Objective To analyze the clinical effect of ostimeatal complex surgery on chronic sinusitis under nasal endoscope.Methods A total of 270 patients with chronic sinusitis treated in Huzhou Central Hospital from March 2014 to May 2017 were selected.The patients were randomly divided into control group and observation group according to the digital table,with 135 cases in each group.The observation group received ostimeatal complex surgery under nasal endoscope.The control group was treated with local excision,local glucocorticoid injection,and maxillary sinus puncture and irrigation. The patients were followed up for 6 months after surgery, the clinical effect was observed.The life quality of patients was evaluated with 36-items short form health survey (SF-36) and sino-nasal outcome test-20 (SNOT-20).Results At the last follow-up,the cure rate of the observation group was 84.4% , the improvement rate was 13.3% , the cure rate of the control group was 45.2% , and the improvement rate was 20.0%.The clinical efficacy of the observation group was significantly better than that of the control group ( Z =7.291,P<0.001).Three months after treatment,the physiological role score[(69.5 ± 14.1) points] and general health score [(62.9 ± 11.4) points], the total score of 20 items [( 15.5 ± 3.4 ) points] and 5 items [( 8.1 ± 3.7)points] of SNOT-20 scale in the observation group were significantly improved (t=4.881,5.102,20.283, 14.360,all P<0.05).The scores of physiological function,physiological role,body pain,vigor,social function,emotional role,mental health and general health in the observation group were (86.8 ± 11.5) points,(81.0 ± 12.1) points, (82.8 ± 12.7)points,(70.4 ± 11.0)points,(84.5 ± 13.0) points,(73.4 ± 11.6) points,(87.0 ± 12.4)points and (68.7 ± 16.4)points,which were significantly better than those in the control group [(83.8 ± 11.4)points,(69.5 ± 12.4)points,(78.5 ± 13.1) points,(68.4 ± 11.9) points,(74.4 ± 11.7) points,(67.4 ± 11.9) points,(78.9 ± 12.3)points and (64.3 ± 12.9) points],the differences were statistically significant (t =2.153,7.712,2.738, 2.012,6.710,4.195,5.388,2.450,all P<0.05).There were no statistically significant differences in the score of 20 general items and the score of 5 items compared with those at 3 months (all P>0.05).Conclusion The clinical effect of ostimeatal complex surgery on chronic sinusitis under nasal endoscope is satisfactory.The overall symptoms and quality of life of the patients returned to normal,but the 5 major problems such as nasal mucus,mucus nose,bad sleep at night,nasal discharge backstreaming and inattention have not been solved thoroughly.

Objective: To compare the visualization ability for thyroid nodular vascularity among superb micro-vascular imaging (SMI), power Doppler flow imaging (PDFI), and color Doppler flow imaging(CDFI), and determine optimal vascular findings for the diagnosis of thyroid nodules. Methods: A total of 58 thyroid nodules from 50 patients were enrolled, including 27 benign nodules (benign group) and 31 malignant nodules (malignant group). Vascular patterns of these nodules were detected by SMI, PDFI and CDFI, respectively. Results: Thyroid cancer was characterized by type III vascular pattern. "Only central vascularity" performed best in detecting thyroid cancers. When using the criterion, SMI performed a better specificity (96.3%) and sensitivity (77.4%) than PDFI (92.5%, 41.9%) and CDFI (88.9%, 48.3%); and the specificity of SMI was significantly higher than the others (all P<0.01). Conclusions The sign of only central vascularity is of value in distinguishing malignant thyroid nodules. SMI is better on presenting thyroid nodular vascularity than CDFI and PDFI, and it could be used to differentiate thyroid nodules.

Objective To study the safety and efficacy of laparoscopic resection of hemangioma in the right posterior hepatic section without any blood flow occlusion.Methods Patients with hemangiomas in the right posterior section of liver operated from January 2016 to June 2018 in the Affiliated Hospital of Youjiang Medical College for Nationalities were studied retrospectively.There were 19 females and 9 males.The average age was (37.9 ± 6.1).The operation methods,perioperative factors,hospitalization cost and follow-up outcomes were recorded and analyzed.Results 28 patients with hemangiomas were treated with laparoscopic resection of right posterior hepatic section without any blood flow occlusion.An ultrasound scalpel was applied to split the liver in 27 patients,and ultrasound scalpel combined with Ligasure to split the liver in 1 patient.The mean diameter of the hepatic hemangiomas was (6.7 ± 1.3) cm.The intraoperative blood loss was (330.4 ± 139.0) ml and the operation time was (87.4 ±27.9) min.One patient required conversion to open surgery due to rupture and bleeding of the hemangioma.The conversion rate was 3.6％ (1/28).The postoperative drainage time was (45.4 ± 18.9) h.The postoperative hospitalization time was (7.5 ± 1.3) d,and the hospitalization cost was (3.1 ± 0.5) ten thousand yuan.No death or serious complications occurred.No reoperation was needed.The follow-up period ranged from 1 to 30 months,and all the patients were well on follow-up.Conclusions Laparoscopic resection of hemangioma in the right posterior hepatic section without any blood flow occlusion was safe and efficacious.This method can be used for hemangiomas in the right posterior section of liver.

Objective:To study the feasibility and safety in treatment of trauma to right posterior liver using laparoscopic surgery with patients in the left semiprone position.Methods:The clinical data of consecutive patients who were diagnosed to have trauma to the right posterior liver and were treated with laparoscopic surgery with patients in the left semiprone position at the Department of Hepatobiliary Surgery, the Affiliated Hospital of Youjiang Medical University for Nationalities between February 2016 and August 2020 were retrospectively analysed. The patients’ gender, age, mechanisms of injury, operative methods, operative time, amounts of abdominal effusion, degrees of liver injury, extents of intraoperative bleeding, amounts of postoperative drainage, lengths of postoperative hospital stay, and major postoperative complications were recorded and analyzed.Results:Among the 18 patients, there were 16 males and 2 females, aged (41.6±14.4) years. The mechanisms of liver trauma were caused by fall injury ( n=10), traffic accidents ( n=4), blunt injury ( n=2) and penetrating injury ( n=2). The levels of injuries were level Ⅲ in 16 patients and level Ⅳ in 2 patients. Laparoscopic suture repair was performed in 8 patients, partial hepatectomy in 4 patients, electrocoagulation hemostasis in 4 patients and ligation of bleeding vessels in 2 patients. All were successful in hemostasis. Abdominal effusion was (1 528.8±373.2) ml, intraoperative blood loss (80.6±16.7) ml, operation time (88.5±9.1) min, postoperative hospital stay 7 days and postoperative total drainage (93.8±13.6) ml. Ten patients were complicated with right pleural effusion, and they recovered with conservative treatment. There were no bile leakage, infection and other complications. Conclusion:Trauma to right posterior liver treated with laparoscopic with surgery patients in the left semiprone position had the advantages of adequate exposure which facilitated surgical hemostasis, resulting in minimal collateral damages and short hospital stay. The treatment was feasibility and safe.

Objective To summarize the clinical and sonographic features of mammary Paget's disease (MPD). Methods Totally 34 female patients with pathologically confirmed MPD were retrospectively recruited. According to diagnosis,the clinical data and sonographic findings were reviewed and analyzed. Results Among these 34 patients,7 patients had single MPD; in the remaining 27 patients,16 were accompanied by invasive ductal carcinoma (IDC),7 by ductal carcinoma in situ (DCIS),3 by both IDC and DCIS,and 1 by other pathologic types of carcinoma. Twenty-four patients presented with typical clinical features of MPD,whereas 10 patients had no typical features of MPD. Among the 24 patients with typical clinical features,ultrasound examinations showed that 11 had echoic abnormality in nipple-areolar complex,14 had lesions of breast,and 14 had microcalcifications. Among the 10 patients without typical clinical features,ultrasound examinations revealed echoic abnormality in nipple-areolar complex in 3 cases,breast lesions in 9 cases,and microcalcifications in 6 cases. Among the 14 patients with echoic abnormality in nipple-areolar complex,all of them presented as rich blood flow in nipple detected by color Doppler ultrasonography. Conclusions The main clinical feature of MPD is abnormalities in nipple-areolar complex. Sonography can recognize the echoic abnormalities of nipple and lesions of breast. Sonographer should be careful of the nipple-areolar complex when mass is found in breast.

Objective Explore the diagnostic value of color Doppler ultrasonography in renal vein embolism compared with contrast-enhanced CT.Analyze and summarize the sonographic features and reasons of misdiagnosis of renal vein embolism.Methods Reports of color Doppler ultrasonography and contrast-enhanced CT in 15 patients with 20 renal vein thrombosis and 25 patients with 25 renal vein tumor thrombosis were retrospectively analyzed.We summarized the sonographic features including the location of emboli,the lumen and wall of the involved veins,the information of collateral circulation and the color Doppler sonographic features.Results The diagnostic accuracy of renal vein thrombosis and tumor thrombosis were 85%and 84%for ultrasound,100%and 96%for contrast-enhanced CT,the difference was not statistically significant(all P＞0.05).The typical sonographic features include(1)Expansion of the renal vein and full of solid echogenicity;(2)No flow signals or flow filling defect in renal veins;(3)No or sparse venous flow signal in the involved kidney.Conclusions Color Doppler ultrasonography and contrast-enhanced CT have a good consistency in the diagnosis of renal vein embolism.Color Doppler ultrasonography can be used as an important imaging method to evaluate the renal vein embolism,which can combine medical history and provide a more reliable basis for the diagnosis of renal vein embolism.

Objective To investigate the significance of superb microvascular imaging (SMI) for the detection of neovascularization in carotid atherosclerotic plaques.Methods SMI detected 28 carotid atherosclerotic plaques in 28 patients who underwent carotid endarterectomy.The SMI grade of carotid plaque neovascularization was assigned based on the following grading system:Grade 0,no neovascularization;grade 1,some neovascularization;grade 2,neovascularization observed in the shoulder of the plaque;and grade 3,widely distributed new blood vessels.SMI was used to evaluate the degree of blood flow,maximum flow velocity,and resistance index of the new vessels in the plaque.Microvascular density was measured with CD31 staining.Results Clear correlations were observed between neovascularization density on histopathological staining of the plaque and the degree of blood flow detected with SMI (rs=0.788,P ＜ 0.001).The classification of neovascular blood flow in the plaque was positively correlated with plaque thickness (rs=0.686,P=0.002).Of the 28 cases,neovascularization was detected in 23;of these 23 cases,the direction of blood flow was from the adventitia to the intima in 17 (75％) cases,while 6 (25％) cases showed an irregular direction of blood flow.The mean neovascular flow velocity was (5.620±0.131) cm/s,and the mean neovascular resistance index was 0.660 ± 0.090.Conclusion SMI is useful for the evaluation of carotid atherosclerotic plaque neovascularization.

Objective:To discuss the value of ultrasound in the diagnosis of pelvic lipomatosis and analyze the causes of misdiagnosis.Methods:A retrospective analysis of 68 cases of pelvic lipomatosis confirmed by operation or imaging in Peking Union Medical College Hospital from January 2000 to December 2018 was made to summarize the characteristics of ultrasonic manifestations.Results:Ultrasonographic findings were as follows: 6 cases (8.8%) had increased fat-like hyperecho in pelvic cavity; 60 cases (88.2%) had abnormal bladder; 42 cases (61.7%) had pyelectasis and 24 cases (35.3%) had ureterectasis. Of the 68 cases, 6 cases (8.8%) were correctly diagnosed; 54 cases (79.4%) were missed; 8 cases (11.8%) were misdiagnosed, including 7 cases (10.3%) of bladder tumor and 1 case (1.5%) of retroperitoneal giant mass.Conclusions:Pelvic lipomatosis has characteristic sonographic features.When urinary tract obstruction and bladder wall thickening are observed, pelvic lipomatosis should be considered. Bladder shape and existence of increasing fat-like hyperecho in the pelvis should be further scanned to reduce the misdiagnosis rate of pelvic lipomatosis.

BACKGROUND: Although intensively studied in patients with cardiovascular diseases (CVDs), the prognostic value of diastolic blood pressure (DBP) has little been elucidated in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study aimed to reveal the prognostic value of DBP in AECOPD patients. METHODS: Inpatients with AECOPD were prospectively enrolled from 10 medical centers in China between September 2017 and July 2021. DBP was measured on admission. The primary outcome was all-cause in-hospital mortality; invasive mechanical ventilation and intensive care unit (ICU) admission were secondary outcomes. Least absolute shrinkage and selection operator (LASSO) and multivariable Cox regressions were used to identify independent prognostic factors and calculate the hazard ratio (HR) and 95% confidence interval (CI) for adverse outcomes. RESULTS: Among 13,633 included patients with AECOPD, 197 (1.45%) died during their hospital stay. Multivariable Cox regression analysis showed that low DBP on admission (<70 mmHg) was associated with increased risk of in-hospital mortality (HR = 2.16, 95% CI: 1.53-3.05, Z = 4.37, P <0.01), invasive mechanical ventilation (HR = 1.65, 95% CI: 1.32-2.05, Z = 19.67, P <0.01), and ICU admission (HR = 1.45, 95% CI: 1.24-1.69, Z = 22.08, P <0.01) in the overall cohort. Similar findings were observed in subgroups with or without CVDs, except for invasive mechanical ventilation in the subgroup with CVDs. When DBP was further categorized in 5-mmHg increments from <50 mmHg to ≥100 mmHg, and 75 to <80 mmHg was taken as reference, HRs for in-hospital mortality increased almost linearly with decreased DBP in the overall cohort and subgroups of patients with CVDs; higher DBP was not associated with the risk of in-hospital mortality. CONCLUSION: Low on-admission DBP, particularly <70 mmHg, was associated with an increased risk of adverse outcomes among inpatients with AECOPD, with or without CVDs, which may serve as a convenient predictor of poor prognosis in these patients. CLINICAL TRIAL REGISTRATION Chinese Clinical Trail Registry, No. ChiCTR2100044625.
Humans ; Blood Pressure ; Pulmonary Disease, Chronic Obstructive/therapy* ; Cohort Studies ; Respiration, Artificial ; Inpatients ; Hospital Mortality