网格定位器在腰椎椎体成形术中的应用

目的比较网格优化椎体成形术(percutaneous vertebroplasty,PVP)与传统PVP治疗骨质疏松性椎体压缩骨折的疗效。方法回顾性分析2016年5月至2019年5月北部战区总医院脊柱外科收治196例腰椎单节段行PVP治疗患者的临床资料,根据手术方法不同分为网格优化组(102例)和传统PVP组(94例)。网格优化组:男38例、女64例,年龄(67.3±8.5)岁,病程(2.3±1.2)d,L1椎体59例、L2椎体31例、L3椎体8例、L4椎体3例、L5椎体1例。传统PVP组:男26例、女68例,年龄(71.5±5.6)岁,病程(2.1±1.1)d,L1椎体52例、L2椎体33例、L3椎体7例、L4椎体2例。术前按两组不同方法选择最佳穿刺点及穿刺角度,完成穿刺后置入导丝及工作通道,推入骨水泥,术毕。主要观察指标为手术时间、术中X线透视次数、骨水泥注入量、骨水泥渗漏情况,以及疼痛视觉模拟评分(visual analogue scale,VAS)、伤椎前缘和伤椎中缘高度。结果两组患者术前一般资料的差异均无统计学意义(P>0.05),证明两组患者的基线资料具有可比性。所有患者均顺利完成手术,术中、术后均未出现脊髓神经损伤、切口感染、肺栓塞、死亡等严重并发症。网格优化组患者手术时间(34.8±6.5)min、透视次数(29.5±5.5)次、骨水泥注入量(5.3±2.1)ml、骨水泥渗透率3.9%(4/98)均优于传统PVP组,差异均有统计学意义(P<0.05)。网格优化组术后第3天、3个月及末次随访时VAS评分分别为(1.1±0.6)分、(1.0±0.3)分和(0.9±0.2)分,均优于传统PVP组(P<0.05)。两组患者术后第3天伤椎前缘及中缘高度的差异均无统计学意义(P>0.05),但网格优化组术后3个月伤椎前缘和中缘高度分别为(1.8±0.4)mm、(1.8±0.3)mm,末次随访时分别为(1.7±0.3)mm、(1.7±0.3)mm,均优于传统PVP组,差异均有统计学意义(P<0.05)。结论相比传统PVP手术,术前应用网格定位器进行网格优化PVP手术治疗骨质疏松性椎体压缩骨折更安全、有效。     

猪尾型鼻胆引流管改制新型胆管塑料支架在肝门部胆管癌中的应用

目的　比较猪尾型鼻胆引流管改制的新型胆管塑料支架与普通胆管塑料支架在姑息治疗肝门部胆管癌中的有效性和安全性。方法　收集2018年6月—2020年12月于北部战区总医院内窥镜科因肝门部胆管癌导致的梗阻性黄疸行经内镜逆行胰胆管造影术姑息性治疗的38例患者资料,其中20例患者使用猪尾型鼻胆引流管改制支架（新型组）,18例患者使用普通塑料支架（普通组）。随访至2021年5月30日,比较两组的操作时间、住院时间、术后胆管炎发生率、胆红素下降水平、支架通畅时间等指标。结果　新型组和普通组的操作时间分别为（19.85±1.07） min和（22.00±3.38） min, 差异无统计学意义（t=1.26,P=0.607）。新型组和普通组的住院时间分别为（11.45±2.39）d和（11.33±3.51） d,差异无统计学意义（t=-0.52,P=0.938）。新型支架与普通支架术后第5天较术前总胆红素降低幅度中位数分别为122.85 μmol/L 和 96.25 μmol/L,差异有统计学意义（Z=-2.03,P=0.042）。新型组远期胆管炎发生率低于普通组［10.0%（2/20）比44.4%（8/18）］,差异有统计学意义（P=0.027）。新型组支架引流通畅时间高于普通组［（109.45±32.67）d比（82.11±20.95）d］,差异有统计学意义（t=2.23,P=0.032）。结论　相比普通胆管塑料支架,猪尾型鼻胆引流管改制的新型胆管塑料支架在姑息性治疗肝门部胆管梗阻时,可降低远期胆管炎发生率、延长胆管支架通畅期。     

驻极体联合5-氟尿嘧啶对瘢痕形成中TGF-β/MMPs通道的影响

目的:研究驻极体联合5-氟尿嘧啶（5-Fu）对瘢痕生长的抑制作用及其相关的作用机制。方法:将驻极体贴剂、5- Fu 贴剂、驻极体联合5-Fu 贴剂分别作用于大鼠创伤创面愈合的瘢痕形成过程,通过对创面组织瘢痕增生指数、显微结构 以及组织中TGF-β、MMP1、TIMP1 和MMP2 含量情况的检测,研究驻极体以及驻极体与5-Fu 联合对瘢痕形成的抑制作 用及作用机制。结果:（1）驻极体、5-Fu 以及驻极体联合5-Fu 贴剂均能有效抑制瘢痕的形成和生长。三者分别作用创面 4 周后,瘢痕增生指数依次是对照组的85.8%、85.1%和64.9%（P<0.05）。（2）驻极体、5-Fu 以及驻极体与5-Fu 联合均能影 响瘢痕形成中的TGF-β/MMPs 通路。表现为三者均能抑制TGF-β 的表达,上调MMP1 的表达,增加MMP1/TIMP1 比例, 下调MMP2 表达。并且作用效果为驻极体联合5-Fu>5-Fu>驻极体。结论:与5-Fu 一样,驻极体也能抑制瘢痕组织的生 长,且两者具有协同作用;它们的作用机制与瘢痕组织内TGF-β、MMP1、TIMP1 和MMP2 的表达有关;驻极体与5-Fu 联 用后,在相同治疗效果的基础上,可减少5-Fu 的剂量,降低它的毒副作用。     

针刺结合医用臭氧注射在膝骨性关节炎治疗作用中的系统评价

目的:系统评价针刺结合医用臭氧注射治疗膝骨性关节炎的临床疗效和安全性。方法:依据荟萃分析要求,全面检索CBM、CNKI、VIP、PubMed、Embase及TheCochraneLibrary等数据库,纳入以针刺结合医用臭氧注射为干预措施治疗膝骨性关节炎且为随机对照试验或临床对照试验的研究文献,文献的检索年限均为建库至2019年4月。由两名经过培训的研究人员独立进行检索并提取资料,如果遇到分歧,找第三方(老师或者专家)协助解决。采用Cochrane协作网提供的ReviewManager5.3软件进行数据的荟萃分析。结果:最终纳入15篇RCT或CCT,受试者共1244例,10篇文献报道总有效率,总有效率异质性检验:[Chi2=5.07,P=0.83,I2=0%,OR=4.00,95%CI(2.72,5.89),Z=7.03,P<0.00001]。10篇文献报道了VAS评分,异质性检验,[MD=-1.72,95%CI(-2.39,-1.06),Z=5.10,(P<0.00001)]。2篇文献报道了WOMAC指数,异质性检验,[Chi2=0.01,P=0.91,I2=0%,MD=-6.84,95%CI(-9.23,-4.45),Z=5.61,P<0.00001]。2篇文献报道了Lysholm膝关节功能评分,异质性检验,[Chi2=0.84,P=0.36,I2=0%,MD=7.97,95%CI(5.60,10.34),Z=6.60,P<0.00001]。仅有1篇文献报道不良反应的发生。结论:针刺结合医用臭氧注射治疗膝骨性关节炎疗效显著,易于推广,但其结论的验证还需要大样本高质量临床试验进一步验证。     

Decoding the Evolutionary Response to Ensartinib in Patients With ALK-Positive NSCLC by Dynamic Circulating Tumor DNA Sequencing

IntroductionBy implementing dynamic circulating tumor DNA (ctDNA) analysis, we explored the impact of TP53 mutations on tumor evolution and resistance mechanisms to ensartinib in patients with ALK-positive NSCLC.MethodsIn a multicenter phase 2 trial, patients with ALK-positive NSCLC who progressed on crizotinib were treated with ensartinib. Blood samples for ctDNA analysis were collected at baseline, cycle 3 day 1, and progression disease (PD) and analyzed with a 212-gene panel.ResultsA total of 440 samples were collected from 168 patients. Baseline TP53 mutations (20.2%) significantly correlated with inferior progression-free survival (4.2 mo versus 11.7 mo, p < 0.0001). Patients with TP53 mutations had higher mutation load than those without TP53 mutations at baseline (13.79 ± 3.72 versus 4.67 ± 0.39, p < 0.001). Although there was no significant difference in mutation load between these groups at cycle 3 day 1 (5.89 ± 2.25 versus 3.72 ± 0.62, p = 0.425), patients with mutated TP53 developed more mutations at PD (7.07 ± 1.25 versus 3.20 ± 0.33, p = 0.003). Frequency and abundance of secondary ALK mutations G1269A, G1202R, and E1210K increased markedly at PD than baseline. In patients without secondary ALK mutations, we identified ALK-independent resistance mechanisms including bypass signaling activation, downstream effector protein reactivation, epithelial-mesenchymal transformation, and epigenetic dysregulation.ConclusionsOur study highlighted the advantage of ctDNA analysis for monitoring tumor evolution. TP53 mutations promoted genetic evolution and accelerated occurrence of resistance. We also unveiled ALK-dependent resistance mechanisms, mainly by G1269A, G1202R, and E1210K mutations, and ALK-independent resistance mechanisms to ensartinib.     

Artificial Intelligence Application in Graves Disease: Atrial Fibrillation,Heart Failure and Menstrual Changes

ObjectiveTo study the utility of artificial intelligence (AI)–enabled electrocardiograms (ECGs) in patients with Graves disease (GD) in identifying patients at high risk of atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF), and to study whether AI-ECG can reflect hormonal changes and the resulting menstrual changes in GD.Patients and MethodsPatients diagnosed with GD between January 1, 2009, and December 31, 2019, were included. We considered AF diagnosed at 30 days or fewer before or any time after GD and de novo HFrEF not explained by ischemia, valve disorder, or other cardiomyopathy at/after GD diagnosis. Electrocardiograms at/after index condition were excluded. A subset analysis included females younger than 45 years of age to study the association between ECG-derived female probability and menstrual changes (shorter, lighter, or newly irregular cycles).ResultsAmong 430 patients (mean age, 50±17 years; 337 (78.4%) female), independent risk factors for AF included ECG probability of AF (hazard ratio [HR], 1.5; 95% CI, 1.2 to 1.6 per 10%; P<.001), older age (HR, 1.05; 95% CI, 1.03 to 1.07 per year; P<.001), and overt hyperthyroidism (HR, 3.9; 95% CI, 1.2 to 12.7; P=.03). The C-statistic was 0.85 for the combined model. Among 495 patients (mean age, 52±17 years; 374 (75.6%) female), independent risk factors for HFrEF were ECG probability of low ejection fraction (HR, 1.4; 95% CI, 1.1 to 1.6 per 10%; P=.001) and presence of AF (HR, 8.3; 95% CI, 2.2 to 30.9; P=.002), and a C-statistic of 0.89 for the combined model. Lastly, of 72 females younger than 45 years, 30 had menstrual changes at time of GD and had a significantly lower AI ECG–derived female probability [median 77.3; (IQR 57.9 to 94.4)% vs. median 97.7 (IQR 92.4 to 99.5)%, P<.001].ConclusionAI-enabled ECG identifies patients at risk for GD-related AF and HFrEF and was associated with menstrual changes in women with GD.     

吡贝地尔缓释片辅治老年帕金森病合并糖尿病的炎性指标及神经功能改善研究

目的探究吡贝地尔缓释片辅治老年帕金森病合并糖尿病对炎性指标及神经功能的改善情况。方法回顾性分析2015年1月至2016年12月中国人民解放军北部战区总医院收治的126例老年帕金森病合并糖尿病患者的临床资料,根据治疗方案的不同将患者分为两组:对照组(n=62)和研究组(n=64)。对照组患者采用多巴丝肼片治疗,研究组患者采用多巴丝肼片联合吡贝地尔缓释片治疗。对比两组患者治疗前后血清炎性指标肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)与白细胞介素-18(IL-18)的改善情况。观察记录两组患者的神经功能改善情况,包括肢体感觉症状、自主神经症状以及HY分级等。结果研究组与对照组患者治疗后血清炎性因子TNF-α、IL-6与IL-18的表达水平均较治疗前有明显改善(P<0.05),而相比于对照组,研究组患者的改善更为显著(t=3.362,2.129,6.257,P<0.05);治疗后研究组患者的肢体疼痛、肢体寒凉、肢体痉挛和不安腿综合征等症状的发生率均有明显降低(χ^2=4.354,5.680、5.395,4.614,P<0.05),而对照组患者的发生率降低并不显著(χ^2=1.442,2.185,2.563,1.846,P>0.05);治疗后研究组患者HY分级1、2级的数量较治疗前明显增多,3、4级的数量明显降低(Z=2.887,P<0.05);而对照组患者治疗前后的HY分级的变化情况差异无统计学意义(Z=1.225,P>0.05);治疗后研究组患者的口干、便秘、尿频尿急、出汗等自主神经异常症状的发生率均有明显降低(χ^2=5.236,7.127,30.676,30.040,P<0.05),而对照组患者的口干、便秘发生率降低并不显著(χ^2=1.679,3.345,P>0.05),尿频尿急、出汗的发生率明显降低(χ^2=15.629,23.522,P<0.05)。结论吡贝地尔缓释片联合多巴丝肼片治疗老年帕金森病合并糖尿病,可以明显改善患者的血清炎性指标水平和肢体感觉症状、运动症状、自主神经症状等神经功能,具有一定的临床价值。