经导管动脉栓塞术治疗纵隔出血4例

目的 探讨经导管动脉栓塞术(TAE)治疗纵隔出血的临床应用价值.方法 收集采用TAE术治疗的4例纵隔出血患者临床资料.术前作胸部CT平扫或增强检查,治疗时先行主动脉造影并探寻出血动脉,用微导管超选择至出血动脉后分别用明胶海绵、聚乙烯醇(PVA)颗粒或两者联合作栓塞,术后胸部CT平扫观察栓塞治疗效果并进行随访.结果 术前CT检查确定4例患者均为纵隔出血.术中经主动脉造影和探寻出血动脉发现,4例患者出血分别源自右侧第5肋间动脉纵隔分支、左侧支气管动脉分支、胸主动脉的食管动脉纵隔分支及左膈下动脉纵隔分支,给予明胶海绵及PVA颗粒后造影见对比剂外溢及动脉瘤征象消失.术后复查胸部CT显示4例患者纵隔血肿范围均缩小,随访6个月时3例未发生再出血,1例术后2个月病死于原发病.结论 TAE术治疗纵隔出血具有创伤小、止血直接迅速、疗效确切等优点,为临床治疗提供了一种新手段.     

Meta-analysis on radiofrequency ablation in combination with transarterial chemoembolization for the treatment of hepatocellular carcinoma

To evaluate the efficacy and safety of transcatheter arterial chemoembolization （TACE） combined with radiofrequency ablation （RFA） and TACE alone for hepatocellular carcinoma （HCC）, Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure （CNKI） and Wanfang Datebases were searched for the randomized controlled trials （RCTs） and retrospective cohort studies from the establishment of the databases to January 2014. The bibliographies of the included studies were searched, too. After study selection, assessment, data collection and analysis were under- taken, we performed this meta-analysis by using the RevMan5.2 software. Seventeen studies involving 1116 patients met the inclusion criteria with 530 treated with RFA-plus-TACE and 586 with TACE alone. The results of meta-analysis showed that the combination of TACE and RFA was obviously as- sociated with higher 1-, 2-, and 3-year overall survival rates （OR1-year=3.98, 95% CI 2.87-5.51, P〈0.00001; OR2-year=3.03, 95% CI 2.10-4.38, P〈0.00001; OR3-year=7.02, 95% CI 4.14-11.92, P〈0.00001） than TACE alone. The tumor complete necrosis rate in patients treated with TACE and RFA was higher than that of TACE alone （OR=13.86, 95% CI 8.04-23.89, P〈0.00001）. And there was a significant difference in local recurrence rate between two different kinds of treatment （OR=0.24, 95%CI 0.14-0.44, P〈0.00001）. Additionally, combination of TACE and RFA was associated with higher complete tumor necrosis rates than TACE mono-therapy in the treatment of HCC. However, RFA plus TACE was found to be associated with a lower local recurrence rate than TACE monotherapy TACE-plus-RFA treatment was associated with a higher response rate （RR） than the TACE-alone treat- ment （OR=3.90, 95% CI=2.37-5.42, P〈0.00001）. TACE-plus-RFA treatment did not differ from the TACE-alone treatment in terms of stable disease （SD） rate （OR=0.38, 95% CI=0.11-1.26, P=-0.11）. Meta-analyses showed that the combination of RFA and TACE was assoc     

分支动脉粥样硬化病和腔隙性脑梗死临床差异meta分析

目的 比较分支动脉粥样硬化病（branch atheromatous disease,BAD）和腔隙性脑梗死（lacunar i nfarcti on,LI）之间的临床差异。 方法 检索国内外数据库,查找分支动脉粥样硬化病和腔隙性脑梗死相关文献,使用RevMan 5.2进 行数据处理,对文献进行meta分析。 结果 在中国人群中BAD患者年龄小于LI患者（MD -2.70,95%CI -4.29～-1.11,P＜0.01）;在日本 人群中BAD患者年龄大于LI患者（MD 2.58,95%CI 0.75～4.41,P＜0.01）。BAD患者的高脂血症患病 率更高（OR 1.26,95%CI 1.03～1.55,P =0.03）。行敏感性分析后发现,BAD患者糖尿病（OR 1.28, 95%CI 1.02～1.61,P =0.03）、入院时美国国立卫生研究院卒中量表（national institutes of health stroke scale,NIHSS）评分（MD 0.76,95%CI 0.50～1.02,P＜0.01）和预后情况（OR 0.54,95%CI 0.38～0.77, P＜0.01）在BAD和LI患者之间存在差异性显著。 结论 BAD患者糖尿病、高脂血症发病率显著高于LI患者,其早期神经功能和预后情况均差于LI患者。 中国人群中BAD和LI患者的年龄分布特征与和日本人群相反。     

青少年重性抑郁症患者脑功能网络拓扑属性研究

目的探讨首发未用药青少年重性抑郁症(MDD)患者脑功能网络的拓扑属性改变。方法选择湖北医药学院附属襄阳市第一人民医院神经内科门诊自2022年1月至2023年1月收治的76例首发未用药青少年MDD患者(MDD组)为研究对象, 另选择同期广告招募的66例与MDD组患者性别、年龄相匹配的健康志愿者为对照组。对所有受试者行静息态功能磁共振成像(fMRI)检查, 在每个被试下构建全脑功能网络, 应用图论方法分析2组成员间脑功能网络全局拓扑指标(全局效率、局部效率、聚类系数、特征路径长度、标准化聚类系数、标准化特征路径长度、小世界属性)及节点拓扑指标(节点效率、节点度和节点介数)的差异, 并采用基于网络的统计方法检验全脑网络功能连接强度的组间差异。结果 MDD组患者和对照组成员的脑功能网络均显示出小世界属性。与对照组相比, MDD组患者脑功能网络的全局效率明显升高[0.129(0.124, 0.132)vs. 0.131(0.128, 0.133)], 聚类系数、特征路径长度明显降低[0.143(0.139, 0.146)vs. 0.139(0.135, 0.144);0.457(0.446, 0...