Objective: To investigate the abnormal fluctuation of coagulation function indicators in pediatric Burkitt lymphoma patients, and to analyze its correlation with disease progression and prognosis. Methods: The data of 172 children with Burkitt lymphoma in Children's Medical Center, Shanghai Jiao Tong University School of Medicine from January 2020 to December 2023 were retrospectively analyzed, and 120 healthy children were used as control group. Plasma prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fib), International standardized ratio (INR), D-dimer (D-D), fibrinogen degradation products (FDP), and antithrombin (AT) were measured. Appropriate statistical methods were used to compare the data between two groups, and the Cox regression model was employed to analyze the influencing factors. A P-value <0.05 was considered statistically significant. Results: Levels of D-D, FDP, INR, and PT were significantly higher in children with Burkitt lymphoma than in the healthy controls [median (P25, P75) for the case group: 0.35 (0.13, 1.22), 3.10 (1.30, 10.20), 1.16 (1.06, 1.24), 12.60 (11.43, 13.50); median (P25, P75) for the healthy control group: 0.10 (0.07, 0.15), 0.60 (0.20, 1.08), 1.06 (1.02, 1.13), 11.50 (11.00, 12.30)](P<0.05). Levels of D-D, FDP, INR, PT, and TT were significantly elevated in children with recurrence compared to those without recurrence [median (P25, P75) for the recurrent group: 0.44 (0.16, 1.42), 3.85 (1.50, 12.25), 1.17 (1.08, 1.24), 12.70 (11.73, 13.50), 16.20 (14.80, 17.80); median (P25, P75) for the non-recurrent group: 0.21 (0.11, 0.69), 2.00 (1.00, 6.85), 1.11 (1.03, 1.24), 11.90 (11.10, 13.43), 15.20 (14.50, 16.40)](P<0.05). Levels of D-D, FDP in children with metastasis were significantly higher than those without metastasis [median (P25, P75) for the metastatic group: 0.51 (0.17, 1.84), 4.38 (1.70, 13.45); median (P25, P75) for the non-metastatic group: 0.20 (0.11, 0.39), 1.50 (1.00, 3.10)] (P<0.05). Levels of D-D and FDP were significantly higher in children with advanced stage than in those with early stage [median (P25, P75) for the high-stage group: 0.33 (0.14, 1.20), 3.10 (1.40, 10.23); median (P25, P75) for the low-stage group: 0.12 (0.08, 0.24), 0.90 (0.50, 2.50)] (P<0.05). Levels of D-D and FDP in high-risk children were significantly higher than those of low-risk [median (P25, P75) for the high-risk group: 0.28 (0.13, 1.01), 2.90 (1.15, 9.65); median (P25, P75) for the low-risk group: 0.12 (0.08, 0.17), 0.80 (0.43, 1.98)] (P<0.05). Levels of D-D, FDP, INR, and PT were significantly higher in children with poor prognosis than in those with favorable prognosis [median (P25, P75) for the poor prognosis group: 1.76 (0.80, 2.72), 13.45 (7.20, 25.30), 1.19 (1.12, 1.32), 12.85 (12.10, 14.35); median (P25, P75) for the favorable prognosis group: 0.23 (0.12, 0.52), 2.00 (1.00, 4.80), 1.14 (1.05, 1.23), 12.30 (11.40, 13.40)] (P<0.05). INR levels significantly increased with accumulating chemotherapy cycles [median (P25, P75) for one session: 1.09 (1.02, 1.20); two sessions: 1.31 (1.23, 1.38); three sessions: 1.79 (1.52, 2.41)] (P<0.05). Age, APTT, D-D, FDP, INR, PT, recurrence and metastasis had a significant effect on the survival of children with Burkitt lymphoma (P<0.05). Conclusion: Patients with Burkitt lymphoma exhibit coagulation disorders, which are influenced by recurrence, metastasis, clinical stage, risk stratification, and prognosis. In clinical practice, it is crucial to prioritize the monitoring of coagulation indicators to facilitate timely detection of coagulation dysfunction.

Objective To investigate the early clinical efficacy of minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) via left intercostal small incision for multivessel coronary artery disease. Methods The patients who received off-pump CABG in the Central China Fuwai Hospital of Zhengzhou University from June 2021 to June 2023 were enrolled. Patients were divided into two groups according to the operative technique used, including a traditional midline sternotomy group and a left intercostal small incision group. The clinical data of the two groups were compared. Results A total of 143 patients were enrolled, including 70 patients in the traditional midline sternotomy group and 73 patients in the left intercostal small incision group. The age of the patients in the left intercostal small incision group and the traditional midline sternotomy group was (63.8±8.0) years and (63.0±7.8) years, respectively; the proportions of males were 69.9% and 74.3%, respectively. The differences were not statistically significant (all P>0.05). All patients in the two groups successfully completed the operation, and no patients in the left intercostal small incision group were converted to thoracotomy. The patients in the left intercostal small incision group showed less postoperative drainage within postoperative 24 hours [(239.4±177.7) mL vs. (338.0±151.9) mL, P<0.001], lower perioperative blood transfusion rate [32.9% (24/73) vs. 51.4% (36/70), P=0.028], higher postoperative myoglobin level within postoperative 24 hours [366.1 (247.9, 513.0) ng/mL vs. 220.8 (147.2, 314.9) ng/mL, P<0.001], shorter intensive care unit stay [45.5 (31.5, 67.5) h vs. 68.0 (46.0, 78.5) h, P=0.001] and postoperative hospital stay [(10.8±4.0) d vs. (13.1±5.3) d, P=0.028] compared to the traditional midline sternotomy group. There was no significant difference in the incidence of major adverse cardiac and cerebrovascular event between the two groups [2.7% (2/73) vs. 2.9% (2/70), P=1.000]. Conclusion Compared to the full median sternotomy, MICS CABG leads to a good clinical result with smaller trauma, faster overall recovery, and less perioperative blood transfusion.

Objective:To explore the value of deep learning (DL) models based on conventional MRI in differentiating orbital solitary fibrous tumors (SFT) from schwannomas.Methods:This was a case-control study. A retrospective analysis was conducted on patients with pathologically confirmed orbital SFT and schwannoma admitted to Eye & ENT Hospital, Fudan University (institution 1) from December 2014 to January 2022 and Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine (institution 2) from July 2015 to May 2022. A total of 140 patients were included, with 104 patients from institution 1 comprising the training cohort for building DL models and 36 patients from institution 2 comprising the external validation cohort for assessing model performance. Based on the preoperative cross-sectional fat-suppressed T 2WI and contrast-enhanced T 1WI (ceT 1WI), tumor contours were outlined on all tumor-containing slices. Six diagnostic models were constructed using residual networks (ResNet) and split-attention residual networks (ResNeSt) with 18 layers (ResNet-18 and ResNeSt-18), based solely on individual T 2WI and ceT 1WI, as well as a combination of both. A radiology resident and an attending radiologist independently reviewed conventional MRI images to determine the tumor type. The performance of the DL models and radiologists in differentiating orbital SFT from schwannoma in the external validation cohort was evaluated using receiver operating characteristic curves, and the areas under the curves (AUC) were compared using the DeLong test. Results:In the external validation cohort, the AUC (95% CI) of the ResNet-18 models based on T 2WI, ceT 1WI, and their combination were 0.861 (0.719-1), 0.896 (0.774-1), and 0.885 (0.755-1), respectively, while the AUC (95% CI) of the ResNeSt-18 models were 0.889 (0.748-1), 0.872 (0.726-1), and 0.910 (0.801-1), respectively. Among these, the ResNeSt-18 model based on the combined sequences achieved the best performance in differentiating the two tumors. The AUC (95% CI) for the individual interpretation of the radiology resident and attending radiologist were 0.729 (0.571-0.887) and 0.771 (0.618-0.923), respectively. The AUC of the ResNeSt-18 model based on the combined sequences was statistically significantly higher than those of the resident and attending radiologist ( Z=1.96, P=0.049; Z=2.00, P=0.045). Conclusion:The ResNeSt-18 model based on conventional MRI can effectively differentiate orbital SFT from schwannoma, demonstrating better performance than those of the radiology resident and the attending radiologist.

Objective:To explore the molecular epidemiological characteristics of human metapneumovirus (HMPV) in children with acute respiratory infection (ARI) in Beijing from 2023 to 2024.Methods:In the longitudinal study, 9 834 children with ARI were enrolled from August 2023 to December 2024, including the influenza-like illness (ILI) group from emergency and outpatient department receiving influenza virus (Flu) and HMPV test and the ARI inpatient group for 13 common respiratory pathogen screening test including HMPV, Flu, respiratory syncytial virus, and so on. All respiratory samples positive with HMPV were genotyped by amplifying and sequencing of G gene and further phylogenetic analysis. The χ2 test and Wilcoxon rank-sum test were used to compare the positive rate and basic clinical data of the 2 groups. Results:Among 9 834 enrolled patient, there were 5 276 male and 4 558 female children, with age 5.4 (1.9, 8.2) years. In ILI group of 1 460 patients, there were 83 cases (5.7%) positive for HMPV, with the age 4.9 (3.6, 6.6) years and children under 6.0 years old 59 cases (71.1%). Among 8 374 ARI inpatients, there were 256 cases (3.1%) positive for HMPV, with age 3.5 (1.3, 6.4) years and children under 6.0 years old 188 cases (73.4%). The HMPV positive rate and the age of children positive for HMPV in ARI inpatient group were significantly lower than that in ILI group (both P<0.001). In December, 2024, the HMPV positive rates of ILI and ARI inpatient group (21.3% (17/80), 15.0% (47/314)) were significantly higher than the total positive rates of each group (both P<0.001). Among 279 subtyped specimens, there were 155 cases (55.6%) belonging to genotype A and 124 cases (44.4%) belonging to genotype B. Sub-lineage A2.2.2 containing 111nt-insertions was predominate one in 2023 with positive ratio 89.2% (91/102), and B2 was predominate in 2024 with positive ratio 64.4% (114/177). Conclusions:From 2023 to 2024, the positive rate of HMPV in the ILI group was higher than that in the ARI inpatient group, suggesting a common epidemic of HMPV infection. Children positive for HMPV in the ARI inpatient group were younger than that in the ILI group. A severe epidemic of HMPV was observed in the winter of 2024, which requires attention. Sub-lineage A2.2.2 with 111nt-duplicate insertions and B2 were the predominant epidemic strains in 2023 and 2024, respectively.

Objective:To investigate the correlation between the set mechanical angle(MA)by using an auxiliary photography device and the actual knee flexion angle(FA)in axial X-ray imaging for patellofemoral joint,so as to provide a theoretical basis for applying a self-developed dynamic adjustment device to achieve precisely dynamic radiography for patellofemoral joint,and to optimize diagnostic protocols of imaging for patellar dislocation,subluxation,etc..Methods:A prospective experimental design was adopted,which enrolled 96 healthy volunteers(40 males,56 females)whose age was 18-65 years old(mean age:32.6 years old).Using a self-developed dynamically auxiliary radiography device for axial position of patellofemoral joint,and the MA was set at 90°,120°,135°,150°,and 160°,and the corresponding FA was measured.At the same time,the gender,age,body mass index(BMI),thigh circumference,and calf circumference were also recorded.Statistical analysis was performed using SPSS 25.0 software.One-sample t-test was applied to analyze the difference value between MA and FA(MA-FA).Pearson correlation analysis and multiple linear regression analysis were conducted to conduct correlation analysis for the distribution characteristics of FA under different MA values,the FA and each anthropometric indicator.Results:FA showed a linear relationship with MA,BMI,thigh circumference,calf circumference,and gender.The regression equation was:FA=62.031+0.511×MA+0.489×BMI+0.189×thigh circumference-0.445×calf circumference+4.67×gender(R2=0.82,P<0.001).When MA was set at 90°,The actual FA was(112.21±4.7)° that was significantly larger than MA(90°),and the difference was significant(t=46.26,P<0.001).When MA was set at 120°,the actual FA was(126.19±6.43°),which was significantly greater than MA(120°)(t=9.42,P<0.001).When MA was set at 135°,there was not significant difference between FA and MA(P>0.05).When MA was set at 150°,the actual FA was(141.44±4.42°)that was significantly smaller than MA(150°),and the difference was significant(t=-18.97,P<0.001).When MA was set at 160°,the actual FA was(148.55±5.33°)that was significantly smaller than MA(160°),and the difference was significant(t=-21.03,P<0.001).BMI,thigh circumference,and calf circumference were the main factors of influencing the difference between MA and FA.Conclusion:Using the self-developed dynamic auxiliary radiography device for axial position of patellofemoral joint can construct a mathematical model to accurately predict,regulate and control the knee flexion angle,which can realize standardization for dynamic radiography on patellofemoral joint,and has significant clinical value in improving the diagnostic accuracy for imaging of patellar dislocation and subluxation.

Objective:To investigate the correlation between the set mechanical angle(MA)by using an auxiliary photography device and the actual knee flexion angle(FA)in axial X-ray imaging for patellofemoral joint,so as to provide a theoretical basis for applying a self-developed dynamic adjustment device to achieve precisely dynamic radiography for patellofemoral joint,and to optimize diagnostic protocols of imaging for patellar dislocation,subluxation,etc..Methods:A prospective experimental design was adopted,which enrolled 96 healthy volunteers(40 males,56 females)whose age was 18-65 years old(mean age:32.6 years old).Using a self-developed dynamically auxiliary radiography device for axial position of patellofemoral joint,and the MA was set at 90°,120°,135°,150°,and 160°,and the corresponding FA was measured.At the same time,the gender,age,body mass index(BMI),thigh circumference,and calf circumference were also recorded.Statistical analysis was performed using SPSS 25.0 software.One-sample t-test was applied to analyze the difference value between MA and FA(MA-FA).Pearson correlation analysis and multiple linear regression analysis were conducted to conduct correlation analysis for the distribution characteristics of FA under different MA values,the FA and each anthropometric indicator.Results:FA showed a linear relationship with MA,BMI,thigh circumference,calf circumference,and gender.The regression equation was:FA=62.031+0.511×MA+0.489×BMI+0.189×thigh circumference-0.445×calf circumference+4.67×gender(R2=0.82,P<0.001).When MA was set at 90°,The actual FA was(112.21±4.7)° that was significantly larger than MA(90°),and the difference was significant(t=46.26,P<0.001).When MA was set at 120°,the actual FA was(126.19±6.43°),which was significantly greater than MA(120°)(t=9.42,P<0.001).When MA was set at 135°,there was not significant difference between FA and MA(P>0.05).When MA was set at 150°,the actual FA was(141.44±4.42°)that was significantly smaller than MA(150°),and the difference was significant(t=-18.97,P<0.001).When MA was set at 160°,the actual FA was(148.55±5.33°)that was significantly smaller than MA(160°),and the difference was significant(t=-21.03,P<0.001).BMI,thigh circumference,and calf circumference were the main factors of influencing the difference between MA and FA.Conclusion:Using the self-developed dynamic auxiliary radiography device for axial position of patellofemoral joint can construct a mathematical model to accurately predict,regulate and control the knee flexion angle,which can realize standardization for dynamic radiography on patellofemoral joint,and has significant clinical value in improving the diagnostic accuracy for imaging of patellar dislocation and subluxation.

Objective:To explore the molecular epidemiological characteristics of human metapneumovirus (HMPV) in children with acute respiratory infection (ARI) in Beijing from 2023 to 2024.Methods:In the longitudinal study, 9 834 children with ARI were enrolled from August 2023 to December 2024, including the influenza-like illness (ILI) group from emergency and outpatient department receiving influenza virus (Flu) and HMPV test and the ARI inpatient group for 13 common respiratory pathogen screening test including HMPV, Flu, respiratory syncytial virus, and so on. All respiratory samples positive with HMPV were genotyped by amplifying and sequencing of G gene and further phylogenetic analysis. The χ2 test and Wilcoxon rank-sum test were used to compare the positive rate and basic clinical data of the 2 groups. Results:Among 9 834 enrolled patient, there were 5 276 male and 4 558 female children, with age 5.4 (1.9, 8.2) years. In ILI group of 1 460 patients, there were 83 cases (5.7%) positive for HMPV, with the age 4.9 (3.6, 6.6) years and children under 6.0 years old 59 cases (71.1%). Among 8 374 ARI inpatients, there were 256 cases (3.1%) positive for HMPV, with age 3.5 (1.3, 6.4) years and children under 6.0 years old 188 cases (73.4%). The HMPV positive rate and the age of children positive for HMPV in ARI inpatient group were significantly lower than that in ILI group (both P<0.001). In December, 2024, the HMPV positive rates of ILI and ARI inpatient group (21.3% (17/80), 15.0% (47/314)) were significantly higher than the total positive rates of each group (both P<0.001). Among 279 subtyped specimens, there were 155 cases (55.6%) belonging to genotype A and 124 cases (44.4%) belonging to genotype B. Sub-lineage A2.2.2 containing 111nt-insertions was predominate one in 2023 with positive ratio 89.2% (91/102), and B2 was predominate in 2024 with positive ratio 64.4% (114/177). Conclusions:From 2023 to 2024, the positive rate of HMPV in the ILI group was higher than that in the ARI inpatient group, suggesting a common epidemic of HMPV infection. Children positive for HMPV in the ARI inpatient group were younger than that in the ILI group. A severe epidemic of HMPV was observed in the winter of 2024, which requires attention. Sub-lineage A2.2.2 with 111nt-duplicate insertions and B2 were the predominant epidemic strains in 2023 and 2024, respectively.

Objective:To explore the value of deep learning (DL) models based on conventional MRI in differentiating orbital solitary fibrous tumors (SFT) from schwannomas.Methods:This was a case-control study. A retrospective analysis was conducted on patients with pathologically confirmed orbital SFT and schwannoma admitted to Eye & ENT Hospital, Fudan University (institution 1) from December 2014 to January 2022 and Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine (institution 2) from July 2015 to May 2022. A total of 140 patients were included, with 104 patients from institution 1 comprising the training cohort for building DL models and 36 patients from institution 2 comprising the external validation cohort for assessing model performance. Based on the preoperative cross-sectional fat-suppressed T 2WI and contrast-enhanced T 1WI (ceT 1WI), tumor contours were outlined on all tumor-containing slices. Six diagnostic models were constructed using residual networks (ResNet) and split-attention residual networks (ResNeSt) with 18 layers (ResNet-18 and ResNeSt-18), based solely on individual T 2WI and ceT 1WI, as well as a combination of both. A radiology resident and an attending radiologist independently reviewed conventional MRI images to determine the tumor type. The performance of the DL models and radiologists in differentiating orbital SFT from schwannoma in the external validation cohort was evaluated using receiver operating characteristic curves, and the areas under the curves (AUC) were compared using the DeLong test. Results:In the external validation cohort, the AUC (95% CI) of the ResNet-18 models based on T 2WI, ceT 1WI, and their combination were 0.861 (0.719-1), 0.896 (0.774-1), and 0.885 (0.755-1), respectively, while the AUC (95% CI) of the ResNeSt-18 models were 0.889 (0.748-1), 0.872 (0.726-1), and 0.910 (0.801-1), respectively. Among these, the ResNeSt-18 model based on the combined sequences achieved the best performance in differentiating the two tumors. The AUC (95% CI) for the individual interpretation of the radiology resident and attending radiologist were 0.729 (0.571-0.887) and 0.771 (0.618-0.923), respectively. The AUC of the ResNeSt-18 model based on the combined sequences was statistically significantly higher than those of the resident and attending radiologist ( Z=1.96, P=0.049; Z=2.00, P=0.045). Conclusion:The ResNeSt-18 model based on conventional MRI can effectively differentiate orbital SFT from schwannoma, demonstrating better performance than those of the radiology resident and the attending radiologist.

Spinal surgical site infection (SSI), especially deep SSI after internal fixation is difficult in treatment, with long course of disease and poor prognosis. At present, there are many controversies in the diagnosis and treatment of spinal SSI, with unsatisfactory overall efficacy of its diagnosis and treatment. Besides, no diagnosis and treatment guideline based on evidence-based medicine has been in existence. To this end, the Spinal Infection Group of the Orthopedic Branch of the Chinese Medical Doctor Association and the Spinal Infection Group of the Spinal Surgery Branch of the Chinese Rehabilitation Medicine Association jointly organized relevant experts to formulate Evidence-based clinical guideline for the diagnosis and treatment of surgical site infection in spinal trauma ( version 2024) based on an evidence-based approach. A total of 10 recommendations were proposed on the diagnosis and treatment of spinal SSI, so as to provide a clinical reference for the diagnosis and treatment of spinal SSI.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.