Mechanical thrombectomy with the Solitaire AB device in acute ischemic stroke of posterior circulation: a series of 17 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of mechanical thrombectomy with the Solitaire AB device in recanalization of patients with acute ischemic stroke of posterior circulation.</p><p><b>METHODS</b>The clinical data of 17 consecutive patients with acute ischemic stroke of posterior circulation, treated with the Solitaire AB device from August 2011 to August 2015 in Department of Neurosurgery, the Military General Hospital of Beijing People's Liberation Army, were extracted and then retrospectively analyzed. There were 12 male and 5 female patients with a median age of 60 years (ranging from 44 to 75 years). Among them, 8 cases occluded in basilar artery, 4 cases occluded in vertebral artery and 5 cases occluded in vertebral plus basilar artery. Recanalization rate as well as complications after treatment were analysized. Also, neurological functions of the patients before and after treatment, measured by National Institute of Health stroke scale (NIHSS) score, were compared via t test and the clinical outcomes were assessed by modified Rankin score (mRS) at 90 days after treatment.</p><p><b>RESULTS</b>Fifteen patients resulted in successfully recanalization, and 2 cases failed both of whose onset to sheath time were above 7.5 hours. The NIHSS score at 7 days was 11±10, which was significantly decreased compared to the admission NIHSS score 17±5 (t=2.949, P=0.009). No symptomatic intracranial hemorrhage case was found after thrombectomy. At 90 days, one patient died(mRS 6), one patient seriously disabled (mRS 5), two patients moderately seriously disabled (mRS 4), four patients resulted in moderate outcome (mRS 3) and the other 9 patients achieved good outcome (mRS 0 to 2). The dead and seriously disabled cases were both due to failure in recanalization. Two moderately seriously disabled cases were probably attributed to their severe admission condition (NIHSS >20) and prolonged time (onset to sheath time >6 hours).</p><p><b>CONCLUSION</b>Mechanical thrombectomy with the Solitaire AB device contributes to a high rate of recanalization with a low probability of complication and improves functional outcome in patients with acute ischemic stroke of posterior circulation.</p>

Evaluation of a relationship between nutritional risk and nutritional support in elderly hospitalized patients with gastrointestinal cancer / 中华老年医学杂志

Objective To evaluate a relationship between the nutritional risk and nutritional support in elderly hospitalized patients (aged ≥ 65 years) with gastrointestinal cancer,and to analyze the relationship between nutrition support and clinical outcomes.Methods Elderly hospitalized patients with gastrointestinal cancer were recruited from September 2009 to November 2011.Patients were screened using Nutritional Risk Screening 2002 (NRS 2002) on admission.Data were collected on the application of nutrition support,including complication rate,length of hospital stay and medical care costs.Results In 592 recruited patients,the malnutrition rate was 14.0％ (83/592) and the rate of a validated nutrition risk was 43.7％ (259/592).79.2％ of patients with nutritional risk received nutritional support while 62.2％of non-risk patients received nutritional support.The case numbers of paraenteral nutrition (PN),enteral nutrition(EN) and paraenteral nutrition + enteral nutrition(PN + EN) were 141,64 and 49 respectively,with the PN:EN ratio of 2.2 ∶ 1.The rate of postoperative complications,lengths of hospital stay and medical care cost were higher in patients with nutritional risk than without nutritional risk[complications 39.8 ％ (103/259) vs.20.4 ％ (68/333),lengths of hospital stay (17.1±4.8) d vs.(12.6±3.6) d,medical care cost(62 191.5 ±4 251.2) RMB vs.(46 792.3±3 115.4) RMB,x2 =26.55 or t=13.03,50.84 respectively,all P＜ 0.01].The average of the rate of postoperative complication [36.8 ％ (75/205) vs.45.9％ (20/44),x2 =19.38,P＜0.01],length of hospital stay [(15.6±3.5) d vs.(18.1±5.4) d,(12.1±4.8) d vs.(15.6±3.5) d,P＜0.05 or 0.01] and medical care cost[62843.3±3491.7) RMB vs.(68925.1± 4633.2) RMB,(53410.5±1954.3) RMBvs.(59857.3±3221.6) RMB,allP＜0.05 or0.01] were lower or shorter in elderly gastric cancer or colorectal cancer patients with nutritional support than in patients without nutritional support.Conclusions A considerable numbers of elderly hospitalized patients with gastrointestinal cancer are at nutritional risk.There is significant relationship between the nutritional risk and clinical outcome.Nutritional support for elderly hospitalized patients with nutritional risk may improve the clinical outcome.

Hyper-early embolotherapy in treatment of intracranial ruptured aneurysm / 中国医师进修杂志

Objective To explore the clinical efficacy and safety of hyper-early embolotherapy in treatment of intracranial ruptured aneurysm.Methods A retrospective analysis was made on 33 patients with intracranial ruptured aneurysm.Preoperative Hunt-Hess grade:grade Ⅰ-Ⅱ in 16 patients,gradeⅢin 5 patients,grade Ⅳ in 9 patients,grade Ⅴ in 3 patients.All patients were confirmed with subarachnoid hemorrhage (SAH) by angiography and then underwent embolization under general anesthesia by detachable coils within 6 h from onset.Results After operation,25 patients (75.8％) recovered well,4 patients (12.1％) were with mild disability with paralysis and aphasia,4 patients (12.1％) were dead (1 patient for intraoperative aneurysm rupture,1 patient for postoperative pneumonia,1 patient for infection of hematoma at puncture site and 1 patient for postoperative gastrointestinal bleeding).Followed up 1-6 months,no rebleeding occurred.Conclusions Hyper-early embolotherapy could avoid rebleeding of the aneurysm,and relieve the vasespasm,without increasing the intra-operative rebleeding rate.Moreover hyper-early embolotherapy could greatly decrease the mortality of poor-grade SAH patients.

Pre-hospital analysis of death factors and management on 62 cases treatment of severe traffic accident trauma / 中国医师进修杂志

Objective To explore the method and management of pre-hospital care and raise the level of traffic injuries in pre-hospital care by summarizing the clinical features of death patients with severe tragic accident trauma Methods The basic data of 62 death patients with severe traffic accident trauma was analyzed according to death report statistics of severe traffic accident trauma from January 1st,2005 to December 31th,2008 Results Brain injury death accounted for most of traffic accident trauma death.The mortality rate of brain injury in the wounded wag 8.28%(13/157),but of asphyxia and hemorrhagic shock was 2.55%(4/157),3.18%(5/157)respectively in 2005.With the development of treatment and rescued in time, the mortality rate reduced to 6.11%(11/180),0,0.56%(1/180)in 2008.Conclesions It should be trying to shorten the time of pre-hospital care for pafients with trsffic accident trauma,especially in patients combined with hemorrhagic shock,asphyxia,severe brain injury.It is concluded that rapid and effective pre-hospital care can significantly reduce death rate and self-help or each other rescue training would also be effective to reduce mortality.

Feridex labeling of bone marrow stromal cells of crab-eating macaque / 中国组织工程研究

BACKGROUND: Studies regarding Feridex in vitro cell labeling are mainly in rodents, while little information is known on primate crab-eating macaque.OBJECTIVE: To explore the feasibility of protocols using Feridex and transfection agents for in vitro magnetic labeling of bone marrow stromal cells (BMSCs) in crab-eating macaque.METHODS: Under the sterile condition, the crab-eating macaque BMSCs were obtained by means of density gradient centrifugation following a bone puncture. Feridex-poly-l-lysine complexes were used to magnetically label BMSCs. The efficiency and cellular viability of Feridex-poly-l-lysine labeled BMSCs were evaluated by Prussian blue staining, electron microscopy, and trypan blue dye exclusion test. The proliferation and differentiation ability of Feridex-poly-l-lysine labeling BMSCs were also investigated by inverted phase contrast microscope and immunocytochemistry. RESULTS AND CONCLUSION: BMSCs could be effectively labeled by Feridex and labeling efficiency was around 99%. Tiny blue stained fine particles and numerous vesicles coated with the electron-dense magnetic iron particles could be found in the cytoplasm of Feridex-poly-l-lysine labeled BMSCs under optical microscopy and transmission electron microscopy respectively. Cell viability, proliferation and differentiation ability of labeled BMSCs were not affected by Feridex-poly-l-lysine labeling. Results indicated that Feridex might be used to label BMSCs of crab-eating macaque.

Prevention and cure of intracranial infections following posterior fossa craniotomy / 中国医师进修杂志

Objective For decreasing the infected rate,the prevention and cure methods of intracranial infections following posterior fossa craniotomy were study. Methods Twenty-eight patients with the intracranial infections following posterior fossa craniotomy were examined by lumbar puncture,and analyzed cerebrospinal fluid with routine examination and reference to the bacteriological data and drug sensitive tests. All the patients were treated with high dosage sensitive antibiotics, and draining continually the infected cerebrospinal fluid by lumbar puncture catheterization and injected small dosages of antibiotics into intraspinal for most cases. Results Twenty-eight patients had intracranial hypertension by lumbar puncture examination, outcome of cerebrospinal fluid culture indicated that 17 cases had bacteria growth and 11 cases had no bacteria. The intracranial infection was controlled effectively,and 96.4%(27 cases) were cured, 1 case dead of systemic failure. Conclusions Strict aseptic techniques,reduce operative time,decrease intracranial place of foreign matters, such as gelfoam, hemostatic gauze and artificial implants, could reduce the possibilities of intracranial infections. Appropriate antibiotics selection,lumbar puncture catheterization and intraspinal administration of antibiotics can cure intracranial infections effectively.

Role of matrix metalloproteinase-9 dynamic expression in the development of early vascular restenosis after carotid endarterectomy / 中国组织工程研究

BACKGROUND: Vascular restenosis alter carotid endarteractomy (CEA) is an important factor affecting curative affect ofoperation.OBJECTIVE: To explore the role of matrix metalloproteinase-9 (MMP-9) mRNA dynamic expression in the development of early vascular restenosis after carotid endarterectomy.DESIGN, TIME AND SETTING: A random grouping contrast observation was completed in the General Hospital of Beijing Military Area Command of Chinese PLA from February 2006 to December 2007. MATERIALS: Forty-one healthy male New Zealand rabbit, weighing about 3.0 kg, with 36 ones used for preparing carotid atherosclerotic stenosis (CASS) models. experimental group, each 6 of the CASS rabbit models (n =36) were selected at the time points of hour 4, day 1, 3, 7, 30, and 90 following CEA respectively. Then they were fixed with 40 g/L polyoxymethylene perfusion and stained with hematoxylin-eosin to observe their morphologic changes.MAIN OUTCOME MEASURES: The expression changes of MMP-9 mRNA were observed dudng the development of early vascular restenosis by the quantitative real-time polymerase chain reaction technique preoperatively as well as at day 1, 3 and 7 following CEA.RESULTS: Several stages could be seen in the reparative process of neointima after CEA, including the thrombosis, the inflammatory reaction, the repair of endothelium, the proliferation of vascular smooth muscle call, the formation and accumulation of extracellular matrix. MMP-9 mRNA was expressed since day 1, reached a peak at day 3 and then decreased significantly at day 7 postoperatively.CONCLUSION: MMP-9 plays an important role in the proliferation, migration and reconstruction of vascular smooth muscle calls, the mediated reconstruction of local blood vessels, as well as the development of vascular restenosis.