颈动脉壁结构变化与心脑血管事件关系的研究

目的研究老年人颈动脉血管壁结构变化与心脑血管事件的关系。方法采用高分辨率彩色多普勒超声仪,对255例老年疗养干部颈动脉结构进行超声检测和临床观察,并将心脑血管疾病组患者的血管壁结构、血流动力学参数及临床检测结果与对照组作比较。结果心脑血管疾病组老人颈部血管硬化指标IMT、PI、R I以及脂质代谢指标TG、HDL等显著大于对照组(P<0.05),Vs、Vd显著低于对照组(P<0.05)。结论颈动脉超声检测对于评估和防治心脑血管疾病有重要临床价值。     

健康成人颈动脉弹性特征的研究

目的 应用速度向量成像(VVI)技术分析健康成人颈总动脉(CCA)短轴方向管壁运动和弹性参数特点及其与影响因素间的关系.方法 2013年12月至2015年7月我院健康体检者400例依据年龄、性别分组,采用Siemens Acuson Sequoia 512彩色多普勒超声诊断仪采集CCA动态短轴二维图像,以VVI技术测量各组颈总动脉管壁短轴方向各侧壁(前壁、外侧壁、后壁、内侧壁)的收缩期峰值速度(Vmax)、峰值应变(Smax)及峰值应变率(SRmax).结果 健康成人颈总动脉各侧壁的弹性参数Smax、SRmax比较差异均无统计学意义(P>0.05),而外侧壁和前壁的运动参数Vmax分别为(6.65±0.80)×10-2 cm/s、(5.66±0.73)×10-2 cm/s,明显高于后壁和内侧壁的(3.70±0.81)×10-2 cm/s、(3.86±0.36)×10-2 cm/s,差异均有统计学意义(P<0.05);运动参数Vmax男性组均数为(6.25±1.17)×10-2 cm/s,均大于女性组的(4.66±1.28)×10-2 cm/s,而弹性参数Smax、SRmax女性组均数分别为(3.72±0.42)%、(0.21±0.17)/s,均大于男性组的(3.02±0.42)%、(0.17±0.20)/s,各项指标比较差异均有统计学意义(P<0.05);随着年龄的增长,各项指标呈下降趋势,差异有统计学意义(P<0.05).结论 VVI技术可用于研究健康成人CCA管壁的运动力学特点及其与影响因素之间的关系.     

CVI-Q检测颈动脉血流量的临床应用价值

目的 :用彩色速度显像定量 (CVI Q)技术测定颈动脉血流量并给出青年组正常参考值。方法 :应用传统的多普勒法及CVI Q法对正常 5 0名在校四年级大学生进行左、右颈总动脉血流量的测定比较。结果 :单侧颈总动脉血流量传统法测定为 (789.49± 15 3 .40 )ml·min-1,CVI Q法为 (3 92 .85± 63 .95 )ml·min-1,两者有显著性差异 (P <0 .0 0 1) ,男女之间、左右之间无明显差异 ,S/D、RI和PI 3组数据两两之间亦无显著性差异。结论 :CVI Q是一种实用、无创、简便、可靠的测量方法 ,具有良好的临床应用价值     

Endovascular Stent Placement for Cervical Internal Carotid Artery Aneurysm Causing Cerebral Embolism: Usefulness of Neuroradiological Evaluation

Summary  We present a case of a cervical internal carotid artery aneurysm that caused cerebral embolism. This lesion was supposed to be a dissecting aneurysm due to blunt neck injury. The large aneurysm with intramural thrombus was treated with endovascular placement of a balloon-expandable stent. Both CT and MRI were useful for evaluating the size and characteristics of the aneurysmal wall. Intravascular ultrasound imaging was also useful for evaluation of the satisfactory stent deployment and identification of the neck of the aneurysm. We disscuss effectiveness of endovascular stenting for cervical internal carotid artery aneurysm with intramural thrombus and the usefulness of a combination of the neuroradiological imaging before, during and after the interventional procedure.     

瑞芬太尼对人肠系膜小动脉平滑肌细胞L-型钙通道电流的影响

目的观察瑞芬太尼对人肠系膜小动脉平滑肌细胞(MASMCs)L-型钙通道电流的影响,探讨其扩张血管的机制。方法酶解法分离人肠系膜小动脉单个平滑肌细胞,采用全细胞膜片钳技术,以钡电流作为载流子,观察19.4nmol／L瑞芬太尼在不同钳制电压下以及不同浓度瑞芬太尼在最大激活电压下对MASMCs L-型钡电流(TBa-L)的影响。结果19．4 nmol／L瑞芬太尼可抑制TBa-L,使电流密度-电压曲线上移,最大激活电压及翻转电压均向膜的负电位方向移动(P<0．01)。瑞芬太尼浓度依赖性地抑制TBa-L,其半数最大抑制效应的浓度为(39±4)nmol／L。结论瑞芬太尼浓度依赖性地抑制人肠系膜小动脉平滑肌细胞L-型钙通道,从而产生扩张血管的作用。     

颈动脉损伤的外科治疗(附16例报告)

目的 探讨颈动脉损伤的早期诊断和外科治疗方法。方法 回顾性分析2003年10月至2006年12月哈尔滨医科大学附属第二医院血管外科收治的16例颈动脉损伤的临床资料。颈外动脉损伤4例,颈总动脉损伤3例,颈内动脉损伤1例,颈动脉假性动脉瘤3例,颈动脉血栓形成1例,医源性颈动脉损伤4例。结果行颈外动脉结扎4例,颈总动脉修补2例,自体大隐静脉移植7例,覆膜支架植入2例,抗凝溶栓1例。死亡1例,偏瘫、失语1例．Homer综合征5例,声音嘶哑、饮水呛咳5例,7例痊愈。结论 早期诊断,及时有效的止血,修复血管．尽快恢寅颈动脉血流和必要的脑保护措施是降低病死率,减少神经系统并发症的关键。     

Predictive model of postoperative pneumonia after neoadjuvant immunochemotherapy for esophageal cancer

BackgroundPostoperative pneumonia (PP) is the most common pulmonary complication of esophagectomy. It is of great importance to identify any high-risk factors and prevent pulmonary complications to improve the prognosis of patients with esophageal cancer undergoing esophagectomy. Thus, we established a predictive model of PP in patients with neoadjuvant immunochemotherapy for resectable esophageal squamous cell carcinoma (ESCC), and provide suggestions for the best strategy for the perioperative period of the patients.MethodWe retrospectively analyzed 78 patients who underwent esophagectomy for squamous cell carcinoma after neoadjuvant immunochemotherapy between September 2019 and August 2021.We used the “glmnet” language package in R to perform least absolute shrinkage and selection operator (LASSO) regression to screen the best predictors of PP, and nomograms predicting PP were constructed utilizing screened factors. The performance of nomograms was internally validated by calibration curves, concordance index (C-index), and the Brier score for overall performance.ResultsTwenty-six patients (33.3%) had postoperative pneumonia. After LASSO regression, the factors that were independently associated with PP were diffusing capacity of the lungs for carbon monoxide (DLCO) (P=0.0002), white blood cell (WBC) difference before vs. after neoadjuvant immunochemotherapy (P=0.0133). We constructed a prediction model, plotted the nomogram, and verified its accuracy. Its Brier score was 0.147, its calibration slope was 0.98, and its C-index was 0.85 (95% CI: 0.75–0.95). Internal validation demonstrated a good discrimination power that the actual probability corresponds closely with the predicted probability.ConclusionsOur prediction model can predict the possibility of PP in patients with neoadjuvant immunochemotherapy for resectable esophageal squamous cell carcinoma and may facilitate physicians’ efforts to reduce the incidence of postoperative pneumonia.     

Three blistering diseases

The three blistering conditions described in this article—dermatitis herpetiformis, pemphigus vulgaris, and bullous pemphigoid—are unusual but not rare. Proper management is critical and should include supervision by a physician thoroughly familiar with treatment and potential complications. Dr Wooldridge discusses the primary care physician's role in diagnosis, treatment, and follow-up of these diseases.     

Suture-mediated percutaneous closure of the arterial puncture site after abdominal aortic stent implantation

Summary

We report the use of a vascular surgical device to provide safe closure of the arterial access site after abdominal aortic-stent implantation. After suture-mediated percutaneous closure of the arterial puncture site, bleeding stopped immediately. There was no need for adjunctive compression. Immobilisation of the patient lasted only 1 h.