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Objective:To investigate the application value of Hisense computer-assisted surgery system (CAS) three-dimensional reconstruction in the precision treatment of pediatric liver tumors.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 82 children with liver tumors who were admitted to Affiliated Hospital of Qingdao University from January 2013 to September 2021 were collected. There were 39 males and 43 females, aged 13(19)months. Children underwent upper abdominal dynamic enhanced computed tomography (CT) examination, and three-dimensional reconstruction was performed on CT images of arterial, equili-brium and venous phases with Hisense CAS. Surgical feasibility and scheme were evaluated and conducted based on the results of upper abdominal dynamic enhanced CT examination, and then revised according to three-dimensional reconstruction results of Hisense CAS. Observation indicators: (1) comparison of surgical scheme between two-dimensional enhanced CT images and three-dimensional reconstruction results of Hisense CAS; (2) intraoperative and postoperative situations; (3) follow-up. Follow-up was conducted by outpatient examination to detect postoperative compli-cations and residual liver compensation up to November 2021. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(IQR) or M(range). Count data were described as absolute numbers or percentages. Results:(1) Comparison of surgical scheme between two-dimensional CT images and three-dimensional reconstruction results of Hisense CAS. ① Based on the two-dimensional CT images, 42 cases of 82 children could undergo one-stage resection and 40 children could not. However, based on the three-dimensional reconstruction results of Hisense CAS, 48 cases of 82 children could undergo one-stage resection and 34 children could not. There were 6 children with one-stage resection feasibility based on the three-dimensional reconstruction results of Hisense CAS rather than the two-dimensional CT images. For the 34 children undergoing chemotherapy firstly, 31 cases had surgical feasibility after chemotherapy based on the two-dimensional CT images and 3 cases could not undergo surgery because of unapparent tumor regression or tumor surrounding impor-tant vessels. However, the 34 children had surgical feasibility after chemotherapy based on the three-dimensional reconstruction results of Hisense CAS. The revision rate of surgical feasibility was 11.0%(9/82) for the 82 children. ② Based on the two-dimensional CT images, 15 cases of 82 children underwent liver left lobectomy, 21 cases underwent liver right lobectomy, 7 cases underwent mesohepatectomy, 13 cases underwent extended left hemihepatectomy, 23 cases underwent extended right hemihepatectomy, 3 cases underwent segmental hepatectomy. However, based on the three-dimensional reconstruction results of Hisense CAS, 20 cases of 82 children underwent liver left lobectomy, 29 cases underwent liver right lobectomy, 7 cases underwent mesohepatectomy, 7 cases underwent extended left hemihepatectomy, 14 cases underwent extended right hemihepatectomy, 5 cases underwent segmental hepatectomy. The revision rate of surgical scheme was 36.6%(30/82) for the 82 children. (2) Intraoperative and postoperative situations. The operation time, volume of intraoperative blood loss, duration of postoperative hospital stay of the 82 children were (182±18)minutes, 20(10)mL, (10.2±1.9)days, respectively. (3) Follow-up. All the 82 children were followed up for 10 (range, 2?18)months. There was no obvious complication occurred to the 82 children after surgery, and the residual liver can satisfy the liver compensation of body. All the children survived well.Conclusion:Three-dimensional reconstruction of Hisense CAS is conducive to judging the surgical feasibility and formulation of accurate surgical plan of children with liver tumors.
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Objective The loop electrosurgical excision procedure (LEEP) is a major option for the treatment of cervical in-traepithelial neoplastic (CIN) lesions,but reports are rarely seen on the consistency of the result of post-LEEP pathology with that of preoperative biopsy as well as on the postoperative pathological upgrading of related factors. This study analyzes the consistency of the result of preoperative biopsy with that of post-LEEP pathology for CIN lesions and the risk factors for residual and/or recurrence after LEEP. Methods A retrospective study was conducted on 1 089 patients with CIN lesions treated by LEEP in our hospital from May 2014 to A-pril 2017. All the patients underwent liquid-based thin-layer cytology (TCT) and vaginoscopic biopsy preoperatively,followed by analysis of the results of TCT,the consistency of the result of preoperative bi-opsy with that of post-LEEP pathology,and the risk factors for residu- al and/or recurrence after LEEP. Results Preoperative biopsy showed 447 cases of low-grade squamous intraepithelial lesion (LSIL),among which TCT revealed 85 cases negative for intraepithelial lesion and malignancy (NILM),with a false negative rate of LSIL of 19.0%. Of the 645 cases of high-grade squamous intraepithelial lesion (HSIL) revealed by preoperative biopsy,TCT manifes-ted 95 cases of NILM,with a false negative rate of HSIL of 14.7%,which was significantly lower than that of LSIL (P<0.05). Preop-erative biopsy showed 447 cases of LSIL,among which post-LEEP pathology manifested 316 cases of LSIL (70.69%) and 51 cases of HSIL (11.4%). Of the 635 cases of HSIL revealed by preoperative biopsy,post-LEEP pathology exhibited 4 cases (0.63%) of inva-sive cervical cancer (ICC). Multivariate analysis showed the risk factors for pathological upgrading after LEEP were sexual partners >2 (OR=0.139,95% CI: 0.034-0.561) and LSIL in TCT (OR=0.111,95% CI: 0.040-0.310) (P<0.05) and those for postopera-tive recurrence included positive incision margin (OR=2.970,95% CI: 1.010-8.733) and persistent human papilloma virus (HPV) infection (OR=5.446,95% CI: 3.109-9.540). Preoperative HPV16 infection was correlated with lesion residual and/or recurrence after LEEP (P<0.05). Conclusion LEEP can significantly improve the diagnosis rate of HSIL in low-grade CIN patients with high risk factors. The risk factors for lesion residual and/or recurrence after LEEP include HPV16 infection,lesion involvement of the inci-sion margin,and persistent HPV infection.
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OBJECTIVE:To evaluate the pharmacoeconomics of pantoprazole vs. ranitidine in the treatment of gastricesophagitis reflux disease(GERD). METHODS:Retrieved from PubMed,EMBase,The Cochrane Library,CNKI,VIP and Wanfang database, RCTs about pantoprazole vs. ranitidine in the treatment of GERD were selected until Sept. 2014. Two reviewers independently screened literature in accordance with the inclusion and exclusion criteria,and extracted the data of included studies. Stata 12.0 soft-ware was used to estimate therapeutic efficacy index and cost,and cost-effectiveness analysis was performed with the decision tree model. RESULTS:A total of 7 RCTs were included,involving 1 389 patients. Cost-effectiveness analysis showed that for gradeⅠ-Ⅲ(by Savary-Miller standard)GERD,cost-effectiveness ratios of ranitidine were all lower than those of pantoprazole(gradeⅠ:18.86 vs. 57.93;gradeⅡorⅢ:35.58 vs. 146.13);gradeⅠ,Ⅱ,Ⅲincremental cost-effectiveness ratio(ICER)were 335.53,349.85,349.85. Sensitivity analysis supported this conclusion. CONCLUSIONS:Ranitidine is more economic therapy plan for gradeⅠ-Ⅲ GERD, but its ICER fluctuates greatly. Individual therapy plan should be formulated according to disease condition and economic condition.
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A autora estuda um personagem de Aldous Huxley no livro Demônios da loucura. Nesse texto, misto de ensaio histórico e ficção, Huxley aborda o processo de endemoninhamento das freiras ursulinas de Loudun, dando destaque ao padre exorcista Jean Joseph Surin. Surin adoece, padecendo por vinte anos de transtornos psicossomáticos. A autora analisa os seus sintomas à luz da teoria psicossomática de Winnicott, aplicando, em especial, as idéias sobre as bases para o selfno corpo.
La autora estudia un personaje de Aldous Huxley en su libro Los demonios de Loudun. En el texto, mescla de ensayo histórico y ficcional, Huxley trata sobre el proceso de endemoniamiento de las monjas ursulinas de Loudun, destacando el padre exorcista Jean Joseph Surin. Surin se enferma, padecendo durante veinte años, de transtornos psicosomáticos. La autora analisa sus síntomas a la luz de la teoría psicosomática de Winnicott, usando en especial sus ideas sobre las bases para el self en el cuerpo.
The author studies a character in Aldous Huxleys Devils of Loudun, a semi-fictional essay. Huxley approaches the subject of the possession of nuns from the Loudun convent by the devils, and their exorcism, giving special emphasis to the exorcist priest Jean-Joseph Surin. Surin becomes ill, suffering psychosomatic ailments for twenty years. The author analyses these diseases in the light of Winnicotts psychosomatic theory, applying mostly his ideas about the basis of the self in the body.
Subject(s)
Humans , Female , Somatoform Disorders/psychologyABSTRACT
A group of 25 preoperative against-the-rule(AR) eyes had undergone phacoemulsification and posterior chamber lens implantation, 15 of them prepared with lateral(temporal) scleral pocket incision and 10 with superior scleral incision. Temporal incision group showed early AR astigmatism increment by about 1 diopter(D), which decayed slowly over the next 2 months. Superior incision group showed early with-the-rule (WR) astigmatism by about 2.5D, which shifted toward AR astigmatism at postoperative 10 day and the AR astigmatism increased substantially by the next 2 months. The early postoperative complications were hyphema(2 eyes, 13.3%) and corneal edema(1 eye, 6.7%) in the temporal incision group, which cleared spontaneously within 1 week pctoperative. There were no hyphema and corneal edema in the superior incision group. In summary, the temporal incision effectively achived rapid post-operative astigmatic recovery with strong axial stability in a manner that surgically induced astigmatism favorably reduces pre-existing AR astigmatism.