Objective This study aims to develop an early in-hospital temperature management protocol for heat stroke patients and assess its effectiveness,providing guidance for rapid cooling and precise target temperature control.Methods The protocol was developed through a Delphi expert consultation combined with expert panel meetings.A multi-center,non-randomized,historical control study was conducted,utilizing convenience sampling to select heat stroke patients from the emergency departments of 7 tertiary hospitals in Zhejiang Province,China,between June and August 2024 as an experimental group.The protocol was implemented in this group,while the control group consisted of heat stroke patients treated between June and August 2022,prior to protocol implementation.Cooling rates,target temperature attainment rates,and clinical outcomes were compared between the 2 groups.Results The final protocol included 6 primary indicators,23 secondary indicators,and 56 tertiary indicators.After protocol implementation,the experimental group achieved a cooling rate of 0.08(0.05～0.09)℃/min within 0.5 hours,significantly higher than the control group,which had a rate of 0.04(0.02～0.06)℃/min(P＜0.001).The target temperature attainment rates at 0.5 hours and 2.0 hours were 55.93％and 98.31％,respectively,significantly higher than the rates of 15.87％and 61.11％in the control group(P＜0.001).The mechanical ventilation rate,hospitalization rate,ICU admission rate,and mortality rate in the experimental group were 25.42％,61.02％,44.07％,and 8.47％,respectively.Logistic regression analysis revealed that the early in-hospital temperature management protocol significantly reduced the risk of mechanical ventilation and hospitalization in heat stroke patients,with odds ratios(ORs)of 0.294 and 0.300,respectively(both P＜0.05).Conclusion The developed protocol for early in-hospital temperature management in heat stroke patients is scientific,systematic,and practical.It improves cooling rates and target temperature attainment,thereby enhancing the prognosis of heat stroke patients.

Objective:To explore the impact of a staged trauma integrated treatment model based on information network platforms on the emergency treatment outcomes of patients with severe cranial injury.Methods:A convenience sampling method was used to select 80 patients with severe cranial injury treated at Yiwu Central Hospital from June 2023 to June 2024. Patients admitted from June to December 2023 were assigned to the control group ( n=37), while patients admitted from January to June 2024 were assigned to the intervention group ( n=43). The control group received conventional emergency treatment for cranial injury, while the intervention group received the staged trauma integrated treatment model based on an information network platform. The emergency response time (response time, triage time, emergency room treatment time, and handover time to the ward), National Institutes of Health Stroke Scale (NIHSS) score, Glasgow Coma Scale (GCS) score, incidence of complications, and family satisfaction were compared between the two groups. Results:After intervention, the intervention group had shorter emergency response time, triage time, emergency room treatment time, and handover time to the ward compared to the control group, with statistically significant differences ( P<0.01). The NIHSS score in the intervention group was lower, and the GCS score was higher, with statistically significant differences ( P<0.05). The incidence of complications in the intervention group was lower, and family satisfaction was higher compared to the control group, with statistically significant differences ( P<0.05) . Conclusions:The staged trauma integrated treatment model based on an information network platform can optimize the emergency treatment process for severe cranial injury, shorten treatment times, improve hospital-to-hospital and interdepartmental coordination, reduce neurological damage and complication rates, and increase family satisfaction. It is worth promoting for clinical use.

Objective This study aims to develop an early in-hospital temperature management protocol for heat stroke patients and assess its effectiveness,providing guidance for rapid cooling and precise target temperature control.Methods The protocol was developed through a Delphi expert consultation combined with expert panel meetings.A multi-center,non-randomized,historical control study was conducted,utilizing convenience sampling to select heat stroke patients from the emergency departments of 7 tertiary hospitals in Zhejiang Province,China,between June and August 2024 as an experimental group.The protocol was implemented in this group,while the control group consisted of heat stroke patients treated between June and August 2022,prior to protocol implementation.Cooling rates,target temperature attainment rates,and clinical outcomes were compared between the 2 groups.Results The final protocol included 6 primary indicators,23 secondary indicators,and 56 tertiary indicators.After protocol implementation,the experimental group achieved a cooling rate of 0.08(0.05～0.09)℃/min within 0.5 hours,significantly higher than the control group,which had a rate of 0.04(0.02～0.06)℃/min(P＜0.001).The target temperature attainment rates at 0.5 hours and 2.0 hours were 55.93％and 98.31％,respectively,significantly higher than the rates of 15.87％and 61.11％in the control group(P＜0.001).The mechanical ventilation rate,hospitalization rate,ICU admission rate,and mortality rate in the experimental group were 25.42％,61.02％,44.07％,and 8.47％,respectively.Logistic regression analysis revealed that the early in-hospital temperature management protocol significantly reduced the risk of mechanical ventilation and hospitalization in heat stroke patients,with odds ratios(ORs)of 0.294 and 0.300,respectively(both P＜0.05).Conclusion The developed protocol for early in-hospital temperature management in heat stroke patients is scientific,systematic,and practical.It improves cooling rates and target temperature attainment,thereby enhancing the prognosis of heat stroke patients.

Objective:To explore the impact of a staged trauma integrated treatment model based on information network platforms on the emergency treatment outcomes of patients with severe cranial injury.Methods:A convenience sampling method was used to select 80 patients with severe cranial injury treated at Yiwu Central Hospital from June 2023 to June 2024. Patients admitted from June to December 2023 were assigned to the control group ( n=37), while patients admitted from January to June 2024 were assigned to the intervention group ( n=43). The control group received conventional emergency treatment for cranial injury, while the intervention group received the staged trauma integrated treatment model based on an information network platform. The emergency response time (response time, triage time, emergency room treatment time, and handover time to the ward), National Institutes of Health Stroke Scale (NIHSS) score, Glasgow Coma Scale (GCS) score, incidence of complications, and family satisfaction were compared between the two groups. Results:After intervention, the intervention group had shorter emergency response time, triage time, emergency room treatment time, and handover time to the ward compared to the control group, with statistically significant differences ( P<0.01). The NIHSS score in the intervention group was lower, and the GCS score was higher, with statistically significant differences ( P<0.05). The incidence of complications in the intervention group was lower, and family satisfaction was higher compared to the control group, with statistically significant differences ( P<0.05) . Conclusions:The staged trauma integrated treatment model based on an information network platform can optimize the emergency treatment process for severe cranial injury, shorten treatment times, improve hospital-to-hospital and interdepartmental coordination, reduce neurological damage and complication rates, and increase family satisfaction. It is worth promoting for clinical use.

Objective:To investigate the feasibility of a three-dimensional no new U-Net (3D nnU-Net) deep learning (DL) network for the automatic segmentation of colorectal cancer (CRC) based on abdominal CT images.Methods:This was a cross-sectional study. From January 2018 to May 2023, a total of 2180 primary CRC patients, confirmed by pathology at the Guangdong Provincial Hospital of Traditional Chinese Medicine (center 1, n=777), Nanfang Hospital, Southern Medical University (center 2, n=732), and Sun Yat-sen Memorial Hospital (center 3, n=671), were enrolled in this retrospective study. The baseline abdominal CT examination of each patient was conducted using CT equipment from 7 different models across 4 vendors, at the 3 centers, encompassing both the arterial phase (AP) and venous phase (VP). Two radiologists manually delineated the volume of interest to circumscribe the entire tumors in dual-enhanced phase CT images. The CT data of CRC patients from center 1 and center 3 were merged and divided into a training set ( n=1 159) and a validation set ( n=289) using a weighted random method with a ratio of 4∶1. The patients from center 2 were used as an independent external test set ( n=732). The 3D nnU-Net segmentation model was trained and tested. Using manually annotated label data as the benchmark, segmentation performance of the model was evaluated based on different phases and tumor locations. The segmentation coverage rate (SCR), Dice similarity coefficient (DSC), recall (REC), precision (PRE), F1-score, and 95% Hausdorff distance (HD 95) were calculated. The mean manual segmentation time and the mean automatic time were compared using independent samples t-test. Results:In the independent external test set, the performance of the 3D nnU-Net model based on the AP CT images was superior to that based on the VP CT images. On the AP images, the SCR, DSC, REC, PRE, F1-score, and HD 95 were 0.865, 0.714, 0.716, 0.736, 0.714, and 27.228, respectively; on the VP images, they were 0.834, 0.679, 0.710, 0.675, 0.679, and 29.358, respectively. The model achieved the best performance on right-sided colon cancer, with SCR, DSC, REC, PRE, F1-score, and HD95 on the AP CT images at 0.901, 0.775, 0.780, 0.787, 0.775, and 21.793, respectively. Next were left-sided colon cancer and rectal cancer, while the segmentation performance for transverse colon cancer was the worst (SCR, DSC, REC, PRE, F1-score, and HD 95 were 0.731, 0.631, 0.641, 0.630, 0.631 and 38.721, respectively). The automatic segmentation time on a single phase was (1.0±0.3) min, while the manual segmentation time was (17.5±6.0) min ( t=128.24, P<0.001). Conclusions:After training and validating on a dataset from multiple centers with various CT scanner vendors, the 3D nnU-Net DL model demonstrates the capability to automatically segment CRC based on abdominal CT images, while also showcasing commendable robustness and generalization ability.

Objective: To analyze the characteristics of influenza virus detection in an influenza outbreak in schools, so as to provide a strategic basis for the treatment of influenza outbreaks in schools. Methods: A total of 1 702 samples were collected from 52 school influenza outbreaks reported in Linyi City in 2021-2022. The samples were divided into 3 types according to different symptoms during the management of the epidemic [group A:influenzalike illness (ILI) group; group B:mild illness group; group C:close contacts group]. Rt-PCR was used to detect influenza virus nucleic acid in the collected samples. The detection rate of influenza virus in the outbreaks was analyzed by χ2 test. Results: In total, 1 071 samples (62.93%) tested positive for influenza virus nucleic acid. Among them, 610 out of 726 samples (84.02%) were detected in group A, while 331 out of 634 samples (52.21%) were detected in group B. In group C, 130 out of 342 samples (38.01%) tested positive. The differences were statistically significant (χ2=260.71, P<0.01). In group A, males had a detection rate of 80.83% for influenza virus nucleic acid, compared to 91.36% for females. For group B, the rates were 53.31% for males and 50.87% for females. In group C, males had a rate of 30.72%, while females had a rate of 43.92%. Statistical significance for gender differences was observed only in groups A and C (χ2=12.67, 6.25, P<0.05). According to the days of onset, the detection rates of influenza virus nucleic acid among patients with onset 0-6 days were 56.30%, 74.49%, 89.35%, 86.23%, 69.67%, 62.75%, 34.33%, respectively, and the difference was statistically significant (χ2=128.27, P<0.01). Conclusions Mild cases and close contacts are likely key factors contributing to the prolonged emergence of new cases within classrooms during school influenza outbreaks. The progression of influenza symptoms is related to the risk of transmission.

Objective:To investigate cognitive function changes and their influential factors in patients with ischemic stroke and leukoaraiosis.Methods:A total of 500 patients with ischemic stroke who received treatment in Yiwu Central Hospital from January 2018 to October 2019 were included in this study. They were divided into simple ischemic stroke group ( n = 200) and ischemic stroke complicated by leukoaraiosis group (combination group, n = 300). The infarct location and the degree of leukoaraiosis in the combination group were analyzed. An additional 150 volunteers who concurrently underwent the Cognitive Function Test in the same hospital were selected as controls. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Patients in the combination group were divided into cognitive impairment group (MoCA score ≥ 26 points) and non-cognitive impairment group (MoCA score < 26 points) according to MoCA score. The risk factors of cognitive impairment in patients with ischemic stroke and leukoaraiosis were analyzed. Results:The scores of the MMSE, MoCA, Clock Drawing Test (CDT), Verbal Fluency Test (VFT), and Digit Span Test (DST) in the control group were (28.93 ± 2.70) points, (28.35 ± 2.74) points, (4.69 ± 1.14) points, (4.94 ± 0.42) points, and (14.33 ± 1.66) points respectively. They were (26.92 ± 2.18) points, (25.02 ± 3.52) points, (3.61 ± 1.60) points, (4.77 ± 0.46) points, and (11.73 ± 1.16) points, respectively in the simple ischemic stroke group and (24.91 ± 2.79) points, (20.70 ± 3.06) points, (2.87 ± 1.23) points, (4.07 ± 0.85) points, and (10.82 ± 0.93) points respectively in the combination group. There were significant differences in the scores of the MMSE, MoCA, CDT, VFT, and DST among the three groups ( F = 124.50, 318.50, 93.43, 112.60, 428.60, all P < 0.001). Significant differences in the scores of the MMSE, MoCA, CDT, VFT, and DST were observed between patients with different degrees of leukoaraiosis ( F = 69.09, 102.40, 20.98, 60.90, 57.00, all P < 0.001). Spearman correlation analysis results showed that the scores of the MMSE, MoCA, CDT, VFT, and DST were negatively correlated with the degree of leukoaraiosis ( r = -0.61, -0.69, -0.43, -0.56, -0.44, all P < 0.05). Logistic regression analysis results showed that age, history of smoking and drinking, history of diabetes, history of stroke, and infarct location were the independent risk factors for cognitive impairment in patients with ischemic stroke and leukoaraiosis. Education level was a protective factor against ischemic stroke and leukoaraiosis. Conclusion:The degree of cognitive impairment in patients with ischemic stroke and leukoaraiosis is related to the degree of leukoaraiosis. Age, history of smoking and drinking, history of diabetes, history of stroke, infarction location, and education level are the influential factors of cognitive impairment.

Objective:To design a simple and reusable artificial airway cap to evaluate the application effect in establishing artificial airway of patients without mechanical ventilation.Methods:A total of 100 patients who were admitted to Yiwu Central Hospital from January 2018 to January 2019 to establish artificial airway without mechanical ventilation were selected as the research objects by convenient sampling. By the random number table method, they were divided into the control group and the observation group, with 50 cases in each group. The control group was given conventional airway management, that was intermittent intratracheal instillation while the observation group was given artificial airway caps for airway management. Airway comfort cases and complication cases, respiratory rate, blood oxygen saturation and respiratory tract infection were compared between the two groups.Results:After intervention, the number of patients with airway comfort in the observation group was larger than that in the control group and the number of cases of respiratory tract infection and foreign body inhalation was smaller than that in the control group, and the differences were statistically significant ( P<0.05) . The respiratory rate of the observation group was lower than that of the control group, and the blood oxygen saturation was higher than that of the control group, and the differences were statistically significant ( P<0.05) . The sputum dilution 1-4 level of the observation group was higher than that of the control group, and the frequency of sputum excretion was lower than that of the control group, and the differences between the two groups were statistically significant ( P<0.05) . Conclusions:The self-made simple and reusable artificial airway cap has better application safety and effectiveness in establishment of artificial airway in patients without mechanical ventilation. It is easy to operate, economical and practical and it can improve the comfort and nursing quality of airway management, which has good promotion value.

Objective To investigate the factors affecting the survival and prognosis of patients with stage Ⅲ～ Ⅳgastric cancers.Methods A total of 156 cases of Ⅲ ～ Ⅳ gastric cancer was studied retrospectively from September 1,2006 to December 31,2012.Kaplan-Meier analysis,Log-rank univariate analysis,Cox proportional hazards model analysis were used to analyze survival and prognostic factors.Results Twelve cases were lost,to the end of the follow-up,22 cases were alive.The median survival time was 29.3 months.1-year,3-year,and 5-year overall survival rates were 83.3％,37.8％,and 21.2％,respectively.Univariate analysis showed that tumor size,tumor node metastasis (TNM) staging,curative resection,hyperthermic intraperitoneal perfusion chemotherapy (HIPEC),and postoperative chemotherapy were correlated with prognosis (P ＜0.05 for all).Multivariate analysis showed that TNM staging,curative resection,HIPEC,and postoperative chemotherapy were independent prognostic factors (P ＜ 0.01 for all).Conclusions TNM staging,curative resection,hyperthermic intraperitoneal perfusion chemotherapy and postoperative chemotherapy are the independent factors affecting the prognosis of stage Ⅲ～ Ⅳ gastric cancer after resection.Hyperthermic intraperitoneal perfusion chemotherapy and postoperative chemotherapy can improve their survival.

Objective To investigate the methods and effectiveness of heterotopic reconstruetion of hepatic artery in orthotopic liver transplantation. Methods The methods of heterotopic hepatic artery reconstruction and postoperative management of 36 cases of recipient vascular anomalies among 440 cases of liver transplantation performed in our hospital over a ten year period,were retospectively analysed. Results In 10 of 36 recipients the donor hepatic artery was anastomosed to recipient infrarenal aorta ,10 to the suprarenal aorta ,4 to the left gastric artery and 2 to the splenic artery. Five patients died perioperatively with patency of hepatic artery, and 31 recipients have survived for 3 to 48 months without hepatic artery complications; 1 patient had to receive liver retransplantation because of ischemic necrosis of bile duct. Conclusions In cases of disease or anomaly of recipient hepatic artery during liver transplantation,the heterotopic reconstruction of donor hepatic artery to the infarenal or suprarenal aorta,splenic artery or left gastric artery of the reeipient is indicated,and the results are satisfactory.