目的探讨SolitaireAB型支架取栓术治疗急性颅内血管栓塞的有效性、安全性及技术要点。方法2015—01～2016—01上海交通大学医学院附属新华医院神经外科应用SolitaireAB型支架取栓治疗42例颅内大血管急性栓塞患者，其中大脑中动脉（MCA...目的探讨SolitaireAB型支架取栓术治疗急性颅内血管栓塞的有效性、安全性及技术要点。方法2015—01～2016—01上海交通大学医学院附属新华医院神经外科应用SolitaireAB型支架取栓治疗42例颅内大血管急性栓塞患者，其中大脑中动脉（MCA）栓塞28例；颈内动脉颅内段（ICA）闭塞7例；伴有大脑前、中动脉栓塞2例；基底动脉（BA）栓塞5例，分析开通的耗时、效果及术后情况。对比分析患者术前、出院时美国国立卫生研究院卒中量表（the National Institutes of Health Stroke Scale，NIHSS）评分及随访90d时改良Rankin量表（modified Rankin Scale，mRS）。结果所有患者均在入院后30min～2h进行穿刺，平均（59．31±33．58）min。仅3例（7．14％）未开通。从发病到开通的时间为3．5—7．0h（超过6h4例），平均（5．289±0．932）h。死亡7例，来院时NIHSS评分18～30分。90dmRS〉2有18例（42．85％），来院时NIHSS评分13～28分，15分以下2例。90dmRS≤2有24例（57．15％），来院时NIHSS评分10—18分，其中15分以上3例。大部分栓子病理检查为血栓。术后CT及MRI检查发现，出现大面积脑梗死及严重的梗死性出血共10例，基底节区梗死5例，小片状梗死3例，少量梗死性出血5例，散在多发小梗死8例。出院时NIHSS评分0～18分，平均（6．58±5．72）分。结论运用SolitaireAB型支架进行动脉取栓能获得较好的再通率，且安全有效。每个患者的有效取栓时间窗不完全一致，有效时间窗内开通将进一步提高患者的预后。展开更多
During the Vietnam War, millions of liters of six tactical herbicides were sprayed on the southern Vietnam landscape to defoliate forests, to clear military perimeters and to destroy enemy food supplies. The environme...During the Vietnam War, millions of liters of six tactical herbicides were sprayed on the southern Vietnam landscape to defoliate forests, to clear military perimeters and to destroy enemy food supplies. The environmental and human health impacts of spraying these herbicides, especially Agent Orange and those formulated with mixtures that included 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) which was contaminated with 2,3,7,8-tetracholorodibenzo-p-dioxin (TCDD) have been documented over the last 60 years. The dioxin TCDD clean-up efforts at former military bases and other Vietnam hotspots are ongoing. However, the lesser-told story was the environmental and human health impacts on the communities and chemical plant workers who manufactured Agent Orange and other herbicides that became contaminated with dioxin TCDD in the manufacturing processes at seven locations in the United States and one site in Canada. The pollution at these chemical plant sites, adjacent rivers and groundwater is well known within each affected state or province but not widely recognized beyond their localities. In this paper we assess the national long-term effects on land, groundwater and river resources where Agent Orange and other agricultural herbicides containing 2,4,5-T with unknown amounts of dioxin TCDD were manufactured, transported, and temporarily stored. The sites where residual tactical herbicides with contaminated by-products were applied to public lands or disposed of by military and civilian workers within the United States and Canada are identified. After 60 years, these communities are still paying the price for the U.S. Government, DOD and USDA decisions to provide and use agricultural herbicides as tactical chemical weapons during the Vietnam War (1962-1971). There have been human health issues associated with the chemical manufacture, transport, storage and disposal of these herbicides related to workers who moved these chemical weapons from United States and Canada to SE Asia. Most of these dioxin contaminated tactical herbicides were transported via railroads to ports at Mobile, Alabama and Gulfport, Mississippi. They were then loaded on ocean-going ships and transported via the Panama Canal for use during the Vietnam War. The objective of this study is to document the environmental and human consequences of the manufacture of tactical herbicides with dioxin TCDD and arsenic on the chemical plant, transportation, application, storage and disposal workers. The costs of cleanup of these North America chemical plant sites, transportation corridors, temporary and long-term storage areas, supply chain storage facilities with residual tactical herbicide, application, and disposal sites to date, is in the billions of dollars. Billions have been spent on hazardous waste incineration to destroy the dioxin TCDD or bury it in certified landfills. Government mandated environmental covenants are on titles of properties still contaminated with high levels of dioxin TCDD. If landowners attempt to rescind land use restrictions, many more billions of dollars will be needed to finish the environmental cleanup and restore natural resources. These cost estimates do not include the billions of dollars needed to treat the effects of dioxin TCDD exposure of U.S. and Canadian civilian workers who manufactured and handled these contaminated herbicides during the Vietnam War as well as address human health issues of their offspring.展开更多
文摘目的探讨SolitaireAB型支架取栓术治疗急性颅内血管栓塞的有效性、安全性及技术要点。方法2015—01～2016—01上海交通大学医学院附属新华医院神经外科应用SolitaireAB型支架取栓治疗42例颅内大血管急性栓塞患者，其中大脑中动脉（MCA）栓塞28例；颈内动脉颅内段（ICA）闭塞7例；伴有大脑前、中动脉栓塞2例；基底动脉（BA）栓塞5例，分析开通的耗时、效果及术后情况。对比分析患者术前、出院时美国国立卫生研究院卒中量表（the National Institutes of Health Stroke Scale，NIHSS）评分及随访90d时改良Rankin量表（modified Rankin Scale，mRS）。结果所有患者均在入院后30min～2h进行穿刺，平均（59．31±33．58）min。仅3例（7．14％）未开通。从发病到开通的时间为3．5—7．0h（超过6h4例），平均（5．289±0．932）h。死亡7例，来院时NIHSS评分18～30分。90dmRS〉2有18例（42．85％），来院时NIHSS评分13～28分，15分以下2例。90dmRS≤2有24例（57．15％），来院时NIHSS评分10—18分，其中15分以上3例。大部分栓子病理检查为血栓。术后CT及MRI检查发现，出现大面积脑梗死及严重的梗死性出血共10例，基底节区梗死5例，小片状梗死3例，少量梗死性出血5例，散在多发小梗死8例。出院时NIHSS评分0～18分，平均（6．58±5．72）分。结论运用SolitaireAB型支架进行动脉取栓能获得较好的再通率，且安全有效。每个患者的有效取栓时间窗不完全一致，有效时间窗内开通将进一步提高患者的预后。
文摘During the Vietnam War, millions of liters of six tactical herbicides were sprayed on the southern Vietnam landscape to defoliate forests, to clear military perimeters and to destroy enemy food supplies. The environmental and human health impacts of spraying these herbicides, especially Agent Orange and those formulated with mixtures that included 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) which was contaminated with 2,3,7,8-tetracholorodibenzo-p-dioxin (TCDD) have been documented over the last 60 years. The dioxin TCDD clean-up efforts at former military bases and other Vietnam hotspots are ongoing. However, the lesser-told story was the environmental and human health impacts on the communities and chemical plant workers who manufactured Agent Orange and other herbicides that became contaminated with dioxin TCDD in the manufacturing processes at seven locations in the United States and one site in Canada. The pollution at these chemical plant sites, adjacent rivers and groundwater is well known within each affected state or province but not widely recognized beyond their localities. In this paper we assess the national long-term effects on land, groundwater and river resources where Agent Orange and other agricultural herbicides containing 2,4,5-T with unknown amounts of dioxin TCDD were manufactured, transported, and temporarily stored. The sites where residual tactical herbicides with contaminated by-products were applied to public lands or disposed of by military and civilian workers within the United States and Canada are identified. After 60 years, these communities are still paying the price for the U.S. Government, DOD and USDA decisions to provide and use agricultural herbicides as tactical chemical weapons during the Vietnam War (1962-1971). There have been human health issues associated with the chemical manufacture, transport, storage and disposal of these herbicides related to workers who moved these chemical weapons from United States and Canada to SE Asia. Most of these dioxin contaminated tactical herbicides were transported via railroads to ports at Mobile, Alabama and Gulfport, Mississippi. They were then loaded on ocean-going ships and transported via the Panama Canal for use during the Vietnam War. The objective of this study is to document the environmental and human consequences of the manufacture of tactical herbicides with dioxin TCDD and arsenic on the chemical plant, transportation, application, storage and disposal workers. The costs of cleanup of these North America chemical plant sites, transportation corridors, temporary and long-term storage areas, supply chain storage facilities with residual tactical herbicide, application, and disposal sites to date, is in the billions of dollars. Billions have been spent on hazardous waste incineration to destroy the dioxin TCDD or bury it in certified landfills. Government mandated environmental covenants are on titles of properties still contaminated with high levels of dioxin TCDD. If landowners attempt to rescind land use restrictions, many more billions of dollars will be needed to finish the environmental cleanup and restore natural resources. These cost estimates do not include the billions of dollars needed to treat the effects of dioxin TCDD exposure of U.S. and Canadian civilian workers who manufactured and handled these contaminated herbicides during the Vietnam War as well as address human health issues of their offspring.
