Orbital metastases rarely occur in the patients with cancer,especially from a primary pancreat-ic carcinoma.In patients presenting ophthalmologic symptoms such as local pain and periorbital edema,it is im-portant to consider orbital metastatic disease.And it is also crucial to determine the site of the primary tumor for better treatments.The mechanism underlying the orbital metastasis from pancreatic carcinoma remains to be clari-fied.In this report,we describe the clinical characteristics of a case with orbital and hepatic metastases from pri-mary pancreatic carcinoma,providing a reference for clinical diagnosis.Computed tomography of the abdomen and left orbit,in combination with intraorbital biopsy,suggesting a primary pancreatic malignancy with metastatic dis-ease.Surgical pathology and histopathological examination results confirmed the diagnosis.After single agent gem-citabine chemotherapy,the patient′s symptoms relieved.

Objective　To assess fetal cardiac hypertrophy and ventricular function in fetuses of diabetic mothers. Methods　Study group was consist of 23 fetuses of diabetic pregnancies. Control group was consist of 108 fetuses of normal pregnancies. Cardiac size was measured by ultrasound as inter-ventricular septal (IVS) thickness and ventricular diastolic and systolic (VD and VS) dimensions and perimeter. Cardiac function was expressed as ventricular shortening fraction 1 (VSF1) (ventricular diastolic perimeter -ventricular systolic perimeter/ventricular diastolic perimeter)and ventricular shortening fraction 2 (VSF2) (ventricular diastolic dimension-Ventricular systolic dimension/ventricular diastolic dimension).Fetal birth weight was recorded. Results　 IVS of study group （6.1±0.7） mm, which was significantly thicker than IVS of control group （4.4±0.7） mm. Left ventricular diastolic dimension (LVDD) and Left ventricular systolic dimension (LVSD) of study group were （3.3±0.8）cm2 and （2.2±0.6） cm2, which were greater than those of control group （2.6±0.6） cm2 and （2.0±0.5） cm2. Right ventricular diastolic dimension (RVDD) and Right ventricular systolic dimension (RVSD) of study group were （3.9±0.7） cm2　and （2.6±0.7） cm2, which were also greater than those of control group （3.5±0.5） cm2 and （2.4±0.7） cm2. Left ventricular shortening fraction 1 of left ventricular (LVSF1) of study group was 0.20±0.07, which was greater than that of control group （0.12±0.04）. LVSF2 of study group was 0.35±0.11，which was greater than that of control group too （0.23±0.10）. Right ventricular shortening fraction 1 of left ventricular (RVSF1) of study group was 0.19±0.05，which was greater than that of control group （0.13±0.11）. RVSF2 of study group was 0.33±0.09，which was greater than that of control group （0.23±0.14）. Estimated fetal birth weight of study group was （4 076±608） g, which was greater than that of control group （3 440±377） g. Conclusion　These findings showed that fetal hyperinsulinemia result in fetal weight increasing, global cardiac enlarger inter-ventricular septal thickness larger and revealed hypercontractillty of ventricle in fetuses of diabetas mothers.

Objective　To investigate the characteristics of fetal growth in uterus. Methods　A total of 695 term singleton infant were studied. Various ultrasound measurements (including Biparietal diameter BPD, Transverse abdomen-diameter AD, femur length FL) obtained from 26 weeks' gestation to term. 147 cases were macrosomia. 48 cases were intra-uterine growth retardation (IUGR). 500 cases were normal weight. We assessed the tendency of BPD/AD and AD/FL of fetal. Results　BPD/AD ratio of macrosomia was lowest, and BPD/AD ratio of IUGR was highest of them. The tendency of BPD/AD ratio were declined in gestation. AD/FL ratio of macrosomia were highest, and AD/FL ratio of IUGR was lowest of them. The tendency of AD/FL ratios were smooth in gestation. Conclusion　The tendency of fetal growth in uterus showed that the add of abdominal diameter contributed to gain in weight.

Objective To assess the diagnostic value of Logistic model in differentiating between malignant and benign ovarian lesions. Methods Thirty-five indexes of clinical and ultrasound data were recorded in 601 ovarian lesions confirmed by surgical pathology. The Logistic model was developed on a training set( n - 400) and tested on a test set( n = 201). Results Variable selection resulted in a set of 10 variables for the models: personal history of ovarian cancer, maximal diameter of the lesion, maximal diameter of the solid component, multilocular-solid tumor, solid tumor, ascites, flow within papillation, irregular walls, very strong intratumoral blood flow (i. e. color score 4) and acoustic shadows. Test set area under the receiver-operating characteristics curve was 0.963 with a sensitivity 93.9% and a specificity 93. 1 %. Conclusions Logistic model can accurately separate malignant from benign ovarian masses.

Objective To observe clinical efficacy of external bath of modified Huangqi Guizhi Wuwu Decoction in relieving peripheral neurotoxicity induced by oxaliplatin.Methods Sixty patients were randomly divided into control group and treatment group (30 cases in each group). Both groups received intramuscular injection of mecobalamine (0.5 mg/d, three times a week). At the same time, the treatment group received external bath of modifiedHuangqi Guizhi Wuwu Decoction. All the courses of treatment lasted for 14 days. Clinical efficacy and adverse reactions of the two groups were observed.Results The total effective rate of treatment group was 73.3% (22/30), which was superior to that of 40.0% (12/30) in the control group, with statistical significance (P<0.05), without any adverse reaction.Conclusion External bath of modifiedHuangqi Guizhi Wuwu Decoction is effective as supportive care for alleviating chronic peripheral neurotoxicity induced by oxaliplatin.

Objective To assess prenatal heart disease screening program by ultrasound. Methods A total of 11 544 second-trimester screening scans were performed before 24 weeks′ gestation on 11 410 women between February 2004 and May 2007 in Obstetrics and Gynecology Hospital of Fudan University. Fetal heart screening was based on four-chamber and outflow tract views( left ventricular outflow + three vessel view). The sensitivity and specificity of different views were evaluated. Follow-up data of newborns was obstained. Results (1) Among 11 544 cases, 48 cases of congenital heart disease (CHD) were diagnosed in utero. Six cases were false negative, and 2 cases were false positive. The incidence of CHD was 0.47% (54/11 544). (2) Thirty-three CHDs were detected based on the four-chamber view, including 18 ventricular septal defect (9 with conotroncal anomalies),6 anomalous atrioventricle valve, 9 disproportion of left/right ventricle. The sensitivity of the four-chamber view alone was 61.11% (33/54), and the specificity was 99. 98% ( 11 488/11 490). Fifteen CHDs were detected based on the left ventricular outflow and three vessel views, including 1 pulmonary atresia, 3 pulmonary valve stenosis, 2 transposition of the great arteries ( TGA ), 1 pulmonary stanosis with TGA, 6 tetralogy of Fallot, and 2 pulmonary stenosis. The sensitivity of the combination of the four-chamber and outflow tract views was 88. 89% (48/54), and the specificity was 99. 98% (11 488/11 490). (3)Of 48 CHDs,11 cases were eceompanied by other malformations. Eleven cases were performed amniocentesis, amony whom 5 cases were trisemy 21. Conclusion The screening program based on four-chamber and outflow tract views shows good sensitivity and excellent specificity. Our prenatal heart screening program is clinically feasible.

OBJECTIVE: To explore the correlation between allergic factors and chronic rhinosinusitis, and discuss its effects on the development of illness. METHOD: One hundred and one cases were selected to detect allergic serum relative index: the concentration of serum TIgE, specific IgE semi-quantitative test, the concentration of serum ECP as well as inquiring medical record, Lund-Mackay CT system scoring. RESULT: The concentration of serum TIgE and serum ECP in CRS was higher than those in control (P < 0.01). The increased proportion of serum TIgE and serum ECP was significantly different among clinical stages (P < 0.05) and between the cases with and without prior sinus surgery (P < 0.05). CT scores of the cases with serum TIgE and serum ECP increased were significantly higher than those without serum TIgE and serum ECP increased. The strong positive rate in CRS was significantly different among clinical stages (P < 0.05). The strong positive rate increased significantly in the cases with prior sinus surgery (P < 0.05). CT scores in the cases with strong positive allergen were significantly higher than that in the cases without positive allergen (P < 0.05). CONCLUSION These results suggest that allergic factors make some negative effect on the severity of CRS and are the index for the severity and worse prognosis of illness.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Allergens ; blood ; Case-Control Studies ; Chronic Disease ; Eosinophil Cationic Protein ; blood ; Female ; Humans ; Immunoglobulin E ; blood ; Male ; Middle Aged ; Sinusitis ; blood ; immunology ; pathology ; Young Adult

OBJECTIVE: To explore correlation of allergy and outcomes after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis. METHOD: Before ESS, 115 cases were arranged to detect allergic serum relative index: the concentration of serum TIgE, specific IgE semi-quantitative test and the concentration of serum ECP; to survey QOL status: VAS, SNOT-20 and SF-36; as well as inquire medical record, Lund-Mackay CT system scoring, clinical classification of chronic rhinosinusitis. After ESS (>1 year), 74 cases were followed up. The subjective and objective assessment were achieved by means of VAS, SNOT-20, SF-36 and Lund-Kennedy endoscopic scores. RESULT: The improvements of VAS scores of the cases with increased serum TIgE were significantly lower than those without increased serum TIgE (P<0.05). In cases of II, III types, the objective outcomes of the cases with increased serum TIgE were significantly worse than those without increased serum TIgE (P<0.05). The objective outcomes of the cases with positive allergen (> or = 3) were significantly worse than those with positive allergen (<3) (P<0.05). The objective outcomes of the cases with strong positive allergen were significantly worse than those without strong positive allergen (P<0.05). VAS scores and SNOT-20 scores after endoscopic sinus surgery of the cases with strong positive allergen were significantly worse than those without strong positive allergen (P<0.05). The concentration of serum ECP of the invalid cases was significantly higher than effective cases (P<0.05). The concentration of serum ECP was positive correlated with Lund-Kennedy endoscopic scores (r=0.49, P<0.05). In cases of II, III types, the objective outcomes of the cases with increased serum ECP were significantly worse than those without increased serum ECP (P<0.05), VAS scores and SNOT-20 scores after endoscopic sinus surgery of the cases with increased serum ECP were significantly worse than those without incre- ased serum ECP (P<0.05), the improvements of VAS scores of the cases with increased serum ECP were significantly lower than those without increased serum ECP (P<0.05). CONCLUSION Those allergic serum relative indexes make some negative effect on subjective and objective outcomes. Especially, in cases with polyps, the increase of serum TIgE and serum ECP has more negative effect. Our results might help to choose immunotherapy to combine with endoscopic sinus surgery for those selected patients to improve the outcomes of chronic rhinosinusitis.
Adolescent ; Adult ; Aged ; Allergens ; blood ; Cation Transport Proteins ; blood ; Chronic Disease ; Endoscopy ; Eosinophil Cationic Protein ; blood ; Humans ; Immunoglobulin E ; blood ; Middle Aged ; Postoperative Period ; Quality of Life ; Sinusitis ; blood ; surgery ; Treatment Outcome ; Young Adult

Objective:To search, evaluate and summarize the best evidence for oral fluid intake management in adult patients with urinary calculi, providing a decision-making basis for clinical nursing.Methods:Using keywords such as urolithiasis, urinary calculi, fluid intake, water intake, fluid, etc., a systematic search was conducted in relevant domestic and international databases, guideline websites, and professional association sites for evidence related to oral fluid intake management in adult urolithiasis patients. This included clinical decisions, best practices, guidelines, expert consensus, evidence summaries, systematic reviews, and recommended practices, covering the period from January 1, 2018 to June 1, 2023. Two researchers trained in evidence-based nursing independently evaluated the quality of the literature and extracted and integrated the evidence.Results:A total of 23 articles were included, comprising two clinical decisions, one best practice, four guidelines, 13 systematic reviews, and three recommended practices. Ultimately, 18 pieces of best evidence were summarized from six aspects: the importance of fluid intake, intake volume, timing of intake, the relationship between different types of fluids and the risk of urinary calculi, intake recommendations, monitoring methods, and precautions.Conclusions:This study summarizes the best evidence for oral fluid intake management in adult patients with urinary calculi, which can provide reference for clinical nursing. When applying this evidence, it is essential to fully consider clinical circumstances and patient characteristics to reduce the recurrence rate of urinary calculi.

Objective To investigate the clinical effect of angioplasty for symptomatic intracranial atherosclerotic stenosis. Methods Eighty-two patients with symptomatic intracranial atherosclerotic stenosis whom underwent angioplasty after the failure of standard medical therapy were enrolled from Nan-jing Stroke Registry Program from September 2010 to June 2013.Nine of them underwent routine balloon angioplasty alone and 73 underwent intracranial stenting.The median time from onset to surgery was 24.5 days.The occurrence of endpoint events (any stroke ≤30 d after procedure,death and ischemic stroke >30 d in guilty vessels or original stenosis had restenosis and needed to be treated again)was assessed. The incidence of restenosis was followed up with imaging (CTA or DSA). Results (1)In the 82 patients, the success rate of operation was 92.7%(n=72 ),and 78 (95.1%)received follow-up,4 were lost to follow-up.The median follow-up time was 22.5 months (range 9 to 29 months ).Ten patients had an endpoint event,7 of them were ischemic stroke,1 was cerebral hemorrhage,and two were severe asymptomatic restenosis who underwent stenting again.The endpoint events of 3 patients occurred at day 30 after procedure (at ≤24 h after procedure).Kaplan-Meier curves showed that the incidences of cumulative endpoint events at 1,6,12,and 24 months were 3.7%,8.6%,11%,and 13%,respectively.(2)60 patients (73.2%)received imaging examination (11 CTA and 49 DSA ).Restenosis occurred in 17 patients (28.3%),among them the incidence of symptomatic restenosis was 5%(n =3 ),and asymptomatic restenosis was 23.3%(n=14). Conclusion After a comprehensive assessment and a rigorous screening, the safety is high and the mid- and long-term efficacy are satisfactory in patients with symptomatic intracranial arterial stenosis who are treated with angioplasty when their medical treatment is invalid.