Outcomes of Fluoroscopy-Guided Percutaneous High Ligation of the Great Saphenous Vein Combined With Foam Sclerotherapy for Symptomatic Great Saphenous Veins

PurposeTo evaluate the effectiveness and safety of fluoroscopy-guided percutaneous high ligation (FPHL) combined with fluoroscopy-guided foam sclerotherapy (FGFS) to treat varicose veins of the great saphenous veins (GSVs).Materials and MethodsThis was a retrospective study of 113 patients (mean age, 62.1 ± 10.8 years; 60 men) with varicose veins of the GSVs (133 limbs) that were treated with FPHL combined with FGFS between April 1 and October 31, 2019. Demographic and clinical data were collected from these patients before the FPHL procedure, after which FGFS was performed. The preterminal GSV was ligated percutaneously by a percutaneously-positioned polypropylene ligature under fluoroscopic guidance. The outcome of ligation was confirmed by venography. Then, foam sclerotherapy was performed under fluoroscopy. At 1-year follow-up, GSV occlusion was evaluated by ultrasound. The venous clinical severity scores (VCSSs) were compared between the preoperative and 1-year follow-up periods.ResultsThe technical success rate was 100% (133 limbs). Complete 12-month follow-up was available for 112 limbs (84.2%) and 103 of these limbs (92.0%) remained occluded during this period. The VCSS improved from 4.71 ± 2.15 to 0.74 ± 0.60 (V = 6328, P < .001). During follow-up, there were 16 limbs with thrombophlebitis and 38 limbs with saphenous junction pain; these events were alleviated within 2 weeks of the procedure. There was no deep venous thrombosis or other severe adverse events.ConclusionsFPHL combined with FGFS to treat varicose veins in the GSVs achieved an occlusion rate of 92% and improved the clinical symptoms within 1 year; this minimally-invasive procedure was safe and effective.     

重组人表皮生长因子凝胶联合CO2点阵激光治疗增生性瘢痕的效果观察

目的观察重组人表皮生长因子凝胶联合CO₂点阵激光治疗烧伤及创伤后增生性瘢痕的临床效果。 方法选择2020年12月至2021年10月安徽医科大学第一附属医院烧伤与创面修复外科收治的20例增生性瘢痕患者，按照随机数字表法将患者分为联合治疗组及单纯激光治疗组，每组10例。术前均对2组患者术区进行拍照存像、消毒、擦干，局部均匀涂抹5%复方利多卡因乳膏后以无菌薄膜封闭保护60 min，擦去乳膏后再次消毒术区。术中使用CO₂点阵激光治疗仪对患者瘢痕部位进行扫描，根据患者增生性瘢痕厚度选定合适的机器参数，维持机器频率300 Hz及密度5%，在20～30 J调整能量参数的大小，时间间隔1 s，保证点阵矩形完全覆盖增生瘢痕，允许2次激光形成的热损伤矩阵之间存在25%面积的重叠。术后即刻冷敷创面60 min，冷敷结束至术后1周，单纯激光治疗组不外用任何药物，联合治疗组术区加用重组人表皮生长因子凝胶外用，3次/d。术后3 d治疗部位不碰水，若出现感染情况，可以加用抗生素软膏，点状损伤创面外痂皮未掉落完全时禁止擦洗创面，禁止直接剥除痂皮，禁止术区涂抹化妆品等，避免接受阳光直射。于第1次激光治疗后2个月进行第2次激光治疗，以2次CO₂点阵激光治疗为1个疗程，1个疗程治疗后间隔2个月待术区稳定后行疗效判断，计算2组患者治疗的总有效率；根据温哥华瘢痕量表(VSS)与患者与观察者瘢痕评估量表(POSAS)对患者治疗前、第1次激光治疗后2个月、第2次激光治疗后2个月瘢痕的各项指标进行评分。数据比较采用重复测量方差分析和χ²检验。 结果(1)治疗1个疗程后2个月，单纯激光治疗组与联合治疗组患者治疗的总有效率分别为80%(8/10)、90%(9/10)，2组间比较差异无统计学意义(χ²＝2.40，P＝0.49)。(2)对2组VSS评分的各项指标进行比较，其中疼痛、瘙痒、柔软度及厚度评分的组内及组间各时相点比较，差异均无统计学意义(P>0.05)。治疗前、第1次激光治疗后2个月及第2次激光治疗后2个月，单纯激光治疗组VSS评分中色泽评分分别为(1.9±0.7)、(1.9±0.1)、(1.8±1.0)分，联合治疗组分别为(2.9±0.7)、(2.8±0.6)、(1.9±0.7)分，2组在不同时相点组内比较，差异有统计学意义(F＝ 26.143，P<0.05)；2组组间不同时相点比较，差异有统计学意义(F＝6.753，P＝0.018)。治疗前、第1次激光治疗后2个月及第2次激光治疗后2个月，单纯激光治疗组VSS评分中血管分布评分分别为(1.8±1.0)、(1.7±0.7)、(1.5±1.0)分，联合治疗组分别为(2.6±0.5)、(2.5±0.5)、(1.7±0.8)分，2组在不同时相点组内比较，差异有统计学意义(F＝17.603，P<0.05)，2组组间不同时相点比较，差异无统计学意义(F＝ 2.538，P＝0.129)。(3)对2组POSAS评分的各项指标进行比较，其中厚度、粗糙度、柔软度和表面积评分的组内及组间各时相点比较，差异均无统计学意义(P>0.05)。治疗前、第1次激光治疗后2个月及第2次激光治疗后2个月，单纯激光治疗组POSAS评分中色泽评分分别为(4.9±2.6)、(4.1±0.8)、(3.5±2.0)分，联合治疗组分别为(7.6±1.1)、(6.8±1.4)、(5.4±1.8)分，2组在不同时相点组内比较，差异有统计学意义(F＝ 26.509，P<0.05)，2组组间不同时相点比较，差异有统计学意义(F＝ 8.973，P＝0.008)。治疗前、第1次激光治疗后2个月及第2次激光治疗后2个月，单纯激光治疗组POSAS评分中血管分布评分分别为(4.4±2.1)、(3.9±0.9)、(3.5±1.6)分，联合治疗组分别为(6.3±1.1)、(5.7±2.0)、(4.5±1.6)分，2组在不同时相点组内比较，差异有统计学意义(F＝ 20.118，P<0.05)，2组组间不同时相点比较，差异有统计学意义(F＝ 5.744，P＝0.028)。 结论重组人表皮生长因子凝胶联合CO₂点阵激光及单独使用CO₂点阵激光治疗增生性瘢痕均效果明确，但联合使用重组人表皮生长因子凝胶能有效促进创面愈合、改善瘢痕组织血管分布和减少局部色素沉着。     

Phase 0 Study of Vandetanib-Eluting Radiopaque Embolics as a Preoperative Embolization Treatment in Patients with Resectable Liver Malignancies

PurposeTo assess the safety and tolerability of a vandetanib-eluting radiopaque embolic (BTG-002814) for transarterial chemoembolization (TACE) in patients with resectable liver malignancies.Materials and MethodsThe VEROnA clinical trial was a first-in-human, phase 0, single-arm, window-of-opportunity study. Eligible patients were aged ≥18 years and had resectable hepatocellular carcinoma (HCC) (Child-Pugh A) or metastatic colorectal cancer (mCRC). Patients received 1 mL of BTG-002814 transarterially (containing 100 mg of vandetanib) 7–21 days prior to surgery. The primary objectives were to establish the safety and tolerability of BTG-002814 and determine the concentrations of vandetanib and the N-desmethyl vandetanib metabolite in the plasma and resected liver after treatment. Biomarker studies included circulating proangiogenic factors, perfusion computed tomography, and dynamic contrast-enhanced magnetic resonance imaging.ResultsEight patients were enrolled: 2 with HCC and 6 with mCRC. There was 1 grade 3 adverse event (AE) before surgery and 18 after surgery; 6 AEs were deemed to be related to BTG-002814. Surgical resection was not delayed. Vandetanib was present in the plasma of all patients 12 days after treatment, with a mean maximum concentration of 24.3 ng/mL (standard deviation ± 13.94 ng/mL), and in resected liver tissue up to 32 days after treatment (441–404,000 ng/g). The median percentage of tumor necrosis was 92.5% (range, 5%–100%). There were no significant changes in perfusion imaging parameters after TACE.ConclusionsBTG-002814 has an acceptable safety profile in patients before surgery. The presence of vandetanib in the tumor specimens up to 32 days after treatment suggests sustained anticancer activity, while the low vandetanib levels in the plasma suggest minimal release into the systemic circulation. Further evaluation of this TACE combination is warranted in dose-finding and efficacy studies.     

Arterial spin labeling MR image denoising and reconstruction using unsupervised deep learning

Arterial spin labeling (ASL) imaging is a powerful magnetic resonance imaging technique that allows to quantitatively measure blood perfusion non-invasively, which has great potential for assessing tissue viability in various clinical settings. However, the clinical applications of ASL are currently limited by its low signal-to-noise ratio (SNR), limited spatial resolution, and long imaging time. In this work, we propose an unsupervised deep learning-based image denoising and reconstruction framework to improve the SNR and accelerate the imaging speed of high resolution ASL imaging. The unique feature of the proposed framework is that it does not require any prior training pairs but only the subject's own anatomical prior, such as T1-weighted images, as network input. The neural network was trained from scratch in the denoising or reconstruction process, with noisy images or sparely sampled k-space data as training labels. Performance of the proposed method was evaluated using in vivo experiment data obtained from 3 healthy subjects on a 3T MR scanner, using ASL images acquired with 44-min acquisition time as the ground truth. Both qualitative and quantitative analyses demonstrate the superior performance of the proposed txtc framework over the reference methods. In summary, our proposed unsupervised deep learning-based denoising and reconstruction framework can improve the image quality and accelerate the imaging speed of ASL imaging.     

Differing Characteristics of Human-Shaped Visual Stimuli Affect Clinicians’ Dosage of a Spinal Manipulative Thrust on a Low-Fidelity Model: A Cross-Sectional Study

ObjectiveThe purpose of this study was to determine whether chiropractic clinicians modulate spinal manipulation (SM) thrust characteristics based on visual perception of simulated human silhouette attributes.MethodsWe performed a cross-sectional within-participant design with 8 experienced chiropractors. During each trial, participants observed a human-shaped life-sized silhouette of a mock patient and delivered an SM thrust on a low-fidelity thoracic spine model based on their visual perception. Silhouettes varied on the following 3 factors: apparent sex (male or female silhouette), height (short, average, tall), and body mass index (BMI) (underweight, healthy, obese). Each combination was presented 6 times for a total of 108 trials in random order. Outcome measures included peak thrust force, thrust duration, peak preload force, peak acceleration, time to peak acceleration, and rate of force application. A 3-way repeated measures analysis of variance model was used to for each variable, followed by Tukey's honestly significant difference on significant interactions.ResultsPeak thrust force was reduced when apparent sex of the presented silhouette was female (F_1,7 = 5.70, P = .048). Thrust duration was largely invariant, except that a BMI by height interaction revealed a longer duration occurred for healthy tall participants than healthy short participants (F_4,28 = 4.34, P = .007). Compared to an image depicting obese BMI, an image appearing underweight lead to reduced peak acceleration (F_2,5 = 6.756, P = .009). Clinician time to peak acceleration was reduced in short compared to tall silhouettes (t₇ = 2.20, P = .032).ConclusionVisual perception of simulated human silhouette attributes, including apparent sex, height, and BMI, influenced SM dose characteristics through both kinetic and kinematic measures. The results suggest that visual information from mock patients affects the decision-making of chiropractic clinicians delivering SM thrusts.