Objective:To analyze the safety and efficacy of regular aspirin use after combined cerebral revascularization in patients with ischemic moyamoya disease. Methods:From December 2020 to October 2021, a total of 326 patients diagnosed with ischemic moyamoya disease by global cerebral angiography and undergoing first-time combined cerebral revascularization at the Moyamoya Disease Diagnosis and Treatment Research Center of our hospital were selected. Combined cerebral revascularization: superficial temporal artery-middle cerebral artery (STA-MCA) +encephalo-duro-myo-synangiosis (EDMS).Patients were screened by 2 senior physicians according to established inclusion/exclusion criteria. Patients were divided into aspirin and non-aspirin groups based on whether they received regular oral aspirin after surgery. A total of 133 patients were enrolled in the aspirin group. A total of 71 patients (204 cases) were enrolled in the non-aspirin group. Related data were collected before and 1 year after surgery and statistically analyzed to assess the prognosis of both groups. Results:In the two groups, the mRS Score was significantly different after one year (P = 0.023). TIA occurred in 26 patients (19.5%) in the aspirin group and 27 patients (38.0%) in the non-aspirin group within one year after surgery, and the difference between the two groups was statistically significant (P = 0.004). There was no significant difference in cerebral perfusion stage, the improvement rate of cerebral perfusion, Matsushima grading, bypass patency, and other complications within one year after the operation (P > 0.05). Conclusions:In patients with ischemic moyamoya disease who underwent combined cerebral revascularization, postoperative administration of aspirin can reduce the incidence of TIA without increasing the risk of bleeding, but it can not significantly improve the cerebral perfusion of the operation side, Matsushima grading, and bypass patency.

目的 探讨烟雾病患者行颅内外血运重建术中应用去氧肾上腺素和去甲肾上腺素对术后发生早期脑梗死的影响.方法 择期行颅内外血运重建术的烟雾病患者80例,随机分为去氧肾上腺素组40例和去甲肾上腺素组40例,2组分别在麻醉诱导开始时静脉泵注初始剂量去氧肾上腺素0.1 μg/(kg·min)和去甲肾上腺素0.01 μg/(kg·min),间断调整剂量,维持目标血压.比较2组麻醉诱导前(T1)、气管插管术后即刻(T2)、血运重建后10 min(T3)、拔除气管导管后(T4)平均动脉压、pa(CO2)、颈静脉球部血氧饱和度、手术对侧脑半球局部脑氧饱和度.比较2组术中心动过缓、术后早期脑梗死、术后恶心呕吐发生率及术后住院时间等临床资料.结果 去氧肾上腺素组术中心动过缓发生率(37.5％)高于去甲肾上腺素组(17.5％)(x2=4.013,P=0.045).2组不同时间点平均动脉压、pa(CO2)、颈静脉球部血氧饱和度、手术对侧脑半球局部脑氧饱和度比较差异均无统计学意义(P＞0.05).去氧肾上腺素组术后早期脑梗死发生率(2.5％)、术后住院时间[7(6,9)d]、术后恶心呕吐发生率(15.0％)与去甲肾上腺素组[2.5％、7(6,8)d、17.5％]比较差异均无统计学意义(P＞0.05).结论 去氧肾上腺素和去甲肾上腺素均可维持烟雾病患者颅内外血运重建术术中血流动力学平稳及脑灌注正常,术后早期脑梗死发生率低,应用去甲肾上腺素可减少术中心动过缓发生.

"口语诗"是从第三代诗中萌蘖而出的一个新诗亚种,具有反对过度修辞、突出口说价值、崇尚"事实的诗意"等特征,其对"说话""声音"和"废话"的强调尤为引人注目.这些因素的存在不仅具有深远的诗学传统,而且具有深刻的哲学根基.在语言哲学视域里,"说"是此在之显现,是人的在场,也是诗的本真状态;"声音"在西方语言传统中是本体的代名词,在中国气本诗文传统中则是"诗之源";而"废话主义"的去价值、去功利、去语义等,也是现代语言哲学的诗学转化.口语诗的存在是功能性的,具有解构与建构的双重作用,它在否定现代诗歌书写霸权等异化形式的同时,也在进行一场返回在场、返回声音、返回身体、返回原初的"感性革命",具有积极的诗学意义.

欧化语法指因受西洋语法影响及刺激而出现的不同于原有汉语语法特征的语言规则.其与现代汉诗发生关联主要得益于宋诗派"以文为诗"、近代译诗、诗人创作等因素的综合作用.欧化语法对现代汉诗的发生、发展具有重要影响.横向来看,形成了汉语诗歌的异质性,造成了其从"自演诗"到"他演诗"、从单音节奏到音组节奏、从"表现诗"到"表达诗"、从"朦胧"到"明了"等方面的变异;纵向来看,推动了中国诗体从古代向现代形态的转变,具体表现为促进了诗歌体式从文字型向语言型、语言结构从"意象语言"到"推论语言"、意象构造从简单向繁复转化等.欧化语法进入汉语诗歌,不仅改变了诗的语言表象,也改变了诗的思维结构,在中国诗歌从传统到现代转变过程中起到了关键作用,有力地推动了中国诗体现代品格的形成.对于这种文学语言现象,应以开放包容的文化态度辩证待之.

目的 观察联合脑血运重建术治疗儿童烟雾病的临床疗效.方法 回顾性分析2020-01—2021-12河南省人民医院烟雾病诊疗中心收治的儿童烟雾病(年龄8～15岁)14例,收集和分析患儿的一般资料、临床特征、围术期并发症和改良Rankin量表(mRS)评分.结果 14例儿童烟雾病共行25次手术,其中21次联合脑血运重建术,1次手术后患儿出现一过性癫痫发作,1次手术后患儿出现头皮局部坏死,2次手术后患儿出现小梗死,无大梗死和脑出血等严重并发症.术后中期随访DSA显示,颈外动脉系统通过桥血管和颞中、深动脉向脑皮层代偿供血,PWI显示脑灌注缺血情况不同程度改善;术后4例(28.57％)患儿神经功能缺损症状得到改善,9例(64.29％)患儿症状稳定,未再出现新发的神经功能缺损症状,1例(7.14％)患者出现新的神经功能缺损症状.结论 联合脑血运重建术治疗儿童烟雾病较安全,可以明显改善脑灌注情况,中期随访效果好.

目的:分析网状大脑中动脉(MCA)的临床特征和影像学特点,探讨联合脑血运重建术治疗症状型网状MCA的疗效。方法:回顾性分析2018年1月至2021年3月收治的8例33~52岁症状型网状MCA患者。8例患者中1例先行前交通动脉瘤栓塞术,后行联合脑血运重建术;7例行联合脑血运重建术。术后定期对患者进行临床随访。采用数字减影脑血管造影(DSA)和核磁共振灌注成像(PWI)评估术后效果;采用改良Rankin量表(mRS)评分评估患者神经功能恢复情况。结果:术后1例出现一过性癫痫发作,无脑梗塞和脑出血等严重并发症出现。术后6个月DSA和PWI显示,7例出现颈外动脉系统向颅内代偿供血,脑灌注缺血情况改善。术后6个月的mRS评分为(0.38±0.52)分,较术前[(1.13±0.35)分]降低。术后6例患者神经功能缺损症状得到改善,术后2例患者症状稳定,未再出现新发的神经功能障碍。结论:联合脑血运重建术是治疗有临床症状的网状MCA患者有效的方法,可以明显改善脑灌注情况,短期随访效果好。

关系词是诗文意脉的重要载体.在中国诗体发达史上,关系词在诗中的出没呈现出"显—隐—显"的U字形轨迹,具体表现为古体中尚不忌讳,近体中基本消失,词曲中逐渐增多,而在新诗中则被广泛使用.新诗中关系词的这种"散文化"用法,不仅为中国诗体带来了从意合到形合、由混指到确指、由断续到连续等方面的重大改变,还牵涉出中国诗歌古今中外关系以及文野高下程度等诗学问题,具有重要的文体价值和文化价值.

Objective:To investigate the clinical features, surgical treatment and curative effect of pediatric moyamoya disease.Methods:A group of 17 pediatric patients with moyamoya disease (aged 3-14 years ) was retrospectively analyzed from June 2017 to June 2020 in Henan Provincial People's Hospital, in regard to clinical data, imaging features, surgical methods and postoperative treatment. Totally 17 cases (26 sides) underwent brain-dural-temporal muscle-vascular fusion (encepho-dural-myo-synangiosis, EDMS). Postoperative follow-up was conducted, with magnetic resonance angiography (MRA) or digital subtraction angiography (DSA) and perfusion imaging (PWI) or arterial spin labeling (ASL), to evaluate the efficacy of long-term cerebral revascularization after surgery. The improved Rankin scale score (mRs) was used to evaluate the neurological functional recovery.Results:Six months after the operation, MRA or DSA showed that external carotid artery system compensated blood supply to the cerebral cortex on 24 sides, and PWI or ASL showed that cerebral perfusion ischemia was significantly improved. Totally 24 side surgeries (92.3%) improved the symptoms of neurological impairment, while in the other 2 side surgeries (7.7%), the symptoms were stable, with no new-onset symptoms of neurological impairment. Transient epileptic seizures occurred after 3 operations; local scalp necrosis occurred after 1 operation; and no serious complications such as cerebral infarction and cerebral hemorrhage occurred.Conclusion:EDMS is safe in the treatment of children with moyamoya disease. It can significantly improve cerebral perfusion, and shows a good effect during short-term follow-up.

"讲求文法"是胡适文学改良的"八事"之一,在《文学改良刍议》中胡适对其他义项详加解释,唯独对此一笔带过,给人留下不少疑惑.然而揆诸实际,胡适的"诗体大解放"活动一直与"国语文法"如影随形,从语法角度改造诗歌可谓是其"文学改良"的另一红线.扬弃宋诗句法,吸收其"说话""作文"因素;否定五七言整齐句法,肯定词的自然文法;打破诗文壁垒,恢复诗的自然语序;废除平仄对仗,用白话拆除旧体诗最后屏障,等等.基于中国诗语演变的历史实际,倡导诗歌语言的自然文法,胡适提出的这种文学革命方略无疑具有开创之功,不过也给后人留下很多文体困惑和艺术难题,如何在"散文"的形式里实现"诗性",至今仍是一个有待解开的斯芬克斯之谜.

目的 研究联合脑血运重建术治疗老年烟雾病患者临床效果.方法 回顾性分析2017-01—2019-12河南省人民医院烟雾病诊疗中心收治的老年烟雾病患者(年龄>60岁)共52例,分为2组,联合脑血运重建组39例,保守治疗组13例,收集患者一般资料、临床特征、围术期并发症、神经功能并发症和改良Rankin量表(mRS)评分.结果 长期随访后,联合脑血运重建组新发卒中5例(12.82％),保守治疗组新发卒中7例(53.84％);mRS评分改善情况:联合脑血运重建组33例(84.62％)明显改善,保守治疗组仅1例(7.69％);2组患者新发卒中事件(χ2=9.244,P=0.002)、mRS评分改善情况(χ2=4.675,P<0.001)差异均有统计学意义.结论 联合脑血运重建术可明显改善老年烟雾病脑血流供应,降低mRS评分,提高老年烟雾病患者生活质量.

Objective:To explore the influencing factors of postoperative complications and efficacy of combined cerebral revascularization for the treatment of moyamoya disease (MMD) in adults.Methods:A retrospective analysis was conducted about the clinical data of 370 adult patients with moyamoya disease who underwent combined cerebral revascularization (superficial temporal artery-middle cerebral artery anastomosis + encepho-duro-myo-synangiosis) at Department of Neurosurgery, Henan Provincial People′s Hospital from January 2017 to June 2019. The incidence of neurological complications after unilateral operation was observed, and the risk factors of postoperative complications were analyzed by univariate and multivariate logistic regression analyses. The clinical efficacy of the patients was evaluated based on the modified Rankin Scale (mRS), and the cerebral blood flow reconstruction was evaluated according to the Matsushima score standard based on digital subtraction angiography(DSA) results.Results:All 370 patients underwent successful operation, and 75 cases (20.3%) developed neurological complications after operation, including 6 cases of cerebral hemorrhage, 12 cases of cerebral infarction, 2 cases of subarachnoid hemorrhage, 29 cases of transient neurological defect and 26 cases of epilepsy. The outcomes of 15 patients were poor(mRS 3-6 points), of which 2 patients died. Multivariate logistic regression analysis showed that the development of TIA as the first symptom before operation ( OR=2.616, 95% CI: 1.442-4.744, P=0.002), comorbidity with essential hypertension ( OR=2.308, 95% CI: 1.326-4.015, P=0.003), and preoperative mRS of 3-5 points ( OR=2.371, 95% CI: 1.236-4.547, P=0.009) were risk factors for postoperative complications. The follow-up time of 370 patients was 15.6±5.3 months (6-32 months). The median mRS at the last follow-up was 1 point ( P25: 1 point; P75: 2 points), which was significantly different from preoperative mRS (median: 2 points; P25: 1 point; P75: 2 points) ( P<0.01). A total of 362 patients underwent DSA examination. Among them, grade 0 was reported in 12 cases, grade 1 in 121 cases, grade 2 in 198 cases, and grade 3 in 31 cases. Conclusions:The development of TIA as the first symptom before operation, comorbidity with essential hypertension, and the preoperative mRS 3-5 points are risk factors for postoperative complications of combined cerebral revascularization for the treatment of adult moyamoya disease. The cerebral blood flow in most of those patients could be improved to some extent after operation.

Objective:To explore the clinical characteristics and risk factors of unstable moyamoya disease.Methods:The clinical data of 261 patients with moyamoya disease, who received combined cerebral reconstruction in the Moyamoya Disease Center of Henan Provincial People's Hospital from January 1, 2019 to December 31, 2019, were analyzed retrospectively. The clinical variables of stable group and unstable group were compared, and the clinical characteristics of unstable moyamoya disease were summarized. Univariate and multivariate logistic regression analysis was used to summarize the risk factors of unstable moyamoya disease.Results:The patients with unstable moyamoya disease showed higher frequency of preoperative TIA attacks (OR=3.439, P=0.023) and higher systolic blood pressure (OR=1.097, P＜0.001). The incidence of new-onset postoperative stroke events in the unstable group was 42.31% (11/26), which was significantly higher than that of stable group (3.40%, 8/235; χ2=39.133, P＜0.001).Conclusion:Unstable moyamoya disease has asymmetrical changes of bilateral intracranial vessels on imaging, and such patients are more likely to present frequent preoperative TIA attacks and higher uncontrollable blood pressure. New-onset stroke events are more likely to occur after combined cerebral blood flow reconstruction. For this group of patients, we should strengthen the perioperative evaluation management, implement detailed surgical plans and postoperative management to prevent complications, which is fundamental to reduce the mortality and disability of surgical treatment of moyamoya disease.

诗是最精粹的语言,语言是存在之家,海德格尔的语言母题与当代汉诗的家园形塑具有意味深长的呼应关系.与语言存在论相对应,当代汉诗的家园抒写主要从三个维度展开:一是基于汉字的家园属性,开展重新发明汉字,从中寻求认同的"字思维"写作;二是鉴于大地的家园本质,形成一股抒写大地、"制造大地"的乡土写作潮流;三是从诗的"民族元语言"功能出发,展开对山川名物和历史废墟的"创建性命名".当代诗人的这种家园抒写,不仅为人们奉献了一帧帧美的表象,而且还形塑了一个民族的精神之家和存在之所,起到了凝聚国族、增强认同的重要作用,具有非同寻常的文化价值.

"第三代人"是朦胧诗之后新一代诗人的统称,是被称为"语言自觉"的一代,然其诗学话语多来自现代语言哲学,言说逻辑也是语言哲学的延伸.他们关于语言"划界"和"日常生活"的论述,源于维特根斯坦的相关话语;其"诗到语言为止""废话理论"等,也来自海德格尔的存在主义语言观;而"能指还原""拒绝隐喻"诸说,则是对索绪尔能指/所指理论的直接演绎."第三代人"诗学话语与现代语言哲学并不在一个论域,其对哲学的解读浮光掠影,各种说法之中"误读"者有之,望文生义者有之,尽管如此,还是成功地将哲学资源转化成诗学资源,发起了一场轰轰烈烈的诗歌运动.不仅这样,他们还将语言事件变成行动事件,将思想的诗学变成行为的诗学,为当代文学发展提供了一份别样的经验.

目的 探讨烟雾病的性别、年龄、地区分布特点、临床表现以及外科治疗效果分析.方法 回顾性分析2017-01—2019-04河南省人民医院收治的542例烟雾病患者的临床资料,包括性别、年龄、地区分布、临床表现等,分析其手术效果及预后.结果 542例烟雾病患者中,男女比例为1:1.05(男265/女277);年龄(45±12.7)岁(3～75岁),年龄分布呈现双峰形态,好发于9～11岁儿童及46～51岁成人段;河南南方地区发病率明显高于其他区域,呈区域集中现象.儿童成人均以缺血性症状为主;缺血型以头痛、头晕为主要首发症状,出血型中以脑室出血最常见.432例接收手术治疗的烟雾病患者中,行间接血管重建术66例,联合血管重建术366例,18例围手术期出现并发症,其余均恢复顺利,临床症状得到改善,随访结果 良好.结论 河南地区烟雾病的发病无明显性别差异,年龄呈双峰分布,成人多见,多为缺血型,纳入病例中儿童均为缺血型;豫南地区发病率明显高于其他地区;个体化脑血管重建术具有明确的疗效.

刘震云是一位极具文体意识的作家,其文体实践无不打上"语言学转向"的鲜明烙印.从《故乡相处流传》开始,其小说叙事开始实现从"写实"向"叙述"的转变.从文本事实来看,刘震云小说写作的几次变化都与"语言学转向"的相关论题若合符契:语言哲学的"正名""说话"与"交往"等命题,被小说以母题形式加以呈现;其虚化事实、凸显讲述的"喷空叙事",也与现代语言学思潮影响下的历史叙事学声气相通.现代语言哲学的润泽,哲学与文学之间的共振,不仅使作家的文学观发生了裂变,也使其小说获得了一定的哲学深度.这种影响是一柄双刃剑,在给其小说带来若干文体新质的同时,也带来了非现实化、非历史化等问题,需要辩证地看待.

目的:探究轻中度脑梗死急性期患者睡眠状况.方法:选取2016年1月至2017年2月期间在我院接受治疗的轻中度脑梗死急性期患者45例作为观察组,另选取与观察组患者年龄、 性别相匹配的无脑梗死病史的住院患者40例作为对照组.记录2组的睡眠参数,观察比较2组患者的失眠率及失眠类型.结果:观察组患者的睡眠潜伏期、 入睡后清醒时间数据高于对照组,总睡眠时间低于对照组,实验数据比较差异有统计学意义(P<0.05);观察组患者的失眠率为92.4％,对照组患者的失眠率为63.2％,观察组数据高于对照组,数据比较差异有统计学意义(P<0.05).结论:轻中度脑梗死急性期患者睡眠状况较差,失眠率较高,睡眠结构紊乱,故在临床中应及时采取措施干预以改善轻中度脑梗死急性期患者睡眠状况.

境界诗学传统在新诗坛看似遭遇“断裂”命运实则以碎片形式曲折存续,其核心元素如情感本位、情景交融、自然英旨、境生象外等被不同程度接受就是明证.不过,境界自身也经历了整体变异的过程,具体表现在“语象化”“事象化”“理象化”“虚境化”诸方面.以横向移植为能事的新诗学,使用一套现代西方诗学话语,但这些话语与境界诗学范畴之间存在着巨大交集,这也充分说明境界传统具有贯通古今中西诗学的活力.境界遗产对中国新诗学建构的召唤意义在于:新诗需建立一套既保持精神高度又坚持感性底色,具有直寻色彩同时维持必要深度的艺术典则.

1920年罗素应邀访华,开始为期一年的讲学之旅.《东方杂志》借此大做文章,把一位西方哲学家演绎为探寻中国文化出路的扩音器.基于罗素文化志趣与《东方杂志》编者的巨大交集, “东方”文人群体一直关心的问题,如东西文化关系、中国国民性、“德、赛先生”关系以及社会主义前途等,都交付罗素,并借罗素之口再次迂回表达.迎接罗素是一次寻找思想外援的自觉文化活动,也是一次中西文化对话的重要文化事件.《东方杂志》对罗素的译介,还是当时知识分子“无限制尽量输入”西学,并做“绝对的自由研究”文化试验的一部分,意义十分深远.

梁启超是活跃在清季和民初两个时期的诗歌文体家,其在五四前后提出了“过渡时期”的“最中庸”新诗文体观.他主张文言诗与白话诗折中,新体诗与旧体诗调和;他还主张积极拓展诗体的疆界,调和诗词曲赋歌谣山歌弹词,将其一并纳入新诗以建构“广义的诗”;借助音乐元素建立新诗的“音节;而其“过渡期”的“新诗”文体典范,仍然是“旧风格”与“新意境”相统一的黄遵宪诗歌.进入五四新文学之后,梁启超仍然停留在清末之时自己的认识水平上,这也反映了其文学认知的“常”与时代要求的“变”之间的落差.