Objective:To explore the application value and treatment effects of multiple free anterolateral perforator flaps of calf for reconstruction of multiple digital wounds in single hand.Methods:From August 2020 to March 2022, 12 patients with soft tissue defects in 35 digits were treated in Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital. Ten patients were male and 2 were female, aged 25 to 58 years old. Of the patients, 1 had soft tissue defects in 5 digits, 3 in 4 digits, 2 in 3 digits and 6 in 2 digits. The size of defects was from 1.2 cm ×1.2 cm to 7.0 cm×3.5 cm after debridement. The vascular perforators discovered from intraoperative explorations were found originating from the superficial peroneal artery in 24 flaps, from the peroneal artery in 7 flaps and from the anterior tibial artery in 4 flaps. During surgery, the perforator artery and accompanying veins of the flaps were anastomosed with the proper digital artery and palmar or dorsal subcutaneous veins in the recipient site, respectively. The size of the flaps was from 1.5 cm×1.5 cm to 7.5 cm×4.0 cm. No nerve was affected in the surgery. The wound at donor sites in the calf was sutured directly. Regular postoperative follow-ups were conducted at outpatient clinics. The comprehensive evaluation scale of flap was used to assess the conditions of the donor and recipient sites.Results:In this study, all 35 soft tissue defects of digits in 12 patients were reconstructed by the anterolateral perforator flaps of calf. All the 35 flaps survived after surgery, with a 100% of survival rate. The patients were instructed to carry out early functional training after surgery. Follow-up lasted 6 to 24 months, with an average of 11 months. Twenty-five flaps were found in slightly swollen, and further flap thinning surgery were carried out 3 months after the primary surgery, while the rest of the flaps had good appearance and texture. At 6 months after surgery, all flaps recovered a partial deep and shallow sensory and sense of touch. All wound at donor sites in calf had one-stage healing without dysfunction. The comprehensive evaluation scale was excellent in 28 flaps and good in 7 flaps. The excellent and good rate was 100%.Conclusion:It is an effective method to use multiple free anterolateral perforator flaps of calf to reconstruct multiple digit defects in single hand. The flaps can be conveniently harvested and the multiple digital defects in single hand can be reconstructed in primary surgery with small damages to the donor sites and together with satisfactory clinical outcomes.

Objective To observe the clinical and CT features of neonatal adrenal cystic neuroblastoma(CNB).Methods Eight newborns with adrenal CNB confirmed by surgical pathology were retrospectively analyzed.The clinical data were recorded,and the plain and enhancement abdominal CT manifestations were observed.Results Among 8 cases,6(6/8,75.00％)were detected with prenatal ultrasound,while 2(2/8,25.00％)were detected after birth with ultrasound,all with single adrenal grand lesion,located half in left and half in right adrenal gland(each 4/8,50.00％).The maximum diameter of CNB lesion was 2.3-6.1 cm,with the median maximum diameter of 4.5 cm.CT showed all 8 lesions(8/8,100％)presented as single localized adrenal grand thick-walled cystic lesion,among which 3(3/8,37.50％)with uniform density within the cysts,3(3/8,37.50％)with internal septum within the cysts,1(1/8,12.50％)with slight floating debris and the rest 1(1/8,12.50％)with both internal septum and floating debris in the cyst.No calcification,cross the midline nor surround blood vessels were observed.Seven(7/8,87.50％)lesions had clear while 1(1/8,12.50％)had unclear boundaries,all mildly compressed surrounding structures.The capsule wall and internal septum of the cysts slightly enhanced after enhancement.Multiple liver metastases occurred in 2 cases.Conclusion Most neonatal adrenal CNB were detected before delivery,which mainly presented as thick-walled cystic mass with clear boundary,accompanied by septa and floating debris,and the cystic wall and septa slightly enhanced after enhancement,and liver metastasis might occur.

ObjectiveWe examined the principal respiratory pathogens in patients with acute respiratory tract infection in Taizhou， Zhejiang Province during 2020‒2021 to provide evidence for prevention， diagnosis and treatment of acute respiratory tract infection. MethodsFrom September 2020 to August 2021， a total of 2 831 cases with acute respiratory tract infection were collected from two influenza sentinel surveillance hospitals in Taizhou， which had then received the examination of 22 respiratory pathogens by multiple fluorescence quantitative PCR. ResultsThe total positive rate of respiratory pathogens in 2 831 samples was 14.13%， among which enterovirus （7.77%） and respiratory syncytial virus （1.59%） were the principal pathogens. Except enterovirus， there was no significant difference in the positive rate of pathogens detected by gender（P>0.05）. Moreover， there was significant difference in pathogens by age （P<0.05）， with the highest positive rate in 0‒4 years（35.21%）. There was also significant difference in pathogens by seasons （P<0.05）， with the highest positive rate in summer（20.54%）. ConclusionThe positive rate of acute respiratory tract infection decreases significantly， compared with that before the COVID-19 epidemic. The differences in the positive rate differ significantly by age and seasons. Comprehensive consideration of diverse factors before diagnosis and the utilization of multiple fluorescent quantitative PCR can quickly and effectively determine the pathogens in the early stage of infection. Our findings may provide certain support for the diagnosis and treatment of acute respiratory infections in the context of COVID-19 in Taizhou.

Objective:To investigate the value of CT-radiomics based machine learning model in predicting the abundance of tumor infiltrating CD8 +T cells and the prognosis of pancreatic cancer patients. Methods:A total of 150 pancreatic cancer patients who underwent surgical excision and confirmed by pathology from Fudan University Shanghai Cancer Center between December 2011 and January 2017 were retrospectively enrolled. The patients were randomly divided into the training set ( n=105) and the validation set ( n=45) in a 7∶3 ratio with simple random sampling. The immunohistochemical method was used to assess the abundance of tumor infiltrating CD8 +T cells, and the patients were then divided into high infiltrating group ( n=75) and low infiltrating group ( n=75) according to the median. The prognosis between the 2 groups was evaluated using Kaplan-Meier method and log-rank test. Radiomic features were extracted from preoperative venous-phase enhanced CT images in the training set. The Wilcoxon test, the max-relevance and min-redundancy algorithm were used to select the optimal feature set. Three supervised machine learning models (decision tree, random forest and extra tree) were established based on the optimal feature set to predict the abundance of tumor infiltrating CD8 +T cells. Performance of above-mentioned models to predict the abundance of tumor infiltrating CD8 +T cells in pancreatic cancer was tested in the validation set. The evaluation parameters included area under the receiver operating characteristic curve (AUC), F1-score, accuracy, precision and recall. Results:The median overall survival time of patients in high infiltrating group and low infiltrating group were 875 days and 529 days, respectively (χ2=11.53, P<0.001). The optimal feature set consisted of 10 radiomic features in training set. In the validation set, the decision tree, random forest and extra tree model showed the AUC of 0.620, 0.704 and 0.745, respectively; corresponding to a F1-score of 0.457, 0.667 and 0.744, the accuracy of 57.8%, 68.9% and 75.6%, the precision of 66.7%, 73.7% and 80.0%, the recall of 34.8%, 60.9% and 69.6%. Conclusions:Pancreatic cancer patients with high tumor infiltrating CD8 +T cells have better prognosis than those with low tumor infiltrating CD8 +T cells. The radiomics-based extra tree model is valuable in predicting the CD8 +T cells infiltrating level in pancreatic cancer.

Objective:To investigate the effect of CRT on thapsigargin (TG)-induced epithelial mesenchymal transition (EMT) of pancreatic cancer (PC) cells.Methods:Immunohistochemistry was used to investigate the differential CRT expression in PC tissues. Western blot (WB) and transwell were used to detect the effect of CRT silencing on TG induced EMT phenotype. Fluro-4/AM and confocal microscopy were used to detect intracellular calcium level in PC cells.Results:CRT was overexpressed in PC tissues ( P<0.01). Overexpression of CRT was positively associated with lymph node metastasis ( P=0.017) and UICC stage ( P=0.021) of PC patients, and negatively associated with E-cadherin expression ( P=0.013). High CRT and low E-cad expression contributed to the poor prognosis of PC patients ( P=0.023). In PC cells, TG induced EMT phenotype was reversed by siRNA-mediated CRT silencing. TG induced EMT was significantly reversed by CRT silencing in vitro. Conclusions:CRT mediates TG induced intracytoplasmic Ca 2+, and ultimately promotes EMT of PC cells.

Objective:To investigate the effects of anterolateral wide pedicled double dynamic flap of the calf in repair of soft tissue defects of mid-and forefoot.Methods:From September 2015 to Septemler 2020, 15 cases with severe soft tissue defects of mid-and forefoot were repaired with the anterolateral wide pedicled double dynamic flap of the calf. There were 11 males and 4 females with an average age of 37(range, 22-53)years old. Of the 15 cases, the defects were caused by traffic accident in 6 cases and objects smash in 9 cases. Three cases were simple soft tissue defect, and 12 cases combined with fracture or dislocation and bone defect. The size of soft tissue defects ranged from 4 cm×5 cm to 7 cm×12 cm. All wounds of donor sites were repaired by skin grafting. All patients entered follow-ups at the outpatient clinic or through WeChat. The appearance of flaps and limb recovery were recorded after surgery.Results:All cases followed-up for 6-24 (mean, 16) months. Two days after surgery, 1 case had flap swelling and cyanosis, which was improved after pedicle suture removal and surface bloodletting. The pedicle of the flap was slightly bloated in 4 cases, and the texture and appearance were good in 11 cases. The ankle function of all cases recovered satisfactorily. The ranges of ankle motion were 15°-20° for dorsiflexion and 30°-40° for plantar flexion. The donor site healed well and all the skin grafts survived.Conclusion:The anterolateral wide pedicled double dynamic flap of the calf is one of the ideal flaps for repairing the soft tissue defects of the mid-and forefoot with reliable blood supply, sufficient venous return, simple operation and no require a vascular anastomosis.

Objective: To investigate the clinicopathological features and outcome of gastroenteropancreatic high-grade neuroendocrine tumors. Methods: A total of 60 gastroenteropancreatic high-grade neuroendocrine tumors were collected from January 1st, 2013 to December 31th, 2018 at Fudan University Shanghai Cancer Center, with available pathology databases and clinic follow-up information. At the same time, 157 cases of gastrointestinal pancreatic neuroendocrine neoplasm (NEN) diagnosed at the hospital in 2018 were collected and the incidence of NEN at all grades was compared. Results: There were 32 males and 28 females, aged 13-80 years (mean 54 years). Pancreas primary was the most common (48%, 29/60). Nodal metastatic rate was 9/16 and distant metastatic rate was 41%(18/44). Liver was the most common site of metastasis. Among all the gastroenteropancreatic neuroendocrine neoplasms diagnosed in the hospital in 2018, the incidence of high-grade neuroendocrine tumors was the lowest (7%, 11/157). High-grade neuroendocrine tumors had typical pathologic features of well-differentiated/moderate neuroendocrine tumors, but with significant differences in mitotic rates. By immunohistochemical staining, most of the tumors expressed neuroendocrine markers and somatostatin receptor 2 was positive in 60% (12/20) of the cases. The average Ki-67 index was 30%-40%, and there was significant difference between cases (18%-80%). The overall survival of high-grade neuroendocrine tumors was 43 months, and the disease-free survival was 12 months. Conclusions High-grade neuroendocrine tumor is a rare group of neuroendocrine tumors, with unique clinicopathological features and good prognosis. Pathological classification and grading of gastroenteropancreatic neuroendocrine neoplasms can help clinicians to select appropriate treatment and accurately evaluate prognosis.

Objective:To investigate the association of preoperative neutrophil-lymphocyte ratio combined with platelet-to-lymphocyte ratio (NLR-PLR) score with clinicopathological parameters and prognosis in patients with colorectal cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 178 patients with colorectal cancer who were admitted to the First Affiliated Hospital of China Medical University from January 2013 to December 2014 were collected. There were 101 males and 77 females, aged from 21 to 90 years, with an average age of 63 years. All patients underwent radical resection of colorectal cancer. Observation indicators: (1) cutoffs of NLR and PLR and correlation between them; (2) association between preoperative NLR-PLR score and clinicopathological characteristics of patients with colorectal cancer; (3) follow-up and survival; (4) analysis of the risk factors for prognosis of patients with colorectal cancer. Follow-up was performed once every 3 months using outpatient examination or telephone interview including tumor markers, computed tomography and enteroscopy to detect postoperative survival of patients up to June 2017. Overall survival time was defined as the date of surgery to the date of the last valid follow-up or the date of death. Measurement data with skewed distribution were expressed as M (range). Count data were expressed as absolute numbers, and comparison between groups was performed using the chi-square test. Comparison of ordinal data was performed using the Mann-Whitney U test. Kaplan-Meier method was used to draw survival curve, and Log-rank test was used for survival analysis. The COX proportional hazard model was used for univariate and multivariate analyses. Results:(1) Cutoffs of NLR and PLR and correlation between them. Receiver working characteristics of NLR and PLR showed that the NLR had a cutoff of 2.7 [area under curve (AUC)=0.739, 95% confidence interval ( CI): 0.638-0.841, P<0.05] and PLR had a cutoff of 246 (AUC=0.640, 95% CI: 0.521-0.758, P<0.05). There was a correlation between NLR and PLR ( r=0.712, P<0.05). (2) Association between preoperative NLR-PLR score and clinicopathological characteristics of patients with colorectal cancer. Results of preoperative NLR-PLR score showed that the NLR-PLR score was 0, 1, and 2 in 99, 52, and 27 patients, respectively. There were significant differences in tumor diameter, degree of tumor invasion, TNM staging, Dukes staging, and distant metastasis between patients with different preoperative NLR-PLR scores ( χ2=11.294, 10.816, 9.802, 9.525, 8.759, P<0.05). (3) Follow-up and survival: 178 patients were followed up for 1-53 months, with a median follow-up time of 37 months. The average survival time was 37 months for all the 178 patients, 50 months for 99 patients with NLR-PLR score of 0, 44 months for 52 patients with NLR-PLR score of 1, and 35 months for 27 patients with NLR-PLR score of 2. There was a significant difference in survival time between patients with NLR-PLR score of 0 and patients with NLR-PLR score of 1 ( χ2=6.388, P<0.05), between patients with NLR-PLR score of 0 and patients with NLR-PLR score of 2 ( χ2=26.388, P<0.05), between patients with NLR-PLR score of 1 and patients with NLR-PLR score of 2 ( χ2=5.350, P<0.05). (4) Analysis of the risk factors for prognosis of patients with colorectal cancer. Results of univariate analysis showed that degree of tumor invasion, TNM staging, Dukes staging, distant metastasis, NLR-PLR score, and platelet-NLR score were related factors for prognosis of patients with colorectal cancer [ hazard ratio ( HR)=2.439, 2.472, 2.221, 9.020, 2.671, 2.099, 95% CI: 1.443-4.124, 1.413-4.323, 1.282-3.849, 4.449-18.082, 1.742-4.097, 1.339-3.290, P<0.05]. Results of multivariate analysis showed that degree of tumor invasion, distant metastasis, and NLR-PLR score were independent factors for prognosis of patients with colorectal cancer ( HR=2.045, 5.641, 2.271, 95% CI: 1.051-3.979, 2.590-12.288, 1.185-4.354, P<0.05). Conclusions:The preoperative NLR-PLR score is associated with tumor diameter, degree of tumor invasion, TNM staging, Dukes staging, and distant metastasis in patients with colorectal cancer. Patients with higher score have larger tumor diameter, higher degree of tumor invasion, higher stage, and easier distant metastasis. Preoperative NLR-PLR score can effectively evaluate the prognosis of patients with colorectal cancer. Patients with higher NLR-PLR score have shorter survival time. The NLR-PLR score is an independent influencing factor for prognosis of patients with colorectal cancer.

OBJECTIVE：To study the ef fects of Gegen qinlian decoction （GGQLD）on blood lipid and blood glucose of hyperlipidemia（HLP）model rats ，and to explore its mechanism from the perspective of intestinal flora. METHODS ：Totally 48 rats were randomly divided into blank control group （n＝8）and modeling group （n＝40）. For consecutive 5 weeks，model group was given high-lipid diet to induce HLP model ；blank control group was given routine diet. After modeling ，30 modeling rats were randomly divided into model group ，simvastatin group （positive control ，10 mg/kg），GGQLD high-dose ，medium-dose and low-dose groups （14.85，4.95，1.65 g/kg，by crude drug ），with 6 rats in each group. Blank control group and model group were given constant volume of normal saline intragastrically ；administration groups were given relevant medicine intragastrically ，once a day，for consecutive 11 weeks. At the same time ，each group was continuously given corresponding diet. After the last medication ， body mass and body length of rats were determined ，and Lee ’s index was calculated. Serum levels of TG ，TC，HDL-C，LDL-C and fasting blood glucose （FBG）were determined in rats. DNA of rat caecum content was extracted for 16S rRNA V 3-V4 region sequencing. The Two-part model was used to analyze the correlation between intestinal flora with lipids and blood glucose. RESULTS：After 11 weeks of administration ，compared with blank control group ，the body mass ，body length ，Lee’s index ， serum levels of TC ，TG，HDL-C and FBG of model group were increased significantly （P＜0.05 or P＜0.01），while the level of HDL-C was decreased significantly （P＜0.05）. Compared with model group ，body mass and Lee ’s index and serum levels of TG ， FBG of rats in GGQLD high-dose group ，and serum levels of TC ，TG in GGQLD medium-dose group ，as well as serum level of TG of rats in GGQLD low-dose group was decreased significantly （P＜0.05 or P＜0.01）. Correlation analysis with intestinal flora showed that TC and TG shared 3 operational taxonomic units （OTU），including OTU 559，OTU701 and OTU 135（OTU135 was also shared with FBG ），which were all positively correlated with the level of TC ，TG and FBG （P＜0.01）. The three OTU were annotated as Tyzzerella of Spirillaceae ，Anaerotruncus of Verrucaceae and Peptoclostridium of Streptococcidae ，respectively. High-dose and low-dose GGQLD had a down-regulating effect on Tyzzerella and Anaerotruncus（P＜0.05 or P＜0.01），while had up-regulating effect on Peptoclostridium（P＜0.01）. CONCLUSIONS ：High-dose GGQLD （14.85 g/kg）can effectively reduce the body mass and blood lipid of HLP model rats ，and can prevent the abnormal increase of blood glucose of model rats. The mechanism may be associated with that the reduction of intestinal flora （Tyzzerella，Anaerotruncus）content.

Objective To study the micro-hardness distribution of ulna and explore its correlation with surgical procedures of ulnar fractures,internal fixator,total elbow arthroplasty and the epidemiology of ulna fracture.Methods The ulna wasdivided into proximal metaphysis,diaphysis,and distal metaphysis.The proximal metaphysis was divided into the olecranon and the metaphysis olecranon of ulna.Thedistal epiphysis included the head of ulna.The shaft of the ulna was divided equally into nine segments.Each ulna was sawed by a band saw into twelve parts,which were prepared for the micro-indention testing.The micro-indention testing samples precision cuts were conductedwith a Buehler Isomet 11-1280-250 low speed diamond saw.Each micro-indention sample was cut 3mm thickness and fixed on glass sheet with epoxy resin.The samples surface was polished with progressive grades of sandpaper.Micro-indentation was pedormed on each bone sample sudace using a vicker micro-hardness tester,and the hardness value were measured as Hardness value (HV,HV=kgf/mm2).Twenty indentions were randomly selected on each sample,which were equally divided into four quadrants (anterior,medial,posterior and lateral).Hence,a total of 720 micro-indentations were pedormed on the three ulna.Before indention,each sample was controlled under the optical microscope where the bone surface was intact and not damaged.The micro-indentations were performed on each sample with a load of 50 g.The indentation time was set to 12 s.Hardness value (HV/0.05) was computed for each indentation.The lengths of the diagonals were measured under reflected light microscopy,and the Vickers hardness value was calculated.Indentations in which one diagonal was 10％ longer or more than the other were ignored.The indention was repeated.These preliminary data were used to determine the appropriate sample size of micro =indentation to be performed on each bone segment.SPSS 19.0 statistical software was used for statisticalanalysis.The one =way ANOVA analysis was used to compare the difference of bone micro-hardness values in different parts,and P ＜ 0.05 was statistically significant.Results The hardest part of the ulna is the lower ulnaand the value of micro-hardness was 47.77 HV.The least hard part was the head of ulna and the value of micro-hardness was 29.64 HV.The proximal metaphysis hardness value was 34.39 HV.The shaft hardness value was 43.47 HV.Thedistal metaphysis hardness value was 29.64 HV.The hardness was higher in diaphysis than metaphysis in the ulna with statistical significance.There was no statistically significant difference in the hardness of ulna anterior,medial,posterior and lateral quadrant.Conclusion It is demonstrated that the micro-hardnessof ulna shaft is significant higher than other two parts of ulna.The micro-hardness value difference was not significant among the anterior,medial,posterior and lateral quadrant.This study revealed the distribution rule of ulna micro-hardness and provided data support for the total elbow arthroplasty with human physiological characteristics through 3D printing.