模拟定位机引导下经皮穿刺集束巨能刀射频治疗肺癌的临床应用

为了探讨局部麻醉和模拟定位机引导在集束巨能刀治疗肺癌的射频治疗的适应证、治疗效果以及并发症的预防和处理,采用0·5%普鲁卡因局部浸润麻醉,模拟定位机引导下经皮穿刺集束巨能刀治疗肺癌46例。CT显示条索状瘢痕残余11例,空洞形成或直径缩小32例,无变化1例,增大2例。治疗中患者均有不同程度的胸腔内热感及短时间内可以忍受的疼痛感。并发症包括气胸7例、皮下气肿5例、发热24例、咯血13例和慢性支气管炎急性发作4例。初步研究结果提示,集束巨能刀射频治疗周围型肺癌疗效满意,尤其适用于直径<3cm的肿瘤。局部麻醉配合全身止痛药物应用可以很好地解决治疗中的疼痛问题,与全麻相比还具有省时省力、费用低的优势;对于周围型肺癌,模拟定位机引导经皮穿刺定位与CT引导相比,同样准确、安全,但操作更为方便。     

Histological findings after angioplasty using conventional balloon, radiofrequency thermal balloon, and stent for experimental aortic coarctation

Abstract Background : Use of balloon angioplasty or stent implantation has been reported to be effective in relieving coarctation of the aorta. However, restenosis frequently occurs after balloon angioplasty for native aortic coarctation in small infants, and sometimes develops after stent implantation because of vessel growth. The causes of restenosis remain uncertain. The purpose of this study was to assess the histologic differences in vascular responses to angioplasty using conventional balloon, radiofrequency thermal balloon (RFTB), or stent for experimental aortic coarctation. Methods : The authors surgically created an aortic coarctation model using 14 puppies. Angioplasty using conventional balloon, RFTB, or stent was performed 1 month after the initial operation. At the acute or chronic phase after angioplasty, the animals were killed and histologic studies were performed. Results : More vascular injuries were noted in the specimens from animals undergoing conventional angioplasty than in those with RFTB or stent. However, neointimal hyperplasia was seen more often after RFTB or stent because of the proliferation of smooth muscle cells from the tunica media, caused by secretion of growth factors. Apoptosis reached a peak 1?2 weeks after angioplasty, regardless of the type of intervention. Conclusions : The authors conclude that angioplasty with RFTB or stent can provide relatively small injuries in the vessel wall for aortic coarctation, but care must be taken to prevent restenosis caused by intimal hyperplasia, because neointima hyperplasia is more frequent after RFTB or stent.     

经导管射频消融术治疗快速性心律失常2 064例结果分析

目的 通过对射频消融（RFCA）治疗快速性心律失常的结果进行分析，以总结RFCA的治疗经验。方法 对我科开展RFCA治疗快速性心律失常11年的工作进行总结，对2064例患者的治疗结果进行回顾性分析。结果 2064例患者中2008例RFCA治疗成功，成功率达97．3％。并发症发生率为0．73％（15／2064），其中前5年为1．48％（9／609），后6年为0．41％（6／1455）；2例安置了永久性心脏起搏器。复发率为1．54％（31／2008），有28例再次行RFCA治疗获得成功。结论 （1）RFCA治疗快速性心律失常安全、有效、成功率高、并发症发生率低。（2）RFCA治疗快速性心律失常的成功率及并发症发生率与术者的操作技术及经验密切相关。     

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。     

Interaction of treatment with a continuous variable: simulation study of power for several methods of analysis

In a large simulation study reported in a companion paper, we investigated the significance levels of 21 methods for investigating interactions between binary treatment and a continuous covariate in a randomised controlled trial. Several of the methods were shown to have inflated type 1 errors. In the present paper, we report the second part of the simulation study in which we investigated the power of the interaction procedures for two sample sizes and with two distributions of the covariate (well and badly behaved). We studied several methods involving categorisation and others in which the covariate was kept continuous, including fractional polynomials and splines. We believe that the results provide sufficient evidence to recommend the multivariable fractional polynomial interaction procedure as a suitable approach to investigate interactions of treatment with a continuous variable. If subject‐matter knowledge gives good arguments for a non‐monotone treatment effect function, we propose to use a second‐degree fractional polynomial approach, but otherwise a first‐degree fractional polynomial (FP1) function with added flexibility (FLEX3) is the method of choice. The FP1 class includes the linear function, and the selected functions are simple, understandable, and transferable. Furthermore, software is available. We caution that investigation of interactions in one dataset can only be interpreted in a hypothesis‐generating sense and needs validation in new data. Copyright © 2014 John Wiley & Sons, Ltd.     

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.     

Induction of apoptosis by fractional CO2 laser treatment

Abstract

Introduction: Fractional CO₂-laser is considered a preferential method for skin resurfacing, but little is known about the molecular mechanisms underlying this surgical tool. In the present study, we investigated the possible role of apoptosis by the sequential analysis of lesional skin after laser treatment, with special attention to power. Moreover, we have analyzed if there is a correlation with clinical improvement. Materials and methods: We evaluated the effects of fractional CO₂-laser in twelve patients with photodamage skin Fitzpatrick types I to III. Apoptosis markers were assessed by an immunohistochemical study on skin samples of foream at 24 h, 72 h and 7 days after the irradiation with 15 W or 20 W. Moreover, clinical improvement was assessed by iconography. Results: Fractional CO₂-laser induced an inflammatory repair process mediated by activation of apoptotic pathway that was completed in 7 days. The expression of proapototic markers, as annexin-VII and Caspases-9 was increased 24–72 hours after irradiation and decreased after 7 days. While the expression of the anti-apototic marker Bcl-2 increased progressively during 7 days after treatment. Conclusion: Our study suggests that the skin's appearance may be enhanced by creating skin changes through apoptosis. Apoptosis, one of the major mechanisms of cell death, might play a key role in initiating the paracrine cascades that lead to cell proliferation.