Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Objective:To quantitatively evaluate the risk of recurrence in patients with secondary hyperparathyroidism after parathyroidectomy. Methods:The clinical data of 168 patients who underwent parathyroidectomy（PTX） from June 2017 to May 2019 were collected. The prediction model was constructed by using Akaike information criterion（AIC） to screen factors. A total of 158 patients treated with PTX from June 2019 to September 2021 were included in the validation set to conduct external validation of the model in three aspects of differentiation, consistency and clinical utility. Results:The prediction model we constructed includes different dialysis methods, ectopic parathyroid gland, the iPTH level at one day and one month after surgery, the number of excisional parathyroid and postoperative blood phosphorus. The C index of external validation of this model is 0.992 and the P value of the Calibration curve is 0.886[KG0.5mm]1. The decision curve analysis also shows that the evaluation effect of this model is perfect. Conclusion:The prediction model constructed in this study is useful for individualized prediction of recurrence after PTX in patients with secondary hyperparathyroidism.
Humans ; Parathyroidectomy/methods* ; Parathyroid Hormone ; Retrospective Studies ; Hyperparathyroidism, Secondary/surgery* ; Parathyroid Glands ; Recurrence ; Calcium

Objective:To study the learning curve in laparoscopic left lateral hepatic sectionectomy.Methods:The clinical data of 62 consecutive patients who underwent left lateral hepatic sectionectomy by a single operator from February 2015 to May 2022 in General Hospital of Northern Theater Command were retrospectively analyzed. There were 22 males and 40 females, with mean ±s.d. of (50.7±11.7) years. The learning curve was depicted and evaluated by using the cumulative summation test. The general information, operation and postoperative indicators of the growth level group and the master level group were compared.Results:The average operation time of the 62 consecutive subjects was (172.9±70.1) minutes. Intraoperative blood loss was 100 (50, 200) ml. Two patients were converted to open hepatectomy. Clavien-Dindo grade I postoperative complications occurred in 20 patients (32.3%), with grade Ⅱ in 1 patient (1.6%) and grade Ⅲb in another patient (1.6%). The learning curve reached its highest point on the 20th patient by using the cumulative summation test. The study subjects were then assigned into the growth level group (patient 1-20) and the master level group (patient 21-62). The master level group had a significantly wider spread of patient age [(52.9±11.0) years vs (46.1±11.9) years], decreased operation time [(146.8±55.6) min vs (227.9±66.7) min], shortened drainage tube removal time [4(3, 5) d vs 6(4, 7) d] and decreased postoperative hospital stay [5(5, 7) d vs 6.5(4, 9) d] (all P<0.05) when compared with the growth level group. Conclusion:Left lateral hepatic sectionectomy was safe and feasible, and a single operator went through a learning curve of 20 patients before he/she could master the operation more proficiently.

Objective:To investigate the feasibility of classifying imaging patterns of dermatomyositis/polymyositis-related interstitial lung disease (DM/PM-ILD) into subtypes based on chest CT radiomics features and a model was constructed by machine learning algorithms.Methods:From November 2011 to November 2020, 107 patients diagnosed with PM/DM-ILD at the First Affiliated Hospital of Xi′an Jiaotong University were retrospectively analyzed. A total of 315 cases with chest CT were collected. Doctors pre-classified image patterns, including 105 cases with non-specific interstitial pneumonia (NSIP), 90 cases with organizing pneumonia (OP), and 66 cases with non-specific interstitial pneumonia combined with organizing pneumonia (NSIP+OP), 35 cases with common interstitial pneumonia (UIP), and 19 cases with diffuse alveolar damage (DAD), ANOVA was used to test the difference of baseline clinical information among the imaging classification groups. All images were divided into the training set and the est set by stratified random sampling at a ratio of 4∶1. In each CT scan, 3D slicer was used to segment each lung lobe, and then reconstructed into 3 mm 3 of voxels, and Pyradiomics library was used to extract the radiomic features of the whole lung and each lobe. The multi-classification goal was achieved by constructing random forest base classifiers for each of the five groups and then voting as the final model. In the process of constructing the base classifier, firstly, the balance between sample groups was achieved by SMOTETomek comprehensive sampling, and the optimal feature set was selected by independent sample t test and L1 regularized least absolute shrinkage and selection operator (LASSO) regression. In this study, the Radiomics model was constructed based on chest CT radiomics features, and the Radiomics + model was constructed by introducing gender and age information. The base classifier and the integration model use the mean accuracy and the area under the receiver operator characteristics analysis curve (AUC) to evaluate the performance, respectively. Results:There was a statistically significant difference ( P<0.05) between the ages of the NSIP, OP, NSIP+OP, UIP, and DAD groups [(57±13),(53±8),(54±10),(44±11), and (46±8)years old, respectively], F=11.82, P<0.001. In the Radiomics model, for each group of NSIP, OP, NSIP+OP, UIP, and DAD, the AUCs of the training set were 0.87, 0.91, 0.91, 0.96, and 0.99, respectively, and the AUC of the test set were 0.81, 0.82, 0.79, 0.93, 0.89. In the final Radiomics + model, for each group of NSIP, OP, NSIP+OP, UIP, and DAD, the AUCs of the training set were 0.89, 0.91, 0.92, 0.97, and 0.99, respectively, and the AUCs of the test set were 0.84, 0.82, 0.78, 0.94, 0.90. Conclusion:Based on chest CT radiomics features and key clinical features (sex, age), the Radiomics + model constructed by machine learning has good classification performance for the imaging patterns of PM/DM-LD.

Objective:To investigate the occurrence of carotid artery abnormalities in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients and the related risk factors affecting the occurrence of carotid artery abnormalities.Methods:A total of 169 regular follow-up outpatients with HIV/AIDS from April 2003 to December 2019 in Peking Union Medical College Hospital, whose carotid artery ultrasound examination were performed from July 2015 to December 2019 were included. The patients were divided into young (≤44 years old), middle-aged and elderly (≥45 years old) according to their ages, and the physical examination data of the included patients were collected.The statistical methods were logistic regression analysis and single sample t test. Results:Among the 169 HIV/AIDS patients, 40(23.7%) had abnormal carotid artery and 129(76.3%) had no abnormal carotid artery. Middle-aged and elderly people (odds ratio ( OR)=3.85, 95%confidence interval (95% CI) 1.54-9.65, P<0.01), hypertension ( OR=6.24, 95% CI 1.95-20.00, P<0.01), hyperlipidemia ( OR=2.44, 95% CI 1.00-5.93, P<0.05), and elevated human leucocyte antigen (HLA)-DR + CD8 + /CD8 + ( OR=1.03, 95% CI 1.01-1.06, P<0.05) were the risk factors for carotid artery abnormality. The common carotid artery inner medium film thickness (IMT) of patients in HIV/AIDS group Ⅰ (20 to 30 years old), group Ⅱ (31 to 40 years old), group Ⅲ (41 to 50 years old) were (0.061 0±0.001 2), (0.062 9±0.001 4) and (0.065 6±0.002 6) cm, respectively, which were thicker than the control groups ((0.051±0.003), (0.056±0.004) and (0.063±0.002) cm, respectively). The differences were all statistically significant ( t=5.119, 4.775 and 1.739, respectively, all P<0.05). The common carotid artery IMT of patients in HIV/AIDS group A (30 to 44 years old) and group B (45 to 59 years old) were (0.062 6±0.001 1) and (0.072 3±0.003 4) cm, respectively, which were thicker than the control groups ((0.052±0.011) and (0.064±0.015) cm, respectively), the differences were both statistically significant ( t=9.520 and 3.012, respectively, both P<0.01). Conclusion:Younger HIV-positive people have a higher probability of abnormal carotid arteries and may be at greater risk of cardiovascular disease than HIV-negative people of the same age, suggesting that HIV-positive people, especially young people, should be examined early with ultrasound of the neck arteries to detect abnormalities and intervene as soon as possible.

Objective:To investigate the possible molecular mechanism of high-risk human papillomavirus (HPV) 16 E6 protein in promoting the proliferation, invasion and migration of cervical cancer cells.Methods:C33A cells were infected with HPV E6 protein overexpression lentivirus to construct a stable C33A-E6 cell line. The expression of heat shock protein 70 (HSP70) was detected by qRT-PCR and Western blot. Degradation rates of HSP70 at mRNA and protein levels were detected by qRT-PCR and Western blot at different time points after actinomycin D (ActD) and actinomycin ketone (CHX) treatment. Exosomes were extracted by hypervelocity centrifugation and the concentrations of HSP70 in exosomes were detected by enzyme-linked immunosorbent assay (ELISA). The concentrations of TNF-α, IL-1β, IL-6 and IL-10 in the supernatants of THP-1 cell culture that treated with exosomes isolated from C33A and C33A-E6 cells after interfering HSP70 expression were detected by ELISA. C33A cells were co-cultured with exosome-treated THP-1 cells to evaluate the changes in cell proliferation with CCK-8 method. The invasion and migration of C33A cells were assessed by Transwell assay.Results:Compared with the C33A cells, the expression of HSP70 at mRNA level in C33A-E6 cells was significantly increased ( P<0.05), but no significant change was observed at the protein level ( P>0.05). No significant difference in the degradation rate of HSP70 at mRNA or protein level was detected between C33A and C33A-E6 groups after treating with ActD and CHX for different times, but the concentration of HSP70 in exosomes was significantly increased in the C33A-E6 group ( P<0.001). The exosomes secreted by C33A-E6 cells could enhance the secretion of IL-6, TNF-α and IL-10 by THP-1 cells ( P<0.001), and the THP-1 cells treated with the exosomes could promote the proliferation, migration and invasion of C33A cells ( P<0.001). However, interfering the expression of HSP70 in C33A-E6 cells could significantly reduce the secretion of IL-6 and IL-10 by exosome-treated THP-1 cells, and inhibit the THP-1 cell-induced proliferation, migration and invasion of C33A cells ( P<0.001). Conclusions:High-risk HPV 16 E6 protein upregulated the level of HSP70 in the exosomes secreted by cervical cancer cells, thereby promoting the secretion of IL-6 and IL-10 by macrophages and enhancing the macrophage-induced proliferation, migration and invasion of cervical cancer cells.

Objective:To explore the effects of comprehensive reform of separation of medicine and pharmacy on intent to stay, perceived professional benefit and job satisfaction among nurses so as to provide a theoretical basis for stabilizing nursing team under the new situation of medical reform.Methods:This study was a cross-sectional survey. We selected 600 nurses and 300 inpatients from on one ClassⅡ hospital and two ClassⅢ hospitals in Beijing in June 2017 (before comprehensive reform of separation of medicine and pharmacy) and June 2018 (after comprehensive reform of separation of medicine and pharmacy) as the research objects by convenience sampling. All research objects were investigated with the General Information Questionnaire for Nurses, Questionnaire for Nurse Intention to Remain Employed, Nurses' Perceived Professional Benefits Questionnaire, Job Satisfaction Survey and the Inpatients' Satisfaction with Nursing Job Satisfaction Questionnaire. In June 2017, a total of 600 nurse questionnaires were distributed, and 589 valid questionnaires were recovered with a recovery rate of 98.17%; 300 patient questionnaires were distributed, and 295 valid questionnaires were recovered with a recovery rate of 98.33%. In June 2018, a total of 600 nurse questionnaires were distributed, and 586 valid questionnaires were recovered with a recovery rate of 97.67%; 300 patient questionnaires were distributed, and 296 valid questionnaires were recovered with a recovery rate of 98.67%. We compared the intent to stay, perceived professional benefit and job satisfaction of nurses and patients' satisfaction with nursing work before and after medical reform.Results:After the comprehensive reform of separation of medicine and pharmacy, the score of intent to stay, total scores of perceived professional benefit and job satisfaction were (3.49±0.65) , (130.49±18.23) and (85.76±3.77) respectively among 586 nurses; among 296 patients, the total score of their satisfaction with nursing work was (96.52±2.01) ; those scores were higher than those before reform with statistical differences ( P<0.05) . Conclusions:The implementation of comprehensive reform of separation of medicine and pharmacy has increased the satisfaction of patients with nursing work to a certain extent, and at the same time has increased nurses' intent to stay, perceived professional benefit and job satisfaction which is conducive to the stability of the nursing team and the improvement of the quality of nursing services.

Objective To explore what kind of strategies should be adopted by the medical disciplines of comprehensive universities in China,taking into account and respect the particularity nature of medical science,inspiring innovative creation to build the First-Class disciplines.Methods Literature review and quantitative research were adopted in this paper.By reviewing published articles to better understand the special laws of medical disciplines and identify current development problems.Furthermore,the data from ESI,QS Ranking,and the Ministry of Education were collected to reveal problems and to propose strategies.Results The future development of Medicine disciplines possesses the characteristics of integration,technology dependence,heterogeneity,etc.In the new era of building world-class disciplines and first-class universities,compared with international first-class disciplines,peaks of medical disciplines in Chinese universities are still relatively scarce.The comprehensive university medical discipline should adhere to the principle of ‘connotative development’.In the process of construction,medical discipline should pay full attention to cross-integration,promote cross-disciplinary,adjust and optimize the former system.Strengthen the construction of new disciplines development to build medical disciplines with distinctive features.Optimize top-level design to foster disciplines peaks.Attach great importance to the construction of talents to build up high-level talent team with sustainable development ability.Emphasize on medical education to improve the quality of personnel training.Promote institutional innovation to activate the vitality of integration.Build an effective evaluation system to promote construction.Conclusions With the premise of fully respecting the special laws and characteristics,the medical discipline constructions of comprehensive universities should be guided by the future development model of medicine and clinical needs,and adhered to the ‘connotative development’.With the development of medical disciplines,the level of clinical diagnosis and treatment will be improved,the original innovation will be enhanced,as well as the social service capabilities of comprehensive universities,furthermore,the frontiers of scientific development and national strategic development needs will be effectively supported.

Objective: To summarize the measures and experience in diagnosis and treatment of extremely severe burn patients with severe inhalation injury in dust explosion accident. Methods: The medical records of 13 patients with extremely severe burn complicated with severe inhalation injury in August 2nd Kunshan factory aluminum dust explosion accident who were treated at the First Affiliated Hospital of Soochow University (hereinafter referred to as our hospital) on August 2nd, 2014, were retrospectively analyzed. All the patients were transferred to our hospital 3-8 hours after injury under the condition of inhalation of pure oxygen. Twelve patients underwent tracheotomy within 5 hours after admission, while 1 patient underwent tracheotomy before admission. All the patients were in ventilator-assisted respiration, with synchronized intermittent mandatory ventilation combined with positive end expiratory pressure. All the patients underwent thorax or limbs escharotomy on the second day after admission, so as to reduce the restrictive ventilatory dysfunction caused by the contraction of thorax eschar and the terminal circulation disorder caused by the contraction of limbs eschar. All the patients underwent electronic bronchoscopy within 48 hours after admission, airway secretion were cleared and airway lavage were carried out under electronic bronchoscope according to the patients′ condition, and the sputum, lavage solution, pathological tissue were collected for microbiological culture. All the patients underwent chest X-ray examination on the second day after admission and reexamination as required. Patients were all treated with a combination of broad-spectrum antibiotics early after admission to control lung and systemic infection. One patient was treated with extracorporeal membrane oxygenation for acute respiratory distress syndrome 1 week after admission. Results: One patient suffered from cardiopulmonary arrest during tracheotomy, which recovered autonomous respiration and cardiac impulse after cardiopulmonary resuscitation. Three patients showed decreased pulse oxygen saturation (SpO₂) within 48 hours after injury, and the SpO₂ returned to normal after sputum aspiration, scab removal and lavage under electronic bronchoscope. During the course of disease, bacteria were cultured from wound exudate of 7 patients, bacteremia occurred in 10 patients, and sputum microbiological culture results of 13 patients were positive. Eight of the 13 patients in this group survived, and 5 died. One patient died 19 days after injury, and 4 patients died 33-46 days after injury. The main cause of death was multiple organ dysfunction syndrome induced by severe septic shock eventually. Conclusions For this batch of patients with extremely severe burn complicated with severe inhalation injury caused by dust explosion accident, the treatment and cure measures including early definite diagnosis and timely tracheotomy, the application of effective ventilation, the effective treatment of respiratory system complications, and rational use of antibiotics for the control of lung infection obtained quite good curative effect.

OBJECTIVE:To provide ideas for revise and improve the standard and related method of the quality control of ben-zalkonium chloride in Chinese Pharmacopoeia (2015 edition,Ⅱ). METHODS:The standards and related methods of the quality control of benzalkonium chloride in Chinese Pharmacopoeia(2015 edition,Ⅱ),British Pharmacopoeia(2013 edition),European Pharmacopoeia (7.0 edition) and United States Pharmacopoeia (36 edition) were comprehensively compared. RESULTS:Com-pared with Chinese Pharmacopoeia(2015 edition,Ⅱ),the standards abroad provided the component and the ratio of the benzalko-nium chloride substituted homolog,the method for ammonia compound test had higher sensibility,it also added the test for benzyl alcohol,benzaldehyde and benzyl chloride impurity,as well as the component ratio test and average relative molecular mass calcu-lation. CONCLUSIONS:The standard and related method of the quality control of benzalkonium chloride in Chinese Pharmacopoe-ia(2015 edition,Ⅱ)still need to be further improved.