Objective To observe the influence of different energy windows of the medium-energy general-purpose(MEGP)collimator on image quality,so as to optimize the energy window of yttrium-90(90Y)bremsstrahlung SPECT imaging.Methods 90Y bremsstrahlung spectrum was acquired,and the sensitivity,percentage of the source counts in useful field of view(S/FOV%)and signal-to-background ratio(S/B)of 90Y bremsstrahlung SPECT imaging at MEGP under different energy windows were compared.Results The energy spectrum of 90Y bremsstrahlung was a continuous curve,with the peak of 76.2 keV with MEGP collimator.The images obtained with MEGP collimator were clear,and no significant differences of S/FOV%nor S/B was found between 10%and 20%window width groups(both P＞0.05),but the sensitivities of the latter was higher than the former(P＜0.05).The sensitivity of 70-90 keV images was relatively high,while the S/FOV%and S/B had decreased.The S/FOV%and S/B of images ranging from 40-60 keV were high,but the sensitivity was low.Images acquired with 100 keV±20%showed fairly high sensitivity,S/FOV%and S/B,which was 69.73%,0.62 and 1.64,respectively.Conclusion When performing 90Y bremsstrahlung SPECT with MEGP collimator,the image quality at 20%window width was better than at 10%window width,and 100 keV±20%showed fairly high sensitivity and not significantly decreased S/FOV%and S/B.

Background/Aims: The aim of this study was to analyze the chronological changes in postoperative complications in surgical ulcerative colitis patients over the past decade in China and to investigate the potential parameters that contributed to the changes. Methods: Ulcerative colitis patients who underwent surgery during 2008–2017 were retrospectively enrolled from 13 hospitals in China. Postoperative complications were compared among different operation years. Risk factors for complications were identified by logistic regression analysis. Results: A total of 446 surgical ulcerative colitis patients were analyzed. Fewer short-term complications (24.8% vs. 41.0%, P=0.001) and more laparoscopic surgeries (66.4% vs. 25.0%, P<0.001) were found among patients who received surgery during 2014–2017 than 2008–2013. Logistic regression suggested that independent protective factors against short-term complications were a higher preoperative body mass index (odds ratio [OR], 0.870; 95% confidence interval [CI], 0.785–0.964; P=0.008), laparoscopic surgery (OR, 0.391; 95% CI, 0.217–0.705; P=0.002) and elective surgery (OR, 0.213; 95% CI, 0.067–0.675; P=0.009). The chronological decrease in short-term complications was associated with an increase in laparoscopic surgery. Conclusions Our data revealed a downward trend of short-term postoperative complications among surgical ulcerative colitis patients in China during the past decade, which may be due to the promotion of minimally invasive techniques among Chinese surgeons.

Liver sinusoidal endothelial cells (LSECs) are crucial to the maintenance of hepatic homeostasis under physiologic conditions, while under the conditions of pathological liver damage, LSEC can respond to the damage by changing their structure through the process called capillarization, thereby aggravating liver damage. In addition, the interaction between LSEC and other cells in the liver plays a certain role in the development and progression of liver fibrosis, especially the interaction between LSEC and hepatic stellate cells, which are the primary effector cells of liver fibrosis. This article mainly elaborates on the role of LSEC in the development and progression of liver fibrosis during chronic liver injury.

Objective:To evaluate the efficacy of preoperative three-dimensional (3D) image reconstruction combined with intraoperative dynamic ultrasonography (IOUS) in laparoscopic precision hepatectomy for intrahepatic bile duct stones.Methods:The clinical data of 66 patients with intrahepatic bile duct stones undergoing laparoscopic hepatectomy in the First People's Hospital of Fuyang District, Hangzhou from January 2018 to January 2023 were retrospectively analyzed, including 32 males and 34 females, aged (49.6±15.2) years old. Patients were divided into the study group ( n=32), who underwent laparoscopic precision hepatectomy using 3D reconstruction combined with IOUS, and the control group ( n=34), who underwent conventional laparoscopic hepatectomy. Perioperative data including the operation time, intraopera-tive blood loss, total volume of drainage on postoperative day (POD) 3, and the rates of complications were compared between the groups. Serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), liver function indices including total bilirubin (TBil) and alanine aminotransferase (ALT) were monitored preoperatively and on POD 1, 3, 5, and 7. Results:The operation time was shorter in the study group [(178±17) min vs. (189±18) min, t=2.55, P=0.010]. The intraoperative blood loss was reduced in the study group [(218±19) ml vs. (395±21) ml, P<0.001]. The incidence of total volume of drainage >300 ml on POD 3 were comparable between the groups [9.4%(3/32) vs. 14.7%(5/34), P=0.507]. There were no significant differences in preoperative serum level of TBil, ALT, CRP and IL-6 between the groups (all P>0.05). Compared to the control group, serum levels of TBil, ALT and CRP in the study group were decreased on POD 1, 3, 5 and 7, and IL-6 was decreased on POD 1 and 3 (all P<0.05). The occurrences of postoperative bile leakage [9.4% (3/32) vs. 29.4% (10/34)] and liver cutting surface fluid accumulation [12.5% (4/32) vs. 35.3% (12/34)] and the rate of stone retention [3.0% (1/32) vs. 20.6% (7/34)] were lower in the study group (all P<0.05). Conclusion:Preoperative 3D image reconstruction combined with IOUS in laparoscopic precision hepatectomy for intrahepatic bile duct stones could reduce intra-operative blood loss, hepatic inflammatory response, and postoperative complications.

Objective:To summarize the experience of the precise prevention and control strategy of novel coronavirus infection in the pediatric intensive care unit(PICU)during the epidemic of the Omicron variant.Methods:A retrospective analysis was performed on the strategies and management experience of precise prevention and control of novel coronavirus infection in PICU at Pediatric Hospital of Fudan University from March 1 to May 10, 2022.Results:According to the national and Shanghai novel coronavirus infection prevention and control standards, the PICU in our hospital, in accordance with the specialty characteristics of PICU, cooperated with the hospital′s department of infection and medical department to jointly construct a precise ward management strategy for the outbreak of the omicron mutants infection.Precise prevention and control management strategies were formulated from four aspects: the admission process of critically ill children, the division of PICU ward areas and nosocomial infection protection, the reception management system for children′s family members, and the " bubble management" system for PICU staff, and run them for 3 months.During the epidemic, there was no nosocomial infection of novel coronavirus infection in children or medical staff.During the period, a total of 140 critically ill children were admitted, including 87 cases transferred from the general ward in the hospital, 48 cases from the emergency department(non-febrile, 3 cases transferred by the transfer team), four cases from fever clinic, and one case from control ward.Four of the critically ill children had no emergency nucleic acid test report when they were admitted to the PICU.Among the 140 critically ill children, 54 patients received mechanical ventilation, 18 patients received blood purification, and two patients were monitored after liver transplantation.Seventy-eight (55.7%) children had underlying diseases.Conclusion:During the current round of novel coronavirus epidemic in Shanghai, PICU in our hospital formulated the admission and ward management procedures for critically ill children, which ensured the prevention and control of nosocomial infection of novel coronavirus, and at the same time ensured the treatment of critically ill children to the greatest extent.

Objective:To prospectively investigate the prevalence of heparin-induced thrombocytopenia (HIT) in critically ill children during extracorporeal membrane oxygenation(ECMO) and explore the clinical characteristics and prognosis of HIT during ECMO.Methods:A total of 22 critically ill children, who had received ECMO support for more than 96 hours in the Intensive Care Unit at the Children′s Hospital of Fudan University from March 2019 to December 2020, were enrolled.According to the 4T score and the heparin/platelet factor 4(PF4) antibody, children whose 4T scores were not less than 6 and heparin/ PF4 antibodies were positive, were classified into HIT group ( n=6), and non-HIT group ( n=16). The clinical outcomes and the incidence of thrombotic events were compared between two groups. Results:The incidence of HIT during ECMO in critically ill children was 27% in this study.The incidence of thrombosis in the ECMO circuit in the HIT group was higher (100% vs.63%, P=0.133), and the average time to the first thrombosis in ECMO circuit in the HIT group was shorter than that in the non-HIT group (3.70 d vs.5.44 d, P=0.06). During the first 14 days of ECMO, the proportion of children with thrombotic events no less than twice was higher in the HIT group (67% vs.19%, P=0.054). There was no significant difference regarding the survival rate at 28 days after ECMO withdrawal between two groups (33% vs.50%, P=0.664). Conclusion:The prevalence of HIT during ECMO in critically ill children is high.Thrombosis events tend to occur earlier and more extensively in children with HIT during ECMO.No significant effect of HIT on the survival rate of children during ECMO is found.Whether HIT has effect on the survival rate of children with ECMO requires a prospective and large clinical study.

Thirteen patients with colorectal lesions underwent laparoscopic surgery from January to December 2019. Before surgery, 5.0 ml autogenous blood was injected under colonoscopy into the inferior margin and opposite sides of the lesion for localization. The operation time，success rate，complications，location efficiency and postoperative pathology were evaluated. The autologous blood tattooing was easily applied for all patients without complication. At laparoscopic surgery，the lesions of all patients were clearly visualized except one obese patients with rectal tumors, because the tumor was located below the retroperitoneal fold. No blood diffusion and leakage，and local inflammatory responses were observed. The surgical margins of all samples were tumor negative. Preoperative tattooing with autologous blood is recommended as an easy，safe and economical procedure for colonoscopic surgery in patients with colorectal lesions.

Objective:To describe a new technique for chronic anal fissure surgery aimed at minimal invasion and reducing pain, and to evaluate the preliminary results concerning non-healing and intact anal function.Methods:A prospective observational study in twenty-five chronic anal fissure patients treated by Intersphincteric Lateral Internal Sphincterotomy (ILIS) technique from February to June 2018 in the Affiliated Hospital of Medical School of Ningbo University were conducted.Results:Chronic anal fissure in twenty-five patients healed primarily (96%, 24/25). There was one non-healing case. The mean healing time was(14.66 ± 5.63) d. Pain scores of 1, 3 and 5 d after surgery were (2.32 ± 0.82), (1.66 ± 0.74), (1.22 ± 0.63) scores. None had disturbance in clinical anal continence. Wexner score was 0.Conclusions:The early outcome of the ILIS technique is quite impressive. This technique is minimally invasive, with shorter healing time and less pain. It has the potential to become a viable option for chronic anal fissure surgery.

Twelve patients with complex anal fistulas were treated in the Affiliated Hospital of Medical School of Ningbo University from June to December 2018. All the patients were successfully operated, and after the operation the wound was rinsed twice a day by buried drainage tube. Patients were followed up for 3 months, the wound was healed in 11 cases and relapsed in 1 case with a mean wound healing time of (25.2±7.0) d; the pain scores at 1 d, 3 d and 5 d after surgery were 3.21±1.27, 2.34±1.22 and 1.89±0.78, respectively. There was no significant difference in preoperative and postoperative Wexner scores, anal resting pressure, and anal maximum systolic pressure (P>0.05).This innovative technique with buried drainage tube is safe and effective, which can shorten the recovery time and reduce the recurrence rate.

Objective To explore the clinical features and risk factors of poor prognosis in neonatal necrotizing enterocolitis(NEC).Methods A retrospective study was carried out in the infants with NEC admitted to 6 cooperative hospitals in Guangdong Province between January 2005 and December 2014.The clinical features and risk factors of poor prognosis in preterm and full-term infants diagnosed NEC,early onset and late onset NEC were analyzed.Results A total of 449 cases who met the criteria were admitted during the study time.The mortality was 23.6％ (106/449 cases),of which the preterm group was 24.6％ (58/238 cases) while the full-term group was 22.7％ (48/211 cases),the early onset group was 22.1％ (45/204 cases) while the late onset group was 24.3％ (57/235 cases).The median number of NEC onset in preterm group was 11 d after birth while the number of the full-term group was 6 d.Full-term infants who diagnosed NEC were more likely to manifest themselves as abdominal distension (52.1％ vs.42.0％,x2 =4.597,P =0.032),vomiting(36.5％ vs.17.2％,x2 =21.428,P =0.000) and bloody stool(30.3％ vs.21.4％,x2 =4.653,P =0.031);but in the onset of NEC,preterm infants more likely to have feeding intolerance (21.0％ vs.12.8％,x2=5.309,P =0.021).The early onset group of full-term NEC was much common in twins or multiplets(9.4％ vs.1.1％,x2 =6.226,P =0.013),which rate of surgical therapy was much higher (41.0％ vs.27.0％,P =0.036) and the breast-feeding rate before NEC was lower than the late onset group(14.5％ vs.32.6％,x2 =9.500,P =0.002),the differences were statistically significant.The gestational age and birth weight were bigger in the early onset group of preterm NEC[(33.8 ±2.5) weeks vs.(32.2 ±2.8) weeks,t =4.261,P =0.000;(2.1 ±0.5) kg vs.(1.7 ± 0.5) kg,t =4.735,P =0.000)],but length of stay was shorter than the late onset group (18.0 d vs.26.5 d,P =0.000).Logistic regression analysis showed that the risk factors of poor prognosis of full-term NEC were shock,peritonitis and sepsis;while risk factors of poor prognosis of preterm NEC were small for gestational age infant,pulmonary hemorrhage,shock,intestinal perforation and sepsis;the risk factors of poor prognosis of the early onset group of full-term NEC was shock;while those of the late onset group were shock and peritonitis;the risk factors of poor prognosis in the early onset group of preterm NEC were shock and sepsis,while those in the late onset group were pulmonary hemorrhage,shock,intestinal perforation and sepsis.Conclusions Compared to the preterm NEC,the onset time of full-term NEC was earlier and the clinical manifestations were more typical.Early identification and management of shock,peritonitis,intestinal perforation,sepsis and pulmonary hemorrhage can reduce the risk of poor prognosis of neonate NEC.