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Objective:To explore the demand and mode of palliative care for emergency dying patients by analyzing the case data of emergency death and cardiopulmonary resuscitation.Methods:The data of 776 cases of emergency clinical death and cardiopulmonary resuscitation in the Second Affiliated Hospital of Soochow University from 2017 to 2020 were retrospectively analyzed.Results:A total of 687 patients were included with (70.38 ± 16.57) years old, and 49.8% (342/687) of them were 75 years old and above; among them, 36.0% (247/687) patients or their families chose not to give cardiopulmonary resuscitation (DNR) in the last stage of their lives,and 63.2%(156/247) of DNR patients were 75 years old and above. The top four etiology of DNR were cerebral hemorrhage, respiratory failure, multiple organ dysfunction syndrome and out of hospital cardiac and respiratory arrest.After successful cardiopulmonary resuscitation, 37.5% (45/120) of the patients' family members chose to give up treatment again. The median stay time of DNR patients in the emergency room was 738.7 minutes.Conclusions:The patients who choosed DNR were mainly 75 years old and above, with cerebral hemorrhage, respiratory failure, multiple organ failure and cardiac and respiratory arrest. The detention of these patients in the emergency room increases the congestion of the emergency room, and at the same time, they can not get a peaceful palliative care environment. It is suggested that emergency medical staff should strengthen the awareness and improve the ability of palliative care. A relative independent area and corresponding soothing palliative treatment and nursing should be given to the DNR patients.
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Objective:To analyze the value of maximum standardized uptake value (SUV max) of 18F-fluorodeoxyglucose (FDG) PET/CT in differentiating the malignant solitary pulmonary nodules (SPN) from benign ones. Methods:18F-FDG PET/CT imaging data of 84 patients (39 males, 45 females; age: 34-81(average: 61.1) years) with SPN in the First People′s Hospital of Lianyungang between September 2017 and June 2019 were retrospectively analyzed. The pathological results were taken as the gold standard. Differences of SUV max between benign and malignant SPN were analyzed with Mann-Whitney U test, and the best cut-off value for the diagnosis of benign and malignant SPN was measured by receiver operating characteristic (ROC) curve. The diagnostic efficacy was analyzed based on SUV max. Results:The pathological results confirmed 54 patients with malignant SPN, and 30 patients with benign SPN. SUV max of malignant group was significantly higher than that of benign group (5.48±4.08 vs 1.70(0.73, 3.33); U=443.50, P=0.001). The 84 SPN included 58 solid SPN and 26 subsolid SPN. SUV max of malignant subsolid SPN and benign ones were not significantly different ( U=56.00, P>0.05). The diagnostic value of SUV max in 58 cases of solid nodules were analyzed based on ROC curves, and the optimal cut-off value was 1.85. The corresponding diagnostic sensitivity, specificity, accuracy, negative predictive value and positive predictive value were 97.06%(33/34), 62.50%(15/24), 82.76%(48/58), 15/16, 78.57%(33/42), respectively. Conclusions:18F-FDG uptake of malignant SPN were higher than benign ones. The diagnosis of benign and malignant solid SPNs based on SUV max 1.85 has high sensitivity, negative predictive value and accuracy. SUV max has limited diagnostic value on subsolid SPN.
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Objective To investigate the clinical efficacy of CT-guided 125I seeds implantation combined with gemcitabine + cis-platinum (GP) in the treatment of unresectable non-small cell lung cancer (NSCLC).Methods From January 2013 to January 2017,62 patients with unresectable Ⅱ b-Ⅲb NSCLC were randomly divided into 2 groups.In the study group,32 patients (17 males,15 females,age (62.7± 8.9) years) underwent 125I seeds implantation combined with 4 courses of GP chemotherapy,and 30 patients (18 males,12 females,age (61.9±7.0) years) in the control group underwent concurrent radiotherapy combined with 4 courses of GP chemotherapy.The short-term effects at 3 and 6 months after treatment were compared between 2 groups,as well as the survival time.Log-rank test was used to analyze the data.Results The effective rates at 3 and 6 months after treatment in the study group and control group were statistically significant (90.62％ (29/32) vs 70.00％ (21/30),96.88％ (31/32) vs 66.67％ (20/30);x2 values:3.00 and 7.22,both P＜0.05).The median survival time of the study group and control group were 17 and 15 months (x2 =2.194,P＞0.05).The 1-year survival rates of 2 groups were 87.50％ (28/32) and 76.67％ (23/30),respectively (x2=1.24,P＞0.05),and the 2-year survival rates were 40.62％ (13/32)and 20.00％(6/30),respectively (x2=4.00,P＜0.05).Conclusions 125I seeds implantation combined with GP chemotherapy is a significant treatment for unresectable NSCLC.The short-term efficacy is better than concurrent radiotherapy combined with GP regimen.
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Objective To investigate the value of tracing thyroglobulin(Tg)in predicting metastasis of post-operative patients with differentiated thyroid carcinoma(DTC)before its first pre-ablation with 131I. Methods 106 cases with DTC, undergoing total thyroidectomy and lymphadenectomy, were assigned to 2 groups as M0 group (without metastasis)and M1 group(with metastasis). Clinical data including pre-ablation stimulated thyroglobulin (sTg)and pre-operative Tg were determined. sTg, pre-operative Tg, Tg variation(△Tg), and Tg variation rate (△Tg/pre-operative Tg)between 2 groups were compared. The ROC curve and the diagnostic critical point(DCP) were analyzed. Results sTg, Pre-operative Tg, Tg variation, and Tg variation rate were significantly higher than those of M0(all P<0.01). The corresponding areas under the ROC curve(AUC)to differentiate the two groups were 0.913,0.702,0.773,and 0.943,respectively. The best diagnostic value points(DCP)were 40.60 ng/ml and-72.5%. The sensitivity and specificity were 70. 21%, 100. 00%, and 89. 36%, 88. 13%, respectively. Conclusion The pre-ablation sTg seems to be a useful diagnostic marker for predicting metastasis before the first 131I ablation. The sTg value can be effectively corrected by the Tg variation rate,and the sensitivity and accuracy of sTg for metastasis in DTC patients can be improved,finally providing evidence for pre-ablative assessment as well as strategies of 131I therapy.
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Purpose To explore the value of postoperative stimulated thyroglobulin (ps-Tg) level in predicting functional metastasis in patients with differentiated thyroid carcinoma (DTC) before 131I therapy,in order to guide 131I therapy.Materials and Methods 101 DTC patients who accepted total thyroidectomy and lymphadenectomy in the First People's Hospital of Lianyungang were retrospectively analyzed.The ps-Tg level after DTC surgery was detected 1 day before 131I therapy,and 131I-SPECT/CT scan was performed 5-7 days after 131I therapy.The presence of functional metastasis was confirmed on the basis of 131I-SPECT/CT imaging,and the patients were assigned into non-metastic (M0) group and metastatic (M1) group.The ROC curve was used to evaluate the value of ps-Tg in predicting functional metastasis.Results The ps-Tg level in M 1 group was higher than that in M0 group,and the difference was statistically significant (U=328.00,P＜0.001).The area of ps-Tg value under the ROC curve was 0.870,and the diagnostic cut-off point was 40.60 ng/ml.The sensitivity,specificity and accuracy was 72.34％,100.00％ and 87.13％,respectively.Concltsion The ps-Tg value can be used as an effective indicator to predict functional metastasis,and is able to guide 131I therapy.
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Objective To explore the optimal semi-quantitative uptake ratio for differentiation between benign and malignant lung lesions with 18F-FDG coincidence imaging.Methods One hundred and thirty-seven patients (89 males,48 females,age range:33-78 years) with lung diseases underwent 18 FFDG coincidence imaging.The maximum radioactivity counts of the lung lesions (T),normal chest wall soft tissues (NT1) and the contralateral lung tissue (NT2) were measured.The ratios of R1 (T/NT1) and R2(T/NT2) were calculated.The optimal threshold values of R1(cutoff)and R2(cutoff) were identified by ROC curve analysis.Using the optimal threshold,the sensitivity,specificity and accuracy were calculated.Results The optimal threshold values R1(cutoff)and R2(cutoff) were identified as 3.58 and 4.40.The sensitivity,specificity and accuracy were 90.0％(90/100),89.2％(33/37),89.8％(123/137) according to R1(cutoff) and 90.0％ (90/100),78.4％(29/37),86.9％(119/137) according to R2(cutoff) Conclusion Based on which the chest wall soft tissue is taken as a reference point,the optimal threshold value of T/NT1 is 3.58 in differentiation between benign and malignant lung lesions with 18F-FDG coincidence imaging.