Central location and risk of imaging occult mediastinal lymph node involvement in cN0T2-4 non-small cell lung cancer

BackgroundAppropriate pre-operative staging is a cornerstone in the treatment of non-small cell lung cancer (NSCLC). Central location and size greater than 3 cm are amongst indications for pre-operative invasive mediastinal staging but the quality of the evidence behind this recommendation is low.MethodsWe retrospectively reviewed all cases of cT2-4N0M0 NSCLCL after CT and TEP-CT which underwent surgical resection with lymph node dissection or had a positive invasive pre-operative mediastinal staging in our institution from 2014 to 2018.ResultsThree hundred and ten patients met inclusion criteria, 79 (25.5%) central and 231 (74.5%) peripheral tumors. Central tumor location was associated with a higher prevalence of pN2-3 disease (17.7% vs. 6.1%, P<0.001). In a multivariate analysis, central tumor location remained the only factor statistically associated with imaging occult mediastinal disease (OR 3.23, 95% CI: 1.45–7.18). NPV of PET-CT for occult mediastinal disease was 0.83 (95% CI: 0.72–0.90) in central and 0.94 (95% CI: 0.90–0.97) in peripheral tumor. Central location was also associated with a higher prevalence of occult N1 to N3 disease (43.0% vs. 15.2%, P<0.001).ConclusionsThis study suggests that invasive mediastinal staging is required in central cT2-4N0 NSCLC but can be questioned in peripheral one, especially in cT2N2 subgroup if the patient is a candidate for lobar resection.     

阴陵泉穴在《针灸大成》中的应用解析

《针灸大成》是集明以前的针灸文献之巨著,记载了阴陵泉穴的经脉归属、穴位定位及取穴方法、特定穴类属、操作方法以及临床功用和主治,相关内容有56处条文,其中临床功用主治相关条文较多,包括津液代谢异常病证,脾胃、心胸、肝胆等脏腑病证,前阴病证及肢体病证等。结合现代临床,创新性地从多方面具体解析《针灸大成》中有关阴陵泉穴的条文,为临床提供文献理论依据。     

Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy

IntroductionCurrent Advanced Trauma Life Support guidelines recommend decompression for thoracic tension physiology using a 5-cm angiocatheter at the second intercostal space (ICS) on the midclavicular line (MCL). High failure rates occur. Through systematic review and meta-analysis, we aimed to determine the chest wall thickness (CWT) of the 2nd ICS-MCL, the 4th/5th ICS at the anterior axillary line (AAL), the 4th/5th ICS mid axillary line (MAL) and needle thoracostomy failure rates using the currently recommended 5-cm angiocatheter.MethodsA comprehensive search of several databases from their inception to July 24, 2014 was conducted. The search was limited to the English language, and all study populations were included. Studies were appraised by two independent reviewers according to a priori defined PRISMA inclusion and exclusion criteria. Continuous outcomes (CWT) were evaluated using weighted mean difference and binary outcomes (failure with 5-cm needle) were assessed using incidence rate. Outcomes were pooled using the random-effects model.ResultsThe search resulted in 34,652 studies of which 15 were included for CWT analysis, 13 for NT effectiveness. Mean CWT was 42.79 mm (95% CI, 38.78–46.81) at 2nd ICS-MCL, 39.85 mm (95% CI, 28.70–51.00) at MAL, and 34.33 mm (95% CI, 28.20–40.47) at AAL (P = .08). Mean failure rate was 38% (95% CI, 24–54) at 2nd ICS-MCL, 31% (95% CI, 10–64) at MAL, and 13% (95% CI, 8–22) at AAL (P = .01).ConclusionEvidence from observational studies suggests that the 4th/5th ICS-AAL has the lowest predicted failure rate of needle decompression in multiple populations.Level of evidenceLevel 3 SR/MA with up to two negative criteria.Study typeTherapeutic.     

不同位置胎盘发生胎盘植入产前诊断情况及围产结局分析

目的：　探讨不同位置胎盘发生胎盘植入（placenta accreta spectrum，PAS）的产前诊断情况、临床特点及围产结局。方法：　回顾性纳入2012年1月至2021年12月于重庆医科大学附属第一医院分娩孕周≥28周且最终被诊断为PAS的孕妇，按照胎盘位置不同分为3组（前壁组、后壁组、两侧壁及宫底部组），比较3组PAS的产前诊断情况、临床特点及围产结局上是否存在差异。结果：　共纳入2 070名孕妇。一般资料比较上，前壁组在孕次、产次、前置胎盘率、剖宫产次数≥2和既往前置胎盘病史上明显高于后壁组（P<0.05）；而后壁组在胎盘粘连、多胎妊娠、人工辅助生殖、阴道分娩率和分娩孕周上均高于前壁组（P<0.05）。胎盘植入程度和产前诊断方面，前壁胎盘中胎盘植入和穿透性胎盘植入发生率明显高于后壁组，总的PAS产前识别率前壁组明显高于另外2组（P<0.05）；进一步比较胎盘粘连中的产前诊断率，前壁明显高于另外2组（P<0.05），胎盘植入中产前诊断也是前壁高于后壁（P<0.05），穿透性胎盘植入方面，3组没有明显统计学差异。围产期处理方式上，前壁组在术前腹主动脉球囊、使用宫腔填塞、子宫捆绑、子宫切除、术后子宫动脉栓塞上高于后壁组（P<0.05）。围产结局方面，前壁组在24 h出血量、输注血液制品情况、其他器官损伤、孕妇转重症监护病房（intensive care unit，ICU）、术后住院天数上均高于后壁组（P<0.05），而后壁组新生儿平均出生体质量高于前壁组（P<0.05）。结论：　非前壁胎盘发生PAS的产前诊断率低，但是前壁胎盘发生严重胎盘植入的比例更高，其最终围产结局比后壁组更差。临床工作中一方面需对后壁胎盘发生PAS有更高的警惕性，必要时可通过磁共振成像（magnetic resonance imaging，MRI）进一步确诊，另一方面有必要对产前诊断PAS孕妇进行积极的多学科管理，以改善这些孕妇的围产结局。     

床旁彩超定位在危急患者困难颈内静脉置管中的应用

目的探讨床旁彩超在危急重症患者困难颈内静脉置管中的应用和效果。 方法回顾性研究2017年9月至2019年3月在徐州医科大学附属宿迁医院急诊行颈内深静脉置管的患者116例，其中男性60例，女性56例；年龄13～83岁，平均(44.5±6.8)岁，所有患者中彩超定位组57例，传统体表解剖定位组59例，统计两组患者的置管时间，置管成功率，误穿动脉数，局部血肿，气胸等情况。 结果彩超定位组患者置管时间5.32 min，一次置管成功率100%，误穿动脉数0例，局部血肿0例，而传统体表解剖定位组置管时间11.13 min，一次置管成功率74.6%(44例)，二次置管成功率86.4%(51例)，二次置管未成功转为彩超定位后均一次成功，误穿动脉5例，局部血肿9例。 结论床旁彩超定位在危重症颈内静脉置管中具耗时短，且有较高的成功率，并发症低，符合急诊治疗的需求，应用效果好，尤其适用于局部解剖定位不清的危重患者，并且在实习生教学及低年资医师带教中更容易被理解和掌握、可以广泛开展应用。     

新生儿疾病筛查中不同采血部位采血效果的比较

目的比较新生儿疾病筛查中不同采血部位的采血效果。方法将我院2008年1月至2009年12月出生的1200例新生儿随机分成实验组和对照组，并分别进行血片采集。实验组采取采集头皮静脉血的方法，采血部位在额静脉、颞浅静脉及颞浅静脉前支。对照组采取常规足底采血法，采血部位在新生儿足跟部内侧或外侧，无具体定位。结果采血一次成功率实验组高于对照组，差异有统计学意义（P〈0．01）。实验组采集血斑滤片质量合格数明显高于对照组，差异有统计学意义（P〈0．01）。结论实验组的采血方法缩短采血时间，提高采血质量，减轻新生儿的痛苦，提高家长满意度，提高了工作效率。     

Granular Cell Tumors on Unusual Anatomic Locations

Granular cell tumors (GCTs) are soft tissue tumors, which are thought to be derived from Schwann cells. Although most GCTs are reported to arise in tongue and oral cavity (30-50%), they can appear on any anatomic sites, even visceral organs. Herein, we report 5 cases of GCTs on unusual anatomic locations, such as palm, arm, thigh, finger, and vulvar area. Complete surgical excision is preferred treatment of choice to prevent recurrence. These cases emphasize that GCTs not involving oral cavity are more prevalent than expected, and the diagnosis should be histopathologically confirmed.     

Lymph node location of a clear cell hidradenoma: report of a patient and review of literature

Cutaneous clear cell hidradenoma is an uncommon benign adnexal tumor which is not supposed to metastasize, contrary to its rare malignant counterpart, hidradenocarcinoma. We report the case of a 49‐year‐old man, who had had a stable inguinal lymph node enlargement for 6 years. An excision was performed and revealed an intra‐nodal tumor, made of large clear cells with abundant cytoplasm and round nuclei without atypia or mitosis. The immunohistochemical staining showed diffuse positivity for keratin AE1/AE3, keratin 5/6 and p63, and focal staining with keratin 7, epithelial membrane antigen (EMA) and carcinous epithelial antigen (CEA), which underlined some ductular structures. Tumor cells were negative for renal markers PAX8 and CD10. Ki67 stained less than 1% of tumor cells. A translocation involving MAML2 gene was evidenced by fluorescence in situ hybridization (FISH) analysis. No primary cutaneous tumor was found after extensive examination. Altogether, these results are in favor of an isolated nodal hidradenoma, for which we discuss two hypothesis: a primary nodal lesion, or a ‘benign metastasis’ of a cutaneous tumor. Cases of morphologically benign hidradenoma with lymph node involvement are exceptional. Our case, similar to every other reported case, was associated with an excellent prognosis, supporting the idea that these patients should not be overtreated.