Objective:To explore the pattern of lymph node metastasis in the lung lobes of stage Ⅱa non-small cell lung cancer (NSCLC) and the lymph node dissection method during complete video-assisted thoracoscopic lobectomy surgery (cVATS) .Methods:A total of 244 patients with NSCLC who underwent cVATS treatment at Nanjing Tongren Hospital Affiliated to Southeast University School of Medicine from January 2015 to November 2018 were selected. Patients admitted from January 2015 to April 2018 were defined as the training set ( n=183), and patients admitted from May 2018 to November 2018 were defined as the validation set ( n=61). The training set was used to build the model, and the validation set was used to evaluate the performance of the model. In the training set, patients were divided into systematic meditational lymphadenectomy (SML) group ( n=93) and lobe-specific systematic node dissection (LSND) group ( n=90) based on lymph node dissection methods. The lymph node metastasis rate of patients in the training set was calculated, and the clinical data of patients with ( n=55) and without ( n=128) lymph node metastasis were compared. Multivariate logistic regression was used to analyze the influencing factors of lymph node metastasis, and a nomogram prediction model was constructed based on the results of the multivariate analysis, and the model was validated. Clinical data, perioperative clinical indicators, overall survival (OS), and incidence of postoperative complications were compared between the SML group and LSND group in the training set. Results:In the training set, the lymph node metastasis rate of 183 patients with NSCLC was 30.05% (55/183), with a total of 328 metastatic lymph nodes; from the 2nd to the 13th groups of lymph nodes, the 10th (15.60%, 44/282), the 11th (22.79%, 98/430), and the 12th to the 13th (15.25%, 61/400) groups had the highest lymph node metastasis rate. Multivariate analysis showed that maximum tumor diameter ( OR=2.71, 95% CI: 1.82-4.09, P<0.001), CT imaging features ( OR=2.49, 95% CI: 1.59-6.99, P=0.001), degree of differentiation ( OR=2.06, 95% CI: 1.11-3.81, P=0.010), serum carcinoembryonic antigen (CEA) ( OR=1.87, 95% CI: 1.42-2.58, P=0.015), and pleural invasion ( OR=1.81, 95% CI: 1.07-3.07, P=0.021) were all independent influencing factors for the occurrence of lymph node metastasis in Ⅱa NSCLC patients. The C-index of the training set and the validation set were 0.91 (95% CI: 0.88-0.97) and 0.89 (95% CI: 0.84-0.96), respectively, and the calibration curves of the two sets were well fitted to the ideal curves. Receiver operating characteristic curve analysis showed that, the area under curve of the nomogram prediction model used for differential diagnosis of patients in the training and validation sets were 0.92 (95% CI: 0.87-0.96) and 0.91 (95% CI: 0.85-0.98), respectively. There were statistically significant differences in surgical time [(203.08±38.26) min vs. (177.14±22.18) min, t=5.59, P<0.001], intraoperative blood loss [(458.14±65.04) ml vs. (426.08±26.58) ml, t=4.34, P<0.001], thoracic drainage volume [(1 200.14±226.58) ml vs. (1 114.38±164.34) ml, t=2.92, P=0.004], extubation time [(6.57±1.28) d vs. (5.02±1.12) d, t=8.71, P<0.001], hospital stay [(15.02±1.29) d vs. (12.08±1.57) d, t=13.86, P<0.001) between the SML group and the LSND group in the training set. There was no statistically significant difference in OS rate between two groups of patients at 1 year (96.77% vs. 96.67%), 3 years (84.95% vs. 86.67%), and 5 years (75.27% vs. 77.78%) ( χ2=0.16, P=0.689). There was a statistically significant difference in the overall incidence of adverse reactions [18.28% (17/93) vs. 7.78% (7/90) ] between two groups of patients ( χ2=4.43, P=0.035) . Conclusion:Intrapulmonary segment lymph node accounts for a considerable proportion in the metastasis process of NSCLC, with the highest degree of lymph node metastasis rate in groups 10, 11, and 12-13. Maximum tumor diameter, CT imaging features, degree of differentiation, serum CEA, and pleural invasion are all independent influencing factors for the occurrence of lymph node metastasis in NSCLC patients. Compared with SML, LSND has less trauma and a lower incidence of adverse reactions.

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.

Hemangioma of the penile head is rare. This paper reported a patient, 16 years old, who was admitted to hospital due to the discovery of multiple masses on the head of the penis for more than two years. Physical examination showed that three vascular mass-like masses were distributed along the coronal sulcus at the 3, 9, and 12 points of the penile head, and the larger one was about 10 mm×5 mm size, blue-purple, soft, and painless. Ultrasound examination suggested that the patient had a penile head hemangioma. Surgical resection was performed, and the postoperative pathological diagnosis was penile head hemangioma.The follow-up of 3 months showed that the wound healed well without recurrence, and the penile head appearance was not obviously deform.

OBJECTIVE: To investigate the early effectiveness of transiliac-transsacral screws internal fixation assisted by augmented reality navigation system HoloSight (hereinafter referred to as "computer navigation system") in the treatment of posterior pelvic ring injuries. METHODS: A retrospective analysis was made in the 41 patients with posterior pelvic ring injuries who had been treated surgically with transiliac-transsacral screws between June 2022 and June 2023. The patients were divided into navigation group (18 cases, using computer navigation system to assist screw implantation) and freehand group (23 cases, using C-arm X-ray fluoroscopy to guide screw implantation) according to the different methods of transiliac-transsacral screws placement. There was no significant difference in gender, age, body mass index, causes of injuries, Tile classification of pelvic fracture, days from injury to operation, usage of unlocking closed reduction technique between the two groups ( P>0.05). The time of screw implantation, the fluoroscopy times, the guide wire adjustment times of each screw, and the incidence of complications were recorded and compared between the two groups. The position of the transiliac-transsacral screw was scanned by CT within 2 days after operation, and the position of the screw was classified according to Gras standard. RESULTS: The operation was successfully completed in both groups. The time of screw implantation, the fluoroscopy times, and the guide wire adjustment times of each screw in the navigation group were significantly less than those in the freehand group ( P<0.05). There were 2 cases of incision infection in the freehand group, and the incision healed by first intention after active dressing change; there was no screw-related complication in the navigation group during operation and early period after operation; the difference in incidence of complications between the two groups (8.7% vs. 0) was not significant ( P=0.495). According to the Gras standard, the screw position of the navigation group was significantly better than that of the freehand group ( P<0.05). CONCLUSION Compared with the traditional freehand method, the computer navigation system assisted transiliac-transsacral screws internal fixation in the treatment of posterior pelvic ring injuries has advantages of improving the accuracy of screw implantation and reducing radiation damage and the time of screw implantation.
Humans ; Retrospective Studies ; Surgical Wound Infection ; Replantation ; Body Mass Index

Objective:To compare the biomechanical differences of dynamic condylar screw (DCS), locking compression plate (LCP) combined with DCS and medial anatomic buttress plate (MABP) combined with DCS in the revision of medial defective intertrochanteric fractures by finite element analysis.Methods:The femoral CT imaging data provided by a healthy adult volunteer were used to reconstruct the solid three-dimensional model of femur by Mimics 21.0 and Geomagics Studio 12. Evans-Jensen II B intertrochanteric fracture was established by Ansys Workbench18.0. The three-dimensional models of proximal femoral nail antirotation (PFNA), DCS, LCP and MABP were reconstructed in Solidworks 2015. The PFNA was assembled with the fracture model, and then the PFNA was removed to establish the postoperative failure model of femoral intertrochanteric fracture and then simulated the fixation in the hip-preserving revision surgery of femoral intertrochanteric fractures: non-medial support reconstruction group (DCS); indirect medial support reconstruction group (DCS+LCP) and partial direct medial support reconstruction group (DCS+MABP). Finally, the forces on the hip joint of 70 kg normal people during standing (700 N), slow walking (1,400 N), brisk walking (1,750 N) and going up and down stairs (2,100 N) were simulated in Abaqus 6.14, the relative displacement and stress peak value of fracture end and stress distribution and stress peak value of internal fixation in different models were recorded.Results:At 700 N axial load, the relative displacement of fracture end fixed by DCS, DCS+LCP and DCS+MABP was 0.28, 0.13 and 0.09 mm; the peak stress of the fracture end was 49.01, 15.29 and 1.35 MPa; the peak stress of internal fixation was 230, 220 and 174 MPa, respectively. At 1,400 N axial load, the relative displacement of the fracture end of the three internal fixation methods was 0.56, 0.24 and 0.16 mm; the peak stress of fracture end was 108.49, 28.96 and 3.12 MPa; the peak stress of internal fixation was 469, 352 and 324 MPa, respectively. At 1,750 N axial load, the relative displacement of the fracture end of the three group was 0.70, 0.30 and 0.20 mm; the peak stress of the fracture end was 139.59, 37.57 and 4.17 MPa; the peak stress of internal fixation was 594, 421 and 393 MPa, respectively. At 2,100 N axial load, the relative displacement of the fracture end of the three internal fixation methods was 0.85, 0.35 and 0.23 mm; the peak stress of the fracture end was 170.05, 46.36 and 5.24 MPa; the peak stress of internal fixation was 724, 504 and 460 MPa, respectively.Conclusion:The partial direct reconstruction of medial support under the neck by DCS+MABP may have better biomechanical properties in the revision of medial defective intertrochanteric fractures.

Objective:To explore which configuration schemes of proximal humerus internal locking system (PHILOS) fixation with endosteal augmentation can provide the optimal biomechanical stability for treatment of osteoporotic proximal humeral fractures by means of finite element analysis.Methods:Based on the CT data of the humerus of an old female volunteer (78 years old, with a bone density T-value of -3.0), a three-dimensional finite element model of the humerus was established by digital medical software such as Mimics 19.0, Geomagic Studio 12, and Creo 2.0 ANSYS Workbench2019. Next, a model of unstable proximal humerus fracture was established and subjected respectively to 5 different fixations: simple PHILOS fixation (PHILOS group), PHILOS plus 6-cm fibula fixation with calcar screws (PHILOS-F-C-6 group), PHILOS plus 6-cm fibula fixation without calcar screws (PHILOS-F-6 group), PHILOS plus 9-cm fibula fixation with calcar screws (PHILOS-F-C-9), and PHILOS plus 9-cm fibula fixation without calcar screws (PHILOS-F-9 group). After a stress mode of shoulder joint abduction at 25° was simulated, a compressive load of 200N was applied to the 5 fixation models. The stress distribution and displacement of fracture ends in different fixation models were tested, and the biomechanical stability was compared among the 5 different internal fixations.Results:Under a shoulder joint abduction at 25° and a load of 200 N, the maximum stress and the displacement of the fracture ends in PHILOS-F-C-9 group (38.678 Mpa and 0.012 mm) decreased by 30.08% and 45.45%, respectively, compared with PHILOS-F-C-6 group (55.321 Mpa and 0.022 mm), and decreased by 12.48% and 15.38%, respectively, in PHILOS-F-9 group (77.012 Mpa and 0.033 mm) compared with PHILOS-F-6 group (88.106 Mpa and 0.039 mm). The maximum stress and the displacement of the fracture ends in PHILOS-F-C-6 group decreased by 37.21% and 43.59%, respectively, compared with PHILOS-F-6 group while decreased by 49.83% and 63.63% in PHILOS-F-C-9 group compared with PHILOS-F-9 group, respectively.Conclusion:For treatment of osteoporotic proximal humeral fractures with medial instability, PHILOS fixation with longer fibula endosteal augmentation plus insertion of calcar screws is a more appropriate choice which can reduce the stress of internal fixation and reduce the displacement of the fracture ends.

Irradiation based on accelerator is the main method of radionuclide production. In recent years, with the development of theranostics of nuclear medicine, there is a new demand for the preparation of accelerator radionuclides. In this paper, the nuclides and nuclide pairs of theranostics prepared by accelerators are divided into the three categories: nuclides of theranostics, nuclide pairs of theranostics of same element and different elements. The physical properties and current applications of some nuclides and nuclide pairs are introduced. The problems in the application of accelerator radionuclides preparation in China are analyzed, and the application prospect of the integration of accelerator radionuclides diagnosis and treatment is prospected.

Objective:To summarize the clinical characteristics and liver biochemical parameters of 324 cases admitted with novel coronavirus pneumonia in Shanghai area.Methods:Clinical data and baseline liver biochemical parameters of 324 cases with novel coronavirus pneumonia admitted to the Shanghai Public Health Clinical Center from January 20, 2020 to February 24, 2020 were retrospectively analyzed. Patients were divided into two groups based on the status of illness: mild type (mild and typical) and severe type (severe and critical).The differences in clinical data and baseline liver biochemical parameters of the two groups were described and compared. The t-test and Wilcoxon rank-sum test were used for measurement data. The enumeration data were expressed by frequency and rate, and chi-square test was used.Results:Of the 324 cases with novel coronavirus pneumonia, 26 were severe cases (8%), with median onset of 5 days, 20 cases were HBsAg positive (6.2%), and 70 cases (21.6%) with fatty liver, diagnosed with X-ray computed tomography. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyl transferase (GGT), total bilirubin (TBil), albumin(ALB) and international normalized ratio (INR) of 324 cases at baseline were 27.86 ± 20.02 U/L, 29.33 ± 21.02 U/L, 59.93 ± 18.96 U / L, 39.00 ± 54.44 U/L, 9.46 ± 4.58 μmol / L, 40.64 ± 4.13 g / L and 1.02 ± 0.10. Of which, ALT was > than the upper limit of normal (> ULN), accounting for 15.7% (51/324). ALT and AST > ULN, accounting for 10.5% (34/324). ALP > ULN, accounting for 1.2% (4/324). ALP and GGT > ULN, accounting for 0.9% (3/324). INR > ULN was lowest, accounting for 0.6% (2/324). There were no statistically significant differences ( P > 0.05) in ALT [(21.5 vs. 26) U / L, P = 0.093], ALP [(57 vs.59) U/L, P = 0.674], and GGT [(24 vs.28) U/L, P = 0.101] between the severe group and the mild group. There were statistically significant differences in AST (23 U/L vs. 34 U/L, P < 0.01), TBil (10.75 vs. 8.05 μmol / L, P < 0.01), ALB (35.79 ± 4.75 vs. 41.07 ± 3.80 g/L, P < 0.01), and INR (1.00 vs. 1.04, P < 0.01). Conclusion:The baseline liver biochemical parameters of 324 cases with novel coronavirus pneumonia in Shanghai area was comparatively lower and the liverinjury degree was mild, and the bile duct cell damage was rare.

Objective To investigate the efficacy of external pelvic reduction frame system combined with tunnel screw fixation in the treatment of Tile C1 pelvic fracture.Methods A retrospective case series analysis of 15 patients with Tile C1 pelvic fractures from January 2014 to October 2016 was pedormed.Clinical data included seven males and eight females,aged 26-84 years (mean,48.9 years).According to Tile classification,there were five cases of type C1.1,three cases of C1.2,and seven cases of type C1.3.The average time from injury to surgery was 9.5 days (range,4-33 days).All patients received the treatment of external pelvic reduction frame system combined with tunnel screw fixation.The operation time,intraoperative blood loss,and complications were recorded.The fracture reduction quality was evaluated according to the Matta criteria,and the clinical function and neurological function were evaluated by the Majeed functional scoring system and the Gibbons sacral nerve injury grading,respectively.Results The patients were followed up for an average of 16 months (range,12-24 months).The mean operation time was 139 minutes (range,50-250 minutes),and the mean intraoperative blood loss was 90 ml (range,20-260 ml).No complications such as wound infection,loose internal fixation,rupture or loss of reduction occurred in the patients.According to the Matta score,14 patients obtained anatomical reduction,and one obtained satisfactory reduction.At the last follow-up,according to the Majeed functional scoring criteria,the results were excellent in all 15 patients,with an excellent and good rate of 100％.According to Gibbons sacral nerve injury grading,two out of the three patients with neurologic impairment before the operation recovered completely while the remaining one did not recover.Conclusion In the treatment of Tile C 1 pelvic fractures,external pelvic frame reduction system combined with tunnel screw fixation can attain satisfactory fracture reduction,reliable fixation,and good functional recovery.

Objective To investigate the efficacy of microsurgical subinguinal varicocelectomy for unilateral varicocele.Methods One hundred and five cases with left side varicocele were enrolled from August 2012 to October 2016.Thirty one cases suffered from varicocele in Ⅱ degree,and other seventy four cases in Ⅲ degree.Clinical data including operation time,sperm quality,testosterone level,complications and natural pregnoncy rate were retrospectively analyzed.The measurement data were expressed by (x) ± s.Sperm concentration,sperm motility,the rate of sperm normal morphology and serum testosterone levels were compared before and after operation with paired t test.Results The average operative time of varieocele was (58 ± 9) minutes in the outer ring of the microscope.Compared with preoperation's,sperm concentration,sperm motility,the rate of sperm normal morphology was remarkable improved after 3 month.However,serum testosterone levels were steady.In the outpatient follow-up,there were no complications,such as orchiatrophy,hydrocele of tunica vaginalis or recurrence of varicocele.The rate of natural pregnoncy in one year was 46.7％.Conclusions Microsurgical subinguinal varicocelectomy can remarkably improve sperm quality for patients,who suffer from varicocele in Ⅱ or Ⅲ degree.The complication of microsurgical subinguinal varicocelectomy is rare.Male infertility patients resulted from varicocele will get favorable natural pregnoncy rate.