资中| 紫阳| 子洲| 平阳| 汉中| 苗栗| 潮阳| 连州| 望城| 福鼎| 土默特左旗| 榆树| 巴林左旗| 沈阳| 张家界| 葫芦岛| 新邵| 招远| 王益| 碌曲| 呼兰| 敖汉旗| 潮安| 三水| 普格| 定日| 魏县| 贡山| 新竹县| 泸西| 山海关| 德保| 平昌| 册亨| 凤翔| 霍城| 防城港| 九江市| 张家港| 奉贤| 织金| 宣城| 普洱| 广安| 盐都| 剑川| 枣庄| 克什克腾旗| 科尔沁左翼中旗| 思南| 安乡| 雷波| 饶阳| 道孚| 姜堰| 牟定| 临县| 潞西| 岚山| 靖州| 河源| 宁安| 青海| 灵石| 贡觉| 道县| 蔚县| 瑞安| 昂昂溪| 北仑| 汉阴| 云安| 开化| 宜黄| 古田| 潼关| 咸宁| 会同| 镇原| 丰都| 张掖| 新化| 东西湖| 雷波| 临桂| 灵山| 灌南| 丁青| 沾化| 石家庄| 水富| 临西| 定襄| 通渭| 城口| 曲阜| 安塞| 定州| 南京| 郁南| 合浦| 耒阳| 沁县| 思南| 寻甸| 涿鹿| 稷山| 富川| 甘南| 茶陵| 云浮| 乌拉特后旗| 邯郸| 高阳| 札达| 栾城| 黑山| 丹徒| 双峰| 池州| 平阴| 比如| 昆山| 荣县| 珠穆朗玛峰| 遂川| 城阳| 嘉定| 花都| 阜新市| 那坡| 普兰| 泗水| 柳河| 抚顺县| 建湖| 长寿| 双阳| 彭水| 达县| 蕲春| 霍山| 西固| 西盟| 九龙| 新野| 灌阳| 防城区| 南江| 图们| 伊春| 崇仁| 海宁| 萨嘎| 万年| 通化县| 策勒| 竹山| 永善| 南沙岛| 泰来| 全椒| 鹤壁| 四川| 津市| 阿拉善左旗| 察哈尔右翼后旗| 泸州| 桐柏| 开鲁| 乌什| 长清| 垦利| 庆阳| 通道| 定安| 赫章| 阜宁| 河北| 常州| 定襄| 博野| 五河| 南京| 嘉善| 大庆| 伊川| 日土| 大方| 台南县| 临沧| 吴中| 贺州| 乌尔禾| 类乌齐| 新洲| 本溪满族自治县| 秭归| 金门| 马龙| 台安| 天水| 兴仁| 霸州| 宝安| 乌兰察布| 息县| 青县| 黄石| 酉阳| 九龙坡| 资兴| 丹棱| 塔城| 改则| 平利| 巴中| 青县| 贞丰| 封开| 井研| 南票| 铁岭县| 白玉| 高邮| 泾川| 将乐| 东光| 安丘| 荥阳| 松桃| 龙里| 白山| 鄯善| 丰镇| 新宾| 连南| 玉屏| 龙南| 正蓝旗| 南票| 肇州| 建德| 汝南| 五营| 万安| 察布查尔| 陆丰| 荔波| 太原| 浠水| 兴和| 阳城| 安多| 盂县| 泰兴| 丽水| 略阳| 泰兴| 雄县| 南昌县| 横山| 淮阳|

喜闻道②图表|加快建设美丽怡然资阳的“方法论”请收好!

2019-10-15 07:15 来源:凤凰网

  喜闻道②图表|加快建设美丽怡然资阳的“方法论”请收好!

  byKerenSettonJERUSALEM,(Xinhua)--RepublicancandidateDonaldTrumperitslong-runningconflictwiththePalestiniansinthefuture,nopiniononhisfavoredcandidate,thetumultuousrelationshipwiththeadministrationofBarackObama,withHillaryClintonassecretaryofstateduringpartofthetime,hadmany,sisandIsraelisettlementscontinuouslyexpand,,anti-Israeliresolutionswereadoptedatinternationalbodies,,itisseenunlikelythatNe,scapital,,akeymemberinNetanyahusultra-rightcoalition,hailedthewinningofTrump,sayingitmeansthatthe"eraofaPalestinianstateisover."Trump,saidAlonLiel,,theremainingtwomonthsuntilTrumptakesovertheovalofficemaybethegoldenhour."IthinkthenexttwomonthsarecriticaltotheIsraeli-Palestinianpeaceprocess,"Lielsaid."AftersevenandahalfyearsofloudlyspeakinginfavorofaPalestinianstateandagainstthesettlements,hewillleavehismark."LielwasreferringtoapossibleUnitedNationsSecurityCouncilresolutioncallingfortheestablishmentofaPalestinianstatealongsidethe1967MiddleEastWarborders."MygutfeelingisthatObamawillnotvetoitinordertopreventahugechangeintheAmericanpolicyonceTrumpisintheWhiteHouse,"Lielsaid."ThisisnotsomethingthatTrumpcancancel."AlthoughthePalestiniansandIsraelishavenotsatatthenegotiatingtablesinceApril2014,,hesaid."IfthereisnoUNSCresolution,,andcontinuewiththesettlements,"Lielsaid."NobodywillevenaskAmericatostopit.""WhatthisvictoryisdoingisthatitputseverythinginIsrael,butwewillhavefouryears,wheretherewillbenoonephonecallscreamingfromtheWhiteHousetoJerusalem,"Lielsaid."Idontseethepossibilityofapeaceprocess,"hesaid,notingthatasIsraelisettlementsexpand,nationalcommunityorhewillbeindifferenttotheIsraeli-Palestinianconflict,,politicalanalystMoavVardisaidNetanyahucanbe"calm"aboutthePalestineissue,butonotherissuesNetanyahu"doesnotknowwhattoexpect."ID:22924296----URL:http:///2016-11/10/content_Adjustfontsize:视频播放位置TopleaderoftheDemocraticPeoplesRepublicofKorea(DPRK)KimJongUn(2ndL)(2ndR)signajointstatementinSingaporeonJune12,2018.[Photo/Xinhua]icofKorea(DPRK)wasnolongeranuclearthreat,(theDPRK).MeetingwithKimJongUnwasaninterestingandverypositiveexperience,ingapore,gerousproblem,,followedbyajointstatementinwhichtheUnitedStateswascommittedtoprovidingsecurityguaranteestotheDPRKinexchangeforPyon,

BEIJING,June4(Xinhua)--ChinesePresidentXiJinpingwillchairthe18thShanghaiCooperationOrganization(SCO)Summit,whichisscheduledforJune9to10inQingdao,acoastalcityineastChinamprehensiverructiverolesinregionalandinternationalissues,andthereforesetanexampleofanewtypeofinternationalrelationsfeaturingmutualrespect,fairnessandjustice,andwin-wincooperation.--WhowillattendthesummitLeadersoftheeightSCOmemberstatesandthefourobserverstates,aswellasheadsofinternationalorsfullmembersareChina,Kazakhstan,Kyrgyzstan,Russia,Tajikistan,Uzbekistan,,Belarus,Iran,andMongolia.--WhatisonagendaXiwillchairt,advocatethe"ShanghaiSpirit,"anddiscussmeasurestofightthe"threeevilforces"ofterrorism,extremismandseparatism,drugtrafficking,onsolidatingthemultilateraltradesystem,andlayoutnewplanstoenhancethesynergyofdevelopmentstrategiesofmemberstates,especiallypromotingt,thepresidentsofRussia,Kazakhstan,andKyrgyzstanwillpaystatevisitstoChina,--ConsensustobereachedThesummitwillissuetheQingdaoDeclarationtosummarizethedevelopmentexperienceoftheSCOandpromotethe"ShanghaiSpirit"ofmutualtrust,mutualbenefit,equality,consultation,respectfordiversecivilizations,ong-termGoodNeighborliness,FriendshipandCooperation,andapprovemorethan10cooperationdealscoveringareasincludingsecurity,economy,andpeople-to-peopleexchanges.TRIPOLI,June14(Xinhua)--CommanderofLibyaseastern-basedarmy,GeneralKhalifaHaftar,calledforinvestigationintoallegedillegalexecutionoftwoprisonersbysoldiers."GeneralHaftarcalledforathoroughinvestigationintothevideofootagethatsurfacedonlineandshowsillegalpracticesindealingwithterroristprisonersandreferringtheresultsoftheinvestigationtocompetentlegalauthorities."cedurestakenoneveryprisoner,andorderedthearmytoheeasterncityofDarnabeatingandkil,demandingthearmedgroupoftheShuraCouncil(ConsultativeCouncil)oftheMujahideen,acoalitionofIslamistmilitias,tofDarna,expectingfullcontrolofthecityinthenextfewdays.

  TherearemanyanecdotesandtalesaboutChinesefansinhistoricalrecords,novels,,afamousmilitarystrategistduringtheThreeKingdomsPeriod(220-280),andthebananaleaffanthatbelongstoPrincessIronFan,,,manypeoplepref,Chinesefanshaveevolvedfromanaccessoryfordailyusetoanartifactthatincorporatestheessenceofvariousformsofartsandcrafts,,,menofletterspreferredfoldingfans;militarystrategistsandTaoistpriestspreferredfeatherfans;girlsofnoblefamiomenofletters,wholikedtousefansascanvasesforartworkorforwritingpoetry,,theypursuedbetterdecorationoffans,eventuallyleadingtofansemergingasartworkthatcombinedvariousformsofartssuchaspoems,calligraphy,painting,engraving,,(303-361),,itisapityhisworkswerelostandonlythereplicasintheTangDynasty(618-907),,,peopleallcompetedtobuythem,,anditbecameevenmorepopularduringtheSongandYuandynasties(960-1368).,thepaintersneedtopaycloseattentiontothecompositioninthehalf-circlefan,sothecreationo,theChinesepeopleneverstoppedinnovatingfandesignandmanufacturing,adoptingdifferentmaterialssuchasbamboo,palmtreeleaves,wood,paper,feather,silk,bone,andsandalwood,andmadefansofvariousshapes,suchascircular,square,oval,flowerpetals,,mostpeopleuseelectricfansandairconditionersforcooling,butinmanyplaces,especiallyamongtheelderly,rsfantheirinfantswiththesoundsofchildrenrunningaroundechoinginthestreetsandwomenbrandishingtheirfansinelegantdancesinthepublicsquare.The28-year-oldrefersinsteadtoseniorIndonesianpoetssuchasRemySylado(throughthembelingmovementinthe1970s)andHerryGendutJanartosGado-GadoKredo,,,[bythoseartists]areimportant,,arguesBeni,,doingnothing,gettingpissy,daydreaming,chattingandhangingout,[tome].ThosearethingsIamfamiliarwith,whyshouldItalkaboutissueswhichIamalientoForBeni,th,Istartbylookinginwards,butintheend,Iseenothingtherebutemptiness,hesays,[Iam],thebetter;,,hewasintroducedtothewriterPutuWijaya,,,Beniwouldl,Benisays,practicallyactingasasoundtracktoeverylittlethinghedidinadolescent,suchasrunningawayfromhome(itwasntadramaticthing,heinsists).ThroughIwanFals,Benibeganwritingpoetry:buyinghisfirstpoetrybook(PenyairMudadiDepanForumorTheYoungPoetinFrontoftheForum,releasedin1976),suchastheinfluentialJokpinandSapardi,,whichnowwor,,

  Adjustfontsize:Chinashouldspeedupeconomicupgradeandpushindustrialtransfersinareasonableandorderlymanner,ngsha,capitalofcentralChinasHunanProvince,June12,2018.[Photo/Xinhua]Goodbusinessenvironment,ratherthanfavorablepolicies,shouldbethekeytowinbusinessesinindustrialtransfers,Lisaidduringatwo-dayinspectiontriptocentralChinasHunanProvince,,weopenourarmstoembraceforeignbusinessesthatwillinvestinChina,LisaidwhilevisitingawhollyownedsubsidiaryofGermanysBoschGroupinChangsha,tsandwillbetreatedequally,,,andimprovementofwaterconservancy,,LipointedoutthattransferofindustriesfromeastregionstocentralandwesternregionswasinlinewitheconomicsrulesandwouldGroup,LiencouragedChineseenterprisestorolloutmorehighlycompetitiveproductstomeetindividualclie,whichhasthecountryslargestonlinerecruitmentplatform,Listressedthathesharingeconomyandgigeconomy,whichofferChinahasbeendedicatedtoprovidingpublicgoodstotheinternationalcommunity,aswellasgettinginvolvedintheglobalgovernanceonenvironment,saidErikSolheim,ExecutiveDirectoroftheUnitedNationsEnvironmentProgramme(UNEP),inarecentinterviewwithPeople’ingeandestablishaglo,Chinawillestablishitsimageasaresponsiblemajorcountryanddrivetheconstructionofacommunitywithasharedfutureforhumanbeings,stressedChinesePresidentXiJinping,vironmentnotedthatChinahasmadehistoricalcontributionstotheParisAgreement,whichaimstoreducegreenhousegasesbeyond2020,andhasgreatlyenhancedthecountry’,PresidentXiissuedseveraljointstatementswiththenUSPresidentObamaandthenFrenchPresidentHollande,bridgingtheirdifferencestonegotiateandreachaconsensus,entiononClimateChange,puttingforwardChina’ssolutionanddrivingtheagreementonoutcomed,ChinahassetupministerialconsultationmechanismsonclimatechangewithBRICSmemberstatesandlaunchedtheministerialmeetingmechanismwithCanadaaswellastheEU,alparticipation,saidPanJiahua,directoroftheInstituteof,,acityineastChina’sJiangsuProvinceasanexample,itsthefirstcityinChinatoestablishalowcarboncitymanagementcloudplatform,basedoninformationtechnologiesincludingcloudcomputing,Internetofthings,geographicalinform,Zhenjiang,asoneofChina’sfirstbatchesofecologicalcivilizationleadingdemonstrationareas,alsodevelopedapproachestoterminatehighenergyconsumption,industryinDecember2017,and,thecountry’’scarbondioxi,ChinahassetthethirddayofNationalEner,tointroducethecountry’,theChinesegovernmentsupportsinitiativeofenterprisesandthegeneralpublic,effectivelyimprovingtheawarenessandactionabilities,activitiesconsideredlow-carbonincludingwalking,takingthesubwayorridingabikeandsellingsecondhandgoodscanbeconvertedintovirtual“greenenergy”inthe“AntForest”“greenenergy”isearned,publicserviceorganizationswillplantarealtreeinareassuchastheInnerMongoliaAutonomousRegion.“I’mgladthatIcanmakecontributionstoprotectingtheearth,”’,buildingenergyefficiencyandthermalpowergeneration,,andthecountryisnowworkingonanimplementationplantoachievethisgoal.

PhototakenonJune13,2018showstheinteriorofChinasnewgenerationdomesticmedium-low-speedmagneticlevitation(maglev)trainattheCRRCZhuzhouLocomotiveCo.,Ltd.,ZhuzhouofcentralChinamperhour,comparedwiththefirstgenerationstopspeedof100kmperhour.(Xinhua)CHANGSHA,June13(Xinhua)--Anewgenerationdomesticmedium-low-speedmagneticlevitation(maglev)trai,comparedwiththefirstgenerationstopspeedof100kmperhour,saidTongLaisheng,headofthemaglevresearchinstituteoftheCRRCZhuzhouLocomotiveCo.,Ltd.,500passengerswiththreecarriages,sfirstmedium-low-speedmaglevraillinewasputintocommercialoperationinMay2016inChangsha,thatopspeedof200kmperhour.

  Accordingtothestudyopenpersonalitieslikedsophisticatedmusicovertunesthatweremellow.研究发现,开放型的人喜欢复杂的音乐,而非柔和的音乐。

  Adjustfontsize:Participantsfrom31countriesattendtheopeningceremonyofthe2018Sino-foreignAudiovisualTranslationDubbingCooperationWorkshoponJune13,2018.[PhotocourtesyofCCTSS]Theopeningceremonyofthe2018Sino-foreignAudiovisualTranslationDubbingCooperationWorkshop(SFATD)washeldonJune13atShanghaiStarDynami,includingtheUnitedStates,Russia,Pakistan,Argentina,HungaryandCuba,andmore,theDeputyDirectoroftheMinistrysBureauforExternalCulturalRelationsZhuQi,mentionedthatthecooperationandcommunicationbetweenChinaandothercountriesonChina-foreignaudiovisualtranslationisanessentialwaytopromotetheBeltandRoadInitiativeandoásKovács,CEOofHungaryATVtelevisionchannel,expressedhishopesduringtheopeningceremonythatbyparticipatingintheworkshopChinaandHungarywillcooperat,MinistryofCultureandTourismofthePeoplesRepublicofChinaandtheInternationalCooperationDepartmentoftheStateAdministrationofRadioandTelevisionandwillbeheldf,heldannuallysince2015,aimstostrengthencommunicationandcooperation,encouragemutualappreciationofoutstandingfilmandtelevisionproductsandenhanceChinawillenactalargenumberofincentivestofurtherboostimportsinordertodrivedomesticindustrialupgradingandbettermeettheincreasinglydiversifiedconsumptiondemandsofpeople,theStateCouncil,medicineandnursingandrehastitutionalproceduresandunreasonablepriceincreasessoconsumerswillbenefitfromtheimportdutycuts."thetradeinservices,"Lisaidatthemeeting."Ourdeficitinservicestrademaybeturnedintoacatalystfortheupgradingoftheservicessector,",andimportsofproducerservicescoveringresearchanddesign,tradelogistics,consulting,energyconservationandenvironmentalprotectionwillbeencouraged,ceduresandpromotingauthorizedeconomicopera,,acreditinformationsysteminforeigntradeaswellasenhancedintellectualpropertyrightsprotectionareneededsothatforeigntradeandforeigninvestmentwillcomplementeachother."OurinitiativeofboostingimportsdemonstratesChinascommitmenttoanewroundofhigh-standardopening-up,toeconomicrestructuringandtoeconomictransformationandhigh-qualitydevelopment,",,accordingtofiguresprovidedbytheGeneralAdministrationofCustoms.

  "majordisarmament"bytheDemocraticPeoplesRepublicofKorea(DPRK)bytheendof2020,(ROK),dsthe"completedenuclearizationoftheKoreanPeninsula,""Majordisarmament...Werehopefulthatwecanachievethatinthetwoandhalfyears,"hesaid,addingthatthereis"alotofworklefttodo."Whenquestionedonthewordingofthestatement,PompeosaidTrumpithPyongyang."Letmeassureyouthatcompletetcompletelydenuclearizewithoutvalidating,authenticating,""fairlyquicklyafterwereturntoourhomecountries,"addingthathewas"veryconfident"thatsosstancefromSeoul,sayingthejointdrillscouldbebroughtbackifnegotiationswiththeDPRKdeteriorated."He(Trump)madeitveryclearthattheconditionprecedentfortheexercisesnottoproceedwasaproductive,goodfaithnegotiationsbeingongoing,",,PompeowillmeetwiththecountrysForeignMinisterKangKyung-whaandJapansDefenceMinisterItsunoriOnoderapointedlyonWednesdayalsosaidthedrillsplayeda"vitalroleinEastAsiassecurity,"expressingconcernabouttheircancellation.",oramongJapan,,"hetoldreporters.

  MARRAKECH,Morocco,(Xinhua)--Presidentofthe22ndConferenceofPartiestotheUnitedNationsFrameworkConventiononClimateChange(COP22),SalaheddineMezouar,saidWednesdayclimatechangeissuetranscendspolitics,,whileattachedgreatimportancetotheclimatechangeissue,sayingthatittranscendspoliticsandconcerns"thepreservationofourlivelihood,dignityandtheonlyplanetonwhichwealllive."TrumphasexpressedhiswillingnesstoditchtheParisAgreementinhispresidentialcampaign,doubtingmainstreamscientificfindingsthatdroughts,"weareconvincedthatallpartieswillrespecttheircommitmentsandstaythecourseinthiscollectiveeffort,"insistingthatthepresidencyofCOP22willcontinuetodiscussandmobilizetopursueprogress,,allpartieshavethesharedresponsibilitytocontinuethegreatprogressachievedtodate,,denouncetheelectionofTrump,"mourning",mestically,:22924223----URL:http:///2016-11/10/content_HeateddiscussionsonthehistoricsummitbetweenNorthKoreanleaderKimJong-unandUSPresidentDonaldTrumpamongChinesehaveyettosubside,andsomeChinesehavehighexpectationsofbusinessoppoopicsonChinesesocialmediaplatformSinaWeibo,withthepage"Kim-Trumpsummit"opportunitiesinNorthKorea."ChinaandNorthKoreahavemutualtrustandfriendlyties,whichisouradvantageoverothercountries,"abusinessmansurnamedZhangfromDandong,acityborderingNorthKoreainNortheastChinasLiaoningProvince,gainstNorthKorea,,som,28,whovisitedPyongyangin2016,toldtheGlobalTimesthat"ifNorthKoreabecomesmoreopenandallowsgreaterindependenttravel,Iwilldefinitelygothereagain."NorthKoreabansindependenttravelforforeigners,,someanalystswarnedagainstbeingoverlyoptimisticaboutNorthKoreasopening-upsincethereisstilllongwaytogoforNorthKoreatosetupthelegalandphysicalinfrastructurefortheopening-up,anditwilltakeatleastseveralyearselopment,itistooearlytohavehighexpectationsofbusinessopportunitiesinNorthKorea,ChengXiaohe,anassociateprofessorattheRenminUniversityofChinasSchoolofInternationalStudies,toldtheGlobalTimesonWednesday."Theopening-upofNorthKorearequiresafirmdeterminationandconcretepoliciesfromthegovernmentandtheestablishmentofformaldiplomatictieswithothermajoreconomies,especiallytheUSandJapan,,",theyshouldalsoconsidertherisks,Chengsaid."NorthKoreaisnotaplacewhereyoucangetgoldeverywhere,",NorthKoreaslaws,regulationsandpoliticalsystemarenotreadyforamassiveopening-up,ZhengJiyong,directoroftheShanghai-basedFudanUniversitysCenterforKoreanStudies,,expertsstillpraisedtheoutcomeofTuesdaysKim-Trumpsummit,spressconferenceonTuesdayattheCapellaHotelinSingapore,theWhiteHouseshowedavideotojournali,",youhaveChina,andthey[NorthKorea],rightItsgreat,"accordingtoaWhiteHousetranscript.

  AbeecollectshoneyonalotusflowerattheZhuozhengyuanGardeninSuzhou,eastChinasJiangsuProvince,June3,2018.(Xinhua/HangXingwei)AbirdrestsonalotusflowerinWufuTownshipofWuyishanCity,southeastChinasFujianProvince,June1,2018.(Xinhua/QiuRuquan)AbeecollectshoneyonalotusflowerattheZhuozhengyuanGardeninSuzhou,eastChinasJiangsuProvince,June3,2018.(Xinhua/HangXingwei)AbirdrestsonalotusflowerinWufuTownshipofWuyishanCity,southeastChinasFujianProvince,June1,2018.(Xinhua/QiuRuquan)

  Special:The18thShanghaiCooperationOrganization(SCO)summithasinjectedfreshimpetustothebuildingofanSCOcommunitywith,PresidentXiJinpingofferedhisinsightsondevelopment,security,cooperation,civilization,andglobalgovernance,,strengthenthefoundationforsharedpeaceandsecurity,buildapowerfulenginetoachievecommondevelopmentandprosperity,forgeclosertiesthroughculturalandpeople-to-peopleexchanges,sportcityofQingdaomarkedthefirstgatheringofleadersofalleightmem,memberstatesstressedunity,coordination,"buildingacommunitywithasharedfutureforhumanity",theworldisfacedwithchallengessuchashegemony,powerpolitics,securitythreats,unilateralism,tnerships,prioritizecooperationonsecurity,followthetrendofeconomicglobalizationandregionalintegration,enhancepeople-to-peopleconnectivityandmutuallearninginculture,,theSCOmem,with23cooperativedocumentsindiversefieldssigned,,000lawenforcementofficersforallpartiesinthenextthreeyearsthroughChinaNationalInstituteforSCOInternationalExchangeandJudicialCooperationandotherplatforms,setupa30-billion-yuan()equivalentspeciallendingfacilitywithintheframeworkoftheSCOInter-bankConsortium,andsupportbuildingademonst,theSCOstandsasacomprehensiveregionalcoopera,namely,China,India,Kazakhstan,Kyrgyzstan,Pakistan,Russia,TajikistanandUzbekistan,accoundevelopment,,theSCOwillmakegreatercontributionstotheloftycauseofhumanprogress.

  NEWDELHI,June14(Xinhua)--ThequalityofairinIndiaromthewesternstateofRajasthanwhichisfacin"severe"conditionofairqualityforcedthecountrysMinistryoconti,evenasthe"PM10"ssueddirectionstotheconcernedauthoritiestocarryoutsprinklingofwatertobringdownthedustintheairoverthenextcoupleofdays."Majorconstructionagencies,municipalcorporationsandDelhiPollutionControlCommittee(DPCC)havebeenalertedtoensurewatersprinkling,asrequired,"ndiancapitalare"unusual"ndthensinceTuesdaytoWestandSouthWest,duetowhichhotair,alongwithdustfromRajasthanhasstartedmovingintoDelhi.LONDON,June13(Xinhua)--BritishPrimeMinisterTheresaMaysgovernmentsuccessfullyfoughtoffthreeattemptsWednesdaytotieBritainshandstoacustomsunionortheEuropeanEconomicArea(EEA)scrucialBrexitWithdrawalBill,,fiveLabourMPs,oneofthemashadowcabinetminister,resignedfromtheirpartyrolessot,TheHouseofCommonsrejectedbyacomfortable201margin,yingintheEuropeanEconomicArea,,MPsvotedonanamendmentfromtheHouseofLordsaimedatpreventingtherepealofthe1972BritishActofParliamsgovsQuestionsdescendedintochaoswhentheleaderoftheScottishNationalistParty(SNP)usingtositdownafterBercow,declinedmpactofBrexitonScotlandsdevolvedgovernmentduringTuesdayent(MPs)heday,sMPswerebeingtreatedwithcontemptbyWestminsteranditneededtobehighlighted.

  

  喜闻道②图表|加快建设美丽怡然资阳的“方法论”请收好!

 
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介入治疗

时间:2019-10-15 01:01  来源:新快报

●介入治疗是一种新兴疗法,利用影像设备作导航,在不暴露病灶的情况下,对其进行治疗。

扫码下载“广东头条”APP,《发现广东》内容将在广东头条“广东频道”当日置顶

扫扫这个二维码,即可欣赏上期《东江麒麟舞“沙仙驯麒麟”是舞也是武》专题的视频短片。
SHENZHEN,(Xinhua)--()ayeartofundfreeadmission,saidLiuYuzhu,headoftheStateAdministrationofCulturalHeritage,attheUNESCOhighlevelforumonmuseums,whichbeganThursdayinShenzhen,southChina,692,with4,013freetovisitorssince2008,very290,,000Chineseby2020,,thegovernmentwillbuildmuseumsinpoorandremoteareasandregionsinhabitedbyethnicminorities,aswellassettingupmobileanddigitalmuseumsincommunities,schoolsandremoteareas,:22944391----URL:http:///2016-11/11/content_

心脏搭桥、“吹波仔”都是通俗说法

总第196期

策划:肖 萍

撰稿:曹洪梅

美术:张汉松

绘图:廖木兴

介入治疗

历史:1979年介入放射学得到国际学术界公认

工具:穿刺针、导管、导丝、导管鞘、注射器等

特点:微创、安全、有效、并发症少、明显缩短住院时间等

在一般人眼里,介入治疗就是“不用开刀、创伤少、伤口愈合快”,而对于心脏疾病的介入治疗,广东老百姓还将心脏搭桥所用的医疗器材形象地称呼为“吹波仔”。不过,介入治疗作为一门新兴学科,绝对不止上述这些说法那么简单。

本期《发现广东》,新快报记者采访了暨南大学附属第一医院介入血管外科的几位教授和医护人员,听他们讲述介入治疗的医学知识和病患故事。而当介入科男护士说起“最忙时一天做18台手术,(其辐射程度)相当于拍1000次胸片”时,记者对医护人员的付出心生敬佩。

曹洪梅

记者手记

介入治疗与普通老百姓的生活其实很近,但作为一门新兴学科,了解它的人并不多。介入放射学是影像专业的一个分支,早在19世纪初,西方人就在造影技术上有了很大突破和进展,后来一次偶然事件,发现原来可以利用同轴导管扩张血管,从而让血流疏通,病症消失;再接着不断改进各种器械和技术,如今介入治疗可以解决很多传统医术不能解决的问题。

采访中,暨南大学附属第一医院介入血管外科副主任张艳副教授说了不少她与病患者的故事。2008年重庆一个小伙带着父亲找到张艳副教授,他父亲的脚烂了,很痛,做了介入治疗后,治好了。他们回到重庆后,跟张艳也没联系,直到3年后,这个小伙突然发短信给张艳说,他父亲去世了,因为心脏病,但自从那次手术后一直到去世,他父亲的脚再也没有痛过。

痛,不但是一种身体负担,更是一种精神重荷。每个人都深知痛的滋味,如果能用简单的一些器械和手法就能解决这个问题,真是一件好事。但凡事必有两面性,有利必有弊,病人享受病痛解除后的轻松愉悦同时也要承担昂贵的手术费用;而医护人员则要承受辐射的侵蚀,听到张艳说她的身体状况时,每个听众都会为之揪心。与张艳在同一科室的李承志医生现在处于“隔离期”,他们的行规是“造人”之前要有3个月的暂停手术期,“我太太来医院做B超检测排卵期卵子长熟了没有,按照周期算,今天不行,明天再来。”

最后,介入治疗并非完美无缺的,现在的问题是血管血栓还会再长回来,如何攻克血管再狭窄问题,是李承志医生他们正在积极推进的事情。
 

 
●德国一家医疗器械公司特别为华侨医院生产的一台造影机,机臂上有一条中国龙,全世界仅此一台。

●介入治疗所用到的工具有:穿刺针、导管、导丝、导管鞘、注射器、支架、球囊等。

●血管病灶部位的影像展示。

(外周血管)出血、缺血、肿瘤等情况,介入治疗放个支架,10分钟就能搞掂,就像补衣服一样。”

——暨南大学附属第一医院介入血管外科主任 王晓白教授

仅用一个造影机、几根导管这么简单的器械就能完美地完成一个大手术,这么神奇?请看实例。今年2月中旬,一位92岁的老爷子因为腰间盘突出,不能平卧,而且日夜不停地疼痛,每天晚上都会疼得大喊大叫,根本无法入睡。面对此种情况,家属心情如焚,多方打听后,来到广州的暨南大学附属第一医院,经过快速检查确认病灶后,老爷子被推进了手术室,25分钟后,手术结束了,他还没下手术台时就说道:“脚暖了,不痛了。”

介入治疗是如何诞生的

上述这种疗法叫做介入治疗,是一种新兴的治疗方法,“传统西医分为内科和外科,介入治疗介于二者之间,包括血管内介入和非血管介入治疗”,暨南大学附属第一医院介入血管外科主任王晓白教授向新快报记者介绍,“说起来介入治疗有几个方面的特点,一是非传统开刀方法,二是非传统吃药方法,三是非传统内科和外科治疗手法,四是利用影像设备作导航,比如血管造影机、透视机、CT、MR、B超等,在血管、皮肤上做一个很小的刺穿孔,然后借用同轴导管,深入病人体内血管,进行修补、扩充、疏通工作,在不暴露病灶的情况下,对其进行治疗。”

1967年美国放射学家Margulis首次提出Interventional Radiology这个词,被称作“介入放射学”或“介入治疗学”,1979年得到国际学术界正式认可,自此介入放射学与内科、外科并列三大支柱性学科。1898年发现射线后,国外就有人开始利用石膏作造影剂开始尸体动脉造影研究,其后一路向前发展,“1964年美国的Dotter在为一个下肢坏疽的老太太做检查时,利用同轴导管对血管狭窄部位进行了一次扩张,这个偶然之举产生了一个奇迹,狭窄部位消失了,缺血症状缓解了。这样就不用按照传统做法截肢了,只是把坏死的脚指头切掉就行了,这样就保住了一条腿,因此Dotter被称作介入治疗之父。”王晓白说道。

心脏搭桥90%以上采用介入治疗

接着,王晓白通俗易懂地介绍了介入治疗的应用,“主要有四大治疗领域,一是心脏,通常所称的搭桥,现在90%以上都是采用介入治疗,为此还发明了新的医疗器材,通俗点说就是细导管+气球,广东老百姓形象地称它为‘吹波仔’,就是在需要时充气,利用物理压力把血管斑块压到壁里去,接着再照影,不行的话,就再放个支架。此外,像先心病,在妈妈分娩之前就可以进行手术治疗。”

新快报记者让王晓白做一个对比,与传统手术相比,“对比的话要牵涉很多因素,如果非要对比的话,可以这样说,介入治疗的风险系数大大降低,传统治疗的风险系数是60%的话,介入治疗则0.6%都不到。最主要的优势是介入治疗的安全成几十倍、上百倍提高,仅有牙签、火柴棍大小的微创,几个小时就能愈合。”

“二是神经,尤其是颅内动脉瘤、颅内动静脉瘘、颅内动静脉畸形等都是高发死亡病症,如果病灶的位置理想,范围不大,可以考虑用脑外科手术治疗;如果位置不理想,轻则可以损伤语言、听觉、视觉等功能,重则变成植物人,此时医生一般都会说:多保重吧!”王晓白说,“现在中风已成为常见病,如果在6小时内,病人接受了介入治疗的话,不会留下任何残疾和后遗症。三是外周血管,对于出血、缺血、肿瘤等情况,介入治疗放个支架,10分钟就能搞掂,就像补衣服一样。四是肿瘤,无论恶性还是良性,传统的首选方法是手术,有了介入治疗后,这种局面就打破了。一种做法是,查清肿瘤有多少血管供给营养,把这些血管堵死,掐断肿瘤的营养来源,让它自己饿死;第二个是把药物直接灌注到肿瘤里面,避免了药物对身体的副作用。”

十几年来用时最短的手术

再详细说说本文开头提到的老爷子,“他是下肢动脉长段闭塞,三十多厘米,右足静息痛,无法入睡;另外,他只能侧卧,不能平卧。”主治医生、暨南大学附属第一医院介入血管外科副主任张艳副教授说,“这就是一个挑战,手术姿势要求就是平卧,所以我们以最快的速度,几分钟之内把导管从左穿到右侧,然后打破常规,让他侧卧进行手术。由于病人体型较胖较重,我们也要克服这方面的困难,以最快速度完成手术,只用了25分钟就结束了。这是十几年间,我做过的最快的一次手术。”

“因为病人耳聋,但是可以说话,所以手术结束后,我们拿了一张纸给他看,上面写道:治好了,你觉得怎么样?他说,我很舒服,不痛了,很久没这么安静地休息过了,今晚可以睡个好觉了。病人家属很吃惊,也很感激,然后对我说:我可以抱抱你吗?”张艳副教授说。
 

 
●防辐射的铅衣,最轻的也要15斤以上,记者用单手拿起来都很费力。

●铅衣和防辐射围脖。

如果从上往下开通血管,导丝没办法一次进入远端,这怎么办呢?我就开动想象力,如果从反方向,也就是小腿穿刺,然后再跟上面会合,用两个影像观察病情,这就相当于用线找针,穿针引线。”

——暨南大学附属第一医院介入血管外科副主任 张艳副教授

施行介入治疗的医护人员通常被称作“吃射线”的人,目前最通行的防辐射办法是穿铅衣、戴铅帽和铅眼镜,最轻的铅衣都有15斤重,每天负重上班的情景可想而知。医生做完手术后,可以脱掉这些负重,而护士则要时时把铅衣穿在身上,以防急诊病人来了,还要临时穿戴浪费时间。如果长时间穿戴铅衣,会造成腰椎间盘突出、颈椎痛、膝关节痛、跟痛症以及眼睛老化、掉头发等病症。暨南大学附属第一医院介入血管外科副主任张艳副教授告诉新快报记者:“每天只能蜷着睡觉,梦里也是全身酸痛。”

独创“双像会师”

张艳是国内数一数二的下肢动脉再通术专家, 2006年她在德国进修期间接触到了介入治疗,次年回国后就边摸索边开展下肢动脉再通术的工作。“当时大家都是一片空白,只能一步步实践。一开始手生,小心翼翼,做一次手术总结一次,由于器材熟练程度和经验都比较欠缺,用时比较长,一般都是2-3个小时,有时候是4个小时。但从来没出现过意外。病例多了,器械改进了,就可以解决很多复杂病症了,可以做其他医院做不了的,现在平均手术时间只有1-1.5个小时。”

2007年,张艳碰到一个病例是股动脉长段堵塞,“如果从上往下开通血管,导丝没办法一次进入远端,这怎么办呢?我就开动想象力,如果从反方向,也就是小腿穿刺,然后再跟上面会合,用两个影像观察病情,这就相当于用线找针,穿针引线。”张艳说,当时国内还没有此类做法,遇到案例只能自己琢磨,她把这种做法命名为:双像会师。

要牢记几千条血管的中英文名

2011年,一位70多岁的老爷子因主动脉、髂动脉、股动脉双侧全程闭塞,每天晚上都很煎熬,他女儿一直哭,希望能减轻老人家的疼痛。鉴于病情非常复杂,全科一起讨论了5套方案,有分期治疗方案,也有一次性治疗方案。暨南大学附属第一医院介入血管外科主治医师李承志参与了此次治疗,“手术进行了12个小时,这也是迄今最长时间的一次。中间病人出现了意外,心脏骤停,立即抢救拉长了手术时间。另外,术中出现情况,医生出来跟家属说明,家属要考虑至少半小时到1个小时,我就一直穿着铅衣站在台上等着,防止有情况发生。”

李承志说介入放射学是一门新兴学科,目前他在本科生中讲授此科目,“除了一些必须的医学知识储备外,血管介入治疗还要了解血管解剖知识,任何一条血管都要知道它的名字,几千个名字都要记住,另外还要记住它的英文名字,便于国际交流。第二个要掌握的是产品器械和公司,不同公司、不同型号的器械的特点都不相同,比如说支撑力更强的支架和柔韧性较强的支架等,而且耗材的价格也要知道,因为医生要直接跟患者谈价钱。”

李承志说他所在的医院在全国率先引进全新的下肢动脉腔内斑块旋切+药物涂层球囊成形术,该设备配有1.35米长的导管、一个每分钟6000转的旋转刀片,导管口径2-3mm,在口径为6-8mm的股动脉中游动绰绰有余,在影像指导下进行药物涂层球囊扩张,能更好地起到治疗效果。但费用很高,所使用的导管、刀头、保护伞均为一次性耗材,大部分都是自费项目,无法享受医保报销,单次手术费用加起来约10万元。

介入科多数是身强力壮男护士

由于介入治疗要负重近20几斤的铅衣工作,所以一般很少有女护士,男护士较多,伍先忠就是其中之一,他们与一般的护士有很大区别。他说护士长挑选护士时一般都是挑身强力壮、思维敏捷的人。伍先忠说,一开始培训时,他要背着铅衣上班,每天至少背5个小时以上,“要习惯性地背铅衣。入职前期,我的白细胞一度低于正常水平 ,抵抗力也下降。过了大半年时间,才适应过来。”

“除了做手术前的准备工作外,手术中会需要导管、支架、导管鞘、导丝、球囊等多种器械,护士必须第一时间从相应的柜子里取出拿给医生;另外,病人出现心律慢、血压骤降等情况时,要第一时间给药,否则病人就有生命危险。有的手术需要好几个小时,在此期间,我们都必须保持高度紧张状态。”伍先忠说,介入科的工作量很大,最忙时一天的手术量可以达到18台,“做一天手术,相当于拍1000次胸片。”

谈资

介入放射学发展简史

1895年Haschek和Lindenthal首次在截肢手的动脉内作动脉内注入造影剂造影。

1898年Morton开始用石膏作造影剂进行尸体动脉造影的研究。

1904年Dawbam将凡士林和蜡制成的栓子注入颈外动脉,进行肿瘤手术切除前栓塞。

1910年Franck和Alwens在活狗及活兔的动脉内进行造影。

1923年血管造影始用于人类,德国的Berberich经皮穿刺将溴化锶水溶液注入人体血管内造影成功;法国的Sicard和Forestier用含碘罂子油作静脉注射造影也获得成功。

1924年美国的Brooks用50%的碘化钠成功地作了第一例股动脉造影。

1929年Dos Santos采用长针经皮腰部穿刺作腹主动脉造影成功,安全有效,至今仍有人在沿用;同年Fotsmann从上臂静脉将导尿管插入自己的右心房,首创心导管造影术,因此荣膺诺贝尔奖。

1953年Seldinger首创了经皮股动脉穿刺、钢丝引导插管的动静脉造影法,由于操作简单,容易掌握,对病人损伤小,不需要结扎修补血管,很快就被广泛应用。为此,他本人也获得诺贝尔奖。

1964年,Dotter利用同轴导管开创了经皮血管成型技术。

1970年代,恶性肿瘤介入治疗。

(据公开资料)


编 辑:韩冬
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