During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective:To investigate the correlation between the SUV index (SUV max of the lesion/SUV mean of the liver) in 18F-FDG PET/CT imaging and the invasiveness of early lung adenocarcinoma presenting as ground-glass nodule (GGN). Methods:From January 2012 to March 2020, 167 GGN patients (49 males, 118 females; age: (61.5±9.0) years) with early lung adenocarcinoma who underwent PET/CT imaging in Changzhou First People′s Hospital were retrospectively enrolled. The image parameters including the GGN number, location, type, edge, shape, abnormal bronchus sign, vacuole sign, pleural depression, vessel convergence sign, GGN diameter ( DGGN), solid component diameter ( Dsolid), consolidation to tumor ratio (CTR, Dsolid/ DGGN), CT values (CT value of ground-glass opacity (CT GGO), CT value of lung parenchyma (CT LP), ΔCT GGO-LP (CT GGO-CT LP)) and SUV index were analyzed. Single and multivariate logistic regressions were used to analyze the correlation between SUV index and infiltration. The generalized additive model was used for curve fitting, and the piece-wise regression model was used to further explain the nonlinearity. Results:In 189 GGNs, invasive adenocarcinoma accounted for 85.2% (161/189). Single logistic regression showed that the GGN number, type, shape, edge, abnormal bronchus sign, pleural depression, vessel convergence sign, DGGN, Dsolid, CTR, CT GGO, ΔCT GGO-LP and SUV index were related factors of infiltration (odds ratio ( OR) values: 0.396-224.083, P<0.001 or P<0.05). After fully adjusting for confounding factors, SUV index was significantly correlated with increased risk of invasion ( OR=2.162 (95% CI: 1.191-3.923), P=0.011). Curve fitting showed that the SUV index was non-linearly related to the risk of infiltration, and the risk of infiltration increased significantly only when the SUV index was greater than 0.43 ( OR=3.509 (95% CI: 1.429-8.620), P=0.006). The correlation between SUV index and infiltration had no interaction between age, vacuoles, pleural depression and CTR subgroups (all P>0.05). Conclusions:SUV index is an independent factor related to the invasiveness of early lung adenocarcinoma. The higher the SUV index, the greater the risk of invasion; but the two are not simply linearly correlated.

Objective:To investigate the predictive value of 18F-fluorodeoxyglucose (FDG) PET/CT metabolic parameters for occult lymph node metastasis (OLM) in non-small cell lung cancer (NSCLC). Methods:A total of 183 patients (72 males, 111 females; age (61.5±8.4) years) who underwent 18F-FDG PET/CT and preoperatively diagnosed with clinical N0 stage (cN0) in Third Affiliated Hospital of Soochow University from January 2013 to December 2018 were retrospectively enrolled. All patients underwent anatomical pulmonary resection with systematic lymph node dissections within 3 weeks after 18F-FDG PET/CT examinations. According to the presence or absence of lymph node metastasis, patients were divided into OLM positive (OLM+ ) group and OLM negative (OLM-) group. Parameters of primary lesions, such as the maximum diameter (D max), tumor sites, morphological features, maximum standardized uptake value (SUV max), mean standardized uptake value (SUV mean), metabolic total volume (MTV), total lesion glycolysis (TLG), tumor SUV max to liver SUV mean (TLR max), tumor TLG to liver SUV mean (TLR TLG) were analyzed. Mann-Whitney U test and χ2 test were used to compare the parameters between groups. Multivariable logistic regression was used to analyze the independent risk factors for OLM. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of different parameters. Results:Among 183 patients, 25 (13.7%, 25/183) of them were diagnosed as OLM. In OLM+ group, 46 lymph nodes were pathologically positive for metastasis, including 15 N1 disease and 31 N2 disease. D max (2.9(2.3, 3.7) vs 2.3(1.7, 2.8) cm), lobulation ((76.0%(19/25) vs 37.3%(59/158)), SUV max (11.1(7.9, 17.7) vs 4.7(2.3, 9.2)), TLG (41.5(10.2, 91.1) vs 15.6(6.5, 23.8) ml), TLR max (4.7(3.5, 7.6) vs 2.1(0.9, 4.0)) and TLR TLG (18.1(5.0, 44.3) vs 6.1(3.0, 11.4) ml) of the primary lesions in OLM+ group were significantly higher than those in OLM-group ( z values: from -4.709 to -3.247, χ2=13.190, all P<0.05). Multivariable logistic regression analysis showed that TLR max (odds ratio ( OR)=15.145, 95% CI: 3.381-67.830, P<0.001) and D max ( OR=3.220, 95% CI: 1.192-8.701, P=0.021) were independent risk factors for OLM. TLR max yielded the highest area under curve (AUC; AUC=0.794) with the threshold of 3.12, and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value for predicting OLM were 92.0%(23/25), 63.3%(100/158), 67.2%(123/183), 28.4%(23/81) and 98.0%(100/102), respectively. Conclusions:TLR max of tumor is the independent risk factor for OLM in NSCLC patients. TLR max can sensitively predict OLM preoperatively in patients with NSCLC.

Objective: To explore the reliability and validity of the Chinese Pediatric Quality of Life Inventory（PedsQL）in influenza children. Methods: From January 2017 to February 2018,we selected laboratory-diagnosed influenza cases and healthy children according to age and gender ratio by stratified random sampling and systematic sampling method. We employed Chinese version of PedsQL 4.0 to investigate their quality of life,used Cronbach's α to evaluate the reliability,and used Pearson correlation coefficient, t-test,confirmatory factor analysis（CFA）and ROC curve to evaluate the validity. Results: Totally 300 influenza cases and 300 healthy children were surveyed,with 294（98.00%）and 295（98.33%）valid questionnaires recovered. The general Cronbach's α was 0.89,and the Cronbach's α of each dimension ranged from 0.79 to 0.84. The Pearson correlation coefficients between the items and their belonged dimension ranged from 0.537 to 0.755,between the items and other dimension ranged from 0.203 to 0.384. The CFA resulted in RMSEA of 0.06,GFI of 0.88,AGFI of 0.90,CFI of 0.91 and NFI of 0.89. The scores in total and in all the dimensions in influenza cases were significantly different with those in healthy children（P<0.05）. Taking the scores in influenza cases as a golden standard,the area under the ROC curve was 0. 985（P<0.05）,the sensitivity was 0.92,and the specificity was 0.95. When the limit score was 82.18,the Youden index was the largest. Conclusion The Chinese version of PedsQL4.0 has good reliability and validity, which can be applied to quality of life assessment in children.

Objective:To evaluate the safety and immune effect of recombinant hepatitis B vaccine （CpG ODN adjuvant).Methods:On Oct. 26, 2016, we launched volunteer recruitment in Kaihua county, Quzhou city, Zhejiang Province. In the randomized, double-blind, controlled trial, a total of 48 subjects with negative HBV screening tests and normal hepatorenal function among 18 and 60 years old were selected and divided into two groups randomly, 24 cases each. The experimental group was given 250 μg of CpG ODN recombinant （Hansenula polymorpha) Hepatitis B vaccine and the control group was given 10 μg of commercial Hepatitis B vaccine with timed at 0, 1and 6 months. The inoculation reactions were compared the difference between the two groups after observed and recorded in time periods. We also collected serum before and after immunization to compare the two groups of anti-HBs positive rate, geometric mean concentration（GMC).Results:During the study period, the incidence of adverse events was 66.67%（16/24) in the experimental group and 54.17%（13/24) in the control group, with no significant difference（ P=0.556). The severities of adverse events were level 1 or level 2, and no level 3 or above adverse reactions occurred. After full-course immunization, in the FAS data set, the anti-HBs GMC in the experimental group [2 598.56（1 127.90-5 986.90) mIU/ml] was higher than that in the control group[371.97（164.54-840.91) mIU/ml] In the PPS set, the GMC of test group was 7 808.21（3 377.00-18 052.00) mIU/ml, which was higher than that of the control group [843.22（213.80-3 325.90) mIU/ml]. The anti-HBs positive rate of FAS（PPS) was 95.83%（100.00%) in the experimental group and the control group; The anti-HBs strongly positive rate of FAS（PPS) was 79.17%（90.00%) in the experimental group and 33.33%（50.00%) in the control group, with statistically significant differences among the FAS set（ P=0.003) and no statistically significance differences among the PPS set（ P=0.074). Conclusion:CpG Hepatitis B Vaccine is safe and shows better immunogenicity than the control vaccine.

Objective:To evaluate the safety and immune effect of recombinant hepatitis B vaccine （CpG ODN adjuvant).Methods:On Oct. 26, 2016, we launched volunteer recruitment in Kaihua county, Quzhou city, Zhejiang Province. In the randomized, double-blind, controlled trial, a total of 48 subjects with negative HBV screening tests and normal hepatorenal function among 18 and 60 years old were selected and divided into two groups randomly, 24 cases each. The experimental group was given 250 μg of CpG ODN recombinant （Hansenula polymorpha) Hepatitis B vaccine and the control group was given 10 μg of commercial Hepatitis B vaccine with timed at 0, 1and 6 months. The inoculation reactions were compared the difference between the two groups after observed and recorded in time periods. We also collected serum before and after immunization to compare the two groups of anti-HBs positive rate, geometric mean concentration（GMC).Results:During the study period, the incidence of adverse events was 66.67%（16/24) in the experimental group and 54.17%（13/24) in the control group, with no significant difference（ P=0.556). The severities of adverse events were level 1 or level 2, and no level 3 or above adverse reactions occurred. After full-course immunization, in the FAS data set, the anti-HBs GMC in the experimental group [2 598.56（1 127.90-5 986.90) mIU/ml] was higher than that in the control group[371.97（164.54-840.91) mIU/ml] In the PPS set, the GMC of test group was 7 808.21（3 377.00-18 052.00) mIU/ml, which was higher than that of the control group [843.22（213.80-3 325.90) mIU/ml]. The anti-HBs positive rate of FAS（PPS) was 95.83%（100.00%) in the experimental group and the control group; The anti-HBs strongly positive rate of FAS（PPS) was 79.17%（90.00%) in the experimental group and 33.33%（50.00%) in the control group, with statistically significant differences among the FAS set（ P=0.003) and no statistically significance differences among the PPS set（ P=0.074). Conclusion:CpG Hepatitis B Vaccine is safe and shows better immunogenicity than the control vaccine.

Objective To investigate the predictive value of preoperative viable myocardium and postoperative left ventricular mechanical dyssynchrony (LVMD) for adverse cardiovascular events(ACE) after coronary artery bypass graft (CABG) in patients with coronary artery disease (CAD) using myocardial perfusion imaging (MPI).Methods From September 2012 to March 2016,49 patients (44 males,5 females,average age:(64±8) years) with CAD were prospectively recruited.All patients underwent 99Tcmmethoxyisobutylisonitrile (MIBI) SPECT gated MPI (GMPI) and 18F-fluorodeoxyglucose (FDG) PET myocardial metabolic imaging to assess myocardial viability preoperatively.GMPI was repeated 4-6 months after CABG to record postoperative LVMD.Phase analysis was used to measure bandwidth (BW) and standard deviation (SD).Regular follow-up was performed,and ACE were taken as the end point.Cox proportional hazard model,Kaplan-Meier method and log-rank test were used to analyze the data.Results The mean duration of follow-up was (3.82±0.80) years,and ACE were present after CABG in 17 CAD patients (34.7％,17/49).Cox multi-analysis revealed that the number of preoperative viable segments (hazard ratio (HR)=0.208,95％ CI:0.068-0.642) and postoperative BW (HR=1.245,95％ CI:1.099-1.411)were independent influencing factors of ACE in CAD patients after CABG (both P＜0.01).Kaplan-Meier survival analysis showed that the incidence of ACE in patients with ＜ 3 viable segments was significantly higher than those with ≥ 3 viable segments (57.1％ (12/21) vs 17.9％ (5/28);x2 =21.023,P＜0.01).The incidence of ACE was significantly higher in the postoperative BW≥98° group than that in the postoperative BW＜98° group (14/19 vs 10％ (3/30);x2 =38.395,P＜0.01).Conclusions Less preoperative viable segments and severe postoperative LVMD are independent risk factors of ACE after CABG in CAD patients.Postoperative LVMD in CAD patients undergoing CABG may have important clinical value in the riskrestratification and prognosis evaluation.

Objective To assess left ventricular remodeling (LVRM) after acute myocardial in-farction (AMI) quantitatively by SPECT gated myocardial perfusion imaging (GMPI), and further explore its influencing factors. Methods Twelve Ba-Ma miniature swine were used to establish AMI model. GMPI was performed at the baseline (before AMI), 24 h, 1 and 4 weeks after AMI. Infarct expansion index, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction ( LVEF) and myocardial perfusion defect were measured. Meanwhile, creatine kinase isozyme MB (CK-MB) and hypersensitive cardiac troponin I (hs-cTn I) were detected. The changes of LVEDV and LVESV before and after AMI (ΔLVEDV and ΔLVESV) were calculated. Repeated measurement analy-sis of variance, the least significant difference t test and Pearson correlation analysis were performed. Re?sults Nine AMI swine were successfully created. LVRM was present 24 h after AMI. LVEDV and LVESV were significantly greater than those before AMI and aggravated within 1 week after AMI, then were down-wards at 4 weeks after AMI. Before AMI, 24 h, 1 and 4 weeks after AMI, the LVEDV was (34.44±7. 90), (47.56±22.66), (71.89±14.90) and (70.33±19.47) ml (F = 28.836, P<0.001), and the LVESV was (10.11±5.49), (25.33±11.62), (40.89±15.88) and (35.44±17.11) ml (F = 22.450, P<0. 001). In-farct expansion index increased progressively within 4 weeks after AMI (F= 16.054, P<0.001). LVEF was significantly lower after AMI than that before AMI (F = 18.267, P<0.001) and improved at 4 weeks after AMI compared to that at 1 week ((52.56±14.96)％ vs (45.11±15.80)％; t= 2.440, P<0. 05). There was a significant correlation between the change in perfusion defect and the ΔLVEDV or ΔLVESV (r values:0. 731 and 0.700, both P<0.05) at 1 week after AMI. In addition, hs-cTn I at 24 h was correlated withΔLVEDV at 24 h and 4 weeks after AMI, respectively (r values: 0.669 and 0.693, both P<0.05). Conclu?sions LVRM and cardiac dysfunction occur in the early period after AMI. LVRM and cardiac dysfunction are most severe at 1 week after AMI, and recover at 4 weeks after AMI, whereas infarct expansion is aggra-vated within 4 weeks. Infarct size and hs-cTn I are closely related to the degree of LVRM.

Objective: To analyze the imaging characteristics and diagnostic value of ¹⁸F-fluorodeoxyglucose (FDG) PET/CT in muscular inflammation in dermatomyositis (DM), as well as the relationship between maximum standardized uptake value (SUV_max) and activity of muscular inflammation. Methods: From July 2013 to November 2016, 17 hospitalized DM patients (8 males, 9 females, age range: 35-78 years) who underwent ¹⁸F-FDG PET/CT were retrospectively reviewed, including 13 typical DM (TDM) and 4 amyopathic DM (ADM). Seventeen healthy volunteers (8 males, 9 females, age range: 35-78 years) in the same period were enrolled as the control group. The proximal limb muscles of whole body were divided into 7 areas, and the SUV_max of each was measured and recorded. Two-sample t test, one-way analysis of variance, Dunnett-t test and Spearman correlation analysis were used to analyze data. Results: Five TDM cases showed diffuse increased FDG uptake in global muscles; 8 TDM cases showed increased FDG uptake in local muscles, mainly in the shoulder and hip. The FDG uptake by muscles of 4 ADM patients was similar with that of controls. The SUV_max was lower and lower in the order of shoulder and back muscles, hip muscles, thoracic vertebra muscles, cervical vertebra muscles, biceps, proximal quadriceps and lumbar vertebra muscles in DM group. The muscle SUV_max of DM, TDM, ADM and the controls were 1.92±0.86, 2.14±0.85, 1.19±0.44 and 0.93±0.26, respectively (F=69.50, P<0.001). Muscle SUV_max of DM group was higher than that of controls, muscle SUV_max of TDM was higher than that of ADM, and muscle SUV_max of ADM was higher than that of controls (t values: 4.102-11.970, all P<0.05). Muscle SUV_max of 9 DM patients with interstitial lung disease (ILD) was lower than that of patients without ILD (1.73±0.09 vs 2.13±0.13; t=5.857, P<0.001). Muscle SUV_max of DM was positive correlated with serum levels of creatine kinase (CK) and creatine kinase isoenzyme composed by M and B subunits (CK-MB) (r_s values: 0.814 and 0.751, both P<0.001). Conclusion ¹⁸F-FDG PET/CT is helpful to detect muscular inflammation of DM and it can reflect the activity and severity with SUV_max, and meanwhile evaluate the condition of ILD associated with DM.

Objective To investigate the characteristics of 18F-FDG PET/CT imaging in Takayasu arteritis (TA) and its clinical value.Methods Five male patients with TA in active phase (age range:65-82 years;mean age:(72.8±6.6) years) from November 2011 to August 2014 were retrospectively analyzed.All patients underwent 18F-FDG PET/CT imaging,and one of them who was in stable phase after one year's treatment underwent follow-up PET/CT imaging.The characteristics of the abnormal 18F-FDG uptake and SUVmax of lesions were analyzed.Another 5 age-and gender-matched patients with slightly elevated tumor markers and normal results of 18F-FDG PET/CT imaging in the same period were selected as the control group.Arteries were divided into 18 segments,including the ascending aorta,the aortic arch,the descending aorta,the abdominal aorta,the brachiocephalic trunk,the left/right common carotid,the left/right subclavian,the left/right brachial,the superior mesenteric,the left/right common iliac,the left/right renal,and the left/right femoral,and their SUVmax were measured respectively.Paired t test was used to analyze the difference of SUVmax between TA group and the control group.Results (1) 18 F-FDG PET/CT imaging displayed diffused increase of radioactivity in the wall of aorta and its major branches in TA group,and CT showed multiple irregular thickening,punctate and banding calcification in arterial walls of those patients.The ascending aorta,the aortic arch,the descending aorta,the abdominal aorta,the brachiocephalic trunk,the left/right subclavian,the left/right common carotid,and the left/right common iliac artery were all involved in 5 patients;the left/right brachial and the left/right femoral artery were involved in 4 patients and the superior mesenteric artery was involved in 2 cases.The SUVmax range was 1.4-7.6,the highest SUVmax was in the left subclavian artery (n=2),the right subclavian artery (n=1) and the abdominal aorta artery (n=2).(2)The SUVmax of TA group and the control group were 3.96±1.35 and 2.13±0.53,respectively(t=10.40,P＜0.001).(3) As to the TA patient in stable phase after treatment,the FDG uptake of the wall of aorta and its major branches decreased obviously compared with that before treatment.The SUVmax of left subclavian artery decreased from 6.8 to 3.2.Conclusions 18F-FDG PET/CT is helpful in diagnosis of TA.It could accurately display the range of involved arteries,reflect the activity of the lesion and evaluate the therapeutic response.