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.
Lung cancer ranks among the most prevalent and lethal malignancies globally. Its prognostic outcomes are not only contingent upon tumor characteristics and therapeutic interventions but also intricately linked to the nutritional and immune profiles of patients. This article conducts a thorough review of both domestic and international research, providing a comprehensive synthesis of the prognostic value of widely investigated nutritional and immune indicators in the context of lung cancer. The primary objective is to identify optimal prognostic markers in clinical practice, offering guidance for precise post-treatment assessment and early intervention for lung cancer patients.
ObjectiveTo evaluate the value of 120 kV portal venous phase images combined with iodine maps created from dual-source dual-energy CT (DECT) for the diagnosis of pancreatic necrosis in the early stage of acute pancreatitis. MethodsThis prospective study enrolled 17 patients who underwent abdominal dual-source DECT within 72 hours from the onset of acute pancreatitis. All patients had received treatment in West China Hospital from May 2014 to August 2014. Comparison of the diagnostic value of 120 kV portal venous phase images alone and 120 kV portal venous phase images combined with iodine maps created from dual-source DECT was performed. ResultsSix of the 17 patients were found the presence of pancreatic necrosis (4 patients without obvious necrosis in the early stage developed to pancreatic necrosis, and 2 patients with the presence of necrosis in the early stage improved). The sensitivity, specificity, and accuracy of 120 kV portal venous phase images for the diagnosis of pancreatic necrosis were 50.0% (3/6), 100% (11/11), and 82.4% (14/17), respectively, and it had a good diagnostic value (AUC=0.856, P=0.018). The sensitivity, specificity, and accuracy of 120 kV portal venous phase images combined with iodine maps created from dual-source DECT for predicting pancreatic necrosis were 100% (6/6), 90.9% (10/11), and 94.1% (16/17), respectively, and this method had good value too (AUC=0.977, P=0.002), which higher than that of 120 kV portal venous phase images (P=0.002). ConclusionsThe 120 kV portal venous phase images combined with iodine maps created from dual-source DECT is helpful to improve subjective judgment in the diagnosis of pancreatic necrosis in the early stage of acute pancreatitis. It also contributes to the display of hypo-perfusion area of the pancreatic parenchyma, and has higher diagnostic value.
Objective To investigate the application value of spiral CT postprocessing technique in the airway stent implantation technology. Methods Twenty-three patients with malignant airway stenosis or malignant tracheoesophageal fistula who needed the treatment of airway stent implantation from May 2012 to April 2016 were collected, including 19 males and 4 females with an average age of (61.6±10.0) years. Bronchoscopy and spiral CT with three-dimensional airway reconstruction were proceeded for the same patients before and after stent implantation, and the relevant data about narrow airway was measured by volume rendering, multiplanar reformation (MPR) and CT virtual endoscopy (CTVE) in a variety of ways, to confirm the location and size of narrow airway and fistulas, the degree and length of airway stenosis, as well as the distal end of the situation, and evaluate the patency of airway, the position and shape of stents, adjacent airway and complications after stenting. The positive forecast outcomes of the two inspections wascompared. Results Airway stents were placed successfully according to the data from the spiral CT airway three-dimensional reconstruction. Thirty stents were implantated in the 23 patients, including 21 column-type stents, 3 L-type stents, and 6 Y-type stents. All stents stayed in situ, with patency and no deformation.The fistulas were closed and the airways were reopened. Symptoms of cough after eating and drinking and dyspnea were relieved. The positive rates of bronchoscopy and CT examination on diagnosis of airway stenosis were both 100% (23/23). Complications: MRP showed tumor growth leading to stenosis again in 3 patients, and CTVE displayed mucous congestion in 2 patients. Conclusions The technique of 64-layer spiral CT postprocessing technique can measure the relate data of airway stricture or fistulas as a kind of convenient, quick, accurate, and noninvasive method in patients with malignant airway stenosis or tracheoesophageal fistula who need the treatment of airway stenting. It is of high reference value both to airway stent implanting and postoperative observation, and is worthy of application.
As one of the most sophisticated research methods of evidence-based medicine, systematic review is an activity of collecting, arranging and analyzing medical information. The methodological characteristics of systematic review reflect the value orientation of this activity. By analyzing and summarizing these characteristics, this paper points that the process of systematic review reflects the value orientation of attaching importance to obtaining universal information sources, treating individual information in an add-weight way, discretion in interpreting results and updating of time-limited information in medical information activities.
Objective To systematically review the effect of inspiratory muscle training (IMT) on postoperative clinical outcomes among esophageal cancer patients. Methods The PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched from inception to January 16th, 2022 for randomized controlled trials (RCTs) and cohort studies on the clinical application of IMT among postoperative esophageal cancer patients. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results Eight studies were included, including 7 RCTs and 1 cohort study, involving 728 participants. The results of the meta-analysis demonstrated that IMT significantly enhanced postoperative respiratory muscle function [maximum inspiratory pressure (MIP): MD=5.75, 95%CI 0.81 to 10.70, P=0.02; maximum expiratory pressure (MEP): MD=8.19, 95%CI 4.14 to 12.24, P<0.001] and pulmonary function (FEV1%: MD=6.94, 95%CI 5.43 to 8.45, P<0.001; FVC%: MD=4.65, 95%CI 2.70 to 6.60, P<0.001; MVV: MD=8.66, 95%CI 7.17 50 10.14, P<0.001; FEV1/FVC%: MD=8.04, 95%CI 4.68 to 11.40, P<0.001). Additionally, the results indicated that IMT could substantially improve postoperative functional performance [six-minute walk test (6MWT): MD=66.99, 95%CI 10.13 to 123.85, P=0.02; Borg index: MD=−1.03, 95%CI −1.26 to −0.81, P<0.001]. However, no significant reduction in the incidence of postoperative complications was observed. Conclusion IMT can improve the postoperative clinical outcomes of esophageal cancer patients and facilitate patient recovery after surgery, which has high clinical value. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo investigate the value of esophageal activity examination under X-ray fluoroscopy and chest CT in evaluating the resectability of upper thoracic esophageal cancer.MethodsA total of 221 upper thoracic esophageal carcinoma patients underwent radical operation between 2009 and 2015 in our hospital were enrolled, including 141 males and 80 females with a median age of 59 (47-79) years. Preoperative routine esophageal activity examination under X-ray fluoroscopy and chest enhanced CT were performed to determine whether the tumor had external invasion. The results of the two methods were compared with that observed during the operation.ResultsThe number of patients with esophageal activity score 1-6 was 70, 85, 32, 29, 2 and 3, respectively. The area under the receiver operating characteristic (ROC) curve (AUC) of esophageal activity examination was 0.897 (95%CI 0.85-0.93, P<0.001), and the cut off value was >3. According to the ROC curve activity score, 4-6 points were considered as invasion, and 1-3 points were non-invasion. The sensitivity, specificity, accuracy and misdiagnosis rate of esophageal activity examination was 75.0%, 89.3%, 88.2%, 10.7%, respectively, and those of CT scan were 75.0%, 66.8%, 67.4%, 33.2%, respectively. Compared with CT scan, the specificity of esophageal activity examination was higher and the misdiagnosis rate was lower. Compared with the detection during the operation, 86.7% of patients with actual invasion of trachea and 85.7% of patients with actual invasion of other parts were in accordance with the esophageal activity examination results.ConclusionEsophageal activity examination under X-ray fluoroscopy can accurately predict the resectability of upper thoracic esophageal cancer, which is a useful supplement to chest CT examination, especially in the aspect of judging the relationship between lesions and the trachea.
Blockchain is a modern technological model for concatenating transaction records (also called blocks) by means of cryptography to concatenate and protect the contents. The core of blockchain technology lies in the demand of reducing cost, improving efficiency and optimizing the industry credit environment. The role of blockchain is mainly manifested in the value increment brought by application in industrial scenarios. This paper introduces the application of blockchain technology in medical records information preservation and sharing, regional medical complex construction, protection of sensitive information of patients, improvement of industry transparency, drug authenticity tracing, improvement of medical work mode, and effective improvement of medical cost safety accounting efficiency and discusses the existing problems in the application of blockchain technology in medical care industry, aiming to provide a reference for better application of blockchain technology in medical care industry in the future.