大动脉炎的血管内介入诊疗

目的 探讨大动脉炎的血管造影诊断与介入治疗价值。方法 38例大动脉炎患者行血管造影检查。由2名有经验的介入放射学医师按盲法对其血管造影及介入治疗资料进行回顾性分析，然后共同讨论并达成一致意见。结果38例中，经血管造影按Lupi-Herrem综合分型法，Ⅰ型11例，Ⅱ型15例，Ⅲ型7例，Ⅳ型5例。主要受累的动脉包括锁骨下动脉20例(52．6％)，腹主动脉15例(39．5％)，肾动脉，4例(36．8％)，胸主动脉lO例(26．3％)，颈动脉9例(23．7％)，髂动脉9例(23．7％)，腋动脉7例(18．4％)，肠系膜上动脉4例(10．5％)，冠状动脉3例(7．9％)和肺动脉3例(7．9%)等。22例行经皮腔内血管成形术和12例行狭窄段支架置人术均获成功。结论 血管造影有利于大动脉炎的临床诊断与指导治疗，血管内介入治疗是一种微创的疗效可靠的治疗手段。     

药物洗脱支架治疗椎动脉狭窄一例及文献复习

目的　探讨药物洗脱支架在椎动脉狭窄中的初步应用。方法　应用CYPHERTM 支架治疗椎动脉起始段狭窄 1例。结果　患者表现为发作性眩晕伴左侧肢体活动不利 ,头颅磁共振 (弥散加权成像 )正常 ,DSA为右椎动脉起始部有一长 4 .6mm 90 %以上狭窄 ,狭窄远端动脉直径 2 .6mm ,右椎动脉开口处造影时右小脑后下动脉 (PICA)充盈欠佳 ,基底动脉未显影 ;左椎动脉造影时亦未见右PICA充盈。术前准备后置入 2 .75mm× 13mm球囊扩张式Cypher支架 ,再造影见狭窄消失 ,右PICA充盈良好 ,基底动脉显影。常规抗血小板聚集等治疗 ,已随访 1个月 ,未再有眩晕、肢体活动不利等症状发作。结论　药物洗脱支架在椎动脉的成功应用 ,为缺血性脑卒中的防治提供了新的手段 ,其长期疗效有待于进一步评价。     

肾移植术后动脉并发症的介入治疗

目的总结肾移植术后动脉性并发症介入治疗的经验及价值评估。方法回顾分析肾移植患者中进行血管造影检查者52例，介入治疗方法包括动脉内血管成形术治疗动脉狭窄，动脉内用尿激酶溶栓治疗急性血栓栓塞和假性动脉瘤的栓塞治疗。结果12例移植肾动脉基本正常，21例显示动脉吻合13狭窄，2例吻合13处动脉瘤形成(其中1例合并吻合13狭窄)，14例为移植肾动脉内血栓形成，3例为移植肾内动脉稀少。单纯移植。肾动脉狭窄中，16例行经动脉内血管成形术(单纯球囊扩张12例，血管内支架4例)治疗，其中14例肾功能逐渐恢复正常，2例术后肾功能恢复不良，移植肾切除。13例动脉血栓患者接受溶栓治疗(1例溶栓后放置支架)，其中3例溶栓失败，1例血管通畅后肾功能未见明显恢复，余9例。肾功能恢复正常。1例假性动脉瘤合并吻合口狭窄接受吻合口球囊扩张及支架治疗，动脉瘤栓塞治疗，造影复查动脉瘤消失，临床症状改善。结论血管内介入治疗为肾移植术后并发症提供进一步治疗，可及早挽救移植肾。     

症状性颅外颈动脉狭窄的血管内支架和药物治疗的临床疗效研究

目的　对比分析症状性颅外颈动脉狭窄的血管内支架和单纯药物治疗的疗效 ,评价两种治疗方法的有效性和安全性。方法　 2 0 0 1年到 2 0 0 3年我科门诊及病房治疗的症状性颅外颈动脉狭窄2 6 5例 ,其中支架治疗组 16 0例 ,单纯药物治疗组 10 5例。结果　颈动脉支架成形术 (CAS)手术的技术成功率 10 0 % ,血管狭窄由术前平均 79.5 %± 14 .6 %降至术后平均 11.2 %± 7.8% (P <0 .0 1) ,血管直径由术前 1.5± 0 .6mm恢复至 4 .1± 0 .4mm。治疗 30d内支架组和药物组各有 1例大卒中 (0 .6 3%、0 .95 % ,P >0 .0 5 ) ,药物组死亡 1例 (0 .95 % ) ,支架组无死亡。平均随访 13.5个月 ,支架组无死亡 ,同侧卒中 1例(0 .6 3% ) ,总的卒中和死亡 2例 (1.2 5 % ) ,药物组同侧卒中 4例 (3.81% ) ,死亡 1例 (0 .95 % ) ,总的卒中和死亡 5例 (4 .76 % )。支架组再狭窄 1例 (0 .6 3% ) ,因患者临床没有脑缺血症状 ,未进行再次治疗。结论　颈动脉支架成形术是治疗症状性颅外颈动脉狭窄和预防卒中安全而有效的方法 ,其围手术期总的卒中和死亡率低 ,1年随访卒中复发率和再狭窄率低 ,较单纯药物疗效更好。     

Characterization of 6q deletions in mature B cell lymphomas and childhood acute lymphoblastic leukemia

The study was undertaken with the aim to outline deletion patterns involving the long arm of chromosome 6, a common abnormality in lymphoproliferative disorders. Using a chromosome 6 specific tile path array, 60 samples from in total 49 cases with mantle cell lymphoma (MCL), de novo diffuse large B-cell lymphoma (DLBCL), transformed DLBCL as well as preceding follicular lymphoma (FL), and childhood acute lymphoblastic leukemia (ALL), were characterized. Twenty-six of the studied cases, representing all diagnoses, showed a 6q deletion among which 85% involved a 3 Mb region in 6q21. The minimal deleted interval in 6q21 encompasses the FOXO3A, PRDM1 and HACE1 candidate genes. The PRDM1 gene was found homozygously deleted in a case of DLBCL. Moreover, in two DLBCL cases, an overlapping homozygous deletion was identified in 6q23.3 - 24.1, encompassing the TNFAIP3 gene among others. Taken together, we refined the deletion pattern within the long arm of chromosome 6 in four different types of hematological malignances, suggesting the location of tumor suppressor genes involved in the tumor progression.     

辛伐他汀对冠心病患者PCI术后高敏C反应蛋白的影响

目的观察口服辛伐他汀对冠心病患者介入治疗后高敏C反应蛋白的影响。方法入选冠心病拟PC I治疗的患者74例,随机分为辛伐他汀组（n=37例）和对照组（n=37例）,辛伐他汀组患者术前在标准治疗基础上口服辛伐他汀40mg/d共1周,对照组除未服辛伐他汀外其他治疗均与辛伐他汀组相同,两组患者分别于术前、术后5天每天采集空腹静脉血3m l,对高敏C反应蛋白进行定量分析。结果PC I术后两组高敏C反应蛋白均显著升高（P〈0.05）,辛伐他汀组高敏C反应蛋白升高幅度显著低于对照组（P〈0.05）。结论冠心病患者PC I术前口服辛伐他汀可显著减低PC I术后高敏C反应蛋白的升高。     

The role of diet in animal models of systemic lupus erythematosus: possible implications for human lupus

Studies of diet in the mouse model of SLE have established the beneficial effects of a low calorie, low fat diet in these animals as well as the importance of the specific source of dietary fat. The role of zinc in murine and human SLE is less clear. The reported improvement of patients with SLE and other related diseases on a low phenylalanine and tyrosine diet high in fish content, and the lupus inducing capacity of a nonphysiologic amino acid present in alfalfa are also reviewed. The need for carefully controlled prospective studies of diet in patients with SLE is noted, and a diet of potential therapeutic benefit is described.     

四种重金属化合物不同条件下对EROD诱导活性的影响

目的：研究４种重金属化合物对Ｐ４５０１Ａ１基因产物乙氧基－９－羟基异吩恶唑酮－邻－去乙基酶（ＥＲＯＤ）诱导活性的影响。方法：４种重金属化合物及诱导物Ｌ－去甲肾上腺素不同时间与ＦＬ／Ｐ４５０ １Ａ１细胞作用，通过测定ＥＲＯＤ反应终产物乙氧基－９－羟基异吩恶酮荧光强度来了解ＥＲＯＤ活性。结果：ＦＬ细胞的ＥＲＯＤ诱导活性较低，ＦＬ／Ｐ４５０ １Ａ１细胞的ＥＲＯＤ诱导活性较高；重金属化合物同时加入时可抑制     

利用光学相干断层成像技术检测支架内新生动脉粥样硬化

冠心病患者经皮冠状动脉介入治疗(PCI)后支架内再狭窄及晚期血栓形成可导致严重的心血管事件,病理学研究已证实晚期支架内再狭窄与多种因素有关。研究表明新生动脉粥样硬化与支架内再狭窄机制相同。本文通过分析光学相干断层成像技术(OCT)的影像学特点,探索支架内新生动脉粥样硬化的早期诊断及不足。     

Clustered randomized controlled trial of a clinic-based problem-solving intervention to improve adherence in adolescents with cystic fibrosis

BackgroundIn Cystic Fibrosis (CF), adherence to pulmonary medications is about 50% and decreases during adolescence. Effective interventions have not been integrated into CF care. This effectiveness study tested a brief, clinic-based behavioral intervention to improve adherence.MethodsiCARE (I Change Adherence and Raise Expectations) was a pragmatic, clustered, 2-arm randomized controlled trial at 18 CF Centers. 607 adolescents with CF, ages 11–20 years, participated. Centers were randomized to IMPACT (n = 9; 300 adolescents), a brief problem-solving + education intervention, or standard care (SC; n = 9; 307 adolescents). IMPACT was delivered during a regularly scheduled clinic visit by a member of the clinical care team. The primary outcome was composite pulmonary medication possession ratio (cMPR); secondary endpoints were lung function, Body Mass Index percentile, courses of IV antibiotics, and health-related quality of life at 12 months.ResultsEffectiveness of the intervention was tested using mixed models, generalized estimating equations comparing IMPACT to SC. Fifty-eight percent of problem-solving sessions targeted barriers to airway clearance, exercise or nutrition, while 18% addressed pulmonary medications. Average intervention fidelity score was 67% (SD = 14%; Range = 25–100%). No significant intervention effects were found for cMPR or any of the secondary outcomes compared to SC.ConclusionsThe IMPACT intervention did not improve medication adherence or health outcomes over 12 months. Challenges to implementing the intervention as intended during busy clinic visits were identified.Trial RegistryClinicalTrials.gov; No.: NCT01232478; URL: www.clinicaltrials.gov.