ABSTRACT
Objective:Taking the research field of pulmonary infection as an example, this study analyzed the core author institutions, research hotspots and burst keywords, and explored the application value of scientific knowledge graph in the first step of scientific research management-optimization of scientific research project selection.Methods:" Pulmonary infection" or " pneumonia" were used as key words in CNKI data base from 2014 to 2020, and medical science was selected as the discipline. Cite Space was used to generate the visual graph to analyze publishing institutions, keyword co-occurrence, topic clustering, and timeline burst keywords.Results:13 169 documents were retrieved, and 4 of the top 5 institutions were in Henan Province. In 2020, " Novel Coronavirus" and " Novel Coronavirus pneumonia" were the new hotspot words. " Chronic obstructive pulmonary disease " , " blood gas index" , " inflammatory factor" , and " vitamin A" were the burst keywords in 2018.Conclusions:Scientific knowledge graph is objective, scientific, and efficient in the development of science. It has certain feasibility in the optimization of project selection in scientific research work, and can also be used as a reference basis for experts to evaluate the project reasonability, so as to ensure objectivity and equity. This study also provides reference for scientific research management strategy, reduces research funding costs, and improves the efficiency and capacity of scientific research management.
ABSTRACT
Hashimoto’s thyroiditis (HT) is one of the most common autoimmune diseases, and often combined with papillary thyroid carcinoma (PTC) .Thyroglobulin antibody and thyroid peroxidase antibody are used as HT marker antibodies and effective indicators for diagnosis. By activating the corresponding immune response, chronic inflammation of the thyroid gland is caused, which is related to the development of tumors. In this review, we analyze the significance of Tg and TgAb in diagnosis and treatment of HT-PTC to provide evidence for future clinical studies.
ABSTRACT
Dyslipidemia is an important risk factor of atherosclerotic cardiovascular disease (ASCVD). Statins delay the occurrence and development of ASCVD, and reduce the risk of cardiovascular events and death. Due to safety concerns, there exist insufficient use of lipid-lowering agents and a high withdrawal rate of the agents in the elderly. To promote the prevention and treatment of ASCVD, this expert consensus is issued and focuses on the management of dyslipidemia of Chinese elderly basing on the clinical evidence of the use of lipid-lowering drugs by the elderly, and the lipid management guidelines and expert consensus recommendations at home and abroad.
ABSTRACT
BRAF V600E mutation is a common gene mutation in papillary thyroid carcinoma (PTC) , which is associated with the occurrence, development, and prognosis of PTC. TERT promoter mutations are rare in PTC, but PTC with its mutations is more aggressive and has a worse prognosis. Clinically, a small number of PTC patients have both BRAF V600E mutation and TERT promoter mutations. This article provides a brief overview of the co-mutation of BRAF V600E and TERT promoter and the occurrence and development, clinical diagnosis, surgical strategies, postoperative adjuvant treatment, and prognosis of PTC.
ABSTRACT
Fetal omphalocele is a surgical disease with severe defect of fetal abdominal wall which requires emergency treatment after birth. The incidence rate is 2.1/10000, and the mortality rate is 52% to 67%. The improper handling of omphalocele can cause capsular rupture and intestinal exposure, leading to neonatal fluid loss, hypothermia, intestinal necrosis and other complications. It is the major cause of death in newborns. In this paper, we reviewed the characteristics, delivery mode, delivery time, umbilical cord care, and transferring of omphalocele newborns to provide reference for clinical nursing.
ABSTRACT
Objective:To discuss strategies in treatment of poorly differentiated thyroid carcinoma (PDTC) .Methods:Clinical data of 31 cases with PDTC were reviewed retrospectively, who were treated in Department of Head & Neck Surgery, Sichuan Cancer Hospital & Institute by primary surgical resection with or without adjuvant therapy. 27 cases had total thyroidectomy compounded neck dissection or extened total thyroidectomy when trachea or esophagus involved. 4 cases underwent partial resection of tumor. 11 cases were treated with external beam radiotherapy (EBRT) after surgery, 10 cases were treated with postoperative radioiodine, and 8 cases had chemotherapy.Results:The median follow-up time was 18 months (ranged from 3-96 months) . 19 patients died of local recurrence or distant metastasis. Kaplan-Meier analysis and Log-rank analysis was used to compare the differences between groups. Five-year survival was 35.9%. Compared to the cases with partial resection, the cases with surgical disease clearance had longer survival ( P=0.00) . The same statistical difference was found between patients with or without radioiodine ( P=0.017) . The patients treated with radioiodine had longer survival. No statistical differences were found among patients with or without chemotherapy or EBRT. COX regression analysis showed stage of tumor ( P=0.005) , total resection ( P=0.006) and postoperative radioiodine ( P=0.013) were same to predict longer survival. Conclusions:Thorough resection of tumor is the most important therapy for PDTC. Postoperative radioiodine is recommended for patients with high recurrence risk. EBRT is recommended to control local unresectable PDTC.
ABSTRACT
Objective:To observe the effect of radiofrequency thermocoagulation (RFTC) combined with pulsed radiofrequency (PRF) therapy on lumbar disc herniation (LDH) and the impacts on serum interleukin-8 (IL-8), CXC chemokine ligand 10 (CXCL10).Methods:From July 2014 to May 2017, 60 patients with LDH were randomly divided into two groups according to the random digital table method, with 30 patients in each group.The combination group was given RFTC combined with PRF therapy, while the PRF group was given single foraminal nerve PRF therapy.The visual analogue scale (VAS), the curative effect score of Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) were assessed in the two groups before treatment, 7 days after treatment and 3 months after treatment.The serum levels of IL-8, CXCL10 were determined simultaneously.Results:After treatment, the VAS score and ODI in the two groups were decreased(VAS score: t=12.14, 27.85, all P<0.05; ODI: PRF group t=4.932, 7.414, all P<0.05; combination group t=4.235, 9.706, all P<0.05), and the JOA scores increased(PRF group: t=5.329, 7.576, all P<0.05; combination group: t=5.980, 9.526, all P<0.05). There were statistically significant differences in VAS score, JOA score and ODI between the two groups at 3 months after treatment( t=7.329, 5.719, 2.255, all P<0.05), which of the combination group after treatmentwere superior to the PRF group (all P<0.05). The serum levels of IL-8 in the two groups after treatment were decreased (PRF group: t=3.621, 4.631, all P<0.05; combination group: t=3.393, 5.370, all P<0.05), and the CXCL10 levels in the two groups after treatment were increased(PRF group: t=2.251, 3.559, all P<0.05; combination group: t=3.393, 5.370, all P<0.05). There were statistically significant differences in IL-8, CXCL10 levels between the two groups at 3 months after treatment, and the regulation of IL-8 and CXCL10 levels in the combination group was significantly better than those in the PRF group ( t=20258, 2.237, all P<0.05). Conclusion:RFTC combined with PRF is effective in the treatment of LDH, which can significantly relieve the clinical symptoms, reduce the inflammatory response and has a lasting efficacy.
ABSTRACT
Autism spectrum disorder (ASD) are kind of developmental behavior disorders with the core symptoms of social communication disorders, stereotyped behavior and narrow interest.Genetic factors play an important role in the incidence of ASD.Ion channels are a pore-forming protein on biofilm.They allow certain types of ions to pass through, and help to establish the voltage difference between cytoplasmic membranes, acting as the basis of neuroelectrophysiology.Ion channel abnormalities are related to many diseases, including ASD.In this paper, several kinds of genes related to ASDs in ion channels were reviewed, and in order to provide new ideas in the pathogenesis.
ABSTRACT
Objective:To investigate the clinical characteristics of patients complicated with Hashimoto’s thyroiditis (HT) and papillary thyroid micro-carcinoma (PTMC) and risk factors for central lymph node metastasis (CLNM) by analyzing the clinical data.Methods:Clinical data of 770 patients with PTMC admitted to Head and Neck Surgery Center of Sichuan Cancer Hospital from May. 2015 to Nov. 2017 were retrospectively analyzed, including 250 HT-PTMC patients (observation group) and 520 non-HT-PTMC patients (control group) . There were 197 males and 573 females, with a male to female ratio of 1.00:2.91. Into observation indexes included patient’s age, gender, serum thyroid stimulating hormone (TSH) , thyroglobulin antibody (TG-Ab) , thyroid peroxidase antibody (TPO-Ab) , number of foci, diameter of foci, calcification of foci, location of foci (with or without extra-glandular invasion) , number of nodules (no matter benign or malignant) , and lymph node metastasis in central and lateral cervical regions. SPSS 22.0 software was used for statistical analysis. Normally distributed data were expressed ± s. The difference between observation group and control group was compared by chi-square test of single factor analysis. The risk factors of CLNM of the observation group were analyzed with multivariate Logistic regression, the difference was statistically significant if P<0.05. Results:There were statistically significant differences between the observation group and the control group in age ( P=0.006) , gender ( P<0.001) , TSH ( P<0.001) , TG-Ab ( P<0.001) , TPO-Ab ( P<0.001) , number of nodules ( P=0.016) , and central lymph node ( P<0.001) . Compared with non-HT-PTMC group, HT-PTMC group had a higher proportion of women under 55 years old, and both TG-Ab and TPO-Ab had higher positive rates. Patients with HT-PTMC were more likely to show polynodule changes, but their central lymph node metastasis rate was lower than that of the non-HT-PTMC group. Single-factor analysis showed that the number of cancer foci, calcification of cancer foci, and location of cancer foci were significantly correlated with the CLNM of HT-PTMC patients (all P<0.001) . Multivariate Logistic regression analysis showed that multiple cancer foci ( P<0.001) , invasion and capsule ( P<0.001) , and cancer foci with calcification ( P=0.005) were independent risk factors for CLNM. Conclusions:HT-PTMC is more common in women under 55 years of age, and most of them show multiple nodules in bilateral glandular lobes, often accompanied by elevated serum TSH, TG-Ab and TPO-Ab levels. Meanwhile, the lymph node metastasis rate of HT-PTMC is relatively low, and the prognosis may be relatively good. In HT-PTMC, the risk of multiple carcinoma foci, cancer foci with calcification, cancer foci invasion and the occurrence of CLNM is higher. Preventive central lymph node dissection helps to reduce the occurrence of postoperative cervical lymph node recurrence.
ABSTRACT
In the past 10 years, digital surgery has been widely used in all aspects of clinical medicine, which has promoted the development of surgical operation to individuation and precision. By analyzing the traditional image data and transforming it into real-time images, surgeons can intuitively discover the scope of the lesion and the anatomical relationship between the lesion and the surrounding tissue through 3D visualization. 3D visualization technology plays an important role in predicting the resectability of tumor, surgical planning, surgical approach and so on. The operation of refractory thyroid tumors involves important blood vessels, trachea, esophagus and other important organs of neck and mediastinum. Adequate preoperative assessment of surgical risk and scope is necessary. This paper reviews the application of digital surgical technique in refractory thyroid tumor surgery, and analyzes the advantages of digital surgical technique used in refractory thyroid surgery.
ABSTRACT
Objective:To investigate the expression and its clinical significance of cydooxygenase-2(COX-2)and tumor necrosis factor-alpha(TNF-α)in mucosal tissues in elderly ulcerative colitis(UC)patients with arthritis.Methods:A total of 164 active(observation group)and 50 non-active(control group)UC patients with arthritis were admitted in our hospital from April 2016 to March 2019.Diagnostic criteria of UC and its severity were based on Consensus on the Norms for Diagnosis and Treatment of Inflammatory Bowel Disease in China(2007). The expressions of COX-2 and TNF-alpha in mucosal tissues were detected and compared between the two groups.Patients in the observation group were re-grouped according to the severity of ulcer lesion and Kellgren-Lawrence(K-L)score of arthritis.Based on severity of ulcer lesion and Kellgren-Lawrence(K-L)score of arthritis, the patients in observation group were re-grouped intoⅠ, Ⅱ, Ⅲ, Ⅳ subgroups, among those subgroups the expressions of COX-2 and TNF-alpha in mucosal tissues were compared.Results:The expressions of COX-2 and TNF-alpha in mucosal tissue were higher in the observation group than in the control group( P<0.05), and were increased along with the increased severity of UC and the K-L grade of arthritis( P<0.05). The differences in above expressions had statistical significance among patients with different severity of ulcer and different K-L grade of arthritis.The expressions of COX-2 and TNF-alpha in mucosal tissues were positively correlated with the severity of ulcer( r=0.491 and 0.627, P<0.05 or 0.01)and K-L grade of arthritis( r=0.438 and 0.597, P<0.05 or 0.01). Conclusions:The expressions of COX-2 and TNF-alpha in mucosal tissues are positively correlated with the severity of ulcer and K-L grade of arthritis in elderly UC patients with arthritis.The detection of COX-2 and TNF-alpha levels is helpful to evaluate the disease severity.
ABSTRACT
Objective:To investigate the effect of Masquelet technique combined with platelet-rich plasma (PRP) on repair of massive tibial defects.Methods:A prospective randomized controlled single blind trial was conducted in the 21 patients who had been admitted to Department of Repair and Reconstruction Surgery, Foshan Hospital of Chinese Medicine for massive tibial defects from June 2016 to June 2018.The length of bone defects ranged from 6.0 to 22.5 cm (mean, 10.8 cm)in length.They were 14 males and 7 females, aged from 29 to 60 years(mean, 42.1 years).The patients were divided into 2 groups by an en-crypting envelope with a random digital table.In the experimental group of 11 cases, the bone defects were repaired with Masquelet technique combined with PRP; in the control group of 10 cases, the bone defects were reconstructed with only Masquelet technique.The 2 groups were compared in terms of operation time, hospital stay, wound healing, weight-bearing time, bony union time, clinical union time, complications and John-er-Wruhs scores at the second stage.Results:The 2 groups were comparable due to insignificant differ-ences between them in the preoperative general data ( P>0.05).All patients were followed up for 12 to 24 months (mean, 14.9 months).There were no significant differences in operation time, hospital stay, wound healing, weight-bearing time, Johner-Wruhs scores or rate of complications at the second stage between the 2 groups ( P>0.05).The bony union time (4.5 months ± 1.2 months) and clinical union time (4.1 months ± 0.9 months) in the experimental group were significantly shorter than those (5.7 months ± 1.5 months and 5.4 months ± 1.1 months) in the control group ( P<0.05).No such postoperative complications as infection, loosening of internal fixator, bone resorption or nonunion were found in the experimental group.One case of wound infection occurred in the control group but responded to dressing change. Conclusion:Masquelet technique combined with PRP is a safe and effective reparative treatment for massive tibial defects and can speed up bone healing.
ABSTRACT
Objective:To explore the patterns and causes of occupational exposure to infectious diseases (OEID) among frontline medical staffs (FMS) in coronavirus disease 2019 (COVID-19) isolation wards (CIW), and the particularity of post-OEID management and the measures to prevent OEID.Methods:A total of 1 061 FMS of Wuhan Huoshenshan Hospital from February 4 to March 21, 2020 were enrolled. The OEID of FMS was investigated and analyzed from the perspectives of FMS physical and psychological conditions, protective equipment, infection-control related regulations and procedures, local air quality, exposure patterns, and the particularity of emergency treatment after exposure.Results:The incidence of OEID among FMS was 2.0%(21/1 061). The nurses and doctors accounted for 95.2%(20/21) and 4.8%(1/21), respectively. The incidences in 17 general wards and two intensive care units (ICU) were 71.4%(15/21) and 28.6%(6/21), respectively. Nearly 90.5%(19/21) and 9.5%(2/21) of the OEID events occurred in contaminated area and potential contaminated area, respectively. About 23.8%(5/21) of the OEID events were air exposure of oral-nasal skin, mucosa and respiratory tract, which was secondary to uncontrollable vomiting, and 76.2%(16/21) were pricking injuries. The inducement factors involved poor quality and inappropriate wearing of some goggles, atomization of the inside of goggles leading to blurring vision, chest distress and decreased sense of touch and operational flexibility related to level-3 protection equipment, poor air quality, FMS physical and psychological conditions, etc. Under the direction of "the Procedures for Handling OEID" , all incidents are properly handled and no FMS was infected by 2019 novel coronavirus and blood-borne pathogens. No new OEID event was found after the strict implement of set of preventive measures.Conclusions:The OEID among FMS in CIW is attributed to multiple causes. The optimized process that takes into account the specificity of OEID management for both COVID-19 and blood-borne infectious diseases can effectively prevent potential post-exposure infections. And reasonable precautions can fully reduce the risk of OEID of FMS in CIW.
ABSTRACT
Objective@#To analyze the risk factors of lymph node metastasis in central region of patients with papillary thyroid microcarcinoma (PTMC). To evaluate the reliability of different risk factors on the prognosis of cervical lymph node metastasis in PTMC patients, and to provide the clinical support for PTMC in the central area.@*Methods@#The clinical data of 700 patients with PTMC treated with surgery from January 2015 to July 2017 were analyzed retrospectively. Risk factors for lymph node metastasis in central region were analyzed by single factor analysis, multivariate Logistic regression analysis and receiver operating characteristic curve (ROC) curve.@*Results@#Central lymph node metastasis (CLNM) rate was 48.29% (338/700). Multifactor analysis indicated that age≤45 years old, male, multifocality, capsule invasion, the tumor calcification and tumor diameter ≥5 mm were independent risk factors for CLNM in patients with PTMC. In the risk prediction of CLNM, the optimal critical value of diameter prediction was 7 mm and the area under the curve (AUC) of ROC=0.647. The optimal threshold for age prediction was 41 years old and AUC=0.597. Single factor analysis for ROC curve showed that gender factor AUC=0.588, tumor number factor AUC=0.627, tumor location factor AUC=0.613. and calcification factor AUC=0.603. The ROC curve of multiple risk factors was analyzed according to age, gender, diameter, location, number of cancer foci and calcification, and AUC=0.768.@*Conclusions@#Age less than 45 years old, male, multiple cancer foci, focal invasion and capsule invasion, calcification, and tumor diameter ≥5 mm are independent risk factors for CLNM of PTMC. With an accumulation of multiple risk factors, CLNM risk increases, and central lymph node dissection should be recommend.
ABSTRACT
Objective: To explore the effectiveness of one-stage debridement and two-stage Ilizarov bone transport technology in repairing post-traumatic lateral malleolus defect. Methods: Between June 2013 and December 2016, 7 patients with bone defect of lateral malleolus were treated. There were 5 males and 2 females with an average age of 45.9 years (range, 35-60 years). There were 6 cases of traffic accident injury and 1 case of strangulation injury. All patients had extensive soft tissue injury and lateral malleolus bone exposure. There were 4 cases of Gustilo type ⅢB and 3 case of Gustilo type ⅢC. The time from injury to admission was 3-10 hours (mean, 6.3 hours). Through one-stage thorough debridement, exploration and repair of vessels and nerves, external fixation of scaffolds and coverage of wounds, free fibulas were removed in 3 cases at one-stage and fibulas were resected in 4 cases after expansion. The bone defects ranged from 4.5 to 15.0 cm in length (mean, 8.2 cm). The Ilizarov circular external fixators were used to transport with fibula osteotomy for repairing bone defect of lateral malleolus when the wound healing. Results: During fibular osteotomy, the stents were adjusted 2-4 times (mean, 2.8 times) and the external fixators were removed after 10-16 months (mean, 12.8 months). The nail tract infection occurred in 2 cases during transporting and was controlled after symptomatic treatment. All patients were followed up 24-48 months (mean, 32.9 months). The shape of lateral malleolus was close to normal without obvious varus or valgus deformity. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score was 86-92 (mean, 90.3), and 5 cases were excellent and 2 cases were good. X-ray film showed that there was no obvious widening of the gap between the ankle points and no sign of absorption of the lateral malleolus. Conclusion: The one-stage debridement combined with two-stage Ilizarov bone transport technology can maintain the stability of ankle joint structure and obtain better effectiveness in repairing post-traumatic lateral malleolus defect.
ABSTRACT
Objective@#To explore the advantages and clinical efficacy of free chimeric perforator flap based on the descending branch of circumflex femoral artery applied to tongue reconstruction after advanced tongue cancer resection.@*Methods@#From October 2013 to December 2018, 57 cases received tongue and oral base reconstruction surgeries using the descending branch of circumflex femoral artery chimeric perforator flap, including 39 males and 18 females, ranged from 20 to 76 years old. And all cases were with stage T3 and T4 tongue cancers, including 35 cases of squamous cell carcinoma, 7 cases of low differentiation cancer, 5 cases of oncosarcoma, and 10 cases of adenoid cystic carcinoma. The tongue was reconstructed by using perforator flap and muscle flap to fill the dead space at the oral floor. The artery anastomoses with the superior thyroid artery or facial artery in the receiving area, and the vein anastomoses with the internal jugular vein in the receiving area. The shape, function and local complications of the reconstructed tongue were observed after operation.@*Results@#Of 57 cases, only one case had partial necrosis of flap, while other 56 cases with chimeric perforator flap survived. Postoperative gastric tube and tracheal cannula were removed in all patients, no cases with oral fistula. All donor sites were sutured in one stage. Postoperative radiotherapy was performed in 41 of the patients. All patients were followed up for 3 to 60 months (average of 20.7 months), with satisfactory esthetic and functional results in reconstructed tongues. Only linear scars were left in the donor areas of the legs, and no lower limb dysfunction was observed.@*Conclusions@#The descending branch of circumflex femoral artery chimeric perforator flap can used for repairing simultaneously the defects of both tongue and oral base. It is helpful to avoid the occurrence of oral fistula and to provide the reconstructed tongue with a good function. It is a good choice to use the descending branch of circumflex femoral artery chimeric perforator flap for tongue reconstruction after resection of advanced tongue cancer resection.
ABSTRACT
Objective To study the efficacy and safety of radiofrequency ablation combined with splenectomy in treatment of primary liver cancer with liver cirrhosis and hypersplenism.Methods Thirty patients with hepatocellular carcinoma complicated with liver cirrhosis and hypersplenism were treated in Fuyang People's Hospital from January 2016 to December 2017.These patients were randomly divided into the observation group (n =15) and the control group (n =15).Surgical liver resection combined with splenectomy was performed in the control group,and radiofrequency ablation combined with splenectomy was performed in the observation group.The time of thermal ischemia,operation time,intraoperative blood loss,blood transfusion volume,length of hospital stay,platelet level and liver function 1 week after surgery,and the incidences of postoperative complications and the overall survival rates 2 years after surgery were compared between the two groups.Results The operation times of the observation group and the control group were (89.1 ± 18.4 vs.118.9 ± 33.6) rin,blood loss (228.4 ± 120.5 vs.362.2 ± 159.5) ml,blood transfusion (192.3±112.4 vs.503.8±196.2) ml,and length of hospital stay (13.5±6.0 vs.21.9±11.6) d (all P＜0.05).After a week of operation,the indicators in the observation group were significantly better than the control group (all P＜0.05).The postoperative two-years complication rate in the observation group was 13.3％,which was significantly lower than the control group (46.7％,P＜0.05).There was no significant difference in the survival rates between the two groups two years after surgery.Conclusions Radiofrequency ablation combined with splenectomy for treatment of liver cancer with cirrhosis and hypersplenism effectively reduced postoperative complications,preserved liver function,increased platelet levels,improved hypersplenism,and was safer.It is a surgical method worthy of generalization.
ABSTRACT
Objective To discuss clinical application,value and effect of tracheal stent in surgical operation for tracheostenosis caused by thyroid tumor.Methods Clinical data of 6 patients with tracheal stenosis and dyspnea caused by thyroid tumor invasiveness or tracheal compression from Oct.2015 to Sep.2016 were retrospectively analyzed.Of the 6 patients,1 case had nodular goiter and 5 cases had differentiated thyroid carcinoma(DTC).Results All patients had dyspnea caused by thyroid tumor invasiveness or tracheal compression.Dyspnea relieved dramatically after tracheal stent was implantated under local anesthesia.Thyroidectomy was given later,with intraoperative tracheal intubation as well as anesthesia,and the surgery finally succeeded.One case with benign multinodular goiter received complete resection and 5 cases with DTC invading the trachea received complete resection of thyroid and neck lymph node dissection,followed by end-to-end anastomosis of invaded trachea sleeve resection.All patients got stage Ⅰ healing in surgical wound.Five cases received radioactive 131I treatment as well as TSH suppression therapy after DTC surgery.All patients were alive and disease-free after a follow-up of 4 to 15 months.Conclusions For patients with tracheostenosis caused by thyroid tumor invasiveness or tracheal compression,operation under cardiopulmonary bypass is necessary if tracheal intubation is difficult.For hospitals without cardiopulmonary bypass,tracheal stent implantation can effectively relieve dyspnea symptom and reduce risk of tracheal intubation under anesthesia,which provides possibility for surgical treatment.
ABSTRACT
Objective To explore the value of intraoperative neuromonitoring (IONM) for recurrent laryngeal nerve (RLN) injury during difficult thyroid carcinoma operation.Methods Data of 102 patients admitted from Nov.2012 to Nov.2015 who underwent complex thyroid carcinoma operation were retrospectively analyzed.Among the 102 patients,39 were receiving the first operation due to local advanced thyroid cancer,and 63 were receiving the second operation.According to whether IONM was applied,the patients were divided into the observation group(57 patients) and the control group(45 patients).Difference of the time cost in exposing and dissecting RLN and RLN injury rate between the two groups was compared.Results The time cost in exposing and dissecting RLN was shorter in the observation group ((7.88±1.55)min) than in the control group ((12.60±3.56)min),with statistical difference (t=-2.449,P=0.044).Three patients (5.26％) in the observation group and 7 patients(15.56％) in the control group had temporary RLN injury,with no statistical difference (P=0.161).No one in the observation group and 2 patients (4.44％) in the control group had permanent RLN injury,and the difference had no statistical significance(P=0.192).Conclusions On the basis of normative surgical procedure,IONM technology can reduce the time of exposing and dissecting RLN,and it has practical value in reducing the risk of RLN injury in difficult thyroid carcinoma operation.
ABSTRACT
Objective To evaluate the diagnostic value of quantitative rest and stress 13N-NH3 PET myocardial perfusion imaging (MPI) on coronary microvascular disease (CMVD),and provide basis for accurate classification.Methods From July 2016 to September 2017,a total of 23 patients (16 males,7 females;27-70 years) who were suspected of CMVD were prospectively enrolled in this study.Rest and ATPstress MPI were acquired using 13N-NH3 PET and analyzed using Heartsee software.Rest and stress relative uptake,absolute myocardial blood flow (MBF) and coronary flow reserve (CFR) were obtained and present on sectional images and cup maps.Based on the information,CMVD was diagnosed or excluded.Combined with myocardial enzymes,echocardiography,cardiac MRI,coronary angiography,CT angiography (CTA),CMVD was further divided into CMVD without (type 1) or with obstructive coronary disease (type 2),and other CMVD (type 3).Two-sample t test and one-way analysis of variance were used to analyze the data.Results In 23 patients,17 cases were diagnosed as CMVD (including 10 cases with type 1,3 cases with type 2 and 4 cases with type 3),and 6 cases were excluded.There were no significant differences in the age,gender and risk factors between CMVD group and exclusion group (all P＞0.05).The relative uptake results,including average uptake of whole left ventricle in rest and stress states,rest minimum quadrant,and area of stress uptake less than 60％ of maximum were significantly different between the two groups (t values:from -3.249 to 2.469,all P＜0.05).All the absolute blood flow parameters,including rest and stress whole MBF and CFR,rest and stress minimum quadrant MBF and CFR,were significantly different between CMVD group and exclusion group (t values:from-8.278 to-3.258,all P＜0.05).There was no statistically significant difference for relative uptake data among three types of CMVD (F values:from 0.002 to 1.440,all P＞0.05).For absolute quantitative values of whole MBF and minimum quadrant MBF in both rest and stress states,difference was statistically significant among groups (F values:from 3.885 to 8.452,all P＜0.05).Conclusion Quantitative PET MPI could provide a noninvasive,safe and accurate method for the diagnosis and classification of CMVD.