Malignant peritoneal mesothelioma is a very rare serous malignant tumor, which often manifests as multiple soft tissue masses in peritoneum and omentum, most of which are accompanied by ascites. In this study, a case of peritoneal malignant mesothelioma confirmed by pathological examination was presented. The case was rarely confined to the perihepatic peritoneum and grew into the liver. Without ascites, it was easy to be confused with intrahepatic lesions. Through case analysis, on the one hand, the MRI manifestations of malignant peritoneal mesothelioma are displayed. On the other hand, the main points of differentiation between extrahepatic and intrahepatic origin lesions are discussed, so as to improve the understanding and differential diagnosis ability of this disease.
It is difficult to distinguish the inferior alveolar nerve (IAN) from other tissues inside the IAN canal due to their similar CT values in the X image which are smaller than that of the bones. The direct reconstruction, therefore, is difficult to achieve the effects. The traditional clinical treatments mainly rely on doctors' manually drawing the X images so that some subjective results could not be avoided. This paper proposes the partition reconstruction of IAN canal based on shape features. According to the anatomical features of the IAN canal, we divided the image into three parts and treated the three parts differently. For the first, the directly part of the mandibular, we used Shape-driven Level-set Algorithm Restrained by Local Information (BSLARLI) segment IAN canal. For the second part, the mandibular body, we used Space B-spline curve fitting IAN canal's center, then along the center curve established the cross section. And for the third part, the mental foramen, we used an adaptive threshold Canny algorithm to extract IAN canal's edge to find center curve, and then along it established the cross section similarly. Finally we used the Visualization Toolkit (VTK) to reconstruct the CT data as mentioned above. The VTK reconstruction result by setting a different opacity and color values of tissues CT data can perspectively display the INA canal clearly. The reconstruction result by using this method is smoother than that using the segmentation results and the anatomical structure of mental foramen position is similar to the real tissues, so it provides an effective method for locating the spatial position of the IAN canal for implant surgeries.
Hepatoid adenocarcinoma is a rare extrahepatic malignant tumor with pathological characteristics similar to hepatocellular carcinoma. It is more common in the gastrointestinal tract and patients often have a history of hepatitis and elevated serum alpha fetoprotein (AFP). In clinical practice, patients may seek medical treatment due to liver lesions or elevated AFP, while primary gastrointestinal lesions are easily ignored. The author presents imaging findings of two patients who were diagnosed with hepatoid adenocarcinoma of stomach (HAS) due to elevated AFP in our hospital. By summarizing their clinical imaging characteristics and sorting out various clinical conditions that may cause elevated serum AFP, in order to improve the recognition and differential diagnosis of HAS.
Objective To explore the risk factors for new-onset atrial fibrillation (POAF) after off-pump coronary artery bypass grafting (OPCAB) alone. Methods A retrospective analysis was conducted on the clinical data of patients who underwent OPCAB in the Department of Cardiac Surgery Ward No.1 of Zhengzhou Seventh People’s Hospital from January 2020 to January 2024. Patients were categorized into POAF and non-POAF groups based on the occurrence of POAF. The clinical data of both groups were analyzed. Parameters underwent single-factor analysis, and variables with P≤0.05 in single-factor analysis were further analyzed through binary logistic regression to identify independent risk factors. Results A total of 496 patients were included. There were 312 males and 184 females, with age ranging from 50 to 78 years. There were 148 patients in the POAF group and 348 patients in the non-POAF group. The incidence of POAF after isolated OPCAB surgery was 29.8%. Results of univariate analysis showed that there was statistical difference in the incidence of diabetes (P=0.012), >75% stenosis of the left circumflex artery (LCX) (P=0.036), shock (P<0.001), graded left ventricular diastolic function (P<0.001), left ventricular ejection fraction (P<0.001), age (P<0.001), preoperative resting heart rate (P<0.001), left atrial diameter (P<0.001), E/A ratio (P<0.001), postoperative K+ concentration (P<0.001), and postoperative Mg2+ concentration (P<0.001). Binary logistic regression multifactor analysis revealed that age (OR=1.436, 95%CI 1.094 to 1.884, P=0.009), diabetes (OR=2.032, 95%CI 1.094 to 1.884, P=0.043), preoperative resting heart rate (OR=1.008, 95%CI 1.001 to 0.018, P=0.018), left atrial diameter (OR=4.409, 95%CI 1.711 to 11.359, P=0.002), E/A ratio (OR=1.713, 95%CI 1.115 to 2.633, P=0.014). The occurrence of POAF significantly prolonged mechanical ventilation time and ICU stay (both P＜0.001). Conclusion Age, diabetes, left atrial diameter, EA ratio, and preoperative resting heart rate are potential independent risk factors for POAF following OPCAB surgery. Additionally, the occurrence of POAF post-surgery can lead to prolonged mechanical ventilation and extended stay in the intensive care unit.
By analyzing the characteristics of elderly outpatients and their specific needs, we provided for them humane and personalized health services, through following the physiological and social medical model, and melting the humanistic care into the high quality of nursing care. With this mode, we can build a harmonious relationship between nurses and patients, and improve the elderly patients' quality of life and living.
ObjectiveTo understand the current situation of outpatient service, strengthen outpatient physicians management, maintain outpatient clinical order, and improve the credibility and service quality of public hospitals.MethodsThe measures such as deepening the supply-side reform of outpatient service, strengthening the awareness of integrity service, regulating suspending or substituting diagnosis service management, and optimizing doctors’ scheduling were performed to improve the outpatient service plan management since 2012. The data of outpatient diagnosis and treatment and doctor appraisals from 2013 to 2016 were retrospectively collected from hospital information system, combined with the third party satisfaction data; and the rates of suspending and substituting of outpatient service, clinical service time distribution for doctors at all levels, proportion of appointment register, and the average satisfaction index were analyzed.ResultsThe rates of suspending and substituting of clinical service reduced from 5.8% and 6.4% in 2013 to 2.5% and 4.1% in 2016, respectively, and the differences were statistically significant (P<0.05); the proportion of outpatient physicians with vice-senior title or above from 2014 to 2016 was lower than that in 2013, with the decrease from 81.0% in the morning and 73.0% in the afternoon to 75.9% and 69.1%, respectively; the proportion of appointment register increased from 54.7% in 2013 to 68.2% in 2016; the patients’ satisfaction was higher in 2016 than that in 2015.ConclusionThe outpatient service management of large general hospitals should be patients’ needs-oriented; with the awareness of integrity service, regulating the approval system of suspending or substituting of outpatient service, improving the pre-arranged planning for suspending service, optimizing the qualification admittance system, and improving the regular appraisal system, may effectively solve the problems of unbalanced outpatient physicians resources and service, maintain the good order of medical service, improve medical care quality, and raise patients satisfaction.
Objective To investigate the clinical characteristics of allergic and non-allergic asthma in Chinese adult asthmatic patients. Methods Consecutive treatment-naive adult outpatients with asthma were retrospectively analyzed in West China Hospital, Sichuan University from October 2014 to June 2016. The patients were classified into a non-allergic asthma (NAAS) group and an allergic asthma (AAS) group by skin prick test or antigen-specific IgE test. The differences between allergic and non-allergic asthma were compared in respect of gender, age, asthma control test (ACT) score, lung function, fractional exhaled nitric oxide (FeNO) level, body mass index (BMI), disease severity,etc. Results A total of 131 patients were enrolled in which 72 cases (54.96%) were allergic asthmatics and 59 cases (45.04%) were non-allergic asthmatics. The level of FeNO was statistically different (t=–2.762,P=0.007) between the NAAS group and the AAS group [(51.1±32.6)ppbvs. (69.1±41.7)ppb]. Seventeen cases of the NAAS group and 48 cases of the AAS group were complicated with rhinitis with statistically significant difference (χ2 =19.396,P=0.000). Airway limitation reversibility test showed that there were 37 cases in AAS and 20 cases in NAAS with no airway obstruction (NAO), 26 cases in AAS and 22 cases in NAAS with reversible airflow obstruction (RAO), 9 cases in AAS and 17 cases in NAAS with irreversible airflow obstruction (IAO), respectively, with statistically significant difference between two groups (Z=–2.461,P=0.014). There were 20 cases (33.9%) in NAAS and 37 cases (51.4%) in AAS with mild intermittent or persistent asthma, 18 cases (30.5%) in NAAS and 19 cases (26.4%) in AAS with moderate persistent asthma, 21 cases (35.6%) in NAAS and 16 (22.2%) in AAS with severe persistent asthma, respectively, with statistically significant difference (Z=–2.115,P=–0.034). The age, ACT score, FEV1%pred, and BMI had no statistical difference between two groups (allP>0.05). Conclusion Compared with allergic asthma, non-allergic asthma has less rhinitis, lower FeNO levels and higher prevalence of irreversible airflow obstruction.
Objective To evaluate the efficacy of normalization management on prognosis in elderly patients with coronary artery disease, in aspects of drug compliance, readmission rate and quality of life. Methods A total of 110 patients above 65 years old with coronary artery disease visiting West China Hospital from August 2010 to February 2011 were investigated. The patients were divided into two groups: the intensive management group (n=55) and the general management group (n=55). The measures such as regular follow-up, regular examination and medical education were conducted in the intensive management group, and the two groups were observed in aspects of drug compliance, readmission rate and quality of life. Results After 1-year follow-up, the percentages of patients taking aspirin/clopidogrel (98.18% vs. 67.27%, Plt;0.05), nitrate (85.45% vs. 40.00%, Plt;0.05), ACEI/ARB (56.36% vs. 18.18%, Plt;0.05), β receptor blocker (58.18% vs. 29.09%, Plt;0.05) and statin (94.55% vs. 32.73%, Plt;0.05) were higher in the intensive management group than those in the general management group. Also, the readmission rate was lower (12.73% vs. 41.42%, Plt;0.05) and the score of quality of life was higher in the intensive management group than that in the general management group. Conclusion The normalization management guided by evidence-based medicine for the elderly patients with coronary artery disease is helpful to improve the drug compliance, reduce the readmission rate, and improve the quality of life.