Clinical diagnosis and treatment of alpha-fetoprotein-negative small hepatic lesions

Objective： We examined 103 cases over the last five years and discussed diagnosis and treatment of alpha- fetoprotein （AFP）-negative small hepatic lesions. Background： Small hepatic lesions （less than 2 cm in diameter） usually have no typical imaging characteristics and therefore are difficult to diagnose, especially when AFP tests provide a negative result. Methods： A total of 103 patients with AFP-negative small hepatic lesions from January 2003 to December 2008 were retrospectively reviewed. Differential diagnosis was performed by digital subtraction angiography （DSA）, dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI）, contrast-enhanced ultrasound （CEUS）, or positron emission tomography-computed tomography （PET-CT） based on the multiplicity of lesions. Ninety-four patients with suspected cancers underwent partial hepatectomy. Clinical data were collected from hospital records and follow-up questionnaires. Results： Hepatocellular carcinoma （HCC） diagnostic sensitivity of DSA, DCE-MRI, CEUS and PET-CT was 88.2%, 93.9%, 88.9% and 88.9%, respectively. The surgery-related complication rate was 6.4%. Prognosis was good, with 1- and 3-year survival rates of 98.8% and 76.1%, respectively. Conclusions： DSA, DCE-MRI, CEUS and PET-CT are valuable for diagnosis of small hepatic lesions. Partial hepatectomy is a preferred surgical procedure. Surgery for small liver cancers usually has little risk and good prognosis, therefore it can be actively applied in suspected HCC cases.

Small bowel ulcerative lesions are common in elderly NSAIDs users with peptic ulcer bleeding

AIM: To determine the frequency of small bowel ulcerative lesions in patients with peptic ulcer and define the significance of those lesions. METHODS: In our prospective study, 60 consecutive elderly patients with upper gastrointestinal bleeding from a peptic ulceration(cases) and 60 matched patients with a non-bleeding peptic ulcer(controls) underwent small bowel capsule endoscopy, after a negative colonoscopy(compulsory in our institution). Controls were evaluated for non-bleeding indications. Known or suspected chronic inflammatory conditions and medication that could harm the gut were excluded. During capsule endoscopy, small bowel ulcerative lesions were counted thoroughly and classified according to Graham classification. Other small bowellesions were also recorded. Peptic ulcer bleeding was controlled endoscopically, when adequate, proton pump inhibitors were started in both cases and controls, and Helicobacter pylori eradicated whenever present. Both cases and controls were followed up for a year. In case of bleeding recurrence upper gastrointestinal endoscopy was repeated and whenever it remained unexplained it was followed by repeat colonoscopy and capsule endoscopy.RESULTS: Forty(67%) cases and 18(30%) controls presented small bowel erosions(P = 0.0001), while 22(37%) cases and 4(8%) controls presented small bowel ulcers(P < 0.0001). Among non-steroidal antiinflammatory drug(NSAID) consumers, 39(95%) cases and 17(33%) controls presented small bowel erosions(P < 0.0001), while 22(55%) cases and 4(10%) controls presented small bowel ulcers(P < 0.0001). Small bowel ulcerative lesions were infrequent among patients not consuming NSAIDs. Mean entry hemoglobin was 9.3(SD = 1.4) g/d L in cases with small bowel ulcerative lesions and 10.5(SD = 1.3) g/dL in those without(P = 0.002). Cases with small bowel ulcers necessitate more units of packed red blood cells. During their hospitalization, 6(27%) cases with small bowel ulcers presented bleeding recurrence most possibly attributed to small bowel ulcers, nevertheless 30-d mortality was zero. Presence of chronic obstructive lung disease and diabetes was related with unexplained recurrence of hemorrhage in logistic regression analysis, while absence of small bowel ulcers was protective(relative risk 0.13, P = 0.05).CONCLUSION: Among NSAID consumers, more bleeders than non-bleeders with peptic ulcers present small bowel ulcers; lesions related to more severe bleeding and unexplained episodes of bleeding recurrence.

Non-small bowel lesion detection at small bowel capsule endoscopy: A comprehensive literature review

Small bowel capsule endoscopy is a minimally-invasive endoscopic investigation that is often used in clinical practice to investigate overt or occult gastrointestinal(GI) bleeding among other clinical indications. International guidance recommends small bowel capsule endoscopy as a first-line investigation to detect abnormalities in the small bowel, when gastroscopy and colonoscopy fail to identify a cause of GI bleeding. It can diagnose with accuracy abnormalities in the small bowel. However, there has been increasing evidence indicating that small bowel capsule endoscopy may also detect lesions outside the small intestine that are within the reach of conventional endoscopy and have been probably missed during prior endoscopic investigations. Such lesions vary from vascular deformities to malignancy and their detection often alters patient management, leading to further endoscopic and/or surgical interventions. The current study attempts to review all available studies in the literature and summarise their relevant findings.

Culprit for recurrent acute gastrointestinal massive bleeding: “Small bowel Dieulafoy's lesions”-a case report and literature review

A Dieulafoy's lesion is a dilated,aberrant,submucosal vessel that erodes the overlying epithelium without evidence of a primary ulcer or erosion.It can be located anywhere in the gastrointestinal tract.We describe a case of massive gastrointestinal bleeding from Dieulafoy's lesions in the duodenum.Etiology and precipitating events of a Dieulafoy's lesion are not well known.Bleeding can range from being self-limited to massive life- threatening.Endoscopic hemostasis can be achieved with a combination of therapeutic modalities.The endoscopic management includes sclerosant injection,heater probe,laser therapy,electrocautery,cyanoacrylate glue,banding,and clipping.Endoscopic tattooing can be helpful to locate the lesion for further endoscopic re-treatment or intraoperative wedge resection.Therapeutic options for re-bleeding lesions comprise of repeated endoscopic hemostasis,angiographic embolization or surgical wedge resection of the lesions.We present a 63-yearold Caucasian male with active bleeding from the two small bowel Dieulafoy's lesions,which was successfully controlled with epinephrine injection and clip applications.

Angiodysplasia Presenting with Multiple Polypoid Lesions: An Unusual Cause of Small Bowel Obstruction

Angiodysplasia (AD), a morphologic vascular abnormality, is a common cause of gastrointestinal bleeding. We present a rare case of polypoid AD lesions. Three years after treatment for adhesive bowel obstruction, a 57-year-old man was admitted with recurrent abdominal distension, anorexia, and lower extremity edema. Computed tomography showed his dilated proximal and collapsed distal small bowel loops had disparate calibers. The transition point demonstrated mucosal enhancement and mesenteric lymphadenopathy. We observed small intestinal wall outpouching with strong mucosal enhancement and polypoid lesions dotting the dilated intestine. Intraoperative findings revealed a hard but elastic intraluminal nodule causing small bowel obstruction and the outpouching’s occurrence on the ileum’s antimesenteric border. We performed partial resection of the small intestine involving the nodule and Meckel’s diverticulum. Macroscopically, the nodule, diverticulum, and intestinal mucosa had polypoid lesions. Histopathologically, these lesions had foci within dilated thin- or thick-walled vascular channels in the submucosa, without specific histological abnormalities. These features led to a diagnosis of AD.

Two cameras detect more lesions in the small-bowel than one

AIM:To explore the feasibility of dual camera capsule (DCC)small-bowel(SB)imaging and to examine if two cameras complement each other to detect more SB lesions.METHODS:Forty-one eligible,consecutive patients underwent DCC SB imaging.Two experienced investigators examined the videos and compared the total number of detected lesions to the number of lesions detected by each camera separately.Examination tolerability was assessed using a questionnaire.RESULTS:One patient was excluded.DCC cameras detected 68 positive findings(POS)in 20(50%)cases.Fifty of them were detected by the"yellow"camera,48 by the"green"and 28 by both cameras;44%(n=22)of the"yellow"camera’s POS were not detected by the"green"camera and 42%(n=20)of the"green" camera’s POS were not detected by the"yellow"camera.In two cases,only one camera detected significant findings.All participants had 216 findings of unknown significance(FUS).The"yellow","green"and both cameras detected 171,161,and 116 FUS,respectively;32%(n=55)of the"yellow"camera’s FUS were not detected by the"green"camera and 28%(n=45)of the"green"camera’s FUS were not detected by the "yellow"camera.There were no complications related to the examination,and 97.6%of the patients would repeat the examination,if necessary.CONCLUSION:DCC SB examination is feasible and well tolerated.The two cameras complement each other to detect more SB lesions.

Uncovering the uncertainty: Risk factors and clinical relevance of P1 lesions on small bowel capsule endoscopy of anemic patients

AIM To identify risk factors for P1 lesions on small bowel capsule endoscopy(SBCE) and to describe the natural history of anemic patients with such type of lesions.METHODS One hundred patients were consecutively selected for a case-control analysis performed between 37 cases with P1 lesions and 63 controls with negative SBCE. Age, gender, comorbidities and regular medication were collected. Rebleeding, further investigational studies and death were also analyzed during the follow-up.RESULTS No significant differences on gender, median age or Charlson index were found between groups. Although no differences were found on the use of proton pump inhibitors, acetylsalicylic acid, anticoagulants or antiplatelet agents, the use of non-steroidal antiinflammatory drugs(NSAID) was associated with a higher risk of P1 lesions(OR = 12.00, 95%CI: 1.38-104.1). From the 87 patients followed at our center, 39 were submitted to additional studies for investigation of iron-deficiency anemia(IDA), and this was significantly more common in those patients with no findings on SBCE(53.7% vs 30.3%, P = 0.033). A total of 29 patients had at least one rebleeding or IDA recurrence episode and 9 patients died of non-anemia related causes but no differences were found between cases and controls.CONCLUSION P1 lesions are commonly found in patients with IDA submitted to SBCE. The use of NSAID seems to be a risk factor for P1 lesions. The outcomes of patients with P1 lesions do not differ significantly from those with P0 lesions or normal SBCE.

512层螺旋CT薄层扫描结合计算机人工神经网络对小肠病变的诊断价值研究

目的:运用图像识别和图像描述技术,研究512层螺旋CT薄层扫描结合计算机人工神经网络在小肠病变诊断上的应用价值。方法:建立基于ResNet 101、Faster R-CNN、LSTM的小肠CT图像识别描述人工神经网络模型,采用ResNet 101和Faster R-CNN联合提取图像特征信息进行ROI融合建立图像编码,采用LSTM进行图像解码输出CT图像诊断报告。设计11个病变图像特征标签,选择我院2020年1月—2022年1月行512层螺旋CT薄层扫描病例材料1572套,材料覆盖正常图像及出血、炎性息肉等9种病变类型,按7∶3随机分为训练组和测试组,对模型进行训练并展开性能测试,评价模型输出的CT诊断文字报告质量、诊断准确率及病变部位提取正确率。结果:文字报告质量评分为(4.0325±0.684)分,出现错误评估项样本占比0.8%,仅语句结合约35%存在不合理现象;各病变类型诊断准确率均在97%左右,仅腺癌存在轻微的诊断为腺瘤性息肉现象,整体病变类型诊断正确率97.17%;病变部位正确识别提取率99.43%。结论:基于ResNet 101、Faster R-CNN、LSTM建立人工神经网络模型,进行小肠512层螺旋CT扫描图像的诊断识别,可准确定位图像病变部位,根据病变部位图像特征准确进行病变类型诊断,并就11个CT图像特征进行文字化描述,输出符合医师阅读理解的图像诊断报告,并发现部分医师人工阅片遗漏错误的地方,可为医师提供更为丰富、有效、准确的CT图像诊断信息,有利于医师作出正确的诊断。

初发小血管闭塞型脑梗死患者合并脑白质变性危险因素的研究

目的探讨初发小血管闭塞(SAO)型脑梗死患者合并脑白质变性(WML)的危险因素。方法选择2019年1月至2022年7月亳州市人民医院神经内科收治的150例初发SAO型脑梗死患者,根据WML情况将患者分为无WML组30例、轻度WML组52例和中重度WML组68例。回顾性分析三组患者的临床资料后采用多因素Logistic回归分析初发SAO型脑梗死患者合并WML的相关危险因素,ROC曲线分析相关危险因素对初发SAO型脑梗死患者合并WML的预测价值。结果三组患者年龄、高血压、尿酸水平、美国国立卫生研究院卒中量表评分差异有统计学意义(χ2/F=6.350、12.600、6.630、5.485,P<0.05)。多因素Logistic回归分析显示,高血压和年龄是初发SAO型脑梗死合并WML的危险因素(OR=7.039、1.090,P<0.01)。ROC曲线显示高血压和年龄预测初发SAO型脑梗死患者合并WML的AUC分别为0.691、0.698,最佳截断值分别为150/90 mmHg、56.50岁,约登指数分别为0.383、0.389,敏感度分别为73.52%、71.70%,特异度分别为68.42%、67.20%。结论高血压和年龄是初发SAO型脑梗死患者合并WML的危险因素,高血压和年龄对预测初发SAO型脑梗死患者合并WML均有一定价值。

基于Swin Transformer网络与Adapt-RandAugment数据增强方法的小肠胶囊内镜图像分类方法研究

目的:为提高小肠病变分类识别的准确性,提出一种基于Swin Transformer网络与Adapt-RandAugment数据增强方法的小肠胶囊内镜图像分类方法。方法:基于RandAugment数据增强子策略和增强小肠胶囊内镜图像时不丢失特征、不失真的原则提出Adapt-RandAugment数据增强方法。在公开的小肠胶囊内镜图像Kvasir-Capsule数据集中,基于Swin Transformer网络,采用Adapt-RandAugment数据增强方法进行训练,以卷积神经网络ResNet152、DenseNet161为基准,验证Swin Transformer网络和Adapt-RandAugment数据增强方法组合对小肠胶囊内镜图像分类识别的性能。结果:提出的方法宏平均精度(macro average precision,MAC-PRE)、宏平均召回率(macro average recall,MAC-REC)、宏F1分数(macro average F1 score,MAC-F1-S)分别为0.3832、0.3148、0.2905,微平均精度(micro average precision,MIC-PRE)、微平均召回率(micro average recall,MIC-REC)、微平均F1分数(micro average F1 score,MIC-F1-S)均为0.7553,马修斯相关系数(Matthews correlation coefficient,MCC)为0.4523,均优于ResNet152和DenseNet161网络。结论:基于Swin Transformer网络与Adapt-RandAugment数据增强方法的小肠胶囊内镜图像分类方法具有较好的小肠胶囊内镜图像分类识别效果和较高的识别准确率。

胶囊内镜中人工智能的应用现状

胶囊内镜(CE)是检测小肠病变的主要手段,然而一次检查产生约6万张图像,筛选病变图像耗时、枯燥,且受医师经验和专业技术水平影响,易造成漏诊。近年来,人工智能(AI)逐渐深入医学领域,以卷积神经网络(CNN)为代表的深度学习(DL)模型对病灶具有快速识别能力,可在有效降低漏诊率的同时提高病变诊断率。本文就AI技术在CE图像识别中的应用现状作一综述,为其在CE领域的持续发展提供借鉴。

Small intestine contrast ultrasonography vs computed tomography enteroclysis for assessing ileal Crohn's disease

AIM:To compare computed tomography enteroclysis(CTE) vs small intestine contrast ultrasonography(SICUS) for assessing small bowel lesions in Crohn's disease(CD),when using surgical pathology as gold standard.METHODS:From January 2007 to July 2008,15 eligible patients undergoing elective resection of the distal ileum and coecum(or right colon) were prospectively enrolled.All patients were under follow-up.The study population included 6 males and 9 females,with a median age of 44 years(range:18-80 years).Inclusion criteria:(1) certain diagnosis of small bowel requiring elective ileo-colonic resection;(2) age between 18-80 years;(3) elective surgery in our Surgical Unit;and(4) written informed consent.SICUS and CTE were performed ≤ 3 mo before surgery,followed by surgical pathology.The following small bowel lesions were blindly reported by one sonologist,radiologist,surgeon and histolopathologist:disease site,extent,strictures,abscesses,fistulae,small bowel dilation.Comparison between findings at SICUS,CTE,surgical specimens and histological examination was made by assessing the specificity,sensitivity and accuracy of each technique,when using surgical findings as gold standard.RESULTS:Among the 15 patients enrolled,CTE was not feasible in 2 patients,due to urgent surgery in one patients and to low compliance in the second patient,refusing to perform CTE due to the discomfort related to the naso-jejunal tube.The analysis for comparing CTE vs SICUS findings was therefore performed in 13 out of the 15 CD patients enrolled.Differently from CTE,SICUS was feasible in all the 15 patients enrolled.No complications were observed when using SICUS or CTE.Surgical pathology findings in the tested population included:small bowel stricture in 13 patients,small bowel dilation above ileal stricture in 10 patients,abdominal abscesses in 2 patients,enteric fistulae in 5 patients,lymphnodes enlargement(> 1 cm) in 7 patients and mesenteric enlargement in 9 patients.In order to compare findings by using SICUS,CTE,histology and surgery,characteristics of the small bowel lesions observed in CD each patient were blindly reported in the same form by one gastroenterologistsonologist,radiologist,surgeon and anatomopathologist.At surgery,lesions related to CD were detected in the distal ileum in all 13 patients,also visualized by both SICUS and CTE in all 13 patients.Ileal lesions > 10 cm length were detected at surgery in all the 13 CD patients,confirmed by SICUS and CTE in the same 12 out of the 13 patients.When using surgical findings as a gold standard,SICUS and CTE showed the exactly same sensitivity,specificity and accuracy for detecting the presence of small bowel fistulae(accuracy 77% for both) and abscesses(accuracy 85% for both).In the tested CD population,SICUS and CTE were also quite comparable in terms of accuracy for detecting the presence of small bowel strictures(92% vs 100%),small bowel fistulae(77% for both) and small bowel dilation(85% vs 82%).CONCLUSION:In our study population,CTE and the non-invasive and radiation-free SICUS showed a comparable high accuracy for assessing small bowel lesions in CD.

Bleeding Dieulafoy's-like lesions of the gut identified by capsule endoscopy

Dieulafoy's-like lesions (DLs-like) represent a cause of obscure gastrointestinal bleeding, enteroscopy being the main diagnostic and therapeutic procedure. Frequently, more than one enteroscopy is needed to identify the bleeding vessel. In our practice, video capsule endoscopy (VCE) identified and guided therapy in four cases of DLs-like; three of them were localized on the small bowel. We report, for the first time, a diagnosis of colonic DL-like performed by colon capsule endoscopy. Two patients presented with severe cardiovascular disorders, being hemodynamically unstable during VCE examination. Based on the VCE findings, only one invasive therapeutic procedure per patient was necessary to achieve hemostasis. VCE and enteroscopy may be regarded as complementary procedures in patients with gut DLs-like.

药物洗脱球囊治疗冠状动脉极小血管原位病变有效性与安全性

目的 分析药物洗脱球囊(DCB)治疗冠状动脉(冠脉)极小血管原位病变的安全性及有效性。方法 连续前瞻性入选2019年11月至2020年5月于北京安贞医院等六家医院心内科收入的冠脉病变血管<2.0 mm且接受DCB治疗的原位病变患者29例,在术后9个月有18例(56.25%)患者行随访冠脉造影检查和定量分析。观察入组患者DCB治疗前后血管腔变化并记录不良事件发生率。观察终点是随访时冠脉造影的晚期管腔丢失(LLL)和主要不良心血管事件(MACE),包括靶病变血运重建、死亡、心肌梗死及复合终点。结果 纳入病例靶病变参考血管平均直径为(1.71±0.27) mm,靶病变术前最小管腔直径(MLD)为(0.31±0.24) mm,靶病变LLL平均为(0.13±0.28) mm,术后即刻MLD(1.19±0.20) mm及术后9个月靶血管MLD (1.06±0.31) mm均明显大于术前(P<0.05)。1例患者(5.56%)进行了再次血运重建,DCB处理后随访期间,无心梗或死亡发生。结论 DCB治疗冠脉极小血管原位病变有效、安全。

Latest developments in precancerous lesions of hepatocellular carcinoma

Hepatocarcinogenesis in human chronic liver diseases is a multi-step process in which hepatic precancerous lesions progress into early hepatocellular carcinoma(HCC) and progressed HCC, and the close surveillance and treatment of these lesions will help improve the survival rates of patients with HCC. The rapid development and extensive application of imaging technology have facilitated the discovery of nodular lesions of ambiguous significance, such as dysplastic nodules. Further investigations showed that these nodules may be hepatic precancerous lesions, and they often appear in patients with liver cirrhosis. Although the morphology of these nodules is not sufficient to support a diagnosis of malignant tumor, these nodules are closely correlated with the occurrence of HCC, as indicated by long-term follow-up studies. In recent years, the rapid development and wide application of pathology, molecular genetics and imaging technology have elucidated the characteristics of precancerous lesions. Based on our extensive review of the relevant literature, this article focuses on evidence indicating that high-grade dysplastic nodules are more likely to transform into HCC than low-grade dysplastic nodules based on clinical, pathological, molecular genetic and radiological assessments. In addition, evidence supporting the precancerous nature of large cell change in hepatitis B virus-related HCC is discussed.

超脉冲CO_(2)激光治疗睑缘小肿物的临床研究

目的:超脉冲二氧化碳(CO_(2))激光气化治疗睑缘小肿物。方法:对睑缘小肿物200例患者,采用超脉冲二氧化碳激光进行治疗,根据眼睑小肿物病变情况,使用能量范围区间125-150mJ,光斑直径为0.21mm。6个月后,观察临床疗效。结果:148例患者术后2周左右创面湿性愈合,其余52例患者愈合时间稍长。其中睑缘疣状物113例,一次性完全治愈;色素痣47例,42例一次治愈,2例进行二次复点治疗后完全治愈,3例复发;肉芽炎性增生10例,乳头状瘤4例,都一次治愈;皮肤血管瘤14例,1例复发,黄色瘤12例,2例复发。患者睑缘治疗部位愈合良好,无瘢痕,无睫毛损伤。治疗总有效率为97%。结论:超脉冲CO_(2)激光治疗睑缘小肿物,医师操作灵活方便,病变部位治疗面积和深度把控精准,病人不需要特殊检查化验,治疗费用低,无须住院,治疗完即可回家,后续涂药修复即可,而且治疗效果满意,值得临床推广。

识别脑卒中微小病灶的多维度图像分割模型和系统开发

目的开发一种基于深度学习的多维度分割系统,在磁共振成像(magnetic resonance imaging,MRI)影像中识别微小病灶,为急性缺血性脑卒中(acute ischemic stroke,AIS)的诊治提供决策依据。方法提取并融合2D、3D网络的特征,引入了联合损失函数,进而提出了一种新的2.5D方法——多维度多尺度注意力增强网络(multi-dimensional multi-scale attention enhanced network,MMAE-Net)。在AIS分割数据集(训练集171例、测试集43例)上训练和测试了所提方法的性能,并与其他方法进行比较。结果相较于2D、3D网络,2.5D网络(MMAE-Net)在各项评价指标上均可取得最优异的分割性能,获得了81.25%的Dice相似系数(dice similarity coefficient,DSC)和84.82%的灵敏度(sensitivity,SEN)。相较于U-Net、ResU-Net、DenseU-Net、AttentionU-Net和SEgmentation TRansformer(SETR)等经典方法和既往研究,MMAE-Net取得了更优异的分割性能。我们还开发了可视化自动分割系统以提升方法的实践和推广能力。结论本文基于2D、3D特征融合的理念设计了2.5D多维度分割模型MMAE-Net,其在MRI微小病灶的识别中取得了优异性能,为AIS疾病诊治提供了有效的解决方案。

远端缺血预处理对皮质下缺血性血管性痴呆患者认知能力的改善作用

目的:评价远端缺血预处理(RIPC)对皮质下缺血性血管性痴呆(SIVD)患者认知能力的改善作用。方法:选取2019年1月—2021年1月佳木斯市中心医院诊治的74例SIVD患者,按随机数字表法分为治疗组36例,对照组38例,治疗组进行RIPC治疗,对照组给予安慰剂治疗,为期3个月,比较两组治疗前后认知能力评分、血清炎症因子和磁共振成像参数。结果:治疗前两组认知能力评分、血清炎症因子和影像学参数比较差异均无统计学意义(P>0.05)。治疗后,治疗组霍普金斯词语学习测验修订版(HVLT-R)、受控口头词语联想测试(COWAT)、连线试验A和B(TMT-A、TMT-B)及线方向判断(JLO)评分优于治疗前(P<0.05);治疗组所有炎症因子均低于治疗前和对照组(P<0.05);对照组仅HVLT-R和TMT-B评分优于治疗前,差异均有统计学意义(P<0.05)。磁共振成像参数组间及组内治疗前后比较差异均无统计学意义(P>0.05)。所有患者均顺利完成治疗,无明显不良反应。结论:RIPC可在一定程度上改善SIVD患者的认知功能,且无明显不良反应。

脑小血管病患者血清SIRT1水平与脑白质病变及认知障碍的相关性分析

目的研究脑小血管病(CSVD)患者血清沉默信息调节因子1(SIRT1)水平与脑白质病变严重程度及认知障碍的相关性。方法选择CSVD患者209例,ELISA法检测入院次日血清SIRT1水平。使用Fazekas量表对入组患者脑白质病变进行评分,并评估CSVD患者的腔隙性梗死、脑微出血和血管周围间隙增大。为评估SIRT1和CSVD疾病进展之间的关系,对CSVD的每个影像学标志物的负荷进行评分,并根据Fazekas量表评分将脑白质病变分为轻度无症状WMH组与中重度WMH组。分析入组患者血清SIRT1表达水平与不同程度的脑白质病变是否相关,以及血清SIRT1表达水平与患者认知功能之间的相关性。结果在多变量logistic回归分析中,校正了其他混杂因素后,SIRT1仍然是中重度WMH(OR=1.25,95%CI=1.034~1.512,P=0.021)的独立预测因素,血清SIRT1表达水平与腔隙性脑梗死(OR=0.979,95%CI=0.817~1.173,P=0.819),脑微出血(OR=0.996,95%CI=0.860~1.153,P=0.958)和中重度EPVS(OR=1.147,95%CI=0.956~1.377,P=0.141)无显著相关。此外,SIRT1与Fazekas评分(r=0.262,P=0.001)、EPVS负荷(r=0.237,P=0.001)呈正剂量依赖性显著相关。结论血清SIRT1水平与CSVD患者WMH严重程度呈剂量依赖关系,并与脑小血管病患者认知功能改变密切相关。这些发现为今后研究CSVD发生发展的病理生理学提供了线索。

药物涂层球囊治疗老年冠状动脉分支开口病变病人的疗效观察

目的探讨药物涂层球囊(DCB)治疗老年冠状动脉分支开口病变的疗效。方法回顾性分析南京市第一医院2018年1月至2021年6月确诊的81例老年冠状动脉分支开口病变病人,收集并分析其一般临床资料、实验室检查结果、冠状动脉造影定量分析结果以及介入治疗经过及随访结果。结果冠状动脉分支开口病变病人共81例,其中男58例,女23例,平均年龄为(70.1±7.1)岁。临床表现为ST段抬高型心肌梗死9例,非ST段抬高型心肌梗死7例,不稳定型心绞痛55例,稳定型心绞痛10例。81处靶病变中,29例为回旋支开口病变,44例为第一对角支开口病变,4例为钝缘支开口病变,4例为后侧支开口病变。病变长度为(18.98±6.40)mm,DCB长度为(20.38±3.26)mm,即刻管腔获得(1.12±0.32)mm。5例病人DCB后出现C型以上的夹层,均行补救性植入支架。随访期间4例病人行再次靶病变血运重建治疗,其中3例发生在DCB治疗后,1例为补救性支架治疗术后;均未出现死亡及心肌梗死。复查造影显示最小管腔直径和直径狭窄程度较术后即刻差异无统计学意义,晚期管腔丢失(0.02±0.32)mm。结论DCB治疗冠状动脉分支开口病变安全有效,但仍有待于大规模随机对照研究证实。