Volume 101 ·  Issue 05 ·  2021

Evidence-based interventional radiology is the result of the evolution and integration of evidence-based medicine and interventional radiology. It adopts the concepts and methods of evidence-based medicine to guide the best clinical practice in interventional radiology. We aim to systematically elaborate on the status quo of Clinical Research, Systematic Review/Meta-Analysis and Clinical Practice Guidelines in interventional radiology, analyze the existing problems, and put forward thoughts and suggestions on promoting the development of evidence-based interventional radiology in the future.

Differential diagnosis of stroke and monitoring of disease changes are the key links in the treatment of stroke patients. With the increasing application of imaging, ultrasound, electrophysiology, electrical impedance and other technologies in stroke monitoring, scientific understanding of the relationship between clinical data generated by these technologies and stroke prognosis is conducive to improving the treatment level of stroke. Therefore, the author puts forward consensus opinions by inquiring and evaluating the existing research evidence, in order to provide guidance and reference for standardized monitoring and clinical diagnosis and treatment of stroke.

To investigate the expression of peroxisome proliferator-activated receptor-gamma coactivator (PGC)1β in synovium of patients with rheumatoid arthritis (RA) and its association with histological synovitis.

This cross-sectional study recruited RA patients at the Department of Rheumatology, Sun Yat-Sen Memorial Hospital from May 2010 to October 2016. Clinical data were collected. Conventional radiographs of bilateral hands and wrists were performed and assessed according to Sharp/van der Heijde-modified Sharp score(mTSS). Synovial tissues from knee joints of all RA patients were obtained by biopsies, and then stained with HE and immunohistochemically for PGC-1β, CD3, CD20, CD38, CD68, CD15 and CD34 to evaluate synovitis, synovial PGC-1β expression and the densities of inflammatory cells and endothelial cells. The relationship between synovial PGC-1β expression and histological synovitis, disease activity and joint destruction in RA was analyzed by Spearman′s rank correlation and multivariate linear regression.

There were 83 RA patients recruited with 20 (24.1%) males and 63 (75.9%) females, aged (54±14) years. PGC-1β expressed in the nuclei of lining synoviocytes, sublining inflammatory cells and vascular endothelial cells of RA synovium. The percentage of synovial PGC-1β⁺cells was positively correlated with histological synovitis score (r=0.333) and the densities of sublining CD3⁺ T cells (r=0.259), CD20⁺ B cells (r=0.320), CD38⁺plasma cells (r=0.342) and CD68⁺ macrophages (r=0.309)(all P<0.05). It was also positively correlated with erythrocyte sedimentation rate, C reactive protein and total mTSS (r=0.219-0.301, all P<0.05). Multiple linear regression analysis further confirmed the positive correlation between the percentage of synovial PGC-1β⁺cells and mTSS (β=0.312, P=0.004).

Synovial PGC-1β is positively associated with local and systemic inflammation as well as joint destruction, which implies that PGC-1β might involve in the pathogenesis of synovitis and joint destruction in RA.

To investigate the effect of continuous renal replacement therapy (CRRT) on acute kidney injury (AKI) after acute Stanford type A aortic dissection (ATTAD).

In this study, 120 patients with AKI after ATTAD surgery treat in Gansu Provincial People′s Hospital were selected as research objects. Among them, there were 86 males (71.7%) and 34 females (28.3%) with a mean age of (55±5) years. These patients were randomly divided into experimental group (n=60) and control group (n=60) with stratified random sampling. CRRT and intermittent hemodialysis (IHD) were performed in the experimental group and the control group respectively. The therapeutic effect of CRRT on ATTAD patients with AKI was evaluated by blood purification index, renal function index, Sequential Organ Failure Assessment (SOFA) score, inflammatory level, hemodynamic index and fluid infusion volume.

The two treatment schemes both had considerable therapeutic effects on the condition of patients, but the therapeutic effect of CRRT was more superior. In the patients treated with CRRT, the levels of serium creatinine (SCr), blood urea nitrogen (BUN) and blood lactic acid (Lac) were all lower than those in the control group (all P<0.05). The time of staying in intensive care units (ICU), the period of oliguria, the times of renal replacement therapy, the time from the first dialysis to the last dialysis and the total hospital stay in the experimental group were all shorter than those in the control group (allP<0.05). The volume of fluid infusion was less and the hemodynamic index was better than that in the control group, but there was no significant difference in hospital mortality between the two groups (P>0.05). The levels of interleukin (IL)-6, IL-8 and C-reactive protein (CRP) in the experimental group were (21.9±1.8) ng/L, (18.6±1.4) ng/L and (22.7±2.2) mg/L, respectively, which were all significantly lower than those in control group ((27.9±3.2) ng/L, (28.3±1.4) ng/L, (60.1±2.5)mg/L, respectively; t=14.527, 13.255, 11.247, all P<0.05). The scores of SOFA at all time points in the experimental group were all lower than those in the control group (allP<0.05).

Compared with IHD, CRRT brings no significant reduction in hospital mortality in patients with AKI after ATTAD, but shows better prognosis.

To compare the impact of mediolateral episiotomy on pelvic floor muscle (PFM) function through surface electromyography (sEMG) and quality of life questionnaire assessment.

From January 2018 to June 2019, 1 250 eligible primiparous women were enrolled in Beijing Hospital and the First People′s Hospital of Yunnan Province. Participants were divided into episiotomy group (n=676)and non-episiotomy group (n=574). Both groups underwent clinical pelvic examination, sEMG assessment, and quality of life (QOL) questionnaire assessment at two fixed time points: 6-8 weeks, 6 months after vaginal delivery. Follow-up of sEMG amplitudes and their correlation with QOL questionnaire scores were evaluated.

Among the women delivered with episiotomy, the peak amplitude of phasic contraction (PPC) was (17.7±5.3) μV at 6-8 weeks after childbirth and (29.6±8.7) μV at 6 months after childbirth. The mean amplitude of tonic contraction (MTC) was (14.8±7.4) μV and (22.2±8.9) μV, respectively. In the non-episiotomy group, PPC was (20.0±7.9) μV and (35.4±10.7) μV at 6-8 weeks and 6 months, and MTC was (17.8±9.0) μV and (27.5±8.9) μV, respectively. Compared with EMG amplitudes at 6-8 weeks, both PPC and MTC significantly improved at 6 months in both groups (all P<0.01). Moreover, episiotomy was related with significantly lower PPC and MTC at both fixed checkups. Besides, both IIQ-7 and PFIQ-7 questionnaire scores improved at 6 months compared with those at 6-8 weeks in both groups (all P<0.001). There was consistently significant difference in QOL scores between episiotomy and non-episiotomy group at two checkups (allP<0.05). A negative correlation was observed between PFM contractile amplitudes and QOL scores at both time points after childbirth (all P<0.05), and the correlation weakened with time.

Episiotomy has a negative impact on the postpartum PFM contractile function within 6 months after childbirth. The negative correlation between the sEMG and QOL scores indicates that sEMG is a candidate assessment for PFM function follow-up after childbirth.

To investigate the effect of cerebral oxygen saturation (rSO₂) on postoperative cognitive dysfunction (POCD) in elderly patients undergoing cardiac anesthesia.

Retrospective analysis was performed on 113 elderly patients (age 65-89) underwent cardiac surgery in Peking University International Hospital from June 2017 to December 2019, 67 male and 46 female patients were included. All operations were performed under general anesthesia, cardiopulmonary bypass, rSO₂ and other relevant monitoring. Statistical analysis of the elderly patients with complications, cardiac surgery history, time of CPB, baseline value of rSO₂ (rSO_2baseline), lowest intraoperative value of rSO₂ (rSO_{2 min}), time of operation, length of stay in CCU, length of hospital stay; Preoperative and postoperative NSE values; number of postoperative POCD and postoperative deaths were recorded. All data were obtained from the medical records system and anesthesia information system of Peking University International Hospital and risk factors related to POCD were analyzed by Logistic regression.

POCD occurred in 19 patients (16.8%), and also, intraoperative rSO₂ decreased by more than 30% over the baseline. The variance of rSO₂ (rSO_{2 baseline}-rSO_{2 min}) in POCD group and non-POCD group was (18.0±2.7) and (6.6±2.3), the variance of NSE (NSE_{after surgery}-NSE _{before surgery}) was (31.3±9.7) and (9.5±3.0) μg/L, respectively. The differences were statistically significant (t=18.35, 17.70, allP<0.05). rSO₂ variability was positively correlated with NSE variability (r=0.697, P<0.05). Logistic regression analysis showed that the variation degree of rSO₂ [OR(95%CI)was 0.374(0.059-1.895)]、 patients combined with diabetes mellitus [OR(95%CI)was 0.493 (0.041-1.812), history of stroke [OR(95%CI)was 0.325 (0.084-0.917)] and atrial fibrillation [OR(95%CI)was 0.176 (0.091-0.943)] were the risk factors for POCD.

POCD can be predicted by monitoring the decline range of rSO₂ intraoperatively. rSO₂ is recommended as a routine monitoring item for elderly patients undergoing cardiac surgery.

To evaluate the long-term efficacy of subthalamic nucleus deep brain stimulation (STN-DBS) in the treatment of isolated dystonia, and explore the factors influencing the results.

The clinical data of 23 consecutive patients with isolated dystonia treated with STN-DBS in the Department of Neurosurgery, Tangdu Hospital, Air Force Military Medical University from December 2004 to December 2014,were retrospectively analyzed. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to quantify the dystonia symptoms and signs. Multiple linear regression analysis was used to explore the influencing factors of the results.

The age of the 23 patients including 8 females and 15 males was 19(10, 27) years old. The follow-up time was 5-12 years, with an average of (8.1±1.8) years.Compared with the preoperative period, the BFMDRS movement score decreased by 30.1 [95% confidence interval (CI): 12.3-47.8)] points, 34.7 (95%CI: 17.0-52.4) points, 34.1 (95%CI: 16.4-51.8) points and 34.0 (95%CI: 16.3-51.7) points (all P<0.001) respectively at 1 year, 3 years, 5 years after surgery and the last follow-up, the average improvement rates were (56.0±20.2)%, (65.3±24.0)%, (64.4±25.1)% and (64.3±25.1)%;the disability score decreased by 6.9 (95%CI: 1.4-12.3)points, 8.7 (95%CI: 3.3-14.2)points, 9.0 (95%CI: 3.6-14.5)points, and 9.2 (95%CI: 3.7-14.7) points (all P<0.001), the average improvement rates were (42.9±17.1)%, (55.5±23.2)%, (57.8±24.8)% and (58.7±24.8)%. Patients with DYT1-positive dystonia had higher rates of improvement in movement and disability scores than patients with DYT1-negative, but there was no statistically significant difference. Multiple linear regression analysis showed that gender, age at onset, course of disease, preoperative movement or disability score had no linear relationship with long-term results (improvement rate of movement or disability score) (bothP>0.05).

STN-DBS is effective and long-lasting in the treatment of isolated dystonia, but no reliable predictor has been found.

Vaginal rupture is rare clinically, most often secondary to hysterectomy and improper sexual intercourse; Advanced age and uterine prolapse are also risk factors for vaginal rupture. Vaginal rupture accompanied by visceral prolapse is a very rare surgical emergency. After visceral prolapse, it is easy to cause incarceration necrosis and even life-threatening. This paper reports a case of spontaneous posterior vaginal fornix rupture with multiple pelvic organ prolapse in an elderly patient.

This article reports a case of white fibrous papulosis. A 49-year-old female had multiple asymptomatic yellowish-white papules on the face, neck and back of hands for 6 years. The histological manifestations of papules were hyperkeratosis of the epidermis, hyperplasia of collagen fibers in the upper and middle dermis, accompanied by collagen degeneration, and elastic fiber staining showed that elastic fibers were reduced and fractured in a small part of the upper dermis.

It was found that neuroendoscopic transorbital approach as a new surgical approach has special advantages for the treatment of tumors involving the orbital apex, cavernous sinus, Meckel's sac and other areas. At present, there are no reports of endoscopic transorbital approach to treat tumors in this site in China. This paper discusses the experience of endoscopic transorbital approach in the treatment of left orbital cavernous sinus hemangioma.

Hereditary diffuse white matter lesions with globular axons (HDLS) are a rare autosomal dominant leukoencephalopathy. At present, there are few reports of this disease in China. This paper reports a young female patient with HDLS who had difficulty in speech, slow onset of movement, white matter lesions, thinning of corpus callosum and CSF1R gene: C. 2463G>C (p. W821C). The patient was followed up for 9 months.

Herpes zoster is a viral infectious disease caused by the reactivation of varicella-zoster virus, which occurs in middle-aged and elderly people. Herpes zoster vaccine provides an effective means to prevent the occurrence of herpes zoster. This article interprets the 2018 guidelines for shingles vaccination of the American Advisory Committee on Immunization Practices (ACIP) and the Canadian Advisory Committee on Immunization Practices (NACI) from the types of shingles vaccines, immunogenicity and durability, safety, and immunization strategies, and provides a basis for the formulation of vaccination and public health strategies for shingles vaccines in China.

Due to the lack of effective second-line and back-line treatment, the survival time of patients with advanced gastric cancer is always difficult to break through 1 year. In recent years, with the advancement of multidisciplinary diagnosis and treatment and new drug research and development, the drug treatment and treatment strategies of advanced gastric cancer are undergoing major changes. Several recent phase III clinical trials have confirmed that cytotoxic drugs represented by irinotecan and taxans are still the cornerstone of second-line treatment, and targeted drugs with different targets can also be used as one of the second-line treatment options. In addition, the emergence of immune checkpoint inhibitors may become the key to rewriting the third-line treatment pattern of advanced gastric cancer. This article summarizes the current advances and future potential development directions of second-line and posterior-line drug therapy for advanced gastric cancer, and provides a basis for clinical diagnosis and treatment.

In the past decades, intelligent medical technology has been a hot research topic, among which medical robot is one of the most promising intelligent technologies. Many robot products at home and abroad have been successfully applied clinically, and robots have shown their advantages in many medical fields. We should pay attention to the research and development and application of medical robots in China.

Cluster headache (CH), which belongs to the trigeminal autonomic headache, is called the most severe primary headache and greatly affects the quality of life of patients. Current studies have shown that smoking is closely related to cluster headache, but there is still no consensus literature on the extent of tobacco action and specific mechanism. This article reviews the epidemiology, the influence of smoking on the clinical symptoms of cluster headache, the influence of smoking and smoking cessation on the treatment of cluster headache, the action mechanism of smoking, the role of passive smoking in childhood on the pathogenesis of cluster headache in adulthood, and explores the influence and mechanism of smoking on cluster headache.