Objective:To analyze the imaging features of spontaneous rupture of primary liver cancer (PLC) and to study the high-risk factors associated with tumor rupture.Methods:From September 2016 to August 2020, 81 patients who developed spontaneous rupture of PLC at the General Hospital of Ningxia Medical University were included into this study. A control group of 81 patients with tumors located on the periphery of the liver but without rupture treated in the same period were selected by matching the two groups with age, sex and BCLC staging. The clinical data and CT imaging characteristics including tumor location, extent, size, and morphology of the two groups of patients were compared retrospectively between groups.Multivariate logistics regression was used to analyze.Results:A total of 81 patients were included in the case group, including 72 males and 9 females, aged (53.69±10.34) years. The control group included 81 patients, 64 males and 17 females, aged (54.78±9.04) years. The main risk factors for spontaneous rupture of PLC included in this study were cirrhosis, tumor close to diaphragm, biolobar distribution, portal vein obstruction, tumor diameter >10 cm, invasion of liver capsule (arc-to-chord ratio>1) and tumor protrusion ≥25% ( P<0.05). Logistic regression analysis showed that cirrhosis ( OR=2.796, 95% CI: 1.721-10.834), portal vein obstruction ( OR=3.586, 95% CI: 1.272-10.107) and tumor protrusion (≥25%) ( OR=2.831, 95% CI: 1.668-22.210) were independent predictive factors of spontaneous rupture of PLC. Conclusion:Tumor protrusion≥25%, cirrhosis and portal vein obstruction were closely related to spontaneous rupture of PLC. They were independent risk factors in predicting rupture of primary liver cancer.

In recent years,growth hormone and insulin-like growth factors have become key regulators of bone metabolism and remodeling,crucial for maintaining healthy bone mass throughout life.Studies have shown that adult growth hormone deficiency leads to alterations in bone remodeling,significantly affecting bone microarchitecture and increasing fracture risk.Although recombinant human growth hormone replacement therapy can mitigate these adverse effects,improving bone density,and reduce fracture risk,its effectiveness in treating osteoporosis,especially in adults with established growth hormone deficiency,seems limited.Bisphosphonates inhibit bone resorption by targeting farnesyl pyrophosphate synthase in osteoclasts,and clinical trials have confirmed their efficacy in improving osteoporosis.Therefore,for adult growth hormone deficiency patients with osteoporosis,the use of bisphosphonates alongside growth hormone replacement therapy is recommended.

Objective:To investigate the differences and changes of blood flow status of splenic volume, common hepatic artery, splenic arteriovenous, inner diameter of portal vein and hepatic in patients with hypersplenism of different degrees using multi-slice spiral CT whole-liver perfusion model.Methods:42 cases with hypersplenism of chronic hepatitis B with cirrhosis and 15 cases without hepatosplenic disease were collected as controls. All patients underwent multi-slice spiral CT whole-liver perfusion imaging. (1) The differences of spleen volume, common hepatic artery, splenic arteriovenous, and portal vein diameter between different degrees of hypersplenism and the control group were measured and compared. (2) The correlation between spleen volume and the inner diameter of each related vessels were analyzed and compared. (3) The values of perfusion parameters related to the five lobes of the liver in Couinaud segments based on hepatic artery perfusion (HAP), portal venous perfusion (PVP), total hepatic perfusion (TLP) and hepatic artery perfusion index (HPI) were measured and compared. One-way ANOVA was used to analyze the measurement data. The correlation between the spleen volume and the inner diameter of each blood vessel was analyzed by Pearson’s correlation analysis.Results:(1) spleen volume and the inner diameter of splenic artery, splenic vein and portal vein in the cirrhotic hypersplenism group were significantly larger than control group, and the difference was statistically significant ( F = 37.108, 17.484, 23.124, 13.636, P < 0.05). (2) spleen volume and the inner diameter of splenic artery, vein and portal vein in the moderate and severe hypersplenism groups were significantly larger than the mild hypersplenism group, and the difference was statistically significant ( F = 25.418, 13.293, 15.136, 7.093, P < 0.05), but there was no statistically significant difference between the moderate and severe hypersplenism groups ( P > 0.05). (3) The inner diameter of splenic vein, portal vein, and splenic artery was positively correlated with spleen volume ( r = 0.680, 0.548, and 0.726). (4) PVP and TLP of the whole liver in hypersplenism group were lower than control group ( P < 0.05), and the differences were statistically significant ( P < 0.05). HPI in the right posterior lobe of the liver in the moderate and severe hypersplenism group was higher than mild hypersplenism group ( F = 3.555, 4.570, P < 0.05), and there was no significant difference in the HAP in the whole liver among the groups ( P > 0.05), but the HAP in the whole liver in the severe hypersplenism group was lower than control, mild and moderate hypersplenism group. Conclusion:The inner diameter of the splenic arteriovenous in patients with hypersplenism of different degrees has widened to varying degrees, and is consistent with the increase in spleen volume, particularly in moderate and severe cases. Portal venous perfusion and total liver perfusion in patients with hypersplenism of different degrees have declined and the hepatic arterial perfusion in patients with severe hypersplenism is significantly reduced.

Objective To explore the influence of disability acceptance and resilience on stigma in laryngeal carcinoma patients with permanent tracheostomy and analyze the impact path. Methods From June 2016 to August 2018, this study selected 264 laryngeal carcinoma patients with permanent tracheostomy of Inpatient and Outpatient Department in Guangxi Medical University Affiliated Tumor Hospital as subjects by convenience sampling. All patients were investigated with the Social Impact Scale (SIS), Acceptance of Disability Scale (AODS) and the 10-item Connor-Davidson Resilience Scale (CD-RISC10). The correlations were analyzed and structure equation model was used to path analysis. A total of 264 questionnaire were sent out and 256 valid questionnaires were collected. Results Among those patients with permanent tracheostomy, the total scores of stigma, disability acceptance and resilience were (61.50±9.27), (76.88±9.34) and (26.49±4.05) respectively. Correlation analysis showed that the scores of disability acceptance and resilience had negative correlations with stigma with statistical differences (P< 0.01). Structure equation model analysis showed that disability acceptance and resilience of laryngeal carcinoma patients with permanenttracheostomy had direct effect on stigma (β=-0.43,-0.28), the indirect effect of disability acceptance on stigma by resilience was -0.06. Conclusions Laryngeal carcinoma patients with permanenttracheostomy have a high level of stigma, the disability acceptance and resilience has significant roles on stigma.

Objective:To compare the clinical characteristics of critically ill pregnant women admitted to the intensive care unit (ICU) with different admission methods, in order to make more effective and rational use of ICU resources.Methods:A retrospective study was conducted. The clinical data of critically ill pregnant women admitted to ICU of Peking University Third Hospital from January 2006 to July 2019 were analyzed. According to the admission mode to ICU, the pregnant women were divided into emergency admission group (transferred to ICU on the same day or the next day due to critical illness) and planned admission group (transferred to ICU 2 days after admitting in obstetric ward). The clinical characteristics of ICU critical pregnant women, such as the incidence, causes of admission, severity of the disease, main treatment measures, mortality, and medical expenses were collected, and a comparative analysis between the two groups was performed.Results:During the nearly 14 years, a total of 576 critical pregnant women in ICU were enrolled, accounting for 0.8% (576/71 790) of the total number of obstetric inpatients and 4.6% (576/12 412) of the total number of ICU inpatients. Seven maternal deaths accounted for 1.2% of all critically pregnant women transferred to ICU, and the overall mortality of pregnant women was 10/100 thousand. Of the 576 critically pregnant women, there were 327 patients (56.8%) in the emergency admission group and 249 patients (43.2%) in the planned admission group. Compared with the planned admission group, the proportion of elective cesarean section in the emergency admission group was significantly lower (17.7% vs. 94.0%, P < 0.01), and the proportion of emergency cesarean section was significantly higher (65.1% vs. 2.4%, P < 0.01), the acute physiology and chronic health evaluation (APACHE Ⅱ, APACHE Ⅲ) scores, simplified acute physiology score Ⅱ (SAPS Ⅱ) and Marshall score were significantly higher [APACHE Ⅱ score: 6.0 (4.0, 9.8) vs. 4.0 (3.0, 7.0), APACHE Ⅲ score: 14.0 (11.0, 20.3) vs. 12.0 (9.0, 16.0), SAPS Ⅱ score: 8 (0, 12) vs. 3 (0, 8), Marshall score: 2 (1, 4) vs. 1 (1, 3), all P < 0.01]. The length of ICU stay in the emergency admission group was significantly longer than that in the planned admission group [days: 2 (1, 5) vs. 2 (1, 3), P < 0.01], and the total length of hospital stay was significantly shorter [days: 9 (7, 13) vs. 13 (10, 18), P < 0.01]. Both in the emergency admission group and the planned admission group, obstetric factors were the main reason for admission, 60.9% (199/327) and 70.3% (175/249), respectively. The proportion of postpartum hemorrhage was the highest [35.2% (115/327) and 57.0% (142/249)], followed by preeclampsia/eclampsia [7.0% (23/327) and 7.6% (19/249)]. Only 7 of the 19 critically pregnant women with puerperal infection were planned admission. All 21 patients with acute fatty liver of pregnancy (AFLP) during pregnancy were emergency admission. Among the emergency and planned admission patients, 73 patients (22.3%) and 42 patients (16.9%) required mechanical ventilation (duration of mechanical ventilation > 24 hours), 99 patients (30.3%) and 35 patients (14.1%) needed vasoactive agents, 67 patients (20.5%) and 20 patients (8.0%) received hemodynamic monitoring, and 123 patients (37.6%) and 154 patients (61.8%) were given anticoagulation therapy, respectively. In terms of severity score of critical pregnant women, there were significant differences in APACHE Ⅱ, APACHE Ⅲ, SAPS Ⅱ and Marshall scores of pregnant women with different diseases. Among them, the APACHE Ⅲ, SAPS Ⅱ and Marshall scores of AFLP were the highest [21.0 (15.0, 32.5), 12.0 (6.0, 16.5) and 6.0 (3.5, 8.0), respectively]. The APACHE Ⅱ and APACHE Ⅲ scores of postpartum hemorrhage were the lowest [4.0 (3.0, 7.0), 12.0 (10.0, 16.0)]. The SAPS Ⅱ score of pneumonia was the lowest [2.0 (0, 14.0)]. The Marshall score for puerperal infection was the lowest [1.0 (0, 3.0)]. In terms of the total medical expenses, the cost in the emergency admission group was significantly lower than that in the planned admission group [10 thousand Yuan: 3.1 (2.0, 4.7) vs. 4.1 (2.9, 5.8), P < 0.05]. Conclusions:Compared with the critically ill pregnant women who planned to be admitted to ICU, the patients emergency admitted to ICU were more complicated and urgent, and the severity of the condition was scored higher. At present, the severity scoring system commonly used in ICU can only partly evaluate the severity of critically ill pregnant women, therefore, it is necessary to design the specific severity scoring system for critically ill pregnant women to effectively and rationally use the precious ICU resources.

Objective:To explore the value of clinical data and MRI image features in predicting and analyzing the degree of differentiation of hepatocellular carcinoma (HCC).Methods:The clinical and imaging data of 180 patients with surgical outcomes of HCC from March 2015 to June 2019 in the General Hospital of Ningxia Medical University were retrospectively analyzed. Alpha-fetoprotein (AFP)、aspartate aminotransferase (AST)、D-dimer、clinical stage、tumor length、apparent diffusion coefficient(ADC)、enhancement types and so on the clinical and imaging data of the poorly differentiated and non-differentiated HCC were compared and analyzed. Multivariate logistic regression was used to predict independent risk factors for poorly differentiated HCC.Results:Of the 180 HCC patients, 121 were moderately and highly differentiated, and 59 were poorly differentiated. Univariate analysis showed that the patient’s age, gender, AFP, AST, D-dimer level, clinical stage, Child-Pugh score, tumor length, whether the capsule was complete, tumor apparent diffusion coefficient, the maximum level ADC value, enhancement type with HCC differentiation degree were correlated(all P<0.05). Multivariate logistic regression analysis showed that the patients' gender ( OR=4.524, P<0.05), clinical stage ( OR=5.598, P<0.05), D-dimer ( OR=8.576, P<0.05), HCC diameter ( OR=0.498, P<0.05), enhancement types ( OR=2.988, P<0.05), tumour ADC value ( OR=0.059, P<0.05) were independent of poorly differentiated HCC risk factor. Conclusion:MRI image features can be used as an effective indicator to predict the degree of HCC differentiation before surgery. It is more valuable to accurately predict the degree of HCC combined with D-dimer and AFP value.

Objective:To evaluate the radiation doses from head and chest CT examinations of children in Ningxia, and provide basic data for the optimization of CT radiation doses to children of different ages.Methods:By using stratified cluster sampling method , the dose parameters on head and chest CT scanning, CTDI vol and DLP for the children under 15 years old were sampled within 1-2 weeks from hospitals at different levels in different regions of Ningxia for the calculation of effective doses. The 75th percentile (P75) of CTDI vol and DLP was compared with those recommended by other countries. All children included four age groups: up to 1 year old, 1 to 5 years, 6 to 10 years, 11 to 15 years. Results:There were 39 hospitals and 47 CT scanners in this survey, and 1 134 head scanning and 636 chest scanning were investigating. The 75th percentile (P75) of CTDI vol and DLP for head scanning were 44.2 mGy and 456.2 mGy·cm for those up to 1 year old; 57.2 mGy and 659.6 mGy·cm for 1 to 5 years old, 61.1 mGy and 668.7 mGy·cm for 6-10 years old, and 63.6 mGy and 849.3 mGy·cm for 11-15 years old, respectively. The 75th percentile (P75) of CTDI vol and DLP for chest scanning were 5.0 mGy and 89.2 mGy·cm for those up to 1 year old, 5.9 mGy and 124.8 mGy·cm for 1 to 5 years old, 6.0 mGy and 167.9 mGy·cm for 6 to 10 years, and 7.1 mGy and 235.0 mGy·cm for 11 to 15 years old, respectively. Conclusions:The chest CT radiation dose to children in Ningxia is close to the reported values, but the head CT radiation dose is relatively high in all age groups, especially in infants. The optimization and regulation of head CT radiation doses to children in Ningxia should be strengthened. It is high time to increase dose awareness for pediatricians and radiologists and raise awareness of radiation-related risks.

Objective To analyze the clinical characteristics and screen pathogens and prognosis of anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis in children and so as to improve the diagnosis and treatment of anti-NMDAR encephalitis in children.Methods A retrospective and follow-up analysis of 38 cases of pediatric anti-NMDAR encephalitis was performed,who were admitted to the West China Second University Hospital,Sichuan University from May 2012 to June 2016,and their clinical features,associated pathogen screening,treatment and progno-sis were reviewed.Results Those 38 cases included 14 males and 24 females.The age ranged from 1 year and 10 months to 17 years and 6 months.The most common symptoms were psychiatric symptoms(33 cases),and dyskinesias and movement disorders(33 cases),speech disturbances(31 cases).Twenty-four cases(63.2%)received positive pathogenic screening and only one case had right ovarian mature cystic teratoma.Among them,11 cases had positive mycoplasma pneumonia immunoglobulin M(IgM)antibodies,10 cases had positive virus screening,and 1 case had toxoplasma gondii IgM antibodies positive,and 2 cases had mix infection.Symptoms of one case were relieved after anti-toxoplasma treatment without immunosuppression treatment,and another case had partial symptom relief after mycoplas-ma pneumonia treatment.Thirty-seven cases received immunosuppressant therapy(4 cases were treated with glucocor-ticoid,12 cases were treated with glucocorticoid combined with immune globulin,2 cases were treated with glucocorti-coid combined with plasma exchange,still 19 cases were treated with glucocorticoid combined with immune globulin and plasma exchange).After follow-up for median 12 months,3 cases relapsed,29 cases were fully recovered,5 cases had mild language impairment,2 cases had mild memory impairment,and 2 cases had involuntary movement.Conclusions The most common symptoms of the patients were psychiatric symptoms,dyskinesias and movement disorders,and speech disturbances.Children with anti-NMDAR encephalitis had a low incidence of tumors,while various pathogen infections including mycoplasma pneumonia,virus and toxoplasma gondii,which may trigger abnormal immune response of anti-NMDAR encephalitis.Pathogen screening needs to be done for pediatric anti-NMDAR encephalitis and anti-patho-genic treatment may be helpful for disease remission.

Objective: To explore the optimization of CT urography imaging parameters and the control measures of radiation dose to patients with different body mass index. Methods: A total of 133 patients who were required to undergo CT urography were prospectively selected in terms of three different types of CT urography scan; firstly, conventional parameter scan (120 kV, CARE Dose4D); secondly, low kV scan (BMI ≤ 22.9∶80 kV, 22.9 < BMI < 30∶100 kV, BMI ≥ 30∶120 kV, CARE Dose4D) and thirdly, low mAs scan (120 kV, 40% reduction in mAs on CARE Dose4D). Noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of all images were measured as objective evaluation indicators of image quality. The subjective evaluation of the images was performed by two radiologists who had been working for more than five years using a double-blind method and a 5-score system evaluation. The effective dose values (CTDI_vol, DLP, E) in each group were measured. Results: Patients′ effective dose was decreased by 77.7% in 80 kV group and 38.3% in 100 kV group, with a statistical difference between the two groups (Z=-3.330, -5.559, P<0.05). There was a statistically significant difference in renal cortex noise, SNR, CNR and ureteral noise between the 80 kV scan and the routine scan (Z=-3.705-2.392, P<0.05), but no significant difference in ureteral SNR, CNR and renal pelvis noise, SNR, CNR (P>0.05). There was a statistically significant difference in renal cortex noise and SNR between the 100 kV scan group and the routine scan group (Z=-5.096, -3.566, P<0.05), but no statistical difference in renal cortex CNR, renal pelvis and ureteral noise, SNR, CNR(Z=-5.086, -5.912, -2.842, P>0.05). The effective dose from low mAs scan in the three types of patients was decreased by 38.3%, 32.0%, and 34.7%, respectively, with a statistical difference between them (P <0.05). There was no significant difference in noise, SNR, and CNR between renal cortex, renal pelvis and ureter (P>0.05) besides ureteral CNR in the 22.9 < BMI < 30 group (Z=-2.587, P<0.05). The subjective evaluation scores of all images were greater than 3 points. Conclusions In this study, the scan method for low kV and low mAs used for patients with different body mass index can effectively reduce the radiation dose to patients and meet the requirements of clinical diagnosis.