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@#<b>Objective</b> To evaluate the effect of chest low-dose spiral computed tomography (LDCT) scan for lung cancer screening among asymptomatic adults. <b>Methods</b> Asymptomatic adults at the age of 18 years and older receiving LDCT scans for lung cancer screening in Shanghai Pudong New Area People’s Hospital from January 2019 to December 2021 were recruited, and those with positive pulmonary nodules underwent percutaneous needle biopsy or bronchoscopic biopsy for pathological examination of pulmonary nodules. The effect of LDCT scan for lung cancer screening was compared between never-smokers and ever-smokers. <b>Results</b> A total of 9359 eligible individuals meeting inclusion and exclusion criteria were enrolled, including 4492 never-smokers and 4867 ever-smokers, and the overall detection rate of positive pulmonary nodules was 16.2%. There were significant differences between never-smokers and ever-smokers in terms of age at the first LDCT screening, gender composition, body mass index, and cumulative follow-up period (<i>P</i> < 0.05), and no significant differences were seen in terms of types of pulmonary nodules at the first LDCT screening and proportion of subjects with positive pulmonary nodules (<i>P</i> > 0.05). There were no significant differences between never-smokers and ever-smokers with positive pulmonary nodules in terms of proportion of subjects with positive pulmonary nodules at the first LDCT screening, proportion of subjects with positive pulmonary nodules during the follow-up, types of pulmonary nodules at the first LDCT screening, proportion of subjects with multiple pulmonary nodules, and mean size of pulmonary nodules at the first LDCT screening (<i>P</i> > 0.05); however, there was a significant difference in the nature of pulmonary nodules (<i>χ</i><sup>2</sup> = 47.23, <i>P</i> < 0.01). In addition, the incidence rate of lung cancer was significantly lower among never-smokers with positive pulmonary nodules than among ever-smokers with positive pulmonary nodules (<i>χ</i><sup>2</sup>=6.42, <i>P</i> < 0.01). <b>Conclusion</b> Chest LDCT scan may significantly improve the detection rate of pulmonary nodules among never-smokers. Although the detection rate of lung cancer is significantly lower among never-smokers with positive pulmonary nodules than among ever-smokers with positive pulmonary nodules, there is no significant difference between never-smokers and ever-smokers in the false-positive rate of lung cancer screening with chest LDCT scan. Chest LDCT scan is recommended for lung cancer screening among asymptomatic adults.
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Objective To investigate the MRI findings of duodenal papillary adenocarcinoma(DPA),and to evaluate the importance of diffusion-weighted imaging(DWI)in diagnosis of DPA.Methods A complete data of 52 patients with DPA were prospectively collected.All patients underwent surgery within 72 hours after conventional MRI,DWI and MRCP scans.Before surgery,four different MRI findings were used to calculate the sensitivity,specificity and the probability of correctness.Two experienced radiologists who were blind to the pathologic diagnosis handled the MRI findings.Thirty eight patients were pathologically diagnosed for DPA.Based on the pathological diagnosis,the detection rate of DPA by the MR sequence was recorded and the chi square test was used to do the statistical analysis. Results The accuracy rate in diagnosis of DPA with MRI was 78.8% in our study.The findings of DPA consist of thickening wall of duodenal,duodenal papilla node imaging,DWI showing high signal of duodenal papilla and"beak"sign of dilated bile duct.Corresponding sensitivities were 70.5%,66.7%,86.3% and 87.9%,and specificities were 75.0%,30.0%,50.0% and 63.1% respectively.The incidences of positive on T2WI and T1WI,MRCP,DWI scans were 60.5%,76.3% and 92.1% respectively.The detection rate of each sequence has significant difference(χ2=10.48,P<0.005).Conclusion The MRI manifestations of DPA consist of thickening wall of duodenal,duodenal papilla node imaging,DWI showing high signal of duodenal papilla and"beak"sign of dilated bile duct.The detection rate of DWI sepuence on DPA lesions is significantly higher than that of other sequences.
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Objective To investigate the value of magnetic resonance imaging (MRI)-based intravenous thrombolysis in patients with wake-up ischemic strokes (WUIS).Methods Patients presenting within 12 hours of acute stroke symptom onset and those with WUIS confirmed by CT,excluding intracranial hemorrhage,were encouraged to perform an emergent brain MRI scan to confirm the diagnosis of hyperacute ischemic stroke (hyper-intense in DWI without hyper-intense change in T2WI or fluid attenuated inversion recovery (FLAIR)).These patients then received intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA).All patients were divided into either stroke presenting within 12 hours or WUIS.The clinical outcomes were assessed by the modified Rankin scale (mRS) and the Barthal index (BI) at baseline and at 90 days after the thrombolysis therapy.Results Two hundred and sixty-one patients (261/563,56.4％) had confirmed diagnosis of hyperacute ischemic stroke (WUIS,n =73,73/121 =60.3％ vs within 12 hours,n =188,188/342 =55.0％).Altogether,192 patients (139 in within 12 hours group,and 53 in WUIS group) received intravenous thrombolytic therapy with rt-PA.No significant differences were found between the 2 groups at the baseline characteristics and at 90 days outcomes after the thrombolysis therapy(x2 =1.296 and 1.473,P =0.538 and 0.489,respectively).Also no significant differences were found in the incidence rate of secondary hemorrhage (including both of asymptomatic and symptomatic) and mortality rate between the 2 groups.Conclusion MRI-based intravenous thrombolysis is safe and effective in the treatment of patients with hyperacute WUIS.
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Gallstone ileus is a rare and potentially serious complication of cholelithiasis.Its clinical symptoms are nonspecific.From March 2005 to September 2012,19 patients with gallstone ileus confirmed by surgery or endoscopy were admitted to the Pudong New Area People's Hospital.The accuracies of X-ray,uhrasonography,CT and magnetic resonance imaging (MRI) were 0/10,0/5,19/19 and 9/9,respectively.CT examination might be the first choice for diagnosing gallstone ileus ; the classical computed tomography (CT) presentation of gallstone ileus was the Rigler triad,including pneumobilia,ectopic stone and mechanical ileus; MRI examination was superior to CT examination in exposing the fistula,and can provide abundant information,which is important for designing the surgical procedures and judging the prognosis; X-ray and ultrasonography are beneficial in screening the diseases.
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Training anesthesiology postgraduates should be started with clinical skill and scien-tific thinking. This article advocated setting up a multi-level and multi-mode training strategy based on theoretical study ,clinical skill training and scientific ability development according to the features of anesthesiology. Meanwhile,the training should have focus and orientation for postgraduates at different grades. This study solved the problems of training for postgraduates of anesthesiology and made a feasible training strategy to develop the clinical and scientific ability of postgraduates.
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The good cooperation between the operating room nurses and anesthesiologists is benefitial to improving working efficiency and can make the patients uneventful during operating period.As an anesthesiologist,the author taught the basic anesthesia knowledge such as the commonly used anesthesia methods,the prevention and treatment of complications and gave advice to the nurses of the nursing trainning group.The cooperations before anesthesia,during anesthesia,after anesthesia were analyzed and the significance of nursing cooperation with anesthesiologist was discussed.
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Objective To discuss the imaging diagnostic features of adrenal injury. Methods The imaging features of the 29 patients of adrenal bruise and hernatoma (20 male and 9 females, average age 37) were retrospectively analyzed. The clinical appearances were all flank and hack pain, local sensitive to percus-sion and associated injury appearance. Among the 29 cases, 25 cases(86%) had adrenal injuries on right side, 2 cases(7%) on left side, and 2 cases(7%) on both sides, and no apparent abnormality was found in the relevant endocrine examination after injury. CT (n=29), MRI (n=5) and ultrasonography (n=6) were checked. CT follow-up were taken in 23 eases. MRI (n=1) and ultrasonography (n=l) were followed as well. Results The first-time exam coincidences of CT, MRI and sonography were 28/29 (97%), 5/5 (100%) and 3/6 (50%) respectively. One case of simple right-side adrenal hematoma 3 weeks after injury wasn't clearly diagnosed by CT, which was later diagnosed by MRI. The CT features of adrenal bruise were local or diffuse intumescence and focus high-density hemorrhage shadow. The CT appearances of acute stage adrenal hematoma were round-like high-density shadow without enhancement and the diameters were 1-3 cm. MRI appearances of 5 cases of subacute and chronic phase hematoma were typical high signal of T1WI, T2WI and DWI and toroid low signal around T2WI. Hematorna was not be enhanced when CT or MRI en-hancement scanning, and formed characteristic "nut-like" image feature with toroid high-density or high sig-nal enhanced shadow forming around. Uhrasonography appearances of 3 cases of hematoma were abnormal shadow of the adrenal gland. Conclusions CT is the prior imaging method for adrenal bruise and hemato-ma. MRI has the characteristic appearance for the few cases which are difficult to be identified by CT and ul-trasonography. Characteristic "nut-like" image feature is helpful for the diagnosis and differential diagnosis.
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Objective To investigate the value of MRI in thmmbolytic thempy of hyperacute cerebral arterial thrombosis.Methods One hundred and sixteen patients with acute cerebral arterial thrombosis were recruited.plain CT and multi.modal MRI were performed in all patients.Thirty-three patients with hyperacute cerebral infarction were treated bv recombinant tissue plasminogen activator(rt-PA) and followed-up periodically using MRI.Results The 33 patients with thrombolysis selected by MRI demonstrated clinical improvement.90 d moclified Rankin scale scores(mRs)were less than 2 and life quality Barthal indexes(BI)were from 80 to 100.The complication included one asymptomatic parenchymal hematoma(PH1)one weeks after thrombolytic therapy and 4(12.2%)hemorrhagic infarction(HI)6 to 24 hours after thrombolytic therapy.Condusions MRI has significant clinical value for the screening and follow-up of intravenous thrombolytic therapy of hyperacute ischemic stroke.MRI-based thrombolysis is a safe and effective method for hyperacute ischemic stroke.