封堵器治疗房间隔缺损和动脉导管未闭的疗效评价

目的研究非常规方法选择Amplatzer治疗房间隔缺损及动脉导管未闭的可行性。方法14例II孔型ASD和1例动脉导管未闭,经术中常规右心导管检查,测量右室与肺动脉压力,经导引钢丝导入球囊导管测AS最大伸展直径,用体表经胸超声心动图(TTE)或经食管超声(TEE)测量房间隔直径及确定ASD的位置及大小,根据球囊最大伸展直径选择应用等于或大于其1～2mm型号的国产ASD和PDA封堵器。结果15例患者应用15个封堵器均获成功,成功率为100%,无并发症,亦无残余分流。结论国产封堵器具有操作简便、效果可靠、成功率高、安全等优点,应用封堵器封堵ASD和PDA是安全有效的。     

成人房间隔膨出瘤及合并畸形彩色多普勒超声心动图特征和规律性研究

目的:探寻成人房间隔膨出瘤(IASA)及合并畸形彩色多普勒超声心动图(CDE)的特征和规律性.材料和方法:应用CDE检查38例成人IASA及合并畸形,在经胸超声心动图检查之后22例又行经食管超声心动图检查,26例行心导管检查,20例行房间隔缺损(ASD)封堵术,8例行合并畸形手术治疗.结果:根据CDE特征对38例成人IASA及合并畸形全部做出正确诊断.成人IASA及合并畸形CDE特征和规律性明显:①在二维超声心动图(2DE)心尖四腔心切面、胸骨旁四腔心切面和剑下四腔心切面显示房间隔中部变薄,局部凸向右心房,并随心动周期摆动.② IASA合并畸形者多见(94.7%),孤立性IASA少见(5.3%).在合并的畸形中ASD多见(80.0%),其次是室间隔缺损(5.3%)和房间隔卵圆孔未闭(5.3%),还有主动脉瓣狭窄和主动脉窦瘤破裂等,但少见.③孤立性IASA患者2DE显示各心腔内径正常;合并ASD患者2DE显示右心房、右心室内径增大,彩色多普勒血流显像(CDFI)显示过房间隔左向右五彩镶嵌分流束血流信号;合并室间隔缺损2DE显示左心房内径增大,CDFI显示过室间隔左向右五彩镶嵌分流束血流信号.④经胸超声心动图很难准确显示IASA合并ASD的数目、大小和位置;经食管超声心动图可准确显示IASA合并ASD的数目、大小和位置.结论:CDE对成人IASA及合并畸形有特异性诊断价值.应用CDE明确判断合并畸形比诊断IASA更重要;应用经食管超声心动图诊断合并畸形ASD比经胸超声心动图更具有临床价值.     

彩色多普勒血流显像经胸超声心动图对室间隔缺损介入封堵治疗的价值

 目的探讨彩色多普勒血流显像(Color doppler flow imaging,CDFI)经胸超声心动图(Transthoraic echocardiogram,TTE)在室间隔缺损(Ventricular septal defect,VSD)介入封堵术前、术中及术后的应用价值.方法首先使用CDFI经胸超声心动图扫查选择适合做封堵术的VSD患者,然后监测导管引导Amplatzer封堵器治疗VSD的全过程,在监测过程中认真观察导管及封堵器的位置,配合封堵器的释放,观察封堵器是否已封堵好室间隔缺损处,周边有无残余分流.结果 CDFI经胸超声心动图扫查选择VSD 11例,均为膜部缺损.除1例因VSD上缘距主动脉瓣右冠瓣1.9～2.0mm,缺损口6.0 mm,并有胸骨畸形,封堵术改为经胸手术外,其余10例封堵成功,CDFI未见残余分流.结论 CDFI经胸超声心动图扫查对VSD封堵适应证的选择,封堵术中监测及封堵术后判断及追访均有着重要价值.     

经导管封堵外科结扎术后再通的动脉导管未闭

目的：评价经导管封堵外科结扎术后再通的动脉导管未闭（PDA）的效果。方法：1995年6月至2000年11月，14例外科结扎术后再通的PDA患者进行了经导管封堵术，男5例，女9例，年龄4－48岁，平均13岁。外科手术至介入治疗的时间为1个月至22年。经股静脉途径置入Amplatzer封堵器和Rashkind封堵伞，经股动脉途径置入可控弹簧圈。分别于术后24h ,1,3,6个月及1年以上行X线胸片和超声心动图随访。结果：再通PDA为漏斗型12型，管型2例。动脉导管最窄处直径为1－8mm，平均4mm。封堵后10min，主动脉弓降部造影示无残余分流11例，微量残余分流3例。技术成功率100％，无并发症。术后24h 声心动图检查均无残余分流，所有患者均于术后1-2d出院，10例随访1－18个月，未发现封堵器移位及PDA残余分流。结论：经导管封堵外科结扎术后再通的PDA是一种有效方法，可以替代外科二次手术。     

16层螺旋CT血管分析技术在动脉导管未闭显示中的应用价值

目的:探讨16层螺旋CT血管分析技术在动脉导管未闭显示中的应用价值。方法:回顾性分析12例经手术或心血管造影证实的动脉导管未闭16层螺旋CT血管分析技术显示的检查结果,并与手术或心血管造影结果及超声心动图结果对照。结果:16层螺旋CT血管分析技术能清晰直观显示动脉导管未闭的直接CT征象及类型,诊断符合率为100%;并可拉直测量导管的内径和长度,诊断符合率分别为91.67%和83.33%;在诊断动脉导管未闭的程度方面与超声心动图无明显差异,在诊断动脉导管未闭的类型方面优于超声心动图。结论:16层CT与超声心动图检查相结合,可大大提高对动脉导管未闭的诊断准确率,减少有创的心血管造影检查,以指导手术。     

房间隔膨出瘤及合并畸形彩色多普勒超声心动图特征及规律性研究

目的：探寻房间隔膨出瘤（IASA）及合并畸形彩色多普勒超声心动图（CDE）特征及规律性。方法：应用CDE检查32例IASA,在经胸超声心动图（TTE）检查之后18例又行经食管超声心动图（TEE）检查。10例行合并畸形房间隔缺损（ASD）封堵术,16例行合并畸形手术治疗。结果：根据CDE特征对32例IASA及合并畸形全部做出正确诊断。IASA及合并畸形CDE特征及规律性明显：①二维超声心动图（2DE）心尖四腔心切面、胸骨旁四腔心切面和剑下四腔心切面显示房间隔中部变薄,局部向右心房或左心房凸出,并随心动周期摆动;②IASA多并畸形,在合并畸形中ASD（84.4%）多见,其次是室间隔缺损（12.5%）和房间隔卵圆孔未闭（6.3%）,还有法乐三联症、法乐四联症、室间隔完整的肺动脉闭锁和主动脉瓣狭窄等,但少见;③孤立性IASA患者2DE显示心腔内径正常;合并ASD患者2DE显示右心房、右心室内径增大,彩色多普勒血流显像显示过房间隔左向右五彩镶嵌分流束血流信号;合并室间隔缺损2DE显示左心房内径增大,彩色多普勒血流显像显示过室间隔左向右五彩镶嵌分流束血流信号;④TTE很难准确显示IASA合并ASD的数目、大小和位置;TEE可准确显示IASA合并ASD的数目、大小和位置;⑤IASA女性（75．0％）明显多于男性（25．0％）。结论：CDE对IASA有特异性诊断价值。应用CDE明确判断合并畸形比诊断IASA更重要;应用TEE判断合并畸形ASD比TTE更具有特异性诊断价值。     

单静脉入路Amplatzer封堵器治疗动脉导管未闭

目的　探讨单静脉入路Amplatzer封堵器治疗动脉导管未闭的有效性、安全性及并发症。方法　9例,动脉导管未闭,瘤变最窄处直径为2 .4～8(5 .0 6±3.38)mm。经股静脉建立右房-右室-肺动脉-动脉导管-主动脉轨道,主动脉弓降部侧位造影观察PDA的位置、形态、大小,选择合适型号的Amplatzer伞经股静脉建立的轨道进行封堵。术后15min经胸超声及心脏听诊判断有无分流。术前、术后均行血流动力学测定,术后3d、1个复查超声心动图,观察大动脉水平有无分流及动脉导管未闭再通。结果　9例患者全部一次封堵成功,技术成功率10 0 %。心导管检查测肺动脉收缩压由术前轻度增高(33.2±3.11mmHg)降为正常(2 1.4±2 .7mmHg)。术后即刻所有患者心前区双期连续性杂音消失,术后15min彩超检查有1例少量分流,3d后分流消失,操作透视时间7.3～11.2 (9.2±1.7)min。无任何并发症发生,随访1个月未发生动脉水平分流及动脉导管再通。结论　单静脉入路Amplatzer封堵器治疗动脉导管未闭简化了手术程序,减少了血管并发症,缩短了操作透视时间,手术成功率高,疗效可靠,值得推广应用     

房间隔膨出瘤合并畸形的彩色多普勒超声心动图特征及规律性研究

目的：探寻房间隔膨出瘤（IASA）合并畸形的彩色多普勒超声心动图（CDE）特征及规律性。方法：应用CDE检查32例IASA,在经胸超声心动图（TTE）检查之后18例又行经食管超声心动图（TEE）检查。10例行合并畸形房间隔缺损（ASD）封堵术,16例行合并畸形手术治疗。结果：根据CDE特征对32例IASA及合并畸形全部做出正确诊断。IASA及合并畸形CDE特征及规律性明显：①二维超声心动图（2DE）心尖四腔心切面、胸骨旁四腔心切面和剑下四腔心切面显示房间隔中部变薄,局部向右心房或左心房凸出,并随心动周期摆动;②IASA多并畸形,在合并畸形中ASD（84．4％）多见,其次是室间隔缺损（12．5％）和房间隔卯圆孔未闭（6．3％）,还有法乐三联症、法乐四联症、室间隔完整的肺动脉闭锁和主动脉瓣狭窄等,但少见;③孤立性IASA患者2DE显示心腔内径正常;合并ASD患者2DE显示右心房、右心室内径增大,彩色多普勒血流显像显示过房间隔左向右五彩镶嵌分流束血流信号;合并室间隔缺损2DE显示左心房内径增大,彩色多普勒血流显像显示过室间隔左向右五彩镶嵌分流束血流信号;④TIE很难准确显示IASA合并ASD的数目、大小和位置;TEE可准确显示IASA合并ASD的数目、大小和位置;⑤IASA女性（75．0％）明显多于男性（25.0％）。结论：CDE对IASA有特异性诊断价值。应用CDE明确判断合并畸形比诊断IASA更重要;应用TEE判断合并畸形SD比TIE更具有特异性诊断价值。     

国产封堵器经导管介入治疗巨大房间隔缺损的疗效

 目的 探讨使用国产封堵器介入治疗巨大房间隔继发孔缺损(atrial septal defect ,ASD) 的可行性和安全性.方法 经胸/经食管彩色多普勒超声心动图证实巨大ASD患者62例,在经胸超声心动图及X线透视监护下,根据ASD边缘不足情况分别制定封堵策略,选用国产封堵器行介入封堵治疗,记录围术期并发症,随访复查7 d、6个月、18个月经胸多普勒超声心动图、心电图和胸片和临床事件(心包填塞、心脏破裂、血栓、感染性心内膜炎和死亡).结果 56例巨大继发孔ASD经导管封堵成功,成功率90.3%.6例患者试封堵失败,根据分型分别为后缘并下腔静脉缘不足型3例,主动脉缘并下腔静脉缘不足型3例.围术期并发症包括封堵器脱落2例、房间隔残缘断裂1例,3例患者均行外科手术、取出封堵器/房间隔补片修补术.一过性ST段抬高和一过性黑矇各1例.术中及随访期间无临床事件发生.结论 巨大ASD 可以行介入封堵治疗,国产封堵器介入封堵巨大房间隔缺损患者安全、有效、并发症少、费用低,可作为有封堵适应证患者的首选方案.     

经食管超声心动图和经胸超声心动图在房、室间隔缺损封堵术中的应用价值

目的 探讨经食管超声心动图(TEE)和经胸超声心动图(TTE)引导Amplatzer封堵器堵闭继发孔型房中隔缺损(ASD)、膜周部室中隔缺损(VSD)的应用价值。方法 术前经TEE筛选符合条件的28例继发孔型ASD，2例膜周部VSD患者，测量ASD的位置、大小及其与周围的关系，VSD的大小位置，在TFE引导下，以球囊测量ASD的最大伸展径，DSA下以造影测量VSD的大小，选择适当型号的封堵器，经导管堵闭ASD和VSD．结果 术前TEE所测的ASD直径11mm～36mm，术中TTE测得ASD的最大伸展径14mm～38mm．前者均小于后者，选择的封堵器的直径为14mm～40mm,28例中，除1例术中转为外科手术治疗，1例未封堵外，余26例均封堵成功，术后即刻、24h、3个月、6个月TTE随访复查均无残余分流及其他并发症。2例VSD术前TEE测量的直径分别为9mm，15mm，术中造影测得的大小为10mm，15mm，两者高度相关。结论 超声引导下经导管置入Amplatzer封堵器治疗ASD，VSD是一种安全、快捷、有效的非手术治疗方法。     

Physiologic and pathologic calcifications and ossifications in the face and neck

The aim was to give a systematic presentation of physiologic and pathologic calcifications and ossifications in the face and neck with a special emphasis on clinical relevance. In a sometimes subacute setting one should recognize specific calcifications which often lead to important diagnoses such as fungal sinusitis or sclerosing labyrinthitis. In a more chronic situation intraocular calcifications in small children are pathognomonic for retinoblastoma. Juxtatumoral sclerosis of the laryngeal cartilage in laryngopharyngeal carcinoma is usually caused by tumor infiltration of the cartilage resulting in a higher tumor stage and, this way, has a major impact on the therapeutical strategy. Calcified lymph nodes are mainly unspecific but can be the result of tuberculosis or metastases of thyroid cancer. Cross-sectional imaging methods, most of all computed tomography, are ideally suited to reveal head and neck calcifications and ossifications, especially those which are clinically relevant.     

Head and neck infection and inflammation

This article discusses the imaging manifestations of infectious and inflammatory conditions of the head and neck. Special attention is paid to the sites, routes of spread, and complications of neck infections. Because the clinical signs and symptoms and the complications of these conditions are often determined by the precise anatomic site involved, anatomic considerations are stressed. Familiarity with the fascial layers, spaces of the neck, and the contents of each space is helpful for this discussion. The fascial layers of the neck are important barriers to infection, and once infection is established, the fascial layers play a part in directing its spread.     

幽门螺杆菌分泌与重组表达的VacA蛋白的分离纯化及其致细胞空泡效应与凋亡的对比研究

目的：分离纯化幽门螺杆菌分泌和重组表达的细胞空泡毒素抗原（ VacA）蛋白,并评价其致细胞空泡效应及致细胞凋亡效应。方法分别从幽门螺杆菌ATCC26695菌株培养上清和重组表达VacA蛋白的pQE30-VacA-E．coliM15基因工程菌中分离纯化VacA蛋白,经酸化后,以不同终浓度（5,10 ng／ml）分别与人胃腺癌AGS细胞共孵24 h,观察致空泡效应,并通过流式细胞术检测细胞凋亡。结果成功分离纯化出幽门螺杆菌分泌和重组表达的VacA蛋白;幽门螺杆菌分泌的VacA蛋白能显著引起AGS细胞的空泡样改变及凋亡（P＜0．01）,而重组表达的VacA蛋白致细胞空泡样改变及凋亡不显著（ P＞0．05）。结论幽门螺杆菌分泌的VacA蛋白有良好的空泡毒性及致凋亡效应,而重组表达的VacA蛋白无致空泡及凋亡效应,幽门螺杆菌分泌的VacA蛋白可用于VacA作用机制的研究。     

化学和生物学融合对国际武器公约履约的影响

化学武器公约（ CWC）和生物武器公约（ BWC）是为禁止生产、发展、储存和使用化学武器和生物武器而制定的国际公约。近年来,科学技术快速发展,知识交叉渗透,学科之间出现整合和融合,促进了科技进步和经济发展。其中化学和生物学融合在有力促进制药、健康卫生、绿色化学和环境保护等产业进步的同时,也对化学和生物武器公约的履约产生了重要的影响。该文综述了与化学武器和生物武器公约相关的化学和生物学融合进展,并分析其对公约履约的影响。     

Oxygen uptake and ventilation during rowing and running in females and males

This study evaluated if the ventilatory response to exercise is impaired by the cramp position of rowing. Maximal oxygen uptake (VO2max), maximal expiratory volume (VEmax), and maximal heart rate (HRmax) during rowing and running were compared in 55 males (age, mean +/- SD, 21 +/- 3 years; height 176 +/- 5 cm; body mass 72 +/- 6 kg) and 18 females (age 20 +/- 2 years; height 164 +/- 5 cm; body mass 61 +/- 4 kg). VEmax was larger during rowing than during running (males, 157 +/- 16 vs. 147 +/- 13 L min(-1); 114 +/- 9 vs. 105 +/- 11 L min(-1), P<0.01). Also VO2max was larger during rowing than during running (males, 4.5 +/- 0.5 vs. 4.3 +/- 0.4 L min(-1); females, 3.3 +/- 0.4 vs. 3.2 +/- 0.4 L min(-1), P<0.01). However, HRmax was lower during rowing than during running (males, 194 +/- 8 vs. 198 +/- 11 beats min(-1); females, 192 +/- 6 vs. 196 +/- 8 beats min(-1), P<0.05). VEmax was correlated to body mass and fat-free mass, as was VO2max. Thus, the oxygen pulse (VO2max/HRmax) was larger during rowing than during running, while the ventilatory equivalent for oxygen (VEmax/VO2max) was similar. We showed that bending the body during rowing does not seem to impair ventilation either in males or in females. The results indicate that VEmax and VO2max relate to body size and fat-free mass for both females and males. The findings indicate that the involvement of more muscles, the entrainment, and the body position during rowing facilitates ventilation and venous return and lowers maximal heart rate.     

Coracoclavicular and coracoacromial ligament calcification and ossification

Thirty-six patients with calcification or ossification at or around the coracoclavicular and coracoacromial regions were analyzed with regard to type, location, and configuration of the deposits and related clinical history. Calcification or ossification in the coracoclavicular region resulted largely from trauma (36%) or renal failure (28%). Trauma patients may develop punctate calcification or ossification but do not develop the tumoral type of calcification. About 5% of the renal failure patients had coracoclavicular ligament calcifications, one-half of which were of the tumoral type. Renal failure patients may have punctate or tumoral calcifications but do not develop ossification.     

CLIP相关技术的研究进展

在真核生物基因表达的转录后调节中,RNA结合蛋白（ RBP）起着关键作用,很多RBP的异常与人类疾病的发生密切相关。自2000年的RNA免疫沉淀和芯片分析方法（ RNA immunoprecipitation with differential display or microarray analysis , RIP-ChIP）出现以来,人们开始就RBP与RNA相互作用进行了系统而广泛的研究。经过改良和发展,基于体内实时紫外交联免疫沉淀法（ ultraviolet crosslinking and immunoprecipitation , CLIP ）、交联免疫沉淀cDNA文库高通量测序法（ high-throughput sequencing of CLIP cDNA library , HITS-CLIP）、光催化核糖核苷增强交联和免疫沉淀法（ photoactivatable-ribonucleoside-enhanced crosslinking and immunprecipitation , PAR-CLIP）以及提高个别核苷酸分辨率交联和免疫共沉淀法（ individual nucleotide resolution CLIP , iCLIP）等RIP-ChIP衍生方法相继产生,使用这些方法,可以解析RBP的RNA识别特异性,而且通过与高通量测序技术结合,可以实现转录组尺度的RBP的靶序列的鉴定,分辨率也得到极大提高。该文就RNA与蛋白的相互作用的基本原理及其研究进展、相关技术存在的问题以及发展趋势进行简要综述。     

Old and dangerous: Prison and dementia

Older prisoners are the fastest growing group of prisoners in many countries. The purpose of this study is to explore the phenomenon of detention of persons suffering from dementia. Medline searches were conducted for relevant articles, chapters and books published until August 2016. Search terms included dementia, elderly, prison and criminal. Publications found through this indexed search were reviewed for further relevant references. As results, there is a lack of data about elderly with dementia in prisons. Given the rise in the average age, it is reasonable to hypothesize that the number of older prisoners is growing. Moreover, some elderly are imprisoned with a concomitant cognitive impairment or psychiatric disorder while others will develop such diseases once incarcerated. At the present time, legal and social systems seem unprepared to handle the phenomenon of dementia in prison. As proposal, health assessments for older first time offenders should become a practice inside the correctional facilities and include an evaluation for specific health issues, such as psychiatric comorbidity and cognitive impairment.     

Kidney and iodinated and gadolinium-based contrast agents

In patients with renal failure, iodinated contrast agents may cause acute deterioration of the renal function and gadolinium-based contrast agents (GBCAs) may cause nephrogenic systemic fibrosis (NSF). The administration of a contrast agent must thus be reviewed for each patient and evaluation of renal function is paramount even though its estimation using formulas derived from the creatinine level may fluctuate. For iodinated contrast agents, contrast induced nephropathy is reduced by hydratation, preferably intravenous, when the GFR is less than 60 ml/min. The risk for intravenous injections is less than the risk for arterial injections, and the GFR threshold may be reduced to 45 ml/min. For gadolinium-based contrast agents, patients at risk for NSF are those with end-stage renal disease and patients undergoing dialysis. In such cases, the injection of a gadolinium-based contrast agent is only considered after a risk-benefit analysis has been completed, an alternate linear or macrocyclic agent issued and the dose limited to 0,1 mmol Gd/kg. Recently, recommendations from US and European agencies have converged. Learning objectives: to be familiar with the risk factors of CIN with iodinated contrast agents; to be familiar with hydration procedures for patients at risk of CIN; to be familiar with the diagnostic criteria of NSF; to be familiar with the classification of GBCA with regards to the risk of NSF; to be familiar with the contraindications of the different groups of GBCA.