ObjectiveTo sum up the experience in the treatment of huge primary retroperitoneal pelvic tumors (diameter≥10 cm), and analyze factors influencing the removal of the tumors during surgical procedures. MethodsA clinical retrospective review of 26 cases with huge primary retroperitoneal pelvic tumors undergoing surgical resection was made during a period of 1980～2000 in our hospital. The rate of tumors resected was compared between benign and malignant, male and female patients. Results The tumor resection rate in this group was 73%(19/26). There was no mortality within 30 days and no severe postoperative complication. Conclusion Resection should be attempted whenever possible for patients suffering from huge pelvic tumors. The resection rate was higher in female patients than that in male patients. Major blood vessels invasion is responsible for low radical resection rate.

Objective:To compare the clinical effects of direct mechanical thrombectomy (MT) and intravenous thrombolysis (IVT) bridging MT (IVT+ MT) in the treatment of patients with acute anterior circulation large vessel occlusive stroke with high clot burden.Methods:Consecutive patients with acute anterior circulation large vessel occlusion with clot burden score ≤6 admitted to the Department of Neurology, Liuzhou People's Hospital and received endovascular treatment (MT or IVT+ MT) from June 2015 to April 2019 were enrolled retrospectively. The baseline clinical data, surgical status, clinical outcome, length of stay and cost of hospitalization in the direct MT group and the IVT+ MT group were compared. The modified Rankin Scale was used to evaluate the outcomes at 90 d after the onset of stroke. 0-2 was defined as a good outcome and >2 was defined as a poor outcome. Multivariate logistic regression analysis was used to identify the independent influencing factors of poor outcomes. Results:A total of 115 patients with acute anterior circulation large vascular occlusive stroke with high clot burden were enrolled, aged 65.4±12.0 years, 70 (60.9%) were male. The baseline National Institutes of Health Stroke Scale (NIHSS) score was 18.0 (14.0-22.0). Seventy patients (60.9%) in the direct MT group, 45 in the IVT+ MT group (39.1%). Forty-nine patients (42.6%) had a good outcome and 66 (57.4%) had a poor outcome. The time from onset to inguinal puncture (210 [130-255] min vs. 230 [187-268] min; Z=-1.982, P=0.047) and the time from onset to successful vascular recanalization (283 [228-358] min vs. 320 [268-385] min; Z=-2.017, P=0.044) were significantly shorter than the IVT+ MT group, but there were no significant differences in the successful recanalization rate (84.4% vs. 81.4%; χ2=0.173, P=0.677), the incidence of postoperative symptomatic intracranial hemorrhage (6.7% vs. 7.1%; P=1.000) and the good outcome rate at 90 d (40.0% vs. 44.3%; χ2=0.206, P=0.650) between the direct MT group and the IVT+ MT group. In addition, although there was no significant difference in length of stay between the two groups (12.1±7.1 d vs. 10.6±6.6 d; t=1.128, P=0.262), the total hospitalization cost of the direct MT group was significantly lower than that of the IVT+ MT group (80 328 [63 214-101 136] CNY vs. 88 517 [68 001-115 590] CNY; Z=-1.972, P=0.049). Multivariate logistic regression analysis showed that higher baseline systolic blood pressure (odds ratio [ OR] 1.033, 95% confidence interval [ CI] 1.005-1.062; P=0.019), higher baseline NIHSS score ( OR 1.117, 95% CI 1.029-1.213; P=0.008) and lower baseline Alberta Stroke Program Early CT Score ( OR 0.189, 95% CI 0.056-0.641; P=0.008) were independently associated with the poor outcomes, while there was no independent correlation between the endovascular treatment mode and the outcomes. Conclusions:For patients with anterior circulation large vessel occlusive stroke with high clot burden, the successful recanalization rate and good clinical outcome rate of direct MT were equivalent to IVT+ MT, but the cost was less. Therefore, direct MT may be a better choice for the treatment of anterior circulation large vessel occlusive stroke with high clot burden.

Objective To investigate the feasibility,safety and efficacy of transcatheter drug-loaded microsphere embolization(DLME)in treating patients with advanced bladder cancer with bleeding(ABCB).Methods A total of 26 ABCB patients who underwent DLME for tumor supply arteries were retrospectively selected.The postoperative efficacy and related complications were observed.The recurrence of hematuria and survival situation were followed up.Results All 26 surgeries achieved success with a technical success rate of 100.0％.There were 21 cases(80.8％)of bilateral bladder artery embolism and 5 cases(19.2％)of unilateral bladder artery embolism.Three days after the operation,24 patients(92.3％)had hematuria remission.And the other two patients(7.7％)had no hematuria remission,they were relieved after interventional embolization again.Compared with that before operation,the blood transfusion rate,blood transfusion volume,hematocrit and hemoglobin at one week after operation were significantly improved(P＜0.05).One month after the last intervention,there were 2 cases of complete response,19 cases of partial response,3 cases of stable disease,and 2 cases of progressive disease.The objective remission rate was 80.8％,and the disease control rate was 92.3％.Compared with that before operation,the T stage was significantly improved at one month after operation(P＜0.05).No patients had severe complications such as ectopic embolism.After follow-up for 3-36 months,5 cases(19.2％)had a recurrence of hematuria.Conclusion Transcatheter DLME is feasible,safe,and effective in the treatment of patients with ABCB.It is an optional,minimally invasive palliative measure.

OBJECTIVETo study the application of hand-assisted laparoscopic surgery (HALS) in colorectal carcinoma resection.

METHODSFourteen patients with colorectal carcinoma underwent resection by HALS.

RESULTSHand-assisted laparoscopic right hemicolectomy was performed in 6 of 8 ascending colon cancer patients, spending an average of 160 minutes (110 to 220 minutes) for the procedure. The amount of bleeding was 40 approximately 100 ml. Bowel sounds resumed in 36 approximately 72 hours after the operation. The average interval between the operation and patients' discharge was 8 days (7 to 12 days). For 2 patients the surgeons had to resort to laparotomy. All patients received postoperative chemotherapy. Hand-assisted laparoscopic abdominoperineal resection was performed in 5 of 6 patients with lower rectal cancer, with the average duration of 180 minutes (120 to 270 minutes), with bleeding of 40 to 80 ml. Bowel sounds resumed within 24 to 72 hours and the average discharge interval was 14 days (12 to 18 days). The urinary catheter in 6 patients was removed in 7 to 8 days after the operation. All patients with rectal carcinoma received postoperative chemotherapy and radiotherapy. One patient was shifted to laparotomy because of extensive adhesion in the pelvic cavity. Four of 11 patients treated by HALS experienced slight pain in the incision. No other complications were observed in any of the patients. Remote results await further follow-up.

CONCLUSIONHand-assisted laparoscopic surgery in the treatment of colorectal carcinoma, a safe and simple procedure, not only ensures the clearance of tumor, but also reduces operative trauma and hastens recovery.

Adult ; Aged ; Colectomy ; Colorectal Neoplasms ; surgery ; Female ; Hand ; Humans ; Laparoscopy ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVETo improve the diagnosis and treatment of carcinoma of head of pancreas.

METHODSA retrospective study was carried out to evaluate 178 patients suffering from carcinoma of head of pancreas.

RESULTSPain in the epigastrium and obstructive jaundice were observed in 70% and 74.2% of these 178 patients, both of which were of significance (P < 0.001) between stage I, II and stage III, IV disease. Only 18% of patients had pain in the back, 81.3% of whom belonged to the stage IV category. The detection rate of the tumor by B-ultrasound, CT and MRI were 74.2%, 87.3% and 85.5%, respectively. The success rate of pancreatoduodenectomy was 10.1%. The postoperative 1-, 3- and 5-year survival rates were 67.5%, 36% and 5.6%. Internal drainage was performed in 115 patients. The median survival time was 7 months in patients with unresectable tumor who received radiotherapy and/or chemotherapy.

CONCLUSIONPain in the epigastrium and obstructive jaundice are the most common symptoms. Hyperglycemia is the most common complication. Pain in the back implies an advanced lesion. CT is the most important way of diagnosis and the combination of B-ultrasound, CT and MRI may improve the rate of diagnosis up to 96.6%. By now, pancreaticoduodenectomy is still the only effective treatment for the carcinoma of head of pancreas and internal drainage is an important palliative measure.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Hyperglycemia ; etiology ; Male ; Middle Aged ; Neoplasm Staging ; Pain ; etiology ; Pancreatic Neoplasms ; complications ; diagnosis ; mortality ; surgery ; Retrospective Studies ; Survival Rate ; Tomography, X-Ray Computed

Objective:To test the practical effect of the research projects outpatient strategy for application of the National Natural Science Foundation (NSFC) in a hospital of Chinese medicine.Methods:We compared the number and success rate of the National Natural Science Foundation of China grant awards before and after the implementation of the research projects outpatient strategy, and further analyzed the promotional effect of the research projects outpatient strategy on general programs and youth scientists funds through univariate analysis and multivariate Logistic regression.Results:Since the implementation of the research projects outpatient strategy, both the number of NSFC grant awards and the success rate continuously increased, indicating that the strategy played a positive role in improving the overall success rate of the hospital. However, this effect was primarily reflected in the assistance provided to applications for youth scientists funds. The main favorable factor for winning general programs was the applicant′s preliminary foundation. Applicants who have previously received NSFC funding had a higher success rate.Conclusions:The strategy of research projects outpatient can promote the winning of NSFC youth scientists funds.

Objective:To explore the relationship between the maximum standard uptake value (SUV max) based on 18F-fluorodeoxyglucose (FDG) PET-CT and the epidermal growth factor receptor (EGFR) mutation status of lung adenocarcinoma appearing as ground glass nodules (GGN). Methods:A total of 103 patients with lung adenocarcinoma from October 2011 to December 2020 in the Third Affiliated Hospital of Soochow University were retrospectively enrolled. All patients underwent 18F-FDG PET-CT and high-resolution CT, and underwent surgical resection and EGFR detecting within one month. The patients were divided into EGFR mutation group and wild group according to the EGFR test results. The GGN number, type, location, shape, lobulation sign, spicule sign, abnormal bronchial sign, vacuole sign, pleural indentation, diameter of GGNs (D GGN), diameter of solid component (D solid) and nodule ground-glass opacity component CT mean (CT GGO) were analyzed on CT images. The maximum standard uptake value (SUV max) of nodules was measured on PET-CT images. The t test, Mann-Whitney U test or χ 2 test were used to compare the differences of clinical data, pathological data, CT imaging parameters and SUV max between the two groups. Hierarchical binary logistic regression model was used to assess whether there was any association between SUV max and EGFR mutation status in different subgroups. Generalized additive model and smooth curve fitting were applied to solve nonlinear problems, and piecewise binary logistic regression model was used to explain nonlinearity. Results:A total of 103 patients with 106 nodules were finally included. There were 75 patients (78 nodules) in the EGFR mutation group and 28 patients (28 nodules) in the EGFR wild group. Adenocarcinomas with EGFR mutation showed significantly higher spiculated edge, pleural depression sign and invasive adenocarcinoma proportions than those in EGFR wild group ( P<0.05). There were no significant differences in other indicators between groups ( P>0.05). After adjusting for age and fasting blood glucose, gender and the number of GGNs significantly affected the relationship between SUV max and EGFR mutation ( P<0.05), which suggested that there was an interaction. After adjusting for confounding factors, there was a non-linear relationship between SUV max and EGFR mutation status in female subgroup (degree of freedom was 1.817, P=0.026). When SUV max<2.4, the risk of EGFR mutation increased significantly with the increase of SUV max (OR=43.621, 95%CI 4.686-406.042), P<0.001]. When SUV max>2.4, the risk of EGFR mutation increased insignificantly ( P=0.392). Conclusions:Lung adenocarcinoma appearing as GGN has a higher risk of EGFR mutation. The risk of EGFR mutation in female patients increases with increasing SUV max, but there is saturation effect.

Objective:To investigate the value of intratumoral and peritumoral radiomics models based on 18F-FDG PET-CT in predicting epidermal growth factor receptor (EGFR) mutation status in lung adenocarcinoma and interpret peritumoral radiomics features. Methods:This study was a cross-sectional study. Patients with lung adenocarcinoma who underwent 18F-FDG PET-CT at the Third Affiliated Hospital of Soochow University between January 2018 and April 2022 were retrospectively collected and samplied into a training set (309 cases) and a test set (206 cases) in a 6∶4 ratio randomly. Radiomics features were extracted from the intratumoral and peritumoral regions of interest based on PET and CT images, respectively, and the optimal feature sets were selected. Radiomics models were established using the XGBoost algorithm, and radiomics scores (intratumoral CT label, peritumoral CT label, intratumoral PET label, peritumoral PET label) were calculated. Logistic regression analysis was used to construct a clinical model and a combined model (incorporating PET-CT intratumoral and peritumoral radiomics, clinical features, and CT semantic features). The predictive performance of the models was evaluated using receiver operating characteristic curves and the area under the curve (AUC). Unsupervised clustering, Spearman correlation analysis, and visualization methods were used for the interpretability of peritumoral radiomics features. Results:In both the training and test sets, the AUC value of CT peritumoral labels was greater than that of CT intratumoral labels for predicting EGFR mutation status in lung adenocarcinoma (training set: Z=3.84, P<0.001; test set: Z=1.99, P=0.046). In the test set, the AUC value of PET intratumoral labels (0.684) was slightly higher than that of PET peritumoral labels (0.672) for predicting EGFR mutation status, but the difference was not statistically significant ( P>0.05). The combined model had the highest AUC value for predicting EGFR mutation status of lung adenocarcinoma in both the training and test sets and was significantly better than the clinical model (training set: Z=6.52, P<0.001; test set: Z=2.31, P=0.021). Interpretability analysis revealed that CT peritumoral radiomics features were correlated with CT shape features, and there were significant differences in CT peritumoral features between different EGFR mutation statuses. Conclusions:The value of CT peritumoral labels is superior to that of CT intratumoral labels in predicting EGFR mutation status in lung adenocarcinoma. The predictive performance of the model can be improved by combining PET-CT intratumoral and peritumoral radiomics, clinical features, and CT semantic features.

Adult ; Anesthesia, General ; methods ; Anesthesia, Intravenous ; methods ; Cesarean Section ; methods ; Female ; Humans ; Muscular Atrophy, Spinal ; Pregnancy

Background Air pollution is a major public health concern. Air Quality Health Index (AQHI) is a very important air quality risk communication tool. However, AQHI is usually constructed by single-pollutant model, which has obvious disadvantages. Objective To construct an AQHI based on the joint effects of multiple air pollutants (J-AQHI), and to provide a scientific tool for health risk warning and risk communication of air pollution. Methods Data on non-accidental deaths in Yunnan, Guangdong, Hunan, Zhejiang, and Jilin provinces from January 1, 2013 to December 31, 2018 were obtained from the corresponding provincial disease surveillance points systems (DSPS), including date of death, age, gender, and cause of death. Daily meteorological (temperature and relative humidity) and air pollution data (SO₂, NO₂, CO, PM_2.5, PM₁₀, and maximum 8 h O₃ concentrations) at the same period were respectively derived from China Meteorological Data Sharing Service System and National Urban Air Quality Real-time Publishing Platform. Lasso regression was first applied to select air pollutants, then a time-stratified case-crossover design was applied. Each case was matched to 3 or 4 control days which were selected on the same days of the week in the same calendar month. Then a distributed lag nonlinear model (DLNM) was used to estimate the exposure-response relationship between selected air pollutants and mortality, which was used to construct the AQHI. Finally, AQHI was classified into four levels according to the air pollutant guidance limit values from World Health Organization Global Air Quality Guidelines (AQG 2021), and the excess risks (ERs) were calculated to compare the AQHI based on single-pollutant model and the J-AQHI based on multi-pollutant model. Results PM_2.5, NO₂, SO₂, and O₃ were selected by Lasso regression to establish DLNM model. The ERs for an interquartile range (IQR) increase and 95% confidence intervals (CI) for PM_2.5, NO₂, SO₂ and O₃ were 0.71% (0.34%–1.09%), 2.46% (1.78%–3.15%), 1.25% (0.9%–1.6%), and 0.27% (−0.11%–0.65%) respectively. The distribution of J-AQHI was right-skewed, and it was divided into four levels, with ranges of 0-1 for low risk, 2-3 for moderate risk, 4-5 for high health risk, and ≥6 for severe risk, and the corresponding proportions were 11.25%, 64.61%, 19.33%, and 4.81%, respectively. The ER (95%CI) of mortality risk increased by 3.61% (2.93–4.29) for each IQR increase of the multi-pollutant based J-AQHI , while it was 3.39% (2.68–4.11) for the single-pollutant based AQHI . Conclusion The J-AQHI generated by multi-pollutant model demonstrates the actual exposure health risk of air pollution in the population and provides new ideas for further improvement of AQHI calculation methods.