BACKGROUND:Muscle weakness is a common symptom after coronavirus disease 2019(COVID-19)infection and affects the ability to perform daily activities in humans during recovery.Low-frequency pulsed magnetic field stimulation at a strength of 1.5 mT and a frequency of 3 300 Hz can enhance the maximal voluntary contraction and strength endurance of human skeletal muscle by inducing and activating classical transient receptor potential channel 1(TRPC1),which produces a series of pathological support effects on muscle tissue.It has not been studied whether this means will improve muscle weakness in patients recovering from COVID-19. OBJECTIVE:To select the low-frequency pulsed magnetic field for magnetic stimulation of lower limb muscle groups in patients with COVID-19,in order to observe the effect of this stimulation on the improvement of muscle weakness of lower limb muscle groups in patients with COVID-19 during the recovery period. METHODS:Fourteen patients infected with COVID-19(Omicron strain)positive for Innovita COVID-19 Ab Test(Colloidal Gold)and accompanied by muscle weakness were recruited and randomly divided into two groups:a test group receiving magnetic field stimulation and a control group receiving sham treatment,respectively.The total duration of the trial was 3 weeks.The test group was given low-frequency pulsed magnetic stimulation of the lower limbs every 48 hours and the control group was given the same intervention procedure as the test group but with sham stimulation.Patients in both groups were not informed whether the magnetic stimulation apparatus was running or not.Nine sessions were performed in both groups and the changes in the maximum voluntary contraction,explosive leg force and strength endurance of the local muscle groups of the lower limbs were subsequently observed in both groups. RESULTS AND CONCLUSION:Among the eight local muscle groups collected,seven local muscle groups in the test group showed an increase in the maximum voluntary contraction value after 3 weeks of low-frequency pulsed magnetic field stimulation.In the control group,there were only three muscle groups with improvement in the maximum voluntary contraction.The rate of improvement in the anterior and posterior muscle groups of the left leg in the test group was significantly higher than that in the control group.The longitudinal jump height and peak angular velocity of the knee joint in both groups were improved compared with the pre-test measurement,and the elevation rate of jumping height in the test group was higher than that in the control group.Under the fatigue condition,the decline rates of peak angular velocity of the knee joint and jumping height in the test group decreased significantly,while those in the control group did not change significantly.The above data confirmed that the low-frequency pulsed magnetic field stimulation with the intensity of 1.5 mT and frequency of 3 300 Hz could improve the muscle strength of more local muscle groups in the lower limbs of patients with COVID-19 during the recovery period compared with the human self-healing process,and the whole-body coordination ability and functional status based on explosive leg force of the legs could be significantly improved.Therefore,low-frequency pulsed magnetic field stimulation can be used as an effective,non-exercise rehabilitation tool to improve muscle weakness in the lower limbs of patients with COVID-19.

Objective:To evaluate the effect of electroacupuncture on liver regeneration after partial hepatectomy in mice and the role of the Notch signaling pathway.Methods:Thirty-six SPF healthy male C57BL/6 mice, aged 6 weeks, weighing 20-22 g, were divided into 6 groups ( n=6 each) using a random number table method: sham operation group (group S), partial hepatectomy group (group PH), non-acupoint electroacupuncture+ partial hepatectomy group (group NPH), partial hepatectomy+ Fli-06 group (group PH+ F), acupoint electroacupuncture+ partial hepatectomy group (group EPH), and acupoint electroacupuncture+ partial hepatectomy+ Fli-06 group (group EPH+ F). All the mice except for group S underwent partial hepatectomy. Fli-06 4.8 mg/kg was intraperitoneally injected starting from 2 days before surgery, once a day, until the mice were sacrificed in group PH+ F and group EPH+ F, while the equal volume of 0.9% sodium chloride solution was injected in the other groups. In EPH group, electroacupuncture of bilateral " Zusanli" acupoints lasting for 15 min was performed using continuous waves with a frequency of 2 Hz and an intensity of 1 mA once a day starting from the time point immediately after surgery for 3 consecutive days. Mice were anesthetized at day 2 after partial hepatectomy, and blood samples were taken from the eyeball for determination of the serum alanine transaminase (ALT) and aspartate aminotransferase (AST) concentrations (using a fully automated biochemical analyzer) and concentrations of serum epidermal growth factor (EGF) and hepatocyte growth factor (HGF) (by enzyme-linked immunosorbent assay). The mice were subsequently sacrificed and liver tissues were taken for calculation of the liver mass to body mass ratio and for determination of the expression of liver proliferation marker Ki-67 (by immunohistochemical staining), proliferating cell nuclear antigen (PCNA), cyclin D1 (CCND1), Notch Intracellular Domain (NICD), and hypoxia-inducible factor-1alpha (HIF-1α) (using Western blot) and Notch1, jagged canonical Notch ligand 1 (Jagged1) and hairy and enhancer of split 1 (Hes1) mRNA (by real-time polymerase chain reaction). Results:Compared with group S, the serum ALT, AST, EGF and HGF concentrations were significantly increased, and the expression of hepatic Notch1, Jagged1 and Hes1 mRNA and Ki-67, PCNA, CCND1 and NICD was up-regulated in group PH ( P<0.05 or 0.01). Compared with group PH, the liver mass to body mass ratio and serum EGF and HGF concentrations were significantly increased, the serum ALT and AST concentrations were decreased, and the expression of hepatic Notch1, Jagged1, Hes1 mRNA and Ki-67, PCNA, CCND1, NICD and HIF-1α was up-regulated in group EPH, and the liver mass to body mass ratio and the serum HGF concentrations were significantly decreased, the serum ALT and AST concentrations were increased, and the expression of hepatic Jagged1 and Hes1 mRNA and Ki-67, PCNA, CCND1, NICD, and HIF-1α was down-regulated in group PH+ F ( P<0.05 or 0.01). Compared with group EPH, the liver mass to body mass ratio and serum EGF and HGF concentrations were significantly decreased, the serum ALT and AST concentrations were increased, and the expression of hepatic Notch1, Jagged1, Hes1 mRNA and Ki-67, PCNA, CCND1, NICD and HIF-1α was down-regulated in group EPH+ F ( P<0.01). Conclusions:Electroacupuncture at Zusanli acupoint promotes liver regeneration after partial hepatectomy in mice, and the mechanism may be related to the activation of the Notch signaling pathway.

Gradual distraction with an external fixator is a widely used treatment for severe postburn ankle contracture (SPAC). However, application of external fixators is complex, and conventional two-dimensional (2D) imaging-based surgical planning is not particularly helpful due to a lack of spatial geometry. The purpose of this study was to evaluate the surgical planning process for this procedure with patient-specific three-dimension-printed models (3DPMs). In this study, patients coming from two centers were divided into two cohorts (3DPM group vs. control group) depending on whether a 3DPM was used for preoperative surgical planning. Operation duration, improvement in metatarsal-tibial angle (MTA), range of motion (ROM), the American Orthopedic Foot and Ankle Society (AOFAS) scores, complications, and patient-reported satisfaction were compared between two groups. The 3DPM group had significantly shorter operation duration than the control group ((2.0±0.3) h vs. (3.2±0.3) h,

Objective:To observe the expression of vascular endothelial growth factor (VEGF) and aquaporin 4 (AQP4) in the inner limiting membrane (ILM) of diabetic retinopathy (DR) with macular edema, and analyze the correlation between VEGF and AQP4 expression.Methods:A cross-sectional study. From September 2019 to September 2020, 38 eyes of 38 patients with DR and idiopathic macular hole (iMH) who underwent vitrectomy (PPV) combined with ILM stripping at the Hangzhou campus of The Affiliated Eye Hospital of Wenzhou Medical University at Hangzhou were included in the study. Among them, there were 25 males and 13 females who aged 37-76 years old, average age was 59±10 years old; All eye included 15 right eyes and 23 left eyes. iMH and DR included 9 eyes in 9 cases and 29 eyes in 29 cases, respectively, and they were divided into iMH group and DR group. The DR group was divided into DME group and no DME group according to whether it was accompanied by diabetic macular edema (DME), with 14 eyes and 15 eyes respectively. After the stripped ILM tissue was fixed, immunofluorescence analysis was performed to obtain a picture of the fluorescence mode of AQP4 and VEGF, and the fluorescence intensity value of VEGF and AQP4 was measured by Image J software. The differences of VEGF and AQP4 immunofluorescence values in the specimens between groups were compared by one-way analysis of variance. The correlation between the fluorescence intensity of AQP4 and the fluorescence intensity of VEGF was analyzed by Pearson correlation analysis.Results:The average fluorescence intensity valuesof VEGF and AQP4 in ILM specimens of DME group, no DME group and iMH group were 38.96±7.53, 28.25±3.12, 30.07±4.84 and 49.07±8.73, 37.96±6.45, 38.08±5.04, respectively. The average fluorescence intensity of VEGF and AQP4 in the ILM specimens of the DME group was significantly higher than that of the no DME group and iMH group, and the difference was statistically significant ( F=13.977, 9.454; P<0.05). The average fluorescence intensity values of VEGF and AQP4 on IML specimens in the DR group were 33.80±7.91, 43.76±9.44, respectively. The results of Pearson correlation analysis showed that the fluorescence intensity of VEGF and AQP4 in the ILM specimens of the DR group was significantly positively correlated ( r=0.597, P=0.003). Conclusions:The expressions of VEGF and AQP4 in ILM of eyes with DR and DME are significantly increased compared with those without DME. The expression of VEGF and AQP4 in ILM of eyes with DR is positively correlated.

Objective:This study is to investigate the parameter settings and imaging effects of Micro-CT scanning externalmalignancies during operation and summarize the characteristics of Micro-CT images regarding external soft tissue and tumors.Methods:According to the inclusion criteria, patients with externalmalignancies admitted to the Department of Plastic and Reconstructive Surgery of the First Medical Center of the PLA General Hospital from October 2018 to January 2020 were collected. Through the surgical resection of tumors, the isolated tumor specimens were divided into appropriate sizes (length × width × thickness not exceeding 5 cm×3 cm×3 cm), placed on the Micro-CT scanning bed, and scanned with different parameters. (1) Scanning with different times: with the fixedscanning voltage (50 kV for sarcoma, 70 kV for other tumors), the same specimen was scanned with 4min and 14min protocols respectively. (2) Scanning with different voltages: with the fixed scanning time (4 min), the same specimen was scanned with 30, 50, 70, and 90 kV voltages respectively. After comparing the imaging results with different scanning times and different scanning voltages, the optimal scanning parameters for different tumors were obtained. (3) The regions of interest for radiology were taken from the specimens, and pathological HE stained slides were prepared. Digital slices were obtained by precice automatic digital slice scanning system. The slices were compared with Micro-CT corresponding cross-sectional images and the radiological characteristics of different tissues were recorded.Results:A total of 27 patients were included/incorporated into the study and there were 15 males and 12 females, aged from 33 to 82, with an average age of 63.9 years old, including 16 cases of skin squamous cell carcinoma, 2 cases of basal cell carcinoma, and 2 cases of extramammary Paget′s disease, 1 case of melanoma, 3 cases of cutaneous fibrosarcoma, 1 case of angiosarcoma, and 2 cases of liposarcoma. A total of 65 groups were compared between Micro-CT images and pathology slides. (1) Scanning time: both 4 min and 14 min scanning times can obtain clear images which can meet requirements for morphology observation and identification of margins of tumors. (2) Scanning voltage: as for squamous cell carcinoma, the quality of images obtained by the scanning voltage of 30 and 50 kV is poor, while by the voltage of 70 and 90 kV is high. As for sarcoma, the quality of images obtained by the scanning voltage of 30 kV is poor; by the voltage of 50 kV is high and the contrast between tumor and subcutaneous fat is low by the scanning voltage of 70 and 90 kV. (3) The radiological morphology of external tumors and surrounding tissues are similar with the pathology slides. The boundary between skin and subcutaneous tissue is clear and the hair follicles are clearly distinguishable. The radiological characteristics of tumors are related to the type of tumors and the density of tumors, including high-density shadows, thicker than normal skin, no hair follicles and some small calcification points. The boundary between squamous cell carcinoma or sarcoma and normal skin or subcutaneous can be distinguished. As for the tumors in the skin, such as basal cell carcinoma, extra-mammary Paget′s disease, etc. the imaging results are poor.Conclusions:The Micro-CT scanning parameters need to be set according to the type of the tumor. The scanning time has little effect on the evaluation of the tumor. It is recommended to choose the protocol of 4 min during operation. The recommended scanning voltage of squamous cell carcinoma is 70 kV and the voltage of sarcoma is 50 kV. Micro-CT can clearly imaging the skin structure of soft tissue specimens on the body surface; configuration is identifiable for tumors that invade beyond skin and have a large heterogeneity of density compared with surrounding tissues; for tumors that do not exceed the dermis, the imaging effect is not good.

Objective:This study is to investigate the parameter settings and imaging effects of Micro-CT scanning externalmalignancies during operation and summarize the characteristics of Micro-CT images regarding external soft tissue and tumors.Methods:According to the inclusion criteria, patients with externalmalignancies admitted to the Department of Plastic and Reconstructive Surgery of the First Medical Center of the PLA General Hospital from October 2018 to January 2020 were collected. Through the surgical resection of tumors, the isolated tumor specimens were divided into appropriate sizes (length × width × thickness not exceeding 5 cm×3 cm×3 cm), placed on the Micro-CT scanning bed, and scanned with different parameters. (1) Scanning with different times: with the fixedscanning voltage (50 kV for sarcoma, 70 kV for other tumors), the same specimen was scanned with 4min and 14min protocols respectively. (2) Scanning with different voltages: with the fixed scanning time (4 min), the same specimen was scanned with 30, 50, 70, and 90 kV voltages respectively. After comparing the imaging results with different scanning times and different scanning voltages, the optimal scanning parameters for different tumors were obtained. (3) The regions of interest for radiology were taken from the specimens, and pathological HE stained slides were prepared. Digital slices were obtained by precice automatic digital slice scanning system. The slices were compared with Micro-CT corresponding cross-sectional images and the radiological characteristics of different tissues were recorded.Results:A total of 27 patients were included/incorporated into the study and there were 15 males and 12 females, aged from 33 to 82, with an average age of 63.9 years old, including 16 cases of skin squamous cell carcinoma, 2 cases of basal cell carcinoma, and 2 cases of extramammary Paget′s disease, 1 case of melanoma, 3 cases of cutaneous fibrosarcoma, 1 case of angiosarcoma, and 2 cases of liposarcoma. A total of 65 groups were compared between Micro-CT images and pathology slides. (1) Scanning time: both 4 min and 14 min scanning times can obtain clear images which can meet requirements for morphology observation and identification of margins of tumors. (2) Scanning voltage: as for squamous cell carcinoma, the quality of images obtained by the scanning voltage of 30 and 50 kV is poor, while by the voltage of 70 and 90 kV is high. As for sarcoma, the quality of images obtained by the scanning voltage of 30 kV is poor; by the voltage of 50 kV is high and the contrast between tumor and subcutaneous fat is low by the scanning voltage of 70 and 90 kV. (3) The radiological morphology of external tumors and surrounding tissues are similar with the pathology slides. The boundary between skin and subcutaneous tissue is clear and the hair follicles are clearly distinguishable. The radiological characteristics of tumors are related to the type of tumors and the density of tumors, including high-density shadows, thicker than normal skin, no hair follicles and some small calcification points. The boundary between squamous cell carcinoma or sarcoma and normal skin or subcutaneous can be distinguished. As for the tumors in the skin, such as basal cell carcinoma, extra-mammary Paget′s disease, etc. the imaging results are poor.Conclusions:The Micro-CT scanning parameters need to be set according to the type of the tumor. The scanning time has little effect on the evaluation of the tumor. It is recommended to choose the protocol of 4 min during operation. The recommended scanning voltage of squamous cell carcinoma is 70 kV and the voltage of sarcoma is 50 kV. Micro-CT can clearly imaging the skin structure of soft tissue specimens on the body surface; configuration is identifiable for tumors that invade beyond skin and have a large heterogeneity of density compared with surrounding tissues; for tumors that do not exceed the dermis, the imaging effect is not good.

The clinical, pathological features and diagnostic methods of one case of adult-onset neuronal intranuclear inclusion disease (NIID) were analyzed. The patient was 61-year-old female presented with progressive cognitive impairment, episodic unconsciousness, stroke-like attack and paroxysmal digestive tract symptoms. Diffusion-weighted images showed high signals at the cerebral cortico-medullary junction with lace-type distribution, which persisted. Skin biopsy revealed intranuclear inclusion bodies in adipocytes, fibroblasts, and sweat gland cells. This case suggests that adult neuronal nuclear inclusion disease is a chronically progressive neurodegenerative disease with a highly clinical heterogeneity. The subcortical lace sign and eosinophilic intranuclear inclusion bodies by skin biopsy contribute to the diagnosis.

AIM: To investigate the effect of hypercapnia on hypoxia-induced pulmonary hypertension and the changes of lysyl oxidase (LOX) and extracellular matrix collagen cross-links in the rat.METHODS: Sprague-Dawley rats were randomly divided into 4 groups: normoxia group, hypoxia group, hypercapnia group and hypoxia+hypercapnia group.LOX activity was detected by fluorescence spectrophotometry.LOX protein expression was detected by immunohistochemistry and Western blot.The mRNA expression of LOX in the pulmonary artery was detected by real-time PCR.RESULTS: The levels of mean pulmonary artery pressure (mPAP), RV/(LV+S) and WA/TA in hypoxia group were significantly higher than those in normoxia group (P<0.01).Moreover, the levels of mPAP and RV/(LV+S) in hypoxia+hypercapnia group were significantly lower than those in hypoxia group (P<0.01).However, no significant difference of mPAP and RV/(LV+S) between hypercapnia group and normoxia group was observed.In hypoxia group, the collagen cross-links in the lung tissue was significantly higher than that in normoxia group and hypercapnia group (P<0.01).Importantly, collagen cross-links in the lung tissue of hypoxia+hypercapnia group was significantly lower than that in hypoxia group (P<0.01).There was no significant difference in collagen cross-links between hypercapnia group and normoxia group.The expression of LOX at mRNA and protein levels and its activity in the pulmonary arteries of hypoxia group were significantly increased as compared with normoxia group (P<0.01).Furthermore, the expression of LOX at mRNA and protein levels and its activity in the pulmonary arteries in hypoxia+hypercapnia group were lower than those in hypoxia group (P<0.01).CONCLUSION: Hypoxia not only up-regulates LOX but also promotes collagen cross-linking in the rat lung, which contributes to the development of pulmonary hypertension.Hypercapnia inhibits hypoxia-induced LOX expression and collagen cross-linking, therefore impairing the progress in hypoxia-induced pulmonary hypertension.

The information-knowledge-intelligence transformation rules were introduced as the theory for the transformation of information service main body for evidence-based medicine according to the analysis of domestic and foreign institutional main body and personal main body for the information service of evidence-based medicine.It was proposed that medical library as the institutional main body should be transformed into information repository + thinking library and clinical medical librarians as the personal main body should be transformed into evidence witness + decision making adviser with associated literacy.