Impact of metabolic syndrome on short-term outcome of carotid revascularization: a large sample size study in Chinese population / 中华医学杂志(英文版)

BACKGROUND@#Metabolic syndrome (MetS) is relatively common worldwide and an important risk factor for cardiovascular diseases. It is closely linked to arterial stiffness of the carotid artery. However, the association of MetS with the safety of carotid revascularization has been rarely studied. The aim of this study was to observe the current status of MetS and its components in Chinese carotid revascularized patients, and investigate the impact on major adverse clinical events (MACEs) after carotid endarterectomy (CEA) or carotid artery stenting (CAS).@*METHODS@#From January 2013 to December 2017, patients undergoing CEA or CAS in the Neurosurgery Department of Xuanwu Hospital were retrospectively recruited. The changes in prevalence of MetS and each component with time were investigated. The primary outcome was 30-day post-operative MACEs. Univariable and multivariable analyses were performed to identify the impact of MetS on CEA or CAS.@*RESULTS@#A total of 2068 patients who underwent CEA (766 cases) or CAS (1302 cases) were included. The rate of MetS was 17.9%; the prevalence rate of MetS increased with time. The occurrence rate of MACEs in CEA was 3.4% (26 cases) and in CAS, 3.1% (40 cases). There was no statistical difference between the two groups (3.4% vs. 3.1%, P = 0.600). For CEA patients, univariate analysis showed that the MACE (+) group had increased diabetes history (53.8% vs. 30.9%, P = 0.014) and MetS (34.6% vs. 15.8%, P = 0.023). For CAS patients, univariate analysis showed that the MACE (+) group had increased coronary artery disease history (40.0% vs. 21.6%, P = 0.006) and internal carotid artery tortuosity (67.5%% vs. 37.6%, P < 0.001). Furthermore, the MACE (+) group had higher systolic blood pressure (143.38 ± 22.74 vs. 135.42 ± 17.17 mmHg, P = 0.004). Multivariable analysis showed that the influencing factors for MACEs in CEA included history of diabetes (odds ratio [OR] = 2.345; 95% confidence interval [CI] = 1.057-5.205; P = 0.036) and MetS (OR = 2.476; 95% CI = 1.065-5.757; P = 0.035). The influencing factors for MACEs in CAS included systolic blood pressure (OR = 1.023; 95% CI = 1.005-1.040; P = 0.010), coronary artery disease (OR = 2.382; 95% CI = 1.237-4.587; P = 0.009) and internal carotid artery tortuosity (OR = 3.221; 95% CI = 1.637-6.337; P = 0.001).@*CONCLUSIONS@#The prevalence rate of MetS increased with time in carotid revascularized patients. MetS is a risk for short-term MACEs after CEA, but not CAS.

Association of GNA11 gene polymorphisms with idiopathic hypoparathyroidism and its complications / 基础医学与临床

Objective To investigate the association of GNA 11 gene polymorphisms with idiopathic hypoparathyroidism (IHP) and its complications. Methods Two hundred and three patients with IHP and 209 control subjects were recruited at Peking Union Medical College Hospital from December 1987 to December 2015. The GNA11 gene polymorphisms were selected and genotyped by Sequenom MassArray iPLEX system.Results The minor allele T of rs308060 was associated with an increased risk of IHP in the additive [OR = 2.505(1.005-6.245) , P＜0.05; OR=3.269(1.264-8.458), P＜0.05]and recessive model[OR= 2.727(1.105-6.727), P＜0.05]. Although no significant difference was found in the incidence of intracranial calcification and cataract in IHP patients, the haplotype CTCGCT consisting of minor allele T of rs308060 was correlated with their 24 hours urinary calcium levels (β = 0. 186, P＜0.05). Conclusions The minor allele T of rs308060 in GNA11 means high risk of IHP, and is positively correlated with urinary calcium excretion in IHP patients after treatment with oral calcium and vitamin D analogs supplements.

Thirty-day outcome of carotid artery stenting in Chinese patients: a single-center experience / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Carotid artery stenting (CAS) as a competing treatment modality has had to adhere to limits to gain widespread acceptance in some studies. This study analyzed the clinical data of 1700 consecutive patients after CAS to retrospectively evaluate the 30-day outcome of CAS for internal carotid artery stenosis in a Chinese population.</p><p><b>METHODS</b>Medical records of 1700 patients who underwent CAS at Xuanwu Hospital affiliated to Capital Medical University between January 2001 and August 2012 were reviewed. Postoperative 30-day complication rates were analyzed and compared with those of other studies. Univariate and multivariate Logistic regression analyses were used to identify factors associated with perioperation myocardial infarction (MI), stroke, and death.</p><p><b>RESULTS</b>The overall 30-day rate of MI, stroke, and death after CAS was 2.53%. In univariate analysis, patients who were symptomatic, had a neurological deficit (modified Rankin score (mRS) ≥3; P = 0.001), and who were not taking statins experienced a significantly increased rate of MI, stroke, and death (P = 0.017). In multivariate Logistic regression analysis, the presence of symptoms (odds ratio (OR) = 2.485; 95% confidence interval (CI) = 1.267-4.876; P = 0.008) and a neurological deficit (mRS ≥3) (OR = 3.025; 95% CI = 1.353-6.763; P = 0.007) were independent risk factors for perioperative MI, stroke, and death.</p><p><b>CONCLUSIONS</b>According to this single-center experience, CAS may effectively prevent and treat carotid artery stenosis that would otherwise lead to stroke. Being symptomatic and having a neurological deficit (mRS ≥3) increased the risk of perioperative MI, stroke, and death.</p>

Intra-arterial thrombolysis for 576 cases of acute ischemic stroke; a single center analysis / 中国脑血管病杂志

Objective: To investigate the safety and efficacy of intra-arterial thrombolysis in the treatment of acute ischemic stroke. Methods: The clinical data of the patients in the Department of Interventional Radiology, Xuanwu Hospital, Capital Medical University from January 2000 to September 2010 were analyzed retrospectively. A total of 576 patients with acute ischemic stroke were treated with intra-arterial thrombolysis, 160 patients were female and 416 were male, their mean age was 55±10 years old. The therapeutic time windows of anterior and posterior circulation lesions were 5.1±1.8 and 9.1±2.2 h respectively, and the dosages of urokinase were 82±21 and 104±15 U respectively. Results: Circled digit one 389 patients had internal carotid arterial occlusion, their recanalization rate was 61.7%, and 68 patients were conducted with laser-assisted balloon dilation or stent placement. The improvement rate of mRS was 66.1% 2 weeks after thrombolysis, and the symptomatic intracranial hemorrhage rate was 13.3%. Circled digit two101 patients had vertebral-basilar arterial occlusion, the recanalization rate was 64.3%. Thirty patients were conducted with laser-assisted balloon dilation or stent placement. The improved rate of mRS was 43.6% 2 weeks after thrombolysis, and the symptomatic intracranial hemorrhage rate was 5.0%. Circled digit threeCerebral angiography was negative in 86 patients, accounting for 14.9% of all the cases. Conclusion: After thrombolysis of extracranial and intracranial arterial occlusion, the rate of recanalization, the improved rate of mRS, and the rate of symptomatic intracranial hemorrhage showed that arterial thrombolysis in the treatment of acute ischemic stroke is a relatively safe and effective method of treatment.

Expression of vascular endothelial growth factor in vascular malformations of spinal cord / 中国脑血管病杂志

Objective: To observe the expression of VEGF in the spinal vascular malformations by immunohistochemical staining. This study will provide useful information for better understanding of the etiology and development of the spinal vascular malformations. Methods: The specimens (including 31 AVMS, 17 CMs) were collected as the experimental group. Ten specimens of normal spinal cord were obtained from autopsy served as the control group. VEGF expression were performed by immunohistochemistry and all the stained sections were observed under light microscope recording the positive site. SPSS 11.0 statistical software were used to analyze the relationship between VEGF and some clinical features. Results: All 58 lesions were stained positive for VEGF, with the SCAVMs staining somewhat more intensely (P < 0.01) and the control group are almost negative staining. Bleeding and pre-embolization can lead to the raising of expression of VEGF. To the SCAVM group, the expression of VEGF on inner membrane and tunica media stains more intensely than ectal membrane. And the artery showed more positive staining than vein. Conclusion: VEGF maybe play an important role in the etiology and development of spinal vascular malformations. Haemorrhagia and embolism influence the express of VEGF in vascular malformations of spinal cord.