Objective:To explore the effects of small-group collaborative stratified teaching in critical care medicine training for professional postgraduate students.Methods:We randomly assigned 71 professional postgraduate students who entered the Intensive Care Unit of The Affiliated Hospital of Qingdao University for standardized training between June 2020 and November 2020 into experimental group and control group. An entrance examination was taken after one week of unified training. Then the experimental group adopted small-group collaborative stratified teaching, while the control group adopted traditional teaching for training. After two months of training, the Mini-Clinical Evaluation Exercise (Mini-CEX) assessment, post competency assessment, exit examination, and teaching satisfaction evaluation were conducted. SPSS 25.0 was used for the t test and chi-square test. Results:In the Mini-CEX assessment, the experimental group had significantly higher scores in history-taking skills [(7.42±0.60) vs. (7.00±0.55)], physical examination [(7.47±0.56) vs. (6.94±0.24)], communication skills [(7.56±0.50）vs.(7.24±0.49)], clinical dialectical thinking [(7.53±0.56) vs. (7.03±0.39)], clinical judgement [(7.50±0.51) vs.(6.90±0.42)], organization/efficiency [(7.58±0.50) vs. (7.15±0.44)], and overall clinical competence [(7.64±0.49) vs. (7.17±0.39); all P<0.05] than the control group. In the post competency assessment, the experimental group had significantly better performance in clinical basic competence [(89.15±9.12) vs. (86.24±10.23)], medical knowledge application [(48.37±5.87) vs. (46.98±3.68)], teamwork [(48.10±3.55) vs. (45.96±4.83)], information and management [(68.52±7.61) vs. (66.38±5.54)], and academic research [(22.18±0.95) vs. (20.87±1.22); all P<0.05] than the control group. The experimental group was also significantly superior to the control group in terms of the exit examination score and teaching satisfaction (both P<0.05). Conclusions:Small-group collaborative stratified teaching can improve the quality of critical care medicine training for professional postgraduate students, and strengthen their clinical comprehensive abilities and post competencies.

BACKGROUND:The research of dental stem cells in the fields of regenerative medicine and tissue engineering has been deepening,bringing hope for the repair of tooth-related tissues and the treatment of systemic diseases.However,there is a lack of systematic research and analysis on the biological characteristics of dental stem cells in different age groups. OBJECTIVE:To explore the biological characteristics of the human deciduous tooth and permanent tooth pulp stem cells cultured in umbilical cord blood platelet lysate to provide a reliable basis for human platelet lysates to replace fetal bovine serum. METHODS:The pulp tissues of deciduous teeth,juvenile permanent teeth and adult permanent teeth were taken out and cultured in DMEM/F-12 medium supplemented with 10%fetal bovine serum or different concentrations(5%,10%and 15%)of human platelet lysates.Cell proliferation in the four groups was detected by cytometry.The optimal concentration of human platelet lysates was selected for subsequent experiments.Under the optimal concentration of human platelet lysates,human deciduous tooth and juvenile and adult permanent tooth pulp stem cells were cultured in vitro.The cell growth status was observed under the microscope.The specific antigen on the cell surface was detected by flow cytometry.The cell proliferation ability was tested by the cell counting method and CCK-8 assay.The cell differentiation ability in vitro was observed by a three-line differentiation assay. RESULTS AND CONCLUSION:(1)The cell proliferation rate of the 10%human platelet lysate group was the highest.(2)In all three groups,fusiform fibrous cells grew and expanded from around the tissue block.There was no significant difference between deciduous teeth and juvenile permanent tooth cells,but the adult permanent tooth cells were larger than the deciduous and juvenile permanent tooth cells of the same generation.(3)The results of flow cytometry showed that deciduous teeth,juvenile permanent teeth and adult permanent teeth conformed to the phenotypic characteristics of mesenchymal stem cells.(4)The proliferative capacity of adult permanent dental pulp stem cells was significantly lower than those of deciduous teeth and juvenile permanent dental pulp stem cells(P<0.01).(5)mRNA expressions of osteoblast-related genes alkaline phosphatase and bone morphogenetic protein 2,lipoprotein lipase and peroxisome proliferator-activated receptor γ2,mRNA expressions of chondroblast related gene type II collagen α1 and cartilage oligomeric matrix protein in adult pulp stem cells of permanent teeth were significantly lower than those of deciduous teeth and juvenile permanent teeth pulp stem cells(P<0.01).(6)Compared with adult dental pulp stem cells,human deciduous teeth and juvenile permanent teeth dental pulp stem cells have the stronger proliferative capacity and multidirectional differentiation potential,and are more suitable for clinical research and disease treatment.

Purpose: The interval between neoadjuvant chemotherapy (NAC) and surgery for locally advanced breast cancer (LABC) remains controversial. At the same time, the prognostic effect of delayed surgery in patients with poor responses is currently unclear. Methods: Data was collected from patients who had poor responses to NAC and underwent modified radical surgery from January 2013 to December 2018. The interval from completion of NAC to surgery was divided into two groups: a longer (greater than four weeks) or shorter (four weeks or less) interval. The associations of these interval groups with overall survival (OS) and recurrence-free survival (RFS) were evaluated by multivariable Cox models adjusting for the existing prognostic factors. Propensity score matching (PSM) was used to minimize election bias. Results: A total of 1,229 patients (mean age, 47.2 ± 8.9 years; median follow-up duration, 32.67 [6.57–52.63] months) were included. The 5-year OS rates were 73.2% and 60.8% in the shorter (n = 171) and longer interval group (n = 1,058), respectively, while the 3-year RFS rates were 80.8% and 71.7%, respectively. In multivariate Cox analysis, the longer interval was associated with an increased risk of mortality (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.01–2.02; p = 0.046) and recurrence (HR, 1.50; 95% CI, 1.12–1.99; p = 0.006).There was an interaction between the molecular subtype and the surgery interval for OS (pinteraction = 0.014) and RFS (pinteraction = 0.027). After PSM, no significant difference in OS (p = 0.180) and RFS (p = 0.069) was observed between the two groups. Conclusion Among LABC patients with a poor response, those with a longer interval between NAC and surgery had worse OS and RFS. The results indicate that these patients should receive modified radical surgery timely, which may in turn improve their prognosis.

Objective:To study the clinical characteristics of neonatal leukemoid reaction (NLR).Methods:The newborns with NLR admitted to the neonatal intensive care unit of the Seventh Medical Center of PLA General Hospital from September 2010 to January 2022 were selected as the observation group, and the newborns without NLR, who were admitted to the Hospital at the same time and matched with gestational age and birth weight of the NLR newborns were selected as the control group at a ratio of 1∶2. The gestational age, birth weight, maternal complications, maximum leukocyte count, percentage of neutrophils, C-reactive protein, hemoglobin, platelet count, disease diagnosis and other relevant information of the newborns were recorded, and SPSS 21.0 statistical software was applied to compare the data of the two groups of newborns.Results:A total of 36 cases were in the observation group and 72 cases in the control group. Naive granulocytes were found in the peripheral blood of all patients in the observation group, and leukocyte count was higher than that of the control group [61.7 (54.2, 90.6)×10 9/L vs. 19.6 (14.2,27.3)×10 9/L], the difference was statistically significant ( P<0.001), but there was no statistically significant difference in the percentage of neutrophils, hemoglobin, platelets, and C-reactive protein between the two groups ( P>0.05). The proportion of vaginal delivery, meconium-stained amniotic fluid, and neonatal sepsis in the observation group were higher than that in the control group [69.4% (25/36) vs. 38.9% (28/72), 19.4% (7/36) vs. 5.6% (4/72), 47.2% (17/36) vs. 8.3% (6/72)], and the proportion of gestational diabetes mellitus, gestational hypertension and prenatal use of glucocorticoid was lower than that in the control group, with statistical significance ( P<0.05). There was no significant difference in the incidence of premature rupture of membranes, neonatal asphyxia, intracranial hemorrhage, pulmonary hemorrhage, bacterial meningitis, and bronchopulmonary dysplasia between the two groups ( P>0.05). Conclusions:Newborns with NLR are frequently complicated with sepsis. Early prevention and treatment of maternal comorbidities and active control of infection are important for the prevention and treatment of NLR.

Objective:To compare the efficacy between deep continuous irrigation combined with vacuum sealing drainage (VSD) and routine dressing change in treating multidrug-resistant bacterial infections at the surgical wound site in patients with major vascular injury.Methods:A retrospective cohort study was conducted to analyze the clinical data of 28 patients with surgical wound infections by multidrug-resistant bacteria after major vascular injury treated at the First Affiliated Hospital of Henan University of Science and Technology from March 2015 to December 2021. There were 15 males and 13 females, aged 15-65 years [(41.8±12.9)years]. All patients received vascular graft surgery after major vascular injury. Postoperative microbiological culture indicated that the wound infections were caused by Carbapenem-resistant organisms (CRO) or vancomycin- resistant Enterococci (VRE), with no available sensitive antibiotics for treatment. The patients received surgical debridement every five days after vascular graft surgery and were divided into two groups to receive the subsequent treatments including a routine dressing change (routine dressing group, 14 patients) or a deep continuous irrigation combined with VSD (irrigation combined with VSD group, 14 patients). On the first day post-operation and then every 3 days, inflammatory indicators [white blood cell count, neutrophils, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and procalcitonin] were observed in the two groups (repeat tests when a patient′s condition changed). Microbiological cultures were applied with patient samples every 5 days to observe the wound and infection control. Comparisons were made between the two groups regarding the duration to normal levels of inflammatory indicators, duration to negative CRO or VRE cultures, visual analogue score (VAS) before and at 1, 2 and 3 hours after changing the irrigation fluid (changing the dressing), conditions of wound skin grafting or flap repair, and incidences of anastomotic fistula.Results:All patients were followed up for 12-24 months [(14.3±2.4)months], during which no wound redness, rupture, purulent discharge or infection recurrence was noted. The duration to normal levels was (9.4±2.4)days for white blood cells, (9.6±2.8)days for neutrophils, (9.8±3.1)days for CRP, (12.2±3.6)days for ESR, and (7.6±1.9)days for procalcitonin in the irrigation combined with VSD group, significantly shorter than those in the routine dressing group [(15.2±3.1)days, (13.6±3.4)days, (14.2±3.9)days, (19.9±3.3)days, and (12.9±4.1)days, respectively] (all P<0.01). The duration to negative CRO or VRE cultures was (13.9±3.1)days in the irrigation combined with VSD group, significantly shorter than that in the routine dressing group [(19.2±6.9)days] ( P<0.05). The VAS before and at 1, 2 and 3 hours after changing the irrigation fluid was (4.2±0.7)points, (4.1±0.9)points, (4.2±0.9)points and (4.1±0.8)points in the irrigation combined with VSD group, respectively, and was (4.3±0.6)points, (6.9±0.7)points, (5.4±0.9)points and (4.5±0.9)points in the routine dressing group, respectively. The VAS score in the irrigation combined with VSD group was significantly lower than that in the routine dressing group at 1 hour and 2 hours after changing the irrigation fluid (all P<0.01), while no significant differences were found before and at 3 hours after changing the irrigation fluid (all P>0.05). After infection control, 5 patients (35.7%) in the irrigation combined with VSD group required skin grafting or flap repair at the wound site, lower than 11 patients (78.6%) in the routine dressing group ( P<0.01). The incidence of anastomotic fistula was 7.1% (1/14) in the irrigation combined with VSD group, lower than 42.9% (6/14) in the routine dressing group ( P<0.05). Conclusion:When multidrug-resistant bacterial infections occur at the surgical wound site after major vascular injury, deep continuous irrigation combined with VSD performs better than routine dressing change in controlling infection as well as in reducing pain, rate of wound skin grafting or flap repair and incidence of anastomotic fistula, without reliance on antibiotics.

Objective:To explore the predictive value of the modified NUTrition risk in the critically ill (mNUTRIC) score for chronic critical illness (CCI) in elderly sepsis patients.Methods:A prospective observational study was conducted. Elderly sepsis patients admitted to Medical Intensive Care Unit (MICU) of General Hospital of Southern Theatre Command for more than 24 h from August 2019 to January 2021 were enrolled. Age, sex, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, acute gastrointestinal injury (AGI) score, clinical frailty score and mNUTRIC score at admission, length of ICU stay, usage of mechanical ventilation and renal replacement therapy were recorded. According to the occurrence of CCI, patients were divided into the CCI group and rapid recovery (RAP) group, and the differences between the two groups were compared. The risk factor of CCI after sepsis in elderly patients were analyzed by log-binomial regression analysis. Receiver operating characteristic (ROC) analysis was performed for mNUTRIC score. Differences were considered significant at P<0.05. Results:Of the enrolled 91 sepsis patients, 14 (15%) patients died within the first week, 37 (41%) exhibited RAP and 40 (44%) developed CCI. The CCI patients were significantly older and presented a higher APACHE Ⅱ score, CFS score, mNUTRIC score, and usage of mechanical ventilation and renal replacement therapy compared with the RAP patients ( P<0.05). Multivariate regression analysis revealed that mNUTRIC score was an independent risk factor for the development of CCI in elderly sepsis patients, prevalence ratio was 1.503 (95% CI: 1.007-2.244). The area under the curve (AUC) of mNUTRIC score was 0.706 (95% CI: 0.592-0.805). Conclusions:The mNUTRIC score at the time of admission in the intensive care unit can be used to predict CCI after sepsis in elderly sepsis patients.

Objective:To establish a 180-day mortality predictive score based on frailty syndrome in elderly sepsis patients [elderly sepsis score (ESS)].Methods:A prospective study for sepsis patients aged 60 years and above who were admitted to a medical intensive care unit of the General Hospital of Southern Theatre Command from January 1st, 2018 to December 31st, 2018 was conducted. Univariate analysis was performed on 19 independent variables including gender, age, body mass index (BMI), tumor, charlson comorbidity index (CCI), activity of daily living (ADL), instrumental activity of daily living (IADL), mini-mental state examination (MMSE), geriatric depression scale (GDS), clinical frail scale (CFS), sequential organ failure assessment (SOFA), Glasgow coma scale (GCS), acute physiology and chronic health evaluation (APACHEⅡ, APACHEⅣ), modified NUTRIC score (MNS), multiple drug resistance (MDR), mechanical ventilation (MV), continuous renal replacement therapy (CRRT) and palliative care. Continuous independent variables were converted into classified variables. Multivariate binary regression analysis of risk factors was conducted to screen independent risk factors which affecting 180-day mortality in elderly sepsis patients. Then a 180-day mortality predictive score was established, and the discrimination of the mortality of patients using CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ, MNS scores were compared.Results:A total of 257 patients were enrolled, with a 180-day mortality of 60.7%. Univariate analysis showed that age, tumor, CCI, ADL, IADL, MMSE, CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ, MNS, MDR, MV, CRRT, palliative care were risk factors of 180-day mortality in elderly sepsis patients [age: odds ratio ( OR) = 1.027, 95% confidence interval (95% CI) was 1.005-1.050, P = 0.018; tumor: OR =2.001, 95% CI was 1.022-3.920, P = 0.043; CCI: OR = 1.193, 95% CI was 1.064-1.339, P = 0.003; ADL: OR = 0.851, 95% CI was 0.772-0.940, P = 0.001; IADL: OR = 0.894, 95% CI was 0.826-0.967, P = 0.005; MMSE: OR = 0.962, 95% CI was 0.937-0.988, P = 0.004; CFS: OR = 1.303, 95% CI was 1.089-1.558, P = 0.004; SOFA: OR = 1.112, 95% CI was 1.038-1.191, P = 0.003; GCS: OR = 0.918, 95% CI was 0.863-0.977, P = 0.007; APACHEⅡ: OR = 1.098, 95% CI was 1.053-1.145, P < 0.001; APACHEⅣ: OR = 1.032, 95% CI was 1.020-1.044, P < 0.001; MNS: OR = 1.315, 95% CI was 1.159-1.493, P < 0.001; MDR: OR = 2.029, 95% CI was 1.197-3.437, P = 0.009; MV: OR = 6.408, 95% CI was 3.480-11.798, P < 0.001, CRRT: OR = 2.744, 95% CI was 1.529-4.923, P = 0.001, palliative care: OR = 5.760, 95% CI was 2.177-15.245, P < 0.001]. By binary regression analysis, CFS stratification ( OR = 1.934, 95% CI was 1.267-2.953, P = 0.002), MV ( OR = 4.531, 95% CI was 2.376-8.644, P < 0.001), CRRT ( OR = 2.471, 95% CI was 1.285-4.752, P = 0.007), palliative care ( OR = 6.169, 95% CI was 2.173-17.515, P = 0.001) were independent risk factors of 180-day mortality in elderly patients with sepsis. The model of "ESS = 0.660×CFS stratification+1.511×MV+0.905×CRRT+1.820×palliative care" was established. Receiver operating characteristic curve (ROC curve) analysis showed that the area under the ROC curve (AUC) for predicting 180-day mortality by ESS was 0.785 (95% CI was 0.730-0.834, P < 0.001). When the best cut-off value was 2.2 points, its sensitivity was 78.9%, specificity was 70.3%, the positive predictive value was 80.4%, and the negative predictive value was 68.3%. Simplified ESS was defined as "0.5×CFS stratification+1.5×MV+1×CRRT+2×palliative care". ROC curve analysis showed that AUC for predicting 180-day mortality by simplified ESS was 0.784 (95% CI was 0.729-0.833, P < 0.001). When the best cut-off value was 2.0 points, sensitivity was 76.9%, specificity was 70.3%, the positive predictive value was 80.0%, and the negative predictive value was 66.4%. Compared with CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ and MNS, ESS had a significant difference in discriminating 180-day mortality in elderly patients with sepsis (AUC was 0.785 vs. 0.607, 0.607, 0.600, 0.664, 0.702, 0.657, 95% CI: 0.730-0.734 vs. 0.537-0.678, 0.537-0.677, 0.529-0.671, 0.598-0.730, 0.638-0.766, 0.590-0.725, all P < 0.05). Conclusions:CFS, MV, CRRT, and palliative care are independent risk factors of 180-day mortality in elderly patients with sepsis. We established ESS based on these risk factors. The ESS model has good discrimination and can be used as a reference and assessment tool for prediction and treatment guidance in elderly patients with sepsis.

Over the last decade, chronic critically ill (CCI) has emerged as an epidemic in intensive care unit (ICU) survivors worldwide. Advances in ICU technology and implementation of care bundles has significantly decreased early deaths of critically ill patients, and have allowed them to survive previously lethal multiple organ failure (MOF). However, more and more survivors leave persistent low grade organ dysfunctions, depend on continues organ support, need to stay in ICU, and become CCI patients. These patients experience a persistent immune dysregulation with persistent inflammation, immunosuppression, and catabolic syndrome. Therefore, malnutrition is an important feature of patients with CCI, and nutritional support is a crucial part of their treatment. The main strategies of nutritional support are as follows: providing sufficient calories and proteins with appropriate anabolic agents to promote anabolic metabolism, using immunomodulators to improve immune suppression and inflammatory responses, and supplementing micronutrients to enhance metabolic support. In this review, the nutritional assessment, calorie assessment, protein assessment and other nutrient supplementation (such as β blocker, testosterone and oxandrolone, immunonutrition, vitamins) of CCI patients were reviewed, so as to provide reference for the treatment of CCI.

Objective:To explore the predictive value of neutrophil to lymphocyte ratio (NLR) in the progression of sepsis to chronic critical illness (CCI) in elderly patients.Methods:Patients with sepsis who were hospitalized more than 24 hours and older than 60 years old admitted to the department of medical intensive care unit (MICU) of General Hospital of Southern Theatre Command from August 2019 to April 2021 were enrolled. The neutrophil count (NEU), lymphocyte count (LYM) and NLR of peripheral blood cells were recorded on the 1st, 4th and 7th day after admission. Patients were divided into the CCI group and the non-CCI group according to whether they progressed to CCI, and differences between the two groups were compared. The CCI was defined as a MICU length of stay (LOS) ≥ 14 days and persistent organ dysfunction [sequential organ failure assessment (SOFA) score ≥ 2]. Logistic regression analysis was performed to evaluate the risk factors for predicting CCI. The receiver operator characteristic curve (ROC curve) was plotted for evaluating the predictive value of NLR in the progression of sepsis to CCI in elderly patients.Results:① Among 103 sepsis patients enrolled, 16 (15.5%) died within 2 weeks of admission to the MICU, 46 (44.7%) developed CCI, and 41 (39.8%) were non-CCI. ② Compared between the two groups, the NEU of CCI group on day 7 was significantly higher than that of non-CCI group [×10 9/L: 9.80 (6.72, 16.80) vs. 6.66 (5.14, 9.29), P < 0.01], LYM was significantly lower than that of non-CCI group [×10 9/L: 0.77 (0.46, 1.20) vs. 1.00 (0.86, 1.48), P < 0.05], and NLR on day 4 and day 7 were significantly higher than those of non-CCI group [12.85 (6.56, 17.56) vs. 8.26 (5.34, 13.17), 13.76 (6.97, 23.66) vs. 6.14 (4.04, 8.84), both P < 0.05]. Compared with different time points in the same group, NEU and NLR decreased gradually and LYM increased gradually in non-CCI group (χ 2 values were 10.216, 28.343, 7.189, respectively, all P < 0.05), which tended to be normal. There were no significant differences in NEU, LYM and NLR of CCI group at each time point (χ 2 values were 0.798, 4.478, 5.783, respectively, all P > 0.05). ③ Multivariate Logistic regression analysis showed that NLR on day 7 was an independent risk factor for sepsis progression to CCI [odds ratio ( OR) = 1.155, P = 0.005]. ④ ROC curve analysis showed that the area under the curve (AUC) of NLR predicting the sepsis progression to CCI on day 7 was 0.775, and the 95% confidence interval (95% CI) was 0.670-0.860, P < 0.01; when the cut-off value was 9.25, the sensitivity was 69.57% and the specificity was 80.56%. Conclusion:Dynamic monitoring of NLR is helpful to determine the progress of sepsis in elderly patients, NLR on day 7 has a certain predictive value for the occurrence of CCI.

OBJECTIVETo compare the difference in CT manifestations between primary colorectal mucinous adenocarcinoma and signet ring cell carcinoma in order to improve radiologic diagnosis.

METHODSClinicopathological data and CT findings of 109 patients with colorectal mucinous adenocarcinoma and 46 patients with primary colorectal signet-ring cell carcinoma confirmed by surgery and pathology from March 2008 to February 2015 in the Tumor Hospital of Yunnan Province were retrospectively collected. Differences in age, gender, tumor location, length and thickness of the involved intestinal wall, thickening pattern of the intestinal wall, lesion density, calcification, contrast-enhanced form, peri-intestinal invasion, occurrence of intestinal obstruction and metastasis of other organs were compared between the two groups.

RESULTSAmong 109 patients with colorectal mucinous adenocarcinoma, 68 were men and 41 were women with a mean age of (56.8±15.4) years. Among 46 patients with primary colorectal signet-ring cell carcinoma, 26 were men and 20 were women with a mean age of (42.9±15.6) years. Compared with mucinous adenocarcinoma group, signet-ring cell carcinoma group showed more concentric bowel-wall thickening[93.5%(43/46) vs. 81.6%(89/109), χ=9.19, P=0.030], higher lesion density [(42.0±3.0) Hu vs. (28.5±1.5) Hu, t=37.30, P=0.000], more marked enhancement [54.3%(25/46) vs. 12.8%(14/109), χ=35.21, P=0.000], less vast-low-density region in enhanced CT imaging[2.2%(1/46) vs. 45.0%(49/109), χ=73.31, P=0.000] and more severe peri-intestinal invasion [41.3% (19/46) vs. 17.4%(19/109), χ=10.25, P=0.006]. Calcification was found in 18.3%(20/109) of mucinous adenocarcinoma cases, but was not found in signet-ring cell carcinoma cases (χ=9.69, P=0.002). Target ring sign in contrast-enhanced scan was observed in 15.2%(7/46) of signet-ring cell carcinoma cases, while in none of mucinous adenocarcinoma cases (χ=17.37, P=0.000). There were no statistically significant differences in lesion location, length and thickness of the involved intestinal wall, occurrence of intestinal obstruction, lymph node metastasis, liver or peritoneum metastasis between two groups(all P>0.05).

CONCLUSIONSSignet-ring cell carcinoma is often found in younger patients, whose CT manifestation is characterized by the target ring sign in contrast-enhanced scan, while primary colorectal mucinous adenocarcinoma is often in older patients, whose CT manifestation is characterized by calcification in unenhanced scan and low density region in enhanced CT show.

Adenocarcinoma, Mucinous ; diagnostic imaging ; pathology ; Adult ; Age Factors ; Aged ; Calcinosis ; diagnostic imaging ; pathology ; Carcinoma, Signet Ring Cell ; diagnostic imaging ; pathology ; China ; Colorectal Neoplasms ; diagnostic imaging ; pathology ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Tomography, X-Ray Computed ; methods