<strong>Background: </strong>Patients with severe hypertensive brainstem hemorrhages have poor prognoses if they only receive conservative medical management. In contrast, aggressive operative intervention...<strong>Background: </strong>Patients with severe hypertensive brainstem hemorrhages have poor prognoses if they only receive conservative medical management. In contrast, aggressive operative interventions may decrease the morbidity and mortality in such patients. These operative treatments include craniotomy for evacuation of the hematoma, stereotactic positioning, and neuronavigational-guided hemorrhage puncture and drainage. Here, we report a novel and relatively simple procedure to achieve satisfactory outcomes in a patient with a brainstem pontine hemorrhage.<strong> Case Presentation:</strong> A 53-year-old man who was diagnosed with brainstem pontine hemorrhage. On hospital day 6, he underwent CT-guided, virtual stereotactic puncture and catheter drainage of this brainstem pontine hemorrhage. Medical treatments were continued after this procedure. On postoperative day 16 (hospital day 22), the patient was discharged from the hospital, awake and able to answer questions appropriately. Muscle strengths were grades V and IV for the left and right extremities, respectively. The patient was continued with active rehabilitation and achieved a Barthel index of 85 points at one month after the percutaneous drainage procedure. <strong>Conclusion:</strong> CT-guided, virtual stereotactic percutaneous transcranial puncture and catheter drainage for brainstem pontine hemorrhages has obvious potential advantages and offers a possible alternative to achieve the best outcomes with minimal operative trauma compared to open microcraniotomy.展开更多
BACKGROUND Thoracic intervertebral foramen puncture is the key step for interventional therapy on the thoracic nerve roots or dorsal root ganglia.The anatomical features of the thoracic spine are complex,and puncture ...BACKGROUND Thoracic intervertebral foramen puncture is the key step for interventional therapy on the thoracic nerve roots or dorsal root ganglia.The anatomical features of the thoracic spine are complex,and puncture injury to the pleura,blood vessels,spinal cord,and other tissues may cause serious complications.The spatial anatomical characteristics and related parameters for thoracic intervertebral foramen puncture remain poorly understood.AIM To observe and summarize the spatially applied anatomical characteristics for intervertebral foramen puncture on different vertebral segments.METHODS A total of 88 patients(41 males and 47 females)who underwent thoracic minimally invasive interventional treatment at Nanjing Drum Tower Hospital from January 2019 to June 2020 were included.Computed tomography images of 167 thoracic vertebral segments scanned in the prone position were collected.The width of the intertransverse space(D_(P)),the height of the rib neck/head above the lower transverse process(D_(R)),the width of the lateral border of the articular process/lamina(W_(P)),and the width of the posterior border of the vertebral body(W_(V))were measured.At the upper 1/3 of the intervertebral foramina,the horizontal inclination angle(α)from the lateral border of the articular process/lamina to the posterolateral border of the vertebral body was measured.The ratios D_(R)/D_(P) and W_(P)/W_(V) were calculated.The intervertebral foramen parameters were compared between segments.RESULTS No rib head/neck occlusion(D_(R)/D_(P)>0)was found in the intertransverse spaces of T1-2 and T12-L1.The incidence of occlusion for the upper thoracic segments(T1-5,n=138),middle thoracic segments(T5-9,n=116),and lower thoracic segments(T9-L1,n=80)were 76.81%,100%,and 82.50%,respectively.The incidence of occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments(P<0.05).The incidence of>1/2 occlusion(D_(R)/D_(P)>1/2)for the upper,middle,and lower thoracic segments was 7.97%,74.14%,and 32.50%,respectively.The incidence of>1/2 occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments(P<0.05).W_(P) was longer than W_(V) on T1-2 to T9-10 and shorter than W_(V) on T10-11 to T12-L1.The horizontal puncture angle(α)into the external opening of the intervertebral foramina was positively correlated with the segments of the thoracic vertebrae from the cephalic to caudal portion(left:r=0.772,P<0.01;right:r=0.771,P<0.01),and the horizontal inclination angle for T11-12 and T12-L1 was 90°.CONCLUSION It is necessary to identify the spatial impact of the rib head/neck on the puncture path of the intervertebral foramina and design appropriate puncture angles for different segments.展开更多
Objective:To assess the clinical efficacy and safety of transarterial embolization(TAE)in simultaneous combination with computed tomography(CT)-guided radiofrequency ablation(RFA)for recurrent or residual hepatocellul...Objective:To assess the clinical efficacy and safety of transarterial embolization(TAE)in simultaneous combination with computed tomography(CT)-guided radiofrequency ablation(RFA)for recurrent or residual hepatocellular carcinoma(HCC),and to determine the risk factors influencing local tumor progression following this procedure.Methods:One hundred eighteen patients with recurrent or residual HCC(tumor size,10–30 mm)underwent RFA.During the 19-month follow-up,59 patients received RFA only(RFA group),and the remaining 59 received RFA immediately after TAE(TAE+RFA group).All patients were followed up to observe the short-term therapeutic effects and complications.The cumulative local tumor progression rates in both groups were calculated using unpaired Student’s t tests and the Kaplan-Meier method.Results:The rate of major complications was 5.08%in the TAE+RFA group and 3.39%in the RFA group.The overall response rate was 96.61%in the TAE+RFA group and 79.66%in the RFA group(P=0.008).The disease control rate was significantly higher in the TAE+RFA group than in the RFA group(94.92%vs.79.66%,P=0.024).The median time to local tumor progression was 4.8 months in the RFA group and 9.6 months in the TAE+RFA group.The cumulative local tumor progression rate at 1 year was 10.60%in the RFA group and 23.60%in the TAE+RFA group(P=0.016).Conclusion:TAE in simultaneous combination with CT-guided RFA was effective and safe against recurrent or residual HCC.Local tumor progression can be minimized by the complete ablation of targeted iodized oil deposits after simultaneous TAE.展开更多
We are interested in a quantum mechanical system on a triply punctured two-sphere surface with hyperbolic metric. The bound states on this system are described by the Maass cusp forms （MCFs） which are smooth square ...We are interested in a quantum mechanical system on a triply punctured two-sphere surface with hyperbolic metric. The bound states on this system are described by the Maass cusp forms （MCFs） which are smooth square integrable eigenfunctions of the hyperbolic Laplacian. Their discrete eigenvalues and the MCF are not known analytically. We solve numerically using a modified Hejhal and Then algorithm, which is suitable to compute eigenvalues for a surface with more than one cusp. We report on the computational results of some lower-lying eigenvalues for the triply punctured surface as well as providing plots of the MCF using GridMathematica.展开更多
Background： Percutaneous brachytherapy is a valuable method for the treatment of lung cancer and mediastinal lymph nodes metastasis. However, in some of the metastatic lymph nodes in the middle mediastinum, the percu...Background： Percutaneous brachytherapy is a valuable method for the treatment of lung cancer and mediastinal lymph nodes metastasis. However, in some of the metastatic lymph nodes in the middle mediastinum, the percutaneous approach cannot be used safely due to possible damage to surrounding anatomical structures. We established an animal model （group of 12 pigs） to assess the safety and feasibility of computed tomography （CT）-guided vena cava puncture. Methods： Under CT guidance, an 18G needle was used to puncture the anterior wall of the anterior vena cava （AVC） in 12 pigs. The 18G needle was chosen as it is similar in size to the needles employed for clinical application in brachytherapy. The incidence of complications and vital signs was monitored during the procedure. Thoracotomy was performed to remove AVC specimens, which were analyzed for histological evidence of vessel wall damage and repair. Results： Following postoperative enhanced CT, two animals were found to have a small pneumothorax （one being hemopneumothorax）. The intraoperative oxygen saturation of both animals was not significantly decreased and was maintained at 93-100%. No animals developed mediastinal hematoma. Preoperative, intraoperative, and postoperative changes in blood pressure, heart rate, hemoglobin, and blood oxygen saturation were not significant. Histological evaluation of AVC specimens showed that by 7 days following the procedure, the endothelial layer was smooth with notable scar repair in the muscularis layer. Conclusions： CT performed after the procedure and histological preparations confirmed the safety of the procedure. This indicates that percutaneous brachytherapy for metastatic middle mediastinal lymph nodes can be carried out via the superior vena cava.展开更多
文摘<strong>Background: </strong>Patients with severe hypertensive brainstem hemorrhages have poor prognoses if they only receive conservative medical management. In contrast, aggressive operative interventions may decrease the morbidity and mortality in such patients. These operative treatments include craniotomy for evacuation of the hematoma, stereotactic positioning, and neuronavigational-guided hemorrhage puncture and drainage. Here, we report a novel and relatively simple procedure to achieve satisfactory outcomes in a patient with a brainstem pontine hemorrhage.<strong> Case Presentation:</strong> A 53-year-old man who was diagnosed with brainstem pontine hemorrhage. On hospital day 6, he underwent CT-guided, virtual stereotactic puncture and catheter drainage of this brainstem pontine hemorrhage. Medical treatments were continued after this procedure. On postoperative day 16 (hospital day 22), the patient was discharged from the hospital, awake and able to answer questions appropriately. Muscle strengths were grades V and IV for the left and right extremities, respectively. The patient was continued with active rehabilitation and achieved a Barthel index of 85 points at one month after the percutaneous drainage procedure. <strong>Conclusion:</strong> CT-guided, virtual stereotactic percutaneous transcranial puncture and catheter drainage for brainstem pontine hemorrhages has obvious potential advantages and offers a possible alternative to achieve the best outcomes with minimal operative trauma compared to open microcraniotomy.
基金Supported by The Key R&D Project in Jiangsu Province,No.BE2017603 and No.BE2017675the Key Program of Medical Science and Technology Development Projects in Nanjing,No.ZKX19016.
文摘BACKGROUND Thoracic intervertebral foramen puncture is the key step for interventional therapy on the thoracic nerve roots or dorsal root ganglia.The anatomical features of the thoracic spine are complex,and puncture injury to the pleura,blood vessels,spinal cord,and other tissues may cause serious complications.The spatial anatomical characteristics and related parameters for thoracic intervertebral foramen puncture remain poorly understood.AIM To observe and summarize the spatially applied anatomical characteristics for intervertebral foramen puncture on different vertebral segments.METHODS A total of 88 patients(41 males and 47 females)who underwent thoracic minimally invasive interventional treatment at Nanjing Drum Tower Hospital from January 2019 to June 2020 were included.Computed tomography images of 167 thoracic vertebral segments scanned in the prone position were collected.The width of the intertransverse space(D_(P)),the height of the rib neck/head above the lower transverse process(D_(R)),the width of the lateral border of the articular process/lamina(W_(P)),and the width of the posterior border of the vertebral body(W_(V))were measured.At the upper 1/3 of the intervertebral foramina,the horizontal inclination angle(α)from the lateral border of the articular process/lamina to the posterolateral border of the vertebral body was measured.The ratios D_(R)/D_(P) and W_(P)/W_(V) were calculated.The intervertebral foramen parameters were compared between segments.RESULTS No rib head/neck occlusion(D_(R)/D_(P)>0)was found in the intertransverse spaces of T1-2 and T12-L1.The incidence of occlusion for the upper thoracic segments(T1-5,n=138),middle thoracic segments(T5-9,n=116),and lower thoracic segments(T9-L1,n=80)were 76.81%,100%,and 82.50%,respectively.The incidence of occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments(P<0.05).The incidence of>1/2 occlusion(D_(R)/D_(P)>1/2)for the upper,middle,and lower thoracic segments was 7.97%,74.14%,and 32.50%,respectively.The incidence of>1/2 occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments(P<0.05).W_(P) was longer than W_(V) on T1-2 to T9-10 and shorter than W_(V) on T10-11 to T12-L1.The horizontal puncture angle(α)into the external opening of the intervertebral foramina was positively correlated with the segments of the thoracic vertebrae from the cephalic to caudal portion(left:r=0.772,P<0.01;right:r=0.771,P<0.01),and the horizontal inclination angle for T11-12 and T12-L1 was 90°.CONCLUSION It is necessary to identify the spatial impact of the rib head/neck on the puncture path of the intervertebral foramina and design appropriate puncture angles for different segments.
基金supported by the National Natural Science Foundation of China(No.81771955)Sun Yat-sen University Clinical Trial 5010Project(No.2016002)Guangzhou Science and Technology Program of China(No.201704020134)
文摘Objective:To assess the clinical efficacy and safety of transarterial embolization(TAE)in simultaneous combination with computed tomography(CT)-guided radiofrequency ablation(RFA)for recurrent or residual hepatocellular carcinoma(HCC),and to determine the risk factors influencing local tumor progression following this procedure.Methods:One hundred eighteen patients with recurrent or residual HCC(tumor size,10–30 mm)underwent RFA.During the 19-month follow-up,59 patients received RFA only(RFA group),and the remaining 59 received RFA immediately after TAE(TAE+RFA group).All patients were followed up to observe the short-term therapeutic effects and complications.The cumulative local tumor progression rates in both groups were calculated using unpaired Student’s t tests and the Kaplan-Meier method.Results:The rate of major complications was 5.08%in the TAE+RFA group and 3.39%in the RFA group.The overall response rate was 96.61%in the TAE+RFA group and 79.66%in the RFA group(P=0.008).The disease control rate was significantly higher in the TAE+RFA group than in the RFA group(94.92%vs.79.66%,P=0.024).The median time to local tumor progression was 4.8 months in the RFA group and 9.6 months in the TAE+RFA group.The cumulative local tumor progression rate at 1 year was 10.60%in the RFA group and 23.60%in the TAE+RFA group(P=0.016).Conclusion:TAE in simultaneous combination with CT-guided RFA was effective and safe against recurrent or residual HCC.Local tumor progression can be minimized by the complete ablation of targeted iodized oil deposits after simultaneous TAE.
文摘We are interested in a quantum mechanical system on a triply punctured two-sphere surface with hyperbolic metric. The bound states on this system are described by the Maass cusp forms （MCFs） which are smooth square integrable eigenfunctions of the hyperbolic Laplacian. Their discrete eigenvalues and the MCF are not known analytically. We solve numerically using a modified Hejhal and Then algorithm, which is suitable to compute eigenvalues for a surface with more than one cusp. We report on the computational results of some lower-lying eigenvalues for the triply punctured surface as well as providing plots of the MCF using GridMathematica.
文摘Background： Percutaneous brachytherapy is a valuable method for the treatment of lung cancer and mediastinal lymph nodes metastasis. However, in some of the metastatic lymph nodes in the middle mediastinum, the percutaneous approach cannot be used safely due to possible damage to surrounding anatomical structures. We established an animal model （group of 12 pigs） to assess the safety and feasibility of computed tomography （CT）-guided vena cava puncture. Methods： Under CT guidance, an 18G needle was used to puncture the anterior wall of the anterior vena cava （AVC） in 12 pigs. The 18G needle was chosen as it is similar in size to the needles employed for clinical application in brachytherapy. The incidence of complications and vital signs was monitored during the procedure. Thoracotomy was performed to remove AVC specimens, which were analyzed for histological evidence of vessel wall damage and repair. Results： Following postoperative enhanced CT, two animals were found to have a small pneumothorax （one being hemopneumothorax）. The intraoperative oxygen saturation of both animals was not significantly decreased and was maintained at 93-100%. No animals developed mediastinal hematoma. Preoperative, intraoperative, and postoperative changes in blood pressure, heart rate, hemoglobin, and blood oxygen saturation were not significant. Histological evaluation of AVC specimens showed that by 7 days following the procedure, the endothelial layer was smooth with notable scar repair in the muscularis layer. Conclusions： CT performed after the procedure and histological preparations confirmed the safety of the procedure. This indicates that percutaneous brachytherapy for metastatic middle mediastinal lymph nodes can be carried out via the superior vena cava.
