经股动脉脑血管造影术后改良下肢制动时间的临床观察

目的：探讨经股动脉行脑血管造影术后改良下肢制动时间的可行性和安全性。 方法：前瞻性收集河南省人民医院脑血管五病区2019年3月1日到2019年5月20日收治的100例经股动脉行脑血管造影患者,并对其术后下肢制动时间进行改良：下肢制动4 h后去除绷带,床上活动穿刺侧下肢2 h后可下床活动。观察的主要安全性指标是下肢活动后出现的皮下血肿、假性动脉瘤、动静脉瘘,次要安全性指标有穿刺点渗血、下肢深静脉血栓形成。 结果：所有患者活动后均未出现迟发的皮下血肿、假性动脉瘤、动静脉瘘。其他不良事件有：1例患者卧床制动2 h后弹力绷带松开,发现穿刺侧皮下淤血,但皮软、无硬结,考虑穿刺时皮下血肿扩散,给予继续弹力绷带加压包扎2 h后下床活动血肿无增大,24 h内超声未见假性动脉瘤;1例患者卧床制动4 h去除绷带后穿刺点少量渗血,无血肿,继续给予加压包扎4 h后下床活动,无渗血及血肿形成;1例术后常规超声发现皮下小血肿,但无肉眼可见血肿。所有患者24 h内下肢静脉超声未发现深静脉血栓。 结论：经股动脉脑血管造影术后下肢制动4 h,术后6 h下床活动是安全可行的,但仍需大宗病例的对照研究加以验证。     

A prospective trial of stereotactic body radiation therapy for unresectable pancreatic cancer testing ablative doses

BackgroundWe explored the safety and efficacy of ablative doses of stereotactic body radiation therapy (SBRT) for unresectable pancreatic cancer.MethodsThis phase I/II trial included patients with unresectable pancreatic cancer previously treated with any number of cycles of induction chemotherapy. Patients were enrolled according to a 3+3 dose escalation design at 10, 12.5, and 15 Gy ×3, with subsequent patients at the maximally tolerated dose (MTD). Treatment was delivered to gross tumor delineated with MRI fusion using image-guidance to fiducial markers. Dose-limiting toxicity (DLT) was defined as grade 3+ toxicity within 30 days. Secondary endpoints included late gastrointestinal (GI) toxicity, freedom from local failure (FFLF), and survival.ResultsFifteen patients received a median 10 cycles of chemotherapy. There were no DLTs, and the MTD was 15 Gy ×3. Thirty-day toxicity included grade 2 nausea (46%) and grade 2 diarrhea (7%). Median survival after SBRT was 12.8 months (23 months after diagnosis) and median relapse-free survival was 7 months. At 1-year, FFLF was 80%. Four patients had grade 3+ GI bleeding after 30 days (median 6 months). Grade 3+ GI bleeding was associated with tumor volume (P=0.01), heterogeneity of dose within the planning target volume (PTV) (V120, P=0.03), and duodenal dose (V26–30 Gy, P<0.2).ConclusionsThis aggressive SBRT regimen demonstrated limited 30-day morbidity, a moderate degree of local control, and a moderate risk for late GI bleeding. Further work is necessary to define the most appropriate hypofractionated radiation therapy (RT) regimen in the ablative dose range.     

Rank-Adaptive Non-Negative Matrix Factorization

Dimension reduction is a challenge task in data processing, especially in high-dimensional data processing area. Non-negative matrix factorization (NMF), as a classical dimension reduction method, has a contribution to the parts-based representation for the characteristics of non-negative constraints in the NMF algorithm. In this paper, the NMF algorithm is introduced to extract local features for dimension reduction. Considering the problem of which NMF is required to define the number of the decomposition rank manually, we proposed a rank-adaptive NMF algorithm, in which the affinity propagation (AP) clustering algorithm is introduced to determine adaptively the number of the decomposition rank of NMF. Then, the rank-adaptive NMF algorithm is used to extract features for the original image. After that, a low-dimensional representation of the original image is obtained through the projection from the original images to the feature space. Finally, we used extreme learning machine (ELM) and k-nearest neighbor (KNN) as the classifier to classify those low-dimensional feature representations. The experimental results demonstrate that the decomposition rank determined by the AP clustering algorithm can reflect the characteristics of the original data. When it is combined with the classification algorithm ELM or KNN and applied to handwritten character recognition, the proposed method not only reduces the dimension of original images but also performs well in terms of classification accuracy and time consumption. A new rank-adaptive NMF algorithm is proposed based on the AP clustering algorithm and the original NMF algorithm. According to this algorithm, the low-dimensional representation of the original data can be obtained without any prior knowledge. In addition, the proposed rank-adaptive NMF algorithm combined with the ELM and KNN classification algorithms performs well.     

低温射频消融治疗儿童阻塞性睡眠呼吸暂停低通气综合征

目的 探讨低温射频消融双侧扁桃体对儿童阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）的治疗作用. 方法 2003年1月～2006年1月,30例经多导睡眠监测（polysomnography,PSG）证实的儿童OSAHS,年龄3～10岁,平均5.8岁,均行双侧扁桃体低温等离子刀消融术,对21例合并腺样体肥大者同时行腺样体刮除术,其中3例合并分泌性中耳炎行鼓膜穿刺抽液. 结果 术后6个月睡眠打鼾、张口呼吸症状消失,双侧扁桃体Ⅰ～Ⅱ度,咽腔无狭窄,听力恢复正常.20例术后1年PSG示治愈10例,显效8例,有效2例. 结论 低温射频等离子扁桃体消融术治疗儿童OSAHS是有效而且安全的.     

苯丁酸钠对BT325细胞的生长抑制和分化诱导

目的研究非毒性分化诱导剂苯了酸钠（phenylbutyrate，NaPB）在体外对人脑胶质细胞瘤BT325细胞的生长、分化的影响。方法应用形态学观察法、MTT分析法、流式细胞仪对在体外经不同浓度的NaPB处理过的BT325细胞进行检测。结果1．电子显微镜观察，在NaPB处理过的BT325细胞中，线粒体、内质网、弹力丝丰富，而在NaPB未处理的细胞中，有大量游离核糖体，上述细胞结构却未能观察到；2．NaPB在2mM时就能明显抑制BT325细胞的生长．并且有时间依赖关系及剂量依赖关系；3．应用流式细胞仪测定发现，经NaPB处理的细胞其S期在11．99％或13．17％．而未经处理的细胞其S期在20．17％。结论NaPB在体外不仅能够抑制人脑胶质细胞瘤的生长，而且能诱导细胞的分化，为NaPB分化治疗胶质瘤提供了实验依据。     

后路经皮椎弓根螺钉撑开复位固定联合斜外侧入路椎间融合术治疗腰椎滑脱症的疗效分析

【摘要】 目的：探讨后路经皮椎弓根螺钉撑开复位固定联合斜外侧入路椎间融合术（oblique lateral interbody fusion,OLIF）治疗腰椎滑脱症的疗效。方法：回顾性分析2018年9月~2021年1月我院采用后路经皮椎弓根螺钉撑开复位固定技术联合OLIF治疗的30例腰椎滑脱症患者,其中男9例、女21例;年龄44～76岁（61.5±7.4岁）,随访时间13.3±5.1个月（8~26个月）。记录手术时间、术中出血量、术后并发症,比较术前、术后1周、术后3、6、12个月和末次随访时的腰腿痛VAS评分、Oswestry功能障碍指数（Oswestry disability index,ODI）及健康调查简表（the MOS 36-item short-form health survey,SF-36）评分;于术前、术后1周、术后6个月及末次随访时在X线片上测量手术节段椎间孔高度（foramen height,FH）、椎间隙高度（disc height,DH）、滑移百分比（slipping percentage,SP）、节段前凸角（segmental lordosis,SL）、腰椎前凸角（lumbar lordosis,LL）,通过MRI测量硬膜囊轴向直径及横截面积,通过CT评估椎间融合情况。结果：所有患者手术顺利,手术时间105．0±20．8min,术中出血量55．8±20．6ml。术中节段血管损伤出血1例,应用双极电凝及明胶海绵压迫止血成功。术后出现短暂的腰大肌无力3例;单侧大腿外侧疼痛、感觉减退4例,保守治疗,术后1个月随访时症状均已完全消失。术中未出现终板、腹膜及输尿管损伤情况,术后无下肢运动障碍、无感染及融合器下沉移位等并发症。术后1周、术后3、6、12个月及末次随访时腰腿痛VAS评分、ODI及SF-36评分均较术前显著性改善,差异有统计学意义（P<0．05）,术后各时间点随访比较差异均无统计学意义（P>0．05）。术后1周、6个月及末次随访时手术节段FH、DH、SP、SL、LL、硬膜囊轴向直径及横截面积均较术前显著性改善,差异有统计学意义（P<0．05）,术后各时间点随访比较差异均无统计学意义（P>0．05）。术后6个月至末次随访时所有患者椎间均骨融合。结论：后路经皮椎弓根螺钉撑开复位固定联合OLIF治疗腰椎滑脱症的临床疗效满意,椎体滑脱复位确切,有效矫正腰椎前凸及节段前凸,椎间融合率高,椎管间接减压效果满意,是治疗腰椎滑脱症安全、有效的术式。     

克罗恩病并发肠膀胱瘘患者的临床特征及长期预后研究

目的描述克罗恩病(Crohn’s disease,CD)并发肠膀胱瘘患者的临床特征及长期预后,并评估英夫利西单抗(Infliximab,IFX)的疗效。方法纳入2002年1月至2021年1月在北京协和医院收入院的CD并发肠膀胱瘘患者15例。通过门诊访谈或电话随访,了解患者的症状改善、瘘管愈合及腹部手术情况。结果15例患者均为男性。诊断肠膀胱瘘的年龄为(34±13)岁。主要临床症状包括气尿、粪尿(86.7%)及膀胱刺激症状(60.0%)。肠膀胱瘘最常发生于回肠(66.7%),其次是乙状结肠(26.7%)和空肠(6.7%)。除肠膀胱瘘外,11例(73.3%)患者合并其他类型肠瘘。患者中位随访时间为60(20,93)个月。7例(46.7%)患者最终进行手术,2例(13.3%)患者死亡。2例患者(13.3%)经药物治疗达到完全缓解。在接受IFX治疗的6例患者中,4例(66.7%)最终接受了手术。统计分析发现,是否使用IFX并不影响患者的无手术生存率。结论CD并发肠膀胱瘘患者的长期预后欠佳,仍以手术治疗为主,IFX治疗的确切疗效仍待进一步研究。     

射频消融术治疗肝癌的临床疗效与并发症观察

目的 观察与分析经皮射频消融术(RFA)治疗原发性肝癌的临床疗效和并发症.方法 从2000年1月～2007年6月,B超引导下对256例原发性肝癌患者行354例次RFA,治疗前后行AFP、B超或CT检查,治疗后随访,最长随访5年以上.结果 2例治疗后24h内出现严重并发症而死亡.RFA术后并发症有:感染、发热223例次(62.99%),肝细胞明显损害117例次(33.05%),黄疸明显加重67例次(18.92%),血性腹水14例次(3.95%),气胸3例次(0.84%),消化道出血2例次(0.56%).治疗后随访到6月者187例,AFP下降50%者129例(68.98%),死亡23例,存活164例(87.70%).随访1年者129例,AFP下降50%者67例(51.93%),死亡37例,存活92例(71.3l%).随访3年者83例,AFP下降50%者28例(37.73%),死亡5l例,存活32例(38.55%).随访5年者56例,AFP下降50%者12例(21.42%),死亡44例.存活12例(21.42%).肝脏肿瘤个数少和病灶体积小或者肝功Child-Pugh分级较好的患者生存率高.结论 RFA具有简单、微创、安全、有效和反复治疗等优点.尤其对于无手术指征及TACE风险较大者,具有更重要的意义.当肿瘤<5 cm尤其是单个病灶或肝功Child-Pugh分级较好时效果更加明显.但并发症较多,长期疗效有待提高.     

鸦胆子油乳联合含铂类一线化疗方案治疗非小细胞肺癌的Meta分析

目的:该研究旨在评价鸦胆子油乳(brucea javanica oil emulsion,BJOE)联合含铂类一线化疗药物治疗非小细胞肺癌(non-small cell lung cancer,NSCLC)的疗效和安全性。方法:计算机检索Cochrane Library,PubMed,EMBASE,中国生物医学文献数据库,中国期刊全文数据库,中文科技期刊全文数据库,检索时间截止2011年2月,纳入有关鸦胆子油乳联合含铂类一线化疗药物治疗NSCLC的随机对照试验(randomized controlled trials,RCTs),由2名研究员分别独立提取数据和进行文献质量评价,并用RevMan5.1.2软件进行Meta分析。结果:共纳入22篇RCTs,共计病例数为1 512例。Meta分析结果显示,与单纯运用含铂类一线化疗方案相比,联合鸦胆子油乳能明显增加NSCLC患者化疗效果(RR=1.31,95%CI:1.18～1.45,P<0.000 01),提高生活质量(RR=1.78,95%CI:1.51～2.09,P<0.000 01),增强机体免疫力,降低骨髓抑制(OR=0.37,95%CI:0.27～0.51,P<0.000 01)和消化道毒副反应(OR=0.59,95%CI:0.44～0.80,P=0.000 7)。结论:鸦胆子油乳能提高非小细胞肺癌患者的化疗效果,改善生活质量,并降低含铂类化疗药物的毒副作用,值得临床借鉴。