Objective To explore the effects of three different patient-controlled analgesia protocols on sedation and analgesia in patients undergoing thoracoscopic surgery for lung cancer.Methods Ninety-three patients undergoing thoracoscopic surgery for lung cancer in our hospital from November 2022 to April 2023 were selected,and randomly assigned into three groups according to different postoperative analgesic protocols.Group P(n=30)was given patient-controlled intravenous analgesia,group T(n=31)received patient-controlled intravenous analgesia combined with thoracic paravertebral block,while group S(n=32)received patient-controlled intravenous analgesia combined with serratus intercostal plane block.Then the Visual Analogue Scale(VAS)score,Ramsay sedation scores,the press times of analgesic pump,the use of sedative drugs and adverse effects were compared among all three groups,and the sensory block plane,performance time,onset time and duration of the block were compared between group T and S.Results VAS scores in the resting state at postoperative 2 h,24 h and 48 h were(3.09±0.69),(2.83±0.59)and(2.07±0.51)in group P,which were higher than group T[(1.22±0.33),(2.51±0.54)and(1.57±0.45)]and group S[(1.01±0.30),(2.23±0.51)and(1.22±0.25)],group T was higher than group S.VAS scores in the coughing state at postoperative 2 h,24 h and 48 h were(3.63±0.55),(3.24±0.67)and(2.61±0.51)in group P,which were higher than the group T[(1.45±0.29),(2.71±0.56)and(2.33±0.53)]and group S[(1.14±0.28),(2.40±0.57)and(2.03±0.52)],group T was higher than group S.VAS scores in the resting and coughing states at postoperative 2 h,24 h and 48 h yielded statistical difference among three groups(all P＜0.05).Ramsay sedation scores at postoperative 2 h,24 h and 48 h were(2.21±0.51),(2.34±0.56)and(2.31±0.55)in group P,(2.23±0.53),(2.35±0.55)and(2.33±0.54)in group T and(2.22±0.52),(2.36±0.57)and(2.32±0.55)in group S,with no statistical difference(all P＞0.05).The press times of analgesic pump at postoperative 24 h and 48 h were(10.18±2.42)and(14.51±3.20)in group P,which were higher than the group T[(3.32±0.79)and(6.84±1.62)]and group S[(1.17±0.28)and(2.63±0.62)],group T was higher than group S,with statistical difference(all P＜0.05).The additional dose of sufentanil and the total amount of sufentanil used in postoperative period were(8.05±1.99)μg and(71.53±6.91)μg in group P,which were more than the group T[(3.77±0.93)pg and(65.82±5.77)μg]and the group S[(2.23±0.55)μg and(47.54±4.56)μg],group T was higher than group S,with statistical difference(all P＜0.05).Group S had shorter performance time[(5.32±1.77)min]and longer block duration time[(12.51±2.14)h]than those of group T[(12.41±3.42)min and(10.31±2.01)h],with statistical difference(all P＜0.05).The incidence of adverse reactions was 6.25％in group S,which was lower than the group P(30.00％,P＜0.05),and no statistical difference was reported among three groups in the occurrence rate of comparisons(all P＞0.05).Conclusion The sedation effects of the three different patient-controlled analgesia protocols are comparable,but patient-controlled intravenous analgesia combined with serratus intercostal plane block provides better postoperative analgesia for patients undergoing thoracoscopic surgery for lung cancer,which has less analgesic pump presses and lower dose of postoperative analgesic drugs used,and fewer adverse effects.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To compare the clinical efficacy of robot-assisted versus fluoroscopy-assisted sacroiliac screw internal fixation for posterior pelvic ring fractures.Methods:China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Medical Journal Full-text Database, PubMed, Web of Science and ScienceDirect were searched for literature on robot-assisted versus fluoroscopy-assisted sacroiliac screw internal fixation for posterior pelvic ring fractures. The search time was from the establishment of each database to March 2023. Meta-analysis was performed on the included literature. The random-effects model was used when the heterogeneity between groups was large, and the fixed-effects model was used when the heterogeneity between groups was small.Results:A total of 15 studies were included in the meta-analysis, including 465 patients in the robot-assisted group and 396 patients in the fluoroscopy-assisted group. Meta-analysis showed that the number of fluoroscopies [ SMD=-3.12, 95% CI (-4.34, -1.89), P<0.001], the number of guide pin adjustments [ SMD=-3.75, 95% CI (-6.77, -0.72), P=0.015], intraoperative blood loss [ SMD=-0.83, 95% CI (-1.18, -0.49), P<0.001], and operative time [ SMD=-2.59, 95% CI (-4.11, -1.08), P<0.001] were smaller than those in the fluoroscopy-assisted group. The rate of excellent screw implantation [ OR=10.13, 95% CI (3.67,27.98), P<0.001] of the robot-assisted was larger than the fluoroscopy-assisted group. There was no significant difference in Majeed functional score [ SMD=0.28, 95% CI (-0.0003, 0.55), P=0.050] and fracture healing time [ SMD=-0.14, 95% CI (-0.46, 0.17), P=0.367] between the two groups. Conclusion:Robot-assisted percutaneous sacroiliac screw fixation for posterior pelvic ring fractures has the advantages of less fluoroscopy, less guide pin adjustment, less intraoperative blood loss, shorter operation time, and higher rate of excellent screw position. However, there is no difference in Majeed score and fracture healing time between robot-assisted percutaneous sacroiliac screw fixation and fluoroscopy-assisted percutaneous sacroiliac screw fixation.

Objective:To explore the clinical value of modified infrared thermal imaging assisted design of peroneal artery perforator propeller flap.Methods:From March 2019 to May 2021, tourniquet-reperfusion augmented thermal imaging method (TRATIM) was used to locate the perforating vessels in 14 patients for surgery or peroneal artery perforator propeller flap. The sensitivity, positive predictive value and detection time were calculated and compared with the perforating vessels located by color Doppler ultrasound(CDU), P<0.05 is statistially significant. Results:After operation, 13 flaps survived completely, but 1 flap with distal surface necrosis and healed after dressing change. Only one linear scar was left in 12 cases, and 2 cases healed well by skin grafts. Followed-up for 6-13 months, and showed that the colour and texture of the flaps were similar to the surrounding skin, without obvious swelling. The sensitivity of TRATIM and CDU in location of peral perforator vessels were 88.0% and 92.0%, respectively, and the positive predictive value was 93.6% and 95.8%, with no statistical difference between TRATIM and CDU( P>0.05). The time of positioning perforator was (3.71±0.80) min for TRATIM and(16.21±4.97) min for CDU, There was significant difference between TRATIM and CDU( P<0.01). Conclusion:With TRATIM, a surgeon can locate the peroneal perforator vessels simply, quickly and accurately, and help in design more accurate peroneal artery perforator propeller flap.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

Acute coronary syndrome is a group of clinical syndromes based on the pathological basis of complete or incomplete occlusion of coronary artery caused by the rupture or invasion of coronary atherosclerotic plaque. It is a serious type of coronary heart disease. Acute coronary syndrome is clinically characterized by an acute onset of action and rapid pathological changes. Its prognosis differs greatly among patients with different categories of acute coronary syndrome and patients with the same category of acute coronary syndrome. Therefore, it is particularly important to reasonably use the risk score for risk stratification in patients with acute coronary syndrome, and select the optimized clinical treatment strategy according to the risk stratification, so as to reduce complications, reduce mortality and improve prognosis. This paper reviews the application of risk score in acute coronary syndrome.

December 2019 witnessed the outbreak of COVID-19 in Wuhan and spread of the epidemic across the country. As a provincial designated hospital for critical patients, the First Affiliated Hospital of Zhejiang University responded rapidly since then by advocating the four-concentration principles, namely " concentrating patients, experts, resources and treatment" . In its rescue of critical patients, the hospital formulated comprehensive emergency plans, optimized hospital-wide resources, effectively arranged rescue spacing, established medical echelons, and implemented multi-disciplinary strategy. These efforts ensured efficient rescue and treatment, achieving a cure rate up to 98.7% of such patients, with no deaths.

Objective: To estimate the effective dose burden to the public in Suzhoui induced by medical exposure from computed tomography (CT) and digital radiography (DR). Methods: Twenty-seven hospitals were selected by stratified random sampling. The application information was colleted from picture archiving and communication system (PACS) and radiology information system (RIS). For DR, DAP was measured by the dose-area product meter in different body parts, then the effective dose values were calculated by the DAP. For CT, effective dose was estimated by measuring CT dose index weighted (CTDI_w) and scanning parameters in different parts of the body. The public dose burden caused by DR and CT medical exposure in Suzhou was estimated according to the scanning time and effective dose to each part. Results: The effective dose due to DR examination was abdomen AP 0.565 mSv, pelvis AP 0.280 mSv, skull LAT 0.016 mSv, skull AP 0.012 mSv, chest LAT 0.111 mSv, chest AP 0.060 mSv, thoracic spine LAT 0.100 mSv, thoracic spine AP 0.102 mSv, lumbar spine LAT 0.307 mSv and lumbar spine AP 0.152 mSv, respectively. The effective doses from CT scanning were 1.33 mSv for head, 5.75 mSv for thorax and 7.31 mSv for abdomen, respectively. The annual collective effective dose in Suzhou in 2017 from DR exposures and CT scans was 9 593.07 man·Sv, and the average annual effective dose was 0.898 mSv. Conclusions The contribution of CT medical radiation to the public dose is much greater than that of DR. Controlling the frequency of medical exposure and single scan dose is an effective way to reduce the public dose burden. The public dose burden from DR and CT medical exposure in Suzhou is at a high level and attention needs to be paid by relevant health administrative departments.

Objective To investigate the clinical efficacy of pemetrexed alone or combined with gefitinib in treatment of advanced non-small cell lung cancer (NSCLC) after epidermal growth factor receptortyrosine kinase inhibitor (EGFR-TKI) drug resistance.Methods The clinical data of 80 patients with advanced NSCLC after EGFR-TKI drug resistance from August 2014 to April 2018 were retrospectively analyzed.They were divided into two groups according to their treatment regimens:40 patients received pemetrexed alone (the control group) and 40 patients received pemetrexed combined with gefitinib (the observation group).The recent clinical efficacy,adverse reactions and the survival time of both groups were compared.The count data was compared by using x2 test or Fisher exact test.Kaplan-Meier method was used to make survival analysis and log-rank method was used to detect.Results The total effective rate of the observation group was higher than that of the control group [70.0％ (28/40) vs.32.5％ (13/40),x2 =11.257,P =0.001].There was no statistical difference in the adverse reactions [17.5％ (7/40) vs.20.0％ (8/40),x2 =0.082,P =0.775].The median progression-free survival time and median overall survival time of the observation group were longer than those of the control group (6.5 months vs.3.5 months,15.5 months vs.8.5 months,all P ＜ 0.01).Conclusion Pemetrexed combined with gefitinib has a recent favorable effect in advanced NSCLC after EGFR-TKI drug resistance,including low incidence of adverse reactions and prolonged survival time,which is worthy of further application.

Objective To discuss the microsurgical anatomy of carotid bifurcation and external branch of the superior laryngeal nerve (EBSLN),and to explore the operative techniques in carotid endarterectomy.Methods The carotid bifurcation (20 sides) of 10 cadaveric heads was studied by using microanatomy from January 2017 to January 2018.The distance between bifurcation of carotid artery to peripheral bone structure,and the distances between point of EBSLN to medial margin of the carotid artery to mandibular angle,most prominent point of the larynx,apex of the mastoid,and bifurcation of carotid artery were measured.Results (1) The vertical distance from carotid bifurcation to larynx point and mandibular angle was 24.32 (18.8-35.78) mm and 13.55 (9.26-19.60) mm.The straight distance from carotid bifurcation to mastoid tip was 68.59 (49.48-76.94) ram.According to the vertical distance of larynx point to carotid bifurcation,the height of bifurcation of the carotid artery was consistent with the results of wain measurement (K=0.90),and the difference was statistically significant (P＜0.05).(2) The distances between the point of EBSLN to medial margin of the carotid artery to carotid artery bifurcation,upper thyroid artery bifurcation,mandibular angle and mastoid process were 17.81 (15.24-25.58) mm,19.42 (17.08-29.12) mm,20.51 (17.98-22.20) mm,71.00 (69.00-74.50) mm in normal bifurcations.Those in the high bifurcation specimens were 6.40 (2.44-9.20) mm,8.84(4.74-10.88) mm,12.15(10.64-13.54),60.90 (59.80-66.50) mm,respectively.Conclusions The position of the laryngeal prominence is fixed,which can be used as a marker for surgical incision.When the vertical distance from the larynx point to the bifurcation of the carotid artery is greater than or equal to 2.5 cm,it is highly bifurcated;the bifurcation is normal when less than 2.5 cm.In patients with normal carotid bifurcation,1.5 cm of the carotid artery bifurcation can be used as a safety mark limit during the operation.For patients with high carotid artery,the EBSLN is almost parallel to or down the superior thyroid artery,and it should be closely attached to the bifurcation of the carotid artery and the outer membrane of the superior thyroid artery,and there is no safety margin.