不可逆电穿孔治疗肿瘤与冷热消融治疗的原理比较

目前,针对肿瘤的治疗,非血管介入技术已经成为了常规手段,但是,其治疗方法和原理各不相同。总结了各种治疗手段的原理,介绍和比较了最新的不可逆电穿孔技术的优点和缺点,以期为其今后的应用提供必要的参考。     

南水北调配套工程大宁调蓄水库西堤防渗墙施工技术

北京市南水北调配套工程大宁调蓄水库工程西堤防渗采用塑性混凝土防渗墙布置,＂两站一抓＂法成槽,＂泥浆下直升＂法浇筑,＂接头管＂法槽段连接。大宁水库西堤防渗墙施工投入足够资源,选择实力强大、信誉良好的施工队伍,为类似工程的施工管理提供了较好的实例。     

Catheter‐related fungal endocarditis caused by Candida parapsilosis in a hemodialysis patient

Fungal endocarditis (FE) is commonly regarded as a rare but fatal disease. The incidence of infective endocarditis (IE) in hemodialysis (HD) patients is thought to be obviously higher than that in the general population. Moreover, IE occurs more likely in HD patients with catheters. With the increase of HD population and extensive use of catheters in HD patients, FE, as a special form of IE, may increase and bring new challenges to clinicians. We reported a case of FE associated with catheter infection in a 44‐year‐old woman on HD. The risk factors and treatment strategies of FE in HD patients were discussed.     

一种具有力检测机制的新型血管介入手术机器人

为了在机器人辅助远程介入手术中实现向医生提供高精度的力反馈,设计了一种具有力检测机制的新型血管介入手术机器人,其是一个主从控制系统,包括一个操作方便的主端装置和一个递送导丝/导管的从端装置。首先,设计了血管介入手术机器人的力检测机制,以实现轴向近端力的精准测量和径向夹紧力的感知。然后,基于血管介入手术机器人的动力学分析,设计了具有在线整定参数功能的模糊PID (proportional integral derivative,比例积分微分)控制器,以提高从端装置的递送精度和抗干扰能力,同时选择阶跃信号对所设计的模糊PID控制器进行仿真验证。最后,搭建血管介入手术机器人物理样机,并开展主从运动跟踪实验和轴向近端力、径向夹紧力检测评估实验。实验结果表明,该血管介入手术机器人具有[-0.31, 0.25] mm的运动跟踪误差,可检测平均误差为0.12 N的轴向近端力以及可感知0.47～4 N的径向夹紧力。研究结果验证了所设计血管介入手术机器人的鲁棒性以及其力检测机制的可行性,可为同类产品的设计和改进提供参考依据。     

有限元在心脏瓣膜支架设计中的应用

通过SolidWorks建立某心脏瓣膜支架的三维模型,用Abaqus对瓣膜支架压握入鞘过程与疲劳情况进行分析,得到支架的应变分布和疲劳性能.结果可以判断支架设计的优劣,为支架优化设计提供参考.     

Multiple metastatic infections in a hemodialysis patient with untunneled internal jugular catheter

We present an end‐stage renal disease patient on dialysis with fever. The primary source was right internal jugular vein catheter which had metastatic infections in the body probably via an arteriovenous communication in a cavity in left lung. Patient had right psoas muscle abscess and a left kidney abscess. An ¹⁸F‐fluorodeoxyglucose‐positron emission spectroscopy scan was done to find out left kidney abscess. A search of literature did not reveal many patients of psoas abscess secondary to infection of hemodialysis access.     

Comparison of alteplase (tissue plasminogen activator) high‐dose vs. low‐dose protocol in restoring hemodialysis catheter function: The ALTE‐DOSE study

Hemodialysis catheter (HDC) dysfunction due to thrombosis is common, and dysfunction incidence can reach up to 50% within 1 year of use. Although administration of intraluminal alteplase (tissue plasminogen activator [tPA]) is the standard of practice to pharmacologically restore HDC function, there are no evidence‐based guidelines concerning the optimal tPA dose. The purpose of this study was to compare the efficacy of 1.0‐mg vs. 2.0‐mg tPA dwell protocols in restoring the HDC function in thrombotic dysfunctional catheters. A retrospective, single‐center study was conducted on two independent cohorts of patients; the first (n = 129) received 2.0 mg tPA/catheter lumen, while the second (n = 108) received 1.0 mg tPA/catheter lumen. Kaplan–Meier and Cox regression analyses were performed to compare the catheter survival time between patients who received 1.0 mg tPA and those who received 2.0 mg tPA. Catheter removal occurred in 25 (19.4%) of those catheters treated with 1.0 mg tPA compared with 11 (10.2%) of catheters treated with 2.0 mg tPA (P = 0.05). The hazard ratio (HR) for catheter removal was 2.75 (95% confidence interval [^95%CI] = 1.25–6.04) for the 1.0‐mg tPA cohort compared with the 2.0‐mg tPA cohort. Correction added on 3 December 2012, after first online publication: The tPA cohort values were changed. Female gender (HR = 2.51; ^95%CI = 1.20–5.27) and age (HR = 0.96; ^95%CI = 0.94–0.98) were also associated with catheter survival. Our findings suggest that treatment of dysfunctional HDC with 2.0‐mg tPA dwells is superior to 1.0‐mg tPA dwells.     

依折麦布联合他汀对急性冠脉综合征行急诊介入患者残粒脂蛋白胆固醇及MACE影响的临床研究

目的：研究依折麦布联合他汀对急性冠脉综合征（ACS）行急诊介入术（PCI）后患者残粒样脂蛋白-胆固醇（RLP-C）水平及主要心血管不良事件（MACE）的影响。方法：选取入院诊断ACS并行急诊PCI患者共90人,术后常规冠心病二级预防用药,将其随机分为两组,对照组48例服用阿托伐他汀,研究组42例加用依折麦布治疗,检测治疗前后RLP-C水平,并通过定期随访获取患者治疗期间MACE及药物不良反应。结果：与对照组相比,研究组治疗后RLP-C水平明显下降（P<0.05）,MACE发生率明显降低（P<0.05）,药物不良反应没有增加。结论：依折麦布联合他汀治疗可以降低ACS行急诊PCI术后患者RLP-C水平,减少MACE,不良反应少,值得推广应用。     

某院介入手术围术期使用抗菌药物的合理性分析

目的 通过开展抗菌药物临床应用专项整治活动,探讨南昌大学第一附属医院介入手术围术期预防用药的合理性.方法收集该院2013年3-5月住院的1 160例10种介入手术病例的抗菌药物使用情况,并对其合理性进行分析.结果 永久或临时起搏器安置/更换术、椎间盘射频消融术的预防使用抗菌药物的使用率分别是87.95%、83.33%,其他8种介入手术的使用率都为0.结论 该院介入手术围术期抗菌药物的使用率已趋达到卫生部的标准,呈整体合理趋势.加大对医护人员的培训和监督力度,能够明显改善抗菌药物用药不合理的局面.     

改善胶乳三腔双囊胃管质量的生产工艺研究

以浓缩天然胶乳并用20份MG49天甲胶乳作胃管基础管身胶料可有效提高管身硬度和撕裂强度,并解决纯天然胶乳管身硬度不足、临床不易插管的难题,而对产品工艺性能及其他性能无不良影响。用"硝酸钙+工业酒精+表面活性剂"代替"硝酸钙+生粉附型剂+表面活性剂"作凝固体系,可改善胃管球囊胶膜厚度的均匀性。对胃管球囊内表面做适度氯化处理,可克服球囊与胃管管身产生的粘连或粘伤。适当改变绑线位置可有效减少胃管球囊胶膜出现的龟裂纹;球囊绑线处涂覆氯仿值二中~三中(见表9注)、总固体25%~35%的胶料3~4次,可获得较好涂胶效果。