EBUS-TBNA超声内镜对纵隔肿大淋巴结良恶性的鉴别诊断价值

目的:分析超声内镜引导下经支气管针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration，EBUS-TBNA)术中肿大纵隔淋巴结的超声图像特点，探讨EBUS-TBNA超声内镜对纵隔淋巴结良恶性的鉴别诊断价值，以期提高EBUS-TBNA对纵隔淋巴结恶性病变的活检率。方法:回顾性分析2014年10月至2018年11月行EBUS-TBNA患者的超声内镜图像。我们使用以下EBUS超声内镜特征来预测淋巴结的良恶:回声，长轴长度，短轴长度，纵横比，形态，边界，淋巴门有无，淋巴结内血流信号分级。将超声检查结果与最终病理结果或临床随访结果进行比较。采用SPSS 20.0软件进行统计学分析，采用logistic回归分析评价肿大淋巴结EBUS-TBNA超声内镜下的特征与良恶性的相关性，以 P<0.05 为标准判定差异有统计学意义。结果:对130例纵隔淋巴结肿大患者的227个淋巴结进行回顾性分析，67.4%的肿大淋巴结被证实为恶性转移。Logistic回归分析显示回声、长轴及短轴的长度、正常淋巴门结构的消失是诊断恶性淋巴结的独立预测因素。结论:纵隔恶性淋巴结具有一定的超声特征，可以通过这些超声特征提高EBUS-TBNA对纵隔恶性淋巴结的检出率。     

微创穿刺抽吸术与开颅手术治疗脑出血的疗效

目的探讨微创穿刺抽吸术与开颅手术治疗脑出血的疗效。方法选择2017年1月-2018年1月治疗的脑出血患者80例作为对象,根据住院时间先后顺序随机数字表分为对照组(n=40)和观察组(n=40)。观察组给予患者微创穿刺抽吸术治疗,对照组给予患者开颅手术治疗,比较两组患者术后总治愈效率和手术开展时间、住院天数。结果观察组手术开展时间、住院天数短于对照组(P<0.05);观察组的总治愈效率为90%高于对照组75%(P<0.05);观察组患者术后意识恢复时间短于对照组(P<0.05)观察组患者术后肢体障碍及肺部感染、伤口感染发生率均略低于对照组,但差异不具有统计学意义(P>0.05)。结论微创穿刺抽吸术在脑出血临床治疗中比开颅手术总治愈率高、安全性高、恢复快。     

多学科协作模式康复护理对脑卒中吞咽功能障碍患者吞咽功能及吸入性肺炎发生的影响

目的探讨多学科协作模式康复护理对脑卒中吞咽功能障碍患者吞咽功能及吸入性肺炎发生的影响。方法选择2018年3月-2020年3月我科收治的脑卒中吞咽功能障碍患者86例,按照随机数字表法分为对照组和观察组,每组43例。对照组采取常规专科护理。观察组采取多学科协作模式康复护理,持续干预12周。比较两组护理前后心理状态、神经功能、吞咽功能及吸入性肺炎发生率。结果两组护理前焦虑自评量表(SAS)、抑郁自评量表(SDS)、美国国立卫生研究院卒中量表(NIHSS)评分比较,差异无统计学意义(P>0.05);观察组护理后SAS、SDS、NIHSS评分低于对照组(P<0.05);观察组吞咽功能恢复优良率为90.70%,高于对照组的74.42%,吸入性肺炎发生率为4.65%,低于对照组的20.93%(P<0.05)。结论多学科协作模式康复护理能够改善脑卒中吞咽功能障碍患者心理状态,促进神经及吞咽功能恢复,预防吸入性肺炎的发生。     

Hybrid mechanical thrombectomy for acute ischemic stroke using an intermediate aspiration catheter and Trevo stent simultaneously

PurposeTo overcome the limitations of traditional mechanical thrombectomy (MT), including catheter aspiration and stent retrievers, such as thrombus fragmentation or migration, we designed hybrid MT using an intermediate aspiration catheter and a Trevo stent simultaneously. We retrospectively compared hybrid MT with the traditional MT.MethodsFrom January 2017 to January 2019, we performed MT on 91 occlusions, including internal carotid artery bifurcation (n = 17), M1 segment (n = 53) and M2 segment (n = 21), using hybrid MT (n = 42) and traditional MT (n = 49).ResultsHybrid MT had a shorter procedure time (52.4 ± 22.0 vs. 73.0 ± 36.2 min, p = 0.002) and fewer attempts (1.50 ± 0.86 vs. 1.92 ± 1.10 times, p = 0.049) than traditional MT did. Hybrid MT achieved more good clinical outcome (3-month modified Rankin Scale score, 2 or less) and better successful recanalization (Thrombolysis In Cerebral Infarction grade, 2b or 3) than traditional MT did, but the difference was not significant (61.9% vs. 55.1%, p = 0.531, 92.9% vs. 87.8%, p = 0.498). Hybrid MT showed a higher first pass successful recanalization rate than traditional MT did (69.0% vs. 40.8%, p = 0.011). Multivariable logistic regression analysis demonstrated that first pass successful recanalization is related to the M1 segment rather than other segments (adjusted odds ratio (OR); 3.277, confidence interval (CI); 1.227–8.749, p = 0.018) and hybrid MT rather than traditional MT (adjusted OR; 4.995, CI; 1.725–14.460, p = 0.003).ConclusionsHybrid MT can be used as a first-line MT modality, particularly in M1 occlusion, based on our high first pass successful recanalization results.     

Bronchogenic cyst of the stomach:A case report

BACKGROUND Gastric bronchogenic cysts(BCs)are extremely rare cystic masses caused by abnormal development of the respiratory system during the embryonic period.Gastric bronchial cysts are rare lesions first reported in 1956;as of 2019,only 37 cases are available in the MEDLINE/PubMed online databases.BCs usually have no clinical symptoms in the early stage,and their imaging findings also lack specificity.Therefore,they are difficult to diagnose before histopathological examination.CASE SUMMARY A 55-year-old woman presented at our hospital with intermittent epigastric pain.She had a slightly high level of serum carbohydrate antigen 72-4(CA 72-4).Endoscopic ultrasound found that a cystic mass originated from the submucosa of the posterior gastric wall near the cardia,indicating a diagnosis of cystic hygroma of the stomach.Furthermore,a computed tomography scan demonstrated a quasi-circular cystic mass closely related to the lesser curvature of the gastric fundus with a low density.Because the imaging examinations did not suggest a malignancy and the patient required complete resection,she underwent laparoscopic surgery.As an intraoperative finding,this cystic lesion was located in the posterior wall of the fundus and contained some yellow viscous liquid.Finally,the pathologists verified that the cyst in the fundus was a gastric BC.The patient recovered well with normal CA 72-4 levels,and her course was uneventful at 10 mo.CONCLUSION This is a valuable report as it describes an extremely rare case of gastric BC.Moreover,this is the first case of BC to present with elevated CA 72-4 levels.