Objective:To explore the clinical effects of combined surgical and high-frequency electro-acupuncture treatment for aesthetic restoration in children with eyelid split nevus.Methods:A retrospective analysis was conducted on the medical records of children treated for eyelid split nevus in the Plastic Surgery Department of the First Affiliated Hospital of Army Medical University from January 2019 to December 2023. All cases underwent combined surgical excision and high-frequency electro-acupuncture vaporization. Surgical removal was used for nevi with significant pigmentation and deep involvement, and high-frequency electro-acupuncture was simultaneously applied to vaporize residual superficial pigmentation layer by layer based on the depth of the pigmentation. The wounds were repaired using either direct suturing or local flap transfer. Postoperative management included the application of growth factors and anti-scar treatments. Postoperative healing, adverse effects, and pigment clearance rate (categorized as healed, significant effect, improved, or ineffective) were observed by comparsons of the pre-treatment and the last follow-up photographs. Eyelid function, appearance, and scar hypertrophy were assessed during follow-up, and family satisfaction (categorized as very satisfied, satisfied, or dissatisfied) was surveyed via telephone.Results:Five children were included, with one male and four females aged between 2 and 10 years (average 7 years). Pigment areas ranged from 0.3 cm × 0.5 cm to 1.7 cm × 1.1 cm, with surgical excision areas from 0.3 cm × 0.4 cm to 1.5 cm × 1.1 cm. All children had good wound healing without complications such as infection, flap ischemic necrosis, wound dehiscence or bleeding. The pigment clearance rate was over 90%, achieving a healed effect. During the follow-up of 14 to 48 months (average 24.2 months), all patients had normal eyelid function without difficulties in opening or closing the eyes, or epiphora. The eyelid appearance was satisfactory without asymmetry, ptosis, ectropion or hypertrophic scars. The aesthetic outcomes and functionality of the eyelids were ideal, and satisfaction was generally rated as very satisfied.Conclusion:Surgical removal combined with high-frequency electro-acupuncture is beneficial for preserving aesthetic appearance while pigmentation in children with eyelid split nevus is removed, offering a new treatment option.

Purpose To explore the value of CT-based radiomics in the preoperative prediction of lymphatic invasion of node-negative gastric cancer,and to construct a nomogram combined with clinical variables.Materials and Methods The clinical and CT imaging data of 173 gastric cancer patients with lymph node negative and pathologically confirmed gastric cancer in the Sir Run Run Shaw Hospital from January 2019 to June 2021 were retrospectively analyzed.A total of 60 cases with lymphovascular invasion(LVI)positive patients and 113 cases with LVI negative patients were included,and randomly divided into train cohort(n=121)and test cohort(n=52)at 7∶3.Based on the train cohort,the clinical model,the radiomics model,the fusion model were constructed and verified in the test cohort.Clinical data and conventional CT features included age,gender,tumor marker,tumor location,tumor morphology,enhancement range,etc.The clinical significant variables were selected through univariate and multivariate analysis to establish the clinical model.The tumor regions of interest were segmented and radiomics features were extracted by using the 3D-Slicer software.Key features were screened through least absolute shrinkage and selection operator regression analysis,and then the radiomics model was constructed with random forest algorithm,and converted to random forest score(RF score).The fusion model was constructed via combining clinical significant variables and RF score,and visualized as a nomogram.The receiver operator characteristic curve and area under curve(AUC)were used to evaluate the prediction performance of the models.Decision curve analysis was used to calculate the clinical practicability.Results The radiomics model was superior to the clinical model.The radiomics model AUC of the train cohort and the test cohort were 0.872(0.810 to 0.935)and 0.827(0.707 to 0.947),the clinical model AUC were 0.767(0.682 to 0.852)and 0.761(0.610 to 0.913).The nomogram further improved the predictive efficiency,the AUC in train cohort and test cohort reached 0.898(0.842 to 0.953)and 0.844(0.717 to 0.971),respectively.Decision curve analysis demonstrated clinical benefits of nomogram.Conclusion The radiomics model can be used to preoperatively predict LVI of node-negative gastric cancer.The nomogram can further improve the prediction efficiency.

Objective:To investigate the clinical efficacy of pentoxifylline sequential therapy combined with rasagiline and levodopa in the treatment of elderly patients with symptoms of Parkinson disease (PD), and the influence on hemorheology and serum Toll-like receptor 4 (TLR4) signaling pathway downstream related inflammatory factors.Methods:A prospective study method was used to select 90 elderly patients with PD with fluctuating symptoms who were admitted to the Eighth People′s Hospital of Hebei Province from June 2021 to October 2022 as research objects. The patients were divided into observation group and control group with 45 cases in each group according to random number table method. The observation group was treated with pentoxifylline sequential therapy combined with rasagiline and levodopa. The control group was treated with rasagiline combined with levodopa. The clinical efficacy of the two groups was compared. The unified Parkinson disease rating scale (UPDRS), Montreal cognitive assessment scale (MoCA), Berg balance scale (BBS) and 39-item Parkinson disease quality of life questionnaire (PDQ-39) were scored before and after treatment. Hemorheology indexes and serum levels of related inflammatory factors downstream of TLR4 signaling pathway, including whole blood high viscosity (HBV), whole blood low shear viscosity (LBV), plasma viscosity (PV), fibrinogen (FIB); TLR4, interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF) -α, were detected before and after treatment in both groups. The adverse reactions of the two groups were compared.Results:The total effective rate in observation group was significantly higher than that in control group: 93.33% (42/45) vs. 77.78% (35/45), and there was statistical difference ( P<0.05). After treatment, the UPDRS mental activity and emotional disorders, daily living ability, motor function, motor complications scores and PDQ-39 score of the two groups were significantly lower than before treatment, the MoCA and BBS scores were significantly higher than before treatment, and the improvement was more significant in the observation group, there were statistical differences ( P<0.05). After treatment, HBV, LBV, PV and FIB in the observation group were significantly decreased compared with those before treatment: (6.52 ± 0.92) mPa·s vs. (7.25 ± 1.24) mPa·s, (11.45 ± 1.24) mPa·s vs. (14.13 ± 1.64) mPa·s, (1.55 ± 0.17) mPa·s vs. (1.88 ± 0.22) mPa·s, (3.25 ± 0.47) g/L vs. (3.82 ± 0.52) g/L, and there were statistical differences ( P<0.05). There were no significant differences in hemorheology indexes of control group before and after treatment ( P>0.05). After treatment, serum levels of TLR4, IL-1β, IL-6 and TNF-α in both groups were significantly decreased compared with those before treatment, and the indexes in observation group were significantly lower than those in control group: (2.07 ± 0.18) ng/L vs. (2.58 ± 0.21) ng/L, (1.42 ± 0.17) ng/L vs. (2.28 ± 0.25) ng/L, (1.56 ± 0.22) ng/L vs. (2.42 ± 0.28) ng/L, (46.31 ± 3.17) ng/L vs. (54.34 ± 3.65) ng/L, and the differences were statistically significant ( P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P>0.05). Conclusions:Pentoxifylline sequential therapy combined with rasagiline and levodopa can effectively improve the hemorheology of elderly patients with PD accompanied by symptom fluctuations, reduce the levels of related inflammatory factors downstream of serum TLR4 signaling pathway, and improve clinical efficacy.

Objective To investigate the content stability of polymyxin B sulfate in high concentration solution and its finished infusion,and to provide a scientific basis for clinical administration.Methods Polymyxin B sulfate was dissolved in 0.9%sodium chloride injection and 5%glucose solution to the concentrations of 0.5 mg·mL-1,1 mg·mL-1 and 5 mg·mL-1,respectively.The content of polymyxin B was determined at 0,2,4,6,8,12,16,20 and 24 h by high-performance liquid chromatography under storage conditions of 4℃and 25℃.Results Polymyxin B sulfate was stable in the concentrations of 0.5 mg·mL-1,1 mg·mL-1 and 5 mg·mL-1,respectively,in 0.9%sodium chloride injection or 5%glucose injection.Under the storage conditions of 4℃and 25℃,the content of polymyxin B1 and polymyxin B2 ranged from 97.23%to 101.26%and 97.30%to 102.63%,respectively.Conclusion Polymyxin B sulfate was stable within 24 h dissolved either in 0.9%sodium chloride injection or in 5%glucose injection with the concentrations of 0.5 mg·mL-1,1 mg·mL-1 and 5 mg·mL-1 under the storage condition of 4℃and 25℃.

Objective:To explore the clinical effects of combined surgical and high-frequency electro-acupuncture treatment for aesthetic restoration in children with eyelid split nevus.Methods:A retrospective analysis was conducted on the medical records of children treated for eyelid split nevus in the Plastic Surgery Department of the First Affiliated Hospital of Army Medical University from January 2019 to December 2023. All cases underwent combined surgical excision and high-frequency electro-acupuncture vaporization. Surgical removal was used for nevi with significant pigmentation and deep involvement, and high-frequency electro-acupuncture was simultaneously applied to vaporize residual superficial pigmentation layer by layer based on the depth of the pigmentation. The wounds were repaired using either direct suturing or local flap transfer. Postoperative management included the application of growth factors and anti-scar treatments. Postoperative healing, adverse effects, and pigment clearance rate (categorized as healed, significant effect, improved, or ineffective) were observed by comparsons of the pre-treatment and the last follow-up photographs. Eyelid function, appearance, and scar hypertrophy were assessed during follow-up, and family satisfaction (categorized as very satisfied, satisfied, or dissatisfied) was surveyed via telephone.Results:Five children were included, with one male and four females aged between 2 and 10 years (average 7 years). Pigment areas ranged from 0.3 cm × 0.5 cm to 1.7 cm × 1.1 cm, with surgical excision areas from 0.3 cm × 0.4 cm to 1.5 cm × 1.1 cm. All children had good wound healing without complications such as infection, flap ischemic necrosis, wound dehiscence or bleeding. The pigment clearance rate was over 90%, achieving a healed effect. During the follow-up of 14 to 48 months (average 24.2 months), all patients had normal eyelid function without difficulties in opening or closing the eyes, or epiphora. The eyelid appearance was satisfactory without asymmetry, ptosis, ectropion or hypertrophic scars. The aesthetic outcomes and functionality of the eyelids were ideal, and satisfaction was generally rated as very satisfied.Conclusion:Surgical removal combined with high-frequency electro-acupuncture is beneficial for preserving aesthetic appearance while pigmentation in children with eyelid split nevus is removed, offering a new treatment option.

Objective:To provide evidence-based recommendations for the prevention and management of lower limb ischemia in veno-arterial extracorporeal membrane oxygenation (VA-ECMO) patients during treatment according to search, evaluate, and summarize the best evidence on the prevention and management of lower limb ischemia in patients with VA-ECMO.Methods:Based on the PIPOST framework (population, intervention, professional, outcome, setting, and type of evidence), an evidence-based question was formulated. A systematic search was conducted according to the "6S" evidence pyramid model in both domestic and international databases, as well as professional association websites, for all evidence related to the prevention and management of lower limb ischemia in VA-ECMO patients (aged ≥18 years). The types of evidence included clinical decisions, guidelines, expert consensus, systematic reviews, evidence summaries, and original studies. The search was conducted from the construction of the databases to February 2024. Two researchers independently conducted a literature quality evaluation, extracted and summarized evidence from the studies that met the quality criteria.Results:A total of 13 articles were included, consisting of 3 clinical decisions, 3 guidelines, 3 expert consensus, 3 systematic reviews, and 1 randomized controlled trial. A total of 18 pieces of evidence in 7 dimensions were summarized, including risk factors of VA-ECMO lower limb ischemia, evaluation before catheterization, evaluation and monitoring during treatment, prevention of lower limb ischemia, treatment of lower limb ischemia, management of distal perfusion catheter (DPC), and monitoring after VA-ECMO weaning.Conclusion:This evidence summary provides evidence-based recommendations for the prevention and management of lower limb ischemia in VA-ECMO patients, aiming to assist clinical healthcare professionals in developing tailored strategies for the prevention and management of lower limb ischemia based on during VA-ECMO support.

Objective To detect the expression of translationally-controlled tumor protein 1(TPT1)in renal cell carcinoma(RCC)and to explore its role in RCC.Methods Microarray dataset GSE15641(including 23 normal kidney tissue samples and 32 RCC tissue samples)was downloaded from the Gene Expression Omnibus,and differentially expressed genes between RCC tissue and normal kidney tissue were screened using R 4.3.0 software.The TPT1 expression in RCC tissue and adjacent non-tumor tissue of 90 patients diagnosed and treated at Affiliated Hospital of Nantong University,as well as in human RCC cells(769-P,786-O,ACHN,and Caki-1)and human embryonic kidney 293 cell(HEK293)was detected by quantitative polymerase chain reaction(qPCR)and Western blotting.The relationship between TPT1 expression and clinical pathological characteristics of RCC patients was analyzed by χ2 test.The clinical data of 522 RCC patients were derived from The Cancer Genome Atlas,and the correlation between TPT1 expression and prognosis of RCC patients was analyzed by receiver operating characteristic(ROC)curve and Kaplan-Meier survival curve.After in vitro transfection of TPT1 small interfering RNA(siRNA)and its negative control(NC)into 786-O and Caki-1 cells,the TPT1 expression was detected by qPCR and Western blotting;the proliferation,migration,and invasion were detected by cell counting kit 8 assay,scratch assay,and Transwell assay,respectively;and the expression of apoptosis-related proteins was detected by Western blotting.Results TPT1 expression was significantly upregulated in the RCC tissue and cells compared with the normal kidney tissue and HEK293 cells(all P＜0.05).The RCC patients with low TPT1 expression levels had significantly smaller tumor size and lower metastasis rate than those with high TPT1 expression levels(both P＜0.05).The ROC curve analysis results indicated that TPT1 had high diagnostic value for RCC(area under curve was 0.856 9,95%confidence interval was 0.804 5-0.909 3,P＜0.001).The Kaplan-Meier survival analysis results showed that the overall survival of RCC patients in the low TPT1 expression group was significantly longer than that in the high TPT1 expression group(P=0.018 4).In the cell experiment,compared with the siRNA NC group,the proliferation activity,scratch healing rate,and invading transmembrane cell number of 786-O and Caki-1 cells were significantly decreased after transfection with TPT1 siRNA(all P＜0.01);the expression levels of B-lymphoma gene 2(Bcl-2)and matrix metalloproteinase-9 were significantly decreased,while the expression of Bcl-2 associated X protein was significantly increased(all P＜0.05).Conclusion TPT1 is involved in the progression of RCC and may be a potential therapeutic target for RCC.

Purpose To investigate the value of MRI multimodal parameters in predicting sentinel lymph node(SLN)metastasis of breast cancer,and to develop an effective prediction model to reduce the unnecessary biopsy rate of SLN.Materials and Methods Preoperative MRI data of 310 patients with cN0 breast cancer confirmed by operation and pathology in Sir Run Run Shaw Hospital,Zhejiang University School of Medicine from January 2019 to December 2021 were retrospectively analyzed,and all patients were divided into positive group and negative group according to whether SLN metastasized.Imaging features of breast lesions were evaluated independently by two radiologists,differences in parameter between the two groups were compared,independent predictors were screened to build models and evaluate diagnostic efficacy.Results The breast lesions in SLN positive group were located in the upper quadrant(χ2=14.94),non-single(χ2=9.29),circular enhancement(χ2=9.23)and the positive rate of adjacent angiogenesis(χ2=9.91)were higher than those in SLN negative group.The lesions in SLN positive group were larger(Z=-2.97,-2.73),and the early enhancement rate was higher(t=-3.48).The minimum apparent diffusion coefficient and relative apparent diffusion coefficient(minimum apparent diffusion coefficient of lesions/apparent diffusion coefficient of glands,rADC)were lower(Z=-7.33,-10.74),all P<0.05.Logistic regression results showed lesion location(OR=4.17,95%CI 1.86-9.35,P=0.001),early enhancement rate(OR=1.01,95%CI 1.00-1.02,P=0.019)and rADC(OR=54.67,95%CI 23.72-126.02,P<0.001)were independent risk factors for SLN metastasis.The model combining lesion location and rADC had the best predictive performance,with a negative predictive value of 96.5%and a 46.1%reduction in unnecessary biopsies.Conclusion SLN preoperative prediction model(lesion location,rADC)based on conventional MRI characteristic parameters has reliable negative prediction value,which is expected to reduce the unnecessary biopsy of nearly half of the patients with stage cN0 breast cancer.

Objective To explore the improvements of high-fat intake on lung injury induced by Paragonimus proliferus infection in rats, and to preliminarily explore the mechanisms underlying the role of cytochrome P450 4A1 (CYP 4A1) in the improve ments. Methods SD rats were randomly assigned into three groups, including the normal control group (n = 10), the infection and normal diet group (n = 12) and the infection and high-fat diet group (n = 12). Rats in the normal control group were fed with normal diet and without any other treatments, and animals in the infection and normal diet group were subcutaneously injected with 8 excysted metacercariae of P. proliferus via the abdominal wall, followed by feeding with normal diet, while rats in the infection and high-fat diet group were subcutaneously injected with 8 excysted metacercariae of P. proliferus via the abdominal wall, followed by feeding with high-fat diet. All rats were sacrificed 28 weeks post-infection, and serum samples and lung specimens were collected. Following hematoxylin-eosin (HE) staining of rat lung specimens, the rat lung injury was observed under an optical microscope, and alveolitis was evaluated using semi-quantitative scoring. Serum interleukin-1β (IL-1β) and tumor necrosis factor alpha (TNF-α) levels were measured using enzyme-linked immunosorbent assay (ELISA), and the cytochrome P450 4A1 (CYP 4A1) expression was quantified in rat lung specimens at transcriptional and translational levels using quantitative real-time PCR (qPCR) and Western blotting assays. Results Alveolar wall thickening, edema and inflammatory cell infiltration were alleviated 28 weeks post-infection with P. proliferus in rats in the infection and high-fat diet group relative to the infection and normal diet group, and no alveolar consolidation was seen in the infection and high-fat diet group. The semi-quantitative score of alveolitis was significantly higher in the infection and normal diet group [(2.200 ± 0.289) points] than in the normal control group [(0.300 ± 0.083) points] and the infection and high-fat diet group [(1.300 ± 0.475) points] (both P values < 0.05), and higher serum IL-1β [(151.586 ± 20.492)] pg/mL and TNF-α levels [(180.207 ± 23.379) pg/mL] were detected in the infection and normal diet group than in the normal control group [IL-1β: (103.226 ± 3.366) pg/mL; TNF-α: (144.807 ± 1.348) pg/mL] and the infection and high-fat diet group [IL-1β: (110.131 ± 12.946) pg/mL; TNF-α: (131.764 ± 27.831) pg/mL] (all P values < 0.05). In addition, lower CYP 4A1 mRNA (3.00 ± 0.81) and protein expression (0.40 ± 0.02) was quantified in lung specimens in the infection and normal diet group than in the normal control group [(5.03 ± 2.05) and (0.84 ± 0.14)] and the infection and high-fat diet group [(11.19 ± 3.51) and (0.68 ± 0.18)] (all P values < 0.05). Conclusion High-fat intake may alleviate lung injuries caused by P. proliferus infection in rats through up-regulating CYP 4A1 expression in lung tissues at both translational and transcriptional levels.

OBJECTIVE: To explore the clinical and molecular characteristics of a child with Congenital disorders of glycosylation (CDG). METHODS: A 4-month-old boy who had presented at the Children's Hospital Affiliated to Zhejiang University Medical School on December 31, 2019 due to feeding difficulties after birth was selected as the study subject. High-throughput sequencing was carried out for the patient, and real-time qPCR was used for validating the suspected deletion fragments and the carrier status of other members of his family. RESULTS: High-throughput sequencing revealed that the child had lost the capture signal for chrX: 153 045 645-153 095 809 (approximately 50 kb), which has involved 4 OMIM genes including SRPK3, IDH3G, SSR4 and PDZD4. qPCR verified that the copy number in this region was zero, while that of his elder brother and parents was all normal. CONCLUSION The deletion of the fragment containing the SSR4 gene in the Xq28 region probably underlay the SSR4-CDG in this child.
Aged ; Child ; Humans ; Infant ; Male ; Gene Deletion ; Glycosylation ; High-Throughput Nucleotide Sequencing ; Neoplasm Proteins ; Parents ; Siblings