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Objective To compare the efficacy and safety of low-dose and standard-dose alteplase intravenous thrombolytic therapy in patients with acute ischemic stroke and to investigate whether low-dose alteplase is more suitable for patients with acute ischemic stroke in China.Methods Patients with acute ischemic stroke treated with alteplase intravenous thrombolysis from July 2016 to December 2018 in Anhui No.2 Provincial People's Hospital were enrolled retrospectively.According to the dose of alteplase,they were divided into low-dose group (0.6 mg/kg,the total dose not exceeding 60 mg) and standard dose group (0.9 mg/kg,the total dose not exceeding 90 mg).The efficacy endpoint was the clinical outcome at 90 d after onset evaluated by the modified Rankin Scale (mRS).The mRS score 0-2 was defined as self-care in life,and 0-1 was defined as good outcome.The safety endpoints were the incidence of symptomatic intracerebral hemorrhage (sICH) within 24-48 h after thrombolytic therapy and the mortality at 3 months.Results A total of 103 patients were enrolled,including 45 in the low-dose group and 58 in the standard dose group.There were no significant differences in demography,baseline clinical data,as well as self-care and good outcome rates at 90 d between the 2 groups.The incidence of sICH in the low-dose group (National Institute of Neurological Disorders and Stroke criteria:2.22％ vs.17.24％;x2 =4.521,P=0.033) and mortality at 90 d (6.67％ vs.24.14％;x2 =4.417,P =0.036) were significantly lower than those in the standard dose group.Conclusion The efficacy of low-dose alteplase in the treatment of acute ischemic stroke was comparable to that of standard dose,but the incidence of sICH and mortality at 90 d were significantly reduced,which might be more suitable for Chinese patients.
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Objective To investigate the clinical effect of adductor magnus tendon transposition with arthroscopic in reconstruction medial patellofemoral ligament (MPFL) for the treatment of patellofemoral joint instability of adolescents. Methods Eighteen juvenile patients (21 knees) with patellofemoral joint instability (including chronic patellar dislocation and recurrent patellar dislocation) were treated with adductor magnus tendon transposition for MPFL reconstruction, combined with lateral patellofemoral ligament release. They were followed up for 12- 30 months. The complications, patellofemoral angles and Lysholm scores before and after operation were recorded and compared. Results There was no complications such as wound infection, redislocation, patellofemoral joint instability and epiphyses injured. All patients got excellent knee flexion and extension function. Patella fear tests were all negative. The patellofemoral angles and Lysholm scores after operation were improved significantly than those before operation:(10.3 ± 4.1)° vs. (-3.8 ± 4.9)°, (92.7 ± 3.6) scores vs. (61.5 ±2.4) scores, P<0.01. Conclusions Adductor magnus tendon transposition with arthroscopic in reconstruction MPFL can significantly improve the stability of patellofemoral joints. This is one of the effective methods for the treatment of patellofemoral joint instability of adolescents.
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Objective To investigate the clinical effect and value of applications on different surgical treatments of unstable fracture and dislocation of the lower cervical spine combined spinal cord injury. Methods From January 2008 to December 2011, 110 cases of unstable fracture and dislocation of the lower cervical spine combined spinal cord injury patients who underwent surgical reduction, decompression, stabilization and fusion were divided into three groups with different operations: anterior group of 40 cases, posterior group of 22 cases, coadunation group of 48 cases. Preoperative Frankel grade: A-class of 12 cases, B-class of 17 cases, C-class of 30 cases, D-class of 38 cases, E-class of 13 cases. The average Cobb angle, sliding distance between vertebral body and Japanese Orthopaedic Association (JOA) scores before operation and after operation were compared. Results All the patients were followed up for 6 -24 months, the averaged period was 16 months. Solid fusion were obtained in all the cases at 4.3 months post-operative. There were no vascular, nervous, esophagus or spinal cord iatrogenic injury complications during the operation. There were no pseudarthrosis, bone nonunion or bone resorption, and there was no complications related to internal fixation breakage, loosening or displacement. One or two degree of Frankel grade recovery was achieved after surgery. The average Cobb angle, sliding distance between vertebral body and JOA scores in three group after operation were significant improved than those before operation (P<0.05). The JOA scores in coadunation group was significantly higher than that in anterior group and posterior group:(15.8±3.7) scores vs.(13.8±5.6), (14.2±3.5) scores, P<0.05. Conclusions One-stage anterior-posterior approach surgery is an ideal choice for unstable fracture and dislocation of the lower cervical spine combined spinal cord injury, for it provides unlocking reduction, canal decompression, and rigid reconstruction of the anterior-posterior column.It is benefit for the functional recovery of the spinal cord. But the risk increased, according to patient' s conditions carefully choose surgical options.
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Objective To investigate association between gene mutations of surfactant protein C (SP-C) exon Ⅱ and neonatal respiratory distress syndrome(NRDS).Methods From January 2013 to December 2014 in Neonatal Intensive Care Unit of Bayi Children's Hospital Affiliated to Beijing Military General Hospital,a total of 90 cases with NRDS were selected as NRDS group,and they were grouped into 3 subgroups,30 cases in each subgroup.Clinical data were collected by observation figures.A total of 90 cases without NRDS as control group were matched with NRDS group as for the gestational age (GA),gender and birth weight(BW).The study samples were from the clinically diagnosed venous sampling 1 mL,and genomic DNA was extracted with routine technique.After the polymerase chain reaction (PCR) amplification of sequencing was performed.Chromas software and Vector NTI Advanc software were used for analysis,the results were compared with the normal SP-C sequence of GenBank.Results Heterozygous missense mutations included c.115G ＞ T and c.139G ＞ C existed in exon Ⅱ of SP-C gene,which changed protein sequence.GT genotype frequency(0.067) of c.115G ＞T mutation in NRDS group was higher than that(0) in control group (x2 =7.283,P ＜ 0.05).With c.115 G ＞ T gene mutations in patients with NRDS,Ⅲ-Ⅳ grade chest changed and mortality was higher than that of control group.GC genotype frequency (0.067) of c.139G ＞ C mutation in NRDS group was higher than that(0) in control group (x2 =6.207,P ＜ 0.05).Among NRDS group,64 cases of cesarean section patients,GC genotype frequencies were lower than GG genotype frequency (x2 =9.276,P ＜ 0.01),55 cases of patients needed 3-4 PS pulmonary surfactant treatment,GC genotype frequencies were lower than GG genotype frequency (x2 =5.343,P ＜ 0.05).Conclusions Two heterozygous mutations were located in SP-C gene of exon Ⅱ in Chinese Han population of this study.These mutations have never been reported before.c.115G ＞ T of SP-C gene mutation is associated with pathogenesis and severity of NRDS and increases the risk of death in NRDS;while c.139G ＞ C of SP-C gene mutation is associated with pathogenesis of NRDS,but it does not increase the risk of severity and death in NRDS.
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@# Objective To explore the effetc of different intensity of exercise on learning ablility and oxygen free radical metabolism in rats after cerebral ischemia-reperfusion (I/R). Methods 60 male Sprague-Dawley rats were randomly divided into sham group, I/R group, aerobic exercise preconditioning group and exhaustive exercise preconditioning group. The morphological changes of neural cells in hippocampus were observed with HE staining, the learning ablility was assessed with shuttle box, the activity of superoxide dismutase and malondialdehyde level in hippocampus were measured with hydroxylamine method and TBA method respectively 1, 3, 7 days after injury. Results The number of survival neurons, active avoidance reaction and activity of superoxide dismutase decreased, and the latency of passive avoidance and malondialdehyde levels increased in all the other groups compare with the sham group (P<0.001). Further more, the number of surviving neurons, active avoidance reaction rate and the activity of superoxide dismutase were less in the I/R group than in the aerobic exercise preconditioning group (P<0.001), and more than in the exhaustive exercise preconditioning group (P<0.001), while the latency of passive avoidance and the level of malondialdehyde was more than in the aerobic exercise preconditioning group (P<0.001), and less than in the exhaustive exercise preconditioning group (P<0.001). Conclusion Regular aerobic exercise is beneficial to protect the learning ability from cerebral I/R in rats, but exhaustive exercise may be negative, which may associated with the metabolism of oxygen free radical in hippocampus impacted by exercise.
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Objective To investigate the diffusion-weighted imaging (DWI)characteristics and the correlation of diffusion coeffi-cient (ADC)and differentiation grade of rectal tubular adenocarcinoma.Methods The DWI characteristics of thirty-eight patients pathologically comfirmed rectal tubular adenocarcinomas were evaluated respectively.There were 9 highly differentiated tubular ade-nocarcinomas,1 5 moderately differentiated tubular adenocarcinomas and 14 poorly differentiated tubular adenocarcinomas.The ADC value was calculated from two different factors (0 and 1 000 s/mm2 ).The correlation between ADC value and the differentiated de-gree of tumour was statistically analysed.Results The mean ADC for highly differentiated group was (0.92±0.05)×10 -3 mm2/s, and the mean ADC for moderately differentiated group was (0.79 ± 0.10)× 10 -3 mm2/s whereas that for poorly differentiated group was (0.71±0.06)×10 -3 mm2/s.The difference among three groups was statistically significant(P <0.05).The ADC value and the differentiated degree of tumour were negatively correlated(Spearman r =-0.704)P<0.01.Conclusion DWI and ADC value can be a useful estimating for the differentiation of rectal tubular adenocarcinoma.
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Objective To analyze the clinical characters in old patients undergoing coronary artery bypass grafting (CABG). Methods The clinical data of 426 patients undergoing CABG from January 2000 to April 2009 in our hospital were retrospectively analyzed. One hundred eighteen patients were 70-82 years old (older group), 308 patients were 24-69 years old (younger group). The perioperative risk factors, surgical complication and outcomes between the two groups were compared.Results The older group had higher incidences of post-operative complications than younger group.Pre-operative risk factors included the female, chronic obstructive pulmonary disease, peripheral vessel disease, New york heart association(NYHA) class Ⅳ, unstable angina requiring intravenous nitrates until arrival in the anaesthetic room, left ventricular ejection fraction ＜30%. The older group showed higher incidences of postoperative severe complication, operative mortality, and more grafts and longer time in intensive care unit (ICU), and had lower incidents of valve disease and less use of left internal mammary artery [16 patients (13. 6%) vs. 152 patients (49.4%), all P＜0. 05].Conclusions The many CABG risk factors in China are different from those in the western countries.Although the higher incidents of postoperative severe complication and higher operative mortality are found in the older patients, the recovery period after operation isn't obviously prolonged. The operative outcomes are satisfactory.
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This study was aimed to construct a prokaryotic expressing vector of Hap gene from Nontypeable Haemophilus influenzae, and express and identify the fusion proteins of Hap-His in E. coli. The gene encoding protein Hap was amplified from Nontypeable Haemophilus influenzae ATCC49247 chromosomal DNA by PCR, then it was cloned into prokaryotic expression plasmid pET-32a (+). The recombinant plasmid pET-32a(+)-Hap was transformed into E. coli BL21 and expression was induced by Isopropy-beta-D-thiogalatoside(IPTG). The Hap-His fusion protein expressed so was analyzed by SDS-PAGE and Western-blot. The results showed that the recombinant expressive plasmid pET-32a (+)-Hap was constructed successfully, and the recombinant plasmid expressed Hap-His fusion protein with relative molecule mass 176 000 and mainly existed in inclusion body. This fusion protein could combine with anti-His monoclonal antibody specifically through Western blot analysis. Successful expression of Hap-His fusion protein in prokaryotic cell could lay a basis for further study of immunocompetence of Hap protein and development of NTHi vaccine.
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Bacterial Outer Membrane Proteins , Genetics , Cloning, Molecular , Escherichia coli , Genetics , Metabolism , Genetic Vectors , Genetics , Haemophilus influenzae , Genetics , Recombinant Fusion Proteins , Genetics , Serine Endopeptidases , GeneticsABSTRACT
Objective To explore the diagnosis and surgical treatment of duodenal trauma.Methods A retrospective study was accomplished on the clinical data of 52 patients with duodenal trauma.Results Of 52 patients with duodenal trauma,11 cases were simply anterior wall trauma,41 cases were anterior and posterior wall trauma and 6 cases were complicated with other organs traumatic.All patients were treated by surgery,and 45 cases were cured and 7 cases died.Conclusions Duodenal trauma often betides when patients have suffered road accident or closed impact injury in abodomen.Anterior wall trauma is often complicated with contrecoup of corresponding posterior wall.The diagnosis of posterior wall trauma is easily missed and the leakage of duodenum often happens in the operation.It is critical to check the doubtful cases with careful operations research and select reasonable and appropriate operation types for the diagnosis and surgical treatment of duodenal trauma.
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The authors studied the changes of myocardial enzymes (CPK, CPK-MB, LDH) in the wall of the right atrium during cardioplegic arrest in ninsecutive patients who had an open heart operation, observed the changes of these enzymes in seium as well The results indicate that when the crystalloid cardioplegic solution, systemic moderate hypothermia and decp local hypothermia are used to protect the myocardium, the right atrium can get satisfactory protection during cardioplegic arrest and there is no statistical differences of enzyme changes between samples taken from the right atrium before and after the arrest. The article still discussed the possibility of using the changes of atrial myocardial enzymes as an index to reflect the extent of myocardial protion. The authors consider that the change of myocardial enzyme can better reflect the metabolic activity of myocardium during cardioplegic arrest.