Application of the Willis covered stent in the treatment of internal carotid artery blood blister-like aneurysms

The optimal treatment for blood blister-like aneurysm (BBA) has not yet been determined, and BBA has a high recurrence rate after stent-assisted embolization. The purpose of the present study was to evaluate the safety and feasibility of patients with BBA rupture in the acute phase or patients with BBA who have recurrence after stent-assisted coil embolization. Eight patients (8 women, mean age 50.3?±?3.7 years) who presented with ruptured BBA or recurrence BBA that had been treated by stent-assisted embolization (5 patients after primary treatment of stent-assisted embolization) were retrospectively reviewed. Clinical follow-up was performed at 1 year after endovascular treatment. All patients were successfully treated with the WCS, and immediate postoperative angiography showed that the aneurysms were completely isolated. The ophthalmic artery was covered by WCS in one patient; however, this patient did not show any clinical visual field or vision symptoms. Procedure-related complications such as aneurysm rupture, vasospasm, acute thrombosis, or thromboembolism did not occur in any case. All patients were followed up for 1 year after endovascular treatment, and they were in good condition without recurrence. One patient developed delayed bleeding at the right temporal lobe. All patients had good clinical prognosis (modified Rankin Scale score?≤?2). WCS implantation may be a safe and feasible strategy for patients with BBA rupture in the acute phase and patients with BBA who have recurrence after stent-assisted coil embolization and is a promising option worth exploring.

     

机器人辅助微创三角固定治疗单侧不稳定性骶骨骨折

目的比较机器人辅助微创入路与传统切开入路三角固定治疗单侧不稳定性骶骨骨折的临床疗效。方法回顾性分析2014年8月至2018年2月收治并获得完整随访的24例单侧不稳定性骶骨骨折患者资料。所有患者均合并骨盆前环损伤,均为AO C1.3型骨盆骨折,术前均接受神经核磁检查明确腰骶神经未被骨折断端或骨块卡压;骨盆损伤均一期采用前后联合固定,骶骨骨折采用三角固定。根据不同手术方法分为机器人辅助微创入路组[简称机器人组,12例,男10例,女2例;年龄(36.3±1.2)岁(范围,22~56岁);Dennis骶骨骨折分型,Ⅰ型4例,Ⅱ型8例;神经损伤2例,Gibbons分级Ⅱ级1例,Ⅲ级1例]和传统后正中切开入路组[简称切开组,12例,男11例,女1例;年龄(38.2±1.6)岁(范围,19~58岁);Dennis骶骨骨折分型,Ⅰ型3例,Ⅱ型9例;神经损伤3例,Gibbons分级Ⅱ级2例,Ⅲ级1例]。比较两组患者的手术时间、术中出血量、术中透视时间、骨折愈合时间及Majeed功能评分采用t检验,Mears和Velyvis评价、内固定置入准确度、骨折愈合率采用卡方检验,术后感染率采用Fisher精确检验,Gibbons分级变化采用秩和检验。结果所有患者均获得随访,随访时间(21.2±3.2)个月(范围,14~36个月)。手术时间,机器人组为(100.3±14.5)min,切开组为(202.0±18.5)min;术中出血量,机器人组为(180.0±17.4)ml,切开组为(850.0±15.2)ml;术中透视时间,机器人组为(23.3±4.5)s(包括切开前机器人扫描定位图像时间);切开组为(90.0±7.7)s。Mears和Velyvis评价,机器人组解剖复位7例,满意4例,不满意1例;切开组解剖复位7例,满意4例,不满意1例;两组复位满意率均为91.7%(11/12)。两组均置入36枚螺钉,其中机器人组螺钉置入准确率100%,切开组螺钉置入准确率为77.78%(28/36)。两组骶骨骨折均愈合,愈合率100%;愈合时间,机器人组(8.5±1.9)个月,切开组(12.8±2.4)个月。Majeed评分,机器人组(86.2±3.4)分,其中优7例,良4例,可1例;切开组(84.2±2.7)分,其中优6例,良4例,可2例。机器人组术后均未出现伤口感染,切开组术后出现1例伤口深部感染,2例表浅感染,感染率为25%。Gibbons分级,机器人组1例由术前Ⅱ级恢复至术后Ⅰ级,1例Ⅲ级恢复至术后Ⅱ级;切开组2例由术前Ⅱ级恢复至术后Ⅰ级,1例Ⅲ级恢复至术后Ⅱ级。机器人组与切开组患者Gibbons分级变化、Mears和Velyvis评价、骨折愈合率、Majeed评分及术后伤口感染率无统计学差异(均P>0.05);而在手术时间(t=14.99)、术中透视时间(t=32.13)、术中出血量(t=100.46)、内固定置入准确率(χ2=9.00)及骨折愈合时间(t=4.87)方面,机器人组均优于切开组,两组比较差异均有统计学意义(均P<0.05)。结论机器人辅助微创入路三角固定与传统切开固定相比,具有手术时间短、透视少、出血量小、内固定置入更为准确及骨折愈合时间短等优点,可作为治疗单侧不稳定性骶骨骨折的更优选择。     

七氟烷通过影响神经元能量代谢和氧化应激水平促进神经元凋亡

目的研究吸入性麻醉药七氟烷对发育期神经元的凋亡作用,并探究七氟烷对原代神经元线粒体功能的影响。方法体外培养原代神经元,并随机分为对照组和实验组,实验组用4.1%七氟烷处理6 h,western blot检测Cleaved caspase-3凋亡蛋白的变化,流式细胞术检测神经元的凋亡率,DCFH-DA法检测细胞中ROS含量的变化,并检测ATP水平的变化。结果与对照组相比,七氟烷组的凋亡蛋白Cleaved caspase-3上调(P<0.01),凋亡率增加(P<0.05),ROS生成增加(P<0.05)同时ATP生成减少(P<0.05)。结论七氟烷可以诱导原代神经元的凋亡,其作用机制可能是通过线粒体能量代谢和氧化应激水平改变引起。     

碘化钾制备的碘涂层钛板的抗菌性能研究

目的探讨利用碘化钾制备碘涂层钛板的可行性,并验证其抗菌性能。方法以碘化钾作为电解液,使用电泳沉积法将碘负载到钛板表面,制备出碘涂层钛板。通过扫描电镜与能谱分析,观察碘涂层钛板的表面征象和成分结构。实验分组:对照组是经过预处理但未行载碘的钛板,共10块;实验组是经过预处理后再行载碘的碘涂层钛板,根据电解液浓度的不同分为3组:1000 mg/L、2000 mg/L、4000 mg/L组,每组各10块。使用1×106 CFU/mL的金黄色葡萄球菌(ATCC25923)进行体外抗菌实验,并对其抗菌性能进行研究。结果碘涂层钛板外观呈灰色,表面可均匀覆盖一层平整、无塌陷的涂层,电镜下见其表面可形成碘涂层,局部散在分布大小不等的不规则陷凹。对照组、1000 mg/L组、2000 mg/L组、4000 mg/L组的钛板碘含量分别为0、5.10、10.32、15.05 mass%;其体外抗菌菌落计数分别为56.00±5.09、21.40±2.76、9.10±2.51和2.00±1.88,4组之间菌落计数比较差异均有统计学意义(P<0.05)。结论碘化钾作为电解液,使用电泳沉积法可成功制备出碘含量稳定、涂层分布均匀的碘涂层钛板。体外抗菌实验证明碘涂层钛板的抗菌性能强于未载碘钛板。     

微创McKeown食管切除术治疗食管下段癌的临床价值

目的探讨微创McKeown食管切除术治疗下段食管癌的临床价值。方法选取2013-01-2017-06间在郑州大学第一附属医院接受食管切除术的下段食管癌患者。将行微创McKeown手术的患者作为微创组,将行开放Sweet手术的患者作为开放组,倾向得分匹配(PSM)用于降低2组一般资料的统计学差异。比较2组患者的疗效。结果全部患者均顺利完成手术。2组患者的病死率、肺部并发症和吻合口漏发生率差异无统计学意义(P>0.05)。微创组淋巴结清扫数、平均住院费用和手术时间均多于开放组,差异均有统计学意义(P<0.05)。结论微创McKeown食管切除术治疗下段食管癌,较传统开放手术淋巴结清扫数多,但手术时间和治疗费用较多。     

Prediction model for malignant pulmonary nodules based on cfMeDIP-seq and machine learning

Cell-free methylated DNA immunoprecipitation and high-throughput sequencing (cfMeDIP-seq) is a new bisulfite-free technique, which can detect the whole-genome methylation of blood cell-free DNA (cfDNA). Using this technique, we identified differentially methylated regions (DMR) of cfDNA between lung tumors and normal controls. Based on the top 300 DMR, we built a random forest prediction model, which was able to distinguish malignant lung tumors from normal controls with high sensitivity and specificity of 91.0% and 93.3% (AUROC curve of 0.963). In summary, we reported a non–invasive prediction model that had good ability to distinguish malignant pulmonary nodules.     

Mediation analysis of racial disparities in triple-negative breast cancer incidence among postmenopausal women

Breast Cancer Research and Treatment - Triple-negative breast cancer (TNBC) is disproportionately higher in Black women relative to White women. The objective of this study was to examine to what...