Significance To investigate the influence of different degrees of tumor resection on cerebral edema and prognosis after photodynamic therapy (PDT) for high-grade glioma. Approach A retrospective case-control study was conducted for the patients with high-grade glioma who underwent PDT and microsurgery in Zhejiang Provincial People’s Hospital from January 2020 to December 2022. Results There were 30 cases in the near-total resection group and 26 cases in the subtotal resection group. The statistical analysis showed that the patients receiving photodynamic-assisted near-total resection had a lower degree of postoperative cerebral edema, as well as significantly better progression-free survival. Conclusions The multimodality therapy with PDT and near-total resection can significantly reduce the degree of cerebral edema in patients with highgrade glioma and help to improve postoperative quality of life, inhibit tumor recurrence, and prolong the overall survival of patients.
To investigate the safety and effectiveness of retroperitoneal adrenalectomy via extra and intra perinephric fat approaches to provide experience and basis for resection of adrenal tumors through the retroperitoneal cavity. The clinical data of 284 patients undergoing retroperitoneal adrenalectomy in our hospital from December 2017 to March 2023 were collected. The basic characteristics of the two groups of patients and the changes in perioperative indicators were retrospectively analyzed. A total of 117 patients with intra perinephric fat approach (IPFA) were included,and 167 patients with extra perinephric fat approach (EPFA) were included. The estimated blood loss in the IPFA group (123.59 ± 50.76 ml) was higher than that in the EPFA group (99.10 ± 99.51 ml) (p = 0.015),and the operative time in the IPFA group(105.25 ± 42.25 min) was longer than that in the EPFA group(81.75 ± 30.45 min) (p < 0.001).The hospitalization expenses of IPFA patients (36,306.39 ± 7544.25RMB) were higher compared with patients receiving EPFA (32,122.77 ± 7284.00RMB) (p < 0.001).There were no significant differences between the two groups in terms of tumor size,blood transfusion times and postoperative hospitalization time. Retroperitoneal laparoscopic adrenalectomy is a safe and effective procedure that can be performed via extra and intra perinephric fat approaches.IPFA is associated with higher estimated blood loss, and the operation time of EPFA is shorter than IPFA. The choice of surgical approach may depend primarily on the experience of the surgeon, the characteristics of adrenal tumor, and the nature of perirenal adipose tissue.
ObjectiveThe purpose of this study was to construct a diagnostic model by exploring the potential predictors of high-risk Papillary Thyroid Microcarcinoma (PTMC) and verifying its reliability.MethodsA retrospective analysis of PTMC patients who underwent surgical treatment from 2004 to 2015 in the SEER database (training set) and the clinical pathological ultrasound information of PTMC patients at the Sichuan Provincial People's Hospital from 2020 to 2022 (external validation set) was conducted. In the training set, univariate and multivariate logistic regression analyses were used to screen independent predictive factors for high-risk PTMC patients in pathology. A nomogram diagnostic model was further constructed. Additionally, ROC curves and calibration curves were drawn to evaluate the efficiency of the model. In the external validation set, the diagnostic model was indirectly evaluated based on preoperative ultrasound imaging features to explore the feasibility and reliability of diagnosing high-risk PTMC through preoperative ultrasound imaging features.ResultsA total of 1628 patients were included in the training set, and 530 patients were included in the test set. The independent risk factors for pathological high-risk PTMC were sex, age, tumor maximum diameter, tumor invasive, and cervical lymph nodes (P<0.05). The C-index of the nomogram constructed based on these five factors was 0.947, with an optimal sensitivity of 96.7% and a specificity of 86.0%. The calibration curve showed that the model had high consistency. The area under the curve (AUC) value of the ROC curve for high-risk PTMC predicted by the risk score based on ultrasound features was 0.824 [95% CI (0.789, 0.860)], which was highly consistent with the risk score based on pathological features (κ= 0.758, P<0.05).ConclusionIndirect evaluation of a high-risk PTMC diagnostic model based on preoperative ultrasound imaging features had high predictive efficiency and potential value for clinical application.
小儿严重脓毒症是指机体对感染（可疑或证实）引发的全身性炎症反应失调,表现为过度反应或“瀑布效应”样连锁反应 [1] ,从而诱导的急性器官功能不全,如心血管、肺、脑和肾的功能障碍等,如病情急剧恶化,甚至可同时出现危及生命的心血管功能障碍及组织低灌注 [2-3] ,即脓毒性休克。小儿严重脓毒症往往会导致凝血功能障碍,但小儿严重脓毒症早期即以皮肤微血管栓塞为突出表现者实属少见。本文回顾分析1例重庆医科大学附属永川医院2019年收治的严重脓毒症合并SIC致皮肤坏死、截指的患儿的临床资料。
目的:比较2种探头经肛直肠腔内超声（endorectal ultrasonography,ERUS）在直肠癌术前T分期的应用价值及2种探头在不同位置直肠癌分期中的价值。方法:收集重庆医科大学附属第一医院2014年1月至2021年9月间440例直肠癌患者资料（直凸探头277例、环扫探头163例）,筛选出术前行ERUS检查及有术后病检结果的患者共301例,然后将术前超声T分期（uT）与病理分期（参考美国癌症委员会AJCC第八版）结果进行对照,计算术前超声分期的敏感性、特异性和准确性。结果:180例（直凸探头）直肠癌超声检查与病理结果比较,经ERUS的T分期总准确性为73%,各分期的准确率分别为T1 97%;T291%;T3 79%;T4 79%。121例（环扫探头）直肠癌超声检查与病理结果比较,经ERUS的T分期总准确性为74%,各分期的准确率分别为T1 93%;T2 84%;T3 83%;T4 88%。不同位置2种探头直肠癌诊断的准确率分别为直凸探头高位60%;中位75%;低位73%,环扫探头高位73%;中位75%;低位75%。结论:2种探头对于直肠癌术前T分期均有重要价值,对于不同位置直肠癌术前诊断,环扫探头的准确率稍高于直凸探头。结合实际情况,选择合适的探头或联合使用2种探头,能提高术前分期的准确率,为临床医师治疗提供良好依据。
