Diagnostic criteria, as a critical component of clinical practice guidelines, play a direct role in guiding clinicians' diagnostic and treatment decisions. Although China has increasingly emphasized the development and updating of clinical guidelines in recent years, research focusing on the diagnostic criteria within these guidelines remains limited. This paper aims to explore the types of diagnostic criteria, the issues they present, and the processes involved in their formulation. Based on this analysis, suggestions are proposed to improve the recommendation and application of diagnostic criteria in Chinese guidelines.

Diagnostic criteria, as a critical component of clinical practice guidelines, play a direct role in guiding clinicians' diagnostic and treatment decisions. Although China has increasingly emphasized the development and updating of clinical guidelines in recent years, research focusing on the diagnostic criteria within these guidelines remains limited. This paper aims to explore the types of diagnostic criteria, the issues they present, and the processes involved in their formulation. Based on this analysis, suggestions are proposed to improve the recommendation and application of diagnostic criteria in Chinese guidelines.

Sepsis is a life-threatening organ dysfunction caused by the host's uncontrolled response to infection, and is one of the main causes of death in critically ill patients. Sepsis-associated acute kidney injury (SA-AKI) is associated with the poor prognosis of sepsis patients, and its pathogenesis is complex and still unclear to this day.Mitochondrial dynamics is crucial for maintaining the normal morphology, quantity, number and function of mitochondria, which is a new research hotspot in recent years. Mitochondrial dynamics disorder is involved in the occurrence and development of SA-AKI by regulating renal tubular dysfunction, which is expected to become new therapeutic targets. Deeply exploring the role of mitochondrial dynamic disorders in the pathogenesis of SA-AKI will help to find more effective treatment methods, thereby improving the success rate of rescue in SA-AKI patients.

The phenomenon of coronary artery ectasia is typically discovered incidentally during coronary angiography.As a relatively uncommon manifestation of coronary arteries,it has attracted the interest of numerous researchers.However,despite extensive research on coronary artery ectasia,substantial controversies persist regarding both its etiology and treatment modalities.This article provides a comprehensive summary of recent research on coronary artery ectasia,elucidates various aspects of research progress,with the aim of offering substantive support and guidance for subsequent investigations.

Objective:To objectively evaluate the postoperative efficacy and rotational stability of two common types of toric intraocular lenses (IOLs), and perform vector analysis of postoperative residual astigmatism.Methods:A cohort study was performed.A total of 80 cases (80 eyes) of age-related cataract combined with corneal regular astigmatism patients who underwent phacoemulsification combined with toric IOL implantation in Ningbo Aier Guangming Eye Hospital from January 2019 to October 2021 were selected.The astigmatic corrected IOL was implanted according to the patients' wishes.Among them, 39 cases (39 eyes) implanted with Tecnis ? ZCT IOL were classified as Tecnis group, and 41 cases (41 eyes) implanted with AcrySof ? IQ Toric IOL were classified as AcrySof group.The uncorrected distance visual acuity (UCDVA), best corrected distance visual acuity (BCDVA), and residual astigmatism of subjective refraction were observed 1 week, 1 month, and 3 months after operation.After mydriasis, OPD-Scan Ⅲ was used to measure the toric IOL axial position, and the IOL axial deviation (LAD) was calculated.Vector analysis of preoperative corneal astigmatism, expected residual astigmatism and postoperative residual astigmatism was performed using the astigmatism double-angle map.The study protocol was approved by the Ethics Committee of Ningbo Aier Guangming Eye Hospital (No.2019-001). Results:There was no significant difference in the overall comparisons of UCDVA and BCDVA between the two groups ( Hgroup=2.503, P=0.113; Hgroup=0.399, P=0.527), while there were statistically significant differences between before and different time points after operation ( Htime=147.535, P<0.001; Htime=146.808, P<0.001). Postoperative UCDVA and BCDVA were significantly improved compared to preoperative, and the difference was statistically significant (all at P<0.001). There were statistically significant differences in the overall comparison of astigmatism between the two groups before and at different time points after operation ( Hgroup=5.489, P=0.019; Htime=171.070, P<0.001). The residual astigmatism was significantly higher in AcrySof group than in Tecnis group 1 month after operation ( P=0.016), and the residual astigmatism after operation in both groups decreased compared to before operation, showing statistically significant differences (both at P<0.001). There was no statistically significant difference in IOL LAD between the two groups at different time points after operation ( Hgroup=3.013, P=0.083; Htime=1.689, P=0.430). Vector analysis of astigmatism showed that residual astigmatism was significantly reduced in both groups at 3 months after operation compared to before operation, and the 95% confidence ellipses were significantly reduced.There were differences in the mean and centroid values of residual astigmatism prediction errors between the two groups 3 months after operation, but there was no significant difference in the 95% confidence ellipse.The percentage of eyes with residual astigmatism prediction error ≤1.0 D in Tecnis group and AcrySof group was 82%(32/39) and 90%(37/41), respectively, showing no statistically significant difference ( χ2=1.131, P=0.288). Conclusions:Both Tecnis ? ZCT IOL and AcrySof ? IQ Toric IOL can effectively improve postoperative visual acuity of patients with cataract and corneal astigmatism, reduce postoperative residual astigmatism and have good rotational stability.The online calculators of the two types of toric IOLs have good performance in the prediction of postoperative residual astigmatism.

The incidence of portal vein tumor thrombus (PVTT) in patients with hepato-cellular carcinoma (HCC) is high and the prognosis is poor. The treatment mode of HCC+PVTT is changing to multidisciplinary comprehensive treatment. The authors make a deep investigation on the occurrence basis, classification, surgical treatment indication, postoperative adjuvant treatment and preoperative conversion treatment plan of HCC+PVTT, in order to provide reference for the diagnosis and treatment of this disease.

Objective:To explore the clinical efficacy and safety of single-layer with full thickness of duct-to-mucosa pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy.Methods:The clinical data of 45 patients who underwent laparoscopic pancreaticoduodenectomy with the procedures of single-layer with full thickness in Second Hospital of Hebei Medical University from Jan 2020 to Jan 2022 were retrospectively collected and compared with 45 matched patients with traditional two-layer pancreaticojejunostomy.Results:The laparoscopic pancreaticoduodenectomy procedures were successfully performed in all the 90 cases. The mean operation time (285.6±92.4 minutes) and the media pancreaticojejunostomy time 20(15, 35) minutes) of the single-layer with full thickness pancreaticojejunostomy group were shorter than those of the two-layer pancreaticojejunostomy group [the mean operation time: 317.0±85.5 minutes, the media pancreaticojejunostomy time: 46(30, 58) minutes] with significantly statistical differences (all P value<0.05). There were no significantly statistical differences on intraoperative blood loss, the postoperative complications or hospital stay between the two groups. Conclusions:Compared with traditional pancreaticojejunostomy, the single-layer with full thickness of duct-to-mucosa pancreaticojejunostomy is simple and safe, which has the advantage of easy manipulation and less time-consuming and can be recommended for laparoscopic procedures.

Objective:To summarize the clinical characteristics of patients with unicentric Castleman disease(UCD).Method:The clinical data of 8 abdominal UCD patients who received surgical resection at the Second Hospital of Hebei Medical University from Oct 2019 to Oct 2022 were analyzed, and the imaging characteristics, pathological types and prognosis were summarized.Result:There were 2 males and 6 females. The average age of patients was (33.0±13.7) years old, and their BMI was (23.2±4.5) kg/m 2. The median maximum diameter of the tumor was 4.5 (3.0-4.9) cm. The average postoperative hospital stay was 6.5 (3.3-12.0) days. One was lost during follow up, there was no recurrence or other postoperative complications in the remaining 7 patients. Conclusion:The incidence of unicentric Castleman disease is rare. Complete resection of the tumor is the main treatment for UCD patients, and the prognosis of UCD is good.

Objective:To investigate the application value of three dimensional (3D) imaging fusion navigation system (hereinafter referred as navigation system) in laparoscopic pan-creatic surgery.Methods:The retrospective and descriptive study was conducted. The clinical data of two volunteers, including volunteer 1 undergoing laparoscopic pancreaticoduodenectomy for cholangiocarcinoma and volunteer 2 undergoing laparoscopic pancreaticotomy + splenectomy for pancreatic cancer, who were admitted to the Second Hospital of Hebei Medical University from December 2020 to May 2021 were collected. The 2 volunteers were females, aged 68 years and 40 years, respectively. The self-developed navigation system was applied in laparoscopic simulator model test, including in rigid-body model and prosthesis model, and clinical test. Observation indicators: (1) results of model test; (2) results of clinical test. Measurement data with normal distribution were represented as Mean± SD. Results:(1) Results of model test. The rigid-body model or prosthesis model with occlusion can be seen in the laparoscopic visual field of the initial laparoscopic simulator. The rigid-body model or prosthesis model with occlusion and rigid-body model or prosthesis model without occlusion can be seen in the 3D visual reconstruction image of enhanced computer tomography (CT) examination. The rigid-body model or prosthesis model with occlusion can be seen in the laparoscopic visual field of the initial laparoscopic simulator after the 3D visual reconstruction image was superimposed and fused with the real-time laparoscopic image. Both of the rigid-body model and prosthesis model were in high consistency, with the distance error of marker points were (0.26±0.11)mm and (0.29±0.18)mm, respectively. (2) Results of clinical test. The abdominal organs and blood vessels with occlusion of the 2 volunteers can be seen in the initial laparoscopic visual field. The location of tumor, important organs and blood vessels can be seen in the navigation system using the 3D visual reconstruction image of enhanced CT examination. The location of tumor, important organs and important blood vessels can be seen in the laparoscopic visual field after the 3D visual reconstruction image was superimposed and fused with the real-time laparoscopic image. The distance error of marker points of the volunteer 1 was (1.36±0.57)mm and the distance error of marker points of the volunteer 2 was (1.24±0.33)mm.Conclusions:The self-developed navigation system can integrate the preoperative 3D visual reconstruction image of enhanced CT examination and the intraoperative real-time laparoscopic image with a good effect. The relationship between deep tissue and blood vessels which is not clarified in conventional laparoscopy can be shown in the navigation system assisted laparoscopic pancreatic surgery.

Objective:To compare and analyze the perioperative outcomes of jaundiced patients undergoing laparoscopic pancreaticoduodenectomy (LPD) using preoperative percutaneous transhepatic cholangial drainage (PTCD) versus endoscopic nasobiliary drainage (ENBD).Methods:The perioperative data of 173 patients who underwent LPD at the Second Hospital of Hebei Medical University from January 2016 to December 2020 and were treated preoperatively with either PTCD versus ENBD to alleviate jaundiced were retrospectively analyzed. There were 100 males and 73 females, with age of (60.4±10.8) years old. These patients were divided into the PTCD group ( n=126) and the ENBD group ( n=47). Clinical data including operation time, blood loss, transfusion volume, R 0 resection, and postoperative complications were compared. Results:There was no convension to open surgery. There were no significant differences in operation time, blood loss, transfusion volume, R 0 resection rate, pathological results and hospital stay between the two groups ( P>0.05). For the PTCD group, the pancreatic fistula rate was 10.3% (13/126) and the post-operative hemorrhage rate was 8.7% (11/126). They were both significantly lower than those of the ENBD group [25.5% (12/47) and 25.5% (12/47) respectively, P<0.05]. There were also significant differences in the postoperative complications according to the Clavien-Dindo classification system between the two groups ( P=0.008). Conclusion:Compared with ENBD, PTCD had the advantages of lower post-operative pancreatic fistula and post-operative hemorrhage rates, resulting in a better postoperative recovery.