半月神经节射频热凝治疗难治性三叉神经痛

目的探讨半月神经节射频热凝治疗难治性三叉神经痛效果和安全性。方法对三叉神经第Ⅱ支合并第Ⅰ、Ⅲ支或Ⅰ、Ⅱ、Ⅲ支并存疼痛者应用改良的前入路卵圆孔穿刺法行射频热凝毁损术。应用C型臂定位下行卵圆孔穿刺。射频温度控制在75-90℃。结果优良46例，良好1例，总有效率为100％。无严重并发症，随访42例3～18个月，无复发患者。结论在C型臂引导下射频热凝半月神经节毁损术治疗难治性三叉神经痛疗效可靠、定位准确，时患者更安全。     

阵发性心房颤动时右心房f波振幅的测量

目的:测量阵发性心房颤动(atrial fibrillation,AF)患者右心房不同部位的f波振幅,探讨在AF律状态下起搏器心房电极固定位置的选择和植入的可行性。方法:13例阵发性AF患者,窦性心律和AF时,分别把6F的4极电极导管送至高位右心房、中位右心房、低位右心房、房间隔上部、房间隔中部和冠状窦口处。利用Medtronic PSA 5311分析仪测量6F电极1～2极间的电位差。结果:(1)右心房中部和房间隔上部的f波振幅均值分别为(3．93±1．84)mV和(3．96±1．35)mV。(2)右心房中部与高、低位右心房之间的f波振幅均有明显差异(P＜0．05);房间隔上部与房间隔中部的f波振幅也有明显差异(P＜0．05)。(3)AF时f波振幅均值低于A波振幅均值(P=0．002)。结论:(1)右心房中部和房间隔上部的f波振幅值较其它4个部位的振幅高。(2)AF时f波振幅波动范围明显较大。(3)阵发性AF时,右心房中部与高位、低位右心房之间的电位均有明显差异。右心房中部和房间隔上部的f波振幅较其它部位高,可选为右心房主动固定电极的植入部位。     

强脉冲光联合睑板腺按摩与眼睑熏蒸按摩治疗MGD相关干眼的疗效对比

目的：观察对比强脉冲光(IPL)联合睑板腺按摩与眼睑熏蒸按摩对睑板腺功能障碍(MGD)相关干眼的治疗效果。

方法：本研究为前瞻性随机对照临床试验。选取2018-03/08在西安市第四医院干眼门诊就诊的73例146眼MGD相关干眼患者,试验组38例76眼,给予IPL联合睑板腺按摩治疗(每3wk 1次,共3次)。对照组35例70眼给予眼睑熏蒸联合睑板腺按摩治疗(每天熏蒸、清洗睑缘,连续5d,第5d进行睑板腺按摩,间隔2wk后再次重复治疗,共3次)。本研究时间共12wk,记录首次治疗前及首次治疗后1、4、7、12wk时患者的眼表疾病指数(OSDI)评估、标准干眼评估问卷(SPEED)、非侵入泪膜破裂时间(NITBUT)、非侵入泪河高度测量(NITMH)、睑板腺缺失积分(MGS)、睑板腺分泌物评估(MGYSS)等数据,评估两种治疗方法的有效性及二者的疗效对比。

结果：两组间性别、年龄无差异(P>0.05)。两组治疗前各观察指标无差异(P>0.05); 两组治疗后各时间点除NITMH、MGS外各项指标均较治疗前有明显改善(P<0.05)。试验组在治疗后1wk时各项指标与对照组无差异(P>0.05); 试验组在治疗后4、7、12wk时,除NITMH、MGS外均优于对照组(P<0.05)。从指标变化趋势上看,试验组于首次治疗后疗效指标持续好转,于第12wk时疗效最佳,而对照组于首次治疗后第7wk疗效最佳,之后疗效减弱。治疗后两组均未见明显并发症。

结论：强脉冲光联合睑板腺按摩及眼睑熏蒸按摩两种治疗方式均对MGD相关干眼治疗方便、安全、有效,且强脉冲光联合睑板腺按摩疗效及维持时间优于眼睑熏蒸按摩治疗。     

强脉冲光联合睑板腺按摩治疗睑板腺功能障碍的短期疗效

目的：评估强脉冲光（IPL）联合睑板腺按摩（MGX）（IPL/MGX）治疗睑板腺功能障碍（MGD）的短期 疗效。方法：前瞻性临床研究。选择2016年11月至2017年12月于汉口爱尔眼科医院门诊连续就诊 的MGD患者55例,最终完成随访的有48例（96眼）,双眼均行IPL/MGX治疗,每3周治疗1次,共3次。 在治疗前、治疗结束后1周进行眼表疾病指数（OSDI）问卷调查、泪膜破裂时间、角膜染色、睑板腺 功能及成像、结膜眼红评分、共聚焦显微镜下睑板腺及蠕形螨检查等。使用配对t检验、Wilcoxon 秩和检验及Spearman秩相关分析对数据进行处理。结果：IPL/MGX治疗结束后1周与治疗前比较, OSDI评分降低（t=2.300,P=0.024）,睑板腺分泌能力与睑酯质量均得到改善（Z=-3.617,P<0.001;t= 2.472,P=0.017）,角膜染色评分、球结膜眼红评分降低（Z=-2.757,P=0.006;t=2.040,P=0.044）,睑 板腺腺周炎症细胞密度下降（t=4.765,P<0.001）,睫毛根部蠕形螨总数减少（t=2.121,P=0.037）。睑 板腺萎缩面积<50%的MGD患者,治疗后症状评分、眼表炎症状态及睑板腺功能显著改善,睑板腺 萎缩面积≥70%的MGD患者,治疗前后各项指标均未见明显改善。结论：IPL/MGX可明显改善睑板 腺萎缩程度尚轻的MGD患者主观症状及睑板腺功能,减轻患者眼表炎症,减少眼蠕形螨数量,降低 眼表损害。     

Radiofrequency hyperthermia-enhanced herpes simplex virus-thymidine kinase/ganciclovir direct intratumoral gene therapy of hepatocellular carcinoma

Purpose: To determine the feasibility of using radiofrequency hyperthermia (RFH) and to enhance the therapeutic effect of herpes simplex virus-thymidine kinase/ganciclovir (HSV-TK/GCV) for the treatment of hepatocellular carcinoma (HCC).

Materials and methods: Human HCC cells (HepG2) were first transfected with lentivirus/luciferase. For both in vitro confirmation and in vivo validation, luciferase-labeled HCC cells and HCC tumour xenografts on mice received different treatments: (i) combination therapy of intratumoral HSV-TK/GCV-mediated gene therapy plus magnetic resonance imaging heating guidewire (MRIHG)-mediated RFH; (ii) gene therapy only; (iii) RFH only; and (iv) phosphate-buffered saline (PBS) as control. Cell proliferation was quantified. Tumour changes were monitored by ultrasound imaging and bioluminescence optical imaging before and at days 7 and 14 after treatments, which were correlated with subsequent histology.

Results: In vitro, the lowest cell proliferation was seen in the combination therapy group compared with control groups (29?±?6% vs. 56?±?9%, 93?±?4%, and 100?±?5%, p?p?p?Conclusion: RFH can enhance HSV-TK/GCV-mediated gene therapy of HepG2 cell line and mice human HCC xenografts, which may open new avenues for effective management of HCC using MR/RFH integrated interventional gene therapy.     

Diffusion‐weighted MRI monitoring of pancreatic cancer response to radiofrequency heat‐enhanced intratumor chemotherapy

The aim of this study was to evaluate the feasibility of using diffusion‐weighted MRI to monitor the early response of pancreatic cancers to radiofrequency heat (RFH)‐enhanced chemotherapy. Human pancreatic carcinoma cells (PANC‐1) in different groups and 24 mice with pancreatic cancer xenografts in four groups were treated with phosphate‐buffered saline (PBS) as a control, RFH at 42 °C, gemcitabine and gemcitabine plus RFH at 42 °C. One day before and 1, 7 and 14 days after treatment, diffusion‐weighted MRI and T₂‐weighted imaging were applied to monitor the apparent diffusion coefficients (ADCs) of tumors and tumor growth. MRI findings were correlated with the results of tumor apoptosis analysis. In the in vitro experiments, the quantitative viability assay showed lower relative cell viabilities for treatment with gemcitabine plus RFH at 42 °C relative to treatment with RFH only and gemcitabine only (37 ± 5% versus 65 ± 4% and 58 ± 8%, respectively, p < 0.05). In the in vivo experiments, the combination therapy resulted in smaller relative tumor volumes than RFH only and chemotherapy only (0.82 ± 0.17 versus 2.23 ± 0.90 and 1.64 ± 0.44, respectively, p = 0.003). In vivo, 14‐T MRI demonstrated a remarkable decrease in ADCs at day 1 and increased ADCs at days 7 and 14 in the combination therapy group. The apoptosis index in the combination therapy group was significantly higher than those in the chemotherapy‐only, RFH‐only and PBS treatment groups (37 ± 6% versus 20 ± 5%, 8 ± 2% and 3 ± 1%, respectively, p < 0.05). This study confirms that it is feasible to use MRI to monitor RFH‐enhanced chemotherapy in pancreatic cancers, which may present new options for the efficient treatment of pancreatic malignancies using MRI/RFH‐integrated local chemotherapy. Copyright © 2013 John Wiley & Sons, Ltd.     

Irreversible Electroporation of a Hepatocellular Carcinoma Lesion Adjacent to a Transjugular Intrahepatic Portosystemic Shunt Stent Graft

We report in a 65-year-old man hepatocellular carcinoma adjacent to a transjugular intrahepatic portosystemic shunt stent-graft which was successfully treated with irreversible electroporation (IRE). IRE is a new non-thermal tissue ablation technique which uses electrical pulses to induce cell necrosis by irreversible membrane poration. IRE proved to be more advantageous in the ablation of perivascular tumor with little injury to the surrounding structures.     

Resolution of retracted scar after 585-nm pulse dye laser surgery

BACKGROUND: Laser scar revision has been an effective method for improving several aspects of scarring through ablative and non-ablative sources. The 585-nm pulsed dye laser (PDL) is an important non-ablative instrument for reducing scar bulk and symptoms. OBJECTIVE: To describe the use of a 585-nm PDL for the treatment of a retracted and atrophic facial scar. METHODS: We report the case of a 26-year-old patient who presented with a retracted facial scar following surgical excision of an aggressive benign tumor. Treatment was carried out using the 585-nm PDL. RESULTS: Treatment of the scar using two low-level PDL therapies significantly altered the appearance of the scar and augmentation of the retracted defect was avoided. CONCLUSION: Treatment of this retracted and atrophic facial scar with the 585-nm PDL was very effective and safe.     

GI and Hepatology 2008: Advances and Case Discussions

Mayo Clinic recently presented an outstanding education meeting in Orlando, FL, USA. This meeting is one of several education meetings coordinated by the gastroenterology and hepatology divisions from Mayo Clinic held throughout the year in multiple locations in the USA. The focus of this 3-day meeting was to provide an update on advances in all areas of gastroenterology with an emphasis on the management of difficult cases. A total of 23 podium presentations, 17 breakout sessions and a Fellow’s poster program were presented. In addition, there was a specific program directed at nurses involved in the care of gastroenterology patients. Highlights from selected presentations are included in this report.     

A low‐cost,mechanically simple apparatus for measuring eddy current‐induced magnetic fields in MRI

The fidelity of gradient waveforms in MRI pulse sequences is essential to the acquisition of images and spectra with minimal distortion artefacts. Gradient waveforms can become nonideal when eddy currents are created in nearby conducting structures; however, the resultant magnetic fields can be characterised and compensated for by measuring the spatial and temporal field response following a gradient impulse. This can be accomplished using a grid of radiofrequency (RF) coils. The RF coils must adhere to strict performance requirements: they must achieve a high sensitivity and signal‐to‐noise ratio (SNR), have minimal susceptibility field gradients between the sample and surrounding material interfaces and be highly decoupled from each other. In this study, an apparatus is presented that accomplishes these tasks with a low‐cost, mechanically simple solution. The coil system consists of six transmit/receive RF coils immersed in a high‐molarity saline solution. The sensitivity and SNR following an excitation pulse are sufficiently high to allow accurate phase measurements during free‐induction decays; the intrinsic susceptibility matching of the materials, because of the unique design of the coil system, results in sufficiently narrow spectral line widths (mean of 19 Hz), and adjacent RF coils are highly decoupled (mean S₁₂ of ?47 dB). The temporal and spatial distributions of eddy currents following a gradient pulse are measured to validate the efficacy of the design, and the resultant amplitudes and time constants required for zeroth‐ and first‐order compensation are provided. Copyright © 2013 John Wiley & Sons, Ltd.