OBJECTIVE: To probe into the causes of drug repercussion of inpatients in psychiatric hospital to promote rational drug use. METHODS: Using HIS (hospital information system), the drug repercussion data in 8 psychiatirc departments (ward pharmacy) between 2004 and 2005 were analyzed statistically. RESULTS: Of the total 203 drug repercussion cases analzyed, most were resulted from alteration of doctor’s orders, man-made entry errors of drug information, and high drug costs etc. CONCLUSION: The effective way to reduce drug repercussion is to improve technical level and working attitude, establish good rules and regulations and standardize service conditions.

Interspinous dynamic stabilization is popular in the non-fusion spine surgery.It is characterized in the motion preservation of segmental lumbar,avoiding the stress change after fusion surgery and adjacent disc degeneration.Interspinous dynamic stabilization systems have got fast development and are widely used in the treatment of lumbar spine disease.As an innovation of traditional fusion surgery,the clinical evaluation is the focus of spine surgeon.In this paper,the recent studies of the clinical evaluation of interspinous dynamic stabilization are reviewed.

Objective To investigate the efficacy of different radical surgical procedures for the treatment of hilar cholangiocarcinoma.Methods The clinical data of 207 patients with hilar cholangiocarcinoma who were treated at the Southwest Hospital from June 2007 to June 2012 were retrospectively analyzed.Local resection or hemihepatectomy combined with caudate lobectomy was applied to patients with Bismuth type Ⅰ hilar cholangiocarcinoma; dumbbell type radical resection was applied to patients with Bismuth type Ⅱ hilar cholangiocarcinoma or some patients with type Ⅲ a,Ⅲ b and Ⅳ hilar cholangiocarcinoma; hemihepatectomy or extended hemihepatectomy combined with caudate lobectomy was applied to patients with Bismuth type Ⅲ a,Ⅲ b and Ⅳ hilar cholangiocarcinoma.The patients were followed up every 3 months postoperatively till December 2012.All data were analyzed using the chi-square test or Fisher exact probability test,the survival curve was drawn by Kaplan-Meier method,and the survival was analyzed using the Log-rank test.Results Of the 207 patients,124 received radical resection,including 14 received local resection,23 received dumbbell type resection,87 received lobectomy + caudate lobectomy,49 received palliative resection; 34 received biliary drainage.Four patients died perioperatively.The incidences of complications of dumbbell type radical resection,left hemihepatectomy + caudate lobectomy,right hemihepatectomy + caudate lobectomy were 21.7％ (5/23),46.6％ (27/58) and 48.3％ (14/29),respectively.The incidence of complications after dumbbell type radical resection was significantly lower than left hemihepatectomy + caudate lobectomy and right hemihepatectomy + caudate lobectomy (x2 =4.42,3.90,P ＜ 0.05).One hundred and seventy patients were followed up.The median survival time of the 112 patients who received radical radical resection was 26.5 months,and the 1-,3-,5-year survival rates were 75.9％ (85/112),42.9％ (24/56) and 28.9％ (11/38),respectively.The median survival time of the 38 patients who received palliative resection was 8.5 months,and the 1-,3-year survival rates were 31.6％ (12/38) and 0.The survival time of 20 patients who received biliary drainage was 4.0 months,and the l-year survival rate was 0.The survival rate of patients who received radical resection was significantly higher than those who received palliative resection (x2=65.32,P ＜ 0.05).There was a significant difference in the survival rate between patients who received surgical treatment and those who received biliary drainage (x2=99.97,P ＜ 0.05).Of the 112 patients who received radical resection,the median survival time of 10 patients who received local resection of tumor was 47.0 months,the 1-year survival rate was 10/10,and 4 patients survived at the end of the follow-up; the median survival time of 23 patients who received dumbbell type radical resection was 32.0 months,and the 1-,3-year survival rates were 95.7％ (22/23) and 7/15,and the survival time of 6 patients was longer than 5 years; the median survival time of 54 patients who received left hemihepatectomy or extended left hemihepatectomy + caudate lobectomy was 27.6 months,and the 1-,3-year survival rates were 42.1％ (24/57) and 38.7％ (12/32),and the survival time of 9 patients was longer than 5 years,3 patients survived at the end of the follow-up ; the median survival time of 25 patients who received right hemihepatectomy or extended right hemihepatectomy + caudate lobectomy was 28.3 months,and the 1-,3-year survival rates were 45.8％ (11/24) and 6/15,and the survival time of 6 patients was longer than 5 years,2 patients survived at the end of follow-up.The median survival time of 35 patients (patients with Bismuth type Ⅰ,Ⅱ hilar cholangiocarcinoma and Bismuth Ⅲ a and Ⅲ b hilar cholangiocarcinoma which did not invade the secondary bile duct) who received hemihepatectomy + caudate lobectomy was 32.0 months,and the 1-,3-,5-year survival rates were 91.4％ (32/35),45.8％ (11/24) and 5/16,which were not different from the survival rate of patients who received dumbbell type radical resection (x2 =0.17,P ＞ 0.05).The 5-year survival rate of patients with lymph node metastasis was 4/19,which was significantly lower than 30.4％ (7/23) of patients without lymph node metastasis (x2 =23.40,P ＜ 0.05).Conclusion Joint lobectomy and standardized lymph node dissection could help to improve the efficacy of surgical treatment for patients with hilar cholangiocarcinoma.

Objective To investigate the clinical significance of multiple tumor markers in the early diagnosis of cholangiocarcinoma.Methods 165 patients with histopathologically confirmed cholangiocarcinoma and 25 patients with gallstone canceration were enrolled in this study.36 patients with gallstones and 46 patients with bile duct stenosis were enrolled as controls.The determinations of multiple tumor markers,including carcinoembryonic antigen (CEA),CA125,CA153,CA242,CA19-9,alpha-fIetoprotein (AFP) and Ferritin,of all subjects and the imageological determinations of all the patients with cholangiocarcinoma and with gallstone canceration were analysed retrospectively.Comparisons between the groups were performed using the likelihood ratio test of the Chi-square test.Results CA19-9 had the highest sensitivity and specificity (83.6％ and 96.3％ respectively) for cholangiocarcinoma,and CA242 had a high sensitivity for gallstone canceration though it was not so sensitive in cholangiocarcinoma.Multiple tumor markers increased the sensitivity and specificity in the early diagnosis of cholangiocarcinoma.Compared with imageological determinations,multiple tumor markers had a higher sensitivity for the early diagnosis of cholangiocarcinoma with a tumor mass ＜1 cm.Conclusion Multiple tumor markers have important clinical values in the early diagnosis of cholangiocarcinoma.

Surgical resection is considered to be the most effective therapy for hilar cholangiocarcinoma.Inadequate excision range is the main reason for recurrence after surgery.Extended radical resection provides better long-term survival,however,it may also increase the risk of liver failure because of the extensive hepatic resection.In present study,we showed a new operation which could excise enough length of bile ducts and avoid large volume hepatic tissue resection.The excision extension includes:segment Ⅰ,Ⅳb and partial Ⅳ,left,right and furcation of hepatic duct,extrahepatic ducts,skeletonization of hilar vessels,and dissection of at least second station lymph nodes.As the tissue resected resembles a dumbbell,this surgical technique is named dumbbell type radical resection.The operative indications include:(1) hilar cholangiocarcinoma,Bithmuth Ⅱ and Bithmuth Ⅲ with tumor limited in left or right hepatic ducts ; (2) Without portal invasion; (3) Without third station lymph node metastasis; (4) Without liver or distant organ metastasis.Twenty-three patients had undergone this operation sucessfully.Most patients have high total bilirubin levels (more than 300 μmol/L) and have not received percutaneous transhepatic cholangial drainage or biliary drainage.The average operation time was 355 minutes,and average volume of blood loss during operation was 350 ml.The total survival rate was 65.2％.One-year tumour free survival rate was 95.7％ (22/23),and three-year tumor free survival rate was 7/15.The results indicated that dumbbell type radical resection was feasible for hilar cholangiocarcinoam of Bismuth Ⅱ and Bismuth Ⅲ with tumor limited in left or right hepatic ducts.

Objective:To explore clinical application value of immediate breast reconstruction with silicone prosthesis after nipple areolar sparing mastectomy for breast cancer.Methods:The clinical data of 30 breast cancer patients underwent immediate breast reconstruction with the silicone prosthesis after nipple areolar sparing mastectomy from January 2016 to January 2018 were collected. In the observation group, 15 patients underwent immediate breast reconstruction with the silicone prosthesis after nipple areolar sparing mastectomy. In the control group, 15 patients underwent conventional modified radical mastectomy only. The differences of operation indicator and postoperative complications between the two groups were compared, and the postoperative cosmetic effects were evaluated.Results:The patients successfully completed prosthetic breast reconstruction in the observation group. The surgical time and indwelling time of the drainage tube in the observation group were both increased compared with the control group, and the difference was statistically significant ( t=118.8 and t=23.9, P<0.05). There were no statistically significant differences between the two groups in the complications of postoperative flap necrosis, subcutaneous hematoma, intraoperative infection and incision dehiscence ( P>0.05). The total complications rate of the observation group was 40%, compared with the control group (20%), there were not statistically significant differences ( P>0.05). The postoperative aesthetic effect evaluation showed that the reconstructed breast was full in shape and basically symmetrical to the contralateral side, with an excellent and good rate of 83.3%. The patients were satisfied with the appearance of the breast. All patients were followed up for 12 to 36 months with the average time of 24 months, and local recurrence and distant metastasis were not observed. Conclusions:In the modified radical mastectomy for breast cancer with preserved nipple and areola, the immediate application of silicone prosthesis for breast reconstruction has the advantages of less trauma, faster postoperative recovery and better cosmetic effect, which is worthy of clinical application.

Objective To explore the clinical outcome of perforator flaps for reconstruction of limb soft tissue defects. Methods In this case series, from 2007 July to 2009 May, 108 cases of perforator flap to reconstruct the defects of the extremities were performed, of these, 98 were free perforator flaps, 10 were pedicled flaps. The perforator flaps included deep inferior epigastric artery perforator flap, anterolateral thigh perforator flap, thoracodorsal artery perforator flap, lateral thigh perforator flap, posterior interosseous artery perforator flap, collateral radial artery perforator flap, medial sural artery perforator flap, posterior tibial artery perforator flap, deep circumflex iliac artery perforator flap and peroneal artery perforator flap. The maximum size of the perforator flap was 44 cmx 9 cm, the minimum size of the perforator flap was 4 em x 2 cm.The donor defect was closed directly. Results Venous congestion occurred in 5 flaps, in 1 case venous congestion was overcomed after released the dressing, 4 flaps requiring reexploration for venous insufficiency,2 had a successful outcome, the other 2 flaps failed . The other 103 flaps were successful. The wounds healed without any infection complications. The follow-up ranges from 6-24 months( 10 months on average). The flaps were of good appearance and not bulky; there were only linear scars on the donor sites, the cosmesis and function of the donor sites were satisfying. Conclusion The muscle, deep fascia and motor nerve are not contained in the flap, the advantages of this type of flap is reducing morbidity of the donor site and its reliable blood supply and suitable thickness for resurfacing, no secondary debuiking is necessary. The perforator flaps can be chosen as the first option to deal with superficial extremity wounds.

Objective: To clarify whether the surgical treatment for hilar cholangiocarcinoma combined with artery reconstruction is optimistic to the patients with hilar cholangiocarcinoma with hepatic artery invasion. Methods: There were 384 patients who received treatment in the First Affiliated Hospital to Army Medical University from January 2008 to January 2016 analyzed retrospectively. There were 27 patients underwent palliative operation, 245 patients underwent radical operation, radical resection account for 63.8%. Patients were divided into four groups according to different operation method: routine radical resection group(n=174), portal vein reconstruction group (n=47), hepatic artery reconstruction group (n=24), palliative group(n=27). General information of patients who underwent radical operation treatment was analyzed by chi-square test and analysis of variance. The period of operation time, blood loss, the length of hospital stay and hospitalization expenses of the radical operation patients were analyzed by one-way ANOVA. Comparison among groups was analyzed by LSD-t test. Results: The follow-up ended up in June first, 2016. Each of patients followed for 6 to 60 months, the median follow-up period was 24 months. 1-, 3-, and 5-year survival rates were 81.3%, 44.9% and 13.5% of routine radical operation group, and were 83.0%, 44.7% and 15.1% of portal vein reconstruction group, and were 70.8%, 27.7% and 6.9% of hepatic artery reconstruction group, respectively. And 1-, 3-, and 5-year survival rates of hepatic artery reconstruction group was lower than routine radical group and portal vein reconstruction group significantly (P<0.05). However, the rate of postoperative complications of the hepatic artery reconstruction group and the routine radical operation group and the portal vein reconstruction group were 62.5%(15/24), 55.3%(96/174) and 51.5%(24/47), respectively. There was no significant difference among them (P>0.05). The data shows that the ratio of lymphatic metastasis in hepatic artery reconstruction group (70.8%) is much higher than them in routine radical operation group (20.1%) and portal vein reconstruction group (19.1%) significantly (P<0.05). The presented data also indicate that hepatic artery resection prolongs survival time comparing with patients undergoing palliative therapy for hilar cholangiocarcinoma. Cox regression analysis indicate that hepatic artery resection and reconstruction is a protective factor compare with palliative therapy (RR=0.38, 95%CI: 0.22-0.67). The significant reason for shorter survival time is a positive correlation between hepatic artery invasion and lymph node metastasis. Conclusion Hepatic artery resection and reconstruction has beneficial impact on oncologic long-term outcome in patients with advanced stage hilar cholangiocarcinoma.

Recent advancement in natural language processing (NLP) and medical imaging empowers the wide applicability of deep learning models. These developments have increased not only data understanding, but also knowledge of state-of-the-art architectures and their real-world potentials. Medical imaging researchers have recognized the limitations of only targeting images, as well as the importance of integrating multimodal inputs into medical image analysis. The lack of comprehensive surveys of the current literature, however, impedes the progress of this domain. Existing research perspectives, as well as the architectures, tasks, datasets, and performance measures examined in the present literature, are reviewed in this work, and we also provide a brief description of possible future directions in the field, aiming to provide researchers and healthcare professionals with a detailed summary of existing academic research and to provide rational insights to facilitate future research.
Humans ; Natural Language Processing ; Surveys and Questionnaires