综合性心理干预对冠心病介入治疗患者抑郁焦虑及生活质量的影响

目的:探究综合性心理干预对冠心病介入治疗患者焦虑、抑郁及生活质量的影响。方法:选择2014年6月~2015年6月期间我院收治冠心病性介入治疗患者3280例为研究对象,采用随机数字法将其分为观察组(1648例)和对照组(1632例),观察组患者给予常规治疗、抗抑郁治疗及综合心理干预,对照组给予常规治疗、抗抑郁治疗;采用焦虑自评量表(SAS)、抑郁自评量表(SDS)评价患者治疗前后焦虑、抑郁状态,生活质量评价量表QLQ-C30量表评价患者治疗前后生活质量的变化情况。结果:两组患者在入院时SAS和SDS得分不存在差异(P0.05);干预1月后两组组患者的SAS和SDS得分均出现显著降低(P0.05),且观察组患者的SAS和SDS评分均明显低于对照组(P0.05);干预前两组患者生存质量各维度的评分均不存在显著差异(P0.05);干预1个月后两组患者躯体功能、角色功能、社会功能、情绪功能及总体症状较干预前均出现明显改善(P0.05),且干预后观察组患者躯体功能、角色功能、社会功能、情绪功能及总体症状均显著优于对照组(P0.05)。结论:冠心病介入治疗患者进行综合性心理干预能够改善患者心理状态,降低患者焦虑、抑郁情绪,提高生活质量,对临床冠心病的治疗有重要的意义。     

16例婴幼儿卡梅现象临床疗效分析

目的:总结16例卡梅现象患儿的临床治疗过程,为该病提供诊疗方案.方法:收集我科在2016年5月至2020年1月期间收治并确诊为卡梅现象的16例患儿(男13例、女3例)的临床资料并进行回顾性分析.结果:患儿在住院和门诊期间接受药物(糖皮质激素、长春新碱、西罗莫司)、介入栓塞、微波消融术和瘤内硬化剂注射等治疗.5例(31....     

Real-time patient radiation dosimeter for use in interventional radiology

There is currently no effective real-time patient dosimeter available for use in interventional radiology (IR). We conducted a feasibility study in a clinical setting to investigate the use of the new dosimeter using photoluminescence sensors during procedures. Reference dosimeters were set at almost the same position of the prototype dosimeter sensors.We found excellent correlations between the reference measurements and those of the prototype dosimeter (r² = 0.950). The sensor of the new dosimeter does not interfere with the IR procedure. The new dosimeter will be an effective tool for the real-time measurement of patient skin doses during IR.     

Institutional Diagnostic Reference Levels and Peak Skin Doses in selected diagnostic and therapeutic interventional radiology procedures

PurposeInstitutional (local) Diagnostic Reference Levels for Cerebral Angiography (CA), Percutaneous Transhepatic Cholangiography (PTC), Transarterial Chemoembolization (TACE) and Percutaneous Transhepatic Biliary Drainage (PTBD) are reported in this study.Materials and methodsData for air kerma-area product (P_KA), air kerma at the patient entrance reference point (K_a,r), fluoroscopy time (FT) and number of images (NI) as well as estimates of Peak Skin Dose (PSD) were collected for 142 patients. Therapeutic procedure complexity was also evaluated, in an attempt to incorporate it into the DRL analysis.ResultsLocal P_KA DRL values were 70, 34, 189 and 54 Gy.cm² for CA, PTC, TACE and PTBD respectively. The corresponding DRL values for K_a,r were 494, 194, 1186 and 400 mGy, for FT they were 9.2, 14.2, 27.5 and 22.9 min, for the NI they were 844, 32, 602 and 13 and for PSD they were 254, 256, 1598 and 540 mGy respectively. P_KA for medium complexity PTBD procedures was 2.5 times higher than for simple procedures. For TACE, the corresponding ratio was 1.6. PSD was estimated to be roughly 50% of recorded K_a,r for procedures in the head/neck region and 10% higher than recorded K_a,r for procedures in the body region. In only 5 cases the 2 Gy dose alarm threshold for skin deterministic effects was exceeded.ConclusionProcedure complexity can differentiate DRLs in Interventional Radiology procedures. PSD could be deduced with reasonable accuracy from values of K_a,r that are reported in every angiography system.     

Correlation between eye lens doses and over apron doses in interventional procedures

Measurements of eye lens dose using over apron dosimeters with a geometric correction factor is an international accepted practice. However, further knowledge regarding geometric correction factors in different contexts is required. The authors studied the correlation between eye lens dose and over apron dosimetry for different medical specialties in eleven hospitals, using a standardized protocol, two independent over apron dosimeters (worn at chest and at neck levels) and a dedicated calibration procedure. The results show good correlation between subjects working on the same medical specialty for 5 specialties: Interventional Radiology, Vascular Surgery, Vascular Radiology, Hemodynamics and Neuroradiology. The geometric correction factors resulting from this study could be used to estimate eye lens dose using over apron dosimeters, which are more comfortable than eye lens dosimeters, as reported by the study subjects, as long as the increased uncertainty of the over apron dosimetry compared to the dedicated eye lens dosimetry is acceptable.     

The efficacy of pre-warming on reducing intraprocedural hypothermia in endovascular coiling of cerebral aneurysms

Background

The anesthetic management of patients undergoing endovascular treatment of cerebral aneurysms in the interventional neuroradiology suite can be challenged by hypothermia because of low ambient temperature for operating and maintaining its equipments. We evaluated the efficacy of skin surface warming prior to induction of anesthesia to prevent the decrease in core temperature and reduce the incidence of hypothermia.

Methods

Seventy-two patients were randomized to pre-warmed and control group. The patients in pre-warmed group were warmed 30 minutes before induction with a forced-air warming blanket set at 38°C. Pre-induction tympanic temperature (Tpre) was measured using an infrared tympanic thermometer and core temperature was measured at the esophagus immediately after intubation (T0) and recorded at 20 minutes intervals (T20, T40, T60, T80, T100, and T120). The number of patients who became hypothermic at each time was recorded.

Results

Tpre in the control and pre-warmed group were 36.4 ± 0.4°C and 36.6 ± 0.3°C, whereas T0 were 36.5 ± 0.4°C and 36.6 ± 0.2°C. Core temperatures in the pre-warmed group were significantly higher than the control group at T20, T40, T60, T80, T100, and T120 (P < 0.001). Compared to T0, core temperatures at each time were significantly lower in both two groups (P = 0.007 at T20 in pre-warmed group, P < 0.001 at the other times in both groups). The incidence of hypothermia was significantly lower in the pre-warmed group than the control group from T20 to T120 (P = 0.002 at T20, P < 0.001 at the other times).

Conclusion

Pre-warming for 30 minutes at 38°C did not modify the trends of the temperature decrease seen in the INR suite. It just slightly elevated the beginning post intubation base temperature. The rate of decrease was similar from T20 to T120. However, pre-warming considerably reduced the risk of intraprocedural hypothermia.

Trial registration

Clinical Research Information Service (CRiS) Identifier: KCT0001320. Registered December 19th, 2014.     

CT-guided 125I brachytherapy in the treatment of distant metastases in the oral cavity and maxillofacial region

PURPOSE: We aimed to evaluate the feasibility and clinical effectiveness of CT-guided ¹²⁵I brachytherapy for distant oral and maxillofacial metastases. MATERIALS AND METHODS: We retrospectively analyzed 65 patients with 84 distant oral and maxillofacial metastases. Thirty-one patients with 38 lesions received ¹²⁵I brachytherapy (group A) and 34 with 46 lesions received external beam radiotherapy (EBRT; group B). RESULTS: Median follow-up time was 16 months. The 3-, 6-, 12-, 18-, and 24-month local control rates for group A were 83.9%, 75.9%, 66.7%, 38.4%, and 25.0%, respectively; for group B they were 76.5%, 62.5%, 43.8%, 25.0%, and 0.0%, respectively (P < .05); the median local tumor progression-free survival times were 14 and 9 months, respectively. Group A had a better local tumor progression-free survival (LTPFS) relative to group B (P < .001; HR, 6.961 [95%CI, 2.109, 9.356]). Cox proportional hazards regression analysis indicated that ¹²⁵I brachytherapy, tumor size, and primary pathological type were the independent factors affecting LTPFS. Additionally, ¹²⁵I brachytherapy showed better performance in relieving patient clinical symptoms relative to EBRT (P < .05). Group A also had fewer complications than group B, especially regarding grade 3/4 complications according to Radiation Therapy Oncology Group grading criteria. Mean overall survival times in groups A and B were 17.1 and 14.8 months, respectively. CONCLUSION: CT-guided ¹²⁵I brachytherapy is feasible and safe for distant oral and maxillofacial metastases; it achieved a better local control rate, longer LTPFS and fewer complications without compromising overall survival compared with EBRT.     

急性ST段抬高型心肌梗死介入手术时间窗与血清FGF-21水平的相关性

摘要 目的：探究急性ST段抬高型心肌梗死介入手术时间窗与血清FGF-21水平的相关性。方法：选取2019年3月-2021年5月在我院接受PPCI手术并住院治疗且符合STEMI诊断标准的73例患者,根据FGF-21水平高低,将73例患者分为FGF-21低水平组（>140.41 ng/L,n=54例）和FGF-21高水平组（<140.41 ng/L,n=19例）。对比分析两组患者的一般临床资料、急救时间窗和SO-to-FMC时间差异,再通过Spearson法判断急救时间窗与FGF-21水平的相关性。结果：FGF-21低水平组患者的急救时间窗SO-to-FMC、FMC-to-B、D2B和STB均较FGF-21高水平组患者时间长,且SO-to-FMC时间>120 min是导致FGF-21水平变低的危险因素,介入手术时间窗指标与FGF-21水平均呈正相关（r=0.235、0.462、0.298、0.337）。高血压史、糖尿病史、首次医疗接触方式（急诊）和SO-to-FMC均是FGF-21水平变化的独立危险因素,且差异有统计学意义（P<0.05）。结论：SO-to-FMC时间和STB时间延长可能促进STEMI患者FGF-21水平异常,故应严格把握好院外的急救时间。     

子宫动脉栓塞术治疗子宫肌瘤的临床应用价值

目的：研究子宫动脉栓塞术（UAE）治疗子宫肌瘤的安全性和临床应用价值,材料和方法：25例经临床,B超证实的子宫肌瘤患者,平均年龄43．5岁,主要临床表现为月经量增多21例,贫血16例,有压迫症状4例,选择性双侧子宫动脉插管造影,用聚己烯已醇海绵（PVA）颗粒栓塞该动脉。结果：UAE后第3,6个月随访,所有患者月经量均恢复正常,15例贫血,4例压迫症状者均缓解,第3,6个月B超复查子宫肌瘤体积分别缩小47．37％和51．31％,与UAE产比较有显著差异（P＜0．01）,缺血性盆腔疼痛（92％）是最常见的副反应,UAE后卵巢体积均无显著缩小（P＞0．05）,结论：介入性双侧子宫动脉栓塞术治疗子宫肌瘤是一种微创,安全的手术,可保留子宫及其功能,其近期疗效显著,子宫动脉栓塞治疗子宫肌瘤具有重要的临床应用价值。     

犬肝动脉介入性热疗的安全性

经犬肝动脉灌注入 60℃生理盐水 1 80ml,持续 3 0min。观察、比较热灌注前后肝脏穿刺活检及肝、肾功能的动态变化情况。结果是 ,①谷丙转氨酶 (ALT)、谷草转氨酶 (AST)于灌注后 2 4h开始升高 ,72h达到高峰 (P <0 0 1 ) ,1 68h后逐渐下降 ,2 1 6h后恢复正常 ,总胆红素 (T BIL)、白蛋白 (ALB)、γ GT无明显变化 (P >0 0 5 ) ;②肝组织可见一过性淋巴细胞浸润、肝细胞混浊肿胀 ,1 68h后恢复正常 ;③肾功能尿素氮 (BUN)、肌苷 (Cr)无显著性变化 (P >0 0 5 ) ,尿酸 (UA)呈一过性增高 (P <0 0 5 )。结果说明 ,经肝动脉60℃灌注液介入性热疗对犬肝组织有一过性损伤 ,对肝、肾功能呈一过性影响