他山之石 何以攻玉:从脑出血国际临床研究现状看我国的规范化治疗

自发性脑出血病死率和病残率较高,但缺乏有效的治疗策略。我国的脑出血相关研究与国际先进水平存在一定差距。近年国际上一系列临床研究从不同角度探讨脑出血的治疗方式,对我国脑出血研究和规范化治疗具有十分重要的参考价值。我国的脑出血临床治疗经验和研究成果要想走向世界,必须开展高质量的临床试验。四川大学华西医院神经外科正在开展INTERACT3试验,以及准备开展STICHⅢ试验,希望能够推动中国脑出血研究事业的进步。     

Esophageal Surveillance Practices in Esophageal Atresia Patients: A Survey by the Eastern Pediatric Surgery Network

IntroductionEndoscopic surveillance guidelines for patients with repaired esophageal atresia (EA) rely primarily on expert opinion. Prior to embarking on a prospective EA surveillance registry, we sought to understand EA surveillance practices within the Eastern Pediatric Surgery Network (EPSN).MethodsAn anonymous, 23-question Qualtrics survey was emailed to 181 physicians (surgeons and gastroenterologists) at 19 member institutions. Likert scale questions gauged agreement with international EA surveillance guideline-derived statements. Multiple-choice questions assessed individual and institutional practices.ResultsThe response rate was 77%. Most respondents (80%) strongly agree or agree that EA surveillance endoscopy should follow a set schedule, while only 36% claimed to perform routine upper GI endoscopy regardless of symptoms. Many institutions (77%) have an aerodigestive clinic, even if some lack a multi-disciplinary EA team. Most physicians (72%) expressed strong interest in helping develop evidence-based guidelines.ConclusionsOur survey reveals physician agreement with current guidelines but weak adherence. Surveillance methods vary greatly, underscoring the lack of evidence-based data to guide EA care. Aerodigestive clinics may help implement surveillance schedules. Respondents support evidence-based protocols, which bodes well for care standardization. Results will inform the first multi-institutional EA databases in the United States (US), which will be essential for evidence-based care.Level of EvidenceThis is a prognosis study with level 4 evidence.     

Percutaneous transcatheter super-selective renal arterial embolization with N-butyl cyanoacrylate for iatrogenic renal hemorrhage

BackgroundTo evaluate the safety and efficacy of percutaneous transcatheter super-selective renal arterial embolization (SRAE) with N-butyl cyanoacrylate (NBCA) for iatrogenic renal hemorrhage.MethodsBetween January 2014 and December 2019, 45 patients (including 18 patients with coagulopathy), who underwent percutaneous transcatheter SRAE with NBCA for iatrogenic renal hemorrhage at our institution, were retrospectively reviewed. The technical success rate, clinical success rate, and embolization-related complications were analyzed. The values of estimated glomerular filtration rate (eGFR), serum creatinine (sCr), and serum urea (sUr) were analyzed at the time of pre-SRAE, post-SRAE, and last follow-up to evaluate the effects of NBCA-based SRAE on renal function.ResultsDiagnostic renal arteriography revealed contrast extravasation in 18 patients and pseudoaneurysms in 27 patients. NBCA mixed with iodized oil in a 1:2–1:4 ratio was the sole embolic agent. No procedure-related mortality or major complications occurred. The technical and clinical success rates were both 100%. The values of eGFR, sCr and sUr were not found to be significantly different between pre-SRAE, post-SRAE and last follow-up (eGFR: 91.52 ?± ?21.17 vs. 90.98 ?± ?22.11 vs. 92.14 ?± ?23.51 ?mL/min/1.73 ?m², p ?= ?0.729; sCr: 74.73 ?± ?11.08 vs. 75.27 ?± ?12.43 vs. 73.95 ?± ?10.14 ?μmol/L, p ?= ?0.543; sUr: 5.69 ?± ?0.84 vs. 5.71 ?± ?0.96 vs. 5.70 ?± ?0.79, p ?= ?0.515, respectively).ConclusionsPercutaneous transcatheter SRAE with NBCA is a safe and effective treatment modality for iatrogenic renal hemorrhage with no deterioration of renal function.     

凉血通瘀方干预高血压大鼠急性脑出血模型对脑组织中差异miRNA表达的影响＊

目的 研究凉血通瘀方对高血压大鼠急性脑出血模型脑组织miRNA表达的影响，对差异表达的miRNA靶基因进行分析，探索凉血通瘀方可能的药效机制。方法 将自发性高血压大鼠随机分成对照组（B）和实验组（C）。适应性饲养一周后，C组灌胃凉血通瘀方，B组灌胃等体积生理盐水，连续5天，每天1次。构建脑出血模型后收集脑组织，借助全转录组测序技术获得miRNA表达量，与miRBase数据库比对获取已知miRNA，使用miRDeep2预测新miRNA。差异分析软件为DESeq2，筛选阈值为|log₂FC| ≥1 并且P <0.05。对显著差异表达的miRNA进行靶基因预测，对靶基因进行GO功能、KEGG通路富集和PPI网络分析。结果 实验组和对照组对比，共发现21个显著差异表达的miRNA，上调有9个，下调有12个，共预测得到1243个有统计学意义的靶基因。GO富集分析发现，生物过程中突触囊泡分泌的调节、神经递质分泌的调节和神经递质运输的调节占前三位，神经元投射终点、全膜、质膜区域和细胞投射则是主要的细胞成分。分子功能分别为小GTPase绑定、底物特异性跨膜转运蛋白活性和离子跨膜转运体活性。通路分析结果显示，靶基因在癌证通路、pI3K-Akt信号通路、人类乳头瘤病毒感染、神经活性配体-受体相互作用和MAPK通路等分布广泛。采用STRING网站和Cytoscape软件，根据MCC算法筛选出ADRA2C、CASR、CCL28、CCR1、DRD2、GNAT3、GRM2、DYNC1LI1、GABBR1、GNAI1等核心靶基因。结论 凉血通瘀方对脑出血急性期鼠脑组织内miRNA的表达有重要影响；显著差异表达miRNAs可能通过靶向核心基因调控凉血通瘀方干预急性脑出血的病理过程及预后。     

Development and validation of a novel scoring system to predict severe intraventricular hemorrhage in very low birth weight infants

ObjectiveWe sought to develop and validate a novel scoring system for the prediction of severe intraventricular hemorrhage (SIVH) in very low birth weight infants (VLBWI).MethodsThis retrospective cohort multicenter study included 615 VLBWI born between 24 and 32 weeks gestational age (GA). Multivariable logistic regression analyses were used to determine which factors evaluated within the first 5 days of life were associated with SIVH and the weights of these variables. The accuracy of the predictive scoring system was prospectively tested in the same units.ResultsThe final SIVH scoring system included the following variables: antenatal steroid therapy, GA, birth weight (BW), 1-min Apgar score, mechanical ventilation and hypotension. The SIVH scores used to divide the subjects into three tiers (low-risk (<5), moderate-risk (5–8) and high-risk (>8)) were developed based on these variables. Of infants with a score below 5, 1.2% (4/339) developed SIVH. Of those with a score above 8, 42.5% (17/40) developed SIVH. The scores were successfully verified in 99 VLBWI.ConclusionsThese findings suggest that among infants with a score >8, the incidence of SIVH is significantly higher. This scoring system can be used to predict the incidence of SIVH during the first 5 days after birth and may contribute to the early intervention in and prevention of SIVH.     

Prevalence and pathophysiology of early dumping in patients after primary Roux-en-Y gastric bypass during a mixed-meal tolerance test

Background

Early dumping is a poorly defined and incompletely understood complication after Roux-en-Y gastric (RYGB).

经额部与经颞部血肿钻孔引流术治疗高血压脑出血疗效的Meta分析

目的比较经额部与经颞部血肿钻孔引流术治疗高血压脑出血的疗效。 方法按照制定的检索策略，检索中国知网、万方、维普等中文数据库及Medline、Embase、Cochrane等英文数据库，对于符合纳入排除标准的研究利用RevMan 5.3软件进行Meta分析。 结果经检索，5个临床研究符合标准，共488例病例，其中经额部钻孔引流组236例，经颞部钻孔引流组252例。2组在手术时间、术后第7天血肿残余量及术后并发症发生率方面比较差异无统计学意义，经额部钻孔引流组在术后第3天血肿残余量、住院时间、术后日常活动能力方面更有优势。 结论经额部血肿钻孔引流较经颞部在血肿清除效率、改善预后方面更有优势。