Objective To evaluate the radiation impact of a self-developed digital miniature CT on the human body and the environment under simulated scanning conditions, and verify its safety and regulatory compliance. Methods Under typical head scanning conditions with the digital miniature CT (70 kV/10 mA), the equivalent doses received at the body surface sites corresponding to the thyroid, breast, stomach, liver, kidney, and gonads of the phantom were measured without protection and with 0.5 mmPb equivalent protection using LiF (Mg, Cu, P) thermoluminescent dosimeters. The ambient dose equivalent rates at the bed level inside the CT room at different directions and distances from the scanning center were measured using a model AT1121 X/γ dosimeter. The equivalent doses of organs on both sides of the phantom and the ambient equivalent dose rates on the left and right sides of the longitudinal axis of the bed in the CT room were compared. The Mann-Whitney test was used at a significance level of P < 0.05. Results During a single scan of the head with the digital miniature CT, the equivalent doses at the body surface sites corresponding to the thyroid, breast, stomach, liver, kidney, and gonads without protection were 1.04, 0.95, 0.55, 0.57, 0.40, and 0.12 mSv, respectively, which were only 0.84% to 8.24% of the doses inside the irradiation field. With 0.5 mm Pb equivalent protection, the equivalent dose of the thyroid decreased from 8.24 mSv to 3.27 mSv with a reduction of 60.3%, and the doses of the other organs were reduced to 1.5-11.5 μSv with the maximum reduction of 14 times. In the longitudinal axis direction of the CT bed, the ambient dose equivalent rate at a distance of 2 m from the scanning center was reduced to 0.066 mSv/h, which was only 9.6% of the ambient equivalent dose rate at a distance of 50 cm from the scanning center. Conclusion The digital miniature CT has advantages in ensuring patient safety, optimizing imaging quality, and promoting technological development, demonstrating promising application potential. However, the radiation protection of personal and CT room should not be ignored.

Objective To explore the detection rate and distribution characteristics of gene mutations in pa-tients with non-small cell lung cancer,and to analyze their relationship with clinicopathological characteristics.Methods The genetic testing results and clinicopathological data of 213 patients with non-small cell lung cancer who underwent high-throughput genetic testing at the Gene Detection Center,Changchun Cancer Hos-pital from April 2020 to December 2023 were collected.High-throughput sequencing technology was used to detect mutations in 26 genes,and the relationship between the mutation frequency and its distribution and the clinicopathological characteristics of patients was analyzed.Results Among 213 patients with non-small cell lung cancer,192 cases(90.14％)had at least one gene mutation detected.Among them,the genes with rela-tively high mutation frequencies were TP53(60.56％),EGFR(46.48％),KRAS(14.55％),ALK fusion(11.74％),and PIK3CA(8.92％).There were 132 cases(30.28％)of evidence level for Class 1 drugs and 11 cases(2.52％)of evidence level for Class 2 drugs.The incidence of EGFR gene mutations was higher in women,non-smokers and patients with lung adenocarcinoma(P＜0.05).TP53 mutations usually occured in women,smokers and patients with stage Ⅳ.ALK mutations were more common in young patients,while KRAS mutations were more frequently seen in male smokers.Conclusion Analyzing the distribution charac-teristics of gene mutations in non-small cell lung cancer and their relationship with clinicopathological charac-teristics can provide a scientific basis for further optimizing genetic testing for patients with non-small cell lung cancer and offer guidance for clinical treatment.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective To make a comparative analysis on mechancial properties of the modified cortical bone trajectory(MCBT)nailing technique using a novel variable-diameter screw and the traditional pedicle nailing technique using the cement-augmented pedicle screw(CAPS)in the L4 vertebral body.Merthods CAPS and MCBT instrumentation in the L4 vertebral body model were established by obtaining CT scan data from osteoporotic patients.The finite element method was used to compare the stability,screw axial pull-out force and lumbar spine motion under four working conditions(upper,lower,left and right loads)by using different nailing techniques.Results The axial pull-out force of the screws in MCBT group was 25.3％higher than that of the CAPS group(P＜0.05);the load-displacement ratios of the screws in MCBT group were 14.9％(P＞0.05),23.2％(P＞0.05),and 19.1％(P＜0.05)higher than those of CAPS group under the lower,left,and right working conditions,respectively;the load-displacement ratios of the screws in MCBT group were slightly lower than those of CAPS group under the upper working condition,but the differences were not statistically significant(P＞0.05);under the anterior and posterior flexion conditions,the lumbar spine motion of MCBT group was reduced by 13.3％and 2.5％,respectively,compared with CAPS group;under the left lateral bending,right lateral bending,and axial rotational conditions,the lumbar spine motion of MCBT group was improved by 69.1％,74.6％,and 118.1％,respectively,compared with CAPS group,but these differences were not statistically significant(P＞0.05).Conclusions MCBT screw was slightly better than CAPS in axial resistance to extraction force,and stability of vertebral anterior flexion under lower,left and right working conditions,and slightly weaker than CAPS in stability under upper,left lateral bending,right lateral bending,and axial rotational conditions.This study demonstrates that MCBT screw has certain advantages over CAPS,providing a pre-basic foundation for the clinical application of MCBT nailing technique for treating osteoporosis.

Objective To make a comparative analysis on mechancial properties of the modified cortical bone trajectory(MCBT)nailing technique using a novel variable-diameter screw and the traditional pedicle nailing technique using the cement-augmented pedicle screw(CAPS)in the L4 vertebral body.Merthods CAPS and MCBT instrumentation in the L4 vertebral body model were established by obtaining CT scan data from osteoporotic patients.The finite element method was used to compare the stability,screw axial pull-out force and lumbar spine motion under four working conditions(upper,lower,left and right loads)by using different nailing techniques.Results The axial pull-out force of the screws in MCBT group was 25.3％higher than that of the CAPS group(P＜0.05);the load-displacement ratios of the screws in MCBT group were 14.9％(P＞0.05),23.2％(P＞0.05),and 19.1％(P＜0.05)higher than those of CAPS group under the lower,left,and right working conditions,respectively;the load-displacement ratios of the screws in MCBT group were slightly lower than those of CAPS group under the upper working condition,but the differences were not statistically significant(P＞0.05);under the anterior and posterior flexion conditions,the lumbar spine motion of MCBT group was reduced by 13.3％and 2.5％,respectively,compared with CAPS group;under the left lateral bending,right lateral bending,and axial rotational conditions,the lumbar spine motion of MCBT group was improved by 69.1％,74.6％,and 118.1％,respectively,compared with CAPS group,but these differences were not statistically significant(P＞0.05).Conclusions MCBT screw was slightly better than CAPS in axial resistance to extraction force,and stability of vertebral anterior flexion under lower,left and right working conditions,and slightly weaker than CAPS in stability under upper,left lateral bending,right lateral bending,and axial rotational conditions.This study demonstrates that MCBT screw has certain advantages over CAPS,providing a pre-basic foundation for the clinical application of MCBT nailing technique for treating osteoporosis.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective:To investigate the application value of enhanced recovery after surgery (ERAS) in perioperative period of laparoscopic sleeve gastrectomy (LSG).Method:The retrospective cohort study was conducted. The clinical data of 1 181 patients undergoing LSG in the Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine from January 2021 to December 2023 were collected. There were 242 males and 939 females, aged (31±8)years. Of 1 181 patients, 598 cases receiving routine perioperative care were divided into the control group, and 583 cases receiving perioperative care with ERAS were divided into the ERAS group. Measurement data with normal distribution were represented as Mean± SD, and the independent sample t test was used for comparison between the groups. Measurement data with skewed distribution were represented as M( Q1, Q3), and the Mann-Whitney rank sum test was used for comparison between the groups. Count data were expressed as absolute numbers or percentages, and the chi-square test or Fisher exact probability were used for comparison between the groups. Repeated measurement data were analyzed using the repeated ANOVA, with baseline scores as covariates. Simple effects analysis was conducted in case of interaction, and multiple comparisons were adjusted using the Bonferroni method. Results:(1) Postoperative outcomes. The numerical rating scale (NRS) scores for pain at immediate return to the ward and on the third postoperative mornings changed from 5.35±0.93 to 2.57±0.83 in the control group, versus changed from 3.15±0.93 to 0.70±0.65 in the ERAS group, showing significant difference between the two groups ( Ftime=66.58, Fgroup=1 765.85, Finteraction=6.90, P<0.05). After adjusting NRS scores for pain at immediate return to the ward as the baseline, results of simple effects analysis showed that on the third postoperative mornings, the NRS scores in the ERAS group were lower by 1.89, 1.53, and 1.76 respectively compared to the control group ( P<0.05). Cases with nausea at immediate return to the ward and on the third postoperative mornings changed from 497 to 97 in the control group, versus changed from 198 to 11 in the ERAS group, showing signifi-cant difference between the two groups ( χ2=294.45, 398.76,209.39, 73.00, P<0.05). Cases with vomiting at immediate return to the ward and on the third postoperative mornings changed from 243 to 41 in the control group, versus changed from 51 to 2 in the ERAS group, showing significant difference between the two groups ( χ2=160.54, 149.37, 71.76, 35.69, P<0.05). The duration of postoperative hospital stay was (3.22±0.65)days in the control group, versus (2.17±0.49)days in the ERAS group, showing a significant difference between the two groups ( t=-11.89, P<0.05). (2) Complications. The incidence of cases with dehydration within postoperative 30 days was 0.50%(3/598) in the control group, versus 0.69%(4/583) in the ERAS group, showing no significant difference between the two groups ( P>0.05). None of patient in the control group and the ERAS group experienced bleeding, gastric leakage, intra-abdominal infection, and no patient had unplanned secondary surgery within postoperative 30 days. Conclusions:ERAS in perioperative period of LSG are safe and feasible. Compared to routine care, ERAS can significantly reduce postoperative pain, decrease the incidence of postoperative nausea and vomiting, shorten the postoperative hospital stay, and do not increase the rate of postoperative complications or unplanned secondary surgeries within postoperative 30 days.

Objective:To develop the Psychological Monitors'Interpersonal Trust Questionnaire in Colleges(PMITQC)and test its validity and reliability.Methods:A preliminary questionnaire was formulated by construc-ting a model of the psychological monitors'interpersonal trust.Totally 515 psychological monitors were selected for item analysis and exploratory factor analysis.In addition,556 psychological monitors were selected for confirmatory factor analysis and internal consistency reliability tests,of which 114 were retested after 4 weeks.The Trust Scale(TS)and Interpersonal Trust Scale(ITS)were used to test the criterion validity.Results:The PMITQC contained 22 items and was composed of four factors that accounted for 68.634％of the variance.The confirmatory factor a-nalysis showed that the four-factor structure model fitted nicely(x2/df=4.22,NFI=0.92,RFI=0.91,IFI=0.94,TLI=0.93,CFI=0.94,RMSEA=0.076).The criterion validity test showed that the total scores and scores of 4 factor of PMITQC were positively correlated with the total scores of TS and ITS(r=0.28-0.48,Ps＜0.01).The Cronbach's coefficients of the total questionnaire and the 4 factors ranged from 0.87 to 0.97 and the test-retest reli-abilities ranged from 0.73 to 0.89.Conclusion:The Psychological Monitors'Interpersonal Trust Questionnaire in Colleges has good validity and reliability.

Objective:To assess the capability of seven reference medical laboratories to detect BCR::ABL1 p210 transcription levels and to compare the results among those laboratories.Methods:The interlaboratory comparison was carried out in two stages. The samples were prepared by the reference laboratory. The quantitative values of BCR::ABL1 p210 of the comparison samples covered 0.001%-0.01%, 0.01%-0.1%, 0.1%-1%, 1%-10% and>10% in each stage. Real-time quantitative PCR (RT-PCR) and dPCR (digital PCR) were used to examine the samples. The conversion factor (CF) was calculated and validated for each laboratory.Results:In the RT-PCR comparison, one laboratory was failed to detect BCR::ABL1 p210 in fourteen samples at the first stage. The results of the other six laboratories were qualified with the bias <±1.2 folds (-0.133-0.338) and 95% limits of agreement within ±5 folds (upper limit 0.147-0.785, lower limit -0.770--0.109), and the corresponding CF values were calculated and validated. In the dPCR comparison, one laboratory did not report results at the second stage. The results of the other six laboratories were qualified with the bias <±1.2 folds (-0.026-0.267) and 95% limits of agreement within±5 folds (upper limit 0.084-0.991, lower limit -0.669--0.135), and the corresponding CF values were calculated and validated. The samples with BCR::ABL1 p210 quantitative values of 0.01%-0.1%, 0.1%-1%, 1%-10% and >10% could be detected by both RT-PCR and qPCR. When the quantitative value of BCR::ABL1 p210 was 0.001%-0.01%, the detection rate of dPCR was higher than that of RT-PCR (85.56% vs. 68.00%).Conclusions:A good consistency is present among various laboratories. The quantitative value of BCR::ABL1 p210 is comparable among laboratories as shown by the CF value conversion. For quantitative detection of BCR::ABL1 p210 deep molecular reaction, dPCR has a higher positive detection rate and more advantages than RT-PCR. To ensure the accuracy and reproducibility of the BCR::ABL1 p210 test, it is imperative for every laboratory to enhance their daily quality control practices.

Objective:To investigate the application value of intrathoracic Kamikawa anas-tomosis after laparoscopic proximal stomach and lower esophagus resection through the abdominal-left diaphragmatic approach for adenocarcinoma of esophagogastric junction.Methods:The retros-pective and descriptive method was conducted. The clinical data of 3 patients with adenocarcinoma of esophagogastric junction who were admitted to Changzhi People ′s Hospital Affiliated to Changzhi Medical College from April to June 2022 were collected. All patients were male, aged 69 years, 60 years and 66 years, respectively. Patients underwent total laparoscopic proximal gastrectomy and lower esophageal resection with intrathoracic Kamikawa anastomosis through the abdominal-left diaph-ragmatic approach.Results:(1) Operative and postoperative situations. All the 3 patients success-fully underwent total laparoscopic proximal stomach and lower esophagus resection with intra-thoracic Kamikawa anastomosis through the abdominal-left diaphragmatic approach. The operation time was 5.3 hours, 5.3 hours and 4.8 hours, respectively. The digestive tract reconstruction time was 68 minutes, 62 minutes and 55 minutes, respectively. The volume of intraoperative blood loss was 80 mL, 30 mL and 100 mL, respectively. The postoperative first flatus time of 3 patients was on the third day after operation, and the first defecation time was on the postoperative fourth, sixth and third day. All the 3 patients underwent upper gastrointestinal imaging on the postoperative third and seventh day, and no anastomotic leakage, anastomotic stenosis or contrast agent reflux occurred. The indwelling time of abdominal drainage tube was 6 days, 7 days and 6 days, respectively. The indwel-ling time of thoracic drainage tube was 3 days, 5 days and 4 days, respectively. The duration of post-operative hospital stay was 14 days, 14 days, and 16 days, respectively. (2) Postoperative complica-tions and pathological examination. Of the 3 patients, 1 patient had postoperative pleural effusion of Clavien-Dindo grade Ⅰ, and 1 patient had bilateral pleural effusion of Clavien-Dindo grade Ⅰ. The postoperative pathological examination of 3 patients showed high-moderately differentiated adeno-carcinoma, moderately differentiated adenocarcinoma and moderately differentiated adenocarcinoma, respectively. The tumor maximum diameter of 3 patients was 3.0 cm, 3.5 cm and 3.5 cm, respec-tively. The ratio of the number of lymph node metastasis to the number of lymph node dissection was 0/43, 1/34 and 6/44, respectively. Postoperative pathological staging showed stage T3N0M0, T3N1M0, T3N2M0, respectively. (3) Follow-up. There was no reflux of contrast agent or anastomotic stenosis in upper gastrointestinal imaging of the 3 positions at 3 and 12 months after operation. No reflux esophagitis of LA-B grade or above was found by electronic gastroscopy at 3 and 12 months after operation. Nutritional indicators and quality of life were good in 3 patients. No tumor recur-rence or metastasis was found in chest and abdominal computed tonography at 12 months after operation, and anti-reflux structure was found after reconstruction of digestive tract in thoracic cavity.Conclusion:Intrathoracic Kamikawa anastomosis after laparoscopic proximal stomach and lower esophagus resection through the abdominal-left diaphragmatic approach for adenocarcinoma of esophagogastric junction is safe and feasible, with excellent anti-reflux effect.