TIPSS治疗肝硬化门脉高压症的临床应用

报告了12例应用 TIPSS 并 SEEV 治疗 CPH 合并上消道出血的临床研究结果。技术成功率91.7%。分流道为10mm。门脉平均压力由术前的43.2±5.3cmH_2O,降至术后的26.8±3.4cmH_2O。术后随访6～12月。分流道狭窄1例。3个月内死亡3例。初步结果表明:1.TIPSS 是治疗 CPH 合并消化道出血的新的有效的方法,近中期疗效满意。2.TIPSS 同时行 SEEV 对减少再出血,预防食管静脉破裂出血是非常有效的。3.支架以 Wall-stent 为最佳。4.对曾有过肝性脑病,肝功能差者,要加强预防性治疗措施。     

肝硬化门脉高压顽固性腹水病人TIPSS术前后血管紧张素Ⅱ水平的变化

目的 监测和分析肝硬化门脉高压顽固性腹水患者TIPSS术前后血中血管紧张素Ⅱ（AT－Ⅱ）的变化。材料与方法 采用放射免疫分析法对行TIPSS术的56例患者术前,术中及术后与33例原发性肝癌行肝动脉栓塞（TAE）治疗前后的空腹外周静脉,门静脉及肝固有动脉血中AT－Ⅱ水平进行了比较。结果 TIPSS术前的门静脉AT－Ⅱ水平为最高,依次高于肝静脉,外周静脉,对照组的外周静脉及肝固有动脉,P＜0．01。结论 肝硬化门脉高压顽固性腹水患者TIPSS术前AT－Ⅱ水平较高,尤其TIPSS术中肝内门静脉穿刺所取血样AT－Ⅱ水平最高;而术后的AT－Ⅱ水平则明显降低。这可能是肝硬化门脉高压顽固性腹水患者行TIPSS术后腹水消失的原因之一。     

跨肾动脉放置覆膜内支架治疗腹主动脉瘤对肾功能的影响

目的 :血管内覆膜内支架放置修补术治疗腹主动脉瘤基本标准是要求近端瘤颈长度 >1 5～ 2 0mm。通过比较术前术后BUN及血清肌酐水平 ,探讨跨肾动脉放置支架对肾功能的影响。方法 :1 3例腹主动脉瘤患者行经腹血管内覆膜内支架修补术 ,支架的裸露部分跨过肾动脉开口放置 ,以利于支架与血管壁附着牢固。术前及术后均检查患者的肾功能。结果 :术前 2例血清BUN异常 ,4例血肌酐浓度异常 ,术前DSA显示有肾动脉狭窄的 2例。术后 1个月 4例出现肾功能异常 ,2例术前BUN正常者出现异常。BUN平均值为 (7.1 7± 3 .92 )mmol/l,与术前比较差异无显著性意义 (P >0 .0 5)。血肌酐浓度平均值为 (1 57.69± 1 80 .2 7) μmol/l,与术前比较差异无显著性意义 (P >0 .0 5)。术后 3个月BUN为(6 .62± 3 .50 )mmol/l,血肌酐浓度为 (1 54 .2 3± 1 75 .49) μmol/l,与术前比较差异亦无显著性意义 (P >0 .0 5)。 结论 :只要支架位置正确 ,支架的开放性“筛孔”可以容许血流顺利进入肾动脉 ,则不会损害肾功能     

门静脉高压症介入治疗术式的临床选择

目的探讨在不同条件下选择合理治疗门静脉高压症的介入方式.方法回顾分析1997～2002年5年间介入治疗的76例门静脉高压症患者.经颈内静脉肝内门体分流术(TIPSS)治疗26例,其中11例为外科断流后再出血,6例为胃镜套扎后再出血,余9例为内科保守治疗无效且无外科或胃镜套扎治疗史者.经皮经肝食管胃曲张静脉栓塞术(PTVE)联合部分性脾栓塞(PSE)治疗50例,50例患者均为内科保守治疗无效者.所有76例患者于治疗前后均测量自由门静脉压(FPP),术前均由螺旋CT测量肝脏体积并于治疗1年后复查.结果 TIPSS治疗组与PTVE联合PSE治疗组中门静脉压分别由术前(3.85±0.42)kPa(1 kPa = 7.5 mm Hg)下降至术后(3.09±0.44)kPa(P<0.01), (3.79±0.51)kPa降至术后(3.28±0.57) kPa,(P<0.01).两组术后1年再出血率分别为0%,4%,肝性脑病发生率为19.2%(5/26),2.0%(1/50).TIPSS组术后肝脏体积明显缩小而PTVE联合 PSE组无明显改变.肝脏体积小于700 cm3与大于700 cm3者相比,TIPSS治疗后肝性脑病发生率明显增高﹙P<0.05).脾功能亢进均有效控制.结论门静脉高压症介入治疗的2种方式各有长短,应根据具体情况加以选择; 肝脏体积是评估及选择治疗方式的重要因素.     

胆管内支架治疗肝门部胆管梗阻

目的 探讨肝门部胆管梗阻置入支架治疗梗阻性黄疸的可行性和操作方法.资料与方法 28例肝门部胆管梗阻患者经皮经肝穿刺,分别在左右肝管置入支架.经单侧穿刺5例,经左右肝分别穿刺23例.2枚支架并排放置21例,经第1枚支架网眼放置第2枚支架7例.结果 手术成功率100%,无与操作有关的严重的并发症发生,血胆红素术前(19.34±15.47) mg/dl,术后1周内下降为(9.75±8.21) mg/dl.生存期25～816天(平均213天).结论 通过介入手段置入胆管内支架是缓解肝门部梗阻引起的黄疸安全、有效的方法 .     

双途径介入治疗原发性肝癌合并梗阻性黄疸

目的 回顾性分析经皮胆道内支架置入术和动脉内栓塞术双介入途径治疗原发性肝癌合并梗阻性黄疸的技术与疗效。方法 对12例原发性肝癌合并梗阻性黄疸的患者采用在经皮肝穿刺胆道内支架置入术的基础上,行动脉内化疗栓塞术的双介入治疗。肝内肿瘤5例为巨块型,6例为多发结节型,1例为弥漫型,病变均累及肝门部或左右肝管。结果 12例患者共置入14枚支架,3支外引流管。7例左右肝管之间相通,各置入1枚支架;5例左右肝管之间无法相通,分别通过支架或外引流管进行内引流或外引流,其中1例于左右肝管间及左肝管与胆总管之间各置入1枚支架。术后1周,血清总胆红素(TBIL)从术前的(405.3±175.4)μmol/L降至(188.3±101.5)μmol/L(P<0.01),碱性磷酸酶与丙氨酸转氨酶均下降明显(P均<0.05)。术后1个月,TBIL均降至100μmol/L以下,其中5例降至正常范围。胆道引流术后进行肝内肿瘤的动脉内化疗栓塞术1～4次(平均2.1次)。均未出现与介入治疗相关的严重并发症。平均生存9.5个月,5例仍存活。结论 经皮胆道内支架置入术与动脉内栓塞术双途径介入可安全、有效地治疗合并梗阻性黄疸的原发性肝癌,可明显缓解黄疸,改善肝脏功能,延长患者生命。     

经颈静脉肝内门体分流术的初步临床体会

本院自1993年11月至1994年4月用经颈静脉肝内门体分流术(TIPS)收治肝硬化门脉高压患者5例。其中4例穿刺成功,1例失败,1例于术后2月余复发上消化道出血,1例手术后出现一过性肝性脑病症状。门静脉压力从术前35.5±3.3cmH_2O降至术后的24.3±4.5cmH_2O,术后测压显示门腔静脉压力差为8.4±0.7cmH_2O。术后1个月食管钡餐随访,食管静脉曲张均较术前明显改善。作者认为: TIPS操作较外科手术简便,适应证广,降低门脉压力可靠,是治疗肝硬化门脉高压症的有效方法。此外,内支架的选择对防止TIPS术后分流道狭窄有一定作用。     

恶性梗阻性黄疸的介入治疗

目的　探讨经皮肝胆管引流和置入内支架治疗恶性梗阻性黄疸的方法及并发症的预防。材料与方法　 130例恶性梗阻性黄疸患者接受经皮肝胆管引流 ,男 83例 ,女 47例。年龄 31～ 86岁 ,平均 6 3 .5岁。其中胆管癌 5 7例 ,转移癌 2 3例 ,肝癌 2 0例 ,胰腺癌 2 2例 ,胆囊癌 8例。结果　 97例放置了胆管支架 ,其中 2 8例因多支胆管梗阻除放置支架外还放置了引流管 ,33例单纯放置了内、外引流管。血胆红素 1周内由 2 3 .4± 16 .2mg/dl降为 15 .7± 8.8mg/dl ,肝内多发胆管梗阻胆红素下降不明显。与操作有关的并发症为感染 15例 ,3例出现败血症 ,肝功能损害 11例 ,胆管出血 2例。术后 30天内患者死亡率为 9.2 % (12 /130 )。结论　恶性梗阻性黄疸介入治疗方法简单、疗效确切 ,能延长患者的生存期。     

TIPSS术后肝昏迷的防治：附2例报告

TIPSS 术后肝昏迷的发生率虽然远较外科门腔分流术低,但仍是 TIPSS 术后最常见的并发症,如不慎重对待亦可酿成大错。说明:1.TIPSS 术后常规观察神志变化,监测血氨,以便及早发现,及时治疗。2.常规应用乳果糖,精氨酸治疗,以通畅大便减少氨等有害物的吸收,降低血氨。3.慎用或半量应用含蛋白制剂。     

经皮腔内介入治疗移植肾动脉狭窄的临床疗效

目的:探讨经皮腔内球囊扩张术(PTA)/支架植入术(PTAS)治疗移植肾动脉狭窄(TRAS)的临床疗效。方法:搜集29例经多普勒超声检查确诊为TRAS的患者。所有患者均行PTA/PTAS治疗,分析并比较TRAS患者介入治疗前后相关指标的改变,评估介入治疗疗效及预后。结果:29例患者均成功行PTA/PTAS治疗,其中6例患者行PTA,23例行PTA+PTAS,术中未出现介入治疗相关严重并发症,患者术后肾功能相关指标均明显好转。术后患者血清肌酐由术前(261.96±193.79)μmol/L降至(167.44±76.94)μmol/L(术后1个月),术前与术后比较差异有统计学意义(P=0.007);尿素氮由术前(14.15±7.08) mmol/L降至(9.83±4.12) mmol/L(术后1个月),术前与术后比较差异有统计学意义(P=0.000)。2例伴高血压患者术后用药减少,1例蛋白尿患者支架植入治疗后蛋白尿消失。29例TRAS患者中4例失访,平均随访时间为22.6个月,其中2例进展为移植肾功能衰竭,2例出现支架相关并发症,给予介入治疗后好转,余患者预后良好。结论:PTA/PTAS是...     

Physiologic and pathologic calcifications and ossifications in the face and neck

The aim was to give a systematic presentation of physiologic and pathologic calcifications and ossifications in the face and neck with a special emphasis on clinical relevance. In a sometimes subacute setting one should recognize specific calcifications which often lead to important diagnoses such as fungal sinusitis or sclerosing labyrinthitis. In a more chronic situation intraocular calcifications in small children are pathognomonic for retinoblastoma. Juxtatumoral sclerosis of the laryngeal cartilage in laryngopharyngeal carcinoma is usually caused by tumor infiltration of the cartilage resulting in a higher tumor stage and, this way, has a major impact on the therapeutical strategy. Calcified lymph nodes are mainly unspecific but can be the result of tuberculosis or metastases of thyroid cancer. Cross-sectional imaging methods, most of all computed tomography, are ideally suited to reveal head and neck calcifications and ossifications, especially those which are clinically relevant.     

Head and neck infection and inflammation

This article discusses the imaging manifestations of infectious and inflammatory conditions of the head and neck. Special attention is paid to the sites, routes of spread, and complications of neck infections. Because the clinical signs and symptoms and the complications of these conditions are often determined by the precise anatomic site involved, anatomic considerations are stressed. Familiarity with the fascial layers, spaces of the neck, and the contents of each space is helpful for this discussion. The fascial layers of the neck are important barriers to infection, and once infection is established, the fascial layers play a part in directing its spread.     

幽门螺杆菌分泌与重组表达的VacA蛋白的分离纯化及其致细胞空泡效应与凋亡的对比研究

目的：分离纯化幽门螺杆菌分泌和重组表达的细胞空泡毒素抗原（ VacA）蛋白,并评价其致细胞空泡效应及致细胞凋亡效应。方法分别从幽门螺杆菌ATCC26695菌株培养上清和重组表达VacA蛋白的pQE30-VacA-E．coliM15基因工程菌中分离纯化VacA蛋白,经酸化后,以不同终浓度（5,10 ng／ml）分别与人胃腺癌AGS细胞共孵24 h,观察致空泡效应,并通过流式细胞术检测细胞凋亡。结果成功分离纯化出幽门螺杆菌分泌和重组表达的VacA蛋白;幽门螺杆菌分泌的VacA蛋白能显著引起AGS细胞的空泡样改变及凋亡（P＜0．01）,而重组表达的VacA蛋白致细胞空泡样改变及凋亡不显著（ P＞0．05）。结论幽门螺杆菌分泌的VacA蛋白有良好的空泡毒性及致凋亡效应,而重组表达的VacA蛋白无致空泡及凋亡效应,幽门螺杆菌分泌的VacA蛋白可用于VacA作用机制的研究。     

化学和生物学融合对国际武器公约履约的影响

化学武器公约（ CWC）和生物武器公约（ BWC）是为禁止生产、发展、储存和使用化学武器和生物武器而制定的国际公约。近年来,科学技术快速发展,知识交叉渗透,学科之间出现整合和融合,促进了科技进步和经济发展。其中化学和生物学融合在有力促进制药、健康卫生、绿色化学和环境保护等产业进步的同时,也对化学和生物武器公约的履约产生了重要的影响。该文综述了与化学武器和生物武器公约相关的化学和生物学融合进展,并分析其对公约履约的影响。     

Oxygen uptake and ventilation during rowing and running in females and males

This study evaluated if the ventilatory response to exercise is impaired by the cramp position of rowing. Maximal oxygen uptake (VO2max), maximal expiratory volume (VEmax), and maximal heart rate (HRmax) during rowing and running were compared in 55 males (age, mean +/- SD, 21 +/- 3 years; height 176 +/- 5 cm; body mass 72 +/- 6 kg) and 18 females (age 20 +/- 2 years; height 164 +/- 5 cm; body mass 61 +/- 4 kg). VEmax was larger during rowing than during running (males, 157 +/- 16 vs. 147 +/- 13 L min(-1); 114 +/- 9 vs. 105 +/- 11 L min(-1), P<0.01). Also VO2max was larger during rowing than during running (males, 4.5 +/- 0.5 vs. 4.3 +/- 0.4 L min(-1); females, 3.3 +/- 0.4 vs. 3.2 +/- 0.4 L min(-1), P<0.01). However, HRmax was lower during rowing than during running (males, 194 +/- 8 vs. 198 +/- 11 beats min(-1); females, 192 +/- 6 vs. 196 +/- 8 beats min(-1), P<0.05). VEmax was correlated to body mass and fat-free mass, as was VO2max. Thus, the oxygen pulse (VO2max/HRmax) was larger during rowing than during running, while the ventilatory equivalent for oxygen (VEmax/VO2max) was similar. We showed that bending the body during rowing does not seem to impair ventilation either in males or in females. The results indicate that VEmax and VO2max relate to body size and fat-free mass for both females and males. The findings indicate that the involvement of more muscles, the entrainment, and the body position during rowing facilitates ventilation and venous return and lowers maximal heart rate.     

Coracoclavicular and coracoacromial ligament calcification and ossification

Thirty-six patients with calcification or ossification at or around the coracoclavicular and coracoacromial regions were analyzed with regard to type, location, and configuration of the deposits and related clinical history. Calcification or ossification in the coracoclavicular region resulted largely from trauma (36%) or renal failure (28%). Trauma patients may develop punctate calcification or ossification but do not develop the tumoral type of calcification. About 5% of the renal failure patients had coracoclavicular ligament calcifications, one-half of which were of the tumoral type. Renal failure patients may have punctate or tumoral calcifications but do not develop ossification.     

CLIP相关技术的研究进展

在真核生物基因表达的转录后调节中,RNA结合蛋白（ RBP）起着关键作用,很多RBP的异常与人类疾病的发生密切相关。自2000年的RNA免疫沉淀和芯片分析方法（ RNA immunoprecipitation with differential display or microarray analysis , RIP-ChIP）出现以来,人们开始就RBP与RNA相互作用进行了系统而广泛的研究。经过改良和发展,基于体内实时紫外交联免疫沉淀法（ ultraviolet crosslinking and immunoprecipitation , CLIP ）、交联免疫沉淀cDNA文库高通量测序法（ high-throughput sequencing of CLIP cDNA library , HITS-CLIP）、光催化核糖核苷增强交联和免疫沉淀法（ photoactivatable-ribonucleoside-enhanced crosslinking and immunprecipitation , PAR-CLIP）以及提高个别核苷酸分辨率交联和免疫共沉淀法（ individual nucleotide resolution CLIP , iCLIP）等RIP-ChIP衍生方法相继产生,使用这些方法,可以解析RBP的RNA识别特异性,而且通过与高通量测序技术结合,可以实现转录组尺度的RBP的靶序列的鉴定,分辨率也得到极大提高。该文就RNA与蛋白的相互作用的基本原理及其研究进展、相关技术存在的问题以及发展趋势进行简要综述。     

Cross-sectional and longitudinal comparisons of self-reported and device-assessed physical activity and sedentary behaviour

ObjectivesTo examine the longitudinal associations and differences between self-reported and device-assessed physical activity (PA) and sedentary behaviour (SB), using a multifaceted statistical approach.DesignLongitudinal measurement burst.MethodsIn total, 52 university students (78% female) aged 18–38 years (mean = 21.94 ± 4.57 years) participated. The study consisted of three blocks of six days of measurement, during which participants wore an accelerometer on their wrist for the entire block, and self-reported their PA over the 6 days at the end of each block.ResultsMeaningful latent differences between methods were observed for moderate PA and SB across all three assessment periods, such that participants underreported the time spent in each activity. Bland–Altman plots revealed a positive mean difference for vigorous PA, with over-reporting increasing as mean levels increased. Negative mean differences were observed for all other intensities. Underreporting of moderate PA increased as the mean level increased, whereas for light PA and SB, underreporting decreased at high levels. Repeated measures correlations revealed a meaningful association for vigorous PA only, suggesting that as self-reported minutes increase so too do device-measured minutes.ConclusionsWe found evidence of cross-sectional and longitudinal differences and weak associations between self-reported and device-assessed PA and SB. Future work is needed to enhance the quality of self-reported methods to assess PA and SB (e.g., face and content validity), and consider improvements to the processing of device-based data.     

Old and dangerous: Prison and dementia

Older prisoners are the fastest growing group of prisoners in many countries. The purpose of this study is to explore the phenomenon of detention of persons suffering from dementia. Medline searches were conducted for relevant articles, chapters and books published until August 2016. Search terms included dementia, elderly, prison and criminal. Publications found through this indexed search were reviewed for further relevant references. As results, there is a lack of data about elderly with dementia in prisons. Given the rise in the average age, it is reasonable to hypothesize that the number of older prisoners is growing. Moreover, some elderly are imprisoned with a concomitant cognitive impairment or psychiatric disorder while others will develop such diseases once incarcerated. At the present time, legal and social systems seem unprepared to handle the phenomenon of dementia in prison. As proposal, health assessments for older first time offenders should become a practice inside the correctional facilities and include an evaluation for specific health issues, such as psychiatric comorbidity and cognitive impairment.