Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Objective:To automatically synthesize Al 18F-fibroblast activation protein inhibitor (FAPI)-74, and explore its value of clinical application. Methods:Al 18F-FAPI-74 was synthesized automatically by the commercial synthesis module CFN-MPS-100, and its yield, radiochemical purity and stability were determined. Sixteen normal Kunming (KM) mice were randomly divided into 4 groups and euthanized at 10, 30, 60 and 90 min after Al 18F-FAPI-74 injection, and the biodistribution was measured. MicroPET/CT dynamic scanning (60 min) was performed in 5 rat pancreatic tumor-bearing BALB/c nude mice to observe the tumor uptake. Al 18F-FAPI-74 PET/CT imaging was performed on 3 volunteers (1 male, 2 females; age: 37, 41, 43 years) to evaluate the clinical application value of Al 18F-FAPI-74. Results:The automated synthesis time of Al 18F-FAPI-74 was about 35 min, with the synthesis yield of (21.34±3.86)% (without attenuation correction, n=5) and the radiochemical purity more than 99%. The radiochemical purity was still more than 96% after placement at 37 ℃ for 6 h. Biodistribution in normal mice and microPET/CT dynamic scanning in tumor-bearing nude mice showed that consistently high uptake in the kidneys and bladder, and the tumor uptake was the highest at 20 min, and the maximum tumor-to-muscle ratio was 3.16±0.01 at 60 min. PET/CT imaging on volunteers showed that there was a small amount of uptake in myocardium, most organs such as the liver and lung had background uptake, and the maximum SUV max of persistent high uptake of tumor was 17.08. Conclusions:Al 18F-FAPI-74 has the advantages of simple synthesis, high yield, stable quality and good imaging performance in mice and volunteers. It is a kind of imaging agent that meets the requirements of clinical diagnosis.

Objective:To evaluate the laparoscopic sleeve gastrectomy combined with hiatal hernia repair surgery for weight loss and antireflux.Methods:This study included 21 obese patients with gastroesophageal reflux who underwent laparoscopic sleeve gastrectomy at the Weight Loss Metabolism Center of the Department of Hepatobiliary and Pancreatic Surgery of Zhejiang Provincial People's Hospital from Dec 2019 to Dec 2020. Patients were divided into simple bariatric surgery group (9 cases) and simultaneous combined surgery group (12 cases).Results:In the combined surgery group, 1 case had postoperative gastric leakage. The postoperative body weight, waist circumference, and BMI indexes of the two groups showed a downward trend ( F=5.154, P=0.013; F=14.319, P<0.001; F=6.725, P=0.004). There was a statistically significant difference in the excess weight loss in both the two groups at 6 months after the operation compared to 1 month after the operation ( t=8.927, P<0.001; t=8.926, P<0.001). There was no statistically significant difference in postoperative lower esophageal sphincter resting pressure and Gerd symptom score in the bariatric surgery group compared with preoperative ( t=-0.891, P=0.507; t=0.629, P=0.298). The postoperative Gerd symptom score of the patients in the combined surgery group was significantly lower than that before the operation, and the resting pressure of the lower esophageal sphincter was significantly higher than that before the operation, ( t=-10.539, P<0.001; t=5.066, P=0.038). Conclusion:Combined surgery have the same weight loss effect as in simple bariatric surgery in obese patients with gastroesophageal reflux, in addition to stronger anti-reflux effect.

Fiber photometry is a recently-developed method that indirectly measures neural activity by monitoring Ca

Objective:To analyze variant patterns and characteristics of focal physiological uptake (FPU) in the tongue on 18F-fluorodeoxyglucose (FDG) PET/CT imaging in patients without a history of oral tumor surgery and radiotherapy. Methods:A total of 6 233 consecutive patients who underwent routine whole-body PET/CT scan between January 2013 and December 2017 in the First Hospital of Shanxi Medical University were investigated retrospectively, and 324 patients with a history of oral surgery and radiotherapy were excluded, the remaining 5 909 patients (3 418 males, 2 491 females, age range: 2-95 (average: 58) years) were enrolled. A part of the patients underwent local PET/CT scan and CT scan with diagnostic dose, covering the oral cavity on mouth-opening position. The morphological characteristics of FPU patterns were analyzed, and the maximum standardized uptake value (SUV max) was measured. Results:Seventy-six FPUs in 76 patients (49 males, 27 females, age range: 40-83 (average 64) years) identified by routine whole-body PET/CT scan were confirmed by clinical examination from a specialist in stomatology or follow-up for more than 6 months. Forty-one of the 76 patients subsequently underwent local PET/CT scan and diagnostic CT scan on mouth-opening position. The incidence of FPU in the tongue was 1.29%(76/5 909). The FPU patterns could be classified into three types: type Ⅰ with FDG uptake involved only anterior part of the tongue body in the midline (near the tip of the tongue), which showed as a " dotted" shape( n=68; 1.15%, 68/5 909); type Ⅱ with FDG uptake involved mainly middle part of the genioglossus muscle, which showed as a " bar-shorted" shape ( n=5; 0.08%, 5/5 909); type Ⅲ with FDG uptake involved large part of the tongue body and the genioglossus, which showed as a " T" shape( n=3; 0.05%, 3/5 909). The SUV max in patients with type Ⅰ and type Ⅱ were 5.53(4.53, 7.30), 19.50(17.10, 22.74) respectively. The SUV max in 3 patients with type Ⅲ were 23.34, 27.50 and 35.14, respectively. Conclusion:In patients without a history of oral tumor surgery and radiotherapy, the FPU in the tongue has its specific pattern, and PET/CT scan on mouth-opening position helps to reveal the detailed features.

Objective: To explore the diagnostic efficacy of by ¹⁸F-FDG PET-CT for hypermetabolic thyroid nodules. Methods: To retrospectively analyze the clinical data of 3 192 patients underwent ¹⁸F-FDG PET-CT in our hospital from May 2012 to October 2014. Among them, 98 patients were diagnosed with focal hypermetabolic thyroid nodules. 61 of the 98 patients were diagnosed with malignant or benign thyroid nodules using histopathological or clinical follow-up (22 malignant nodules, 39 benign nodules). The average age of these 61 patients was 61.6±12.5 years. Results: The lgSUVmax of malignant group (0.69±0.31) was significantly higher than that in benign group (0.43±0.27) (P=0.001). There was no significant difference in age, gender, nodule size, minimum diameter of nodule, lgCT, calcification, the boundary definition, density uniformity, and history of malignancy between the two groups (P>0.05). Binary Logistic regression indicated the AUC of Logistic regressive model(AUC) was 0.866±0.049 (95% CI: 0.769-0.963), and the malignant AUCs of ROC curve was 0.747±0.068 (95%CI: 0.614-0.880) which was only determined by lgSUVmax. The difference was statistically significant (P<0.01). Conclusion ¹⁸F-FDG PET-CT imaging can not only detect hypermetabolic thyroid nodules, but also have a certain clinical value for the identification of benign and malignant nodules.

Objective To establish radiation-induced heart disease ( RIHD) Beagle models, in-vestigate the efficacy of 18 F-FDG PET/CT in the detection of RIHD and observe the pathological changes. Methods The ventricular anterior wall of 12 Beagle dogs were X-ray irradiated locally with a single dose of 20 Gy. 18 F-FDG PET/CT and echocardiography were performed at baseline and 3 months after radiation. ROI was drawn on the irradiation field and the non-irradiation field ( the posterior wall of left ventricle) to obtain the SUVmax . Then the SUVmax ratio of the irradiation field to the non-irradiation field ( INR) was cal-culated. The left ventricular function parameters before and after radiation were obtained by echocardio-graphy. Within 1 week after the imaging examinations were finished, the dogs were sacrificed, and hearts were taken out to perform pathological observation. Paired t test was used to analyze the data. Results High 18 F-FDG uptake in the irradiation field was shown 3 months after radiation. The average INRs before and after radiation were 0.99±0.15 and 2.54±0.43 respectively (t=7.021, P=0.001). No significant difference was ob-served on cardiac function parameters between baseline and 3 months after radiation( t values:from-1.253 to-0.786, all P>0.05) . The pathological results showed a few degenerated myocytes, increased thickness of myocardial vascular walls in irradiated myocardium. Conclusions 18 F-FDG PET/CT can detect early RIHD before abnormal cardiac function. Increased 18 F-FDG uptake in irradiated field may be related to myocardial ischemia which results from microvascular damage by radiation.

Objective To investigate the effect of Sirt1 gene knockout on chronic kidney disease induced by 5/6 nephrectomy in mice and vascular endothelial growth factor (VEGF)/fetal liver kinase-1 (Flk-1) signaling pathway.Methods Twenty four male Sirt1 +/+ and Sirt1 +/-mice wererandomly divided into four groups:Sirt1+/+ mice with sham-operation (WT-Sham,n=6),Sirt1+/-mice with sham-operation (KO-Sham,n=6),Sirt1 +/+ mice with 5/6 nephrectomy (WT-Nx,n=6) and Sirt1 +/-mice with 5/6 nephrectomy (KO-Nx,n=6).Proteinuria was determined by urine collection from 8:00 to 8:00 the next day at 20 weeks.Serum creatinine (Scr),urea nitrogen (BUN) and the renal pathological changes were measured after 20 weeks.Expressions of Sirt1,collagen Ⅰ and transforming growth factor β(TGF-β) were used to analyze the changes of renal fibrosis by immunohistochemistry staining.Real-time PCR and Western blotting were used to measure the mRNA and protein expressions of Sirt1,fibronectin,collagen Ⅰ,VEGF and Flk-1 in kidney.Results Sirt1 expressed in glomernlar endothelial cells,podocytes,mesangial cells and renal tubular epithelial cells in Sirt1 +/+ mice,while Sirt1 expression intensity was significantly reduced in Sirt1 +/-mice.Compared with the WT-Sham group,WT-Nx group had increased proteinuria,BUN,Scr,glomernlar sclerosis index and tubulointerstitial fibrosis index at 12 weeks after operation (all P ＜ 0.01),and KO-Nx group had exacerbated the above up-regulations (all P ＜ 0.01).Compared with those in WT-Sham group,the expressions of fibronectin,collagen Ⅰ and TGF-β were up-regulated in WT-Nx group (all P ＜ 0.01),and were significantly augmented in KO-Nx group (all P ＜ 0.01).Compared with those in WT-Sham group,renal mRNA and protein expressions of VEGF and Flk-1 were decreased in WT-Nx group,and KO-Nx group aggravated their down-regulation (all P ＜ 0.01).Conclusions Sirt1 gene knockout can increase proteinuria and Scr,and aggravate renal pathology and renal fibrosis in 5/6 nephrectomized mice,which is associated with the inhibition of VEGF/Flk-1 signaling pathway.It is suggested that Sirt1 may be a potential therapeutic target of chronic kidney disease.

Objective To explore CT findings of pulmonary non‐tuberculosis mycobacteria (NTM ) disease .Methods Forty‐two patients with pulmonary NTM disease confirmed by the biphasic medium flora identification (NTM group) ,and 60 patients with lung tuberculosis (TB group) confirmed by the tubercle bacillus cultivation and flora identification in our hospital were included in the ret‐rospective analysis .9 CT signs and distribution features of the lesions were analyzed and compared between the two groups .The difference was statistically significant if P<0 .05 .Results Pulmonary NTM disease was more common in female patients (χ2=5 .500 ,P=0 .019) ,and the mean age was significantly older than that of the tuberculosis (t=3 .456 ,P=0 .001) .The detection rate in the right middle lobe and left tongue section was high in NTM group than in TB group (χ2 =8 .361 ,P=0 .004) .Logistic regression showed that bronchiectasis and bronchial stenosis or occlusion were independent risk factors for the NTM disease .They were important signs for the differential diagnosis from tuberculosis .Conclusion MSCT findings of pulmonary NTM disease have certain characteristic , which are helpful for the diagnosis .

OBJECTIVE: To determine the efficacy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the detection of radiation-induced myocardial damage in beagles by comparing two pre-scan preparation protocols as well as to determine the correlation between abnormal myocardial FDG uptake and pathological findings. MATERIALS AND METHODS: The anterior myocardium of 12 beagles received radiotherapy locally with a single X-ray dose of 20 Gy. 18F-FDG cardiac PET/CT was performed at baseline and 3 months after radiation. Twelve beagles underwent two protocols before PET/CT: 12 hours of fasting (12H-F), 12H-F followed by a high-fat diet (F-HFD). Regions of interest were drawn on the irradiation and the non-irradiation fields to obtain their maximal standardized uptake values (SUVmax). Then the ratio of the SUV of the irradiation to the non-irradiation fields (INR) was computed. Histopathological changes were identified by light and electron microscopy. RESULTS: Using the 12H-F protocol, the average INRs were 1.18 +/- 0.10 and 1.41 +/- 0.18 before and after irradiation, respectively (p = 0.021). Using the F-HFD protocol, the average INRs were 0.99 +/- 0.15 and 2.54 +/- 0.43, respectively (p < 0.001). High FDG uptake in irradiation field was detected in 33.3% (4/12) of 12H-F protocol and 83.3% (10/12) of F-HFD protocol in visual analysis, respectively (p = 0.031). The pathology of the irradiated myocardium showed obvious perivascular fibrosis and changes in mitochondrial vacuoles. CONCLUSION: High FDG uptake in an irradiated field may be related with radiation-induced myocardial damage resulting from microvascular damage and mitochondrial injury. An F-HFD preparation protocol used before obtaining PET/CT can improve the sensitivity of the detection of cardiotoxicity associated with radiotherapy.
Animals ; Dogs ; Fasting ; Fluorodeoxyglucose F18/*metabolism ; Heart/*radiography ; Heart Injuries/*radiography ; Male ; Myocardium/metabolism/pathology ; Positron-Emission Tomography/*methods ; Radiation Injuries/diagnosis/*radiography ; Thoracic Neoplasms/radiotherapy ; Tomography, X-Ray Computed/*methods