Differentiated liposarcoma is a rare connective tissue malignancy in adults that mostly occurs in the extremities and retroperitoneum, with a tendency to aggressiveness and recurrence, and the ten-year survival rate of about 10%. Clinically, dedifferentiated liposarcoma of the pharynx has been reported to be rare abroad and only one case has been reported in China. Clinical symptoms are mainly foreign body sensation in the pharynx, which can be easily misdiagnosed as benign tumors. Pathological diagnosis is the main examination tool for this kind of disease, and immunohistochemistry and FISH test can help to differentiate it from other tumors. This article presents a case of a male patient with dedifferentiated liposarcoma of the hypopharynx, who had a foreign body sensation in the pharynx for more than 1 month, and underwent supported laryngoscopic pharyngeal lesion resection after completing the preoperative relevant examinations and postoperative radiation therapy, with postoperative pathology returned as dedifferentiated liposarcoma. The present postoperative follow-up was 12 months without recurrence. Therefore, accurate diagnosis and timely treatment are extremely important for the prognosis of this disease.
Humans ; Male ; Liposarcoma/diagnosis* ; Hypopharyngeal Neoplasms/diagnosis* ; Middle Aged ; Hypopharynx ; Adult

Objective:To analyze the clinical characteristics and all-cause mortality influencing factors of patients with Keshan disease.Methods:Clinical data of patients with Keshan disease from Keshan disease areas in Sichuan Province and Yunnan Province were collected and retrospectively analyzed for clinical characteristics and survival status during regular follow-up. According to the survival status of patients, the survey subjects were divided into a survival group and a death group. All-cause mortality (referring to the death caused by various reasons throughout the follow-up period) was used as the study endpoint. Kaplan-Meier (K-M) survival curve analysis and log-rank χ 2 test were performed, univariate and multivariate Cox regression analysis were used for all-cause mortality factor analysis. Results:A total of 176 patients with Keshan disease were collected, including 92 cases in Sichuan Province and 84 cases in Yunnan Province. Among all the patients, there were 105 males, accounting for 59.66%, and 71 females, accounting for 40.34%. The age was (53.89 ± 13.19) years old. Thirty-five cases died from all causes, with a mortality rate of 19.89%. There were significant differences in age ( t = 2.09, P = 0.038), New York Heart Association (NYHA) cardiac function grading (χ 2 = 14.62, P < 0.001) and ventricular premature contraction (χ 2 = 6.82, P = 0.009) between the survival group and the death group. K-M survival curve analysis showed that patients with Keshan disease complicated by premature ventricular contraction and high NYHA cardiac function grading (Ⅲ and Ⅳ) had higher all-cause mortality (log-rank χ 2 = 8.72, 22.49, P < 0.05). Univariate Cox regression analysis showed that NYHA cardiac function grading and ventricular premature contraction ( HR = 3.09, 2.71, P < 0.05) were predictive influencing factors for all-cause mortality in patients with Keshan disease. Multivariate Cox regression analysis showed that NYHA cardiac function grading ( HR = 6.57, P = 0.002) and ventricular premature contraction ( HR = 2.98, P = 0.050) were independent factors for all-cause mortality in patients with Keshan disease. Conclusions:Among 176 patients with Keshan disease, the number of patients with poor cardiac function (NYHA cardiac function grading Ⅲ and Ⅳ) and arrhythmia is high. NYHA cardiac function grading and ventricular premature contractions are independent influencing factors for all-cause mortality in patients with Keshan disease.

Objective:To analyze the clinical characteristics, prognosis and gene mutation in patients with dilated cardiomyopathy (DCM) in Keshan disease area of Sichuan Province, and to explore the risk factors for all-cause death in DCM patients.Methods:In June 2016, 55 DCM patients diagnosed at the local disease prevention and control center through clinical manifestations, electrocardiogram examination, and echocardiography were selected as the survey subjects in Mianning County, Liangshan Yi Autonomous Prefecture, and Renhe District, Panzhihua City, Keshan disease areas of Sichuan Province. Baseline clinical data were analyzed and long-term follow-up was conducted. The follow-up period ended June 15, 2021, with the endpoint of all-cause death. Univariate Cox regression was used to analyze the influencing factors of all-cause death in patients, and Kaplan-Meier (K-M) survival curve was used to analyze the survival time of patients. At the same time, peripheral venous blood was collected from 27 DCM patients. After separating white blood cells, DNA was extracted, and whole exome sequencing was performed to screen potential pathogenic genes.Results:Among the 55 DCM patients, 40 were males and 15 were females. The age was (54.09 ± 12.38) years old. The heart function classification of New York Heart Association (NYHA) was mainly grade Ⅱ and Ⅲ, accounting for 94.55% (52/55). The follow-up time for 55 DCM patients was (7.02 ± 2.96) years, and 17 patients experienced all-cause death, accounting for 30.91% (17/55), including 15 males and 2 females. Compared with the survival group, the death group had a lower incidence of syncope (χ 2 = 6.57, P = 0.010), but higher rates of bilateral lower limb edema (χ 2 = 6.43, P = 0.017), pulmonary congestion (χ 2 = 7.61, P = 0.006), intraventricular conduction block (χ 2 = 6.41, P = 0.011), and angiotensin-converting enzyme inhibitor (ACEI) use (χ 2 = 6.57, P = 0.010), as well as increased left ventricular diameter ( t = 2.36, P = 0.022). Univariate Cox regression analysis showed that bilateral lower limb edema [hazard ratio ( HR) = 4.61, P = 0.042] and intraventricular conduction block ( HR = 3.20, P = 0.019) were risk factors for all-cause death of DCM patients. The results of K-M survival curve analysis showed that patients with bilateral lower limb edema and intraventricular conduction block had higher all-cause death rates (log-rank χ 2 = 5.02, 6.24, P = 0.025, 0.012). Whole exome sequencing results showed that 4 patients were detected to carry pathogenic or suspected pathogenic gene mutations, with a positive rate of 14.81% (4/27), involving three genes: β-myosin heavy chain 7 (MYH7), calreticulin 3 (CALR3), and gelsolin (GSN). Conclusions:The all-cause death rate of DCM patients in the Keshan disease area of Sichuan Province is relatively high. Dead patients are prone to bilateral lower limb edema, pulmonary congestion, and intraventricular conduction block, as well as increased left ventricular diameter. Bilateral lower limb edema and intraventricular conduction block are independent predictive risk factors for all-cause death in DCM patients. MYH7, CALR3 and GSN are involved in the pathogenesis of DCM.

Objective:To analyze the causes of postoperative stricture of biliary-enteric anastomotic for congenital choledochal cysts.Methods:These 28 patients underwent salvage operation on an average 15 years (0.2-25 years) after initial surgeries at the Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital from Jan 2014 to Jun 2018.Results:In 26 patients the biliary-enteric anastomotic stenosis was benign, and in 2 the stricture was caused by cancerration. In 26 cases the Roux-en-Y hepaticojejunostomy was redone,among them 8 cases underwent concurrent hepatectomy for a better exposure of the intrahepatic bile duct. In 2 cases the anastomotic stenosis was found to be caused by canceration with extensive intraabdominal metastasis ,an external drainage was adopted. There were no inhospital deaths, and no serious complications. The postoperative follow-up time was 6-67 months. Two cancerated patients died within half a year, and the remaining patients had no long-term complications.Conclusions:Biliary-enteric anastomotic stenosis is one of the serious complications in postoperative patients for congenital choledochal cysts. Hence a wide, tension free biliary-enteric anastomosis performed by a experienced hand is necessary.

Objective To investigate the difference of styrofoam and breast carrier in postposition fixation of intensity-modulated radiotherapy after breast conservative surgery for breast cancer patients.Methods From February 2018 to August 2018,tweenty-four patients with breast cancer in Sun Yet-Sen Memorial Hospital of Sun Yet-sen University were selected for this study,who underwent hypofactionationed radiotherapy after breast conservative surgery with total dose 42.56 Gy/16Fractions.They were randomized into styrofoam test group and breastcarrier control group.Cone beam CT as used to record the positioning error under the directions of left and right (x),head and foot (y),abdomen and back (y) within two groups at the first,third,fifth,seventh,eleventh time before irradiation.Furthermore,the PTV extension margin was calculated and the positioning time of two groups was recorded.Two sets of pendulum errors were analyzed by independent sample T-test,and the outspread value of inter-fractional set up error of the PTV was calculated.Results The errors of the test group and the control group in the direction of x,y,z were as follows:(2.36±1.89) and (2.56±2.05) mm (P=0.49),(1.76± 1.78) and (3.28±2.79) mm (P＜0.05),(1.47± 1.49) and (1.73± 1.81) mm (P=0.28).The extension values of inter-fractional set up error of CTV to PTV were 2.97,2.92,2.21 mm and 3.41,4.09,2.59 mm respectively.The time of single positioning was (3.4± 1.1) and (5.5 ± 3.1) min respectively (P=0.01).Conclusion Styrofoam has better positioning accuracy and efficiency compared with breast carrier.

Objective: To develop a simple radiotherapy information system for the developments of multiple hospital areas. Methods: Using C/S+ B/S dual technology architecture, Visual Studio 2015+ C#+ HTML5+ JavaScript+ PostgreSQL9.5 were utilized as the programming tools selected for development. The two-dimensional barcode, intelligent IC card, identity card recognition, face recognition, speech synthesis and other technologies were integrated and applied in the radiotherapy process management. The normal business processes were designed by default automatic processing. Previous multi-step operation was simplified to single-key operation. Results: System development was completed and implemented at the end of 2017, which connected the south and north hospital areas. The system not only resolved the problem that required the doctors to manually input or make telephone call for consulting patients’ data, but also achieved paperless business process in different departments. The outstanding advantage was reflected in the aspects of intelligence and optimization. Approximately 95% of the normal flows could be completed by single-key automatic processing, and the remaining 5% requiring special operations (such as, modification or deletion, etc.) were prompted and restricted to ensure data security and system stability. Conclusion The application of this system improves the level of information management in the departments and saves the cost of supplies and human resources.

Objective: To investigate the self-reported prevalence, clinical characteristics, complications of allergic rhinitis (AR) and the sensitization of outdoor air pollen allergens in children in the Inner mongolia grassland region. Methods: A multistage, stratified and random clustered sampling with a face-to-face interview survey study in children from 0 to 17 years old was performed together with 10 common allergen skin prick tests (SPT) and measurements of the daily pollen count in 6 regions in the Inner mongolia grassland region from May to August of 2015. SAS 9.4 software was used for data analysis. Results: A total of 2 443 subjects completed the study. The self-reported prevalence of AR was 26.6%. The prevalence of boys was higher than that of girls (28.8% vs 24.3%, χ²=6.157, P<0.05). Subjects from urban areas showed higher prevalence than rural areas (34.7% vs 18.8%, χ²=79.107, P<0.05). There was significant regional difference in the prevalence of AR among the six areas investigated (χ²=221.416, P<0.05). The main clinical symptoms of AR were sneezing (88.2%) and nasal congestion (78.6%). Among combined diseases, asthma accounted for 16.5% (107/650), rhinoconjunctivitis accounted for 47.9% (311/650). The peak season of AR was April and July, with the top SPT positive allergens of Artemisia species and chenopodium in this area. Conclusions The prevalence AR in children in the Inner mongolia grassland region is extremely high. Sneezing is the main clinical symptom. Rhinoconjunctivitis is the most common combined disease. High summer and autumn pollen exposure is the main cause of AR.

Objective To explore the influencing factors of urinary tract infection in patients with spinal cord injury in rehabilitation period, so as to provide the basis to minimize urinary tract infection.Methods The patients' information and the incidence of urinary tract infection (UTI) during the rehabilitation period of 503 cases of spinal cord injury admitted to the First Affiliated Hospital of PLA General Hospital from January 2013 to December 2015 were retrospectively analyzed. Logistic regression analysis was used to analyze the influencing factors of UTI in patients with spinal cord injury during rehabilitation period.Results The degree of injury, the site of injury, the way of urination, and the course of the disease were the factors affecting the incidence of UTI in the patients with spinal cord injury during the rehabilitation period (P<0.05). Conclusions The degree of injury, the location of injury, the way of micturition and the duration of disease are the influencing factors of UTI in patients with spinal cord injury during rehabilitation. As the course of disease goes on, we need to choose intermittent catheterization as a way of micturition according to the bladder function of patients with spinal cord injury.

Objective To explore the effects of intermittent catheterization conducted by bladder safe capacity on bladder function rehabilitation among patients with spinal injury.Methods A total of 60 patients with spinal injury and neurogenic bladder of Rehabilitation Department of Spine were selected as subjects by convenience sampling from January 2015 to January 2016. They were randomly divided into intervention group (intermittent catheterization conducted by the bladder capacity scanner) and control group (routinely regular intermittent catheterization). And then, this study compared the recovery of bladder function and the incidence of urinary tract infection of patients in two groups.Results At the fourth week, there were 9 patients with reflex bladder in intervention group more than that (4 patients) in control group with a significant difference (P<0.05). At discharge, there were 18 patients with reflex bladder in intervention group, while there were 14 patients in control group with a significant difference (P<0.05). After intervention, the residual urine volume of intervention group was significantly higher than that of control group (P<0.05). There was no statistically significant difference in bladder compliance between two groups (P>0.05). The difference on cases with urinary tract infection in control group (66 times) and intervention group (35 times) was significant (P<0.05). The times of reflex urination for the first time and bladder functional reconstruction in intervention group were lower than those in control group with significant differences (P<0.05).Conclusions Intermittent catheterization based on individual bladder safe capacity can effectively shorten the times of reflex urination for the first time and bladder functional reconstruction, reduce the residual urine and decrease the incidence of urinary infection.

Objective To investigate the urinary patterns in cervical spinal cord injury patients with different courses and degrees of injury.Methods A total of 49 patients with cervical spinal cord injury in the First Affiliated Hospital of PLA General Hospital from January 2014 to October 2016 were enrolled in this study using purposive sampling. Medical data and normal information of patients were recorded. A number of 5 hospitalized patients were interviewed face-to-face, while 44 patients were interviewed by telephone to record the urinary patterns and time of changing urination pattern.Results Indwelling catheter was the main urinary pattern and accounted for 31.0%-61.2% of patients. Patients with different injury degrees had different urinary patterns. Indwelling was the main urinary pattern of patients with complete cervical spinal cord injury and accounted for 42.9%; 14.3% of patients with complete cervical spinal cord injury could urinate by themselves. The main urinary pattern of patients with incomplete injury was self-urination, which accounted for 34.6%; there were 26.9% of these patients with indwelling catheterization.Conclusions The course and degree of injury affect the urinary pattern. Patients with cervical spinal cord injury should have individual urinary patterns to improve their bladder function and restore spontaneous urination so as to improve their quality of life to return to society.