国产封堵器介入治疗动脉导管未闭198例

目的 观察应用国产蘑菇伞型封堵器介入治疗动脉导管未闭(PDA)的临床疗效.方法 198例PDA患者于主动脉弓降部造影,测量动脉导管大小,在透视下经传送装置将国产蘑菇伞型封堵器置入动脉导管内,使之在动脉导管处固定,即刻造影,术后行超声心动图(UCG)检查.结果 全组成功196例,技术成功率99%;主动脉弓造影即刻无分流146例;50例存在微量或少量残余分流,经UCG复查,其中25例术后48 h分流消失,22例术后1个月分流消失,3例术后3个月分流消失;封堵术后即刻肺动脉平均压由封堵前(42.8±16.4)mmHg下降至(31.3±14.5)mmHg(P<0.05);术后3个月心室舒张末期容积均较术前缩小(94.2±28.4)mL vs(112.5±31.5)mL,(52.1±12.4)mL vs(61.0±15.7)mL(P<0.05).结论 应用国产蘑菇伞型封堵器治疗动脉导管未闭操作方法简便,治疗范围广,成功率高.     

国产蘑菇伞型封堵器封堵巨大动脉导管未闭的可行性研究

目的探讨采用国产蘑菇伞型封堵器经导管封堵巨大动脉导管未闭(PDA)的可行性。方法全组15例,其中男3例,女12例,年龄21±8(16～46)岁。PDA最窄处直径为16±3mm(13～22mm),均采用国产蘑菇伞型封堵器经股静脉途径对PDA进行封堵。封堵前后行主动脉弓降部造影并测定肺动脉压力。封堵成功者分别于术后1周、1个月和6个月复查超声心动图。结果15例巨大PDA选用的封堵器直径为23±4mm(18～32mm),封堵后30min主动脉弓降部造影均显示主-肺动脉水平仅有经封堵器孔眼的微量到少量残余分流。封堵后13例患者肺动脉收缩压峰值较封堵前有不同程度下降(70±29mmHgvs113±21mmHg,P<0.05,1mmHg=0.133kPa),2例因试封堵后肺动脉压力升高而放弃封堵。无一例发生严重并发症。封堵成功者术后复查超声心动图,其中11例于术后1周、1例于术后1个月残余分流消失,另1例于术后6个月时残存少量分流。结论采用国产蘑菇伞型封堵器经导管封堵巨大PDA是一种安全有效的介入治疗方法。     

国产封堵器介入治疗巨大动脉导管未闭的临床评价

目的应用国产封堵器经导管治疗巨大动脉导管未闭（PDA）并对其疗效进行评价。方法全组27（男8,女19）例,年龄6～54（24±15）岁,主动脉造影示PDA最窄径为13～28（16±4）mm。封堵后即刻和30min行侧位降主动脉造影,术后2d,1、3、6个月分别行超声心动图及X线平片检查。结果24例成功,3例PDA封堵后判断为有阻力性肺动脉高压,放弃治疗。成功的患者中,14例选用国产PDA封堵器,10例选用国产ASD封堵器。术后即刻降主动脉造影检查示,使用ASD封堵器中,有2例微量残余分流,5例少量残余分流,1例少～中量残余分流;PDA封堵器中,有4例微量残余分流,2例少量残余分流。术后30min,ASD封堵器4例微～少量残余分流,1例仍为少～中量残余分流;PDA封堵器仅2例微量残余分流。1例ASD封堵器治疗术后7h发生溶血,治疗72h溶血无减轻迹象,外科开胸取出封堵器并行PDA结扎术。术后2d,超声心动图示PDA封堵器1例微量残余分流,ASD封堵器5例微量残余分流。随访1～6个月,所有左心内径增大的患者均明显回缩,未发现残余分流和导管再通。结论应用国产封堵器经导管治疗直径≥13mm的PDA是一种安全有效地介入方法。     

国产动脉导管未闭封堵器与Amplatzer封堵器在经动脉导管未闭封堵术中应用的疗效比较

目的比较国产动脉导管未闭封堵器与Amplatzer封堵器(美国进口)在经动脉导管未闭(PDA)封堵术中应用的疗效。方法对2006年1月至12月广东省人民医院确诊为PDA的206例患者,110例采用国产封堵器,96例采用Amplatzer封堵器,分别进行PDA封堵术,对比两组的疗效、并发症和费用等情况。结果国产组109例封堵成功(成功率99.1%),进口组95例封堵成功(成功率99.0%)。两组PDA术前各项临床资料指标、手术和X线曝光时间、封堵成功率及住院天数、术后各项并发症发生率比较,差异无显著性意义,两组PDA治疗前后左室舒张末压及心胸比率降低程度差异无显著性意义,治疗总费用国产组明显低于进口组。结论国产PDA封堵器与Amplatzer封堵器相比其疗效、并发症发生率差异无显著性意义,治疗费用低,临床应用前景广泛。     

经导管介入治疗婴幼儿大型动脉导管未闭临床疗效

目的 探讨应用导管介入治疗直径≥5 mm婴幼儿大型动脉导管未闭(patent ductus arteriosus,PDA)的临床疗效.方法 回顾性分析60例大型PDA(直径≥5 mm)患儿的临床资料,着重分析手术方法、临床疗效和随访结果.结果 56例PDA采用Amplatzer或国产先健动脉导管封堵器,3例采用膜部室间隔缺损封堵器,1例采用肌部室间隔缺损封堵器.封堵成功率为98.3%(59/60),术后1 d超声心动图显示15%(9/60)微量至少量残余分流,术后3月超声心动图复查未见残余分流;3例采用室间隔缺损封堵器患儿术后12月超声心动图示左肺动脉血流速度增快.结论 应用导管介入治疗直径≥5 mm婴幼儿大型PDA是安全、有效的方法.     

应用Amplatzer封堵器经导管治疗直径≥8mm动脉导管未闭的疗效评价

目的 :应用 Amplatzer封堵器经导管治疗直径≥ 8mm的大型动脉导管未闭 （PDA）并对其疗效进行评价。方法 :全组 5 0例 ,年龄 2 6 .4± 2 3.2 （4.0～ 6 0 .0 ）岁。 PDA最窄处直径为 10 .2± 2 .3（8.0～ 15 .0 ） mm。封堵 10 m in后行侧位降主动脉造影 ,术后 1d及 1月行超声心动图检查 ,观察有无残余分流及 PDA再通。结果 :47例 PDA采用Amplatzer PDA封堵器治疗 ,2例采用 Amplatzer ASD封堵器治疗 ,1例 PDA伴有阻力性肺动脉高压未行介入治疗。术后 10 min降主动脉造影显示 ,19例存在微～少量残余分流 ,30例封堵完全无残余分流。术后 2 4h、术后 1月超声心动图未见残余分流及再通。结论 :应用 Am platzer封堵器治疗直径≥ 8mm的大型动脉导管未闭是一种安全有效的介入方法。     

经导管介入治疗动脉导管未闭

采用介入方法治疗动脉导管未闭(PDA)已在临床上探索了近40年。Masura等[1]1998年首次报道应用蘑菇形伞封堵PDA获得成功,同期国产新型PDA封堵器成功应用于临床[2]。我院自2004年6月始应用国产封堵器治疗PDA患者18例,获得满意疗效,现报道如下。1资料与方法1.1临床资料18例患者,男     

国产蘑菇伞介入治疗成人动脉导管未闭的临床疗效评价

目的: 评价国产蘑菇伞经导管介入治疗成人动脉导管未闭(PDA)的临床疗效。方法: 选择我科156(男54,女102)例成人PDA实施经导管介入治疗的患者,年龄18～65(32±13)岁;体质量43.8～68.5(51±8)kg;行右心导管检查测定肺动脉压力、主动脉压力,行主动脉弓降部造影,确定PDA位置、形状及大小,PDA最窄处内径1.5～18.2 (5±5)mm。以国产蘑菇伞堵闭器行介入治疗,根据封堵实验决定能否行永久封堵。术后24 h、1、3、6 和12个月行彩色多普勒超声心动图检查随访。结果: 4例封堵后30 min肺动脉收缩压无下降,反而有轻度上升,考虑为阻力性重度肺动脉高压,撤出封堵器。余152例成功地植入封堵器,术后30 min肺动脉压收缩压由术前(48±23)mmHg降为(36±12)mmHg(P<0.05),肺动脉平均压降由术前(40±14)mmHg降为(27±11)mmHg(P<0.05),主动脉压由术前(102±13)mmHg变化至(107±14)mmHg(P>0.05)。术后30 min主动脉弓降部造影显示,119例(78.3％)封堵完全,33例(21.7％)可见极少量残余分流,术后24 h心脏彩超复查147例(96.7％)封堵完全,5例(3.3％)有少量残余分流,术后1个月彩超复查皆无残余分流;无再通和堵闭器移位等并发症发生。结论: 在不可逆性阻力性重度肺动脉高压发生前应用国产蘑菇伞经导管封堵治疗成人PDA是一种安全、简便、有效、创伤小、恢复快的方法。     

特殊形态动脉导管未闭的介入治疗

目的探讨特殊形态动脉导管未闭(PDA)的介入治疗方法,评价其临床应用价值。方法7例应用标准型Amplatzer导管封堵器难以完成介入治疗的PDA患者,根据造影显示PDA形态及临床特点,相应选用成角型Amplatzer导管封堵器以及偏心型导管封堵器进行介入治疗,术后以心脏超声随诊评价疗效。结果7例患者皆成功完成介入治疗,无严重并发症发生;其中2例应用成角型Amplatzer导管封堵器,5例应用偏心型导管封堵器;2例经二次手术完成,余患者一次治疗完成。7例患者中,封堵术后即刻造影显示有2例封堵完全,术后24h心脏超声检查示6例封堵完全,术后3个月复查皆封堵完全。结论需要设计和生产不同形态和大小的封堵装置,以扩大PDA介入治疗的适应证。     

经导管封堵动脉导管未闭介入治疗后残余分流

目的探讨经导管封堵动脉导管未闭(PDA)介入治疗后残余分流的可行性和临床疗效。方法自1997年3月至2001年8月16例PDA介入治疗后残余分流的患者,其中男4例,女12例,平均年龄5.9±2.4岁(2～9岁),平均体重17.7±5.4kg(9～28kg),应用不同介入方法经动脉或静脉途径封堵残余分流,首次介入治疗与再次介入治疗的时间间隔平均为1.5±1.1年(1天～3.5年)。结果残余分流直径平均为2.7±0.9mm(1.2～5.0mm)。15例成功完成残余分流封堵术,1例失败,技术成功率为94%(15/16)。单纯应用Cook可控弹簧圈9例(其中双弹簧圈2例),Rashkind双面伞2例,Sidris纽扣式补片1例,Amplatzer蘑菇伞2例,同时应用Cook可控弹簧圈和Sidris纽扣式补片1例。封堵术后即刻造影,3例仍有少量残余分流,完全闭合率为80%(12/15)。平均手术时间为75.0±22.8min(45～120min),平均X线透视时间为10.4±3.9min(5～20min)。股动脉并发症1例,其余无并发症出现。封堵术后24h复查超声心动图,所有残余分流均完全闭合(100%),在平均2年随访中未出现残余分流再通、封堵器移位和左右肺动脉狭窄。结论经导管封堵PDA介入治疗后残余分流安全、疗效确切、创伤小,可作为外科手术治疗PDA介入治疗后残余分流的一种替代方法。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.