Objective To estimate the diagnostic value of dual-energy CT in gouty arthritis.Methods English and Chinese litera-tures publicated before May 2014 were searched in PubMed,Embase,Cochrane and Wanfang database.Available literatures were selected according to the inclusion and exclusion criterias.Sensitivity,specificity with 95% confidence interval (95% CI)was pooled with bivariate random-effects model.Hierarchical weighted symmetric summary receiver-operating curve (HSROC)was also used in estimating.Meta-regression and sensitivity analysis were used to explore the potential sources of heterogeneity.Results Nine studies were included in the analysis.The pooled sensitivity,specificity and 95% CI were 92%(84-96%)and 88%(83-92%)respectively, area under the HSROC curve was 0.91 (0.88-0.93).There was substantial heterogeneity between studies(I 2 =85%).Conclusion Dual-energy CT is accuracy in diagnosing gouty arthritis.The sources of heterogeneity was not been explored.

CT data regarding PUMCⅡ d2 adolescent idiopathic scoliosis obtained from one female patient were input into modeling software minics 11.11 to obtain medical simulation model.Then finite element analysis models of AIS patients (T1-S) were created by introducing simulation models into software abaqus 6.7.Finite element models of T6 11 segments were corrected by 5 different correction methods:simple concave bracing,simple convex pressurization,concave distraction and convex compression simultaneously,concave distraction prior to convex compression and concave distraction after convex pressurization.Abaqus software was used to simulate correction of scoliosis with vertebral arch pedicle screw by loading 50 N,100 N,and 200 N distraction forces on the concave side pedicles of the end vertebrae T6 and T11.The displacement of vertebrae T6 in Y-axis (sagittal plane) and Z-axis (coronal plane),which respectively represented the correction effects of kyphosis and scoliosis,was compared between prior to and after correction.Simple concave distraction provided better outcomes in terms of displacement of T6 in Z-axis than the remaining four methods (P ＜ 0.01).Concave distraction and convex compression simultaneously,concave distraction prior to convex pressurization and concave distraction after convex compression produced identical displacements of T6 in Y-axis,which were all better than simple concave distraction (P＜ 0.01).The present findings imply that for curative effects of five methods on correction of scoliosis in the coronal plane:simple concave distraction＞ concave distraction and convex compression simultaneously = concave distraction prior to convex compressio= concave distraction after convex compression ＞ simple convex pressurization;for curative effects of five methods on correction of kyphosis in the sagittal plane:simple convex compression ＞ concave distraction and convex compression simultaneously = concave distraction prior to convex compression= concave distraction after convex compression＞ simple concave bracing.Simple concave distraction could not produce obvious corrective effects on kyphosis rather than lead to worsened kyphosis to some extent.Simple convex compression could not produce obvious corrective effects on scoliosis rather than result in aggravated scoliosis to some extent.

Objective To evaluate the efficacy and safety of sunitinib as first line treatment in patients with metastatic renal cell carcinoma (RCC). Methods This study included 46 Chinese patients who were diagnosed with metastatic RCC after radical nephrectomy. The patients received oral sunitinib (50 mg once daily on a 4 weeks on, 2 weeks off) on a 6 weeks cycle dose schedule until disease progression or intolerable toxicities occurred. Results The overall objective response rate was 32.6% (95% confidence interval [CI, 19.1% to 46. 1%]), and the disease control rate was 86.9%,with complete response (CR) 0 (0%), partial responses (PRs) 15 (32.6%), stable disease (SD) 25(54.3 %), and progression disease (PD) 6 ( 13. 1%). The median progression-free survival was 11 months, and the 1-year survival rate was 65.2%, while the median overall survival (mOS) has not been reached. The main adverse events included fatigue 33 (71.7%), skin discoloration 29 (63.0 %),anorexia 28 (60.9%), hand-foot syndrome 26 (56.5%), oral mucositis 25 (54.3%), hypertension 19 (41.3%), facial edema 18 (39.1%), diarrhea 17 (37.0%), hemorrhage 17 (37.0%), nausea 15 (32.6%), and hematological toxicity: leukopenia 32 (69.6%), neutropenia 30 (65.2%), thrombocytopenia 28 (60.9%), anemia 21 (45.7%). Most of grade 3/4 serious adverse events were thrombocytopenia in 15 (32. 6%) patients. Conclusions Sunitinib has a prominent effect in metastatic renal cell cancer in a Chinese population with mostly mild to moderate adverse reactions. More attention should be paid to grade 3/4 adverse reaction of thrombocytopenia.

Objective To identify the relationship between sorafenib's efficacy and its side effects in treatment of advanced renal cell carcinoma patients. Methods Fifty-one patients having measurable diseases were diagnosed with advanced renal cell carcinoma. Of whom, 26 patients were in stage T1Nx,0,1M1, 12 patients in stage T2Nx,0 M1, 8 patients in stage T3NxM1, 5 patients in stage T4NxM1. These 46 patients of T1 -T3 had their primary diseases removed, but the 5 T~ patients didn"t have their primary diseases removed. These 51 patients received oral sorafenib 400 mg Bid continual-ly and they had CT scan every two months to evaluate the progression. The dosage of sorafenib wasmodified according to efficacy and toxicity. Two patients changed the dosage to 200 mg Bid due to se-vere side effects. Sixteen patients increased the dosage to 600 mg Bid or 800 mg Bid. The response ofSorafenib and toxicities as well as their severity were recorded. The toxicity severity was graded ac-cording to National Cancer Institute Common Toxicity Criteria version 3.0. The efficacy was deter-mined by RECIST criteria. The efficacy and progression free survival (PFS) were recorded. The sta-tistics analysis was conducted between sorafenib's side effects and efficacy as well as their severity by multi-faetor Logistic regression. Results The rates of adverse events in the patients receiving oral sorafenib were hand-foot skin reaetion 68. 6% (35/51), diarrhea 39. 2% (20/51), rash 25. 5% (13/ 51), mucositis 23.5% (12/51), hypertension 17.6% (9/51), and myelosuppression 13. 7%(7/51). The response rate in the patients who had toxicity of grade 3-4 was 33.3%(12/36), and that in the patients who had slight toxicity was 12.0%(3/25). The rate of hand-foot skin reaction was higher than that of diarrhea, rash, mucositis, hypertension and bone marrow suppression (P<0.01). Sor-afenib's efficacy was eorrelated to rash and mueositis (P=0.048, 0.045 respectively). More grade 3 4 side effects occurred in the patients who would have better response to sorafenib (P=0.008). The median PFS was 15.0 months and PFS was not related to the toxicity and its severity. Conclusions It may help to predict the response for sorafenib's side effects and efficacy in the treatment of the patients with advaneed renal cell earcinoma.

Objective To analyze the effect and related factors of sorafenib in the treatment of metastatic renal cell carcinoma(MRCC), and identify the potential predictive factors of sorafenib re-sponse. Methods The data of 51 MRCC patients who received sorafenib therapy, with or without combination with interferon or chemotherapy were retrospectively reviewed. After two cycles of treat-ment, patients were evaluated for progression or response. Pearson Chi-square test and Logistic re-gression test were performed respectively as univariate and multivariate analyses of sorafenib response. Results The overall objective response rate was 29.4%(95% confidence interval 16.9% to 41.9%, with 1(2.0%) complete response and 14(27.4%) partial responses. Twenty-nine(56.9%) had stable disease, and 7 (13.7%) had progression disease (PD). Significant independent predictive factors asso-ciated with good response in multivariate analysis were lung metastasis only(P=0.021, HR=5.127). Conclusions Sorafenib is effective in MRCC patients. Lung metastasis only is predictive factor in mul-tivariate analysis for sorafenib response.

OBJECTIVE: To explore the effect of a comprehensive surgical approach of hyoid suspension with Repose system plus uvulopalatopharyngoplasty (UPPP) on the treatment of severe obstructive sleep apnea hypopnea syndrome (OSAHS). METHOD: Twelve patients with severe OSAHS (AHI > 40) diagnosed by polysomnography, were determined for the obstruction in both the velo-pharyngeal and the hypopharynx by preoperative physical examination, fiberoptic pharyngo-laryngoscopy. Two cases were given continuous airway pressure via nose, seven days before operation and then were performed hyoid suspension plus UPPP. The follow up was 3 months postoperatively. The pair T test was used to compare the preoperative and postoperative results by SPSS11.0 for windows. RESULT: At postoperative 3 month, there were statistically significance between preoperative and postoperative measurement in all. Mean AHI decreased from preoperative 69.28 +/- 6.50 to postoperative 19.77 +/- 9.23, lowest mean oxygen saturation increased from 65.25 -/+ 3.14 to 90.17 +/- 2.86. Snoring and sleep apnea disappeared or lessened, with the disappearance or decrease of lethargy at daytime. No severe complication occurred. CONCLUSION Comprehensive surgical approach of hyoid suspension with Repose system plus UPPP is effective surgical approach for patients with severe OSAHS who suffered from oropharyngeal and hypopharyngeal obstruction in short- term result.
Adult ; Female ; Humans ; Hyoid Bone ; surgery ; Male ; Middle Aged ; Otorhinolaryngologic Surgical Procedures ; methods ; Palate, Soft ; surgery ; Pharynx ; surgery ; Sleep Apnea, Obstructive ; surgery ; Treatment Outcome ; Uvula ; surgery ; Young Adult

Objective:To investigate the clinical value of virtual monoenergetic images (VMI) and electron density map (EDM) derived from the dual-layer spectral detector CT (DLCT) in the differential diagnosis of benign and malignant pulmonary ground glass nodules (GGN).Methods:From July 2019 to August 2020, a total of 65 patients with lung GGN (27 benign GGNs and 38 malignant GGNs) confirmed by pathology were retrospectively enrolled in Gulou Clinical Medical College of Nanjing Medical University. All the patients underwent DLCT plain scanning within two weeks before the surgery. The conventional 120 kVp polyenergetic image (PI), EDM and 40-80 keV VMI were reconstructed. The differences of CT and electron density (ED) values between benign and malignant lesions on different images were compared by Mann-Whitney U test. Independent t-test was used to compare the lesion size and χ 2 test was used to analyze the CT features (including lesion location, shape, edge, internal structure, adjacent structure, nodule type) between benign and malignant lesions. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of different energy spectrum quantitative parameters in the differential diagnosis of benign and malignant GGN. The statistically significant CT signs and energy spectrum quantitative parameters were analyzed by logistic regression analysis to find out the independent risk factors of malignant GGN, and then ROC curve analysis was performed for each independent risk factor alone or in combination. Results:There were significant differences in lesion shape, spiculation, lobulation, location and size between benign and malignant groups ( P<0.05). The CT value of pulmonary GGN in PI, 40-80 keV VMI and the ED value in EDM were statistically different between benign and malignant lesions ( P<0.05). The area under ROC curve (AUC) were 0.680, 0.682, 0.683, 0.686, 0.694, 0.676 and 0.722, respectively, among which the ED value had the highest AUC. Binary logistic regression analysis was carried out with GGN shape, spiculation, lobulation, location, size, ED value and CT value in PI, 40-80 keV VMI as independent variables, and malignant GGN as dependent variables. The results showed that ED value (OR=1.045, 95%CI 1.001-1.090, P=0.044), lesion size (OR=1.582, 95%CI 1.159-2.158, P=0.004), spiculation sign (OR=11.352, 95%CI 2.379-54.172, P=0.002) were independent risk factors for malignant GGN. ROC curve analysis showed the AUC of ED value, lesion size, spiculation sign and combination of the three for differential diagnosis of benign and malignant GGN were 0.722, 0.772, 0.698 and 0.885. The AUC for the combined parameters was the largest, with sensitivity of 92.1% and specificity of 74.1%. Conclusion:The diagnostic efficacy of EDM is higher than that of other VMI in the differential diagnosis of pulmonary GGN by DLCT images; The efficacy is further improved when EDM is combined with lesion size and spiculation sign for comprehensive diagnosis.

Objective:To construct the quality evaluation system for tracheal extubation in the patients undergoing general anesthesia based on zero-defect management theory.Methods:Based on the model of zero-defect theory, literature review, semi-structured interviews, expert consultation and analytic hierarchy process were used to determine the content and weight of each index of the quality evaluation system for tracheal extubation in the patients undergoing general anesthesia.Results:The effective recovery rates of the two rounds of expert consultation questionnaires were 93% and 96% respectively; the expert authority coefficients were 0.946 and 0.947 respectively; the Kendall harmony coefficients were 0.247 and 0.250 respectively ( P<0.001). The final evaluation index system included 3 first-level indicators, 11 second-level indicators and 48 third-level indicators.The consistency coefficients of indicators at all levels were <0.1. Conclusions:The quality evaluation system for endotracheal extubation constructed for patients undergoing general anesthesia is highly scientific and reliable and can provide a basis for the quality evaluation of and continuous improvement in endotracheal extubation in the patients undergoing general anesthesia.

Objective: To summarize the peri-operative management experience of pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: A total of 56 CTEPH patients received PEA in our hospital from 2015-01 to 2016-11 were retrospectively analyzed. Our study was focused on the medication in respiratory and circulatory system during ICU stay, peri-operative application of vasoactive drug and target drug to pulmonary hypertension (HP), usage of ventilators, mechanical assisted devices and other management experiences. Results: No peri-operative death occurred. There were 2/56 (3.6%) patients with lung reperfusion, 2 (3.6%) with PH crisis. Compared with pre-operation, the post-operative pulmonary artery hemodynamics parameters were improved as right heart catheter measured pulmonary artery systolic pressure (PASP) decreased from (85.05±22.40) mmHg to (36.83 ±17.21) mmHg and pulmonary vascular resistance decreased from (773.84±342.95) dyn·s·cm-5 to (293.59±214.95) dyn·s·cm-5. Post-operative oxygen saturation was maintained at (95-100) % in all patients. Echocardiography found that PASP from pre-operation (85.03±25.78) mmHg decreased to (39.44±19.24) mmHg at follow-up period, P<0.01.Conclusion: A comprehensive peri-operative management of PEA was helpful to improve pulmonary hemodynamics in CTEPH patients; meanwhile, effective prevention and treatment of severe complication could obviously reduce peri-operative mortality.

Objective: To investigate the clinical characteristics, treatment methods, and prognosis of metastatic papillary renal cell car-cinoma (pRCC). Methods: The clinical data of metastatic pRCC patients treated at the Department of Kidney Cancer and Melanoma, Pe-king University Cancer Hospital, were retrospectively analyzed. The prognosis of these patients was stratified through international metastatic renal cell carcinoma database consortium (IMDC) model. Survival and influencing factors were further analyzed using the Kaplan-Meier method and Cox proportional risk regression model. Results: From January 2003 to March 2018, 93 patients (median age, 50.0 years) were diagnosed with metastatic pRCC: 89 (95.7%) typeⅡcases and 4 (4.3%) typeⅠcases. The median follow-up dura-tion was 23.1 months, with 90, 44, and 14 patients having received first-line, second-line, and third-line treatments, respectively. The median overall survival (OS) of the 93 patients was (31.5±5.9) months [95% confidence interval (CI): 19.9-43.1], while the median OS of patients with low-, intermediate-, and high-risk (classified as per the International Metastatic Renal Cell Carcinoma Database Con-sortium [IMDC]) were (100.0±32.8), (38.3±8.2), and (16.4±1.2) months, respectively (high-risk vs. low/intermediate-risk, P<0.001; low-risk vs. intermediate-risk, P=0.015). The median progression free survival (PFS) with first-line treatment was (6.6±0.5) months. And the median PFS of the corresponding three groups stratified by IMDC score were (17.5±5.7), (7.1±2.3), and (5.2±1.5) months, respectively (high-risk vs . low-risk, P=0.002; high-risk vs . intermediate-risk, P=0.01). Conclusions: Metastatic pRCC is noted to have unique biologi-cal characteristics. The IMDC model can be used to predict the efficacy of first-line treatment using tyrosine kinase inhibitors as well as the prognosis of metastatic papillary renal cell carcinoma in such patients.