Structural and functional connectivity of the whole brain and subnetworks in individuals with mild traumatic brain injury:predictors of patient prognosis

Patients with mild traumatic brain injury have a diverse clinical presentation,and the underlying pathophysiology remains poorly understood.Magnetic resonance imaging is a non-invasive technique that has been widely utilized to investigate neuro biological markers after mild traumatic brain injury.This approach has emerged as a promising tool for investigating the pathogenesis of mild traumatic brain injury.G raph theory is a quantitative method of analyzing complex networks that has been widely used to study changes in brain structure and function.However,most previous mild traumatic brain injury studies using graph theory have focused on specific populations,with limited exploration of simultaneous abnormalities in structural and functional connectivity.Given that mild traumatic brain injury is the most common type of traumatic brain injury encounte red in clinical practice,further investigation of the patient characteristics and evolution of structural and functional connectivity is critical.In the present study,we explored whether abnormal structural and functional connectivity in the acute phase could serve as indicators of longitudinal changes in imaging data and cognitive function in patients with mild traumatic brain injury.In this longitudinal study,we enrolled 46 patients with mild traumatic brain injury who were assessed within 2 wee ks of injury,as well as 36 healthy controls.Resting-state functional magnetic resonance imaging and diffusion-weighted imaging data were acquired for graph theoretical network analysis.In the acute phase,patients with mild traumatic brain injury demonstrated reduced structural connectivity in the dorsal attention network.More than 3 months of followup data revealed signs of recovery in structural and functional connectivity,as well as cognitive function,in 22 out of the 46 patients.Furthermore,better cognitive function was associated with more efficient networks.Finally,our data indicated that small-worldness in the acute stage could serve as a predictor of longitudinal changes in connectivity in patients with mild traumatic brain injury.These findings highlight the importance of integrating structural and functional connectivity in unde rstanding the occurrence and evolution of mild traumatic brain injury.Additionally,exploratory analysis based on subnetworks could serve a predictive function in the prognosis of patients with mild traumatic brain injury.

The effects of three-dimensional conformal radiotherapy combined with whole brain irradiation on brain metastases

观察三维的保角的放射疗法的最近治疗学的效果和毒性的目的与大脑转移为病人与整个大脑照耀结合了。33 个盒子其剂量是 36 40 Gy (18 20 f ) 起初被整个大脑照耀对待的方法。然后三维的保角的放射疗法与 20 25 Gy 的全部的剂量被加到焦点，其 fractionated 剂量是 2 5 Gy/time， 5 时间 / 星期或 3 时间 / 星期。在在放射疗法以后的 1 个月以内的结果根据大脑的成像，所有病人的 CR 是 45.5% ， PR 36.4% ， NC 15.1% ，和 PD 3% 。为有在放射前的神经症状的 32 个盒子，症状的 CR 是 40.6% 并且 PR 59.4% 。所有病人在 KPS 等级获得了不同增加。在后续时期底，有有直到 9.3 个月的吝啬的幸存时间的 22 死亡。与整个大脑照耀相结合的结论三维的保角的放射疗法不能仅仅有效地控制大脑转移并且改进生活质量，而且趋于延长幸存时间。

Analyzing Planning Techniques for Whole Brain Radiotherapy

Aims: This study compares data between the Field in Field planning and Wedge planning techniques to figure out which technique has better dose coverage and distribution for PTV, and, if using FiF technique for whole brain treatment, how many beams will have better plan. Methods: 56 patients, who need to radiate whole brain with 30 Gy/10 fractions, have been selected for this study. Four plans have been made for each patient (FiF1—one subfield per field plan, FiF2—two subfields per field plan, FiF3—three subfields per field plan, and a Wedge plan). Results: The results of Field in Field plans including Compare dose distribution on the transverse CT slice, plan evaluation using DVH, number MU of plan, Dmax, HI, HTCI, DmaxPTV, DmeanPTV. Volume of PTV with the dose over 105% prescribed dose, dose of organ at risk, and Quality Assurance (QA) plan, are better than those of Wedge plan. Conclusions: Plans using Field in Field technique has better coverage, is more homogeneous in dose distribution than plan using Wedge technique. When using Field in Field technique for whole brain radiotherapy, using three subfields per field has better result than two subfields per field and one subfield per field.

Efficacy of Temozolomide Combined with Whole Brain Radiotherapy in the Treatment of Cerebral Metastases from Lung Cancer

[Objectives] To observe the clinical efficacy,adverse reaction and survival time of temozolomide combined with whole brain radiotherapy in the treatment of lung cancer. [Methods] A total of 43 patients with lung cancer and cerebral metastases were reviewed and analyzed. Three-dimensional conformal radiotherapy(3D-CRT) technique was used to perform whole brain radiotherapy,one time a day and5 times a week. At the same time of radiotherapy,temozolomide chemotherapy was performed,150 mg/( m2·d),continuous oral administration of 5 d,every 28 days were a cycle( those patients who continue receiving temozolomide chemotherapy did not receive other related antitumor therapy,such as systemic chemotherapy and molecular targeted therapy,etc.),and drugs were administered for 4-6 cycles according to tolerance of patients. Kaplan-Meier method was used to calculate the survival rate. [Results]The objective response rate of 43 patients was79. 0%(34/43),in which CR was 6/43,PR was 28/43,and 9 cases had PD. By December 31,2016,7 patients in 43 cases died,one patient died of cerebral hernia due to intracranial lesions and 6 patients died of failure of other important organs due to metastasis. The OS and PFS of the whole group of patients in one year were 49. 1% and 56. 9% respectively. The adverse reactions were mild and the patients could tolerate such treatment. [Conclusions] Temozolomide combined with whole brain radiotherapy in the treatment of lung cancer with cerebral metastases has excellent clinical efficacy,while patients can tolerate such treatment.

A Single Institutional Phase II Randomized Trial of Whole Brain Radiation Therapy with or without Irinotecan for the Treatment of Brain Metastases from Solid Tumours

Background: The relatively suboptimal results of whole brain radiation therapy (WBRT) alone in eradication of brain metastases and an attempt to improve outcomes with WBRT have led to studies combining radiotherapy with chemotherapy drugs that could act as radiosensitizers with a rationale of improving local tumor control. Materials and Methods: This randomized phase II study evaluated the use of Irinotecan concomitant with 37.5 Gray (Gy) of WBRT in 2.5 Gy daily fractions × 5 days each week for 3 weeks versus Whole WBRT alone in patients with brain metastasis (BM) from solid tumors. Fifty patients were randomized to receive either WBRT alone or concomitant with three irinotecan IV infusions 80 mg/m2, 2 hrs before RT on days 1, 8, and 15. Results: The objective response rate (ORR) was significantly improved in patients receiving Irinotecan with radiotherapy versus radiotherapy alone (48% vs. 28%;p = 0.048). The median time to progression of brain metastasis was significantly longer in the irinotecan and WBRT arm as compared to the WBRT arm (8 vs. 5 months;p < 0.001). There was no significant difference in survival between treatment arms (p = 0.361). Irinotecan with radiotherapy was generally well tolerated and did not interfere with the delivery of WBRT. Conclusions: Irinotecan concomitant with WBRT was well tolerated and significantly improved local control of BM compared with WBRT alone. These findings require confirmation in a phase III trial with addition of quality of life assessment.

Survival and effective prognostic factors in lung cancer patients with brain metastases treated with whole brain radiotherapy

Objective:To evaluate the outcomes and explore the risk factors for survival of lung cancer patients with brain metastases(BMs)who were treated with whole brain radiotherapy(WBRT)and to identify the significance of the risk factors.Methods:A retrospective analysis was carried out for lung cancer patients with BMs who were treated with WBRT in the Second Affiliated Hospital of Soochow University from January 2014 to December 2017.Their survival time was calculated using the Kaplan-Meier method.Meanwhile,the neutrophil-lymphocyte ratio(NLR)cutoff values were defined using the receiver operating characteristic(ROC)curve analysis,and the characteristics of different NLR groups were compared using the Wilcoxon Rank Sum Test.Results:A total of 179 patients were assessed.Their median overall survival(OS)was 9.9(95%CI 7.08–12.72)months.As shown by univariate analyses,their OS was significantly affected by histology(P<0.001),number of BMs(P=0.009),local treatment of BMs(P=0.019),Karnofsky Performance Status score(P=0.001),Graded Prognostic Assessment(GPA)score(P<0.001),hemoglobin level(P=0.002),lymphocyte count(P=0.006),albumin level(P=0.001),and NLR(P<0.001).Meanwhile,according to multivariate analyses,independent risk factors for OS included non-adenocarcinoma(ADCA)histology(P<0.001)and high NLR(P=0.006).Moreover,the optimal NLR cutoff value was determined to be 7.0.The patients in this study were divided into three categories based on their total score determined by assigning each risk factor of histology and NLR one point.The median survival in the patients with scores of 0,1,and 2 was 19.6 months,8.5 months,and 2.2 months,respectively(P=0.001).The survival time and prognostic factors of different pathological types of patients were further analyzed.As a result,the median OS of patients with small-cell lung cancer(SCLC),ADCA patients receiving targeted therapy,and ADCA patients not receiving targeted therapy was 10.9 months,13.2 months,and 9.5 months,respectively.The results of multivariate analyses all showed that NLR was an independent risk factor for OS of these three pathological types of patients.Conclusions:Non-ADCA histology and high NLR serve as independent prognostic factors for survival of lung cancer patients with BMs who have been treated with WBRT.A prognostic model comprising histological type and NLR can be used to evaluate the survival.

Use of a tissue clearing technique combined with retrograde trans-synaptic viral tracing to evaluate changes in mouse retinorecipient brain regions following optic nerve crush

Successful establishment of reconnection between retinal ganglion cells and retinorecipient regions in the brain is critical to optic nerve regeneration.However,morphological assessments of retinorecipient regions are limited by the opacity of brain tissue.In this study,we used an innovative tissue cleaning technique combined with retrograde trans-synaptic viral tracing to observe changes in retinorecipient regions connected to retinal ganglion cells in mice after optic nerve injury.Specifically,we performed light-sheet imaging of whole brain tissue after a clearing process.We found that pseudorabies virus 724(PRV724)mostly infected retinal ganglion cells,and that we could use it to retrogradely trace the retinorecipient regions in whole tissue-cleared brains.Unexpectedly,PRV724-traced neurons were more widely distributed compared with data from previous studies.We found that optic nerve injury could selectively modify projections from retinal ganglion cells in the hypothalamic paraventricular nucleus,intergeniculate leaflet,ventral lateral geniculate nucleus,central amygdala,basolateral amygdala,Edinger-Westphal nucleus,and oculomotor nucleus,but not the superior vestibular nucleus,red nucleus,locus coeruleus,gigantocellular reticular nucleus,or facial nerve nucleus.Our findings demonstrate that the tissue clearing technique,combined with retrograde trans-synaptic viral tracing,can be used to objectively and comprehensively evaluate changes in mouse retinorecipient regions that receive projections from retinal ganglion cells after optic nerve injury.Thus,our approach may be useful for future estimations of optic nerve injury and regeneration.

Whole-brain radiation therapy alone vs. combined therapy with stereotactic radiosurgery for the treatment of limited brain metastases: A systematic review

Objective The aim of the study was to compare the efficacy and safety of whole brain radiotherapy(WBRT) used alone and combined with stereotactic radiosurgery(SRS) in the treatment of limited(1–4)brain metastases. Methods We searched for randomized controlled and matched-pair analysis trials comparing WBRT plus SRS versus WBRT alone for brain metastases. The primary outcomes were the overall survival(OS), intracranial control(IC), and localcontrol(LC). The secondary outcome was radiation toxicity. The log hazard ratios(lnHRs) and their variances were extracted from published Kaplan-Meier curves and pooled using the generic inverse variance method in the RevMan 5.3 software. The non-pooled outcome measures were evaluated using descriptive analysis. Results Three randomized controlled trials and two matched-pair analysis studies were included. There was no difference in the OS for limited brain metastases between the two groups [lnHR 0.91(95% CI 0.76–1.09, P = 0.32) vs. 0.72(95% CI 0.44–1.19, P = 0.20)]. The LC and IC were significantly higher in the combined treatment group [lnHR 0.69(95% CI 0.55–0.86, P = 0.001) vs. 0.41(95% CI 0.29–0.58, P < 0.0001)]. For patients with a single lesion, one trial showed a higher survival in the combined treatment group(median OS: 6.5 months vs. 4.9 months, P = 0.04). The combined treatment was not associated with significantly higher incidence of radiation toxicity. Conclusion Combined treatment with WBRT plus SRS should be recommended for patients with limited brain metastases based on the better LC and IC without increased toxicity. It should also be considered a routine treatment option for patients with solitary brain metastases based on the prolonged OS.

Neural stem cell-derived exosomes promote mitochondrial biogenesis and restore abnormal protein distribution in a mouse model of Alzheimer's disease

Mitochondrial dysfunction is a hallmark of Alzheimer’s disease.We previously showed that neural stem cell-derived extracellular vesicles improved mitochondrial function in the cortex of AP P/PS1 mice.Because Alzheimer’s disease affects the entire brain,further research is needed to elucidate alterations in mitochondrial metabolism in the brain as a whole.Here,we investigated the expression of several important mitochondrial biogenesis-related cytokines in multiple brain regions after treatment with neural stem cell-derived exosomes and used a combination of whole brain clearing,immunostaining,and lightsheet imaging to clarify their spatial distribution.Additionally,to clarify whether the sirtuin 1(SIRT1)-related pathway plays a regulatory role in neural stem cell-de rived exosomes interfering with mitochondrial functional changes,we generated a novel nervous system-SIRT1 conditional knoc kout AP P/PS1mouse model.Our findings demonstrate that neural stem cell-de rived exosomes significantly increase SIRT1 levels,enhance the production of mitochondrial biogenesis-related fa ctors,and inhibit astrocyte activation,but do not suppress amyloid-βproduction.Thus,neural stem cell-derived exosomes may be a useful therapeutic strategy for Alzheimer’s disease that activates the SIRT1-PGC1αsignaling pathway and increases NRF1 and COXIV synthesis to improve mitochondrial biogenesis.In addition,we showed that the spatial distribution of mitochondrial biogenesis-related factors is disrupted in Alzheimer’s disease,and that neural stem cell-derived exosome treatment can reverse this effect,indicating that neural stem cell-derived exosomes promote mitochondrial biogenesis.

Stimulatory Effect of Whole Coffee Fruit Concentrate Powder on Plasma Levels of Total and Exosomal Brain-Derived Neurotrophic Factor in Healthy Subjects: An Acute Within-Subject Clinical Study

A pilot study by Reyes [1] previously showed that ingestion of single dose of whole coffee fruit concentrate (WCFC) powder increased blood levels of brain derived neurotrophic factor (BDNF) during the first 60 minutes after ingestion. In the present report, we performed a single dose, placebo-controlled, within-subject study to confirm and further investigate this effect. Twenty healthy subjects with ages ranging from 25 to 35 participated in this study. All fasted and resting subjects received placebo on Day 1, WCFC on Day 2, and a cup of freshly brewed coffee on Day 3. Treatment with WCFC resulted in a statistically significant increase in plasma BDNF compared to placebo (p = 0.0073) or coffee (p = 0.0219) during first 60 minutes. In addition, e isolated exosomes from serum and found that they contained BDNF. Furthermore, oral WCFC consumption acutely increased BDNF levels in serum exosomes. In summary, all presented results justify further clinical investigation of WCFC as a tool to manage BDNF-dependent health conditions.

肝豆状核变性伴认知损害的尾状核静息态功能连接改变的fMRI研究

目的:利用静息态fMRI分析肝豆状核变性(WD)伴认知损害患者的尾状核功能连接改变。方法:选取19例WD患者(WD组)及24例健康志愿者(对照组)为研究对象,并行静息态fMRI检查;采用简明智力状态量表(MMSE)、言语流畅性测验(VFT)、数字广度测验(DST)、前瞻记忆(PM)测试法评估患者认知功能;利用AFNI软件,分别以双侧尾状核为种子点(ROI),与全脑其他体素行功能连接分析,得到2组功能连接的差异脑区,对差异脑区的功能连接强度值与基于事件的前瞻性记忆(EBPM)评分及基于时间的前瞻性记忆(TBPM)评分行相关性分析。结果:WD组的MMSE评分、VFT评分、DST评分、TBPM评分和EBPM评分均较对照组低,差异均有统计学意义(均P<0.05)。与对照组相比,WD组左侧尾状核与双侧丘脑、双侧额上回、右侧额中回功能连接减低,右侧尾状核与小脑蚓部、双侧豆状核、双侧丘脑、双侧额上回、右侧角回功能连接减低。WD组右侧尾状核和右侧额上回间的功能连接强度值与EBPM评分呈正相关(r=0.508,P=0.028);右侧尾状核和右侧丘脑间的功能连接强度值与TBPM评分呈正相关(r=0.473,P=0.041);左侧尾状核和左侧丘脑间的功能连接强度值与TBPM评分呈正相关(r=0.462,P=0.047)。结论:WD患者认知障碍与纹状体-丘脑-皮质连接受损有关,尤其是尾状核与丘脑及额上回的功能连接减低有关。fMRI可作为WD患者脑功能障碍的重要研究手段。

High-dose methotrexate and zanubrutinib combination therapy for primary central nervous system lymphoma

In this editorial I comment on the article,published in the current issue of the World Journal of Clinical Oncology.Primary central nervous system lymphoma(PCNSL)is a disease of elderly and immunocompromised patients.The authors reported clinical results of 19 patients with PCNSL treated with zanubrutinib/high dose methotrexate(HD-MTX)until disease progression.They demonstrated that the combination of zanubrutinib with HD-MTX led to a marked clinical response and tolerability among these patients.They also observed that cerebrospinal fluid liquid biopsy to detect circulating tumor DNA may be a good option for evaluating treatment response and tumor burden in patients with PCNSL.PCNSL is a challenging disease for treatment as these patients present with different neurological states and comorbidities.Treatment has evolved over the years from whole brain radiotherapy to HD-MTX followed by autologous stem cell transplant.Gradually,treatment of patients with PCNSL is going to become individualized.

全脑CT灌注及磁共振弥散加权成像评价短暂性脑缺血发作继发脑梗死的价值

目的探究全脑CT灌注及磁共振弥散加权成像(DWI)评价短暂性脑缺血发作(TIA)继发脑梗死的价值。方法选取2022-06—2023-04中国人民解放军联勤保障部队第九〇二医院治疗的70例TIA患者,对其临床资料进行回顾性分析,根据患者发病7 d内临床诊断继发性脑梗死状况分为脑梗死组(n=22)与非脑梗死组(n=48),对比2组全脑CT灌注参数,经ROC曲线分析全脑CT灌注参数联合诊断TIA继发脑梗死的最佳阈值,对比全脑CT灌注参数、DWI及两项联合诊断TIA继发脑梗死的灵敏度、特异性,并通过Kappa值分析其一致性。结果脑梗死组CBF、CBV低于非脑梗死组,TTP、MTT高于非脑梗死组(P<0.05)。采用ROC分析获取CBF、CBV、TTP、MTT诊断TIA继发脑梗死的AUC分别为0.670、0.854、0.681、0.754,联合诊断TIA继发脑梗死的AUC为0.925。以临床诊断为金标准,全脑CT灌注诊断TIA继发脑梗死的敏感度77.27%,特异性95.83%,Kappa值0.759;磁共振弥散加权成像诊断TIA继发脑梗死的敏感度81.82%,特异性97.92%,Kappa值0.828;两项联合诊断TIA继发脑梗死的敏感度95.45%,特异性95.83%,Kappa值0.902,一致性较好。结论全脑CT灌注及DWI诊断TIA继发脑梗死均具有一定价值,且两项联合诊断的准确性更好。

经桡动脉入路和经股动脉入路行全脑血管造影术的效果及安全性分析

目的观察经桡动脉入路和经股动脉入路行全脑血管造影术的效果及安全性。方法回顾性选取新疆生产建设兵团第一师医院神经外科2021年01月至2023年01月收治的120例需行全脑血管造影患者,按照不同治疗方式分为两组,各60例。对照组为经股动脉入路造影,研究组为经桡动脉入路造影,比较两组方案的临床效果。结果研究组手术成功率高于对照组,并发症发生率和排尿困难发生率、需要陪护率低于对照组,住院时间、卧床时间和压迫止血时间、穿刺肢体制动时间短于对照组(P<0.05),手术时间长于对照组(P>0.05)。结论经桡动脉入路行全脑血管造影术手术成功率更高,并且能够在保证患者术中指标和术后舒适度提升的同时降低并发症发生风险,促进其体征恢复,临床实用性和安全性更好。

脊髓损伤重塑皮质脊髓运动神经元突触输入的作用

背景:脊髓损伤后的功能恢复依赖于运动皮质的功能重塑,然而运动皮质功能重塑的解剖基础研究较少,了解脊髓损伤后运动皮质功能的解剖变化可对脊髓损伤后功能恢复的调控以及康复治疗等提供新的思路以及研究方向。目的:解析脊髓损伤后初级运动皮质功能重塑的神经回路结构基础。方法:C57BL/6J小鼠随机分为假手术组、脊髓损伤组。向两组小鼠C4脊髓注射表达Cre重组酶融合蛋白的腺相关病毒,同时在大脑初级运动皮质注射Cre重组酶依赖的分别表达禽类肉瘤/白血病病毒包膜蛋白受体TVA和狂犬病毒糖蛋白的假性狂犬病毒辅助腺相关病毒。第14天时脊髓损伤组小鼠建立C6脊髓背侧半切模型,同时向两组小鼠初级运动皮质注射假性狂犬病毒,7 d后收集小鼠脑部样本,制作冰冻切片,观察支配皮质脊髓运动神经元的输入神经元在脑内的分布情况并进行定量分析。结果与结论:荧光显微镜观察及定量分析结果发现,两组小鼠支配初级运动皮质脊髓运动神经元的输入神经元在大脑皮质、间脑和中脑均有分布。其中,假手术组小鼠大脑皮质的输入神经元占全脑输入神经元总数的(84.0±3.6)%,间脑占(10.6±2.3)%,中脑占(0.7±0.4)%;脊髓损伤组直接突触的输入神经元在皮质、间脑和中脑中的占比分别为(81.7±1.0)%,(13.1±0.5)%和(1.6±0.8)%。脊髓损伤组初级运动皮质输入神经元在3个区域的比例以及数量均与假手术组无明显差异。脊髓损伤后,各脑区内支配皮质脊髓运动神经元的输入神经元数量无明显变化,提示皮质脊髓束受损后初级运动皮质的功能重塑可能不仅依赖于受损皮质脊髓运动神经元相关突触输入的改变,而更多地与受损神经元自身的转录调控变化有关。

学龄前期儿童焦虑的楔前叶与全脑功能连接特征研究

目的:探索学龄前期儿童焦虑的楔前叶与全脑功能连接特征。方法:选取2019年7月—2020年10月安徽省儿童医院儿童保健门诊体检或就诊的63名学龄前期儿童为研究对象,采用自编的调查问卷收集儿童基本信息,采用中文版《Spence学龄前儿童焦虑量表(SPAS)》评估儿童焦虑状况,以SPAS总得分的上、下50百分位分为焦虑得分高分组(32名)和焦虑得分低分组(31名)。采集儿童脑静息态功能磁共振图像,采用t检验比较2组儿童的楔前叶与全脑功能连接的差异。结果:焦虑得分高分组与焦虑得分低分组儿童年龄、性别、身高、体质量、分娩方式及独生子女情况比较,差异均无统计学意义(P>0.05)。焦虑得分高分组儿童左侧楔前叶与右侧颞下回(t=-3.853)、左侧额上回内侧眶(t=-3.915)、右侧眶部额上回(t=-3.517)、右侧苍白球(t=-3.789)、右侧三角部额下回(t=-5.032)、前额叶(t=-3.490)、左侧岛盖部额下回(t=-4.106)、左侧内侧额上回(t=-3.642)的功能连接较焦虑得分低分组减弱,与顶叶(t=3.709)的功能连接较焦虑得分低分组增强,差异有统计学意义(P<0.001)。焦虑得分高分组儿童右侧楔前叶与右侧颞下回(t=-4.286)、梭状回(t=-4.297)、前扣带回(t=-3.664)、左右侧三角部额下回(t=-4.211,t=-5.082)、左侧额中回(t=-3.698)的功能连接较焦虑得分低分组减弱,与顶叶(t=3.769)的功能连接较焦虑得分低分组增强,差异有统计学意义(P<0.001)。结论:焦虑得分高分组儿童的楔前叶与前额叶、颞叶等脑区的功能连接存在异常,研究结果可为进一步探索儿童焦虑发生的神经学机制和诊治提供参考。

集束化护理对全脑血管造影术患者并发症及满意度的影响

目的探讨集束化护理对全脑血管造影术(DSA)患者并发症及满意度的影响。方法采用前瞻性研究方法,选取德阳市某三甲医院神经内科2022年3月—2023年2月收治的120例DSA患者,随机分为对照组(n=60,常规护理)和干预组(n=60,常规+集束化护理),统计两组的并发症、满意度及干预前后的焦虑、抑郁情绪(SAS、SDS评分)。结果与对照组相比,干预组的并发症总发生率及焦虑、抑郁情绪评分更低,护理满意度评分更高,组间差异有统计学意义(P<0.05)。结论集束化护理的应用,可降低并发症,减轻焦虑、抑郁情绪,提高护理满意度。

分次立体定向放疗联合全脑放疗治疗乳腺癌脑转移患者的临床疗效

目的探讨分次立体定向放疗(FSRT)联合全脑放疗治疗乳腺癌脑转移患者的临床疗效。方法采用随机数字表法将140例乳腺癌脑转移患者分为观察组和对照组,每组70例,对照组患者采取全脑放疗,观察组患者采取FSRT联合全脑放疗。比较两组患者的近期疗效、生活质量[卡氏功能状态(KPS)评分]、血清学指标[CC趋化因子配体20(CCL20)、单核细胞趋化因子-1(MCP-1)、血管内皮生长因子(VEGF)]、不良反应发生情况及生存情况。结果观察组患者的总有效率为88.57%,明显高于对照组患者的68.57%,差异有统计学意义(P﹤0.01)。治疗后,两组患者KPS评分均高于本组治疗前,观察组患者KPS评分高于对照组,差异均有统计学意义(P﹤0.05)。治疗后,两组患者血清CCL20、MCP-1、VEGF水平均低于本组治疗前,观察组患者血清CCL20、MCP-1、VEGF水平均低于对照组,差异均有统计学意义(P﹤0.05)。观察组患者的不良反应总发生率为5.71%,低于对照组患者的18.57%,差异有统计学意义(P﹤0.05)。观察组患者的1年生存率为94.29%,高于对照组患者的80.00%,差异有统计学意义(P﹤0.05)。结论FSRT联合全脑放疗治疗乳腺癌脑转移患者可提高近期和远期疗效,改善生活质量,降低血清CCL20、MCP-1、VEGF水平,且安全性较好。

多层螺旋CT冠脉造影在心脏血管狭窄中的应用价值

目的探讨多层螺旋CT冠脉造影(CTA)在心脏血管狭窄中的诊断情况。方法收集2019年3月至2022年5月在本院进行CTA、数字减影全脑血管造影术(DSA)检查的患者86例,以DSA检查为金标准,统计CTA检查技术的诊断效能。结果经CTA技术检查后,灵敏度为92%、特异度为81.82%、阳性预测值为97.18%、阴性预测值为60.00%、准确度为90.70%。结论CTA在心脏血管狭窄具有较好的诊断效能,值得在临床上推广应用。

全流程干预对脑外科手术重症患者住院期间下肢深静脉血栓的预防价值

目的探讨全流程干预对脑外科手术重症患者住院期间下肢深静脉血栓(DVT)的预防价值。方法收集2021年1月至2022年12月于南京医科大学第一附属医院(江苏省人民医院)住院并接受手术治疗的146例脑外科手术重症患者的临床资料,并根据住院期间是否接受了预防下肢DVT的全流程干预措施将患者分为干预组(n=69)和对照组(n=77)。主要观察终点为住院期间患者下肢DVT的发生率,次要终点为患者脑外科专科信息以及住院期间的D-二聚体水平、并发症发生率、病死率和国际标准化比值。结果两组患者疾病类型、清醒的比例和接受开颅手术的比例比较,差异均无统计学意义(P>0.05)。干预组患者术中发生低体温的比例低于对照组患者,术后使用低分子量肝素的比例高于对照组患者,差异均有统计学意义(P<0.05)。住院期间,干预组患者下肢DVT的发生率、D-二聚体水平均低于对照组患者,差异均有统计学意义(P<0.05)。两组患者住院期间并发症的发生率、病死率和国际标准化比值比较,差异均无统计学意义(P>0.05)。结论全流程干预可明显降低脑外科手术重症患者住院期间下肢DVT的发生率,同时没有增加住院期间并发症的发生率和病死率。