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1.
ObjectivesMap regional lymph node metastases for lateralized oral cavity squamous cell carcinoma (OCSCC) and evaluate factors associated with regional metastases and recurrence.Materials and methodsRetrospective cohort study of 715 patients with lateralized OCSCC surgically treated in 1997–2011. Analysis was performed using log-rank, Kaplan-Meier, and multivariable logistic and Cox regression.ResultsRegional metastases were identified in ipsilateral levels IIA (24%), IB (18%), III (13%), V (9%), IV (7%), IA (2%) and IIB (1%) and the contralateral neck (3%). Lymphovascular invasion (LVI) (Hazard Ratio [HR] 2.2, 95% Confidence Interval [CI] 1.2–3.9) and T category (T3 vs. T1: HR 4.1, 95% CI 1.9–9.3; T4 vs. T1: HR 2.3, 95% CI 1.2–4.3) were associated with regional metastases. Most (71%) isolated regional metastatic recurrences were in undissected levels of the neck, including 58% in levels IV and V. Tumors of the hard palate (HR 4.3, 95% CI 1.2–16.1), upper alveolus (HR 3.2, 95% CI 1.0–4.7) or with LVI (HR 2.0, 95% CI 1.0–3.9) were associated with isolated regional recurrence. For upper alveolar/hard palate tumors, depth of invasion (DOI) ≥4 mm (P = .003) and LVI (P = .04) were associated with regional metastases.ConclusionsFor lateralized OCSCC, elective neck dissection of level IIB or the contralateral neck may rarely be needed, but additional surgical or radiation treatment of levels IV and V may be considered based on patient risk factors, including T category 3–4 or LVI. For upper alveolar/hard palate tumors, DOI ≥4 mm is an appropriate threshold for elective neck dissection. 相似文献
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《Health & place》2022
BackgroundFrom birth to young adulthood, health and development of young people are strongly linked to their living situation, including their family’s socioeconomic position (SEP) and living environment. The impact of regional characteristics on development in early childhood beyond family SEP has been rarely investigated. This study aimed to identify regional predictors of global developmental delay at school entry taking family SEP into consideration.MethodWe used representative, population-based data from mandatory school entry examinations of the German federal state of Brandenburg in 2018/2019 with n=22,801 preschool children. By applying binary multilevel models, we hierarchically analyzed the effect of regional deprivation defined by the German Index of Socioeconomic Deprivation (GISD) and rurality operationalized as inverted population density of the children’s school district on global developmental delay (GDD) while adjusting for family SEP (low, medium and high).ResultsFamily SEP was significantly and strongly linked to GDD. Children with the highest family SEP showed a lower odds for GDD compared to a medium SEP (female: OR=4.26, male: OR=3.46) and low SEP (female: OR=16.58, male: OR=12.79). Furthermore, we discovered a smaller, but additional and independent effect of regional socioeconomic deprivation on GDD, with a higher odds for children from a more deprived school district (female: OR=1.35, male: OR=1.20). However, rurality did not show a significant link to GDD in preschool children beyond family SEP and regional deprivation.ConclusionFamily SEP and regional deprivation are risk factors for child development and of particular interest to promote health of children in early childhood and over the life course. 相似文献
4.
Alessandro De Cassai Tommaso Tonetti Helmut Galligioni Carlo Ori 《Brazilian Journal of Anesthesiology》2019,69(1):95-98
Background and objective
Erector spinae plane block is a valid technique to provide simultaneously analgesia for combined thoracic and abdominal surgery.Case report
A patient underwent open esophagectomy followed by reconstructive esophagogastroplasty but refused thoracic epidural analgesia; a multi‐modal analgesia with a multiple erector spinae plane block was then planned. Three erector spinae plane catheters (T5 and T10 on the right side and T9 on the left side) for continuous analgesia were placed before surgery. During the first 48 h pain was never reported in the thoracic area but the patient reported multiple times to feel a pain well localized in epigastrium, but never localized in any other abdominal quadrant.Discussion
Erector spinae plane block is a valid technique to provide analgesia simultaneously for combined thoracic and abdominal surgery and could be a valid alternative strategy if the use of epidural analgesia is contraindicated. 相似文献5.
《中国现代医生》2020,58(34):60-63
目的 通过检测老年轻度认知障碍(MCI)患者血清瘦素(LEP)、甲状腺激素水平,分析其与局部脑血流量(rCBF)的关系。方法 选择本院收治的128 例老年MCI 患者,另选健康者128 例作为对照组。检测血清LEP、甲状腺激素、大脑各区域rCBF 水平并分析其相关性。结果 老年MCI 组患者左右侧额叶、右侧颞叶、左侧顶叶、左右侧基底节区域脑血流量[(43.81±8.62)mL/(100 g·min)、(43.24±7.93)mL/(100 g·min)、(45.14±6.98)mL/(100 g·min)、(45.86±6.77)mL/(100 g·min)、(67.95±8.52)mL/(100 g·min)、(68.36±8.34)mL/(100 g·min)]低于对照组[(46.39±8.31)mL/(100 g·min)、(46.52±8.56)mL/(100 g·min)、(47.37±7.04)mL/(100 g·min)、(48.25±6.98)mL/(100 g·min)、(70.34±8.96)mL/(100 g·min)、(70.58±8.57)mL/(100 g·min)](P<0.05)。老年MCI 组患者血清LEP、T3、FT3 水平[(4.87±1.56)μg/L、(1.21±0.16)nmol/L、(3.04±0.36)pmol/L]低于对照组[(11.45±3.92)μg/L、(1.68±0.21)nmol/L、(4.82±1.21)pmol/L](P<0.05),TSH 水平为(2.78±0.75)IU/mL,高于对照组的(1.13±0.38)IU/mL(P<0.05)。老年MCI 患者血清LEP 水平与左侧额叶、右侧颞叶、左侧顶叶rCBF 呈正相关(r=0.452、0.537、0.544,P 均<0.05),T3 水平与左侧额叶、右侧颞叶rCBF 呈正相关(r=0.427、0.521,P 均<0.05),FT3 水平与右侧颞叶rCBF 呈正相关(r=0.492,P<0.05),TSH 水平与左侧额叶、右侧颞叶rCBF 呈负相关(r=-0.463、-0.489,P 均<0.05)。结论 老年MCI 患者血清中LEP、T3、FT3 水平降低,TSH 水平升高,且与不同区域rCBF 有相关性,可通过调控脑血管功能影响rCBF 变化水平。 相似文献
6.
Lingual lymph nodes are an inconstant group of in-transit nodes, which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II. There is growing academic data on the metastatic spread of oral cancer, particularly regarding the spreading of oral tongue squamous cell carcinoma to lingual nodes. These nodes are not currently included in diagnostic and treatment protocols for oral tongue cancer. Combined information on surgical anatomy, clinical observations, means of detection, and prognostic value is presented. Anatomically obtained incidence of lingual nodes ranges from 8.6% to 30.2%. Incidence of lingual lymph node metastasis ranges from 1.3% to 17.1%. It is clear that lymph nodes that bear intervening tissues from the floor of the mouth should be removed to improve loco-regional control. Extended resection volume, which is required for the surgical treatment of lingual node metastasis, cannot be implied to every tongue cancer patient. As these lesions significantly influence prognosis, special efforts of their detection must be made. Reasonably, every tongue cancer patient must be investigated for the existence of lingual lymph node metastasis. Lymphographic tracing methods, which are currently implied for sentinel lymph node biopsies, may improve the detection of lingual lymph nodes. 相似文献
7.
目的:窦道是通达组织深部的盲管性创道,时发时愈,迁延日久.是临床工作者常见的问题,治疗十分困难;为探索窦道的新的治疗途径,开展了微波治疗窦道的临床研究.方法:微波组:采用微波热机局部照射 外科常规换药治疗;根据病变部位分别选择直径为10cm或16cm的辐射器,辐射器距窦道口距离为3cm~5cm,隔1d或隔2d治疗1次,每次30 min,10次为1个疗程,微波治疗功率为70W,治疗结束观察治疗效果.对照组:按外科常规换药治疗.结果:微波组痊愈率98%,好转率2%,总有效率100%;对照组痊愈率37.5%,有效率37.5%,无效率25%,总有效率75%;结论:微波治疗窦道不愈患者具有简单、安全、方便、疗效独特等优点. 相似文献
8.
多层螺旋CT灌注成像在颅脑系统疾病中的应用研究 总被引:10,自引:0,他引:10
随着多层螺旋CT的推广使用,使以脑血流动力学研究为目的的多层螺旋CT脑灌注成像(MSCT perfusion imaging)逐渐变为现实,为综合应用CT扫描技术提供了条件,为临床提供了一种全新的、极具潜力的、适用面广的影像检查新技术。一、CT脑灌注成像理论基础1.脑灌注成像理论的形成:在198 相似文献
9.
局麻胸腔镜清创术治疗脓胸实用性研究 总被引:1,自引:0,他引:1
目的探讨脓胸患者经局麻胸腔镜清创术治疗的实用价值。方法在局麻下用硬质电视胸腔镜行脓胸清创术,介绍操作方法及清创步骤,观察患者的耐受性及疗效。结果总有效率为90.6%,早、中、晚期治疗有效率分别是100.0%、90.9%、50.0%。术中监测患者对操作的反应及血氧饱和度、呼吸、脉搏、心电图改变均无统计学意义。结论局麻胸腔镜清创术在患者清醒状态下操作,除抽净黏稠脓液外尚可取出团块状脓苔及坏死组织,打穿包裹性脓腔,充分冲洗,可迅速控制感染。方法简单,避免全麻气管插管带来的并发症,术后恢复快,适应证广,患者易耐受,是治疗脓胸的实用方法。 相似文献
10.