Malignant Transformation of Dysplastic Vocal Fold Lesions: A Systematic Review and Meta-Analysis.

Importance: The reported rates of malignant transformation of dysplastic laryngeal lesions are highly variable, as is time to malignant degeneration. Objective: To evaluate the rate of and time to malignant transformation of dysplastic laryngeal lesions based on the World Health Organization (WHO) dysplasia classification system. Data Sources: PubMed, MEDLINE, Embase, CINAHL, CENTRAL, and Cochrane Reviews were searched from the date of database inception to June 8, 2023. Study Selection: English-language articles assessing the rate of malignant transformation using the 2005 WHO dysplasia classification system were included in this systematic review and meta-analysis. Data Extraction and Synthesis: The study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data extraction was performed by 2 independent investigators. Study quality was assessed using a validated quality tool. When possible, data were pooled using random-effects meta-analysis. Main Outcome Measures: The primary outcome measure was the malignant transformation rate in each laryngeal dysplasia category. Secondary outcome measure was the time interval over which malignant transformation had occurred. Results: A total of 5585 records were screened, 61 full texts were assessed, and 18 retrospective cohort studies with 3243 participants were included in the final review. The weighted pooled mean malignant transformation rates of mildly, moderately, and severely dysplastic lesions were 10.9%, 23.3%, and 30.5%, respectively. Malignant transformation rate of nondysplastic laryngeal lesions was 4.5%. Moderately and severely dysplastic lesions had significantly higher odds of malignant transformation compared with mildly dysplastic lesions (moderate: odds ratio [OR], 2.90 [95% CI, 2.06-4.09]; I2 = 0%; severe: OR, 3.42 [95% CI, 2.11-5.52]; I2 = 40%). Lesions without dysplasia had a significantly lower odds of malignant transformation compared with lesions with mild dysplasia (OR, 0.48; 95% CI, 0.28-0.81; I2 = 0%). The overall mean time to malignant transformation was 28.8 months (range, 22.0-35.6 months) for all dysplasia grades. Conclusion and Relevance: This systematic review and meta-analysis found that the rate of malignant transformation increased with the grade of laryngeal dysplasia. Moderately dysplastic lesions were more likely to undergo malignant degeneration compared with mildly dysplastic lesions.

Laryngeal surface reconstructions from monocular endoscopic videos: a structure from motion pipeline for periodic deformations.

PURPOSE: Surface reconstructions from laryngoscopic videos have the potential to assist clinicians in diagnosing, quantifying, and monitoring airway diseases using minimally invasive techniques. However, tissue movements and deformations make these reconstructions challenging using conventional pipelines. METHODS: To facilitate such reconstructions, we developed video frame pre-filtering and featureless dense matching steps to enhance the Alicevision Meshroom SfM pipeline. Time and the anterior glottic angle were used to approximate the rigid state of the airway and to collect frames with different camera poses. Featureless dense matches were tracked with a correspondence transformer across subsets of images to extract matched points that could be used to estimate the point cloud and reconstructed surface. The proposed pipeline was tested on a simulated dataset under various conditions like illumination and resolution as well as real laryngoscopic videos. RESULTS: Our pipeline was able to reconstruct the laryngeal region based on 4, 8, and 16 images obtained from simulated and real patient exams. The pipeline was robust to sparse inputs, blur, and extreme lighting conditions, unlike the Meshroom pipeline which failed to produce a point cloud for 6 of 15 simulated datasets. CONCLUSION: The pre-filtering and featureless dense matching modules specialize the conventional SfM pipeline to handle the challenging laryngoscopic examinations, directly from patient videos. These 3D visualizations have the potential to improve spatial understanding of airway conditions.

[The effect of the ratio of aneurysm sac diameter to patient age on the long-term efficacy of different surgical methods for infrarenal abdominal aortic aneurysm].

Objective: To investigate the effect of the ratio of the maximum diameter of aneurysm sac to age (R) on the long-term efficacy of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in patients with infrarenal abdominal aortic aneurysm (IAAA). Methods: This is a retrospective cohort study.The clinical data of 317 patients with IAAA who underwent surgical repair in the Department of Vascular Surgery,the Third Affiliated Hospital of Sun Yat-Sen University from January 2016 to October 2022 were retrospectively collected.There were 266 males and 51 females,aged (69.7±8.3) years (range:37 to 87 years).The R value of the patient was calculated and the receiver operating characteristic(ROC) curve was used to establish a model to calculate the optimal cut-off value.The propensity score matching method was used to match the baseline data of patients in the EVAR and OSR group by 3∶1 (the caliper value was 0.05),and the patients were stratified according to the cutoff value of R,and the postoperative efficacy and survival of the patients were analyzed.The primary endpoint was the total mortality rate,and the secondary endpoints included the occurrence of postoperative complications and reintervention.Pearson χ2 or Fisher 's exact test was used for categorical variables,and t test was used for continuous variables to compare differences between groups.The survival curves of the two groups were described by Kaplan-Meier method. Results: After propensity score matching,198 cases were in the EVAR group and 66 cases were in the OSR group.The ROC model showed that the best cut-off value of R value was 0.90,and the two groups were divided into two layers:R<0.90 and R≥0.90.Among them,112 patients with R<0.90 (84 cases of EVAR,28 cases of OSR);there were 152 patients with R≥0.90 (114 cases of EVAR and 38 cases of OSR).The follow-up time was (23.6±1.6) months (range:1 to 70 months).In the R≥0.90 stratification,the total mortality (26.3% vs.5.3%,P<0.05),complication rate (44.7% vs.26.3%,P<0.05), and secondary intervention rate (31.6% vs.13.2%,P<0.05) in the EVAR group were higher than those in the OSR group.In the R<0.90 stratification,there was no significant difference in the total mortality rate (13.1% vs.10.7%,P<0.05),complication rate (28.6% vs.35.7%,P>0.05) and secondary intervention rate (14.3% vs.21.4%, P>0.05) between the two groups. Conclusions: When R≥0.90 in IAAA patients,OSR maybe more beneficial to patients in terms of survival rate,postoperative complication rate and secondary intervention rate than EVAR.When R<0.90,there are no significant differences in survival rate,complication rate and secondary intervention rate between the two surgical methods.

[Metagenomic next-generation sequencing for the diagnosis of Pneumocystis jirovecii pneumonia after allogeneic hematopoietic stem cell transplantation].

Objectives: To investigate the value of metagenomic next-generation sequencing (mNGS) in the diagnosis of Pneumocystis jirovecii pneumonia (PJP) in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: The data of 98 patients with suspected pulmonary infection after allo-HSCT who underwent pathogen detection from bronchoalveolar lavage fluid between June 2016 and August 2023 at Nanfang Hospital were analyzed. The diagnostic performance of mNGS, conventional methods, and real-time quantitative polymerase chain reaction (qPCR) for PJP were compared. Results: A total of 12 patients were diagnosed with PJP, including 11 with a proven diagnosis and 1 with a probable diagnosis. Among the patients with a proven diagnosis, 1 was positive by both conventional methods and qPCR, and 10 were positive by qPCR only. Pneumocystis jirovecii was detected by mNGS in all 12 patients. The diagnostic sensitivity of mNGS for PJP was 100%, which was greater than that of conventional methods (8.3%, P=0.001) and similar to that of qPCR (91.6%, P=1.000) . A total of 75% of the patients developed mixed pulmonary infections, and cytomegalovirus and Epstein-Barr virus were the most common pathogens. Mixed infection was detected in eight patients by mNGS and in five patients by qPCR, but not by conventional methods (P=0.008) . Conclusions: mNGS had good sensitivity for diagnosing PJP after allo-HSCT and was advantageous for detecting mixed infectious pathogens; therefore, mNGS might be an effective supplement to regular detection methods and qPCR.

Patient Experience With Absolute Voice Rest Following Phonomicrosurgery: A Qualitative Study.

OBJECTIVE(S): Voice rest is commonly recommended following phonomicrosurgery to minimize vocal fold scarring, but associated quality of life (QoL) is low resulting in poor compliance. This study aimed to explore patients' experiences with voice rest following phonomicrosurgery to identify facilitators and barriers. METHODS: This qualitative study used prospective, typical case technique for purposive sampling of consecutive patients who underwent voice rest following phonomicrosurgery for benign vocal fold lesions. Participants were enrolled at a single tertiary Laryngology center located at Unity Health Toronto - St. Michael's Hospital from 2020 to 2022. Semi-structured virtual interviews were conducted 4 weeks following patients' surgery. All interview transcripts were transcribed verbatim and underwent thematic analysis. Participant recruitment was stopped once thematic saturation was achieved. RESULTS: Twenty participants were recruited and 4 withdrew due to scheduling conflicts. Sixteen participants completed interviews, all of whom reported minimal impact of postoperative voice rest on QoL. The participants attributed their success to facilitators such as notifying close contacts of their situation beforehand and adopting nonverbal forms of communication. No participant endorsed a negative attitude toward voice rest. Understanding the rationale for voice rest and the consequences of noncompliance were reported to be effective in encouraging compliance. CONCLUSION: Overall, the participants tolerated voice rest well owing to facilitators such as early preparation, lifestyle modifications, and understanding the rationale for voice rest. Social disconnect and work demands were barriers of voice rest. Moving forward, facilitators and barriers should be addressed in efforts to optimize the voice rest experience for future patient populations. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:361-366, 2024.

Technical Challenges for Laryngeal Electromyography.

BACKGROUND/OBJECTIVE: Laryngeal electromyography (LEMG) is a useful diagnostic test in the evaluation of vocal fold paralysis (VFP). This study investigates factors that can make LEMG challenging to perform. METHODS: Patients with subacute unilateral VFP presented for LEMG were prospectively enrolled. Demographic data including BMI, previous neck surgery, and anatomic factors were collected. Patient-reported pain related to the procedure was recorded on a visual analogue scale (VAS). Electromyographer and otolaryngologist recorded a consensus rating of the perceived difficulty in performing the test and confidence in using the results for clinical decision-making. RESULTS: A total of 111 patients (56.8% female) were enrolled between August 2015 and August 2018. The mean age was 55 ± 14 years, and the average body mass index (BMI) was 28.5 ± 6.4. The mean patient-reported VAS score for pain was 35 ± 24. Notably, 31.2% of the tests were considered "very easy," 32.1% were considered "mildly challenging" and 23.9% and 12.8% were considered "moderately challenging" and "extremely challenging," respectively, by the clinicians. Common factors affecting LEMG difficulty included poorly palpable surface anatomy (50.5%) and patient intolerance (15.6%). Clinicians felt confident in 76.1% of the test findings. Bivariate analyses showed that prior neck surgery is associated with elevated VAS (p = 0.02), but clinician-perceived difficulty of performing the test is not associated with elevated VAS scores (p = 0.55). CONCLUSIONS: Majority of LEMG tests are well tolerated by patients. Physicians reported more confidence using LEMG for clinical decision-making when the test was easier to perform. Difficult surface anatomy and patient intolerance affects clinician confidence in integrating the test results with clinical care. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:831-834, 2024.

Effect of contact precautions on preventing meticillin-resistant Staphylococcus aureus transmission in intensive care units: a review and modelling study of field trials.

BACKGROUND: Contact precautions (CPs) have been widely implemented in hospitals, particularly in intensive care units (ICUs), as the standard approach for managing meticillin-resistant Staphylococcus aureus (MRSA). However, the effectiveness of CPs in preventing MRSA transmission remains a subject of debate. AIM: To assess the effectiveness of CPs in reducing MRSA transmission within ICUs. METHODS: A comprehensive analysis was conducted using data from 16 sets of parameters collected from 13 field studies investigating the effectiveness of CPs in ICUs, and an epidemiologic model was developed to simulate the dynamics of MRSA incidence in the hospital setting. FINDINGS: The analysis demonstrated a mean reduction of 20.52% (95% confidence interval -30.52 to 71.60%) in the MRSA transmission rate associated with the implementation of CPs. Furthermore, reducing the time-delay of screening tests and increasing the percentage of patients identified with MRSA through screening at admission were found to contribute to the effectiveness of CPs. CONCLUSION: Proper implementation of CPs, with a particular emphasis on early identification of MRSA-colonized/infected patients, demonstrated a strong association with reduced MRSA transmission within the hospital setting. However, further research is necessary to investigate the effectiveness and safety of decolonization and other interventions used in conjunction with CPs to mitigate the risk of infection among colonized patients.

The association between the serum concentration of CXC subfamily chemokine 13 and post-surgical clinical outcomes in cervical cancer patients.

OBJECTIVE: This study aimed to investigate the relationship between serum levels of CXC subfamily chemokine 13 (CXCL13) and clinical outcomes following radical surgery for cervical cancer. PATIENTS AND METHODS: A total of 70 cervical cancer patients admitted to our hospital between August 2021 and December 2022 were selected as the study group, while 30 healthy individuals who underwent regular physical examinations during the same period were selected as the control group. The levels of CXCL13 were measured in both groups, and a comparison was made between pre- and post-operative CXCL13 levels in the study group and the control group. Follow-up data on clinical outcomes were collected for the study group, and clinical data were compared between the recurrence/metastasis group and the non-recurrence/metastasis group. Logistic regression analysis was performed to identify factors influencing recurrence and metastasis by incorporating variables showing significant differences. Additionally, Pearson's correlation analysis was used to examine the relationship between CXCL13 and clinical data. RESULTS: Postoperative levels of CXCL13 in the study group showed a significant decrease compared to preoperative levels, and they were lower than those in the control group (p<0.05). Among the 70 patients in the study group, 23 experienced recurrence or metastasis, while 47 did not. Significant differences were observed between the recurrence/metastasis group and the non-recurrence/metastasis group in terms of histological grade, depth of cervical invasion, FIGO stage, parametrial infiltration, lymph node metastasis, and CXCL13 (p<0.05). Logistic regression analysis revealed that CXCL13, histological grade, depth of cervical invasion, FIGO stage, parametrial infiltration, and lymph node metastasis were all factors influencing recurrence and metastasis. There was a positive correlation between CXCL13 and histological grade, depth of cervical invasion, FIGO stage, parametrial infiltration, and lymph node metastasis (p<0.05). CONCLUSIONS: The level of CXCL13 is closely associated with the clinical outcome of cervical cancer after radical surgery and can serve as an important indicator for predicting clinical outcomes. Its application in clinical practice is highly recommended.

Associations between Various Sleep-Wake-Related Indicators and Nutritional Status in Community-Dwelling Older Adults: The Yilan Study, Taiwan.

OBJECTIVES: To elucidate the relationship between various sleep-wake-related indicators and nutritional status. DESIGN: Cross-sectional study. SETTING: Community-based survey between 2017 and 2022 in Yilan City, Taiwan. PARTICIPANTS: 1,905 community-dwelling older adults aged ≥65 years. MEASUREMENTS: Nutritional status was evaluated using the Mini Nutritional Assessment, and participants were classified into normal nutritional status and undernutrition groups. Regarding sleep-wake-related indicators, specific items or component scores of the Pittsburgh Sleep Quality Index were used to assess sleep-wake schedule, subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, presence of sleep disturbances, hypnotic use, and dysfunction in maintaining enthusiasm. The 5-item Athens Insomnia Scale and the Epworth Sleepiness Scale were used to evaluate insomnia and excessive daytime sleepiness, respectively. RESULTS: Of the 1,905 participants, the mean age was 75.6±7.1, with 52.2% being ≥75 years old, 58.9% were women, and 11.4% had undernutrition. After controlling for covariates, short sleepers were less likely to have undernutrition (OR: 0.63; 95% CI: 0.41-0.97); in contrast, long sleepers were more likely to exhibit undernutrition (OR: 1.52; 95% CI: 1.06-2.17). In addition, poor habitual sleep efficiency (OR:1.69; 95% CI:1.15-2.50), taking hypnotics in the past month (OR: 1.58; 95% CI: 1.12-2.24), and dysfunction in maintaining enthusiasm (OR: 1.93; 95% CI: 1.24-2.99) were associated with increased risk of undernutrition. CONCLUSIONS: Among older adults, various sleep-wake-related indicators differed in their relationships with nutritional status. Specific sleep-wake disturbances may indicate undernutrition in this population.

Formation and Assessment of a Laryngology Pathology Video Atlas for Resident Education.

OBJECTIVE: Conventional reference images of laryngeal pathologies may provide educational value for Otolaryngology-Head & Neck Surgery (OHNS) residents, but observing dynamic vocal fold function is critical for diagnosis. Our aim was to develop and validate a video atlas of laryngeal pathologies for resident education in OHNS. DESIGN: A multi-institution, prospective case-control study. SETTING/PARTICIPANTS: Ten videos showing 10 representative laryngeal pathologies were verified by two laryngologists. Six videos per category with kappa>0.8 were included in the video database. A collection of the videos was shown to a group of OHNS residents in a quiz fashion to determine if senior trainees would score higher than junior trainees. Another group of residents in OHNS was recruited and randomized to control or intervention. The control group was shown a quiz of 10 laryngeal videos at baseline and 24 weeks later. The intervention group was shown quizzes at baseline and every 6 weeks, ending at 24 weeks. Free-text diagnoses were scored for accuracy. Descriptive statistics, two-tailed tests, and analysis of covariance were performed. RESULTS: Twenty-nine residents participated, with 14 (48.3%) randomized to control, and 15 (51.7%) to the intervention. The postgraduate year (PGY) level had a significant impact on diagnostic performance. PGY1 and 2 had a significantly lower score than PGY5 (P = 0.017 and P = 0.035, respectively). PGY3 and PGY4 scores were not statistically different from PGY5 scores. The mean score difference between groups decreases as the PGY level increases (mean difference between groups = 0.87, P = 0.153), but this was not significant. CONCLUSIONS: The current study has created a validated collection of videos that are representative of common laryngeal pathologies and can be easily incorporated into resident video-based learning. Future directions include larger multi-site studies to further elucidate whether repeated viewing of this video atlas can improve OHNS resident laryngology knowledge.

Duration-response association between occupational exposure and pancreatic cancer risk: meta-analysis.

BACKGROUND: Evidence is lacking on the occupational exposure time window to chemical agents related to pancreatic cancer risk. AIMS: This study performed meta-regression and meta-analysis to examine the dose-response association between occupational exposure duration to chemical agents and pancreatic cancer risk. METHODS: We searched and reviewed studies on exposure duration and pancreatic cancer in five databases (Cochrane Library, EMBASE, PubMed, ScienceDirect and Web of Science) from inception to 16 May 2022. Exposure refers to the years a worker was exposed to any chemical agent, and outcome variables were pancreatic cancer incidence and mortality. RESULTS: We identified 31 studies, including 288 389 participants. In the meta-regression, the positive dose-response association indicated pancreatic cancer risk increased slightly with every additional year of exposure duration (slope = 1.01; 95% confidence interval [CI] 1.00-1.02). Pancreatic cancer risk increased with an exposure duration of 1-10 (relative risk [RR] = 1.04; 95% CI 1.02-1.06), 11-20 (RR = 1.11; 95% CI 1.05-1.16), and 21-30 years (RR = 1.39; 95% CI 1.12-1.73). CONCLUSIONS: Pancreatic cancer risk increased as occupational exposure duration increased, with an exposure time window ranging from 1 to 30 years.

In-hospital mortality for aspiration pneumonia in a tertiary teaching hospital: A retrospective cohort review from 2008 to 2018.

BACKGROUND: Aspiration pneumonia is a preventable condition that has higher rates of recurrence and mortality compared to non-aspiration pneumonia. The primary objective of the study was to examine independent patient factors that are associated with mortality in those requiring acute admission for aspiration pneumonia at a tertiary institution. Secondary goals of the study were to review whether factors such as mechanical ventilation and speech language pathology intervention can impact patient mortality, length of stay (LOS), and costs relating to hospitalization. METHODS: Patients older than 18 years of age who were admitted with a primary diagnosis of aspiration pneumonia from January 1, 2008 to December 31, 2018 at Unity Health Toronto-St. Michael's hospital in Toronto, Canada, were included in the study. Descriptive analyses were performed on patient characteristics using age as a continuous variable as well as a dichotomous variable with age 65 as a cut-off. Multivariable logistic regression was used to identify independent factors that contributed to in-hospital mortality and Cox proportional-hazard regression was used to identify independent factors that affected LOS. RESULTS: A total of 634 patients were included in this study. 134 (21.1%) patients died during hospitalization with an average age of 80.3 ± 13.4. The in-hospital mortality did not change significantly over the ten-year period (p = 0.718). Patients who died had longer LOS with a median length of 10.5 days (p = 0.012). Age [Odds Ratio (OR) 1.72, 95% Confidence Interval (95% CI) 1.47-2.02, p < 0.05] and invasive mechanical ventilation (OR 2.57, 95% CI 1.54-4.31, p < 0.05) were independent predictors of mortality while female gender was found to be a protective factor (OR 0.60, 95% CI 0.38-0.92, p = 0.02). Elderly patients had five times higher risk of dying during their hospital course when compared to younger patients [Hazard Ratio (HR) 5.25, 95% CI 2.99-9.23, p < 0.05). CONCLUSION: Elderly patients are a high-risk population for developing aspiration pneumonia and are at higher risk of death when hospitalized for this condition. This warrants improved preventative strategies in the community. Further studies involving other institutions and creating a Canada-wide database are required.

Deep learning for predicting the risk of immune checkpoint inhibitor-related pneumonitis in lung cancer.

AIM: To develop and validate a nomogram model that combines computed tomography (CT)-based radiological factors extracted from deep-learning and clinical factors for the early predictions of immune checkpoint inhibitor-related pneumonitis (ICI-P). MATERIALS AND METHODS: Forty ICI-P patients and 101 patients without ICI-P were divided randomly into the training (n=113) and test (n=28) sets. The convolution neural network (CNN) algorithm was used to extract the CT-based radiological features of predictable ICI-P and calculated the CT score of each patient. A nomogram model to predict the risk of ICI-P was developed by logistic regression. RESULTS: CT score was calculated from five radiological features extracted by the residual neural network-50-V2 with feature pyramid networks. Four predictors of ICI-P in the nomogram model included a clinical feature (pre-existing lung diseases), two serum markers (absolute lymphocyte count and lactate dehydrogenase), and a CT score. The area under curve of the nomogram model in the training (0.910 versus 0.871 versus 0.778) and test (0.900 versus 0.856 versus 0.869) sets was better than the radiological and clinical models. The nomogram model showed good consistency and better clinical practicability. CONCLUSION: The nomogram model that combined CT-based radiological factors and clinical factors can be used as a new non-invasive tool for the early prediction of ICI-P in lung cancer patients after immunotherapy with low cost and low manual input.

[A nomogram for preoperative prediction of lymph node metastasis in patients with intrahepatic cholangiocarcinoma based on inflammation-related markers].

Objectives: To construct a nomogram for prediction of intrahepatic cholangiocarcinoma (ICC) lymph node metastasis based on inflammation-related markers,and to conduct its clinical verification. Methods: Clinical and pathological data of 858 ICC patients who underwent radical resection were retrospectively collected at 10 domestic tertiary hospitals in China from January 2010 to December 2018. Among the 508 patients who underwent lymph node dissection,207 cases had complete variable clinical data for constructing the nomogram,including 84 males,123 females,109 patients≥60 years old,98 patients<60 years old and 69 patients were pathologically diagnosed with positive lymph nodes after surgery. Receiver operating characteristic curve was drawn to calculate the accuracy of preoperative imaging examinations to determine lymph node status,and the difference in overall survival time was compared by Log-rank test. Partial regression squares and statistically significant preoperative variables were screened by backward stepwise regression analysis. R software was applied to construct a nomogram,clinical decision curve and clinical influence curve,and Bootstrap method was used for internal verification. Moreover,retrospectively collecting clinical information of 107 ICC patients with intraoperative lymph node dissection admitted to 9 tertiary hospitals in China from January 2019 to June 2021 was for external verification to verify the accuracy of the nomogram. 80 patients with complete clinical data but without lymph node dissection were divided into lymph node metastasis high-risk group and low-risk group according to the score of the nomogram among the 858 patients. Log-rank test was used to compare the overall survival of patients with or without lymph node metastasis diagnosed by pathology. Results: The area under the curve of preoperative imaging examinations for lymph node status assessment of 440 patients was 0.615,with a false negative rate of 62.8% (113/180) and a false positive rate of 14.2% (37/260). The median survival time of 207 patients used to construct a nomogram with positive or negative postoperative pathological lymph node metastases was 18.5 months and 27.1 months,respectively (P<0.05). Five variables related to lymph node metastasis were screened out by backward stepwise regression analysis,which were combined calculi,neutrophil/lymphocyte ratio,albumin,liver capsule invasion and systemic immune inflammation index,according to which a nomogram was constructed with concordance index(C-index) of 0.737 (95%CI: 0.667 to 0.806). The C-index of external verification was 0.674 (95%CI:0.569 to 0.779). The calibration prediction curve was in good agreement with the reference curve. The results of the clinical decision curve showed that when the risk threshold of high lymph node metastasis in the nomogram was set to about 0.32,the maximum net benefit could be obtained by 0.11,and the cost/benefit ratio was 1∶2. The results of clinical influence curve showed that when the risk threshold of high lymph node metastasis in the nomogram was set to about 0.6,the probability of correctly predicting lymph node metastasis could reach more than 90%. There was no significant difference in overall survival time between patients with high/low risk of lymph node metastasis assessed by the nomogram and those with pathologically confirmed lymph node metastasis or without lymph node metastasis (Log-rank test:P=0.082 and 0.510,respectively). Conclusion: The prediction accuracy of preoperative nomogram for ICC lymph node metastasis based on inflammation-related markers is satisfactory,which can be used as a supplementary method for preoperative diagnosis of lymph node metastasis and is helpful for clinicians to make personalized decision of lymph node dissection for patients with ICC.

Nurse-led dexmedetomidine sedation for magnetic resonance imaging in children: a 6-year quality improvement project.

We aimed to safely introduce dexmedetomidine into a nurse-led sedation service for magnetic resonance imaging in children. Secondary aims were to increase the number of children eligible for sedation and to increase the actual number of children having sedation performed by our nurse sedation team. We analysed 1768 consecutive intravenous and 219 intranasal dexmedetomidine sedation episodes in infants, children and adolescents having magnetic resonance imaging scans between March 2016 and March 2022. The overall sedation success rate was 98.4%, with a 98.9% success rate for intravenous dexmedetomidine and a 95.0% success rate for intranasal dexmedetomidine. The incidence of scan interruption during intravenous and intranasal dexmedetomidine sedation was 8.8% and 21.9%, respectively. We conclude that paediatric sedation with dexmedetomidine for magnetic resonance scanning is safe and successful.

[The analysis of long-term prognostic factors after laparoscopic liver resection for intrahepatic cholangiocarcinoma and establishment of survival Nomogram model].

Objective: To establish a survival prediction model based on the independent prognostic factors of long-term prognosis after laparoscopic liver resection(LLR) for intrahepatic cholangiocarcinoma(ICC). Methods: The clinical and pathological data of 351 consecutive patients with ICC who received radical LLR in 13 Chinese medical centers from August 2010 to May 2021 were collected retrospectively. There were 190 males and 161 females,aged(M(IQR)) 61(14)years(range:23 to 93 years). The total cohort was randomly divided into a training dataset(264 cases) and a validation dataset(87 cases). The patients were followed up by outpatient service or telephone,and the deadline for follow-up was October 2021. Based on the training dataset,the multivariate Cox proportional hazards regression model was used to screen the independent influencing factors of long-term prognosis to construct a Nomogram model. The Nomogram model's discrimination,calibration,and clinical benefit were evaluated through internal and external validation,and an assessment of the overall value of two groups was made through the use of a receiver operating characteristic(ROC) curve. Results: There was no significant difference in clinical and pathological characteristics and long-term survival results between the training and validation datasets(all P>0.05). The multivariate Cox analysis showed that CA19-9,CA125,conversion to laparotomy during laparoscopic surgery,and lymph node metastasis were independent prognostic factors for ICC patients after LLR(all P<0.05). The survival Nomogram was established based on the independent prognostic factors obtained from the above screening. The ROC curve showed that the area under the curve of 1, 3 and 5-year overall survival rates of patients in the training dataset were 0.794(95%CI:0.721 to 0.867),0.728(95%CI:0.618 to 0.839) and 0.799(95%CI:0.670 to 0.928),and those in the validation dataset were 0.787(95%CI:0.660 to 0.915),0.831(95%CI:0.678 to 0.983) and 0.810(95%CI:0.639 to 0.982). Internal and external validation proved that the model exhibited a certain discrimination,calibration,and clinical applicability. Conclusion: The survival Nomogram model based on the independent influencing factors of long-term prognosis after LLR for ICC(including CA19-9,CA125,conversion to laparotomy during laparoscopic surgery,and lymph node metastasis) exhibites a certain differentiation,calibration,and clinical practicability.

Lung cancer screening study from a smoking population in Kunming.

OBJECTIVE: Yunnan, China, is a central tobacco-producing region with a large smoking population and an increasing incidence of lung cancer in recent years. This study aimed to understand the incidence of lung cancer and the characteristics of lung nodules on low-dose computed tomography (LDCT) scans of the chest in a long-term smoking population in Kunming. PATIENTS AND METHODS: Long-term smokers in Kunming who were not at risk of evident lung disease symptoms were recruited through recommendation and publicity by the Kunming University of Science and Technology. RESULTS: Among 375 cases eligible for inclusion,14 cases of lung cancer were detected with a detection rate of 3.73% (95% CI: 2.55%-4.27%), including one case of squamous carcinoma, one case of small cell lung cancer, seven cases of adenocarcinoma of the lung and five cases of early-stage lung cancer (35.71%). In the group of < 6 mm solid nodules and < 5 mm non-solid nodules, no lung cancer was detected in 201 cases; lung cancer was detected in 14 cases in 61 cases, and there was a statistical difference between the two groups (p < 0.05). CONCLUSIONS: The lung cancer detection rate in long-term smokers was high, with the type predominantly adenocarcinoma and a high incidence of lung nodules, and increased when solid nodules≥6 mm or non-solid nodules ≥ 5 mm were present. It is recommended that screening for lung cancer by LDCT of the chest be introduced in the male smoking population who meet the risk factors and that screening for lung cancer in women should be redefined as a high-risk factor.