Objective:To investigate the clinical value of multiparametric myocardial imaging using a dual-layer detector spectral CT in the non-invasive preoperative assessment of patients with coronary atherosclerotic heart disease (CHD) undergoing percutaneous coronary intervention (PCI).Methods:The clinical and imaging data of 90 patients who underwent coronary CT angiography (CCTA) with dual-layer spectral detector CT and invasive coronary angiography (ICA) within 30 days at the Affiliated Changshu Hospital of Nantong University from January 2021 to October 2022 were retrospectively analyzed. A total of 189 coronary arteries were included in the study cohort. The patients were divided into PCI ( n=44) and non-PCI groups ( n=46) according to whether they received PCI after evaluation with ICA. The diameter stenosis rate of the coronary arteries, myocardial iodine concentration (IC) and effective atomic number (Z eff) values were obtained from CCTA conventional and spectral images. The IC values and Z eff values of the myocardium in the areas with abnormal perfusion were compared with those in the areas with normal perfusion. The diagnostic performance of these parameters, as well as their combined model, was evaluated and compared using receiver operating characteristic (ROC) curve and area under the curve (AUC) in the pre-PCI assessment of patients with CHD. Results:Baseline patient data did not show statistically significant differences between the PCI and non-PCI groups (all P>0.05). There were statistically significant differences in IC values [(0.42±0.28) and (2.26±0.48) mg/ml] and Z eff values (7.39±0.33 and 8.50±0.25) between the myocardium areas with abnormal perfusion and the myocardium areas with normal perfusion in all patients (all P<0.001). The AUC for assessing whether patients with CHD need PCI treatment using myocardial IC and Z eff values were 0.865 and 0.853, respectively, which were significantly higher than assessment based only on lumen diameter stenosis rate (AUC=0.726, P<0.001). Conclusions:The IC and Z eff derived from myocardial spectral images can be used to diagnose myocardial perfusion abnormalities in patients with CHD. The spectral myocardial multi-parameters imaging shows promising potentials in pre-PCI assessment of patients with CHD, which can improve the efficiency of evaluation and may help to avoid unnecessarily invasive procedures.

Objective:To explore the characteristics of the changes in risk score for intensive care unit (ICU) patients during hospitalization by the intelligent calculation method, and to provide evidence for the risk prevention.Methods:In this retrospective study, ICU patients of the Fifth Central Hospital in Tianjin from November 3, 2021 to March 28, 2022 were enrolled and divided into ≥ 14 days group, 10-13 days group, 7-9 days group, and 3-6 days group according to the ICU length of stay. Risk scores assessed by the intelligent calculation method of the ICU patients were collected, including nutritional risk screening 2002 (NRS 2002), Caprini score and Padua score. NRS 2002 score for all patients, Caprini score for surgical patients and Padua score for internal medicine patients were selected. Trends in change of each score were compared between patients admitted to ICU 1, 3, 7 (if necessary), 10 (if necessary), and 14 days (if necessary).Results:A total of 138 patients were involved, including 79 males and 59 females, with an average age of (61.71±18.86) years and an average hospital stay of [6.00 (4.00, 9.25)] days. ① in the group with ICU length of stay ≥ 14 days (21 cases): there was no significant change in the NRS 2002 scores of the patients within 10 days, but the NRS 2002 score was significantly decreased in 14 days as compared with 1 day [3.00 (2.50, 3.50) vs. 4.00 (3.00, 5.00), P < 0.05]; both Caprini and Padua score were increased with prolonged hospital stay and compared with 1 day, the scores at the other time points were significantly increased, especially at 14 days [Caprini score: 5.00 (3.25, 7.00) vs. 2.50 (1.25, 5.50), Padua score: 6.00 (6.00, 7.00) vs. 3.00 (1.00, 3.00), both P < 0.05].② in the group with ICU length of stay from 10-13 days (15 cases): with the prolonged hospital stay, there was no significant change in NRS 2002 score, but both Caprini and Padua score were increased at 3, 7, 10 days, especially at 10 days [Caprini score: 3.00 (2.00, 4.75) vs. 2.00 (0.25, 2.75), Padua score: 5.00 (3.50, 6.00) vs. 2.00 (0.50, 4.00), both P < 0.05].③ in the group with ICU length of stay from 7-9 days (23 cases): compared with 1 day, the NRS 2002 score at 3 days and7 days were decreased, but the Caprini and Padua score were increased, especially at 7 days [NRS 2002 score: 2.00 (1.00, 4.00) vs. 2.00 (2.00, 4.00), Caprini score: 3.00 (2.00, 5.50) vs. 2.00 (0.25, 3.00), Padua score: 5.00 (4.00, 6.00) vs. 2.00 (0, 2.00), all P < 0.05]. ④ in the group with ICU length of stay from 3-6 days (79 cases): compared with 1 day, the NRS 2002 score at 3 days was decreased [NRS 2002 score: 2.00 (1.00, 3.00) vs. 2.00 (1.00, 3.00), P < 0.05], Caprini and Padua score were significantly increased [Caprini score: 3.00 (2.00, 4.00) vs. 2.00 (1.00, 3.00), Padua score: 5.00 (4.00, 5.00) vs. 2.00 (1.00, 3.00), both P < 0.05]. Conclusion:Based on dynamic assessment of intelligent calculation methods, the risk of thrombosis in ICU patients increased with hospital length of stay, and the nutritional risk was generally flat or reducing in different hospitalization periods.

This paper briefly introduces the characteristics of the SAA method and its clinical research. The SHA-AM Acupuncture (SAA) method was developed by Sheyan Daoren, who published a book titled by Tips of acupuncture by Sheyan Daoren. Based on the traditional theory of yin and yang, five elements, visceral, qi and blood, and meridians, the SAA method further developed the principles of acupuncture reinforcing and reducing methods from Huang Di Nei Jing and Nan Jing. And it has further developed it's own unique theoretical system, which has been widely applied in Korea.

Objective To assess the efficacy and side effects of intravesical instillation of BCG after transurethral resection of the bladder tumor (TURBT) in non-muscle invasive bladder cancer (NMIBC) patients.Methods The clinical data of patients treated with BCG 120 mg per course induced perfusion or more after TURBT from December 2013 to October 2016 in 18 hospitals of northeast China region,were analyzed retrospectively.The first part,data of 106 patients with moderate,high-risk NMIBC were collected.A total of 83 patients were male,while the other 23 patients were female.The average age was 66.7 years old.The clinical staging were T1 in 86(81.1％) cases,Ta in 20(18.9％) cases and carcinoma in situ in 6 (5.7％) patients.Intravesical instillation of BCG was executed after transurethral resection of the bladder tumor.The incidence rate of recurrence and progression during more than 6 months' follow-up time were observed.Multivariate analyses were done by using logistic analysis and Cox proportional hazards regression model with Kaplan-Meier method.The second part,treatment compliance of 276 patients with bladder cancer,including moderate/high-risk NMIBC in 263 cases,moderate/high-risk NMIBC followed with renal pelvis/ureteral carcinoma in 8 cases were and moderate/high-risk NMIBC with renal pelvis/ureteral carcinoma in 5 cases who treated with BCG after the surgeries,were observed.Patients consisted of 211 males and 65 females with average age of 68.3 years.Results With a median follow-up of 12 months,9 (8.5％) patients experienced tumor recurrence and 2 (1.9％) patients were found progression in the first part.The one-year cancer free recurrence rate of the patients was 91.5％.Statistically significant prognostic factors for recurrence identified by multivariable analyses were prior recurrence of the tumors (OR =3.214,95％CI0.804-12.845,P =0.099).In the second port,an incidence rate of adverse effects was 64.1％ (177/276).The Ⅲ/Ⅳ degree complications were occurred in 11 patients and satisfactory outcomes achieved with active treatment.A total of 36 patients withdrawal with the major causes were recurrence and progression of bladder tumor in 12 cases (4.4 ％),9 cases (3.3 ％) with economic reasons and 11 cases (4.0％) with serious complications.Conclusions NMIBC patients treated with intravesical BCG therapy have approving cancer free recurrence rates and acceptable adverse effects.Prior recurrence may be prognostic factor of recurrence after intravesical BCG therapy.

Objective To use the fusion image of the end-inhalation holding (EIH) phase and endexhalation holding (EEH) phase to define the target volume of individual patient with liver cancer,and to evaluate the target geometry,feasibility,and clinical significance of the technology.Methods Eighteen patients with liver caucer who were treated in our hospital from 2012 to 2013 were enrolled as subjects.With the same posture and scan range,all patients underwent contrast-enhanced three-dimensional computed tomography (3DCT) scans in the phases of free breathing (FB),EIH,and EEH.Gross tumor volume (GTV),clinical target volume (CTV),and organ of risk (OAR) were delineated on the above images.CTVFB was defined as GTV on the FB phase image (GTVFB) plus a margin of 10 mm,while planning target volume (PTVFB) was defined as CTVFB plus a margin of 10 mm in the right-left and anterior-posterior directions and a margin of 20 mm in the superior-inferior direction.GTVEI and GTVEE were defined as GTV on the EIH and EEH images,respectively.Based on the EEH images,the registered EEH and EIH images were fused to form GTVEI+EI.CTVEI+EE was defined as GTVEI+EI plus a margin of 10 mm,while PTVEI+EE was defined as CTVEI+EE plus a margin of 5 mm in the right-left and anterior-posterior directions and a margin of 10 mm in the superior-inferior direction.The Pinnacle3 v8.0m treatment planning system was used to design two 3D conformal radiotherapy plans for each patient.The volume,degree of inclusion (DI),matching index (MI),and central displacement of CTVFB and CTVEI+EE,as well as PTVFB and PTVEI+EE,were compared between the two plans.Results In the 18 patients,the mean CTVFB was significantly smaller than the mean CTVEI+EE(149.00±87.54 cm3 vs.188.17± 125.72 cm3,P=0.014);there was no significant difference between the mean PTVFB and PTVEI+EE (276.68± 146.41 cm3 vs.253.66± 117.35 cm3,P=0.080).DI of CTVFB to CTVEI+EF,PTVFB to PTVEI+EE,CTVEI+EE to CTVFB,and PTVEI+EE to PTVFB were (99.83±0.09)％,(84.55±8.45) ％,(80.83± 12.31) ％,and (99.78±0.08) ％,respectively.MI of CTVEI+EE to CTVFB and PTVEI+EE to PTVFB were 0.83± 0.07 and 0.87± 0.03,respectively.The central displacements of CTVEI+EE from CTVFB in x,y,and z axes were 0.55± 1.07 cm,0.76±3.02 cm,and-0.26± 1.98 cm,respectively (P =0.432,0.971,0.587).Conclusions In the treatment of liver cancer,the target volume delineation and image fusion using 3DCT images in EIH and EEH phases may avoid target omission due to respiratory movement,making it possible to increase radiation dose to target volume and improve the efficacy of radiotherapy.

Objective To discuss the ultrasonographic characteristics of schistosomal appendicitis lesions. Methods Among the patients with schistosomal hepatopathy who were discovered by Color Doppler ultrasound in Huzhou Central Hospital from January 2012 to December 2015,50 cases with clear history of schistosomiasis and treatment were chosen as a schistosom?al hepatopathy group,meanwhile,50 normal people,who came from non?endemic areas,without schistosomal hepatopathy and schistosomiasis history were chosen as a control group. The two groups were examined by ultrasound scan of the appendix ,and the data of the largest diameter of the appendix and the thickness of the appendix wall were collected,and the sonographic char?acteristics of their appendixes,such as whether the echo of the appendix wall was even or not,were observed. Results The minimum internal diameter of the appendix cavity and the thickness of the appendix wall of the schistosomal hepatopathy group were(2.090 ± 0.790)mm and(1.332 ± 0.313)mm ,respectively,the former was significantly narrower than that of the control group,while the latter was significantly thicker than that of the control group(t=2.647,-4.526,respectively,both P<0.05). The proportions of those with inhomogeneous echo,indistinctness structure,uneven thickening of the appendix wall,as well as having intestinal contents in the appendix cavity in the schistosomal hepatopathy group were higher than those in the control group(χ2=12.000,18.537,24.008,4.244,respectively,all P<0.05). Conclusions Schistosomal appendicitis lesions have obvious ultrasonographic characteristics under ultrasound. Ultrasound can play an important role in judging whether the appen?dix of schistosomiasis patients is involved and discovering the lesion of appendix early.

Objective To explore the life quality of postoperative patients after a hypertensive cerebral hem-orrhage in the basal ganglia and the factors influencing it, so as to provide evidence for improving the life quality of such patients. Methods A total of 128 patients were studied retrospectively. Their gender, age, occupation, mari-tal status, education level, place of residence and family size were tabulated, as well as whether or not they were liv-ing with their children, smoking or drinking alcohol. Their household income was recorded along with their clinical condition during surgery ( midline shift, blood loss, operative time, whether a hernia occurred, consciousness, and whether bleeding broke into the ventricles. The SF-36 health measurement scale was used to evaluate the patients′life quality, and the factors influencing it were analyzed. Results Univariate analysis showed that: ( 1) Their physio-logical functioning ( PF) and global health ( GH) were mainly affected by age, marital status, family size, midline shift, quantity of cerebral hemorrhage, occurrence of herniation, consciousness and whether the hemorrhage broke in-to the ventricles. (2) Their physiological role (RP) was influenced by marital status, education background, household monthly income, midline shift, consciousness and whether the hemorrhage broke into the ventricles. (3) Pain (BP) was mainly affected by marital status and family size. (4) Social functioning (SF) was closely related to marital status, family size, consciousness and whether hemorrhage broke into the ventricles. (5) Their mental health (MH) was main-ly affected by the amount of bleeding, whether they were living with their children, the operation′s duration and whether the hemorrhage broke into the ventricles. (6) Their emotions (RE) were influenced by their consciousness and whether bleeding broke into the ventricles. (7) Their vitality (VT) was affected by their marital status, smoking, consciousness and whether the bleeding broke into the ventricles. Multivariate analysis showed that whether the hemorrhage broke into the ventricles was the most influential factor. Family size was also influential. Conclusions Age, number of family members, whether they are living with their children, and whether hemorrhage broke into the ventricles are all influen-tial in predicting the life quality of survivors of hypertensive cerebral hemorrhage in the basal ganglia.

OBJECTIVETo investigate the reconstruction of thumb II-III degree defect by big toe wrap-around flap combined with second toe proximal interphalangeal joint.

METHODSBetween May 2004 to July 2012, 25 cases with thumbs II-III degree defects were treated. The ipsilateral big toe wrap-around flap combined with second toe proximal interphalangeal joint was designed to reconstruct the thumb defects based on the thumb size on the healthy side. The distal end of hallux was covered by flap at tibial side. The wound at the fibula side was covered by skin graft and flap. The bone defect at the second toe was filled with remnant hallux or iliac bone.

RESULTSAll the 25 reconstructed thumbs survived completely. The patients were followed up for 6-26 months without any joint degeneration. According to the finger reconstruction functional criterion publicized by China Medical Association, the finger function was assessed as excellent in 10 case, good in 11 cases, poor in 4 cases. Joint necrosis happened in 2 cases and bone malunion in 2 cases. The 4 cases received dead bone debridement and iliac bone graft. No malfunction occurred in the donor site.

CONCLUSIONSOur surgical method is a currently effective way to reconstruct II-III degree thumb defects. Satisfactory functional and cosmetic results can be achieved both in donor site and recipient site.

Aged ; Bone Transplantation ; methods ; China ; Hallux ; Humans ; Ilium ; transplantation ; Necrosis ; etiology ; Postoperative Complications ; pathology ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; Thumb ; surgery ; Toes

OBJECTIVETo compare the efficacy of laparoscopic versus open tension-free mesh repair using biologic mesh for inguinal strangulated hernia.

METHODSClinical data of 27 patients with inguinal strangulated hernia in the Shanxi Provincial People's Hospital between January 2012 and April 2014 were analyzed retrospectively. All the patients underwent one-stage tension-free repair using biological mesh, including laparoscopic(n=13) and open procedures(n=14).

RESULTSAs compared with the open group, the laparoscopic group had shorter operative time [(90.8±11.6) min vs. (130.8±32.5) min, P<0.01], lower rates of hematoma/seroma and wound infection[(7.7% vs. 42.9%) and (0 vs. 28.6%) respectively, both P<0.05], faster recovery of bowel function [(2.5±0.3) d vs. (3.8±1.4) d, P<0.01], and shorter hospital stay [(6.3±1.8) d vs. (9.8±3.2) d, P<0.01]. The mean follow-up was 5.7 months (ranged from 2 to 12 months), and no recurrence or serious complications occurred.

CONCLUSIONLaparoscopic tension-free hernia repair using biological mesh for inguinal strangulated hernia has significant advantage versus open operation.

OBJECTIVETo investigate the emergency treatment for large amputated ear defect.

METHODSFrom Feb. 2010 to Oct. 2013, 5 cases with large unilateral amputated ear defects were treated. The amputated auricular cartilage was replanted subcutaneously in mastoid area at the first stage. Cranioauricular sulcus was reconstructed and skin grafting was performed at the second stage.

RESULTSAll cases were followed up for 3-6 months with satisfactory result. The reconstructed helix, scapha and cavity of auricular concha had similar color and elasticity as the ear at healthy side. Scar at donor sites, such as inguinal region and armpit, was inconspicuous.

CONCLUSIONSThe method of auricular cartilage replantation is an effective way for emergency treatment of large amputated auricular defect with less morbidity at donor site.

Adolescent ; Adult ; Ear Cartilage ; transplantation ; Ear, External ; injuries ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Replantation ; Treatment Outcome ; Young Adult