内膜下血管成形术治疗下肢动脉慢性缺血

Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.     

医德教育改革应处理好几个关系

随着人文学科在医学教育中比重的增加,对医德教育提出了更高的要求.为适应这一变化,医德教育必须进行改革.就各类医学院校而言,要使医德教育的改革顺利进行,必须处理好几个关系.     

Angiosome概念在重症肢体缺血中的应用进展

重症肢体缺血(critical limb ischemia,CLI)指周围动脉血管疾病(peripheral arterial disease,PAD)中最具严重症状者,出现静息痛、肢端溃疡、坏疽等,病程至少持续2~4周[1],主要病理变化是多节段、多平面大小腿动脉的粥样硬化闭塞,病变程度相当于Rutherford 4~6级或FontaineⅢ~Ⅳ期[2]。对于CLI,无论是行旁路转流术或是腔内血管成形     

高度近视白内障植入晶状体囊袋张力环52例分析

目的 探讨高度近视白内障超声乳化后囊袋内植入晶状体囊袋扩张环的临床疗效.方法 对高度近视白内障患者52例64眼行白内障超声乳化后植入囊袋张力环和人工晶体,观察其手术效果.结果 术后矫正视力>0.8者15例(21眼),0.6～0.8者29例(33眼),<0.5者8例(10眼).术后2 a内发生视网膜脱离的1例.后囊膜混浊的2例.结论 高度近视白内障患者植入晶体囊袋扩张环能较好的维持眼内组织稳定性,视力恢复明显,并有效地预防视网膜脱离及后发障的发生,使高度近视白内障的手术更加安全.     

内膜下血管成形术治疗下肢动脉慢性缺血

Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.     

确立课堂教学设计原则的依据

确立课堂教学设计原则的依据解放军广州医学高等专科学校刘晓兵人们越来越重视课堂教学设计，并努力探索指导这一实践活动的客观规律。课堂教学设计原则，是人们研究的一个重要课题。笔者认为，要确立正确的课堂教学设计原则，必须认真探求这一原则确立的依据。由此，才能...     

内膜下血管成形术治疗下肢动脉慢性缺血

Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.     

贝前列腺素钠治疗下肢动脉硬化性闭塞症的疗效

目的 观察贝前列腺素钠治疗下肢动脉硬化性闭塞症(ASO)的疗效.方法 选择下肢ASO患者35例,口服贝前列腺素钠24周,前4周服用60 μg/d,后20周120 μg/d.观察患肢服药前和服药后4、12、24周踝肱指数、初始步行距离、绝对步行距离的变化以及临床症状、行走距离、行走速度、走楼梯层数变化的主观判断,服药前和服药后24周行实验室检查,每4周检测心率和血压,记录任何不良事件和不良反应.结果 有效观察病例29例.患肢服药前和服药后4、12、24周踝肱指数、初始步行距离和绝对步行距离的差异无统计学意义(P>0.05);服药后患者自觉临床症状逐渐改善(P<0.05),行走距离、行走速度、走楼梯层数服药前后差异无统计学意义(P>0.05);服药前后各实验室检查指标、心率和血压差异无统计学意义(P>0.05);服药后出现的不良事件和不良反应有心律失常(n=1)、心功能衰竭(n=1)、胃肠道反应(n=2)和头痛(n=2).结论 贝前列腺素钠在治疗下肢ASO患者缺血症状的早期疗效上有一定局限性,在减少心血管意外发生中的有效性和作用机制仍待进一步明确.     

siRNA沉默Smad3对肝星状细胞增殖与凋亡的影响及其机制研究

目的: 观察 Smad3 小干扰RNA(siRNA-Smad3)沉默肝星状细胞(HSCs) Smad3 基因对肝星状细胞增殖、凋亡的影响,并探讨其可能机制。方法: 肝星状细胞株HSCs-T6分为3组:空白对照组、阴性对照组、siRNA-Smad3转染组。siRNA-Smad3转染HSCs细胞株,转染不同时间后,CCK-8检测HSCs增殖的变化,流式细胞术检测HSCs凋亡的变化,免疫细胞化学法检测HSCs凋亡相关蛋白P53和Bcl-2表达的变化。结果: (1)24 h、48 h、72 h siRNA-Smad3转染组HSCs增殖受到显著抑制且凋亡明显增多(P<0.01)。(2)转染48 h后,siRNA-Smad3转染组P53蛋白表达显著增多,Bcl-2蛋白表达显著减少(P<0.01)。结论: siRNA-Smad3沉默Smad3基因可以在一定时间内显著抑制HSCs的增殖并诱导其凋亡,其可能通过上调凋亡相关蛋白P53表达、下调Bcl-2的表达来发挥诱导凋亡的作用;Smad3沉默有望成为抗肝纤维化治疗的一个新途径。