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Objective To establish a prediction model for 3-years recurrence after initial ischemic stroke by Cox proportional hazards regression and individual prognostic Index(PI)equation, and to evaluate its application value and external reality. Methods The inpatients with cerebral ischemic stroke hospitalized in Neurology Department in North China University of Science and Technology Affiliated Hospital were finally internalized between January 2013 and December 2013.Follow-up study on recurrence was carried out between January 2016 and December 2016.The recurrence prediction model was constructed by the Cox proportional hazards regression model.During January 2016 and December 2016,data of patients with ischemic stroke were prospectively continuously collected.And PI equation was used to verify its external reality in ischemic stroke patients. Results A total of 184 cases had stroke recurrence during the follow-up period.The Cox proportional hazards regression model analysis showed that age(RR=1.303,95% CI:1.019-1.666),history of heart disease(RR=1.788,95% CI:1.127-2.836),hypertension(RR=1.897,95% CI:1.097-3.280),diabetes(RR= 1.674,95% CI:1.015-2.760)and total cholesterol(RR= 2.136,95% CI:1.396-3.266)were the independent risk factors for stroke recurrence.The established recurrence model was correlated with individual PI equation,which was PI = 0.265X1+ 0.581X2+ 0.640X3+ 0.515X4+0.759X5.By the validation study of PI equation to predict stroke recurrence among patients admitted later, the sensitivity was 0.719,specificity was 0.769,and accuracy was 0.800. Conclusions Age,history of heart disease,hypertension,diabetes,and total cholesterol are independent risk factors for recurrence of ischemic stroke.And the PI for predicting stroke recurrence within 3 years after initial stroke is successfully established,which is good and helpful for predicting ischemic stroke recurrence.
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Objective To investigate the risk factors and establish the Cox's regression model and the personal prognosis index for the recurrence of ischemic stroke in 3-year follow-up.methods 1058 patients were retrospectively reviewed consecutively diagnosed with ischemic stroke admitted to the Neurology Department of the Hebei united University Affiliated Hospital from January 1,2013 to December 31,2013.Cases were followed up since the onset of ischemic stroke.The follow-up was finished in January 1,2016.Kaplan-Meier methods were used for recurrence rate description.Monovariant and multivariate Cox's proportional hazard regression model were used to analyze risk factors associated with recurrence.Thus,a recurrence model was set up.Result sDuring the period of follow-up,184 cases relapsed.The 1-year recurrence rate was 29.9 person-year,2-year recurrence rate was 46.6 person-year,3-year recurrence rate was 52.7 person-year.Monovariant and multivariant Cox's proportional hazard regression model showed that the independent risk factors associated with recurrence were age(X1)(RR=1.303;95%CI:1.019~1.666)history of heart disease(X2)(RR=1.788;95%CI:1.127~2.836),hypertension(X3)(RR=1.897;95%CI:1.097~3.280),diabetes(X4)(RR=1.674;95%CI:1.015~2.760),total cholesterol(X5)(RR=2.136;95%CI:1.396~3.266).The personal prognosis index(PI)of recurrence model was as the following: PI=0.265X1+0.581X2+0.640X3+0.515X4+0.759X5.Conclusion sAge,history of heart disease,hypertension,disease progression,and total cholesterol are the independent risk factors associated with recurrence of ischemic stroke.The recurrence model and the personal prognosis index equation are successful constructed.
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OBJECTIVE:To observe the bleeding,therapeutic efficacy and ADR of patients with acute cerebral infarction (ACI) treated by alteplase intravenous thrombolysis. METHODS:140 ACI patients were randomly divided into group A and B with 70 cases in each group. Group A was give alteplase 0.6 mg/kg for intravenous thrombolytic therapy,and group B was given al-teplase 0.9 mg/kg for intravenous thrombolytic therapy. The bleeding after thrombolysis,bleeding time,therapeutic efficacy and ADR were compared between 2 groups. RESULTS:The incidence of Subcutaneous ecchymosis,gingival bleeding,bleeding of di-gestive tract and intracranial hemorrhage of group A were 4.29%,2.86%,2.86% and 2.86%;those of group B were 14.29%, 12.86%,11.43% and 11.43%;the bleeding time of those symptomsin 2 groups were(6.04±0.75)and(7.22±0.56)h、(24.63± 10.24)and(35.22±9.87)min、(3.04±0.11)and(4.08±0.25)h、(3.12±0.48)和(4.53±0.66)h respectirely,with statistical signifi-cance(P0.05). CONCLUSIONS:The bleeding should be monitored strictly when ACI patients receive alteplase intravenous thrombolysis,and low-dose alteplase thrombolysis can ultimately reduce the incidence of bleeding.
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Objective To build of lentiviral mediated RNA interference of mammalian target of rapamcin (mTOR) ,because the mammalian target of rapamycin plays a important role in tumor development and the signal path .Methods According to RNA in-terference (RNAi) design rules Completely ,in view of the gene called mTOR was desiged four interference targets and Negative control (FAM ) sequence ,first of all ,synthetic oligonucleotides nucleotide fragments with artificial ,and can obtain siRNA fragments effectively by the method of PCR joining together ,then undertake transfection on lung adenocarcinoma A 549 cell by Lipofectamine transfection reagent 2000 .To begin to observe the enhanced green fluorescent protein expression in lung adenocarcinoma A 549 cells by fluorescence microscopy at high magnification after 1 days .We can use semi-quantitative RT-PCR method ,and detect of mTOR gene expression of mRNA level after 1 days ,meanwhile ,testing the expression of protein levels by Western Blot after 2 days ,in or-der to select the most efficient interference target sequence ,,afterwards ,synthetic double-stranded DNA ,and it can be make up vec-tor system with plasmid pHelper 1 .0 and pHelper 2 .0 by the pGCL-GFP carrier ,further transfect 293 T cells ,at last produce lenti-viral after packaging ,then detection GFP protein expression levels by Western-Blot method ,and consequently detect the virus drops degree of 293T cells ,at the same time ,identify the activity .Results The high efficiently target of mTOR gene has been successfully selected ;mTOR siRNA infecte of human lung adenocarcinoma A549 cells in vitro culture ,and the gene is obviously silence no mat-ter from the mRNA level or protein level ;3 mTOR gene lentivirus siRNA carrier was successfully build .geting virus supernatant al-so ,and virus drops to 1 × 108 UT/mL .Conclusion MTOR siRNA infected of human lung adenocarcinoma A549 cells in vitro cul-ture ,and could lead to mTOR gene obviously silence ;The construction was successfully gene mTOR siRNA lentivirus vectors .
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Objective To investigate the association between inflammatory biomarkers and survival in patients with stable chronic obstructive pulmonary disease(COPD).Methods A total of 1038 patients with stable COPD from January 2008 to December 2009 were included in a prospective cohort study.Clinical characteristics,pulmonary function tests,6 min walk test and a modified British Medical Research Council dyspnea scale (MMRC) were completed.Fasting blood was obtained to detect inflammatory biomarkers including neutrophils,C-reactive protein(CRP),fibrinogen,TNF-a,IL-6 and IL-8.Participants were evaluated every 3 months,all-cause mortality was used as the end event.Results 120 patients (9.2％) died in the period of follow-up.Kaplan-Meier analysis showed that 1 year,2-year-and 3-year survival rates were 94.4％,88.3％ and 84.0％,respectively.Compared with survivors,those who died had a higher level of inflammatory biomarkers.Cox multivariate regression analysis demonstrated that the independent risk factors for death were neutrophils (HR:1.262,95％CI:1.143-1.512,P=0.035),CRP (HR:1.234,95％CI:1.097-1.624,P=0.029),fibrinogen (HR:1.327,95％CI:1.141-1.619,P=0.026),TNF-α (HR:1.124,95％CI:1.043-1.659,P=0.045),IL-6 (HR:1,429,95％CI:1.237-1.816,P=0.014) and IL-8 (HR:1.188,95％CI:1.024-1.383,P=0.042).C statistical analysis showed that no single biomarker significantly improved the C statistic value on the base of clinical model,but it was further improved by the addition of all biomarkers (C =0.764,P =0.010).Conclusions The level of inflammatory biomarkers in the death with stable COPD is significantly increased.Age.BODE index,neutrophils,CRP,fibrinogen,TNF-α,IL-6 and IL-8 are independent risk factor for the prediction of mortality in patients with COPD.
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Objective To observe the occurring time of heparin-induced thrombocytopenia,resuming time and effects of treatment during continuous hemofiltration.Methods To select 9 cases of patients with continuous veno-venous hemofiltration(CVVH)hospitalized in Luohe centre hospital,70 cases of patients with hemoperfusion and 20 hemodiaglysis cases of patients with acute and chronic renal failure during 2005,1 to 2006,1,blood samples were collected from the patients,platelet was tested before and after the treatment,the bleeding symptoms and effects of treatment were observed.Results There was 1 case during the 27th hour of CVVH,the lowest platelet was 10?10～9/L,resumed 48h hours after stoping heparin;there was 1 case during the first hour of hemoperfusion,the lowest platelet was 67?10～9/L,resumed 60h hours after stoping heparin.Conclusions It is essential to observe the changes of disease condition closely,to test platelet and whenever necessary to give cortex hormone,hemostatics and interrupted using platelet transfusion.