Objective To explore the value of low contrast dose and low flow rate one-stop craniocervical CT angiography(CT A)-cerebral CT perfusion(CTP)for detecting carotid atherosclerosis(CAS).Methods Totally 117 CAS patients were prospectively enrolled and divided into group A(n=19),B(n=52),C(n=46),and low contrast dose and low flow rate one-stop craniocervical CTA-brain CTP scanning,low contrast dose and low flow rate craniocervical CT A scanning,as well as conventional craniocervical CT A scanning were performed,respectively.Virtual monoenergetic images(VMI)of 40,50 and 60 keV were reconstructed in group A and B.The subjective and objective evaluations of image quality were compared among 3 groups.Results Subjective scores of image quality and diagnostic confidence of 40 and 50 keV VMI,and the diagnostic confidence of 60 keV VMI in group A and B were not significant different compared with those in group C(all P＞0.05).Signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of each segment of craniocervical blood vessels at 40 and 50 keV VMI in group A and B were all higher than those in group C(all P＜0.05).CNR of cavernous sinus segment of internal carotid artery(C5 segment),horizontal segment of middle cerebral artery(MCA)(A1 segment),lateral sulcus segment of MCA(M2 segment)and basilar artery(BA)segment in group A at 60 keV VMI were all higher than those in group C(all P＜0.05).SNR of C5 segment,A1 segment and BA segment,as well as CNR of BA segment of 60 keV VMI in group B were all higher than those in group C(all P＜0.05).Conclusion Low contrast dose and low flow rate one-stop craniocervical was feasible for detecting CAS.

Objective:To systematically compares the medial plantar venous flap (MPVF) and the lateral toe flap (LTF) reconstruction of digit-pulp defect, aiming to establish whether there exist significant differences between the 2 flaps in flap survival rate, two-point discrimination (TPD), score of Vancouver Scar Scale (VSS) and score of digit-pulp defect reconstruction evaluation.Methods:With a prospective cohort design, this study enrolled 36 patients who were admitted in Department of Hand Surgery, Longgang Eighth People's Hospital of Shenzhen for digit-pulp defects with bone or tendon exposure between January 2024 and September 2024. According to the random grouping method, participants were divided into 2 groups. The MPVF group comprised 18 patients (21 digits) of 13 males (15 digits) and 5 females (6 digits), aged 13-58 (mean 44±12) years. The MPVF group included 9 left and 12 right digits, with distribution as follows: 2 thumbs, 5 index fingers, 7 middle fingers, 5 ring fingers and 2 little fingers. The soft tissue defect area ranged from 2.0 cm × 1.0 cm to 9.2 cm × 3.3 cm (mean 6.69 cm 2± 6.69 cm 2). Flap dimensions ranged from 2.1 cm×1.1 cm to 9.5 cm×3.5 cm (mean 7.54 cm 2±7.22 cm 2). Donor sites were closed primarily or by full-thickness skin grafts harvested from the leg. The LTF group included 18 patients (21 digits) of 15 males (17 digits) and 3 females (4 digits), aged 22-62 (mean 41±12) years. The affected digits in LTF group comprised 12 left and 9 right digits, with a distribution of: 3 thumbs, 9 index fingers, 5 middle fingers, 2 ring fingers and 2 little fingers. The area of soft tissue defect ranges from 1.4 cm × 1.0 cm to 3.9 cm × 1.8 cm (mean 3.93 cm 2± 1.80 cm 2). Flap dimensions ranged from 1.5 cm×1.2 cm to 4.0 cm×1.9 cm (mean 4.52 cm 2±1.89 cm 2). Donor sites were closed primarily, or by full-thickness skin grafts harvested through extension of proximal wound extension or from calf for defect coverage. Patients were contacted for postoperative follow-up by telephone or WeChat to arrange a visit of outpatient clinic or a home visit by surgeon. Statistical analysis was conducted to compare the 2 groups regarding: gender, age and flap dimensions, flap survival rate at 2 weeks after surgery and TPD of flaps, VSS scores, and digit-pulp defect reconstruction evaluation scale scores at 4 months and 6 months postoperatively. P<0.05 indicates a statistically significant difference. Results:The comparative analysis revealed no statistically significant differences between 2 groups in baseline characteristics: gender distribution ( χ2=0.53, P=0.47), mean age ( t=0.75, P=0.46), flap dimensions ( t=1.86, P=0.08), confirming a demographic and surgical parameter equivalence in subsequent outcome comparisons ( P>0.05). All flaps survived at 2 weeks after surgery. All skin grafts at donor sites demonstrated complete viability with uneventful primary wound healing. At 4 months after surgey, the TPD in the MPVF group were 14.71 mm±1.90 mm and 7.81 mm±1.78 mm, respectively, compared to 14.48 mm±1.57 mm and 7.67 mm±1.39 mm in the LTF group at 6 months after surgery. The VSS scores were 1.67±1.11 and 1.29±0.72 for MPVF versus 1.86±1.15 and 1.38±0.81 for LTF at corresponding time points. The digit-pulp defects reconstruction evaluation scale scores showed 88.43±2.62 and 91.43±3.59 for MPVF versus 88.19±2.70 and 91.19±3.50 for LTF. Statistical analysis revealed no significant differences (all P>0.05) at 2 postoperative time points. Conclusion:The MPVF demonstrated non-inferior clinical efficacy to the LTF in reconstruction of digit-pulp defects, with comparable outcomes in flap survival rate at 2 weeks, and in TPD, VSS scores, digit-pulp defect reconstruction evaluation scale scores at 4 months and at 6 month after surgey.

With the continuous advancement and development of minimally invasive techniques, uniportal thoracoscopic minimally invasive esophagectomy (UTMIE) has gradually expanded its application in the surgical treatment of esophageal cancer due to its significant advantages, including minimal trauma, aesthetically pleasing incisions, and reduced postoperative pain. This consensus is based on the latest evidence-based medical data from both domestically and internationally, combined with extensive clinical practice experiences from numerous experts. It systematically reviews and summarizes the indications, key technical points, learning curve characteristics, perioperative management strategies, as well as prevention and management of complications associated with UTMIE. To ensure the scientific rigor and authority of this consensus, a total of 83 experts in the field were invited to participate in multiple rounds of Delphi surveys for in-depth discussion and consultation. Ultimately, 24 recommendations were formulated to guide the standardized application of UTMIE in clinical practice. The aim of this consensus is to standardize and guide the clinical implementation of UTMIE, ensuring safety and efficacy while promoting more efficient and widespread development of this surgical approach.

The operating room is the core settings of various surgical treatments, and exhibits distinct attributes and systemic complexities. Medical staff who work long term in operating rooms face multiple exposures to potential health hazards. Especially with the progress of electrosurgical technology and the frequent use of electrosurgical equipment, the possible health effects of the resulting electrosurgical smoke to those working in operating rooms have gradually attracted attention. This paper reviewed the composition, hazard, exposure risk monitoring, and protective measures of electrosurgical smoke, aiming to deepen the understandings of potential health risks of electrosurgical smoke, improve the self-protection awareness of medical staff, strengthen attention to electrosurgical smoke protection in all hospitals, and ensure the occupational safety of medical staff.

Objective:To systematically compares the medial plantar venous flap (MPVF) and the lateral toe flap (LTF) reconstruction of digit-pulp defect, aiming to establish whether there exist significant differences between the 2 flaps in flap survival rate, two-point discrimination (TPD), score of Vancouver Scar Scale (VSS) and score of digit-pulp defect reconstruction evaluation.Methods:With a prospective cohort design, this study enrolled 36 patients who were admitted in Department of Hand Surgery, Longgang Eighth People's Hospital of Shenzhen for digit-pulp defects with bone or tendon exposure between January 2024 and September 2024. According to the random grouping method, participants were divided into 2 groups. The MPVF group comprised 18 patients (21 digits) of 13 males (15 digits) and 5 females (6 digits), aged 13-58 (mean 44±12) years. The MPVF group included 9 left and 12 right digits, with distribution as follows: 2 thumbs, 5 index fingers, 7 middle fingers, 5 ring fingers and 2 little fingers. The soft tissue defect area ranged from 2.0 cm × 1.0 cm to 9.2 cm × 3.3 cm (mean 6.69 cm 2± 6.69 cm 2). Flap dimensions ranged from 2.1 cm×1.1 cm to 9.5 cm×3.5 cm (mean 7.54 cm 2±7.22 cm 2). Donor sites were closed primarily or by full-thickness skin grafts harvested from the leg. The LTF group included 18 patients (21 digits) of 15 males (17 digits) and 3 females (4 digits), aged 22-62 (mean 41±12) years. The affected digits in LTF group comprised 12 left and 9 right digits, with a distribution of: 3 thumbs, 9 index fingers, 5 middle fingers, 2 ring fingers and 2 little fingers. The area of soft tissue defect ranges from 1.4 cm × 1.0 cm to 3.9 cm × 1.8 cm (mean 3.93 cm 2± 1.80 cm 2). Flap dimensions ranged from 1.5 cm×1.2 cm to 4.0 cm×1.9 cm (mean 4.52 cm 2±1.89 cm 2). Donor sites were closed primarily, or by full-thickness skin grafts harvested through extension of proximal wound extension or from calf for defect coverage. Patients were contacted for postoperative follow-up by telephone or WeChat to arrange a visit of outpatient clinic or a home visit by surgeon. Statistical analysis was conducted to compare the 2 groups regarding: gender, age and flap dimensions, flap survival rate at 2 weeks after surgery and TPD of flaps, VSS scores, and digit-pulp defect reconstruction evaluation scale scores at 4 months and 6 months postoperatively. P<0.05 indicates a statistically significant difference. Results:The comparative analysis revealed no statistically significant differences between 2 groups in baseline characteristics: gender distribution ( χ2=0.53, P=0.47), mean age ( t=0.75, P=0.46), flap dimensions ( t=1.86, P=0.08), confirming a demographic and surgical parameter equivalence in subsequent outcome comparisons ( P>0.05). All flaps survived at 2 weeks after surgery. All skin grafts at donor sites demonstrated complete viability with uneventful primary wound healing. At 4 months after surgey, the TPD in the MPVF group were 14.71 mm±1.90 mm and 7.81 mm±1.78 mm, respectively, compared to 14.48 mm±1.57 mm and 7.67 mm±1.39 mm in the LTF group at 6 months after surgery. The VSS scores were 1.67±1.11 and 1.29±0.72 for MPVF versus 1.86±1.15 and 1.38±0.81 for LTF at corresponding time points. The digit-pulp defects reconstruction evaluation scale scores showed 88.43±2.62 and 91.43±3.59 for MPVF versus 88.19±2.70 and 91.19±3.50 for LTF. Statistical analysis revealed no significant differences (all P>0.05) at 2 postoperative time points. Conclusion:The MPVF demonstrated non-inferior clinical efficacy to the LTF in reconstruction of digit-pulp defects, with comparable outcomes in flap survival rate at 2 weeks, and in TPD, VSS scores, digit-pulp defect reconstruction evaluation scale scores at 4 months and at 6 month after surgey.

Objective To evaluate the impact of medical service price adjustment policies on the economic operations of public hospitals.Methods Utilizing operational data from a provincial tertiary hospital in Anhui Province spanning December 2022 to December 2024,an interrupted time series analysis(ITS)was conducted,with the price adjustment policy implemented in December 2023 as the intervention node.This study quantified trends in surgical income,laboratory income,and cost structure changes before and after the policy implementation.Sensitivity analysis was performed to validate the robustness of findings.Results Following the surgical service price adjustment,income surged by 6.125 million(11.72％)in the first month,with adjusted items contributing 42.5％to this increase.The long-term monthly growth rate rose to 78.9 thousand,and the proportion of technical labor income increased from 6.1％to 10.1％.For laboratory services,the price adjustment led to an initial income decline of 10.324 million(P＜0.001).However,through domestic consumable substitution(provincially centralized procure-ment of testing reagents achieved an average price reduction of 53.9％)and process automation(reducing 30％-40％ of repeti-tive labor in testing personnel),the monthly decline narrowed to 195 thousand driving a transition toward technology-driven labo-ratory services.Conclusion The price adjustment policy optimized public hospital revenue structures through dual mechanisms of"technical value compensation"and"separation of technical services from consumables",effectively addressing the issue of"consumable-dependent revenue models".Public hospitals should enhance refined management,establish a technical labor val-ue-oriented pricing system,and coordinate with dynamic policy adjustments to achieve synergistic improvements in economic effi-ciency and healthcare quality.

Objective To establish a predictive nomogram model for diabetic peripheral neuropathy(DPN)in elderly diabetic patients.Methods A total of 200 elderly patients with T2DM admitted to our hospital were enrolled in this study from January 2021 to October 2023.All the patients were divided into a simple T2DM group(n=160)and a T2DM combined with DPN(DPN,n=40)group.The general data and biochemical indexes were compared between the two groups.Spearman correlation analysis was used to explore the correlation between clinical indicators and the occurrence of DPN in the elderly.Logistic regression was used to analyze the influencing factors for DPN in the elderly,and a nomogram was constructed.The receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of the model.Results The DM duration,DR and HbA1c were higher(P<0.05),while HDL-C was lower in the DPN group than in the T2DM group(P<0.05).Spearman correlation analysis showed that elderly DPN were positively correlated with DR,DM duration and HbA1c(r=0.456,0.565,0.580,P<0.05),and negatively correlated with HDL-C(r=-0.542,P<0.05).Logistic regression analysis showed that DR(OR 1.035,95%CI 1.032～1.040),DM duration(OR 1.070,95%CI 1.045～1.080),HbA1c(OR 1.235,95%CI 1.156～1.280)and HDL-C(OR 0.895,95%CI 0.877～0.950)were both influencing factors for elderly DPN.A nomogram prediction model for elderly DPN was constructed based on DR,DM duration,HbA1c and HDL-C.ROC curve analysis showed that the area under curve of this prediction model was 0.955,with a sensitivity of 92.50%,a specificity of 95.00%,and a cutoff value of 0.251.Conclusions The established predictive diagram model involves four variables,including DR,DM duration,HbA1c and HDL-C,which can assist the clinic to make an early assessment of DPN risk.

Objective To evaluate the impact of medical service price adjustment policies on the economic operations of public hospitals.Methods Utilizing operational data from a provincial tertiary hospital in Anhui Province spanning December 2022 to December 2024,an interrupted time series analysis(ITS)was conducted,with the price adjustment policy implemented in December 2023 as the intervention node.This study quantified trends in surgical income,laboratory income,and cost structure changes before and after the policy implementation.Sensitivity analysis was performed to validate the robustness of findings.Results Following the surgical service price adjustment,income surged by 6.125 million(11.72％)in the first month,with adjusted items contributing 42.5％to this increase.The long-term monthly growth rate rose to 78.9 thousand,and the proportion of technical labor income increased from 6.1％to 10.1％.For laboratory services,the price adjustment led to an initial income decline of 10.324 million(P＜0.001).However,through domestic consumable substitution(provincially centralized procure-ment of testing reagents achieved an average price reduction of 53.9％)and process automation(reducing 30％-40％ of repeti-tive labor in testing personnel),the monthly decline narrowed to 195 thousand driving a transition toward technology-driven labo-ratory services.Conclusion The price adjustment policy optimized public hospital revenue structures through dual mechanisms of"technical value compensation"and"separation of technical services from consumables",effectively addressing the issue of"consumable-dependent revenue models".Public hospitals should enhance refined management,establish a technical labor val-ue-oriented pricing system,and coordinate with dynamic policy adjustments to achieve synergistic improvements in economic effi-ciency and healthcare quality.

Objective To establish a predictive nomogram model for diabetic peripheral neuropathy(DPN)in elderly diabetic patients.Methods A total of 200 elderly patients with T2DM admitted to our hospital were enrolled in this study from January 2021 to October 2023.All the patients were divided into a simple T2DM group(n=160)and a T2DM combined with DPN(DPN,n=40)group.The general data and biochemical indexes were compared between the two groups.Spearman correlation analysis was used to explore the correlation between clinical indicators and the occurrence of DPN in the elderly.Logistic regression was used to analyze the influencing factors for DPN in the elderly,and a nomogram was constructed.The receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of the model.Results The DM duration,DR and HbA1c were higher(P<0.05),while HDL-C was lower in the DPN group than in the T2DM group(P<0.05).Spearman correlation analysis showed that elderly DPN were positively correlated with DR,DM duration and HbA1c(r=0.456,0.565,0.580,P<0.05),and negatively correlated with HDL-C(r=-0.542,P<0.05).Logistic regression analysis showed that DR(OR 1.035,95%CI 1.032～1.040),DM duration(OR 1.070,95%CI 1.045～1.080),HbA1c(OR 1.235,95%CI 1.156～1.280)and HDL-C(OR 0.895,95%CI 0.877～0.950)were both influencing factors for elderly DPN.A nomogram prediction model for elderly DPN was constructed based on DR,DM duration,HbA1c and HDL-C.ROC curve analysis showed that the area under curve of this prediction model was 0.955,with a sensitivity of 92.50%,a specificity of 95.00%,and a cutoff value of 0.251.Conclusions The established predictive diagram model involves four variables,including DR,DM duration,HbA1c and HDL-C,which can assist the clinic to make an early assessment of DPN risk.

Objective To explore the value of low contrast dose and low flow rate one-stop craniocervical CT angiography(CT A)-cerebral CT perfusion(CTP)for detecting carotid atherosclerosis(CAS).Methods Totally 117 CAS patients were prospectively enrolled and divided into group A(n=19),B(n=52),C(n=46),and low contrast dose and low flow rate one-stop craniocervical CTA-brain CTP scanning,low contrast dose and low flow rate craniocervical CT A scanning,as well as conventional craniocervical CT A scanning were performed,respectively.Virtual monoenergetic images(VMI)of 40,50 and 60 keV were reconstructed in group A and B.The subjective and objective evaluations of image quality were compared among 3 groups.Results Subjective scores of image quality and diagnostic confidence of 40 and 50 keV VMI,and the diagnostic confidence of 60 keV VMI in group A and B were not significant different compared with those in group C(all P＞0.05).Signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of each segment of craniocervical blood vessels at 40 and 50 keV VMI in group A and B were all higher than those in group C(all P＜0.05).CNR of cavernous sinus segment of internal carotid artery(C5 segment),horizontal segment of middle cerebral artery(MCA)(A1 segment),lateral sulcus segment of MCA(M2 segment)and basilar artery(BA)segment in group A at 60 keV VMI were all higher than those in group C(all P＜0.05).SNR of C5 segment,A1 segment and BA segment,as well as CNR of BA segment of 60 keV VMI in group B were all higher than those in group C(all P＜0.05).Conclusion Low contrast dose and low flow rate one-stop craniocervical was feasible for detecting CAS.