Classification system for flexor digitorum accessorius longus muscle variants within the leg: Clinical correlations

The flexor digitorum accessorius longus (FDAL), a variant leg muscle, can cause tarsal tunnel syndrome. This study was performed to classify the variants of the FDAL by dissection and to correlate the dissection results with clinical cases of tarsal tunnel syndrome caused by this muscle. Eighty lower limbs of embalmed Korean cadavers were dissected. MR images of two clinical cases of tarsal tunnel syndrome caused by the FDAL were correlated with the dissection results. The FDAL was observed in nine out of 80 specimens (11.3%) and it was classified into three types depending on its site of origin and its relationship to the posterior tibial neurovascular bundle (PTNV) in the leg. In Type I (6.3%), the FDAL originated in the leg and ran superficially along the PTNV, either not crossing (Type Ia, 3.8%) or crossing (Type Ib, 2.5%) the neurovascular bundle. In Type II (6.3%), it originated in the tarsal tunnel. Most FDALs followed a similar course in the tarsal tunnel and the plantar pedis. On correlating the MR images of the clinical cases with this classification, the FDAL corresponded to Types Ia and II. All three types of FDAL can compress the tibial nerve in the tarsal tunnel or the distal leg. Clarification of the topographical relationship between this muscle and the PTNV would help to improve the results of surgery for tarsal tunnel syndrome caused by the FDAL. Clin. Anat. 27:1111–1116, 2014. © 2014 Wiley Periodicals, Inc.     

Effect of concomitant variant histology on the prognosis of patients with upper urinary tract urothelial carcinoma after radical nephroureterectomy

ObjectiveTo evaluate the prognostic effect of concomitant variant histology (CVH) on survival outcomes in patients with upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy.Materials and methodsData on 417 patients with UTUC treated with radical nephroureterectomy without preoperative adjuvant therapy were retrospectively reviewed with a focus on CVH. Clinicopathological features and prognostic factors were compared between patients with pure UTUC and patients with UTUC with CVH. The primary end points were cancer-specific survival (CSS), disease recurrence-free survival (DFS), and overall survival (OS).ResultsUTUC with CVH was present in 90 (21.6%) of 417 patients. At a median follow-up of 26 months, 153 (36.7%) had died of UTUC, 161 (38.6%) had experienced a relapse, and 176 (42.2%) had died of other causes. UTUC with CVH was significantly associated with advanced tumor stage, high tumor grade, tumor diameter, lymphovascular invasion, lymph node metastasis, positive surgical margins, and tumor architecture compared with pure UTUC (all P<0.01). The estimated 5-year CSS, DFS, and OS rates were 64.9%, 61.1%, and 62.1%, respectively, in the pure UTUC group, compared with 36.3%, 34.3%, and 26.5%, respectively, in the UTUC with CVH group (P<0.001). Multivariate analysis demonstrated that CVH was an independent predictor of CSS (hazard ratio [HR] = 1.594; 95% CI: 1.125–2.259; P = 0.009), DFS (HR = 1.549; 95% CI: 1.077–2.152; P = 0.017), and OS (HR = 1.685; 95% CI: 1.212–2.343; P = 0.002).ConclusionsApproximately one-fifth of the specimens of patients with UTUC were observed to exhibit CVH. CVH was an independent prognostic factor for CSS, DFS, and OS in patients with UTUC on both univariate and multivariate analyses. Genitourinary pathologists should look for potential CVH components in UTUC specimens and report this in routine pathological practice. The presence of CVH should identify patients as candidates for consultation regarding early adjuvant therapy and intensive surveillance protocols.     

奥密克戎变异株流行期间上海方舱医院军队医务人员心理健康状况及其影响因素分析

目的 调查上海方舱医院医护人员在抗击新型冠状病毒肺炎（COVID-19）疫情期间的身心状况及各类药物的使用情况。方法 通过线上问卷的形式,调查分析2022年4月4日至5月12日某三甲医院144名抗击COVID-19疫情的援沪医疗队队员在援沪前和援沪1个月后的体重变化,援沪抗疫期间的失眠情况、其他身体疾病状况和药物使用情况。结果 抗击COVID-19疫情的一线医生在援沪前和援沪1个月后的体重平均值分别为（69.80±8.35）kg和（68.60±7.37）kg,护士在援沪前和援沪1个月后的体重平均值分别为（55.36±8.27）kg和（53.80±7.38）kg。医生和护士的体重有下降趋势,但援沪前后比较差异无统计学意义（P＞0.05）。一线医疗队员中有63.89%（92/144）的队员出现失眠情况,其中27.08%（39/144）需靠药物干预。抗疫一线医疗队员常见的疾病排名前5位分别是睡眠障碍（63.89%,92/144）、皮肤破损（25.69%,37/144）、疼痛（23.61%,34/144）、口腔溃疡（13.19%,19/144）、急性上呼吸道感染（9.72%,14/144）。共155人次使用了药物,常见药物使用排名前5位的分别是皮肤敷贴（16.77%,26/155）、感冒安颗粒（12.26%,19/155）、酒石酸唑吡坦片（11.61%,18/155）、康复新液（11.61%,18/155）、塞来昔布胶囊（8.39%,13/155）。结论 方舱内一线抗疫医护人员易出现体重变化、睡眠障碍以及发生皮肤破损、疼痛、口腔溃疡、急性上呼吸道感染等,提示在今后类似大型卫勤保障工作中,需对一线人员身体状态给予适当关注,并提供相关药物保障。     

养阴祛风法治疗小儿肺阴亏虚型咳嗽变异性哮喘临床疗效观察

目的:观察养阴祛风法治疗小儿肺阴亏虚型咳嗽变异性哮喘的临床疗效。方法:将115例患儿随机分成2组,其中治疗组59例、对照组56例。治疗组口服自拟养阴祛风汤加槐杞黄颗粒;对照组口服孟鲁司特钠咀嚼片加槐杞黄颗粒,2组均治疗4周后观察疗效,评价临床症状积分的改善情况。结果:总有效率:治疗组93.2%,对照组67.9%,差异有统计学意义(P0.05),表明治疗组明显优于对照组;治疗组与对照组治疗后证候积分比较,差异有统计学意义(P0.05),表明治疗组明显优于对照组。结论:养阴祛风法治疗小儿肺阴亏虚型咳嗽变异性哮喘,疗效确切,值得推广应用。     

小儿治哮灵片对发作期小儿咳嗽变异性哮喘气道反应性的影响

目的:评价小儿治哮灵片对发作期咳嗽变异性哮喘(CVA)的临床疗效及对气道反应性和慢性炎症反应的影响。方法:将170例发作期CVA患儿,采用区组随机按数字表法分为对照组和观察组各85例。两组患儿均采用布地奈德气雾剂+孟鲁司特钠咀嚼片进行治疗,观察组加服小儿治哮灵片。两组疗程均为4周,并进行16周的随访。进行日间咳嗽、夜间咳嗽情况和咳嗽视觉模拟(VAS)评分;进行治疗前后莱塞斯特咳嗽问卷(LCQ)评分和中医证候评分;记录咳嗽缓解时间和16周内的复发情况;进行治疗前后气道反应检测;进行治疗前后白细胞介素-4(IL-4),IL-5,IL-13,嗜酸性粒细胞(EOS)和血清免疫球蛋白(Ig E)检测。结果:观察组中医疗效总有效率为93.59%,高于对照组的81.33%(χ~2=5.281,P0.05);治疗后观察组患儿日间咳嗽、夜间咳嗽、咳嗽总积分及咳嗽VAS评分均低于对照组(P0.01);观察组平均咳嗽缓解时间短于对照组(P0.01);在16周的随访期中,观察组复发率为39.74%,低于对照组的61.33%(χ~2=5.281,P0.05),观察组平均复发次数低于对照组(P0.01);治疗后观察组LCQ量表2个维度评分和总分均高于对照组(P0.01);观察组患儿血清IL-4,IL-5,IL-13,总Ig E和EOS水平均低于对照组(P0.01);观察组患儿最小诱发累积剂量(Dmin)和PD35水平均高于对照组(P0.01)。结论:小儿治哮灵片治疗发作期咳嗽变异性哮喘,能进一步的缓解咳嗽等临床症状,提高患者的生活质量,并能降低复发频率,其作用机制可能是通过减轻气道炎症反应、降低气道高反应性来实现的。     

AR-V7表达与去势抵抗性前列腺癌阿比特龙治疗敏感性的相关性研究

目的:探讨去势抵抗性前列腺癌(CRPC)患者中雄激素受体剪切变异体7(AR-V7)的表达与阿比特龙治疗敏感性的相关性。方法:采用前瞻性队列研究对2016年1月至2019年1月北京大学肿瘤医院收治的年龄≥18岁,存在1≥处全身转移,拟使用阿比特龙治疗的新发CRPC患者行外周血循环肿瘤细胞(CTCs)AR-V7检测,根据检测结果将患者分为AR-V7阳性组和AR-V7阴性组,对两组患者PSA下降时间、PSA无进展生存(PFS)、临床状态PFS、影像学PFS以及总生存进行统计分析。结果:共入组77例患者,其中AR-V7阴性组49例,AR-V7阳性组28例。AR-V7阴性组PSA下降时间[(72.04±66.92)d与(190.11±102.44)d,P=0.000]、PSA无应答率[6.12%(3/49)与21.4%(6/28),P=0.040]明显小于AR-V7阳性组,而PSA PFS[(489.17±269.39)d与(130.56±120)d,P=0.010]、临床状态PFS[(551.91±322.05)d与(261.44±200.85)d,P=0.018]、影像学PFS[(523.7±223.28)d与(247.56±202.80)d,P=0.003]明显长于AR-V7阳性组。AR-V7阳性组和AR-V7阴性组的肿瘤特异性生存时间分别为(1246.89±375.65)d和(1001.42±248.94)d(P=0.159),总生存率分别为89.8%(44/49)和89.3%(25/28)(P=0.176),差异均无统计学意义。结论:CRPC患者中,AR-V7表达与阿比特龙治疗敏感性及患者预后密切相关,阳性表达患者阿比特龙治疗效果及预后较差。