Acute cholecystitis and acute cholangitis are common acute abdomen in biliary surgery. The morbidity of acute cholecystitis is high, and abdominal ultrasound has become the first choice for imaging examination. Disease assessment and severity grading are used to guide the formulation of treatment plan. Early laparoscopic cholecystectomy is the first choice for mild acute cholecystitis. Supportive treatment should be used in patients with severe acute cholecystitis to improve symptoms for elective cholecystectomy. For patients with severe cholecystitis who can not tolerate the risk of surgery and have no effect on conservative treatment, gallbladder drainage should be performed in time. Acute cholangitis is an acute disease with high mortality. Magnetic resonance cholangiopancreatography is an important imaging examination. The treatment principle of acute cholangitis is early biliary decompression, antibiotic application and general supportive treatment. The common methods of biliary decompression include percutaneous transhepatic cholangiography drainage, endoscopic duodenal papillary bile duct drainage, endoscopic ultrasound-guided biliary drainage, and surgical placement of T-tube drainage.

Objective To evaluate atrial septal defect (ASD) occlusion employing a small right anterior thoracotomy approach. Methods A total of 21 patients with ASD underwent general anesthesia and 2 -3 cm incision was made in the fourth right intercostal space. Utilizing transesophageal or transthoracic echocardiography, the occluder was released using a monotube unit. Results All patients were occluded successfully. No patient required open surgery utilizing extracorporeal circulation. There were no major complications and no evidence of residual atrial shunt. Conclusion ASD occlusion via a minimal surgical incision is safe, less invasive, and has excellent outcomes.

Objective To investigate the predictive value of 18F?FDG PET?CT scan for occult lymph node metastasis in patients with stageⅠA lung adenocarcinoma. Methods The image and pathological data of 272 patients with stage ⅠA lung adenocarcinoma from October 2006 to September 2015 were retrospectively analyzed. All patients underwent preoperative 18F?FDG PET?CT scan followed by lobectomy and systematic lymph node dissection. The correlation between occult lymph node metastasis and the maximum standardized uptake value (SUVmax) of primary tumor as well as other clinicopathological factors was analyzed to screen the risk factors of occult lymph node metastasis in stage ⅠA lung adenocarcinoma. Results Occult lymph node metastasis was detected in 50 patients (18.4%), with 24 (8.8%) patients of pN1 involvement and 26 (9.6%) of pN2 involvement. Among the 272 patients enrolled, 39 had pure ground glass nodule, 59 had part?solid nodule and 174 had solid nodule. All patients with pure ground glass nodule or nodule≤1 cm were pN0. For the 233 patients with part?solid and solid nodule, no lymph node metastasis was found in T1a stage (tumor length≤1 cm). Primary tumor SUVmax(Z＝－5.663, P＜0.001), nodule type (χ2＝21.586, P＜0.001), tumor location (χ2＝ 12.790, P＜ 0.001), histological grade ( χ2＝ 22.784, P＜0.001) and visceral pleural invasion (χ2＝5.357, P＝0.021) showed significant differences between occult lymph node metastasis group (pN+) and non?lymph node metastasis group (pN0). With SUVmax＝2.405 as cut?off value, the sensitivity and specificity for predicting occult lymph node metastasis were 90.0% and 61.7%, the area under curve was 0.761(95%CI＝0.700～0.823), and the negative predictive value was 95.8%. Multivariate analysis revealed that SUVmax＞2.405 (P＜0.001), central location ( P＝0.030) and higher histological grade ( P ＝ 0.024 ) were independent predictors of occult lymph node metastasis. Conclusions For clinical stage ⅠA adenocarcinoma, primary tumor SUVmax＞ 2.405, central location and higher histological grade were independent risk factors for occult lymph node metastasis. Systematic lymph node dissection may be avoided in lung adenocarcinoma with pure ground glass density, tumor length≤1 cm or SUVmax≤2.405, due to the very low probability of nodal involvement.

Objective To investigate the predictive value of 18F?FDG PET?CT scan for occult lymph node metastasis in patients with stageⅠA lung adenocarcinoma. Methods The image and pathological data of 272 patients with stage ⅠA lung adenocarcinoma from October 2006 to September 2015 were retrospectively analyzed. All patients underwent preoperative 18F?FDG PET?CT scan followed by lobectomy and systematic lymph node dissection. The correlation between occult lymph node metastasis and the maximum standardized uptake value (SUVmax) of primary tumor as well as other clinicopathological factors was analyzed to screen the risk factors of occult lymph node metastasis in stage ⅠA lung adenocarcinoma. Results Occult lymph node metastasis was detected in 50 patients (18.4%), with 24 (8.8%) patients of pN1 involvement and 26 (9.6%) of pN2 involvement. Among the 272 patients enrolled, 39 had pure ground glass nodule, 59 had part?solid nodule and 174 had solid nodule. All patients with pure ground glass nodule or nodule≤1 cm were pN0. For the 233 patients with part?solid and solid nodule, no lymph node metastasis was found in T1a stage (tumor length≤1 cm). Primary tumor SUVmax(Z＝－5.663, P＜0.001), nodule type (χ2＝21.586, P＜0.001), tumor location (χ2＝ 12.790, P＜ 0.001), histological grade ( χ2＝ 22.784, P＜0.001) and visceral pleural invasion (χ2＝5.357, P＝0.021) showed significant differences between occult lymph node metastasis group (pN+) and non?lymph node metastasis group (pN0). With SUVmax＝2.405 as cut?off value, the sensitivity and specificity for predicting occult lymph node metastasis were 90.0% and 61.7%, the area under curve was 0.761(95%CI＝0.700～0.823), and the negative predictive value was 95.8%. Multivariate analysis revealed that SUVmax＞2.405 (P＜0.001), central location ( P＝0.030) and higher histological grade ( P ＝ 0.024 ) were independent predictors of occult lymph node metastasis. Conclusions For clinical stage ⅠA adenocarcinoma, primary tumor SUVmax＞ 2.405, central location and higher histological grade were independent risk factors for occult lymph node metastasis. Systematic lymph node dissection may be avoided in lung adenocarcinoma with pure ground glass density, tumor length≤1 cm or SUVmax≤2.405, due to the very low probability of nodal involvement.

Objective: To investigate the predictive value of ¹⁸F-FDG PET-CT scan for occult lymph node metastasis in patients with stage ⅠA lung adenocarcinoma. Methods: The image and pathological data of 272 patients with stage ⅠA lung adenocarcinoma from October 2006 to September 2015 were retrospectively analyzed. All patients underwent preoperative ¹⁸F-FDG PET-CT scan followed by lobectomy and systematic lymph node dissection. The correlation between occult lymph node metastasis and the maximum standardized uptake value (SUV_max) of primary tumor as well as other clinicopathological factors was analyzed to screen the risk factors of occult lymph node metastasis in stage ⅠA lung adenocarcinoma. Results: Occult lymph node metastasis was detected in 50 patients (18.4%), with 24 (8.8%) patients of pN1 involvement and 26 (9.6%) of pN2 involvement. Among the 272 patients enrolled, 39 had pure ground glass nodule, 59 had part-solid nodule and 174 had solid nodule. All patients with pure ground glass nodule or nodule≤1 cm were pN0. For the 233 patients with part-solid and solid nodule, no lymph node metastasis was found in T1a stage (tumor length ≤1 cm). Primary tumor SUV_max (Z=-5.663, P<0.001), nodule type (χ²=21.586, P<0.001), tumor location (χ²= 12.790, P< 0.001), histological grade (χ²= 22.784, P< 0.001) and visceral pleural invasion (χ²=5.357, P=0.021) showed significant differences between occult lymph node metastasis group (pN+ ) and non-lymph node metastasis group (pN0). With SUV_max=2.405 as cut-off value, the sensitivity and specificity for predicting occult lymph node metastasis were 90.0% and 61.7%, the area under curve was 0.761(95%CI=0.700~0.823), and the negative predictive value was 95.8%. Multivariate analysis revealed that SUV_max >2.405 (P<0.001), central location (P=0.030) and higher histological grade (P=0.024) were independent predictors of occult lymph node metastasis. Conclusions For clinical stage ⅠA adenocarcinoma, primary tumor SUV_max > 2.405, central location and higher histological grade were independent risk factors for occult lymph node metastasis. Systematic lymph node dissection may be avoided in lung adenocarcinoma with pure ground glass density, tumor length ≤1 cm or SUV_max ≤ 2.405, due to the very low probability of nodal involvement.

Background Essential and non-essential elements have an important impact on the development of the central nervous system during fetal development. Due to their less developed brain, preterm infants are more sensitive to element exposure, and are high-risk groups of neurodevelopmental abnormalities. However, it is not clear whether the effects of element exposure in utero on postpartum neurodevelopment are different between full-term infants and preterm infants. Objective To evaluate the effects of element exposure levels during pregnancy on neurodevelopment of children aged 6-24 months (of corrected age), and compare the effects between preterm and full-term children. Methods A prospective study design was adopted and this study was conducted based on the Maoming Birth Cohort Study (MBCS) in Maoming City, Guangdong Province. Twenty elements in cord blood of 197 preterm infants and 297 full-term infants were measured, including 11 essential trace elements [vanadium (V), chromium (Cr), manganese (Mn), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), selenium (Se), strontium (Sr), tin (Sn), and iron (Fe)], and 9 non-essential trace elements [aluminum (Al), arsenic (As), thallium (Tl), lead (Pb), uranium (U), cerium (Ce), antimony (Sb), cadmium (Cd), and yttrium (Y)]. The neurodevelopment of the children at 6, 12, and 24 months were evaluated by the Ages and Stages Questionnaires-the Third Edition (ASQ-3). A generalized estimating equation (GEE) model was adopted to evaluate the associations between elements and neurodevelopment in full-term and preterm children separately. Results The positive rates of 10 elements (Mn, Cu, Zn, Se, Sr, Fe, Sb, Tl, Pb, and As) in cord blood were greater than 80%. Among the preterm birth children, the results of GEE analysis showed that after adjusting for the covariates, for each increase of interquartile range (IQR) in ln-transformed concentration, As was associated with problems/delay in the communication and problem-solving sub-scales, with the adjusted odds ratios (OR) and 95% confidence intervals (CI) of 1.36 (1.03-1.80) and 1.55 (1.10-2.20), respectively; the adjusted OR (95%CI) of problems/delay in the fine motor and problem-solving sub-scales were 1.44 (1.00-2.07) and 1.76 (1.09-2.84) for Sb, respectively; the adjusted OR (95%CI) of problems/delay in the communication sub-scale was 1.37 (1.09-1.74) for Se. No statistically significant associations between umbilical cord blood element concentrations and neurodevelopment indicators were observed among full-term children. The results of stratified analysis by sex showed that the associations between umbilical cord blood element concentrations and neurodevelopment problems/delay were only significant among female preterm children. Conclusion Exposures to As, Se, and Sb during pregnancy may increase the risk of neurodevelopment problems/delay in preterm children aged 6-24 months, and female seem to be more vulnerable.