下腔静脉闭塞段切除人工血管原位移植治疗布一加氏综合征18例报道

自1994年以来，采用下腔静脉闭塞或狭窄段切除人工血管原位移植治疗布一加氏综台征18例。手术适宜于短段闭塞型、伴有明显狭窄的隔膜型或局限性狭窄型而采用经皮球囊扩张失败或以往采用隔膜切除、心包片成形术而术后复发。经本治疗术后3-36个月随访，所有病例疗效满意，无一例复发。     

布-加氏综合征的治疗进展

布-加氏综合征(Budd-Chiari Syndrome)是由于肝静脉或邻近的下腔静脉阻塞而产生的一系列临床综合征。随着血管外科的发展，对这种疾病的认识有了进一步提高。由于其病理类型的不同，对于该病征的治疗方法亦较多，约有30余种。本综合近年国内献，对目前常用的布-加氏综合征的治疗方法作一评述。     

5例布-加氏综合征彩色多普勒超声诊断分析

目的 探索彩色多普勒超声对肝静脉阻塞型布-加氏综合征的诊断价值.方法 应用彩色多普勒超声观察5例肝静脉阻塞型布-加氏综合征的彩色多普勒超声的声像图特点.结果 下腔静脉型3例,肝静脉型2例.结论 彩色多普勒超声可较准确地判定血管狭窄及阻塞的部位和类型.     

5例布-加氏综合征彩色多普勒超声诊断分析

目的探索彩色多普勒超声对肝静脉阻塞型布-加氏综合征的诊断价值。方法应用彩色多普勒超声观察5例肝静脉阻塞型布-加氏综合征的彩色多普勒超声的声像图特点。结果下腔静脉型3例,肝静脉型2例。结论彩色多普勒超声可较准确地判定血管狭窄及阻塞的部位和类型。     

布-加氏综合征根治性术式的探讨

目的：统计布-加氏综合征直视下根治术的45例资料，并探讨三种根治性手术的优缺点及适应症。方法：隔膜切除或病变的下腔静脉段切开、心包片扩大成形17例；闭塞或狭窄的下腔静脉段切除、人工血管原位移植24例；肝静脉流出道成形6例。同时行肝静脉至右心房的下腔静脉人口处人工血管间置移植4例。结果：因术后并发症死亡2例；复发4例．均为心包片扩大成形术后的病人。结论：心包片成形术适用于隔膜型，人工血管原位移植适用于短段闭塞或狭窄型．肝静脉流出道成形可用于长段下腔静脉闭塞型。     

经皮血管腔内成形术在布-加综合征中的应用

我们自1991年11月～1996年12月为32例布-加综合征患进行经皮血管腔内成形术治疗，其中膜型阻塞或狭窄21例，采用大球囊一次性扩张；段型11例，采用内支架植入术。其中28例随访2～60个月，疗效满意；管腔通畅，无严重并发症，无死亡。我们认为该技术安全，简单，对布-加氏综合征治疗有效，尤适合于肝段下腔静脉膜型阻塞的患。     

肝右静脉与下腔静脉位置对布-加综合征产生机制的影响

目的探讨不同肝右静脉与下腔静脉夹角变化对布-加综合征患者下腔静脉隔膜发生机制的影响。方法运用Mimics软件对临床磁共振成像血管造影下腔静脉和主要肝静脉图像进行三维实体模型重建,测得正常模型下腔静脉与肝右静脉夹角为56°。在保持模型基本结构不变基础上,分别构建肝右静脉与下腔静脉夹角为30°和120°的模型,并数值模拟计算3个模型的壁面剪切力、壁面压强、速度分布。结果 3个模型壁面压强、壁面剪切力差异显著。与正常人56°模型相比,30°模型有较高的壁面压强和较低的血液流速,120°模型有较低的壁面剪切力和血液流速,并伴随有涡流的出现,这些血流动力学因素的改变更易于血栓的形成。56°模型血管内血流流速最快。结论对下腔静脉与肝右静脉血液流场的数值模拟有助于了解布-加综合征的发病机制,提高下腔静脉阻塞隔膜形成风险的预测,为治疗提供理论依据。     

布-加综合征的彩色多普勒超声诊断及与肝硬化的鉴别诊断

目的探讨彩色多普勒超声在诊断布-加综合征及与肝硬化的鉴别诊断中的应用价值。方法32例布-加综合征患者（男性19例,女性13例,平均年龄37岁）和40例门脉性肝硬化患者（男性28例,女性12例,平均年龄48岁）,分别接受二维超声、彩色多普勒超声和频谱多普勒超声检查,并对获得的资料进行回顾性分析。所有患者经血管造影和/或病理、CT证实。结果布-加综合征的典型特征是病变主要累及下腔静脉和肝静脉,病变处管腔闭塞或狭窄,其内血流紊乱,并可出现侧支循环和交通支;肝硬化患者主要表现为肝脏缩小、脾大、门静脉增宽、腹水,血流动力学改变主要以门静脉和肝静脉为主。结论彩色多普勒超声对布-加综合征、肝硬化的诊断及鉴别诊断符合率较高,为诊断布-加综合征和肝硬化提供有效手段,对选择合理治疗方案及评价治疗效果具有指导意义。     

低位直肠癌保肛手术的适应症及术式选择（附18例临床报告）

Miles手术已是公认的治疗低位直肠癌的经典术式。但近年来国内外学通过对大量直肠癌标本的组织学检查及随访结果研究，以及耐直肠解剖、生理和病理学认识的不断提高，发现低位直肠癌向下浸润超过2cm≤2％。且在肿瘤控制，成活率与术后复发方面，保肛手术与Miles手术基本相同。因此在手术中只要切除癌肿下缘正常直肠2．5-3cm就足够．对传统奉行的“5cm法则”提出了不同见解，学们纷纷将低位直肠癌的研究重点放在保肛手术上。我院自1993年至1996年对18例低位直肠癌患(癌肿距肛缘)4cm＜8cm)行了保肛手术治疗．初步疗效令人满意，本结合18例保肛手术的体会，对低位直肠癌时行保肛手术的台理性、安全性、适应证及术式选择进行了探讨。     

Modification of Chlorinated Poly(propylene) via Atom Transfer Radical Graft Copolymerization of 2‐Ethylhexyl Acrylate: A Brush‐like Graft Copolymer

The modification of chlorinated poly(propylene) (CPP) via graft copolymerization of EHA using ATRgP is reported. The kinetic plot of monomer conversion versus reaction time was found to be linear, which is the typical characteristic of a living controlled polymerization. The grafted copolymers were characterized by means of FT‐IR and ¹H NMR spectroscopy, GPC, DSC, and TGA. Mechanical properties were also studied by means of UTM and DMA. The stress/strain plot and the tension set properties indicate that the brush‐type graft copolymer (CPP‐g‐PEHA) behaves as a thermoplastic elastomer.

     

Preparation of Polyisobutene‐graft‐Poly(methyl methacrylate) and Polyisobutene‐graft‐Polystyrene with Different Compositions and Side Chain Architectures through Atom Transfer Radical Polymerization (ATRP)

Polyisobutene‐graft‐poly(methyl methacrylate) and polyisobutene‐graft‐polystyrene with controlled compositions and side chain architectures were prepared through atom transfer radical polymerization (ATRP). Poly[isobutene‐co‐(p‐methylstyrene)‐co‐(p‐bromomethylstyrene)] (PIB) was used as a macroinitiator in the presence of CuCl or CuBr as a catalyst and dNbpy as a ligand. The compositions were controlled by the conversion of the monomer with polymerization time. The molecular weight distributions of the side chains were controlled through ATRP in the presence/absence of a halogen exchange reaction. DSC and DMA measurements showed that graft copolymers have two glass transition temperatures suggesting microphase separated behavior, which was also confirmed by SAXS measurements. The phase and dynamic mechanical behaviors were strongly affected by the compositions and/or the side chain architectures. The properties of the graft copolymers were controlled in a wide range leading to toughened glassy polymers or elastomers.     

“Greener” Coupling of Poly(methyl methacrylate) and Poly(methyl acrylate) Chains using Activators Generated by Electron Transfer and Radical Traps

Monobrominated versions of poly(methyl methacrylate) (PMMABr) and poly(methyl acrylate) (PMABr) are prepared by atom transfer radical polymerization and subjected to a variety of chain end‐coupling reactions, with the goal of achieving high extents of coupling with minimal metal content. By using atom transfer radical coupling (ATRC) with radical trap assistance in conjunction with activators generated by electron transfer, high extents of coupling (X_c) could be achieved for both polymer classes without requiring copper(I) as an initial reactant, and replacing elemental copper with environmentally benign reducing agents (X_c > 0.85). Specifically, the highest extents of coupling are observed with ascorbic acid as the reducing agent along with copper(II) bromide as the pre‐catalyst. Overall, similar extents of coupling are observed while using ≈1% of the total metal of a traditional ATRC reaction for PMABr and ≈3% for PMMABr.     

肾病综合征患儿治疗前后血浆leptin、血清IL-6和IL-18水平的变化及临床意义

目的:探讨了肾病综合征患儿治疗前后血浆leptin和血清IL-6、IL-18水平的变化及临床意义.方法:应用放射免疫分析和酶联法对31例肾病综合征患儿进行了治疗前后血浆leptin和血清IL-6、IL-18的检测,并与30名正常健康儿作比较.结果:肾病综合征患儿在治疗前血浆leptin和血清IL-6、IL-18水平均非...     

Gel Formation and Molecular Characteristics of Poly(N‐isopropylacrylamide) Prepared by Free‐Radical Redox Polymerization in Aqueous Solution

The molecular characteristics of poly(N‐isopropylacrylamide) (PNIPA), prepared by free‐radical polymerization using an aqueous redox initiator and reaction conditions comparable to those used in the synthesis of nanocomposite gels, were investigated by altering the monomer concentration ([NIPA]) and the polymerization temperature (T_p) across the transition temperature (LCST). When T_p<LCST, there is a critical [NIPA] (=n*) above which PNIPA partially forms gels in the absence of a chemical crosslinker, and the gel fraction increases with increasing [NIPA] and decreasing T_p. In the range of n<n*, the molecular weight of soluble PNIPA correlated well with [NIPA]. When T_p>LCST, gels were not formed regardless of [NIPA]. The structure and mechanism of formation of self‐crosslinked PNIPA gels are discussed.

     

Concurrent Initiation by Air in the Atom Transfer Radical Polymerization of Methyl Methacrylate

The effect of air in atom transfer radical polymerization (ATRP) of methyl methacrylate (MMA) was studied. Air initiated polymerization was clearly noticed by the appearance of a low molecular weight peak in the synthesis of high molecular weight poly(isobutylene)‐graft‐poly(methyl methacrylate) (M _n = 5.0 × 10⁵ g/mol). The concentration of chains initiated by oxygen (air) was ≈8 × 10^?4 mol/L, determined using the Gladstone‐Dale relationship. The tentatively proposed mechanism for air initiated polymerization was supported by kinetic studies. Similar to typical ATRP systems, the rate of air initiated polymerization increased with temperature, [MMA], amount of air, and activity of the catalyst complex. Polymers with lower polydispersities (M _w/M _n = 1.13) were obtained in the presence of Cu(II) as compared to Cu(I) catalyst complex system.

Kinetic plots for the air initiated bulk polymerization of MMA at (?) 20 °C, (?) 50 °C, and (?) 90 °C.     

The value of Autoimmune Syndrome Induced by Adjuvant (ASIA) - Shedding light on orphan diseases in autoimmunity

Autoimmune Syndrome Induced by Adjuvant (ASIA) is a definition aimed to describe the common etiological process at the root of five clinical entities sharing similar symptomatology: macrophagic myofasciitis syndrome (MMF), Gulf War Syndrome (GWS), sick building syndrome (SBS), siliconosis, and post vaccination autoimmune phenomena. ASIA illustrates the role of environmental immune stimulating agents, or adjuvants, in the instigation of complex autoimmune reactions among individuals bearing a genetic preponderance for autoimmunity. The value of ASIA lies first in the acknowledgment it provides for patients suffering from these as yet ill-defined medical conditions. Equally important is the spotlight it sheds for further research of these poorly understood conditions sharing a common pathogenesis.In this article we elaborate on the significance of ASIA, review the current evidence in support of the syndrome, and address recent reservations raised regarding its validity.     

Atom‐Transfer Radical Copolymerization of Furfuryl Methacrylate (FMA) and Methyl Methacrylate (MMA): A Thermally‐Amendable Copolymer

Polymers of furfuryl methacrylate (FMA) are interesting materials because of the presence of the furfuryl group as the reactive diene functionality in the pendent group. Copolymers of FMA and MMA were prepared using atom‐transfer radical polymerization (ATRP) catalyzed by CuCl, in combination with HMTETA as a ligand at 90 °C. It was very difficult to prepare by conventional radical polymerization because of several side reactions involving the reactive diene group. The copolymer composition was calculated using ¹H NMR studies. The reactivity ratios of FMA and MMA (r₁ and r₂) were determined using the Finemann‐Ross and Kelen‐Tudos linearization methods. The reactivity ratios obtained were r₁ = 1.56 and r₂ = 0.56. Diels‐Alder chemistry was carried out using the reactive diene of the copolymers and a maleimide as the dienophile. Interestingly, the resultant material was observed to be thermo‐reversible as evidenced by FT‐IR spectroscopy and DSC studies.