatory wounds, 3 relief incisions due to osteofascial compartment syndrome, and 1 scar. The areas of skin defect ranged from 2.5 cm × 2.0 cm to 20.0 cm × 10.0 cm. The duration of wounds was (8.6±7.8) d. All the wounds were repaired with adjustable traction skin stretchers. The row-hook type of skin stretchers was used in 28 cases, the single-rod type in 20 cases, the single-rod type combined with an external fixator in 5 cases, and a combination of the row-hook type and the single-rod type in 3 cases.The time for wound traction closure, color of wound skin margin, skin swelling around the wound, functional recovery of affected limb and complications were recorded.Results:The time from skin stretching to wound closure was (7.8±3.8) d in the 56 patients. The color of wound skin edge after stretching was normal in 16 cases, dark red in 38 cases, and dark in 2 cases; the skin swelling around the wound was degree 1 in 21 cases, degree 2 in 33 cases, and degree 3 in 2 cases. The 56 patients were followed up for (8.9±4.1) months. Primary wound closure was achieved in 48 patients, and secondary wound closure in 8 patients after repair with an autologous skin graft. Partial skin necrosis occurred due to tension blisters after skin stretching in 2 patients, one of whom was repaired with an autologous skin graft and the other of whom by dressing change. Deep bone infection recurred in 2 patients whose wounds healed after their bone defects were repaired using Ilizarov technique of bone transfer. In the 56 patients, the muscle strength of the lower extremity beyond the wound was recovered to normal, and the range of motion of the joints adjacent to the wound also recovered to normal.Conclusion:In repair of wounds at the lower leg, foot and ankle, adjustable traction skin stretchers can lead to fine clinical effects and limited complications, because the stretchers can control the tension of skin digitally and precisely.

Objective : To evaluate the effects of low temperature plasma modification on the surface morphology and bonding durability of zirconia ceramics. Methods: 180 pieces of zirconia ceramic(Y-TZP) were randomly divided into 5 groups(n= 36). Group A:blank group; Group B:sandblast group; Group C:nitrogen( N2) plasma group; Group D:oxygen(O2) plasma group; Group E:argon(Ar) plasma group. The surface hydrophilicity and microstructure of zirconia ceramics were observed,and the changes of surface elements and functional groups were detected. Each group of bonded specimens was randomly divided into two subgroups(n= 15). After receiving 0 and10 000 cycles of heat and cold,the shear strength was measured. The measured results were statistically analyzed and the fracture mode was analyzed. Results: The surface contact angles of groups B,C,D and E were significantly lower than those of group A,with statistically significant differences(P<0. 001). Compared with group A,the surface morphology of group C,D and E did not significantly change,while that of group B significantly changed. XPS showed that the surface carbon decreased,oxygen increased and carbon/oxygen ratio decreased after plasma treatment. SBS results showed that the immediate shear bonding strength of group A was lower than that of the other four groups(P<0. 001),and there was no significant difference in the immediate shear bonding strength of groups B,C,D and E(P>0. 05);After artificial aging,the shear bonding strength of group A was significantly lower than that of the other four groups,and the difference of shear bonding strength between groups A and B before and after artificial aging was statistically significant(P<0. 001). Conclusion The zirconia ceramics achieves better bonding strength and durability with resin cement through three kinds of low temperature plasmas,without changing the surface morphology.

Objective ToexplorethevalueofspectralCTimaginginmultiGparameterquantitativeanalysisoflungcancerwithdifferent pathologicaltypes.Methods SpectralCTimagesof72patientswithlungcancerprovedbypathologywereanalyzed,includingadenocarcinoma (ADC)in44cases,squamouscellcarcinoma(SQCC)in23casesandsmallcelllungcancer(SCLC)in5cases.Theslopeof40－100keVspectralattenuationcurve(λH),effectiveatomicnumber(EffectiveGZ),Calciumconcentration,hydroxyapatite(HAP)concentration, normalizediodineconcentration(NIC)and Waterconcentration were measuredandcomparedrespectively.The O n eG W a y analysisof variance (ANOVA ) was used and a value of P＜0.05 was considered statistically significant.Results (1 )O n plain C T ,there were statisticallysignificantdifferencesinEffectiveGZandλHamongthreeGdiseasegroups(F＝3.423,P＝0.04,F＝3.476,P＝0.038,respectively). (2)IncontrastGenhancedarterialphase,theWaterconcentrationandλHshowedstatisticallysignificantdifferencesamongthreegroups (F＝6.303,P＝0.003,F＝5.833,P＝0.005,respectively).(3)Invenousphase,thedifferenceinNICandλH wasstatisticallysignificant amongthegroups(F＝3.974,P＝0.023,F＝6.766,P＝0.002,respectively).(4)Apairwisecomparisonshowedtherewerestatistically significantdifferencesinallquantitativeparametersofspectralCTbetweenADCandSQCCgroups.ROCcurveanalysisshowedthat thosequantitativeparametersinvenousphaseappearedtohavehighdiagnosticefficiencyindifferentiatingADCfromSQCC,especiallyfor theλHinVP,withaAUCof0.754,sensitivityof79.5%,specificityof69.6%andthresholdvalueof1.78.Conclusion CTSpectral multiGparameterimagingprovidesanewsupplementarymethodforpreoperativediagnosisofADCandSQCC,andλHinvenousphase hasthehighestvalueindifferentiatingADCfromSQCC.

Objective: To analyze the clinical effect of low molecular weight heparin calcium(LMWH) combined with aspirin in preventing portal venous thrombosis (PVT) after devascularization. Methods: Retrospective cohort study was carried out. A total of 61 patients with portal hypertension in Zhongshan Hospital affiliated to Fudan University from December 2014 to April 2017 were included in the study, including 43 males and 18 females, aged 24~74 years. According to anticoagulation methods, the patients were divided into treatment group (31 cases of LMWH combined with aspirin) and control group (30 cases of aspirin). Splenectomy and pericardial devascularization or combined devascularization were performed in both groups. Platelet count, prothrombin time, Child-Pugh score, PVT status and surgical complications were observed after surgery. Results: There were no significant differences for platelet count and prothrombin time between the two groups after 7, 14, 30, 60 and 90 days (P>0.05). Child-Pugh scores at 3, 7, 14, 30, 60 and 90 d after operation of the two groups showed no significant differences (P>0.05). Seven days after the operation, PVT in the treatment group and control group was 7 (22.6%) and 7 (23.3%), respectively. Thirty days after the operation, PVT was detected in 8 patients (25.8%) in the treatment group and 15 patients (50.0%) in the control group. Sixty days after the operation, 6 patients (19.4%) had PVT in the treatment group and 13 patients (43.3%) in the control group. PVT was detected in 4 patients (12.9%) in the treatment group and 12 patients (40.0%) in the control group 90 days after operation. The incidence of PVT in the 30, 60 and 90 days after surgery was lower than that in the control group, with significant difference (P<0.05), and the degree of thrombosis was relatively mild. There were 6 cases (20.0%) of complications in the control group and 6 cases (19.4%) in the treatment group, there were no significant differences between the two groups (P>0.05). Conclusion LMWH combined with aspirin is safe and effective in preventing PVT after devascularization.

Objective To analyze the MSCT features of subepithelial lesions of the urinary bladder.Methods Thirty-one patients with subepithelial lesions of the urinary bladder proved by pathology were enrolled in this study.The MSCT findings were analyzed. Results Among the 3 1 cases with subpeithelial lesions of the urinary bladder,7 cases were non-epithelial tumors (including 3 cases of leiomyomas,2 cases of paragangliomas,1 case of hemangioma and 1 case of granulocytic sarcoma),and other 24 cases were inflammatory/reactive lesions,all as cystitis glandularis.MSCT findings were as follows:paragangliomas were solitary masses with homogeneous density,smooth border and wide base,with rapid wash-in and wash-out enhancement pattern and peak enhancement in the arterial phase.Hemangiomas and leiomyomas both presented as single round mass with slight enhancement.Granulocytic sarcoma appeared as diffuse bladder wall thickening with pebble-like projections,and slight enhancement.Cystitis glandularis was characterized by local thickening of the bladder wall with nodular or aquatics-like uplift,and was also characterized by diffuse thickening,with slight and progressive enhancement in 22 cases,and significant enhancement in venous phase in 2 cases.Conclusion The subepithelial lesions of urinary bladder may present with tumor-like appearance.The key characteristic feature for cystitis glandularis is local thickening of the bladder wall with nodular or aquatics-like uplift.Rapid wash-in and wash-out enhancement pattern is considered to be diagnostically significant for paragangliomas.However,the rest of the lesions overlap in the imaging appearances,and the diagnosis should be combined with clinical manifestations to improve the accuracy of preoperative diagnosis.

Objective This study is to compare flap-viability-related complications, coverage reach, recon-struction outcomes and donor-mobidities between distally-based peroneal artery perforator-plus fasciocutaneous (DPAPF)flap and distally-based posterior tibial artery perforator-plus fasciocutaneous(DPTAPF)flap for recon-struction of soft-tissue defects over the distal lower leg, ankle and foot, and thus provide evidence for selection of the flaps. Methods Between April, 2002 and February, 2012, 216 and 59 patients underwent the reconstructions with DPAPF flaps(peroneal group)and DPTAPF flaps(posterior tibial group)respectively. We subdivided the distal lower leg, ankle and foot into 12 subregions. In all the patients, flap-viability-related complications and its potential risk factors(including age,sex,etiology,location of top edge,location of pivot point,length and width of both the skin is-land and adipofascial pedicle, length-width ratio, and total length), coverage reach(the subregion in which the most distal part of the reconstructed defect lies),duration of flap elevation and hospital stay were compared between the two groups. In patients with at least 3 months postoperative follow-up, comparative study of reconstruction outcomes, pa-tient's satisfaction with flap appearance and donor-site morbidities were performed between the groups. Results Partial necrosis rate in the peroneal of the posterior tibial group were 12.0 percent versus 20.3 percent,respectively(P> 0.05). Marginal necrosis and overall complication (including partial and marginal necrosis)rates in the peroneal group(1.9 percent and 13.9 percent, respectively)were significantly lower than those in the posterior tibial group (8.5 percent and 28.8 percent,respectively)(P<0.05).Incidence of partial necrosis of the flaps for the defects over subregions 7 to 10 in the peroneal group(7 of 41)was significantly lower than that in the posterior tibial group(2 of 2).There was no difference in reconstruction outcomes and patient's satisfaction with flap appearance in both groups(P >0.05).Incidences of hypertrophic scar,itching and pigmentation at the donor site were significantly lower in the peroneal group(P<0.05). Conclusion DPAPF flap is superior to DPTAPF flap in reliability,safe coverage reach and less donor-site morbidities.The former is recommended as the first choice when local pedicle flaps are considered to recon-struct soft-tissue defects over the distal lower leg,ankle and foot.

Pancreatic sinistral portal hypertension is a localized kind of portal hypertension that usually occurs as a result of the splenic vein obstruction caused by pancreatic diseases.Furthermore,it is also an important cause of upper gastrointestinal hemorrhage.Management in clinical practice should be directed at the sinistral portal hypertension and primary pancreatic diseases.

Objective To investigate the clinical outcomes of alprostadil in prevention of portal vein thrombosis after splenectomy and devascularization.Methods 113 patients with PHT who were treated with prophylactic alprostadil after splenectomy and devascularization procedures from May 2009 to Apr 2013 were included into the treatment group.112 conservative patients with PHT who were treated with traditional prophylactic anticoagulants after the same operations before May 2009 were included as the control group.The postoperative complication rates,mortality,postoperative drainage volume from the abdominal cavity,blood platelet counts,prothrombin time,liver function,Child-Pugh's scores and portal vein thrombosis rates between the two groups were compared.Results When compared with the control group,the postoperative complication rate and mortality in the alprostadil group were not increased,while the postoperative drainage volume from the abdominal cavity was significantly reduced.The increase in blood platelet counts and prothrombin time were similar in the 2 groups.Furthermore,the extent of hepatic dysfunction on the 3rd and 7th after operation was significantly decreased.On short term follow-up,color droppler ultrasonography showed the portal vein thrombosis rate of the treatment group was significantly lower than the control group,with less extensive degree of thrombosis in the treatment group.Conclusion Alprostadil is a safe and effective anticoagulant which provided better prevention of portal vein thrombosis after splenectomy combined with devascularization.

Objective: To explore the cognitive level and the mental status of the patients suffering from perimenopausal syndrome in Shanghai, and to identify the traditional Chinese medicine syndrome distribution feature of perimenopausal syndrome. Methods: The cognitive level of the perimenopausal women was evaluated by using general living problem questionnaire. The mental status of the perimenopausal women was evaluated by using self-rating depressive scale. The traditional Chinese medicine syndrome distribution feature of perimenopausal syndrome was identified by using traditional Chinese medical symptoms questionnaire. Results: A total of 634 perimenopausal women finished the investigation. There were 74.76% (474/634) patients who knew little about the perimenopausal syndrome; 77.29% (490/634) patients had a depressive tendency; 8.36% (53/634) patients had depressive disorder. There were 72.40% (459/634) patients who had the symptoms such as susceptibility to anger and restlessness, restless sleep at night, thirst with dry throat and bitter taste, and all these symptoms could be classified into hyperactivity of heart and liver fire syndrome. Conclusion: Patients suffering from perimenopausal syndrome know little about this disease and mostly have depressive tendency, and the major traditional Chinese medicine syndrome pattern is hyperactivity of heart and liver fire based on the chief clinical manifestations of the patients.