To analyze the prognostic factors and survival rate of lung cancer patients with obstructive sleep apnea (OSA) by nomogram. The nomogram was established by a development cohort ( n = 90), and the validation cohort included 38 patients. Factors in the nomogram were identified by Cox hazard analysis. We tested the accuracy of the nomograms by discrimination and calibration, and plotted decision curves to assess the benefits of nomogram-assisted decisions. There were significant difference in sex, apnea hypopnea index (AHI), Tumor Node Metastasis (TNM), coronary heart disease, lowest arterial oxygen saturation [LSpO2 (%)], oxygen below 90% of the time [T90% (min)], the percentage of the total recorded time spend below 90% oxygen saturation (TS90%) and oxygen desaturation index (ODI4) between lung cancer subgroup and lung cancer with OSA subgroup ( P < 0.05). Lung cancer patients with OSA age, AHI, TNM, cancer types, BMI and ODI4 were independent prognostic factor. Based on these six factors, a nomogram model was established. The c-index of internal verification was 0.802 (95% CI 0.767–0.885). The ROC curve analysis for the nomogram show 1-year survival (AUC = 0.827), 3-year survival (AUC = 0.867), 5-year survival (AUC = 0.801) in the development cohort were good accuracy. The calibration curve shows that this prediction model is in good agreement. Decision curve analysis (DCA) suggests that the net benefit of decision-making with this nomogram is higher, especially in the probability interval of <20% threshold. The nomogram can predict the prognosis of patients and guide individualized treatment.

Several cases of pigmented mammary Paget’s disease (PMPD) mimicking cutaneous malignant melanoma have been reported. In these cases, the tumor cells are colonized by melanocytes, particularly with the presence of a population of melanocytes staining for HMB-45 and S100. Here, we report a case of mammary Paget disease (MPD) which was misdiagnosed as melanoma in situ due to the interpretation of the staining of melanocytic markers S-100, Melan-A, and HMB-45. The tumor cells strongly expressed CK7 and GATA3, and a dual-labeling showed negative PHH3 labeling for the melanocytes. Pathologists need to be aware of the caveat of colonization of melanocytes in Paget disease.

Background For pregnant women transferred to emergency cesarean section after receiving epidural labor analgesia, there is still a debate over the effective and safe means of rapidly delivering surgical anesthesia. Alkalized lidocaine is often adopted for fast onset time; however, crystallization of the anesthetic may cause severe neurologic symptoms. Case Presentation We report a case of a pregnant woman who underwent emergency cesarean section with satisfied analgesia but experienced severe weakness and paranaesthesia in the lower limb. After excluding lumbar disc herniation, obstetric nerve injury, and anesthesia technique causes by symptoms signs and magnetic resonance imaging, drug-related injury became the most likely cause. Our in vitro testing confirmed the obvious precipitation of additional anesthetic-concentrated ropivacaine (0.5–1%) with pretreated alkalized lidocaine. With trophic neurotherapy, the parturient attained prompt relief of weakness by day four, but delayed recovery of numbness, which lasted for 4 weeks. Conclusion To date, this is the first case reporting neurologic complication possibly due to drug crystallization in cesarean section. Our study confirmed the rapid onset of alkalized lidocaine and its safety to pretreated routine labor dose of ropivacaine (0.09%). However, additional anesthetic-concentrated ropivacaine (0.5–1%) to maintain the anesthesia and analgesia level is not suggested.