Surpass Flow Diverter for Treatment of Posterior Circulation Aneurysms

BACKGROUND AND PURPOSE:Flow diverters for the treatment of posterior circulation aneurysms remain controversial. We aimed to identify factors contributing to outcome measures in patients treated with the Surpass flow diverter for aneurysms in this location.MATERIALS AND METHODS:We conducted an observational study of 53 patients who underwent flow-diverter treatment for posterior circulation aneurysms at 15 centers. Key outcome measures were mortality, complete aneurysm occlusion, and modified Rankin Scale score at follow-up.RESULTS:At follow-up (median, 11.3 months; interquartile range, 5.9–12.7 months), 9 patients had died, resulting in an all-cause mortality rate of 17.3% (95% CI, 7%–27.6%); 7 deaths (14%) were directly related to the procedure and none occurred in patients with a baseline mRS score of zero. After adjusting for covariates, a baseline mRS of 3–5 was more significantly (P = .003) associated with a higher hazard ratio for death than a baseline mRS of 0–2 (hazard ratio, 17.11; 95% CI, 2.69–109.02). After adjusting for follow-up duration, a 1-point increase in the baseline mRS was significantly (P < .001) associated with higher values of mRS at follow-up (odds ratio, 2.93; 95% CI, 1.79–4.79). Follow-up angiography in 44 patients (median, 11.3 months; interquartile range, 5.9–12.7 months) showed complete aneurysm occlusion in 29 (66%; 95% CI, 50.1%–79.5%).CONCLUSIONS:Clinical results of flow-diverter treatment of posterior circulation aneurysms depend very much on patient selection. In this study, poorer outcomes were related to the treatment of aneurysms in patients with higher baseline mRS scores. Angiographic results showed a high occlusion rate for this subset of complex aneurysms.

Flow diverters (FDs) have proved to be reliable tools for the treatment of complex aneurysms,¹ but their use for aneurysms in the posterior circulation remains controversial.^2–4 The large number of perforating and branching arteries of the posterior circulation potentially increases the risk in flow diversion, exposing patients to thromboembolic complications and brain stem stroke. FD treatment of giant, fusiform aneurysms of the vertebrobasilar (VB) junction or basilar trunk (BT) has been associated with high morbidity and mortality of up to 71%.^2–4A recent meta-analysis identified 14 studies, which reported on 225 posterior circulation aneurysms treated with FDs in 220 patients.⁵ The procedure-related good outcome rate was 79% (95% confidence interval, 72%–84%), and the procedure-related mortality rate was 15% (95% CI, 10%–21%). Most studies included only a small number of patients (median, 9.5; range, 5–55), and most of these patients (155/220) were treated with the Pipeline Embolization Device (Covidien, Irvine, California).The Surpass FD (Stryker Neurovascular, Fremont, California) has various features that seem to predetermine its use in the posterior circulation: 1) The maximum length of 50 mm allows aneurysm treatment with a single device, thus avoiding telescoping; 2) due to the rhomboid shape of the FD cells, the flow-diverting effect remains constant in tapered vessels. The rhomboid shape allows a consistent cell shape across a wide range of vessel diameters. Specifically, this feature enables consistent porosity and pore density along the length of the implant in a tapering vessel. These are known variables that contribute to flow diversion and thrombosis of the aneurysm.On the other hand, the Surpass FD has a particularly high mesh density compared with the Pipeline Embolization Device, potentially increasing the risk of perforator strokes.⁶ The purpose of this study was to identify factors contributing to outcome measures in patients treated with the Surpass FD for aneurysms located in the posterior circulation.     

肿瘤内科住院患者膳食认知行为横断面多中心研究

目的  调查肿瘤内科住院患者膳食认知现状、膳食摄入量、营养状况,分析肿瘤患者膳食营养知识水平、行为习 惯及营养不良可能的发生原因,为医护人员对患者进行营养宣教及营养治疗提供依据。方法  以全国分布的18 家医院,选 择肿瘤内科住院患者进行横断面调查研究。患者以面对面调查形式自行填写膳食知识及行为问卷调查,主诊医生查房询问 患者膳食摄入情况及进行食欲评分;营养师进行营养风险筛查、膳食史回顾调查,按 ESPEN 及中国肿瘤营养指南推荐的拇 指法则计算患者的能量及蛋白质每日目标需要量。比较患者实际营养摄入量与目标摄入量是否有差别。结果  共完成 535 例 有效问卷调查：95.2% 的患者认为科学的膳食非常重要,70% 的患者对如何科学的膳食存在疑问,82.0% 的患者会遇到膳 食知识矛盾的困惑,当获取的膳食信息有矛盾时,64.2% 的患者会听取主诊医师的意见;主诊医师、网络、电视是患者了 解如何科学膳食的最主要的 3 条途径,分别占所有途径的 26.0%、18.5% 以及16.1%;99.6% 的患者存在膳食知识误区,认 为患病后不可食用某类或全部富含蛋白质的食物;90.0% 以上的患者服用灵芝孢子粉、海参、人参、冬虫夏草以及其他类 保健食品;93.0% 的患者未接受过规范的营养教育。通过营养风险筛查、膳食调查及评价发现：15.6% 的患者存在营养风 险（NRS 2002≥3分）,实际每日摄入能量为1169.20±465.97kcal,显著性低于目标需求量1797.95±375.27kcal（P＜0.01）, 仅达目标需要量的 65.3%;实际每日蛋白质摄入量为 46.55±21.40g,显著性低于目标需求量（P ＜ 0.01）,仅达目标需要量 的 74.4%。主诊医师查房询问患者膳食情况表明：69.0% 的患者认为饮食还行、挺好的、很好或者非常好。通过膳食回顾 调查发现,其中有34.0% 的患者能量摄入不足目标量60.0%。可见如果仅通过查房医生简单的询问,不足以正确的反应患 者的实际膳食摄入情况。结论  肿瘤内科住院患者对科学的膳食营养认知差,接受规范的营养教育率低。患者普遍存在膳食 摄入量低,NRS 2002 评分或查房医生的询问不足以反映肿瘤患者的实际摄入情况。因此,加强临床医生与营养师的密切合 作,有针对性的进行营养宣教将对改善患者的膳食知识及行为起到重要作用。     

经蝶手术治疗垂体生长激素腺瘤合并空蝶鞍综合征疗效分析

目的 探讨垂体生长激素（GH）腺瘤合并空蝶鞍综合征（ESS）的手术方法及其疗效。方法 回顾性分析2010年1月至2013年12月经蝶入路手术治疗的41例垂体GH腺瘤合并ESS患者的临床资料。所有患者术后随访1~4年,平均2.3年;空腹或随机血清GH<2.5 ng/ml,或GH葡萄糖抑制试验示GH谷值<1 ng/ml为治愈标准。结果 术后6个月治愈32例（78.0%）,未愈9例（22.0%）。随访期间32例治愈患者均未复发;9例未愈患者中,1例行放疗,其随机GH未降至正常水平、GH葡萄糖抑制试验GH谷值>1 ng/ml,其他8例患者未行特殊治疗患者中3例治愈。术后发生并发症13例（31.7%,13/41）,其中一过性电解质紊乱12例（低钾血症8例,低钠血症3例,高钠血症1例）,一过性尿崩症4例,脑膜炎1例,经积极治疗均痊愈出院。结论 经蝶手术是垂体GH腺瘤合并ESS患者的有效治疗方法。     

非甾体与甾体类抗炎药物在薄瓣LASIK术后的疗效比较

目的比较非甾体与甾体类抗炎药物在薄瓣准分子激光原位角膜磨镶术（LASIK）后使用的有效性与安全性,为非甾体类抗炎药物在角膜屈光手术后的使用提供临床依据。方法前瞻性随机对照临床研究。收集第三军医大学大坪医院野战外科研究所眼科行薄瓣LASIK手术患者314例（628眼）,采用随机数字法分为氯替泼诺组和溴芬酸钠组各157例（314眼）。分别于术前,术后3 d、15 d、1个月、3个月行视力、电脑验光、眼压（IOP）和裂隙灯显微镜检查。采用重复测量两因素方差分析比较不同观察时间点2组间裸眼视力（UCVA）、球镜度、柱镜度和IOP的差异;混合线性模型分析不同观察时间点UCVA达术前最佳矫正视力（BCVA）的比例;χ2检验比较2组术后弥漫性板层角膜炎（DLK）发生率。结果氯替泼诺组与溴芬酸钠组在观察时间点达到术前BCVA的UCVA比例差异无统计学意义（F=0.717,P＞0.05）。术后15 d氯替泼诺组与溴芬酸钠组球镜度分别为（0.04±0.68）D和（0.16±0.58）D,差异有统计学意义（F=6.184,P＜0.05）;IOP分别为（14.67±4.00）mmHg（1 mmHg=0.133 kPa）和（10.91±2.40）mmHg,差异有统计学意义（F=204.232,P＜0.01）。术后15 d氯替泼诺组高眼压累计发生35眼（11.2%）,溴芬酸钠组无一例发生高眼压。2组间Ⅲ级以下DLK发生率差异无统计学意义（χ2=0.53,P＞0.05）。结论溴芬酸钠滴眼液替代氯替泼诺滴眼液用于薄瓣LASIK术后有良好的抗炎效果,并且减少了术后激素性高眼压的发生率,更有利于术后获得较稳定的屈光状态。     

Identification and Characterization of Clinically Isolated Biofilm-forming Gram-positive Rods from Teeth Associated with Persistent Apical Periodontitis

We isolated spore-forming gram-positive aerobic rods from three patients with persistent periapical periodontitis. These cells possessed unique phenotypic characteristics by exhibiting dense meshwork-like structures on their cell surfaces that could be found in a number of biofilm-forming bacteria. We identified these strains as Bacillus subtilis by the API system and 16S ribosomal RNA gene (rRNA) sequencing. Treatment of the meshwork-like structures with protease K and staining with calcofluor for polysaccharides indicated that these structures were polysaccharides in nature and could be essential for biofilm formation by these isolates. Our findings suggest that B. subtilis could form biofilms in periapical periodontitis lesions, and this might contribute to the resistance to treatment resulting in the development of persistent periapical periodontitis observed in these patients. The particular mechanisms for B. subtilis biofilms to develop periapical periodontitis are still unknown. Further studies are needed to clarify the role of biofilms in persistent infections.     

肺挫伤致急性呼吸窘迫综合征临床分析

目的　探讨肺挫伤致ARDS相关危险因素。方法　总结 1 2 6例肺挫伤的临床资料 ,并将住院时间 >2 4小时的 1 1 0例分为ARDS组和非ARDS组 ,对其致伤原因、伤情及治疗结果进行对比分析。结果　本组ARDS发生率 30 .2 % ,肺挫伤并严重多发伤ARDS发生率较单纯肺挫伤高 (P <0 .0 1 )。交通伤为肺挫伤最主要原因 ,ARDS组挤压伤多 ,坠落伤较少 (P <0 .0 1 ) ;ARDS组损伤严重 (ISS >2 5 ) ,ISS评分明显高于非ARDS组 (P <0 .0 1 ) ,其浮动胸壁、休克、多发伤发生率明显高于非ARDS组 (P <0 .0 1 )。结论　合并严重多发伤 (ISS >2 5 )、浮动胸壁、休克等是肺挫伤致ARDS重要危险因素 ,应针对其进行早期有效治疗     

组建上海医学科学院的可行性研究

上海医科院的组建是在外部研究环境发生重大变化,上海医学科研机构经过长时间运行,各类矛盾需要解决的背景下提出的。本文主要探讨组建上海医学科学院的必要性和组建方案。     

湖南省最年轻急性心肌梗死患者1例报道

原发性血小板增多症致急性心肌梗死由于症状不典型,易被医生忽视而漏诊、漏治。本文报道湖南省迄今为止最年轻1例原发性血小板增多症致急性心肌梗死,旨在加深对该病的认识和了解。     

The notorious "drug lag" for oncology drugs in Japan

This study aimed to analyze the oncology “drug lag” (i.e., the delay in time required for the approval of oncology drugs) in Japan compared with that in the United States of America (US) or the European Union (EU) and to identify the factors associated with this lag. Using publicly available information, we collected data on 42 approvals of 30 oncology drugs in Japan, the US, and the EU that included dates of drug development initiation, submission, review, and approval. Lags in each step of the process were then examined and compared among the three regions. We found that median submission and approval lag times between Japan and the US were 20.0 and 29.9 months, respectively, while those between Japan and the EU were 14.9 and 21.3 months, respectively. The median review periods for Japan, the US, and the EU were 14.3, 6.0, and 13.2 months, respectively, and the median lag in initiation of oncology drug development between Japan and the US/EU was 38.9 months. The proportion of approvals for which Japanese Phase I registration trials started after corresponding approvals in the US were 39% compared with 47% for the EU. Multivariate analysis suggests that delays in the initiation of drug development and the extended length of the regulatory review period in Japan may contribute to the longer oncology drug lag observed in Japan compared with that of the US or EU.