支架辅助机械解脱弹簧圈栓塞治疗Willis环周围宽颈动脉瘤的临床应用

目的 探讨应用Ｓｏｌｉｔａｉｒｅ ＡＢ支架辅助ＡｘｉｕｍＴＭ机械解脱弹簧圈栓塞治疗Ｗｉｌｌｉｓ环周围宽颈动脉瘤的技术、方法及疗效。方法 采用Ｓｅｌｄｉｎｇｅｒ技术,对２１例Ｗｉｌｌｉｓ环周围宽颈动脉瘤应用Ｓｏｌｉｔａｉｒｅ ＡＢ支架辅助ＡｘｉｕｍＴＭ机械解脱弹簧圈栓塞治疗,９例通过支架网孔置入微导管行动脉瘤栓塞,支架解脱;对１２例载瘤动脉迂曲导管不易进入网孔者,采用先将支架跨过动脉瘤两端,将微导管置于动脉瘤内距瘤底部１／３ ～ １／２处,弹簧圈部分释放后,再释放支架进行动脉瘤栓塞,解脱支架。结果 ２１例患者所有支架、弹簧圈置入顺利,释放位置满意,技术成功率１００％。２１枚动脉瘤完全栓塞１６枚,占７６．２％;大部栓塞５枚,占２４．８％。术后患者恢复良好,随访３ ～ ６个月,未发生出血或脑血栓形成。结论 联合使用Ｓｏｌｉｔａｉｒｅ ＡＢ支架辅助ＡｘｉｕｍＴＭ机械解脱弹簧圈栓塞治疗Ｗｉｌｌｉｓ环周围宽颈动脉瘤是一种安全、有效的方法,但其长期疗效仍需进一步观察。     

Neuroform自膨式支架结合弹簧圈栓塞颅内宽颈动脉瘤

目的探讨Neuroform自膨式支架结合弹簧圈治疗颅内宽颈动脉瘤的安全性、术中并发症、近中期疗效和应用前景。方法采用Neuroform支架结合弹簧圈栓塞治疗２５例２７枚颅内宽颈动脉瘤。动脉瘤位于颈内动脉海绵窦段３枚,眼动脉１枚,后交通动脉１８枚,前交通动脉２枚,大脑中动脉M１段１枚,大脑中动脉分叉部１枚,基底动脉干１枚。其中２例患者为多发动脉瘤,绝对宽颈（瘤颈＞４mm）动脉瘤２１枚,相对宽颈６枚,瘤颈／瘤体均大于０．７。结果４枚采用NeuroformⅡ代自膨式支架结合弹簧圈栓塞治疗,其余均采用NeuroformⅢ代支架结合弹簧圈栓塞治疗。２５例２６枚支架均成功到位释放,１例多发动脉瘤患者置入２枚支架。７枚动脉瘤完全栓塞（１００％）,９枚几乎完全栓塞（９５％～９９％）,１１枚不完全栓塞（９５％以下）。２例术中出血;２例术中支架内血栓形成,其中１例术后遗留肢体偏瘫,另１例死亡;１例术中弹簧圈尾端从支架网孔突入颈内动脉,术后出现一过性脑缺血表现,其余患者均恢复良好出院。临床随访２４例,随访期１～３２个月,平均１０．８个月。３例术后３～６个月血管造影随访,其中１例后交通动脉瘤患者同侧大脑前动脉闭塞,大脑中动脉主干血栓形成;另２例原有瘤颈残留者无变化。结论在栓塞颅内宽颈动脉瘤时应用Neuroform自膨式支架结合弹簧圈技术,使弹簧圈无法突入载瘤动脉,可提高栓塞致密度,安全、疗效好。     

新型颅内支架Enterprise结合水解脱弹簧圈栓塞治疗颅内微小宽颈动脉瘤

目的总结应用新型颅内支架Enterprise结合水解脱弹簧圈栓塞治疗颅内微小宽颈动脉瘤的技术及疗效。方法６例颅内微小宽颈动脉瘤（直径＜３mm,体／颈比＜１．５）采用Enterprise支架结合水解脱弹簧圈栓塞,其中５例采用先放置支架覆盖动脉瘤颈再将微导管经支架网孔放入动脉瘤腔填塞弹簧圈进行栓塞,１例将微导管进入瘤腔后再释放支架进行弹簧圈栓塞。术后３～６个月进行临床随访。结果６例全部技术成功,支架均满意到位,载瘤动脉通畅,无手术并发症;动脉瘤完全闭塞４例,闭塞９５％以上２例。术后患者均恢复良好,３～６个月临床随访无再出血及脑血栓形成。结论联合使用Enterprise支架和水解弹簧圈栓塞治疗颅内微小宽颈动脉瘤是一种安全有效的方法,但其长期疗效仍需进一步观察。     

Solitaire AB支架在辅助栓塞颅内宽颈动脉瘤中的临床应用

【摘要】 目的 评价Solitaire AB支架在辅助栓塞颅内宽颈动脉瘤中的临床应用价值。方法 应用Solitaire AB支架治疗颅内宽颈动脉瘤25例,其中后交通动脉瘤15枚,眼动脉段动脉瘤4枚,颈内动脉海绵窦段动脉瘤1枚,大脑中动脉瘤1枚,椎动脉动脉瘤4枚。结果 25例中,完全栓塞22例, 瘤颈残留1例,部分栓塞2例。术中动脉瘤破裂1例,术后脑积水行脑脊液分流术1例,弹簧圈移位1例。随访未有再出血病例。造影随访12例,复发1例。结论 应用Solitaire AB支架在辅助栓塞颅内宽颈动脉瘤具有较高的临床价值,值得临床推广。

     

Neuroform3支架在急诊血管内栓塞破裂性颅内宽颈动脉瘤中的应用

目的 评价急诊血管内Neuroform3支架辅助下可解脱弹簧圈栓塞破裂的颅内宽颈动脉瘤的疗效和中期随访.方法 回顾性分析最近18个月急诊介入栓塞治疗的破裂出血性颅内动脉瘤48例,其中26例在72 h内实施Neuroform3支架辅助下弹簧圈栓塞术.其中3例动脉瘤位于大脑前动脉A1段,3例位于大脑中动脉M1和M2段,13例位于后交通,2例位于颈内动脉眼动脉段,2例位于基底动脉顶端,2例位于椎动脉V2和V4段,1例位于小脑后下动脉;3例在第1枚弹簧圈释放后植入支架,1例在第2枚弹簧圈释放后植入支架,2例在第4枚弹簧圈释放后植入支架,10例在第1枚弹簧圈无法在瘤腔内成篮后植入支架,其余10例先植入支架再进行弹簧圈栓塞,所有微导管均通过支架网眼进入动脉瘤.结果 所有病例均成功释放支架(100%),覆盖了瘤颈,同期行弹簧圈填塞动脉瘤.术后即刻造影显示动脉瘤完全栓塞23例(88.5%),次全栓塞3例(11.5%);术中1例支架轻度回撤,无血栓事件和动脉瘤再破裂出血发生,所有患者均恢复良好出院.栓塞术后随访到23例,至少复查1次脑血管造影,最多复查3次;完全致密栓塞14例(60.8%)动脉瘤均末显影,6例瘤颈少许显影病例中3例(11.5%)存在血栓形成,次全栓塞1例(3.3%)瘤体再通,另外2例始终稳定,所有病例载瘤动脉通畅,狭窄2例(7.7%),临床上无任何症状,术后所有患者均无再出血.结论 急症血管内应用Neuroform3支架辅助弹簧圈栓塞破裂出血的颅内宽颈动脉瘤足方便的、安全的和有效的.     

Neuroform支架辅助弹簧圈填塞治疗颅内宽颈动脉瘤

目的探讨Neuroform支架辅助弹簧圈填塞治疗颅内宽颈动脉瘤的技术,并评价临床疗效和并发症。方法采用Neuroform支架辅助技术对３１例颅内宽颈动脉瘤进行了弹簧圈填塞治疗。３１例患者共有颅内动脉瘤４３枚,均为破裂动脉瘤,其中３９枚为宽颈动脉瘤,２１枚颈∶体≥１,１８枚颈∶体＜１;４枚为宽颈动脉瘤患者合并的非宽颈动脉瘤。结果３１例患者共置入支架３５枚,其中３例患者两侧颈内动脉各置入１枚支架,１例两侧大脑中动脉各置入１枚。４３枚动脉瘤中４１枚进行了不同程度的填塞,２枚未行填塞。２例宽颈动脉瘤患者置入支架后出现非动脉瘤破裂性出血,均可能由于输送导丝损伤大脑中动脉分支引起;１例后交通动脉瘤患者,弹簧圈飘至大脑中动脉M２段,引起相应脑缺血症状。获随访的２９例中无死亡病例和再次出血病例,２８例生存良好,１例留有明显神经功能障碍。结论支架辅助技术进行弹簧圈填塞治疗颅内宽颈动脉瘤是安全、有效的临床技术,可以拓宽颅内动脉瘤治疗的适应证。     

"Y”型支架技术辅助弹簧圈栓塞基底动脉尖部宽颈动脉瘤

目的 探讨“Ｙ”型支架技术辅助弹簧圈栓塞基底动脉尖部宽颈动脉瘤技术难点及难治病例的处置方法。方法 回顾分析２００８年１月至２０１１年１月６例“Ｙ”型支架技术辅助弹簧圈栓塞基底动脉尖部宽颈破裂动脉瘤患者的临床资料。６例患者术前均行ＣＴＡ、ＭＲＡ或ＤＳＡ检查明确诊断,动脉瘤直径 ＞ １０ ｍｍ １例,５ ～ １０ ｍｍ ４例,３ ～ ５ ｍｍ １例,均采用“Ｙ”型支架技术辅助弹簧圈栓塞治疗。结果 术中共用支架１１枚,其中Ｎｅｕｒｏｆｏｒｍ支架９枚,Ｅｎｔｅｒｐｒｉｓｅ支架２枚。所有患者动脉瘤均得到致密栓塞,其中４例 “Ｙ”型支架技术构建顺利,２例出现支架移位,无严重并发症发生。结论 正规熟练地操作,合适支架的选用,可以使“Ｙ”型支架技术辅助治疗基底动脉宽颈动脉瘤并发症降至最低。     

支架辅助弹簧圈介入栓塞颅内宽颈动脉瘤

【摘要】 目的 探讨支架辅助弹簧圈介入栓塞治疗颅内宽颈动脉瘤的方法和疗效。方法 回顾性分析16例患者的临床资料，应用支架包括Neuroform 6枚和Enterprise 10枚。结果 所有支架均成功释放并行弹簧圈栓塞，即刻造影动脉瘤获得完全及大部分栓塞13例，瘤颈残留1例，部分栓塞2例。14例患者术后3 ~ 12个月复查，13例完全及大部分栓塞中11例复查未见复发，瘤颈残留1例6个月后复查复发，再次行支架植入完全栓塞，部分栓塞2例复查时瘤腔消失。结论 通过支架辅助对宽颈动脉瘤瘤颈重塑及弹簧圈的介入栓塞作用，使动脉瘤栓塞疗效满意。
     

单个弹簧圈栓塞颅内微小动脉瘤的单中心经验

【摘要】 目的 探讨单个弹簧圈栓塞颅内微小动脉瘤(最大径< 3 mm)的可行性和疗效。方法 2001年1月至2011年1月对72例颅内微小动脉瘤患者的77个动脉瘤进行单个弹簧圈栓塞,其中动脉瘤破裂出血52例,多发性动脉瘤13例。用3D DSA选择工作角度测量动脉瘤大小(前后径、上下径、宽颈、最大径和瘤颈）。随访脑血管造影3 ~ 88个月(平均24.8个月)。结果 对所有77个微小动脉瘤成功实施了单个弹簧圈栓塞,其中10个采用球囊辅助弹簧圈栓塞,19个联合支架辅助弹簧圈栓塞。术中破裂出血7例,发生脑栓塞事件2例,术中弹簧圈移位2例。术后即刻造影示完全栓塞42个,次全栓塞30个,部分栓塞5个。除2例死亡外,所有病例进行了至少2次复查(术后3和12个月),其中再通5个,对3个进行了再次栓塞,延迟性弹簧圈移位2例。12个月后复查造影示完全栓塞61个,次全栓塞14个。结论 单个弹簧圈栓塞颅内微小动脉瘤可行、安全并有效,联合支架辅助治疗可以降低其再通率。     

Nanostructured Bi2Te3 as anode material as well as a destabilizing agent for LiBH4

Lithium borohydride, a well known complex hydride with its high hydrogen capacity, has shown its application as a solid electrolyte for Li-ion battery. It has been employed as a solid electrolyte with Bi₂Te₃ nanosheets as anode material for lithium-ion batteries (LIBs). The Bi₂Te₃ nanosheets were synthesized by the solvothermal method with an average crystallite size of 55 nm as calculated by Debye Scherrer formula. The scanning electron microscopy (SEM), and transmission electron microscopy (TEM) experiments reveal the morphology of the prepared sample as hexagonal nanosheets with the thickness in the range of 20–40 nm. Initial discharge and charge capacity of the negative electrode is found to be 555 mAhg⁻¹ & 1290 mAhg⁻¹ using galvanostatic charge-discharge analyzer at a rate of 0.1C. During the electrochemical charging-discharging experiment, strange but interesting gas evolution was observed, which resulted in the opening of the cell. The careful investigation of this reaction using TG/MS suggest the destabilization of LiBH₄. The thermal dehydrogenation analysis depicts that the LiBH₄–Bi₂Te₃ nanosheets composite starts to desorb hydrogen at 61 °C with a total of 9% weight loss. The above destabilization is investigated using XRD and XPS experiments and the detailed mechanism is proposed herein.     

Novel green composites using zein as matrix and jute fibers as reinforcement

We demonstrate that zein-jute fiber composites developed using water plasticized zein as matrix can have substantially higher flexural and tensile properties than composites obtained using polypropylene as matrix. Zein is a plant protein that has been used to develop various types of thermoplastic products. Zein can be extracted from corn distillers dried grains (DDG) with potentially much lower cost than biopolymers in current use. However, thermoplastics developed from zein are brittle and it is necessary to use plasticizers or chemically modify zein to obtain useful zein-based products. Hydrophilic plasticizers such as glycerol that are retained in the composite after fabrication absorb moisture and considerably decrease the properties of the composites. Similarly, chemical modifications make the matrix materials expensive and/or decrease their biodegradability. In this research, we have used water to plasticize zein composites reinforced with jute fibers. Unlike plasticizers such as glycerol, water used as a plasticizer in this research evaporates during composite formation and does not affect the properties of the composites. Zein-jute composites have about 100% higher flexural strength, 82% higher tensile strength than similar PP-jute composites. The zein-jute composites have better flexural and tensile properties than PP-jute composites even at 21 °C and 90% relative humidity. Water serves as an effective plasticizer to utilize zein as a matrix for composites.     

节能降本与物流管理优化

物流仓储促进了经济的发展熏但是同时也给环境带来负面的影响熏如大量燃料和能源在物流过程中被消耗。文章介绍了上海大众汽车有限公司如何通过对化学品及燃料的物流管理方式的优化,在实现降低物流成本的同时实现能耗的降低。     

Hydrogen as a fuel

Hydrogen, used as fuel, has a number of attractive features that make it a leading candidate in the search for an alternative to the dwindling and progressively less reliable supply of fluid hydrocarbon fuels. Hydrogen produced by electrolysis using hydro- or nuclear-generated electricity will be available in Canada at prices competitive with other portable forms of energy before the end of the century. This paper examines the use of carbon-free electrolytic hydrogen as a motor vehicle fuel and as a fuel for fuel cells. A review of onboard hydrogen storage systems indicates that the propulsion power unit of hydrogen-fueled vehicles must be considerably more efficient than present gasoline-fueled internal combustion engines in order to compensate for the larger size and greater weight of hydrogen storage systems. Hydrogen-fueled internal combustion engines are more efficient than similar gasoline-fueled engines, but the improvement is not sufficient to offset the storage system limitation. Fuel cells operate with much higher efficiency than internal combustion engines, especially at partial loads. A comparison between H₃PO₄ and KOH fuel cells show that where carbon-free hydrogen is available from the onboard storage system, the KOH fuel cell offers the higher level of performance.     

应该注意电力体制改革中可能出现的问题

我国电力体制改革方案已经国务院批准.厂网分开,电网方面成立国家电网公司和南方电网,电源方面成立若干个发电公司竞价上网.今后输电和销售还将分开,按照市场经济规则运行.中央的决策,我们一定坚决贯彻.     

UK government policy for refuse disposal: Actions as well as words!

Recent pertinent legislation concerning the handling, recycling and/or disposal of domestic, municipal and industrial refuse in the UK is reviewed. At present it appears that UK energy policy is being influenced significantly by EC environmental legislation. Nevertheless, an overall strategy for dealing with garbage is needed urgently.     

农用机动车及其柴油发动机的发展与WTO

本文分析了我国农用车及与之配套的柴油发动机的现状、行业结构和产品存在的问题与差距,分析了技术的发展趋势,加入WTO后发展的机遇与挑战,应对WTO可采取的措施.我国加入WTO为农用车提供了更加巨大的国内外市场,农用车行业在新的机遇和挑战中向更大、更强和国际化方向发展.     

Hydrofluorocarbons as geothermal vapor-phase tracers

Two hydrofluorocarbons, R-134a and R-23, have been developed for use as a vapor-phase tracer in geothermal systems. These low molecular weight compounds are volatile, electrically neutral, nontoxic, relatively inexpensive, and have detection limits as low as 10⁻⁵ ppm. Data from laboratory and field tests indicate that they are stable enough to be used as tracers in vapor-dominated systems such as The Geysers. However, these compounds have a higher volatility than water, which affects the rate of transfer of the tracer from the liquid injectate to reservoir steam during boiling. Simple analytic models of boiling were used to estimate the effects of the high tracer volatilities on the outcome of tracer tests in vapor-dominated systems. The results imply that the effects of volatility are exaggerated under conditions of high superheat, which promote the continuous removal of steam from the vicinity of the boiling interface. In contrast, low to moderate superheat reduces the effects of volatility to the extent that the volatile-tracer test results qualitatively resemble those in which tritiated water is used as a tracer. Thus, volatile tracers can be used with confidence to qualitatively describe the distribution of injected water in vapor-dominated systems where superheat is low to moderate.     

Production of hydrogenases as biocatalysts

Hydrogen is emerging as one of the most promising energy carriers for the future. Most of the methodologies used for hydrogen production employ use of hydrogenases, known to play a critical role in biological hydrogen production as well as its utilization. These hydrogenases display fascinating redox-chemical properties with tremendous efficiency as a biocatalyst for hydrogen fuel. However, Due to the complex structure and maturation process of hydrogenases, their heterologous production has been a challenging task. This results in the limitation of the viable application of this metalloprotein for hydrogen fuel. This review briefly discusses various hydrogenase expression systems and their perspectives.