急诊介入栓塞治疗支气管动脉-肺动脉瘘大咯血的效果

目的:观察急诊介入栓塞治疗支气管动脉-肺动脉瘘大咯血患者的疗效,分析栓塞剂的选择及合理应用,为临床研究提供参考。方法:30例支气管动脉-肺动脉瘘大咯血患者采用急诊介入造影检查,使用丙烯酸微球和明胶海绵条对出血动脉行急诊栓塞治疗,对动脉造影表现及治疗结果进行回顾性分析。结果:共找到并成功栓塞42支出血的支气管动脉,28支采用单独丙烯酸微球栓塞治疗,14支行丙烯酸微球与明胶海绵条联合栓塞治疗。栓塞术后随访1年,所有患者栓塞术后均无再次咯血及严重并发症出现。结论:急诊动脉栓塞治疗支气管动脉-肺动脉瘘大咯血是一种安全、有效的微创治疗手段。合理的选择和使用栓塞剂是确保栓塞治疗成功的的关键。     

大咯血介入治疗失败的罕见原因：腹腔动脉系统参与供血（附2例报告及文献复习）

目的：咯血的主要责任血管是支气管动脉,非支气管性体动脉参与供血是大咯血介入治疗失败的重要原因,腹腔动脉系统分支动脉参与供血更为罕见。本文通过收集相关病例,结合国内外相关研究,提高对腹腔动脉系统分支动脉为咯血责任动脉的认识,探讨其可能的病理机制、危险因素。方法：回顾分析2例腹腔动脉系统分支（胃左动脉、肝左动脉）参与大咯血供血动脉的临床及影像学资料,并报道介入栓塞治疗的效果。结果：2例患者均为支气管动脉栓塞后再发大咯血,再次血管造影显示1例肝左动脉参与供血,1例胃左动脉参与供血。栓塞上述血管后,患者止血成功。病变位于下肺、伴有胸膜增厚,提示有腹腔动脉系统分支动脉参与供血的可能。术前仔细阅读患者影像学资料,术前行主动脉分支动脉CT血管成像,可减少对责任性非支气管性体动脉的遗漏。结论：腹腔动脉系统参与供血是介入栓塞治疗后咯血复发的少见原因,了解其病理机制、危险因素,及时进行栓塞,可以降低咯血的复发率。     

儿童颅面部血管瘤及血管畸形的DSA诊断及介入治疗分析

探讨儿童颅面部血管瘤及血管畸形的数字减影血管造影(DSA)诊断及介入治疗效果。选取2014年2月至2016年12月在我院治疗的颅面部血管瘤及血管畸形儿童32例,采用DSA诊断,并采用经皮股动脉穿刺插管行双侧颈外动脉造影栓塞,观察治疗效果。采用选择性DSA诊断儿童颅面部血管瘤及血管畸形的准确率为100%;介入治疗即刻疗效和术后6个月疗效比较差异无统计学意义(p0.05),术后6个月显效和有效比例分别为75.00%和21.88%;不同性别、年龄患儿介入治疗术后6个月疗效比较差异无统计学意义(p0.05);患者治疗前及治疗后TNF-α和IL-6差异比较无统计学意义(p0.05);患者治疗后VEGF浓度为(102.01±37.10)pg/m L,明显较治疗前降低(p0.05)。DSA在儿童颅面部血管瘤及血管畸形诊断中有较好的应用价值,是一种可靠有效的诊断方法;介入治疗有较好的效果,值得临床推广使用。     

支气管动脉栓塞术治疗肺结核大咯血的临床研究及分析

目的观察和评价支气管动脉栓塞术治疗肺结核大咯血的疗效。方法选择84例肺结核大咯血患者随机分成两组,A组(42例)常规治疗组,B组常规治疗组加支气管动脉栓塞治疗。结果全部咯血病例支气管动脉造影均有不同程度血管增生紊乱,典型者为扫帚状增生紊乱的血管束,严重者伴有肺内出血病灶。两组治疗成功率为A组71.4%,B组95.2%,两者之间差异有统计学意义(P0.05)。结论支气管动脉栓塞术治疗肺结核大咯血患者创伤小,且安全有效,在抢救大咯血方面具有实际意义,为控制大咯血提供了一种实用新途径。     

经股动脉导管介入支气管动脉栓塞救治难治性大咯血

目的：1996—3至2005—12期间我科与介入放射科合作,对66例内科方法未能止血的大咯血患者行支气管动脉介入栓塞术止血。观察分析止血效果及并发症。方法：患者在1250数字减影机下,经股动脉插入美国COOK公司生产的3—5FCobra导管。找到支气管动脉,造影后确定出血部位,在明确无栓塞禁忌症后,以明胶海绵粉末或PVA颗粒栓塞支气管动脉,观察止血状况及并发症。结果：总体止血率95．3％（61／64）,半年内9例复发咯血,但咯血量明显减小,复发率14．1％（9／64）。仅1例栓塞后未止血。2例动静脉瘘患者不能实行栓塞。15例出现发热,占23．4％（15／64）,所有患者均不同程度出现气短,吸氧后缓解。结论：支气管动脉栓塞救治难治性大咯血十分有效、可靠且较为安全。     

数字减影血管造影用于重症胰腺炎并发出血患者诊断及介入治疗

目的:探讨数字减影血管造影(DigitalSubtractionAngiography,DSA)诊断及介入治疗重症胰腺炎(Severe panreatitis,SP)并发出血的临床疗效。方法:回顾性分析2009年1月-2013年11月南京军区总医院收治的42例SP并发出血患者行动脉造影,发现出血征象时采用微钢圈配合明胶海绵栓塞或经导管灌注缩血管药治疗。观察选择性动脉造影对诊断出血部位及止血效果的价值。结果:通过造影42例患者中28例发现出血征象,出血阳性率为66.7%(28/42),25例通过超选择栓塞以控制出血,初次止血率89.2%(25/28)。6例栓塞后复发出血,再出血率为24.0%(6/25),4例再行栓塞成功,再止血成功率为66.7%,累计止血成功率为82.1%。3例栓塞后反复出血未能控制,死于多器官功能衰竭,1例栓塞后脾脓肿并行脾切除,1例栓塞后肠缺血。结论:DAS不仅可以快速诊断出血部位,还可以同时进行介入治疗,止血效果肯定。     

PVA颗粒超选择栓塞支气管动脉治疗急性大咯血

目的:探讨应用介入技术,超选择支气管动脉,行PVA颗粒栓塞治疗急性大咯血的治疗价值.方法:对我院2001年以来34例采用PVA颗粒栓塞的大咯血病人的术后反应.并发症发生情况及止血情况进行随访和回顾性分析.结果:所有病人均为一次性栓塞成功,术后随访时间长迭36个月,随访率达100%.除一例肺癌病人因咯血死亡外,未发现复发性咯血.术后病人出现胸部疼痛症状,短期内对证治疗可以缓解.未见明显并发症发生.结论:应用PVA颗粒栓塞支气管动脉是治疗急性大咯血的一种有效方法.     

三维DSA在颅内动脉瘤中的应用

目的探讨三维数字减影血管造影(3D DSA)在颅内动脉瘤中的应用价值。方法使用GE Innova 3100平板血管造影机对40例疑似颅内动脉瘤患者行双侧颈内、外动脉和双侧椎动脉正、侧位2D DSA,进一步对感兴趣血管行3D DSA,通过容积再现(VR)进行颅内血管重建。结果 3D DSA检出39例动脉瘤患者,47枚动脉瘤,2D DSA检出31例动脉瘤患者,35枚动脉瘤,二者检出动脉瘤的长、短径无统计学差异(P>0.05),图像质量有统计学差异(P<0.05)。2D DSA出现假阳性动脉瘤3枚,假阴性动脉瘤15枚,评估颅内动脉瘤的灵敏度为78.9%,特异性为85.2%;3D DSA没有出现假阳性、假阴性动脉瘤,评估颅内动脉瘤的灵敏度为100%,特异性为100%。在动脉瘤形态、瘤颈尺寸及与相邻血管间的关系的显示上,3D DSA明显优于2D DSA。结论 3D DSA作为脑动脉造影中2D DSA的进一步补充,对颅内动脉瘤的诊断与治疗具有重要价值。     

肠系膜上动脉栓塞临床表现及影像特征研究

目的:探讨肠系膜上动脉栓塞(superior mesenteric artery embolism,SMA embolism)临床及影像特征,以及时准确诊断从而改善病人预后。方法:搜集我院2011年7月至2014年8月临床诊断为SMA栓塞的患者24例,回顾性分析其临床及影像资料。结果:24例SMA栓塞发病年龄51~84岁,平均71.9±8.1岁;临床均表现为突发腹痛(24/24,100%),腹痛多持续不缓解(18/24,75%),少有放射痛(1/24,4.17%),多伴有恶心呕吐(16/24,66.67%)、腹泻便血(15/24,62.5%),体格检查多有肠鸣音亢进(19/24,79.17%),少有腹膜刺激征(2/24,8.33%)。多合并高血压(18/24,75%)、房颤(16/24,66.67%)、冠心病(14/24,58.33%)、心脏瓣膜病变(6/24,25%)及其他周围动脉栓塞(9/24,37.5%)。临床上符合SMA栓塞三联征中至少两项特征20例(83.33%),具备典型三联征13例(54.17%)。MSCTA或DSA均表现为SMA主干截断或充盈缺损(24/24,100%),栓塞位置多位于第1空肠动脉起始至回结肠动脉起始水平段(18/24,75%),栓塞远端分支血管多显影不良(23/24,95.83%),少有侧枝循环形成(3/24,12.5%)。MSCTA显示栓塞段血管密度多有增高(12/17,70.59%),少有管径增粗(3/17,17.65%)及脂肪间隙模糊(2/17,11.76%)。肠管多有缺血改变(15/17,88.24%),肠系膜多增粗模糊(15/17,88.24%),腹水少见(1/17,5.82%)。结论:SMA栓塞临床和影像具有一定的特征性,临床怀疑SMA栓塞应及早行MSCTA或DSA明确诊断。     

DynaCT对肝转移瘤介入治疗具有指导意义

为了探讨锥形束CT (DynaCT)在肝癌患者实施经导管肝动脉化疗栓塞(TACE)手术治疗中的指导作用、栓塞效果评估中的价值,本研究选取了2012年3月至2015年5月在本院实施TACE手术治疗的102例原发性肝癌或转移性肝癌患者进行研究。通过对102例患者病灶进行手术前螺旋CT检测、术中数字减影血管造影(DSA)及DynaCT检测,并对比DSA与DynaCT对肝癌病灶、供血动脉、术后栓塞效果的检测结果。本研究发现术前普通螺旋CT共计检出病灶105个,术中DSA检出病灶数目176个,DynaCT术中检出肿瘤病灶285个;DynaCT和DSA的平均检出病灶数目均显著的高于普通螺旋CT (p<0.05),DynaCT平均检出病灶数目均显著的高于DSA (p<0.05);DynaCT的病灶供血动脉检出率为86.67%,显著地高于DSA (55.68%)(p<0.05);DynaCT检出的285个病灶对栓塞效果评估结果与实际栓塞效果一致的有271个病灶(95.09%),DSA评估结果与实际结果一致的有138个病灶(78.41%),DynaCT对于TACE术后效果评估的一致性高于DSA (p<0.05)。本研究表明,DynaCT在肝癌患者实施TACE手术治疗中能够更有效的发现病灶,指导栓塞操作。     

Ectogenesis and the case against the right to the death of the foetus

Ectogenesis, or the use of an artificial womb to allow a foetus to develop, will likely become a reality within a few decades, and could significantly affect the abortion debate. We first examine the implications for Judith Jarvis Thomson’s violinist analogy, which argues for a woman’s right to withdraw life support from the foetus and so terminate her pregnancy, even if the foetus is granted full moral status. We show that on Thomson’s reasoning, there is no right to the death of the foetus, and abortion is not permissible if ectogenesis is available, provided it is safe and inexpensive. This raises the question of whether there are persuasive reasons for the right to the death of the foetus that could be exercised in the context of ectogenesis. Eric Mathison and Jeremy Davis have examined several arguments for this right, doubting that it exists, while Joona Räsänen has recently criticized their reasoning. We respond to Räsänen’s analysis, concluding that his arguments are unsuccessful, and that there is no right to the death of the foetus in these circumstances.     

On the diversity of the Cladocera in the tropics

The mythical concept of an impoverished tropical cladoceran fauna is refuted. On a planetary scale, around half of the cladoceran species presently known occur exclusively in the tropics-subtropics, often with considerable restriction to particular geographical subzones. On a regional (political) scale, the situation is often unclear because of the continued fragmentary nature of studies, and because political units are not a good basis for biogeographical comparisons. At the finest level of resolution (lake-perlake comparisons), there appears to be an upper limit of c. 50 cladoceran species per individual lake. No significant difference between lakes in the temperate zone and in the tropics could be established here. Daphnia is largely absent from the tropics, but is replaced by more Sidids, Moinids, and Bosminids, such that the average cladoceran community in the limnetic zone of a tropical lake is not characterized by less species but rather by lower population densities. This, in turn, is considered a consequence of higher prevalent predation levels in the tropics.     

Tubular networks in the terminal endings of the visual receptor cells in the human,the monkey,the cat and the dog

Summary A tubular network was found in the terminal endings of the visual receptor cells in the human, the monkey (Macaca mulatta), the cat and the dog. These tubules are arranged in close groups in the vicinity of the synaptic lamellae and the invaginated dendrites. According to the form, diameter, density of the tubules and to the consistence of the network formed by them one can distinguish at these places an initial type (type I), a transitory (type II) and a vesicular one (type III). In the the type III branching, bizarre forms are frequent. The diameter of all the tubules reaches 500–600 Å, their density and walls being the same as in the synaptic vesicles.Similar networks also occur in the axons of the visual receptor cells of the monkey.

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Zusammenfassung In den Endigungen der Photorezeptorzellen von Mensch, Affe (Macaca mulatta), Katze und Hund kommen aus Tubuli bestehende Komplexe vor. Organellenartig in geschlossenen Gruppen angeordnet, liegen sie in Nähe der synaptischen Lamellen und der invaginierten Dendriten. An diesen Stellen kann man nach Form, Durchmesser, Dichte und Konsistenz der von den Tubuli gebildeten Komplexe drei Typen unterscheiden: 1. einen initialen (Typus I), 2. einen Übergangstypus (Typus II) und 3. einen vesiculären Typus (Typus III). In letzterem kommen häufig verzweigte, bizarre Formen vor. Der Durchmesser sämtlicher Tubuli erreicht 500–600 Å. Ihre Dichte und ihre Wand gleicht denen der synaptischen Vesikel.Ähnliche Komplexe fanden wir auch in den Axonen der Photorezeptorzellen vom Affen.

     

Assessing the Physiological State of the Fucoids from the Barents Sea Littoral by the End of the Polar Night

Methods of amperometry and potentiometric titration were used to follow dark respiration (DR) and apparent photosynthesis (AP) in the fucoids Ascophyllum nodosum (L.) Le Jol, Fucus vesiculosus L., and F. serratus L. from the Barents Sea littoral by the end of the 40-day-long polar night. The macroalgae were shown to manifest species-specific low rates of photosynthesis and respiration. However, in spite of their low photosynthetic status due to the effects of subzero temperature and prolonged low or zero illumination, the macroalgae have been able to restore DR and AP to the initial level already by the day 9; the ability to restore AP depended on the level of illumination. The study of the changes in the carbonate–bicarbonate system in the light and darkness demonstrated that the macroalgae grown in darkness, in contrast to those grown in twilight, could absorb bicarbonate in darkness; however, they lost this capacity after two-day-long illumination at an irradiance of 7 mol/(m² s). Bicarbonate uptake in darkness and the capacity to restore the systems of photosynthesis and respiration in fucoid cells are discussed in the context of algal energy metabolism under the polar night conditions.     

Arranging the elements of the potassium channel: the T1 domain occludes the cytoplasmic face of the channel

The voltage-gated potassium channel is currently one of the few membrane proteins where functional roles have been mapped onto specific segments of sequence. Although high-resolution structures of the transmembrane portions of three bacterial potassium channels, the tetramerization domain and the cytoplasmic ball are available, their relative spatial arrangement in mammalian channels remains a matter of ongoing debate. Cryo-electron microscopic images of the six transmembrane voltage-gated Kv channel have been reconstructed at up to 18 Å resolution, revealing that the T1 domain tetramerizes and is suspended below the transmembrane segments. However, the resolution of these images is insufficient to reveal the location of the third piece of the puzzle, the inactivating ball domain. We have used the aberrant interactions observed in a series of chimæric channels to establish that an assembled T1 domain restricts access to the cytoplasmic face of the channel, suggesting that the N-terminal ball and chain may be confined in the space between the T1 domain and the transmembrane portion of the channel.     

Separation of the pineal vesicle from the wall of the third ventricle during the post-hatching development of the chicken

Summary According to light- and electron-microscopic observations the pineal organ of the 3-day-old chicken consists of a prominent end vesicle and a tapering parenchymal stalk. During this stage the pineal lumen is in open communication with the third ventricle. However, in the 40-day-old chicken, which still possesses a well-developed end vesicle, the proximal portion of the pineal stalk displays regressive changes leading to local fragmentation. At this stage the pineal stalk is reduced, and the pineal lumen is missing. In 1-year-old chickens the parenchyma of the proximal portion of the stalk is further diminished, and in 3-year-old domestic fowl is completely displaced by bundles of collagenous fibers, only some nerve fibers being present. This post-hatching pineal development may reflect the sequence of changes leading from pineal sense organs to pineal glands.This work was supported by a grant-in-aid for Scientific Research from the Ministry of Education, Science and Culture of Japan     

On the Dependence of the Quadratic Risk of the Classical Predictor and the Prediction-Horizon

When constructing predictors on the basis of the linear model of time series of various indicators often the question arises on the dependence of forecasting accuracy and the changing prediction horizon. The dependency of the quadratic risk of the classical predictor and the time horizon is considered.     

中国植物区系与其它地区区系的联系及其在世界区系中的地位和作用

基于吴征镒将中国全部种子植物３２３８个属的分布区划分为１５个大类型和３４个变型的基础上,简要地讨论了中国植物区系与其它地区区系的联系,以及它在被子植物起源方面的作用。主要论点如下：（１）与热带亚洲区系的联系。这种联系主要通过第７类型（热带亚洲分布）及其５个变型来体现的。本文列举了１０个科,龙脑香料、狭义隐翼科、交让木科、五隔草科、五列木科、肉实树科、心翼果科、八宝树科、兰花蕉科和四数木科,来说明这