颅内动脉瘤血管内栓塞术后复发的影响因素分析

目的探讨影响颅内动脉瘤血管内栓塞术后复发的危险因素,建立回归模型以预测特定颅内动脉瘤患者经血管内栓塞治疗后的复发风险。方法回顾性连续纳入2012年5月至2014年5月第二军医大学长海医院脑血管病治疗中心经血管内栓塞治疗且有符合纳入标准的颅内囊状动脉瘤患者429例(共计动脉瘤441个),多发动脉瘤均按每个动脉瘤单独计算例数。根据动脉瘤是否复发,分为复发组(66例)和未复发组(375例)。比较两组临床特征、治疗技术及材料、动脉瘤解剖学等共计11项因素的差异,采用Logistic回归分析颅内动脉瘤血管内栓塞术后复发的危险因素,并评价其预测复发的有效性。结果复发组与未复发组的动脉瘤大小(χ2=46.352,P0.01)、破裂与否(χ2=4.198,P=0.040)、是否使用支架(χ2=9.554,P=0.002)、术后即刻栓塞结果(χ2=10.397,P=0.003)的差异均有统计学意义。多因素Logistic回归分析结果显示,非支架辅助栓塞(OR=4.076,95%CI:2.147~7.736,P0.01)、RaymondⅡ级(OR=4.222,95%CI:1.537~11.579,P=0.005)、RaymondⅢ级(OR=4.467,95%CI:1.600~12.470,P=0.004)、大型动脉瘤(10~25 mm,OR=4.914,95%CI:2.277~10.604,P0.01)和巨大型动脉瘤(25 mm,OR=35.743,95%CI:3.511~363.837,P=0.003)是动脉瘤栓塞术后复发的危险因素。回归模型预测复发的有效性检验结果显示,复发预测模型的曲线下面积为73.5%,Raymond分级为56.6%,非支架栓塞为60.1%,动脉瘤大小为40.3%,利用Z检验计算复发评分与非支架栓塞、Raymond分级、动脉瘤大小的ROC曲线下面积差异,Z值分别为2.662、3.513、6.308,P值分别为0.007、0.004、0.001。结论大型或巨大型动脉瘤、非支架辅助栓塞、术后即刻栓塞不全与颅内动脉瘤血管内栓塞术后复发有关,所建立的回归模型可反映患者术后复发风险大小。     

Solitaire AB支架辅助弹簧圈栓塞术与单纯弹簧圈栓塞术治疗急性期颅内破裂宽颈动脉瘤的疗效对比

目的探讨Solitaire AB支架辅助弹簧圈栓塞术与单纯弹簧圈栓塞术治疗急性期颅内破裂宽颈动脉瘤的疗效。方法 126例急性期颅内破裂宽颈动脉瘤患者随机分为对照组(63例)和观察组(63例),对照组给予单纯弹簧圈栓塞术,观察组给予Solitaire AB支架辅助弹簧圈栓塞术;对比两组治疗效果,术后并发症及随访结果。结果观察组栓塞效果明显好于对照组(P0.05);观察组并发症发生率与对照组相比差异无统计学意义(P0.05);术后6个月,观察组复发率低于对照组,但差异无统计学意义(P0.05);观察组预后良好率明显高于对照组(P0.05)。结论 Solitaire AB支架辅助弹簧圈栓塞术治疗急性期颅内破裂宽颈动脉瘤效果较好,且未引起明显并发症,患者复发率低,预后好。     

后交通动脉动脉瘤血管内栓塞术后复发的影响因素分析

目的探讨影响后交通动脉动脉瘤血管内栓塞术后复发的危险因素。方法回顾性连续纳入2014年1月至12月皖南医学院附属弋矶山医院神经外科接受血管内治疗的后交通动脉动脉瘤患者71例(共74个动脉瘤),以动脉瘤数计为例数(74例)。根据动脉瘤是否复发,分为复发组(18例)和未复发组(56例)。比较两组临床资料及动脉瘤特征的差异,采用Logistic多因素回归分析后交通动脉动脉瘤血管内栓塞术后复发的危险因素。结果 74例动脉瘤中,单纯弹簧圈栓塞51例,使用支架辅助栓塞23例,均释放满意。两组患者动脉瘤大小、Raymond分级的组间差异均有统计学意义(均P0.01);复发组合并子囊发生率[55.6%(10/18)]、非支架辅助比例[88.9%(16/18)]均高于未复发组[23.2%(13/56)、62.5%(35/56)],组间差异均有统计学意义(均P0.05);其余动脉瘤特征的组间差异均无统计学意义(均P0.05)。经变量筛选,Raymond分级以RaymondⅠ级为参照,进行多因素Logistic回归分析显示,非支架辅助(OR=4.789,95%CI:1.207~19.009,P=0.026)、RaymondⅡ级(OR=12.326,95%CI:3.838~39.592,P0.01)、RaymondⅢ级(OR=36.884,95%CI:2.892~470.454,P=0.005)是后交通动脉动脉瘤栓塞术后复发的独立危险因素。结论非支架辅助、RaymondⅡ~Ⅲ级可能会引起后交通动脉动脉瘤术后复发。     

动脉瘤合并心肌损伤与血管痉挛关系的研究

目的:探讨动脉瘤合并心肌损伤的病理神经机制及其与血管痉挛关系,寻找有效防治方法。方法:60只日本大耳白兔按照改良胰弹性蛋白酶诱导动脉瘤方法制作颈总动脉瘤模型(通常反映颅内动脉瘤),术后根据心电图ST段有无抬高分为ST段抬高组(25只)和ST段无抬高组(21只),同时以心脏超声、心肌肌钙蛋白I(cTnI)评估心肌损伤情况,术后以血管超声动态测定颈动脉瘤血管扩张内径、局部血流速度,评估血管痉挛与颈总动脉瘤合并心肌损伤之间关系。结果:ST段抬高组术后3d较1d、5d颈总动脉瘤血管内径明显变小,远近端血流速度明显加快,其后恢复,术后7d瘤样血管内径再度明显变小,血流速度明显加快(P0.05或0.01)。与无ST段抬高组术后3d、7d比较,ST段抬高组术后颈总动脉瘤血管内径明显变小[3d:(0.29±0.05)cm比(0.18±0.01)cm,7d:(0.39±0.03)cm比(0.19±0.03)cm,P0.01],瘤样扩张血管远近端血流速度明显增大[V_远:3d:(0.52±0.01)m/s比(0.71±0.02)m/s,7d:(0.56±0.02)m/s比(0.79±0.09)m/s;V_近:3d:(0.59±0.07)m/s比(0.78±0.06)m/s,7d:(0.68±0.07)m/s比(0.89±0.09)m/s,P均0.01]。术后与ST段无抬高组比较,ST段抬高组左室射血分数明显降低,左室舒张末期内径明显增大,cTnI水平明显升高(P0.05或0.01)。结论:CCA动脉瘤存在颈总动脉、冠状动脉血管痉挛,冠脉血管痉挛是动脉瘤心肌损伤的主要机制。     

颅内动脉瘤栓塞术中破裂危险因素的分析

目的 S分析颅内动脉瘤栓塞术中破裂危险因素及处理方案。方法对120例经血管内治疗颅内动脉瘤患者临床资料进行回顾性分析。结果病例组前循环动脉破裂率8.42%(8/95)低于后循环动脉48.00%(12/25)(P0.05);规则囊状、多分叶伴子瘤、多分叶无子瘤破裂率分别为10.81%(8/74)、21.42%(6/28)、36.84%(7/19),规则囊状破裂率与多分叶无子瘤差异显著(P0.05);两组动脉瘤直径3 mm对比差异显著(P0.05);两组动脉瘤宽颈、窄颈对比差异无统计学意义(P0.05);动脉瘤部位、大小是颅内脉瘤栓塞术中破裂独立危险因素(P0.05),动脉瘤形态是非独立因素。结论颅内动脉瘤栓塞术中破裂危险因素主要为动脉瘤部位及大小。     

颅内后交通动脉动脉瘤栓塞后复发的血流动力学数值模拟分析

目的采用血流动力学数值模拟的方法探讨颅内后交通动脉动脉瘤(PCoA-An)栓塞前后的血流动力学特点及其对栓塞术后复发的影响。方法连续纳入2008年1月—2010年2月行栓塞治疗的PCoA-An患者13例,根据随访的结果将其分为复发组4例和稳定组9例。基于栓塞前后的三维脑血管造影资料建立动脉瘤模型,通过计算流体力学软件,采用有限元算法对术前及术后瘤颈区域的血流动力学特征进行分析,并评价其对动脉瘤复发(2～18个月)的影响。结果栓塞术前,复发组瘤颈区域的收缩峰期壁面切应力(WSS)和血流速度分别为(29±7)Pa和(0.62±0.12)m/s,稳定组分别为(31±12)Pa和(0.85±0.29)m/s,两组比较差异均无统计学意义,P>0.05。栓塞术后,复发组相同区域收缩峰期的WSS和血流速度分别为(48±4)Pa和(0.99±0.09)m/s,与术前比较均明显增高,P<0.05;稳定组分别为(21±12)Pa和(0.57±0.27)m/s,与术前比较均明显降低,P<0.05。栓塞术后,复发组瘤颈区域收缩峰期的WSS和血流速度均明显高于稳定组,差异有统计学意义,P<0.01,P<0.05。结论栓塞PCoA-An后,瘤颈区域存在的高WSS、高血流速度可能是导致术后动脉瘤复发的重要因素。     

早期神经介入栓塞治疗老年破裂颅内动脉瘤患者的临床优势

目的 探析早期神经介入栓塞在老年破裂颅内动脉瘤患者治疗中的应用效果。方法 连续收集2014年1月至2020年10月在解放军总医院第一医学中心神经内科住院的老年破裂颅内动脉瘤患者68例，采用随机数字表法分为对照组(32例)和观察组(36例)。观察组于早期实施神经介入栓塞治疗(动脉瘤破裂后24 h内),对照组于非早期神经介入治疗(动脉瘤破裂24 h后),比较2组卧床时间、住院时间、美国国立卫生研究院卒中量表(NIHSS)评分、并发症发生率及栓塞程度。结果 观察组卧床时间、住院时间显著短于对照组[(4.95±1.15)d vs(6.42±0.89)d,(10.21±2.34)d vs(14.57±2.31)d,P=0.000];观察组完全栓塞比例显著高于对照组(88.89%vs 68.75%,P=0.040);2组入院时及术后2周NIHSS评分、肺部感染、再破裂出血、下肢静脉血栓、脑水肿发生率、大部分栓塞、部分栓塞比例比较，差异无统计学意义(P>0.05)。结论 早期神经介入栓塞术在老年破裂颅内动脉瘤患者治疗中应用效果显著，其有助于患者神经功能、生活自理能力改善，且能够降低并发症发生率...     

Solitaire AB与Enterprise支架辅助栓塞颅内宽颈动脉瘤患者的疗效对比

目的比较Solitaire AB与Enterprise支架对血管内辅助栓塞颅内宽颈动脉瘤的效果。方法回顾性分析广东省人民医院2012年1月至2014年12月采用Solitaire AB或Enterprise支架治疗的218例颅内宽颈动脉瘤患者的临床资料。其中使用Solitaire AB支架治疗(Solitaire AB组)70例,Enterprise治疗(Enterprise组)148例。随访时间为术后2个月至2年,以术后Raymond分级和改良Rankin量表(mRS)评分对两种支架的疗效进行比较。结果术前两组患者Hunt-Hess分级(Z=1.550,P=0.121)、Fisher分级(Z=1.537,P=0.124)、动脉瘤大小(Z=0.192,P=0.848)和部位(χ~2=0.337,P=0.736)差异均无统计学意义。术后两组患者即刻Raymond分级(Z=0.682,P=0.495)、随访Raymond分级(Z=0.206,P=0.837)和mRS评分(P=0.662)比较,差异均无统计学意义。进一步行多因素Logistic回归分析,显示支架种类不是影响预后的因素[随访Raymond分级(OR=0.029,95%CI:0.126~0.199,P=0.661)和术后mRS评分(OR=2.000,95%CI:0.204~19.603,P=0.552]。结论 Solitaire AB和Enterprise支架辅助栓塞颅内宽颈动脉瘤效果均良好。     

血管内完全栓塞颅内动脉瘤的影响因素分析

目的分析颅内动脉瘤血管内完全栓塞的影响因素。方法回顾性分析安徽医科大学附属安徽省立医院神经外科2013年1月至2017年1月行介入栓塞治疗的546例单发颅内动脉瘤住院患者的临床资料及影像学资料,将所有患者按照动脉瘤即刻栓塞程度,分为完全栓塞组(255例)和非完全栓塞组(291例),采用单因素、多因素Logistic回归分析方法,分析与颅内动脉瘤完全栓塞的相关因素。结果单因素分析显示,完全栓塞组与非完全栓塞组患者动脉瘤是否破裂、解剖形态、Hunt-Hess分级、动脉瘤大小及瘤颈宽度、不同治疗方案、动脉瘤角度差异均有统计学意义(均P0.05)。多因素回归分析结果显示,动脉瘤大小(OR=0.344,95%CI:0.204~0.578,P0.01)、是否破裂(OR=0.568,95%CI:0.314~0.947,P=0.030)、栓塞方式(OR=3.699,95%CI:2.223~6.153,P0.01)、瘤颈宽度(OR=0.326,95%CI:0.198~0.539,P=0.003)、动脉瘤角度(OR=0.647,95%CI:0.451~0.928,P=0.018)、动脉瘤形态(OR=1.689,95%CI:1.118~2.552,P=0.013)是影响颅内动脉瘤完全栓塞的独立因素。结论微小动脉瘤、未破裂动脉瘤、窄颈动脉瘤、小夹角动脉瘤、规则动脉瘤、支架或球囊辅助更易于完全栓塞颅内动脉瘤。     

颅内动脉瘤血管内栓塞术后复发风险预测评分模型的建立与验证

目的建立一个综合、简易、有效的复发风险预测评分模型以评估颅内动脉瘤血管内栓塞术后复发可能性大小,为手术方案的选择及术后处理提供指导意义。方法回顾性纳入长海医院神经外科2012年5月至2014年5月接受血管内栓塞治疗的颅内动脉瘤患者434例(共441个动脉瘤)并作为建模组,模型建立后,前瞻性纳入2015年1月至6月接受血管内栓塞治疗的颅内动脉瘤患者109例(共109个动脉瘤)并作为验证组。在建模队列中,依据前期动脉瘤复发危险因素的多因素Logistic回归分析结果建立复发风险预测评分模型;在验证队列中对模型进行验证。根据建模组评分模型受试者工作特征(ROC)曲线最佳cut-off值将评分表分为复发低危和复发高危。将复发风险预测评分模型与北美复发风险分层评分(ARSS)模型和Raymond分级进行比较。结果多因素Logistic回归分析显示,纳入评分并最终建立复发风险预测评分模型的3个因素为非支架辅助栓塞(1分)、Raymond分级≥Ⅱ级(1分)及动脉瘤大小[动脉瘤25 mm(3分),动脉瘤10~25 mm(1分),动脉瘤10 mm(0分)]。验证提示该评分体系具有较高的预测价值(AUC=0.738,95%CI:0.641~0.834,P0.05)和拟合优度(Hosmer-Lemeshowχ2=2.109,P=0.146);将评分模型进一步分为复发低危(0~1分)和复发高危(2~5分),其敏感度为72.73%(48/66),特异度为68.80%(258/375)。动脉瘤复发风险预测评分模型的预测能力与ARSS评分相似(χ2=0.54,P=0.462),并且优于Raymond分级(χ2=15.10,P0.01)。结论该研究所构建的简易动脉瘤复发风险预测评分模型可准确预测动脉瘤复发,但尚需开展多中心大样本的前瞻性研究以进一步验证。     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

Use of fab fragments of digoxin-specific antibodies in the therapy of massive digoxin poisoning

A case of massive digoxin ingestion with multiple arrhythmias, consisting of high grade A-V block and ventricular ectopy not responsive to lidocaine, is described. The arrhythmias ceased following administration of digoxin-specific Fab fragments. The patient improved and was transferred to the psychiatric unit.     

Comparison of intravenous and oral routes of theophylline loading in acute asthma

In a prospective, randomized clinical trial, 19 patients with an acute exacerbation of asthma were given a loading dose of aminophylline by the IV (n = 10) or oral route (n = 9) of administration following treatment with epinephrine. Plasma concentrations of theophylline were measured prior to giving the loading dose, and one, two, three, and 24 to 48 hours later. Therapeutic effectiveness was evaluated by analyzing spirometric measurements prior to giving the loading dose, and one, three, and 24 to 48 hours later. Side effects also were recorded. In the IV group, the mean peak plasma theophylline concentration was 15.1 micrograms/mL one hour after loading, and in the oral group the mean peak serum theophylline concentration was 14.2 micrograms/mL three hours after loading. There was no correlation between theophylline concentrations and normalized change in spirometric values. There was no significant difference in spirometric values between the IV and oral groups. Nausea was slightly more common in the IV group. We conclude that there is no therapeutic advantage to giving a loading dose of aminophylline by the IV route rather than orally in patients with mild-to-moderate exacerbation of asthma initially treated with epinephrine.     

Application of Granular Biocomposites Based on Homogenised Peat for Absorption of Oil Products

Among the various methods for collecting oil spills and oil products, including from the water surface, one of the most effective is the use of sorbents. In this work, three-component bio-based composite granular adsorbents were produced and studied for oil products’ pollution collection. A bio-based binder made of peat, devulcanised crumb rubber from used tyres, and part fly ash as cenospheres were used for absorbent production. The structure, surface morphology, porosity, mechanical properties, and sorption kinetics of the obtained samples were studied. Composite hydrophobicity and sorption capacity to oil products, such as diesel fuel (DF) and motor oil (MO), were determined. The obtained pellets are characterised by a sufficiently pronounced ability to absorb oil products such as DF. As the amount of CR in the granules increases, the diesel absorption capacity increases significantly. The case of 30-70-0 is almost three times higher than the granules from homogenised peat. The increase in q is due to two factors: the pronounced surface hydrophobicity of the samples (Θ = 152°) and a heterogeneous porous granule structure. The presence of the cenosphere in the biocomposite reduces its surface hydrophobicity while increasing the diesel absorption capacity. Relatively rapid realisation of the maximum saturation by the MO was noted. In common, the designed absorbent shows up to 0.7 g·g⁻¹ sorption capacity for MO and up to 1.55 g·g⁻¹ sorption capacity for diesel. A possible mechanism of DF absorption and the limiting stages of the process approximated for different kinetic models are discussed. The Weber–Morris diffusion model is used to primarily distinguish the limiting effect of the external and internal diffusion of the adsorbate on the absorption process.     

Role of microRNA in regulation of myeloma-related angiogenesis and survival

Multiple myeloma (MM) is a malignant disease caused by clonal proliferation of plasma cells that result in monoclonal gammopathy and severe end organ damage. Despite the uniform clinical signs, the disease is very diverse in terms of the nature and sequence of the underlying molecular events. Multiple cellular processes are involved in helping the malignant cells to remain viable and maintain proliferative properties in the hypoxic microenvironment of the bone marrow. Specifically, the process of angiogenesis, triggered by the interactions between the malignant MM cells and the stroma cells around them, was found to be critical for MM progression. In this review we highlight the current understanding about the epigenetic regulation of the proliferation and apoptosis of MM cells and its dependency on angiogenesis in the bone marrow that is carried out by different microRNAs.     

RNA-Seq在老年神经退行性疾病研究中的应用

阿尔茨海默病及帕金森病是老年人最常见的两种神经退行性疾病,但其发病机制及治疗是研究的热点。随着高通量测序技术的进步及成本的下降,RNA-Seq也成为神经退行性疾病机制研究及生物标志物发现的有力手段。RNA-Seq相对于microarray具有高灵敏度、高准确性、高重复性以及噪声低等优势,在阿尔茨海默病及帕金森病研究中有较为广泛的应用,包括检测差异表达基因,可变剪接、新长链非编码RNA预测分析和miRNAs调控等,但是容易受病理复杂性及样本等因素影响。目前阿尔茨海默病及帕金森病转录组研究相比于癌症等还不够深入,在临床诊断及治疗应用还面临较大挑战。但是随着新技术及新方法的发展,RNA-Seq将进一步推动神经退行性相关疾病的研究和临床转化。     

安徽巢湖市丝虫病控制、消除历程和监测报告

【摘要】 目的  回顾并总结巢湖市丝虫病的流行、控制,以及消除丝虫病的历程。 方法  统计分析1970~1989年在该市采取以消灭传染源、切断传播途径为主的防治策略,以及展开大规模防治的各个阶段。 结果  1989年,采用分层整群抽样调查方法调查,微丝蚴率下降至0.032%,以行政村为单位,微丝蚴率已控制在1.0%以下,达到卫生部规定的基本消灭丝虫病标准;1991年,经省级调查考核,认定全市已达到卫生部规定的基本消灭丝虫病标准。1996年,省级审评确认已达到卫生部颁布的消灭丝虫病标准。经过10年的监测和跟踪治疗,到2005年,全市丝虫病病原学监测未查见微丝蚴阳性者,解剖镜检人房内淡色库蚊1 348只,蚊体内均未查见人体幼丝虫。 结论  巢湖市达到了消除丝虫病的标准。     

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation

The role of the external and internal anal sphincters in the mechanism of anal continence is presented. The external sphincter induces continence by 1) preventing internal sphincter relaxation, what I have called the “voluntary inhibition action,” and 2) mechanical compression of the rectal neck and anal canal proper. The mechanism of both actions is described. The internal sphincter plays a significant role not only in involuntary, but also in voluntary, continence. The importance of this role in the correction of anal incontinence is clarified. “Stress defecation,” a condition which follows internal sphincter damage, is discussed. A “single loop continence” theory is presented, based on the fact that each of the three loops of the external sphincter has its own innervation, attachment, and direction of muscle bundles; each loop thus acts as a separate sphincter. The clinical application of this theory is presented.