ObjectiveTo obtain the epidemiological characteristics of re-positive cases infected with SARS-CoV-2 in Pudong New Area from March to July 2022, including clinical manifestations, duration of a negative nucleic acid conversion after tested for re-positive, and length of time from the discharge of the initial infection to the most recent re-positivity, so as to provide a scientific basis for the prevention and control of COVID-19. MethodsA questionnaire survey was conducted among the re-positive cases infected with SARS-CoV-2 after discharged from hospital/quarantine facility in Pudong New Area, and descriptive epidemiological methods were used for characteristics analysis. ResultsA total of 2 422 re-positive cases met the inclusive and exclusive criteria, with males accounting for 61.02%. The age distribution mainly fell between 18 and <60 years old, accounting for 62.39%. Clinical manifestations were predominantly asymptomatic (72.15%), followed by cough (12.03%) and sore throat (6.58%). Among the stratified randomized sample of 416 individuals, there were statistically significant differences in symptoms (χ²=262.667, P<0.001), clinical typing (χ²=12.996, P=0.001), and duration of a negative nucleic acid conversion (χ²=142.578, P<0.001) between the initial positive and re-positive instances. Besides, statistically significant differences in symptoms (χ²=13.696, P=0.016) and self-perception of the severity of re-infection (χ²=7.923, P=0.048) between the initial and re-positive cases were observed by different genders. ConclusionAmong re-positive cases, males experienced milder symptoms compared to females, and the self-perception of symptoms during re-positivity is milder than that in the initial positive infection. The length of time for negative nucleic acid conversion during the initial positive period is shorter than that during the re-positive period.

OBJECTIVE: To investigate the short-term effectiveness of uni-portal non-coaxial spinal endoscopic surgery (UNSES) via crossing midline approach (CMA) in the treatment of free lumbar disc herniation (FLDH). METHODS: Between March 2024 and June 2024, 16 patients with FLDH were admitted and treated with UNSES via CMA. There were 9 males and 7 females with an average age of 55.1 years (range, 47-62 years). The disease duration was 8-30 months (mean, 15.6 months). The pathological segments was L _{3, 4} in 4 cases, L _{4, 5} in 5 cases, and L ₅, S ₁ in 7 cases. The preoperative pain visual analogue scale (VAS) score was 6.9±0.9 and the Oswestry disability index (ODI) was 57.22%±4.16%. The operation time, intraoperative bleeding volume, postoperative hospital stay, and incidence of complications were recorded. The spinal pain and functional status were evaluated by VAS score and ODI, and effectiveness was evaluated according to the modified MacNab criteria. CT and MRI were used to evaluate the effect of nerve decompression. RESULTS: All 16 patients underwent operation successfully without any complications. The operation time was 63-81 minutes (mean, 71.0 minutes). The intraoperative bleeding volume was 47.3-59.0 mL (mean, 55.0 mL). The length of hospital stay after operation was 3-4 days (mean, 3.5 days). All patients were followed up 1-3 months, with 15 cases followed up for 2 months and 14 cases for 3 months. The VAS score and ODI gradually decreased over time after operation, and there were significant differences between different time points ( P<0.05). At 3 months after operation, the effectiveness was rated as excellent in 12 cases and good in 2 cases according to the modified MacNab criteria, with an excellent and good rate of 100%. CT and MRI during follow-up showed a significant increase in the diameter and cross-sectional area of the spinal canal, indicating effective decompression of the canal. CONCLUSION When using UNSES to treat FLDH, choosing CMA for nerve decompression has the advantages of wide decompression range, large operating space, and freedom of operation. It can maximize the preservation of the articular process, avoid fracture and breakage of the isthmus, clearly display the exiting and traversing nerve root, and achieve good short-term effectiveness.
Humans ; Male ; Intervertebral Disc Displacement/diagnostic imaging* ; Middle Aged ; Female ; Lumbar Vertebrae/surgery* ; Endoscopy/methods* ; Treatment Outcome ; Operative Time ; Pain Measurement ; Length of Stay

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

OBJECTIVE: To evaluate the risks and benefits of different resuscitation fluids in patients with early sepsis and septic shock by observing and comparing clinical indicators, clinical outcomes, and the concentration changes of glycocalyx biomarkers, and to determine how to appropriately select suitable resuscitation fluids for sepsis patients to aid fluid therapy. METHODS: A single center, prospective, randomized controlled trial was conducted. Patients with early sepsis and septic shock who have required fluid resuscitation after capacity status assessment admitted to the department of critical care medicine of Fourth Hospital of Hebei Medical University from April to October 2023 were enrolled. Patients were randomly assigned to either the experimental group (balanced crystalloid solution+albumin) or the control group (balanced crystalloid solution) by a random number table method. Clinical data of both groups of patients before and after resuscitation at 3, 8, and 24 hours were monitored, and blood samples were collected, enzyme-linked immunosorbent assay (ELISA) was used to measure the concentration of plasma glycocalyx biomarker syndecan-1. The 28-day and 90-day survival rates and complications were also assessed. RESULTS: A total of 66 patients were enrolled, including 44 in the experimental group and 22 in the control group. The baseline data of two groups were balanced and comparable. There was no statistically significant difference in the plasma concentration of syndecan-1 between the experimental group and the control group before and after resuscitation, and both showed a trend of first increasing and then decreasing. However, the plasma syndecan-1 level in the control group at 8 hours and 24 hours after resuscitation were significantly higher than the baseline level before resuscitation [ng/L: 19.02 (14.41, 27.80), 18.95 (12.40, 22.50) vs. 14.67 (11.57, 21.14), both P < 0.05], while there was no statistically significant difference at any time point within the experimental group. The correlation analysis between plasma syndecan-1 level and lactic acid, albumin, and sequential organ failure assessment (SOFA) in all patients showed that a positive correlation between syndecan-1 level and SOFA score before resuscitation (r = 0.247, P = 0.046), and a negative correlation between syndecan-1 level and albumin level at 24 hours after resuscitation (r = -0.308, P = 0.012). There were no statistically significant differences in 28-day and 90-day mortality, length of hospital stay, length of intensive care unit (ICU) stay, duration of mechanical ventilation, blood purification time, number of organ injuries, and complications between the two groups. However, the baseline albumin level in the experimental group was significantly lower than that in the control group (g/L: 28.7±4.5 vs. 31.6±4.2, P < 0.05). Analysis of clinical treatment data showed that compared with the control group, the experimental group had lower absolute lactate level at 8 hours and 24 hours after resuscitation [mmol/L: 8 hours was 1.30 (1.00, 1.88) vs. 1.60 (1.30, 3.05), 24 hours was 1.15 (0.80, 1.78) vs. 1.55 (1.08, 2.05), both P < 0.05], and higher lactate clearance rate [8 hours was 45% (27%, 56%) vs. 20% (-4%, 46%), 24 hours was 55% (34%, 70%) vs. 34% (-14%, 59%), both P < 0.05]. However, there were no statistically significant differences in the amount of fluid resuscitation, use of vasoactive drugs, and oxygenation index between the two groups during the resuscitation process. Multivariate Logistic regression analysis showed that body mass index (BMI) was independently correlated with 90-day mortality [odds ratio (OR) = 1.991, 95% confidence interval (95%CI) was 1.023-3.387, P = 0.043]. CONCLUSIONS There are no significant difference in plasma syndecan-1 level during fluid resuscitation of early sepsis and septic shock patients using balanced crystalloid fluid and balanced crystalloid fluid combined with albumin resuscitation, and there are no statistically significant differences in the impact on 28-day and 90-day prognosis, length of hospital stay, complications, and other aspects of the patients. However, compared to balanced crystalloid fluid, the combination of balanced crystalloid fluid and albumin for fluid resuscitation in sepsis patients has lower lactate level and better lactate clearance effect, but further validation is still needed through large-scale randomized controlled trials.
Humans ; Clinical Relevance ; Crystalloid Solutions/administration & dosage* ; Fluid Therapy/methods* ; Glycocalyx/metabolism* ; Isotonic Solutions/administration & dosage* ; Prospective Studies ; Resuscitation/methods* ; Sepsis/therapy* ; Shock, Septic/therapy* ; Syndecan-1/blood*

Objective:To explore the feasibility of autosegmentation and reconstruction of interstitial needles in intracavitary / interstitial brachytherapy (IC-ISBT) for cervical cancer based on deep learning.Methods:The data of 180 treatment plans from 98 patients who received IC-ISBT were retrospectively collected and divided into the training, validation, and testing sets in a 16:1:1 ratio. Masks of needles were created using the dwell positions of radiation sources, and a 3D U-Net model was trained. The performance of the model was evaluated using the Dice similarity coefficient (DSC). Absolute and relative accuracy rates were used to assess the results of this method, and the position bias was used to evaluate the precision of predictions in the transversal plan of CT scans. Wilcoxon rank-sum test was performed to evaluate the reconstruction efficiency by comparing the time required for automated versus manual reconstruction.Results:DSC of the model was 0.93 ± 0.02. The absolute and relative accuracy rates were 0.44 ± 0.09 and 0.95 ± 0.03, respectively. The distance deviation on the CT horizontal plane was (0.58 ± 0.54) mm. The average time of autosegmentation and reconstruction was (6.2 ± 0.4) s, leading to a significant reduction in time consumption compared with manual construction ( P<0.001). Conclusions:Based on deep learning, using the dwell positions of radiation sources for data annotation, combined with post-processing algorithms, accurate automated segmentation and digital reconstruction of needles in IC-ISBT three-dimensional CT images can be achieved, significantly improving reconstruction efficiency.

Objective:To investigate the efficacy of enteral nutrition in preventing bone marrow suppression in patients with nasopharyngeal carcinoma undergoing concurrent radiotherapy and chemotherapy.Methods:The clinical data of 150 nasopharyngeal carcinoma patients undergoing concurrent radiotherapy and chemotherapy treatment in our hospital from Sep 2022 to Sep 2024 were analyzed.They were divided into the conventional group(74 cases)and the enteral nutrition group(76 cases)according to different nutritional intervention plans.The conventional group received conventional nutritional therapy,while the enteral nutrition group received enteral nutrition therapy.The occurrence of bone marrow suppression,blood routine indicators,nutritional status indicators were compared,and quality of life was evaluated with cancer patient quality of life measurement scale(EORTC-QLQ-C30)and compared.Results:The total incidence of bone marrow suppression in the enteral nutrition group was lower than that in the conventional group(P＜0.05),and the degree of bone marrow suppression was milder than that in the conventional group(P＜0.05).At the end of treatment,the enteral nutrition group had higher levels of hemoglobin,granulocytes count,red blood cells count,white blood cells count,platelets count,body mass index,upper arm circumference,waist circumference,and scores of each functional domain of EORTC-QLQ-C30 compared to the conventional group(P＜0.05).Conclusion:Enteral nutrition therapy for nasopharyngeal carcinoma patients undergoing concurrent radiotherapy and chemotherapy can prevent bone marrow suppression,improve blood routine indicators and nutritional status,and enhance quality of life.

Objective:To investigate the efficacy of enteral nutrition in preventing bone marrow suppression in patients with nasopharyngeal carcinoma undergoing concurrent radiotherapy and chemotherapy.Methods:The clinical data of 150 nasopharyngeal carcinoma patients undergoing concurrent radiotherapy and chemotherapy treatment in our hospital from Sep 2022 to Sep 2024 were analyzed.They were divided into the conventional group(74 cases)and the enteral nutrition group(76 cases)according to different nutritional intervention plans.The conventional group received conventional nutritional therapy,while the enteral nutrition group received enteral nutrition therapy.The occurrence of bone marrow suppression,blood routine indicators,nutritional status indicators were compared,and quality of life was evaluated with cancer patient quality of life measurement scale(EORTC-QLQ-C30)and compared.Results:The total incidence of bone marrow suppression in the enteral nutrition group was lower than that in the conventional group(P＜0.05),and the degree of bone marrow suppression was milder than that in the conventional group(P＜0.05).At the end of treatment,the enteral nutrition group had higher levels of hemoglobin,granulocytes count,red blood cells count,white blood cells count,platelets count,body mass index,upper arm circumference,waist circumference,and scores of each functional domain of EORTC-QLQ-C30 compared to the conventional group(P＜0.05).Conclusion:Enteral nutrition therapy for nasopharyngeal carcinoma patients undergoing concurrent radiotherapy and chemotherapy can prevent bone marrow suppression,improve blood routine indicators and nutritional status,and enhance quality of life.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective:To explore the feasibility of autosegmentation and reconstruction of interstitial needles in intracavitary / interstitial brachytherapy (IC-ISBT) for cervical cancer based on deep learning.Methods:The data of 180 treatment plans from 98 patients who received IC-ISBT were retrospectively collected and divided into the training, validation, and testing sets in a 16:1:1 ratio. Masks of needles were created using the dwell positions of radiation sources, and a 3D U-Net model was trained. The performance of the model was evaluated using the Dice similarity coefficient (DSC). Absolute and relative accuracy rates were used to assess the results of this method, and the position bias was used to evaluate the precision of predictions in the transversal plan of CT scans. Wilcoxon rank-sum test was performed to evaluate the reconstruction efficiency by comparing the time required for automated versus manual reconstruction.Results:DSC of the model was 0.93 ± 0.02. The absolute and relative accuracy rates were 0.44 ± 0.09 and 0.95 ± 0.03, respectively. The distance deviation on the CT horizontal plane was (0.58 ± 0.54) mm. The average time of autosegmentation and reconstruction was (6.2 ± 0.4) s, leading to a significant reduction in time consumption compared with manual construction ( P<0.001). Conclusions:Based on deep learning, using the dwell positions of radiation sources for data annotation, combined with post-processing algorithms, accurate automated segmentation and digital reconstruction of needles in IC-ISBT three-dimensional CT images can be achieved, significantly improving reconstruction efficiency.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.