Primary breast angiosarcoma (PBA) is a rare malignant tumor, and few clinical cases have been reported. In this case, the mammographic and contrast-enhanced magnetic resonance imaging of PBA were reported, and the relevant pathologic basis was also briefly introduced in order to enhance the clinicians’ understanding of the imaging manifestations of this rare disease.
Objective To investigate the risk factors and the prevention and cure methods of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement. Methods From March 2004 to July 2008，twentythree patients with ischemic stroke after mechanical heart valve replacement had been researched(ischemic stroke group). One hundred and twenty patients who had undergone mechanical heart valve replacement were randomly chosen in the same period as control group. Gender, age, the dose of warfarin , anticoagulation intensity(INR), INR review interval, left atrial diameter and heart rhythm were compared between the two groups, and the risk factors of ischemic stroke were analyzed by logistic regression analysis. Results (1) Patients in ischemic stroke group all discharged from hospital after treatment, and they were followed up for 1 month-3 years after discharged. All the patients’ neurological complications improved obviously, and no recurrent embolism and severe hemorrhage was found. (2) There was no statistical significance between two groups in gender, age and the dose of warfarin（Pgt;0.05）. (3) Nonconditional logistic regression analysis on influence factors showed that atrial fibrillation（P=0.000）, left atrial enlargement（P=0.002）, low anticoagulation intensity（P=0.012） and longtime INR review interval（P=0.047）were the risk factors of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement. Conclusions (1)The prognosis of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement is better than that of intracranial hemorrhage, and the occurrence of ischemic stroke is related to many risk factors. (2)The influences of risk factors should be minimized in order to avoid ischemic stroke. (3) Early low intensity anticoagulation therapy is safe and effective for patients with ischemic stroke after heart valve replacement.
Sleep stage classification is a necessary fundamental method for the diagnosis of sleep diseases, which has attracted extensive attention in recent years. Traditional methods for sleep stage classification, such as manual marking methods and machine learning algorithms, have the limitations of low efficiency and defective generalization. Recently, deep neural networks have shown improved results by the capability of learning complex pattern in the sleep data. However, these models ignore the intra-temporal sequential information and the correlation among all channels in each segment of the sleep data. To solve these problems, a hybrid attention temporal sequential network model is proposed in this paper, choosing recurrent neural network to replace traditional convolutional neural network, and extracting temporal features of polysomnography from the perspective of time. Furthermore, intra-temporal attention mechanism and channel attention mechanism are adopted to achieve the fusion of the intra-temporal representation and the fusion of channel-correlated representation. And then, based on recurrent neural network and inter-temporal attention mechanism, this model further realized the fusion of inter-temporal contextual representation. Finally, the end-to-end automatic sleep stage classification is accomplished according to the above hybrid representation. This paper evaluates the proposed model based on two public benchmark sleep datasets downloaded from open-source website, which include a number of polysomnography. Experimental results show that the proposed model could achieve better performance compared with ten state-of-the-art baselines. The overall accuracy of sleep stage classification could reach 0.801, 0.801 and 0.717, respectively. Meanwhile, the macro average F1-scores of the proposed model could reach 0.752, 0.728 and 0.700. All experimental results could demonstrate the effectiveness of the proposed model.
ObjectiveTo explore and analyze the risk factors for arrhythmia in patients after heart valve replacement.MethodsA retrospective analysis of 213 patients undergoing cardiac valve replacement surgery under cardiopulmonary bypass in our hospital from August 2017 to August 2019 was performed, including 97 males and 116 females, with an average age of 53.4±10.5 year and cardiac function classification (NYHA) grade of Ⅱ-Ⅳ. According to the occurrence of postoperative arrhythmia, the patients were divided into a non-postoperative arrhythmia group and a postoperative arrhythmia group. The clinical data of the two groups were compared, and the influencing factors for arrhythmia after heart valve replacement were analyzed by logistic regression analysis.ResultsThere were 96 (45%) patients with new arrhythmia after heart valve replacement surgery, and the most common type of arrhythmia was atrial fibrillation (45 patients, 18.44%). Preoperative arrhythmia rate, atrial fibrillation operation rate, postoperative minimum blood potassium value, blood magnesium value in the postoperative arrhythmia group were significantly lower than those in the non-postoperative arrhythmia group (P<0.05); hypoxemia incidence, hyperglycemia incidence, acidosis incidence, fever incidence probability were significantly higher than those in the non-postoperative arrhythmia group (P<0.05). The independent risk factors for postoperative arrhythmia were the lowest postoperative serum potassium value (OR=0.305, 95%CI 0.114-0.817), serum magnesium value (OR=0.021, 95%CI 0.002-0.218), and hypoxemia (OR=2.490, 95%CI 1.045-5.930).ConclusionTaking precautions before surgery, improving hypoxemia after surgery, maintaining electrolyte balance and acid-base balance, monitoring blood sugar, detecting arrhythmia as soon as possible and dealing with it in time can shorten the ICU stay time, reduce the occurrence of complications, and improve the prognosis of patients.
ObjectiveTo investigate the effectiveness of retrograde muscle release in treatment of mild to moderate type ischemic muscle contracture of forearm classified by Tsuge.MethodsBetween March 2010 and September 2018, 11 patients with mild to moderate ischemic muscle contracture of forearm were treated with retrograde muscle release. There were 6 males and 5 females with an average age of 24 years (range, 16-29 years). According to Tsuge classification, 6 cases were mild type and 5 cases were moderate type. The interval between injury and operation was 9 months to 25 years, with a median of 17 years. The scar cords in the muscle of the middle one-third of the forearm was released firstly. If the standard of sufficient release was not reached, further releasing the scar cords in the muscle and the tense tendon structure in the proximal one-third of the forearm and the origins of the flexor muscles was necessary. If the standard was still not reached, the origins of the flexor muscles can be released and slid. The effectiveness was evaluated from six aspects of the range of motion of the hand and wrist, dexterity, grip strength, sensation, subjective function scores [quick-disability of the arm, shoulder, and hand questionnaire (Quick-DASH) and the patient-related wrist/hand evaluation (PRWHE)] and satisfaction.ResultsAll the incisions healed by first intention. Eight patients were followed up 1-106 months (median, 13 months). The range of motion of the hand and wrist was significantly improved, the results were excellent in 3 cases, good in 3 cases, and fair in 2 cases, with an excellent and good rate of 75%. The patient’s dexterity evaluation scored a perfect score of 12, which was close to the normal hand dexterity. At last follow-up, the grip strength on the affected side was 37.6%-95.5% of the contralateral side, with an average of 77.6%. Seven patients had normal sensation before and after operation, and the two-point discrimination of median nerve and ulnar nerve was 4-5 mm at last follow-up; 1 patient with forearm mechanical crush injury still felt numb after operation, and the two-point discrimination of median nerve and ulnar nerve was 8 mm and 7 mm, respectively. The Quick-DASH score was 0-15.9, with an average of 4.5, and the PRWHE score was 0-23.0, with an average of 6.6. All the patients were satisfied with the surgery and the effectiveness.ConclusionA targeted retrograde muscle release method for mild to moderate type ischemic contracture of forearm can achieve satisfactory effectiveness.
ObjectiveTo explore the application effect of telephone and WeChat follow-up in patients discharged from hospital with a lagging closed chest drain after stage Ⅲ tuberculous pyothorax surgery. MethodsThe patients discharged with tubes after stage Ⅲ tuberculous pyothorax surgery in the Department of Thoracic Surgery of Chengdu Public Health Clinical Medical Centre from November 2021 to November 2022 were selected for follow-up, and were divided into an observation group and a control group through random grouping to compare and analyse the patients' quality of life, adherence and recovery. Results A total of 81 patients' data were collected in this study, 49 patients in the observation group, with a mean age of 38.63±15.86 years, 63.27% (31/49) males and 36.73% (18/49) females, and 32 patients in the control group, with a mean age of 36.91±17.33 years, 84.38% (27/32) males and 15.63% (5/32) females.The postoperative quality of life scores of patients in the observation group were better than those of the control group in terms of physical function, emotional function, physical symptoms, general health, and quality of life (P<0.05), treatment adherence: daily activity time, use of respiratory trainer, and frequency of coughing were better than those of the control group (all P<0.001), the time of tube banding was less than those of the control group (P<0.001), and the recovery of albumin and haemoglobin was better than those of the control group (P<0.001). control group (P<0.001). ConclusionTelephone combined with WeChat follow-up can improve the quality of life ,compliance of follow-up care, who discharged with tubes ,effectively reduce the time of patients with tubes after surgery, promote nutritional recovery, and accelerate postoperative rehabilitation.
Objective To collect and store all interactions relating to medical information between our center and allied specialized hospitals by constructing a database system for thoracic surgery and pulmonary tuberculosis. Methods We collected all related medical records of patients who had been clinically diagnosed with pulmonary tuberculosis and tuberculous empyema using the CouchBase Database, including outpatient and inpatient system of the Department of Thoracic Surgery at the Public Health Clinical Center of Chengdu between January 2017 to June 2023. Then, we integrated all medical records derived from the radiology information system, hospital information system, image archiving and communication systems, and the laboratory information management system. Finally, we used artificial intelligence to generate a database system for the application of thoracic surgery on pulmonary tuberculosis, which stored structured medical data from different hospitals along with data collected from patients via WeChat users. The new database could share medical data between our center and allied hospitals by using a front-end processor. ResultsWe finally included 124 patients with 86 males and 38 females aged 43 (26, 56) years. A structured database for the application of thoracic surgery on patients with pulmonary tuberculosis was successfully constructed. A follow-up list created by the database can help outpatient doctors to complete follow-up tasks on time. All structured data can be downloaded in the form of Microsoft Excel files to meet the needs of different clinical researchers. Conclusion Our new database allows medical data to be structured, stored and shared between our center and allied hospitals. The database represents a powerful platform for interactions relating to regional information concerning pulmonary tuberculosis.
Objective To investigate the risk factors for arrhythmia after robotic cardiac surgery. Methods The data of the patients who underwent robotic cardiac surgery under cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed. According to whether arrhythmia occurred after operation, the patients were divided into an arrhythmia group and a non-arrhythmia group. Univariate analysis and multivariate logistic analysis were used to screen the risk factors for arrhythmia after robotic cardiac surgery. ResultsA total of 146 patients were enrolled, including 55 males and 91 females, with an average age of 43.03±13.11 years. There were 23 patients in the arrhythmia group and 123 patients in the non-arrhythmia group. One (0.49%) patient died in the hospital. Univariate analysis suggested that age, body weight, body mass index (BMI), diabetes, New York Heart Association (NYHA) classification, left atrial anteroposterior diameter, left ventricular anteroposterior diameter, right ventricular anteroposterior diameter, total bilirubin, direct bilirubin, uric acid, red blood cell width, operation time, CPB time, aortic cross-clamping time, and operation type were associated with postoperative arrhythmia (P<0.05). Multivariate binary logistic regression analysis suggested that direct bilirubin (OR=1.334, 95%CI 1.003-1.774, P=0.048) and aortic cross-clamping time (OR=1.018, 95%CI 1.005-1.031, P=0.008) were independent risk factors for arrhythmia after robotic cardiac surgery. In the arrhythmia group, postoperative tracheal intubation time (P<0.001), intensive care unit stay (P<0.001) and postoperative hospital stay (P<0.001) were significantly prolonged, and postoperative high-dose blood transfusion events were significantly increased (P=0.002). Conclusion Preoperative direct bilirubin level and aortic cross-clamping time are independent risk factors for arrhythmia after robotic cardiac surgery. Postoperative tracheal intubation time, intensive care unit stay, and postoperative hospital stay are significantly prolonged in patients with postoperative arrhythmia, and postoperative high-dose blood transfusion events are significantly increased.