Objective:To explore the clinical application of three-dimensional CT angiography (3D-CTA) in repair of limb wounds with free lateral thoracic perforator flaps.Methods:A retrospective study was conducted to analyze the clinical data of 61 patients with limb soft tissue defects who had been treated at The Third Department of Orthopedics, Xingtai General Hospital of North China Medical and Health Group from January 2018 to September 2022. There were 37 males and 24 females with an age of (43.9±12.0) years. Thirty-three left and 28 right sides were injured. Soft tissue defects ranged from 4.0 cm × 3.0 cm to 17.0 cm × 8.0 cm, and flap areas from 5.0 cm × 4.0 cm to 18.0 cm × 9.0 cm. The patients were divided into 2 groups according to the different preoperative vascular exploration methods: an ultrasound group of 30 cases subjected to ultrasound Doppler examination and a 3D-CTA group of 31 cases subjected to 3D-CTA examination. The preoperative findings were compared with those of intraoperative exploration in the 2 groups. The operation time, flap survival rate, patient satisfaction with trauma repair, sensory recovery of the flap area, and the excellent and good rate of the donor area were also compared between the 2 groups.Results:The differences in preoperative general data between the 2 groups were not statistically significant, indicating the 2 groups were comparable ( P>0.05). In the ultrasound group, the inraoperative classification of the lateral thoracic perforator flaps showed a low concordance with preoperative classification (Kappa coefficient of 0.104, P=0.088). In the 3D-CTA group, the classification of lateral thoracic perforator flaps was consistent with the preoperative 3D-CTA examination (Kappa coefficient of 1.00, P<0.001). The preoperative measurements in the 3D-CTA group found that the diameter at the origin of the lateral thoracic artery was (1.2±0.3) mm, the vascular pedicle length (8.1±2.1) cm, and the diameter at the perforator exit (0.6±0.2) mm; the preoperative surface positioning at the perforator exit found that the perforator exit was (1.6±0.3) cm above the horizontal line of the subscapular angle and (5.3±1.4) cm outside the vertical line of the subscapular angle. These measurements were similar to the intraoperative ones [(1.1±0.3) mm, (8.3±2.4) cm, (0.7±0.2) mm, (1.5±0.4) cm, and (5.2±1.5) cm], showing no significant differences ( P>0.05). In contrast, the preoperative measurements of the above indexes in the ultrasound group did not coincide with the actual intraoperative measurements, and the differences were all statistically significant ( P<0.05). The operation time, flap survival rate, rate of patient satisfaction with wound repair, rate of sensory recovery in the flap area, and the excellence and good rate of the donor area in the 3D-CTA group were (52.9±16.7) min, 100.0% (31/31), 96.8% (30/31), 83.9% (26/31), and 87.1% (27/31), respectively, which were significantly better than those in the ultrasound group [(76.3±21.4) min, 86.7% (26/30), 76.7% (23/30), 60.0% (18/30), 63.3% (20/30)] ( P<0.05). Conclusions:As preoperative 3D-CTA examination can clarify the types and anatomical characteristics of the lateral thoracic artery and its perforators, it helps the design and harvest of the lateral thoracic perforator flaps. Compared with the ultrasound Doppler examination, preoperative 3D-CTA examination shortens operation time, raises survival rate of the flaps, and facilitates recovery of the appearance and function of the limb wounds, and leads to little impact on the donor site.

Objective:To study and analyze the epidemiological regularity of acute poisoning in Tianjin-Hebei region from 2020 to 2022, and to provide reference for the treatment and prevention of related patients.Methods:In December 2023, the analysis results and clinical data of 4695 patients with drug poisoning from January 2020 to December 2022 in multiple centers of Tianjin-Hebei region were collected as research objects. Gender, age, type of drug poisoning, season and poisoning route of the research objects were analyzed, and statistical analysis was conducted as well.Results:The sex ratio of men and women was 1∶1.16 (2173/2522). The poisoning of antidepressants and benzodiazepines were the most common drug poisonings, accounting for 1550 and 1274 cases respectively (33%, 27.1%). Paraquat poisoning has decreased year by year, while the poisonings of herbicides with low toxicity such as diquat, glyphosate and cremart have increased. The number of cases reached a peak during May to August which was the poisoning season, while was relatively fewer during October to December.Conclusion:Effective intervention measures should be taken according to the age of high incidence of poisoning, different seasons and populations. Essential drug poisoning prevention measures should be established and improved. The systems of sedative drug management and use should be established, and pesticide management and storage need to be strengthened.

Objective:To investigate the risk factors of white matter damage（WMD）in premature infants，especially intraventricular hemorrhage（IVH）.Methods:This retrospective study included 639 premature infants admitted to the neonatal intensive care unit of Shanxi Children's Hospital from June 2022 to June 2023.The premature infants were divided into WMD group（145 cases）and control group（494 cases）according to the results of head MRI.Univariate analysis and multivariate logistic regression analysis were used to explore the risk factors for WMD in premature infants.Results:There were no significant differences in gender，gestational age，fetal distress，cesarean section，asphyxia，Apgar 1min，umbilical artery pH，maternal age，number of pregnancy，infants of assisted reproductive technology，gestational hypertension，gestational diabetes mellitus，acute chorioamnionitis and prelabor rupture of membranes between the two groups（all P>0.05）.Compared the WMD group with the control group，birth weight［（1 571±611）g vs（1 438±489）g， t=-2.393］，umbilical artery base excess［-5.9（-8.2，-3.9）mmol/L vs -5.3（-7.2，-3.5）mmol/L， Z=-2.538］，umbilical artery lactate［3.7（2.4，5.3）mmol/L vs 2.8（2.0，4.1）mmol/L， Z=-4.607］，sepsis（28.5% vs 15.6%， χ 2=12.280），patent ductus arteriosus（82.6% vs 74.7%， χ 2=3.911），hypocarbia（57.2% vs 45.0%， χ 2=6.696），invasive ventilation（75.9% vs 53.0%， χ 2= 24.010），multifetal pregnancy（19.3% vs 30.6%， χ 2=7.111），antenatal corticosteroids（51.0% vs 61.9%， χ 2=5.451），lowest PaCO 2 value［（28.4±6.7）mmHg vs（31.4±8.0）mmHg， t=4.471］were different significantly（all P<0.05）.There was significant difference in the distribution of IVH between the two groups（ χ 2 =40.015， P<0.01）and multiple comparisons showed that the proportion of grade Ⅲ-Ⅳ IVH in the WMD group was higher than that in the control group（ P<0.05）.Multiple logistic regression analysis showed that umbilical artery lactate，grade Ⅲ-Ⅳ IVH，sepsis and invasive ventilation were high risk factors of WMD，and multifetal pregnancy was protective factor of WMD，with OR（ 95%CI）1.121（1.023，1.228），11.435（3.925，33.314），1.758（1.064，2.904），1.640（1.004，2.680），and 0.587（0.358，0.962），respectively. Conclusions:Umbilical artery lactate，grade Ⅲ-Ⅳ IVH，sepsis，and invasive ventilation are independent risk factors for WMD.

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 investigate the surgical method of preoperative computed tomography angiography(CTA) combined with color Doppler ultrasonography(CDU) vascular localization assisted by downstream vascularized medial femoral condylar bone flap and its clinical effect in the treatment of refractory scaphoid fracture nonunion.Methods:Retrospective analysis of case data from January 2018 to June 2022 in the Department of Orthopedics at Xingtai General Hospital of North China Medical and Health Group, using a free medial femoral condylar bone flap with descending knee artery as the blood supply to repair old fractures of the scaphoid bone with bone damage. Prior to surgery, CTA combined with CDU technology was used to locate the descending knee artery, and the medial femoral condylar bone flap was designed based on the localization result and bone defects. Follow-up was conducted using outpatient and telephone method. The degree of wrist pain was evaluated using the visual analogue scale (VAS), wrist function was evaluated using the improved Mayo scoring method, the degree of scaphoid arch back deformity was evaluated based on the angle of the scaphoid bone, and stability between the carpal bones was evaluated based on the angle of the scaphoid moon. The normal distribution metric data was represented as Mean±SD, and paired sample t-tests were used to compare the preoperative CDU measurement and the actual intraoperative measurement of the vessel diameter at the origin of the descending knee artery, as well as the distance to the inferior edge of the medial femoral condyle. The VAS score for pain before and after surgery, the Mayo score for wrist function, wrist grip strength, range of motion, scaphoid angle, and scaphoid angle are also compared. Results:A total of 12 patients were enrolled, including 9 males and 3 females; age ranged from 23 to 56 years old, with an average of 36 years old. There were 7 cases of right side fractures, 5 cases of left side fractures, 8 cases of scaphoid waist fractures, and 4 cases of proximal pole fractures. There was no difference between the preoperative CDU location and the actual vessel diameter at the origin of the descending geniculate artery [(1.7±0.5) mm vs. (1.8±0.7) mm] and the distance to the inferior border of the medial femoral condyle [(11.9±2.1) cm vs. (12.1±1.9) cm]( P>0.05). All patients were followed up after the operation, the specific time ranged from 6 months to 2 years, with an average of 13 months. The X-ray films showed that the scaphoid bone healed in all patients after operation, and the average healing time was 15 weeks. After 6 months of follow-up, the VAS scores (3.7±0.9 vs. 0.5±0.1), Mayo scores (46.1±3.8 vs. 86.2±6.1), scapholunar angle [(65.3±4.1)° vs. (47.9±3.5)°], scaphoid angle [(37.1±3.9)° vs. (22.8±2.3)°], wrist flexion and extension range of motion [(79.0±11.7)° vs. (118.5±15.8)°], grip strength [(6.7±4.6) kg vs. (26.1±5.3) kg]were compared before and after surgery, the differences were statistically significant (all P<0.05). Conclusion:The free medial femoral condyle bone flap with a vascular pedicle is one of the ideal method to repair the old navicular fracture with osteonecrosis. The preoperative vascular positioning technique effectively guides the design and cutting of the bone flap and ensures fast and accurate operation during the operation.

Objective:To investigate the application of CT image omics model in the differential diagnosis of ganglioneuroblastoma (GNB) and neuroblastoma (NB) in childhood.Methods:A retrospective case series study was performed. The clinical and imaging data of 23 NB and 23 GNB pediatric patients confirmed by surgery and pathology in Shanxi Children's Hospital from January 2013 to December 2013 were collected. The original CT images in the normal scan phase, arterial phase and venous phase of all the children before operation were extracted from the PACS system in DICOM format. ITK-SNAP (ver.3.4.0) software was applied to manually outline and extract the image omics features layer by layer of the lesions in the normal scan phase, arterial phase and venous phase of each patient before surgery. The minimum absolute contraction selection operator and stepwise multi-factor logistic regression method were used to screen out effective features in different scan phases. The corresponding phase image omics model was established by using logistic model. The diagnostic efficiency of each phase of the image omics model was evaluated by using the receiver operating characteristic curve, calibration curve and decision curve.Results:A total of 1 361 image omics features were extracted from the original CT images in the 3 phases. The model was established by using multi-factor logistic regression to extract 4 features in the normal scan phase, 2 features in the arterial phase, 3 features in the venous phase and 7 features in the combination of the 3 phases. The area under the curve (AUC) of the model in the normal scan phase was 0.940, the accuracy was 89.1%, the sensitivity was 91.3% and the specificity was 87.0%; the AUC of the model in the arterial phase was 0.923, the accuracy was 84.8%, the sensitivity was 82.6%, and the specificity was 87.0%; the AUC of the model in the venous phase was 0.949, the accuracy was 87.8%, the sensitivity was 83.3%, and the specificity was 91.3%; the AUC of 3 phases combined model was 0.964, the accuracy was 95.1%, the sensitivity was 94.7%, and the specificity was 95.5%. The results showed that the single-phase image omics model was effective in the differential diagnosis of NB and GNB in childhood; the AUC, accuracy, sensitivity and specificity of the 3 phases combined imaging model were higher than those of the single-phase imaging model. The calibration curve and decision curve showed that the probability of differential diagnosis of NB and GNB in childhood by the 3 phases combined model had a high consistency with the observed value, and a good net benefit could be achieved.Conclusions:CT-based image omics model has a high clinical value in the differential diagnosis of NB and GNB in childhood.

Objective:To study and analyze the epidemiological regularity of acute poisoning in Tianjin-Hebei region from 2020 to 2022, and to provide reference for the treatment and prevention of related patients.Methods:In December 2023, the analysis results and clinical data of 4695 patients with drug poisoning from January 2020 to December 2022 in multiple centers of Tianjin-Hebei region were collected as research objects. Gender, age, type of drug poisoning, season and poisoning route of the research objects were analyzed, and statistical analysis was conducted as well.Results:The sex ratio of men and women was 1∶1.16 (2173/2522). The poisoning of antidepressants and benzodiazepines were the most common drug poisonings, accounting for 1550 and 1274 cases respectively (33%, 27.1%). Paraquat poisoning has decreased year by year, while the poisonings of herbicides with low toxicity such as diquat, glyphosate and cremart have increased. The number of cases reached a peak during May to August which was the poisoning season, while was relatively fewer during October to December.Conclusion:Effective intervention measures should be taken according to the age of high incidence of poisoning, different seasons and populations. Essential drug poisoning prevention measures should be established and improved. The systems of sedative drug management and use should be established, and pesticide management and storage need to be strengthened.

Objective:To investigate the surgical method of preoperative computed tomography angiography(CTA) combined with color Doppler ultrasonography(CDU) vascular localization assisted by downstream vascularized medial femoral condylar bone flap and its clinical effect in the treatment of refractory scaphoid fracture nonunion.Methods:Retrospective analysis of case data from January 2018 to June 2022 in the Department of Orthopedics at Xingtai General Hospital of North China Medical and Health Group, using a free medial femoral condylar bone flap with descending knee artery as the blood supply to repair old fractures of the scaphoid bone with bone damage. Prior to surgery, CTA combined with CDU technology was used to locate the descending knee artery, and the medial femoral condylar bone flap was designed based on the localization result and bone defects. Follow-up was conducted using outpatient and telephone method. The degree of wrist pain was evaluated using the visual analogue scale (VAS), wrist function was evaluated using the improved Mayo scoring method, the degree of scaphoid arch back deformity was evaluated based on the angle of the scaphoid bone, and stability between the carpal bones was evaluated based on the angle of the scaphoid moon. The normal distribution metric data was represented as Mean±SD, and paired sample t-tests were used to compare the preoperative CDU measurement and the actual intraoperative measurement of the vessel diameter at the origin of the descending knee artery, as well as the distance to the inferior edge of the medial femoral condyle. The VAS score for pain before and after surgery, the Mayo score for wrist function, wrist grip strength, range of motion, scaphoid angle, and scaphoid angle are also compared. Results:A total of 12 patients were enrolled, including 9 males and 3 females; age ranged from 23 to 56 years old, with an average of 36 years old. There were 7 cases of right side fractures, 5 cases of left side fractures, 8 cases of scaphoid waist fractures, and 4 cases of proximal pole fractures. There was no difference between the preoperative CDU location and the actual vessel diameter at the origin of the descending geniculate artery [(1.7±0.5) mm vs. (1.8±0.7) mm] and the distance to the inferior border of the medial femoral condyle [(11.9±2.1) cm vs. (12.1±1.9) cm]( P>0.05). All patients were followed up after the operation, the specific time ranged from 6 months to 2 years, with an average of 13 months. The X-ray films showed that the scaphoid bone healed in all patients after operation, and the average healing time was 15 weeks. After 6 months of follow-up, the VAS scores (3.7±0.9 vs. 0.5±0.1), Mayo scores (46.1±3.8 vs. 86.2±6.1), scapholunar angle [(65.3±4.1)° vs. (47.9±3.5)°], scaphoid angle [(37.1±3.9)° vs. (22.8±2.3)°], wrist flexion and extension range of motion [(79.0±11.7)° vs. (118.5±15.8)°], grip strength [(6.7±4.6) kg vs. (26.1±5.3) kg]were compared before and after surgery, the differences were statistically significant (all P<0.05). Conclusion:The free medial femoral condyle bone flap with a vascular pedicle is one of the ideal method to repair the old navicular fracture with osteonecrosis. The preoperative vascular positioning technique effectively guides the design and cutting of the bone flap and ensures fast and accurate operation during the operation.

Objective:To explore the cutting scheme and clinical application effects of ultrathin thoracodorsal artery perforator flap assisted by color Doppler ultrasound.Methods:This study was a retrospective historical control study. From February 2017 to October 2019, 20 patients who were admitted to the Third Department of Orthopedics of Xingtai General Hospital of North China Medical and Health Group (hereinafter referred to as our department), met the inclusion criteria, and underwent repair of skin and soft tissue defects of extremities with ultrathin thoracodorsal artery perforator flap designed and harvested based on the surgeon's clinical experience were selected as control group, including 16 males and 4 females, aged (37±5) years. From November 2019 to December 2022, 21 patients who were admitted to our department, met the inclusion criteria, and underwent repair of skin and soft tissue defects of extremities with ultrathin thoracodorsal artery perforator flap designed and harvested under the assistance of color Doppler ultrasound were selected as ultrasound-assisted group, including 15 males and 6 females, aged (38±6) years. After debridement, the area of skin and soft tissue defects of extremities ranged 5.0 cm×4.0 cm to 19.0 cm×8.0 cm, and the area of thoracodorsal artery perforator flaps ranged 6.0 cm×5.0 cm to 20.0 cm×9.0 cm. The wounds in flap donor sites were closed directly. For patients in ultrasound-assisted group, the time and cost required for color Doppler ultrasound examination were recorded, and the number, type, and location of thoracodorsal artery perforator vessels detected by preoperative color Doppler ultrasound were compared with those of intraoperative actual detection. The time required for complete flap harvest of patients in 2 groups was recorded. On postoperative day (POD) 1, 3, 5, 7, and 14, the blood perfusion of flaps in the 2 groups of patients was assessed using a flap perfusion assessment scale. On POD 14, flap survival of patients in 2 groups was observed, and the percentage of flap survival area was calculated. In postoperative 6 months, satisfaction of patients with the treatment outcome in the 2 groups was assessed using 5-grade Likert scale, and the satisfaction rate was calculated.Results:For patients in ultrasound-assisted group, the time required for preoperative color Doppler ultrasound examination was (10.5±2.3) min, and the cost was 120 yuan; 21 thoracodorsal artery perforator vessels were detected and marked using preoperative color Doppler ultrasound, including 8 (38.10%) type 1 perforator vessels, 10 (47.62%) type 2 perforator vessels, and 3 (14.29%) type 3 perforator vessels; the number, type, and location of thoracodorsal artery perforator vessels detected preoperatively were consistent with those detected intraoperatively. The time required for complete flap harvest of patients in ultrasound-assisted group was (41±10) min, which was significantly shorter than (63±12) min in control group ( t=6.32, P<0.05). On POD 1, 3, 5, 7, and 14, the blood perfusion scores of flaps of patients in ultrasound-assisted group were significantly better than those in control group (with t values of 6.67, 7.48, 8.03, 8.75, and 7.99, respectively P<0.05). On POD 14, only one patient in ultrasound-assisted group had partial flap necrosis and 6 patients in control group had complete or partial necrosis of the flap; the percentage of flap survival area of patients in ultrasound-assisted group was (99±8)%, which was significantly higher than (87±8)% in control group ( t=4.57, P<0.05). In postoperative 6 months, there was no significant difference in the satisfaction rate of patients with the treatment outcome between the two groups ( P>0.05). Conclusions:Preoperative color Doppler ultrasound is highly accurate in detecting the number, type, and location of perforator vessels. The cutting scheme of ultrathin thoracodorsal artery perforator flaps can be designed according to the different types of perforator vessels, with shorted flap cutting time and improved flap survival rate.

【Objective】 To explore the perioperative blood management in patients with pancreatic pseudocyst combiend with coagulation factor Ⅴ(FⅤ) deficiency. 【Methods】 Preoperative: In order to determine the effect of cryoprecipitated antihemophilic factor and fresh frozen plasma (FFP) on the elevation level of factor Ⅴ, we alternately infused cryoprecipitate and FFP in the resting state. TEG, coagulation function and coagulation factor activity were monitored before and 1 h, 24 h and 48 h after infusion, and intraoperative and postoperative blood transfusion strategies were formulated. FFP 600 mL and cryoprecipitate 10 U were supplemented preoperatively. Intraoperative: The operation procedure was performed for 7 hours with an infusion of 600 mL FFP without significant bleeding. Postoperative: FFP was infused. 【Results】 Preoperative: The coagulation factor Ⅴ activity on pre-operation was 1.9% and 1.8%. After alternating infusion cryoprecipitate 10 U and FFP 1 200 mL, the FⅤactivity increased to 5.1% and 6.0%, respectively. There was no significant difference in TEG parameters, PT and ATPP results were decreased to varying degrees. Intraoperative: The operation was successful without obvious bleeding. Postoperative: FFP 500 mL was infused 2 h after operation, and FFP 250-500 mL was injected daily from 1 to 7 days after surgery. No significant bleeding was observed in the wound, the results of TEG, PT, APTT and hemoglobin (Hb) did not change significantly compared with those before surgery. The patient was discharged successfully 12 days after surgery. The genetic test results showed that he had inherited coagulation factor Ⅴ deficiency, which was a compound heterozygous variation. 【Conclusion】 Perioperative blood management in patients with FⅤ deficiency combined with surgical disease, requiring pre-transfusion evaluation and post-transfusion evaluation in combination with laboratory investigations and clinical manifestations, cryoprecipitate and fresh frozen plasma can be effective in supplementing coagulation factors. The TEG seems to be better than the Seven items of coagulation function in judging the clotting status of patients with FⅤ deficiency.