ABSTRACT
The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.
ABSTRACT
Objective:To explore application of the mixed reality (MR) technique in the surgery for complex pilon fractures.Methods:A retrospective analysis was conducted of the 22 patients with pilon fracture of Rüedi-Allg?wer type Ⅲ who had been treated at the Department of Orthopedics, Nanjing Tongren Hospital from May 2018 to October 2020. They were divided into 2 groups according to their treatment procedures. In the MR group of 9 cases, there were 8 males and one female, with an age of (39.2 ± 15.1) years. In addition to calcaneal traction plus open reduction and internal fixation, the MR technique was used to assist doctor-patient communication, preoperative planning, surgical guidance and rehabilitation exercises. In the control group of 13 male cases with an age of (33.7 ± 9.6) years, only conventional calcaneal traction plus open reduction and internal fixation were carried out. The communication efficiency, operation time, intraoperative blood loss, fluoroscopy frequency, fracture reduction, post-operative complications and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at one year postoperatively were recorded and compared between the 2 groups.Results:There was no significant difference in the general data between the MR group and the control group, showing they were comparable ( P > 0.05). The questionnaire score of patients' surgical awareness [(77.8 ± 19.2) points] in the MR group was significantly higher than that in the control group [(50.0 ± 30.6) points] ( P = 0.017). The fluoroscopy frequency [(7.3 ± 2.6) times] in the MR group was significantly lower than that in the control group [(9.5 ± 2.3) times] ( P = 0.043). No significant differences were observed between the 2 groups in either the operation time [(98.3 ± 14.4) min versus (110.4 ± 20.4) min] or the intraoperative blood loss [(118.9 ± 36.5) mL versus (128.8 ± 35.2) mL] ( P = 0.142, P = 0.527). In the MR group, 8 cases achieved anatomical reduction and one case good reduction; in the control group, 4 cases achieved anatomical reduction, 8 cases good reduction and one case poor reduction. The anatomical reduction in the MR group was significantly better than that in the control group ( P = 0.011). There were one case of delayed wound healing, one case of nonunion, and one case of traumatic osteoarthritis in the MR group while there were 2 cases of delayed wound healing, one case of superficial soft tissue infection, one case of nonunion, and 2 cases of traumatic osteoarthritis in the control group. The average AOFSA ankle-hindfoot score at one year postoperatively in the MR group [(83.8 ± 9.0) points] was significantly higher than that in the control group [(73.3 ± 11.8) points] ( P = 0.035). However, there was no significant difference between the MR group and the control group in the good to excellent rate by the AOFSA ankle-hindfoot score at one year postoperatively (6 excellent cases, one good case, and 2 fair cases in the former versus 6 excellent cases, 2 good cases, 4 fair cases, and one poor case in the latter) ( P = 0.648). Conclusions:In the surgery for complex pilon fractures, MR technique can increase the efficiency of doctor-patient communication, reduce intraoperative fluoroscopy frequency, and improve reduction quality and ankle function, but fails to significantly reduce operation time and intraoperative blood loss.
ABSTRACT
OBJECT IVE To evaluate the application effect of the whole cour se medication management mode led by pharmacists in rheumatic immune diseases. METHODS A total of 122 patients treated with tacrolimus or cyclosporine in the department of rheumatology and immunology of Wuhan No. 1 Hospital from 2018 to 2020 were selected as the study subjects. Among them ，44 cases in the control group were under the traditional supervision mode ；78 patients in the observation group adopted the whole course medication management mode led by pharmacists ，that was ，individual pharmacists and specialist clinical pharmacists cooperated and led ，and not only participated in the whole process of drug treatment but also involved in the whole process of therapeutic drug monitoring （TDM）. On the basis of the control group ，the division of labor and cooperation among medical，pharmaceutical and nursing parties were strengthened ，and the homogeneous supervision was carried out for the outpatients and inpatients from admission to discharge . The daily dose of medication ，the rate of reaching the standard of blood drug concentration ，the incidence of problematic samples （the sample was calculated by the number of times ），the average hospitalization days ，the re-admission rate within 6 months after discharge ，the medication compliance score and the patient ’s satisfaction rate were compared between the two groups. RESULTS In the control group ，53 times of TDM were performed ， including 18 times of tacrolimus monitoring and 35 times of cyclosporine monitoring ；in the observation group ，123 timesof TDM were performed ，including 55 times of tacrolimus monitoring and 68 times of cyclosporine monitoring. The daily dose of tacrolimus ，the daily dose of cyclosporine ，the rate of reaching the standard of cyclosporine blood drugconcentration，the inc idence of problematic samples ，the rate of re-admission within 6 months after discharge ， the medication compliance score and the patient ’s satisfaction rate in the observation group were significantly better than those in the control group （P＜0.05）. CONCLUSIONS It can effectively improve the effect of the quality of pharmaceutical care to implement whole course and homogeneous medication management led by pharmacists and provide precise drug guidance for patients with rheumatic and immune diseases.
ABSTRACT
Rare diseases have been a major challenge for clinical medicine and public health challenge in China. One of the effective measures is to conduct proactive research on rare diseases to deal with the disease burden of the diseases. However, low prevalence, disperse distribution of patients, lack of knowledge about the disease course, and phenotype heterogeneity hamper the development of research for rare diseases. Recently, it has been found that patients registry is effective in understanding the course of the disease and accu- mulating the cases and data of clinical research or clinical trial design. At present, most of developed countries or regions in the world have promoted clinical research and clinical trials of new medications on rare diseases by using the registration of rare disease. In 2016, Peking Union Medical College Hospital established China's first registry system at the national level-National Rare Disease Registry System of China(NRDRS). NRDRS has accumulated 68 137 cases data registered by the researchers from China's 101 collaborating hospitals in 29 provinces/municipalities/autonomous regions, covering 171 different, and forming 188 cohorts. To date, NRDRS complete the initial stage of resources buildup.Nex stage will be focused on clinical research and clinical trials related to rare diseases based on NRDRS. This article is on the process of building NRDRS, the potential support for conducting clinical research and clinical trials related to rare diseases, and the challenges will be faced.
ABSTRACT
Objective:To evaluate and compare the clinical value of unadjusted fracture risk assessment tool(FRAX) and adjusted FRAX in predicting the risk of hip fracture in patients with type 2 diabetes(T2DM).Methods:In this 10-year retrospective cohort study, 1 730 patients with T2DM were collected from August 2009 to July 2013. The 10-year risk of hip fracture was calculated using the China FRAX model. Hip fracture events during the follow-up period were collected through electronic medical records and telephone interviews. The value of FRAX and adjusted FRAX in predicting the risk of hip fracture in T2DM patients was evaluated from two aspects of discrimination and calibration. Cox regression model was used to investigate the relationship between diabetes related factors and hip fracture.Results:A total of 39 participants(2.3%) experienced hip fracture during a median follow-up of 10 years. The area under the curve of unadjusted FRAX was 0.760, but the calibration ability was poor [calibration χ2: 75.78, P<0.001; calibration ratio(observation/prediction): 3.97(95% CI 2.76~5.17)]. There was no significant improvement in calibration ability of adjusted FRAX. After adjustment for unadjusted or adjusted hip fracture probability calculated by FRAX(FRAX-HF), duration, estimated glomerular filtration rate, insulin use, cerebrovascular diseases, and diabetic peripheral neuropathy were significantly associated with an increased risk of hip fracture( P<0.05). Conclusion:The FRAX tool significantly underestimated the risk of hip fracture in T2DM patients, and there was still significantly underestimation after adjustment due to the failure to eliminate the influence of diabetes-related factors such as disease duration and peripheral neuropathy.
ABSTRACT
BACKGROUND@#Bone defect difficult to manage clinically and it is a big challenge to repair it. Secondary metabolites source from herb has shown potential for the treatment of bone defect. @*METHODS@#Mesenchymal stem cells (MSCs) were isolated from mice and incubated with urolithin A (UA) (10, 25, and 50 lg/mL). 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay was performed to estimate apoptosis and mineralisation was evaluated by alkaline phosphatase assay and alizarin red S staining. A middle femoral defect was induced in mice and bone tissue was prepared for endochondral ossification by treating with UA. The effect of UA was estimated by determining markers of osteoblast proliferation in serum and micro-computed tomography to analyse bone defects. @*RESULTS@#UA enhanced mineralisation of MSCs and osteogenic gene markers in MSCs in vitro. Also, the bone defect score and bone mineral density were improved by UA. Moreover, UA ameliorated the altered Wnt3a protein and histopathological changes in bone defect mice. @*CONCLUSION@#Presented report conclude that UA enhances osteoblast proliferation in bone-defect mice by activating the Wnt pathway.
ABSTRACT
OBJECTIVE：To investigate the effects of integrated su pervision mode by doctors ，pharmacists and nurses on the whole-process implementation of therapeutic drug monitoring （TDM）. METHODS ：The patients monitored with TDM in our hospital admitted from Jan. to Dec. 2018 were selected as control group ，treated with the traditional drug supervision mode （i.e. the work of doctors ，nurses and pharmacists was relatively independent ）. Treatment group was composed of inpatients monitored with TDM from Jan. to Dec. 2019，treated with the integrated supervision mode of doctors ，nurses and pharmacists （i.e. doctors ，nurses and pharmacists cooperated with each other ，taking the patients and sample as the center ，pharmacists as the key link formulated the implementation standards of each link ，and clarified their respective responsibilities ）. The concentration compliance rate ，the incidence of incorrect samples ，critical value notification rate ，clinical satisfaction ，drug recommendation feedback and adoption ， compliance rates of 6 kinds of monitored drugs （sodium valproate ，digoxin，tacrolimus，cyclosporin，methotrexate，vancomycin） were compared between two groups. RESULTS ：The overall compliance rate ，critical value notification rate and clinical satisfaction rate of the observation group were respectively 64.57％，99.39％ and 97.22％，which were significantly higher than 57.86％， 96.80％ and 92.22％ of control group （P＜0.05）. The incidence of incorrect samples in observation group was 0.72％，which was significantly lower than 3.09％ of control group （P＜0.001）. The feedback rate of individual pharmacists （89.19％），the feedback rate of doctors （80.50％）and the adoption rate of medication suggestions （69.98％）in the observation group were significantly higher than control group （50.34％ ，71.46％ and 55.36％ ，P＜0.001）. The compliance rate of tacrolimus concentration in observation group was slightly lower than control group （73.40％ vs 75.77％，P＞0.05）. The concentration compliance rate of other 5 varieties was higher than control group ，and the differences of valproate sodium ，digoxin and vancomycin concentrations between two groups were statistically significant （P＜0.05）. CONCLUSIONS ：The implementation of integrated doctors ，nurses and pharmacists supervision mode in TDM can effectively improve the drug concentration compliance rate ，realize the . dynamic supervision and feedback of individualized drug use ， which is conducive to ensure the safety of clinical medication.
ABSTRACT
Objective:To study the clinical manifestations, diagnosis and treatment of primary hyperparathyroidism (PHPT) in pregnancy.Methods:This study involved six pregnant patients with PHPT who were admitted to Ruijin Hospital of Shanghai Jiao Tong University from August 2014 to November 2019. Their clinical manifestations, treatment strategies (multidisciplinary consultation with departments including Obstetrics, Endocrinology, Neonatology, General Surgery, Anesthesiology and Intensive Care Unit), maternal complications and maternal and infant outcomes were described and retrospectively analyzed.Results:(1) The median age of the six patients was 34(23-38) years old. PHPT was diagnosed in one case before pregnancy, four in the second or third trimester and one after delivery. The main clinical manifestations of four cases were nausea, vomiting, anorexia and other non-specific symptoms. Anemia was the most common maternal complication (five cases). Other complications included hypercalcemia crisis with renal failure (one case), multiple bone destruction and osteoporosis (one case). The median levels of serum calcium, parathyroid hormone and 25-hydroxyvitamin D were 3.08 (2.84-4.21) mmol/L, 216.7(93.1-2 603.6) ng/L and 29.66 (13.50-90.24) nmol/L, respectively. Results of parathyroid ultrasonography showed all patients had hypoechoic focus. Four cases underwent routine parathyroid radionuclide imaging showing abnormal radioactive concentration areas. (2) Obstetricians initiated the multidisciplinary team (MDT) for all patients to determine the treatment plans after communication with the patients and their families. One case received surgical treatment five months after delivery. Three cases received surgical treatment in the second trimester and among them, one terminated the pregnancy in the second trimester and the other two continued and achieved good pregnancy outcomes. Two cases underwent surgical treatment after giving up pregnancy and induced abortion. Postoperative pathology revealed that five cases were isolated parathyroid adenoma and one was parathyroid carcinoma. All of the patients were followed up and no abnormal serum calcium was reported. (3) One newborn had hypocalcemic convulsions one month after birth and was recovered by intravenous calcium supplementation. The newborn was followed up and the serum calcium level was normal so far. The other two neonates had normal serum calcium during follow-ups, but one of them was diagnosed with autism at the age of four and is now undergoing rehabilitation treatment.Conclusions:Pregnancy complicated by PHPT may lead to serious maternal and infant complications. MDT consultation ensures timely diagnosis, comprehensive treatment for the patients and better pregnancy outcomes.
ABSTRACT
Objective To study the effect of N-Methyl-D-asparticacid ( NMDA ) on the intracellular free calcium concentration ( [ Ca2+] i ) in primary cultured rat calvaria osteoblasts. Methods A calcium imaging technique was applied to observe [ Ca2+] i changes in primary cultured rat calvaria osteoblasts after stimulating by NMDA with various concentrations or pretreated with NMDA receptor noncompetitive antagonism MK801 ( Dizocilpin) . Results Different concentrations of NMDA caused [ Ca2+] i increases in varying degrees and by different ways. NMDA could evoke transient increase and secondary change in [ Ca2+] i including calcium oscillation or steady increase. MK801 inhibited NMDA-induced [ Ca2+] i increase in varying degrees. Conclusion These results indicated that there are abundant functional NMDA receptors expressed in primary cultured rat calvaria osteoblasts, showing different forms and varying degrees of [ Ca2+] i increases in response to different concentrations of NMDA. The characters of the blocking effect of MK801 to NMDA-induced [ Ca2+] i increasing, indicated that the NMDA receptors expressed in primary cultured rat calvaria osteoblasts differ in channel properties from those in central nervous system.
ABSTRACT
As China has not yet established a sound regional trauma treatment system and standardized trauma centers at all levels, the trauma treatment capability in China is poorer than that in the developed countries. At present, Shaanxi Province has not established a regional trauma treatment system and standardized trauma centers at all levels. Based on the analysis of the characteristics of geography, population and social environment in Shaanxi Province, the authors explore the concept of the trauma treatment system and the construction of trauma centers at all levels in Shaanxi Province on the platform of the trauma center of Shaanxi People's Hospital ( Grade I trauma center) . The authors clarify the respective hardware facilities, team structure, treatment process and quality control goals, training and management system of professional trauma teams in trauma centers at all levels, so as to provide reference for improving the overall level of trauma treatment in Shaanxi Province.
ABSTRACT
In the past decade, mounting evidence points to the possibility of targeting bone for treating, preventing, and predicting type 2 diabetes mellitus. Osteoblast-derived osteocalcin (OCN) can stimulate insulin secretion, enhance insulin sensitivity, and favor glucose and fatty acid uptake and utilization. Lipocalin 2 is another osteokine secreted by osteoblasts and acts in appetite suppression. Neuropeptide Y may function in browning of white adipose tissue and energy expenditure. Osteocytes are proposed to have impact on the browning of white adipose tissue and energy expenditure through the secretion of bone morphogenetic protein 7 and sclerostin. Active bone resorption is also implicated in glucose homeostasis. In addition, there is evidence indicating the involvement of bone-derived receptor activator of nuclear factor κ-B ligand in the regulation of energy metabolism. We collect and summarize recent advances and the rationales for treating, preventing, and predicting diabetes by targeting skeleton. (Chin J Endocrinol Metab, 2018, 34: 543-548)
ABSTRACT
Objective To investigate the construction and application in practice of information process management system in the treatment of acute ischemic stroke (AIS).Methods From August 2017 to November 2017,the clinical data of the 597 patients with suspected stroke received green channel treatment for stroke and incorporated into the information process management system at the Cerebrovascular Disease Center,Changhai Hospital,the Second Military Mcdical University were analyzed retrospectively.The operation status and operational efficiency of each link in the AIS treatment process were evaluated.The performance assessment indicators for stroke nurses and visiting doctors were developed.The accuracy and missed diagnosis of stroke determined by the stroke nurses were calculated.The operation ability of stroke nurses was evaluated by the doctor's arrival at triage desk to establishment of intravenous access time and signing of informed consent to rt-PA bolus time,with less than 10 min as the standard.The emergency response capability of consultation physicians was evaluated by calling consultation physician to arriving at the triage desk and establishing venous channel to transport to the CT room time,with less than 5 min as the standard.The standard-reaching rate was calculated.Results A total of 597 patients were prechecked as suspected stroke.Among them,549 patients with stroke were judged by doctors,430 established venous access,443 were transported to CT room,441 completed CT scan,and 52 were treated with venous thrombolysis.In the process,the median time of patients to hospital to doctor to triage desk,doctor to triage desk to establishment of venous channel,establishment of venous channel to transportion to CT room to completion of CT scan,completion of CT scan to rt-PA bolus,patients to hospital to completion of CT scan and patients to hospital to rt-PA bolus was 3 (1,5),8 (3,16),3 (2,5),3 (2,9),9 (3,22),20(10,30) and 27 (19,55) min,respectively.The stroke nurses determined the accuracy and misdiagnosis rate of stroke were 92.0％ (549/597) and 8.4％ (50/597) respectively.The standard-reaching rate of doctor to triage desk to establishment of venous channel,signing informed consent to rt-PA bolus time were 82.1％ (353/430) and 80.8％ (42/52) respectively.The standard-reaching rates of calling consultation doctor to doctor to triage desk,establishment of venous channel to transportion to CT room time were 94.5％ (564/597) and 91.4％ (405/443) respectively.Conclusion A process management system centered on "time management" may help analyze the efficiency of various links and personnel in the AIS treatment process,and optimize the process continuously.
ABSTRACT
Objective To investigate the influencing factor of the morphology of unruptured intracranial aneurysms for aneurysm wall enhancement under the high-resolution magnetic resonance imaging. Methods From January 2015 to December 2016,the clinical and imaging data of 68 consecutive patients with unruptured intracranial aneurysm (86 aneurysms) in Changhai Hospital,the Second Military Medical University were enrolled retrospectively. Vascular wall imaging technology was used to conduct aneurysm scan,and the aneurysm wall enhancement was identified by the imaging features before and after contrast enhancement. They were divided into either an enhancement group ( n=32,34 aneurysms) or a non-enhancement group (n=45,52 aneurysms) according to whether having the abnormal enhancement of aneurysm wall or not ( because some patients also have enhanced aneurysms and non-enhanced aneurysms, the number of cases of the enhanced or not was calculated seperately in both groups ) . Morphological parameters were calculated by 3D image data,including aneurysm size,ratio of height to width,volume ratio, dome-to-neck ratio, transverse length ratio, bottleneck factor, and inflow angle. Univariate and multivariate logistic analyses were used to determine the morphological influence factors of aneurysm wall enhancement. Results (1) A total of 34 (39. 5%) aneurysms had aneurysm wall enhancement and 52 (60. 5％) aneurysms did not have aneurysm wall enhancement. There were no significant differences in sex, age, hypertension,diabetes, smoking, family history of subarachnoid hemorrhage, and aneurysm site in both groups (all P>0. 05). (2) The aneurysm size,ratio of height to width,volume ratio,dome-to-neck ratio, and bottleneck factor in the enhancement group were larger than those of the non-enhancement group. There were significant differences between the 2 groups (9. 19 [6. 54,11. 04] mm vs. 5. 31 [4. 17,7. 37] mm, (1. 18 [1. 01,1. 69] vs. 0. 91 [0. 72,1. 25],(3. 62 [2. 30,4. 63] vs. 2. 18 [1. 37,2. 76],1. 52 [1. 25, 1. 99] vs. 1. 19 [1. 03,1. 51],and 1. 21 [1. 11,1. 69] vs. 1. 05 [0. 94,1. 31],all P<0. 01). The proportion of irregular morphologic aneurysms in the enhancement group was higher than that in the non-enhancement group. There was significant difference between the 2 groups (55. 9％ [19/34] vs. 17. 3％ [9/52],P<0. 01 ) . There were no significant differences in transverse length ratio and inflow angle between the 2 groups (all P>0. 05). (3) Because the ratio of height to width,volume ratio,dome-to-neck ratio,and bottleneck factor were related to the aneurysm size,the aneurysm size,inflow angle,and irregular shape were included in the multivariate logistic regression analysis. The results showed that aneurysm size ( OR,3. 727,95％CI 1. 933-6. 971,P<0. 01) and irregular shape (OR,3. 990,95％CI 1. 219-13. 065,P=0. 022) were the independent risk factors for aneurysm wall enhancement. Conclusions The size and irregular shape of unruptured intracranial aneurysms are the independent risk factors for aneurysm wall enhancement. High-resolution magnetic resonance wall imaging may become an effective and noninvasive imaging method for evaluating the ruptured risk of intracranial aneurysms.
ABSTRACT
The prevalence of diabetes is increasing rapidly which becomes a serious economic burden to society. The effects of vitamin D beyond bone are increasingly recognized. Circulating level of vitamin D is associated with the development of obesity and type 2 diabetes in cross-sectional human studies. However, as to the therapeutic efficacy of vitamin D supplementation on the prevention of diabetes, the results derived from randomized controlled clinical trials were disappointing, probably due to variations in the vitamin D receptor genotypes, the dosages and courses of vitamin D treatments. However, two recent basic studies found that central administration of active vitamin D can improve glucose metabolism in diet induced obesity rats; and the combining use of active vitamin D analogue and BRD9 inhibitor rendered the chromatin of vitamin D response elements more accessible, thus more efficiently exerted its anti-inflammatory efficacy and protected islet β cell function in obese and diabetic mice models. Thus it is paramount important to explore some new approaches to prevent and treat diabetes with vitamin D and its active analogues.
ABSTRACT
Objective To investigate the safety and efficacy of endovascular treatment of distal middle cerebral artery aneurysms. Methods From January 2009 to December 2016,the medical records of 13 consecutive patients with distal middle cerebral artery aneurysm (a total of 14 aneurysms)were reviewed and enrolled. Endovascular treatment included coils,coils with liquid embolic materials,or using liquid embolic material alone for embolization of aneurysms or occlusion of parent arteries. The immediate outcome of aneurysm treatment was evaluated by Raymond classification,and the clinical prognosis was evaluated by the modified Rankin scale (mRS). DSA was use to conduct imaging follow-up study and was compared with the immediate treatment outcome in order to determine whether the aneurysms recurred or not. Results Of the 13 patients,8 were males,with an average age of 40 ±14 years. The maximum diameter of aneurysm was 1. 0 -12. 0 mm,the median size was 4. 5 mm. Fourteen aneurysms were successfully treated by endovascular treatment,4 of them were embolized,and the parent aneurysms were retained;10 aneurysms and parent arteries were occluded. Twelve aneurysms did not develop immediately after operation,and 2 of them had residual aneurysms. No new nerve dysfunction and related complications were found after endovascular treatment. The clinical follow-up period was 9 -96 months,and the median time was 30. 9 months. Twelve aneurysms were followed up for 6 -24 months with a median time of 15. 2 months. No recurrence of aneurysms were observed. Conclusions Using endovascular treatment technology for the treatment of distal middle cerebral artery aneurysms is safe and effective. It can be considered in the development of treatment programs.
ABSTRACT
Primary hyperparathyroidism (PHPT) with negative or inconsistent imaging is a significant clinical problem. Surgery is the best chance in curing PHPT. Preoperative imaging is performed for lesion localization to help selecting the proper operative approaches. However,negative or inconsistent imaging could not exclude the diagnosis of PHPT and should not be ruled out the decision of operation. Therefore, for PHPT patients who had indication for surgery but with negative or inconsistent imaging result(s), it is better to transfer the patient to experienced center and surgeons for a proper surgical treatment.
ABSTRACT
Objective To assess the risk of hyperperfusion induced intracranial hemorrhage (HICH) after carotid artery stenting (CAS) in patients with symptomatic severe carotid stenosis.Methods From June 2009 to June 2015,the clinical data of 210 patients with symptomatic severe carotid stenosis (70％-99％) treated with CAS at Department of Neurosurgery,Changhai Hospital,the Second Military Medical University,were analyzed retrospectively.Seven of them (3.3 ％) developed HICH after operation.The relationship between the clinical baseline and imaging characteristics and HICH were assessed.All patients received the evaluation of cerebral CT perfusion examination.The time to peak (TTP) index of cerebral blood flow was defined as the TTP ratio of the affected and contralateral sides,t test was used to conduct the comparison of measurement data,and Poisson test was used to conduct the comparison of the enumeration data.Results There was significant difference in the TTP index between the HICH group and non-HICH group (1.15 ± 0.10 vs.1.30 ± 0.15,t =4.461,P ＜ 0.01).The receiver operating characteristic (ROC)curve analysis results suggested that the TTP index ＞ 1.22 could be used as a risk factor for predicting HICH (sensitivity 100％,specificity 75.9％).Conclusion Under the condition of prompting the preoperative TTP index ＞ 1.22,the risk of HICH may be higher after CAS in patients with severe carotid stenosis.
ABSTRACT
OBJECTIVE:To evaluate the effects of 3 kinds of serum containing blood-activating and stasis-eliminating TCM compound formulas on aggressive behavior,Janus kinase (JAK)/signal transduction and transcriptional activator (STAT) pathway of glioma U251 cells. METHODS:Rats were randomly divided into normal saline group (5 mL/kg),Taohong Siwu decoction group(5.7 g/kg),Xuefu Zhuyu decoction(8.5 g/kg)and Didang decoction(2.8 g/kg),calculated by crude drug,intragastrically administrated once a day,for 10 d. 10% drug-containing serum culture medium was prepared after 2 h of last administration. After 10% drug-containing serum culture medium intervening U251 cells for 1 week,Transwell method was conducted to detect the cell invasion rate, Western blot was adopted to detect the metal matrix protease 2 (MMP-2), MMP-9, phosphorylated JAK2 (p-JAK2),phosphorylated STAT3(p-STAT3)protein expression;and real-time fluorescence quantitative polymerase chain reaction method was used to detect MMP-2,MMP-9 mRNA expression. RESULTS:Compared with blank serum,Xuefu Zhuyu decoction drug-containing serum can reduce cell invasion rate (P0.05). CON-CLUSIONS:In the 3 kinds of blood-activating and stasis-eliminating TCM compound formulas,Xuefu Zhuyu decoction shows sig-nificant invasive effect on inhibiting U251 cells;the mechanism may be related to inhibiting the activation of JAK2/STAT3 signal pathway and decreasing MMP-2,MMP-9 gene and protein expressions.
ABSTRACT
Objective To preliminarily investigate the safety and long-term efficacy of endovascular overlapping multi-stent angioplasty for the treatment of vertebral artery dolichoectasia.Methods From May 2009 to January 2011,the clinical and imaging data of 3 patients with vertebral artery dolichoectasia treated with overlapping multi-stent implantation at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were analyzed retrospectively.All 3 patients had prolongation and dilation on the left intracranial vertebral artery.One suffered compression of left medulla oblongata accompanied by old infarction of right thalamus,one complicated with ruptured aneurysm of left posterior cerebral artery received coil occlusion of the parent artery,and the other had a lacuna infarction on the left medulla oblongata with left intracranial vertebral artery dissection.Results 2-5 LEO stents were implanted into the left vertebral artery of each patient and the lesions were covered completely.The revascularization was successful in all patients and no perioperative complications occurred.The 3 patients were followed up for 5-8 years and no new clinical symptoms occurred.The modified Rankin scale score was 0.The DSA follow-up revealed that the vascular morphology of 2 cases was significantly improved compared with that before procedure.Conclusion The preliminary experience has shown that overlapping multi-stent angioplasty for the treatment of vertebral artery dolichoectasia is safe and the long-term effect of revascularization is satisfactory.
ABSTRACT
Objective Aiming at detecting Staphylococcus aureus、Pseudomonas aeruginosa and Klebsiella pneumoniae in laboratory animals,the paper provides a rapid,sensitive and simple test method.Methods According to Staphylococcus aureus nuc gene,Pseudomonas aeruginosa LasI gene,Klebsiella pneumonia PhoE gene and general 16S rRNA gene, designed specific primers;Through the optimization of multiplex PCR primer concentrations and annealing temperature, the specificity and sensitivity of detection, establishing multiplex PCR system.Application of the PCR system test specimens of artificial infections and experiment animal feces is compared with traditional test method.Results Multiplex PCR amplification of Staphylococcus aureus (153 bp), Pseudomonas aeruginosa (600 bp) with Klebsiella pneumoniae (368 bp) and general (520 bp).The multiplex sensitivity for the purpose of 10pg, specificity of detection was not detected from other pathogens.Application of establishing multiplex PCR system to detect the artificial positive samples, and detect 1 Pseudomonas aeruginosa positive case in 76 fecals.Conclusions This paper established the multiplex PCR method which has the advantages of specific,sensitive,simple and rapid, and provides a reliable way for rapid test in laboratory animals microbiology.