Separation/conversion disorders in functional coma with pseudocataplexy are rare.On De-cember 9,2021,a young female patient with separation/conversion disorders was treated in the Department of Neurology in the First Affiliated Hospital of Shandong First Medical University.The main symptoms were episodic consciousness disorders,sudden fainting,and urinary incontinence.Complete laboratory tests and cranial mag-netic resonance imaging showed no obvious abnormalities.Standard multi-channel sleep monitoring and multiple sleep latency tests were performed.The patient was unable to wake up during nap and underwent stimulation tests.There was no response to orbital pressure,loud calls,or tapping,while the α rhythm in all electroenceph-alogram leads and the increased muscular tone in the mandibular electromyography indicated a period of wakeful-ness.The results of 24-hour sleep monitoring suggested that the patient had sufficient sleep at night and thus was easy to wake up in the morning.The results of daytime unrestricted sleep and wake-up test showed that the patient took one nap in the morning and one nap in the afternoon.When the lead indicated the transition from N3 to N2 sleep,a wake-up test was performed on the patient.At this time,the patient reacted to the surrounding environ-ment and answered questions correctly.Because the level of orexin in the cerebrospinal fluid was over 110 pg/mL,episodic sleep disorder was excluded and the case was diagnosed as functional coma accompanied by pseudocata-plexy.The patient did not present obvious symptom remission after taking oral medication,and thus medication withdrawl was recommended.Meanwhile,the patient was introduced to adjust the daily routine and mood.The follow-up was conducted six months later,and the patient reported that she did not experience similar symptoms after adjusting lifestyle.Up to now,no similar symptoms have appeared in multiple follow-up visits for three years.Functional coma with pseudocataplexy is prone to misdiagnosis and needs to be distinguished from true co-ma and episodic sleep disorders.

Objective:To investigate the application value of domestic robotic surgical system in radical resection of hilar cholangiocarcinoma (hCCA).Methods:The retrospective and descriptive study was constructed. The clinicopathological data of a 66-year-old male patient with hCCA who was admitted to the Second Hospital of Shandong University in November 2022 were collected. Radical resection of hCCA was performed using the Toumai? laparoscopic surgical robot system. Observation indicators: (1) intraoperative conditions; (2) postoperative conditions; (3) follow-up. Count data were represented as absolute numbers and (or) percentages.Results:(1) Intraoperative conditions. The patient underwent radical resection of hCCA successfully using robotic surgical system, including tumor resection, lymph node dissection, and gastrointestinal reconstruc-tion. The operation time and volume of intraoperative blood loss were 400 minutes and 100 mL, respectively, and no intraoperative blood transfusion was required. (2) Postoperative conditions. The patient began ambulation on postoperative day 1 and began taking liquid food on postoperative day 4. Liver function examination and abdominal computed tomograph (CT) on postoperative day 5 showed a decrease in serum bilirubin, no biliary or intestinal leakage, and no edema or necrosis at the anastomotic site. The abdominal pre-anastomotic and post-anastomotic drainage tubes were removed on the 7th and 9th day after the surgery respectively, and the patient was discharged on the 10th day after surgery. Results of postoperative pathological examination showed moderately to poorly differentiated adenocarcinoma of the bile duct. Immunostaining was positive for CK7 and CK19. The Ki-67 proliferation index was 35%. The proximal and distal resection margin of bile duct were negative. The tumor diameter was 30 mm. Perineural invasion was positive. The surgical specimen margin was negative. Two lymph nodes were identified containing tumor cells positive for malignancy. No tumor cell metastasis was detected in the No.8, No.12 or gastric lesser curvature lymph nodes submitted for pathological examination. (3) Follow-up. The patient was followed up at postoperative 1-, 3-, 5-month after discharge. During follow-up period, results of liver function examination and abdominal CT showed liver function restore to normal levels, no complication such as biliary fistula, intestinal fistula, gastroparesis or tumor metastasis.Conclusion:The Domestic Toumai ? laparoscopic surgical robot system can be applied to radical resection of hCCA.

COVID-19, caused by SARS-COV-2, has the characteristics of world epidemic, highly infectious and large base of death. In China, transmission route of SARS-COV-2 has been contained so effectively that COVID-19 has been well controlled due to the proactive national prevention and control strategy. However, not only does it bring a huge impact on the existing medical structure model, but also an objective impact on the treatment of patients with chronic diseases such as malignant tumors. Based on the progress reported in the domestic and international literatures and the actual management experience of our team, this paper reflects on the treatment strategies for patients with gastrointestinal stromal tumor (GIST) during the epidemic period of COVID-19. We focus on risk stratification for primary GIST and forming treatment strategies accordingly. Major considerations include the impact of delayed operation, the burden of medical resources, the waiting time for elective operation, and the principle of emergency operation. In addition, we focus on the level of evidence for non-surgical approaches with a view to developing a holistic strategy of "priority management principles" to guide clinical treatment in the context of limited resources and different GIST priorities.
COVID-19 ; China ; Gastrointestinal Stromal Tumors ; Humans ; SARS-CoV-2

In December 2019, a new outbreak of coronavirus pneumonia began to occur. Its pathogen is 2019-nCoV, which has the characteristics of strong infectivity and general susceptibility. The current situation of prevention and control of new coronavirus pneumonia is severe. In this context, as front-line medical workers bearing important responsibilities and pressure, while through strict management strategy, we can minimize the risk of infection exposure. By summarizing the research progress and guidelines in recent years in the fields of colorectal cancer disease screening, treatment strategies(including early colorectal cancer, locally advanced colorectal cancer, obstructive colorectal cancer, metastatic colorectal cancer and the treatment of patients after neoadjuvant therapy), the choice of medication and time limit for adjuvant therapy, the protective measures for patients undergoing emergency surgery, the re-examination of postoperative patients and the protection of medical staff, etc., authors improve treatment strategies in order to provide more choices for patients to obtain the best treatment under the severe epidemic situation of new coronavirus pneumonia. Meanwhile we hope that it can also provide more timely treatment modeling schemes for colleagues.

In December 2019, a new outbreak of corona virus disease 2019 began to occur. Its pathogen is 2019-nCoV, which has the characteristics of strong infectivity and general susceptibility. The current situation of prevention and control of new coronavirus pneumonia is severe. In this context, as front-line medical workers bearing important responsibilities and pressure, while through strict management strategy, we can minimize the risk of infection exposure. By summarizing the research progress and guidelines in recent years in the fields of colorectal cancer disease screening, treatment strategies (including early colorectal cancer, locally advanced colorectal cancer, obstructive colorectal cancer, metastatic colorectal cancer and the treatment of patients after neoadjuvant therapy), the choice of medication and time limit for adjuvant therapy, the protective measures for patients undergoing emergency surgery, the re-examination of postoperative patients and the protection of medical staff, etc., authors improve treatment strategies in order to provide more choices for patients to obtain the best treatment under the severe epidemic situation of new coronavirus pneumonia. Meanwhile we hope that it can also provide more timely treatment modeling schemes for colleagues.

In December 2019, a new outbreak of corona virus disease 2019 began to occur. Its pathogen is 2019-nCoV, which has the characteristics of strong infectivity and general susceptibility. The current situation of prevention and control of new coronavirus pneumonia is severe. In this context, as front-line medical workers bearing important responsibilities and pressure, while through strict management strategy, we can minimize the risk of infection exposure. By summarizing the research progress and guidelines in recent years in the fields of colorectal cancer disease screening, treatment strategies (including early colorectal cancer, locally advanced colorectal cancer, obstructive colorectal cancer, metastatic colorectal cancer and the treatment of patients after neoadjuvant therapy), the choice of medication and time limit for adjuvant therapy, the protective measures for patients undergoing emergency surgery, the re-examination of postoperative patients and the protection of medical staff, etc., authors improve treatment strategies in order to provide more choices for patients to obtain the best treatment under the severe epidemic situation of new coronavirus pneumonia. Meanwhile we hope that it can also provide more timely treatment modeling schemes for colleagues.

Objective To investigate the advantage of the technique of static compression screws with medial support using one ordinary cannulated compression screw (OCCS) and 2 headless cannulated compression screws (HCCSs) in reducing complications in the treatment of vertical femoral neck fractures.Methods From December 2014 to July 2017,79 patients were treated at Department of Orthopaedics,The Sixth People's Hospital of Shanghai for vertical femoral neck fractures.They were 51 men and 28 women,aged from 20 to 65 years (average,49.1 years).Their injury involved 45 left sides and 34 right sides.Of them,37 were treated with one OCCS at the top and 2 HCCSs at the bottom of a triangle arrangement for fixation of the vertical femoral neck fracture (the experimental group);the other 42 were treated with 3OCCSs at a triangle arrangement for fixation of the vertical femoral neck fracture (the control group).Their fracture healing and complications were followed up at postoperative 6 weeks,3,6 12,18,24 months and any time of discomfort by anteroposterior and lateral X-ray films of the knee joint.Results The 2 groups were compatible due to insignificant differences between their preoperative general data (P ＞ 0.05).This cohort was followed up for 9 to 24 months (average,17.5 months).Of them,52 achieved fracture union.Of the 27 patients who failed,8 were in the experimental group (21.6％) and 19 in the control group (45.2％),showing a significant difference in the rate of failure between the 2 groups (P ＜ 0.05).In the experimental group,the rate of nonunion was 8.1％ (3/37),the rate of implant failure 18.9％ (7/37),and the rate of fermoral neck varus 8.1％ (3/37),all significantly lower than those in the control group [26.2％ (11/42),40.5％ (17/42) and 23.8％ (13/42),respectively] (P ＜0.05).Conclusion For treatment of vertical femoral neck fractures,the technique of static compression screws with medial support is not only easy but also leads to a lower rate of complications.

Objective To analyze the associations between long-term outcomes of fresh femoral neck fractures treated with cannulated screws and the classification based on vertical neck (VN) angle.Methods A retrospective study was conducted of the 162 fresh femoral neck fractures treated with 3 cannulated screws at Department of Orthopaedics,The Sixth People's Hospital of Shanghai from January 2012 to December 2014.The relationships were analyzed using Logistic Regression between long-term complications and VN classification,including fixation failure,fracture nonunion and osteonecrosis of femoral head (ONFH).Results All the patients were followed up for an average of 25.7 months (from 6 to 36 months).Of them,151 obtained fracture union after an average of 4.5 months (from 3 to 9 months).Internal fixation failure occurred in 23 cases,nonunion of femoral neck in 11,ONFH in 21 and femoral neck collapse in 13.Logistic Regression analysis showed no significant associations between internal fixation failure,nonunion or ONFH and gender,age or reduction method (P ＞ 0.05) but significant associations of VN classification with fixation failure (P ＜ 0.001) and nonunion (P =0.001) and insignificant association of VN classification with ONFH (P =0.109).Conclusion VN classification,a new classification method for femoral neck fractures,may be closely related with incidences of fixation failure and nonunion.

Objective To investigate the situation of drug resistance and nosocomial infection of multi-drug resistant bacteria (MDR),guidance for clinical rational use of antibiotics.Methods A total of 1521 strains of MDR was isolated from January 2015 to December in Beijing Tongren Hospital,using matrixassisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) identification of bacteria,VITEK-2 Compact and Kirby Bauer (KB) method for drug sensitivity test.Results In 1 521 strains of MDR,Acinetobacter Baumanii were 589 strains (38.7％),nosocomial infection rate were 16.6％;350 strains of Escherichia coli (23.0％),nosocomial infection rate were 9.0％;249 strains of Staphylococcus aureus (16.4％),nosocomial infection rate were 2.7％;171 strains of Klebsiella pneumoniae (11.2％),nosocomial infection rate were 14.3％;150 strains of pseudomonas aeruginosa (9.9％),nosocomial infection rate were 64.7％;12 strains of Enterococcus faecium (0.8％),nosocomial infection rate were 16.7％.MDR Acinetobacter Baumanii,MDR Pseudomonas aeruginosa,extended-spectrumβ-lactamase (ESBL) + Escherichia coli and ESBL + Klebsiella pneumoniae resistance rate to Imipenem were 100％,91.5％,0.6％ and 55.6％.Conclusions MDR pseudomonas aeruginosa (MDR-PAE),MDR acinetobacter baumanii (MDR-AB) and ESBL + Klebsiella pneumoniae were highly resistant,and the nosocomial infection rate were higher.

Objective To identify the difference in the central venous pressure measured via two different approaches. Methods We had searched the databases including PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure ( CNKI) , VIP Database and Wanfang Database, and Google Scholar was used for supplement search. All the experimental studies with self-control design that investigated the difference in the central venous pressure measured via two different approaches from the database foundation of until 2014 were included. The literature exclusion and data collection were performed independently by two investigators. The literature quality was evaluated by the 2nd edition of quality assessment of diagnostic accuracy studies tool (QUADAS-2). All the studies enrolled were assigned to high-quality and low-quality groups for subsequent stratified meta-analysis. Results A total of 8 studies involving 273 samples were entered in the final analysis. Pooled analyses from all studies revealed a statistically significant difference between the two approaches ( P=0. 002), and the pooled deviation is 0. 436 (95% CI:0. 166-0. 707). Conclusions Consideration of minor difference between the two approaches showed by meta-analysis, peripherally-inserted central catheter ( PICC) remains feasible to measure central venous pressure. The consistency of the two approaches used for measuring central venous pressure requires further validation by large-scale clinical trials.