目的 探讨主动脉腔内修复术(endovascular aorta repair,EVAR)治疗孤立性腹主动脉夹层(isolated abdominal aortic dissection,IAAD)的临床效果.方法 回顾性分析2011年1月至2021年1月在复旦大学附属中山医院血管外科接受EVAR治疗的53例IAAD患者的临床资料,随访术后生存、并发症及二次干预情况等.用SPSS统计软件进行统计描述,应用Kaplan-Meier法计算累计生存率和免于二次干预率.结果 53例患者均成功接受EVAR治疗,其中1例术后因心包积液死亡,围手术期死亡率为1.9％.52例获得随访,平均随访(54.9±38.9)个月.随访期内死亡3例,无IAAD相关死亡.1、3、5和10年累计生存率为98.1％、98.1％、91.4％、87.1％,免于IAAD病死率均为98.1％,免于二次干预率均为91.9％.结论 EVAR治疗IAAD具有良好的安全性、有效性,远期疗效较为理想.

Objective:To discuss the strategies of distal embolic filter protection(DEFP) during excimer laser ablation (ELA) or percutaneous mechanical thrombectomy (PMT) in treatment of peripheral artery disease.Methods:Clinical data of 29 patients undergoing ELA or PMT under the DEFP from Oct 2019 to Aug 2021 were retrospectively collected to analyze the strategies of DEFP and high-risk factors of capturing clinically significant macrodebris.Results:There were 21 males and 8 females, aged (70.3±11.0) years with 32 lesions (29 limbs) including 5 in-stent restenosis (ISR), 10 thrombosis and 17 chronic total occlusion (CTO). The technical success rate of DEFP device release and recovery was 100%. The overall debris capture rate was 77.3% and the macrodebris capture rate was 36.4%. Even with DEFP the distal embolization (DE) incidence was 3.4%. When ELA for CTO with severe calcification or long-segment ISR lesions, the capture rate of macrodebris was as high as 60.0%, and the former was significantly higher than ELA for CTO without high calcification lesions ( P<0.05). Conclusion:ELA or PMT under the DEFP in treatment of peripheral artery disease appears to be of great significance in preventing DE.

以金属为骨架、水泥为主体的人工鱼礁(ARs)作为近海商业养殖和生态恢复的新方式,为海洋高等生物及微生物提供了适宜的生境,是海洋中的生物多样性热点,在生态系统健康和珍稀动物保护上具有重要意义.目前的研究多集中于人工鱼礁材料结构以及经济鱼类数量的变化,而忽视了微生物在人工鱼礁生物膜中的作用,同时近海频繁的渔业活动和船舶往来产生的油污污染可能威胁到人工鱼礁生物群落的稳定.为此,本研究以中国山东庙岛海洋牧场示范区为研究区,利用宏基因组和扩增子测序技术,探究了人工鱼礁不同材质间生物膜微生物组的差异及其对油污污染的响应,涉及病毒、古菌、细菌与真菌.结果表明,金属材质和水泥材质间的生物膜微生物组在群落组成和功能上差异较小.油污污染增加了人工鱼礁两种材质生物膜细菌(0.2％)、古菌(96.9％)和病毒(194.0％)界水平的相对丰度,但降低了生物膜微生物组功能基因的丰度,且水泥材质生物膜微生物组对油污污染的响应更为敏感(金属材质为-6.8％,水泥材质为-20.8％).本研究对于人工鱼礁材料的选择以及人工鱼礁区的渔业活动、生物保护和生态系统循环认识有一定的指导作用.

Objective:To evaluate the effect of Rotarex in peripheral arterial disease (PAD).Methods:The clinical data of 90 PAD patients treated with Rotarex from Aug 2018 to Feb 2020 were retrospectively analyzed.Results:Among the 90 patients, 45 patients had atherosclerotic obliterans complicated with acute thrombosis (ASOCAT), 27 patients had graft restenosis or reocclusion, 16 patients had primary or embolism-induced thrombosis, 2 patients had traumatic or iatrogenic arterial occlusion. Except for 2 patients undergoing hybrid surgery, 88 patients underwent endovascular treatment. Two patients died perioperatively. Within 12 months follow-up, 2 patients died, 4 patients underwent major amputation, target arteries of 10 patients were re-stenosed or re-occluded and 5 patients were lost to follow-up. Compared with the preoperative ankle-branchial index (ABI), significant increase was observed in the 12-month ABI (0.80±0.22 vs. 0.43±0.16, P<0.01). The 12-month restenosis/re-occlusion-free rate was 82.7%, and the 12-month major amputation-free survival (MAFS) was 91.6%. Conclusion:For PAD patients, acceptable outcomes can be achieved with reasonable use of Rotarex for debulking, combined with balloon, stent and other techniques to correct the residual lesions.

Objective:To discuss the clinical treatment for arteriosclerosis obliterans combined with acute thrombosis (ASOCAT) of lower extremities.Methods:The treatment methods and results of 30 patients with ASOCAT admitted to our center from Jan 2009 to May 2019 were retrospectively analyzed.Results:The course of acute thrombosis in 30 patients was (9.5±5.2) days, and the average course of ASO was (2.1±1.4) years. Among 30 patients, 13 patients had aortoiliac occlusion (type Ⅰ), and 17 patients had femoropopliteal lesion (type Ⅱ). Twenty-eight patients underwent endovascular treatment, 1 had hybrid operation, and 1 was given aorto-bilateral femoral bypass. One patient died perioperatively. 24 patients were followed up for (16.3±16.1) months. One died during follow-up.Two patients underwent above-knee amputation within 6 months. Two patients had distal superficial femoral artery reocclusion within 12 months. The restenosis/reocclusion rates within 12 months of type Ⅰ and Ⅱ patients were 12.5% and 21.4%, respectively. The 6/12-month amputation-free survival rates for type Ⅰ and type Ⅱ were 87.5%/87.5% and 92.8%/85.7%, respectively.Conclusion:Reasonable and active use of open surgery, endovascular treatment or hybrid operation could achieve acceptable outcomes in patients with ASOCAT.

急性下肢缺血(ALLI)作为血管外科常见的急重症,具有起病急、缺血重、进展迅速的特点,严重威胁病人的肢体甚至生命.因此,对于ALLI,快速准确的诊断有利于争取时间挽救肢体.确诊后对病人及患肢的情况进行整体评估,进行充分的术前药物管理,根据评估结果,酌情选择开放、腔内或复合手术重建血流.鉴于ALLI病因复杂,且病人常合并各种基础疾病,对于ALLI的准确诊断及治疗方式的选择颇具挑战.

AIM:To establish a reversed-phase HPLC method with fluorescence detection for determination of the concentration of propofol in human plasma. METHODS: Agilent 1100 HPLC instrument was used with the column : Diamonsil C 18(150 mm×4.6 mm,5 μm), Phenomenex Security Guard column(4 mm×3 mm). Plasma samples were precipitated with the thymol (internal standard) methanol solution. 20 μL of supernatant fluid was injected for HPLC analysis. The mobile phase was composed of acetonitrile-water(56:44,V/V).The flow rate was 1.5 mL·min -1. The fluorescence detective wavelengths were: λ ex=276 nm, λ em=312 nm. RESULTS: The standard curve equation was Y= 1.787C- 0.031 (r= 0.9997,n=9).The linear range was (0.02—8.0) mg·L -1. The average recovery was 98.71 %.Intra- and inter-day precision(RSD%) were all less than 4.2 %. The limit of detection was 4 μg·L -1(S/N=2). CONCLUSION:The RP-HPLC method is simple, sensitive and accurate for monitoring propofol concentration in clinical plasma samples.