Objective:Study on a kind of meet the war wounded, public emergency safety, first aid and transportation of severely injured patients with safe, simple, and without lifting height of the liquid infusion apparatus. Methods:The negative pressure of transfusion bag from the eletrical air pump transfusion (blood) pipe extrusion, The transfusion apparatus weight, bubble, drop speed, sound, light alarm device parameters input to the control system by the sensor, according to the parameters set to safely complete transfusion or stop. Steps:Infusion apparatus mounted on the liquid and the transfusion pipe for infusion after stetting the number of drops of liquid infusion, the remaining parameters such as. Results:Infusion apparatus can be placed in any position, the peripheral infusion tube length range without the suspension liquid device and changing the existing infusion (blood) products and procedures, which create convenient, comfortable infusion conditions without position limitation The controllable range of the infusion speed is 50ml-1000ml/h,which can monitor the infusion and the air in the pipeline, liquid flow rate, the remaining amount, According to the set alarm timely and automatically stop the transfusion. Conclusion:To improve the safety of transfusion, save human resources. and it’s dual-use, small volume, easy to carry.

Objective To investigate the spiral CT features of solid pseudopapillary tumor of pancreas (SPTP).Methods Spiral CT features of 34 SPTP cases confirmed by surgery and pathology were analyzed retrospectively.Results There were 30 females and 4 males.Tumors located in the tail,head,body and neck of the pancreas were respectively in 14,11,6 and 3 cases.The maximum diameter was 2.0-20.0 cm,with an average of 6.5 cm.There were 29 cases of solid-cystic mass with a CT value of 12.6-21.3 HU and 5 cases of solid mass with a CT value of 24.5-42.8 HU;Complete capsule were observed in 24 cases,while incomplete capsule were observed in 10 cases;15 cases were found with tumor calcification,13 with hemorrhage and 2 cases with liver metastasis.After dynamic enhancement,the solid part and capsule showed progressive and slight enhancement in the arterial phase with a CT value of 30.1-43.6 HU,and slight enhancement in portal phase with a CT value of 41.2-68.9 HU,and persistent enhancement in delayed phase with a CT value of 48.2-63.8 HU.Conclusions Spiral CT features of SPTP are characterized by progressive enhancement of solid mass in enhanced scan.

Objective To observe the clinical features of atrial fibrillation (AF) patients, and to explore the correlation between the routine detection index and the new-onset AF and to find out risk factors for new AF in critically ill patients. Methods A prospective observational study was conducted. The patients with AF admitted to intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University from March 2016 to June 2017 were enrolled. The patients were divided into new-onset AF group and past-existed AF group according to their past history of AF (including persistent AF, paroxysmal AF or permanent AF). In addition, patients in ICU without history of AF and new-onset AF were selected as the control group (no AF group). The general epidemiological characteristics of patients in three groups, and the blood biochemical, coagulation and other related indicators at the time of AF occurred (new-onset AF group) or 48 hours after ICU admission (AF group and no AF group) were analyzed; the difference of laboratory indexes between patients in new-onset AF group with AF within 48 hours before occurred and patients in no AF group within 48 hours after admission to ICU was compared. The relationship between each index and new-onset AF were analyzed. Pearson or Spearman rank correlation was used for analysis. Risk factors of new-onset AF were analyzed by Logistic regression analysis. Results 1 673 patients were admitted to ICU, including 179 cases of AF (10.70%), and 106 males and 73 females, with an average age of (71.73±23.22) years. There was 75 new-onset AF (morbidity 4.48%), and had a 28-day mortality of 45.33% (34/75). There were differences in age, previous heart disease and heart failure (HF) among new-onset AF group (n = 75), past-existed AF group (n = 104) and no AF group (n = 75). Compared with other two groups, renal insufficiency rates, troponin, serum sodium, calcium and procalcitonin levels were higher, mechanical ventilation time and the length of ICU stay were significantly prolonged, ICU and hospitalization costs were higher in new-onset AF group. Compared with no AF group, new-onset AF patients with the higher percentage of septic shock, the accumulation of vascular contraction drugs within 24 hours after AF usage were higher, and used more anti-arrhythmic drugs, has higher brain natriuretic peptide (pro-BNP), serum creatinine, blood lactic acid levels, and lower albumin, oxygenation index, and serum potassium levels, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score and 28-day mortality were higher. Correlation analysis showed that age, APACHE Ⅱ score, septic shock, HF, cardiovascular disease, renal insufficiency were positively correlated with new-onset AF (r values were 0.393, 0.270, 0.386, 0.251, 0.194, 0.170;P values were 0.000, 0.001, 0.000, 0.002, 0.017, 0.037, respectively). The age [odds ratio (OR) = 0.962, P = 0.046], basic oxygenation index (OR = 1.005, P = 0.028) and serum potassium levels (OR = 1.638, P = 0.022) were the risk factors for new-onset AF. Conclusions Critical patients with a high incidence of AF, new-onset AF significantly prolong the length of ICU stay; age, APACHE Ⅱ score, septic shock, cardiovascular disease, and renal insufficiency are related to new-onset AF; age, basic oxygenation index and serum potassium levels are risk factors for new-onset AF.

OBJECTIVEThe purpose of our study was to evaluate the predictive factors of the presence of invasive carcinoma associated with intraductal papillary mucinous neoplasm (IPMN) of the pancreas on MDCT and MRI.

METHODSPreoperative MDCT or/and MRI of 27 consecutive patients (19 men, 8 women, mean age 61.3 years) who had undergone surgical resection and had a pathological diagnosis of IPMN were retrospectively assessed. The type of ductal involvement, solid appearance of the lesion, location, tumor size of branch duct type and combined type lesions, maximum diameter of the tumor, caliber of the main pancreatic duct and the extent of the common bile duct dilatation were assessed on CT and MRI and correlated with the pathological findings of the invasive carcinoma. Two abdominal radiologists reviewed all the images, and when discrepancies of the findings were found, the consensus was reached by discussion.

RESULTSPathological analysis revealed carcinoma in situ in two patients and invasive carcinoma in 19 patients arising from the IPMN. The type of ductal involvement (P = 0.038), a solid mass (P = 0.003) and the common bile duct dilatation ( ≥ 15 mm, P = 0.004) were correlated with the presence of associated invasive carcinoma. For the finding of solid and cystic mass in predicting invasive IPMN, the sensitivity was 66.7% (8/12) and specificity was 100.0% (8/8), and for bile duct diameter ≥ 15 mm, the sensitivity was 47.4% (9/19) and specificity was 100.0% (8/8). However, no association was found between the location of the lesion and associated invasive carcinoma. The caliber of the main pancreatic duct of patients with associated invasive carcinoma was significantly larger than that in the cases without invasive carcinoma (8.07 ± 2.23 mm vs. 4.86 ± 1.86 mm, P = 0.002). When using the main pancreatic duct dilatation ≥ 4 mm as the threshold, the sensitivity and specificity in predicting invasive IPMN were 94.7% (18/19) and 37.5% (3/8), respectively. For the branch duct type and combined type, the size of the tumor with associated invasive carcinoma was significantly larger than these without invasive carcinoma (41.35 ± 12.58) mm vs. (23.76 ± 8.06) mm (P = 0.003). When the maximum diameter was ≥ 40 mm, the sensitivity and specificity in predicting invasive IPMN were 50.0% (6/12) and 87.5% (7/8), respectively.

CONCLUSIONSThe findings of CT and MRI are helpful to predict invasive carcinoma associated with IPMN, which may play an important role in the preoperative evaluation, surgical planning and predicting the prognosis of IPMN.

Adenocarcinoma, Mucinous ; diagnosis ; Bile Duct Neoplasms ; Carcinoma, Pancreatic Ductal ; Carcinoma, Papillary ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasms, Glandular and Epithelial ; Pancreas ; Pancreatic Neoplasms ; diagnosis ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed

Objective: To explore the correlation between menopausal hormone therapy（MHT）and breast lesions in perimenopausal women,and to provide evidence for safe use of MHT. Methods: The 40-60 year-old women who visited Hangzhou Women's Hospital and met the diagnostic criteria for perimenopausal syndrome were recruited. The intervention group received MHT and was divided into three subgroups according to the MHT regimen：estrogen-progesterone cycle therapy（A）,estrogen-progesterone continuous therapy（B）,estrogen therapy（C）. The control group did not receive MHT. All the patients received regular mammography to quantify and evaluate breast lesions. The generalized estimating equation was used to analyze the changes of breast lesions between different groups. Results: There were 80 cases in the intervention group,with 49 in group A,26 in group B,5 in group C,and 80 cases in the control group. After two years of follow-up,there was no statistically significant differences of time,group and interaction in breast density,volume of breast fibrous tissue and the volume of breast between three intervention groups and the control group（P>0.05）; there was no statistically significant differences of group and interaction in positive rate of calcification and breast mass between the intervention group and the control group（P>0.05）. Conclusion Receiving MHT intervention for two years did not increase the risk of breast lesions.

Objective:To investigate the computed tomography (CT) features of gastric neuroendocrine neoplasm (GNEN).Methods:The retrospective and descriptive method was conducted. The clinicopathological data of 30 GNEN patients who were admitted to two domestic medical centers (13 cases in Wenzhou Hospital of Traditional Chinese Medicine and 17 cases in Wenzhou People′s Hospital) from January 2010 to December 2018 were collected. There were 23 males and 7 females, aged (62±4)years, with a range from 27 to 78 years. The patients underwent abdominal CT plain scan and dynamic enhancement scan. Two associate chief radiologists with more than 20 years of work experience observed and analyzed all the images respectively. Observation indicators: (1) CT examination; (2) treatment and postoperative pathological examination; (3) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect the survival of patients up to December 2018. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were described as M (range). Results:(1) CT examination: of the 30 patients, 14 had the tumor located in the fundus of stomach, 10 had the the tumor located in the body of stomach, and 6 had the tumor located in the antrum. The tumor was elliptical in 18 cases and irregular in 12 cases. There were 15 cases of endogenous type, 13 cases of exogenous type, and 2 cases of intramural type. Patients with G1 neuroendocrine tumor had the maximum diameter of (6.8±1.6)cm, of which 4 cases had the maximum diameter less than 5.0 cm and 4 cases had the maximum diameter of 5.0 to 10.0 cm. Patients with G2 neuroendocrine tumor had the maximum diameter of (8.3±2.7)cm, of which 1 case had the maximum diameter less than 5.0 cm, 4 cases had the maximum diameter of 5.0 to 10.0 cm, and 2 cases had the maximum diameter greater than 10.0 cm. Patients with G3 neuroendocrine carcinoma had the maximum diameter of (17.8±2.2)cm, of which 6 cases had the maximum diameter of 5.0 to 10.0 cm and 9 cases had the maximum diameter more than 10.0 cm. The tumor showed swelling growth in 14 cases and invasive growth in 16 cases. The tumor boundary was clear in 14 cases and unclear in 16 cases. CT plain scan showed homogeneous tumor density in 10 cases and heterogeneous density in 20 cases. Nine patients had iso-density in the tumor parenchymal part, and the CT value was (34.0±3.5)HU. In the 18 cases of low density, the CT value was (16.6±1.4)HU. In the 3 cases of high density, the CT value was (45.3±3.6)HU. Of the 30 patients, 21 cases had small punctate or small round necrotic cyst lesions in the tumor, 10 cases had mesenteric lymph node, peritoneum, liver metastasis and adjacent omentum invasion; 17 cases had abdominal effusion. In the CT enhancement examination, 12 cases showed mild enhancement, and the CT value was (56.5±6.3)HU; 15 cases showed moderate enhancement, and the CT value was (66.0±5.4)HU; 3 cases showed significant enhancement, and the CT value was (76.6±5.8)HU. Seven cases showed homogeneous enhancement and 23 cases had heterogeneous enhancement. There were 8 cases with tortuous vessels. (2) Treatment and postoperative pathological examination: of the 30 patients, 10 cases with mesenteric lymph nodes, peritoneum, liver metastasis and adjacent omentum invasion underwent radical total gastrectomy; 14 cases without surrounding tissue invasion or metastasis underwent radical subtotal gastrectomy; 6 cases with tumor diameter less than 4.0 cm and without surrounding tissue invasion or metastasis underwent endoscopic resection. All the 30 patients were confirmed GNEN by postoperative pathological examination, including 8 cases of G1 neuroendocrine tumor, 7 cases of G2 neuroendocrine tumor, and 15 cases of G3 neuroendocrine carcinoma. Results of immunohistochemical staining showed that 30 patients were positive for synaptophysin, 23 were positive for chromogranin A, and 9 were positive for cytokeratin. (3) Follow-up: all the 30 patients were followed up for 10-80 months, with a median follow-up time of 39 months. The 5-year survival rate of 30 patients was 43.3% (13/30). The 5-year survival rates were 6/8, 3/7 and 4/15 of patients with G1 neuroendocrine tumor, G2 neuroendocrine carcinoma, and G3 neuroendocrine carcinoma.Conclusions:GNEN has the main manifestation as abdominal pain, with G3 as pathological classification, which is common in fundus and body of stomach. The CT findings of GNEN are characterized by swelling or infiltrating growth and round or irregular low-density masses. Tumors are prone to cystic transformation, and showed the mildly to moderately heterogeneous enhancement.

Objective: To investigate the clinical and imaging features of primary peripheral primitive neuroectodermal tumors (pPNETs) of bone. Methods: Clinical and X-ray, CT and MRI findings of 6 cases of primary bone pPNETs in Wenzhou Hospital of Traditional Chinese Medicine of Zhejiang, Yueqing People′s Hospital of Zhejiang, and Wenzhou People′s Hospital of Zhejiang were retrospectively analyzed. Results: There were 4 males and 2 females, aged from 2 to 38 years, with an average age of (18.5 ± 12.0) years old. Local pain was found in all cases, including 4 cases with mass, with an average survival of (22.2 ± 16.9) months. Iliac bone tumor was found in 2 cases, sacrum in 2 cases, scapula in 1 case and femur in 1 case. Digital radiography(DR) examination was performed in 4 cases:4 cases showed osteolytic destruction, including 1 case with mild swelling changes, 1 case with laminar periosteal reaction and radial bone needle, and 3 cases with soft tissue mass. CT examination was done in 4 cases, and there were 4 cases of osteolytic destruction accompanied by soft tissue mass without periosteal reaction. Among them, 1 case had irregular sclerosis at the edge of bone destruction and 2 cases had fine calcification in soft tissue mass. MRI examination in 4 cases:there were 3 cases with equal signal on T₁WI and 1 case with moderate to high signal on T₁WI, 3 cases with inhomogeneous medium and high signal on T₂WI and STIR, and 1 case with homogeneous high signal on T₁WI, and 4 cases with soft tissue masses and peritumoral edema. Conclusions Bone pPNETs is characterized by osteolytic destruction with soft tissue masses, periosteal reaction with or without periosteal reaction, and intratumoral calcification. Imaging examination is helpful to understand the extent of lesions, formulation of therapeutic measures and evaluation of therapeutic effect.

BACKGROUND: There are few multi-city studies on the association between temperature and mortality in basin climates. This study was based on the Sichuan Basin in southwest China to assess the association of basin temperature with non-accidental mortality in the population and with the temperature-related mortality burden. METHODS: Daily mortality data, meteorological and air pollution data were collected for four cities in the Sichuan Basin of southwest China. We used a two-stage time-series analysis to quantify the association between temperature and non-accidental mortality in each city, and a multivariate meta-analysis was performed to obtain the overall cumulative risk. The attributable fractions (AFs) were calculated to access the mortality burden attributable to non-optimal temperature. Additionally, we performed a stratified analyses by gender, age group, education level, and marital status. RESULTS: A total of 751,930 non-accidental deaths were collected in our study. Overall, 10.16% of non-accidental deaths could be attributed to non-optimal temperatures. A majority of temperature-related non-accidental deaths were caused by low temperature, accounting for 9.10% (95% eCI: 5.50%, 12.19%), and heat effects accounted for only 1.06% (95% eCI: 0.76%, 1.33%). The mortality burden attributable to non-optimal temperatures was higher among those under 65 years old, females, those with a low education level, and those with an alternative marriage status. CONCLUSIONS Our study suggested that a significant association between non-optimal temperature and non-accidental mortality. Those under 65 years old, females, and those with a low educational level or alternative marriage status had the highest attributable burden.
Female ; Humans ; China/epidemiology* ; Cities ; Cold Temperature ; Hot Temperature ; Mortality ; Temperature ; Time Factors ; Middle Aged ; Male