Thyroid FNA cytology in Asian practice—Active surveillance for indeterminate thyroid nodules reduces overtreatment of thyroid carcinomas

Although Asian thyroid practices have implemented the American Thyroid Association guidelines, significant deviations in actual risk of malignancy (ROM) have been reported. With review of the literature from Asia, the authors examine the underlining reasons for actual ROMs reported in Asia being so different from western practice based on the author's perspective. Although the most popular diagnostic system for thyroid cytology used in Asian countries is the Bethesda system, the Japan Thyroid Association published clinical guidelines, including a national reporting system for thyroid cytology, to adapt conservative clinical management (active surveillance and strict triage patients for surgery) for low‐risk thyroid carcinomas. As less aggressive clinical management is favoured in Asian societies, strict triage of patients with indeterminate thyroid nodules for surgery is usually applied, which ultimately reduces overtreatment of indolent thyroid tumours. As a result, low resection rates and high ROMs for indeterminate nodules were achieved in Asian practices using the same Bethesda system. Recently, borderline thyroid tumours were introduced in the thyroid tumour classification and significant decreases in ROMs have been reported in the indeterminate categories in western practice. However, ROM of indeterminate nodules remained high in Asian practice even after borderline tumours were deemed benign. These results suggested that the diagnostic threshold of papillary thyroid carcinoma‐type nuclear features varied among practices (stricter in Asia than in western practice), and diagnostic surgery was not performed for a significant number of indeterminate nodules with benign clinical features in Asian practice, resulting in low rates of borderline tumours in surgically‐treated patients.     

Modeling of microorganisms transport in a cylindrical pore

A mathematical model accounting for key parameters as microbial propagation, metabolite formation, dispersion, microbial chemotaxis and water flooding has been proposed to simulate the transport of microorganisms and their metabolites in a cylindrical pore with oil adhered to its inside surface. The model focuses on the transport and the concentration distributions of microorganisms and their metabolites in the cylindrical pore, especially the concentrations that on the oil-water interface. Results from the present model indicate that microorganisms and their metabolites assembled on the oil-water interface during the water flooding process, and the concentration gradients of microorganisms and their metabolites from the pore center region up to the oil-water interface in radial direction of the cylindrical pore were consequently formed. Equilibrium concentrations of microorganisms and their metabolites in the cylindrical pore were obtained when water flow rate within a certain scope, and there existed a critical water flow rate at which the maximum equilibrium concentration of microorganisms on the oil-water interface was developed. Investigations carried out in this study may provide better understanding on the transport mechanism of microorganisms in porous media.     

Long-term results of hemipelvic allograft: Report of four cases

Reconstruction after the excision of pelvic tumors involving the pelvic ring implies difficult problems. Restoration of the function is difficult and an allograft can be one of the possible solutions. Pelvic allograft is recommended by many authors to reconstruct the pelvic ring following extensive resections of bone tumors. Between 1988 and 1989, we performed hemipelvic resection and allograft reconstruction in 4 patients with pelvic sarcomas. The mean age was 42.3 years (range 38–48), consists of 3 male and 1 female. One case developed an infection and one case showed recurrence, both responding to surgical treatment. Outcome in those cases in which surgery was curative to the primary tumor was satisfactory at 10 years follow-up, with a mean total Enneking score of 25.3 (range 24–27) and a good functional result in Merlé D'Aubigne functional score. Despite the limited number of cases presented, our results added to the reported results in the literature led us to consider that allografts are valuable in pelvic reconstructions after en-bloc resections for bone tumors. This revised version was published online in July 2006 with corrections to the Cover Date.     

A cylindrical model for studying subendocardial ischaemia in the left ventricle

In this paper a mathematical model of a left ventricle with a cylindrical geometry is presented with the aim of gaining a better understanding of the relationship between subendocardial ischaemia and ST depression. The model is formulated as an infinite cylinder and takes into account the full bidomain nature of cardiac tissue, as well as fibre rotation. A detailed solution method (based on Fourier series, Fourier transforms and a one dimensional finite difference scheme) for the governing equations for electric potential in the tissue and the blood is also presented. The model presented is used to study the effect increasing subendocardial ischaemia has on the epicardial potential distribution as well as the effects of changing the bidomain conductivity values. The epicardial potential distributions obtained with this cylindrical geometry are compared with results obtained using a previously published slab model. Results of the simulations presented show that the morphologies of the epicardial potential distributions are similar between the two geometries, with the main difference being that the cylindrical model predicts slightly higher potentials.     

Imaging depth variations in hyperspectral imaging: Development of a method to detect tumor up to the required tumor‐free margin width

Hyperspectral imaging is a promising technique for resection margin assessment during cancer surgery. Thereby, only a specific amount of the tissue below the resection surface, the clinically defined margin width, should be assessed. Since the imaging depth of hyperspectral imaging varies with wavelength and tissue composition, this can have consequences for the clinical use of hyperspectral imaging as margin assessment technique. In this study, a method was developed that allows for hyperspectral analysis of resection margins in breast cancer. This method uses the spectral slope of the diffuse reflectance spectrum at wavelength regions where the imaging depth in tumor and healthy tissue is equal. Thereby, tumor can be discriminated from healthy breast tissue while imaging up to a similar depth as the required tumor‐free margin width of 2 mm. Applying this method to hyperspectral images acquired during surgery would allow for robust margin assessment of resected specimens. In this paper, we focused on breast cancer, but the same approach can be applied to develop a method for other types of cancer.     

阑尾炎患者术后创口细菌感染特征及耐药性分析

目的探究急性阑尾炎患者术后切口细菌感染的细菌谱及药物敏感情况。方法选择2015年1月至2019年1月于我院行阑尾切除术后切口感染的66例患者作为研究对象,分析其伤口分泌物细菌培养结果和病原菌药敏情况。结果送检的66例标本中共有59例检出细菌,共分离病原菌15种,66株;其中有7例标本为两种细菌混合感染。检出的细菌中,革兰阳性菌39株,革兰阴性菌27株,其中革兰阳性菌以金黄色葡萄球菌、化脓性链球菌、溶血葡萄球菌为主;革兰阴性菌以大肠埃希菌、阴沟肠杆菌、铜绿假单胞菌为主。药敏试验显示,主要革兰阳性菌对头孢唑林、头孢拉定的敏感性较低,而对氨苄西林、阿莫西林、头孢他啶、头孢噻肟、美罗培南、亚胺培南以及利奈唑胺均具有较高的敏感性。主要革兰阴性菌对氨苄西林、阿莫西林、头孢唑林、头孢拉定以及头孢噻肟均不敏感,对头孢他啶、美罗培南、亚胺培南的敏感率大于50.00%,具有较高的敏感性。结论对于阑尾炎术后切口感染的患者,应加强无菌操作和病房环境清洁,在药敏试验结果明确前,建议使用头孢他啶或相对应的第三代头孢菌素进行抗感染治疗。     

腹腔镜子宫切除术对宫颈癌患者近期疗效及远期复发率的影响

目的:探讨腹腔镜根治性子宫切除术对宫颈癌患者近期疗效及远期复发率和生存率的影响。方法:选取2013年5月-2015年5月在我院接受手术切除治疗的宫颈癌患者71例为研究对象,根据手术方法不同将所选患者分为两组。腹腔镜组37例患者采用腹腔镜根治性子宫切除术,开腹手术组34例患者采用改良式根治性肿瘤切除术。观察并比较两组患者的手术时间、术中出血量、肿瘤切除长度、淋巴结清扫数、盆腔引流量、术后拔管时间等近期疗效,以及远期复发率及生存率。结果:与开腹手术组比较,腹腔镜组患者手术时间长、术中出血量少,差异具有统计学意义(P0.05);两组患者的肿瘤切除长度及淋巴结清除数比较,差异无统计学意义(P0.05);与开腹手术组比较,腹腔镜组患者的盆腔引流量较少,术后排气时间较早,差异具有统计学意义(P0.05);但两组患者术后拔管时间及住院时间比较,差异无统计学意义(P0.05);两组患者术后五年的复发率及生存率比较,差异无统计学意义(P0.05)。结论:腹腔镜根治性子宫切除术治疗宫颈癌的近期疗效显著,且不会影响患者的远期复发率及生存率。     

目标导向液体管理策略对腹腔镜直肠癌根治术患者血流动力学、组织灌注指标及肝肾功能的影响

摘要 目的：探讨目标导向液体管理策略（GDFT）对腹腔镜直肠癌根治术患者血流动力学、组织灌注指标及肝肾功能的影响。方法：选取 2016年7月~2019年4月期间我院收治的84例行腹腔镜直肠癌根治术患者,按照随机数字表法分为对照组（n=42）和研究组（n=42）,其中对照组患者予以常规输液方案,研究组予以GDFT治疗,比较两组患者围术期指标、体液容量、血流动力学、组织灌注指标及肝肾功能。结果：两组气腹时间、手术时间、住院时间、麻醉时间比较差异无统计学意义（P>0.05）,研究组胃肠功能恢复时间短于对照组（P<0.05）。研究组晶体液量、总输液量少于对照组（P<0.05）,胶体液量、尿量均多于对照组（P<0.05）。研究组诱导后即刻 (T2)~ 术毕时（T4）时间点心率（HR）低于对照组（P<0.05）;研究组T2时间点平均动脉压（MAP）高于对照组,手术开始1小时（T3）、T4时间点MAP低于对照组（P<0.05）。研究组T2~T4时间点动脉乳酸（aLac）、血糖（Glu）低于对照组,T3~T4时间点中心静脉血氧饱和度（ScvO2）高于对照组（P<0.05）。两组患者术前、术后3d、术后7d谷草转氨酶（AST）、谷丙转氨酶（ALT）、尿素氮（BUN）、肌酐（Cr）组间比较差异无统计学意义（P>0.05）;两组患者术后3d、术后7d的ALT、AST、BUN、Cr均呈先升高后降低趋势（P<0.05）。结论：GDFT与常规输液对腹腔镜直肠癌根治术患者肝肾功能的影响相当,但GDFT可较好地维持机体血流动力学平稳,并且对组织灌注和体液循环具有更好的改善效果。