Radial probe endobronchial ultrasound: Factors influencing visualization yield of peripheral pulmonary lesions

Background and objective: Endobronchial ultrasound (EBUS) has improved the diagnostic yield of transbronchial biopsy of peripheral pulmonary lesions (PPL). While EBUS diagnostic yield has been the focus of the majority of publications, few have investigated factors associated with EBUS visualization yield. This study evaluated the factors predicting visibility of PPL using EBUS‐guided bronchoscopy. Methods: We performed a retrospective analysis of 196 consecutive patients who underwent investigation with radial EBUS. Size and distance of the lesion from the hilum and pleura measured on computed tomography scans were correlated with malignancy status, gender and EBUS visualization yields. Final diagnosis was obtained from pathology. Results: A definitive diagnosis was established for 109 PPL (56%) using radial EBUS. Visualized lesion by EBUS probe had a higher diagnostic yield (65%) than EBUS‐invisible lesions (20%; P = 0.0001). In multivariate analysis, lesion size, final diagnosis and distance from hilum to lesion were all found to significantly affect EBUS visualization yield. Lesions of ≥20 mm had a significantly greater visualization yield (85%) than lesions of <20 mm (63%; P = 0.0022). Malignant lesions had a higher visualization rate (85%) than benign lesions (66%; P value = 0.0025). Distance of hilum ≤50 mm to PPL was found to have a significantly higher visualization yield (91%) than lesions located >50 mm from the hilum. (66%; P = 0.0001). Conclusions: Lesion size, malignancy status and distance from hilum to lesion are significant predictors of EBUS visualization yield. Clinicians should review these factors in patients to guide choice of optimal investigation and diagnosis of PPL.     

Clinical impact of liquid‐based cytology test on diagnostic yields from transbronchial needle aspiration

Background and objective: Transbronchial needle aspiration (TBNA) is a well‐established diagnostic method that is underutilized due to the relatively high percentage of non‐diagnostic samples and low success rates. This study was designed to evaluate the impact of liquid‐based cytology test (LBC) on the diagnostic yield from TBNA. Methods: Ninety‐seven consecutive patients who underwent TBNA due to significant mediastinal adenopathy were enrolled in the study. Each target site was aspirated four times, with the first and third aspirates being prepared for LBC and the second and fourth aspirates being reserved for conventional pick‐and‐smear (CPS) cytology. Results: Paired aspirates were obtained from 114 target sites, giving a total of 228 test samples from 97 consecutive patients. The overall diagnostic sensitivity of TBNA was 63.6% (56/88). The yields from small cell lung cancers were better than those from non‐small cell lung cancers (P < 0.05), and TBNA of subcarinal nodes provided better diagnostic yields (P < 0.05). Nodal diameters > 20 mm on computed tomography were also associated with better yields than nodes with diameters of 10–20 mm (P = 0.001). The diagnostic sensitivity of TBNA was similar for each processing method—59.8% (61/102) for LBC and 64.7% (65/102) for CPS. Conclusions: LBC was not inferior to CPS with respect to diagnostic yields from TBNA, and enabled efficient pathological evaluation.     

Prediction of Long‐Term Outcomes of Catheter Ablation of Persistent Atrial Fibrillation by Parameters of Preablation DC Cardioversion

Prediction of Long‐Term Outcomes of Catheter Ablation of Persistent Atrial Fibrillation. Aim: It has been demonstrated that atrial fibrillation (AF) frequently recurred after cardioversion (CV) using direct current (DC) or radiofrequency catheter ablation (RFCA) in patients with persistent (PeAF) or longstanding persistent AF (LPAF). We hypothesized that the atrial substrate impeding successful CV would also produce difficulty in catheter ablation, and therefore, the outcomes of RFCA for PeAF and LPAF could be predicted by the parameters determined at the time of DC CV. Method: From 2006 to 2009, 94 patients with PeAF and LPAF who had undergone elective DC CV before RFCA were studied. The parameters associated with DC CV, including number of shocks, cumulative energy adjusted, highest energy adjusted, with or without intravenous amiodarone use, and other clinical parameters were assessed. Result: Thirty‐two out of the 94 patients (34%) experienced AF recurrence during the follow‐up of 19.8 ± 12.3 months after RFCA. The average time to recurrence of AF after RFCA was 9.2 ± 3.2 months. Of the 62 patients, 29 patients (31%) remained sinus rhythm (SR) without antiarrhythmic drug (AAD). The patients who maintained SR had smaller body mass index (BMI) (P = 0.048), shorter duration of AF (P = 0.012), and lower prevalence of diabetes mellitus (P = 0.023) compared with patients in whom AF recurred. Total number of shocks, total energy, and highest shock energy during CV were lower (P < 0.001, P = 0.002, P = 0.048, respectively) in patients with SR during the follow‐up. The outcome in patients who used amiodarone IV prior to CV, however, was not different from that in those who did not use amiodarone IV. Conclusion: DC energy parameters for successful CV before RFCA were useful to predict the long‐term outcome after RFCA in patients with PeAF and LPAF. The presence of the atrial substrate making DC CV difficult might reflect atrial substrate that subsequently related to the recurrence of AF after RFCA in chronic AF. These DC energy parameters may be related to the chronicity or electroanatomical remodeling of AF. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1165–1170, November 2012)     

多导睡眠分析系统在住院空勤人员中的应用及护理干预（摘要）

目的探讨多导睡眠分析系统在飞行员群体中应用的护理干预重点。方法对70例有睡眠异常主诉的飞行人员进行整夜多导睡眠监测（包括脑电图、眼动图、下颌肌电图、口鼻气流、胸腹呼吸运动、血氧饱和度、体位、心电图、鼾声等）,注意检查前宣教,检查中细致讲解及各导联放置准确,检查结束后注意仪器的保养、维护以及对患者进行睡眠健康指导。结果本组70例被检飞行员中单纯鼾症18例,轻度阻塞性睡眠呼吸暂停综合征2l例,中度16例,重度15例。     

SNODGRASS尿道成形术治疗先天性尿道下裂效果

目的探讨应用SNODGRASS尿道成形术治疗先天性尿道下裂的效果。方法对2003～2007年我院应用SNODGRASS尿道成形术治疗的先天性尿道下裂病儿42例的临床资料进行回顾分析,其中冠状沟型30例,阴茎体型12例。本组34例病儿术前无阴茎下弯,6例有轻度下弯,2例明显下弯。结果术后随访6～30个月,42例中治愈36例（90%）,阴茎伸直,外形美观,尿道口开口正位,排尿通畅。术后并发尿道瘘6例,均修补成功。结论SNODGRASS尿道成形术治疗阴茎尿道下裂操作简单,手术时间短,术后外形效果好,并发症少。     

七叶皂苷钠对小鼠变应性接触性皮炎作用研究

目的:研究七叶皂苷钠对小鼠变应性接触性皮炎(ACD)的治疗作用。方法:60只SPF级昆明小鼠随机分为6组:正常对照组、模型对照组、阳性对照组、七叶皂苷钠(SA)低、中、高剂量组(1.8、3.6、7.2 mg/kg),每组10只。用2,4-二硝基氯苯(DNCB)致敏和激发建立小鼠ACD模型,以小鼠耳部耳廓肿胀度、脾指数和组织病理学检查为评价指标。结果:七叶皂苷钠能够减轻小鼠腹部皮损炎症情况,抑制小鼠耳廓肿胀增加,降低小鼠脾指数。随着SA浓度的增加,真皮层细胞水肿变性得到缓解,组织炎症细胞浸润减少。结论:七叶皂苷钠对小鼠变应性接触性皮炎具有一定的治疗作用,其作用机制有待进一步研究。     

心胸外科术后使用体外膜肺氧合治疗重度心肺功能不全23例临床分析

目的 分析我院成人心胸外科术后患者应用体外膜肺氧合(ECMO)治疗的临床资料,总结ECMO治疗经验及其相关并发症的防治措施.方法 回顾性分析2016年1月至2020年6月在上海交通大学医学院附属新华医院心胸外科术后因心肺功能不全行ECMO治疗的23例患者的临床资料,其中男性16例、女性7例,年龄(64.5±8.9)岁....