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Objective:To explore the clinical effects of endoscopic sinuvertebral nerves neurotomy for discogenic low back pain.Methods:Based on the anatomical research of sinuvertebral nerves, a total of 40 patients, including 9 males and 21 females aged 35±10 (24-55) years, with single-segment discogenic low back pain were treated with endoscopic sinuvertebral nerves neurotomy in our hospital from July 2018 to February 2019. The operating section included 4 cases of L 3,4 (10.0%, 4/40), 31 cases of L 4, 5 (77.5%, 31/40), and 5 cases of L 5S 1 (12.5%, 5/40). The preoperative visual analogue scale (VAS) score was 4.5±0.9 with the preoperative Oswestry disability index (ODI) score 49.7%±14.0%. For diagnostic nerves block, lidocaine (0.1-0.3 ml of 0.05 g/L) was successfully injected into the intersection of the lateral edge of the bilateral pedicle projection and the upper edge of the intervertebral disc projection. The initial segment of the sinuvertebral nerves was destroyed by a radiofrequency blade or a nerve dissector after bilateral percutaneous transforaminal endoscopic. All cases were followed up at 1, 3, 6 and 12 months after surgery, observing the changes in VAS and ODI. Results:Filamentous lumbar sinuvertebral nerve was observed under endoscope with its main trunk tranversed into the spinal canal against the intervertebral disc. The deputy trunk crossed at the posterolateral edge of the intervertebral disc and entered the intervertebral disc or the posterior edge of the vertebral body. By moving along with postcentral branches of spinal artery, the main trunk of sinuvertebral nerve was with tension and was capable of moving with the nerve root. In spite of moving the working channel along the main trunk of the sinuvertebral nerve laterally, the starting point of the sinuvertebral nerve at the ventral ganglion could be observed. All 40 patients successfully completed the sinuvertebral nerve destruction. The VAS was reduced to 1.7±0.9, 1.3±0.9, 1.2±0.8, 1.3±0.7 at 1, 3, 6 and 12 months after sugery respectively, which were significantly lower than those at pre-operation ( F=116.7, P=0.00). The improvement rate of VAS in 40 cases was 68.9%± 17.1% (33.3%-100.0%) at 12 months after operation. The VAS score in 6 cases was higher at 12 months after surgery than that preoperatively ( t=4.2, P=0.48), namely 1 case of L 3, 4, 2 cases of L 4, 5, and 3 cases of L 5S 1. In all cases, the ODI was reduced to 18.3%±5.2%, 14.5%±4.3%, 13.6%±3.7%, 12.8%±3.0% points at 1, 3, 6 and 12 months after surgery respectively, which were significantly lower than those before surgery ( F=237.7, P=0.00). The improvement rate of ODI was 72.0%±11.6% (33.3%-88.9%) at 12 months after surgery in all cases. Conclusion:The destruction of sinuvertebral nerve after transforaminal endoscope could improve the pain and function in patients with discogenic low back pain at L 3,4 and L 4, 5 segments within 12 months. For patients with discogenic low back pain at L 5S 1 segment, the clinical effects could be better within 6 months.
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Objective: To explore the value of 99Tcm-MDP SPECT/CT in diagnosis of pelvic insufficiency fracture (PIF) of cervical cancer after radiotherapy. Methods Whole body scan (WBS) and 99Tcm-MDP SPECT/CT data of 37 suspected PIF patients with cervical cancer after radiotherapy were retrospectively analyzed. The diagnosis standard of PIF was based on radiologic investigation, clinical information and follow up for at least 12 months. The efficiency in diagnosis of PIF was compared between WBS and SPECT/CT. Results Among 37 patients (50 pelvic lesions ), 42 PIF lesions were diagnosed in 30 patients. The diagnostic sensitivity, specificity and accuracy of WBS diagnosis of PIF were 45.24% (19/42), 50.00% (4/8) and 46.00% (23/50), while of SPECT/CT diagnosis of PIF were 92.86% (39/42), 75.00% (6/8) and 90.00% (45/50), respectively. The diagnostic sensitivity and accuracy of SPECT/CT were significantly higher than those of WBS (χ2=22.28, 22.24, both P<0.01), and no significant difference of specificity was found between WBS and SPECT/CT (P=0.31). Conclusion: 99Tcm-MDP SPECT/CT can be used for diagnosis of PIF.
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Objective@#To analyze the clinical value of SPECT/CT in diagnosis of skull base bone invasion and clinical decision-making for nasopharyngeal carcinoma (NPC), and to compare their diagnostic value with SPECT/CT, CT, MRI, and MRI combined with SPECT (MRI-SPECT) for skull base bone invasion.@*Methods@#Before treatment, among 348 newly diagnosed NPC patients, CT scan was performed in 186 patients (group A) and the remaining 162 patients received MRI scan (group B). Clinical doctors then made clinical management decisions according to the CT or MRI results. After that, all patients underwent 99Tcm-MDP SPECT/CT examination for nasopharyngeal local tomography, and the results were provided to the clinical doctors to make clinical management decisions again. The changes between the two clinical management decisions were scored according to diagnosis, range of lesion, staging, treatment regimens, and auxiliary examination. The diagnostic value of CT scan, MRI scan, SPECT/CT and MRI-SPECT for skull base bone invasion was then evaluated and compared.@*Results@#In terms of changes in scores of clinical management decisions, the score of group A was 1.387 and group B was 0.951, showing a significant difference between the two groups by Wilcoxon test (Z=6.570, P<0.001). By χ2 test, there were correlations between CT and SPECT/CT (χ2 =98.495, P<0.001), and between MRI and SPECT/CT (χ2 =32.662, P<0.001). The consistency of CT and SPECT/CT (Kappa=0.713) was greater than MRI and SPECT (Kappa=0.449). The sensitivity of CT, MRI, SPECT/CT and MRI-SPECT was 67.1%, 84.5%, 90.8% and 100%, the specificity was 73.3%, 92.3%, 85.6% and 84.6%, and the area under the ROC curve was 0.702, 0.884, 0.882 and 0.923, respectively.@*Conclusions@#SPECT/CT has important impact on clinical management decision for NPC. In the judgement of skull base invasion, the diagnostic value of SPECT/CT is significantly higher than CT and approximately equal to MRI. SPECT/CT should be one of the routine examination methods of nasopharyngeal carcinoma. In addition, in view of its greater diagnostic value, MRI combined with SPECT should be the focus of future imaging studies.
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Objective:To investigate the current situation of junior medical students'cognition on the relationship between doctors and patients,and to provide reference for medical students'medical education and medical education reform,Methods:Self-made questionnaire was adopted to investigate the cognitive status of doctor-patient relationship among junior medical students from three medical universities in Guangzhou.Results:Totally 41.04％ of junior medical students had a basic understanding of doctor-patient relationship,and the degree of understanding of doctor-patient relationship is not different between junior and senior medical students (P ＞ 0.05);76.62％ of medical students got acquainted with the status of doctor-patient relationship mainly through the media;86.57％ of junior medical students thought that the doctor-patient relationship was tense.The cognition of doctor-patient relationship between male and female students was similar (P ＞ 0.05),and so wasit between freshmen and sophomores (P ＞ 0.05).Male and female students had the same opinion on the future trend of doctor-patient relationship (P ＞ 0.05).Many junior medical students were optimistic about the future doctor-patient relationship.Compared with freshmen,sophomore medical students were less optimistic about the future doctor-patient relationship (P ＜ 0.05).Medical students mostly agreed on the causes of medical disputes (P ＞ 0.05),believing that the main reason was the medical system.Conclusions:The cognition of the doctor-patient relationship profoundly affects the junior medical students as well as their choices of future employment and communication styles between patients and them,which may have important significance for avoiding medical disputes.Society,schools and the media should actively create a good atmosphere for the doctor-patient relationship.
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Objective To analyze the value of MRI combined with single photon emission computed tomography?CT (SPECT?CT) for the diagnosis of nasopharyngeal carcinoma with early skull base bone invasion and the effect on clinical decision. Methods This retrospective study included 195 pathologically proven nasopharyngeal carcinoma patients with complete clinical and follow?up data, which did not find the signs of skull base bone invasion by CT and be subsequently performed MRI and SPECT?CT. The MRI and SPECT?CT images were respectively analyzed and the positive or negative judgment was made on whether there was skull base bone invasion. Clinical doctors made the routine clinical decision according to MR results, and then made the combined clinical decision based on the results of MR combined with SPECT?CT. The changes between 2 clinical decisions were analyzed. To assess the value of MR, SPECT-CT and combined examination in the diagnosis of skull base bone invasion on the basis of comprehensive clinical results (including symptoms, imaging and follow up, etc) as qualitative criteria. The diagnostic power of MRI, SPECT?CT and combined examination was analyzed by ROC. Results Compared with the routine clinical decisions, combined clinical decisions (44.6%, 87/195) were changed in 87 cases, including 21 cases with new diagnosis of skull base bone invasion, 46 cases with skull base invasion range increased and 87 cases with treatment plan changes. In 195 cases, 114 cases were confirmed to have the skull base bone invasion by comprehensive clinical results. When MRI was positive and SPECT?CT positive, MRI negative and SPECT?CT negative, MRI positive and SPECT?CT negative, MRI negative and SPECT?CT positive, the presence of skull base bone invasion respectively were 100.0%(74/74), 0 (58/58), 66.7%(16/24), 61.5%(24/39). MRI and (or) SPECT?CT positive was regarded as positive, it was used as the criterion of combined examination. For skull base bone invasion, MRI, SPECT?CT and combined examination had the sensitivities of 78.95%(90/114), 85.96%(98/114), and 100.00%(114/114), the specificities of 90.12%(73/81), 81.48% (66/81), 71.60% (58/81) , the area under the ROC curve of 0.845, 0.837, 0.858; and the misdiagnosis rate of 16.41%, (32/195), 15.90% (31/195), 11.79% (23/195). Conclusion MRI combined with SPECT?CT can improve the accuracy of diagnosing skull base bone invasion and effectively affect the clinical decision of nasopharyngeal carcinoma.