Dosage Formula in Anesthesia for Manual Intrauterine Aspiration Post-Abortion in Resource-Limited Settings

Setting: Provincial General Reference Hospital of Bukavu, General Reference Hospital of Panzi, General Reference Hospital of Ciriri, General Reference Hospital of Nyatende and Biopharm Hospital Center. Objective: Contribute to the improvement of the anesthetic ECP of patients benefiting from MVA for incomplete abortion, Describe the methodology used for adoption of the dosage formula in Anesthesia for MVA, present the mathematical demonstration leading to the dosage formula in anesthesia for MVA. Materials and Methods: Our study was descriptive by mathematical demonstration of obtaining the equilibrium constant of the dosage formula of bipuvacaine 0.1% and Fentanyl 50 µg% adapted to the weight and specific size of patients treated anesthetically in MVA cases for incomplete abortion. We also carried out an operational research by first determining the interval where our equilibrium constant is included and secondly by means of the ends of the intervals found correlated to the ends of intervals of possible weights and sizes in the being normal human female of childbearing age to arrive at the real numerical value of the equilibrium constant of the BUKAVU Dosage Formula in the case of anesthesia for MVA during the management of incomplete abortions. Results: TWO-STAGE OPERATIONAL RESEARCH: • Determination of the interval where the equilibrium constant x = −0.95 x x by crossing the means between the extremes of volumes of anesthetic drugs giving a satisfactory sensory block without hemodynamic disturbance and the extremes of normal weight and height for women of childbearing age. We ended up with X = 0.37. Conclusion: At the end of our study which had the general objectives of contributing to the improvement of the anesthetic PEC of patients receiving MVA for incomplete abortion and specific objectives of describing the methodology used for adoption of the dosage formula in Anesthesia for MVA and present the mathematical demonstration which resulted in the dosage formula in nesthesia for MVA, it appears that the dosage formula of Bukavu, in case of intrathecal spinal analgesia of MVA for incomplete abortion provides precision on the specificity of the doses of bipuvacaine hypobarre 0.1% and Fentanyl 50 µg% reported to each patient according to her weight and height. Its application could therefore reduce morbidity and mortality and improve patient-practitioner comfort in the event of MVA for incomplete abortion following the dosage precision it provides.

Fine-needle aspiration technique under endoscopic ultrasound guidance:A technical approach for RNA profiling of pancreatic neoplasms

BACKGROUND Early diagnosis of pancreatic ductal adenocarcinoma(PDAC)has been a longstanding challenge.The prognosis of patients with PDAC depends on the stage at diagnosis.It is necessary to identify biomarkers for the detection and differentiation of pancreatic tumors and optimize PDAC sample preparation procedures for DNA and RNA analysis.Most molecular studies are done using paraffin-embedded blocks;however,the integrity of DNA and RNA is often compromised in this format.Moreover,RNA isolated from human pancreatic tissue samples is generally of low quality,in part,because of the high concentration of endogenous pancreatic RNAse activity present.AIM To assess the potential of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)to obtain specimens from pancreatic neoplasms for subsequent RNA molecular profiling,including next-generation sequencing(NGS).METHODS Thirty-four EUS-FNA samples were included in this study:PDAC(n=15),chronic pancreatitis(n=5),pancreatic cysts(n=14),mucinous cysts(mucinous cystic neoplasia/intraductal papillary mucinous neoplasia)n=7,serous cystic neoplasms n=5,and pseudocysts n=2.Cyst material consisted of cyst fluid and cyst wall samples obtained by through-the-needle biopsy(TTNB).Samples were stored at -80℃ until analysis.RNA purity(A260/230,A260/280 ratios),concentration,and integrity(RIN)were assessed.Real-time polymerase chain reaction was conducted on all samples,and small RNA libraries were prepared from solid mass samples.RESULTS RNA was successfully extracted from 29/34(85%)EUS-FNA samples:100% pancreatic adenocarcinoma samples,100% chronic pancreatitis samples,70% pancreatic fluid cyst samples,and 50%TTNB samples.The relative expression of GAPDH and HPRT were obtained for all successfully extracted RNA samples(n=29)including lowquality RNA specimens.Low concentration and nonoptimal RIN values(no less than 3)of RNA extracted from EUS-FNA samples did not prevent NGS library preparation.The suitability of cyst fluid samples for RNA profiling varied.The quality of RNA extracted from mucinous cyst fluid had a median RIN of 7.7(5.0-8.2),which was compatible with that from solid neoplasms[6.2(0-7.8)],whereas the quality of the RNA extracted from all fluids of serous cystic neoplasms and TTNB samples had a RIN of 0.CONCLUSION The results demonstrate the high potential of EUS-FNA material for RNA profiling of various pancreatic lesions,including low-quality RNA specimens.

Flexible bronchoscopy for foreign body aspiration in children:A single-centre experience

BACKGROUND The technological evolution of bronchoscopy has led to the widespread adoption of flexible techniques and their use for both diagnostic and therapeutic purposes.Currently,there is an active debate regarding the comparative efficacy and safety of rigid vs flexible bronchoscopy in the treatment of foreign body aspiration.AIM To evaluate our experience with tracheobronchial foreign body extraction using flexible bronchoscopy and provide a literature overview.METHODS This was a single-centre retrospective study.Twenty-four patients were enrolled between January 2017 and January 2023.Medical records of patients aged below 18 years who were admitted to authors’affiliated institution with a suspected diagnosis of foreign body aspiration were collected from hospital’s database to Microsoft Excel 2019.Data were analysed using MedCalc Statistical Software.RESULTS Patient ages varied from 9 months to 11 years.The median age was 23.5 months,95%confidence interval(CI)19.49-44.77.We observed age clustering in children with foreign body aspiration at our institution with three age subgroups:(1)0-25 months;(2)40-60 months;and(3)120-140 months.We expectancy of an organic tracheobronchial foreign body was significantly higher in 0-25 months subgroup than that in older ones when subgroups 40-60 and 120-140 months were combined together(odds ratio=10.0,95%CI:1.44-29.26,P=0.0197).Successful foreign body extraction was performed in all cases.Conversion to a rigid bronchoscope was not required in any of the cases.No major complications(massive bleeding,tracheobronchial tree perforation,or asphyxia)were observed.CONCLUSION Flexible bronchoscopy is an effective and safe method for tracheobronchial foreign body extraction in children.

Application Effect of Stratified Nursing Intervention for ICU Mechanically Ventilated Patients in the Context of Aspiration Risk Assessment

Objective:To explore the application effect of stratified nursing intervention based on the background of misinspiration risk assessment in mechanically ventilated patients in intensive care unit(ICU).Methods:100 cases of mechanically ventilated patients who were admitted to the ICU of our hospital from March 2022 to March 2023 were selected and divided into an observation group and a control group according to the random number table method,with 50 cases in each of the two groups.The control group was given routine care in ICU,and the observation group was given stratified nursing interventions based on the background of the risk of aspiration assessment on the basis of the control group,and both groups were cared for until they were transferred out of the ICU,and the mechanical ventilation time,ICU stay time,muscle strength score,complication rate,adherence,and satisfaction were observed and compared between the two groups.Results:The mechanical ventilation time and ICU stay time of the observation group were shorter than that of the control group after the intervention;the muscle strength score,compliance and satisfaction of the observation group were higher than that of the control group after the intervention;and the complication rate of the observation group was lower than that of the control group after the intervention,all of which were P<0.05.Conclusion:The application of stratified nursing intervention based on the background of misaspiration risk assessment in ICU mechanically ventilated patients can improve the patient's muscle strength,shorten the time of mechanical ventilation,promote the patient's recovery,reduce the occurrence of complications,and improve the patient's compliance and satisfaction.

Endoscopic ultrasound-guided fine-needle aspiration cytology diagnosis of solid pseudopapillary tumor of the pancreas: A case report and literature review

We describe the clinical, imaging and cytopathological features of solid pseudopapillary tumor of the pancreas (SPTP) diagnosed by endoscopic ultrasound- guided (EUS-guided) fine-needle aspiration (FNA). A 17-year-old woman was admitted to our hospital with complaints of an unexplained episodic abdominal pain for 2 mo and a short history of hypertension in the endocrinology clinic. Clinical laboratory examinations revealed polycystic ovary syndrome, splenomegaly and low serum amylase and carcinoembryonic antigen (CEA) levels. Computed tomography (CT) analysis revealed a mass of the pancreatic tail with solid and cystic consistency. EUS confirmed the mass, both in body and tail of the pancreas, with distinct borders, which caused dilation of the peripheral part of the pancreatic duct (major diameter 3.7 mm). The patient underwent EUS-FNA. EUS-FNA cytology specimens consisted of single cells and aggregates of uniform malignant cells, forming microadenoid structures, branching, papillary clusters with delicate fibrovascular cores and nuclear overlapping. Naked capillaries were also seen. The nuclei of malignant cells were round or oval, eccentric with fine granular chromatin, small nucleoli and nuclear grooves in some of them. The malignant cells were periodic acid Schiff (PAS)-Alcian blue (+) and immunocytochemically they were vimentin (+), CA 19.9 (+), synaptophysin (+), chromogranin (-), neuro-specific enolase (-), a1- antitrypsin and a1-antichymotrypsin focal positive. Cytologic findings were strongly suggestive of SPTP. Biopsy confirmed the above cytologic diagnosis. EUS- guided FNA diagnosis of SPTP is accurate. EUS findings,cytomorphologic features and immunostains of cell block help distinguish SPTP from pancreatic endocrine tumors, acinar cell carcinoma and papillary mucinous carcinoma.

Endoscopic ultrasound guided fine needle aspiration and useful ancillary methods

The role of endoscopic ultrasound(EUS) in evaluating pancreatic pathology has been well documented from the beginning of its clinical use. High spatial resolution and the close proximity to the evaluated organs within the mediastinum and abdominal cavity allow detection of small focal lesions and precise tissue acquisition from suspected lesions within the reach of this method. Fine needle aspiration(FNA) is considered of additional value to EUS and is performed to obtain tissue diagnosis. Tissue acquisition from suspected lesions for cytological or histological analysis allows, not only the differentiation between malignant and non-malignant lesions, but, in most cases, also the accurate distinction between the various types of malignant lesions. It is well documented that the best results are achieved only if an adequate sample is obtained for further analysis, if the material is processed in an appropriate way, and if adequate ancillary methods are performed. This is a multi-step process and could be quite a challenge in some cases. In this article, we discuss the technical aspects of tissue acquisition by EUS-guided-FNA(EUS-FNA), as well as the role of an on-site cytopathologist, various means of specimen processing, and the selection of the appropriate ancillary method for providing an accurate tissue diagnosis and maximizing the yield of this method. The main goal of this review is to alert endosonographers, not only to the different possibilities of tissue acquisition, namely EUS-FNA, but also to bring to their attention the importance of proper sample processing in the evaluation of various lesions in the gastrointestinal tract and other accessible organs. All aspects of tissue acquisition(needles, suction, use of stylet, complications, etc.) have been well discussed lately. Adequate tissue samples enable comprehensive diagnoses, which answer the main clinical questions, thus enabling targeted therapy.

Successful treatment of a rare subcutaneous emphysema after a blow-out fracture surgery using needle aspiration:A case report

BACKGROUND Many cases of emphysema associated with blow-out fractures occur before surgery due to trauma.However,emphysema can occur even after surgery,and most of such cases are managed conservatively and allowed to resolve.Swelling in the periorbital area due to emphysema that occurs after surgery can make early recovery difficult.CASE SUMMARY Herein,we describe a case of postoperative subcutaneous emphysema that was treated using a simple needle aspiration method.A 48-year-old male patient visited the hospital with a blow-out fracture of the left medial orbital wall and nasal bone fracture.One day postoperatively,swelling and crepitus in the left periorbital area were observed,and follow-up computed tomography showed emphysema in the left periorbital subcutaneous area.Needle aspiration using an 18-gauge needle and syringe was used to relieve the emphysema.The symptoms of sudden swelling improved immediately,and no recurrence was observed.CONCLUSION We conclude that needle aspiration is a useful method that could help in relieving symptom,resolving discomfort,and enabling early return to daily life in patients with postoperative subcutaneous emphysema.

Role of endoscopic ultrasound in the characterization of solid pseudopapillary neoplasm of the pancreas

BACKGROUND Solid pseudopapillary neoplasm(SPN)is an uncommon pathology of the pancreas with unpredictable malignant potential.Endoscopic ultrasound(EUS)assessment plays a vital role in lesion characterization and confirmation of the tissue diagnosis.However,there is a paucity of data regarding the imaging assessment of these lesions.AIM To determine the characteristic EUS features of SPN and define its role in preoperative assessment.METHODS This was an international,multicenter,retrospective,observational study of prospective cohorts from 7 large hepatopancreaticobiliary centers.All cases with postoperative histology of SPN were included in the study.Data collected included clinical,biochemical,histological and EUS characteristics.RESULTS One hundred and six patients with the diagnosis of SPN were included.The mean age was 26 years(range 9 to 70 years),with female predominance(89.6%).The most frequent clinical presentation was abdominal pain(80/106;75.5%).The mean diameter of the lesion was 53.7 mm(range 15 to 130 mm),with the slight predominant location in the head of the pancreas(44/106;41.5%).The majority of lesions presented with solid imaging features(59/106;55.7%)although 33.0%(35/106)had mixed solid/cystic characteristics and 11.3%(12/106)had cystic morphology.Calcification was observed in only 4(3.8%)cases.Main pancreatic duct dilation was uncommon,evident in only 2 cases(1.9%),whilst common bile duct dilation was observed in 5(11.3%)cases.One patient demonstrated a double duct sign at presentation.Elastography and Doppler evaluation demonstrated inconsistent appearances with no emergence of a predictable pattern.EUS guided biopsy was performed using three different types of needles:Fine needle aspiration(67/106;63.2%),fine needle biopsy(37/106;34.9%),and Sonar Trucut(2/106;1.9%).The diagnosis was conclusive in 103(97.2%)cases.Ninety-seven patients were treated surgically(91.5%)and the post-surgical SPN diagnosis was confirmed in all cases.During the 2-year follow-up period,no recurrence was observed.CONCLUSION SPN presented primarily as a solid lesion on endosonographic assessment.The lesion tended to be located in the head or body of the pancreas.There was no consistent characteristic pattern apparent on either elastography or Doppler assessment.Similarly SPN did not frequently cause stricture of the pancreatic duct or common bile duct.Importantly,we confirmed that EUS-guided biopsy was an efficient and safe diagnostic tool.The needle type used does not appear to have a significant impact on the diagnostic yield.Overall SPN remains a challenging diagnosis based on EUS imaging with no pathognomonic features.EUS guided biopsy remains the gold standard in establishing the diagnosis.

Aspirations of Fisherfolk Communities on Their Children’s Education in Albay, Asid, and Ragay Gulfs of Bicol, Philippines

The study explores the yearnings of fisherfolks on their child’s education, hindrances, and factors that shape their desire as parents. Field observations and key informant interview among elder members of fisherfolk communities surrounding the Albay, Ragay, and Asid Gulfs of the Bicol Region was utilized. The study revealed that the majority of the fisherfolk parents do not want their children to continue fishing as their main source of livelihood because of potential risks, hardships, and cultural factors like collectivism, close family ties, and dependence on the elders. The parents’ aspirations were shaped by their persistence over various threats, fears, personal unfulfilled dreams, and career opportunities thru education. Most of the parents desired a college education and a safe and secure profession for their children. The study deduced that these challenges can be a contributory factor for the declining number of fisherfolks surrounding the gulfs. Influencing this sector is the factor motivating fishers in their aspirations for their children’s education. The study recommends introducing strategies for fisherfolks to develop a strong sense of hope and drive in realizing their aspirations and further research on the impact of culture, the role of women and children, and fisherfolks and their success stories.

New treatment for gastric duplication cyst:Endoscopic ultrasonography-guided fine-needle aspiration combined with lauromacrogol sclerotherapy:A case report

BACKGROUND Gastric duplication cysts are very rare disease that are mainly diagnosed by endoscopic ultrasonographic fine-needle aspiration biopsy.In the past,this disease was usually treated with traditional surgery and rarely with minimally invasive endoscopic surgery.However,minimally invasive endoscopic therapy has many advantages,such as no skin wound,organ preservation,postoperative pain reduction,early food intake,fewer postoperative complications,and shorter post-procedure hospitalization.CASE SUMMARY We report a case of endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)combined with lauromacrogol sclerotherapy for pyloric obstruction due to gastric duplication cysts.CONCLUSION EUS-FNA combined with lauromacrogol sclerotherapy provides a new option for the treatment of gastrointestinal duplication cysts.

Endoscopic ultrasound-guided fine-needle aspiration pancreatic adenocarcinoma samples yield adequate DNA for next-generation sequencing:A cohort analysis

BACKGROUND Genetic tests are increasingly performed for the management of unresectable pancreatic cancer.For genotyping aimed samples current guidelines recommend using core specimens,although based on moderate quality evidence.However,in clinical practice among the endoscopic ultrasound(EUS) guided tissue acquisition methods,fine needle aspiration(FNA) is the most widely performed.AIM To assess the adequacy for next generation sequencing(NGS) of the DNA yielded from EUS-FNA pancreatic adenocarcinoma(PDAC) samples.METHODS Between November 2018 and December 2021,105 patients with PDAC confirmed by EUS-FNA were included in the study at our tertiary gastroenterology center.Either 22 gauge(G) or 19G FNA needles were used.One pass was dedicated to DNA extraction.DNA concentration and purity(A260/280,A260/230) were assessed by spectrophotometry.We assessed the differences in DNA parameters according to needle size and tumor characteristics(size,location) and the adequacy of the extracted DNA for NGS(defined as A260/280 ≥ 1.7,and DNA yield:≥ 10 ng for amplicon based NGS,≥ 50 ng for whole exome sequencing [WES],≥ 100 ng for whole genome sequencing [WGS]) by analysis of variance and ttest respectively.Moreover,we compared DNA purity parameters across the different DNA yield categories.RESULTS Our cohort included 49% male patients,aged 67.02 ± 8.38 years.The 22G needle was used in 71%of the cases.The DNA parameters across our samples varied as follows:DNA yield:1289 ng(inter quartile range:534.75-3101),A260/280 = 1.85(1.79-1.86),A260/230 = 2.2(1.72-2.36).DNA yield was > 10 ng in all samples and > 100 ng in 93% of them(one sample < 50 ng).There were no significant differences in the concentration and A260/280 between samples by needle size.Needle size was the only independent predictor of A260/230 which was higher in the 22G samples(P =0.038).NGS adequacy rate was 90% for 19G samples regardless of NGS type,and for 22G samples it reached 89% for WGS adequacy and 91% for WES and amplicon based NGS.Samples with DNA yield > 100 ng had significantly higher A260/280(1.89 ± 0.32 vs 1.34 ± 0.42,P = 0.013).Tumor characteristics were not corelated with the DNA parameters.CONCLUSION EUS-FNA PDAC samples yield DNA adequate for subsequent NGS.DNA amount was similar between 22G and 19G FNA needles.DNA purity parameters may vary indirectly with needle size.

Submandibular solid-cystic mass as the first and sole manifestation of occult thyroid papillary carcinoma: A case report

BACKGROUND Occult thyroid papillary carcinoma(OTPC)is typically characterized by initial presentation with cervical lymph node metastasis and can be detected through ultrasound.However,the initial and sole manifestation was a submandibular solid-cystic mass.High-frequency ultrasound,enhanced multislice computed tomography(CT)scan,and thyroid function tests revealed no abnormalities,which is relatively uncommon.CASE SUMMARY A 24-year-old Chinese female,who studied at a university in Shandong Province,presented to the clinic in June 2019 with a right submandibular mass that she had noticed 2 mo earlier.Clinical examination revealed a 2-cm,nontender,movable solid-cystic mass in the submandibular region,with no palpable thyroid mass observed.Ultrasonography revealed a 2.0 cm×1.1 cm solid-cystic mass in the right submandibular region,and the thyroid gland showed no abnormalities.CT scan and 131I whole body follow-up scan showed that there were no abnormalities in the thyroid.However,cytology and pathology showed papillary tumor cell clusters,consistent with papillary thyroid carcinoma.Thus,we performed total thyroidectomy and right neck lymph node dissection.The pathology revealed the thyroid was detected as classical thyroid micropapillary carcinoma,and lymph nodes of levels VI central and levels II,III,IV,V on the right side showed no tumor metastasis.The patient was followed up for 2 years without significant recurrence.CONCLUSION The presentation of a submandibular solid-cystic mass as the primary and solitary indication of OTPC is relatively uncommon.Fine needle aspiration is advised for evaluating neck masses.

过去20年城乡高中生的教育效用与教育志向:基于三个出生队列的历史比较研究

本研究采用时间滞后设计,考察过去20年我国高中生教育效用和教育志向水平的年代和城乡差异,以及二者与个体学业成绩、父母学历之间关系的年代和城乡差异。分别在1999年、2010年、2018年对来自相同的三个地区(包括城市和农村)、相同学校的高中生进行问卷调查,使用协方差分析和回归分析进行数据分析。结果发现:(1)自1999年至2018年,城乡高中生的教育效用都遵循先下降、后回升的变化趋势;在教育志向上,城市高中生无明显变化,而农村高中生教育志向上升并超越城市高中生;(2)高中生教育效用、教育志向受父母学历和学业成绩等微观因素影响,且受年代和城乡宏观社会历史因素调节。相比于其他年份,2010年时成绩较差学生的教育效用更低、2018年时成绩较差学生的教育志向更高;自1999年至2018年,低父母学历对农村高中生教育志向的影响方式由“枷锁效应”转变为“鞭策效应”。我国过去20年的社会变迁使城乡高中生对教育的价值认同发生系统性变化,且宏观社会历史因素的演变改变了教育的价值认同形成的微观机制。

Lipoid Pneumonia Caused by Diesel Aspiration: A Case Report and Literature Review

Diesel poisoning is a rare clinical condition.On September 27,2021,a 55-year-old male who mistakenly inhaled 20 mL of diesel through a siphon was admitted to our hospital.The main symptoms were cough and asthma.Chest computed tomography(CT)showed both lungs scattered with patchy consolidation,ground-glass shadow,exudation,and pleural effusion.After 61 days of lung rehabilitation training and other supportive treatment,including oxygen therapy,postural drainage,ventilator support,bronchoalveolar lavage,hemoperfusion,continuous renal replacement therapy(CRRT),hormones,and antibiotics,the patient’s condition improved,and the patient was discharged.Through literature review,we found that lung consolidation,ground-glass shadow,nodular lesions,and pleural effusion can be observed on chest images of patients with lipoid pneumonia,with severe cases showing diffuse lesions involving both lungs,possibly secondary to respiratory failure.Children with acute critical illness deteriorates rapidly and have poor prognosis,whereas adults or patients with chronic poisoning have better prognosis after active treatment.

“亲近”还是“疏远”?———联合投资伙伴的社会期望绩效反馈与联合风险投资关系

风险投资是支持创新创业的重要活动,但风险投资的不确定性催生了“抱团”行为的出现,与风险投资联合投资伙伴选择相关的研究也开始逐渐丰富。本文借鉴企业行为理论中的绩效反馈,以2000—2020年CVSource中记录的投资交易数据,分析了风险投资机构联合投资伙伴的社会期望绩效反馈对双方联合关系强度的影响。研究发现,当联合投资伙伴处于社会期望绩效落差状态时,为得到互惠交易流,风险投资机构与期望绩效水平较高的联合投资伙伴之间的关系变得亲近。当联合投资伙伴处于社会期望绩效顺差状态时,高期望绩效水平的联合投资伙伴为避免摊薄收益,选择不进行联合投资,因而与风险投资机构之间的关系变得疏远。此外,风险投资机构与联合投资伙伴之间的绩效差距也是进一步导致双方联合关系强度降低的重要因素。本研究从绩效反馈理论视角拓展了风险投资联合行为的相关研究,打开了联合投资伙伴之间关系动态性的黑箱,揭示了风险投资联合行为的内在规律。

成人ICU患者显性误吸影响因素分析

目的探讨成人ICU患者发生显性误吸的影响因素,为识别高危人群、降低显性误吸发生率提供参考。方法选取成人ICU患者798例,利用单因素分析和logistic回归分析探讨显性误吸的影响因素。结果成人ICU患者显性误吸发生率为16.9%,机械通气、胃残余量、腹腔内压力、误吸史、呕吐是危险因素(均P<0.05)。结论成人ICU患者有发生显性误吸的风险,需重点关注机械通气、有误吸史及呕吐的患者,减少胃残余量和降低腹腔内压力,以减少显性误吸。

细针穿刺、粗针穿刺及两者联合诊断甲状腺结节的前瞻性对比研究

目的:对比研究超声引导下细针穿刺(FNA)、粗针穿刺(CNB)和粗细针穿刺结合(FNA+CNB)对同一甲状腺结节的诊断效能。方法:选取105例甲状腺结节患者(112个结节)作为研究对象,对每个结节同时行超声引导下细针(FNA)和粗针(CNB)穿刺,分别比较FNA、CNB、FNA+CNB对甲状腺结节的诊断效能;根据超声特征(结节最大径、粗大钙化、纵横比、囊实性)进行分组,比较FNA、CNB的诊断准确度。结果:剔除14个穿刺失败结节后,剩余98个结节进入研究,FNA、CNB取材成功率分别为89.4%、97.3%(P<0.05)。FNA、CNB、FNA+CNB诊断甲状腺结节的敏感度分别为93.1%、75.9%、100%,FNA、FNA+CNB优于CNB(P<0.05);特异度分别为60%、90%、57.5%,CNB优于FNA、FNA+CNB(P<0.05);阴性预测值分别为85.7%、72%、100%,FNA+CNB优于CNB(P<0.05)。ROC曲线分析显示,CNB曲线下面积(AUC)大于FNA(0.829 vs.0.766,P<0.05)。亚组分析中,对于直径<0.5 cm的结节,CNB诊断特异度高于FNA(100%vs.50%,P=0.014),FNA诊断敏感度高于CNB(93.3%vs.46.7%,P=0.033)。结节大小和纵横比可能会影响CNB的诊断结果,直径≥0.5 cm敏感度更高,纵横比≤1准确度更高(P<0.05);结节囊实性可能会影响FNA诊断结果,实性结节准确度更高(P<0.05)。结论:CNB对甲状腺结节良恶性的检出具有更高的诊断价值,但直径<0.5cm的结节使用FNA具有更高的敏感度。

FNAC联合FNA-Tg检测在甲状腺乳头状癌颈侧区淋巴结转移中的诊断价值

目的探讨超声引导下细针穿刺细胞学检查(FNAC)联合细针穿刺洗脱液甲状腺球蛋白(FNA-Tg)在甲状腺乳头状癌(PTC)颈侧区淋巴结转移中的诊断价值。方法回顾性分析行颈侧区淋巴结清扫术的200例PTC患者的临床资料,术前超声评估颈侧区有可疑转移淋巴结236枚,术后病理证实转移性淋巴结178枚,非转移性淋巴结58枚,所有患者均行FNAC、FNA-Tg检查。以术后病理结果为金标准,比较FNAC、FNA-Tg、FNAC联合FNA-Tg的诊断结果及诊断效能。结果FNAC联合FNA-Tg诊断PTC颈侧区淋巴结转移的灵敏度、准确度、阴性预测值高于单一诊断方法,差异具有统计学意义(P<0.05)。结论FNAC与FNA-Tg检测方法在临床中能够用于诊断PTC颈侧区淋巴结转移,两者联合检测可以进一步提高诊断效能,值得推广及应用。

利用持续质量改进工具降低重症脑血管病患者误吸发生率的实践

目的探讨持续质量改进工具在减少重症脑血管病患者误吸发生中的作用。方法选择2020年11月—2021年6月在本院神经内科ICU实施肠内营养的重症脑血管病患者104例作为研究对象,按照入住时间分为对照组和观察组两组,其中2020年11—12月收治的患者53例作为对照组,2021年4—6月收治的51例患者作为观察组。对照组给予常规护理干预,观察组在常规护理的基础上进行持续质量改进活动干预,比较干预前后两组患者误吸、吸入性肺炎发生率的差异。结果持续质量改进活动干预后重症脑血管病患者误吸的发生率由20.75%降低到5.88%(P<0.05),目标达标率109.26%,进步率71.66%。结论利用持续质量改进工具能有效减少重症脑血管病患者误吸的发生。

注射用牛肺表面活性剂不同给药方式在新生儿胎粪吸入综合征中的应用

目的探讨注射用牛肺表面活性剂不同给药方式在新生儿胎粪吸入综合征(MAS)中的应用效果。方法回顾性分析2021年3月至2023年3月南阳市第一人民医院收治的120例MAS患儿的临床资料,根据给药方式不同分为A组和B组各60例。A组患儿采用肺泡灌洗+气管内滴入给药,B组患儿采用气管内滴入给药,连续治疗48 h。比较两组患儿的临床疗效,以及治疗前后的血气指标[氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、氧指数(OI)]、肺动脉收缩压(SPAP)、凝血纤溶指标[D-二聚体(D-D)、纤溶酶原激活抑制剂-1(PAI-1)/组织型纤溶酶原激活物(t-PA)、血小板活化因子(PAF)]、炎症因子[肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、白细胞介素-5(IL-5)、白细胞介素-13(IL-13)]水平,同时比较两组患者的康复相关指标和并发症发生情况。结果A组患儿的治疗总有效率为91.67%,明显高于B组的76.67%,差异有统计学意义(P<0.05);治疗后,A组患儿的PaO_(2)为(60.65±6.33)mmHg,明显高于B组的(56.12±5.93)mmHg,PaCO_(2)、OI、SPAP分别为(42.36±4.02)mmHg、13.10±1.12、(26.14±2.67)mmHg,明显低于B组的(45.66±4.33)mmHg、(15.66±1.53)、(29.46±3.11)mmHg,差异均有统计学意义(P<0.05);治疗后,A组患儿的血浆D-D、PAI-1/t-PA、PAF含量分别为(1.35±0.38)mg/L、3.52±0.78、(404.55±78.78)×10^(9)/L,明显高于B组的(1.00±0.31)mg/L、2.64±0.71、(340.59±65.33)×10^(9)/L,差异均有统计学意义(P<0.05);治疗后,A组患儿的血清TNF-α、PCT、IL-5、IL-13含量分别为(11.11±1.01)ng/L、(0.78±0.23)ng/mL、(0.90±0.34)pg/mL、(1.15±0.66)pg/mL,明显低于B组的(13.75±1.63)ng/L、(1.46±0.34)ng/mL、(1.50±0.40)pg/mL、(1.63±0.94)pg/mL,差异均有统计学意义(P<0.05);A组患儿的发绀、吸气性三凹征消失时间及氧疗时间、住院时间、机械通气时间明显短于B组,差异均有统计学意义(P<0.05);A组患者的并发症总发生率为1.67%,明显低于B组的15.00%,差异有统计学意义(P<0.05)。结论相较于气管内滴入给药,注射用牛肺表面活性剂肺泡灌洗+气管内滴入给药治疗MAS患儿的治疗效果更优,其可促进血气指标、凝血纤溶指标恢复,降低肺动脉高压,减轻机体炎性损伤,降低并发症发生率。