Objective:To explore the clinical outcome and applicability of the comb flap technique and stepwise design concept in plastic aesthetic and reconstructive surgery.Methods:The clinical data of patients who underwent plastic aesthetic and reconstructive surgery with the comb flap technique in Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2022 were retrospectively analyzed. The application of the comb flap technique follows the concept of stepwise design, that was, preoperative and intraoperative design and adjustment were carried out step by step and in sequence, and the design was combined with the surgical procedure. Its main operations included: an incision was designed along the edge of the target area, the tissue flap was widely separated at the base of the target area. The tissue flap was cut in sequence perpendicular to the cutting edge and temporarily sutured and fixed, the edge was cut and fixed. During the operation, the tension of the incision and the local appearance could be adjusted. The incisal edge was finely sutured, and the temporary suture was finally removed. The healing of surgical incision and complications were observed after the operation, and the facial recovery and surgical effect were followed up.Results:Six patients were enrolled, including 3 males and 3 females, aged from 2 to 58 years. One patient underwent upper eyelid tightening and lower eyelid blepharoplasty through subeyebrow incision. One patient underwent middle and lower face rhytidectomy. One patient underwent thick lip thinning and right facial liposuction. One patient underwent facial congenital melanocytic nevi resection. One patient underwent eyebrow congenital melanocytic nevus resection. One patient underwent facial flap repair. All patients had primary healing of incision, and no surgery-related complications occurred. All patients were followed up for 3 to 18 months, and all patients were satisfied with the surgical effect.Conclusion:The application of comb flap technique and stepwise design concept in plastic aesthetic and reconstructive surgery can delicately adjust the alignment of the incision margin, make the tension evenly distributed, and reduce the risk of scar formation and deformity after the operation. It has a wide range of clinical applications and good applicability.

Objective:To explore the clinical outcome and applicability of the comb flap technique and stepwise design concept in plastic aesthetic and reconstructive surgery.Methods:The clinical data of patients who underwent plastic aesthetic and reconstructive surgery with the comb flap technique in Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2022 were retrospectively analyzed. The application of the comb flap technique follows the concept of stepwise design, that was, preoperative and intraoperative design and adjustment were carried out step by step and in sequence, and the design was combined with the surgical procedure. Its main operations included: an incision was designed along the edge of the target area, the tissue flap was widely separated at the base of the target area. The tissue flap was cut in sequence perpendicular to the cutting edge and temporarily sutured and fixed, the edge was cut and fixed. During the operation, the tension of the incision and the local appearance could be adjusted. The incisal edge was finely sutured, and the temporary suture was finally removed. The healing of surgical incision and complications were observed after the operation, and the facial recovery and surgical effect were followed up.Results:Six patients were enrolled, including 3 males and 3 females, aged from 2 to 58 years. One patient underwent upper eyelid tightening and lower eyelid blepharoplasty through subeyebrow incision. One patient underwent middle and lower face rhytidectomy. One patient underwent thick lip thinning and right facial liposuction. One patient underwent facial congenital melanocytic nevi resection. One patient underwent eyebrow congenital melanocytic nevus resection. One patient underwent facial flap repair. All patients had primary healing of incision, and no surgery-related complications occurred. All patients were followed up for 3 to 18 months, and all patients were satisfied with the surgical effect.Conclusion:The application of comb flap technique and stepwise design concept in plastic aesthetic and reconstructive surgery can delicately adjust the alignment of the incision margin, make the tension evenly distributed, and reduce the risk of scar formation and deformity after the operation. It has a wide range of clinical applications and good applicability.

[Objective]To elucidate the meridian manipulations described in the Han bamboo slips of Zhangjiashan from a meridian perspective,providing a theoretical foundation for the application of ancient meridian manipulations in modern clinical practice.[Methods]Based on the records in the unearthed literature and cultural relics of the pre-Qin,Qin and Han Dynasties,this paper summarizes the Daoyin technique in the pre-Qin,Qin and Han Dynasties,explores the in-depth relationship between Daoyin technique and meridian muscles,and selects the common orthopedic diseases in modern clinic,such as neck pain,ankle pain,knee pain and shoulder pain,which are closely related to meridian muscles.The original text and Daoyin movements are analyzed,and the Daoyin movements are discussed from the perspective of meridian muscles.[Results]It is found that the Daoyin described in the pre-Qin,Qin and Han Dynasties is mainly simple body movements.The meridians described in the Book of Pulse are mostly meridiansand tendons,so the theory of meridians and tendons may be more suitable for the thinking of the physicians at that time.Using the theory of meridians and tendons to analyze the Daoyin in Yinshu,it is found that the Daoyin therapy for neck pain in the book should be mainly treated for the neck pain of the sun meridian muscles;the treatment of lateral ankle pain is mainly adjusted by the Shaoyang meridian muscles of the foot,and the treatment of medial ankle pain is mainly adjusted by the Taiyin meridian muscles of the foot;the Daoyin therapy for knee pain is used to adjust the meridian muscles of the six meridians of the foot;the treatment of shoulder pain,the use of"Yuanxing three hundred"to treat the shoulder pain caused by the Shaoyang and Yangming meridian muscles of the hand,the use of"Qianyuan"to treat the shoulder pain caused by the sun meridian muscle disease,the use of"Zhiluo"to treat the shoulder pain caused by the sun meridian muscle disease,and the use of"Houfu"to treat the shoulder pain caused by the Taiyin meridian muscle disease.It is more reasonable to explain the treatment principles of Daoyin using the theory of meridian sinew,which can further elucidate the treatment principles of Daoyin and clarify the corresponding disease indications for different Daoyin.[Conclusion]Looking at the Daoyin manipulations in Yinshu from the perspective of meridians and tendons can further clarify the diseases treated by Daoyin manipulation,make the treatment more accurate and effective,and provide more ideas for the clinical application of Daoyin manipulation in modern traditional Chinese medicine.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

Objective:To ascertain the distribution of interventional radiodiagnosis and treatment resources and the current situation of radiological protection in Beijing, standardize the interventional radiodiagnosis and treatment, and promote the implementation of radiation protection regulatory measures.Methods:Various medical institutions at differetn levels that perform interventional radiodiagnosis and treatment in Beijing were identified as the survey objects. With special questionnaires designed, the investigation groups at two levels of municipality and district was established to investigate the basic situation of interventional radiology and occupational health monitoring by the end of 2020. The indexes and parameters were analyzed and evaluated under the relevant national regulations and standards.Results:By the end of 2020, there were 93 medical institutions performing interventional radiology in Beijing, together with 236 digital subtraction angiography machines (DSA) with higher than 800 mA. A total of 135 593 cases of interventional radiological surgical operation were performed. There were 40 hospitals annually performing more than 1 000 cases and 41 hospitals perfoming 10-1 000 cases. There were 3 539 interventional radiological workers, with 99.0% holding radiological worker certificates. The passing rates of occupational health examination, personal dose monitoring and radiation protection training were 96.9%, 99.5% and 95.8%, respectively. A total of 3 532 sets of protective articles were provided for the workers, of which 98.9% were equipped with split or integrated lead clothing, but 6.5% were not equipped with lead protective glasses and 54.9% were not equipped with lead protective gloves.Conclusions:The radiation protection management for the interventional radiodiagnosis and treatment is generally good. However, the regulatory mechanism should be further improved based on the current distribution of interventional radiodiagnosis and treatment resources, with focus on strengthening the occupational health examination, the radiation protection training, and the configuration and use of protective equipment.

Radiotherapy uses high-energy X-rays or other particles to destroy cancer cells and medical practitioners have used this approach extensively for cancer treatment (Hachadorian et al., 2020). However, it is accompanied by risks because it seriously harms normal cells while killing cancer cells. The side effects can lower cancer patients' quality of life and are very unpredictable due to individual differences (Bentzen, 2006). Therefore, it is essential to assess a patient's body damage after radiotherapy to formulate an individualized recovery treatment plan. Exhaled volatile organic compounds (VOCs) can be changed by radiotherapy and thus used for medical diagnosis (Vaks et al., 2012). During treatment, high-energy X-rays can induce apoptosis; meanwhile, cell membranes are damaged due to lipid peroxidation, converting unsaturated fatty acids into volatile metabolites (Losada-Barreiro and Bravo-Díaz, 2017). At the same time, radiotherapy oxidizes water, resulting in reactive oxygen species (ROS) that can increase the epithelial permeability of pulmonary alveoli, enabling the respiratory system to exhale volatile metabolites (Davidovich et al., 2013; Popa et al., 2020). These exhaled VOCs can be used to monitor body damage caused by radiotherapy.
Breath Tests/methods* ; Exhalation ; Humans ; Quality of Life ; Respiratory System/chemistry* ; Volatile Organic Compounds/analysis*

ObjectiveTo investigate the metabolites and gene expression characteristics in fibrous roots of Dioscorea zingiberensis in response to low phosphorus stress. MethodThe severe stress group， the moderate stress group， and the normal group were set up to stimulate the low phosphorus stress experiment. The fibrous roots of D. zingiberensis were collected during initial stress. The metabolites and transcriptomic characteristics were analyzed by gas chromatography-mass spectrometry （GC-MS） derivatization and RNA-seq techniques. Through multivariate statistical analysis of metabolites treated by different methods，functional analysis of differentially expressed genes， and data mining， the metabolism markers produced in fibrous roots of D. zingiberensis under low phosphorus stress were screened out， and the metabolic pathway characteristics of different genes were analyzed. ResultA total of 116 GC-MS metabolites were detected from the fibrous roots of D. zingiberensis. The metabolic characteristics of fibrous roots of D. zingiberensis under different low phosphorus treatments were obviously different. Orthogonal partial least squares discriminant analysis（OPLS-DA） model was used to screen six differential metabolites represented by sugars and alcohols from metabolites of fibrous roots treated with different methods，and these components were presumedly metabolism markers of fibrous roots of D. zingiberensis in response to low phosphorus stress. The differential genes screened out from the severe stress group and the normal group were mainly enriched in peroxidase pathway，phosphate and hypophosphate metabolism pathway，while the differential genes screened out from the severe stress group and the moderate stress group were mainly enriched in glutathione metabolism pathway and phosphopentose pathway. A total of 177 differential genes in response to low phosphorus stress were screened out from fibrous roots， involving many pathways such as terpenoid skeleton and inositol biosynthesis，which was consistent with the fact that the metabolic differential components in fibrous roots in response to low phosphorus stress were mainly saccharides and inositol. ConclusionThe metabolites and gene expression in fibrous roots of D. zingiberensis responded to low phosphorus stress，and the differential metabolites were closely related to differentially expressed genes. This study is expected to provide a theoretical basis for the research on the molecular mechanism of D. zingiberensis in response to low phosphorus stress.

Objective:To investigate clinical manifestations and dermoscopic characteristics of lichen planus-like keratosis (LPLK) .Methods:Clinical data were collected from 21 patients with LPLK who visited Shanghai Skin Disease Hospital and underwent both dermoscopic and histopathological examinations from January 2017 to September 2019, and clinical and dermoscopic features were retrospectively analyzed.Results:These patients were aged 64.69 ± 13.29 years, and the ratio of males to females was 1∶2. Skin lesions were located on the face of 18 cases and legs of 3 cases, and were red/violaceous in color in 7 cases, reddish-brown in 5, brown/gray in 8, and brown/reddish in 1. There were 3 types of skin lesions, including plaque-like type in 10 cases, flat pigmented patch type in 6, and flat erythema-like type in 5. As dermoscopy showed, 12 cases were non-pigmented LPLK, and 9 were pigmented LPLK. Pigment granules were found in 13 lesions, and there was no significant difference in the prevalence of pigment granules between pigmented and non-pigmented LPLK ( P=0.07) ; pigment granules were often diffusely distributed (9/13) , and the diffuse distribution pattern was common paticularly in pigmented LPLK (8/9) ; locally distributed pigment granules were found in 4 cases of non-pigmented LPLK. Coarse pigment granules were seen in 10 cases (10/13) , including 8 of pigmented LPLK and 2 of non-pigmented LPLK, and the prevalence rate of coarse pigment granules significantly differed between the pigmented LPLK and non-pigmented LPLK groups ( P=0.002) . Moreover, special distribution patterns of pigment granules included the annular granular pattern (8/13) and peppered pattern (7/13) , and no significant difference was observed in the prevalence of the 2 special distribution patterns between the pigmented LPLK and non-pigmented LPLK groups (both P > 0.05) . Scales were seen in 13 cases (13/21) , and vascular structures in 7 (7/21) , and there was no significant difference in the prevalence of the 2 structures between the pigmented and non-pigmented LPLK groups ( P=0.67, 0.16, respectively) . Conclusions:LPLK mostly occurs on the face, and manifests as solitary red, reddish-brown or brownish-gray plaques or patches, whose surfaces may be covered with scales. The characteristic dermoscopic feature of LPLK is the presence of pigment granules, which are coarse, often diffusely distributed, and commonly observed in pigmented LPLK.

OBJECTIVE: To prepare monoclonal antibody against cotinine (COT) and to establish immunoassay for detecting COT in human urinary samples. METHODS: BALB/c mice were immunized with synthesized cotinine-bovine serum albumin (COT-BSA) to screen monoclonal antibody with technique of cell fusion. The monoclonal antibody was used for the indirect competitive enzyme-linked immunosorbent assay (ic-ELISA) and colloidal gold immunochromatographic strip assay for the detection of COT in human urine. RESULTS: The monoclonal antibody against COT was identified by ic-ELISA with a 50%inhibitive concentration (IC CONCLUSIONS The ic-ELISA and colloidal gold immunochromatographic strip assay using the prepared monoclonal antibody against COT have been proved to be reliable for the rapid detection of COT in human urines, which may be used for monitoring of environmental tobacco smoke.
Animals ; Antibodies, Monoclonal ; Cotinine/urine* ; Enzyme-Linked Immunosorbent Assay ; Gold Colloid ; Humans ; Mice ; Mice, Inbred BALB C ; Urinalysis/methods*