Objective To explore median effective dose(ED50)of 0.375％ropivacaine based on the cross sectional area(CSA)of supraclavicular brachial plexus block(SCBPB)with L-shaped baffle intervention.Methods Patients scheduled for upper limb surgery from September 2023 to May 2024 at Ningbo NO.6 Hospital were enrolled.Patients were randomly divided into two groups:L-shaped baffle compression group(group L)and non-compression group(group C).CSA of supraclavicular brachial plexus was measured by ultrasound,and 0.375％ropivacaine was administered based on the CSA.The ED50 was determined by using the Dixon up-and-down sequential method,with an initial dose of 0.4 ml/mm2 and an incremental difference of 0.04ml/mm2.If the block was effective within 30 minutes,the next patient received a lower dose;If ineffective,a higher dose was administered.The process continued until seven cross-over points(ineffective to effective)were observed.ED50 and its 95％CI were calculated by using the Probit method.Adverse reactions,such as phrenic nerve paralysis,nerve injury,dyspnea were recorded.Results The ED50 of 0.375％ropivacaine for SCBPB in group C was 0.254 ml/mm2(95％CI:0.228-0.278),while in group L,it was 0.239 ml/mm2(95％CI:0.215-0.262),with no statistically significant difference between two groups(P＞0.05).The incidence of phrenic nerve paralysis in group L was significantly lower than that in group C(14.29％vs.41.67％,P＜0.05).No significant nerve injuries,dyspnea,or local anesthetic toxicity were observed in either group.Conclusion The ED50 of 0.375％ropivacaine for SCBPB with L-shaped baffle compression,based on the CSA of the brachial plexus,was 0.239 ml/mm2(95％CI:0.215-0.262).L-shaped baffle compression significantly reduced the incidence of phrenic nerve paralysis without notable side effects.

Objective To summarize and analyze the clinical features,imaging manifestations,pathological characteristics,treatment approaches,and prognosis of adrenal anastomotic hemangioma(AH),so as to enhance the clinical understanding of this disease.Methods A retrospective analysis was conducted on 3 adrenal AH patients treated in Tongji Hospital during Jan.2012 and Dec.2024.Relevant literature was reviewed.Results All patients were male,aged 34-56 years,with a maximum tumor diameter of 2.0-5.0 cm.All tumors were solitary.No patients presented with special clinical manifestations.Biochemical tests indicated tumors with no endocrine function.Contrast-enhanced computed tomography showed circular mixed density shadows with uneven edge enhancement.Two patients underwent laparoscopic partial adrenal resection,and one patient received robot-assisted laparoscopic partial adrenal resection.Postoperative pathological results of all three cases indicated AH.Immunohistochemistry showed CD31(+),CD34(+),and ERG(+).No recurrence was found in a postoperative follow-up of 1-45 months.A total of 22 cases of adrenal AH were reported in the literature and our center,with onset age ranging from 34 to 83 years.The patients included 17 males and 5 females,with a maximum tumor diameter of 0.6-8.8 cm.Among them,2 cases were multifocal and the tumors were located in the kidneys,beside kidneys,or in the inferior vena cava.Two cases showed clinical manifestations of lower back pain.During the follow-up of 156 months,no recurrence or metastasis was observed.Conclusion Adrenal AH is a rare benign tumor,which mainly occurs in middle-aged and elderly people with no clinical symptoms and endocrine function.Imaging can easily mistake it for pheochromocytoma or well differentiated vascular sarcoma,and the diagnosis mainly relies on pathological examination.It should be distinguished from pheochromocytoma and well differentiated vascular sarcoma.Surgery is the main treatment method and the prognosis is good.

OBJECTIVE To develop a nomogram model for prediction of the risk of sepsis in the patients with acute liver failure(ALF)and validate its clinical value.METHODS Totally 228 patients with ALF who were treated in the Fifth Medical Center of Chinese PLA General Hospital from Jan.2009 to Mar.2023 were recruited as the re-search subjects and were grouped according to the occurrence of sepsis,the clinical characteristics and results of laboratory tests were collected from the patients.The subjects were brought into multivariate logistic regression a-nalysis after the primary screening with univariate regression analysis,the independent predictive factors were screened out,and the nomogram model was established.The accuracy,calibration accuracy and clinical practica-bility of the model were assessed by means of receiver operating characteristic(ROC)curves,calibration curves and decision curve analysis(DCA).RESULTS Among the 228 patients with ALF,159(69.74％)were diagnosed with sepsis.Totally 6 independent predictive factors were screened out by the multivariate analysis,including age[odd ratio(OR)=1.098,95％CI:1.030 to 1.220],aspartate transaminase(OR=0.998,95％CI:0.996 to 0.999),white blood cells counts(OR=1.037,95％CI:1.020 to 1.064),hemoglobulin(OR=0.981,95％CI:0.962 to 0.998),lactic acid(OR=1.187,95％CI:1.022 to 1.426)and mechanical ventilation(OR=3.463,95％CI:2.340 to 5.125).The area under the curve(AUC)of the nomogram model was 0.864(95％CI:0.807 to 0.921)in the training set,0.817(95％CI:0.717 to 0.918)in the validation set,remarkably better than that of sequential organ failure assessment(SOFA)scores[0.710(95％CI:0.625 to 0.795)and 0.647(95％CI:0.515 to 0.779)].Hosmer-Lemeshow test(P=0.512)and the calibrated curves showed that the predication probability of the model was highly consistent with the actual risk,and DC A indicated that the net clinical benefit was brought more from the model than from SOFA score.CONCLUSION The age,hemoglobulin,aspartate transaminase,white blood cells counts,lactic acid and mechanical ventilation are the independent predictive factors for the sepsis in the ALF patients.The nomogram model established based on the factors has high predictive efficiency and clini-cal application value.

Objective To summarize and analyze the clinical features,imaging manifestations,pathological characteristics,treatment approaches,and prognosis of adrenal anastomotic hemangioma(AH),so as to enhance the clinical understanding of this disease.Methods A retrospective analysis was conducted on 3 adrenal AH patients treated in Tongji Hospital during Jan.2012 and Dec.2024.Relevant literature was reviewed.Results All patients were male,aged 34-56 years,with a maximum tumor diameter of 2.0-5.0 cm.All tumors were solitary.No patients presented with special clinical manifestations.Biochemical tests indicated tumors with no endocrine function.Contrast-enhanced computed tomography showed circular mixed density shadows with uneven edge enhancement.Two patients underwent laparoscopic partial adrenal resection,and one patient received robot-assisted laparoscopic partial adrenal resection.Postoperative pathological results of all three cases indicated AH.Immunohistochemistry showed CD31(+),CD34(+),and ERG(+).No recurrence was found in a postoperative follow-up of 1-45 months.A total of 22 cases of adrenal AH were reported in the literature and our center,with onset age ranging from 34 to 83 years.The patients included 17 males and 5 females,with a maximum tumor diameter of 0.6-8.8 cm.Among them,2 cases were multifocal and the tumors were located in the kidneys,beside kidneys,or in the inferior vena cava.Two cases showed clinical manifestations of lower back pain.During the follow-up of 156 months,no recurrence or metastasis was observed.Conclusion Adrenal AH is a rare benign tumor,which mainly occurs in middle-aged and elderly people with no clinical symptoms and endocrine function.Imaging can easily mistake it for pheochromocytoma or well differentiated vascular sarcoma,and the diagnosis mainly relies on pathological examination.It should be distinguished from pheochromocytoma and well differentiated vascular sarcoma.Surgery is the main treatment method and the prognosis is good.

OBJECTIVE To develop a nomogram model for prediction of the risk of sepsis in the patients with acute liver failure(ALF)and validate its clinical value.METHODS Totally 228 patients with ALF who were treated in the Fifth Medical Center of Chinese PLA General Hospital from Jan.2009 to Mar.2023 were recruited as the re-search subjects and were grouped according to the occurrence of sepsis,the clinical characteristics and results of laboratory tests were collected from the patients.The subjects were brought into multivariate logistic regression a-nalysis after the primary screening with univariate regression analysis,the independent predictive factors were screened out,and the nomogram model was established.The accuracy,calibration accuracy and clinical practica-bility of the model were assessed by means of receiver operating characteristic(ROC)curves,calibration curves and decision curve analysis(DCA).RESULTS Among the 228 patients with ALF,159(69.74％)were diagnosed with sepsis.Totally 6 independent predictive factors were screened out by the multivariate analysis,including age[odd ratio(OR)=1.098,95％CI:1.030 to 1.220],aspartate transaminase(OR=0.998,95％CI:0.996 to 0.999),white blood cells counts(OR=1.037,95％CI:1.020 to 1.064),hemoglobulin(OR=0.981,95％CI:0.962 to 0.998),lactic acid(OR=1.187,95％CI:1.022 to 1.426)and mechanical ventilation(OR=3.463,95％CI:2.340 to 5.125).The area under the curve(AUC)of the nomogram model was 0.864(95％CI:0.807 to 0.921)in the training set,0.817(95％CI:0.717 to 0.918)in the validation set,remarkably better than that of sequential organ failure assessment(SOFA)scores[0.710(95％CI:0.625 to 0.795)and 0.647(95％CI:0.515 to 0.779)].Hosmer-Lemeshow test(P=0.512)and the calibrated curves showed that the predication probability of the model was highly consistent with the actual risk,and DC A indicated that the net clinical benefit was brought more from the model than from SOFA score.CONCLUSION The age,hemoglobulin,aspartate transaminase,white blood cells counts,lactic acid and mechanical ventilation are the independent predictive factors for the sepsis in the ALF patients.The nomogram model established based on the factors has high predictive efficiency and clini-cal application value.

Objective To explore median effective dose(ED50)of 0.375％ropivacaine based on the cross sectional area(CSA)of supraclavicular brachial plexus block(SCBPB)with L-shaped baffle intervention.Methods Patients scheduled for upper limb surgery from September 2023 to May 2024 at Ningbo NO.6 Hospital were enrolled.Patients were randomly divided into two groups:L-shaped baffle compression group(group L)and non-compression group(group C).CSA of supraclavicular brachial plexus was measured by ultrasound,and 0.375％ropivacaine was administered based on the CSA.The ED50 was determined by using the Dixon up-and-down sequential method,with an initial dose of 0.4 ml/mm2 and an incremental difference of 0.04ml/mm2.If the block was effective within 30 minutes,the next patient received a lower dose;If ineffective,a higher dose was administered.The process continued until seven cross-over points(ineffective to effective)were observed.ED50 and its 95％CI were calculated by using the Probit method.Adverse reactions,such as phrenic nerve paralysis,nerve injury,dyspnea were recorded.Results The ED50 of 0.375％ropivacaine for SCBPB in group C was 0.254 ml/mm2(95％CI:0.228-0.278),while in group L,it was 0.239 ml/mm2(95％CI:0.215-0.262),with no statistically significant difference between two groups(P＞0.05).The incidence of phrenic nerve paralysis in group L was significantly lower than that in group C(14.29％vs.41.67％,P＜0.05).No significant nerve injuries,dyspnea,or local anesthetic toxicity were observed in either group.Conclusion The ED50 of 0.375％ropivacaine for SCBPB with L-shaped baffle compression,based on the CSA of the brachial plexus,was 0.239 ml/mm2(95％CI:0.215-0.262).L-shaped baffle compression significantly reduced the incidence of phrenic nerve paralysis without notable side effects.

In this article, we report a case of spontaneous ruptured pyomyoma during pregnancy with successful delivery after myomectomy. A 35-year-old pregnant female (27 weeks of gestation) presented with lower abdominal pain. The patient had a history of uterine fibroids. Ultrasound, computed tomography, and magnetic resonance imaging confirmed a spontaneous ruptured pyomyoma (maximum diameter: 12.6 cm). Myomectomy was performed, and her abdominal distension and pain were significantly improved within 1 day; the condition of the fetus was normal. One month after surgery, severe tenderness was detected in the lower right side of the uterus. Considering the higher risk of uterine rupture and associated complications, a cesarean section was performed. The mother and neonate were discharged 3 and 42 days after delivery, respectively, in good condition. Myomectomy for spontaneous ruptured pyomyoma during pregnancy may be feasible and extend gestational age to improve outcomes for the mother and neonate.

In this article, we report a case of spontaneous ruptured pyomyoma during pregnancy with successful delivery after myomectomy. A 35-year-old pregnant female (27 weeks of gestation) presented with lower abdominal pain. The patient had a history of uterine fibroids. Ultrasound, computed tomography, and magnetic resonance imaging confirmed a spontaneous ruptured pyomyoma (maximum diameter: 12.6 cm). Myomectomy was performed, and her abdominal distension and pain were significantly improved within 1 day; the condition of the fetus was normal. One month after surgery, severe tenderness was detected in the lower right side of the uterus. Considering the higher risk of uterine rupture and associated complications, a cesarean section was performed. The mother and neonate were discharged 3 and 42 days after delivery, respectively, in good condition. Myomectomy for spontaneous ruptured pyomyoma during pregnancy may be feasible and extend gestational age to improve outcomes for the mother and neonate.

The efficacy and safety of venetoclax combined with reduced dose HAD regimen in the treatment of newly diagnosed acute myeloid leukemia (AML) was investigated. From May 2022 to January 2023, a total of 25 patients with newly diagnosed AML were treated with venetoclax combined with reduced-dose HAD regimen as induction therapy. Accoding to the 2017 ELN recommendations, 13 (52.0%) in favoable, 3 (12.0%) in intemediate, and 9 (36.0%) in adverse. The ORR (CR rate+PR rate) was 88.0%, and the CR rate was 84.0%. By May 30, 2023, with a median follow-up of 9 months, 1 year overall survival, event-free survival, and relapse-free survival were 100%, 94.7%, and 94.7%, respectively. All patients received 1-5 cycles of consolidation therapy and two median cycles. Treatment with venetoclax and reduced dose of HAD regimen in the treatment of patients with newly diagnosed AML was high effective and safe.

Objective To explore the clinical significance of ultrasound-guided fine needle aspiration cytology in the diagno-sis of papillary thyroid carcinoma.Methods For cases of thyroid nodules with a diameter less than 1 cm and negative clinical palpation detected by ultrasound,ultrasound-guided fine needle aspiration cytological examination was performed,and the cyto-logical results were compared and analyzed with postoperative histopathological results and BRAFV600E detection re-sults.Results Among the 511 cases,the cytopathological results showed 20 cases of failed sampling,14 cases of benign lesions,230 cases of suspected malignancy,242 cases of papillary thyroid carcinoma,2 cases of non-Hodgkin's lymphoma,and 3 cases of medullary thyroid carcinoma.The histopathological results showed 5 benign cases,496 papillary thyroid carcinoma,3 papillary thyroid carcinoma with Hashimoto's thyroiditis,3 non-Hodgkin's lymphoma,and 4 medullary thyroid carcinoma.There were 10 false negative cases in cellular pathology,with no false positive cases.The consistency rate between cellular pathology and histopathology was 94.27％.Conclusion Ultrasound-guided fine needle aspiration cytology has a high diagnostic accuracy for papilla-ry thyroid carcinoma,and provides accurate results for clinical palpation negative masses before surgery.Combined with postoperative histopathology and BRAFV600E gene testing results,it provides a strategy for subsequent treatment and follow-up.