Objective To observe the value of susceptibility weighted imaging(SWI)based on 5.0T MRI for diagnosing hepatocellular carcinoma(HCC)complicated with vein tumor thrombi.Methods Totally 63 HCC patients were retrospectively enrolled,among them 17 complicated with vein tumor thrombi.The efficacy of 5.0T SWI for detecting vein tumor thrombus was observed,and the image quality were compared between 5.0T and 3.0T.Results 5.0T SWI displayed vein tumor thrombi in 16 cases,except for 1 case with vein tumor thrombi in the upper segment of the left lateral lobe of the left portal vein.The liver edge score,overall image quality score,signal-to-noise ratio and contrast-to-noise ratio of portal venous phase and hepatobiliary phase in 5.0T enhanced MRI were all higher than those in 3.0T(all P＜0.05).Conclusion 5.0T SWI was helpful for diagnosing HCC complicated with vein tumor thrombi.

Objective:The study aimed to investigate the association between lesion location and post-stroke depression (PSD) in acute ischemic stroke patients.Methods:In this case-control study, acute ischemic stroke patients were recruited from the Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), between September 2020 and June 2021. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, the patients were divided into the PSD and non-PSD groups. The 24-item Hamilton Rating Scale (HAMD) was used to evaluate the severity of depression. The Student′s t-test, Mann-Whitney test, and Chi-square test were used to compare the clinical baseline characteristics of PSD and non-PSD groups. Voxel-based lesion-symptom mapping (VLSM) was applied to investigate the association between lesion location and depression occurrence and severity. Results:A total of 70 and 173 patients were admitted to the PSD and non-PSD groups, respectively. The mean age of patients was 59 years (23-86). There were 153 males and 90 females. Univariate analysis showed a significant difference only in Hamilton Anxiety ( P=0.025) and Depression ( P<0.001) scores between the PSD and non-PSD groups. VLSM analysis identified clusters within the anterior cingulate gyrus ( Z=-3.05, P<0.001), left hippocampus ( Z=-3.15, P<0.001), and left lingual lobe ( Z=-3.08, P<0.001) where lesions were significantly associated with PSD. Additionally, the severity of PSD was associated with damage in the anterior cingulate gyrus ( Z=-3.64, P<0.001), left hippocampus ( Z=-3.51, P<0.001), left lingual lobe ( Z=-4.18, P<0.001), and pericalcarine cortex ( Z=-3.65, P<0.001). Conclusion:VLSM demonstrated that lesion location could be used to predict the occurrence of PSD in patients with acute ischemic stroke.

This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015-2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ⩾15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%xnosocomial infection management + 17.97%xcompliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.
Humans ; China/epidemiology* ; Cross Infection/epidemiology* ; Intensive Care Units/statistics & numerical data* ; Quality Control ; Quality Indicators, Health Care/statistics & numerical data* ; Sepsis/therapy* ; East Asian People/statistics & numerical data*

Objective:To explore the clinical effect of the modified double wing flap combined with medial plantar skin graft in the treatment of congenital syndactyly.Methods:The data of children with congenital syndactyly treated by modified double wing flap combined with medial plantar skin graft in the Department of Pediatric Orthopaedics of Xuzhou Renci Hospital from January 2019 to February 2022 were retrospectively analyzed. All of them had skin deficiency after separating syndactyly during the operation. The medial plantar was selected as the skin graft donor area. The patients were followed up through WeChat and outpatient review after operations, the contents include the shape of finger web, the shape of finger, the degree of scar contracture in the skin graft area and the medial plantar skin donor area, and the appearance of finger web was evaluated by the modified Withey correction score, and investigate the satisfaction of parents of the children.Results:A total of 10 children were included, including 5 males and 5 females, aged 1 year and 6 months to 4 years, with an average age of 2 years and 10 months. There were 8 cases of middle ring finger syndactyly, 1 case of ring little finger syndactyly, and 1 case of index middle finger syndactyly. After separating syndactyly, the skin defect area is about 1.0 cm×1.5 cm-1.5 cm×3.0 cm, and a medial plantar full-thickness skin graft with the same area is taken. The postoperative follow-up was 6-18 months, with an average of 11.3 months. All the flaps and grafts survived, and the wounds healed in primary stage. The depth, width and slope of the finger web were normal, there was no color difference between the skin graft and the surrounding skin, and the appearance of the finger was beautiful. The scar in the skin graft area and the medial plantar skin donor area was not obvious. The modified Withey correction score was 0-1, with an average of 0.1. The parents were all satisfied.Conclusion:The texture of the medial plantar skin is similar to that of the hand. After the treatment of congenital syndactyly with the modified double wing flap combined with the medial plantar skin graft, the shape of the finger web is normal, the shape of the hand is beautiful, the scar is not obvious, and the medial plantar skin donor area is hidden, which does not affect walking. After the operation, good function and shape can be obtained. It is one of the effective method to treat congenital syndactyly with insufficient skin.

Objective : To analyze the data related to the clinical outcome of preimplantation genetic testing (PGT) for double frozen , double biopsied blastocysts and double frozen , once biopsied blastocysts , in order to expand the existing data and provide some guidance for the clinical value and safety of PGT for frozen⁃thawed embryos . Methods : Retrospective analysis was made on the 38 PGT cycles of frozen⁃thawed blastocysts . According to the frequency of biopsy , cases in the study were divided into two groups : double frozen , double biopsy ( DFDB) group and double frozen , single biopsy ( DFSB) group . The freezing method was vitrification . Results : There were 24 patients in DFDB group , 34 blastocysts were not diagnosed in the last PGT cycle , 32 blastocysts survived after thawing , and the survival rate of thawed blastocysts was 94. 12% . After the second biopsy of these 32 blastocysts , genetic testing was performed , and all of them were definitely diagnosed , including 15 normal blastocysts (46. 88% ) and 17 abnormal blastocysts (53 . 13% ) . There were 14 patients in DFSB . The remaining 50 blastocysts in the last ICSI cycle were thawed and all blastocysts survived after thawing . Biopsy of these 50 blastocysts and genetic analysis showed that 47 blastocysts were diagnosed , including 9 normal blastocysts (18 . 00% ) , 28 abnormal blastocysts (56. 00% ) , 10 mosaic blastocysts (20. 00% ) , and 3 undiagnosed blastocysts (6. 00% ) . In DFDB group and DFSB group , 8 patients and 5 patients transferred the normal blastocystswhich all survivedafter thawing . There were 5 clinical pregnancies and 3 clinical pregnancies , respectively . One healthy live birth was obtained respectively in each group . Conclusion Acceptable pregnancy rate can be obtained whatever DFSB or DFDB blastocyst , which is of clinical value . However , due to the small sample size , we need to expand the sample size to further explore its safety .

Objective:To explore the clinical effect of the modified double wing flap combined with medial plantar skin graft in the treatment of congenital syndactyly.Methods:The data of children with congenital syndactyly treated by modified double wing flap combined with medial plantar skin graft in the Department of Pediatric Orthopaedics of Xuzhou Renci Hospital from January 2019 to February 2022 were retrospectively analyzed. All of them had skin deficiency after separating syndactyly during the operation. The medial plantar was selected as the skin graft donor area. The patients were followed up through WeChat and outpatient review after operations, the contents include the shape of finger web, the shape of finger, the degree of scar contracture in the skin graft area and the medial plantar skin donor area, and the appearance of finger web was evaluated by the modified Withey correction score, and investigate the satisfaction of parents of the children.Results:A total of 10 children were included, including 5 males and 5 females, aged 1 year and 6 months to 4 years, with an average age of 2 years and 10 months. There were 8 cases of middle ring finger syndactyly, 1 case of ring little finger syndactyly, and 1 case of index middle finger syndactyly. After separating syndactyly, the skin defect area is about 1.0 cm×1.5 cm-1.5 cm×3.0 cm, and a medial plantar full-thickness skin graft with the same area is taken. The postoperative follow-up was 6-18 months, with an average of 11.3 months. All the flaps and grafts survived, and the wounds healed in primary stage. The depth, width and slope of the finger web were normal, there was no color difference between the skin graft and the surrounding skin, and the appearance of the finger was beautiful. The scar in the skin graft area and the medial plantar skin donor area was not obvious. The modified Withey correction score was 0-1, with an average of 0.1. The parents were all satisfied.Conclusion:The texture of the medial plantar skin is similar to that of the hand. After the treatment of congenital syndactyly with the modified double wing flap combined with the medial plantar skin graft, the shape of the finger web is normal, the shape of the hand is beautiful, the scar is not obvious, and the medial plantar skin donor area is hidden, which does not affect walking. After the operation, good function and shape can be obtained. It is one of the effective method to treat congenital syndactyly with insufficient skin.

Critical ultrasonography is widely used in ICU and has become an indispensable tool for clinicians. However, besides operator-dependency of critical ultrasonography, lack of standardized training mainly result in the physicians′ heterogenous ultrasonic skill. Therefore, standardized training as well as strict quality control plays the key role in the development of critical ultrasonography. We present this quality control standards to promote better development of critical ultrasonography.

To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.

Transesophageal echocardiography(TEE) is valuable in intensive care unit (ICU) because its application meets the requirements of diagnosis and treatment of critically ill patients.However, the current application has not fully adapted to the specialty of critical care. TEE could be more valuablein ICU when used with a new way that under the guidance of the theory of critical care and embedded into the treatment workflow. We have expanded and improved the application of traditional TEE and integrated the concept of critical care, established the concept of transesophageal echocardiography for critical care (TEECC). Chinese Critical Ultrasound Study Group (CCUSG) organized experts in the area to form the consensus based the previous studiesand the long term practice of critical care ultrasound and TEE, aiming at clarifying the nature and characteristics of TEECC, promoting the rational and standardized clinical application and the coming researches.The consensus of Chinese experts on clinical application of TEECC (2019) were 33 in total, of whichthe main items were as follows: (1) TEECC is a significant means, which is expanded and improved from the traditional transesophageal echocardiography according to characteristics of critically ill patients and is applied in ICU based on critically clinical scenarios and requirements by the critical care physician, to promote visualized, refined and precisely management of critically ill patients.(2) TEE possesses distinctive superiority in implementation in ICU. It has characteristics of images with good quality, operations with good stability and low-dependent of operators, monitoring with continuity, and visualization with all-dimensional and detail of heart and blood vessels.(3)As a means of refined monitoring that could resulted in precise diagnosis and treatment, TEECC expands the dimension of intensive monitoring and improves the performance of critical care. (4) Indications of TEECC application include clinical etiological searching and invasive procedures guiding when it acted as a traditional role; and also refined hemodynamic monitoring based on critical care rationale and over-all management under specific critical clinical scenarios. (5) TEE and TTE assessments are complementary; they are not alternative. Integrated assessment of TTE and TEE is required under many critical clinical scenarios.(6) TEE should be a necessary configuration in ICU. (7) All-round and significant information regarding to the mechanism of acute circulatory disorders can be provided by TEECC; it is a non-substitutable means of identifying the causes of shock under some special clinical scenarios. (8) Focal extracardiac hematoma can be accurately and rapidly detected by TEE in patients with open-thoracic cardiac surgery or severe chest trauma when highly suspected pericardial tamponade.(9) The priority of pathophysiologic mechanism of septic shock can be rapidly and accurately identified by TEE; even if its pathophysiological changes are complex, including hypovolemia and/or vasospasm and/or left and right heart dysfunction. (10) Causes of hemodynamic disorders can be rapidly and qualitatively evaluated so that the orientation of treatment can be clarified by TEECC. (11) A full range of quantitative indicators for refined hemodynamic management in critically ill patients can be provided by TEECC. (12) TEECC helps to accurately assess volume status and predict fluid responsiveness.(13) TEECC is specially suitable for accurate quantitative assessment of cardiac function.(14) Mini TEE provides long-term continuous hemodynamic monitoring. (15) Standard views are easy to be acquired by TEECC, which is a premise for accurate and repeatable measurements, and a guarantee for assessment of effect and risk of therapy. (16) Compared with invasive hemodynamic monitoring, TEECC is minimally invasive, with low infection risk and high safety.(17) In patients with acute cor pulmonale (ACP) under condition of right ventricular dysfunction and low cardiac output, TEECC is a key tool for assessment. (18) TEECC should be implemented actively when suspicious of left to right shunt in critically ill patients who occurred hypotension that hard to explain the cause. (19) TEECC should be implemented actively when suspicious of right to left shunt in critically ill patients who occurred hypoxemia that hard to explain the cause. (20) TEECC is preferred in hemodynamics monitoring under prone position of ventilated patients.(21) TEECC is an imperative means to achieve over-all management of extracorporeal membrane oxygenation (ECMO) therapy, especially for all-round hemodynamic monitoring. (22) Three basic views is recommended to be used to simplify TEE assessment during cardiac arrest so that reversible causes could be identified, and resuscitation could be guided. (23) The flow related echodynamic evaluation (TEECC-FREE) workflow is preferred in refined hemodynamics monitoring and therapy. (24) Simple workflow of TEECC could be implemented in special critical clinical scenarios. (25) Application of TEECC is highly secure; however, impairments of procedure should also be alert by operators. (26) Pitfalls in application of TEE should be paid attention to by the critical care physician. (27) Timely and rationally application of TEECC is in favor of diagnosis and treatment of critically ill patients and may improve the prognosis.

Objective To explore the direction value of endovascular pressure differences in endovascular management of subclavian steal syndrome (SSS).Methods Eleven SSS patients accepted endovascular management,admitted to our hospital from January 2016 to December 2017,were collected in this study.Before and after operation,pressure-sensing wire was used to measure endovascular pressure differences (mean distal stenosis pressure minus mean proximal pressure),digital substraction angiography (DSA) was used to assess the stenotic rate,transcranial doppler (TCD) was used to assess the steal degrees,and electronic sphygmomanometer was used to measure the systolic pressure differences between bilateral brachial arteries.The pressure differences before and after endovascular management were compared.Before operation,the relations of pressure differences with stenotic rate,steal degrees and systolic pressure differences between bilateral brachial arteries were analyzed.After operation,the relations of pressure differences with stealing and clinical symptom improvements were analyzed.The predictive values of pressure differences and residual stenosis in clinic success were compared.Results (1) After operation,the blood stealing disappeared and the clinical symptoms improved in 10 patients;although residual stenotic rate of one patient decreased obviously,blood stealing and clinical symptoms still existed after operation;the clinic success rate was 90.9％(10/11).(2) Pressure differences before surgery ([11.2±5.7] mmHg) were significantly higher as compared with those after the surgery ([2.5±5.3] mmHg,P＜0.05).(3) Before operation,pressure differences were significantly correlated with stenotic rate (r=0.757,P=0.007) and bilateral systolic pressure differences (r=0.701,P=0.016).Six patients had pressure differences of 6-9 mmHg,enjoying degree I and Ⅱ of stealing,and 5 patients had pressure differences ≥ 10 mmHg,enjoying degree Ⅲ of stealing.(4) After operation,pressure difference was 18 mmHg in one patient without clinic success,but pressure differences were ≤ 3 mmHg in 10 patients with clinic success.(5) Significant difference was noted between the two clinic success indexes (residual stenotic rate ≤ 30％ by DSA and pressure differences ≤ 3 mmHg,P＜0.05).Conclusion Endovascular pressure differences can reflect the hemodynamic changes before and after endovascular management;as compared with residual stenosis,it is better to predict the clinic success after operation;it is useful to guide the endovascular management in the SSS patients.