Objective:To analyze the impact of lung-protective ventilation strategy on postoperative pulmonary function and prognosis in abdominal surgery patients with a history of coronavirus disease 2019 (COVID-19) infection.Methods:A total of 80 patients with a history of COVID-19 who underwent emergency or elective abdominal surgery at the Central Hospital of Yongzhou from December 2023 to April 2025 were selected. They were divided into the lung-protective group ( n=40) and the traditional ventilation group ( n=40) using a random number table method. The lung-protective group was set with a tidal volume (VT) of 6 ml/kg, positive end-expiratory pressure (PEEP) of 5 cmH 2O, and lung recruitment was performed every 30 minutes; the traditional ventilation group was only set with a VT of 8-10 ml/kg. Blood gas analysis indicators [partial pressure of arterial carbon dioxide (PaCO 2) and partial pressure of arterial oxygen (PaO 2)] and pulmonary function indicators [forced expiratory volume in one second (FEV 1), forced vital capacity (FVC), and FEV 1/FVC] were compared between the two groups before surgery and 3 days after surgery. The modified clinical pulmonary infection score (MCPIS) was calculated, and the incidence of postoperative complications was statistically analyzed in both groups. Results:There were no statistically significant differences in blood gas analysis and pulmonary function indicators between the two groups before surgery (all P>0.05). Compared with preoperatively, PaCO 2 decreased and PaO 2 increased in both groups 3 days after surgery (all P<0.05); 3 days after surgery, PaCO 2 in the lung-protective group was lower than that in the traditional ventilation group, and PaO 2 was higher than that in the traditional ventilation group (all P<0.05). Compared with preoperatively, FEV 1 and FVC decreased, and FEV 1/FVC increased in both groups 3 days after surgery (all P<0.05); 3 days after surgery, FEV 1, FVC, and FEV 1/FVC in the lung-protective group were all higher than those in the traditional ventilation group (all P<0.05). The MCPIS of the lung-protective group 3 days after surgery was lower than that of the traditional ventilation group, with a statistically significant difference [(2.75±0.45) vs (4.23±0.68), t=11.479, P<0.05]. There was no statistically significant difference in the total incidence of complications between the lung-protective group and the traditional ventilation group ( P>0.05). Conclusions:Lung-protective ventilation strategy can improve postoperative blood gas analysis indicators and pulmonary function in abdominal surgery patients with a history of COVID-19, thereby improving prognosis, with good safety.

OBJECTIVE:To compare the clinical efficacy and radiological results of arthroscopic all-inside technique and traditional technique in anterior cruciate ligament reconstruction.METHODS:Databases such as CNKI,WanFang,VIP,PubMed,Web of Science,Embase,and Cochrane Library were searched for literature on all-inside technique and traditional technique in anterior cruciate ligament reconstruction.The search time was from the establishment of each database to September 2024.Meta-analysis was conducted on the included literature.RESULTS:(1)A total of 17 articles were included in the meta-analysis,with 631 patients in the all-inside technique reconstruction group and 626 patients in the traditional technique reconstruction group.The earliest time for the last follow-up was half a year after surgery,and the latest was 5 years after surgery.Most follow-up period was 2 years.(2)Meta-analysis results showed that compared with traditional anterior cruciate ligament reconstruction,the all-inside technique had a thicker graft during anterior cruciate ligament reconstruction[mean difference(MD)=0.20,95％confidence interval(CI)(0.09,0.31),P=0.000 5],smaller postoperative maximum diameter[standardized mean difference(SMD)=-3.64,95％CI(-6.00,-1.28),P=0.002]and volume[SMD=-3.69,95％CI(-5.37,-2.00),P＜0.000 1]of the tibial tunnel,and higher International Knee Documentation Committee subjective scores[MD=2.41,95％CI(0.49,4.32),P=0.01]and Lysholm scores[MD=1.11,95％CI(0.42,1.8),P=0.002]2 years after surgery.However,the operation time was relatively longer[MD=10.06,95％CI(4.71,15.4),P=0.000 2],and the knee stability was poorer after 2 years[SMD=0.3,95％CI(0.04,0.55),P=0.02].No significant differences were found between the two groups in the following aspects:the subjective scores of the International Knee Documentation Committee at 6 months and 1 year postoperatively[MD=-0.05,95％CI(-1.96,1.83),P=0.96;MD=0.51,95％CI(-1.17,2.19),P=0.55];the difference in anterior laxity of bilateral knees at 1 year postoperatively[SMD=-0.02,95％CI(-0.3,0.27),P=0.9];the Lysholm score at 6 months postoperatively[MD=0.87,95％CI(-0.15,1.89),P=0.09];the objective score of the International Knee Documentation Committee at the last follow-up[RR=0.95,95％CI(0.86,1.06),P=0.37];the American Knee Society Score at the last follow-up[MD=0.33,95％CI(-0.55,1.21),P=0.47];the Tegner score at the last follow-up[MD=0.05,95％CI(-0.11,0.22),P=0.53];the negative rate of the pivot shift test at the last follow-up[RR=0.92,95％CI(0.83,1.01),P=0.09];the postoperative revision rate at the last follow-up[RR=2.2,95％CI(0.98,4.92),P=0.05];and the result of the single-leg hop test at the last follow-up[MD=-0.06,95％CI(-4.99,4.86),P=0.98].CONCLUSION:There were no significant differences in most functional outcome scores and the position of the tibial tunnel between the all-inside technique and the traditional technique after anterior cruciate ligament reconstruction.The all-inside technique was more favorable in terms of subjective International Knee Documentation Committee scores and Lysholm scores at 2 years postoperatively.Meanwhile,the knee joint was more stable 2 years after anterior cruciate ligament reconstruction using the traditional technique.In addition,it was found that the graft was thicker during the all-inside technique,while the diameter and volume of the tibial tunnel were smaller postoperatively,with more bone tissue preserved.Nevertheless,the operation time of the all-inside technique was longer.

OBJECTIVE:To compare the clinical efficacy and radiological results of arthroscopic all-inside technique and traditional technique in anterior cruciate ligament reconstruction.METHODS:Databases such as CNKI,WanFang,VIP,PubMed,Web of Science,Embase,and Cochrane Library were searched for literature on all-inside technique and traditional technique in anterior cruciate ligament reconstruction.The search time was from the establishment of each database to September 2024.Meta-analysis was conducted on the included literature.RESULTS:(1)A total of 17 articles were included in the meta-analysis,with 631 patients in the all-inside technique reconstruction group and 626 patients in the traditional technique reconstruction group.The earliest time for the last follow-up was half a year after surgery,and the latest was 5 years after surgery.Most follow-up period was 2 years.(2)Meta-analysis results showed that compared with traditional anterior cruciate ligament reconstruction,the all-inside technique had a thicker graft during anterior cruciate ligament reconstruction[mean difference(MD)=0.20,95％confidence interval(CI)(0.09,0.31),P=0.000 5],smaller postoperative maximum diameter[standardized mean difference(SMD)=-3.64,95％CI(-6.00,-1.28),P=0.002]and volume[SMD=-3.69,95％CI(-5.37,-2.00),P＜0.000 1]of the tibial tunnel,and higher International Knee Documentation Committee subjective scores[MD=2.41,95％CI(0.49,4.32),P=0.01]and Lysholm scores[MD=1.11,95％CI(0.42,1.8),P=0.002]2 years after surgery.However,the operation time was relatively longer[MD=10.06,95％CI(4.71,15.4),P=0.000 2],and the knee stability was poorer after 2 years[SMD=0.3,95％CI(0.04,0.55),P=0.02].No significant differences were found between the two groups in the following aspects:the subjective scores of the International Knee Documentation Committee at 6 months and 1 year postoperatively[MD=-0.05,95％CI(-1.96,1.83),P=0.96;MD=0.51,95％CI(-1.17,2.19),P=0.55];the difference in anterior laxity of bilateral knees at 1 year postoperatively[SMD=-0.02,95％CI(-0.3,0.27),P=0.9];the Lysholm score at 6 months postoperatively[MD=0.87,95％CI(-0.15,1.89),P=0.09];the objective score of the International Knee Documentation Committee at the last follow-up[RR=0.95,95％CI(0.86,1.06),P=0.37];the American Knee Society Score at the last follow-up[MD=0.33,95％CI(-0.55,1.21),P=0.47];the Tegner score at the last follow-up[MD=0.05,95％CI(-0.11,0.22),P=0.53];the negative rate of the pivot shift test at the last follow-up[RR=0.92,95％CI(0.83,1.01),P=0.09];the postoperative revision rate at the last follow-up[RR=2.2,95％CI(0.98,4.92),P=0.05];and the result of the single-leg hop test at the last follow-up[MD=-0.06,95％CI(-4.99,4.86),P=0.98].CONCLUSION:There were no significant differences in most functional outcome scores and the position of the tibial tunnel between the all-inside technique and the traditional technique after anterior cruciate ligament reconstruction.The all-inside technique was more favorable in terms of subjective International Knee Documentation Committee scores and Lysholm scores at 2 years postoperatively.Meanwhile,the knee joint was more stable 2 years after anterior cruciate ligament reconstruction using the traditional technique.In addition,it was found that the graft was thicker during the all-inside technique,while the diameter and volume of the tibial tunnel were smaller postoperatively,with more bone tissue preserved.Nevertheless,the operation time of the all-inside technique was longer.

Objective:To analyze the impact of lung-protective ventilation strategy on postoperative pulmonary function and prognosis in abdominal surgery patients with a history of coronavirus disease 2019 (COVID-19) infection.Methods:A total of 80 patients with a history of COVID-19 who underwent emergency or elective abdominal surgery at the Central Hospital of Yongzhou from December 2023 to April 2025 were selected. They were divided into the lung-protective group ( n=40) and the traditional ventilation group ( n=40) using a random number table method. The lung-protective group was set with a tidal volume (VT) of 6 ml/kg, positive end-expiratory pressure (PEEP) of 5 cmH 2O, and lung recruitment was performed every 30 minutes; the traditional ventilation group was only set with a VT of 8-10 ml/kg. Blood gas analysis indicators [partial pressure of arterial carbon dioxide (PaCO 2) and partial pressure of arterial oxygen (PaO 2)] and pulmonary function indicators [forced expiratory volume in one second (FEV 1), forced vital capacity (FVC), and FEV 1/FVC] were compared between the two groups before surgery and 3 days after surgery. The modified clinical pulmonary infection score (MCPIS) was calculated, and the incidence of postoperative complications was statistically analyzed in both groups. Results:There were no statistically significant differences in blood gas analysis and pulmonary function indicators between the two groups before surgery (all P>0.05). Compared with preoperatively, PaCO 2 decreased and PaO 2 increased in both groups 3 days after surgery (all P<0.05); 3 days after surgery, PaCO 2 in the lung-protective group was lower than that in the traditional ventilation group, and PaO 2 was higher than that in the traditional ventilation group (all P<0.05). Compared with preoperatively, FEV 1 and FVC decreased, and FEV 1/FVC increased in both groups 3 days after surgery (all P<0.05); 3 days after surgery, FEV 1, FVC, and FEV 1/FVC in the lung-protective group were all higher than those in the traditional ventilation group (all P<0.05). The MCPIS of the lung-protective group 3 days after surgery was lower than that of the traditional ventilation group, with a statistically significant difference [(2.75±0.45) vs (4.23±0.68), t=11.479, P<0.05]. There was no statistically significant difference in the total incidence of complications between the lung-protective group and the traditional ventilation group ( P>0.05). Conclusions:Lung-protective ventilation strategy can improve postoperative blood gas analysis indicators and pulmonary function in abdominal surgery patients with a history of COVID-19, thereby improving prognosis, with good safety.

Objective To construct and validate of a nomogram predictive model for high-volume lymph node metastasis(HVM)in multifocal papillary thyroid carcinoma(MPTC).Methods Between January 2010 to January 2024,a total of 1146 and 234 patients with multifocal papillary thyroid carcinoma(MPTC)were diagnosed at Hangzhou First People's Hospital(Center A)and Hangzhou Cancer Hospital(Center B),respectively.Patients from Center A were randomly allocated to training set(n=803)and testing set(n=343)in a 7:3 ratio,while those from Center B(n=234)comprised an external validation set.Independent risk factors for HVM in MPTC patients were identified through univariate and multivariate Logistic regression analysis in training set,leading to the development of a nomogram predictive model.The generalizability of this model was subsequently assessed using both testing set and external validation set.The area under the curve(AUC)of receiver operating characteristic curve,sensitivity,and specificity evaluate the discriminative ability of the model.Results The incidence of HVM was 13.3％at center A and 12.8％at center B.Logistic regression identified male gender(OR=2.91,95％CI:1.835-4.599),maximum lesion diameter(OR=1.05,95％CI:1.021-1.070),and age(OR=0.95,95％CI:0.936-0.972)as independent risk factors for HVM.Anomogram based on these factors showed an AUC of 0.767 with 72.6％sensitivity and 70.2％specificity in training set,and 0.838 with 94.9％sensitivity and 68.4％specificity in testing set,and 0.769 with 63.3％sensitivity and 84.3％specificity in external validation set.The calibration curve demonstrated good agreement with the ideal curve.Conclusion The prediction model constructed based on clinical risk factors can effectively predict the probability of HVM in MPTC patients.

Objective:To analyze the clinical characteristics, diagnosis and treatment of 3 children with severe COVID-19 encephalopathy, targeted to improve the clinicians′ understanding of the disease.Methods:The clinical features, laboratory examinations, imaging data and diagnosis and treatment process of 3 cases of severe COVID-19 encephalopathy admitted to the Pediatric Intensive Care Unit of Shengjing Hospital of China Medical University from December 1, 2022 to December 31, 2022 were retrospectively analyzed.Results:Among the 3 patients, 2 were female, age was 2-11 years old, all of them had 2-3 days of medical history, all of them had clinical manifestations of high fever(≥40 ℃), convulsions and consciousness disorders, nucleic acid and antigen tests of SARS-CoV-2 were positive, and mycoplasma pneumonia IgM antibody was positive in 1 case.Within 24 hours after admission, the levels of white blood cells were basically normal, neutrophil fraction was dominant, and procalcitonin was significantly increased.Total T cells and NK cells in the blood of the three patients were significantly decreased, and the levels of blood ammonia, blood glucose and bilirubin were basically normal.In the early stage of the disease, the cell counts of the cerebrospinal fluid was normal in all the three patients, the protein level was significantly increased, there were new symmetrical lesions on head magnetic resonance imaging in 3 patients.After symptomatic treatment and immunotherapy including early use of hormone, human gamma globulin and plasma exchange, all the patients were survived, but had different degrees of new dysfunction of the nervous system.Conclusion:Severe COVID-19 encephalopathy can occur in the acute phase of SARS-CoV-2 infection, mostly manifested as high fever, convulsions and severe disturbance of consciousness, combined with multiple organ dysfunction and irreversible nervous system damage.Early supportive treatment, brain protective treatment and immunotherapy are helpful to improve the prognosis of patients.

Objective:To analyze the clinical characteristics, diagnosis and treatment of 3 children with severe COVID-19 encephalopathy, aiming to improve the clinicians′ understanding of the disease.Methods:The clinical features, laboratory examinations, imaging data and diagnosis as well as treatment process of 3 cases of severe COVID-19 encephalopathy admitted to the Pediatric Intensive Care Unit of Shengjing Hospital of China Medical University from December 1, 2022 to December 31, 2022 were retrospectively analyzed.Results:Among the 3 patients, 2 were female, age was 2-11 years old, all of them had 2-3 days of medical history.All of them had clinical manifestations of high fever(≥40 ℃), convulsions and consciousness disorders, nucleic acid and antigen tests of SARS-CoV-2 were positive, and mycoplasma pneumonia IgM antibody was positive in 1 case.Within 24 hours after admission, the levels of white blood cells were basically normal, neutrophil fraction was dominant, and procalcitonin was significantly increased.Total T cells and NK cells in the blood of the three patients were significantly decreased, and the levels of blood ammonia, blood glucose and bilirubin were basically normal.During the early stage of the disease, the cell counts of the cerebrospinal fluid was normal in all three patients, the protein level was significantly increased, and there were new symmetrical lesions on head magnetic resonance imaging in 3 patients.After symptomatic treatment and immunotherapy including early use of hormone, human gamma globulin and plasma exchange, all patients were survived, but had different degrees of new dysfunction of the nervous system.Conclusion:Severe COVID-19 encephalopathy can occur in the acute phase of SARS-CoV-2 infection, mostly manifested as high fever, convulsions and severe disturbance of consciousness, combining with multiple organ dysfunction and irreversible nervous system damage.Early supportive treatment, brain protective treatment and immunotherapy are helpful to improve the prognosis of the patients.

Background Subways are typical congregate settings and may facilitate aerosol transmission of viruses. However, quantified transmission probability estimates are lacking. Purpose To model spread and diffusion of respiratory aerosols in subways by simulation and calculation of infection probabilities. Methods The internal environment of carriages of Shanghai Metro Line 10 was used to establish a study scene. The movement of tiny particles was simulated using the turbulent model. Trend analysis of infection probabilities and viral quantum doses was conducted in a closed subway carriage scene by a quantum emission-infection probability model. Results Under a typical twelve-vent air conditioning configuration, respiratory droplet aerosols within a subway carriage dispersed rapidly throughout various regions due to airflow, with limited short-term diffusion to other carriages. Concurrently, owing to the uncertainty of airflow patterns, the airflow might circulate and converge within carriages, causing delayed outward dispersion or hindered dispersion of droplet aerosols upon entry into these zones. Passengers boarding the carriage could exacerbate the formation of these zones. When the air conditioning system functioned adequately (air exchange rate=23.21 h⁻¹), the probability of a virus carrier transmitting the virus to other passengers within the same carriage via aerosol transmission was approximately 3.8%. However, in the event of air conditioning system failure (air exchange rate=0.5 h⁻¹), this probability escalated dramatically to 30%. Furthermore, a super-spreader (with virus spreading exceeding 90% of the average) elevated the infection probability to 14.9%. Additionally, due to the complexity of turbulence within the carriage, if local diffusion occurred in 1/2 zones of a carriage, the anticipated infection probability would increase to 8.9%, or during the morning or evening rush hours leading to elevated aerosol concentrations, the infection probability would rise to 4.7%. The subway transmission probability for common coronaviruses diminished to as low as 0.9%. Conclusion Combined computational fluid dynamics and infection probability analysis reveals that in the prevalent twelve-vent air conditioning configurations, despite being a major transportation hub with substantial spatial-temporal overlap, the internal space of subway carriages exhibits a certain level of resistance to virus aerosol transmission owing to built-in ventilation capabilities. However, turbulence and passenger positioning may lead to localized hovering of droplet aerosols, thereby increase the risk of virus transmission. Furthermore, super-spreaders, poor operational status of built-in air conditioning system, and high passenger volume at morning or evening peak hours exert profound effects on virus transmission and infection probability.

Objective:To analyze and summarize the clinical characteristics, diagnosis and treatment, head imaging changes and prognosis of acute necrotizing encephalopathy of childhood (ANEC), aiming to improve the understanding of this disease.Methods:Clinical data of 13 ANEC patients (there were 7 males and 6 females, the median age was 30 months) admitted to the Pediatric Intensive Care Unit (PICU) of Shengjing Hospital, China Medical University from January 2014 to December 2020 were retrospectively analyzed, including clinical manifestations, laboratory examinations, diagnosis and treatment procedures, and head imaging data.Survivors were followed up through telephone.Results:All patients had fever and convulsions before admission, and the median time between fever and consciousness disturbance was 48 hours.The magnetic resonance imaging scans showed symmetrical multifocal brain damages.All 13 patients used glucocorticoid treatment, 10 cases used human immunoglobulin treatment, 8 cases used plasma exchange treatment.A total of 7/13 patients died.Five children were regularly followed up, who presented normal height and weight development and normal immunity.One child had normal motor intelligence with the acceptable Pediatric Overall Performance Category Score, and the remaining 4 children had certain sequelae, mainly manifesting as slow speech speed and limited movement.Conclusions:ANEC mainly occurs in winter and young children with a high mortality.It progresses rapidly, and consciousness disturbance appears soon after fever and convulsion.Survivors usually have sequelae, mostly manifesting as slow speech speed and limited movement, which can be significantly improved after systematic rehabilitation treatment.

Objective:To explore the feasibility of the clinical implementation of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) plans with 6MV photon on two Elekta Linacs (Versa HD and Synergy) after beam matching.Methods:The images of 12 patients with nasopharyngeal carcinoma, central lung cancer and prostate cancer were randomly selected, and the IMRT and VMAT plans were designed. Two different dose tools of ionization chamber and three-dimensional detector ArcCheck were used to verify the individualized radiation treatment of 6MV photon beams on two Linacs and compare the differences.Results:The deviations between the doses of two Linacs (Versa HD and Synergy) measured by the ion chamber and treatment planning system were (0.32±1.32)% and (0.54±1.29)%. The differences of all plans were within the range of ±3%, and the deviations of the point dose between two Linacs were within the range of ±2% with no statistical significance (both P>0.05). The γ analysis of verification using ArcCheck showed that the passing rates of all plans under the 2mm/3% and 3mm/3% with 10% threshold conditions were over 95%, respectively. The average differences between two Linacs were 0.19%(2mm/3%) and 0.09%(3mm/3%). Conclusions:The results of performing IMRT/VMAT plans on two Linacs meet the clinical requirements and the differences between two Linacs are small. Hence, the same plans can be implemented interchangeably on different Linacs.