Objective To measure the rate of changes of the cardiac troponin T (cTnT) and serum urea nitrogen (N), serum creatinine (Cr), estimated glomerular filtration rate (eGFR) of acute type A aortic dissection (AAAD) patients before and after surgery, and to explore the prognostic significance of the rate of changes. Methods We retrospectively analyzed 77 AAAD patients' clinical data between August 2015 and March 2016 from the department of the cardiothoracic surgery in Nanjing Drum Tower Hospital. There were 57 males and 20 females with an average age of 51.1±13.1 years. The test results of cTnT, N, Cr, eGFR were recorded. Patients were divided into three groups based on the duration of ventilation: less than 48 hours, 48 hours to 7 days, longer than 7 days, and divided into two groups based on whether postoperative dialysis was performed: dialysis group and non-dialysis group. Results In the groups with different duration of ventilation, the rate of cTnT change differed significantly. The rate of Cr and eGFR change in the group with the duration of ventilation longer than 7 days showed significantly different compared to other two groups. We found that the rate of Cr and eGFR change were statistically significant between the dialysis group and the non-dialysis group. In the receiver operating characteristic curve (ROC), the optimal cut-off value of the Cr growth rate for predicting postoperative dialysis therapy was 58.1%, and the optimal cut-off value of the eGFR decline rate was 45.5%. Conclusion The rate of changes in cTnT, N, Cr and eGFR can be used as a reliable mean to evaluate respiratory and renal function for AAAD patients in the early stage, which will facilitate an early assessment of the prognosis of AAAD patients.
ObjectiveTo study the diagnostic significance of modified Alvarado Score System for different types of acute appendicitis. MethodsClinical data of 1 930 cases of acute appendicitis, who underwent appendicectomy in The First Hospital of Yulin from Jan. 2004 to Jan. 2014, were retrospectively collected. Then the diagnostic significance of Modified Alvarado Score System was detected and evaluated by receiver operating characteristic (ROC) curve, and its correlation with postoperative pathological results was calculated. ResultsThe modified Alvarado score of cases in progressive group was higher than that of simplex group (7.5±1.3 vs. 3.6±0.7, P < 0.001). The areas under ROC curve of modified Alvarado Score System was 0.943 (95% CI:0.929-0.958, P < 0.001). The critically diagnostic points of Modified Alvarado Score System for differential diagnosis of simplex acute appendicitis and progressive acute appendicitis was 6 score, with sensitivity of 92.9%, specificity of 86.3%, positive predictive value of 96.9%, negative predictive value of 72.6%, positive likelihood ratio of 6.8, negative likelihood ratio of 0.1, and Youden index of 91.7%. ConclusionThis Modified Alvarado Score System has a certain significance for the type diagnosis of acute appendicitis.
Objective To investigate the role of preoperative serum thyroid stimulating hormone (TSH) in evaluating differentiated thyroid cancer (DTC). Methods A total of 551 patients with thyroid nodules met the study criteria, who got treatment in the First Affiliated Hospital of Jiamusi University between Aug. 2017 and Dec. 2017. And the patients were divided into DTC group (n=110) and benign group (n=441) according to the postoperative pathological results. The difference of serum TSH level between the 2 groups was compared and then explored the diagnostic significance of serum TSH level, thyroid imaging report and data system (TI-RADS), and serum TSH combined withTI-RADS. Results The serum TSH level was higher in the DTC group than that of the benign group (Z=5.198, P<0.05). The sensitivity of preoperative serum TSH level in the diagnosis of DTC was 80.9% (89/110), the specificity was 74.4% (328/441), and the area under receiver operating characteristic (ROC) curve was 0.660 ［95%CI was (0.602, 0.719), P<0.05］. The sensitivity of TI-RADS in the diagnosis of DTC was 82.7% (91/110), the specificity was 73.5% (324/441), and the area under the ROC curve was 0.772 ［95%CI was (0.711, 0.823), P<0.05］. The sensitivity of preoperative serum TSH combined with TI-RADS in the diagnosis of DTC was 91.8% (101/110), the specificity was 87.5% (386/441), and the area under the ROC curve was 0.831 ［95%CI was (0.786, 0.876), P<0.05］. Conclusions Preoperative serum TSH level may be a potential risk factor for the occurrence of DTC. Preoperative serum TSH level combined with TI-RADS classification can improve the accuracy of preoperative diagnosis of DTC, not only to reduce the misdiagnosis of thyroid cancer, but also can avoid excessive treatment.
ObjectiveTo observe the dynamic changes of plasma Clara cell secretory protein (CC16) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to explore its role in the occurrence and development of the disease and clinical significance.MethodsA total of 71 AECOPD patients were included in this study as observation group. All subjects completed the CAT questionnaire and were sampled 2 ml of venous blood on day 1 and day 7 after their admission. And the percentage of forced expiratory volume in the first second (FEV1%pred), percentage of forced vital capacity in the estimated value (FVC%pred), FEV1/FVC ratio, arterial partial pressure of carbon dioxide (PaCO2), white blood cell count (WBC), the proportion of neutrophils (NEUT%), C-reactive protein (CRP), procalcitonin (PCT) and the length of stay of subjects were recorded. Another 20 healthy adults were enrolled as the control group. Each subject of the control group was sampled 2 ml of venous blood. The plasma CC16 levels of the two groups were tested and compared, and analyzed its correlation with CAT score and length of stay.ResultsThe plasma CC16 level of AECOPD patients was significantly lower than that of the control group, lung function was significantly lower than that of the healthy control group, WBC and NEUT% were significantly higher than that of the healthy control group, and the difference was statistically significant (P<0.05). Compared with day 1 after admission, the plasma CC16 level, CAT score, PaCO2, WBC, NEUT%, CRP, PCT of AECOPD patients on day 7 were significantly decreased, with statistically significant differences (P<0.05). The plasma CC16 level of AECOPD patients was negatively correlated with their CAT score (r=–0.704, P<0.001), and also was negatively correlated with the length of stay (r=–0.351, P=0.003).ConclusionsCC16 is involved in the development and progression of AECOPD and closely related to the severity and prognosis of the disease. Its dynamic changes can predict the condition changes and evaluate the clinical treatment effect of patients with AECOPD. Combined with common clinical indicators, CC16 can shorten the length of stay of patients.
Objective To investigate the diagnostic significance of fine needle aspiration cytology (FNAC) combined with BRAFV600E gene detection in the diagnosis of cervical lymph node metastasis of thyroid cancer. Methods Atotal of 140 patients with suspected cervical lymph node metastasis of thyroid cancer were collected as the research objects, and all patients were given ultrasound-guided FNAC and detection of BRAFV600E gene. The significance of the diagnosis was analyzed according to the gold standard after pathological examination. Results All the 140 patients underwent surgical treatment. For FNAC, the sensitivity was 63.6% (84/132), the specificity was 100% (8/8), the accuracy was 65.7% (92/140), the positive predictive value was 100% (84/84), and the negative predictive value was 14.3% (8/56). For detection of BRAFV600E gene, the sensitivity was 84.8% (112/132), the specificity was 100% (8/8), the accuracy was 85.7% (120/140), the positive predictive value was 100% (112/112), and the negative predictive value was 28.5% (8/28). For FNAC combined with BRAFV600E gene detection, the sensitivity was 90.9% (120/132), the specificity was 100% (8/8), the accuracy was 91.4% (128/140), the positive predictive value was 100% (120/120), and the negative predictive value was 40.0% (8/20). The area under curve of receiver operating characteristic for FNAC, detection of BRAFV600E gene, and FNAC combined with BRAFV600E gene detection were 0.818, 0.924, and 0.955, respectively. Conclusion FNAC combine with BRAFV600E gene detection improves the accuracy of neck lymph node metastasis in patients with thyroid cancer, which is worthyof performed.
Objective The objective of this study is to evaluate the effect of enhanced recovery after surgery (ERAS) in the perioperative period of pancreatoduodenectomy. Methods This article conducted the forward-looking analysis on the information of 227 patients undergoing the pancreatoduodenectomy in West China Hospital from January 2016 to June 2017, and then compared the differences between the patients subjected to ERAS (ERAS group) and thosesubjected to regular measures (control group) with respect to time of setting in sickbed, time of mobilizing out ofsickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, the time of nasogastric tube, postoperative hospitalization duration and expenses, postoperative complications, and postoperative pain scores. Results ① Postoperative indexes: by comparison of the ERAS group and the control group, it was found that the ERAS group had shorter (or lower) time of setting in sickbed, time of mobilizing out of sickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, the time of nasogastric tube, postoperative hospitalization duration and expenses (P<0.05). ② Postoperative complications: of all postoperative complications, including pancreatic fistula, postoperative hemorrhage, delayed gastric emptying, biliary fistula, abdominal infection, incision complication, lung infection, and heart complication were without statistically significant differences (P>0.05) between the 2 groups.③ Reoperation and readmission: there was no significant difference on the incidences of reoperation and readmission between the 2 groups (P>0.05). ④ Postoperative pain scores: except 22 : 00 of the 6-day after operation, the pain scores in the ERAS group were all lower than those in the control group at 2 h and 8 h after operation, and the time points of 1–6 days after operation (8 : 00, 16 : 00, and 22 : 00), with statistically differences (P<0.05). Conclusion Without increasing the incidence of complications, ERAS may speed up the rehabilitation of patients undergoing the pancreatoduodenectomy and mitigate the pain of patients.
Couinaud first proposed the naming of S9 segment of liver in 1994, and Liu Yunyi further promoted this naming in his work “Applied Anatomy of Hepatectomy and Liver Transplantation” in 2016. However, it has not been widely recognized and supported in the field of liver surgery for a long time. In recent years, due to the promotion and gradual maturity of endoscopic technology, there has been a more detailed understanding and demand for anatomy of liver and bile duct. Therefore, this article further explores the clinical value and significance of S9 segment of liver.
Objective To review the research progress of the vacuum phenomenon in spine. Methods The recent articles about the vacuum phenomenon in spine were reviewed; the features of imaging and the cl inical correlation were summarized. Results The vaccum phenomenon has been described in every segment of the spine. This phenomenon occurs mostly to the disc space and represents a transparent area on radiograph. Conclusion The causes of the vacuum phenomenoninclude degeneration of the anatomic structures of spine, trauma, and other pathologic changes. The vacuum phenomenon has important diagnostic and cl inical significances.
ObjectiveTo explore the different imaging manifestations of osteonecrosis of the femoral head (ONFH) and their correlation with the occurrence of pain during the peri-collapse period.MethodsThe 372 patients (624 hips) with ONFH in the peri-collapse stage who were admitted between December 2016 and October 2019 and met the selection criteria were selected as the research objects. Among them, there were 270 males and 102 females, with an average age of 35.3 years (mean, 15-65 years). There were 120 cases of unilateral hip and 252 cases of bilateral hips. There were 39 cases (39 hips) of traumatic ONFH, 196 cases (346 hips) of hormonal ONFH, 102 cases (178 hips) of alcoholic ONFH, and 35 cases (61 hips) of idiopathic ONFH. Among them, there were 482 hips with pain symptoms and 142 hips without pain. The pain duration was less than 3 months in 212 hips, 3-6 months in 124 hips, 6-12 months in 117 hips, and more than 12 months in 29 hips. According to the Association Research Circulation Osseous (ARCO) staging, the ONFH was rated as stage Ⅱ in 325 hips and stage Ⅲ in 299 hips. The patients were grouped according to ONFH etiology and ARCO staging, and hip joint pain and X-ray film (crescent sign and cystic changes), CT (subchondral bone fractures and cystic changes), and MRI (bone marrow edema, joint effusion, and subchondral hypointensity zone) were compared. Spearman rank correlation was used to determine the correlation between ONFH pain duration and X-ray film, CT, and MRI imaging manifestations.ResultsThere were significant differences (P<0.05) between ONFH patients with different etiologies in crescent sign on X-ray film, subchondral bone fracture on CT, and joint effusion on MRI. And there were significant differences (P<0.05) between ONFH patients with different ARCO stages in hip pain duration and all imaging manifestations. Correlation analysis showed that the pain duration of ONFH patients was correlated with all imaging manifestations (P<0.05). The cystic change on CT was correlated with the subchondral hypointensity zone and joint effusion grade on MRI, and subchondral hypointensity zone and joint effusion grade on MRI were also correlated (P<0.05).ConclusionThe cystic changes, subchondral hypointensity zone, and joint effusion are closely related to the collapse of the femoral head and hip pain in patients with ONFH in the peri-collapse stage. The above-mentioned signals in stage Ⅱ ONFH indicate the instability of the femoral head, which is to predict the development of ONFH and the rational choice of hip-preserving treatment methods provides a basis.
Objective To investigate the CT manifestation and clinical significance of the gastrointestinal tract involvement in acute pancreatitis (AP). Methods Two hundreds CT scans in 131 patients with acute pancreatitis between Jan. 1, 2009 and Jun. 30, 2009 were included into the study. Two radiologists analyzed the images retrospectively, paying attention to the CT features of the gastrointestinal tract involvement, such as the style, distribution, and so on. The correlation between gastrointestinal tract involvement and CT severity index, clinical severity grading, and turnover of acute pancreatitis were studied using a SPSS 14.0 for windows statistics software. Results The CT images in 109 (83.2%) patients showed gastrointestinal tract involvement, which distributing mainly stomach, duodenum, jejunum, and transverse colon, and showing mainly the gastrointestinal tract wall thickening and distension. The gastrointestinal tract involvement had positive correlation with CT severity index, clinical severity grading, and turnover of acute pancreatitis (r=0.689， P=0.000; r=0.584， P=0.000; r=0.346， P=0.000). Conclusions The gastrointestinal tract involvement is common complication in acute pancreatitis and concerns with severity and prognosis of the disease. As other extrapancreatic organs involvement, the gastrointestinal tract involvement has important value for severity assessment, prognosis evaluation, and therapeutic effect monitoring of acute pancreatitis.