Background and Aims:In the era of minimally invasive surgery,the role of pancreatic tumor enucleation(PTE)in treating benign or low-grade malignant tumors is gaining attention.The Da Vinci robot offers advantages such as enhanced visualization and flexible instrument manipulation,which can ensure the safe implementation of PTE.However,whether robotic pancreatic tumor excision(RPTE)is superior to laparoscopic pancreatic tumor enucleation(LPTE)remains undetermined.Therefore,this study was performed to explore this aspect. Methods:The clinical data of 38 patients who underwent surgical treatment for benign or low-grade malignant tumors in the Third Xiangya Hospital of Central South University from April 2020 to May 2024 were collected.Among them,18 cases underwent RPTE(RPTE group),and 20 cases underwent LPTE(LPTE group).Relevant clinical variables were compared between the two groups,and subgroup comparisons were further conducted for patients with tumors in the head and neck/body/tail of the pancreas. Results:The average operative time for the entire group was 125 min,with an average intraoperative blood loss of 67.89 mL,and no C-grade pancreatic fistula occurred.The incidence rates of B-grade pancreatic fistula,postoperative bleeding,and readmission were 39.5％,21.1％,and 18.4％,respectively,with an average postoperative hospital stay of 11.44 d.Overall,the RPTE group had shorter operative time and less intraoperative blood loss than the LPTE group(both P＜0.05).There were no statistically significant differences between the two groups regarding the incidence of B-grade pancreatic fistula,intraoperative bleeding,readmission rate,and postoperative hospital stay(all P＞0.05).Subgroup analysis showed that for patients with head tumors,the RPTE group had shorter operative time,less intraoperative blood loss,and a lower incidence of postoperative bleeding than the LPTE group(all P＜0.05).However,the differences in the incidence of B-grade pancreatic fistula,readmission rate,and postoperative hospital stay were not statistically significant(all P＞0.05).In patients with neck/body/tail tumors,the RPTE group also had shorter operative time and less intraoperative blood loss(both P＜0.05),but the differences in incidence of B-grade pancreatic fistula,incidence of postoperative bleeding,readmission rate,and postoperative hospital stay were not statistically significant(all P＞0.05). Conclusion:Minimally invasive PTE for the treatment of benign or low-grade malignant pancreatic tumors is safe.Compared to LPTE,RPTE can significantly reduce operative time and intraoperative blood loss and shows certain advantages in reducing postoperative complications,particularly for patients with head tumors.However,the conclusion of this study needs to be confirmed by larger prospective studies.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective: To explore the relationship between junior high school students lifestyles and 20 m shuttle run test (20 m SRT) performance, so as to provide a theoretical basis for promoting a healthy lifestyle among junior high school students. Methods: From April to June 2021, a total of 2 397 junior high school students aged 12-17 years in Yushan, Wuyuan, Hengfeng and Yugan counties of Shangrao City, Jiangxi Province were selected by random cluster stratified sampling. A questionnaire survey and 20 m SRT test were conducted. Logistic regression analysis was used to explore the association between lifestyles and 20 m SRT scores. Results: The passing rate of 20 m SRT for middle school students was 83.3%. Chi square test results showed that there were statistically significant differences between gender, grade, household registration, type of schooling, father s education and the 20 m SRT scores of junior high school students ( χ 2=25.26, 25.04, 6.99, 7.96, 16.22, P <0.05). Significant differences were found in 20 m SRT scores between vigorous and moderate physical activity and breakfast behavior in the last seven days ( χ 2=6.78, 6.29, 9.13, P < 0.05). The results of Logistic regression analysis showed that after controlling for confounding factors, "no vigorous physical activity in the last seven days" was positively correlated with the lower performance of 20 m SRT ( OR =1.31, 95% CI =1.03- 1.67 , P < 0.05). "Breakfast skipping" was positively correlated with 20 m SRT lower performance (frequent eating, OR =1.37, 95% CI = 1.09 -1.73, P <0.01). Conclusion Vigorous physical activity and regular breakfast consumption behavior are associated with higher performance 20 m SRT of junior high school students. Schools should encourage students to develop a habit of actively exercising and consuming breakfast regularly in order to ensure the healthy development of cardiopulmonary endurance levels.

Objective:To investigate radiation-induced somatic mutations and variations and provide theoretical basis for clarifying radiation-induced genetic changes and long-term effects by whole-genome sequencing analysis of the genetic variations of the victim of the " 5.7" 192Ir radiation accident in Nanjing. Methods:Normal back skin tissue, irradiated bone and soft tissues, and peripheral blood were collected from the victim 2 047 days post-irradiation. DNA of these samples was extracted and sequenced with high-throughput genomics and analyzed by bioinformatics method. The genetic variations of between irradiated and normal tissues were compared.Results:Compared with normal back skin tissue, there are large amounts of genetic variations in the irradiated bone and soft tissues and peripheral blood, including base substitution (transition, transversion), small insertion, small deletion, copy number variation (gain, loss) and structure variation (large deletion, large duplication, inversion, intra-chromosomal translocation, inter-chromosomal translocation). There were 10 666 genetic variations in the irradiated bone and soft tissues and 11 233 genetic variations in peripheral blood, where thousands of genes were involved in. These variations occurred in the exons, introns, UTR′3, UTR′5, splicing sites, within 5 kb upstream of transcription initiation site, within 5 kb downstream of transcription termination site, ncRNA and intergenic region. All chromosomes had genetic variations.Conclusions:There were a large number of genetic variations in the irradiated tissues and blood of the victim at 2 047 days after irradiation, which may affect the body function and cause the long-term effects.

Objective:To explore the efficacy and safety of urethroplasty combining the reconstruction of urethral plate with the enlargement of urethral cavity in the treatment of short penile urethral atresia or severe stricture.Methods:From January 2017 to September 2020, 10 patients, 22 to 78 years old and the average age 48, with short penile urethral atresia or severe stricture were treated in the Department of Urology, Henan University People’s Hospital, Henan Provincial People’s Hospital. The lengths of the stenotic or atresic segment were 0.2-0.5 cm, with an average length of 0.3 cm. They were all treated with one-stage urethroplasty to reconstructe urethral plate and enlarge urethral cavity with free prepuce skin grafts or pedicled flaps adjacent to the stenosis. By the guidance of urethral dilator, the strictured urethra was incised longitudinally on the ventral side of penis to the distance of 0.5 cm into the normal urethral mucosa at both ends. The stricture or atresic scar tissue of the urethra was removed. The distal and proximal corpus spongiosum were appropriately dissociated, and the urethral mucosa at the both ends of the dorsal side was anastomosed intermittently to reconstruct the urethral plate. Free prepuce skin grafts were used in 4 cases, and pedicled flaps adjacent to the stenosis were used in 6 cases to enlarge the urethral cavity.Results:In this study, the operation time ranged from 75 minutes to 100 minutes, with an average of 85.6 minutes. Intraoperative blood loss ranged from 20 ml to 65 ml, with an average of 45.5 ml. Followed up from 3 months to 3 years postopreatively, all of them did not have painful erection and penile curvature during erection, and felt the same as before in sexual life. Urinary flow rates were significantly improved in 9 cases, and the maximum flow rate was more than 15 ml/s. One recurred patient was cured after urethral dilatation.Conclusions:The one-stage urethroplasty combined the reconstruction of urethral plate with the enlargement of urethral cavity. The urethral plate was reconstructed through urethral resection of narrow segment and the urethral cavity was enlarged with free skin or pedicled flap. This technique has the advantages of a simple and safe operation with a high success rate and a less complication rate. It is an effective procedure to repair short penile urethral atresia or severe stricture.

Objective:To explore the efficacy and safety of urethroplasty combining the reconstruction of urethral plate with the enlargement of urethral cavity in the treatment of short penile urethral atresia or severe stricture.Methods:From January 2017 to September 2020, 10 patients, 22 to 78 years old and the average age 48, with short penile urethral atresia or severe stricture were treated in the Department of Urology, Henan University People’s Hospital, Henan Provincial People’s Hospital. The lengths of the stenotic or atresic segment were 0.2-0.5 cm, with an average length of 0.3 cm. They were all treated with one-stage urethroplasty to reconstructe urethral plate and enlarge urethral cavity with free prepuce skin grafts or pedicled flaps adjacent to the stenosis. By the guidance of urethral dilator, the strictured urethra was incised longitudinally on the ventral side of penis to the distance of 0.5 cm into the normal urethral mucosa at both ends. The stricture or atresic scar tissue of the urethra was removed. The distal and proximal corpus spongiosum were appropriately dissociated, and the urethral mucosa at the both ends of the dorsal side was anastomosed intermittently to reconstruct the urethral plate. Free prepuce skin grafts were used in 4 cases, and pedicled flaps adjacent to the stenosis were used in 6 cases to enlarge the urethral cavity.Results:In this study, the operation time ranged from 75 minutes to 100 minutes, with an average of 85.6 minutes. Intraoperative blood loss ranged from 20 ml to 65 ml, with an average of 45.5 ml. Followed up from 3 months to 3 years postopreatively, all of them did not have painful erection and penile curvature during erection, and felt the same as before in sexual life. Urinary flow rates were significantly improved in 9 cases, and the maximum flow rate was more than 15 ml/s. One recurred patient was cured after urethral dilatation.Conclusions:The one-stage urethroplasty combined the reconstruction of urethral plate with the enlargement of urethral cavity. The urethral plate was reconstructed through urethral resection of narrow segment and the urethral cavity was enlarged with free skin or pedicled flap. This technique has the advantages of a simple and safe operation with a high success rate and a less complication rate. It is an effective procedure to repair short penile urethral atresia or severe stricture.

Children Takayasu arteritis(c-TA)is a potentially life-threatening macrovasculitis that occurs during childhood.The early clinical manifestations are nonspecific, and the damage often leads to ischemic dysfunction of the organ.Non-invasive techniques such as magnetic resonance angiography has been included in the diagnosis and follow-up of children.At present, the conventional treatment plan is the combination of glucocorticoid and immunosuppressant.In the cases of refractory venereal diseases, biological agents should be considered as soon as possible to prevent the damage of ischemia to the terminal organs.When artery stenosis is severe, intravascular(stent or balloon)or bypass intervention is needed to reconstruct the blood vessels of the affected organs.Early diagnosis and timely and correct management are of vital importance in reducing the incidence rate and risk of injury.

Objective:Based on an investigation of an outbreak of COVID-19 in Nanchang, to understand the transmission process, analyze the infectivity of the cases in incubation period and asymptomatic carrier, and evaluate the transmission risks in different exposures.Methods:Case investigation was based on the traditional epidemiological survey, combined with analysis based on big data about population movement trajectories. Transmission chain was identified to indicate transmission relationship.Results:A total of 27 cases were found in this cluster epidemic, including 25 confirmed cases, 1 suspected case (index case) and 1 asymptomatic carrier. A total of 347 close contacts were found. The secondary attack rate was 7.2% (25/347). The infection rates in close contacts of the first, second, third and fourth generation cases were 52.6% (10/19), 6.1% (13/213), 2.3% (2/88) and 0.0% (0/27), respectively. Asymptomatic carrier caused household transmission. The infection rates in close contacts after having meals, sharing rooms/beds, having work contacts, having neighbor contacts, having same time medical services or sharing wards and sharing vehicles with the patients were 10.6%(17/160), 10.0%(20/201), 5.3%(5/94), 0.0%(0/30), 0.0%(0/18) and 0.0%(0/17), respectively.Conclusions:The infection source of this cluster epidemic was a suspected case from Wuhan. Analysis based on big data about population movement trajectories can help to search the cases and close contacts accurately. The proposed epidemic prevention and control measures based on this investigation were effective.

Objective To evaluate FIB-NLR,a combined neutrophil-lymphocyte ratio (NLR) and fibrinogen concentration (FIB) in predicting the prognosis of gastrointestinal stromal tumors (GIST).Methods Data of 79 GIST patients who underwent surgery from Jun 2010 to Dec 2014 were retrospectively analyzed.Patients were divided into 3 groups:NLR ＜ 2.30 and FIB ＜ 3.85 g/L were defined as group 0,NLR≥2.30 and FIB ＜3.85 g/L or NLR ＜2.30 and FIB≥3.85 g/L as group 1,NLR≥2.30 and FIB≥3.85 g/L as group 2.The clinicopathological features of the three groups and the 5-year recurrence-free survival rate after surgery were compared.Results FIB concentration and NLR were significantly correlated with NIH risk grade and tumor size in GIST patients (x2 =9.517,12.41 1,6.081,20.067,all P ＜ 0.05).FIB-NLR was closely related to tumor size,tumor risk and tumor mitosis (x2 =14.406,12.514,28.225,all P ＜ 0.05).Survival analysis showed that high FIB predicts lower 5-year recurrence-free survival rate,it was 87.4％ for group 0,60.8％ for group 1,21.1％ for group2,x2 =29.617,P＜0.000).Conclusion FIB-NLR independently predicts the prognosis of gastrointestinal stromal tumors.

Children arthritis associated infection can be divided into children infectious (invasive) arthritis and post infectious arthritis.Infectious arthritis onset with direct effects on the joints by pathogens,such as bacteria,fungi,viruses,tuberculosis infection.Post infectious arthritis onset often secondary to infection after infection factors of arthritis due to autoimmune reaction,such as reactive arthritis,arthritis after streptococcus infection,and so on.There are their clinical characteristics respectively in infectious arthritis and post infection arthritis in children,and it is important for the diagnosis,treatment and prognosis of children with arthritis to be familiarity with their characteristics.In addition,the factor of infection is closely related to juvenile idiopathic arthritis.It should be pay attention to the role of infectious factors in triggering and aggravating the disease.