Objective:To investigate the risk factors for sepsis in patients severe trauma.Methods:A retrospective case-control study was conducted to analyze the clinical data of 149 patients with severe trauma admitted to General Hospital of Ningxia Medical University from January 2021 to June 2022, including 112 males and 37 females, aged 18-93 years [(50.6±16.3)years]. According to whether the patients developed sepsis, they were divided into sepsis group ( n=66) and non-sepsis group ( n=83). A comparison was made between the two groups in gender, age, measurements of body temperature, heart rate, respiration, systolic blood pressure, diastolic blood pressure, mean artery pressure (MAP), oxygen saturation (SPO 2), white blood cell (WBC), absolute neutrophil count (ANC), percentage of neutrophils (NEUT%), red blood cell count (RBC), hemoglobin (HGB), platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer level, level of lactic acid, level of blood glucose, quick sequential organ failure assessment (qSOFA), sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation II (APACHE II) score, Glasgow coma scale (GCS), and injury severity score (ISS) within 24 hours of admission, causes of injury, injury sites, number of injury sites, hemorrhagic shock (HS), open injury, endotracheal intubation, length of ICU stay and total length of hospital stay. Univariate analysis and multivariate Logistic regression analysis were used to determine the independent risk factors for severe post-traumatic sepsis. Results:The results of univariate analysis showed that there were statistically significant differences in age, respiration, SPO 2, WBC and ANC, D-dimer level, blood glucose level, qSOFA, SOFA, APACHE II score, GCS, ISS, head and neck injury, open injury, tracheal intubation, length of ICU stay, and total length of hospital stay between the sepsis group and non-sepsis group ( P<0.05 or 0.01); whereas there were no significant differences in gender, underlying disease, body temperature, heart rate, systolic blood pressure, diastolic blood pressure, MAP, NEUT%, RBC, HGB, PLT, PT, APTT, lactic acid level, cause of injury, facial injury, chest injury, abdominal and pelvic injury, limb and pelvic injury, number of injury sites, and HS between the two groups ( P>0.05). Multivariate Logistic regression analysis showed that D-dimer level ( OR=0.97, 95% CI 0.96, 0.99, P<0.01) and tracheal intubation ( OR=15.80, 95% CI 2.14, 116.69, P<0.01) were significantly correlated with sepsis in patients with severe trauma. Conclusion:D-dimer level collected within 24 hours of admission and tracheal intubation are independent risk factors for sepsis in patients with severe trauma.

Objective:The transjugular or transfemoral approach is used as a common method for hepatic venous pressure gradient (HVPG) measurement in current practice. This study aims to confirm the safety and effectiveness of measuring HVPG via the forearm venous approach.Methods:Prospective recruitment was conducted for patients with cirrhosis who underwent HVPG measurement via the forearm venous approach at six hospitals in China and Japan from September 2020 to December 2020. Patients' clinical baseline information and HVPG measurement data were collected. The right median cubital vein or basilic vein approach for all enrolled patients was selected. The HVPG standard process was used to measure pressure. Research data were analyzed using SPSS 22.0 statistical software. Quantitative data were used to represent medians (interquartile ranges), while qualitative data were used to represent frequency and rates. The correlation between two sets of data was analyzed using Pearson correlation analysis.Results:A total of 43 cases were enrolled in this study. Of these, 41 (95.3%) successfully underwent HVPG measurement via the forearm venous approach. None of the patients had any serious complications. The median operation time for HVPG detection via forearm vein was 18.0 minutes (12.3~38.8 minutes). This study confirmed that HVPG was positively closely related to Child-Pugh score ( r = 0.47, P = 0.002), albumin-bilirubin score ( r = 0.37, P = 0.001), Lok index ( r = 0.36, P = 0.02), liver stiffness ( r = 0.58, P = 0.01), and spleen stiffness ( r = 0.77, P = 0.01), while negatively correlated with albumin ( r = -0.42, P = 0.006). Conclusion:The results of this multi-centre retrospective study suggest that HVPG measurement via the forearm venous approach is safe and feasible.

The liver reserve function refers to the compensatory ability to maintain liver function after damage, providing implication for the resection of hepatic malignant tumor. Hepatobiliary scintigraphy imaging can provide quantitative evaluation of liver blood perfusion, and has advantages on the evaluation of liver reserve function and the prediction of postoperative complications. 99Tc m-galactosyl serum albumin (GSA) and 99Tc m-mebrofenin are commonly used imaging agents for hepatobiliary scintigraphy imaging assessment of liver reserve function. This article reviews the application and progress of hepatobiliary scintigraphy in liver reserve function assessment.

Objective:To develop an approach for the automatic diagnosis of bone metastasis and to design a parameter of quantitative evaluation for tumor burden on bone scans based on deep learning technology.Methods:A total of 621 cases (389 males, 232 females, age: 12-93 years) of bone scan images from the Department of Nuclear Medicine in Tenth People′s Hospital of Tongji University from March 2018 to July 2019 were retrospectively analyzed. Images were divided into bone metastasis group and non-bone metastasis group. Eighty percent of the cases were randomly extracted from both groups as the training set, and the rest of cases were used as the test set. A deep residual convolutional neural network ResNet34 was used to construct the classification model and the segmentation model. The sensitivity, specificity and accuracy were calculated and the performance differences of the classification model in different age groups (15 cases of <50 years, 75 cases of ≥50 and <70 years, 33 cases of ≥70 years) were analyzed. The regions of metastatic bone lesions were automatically segmented by the segmentation model. The Dice coefficient was used to evaluate the effect of the segmentation model and the manual labeled results. Finally, the bone scans tumor burden index (BSTBI) was calculated to assess the tumor burden of bone metastases.Results:There were 280 cases with bone metastases and 341 cases with non-bone metastases, including 498 in training set and 123 in test set. The classification model could accurately identify bone metastases, with the sensitivity, specificity and accuracy of 92.59%(50/54), 85.51%(59/69) and 88.62%(109/123), respectively, and it performed best in the <50 years group (sensitivity, 2/2; specificity, 12/13; accuracy, 14/15). The specificity in the ≥70 years group (8/12) was the lowest. The Dice coefficient of bone metastatic area and bladder area were 0.739 and 0.925 in the segmentation model, which performed similarly in the three age groups. Preliminary results showed that the value of BSTBI increased with the increase of the number of bone metastatic lesions and the degree of 99Tc m-MDP uptake. The machine learning model in this study took (0.48±0.07) s for the entire analysis process from input to the final BSTBI calculation. Conclusions:The deep learning based on automatic diagnosis framework for bone metastases can automatically and accurately identify segment bone metastases and calculate tumor burden. It provides a new way for the interpretation of bone scans. The proposed BSTBI may be used as a quantitative evaluation indicator in the future to assess the tumor burden of bone metastases based on bone scans.

Iodine is an essential trace element in the human body, and the gastrointestinal tract is the main way for the body to intake iodine. The intestinal tract contains trillions of microorganisms that have important impacts on the substance-energy metabolism and the genetic information processing in the human body. Gut microbiota or their metabolites can act on the thyroid through the circulatory system (namely the " gut-thyroid axis" ), thus potentially regulating iodine metabolism in thyroid. This article reviews the effects of gut microbiota on intestinal iodine uptake, as well as the effects of gut microbiota and their metabolites on the expression and activity of sodium iodide symporter (NIS) in thyroid cells, thus exploring the potential regulatory mechanisms of gut microbiota that involved in thyroid iodine metabolism. Potential factors affecting thyroid iodine metabolism by gut microbiota include the direct and the indirect factors. The direct factors include lipopolysaccharides, short-chain fatty acids, microbial peptides, and microbial proteins, which may affect the expression or activity of NIS in thyroid by regulating the nuclear factor kappa-B pathway, histone acetylation modifications, or antigen-antibody reactions. The indirect factors include the altered cellular environment that effected by gut microbiota which can further affect the transport of iodine ions in thyroid cells by manners like regulating the levels of thyroid-specific transcription factors and regulating the signal pathways mediated by thyroid-stimulating hormone and its receptor.

Objective:To investigate the differential diagnostic value of 18F-FDG PET/CT in multiple myeloma (MM) and unknown osteolytic metastasis (UOM). Methods:A retrospective study was performed on 18F-FDG PET/CT imaging of 43 patients (29 males, 14 females, age: (61.5±12.9) years) with multiple bone destructions and without extraosseous primary malignant tumor between June 2017 and March 2020 in Tenth People′s Hospital of Tongji University. Through follow-up, 20 patients (13 males, 7 females, age: (61.1±12.2) years) were pathologically confirmed as MM and 23 patients (16 males, 7 females, age: (61.4±13.9) years) were pathologically confirmed as UOM. The whole body skeleton was categorized to 8 sites including skull, spine, ribs, pelvis, sternum, clavicle, scapula and limb bone. The differences of the cross-sectional length of the lesion, cortical bone damage, SUV max and the distribution of imaging agent were compared between the two groups in different parts. Independent-sample t test and Mann-Whitney U test were used to analyze data. Results:The UOM group was invisible on clavicles, and spine and pelvis were the most predilection sites in both MM and UOM groups (spine: 41.30%(299/724) and 49.37%(117/237); pelvis: 24.45%(177/724) and 26.58%(63/237)). The cross-sectional length of lesions in the skull, spine, ribs, pelvis and limb bone in MM group were significantly shorter than those in UOM group (5.45(4.30, 8.06) vs (13.89±11.66) mm, 6.15(3.89, 10.06) vs 11.48(7.73, 16.90) mm, 7.01(4.59, 10.56) vs (24.61±16.22) mm, 8.20(5.14, 13.71) vs (21.12±13.31) mm, (8.48±5.75) vs (19.13±14.26) mm; z values: from -8.88 to -2.52, t=-2.76, P<0.001 or P<0.05) and SUV max of above lesions and scapula in MM group were significantly lower than those in UOM group (1.50(1.00, 2.20) vs 17.15±11.40, 2.60(2.00, 4.10) vs 8.20(5.65, 11.90), 2.30(1.40, 5.28) vs 10.58±5.52, 2.50(1.80, 3.90) vs 9.34±6.01, 3.08±2.41 vs 11.38±6.38, 2.45(1.50, 4.43) vs 6.90(4.63, 17.80); z values: from -13.87 to -2.41, t=-4.85, P<0.001 or P<0.05). The imaging agents in lesions on the skull, spine, ribs, pelvis, scapula and limb bone were more evenly distributed in MM group, while the imaging agents in lesions were more unevenly distributed in UOM group. On the skull, spine and ribs sites, the MM group was more likely to show no cortical bone damage; however, the UOM group showed cortical bone damage in the above sites. Conclusion:It is helpful for doctors to distinguish MM and UOM by comparing the cross-sectional length of the lesion, cortical bone damage, SUV max and the distribution of imaging agent in 18F-FDG PET/CT imaging before getting pathologic results.

Differentiated thyroid cancer (DTC) is prone to relapse and metastasize. In addition to thyroglobulin (Tg) and its antibodies, ultrasound and 131I whole-body scan (WBS), 18F-FDG PET/CT gains more use in the setting of recurrent or metastatic DTC and shows promise. This article mainly reviews the value of 18F-FDG PET/CT in the location of recurrent or metastasized DTC with negative 131I WBS but positive Tg ( 131I WBS-/Tg+ ), evaluating their differentiation, predicting the prognosis, guiding 131I treatment and its value in restaging DTC with moderate and high risk of relapse and guiding treatment decision.

Background::The pharmacokinetic and clinical behaviors of many proton pump inhibitors (PPIs) in peptic ulcer treatment are altered by CYP2C19 genetic polymorphisms. This non-inferiority study evaluated the efficacy and safety of the novel PPI anaprazole compared with rabeprazole. We also explored the influence of Helicobacter pylori ( H. pylori) infection status and CYP2C19 polymorphism on anaprazole. Methods::In this multicenter, randomized, double-blind, double-dummy, positive-drug parallel-controlled, phase III study, Chinese patients with duodenal ulcers were randomized 1:1 to receive rabeprazole 10 mg + anaprazole placebo or rabeprazole placebo + anaprazole 20 mg once daily for 4 weeks. The primary efficacy endpoint was the 4-week ulcer healing rate assessed by blinded independent review. Secondary endpoints were the proportion of patients with improved overall and individual duodenal ulcer symptoms at 4 weeks. Furthermore, exploratory subgroup analysis of the primary endpoint by H. pylori status and CYP2C19 polymorphism was conducted. Adverse events were monitored for safety. Non-inferiority analysis was conducted for the primary endpoint. Results::The study enrolled 448 patients (anaprazole, n = 225; rabeprazole, n = 223). The 4-week healing rates were 90.9% and 93.7% for anaprazole and rabeprazole, respectively (difference, -2.8% [95% confidence interval, -7.7%, 2.2%]), demonstrating non-inferiority of anaprazole to rabeprazole. Overall duodenal ulcer symptoms improved in 90.9% and 92.5% of patients, respectively. Improvement rates of individual symptoms were similar between the groups. Healing rates did not significantly differ by H. pylori status or CYP2C19 genotype for either treatment group. The incidence of treatment-emergent adverse events was similar for anaprazole (72/220, 32.7%) and rabeprazole (84/219, 38.4%). Conclusions::The efficacy of anaprazole is non-inferior to that of rabeprazole in Chinese patients with duodenal ulcers.Registration::ClinicalTrials.gov, NCT04215653.

Objective:To evaluate the curative effects of Masquelet technique and 3D printing in repair of Cierny-Mader type Ⅳ long bone osteomyelitis.Methods:A retrospective study was conducted of the 8 patients who had been treated at Department of Orthopaedics, The Third Affiliated Hospital to Peking University for Cierny-Mader type Ⅳ osteomyelitis of the lower extremity from June 2017 to December 2019. They were 6 males and 2 females, aged from 27 to 79 years (average, 54.6 years). The defects involved femoral shaft in 5 cases, femoral metaphysis in one, tibia shaft in one, and tibial metaphysis in one. The defect lengths ranged from 7.7 to 15.5 cm, averaging 10.2 cm. Stage one was local infection control and temporary stability reconstruction using Masquelet technique, stage two design and 3D printing of the prosthesis and stable pattern design, and stage three prosthesis implantation and rehabilitation. The ranges of motion of the knee and ankle were recoded postoperatively and the functions evaluated using the Johner-Wruhs scores.Results:The average follow-up time for the 8 patients was 12.6 months (from 6 to 18 months). The total treatment time from the first admission to the last discharge ranged from 62 to 125 days (average, 91.0 days), the time for stage one from 13 to 57 days (average, 28.7 days), that for stage two from 30 to 87 days(average, 48.3 d), and that for stage three from 28 to 84 days (average, 63.0 days). The infection was controlled and there was no recurrence, implant loosening or breakage. Seven patients were capable of full weight-bearing at 14.7 days (from 4 to 42 days) after surgery. One patient recovered full weight-bearing 6 months after surgery due to severe osteoporosis. Fine functional recovery was achieved in the 8 patients, with a range of motion from 0° to 100° for the knee and a range from 35° dorsal flexion to 40° toe flexion for the ankle. The Johner-Wruhs scores at the last follow-up showed 2 excellent, 5 good and one moderate cases.Conclusion:In repair of Cierny-Mader type Ⅳ long bone osteomyelitis, Masquelet technique and 3D printing can shorten the treatment process and allow for early recovery.

Objective:To compare the short-term outcomes of femoral neck system (FNS) and dynamic hip screw (DHS) in the treatment of femoral neck fractures.Methods:A retrospective analysis was performed of the 105 patients with fresh femoral neck fracture who had been treated by FNS fixation from September 2019 to October 2020 or by DHS fixation from January 2018 to October 2020 at Department of Orthopaedics, The Third Hospital Affiliated to Peking University. In the FNS group of 54 cases, there were 18 males and 36 females with a mean age of (60.7±15.2) years; in the DHS group of 51 cases, there were 14 males and 37 females with a mean age of (63.3±13.2) years. The 2 groups were compared in terms of hospital stay, operation time, intraoperative blood loss, incision length, intraoperative fluoroscopy frequency, qualify of reduction, and femoral neck shortening length, Harris hip score and complications at the last follow-up.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data or follow-up time ( P>0.05). In the FNS group, the median operation time [45.0 (40.0, 59.0) min], intraoperative blood loss [30.0 (20.0, 50.0) mL], incision length [4.0 (4.0, 5.0) cm], intraoperative fluoroscopy frequency [10.5 (9.0, 12.0) times] and hospital stay [2.0 (2.0, 4.0) d] were significantly superior to those in the DHS group [72.0 (55.0, 89.0) min, 50.0 (30.0, 50.0) mL, 7.0 (6.0, 8.0) cm, 18.0 (15.0, 19.0) times, and 3.0 (3.0, 6.0) d] (all P<0.05). There were no statistical differences between the 2 groups in quality of reduction, length of femoral neck shortening, failure rate of internal fixation or Harris hip score at the last follow-up ( P>0.05). There were no such surgical complications as deep infection or femoral head necrosis in either of the 2 groups. Conclusions:In the fixation of femoral neck fractures, both FNS and DHS may lead to fine short-term outcomes. However, compared with DHS, FNS exhibits advantages of simplicity, minimal invasion, less surgical trauma and intraoperative fluoroscopy frequency, and reduced operation time and hospital stay.