足头向穿刺路径在膈肌下方肝肿瘤消融治疗中的CT模拟测量研究

【摘要】 目的 对足头向穿刺路径进行模拟测量并评价在膈肌下方肝肿瘤热消融治疗中的临床应用价值。方法 重建患者上腹部CT图像,选取有代表性的3个矢状面和1个冠状面作为标准层面,在各层面建立膈下标准病灶模型,并采用足头向穿刺路径进行模拟穿刺。测量各平面上膈肌高度、穿刺路径长度及间距。采用可到达性评价模拟穿刺时穿刺针分布于标准病灶中的最理想的位置情况。结果 纳入86例患者行测量研究,多数患者矢状2、3面的膈肌高度低于2cm,仅分别对平面内1511%的病灶e和813%的病灶f进行了测量。标准病灶a、b、c、d、b’的完全到达比例分别为5243%、6097%、3837%、5294%、6353%,中位路径长度分别为1039cm、1337cm（背侧,腹侧1266cm）、1315cm、888cm、1126cm,中位穿刺路径间距分别为21cm、209cm（背侧,214cm腹侧）、206cm、211cm、2145cm。结论 采用足头向穿刺路径进行穿刺,标准病灶a、b、d、b’有较高的完全到达比例,穿刺宽容度较高,有进一步在临床中应用的价值。标准病灶c的完全到达率不高。标准病灶e、f需要采用该路径穿刺的比例不高。     

Prognostic predictive value of TLR4 polymorphisms in Han Chinese population with hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease and is an important cause of sudden death in patients of all ages. The aim of this study was to find out whether Toll-like receptor-4 (TLR4) polymorphism is associated with HCM. To explore the association between TLR4 gene polymorphisms and HCM, 486 HCM patients and 214 healthy controls were enrolled in a case–control study of Chinese Han population. Two single nucleotide polymorphisms (SNPs) in the promoter region of TLR4 gene, ?728G > C (rs11536865) and ?2081G > A (rs10983755), were genotyped by PCR restriction fragment length polymorphism (PCR-RFLP). The associations between TLR4 SNPs and overall survival (OS) of HCM patients were analyzed by the Kaplan–Meier estimation method and Cox proportional hazards regression analysis. Serum TLR4 level was determined by ELISA. Our results showed that the C allelic frequency of ?728G > C and A allelic frequency of ?2081G > A were higher in HCM patients than those in controls (P < 0.001). The ratios of genotype frequencies for both SNPs were associated with HCM susceptibility under three genetic models (P < 0.01). Two SNPs were also associated with the OS in HCM patients (P < 0.001). The CC genotype of ?728G > C and AA genotype of ?2081G > A were associated with poor prognosis of HCM (P < 0.001). Moreover, HCM patients had a higher serum TLR4 level compared with the controls (242.6 pg/ml versus 135.7 pg/ml, P = 0.027). In addition, significant associations were observed between CC genotype of ?728G > C or AA genotype of ?2081G > A and plasma TLR4 level (P < 0.01). The results of this study indicated that TLR4 polymorphisms may be a genetic susceptibility factor for HCM in the Han Chinese population.     

Consensus among Chinese experts on standard interventional therapy for deep venous thrombosis of lower extremity (second edition)

This is an update on the first edition of the expert consensus. This document discusses the indications and contraindications of interventional treatment methods for deep venous thrombosis such as anticoagulation, catheter-directed thrombolysis, percutaneous mechanical thrombectomy, percutaneous transluminal angioplasty and stent implantation. The operational procedures, considerations, preoperative management, and prevention of complications were also updated, supplemented, and revised. Emphasis is placed on the interventional treatment of acute and subacute deep venous thrombosis to effectively reduce the incidence of post-thrombosis syndrome.     

Precise engineering of cetuximab encapsulated gadollium nanoassemblies: in vitro ultrasound diagnosis and in vivo thyroid cancer therapy

We report the formulation of nanoassemblies (NAs) comprising C225 conjugates Gd-PFH-NAs (C-Gd-PFH-NAs) for low-intensity focused ultrasound diagnosis ablation of thyroid cancer. C-Gd-PFH-NAs showed excellent stability in water, phosphate-buffered saline (PBS), and 20% rat serum. Transmission electron microscopy (TEM) images also revealed the effective construction of C-Gd-PFH-NAs as common spherical assemblies. The incubation of C625 thyroid carcinoma with C-Gd-PFH-NAs triggers apoptosis, as confirmed by flow cytometry analysis. The C-Gd-PFH-NAs exhibited antitumor efficacy in human thyroid carcinoma xenografts, where histopathological results further confirmed these outcomes. Furthermore, we were able to use low-intensity focused ultrasound diagnosis imaging (LIFUS) to examine the efficiency of C-Gd-PFH-NAs in thyroid carcinoma in vivo. These findings clearly show that the use of LIFUS agents with high performance imaging in different therapeutic settings will have extensive potential for future biomedical applications.     

d-dimer as a marker of severity in patients with severe acute pancreatitis

Background/purpose

Coagulative disorder is known to occur in the early phase of severe acute pancreatitis (SAP) and d-dimer is a commonly used clinical parameter of hemostasis. The aim of this study was to assess the value of the plasma d-dimer level as a marker of severity in the first 3?days after admission in patients with SAP.

Methods

From January 2009 to February 2011, 45 patients admitted for SAP were included in this observational study. The d-dimer level was measured on a daily basis during days 1?C3 after admission and the acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, and other clinical parameters were recorded at the same time. The maximum and the mean d-dimer values were used for analysis and compared with other prognostic factors of SAP.

Results

Both the maximum and mean levels of d-dimer were significantly different between patients with and without clinical variables such as multiple-organ dysfunction syndrome (MODS), need for surgical intervention, and the presence of pancreatic infection. The d-dimer level also showed great precision for the prediction of MODS and secondary infection. Additionally, the d-dimer level correlated well with two usual markers of SAP severity?Cthe APACHE II score and the C-reactive protein level.

Conclusion

d-dimer measurement is a useful, easy, and inexpensive early prognostic marker of the evolution and complications of SAP.     

Factors Predictive of Treatment-Emergent Adverse Events of Prucalopride: An Integrated Analysis of Four Randomized,Double-Blind,Placebo-Controlled Trials

Background/AimsThis integrated analysis aimed to identify the factors associated with the most frequently reported treatment-emergent adverse events (TEAEs) in Asian and non-Asian patients with chronic constipation (CC) who receive prucalopride or placebo over 12 weeks.MethodsPooled data from four randomized, double-blind, placebo-controlled, multicenter, phase III studies ({"type":"clinical-trial","attrs":{"text":"NCT00488137","term_id":"NCT00488137"}}NCT00488137, {"type":"clinical-trial","attrs":{"text":"NCT00483886","term_id":"NCT00483886"}}NCT00483886, {"type":"clinical-trial","attrs":{"text":"NCT00485940","term_id":"NCT00485940"}}NCT00485940, and {"type":"clinical-trial","attrs":{"text":"NCT01116206","term_id":"NCT01116206"}}NCT01116206) on patients treated with prucalopride 2 mg or placebo were analyzed. The associations between predictors and TEAEs were evaluated based on a logistic regression model.ResultsOverall, 1,821 patients (Asian, 26.1%; non-Asian, 73.9%) were analyzed. Prucalopride treatment was significantly associated with diarrhea, headache, and nausea (p<0.001), but not with abdominal pain, compared with placebo. Differences in the prevalence of TEAEs between prucalopride and placebo decreased greatly after the first day of treatment. Compared with non-Asians, Asians were more likely to experience diarrhea and less likely to develop abdominal pain, headache, and nausea. Prior laxative use, CC duration, and body weight were not predictive of any of these TEAEs.ConclusionsPrucalopride treatment was positively associated with diarrhea, headache, and nausea. Asian patients tended to have a higher frequency of diarrhea but lower frequencies of headache, abdominal pain, and nausea compared with non-Asians.     

血清胱抑素C与慢性心力衰竭的关系及临床意义

目的 探讨血清胱抑素C与慢性心力衰竭的关系及对心衰程度的评估价值。方法 入选住院心衰患者及年龄、性别匹配的对照组各64例,完成病史采集、超声心动图检查,测血压、心率,检测肾功能指标、血清胱抑素C及N末端B型脑钠肽前体浓度(NT-proBNP, pg/ml)。结果 （1）心衰组中血压、心率、肾功能指标、左房室结构参数、NT-proBNP及血清胱抑素C均较对照组显著升高（P<0.0001）,而射血分数明显较对照组下降（P<0.0001）;（2）心衰组Pearson相关分析显示,血清胱抑素C与年龄、尿素氮、肌酐、尿酸、左房内径、左室舒张末内径及NT-proBNP呈显著正相关（P<0.05）,而与射血分数呈显著负相关（P<0.0001）;（3）心衰组多元逐步回归分析示,血清胱抑素C为NT-proBNP、左房内径、左室舒张末内径及射血分数的独立影响因素（P<0.0001）;（4）心衰组受试者工作特征曲线 （Receiver operating characteristic curve, ROC曲线）显示血清胱抑素C及肌酐对中重度临床心衰症状的诊断准确性分别为0.844和0.672,当血清胱抑素C> 0.89mg/L或肌酐>86.7μmol/L时,就有可能伴有较重的临床症状。结论 血清胱抑素C与心衰患者心功能和心脏结构密切相关,并且是比血清肌酐更为可靠的评估心衰程度的临床指标。     

室内环境因素对支气管哮喘控制的影响

目的探讨室内环境影响因素对支气管哮喘（简称哮喘）的影响。方法采用现场问卷调查的方法,选择在我院哮喘门诊规律就诊的患者,调查室内环境因素对哮喘控制水平的影响。结果实际完成调查问卷440份,其中男性197例,女性243例,平均年龄（35．861±10．063）岁。达到哮喘控制人数112例（25．45％）,部分控制人数252例（57．27％）,未控制人数76例（17．27％）。采用多因素Logistic回归分析去除相互影响后的结果显示：使用地毯、饲养带毛宠物、主动吸烟、被动吸烟、近1年内家庭装修这5个因素将会对哮喘的控制产生不利影响。同时采用每周热水清洗床上用品加上防螨枕套或空气净化器的任何两种方法的组合将会改善哮喘的控制情况,预测发生控制水平为3级的风险的相对危险度分别为OR0．322（95％CI0．116～0．892）及OR0．378（95％CI0．148～0．969）。结论多种环境因素均会对哮喘的控制产生不利影响,但一些控制环境因素手段的组合将有利于我们更好的控制哮喘。     

Comparison of the Effects of Prostaglandins E1, E2 and F2α on the Sympathetically Stimulated Rabbit Heart

PGE₁, PGE₂ and PGF_2α in concentrations ranging from 3×10^-9M to 1.5 × 10^-6 M were infused into the isolated perfused, sympathetically innervated rabbit heart in order to assess their capacity to inhibit the chronotropic, inotropic and noradrenaline overflow responses to sympathetic nerve stimulation, as well as the chronotropic and inotropic responses to infusion of noradrenaline. The coronary flow was increased by PGE₁ but not by PGE₂ of PGF_2α. The three compounds did not change the heart rate or the contractile force, indicating that the reported increase in heart rate after i.v. infusion of PGE₁ or PGE₂ is reflex in origin. PGE₁ and PGE₂ inhibited the outflow of noradrenaline as well as the chronotropic and inotropic responses to nerve stimulation in a dose-dependent way, while PGF_2α was ineffective. None of the compounds altered the chronotropic or inotropic response to exogenous noradrenaline. It is concluded that PGE₁ and PGE₂ but not PGF_2α, inhibit the sympathetic neurotransmission in the rabbit heart, and that they do this mainly by reducing the release of the transmitter from the adrenergic nerve terminals.