Solitaire支架辅助弹簧圈栓塞治疗颅内复杂动脉瘤效果

目的研究Solitaire颅内支架对颅内复杂动脉瘤的疗效与并发症并对比单纯弹簧圈栓塞和颅内支架辅助弹簧圈栓塞治疗患者的康复情况。方法 60例颅内复杂动脉瘤患者中18例接受单纯弹簧圈栓塞治疗,42例使用Solitaire支架辅助弹簧圈栓塞治疗。手术1个月内观察各种并发症(血栓、短暂性脑缺血、脑梗死、脑出血)发生率。手术后3～6个月内对患者进行血管造影复查,判断是否有动脉瘤复发或血管栓塞。利用修订Rankin量表(MRS)评价患者术后3个月状况。结果使用颅内Solitaire支架辅助弹簧圈栓塞治疗的患者均比不使用的患者恢复效果好,复发率和再出血率均显著较低(P0. 05)。结论 Solitaire支架辅助弹簧圈栓塞治疗颅内复杂动脉瘤可提高治愈率,减少复发率。     

新型可回撤自膨胀支架辅助栓塞颈内动脉宽颈动脉瘤的疗效及安全性

目的探讨新型可回撤自膨胀支架(LEO)辅助栓塞颈内动脉宽颈动脉瘤临床疗效、安全性及预后。方法回顾分析颈内动脉动脉瘤89例,其中47例颈内动脉宽颈动脉瘤病例,因瘤颈相对较宽,使用LEO支架辅助弹簧圈栓塞术治疗;其余42例非宽颈动脉瘤患者单纯使用弹簧圈栓塞。术后行3D-DSA造影,术后3~6个月随访PSA或MRA,评估效果、评价安全性,随访6个月~1年,用GOS评分评价预后。结果 LEO支架辅助弹簧圈栓塞术后,3例发生缺血表现,1例继发脑出血,2例死亡,在治愈率、复发率、术后及远期并发症及GOS评分方面,与单纯弹簧圈栓塞术相关数据比较,无明显差异(P>0.05)。结论新型LEO辅助栓塞颈内动脉动脉瘤闭塞效果良好,术后并发症少,预后佳。     

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。     

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。     

支架与非支架辅助弹簧圈栓塞后交通动脉破裂动脉瘤的疗效分析

目的比较支架与非支架辅助弹簧圈栓塞治疗后交通动脉破裂动脉瘤的安全性和有效性。方法回顾性连续纳入2014年6月至2017年6月菏泽市立医院神经外科治疗的后交通动脉破裂动脉瘤121例,根据是否使用支架治疗,分为支架组(63例)和非支架组(58例),比较两组的临床资料、手术相关并发症、动脉瘤术后即刻栓塞程度以及临床和影像学随访结果。结果对患者均成功行介入栓塞治疗。(1)支架组宽颈动脉瘤比例高于非支架组,差异有统计学意义[92.1%(58/63)比8.6%(5/58),χ~2=84.249,P0.01],两组患者年龄、动脉瘤大小、性别、Hunt-Hess分级差异均无统计学意义(均P0.05)。(2)支架组和非支架组术中动脉瘤破裂出血的发生率分别为4.8%(3/63)、3.4%(2/58),差异无统计学意义(χ~2=0.132,P=0.717);栓塞性并发症发生率分别为12.7%(8/63)、5.2%(3/58),差异无统计学意义(χ~2=2.070,P=0.150)。支架组1例残疾,1例死亡;非支架组无手术相关致残病例,1例死亡。(3)支架组与非支架组术后即刻栓塞结果比较,完全闭塞率[39.7%(25/63)比37.9%(22/58),χ~2=0.039]、瘤颈残留率[25.4%(16/63)比39.7%(23/58),χ~2=2.811]、瘤体残留率[34.9%(22/63)比22.4%(13/58),χ~2=2.298]的差异均无统计学意义(均P0.05)。(4)支架组动脉瘤复发率[4.3%(2/46)]低于非支架组[31.8%(14/44)],组间差异有统计学意义(χ~2=112.610,P=0.001)。所有动脉瘤均未发生术后再出血。结论与非支架辅助弹簧圈栓塞相比,急性期支架辅助栓塞后交通动脉破裂动脉瘤可降低动脉瘤的复发率,并且未明显增加手术相关并发症的发生率。     

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。     

支架治疗破裂颅内动脉瘤并发出血的危险因素分析

目的分析支架治疗破裂颅内动脉瘤术中及术后发生出血并发症的危险因素。方法回顾性连续纳入2014年8月至2017年7月于第四军医大学第二附属医院唐都医院神经外科经单独支架置入或支架辅助弹簧圈行血管内介入治疗的动脉瘤性蛛网膜下腔出血(a SAH)患者249例,根据支架治疗术中及术后是否发生出血并发症,分为出血并发症组(33例)和无并发症组(216例)。记录并分析两组患者的基线资料、临床资料及动脉瘤特征,包括年龄、性别、高血压病、格拉斯哥昏迷(GCS)评分、a SAH至手术时间、Hunt-Hess分级、Fisher评分、动脉瘤部位、个数、大小、Raymond分级,并对发生出血并发症的危险因素行多因素Logistic回归分析。结果 (1)围手术期出血并发症发生率13.3%(33/249)。(2)出血并发症组GCS评分与无并发症组比较,差异有统计学意义(P0.05);年龄、男性、高血压病、a SAH至手术时间的组间差异均无统计学意义(均P0.05)。(3)出血并发症组与无并发症组比较,Hunt-Hess分级(χ2=10.392,P=0.001)、Fisher评分(χ2=7.370,P=0.007)、动脉瘤个数(χ2=4.825,P=0.028)、动脉瘤部位(χ2=6.818,P=0.033)的组间差异均有统计学意义;Raymond分级的组间差异无统计学意义(P0.05)。(4)以发生出血并发症为因变量,经变量筛选,将Hunt-Hess分级Ⅲ~Ⅴ级、多发动脉瘤进一步行多因素Logistic回归分析,结果显示,Hunt-HessⅢ~Ⅴ级(OR=3.658,95%CI:1.660~8.061)和多发动脉瘤(OR=2.667,95%CI:1.178~6.036)是支架治疗破裂颅内动脉瘤发生出血并发症的独立危险因素(均P0.05)。结论单独支架置入及支架辅助弹簧圈可用于血管内治疗破裂颅内动脉瘤,但术前Hunt-Hess分级Ⅲ~Ⅴ级、多发动脉瘤易致a SAH患者发生围手术期出血并发症。     

支架辅助弹簧圈栓塞术治疗颅内复杂动脉瘤效果观察

目的 探讨支架辅助弹簧圈栓塞术在颅内复杂动脉瘤中的治疗效果.方法 选取2008年10月-2011年6月我院42例颅内复杂动脉瘤患者,根据治疗方法分为单纯微弹簧圈栓塞组(对照组)21例和支架辅助弹簧圈栓塞组(观察组)21例,将两组患者出院时及随访6个月时的GOS评分、并发症发生率及生存质量评分进行统计并比较分析.结果 观察组出院时和随访6个月得分为4分及5分分别与对照组比较,差异均有统计学意义(P＜0.05);观察组并发症发生率及生存质量评分分别与对照组比较,差异均有统计学意义(P＜0.05).结论 支架辅助弹簧圈栓塞术治疗颅内复杂动脉瘤效果明显,安全性较高,值得进一步研究探讨.     

颅内动脉瘤支架辅助弹簧圈栓塞的围手术期护理

颅内动脉瘤是自发性蛛网膜下腔出血最常见的原因,具有较高的死残率和复发率。随着介入技术的发展,单纯弹簧圈栓塞对大部分囊性动脉瘤取得了较好疗效,但对宽颈、梭形和夹层等复杂动脉瘤,单纯弹簧圈栓塞和显微手术治疗仍较为棘手。近年来,颅内支架系统开始应用于复杂动脉瘤的治疗。由于支架辅助栓塞操作比单纯弹簧圈栓塞复杂,要求对支架辅助栓塞的综合护理以利于围手术期并发症的预防和处理。我院自2005年1月至2008年1月在支架辅助下栓塞动脉瘤52例,效果良好。现将护理体会报告如下。     

血管内超声指导药物洗脱支架置入术疗效的Meta分析

目的比较血管内超声(IVUS)和传统冠状动脉造影指导的药物洗脱支架(DES)置入术的疗效。方法计算机检索Pub Med、Cochrane图书馆、EMBASE、中国知网及万方数据库,同时手工检索相关文献的引文目录,纳入满足要求的临床研究。结果最终纳入随机对照试验10项,总计患者3459例,其中IVUS组1718例,造影组1741例。Meta分析结果表明,相比传统冠状动脉造影,IVUS指导的DES置入术能显著降低主要心脏不良事件发生率(OR=0.58,95%CI:0.45~0.75,I2=0%,P0.0001)、靶血管血运重建率(OR=0.61,95%CI:0.40~0.92,I2=0%,P=0.02)及靶病变血运重建率(OR=0.59,95%CI:0.41~0.84,I2=0%,P=0.003)。两种指导DES置入的方案在支架内血栓形成(P=0.07)、心脏原因死亡率(P=0.13)、心肌梗死发生率方面无显著差异(P=0.61),但支架内血栓形成方面的结果缺乏稳定性。结论相比传统冠状动脉造影指导,IVUS指导下的DES置入可显著降低主要不良心脏事件和血运重建的风险,但支架内血栓形成方面的获益还需更多的高质量的研究来证明。     

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.     

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.     

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.     

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.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.