Objective:To explore the value of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) of MRI in evaluating the response of osteosarcoma to neoadjuvant chemotherapy (NAC) in different cycles, and to analyze the diagnostic efficacy of each ADC and its difference.Methods:A total of 31 patients with pathologically confirmed osteosarcoma in the Nanjing Drum Tower Hospital, Nanjing University Medical School from January 2019 to December 2022 were retrospectively analyzed. All patients received NAC before surgery, and routine MRI and DWI were performed before and during chemotherapy. The ADC values were measured before, during and after chemotherapy (ADCpre, ADCmid, ADCpost), and the difference were calculated. According to whether the tumor necrosis rate was more than 90%, the patients were divided into good response group and poor response group. The differences of ADC values in each stage within the two groups were compared, and the differences of related parameters between the two groups were compared, and the diagnostic efficacy of each parameter in predicting tumor necrosis rate was analyzed by receiver operating characteristic(ROC) curve.Results:The ADC values of the two groups at different stages of NAC were compared. Except for the intermediate ADCmid and ADCpost in the poor response group ( P = 0.226), all the ADC values were statistical differences ( P<0.05). There were significant differences in ADCmid and ADCpost between the good response group and the poor response group (1.52 ± 0.39 vs. 1.39 ± 0.25, 1.65 ± 0.16 vs. 1.46 ± 0.44, P<0.05), but there was no significant difference in ADCpre between the two groups ( P>0.05). ROC curve showed that the area under the curve of ADCmid, ADCpost and △ADC3 (ADCpost -ADCpre) were 0.897, 0.810 and 0.714, respectively, and ADCmid had the best diagnostic efficiency. Conclusions:ADCmid, ADCpost and △ADC3 can be used to evaluate the efficacy of NAC in osteosarcoma. The ADCmid can provide some reference for the adjustment and improvement of clinical treatment.

Soft tissue defects resulting from head and neck tumor resection seriously impact the physical appearance and psychological well-being of patients. The complex curvature of the human head and neck poses a formidable challenge for maxillofacial surgeons to achieve precise aesthetic and functional restoration after surgery. To this end, a normal head and neck volunteer was selected as the subject of investigation. Employing Gaussian curvature analysis, combined with mechanical constraints and principal curvature analysis methods of soft tissue clinical treatment, a precise developable/non-developable area partition map of the head and neck surface was obtained, and a non-developable surface was constructed. Subsequently, a digital design method was proposed for the repair of head and neck soft tissue defects, and an in vitro simulated surgery experiment was conducted. Clinical verification was performed on a patient with tonsil tumor, and the results demonstrated that digital technology-designed flaps improved the accuracy and aesthetic outcome of head and neck soft tissue defect repair surgery. This study validates the feasibility of digital precision repair technology for soft tissue defects after head and neck tumor resection, which effectively assists surgeons in achieving precise flap transplantation reconstruction and improves patients' postoperative satisfaction.
Humans ; Plastic Surgery Procedures ; Surgical Flaps/surgery* ; Head and Neck Neoplasms/surgery* ; Head/surgery* ; Neck/surgery*

Objective To establish a two-dimensional high-performance liquid chromatography method for the determination of tigecycline in human cerebrospinal fluid, which can be used for the drug monitoring in patients with intracranial infection. Methods The quantification was carried out by an external standard method. The first-dimension column was a Aston SNX5 phenyl chromatographic column (50 mm×4.6 mm, 5 μm) with ammonium phosphate (pH was adjusted with ammonium hydroxide to 7.5)-methanol (45∶55, V/V) as the mobile phase and the flow rate was 1.2 ml/min. The second-dimension chromatographic column was Aston SC5 C₁₈ (275 mm×4.6 mm, 5 μm), with ammonium phosphate (pH was adjusted with ammonium hydroxide to 7.4)-ammonium phosphate (pH was adjusted with ammonium hydroxide to 3.0)- acetonitrile (30∶50∶20, V/V/V) as the mobile phase and the flow rate was 1.0 ml/min. The detection wavelength was 340 nm. The temperature was 40 ℃ and the injection volume was 200 μl. Results The calibration curve of tigecycline showed good linearity from 64.5 to 1 290.0 ng/ml in human cerebrospinal fluid (r=0.999 8). The RSD of intra and inter-day precision were less than 5.0% with the detection accuracy of 98.80%−106.51%. Conclusion This method is simple, quick, accurate, specific and sensitive. It meets the requirements of tigecycline determination in clinical human cerebrospinal fluid, which offers the individualized therapeutic assurance for patients with intracranial infection.

Objective: To compare the results of invasive dual mitral and aortic valve replacement(DVR) through anterolateral minithoracotomy(RT) and partial upper hemistemotomy(PS) approaches. Methods: This was a retrospective, observational, cohort study of collected data on 30 patients undergoing dual mitral and aortic valve replacement between July 2009 and March 2018 at Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University. There were 10 male and 20 female patients, aging from 15 to 65 years with a mean age of(45.67±12.25) years. Of these, 8 were performed through right RT and 22 through PS. SPSS 23.0 was used to analysis gender, age, left ventricle ejection fraction, New York Heart Association class, perioperative complications, total operative duration, cardiopulmonary bypass duration, aortic cross clamp time, ICU monitoring time and postoperative hospital stay of the two groups. Results: Both groups successfully completed minimally invasive double-valve replacement surgery, without middle-opening thoracic surgery. Compared with PS group, patients in the RT group had longer aortic cross clamp time[(109.00±27.80)min vs.(81.23±14.10)min, P=0.026], cardiopulmonary bypass duration[(152.13±27.15)min vs.(129.55±26.36)min, P=0.049]and total operative duration[(4.81±0.77)h vs.(4.15±0.44)h, P=0.006]. In addition, the ICU monitoring time and postoperative hospital stay of patients in RT group were shorter than PS group[(24.63±11.55)h vs.(30.55±13.21)h; (5.50±0.93)day vs.(6.59±3.88)day] but there were no statistically significant(P=0.273; P=0.442). Conclusion Minimally invasive dual mitral and aortic valve replacement via RT and PS are both safe and effective. The incision of RT group is more concealed than the PS group as well as retaining sternal integrity. However, the total operative duration, cardiopulmonary bypass duration and aortic cross clamp time were longer than PS group and the requirements of the surgeon are higher. The PS group has a shorter operation time and does not change the habit of the surgeon. It is more suitable for the heart center that proposed to launch the minimally invasive dual mitral and aortic valve replacement.

Objective To prepare human epidermal extracts by thermal separation,and to evaluate the value of epidermal extract-based Western blot analysis in the diagnosis of bullous pemphigoid (BP).Methods Human epidermal extracts were prepared by thermal separation from circumcised foreskins of healthy males.Serum samples were obtained from 22 inpatients with BP and 25 inpatients without BP in Hospital for Skin Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College between January 2015 and August 2017.These serum samples were subjected to Western blot analysis with epidermal extracts as substrates,as well as to BP180-NC16A enzyme-linked immunosorbent assay (ELISA).Statistical analysis was carried out using chi-square test and Fisher's exact test with the SPSS22.0 software.Results The sensitivities of epidermal extract-based Western blot analysis and BP 180-NC16A ELISA in the diagnosis of BP were 86.36％ (95 ％ CI:64.03％-96.41％) and 95.45％ (95％ CI:75.11％-99.76％) respectively (~ =1.10,P =0.294),and the specificities were 100％ (95％ CI:83.42％-100％) and 92％ (95％ CI:75.11％-99.76％) respectively (x2 =20.8,P =0.149).Epidermal extract-based Western blot analysis in the 22 patients with BP showed a protein band with relative molecular mass (RMM) of 230 000 in 4 patients,a protein band with RMM of 180 000 in 18,a protein band with RMM of 120 000 in 1,and a protein band with RMM of 97 000 in 1.The BP180-NC16A ELISA showed that the antibody titers were more than 50 U/ml in the BP patients with protein bands of RMM of 180 000.Conclusions The epidermal extract-based Western blot analysis mainly showed the protein band with RMM of 180 000 in the patients with BP.The sensitivity of the epidermal extract-based Western blot analysis was lower than that of the BP180-NC16A ELISA,and the epidermal extract-based Western blot analysis tends to be negative when the titer of the autoantibody is low.

Objective To investigate the infection status in patients with vitiligo.Methods A total of 434 patients with vitiligo were collected eligible data by a uniform questionnaire.Anti-HEV IgG and anti-HEV IgM were detected by enzyme-linked immunosorbent assay(ELISA).The correlation between the positive rate of anti-HEV IgG and sex,age,duration and immunology in-dex were analyzed.Results Out of the 434 patients,26.26％ of the total subjects were anti-HEV IgG positive.The positivity of anti-HEV IgG in adults and the progress of vitiligo patients was higher than that of teenagers and stabilization of vitiligo patients,the difference was statistically significant(P<0.05).Compared to the normal cases of IgA,IgG,C4,the positivity of anti-HEV IgG was significantly higher in the abnormal cases,the difference was statistically significant(P<0.05).Those 10 cases who were anti-HEV IgM positive,were anti-HEV IgG positive also.Conclusion The infection status in patients with vitiligo is serious and effective prevention strategies are required in future for reducing HEV transmission in these patients in order to reduce the incidence.

Objective To investigate the relationship between vitiligo and thyroid diseases .Methods Chemiluminescence was used to detect serum levels of free triiodothyronine (FT3) ,free thyroxine(FT4) ,thyrotropic stimulating hormone(TSH) ,anti‐thy‐roglobulin antibody(TG‐Ab) and anti‐thyroperoxidase antibody(TPO‐Ab) in 289 vitiligo patients and 128 healthy subjects .All re‐sults were statistically analyzed .Results The abnormal rates of FT3 ,TG‐Ab and TPO‐Ab in vitiligo patients were higher than healthy subjects (P<0 .05) ,which might be correlated with the age and gender of vilitigo patients .Conclusion Levels of thyroid function and autoantibody might be abnormal in vilitigo patients ,which could be more obvious in male and adolescent patients .It could be advantageous to screen thyroid function and antibody levels in patients with vitiligo .

China ; Humans ; Streptococcus pneumoniae

OBJECTIVE: Interventional occlusion of intracristal ventricular septal defects (IVSD) is a node point. Reports concerning angiography features and successful occlusion of IVSD using domestic occluder are rare. The aim of this paper is to investigate the angiography features of IVSD and the experience of interventional occlusion with domestic occluder. METHODS: Totally 46 cases of IVSD were diagnosed by color Doppler echocardiography that they had interventional indications.According to the short axis view of aortic, they were divided into 4 groups: A (11:30-12:00), B (12:00-12:30), C (12:30-13:00) and D (13:00-13:30). Different groups were performed with adequate angle angiography to show ventricular septal defect, as well as to decide strategy, which to choose occluder and occluded methods.RESULTS: All 46 patients were occluded successful. Technical success rate was 100%, without related complications. A group included 10 cases, B group 13 cases, C group 16 cases and D group 7 cases. The left anterior oblique angle of IVSD left ventricular angiography was greater than other type of VSD, and increased gradually with the changes in the defect location (Group A to D). According to the defect size and different groups, the defects were successfully occluded with symmetric,decentered, zere-decentered type occluder. Modified pigtail catheter was good value in practice occlusion of IVSD.CONCLUSIONS: Left anterior oblique angle in IVSD left ventricular angiography should be bigger. Domestic occluder is safe,effective, with less complication and cost, which can be the first choose for patients with LVSD.

Objective To predict the value of 99mTc-NOET gated myocardial perfusion SPECT imaging (GSPECT) in detecting coronary artery disease (CAD) and the theraputic effect of percutaneous transluminal coronary angioplasty (PTCA). Methods First, 70 patients suspected of CAD underwent 99mTc-NOET (group NOET1) or 99mTc-MIBI (group MIBI1) rest GSPECT and coronary angiography (CAG) was performed within 1 week after GSPECT. Second, 53 patients with CAD underwent 99mTc-NOET (group NOET2) or 99mTc-MIBI (group MIBI2) rest GSPECT before and 1, 3 and 6 months after PTCA and/or stent treatment. Results The sensitivity and specificity had no difference between group NOET1 and MIBI1 in detecting CAD. Comparison of group NOET 2 and MIBI 2: ①59.29%, 64.60% and 66.37% of the abnormal myocardial segment was improved in group NOET2.1, 3 and 6 months after PTCA, while 20.35%, 55.10% and 61.22% respectively in group MIBI2;②There was no difference of the incidence of clinical events and the myocardial function parameters before and after PTCA in group NOET2 and MIBI2. Conclusion Compared with 99mTc-MIBI, 99mTc-NOET has a greater clinical value for CAD diagnosis, PTCA efficacy and observation of the clinical events incidence.