Effects of cytoreductive surgery combined with hyperthermic perfusion chemotherapy on prognosis of patients with advanced gallbladder cancer

BACKGROUND Gallbladder cancer(GC)is a common malignant tumor and one of the leading causes of cancer-related death worldwide.It is typically highly invasive,difficult to detect in the early stages,and has poor treatment outcomes,resulting in high mortality rates.The available treatment options for GC are relatively limited.One emerging treatment modality is hyperthermic intraperitoneal chemotherapy(HIPEC).HIPEC involves delivering heated chemotherapy directly into the abdominal cavity.It combines the strategies of surgical tumor resection and localized chemotherapy administration under hyperthermic conditions,aiming to enhance the concentration and effectiveness of drugs within the local tumor site while minimizing systemic toxicity.AIM To determine the effects of cytoreductive surgery(CRS)combined with HIPEC on the short-term prognosis of patients with advanced GC.METHODS Data from 80 patients treated at the Punan Branch of Renji Hospital,Shanghai Jiao Tong University School of Medicine between January 2018 and January 2020 were retrospectively analyzed.The control group comprised 44 patients treated with CRS,and the research group comprised 36 patients treated with CRS combined RESULTS The baseline data of the research and control groups were similar(P>0.05).Six days after surgery,the alanine aminotransferase,aspartate aminotransferase,total bilirubin,and direct bilirubin levels significantly decreased compared to the preoperative levels in both groups(P<0.05).However,the values did not differ between the two groups six days postoperatively(P>0.05).Similarly,the postoperative creatinine and blood urea nitrogen levels were significantly lower than the preoperative levels in both groups(P<0.05),but they did not differ between the groups six days postoperatively(P>0.05).Furthermore,the research group had fewer postoperative adverse reactions than the control group(P=0.027).Finally,a multivariate Cox analysis identified the tumor stage,distant metastasis,and the treatment plan as independent factors affecting prognosis(P<0.05).The three-year survival rate in the study group was higher than that in the control group(P=0.002).CONCLUSION CRS combined with HIPEC lowers the incidence of adverse reactions and improves survival in patients with advanced GC.

Reduced Heart Rate Response during Drug-Induced Stress Is Related to the Severity of Perfusion Defect

Introduction: During the pharmacological stress test with dipyridamole, a normal hemodynamic response is slightly reduced blood pressure and raised heart rate (HR). However, sometimes the HR response is reduced. This study investigated the relationship between the HR response during the dipyridamole stress test and the severity of the perfusion defects using Thallium 201 myocardial perfusion imaging. Methods: We enrolled 50 patients undergoing dipyridamole stress at the nuclear cardiology Lab, Main University Hospital of Alexandria. Standard dipyridamole protocol (infusion over 4 min) and standard thallium 201 protocol (2 min after dipyridamole infusion) were followed. If the heart rate (HR) ratio (peak HR/rest HR) was 1.20 or less, it was considered a reduced response. Total perfusion defect (TPD), summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) for myocardial perfusion were calculated. Patients with reduced HR response and normal HR responses were compared and independent predictors of reduced HR response were determined. Results: About 56% of patients had reduced HR response;which included a high number of patients with a history of dyslipidemia and diabetes mellitus. The reduced HR response group showed lower SSS, SRS. The analysis showed that the independent predictors of reduced HR response were rest HR, SSS, and diabetes mellitus. Conclusions: Reduction in the HR response during the dipyridamole-induced stress test is related to the severity of perfusion defect, diabetes mellitus, and Dyslipidemia.

A harmonic-wave bio-thermal method for continuous monitoring skin thermal conductivity and capillary perfusion rate

The revelation of thermal energy exchange mechanism of human body is challenging yet worthwhile,because it can clearly explain the changes in human symptoms and health status.Understanding,the heat transfer of the skin is significant because the skin is the foremost organ for the energy exchange between the human body and the environment.In order to diagnose the physiological conditions of human skin without causing any damage,it is necessary to use a non-invasive measurement technique by means of a conformal flexible sensor.The harmonic method can minimize the thermal-induced injury to the skin due to its low heat generating properties.A novel type of computational theory assessing skin thermal conductivity,blood perfusion rate of capillaries in the dermis,and superficial subcutaneous tissues was formed by combining the multi-medium thermal diffusion model and the bio-thermal model(Pennes equation).The skins of the hand back of six healthy subjects were measured.It was found that the results revealed no consistent changes in thermal conductivity were observed across genders and ages.The measured blood perfusion rates were within the range of human capillary flow.It was found that female subjects had a higher perfusion rate range(0.0058-0.0061 s^(-1))than male subjects(0.0032-0.0049 s^(-1)),which is consistent with invasive medical studies about the gender difference in blood flow rates and stimulated effects in relaxation situations.

Intestinal injury can be reduced by intra-arterial postischemic perfusion with hypertonic saline

AIM:To investigate the effect of local intestinal perfusion with hypertonic saline(HTS) on intestinal ischemia-reperfusion injury(IRI) in bothex vivo andin vivo rat models.METHODS:All experiments were performed on male Wistar rats anesthetized with pentobarbital sodium given intraperitoneally at a dose of 60 mg/kg.Ex vivo vascularly perfused rat intestine was subjected to 60-min ischemia and either 30-min reperfusion with isotonic buffer(controls),or 5 min with HTS of 365 or 415 mOsm/L osmolarity(HTS 365mOsm or HTS 415mOsm,respectively) followed by 25-min reperfusion with isotonic buffer.The vascular intestinal perfusate flow(IPF) rate was determined by collection of the effluent from the portal vein in a calibrated tube.Spontaneous intestinal contraction rate was monitored throughout.Irreversible intestinal injury or area of necrosis(AN) was evaluated histochemically using 2.3.5-triphenyltetrazolium chloride staining.In vivo,30-min ischemia was followed by either 30-min blood perfusion or 5-min reperfusion with HTS 365mOsm through the superior mesenteric artery(SMA) followed by 25-min blood perfusion.Arterial blood pressure(BP) was measured in the common carotid artery using a miniature pressure transducer.Histological injury was evaluated in both preparations using the Chui score.RESULTS:Ex vivo,intestinal IRI resulted in a reduction in the IPF rate during reperfusion(P < 0.05 vs sham).The postischemic recovery of the IPF rate did not differ between the controls and the HTS 365mOsm group.In the HTS 415mOsm group,postischemic IPF rates were lower than in the controls and the HTS 365mOsm group(P < 0.05).The intestinal contraction rate was similar at baseline in all groups.An increase in this parameter was observed during the first 10 min of reperfusion in the control group as compared to the sham-treated group,but no such increase was seen in the HTS 365mOsm group.In controls,AN averaged 14.8% ± 5.07% of the total tissue volume.Administration of HTS 365mOsm for 5 min after 60-min ischemia resulted in decrease in AN(5.1% ± 1.20% vs controls,P < 0.01).However,perfusion of the intestine with the HTS of greater osmolarity(HTS 415mOsm) failed to protect the intestine from irreversible injury.The Chiu score was lower in the HTS 365mOsm group in comparison with controls(2.4 ± 0.54 vs 3.2 ± 0.44,P = 0.042),while intestinal perfusion with HTS 415mOsm failed to improve the Chiu score.Intestinal reperfusion with HTS 365mOsm in the in vivo series secured rapid recovery of BP after its transient fall,whereas in the controls no recovery was seen.The Chiu score was lower in the HTS 365mOsm group vs controls(3.1 ± 0.26 and 3.8 ± 0.22,P = 0.0079 respectively,),although the magnitude of the effect was lower than in the ex vivo series.CONCLUSION:Brief intestinal postischemic perfusion with HTS 365mOsm through the SMA followed by blood flow restoration is a protective procedure that could be used for the prevention of intestinal IRI.

坡率对半柔性路面材料灌注率及路用性能的影响

基于半柔性路面材料灌浆工艺的独特性,为探究坡率对其灌注率及路用性能的影响,采用3种不同流动度的灌浆料,在5个设计坡率下制备半柔性路面试件。通过计算和试验,系统评价了坡率对半柔性路面材料灌注率、高温稳定性、水稳定性及抗滑性能等关键指标的影响规律。结果显示,随着坡率的增加,半柔性路面材料的灌注率和水稳定性呈下降趋势,而高温稳定性则先增大后减小。坡度对半柔性路面构造深度的影响显著,坡率越大,坡底和坡顶的构造深度差异越大,抗滑性能受到不利影响。针对上述问题,研究提出了施工工艺优化措施,并通过室内试验加以验证。

成人烟雾病不同临床表现患者全脑CTP与CTA影像特征研究

目的通过观察分析成人烟雾病的脑动脉CT血管成像(CTA)及全脑CT灌注成像(CTP)图像的特点,探讨成人烟雾病出血型、缺血型及无症状型患者的影像学特征。方法回顾性分析82例成人烟雾病患者的临床资料、全脑CTA和CTP图像,以20例健康人作为对照组。根据82例成人烟雾病患者临床表现分为脑出血组(32例,64个大脑半球)、脑缺血组(26例,52个大脑半球)和无症状组(24例,48个大脑半球),分析各组CTA改良法Suzuki分级差异、CTP灌注参数值[脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)、达峰时间(TTP)]的差异。结果CTA改良法Suzuki分级结果为无症状组患者多为Ⅰ级(39.6%),脑缺血组患者多为Ⅳ级(59.6%),脑出血组患者多为Ⅱ~Ⅲ级(68.7%),无症状组、脑缺血组、脑出血组任意两组间改良法Suzuki分级情况比较,差异均有统计学意义(P<0.05)。无症状组CBV、CBF、MTT及TTP与对照组比较,差异均无统计学意义(P>0.05)。脑缺血组CBV、CBF明显低于对照组,MTT、TTP较对照组明显延长,差异均有统计学意义(P<0.05)。脑出血组CBV、CBF与对照组比较,差异均无统计学意义(P>0.05),但MTT、TTP较对照组明显延长(P<0.05)。脑缺血组CBV、CBF与脑出血组相比,差异均有统计学意义(P<0.05);无症状组的CBV、CBF、MTT、TTP与脑缺血组相比,差异均有统计学意义(P<0.05);无症状组MTT、TTP与脑出血组相比,差异均有统计学意义(P<0.05)。结论成人烟雾病出血型、缺血型及无症状型患者的脑动脉CTA改良法Suzuki分级及全脑CTP灌注参数具有一定的差异,对临床个性化诊疗具有指导意义。

肝动脉灌注化疗栓塞术联合信迪利单抗治疗晚期原发性肝癌近期疗效及远期生存率

目的 探讨肝动脉灌注化疗栓塞术(TACE)联合信迪利单抗治疗晚期原发性肝癌(PLC)的近期疗效及远期生存率。方法2018年4月至2019年4月在资阳市人民医院82个随机双盲实验中,对符合AASLD指南,巴塞罗那(BCLC)分期为B/C期者;肝功能Child-Pugh分级A/B级的PLC进行研究。经计算机生成的随机列表随机分配,对照组仅行TACE治疗,研究组则采用TACE联合信迪利单抗治疗,连续治疗4周期比较两组临床疗效、肿瘤标志物水平T淋巴细胞亚群指标变化,随访观察远期生存情况。结果 对照组和研究组病人各41例,治疗后1个月时对照组肿瘤控制率(DCR)为80.49%,研究组DCR为92.68%,组间差异无统计学意义(χ^(2)=2.63,P=0.105);治疗后3个月时研究组DCR为87.80%,明显高于对照组的73.17%,组间差异有统计学意义(χ^(2)=4.00,P=0.046)。治疗前,研究组甲胎蛋白(AFP)、高尔基体蛋白73(GP-73)及甲胎蛋白异质体3(AFP-L3)水平分别为(82.74±5.77)μg/L、(90.27±4.67)μg/L及(148.74±62.15)mg/L,对照组3项指标水平依次为(84.28±6.02)μg/L、(89.74±5.32)μg/L、(156.20±41.03)mg/L,组间数据差异无统计学意义(t=1.18,t=0.48,t=0.64,P>0.05);治疗后研究组AFP、GP-73及AFP-L水平分别为(14.22±2.60)μg/L、(49.39±5.63)μg/L、(82.41±21.75)mg/L,均显著低于对照组的(57.13±6.21)μg/L、(65.28±3.74)μg/L、(117.20±35.62)mg/L,组间差异有统计学意义(t=40.81,t=15.05,t=5.34,P<0.05)。治疗前,研究组CD4+、CD8+及CD4+/CD8+水平分别为(29.17±6.33)%、(27.86±3.92)%、(1.04±0.25),对照组依次为(28.63±5.41)%、(28.53±4.63)%及(1.01±0.20),组间差异无统计学意义(t=0.42,t=0.73,t=0.60,P>0.05);治疗后研究组CD4+、CD4+/CD8+水平分别为(36.28±4.11)%、(1.33±0.40),显著高于对照组的(30.52±5.01)%及(1.09±0.32),组间差异有统计学意义(t=5.69,t=3.00,P<0.05)。治疗前,研究组CD151、CD168、CD9及CD63分别为(94.18±18.33)%、(96.27±16.08)%、(98.52±16.33)%、(94.57±10.96)%,对照组4项数据水平依次为(96.31±21.05)%、(97.24±14.20)%、(99.36±17.41)%、(93.64±12.60)%,组间差异无统计学意义(t=0.49,t=0.29,t=0.23,t=0.36,P>0.05);治疗后研究组CD151、CD168指标水平分别为(32.06±6.34)%、(31.28±4.78)%,显著低于对照组的(87.36±15.03)%、(76.34±11.52)%,而CD9及CD63水平分别为(210.54±27.12)%、(247.02±30.21)%,显著高于对照组的(104.52±12.94)%、(110.32±16.30)%,组间差异有统计学意义(t=21.71,t=23.13,t=22.59,t=25.50,P<0.05)。治疗后随访36~48个月,研究组失访3例,总生存率为47.37%,对照组失访1例,总生存率为25.0%,组间差异有统计学意义(χ^(2)=4.24,P=0.040)。研究组≥3级毒副反应总发生率为13.16%,与对照组27.5%差异无统计学意义(χ^(2)=2.46,P=0.117)。结论 TACE联合PD-1治疗晚期PLC可降低机体肿瘤标志物水平、提升病人的免疫功能及近期疗效,同时可延长病人远期生存率,严重毒副反应发生率较低。

腹腔镜肝切除术中不同肌松程度对肝脏灌注和肝功能的影响

目的比较腹腔镜肝切除术中深度和中度神经肌肉阻滞(以下简称:肌松)对肝脏灌注和围术期肝功能的影响。方法选择2021年12月至2022年12月于复旦大学附属肿瘤医院择期行腹腔镜肝切除术患者60例,随机分为深度肌松组(D组,n=30)和中度肌松组(M组,n=30)。麻醉诱导时,D组给予罗库溴铵0.9 mg/kg,M组给予罗库溴铵0.6 mg/kg,术中持续输注罗库溴铵,维持D组强直刺激后计数(post-tetanic count,PTC)1-2和M组四个成串刺激(train-of-four ratio,TOF)1-2。两组患者分别于麻醉诱导后和标本切除后,静脉给予吲哚菁绿(indocyanine green,ICG)0.25 mg/kg,监测ICG 15 min残留率(retention rate at fifteen minutes,ICG_(R15))。记录两组患者术中罗库溴铵用量、外科手术操作满意度、术后肩膀疼痛以及术后第一天肝功能和呕吐发生情况。结果与M组相比,D组罗库溴铵用量明显增加(P<0.01),但两组间麻醉诱导后和标本切除后ICG_(R15)差异均无统计学意义(P=0.581),围术期肝功能各指标差异亦无统计学意义。与M组相比,D组外科满意度评分明显升高(P<0.05),术后肩膀痛发生率(P=0.037,OR=1.37,95%CI:1.01~1.86)及术后第一天呕吐发生率(P=0.017,OR=1.64,95%CI:1.07~2.53)明显降低。结论与中度肌松组相比,腹腔镜肝切除术中深度肌松组外科手术操作满意度增加,术后肩部疼痛以及呕吐发生率降低,但两组患者术中肝脏灌注及围术期肝功能未发现明显差异。

舌下微循环灌注血管比例变化率联合血清多配体蛋白聚糖-1水平对脓毒症休克并急性呼吸窘迫综合征预后的预测价值

目的:探讨舌下微循环灌注血管比例变化率(ΔPPV)联合血清多配体蛋白聚糖-1(SDC-1)水平对脓毒症休克并急性呼吸窘迫综合征(ARDS)预后的预测价值。方法:选取2021年10月至2023年1月入住本院呼吸重症监护病房的脓毒症休克并ARDS患者,采集确诊后0、6、24和72 h的外周血,检测SDC-1、乳酸(Lac)等实验室指标,并收集相同时间点的舌下微循环图像,计算得到ΔPPV、乳酸清除率(LCR);分别于0、24 h和72 h行序贯器官衰竭(SOFA)评分。根据28 d生存情况分为生存组和死亡组。选取2组间单因素分析有意义的变量及72 hΔPPV联合SDC-1绘制ROC曲线,分析上述指标预测脓毒症休克并ARDS患者28 d内死亡的价值。结果:ROC分析结果显示,24 h SDC-1、LCR,72 h SOFA评分、ΔPPV、SDC-1及72 hΔPPV联合SDC-1对预后有预测价值(P均<0.05),其中72 hΔPPV联合SDC-1曲线下面积最大[AUC(95%CI)为0.832(0.721~0.943)],敏感度为0.931,特异度为0.680。结论:72 hΔPPV联合SDC-1比单一指标对脓毒症休克并ARDS预后具有更高的预测价值。

基于亥姆霍兹线圈装置的磁热疗优化方法

该文研究了两种常见亥姆霍兹线圈产生磁场的均匀性,并根据装置线圈所产生磁场作用下的生物组织治疗温度分布分析了磁场均匀性对治疗效果的影响。其中,文中的磁纳米粒子(MNPs)以磁流体形式注射进肿瘤区域并假定以注射点为中心呈现高斯分布。该文在多种约束条件下应用改进粒子群算法优化了磁场的频率和强度、磁纳米粒子粒径,以及磁纳米粒子体积分数等参数,而涉及的约束条件包括治疗最高安全温度、治疗磁场安全范围上限、MNPs粒径范围,以及MNPs产热有效条件等。同时,该文以累积等效分钟数来评估圆形和正方形亥姆霍兹线圈及理想磁场在不同血液灌注率下的细胞热损伤程度。研究结果表明,正方形亥姆霍兹线圈相比于圆形线圈能产生更大范围的匀强磁场,这使其磁热疗效果更接近于理想磁场情况。同时,考虑温度依赖的血液灌注率相比定值情况具有更高的治疗温度。

不同种类沥青对灌入式半柔性材料的影响

为了明确沥青种类对灌入式半柔性材料路用性能的影响,分别使用基质沥青、SBS(styrene-butadiene-styrene)改性沥青和高黏沥青制备灌入式半柔性材料,进行级配优化,并对其进行试验探究沥青种类对半柔性路面灌注率、高温稳定性、水稳定性和强度的影响效果。结果表明:使用不同沥青制备的母体沥青混合料随着油石比增大,稳定度均呈现先增大后减小的规律,而空隙率则表现为持续减小,相同油石比下使用SBS改性沥青和高黏沥青的混合料稳定度升高,空隙率减小;沥青种类对灌注率影响较小;SBS改性沥青和高粘沥青能提升路面的水稳定性和高温稳定性和强度,提升效果基本相同。

基于Morris方法的微波消融肺组织温度场参数敏感度分析

为了获取微波消融肺组织温度场中组织特性敏感度,采用有限元方法建立微波消融肺组织计算模型,进行电磁场-温度场的耦合,基于Morris方法获取组织电导率(σ)、相对介电常数(ε)、导热率(k)、密度(ρ)、比热容(Cp)和血液灌注率(ωb)的敏感度,建立二维有限元模型.肺组织的σ、ε、k、ρ、Cp、ωb六个参数各设置4个水平,分别获取在50 W、300 s时的微波消融肺组织的消融面积和中心温度,并采用Morris方法,分析各参数对消融面积和消融形状的影响程度.结果表明,血液灌注率、相对介电常数、电导率是对微波消融肺组织的消融区域和消融形状影响较大的参数.

生物传热简化模型在冷冻手术中的应用

本文采用多项式拟合结合临床实验测试的方法,研究了血液灌注率计算模型的合理简化方法,对简化后的组织血液灌注率计算模型对病灶区生物组织温度场预测精度的影响进行了详细分析。结果表明,当采用肿瘤非冻结区边界温度对血液灌注率计算模型进行简化后,与经典的分段计算模型相比,简化模型对于肿瘤大尺寸血管周围的组织温度计算偏差平均为0.6~2.7℃,与实测值平均偏差1.6~3.8℃,考虑拟合误差和温度分段阙值的不确定性误差,简化模型的最大误差约为2.5~4.0℃,计算精度满足临床要求。通过对若干典型血管构型的家兔气道肿瘤组织进行临床冷冻手术,验证了该简化模型对肿瘤组织温度场的预测精度平均在3℃以内,证明了该简化模型具备指导临床手术的可行性。

简易负压灌注清创术在糖尿病足中的应用

目的探讨简易负压灌注清创术(simple negative pressure perfusion debridement,SNPPD)在糖尿病足中的应用前景,为糖尿病足患者提供一种经济有效的治疗手段。方法收集2017年7月—2019年7月糖尿病足患者45例,随机分成三组,简易负压灌注清创组(SNPPD组)、超声清创组、常规清创组,对比清创7天、14天后各组患者的创面愈合率及第3天、第7天、第14天的感染指标等,观察三种不同清创方法对糖尿病足溃疡愈合的影响。结果(1)三组患者创面愈合率对比,在清创后7天及14天时,超声清创组及SNPPD组的创面愈合率明显高于常规清创组(P<0.01),超声清创组第7天时优于SNPPD组,但两组第14天时差异无统计学意义(P>0.05)。(2)感染指标对比,超声清创组优于常规清创组及SNPPD组(P<0.05),SNPPD组优于常规清创组(P<0.01)。结论SNPPD安全、经济、有效,可考虑作为贫困或无法开展超声清创地区医疗机构治疗糖尿病足溃疡的一种新型手段。

马归液联合吉西他滨膀胱灌注治疗膀胱癌的疗效观察

目的观察马归液联合吉西他滨(gemcitabine,GEM)膀胱灌注治疗膀胱癌的疗效。方法将2016年1月至2017年12月在湖南中医药大学第一附属医院泌尿外科行经尿道膀胱肿瘤电切除术(transurethral resection of bladder tumors,TURBT)的90例非肌层浸润性膀胱癌(non-muscular-invasive bladder cancer,NMIBC)患者随机分为治疗1组、治疗2组和对照组,每组30例。对照组采用GEM膀胱灌注治疗;治疗1组以GEM联合马归液膀胱灌注治疗;治疗2组在治疗1组基础上加入马归液口服。检测治疗前后各组患者的CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、血管内皮生长因子(vascular endothelial growth factor,VEGF)水平;随访各组患者术后1年、2年、3年的复发例数;记录各组患者恶心呕吐、血尿、膀胱刺激征、尿常规异常、发热的不良反应发生例数。结果治疗后,治疗1组、治疗2组CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)较治疗前均升高,血清VEGF水平均降低(P<0.05);与对照组相比,治疗1组、治疗2组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均升高,血清VEGF水平均降低(P<0.05);两组治疗组的上述指标比较,差异无统计学意义(P>0.05)。术后2年、3年,治疗1组、治疗2组的复发率均低于对照组(P<0.05),治疗2组复发率低于治疗1组(P<0.05)。治疗1组、治疗2组的不良反应发生率均低于对照组(P<0.05),治疗2组的不良反应发生率低于治疗1组(P<0.05)。结论马归液口服加膀胱灌注的“内服外治”法联合GEM膀胱灌注治疗NMIBC,能有效提高CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平,降低血清VEGF水平,改善免疫系统,减少复发风险和不良反应,临床应用安全有效。

CT灌注成像联合MRI诊断超急性期脑梗死患者的价值分析

目的探讨CT灌注成像联合MRI在超急性期脑梗死患者的诊断价值。方法选择2020年9月—2022年11月于黑龙江省医院急诊科就诊的超急性期脑梗死患者56例,所有患者均行多层螺旋CT灌注成像联合MRI成像及单纯MRI扫描,分析多层螺旋CT灌注成像联合MRI及单纯MRI扫描的诊断结果及CT灌注成像联合MRI成像对超急性期脑梗死患者的检出率、病灶检出数目和病灶位置等情况。结果多层螺旋CT灌注成像联合MRI成像检出超急性期脑梗死患者53例,检出率为94.64%(53/56),单纯MRI成像检查超急性期脑梗死37例,检出率为66.07%(37/56),差异有统计学意义(P<0.05)。多层螺旋CT灌注成像联合MRI成像检查出梗死灶82例,单纯MRI成像检查出梗死灶54例,多层螺旋CT灌注成像联合MRI成像相较于单纯MRI成像检出的梗死灶更多。结论多层螺旋CT灌注成像联合MRI成像相较于单纯MRI成像的超急性期脑梗死患者检出率更高、更容易发现梗死病灶。该方法检查效果良好,值得在临床推广应用。

载药微球动脉灌注联合TACE治疗中晚期原发性肝癌的效果及对肝功能和生存率的影响

目的:观察载药微球动脉灌注联合肝动脉化疗栓塞术(TACE)治疗中晚期原发性肝癌的效果及对肝功能及生存率的影响。方法:选取2020年3月—2022年3月蚌埠医学院第二附属医院收治的70例中晚期原发性肝癌患者为研究对象,经随机数表法分为对照组与试验组,各35例。对照组应用TACE治疗,试验组应用载药微球动脉灌注联合TACE治疗。比较两组治疗效果、治疗前后肝功能[总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白(ALB)]指标、不良反应发生率及术后生存率。结果:试验组临床控制率、客观缓解率均高于对照组,差异有统计学意义(P<0.05)。治疗前、治疗1个月后,两组TBIL、ALT、AST及ALB水平比较,差异无统计学意义(P>0.05)。治疗1个月后,两组TBIL、ALT、AST及ALB水平均低于治疗前,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。术后3个月、6个月,两组生存率比较,差异无统计学意义(P>0.05),术后12个月,试验组生存率高于对照组,差异有统计学意义(P<0.05)。结论:中晚期原发性肝癌患者应用载药微球动脉灌注联合TACE治疗的效果确切,对肝功能影响较小,能够提升患者术后远期生存率。

冻融胚胎移植使用阿托西班、子宫内膜搔刮、粒细胞集落刺激因子宫腔灌注对反复移植失败患者妊娠结局的影响

目的探讨阿托西班、子宫内膜搔刮、粒细胞集落刺激因子宫腔灌注治疗对反复移植失败患者妊娠结局的影响。方法回顾性分析中国人民解放军联勤保障部队第九四○医院妇产科生殖中心行冻融胚胎移植治疗的227个反复种植失败患者的临床资料及周期资料。根据患者的治疗方式分为A组(阿托西班治疗)、B组(子宫内膜搔刮治疗)、C组(粒细胞集落刺激因子宫腔灌注治疗)。比较三组临床妊娠率、活产率、足月产率及早产率、流产、异位妊娠率,并分析妊娠结局为活产的患者发生非足月产的风险因素。结果三组治疗后临床妊娠率、足月产率比较,差异具有统计学意义(P<0.05);A组高于B组和C组。单因素、多因素Logistic风险回归分析结果显示,子宫调节方案、是否双胎妊娠是妊娠结局为活产的患者发生非足月产的独立风险因素。行子宫内膜搔刮、粒细胞集落刺激因子宫腔灌注的患者发生非足月产的风险高于阿托西班治疗(OR=1.865,P=0.044);双胎妊娠患者发生非足月产的风险高于单胎妊娠患者(OR=3.203,P=0.035)。结论对于反复移植失败患者采用阿托西班治疗,不但妊娠结局优于子宫内膜搔刮、粒细胞集落刺激因子宫腔灌注治疗,而且还可以减少非足月产的风险。

脉搏血氧仪血氧饱和度和脉搏率准确性试验方法的研究

目的为验证脉搏血氧仪血氧饱和度(Oxygen Saturation,SpO_(2))和脉搏率准确性,保证使用者的安全和有效。方法在不同光照和弱灌注条件下进行测量,以验证SpO_(2)水平、脉搏率及脉搏振幅的变化。结果指环式脉搏血氧仪在血压波形上叠加60 Hz或1~10 kHz的噪音弱脉或弱灌注,SpO_(2)和脉搏率显示读数误差超出厂家宣称的精度范围(SpO_(2)70%~100%范围内,绝对值允差±3%;脉搏率25~250次/min范围内,允差±3次/min);指夹式脉搏血氧仪在不同光照下的SpO_(2)和脉搏率基本不受影响。结论在不同光照下,指环式脉搏血氧仪在强光条件下数据显示不准确,指夹式脉搏血氧仪在不同光照下的血氧饱和度和脉搏率基本不受影响;在弱灌注条件下,当指环式和指夹式脉搏血氧仪的脉搏充盈度小于1%时,血氧饱和度和脉搏率显示读数不稳定,在一定区间内跳动,超出厂家宣称的准确性要求,研究结果为指导和规范脉搏血氧仪SpO_(2)和脉搏率准确性试验方法提供参考依据。

Extraction method of nanoparticles concentration distribution from magnetic particle image and its application in thermal damage of magnetic hyperthermia

Magnetic particle imaging(MPI)technology can generate a real-time magnetic nanoparticle(MNP)distribution image for biological tissues,and its use can overcome the limitations imposed in magnetic hyperthermia treatments by the unpredictable MNP distribution after the intratumoral injection of nanofluid.However,the MNP concentration distribution is generally difficult to be extracted from MPI images.This study proposes an approach to extract the corresponding concentration value of each pixel from an MPI image by a least squares method(LSM),which is then translated as MNP concentration distribution by an interpolation function.The resulting MPI-based concentration distribution is used to evaluate the treatment effect and the results are compared with the ones of two baseline cases under the same dose:uniform distribution and MPI-based distribution considering diffusion.Additionally,the treatment effect for all these cases is affected by the blood perfusion rate,which is also investigated deeply in this study.The results demonstrate that the proposed method can be used to effectively reconstruct the concentration distribution from MPI images,and that the weighted LSM considering a quartic polynomial for interpolation provides the best results with respect to other cases considered.Furthermore,the results show that the uniformity of MNP distribution has a positive correlation with both therapeutic temperature distribution and thermal damage degree for the same dose and a critical power dissipation value in the MNPs.The MNPs uniformity inside biological tissue can be improved by the diffusion behavior after the nanofluid injection,which can ultimately reflect as an improvement of treatment effect.In addition,the blood perfusion rate considering local temperature can have a positive effect on the treatment compared to the case which considers a constant value during magnetic hyperthermia.