超声成像在急性下肢深静脉血栓机械性清除治疗中应用价值

目的 探讨超声在急性下肢深静脉血栓(DVT)机械性血栓清除(PMT)治疗中应用的有效性和安全性。方法 132例急性期DVT患者置入滤器后分为82例超声组和50例造影组进行PMT及导管溶栓治疗,术后评估并比较两组静脉通畅情况、患肢周径差、血生化指标、手术时间、并发症及疗效随访。结果 超声组、造影组术后静脉通畅率较高,分别为82%、77.7%,术后两组静脉通畅情况组间对比差异均无统计学意义( P均＞0.05) 。平均手术时间超声组(1.08±0.32h)少于造影组(2.36±0.25h)(P=0.000)。并发症发生率超声组(12.2%)低于造影组(26%)(P=0.016)。术后血红蛋白含量超声组(125.66±15.48g/L)高于造影组(91.53±11.73g/L)(P=0.004)。两组术后患肢周径差、D-二聚体浓度、Villalta评分及VEINES-QOL评分组间对比差异均无统计学意义( P均＞0.05)。 结论 超声监测对急性DVT行PMT治疗安全有效,与传统静脉造影模式相比具有无辐射、手术时间短及并发症低的优点。     

白藜芦醇保护缺血再灌注大鼠心肌作用与miR-21的相关性

目的 观察白藜芦醇预处理后大鼠心肌微小RNA(miRNA)的表达变化,分析白藜芦醇介导的心肌保护作用与miR-21之间有否关系.方法 通过miRNA芯片微阵列方法和qRT-PCR检测并验证白藜芦醇灌胃预处理后的大鼠心肌miRNA表达谱；建立大鼠心肌缺血再灌注损伤模型,检测各组心肌梗死面积、心肌细胞凋亡率以及miR-21的表达水平.结果 白藜芦醇预处理后,大鼠心肌的miR-21表达水平约为对照组的2.5倍;miR-21阻逼剂对白藜芦醇预处理引起的miR-21高表达产生了明显的抑制作用；过表达的miR-21显著降低了心肌细胞凋亡率,心肌组织梗死面积明显缩小.结论 白藜芦醇可以调控心肌多种miRNA的表达水平,通过促进miR-21的表达,白藜芦醇能够抑制心肌细胞的凋亡,从而减轻缺血再灌注对心肌的损伤.     

Percutaneous ultrasound and endoscopic ultrasound-guided biopsy of solid pancreatic lesions: An analysis of 1074 lesions

Backgrounds: Percutaneous ultrasound (US) and endoscopic ultrasound (EUS)-guided pancreatic biopsies are widely accepted in the diagnosis of pancreatic diseases. Studies comparing the diagnostic performance of US- and EUS-guided pancreatic biopsies are lacking. This study aimed to evaluate and compare the diagnostic yields of US- and EUS-guided pancreatic biopsies and identify the risk factors for inconclusive biopsies. Methods: Of the 1074 solid pancreatic lesions diagnosed from January 2017 to February 2021 in our center, 275 underwent EUS-guided fine needle aspiration (EUS-FNA), and 799 underwent US-guided core needle biopsy (US-CNB/FNA). The outcomes were inconclusive pathological biopsy, diagnostic accuracy and the need for repeat biopsy. All of the included factors and diagnostic performances of both US-CNB/FNA and EUS-FNA were compared, and the independent predictors for the study outcomes were identified. Results: The diagnostic accuracy was 89.8% for EUS-FNA and 95.2% for US-CNB/FNA ( P = 0.001). Biopsy under EUS guidance [odds ratio (OR) = 1.808, 95% confidence interval (CI): 1.083-3.019; P = 0.024], lesion size < 2 cm (OR = 2.069, 95% CI: 1.145-3.737; P = 0.016), hypoechoic appearance (OR = 0.274, 95% CI: 0.097-0.775; P = 0.015) and non-pancreatic ductal adenocarcinoma carcinoma (PDAC) diagnosis (OR = 2.637, 95% CI: 1.563-4.449; P < 0.001) were identified as factors associated with inconclusive pathological biopsy. Hypoechoic appearance (OR = 0.236, 95% CI: 0.064-0.869; P = 0.030), lesions in the uncinate process of the pancreas (OR = 3.506, 95% CI: 1.831-6.713; P < 0.001) and non-PDAC diagnosis (OR = 2.622, 95% CI: 1.278-5.377; P = 0.009) were independent predictors for repeat biopsy. Biopsy under EUS guidance (OR = 2.024, 95% CI: 1.195-3.429; P = 0.009), lesions in the uncinate process of the pancreas (OR = 1.776, 95% CI: 1.014-3.108; P = 0.044) and hypoechoic appearance (OR = 0.127, 95% CI: 0.047-0.347; P < 0.001) were associated with diagnostic accuracy. Conclusions: Both percutaneous US- and EUS-guided biopsies of solid pancreatic lesions are safe and effective; though the diagnostic accuracy of EUS-FNA is inferior to US-CNB/FNA. A tailored pancreatic biopsy should be considered a part of the management algorithm for the diagnosis of solid pancreatic disease.