经动脉栓塞术治疗食管癌出血14例

【摘要】 目的 探讨经动脉栓塞术（transarterial embolization，TAE）治疗食管癌出血的有效性及安全性。方法 收集2018年1月至2020年12月行TAE治疗的14例食管癌出血患者的临床资料、技术成功率、临床成功率，严重并发症情况。评估TAE治疗的有效性及安全性。结果 14例患者中导管成功选择性插入靶动脉并行栓塞患者11例。9例患者接受治疗后未再出现出血征象。出血的主要责任血管为胃左动脉7例，支气管动脉6例和食管固有动脉6例。栓塞材料为微弹簧圈、明胶海绵颗粒及聚乙烯醇颗粒。常见不良反应有疼痛、发热，其中1例患者发生食管瘘。结论 对于内科治疗无效的食管癌出血，TAE可以起到良好的疗效。食管瘘作为术后的严重并发症，需特别注意预防。对于胸段食管癌及食管胃交界处癌，最常见的责任血管为胃左动脉、支气管动脉及食管固有动脉。     

糖尿病合并结核潜伏感染的研究热点与趋势分析

目的 探讨糖尿病合并结核潜伏感染的研究现状、热点与前沿。方法 收集Web of Science核心合集于2000年1月1日至2021年11月20日发表的糖尿病合并结核潜伏感染的相关文章，运用CiteSpace 5.8.R3软件进行可视化分析。结果 共纳入英文文献148篇，近20年来该领域发文量呈上升趋势。美国发文量最多（46篇, 31.08%），机构间合作情况的可视化分析共得到个340节点、929条连线，网络密度为0.0161，作者间合作关系的知识图谱共得到790个节点、2425条连线，网络密度为0.0078，关键词共现分析结果显示，糖尿病合并结核潜伏感染的危险因素、患病率、诊断和治疗是该领域的研究热点和趋势。结论 糖尿病合并结核潜伏感染的发文量不断增加，机构间、区域内和国际范围内的合作有待进一步开展。立足国情，探索慢病共病的管理模式将有助于优化共病管理，进一步推动慢病管理的进程。     

中药药浴治疗痉挛型脑性瘫痪患儿的临床效果

目的研究中药药浴治疗痉挛型脑性瘫痪患儿的临床效果。方法选取2021年1月至12月于粤北人民医院儿童康复科确诊的80例痉挛型脑性瘫痪患儿,按随机数字表法分为对照组和观察组,每组各40例。对照组实施常规康复疗法,涉及运动疗法、作业疗法、物理因子治疗等,观察组进行常规康复治疗并结合中药药浴疗法,分别评估两组的肌张力及大运动功能并进行比较。结果治疗后观察组的肌张力低于对照组,大运动功能评估得分高于对照组,差异均有统计学意义(P<0.05)。结论中药药浴治疗痉挛型脑性瘫痪患儿可获得显著的效果,可改善肌张力,促进大运动功能提升,具有临床推广价值。     

高密度多孔聚乙烯植入体在鼻整形中的应用

目的 探究高密度多孔聚乙烯植入体在鼻整形中的应用价值方法 选取2019年5月-2021年8月我院接受综合鼻整形手术的106例患者为研究对象，采用照随机数字表法分为对照组和观察组，各53例。 对照组采用自体肋骨植入术，观察组采用高密度多孔聚乙烯植入体植入治疗，比较两组临床手术指标(手术时间、恢复时间)、整形优良率、鼻指标(鼻高度/鼻长度比例、鼻唇角)、并发症发生率以及疼痛评分结果 观察组手术时间、术后恢复时间均短于对照组(P＜0.05)；观察组整形优良率为94.34%，高于对照组的86.79%，差异有统计学意义(P＜0.05)；观察组鼻高度/鼻长度比例高于对照组，鼻唇角小于对照组，差异有统计学意义(P＜0.05)；观察组并发症发生率为5.66%，低于对照组的15.09%，差异有统计学意义(P＜0.05)；观察组疼痛评分低于对照组，差异有统计学意义(P＜0.05)；观察组治疗满意度为 96.23%，高于对照组的84.91%，差异有统计学意义(P＜0.05)结论 高密度多孔聚乙烯植入体在鼻整形中的应用效果理想，可减轻患者疼痛度，缩短手术和恢复时间，降低并发症发生率，改善鼻高度/鼻长度比例和鼻唇角，实现理想的整形效果。     

China special issue on gastrointestinal tumors-Radiological features of pathological complete response in mismatch repair deficient colorectal cancer after neoadjuvant PD-1 blockade: A post hoc analysis of the PICC phase II trial

Neoadjuvant programmed cell death protein 1 (PD-1) blockade exhibits promising efficacy in patients with mismatch repair deficient (dMMR) colorectal cancer (CRC). However, discrepancies between radiological and histological findings have been reported in the PICC phase II trial (NCT 03926338). Therefore, we strived to discern radiological features associated with pathological complete response (pCR) based on computed tomography (CT) images. Data were obtained from the PICC trial that included 36 tumors from 34 locally advanced dMMR CRC patients, who received neoadjuvant PD-1 blockade for 3 months. Among the 36 tumors, 28 (77.8%) tumors achieved pCR. There were no statistically significant differences in tumor longitudinal diameter, the percentage change in tumor longitudinal diameter from baseline, primary tumor sidedness, clinical stage, extramural venous invasion status, intratumoral calcification, peritumoral fat infiltration, intestinal fistula and tumor necrosis between the pCR and non-pCR tumors. Otherwise, tumors with pCR had smaller posttreatment tumor maximum thickness (median: 10 mm vs 13 mm, P = .004) and higher percentage decrease in tumor maximum thickness from baseline (52.9% vs 21.6%, P = .005) compared to non-pCR tumors. Additionally, a higher proportion of the absence of vascular sign (P = .003, odds ratio [OR] = 25.870 [95% CI, 1.357-493.110]), nodular sign (P < .001, OR = 189.000 [95% CI, 10.464-3413.803]) and extramural enhancement sign (P = .003, OR = 21.667 [2.848-164.830]) was observed in tumors with pCR. In conclusion, these CT-defined radiological features may have the potential to serve as valuable tools for clinicians in identifying patients who have achieved pCR after neoadjuvant PD-1 blockade, particularly in individuals who are willing to adopt a watch-and-wait strategy.     

Inter-rater Accuracy and Reliability of a Palpation Protocol of the C7 Spinous Process Comprising a Combination of 3 Traditional Palpation Techniques

ObjectiveThe purpose of this study was to determine the accuracy and intrarater reliability of a palpatory protocol based on a combination of 3 palpatory methods to identify both the C7 spinous process (C7 SP) and the factors that affect the errors and inaccuracy of palpation.MethodsTwenty-five women between the ages of 18 and 60 years were submitted to a palpation protocol of the C7 SP, and a radiopaque marker was fixed on the skin at the possible location of the vertebrae. A radiograph and a photograph of the cervical spine were obtained in the same posture by a first rater. A second rater performed the same palpation protocol and took a second photograph. The accuracy and measurement error of the palpation protocol of C7 SP were assessed through radiographic images. The inter-rater reliability was estimated by the interclass correlation coefficient and assessed using photographs of each rater. The Pearson's correlation coefficients (r), the Fisher exact test, and the χ² test were used to identify the factors associated with the error and inaccuracy of palpation.ResultsAccuracy of the C7 palpation was 76% with excellent reliability (interclass correlation coefficient = 0.99). There was a moderate correlation between weight and the measurement of palpation error (r = –0.6; P = .003). One hundred percent of inaccuracy palpation was related to the increased soft-tissue thickness (P = .005) in the cervical region.ConclusionThe palpation protocol described in this study was accurate and presented excellent reliability in identifying the C7 SP. Increased weight and dorsocervical fat pad were associated to error and palpation inaccuracy, respectively.     

何首乌致药物性肝损伤的病理学特点

目的了解何首乌致药物性肝损伤(Polygonum multiflorum-associated drug induce liver injury,PM-DILI)的临床病理学特点。方法收集2019年3月1日至2021年3月1日深圳市第三人民医院收治的8例PM-DILI患者临床资料。肝穿组织进行苏木素-伊红染色、网状纤维染色、Masson三色染色、铁、铜特殊染色和免疫组织化学染色,显微镜下观察分析。结果8例PM-DILI患者男女比为1∶1,平均年龄43岁,其中6例为急性PM-DILI,2例慢性为PM-DILI。入院血清学检查异常主要包括转氨酶升高和淤胆均为7例。主要组织病理学改变为点灶状坏死8例、界面炎5例、融合坏死4例,融合坏死以肝腺泡3带为主,不伴或伴少数炎细胞浸润;胆汁淤积5例,为肝腺泡3带的肝细胞、毛细胆管内淤胆,不伴或伴少数炎细胞浸润;中央静脉炎3例;病程长者可发生肝纤维化,甚至肝硬化2例。结论肝腺泡3带为主的急性淤胆和肝细胞坏死是PM-DILI主要组织学表现,严重者可发生静脉炎等血管损伤。     

Quantifying and leveraging predictive uncertainty for medical image assessment

The interpretation of medical images is a challenging task, often complicated by the presence of artifacts, occlusions, limited contrast and more. Most notable is the case of chest radiography, where there is a high inter-rater variability in the detection and classification of abnormalities. This is largely due to inconclusive evidence in the data or subjective definitions of disease appearance. An additional example is the classification of anatomical views based on 2D Ultrasound images. Often, the anatomical context captured in a frame is not sufficient to recognize the underlying anatomy. Current machine learning solutions for these problems are typically limited to providing probabilistic predictions, relying on the capacity of underlying models to adapt to limited information and the high degree of label noise. In practice, however, this leads to overconfident systems with poor generalization on unseen data. To account for this, we propose a system that learns not only the probabilistic estimate for classification, but also an explicit uncertainty measure which captures the confidence of the system in the predicted output. We argue that this approach is essential to account for the inherent ambiguity characteristic of medical images from different radiologic exams including computed radiography, ultrasonography and magnetic resonance imaging. In our experiments we demonstrate that sample rejection based on the predicted uncertainty can significantly improve the ROC-AUC for various tasks, e.g., by 8% to 0.91 with an expected rejection rate of under 25% for the classification of different abnormalities in chest radiographs. In addition, we show that using uncertainty-driven bootstrapping to filter the training data, one can achieve a significant increase in robustness and accuracy. Finally, we present a multi-reader study showing that the predictive uncertainty is indicative of reader errors.     

A meta-analysis for Lianhua Qingwen on the treatment of Coronavirus disease 2019 (COVID-19)

BackgroundTraditional Chinese medicine (TCM) has been proven to played a great important role on the treatment of COVID-19. As one of the drugs recommended in Chinese guidelines, Lianhua Qingwen Granules or Capsules (LQ) are widely used.This systematic review and meta-analysis amis to evaluate the clinical efficacy of LQ on the treatment of COVID-19.MethodsSeven databases (PubMed, EMBASE, CENTRAL, CNKI, VIP, CBM and Wanfang) were searched to include all appropriate clinical trials that explore the efficacy of LQ on the treatment of COVID-19.ResultA total of 3 trials including 245 COVID-19 patients were eventually enrolled.Compared with the control group,the LQ group showed great significant difference on reducing the rate of clinical change to severe or critical condition[RR = 0.38, 95 %CI (0.17,0.85), P < 0.05]and the fever time (SMD =-0.57,95 %CI (-0.96,-0.17), P<0.05),as well as the significant improvement on the disappearance rate of the clinical symptoms: fever [RR = 1.36,95 %CI (1.14,1.61), P < 0.05],cough[RR = 1.99,95 %CI (1.39,2.86), P < 0.05],fatigue[RR = 1.52,95 %CI (1.15,2.01), P < 0.05] and anhelation [RR = 4.18,95 %CI (1.99,8.81), P < 0.05], but no significance on expectoration[RR = 2.46,95 %CI (0.81,7.51), P < 0.05].ConclusionThe clinical application of LQ on the treatment of COVID-19 has significant efficacy in improving clinical symptoms and reducing the rate of clinical change to severe or critical condition. Nevertheless, due to the limited quantity and quality of the included studies, more and higher quality trials with more observational indicators are expected to be published.