Surgical management of Squamous Cell Carcinoma of the lower lip: An experience of 109 cases

Objectives: We are presenting our experience collected from a series of 109 cases with SCC of the lower lip focusing on clinical features of patients and surgical approach. Study Design: We retrospectively analyzed medical records of patients diagnosed with Squamous Cell Carcinoma (SCC) of the lower lip at the Oral and Maxillofacial surgery at Xi’an Jiaotong University during a period between 1999 and 2008. Results: A total of 109 patients with lip cancer were included in the study. When no frozen-section test was performed, the neoplasia was removed with a margin of at least 6 mm. Different surgical techniques were used for lip reconstruction after tumor excision. Neck dissection was performed in all patients with clinically palpable lymph nodes. Median follow-up was 38 months. During follow-up, recurrence occurred in 5 patients, 3 patients developed neck metastases, distant metastases developed in 1 patient. Five patients died during observation period. Conclusions: The patient-related and defect-related issues must be taken into consideration during reconstruction for surgical defect. For N0 patients, we recommend wait-and-see policy. Early detection, careful follow-up and prompt neck is essential for the successful treatment. Key words:Lip cancer, surgical management, reconstruction.     

21例新型冠状病毒核酸确诊病例的薄层CT周期变化

目的 回顾性分析21例治愈出院新型冠状病毒核酸确诊病例完整影像学资料,探讨新型冠状病毒肺炎HRCT短期动态影像特征。方法 按胸部CT检查时间及影像学改变过程,将病程分为早期、高峰期及转归期,并观察肺内病变在不同时期的HRCT影像学表现。结果 胸部CT有阳性改变患者16例,胸部CT始终无阳性表现患者5例。早期（1~6天,平均3天）HRCT表现为片状磨玻璃影23个,磨玻璃结节12个,实变结节伴“晕征”1个;高峰期（5~11天,平均8天）HRCT表现为单纯磨玻璃影9个,磨玻璃影伴实变影17个,磨玻璃影伴“铺路石征”6个,实变结节伴“晕征”7个,1例伴少量胸腔积液。危重型病例高峰期病变数量及累及范围高于普通型,两组差异有统计学意义。结论 HRCT检查有助于检出早期及亚临床型新型冠状病毒肺炎,患者多于患病第2周诊断为重型/危重型,HRCT复查对危重型患者具有提示意义。     

分级心理干预联合医护一体化护理对冠状动脉搭桥患者术后负性情绪及睡眠质量的影响

目的探讨分级心理干预联合医护一体化护理干预对冠状动脉搭桥患者术后负性情绪及睡眠质量的影响.方法将103例冠状动脉搭桥手术患者依照入院顺序分为研究组52例,对照组51例,对照组采取常规护理干预,研究组于对照组基础上采取分级心理干预联合医护一体化护理干预,两组均干预至出院.干预前后采用焦虑自评量表评定焦虑状况,抑郁自评量表评定抑郁状况,匹兹堡睡眠质量指数评定睡眠质量,日常生活能力指数评定日常生活能力,自护能力量表评定自护能力,自制护理工作满意度量表评定护理工作满意度.结果干预后两组焦虑自评量表、抑郁自评量表、匹兹堡睡眠质量指数评分较干预前显著下降(P<0.01),研究组评分均显著低于对照组(P<0.01);两组日常生活能力指数、自护能力量表评分较干预前显著升高(P<0.01),研究组评分均显著高于对照组(P<0.01);研究组护理工作满意度(98.1%)显著高于对照组(84.3%)(P<0.05).结论冠状动脉搭桥手术患者采取分级心理干预联合医护一体化护理干预,能显著缓解负性情绪,提升睡眠质量、日常生活能力,改善自护能力,提高护理工作满意度.     

超声医师诊断之外的诊疗风险及其管理策略

正良好的风险管理意识能够同时保护患者和超声医师。其目的并非当事件发生后才进行补救,而是对可能出现的问题进行预估并尽可能避免。避免不良事件及其引发的医疗纠纷是风险管理的基本目标,但更重要的是改善医疗质量,更好地帮助患者。本文总结了超声医师常见且需要警惕并避免的潜在医疗风险,旨在培养超声医师风险管理的意识,尽可能避免不良事件的发生。随着超声诊断与介入的发展,超声医学在患者的诊疗过程中扮演着越来越重要的角色。超声检查数量的不断增加、检查范围的不断扩大、造影剂的使用、超声引导下各种介入操作的实施都不同程度存在潜在的医疗风险。因此,     

同时性结直肠癌肝转移瘤消融治疗后辅助化疗起始时间对患者预后的影响

目的本研究以探究微波消融（MWA）治疗后辅助化疗（AC）起始时间对同时性结直肠癌肝转移瘤（CRLM）患者肝内无复发生存（RFS）及肝损害的影响。 方法回顾性分析2013年10月至2019年1月在中山大学附属第六医院确诊为同时性CRLM且行超声引导下经皮MWA治疗联合AC治疗的患者。本研究共纳入患者144例,其中G1组98例,G2组46例。中位肝内RFS为22.2个月。根据MWA术后AC开始时间,将患者分为≤4周（G1）和4~8周（G2）2组。比较G1组和G2组消融后及第1次AC前后血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）水平的变化。采用Kaplan-Meier法和Log-rank检验计算并比较两组患者的肝内RFS。采用Cox比例风险模型对肝内RFS的危险因素进行单因素和多因素回归分析。 结果G1组肝内RFS较G2组显著延长（中位肝内RFS,40.6个月 vs 12.6个月,Log-rank P=0.007）。采用Cox比例风险模型分析结果发现,辅助化疗开始时间间隔为4~8周（HR=1.917,95%CI：1.104~3.327,P=0.021）和肝转移瘤个数（HR=1.292,95%CI：1.096~1.524,P=0.002）是肝内RFS时间短的独立影响因素。G1组和G2组第1次AC前、后ALT、AST水平,差异均无统计学意义（P均>0.05）。 结论对于同时性CRLM患者,在MWA治疗后早期开始AC（≤4周）有助于延长术后肝内RFS时间。     

Post-dilatation improves stent apposition in patients with ST-segment elevation myocardial infarction receiving primary percutaneous intervention: A multicenter,randomized controlled trial using optical coherence tomography

Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction (STEMI). This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention (pPCI) for acute STEMI. METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation. Patients were randomly assigned to control group (n=20) or post-dilatation group (n=21) in which a non-compliant balloon was inflated to >16 atm pressure. Strut apposition and coverage were evaluated by optical coherence tomography (OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up. The primary endpoint was rate of incomplete strut apposition (ISA) at 7 months after pPCI. RESULTS: There were similar baseline characteristics except for stent length (21.9 [SD 6.5] mm vs. 26.0 [SD 5.8] mm, respectively, P=0.03). In post-dilatation vs. control group, ISA rate was lower (2.5% vs. 4.5%, P=0.04) immediately after pPCI without affecting nal TIMI ow 3 rate (95.2% vs. 95.0%, P>0.05) or corrected TIMI frame counts (22.6±9.4 vs .22.0±9.7, P>0.05);and at 7-month follow-up (0.7% vs .1.8%, P<0.0001), the primary study endpoint, with similar strut coverage (98.5% vs. 98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events (MACE). CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood ow or 1-year MACE rate. Larger and longer term studies are warranted to further assess safety.     

A stable tunnel-type NaGe3/2Mn1/2O4 anode for Na-ion batteries

Tunnel-type NaGe_3/2Mn_1/2O₄ was fabricated for anode of sodium ion batteries, delivering a discharge capacity of 200.32 mAh g⁻¹ and an ultra-low potential platform compared with that of pure Na₄Ge₉O₂₀ (NGO). The results of X-ray photoelectron spectroscopy (XPS) demonstrate that Ge redox occurs, and partial substitution of Mn effectively improves the Na-storage properties compared to those of NGO.

We investigated tunnel-type NaGe_3/2Mn_1/2O₄; the main structure is Na₄Ge₉O₂₀. NaGe_3/2Mn_1/2O₄ electrodes as anodes for sodium ions batteries deliver a discharge capacity of 200.32 mAh g⁻¹ and satisfactory capacity retention after 50 cycles.

In terms of the high abundance and ready availability of sodium, sodium-ion batteries (SIBs) have been generally regarded as a better alternative to lithium-ion batteries for power stations.^1–4 Hard carbon is widely recognized as one of the most attractive and ideal anode materials for SIBs.^5,6 However, the potential required for sodium ions to insert into hard carbon is very close to that for sodium plating, resulting in sodium dendrites, which raise safety concerns.^7,8 Moreover, the reaction of electrode materials with sodium through alloying or conversion mechanisms always results in serious volume changes in the process of sodium insertion and extraction.⁹ Therefore, insertion-type transition-metal oxides as anodes have attracted much attention owing to their suitable operating potentials and minor volume expansion.^10,11 Recently, embedded titanium/vanadium/molybdenum based oxides with layered structures have been studied as anode materials for SIBs,¹² such as layered Na₂Ti₃O₇,¹³ tunnel Na₂Ti₆O₁₃ (ref. 14) and spinel Li₄Ti₅O₁₂.¹⁵ In addition, post-spinel structured materials have been proposed, which show ultra-stable cycle performances via highly reversible sodium-ion insertion/desertion through large-size tunnels. Recently, in Zhou''s group, NaVSnO₄ (ref. 16) and NaV_1.25Ti_0.75O₄ (ref. 17) have been prepared and they have been shown to possess robust cycle lifetimes (more than 10 000 cycles) and discharge plateaus of 0.84 V and 0.7 V, respectively. Meanwhile, in our group, Na_0.76Mn_0.48Ti_0.44O₂ has been developed, which holds an initial discharge capacity of 103.4 mAh g⁻¹, shows a superb rate capability and retains 74.9% capacity after 600 cycles.¹⁸ The large radius of the redox active metal center could optimize the tunnel size and thus boosting the electrochemical performance. It is also a big challenge to find further suitable active centers for insertion-type transition metal oxides as anodes of SIBs. Besides, a host of published reports have said that germanium-based materials can be used as alloy anodes for SIBs with highly reversible sodium storage properties and satisfactory ionic/electronic conductivity.¹⁹ However, it is unclear to us whether Ge could act as an active center in a transition-metal oxide anodes.In this work, we fabricated a tunnel-type NaGe_3/2Mn_1/2O₄ (NGMO) material. When used as the anode of SIBs, it delivers a sustained discharge capacity of 200.32 mAh g⁻¹. Compared with NaVSnO₄ (ref. 16) and NaV_1.25Ti_0.75O₄,¹⁷ NGMO delivers a lower safety voltage of 0.36 V. Pure Na₄Ge₉O₂₀ (NGO) as a comparative sample, only exhibits a capacity of 24.8 mAh g⁻¹, which is far inferior to that of NGMO. During discharge and charge process, reversible redox reactions around Ge center occur, as confirmed by X-ray photoelectron spectroscopy (XPS) analysis. The introduction of Mn in the NGMO improves the reversibility of the Ge redox performance.The structure of NGMO was carefully characterized by XRD, and Rietveld refinement was performed as depicted in Fig. 1. The main Bragg peaks of NGMO could be assigned to space groups of P1(2) and I4₁/a(88), which were fitted to give lattice parameters of a = 10.56/15.04 Å, b = 11.18/15.04 Å, and c = 9.22/7.39 Å, and a volume of 811.2/1672.2 ų, respectively. Na₄Ge₉O₂₀ has a typical tunnel structure, which consists of polymerized Ge/MnO₄ tetrahedra connected with Ge/MnO₆ octahedra. Four Ge/MnO₆ octahedra are connected together by sharing edges to form a tetrameric (Ge/Mn)₄O₁₆ cluster. Each cluster is connected to six GeO₄ tetrahedra, and adjacent clusters are connected by GeO₄ tetrahedra. Na atoms are located in the channels and have elongated Na–O bonds.¹⁹ This highly stable crystal structure can effectively accelerate the migration of sodium ions.²⁰Fig. 2 shows the low and high magnification scanning electron microscopy (SEM) images of NGMO, which is composed of particles of different sizes from 1 to 3 μm; the larger particles are the result of sintering at high temperature. SEM images of NGO with different magnifications are given in Fig. S1,^† and show that the average particle size of NGO is 1 μm.Open in a separate windowFig. 1The Rietveld refinement spectra of NGMO.Open in a separate windowFig. 2(a) and (b) SEM images of NGMO at different magnifications.The morphology and fine structure were studied by transmission electron microscopy (TEM). Fig. 3a and b show the low magnification TEM images. It can be seen from the images that NGMO has an irregular sheet-like morphology with particle sizes from 250 nm to 2 μm. As shown in Fig. 3c, the lattice spacing of the (200) plane is 4.55 Å. In the SAED pattern of Fig. 3d, the red line corresponds to the (020) plane in NGMO, and the lattice spacing is 13.100 Å. These results clearly demonstrate that NGMO exhibits good crystallinity. The corresponding energy dispersive X-ray spectroscopy (EDS) results, and Raman and infrared spectra (IR) are provided in Table S1 and Fig. S2.^† The results indicate that the atomic ratio of Na : Ge : Mn is close to 1 : 1.5 : 0.5 and that there is little sodium loss. The Raman and IR peaks in the high frequency region are attributed to stretching vibrations of Ge–O–Ge and the peaks between 600 and 400 cm⁻¹ are attributed to the bending vibrations of Ge–O–Ge in NGMO.Open in a separate windowFig. 3(a) and (b) Low resolution TEM images, (c) a HRTEM image and (d) a SAED image of NGMO.Galvanostatic electrochemical measurements were evaluated in a voltage range of 0.05–2.0 V, with the current density of 20 mA g⁻¹. Fig. 4a and b show the discharge and charge profiles of NGMO and NGO, respectively. Because of the formation of a solid electrolyte interface (SEI) layer in the initial cycle, the electrochemical behaviour tends stabilize in the second cycle, so voltage profiles are given from the second cycle; the first cycles of the discharge–charge curves of NGMO and NGO materials are given in Fig. S3.^† It can be seen intuitively that both NGMO and NGO have low voltage platforms, while NGMO has the smaller polarization. In Fig. 4a, we notice a reversible voltage profile in the second cycle with discharge capacity of 200.32 mAh g⁻¹ for NGMO. Only NGMO has a flat potential platform and delivers an ultra-low plateau potential. It can be seen from Fig. 4b that NGO shows a capacity of 24.8 mAh g⁻¹, obvious polarization at the 20^th cycle and increased capacity due to the surface side-effect. Fig. 4c indicates that the capacity retention of the NGMO electrode after 50 cycles is 86.2%, which is superior to that of NGO; the coulombic efficiency of NGMO is also provided in Fig. S4.^† To further understand the redox reactions along with the discharge/charge process in NGMO, Fig. 4d displays the differential capacity versus voltage (dQ/dV) curve. The clear anodic peak at 0.33 V and cathodic peak at 0.81 V correspond well with the redox reactions of NGMO.Open in a separate windowFig. 4Electrochemical performance: (a) and (b) voltage profiles of NGMO and NGO, respectively; (c) cycling performance; (d) dQ/dV profile of NGMO. The current density was controlled at 20 mA g⁻¹ over a voltage range of 0.05–2.0 V.The electrochemical impedance spectra (EIS) of fresh and cycled electrodes of NGMO and NGO, with a frequency range of 0.01 Hz to 100 kHz, are shown in Fig. 5. From Fig. 5a, it is obvious that the charge-transfer resistance of the fresh NGMO electrode is lower than that of NGO. This indicates that the migration of charges in the NGMO material occurs more easily than in NGO, which also facilitates the shifting of ions on the surface and inside of the electrodes of NGMO. In Fig. 5b, NGMO electrode in its 10^th cycle exhibits a smaller charge-transfer resistance than both NGO and the NGMO fresh electrode, indicating that the surface of NGMO more readily forms a stable SEI film.¹⁸ The EIS results were fitted by the model shown in Fig. S5.^† The fitting results are provided in Table S2.^† The resistances of the fresh and cycled electrodes of NGMO and NGO are composed of an internal resistance (R_s), the resistance of the surface film (SEI) (R_f; a small semicircle in the high frequency region), the resistance of the charge transfer (R_ct; another opposite semicircle in the middle frequency region), and the Warburg resistance (W; an oblique line in the low frequency region).²¹ Both the fresh and cycled electrodes of NGMO deliver lower charge transfer resistance than NGO. Meanwhile, the transfer resistance of the cycled NGMO electrode is lower than that of the fresh electrode and its slope at low frequency is higher than that of the fresh one (Table S2^†). All these results show that NGMO has lower resistance and better electronic/ionic conductivity than NGO.Open in a separate windowFig. 5Nyquist plots of (a) fresh NGMO and NGO electrodes, and (b) NGMO and NGO electrodes after ten cycles.The evolution of the chemical valence states of the 150-times discharged electrodes were observed by XPS and SEM as provided in Fig. S6.^† It is generally clear that the electrode surface was covered with a thick SEI layer after discharging. Ar plasma etching was used to obtain the internal information. The Ge 3d core-level of the discharged NGMO electrode with and without etching is shown in Fig. S7.^† Before etching, the peaks of the Ge 3d core-level could be fitted to Ge¹⁺ and Ge²⁺.²² After etching, (Fig. S7c^†), the peaks at 30.8 eV and 30.2 eV were also associated with Ge¹⁺ and Ge²⁺, respectively. This result indicates that the valence of Ge decreases as a whole and that there is no obvious difference between the etched and non-etched samples. The reversible redox reactions of Ge remain stable even after cycling. Meanwhile, the Mn 2p core-level spectra are shown in Fig. S7d–f.^† For the Mn 2p core level, owing to the spin orbit coupling, the valence states of Mn comprise two couples including Mn³⁺ and Mn²⁺ (Fig. S7e and f^†). The binding energies of Mn³⁺ are 642.37 eV and 654.04 eV, and the binding energies of Mn²⁺ are 640.71 eV and 652.18 eV. Similarly, after discharging, the binding energies of Mn³⁺ are 642.40 eV and 654.06 eV, and those for Mn²⁺ are 640.69 eV and 652.20 eV, indicating that there are no changes in Mn binding energies before and after etching. This is in good agreement with results in previous reports.^23,24 All results also show that a thin SEI layer has been formed, favoring ions transfer on the repeatedly cycled electrode. It can be seen from the refined XRD results that NGMO consists of Ge⁴⁺, Mn²⁺ and Mn³⁺, and combined with XPS analysis, the results show that the valence states of Mn does not change for the discharged NGMO electrode. Ge displays electrochemical activity in NGMO, and Mn exhibits good chemical stability in the framework.