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1.
Chinese Journal of Trauma ; (12): 1087-1092, 2019.
Article in Chinese | WPRIM | ID: wpr-824393

ABSTRACT

Objective To investigate the clinical practicability and prognostic value of Helsinki CT score in patients with traumatic brain injury(TBI).Methods A retrospective case series study was conducted to analyze the clinical data of 124 TBI patients admitted to First Affiliated Hospital of Xinjiang Medical University from September 2016 to October 2018.There were 91 males and 33 females,aged 14-84 years,with an average age of 49 years.Glasgow coma score(GCS)at admission ranged from 3-8 points in 45 patients,9-12 points in 42 patients,and 13-15 points in 37 patients.According to Glasgow outcome scale(GOS)at 6 months after injury,26 patients were classified into the poor prognosis group with GOS of 1-3 points and 98 patients were in the good prognosis group with GOS of 4-5 points.The prognosis-related risk factors were analyzed,and the role of Helsinki CT score to predict the adverse prognosis and mortality of TBI patients in the two groups was investigated.The sensitivity and specificity of Helsinki CT Score for 6-month poor prognosis were evaluated by receiver operation characteristic(ROC)curve and area under the curve(AUC).Results Univariate analysis suggested that there were significant differences in terms of subdural hematoma,intracranial hematoma,extradural hematoma,hematoma volume>25 cm3,intraventricular hemorrhage and Suprasellar cistern pressure between the poor prognosis group and good prognosis group(P<0.05).Multivariate logistic regression analysis showed that the mortality and bad prognosis were related to the hemorrhage of ventricles,the pressure of suprasellar cistern and the disappearance of suprasellar cistern in the poor prognosis group and the good prognosis group(P<0.05),while intracranial hematoma and hematoma volume showed no association with mortality and poor prognosis(P>0.05).The Helsinki CT score could independentiy predict the advetse prognosis and mortality of TBI patients at 6 months(multivariate logistic regression: ORdealth=1.21,ORadvene prognosis = 1.14).Helsinki CT score had a better predictive ability of 6-month mortality(AUC = 0.85)than that of 6-month advetse prognosis(AUC = 0.76),and had a predictive value for 6-month mortality and advetse prognosis.Conclusions Subdural hematoma,extradural hematoma,intraventricular hemorrhage and suprasellar cistern state(compression or disappearance)are the risk factots for the poor prognosis of TBI patients.Intraventricular hemorrhage and suprasellar cistern state are the main risk factots for predicting the mortality of 6 months.Helsinki CT score can independently predict the advetse prognosis and mortality of TBI patients at 6 months,and has relatively better value in predicting the mortality.

2.
Chinese Journal of Trauma ; (12): 1087-1092, 2019.
Article in Chinese | WPRIM | ID: wpr-799884

ABSTRACT

Objective@#To investigate the clinical practicability and prognostic value of Helsinki CT score in patients with traumatic brain injury (TBI).@*Methods@#A retrospective case series study was conducted to analyze the clinical data of 124 TBI patients admitted to First Affiliated Hospital of Xinjiang Medical University from September 2016 to October 2018. There were 91 males and 33 females, aged 14-84 years, with an average age of 49 years. Glasgow coma score (GCS) at admission ranged from 3-8 points in 45 patients, 9-12 points in 42 patients, and 13-15 points in 37 patients. According to Glasgow outcome scale (GOS) at 6 months after injury, 26 patients were classified into the poor prognosis group with GOS of 1-3 points and 98 patients were in the good prognosis group with GOS of 4-5 points. The prognosis-related risk factors were analyzed, and the role of Helsinki CT score to predict the adverse prognosis and mortality of TBI patients in the two groups was investigated. The sensitivity and specificity of Helsinki CT Score for 6-month poor prognosis were evaluated by receiver operation characteristic (ROC) curve and area under the curve (AUC).@*Results@#Univariate analysis suggested that there were significant differences in terms of subdural hematoma, intracranial hematoma, extradural hematoma, hematoma volume >25 cm3, intraventricular hemorrhage and suprasellar cistern pressure between the poor prognosis group and good prognosis group (P<0.05). Multivariate logistic regression analysis showed that the mortality and bad prognosis were related to the hemorrhage of ventricles, the pressure of suprasellar cistern and the disappearance of suprasellar cistern in the poor prognosis group and the good prognosis group (P<0.05), while intracranial hematoma and hematoma volume showed no association with mortality and poor prognosis (P>0.05). The Helsinki CT score could independently predict the adverse prognosis and mortality of TBI patients at 6 months (multivariate logistic regression: ORdeath=1.21, ORadverse prognosis=1.14). Helsinki CT score had a better predictive ability of 6-month mortality (AUC=0.85) than that of 6-month adverse prognosis (AUC=0.76), and had a predictive value for 6-month mortality and adverse prognosis.@*Conclusions@#Subdural hematoma, extradural hematoma, intraventricular hemorrhage and suprasellar cistern state (compression or disappearance) are the risk factors for the poor prognosis of TBI patients. Intraventricular hemorrhage and suprasellar cistern state are the main risk factors for predicting the mortality of 6 months. Helsinki CT score can independently predict the adverse prognosis and mortality of TBI patients at 6 months, and has relatively better value in predicting the mortality.

3.
Chinese Journal of Trauma ; (12): 430-434, 2019.
Article in Chinese | WPRIM | ID: wpr-745075

ABSTRACT

The efficacy of decompressive craniectomy (DC) in reducing traumatic brain injury mortality has been affirmed,but there are also many serious complications.Syndrome of the trephined (ST) and paradoxical herniation (PH) are rare complications.ST is characterized by a series of neurological deterioration due to skin flaps subsidence from weeks to months after DC.These neurological impairments are closely related to the subsequent repair of skull defects.PH shows progressive decrease in consciousness on the basis of ST,changes in pupils on the side of skull defects,low touch pressure at the defect window,and obvious midline shift and brain stem compression on CT.ST and PH have common inducements in pathophysiology,including cerebrospinal fluid dynamics,atmospheric pressure,cerebral blood flow and brain material metabolism.There is no consensus on the diagnosis of ST and PH,and early cranioplasty is suggested in terms of treatment.This article reviews the clinical manifestations,pathophysiological changes,diagnosis and treatment of ST and PH after DC operation,so as to provide references for clinicians to further understand ST and PH.

4.
Journal of Chinese Physician ; (12): 44-47, 2019.
Article in Chinese | WPRIM | ID: wpr-734064

ABSTRACT

Objective To investigate the clinical therapeutic effect of citicoline sodium combined with Shenxiong glucose in the treatment of senile hypertensive cerebral infarction in the elders.Methods 80 elderly patients with senile hypertensive cerebral infarctiontreated in our hospital were selected and randomly divided into the single treatment group and the combination treatment group,40 cases in each group.Both groups received the routine treatment.The single treatment group additionally received Shenxiong glucose injection (100 ml/d),while patients in the combination treatment group additionally received Shenqiong glucose injection combined with citicoline sodium intravenous infusion therapy (0.5 g/d),both groups were treated for 2 weeks.The levels of serum inflammatory factors,the neurological deficit score,the cognitive function score were compared and analyzed before and after treatment between two groups.Results After systemic treatment,the blood pressure and blood lipid levels of two groups were significantly improved,but there was no significant difference between the two groups (P > 0.05);The serum levels of interleukin (IL)-6,IL-8 and tumor necrosis factor-α (TNF-α) of the combination treatment group improved more significantly (P ≤0.05).After treatment,the oxidative stress indexes were significantly improved in the two groups (P ≤ 0.05).The content of malondialdehyde (MDA) was decreased,while the superoxide dismutase (SOD) activity and nitric oxide (NO) content were increased significantly (P ≤ 0.05);and the improvement degree in the combination treatment group was better than in the single treatment group (P ≤0.05).The degree of improvement in the Modified Edinburgh-Scandinavia Stroke Scale (MESSS) and Hasegawa Dementia Scale (HDS) scores of the combination treatment group was more significant than those in the single treatment group (P ≤ 0.05).The total effective rate of the combination treatment group was 92.5%,which was significantly higher than that of the single group (75.0%),with statistically significant difference (P ≤ 0.05).No obvious adverse reactions happened in two groups during treatment.Conclusions Combination of citicoline sodium and shenxiang glucose on the basis of routine treatment can significantly reduce oxidative stress and inflammation levels,promote the recovery of neurological and cognitive functions,and improve the clinical efficacy and safety.It is worth popularizing and applying in the clinical treatment of senile hypertensive cerebral infarction.

5.
Chinese Journal of Biochemical Pharmaceutics ; (6): 251-253, 2017.
Article in Chinese | WPRIM | ID: wpr-612884

ABSTRACT

Objective To investigate the effect of Weifu'an combined with dietary improvement on immune function and quality of life in patients with advanced gastric cancer chemotherapy.MethodsAnalysis of hospital, 70 cases of Ⅲ~Ⅳ period clinical medical records and treatment in patients with advanced gastric cancer;According to random number table method will be divided into the control group (chemotherapy using OLF) and observation group (chemotherapy combined Weifu'an combined dietary improvement), and 35 cases statistics of two groups of clinical curative effect and adverse reactions after the treatment of four course, carr's quality of life (KPS) score was used to ealuate treatment in both groups before and after the survival quality.Detection in the two groups before and after treatment in patients with immune function.ResultsThe control rate of clinical disease was 68.57% in the observation group and 60.0% in the control group, there was no significant differemce.The KPS score of the observation group and the control group was significantly higher than that of the control group before the treatment and the KPS score of the observation group was significantly higher than that of the control group(P<0.05).Compared with the observation group, the levels of CD4+/CD8+ and NK cells in the control group were significantly lower than those in the control group, the difference was statistically significant (P<0.05).The adverse reaction rate was 37.14% in the observation group and 68.57% in the control group,the difference was statistically significant(P<0.05).ConclusionWeifu'an combined dietary improvement can reduce adverse reactions, immune function and help to improve the patients quality of life.

6.
Chinese Journal of Medical Education Research ; (12): 873-877, 2017.
Article in Chinese | WPRIM | ID: wpr-607905

ABSTRACT

We aim to develop and implement a disaster medicine curriculum for medical student education,so the six-step approach to curriculum development for medical education has been used as a formal process instrument. Recognized experts in disaster health care have provided input using disaster-related physician training programs, scientific evidence if available, proposals for education by international disaster medicine organizations and their expertise as the basis for content development. The final course consists of 14 modules composed of 2-h units. The concepts of disaster medicine, including response, med-ical assistance, law, command, coordination, communication, and mass casualty management, are intro-duced. Hospital preparedness plans and experiences from worldwide disaster assistance are reviewed. Life-saving emergency and limited individual treatment under disaster conditions are discussed . Specifics of initial management of explosive, war-related, radiological/nuclear, chemical, and biological incidents empha-sizing infectious diseases and terrorist attacks are presented. An evacuation exercise is completed, and a mass casualty triage is simulated in collaboration with local disaster response agencies. Decontamination procedures are demonstrated at the local fire department, and personal decontamination practices are exer-cised. Mannequin resuscitation is practiced while personal protective equipment is utilized. An interactive review of professional ethics, stress disorders, psychosocial interventions, and quality improvement efforts complete the training. The curriculum offers medical disaster education in a reasonable time frame, interdis-ciplinary format, multi-experiential course and flexible structure. It can serve as a template for basic medi-cal student disaster education.

7.
Chinese Journal of Emergency Medicine ; (12): 939-943, 2017.
Article in Chinese | WPRIM | ID: wpr-607869

ABSTRACT

Objective To evaluate the association between bradycardia and neurological sequel in patients with restoration of spontaneous circulation (ROSC) after cardiopulmonary resuscitation (CPR) during targeted body temperature management (TTM).Methods Forty-three unconscious patients with ROSC after CPR were treated with TTP.The patients were cooled with therapeutic hypothermia to body temperature target range (32-34°C) after cardiac arrest and divided into bradycardia and control groups depending on the lowest heart rate less than 50 beats/min and more than or equal to 50 beats/min respcetively at that time.The bispectral index (BIS) and the neuron-specific enolase (NSE) values were respectively recorded at the following intervals,0h (h0)、24h (h24)、48h (h48)、72h (h72) after ICU admission.Neurological outcome was defined according to the Pittsburgh cerebral performance category (CPC) at 3 months after ICU discharge.Results Compared with the control group,during TTM the bispectral index levels were significantly higher in the bradycardia group at h0,h48,h72 after admission,(h0 bradycardia group 73.0 ± 12.3;control group 58.0 ± 18.6,P <0.01)、(h48 bradycardia group 71.4 ± 21.2;control group 46.3 ± 18.9,P < 0.01)、(h72 bradycardia group 78.6 ± 24.6;control group 51.8 ± 24.1,P =0.01).The neuron-specific enolase level in bradycardia group was significantly lower than that in control group on day3 (118.8 ± 118.8 ng/mL vs.248.3 ± 191.9 ng/mL,P =0.02).The level of CPC in the bradycardia group was significantly higher than that in the control group (P =0.046).Conclusions Patients with bradycardia during TTM had favorable neurological outcome,which could provide evidence for clinical treatment and prognostic evaluation of the patients.

8.
Chinese Journal of Tissue Engineering Research ; (53): 4007-4012, 2017.
Article in Chinese | WPRIM | ID: wpr-606894

ABSTRACT

BACKGROUND: In animal experiments, ultrasound-mediated microbubbles can promote the homing of transplanted stem cells to the ischemic area, enhance angiogenesis and small arterial formation, improve local blood flow in the ischemic myocardium and restore myocardial contractility.OBJECTIVE: To investigate the effect of ultrasound-mediated microbubbles on intravenously transplanted bone marrow mesenchymal stem cell (BMSC) homing and the therapeutic efficiency on ischemic stroke. METHODS: A middle cerebral artery occlusion (MCAO) model was induced by plug wire preparation. At 72 hours after MCAO, model rats were randomized into four groups: PBS group (n=15), BMSCs group (n=18), ultrasound+BMSCs group (n=18), ultrasound+microbubble+BMSCs group (n=18). Corresponding treatment was done in each group: 2 mL of PBS was injected via tail vein in the PBS group; about 3×106 BMSCs diluted by 2 mL of PBS were injected via tail vein slowly in the BMSCs group; after skull ultrasound radiation (1 MHz, 2 W/cm2) for 120 seconds, BMSCs were injected via tail vein slowly in the ultrasound+BMSCs group; the same process as the ultrasound+BMSCs group was done following intravenous injection of 0.1 mL/kg microbubbles in the ultrasound+microbubble+BMSCs group.RESULTS AND CONCLUSION: (1) Forty-eight hours after BMSCs transplantation, the BMSCs homing rate in the brain was significantly higher in the ultrasound+microbubble+BMSCs group than the other two groups (P < 0.05). (2) Twenty-eight days after MCAO, nerve damage was significantly milder in the ultrasound+microbubble+BMSCs group than the other two groups (P < 0.05). (3) Seven days after transplantation, the water content in the brain tissue was significantly lower in the ultrasound+microbubble+BMSCs group than the other two groups (P < 0.05). (4) Seven days after transplantation, the cerebral infarction volume was significantly reduced in the ultrasound+microbubble+BMSCs group compared with the other two groups (P < 0.05). To conclude, ultrasound-mediated microbubbles can enhance the homing effect of intravenously transplanted BMSCs, reduce cerebral edema and cerebral infarction volume, improve the neurological function, and increase the therapeutic effect of BMSCs transplantation on ischemic stroke.

9.
Chinese Journal of Tissue Engineering Research ; (53): 2678-2683, 2017.
Article in Chinese | WPRIM | ID: wpr-619474

ABSTRACT

BACKGROUND: Recent experimental studies have found ultrasound mediated microbubbles potentiate stem cell therapy in myocardial infarction (MI)-induced heart failure, indicating a good application prospect. But whether ultrasound mediated nitric oxide (NO) microbubbles also have the same effect in the intracoronary transplantation of bone marrow mesenchymal stem cells (BMSCs) for treatment of large animals with MI is still unknown. OBJECTIVE: To investigate the effectiveness and possible mechanism of ultrasound mediated NO microbubbles in potentiating intracoronally transplanted BMSCs homing to the infarcted area in a MI pig model.METHODS: Density gradient centrifugation culture method was used in the isolation and cultivation of BMSCs. CM-Dil was used to label BMSCs in vitro. Twenty-four pigs were used to make MI models by blocking the left anterior descending coronary artery, and then were divided into PBS group, BMSCs group, ultrasound+microbubbles+BMSCs(MB) group, ultrasound+NO microbubbles+BMSCs (NO-MB) group(n=6 per group). In the PBS group, 10 mL of PBS was intracoronally injected. In the BMSCs group, about 1×107 BMSCs were diluted in 10 mL of PBS and then intracoronally infused. In the MB group, 0.1 mL/kg sulphur hexafluoride microbubbles (Sono Vue) was intracoronally injected together with ultrasound treatment (1 MHz, 2 W/cm2, 2 minutes), followed by intracoronary infusion of about 1×107 BMSCs that were diluted in 10 mL of PBS. In the NO-MB group, all methods and conditions were identical to those in the MB group except only 0.1 mL/kg of Sono Vue was replaced by 0.1 mL/kg NO microbubbles. Three pigs were sacrificed in each group 48 hours after CM-Dil positive BMSCs transplantation. The labeled BMSCs were observed and counted by fluorescent microscope after frozen sectioning of the infarct area. We assessed and compared left ventricular systolic function with M-mode ultrasound among groups at 4 weeks after intervention. After cardiac function test, the rest pigs were sacrificed and capillary density in the myocardial ischemic area was counted and compared after hematoxylin-eosin staining. RESULTS AND CONCLUSION: (1) The number of CM-Dil positive cells in the area of MI in the NO-MB group was much more than that in the MB group and BMSCs group with statistical significance (P < 0.05). (2) The left ventricle systolic function was significantly improved in the NO-MB group as compared with the MB group (P < 0.05). The same trend was observed between NO-MB group and BMSCs group as well as between NO-MB group and PBS group (P < 0.05). (3) The density of capillaries increased significantly in the NO-MB group compared with the MB group, BMSCs group and PBS group, respectively. To conclude, ultrasound mediated NO microbubble combined with intracoronary BMSCs transplantation can improve the left ventricular systolic function. The possible mechanism could be that ultrasoundmediated NO mocrobubbles promote the homing of transplanted BMSCs to the myocardial ischemia area as well as improve local angiogenesis.

10.
Chinese Journal of Emergency Medicine ; (12): 470-474, 2016.
Article in Chinese | WPRIM | ID: wpr-672305

ABSTRACT

Objective To evaluate the prognostic value of the neuron-specific enolase ( NSE ) and bispectral index ( BIS) in patient with mild therapeutic hypothermia ( MTH) after cardiopulmonary resuscitation ( CPR ) .Methods Forty-six patients with restoration of spontaneous circulation ( ROSC ) after CPR were treated with MTH.The BIS values were recorded and the serum NSE was measured at the following times:24 h, 48 h, and 72 hours after ICU admission.Neurological outcome was classified according to the Pittsburgh cerebral performance category ( CPC 1 to 5) at 3 months after ICU discharge.Results Fourteen patients had a good neurological outcome with CPC score 1-3, and thirty-two patients had a poor neurological outcome with CPC 4-5 at 3 month.Compared with good outcome group, the NSE values were significantly higher in the poor outcome group on day 2 and day 3 after admission [48 h: (90.1 ±42.7) ng/mL vs.(33.2 ±17.5) ng/mL;72 h: (95.4 ±37.0) ng/mL vs. (29.2 ±17.0) ng/mL, P<0.05].NSE increased markedly in the poor neurological outcome group at 48h and 72h, and decreased significantly in the good group at the same time [△NSE 24 h-48 h: (37.3 ±28.7) ng/mL vs.(-10.7 ±12.1) ng/mL; △NSE 48 h-72h: (5.3 ±13.2) ng/mL vs.(-4.0 ±4.5 ng/mL), P<0.05].Over the 72 h of monitoring, the mean BIS values were lower in the poor outcome group compared to the good outcome group at 48 h [ (39.2 ±24.1) vs.(78.0 ±12.4); 72 h: (45.7 ±26.4) vs.(89.0 ±7.3), P<0.05].Conclusions The values of NSE and BIS were effective prognostic indicators for the neurological outcome of patients with MTH after CPR.

12.
Chinese Journal of Primary Medicine and Pharmacy ; (12): 41-44, 2015.
Article in Chinese | WPRIM | ID: wpr-465820

ABSTRACT

Objective To evaluate the effect of aescine sodium combined with albumin in the treatment of hypertensive intracerebral hemorrhage after intracranial hematoma minimally invasive removal surgery.Methods 50 patients with hypertensive intracerebral hemorrhage after intracranial hematoma minimally invasive removal surgery were randomly divided into the two groups:the treatment group was treated with aescine sodium and albumin,the control group was treated with the conventional medical drugs;The neural function defect scale,brain edema area of postoperative patients after 1d and 15d,clinical effects after 15d were observed.Results 15d after operation,in the treatment group,the brain edema area was (2.40 ± 0.32) cm2,neural function defect scale was (9.44 ± 2.25) points,which were better than (3.40 ±0.85) cm2 (t =4.721,P <0.01) and (15.65 ±3.04) points(t =3.625,P <0.01).The total effective rate of the treatment group was 88.9%,which was better than 69.6% of the control group(x2 =13.58,P <0.01).Conclusion Aescine sodium combined with albumin can effectively reduce perihematomal brain edema area,improve nerve function defect and clinical effect in the patients with hypertensive cerebral hemorrhage after minimally invasive scavenging surgery.

13.
Chinese Journal of Tissue Engineering Research ; (53): 3788-3792, 2015.
Article in Chinese | WPRIM | ID: wpr-461886

ABSTRACT

BACKGROUND:Sodium hyaluronate is a polysaccharide polymer biomaterial, which is considered to have a certain effect to repair the cartilage surface, reduce the release of inflammatory mediators, and promote meniscal repair. OBJECTIVE:To observe the therapeutic effect of Fast-Fix combined with sodium hyaluronate in meniscal repair under arthroscope. METHODS:Eighty-six patients with meniscus injury admitted at the Department of Orthopedics, CNPC Central Hospital, from March 2008 to March 2014 were enrol ed in the study. The average age was 25.5 years, and the average duration of disease was 1.5 months. The main clinical manifestations included knee joint pain and swel ing after exercise and positive McMurray signs. The MRI results showed meniscus tear or degeneration. Arthroscopic repairing surgeries were performed with Fast-Fix combined with sodium hyaluronate injection (2.5 mL at the end of surgery), and then sodium hyaluronate was injected intraarticularly at 1, 2, 3 weeks after surgery. Each patient was assessed with Lysholm knee joint score system before and after operation. RESULTS AND CONCLUSION:Eighty-one patients were fol owed up for an average of 1.5 years and five patients were lost to fol ow-up. Joint locking, significant tenderness and movement disorder symptoms disappeared in 79 of 81 patients, and meniscal healing was shown on MRI review within 1 year after surgery;the Lysholm score was higher than 75 points, and the excel ent rate was 98%. Only the remained two patients felt swel ing and tenderness and the movement was slightly restricted when going down or standing up. The Fast-Fix combined with sodium hyaluronate in meniscal repair under arthroscope has good effect and good function of knee joint.

14.
Chinese Journal of Tissue Engineering Research ; (53): 7294-7298, 2014.
Article in Chinese | WPRIM | ID: wpr-457331

ABSTRACT

BACKGROUND:Animal studies have indicated ultrasound-mediated microbubbles can significantly enhance the effect of stem cel transplantation to treat ischemic diseases. But its mechanism is stil unknown. OBJECTIVE:To explore the mechanism of ultrasound-mediated microbubbles to significantly enhance the effect of stem cel transplantation in the treatment of ischemic diseases. METHODS:Bone marrow mesenchymal stem cel s and vascular endothelial cel s of rats were cultured in vitro, and then randomized to three groups:control group with no intervention, ultrasound group exposed to ultrasound at 1 MHz, 1 W/cm2 for 90 seconds, and ultrasound-mediated microbubble group treated with 5μL liposomes ultrasound microbubbles containing fluorocarbon gases (about 2×1011/L) and ultrasound exposure at 1 MHz, 1 W/cm2 for 90 seconds. RESULTS AND CONCLUSION:Compared to the control group, ultrasound-mediated microbubbles significantly increased expressions of vascular endothelial growth factor and stromal cel-derived factor 1 in the supernatant of vascular endothelial cel s (P0.05). These findings suggest that 1 W/cm2 ultrasound-mediated microbubbles can promote vascular endothelial growth factor and stromal cel-derived factor 1 secretion by vascular endothelia cel s, and meanwhile promote CXCR4 gene expression in bone marrow mesenchymal stem cel s. This may be the mechanism of the ultrasound-mediated microbubbles enhancing homing effect of transplanted stem cel s.

15.
International Journal of Cerebrovascular Diseases ; (12): 555-558, 2012.
Article in Chinese | WPRIM | ID: wpr-427511

ABSTRACT

Left atrial myxoma is one of the rare causes of cerebral infarction.As the left atrial myxoma complicated artery embolization is more common in cerebral vessels,the first clinical manifestation of about 1/3 patients with left atrial myxoma was cerebral infarction.This article reports a 24-year young female without common vascular risk factors,including hypertension,diabetes,and hyperlipidemia.Multiple cerebral infarctions are the first symptom in patients with left atrial myxoma,and they are analyzed in combination with literature.

16.
Chinese Journal of Emergency Medicine ; (12): 514-518, 2012.
Article in Chinese | WPRIM | ID: wpr-418817

ABSTRACT

Objective To investigate the risk factors and outcomes of acute kidney injury (AKI) in patients after intra--coronary stent implantation.Methods A retrospective and case control study was done with data analysis in 325 patients who underwent intra-coronary stent implantation from January 2010 to March 2011.The patients were divided into two groups as per the criteria of AKI identified on the 7th day after implantation of stent.The variables to be studied included:(1) age,gender,hypertension,diabetes,cerebrovascular disease,left ventricular insufficiency,peripheral angiopathy,creatinine,urea nitrogen,estimated glomerular filtration rate,hyperuricemia,proteinuria,emergency operation,hydration,and medication (ACEI/ARB,statins) before operation; (2) dose of contrast media,operation time,hypotension during intra-operative period; and (3) postoperative:hypotension.The variables were analyzed with the process of One-way ANOVA and multivariate Logistical regression analysis.Consequently,the independent risk factors of AKI in patients after intra-coronary stent implantation could be found.Further,the prognosis of AKI patients was analyzed.Results Of the 325 patients,51 (15.7%) developed AKI.Compared the normal group,hospital stay (P < 0.01 ) and in-hospital mortality (P < 0.05) increased significantly in the AKI group.Monofactorial analysis showed that age,pre-operative laboratory and clinical data including left ventricular insufficiency,peripheral angiopathy,creatinine,urea nitrogen,estimated glomerular filtration rate, hyperuricemia, proteinuria, hydration and emergency operation, and intraoperative information such as operation time and hypotension,and postoperative hypotension in AKI patients group were significantly different in comparison with control group ( P < 0.05 ). Multivariate logistic regression analysis revealed that elderly age (OR =0.253),pre-operative proteinuria (OR =5.351 ),preoperative left ventricular insufficiency ( OR =8.704),eGFR ≤ 60 ml/ ( min · 1.73 m2 ) ( OR =6.677 ),prolonged operation time ( OR =1.017),intra-operative hypotension ( OR =25.245 ) were independent risk factors of AKI ( P < 0.05 ).Conclusions AKI is a common complication and associated with increase in mortality after intra-coronary stent implantation.Increase in age,pre-operative proteinuria,pre-operative left ventricular insufficiency,pre-operative low estimated glomerular filtration rate,prolonged operation time,intra-operative hypotension are the independently risk factors associated with AKI.

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