ObjectiveTo explore the risk factors of recurrence of incisional hernia following incisional hernia tension-free repair. MethodsThe clinical data of 162 patients with incisional hernia underwent tension-free repair were retrospectively analyzed in this hospital from January 2005 to January 2011. The relationships of incisional hernia recur-rence to gender, age, body mass index, hernia size, abdominal wall defect site, preoperative chronic comorbidities, type of tension-free repair, operation time, and wound healing disorders were analyzed by univariate and multivariate analysis. ResultsOne hundred and sixty-two patients were followed up 7-70 months with mean 34.5 months. The rate of recur-rence following incisional hernia tension-free repair was 9.26% (15/162). The results of univariate analysis showed that recurrence following incisional hernia tension-free repair was associated with the age (P < 0.05), body mass index (P < 0.05), type of tension-free repair (P < 0.05), hernia size (P < 0.05), and wound healing disorders (P < 0.05). The results of multivariate logistic regression revealed that the body mass index, type of tension-free repair, hernia size, and wound healing disorders were the independent risk factors associated with recurrence following incisional hernia tension-free repair. Fifteen recurrent patients were reperformed successfully. There was no recurrence following up with an average 23 months. ConclusionsIt is necessary to become familiar with the risk factors for recurrence of incisional hernia in order to eliminate or decrease their effects on the positive outcome of incisional herniorrhaphy. The patients with fat, hernia ring bigger, incorrect opera-tion or wound healing disorders might be easy to relapse. Surgical approach should be individualized for recurrence.
ObjectiveTo summarize the research progress of osteonecrosis of femoral head (ONFH) following femoral intertrochanteric fractures in adults.MethodsRelevant literature at home and abroad was extensively reviewed to summarize the pathogenesis, high-risk factors, and treatment of ONFH after femoral intertrochanteric fracture in adults.ResultsONFH after femoral intertrochanteric fracture mostly occurs within 2 years after operation, with a lower incidence. At present, it is believed that comminuted and large displacement fractures caused by high-energy injuries, fracture line close to the base of neck, excessive external rotation deformity, improper intramedullary nail entry points, and rough intraoperative manipulating may injury the deep branch of the medial circumflex femoral artery, causing ONFH. Hip replacement is the main treatment for necrosis, which can achieve good results.ConclusionAddressing the above risks, excessive external rotation, overstretching, and rough manipulating should be avoided. Anatomical reduction should be performed during the operation, the nail entry point should be accurate and avoid repeated drilling and thermally bone necrosis.
Objective To study the distribution of HIV/AIDS high-risk population, HIV infection and the main risk factors for developing HIV/AIDS’ controllable measures and exploring appropriate health education and behavior intervention models. Methods A total of 360 commercial sex workers (CSW) joined together through convenience sampling and 360 drug users (DU) joined together through convenience sampling or snow-balling sampling whose relevant behavior factors were investigated by questionnaires. Results The general rate of knowing knowledge about AIDS was 75.2% among 360 CSW, 67.8% CSW used condom in commercial sex activities; none of 149 CSW blood samples was detected HIV or syphilis antibody positive. The general rate of knowing knowledge about AIDS was 83.7% among 360 DU who injected drugs last month, the rate of sharing needles was 47.6% and the low rate of condom used; 1 HIV antibody and 5 syphilis antibodies positive were found among 198 DU blood samples, so HIV and syphilis infection rate were 0.51%and 2.53%, respectively. Conclusion The rate of HIV infection is a very low level and there are many risk factors among CSW and DU. A good job should be done to integrate AIDS health education with behavioral intervention and the monitoring system for the AIDS/HIV high-risk population should be improved.
Objective To summarize the experience of sequentially minimally invasive treatment for aged and high risk symptomatic pancreatic pseudocyst under ultrasound guided percutaneous catheter drainage combined with endoscopic technique. Methods The clinical data of 30 patients with aged and high risk pancreatic pseudocyst treated from January 2009 to January 2012 in this hospital were analyzed retrospectively. Results Percutaneous tubes were successfully placed in 30 patients， cystic liquid was sufficiently drained， and the compression symptom of cyst was relieved immediately. After stable disease， 12 patients with communicating cysts were diagnosed by using endoscopic retrograde cholangiopancreatography. Pancreatic duct stents were inserted in 12 patients with communicating cysts for 60-90d （with an average 70d） after endoscopic sphincterectomy and endoscopic pancreatic sphincterectomy. Cysts disappeared in the other 18 cases receiving external drainage with external drainage tubes， the drainage time was 15-90 d with an average 30d. Neither recurrence nor complications were found in all the cases during 12-21 months （with an average 18 months） follow-up. Conclusion Interventional ultrasound combined with endoscopic technique sequentially minimally invasive treatment for aged and high risk symptomatic pancreatic pseudocyst has superiorities in little trauma， fewer complications， and exact effect.
ObjectiveTo sort out the historical evolution of diagnostic screening methods for pancreatic cancer, and to explore how to achieve early diagnosis and treatment of pancreatic cancer in the context of China’s large population base and economic development.MethodsSystematic review was performed. The computer was used to search databases inchuding CNKI, VIP, WanFang Data, Web of Science, PubMed and EMbase. Two researchers independently searched Baidu search engine to collect relevant reports on screening methods and effect evaluation of pancreatic cancer published before February 28, 2018, and a qualitative descroption was made.ResultsA total of 117 articles were included in the study. The exploration of screening methods for pancreatic cancer in China has experienced three stages: germination, enlightenment and growth. Current screening methods include clinical manifestations, imaging screening methods, serum tumor markers and molecular biology gene diagnosis, each of which had its advantages and disadvantages. Single method could not achieve higher specificity and sensitivity, and joint detection had become an inevitable trend. Considering the benefit of practical application, screening among high-risk groups could effectively reduce the population size and achieve accurate screening.ConclusionThere was a big gap between domestic and foreign research in screening for pancreatic cancer. Screening methods are diverse, and joint detection is an inevitable trend. Screening for pancreatic cancer in high-risk population will become a breakthrough under the technical bottleneck.
ObjectivesTo evaluate and preliminarily analyze the application value and efficacy of artificial intelligence optical coherence tomography (AI-OCT) technology in the early screening of retinal diseases among the elderly, hypertension, hyperglycemia, high myopia and hyperlipidemia (referred to as "Five-High") population. MethodsA diagnostic trial was conducted. A total of 3 834 patients (7 668 eyes) with "Five-High" risk factors who visited the outpatient clinics of Shenyang Fourth People’s Hospital from July to December 2024 were included. OCT imaging of the macular and peripheral retina was performed using the Bigway AI-OCT image analysis system (wide-field three-dimensional scanning mode). The deep learning-based system automatically identified and labeled eight types of high-risk retinal lesions: subretinal fluid (SRF), intraretinal fluid (IRF), epiretinal membrane (ERM), choroidal neovascularization (CNV), hyper-reflective foci (HRF), retinal pigment epithelium detachment, retinal hemorrhage, and macular hole (MH). The positive rate of AI screening and the distribution of high-risk lesions were analyzed. Consistency between AI-OCT screening results and ophthalmologist review was assessed using Cohen’s Kappa test. Logistic regression was used to identify independent predictors of positive AI-OCT screening. Referral and treatment rates were also analyzed. ResultsAmong 3 834 cases involving 7 668 eyes, 803 cases (1 606 eyes) were positive in AI-OCT screening, with a positive rate of 20.9% (803/3 834), including 266 high-risk and 537 non-high-risk patients, respectively. The positive screening rates of patients with "five highs" were as follows: hyperlipidemia 25.2% (185/735), advanced age 24.9% (746/1 998), hyperglycemia 24.8% (345/1 392), hypertension 23.8% (228/956), and high myopia 19.0% (40/210). Among 1 606 positive eyes, 1 355 high-risk lesions were identified by consensus. Among them, ERM had the largest number of identifications (780, 57.6%), followed by HRF (255, 18.8%), and MH had the smallest number of identifications (7, 0.5%). Physicians randomly reexamined 1 352 cases and 2 704 eyes. The number of positive and negative eyes diagnosed was 753 and 1 952 respectively. The number of positive and negative eyes screened by AI-OCT was 828 and 1,876 respectively. There was an excellent consistency between AI-OCT screening and physician diagnosis (Kappa=0.866, P=0.011). Multivariate logistic regression analysis showed that age [odds ratio (OR) =1.071, P＜0.001], high myopia (OR=1.921, P=0.001), and hyperglycemia (OR=1.287, P=0.005) were independent predictors of positive AI-OCT screening. Among 1 355 high-risk lesions, a total of 703 were referred (referral rate 51.9%). The three lesions with the highest referral rates were SRF (71.1%, 27/38), IRF (69.2%, 54/78), and CNV (61.5%, 24/39), respectively. Among the 803 cases with positive AI-OCT screening, 385 cases (47.9%) actually received referral suggestions, 259 cases (32.3%) were eventually diagnosed, and 109 cases (13.6%) received treatment. Compared with low-risk patients, the referral rate and diagnosis rate of high-risk patients were significantly higher (χ2=6.87, 4.48; P＜0.05), but there was no statistically significant difference in the final treatment acceptance rate between groups (χ2=1.15, P=0.28). ConclusionsThe established AI-OCT based screening model for fundus diseases in the “Five-High” population effectively improves the detection rate of early-stage lesions and promotes a shift from universal to precision screening. Patients with positive screening results have obvious referral and treatment obstacles, which requires clinical attention.
ObjectiveTo investigate the screening value of cervical fluid-based cytology test (TCT), high-risk human papillomavirus (HR-HPV) test, and colposcopy for cervical intraepithelial neoplasia (CIN) and cervical cancer in high-risk populations. MethodsA total of 466 patients between January 2013 and January 2015 with a history of intercourse bleeding were enrolled in this study, and the screening value of TCT, HR-HPV test and colposcopy for CIN and cervical cancer were retrospectively evaluated. ResultsIn the 466 patients, 165 were diagnosed with cervical inflammation, 116 with CIN, 182 with grade 2-3 CIN, and 3 with cervical cancer. The colposcopy had the highest sensitivity (84.1%), the lowest specificity (59.4%), high false positive rate (40.6%), low false negative rate (15.9%), and the highest negative predictive value (67.1%). The TCT had the highest specificity (84.8%) and the lowest false positive rate (15.2%). The indicators of HR-HPV were between those of TCT and colposcopy. There were significant differences in terms of these indicators among the three methods (P < 0.05). And the positive prediction value of HR-HPV was the highest (84.5%), while the negative prediction value of colposcopy was the highest (67.1%). There was a significant difference in the predictive value among the three methods (P < 0.05). The consistency of either TCT or HR-HPV alone with pathological diagnosis was poor (K=0.213, 0.343), while that of colposcopy was moderate (K=0.446). Combination of TCT and HR-HPV could significantly improve the diagnosis sensitivity (93.0%) with a lower false negative rate (7.0%); Youden index was 0.736, and the consistency with pathological examination was high (K=0.748). ConclusionsFor high-risk population with a history of intercourse bleeding or other abnormal cervical disorders, the screening sensitivity of TCT and HR-HPV alone for CIN and cervical cancer is low with a high false negative rate. Colposcopy has a high sensitivity and a low specificity. By combination of TCT and HR-HPV, the validity, reliability and predictive values can be improved significantly, and the sensitivity is high with a low false negative rate and a high consistency with pathological examination.
ObjectiveTo analyze the risk factors of postoperative cognitive dysfunction (POCD) in elderly patients after abdominal surgery. MethodsThe clinical data of 2 286 patients over 60 years old after abdominal surgery were retrospectively analyzed, which were divided into non-POCD group with 2 248 patients and POCD group with 38 patients. The influencing factors of POCD in elderly patients after abdominal surgery, including the age, gender, anesthetic way, the premedication, cormobided with lung or heart disease, diabetes, jaundice, anemia or hypoproteinemia, the duration of surgery, and postoperative analgesia protocols, were analyzed between two groups. ResultsThe age, anesthetic way, cormobided with lung or heart disease, diabetes, jaundice, with or without continuous postoperative effective analgesia, and surgery duration over four hours were relevant with POCD (Plt;0.05), while gender, the premedication, and preexisted anemia or hypoproteinemia were not relevant with that (Pgt;0.05). ConclusionAge over 70 years, general anaesthesia, cormobided with lung or heart disease, diabetes, jaundice, surgery duration over four hours, and incomplete postoperative analgesia are the risk factors of POCD after abdominal surgery.