[Analysis of incidence and risk factors for postoperative venous thromboembolism in patients with stageâ a non-small-cell lung cancer].

Objective: To analyze the incidence and risk factors for postoperative venous thromboembolism(VTE) in patients with stage Ⅰa non-small-cell lung cancer(NSCLC), so as to find evidence for further research of prophylactic anticoagulation. Methods: A total of 132 patients with stage Ⅰa NSCLC, 42 males and 90 females aged from 26 to 79 years with an average of (57±10) years, were retrospectively included in this study. All of them underwent surgical treatment at the Department of Thoracic Surgery of Beijing Chaoyang Hospital Affiliated with Capital Medical University from January 2017 to October 2020. A lower extremity venous ultrasound was performed before and after the operation. Participants were divided into VTE group (n=11) or non-VTE group (n=121) according to whether or not VTE occurred after operation. The surgical conditions, test indicators, imaging information, pathology information were compared between the two groups. Logistic regression analysis was performed to test the associations of VET with putative risks factors in which significant differences were observed. The independent risk factors of VET were determined by this way. Results: Postoperative VTE occurred in 11 cases (8.3%), including 10 cases (90.9%) of deep vein thrombosis (DVT) of lower limbs and 1 case (9.1%) of DVT complicated with pulmonary embolism (PE). The mean age of Patients in the VTE group was older than that in non-VTE Group ((65±9) years vs (57±10) years, P=0.009). On the fifth day after operation, patients in both groups had significantly higher D-dimer level compared with that before operation (3.18(1.55, 5.15) vs 1.54(1.09, 2.57); 2.66(1.17, 4.65) vs 1.34(0.78, 2.04))(both P<0.05). The value of neuron-specific enolase (NSE) and the number of lymph nodes removed during the operation in the VTE group were significantly higher than those in the non-VTE group ((21.54±12.37) vs (14.72±5.75); (19.7±8.2) vs (13.0±7.9)) (both P<0.05). There was no statistically significant difference in the approach of surgery, imaging features (tumor location, vascular cluster signs, etc.), and pathological information (pathological types, etc.) (all P>0.05). The logistic regression analysis showed that the number of lymph nodes removed during the operation was an independent risk factor related to the occurrence of VTE (OR=1.306, 95%CI:1.000-1.600,P<0.05). Conclusions: The incidence of postoperative VTE in patients with stage Ⅰa NSCLC is approximately 8.3%. The number of lymph nodes removed during the operation may be an independent risk factor for postoperative VTE in patients with stage Ⅰa NSCLC.

[Application of three-staged paramedian forehead flap in reconstruction and repair of full-thickness nasal defect].

Objective: To evaluate the application of three-staged paramendian forehead flap technique in reconstruction of severe full-thickness nasal defect. Methods: Clinical data of 7 cases with nasal reconstruction by three-staged forehead flap technique in the First Affiliated Hospital of Xinjiang Medical University and HongKong University Shenzhen Hospital between June 2016 and October 2019 was retrospectively reviewed. All were males aged from 10 to 71 years. There were 4 cases of basal cell carcinoma of the external nose, 2 cases of traumatic nasal defects and 1 case of large rhinophyma. All the operations were performed with the paramedian forehead flap in three stages. In stage Ⅰ, full layered forehead flap was transposed to the nasal detect. Lining flaps were reconstructed with folded forehead skin (n=4), turn-over flap plus septal chondro mucosal pivotal flap (n=2), or bipedicled vestibular skin and nasal mucosa advancement flap (n=1). According to the reconstruction mode of the lining flaps, whether to implant cartilage to reconstruct the external nasal stent at stage Ⅰ was determined. At stage Ⅱ, the folded flaps were partly or completely separated from the covering flaps along the free edges of nasal alar. All the excess soft tissue including subcutaneous fat and frontalis muscle were excised, cartilage grafts were placed or sculpted to make an ideal nasal contour. The covering flaps were then returned on the recontoured, three-dimensional recipient bed. At stage Ⅲ, the pedicles were divided. Descriptive statistical method was used to analyze the data. Results: In all cases, restoration of the nasal contour was remarkably good, no flap necrosis occurred. All patients were followed up for 6 months to 2 years, and the appearance and function of the nose recovered well. All patients were satisfied with their final aesthetic results. Conclusions: Three-staged paramedian forehead flap technique ensures maximal blood supply for the lining flap and the inserted cartilage graft, and restores an ideal three-dimensional nasal contour for reconstruction of large full thickness nasal defects.

[Relationship between upper airway volume and polysomnography parameters of patients with obstructive sleep apnea hypopnea syndrome].

Objective:To study the relationship among upper airway volume of naso-pharyngeal, yelo-pharyngeal,glosso-pharyngeal, hypo-pharyngeal area which measured by spiral computed tomography three-dimensional reconstruction technique, apnea hypopnea indexes, and the lowest oxygen saturation in patients with OSAHS.Method:①fifty-one patients with OSAHS were received polysomnography, and then were divided into groups by the AHI,LSaO2 values. ②To measure upper airway volume at normal breath and Müller maneuver state using spiral computed tomography three-dimensional reconstruction technique of CT measurement, and to calculate volume change rate and observe the upper airway compliance. ③To analyses the relationship between upper airway volume and AHI,LSaO2 values.Result:The smallest upper airway volume of OSAHS was at the velo-pharyngeal level; the volume of velo-pharyngeal level were negatively correlated with AHI during normal respiration and Müller's maneuver state and were positively correlated with LSaO2; the volume of hypo-pharyngeal were negatively correlated with AHI during normal respiration; the volume of glosso-pharyngeal were positively correlated with LSaO2 during Müller's maneuver state.Conclusion:①The volume of velo-pharyngeal level with OSAHS patients can reflect the severity of AHI,LSaO2. ②The measurement of upper airway volume using spiral computed tomography three-dimensional reconstruction technique is good method to evaluate the upper airway compliance of OSAHS patients.

[Functional modified periauricular incision in parotidectomya].

Objective:The purpose of this study was to present the usefulness of modified periauricular incision in parotid surgical procedures. Method:Sixteen consecutive partial superfacial parotidectomies were performed using modified periauricular incision. Clinical evaluation of cosmetic satisfaction, incidence of complications such as Frey's syndrome, facial nerve palsy, earlobe numbness and salivary fistula were observed. Result:The parotid tumors were removed in all cases with need for any further skin procedures, as the incisions produced a good aesthetic result. The average scale of cosmetic satisfaction are 9.2. Temporary paralysis of the facial nerve were found in two patients, and six patients felt numbness around earlobe after operation. Hey all recovered in 1 to 3 months after surgery. All patient healed without salivary fistula and Frey's syndrome. No recurrence was happened during follow-up in 6 to 30 months (median follow-up period was 22 months). Conclusion:The results of the present study indicate that modified periauricular incision have a high-quality and highly aesthetic option for surgical procedures concerning benign conditions of the parotid gland.

[Application of functional parotidectomy via retroauricular hairline incision in the excising superficial parotid tumor].

Objective: To evaluate the usefulness of retroauricular hairline incision (RAHI) in partial superficial parotidectomy (PSP) by comparison with modified Blair incision (MBI). Methods: A retrospective analysis of 64 medical records for patients with benign parotid tumors who underwent partial superficial parotidectomy was undertaken (28 were in MBI group, 36 in RAHI group). Size and location of tumors, operative time, occurrence of facial nerve paralysis and Frey's syndrome, and cosmetic outcomes were compared between RAHI and MBI groups. Results: Compared with MBI group, RAHI group showed better cosmetic results for benign parotid tumors in mean satisfaction score(P<0.001). There were no significant differences in size and location of tumors, operative time, incidence of transient or permanent facial nerve paralysis and Frey's syndrome between two groups (P>0.05). Conclusions: Partial superficial parotidectomy can be performed safely via RAHI in most cases of benign parotid tumors. Compared with MBI, RAHI for benign parotid tumorscan improve the cosmetic outcome, without increasing the operative time or operative morbidity.

Binary logistic regression analysis of solid thyroid nodules imaged by high-frequency ultrasonography, acoustic radiation force impulse, and contrast-enhanced ultrasonography.

OBJECTIVE: The common clinical techniques used for examining thyroid tumors include palpation, imaging, immunoassays and tissue biopsy. Ultrasonography is easy, non-invasive, non-radioactive and highly reproducible imaging technique; however, due to the disease polytropism, diagnosis may become difficult sometimes. Ultrasound elastography, particularly acoustic radiation force impulse (ARFI) imaging and contrast-enhanced ultrasonography (CEUS) have been successfully used to diagnose the thyroid tumors. The objective of this retrospective study was to analyze and compare the solid thyroid nodules imaged by high-frequency ultrasonography (HFUS), ARFI imaging, and CEUS. PATIENTS AND METHODS: For this purpose, images of the 80 solid thyroid nodules (58 benign and 22 malignant) with surgical pathology were obtained and data were compared using binary logistic regression analysis. RESULTS: Morphology (p < 0.001), and internal calcification (p = 0.007) were statistically different. The mean shear wave velocity (SWV) measured by ARFI was significantly different (p = 0.029). Three sets of comparison on CEUS (p = 0.019) and time to peak (TTP) of CEUS were significantly different (p = 0.001). The logistic regression analysis indicated that the morphology, mean SWV of ARFI and TTP were independent risk factors for malignancy. The diagnostic accuracy for solid thyroid nodules was 85.1% (68/80) and the area under the receiver operating characteristic (ROC) curve was 0.945±0.033. CONCLUSIONS: Logistic regression analysis can effectively screen significant parameters for the differential diagnosis of solid thyroid nodules imaged by ultrasonography.