肝细胞癌TACE术后病灶存活或复发18F-FDGPET/CT和增强CT诊断价值Meta分析

目的采用Meta分析方法评价¹⁸F-脱氧葡萄糖正电子发射计算机体层摄影(¹⁸F-FDG PET/CT)和增强CT(CECT)诊断经导管肝动脉化疗栓塞术(TACE)术后存活或复发病灶的临床价值。方法根据PRISMA报告规范开展Meta分析。检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方和维普数据库中¹⁸F-FDG PET/CT和CECT诊断TACE术后存活或复发病灶的临床研究,时间至2019-04。由2位研究人员独立筛选文献、提取资料,根据诊断准确性研究质量评价工具-2(QUADAS-2)评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析,计算其汇总敏感度(Sen)和特异度(Spe),绘制受试者工作特征曲线(SROC)并计算曲线下面积(AUC)。结果共纳入10篇¹⁸F-FDG PET/CT及13篇CECT诊断TACE术后存活或复发病灶的原始研究,分别包括322例患者的467个病灶和748例患者的943个病灶。Meta分析显示,¹⁸F-FDG PET/CT诊断TACE术后存活或复发病灶的Sen=0.92(95%CI为0.87~0.94)、Spe=0.95(95%CI为0.82~0.99)、AUC=0.97(95%CI为0.93~0.99);CECT诊断TACE术后存活或复发病灶的Sen=0.72(95%CI为0.66~0.78)、Spe=0.99(95%CI为0.93~1.00)、AUC=0.87(95%CI为0.83~0.89)。此外,CECT诊断TACE术后存活或复发Sen(Z=2.34,P=0.02)和AUC(Z=2.21,P=0.03)值低于¹⁸F-FDG PET/CT,差异有统计学意义。结论相比于CECT,¹⁸F-FDG PET/CT对TACE术后存活或复发病灶具有较高诊断效能,可视为TACE术后存活或复发病灶有效的影像学诊断方法。     

Transcatheter closure of the patent arterial duct using the Flipper coil in a premature infant weighing 1,400 g: a case report.

A symptomatic 1,400 g premature triplet underwent successful transcatheter coil embolization of patent arterial duct using the umbilical artery. One 3 mm x 3 cm Flipper coil was used with no angiographic residual shunt. To the best of our knowledge, this is one of the smallest preterm infants to undergo this transcatheter procedure.     

先天性心脏病动脉导管未闭介入治疗及血流动力学变化

目的观察动脉导管未闭经皮心导管封堵术前后右心血流动力学的变化,评价其临床意义。方法对50例动脉导管未闭儿童患者,在进行介入性经皮心导管封堵术治疗前应用X线降主动脉造影测量前,术后经导管检测右心血流动力学指标变化。结果未闭动脉导管最窄处直径(5．6±1．3)mm;术前肺动脉平均压(19．1±2．3)mmHg,左向右分流量平均为(0．41±0．13)l／min,血流分流量占肺循环血流量的比例平均为(0．17±0．03);术后肺动脉平均压(14．4±1．7)mmHg,左向右分流量平均为(0．03±0．01)l／min,血流分流量占肺循环血流量的比例平均为(0．02±0．01),相应数据比较,差异有统计学意义(P＜0．05)。结论动脉导管未闭经皮心导管封堵术前后血流动力学会发生改变,肺动脉平均压,左向右分流量以及分流量占肺循环血流量的比例均会不同程度下降,这种改变可以作为评价介入治疗效果的重要指标。     

超声心动图对62例房间隔缺损封堵术后心功能变化的评价

目的：应用超声心动图评价房间隔缺损(ASD)封堵术前后左、右心室功能的变化。方法：对62例成功施行经皮穿刺ASD封堵术的患者进行研究。所有患者在术前、术后1周及1个月分别进行超声心动图检查．观察心脏大小及功能的改变。结果：ASD封堵术后，左室舒张末期前后径、左室舒张末期容积、左室每搏量及左室射血分数增大，而左室收缩末期容积未见明显改变；右室舒张末期前后径、右室舒张末期容积、右室收缩末期容积、右室每搏量、右室射血分数及右室心肌工作指数均减小。结论：经皮穿刺ASD封堵治疗既可减轻右室容量负荷，改善右室功能，也可改善左室的收缩功能：超声心动图对ASD封堵前后心脏血流动力学评价及疗效的观察起了重要的作用。     

Transcatheter arterial embolization of abnormal neovessels in a swine model of knee arthritis

BackgroundIn recent years, transcatheter arterial embolization (TAE) using imipenem/cilastatin (IPM/CS) has attracted attention as a treatment for relieving osteoarthritis (OA) pain. However, IPM/CS is not approved by Japanese medical insurance for use as an embolic material. Therefore, it is necessary to develop new embolic materials for TAE to relieve OA pain. The purpose of this study was to develop a swine model of knee arthritis and embolize abnormal neovessels (ANs) using two different embolic materials. We compared the embolic effects and tissue damage in knees.MethodsKnee arthritis was induced by intra-articular injection of papain into 12 knees in six female swine. The swine were divided into two groups of three swine each (six knees per group) for embolization of ANs in the knees with either IPM/CS or soluble gelatin sponge particles (SGSs). Three days after embolization, we compared the embolic effects using angiography and the tissue damage histopathologically.ResultsANs were observed in all 12 knees at 42 days after papain injection. The ANs disappeared and the patent arteries were recanalized 3 days after TAE in all 12 knees. Histopathological evaluation revealed synovitis changes, such as synovial thickening and inflammatory cell infiltration, in all 12 knees. There was no evidence of skin or muscle necrosis in either group. The appearance of ANs, recanalization of the parent arteries, and histopathological outcomes were not significantly different between the two groups.ConclusionSGSs were as safe as IPM/CS for TAE of ANs in this swine model of knee arthritis.