New method of thrombus preparation using a fluid model for evaluation of thrombectomy devices in a swine model

Background

Mechanical thrombectomy is a promising new modality of interventional stroke treatment. Preparation of thrombus is a very important step for the evaluation of the mechanical thrombectomy devices. The objective of this study was to explore a new method of thrombus preparation with fluid model (FM) for assessment of thrombectomy devices used in the recanalization of acute ischemic stroke.

Methods

Elongation test and catheter injection test were used to evaluate the mechanical properties of thrombi prepared by FM and static model (SM). Histological structures of two artificial clots and specimens of stroke patients were compared. Radiopacity of thrombus made by FM was evaluated in a swine embolization model.

Results

The maximum tensile length of thrombi prepared by FM and SM were significantly higher (4.28 ± 0.23 cm vs 3.16 ± 0.13 cm, P < 0.01) and showed less breakage on catheter injection test (13% vs 60%, P < 0.05). Histological features of thrombi prepared by FM showed mixed thrombus structure, similar to thromboemboli retrieved from acute stroke patients, while clots generated by SM were replete with erythrocytes. A total of twelve vessels in two swine were successfully occluded (TIMI 0 or 1), with sufficient radiopacity of each injected thrombus.

Conclusion

The thrombus prepared by FM had good mechanical stability, sufficient radiopacity, and similar histological structure of thromboemboli retrieved from stroke patients, which make it possible to be used in the evaluation of thrombectomy devices.     

多普勒超声测定左心室Max（dp／dt）的新方法

心室内压力变化率峰值Ｍａｘ（ｄｐ／ｄｔ）是一项评价心肌收缩功能的重要指标。但其测定常需借助于心导管术，临床应用受到限制。依据流体力学基本定律，本文提出：等容收缩期内表现为压力的势能将在射血期部分地转化为以１／２ｐＶ２为形式的动能，因而势能的最大变化率Ｍａｘ（ｄｐ／ｄｔ）将在动能的最大变化率Ｍａｘ（ｄｋ／ｄｔ）上得到反映。应用特制计算机软件将主动脉血流速度曲线转化为４Ｖ２曲线，该曲线的一级导数峰值即为Ｍａｘ（ｄｋ／ｄｔ）。应用脉冲多普勒超声测定２３例先天性心脏病患儿的主动脉血流频谱参数并与心导管测定的左心室Ｍａｘ（ｄｐ／ｄｔ）进行对比分析。结果显示：主动脉血流频谱参数Ｍａｘ（ｄｋ／ｄｔ）与左心室Ｍａｘ（ｄｐ／ｄｔ）呈良好相关（ｒ＝０．８１７，Ｐ＜０．００１），直线回归方程为：Ｍａｘ（ｄｐ／ｄｔ）＝０．４７Ｍａｘ（ｄｋ／ｄｔ）＋６７．９（Ｋｐａ／ｓ），平均加速度ｍＡ及Ｖｐ２／ＡＴ与Ｍａｘ（ｄｐ／ｄｔ）亦有较好的相关性。表明由多普勒超声获得的主动脉血流频谱参数Ｍａｘ（ｄｋ／ｄｔ）能较准确地估侧左室Ｍａｘ（ｄｐ／ｄｔ），因而可作为评价心脏收缩功能的可靠指标     

Oncogenic AKAP9-BRAF fusion is a novel mechanism of MAPK pathway activation in thyroid cancer

Genes crucial for cancer development can be mutated via various mechanisms, which may reflect the nature of the mutagen. In thyroid papillary carcinomas, mutations of genes coding for effectors along the MAPK pathway are central for transformation. BRAF point mutation is most common in sporadic tumors. By contrast, radiation-induced tumors are associated with paracentric inversions activating the receptor tyrosine kinases RET and NTRK1. We report here a rearrangement of BRAF via paracentric inversion of chromosome 7q resulting in an in-frame fusion between exons 1-8 of the AKAP9 gene and exons 9-18 of BRAF. The fusion protein contains the protein kinase domain and lacks the autoinhibitory N-terminal portion of BRAF. It has elevated kinase activity and transforms NIH3T3 cells, which provides evidence, for the first time to our knowledge, of in vivo activation of an intracellular effector along the MAPK pathway by recombination. The AKAP9-BRAF fusion was preferentially found in radiation-induced papillary carcinomas developing after a short latency, whereas BRAF point mutations were absent in this group. These data indicate that in thyroid cancer, radiation activates components of the MAPK pathway primarily through chromosomal paracentric inversions, whereas in sporadic forms of the disease, effectors along the same pathway are activated predominantly by point mutations.     

Efficacy of celecoxib for pain management after arthroscopic surgery of hip: a prospective randomized placebo-controlled study

The present work was conducted to examine whether celecoxib, a selective COX-2 inhibitor, 200 mg administered 1 h preoperatively to patients undergoing arthroscopic hip surgery reduces postoperative pain. Fifty-three patients undergoing arthroscopic hip surgery under spinal anesthesia were randomized to receive either 200 mg of celecoxib (Group I) or 200 mg of placebo (Group II) 1 h preoperatively. Narcotic use was monitored for 24 h, and time in recovery room was determined. Visual analog scale (VAS) scores and Short-Form 12 (SF-12), including a physical composite score (PCS) and a mental composite score (MCS), documented pain in recovery, 12 h postoperatively, and 24 h postoperatively. Moreover, time in recovery room was also investigated. We enrolled 27 patients in Group I and 26 patients in Group II. Groups were comparable for patient characteristics. No significant difference was detected in terms of VAS scores and SF-12 in recovery room. Statistically, patients in Group I showed significantly lower pain VAS scores at 12 and 24 h postoperatively. Patients taking celecoxib had significantly higher PCS at 12 and 24 h postoperatively. No difference occurred between groups for the MCS. Patients taking celecoxib also showed a significant reduction in postoperative narcotic consumption. The obtained results from the current study indicate that patients who took celecoxib 200 mg 1 h before arthroscopic hip surgery had a less painful and more rapid recovery. Celecoxib 200 mg as a single preoperative dose could be considered as part of a perioperative analgesic plan in arthroscopic hip surgery.     

胆管癌组织中信号转导及转录激活因子3信号通路相关基因的表达与意义

目的 探讨胆管癌组织中信号转导及转录激活因子3（STAT3）信号通路相关基因Survivin及环氧化酶2（COX-2）的表达及其与胆管癌患者临床病理特征和预后的关系.方法 收集2007年9月至2012年7月安徽医科大学附属省立医院收治的43例胆管癌患者的癌组织标本,收集同期行胆肠内引流术和胆管修复的12例肝内外胆管结石和胆管损伤患者的正常胆管组织标本作为对照.应用免疫组织化学染色检测胆管癌及正常胆管组织中STAT3、磷酸化STAT3（p-STAT3）、Survivin及COX-2蛋白的表达,并分析其与胆管癌患者临床病理特征和预后的关系.采用门诊或电话方式对胆管癌患者进行随访,随访时间截至2014年3月.计数资料采用x2检验,相关性分析采用Spearman检验.采用Kaplan-Meier法绘制生存曲线,生存分析采用Log-rank检验.结果 STAT3、p-STAT3、Survivin、COX-2蛋白在胆管癌组织中阳性表达率分别为69.8％ （30/43）、65.1％（28/43）、72.1％ （31/43）、79.1％（34/43）,在正常胆管组织中阳性表达率分别为41.7％（5/12）、8.3％（1/12）、16.7％（2/12）、41.7％（5/12）.p-STAT3、Survivin、COX-2蛋白在胆管癌组织中的阳性表达率显著高于正常胆管组织,两组比较,差异有统计学意义（x2=12.136,9.811,4.679,P＜0.05）.p-STAT3、Survivin、COX-2蛋白在胆管癌组织中的高表达与肿瘤局部浸润转移有关（x2=14.700,5.959,4.075,P＜0.05）;p-STAT3蛋白阳性表达与肿瘤神经侵犯有关（x2=10.384,P＜0.05）;Survivin、COX-2蛋白表达与胆管癌患者肿瘤神经侵犯无关（x2=2.718,3.024,P＞0.05）;p-STAT3、Survivin、COX-2蛋白表达与胆管癌患者性别、年龄、肿瘤位置、分化程度、肿瘤直径无关（x2=0.148,0.720,1.835,1.040,0.236;0.001,0.009,0.029,1.863,0.197;0.433,0.686,0.002,2.974,0.029,P＞0.05）.Survivin及COX-2蛋白的表达与p-STAT3呈正相关（r=0.524,0.583,P＜0.05）.43例胆管癌患者获得随访,随访时间为6个     

胸主动脉夹层相关的危险因素认识现状

胸主动脉夹层是一种病情变化快的灾难性疾病,其特点是发病急、病情复杂、急诊诊断困难、进展迅速、误诊率高、病死率高、易引起医疗纠纷.即便如此,形成胸主动脉夹层详细的原因还不明确,许多危险因素与胸主动脉夹层的发生有关,包括高血压、性别(男性)、主动脉的正常老化、吸食毒品、动脉粥样硬化、遗传性疾病和炎性疾病等.