对血栓闭塞性脉管炎患者截肢平面的研究

目的探讨自体外周血干细胞移植联合置管溶栓术重建血栓闭塞性脉管炎（TAO）患者的下肢血供并降低截肢平面的效果。方法回顾性分析2013 年10 月-2016 年6 月该中心收治的36 例拟截肢TAO患者（36 条患肢）,采用自体外周血干细胞移植联合置管溶栓术治疗。结果干细胞移植4 周后27 例患者下肢疼痛、冷感评分、皮温及踝肱指数（ABI）均优于移植前（p <0.05）,肢体溃疡、坏死处得到控制,呈干性坏疽;9 例患者无明显好转行截肢手术,移植前9 例截肢患者拟截肢平面：大腿下段2 例,膝关节4 例,小腿中上段3 例;实际截肢平面：膝关节4 例,小腿中上段2 例,小腿中段3 例。截肢率25%（9/36）,降低截肢率75%,降低截肢平面率77.8%（7/9）。术后3 个月36 例患者行下肢DSA 检查,均形成不同程度的新生侧支血管,27 例保肢患者坏死范围局限,且呈干性坏疽;9 例截肢患者截肢处已愈合。36 例患者随访6～20 个月（平均12.2 个月）病情平稳;其中3 例保肢患者移植6 个月后因患肢疼痛、溃疡坏死加重,再次行自体外周血干细胞移植术,术后3 个月患肢症状好转。结论自体外周血干细胞移植联合置管溶栓术治疗TAO 患者可促进新生侧支血管形成并降低截肢平面。     

手术联合介入治疗合并动脉硬化的急性下肢动脉栓塞临床观察

目的:探讨手术联合介入治疗合并动脉硬化的急性下肢动脉栓塞的疗效及技术要点.方法: 回顾性分析2003年4月至2007年9月收治的27例(30肢)合并动脉硬化的急性下肢动脉栓塞患者DSA下行介入手术联合治疗的临床资料和随访结果.结果: 27例患者中,救肢成功25例(28肢),术后随访10～21个月,1例术后12d血栓形成,1例术后3个月再阻塞,3～6个月再阻塞2例,6～12个月2例再阻塞.结论:介入手术联合治疗合并动脉硬化的急性下肢动脉栓塞有助于提高重建下肢动脉供血成功率.手术效果有赖于正确的手术操作以及对并发症的有效处理.     

自体外周血干细胞移植联合置管溶栓术治疗TAO患者血流重建并降低截肢平面

目的探讨自体外周血干细胞移植联合置管溶栓术重建血栓闭塞性脉管炎(TAO)患者的下肢血供并降低截肢平面的效果.方法回顾性分析2014年10月至2016年6月云南省血管外科中心收治的16例TAO患者(16条患肢),采用自体外周血干细胞移植联合置管溶栓术治疗.结果 16例患者(16条患肢)干细胞移植4周后下肢疼痛、冷感评分均优于移植前(P<0.05),变温带较前分别下降2~10 cm,其中2例患者足趾坏死及足背缺血情况未加重.移植后3个月,1例患者坏死局限于足趾区,1例坏死局限于足背中段,均呈干性坏疽,行局部截肢手术,截肢平面以上皮温、皮色良好;14例保肢患者患肢皮温由(26.68±0.51)℃增加到(31.45±0.49)℃,间歇性跛行距离由(80.59±46.45)m增加到(332.45±150.23)m,ABI由0.42±0.02增加到0.78±0.04,3项指标移植后均优于移植前(P<0.05);16例患者行下肢动脉CTA,均形成不同程度的新生侧支血管.16例患者随访6~20个月(平均12.2个月)病情平稳;其中3例患者移植6个月后因患肢疼痛加重伴足趾溃疡形成,再次行自体... 更多     

介入治疗糖尿病足的临床疗效观察

目的分析探讨糖尿病足下肢的DSA改变及治疗方法,观察血管内介入治疗的临床效果。方法对9例2型糖尿病足患者行下肢动脉血管超声及DSA检查,糖尿病足下肢动脉有不同程度的狭窄与阻塞同时存在,细小动脉多有闭塞,9例12条下肢节段性狭窄动脉行介入治疗（7例10支血管经皮血管球囊成形术2例2支血管腔内支架植入）。术后3到6个月后血管造影或血管超声复查。结果 9例患者中10条患肢症状明显减轻或消失,溃疡面治愈,2条患肢术后截肢。结论 DSA检查可以准确了解糖尿病足下肢动脉阻塞的部位及程度,介入治疗可以改善糖尿病足下肢动脉的血供,通过控制血糖和改善血液循环,其治疗的近期疗效令人满意。     

介入手术联合治疗中晚期下肢动脉栓塞

目的 探讨中晚期下肢动脉栓塞的临床治疗方法.方法 分析2004年3月～2007年8月收治的24例(25肢)中晚期下肢动脉栓塞患者行介入手术联合治疗的临床资料,手术方式:Fogarty导管取栓+球囊扩张.结果 24例患者均救肢成功,术后随访1、2年,3例出现再栓塞,其他患者效果满意.结论 介入手术联合治疗中晚期下肢动脉拴塞有助于提高重建下肢动脉供血成功率和维持远期通畅率.     

干细胞移植治疗糖尿病足的研究进展

糖尿病足患者因患肢远端动脉血管狭小、闭塞常缺乏流出道,临床常规治疗方法效果不理想。干细胞移植是一种通过治疗性血管生成恢复患肢血供、重建患肢动脉侧支循环、促进局部血管生成的安全、有效的临床治疗新方法,为糖尿病足的治疗开拓了新前景。     

下肢血栓闭塞性脉管炎的腔内治疗

目的：探讨下肢血栓闭塞性脉管炎的腔内治疗方法。方法总结25例（30条肢体）下肢血栓闭塞性脉管炎患者的临床资料。根据术前CTA结果对病变肢体行下肢动脉造影,行球囊扩张和（或）置管溶栓术。结果本组25例患者（30条肢体）行下肢动脉球囊扩张成形术。术后患肢皮温明显升高,下肢疼痛减轻或消失,间歇性跛行消失或跛行距离延长,溃疡伤口经清创换药2～3个月后愈合。8例足背或胫后动脉搏动恢复。1例行大腿截肢术。术后随访22例,随访率88％,随访时间1～24个月,无溃疡复发及肢体坏死。结论腔内治疗可改善下肢血栓闭塞性脉管炎患肢血供,促进溃疡及创面的愈合,增加保肢率,降低截肢平面。腔内介入技术为血栓闭塞性脉管炎的治疗提供了一种可行性方法,中短期效果令人鼓舞,长期疗效仍需随访。     

腓肠肌内侧头肌瓣在胫骨上端骨肿瘤保肢术中的应用研究

目的 探讨带血管蒂腓肠肌肌瓣移植在胫骨近端骨肿瘤保肢术中的应用价值.方法 行胫骨近端骨肿瘤保肢术患者共38例,出院后所有患者完成随访.结果 肌瓣移植者中有1例发生肌瓣坏死及骨筋膜室综合征;3例切口浅表感染.38例术后全部做到随访,平均随访时间40个月.结论 胫骨近端骨骨肿瘤保肢术中采用带血管蒂腓肠肌肌瓣移植可重建软组织缺损、降低局部并发症及提高临床疗效.     

特定皮肤区域血供研究应用于中国人群下肢重症缺血腔内治疗价值的回顾分析

目的:探讨特定皮肤区域血供(Angiosome)研究指导膝下动脉腔内重建术(EVR)治疗下肢重症缺血(CLI)的临床疗效。评估特定皮肤区域血供研究指导膝下动脉EVR术治疗CLI的应用价值。同时分析CLI病人通过EVR治疗开放流出道(RO)数量与保肢率相关性,评价流出道再通数量与病人保肢率的关系。方法:收集2005年2月至2015年5月在我院接受EVR的58名CLI患者(58条患肢)进行回顾性分析。患者分为直接组(DR)与间接组(IR)。术后随访5-12个月,平均随访(11.60±1.40)个月。比较两组病人治疗前后踝肱指数(ABI)、溃疡愈合率、溃疡愈合时间、保肢率以及生存率等指标。结果:本组膝下动脉EVR术58例(58条患肢),围手术期死亡0例,随访死亡率8.62%。(1)ABI:术前术后相比,两组患者ABI增高差异均有统计学意义。两组间ABI增加幅度差异有统计学意义。(2)伤口愈合率:DR组90.3%(28/31)较IR组74.7%(20/27)显著提高(P=0.048),卡普兰-迈耶分析(K-M)Log Rank=1.490,P=0.04,差异有统计学意义。(3)患者术后12月保肢率为81.0%(47/58),DR组87.1%(27/31)较IR组74.1%(20/27)显著提高(P=0.027),K-M分析Log Rank=2.504,P=0.03,差异有统计学意义。(4)术后12月累积生存率:DR组97%(30/31)较IR组85.1%(23/27)显著提高,Log Rank=1.299,P=0.254,差异无统计学意义。(5)随访发现,EVR重建RO数量对应保肢率分别为1条83.3%(30/36)、2条80%(14/18)、3条75%(3/4),P=0.842。EVR术重建RO数量与保肢率无明显相关性。结论:特定皮肤区域血供研究指导膝下动脉腔内成形术,能帮助建立精准有效的下肢血液循环,对改善CLI患者下肢缺血情况,促进缺血损伤组织愈合和提高保肢率有重要意义。     

动脉粥样硬化所致下肢动脉狭窄或闭塞患者的血管腔内治疗及疗效观察

目的探讨动脉粥样硬化所致下肢动脉狭窄或闭塞血管腔内治疗的临床可行性及应用价值。方法 2009年1月至2013年12月我科收治经CT血管造影（CTA）和数字减影血管造影（DSA）证实为动脉粥样硬化性下肢动脉狭窄或闭塞患者36例（42条患肢）,将行经皮腔内球囊扩张血管成形术（PTA）或/和支架植入术治疗。按照Fontaine分型治疗后临床症状改善1级或1级以上为临床成功,PTA后血管残余狭窄小于30%为技术成功。通过术后临床症状改善和CTA/MRA随访来评价治疗效果。结果 PTA技术成功率为95.2%（40/42）,1条技术不成功,1例术后合并动脉血栓,无血管夹层形成。39条肢体症状改善明显,2条无明显改善,踝肱指数从（0.50±0.11）至（0.82±0.15）。术后随访6个月Fontaine分型提高1、2、3级的患者分别为23例、13例和4例（40条患肢）。随访3~15个月,1条股动脉在12个月再次闭塞,1条胫后动脉术后8月再次闭塞,通畅率为92.8%。结论动脉粥样硬化所致下肢动脉狭窄或闭塞腔内介入治疗是安全,有效的,其有助于改善下肢血运,提高通畅率,改善患者生存质量,提高中长期保肢率。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.