Catheter-Directed Thrombolysis with a Continuous Infusion of Low-Dose Urokinase for Non-Acute Deep Venous Thrombosis of the Lower Extremity

Objective

We wanted to evaluate the feasibility of catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for treating non-acute (less than 14 days) deep venous thrombosis of the lower extremity.

Materials and Methods

The clinical data of 110 patients who were treated by catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for lower extremity deep venous thrombosis was analysed. Adjunctive angioplasty or/and stenting was performed for the residual stenosis. Venous recanalization was graded by pre- and post-treatment venography. Follow-up was performed by clinical evaluation and Doppler ultrasound.

Results

A total of 112 limbs with deep venous thrombosis with a mean symptom duration of 22.7 days (range: 15-38 days) were treated with a urokinase infusion (mean: 3.5 million IU) for a mean of 196 hours. After thrombolysis, stent placement was performed in 25 iliac vein lesions and percutaneous angioplasty (PTA) alone was done in five iliac veins. Clinically significant recanalization was achieved in 81% (90 of 112) of the treated limbs; complete recanalization was achieved in 28% (31 of 112) and partial recanalization was achieved in 53% (59 of 112). Minor bleeding occurred in 14 (13%) patients, but none of the patients suffered from major bleeding or symptomatic pulmonary embolism. During follow-up (mean: 15.2 months, range: 3-24 months), the veins were patent in 74 (67%) limbs. Thirty seven limbs (32%) showed progression of the stenosis with luminal narrowing more than 50%, including three with rethrombosis, while one revealed an asymptomatic iliac vein occlusion; 25 limbs (22%) developed mild post-thrombotic syndrome, and none had severe post-thrombotic syndrome. Valvular reflux occurred in 24 (21%) limbs.

Conclusion

Catheter-directed thrombolysis with a continuous infusion of low-dose urokinase combined with adjunctive iliac vein stenting is safe and effective for removal of the clot burden and for restoration of the venous flow in patients with non-acute lower extremity deep venous thrombosis.     

非急性胆囊炎并胆囊结石手术中肝脏损害的相关研究

目的探讨非急性胆囊炎并胆囊结石手术中对肝脏损害的影响。方法收入非急性胆囊炎合并胆结石患者30例作为观察组,同期胆囊结石需手术治疗患者30例作为对照组,检查两组患者术后肝功能情况以及病理情况。结果观察组ALT平均值为（38.62±8.42）U/L;AST平均值为（40.11±6.37）U/L;TBIL平均值为（18.428±5.429）μmol/L;对照组ALT平均值为（12.33±6.21）U/L;AST平均值为（18.45±5.42）U/L;TBIL平均值为（9.476±4.542）μmol/L;两组对比有统计学差别（P〈0.05）。结论非急性胆囊炎并胆囊结石手术后存在一定的肝脏损害。     

Processing prosodic boundaries in natural and hummed speech: an FMRI study

Speech contains prosodic cues such as pauses between different phrases of a sentence. These intonational phrase boundaries (IPBs) elicit a specific component in event-related brain potential studies, the so-called closure positive shift. The aim of the present functional magnetic resonance imaging study is to identify the neural correlates of this prosody-related component in sentences containing segmental and prosodic information (natural speech) and hummed sentences only containing prosodic information. Sentences with 2 IPBs both in normal and hummed speech activated the middle superior temporal gyrus, the rolandic operculum, and the gyrus of Heschl more strongly than sentences with 1 IPB. The results from a region of interest analysis of auditory cortex and auditory association areas suggest that the posterior rolandic operculum, in particular, supports the processing of prosodic information. A comparison of natural speech and hummed sentences revealed a number of left-hemispheric areas within the temporal lobe as well as in the frontal and parietal lobe that were activated more strongly for natural speech than for hummed sentences. These areas constitute the neural network for the processing of natural speech. The finding that no area was activated more strongly for hummed sentences compared with natural speech suggests that prosody is an integrated part of natural speech.     

奎硫平合并丙戊酸镁治疗老年精神分裂症急性期的对照研究

目的:观察用奎硫平合并丙戊酸镁与单用奎硫平治疗老年精神分裂症急性期的疗效与安全性。方法:将58例老年精神分裂症患者随机分为研究组(奎硫平合并丙戊酸镁组)29例,对照组(奎硫平组)29例,疗程2周。分别于治疗1周末、2周末,用阳性与阴性症状量表(PANSS)及外显攻击行为量表(MOAS)评定治疗效果;用副反应量表(TESS)评估不良反应。结果:在治疗2周末,两组临床疗效差异无统计学意义(P>0.05)。在治疗1周末、2周末,PANSS量表兴奋激越项目评分研究组与对照组比较均有统计学意义(P<0.05);2周末,PANSS量表总分有统计学意义(P<0.05)。在治疗1周末、2周末MOAS量表与治疗前比较两组均有统计学意义(P<0.01);两组间比较,2周末有统计学意义(P<0.01)。治疗后各组TESS量表评分均无显著性(P>0.05)。结论:奎硫平合并丙戊酸镁治疗老年精神分裂症急性期起效快、疗效佳、安全性好。     

非急性心肌梗死ST段抬高的临床意义

心电图ST段抬高主要见于急性心肌梗死,但心电图ST段抬高还可以在其它情况出现。本综述的目的是描述其他心电图上类似心肌梗死的ST段抬高的各种情况,找出与之区分的线索。     

多普勒评价PCI对近期心肌梗死患者左室结构和功能的影响

目的：评价经皮冠状动脉介入治疗(PCI)术对近期S—T段抬高心肌梗死(STEMI）患左心室结构和功能的影响。方法：51例已确诊为近期STEMI的患，全部行冠状动脉照影检查，25例行梗死相关动脉(IRA)PCI术，其后予以常规药物治疗，26例未行介入治疗直接进行药物治疗；术前或用药前应用多普勒超声测量ESV、EDV、LVEF、WMAS、E、A、E／A、Ei、Ai、Ei／A、SV等指标，并随访3个月，进行复查。结果：介入治疗组术后3个月ESV、EDV、WMAS、Ai较术前分别下降了26．5％(P＜0．01)、15．6％(P＜0．01)、41％(P＜9．01)、26．6％(P＜0．05)，LVEF、Ei／Ai较术前提高了17．8％(P＜0．01)、35．6％(P＜0．01)。对照组随访3个月，ESV、EDV分别较初期提高了10．8％、9．6％(P均＜0．05)，IVEF降低了10．0％(P＜0．05)，两组问Ai、Ei／Ai、ESV、EDV、LVEF、WMAS均有非常显差异(P均＜0．01)。结论：PCI术可改善近期心肌梗死患的左室功能及预后。     

补肾方与调肝方对月经模型小鼠子宫内膜增殖期、分泌期影响的比较研究

目的:探讨补肾方与调肝方对小鼠月经模型子宫内膜增殖期和分泌期的影响。方法:采用激素序贯法复制雌性C57BL/6J小鼠月经模型。检测血清雌、孕激素(E2、P)含量、子宫系数、免疫组化法检测子宫角ER-α、PR以及VEGF的表达。结果:与假手术组比较,模型组子宫系数、E2、P的含量,ER-α、PR与VEGF蛋白表达显著增强(P0.05);与模型组比较,给药各组血清激素均呈不显著性增加(P0.05);给药组子宫系数均增加(P0.05);ER(ER-α)、PR与VEGF的表达在T1点调理肝肾组、补肾组高于调肝组(P0.05),在T2点调理肝肾组高于补肾组与调肝组(P0.05)。结论:调理肝肾按月经周期用药较单一补肾或调肝更能有效调整子宫内膜增值期和分泌期的状态和功能,其作用机制不是增加血清中E2、P的含量,而是与上调ER-α、PR以及VEGF的表达有关。     

颅内动脉瘤破裂急性期与非急性期手术治疗效果研究

目的比较急性期及非急性期手术治疗颅内动脉瘤破裂的临床效果。方法共收集2012年5月~2014年7月来我院就诊的颅内动脉瘤破裂患者176例,将患者按照治疗的不同时间分为两组,急性期手术组91例,手术治疗时间为发病后0~3 d内,非急性期手术组85例,手术治疗时间为发病3 d后。两组患者均行动脉瘤夹闭术。比较两组术前再出血率、术中完全夹闭率、术后常见并发症情况、预后情况。结果 (1)急性期手术组患者的术前再出血率(1.10%)与非急性期手术组(9.41%)比较明显较低,术中完全夹闭率(92.31%)与非急性期手术组(81.18%)比较明显较高,差异有统计学意义(P<0.05)。(2)急性期手术组术后脑梗死发生率(13.19%)、术后脑积水发生率(8.79%)较非急性期手术组(5.88%、4.71%)高,但差异不具有统计学意义(P>0.05)。(3)急性期手术组预后良好率(73.63%)与非急性期手术组(69.41%)比较较高,但差异不具有统计学意义(P>0.05)。结论急性期手术治疗颅内动脉瘤破裂患者可明显降低术前再出血率,提高术中完全夹闭率,明显降低患者由于再出血导致的死亡致残率,有利于疾病早期康复。     

症状性颅内前循环大动脉非急性闭塞血管内治疗的可行性分析

目的 评估血管内治疗症状性颅内前循环大动脉非急性闭塞的可行性及有效性。 方法 回顾性分析2016年1月-2019年10月青岛大学附属医院神经内科采用血管内治疗的颅内前循环 大动脉非急性闭塞患者的临床资料。评价血管内治疗的血管再通率、术后并发症、临床预后,并随访 患者血管再狭窄及卒中复发情况。 结果 共纳入22例患者,血管内治疗后,20例（90.9%）患者闭塞的血管成功再通,术后并发症3例 （13.6%）,其中1例为术中蛛网膜下腔出血,1例为术后出血转化,1例术后出现癫痫发作;血管再通的 患者中单纯球囊扩张术治疗7例,中位血管残余狭窄率为12.4%（8.6%～20.5%）,球囊扩张+自膨式支 架治疗10例,中位血管残余狭窄率为10.4%（6.2%～17.8%）,两种治疗方法的血管残余狭窄率差异无 统计学意义。血管成功再通患者出院时临床症状改善8例（40.0%）,无明显变化12例（60.0%）,无症 状加重患者。术后随访时间为19（12～29）个月,mRS评分良好者12例（60.0%）,1例（5.0%）再发TIA, DSA显示支架内再狭窄,给予球囊扩张术治疗后症状好转。 结论 血管内治疗症状性颅内前循环大动脉非急性闭塞是安全可行的,能够改善患者的缺血症状, 并且术后卒中复发率较低。     

医院下呼吸道感染致病菌及其耐药性监测结果分析

目的探讨医院下呼吸道感染的细菌学及药敏状态,促进临床合理使用抗生素。方法将1218例下呼吸道感染患者的痰进行细菌培养和药物敏感试验。结果1218例标本中检出细菌589株。其中革兰氏阴性肠杆菌占42.28%,革兰氏阴性非发酵菌占24.62%,真菌占24.28%,革兰氏阳性菌占8.83%。主要致病菌依次为大肠埃希菌、铜绿假单胞菌、白假丝酵母和肺炎克雷伯菌,对绝大多数抗生素耐药。结论随着抗生素的广泛使用,细菌耐药性逐渐上升。有关部门应加强监测,指导临床合理用药。