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Acute ischemic stroke with large vessel occlusion (AIS-LVO) refers to ischemic stroke caused by large vessel occlusion of internal carotid artery, middle cerebral artery and vertebrobasilar artery, which has the characteristics of large infarct, relatively poor outcome, higher disability and mortality. Therefore, early vascular recanalization and rescue of ischemic penumbra are the key to improve the outcome of patients with AIS-LVO. Mechanical thrombectomy (MT) has a definite effect on AIS-LVO. The current guidelines recommend that MT should be performed on the basis of IVT for AIS-LVO patients without contraindications of intravenous thrombolysis (IVT), the so-called bridging therapy. IVT can increase the risk of bleeding to a certain extent, delay MT and increase the cost of hospitalization. However, there are still many controversies about whether the patients with AIS-LVO can directly perform MT. This article reviews the comparative study of direct MT and bridging therapy in patients with anterior circulation AIS-LVO, hoping to provide reference for clinicians in the treatment of AIS-LVO.
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Objective:To compare the differences in dosimetric parameters of target areas between 125I seed implantation with degradable catheters and by hand under the assistance of a real-time intraoperative treatment planning system (TPS). Methods:Forty-two simulated lesions were divided into a degradable catheter group and a free-hand group, with twenty-one lesions in each group. 125I seeds were implanted according to the TPS.The pre-plan and post-implant dosimetric parameters were collected, including the minimum dose ( Dmin), maximum dose ( Dmax), mean dose ( Dmean), conformal index (CI), external index (EI), homogeneity index (HI), minimum prescription dose delivered to 90% of the target volume ( D90), and the mean percentage of volume receiving 90% of the prescription doses ( V90). The Bland-Altman method was employed to analyze the consistency of pre-plan and post-implant dosimetric parameters and the Wilcoxon rank-sum test was used for the comparison of the two groups. Results:According to the Bland-Altman analysis, the dosimetric parameters of the two groups were all in agreement before and after seed implantation except for the Dmin and V90 of the free-hand group.Furthermore, the degradable catheter group had smaller error ranges of Dmax ( Z=-3.824, P<0.005), CI ( Z=-1.962, P<0.005), HI ( Z=-2.352, P<0.005), D90 ( Z=-2.453, P<0.005), and V90 ( Z=-3.159, P<0.005). Conclusions:The dosimetric parameters of 125I seed implantation with degradable catheters under the assistance of real-time TPS have good pre-plan and post-implant consistency and smaller error ranges.
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Objective@#To investigate the safety and efficacy of irreversible electroporation (IRE) hepatic ablation with high-frequency bipolar pulse in swine.@*Methods@#The experimental study was conducted. A total of 18 swines of either gender, aged (6.8+ 0.8)months with a range of 5.5-8.0 months, were collected from Animal Laboratory Center of Army Medical University. were randomly divided into 15 in experimental group and 3 in control group. The swines in experimental group underwent IRE hepatic ablation with high-frequency bipolar pulse, and 3 swines were chose randomly and underwent enhanced CT examination immediately after ablation, and at 3, 7, 14, and 28 days after ablation. The liver tissues were taken for histopathological examination. The swines in the control group underwent IRE hepatic ablation with high-frequency monopolar burst, and was performed enhanced CT examination at 3 days after ablation. Liver tissues were taken for histopathological examination. Observation indicators: (1) comparison of muscle contraction of siwnes between two groups; (2) imaging performance on enhanced CT after IRE ablation in the experimental group; (3) hepatic histopathological findings after IRE ablation in the experimental group; (4) comparison of apoptotic index in the ablation zone between two groups. The measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was performed by the independent sample t test.@*Results@#(1) Comparison of muscle contraction between two groups: swines in both groups underwent ablation successfully. The degree of muscle contraction was (9.8±0.4)m/s2 and (48.6±0.5)m/s2 in the experimental group and in the control group, respectively, showing statistically significant difference between the two groups (t=-163.50, P<0.05). (2) Imaging performance on enhanced CT after IRE ablation in the experimental group: the enhanced CT examination of swines immediately after IRE ablation showed a low-density shadow and clear boundary in the ablation zone. There was no obvious abnormality in the ablation zone and its adjacent large vessels. No serious complications occurred after the ablation. The boundary between the ablation zone and the normal liver tissue of the experimental group gradually became blurred over time, and the ablation zone was gradually replaced by normal liver tissue. The ablation zone at the 28 days after ablation was significantly reduced or even disappeared on imaging of enhanced CT examination.The maximum diameter of the ablation zone was (1.81±0.17)cm immediately after ablation, (1.75±0.19)cm at the 3 days after ablation, (1.32±0.22)cm at the 7 days after ablation, (0.65±0.14)cm at the 14 days after ablation, (0.28±0.10)cm at the 28 days after ablation, respectively. (3) Hepatic histopathological findings after IRE ablation in the experimental group: the HE staining of ablated tissue immediately after ablation showed that the cells in the ablation zone were swollen, arranged disorderly, and bleeding was observed around some of the needles.The bile ducts and blood vessels were intact in the ablation zone, and a large number of deeply stained nuclei were seen at 3 days after ablation, some of the nucleus and apoptotic bodies were partially dissolved or cleaved. A large number of inflammatory cell were infiltrated around the ablation zone. Intact vascular and biliary endothelial cells were observed by von Willebrand factor staining, a larger number of apoptotic cells with deeply stained nuclei in the ablation zone were observed by terminal-deoxynucleoitidyl transferase mediated nick end labeling staining, and partial deposited dark brown calcium salt was seen by Von Kossa staining. More newborn hepatocytes were observed growing from the periphery of the ablation zone to the center at the 7, 14, 28 days after ablation. Smooth muscle cell proliferation was observed at 14 and 28 days after ablation. The ablation zone was replaced by new cells on 28 days after ablation. (4) Comparison of apoptotic index in the ablation zone between two groups: the apoptotic index of the ablation zone was significantly higher in the experimental group than in the control group on the 3 days after operation (76.67%±0.04% vs. 64.03%±0.05%, t=4.79, P<0.05).@*Conclusion@#IRE hepatic ablation of swine using high-frequency bipolar pulse is safe and reliable, and it has more apoptotic cells than IRE ablation with high-frequency monopolar burst.
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Objective To investigate the safety and efficacy of irreversible electroporation (IRE) hepatic ablation with high-frequency bipolar pulse in swine.Methods The experimental study was conducted.A total of 18 swines of either gender,aged (6.8+0.8)months with a range of 5.5-8.0 months,were collected from Animal Laboratory Center of Army Medical University.were randomly divided into 15 in experimental group and 3 in control group.The swines in experimental group underwent IRE hepatic ablation with high-frequency bipolar pulse,and 3 swines were chose randomly and underwent enhanced CT examination immediately after ablation,and at 3,7,14,and 28 days after ablation.The liver tissues were taken for histopathological examination.The swines in the control group underwent IRE hepatic ablation with high-frequency monopolar burst,and was performed enhanced CT examination at 3 days after ablation.Liver tissues were taken for histopathological examination.Observation indicators:(1) comparison of muscle contraction of siwnes between two groups;(2) imaging performance on enhanced CT after IRE ablation in the experimental group;(3) hepatic histopathological findings after IRE ablation in the experimental group;(4) comparison of apoptotic index in the ablation zone between two groups.The measurement data with normal distribution were expressed as Mean±SD,and comparison between groups was performed by the independent sample t test.Results (1) Comparison of muscle contraction between two groups:swines in both groups underwent ablation successfully.The degree of muscle contraction was (9.8±0.4)m/s2 and (48.6±0.5) m/s2 in the experimental group and in the control group,respectively,showing statistically significant difference between the two groups (t =-163.50,P＜0.05).(2) Imaging performance on enhanced CT after IRE ablation in the experimental group:the enhanced CT examination of swines immediately after IRE ablation showed a low-density shadow and clear boundary in the ablation zone.There was no obvious abnormality in the ablation zone and its adjacent large vessels.No serious complications occurred after the ablation.The boundary between the ablation zone and the normal liver tissue of the experimental group gradually became blurred over time,and the ablation zone was gradually replaced by normal liver tissue.The ablation zone at the 28 days after ablation was significantly reduced or even disappeared on imaging of enhanced CT examination.The maximum diameter of the ablation zone was (1.81±0.17) cm immediately after ablation,(1.75±0.19) cm at the 3 days after ablation,(1.32±0.22)cm at the 7 days after ablation,(0.65±0.14)cm at the 14 days after ablation,(0.28±0.10)cm at the 28 days after ablation,respectively.(3) Hepatic histopathological findings after IRE ablation in the experimental group:the HE staining of ablated tissue immediately after ablation showed that the cells in the ablation zone were swollen,arranged disorderly,and bleeding was observed around some of the needles.The bile ducts and blood vessels were intact in the ablation zone,and a large number of deeply stained nuclei were seen at 3 days after ablation,some of the nucleus and apoptotic bodies were partially dissolved or cleaved.A large number of inflammatory cell were infiltrated around the ablation zone.Intact vascular and biliary endothelial cells were observed by yon Willebrand factor staining,a larger number of apoptotic cells with deeply stained nuclei in the ablation zone were observed by terminal-deoxynucleoitidyl transferase mediated nick end labeling staining,and partial deposited dark brown calcium salt was seen by Von Kossa staining.More newborn hepatocytes were observed growing from the periphery of the ablation zone to the center at the 7,14,28 days after ablation.Smooth muscle cell proliferation was observed at 14 and 28 days after ablation.The ablation zone was replaced by new cells on 28 days after ablation.(4) Comparison of apoptotic index in the ablation zone between two groups:the apoptotic index of the ablation zone was significantly higher in the experimental group than in the control group on the 3 days after operation (76.67％±0.04％ vs.64.03％±0.05％,t=4.79,P＜0.05).Conclusion IRE hepatic ablation of swine using high-frequency bipolar pulse is safe and reliable,and it has more apoptotic cells than IRE ablation with high-frequency monopolar burst.
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Objective To compare the accuracy of 125I seeds longitudinal distance between groups by degradable catheters and hand.Methods The study was divided into two groups (implantation by degradable catheters and that by hand).There were 12 simulated lesions in each group.Seed needle and 125I seeds were implanted by three physicians according to the set longitudinal distance (0.5 and 1.0 cm).Postoperative CT was conducted and the longitudinal distance between seeds was measured,and then the data was analyzed between the actual distance and the designed distance in each group.Results The degree of deviation from the set distance were (0.184 ±0.047) and (0.127 ±0.051) cm in the group by hand,and (0.007 ± 0.006) and (-0.003 ± 0.006) cm in degradable catheters group.The degree of deviation of the seeds in the catheter group was significantly lower than the group by hand (t =3.804,2.499,P ＜0.05).Conclusions The accuracy of the longitudinal distance of the group by catheter is much better than that by hand.
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BACKGROUND@#The preferred therapy for patients with pulmonary nodules which highly suspected as lung cancer by low-dose spiral computed tomography (CT) is surgery, but the best screening method of whole body is not clear yet. The aim of this study is to investigate the differences in the progression-free survival (PFS) of patients with Ia stage non-small cell lung cancer after screening of positron emission computed tomography (PET)-CT and conventional imaging (B-ultrasound/CT/MRI/ECT, BCME).@*METHODS@#A total of 300 cases of Ia stage non-small cell lung cancer were collected, of which 170 cases were performed PET-CT and 130 cases were performed BCME before operation. The basic characteristics of the two groups were analyzed by propensity score matching (PSM), and 114 cases of each group were included in the study. The survival analysis was carried out by the Kaplan-Meier survival curve and the Cox regression analysis.@*RESULTS@#There was no significant difference between each group analyzed by PSM. The PFS of PET-CT and BCME were (44.9±27.2) months and (44.1±33.1) months (χ2=1.284, P=0.257). Both of the method ssucceed in screening. It is not the PFS influence factors. The false positive of PET-CT and BCME were 10 cases and 8 cases (χ2=0.241, P=0.623).@*CONCLUSIONS@#Both PET-CT and BCME can be used as a screening method for Ia stage non-small cell lung cancer according to individualized choice of patients.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Non-Small-Cell Lung , Diagnostic Imaging , Pathology , General Surgery , Disease-Free Survival , Early Detection of Cancer , Methods , Fluorodeoxyglucose F18 , Lung Neoplasms , Diagnostic Imaging , Pathology , General Surgery , Neoplasm Staging , Positron Emission Tomography Computed Tomography , Preoperative PeriodABSTRACT
Most of the CHD patients reveal string pulse, mainly due to damage of heart function, lowering of arterial compliance and increase of total peripheral resistance. The common pulse in patients of blood diseases reveal frequent, tiny, string and slippery characteristic, mostly due to the increase of compensatory pumping action of the heart, shortening of ejection time of the left heart, with better vessel compliance and hemorheology, low total peripheral resistance.
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Objective:To investigate the pathway of C.albicans-induced murine thymocyte apoptosis.Methods:The chages of TNF-? level in murine plasma and caspase-3 activity were measured by ELISA and flurorescence spectrophoto meter respectively;FCM measurement was adopted for the expression levels of related genes.Results:The level of TNF rise,the caspase-3 activity serengthen significantly and bax,p53 gene expression are upregulated.Conclusion:It is possible that C.albicans elicits apoptosis in murine thymocytes by upregulating bax and p53 gene expression as well as raising the serum TNF-? level to strenghen the activity of caspase-3.