The left transradial access is less widely used in neurointervention. This article reports a case of an internal carotid dissection aneurysm with a aberrant right subclavian artery (ARSA) type aortic arch. Preoperative assessment showed that a risk of selective vascular catheterization through the right radial artery approach. After switching to the left transradial access, angiography and subsequent intervention surgery were successfully completed. This has accumulated valuable clinical experience for neurointerventional treatment through the left transradial access.

ObjectiveTo investigate the current awareness and optimization recommendations on pneumonia with unknown etiology (PUE) surveillance among Shanghai healthcare professionals, and to provide evidence for the improvement of the surveillance system. MethodsIn December 2024, healthcare professional participants from diverse medical and health institutions were randomly selected within each stratum using a stratified cluster sampling method in all 16 districts of Shanghai for questionnaire surveys on their knowledge and suggestions for optimization of the PUE surveillance system. Descriptive statistics analyses, multivariate logistic regressions, and content analyses were used for data analyses. ResultsA total of 385 survey subjects were involved in the study, including 119 professional staffs from disease prevention and control centers and 266 from medical institutions. Those who understood the case definition for PUE correctly accounted for 67.01% (258/385). Multivariate regression model analyses showed that female gender (aOR=2.22, 95%CI: 1.36‒3.66), professionals from disease control institutions (aOR=2.02, 95%CI: 1.12‒3.72), and those who self-assessed as being familiar with the monitoring system (aOR=2.18, 95%CI:1.23‒3.89) had better understanding of the definition. Overall, 89.61% (345/385) of the survey subjects acknowledged the necessity of the surveillance system. Small number of cases meeting the case definition (54.46%, 214/379), insufficient diagnostic awareness (39.84%, 151/379), and lack of incentives for case reporting (29.29%, 111/379) were major problems for the current surveillance system, with variations observed across different types of institutions. Suggested segments for optimizing the surveillance system included monitoring purpose, case definition, form of monitoring and reporting procedure, organization mechanism, and epidemiological investigation and response. ConclusionThe necessity of PUE surveillance is commonly recognized among healthcare workers. However, the existing system falls short in terms of mastery of case definition and overall surveillance adaptability. There is an urgent need for optimization and improvement to enhance the capacity for preventing and controlling emerging and sudden respiratory infectious diseases.

Objective To analyze the risk factors for prolonged length of hospital stay in patients with peritoneal dialysis associated peritonitis(PDAP)and construct a nomogram based on Logistic regression model.Methods A retrospective study was conducted on patients with PDAP who were hospitalized at the Affiliated Hospital of Jiangsu University from January 2013 to December 2023.Using the 75th percentile of hospitalization time as the cutoff(>21 days),the patients were divided into prolonged length of hospital stay group and normal length of hospital stay group.Clinical data were compared between the two groups.Logistic regression analysis was used to analyze the risk factors for prolonged hospital stay in PDAP patients and to construct a nomogram.Results A total of 131 PDAP patients were included in this study,including 40 cases in prolonged length of hospital stay group and 91 cases in normal length of hospital stay group.Multivariate Logistic regression analysis showed that Gram-negative bacteria detected in ascites(OR=6.012,95% CI=1.878-19.248,P=0.003)and elevated platelet count(OR=1.010,95% CI=1.005-1.015,P<0.001)were independent risk factors for prolonged length of hospital stay,while elevated serum chloride(OR=0.885,95% CI=0.802-0.978,P=0.016)was a protective factor.Based on the above three indicators,a nomogram was constructed.The multivariate Logistic regression model showed an area under the receiver operating characteristic curve(AUC)of 0.755,with an internal validation AUC of 0.727 using the Bootstrap method.The calibration curve indicated that the predicted probability was consistent with the actual probability.The decision curve showed that the model was clinically applicable when the threshold probabilities were 9%-10%,13% and 18%-92%.Conclusion A nomogram,based on the detection of gram-negative bacteria in ascites,platelet count and serum chloride,was helpful for clinical screening PADP patients at risk for prolonged length of hospital stay,and can provide a basis for optimizing clinical decision-making.
Humans ; Nomograms ; Risk Factors ; Peritoneal Dialysis/adverse effects* ; Retrospective Studies ; Length of Stay ; Peritonitis/etiology* ; Logistic Models ; Male ; Female ; Middle Aged ; Aged

Objective To develop and validate a scoring system to predict the possibility of laparoscopic cholecystectomy (LC) conversion to laparotomy based on preoperative clinical data, and to establish a grading management model of surgery. Methods A retrospective analysis was conducted on the clinical data of 9 414 patients who underwent LC at Renhe Hospital and Huashan Hospital from June 2013 to June 2018. The patients were divided into two groups: the LC group (9 246 patients who successfully underwent LC) and the conversion to laparotomy group (168 patients who required conversion to open surgery). The data of two groups were compared, and the risk factors affecting conversion to laparotomy were screened out by single factor analysis of Chi-square test. Then, the risk factors were analyzed by multiple Logistic regression, and the pre-coefficient of each variable of the risk factors was assigned according to the established conversion to laparotomy possibility function. After calculating the score of each case, the difference in the actual conversion rate of each group was compared. The area under receiver operating characteristic (ROC) curve was calculated to evaluate the performance of the scoring system. According to the scoring system, LC surgical grading management model was created and verified. Results The following factors were identified as significant risk factors for conversion to laparotomy (P < 0.001): body temperature ≥ 38.5℃, frequency of acute cholecystitis ≥3 times, maximum thickness of gallbladder wall ≥ 5 mm, gallbladder neck stone incarceration, diameter of common bile duct ≥8 mm, and surgical experience ≤50 cases were the risk factors for conversion to laparotomy (P < 0.001). A score >3 points was associated with a high risk of conversion to laparotomy. Conclusions The LC scoring system and surgical grading management are reliable and effective tools for predicting and reducing the conversion rate of LC to laparotomy.

Organophosphorus nerve agents are the most threatening chemical warfare agents and terrorist agents.The number of nerve agents and their related chemicals involved in the verification of Chemical Weapon Convention(CWC)exceeds ten million,with the majority being isomers.Accurate structural identification of these chemicals has always been one of the challenges in CWC related verification analysis.In this work,a total of 17 kinds of alkyl phosphonate isomers and structural analogs from 5 groups were designed and synthesized,and then analyzed by gas chromatography-mass spectrometry(GC-MS)and gas chromatography-infrared spectroscopy(GC-FTIR).The spectra of isomers or structural analogs obtained from two techniques as well as the structural information provided therein were compared and analyzed.The results showed that for isomers or structural analogs with similar MS spectra,FTIR spectra could provided more structural fingerprint information of compounds and had advantages in confirming structures.Combined with the excellent separation ability of GC,GC-FTIR can be used to assist GC-MS in the structural confirmation of alkyl phosphates,achieving rapid and accurate identification of isomers or structural analogues.

Objective:To systematically evaluate the differences in CT values between virtual non-contrast (VNC) images and true non-contrast (TNC) images generated from dual-energy CT (DECT), and to validate the feasibility of VNC images replacing TNC images in dose calculations for photon and proton radiotherapy plans.Methods:A retrospective analysis was conducted on the imaging data of 40 patients with solid tumors (20 cranial, 10 thoracic and 10 abdominal cases) who underwent DECT scans at Cancer Hospital of Shandong First Medical University from February 2022 to May 2023. VNC and TNC images were registered slice-by-slice. The differences in CT values of anatomical structures were compared, and Pearson correlation analysis was used to evaluate the correlation of CT values of different anatomical structures in VNC and TNC images. For structures with significant differences, linear regression models (TNC=β×VNC+α) were established using the least squares method. In the Varian Eclipse 15.5 treatment planning system, photon and proton radiotherapy plans based on TNC images and VNC images, as well as the proton radiotherapy plan based on the VNC images corrected by the regression models, were respectively designed. Dose differences of radiotherapy plans designed based on the two images were evaluated. To evaluate dose variations in regions adjacent to the clinical target volume (CTV), two 2-mm-thick annular reference structures were generated on the axial slice containing the largest cross-section of the CTV, extending cranially and caudally from the CTV. These structures were designated as Ring_p and Ring_d, respectively.Results:The differences in CT values between VNC and TNC images were mainly concentrated in the bony structure. The CT values difference between TNC and VNC images was (409.07±53.38) HU for the skull in 20 cranial tumor patients ( t=13.88, P<0.001), and (118.66±20.90) HU for the vertebral bone in 10 thoracic and 10 abdominal tumor patients ( t=10.43, P<0.001). The CT values of the skull and spine showed high correlation between TNC and VNC images ( r=0.98, P<0.001; r=0.99, P<0.001). The regression models established respectively were: TNC=1.859×VNC+33.896 (skull), and TNC=1.827×VNC+5.491 (spine). For photon radiotherapy plans based on TNC and VNC images, the D mean of the CTV were (60.00±0.00) and (60.00±0.00) Gy respectively, with D mean of Ring_p were (61.17±1.69) and (61.01±1.67) Gy, and Ring_d were (55.26±2.06) and (55.20±1.94) Gy, respectively. The relative dose differences in D mean between the two image types were 0 ( t<0.01, P>0.999), 0.33% ( t=0.30, P=0.766), and 0.19% ( t=0.07, P=0.947), all with no statistically significant differences. For proton radiotherapy plans based on TNC and VNC images, the D mean of the CTV were (61.73±0.32) and (61.67±0.26) Gy (RBE), respectively, with D mean of Ring_p were (61.19±0.44) and (60.53±1.22) Gy (RBE), and Ring_d were (60.97±0.67) and (59.80±4.26) Gy (RBE), respectively. The relative dose differences in D mean between the two image types were 0.24% ( t=0.63, P=0.530), 1.80% ( t=1.45, P=0.156), and 3.56% ( t=2.26, P=0.030), with a statistically significant difference in the Ring_d region. In the proton radiotherapy plan designed based on the corrected VNC images, the D mean of the CTV was (61.75±0.32) Gy (RBE), Ring_p was (61.43±0.71) Gy (RBE), and Ring_d was (59.96±2.80) Gy (RBE). The relative dose differences in D mean between TNC images and corrected VNC images were 0.16% ( t=0.19, P=0.850), 0.76% ( t=1.32, P=0.196), and 2.22% ( t=1.93, P=0.061), respectively, with no statistically significant differences. Conclusions:The differences in CT values between VNC and TNC images in DECT mainly exist in bony structures, particularly in the skull and vertebrae. For patients with cranial tumors, VNC images can be directly used in photon radiotherapy planning. In contrast, for proton therapy, after being corrected by the regression model, VNC images can effectively replace TNC images for the dose calculations of radiotherapy plan.

Objective To construct and validate a risk predictive model for fatigue in soldiers during long voyage based on sleep,mood and constitution.Methods One thousand soldiers during long voyage were selected as research objects by random cluster sampling.The fatigue scale-14(FS-14),Pittsburgh sleep quality index(PSQI),self-rating anxiety scale(SAS),self-rating depression scale(SDS),and TCM constitution scale were used to assess the occurrence of fatigue and its influence factors.Logistic stepwise regression analysis was used to screen variables,and the prediction nomogram model was constructed based on the risk factors of fatigue.The area under the receiver operator characteristic curve(AUC),calibration curve,Hosmer-Lemeshow test and decision curve were used for internal validation and predictive efficacy assessment.Results A total of 935 effective scales were collected,with an effective rate of 93.5%.Excluding 306 soldiers who were already fatigued before voyage,the fatigue incidence rate of 629 soldiers after 15 days and 30 days of voyage were 26.39%and 42.13%,respectively.The total score of FS-14 and the scores of physical fatigue and mental fatigue were significantly proportional to the voyage time(P<0.01).Eight variables including Qi-deficiency,Yang-deficiency,Yin-deficiency,Qi-stagnation,Special-constitution,anxiety,depression,and sleep disorder might be the independent risk factors for the occurrence of fatigue 30 days after voyage.A nomogram model was established according to the selected variables,and the AUC of the model was 0.828(95%CI:0.797-0.858).Calibration curve and Hosmer-Lemeshow test showed that the goodness of fit of the model was good(χ2=15.384,P=0.052).Decision curve showed that the model had a positive net benefit when the threshold probability was 10%-95%.Conclusion The predictive model for fatigue in soldiers during long voyage has good predictive accuracy and efficiency.It is an effective assessment tool for screening high-risk cases of fatigue and implementing preventive interventions in soldiers during long voyage.

OBJECTIVE: To explore the clinical efficacy of conventional transforaminal endoscopic technique and I See transforaminal endoscopic technique in the treatment of recurrent L₅S₁ lumbar disc herniation with high iliac crest. METHODS: A total of 36 patients with recurrent L5S1 lumbar disc herniation with high iliac crest after posterior small-incision discectomy, admitted from May 2016 to May 2023, were selected. They were divided into the conventional transforaminal endoscopy group and the I See transforaminal endoscopy group according to the different transforaminal endoscopic techniques adopted, and all patients in both groups underwent lateral transforaminal spinal canal decompression and discectomy. There were 18 patients in the conventional transforaminal endoscopy group, including 11 males and 7 females, with an age of (52.24±6.68) years;the I See transforaminal endoscopy group also had 18 patients, including 12 males and 6 females, with an age of (50.75±7.79) years. The perioperative indicators (operation time, number of intraoperative radiographs, and length of hospital stay) were compared between two groups. The clinical efficacy was evaluated using the visual analogue scale(VAS) for pain, the Japanese Orthopaedic Association(JOA) low back pain score, and the modified MacNab criteria before and after surgery. RESULTS: All patients achieved gradeⅠincision healing, with no infection cases. The operation time of the I See group was (64.25±16.67) minutes, which was significantly shorter than that of the conventional transforaminal endoscopy group (89.11±17.24) minutes, and the difference was statistically significant(P<0.05). The number of intraoperative radiographs in the I See group was (5.20±2.29) times, which was significantly less than that in the conventional transforaminal endoscopy group(19.16±3.68) times, and the difference was statistically significant(P<0.05). The VAS and total JOA scores of both groups at the 3rd day, the 3rd month after surgery, and the last follow-up were significantly lower than those before surgery, with statistically significant differences(P<0.05);however, there were no statistically significant differences in VAS and total JOA scores between two groups at the 3rd day, the 3rd month after surgery, and the last follow-up (P>0.05). According to the modified MacNab criteria for efficacy evaluation:in the conventional transforaminal endoscopy group, 14 cases were excellent and 4 cases were good;in the I See transforaminal endoscopy group, 15 cases were excellent and 3 cases were good;there was no statistically significant difference in efficacy between two groups(Z=0.177, P=0.674). CONCLUSION Both transforaminal endoscopic techniques have good clinical effects in the treatment of recurrent L₅S₁ lumbar disc herniation with high iliac crest, resulting in significant improvement of postoperative symptoms, and they are safe, reliable, and minimally invasive surgical methods. Compared with the conventional transforaminal endoscopy, the I See transforaminal endoscopic technique has shorter operation time and fewer intraoperative radiographs, so it is generally the first choice.
Humans ; Male ; Female ; Intervertebral Disc Displacement/surgery* ; Endoscopy/methods* ; Middle Aged ; Lumbar Vertebrae/surgery* ; Ilium/surgery* ; Adult ; Diskectomy/methods*

Investigating the correlation between micronucleus formation and male infertility has the potential to improve clinical diagnosis and deepen our understanding of pathological progression. Our study enrolled 2252 male patients whose semen was analyzed from March 2023 to July 2023. Their clinical data, including semen parameters and age, were also collected. Genetic analysis was used to determine whether the sex chromosome involved in male infertility was abnormal (including the increase, deletion, and translocation of the X and Y chromosomes), and subsequent semen analysis was conducted for clinical grouping purposes. The participants were categorized into five groups: normozoospermia, asthenozoospermia, oligozoospermia, oligoasthenozoospermia, and azoospermia. Patients were randomly selected for further study; 41 patients with normozoospermia were included in the control group and 117 patients with non-normozoospermia were included in the study group according to the proportions of all enrolled patients. Cytokinesis-block micronucleus (CBMN) screening was conducted through peripheral blood. Statistical analysis was used to determine the differences in micronuclei (MNi) among the groups and the relationships between MNi and clinical data. There was a significant increase in MNi in infertile men, including those with azoospermia, compared with normozoospermic patients, but there was no significant difference between the genetic and nongenetic groups in azoospermic men. The presence of MNi was associated with sperm concentration, progressive sperm motility, immotile spermatozoa, malformed spermatozoa, total sperm count, and total sperm motility. This study underscores the potential utility of MNi as a diagnostic tool and highlights the need for further research to elucidate the underlying mechanisms of male infertility.
Humans ; Male ; Infertility, Male/genetics* ; Adult ; Micronucleus Tests ; Semen Analysis ; Oligospermia/genetics* ; Azoospermia/genetics* ; Chromosome Aberrations ; Sperm Count ; Micronuclei, Chromosome-Defective ; Middle Aged

To guide clinical blood transfusion practices for pediatric patients, the National Health Commission has issued the health standard "Guideline for pediatric transfusion" (WS/T 795-2022). Blood transfusion is one of the most commonly used supportive treatments for children with hematological diseases. This guideline provides guidance and recommendations for blood transfusions in children with aplastic anemia, thalassemia, autoimmune hemolytic anemia, glucose-6-phosphate dehydrogenase deficiency, acute leukemia, myelodysplastic syndromes, immune thrombocytopenic purpura, and thrombotic thrombocytopenic purpura. This article presents the evidence and interpretation of the blood transfusion provisions for children with hematological diseases in the "Guideline for pediatric transfusion", aiming to assist in the understanding and implementing the blood transfusion section of this guideline.
Humans ; Child ; Hematologic Diseases/therapy* ; Blood Transfusion/standards* ; Practice Guidelines as Topic