RESUMO
Objective:To investigate the correlation between serum albumin and hypoalbuminemia (HA) and the outcome after endovascular mechanical thrombectomy (EMT) in patients with stroke caused by acute anterior circulation large vessel occlusion.Methods:Stroke patients caused by acute anterior circulation large vessel occlusion received EMT treatment at the Department of Emergency Stroke, the Affiliated Hospital of Jining Medical University from June 2020 to August 2022 were retrospectively included. The demographic information, baseline clinical data, endovascular treatment parameters, and clinical outcomes of the patients were collected. HA was defined as serum albumin <35 g/L within 24 h of admission, and poor outcome was defined as the modified Rankin Scale score >2 at 90 d after onset. Multivariate logistic regression analysis was used to identify the independent influencing factors for poor outcomes. Results:A total of 177 patients were included, with a median age of 66 years, and 126 (71.19%) were males. Thirty-nine patients (22.03%) had HA, and 119 (67.23%) had poor outcomes. The proportion of pulmonary infection in the HA group was significantly higher than that in the non-HA group ( P<0.05). Multivariate logistic regression analysis showed that lower serum albumin (odds ratio [ OR] 4.102, 95% confidence interval [ CI] 1.316-16.451; P=0.028), postprocedural neurological deterioration ( OR 6.326, 95% CI 1.263-48.318; P=0.042) and pulmonary infection ( OR 5.873, 95% CI 1.028-24.452; P=0.018) were significantly independently associated with the poor outcomes. Conclusions:The HA group has a higher incidence of postprocedural pulmonary infection. Lower serum albumin, postprocedural neurological deterioration and pulmonary infection are the independent risk factors for the poor outcomes in patients with anterior circulation ischemic stroke who had successful recanalization after EMT.
RESUMO
Objective:To investigate the risk factors of hypoalbuminemia (HA) in patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) after endovascular mechanical thromboectomy (EMT) and impact on outcomes.Methods:Patients first diagnosed with anterior circulation LVO-AIS and underwent emergency EMT at the Department of Acute Stroke, the Affiliated Hospital of Jining Medical University from June 1, 2020 to April 31, 2023 were retrospectively included. According to the first follow-up serum albumin examination after procedure (6-8 d), the patients were divided into HA group (<35 g/L) and non-HA group (≥35 g/L). According to the modified Rankin Scale score at 90 d after EMT, the patients were divided into a good outcome group (0-2) and a poor outcome group (3-6). Univariate and multivariate logistic analysis was used to determine independent risk factors for HA after EMT and their impact on outcomes. Results:A total of 144 patients were enrolled, including 107 males (74.30%) with a median age of 64 years (interquartile range, 56-71 years). There were 50 patients (34.72%) in the HA group and 94 (65.28%) in the non-HA group; 60 (41.67%) in the good outcome group, and 84 (58.33%) in the poor outcome group. Multivariate logistic regression analysis showed that age (odds ratio [ OR] 1.061, 95% confidence interval [ CI] 1.014-1.111; P=0.011) and pulmonary infection ( OR 5.136, 95% CI 1.917-13.760; P=0.001) were independent risk factors for HA; HA ( OR 4.345, 95% CI 1.367-13.814; P=0.013), pneumonia ( OR 5.113, 95% CI 1.217-12.528; P=0.026), and onset to reperfusion time ( OR 5.473, 95% CI 1.090-16.05; P=0.038) were independent risk factors for poor outcomes. Conclusions:Age and pulmonary infection are independent risk factors for HA in LVO-ASI patients after EMT, and HA is the independent risk factor for poor outcomes of the patients.
RESUMO
Objective:To explore the feasibility of mismatch of amide proton transfer weighted (APTw) imaging with diffusion weighted imaging (DWI) in evaluating ischemic penumbra (IP) in patients with wake-up stroke.Methods:A prospective study was performed; 96 patients with wake-up stroke and unilateral middle cerebral artery territory infarction admitted to Emergency Stroke Department, Affiliated Hospital of Jining Medical University from September 2020 to January 2023 were chosen. All patients underwent routine MRI, DWI, APTw imaging and 3D arterial spin labeling (3D-ASL) before treatment and 90 d after treatment. IP presence was defined as changes of abnormal signal on T2-fluid-attenuated inversion recovery (FLAIR) 90 d after treatment greater than 20% of high signal range on DWI before treatment, and it was used as the gold standard to compare the efficacy in evaluating whether the patients had IP based on mismatch of 3D-ASLwith DWI and mismatch of APTw imaging with DWI before treatment. The infarct core (IC) region, mismatch region of APTw imaging with DWI, mismatch region of 3D-ASL with APTw imaging were delineated on the fusion images in patients with IP based on mismatch of 3D-ASLwith DWI and mismatch of APTw with DWI, and the differences of APTw values in different regions were compared.Results:According to the 90-d follow-up results, 50 patients had IP and 46 patients did not have IP. Specificity, accuracy and sensitivity evaluating whether the patients had IP based on mismatch of 3D-ASL with DWI were 86.9%, 93.7% and 100.0%, respectively; specificity, accuracy and sensitivity evaluating whether the patients had IP based on mismatch of APTw imaging with DWI were 100.0%, 95.8% and 92.0%, respectively. The APTw max, APTw min and APTw ave values of the IC region were significantly lower than those of mismatch region of APTw with DWI, and the APTw max-min values of mismatch region of APTw imaging with DWI were significantly higher than those of mismatch region of 3D-ASL with APTw imaging ( P<0.05). Conclusion:APTw imaging can reflect the acidosis status of different brain regions in patients with wake-up stroke; specificity and accuracy evaluating whether the patients have IP based on mismatch of APTw imaging with DWI are higher than those based on mismatch of 3D-ASL with DWI.
RESUMO
Combining the PBL teaching method and the organ system as the core teaching method, we have carried on the teaching practice of 2 comprehensive experiments in the circulation system of hem-orrhagic shock and treatment, as well as the renal function and failure of the urinary system. The implemen-tation process has been divided into two links: preparation before class and class-room practice to improve the students' ability to study and solve the problem of scientific research.
RESUMO
Designed experiment in medical functional experiment has become an important way to promote creative thinking and innovation of medical students.We applied different modes of designed experiment in undergraduates of clinical medicine and basic medicine in capital medical university,including classroom designed experiments,proposition designed experiments and free proposition designed experiments.After above reforming implements,creative thinking and innovation ability of medical students were enhanced.It also provided new ideas in future teaching reform in functional experiment.
RESUMO
BACKGROUND: Puerarin, the main effective component of Chinese herb, Radix puerariae, is isoflavone monomer, which can counteract learning and memory impairment induced by scopolamine or D-galactose etc.OBJECTIVE: To investigate the protective effects of puerarin on β-amYloid peptide-induced learning and memory impairment of model mouse of dementia and the changes of superoxide dismutase activity and malondialdhehyde content in brain and blood.DESIGN: Randomized controlled trailSETTING: Department of Pharmacology, Capital University of MedicalSciencesMATERIALS: The experiment was conducted in Departmentof Pharmacology of Capital University of Medical Sciences from March to June 2002.A total of 40 ICR mice were selected and randomly divided into 4 groups:pseudooperation group, dementia model group, puerarin 25 mg/kg group and puerarin 50 mg/kg group, with 10 in each group.METHODS: ①Model preparation: After anaesthesia with pentobarbital sodium, single intraventricular injection of 3 μL β-amyloid peptide was conducted from right side on each mouse in dementia model group, puerarin 25 mg/kg group and puerarin 50 mg/kg group under aseptic manipulation. The same operation was carried out on the mouse in pseudooperation group but without injection of β-amyloid peptide. ②Giving medicine:10 mL/kg physiological saline was intraperitoneally injected into the mouse in pseudooperation group and model group; 25 mL/kg puerarin was intraperitoneally injected to the mouse in 25 mg/kg puerarin group; 50 mL/kg puerarin was intraperitoneally injected to the mouse in 50 mg/kg puerarin group.The medicines were given to each group from the day of model preparation on and behavioral test was carried out 12 days later. ③ Morris water maze examination was used to detect learning and memory ability of the mice.Time for finding the platform (escape latency) in 2 minutes, swimming distance, original angle and search strategy were recorded as learning results.④When the above experiment was finished, anaesthesia with ether was applied to the mice and blood was collected from the orbit to prepare serum.After that, the mice were put to death by decapitation and the tissue of right-brain of the mice were rapidly took out to prepare cerebral homogenate in ice bath, then superoxide dismutase activity and malondialdhehyde content were determined in brain and serum.MAIN OUTCOME MEASURES: ①Escape latency, swimming distance,search strategy and original angle for the mouse in each group to reach the latform. ②Superoxide dismutase activity and malondialdhehyde content in brain and blood of the mouse in each group.RESULTS: All the 40 mice were involved in result analysis. ① Escape latency and swimming distance were shortened in puerarin 25 mg/kg and 50 mg/kg groups (P ＜ 0.05-0.01). The results of search strategy and original angle indicated that as the number of training days increased, the frequency of randomization+magin strategy gradually decreased; The decreasing rates and extents in pseudooperation group and puerarin 25 mg/kg and 50 mg/kg puerarin were more rapid than that in dementia model group,meanwhile, the increasing rates and extents of frequency of tendency+directness strategy in these groups were more rapid than that in dementia model group. There was no significant difference in original angle between groups (P ＞ 0.05). ② The content of superoxide dismutase increased and that of malondialdhehyde decreased in brain and blood of the model mouse in puerarin 25 mg/kg group andpuerarin 50mg/kg group (P ＜ 0.05 -0.01).CONCLUSION: Puerarin can counteract the neurotoxicity of β-amyloid peptide, which improves learning and memory of model mouse. It is not relevant to the dosage but probably related with elimination of cerebral free radical and improvement of antioxidation activity.