胸主动脉腔内修复术采用裙边型烟囱支架（Longuette™）的PATENCY临床试验研究结果

背景与目的 烟囱技术是胸主动脉腔内修复术（TEVAR）中重建左锁骨下动脉（LSA）的方法,Ⅰa型内漏是其主要并发症。裙边型烟囱支架（Longuette?）专为烟囱技术设计,用于重建LSA时降低Ⅰa型内漏。为评估Longuette?烟囱支架联合TEVAR治疗累及LSA的Stanford B型主动脉夹层（TBAD）的疗效,笔者开展了前瞻性、多中心临床试验（PATENCY临床试验）。本研究总结PATENCY临床试验的1年结果和经验。方法 2018年10月—2022年3月,全国26家血管外科中心参与PATENCY临床试验,共纳入150例符合标准的TBAD患者。所有患者均在TEVAR术中采用Longuette?烟囱支架重建LSA。评估患者围手术期和术后12个月的临床效果和不良事件,并分析患者术后1年累积生存率、LSA通畅率和无内漏率。结果 患者年龄30~77岁,平均（54.48±11.12）岁,138例（92.0%）患者合并高血压病;急性、亚急性和慢性TBAD分别占74.7%,17.3%和8.0%。124例（82.7%）患者采用全身麻醉。手术成功率为99.33%（149/150）,手术时间（91.67±41.47）min,X线暴露时间（31.36±16.71）min,手术出血量为（71.55±60.40）mL。围手术期内漏发生率为5.33%（8/150）,包括Ⅰ型6例、Ⅱ型1例、Ⅳ型1例;1例（0.67%）患者发生Longuette?烟囱支架急性闭塞,再次实施腔内手术后恢复通畅;1例（0.67%）患者术后发生急性脑梗死;2例（1.33%）患者术后发生逆撕的Stanford A型主动脉夹层,其中1例术后3周死亡。术后30 d死亡2例（1.33%）。142例患者进行了密切随访,随访时间为11.67（5~16）个月。无主动脉支架和Longuette?烟囱支架移位。2例Ⅰ型内漏患者分别于术后6个月和1年进行了再次介入栓塞手术治疗,术后1年随访仍有6例患者有轻微的内漏持续存在,患者TBAD假腔保持稳定,无明显症状,均予以保守治疗。Longuette?烟囱支架内狭窄和闭塞分别发生1例和2例,逆撕的Stanford A型主动脉夹层患者1例,假腔增大,患者均无明显症状,予以保守治疗。无发生脑卒中、截瘫、左上肢缺血等并发症。术后12个月累积生存率、LSA通畅率、无内漏率分别为97.96%、97.96%和91.91%。结论 采用Longuette?烟囱支架在TBAD腔内治疗中重建LSA简便、安全、有效,其能够有效降低围手术期Ⅰa型内漏的发生率,为微创治疗主动脉弓部病变提供新的治疗方式。     

Malignant transformation of nevus sebaceous to basal-cell carcinoma: Case series,literature review,and management algorithm

Nevus sebaceous (NS) is a common congenital hamartoma of the skin composed predominantly of sebaceous glands. Although most NS are benign skin tumors, malignant transformations have been reported. There is still controversy about the lifetime risk of malignant degeneration and precise surgical criteria. This study reports cases of malignant degeneration and suggests a surgical treatment algorithm. The medical records of patients with basal-cell carcinoma (BCC) arising from NS between January 2001 and January 2021 were retrospectively reviewed. Patient demographics including lesion location, and tumor size were investigated. The symptoms, histological findings before and after excision, complications, and recurrence during 2-year follow-up periods were investigated. Ten patients were identified with BCC arising from NS lesions. All patients were female and the mean age was 52.11 years. All patients complained of sudden morphological changes, the most common type being rapid color changes. Two cases had histological findings that showed a miss-match between punch biopsy and excisional biopsy results. No recurrence was detected 2 years after surgeries in any patients. Cases after third stage, especially in over 40 years who report morphologic changes, should undergo total surgical excision as the first approach, with strong suspicion of malignant degeneration.     

Surgical approaches to correct corneal astigmatism at time of cataract surgery: a mini-review

Among refractive errors, astigmatism is the most common optical aberration, where refraction changes in different meridians of the eye. It causes blurred vision at any distance and includes corneal, lenticular, and retinal astigmatism. Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism, for example, a large size surgery incision. The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery. Nowadays, three surgical approaches can be used. By placing a sutureless clear corneal incision on the steep meridian of the cornea, a preoperative corneal astigmatism less than 1.0 D can be corrected. Single or paired peripheral corneal relaxing incisions (PCRIs) provide 1.0-3.0 D corneal astigmatism correction. PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism, if more than 2.0 D, the risk of overcorrection and irregular astigmatism is increased. When toric intraocular lenses (IOLs) are unavailable in markets, PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism. Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism. Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D. These approaches can be used alone or in combination.     

Early changes in corneal densitometry after FS-LASIK combined with accelerated corneal cross-linking for correction of high myopia

AIM: To observe the effects of femtosecond laser-assisted excimer laser in situ keratomileusis combined with accelerated corneal cross-linking (FS-LASIK Xtra) on corneal densitometry after correcting for high myopia. METHODS: In this prospectively study, 130 patients underwent FS-LASIK or FS-LASIK Xtra for high myopia. Their right eyes were selected for inclusion in the study, of which 65 cases of 65 eyes in the FS-LASIK group, 65 patients with 65 eyes in the FS-LASIK Xtra group. Patients were evaluated for corneal densitometry at 1, 3, and 6mo postoperatively using Pentacam Scheimpflug imaging. RESULTS: Preoperative differences in corneal densitometry between the FS-LASIK and FS-LASIK Xtra groups in different ranges were not statistically significant (P>0.05). Layer-by-layer analysis revealed statistically significant differences in the anterior (120 μm), central, and total layer corneal densitometry between the FS-LASIK and FS-LASIK Xtra groups at 1 and 3mo postoperatively (all P<0.05), the FS-LASIK Xtra group is higher than that of the FS-LASIK group. Analysis of different diameter ranges showed statistically significant differences between the FS-LASIK group and the FS-LASIK Xtra group at 1mo postoperatively in the ranges of 0–2, 2–6, and 6–10 mm (both P<0.05); At 3mo postoperatively, the FS-LASIK Xtra group is higher than that of the FS-LASIK group in the ranges of 0–2 and 2–6 mm (P<0.05). At 6mo postoperatively, there were no statistically significant differences in corneal densitometry between the FS-LASIK group and the FS-LASIK Xtra group in different diameter ranges (all P>0.05). CONCLUSION: There is an increase in internal corneal densitometry during the early postoperative period after FS-LASIK Xtra for correction of high myopia. However, the densitometry values decreased to the level of conventional FS-LASIK at 6mo after surgery, with the most significant changes observed in the superficial central zone.     

慢性乙型肝炎组织中肝前体细胞的免疫组化特征

目的研究肝前体细胞（hepatic progenitor cells,HPCs）、小管样反应、中间型肝细胞在慢性乙型肝炎组织中的分布特征和数量变化,以及与肝细胞再生之间的可能联系。方法对42例慢性乙型肝炎组织行常规病理HE染色,按炎症活动度（G）分为轻、中、重三度,免疫组织化学方法观察肝胆细胞标记（AFP、GST-π、CK7、CK19）和造血干细胞标记（c-kit、CD34）的表达,并以Ki-67标记增殖的肝细胞,用CK7／CK19作为标记物对符合定义的HPCs、中间型肝细胞进行计数,小管样反应程度的判定利用彩色病理图象分析系统。结果慢性乙型肝炎的早期阶段即存在HPCs的活化和小管样反应,其数量随着炎症活动度的增加而增加,均表达CK7、CK19、GST-π和AFP,肝细胞增殖指数在轻、中度肝炎中逐渐增加,重度肝炎、肝硬化患者增殖的肝细胞数下降,而中间型肝细胞数量显著增加。小管样反应面积百分比与HPCs数目正相关（r=0．739,P〈0．05）,中间型肝细胞数目与HPCs数目正相关（r=0．614,P〈0．05）。结论慢性乙型肝炎中不仅有成熟肝细胞增殖,也存在肝前体细胞活化和分化,可能参与肝脏损伤后的再生修复。     

Grape seed powder increases gastrointestinal motility

Grape seed is an important natural bioactive product with various health benefits. Interstitial cells of Cajal (ICCs) are pacemaker cells in the gastrointestinal (GI) tract. The present study investigated the effects of grape seed powder (GSP) on ICC properties and GI motility. GSP depolarized the pacemaker potentials of ICCs in a dose‑dependent manner. Y25130 or SB269970 slightly inhibited GSP‑induced effects. However, Y25130 and SB269970 together completely blocked GSP-induced effects. In the presence of inhibitors of protein kinase C, protein kinase A, or mitogen-activated protein kinase, GSP‑induced ICC depolarization was inhibited. GSP increased the intestinal transit rate in normal mice and in mice with acetic acid-induced GI motility disorder. In addition, the levels of motilin and substance P were elevated after GSP dosing. These results demonstrate that GSP can regulate GI motility, and therefore, it is a potential therapeutic agent for treating GI motility disorders.     

Structural and functional biomarkers of the insula subregions predict sex differences in aggression subscales

Aggression is a common and complex social behavior that is associated with violence and mental diseases. Although sex differences were observed in aggression, the neural mechanism for the effect of sex on aggression behaviors remains unclear, especially in specific subscales of aggression. In this study, we investigated the effects of sex on aggression subscales, gray matter volume (GMV), and functional connectivity (FC) of each insula subregion as well as the correlation of aggression subscales with GMV and FC. This study found that sex significantly influenced (a) physical aggression, anger, and hostility; (b) the GMV of all insula subregions; and (c) the FC of the dorsal agranular insula (dIa), dorsal dysgranular insula (dId), and ventral dysgranular and granular insula (vId_vIg). Additionally, mediation analysis revealed that the GMV of bilateral dIa mediates the association between sex and physical aggression, and left dId–left medial orbital superior frontal gyrus FC mediates the relationship between sex and anger. These findings revealed the neural mechanism underlying the sex differences in aggression subscales and the important role of the insula in aggression differences between males and females. This finding could potentially explain sexual dimorphism in neuropsychiatric disorders and improve dysregulated aggressive behavior.     

高效毛细管电泳法同时测定尿液清蛋白和肌酐

目的建立同时测定尿液清蛋白和肌酐的高效毛细管电泳法。方法对缓冲系统、pH值、缓冲液的离子强度、检测波长、表面活性剂、电压及电流和进样方法等进行研究,建立同时测定清蛋白和肌酐的毛细管电泳法。结果选择20mmol/L、pH9.3硼砂-NaOH(含6mmol/LSDS)缓冲液作为毛细管区带电泳运行液,利用外标法定量,检测波长214nm,同时测定肌酐和清蛋白。非涂层毛细管有效长度47.5cm,内径75μm;电流79μA,压力进样1psi、4s,电泳时间为12min。肌酐和清蛋白的线性范围分别为4.32～8840μmol/L和1.95～1000mg/L,肌酐和清蛋白最低检出限分别为0.977μmol/L和0.285mg/L。本法的日内和日间变异系数均小于4.8%。肌酐和清蛋白的平均回收率分别为99.6%和102.4%。结论建立的方法线性范围宽,测定简单快速,可用于临床检测。     

气功对顽固性失眠的治疗措施

目的：介绍气功对顽固性失眠的治疗措施。方法：从失眠的病因病机、周天功及六字诀治疗失眠的功理等入手详细分析了治疗的原理和原则。结果：将周天功与六字诀相配合可以有效地取长补短,达到心火下降,肾水上滋,心肾相交的效果。结论：气功对于顽固性失眠具有良好的治疗效果。