Application of digital technology in the reconstruction of orbital fractures: research progress / 中华创伤杂志

Orbital fracture often leads to facial collapse, diplopia, enophthalmos, and even blindness. Traditional surgery relies on the experiences of physicians to achieve fracture reduction and orbital wall reconstruction, but the repair effect is not satisfactory. In recent years, with the development of digital technology, technologies such as computer-assisted surgery, 3D printing, surgical navigation systems, and intraoperative CT imaging have become increasingly widespread in the field of orbital reconstruction. Such techniques can avoid dependence on physicians′ experiences and make it easy for estimating and positioning the implantation sites, which subsequently contributes to better surgery efficiency and precise reconstruction of the orbit, improving aesthetics and visual function of patients. To this end, the authors reviewed the recent progress in application of digital technology for orbital fracture reconstruction, so as to provide reference and theoretical basis for clinical practice.

Efficacy of duplizumab in the treatment of multiple type 2 inflammatory diseases / 中国医师杂志

Objective:To analyze the therapeutic effect of adding interleukin (IL)-4Rα monoclonal antibody (duplizumab) to patients with multiple types of inflammatory diseases.Methods:Six patients with multiple types of inflammatory diseases who started to use duplizumab from August 2020 were enrolled. The changes of airway inflammation, lung function, sinuses computed tomography (CT), Asthma Control Questionnaire-5 (ACQ-5), Sino-Nasal Outcome Test-22 (SNOT-22), Pennsylvania Smell Identification Test (UPSIT) and Numerical Rating Scale (NRS) score before and after duplizumab treatment were retrospectively analyzed. All patients were treated with doprilumab for more than 5 months.Results:4 of the 6 patients had both severe asthma and chronic sinusitis, and 2 patients had both severe asthma, chronic sinusitis and atopic dermatitis. After treatment, the pulmonary function of 6 patients was improved, the levels of sputum eosinophils, exhaled nitric oxide and total IgE were decreased (all P<0.05), and the scores of paranasal sinus CT, ACQ-5, SNOT-22 and UPSIT were significantly improved (all P<0.05). However, 3 patients had increased peripheral blood eosinophils during the treatment. Conclusions:Duplizumab is effective for a variety of type 2 inflammatory diseases without obvious adverse reactions, and the peripheral eosinophils may increase during the treatment.

Clinical analysis of 30 cases of Castleman disease with different types of thoracic involvement / 中华血液学杂志

Objective@#To improve the clinical understanding of Castleman disease (CD) with different types of thoracic involvement, including their clinical features, radiological and pathological findings, diagnosis and current treatment strategies.@*Methods@#Retrospective analysis of 30 patients diagnosed with CD with thoracic involvement and hospitalized between June 2009 and May 2019 in The First Affiliated Hospital of Guangzhou Medical University was performed. Patients were divided into three groups for subsequent analysis based on the clinical data: CD with bronchiolitis obliterans (BO) , unicentric Castleman disease (UCD) without BO, and multicentric Castleman disease (MCD) without BO.@*Results@#Among the 30 patients, there were 5 (16.7%) patients diagnosed with BO, 18 (60.0%) patients had UCD without BO and 7 (23.3%) patients had MCD without BO. The average age of MCD without BO patients was significantly older than that of BO and UCD without BO patients[ (49.29±5.39) ys vs (27.20±3.76) ys and (37.17±2.87) ys; P=0.005 and 0.034, respectively) ]. Pulmonary symptoms were commonly seen in BO group (100%) and MCD without BO group (71.4%) . while no pulmonary symptoms were seen in UCD without BO group. Key abnormal laboratory findings were erythrocyte sedimentation rate (ESR) increase (40%in BO group and 57.1% in MCD without BO group) and hypoxia (60% in BO group and 28.6% in MCD without BO group) . Other abnormal laboratory findings seen in MCD without BO group included anemia and IgG increase (both 57.1%) . Notably, all patients in BO group had extremely severe mixed ventilation dysfunction in the lung function test. CT scan showed lung parenchyma involvement in BO group (100%) , in UCD without BO group (11.1%) featured by solitary pulmonary nodule and in MCD without BO group (57.1%) featured by diffuse lesions in bilateral lungs. The size of lymph nodes was significantly smaller in MCD without BO group comparing to that in BO group and UCD without BO group[short diameter (1.83±0.51) cm vs (4.73±1.63) cm and (3.62±0.26) cm; P=0.006 and 0.011, respectively]. All patients (100%) in the BO group had a pathological type of transparent vascular variant while the same pathological type accounts for 88.9% in UCD without BO patients. The predominantly pathological type (57.1%) was plasma cell variant in the MCD without BO group. Oral ulcers presented in all patients in BO group but were relieved after the mass resection and immunomodulatory therapy, but the pulmonary symptoms were still progressively aggravated. Thoracoscopic mass excision was the main treatment for UCD without BO patients while chemotherapy, immunomodulatory and targeted therapy were commonly used for MCD without BO treatment.@*Conclusion@#The age, clinical symptom, laboratory finding, lung function, imaging manifestation, pathology, treatment and prognosis were different among the three groups. This classification could improve clinical understanding of the disease.

The early evaluation of lowGdose CT perfusion imaging for the treatment efficacy of lung cancer with anrotinib hydrochloride / 实用放射学杂志

Objective To explore whether CT perfusion imaging (CTPI)parameters can early predict the curative effect of anlotinib hydrochloride and their predictive accuracy for the treatment in lung cancer patients.Methods 2 6 patients with advanced nonGsmall cell lung cancer (NSCLC)were treated with anlotinib hydrochloride and underwent CTPI scanning before chemotherapy,after the first and second treatment cycle respectively.The average values of perfusion value (PV),peak enhancement image (PEI),time to peak (TTP),blood volume (BV)and the change rate of these parameters after one treatment cycle every time were measured and recorded. According to the response evaluation criteria in solid tumors 1.1 (RECIST1.1),the maximum diameter of the target tumor was measured and the tumor regression rate after two treatment cycles was calculated.Then a correlation analysis was conducted between the change rate of perfusion parameters (PV%,PEI%,TTP%,BV%)after one treatment cycle and the tumor regression rate (D%)after two treatment cycles. The ROC curve was performed to evaluate the accuracy of those parameters.Results PV after one treatment cycle was significantly lower than that before treatment,and PV% showed a statistical difference (P＝0.00).The PV% after one treatment cycle was positively correlated with D% after two treatment cycles (r＝0.56).In addition,the AUC of PV% and BV% were 0.99 and 0.88 respectively, and specificity were both 100%,with sensitivity respectively 75.7% and 82.6%.Conclusion CTPI can early reflect the curative effect of anlotinib hydrochloride for advanced NSCLC and provide more options for clinical evaluation.

Value of introvoxel incoherent motion imaging on evaluating concurrent chemoradiotherapy responseinpatientswithadvanceduterinecervixcancer / 中华放射学杂志

Objective To investigate the value of introvoxel incoherent motion(IVIM)using 3.0 T MRI to evaluate response to concurrent chemoradiotherapy(CCRT)in patients with advanced uterine cervix cancer. Methods From July 2015 to December 2016,63 patients with advanced(≥ⅡB)cervical cancer diagnosed by clinical and imaging study, who had completed CCRT plan in Henan Cancer Hospital, were prospectively enrolled.Pelvic MRI protocol including T1WI,T2WI,IVIM and dynamic contrasted enhanced scans were performed in each patient before CCRT and 3 weeks after starting therapy(total dose of 30 Gy), and at the end of therapy (total dose of 90 Gy, 8 weeks after therapy). The mean values of ADC, true molecular diffusion coefficient(D),pseudodiffusion coefficient(D*)and perfusion fraction(f)in each tumor at pre-therapy, in the middle of therapy and post-therapy were measured and recorded as ADC-pre, D-pre, D*-pre,f-pre;ADC-mid,D-mid,D*-mid,f-mid and ADC-post,D-post,D*-post,f-post,respectively;the change rates of these parameters during and after therapy (recorded as ΔADC-mid, ΔD-mid, ΔD*-mid, Δf-mid;ΔADC-post, ΔD-post, ΔD*-post, Δf-post) were also calculated. Patients were classified into response group and non-response group,according to response evaluation criteria in solid tumors after CCRT.MRI imaging study was performed in each patient within 1 month after CCRT to follow up,and tumor regression rate was calculated.The Mann-Whitney U test was used to compare differences of parameters and their change rates between response group and non-response group. Spearman correlation analysis was performed to assess relationships between parameters, parameter change rates and tumor regression rate. Logistic regression model was applied to find potential ADC values for predicting therapeutic response. ROC was used to analyze efficacy of ADC values for evaluating therapeutic response in advanced uterine cervix cancer after CCRT. Results The mean value of tumor maximum diameter before and after therapy was (47.5 ± 12.9) and(12.8 ± 10.0)mm,tumor regression rate was(66.7 ± 33.6)%.Forty-eight patients were in the response group and 15 in the non-response group.The mean value of ADC-pre,D-pre,D*-pre and f-pre was 0.74(0.43, 1.14)×10-3,0.58(0.33,0.91)×10-3,12.12(2.30,21.4)×10-3mm2/s,9.65%(4.45%,13.89%),respectively.Tumor regression rate had positive correlation with ADC-pre and D-pre (r=0.773,0.840;P<0.05). Responders had increased ADC-pre, D-pre values than non-responders, which had statistically significant difference (P<0.05). Responders had increased ADC-mid, D-mid and f-mid values than non-responders, which had statistically significant difference (P<0.05), tumor regression rate had positive correlation with ADC-mid, D-mid and f-mid (r=0.808,0.834,0.563;P<0.05). Responders had increased ADC-post, D-post and f-post values than non-responders,which had statistically significant difference(P<0.05),tumor regression rate had positive correlation with ADC-post and D-post (r=0.799, 0.829;P<0.05).Tumor regression rate had positive correlation with ΔADC-mid,ΔD-mid,Δf-mid(r=0.526,0.573,0.454;P<0.05)and with ΔADC-post,ΔD-post, Δf-post (r=0.541, 0.555, 0.388;P<0.05). Responders had increased ΔADC-mid, ΔD-mid, Δf-mid and ΔADC-post, ΔD-post, Δf-post, which had statistically significant difference (P<0.05). Logistic regression analysis revealed only ADC-pre and D-post could be independent factors to predict therapeutic response in advanced uterine cervix cancer after CCRT,values of B,Wald,odds ratio and P was 22.488,8.431,1.429, 0.004 and 16.542,8.517,1.779,0.004.ROC analysis showed the area under the curve(AUC)of ADC-pre, D-pre,ΔADC-mid,ΔD-mid,Δf-mid,ΔADC-post,ΔD-post and Δf-post for predicting therapeutic response in advanced uterine cervix cancer after CCRT were 0.890,0.926,0.942,0.851,0.803,0.929,0.951 and 0.906, respectively. Conclusion The IVIM parameters before and during CCRT process and their changes are valuable for predicting and evaluating therapeutic response in advanced uterine cervix cancer after CCRT, with high clinical practice value.

Correlation between CT manifestations of intramural vascular abnormalities and pathological subtypes, ground glass types in ground-glass opacity lung adenocarcinoma / 中国医学影像技术

Objective To investigate the correlation between CT manifestations of intramural vascular abnormalities and pathological subtypes,ground glass types in ground-glass opacity (GGO) lung adenocarcinoma.Methods CT data of 50 patients (55 lesions) with GGO lung adenocarcinoma confirmed by operative pathology were analyzed.The vascular morphology was observed.Correlation between vascular abnormalities (vascular thickening and hyperplasia) and pathological subtypes,ground glass types in GGO lung adenocarcinoma were analyzed.Results Among 55 GGO lung adenocarcinoma lesions,5 were pre-invasive lesions,no vascular thickening was observed,whereas vascular increasing was noticed in 1 lesion.Among 16 minimally invasive adenocarcinomas (MIA),vascular thickening and vascular increasing were observed in 11 and 16 lesions,respectively.All 34 invasive adenocarcinomas (IAC) were found with vascular thickening and increasing.The overall difference of vascular thickening and vascular increasing among pre-invasive lesions,MIA and IAC was statistically significant (x2 =27.67,20.08,both P＜0.05).There was positive correlation between pathological subtypes and vascular thickening and vascular increasing (r=0.61,0.66,P＜0.01).Significant differences of vascular thickening were found between pre-invasive lesions and MIA (x2=9.19,P=0.01),pre-invasive lesions and IAC (x2 =29.87,P＜0.01),as well as MIA and IAC (x2 =12.63,P＜0.01).There were significant differences of vascular increasing between pre-invasive lesions and MIA,pre-invasive lesions and IAC (x2 =15.45,20.79,both P＜0.01).Of all 55 GGO lung adenocarcinoma lesions,25 were pGGO,17 with vascular thickening and 21 vascular increasing;30 were mGGO,28 with vascular thickening and 30 vascular increasing.There were significant differences of vascular thickening and increasing in pGGO and mGGO (x2=6.12,6.69,both P＜0.05).Conclusion Vascular abnormalities in GGO lung adenocarcinoma suggest increasing of invasion.Vascular thickening and increasing can occur independently.

The application of low dose CT scan and quantitative analysis in airway remodeling and air trapping of asthma / 中华放射学杂志

Objective To explore airway remodeling and air trapping in asthmatic patients with low dose CT scanning and quantitative analysis. Methods 52 stable asthmatic patients in which 29 were severe and 23 were slight,and 20 healthy control cases were underwent low dose dual phase CT scanning. The LA/BSA, WA/BSA, TA/BSA, WA%and Pi10WA were analyzed as airway remolding indexes. The MLD of expiratory, VI-850 (%) of expiratory, MLD E/I, VI-850E-I (%) and VI-850/-950E-I (%) were analyzed as air-trapping indexes. One-Way ANOVA or H Kruskal-Wallis was used to analyze the above indicators. Results Airway remodeling indexes and LA/BSA were (9.6 ± 2.6), (11.0 ± 3.4) and (12.6 ± 3.0)mm2/m2 in severe asthmatics group, non-severe asthmatics group and healthy control group respectively, and there was significant difference between the three groups (F=5.60, P=0.006). WA%of each group was (65.1 ± 2.5)%, (63.3 ± 4.4)%and (62.0 ± 3.0)%, and there was significant difference between the three groups (F=5.53,P=0.006). The Pi10WA was (18.4±2.6), (17.7±3.1) and (16.4±1.4) mm2 respectively with significant difference between the three groups (F=3.59 ,P=0.033). Air-trapping indexes, MLD of expiratory of each group was-(771 ± 59),-(724 ± 43) and-(676 ± 60) HU respectively with significant difference (F=5.60, P=0.006). VI-850(%) of expiratory of each group was 30.79(30.45)%, 13.53(12.09)%and 2.85(6.87)%respectively with significant difference (H=17.20,P<0.001). Conclusions Low dose of CT scan and quantitative analysis can provide an objective and quantitative information for patients with airway disease of asthma, and both WA% and Pi10WA were objective indexes. The severe asthmatic patients were associated with obvious airway remodeling and air trapping compared with non-severe asthmatic patients.

Correlation between CT characters and epidermal growth factor receptor gene mutations in lung adenocarcinoma / 中华放射学杂志

Objective To explore the correlation between CT characters and epidermal growth factor receptor (EGFR) gene mutations in lung adenocarcinoma. Methods Two hundred and three lung adenocarcinoma patients (from September,2014 to March,2015) confirmed by pathology were divided into effective mutation group (97 cases) and non?effective mutation group (106 cases) on the basis of the site and the response to tyrosine kinase inhibitors. Among all the CT characters, rank?sum test was adopted to analyze the difference of diameter between the two groups; Fisher's exact test was applied to explain the difference of density type and Chi?square test was applied to analyze the difference of lobulation, spiculation, necrosis, pleural indentation, cavitation and air?brochogram signs. Logistic regression was used to analyze the significant signs and evaluate the odds ratio (OR). Results There were 65, 67, 45, 74 cases of lobulation, spiculation, necrosis, pleural indentation in the EGFR gene effective mutation group and 56, 51, 26, 61 cases in non?effective mutation group with statistically significant difference between the two groups (χ2=4.230, 9.141, 10.646, 7.986, P0.05). Logistics regression analysis showed that, spiculation (OR=2.120), necrosis (OR=2.853) and pleural indentation (OR=2.094) were in correlation with EGFR effective mutations, and lobulation was not in correlation with EGFR effective mutations. Conclusions Among all the CT sings, spiculation, necrosis and pleural indentation were in correlation with EGFR gene effective mutation, they were more likely to appear in lung adenocarcinoma patients with EGFR gene effective mutation.

Soluble expression, purification and characterization of recombinant Tp0136 selective fragment from Treponema pallidum / 中华微生物学和免疫学杂志

Objective To express and purify recombinant Tp0136 epitope fragment, and study the immunity activity. Methods The Tp0136 selective fragment(Tp0136B) gene was devised by the surface property analysis, solvent-accessible suface calculateions, secondary structure function region analysis, and was inserted between the sites of Nde Ⅰ and Not Ⅰ in pET22b ( + ) . The recombinant plasmid was expressed in E. coli BI21. After nickel ion metal affinity chromatography, the antigenic and immune reactivity of rTp0136B was confirmed. Then indirect ELISA with the rTp0136B as coating antigen was performed to detect the anti-Tp0136 antibody in sera from 100 normal human controls and 131 primary syphilis patients. Results The rTp0136B was soluble expressed with a molecular weight of about 28 000 and was obtained with a purity of ＞98% by chromatography. Western blot proved that the rTp0136B could specifically react with anti-Tp0136 polyclonal antibody. Specific humoral response was elicited by the recombinant protein in Japan negative. The positive detection rate in sera from primary syphilis patients was 85.5%. Conclusion This result suggested that the recombinant Tp0136 epitope fragments have a satisfactory immunocompetence,which may have applications in the serodiagnosis of primary syphilis.

Changes in mechanics of respiration and efficacy of mechanical ventilation during perioperative period in patients undergoing valve replacement / 中华麻醉学杂志

Objective To examine the changes in respiratory mechanics and efficacy of mechanical ventilation during perioperative period in patients undergoing valve replacement and determine the possible causes Methods Twenty ASA Ⅱ Ⅵ patients (8 male, 12 female), aged 24 65 years , undergoing valve replacement were studied The patients were premedicated with intramuscular phenobarbital 0.1g, pethidine 50mg and scopolamine 0 3mg Anesthesia was induced with midazolam, fentanyl and vecuronium and maintained with inhalation of low concentration of desflurane and intermittent intravenous boluses of fentanyl, midazolam and vecuronium Valve replacement was performed with moderate hypothermic cardiopulmonary bypass (CPB), The patients were mechanically ventilated with pure oxygen Tidal volume was maintained at 8 10ml/kg, frequency 12 15 bpm and I∶E ratio 1∶1 5 2 During CPB airway pressure was maintained below 5 cmH 2O After operation the patients were transferred to ICU and mechanically ventilated using Siemens 900C ECG, SpO 2, BP, CVP, left auricle pressure and urine output were routinely monitored Respiratory mechanics was measured with Novametrix 8100 multifunction respiratory monitor Mean airway pressure, peak airway pressure, airway resistance, chest lung compliance and respiratory work were measured 20 min after induction of anesthesia, 10 min before CPB, 10 min after termination of CPB, at the end of operation and 2, 6 and 18h after operation Results Work of breathing and airway resistance increased gradually after induction and reached the maximum at 6h after operation Dynamic compliance decreased significantly before CPB but increased slightly after CPB, then decreased again and to the minimum at 6h after operation Mean airway pressure and peak inspiratory pressure went up significantly after operation All parameters mentioned above returned to the preoperative levels before the patients were weaned from respiratory support in ICU Couclusions Thoracotomy and CPB are the main causes of changes in respiratory mechanics in patients undergoing valve replacement The effects reached the peak at 6 h after operation Therefore mechanical respiratory support is essential for the patients until respiratory function recovers and should be maintained for more than 6h after operation