coil embolization for an extracranial

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高中生物竞赛细胞生物学专业词中英文对照(1-3章)

细胞生物学专业词中英文对照第一章细胞学——Cytology细胞生物——Cell biology细胞学说——Cell theory原生质——protoplasm原生质体——protoplast有丝分裂——mitosis福尔根反应——Feulgen reaction哺乳动物雷帕霉素靶蛋白——mammalian target of rapamycin (mTOR)支原体——mycoplast真核细胞——rucaryotic cell真核生物——procaryote原核细胞——prokaryotic cell原核生物——prokaryote类群、域——domain古核细胞——archaea古核生物——archaeon古细菌——archaebacteria真细菌——eubacteria鞭毛——flagellum鞭毛蛋白——flagellin类核——nucleoid质粒——plasmid管蛋白——tubulin蓝细菌——cyanobacteria类囊体——thylakoid异形胞——heterocyst直系同源基因——orthologous gene 盐细菌——halobacteria热源体——thermoplasma硫氧化菌——sulfolobus核小体——nucleosome核纤层——nuclear lamina核纤层蛋白——lamin核基质——nuclear matrix纳米生物学——nanobiology自我装配——self-assembly协助装配——aided-assembly直接装配——direct-assembly次生代谢产物——secondary metabolite天然产物——natural product衣壳——capsid核壳体——nucleocapsid囊膜——envelope第二章光学显微镜——light microscope分辨率——resolution相差显微镜——phase-contrast microscope微分干涉显微镜——differential-interference microscope录像增差显微镜——video-enhance microscope荧光显微镜——fluorescence microscope绿色荧光蛋白——green fluorescent protein, GFP激光扫描共焦显微镜——laser scanning confocal microscope, LSCM全内反射荧光显微术——total internal reflection fluorescence microscopy 光激活定位显微术——photoactivated localization microscopy, PALM随机光学重构显微术——stochastic optical reconstruction microscopy受激发射损耗显微术——stimulated emission depletion microscopy结构照明显微术——structured-illumination microscopy, SIM电子显微镜——electron microscope, EM电荷耦合器件——charge-coupled device, CCD超薄切片——ultrathin section负染色技术——negative staining冷冻蚀刻技术——frezze etching快速冷冻深度蚀刻技术——quick freeze deep etching低温电镜技术——cryo-electron microscopy单颗粒分析技术——single particle analysis电子断层成像技术——electron tomography背散射电子成像——back scattered electron imaging扫描电镜——scanning electron microscope, SEM光-电关联技术——correlative light microscopy and electron microscopy 扫描隧道显微镜——Scanning tunnel microscope, STM原子力显微镜——atomic force microscope, AFM免疫印记——western blotting放射免疫沉淀——radioimmuno-precipitation原位杂交——in situ hybridization流式细胞术——flow cytometry原代细胞——primary culture cell传代细胞——subculture cell单层细胞——single layer cell细胞系——cell line有限细胞系——finite cell line永生细胞系——infinite cell line连续细胞系——continuous cell line细胞株——cell strain成纤维样细胞——fibroblast like cell上皮样细胞——epithelial like cell外殖体——explant愈伤组织——callus细胞融合——cell fusion电融合技术——electrofusion methodB淋巴细胞杂交瘤技术——B-lymphocyte hybridoma technique 单克隆抗体——monoclonal antibody胞质体——cytoplast核质体——karyoplast细胞松弛素B——cytochalasin B显微操作——micromanipulation微量注射——microinjection荧光漂白恢复技术——fluorescence photobleaching recovery, FPR 荧光恢复——fluorescence recovery酵母双杂交系统——yeast two-hybrid systemDNA结合域——DNA binding domain转录激活域——activation domain荧光共振能量转移——fluorescence resonance energy transfer, FRET 放射自显影技术——autoradiography第三章细胞质膜——plasma membrane细胞内膜系统——internal membrane生物膜——biomembrane单位膜模型——unit membrane model流动镶嵌模型——fluid mosaic model菌紫红质——bacteria rhodopsin脂筏模型——lipid raft model辛德毕斯病毒——sindbis virus, SbV甘油磷脂——glycerophosphatide鞘脂——sphingolipid固醇——sterol磷脂酰胆碱——phosphatidylcholine, PC(卵磷脂)磷脂酰乙醇胺——phosphatidylethanolamine, PE磷脂酰丝氨酸——phosphatidyserine, PS磷脂酰肌醇——phosphaditylinositol, PI心磷脂——cardiolipin鞘磷脂——sphingomyelin, SM磷脂——phospholipid豆固醇——stigmasterol麦角固醇——ergosterol翻转酶——flippase脂质体——liposome微团——micelle膜蛋白——membrane protein周边膜蛋白——peripheral membrane protein外在膜蛋白——extrinsic membrane protein整合膜蛋白——integral membrane protein内在膜蛋白——intrinsic membrane protein脂锚定膜蛋白——lipid-anchored membrane protein 磷脂酶——phospholipase蛋白聚糖——proteoglycan磷脂酰肌醇糖脂——glycosylphosphaditylinositol跨膜蛋白——transmembrane protein单次跨膜蛋白——single-pass transmembrane protein 多次跨膜蛋白——multipass transmembrane protein 孔蛋白——porin卷曲结构——coiled-coil水孔蛋白——aquaporin去垢剂——detergent微团临界浓度——critical micelle concentration,CMC相变温度——phase transition temperature扩散常数——diffusion constant细胞外表面——extrocytoplasmic surface, ES外小叶——outer leaflet原生质表面——protoplasmic surface, PS内小叶——inner leaflet细胞外小叶断裂面——extrocytoplasmic face，EF原生质小叶断裂面——protoplasmic face，PF脂肪细胞——adipocyte鞭毛——flagellum纤毛——cilium微绒毛——microvillus膜相关的细胞骨架——membrane associated cytoskeleton 肌动蛋白——actin基于肌动蛋白的膜骨架——actin-based membrane skeleton 细胞皮层——cortex血影——ghost血影蛋白（或红膜肽）——spectrin锚蛋白——ankyrin血型糖蛋白——glycoprotein内收蛋白——adducin阀蛋白——flotillin膜脂微区——membrane lipid microdomain 阿尔兹海默症——Alzheimer disease。

椎动脉颅内段夹层动脉瘤介入治疗

椎动脉颅内段夹层动脉瘤介入治疗【摘要】目的：总结椎动脉颅内段夹层动脉瘤的介入治疗策略及治疗效果。

方法：回顾性分析2012年10月-2015年8月徐州医学院附属医院介入科收治的16例颅内椎动脉夹层动脉瘤患者资料，就其介入治疗策略作回顾总结，通过❷底旨跤澳匝❷管造影及临床随访观察其治疗效果。

结果：7例无蛛网膜下腔出血，9例临床表现为自发性蛛网膜下腔出血。

采取椎动脉内支架之置入辅助弹簧圈栓塞12例, 2例因夹层累及小脑后下动脉而将支架置于小脑后下动脉内后闭塞动脉瘤，2例采用闭塞载瘤动脉治疗。

术后1例因急性脑积水行脑室腹腔分流术。

15例恢复良好，死亡1例；6 个月后7例DSA随访，未见动脉瘤显影。

结论：积极采取保留或闭塞载瘤动脉的介入方法治疗椎动脉颅内段夹层动脉瘤取得较好的临床效果，远期效果需要进一步观察【关键词】椎动脉；夹层动脉瘤；支架置入；弹簧圈Interventional Treatment for Intracranial VertebralArtery Dissecting Aneurysms/CUI Yan-feng, ZU Mao-heng, GU Yu-ming, et al. //Medical Innovation of China, 2016, 13 (35)： 113-117[Abstract] Objective：To evaluate the treatment strategies and clinical efficacy of interventional therapyfor intracranial vertebral artery dissecting aneurysms. Method : A retrospective analysis was performed of clinical data from 16 patients with intracranial vertebral artery dissecting aneurysms treated in the Department of Interventional Radiology, Xuzhou Medical College Hospital from October 2012 to August 2015. All patients were treated with coil embolization of aneurysms. DSA , CT and clinical follow-up were conducted to observe the therapeutic efficacy of intracranial vertebral artery dissecting aneurysms. Modified RANKIN Scale ( mRS ) scores at hospital discharge were used to evaluate the prognosis of patients. Result : All 16 cases were successful treated without bleeding complication during the operation. 12 aneurysms were treated by stent-assisted coiling, 2 aneurysms was treated by st ent impla nted in PICA and then aneurysm occlusion with coils, 2 aneurysms was treated by proximal vertebral artery and aneurysm occlusion with coils.1 case died after operation. An acute hydrocephalus occurred in 1 case after operation and ventriculoperitoneal shunt was performed・ During the follow up 1-24 months, there was no recurrence of bleeding and infarction. 7 cases were followed up by angiography , DSA showed that 7 aneurysms were disappeared. Conclusion:Interventional treatment of intracranial vertebral artery dissecting aneurysms is feasiable.The selective method of interventional treatment according to the characteristics of aneurysm is safe and effective.【Key words] Vertebral artery；Dissecting aneurysm；Stent implantation； CoilFirst-author' ❷发3讨论自发性椎动脉-基底动脉夹层动脉瘤的年发生率在（1〜10）/万人口[3], 80%发生在30〜50岁人群。

介孔聚多巴胺介导催化

介孔聚多巴胺介导催化下载温馨提示：该文档是我店铺精心编制而成，希望大家下载以后，能够帮助大家解决实际的问题。

文档下载后可定制随意修改，请根据实际需要进行相应的调整和使用，谢谢!并且，本店铺为大家提供各种各样类型的实用资料，如教育随笔、日记赏析、句子摘抄、古诗大全、经典美文、话题作文、工作总结、词语解析、文案摘录、其他资料等等，如想了解不同资料格式和写法，敬请关注!Download tips: This document is carefully compiled by the editor. I hope that after you download them, they can help you solve practical problems. The document can be customized and modified after downloading, please adjust and use it according to actual needs, thank you!In addition, our shop provides you with various types of practical materials, suchas educational essays, diary appreciation, sentence excerpts, ancient poems, classic articles, topic composition, work summary, word parsing, copy excerpts, other materials and so on, want to know different data formats and writing methods, please pay attention!标题：介孔聚多巴胺介导催化：新颖纳米材料在催化领域的应用摘要：催化技术一直是化学领域的热点之一，其在环境保护、能源转化等方面发挥着重要作用。

益生菌对阿尔茨海默病作用的研究进展

益生菌对阿尔茨海默病作用的研究进展发布时间：2021-12-14T06:08:15.523Z 来源：《中国结合医学杂志》2021年12期作者：宋鑫萍1,2，李盛钰2，金清1[导读] 阿尔茨海默病已成为威胁全球老年人生命健康的主要疾病之一，患者数量逐年攀升，其护理的经济成本高，给全球经济造成重大挑战。

近年来研究显示，益生菌在适量使用时作为有益于宿主健康的微生物，在防治阿尔茨海默病方面具有积极影响，其作用机制可能通过调节肠道菌群，影响神经免疫系统，调控神经活性物质以及代谢产物，通过肠-脑轴影响该病发生和发展。

宋鑫萍1,2，李盛钰2，金清11.延边大学农学院，吉林延吉 1330022.吉林省农业科学院农产品加工研究所，吉林长春 130033摘要：阿尔茨海默病已成为威胁全球老年人生命健康的主要疾病之一，患者数量逐年攀升，其护理的经济成本高，给全球经济造成重大挑战。

本文综述了近几年来国内外益生菌对阿尔茨海默病的作用进展，以及其预防和治疗阿尔茨海默病的潜在作用机制。

关键词：益生菌；阿尔茨海默病；肠道菌群；机制Recent Progress in Research on Probiotics Effect on Alzheimer’s DiseaseSONG Xinping1,2，LI Shengyu2，JI Qing1*(1.College of Agricultural, Yanbian University, Yanji 133002，China)(2.Institute of Agro-food Technology, Jilin Academy of Agricultural Sciences, Chanchun 130033, China)Abstract：Alzheimer’s disease has become one of the major diseases threatening the life and health of the global elderly. The number of patients is increasing year by year, and the economic cost of nursing is high, which poses a major challenge to the global economy. In recent years, studies have shown that probiotics, as microorganisms beneficial to the health of the host, have a positive impact on the prevention and treatment of Alzheimer’s disease. Its mechanism may be through regulating intestinal flora, affecting the nervous immune system, regulating the neuroactive substances and metabolites, and affecting the occurrence and development of the disease through thegut- brain axis. This paper reviews the progress of probiotics on Alzheimer’s disease at home and abroad in recent years, as well as its potential mechanism of prevention and treatment.Key words：probiotics; Alzheimer’s disease; gut microbiota; mechanism阿尔茨海默病（Alzheimer’s disease, AD），系中枢神经系统退行性疾病，属于老年期痴呆常见类型，临床特征主要包括：记忆力减退、认知功能障碍、行为改变、焦虑和抑郁等。

用于到达派亚氏淋巴结的口服生物活性剂的制法和配方[发明专利]

专利名称：用于到达派亚氏淋巴结的口服生物活性剂的制法和配方
专利类型：发明专利
发明人：T·R·泰斯,J·K·斯泰斯,R·M·吉利,J·H·埃尔德里奇
申请号：CN95100893.5
申请日：19880409
公开号：CN1111157A
公开日：
19951108
专利内容由知识产权出版社提供
摘要：本发明有关口服生物活性剂的方法和配方，这生物活性剂包括将活性剂在一种或多种可生物降解和生物相容的聚合物或共聚物赋形剂中胶囊化以形成微胶囊。

这种微胶囊能够不受影响的通过胃肠道且被派亚氏淋巴结所吸收。

申请人：南方研究所,UAB研究基金会
地址：美国阿拉巴马州
国籍：US
代理机构：中国专利代理(香港)有限公司
代理人：姜建成
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多环芳烃进入人体途径英语作文

多环芳烃进入人体途径英语作文Polycyclic aromatic hydrocarbons (PAHs) are a group of chemicals that can enter our bodies in various ways. One way is through inhalation. You know, when we breathe in polluted air from factories or traffic, PAHs can be among the particles we take in. These chemicals are lightweight and easily float in the air, so they can be breathed in deeply into our lungs.Another route for PAHs to enter our bodies is through the food we eat. PAHs can contaminate soil and water, which in turn affect the crops and fish we consume. Grains, vegetables, and even meat from animals that have grazed in contaminated areas can carry PAHs. Cooking these foods at high temperatures, like grilling or barbecuing, can even increase the amount of PAHs they contain.Skin contact is another means for PAHs to enter our bodies. Imagine walking barefoot on an oily pavement or coming into contact with tar-soaked soil. PAHs can adhereto our skin and be absorbed through our pores or through minor cuts and abrasions. This is why it's important to wash your hands and feet thoroughly after being outdoors in potentially contaminated areas.Occasionally, PAHs can even enter our bodies through drinking water. Groundwater and surface water can be contaminated with PAHs from industrial waste or runoff from oil spills. Drinking such water without proper filtration can expose us to these harmful chemicals.So, as you can see, PAHs can sneak into our bodies through multiple pathways. It's crucial to be aware of these risks and take steps to minimize our exposure to these potentially harmful compounds.。

用于治疗哮喘和慢性阻塞性肺病的新5,6-二氢吡唑并[3,4-e][1,4]二氮杂

专利名称：用于治疗哮喘和慢性阻塞性肺病的新5,6－二氢吡唑并[3,4－e][1,4]二氮杂－4(1H)－酮衍生物专利类型：发明专利
发明人：克里斯特·亨里克森,安妮娅·利西厄斯,彼得·肖,彼得·斯托姆
申请号：CN200680045407.X
申请日：20061002
公开号：CN101321758A
公开日：
20081210
专利内容由知识产权出版社提供
摘要：本发明涉及式(I)化合物，其中各基团如在本申请中所定义；涉及制备这种化合物的方法；并且涉及这种化合物在治疗PDE4介导的病症中的用途。

申请人：阿斯利康(瑞典)有限公司
地址：瑞典南泰利耶
国籍：SE
代理机构：北京市柳沈律师事务所
代理人：封新琴
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用于治疗心律失常的新的氧杂桥接哌啶化合物[发明专利]

专利名称：用于治疗心律失常的新的氧杂桥接哌啶化合物专利类型：发明专利
发明人：M·比约尔斯尼,D·克拉丁贝尔,F·庞藤,G·斯特拉伦德申请号：CN01816721.7
申请日：20011001
公开号：CN1468244A
公开日：
20040114
专利内容由知识产权出版社提供
摘要：本发明提供4－({3－[7－(3，3－二甲基－2－氧代丁基)－9－氧杂－3，7－二氮杂双环[3.3.1]壬－3－基]丙基}氨基)苄腈，苯磺酸盐，所述化合物用于预防和治疗心律失常，尤其是房性和室性心律失常。

申请人：阿斯拉特曾尼卡有限公司
地址：瑞典南泰利耶
国籍：SE
代理机构：中国专利代理(香港)有限公司
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具有包囊的卵磷脂材料的食物产品[发明专利]

专利名称：具有包囊的卵磷脂材料的食物产品
专利类型：发明专利
发明人：宗熙·A·沈,阿曼多·J·卡斯特罗,迈克·卡蒂佐内,布鲁诺·帕多瓦尼,戴维·G·巴卡洛,夏晓虎
申请号：CN200780028689.7
申请日：20070725
公开号：CN101494996A
公开日：
20090729
专利内容由知识产权出版社提供
摘要：本发明涉及一种组合物，其包括含有磷脂的第一成分以及将所述第一成分包囊的第二成分。

该组合物包含约10％－约80％重量份的磷脂。

该组合物可以用在口香糖中以提供不黏附至混凝土并且咀嚼时不在口中溶解的口香糖。

申请人：WM.雷格利JR.公司
地址：美国伊利诺伊州
国籍：US
代理机构：中原信达知识产权代理有限责任公司
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颈动脉彩超联合CTA评估脑梗死发生危险度预测意义研究

·7CHINESE JOURNAL OF CT AND MRI, MAY. 2024, Vol.22, No.5 Total No.175【通讯作者】徐燕红S i g n i f i ca n ce o f C a rot i d8·中国CT和MRI杂志　2024年5月第22卷第5期总第175期颈动脉狭窄程度评估：轻度狭窄：P S V ＜125c m /s ，E D V ＜40cm/s，PSV1/PSV2＜2，狭窄率为0%~49%；中度狭窄：125≤PSV＜230cm/s，40≤EDV＜100cm/s，2≤PSV1/PSV2＜4，狭窄率为50%~69%；重度狭窄：PSV≥230cm/s，EDV≥100cm/s，PSV1/PSV2≥4，狭窄率为70%~100%。

斑块性质评估：经颈动脉超声显示，软斑：CT值＜50HU，低回声；硬斑：CT值＞120HU，强回声伴声影；混合斑块：CT值为50~119HU，回声强弱不定。

斑块总积分(Crouse积分)：排除斑块长度影响，将孤立性斑块最大厚度相加，获取两侧颈动脉斑块厚度和，即为Crouse积分，如IMT厚度均小于1.2mm，则Crouse积分为0。

1.3 观察指标 (1)两组一般资料；(2)两组颈动脉彩超、CTA检查结果；(3)分析脑梗死发生的相关因素；(4)分析颈动脉彩超、CTA 对脑梗死发生危险度的评估价值。

1.4 统计学方法态分布的计量资料用(χ-±s )表示，两组间比较采用t检验，计数资料用n(%)表示，两组间比较行χ2检验，采用Logistic回归方程分析相关影响因素，评估价值分析采用ROC曲线，随机森林图模型分析脑梗死发生危险度变量的重要性排序，R语言绘制脑梗死发生危险度的列线图，DCA曲线评价列线图的临床效用，默认双侧检验，α=0.05。

2 结　果2.1 两组一般资料比较两组年龄、性别、体质量指数、高血压、高脂血症、冠心病、糖尿病、吸烟、饮酒资料比较均衡可比(P >0.05)。

Pipeline Flex Embolization Device（PVED）用户指南说明书

Results53consecutive elective patients with63aneurysms located in the anterior(87%),posterior(9%),and extracranial (4%)circulations were included.A total of65devices were inserted.Of the anterior circulation aneurysms,14%had the PVED implanted distal to the circle of Willis.Additional coil embolisation was performed in20%of the aneurysms and in-stent balloon angioplasty in6%(performed to improve device opening and proximal wall apposition),which was considered a technical alteration to previous generation Pipeline Embolisa-tion device(PED)deployment at our institution.All patients were discharged without neurological deficits.One patient developed transient contralateral hand weakness during the immediate post-operative period,which resolved24hours post procedure.At45days following the procedure,the mor-bidity and mortality were0%.Occlusion rates at one month was40%,at three months60%and at6months75%. Conclusion The new PVED demonstrates improved device visi-bility,pushability,ease to resheath and precise distal opening with overall good performance,safety and encouraging early aneurysm occlusion rates.The implant requires a modified deployment technique for successful opening of the proximal stent and required balloon angioplasty in a small proportion of cases to optimise proximal device opening and wall apposition.REFERENCES1.Starke RM,Turk A,Ding D,et al.Technology developments in endovascular treat-ment of intracranial aneurysms.J Neurointerv Surg.2016Feb;8(2):135–44.doi:10.1136/neurintsurg-2014-011475.Epub2014Nov20.PMID:25412618.2.Vollherbst DF,Cekirge HS,Saatci I,et al.First clinical multicenter experience withthe new Pipeline Vantage flow diverter.Journal of NeuroInterventional Surgery.Published Online First:16February2022.doi:10.1136/neurintsurg-2021-018480 Disclosures H.Rice:1;C;Medtronic,Stryker,LifeHealthcare. 2;C;Medtronic,Stryker,LifeHealthcare.V.Carraro do Nas-cimento:None.L.de Villiers:1;C;Medtronic,Stryker,Life-Healthcare.2;C;Medtronic,Stryker,LifeHealthcare.E-254EVALUATION OF BRUCH’S MEMBRANE IN THEMANAGEMENT OF IDIOPATHIC INTRACRANIALHYPERTENSIONO Goren.Neurosurgery,Geisinger Health,Danville,PA10.1136/neurintsurg-2022-SNIS.365Venous sinus stenting(VSS)for idiopathic intracranial hyper-tension(IIH)has been demonstrated to achieve significant symptom improvement while harboring a low peri-interven-tional morbidity prehensive neuro-ophthalmologi-cal monitoring represents a cornerstone of disease monitoring. Bruch’s membrane is the innermost membrane of the choroid of the eye.It is assessed by optical coherence tomography (OCT)and is currently used as a tool to help manage patients suffering from glaucoma.The value of assessing Bruch’s mem-brane in IIH requires further exploration.T wenty-one patients with IIH who underwent VSS between04/2018and04/2022 were retrospectively reviewed.Clinical and radiological were analyzed.Neuro-ophthalmological data included visual acuity, visual fields,fundoscopy categorized via Frisén scale,and OCT obtained both Bruch’s membrane.Bruch’s membrane and RNFL thickness were recorded pre-VSS as a baseline and post VSS at post-operative days1,30,90,180.After TSST,man-ometry showed a significant reduction of maximum transverse sinus pressures and trans-stenotic gradient pressures.Chronic headaches,visual disturbance,and pulsatile tinnitus improved significantly.The OCT calculated RNFL thickness significantly decreased in all patients.Stratification according to a minimal-low degree(Frisén1–2)and moderate-marked degree(Frisén 3–4)papilledema demonstrated a significant reduction of RNFL thickness in both groups.Bruch’s membrane analysis correlated with OCT findings and clinical follow-up.Venous sinus stenting provides favorable clinical and neuro-ophthalmo-logical outcomes.This study demonstrates that neuro-ophthal-mologic testing augmented with OCT and Bruch’s membrane evaluation provides objective data that can be used as a bio-marker for treatment success for managing patients with dif-ferent extents of papilledema and may inform patient management.Disclosures O.Goren:None.E-255CATHETER BLOOD VESSEL RATIO FOR MIDDLECEREBRAL ARTERY OCCLUSIONS REQUIRINGMECHANICAL THROMBECTOMY:A PROPENSITYADJUSTED ANALYSISJ Catapano,A Naik,M Pacault,R Sigh,H Stonnington,I Rangel,S Koester,E Winkler, S Desai,A Jadhav,F Albuquerque,A Ducruet.Neurosurgery,BNI,Phoenix,AZ10.1136/neurintsurg-2022-SNIS.366Background Mechanical thrombectomy is considered a gold standard procedure for the management of large vessel occlu-sions in the acute stroke setting.There are currently no guide-lines present to select optimal catheter diameter,and such decisions are based on surgeon preference and experience.In this study,we seek to determine whether catheter-blood ves-sel-ratio(CVR)is predictive of reperfusion and patient out-comes including post-procedure intracerebral hemorrhage (ICH)for patients undergoing mechanical thrombectomy. Methods A retrospective analysis was performed of all patients with a proximal middle cerebral artery(M1)occlusion at a large comprehensive stroke center who underwent a mechani-cal thrombectomy from1/1/2020to6/30/2021.Study included patients with an available pre-intervention axial CTA in which cross-sectional diameter was measured of the occluded M1proximally.An aspiration catheter outside diame-ter and vessel cross-sectional diameter ratio(CVR)was calcu-lated.Patients were grouped and compared based on a CVR threshold of0.9.Additional data extracted for analysis included:demographics,occlusion characteristics,intraoperative and post-operative management,and in-hospital and discharge outcomes.Univariate statistics used Welch’s two-sample t-test for continuous data and chi-squared test for frequency-based variables.Multivariate analysis used multivariate linear and Firth’s logistic regression.A propensity-score adjustment was used consisting of age,gender,admission NIHSS,ASPECT score,prior anti-coagulation,or anti-platelet use,TPA usage, and systolic blood pressure.Results During the19-month study period,60patients met inclusion criteria with25patients(42%)found to have CVR 0.9(vs35(58%)with CVR<0.9).There was no dif-ference between cohorts in demographics or patient presenta-tion on univariate analysis.Of the25patients with a CVR 0.9,8%(N=2)had>2passes compared to20%(N=7 of35)in the CVR<0.9cohort(p=0.22).Puncture to revas-cularization time,admission NIHSS,and discharge NIHSSA218J NeuroIntervent Surg2022;14(Suppl1):A1–A248 on December 24, 2023 by guest. Protected by copyright./ J NeuroIntervent Surg: first published as 10.1136/neurintsurg-2022-SNIS.365 on 23 July 2022. Downloaded from。

NV Onyx 液体堵塞系统编码和支付指南 2023说明书

Onyx TM liquid embolic systemCoding and payment guide 2023Table of contentsICD-10 codes (3)Physician coding and payment (4)Hospital inpatient coding and payement (6)7References and notes.............................................................................................................................ICD-10 codesICD-10-PCS procedure codes1ICD-10-PCS procedure codes are used by hospitals to report surgeries and procedures performed in the inpatient setting.ICD-10-PCS code Code descriptionOnyx™ les procedure for arteriovenous malformation2,3,403LG3DZ Occlusion of intracranial artery with intraluminal device, percutaneous approach Cerebral arteriographyB31R1ZZ Fluoroscopy of intracranial arteries using low osmolar contrastB31RYZZ Fluoroscopy of intracranial arteries using other contrast5Physician coding and paymentEffective January 1, 2023 - December 31, 2023CPT® procedure codes 11Physicians use CPT codes for all services. Under Medicare’s Resource-Based Relative Value Scale (RBRVS) methodology for physician payment, each CPT code is assigned a point value, known as the relative value unit (RVU), which is then converted to a flat payment amount.CPT code 12Code descriptionMultiple procedure discounting 13 Medicare RVUs (facility setting)14,15Medicare national average (facility setting)15,16Onyx™ les embolization procedure 1761624Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method, central nervous system (intracranial, spinal cord)Yes 34.55$1,17175894-26Transcatheter therapy, embolization, any method, radiological supervision and interpretationNo2.10$71Pre-procedural balloon occlusion test 1861623Endovascular temporary balloon arterial occlusion, head or neck (extracranial/ intracranial) including selective catheterization of vessel to be occluded, positioning and inflation of occlusion balloon, concomitant neurological monitoring, and radiologic supervision and interpretation of all angiography required for balloon occlusion and to exclude vascular injury post occlusionYes 17.16$582Cerebral angriography 19,2036224Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated radiologicalsupervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch when performedYes 10.83$36736226Selective catheter placement, vertebral artery,unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch when performedYes 10.76$364+36228Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological supervision and interpretation (eg, middle cerebral artery, posterior inferior cerebellar artery)No 7.26$246Physician coding and payment - CPT® procedure codes 11 (continued)CPT code Code descriptionMultiple procedure discounting 15Medicare RVUs (facility setting)16,17Medicare national average (facility setting)17,18Catherization 2136216Selective catheter placement, arterial system, initialsecond order thoracic or brachiocephalic branch, within a vascular familyYes 7.90$26836217Selective catheter placement, arterial system, initial third order or more selective thoracic or brachiocephalic branch, within a vascular familyYes9.66$327Complete angiography 2275898-26Angiography through existing catheter for follow-up study for transcatheter therapy, embolization, or infusion other than for thrombolysisNo 2.67$90Hospital inpatient coding and paymentEffective October 1, 2022 - September 30, 2023MS-DRG assignmentsUnder Medicare’s MS-DRG methodology for hospital inpatient payment, each inpatient stay is assigned to one of about 765 diagnosis-related groups, based on the ICD-10-CM codes assigned to the diagnoses and ICD-10-PCScodes assigned to the procedures. Each MS-DRG has a relative weight that is then converted to a flat payment amount. Implanted devices are typically included in the flat payment and are not paid separately. Only one MS-DRG is assigned for each inpatient stay, regardless of the number of procedures performed. MS-DRGs shown are those typically assigned to the following scenarios.MS-DRG6MS-DRG title6,7Relativeweight 6Geometric mean length of stay 6Subject to PACT 6,8Medicare national average 9Ruptured brain arteriovenous malformation with hemmorrhage020Intracranial vascular procedures W principal diagnosis of hemorrhage W MCC9.303310.7No $63,816021Intracranial vascular procedures W principal diagnosis of hemorrhage W CC6.78928.1No $46,571022Intracranial vascular procedures W principal diagnosis of hemorrhage WO CC/MCC4.3585 3.2No $29,897Non-ruptured brain arteriovenous malformation025Craniotomy and endovascular intracranial procedures W MCC4.5405 6.6Yes $31,146026Craniotomy and endovascular intracranial procedures W CC3.0235 3.6Yes $20,740027Craniotomy and endovascular intracranial procedures WO CC/MCC2.49541.8Yes$17,117HCPCS device codes 10HCPCS device codes are assigned by the entity that purchased and supplied the device to the patient. In the case of Onyx™ liquid embolic system, that is the hospital. However, hospitals assign HCPCS device codes only when the device is provided in the hospital outpatient setting. HCPCS device codes cannot be assigned or billed for procedures performed in the inpatient setting. If a hospital wishes to assign a HCPCS device code for an inpatient case for internal purposes only, such as for tracking, please refer to the Addendum: HCPCS Device Codes at https:///us-en/healthcare-professionals/reimbursement/neurovascular.html .References and notes1. Centers for Medicare & Medicaid Services. International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS). https:///medicare/icd-10/2023-icd-10-pcs. Updated October 1, 2022.2. In code 03LG3DZ, the fourth character represents the body part. G-Intracranial Artery includes the basilar artery, intracranial portion of the internal carotid artery (petrousto the superior hypophyseal segment), intracranial portion of the vertebral artery, and middle cerebral artery, as well as the anterior cerebral artery and posterior cerebral artery, per the ICD-10-PCS Body Part Key. See also Coding Clinic, 1st Q 2016, p.19.3. Root operation L-Occlusion is used because the objective in treating an AVM is to prevent blood flow between vein and artery by completely closing the unnaturalconnection. Coding Clinic, 4th Q 2014, p.37.4. Onyx™ is considered a device for coding purposes because, while applied as a liquid, it solidifies after application per Coding Clinic, 4th Q 2014, p.37.5. Fifth character Y-Other Contrast can be used for iso-osmolar contrast, eg, Visipaque. Coding Clinic 3rd Q 2016, p.36.6. Centers for Medicare & Medicaid Services. Medicare Program: Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Policy Changes andFY2023 Rates Final Rule 87 Fed. Reg. 48780-49499. https:///content/pkg/FR-2022-08-10/pdf/2022-16472.pdf Published August 10, 2022. Correction Notice 87 Fed. Reg. 66558-66575. https:///content/pkg/FR-2022-11-04/pdf/2022-24077.pdf Published November 4, 2022.7. W MCC in MS-DRG titles refers to secondary diagnosis codes that are designated as major complications or comorbidities. MS-DRGs W MCC have at least one majorsecondary complication or comorbidity. Similarly, W CC in MS-DRG titles refers to secondary diagnosis codes designated as other (non-major) complications or comorbidities, and MS-DRGs W CC have at least one other (non-major) secondary complication or comorbidity. MS-DRGs WO CC/MCCs have no secondary diagnoses that are designated as complications or comorbidities, major or otherwise. Note that some secondary diagnoses are only designated as CCs or MCCs when the conditions were present on admission, and do not count as CCs or MCCs when the conditions are acquired in the hospital during the stay.8. Post-Acute Care Transfer (PACT) status refers to selected DRGs in which payment to the hospital may be reduced when the patient is discharged by being transferredout. The DRGs impacted are those marked “Yes” and the patient must be transferred out before the geometric mean length of stay to certain post-acute care providers, including rehabilitation hospitals, long term care hospitals, skilled nursing facilities, hospice, or to home under the care of a home health agency. When these conditions are met, the DRG payment is converted to a per diem and payment is made at double the per diem rate for the first day plus the per diem rate for each remaining day up to the full DRG payment.9. Payment is based on the average standardized operating amount ($6,375.74) plus the capital standard amount ($483.79). Centers for Medicare & Medicaid Services.Medicare Program: Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Policy Changes and FY2023 Rates. Final Rule 87 Fed Reg 49429-49430 https:///content/pkg/FR-2022-08-10/pdf/2022-16472.pdf . Published August 10, 2022. Correction Notice 87 Fed. Reg. 66564 https://info.gov/content/pkg/FR-2022-11-04/pdf/2022-24077.pdf . Published November 4, 2022. Tables 1A-1D. The payment rate shown is the standardized amount for facilities with a wage index greater than one. The average standard amounts shown also assume facilities receive the full quality update. The payment will also be adjusted by the Wage Index for specific geographic locality. Therefore, payment for a specific hospital will vary from the stated Medicare national average payment levels shown. Also note that any applicable coinsurance, deductible, and other amounts that are patient obligations are included in the national average payment amount shown.10. Healthcare Common Procedure Coding System (HCPCS) Level II codes C-codes are maintained by the Centers for Medicare & Medicaid Services. https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update. Accessed January 16, 2023.11. CPT copyright 2022 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS/DFARSrestrictions apply to government use. Fee schedules, relative value, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.12. Modifier -26 is appended to certain imaging codes to show that the physician is reporting only the professional interpretation, because the hospital is providing theimaging equipment and technicians.13. For codes marked “Yes”, multiple procedure discounting indicates that when a procedure code is reported on the same day as another higher-weighted procedurecode, the highest weighted code is paid at 100% of the fee schedule amount and additional codes are paid at 50% of the fee schedule amount. Procedure codes marked “No” are always paid at 100% of the fee schedule amount regardless of whether they are submitted with other procedure codes. See also the current 2023 release of the PFS Relative Value File at https:///Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files14. Centers for Medicare & Medicaid Services. Medicare Program; CY2023 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B PaymentPolicies Final Rule; 87 Fed. Reg. 69404-70699. https:///content/pkg/FR-2022-11-18/pdf/2022-23873.pdf Published November 18, 2022. The total RVU as shown here is the sum of three components: physician work RVU, practice expense RVU, and malpractice RVU.15. RVUs and the Medicare National Average are shown for the facility setting only because the Onyx™ embolization procedure is always performed in the hospital, ratherthan the non-facility (physician office) setting.16. Medicare national average payment is determined by multiplying the sum of the three RVUs by the conversion factor. The conversion factor for CY 2023 is $33.8872per 87 Fed. Reg. 70177. https:///content/pkg/FR-2022-11-18/pdf/2022-23873.pdf . Published November 18, 2022. See also the current 2023 release of the PFS Relative Value File at http://Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files . Final payment to the physician is adjusted by the Geographic Practice Cost Indices (GPCI). Also note that any applicable coinsurance, deductible, and other amounts that are patient obligations are included in the payment amount shown.17. Component coding conventions apply to code 61624, so radiological supervision and interpretation is coded separately. Code 75894 represents the radiologic servicelinked to code 61624.18. A balloon occlusion test may be performed immediately prior to Onyx™ embolization for AVM, to perform a separate and prolonged assessment of the neurologicalrisks of permanently occluding the vessel. When performed, this may be coded and reported separately.19. Codes 61624 and 75894 for Onyx™ embolization include intraprocedural road-mapping and fluoroscopic guidance necessary to perform the intervention. However,cerebral angiography may be coded separately with 61624 when it is truly diagnostic. According to CPT manual instructions (Radiology section, Vascular Procedures heading), a truly diagnostic study means that no prior angiography is available and the decision to intervene is based on the current angiography or, if angiography was previously performed, the patient’s condition has changed since the prior angiography, there is inadequate visualization of the anatomy or pathology on prior angiography, or there is a clinical change during the procedure requiring new evaluation. See also CPT manual instructions (Surgery section, Cardiovascular System chapter, Diagnostic Studies of Cervicocerebral Arteries heading) and National Correct Coding Initiative (NCCI) Policy Manual, 01/01/2023, Chapter V, D13.20. A 4-view cervical and cerebral angiography, from catheter placement in the internal carotid arteries and vertebral arteries bilaterally, is typically coded 36224-50 and36226-50. Add-on code +36228 would also be assigned if additional angiography was performed from catheter placement in, for example, the superior hypophyseal artery.21. Catheter placement may be coded separately with 61624. Code 36216 would typically represent catheterization of the left internal carotid artery. Code 36217 wouldtypically represent catheterization of the right internal carotid artery or higher level, eg, the middle cerebral artery on either side. However, if codes 61623 or 36224-36226 are also assigned, catheterization may not be coded separately because it is included in these procedure codes.22. The CMS Medically Unlikely Edit (MUE) for code 75898 is 2 units, although denials for units in excess of the MUE value may be appealed.Brief statement for Onyx™ liquid embolic system (AVM)CAUTION: U.S. federal law restricts the sale, distribution and use of this product to physicians or as prescribed by a physician. This product is for the exclusive use by medical specialists experienced in angiographic and percutaneous neurointerventional procedures.Indications For Use: Presurgical embolization of brain arteriovenous malformations (bAVMs).Contraindications: The use of the Onyx™ LES is contraindicated when any of the following conditions exist:• When optimal catheter placement is not possible.• When provocative testing indicates intolerance to the occlusion procedure.• When vasospasm stops blood flow.Precautions: 1) The safety and effectiveness has not been studied in the following patient populations: pregnant and nursing women, individuals less than 18 years old, individuals with aneurysms not associated with a bAVM nidus, or distal feeders to a bAVM nidus or dural AV fistulas. 2) Some data indicate that dimethyl sulfoxide potentiates other concomitantly administered medications. 3) A garlic-like taste may be noted by the patient with use of the Onyx™ LES due to the DMSO component. This taste may last several hours. An odor on the breath and skin may be present.4) Inspect product packaging prior to use. Do not use if sterile barrier is open or damaged. 5) Use prior to expiration date. 6) Verify that the catheters and accessories (see directions for use) used in direct contact with the Onyx™ LES polymer are clean and compatible with the material and do not trigger polymerization or degrade with contact.Use only ev3 approved, Onyx™ LES/DMSO compatible micro catheters indicated for use in the neurovasculature and ev3 syringes. Other micro catheters or syringes may not be compatible with DMSO and their use can result in thromboembolic events due to catheter degradation. Refer to the Warnings and Directions for Use sections. 7) Waita few seconds following completion of the Onyx™ LES injection before attempting catheter retrieval. Failure to waita few seconds to retrieve the micro catheter after the Onyx™ LES injection may result in fragmentation of the Onyx™ LES into non-target vessels.Difficult catheter removal or catheter entrapment may be caused by any of the following: Angioarchitecture: very distal bAVM fed by afferent, lengthened, small, or tortuous pedicles, Vasospasm, Reflux, Injection time. To reduce the risk of catheter entrapment, carefully select catheter placement and manage reflux to minimize the factors listed above. Should catheter removal become difficult, the following will assist in catheter retrieval: Carefully pull the catheter to assess any resistance to removal. If resistance is felt, remove any “slack” in the catheter. Gently apply traction to the catheter (approximately 3-4 cm of stretch to the catheter). Hold this traction for a few seconds and release. Assess traction on vasculature to minimize risk of hemorrhage. This process can be repeated intermittently until catheter is retrieved.Alternate Technique for Difficult to Remove Catheters: Remove all slack from the catheter by putting a few centimeters of traction on the catheter to create a slight tension in the catheter system. Firmly hold the catheter and then pull it using a quick wrist snap motion (from left to right) 10 – 15 centimeters to remove the catheter from the Onyx™ LES cast (Note: Do not apply more than 20 cm of traction to catheter, to minimize risk of catheter separation).For entrapped catheters: Under some difficult clinical situations, rather than risk rupturing the malformation and consequent hemorrhagic complications by applying too much traction on an entrapped catheter, it may be safer to leave the micro catheter in the vascular system. This is accomplished by stretching the catheter and cutting the shaft near the entry point of vascular access allowing the catheter to remain in the artery. If the catheter breaks during removal, distal migration or coiling of the catheter may occur. Same day surgical resection should be considered to minimize the risk of thrombosis.Potential Complications: The following adverse events occurred using Onyx during a prospective, randomized, multi-center clinical trial for the presurgical treatment of bAVMs: Death, Headache +/- nausea and vomiting, Patient discomfort, Laboratory/Imaging abnormalities (Endocrine/Metabolic, Hematologic, Asymptomatic MRI/CT Findings, Respiratory/Pulmonary, General, Gastrointestinal (GI)), Worsening Neurologic Status (Persistent, Resolved), Hyperglycemia, Infection, Bleeding and/or Low Hct requiring transfusion (Surgical Bleeding, Decreased Hct Requiring Transfusion), Intracranial Hemorrhage, Medication reaction, Failed access, Access site bleeding, Fever, Delivery Catheter removal difficulty, Poor penetration/visualization, Hypotension, Stroke, Cardiac arrhythmia, Hydrocephalus, SIADH (Syndrome of inappropriate antidiuretic hormone secretion, dilutional hyponatremia), Vessel Dissection, Hypertension, Limb ischemia, Respiratory failure, Seizures, UTI (Urinary tract infection), Vasospasm, Vaso-vagal episode, catheter shaft rupture, delivery catheter rupture, fragmentation of the Onyx™ LES, hypoxia, laryngospasm, peptic ulcerAdditional adverse events, which may be associated with embolization procedures include: Allergic reaction, Thrombocytopenia, Pulmonary embolism, Catheter entrapment, Catheter rupture, Device migration and cast movement, Hemorrhagic complications related to attempts to remove entrapped catheter.Warnings: Serious, including fatal, consequences could result with the use of the Onyx LES without adequate training. Contact your Medtronic sales representative for information on training courses.Complete indications, contraindications, warnings and instructions for use can be found in the product labeling supplied with each device.Medtronic Inc.9775 Toledo WayIrvine, CA 92618 USATel. 1-763-505-5000 UC201907983e EN © 2023 Medtronic. Medtronic, Medtronic logo, and Engineering the extraordinary are trademarks of Medtronic. All other brands are trademarks of a。

全氟碳载药纳米颗粒诊治血管内膜增生实验研究的开题报告

全氟碳载药纳米颗粒诊治血管内膜增生实验研究的开题报告一、研究背景和意义：随着现代化医疗技术的发展，越来越多的病人开始使用药物治疗。

但是，药物在体内的分布和药效是影响治疗效果的重要因素之一。

为了提高药物的效果并减少副作用，纳米药物成为了一种备受关注的新型药物形式。

纳米粒子药物可以通过改变药物在体内的分布和药效，改善药物的生物利用度和靶向性，提高药物疗效并降低副作用。

血管内膜增生（Vascular restenosis）是很多血管疾病的基础病变，如冠心病、动脉硬化、脑血管病等。

其治疗手段主要是血管成形术或支架置入。

但是，血管成形术或支架置入后易引起血管再狭窄或血栓形成，并且并发症较多。

因此，如何寻找一种更有效的治疗方法已成为当前研究的热点。

近年来，全氟碳（PFCs）作为一种新型载药纳米材料应用于药物治疗领域。

全氟碳纳米颗粒具有良好的生物相容性、生物降解性和持久的血液循环性，可以用于装载抗增生药物，如siRNA和药物VEGF。

全氟碳载药纳米颗粒可以通过调节药物的释放速率和靶向性，选取合适的抗增生药物作为药物载体，降低治疗过程中的副作用，并提高药物的治疗效果。

因此，本研究旨在探讨全氟碳载药纳米颗粒在诊治血管内膜增生方面的应用，旨在为治疗血管内膜增生提供一种新的治疗策略。

二、研究内容和方法：本研究将采用体外和体内实验的方法进行研究，具体方法如下：1.体外实验：采用全氟碳载药纳米颗粒装载siRNA和VEGF药物，通过实验分析纳米颗粒的形态结构、粒径分布、药物载量、药物释放动力学以及对人血管内皮细胞增殖的影响等指标，评估全氟碳载药纳米颗粒降低血管内膜增生的可能性。

2.体内实验：建立血管内膜增生模型，通过体内实验评估全氟碳载药纳米颗粒的疗效和安全性。

将实验动物随机分为纳米颗粒组、空白纳米颗粒组和对照组，注射不同剂量的全氟碳载药纳米颗粒，观察其对血管内膜增生的影响。

三、预期成果和意义本研究通过体外和体内实验，评估全氟碳载药纳米颗粒在对抗血管内膜增生方面的应用前景。

脑脊液异前列烷与复发缓解型多发性硬化的炎症活动无关

脑脊液异前列烷与复发缓解型多发性硬化的炎症活动无关Greco A.;Minghetti L.;Puopolo M.;赵正卿【期刊名称】《世界核心医学期刊文摘：神经病学分册》【年(卷),期】2005(000)002【摘要】Oxidative stress leads to lipid peroxidation and may contribute to the pathoge nesis of lesions in multiple sclerosis (MS), an autoimmune disease characterised by inflammatory as well as degenerative phenomena. We previously found that cer ebrospinal fluid (CSF) levels of isoprostane 8 epi PGF 2α,a marker of free ra dical damage and lipid peroxidation in vivo, were elevated in MS patients. Such levels were correlated with the degree of disability and reduced in subjects und er steroid therapy. Here we investigated weather the CSF isoprostane levels corr elated with disease inflammatory activity. To this aim, we enrolled 41 relapsing remitting (RR) MS patients who underwent at the same time full neurological ex amination, NMR imaging brain scan and diagnostic CSF test. No evidence of corre lation was found between 8 epi PGF2α.levels and the presence of gadolinium (G d) enhancing NMR lesions or the time elapsed since the last relapse. We suggest that isoprostanes are not useful as surrogate inflammatory markers in MS. Howev er, they may represent a sensitive index of degenerative phenomena, which can pe rsist also in the absence of inflammatory activity. 2004 Elsevier B.V. All right s reserved.【总页数】1页(P46-46)【作者】Greco A.;Minghetti L.;Puopolo M.;赵正卿【作者单位】Dept. of Cell Biol. and Neuroscience;Instituto Superiore di Sanit` a;Viale ReginaElena;299;00161;Rome;Italy【正文语种】中文【中图分类】R744.51【相关文献】1.金针王乐亭经验方治疗缓解期复发缓解型多发性硬化8例的临床观察 [J], 王春琛;陈志刚;马昕宇2.复发-缓解型多发性硬化和化脓性脑膜炎患者血清和脑脊液中IL-18和IFN-γ水平的研究 [J], 王军;吕洁;姜友珍3.复发缓解型多发性硬化患者脑脊液及血清中非髓鞘神经相关蛋白的检测及临床意义 [J], 何佳;何进宇;宋晓征;张丽雅;黄睿4.他汀类药物对复发缓解型多发性硬化患者缓解期认知功能影响的系统评价 [J], 张凌锋5.复发缓解型多发性硬化与人类疱疹病毒6型活动性感染 [J], lvarez Lafuente R.;De Las Heras V.;BartoloméM.;黄卫东因版权原因，仅展示原文概要，查看原文内容请购买。

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A case of intravascular epithelioid hemangioendothelioma occurring14yearsafter coil embolization for an extracranialinternal carotid artery aneurysmShin-Ichiro Osawa,MD,a Atsushi Saito,MD,PhD,a Hiroaki Shimizu,MD,PhD,a,bTakenori Ogawa,MD,PhD,c Mika Watanabe,MD,PhD,d andTeiji Tominaga,MD,PhD,a Sendai,Miyagi,JapanEpithelioid hemangioendothelioma(EHE)is a rare neoplasm originating from various organs.The clinical outcome mostly depends on surgical resectability.The authors report an EHE of the extracranial internal carotid artery developed in a59-year-old male patient14years after the intravascular coil embolization for a carotid aneurysm at the same site. Because the lesion was initially diagnosed as regrowth of the thrombosed aneurysm,decision for radical resection was delayed,and the patient died from rapid tumor progression.Differential diagnosis of atypical vascular mass lesions should include neoplasm,because initial radical resection may be the key to achieve a better prognosis.(J Vasc Surg2012;55: 230-3.)Blood vessel tumors are rare,and include heteroge-neous group of benign and malignant tumors.1Because of its rarity and various clinical patterns,1-2the initial diagnosis is often difﬁcult.Epithelioid hemangioendothelioma(EHE)is the most aggressive and common variant of hemangioendotheli-oma.1It arises rarely from intravascular origin.Three cases of EHE have been reported in the peripheral arteries.3-5We report a case of EHE of the extracranial internal carotid artery,which arose from an aneurysmal lesion that was treated by endovascular coil embolization14years earlier. CASE REPORTA59-year-old man complained of slowly progressing hoarse-ness,dysphasia,and a palpable mass in the left submandibular region.He had a history of a left extracranial internal carotid artery aneurysm,which was treated14years earlier.At that time,mag-netic resonance imaging(MRI)demonstrated a large mass in the left cervical region(Fig1).The lesion was diagnosed as an aneu-rysm of the internal carotid artery by conventional angiography (ﬁgures are not available).He was treated by endovascular parent artery occlusion with interlocking detachable coils(IDC).The aneurysm disappeared angiographically,and the symptoms recov-ered completely.His medical history was uneventful for9years after the coil embolization.Then dysphagia,hoarseness,and localized subman-dibular swelling appeared,and they aggravated gradually during the next4years.The left submandibular mass was elastic hard,immobile,and showed no tenderness.Left-sided lingual atrophy was evident,and endonasal laryngoscopy showed symptoms of laryngeal and hypo-glossal nerve palsy.A blood examination showed only mild inﬂam-matoryﬁndings of increased C-reactive protein,which were com-patible with subclinical aspiration pneumonia.Computed tomography(CT)and MRI demonstrated a well-circumscribed large mass(50ϫ40ϫ80mm)in the left cervical region(Fig2,A and B).The signals of the mass on CT and MRI were similar to those of the surrounding soft tissue.Marked enhancement was observed around the border and in the lower portion(just above IDC).A left common carotid angiogram revealed complete occlusion of the internal carotid artery(Fig2,C and D).The lower part of the mass received bloodﬂow from the common carotid artery.The mass was thought to be a thrombosed and partially recanalized aneurysm.Total resection of aneurysm through a mandibulotomy was proposed because we considered that the thrombosed aneurysm might enlarge even after blocking bloodﬂow from parent arteries due to residual blood channels around the wall such as vasa vasorum.The patient rejected this option due to its invasiveness, and separation of the aneurysm from the proximal artery to at least reduce blood supply to the mass was performed by cutting the origin of internal carotid artery and suturing the oriﬁce.The mass lesion occupied the whole intraluminal space of the internal carotid artery above the level of1cm distal to the carotid bifurcation.The surface of arterial walls appeared normal.No histologic specimen was obtained during the initial surgery.From the Departments of Neurosurgery,a Neuroendovascular Therapy,b and Otorhinolaryngology,Head,and Neck Surgery,c Tohoku University Graduate School of Medicine;and the Department of Pathology,Tohoku University Hospital.dCompetition of interest:none.Reprint requests:Hiroaki Shimizu,MD,PhD,Department of Neurosurgery Tohoku University Graduate School of Medicine,1-1Seiryo-machi, Aoba-ku,Sendai,Miyagi980–8574,Japan(e-mail:hshim@nsg. med.tohoku.ac.jp).The editors and reviewers of this article have no relevantﬁnancial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a competition of interest.0741-5214/$36.00Copyright©2012by the Society for Vascular Surgery.doi:10.1016/j.jvs.2011.06.108230Fig 1.Axial (A)and coronal (B)sections of contrast-enhanced T1-weighted magnetic resonance imaging (MRI)taken 14years ago showing a giant mass lesion in the left anterior cervical region.The lesion was 35ϫ25ϫ30mm in size and showed heterogeneous signal intensity compatible with a giant aneurysm (arrowheads).Fig 2.Axial (A)and coronal (B)sections of contrast-enhanced T1-weighted magnetic resonance imaging (MRI)taken on admission showing a heterogeneous mass (45ϫ55ϫ70mm),which compressed the trachea and adjacent tissue.The upper border of the mass was near to the skull base.An oblique view of the left carotid angiogram (C:arterial phase,D:capillary phase)showed the previously occluded internal carotid artery and blood ﬂow passing between the coil and the arterial wall into the lower part of the mass (black arrows ).This blood ﬂow was compatible with the strong enhancement areas seen on MRI (white arrows in A and B ).JOURNAL OF VASCULAR SURGERY Volume 55,Number 1Osawa et al 231During the 2months after the ﬁrst operation,clinical symp-toms and radiological ﬁndings worsened.Therefore,a second operation was performed to remove the mass through the same skin incision,but only partial removal was performed because of excessive bleeding from the mass.The patient then returned to work because clinical symptoms temporarily improved.The histo-pathological study revealed an EHE.Another surgery through the same route was performed when the mass regrew to compress the trachea 2months later.Despite the planned total removal,the surgery resulted in partial removal due to excessive bleeding.Postop-erative full body CT and positron emission tomography revealed multiple metastases in cervical lymph node and bilateral lung.The patient then presented with an even more aggressive local recurrence,so a subtotal removal through a midline mandibu-lotomy was ﬁnally performed 2weeks later.Residual cervical lesion was treated by radiation;however,he died 6months after the initial surgery.Pathologic examination of the specimen during the second operation showed that the tumor cells demonstrated abundant eosinophilic cytoplasm and ovoid nuclei,as well as perivascular epithelioid alignment with focal papillary proliferation (Fig 3,A ).The mitotic index was 1in 10high-power ﬁelds (HPFs).Immu-nohistochemical evaluation revealed that the tumor cells were positive for CD31(Fig 3,B ),CD34,vimentin,pancytokeratin (AE1/AE3),and factor VIII,and negative for S-100and HHF-35(muscle speciﬁc actin).The Ki-67staining index peaked at 24%.Pathologic diagnosis was an EHE.The ﬁndings obtained in the ﬁfth operation showed higher cellular atypia,a less differentiatedepithelioid architecture,and a mild increase in the mitotic index (Fig 3,C )to a level similar to that seen in angiosarcoma.DISCUSSIONMalignant tumors derived from vascular endothelial cells include EHE and angiosarcoma.Previously,EHE was deﬁned as an intermediate grade malignant tumor,6but the recent World Health Organization classiﬁcation redeﬁned EHE as a fully malignant tumor due to its clinical behav-ior.7EHE can occur almost anywhere in the body;over 30cases with an intravascular origin have been reported,pre-dominantly from veins rather than arteries.8In cases origi-nating from arteries,the origin is usually the aorta.9There have been three case reports of EHE originating from peripheral arteries 3-5(occipital,3radial,4and palmar 5arter-ies).In the carotid arteries,three angiosarcomas and no EHE cases have been reported.10-11The present case may be the ﬁrst report of intimal EHE originating from the extracranial internal carotid artery.For malignant tumors arising in blood vessels,it is often difﬁcult to make a correct diagnosis in the early phase.This is partly because they are extremely rare and also because their imaging characteristics are nonspeciﬁc,1,9,11resem-bling inﬂammatory 12or atherosclerotic 2,13,14lesions.In our case,several ﬁndings may have been clues to suggest possible malignancy;hardness,immobility,the similarity of signals on CT and MRI between the mass and softtissue,Fig 3.A,Solid growth pattern of epithelioid tumor cells with mild atypia.Mitosis was seen in 1cell per 10high-power ﬁelds (HPFs)(hematoxylin-eosin,original magniﬁcation ϫ200).B,Immunohistochemical staining for CD31was positive for tumor cells (original magniﬁcation ϫ200).C,Cell atypia was increased in the specimen from the fourth operation.Mitosis was seen in 5cells per 10HPFs (arrow )(hematoxylin-eosin,original magniﬁcation ϫ200).JOURNAL OF VASCULAR SURGERYJanuary 2012232Osawa et aland adjacent nerve palsies.Theﬁrst step toward a correct diagnosis is to consider this disease in cases involving atyp-ical lesions and,if so,we should have planned a total resection or at least obtained a histologic specimen at the ﬁrst surgery.Deﬁnitive treatment involves curative resection with an adequate tumor-free margin.1,4,9,11,15-16Previously re-ported cases of peripheral arterial EHE underwent success-ful curative resection and achieved good outcomes.3-5The role of adjuvant chemotherapy and/or radiation therapy is ambiguous.Although the prognosis of EHE is superior to that of angiosarcoma,it cannot be considered indolent.In a pre-vious report,more than3mitoses per50HPF and a tumor sizeϾ3cm were prognostic factors that implied a5-year disease-speciﬁc survival of59%,and no patient without either of these factors died.17Our patient demonstrated both risk factors at the time when pathologic diagnosis was achieved.The etiology of EHE is not well known;however, causalities for angiosarcoma have been suggested to include radiation,17defunctionalized arteriovenousﬁstula,18for-eign body,16carotid endarterectomy,10and intravascular prosthesis(eg,Dacron intra-aortic grafts).12,15,19-20In our case,a platinum coil(which has been reported to have few dysplastic effects)had been implanted about9years pre-ceding theﬁrst symptoms.Several speculations are possible for the relationship between the treatment and the EHE, although none of them is conclusive.Albeit unlikely,exis-tence of tumor14years earlier and its malignant transfor-mation cannot be ruled out.Nevertheless,the authors emphasize that it is impor-tant to consider vascular neoplasm in cases of atypical vascular mass lesions.REFERENCES1.Koch M,Nielsen GP,Yoon SS.Malignant tumors of blood vessels:angiosarcomas,hemangioendotheliomas,and hemangioperictyomas.J Surg Oncol2008;97:321-9.2.Chiche L,Mongrédien B,Brocheriou I,Kieffer E.Primary tumors ofthe thoracoabdominal aorta:surgical treatment of5patients and review of the literature.Ann Vasc Surg2003;17:354-64.3.Tayeb T,Bouzaiene M.[Epithelioid hemangioendothelioma mimick-ing an 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CA,Friedlaender GE,Cooke RA,Rosai J.Angiosarcoma associated with foreign body material.A report of three cases.Cancer1988;62:2436-44.17.Deyrup AT,Tighiouart M,Montag AG,Weiss SW.Epithelioid heman-gioendothelioma of soft tissue:a proposal for risk stratiﬁcation based on 49cases.Am J Surg Pathol2008;32:924-7.18.Wehrli BM,Janzen DL,Shokeir O,Masri BA,Byrne SK,O’Connell JX.Epithelioid angiosarcoma arising in a surgically constructed arterio-venousﬁstula:a rare complication of chronic immunosuppression in the setting of renal transplantation.Am J Surg Pathol1998;22:1154-9. 19.Weiss WM,Riles TS,Gouge TH,Mizrachi HH.Angiosarcoma at thesite of a Dacron vascular prosthesis:a case report and literature review.J Vasc Surg1991;14:87-91.20.Fehrenbacher JW,Bowers W,Strate R,Pittman J.Angiosarcoma of theaorta associated with a Dacron graft.Ann Thorac Surg1981;32:297-301.Submitted Apr20,2011;accepted Jun20,2011.JOURNAL OF VASCULAR SURGERYVolume55,Number1Osawa et al233。