Hypersplenism is a common complication caused by liver cirrhosis and portal hypertension, and at present, splenectomy and partial splenic artery embolization (PSE) are the main methods for the treatment of hypersplenism. Splenectomy has a marked effect in the treatment of hypersplenism and can significantly improve the clinical symptoms of patients with hypersplenism. Compared with splenectomy, PSE causes partial splenic parenchymal infarction and thus achieve similar clinical efficacy as partial splenectomy while preserving the spleen and its function. Although PSE is an effective method for the treatment of hypersplenism, there are few reports on the effect of PSE on liver fibrosis, immunity, and liver regeneration in China and globally. This article summarizes the common causes of hypersplenism, the mechanism of PSE in the treatment of hypersplenism, the therapeutic effect of different embolization methods and materials, and the effect of PSE on liver fibrosis, immunity, and liver regeneration, so as to provide a theoretical basis and new ideas for the clinical treatment of hypersplenism.

Objective:To establish a qualitative and quantitative analysis method of ginsenoside Rb1, cinnamic acid, paeoniflorin and berberine in Wenxin formula based on UPLC-MS/MS MRM model so as to provide a rapid and accurate evaluation method for the research and development of new drugs.Methods:Adopting Waters ACQUITY UPLCTM HSS T3 (2.1 mm×100 mm, 1.8 μm) and gradient elution was performed by mobile methanol-0.03% formic acid water. chromatographic column was used with electrospray ionization source in the scanning mode of multiple reactive ion monitoring (MRM) for ion separation and screening. The retention time and the relative abundance ratio (qualitative ion pairs/quantitative ion pairs) was used for qualitative analysis, while quantitative ion pairs was used for quantitative analysis.Results:The four components tested in Wenxin Formula have been qualitatively detected and showed a good linear relationship, the method showed accuracy, precision, repeatability, and stability, the recovery rate was 96.24%-104.19% and RSD was 1.29%-3.30%. Conclusion:The established method is simple, accurate, rapid and sensitive, which is reliable for the qualitative and quantitative study of the four main components in Wenxin Formula.

Objective: In this study, a new surgical technique was developed to reconstruct the lateral nail fold in the duplicated thumbs with a common nail and postoperative outcomes were evaluated. Methods: From December 2012 to October 2015, sixteen duplicated thumbs with a common nail were treated in our hospital using a flap from resected finger pulp which did not include the nail and phalanx. Unilateral inverting suture was performed between the flap and nail bed to reconstruct the lateral nail fold and nail groove. Postoperative outcomes were evaluated by Wang-Gao scoring system (total 12). Results: The follow-up period ranged from 10 to 45 months. The reconstructed nails were smooth and had a natural lunula, and the nail width was about 80%-100% of their normal sides. There was a right angle between the nail epithelium and lateral nail fold in four cases, and an acute angle in two cases. The reconstructed nails were asymmetrical in these thumbs. One patient showed a hypertrophy in the lateral nail fold. The reconstructed nails were evaluated by Wang-Gao scoring system: 10 in 2 cases, 11 in 4 and 12 in 10. All the cases had excellent results. Conclusions The nail width usually is more than 80% of the normal sides in the radial polydactyly with a common nail. The surgical technique can reconstruct a natural lateral nail fold and nail groove, and avoid the nail deformity caused by the Bilhaut-Cloquet procedure.

Objective: To evaluate the response of neoadjuvant chemotherapy on osteosarcoma by semi-quantitative parameters of dynamic contrast-enhancement magnetic resonance imaging (DCE-MRI). Methods: Retrospectively analysis 25 cases of osteosarcoma confirmed by pathology.All cases received DCE-MRI scan before and after 4 cycles of neoadjuvant chemotherapy.The following semi-quantitative parameters were calculated by post-processing software: early dynamic enhancement wash-in slope (Slope), maximum signal intensity (SI_max), time to peak (TTP), signal enhanced extent (SEE), peak percent enhancement (PPE), wash out rate (WOR), enhancement rate (R). All cases were divided into good response group (tumor necrosis rate ≥90%, n=12) and non-response group (tumor necrosis rate <90%, n=13) according to the Huvos grading method. Semi-quantitative parameters of DCE-MRI before and after neoadjuvant chemotherapy between good response group and non-response group were compared by Mann-whitney U test. Receiver operating characteristic curve (ROC) analysis was performed to evaluate the efficacy of different good response group and non-response group after neoadjuvant chemotherapy (NAC). Results: Slope, SI_max, TTP, SEE, PPE, WOR, R, TTP, WOR before and after NAC in good response group were significant different (P<0. 05), but only SI_max, SEE in non-response group. TTP, R were significant different between the above two groups before NAC, and Slope, SI_max, TTP, SEE, WOR, R were significant different after NAC (P<0.05). ROC was used to predict the diagnostic efficiency of various parameters for tumor necrosis rate after osteosarcoma NAC. It was found that the sensitivity and specificity of Slope, TTP and R parameters for predicting the response of osteosarcoma after chemotherapy were 83.3% and 92.3%, 91.7% and 69.2%, 84.6% and 75.0% respectively. The area under the curve (AUC) were 0.872 (95% CI: 0.716 to 1.027), 0.846 (95% CI: 0.685 to 1.007), 0.833 (95% CI: 0.662 to 1.004), the cut-off value were 0.032, 175 s, 5.441, Youden index were 0.756, 0.609, 0.596, respectively. Conclusions Slope, TTP, R were the most valuable semi-quantitative parameter of DCE-MRI to predict the response of NAC in osteosarcoma.

Objective To explore the target definition for internal mammary lymph nodes ( IMLNs) irradiation based on the distribution of internal mammary sentinel lymph nodes ( IM-SLNs ) developing on SPECT/CT fusion imaging. Methods A total of 709 breast cancer patients who underwent preoperative SPECT/CT fusion imaging examination in IM-SLN from 2014 to 2018 were selected. All of the selected patients were first diagnosed and did not receive neoadjuvant treatment before SPECT/CT examination. Finally, totally 97 patients with 136 positive imaging IM-SLNs were included in this study. The clinical target volumes ( CTVs) were delineated according to the consensus guidelines from RTOG and DBCG and defined as CTVRTOG and CTVDBCG , respectively. The positional relationship of CTVRTOG , CTVDBCG and IM-SLNs were determined. Results The number of IM-SLNs from the first to fifth intercostal spaces were 55, 40, 33, 6 and 1, respectively. And the number of IM-SLNs in the first three intercostal spaces accounted for 94. 85％ of the total. The average distance from the edge of CTVRTOG to the centre points and the edges of IM-SLNs were 4. 10 mm ( 95％CI 3. 54-4. 65 mm) and 6. 40 mm ( 95％CI 5. 81-6. 98 mm), respectively (t=-30. 486,P<0. 05). For the CTVDBCG, the average distance was 1. 60 mm ( 95％CI 1. 16-2. 05 mm) and 3. 34 mm ( 95％CI 2. 78-3. 89 mm) , respectively ( t=-16. 364,P<0. 05) . The average distances from the edge of CTV to the centre points and the edge of IM-SLNs for CTVRTOG were all significantly greater than those for CTVDBCG(t=16. 640, 19. 815, P<0. 05). The rate of covering IM-SLN center points for CTVRTOG and CTVDBCG were 18. 4％ and 60. 3％, respectively. In order to cover 90％or 100％ of the IM-SLN center points, the edge of CTVRTOG should be expanded by 8 or 15 mm, respectively, and the edge of CTVDBCG should be expanded by 5 or 13 mm, respectively. If the diameter of IM-SLN was assumed as 5 mm, the edge of CTVRTOG needed an expansion of 11 or 17 mm to contain 90％or 100％ of IM-SLNs, respectively, while the edge of CTVDBCG needed 7 or 16 mm to cover 90％ or 100％of IM-SLNs, respectively. Conclusions It is reasonable to include the first three intercostal spaces IMLNs for prophylactic irradiation based on the distribution of IM-SLNs. However, CTVs based on the two guidelines are both insufficient to cover 90％ of IM-SLNs.

Objective To analysis the post-dialysis fatigue status of maintenance hemodialysis patients,explore the influencing factors in these patients and propose effective interventions.Methods One hundred and twenty maintenance hemodialysis patients in Department of Nephrology,Second Affiliated Hospital of Nanjing Medical University were enrolled.Clinical data were obtained by questionnaires.Biochemical changes before and post hemodialysis were recorded.The serum concentrations of hemoglobin,albumin,electrolyte,bicarbonate and lactic acid were collected for analysis.Results One hundred and nine(90.8％)effective questionnaires were collected,in which more than half of patients claimed to experience post-dialysis fatigue.Time to recover from hemodialysis(TIRD)was different:the median(interquartile range)time was 2.00(0.00,3.00)hours.In the study,30.3％patients reported no fatigue after hemodialysis.Recovery time in 35.8％patients was more than 30 minutes to 2 hours,22.0％was 3 to 4 hours,11.0％was 5 to 12 hours,0.9％patients took longer time to recover from a dialysis session.According to the recovery time,these patients were divided into three groups.Among the three groups,the ultrafiltration,the serum sodium and lactic acid after dialysis showed significant difference.It was showed by the unconditional logistic regression analysis that ultrafiltration(OR=2.35,95％CI 1.44-3.83),serum sodium(OR=0.75,95％CI 0.65-0.88),lactic acid(OR=3.16,95％CI 1.32-7.55)were associated of TIRD.Conclusions The incidence of post-dialysis fatigue is high.Most of the patients require more rest or sleep immediately after dialysis.The level of lactic acid is a significant influencing factor of the fatigue of patients.TIRD is correlated with the elevation of lactic acid during the dialysis process,and more attention should be paid to postdialysis fatigue.

Objective: To evaluate the safety, feasibility and operational effectiveness of master-slave system controlled Robot-assisted flexible endoscopy 'YunSRobot’ in upper gastrointestinal endoscopy examination in living pigs. Methods: Seven Guangxi BA-MA Mini-pigs underwent upper gastrointestinal endoscopy examination with master-slave system controlled Robot-assisted flexible endoscopy 'YunSRobot’ and Olympus GIF-Q260J gastroendoscope (Japan). The experiment divided into manual operation group and robot operation group. Nine gastroenterologists skilled with endoscopy operation handled the robot once in vitro to familiar with the mechanism and method of robot operation. And then performed manual operation and robot operation four times each. Endoscopy pictures and operation time were recorded. T test and one-way analysis of variance were performed for statistical analysis. Results: Both manual operation and robot operation could successfully finish standard esophagus and stomach endoscopic examination. There were no complications such as hemorrhage, perforation, mistaken insertion into of trachea, injures of pharynx and larynx and inhalation pneumonia. Esophagus, gastric cardia, gastric fundus, gastric body, gastric angle, gastric antrum and gastric pylorus could be clearly observed in both groups. The manual operating time of nine gastroenterologists was (3.67±1.95) minutes, which was shorter than that of robot operating time ((7.60±2.00) minutes), and the difference was statistically significant (t=8.445, P<0.01). The time of first in vitro operation performed by nine gastroenterologist was (13.10±6.32) minutes. The operation times of each case of nine gastrienterologist were (8.49±0.90) minutes, (7.50±1.19) minutes, (7.30±1.33) minutes and (7.12±1.61) minutes. The difference was statistically significant (F=7.901, P<0.01). Operation time gradually shortened and operation proficiency significantly improved. Conclusion Master-slave system controlled Robot-assisted flexible endoscopy 'YunSRobot’ which provides a clear observation of esophagus and stomach is safe in endoscopic examination of living animal.

Objective To investigate the clinical value of 99Tcm-methoxyisobutylisonitrile (MIBI) double-phase imaging in differential diagnosis of bone lesions in tumor patients,which was indefinite in 99Tcm-methylene diphosphonate (MDP) bone imaging,and evaluate the correlation between 99Tcm-MIBI imaging and chemotherapy efficacy.Methods Fifty-two tumor patients (23 males,29 females,mean age 58 years) with bone isolated lesions(≤3) found by 99Tcm-MDP bone scintigraphy was enrolled from June 2014 to November 2015.Since the results of 99Tcm-MDP imaging were indefinite,99Tcm-MIBI double-phase (10 min and 30 min after injection of 99Tcm-MIBI) SPECT/CT imaging was then performed within 1 week.The final diagnosis was made according to results of more than two imaging modalities (CT,MRI,PET/CT) and/or follow-up (≥6 months).The diagnostic efficacy of 99Tcm-MIBI SPECT/CT imaging was calculated.The clinical dataof chemotherapy were also collected.Patients with bone metastasis were grouped as the treatment response.Retention index (RI) of metastatic lesions was calculated and compared between different groups using two-sample t test.The relationship between RI and chemotherapy efficacy was investigated by Spearman correlation analysis.Results A total of 12 benign lesions and 84 malignant lesions were eventually diagnosed.The sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV) and Youden index of 99Tcm-MIBI imaging were 96.43％(81/84),83.33％(10/12),97.59％(81/83),76.92％(10/13),and 0.80,respectively.The RI was statistically different between complete remission (CR)+partial remission (PR) group and stable disease (SD) + progressive disease (PD) group:-0.142± 0.036 vs-0.384± 0.067 (t =2.367,P＜0.05).The RI of 99Tcm-MIBI in bone metastases was positively correlated with the chemotherapy efficacy (rs =0.78,P＜0.01).Conclusions 99Tcm-MIBI imaging is helpful in differential diagnosis of bone lesions with indefinite diagnosis by 99Tcm-MDP bone imaging in tumor patients.99Tcm-MIBI RI of bone metastasis may predict the therapeutic response of chemotherapy efficacy.

Objective To evaluate the clinical value of 99Tcm-Tilmanocept(TMC) SPECT/CT for the detection of SLN by comparing with 99Tcm-sulfur colloid(SC) SPECT/CT. Methods From March 2016 to September 2016, a total of 160 patients (age range: 30-70 years), selected from Breast Surgery Department of Shandong Cancer Hospital, underwent SPECT/CT and planar imaging with either 99Tcm-TMC (TMC group, n=76) or 99Tcm-SC (SC group, n=84). The results of SLN SPECT/CT and planar imaging were compared. The positive rate of SLN in SPECT/CT was compared with operative results. One-way analysis of variance, χ2 test, and two-sample t test were used for data analysis. Results The radiochemical purity of 99Tcm-TMC (≥92%) had no significant difference in 4 h(F=0.720, P>0.05). In TMC group, the average number of SLN detected by SPECT/CT imaging was higher than that by planar imaging (1.34±0.64 vs 0.96±034; t=4556, P<005). In SC group, the average number of SLN detected by SPECT/CT imaging was also higher than that by planar imaging (2.57±0.99 vs 1.56±0.87; t=7.010, P<0.05). The positive rates of SLN in TMC and SC groups were 94.7%(72/76)and 96.4%(81/84), showing no significant difference (χ2=0273, P>0.05). The average number of SLN detected by 99Tcm-TMC imaging was significantly lower than that detected by 99Tcm-SC (t=9.115, P<0.05). The intraoperative detection rates of SLN were 100% (76/76 and 84/84) in both groups. The average number of SLN detected during operation in TMC group was significantly lower than that in SC group (1.89±0.86 vs 3.05±1.29; t=6.642, P<0.01). In TMC group, the average number of SLN detected during operation was significantly higher than that detected by SPECT/CT(1.89±086 vs 1.34±0.64; t=4.492, P<0.05). In SC group, the average number of SLN detected during operation was significantly higher than that detected by SPECT/CT(3.05±1.29 vs 2.57±0.99; t=2.740, P<005). Conclusions SPECT/CT is superior to planar imaging for the detection and localization of SLN. 99Tcm-TMC is suitable for SLN imaging and intraoperative detection.

OBJECTIVE: To compare and analyze the risk of formaldehyde hazards in a plywood manufacturing factory using two risk assessment methods,and to evaluate the occupational health risk. METHODS: Occupational health investigation and formaldehyde detection for workplaces were carried out in a plywood manufacturing factory in Shandong province. The risk ratings of different posts were assessed by US Environmental Protection Agency( EPA) inhalation risk( EPA assessment model) and Singapore Semi-quantitative Assessment Model( MOM assessment model). The risk classification results of the 2 risk assessment methods were compared and analyzed. RESULTS: The concentration of airborne formaldehyde on the positions of shaving,woods feeding,gluing,hot milling,hot pressing,sanding and reprocessing were 0. 25,0. 13,1. 47,0. 72,0. 92 and 0. 58 mg/m~3,respectively. By the EPA assessment model,all of the positions were evaluated as high carcinogenic risk. Through the MOM assessment model,the feeding position was evaluated as medium risk,the positions of shaving,hot milling,hot pressing sanding and reprocessing were high risk,and the position of gluing was higher risk. CONCLUSION: It suggests that there is a high formaldehyde exposure in several posts in the plywood production processing. EPA assessment model is a suitable for occupational health risk assessment for formaldehyde exposure.