ABSTRACT
Objective:To evaluate the safety and clinical efficacy of Neuroform EZ stent in the treatment of severe intracranial atherosclerotic stenosis (ICAS).Methods:A total of 36 patients with severe ICAS receiving Neuroform EZ stent angioplasty were retrospectively analyzed at Beijing Anzhen Hospital from July 2018 to January 2020. Digital subtraction angiography (DSA) before endovascular intervention confirmed the diagnosis. Follow-up information was reviewed by neurologists at 30 days and 6 months after the procedure. The primary endpoints were transient ischemic attack (TIA), ischemic or hemorrhagic stroke and death caused by any reason within 30 days.Results:The overall technical success rate was 100%. The median stenosis rate was reduced from 93.6%±4.5% to 18.8%±11.2% ( t=37.36, P<0.001).Primary endpoint event was not reported. During follow-up, one patient developed TIA and no death or ischemic stroke was observed. No in-stent restenosis at six months occurred. Conclusion:Neuroform EZ stent is safe and effective in patients with severe ICAS. However, perspective studies need to be operated for further validation via long-term follow-up.
ABSTRACT
Objective:To investigate the feasibility and safety of submaximal balloon dilation and to perform small-diameter stent for symptomatic carotid artery severely stenosis before coronary artery bypass grafting(CABG).Methods:From January 2016 to December 2019, 30 patients of the Department of Neurointervention in Beijing Anzhen Hospital with symptomatic carotid artery stenosis(≥70%) and the left main trunk or triple-vessel of coronary artery disease were analyzed retrospectively. General information, clinical characteristics, and imaging data of all cases were collected. All patients underwent submaximal balloon dilation and small-diameter stent implantation. Preoperative comorbidities or risk factors included hypertension 23 cases(76.7%), diabetes 10 cases(33.3%), hyperglycemia 14 cases(46.7%), moking 13 cases(43.3%). Left main trunk disease 6 cases(20.0%), three-vessels disease 24 cases(80.0%), mitral regurgitation 1 case(3.3%), stable angina 25 cases(83.3%), myocardial infarction 8 cases(26.7%), cerebral infarction 24 cases(80.0%) and transient ischemia attack(TIA) 6 cases(20.0%) caused by ipsilateral carotid artery stenosis. The median National Institutes of Health Stroke Scale(NIHSS) score was 2(0-3), and the median modified Rankin Scale(mRS) score was 1(0-1) before the operation. The mean interval between carotid artery intervention and CABG was(23.4±8.2)days.Results:29 cases(96.7%, 29/30) underwent CAS-CABG operation successfully. In one case of carotid artery extreme tortuosity, the emboli protective device could not place the distal carotid artery. In the operative procedure, 27 cases(90.0%, 27/30) underwent with 3mm diameter balloon, only 3 cases(10.0%) with 3 mm balloon after pre-dilatation with 2 mm diameter balloon because of severely high-grade stenosis(99%). 25 cases(83.3%) with 7mm diameter stents and 5 cases(16.7%) with 6 mm diameter stents, including 22 cases(73.3%) with a closed-cell stent and 8 cases(26.7%) with an open-cell stent. In the perioperative period, the heart rate of two patients was lower than 50 BPM during operation and returned to normal after using atropine immediately. Another patient presented with chest tightness during interventional therapy. TNI elevation was examined urgently. After oxygen inhalation and intravenous infusion of Nitroglycerin, the patient's symptoms improved rapidly. No cardiac and cerebrovascular complications occurred during the perioperative period of CABG, no cardiac-related complications occurred within 30 days of follow-up, one case of TIA and 1 case of cerebral infarction. After intensive anti-platelet aggregation and lipid-lowering treatment, two patient's symptoms improved. There were no death cases in all patients during carotid artery interventional therapy, perioperative CABG and 30-day follow-up. Thirty days later, we performed a clinical follow-up of 23 cases, median 4.5(3.0-7.9) months, mRS Score Median 1(0-1). One patient presented with TIA, any patient had no symptoms of the cardiac or nervous system. Image follow-up of 17 cases, median 3.5(2.8-4.5) months, carotid artery ultrasound showed in-stent restenosis(stenosis rate>50%) in 1 case, the patient was asymptomatic restenosis, continue treatment of aggressive anti-platelet and lipid-lowering drugs.Conclusion:Submaximal balloon dilation and performing small-diameter stent for symptomatic carotid artery severely stenosis before CABG is safe and feasible, which could not only reduce the incidence of vagus reflex resulted in acute coronary syndrome during carotid artery stenosis intervention but also morbidity of acute ischemic stroke events during CABG.
ABSTRACT
Objective To analyze the influence of round window lesion on dynamic responses from the middle ear. Methods Based on CT scan images of healthy human ear, the three-dimensional finite element model of human ear was rebuilt by PATRAN software, then NASTRAN software was applied to conduct coupled solid-fluid frequency response analysis. The feedback of round window lesion on dynamic response of the middle ear was investigated by numerical simulation. Results Round window closure caused by sclerosis led to more decline in amplitude of stapes than congenital round window closed, maximally can reach 30.2 dB, and the latter had no obvious influence on velocity of stapes. In term of phase angle, on condition of sclerosis, change of phase for stapes and round window reached 90° at most and kept a difference value of 180°. In contrast, on condition of congenital round window closed, change of phase for stapes reached 270° at most，meanwhile change of phase for round window disappeared. Conclusions The dynamic response of the middle ear showed different feedback to congenital and otosclerotic round window fixation based on amplitude, velocity and phase. The research findings provide the theoretical basis for diagnosing and fixing round window lesion in future.
ABSTRACT
Objective To study the influence of noise under normal and high pressure environment on the cochlea,so as to make up for the defect caused by the lack of testing means to study the noise effect on behavioral characteristics of cochlear hearing by using numerical simulation method.Methods Based on CT scan images of healthy cochlea,and combined with self-programming,the three-dimensional finite element model of the cochlear spiral was established by using PATRAN software.Analysis on flow solid coupling frequency response and transient response was conducted by using NASTRAN software,and the impact of noise under normal and high pressure environment on the cochlea was numerically simulated.Results The calculated results were in agreement with the experimental results reported in the literature,which verified the correctness of the model.When the frequency was lower than 5 kHz,the basement membrane displacement by noise excitation under normal and high pressure environment was basically the same;when the frequency was higher than 5 kHz,the basement displacement by noise excitation under normal environment decreased gradually.Conclusions Under high pressure environment,the high-frequency noise shows a more obvious effect on the basilar membrane.The numerical simulation results can make up for the deficiency in studies about noise effect on characteristics of human cochlear hearing due to the lack of experimental methods,and provide new ideas and theoretical support for targeted experimental study of the cochlea in the future.
ABSTRACT
Objective: To investigate the clinical efficacy of nalmefene hydrochloride in the treatment of patients with traumatic shock. Methods:Totally 62 cases of patients with traumatic shock were randomly divided into nalmefene treatment group (n=31) and the control group ( n =31 ) according to the random number table. The control group was given the conventional treatment, while nalmefene treatment group was treated with nalmefene hydrochloride additionally. The changes of hemodynamics, plasma TNF-αand vas-cular endothelial function index were compared between the groups. Results:The mean arterial pressure in 24h after the treatment signifi-cantly decreased when compared with that in 12h after the treatment of nalmefene treatment group, and the difference was statistically sig-nificant (P<0. 05);the heart rate in 12h and 24h after the treatment in nalmefene treatment group significantly decreased when com-pared with that before the treatment, and the differences were statistically significant (P<0. 05);the plasma TNF-αlevels in 24h after the treatment in nalmefene treatment group significantly decreased when compared with that in 12h after the treatment, and the difference was statistically significant (P<0. 05), and there was no significant difference in plasma TNF-α levels before the treatment and in 12h after the treatment (P<0. 05);the plasma NO and ET in 24h after the treatment in nalmefene treatment group significantly decreased when compared with that in 12h after the treatment, and the difference were statistically significant (P<0. 05);and there was no signifi-cant difference in plasma NO and ET before the treatment and in 24h after the treatment (P<0. 05);abnormality in electrocardiogram, routine blood tests, routine urine and liver and renal function examinations were not found, and no obvious adverse drug reactions were shown during the treatment course. Conclusion:Nalmefene hydrochloride combined with the conventional treatment in the patients with traumatic shock shows striking efficiency with notable effects on hemodynamics ( heart rate and mean arterial pressure) , which can reduce plasma TNF-α, NO and ET levels and shows significant research significance.
ABSTRACT
Objective To study the effect of neural stem cell transplantation on neurological behavior and expressions of Caspase-3 and Caspase-9 in rats with traumatic brain injury (TBI). Methods A total of 108 SD rats were randomly divided into the sham group (n=36), traumatic brain injury group (TBI, n=36) and neural stem cell transplantation group (NSC, n=36). TBI model of rats was established by using improved Feeney method. Rats of NSC group were injected neural stem cells in cortex after traumatic brain injury was established for 1 week, and then nurological severity scores (NSS) of rats were evaluated at 7 days, 14 days and 21 days after cell transplantation in TBI and NSC groups, respectively. Rats of sham group were only cut the scalp and exposed the skull without striking. The expressions of Caspase-3 and Caspase-9 in brain tissues were detected by immunohistochemistry and Western blot method. Results Compared with NSC group at the same time points, NSS was decreased significantly in TBI group (P<0.01). Compared with the sham group, the optical density (OD) values of Caspase-3 and Caspase-9 positive expressions were increased significantly in TBI group (P<0.05). Compared with TBI group at the same time points, the OD values of Caspase-3 and Caspase-9 positive expressions were decreased significantly in NSC group (P<0.05). Conclusion The neural stem cell transplantation can promote the recovery of brain injury by down-regulating the expressions of Caspase-3 and Caspase-9.
ABSTRACT
Objective To explore the clinical effect of endoscope emergency operation in the treatment of gastric variceal bleeding.Methods According to the digital table,90 patients with acute bleeding gastric varices were randomly divided into the control group and the observation group,each group 45 cases.The control group only received drug treatment,and the observation group was given endoscopic therapy.The clinical effect of the two groups were compared.Results The immediate hemostatic rate,rebleeding rate,varicose veins subsided total efficiency of the observation group were 100.00％,17.78％,86.67％,respectively,which were better than those of the control group (84.44％,44.44％,28.89％) (x2 ＝ 5.72,P ＜ 0.05).Conclusion Endoscope emergency operation combined with oral drug in treatment of gastric variceal bleeding has good effect,can achieve rapid hemostasis,prevent recurrence,and it is worthy of clinical application.
ABSTRACT
Objective To investigate the relationship and mechanism between the serum level of high mobility group box protein-1(HMGB1)and the mortality rate in patients with sepsis.Methods The serum levels of HMGB1,superoxide dismutase(SOD)and malondialdehyde(MDA)in 48 patients with sepsis were determined.The clinical outcomes in those patients were recorded and anlyzed.Results After the onset of sepsis,the serum HMGB1 levels of both death group and survival group were increased gradually and peaked at 72h after the onset of the disease.The semm HMGB1 levels of death group were much higher than those of survival group except at 24h(t=6.07,6.20,24.43,all P＜0.05).The activity of serum SOD of death group was markedly lower than that of survival group at 12h,24h,48h and 72h(t=10.24,20.61,11.67,33.33,all P＜0.05),and the level of serum MDA of death group was significantly higher than those of survival group at all time points(t=26.06,22.17,23.86,9.49,5.95,all P＜0.05).There was a significantly positive correlation between the serum HMGB1 and MDA level.Conlusioa The increase in serum HMGB1 level may be the important reasoll for the increased mortality rate in patients with sepsis;Oxidant/antioxidant imbalance may be olle reason for the increase in serum HMGB1 level.