支气管动脉灌注化疗与栓塞治疗中晚期肺癌的疗效观察

目的：对比分析支气管动脉灌注化疗与支气管动脉灌注化疗十栓塞术治疗中晚期肺癌的临床疗效。方法：将我院2011年1月-2013年1月期间收治的76例中晚期肺癌患者随机分为两组,即观察组38例,对照组38例。观察组患者行支气管动脉灌注化疗联合栓塞术治疗,对照组患者行单纯支气管动脉灌注化疗治疗。分别对两组患者治疗后的临床治疗效果进行评价,同时观察两组患者治疗后的不良反应及并发症的发生情况。结果：观察组患者临床治疗的总有效率为84．21％,对照组为64．78％．两组比较,差异具有统计学意义（P〈0．05）。两组患者治疗后,观察组患者总不良反应率为23．67％,对照组为21．04％,两组比较．差异无统计学意义（P〉0．05）。且经对症处理后,均得到有效改善。结论：支气管动脉灌注化疗联合栓塞术治疗中晚期肺癌的,临床疗效明显优于单纯支气管动脉灌注化疗,且无明显不良反应及并发症的发生,安全性好,值得临床推广与应用。     

Systemic embolisation as presentation and recurrence of cardiac myxoma two years after surgery

Primary cardiac tumours are rare when compared with metastatic involvement. The majority of primary cardiac tumours are benign and in adults the majority of these masses are myxomas. The treatment is surgical removal because of the risk of embolisation and/or cardiovascular complications. We describe a female presenting with systemic embolisation and recurrence of cardiac myxoma after surgery. Recurrence of myxoma is rare after surgery in case of solitary tumours but more frequent in patients with familial myxomas in association with the Carney complex. Genetic analysis revealed a mutation in the PRKAR1A gene that has never been described before. (Neth Heart J 2010;18:499-502.)     

栓塞和夹闭治疗对颅内动脉瘤患者认知功能的影响

目的:评估血管内栓塞治疗和显微手术夹闭两种治疗方法对颅内动脉瘤患者认知功能的影响。方法:选取2014年3月至2015年9月重庆市中医院神经外科收治的颅内动脉瘤患者80例,按随机数字表法分为对照组和实验组各40例,对照组采用显微手术夹闭治疗,实验组采用血管内栓塞治疗。应用简易精神状态检查量表(MMSE)评估术后认知功能,并对比两组住院时间、院内死亡率和1年死亡率以及术后不良反应发生率。结果:实验组MMSE总分为(26.78±0.85)分,高于对照组的(22.25±0.63)分(P0.05);实验组认知功能障碍率为37.50%,低于对照组的55.00%(P0.05);实验组住院时间为(6.7±3.9)天,低于对照组的(9.6±4.5)天(P0.05),两组院内死亡率和1年死亡率比较无统计学差异(P0.05);两组术后不良反应发生率比较无统计学差异(P0.05)。结论:血管内介入治疗可改善颅内动脉瘤患者治疗后的认知功能,缩短住院时间。     

肾病综合征合并肺栓塞的临床研究进展

肾病综合征是一种临床常见疾病,其患者体内常呈高凝状态,极易发生血栓栓塞事件,而其中以肾静脉血栓、肺动脉栓塞和 下肢深静脉血栓最为常见。由于肺动脉栓塞早期缺乏特征性的临床表现,病情隐匿,所以极易误诊或漏诊,发现时患者病情往往 已十分严重,致死率极高。目前,对于肾病综合征合并肺栓塞的发生率国内外报道不一,尚无准确的流行病学资料,而对于其发病 原因、危险因素、早期诊断及是否需要预防性抗凝治疗等均存在争议,本文主要结合文献对肾病综合征合并肺栓塞的流行病学、 病因及发病机制、诊断、高危因素和治疗进行了综述,尤其是对目前争议较大的肾病综合征合并肺栓塞患者是否需要早期抗凝治 疗。     

Low-dose intravenous nitrite improves hemodynamics in a canine model of acute pulmonary thromboembolism

Acute pulmonary thomboembolism (APT)-induced pulmonary hypertension can be counteracted by activating the nitric oxide (NO)-cGMP pathway. Recent studies have demonstrated that the naturally occurring anion nitrite (NO₂^-) is a bioactive storage reservoir for NO, and is reduced to NO under conditions of hypoxia and acidosis. We hypothesized that nitrite infused intravenously could attenuate the hemodynamic changes associated with APT. APT was induced with autologous blood clots injected into the right atrium in mongrel dogs. After APT (or saline), the dogs received an intravenous nitrite (or saline) infusion (6.75 μmol/kg over 15 min and then 0.28 μmol/kg/min) and hemodynamic evaluations were carried out for 2 h. Plasma nitrite concentrations were measured using ozone-based reductive chemiluminescence methodologies. APT decreased cardiac index (CI) and increased pulmonary vascular resistance index (PVRI); these effects were improved during infusions of sodium nitrite. Accordingly, nitrite infusion increased cardiac index by 28%, reduced the PVRI by 48%, and the systemic vascular resistance index (SVRI) by 21% in embolized dogs, suggesting a greater effect on the ischemic embolized vascular system than the systemic circulation following embolization. Interestingly, in nonembolized control dogs the same nitrite infusion decreased MAP and CI (all P < 0.05). The nitrite infusion increased plasma nitrite concentrations by approximately 2 μM, and produced dose-dependent effects on PVRI, MAP, and SVRI. Remarkably, blood levels of nitrite as low as 500 nM decreased PVRI and SVRI in this model, suggesting a potential role of nitrite in physiological blood flow regulation. These results suggest that a low-dose nitrite infusion produces beneficial hemodynamic effects in a dog model of APT. These findings suggest a new therapeutic application for nitrite and support emerging evidence for a surprisingly potent and potentially physiological vasoactivity of nitrite.     

The relevance of xylem network structure for plant hydraulic efficiency and safety

The xylem is one of the two long distance transport tissues in plants, providing a low resistance pathway for water movement from roots to leaves. Its properties determine how much water can be transported and transpired and, at the same time, the plant's vulnerability to transport dysfunctions (the formation and propagation of emboli) associated to important stress factors, such as droughts and frost. Both maximum transport efficiency and safety against embolism have classically been attributed to the properties of individual conduits or of the pit membrane connecting them. But this approach overlooks the fact that the conduits of the xylem constitute a network. The topology of this network is likely to affect its overall transport properties, as well as the propagation of embolism through the xylem, since, according to the air-seeding hypothesis, drought-induced embolism propagates as a contact process (i.e., between neighbouring conduits). Here we present a model of the xylem that takes into account its system-level properties, including the connectivity of the xylem network. With the tools of graph theory and assuming steady state and Darcy's flow we calculated the hydraulic conductivity of idealized wood segments at different water potentials. A Monte Carlo approach was adopted, varying the anatomical and topological properties of the segments within biologically reasonable ranges, based on data available from the literature. Our results showed that maximum hydraulic conductivity and vulnerability to embolism increase with the connectivity of the xylem network. This can be explained by the fact that connectivity determines the fraction of all the potential paths or conduits actually available for water transport and spread of embolism. It is concluded that the xylem can no longer be interpreted as the mere sum of its conduits, because the spatial arrangement of those conduits in the xylem network influences the main functional properties of this tissue. This brings new arguments into the long-standing discussion on the efficiency vs. safety trade-off in the plants' xylem.     

Interrelationships between water use and growth traits in biomass-producing willows

Abstract Water use, drought response and growth were examined under controlled conditions in four interbreeding willow species from different geographical origins (two clones of Salix viminalis L., one clone of S. viminalis × S. schwerenii E. Wolf and one clone of S. purpurea L.). The levels of soil water depletion that plants could sustain without wilting varied markedly between the clones. The level of drought resistance expressed this way was positively related to resistance to xylem cavitation, negatively related to the maximum stomatal conductance, and positively related to early stomatal closure. The rate of stomatal closure, however, was negatively related to the resistance to xylem cavitation. Prior to drought, there were no significant differences between leaf-specific hydraulic conductances of the clones when whole plants were considered. However, there were differences if the roots and shoots were considered separately. Drought resistance was negatively related to maximum growth yields. This is probably because resources were diverted away from leaf production to the production of denser wood (wood density was positively related to cavitation resistance), and, for one clone, to the growth of a larger root system. In addition, because the level of drought resistance was negatively related to the maximum stomatal conductance, growth may have been adversely affected as a result of reduced photosynthesis. Given its high water extraction ability, one of the clones started to wilt sooner than expected, although only lateral shoots were affected. This appeared to indicate a strategy of sacrificing expendable shoots.     

Stem and leaf hydraulics of congeneric tree species from adjacent tropical savanna and forest ecosystems

Leaf and stem functional traits related to plant water relations were studied for six congeneric species pairs, each composed of one tree species typical of savanna habitats and another typical of adjacent forest habitats, to determine whether there were intrinsic differences in plant hydraulics between these two functional types. Only individuals growing in savanna habitats were studied. Most stem traits, including wood density, the xylem water potential at 50% loss of hydraulic conductivity, sapwood area specific conductivity, and leaf area specific conductivity did not differ significantly between savanna and forest species. However, maximum leaf hydraulic conductance (K _leaf) and leaf capacitance tended to be higher in savanna species. Predawn leaf water potential and leaf mass per area were also higher in savanna species in all congeneric pairs. Hydraulic vulnerability curves of stems and leaves indicated that leaves were more vulnerable to drought-induced cavitation than terminal branches regardless of genus. The midday K _leaf values estimated from leaf vulnerability curves were very low implying that daily embolism repair may occur in leaves. An electric circuit analog model predicted that, compared to forest species, savanna species took longer for their leaf water potentials to drop from predawn values to values corresponding to 50% loss of K _leaf or to the turgor loss points, suggesting that savanna species were more buffered from changes in leaf water potential. The results of this study suggest that the relative success of savanna over forest species in savanna is related in part to their ability to cope with drought, which is determined more by leaf than by stem hydraulic traits. Variation among genera accounted for a large proportion of the total variance in most traits, which indicates that, despite different selective pressures in savanna and forest habitats, phylogeny has a stronger effect than habitat in determining most hydraulic traits.     

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。     

Xylem dysfunction during winter and recovery of hydraulic conductivity in diffuse-porous and ring-porous trees

Xylem embolism in winter and spring as well as the occurrence of positive xylem pressure were monitored in several diffuse-porous and one ring-porous tree species (Fraxinus excelsior). In Acer pseudoplatanus and Betula pendula embolism reversal was associated with positive (above-atmospheric) xylem pressures that frequently occurred during a 2-month period prior to leaf expansion. In Acer high stem pressures were occasionally triggered on sunny days after a night frost. The other species investigated showed no positive xylem pressure during the monitoring period in 1995. Populus balsamifera exhibited a complete embolism reversal in 1994, but, like Fagus sylvatica, recovery was slow and incomplete in 1995. Fraxinus did not refill embolized vessels, but relied entirely on the production of new earlywood conduits in May. Populus × canadensis Moench robusta did not recover from embolism during the monitoring period. Under a simulated root pressure of 20 kPa however, excised branches of Populus × canadensis restored maximum hydraulic conductance within 2 days, illustrating the great influence of even small positive pressures on cnductivity recovery in spring. In the absence of positive pressure there was no substantial refilling of embolized vessels within a rehydration period of 9 days.