Multidisciplinary management of intracranial aneurysms: The experience of Lille university hospital center

BackgroundIn recent years, the multidisciplinary approach has become an important concern for the management of intracranial aneurysms.ObjectiveThis study aims to evaluate the functional outcomes of patients treated for an intracranial aneurysm (ruptured or unruptured), when the treatment modality was defined in a multidisciplinary fashion.Materials and methodsIn this retrospective study, we included all patients (n = 209) treated for an intracranial saccular aneurysm at Lille university hospital between January 2009 and December 2009. There were 70 men and 139 women with a mean age of 50.5 years (range 24 to 73 years). The clinical data were recorded before treatment including the American Society of Anesthesiology (ASA) and the World Federation of Neurosurgical Societies (WFNS) scores. Microsurgical approach was performed in 110 patients whereas 99 patients underwent an endovascular procedure. A modified Rankin Scale (mRS) was reported at 3 months after treatment. Intracranial vascular imaging was performed before and immediately after the treatment and then renewed at 3 years in all patients to detect any recurrence.ResultsAmong the 121 patients with ruptured aneurysm, the functional outcomes were similar between patients who underwent microsurgery and patients who had an endovascular treatment. In the 88 patients with an unruptured aneurysm, functional outcomes were also similar between the two treatment modalities. Among the 99 patients treated by the endovascular approach, 4 had a significant aneurysm reopening on follow-up imaging leading to additional treatment (3 clipping, 1 coiling). No aneurysm recurrence was reported among the 110 patients who underwent microsurgical treatment.ConclusionIn a trained team, the multidisciplinary approach appears to be a valuable strategy in the management of intracranial aneurysms, to achieve good functional outcomes.     

胃癌术后残胃功能性排空障碍的治疗方法研究

胃癌术后残胃功能性排空障碍是医学界普遍存在的难题,临床分析和研究的工作依然任重道远。本资料首先简单介绍该并发症的概念和发病机制,然后分析该并发症的临床表现和处理原则,并详细介绍目前常用的治疗方法,最后做出总结性治疗及前景展望。     

乙肝免疫球蛋白预防乙肝相关肝癌患者术后病毒再激活的效果研究

目的 前瞻性评估乙肝免疫球蛋白（HBIg）预防乙肝相关肝癌患者术后HBV再激活的效果。方法 纳入2014 年6 月至10 月在复旦大学附属中山医院诊断为原发性肝癌且血清乙肝表面抗原（HBsAg）阳性的患者51 例,按照治疗方法不同分为2 组,其中治疗组38 例,为血清HBV-DNA阳性患者,术前予以HBIg治疗;对照组13例,为血清HBV-DNA阴性患者。分析比较两组患者术后病毒激活率和HBIg有效率。结果 HBIg治疗组术后病毒激活率明显低于对照组（7.9% vs 53.8%,P=0.001）。Logistic回归分析表明,未予HBIg治疗是术后病毒激活的独立危险因素（OR 64.167,95%CI 9.472～434.696,P＜0.001）。治疗组中合并谷丙转氨酶（ALT）异常的患者术后病毒激活率高于ALT正常者,但无统计学差异（15.4% vs 4.0%,P=0.55）。治疗组中HBIg总体有效率为34.2%,其中合并ALT异常者有效率高于ALT正常者（61.5% vs 20.0%,P=0.011）。另外,长期使用核苷类似物（NAs）的患者术后病毒激活率与未使用者无统计学差异（P＞0.05）。结论 HBIg可有效预防乙肝相关肝癌患者术后HBV再激活,且在伴有ALT水平异常的患者中治疗效果更好。     

胃癌中PTPRS的表达及其对胃癌细胞增殖及迁移侵袭能力的影响

目的 探讨受体型酪氨酸磷酸酶S(protein tyrosine phosphatase receptor S,PTPRS)在胃癌中的表达及其与胃癌患者预后的关系,以及PTPRS对胃癌细胞增殖、迁移侵袭能力的影响。方法 利用复旦大学附属中山医院的胃癌标本的石蜡切片,免疫组化染色分析PTPRS在胃癌组织中的表达情况,进一步运用卡方检验及生存分析探索PTPRS与胃癌患者临床病理因素和生存时间的关系;运用CCK-8和平板克隆实验检测PTPRS的表达变化对细胞增殖和克隆形成能力的影响;采用划痕实验和Transwell实验检测PTPRS的表达变化对细胞迁移侵袭能力的影响;采用Western blot检测胃癌细胞中相关蛋白表达情况。结果 对141例胃癌患者癌组织进行了免疫组化染色,显示PTPRS低表达与不良分化及神经浸润密切相关。生存分析显示PTPRS低表达是胃癌患者生存时间缩短的独立危险因素。对10对胃癌患者的癌组织和癌旁组织进行配qPCR检测,发现癌组织与癌旁组织相比PTPRS表达量显著降低。对胃癌细胞系及正常胃黏膜细胞系的qPCR检测显示,与正常胃黏膜细胞系GES-1相比,胃癌细胞系中PTPRS普遍低表达。在SGC7901及HGC27两种细胞系中用慢病毒转染构建PTPRS表达干扰的稳转株,qPCR验证干扰效率。CCK-8实验发现,PTPRS低表达显著促进胃癌细胞的生长,克隆形成实验表明PTPRS低表达显著促进胃癌细胞克隆形成能力,划痕实验和Transwell实验表明PTPRS低表达显著促进胃癌细胞迁移和侵袭能力。对PTPRS干扰的胃癌细胞系进行EMT相关蛋白的检测,发现PTPRS干扰后细胞出现N-cad、ASMA表达增加等表现。结论 PTPRS在胃癌组织中低表达,且与不良预后密切相关。PTPRS低表达可能通过上皮间质转化促进胃癌细胞的增殖、迁移和侵袭。     

新型自体T细胞回输治疗晚期实体肿瘤的安全性及疗效分析

目的： 探讨采用程序性死亡因子-1（programmed cell death-1，PD-1）单克隆抗体、白细胞介素2（IL-2）及IL-15诱导制备的新型自体T细胞免疫治疗晚期实体肿瘤的疗效及安全性。方法： 前瞻性入组2018年3月至2020年12月复旦大学附属中山医院收治的进行单独新型自体T细胞治疗及新型自体T细胞治疗联合标准治疗的晚期实体肿瘤患者10例，进行Ⅰ期临床研究。主要观察指标为安全性，即治疗相关不良反应的发生率和严重程度；次要观察指标为有效性，包括生活质量评分、无进展生存期等，并分析治疗后患者免疫状态变化。结果： 10例患者中包括肝细胞肝癌3例、肠道肿瘤5例、胰腺癌1例和肺癌1例。细胞治疗后28 d内，未发生与治疗有关的严重不良事件。生活质量调查问卷显示，细胞治疗后，患者生活质量改善。其中，躯体功能、总体健康状况、疲倦改善较明显（P<0.05）。3例单用新型T细胞治疗的患者均短期内出现疾病进展；联合治疗患者的疾病控制率为71.4%。联合治疗无效患者的外周血调节性T细胞（Treg）处于较高水平，治疗后28 d高于治疗有效患者（P=0.03）。结论： 新型自体T细胞治疗实体肿瘤安全可靠，具有一定的抗肿瘤作用，联合标准治疗可显示良好的疗效，值得进一步扩大研究。     

The roles of epicardial adipose tissue in heart failure

Heart Failure Reviews - Heart failure is a growing health problem resulting in the decreased life expectancy of patients and severely increased the healthcare burden. Penetrating research on the...     

Carotid chemodectomas: long-term results of subadventitial resection with deliberate external carotid resection

The aim of this study was to evaluate the short-term and long-term results of the subadventitial resection of carotid chemodectomas and to validate the importance of deliberate resection of the external carotid artery (ECA). From 1981 to 2006, 39 carotid chemodectomas of the carotid bifurcation or of the neighboring nerves were operated on in our department. There were 14 men and 22 women, with a mean age 44.4 +/- 5 (range 21-78) years. One of these operations was a redo surgery for local recurrence. One female patient presented with a bilateral tumor. Two tumors were secreting catecholamines. All these tumors affected the carotid body; 10 of them were also affecting the vagus nerve, and one among these last 10 affected the sympathetic nerve as well. In 11 cases, the tumor had spread into the subparotidal space and, in one case, into the skull. In two cases, the tumor had been revealed by hemispheric ischemia and in every case by tumoral syndrome. All the patients were followed up by clinical examination, duplex scan, or computed tomographic scan until the end of 2006. In 38 cases, complete resection was performed; an incomplete resection was performed in one case with cranial invasion. Under general anesthesia, and most of the time without pharmaceutical preparation, surgery consisted of a deliberate sacrifice of the ECA followed by subadventitial resection of the tumor. In one case, a previous embolization had been carried out to facilitate the cleavage, which in fact rendered it more complicated. In 22 cases, resection concerned the ECA; in seven cases, it concerned the common carotid artery and the internal carotid artery (ICA): in seven cases the superior laryngeal nerve, in nine cases the vagus nerve, in five cases the sympathetic nerve, and in four cases the jugular vein. In 13 cases, node clearing was associated. In 20 cases, an additional vascular procedure was performed: nine dilatations for spasm of the ICA, five autogenous vein grafts, two prosthetic bypasses, and one endarterectomy associated with a patch angioplasty. All patients were followed up until 2006. At 3 months, the observed complications were the sequelae of a homolateral hemispheric accident due to thrombosis of a vein graft, eight peripheral facial nerve palsies, 12 vocal palsies, seven Claude Bernard-Horner (CBH) syndromes, eight palatal paralyses, and 10 nociceptive pains. Some of these complications did persist: nine vocal cord paralyses that were successfully treated by speech therapy, three mild CBH syndromes, and nociceptive pains in 6% of the cases (15.4%), incapacitating in one case. With a follow-up of 115 +/- 27 (range 1-298) months, three local recurrences were recorded at 6 and 10 years. In two cases, local recurrence occurred when initial resection of the ECA had not been performed. Two patients presented with a contralateral lesion, at 12 and 16 years, respectively. At 40 months, one patient had to be reoperated on for an atheromatous stenosis. At 51 months, a female patient's death was not related to the operation. Subadventitial resection of carotid body tumors with deliberate resection of the ECA is a simple and efficient procedure. It is the preferential treatment for these slow-growing localized tumors.     

毛细支气管炎患儿呼出气一氧化氮检测应用价值

目的探讨毛细支气管炎患儿呼出气一氧化氮(FeNO)检测的意义及应用价值。方法以2018年1至9月收治的49例初发毛细支气管炎住院患儿为研究对象,根据呼吸道合胞病毒(RSV)检测结果分为RSV组(27例)和非RSV组(22例);另选取同期同年龄健康体检儿童17例作为健康对照组。对各组进行潮气呼吸法呼出气一氧化氮检测,RSV组和非RSV组患儿在缓解期(1～2周)和恢复期(4～6周)再次检测,比较检测结果。结果 RSV组、非RSV组以及健康对照组间性别、年龄差异无统计学意义(P0.05)。RSV组及非RSV组FeNO水平在急性期、缓解期和恢复期间的差异均有统计学意义(P0.05)。在恢复期,FeNO水平在RSV组、非RSV组和健康对照组间的差异有统计学意义(P0.05),以RSV组FeNO水平最高。在急性期和缓解期,FeNO水平在三组间的差异无统计学意义(P0.05)。结论毛细支气管炎(包括RSV感染和非RSV感染)患儿在急性期和缓解期的FeNO水平与健康同龄儿童无差异,在恢复期高于健康同龄儿童。