电解可脱卸弹簧圈血管内栓塞治疗颅内动脉瘤

目的 回顾分析9例颅内破裂动脉瘤以电解可脱卸弹簧圈(guglielmi detachable coil，GDC)栓塞的临床情况及疗效。方法本组病例均因自发性蛛网膜下腔出血或脑内血肿急诊入院，入院时按Hunt-Hess分级,Ⅲ级5例，Ⅳ级4例；手术前Hunt-Hess分级：Ⅰ级2例，Ⅱ级3例，Ⅲ级2例，Ⅳ级2例。动眼神经麻痹1例，6例伴脑室积血及梗阻性脑积水。DSA显示颈内动脉瘤2个，大脑后动脉瘤3个，前交通动脉瘤2个，后交通动脉瘤1个，大脑中动脉瘤2个。1例在出血后8天，1例12天，2例在出血后15天，5例在3周后行GDC栓塞治疗。结果9例10个动脉瘤栓塞9个，8例完全闭塞，1例术中动脉瘤破裂，术后家属放弃抢救，死于脑疝。1例术中大脑中动脉栓塞，行动脉溶栓后复通，病人遗留左上肢轻瘫。3例在栓塞前再出血。术后随访2～15个月，无再出血。结论GDC栓塞颅内动脉瘤是首选的治疗方法。     

颅脑损伤合并颅内动脉瘤破裂出血9例

目的:探讨颅脑损伤合并颅内动脉瘤破裂出血临床特点及诊治。方法:颅脑损伤合并颅内动脉瘤破裂出血9例均急诊行开颅动脉瘤血肿清除和去骨瓣减压,基底动脉瘤行血管内介入栓塞治疗术,并行腰蛛网膜下腔引流5～7天。结果:颅内动脉瘤破裂出血9例均经CTA或DSA检查证实,其中前交通动脉瘤3例,大脑中动脉瘤3例,颈内动脉-后交通动脉瘤2例,基底动脉瘤1例,行开颅动脉瘤夹闭术8例,行血管内介入栓塞治疗术1例。全部病例恢复良好。结论:颅脑损伤伴蛛网膜下腔出血患者有合并颅内动脉瘤破裂出血的可能,早期明确诊断、积极合理的治疗是提高疗效的关键。     

超早期血管内栓塞治疗颅内动脉瘤破裂

目的:探讨颅内动脉瘤破裂超早期血管内介入治疗的临床效果。方法:23例不同部位颅内动脉瘤(26个)患者,术前Hunt-Hess分级:Ⅰ～Ⅱ级12例,Ⅲ级8例,Ⅳ级2例,Ⅴ级1例。在动脉瘤破裂48 h内气管内插管全麻下行电解式可脱性微弹簧圈(GDC)栓塞治疗。结果:术后随访6～24月,恢复良好者20例(86.95%);出现偏瘫和单纯运动性失语各1例(4.35%),后经综合治疗1个月后逐渐恢复;死亡1例(4.35%)(Hunt-HessⅤ级)。无再出血病例发生。结论:超早期电解式可脱性微弹簧圈栓塞治疗可避免动脉瘤再次破裂出血,减少脑血管痉挛,降低死亡率。     

微弹簧圈栓塞治疗急性破裂颅内动脉瘤的临床分析

目的 探讨急性破裂颅内动脉瘤应用电解可脱性微弹簧圈(GDC)栓塞治疗的效果。方法 34例急性破裂动脉瘤在发病6d内采用GDC早期栓塞治疗动脉瘤。术前Hunt—Hess分级,Ⅰ级6例,Ⅱ级23例,Ⅲ级4例,Ⅳ级1例。其中1～3d内治疗14例,4～6d内治疗20例。2例宽颈动脉瘤采用Medtronic AVE支架结合GDC栓塞治疗。结果 除2例因血管严重痉挛致使微导管无法到位操作失败而实施动脉瘤夹闭术外,其余28例造影证实为完全闭塞,4例为90％闭塞。介入治疗中发生动脉瘤破裂1例,GDC尾端残留于瘤动脉2例,均未导致临床后果。无死亡及严重后遗症。经随访未见再次破裂出血。结论 早期应用GDC栓塞治疗急性破裂颅内动脉瘤,具有微侵袭性,创伤小,安全性高,并发症少,术后恢复快等优点。     

颅内动脉瘤的血管内栓塞治疗

目的评估应用电解可脱性弹簧圈（GDC）及水解可脱铂金弹簧圈（DCS）栓塞治疗颅内动脉瘤的临床疗效，探讨手术时机及术中操作注意事项。方法采用GDC及DCS对23例颅内动脉瘤患者进行动脉瘤囊内栓塞，包括前交通动脉瘤5个，后交通动脉瘤6个，颈内动脉瘤7个，大脑中动脉瘤3个，椎基底动脉瘤2个；其中1例颈内动脉巨大动脉瘤栓塞2次，3例宽瘤颈动脉瘤采用血管内球囊辅助技术（Remodeling technique）或血管内支架（Neuroform）置入后行介入栓塞治疗。结果23例动脉瘤均成功栓塞，按动脉瘤的填塞程度分为：完全填塞20例，不完全填塞3例；2例巨大动脉瘤行载瘤动脉栓塞；术后无血栓形成及血栓性栓塞并发症，亦无神经功能障碍、瘫痪和死亡等永久性并发症；1例颈内动脉巨大动脉瘤在栓塞后24个月行造影随访发现局部复发，再次行动脉瘤栓塞治疗。随访2-42个月，全组术后均无出血或再出血。结论GDC及DCS栓塞颅内动脉瘤是一种安全、可靠、有效的治疗方法，根据动脉瘤病情联合运用多种栓塞技术有助于提高动脉瘤栓塞的治愈率、降低并发症。     

合并脑室出血铸型的Hunt-Hess Ⅳ-Ⅴ级破裂前交通动脉瘤的超早期血管内栓塞治疗

目的总结血管内栓塞治疗合并脑室出血铸型的Hunt-HessⅣ-Ⅴ级破裂前交通动脉瘤的初步经验。方法8例破裂前交通动脉瘤48h内进行血管内介入栓塞治疗,其中2例采用电解可脱弹簧圈（GDC）,4例采用水解可脱弹簧圈（TRUFILL DCS Orbit）,2例采用水凝胶弹簧圈（HES）技术,术毕均行双侧脑室外引流,3例术后1月行脑室-腹腔分流术。结果7例动脉瘤致密填塞,1例大部填塞。出院时患者预后（GOS标准）：良好5例,中残2例,重残1例。结论虽然Hunt-Hess高分级破裂前交通动脉瘤患者病情危重,治疗风险很大,但积极地超早期血管内栓塞治疗辅以脑室外引流术是治疗的有效方法。     

超早期血管内栓塞联合脑室外引流治疗Hunt-HessⅣ～Ⅴ级前交通动脉瘤破裂合并脑室出血的疗效分析

目的探讨超早期血管内栓塞联合脑室外引流治疗Hunt-HessⅣ～Ⅴ级前交通动脉瘤破裂合并脑室出血的疗效。方法选择2019年1月至2020年1月宿州市第一人民医院收治的Hunt-HessⅣ～Ⅴ级前交通动脉瘤破裂合并脑室出血患者16例,均予超早期（发病24h内）血管内栓塞联合脑室外引流治疗。术后评估栓塞结果,并行6个月随访。采用格拉斯哥预后分级量表（GOS）评分评价随访结果。结果16例患者Ⅰ度12例,Ⅱ度4例。术中出现大脑前动脉痉挛4例。术后1个月因脑积水行脑室-腹腔分流术3例。16例患者均获得6个月随访。其中,GOS评分5分10例,4分4例,2分2例。结论超早期血管内栓塞联合脑室外引流是治疗Hunt-HessⅣ～Ⅴ级前交通动脉瘤破裂合并脑室出血有效方法。     

超早期血管内栓塞治疗颅内动脉瘤破裂

目的：探讨颅内动脉瘤破裂超早期血管内介入治疗的临床效果。方法：23例不同部位颅内动脉瘤（26个）患者，术前Hunt—Hess分级：Ⅰ～Ⅱ级12例，Ⅲ级8例，Ⅳ级2例，Ⅴ级1例。在动脉瘤破裂48h内气管内插管全麻下行电解式可脱性微弹簧圈（GDC）栓塞治疗。结果：术后随访6～24月，恢复良好者20例（86．95％）；出现偏瘫和单纯运动性失语各1例（4．35％），后经综合治疗1个月后逐渐恢复；死亡1例（4．35％）（Hunt—Hess Ⅴ级）。无再出血病例发生。结论：超早期电解式可脱性微弹簧圈栓塞治疗可避免动脉瘤再次破裂出血，减少脑血管痉挛，降低死亡率。     

颅内动脉瘤的血管内介入栓塞治疗

目的探讨介入栓塞治疗颅内动脉瘤的效果。方法采用电解可脱性弹簧圈（GDC）、水解可脱铂金弹簧圈（DCS）及α-氰基丙烯酸正丁酯（NBCA）等对26例颅内动脉瘤患者进行动脉瘤血管内介入栓塞,包括前交通动脉瘤8例,后交通动脉瘤5例,颈内动脉瘤6例,大脑中动脉瘤3例,椎基底动脉瘤2例,小脑后下动脉（PICA）远端动脉瘤2例。1例梭形推动脉瘤采用血管内支架置入后行介入栓塞治疗,2例小脑后下动脉远端动脉瘤行NBCA栓塞,其余采用GDC或DCS对颅内动脉瘤患者进行动脉瘤囊内栓塞。结果26例动脉瘤均成功栓塞,按动脉瘤的填塞程度分为：完全填塞23例,不完全填塞3例。1例小脑后下动脉远端动脉瘤行GDC不完全栓塞后3个月复发,再次行NBCA栓塞成功;术后无血栓形成及血栓性栓塞并发症,亦无神经功能障碍、瘫痪等并发症,无死亡病例;随访3～36个月,全组术后均无再出血。结论介入栓塞治疗颅内动脉瘤是一种安全、可靠、有效的治疗方法。     

电解离弹簧圈栓塞术中的颅内动脉瘤破裂

目的:探讨电解离弹簧圈(GDC)栓塞术中颅内动脉瘤破裂的发生率、危险因素和与预后相关的并发症等.方法:对采用GDC栓塞治疗的68例患者72个颅内动脉瘤有关资料进行分析.结果:3例(4.1%)术中发生动脉瘤破裂,其中2例颈内动脉-后交通动脉瘤(ICPC),直径4～6 mm;1例前交通动脉瘤(Acom),直径为2.2 mm.3例均有蛛网膜下腔出血(SAH)病史.动脉瘤破裂的直接原因:1例ICPC为微导管穿破动脉瘤壁的囊泡,另2例为栓塞过程中GDC穿过动脉瘤壁.1例术中可见造影剂外溢,3例术后CT扫描均证实再次出血.3例术中均经继续导入GDC将动脉瘤栓塞,出血停止.1例术中出现脑血管痉挛和颈内动脉闭塞,经动脉内局部应用药物后大脑中动脉血流恢复.2例术后恢复良好,无神经系统功能缺失;1例并发脑血管痉挛患者术后遗留一侧肢体轻偏瘫和语言障碍.结论:GDC栓塞动脉瘤术中与操作直接相关的动脉瘤破裂发生率为3%左右,病死率约1%.危险因素可能与SAH病史、动脉瘤较小和术中使用球囊作为辅助治疗等有关.     

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.