Platelet elevation is a rare manifestation in the peripheral blood of patients with chronic myeloid leukemia (CML). In this paper, we report for the first time a case of CML combined with cerebral hemorrhage manifested by abnormally elevated platelets. The patient had elevated platelets in the peripheral blood, showed normal coagulation function, and underwent intracranial hematoma removal due to cerebral hemorrhage. After the operation, bleeding from the operated area and other systems occurred, and the patient was diagnosed as having accelerated CML after combining bone marrow biopsy and genetic testing. His condition was controlled after administration of flumatinib through a jejunal tube. Based on this patient's experience, the feasibility ofadministering flumatinib via a jejunostomy tube was determined, which is the first report of its kind in China and abroad.This article summarizes the diagnosis and treatment process of this patient, with the aim of providing a warning and reference for clinicians.

Objective:To investigate the clinical characteristics and significance of supraspinatus fragments in proximal humerus fractures.Methods:A total of 210 patients with proximal humerus fractures who underwent surgical treatment in the Department of Orthopaedic and Trauma Surgery, Affiliated Hospital of Yunnan University from July 2016 to December 2020 were retrospectively analyzed. There were 91 males and 119 females, aged 52.4±11.3 years (range, 18-87 years). Preoperatively, the shoulder joint X-ray, CT and 3D reconstruction, and MRI were evaluated for the presence of a small fracture mass on the lateral side of the interarticular sulcus and an "M" shaped fracture mass at the interarticular sulcus. Intraoperative observation, management, postoperative functional exercise and follow-up were performed by the same group of doctors. Postoperative outpatient review was performed at 2, 4, 6, 12, and 24 weeks, shoulder joint X-ray and CT were taken at 2, 6, and 24 weeks to observe the presence of subacromial displaced bone mass. Constant-Murley scale was used to assess shoulder joint function.Results:All 210 patients completed the surgery successfully, and none of them had vascular, nerve or ligament injuries during the operation. According to Neer's classification: 59 cases of two-part humeral greater tuberosity fractures, 36 cases of two-part humeral surgical neck fractures, 50 cases of three-part humeral greater tuberosity fractures, and 65 cases of four-part proximal humeral fractures. 61.0% (128/210) of the patients showed the presence of a supraspinatus fragment on preoperative imaging, including 42 two-part humeral greater tuberosity fractures, 1 two-part humeral surgical neck fracture, and 31 three-part humeral greater tuberosity fractures with a small lateral fracture mass over the intertubular groove; 54 four-part proximal humeral fractures had an "M" shaped fracture mass containing the intertubular groove. All patients were followed up for 11.8±2.4 months (range, 6-20 months). Postoperative X-ray showed that all fractures healed, and the healing time was 3.4±0.3 months (range, 3-5 months). The Constant-Murley scale of the shoulder joint was 86.3±11.5 (range, 61-100).Conclusion:Supraspinatus fragments are more common in proximal humerus fractures. Proper recognition and management of supraspinatus fragments can help understand the mechanism of proximal humeral fracture occurrence, the relationship between fracture displacement and rotator cuff injury, reduce the incidence of postoperative complications, and improve the shoulder joint function.

Objective To analyze the epidemiological characteristics of aggregative vomiting and diarrhea outbreak in Jing'an District of Shanghai in 2017 and 2018，and provide data support for further development of effective prevention and control measures. Methods A descriptive epidemiological method was used to analyze aggregative vomiting and diarrhea outbreak data in Jing'an District in 2017 and 2018. Results A total of 49 outbreaks were reported in Jing'an District in 2017 and 2018，involving 565 cases，with the overall attack rate of 1.89%. The median duration of the outbreak was 5 days and outbreaks mainly occurred in spring and autumn. The attack rate in kindergartens was higher than that in primary and secondary schools, while the total number of outbreak cases in kindergartens was less. The main clinical symptoms of the cases were vomiting, with a higher proportion than that of diarrhea and fever. The vomiting proportion was higher in kindergartens and elementary schools, while the diarrhea proportion was higher in middle schools. Conclusion There were some differences in the epidemic characteristics between kindergartens and primary and secondary schools, therefore different control measures should be adopted according to the characteristics of different institutions. The outbreaks were mainly spread through human-to-human transmission. Early detection and early reporting of epidemics in collective institutions had a positive impact on the control of the spread of the epidemic.

Objective: To investigate the value of radiomics in image quality control with low-dose CT examination of solid pulmonary nodules. Methods: Images were acquired on CT750 HD scanner, and chest pulmonary nodules phantom were scanned at different tube voltage and tube current. The radiation dose CTDI_vol under different scanning conditions were recorded, as well as CNR and SNR of each scanning sequence. The variation of radiation dose, noise, tube voltage and tube current were analyzed. All data were analyzed by radiomics analysis software. R language statistics software was adopted to analyze the extracted features by principal component analysis (PCA), and the characteristic parameters with the largest contribution rate to image quality were selected for analysis. One-way ANOVA was used to analyze all the important characteristic parameters to reveal the difference of characteristic parameters under different tube voltages. Finally, the post-test method was used to find out the differences among different tube voltage groups. Results: Radiation dose rised linearly with the increase of tube current and tube voltage. Although the overall change trend of SNR and CNR in pulmonary nodules was linearly related to the change of tube voltage and tube current, there was no clear change trend threshold at low dose, which could not accurately evaluate the image quality under low radiation. Both CNR and SNR cannot evaluate the image quality effectively, and have no practiced value for optimizing the low dose scanning parameters. There main components including Uniformity, Voxel Value Sum, and Haralick Correlation extracted by radiomics analysis software were proved to play a critical role in image quality control. The cumulative contribution rate of variance was 89.20% and the eigen values were greater than 1. Uniformity curve of characteristic parameter showed that the trend of change was correlated with the change of tube voltage and tube current, and the stability and consistency were good. Uniformity one-way ANOVA analysis showed that when the tube voltage reduced from 140 to 120 kVp, there was no difference (P=0.117) in the uniformity, while from 120 to 80 kVp, significant differences revealed (P<0.001). Considering tube current, no significant variation was observed in uniformity when current was greater than 90 mA, which indicated that tube current of 90 mA could lead to better image quality. Conclusion Radiomics analysis can effectively evaluate and control the CT image quality of low dose solid pulmonary nodules.

Tumor neovascularization plays an important role in the occurrence, development and metastasis of cancer. Non-invasive quantification and detection of tumor neovascularization is crucial for early diagnosis and prognosis assessment of cancer. Targeted molecular imaging has arisen in vascular targeting imaging and precise treatment based on the molecular characteristics of neovascularization. Aminopeptidase N (APN, or CD13) is a multifunctional membrane-bound exopeptidase that is overexpressed in neovascular endothelial cells and some tumor cells but rarely expressed in normal blood vessels, which makes it a potential target for tumor neovascularization imaging and anti-angiogenic therapy. This review summarizes the application progress and the future development trend of target molecular imaging and precise treatment based on CD13.

A retrospective study was conducted on one patient with postmenopausal hyperandrogenism. The postmenopausal female patient was found with significant hyperandrogenism ( total testosterone 6. 4 nmol/ L) and hirsutism, with normal adrenal androgen ( dehydroepiandrosterone-sulfate ) level. Computed tomography and ultrasound did not detect any ovarian and adrenal mass. Positron emission tomography revealed without high metabolic region, either. Ovarian and adrenal vein catheterization did not reveal any positive result. Obviously, ovary-derived hyperandrogenism was highly suspected, but the patient still refused any surgical exploration. After a trial of a single dose of gonadotropin releasing hormone analogue(GnRHa) triptorelin, increased testosterone level returned to normal along with decreasing level of gonadotropin. Multiple doses were needed for maintenance of testosterone at normal level with the intervals of 2 ～ 12 months. This response to the treatment was consistent with that of gonadotropin dependent hyperandrogenism.

Objective To understand the situation of iodine deficiency disorders and iodine nutrition of children in Yunnan Province after the implementation of new standard of salt iodine,and provide the basic data for prevention and control of iodine deficiency disorders.Methods Using multistage sampling method,Yunnan provincial evaluations for iodine deficiency disorders elimination were carried out.According to the comparative analysis of 2010 (pre-adjustment) and 2015 (post-adjustment) evaluation results,the changes of the median of salt iodine,the coverage rate of iodized salt,the qualified rate of iodized salt,the rate of qualified iodized salt consumption,goiter rate of school children aged 8-10 and the median of urinary iodine were evaluated.Salt iodine was tested using the "Salt Industry General Test Method for Determination of Iodine" (GB/T 13025.7-1999);thyroid volume examination of children using B-scan ultrasonography,thyroid volume calculation and enlargement judgment using "Diagnostic Criteria for Endemic Goiter" (WS 276-2007);and urinary iodine detection using "Urinary Iodine Arsenic Cerium Catalytic Spectrophotometry" (WS/T 107-2006).Results The medians of salt iodine in 2010 and 2015 were 30.6 and 22.4 mg/kg,respectively,the difference was statistically significant (U =317 503.50,P ＜ 0.01).The coverage rates of iodized salt in 2010 and 2015 were 99.6％ (1 681/1 688) and 98.9％ (2 592/2 622),the qualified rates of iodized salt were 98.6％ (1 657/1 681) and 89.7％ (2 325/2 592),and the rates of qualified iodized salt consumption were 98.2％ (1 657/1 688) and 88.7％ (2 325/2 622),and the differences were statistically significant (x2 =6.42,125.11,130.18,P ＜ 0.01);the rates of children goiter in 2010 and 2015 were 0.8％ (25/3 272) and 1.4％(44/3 245),respectively;the medians of urinary iodine of children were 289.0 and 157.3 μg/L,respectively,the difference was statistically significant (U =1 121 669.50,P ＜ 0.01).Conclusion After decreasing of salt iodine level starting from 2012 in Yunnan Province,the children iodine nutrition condition is in a more proper level.

Objective To investigate the effectiveness of anterior fixation with an oblique-ilioischial plate for acetabular fractures of lower posterior column.Methods A consecutive series of 7 patients were retrospectively reviewed who had been treated operatively from August 2016 to July 2017 for acetabular fractures of lower posterior column.They were 4 men and 3 women,aged from 45 to 62 years (average,48.6 years).The injury was caused by a traffic accident in 4 cases and by falling from a height in 3.By the Letournel-Judet classification,there were one case of transverse fracture,3 cases of T-shaped fracture,2 cases of anterior + posterior hemitransverse fracture and one case of associated both column fracture.The intervals from injury to operation ranged from 6 to 19 days (average,7 days).All of them were treated by the modified Stoppa approach (or combined with an iliac fossa approach).The anterior column was stabilized with a reconstruction plate for the iliac wing along the iliopectineal line to the pubis in all cases.The lower posterior column was fixated with a newly developed oblique-ilioischial plate running from the ilium to the ischial ramus.Operative time,intraoperative blood loss,reduction quality and postoperative function of the affected hip were recorded.Results The operative time for this cohort ranged from 1.0 to 3.2 h (average,2.1 h) and the intraoperative blood loss from 200 to 500 mL (average,300 mL).The postoperative reduction was rated by the Matta's criteria as excellent in 5 cases,as good in one and as fair in one.This cohort was followed up for 7 months (from 6 to 9 months).At the final follow-up,the hip function was rated by the modified Merle d'Aubigne-Postel scale as excellent in 5 cases,as good in one and as fair in one.Fracture healing was achieved in all the patients after 3 to 6 months (average,4.5 months).No implant failure,infection,heterotopic ossification or neurovascular injury occurred during the follow-up.Conclusion Anterior fixation with an oblique-ilioischial plate via the modified Stoppa approach or combined with an iliac fossa approach is a good treatment for acetabular fractures involving the lower column,due to its advantages of reliable fixation,limited invasion,little intraoperative bleeding and few complications.

Cushing's syndrome in pediatrics is very rare. In most child patients, the onset of Cushing's syndrome is insidious. The most common presenting symptom is growth retardationin inconsistant with the weight gain. The most common cause of Cushing's syndrome in children is exogenous administration of glucocorticoids and Cushing' s disease. Here we present a case of pediatric Cushing' s syndrome; the diagnosis and treatment are discussed.

Objective To investigate the effectiveness of ilioischial plating through modified Stoppa and iliac fossa approaches for complex acetabular fractures. Methods A consecutive series of 40 patients with complex acetabular fracture were treated operatively from January 2014 to February 2015. Of them, 20 were treated through modified Stoppa plus iliac fossa approaches as an experimental group ( including 12 males and 8 females with a mean age of 46. 8 ± 10. 3 years ) . The anterior column was stabilized with a recon-struction plate for the iliac wing along the iliopectineal line to the pubis in all cases. The posterior column was fixed with a newly developed ilioischial plate running from the ilium to the ischial ramus. The other 20 patients ( 10 males and 10 females with a mean age of 45. 6 ± 11. 7 years ) served as a control group, treated with a reconstruction plate for the conventional posterior column fixation through the Kocher-Langenbeck approach. The 2 groups were compared in terms of operative time, intraoperative blood loss, reduction and functional recovery of the hip. Results The 40 patients obtained an average follow-up of 18 months ( from 8 to 24 months ) . The experimental group reported significantly shorter operation time ( 2. 1 ± 0. 7 hours ) and signifi-cantly less intraoperative bleeding ( 320. 8 ± 100. 4 mL ) than the control group ( 2. 9 ± 0. 6 hours and 621. 6 ± 118. 7 mL, respectively ) ( P <0. 05 ) . According to modified Matta's criteria for reduction, the experimental group had 15 excellent, 3 good, one fair and one poor cases ( giving an excellent to good rate of 90％) while the control group had 17 excellent, one good, one fair and one poor cases ( giving an excellent to good rate of 90％) . According to the modified Merle d'Aubigné and Postel scoring for the functional recovery of the af-fected hip at the final follow-ups, the experimental group had 14 excellent, 3 good, 2 fair and one poor cases ( giving an excellent to good rate of 85％) while the control group had 12 excellent, 4 good, 3 fair and one poor cases (giving an excellent to good rate of 80％). There were no significant differences between the 2 groups in the above comparisons ( P> 0. 05 ) . There were no significant differences in the MOS item short form health survey score and postoperative complication rate between the experimental group and the control group. Conclu-sion Ilioischial plating through modified Stoppa and iliac fossa approaches has advantages of reliable fixa-tion, limited invasion, less intraoperative blood loss and fewer complications for complex acetabular fractures.