Laparoscopic hepatectomy is routinely used in the surgical treatment of hepatocellular carcinoma, and has formed a standardized operating procedure. Tumors located in the segments Ⅶ and Ⅷ of liver as well as the paracaval subsegment of caudate lobe are considered to be difficult sites for laparoscopic hepatectomy due to the deep anatomical location, proximity to important vascular structures, difficulty in exposing the visual field under laparoscopy, and limited operating space. Based on the experience of our team and related research reports, the authors analyzed and summarized countermeasures for the difficulties of laparoscopic hepatectomy in the treatment of hepatocellular carcinoma in difficult sites. Adhering to the tumor-centered and margin-based principles, accurate preoperative assessment, selection of the correct surgical approach, designing liver resection plane guided by hepatic vena while taking into account portal vein territory, and giving preference to ananatomical hepatectomy while preserving functional liver parenchyma as much as possible are the prerequisites for ensuring minimally invasive and oncology benefits for patients with hepatocellular carcinoma in difficult sites.
Objective To investigate the effects of exogenous pulmonary surfactant （PS） on ventilation weaning and respiratory mechanics in infants with acute lung injury（ALI） after cardiopulmonary bypass （CPB）.Methods Twelve infants underwent cardiopulmonary bypass cardiac surgery committed with ALI and difficulty in weaning from ventilation were included in this study.Exogenous PS was used in the treatment via intra-tracheal administration.The changes of blood gas，respiratory mechanics and the conditions of ventilation weaning were observed.Results After intra-tracheal PS administration，spontaneous breath remained steady；spontaneous respiratory rate significantly decreased from，tidal volume of spontaneous breath increased significantly.Three concave sign disappeared and koilosternia was alleviated.PaCO2 value decreased significantly and peak inspiratory pressure（PIP） decreased from （36.18±10.25）cm H2O to （25.11±5.14）cm H2O （Plt;0.01）.Static lung compliance （Cstat） increased from （1.49±0.65）mL·cm H2O-1·kg-1 before treatment to （1.95±0.50） mL·cm H2O-1·kg-1 6 h after treatment （Plt;0.01）；and airway resistance （Rstat）decreased from （128.17±26.34） cm H2O·L-1·s-1 before treatment to （78.56±18.22） cm H2O·L-1·s-1 6 h after treatment （Plt;0.01）.All 12 infants weaned from ventilator successfully.Conclusion Combined with PS intra-tracheal treatment，lung protective ventilation strategy can significantly improve parameters of respiratory mechanics，increase dynamic lung compliance，decrease airway resistance，which can decrease the breathing effort of the infants and make it easy to wean from ventilator.
Dyspnea is the most common symptom in patients with acute heart failure syndrome (AHFS), and relieving dyspnea is an important goal in clinical practice, clinical trials and new drug regulatory approval. However, in clinical and scientific research, there is still no consensus on how to evaluate dyspnea, and there is still a lack of unified measurement methods. This article introduces the pathophysiological mechanism of dyspnea in acute heart failure, the measuring time of dyspnea, the posture of patients during measurement, the measuring conditions, and the common measurement methods of dyspnea in clinical trials and their advantages and disadvantages, so as to provide references for the selection of measurement methods of dyspnea in clinical trials of acute heart failure.
目的:探讨5·12地震灾区11～16岁少年儿童的心理健康状况及其影响因素，为下一步开展创伤后心理危机干预提供依据。方法:在地震发生后一个月，使用长处与困难问卷（SDQ）学生版，调查了1268名来自于灾区的少年儿童（平均年龄14.20±1.02岁，男女比例1:1.02）的心理健康状况及其影响因素。结果:（1）灾区少年儿童SDQ总困难因子平均得分为13.66±5.75，74.9%的人报告自身存在主观困难；（2）女性的总困难因子、情绪因子、亲社会因子得分高于男性（z=-4.317，-7.963，-3.717；Pslt;0.001）；（3）困难对少年儿童社会功能的影响程度随年龄增加（χ2=7.684，P=0.021）。年龄越大，多动因子得分有增加的趋势（χ2=13.881，P=0.001）；（4）重度暴露组其总困难因子、情绪因子、影响因子得分高于轻度暴露组（z=-2.374，-4.279，-2.114；Pslt;0.05），困难造成的主观精神困扰程度前组高于后组（z=-2.920，P=0.004）；（5）女性、高年龄者、教师/同学伤亡较重者、震后被转移至安全的帐篷或房屋的间隔时间越长者，SDQ总困难因子异常的危险性越高。结论:震后灾区少年儿童的心理健康状况受到暴露水平、性别、年龄以及震后被转移至安全地点的时间的影响，心理干预应综合考虑相关因素。
目的 了解5.12汶川大地震24个月后震区小学生的心理健康状况，为进行震后长期心理危机干预提供依据。 方法 于2010年5月即汶川大地震发生后24个月，分别使用创伤应激量表儿童版（CRIES-13）、儿童抑郁障碍自评量表（DSRSC）、长处与困难问卷（SDQ）学生版，调查了553名来自于彭州灾区的小学生的心理健康状况及其影响因素。 结果 ① 灾区小学生CRIES-13总分为（22.98 ± 12.29）分，其中大于划界分（30分）者为143人，占总人数的25.9%；女性总分高于男性（Z=?2.031，P=0.042）；震后被转移至安全地点的时间越长（OR=1.025，P=0.012）、家人伤亡越严重（OR=1.141，P=0.021），其CRIES-13总分大于划界分的可能性越高。② 灾区小学生DSRSC总分为（11.07 ± 5.78）分，其中总分大于划界分（15分）者为120人，占总人数的21.7%；女性总分高于男性（Z=?2.508，P=0.012）；灾区小学生的年龄（r=0.098，P=0.021）、震后被转移至安全地点的时间（r=0.117，P=0.004）与DSRSC总分呈正相关。③ 灾区小学生SDQ总困难因子得分为（14.97 ± 5.44）分，62.9%的人报告自身存在主观困难；女性的情绪因子、亲社会因子得分高于男性（Z=?3.123，P=0.002；Z=?2.243，P=0.025）；年龄越大，品行因子（χ2=7.604，P=0.023）、亲社会因子（χ2=8.102；P=0.017）得分增加。 结论 震后灾区小学生的心理健康状况受到性别、年龄、震后被转移至安全地点的时间、家人伤亡程度的影响，震后长期心理危机干预应综合考虑这些相关因素以确定高危人群。
【摘要】 目的 总结非器质性呼吸困难患者的急诊诊治经验，提高急诊医生对心理-生理性疾病的认识。 方法 对2005年-2009年急诊科32例非器质性呼吸困难患者的诊治经过进行回顾性分析。 结果 32例患者发病前均有精神创伤或过度劳累、精神紧张、或应急等心因性诱因；有典型的临床症状；过度通气激发试验阳性；血气分析提示呼吸性碱中毒；Nijmegen问卷积分≤23分者18例（56.2%）；辅助检查未见其他原发性疾病。 结论 随着现代社会身心压力的增大，非器质性呼吸困难患者明显增加，临床医生应加强对社会心理-生理性疾病的认识，提高诊断率，对减轻患者的精神压力及避免过度医疗具有重要的临床意义。【Abstract】 Objective To summarize the medical experiences of treating nonorganic dyspnea in the emergency department and raise physicians’ awareness of psychological-physiological diseases. Methods The clinical data of 32 patients with nonorganic dyspnea between 2005 and 2009 in the emergency department of our hospital were analyzed retrospectively. Results All the 32 patients had psychogenic incentives before onset of the disease, such as mental injury, over-exhaustion, nervousness or emergency. All of them had typical clinical manifestations. The results of hyperventilation provocation test were positive. Arterial blood gas analysis implied respiratory alkalosis. Eighteen of them (56.2%) had a mark ≤23 on the Nijmegen questionnaire. Auxiliary examinations showed no other primary diseases. Conclusions With the increase of emotional stress in the modern society, the number of patients with nonorganic dyspnea have markedly increased. Clinicians should strengthen the awareness of social psychology-physiological diseases, and improve diagnostic accuracy, which will have an obvious clinical value in relieving patients’ mental stress and avoiding excessive medical treatment.
In deep learning-based image registration, the deformable region with complex anatomical structures is an important factor affecting the accuracy of network registration. However, it is difficult for existing methods to pay attention to complex anatomical regions of images. At the same time, the receptive field of the convolutional neural network is limited by the size of its convolution kernel, and it is difficult to learn the relationship between the voxels with far spatial location, making it difficult to deal with the large region deformation problem. Aiming at the above two problems, this paper proposes a cascaded multi-level registration network model based on transformer, and equipped it with a difficult deformable region perceptron based on mean square error. The difficult deformation perceptron uses sliding window and floating window techniques to retrieve the registered images, obtain the difficult deformation coefficient of each voxel, and identify the regions with the worst registration effect. In this study, the cascaded multi-level registration network model adopts the difficult deformation perceptron for hierarchical connection, and the self-attention mechanism is used to extract global features in the basic registration network to optimize the registration results of different scales. The experimental results show that the method proposed in this paper can perform progressive registration of complex deformation regions, thereby optimizing the registration results of brain medical images, which has a good auxiliary effect on the clinical diagnosis of doctors.
ObjectiveTo investigate the effect of recruitment maneuver (RM) following fibrobronchoscopy in invasively mechanically ventilated (IMV) patients with excessive airway secretions or foreign body aspiration. MethodsFrom September 2012 to July 2014, 200 eligible patients were randomly assigned to intervention group (n=100) and control group (n=100) . Airway clearance by fibrobronchoscopy was conducted in both the two groups, but RM was subsequently performed only in the intervention group. Outcome measurements included oxygenation index, partial pressure of carbon dioxide (PaCO2), heart rate (HR), air way resistance (Raw) and dynamic lung compliance (Cdyn) before and 2 hours after treatment, and duration of IMV and Intensive Care Unit (ICU) stay were also analyzed. ResultsAfter treatment with fibrobronchoscopy, oxygenation index [intervention vs. control: (291.14±38.49) vs. (241.39± 35.62) mm Hg (1 mm Hg=0.133 kPa)], PaCO2 [(41.65±7.73) vs. (38.87±7.97) mm Hg] and Cdyn [(48.94±11.21) vs. (39.59±10.98) mL/cm H2O (1 cm H2O=0.098 kPa) ] were significantly increased, while HR [(95.41±20.59) , vs. (106.47±19.11) beats/min] and Raw [(17.87±8.32) vs. (23.98±7.88) cm H2O/(L·s)] were significantly decreased in both groups (P ＜ 0.01) . Duration of IMV and ICU stay in the intervention group were (15.72±6.42) and (19.85±8.12) days respectively, while in the control group were (20.49±7.21) and (27.87±10.33) days. Compared with the control group, patients in the intervention group had lower Raw, duration of IMV and ICU stay, and higher Cdyn, oxygenation index, and PaCO2 (P ＜ 0.01) , but no significant difference was found in HR (P ＞ 0.05) . ConclusionIn mechanically ventilated patients with excessive airway secretion or foreign body aspiration, recruitment maneuver following fibrobronchoscopy is of great clinical importance, due to the decrease of the duration of mechanical ventilation and ICU stay by re-inflating the collapsing alveoli, improving pulmonary ventilation and gas exchange, lung compliance and diffusion capacity.
Accurate segmentation of pulmonary nodules is an important basis for doctors to determine lung cancer. Aiming at the problem of incorrect segmentation of pulmonary nodules, especially the problem that it is difficult to separate adhesive pulmonary nodules connected with chest wall or blood vessels, an improved random walk method is proposed to segment difficult pulmonary nodules accurately in this paper. The innovation of this paper is to introduce geodesic distance to redefine the weights in random walk combining the coordinates of the nodes and seed points in the image with the space distance. The improved algorithm is used to achieve the accurate segmentation of pulmonary nodules. The computed tomography (CT) images of 17 patients with different types of pulmonary nodules were selected for segmentation experiments. The experimental results are compared with the traditional random walk method and those of several literatures. Experiments show that the proposed method has good accuracy in the segmentation of pulmonary nodule, and the accuracy can reach more than 88% with segmentation time is less than 4 seconds. The results could be used to assist doctors in the diagnosis of benign and malignant pulmonary nodules and improve clinical efficiency.