脑动静脉畸形癫痫的相关血管构筑学及栓塞治疗研究

探讨DSA的超选择造影显示的脑动静脉畸形（AVM）相关血管构筑学（AVM的大小、位置、供血动脉）以及血管内栓塞治疗与癫痫发作的关系,以期预测脑动静脉畸形癫痫发作的危险性及栓塞治疗癫痫的有效性。 方法：通过DSA超选择造影显示95例脑动静脉畸形的血管构筑学特点;所有脑AVM应用NBCA或ONYX栓塞治疗;统计学分析采用χ2检验。结果：脑动静脉畸形癫痫发作与AVM的大小、位置有统计学意义(P均＜0.01),与供血动脉支数无统计学意义(P>0.05);本组95例患者中43例有癫痫发作,占45％,术后20例症状消失,11例明显减轻,有效率72.1%。结论：AVM越大、位置越近皮层越易发生癫痫,供血动脉支数的多少与癫痫的发作无关;血管内栓塞AVM治疗由其产生的癫痫效果较好。     

脑动静脉畸形出血的血管构筑学因素探讨

目的：探讨脑动静脉畸形（AVM）的相关血管构筑学因素与出血的关系,以期预测脑AVM出血的危险性。 方法：采用数字减影血管造影（DSA）为200例脑AVM患者进行全脑血管造影,分析脑AVM的供血动脉、畸形血管团和引流静脉等的情况,比较不同血管构筑的AVM患者出血的比率。 结果：穿支动脉供血、小病灶、位于基底节和后颅窝、单支静脉引流、深部引流、有静脉狭窄或闭塞及伴发动脉瘤者易出血。结论：与脑ＡＶＭ出血密切相关的危险因素是供血动脉的类型、ＡＶＭ的大小和部位、引流静脉的数目、引流静脉的类型和有无狭窄或闭塞、是否合并动脉瘤。     

脑动静脉畸形合并出血相关危险因素分析

目的通过数字减影血管造影(DSA)检测脑动静脉畸形(AVM)血管构筑特征,探讨脑动静脉畸形合并出血的相关影响因素,以期预测脑AVM出血的危险性。方法采用DSA为87例脑AVM患者行全脑血管造影。采用SPSS18.0软件行单因素和多因素Logistics回顾分析,分析畸形血管团的大小、位置、供血动脉类型、引流静脉数目、引流静脉路径、有无合并动脉瘤、有无合并静脉瘤等因素与畸形血管团破裂出血的关系。结果单因素分析表明,造成畸形血管团破裂出血的因素包括AVM大小、位置,供应动脉类型,引流静脉支数与合并动脉瘤。多因素Logistics分析发现,畸形血管团破裂出血独立危险因素是引流静脉支数与合并动脉瘤。结论与脑AVM出血密切相关的危险因素是引流静脉的数目和合并动脉瘤。     

脑动静脉畸形合并动脉瘤的血管内治疗

目的：探讨脑动静脉畸形（ Cerebral arteriovenous malformation,AVM）合并动脉瘤治疗策略、治疗方法。方法：经全脑数字减影血管造影（ Digital subtraction angiography DSA）检查确诊出血的10例患者,根据AVM血流动力学及动脉瘤特点,取不同栓塞策略,先栓塞动脉瘤后栓塞动静脉畸形。结果：畸形团内型5例,用Onyx胶、弹簧圈栓塞,单纯弹簧圈栓塞2例;与供血动脉相关型4例,与畸形团无关型1例,弹簧圈栓塞动脉瘤,再Onyx胶栓塞畸形血管。复查DSA,动脉瘤全部栓塞,AVM完全消失5例,3例栓塞80％,2例栓塞60％~80％,1例术后出现病变对例肢体轻度偏瘫。后期再次栓塞畸形血管团2例,行开颅切除畸形血管团1例,立体定向放射治疗2例。结论：动静脉畸形合并动脉瘤的血管内栓塞治疗可取得较好的效果,畸形团供血动脉瘤优先栓塞动脉瘤和载瘤动脉,畸形团内动脉瘤则以闭塞该部血流为主,如技术条件允许也尽量先栓塞带瘤血管巢。     

客家人脑动静脉畸形合并癫痫的相关危险因素

目的 通过头颅影像学检测脑动静脉畸形(AVM)血管构筑特征,探讨脑动静脉畸形合并癫痫的相关危险因素.方法 回顾性分析梅州市人民医院脑AVM患者107例,采用单因素相关分析和多元logistic回归模型,分析年龄、性别、畸形血管大小、位置、供血动脉数目、引流静脉数目、出血及合并动脉瘤或静脉瘤等因素对合并癫痫发生的相关性及...     

颅内动静脉畸形合并近端动脉瘤多因素分析及治疗方式探讨

目的：探讨脑动静脉畸形(AVM)并发供血动脉近端动脉瘤(APIA)的危险因素及其治疗方式。方法：回顾分析了352例AVM病人,按有无APIA,分为Non-APIA组(321例)和APIA组(31例),比较2组性别、年龄、AVM的血供和大小、引流静脉类型,是否出血及出血部位,并进行多因素分析。对于AVM合并APIA的病人根据不同的治疗方式分为血管内治疗组、手术治疗组及手术+血管内治疗组,对不同治疗方式供血动脉、动脉瘤最大径、AVM最大径、治疗后再出血率及GOS预后评分进行比较。结果：APIA组病人年龄高于Non-APIA组(P<0.01),后循环供血率51.6%(16/31)明显高于Non-APIA组的22.7%(73/321)(P<0.05)。多因素分析发现年龄大及AVM血供均为APIA发生的独立危险因素。血管内治疗、手术治疗、手术+血管内治疗3组病人动脉瘤的供血动脉、动脉瘤最大径、AVM最大径、术后再出血率及GOS预后评分差异均无统计学意义(P>0.05)。结论：年龄越大发生APIA的可能性越高,后循环供血的AVM越容易并发APIA,在优先处理动脉瘤的原则指导下,手...     

术中实时超声在脑动静脉畸形外科治疗中的应用

目的 探讨术中实时超声在脑动静脉畸形(AVM)外科治疗中的应用价值。方法 13例脑AVM(幕上12例,幕下1例)接受显微外科治疗,病变切除前进行多模式的术中超声扫描用以：(1)定位和描述AVM边界;(2)辨别栓塞与灌注区;(3)识别供血动脉和引流静脉。病变切除后重复超声检查以发现AVM的残留并与术中和／或术后血管造影结果对比。结果 13例病变均在实时超声导航下获得全切除。畸形血管团由于具有双色血流特征均可被准确定位和界定范围,栓塞区为高回声无血流信号,供血及引流血管的形态和血流动力学有别于正常血管;术中超声影像上病变的全切除为血管造影所证实。结论术中实时超声能够对脑AVM进行准确定位和导航,为手术提供有价值的信息;并可判定脑AVM的全切除。     

鼻咽部纤维血管瘤术前血管栓塞的临床应用

目的探讨鼻咽部纤维血管瘤术前血管造影表现和血管栓塞治疗的临床应用价值.方法采用Seldinger技术,经股动脉入路,分别进行双侧颈内外动脉及椎动脉血管造影;根据造影结果,采取超选择插管对肿瘤颈外系统供血动脉进行栓塞,栓塞后7d内行手术切除.结果 11例患者,患侧颌内动脉分支供血7例,双侧颌内动脉分支供血2例,患侧颌内动脉及咽升动脉分支供血1例,患侧颌内动脉及颈内动脉分支供血1例;所有患者颈外动脉供血分支超选择性栓塞均获得成功;栓塞后均未发生严重并发症;栓塞后,11例7 d内行手术切除,术中出血少,手术平均出血约300 mL.结论血管造影和血管栓塞治疗鼻咽部血管瘤是一种安全有效的术前辅助治疗方法.     

脑动静脉畸形的血管内治疗

脑动静脉畸形 (AVM)是主要发生于青年的中枢神经系统的一种先天性疾病 ,原因为胚胎时期原始动静脉间内皮细胞沟通变异发生瘘道 ,血液直接由动脉流入静脉而形成短路 ,病变畸形血管破裂出血、盗血等造成病人脑缺血及迟发性功能障碍 ,甚至危及生命。对脑 AVM的治疗有多种方法 ,但对各种治疗方案的疗效争论也不少 [1 ] ,至今仍是外科治疗难题之一。1　治疗方法　　脑 AVM的血管内治疗方法目前主要有微粒栓塞术和开孔球囊栓塞术两种 [2 ] 。微粒栓塞术即将微导管超选择插到病变的供血动脉 ,经微导管注入栓塞微粒 ,把微粒带到病灶内进行栓塞 ;…     

脑动静脉畸形的血管内栓塞治疗

目的:探讨血管内栓塞治疗脑动静脉畸形(AVM)的效果。方法:2002年5月～2004年4月,对27例AVM患者(平均年龄30.1岁)进行了血管内栓塞治疗。13例患者首发症状表现为脑出血,7例首发癫痫。颅内杂音1例。血管畸形团位于幕上者26例,位于幕下者1例。根据Spetzler-Martin分级,I级2例,Ⅱ级10例,Ⅲ级11例,Ⅳ级4例。用氰基丙烯酸酯(NBCA)栓塞了13例,用弹簧圈栓塞了5例,用NBCA及弹簧圈联合栓塞了9例。4例患者栓塞后接受了开颅手术。结果:27例患者血管畸形团栓塞后体积平均减少73.1%,3例血管畸形团经介入治疗完全消失。所有患者术后未出现新的神经功能缺失,无死亡病例。结论:血管内栓塞治疗脑动静脉畸形安全、有效性好、并发症少,可以成为治疗脑AVM的主要手段。同时栓塞Spetzler-Martin高级别AVM的深部供血动脉可以降低手术的风险,提高治愈率。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.