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Ultrasonography plays an important role in liver surgery of colorectal cancer liver metastases. Recently, besides grey and doppler ultrasonography, contrast-enhanced ultrasonography, elastography and infusion-image technique has developed and attracted increasing interest. Intraoperative ultrasonography is applied for tumor detection, localization and characterization. It is also used for liver resection and planning surgical strategy, which may improve surgical effect and safety. This article discussed the application of intraoperative ultrasonography in liver resection of colorectal cancer liver metastases.
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Objective To evaluate the factors influencing the diagnostic positivity of endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) for small size pancreatic carcinoma (SSPC) and the occurrence of the adverse events after the aspiration.Methods 51 patients with SSPC ≤2 cm in diameter treated in Changhai hospital from February 2008 to January 2015 were retrospectively studied.The gender,age,tumor diameter,location,the dilation of pancreatic ducts,the number of aspirations and the needle passages,the usage of negative pressure during aspiration,the pathological examination of the specimens and postoperative adverse events and the like were collected.Univariate analysis and logistic regression analyze were applied to determine the factors influencing the diagnostic positivity of EUS-FNA for SSPC and postoperative adverse events.Results Among the 51 patients,positive cytology outcome were identified in 30 patients,which were negative in 21 patients.Univariate analysis identified that there were no statistical differences on the age,sex,dilated pancreatic duct,the number of aspirations and needle passages between two groups (P value ＞0.05).The diagnostic positivity using the 10ml minor negative pressure was obviously higher than that using 20 ml negative pressure,and the differences were statistically significant (P =0.028).Multivariate logistic regression identified 10ml minor negative pressure was easier to obtain positive cytology outcome (Odds Ratio 0.2810,95％ CI 0.093-0.851).In addition,the number of passages in patients with postoperative adverse events was greater than those without postoperative adverse events (30 vs 20),and the difference was statistically significant (P =0.034).Conclusions The introduction of 10 ml negative pressure could improve the diagnostic positivity of EUS-FNA for SSPC,and the increased number of needle passages may increase the occurrence rate of postoperative adverse events.
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Objective To assess the value of carcinoembryonic antigen (CEA) level,liquid based cytology examination and combining 2 methods in predicting advanced pancreatic cystic neoplasms (PCNs).Methods The clinical data of 78 patients pathologically confirmed with PCN who underwent surgical resection after EUS-FNA and cyst fluid analysis in Shanghai Changhai Hospital,from January 2006 to June 2017 were collected and analyzed,including 32 (A-PCNs) patients and 46 non A-PCNs patients.The comparisons on the CEA level in the cyst fluid and liquid based cytology between the two groups were performed.ROC curve for CEA level in cyst fluid was applied and under curve area was calculated.Sensitive,specificity and accuracy were applied to assess the diagnosis value of 2 methods in predicting A-PCNs.Results In 35 patients,the difference on cyst fluid CEA level was statistically significant between 9 A-PCNs and 26 non A PCNs patients) [(1419.9 ± 1416.9) μg/L vs (316.0 ± 475.2) μg/L,P =0.049].Based on ROC curve,CEA ＞ 418.9 ng/ml could help to predicting A-PCNs with the sensitivity of 85.7％,specificity of 73.1％,and accuracy of 75.8％ as the cutoff value,and the area under ROC curve was 0.863.Liquid based cytology were performed in 27 A-PCNs patients and 33 non A PCNs patients,and the positive rate had statistical difference between 2 groups (48.1 vs 9.1％,P =0.001).The sensitivity,specificity and diagnostic accuracy for liquid-based cytology for diagnosing A-PCNs were 48.1％,90.9％,and 55.1％.Cyst fluid CEA combined with liquid based cytology can effectively diagnose A-PCN,and the sensitivity,specificity,and diagnostic accuracy were 100％,64.7％ and 76.0％.Conclusions Liquid-based cytology and cyst fluid CEA level were useful in predicting A-PCNs to a certain degree.Combining 2 methods could improve the sensitivity and accuracy in predicting A-PCNs.
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Conventional imaging examinations including transabdominal ultrasound,computerized tomography,and magnetic resonance ima-ging which have certain limitations in diagnosis of pancreaticobiliary diseases. Endoscopic techniques can scan gallbladder,bile duct and pancreas with high resolution images from which obtained close to digest track. Therefore,they play an important role in diagnosis of pancre-aticobiliary diseases. The rapid development of new techniques including endoscopic retrograde cholangiopancreatography,endoscopic ultra-sound,intraductal ultrasound,and SpyGlass Direct Visualization System help improving the diagnosis accuracy of pancreaticobiliary disea-ses. The article reviews the application of new endoscopic techniques in pancreaticobiliary diseases.
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Objective To evaluate technical feasibility, safety and efficacy of endoscopic ultrasound-guided ethanol ablation (EUS-EA) for pancreatic cystic neoplasms (PCNs). Methods Clinical data of 10 patients with PCNs in Changhai Hospital from July 2013 to April 2017, including demographic information, EUS features, adverse events and follow-up data, were retrospectively studied. Efficacy was assessed according to imaging data.Results The mean largest diameter of the cyst was 2. 95±1. 56 cm.Cyst fluid analysis showed that there were 6 serous cystic neoplasms, 3 mucinous cystic neoplasms, and 1 indeterminate cyst. Totally 12 operations were performed successfully. No infection, pancreatitis, bleeding, pancreatic fistula or other severe complications with clinical significance occurred. The median follow-up time was 4. 0 months ( 3. 0-12. 0 months ). Three patients achieved complete resolution, 6 achieved partial resolution, 1 was stable disease, and no patient showed progressive tumor. Conclusion EUS-EA for PCNs has high operation success rate, less complication and satisfactory overall efficacy.
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Objective:The aim of this paper is to analyze and evaluate the equity and utilization efficiency of public health resource allocation in 31 provinces and cities in China, and provides reference and basis for public health resource allocation planning. Methods:The allocation of public health resources was evaluated by cluster anal-ysis and used data envelopment analysis was to explore the efficiency of public health resource allocation. Results:The degree of aggregation of public health resources in densely populated and economically developed provinces and cities were greater than or close to 1 , and the difference with the population concentration was mostly less than 0 . The degrees of aggregation in less economically backward provinces were less than 1 , and the difference with the popula-tion concentration was mostly more than 0 . The average technical efficiency of public health resource allocation was 0. 44, and the mean of pure technical efficiency and scale efficiency were 0. 74 and 0. 64 respectively. Conclusion:The degrees of aggregation of public health resources in economically developed provinces and cities are higher, but the corresponding population is poorly distributed based on population distribution. For economically backward prov-inces and cities, the geographical availability of public health resources is poor. In addition, due to unreasonable re-source allocation structure and proportion, public health resources configuration efficiency is relatively low.
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Objective To explore the influencing factors for usage of the official App of a hospital, based on Unified Theory of Acceptance and Use of Technology (UTAUT).Methods 616 outpatients were randomly sampled from outpatient clinics of three tertiary hospitals in Hangzhou for questionnaire survey, to learn the usage and intention for hospital′s official App.Results It was found that women (0.134), high performance expectancy (0.321), facilitating conditions (0.256), high effort expectancy (0.224), and desirable social influence (0.100) all contributed positive influence (P<0.05) to usage of such App.Conclusions It is recommended to enhance service functions of such App and simplify its usage, in addition to better promotion and online security measures.
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Objective To compare the efficacy and safety of different drugs in the treatment of patients with endometriosis by laparoscopic conservatism operation.Methods 165 patients with endometriosis met the inclusion were included as research subjects.All patients were treated with laparoscopic conservatism operation,then were divided intoⅠgroup (goserelin),Ⅱ group (mifepristone),Ⅲ group (gestrinone)according to different postoperative medica-tion,55 cases in each group.The clinical efficacy and safety were observed.Results The E2 ,CA125,EMAb,dys-menorrhea VAS scores of Ⅰ group after treatment were (136.7 ±3.8)pmol/L,(18.0 ±2.8)u/mL,(200.8 ± 52.1)pg/mL,(1.91 ±0.35)points,those of Ⅱ group were (155.0 ±3.5)pmol/L,(29.4 ±3.3)u/mL,(265.1 ± 49.8)pg/mL,(1.98 ±0.44)points,those of Ⅲ group were (158.0 ±3.2)pmol/L,(31.1 ±3.5)u/mL,(278.2 ± 45.6)pg/mL,(1.95 ±0.45)points,those in three groups after treatment were significantly lower than before treat-ment(tⅠgroup =10.257,9.029,13.311,7.802,tⅡgroup =8.441,7.083,10.54,6.703,tⅢgroup =7.702,6.448,8.671, 6.784,all P <0.01).There were significant differences between the three groups in E2 ,CA125,EMAb(F =11.375, 8.002,7.671,all P <0.01).The E2 ,CA125,EMAb ofⅠgroup after treatment were significantly lower than Ⅱ,Ⅲgroup(tⅠgroup -ⅡgrouP =3.562,5.017,3.631,tⅠgroup -Ⅲ group =3.268,4.573,4.023,all P <0.05).The total effective rate of I group was 90.91%,which was significantly higher than Ⅱgroup,Ⅲ group(χ2 =10.456,P <0.05).The 1 -year pregnancy rate of I group was 50.91%,which was significantly higher than Ⅱgroup,Ⅲ group(χ2 =7.700,P <0.05).The incidence rate of adverse reactions of I group was 18.18%,which of Ⅱ group was 3.64%,which of Ⅲgroup was 29.09%(χ2 =12.732,P <0.01).Conclusion The goserelin has exact effect in the treatment of patients with endometriosis by laparoscopic conservatism operation,and has better treatment compliance,lower relapse rate and incidence of adverse reactions,higher pregnancy success rate,but the mifepristone has better economy and safety,the patients should be selected according to specific circumstances.