Couinaud first proposed the naming of S9 segment of liver in 1994, and Liu Yunyi further promoted this naming in his work “Applied Anatomy of Hepatectomy and Liver Transplantation” in 2016. However, it has not been widely recognized and supported in the field of liver surgery for a long time. In recent years, due to the promotion and gradual maturity of endoscopic technology, there has been a more detailed understanding and demand for anatomy of liver and bile duct. Therefore, this article further explores the clinical value and significance of S9 segment of liver.
Objective
To investigate the role of preoperative serum thyroid stimulating hormone (TSH) in evaluating differentiated thyroid cancer (DTC).
Methods
A total of 551 patients with thyroid nodules met the study criteria, who got treatment in the First Affiliated Hospital of Jiamusi University between Aug. 2017 and Dec. 2017. And the patients were divided into DTC group (n=110) and benign group (n=441) according to the postoperative pathological results. The difference of serum TSH level between the 2 groups was compared and then explored the diagnostic significance of serum TSH level, thyroid imaging report and data system (TI-RADS), and serum TSH combined withTI-RADS.
Results
The serum TSH level was higher in the DTC group than that of the benign group (Z=5.198, P<0.05). The sensitivity of preoperative serum TSH level in the diagnosis of DTC was 80.9% (89/110), the specificity was 74.4% (328/441), and the area under receiver operating characteristic (ROC) curve was 0.660 ［95%CI was (0.602, 0.719), P<0.05］. The sensitivity of TI-RADS in the diagnosis of DTC was 82.7% (91/110), the specificity was 73.5% (324/441), and the area under the ROC curve was 0.772 ［95%CI was (0.711, 0.823), P<0.05］. The sensitivity of preoperative serum TSH combined with TI-RADS in the diagnosis of DTC was 91.8% (101/110), the specificity was 87.5% (386/441), and the area under the ROC curve was 0.831 ［95%CI was (0.786, 0.876), P<0.05］.
Conclusions
Preoperative serum TSH level may be a potential risk factor for the occurrence of DTC. Preoperative serum TSH level combined with TI-RADS classification can improve the accuracy of preoperative diagnosis of DTC, not only to reduce the misdiagnosis of thyroid cancer, but also can avoid excessive treatment.
Objective
The objective of this study is to evaluate the effect of enhanced recovery after surgery (ERAS) in the perioperative period of pancreatoduodenectomy.
Methods
This article conducted the forward-looking analysis on the information of 227 patients undergoing the pancreatoduodenectomy in West China Hospital from January 2016 to June 2017, and then compared the differences between the patients subjected to ERAS (ERAS group) and thosesubjected to regular measures (control group) with respect to time of setting in sickbed, time of mobilizing out ofsickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, the time of nasogastric tube, postoperative hospitalization duration and expenses, postoperative complications, and postoperative pain scores.
Results
① Postoperative indexes: by comparison of the ERAS group and the control group, it was found that the ERAS group had shorter (or lower) time of setting in sickbed, time of mobilizing out of sickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, the time of nasogastric tube, postoperative hospitalization duration and expenses (P<0.05). ② Postoperative complications: of all postoperative complications, including pancreatic fistula, postoperative hemorrhage, delayed gastric emptying, biliary fistula, abdominal infection, incision complication, lung infection, and heart complication were without statistically significant differences (P>0.05) between the 2 groups.③ Reoperation and readmission: there was no significant difference on the incidences of reoperation and readmission between the 2 groups (P>0.05). ④ Postoperative pain scores: except 22 : 00 of the 6-day after operation, the pain scores in the ERAS group were all lower than those in the control group at 2 h and 8 h after operation, and the time points of 1–6 days after operation (8 : 00, 16 : 00, and 22 : 00), with statistically differences (P<0.05).
Conclusion
Without increasing the incidence of complications, ERAS may speed up the rehabilitation of patients undergoing the pancreatoduodenectomy and mitigate the pain of patients.
Objective
To explore the expression differences of procalcitonin (PCT) in different infection sites and bacterial strains, and to provide the evidence for early differential diagnosis of infectious diseases with PCT as a biomarker.
Methods
The patients with various kinds of infections diagnosed in West China Hospital of Sichuan University between January 2012 and June 2016 were retrospectively included. The expression differences of PCT in various infection sites and bacterial strains were analyzed.
Results
A total of 1 005 patients were include in this study, including 259 with systemic infection and 746 with local infection. The median PCT level in the systemic infection group was higher than that in the local infection group (8.57 vs. 0.10 ng/mL, P<0.05). In the 779 patients with pulmonary infection, the median PCT level of the patients with sepsis caused by pulmonary infection was higher than that of the ones without sepsis (4.61vs. 0.10 ng/mL, P<0.05), and the median PCT level of the patients with positive sputum culture was higher than that of the ones with negative sputum culture (0.28vs. 0.08 ng/mL, P<0.05). In the 48 patients with urinary tract infection, the median PCT level of the patients with sepsis caused by urinary tract infection was higher than that of the ones without sepsis (12.00vs. 0.42 ng/mL, P<0.05), and the median PCT level of the patients with complicated urinary tract infection was higher than that of the patients with simplex urinary tract infection (19.15vs. 5.02 ng/mL, P<0.05). In the 259 patients with systemic infection, the median PCT level of the patients with infective shock was higher than that of the ones without infective shock (40.26vs. 3.83 ng/mL, P<0.05); the mean PCT level of patients with infection of Gram-negative bacteria, Gram-positive bacteria and fungi was 13.66, 0.99, and 3.30 ng/mL with a significant difference (P<0.05).
Conclusion
The PCT level has unique advantages in identifying different sites of the infection, early diagnosing complicated urinary tract infection, and evaluating the severity of infection, which could provide evidence in early identification for sepsis caused by various kinds of infectious pathogens.
ObjectiveTo study the diagnostic significance of modified Alvarado Score System for different types of acute appendicitis.
MethodsClinical data of 1 930 cases of acute appendicitis, who underwent appendicectomy in The First Hospital of Yulin from Jan. 2004 to Jan. 2014, were retrospectively collected. Then the diagnostic significance of Modified Alvarado Score System was detected and evaluated by receiver operating characteristic (ROC) curve, and its correlation with postoperative pathological results was calculated.
ResultsThe modified Alvarado score of cases in progressive group was higher than that of simplex group (7.5±1.3 vs. 3.6±0.7, P < 0.001). The areas under ROC curve of modified Alvarado Score System was 0.943 (95% CI:0.929-0.958, P < 0.001). The critically diagnostic points of Modified Alvarado Score System for differential diagnosis of simplex acute appendicitis and progressive acute appendicitis was 6 score, with sensitivity of 92.9%, specificity of 86.3%, positive predictive value of 96.9%, negative predictive value of 72.6%, positive likelihood ratio of 6.8, negative likelihood ratio of 0.1, and Youden index of 91.7%.
ConclusionThis Modified Alvarado Score System has a certain significance for the type diagnosis of acute appendicitis.
ObjectiveTo investigate the expression and clinical significance of HIST1H1B gene in bladder cancer.MethodsInformation on HIST1H1B in the dataset GSE13507 was downloaded from the GEO database. Discrepancy in expression of HIST1H1B in normal tissues and bladder cancer tissues was analyzed by t-test. Survival analysis was performed by using Log-rank algorithm. The association between HIST1H1B gene expression and clinicpathological features was analyzed using Chi-square test. Gene enrichment analysis (GSEA) was performed to explore possible pathways of HIST1H1B involved in bladder cancer.ResultsHIST1H1B was down-regulated in normal tissues and highly expressed in bladder cancer tissues (P=0.002 5). The expression of HIST1H1B was associated with age, gender, T stage, M stage, N stage, disease stage, but not associated with invasiveness and progression. Whether in overall survival (HR=1.732, 95%CI 1.070 to 2.803) or tumor-specific survival (HR=2.000, 95%CI 0.996 to 4.017), patients with high expression of HIST1H1B were significantly lower than that in patients with low expression (P<0.05). GSEA results showed that HIST1H1B may influence the occurrence and development of bladder cancer by regulating MYC signaling pathway V2, G2M checkpoint, E2F signaling pathway, spermatogenesis, mitotic spindle, etc.ConclusionsHIST1H1B may be a biomarker for determining the prognosis of bladder cancer and a target for treatment of bladder cancer.
ObjectiveTo investigate the dynamic changes of nodule volume in benign thyroid tumors after radiofrequency ablation (RFA), and to analyze the predictive value of risk factors for nodule regeneration. MethodsA total of 165 patients with benign thyroid nodules who received RFA treatment in the People’s Hospital of Yuechi County from June 2019 to June 2021 were retrospectively collected and divided into small nodule volume group (≤15 mL, n=116) and large nodule volume group (>15 mL, n=49) according to the median nodule volume at admission. The clinical data and serological data of the two groups were compared. Multivariate Cox proportional hazard regression model was used to adjust confounding factors to explore the relationship between initial nodule volume, vascular density, nodule location near critical structure and postoperative nodule regeneration in patients with benign thyroid nodules. According to the proposed Nomogram of the model, Bootstrap method was adopted for sampling verification, calibration curve was adopted to evaluate the calibration degree of the model, and area under the curve (AUC) of receiver operating characteristics (ROC) curve was adopted to evaluate the model differentiation. ResultsIn the small volume nodule group, the proportion of unilateral nodule was higher, and the preoperative beauty score, preoperative symptom score, radiofrequency power, ablation time, total energy, operative time, intraoperative blood loss and hospital stay were lower or short, P<0.05. The change value of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), catalase (CAT) after operation in small volume nodule group were higher than those in the large nodule volume group (P<0.05), but change value of the free thyroxine (FT4), malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were lower than those in the large nodule volume group (P<0.05). At 1, 3, 6, 12, and 24 months after RFA operation, the nodule volume of the two groups decreased successively, and volume reduction rate (VRR) increased successively. The changes of nodule volume and VRR in the small nodule volume group were better than those in the large nodule volume group. In the large nodule group, the nodule volume was larger at 1, 3, 6, 12, and 24 months after operation, and the VRR was higher at 1 month after operation, the regeneration time was shorter, the number of residual nodules was higher, and the initial ablation rate (IAR) was lower (P<0.05). After adjusting for age, gender and other factors, the correlation effect value increased with the increase of initial volume and blood vessel density, and the differences in trend test were statistically significant (Ptrend <0.05). Nodules located near the critical structure had an increased risk of regeneration (OR=1.76, P<0.001). The Nomogram constructed according to the multi-factor model has good differentiation (AUC before and after ROC curve validation were 0.854 and 0.814, respectively) and accuracy (mean absolute error of 0.023). ConclusionsRFA achieved clinically relevant volume reduction in both ≤15 mL and >15 mL of single benign thyroid nodules, lasting for at least 2 years. However, the nodule VRR and cosmetic effect were better in the small volume nodule group, and the initial nodule volume, blood vessel density and location were closely related to nodule regeneration. The Nomogram model showed good differentiation and accuracy in predicting the risk of nodule regeneration, providing strong support for clinical decision-making.
ObjectiveTo observe the dynamic changes of plasma Clara cell secretory protein (CC16) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to explore its role in the occurrence and development of the disease and clinical significance.MethodsA total of 71 AECOPD patients were included in this study as observation group. All subjects completed the CAT questionnaire and were sampled 2 ml of venous blood on day 1 and day 7 after their admission. And the percentage of forced expiratory volume in the first second (FEV1%pred), percentage of forced vital capacity in the estimated value (FVC%pred), FEV1/FVC ratio, arterial partial pressure of carbon dioxide (PaCO2), white blood cell count (WBC), the proportion of neutrophils (NEUT%), C-reactive protein (CRP), procalcitonin (PCT) and the length of stay of subjects were recorded. Another 20 healthy adults were enrolled as the control group. Each subject of the control group was sampled 2 ml of venous blood. The plasma CC16 levels of the two groups were tested and compared, and analyzed its correlation with CAT score and length of stay.ResultsThe plasma CC16 level of AECOPD patients was significantly lower than that of the control group, lung function was significantly lower than that of the healthy control group, WBC and NEUT% were significantly higher than that of the healthy control group, and the difference was statistically significant (P<0.05). Compared with day 1 after admission, the plasma CC16 level, CAT score, PaCO2, WBC, NEUT%, CRP, PCT of AECOPD patients on day 7 were significantly decreased, with statistically significant differences (P<0.05). The plasma CC16 level of AECOPD patients was negatively correlated with their CAT score (r=–0.704, P<0.001), and also was negatively correlated with the length of stay (r=–0.351, P=0.003).ConclusionsCC16 is involved in the development and progression of AECOPD and closely related to the severity and prognosis of the disease. Its dynamic changes can predict the condition changes and evaluate the clinical treatment effect of patients with AECOPD. Combined with common clinical indicators, CC16 can shorten the length of stay of patients.
Objective To review the research progress of the vacuum phenomenon in spine. Methods The recent articles about the vacuum phenomenon in spine were reviewed; the features of imaging and the cl inical correlation were summarized. Results The vaccum phenomenon has been described in every segment of the spine. This phenomenon occurs mostly to the disc space and represents a transparent area on radiograph. Conclusion The causes of the vacuum phenomenoninclude degeneration of the anatomic structures of spine, trauma, and other pathologic changes. The vacuum phenomenon has important diagnostic and cl inical significances.
Objective
To measure the rate of changes of the cardiac troponin T (cTnT) and serum urea nitrogen (N), serum creatinine (Cr), estimated glomerular filtration rate (eGFR) of acute type A aortic dissection (AAAD) patients before and after surgery, and to explore the prognostic significance of the rate of changes.
Methods
We retrospectively analyzed 77 AAAD patients' clinical data between August 2015 and March 2016 from the department of the cardiothoracic surgery in Nanjing Drum Tower Hospital. There were 57 males and 20 females with an average age of 51.1±13.1 years. The test results of cTnT, N, Cr, eGFR were recorded. Patients were divided into three groups based on the duration of ventilation: less than 48 hours, 48 hours to 7 days, longer than 7 days, and divided into two groups based on whether postoperative dialysis was performed: dialysis group and non-dialysis group.
Results
In the groups with different duration of ventilation, the rate of cTnT change differed significantly. The rate of Cr and eGFR change in the group with the duration of ventilation longer than 7 days showed significantly different compared to other two groups. We found that the rate of Cr and eGFR change were statistically significant between the dialysis group and the non-dialysis group. In the receiver operating characteristic curve (ROC), the optimal cut-off value of the Cr growth rate for predicting postoperative dialysis therapy was 58.1%, and the optimal cut-off value of the eGFR decline rate was 45.5%.
Conclusion
The rate of changes in cTnT, N, Cr and eGFR can be used as a reliable mean to evaluate respiratory and renal function for AAAD patients in the early stage, which will facilitate an early assessment of the prognosis of AAAD patients.
