Objective To analyze the relationships between pulmonary ground-glass nodules(GGN)and bronchi and blood vessels and their diagnostic values for infiltrative lesions based on high-resolution computed tomography(HRCT)target scanning technology.Methods Patients with GGN detected by HRCT target scanning and complete pathological results were retrospectively selected as the research subjects.The relationships between GGN and bronchi and blood vessels in patients with different pathological types were analyzed,and the relationships for detecting infiltrative lesions were further analyzed,using pathological results as the gold standard.Results Three hundred patients were divided into 237 cases of pre-invasive lesions and 63 cases of infiltrative lesions according to pathological results.There were statistically significant differences in lesion properties and lesion morphology in patients with different types of GGN(P＜0.05).There were statistically significant differences in the relationships between GGN and bronchi and blood vessels in the pre-invasive lesions and the infiltrative lesions(P＜0.05).Based on the pathological results as the gold standard,the sensitivity of HRCT bronchial classification,vascular classification,and their combined detection of infiltrative lesions were 84.13％(53/63),95.24％(60/63),and 95.24％(60/63);specificity were 83.12％(197/237),87.34％(207/237),and 87.34％(207/237);accuracy were 83.33％(250/300),89.00％(267/300),and 89.00％(267/300).Conclusion Evaluating the classification of pulmonary GGN and bronchi and blood vessels by HRCT target scanning technology has good value in identifying infiltrative lesions.The combined diagnosis of the two signs can further improve the accuracy of detection.

Administration, Intravenous ; Ascorbic Acid/therapeutic use* ; COVID-19 ; Humans ; Pneumonia ; SARS-CoV-2

Objective:To explore the role of micro lecture in the standardized residency training of urology.Methods:The residents, who had standardized residency training in the department of urology of Shengjing Hospital of China Medical University from January 2017 to October 2018, were selected to be trained by traditional teaching mode (control group) and micro lecture teaching method (experimental group) respectively. The residents had examination of theory learning, clinical practice and clinical case examination, and completed the satisfaction questionnaire. Then the data were collected and analyzed. SPSS 17.0 was used for t test and chi-square test. Results:The scores of the residents in the experimental group were better than those in the traditional teaching group, with significant differences between the two groups ( P < 0.05). For satisfaction survey, the satisfaction rate of the experimental group was 92.50%, which was better than that of the control group's 75.00% ( P = 0.03). Conclusion:The application of micro lecture in the standardized residency training of urology can stimulate the learning enthusiasm of residents and improve the quality of teaching.

Objective:To explore the effect of plastic surgery suture technique and its proficiency in facial scar inhibition after trauma, and to explore the key factors to improve the suture proficiency of junior residents.Methods:The data of patients with facial trauma who underwent plastic surgery suture in the department of plastic and reconstructive surgery of Ningbo First Hospital from June 2017 to July 2019 were retrospectively analyzed. They were divided into senior group and junior group according to the seniority of chief surgeon. The general condition, scar appearance and local symptoms of the two groups were evaluated by SCAR Scale, including scar expansion, erythema, hyperpigmentation or hypopigmentation, suture marks, hyperplasia or atrophy, scar pruritus, scar pain, and the result were statistically analyzed.Results:A total of 83 patients (54 females and 29 males) were included in this study, the maximum age was 63, the minimum age was 3, and the average age was (31. 7±13. 3), including senior group (52 cases) and junior group (31 cases) . The differences were not statistically significant in gender, age, injury time, wound length and complications between the two groups. The total scores of SCAR Scale in the senior and junior groups were 2. 18±0. 98 and 2. 78±1. 30, respectively, the difference was statistically significant ( P=0. 020 ). The senior group was better than the junior group in inhibiting scar expansion ( P=0. 035 ), eliminating suture marks ( P =0. 018 ) , overall scar impression ( P=0. 038 ) and reducing pigment abnormality ( P =0. 045 ). However, in inhibiting erythema and inhibiting scar hyperplasia or atrophy, the differences were not statistically significant between two groups. In the senior group, 4 patients had pain within 24 hours, 3 patients had pruritus; in the junior group, 2 patients had pain, 3 patients had pruritus. Conclusions:Plastic surgery suture technique will effectively improve the appearance of facial scar after trauma, especially in inhibiting scar expansion, erythema, hyperplasia or atrophy, and overall impression. Junior doctors can be competent for this work to a certain extent, but thay need long-term training to master the technology, and skilled operation can further improve the curative effect.

Objective:To explore the effect of plastic surgery suture technique and its proficiency in facial scar inhibition after trauma, and to explore the key factors to improve the suture proficiency of junior residents.Methods:The data of patients with facial trauma who underwent plastic surgery suture in the Department of Plastic and Reconstructive Surgery of Ningbo First Hospital from June 2017 to July 2019 were retrospectively analyzed. They were divided into senior group and junior group according to the seniority of chief surgeon. The general condition, scar appearance and local symptoms of the two groups were evaluated by the scar cosmesis assessment and rating scale(SCAR), including scar expansion, erythema, hyperpigmentation or hypopigmentation, suture marks, hyperplasia or atrophy, scar pruritus, scar pain, and the results were statistically analyzed.The mean of continuous data were calculated and expressed as Mean ± SD, the differences between groups were tested by t-test, and the classified data were expressed by rate, and the differences between groups were tested by chi-square test. Results:A total of 83 patients (54 females and 29 males) were included in this study, the maximum age was 63, the minimum age was 3, and the average age was 31.7±13.3 years old, including senior group (52 cases) and junior group (31 cases). The differences were not statistically significant in gender, age, injury time, wound length and complications between the two groups. The total scores of SCAR scale in the senior and junior groups were 2.18±0.98 and 2.78±1.30, respectively, the difference was statistically significant ( P=0.020). The senior group was better than the junior group in inhibiting scar expansion ( P=0.035), eliminating suture marks ( P=0.018), overall scar impression ( P=0.038) and reducing pigment abnormality ( P=0.045). However, in inhibiting erythema and inhibiting scar hyperplasia or atrophy, the differences were not statistically significant between two groups. In the senior group, 4 patients had pain within 24 hours, 3 patients had pruritus; in the junior group, 2 patients had pain, 3 patients had pruritus. Conclusions:Plastic surgery suture technique will effectively improve the appearance of facial scar after trauma, especially in inhibiting scar expansion, erythema, hyperplasia or atrophy, and overall impression.Junior doctors can be competent for this work to a certain extent, but thay need long-term training to master the technology, and skilled operation can further improve the curative effect.

Objective:To explore the effect of plastic surgery suture technique and its proficiency in facial scar inhibition after trauma, and to explore the key factors to improve the suture proficiency of junior residents.Methods:The data of patients with facial trauma who underwent plastic surgery suture in the department of plastic and reconstructive surgery of Ningbo First Hospital from June 2017 to July 2019 were retrospectively analyzed. They were divided into senior group and junior group according to the seniority of chief surgeon. The general condition, scar appearance and local symptoms of the two groups were evaluated by SCAR Scale, including scar expansion, erythema, hyperpigmentation or hypopigmentation, suture marks, hyperplasia or atrophy, scar pruritus, scar pain, and the result were statistically analyzed.Results:A total of 83 patients (54 females and 29 males) were included in this study, the maximum age was 63, the minimum age was 3, and the average age was (31. 7±13. 3), including senior group (52 cases) and junior group (31 cases) . The differences were not statistically significant in gender, age, injury time, wound length and complications between the two groups. The total scores of SCAR Scale in the senior and junior groups were 2. 18±0. 98 and 2. 78±1. 30, respectively, the difference was statistically significant ( P=0. 020 ). The senior group was better than the junior group in inhibiting scar expansion ( P=0. 035 ), eliminating suture marks ( P =0. 018 ) , overall scar impression ( P=0. 038 ) and reducing pigment abnormality ( P =0. 045 ). However, in inhibiting erythema and inhibiting scar hyperplasia or atrophy, the differences were not statistically significant between two groups. In the senior group, 4 patients had pain within 24 hours, 3 patients had pruritus; in the junior group, 2 patients had pain, 3 patients had pruritus. Conclusions:Plastic surgery suture technique will effectively improve the appearance of facial scar after trauma, especially in inhibiting scar expansion, erythema, hyperplasia or atrophy, and overall impression. Junior doctors can be competent for this work to a certain extent, but thay need long-term training to master the technology, and skilled operation can further improve the curative effect.

Objective:To explore the effect of plastic surgery suture technique and its proficiency in facial scar inhibition after trauma, and to explore the key factors to improve the suture proficiency of junior residents.Methods:The data of patients with facial trauma who underwent plastic surgery suture in the Department of Plastic and Reconstructive Surgery of Ningbo First Hospital from June 2017 to July 2019 were retrospectively analyzed. They were divided into senior group and junior group according to the seniority of chief surgeon. The general condition, scar appearance and local symptoms of the two groups were evaluated by the scar cosmesis assessment and rating scale(SCAR), including scar expansion, erythema, hyperpigmentation or hypopigmentation, suture marks, hyperplasia or atrophy, scar pruritus, scar pain, and the results were statistically analyzed.The mean of continuous data were calculated and expressed as Mean ± SD, the differences between groups were tested by t-test, and the classified data were expressed by rate, and the differences between groups were tested by chi-square test. Results:A total of 83 patients (54 females and 29 males) were included in this study, the maximum age was 63, the minimum age was 3, and the average age was 31.7±13.3 years old, including senior group (52 cases) and junior group (31 cases). The differences were not statistically significant in gender, age, injury time, wound length and complications between the two groups. The total scores of SCAR scale in the senior and junior groups were 2.18±0.98 and 2.78±1.30, respectively, the difference was statistically significant ( P=0.020). The senior group was better than the junior group in inhibiting scar expansion ( P=0.035), eliminating suture marks ( P=0.018), overall scar impression ( P=0.038) and reducing pigment abnormality ( P=0.045). However, in inhibiting erythema and inhibiting scar hyperplasia or atrophy, the differences were not statistically significant between two groups. In the senior group, 4 patients had pain within 24 hours, 3 patients had pruritus; in the junior group, 2 patients had pain, 3 patients had pruritus. Conclusions:Plastic surgery suture technique will effectively improve the appearance of facial scar after trauma, especially in inhibiting scar expansion, erythema, hyperplasia or atrophy, and overall impression.Junior doctors can be competent for this work to a certain extent, but thay need long-term training to master the technology, and skilled operation can further improve the curative effect.

Objective: To investigate the value of abnormal expression of HLA-DR on peripheral blood monocytes in evaluating the immune function status, clinical prognosis and severity of patients with hand, foot and mouth disease (HFMD). Methods: From June 2017 to October 2018, 100 cases of mild HFMD, 80 cases of severe HFMD, 32 cases of critical HFMD and 40 healthy children (control group) were recruited in this study. The patients were divided into two groups, lower DR group (DR-L, HLA-DR expression<30%) and normal DR group (DR-N, HLA-DR expression>30%) according to the HLA-DR expression on monocytes. Flow cytometry was used to detect the CD14⁺ monocytes expressing HLA-DR and the absolute count of lymphocyte subsets. Immunoturbidimetry was used to detect the levels of IgG, IgM and IgA in plasma samples. Enzyme-linked immunosorbent assay (ELISA) was performed to detect the levels of IFN-γ and IL-10 in plasma samples. Pediatric critical illness score (PCIS) and the pediatric risk of mortality Ⅲ (PRISM Ⅲ) were used to estimate the severity of HFMD. Results: ① There were significant differences in HLA-DR expression on monocytes among children with mild, severe and critical HFMD (F=47.102, P<0.05). Patients with critical HFMD had the lowest HLA-DR expression (P<0.05). ② The numbers of CD14⁺ monocytes, CD3⁺ T cells, CD4⁺ T cells, CD8⁺ T cells, B cells and NK cells in peripheral blood of the DR-L group were significantly lower than those of the DR-N group and the normal group, especially in patients with severe or critical HFMD (P<0.05). ③ There was no significant difference in the level of IgG, IgA or IgM among the DR-L, DR-N and control groups (P>0.05). ④ Compared with the DR-N group, the DR-L group showed decreased IFN-γ level and increased IL-10 level in plasma (P<0.05). The ratio of IFN-γ/IL-10 of the DR-L group was lower than that of the DR-N group and control group (P<0.05). HLA-DR expression was negatively correlated with the concentration of IL-10 in plasma (r=-0.704, P<0.05), and positively correlated with the IFN-γ/IL-10 ratio (r=0.773, P<0.05). ⑤ Compared with the DR-N group, the DR-L group showed lower PCIS and higher PRISM Ⅲ. HLA-DR expression was positively correlated with PCIS (r=0.715, P=0.00) and negatively correlated with PRISM Ⅲ (r=-0.610, P=0.00). ⑥ The incidence of pulmonary edema, pulmonary hemorrhage and cardiopulmonary failure and the mortality of HFMD patients in the DR-L group were significantly higher than those in the DR-N group (P<0.05). Conclusions Patients with severe or critical HFMD had cellular immune dysfunction and abnormal HLA-DR expression on CD14⁺ monocytes. Assessing the expression of HLA-DR on monocytes could be used to evaluate the cellular immunity of patients with severe or critical HFMD. Lower expression of HLA-DR on CD14⁺ monocytes might be associated with severe HFMD and poor prognosis.

Objective To explore the protective effect of magnesium sulfate on the nerve injury in severe hand, foot and mouth disease ( HFMD) caused by enterovirus A71 ( EV-A71) and to investigate its clinical and prognostic effects.Methods A total of 240 cases of severe HFMD with EV-A71 infection and nerve injury were enrolled.According to the random number table method, the patients were randomly divided into conventional treatment group (control group) and magnesium sulfate treatment group ( treatment group), with 120 cases in each group.The control group was given the routine treatment, and the treatment group was given the magnesium sulfate adjuvant treatment on the basis of routine treatment.The neurological symptoms and signs, clinical efficacy and prognosis were observed before and after treatment in the two groups.The blood and cerebrospinal fluid neuron-specific enolase ( NSE), S100-βprotein and neuropeptide Y ( NPY) were analyzed before and after treatment.The amplitude integrated electroencephalogram (aEEG) was used to monitor the abnormal recovery of EEG.The t-test was applied to analyze quantitative data, and the chi-square test was used for qualitative data comparison.Results Among children with severe HFMD, there were 83 cured cases, 29 improved cases and 8 ineffective cases in control group, with the total effective rate of 93.3%; while in the treatment group, 101 cases were cured, 18 cases were improved and 1 case was ineffective, the total effective rate was 99.2%.The therapeutic effects (Z＝2.918, P＝0.004) and the total effective rate ( χ2 ＝4.156, P＝0.041) were statistically significantly different between the two groups.Three days after treatment, the average levels of serum NSE, S100-βprotein and NPY in magnesium sulfate treatment group were significantly lower than those in control group (t＝-7.239,-10.020 and -11.053, respectively, all P＜0.01).Five days after treatment, the average levels of cerebrospinal fluid NSE, S100-β protein and NPY in magnesium sulfate treatment group were significantly lower than those in control group ( t＝-6.546,-13.308 and -10.258, respectively , all P＜0.01).After treatment, the neurological function score in treatment group was significantly lower than that in control group and that before treatment , and the differences were statistically significant ( t ＝-9.473 and 12.162, respectively, both P ＜0.01 ).The recovery time of the main symptoms and signs in treatment group was ( 2.33 ±0.76 ) d, which was significantly shorter than that of control group ([3.21 ±0.82] d), the difference was statistically significant (t＝-12.52, P＜0.05).The average length of hospital stay in treatment group was (5.79 ±1.42) d, which was shorter than that in control group ([ 6.71 ±1.46 ] d ), and the difference was statistically significant ( t＝-4.932, P＜0.05).Of the 240 children with severe HFMD, 194 (80.8%) patients had abnormal aEEG.Before treatment, the aEEG abnormal rates in control group and the magnesium sulfate treatment group were 79.2%(95 cases) and 82.5%(99 cases), respectively, there was no significant difference ( χ2 ＝0.430, P＞0.05); while after treatment for 3 days, 76 cases in treatment group returned to normal, and the recovery rate of aEEG was 76.8%, which was higher than that in control group (52.6%). The difference was statistically significant ( χ2 ＝12.406, P ＜0.05 ).Conclusions Magnesium sulfate adjuvant therapy can reduce the abnormal levels of NSE, S100-βand NPY in blood and cerebrospinal fluid, relieve clinical symptoms, shorten the course of disease and average length of hospital stay, improve the neurological function score, and promote the recovery of abnormal aEEG.Thus, it has neuroprotective effect on severe HFMD with nervous system lesion.

To investigate the clinical efficacy of one-stage repairing the wounds after excision of soft tissue malignant tumor in lower limb with deep inferior epigastric perforator (DIEP) flaps. Methods From Au-gust, 2016 to July, 2018, 11 patients(8 males and 3 females; aged 35-76 years) with the soft tissue defects in the low-er limb underwent immediate reconstructive operations with DIEP flap after their tumor resection. The defects ranged in area from 11 cm×7 cm to 25 cm×10 cm after extended resection, including 5 cases of bone exposure. The DIEP flap area ranged from 11 cm×8 cm to 26 cm×18 cm.Among them, 9 cases were treated with free transplantation and 2 cases with pedicle transplantation.The donor sites were closed directly. The patients’ limb function, tumor recurrence and the healing of surgical incision had been followed-up. Results Eleven flaps survived and the donor sites healed directly. One flap had skin pigmentation due to postoperative vascular crisis, and the other flaps had satisfied texture and appearance. All patients were followed-up from 6 to 30 months. The lower limb movement was normal. All the donor sites had a good healing with no pain and abdominal complications. No tumor recurrence was observed during the followed-up period. Conclusion DIEP flap have many advantages, such as large cutting area, which is suitable for large-area wound repair after extended excision of soft tissue malignant tumor in lower limb. At the same time, the perforator vessel is constant and the caliber are thick, also the donor area is concealed and can be sutured directly.This kind of the technique for reconstruction of lower limb soft tissue defects after malignant tumor resection is well acceptable.