BACKGROUND:Vascularization is essential for wound healing and functional recovery during soft tissue repair.Adipose tissue is believed to be the body's largest source of stem cells,and a number of different fat complexes have been developed for research and treatment.Its ability to promote angiogenesis and soft tissue repair has been extensively studied. OBJECTIVE:To review the progress of vascularization in soft tissue repair,and to summarize the preparation methods of adipose tissue and its derivative and their applications in vascularization and soft tissue repair.It is proven that adipose tissue and its derivative have excellent research value and clinical application prospects in vascular and soft tissue engineering. METHODS:PubMed,Web of Science and CNKI databases were used to search the related articles published from January 2010 to February 2023.The search terms were"soft tissue repair,wound healing,vascularization,angiogenesis,adipose tissue,stromal vascular fraction,adipose tissue-derived microvascular fragment,nanofat,adipose extracellular matrix/stromal vascular fraction gel"in Chinese and English.A small number of old classic literature was also included.An initial screening was performed by reading the titles and abstracts to exclude literature that was not relevant to the topic of the article,and 69 papers were finally included for the analysis of the result. RESULTS AND CONCLUSION:(1)Wound healing is an important physiological process,which mainly occurs when tissue is damaged,such as injury,surgery,burn,tumor,infection and vascular disease caused by tissue damage and defects.(2)Adequate vascularization of the wound site is essential for tissue repair,reconstruction of local homeostasis and functional recovery.(3)Adipose tissue is believed to be the body's largest pool of stem cells and a number of different fat components have been used for research and treatment.(4)Due to its inherent composition and preparation advantages,adipose tissue will continue to play an important role in tissue engineering research and therapy.

Objective To observe the effect of shoulder-high head back-up position on airway ob-struction and hypoxia during fiberoptic bronchoscopy under non-intubated general anesthesia.Methods A total of 170 patients undergoing painless fiberoptic bronchoscopy,97 males and 73 females,aged 18-64 years,BMI 18.5-28.0 kg/m2,ASA physical status Ⅰ-Ⅲ,were randomly divided into two groups by ran-dom number method:observation group(group D,n=84)and control group(group C,n=83).Group D adopted the shoulder-high head back-up position,and group C adopted the supine position.All the pa-tients received intravenous general anesthesia of propfol combined with sufentanil,and were oxygenated via an ordinary endoscopic mask with an oxygen flow rate of 8-10 L/min.Fiberoptic bronchoscopy was per-formed when the modified observer assessment of alertness and sedation(MOAA/S)score was≤1 point.The number of cases in which hypoxia occurred and corrective measures were taken were recorded.The changes of HR,SBP,DBP,and SpO2 before induction of anesthesia(T1),1 minute after induction of an-esthesia(T2),endotracheal surface anesthesia(T3),at the time of examination(T4),and at the end of the examination(T5)were recorded.The degree of obstruction of the retropalatal space and retroglossal space at T2 were recorded.The level of glottic exposure and operating comfort of the endoscopist were recor-ded during the examination,and the incidence of postoperative neck discomfort,postoperative headache,postoperative dizziness,and nausea and vomiting were recorded.Results Compared with group C,the in-cidence of intraoperative moderate hypoxia,severe hypoxia,jaw support,and assisted ventilation was signifi-cantly decreased in group D(P＜0.05).Compared with T1,the HR were significantly increased at T3 and T4(P＜0.05),SBP and DBP were significantly decreased at T2,T4,and T5(P＜0.05),SpO2 was sig-nificantly increased at T2 and decreased at T4 in the two groups(P＜0.05),and SpO2 in group C was sig-nificantly decreased at T3(P＜0.05).Compared with group C,SpO2 was significantly increased at T4,the incidence of non-obstruction in the retrolingual space was significantly increased,and the incidence of com-plete obstruction in the retrolingual space was significantly decreased at T2,and the incidence of good glottic exposure was significantly increased,the incidence of poor glottic exposure was significantly decreased,and the incidence of good operating comfort of the endoscopist was significantly increased in group D(P＜0.05).There was no significant difference in the incidence of postoperative adverse events between the two groups.Conclusion Shoulder-high head back-up position can alleviate airway obstruction and reduce the incidence of hypoxia during fiberoptic bronchoscopy under non-intubated general anesthesia.

Objective:To investigate the alterations in brain dynamic functional network connectivity (dFNC) and their significance in Parkinson's disease (PD) patients with postural instability/gait difficulty (PIGD).Methods:Ninety PD patients admitted to Department of Neurology, First Affiliated Hospital of Nanjing Medical University from May 2016 to August 2019 were recruited, and 54 healthy controls matched with gender and age were chosen; their clinical data and resting-state functional MRI (rs-fMRI) data were collected. PD patients were divided into PD with PIGD (PD-PIGD) group ( n=49) and PD without PIGD (PD-non-PIGD) group ( n=41) according to Unified Parkinson's Disease Rating Scale (UPDRS) scores. Independent component analysis (ICA), sliding window method and k-means clustering were used to analyze the dFNC and compare among groups. Correlations of dFNC alterations with clinical scales were verified by partial correlation analysis. Results:Four repeated recurring functional connectivity states were identified, and PD-PIGD patients had high frequency in state 3 (44%) and state 2 (23%) of the low dFNC. In terms of dFNC time attributes, PD-PIGD patients had longer mean dwell time in state 3 than PD-non-PIGD patients and had lower number of transitions in state 3 than PD-non-PIGD patients and healthy controls, with significant differences ( P<0.05); PD-PIGD patients had significantly higher fractional windows and statistically longer mean dwell time in state 2 than healthy controls ( P<0.05). In terms of dFNC strengths, compared with healthy controls, PD-PIGD patients showed significantly decreased functional connectivity within default mode network (DMN, between medial superior frontal gyrus and precuneus) and auditory network (AN, between superior temporal gyrus and middle temporal gyrus), but significantly increased functional connectivity between sensorimotor network (SMN, supplementary motor area) and DMN (precuneus) in state 2 ( P<0.05, false discovery rate [FDR]-corrected). Partial correlation analysis indicated positive correlation between mean dwell time in state 3 and PIGD scores in PD-PIGD patients ( r=0.450, P=0.039). Conclusion:PD-PIGD patients exhibit specific dFNC, mainly characterized by low connectivity of the brain functional network and prolonged dwell time; local functional network domains often separate between DMN, AN and SMN networks and within the networks.

A 68-year-old male was admitted due to fatigue and poor appetite and diagnosed pathologically as pancreatic adenocarcinoma with liver metastasis. The tumor marker carbohydrate antigen 199 (CA199) level was 2003.4 U/mL. The patient received two cycles of modified FOLFIRINOX plus immune checkpoint inhibitor (penpulimab). However, the tumor did not shrink and CA199 level was even higher. Anlotinib was added from the 3rd cycle, and the size of primary tumor and metastatic lesions were significantly reduced. Laparoscopic distal pancreatectomy and splenectomy as well as liver metastasis resection was performed. Three cycles of combined therapy were adopted after surgery followed by maintenance therapy with anlotinib plus penpulimab. There was no evidence of tumor recurrence during the follow-up (nearly 19 months since diagnosis).
Male ; Humans ; Aged ; Pancreatic Neoplasms/drug therapy* ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Adenocarcinoma ; Neoplasm Recurrence, Local/surgery* ; Immunotherapy ; Liver Neoplasms/therapy* ; Pancreatectomy

Objective:To investigate the characteristics of regional brain functional centrality(DC)in patients with levodopa-induced dyskinesia(LID)and to explore the pathogenesis of LID.Methods:A total of 33 PD patients with LID(PD-LID), 41 PD patients without LID(PD-nLID)and 37 healthy controls from the First Affiliated Hospital of Nanjing Medical University were enrolled in this study.Differences in DC among the three groups were compared and the correlation between Z-DC values of the brain regions with differences and the scores of the involuntary movement scale(items 1-7)was analyzed.Results:Compared with Controls, PD-LID patients showed increased DC in the right amygdala(extending to the right globus pallidus)(MNI: x=30, y=-3, z=-18, t=4.00, P<0.05 after AlphaSim correction)and in the right postcentral gyrus(MNI: x=57, y=-9, z=39, t=-3.59; MNI: x=42, y=-33, z=57, t=-4.23, P<0.05 after AlphaSim correction)and reduced DC in the right superior parietal lobule(MNI: x=24, y=-51, z=72, t=-3.95, P<0.05 after AlphaSim correction).Compared with the PD-nLID group, the PD-LID group showed increased DC in the right globus pallidus(MNI: x=30, y=-12, z=-3, t=3.09, P<0.05 after AlphaSim correction).DC changes in the right globus pallidus were positively correlated with AIMS score( r=0.482, P=0.004). Conclusions:The enhancement of DC function in the right globus pallidus may be closely related to the onset and severity of LID.

Objective:To observe the characteristics of resting-state brain activity in Parkinson disease (PD) patients with peak-dose dyskinesia, and to explore its pathogenesis.Methods:From March 2017 to November 2019, totally 27 PD patients with peak-dose dyskinesia (dyskinetic group), and 29 PD patients without dyskinesia (non-dyskinetic group) treated in the First Affiliated Hospital of Nanjing Medical University and 27 healthy controls from the community were recruited.Resting-state functional magnetic resonance imaging (rs-fMRI) and clinical scale data were collected.SPSS 26.0 software and REST software were used for data analysis.The whole brain amplitude of low-frequency fluctuation (ALFF) values were compared among the three groups.Correlation analysis was performed between ALFF values of the significant brain regions and the scale scores.Finally, receiver operating characteristic (ROC) curve was used to evaluate the efficacy of ALFF values of significant brain regions in identifying three groups of subjects.Results:The peak-dose dyskinetic group showed decreased ALFF in right inferior frontal gyrus(MNI: x=36, y=21, z=30; x=36, y=18, z=30)and increased ALFF in right supplementary motor area (MNI: x=9, y=0, z=69; x=6, y=-3, z=72)(all P<0.05, Alphasim correction) compared with non-dyskinetic group and healthy controls.ALFF value in right inferior frontal gyrus was negatively correlated with unified dyskinesia rating scale (UDysRS) scores ( r=-0.47, P=0.018). The ALFF value of the right inferior frontal gyrus was more effective in identifying peak-dose dyskinetic patients from non-dyskinetic patients and healthy controls, and the area under the curve of right inferior frontal gyrus were 0.881 and 0.787 (both P<0.01), respectively. Conclusion:Abnormal spontaneous brain activity in right inferior frontal gyrus and right supplementary motor area can be the neurobiological basis of peak-dose dyskinesia in PD patients.The severity of peak-dose dyskinesia is associated with abnormal brain activity of right inferior frontal gyrus.The ALFF value of right inferior frontal gyrus is a potential imaging marker for identifying peak-dose dyskinetic patient.

Objective:To examine the efficiacy of a machine learning diagnostic model specifically for solid nodules in multiple pulmonary nodules constructed by combining patient clinical information and CT features.Methods:Totally 446 solid nodules resected from 287 patients with multiple pulmonary nodules in Department of Thoracic Surgery, Peking University People′s Hospital from January 2010 to December 2018 were included. There were 117 males and 170 females, aging (61.4±9.9) yeras (range: 33 to 84 years). The nodules were randomly divided into training set (228 patients with 357 nodules) and test set (59 patients with 89 nodules) by a ratio of 4∶1. The extreme gradient boosting (XGBoost) algorithm was used to generate a predictive model (PKU-ML model) on the training set. The accuracy was verified on the test set and compared with previous published models. Finally, an independent single solid nodule set (155 patients, 95 males, aging (62.3±8.3) years (range: 37 to 77 years)) was used to evaluate the accuracy of the model for predictive value of single solid nodules. Area of receiver operating characteristic curve (AUC) was used to evaluate diagnostic values of models.Results:In the training set, the AUC of the PKU-ML model was 0.883 (95% CI: 0.849 to 0.917). In the test set, the performance of the PKU-ML model (AUC=0.838, 95% CI: 0.754 to 0.921) was better than the models designed for single pulmonary nodules (Brock model: AUC=0.709, 95% CI: 0.603 to 0.816, P=0.04; Mayo model: AUC=0.756, 95% CI: 0.656 to 0.856, P=0.01; VA model: AUC=0.674, 95% CI: 0.561 to 0.787, P<0.01), similar with PKUPH model (AUC=0.750, 95% CI: 0.649 to 0.851, P=0.07). In the independent single solid nodules set, the PKU-ML model also achieved good performance (AUC=0.786, 95% CI: 0.701 to 0.872). Conclusion:The machine learning based PKU-ML model can better predict the malignancy of solid nodules in multiple pulmonary nodules, and also achieved a good performance in predicting the malignancy of single solid pulmonary nodules compared to mathematical models.

Objective:To examine the efficiacy of a machine learning diagnostic model specifically for solid nodules in multiple pulmonary nodules constructed by combining patient clinical information and CT features.Methods:Totally 446 solid nodules resected from 287 patients with multiple pulmonary nodules in Department of Thoracic Surgery, Peking University People′s Hospital from January 2010 to December 2018 were included. There were 117 males and 170 females, aging (61.4±9.9) yeras (range: 33 to 84 years). The nodules were randomly divided into training set (228 patients with 357 nodules) and test set (59 patients with 89 nodules) by a ratio of 4∶1. The extreme gradient boosting (XGBoost) algorithm was used to generate a predictive model (PKU-ML model) on the training set. The accuracy was verified on the test set and compared with previous published models. Finally, an independent single solid nodule set (155 patients, 95 males, aging (62.3±8.3) years (range: 37 to 77 years)) was used to evaluate the accuracy of the model for predictive value of single solid nodules. Area of receiver operating characteristic curve (AUC) was used to evaluate diagnostic values of models.Results:In the training set, the AUC of the PKU-ML model was 0.883 (95% CI: 0.849 to 0.917). In the test set, the performance of the PKU-ML model (AUC=0.838, 95% CI: 0.754 to 0.921) was better than the models designed for single pulmonary nodules (Brock model: AUC=0.709, 95% CI: 0.603 to 0.816, P=0.04; Mayo model: AUC=0.756, 95% CI: 0.656 to 0.856, P=0.01; VA model: AUC=0.674, 95% CI: 0.561 to 0.787, P<0.01), similar with PKUPH model (AUC=0.750, 95% CI: 0.649 to 0.851, P=0.07). In the independent single solid nodules set, the PKU-ML model also achieved good performance (AUC=0.786, 95% CI: 0.701 to 0.872). Conclusion:The machine learning based PKU-ML model can better predict the malignancy of solid nodules in multiple pulmonary nodules, and also achieved a good performance in predicting the malignancy of single solid pulmonary nodules compared to mathematical models.

Objective ToinvestigatethepatternsofbrainactivityabnormalitiesinpatientswithParkinson’sdisease(PD)with freezingofgait(FOG),andtoexploretheneuropathologicalmechanismofFOG.Methods Resting-statefunctionalMRI(rs-fMRI) scanswereobtainedfrom31PDpatientsand16healthycontrols(HCs).Accordingtothefreezingofgaitquestionnaire(FOG-Q),31 PDpatientsweredividedinto15PDFOG(+)and16PDFOG(－).ANCOVAandPost-Hocttestwereperformedtoassessinter groupdifferenceofbrainactivityabnormalitybasedonregionalhomogeneity.Results ComparedtoHCs,PDFOG(+)showeddecreased ReHointheleftinferiortemporalgyrus,rightlingual,bilateralfusiform,rightoccipitalgyrus,rightcalcarine,andrightcerebellum, whileincreasedReHointherightmiddlefrontalgyrus,rightsuperiorfrontalgyrus,rightprecentralgyrus,andrightsupplementary motorarea(SMA).ComparedtoPDFOG(－),PDFOG(+)exhibitedincreasedReHointherightprecentralgyrus,rightmiddle frontalgyrus,rightinferiorfrontalgyrus,andrightSMA,whiledecreasedReHoinleftfusiform.Conclusion Thisstudysuggests thatFOGinPDisassociatedwithabnormalitiesincerebellum,frontallobeandvisualnetwork,whichishelpfultounderstandthe neuralmechanismsunderlyingFOGinPD.

Objective: To explore the changes and significance of local brain activity in different motor subtypes of Parkinson disease(PD) using resting-state functional MRI (rs-fMRI) based on regional homogeneity (ReHo) analysis. Methods: A total of 84 PD patients and age-and gender-matched 29 healthy controls undergoing rs-fMRI were included. PD patients were divided into two groups of tremor dominant(TD) (n=45) and postural instability gait difficulty(PIGD) (n=39) according to the Unified Parkinson′s Disease Rating Scale (UPDRS) scores. Data processing assistant for resting-state fMRI (DPARSF) and resting-state fMRI data analysis Toolkit (REST) V1.8 based on MATLAB were used to calculate the ReHo which measured brain activity in different motor subtypes of PD. Analysis of covariance and post-hoc t-tests were performed to detect the differences of local brain activity among the three groups.Correlation analyses were performed between ReHo values of the regions showing group differences and TD and PIGD scores respectively. Results: Compared to healthy controls, the TD group exhibited increased ReHo in the right superior and middle frontal gyrus, left cerebellum(13 to 21 voxels, P<0.05), while decreased ReHo in the left temporal lobule, left putamen, left paracentral lobule, and bilateral thalamus (12 to 91 voxels, P<0.05). The PIGD group showed increased ReHo in the right superior frontal gyrus, right middle frontal gyrus and anterior cingulate gyrus (ACC) (55 to 92 voxels, P<0.05), while decreased ReHo in the left putamen, left pallidum, left temporal lobule, right occipital lobule, bilateral thalamus, bilateral middle cingulate gyrus, bilateral supplementary motor area (SMA) (15 to 78 voxels, P<0.05). Compared with PIGD, the TD group showed increased ReHo in the left temporal lobule, left cerebellum, bilateral middle cingulate gyrus (19 to 51 voxels, P<0.05), whereas decreased ReHo in the left paracentral lobule, bilateral cuneus, right superior frontal gyrus, and right ACC (14 to 68 voxels, P<0.05). Additionally, ReHo in the left thalamus and left putamen negatively correlated with TD scores (r=-0.355 and -0.498, both P<0.05). ReHo in the left thalamus and right thalamus negatively correlated with PIGD scores (r=-0.478 and -0.397, both P<0.05). Conclusions The changes of brain activity in TD are located in the cerebello-thalamo-cortical (CTC) circuit and the striatal-thalamo-cortical (STC) loop while the changes in PIGD are largely located in the STC loop and visual network cortex. This specific pattern of intrinsic activity in TD and PIGD may provide insights into the neurophysiological mechanisms of PD with different motor subtypes.