MR-Guided percutaneous ethanol ablation of liver tissue in a .2-T open MR system: Preliminary study in porcine model

The purpose of this study was to test the feasibility of MR-guided percutaneous ethanol ablation of liver tissue on a .2-T open MR scanner. Needles were placed by MR guidance first into an ex vivo sheep liver and then into livers of three anesthetized pigs, and injection of 10 ml of 96% alcohol was performed. T1 fast low-angle shot (FLASH), T2 turbo spin echo (TSE), and T1 spin echo (SE) images were obtained after incremental volumes of injection. In one pig, simultaneous injection of saline into normal liver was also performed with subsequent pathological correlation. Ethanol-infiltrated liver was hypointense to liver on all sequences, whereas saline caused no tissue signal changes on T1 SE and either isointense or hyperintense changes on T2 TSE images. Pathological examination confirmed ethanol-induced acute liver changes as compared with the control. MR guidance of needle placement and monitoring of ethanol effects on liver tissue is feasible. This may have implications for potential MR-guided hepatic tumor ablation.     

早中期结直肠癌根治术后中西结合心理康复干预指南解读及典型病例

我国癌症患者普遍存在着心理康复需求,中医药对其有良好的干预效果。目前已有肿瘤相关西医心理指南及标准治疗方案发表,然而中西医结合及中医干预方案仍有待规范。结直肠癌作为中国高发病率、长生存期的肿瘤,其根治术后的时期作为中西医结合心理康复的良好切入点,前期已有一定基础的研究发表。为规范该类疾病的诊疗及随访,提高中西医结合治疗早中期结直肠癌根治术后心理问题的效果,2022年中华中医药学会发布《早中期结直肠癌根治术后中西医结合心理康复干预指南》,包含12条推荐意见。该指南为结直肠癌领域首个中西医结合心理干预指南,但受限于相关研究的数量与质量,未来尚需要更多高质量研究结果的发表以促进其更新完善。     

籍名家影响推广期刊阅读的实践

介绍复旦大学医科图书馆“医学名家荐刊”系列活动,从荐刊内容与形式、初步成效等方面进行阐述,从此活动中得到启示,包括建设有特色的馆藏、加强文献传递服务、多渠道争取专家的支持等方面。     

理解性学习对学科教学的启示

在药学专业学科教学中，基于理解性学习的教学理念和价值启示，采用构建框架、举一反三、找关键词、教学演示等方法指导高职学生掌握合适的学法，积极有效学习，提升理解力和学习力。     

血清PCT对危重新生儿应用抗菌药物的指导价值

目的探讨血清降钙素原(PCT)对危重新生儿应用抗菌药物的价值,以指导临床合理使用抗菌药物。方法纳入186例住院危重新生儿,其中,未应用抗菌药物的124例新生儿作为对照组,应用抗菌药物的62例新生儿为观察组。对比分析患儿住院时的体温状况和住院后的PCT、白细胞计数(WBC)、C-反应蛋白(CRP)和红细胞沉降率(ESR),并记录入选患儿预后状况。记录观察组患儿使用抗菌药物当天的PCT、WBC、CRP、体温,以及用药3 d后的PCT水平和体温状况。结果观察组患儿医院感染部位分布情况:肠道感染28例,占45.2%;上呼吸道感染17例,占27.4%;下呼吸道感染9例,占14.5%;泌尿道感染4例,占6.5%。两组患儿入院时的年龄、性别、体温、PCT、WBC、CRP、ESR和治愈例数[观察组:61例(98.39%),对照组121例(97.58%)]比较差异无统计学意义(P>0.05)。两组患儿预后情况比较差异无统计学意义(P>0.05),但观察组患儿的住院时间比对照组长(P<0.01)。观察组患儿在抗菌药物使用当日,PCT高于入院时(P<0.05),体温、WBC、CRP水平无显著变化(P>0.05);使用抗菌药物3 d后,患儿PCT比用药当日显著降低(P<0.05),体温比入院时和用药当日显著降低(P<0.05)。结论通过监测PCT可以指导危重新生儿的抗菌药物应用。     

Single-Camera Closed-Form Real-Time Needle Tracking for Ultrasound-Guided Needle Insertion

Many common needle intervention procedures are performed with ultrasound guidance because it is a flexible, cost-effective and widely available intra-operative imaging modality. In a needle insertion procedure with ultrasound guidance, real-time calculation and visualization of the needle trajectory can help to guide the choice of puncture site and needle angle to reach the target depicted in the ultrasound image. We found that it is feasible to calculate the needle trajectory with a single camera mounted directly on the ultrasound transducer by using the needle markings. Higher accuracy is achieved compared with other similar transducer-mounted needle trackers. We used an inexpensive, real-time and easy-to-use tracking method based on an automatic feature extraction algorithm and a closed-form method for pose estimation of the needle. The overall accuracy was 0.94 ± 0.46 mm.     

The plexin C1 receptor promotes acute inflammation

Acute inflammation is the pathophysiological basis of important clinical conditions associated with organ failure. The initial inflammatory response is controlled by the chemokine system, yet recent data have indicated that the neuronal guidance cues are significantly involved in the orchestration of this process. Previous work has shown the proinflammatory capacity of the guidance cue semaphorin (Sema) 7a, but the role of one of its target receptors, the plexin C1 (PLXNC1) receptor is to date unknown. We report here that PLXNC1 is expressed outside the nervous system and induced during acute inflammation. PLXNC1^?/? mice with C57BL/6 background demonstrated decreased inflammatory responses during zymosan A (ZyA)‐induced peritonitis. Subsequent in vivo studies revealed altered rolling, adhesion, and transmigration properties of PLXNC1^?/? leukocytes. Blockade of PLXNC1 was associated with attenuated chemotactic transendothelial migration properties in vitro. Studies in chimeric mice revealed that hematopoietic PLXNC1^?/? animals demonstrated an attenuated inflammatory response. To probe the therapeutic potential of PLXNC1 we treated C57BL/6 WT mice with an anti‐PLXNC1 antibody and a PLXNC1 binding peptide. Both of these interventions significantly dampened ZyA‐induced peritonitis. These results implicate an important role of PLXNC1 during an acute inflammatory response and indicate PLXNC1 as a potential target for the control of conditions associated with acute inflammation.     

经皮胸穿活检的临床应用及并发症探讨

目的探讨在CT引导下应用半自动同轴活检枪对胸部占位性病变经皮穿刺活检的临床可行性及安全性。方法56例胸部占位性病变的患者,采用半自动同轴活检枪在CT引导下行经皮穿刺活检术并送病理检查,统计穿刺活检的成功率及病理检查结果;术后行CT扫描,统计穿刺活检的并发症及穿刺活检的安全性。结果半自动同轴活检枪穿刺活检的成功率为92.9%(52/56);病理检查结果:穿刺成功的52例患者中,腺癌18例、鳞癌10例、小细胞癌9例、淋巴瘤2例、胸腺瘤2例、转移癌8例、真菌感染1例、肉芽肿性炎2例;穿刺活检的并发症:合并出血和或咯血的发生率32%(18/56)、气胸发生率19.6%(11/56)、死亡率1.8%(1/56);未发生穿刺点感染、针道种植转移等其他并发症。结论半自动同轴活检枪在CT引导下对胸部占位性病变经皮穿刺活检术是一种创伤小、相对安全、确诊率高的诊断方法,可在胸部占位性疾病临床诊断中广泛推广应用。     

The Lived Experience of MRKH: Sharing Health Information with Peers

Study ObjectiveTo examine the process and emotional effect of disclosing a personal diagnosis of Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) to peers during adolescence and young adulthood.Design and SettingQualitative study using semistructured telephone interviews.ParticipantsNine women diagnosed with MRKH, aged 21-31 years, recruited via patient support groups.Interventions and Main Outcome MeasuresMotivators and barriers to self-disclosure of a diagnosis of MRKH to peers and partners.ResultsMotivators to tell peers about a diagnosis included significant trust in the relationship (whether platonic or romantic), needing to unload the experienced burden of diagnosis, and a sense of responsibility to be forthcoming if a long-term romantic future was desired. The most common barrier to telling others was fear of rejection or being labeled a “freak.” Although most participants did not receive guidance from a health care provider regarding approaches to sharing diagnostic information with others, almost all participants reported wishing they had received such counseling.ConclusionA diagnosis of MRKH elicits recurring anxieties about disclosure and the effect on relationships that are inadequately addressed by health care providers. Guidance and support on disclosure to friends and romantic partners should be provided whenever possible.     

3D-CTA对颅内动脉瘤诊断效能及治疗指导的价值研究

目的探究三维CT血管造影(3D-CTA)对颅内动脉瘤诊断效能及治疗指导的价值。方法回顾性分析因蛛网膜下腔出血入院且均接受3D-CTA检查与三维数字减影血管造影(3D-DSA)检查的208例患者临床资料,以3D-DSA检查结果为"金标准"评价3D-CTA在颅内动脉瘤中的诊断效能及在治疗指导中的价值。结果 212例患者经3D-DSA检查,9例患者未检出动脉瘤,203例患者中检出动脉瘤251个;3D-CTA检查,17例未检出动脉瘤,195例患者中检出动脉瘤243个,诊断效能:灵敏度95.57%,特异度88.89%,准确率95.28%,阳性预测值99.49%,阴性预测值47.06%。3D-CTA诊断后交通动脉、前交通动脉、颈内动脉颅内段、基底动脉诊断符合率为96.05%、97.01%、89.66%、80.00%,其余部位符合率均为100.0 0%。3D-CTA和3D-DSA检查动脉瘤的瘤体最大径和瘤体颈宽比较差异均无统计学意义(P>0.05)。203例手术治疗患者中169例术后采用3D-CTA复查,均能清晰显示动脉瘤夹位置与数目,患者术后动脉瘤完全闭塞,瘤颈无残留。结论 3D-CTA在颅内动脉瘤诊断中具有较高诊断效能,可提供影像学信息指导临床治疗及术后评价。