Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous syestem (CNS) triggered by an autoimmune mechanism, which is the main cause of neurological disability in young people. In MS, a variety of glial cells participate in the pathogenesis and development of the disease, and oligodendrocytes (OL) and myelin cytes are destroyed by autoimmune mediated inflammation. Impaired OL production of oligodendrocyte progenitor cells (OPC) leads to persistent demyelination, myelin fragment accumulation and axonal injury, with clinical manifestation of CNS disability. Microglia (MG), which is involved in the inflammatory response and removal of myelin debris, plays a pivotal role in OPC differentiation and OL maturation, thereby directly or indirectly influencing the process of myelin regeneration. An interactive mechanism exists between these 2 components. The comprehension of the interrelationship between the 2 factors can provide enhanced insights into the pathogenesis of MS and facilitate the development of novel therapeutic strategies, thereby addressing pivotal scientific challenges encountered in clinical management of MS. Therefore, this review summarizes the dynamic changes of microglia in MS and its classic animal models, explores the internal relationship between MG and OL in this process, and focuses on the beneficial effects of targeted regulation of microglia, thereby promoting OPC differentiation and myelin regeneration, in order to provide a new research direction for MS treatment.

OBJECTIVE: To investigate the feasibility and effectiveness of fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus. METHODS: Between March 2019 and August 2022, 9 patients with sacrococcygeal pilonidal sinus were admitted, including 7 males and 2 females with an average age of 29.4 years (range, 17-53 years). The disease duration ranged from 1 to 36 months, with a median of 6 months. There were 7 cases with obesity and dense hair, 3 cases with infection, and 2 cases with positive bacterial culture of sinus secretion. The wound area after excision ranged from 3 cm×3 cm to 8 cm×4 cm, with a depth of 3-5 cm, reaching the perianal or caudal bone; there were 2 cases with perianal abscess formation and 1 case with caudal bone inflammatory edema. Enlarged resection was performed during operation, and the fascial tissue flap and skin flap were designed and excised at both left and right sides of the buttock, ranging from 3.0 cm×1.5 cm to 8.0 cm×2.0 cm. A cross drainage tube was placed at the bottom of the wound, and the fascial tissue flap and skin flap were advanced and sutured in three layers, namely, 8-string sutures in the fascial layer, barbed wire reduction sutures in the dermis, and interrupted skin sutures. RESULTS: All 9 patients were followed up 3-36 months, with an average of 12 months. All incisions healed by first intention, and no complication such as incisional dehiscence or infection in the operative area occurred. There was no recurrence of sinus tracts, the shape of gluteal sulcus was satisfactory, both sides of buttocks were symmetrical, local incision scar was concealed, and the shape disruption was minimal. CONCLUSION Fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus can effectively fill the cavity and reduce the incidence of poor incision healing, with the advantages of small trauma and simple operation.
Male ; Female ; Humans ; Adult ; Pilonidal Sinus/surgery* ; Treatment Outcome ; Surgical Flaps ; Plastic Surgery Procedures ; Skin Transplantation ; Soft Tissue Injuries/surgery* ; Sutures ; Perforator Flap

OBJECTIVE To study the effects of disodium cantharidinate on the pharmacokinetic behavior of capecitabine in rats. METHODS Rats were randomly divided into two control groups and two experimental groups with 6 rats in each group. Two control groups were intraperitoneally injected with normal saline， and two experimental groups were intraperitoneally injected with Disodium cantharidinate injection of 0.5 mL/kg， for 7 consecutive days. Eight days after medication， control group 1 and experimental group 1 were given capecitabine 5 mg/kg intragastrically， while control group 2 and experimental group 2 were given capecitabine 5 mg/kg intravenously. Blood samples were collected at different time points after administration. After extraction with ethyl acetate， the concentration of capecitabine in rat plasma was determined by UPLC-MS/MS method using tolbutamide as the internal standard. The pharmacokinetic parameters were calculated by DAS 2.0 software. RESULTS Compared with control group 1， MRT0－∞， cmax， AUC0－30 h， AUC0－∞ and F of experimental group 1 were increased significantly， while CLz/F was decreased significantly （P＜0.01）. Compared with control group 2， t1/2， MRT0－30 h， MRT0-∞， AUC0－30 h and AUC0－∞ of experimental group 2 were increased significantly （P＜0.01）. CONCLUSIONS Disodium cantharidinate can increase the plasma exposure of capecitabine in rats， improve its oral bioavailability， prolong the average residence time， and reduce its clearance rate.

OBJECTIVE: To explore the effectiveness of hairpin shaped incision combined with cover-lifting flap in plastic surgery of huge fat pad on nape and back. METHODS: Between March 2019 and March 2023, 10 patients with huge fat pad on the nape and back were treated. There was 1 male and 9 females with an average age of 52 years (range, 39-57 years). All patients had soft tissue bulge on the nape and back. Preoperative MRI showed the subcutaneous fat thickening. The length of the longitudinal axis of the fat pad ranged from 10.0 to 25.0 cm (mean, 14.1 cm), the length of the transverse axis ranged from 6.0 to 15.0 cm (mean, 10.8 cm); the thickness of the fat pad ranged from 2.5 to 5.1 cm (mean, 3.9 cm). Under general anesthesia, the patient was placed in a prone position and a hairpin shaped incision was made. The flap was lifted to remove the fat pad according to the marked area. The dressing was changed every 2 days after operation. RESULTS: The operation time was 35-110 minutes (mean, 72 minutes). The intraoperative blood loss was 35-80 mL (mean, 49.5 mL). The drainage tube was removed at 2-5 days after operation (mean, 3.4 days). All incisions healed by first intention without incision dehiscence, infection, subcutaneous bruising, hematoma, or other related complications. All patients were followed up 2-24 months (mean, 12 months). All patients had a good shape of the nape and back and no noticeable scar on the incision. According to the Vancouver Scar Scale evaluation criteria, the incision scar score was 3-5 (mean, 3.7) at 2 months after operation. Patients had good neck movement with no recurrence. CONCLUSION For the huge fat pad on the nape and back, the plastic surgery using hairpin shaped incision and cover-lifting flap has the advantages of fully exposing the fat pad, concealed incision, simple operation, and natural shape of the nape and back after operation.
Female ; Humans ; Male ; Middle Aged ; Surgery, Plastic ; Cicatrix ; Lifting ; Plastic Surgery Procedures ; Surgical Wound ; Adipose Tissue

Objective:To analyze the changes of common pathogens of viral diarrhea in children during the COVID-19 epidemic.Methods:A retrospective analysis was performed on children with acute diarrhea treated in Children’s Hospital affiliated to Zhejiang University School of Medicine from 2019 April to 2019 December(before COVID-19, n=407)and 2020 April to 2020 December (during COVID-19, n=645). Children were further divided into 1-6 months, >6 months-2 years, >2-5 years age groups. Detection rates of norovirus GI (NOVI), norovirus GⅡ (NOVⅡ), rotavirus A (ROVA), rotavirus C (ROVC), intestinal adenovirus (EADV), sapovirus (SAV) and astrovirus (ASV) in different age groups and seasons before and during COVID-19 were compared by χ2 or Fisher exact test. Results:The total detection rates of diarrhea-causing viruses among age groups were significantly higher before COVID-19 than those during COVID-19( χ2=8.43, 38.22 and 9.23, all P<0.05). The detection rates of NOVⅡ and EADV in infants aged 1-6 months and >6 months-2 years were decreased during the period of COVID-19 epidemic( χNOVⅡ2 =36.87 and 17.77, both P<0.001, χEADV2 =9.08, P=0.014 and 0.003); the detection rates of NOVⅡ in children aged 2-5 years was decreased during the period of COVID-19 epidemic( χ2=3.96, P=0.047); the detection rates of other diarrhea-causing viruses were not decreased during the period of COVID-19 epidemic(all P>0.05). The detection rates of diarrhea-causing viruses among 4-6 months, 7-9 months and 10-12 months were higher during the period of COVID-19 epidemic( χ2=11.62, 65.41 and 27.80, all P<0.001). Conclusion:After the outbreak of COVID-19, the detection rate of common pathogens of viral diarrhea in children is decreased, especially NOVⅡ and EADV, which may be related to the measures in response to major public health events in Zhejiang Province.

Objective:To explore the incidence and the risk factors of post-polypectomy bleeding and polyp recurrence after colonoscopic high-frequency electrocoagulation snare polypectomy.Methods:Clinical data of 1 826 children who underwent colonoscopic high-frequency electrocoagulation snare polypectomy in the Children′s Hospital, Zhejiang University School of Medicine from January 2009 to December 2020 was retrospectively analyzed. Demographic characteristics, endoscopic manifestations, pathological features, diagnosis, occurrence of post-polypectomy bleeding and polyp recurrence were collected. The associated risk factors were analyzed by Logistic regression.Results:A total of 1 826 children (1 191 males and 635 females) with 1 967 polypectomies were included. The age was 4.6 (3.2, 6.4) years at initial diagnosis. According to the initial colonoscopy, 1 611 children (88.2%) had solitary polyps, 1 707 children (93.5%) had pedicled polyps, 1 151 children (63.0%) had polyps involving the rectum, and 1 757 children (96.2%) had hamartomatous polyps. Polyposis syndromes were diagnosed in 73 children (4.0%). The post-polypectomy bleeding occurrence was 3.8% (75/1 967). Polyps recurred in 88 children (4.8%). Girls ( OR=2.01, 95% CI 1.26-3.23) and sessile polyps ( OR=2.28, 95% CI 1.15-4.49) were risk factors for post-polypectomy bleeding (both P<0.05). Multiple polyps ( OR=17.49, 95% CI 9.82-31.18), right-colon involvement ( OR=3.44, 95% CI 1.89-6.26) and non-hamartoma ( OR=2.51, 95% CI 1.04-6.07) were risk factors for polyp recurrence (all P<0.05). Conclusions:Colonoscopic high-frequency electrocoagulation snare polypectomy has low incidence of post-polypectomy bleeding and polyp recurrence. Female patients and sessile polyps have higher risk for post-polypectomy bleeding. Multiple polyps, right-colon involvement and non-hamartoma polyps increase the risk for polyp recurrence.

The adjacent anatomy of the pelvis is complicated, with digestive, urinary, reproductive and other organs as well as important blood vessels and nerves. Therefore, accurate resection of pelvic tumors and precise reconstruction of defects after resection are extremely difficult. The development of medical 3D printing technology provides new ideas for precise resection and personalized reconstruction of pelvic tumors. The “triune” application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis in pelvic tumor limb salvage reconstruction treatment has achieved good clinical results. However, the current lack of normative guidance standards such as preparation and application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis restricts its promotion and application. The formulation of this consensus provides normative guidance for 3D printing personalized pelvic tumor limb salvage reconstruction treatment.

Objective:To investigate the differences of gastric mucosa microbiota between children with chronic gastritis and duodenal ulcer under the condition of Helicobacter pylori (Hp) infection. Methods:This prospective cohort study involved 57 children with Hp infection diagnosed by gastric endoscopy who were admitted to the Children′s Hospital of Zhejiang University School of Medicine due to "abdominal pain, abdominal distension and vomiting" between January 2018 to August 2018. According to gastroscopy and pathological examination, the children were divided into chronic gastritis group and duodenal ulcer group. Gastric mucosa from Hp infected patients were sampled, and the flora DNA was analyzed by high-throughput sequencing. The statistical difference of α diversity, β diversity between two groups were analyzed. The relative abundance of the two groups in each taxonomic level was analyzed statistically. T test, Rank sum test or χ 2 test was used for comparison between the two groups. Results:A total of 57 children diagnosed with Hp infection were enrolled in this study, including 42 cases of chronic gastritis (the age was (9.3±2.8) years, 22 males and 20 females) and 15 cases of duodenal ulcer (the age was (11.1±3.3) years, 9 males and 6 females). Alpha diversity index Chao and ACE in Hp infected chronic gastritis group were significantly higher than those in Hp infected duodenal ulcer group (217±50 vs. 183±64, t=2.088, P=0.009;218±47 vs. 192±76, t=1.566, P=0.016, respectively). The Beta-diversity index such as nonmetric multidimensional scaling (NMDS) analysis were significantly different in the two groups (analysis of similarity R=0.304, P=0.028). Among the main bacteria genera, there were 6 genera with significant differences between the two groups, which were Prevotella (0.190% (0.008%-1.983%) vs. 0.021% (0.005%-2.398%), Z=-2.537, P=0.011), Alloprevotella (0.097% (0.010%-0.813%) vs. 0.015% (0.003%-0.576%), Z=-2.492, P=0.013), Haemophilus (0.109% (0.004%-0.985%) vs. 0.014% (0.004%-0.356%), Z=-2.900, P=0.004), Neisseria (0.074% (0.004%-0.999%) vs. 0.024% (0.003%-0.255%), Z=-2.718, P=0.007), Streptococcus (0.166% (0.008%-1.869%) vs. 0.045% (0.006%-0.879%), Z=-2.537, P=0.010), and an unclassified- Microbacteriaceae (0.214% (0.060%-1.762%) vs. 0.117% (0.010%-0.954%), Z=-2.120, P=0.034). Linear discriminant analysis (LDA) effect sized analysis showed that at the genus level, only Prevotella was significantly enriched in the duodenal ulcer group (LDA=2.90, P=0.010), while Streptococcus, Neisseria and Haemophilus were significantly enriched in the chronic gastritis group (LDA=2.83, 2.82, 2.69, P=0.011, 0.007, 0.004, respectively). Conclusions:The gastric mucosal microbiota in duodenal ulcer associated with Hp is significantly different from that in chronic gastritis. Hp may promote the occurrence of peptic ulcer together with gastric microbiota.

Objective:To investigate the metal artifact reduction effect of orthopedic metal artifact reduction (O-MAR) techonology and its improvement effect on the image quality in CT examination in the patients with arthroplasty, and to elaborate the significance of the technology in clinical diagnosis and treatment of arthroplasty.Methods:The CT data of 20patients with hip or knee prostheses was collected.There were two tube voltages in each group of CT data:120and 140Kev.There were also two groups of CT data in each tube voltage group:nonO-MAR group and O-MAR group;there were four subgroups of CT data of each case:120 Kev/-O-MAR, 120Kev/+O-MAR, 140Kev/-O-MAR, 140Kev/+O-MAR.After data collection, Mimics software was applied to conduct three-dimensional (3D) reconstruction for purpose of the qualitative and quantitative analysis of CT data.Qualitative analysis mainly included the grade of severity of metal artifact and quality of data.Quantitative analysis included the volume of metal artifact, the average CT value and standard deviation (SD) in region of interest (ROI) .ROI 1and ROI 2were chosen at the location of beam hardening artifact (radial high-density metal artifact) and photon starvation artifact (band low-density metal artifact) , respectively.Results:According to the result of3D measurement, the volumes of artifact had no significant difference between 120 Kev/-O-MAR group and140Kev/-O-MAR group (P=0.062) , but there were siginificant differences in the volumes of artifact between other groups (P＜0.05) ;O-MAR technology decreased the volume of beam-hardening artifact obviously (P＜0.05) .According to the results of two-dimensional (2D) measurement, there was no significant difference in the average CT values in ROI 2between 120Kev/-O-MAR group and 140Kev/-O-MAR group (P=0.069) , but there were significant differences in the average CT values between other groups (P＜0.05) ;O-MAR technology decreased the high-density beam-hardening metal artifact and the low-density photon-starvation metal artifact in 2D measurement.Conclusion:O-MAR technology could significantly reduce the CT metal artifact of hip and knee prostheses and increase the clinical value of CT data.

Objective To investigate the short- to medium-term therapeutic effects of a new internal fixation device,intraosseous internal fixation(IO-FIX),in the foot-ankle arthrodesis.Methods From August 2016 to December 2018,32 patients(40 feet) underwent foot-ankle arthrodesis with IO-FIX at Department of Orthopaedic Surgery,The Ninth Peopled Hospital of Shanghai.They were 6 males and 26 females,aged from 23 to 83 years(61.7±15.1 years).There were 28 cases(36 feet) of hallux valgus,2 cases(2 feet) of ankle arthritis,one case(1 foot) of ankle rheumatoid arthritis and one case(1 foot) of naviculocuneiform arthrosis.The therapeutic effects were assessed in terms of imaging evaluation,American Orthopaedic Foot and Ankle Society(AOFAS) score,fusion rate and full weight-bearing time.Results The follow-up ranged from 3.0 to 31.3 months(mean,12.6 months).The total fusion rate was 95.0%(38/40);the total AOFAS score increased significantly from preoperative 41.9±9.5 to postoperative 86.9±4.7(P<0.05).The 28 patients(36 feet) with hallux valgus achieved a successful fusion rate of 97.2%(35/36) and full weight-bearing at 8 weeks after operation.Their fusion time ranged from 45 to 64 days(57.1 days).Their metatarsophalangeal angle was decreased significantly from 52.10±13.50 preoperatively to 13.40±4.90 postoperatively and their 1-2 intermetatarsal angle significantly from 14.5°±2.4°to 8.90±2.4°(P<0.05).Their AOFAS ankle-hindfoot score was improved significantly from 41.8±9.9 to 87.0±4.8(P<0.05).All the 3 cases of ankle arthrodesis achieved good bone union and full weight-bearing within 12 weeks and their AOFAS ankle-hindfoot score was improved significantly from preoperative 43.4±3.5 to 86.3±3.5 at the final follow-up.Conclusion In foot-ankle joint arthrodesis,due to advantages of stable fixation,zero profile,limited soft tissue irritation,reinforced bone bridge and easy reproducibility,10-FIX can lead to satisfactory short- to mid-term therapeutic effects.