Influencing factors of textbook outcomes in liver surgery after radical resection of gallbladder carcinoma: a national multicenter study / 中华消化外科杂志

Objective:To investigate the influencing factors of textbook outcomes in liver surgery (TOLS) after radical resection of gallbladder carcinoma.Methods:The retrospective case-control study was conducted. The clinicopathological data of 530 patients who underwent radical resection of gallbladder carcinoma in 15 medical centers, including the First Affiliated Hospital of Army Medical University et al, from January 2014 to January 2020 were collected. There were 209 males and 321 females, aged (61±10)years. Patients underwent radical resection of gallbladder carcinoma, including cholecystectomy, hepatectomy, invasive bile duct resection, and lymph node dissection. Observation indicators: (1) situations of TOLS; (2) influencing factors of TOLS. Measure-ment data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the Mann-Whitney U test. The univariate analysis was conducted using the corresponding statistical methods based on data type, and variables with P<0.10 were included in multivariate analysis. Multivariate analysis was conducted using the Logistic stepwise regression model. Results:(1) Situations of TOLS. All 530 patients underwent radical resection of gallbladder carcinoma, and there were 498 cases achieving R 0 resection, 508 cases without ≥grade 2 intra-operative adverse events, 456 cases without postoperative grade B and grade C biliary leakage, 513 cases without postoperative grade B and grade C liver failure, 395 cases without severe com-plications within postoperative 90 days, 501 cases did not being re-admission caused by severe com-plications within postoperative 90 days. Of the 530 patients, 54.53%(289/530) of patients achieved postoperative TOLS, while 45.47%(241/530) of patients did not achieve postoperative TOLS. (2) Influencing factors of TOLS. Results of multivariate analysis showed that American Society of Anesthesiologists classification >grade Ⅱ, preoperative jaundice, T staging as T3?T4 stage, N staging as N2 stage, liver resection as right hemi-hepatectomy, and neoadjuvant therapy were independent factors influencing TOLS in patients undergoing radical resection of gallbladder carcinoma ( odds ratio=2.65, 1.87, 5.67, 5.65, 2.55, 3.34, 95% confidence interval as 1.22?5.72, 1.18?2.95, 2.51?12.82, 2.83?11.27, 1.41?4.63, 1.88?5.92, P<0.05). Conclusion:American Society of Anesthesiologists classification >grade Ⅱ, preoperative jaundice, T staging as T3?T4 stage, N staging as N2 stage, liver resection as right hemi-hepatectomy, and neoadjuvant therapy are independent factors influencing TOLS in patients undergoing radical resection of gallbladder carcinoma.

Prenatal ultrasound diagnosis and prognosis analysis of vasa previa / 中华超声影像学杂志

Objective@#To investigate the prenatal ultrasonographic features and prognosis of vasa previa, to explore the application value of sector scanning in the intracervical mouth by antenatal ultrasound, then to increase vasa previa detection rate.@*Methods@#Prenatal ultrasound images, clinical characteristics and pregnancy outcome of 35 pregnant women with vasa previa confirmed by surgery and pathology were analyzed retrospectively, the diagnostic effectiveness of sector scanning in the intracervical mouth was evaluated.@*Results@#Thirty-three of the 35 vasa previa cases were detected by sector scanning in the intracervical mouth, with a detection rate of 94.3% (33/35). Of the 35 cases, 20 cases (60.6%) were first contacted in second trimester and 13 cases (39.4%) were first contacted in third trimester. Two cases were missed or misdiagnosed, which were all first contact in third trimester. Among the 35 cases, 25 were velamentous placenta and 4 were battledore placenta. Twenty cases were low-lying placenta or marginal placenta previa. All 35 women underwent cesarean section. No neonatal mortality, 11 term infants, 20 premature infants of more than 34 weeks and 4 premature infants of less than 34 weeks. All placentas underwent pathological examination after delivery, 4 cases placentas underwent vascular casting, and it was found that 2 cases were vasa previa of umbilical artery branch and 2 cases were vasa previa of allantoic veins branch.@*Conclusions@#Vasa previa can be effectively detected by prenatal ultrasonography through sector scanning in the intracervical mouth. Second trimester is the best period to detect vasa previa. Pathomorphological examination on placenta after delivery and vascular casting are helpful to the understanding of vasa previa.

Prenatal ultrasound diagnosis of fetal intestinal volvulus and intussusception and misdiagnosis analysis / 中华超声影像学杂志

To investigate the characteristics of prenatal ultrasound sonography of fetal intestinal volvulus and intussusception , and analyze the misdiagnosis . Methods T he prenatal two‐dimensional and three‐dimensional sonographic features of 11 patients with volvulus and intussusception confirmed by prenatal ultrasound and/or postnatal confirmation from June 2017 to December 2018 were summarized and the prognosis were followed up . Results Of the 11 fetuses ,8 had intestinal volvulus and 3 had intussusception . Of the 8 cases of intestinal volvulus ,6 cases were correctly diagnosed by prenatal ultrasound ,and 2 cases were missed . Among the 6 cases diagnosed correctly ,3 cases showed a typical ＂vortex sign＂on the two‐dimensional sonogram . One case showed ＂coffee beans＂sign ,and 6 cases of three‐dimensional sonograms showed that the intestines were ＂coiled＂.＂Bread ring＂ sign appeared in 3 cases of intussusception ,and 1 case of intrauterine intestine was automatically reset . One of the 11 fetuses was induced to give birth ,1 was still in pregnancy ;9 cases were born and confirmed by surgery ,1 case died after operation . Conclusions Intestinal volvulus and intussusception have their characteristic sonographic features .When there is a short‐term fetal bowel dilatation with meconium peritonitis ,the existence of these two acute abdomen should be considered ,but w hen it is accompanied by intestinal necrosis ,typical signs of two‐dimensional sonograms are missing ,and three‐dimensional imaging aids in diagnosis .

Prenatal ultrasound diagnosis and prognosis analysis of vasa previa / 中华超声影像学杂志

Objective To investigate the prenatal ultrasonographic features and prognosis of vasa previa,to explore the application value of sector scanning in the intracervical mouth by antenatal ultrasound,then to increase vasa previa detection rate.Methods Prenatal ultrasound images,clinical characteristics and pregnancy outcome of 35 pregnant women with vasa previa confirmed by surgery and pathology were analyzed retrospectively,the diagnostic effectiveness of sector scanning in the intracervical mouth was evaluated.Results Thirty-three of the 35 vasa previa cases were detected by sector scanning in the intracervical mouth,with a detection rate of 94.3 ％ (33/35).Of the 35 cases,20 cases (60.6 ％) were first contacted in second trimester and 13 cases (39.4％) were first contacted in third trimester.Two cases were missed or misdiagnosed,which were all first contact in third trimester.Among the 35 cases,25 were velamentous placenta and 4 were battledore placenta.Twenty cases were low-lying placenta or marginal placenta previa.All 35 women underwent cesarean section.No neonatal mortality,11 term infants,20 premature infants of more than 34 weeks and 4 premature infants of less than 34 weeks.All placentas underwent pathological examination after delivery,4 cases placentas underwent vascular casting,and it was found that 2 cases were vasa previa of umbilical artery branch and 2 cases were vasa previa of allantoic veins branch.Conclusions Vasa previa can be effectively detected by prenatal ultrasonography through sector scanning in the intracervical mouth.Second trimester is the best period to detect vasa previa.Pathomorphological examination on placenta after delivery and vascular casting are helpful to the understanding of vasa previa.

Prenatal ultrasound diagnosis of fetal abnormalies of the inferior vena cava / 中华超声影像学杂志

Objective To explore the value of prenatal ultrasound in diagnosis of fetal anomalies of the inferior vena cava (IVC) and to improve the prenatal detection rate.Methods Fourteen cases of fetal anomalies of IVC examined by prenatal ultrasound from June 2013 to April 2016 in our hospital were analyzed,the prenatal ultrasonographic characteristics through abdominal transverse,coronal and IVC long axis were summarized,and were compared with the autopsy results.Results In 14 cases of anomalies of IVC,12 cases were isolated IVC interruption,and 2 cases were high confluence of IVC.In 12 cases of isolated IVC interruption,9 cases compicated by left isomerism,1 case complicated by sistus inversus viscerum,1 case complicated by isolated IVC interruption;2 cases of high confluence of IVC were combined with multiple malformations,including 1 case of chromosome 18-trisomy syndrome.Thirteen cases were confirmed by pathology,and 1 case of the high confluence of IVC lost follow-up.Conclusions Fetal anomalies of IVC have characteristic manifestations in prenatal ultrasonographic.When detecting the IVC interruption,left isomerism should be highly suspected.

Value of MRI in the diagnosis of fetal aortic arch anomalies / 中华放射学杂志

Objective To explore the value of MRI in the diagnosis of fetal aortic arch anomalies. Methods We retrospectively collected 10 fetuses with aortic arch anomalies indicated by prenatal ultrasound and underwent MR examination and were subsequently proven by autopsy or post-birth follow-up from 320 pregnant women. We focused on the observations of the location of the aortic arch and brachiocephalic artery anomalies, the locations of the liver and stomach in the abdominal cavity, and the large vessels in abdomen. The above-mentioned finding were compared with prenatal ultrasound and follow-up findings. Results Of 10 cases, right aortic arch with aberrant left subclavian artery was seen in 7 cases, right aortic arch with the mirror branch, left aortic arch with aberrant right subclavian artery, right aortic arch with aberrant left subclavian artery combined with cervical aortic arch and double aortic arch was seen in 1 case, respectively. All aortic arch anomalies detected by MRI were consistent with post-birth or autopsy findings. Ultrasound misdiagnosed aortic branch malformation in 5 places, which included right aortic arch but misdiagnosed aberrant left subclavian artery in 2 cases, right aortic arch never diagnosed mirror branch anomaly in 1 case, right aortic arch with left subclavian artery misdiagnosed cervical aortic arch in 1 case, left atrial isomerism but misdiagnosed left aortic arch with aberrant right subclavian artery in 1 case;One double aortic arch was misdiagnosed as right aortic arch with aberrant left subclavian artery in ultrasound. Conclusion Fetal cardiovascular MRI is an effective and supplementary examination to complement ultrasound in diagnosis of fetal aortic arch anomalies.

Ultrasonography and magnetic resonance imaging for diagnosis of fetal skull brain deformities / 中国基层医药

Objective To evaluate ultrasonography combined with magnetic resonance imaging(MRI) diagnosis value for fetal brain deformities.Methods The results of ultrasonography and MRI was analysied in 12 fetuses with deformities,which were compared to postnatal,autopsy or other hospital inspection results and evaluated the accuracy.Results In 8 cases,the diagnoses established by ultrasonography were correct.3 cases were misdiagnosed by ultrasonography,1 case was missed the diagnosis.In 11 cases,the diagnoses established by MRI were correct and 1 case was missed the diagnosis.Conclusion Ultrasonography must be choosed in diagnosising fetal skull brain deformities,MRI was supplement to ultrasonography in complicated pregnancies.The combination of ultrasonography and MRI have an important value in guiding pregnant women to determine whether or not to continue the pregnancy.

Applied anatomy of the greater omentum in transplantation / 中华显微外科杂志

ObjectiveTo observe the shape, size, position and vessels of greater omentum. To explore the design of greater omentum and clarify its clinical significance. MethodsThree fresh and 12 formalin-fixed cadaveres were dissected. All of them had no damage nor injury. 1. Macro-micro-dissection: The shape, size and position of greater omentum were observed. The vessels of the greater omentum were studied.2.Lead oxide-gelatin injection technique and three-dimensional reconstruction.Results The length of greater omentum was(24.7±6.9)cm,the width was(28.3+2.8)cm. It could be divided into 3 types: thin type,middle type and thick type, the occurrence rate was 33.3％, 46.7％ and 20.0％ respectively. The blood supply of greater omentum mainly came from the gastroepiploic arch composed of the left gastroepiploic artery and the right gastroepiploic artery.There were 4 main arteries of the greater omentum: ①The right epiploic　artery: The external diameter at origination was (1.0±0.4)mm. ② The middle epiploic artery: The external　diameter at origination was(0.7 + 0.3)mm. ③The left epiploic artery:The external diameter at origination was　(1.2±0.4)mm.④ The accessary epiploic artery:The external diameter at origination was (0.5 ± 0.1)mm.ConclusionAccording to the characteristic of the anterior arch and posterior arch,the position of the middle epiploic artery divarication and the method of spread,the greater omentum is divided into 5 types.It should be according to the characteristic, when the greater omentum is designed and clipped.

Surveillance and Analysis of Nosocomial Infection among Jizheng Patients / 中华医院感染学杂志

OBJECTIVE To realize the status and the impact factors of nosocomial infection among Jizheng patients.METHODS To investigate 562 former inpatients suffered from Jizheng in hospital from Jan 2004 to Dec 2005.RESULTS The incidence rates of nosocomial infection that calculated by the patients and the cases were 14.59% and 16.55%,respectively.Infection mostly occurred on the 22nd day in hospital on average.The main infection sites were lower respiratory tract(48.78%),urinary tract(15.85%),and alimentary tract(12.20%).The most risk factor was aging.CONCLUSIONS The high incidence of nosocomial infection is due to various factors.We should take measures respectively aiming at different factors to reduce the occurrence of nosocomial infection.