The validity of resident admit note is a key factor that determines whether the note can be taken as a testimony in a medical dispute or not.The patient's validation signature is a positive attempt to guarantee the validity of resident admit note.Currently there are a series of insufficiencies in patients' validation signature system,including indefinite legislation,patients' uncooperative attitude,etc.Therefore,certain legislation is in great need to validate patients' right of signature and safeguard the validation of resident admit note,thus providing legal support for regulating medical activities and improving the validity of medical notes as testimonies in medical disputes.

Objective To study prevalence and clinical significance of coronary artery and aortic calcification in lung cancer screening using spiral CT. Methods 1877 subjects without symptom underwent lung cancer screening using spiral CT. Standard mediastinal windows were used for showing the presence or absence of calcification in coronary arteries and aorta.Results (1)The frequency of coronary artery calcification(CAC) was 15% in total 1877 subjects, the prevalence was higher in male than in famale(P0.05), the prevalence of aortic calcification increased with age in both male and famale. The frequency of calcification was the highest in the arch and lowest in the ascending aorta.Conclusion The lung cancer screening using spiral CT can be used to screen of coronary artery and aortic calcification.The detection of calcification of coronary arteries and aorta has important clinical significance which relates with coronary heart disease.

Objective To investigate the expression of Epstein-Barr virus(EBV)-latent membrane protein 1 (LMP1) in chronic atrophic gastritis (CAG) with intestinal metaplasia and discuss its effect on gastric cancer.Methods Immunohistochemistry was used to examine the expression of EBV-LMP1 in 45 cases of chronic superficial gastritis(CSG),63 cases of CAG with intestinal metaplasia and 36 cases of gastric cancer.Results There was no expression of EBV-LMP1 in CSG and gastric cancer,while the positive rate of EBV-LMP1 in CAG with intestinal metaplasia was 36.5％ (23/63) and EBV-LMP1 was mainly stained in the cell nucleus.The expression of EBV-LMP1 in CAG with intestinal metaplasia was significantly higher than that in CSG and gastric cancer,and there was significant difference (P =0.000).Conclusions EBV-LMP1 is expressed in CAG with intestinal metaplasia.The expression of EBV-LMP1 is significantly higher than that in CSG and gastric cancer indicating that EBV infection in gastric carcinogenesis may play an important role in the early stages.

Objective To investigate the methods and results of hand reconstruction by transplanting the fostered residual finger and the second toe,which share the same blood supply system.Methods From January,2014 to January,2016,3 cases with destructive hand injuries in our hospital;and debridement was performed in one session during the early stage of trauma,with skin grafting to cover the wrist stump and foster the residual finger to a branch of the dorsalis pedis artery.The first dorsal metatarsal artery around the toe web was identified and then gradually isolated proximally with dissection of the branches of the dorsalis pedis artery supplying the fostered finger until the convergence of the two blood vessels.Then,reconstructed hand by residual finger and combined second toe transplantation.Results After a follow-up period of 3 months to 2 years,the reconstructed hand had a good appearance and was able to complete basic mundane actions.The function of the limb was restored to a large extent andthe patient was satisfied with the reconstructed hand.Conclusion Transfer of a fostered residual finger and combined second toe which have the same blood supply system for hand reconstruction as a new method need to anastomose only one set of arteries,and it is feasible with the good appearance and function of the reconstructed hand.

This study examined the value of volume rendering (VR) interpretation in assessing the growth of pulmonary nodular ground-glass opacity (nGGO). A total of 47 nGGOs (average size, 9.5 mm; range, 5.7-20.6 mm) were observed by CT scanning at different time under identical parameter settings. The growth of nGGO was analyzed by three radiologists by comparing the thin slice (TS) CT images of initial and repeat scans with side-by-side cine mode. One week later synchronized VR images of the two scans were compared by side-by-side cine mode to evaluate the nGGO growth. The nodule growth was rated on a 5-degree scale: notable growth, slight growth, dubious growth, stagnant growth, shrinkage. Growth standard was defined as: Density increase ≥ 30 HU and (or) diameter increase (by 20% in nodules ≥10 mm, 30% in nodules of 5-9 mm). Receiver operating characteristic (ROC) was performed. The results showed that 32 nGGOs met the growth criteria (29 nGGOs showed an increase in density; 1 nGGO showed an increase in diameter; 2 nGGOs showed an increase in both diameter and density). Area under ROC curve revealed that the performance with VR interpretation was better than that with TS interpretation (P<0.01, P<0.05 and P<0.05 for observers A, B and C respectively). Consistency between different observers was excellent with both VR interpretation (κ=0.89 for observers A&C, A&B, B&C) and TS interpretation (κ=0.71 for A&B, κ=0.68 for A&C, κ= 0.74 for B&C), but time spending was less with VR interpretation than with TS interpretation (P<0.0001, P<0.0001 and P<0.05 for observers A, B and C, respectively). It was concluded that VR is a useful technique for evaluating the growth of nGGO.

Objective To explore the relationship between polyp features at first-time colonoscopy and the recurrence, and to analyze the risk factors of recurrence at different time points of follow-up. Methods The data of 614 patients undergoing colorectal polypectomy between May 2008 and May 2016 were retrospectively analyzed. Patients were classified into 3 groups according to the characteristics and polyp features at first-time colonoscopy. The risk factors influencing polyp recurrence at different time points during follow up were analyzed. Results Univariate analysis showed that age ≥70 years, polyp′s diameter ≥0.5 cm,the number of polyps >2 and distribution throughout colon were risk factors for recurrence. In multivariate models,the number of polyps at baseline was the only significant predictor for recurrence(OR=2.36,95%CI:1.06-5.25). All of 614 patients underwent 6-87 months surveillance colonoscopy. The total recurrence rate was 58.6%(360/614). During four different surveillance intervals including 6-24 months,>24-36 months, >36-48 months, and >48-87 months,the cumulative recurrence rate of high-risk group was 60.1%,65.7%,80.7%,and 83.8%,respectively,whereas,that of low-risk group was 22.7%,40.0%, 53.8%,and 65.4%, respectively. There was a significant difference between the two groups(P=0.00). Conclusion The number of initial colorectal polyps is useful for predicting the risk of polyp recurrence,and the rate of polyp recurrence during surveillance increases with the passage of time. The cumulative recurrence rate of high-risk group after polypectomy is significantly higher than that of low-risk group.

This study examined the value of volume rendering (VR) interpretation in assessing the growth of pulmonary nodular ground-glass opacity (nGGO).A total of 47 nGGOs (average size,9.5mm; range,5.7-20.6 mm) were observed by CT scanning at different time under identical parameter settings.The growth of nGGO was analyzed by three radiologists by comparing the thin slice (TS) CT images of initial and repeat scans with side-by-side cine mode.One week later synchronized VR images of the two scans were compared by side-by-side cine mode to evaluate the nGGO growth.The nodule growth was rated on a 5-degree scale:notable growth,slight growth,dubious growth,stagnant growth,shrinkage.Growth standard was defined as:Density increase ≥ 30 HU and (or) diameter increase (by 20％ in nodules ≥10 mm,30％ in nodules of 5-9 mm).Receiver operating characteristic (ROC) was performed.The results showed that 32 nGGOs met the growth criteria (29 nGGOs showed an increase in density; 1 nGGO showed an increase in diameter; 2 nGGOs showed an increase in both diameter and density).Area under ROC curve revealed that the performance with VR interpretation was better than that with TS interpretation (P＜0.01,P＜0.05 and P＜0.05 for observers A,B and C respectively).Consistency between different observers was excellent with both VR interpretation (κ=0.89 for observers A&C,A&B,B&C) and TS interpretation (κ=0.71 for A&B,κ=0.68 for A&C,κ=0.74 for B&C),but time spending was less with VR interpretation than with TS interpretation (P＜0.0001,P＜0.0001 and P＜0.05for observers A,B and C,respectively).It was concluded that VR is a useful technique for evaluating the growth of nGGO.

0bjective To investigate the relationships between the peripheral lung cancer and pulmonary vessels or bronchi by 16-row muhislice computed tomography(MSCT)and analyze the related factors.Methods Fifty-four patients with peripheral lung cancer confirmed pathologically underwent contrast-erdaanced MSC TI Multiplanar reformation(MPR)and maximum intensity projection(MIP)in all patients were used to demonstrate the relationships between the peripheral lung cancer and pulmonary vessels,bronchi.The relationships were categorized five types:Type 1,erupted at the edge of nodule. Type 2,erupted at the center of nodule.Type 3,penetrated through the nodule.Type 4,contacting the nodule but stretched or encased.Type 5,contacting the nodule but smoothly compressed.The pathology type,stage,size,density and location of the peripheral lung cancer were recorded and the relationships with five types were evaluated by using Chi-square test and correlation analysis.Results (1)Tumor-bronchi relationship:type 1(33,61.1%)was more often seen in≥2.0 cm and solid lesions with stage Ⅱ-Ⅳ.while Type 2(14,25.9%)was often seen in<2.0 am and part-solid or non-solid lesions with stage Ⅰ.(2)Tumor-PA relationship:Type 1 was more often seen in≥2.0 am and solid lesions with stage Ⅱ-Ⅳ.while Type 2 was often seen in part-solid or non-solid lesions with stage Ⅰ.(3)Tumor-PV relationship:type 4 was the most common type(29,53.7%).Type 2(13,24.1%)was more often seen in part-solid or non-solid lesions.(4)Tumor-bronchi relationship and tumor-PA relationship had a positive correlation(r=0.5265,P<0.01).Conclusions MSCT can demonstrate the relations between the peripheral lung cancer and bronchi.PA and PV.It is useful for the differential diagnosis and prognosis evaluation of the lung csncer.