Anatomic bifurcated reconstruction of chronic bilateral innominate-superior vena cava occlusion using the Y-stenting technique

This article presents the case of a 42-year-old man who presented with superior vena cava (SVC) syndrome due to fibrosing mediastinitis with multiple failed attempts at recanalization. We initially treated him with unilateral sharp needle recanalization of the right innominate vein into the SVC stump followed by stenting. Although his symptoms improved immediately, they did not completely resolve. Six months later, he returned with worsening symptoms, and venography revealed in-stent restenosis. The patient requested simultaneous treatment on the left side. The right stent was dilated, and a 3-cm-long occlusion of the left innominate vein was recanalized, again using sharp needle technique, homing into the struts of the right-sided stent. Following fenestration of the stent, a second stent was deployed from the left side into the SVC, and the two Y limbs were sequentially dilated to allow a true bifurcation anatomy (figure). The patient had complete resolution of his symptoms and continues to do well 6 months later.     

11例1型发作性睡病睡眠结构的多导睡眠图分析

目的 探讨1型发作性睡病夜间睡眠的结构特点。 方法 收集1型发作性睡病患者11例和有日间嗜睡但排除相关睡眠疾病的儿童20例。使用多导睡眠监测仪进行整夜(>7 h)连续包括16导脑电图的视频多导睡眠监测(PSG),并于次日进行5次多次小睡潜伏期试验(MSLT)。 结果 与对照组比较,1型发作性睡病组在入睡后觉醒时间占总卧床时间的百分比(WASO%)、非快速眼球运动(NREM)1期睡眠期比例(N1%)增加[17.60(13.10)vs 5.00(12.80),P<0.05;(19.93±12.00)vs(10.12±5.63),P<0.05],入睡潜伏期、快速眼球运动(REM)睡眠潜伏期缩短[5.50 min(11.50 min)vs 13.50 min(22.87 min),P<0.05;(93.50±106.61)min vs(157.47±65.74)min,P<0.05],NREM 3期睡眠期比例(N3%)减少[(17.50±5.60)vs(24.48±7.60),P<0.05]; 但睡眠效率、NREM 2期睡眠期比例(N2%)、REM睡眠期比例(R%)、醒觉指数、睡眠期周期性腿动指数、睡眠呼吸暂停/低通气指数等差别无统计学意义。 结论 1型发作性睡病患者存在夜间睡眠结构紊乱、睡眠片段化现象。     

国内麻醉科医师应用二氧化碳吸收剂的现状调查

目的 调查国内麻醉科医师应用二氧化碳(CO2)吸收剂的现状,为统一CO2吸收剂更换的指标、限值和流程提供参考.方法 采用自主设计调查问卷开展网络问卷调查,主要内容包括麻醉科医师的基本情况、对CO2吸收剂应用理论的理解和CO2吸收剂临床应用的现状.结果 本次调查发放并回收有效问卷475份,其中49.9％来自华南地区,其他...     

深部经颅磁刺激对抑郁症患者大脑自发神经活动的影响

目的 探讨深部经颅磁刺激（dTMS）对抑郁症患者大脑自发神经活动的影响。方法 选取2022 年 9 月— 2024 年 1 月于河北医科大学第一医院精神卫生中心门诊或住院治疗的 17 例抑郁症患者为研究组,选取 2021 年 9 月— 2023 年 8 月于河北医科大学第一医院健康体检中心体检的 10 名健康者为对照组。研究组使用 dTMS 刺激左侧背外侧前额叶皮质,频率为 18 Hz,刺激强度为静息运动阈值的 120%;每周治疗 5 次,连续治疗 2 周,共计 10 次。收集受试者一般资料。采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）评估研究组患者治疗前后的抑郁及焦虑情况,并采集受试者头颅静息态功能核磁共振（rs-fMRI）图像。使用分数低频振幅（fALFF）评估研究组患者治疗前后及研究组治疗前与对照组的大脑自发神经活动变化。采用t检验或非参数检验评估研究组治疗前后的大脑自发神经活动变化,并采用 Pearson 相关分析临床症状与脑区自发神经活动的相关性。结果 最终纳入研究组 16 例,对照组10名。研究组治疗后的HAMA总分、HAMD总分及各因子评分均低于治疗前,差异有统计学意义（P＜0.05）。研究组治疗前的右中央旁小叶 fALFF 值低于对照组,差异有统计学意义（t=5.36,P＜ 0.05）。研究组经 dTMS 治疗后的左侧额中回、右内侧额上回 fALFF 值降低,右侧舌回、左侧舌回、右侧枕中回、右中央旁小叶 fALFF 值升高,差异均有统计学意义（t=12.36、16.01、-11.07、-10.81、-10.19、-14.14,P＜0.05）。Pearson相关分析显示,治疗前的左侧舌回fALFF值与HAMA总分（r=-0.89,P=0.017）、焦虑/躯体因子得分（r=-0.96,P=0.002）呈负相关,治疗后左侧额中回 fAFLL 值下降与迟滞因子得分下降呈正相关（r=0.88,P=0.021）。结论 抑郁症患者的额叶、舌叶和枕叶存在异常的自发神经活动,dTMS 治疗后自发神经活动的平衡与抑郁焦虑和迟滞症状的改善有关。     

童年期创伤与静息态血压、心率及心血管疾病的相关性研究进展

童年期创伤与静息态血压及心率存在着一定的关联性,是预测心血管疾病的重要风险因素。本文通过总结童年期创伤与静息态血压、心率和心血管疾病之间的相关性以及童年期创伤影响静息态血压、心率及心血管疾病的潜在机制,包括表观遗传学、神经内分泌、氧化应激、炎性反应、不良生活方式、心理应激等,明确童年期创伤对心血管系统的潜在影响,旨在为早期防治心血管疾病提供理论依据。     

Dual energy subtraction and temporal subtraction chest radiography

Digital radiography and display systems have revolutionized radiologic practice in recent years and have enabled clinical application of advanced image processing techniques. These include dual energy subtraction and temporal subtraction, both of which can improve diagnostic accuracy for abnormal findings in chest radiographs, especially for subtle lesions such as early lung cancer or focal pneumonia. Dual energy radiography exploits the differential attenuation of low-energy x-ray photons by calcium to produce separate images on the bones and soft tissues, which provides improved detection and characterization of both calcified and noncalcified lung lesions. Dual energy subtraction radiography is currently available from 2 of the major vendors and is in clinical use at many institutions in the United States. Temporal subtraction is a complementary technique that enhances interval change, by using a previous radiograph as a subtraction mask, so that unchanged normal anatomy is suppressed, whereas new abnormalities are enhanced. Though it is not yet a product in the United States, temporal subtraction is available for clinical use in Japan. Temporal subtraction can be combined with energy subtraction to reduce misregistration artifacts, and also has potential to improve computer-aided detection of nodules and other types of lung disease.     

Optimized Cholesterol-siRNA Chemistry Improves Productive Loading onto Extracellular Vesicles

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