Objective To develop a nomogram for predicting the risks of early anastomotic recurrence(EAR)after primary bowel resection in patients with Crohn's disease(CD).Methods The patients with CD under-going preoperative magnetic resonance enterography(MRE)and primary bowel resection were enrolled in this retrospective study and divided into an EAR group(18 patients)and EAR-free group(12 patients).The EAR group included the patients having an endoscopic Rutgeerts score of≥I2 month or the need for anastomotic resection within 12 months after surgery.All the 38 indexes including preoperative demographic characteristics,laboratory examina-tions,multi-parameter MRE features of the resected intestine and its adjacent mesentery,histological findings,and postoperative pharmacotherapy were analyzed.Least absolute shrinkage and selection operator(LASSO)regression and multivariate binary logistic regression analysis were performed to identify independent risk factors to be incorpo-rated into the nomogram for predicting the risks of early anastomotic recurrence and the prediction performance was evaluated.Results Mesenteric creeping fat index on MRE and comb sign were independent risks of EAR,with a concordance index of 0.882(95%CI:0.764～1).The calibration plot revealed a strong relationship between actual observation and predicted probability of EAR.Conclusions The preoperative MRE-based nomogram may be a potential tool for predicting EAR following surgery in patients with CD,which is beneficial to individual management in those patients.It provides reference for the formulation of early postoperative individualized drug adjuvant therapy in patients at high risk of EAR.

Objective:To summarize the ultrasound manifestations of submucosal cleft palate, and explore the diagnostic value of prenatal ultrasound for submucosal cleft palate.Methods:A total of 21 146 pregnant women who underwent fetal ultrasound examination in the second and third trimesters in the Affiliated Hospital of Jining Medical University from January 2013 to May 2018 were collected. They were all singleton pregnancy. The ultrasound image which was the horizontal plate of the palatine bone at the posterior border of the fetal hard palate was routinely obtained. The presence of bone loss at the posterior border of the hard palate was defined as a positive case. Then the palate targeted ultrasound examinations of the positive cases were performed to observe the continuity of the soft palate. The ultrasound images of positive cases were compared with the results of induction or delivery, and their postpartum diagnosis and treatment were tracked.Results:A total of 44 simple cleft palate were detected in 21 146 fetuses, including 23 dominant cleft palate and 21 submucosal cleft palate. Two cases of 21 submucosal cleft palate were induced because of other deformities, the other 19 cases were born. The follow-up of the 19 submucosal cleft palate cases showed that 15 cases visited to stomatology department before 3 years of age, and 2 cases of newborns with dominant cleft palate were misdiagnosed as submucosal cleft palate by prenatal ultrasound, and the other13 of them were clinically diagnosed as submucosal cleft palate. The ultrasound of the submucosal cleft palate showed there was no inverted "V" -shaped bone in the posterior edge of the hard palate which was connected by a membranous connection, and the soft palate was complete, but the center of soft palate was thinner or even present membranous hyperechoic in ultrasound.Conclusions:Submucosal cleft palate has characteristic ultrasound features, and prenatal ultrasound make a diagnosis and provide some basis for obtaining early diagnosis and treatment after birth.

Objective:To investigate the diagnostic value of Chinese-thyroid imaging reporting and data system (C-TIRADS) combined with shear wave elastography (SWE) in thyroid microcarcinoma.Methods:The clinical data of 270 patients (367 nodules) who underwent thyroid ultrasound examination and confirmed by pathology from January 2019 to June 2021 in the Affiliated Hospital of Jining Medical University were analyzed retrospectively. All patients were assisted by SWE in preoperative ultrasound examination to measure the maximum elastic modulus (E max), the average elastic modulus (E mean) and the minimum elastic modulus (E min). The receiver operating characteristic (ROC) curve was drawn to get the optimal threshold of SWE according to the pathological results. The diagnostic value of C-TIRADS, SWE and their combined in different diameters thyroid micronodules was analyzed. Results:Among 367 thyroid nodules, 119 nodules were benign and 248 nodules were malignant. The area under the curve (AUC) of E max in diagnosing TMC was significantly larger than that of E mean and E min (0.883 vs. 0.822 and 0.706), and there was statistical difference ( P<0.05); the best cut-off value of E max was 29.5 kPa. The ROC curve analysis results showed that the AUC of C-TIRADS combined with SWE in diagnosis of TMC was significantly larger than that of C-TIRADS and SWE alone (0.884 vs. 0.800 and 0.853), and there was statistical difference ( P<0.05); the sensitivity, accuracy and negative predictive value of C-TIRADS combined with SWE in diagnosis of TMC were significantly higher than those of C-TIRADS alone (90.32% vs. 80.24%, 89.10% vs. 80.11% and 81.10% vs. 65.97%), and there were statistical differences ( P<0.05). Thyroid nodules were divided into ≤0.5 cm nodules (56 nodules) and 0.5 to 1.0 cm nodules (311 nodules) according to the maximum diameter, the sensitivity and accuracy of C-TIRADS combined with SWE in diagnosing TMC in 0.5 to 1.0 cm nodules were significantly higher than those in ≤0.5 cm nodules: 91.82% (202/220) vs. 78.57% (22/28) and 90.68% (282/311) vs. 80.36% (45/56), and there were statistical differences ( χ2 = 4.99 and 5.20, P<0.05), but there was no statistical difference in specificity between 2 groups ( P<0.05). Conclusions:C-TIRADS combined with SWE can further improve the diagnostic value of TMC, which is worth popularizing and applying in clinic.

Objective: Based on observational, longitudinal and intervention study of common diseases among students in Jiangsu Province, this paper presents the current progress of two year follow up of myopia cohort regarding the association between growth parameters with progression of myopia among children and adolescents in areas with rapid economic growth. Methods: This survey adopted the stratified cluster sampling method for school selection. The full automatic computer optometry (TOPCON RM800) was used to track myopia related parameters for all participants from 2019 to 2020 under the condition of mydriasis (compound topicamide eye drops). Relationship between growth parameters of children and adolescents and the incidence and progression of myopia was analyzed by using Cox regression multiple statistical model. Results: The myopia rates of students from grade 1 to grade 3 in 2019 were 5.4%, 21.5% and 37.3% respectively. After one year, the myopia rates of all school stages increased to 25.3%, 43.3% and 58.1% respectively( χ 2=53.59, 49.63, 32.52, P <0.01). The mean diopter of right eye and left eye after mydriasis were ( 0.30± 1.24/0.39±1.26)D in 2019 and (-0.33±1.54/-0.19±1.55)D in 2020, respectively based on Cox multiple regression results, age ( HR =1.21, 95% CI =1.09-1.34), naked eye vision ( HR =0.08, 95% CI =0.07-0.11), height ( HR =0.98, 95% CI =0.97-0.99) showed a strong correlation with the incidence and progression of myopia( P <0.05). Conclusion Myopia is growing rapidly in the central region of Jiangsu Province. It is suggested that diopter, axial length, naked eye vision, age, height and other indicators should be included in the refractive archives of children and adolescents in the region.

Objective:To evaluate the myocardial work of patients with different degrees of coronary artery stenosis with normal left ventricular ejection fraction and no segmental ventricular wall motion abnormality by left ventricular pressure-strain ring (PSL), and to explore the clinical value of myocardial work parameters in predicting severe coronary artery stenosis.Methods:The data of 238 patients undergoing coronary angiography (CAG) in the Affiliated Hospital of Jining Medical University from December 2020 to August 2021 was prospectively collected. According to the results of CAG, the patients were divided into control group, moderate stenosis group, severe stenosis (1-2 branches) group, severe stenosis (complex multiple branches) group. Global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global work waste (GWW) and global work efficiency (GWE) were measured by PSL. Univariate and multivariate logistics regression were used to analyze the influencing factors of severe coronary artery stenosis. The receiver operating characteristic (ROC) curve was constructed to analyze the predictive value of GLS, GWI, GCW, GWW and GWE for severe coronary artery stenosis.Results:The GLS, GWI, GCW and GWE in severe stenosis group were lower than those in control group and moderate stenosis group (all P<0.05), while GWW was higher than those in control group and moderate stenosis group (all P<0.05); the GWI, GCW and GWE in severe stenosis (complex multiple branches) group were lower than those in severe stenosis (1-2 branches) group (all P<0.05), while GWW was higher than those in severe stenosis (1-2 branches) group (all P<0.05). Multivariate logistic regression analysis showed that GWE was an independent influencing factor for severe coronary stenosis ( OR=0.266, P<0.05). Compared with GLS, GWI, GCW and GWW, GWE had the largest area under the curve (0.920) to predict severe coronary stenosis, with sensitivity of 92.24% and specificity of 73.77%. The intra observer and inter observer correlation coefficients of GWI, GCW, GWW and GWE analyzed by two ultrasound physicians were 0.916 and 0.907, 0.989 and 0.981, 0.932 and 0.955, 0.931 and 0.937, respectively, which showed good repeatability. Conclusions:PSL provides a new method for quantitative evaluation of left ventricular systolic function in patients with coronary artery stenosis. GWE can be used as a sensitive indicator to predict patients with severe coronary artery stenosis, and is worth to be popularized and applied in the clinical.

Objective:To study the efficacy of low-intensity focused ultrasound (LIFU) on neuropathic pain (NP) in mice, and its effect on the activation of astrocytes and the expression of pro-inflammatory cytokines were discussed.Methods:Thirty-six male C57BL/6J mice were randomly divided into three groups: sham operation (Sham) group and chroinc constriction injury (CCI) model group and treatment (CCI+ LIFU) group, 12 mice in each group.NP model was established by CCI on the sciatic nerve. The group of CCI+ LIFU received LIFU treatment for the anterior cingulate cortex (ACC) on the 7th day after surgery, the mechanical withdrawal threshold (MWT) on the affected side of mice was measured at preoperation 3, 6, 12, 18, 24, and 27 days after operation, respectively, H&E staining was used to observe pathological morphological changes in the ACC region, the expression levels of ACC region AQP4 and GFAP protein were detected by Western Blot and immunofluorescence, and the expression levels of ACC region pro-inflammatory cytokines IL-1β and TNF-α were detected by enzyme-linked immunosorption assay.Results:Compared with Sham group, MWT in the CCI group decreased from the 3rd day until the 27th day after surgery( P<0.05); Compared with the CCI group, the MWT in the CCI+ LIFU group increased on the 24th day after surgery, and was significantly higher than that of the CCI group on the 24th and 27th day after surgery ( P<0.05); LIFU stimulation did not produce significant pathological changes in the ACC region; Western Blot and immunofluorescence showed that AQP4 and GFAP protein expression in the ACC region were upregulated ( P<0.05) after peripheral nerve injury, while AQP4 and GFAP protein expression was downregulated after LIFU treatment ( P<0.05); Enzyme-linked immunosorbents showed that the expression of pro-inflammatory cytokines IL-1β and TNF-α in the region of ACC was upregulated ( P<0.05) after peripheral nerve injury, while the expression of IL-1β and TNF-α was downregulated after LIFU treatment ( P<0.05). Conclusions:LIFU can effectively relieve mechanical pain sensitivity symptoms in mice induced by CCI, possibly by inhibiting activation of astrocytes and neuro-inflammatory responses.

Objective: The aim of this study was to investigate the effect of co-culture with AEC (amniotic epithelial cell) on the biological characteristics of AMSC (amniotic mesenchymal stem cell), and to investigate the roles of SDF-1/CXCR4 axis in the homing and migration of AMSC. Methods: AMSC andAEC were isolated from human amnion, and then cultured, amplified and identified, respectively. TheAMSC were divided into three groups:AEC co-cultured group, serum-free cultured group and serum cultured group.After culture for 24 h, 48 h, and 72 h, the proliferation viability ofAMSC was measured by CCK-8 assay and trypan blue staining; the expression of CXCR4 mRNAwas analyzed by flow cytometry and Real-time RT-PCR, and the migration ability ofAMSC in vitro was observed by migration assay. Results: Cell viability (48 h and 72 h) and survival rate in the co-culture and serum groups were higher than those in the serum-free group (all P<0.05). The mRNA and protein expressions of CXCR4 in AMSC of the co-culture and serum-free groups were significantly higher than those of the serum group (P<0.05). The migration ability of AMSC in the co-culture and serumfree groups, which increase with the SDF-1 (stromal cell derived factor-1) concentration gradient, were higher than that in the serum group (P<0.05). Conclusion: AMSC co-cultured with AEC still have the basic biological characteristics of MSC, and showed good growth activity. Co-culture withAEC can up-regulate CXCR4 onAMSC surfaces and enhance the migration ability ofAMSC in vitro.

Objective to investigate the clinical efficacy of decompression and pedicle screw fixation through posterior approach for complete thoracic spine fracture dislocation.Methods The clinical data of six patients with complete thoracic spine fracture and dislocation treated from September 2002 to June 2016 were analyzed retrospectively by case series study.There were five males and one female,aged 21-67 years old (mean,47.2 years).The injury segments were T3～4 dislocation in one case,T5～6 dislocation in two cases,T6 ～7 dislocation in two cases and T8 ～9 dislocation in one case.There was one case of ASIA grade E and five cases of Grade A,and all of six cases were associated with multiple rib fractures and hemopneumothorax.The companied status was one case of sternal fracture,one case of atlantoaxial complex fractures and three cases of pulmonary contusion.The posterior median incision decompression and pedicle screw system fixation were performed,and the intervertebral bone grafting was conducted after restoration.The surgery time,bleeding volume during surgery,fracture restoration,bone grafting fusion,failure of internal fixation and other complications were recorded.The Visual Analogue Scale (VAS) and American Spinal Injury Association (ASIA) classification were used to assess the pain and neurological function improvement between the preoperative visit and final follow-up visit.Results The surgery time was 150-240 minutes (mean,205 minutes).The bleeding volume during the surgery was 700-2 100 ml (mean,1167 ml).One case was died of pulmonary infection at one week after surgery,the others were followed up for 3-14 months (mean,7.4 months).After operation,five patients were satisfied with the reduction,and the lateral displacement was partially restored in one cases.Five cases of intervertebral bone grafting all had bone fusion.There was no fixation failure.The VAS was (7.4 ± 0.6) points before surgery,(4.5 ± 1.6) points at one week after surgery and (1.8 ± 0.3) points at final visit of follow-up,which had significant difference from the preoperative status (P ＜ 0.05).One case of ASIA grade E had no postoperative aggravation and four cases of grade A had no improvement.Conclusion Posterior decompression and pedicle screw fixation system is optimal choice of treatment for complete thoracic fractures and dislocations for it can attain reduction of fracture and dislocation as well as bone fusion,provide stability for spine and relieve pain.

Objective To observe the surface electromyography (sEMG) characteristics of pharyngeal swallowing muscles in different swallowing modes in asymptomatic lacunar infarction (LI) patients. Methods From January, 2015 to January, 2017, a total of 32 asymptom-atic LI patients (LI group) aged over 60 years were consecutively collected, and 30 normal old subjects matched with age and gender (nor-mal group) were also enrolled. The amplitudes of sEMG activity of infrahyoid muscles and submental muscles in different swallowing modes were recorded, and the root mean square (RMS) was analyzed. Results Significant difference was found in both muscle groups in dif-ferent swallowing modes in both groups (F>110.67, P<0.001). There was no significance in the RMS in both two muscle groups in rest and dry swallowing modes between two groups (t<1.484, P>0.05). In the 20 ml water swallowing mode, the RMS was lower in the submental muscles in the LI group than in the normal group (t=3.334, P<0.01), and no significant difference was found in the infrahyoid muscles (t=1.871, P>0.05). In the 100 ml continuous drinking mode, the RMSs were significantly lower in both two muscle groups in LI group than in the normal group (t>3.118, P<0.01). Conclusion Swallow abilities decrease in asymptomatic LI. sEMG could be used to evaluate their swallowing function.

Purpose To investigate the prenatal ultrasonic features of fetal hypospadias and to compare the diagnostic accuracy.Materials and Methods The clinical data of 28 patients with suspected or confirmed hypospadias were retrospectively analyzed.The prenatal ultrasonic features,missed diagnosis and misdiagnosis of the patients were analyzed,and the diagnostic accuracy of different ultrasonic features for hypospadias was compared.Results In 28 cases,21 cases of hypospadias were confirmed by examination after birth or induced abortion with 2 cases of missed diagnosis by ultrasound,and 7 cases of non hypospadias were misdiagnosed by prenatal ultrasound.The diagnostic accuracy rate of 2D ultrasound was 67.9％ (19/28),and that of 3D ultrasound combined with 2D ultrasound was 92.9％ (13/14).The diagnostic accuracy rates of ultrasonic features such as abnormal urinary jet,abnormal urethra,tulip sign,abnormal penis tip,scrotum separation with or without penoscrotal transposition and short penis were 100.0％ (6/6),92.9％ (13/14),88.2％ (15/17),83.3％ (5/6),25.0％ (1/4) and 33.3％ (1/3),respectively.Conclusion The ultrasonic features including abnormal urinary jet,abnormal urethra,tulip sign and abnormal penis tip have great value for prenatal diagnosis of fetal hypospadias.3D ultrasound is more intuitive than 2D ultrasound and provides more details.Comprehensive analysis of all ultrasonic features is helpful for prenatal diagnosis.