Accurate classification of the acetabular injuries and appropriate treatment plan are great challenges for orthopedic surgeons because of the irregular anatomical structure of the acetabulum and aggregation of important vessels and nerves around it. Letournel-Judet classification system has been widely applied to classify acetabular fractures. However, there are several limitations, including incomplete inclusion of fracture types, difficulty in understanding and insufficient guidance for surgical treatment, etc. Serious complications such as traumatic arthritis are common due to wrong classification and diagnosis and improper selection of surgical strategy, which brings a heavy burden to the society and families. Three-column classification, based on anatomic characteristics, has advantages of containing more fracture types and being easy to understand, etc. To solve the problems existing in the diagnosis and treatment process based on Letournel-Judet classification, achieve accurate diagnosis and treatment of patients with acetabular fractures, and obtain satisfactory prognosis, the Orthopedic Trauma Emergency Center of Third Hospital of Hebei Medical University and the Trauma Orthopedic Branch of the Chinese Orthopedic Association organized experts from relevant fields to formulate the Expert consensus on the accurate diagnosis and treatment of acetabular fractures based on three-column classification ( version 2023) in terms of principles of evidence-based medicine. Based on the three-column classification, 15 recommendations were proposed, covering the diagnosis, treatment, complication prevention and management, etc, so as to provide reference for accurate diagnosis and treatment of acetabular fractures.

AIM: To develop software for individualizing dosage regimens of vancomycin (VCM) according to the established population pharmacokinetics (PPK) models. METHODS: VCM dosing software was developed using MyEclipse, SQL Server, and JRE. The software developing schemes included requirement analysis, general design, detailed design, software coding, software test, software maintenance and software redevelopment. RESULTS: The developed software achieved the functions such as input and management of patient information, prediction of trough concentrations under various dosing regimens which could help initial dosage design, and prediction of trough concentrations more accurately based on therapeutic drug monitoring results and Bayesian method which could help dosage adjustment. The software was utilized in the interpretation of VCM serum concentration, pharmacists proposed the suggestions for adjusting dosage regimens. The rechecked serum concentrations all reached the expected target blood concentration range in the group of adopting advice. CONCLUSION: The new developed software based on our established PPK models can provide a useful tool in the clinical setting to facilitate the individualized therapy for the adult and elderly infected patients.

Objective:To develop a novel α vβ 3-targeted theranostic agent 177Lu-Evans blue (EB)-Arg-Gly-Asp (RGD) and evaluate its value for SPECT imaging and targeted radionuclide therapy in the non-small cell lung cancer (NSCLC)-patient-derived xenografts (PDX). Methods:The α vβ 3-targeted molecule RGD was conjugated with the albumin binding moiety EB to obtain EB-RGD, and EB-RGD was further conjugated with the chelator 1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid (DOTA) for 177Lu radiolabeling. NSCLC-PDX mice models ( n=68) were established. 177Lu-EB-RGD SPECT imaging, biodistribution study were performed in 28 PDX mice models after being injected with 177Lu-EB-RGD or 177Lu-RGD. Targeted radionuclide therapy were subsequently performed in NSCLC-PDX mice models, saline group (group A), 18.5 MBq 177Lu-RGD group (group B), 18.5 MBq 177Lu-EB-RGD group (group C), 29.6 MBq 177Lu-EB-RGD group (group D), n=10 in each group; tumor volumes of PDX mice models in each group were observed within 50 d. Differences between 2 groups were compared using independent-sample t test. Results:177Lu-EB-RGD was radiolabeled at a specific activity of (55±14) GBq/μmol, with a radiochemical yield of more than 95% and a radiochemical purity of more than 95%. Regarding the SPECT imaging, tumors in NSCLC-PDX mice were clearly observed from 4 to 96 h post-injection and the tumor to muscle ratio (T/M) reached 7.34±0.67, 14.63±3.82, 15.69±3.58 and 15.99±5.42 at 4, 24, 72, 96 h post-injection, respectively. Biodistribution study further confirmed the findings from SPECT imaging, and the tumor uptake of 177Lu-EB-RGD were markedly increased compared to 177Lu-RGD 4 h post-injection ((10.15±1.17) vs (3.30±1.47) percent injection dose per gram (%ID/g); t=18.60, P<0.05). Regarding targeted radiotherapy, the tumor volumes were quickly increased within 50 d after treatment in group A and B, while the tumor volumes were decreased in group C and D, until the tumors in group C and D disappeared at the 28th day after initial treatment with no sign of recurrence during the observation period. Conclusions:177Lu-EB-RGD can target α vβ 3-positive NSCLC-PDX with intense tumor to background ratio and strong tumor inhibition efficacy. The preclinical data suggests that 177Lu-EB-RGD may be an effective new treatment option for advanced NSCLC patients with resistance or ineffective results for targeted therapy.

Objective : To explore the spatial distribution of occupational diseases in Guangdong Province and to provide evidence for the policy development of occupational disease prevention and control. Methods : A database of occupational disease incidence from 2009 to 2016 in Guangdong Province was built. The distribution of occupational diseases in Guangdong Province was displayed based on the geographic information system（GIS）, then spatial autocorrelation analysis and trend-surface analysis were carried out to explore the clustering areas and spatial epidemic characteristics of occupational diseases in Guangdong Province. Results : The number of cases with occupational diseases was 5 231 and was increasing year by year from 2009 to 2016 in Guangdong Province. The high-incidence areas were located in Guangzhou,Shenzhen,Foshan and Dongguan. Through global spatial autocorrelation analysis,it was found that there were spatial clustering of occupational diseases in Guangdong Province in each year（P<0.05）,and the cumulative incidence was also clustered（Moran's I=0.492,P<0.05）. The number of cases in Guangzhou,Shenzhen,Foshan and Dongguan had local spatial autocorrelation,and the local Moran's I values were 10.329,8.614,3.725 and 9.811,respectively（P<0.05）. The results of trend surface analysis showed that the overall incidence of occupational disease had a slight increase from west to east,and the Pearl River Delta region was a high-incidence area. Conclusion The incidence of occupational diseases in Guangdong Province had an obvious spatial clustering,the Pearl River Delta region was a high-incidence area.

Objective To assess the influence on radiation dose and image quality of bronchial artery CT angiography for hemoptysis patients with high heart rate and free respiratory with single-cardiac dynamic volumetric scanning using 320-row CT.Methods During October 2016 and May 2017,totally 151 hemoptysis patients with heart rate ≥ 65 bmp and free-breathing were scanned for bronchial artery imaging with prospective ECG-gating 320-detector row dynamic volume CT.The patients were randomly divided into two groups,group A(81 cases) and group B(70 cases).Default multi-cardiac cycle scanning style was used for group A to generate multi-sector images A 1 which were reconstructed corresponding single-sector images A2.Single-cardiac periodic scanning was used to get single-sector images for group B.The effective doses (E) of two scanning types,the quantitative parameters of image quality [vascular CT value,image noise (SD),signal-to-noise ratio (SNR),contrast-to-noise ratio (CNR)] and subjective scoring of group B and A1,A2 were compared.The detection accuracy of the systemic artery-pulmonary circulation shunts was evaluated by ROC curve against digital subtraction angiography (DSA).The measurement data was analyzed by independent sample t test while the grade data was tested by independent sample nonparametric test.Results The median value of radiation dose in group B was significantly lower than that of group A (1.42 mSv vs.3.06 mSv,Z=-8.724,P＜0.05).There were no statistically significant differences in quantitative parameters and subjective scoring points of image quality between group B and group A2 (P＞ 0.05).The median subjective scoring points of group B was 4,which was better than that of group A1 (Z =-10.584,P＜ 0.05).The differences of SD,SNR,CNR betweengroup B and group A1 were statistically significant(t =-0.983,7.898,7.695,P＜0.05),and group B had higher SD,SNR and CNR.There was no significant difference in the mean CT values of the aorta and pulmonary artery between the two groups (P ＞ 0.05).The detection accuracy of the systemic arterypulmonary circulation shunts was moderately high in group B and group A2.The area under the ROC curve (AUC) was 0.891 and 0.864,respectively (Z=7.210,7.430,P＜0.05).The accuracy of group A1 was poor.The area under the ROC curve was 0.626 (Z=2.434,P＜0.05).The sensitivity of group B and groupA2 were 80％ and 76.2％,respectively (P＜0.05),and 28.6％ of group A1 (P＜0.05).Conclusions The 320-row single-cardiac periodic dynamic volume CT can effectively improve the image quality and the detection accuracy of the systemic-pulmonary circulation on CT,and reduce the radiation dose of the bronchial artery CT angiography.

Objective To investigate the incidence and predictors of cerebral infarction in patients with ruptured ACoA aneurysms, and to provide diagnostic and therapeutic information.Methods A total of 319 patients with ruptured ACoA aneurysms in our hospital from January 2009 to February 2015 were reviewed in this study. The author collected data regarding clinical characteristics, and measured the aneurysm morphologies on CTA images. Age, flow angle, vessel angle were analyzed by independent-samples t tests in patients with or without cerebral infarction. Mann-Whitney U tests were used for aneurysm size, aneurysm height, perpendicular height, neck size, size ratio, aspect ratio, aneurysm angle , World Federation of Neurosurgical Societies (WFNS) grade at admission and Fisher grade. Chi-square tests and Fisher's exact tests were used for sex, histories of hypertension, smoking and stroke, treatment modalities, anterior cerebral A1 segment configuration and angiographic vasospasm on CTA images. The multivariate logistic regression analyses were used to determine the independent risk factors of cerebral infarction using the stepwise regression method. Results Of the 319 patients, there were 253 without and 66 patients with cerebral infarction. Differences of age(53±11 vs 57±12,respectively;t=-2.415, P=0.016), Fisher grade [Ⅰ 23(9.1%), Ⅱ 27(10.7%), Ⅲ 74(29.2%), Ⅳ 129(51.0%) vs Ⅰ 1(1.5%), Ⅱ 7 (10.6% ), Ⅲ 13(19.7% ), Ⅳ 45(68.2% ), respectively;Z=-2.541, P=0.035] and treatment modalities [endovascular coil embolization 155(61.3% ), neurosurgical clipping 98(38.7% ) vs endovascular coil embolization 23(34.8%), neurosurgical clipping 43(65.2%), respectively;χ2=14.810, P<0.001] reached statistical significance. Multivariate analysis showed that Fisher grade Ⅳ(OR=10.36,95%CI 1.34-80.29, P=0.025) and neurosurgical clipping (OR=3.28, 95% CI 1.84-5.86,P<0.001)still had statistical significance. Conclusions Cerebral infarction in patients with ruptured ACoA aneurysms may be associated with Fisher grade and treatment modalities. Although there is difference between the two groups in age, it is not a predictor of the occurrence of cerebral infarction.

Objective To explore the anatomic positional relationship of bronchial artery(BA)with esophagus and main bronchus on 320-detector CTA.Methods Original and post-processed images of 142 patients were observed.Type,origin,opening direction of BA as well as its concomitant relationship with esophagus were recorded.The positional relationship of BA with main bronchus was also recorded by fusing the images of BA and bronchial tree together.Results In 122 patients,273 BA were identified (146 on the right and 127 on the left).Right BA mainly ran simultaneously along the right and posterior edge of the esophagus (49.3%),while left BA mainly ran far gradually on the left side of the esophagus (82.7%).The left and right BA mainly ran along the middle thoracic esophagus, accounting for 58.3% and 42.5% respectively.45.2% of the right BA ran across the posterior edge of the right main bronchus and 60.6% of left BA ran simultaneously on the posterior and up edge of the esophagus.The most dividing direction of BA from the tho-racic aorta was 9 to 12 o’clock with a frequency of 74.2%.Conclusion The concomitant relationship with esophagus of the BA and the positional relationship with main bronchus of the BA could clearly be demonstrated on 320-detector CTA,thus providing availa-ble information and help for pulmonary and mediastinal sugery.

Objective To evaluate the reliability of CT perfusion parameter values of the normal hepatic segments and neoplasms, obtained with deconvolution (DC) and maximum slope (MS) algorithms. Methods Perfusion parameter values of 111 ROIs in 62 normal hepatic segments and 49 neoplasms derived from 62 CT perfusion studies performed with 320 multi-slice CT, were retrospectively analyzed by two experienced radiologists. BF,BV and PI according to DC and MS algorithms were compared with t paired test, Pearson correlation and Bland-Altman agreement analysis. Interobserver agreement for all perfusion parameters was calculated using intraclass correlation coefficients (ICC). Results Interobserver agreement measured with ICC was very good for all perfusion parameters (≥0.95). BFdc and BVdc exceeded the BFms and BVms in normal hepatic segments and neoplasms (P<0.05); PIdc significantly exceeded the PIms in normal hepatic segments(P<0.05) ,while no difference were found in hepatic neoplasms(P>0.05). Both pairs of perfusion measurements significantly correlated with each other(r>0.9, P<0.01),but the agreement of BF, BV and PI according to DC and MS algorithms was not good. Conclusions CT perfusion values such as BF,BV and PI obtained by DC and MS algorithms correlated significantly with each other, but with poor agreement.

Objective To investigate the effect of geographical differences on human serum metabolic profiles .Methods A total of 169 serum samples were collected from healthy individuals from 9 provinces in China and divided into four groups according to the geographical location .The nuclear magnetic resonance ( NMR) data of these samples were segmentally inte-grated, normalized,and analyzed with multivariate statistical methods using SIMCA-P 10.0 software to investigate the differ-ence in serum metabolites between eastern and western populations or between northern and southern populations .Results There were differences in a variety of small molecule metabolites in serum between eastern and western populations or be -tween northern and southern,including glucose,lipoproteins,amino acids,ketones,creatine and choline.Conclusion The geographical differences in a variety of factors (temperature,precipitation,folk culture, living habits,etc) result in the differences in human serum metabolic profiles ,which can provide appropriate reference for epidemiological studies and nu -tritional metabonomics .

Objective: To investigate the effects of quercetin on hepatic vein metabolic profiles in rats. Methods: Male Wistar rats were administrated orally with 40 mg/kg quercetin. Hepatic vein plasma was collected at 0 h, 0.5 h, 1 h, 2 h and 4 h respectively after administration and analyzed by 1H NMR. Results: The identifiable biochemical effects associated with quercetin dosing included decreased plasma concentration of glucose and increased plasma concentration of succinate,β-hydroxybutyrate and pyruvate. Conclusion: Quercetin changes hepatic metabolism in rats, manifested mainly as increased glucose catabolism and production of ketone bodies.