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Endovascular mechanical thrombectomy (EMT) has become the main treatment of acute ischemic stroke, but the pathological study of thrombi retrieved with EMT is still very limited. This article reviews the routine staining, special components, expression of immune factors, electron microscopic morphology, imaging features of the pathological components of thrombi retrieved with EMT, and their correlation with the etiological differentiation and outcomes of stroke.
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Objective To observe the effect of early goal directed therapy (EGDT) on tissue perfusion,microcirculation and oxygen metabolism in patients with septic shock.Methods A prospective observational study was carried out in 69 patients with early septic shock within 24 hours.The eligible patients were treated with the standard procedure of EGDT.The partial pressure of transcutaneous oxygen (PtcO2) and transcutaneous carbon dioxide (PtcCO2) was monitored and the changes of hemodynamic data,tissue oxygen,microcirculation before and after reaching the criteria of EGDT were recorded.Results Compared with that before treatment,PtcO2,tissue oxygenation index (PtcO2/FiO2) after EGDT was increased [(78.1 ± 30.8) mmHg (1 mmHg =0.133 kPa) vs.(62.8 ± 24.1) mmHg and (141.7 ± 78.3) mmHg vs.(110.8 ± 60.5) mmHg],PtcCO2 and percutaneous arterial carbon dioxide partial pressure difference was decreased[(29.0 ±4.1) mmHg vs.(39.1 ±6.4) mmHg and (1.4 ±0.5) mmHg vs.(1.7 ±0.8) mmHg],there was significant difference(P＜ 0.05).There was no significant difference in PtcO2,PtcO2/FiO2,PtcCO2,central venous blood oxygen saturation,lactic acid,oxygen and oxygen consumption (P ＞ 0.05).Conclusion EGDT can improve local tissue perfusion and microcirculation in patients with septic shock,body tissue perfusion index before and after EGDT may not be able to reflect the local tissue perfusion.
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Objective To discuss the therapy of cholelithiasis complicated with cirrhotic portal hypertension (CPH).Method In this study,clinical data were reviewed on 108 cases with cholelithiasis complicated with hepatic cirrhosis,including 78 cases who underwent surgery.Results Open cholecystectomy,subtotal cholecystectomy,laparoscopic cholecystectomy,open cholecystectomy plus spleectomy,splenectomy plus pericardial devascularization before biliary duct operation,leftlateral hepatectomy with biliary duct operation,and hepatic portal bile duct anaplasty with Roux-en-Y cholangiojejunostomy.10 patients received endoscopic treatment and 20 were treated conservatively.Results 73 patients were cured,with a cure rate of 67.6％; 32 patients were doing well (29.7％);3 patients died (2.8％) of massive hemorrhage and hepatic failure.The operative complications included ascites,jaundice,hemorrhage and hepatic insufficiency.Conclusions Before operation,the conditions of the patient should be accurately evaluated and a correct operative treatment option should be selected.Child C grade patients should be contraindicated for any surgery.
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Objective To investigate the relationship between the cerebral microbleeds (CMBs) and changes of cognitive function,and the possible mechanism of cognitive impairment caused by CMBs.Methods Sixty-eight micro-hemorrhage patients on susceptibility weighted imagine (SWI) sequences composed positive group,and sixty-eight patients selected without micro-hemorrhage in the SWI sequence and meeting the selection criteria as control group.At the same time,both two groups were assessed by MoCA and CDT scale inspection.Results CDT scores of CMBs group (2.00±0.88) were significantly lower than those of control group (3.76±0.53),and there was significantly different in the two groups (t=-3.27,P=0.00).At the same time,MoCA total scores and executive functions,naming,calculation,language,abstraction,recall scores of CMBs group were significantly lower than those of control group,and all of the groups were significantly different (t=-5.48,P=0.00; t=-4.36,P=0.00; t=-2.35,P=0.01 ; t=-2.49,P=0.02; t=-4.09,P=0.00; t=-4.63,P=0.00).CDT scores,MoCA total scores,executive functions,language,abstraction,memory scores between CMBs groups and control group were significantly different at all levels (P＜0.05).Executive functions,languages and calculated inter-group of mild CMBs,moderate CMBs,severe CMBs were significantly different (P＜0.05).The number of CMBs was negative correlation with total scores,executive function,language,and abstract (r=-0.675,P=0.000; r=-0.689,P=0.000; r=-0.536,P=0.000; r=-0.636,P=0.000).Conclusion The existence of CMBs and the number of CMBs are closely related to cognitive dysfunction.The more of CMBs,the more of obvious cognitive impairment.
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10.3969/j.issn.2095-4344.2013.23.015
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Objective To investigate the efficacy of sequential ERCP and laparoscopy for acute biliary pancreatitis (ABP).Methods A total of 80 patients with ABP were randomly divided into 2 groups to receive sequential ERCP and laparoscopy (observation group,n=40) or traditional surgery (control group,n=40).Clinical data including abdominal pain relief time,recovery time of white blood cell,blood amylase and liver function,hospital stay,complication rate and mortality were analyzed.Results ERCP failed in 1 patient in observation group,and the remaining 39 patients (97.5％) were recruited into the study.There were significant differences between 2 groups in regarding of abdominal pain relief time (7.7±2.7 d vs.11.4±3.7 d),recovery time of white blood cell ( 9.7±2.6 d vs.13.3±3.9 d ),blood amylase ( 8.2±2.1 d vs.12.5±3.3 d ),liver function ( 12.5±5.1 d vs.21.3±6.5 d ),hospital stay ( 16.1±5.1 d vs.23.3±7.6 d ) and rate of complication ( 12.8％ vs.30.0％ ).There was no significant difference in morbidity between 2 groups (5.1％ vs.7.5％).Conclusion Sequential ERCP and laparoscopy is effective for ABP.
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Objective To investigate the correlation between cognitive function and cerebral microbleeds (CMBs) in patients with small artery occlusive stroke (SAO).Methods The patients with SAO in Nanjing Stroke Registration Program were recruited from January 2011 to May 2011.The Montreal Cognitive Assessment (MoCA) was used to conduct the cognitive evaluation.At the same time,conventional MRI sequences and susceptibility-weighted imaging (SWI) were used to detect CMBs.Results A total of 70 patients with SAO were included in the study,48 of them had abnormal MoCA scores ( ＜26 points) and 22 of them had normal MoCA scores (≥26).The age of patients (t =-2.237,P =0.023),years of education (t =2.297,P =0.029),history of hypertension (x2 =2.297,P =0.025 ),severity of white matter hyperintensities (Z =-3.263,P =0.001) and presence of CMBs (P =0.001) were associated with the abnormal MoCA scores in patients with SAO.Logistic regression analysis showed that after adjusting for age,sex,white matter lesions,hypertension,diabetes and coronary heart disease,the presence of CMBs (odds ratio 5.648,95％ confidence interval 1.105-28.869; P =0.038) was still an independent risk factor for abnormal MoCA scores.The more serious of CMBs,the lower the MoCA scores (r =- 0.532,P ＜ 0.001 ).In patients with CMBs,the cognitive domain,such as the total MoCA score (t =5.180,P ＜ 0.001 ),visuospatial/executive function (t =3.924,P ＜ 0.001 ) and attention (t =4.309,P ＜ 0.001 ) were impaired significantly.The CMBs at different parts resulted in cognitive impairment in the related fields.Conclusions The numbers of CMBs and their locations were closely associated with cognitive impairment in patients with SAO.
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Lipoprotein-associated phospholipase A2(Lp-PLA2) can rapidly hydrolize and oxidize the oxidized phosphatidylcholine molecules produced in low density lipoprotein and atherogenic lipoprotein (a),generating the soluble proinflammatory and proapoptotic mediatorslyso-phosphatidylcholine and oxidized free fatty acids.It stimulates aggregation and activation of monocyte-macrophage system and induces apoptosis and damages the removal of dead cells.It plays an important role in the development of lipid necrotic core of atherosclerosis.Lp-PLA2 is not an independent risk marker of coronary artery disease and ischemic stroke,but also plays an important role in the development of atherosclerotic plaques.Selective Lp-PLA2 inhibitor reduces the development of necrotic cores.It may play a role in the stabilization of atherosclerotic plaques.At the same time,it may represent a novel target for the treatment of atherosclerosis.
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Objective To analyze imaging infarct patterns and features in patients with severe stenosis or occlusion of internal carotid artery (ICA) and middle cerebral artery (MCA)from the point of view of diffusion-weighted imaging (DWI) and to investigate the infarction related mechanism. Methods Eighty-eight patients with acute ischemic stroke who had moderate to severe ICA or MCA stenosis or occlusion confirmed by cerebral angiography were analyzed retrospectively. They were divided into ICA lesion and MCA lesion groups. The infarct patterns were classified as single and multiple according to DWI. The former were reclassified as perforating artery infarct (PAI), pial infarct (PI), watershed infarct, and large infarct. Results There were 11 types of infarct patterns in MCA territories. The DWI multi-infarct pattern accounted for 62.5% of all patients (55/88). PI with watershed infarction appeared more often in the ICA lesion group (11/45, P=0. 040), and PI with PAI appeared more often in the MCA lesion group (10/43, P = 0. 037). Conclusions In patients with cerebral infarction associated with ICA or MCA severe stenosis or occlusion, most of them showed multi-infarct pattern,which suggested the mixed mechanisms such as embolization, hypoperfusion/impaired clearance of emboli, and local perforating branch occlusion were the main mechanisms of the occurrence of cerebral infarction. The main mechanism of cerebral infarction in the ICA lesion group was embolization combined with hypoperfusion/impaired clearance of emboli, while in the MCA lesion group was embolization combined with local perforating branch occlusion.
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ObjectiveTo explore the relationship between chronic kidney disease (CKD) and cerebral small vessel disease (SVD) in elderly patients. MethodsOne hundred and fifty-two elderly male CKD patients for experimental group and 158 elderly male for control group were recruited. Demographic data and vascular risk factors were recorded. White matter lesion (WML) was semi-quantitatively assessed by cerebral magnetic resonance imaging (MRI), and lacunar infarction (LI) was also calculated. Results(1) The prevalenees of hypertentsion and diabetes mellitus were higher in elderly CKD patients than those in control group (30. 9% vs. 19.0%, 23.7%vs. 14.6%;both P～0. 05). (2) The percentages of grade 2 and grade 3 WMLs were higher in elderly CKD patients than those in control group (34.9% vs. 24.1%, 25.7% vs. 16.5%;both P<0.05). Prevalence of LI was higher in elderly CKD patients than that in control group (45.4% vs.25.3% ,X2= 13. 70, P<0. 05). The similar Resultswere also obtained except for control subjects with hypertension and diabetes mellitus. (3) The logistic regression analysis showed that age, hypertension and low glomerular filtration rate (GFR) were closely associated with SVD in elderly CKD patients. ConclusionsHypertention and diabetes mellitus are risk factors for CKD in elderly patients. SVD is associated with CKD, and age, hypertension and low GFR may be risk factors for SVD in elderly CKD patients.
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OBJECTIVE: To determine the content of the related substances in azithromycin tablet by HPLC-electrochemical detector.METHODS: The column was Gamma ARP-1/P.The mobile phase consisted of 0.014 mol?L-1 dipotassium hydrogen phosphate/0.020 mol?L-1 sodium hydroxide(pH was adjusted to 11 by phosphoric acid and sodium hydroxide)-acetonitrile(71∶29) at a flow rate of 0.7 mL?min-1.The column temperature was 40 ℃.The injection volume was 50 ?L.Glass carbon working electrode was set at +900 mV.RESULTS: The linear ranges of erythromycin peroxide,deoxyazithromycin,azithromycin impurity A,and N-demethlation azithromycin were 0.15～1.80 ?g(r=0.999),0.09～1.08 ?g(r=0.999),0.23～2.76 ?g(r=0.998) and 0.30～3.60 ?g(r=0.998),respectively.The average recoveries were 98.9%(RSD=1.1%),94.6%(RSD=5.4%),103.4%(RSD=3.4%) and 96.2%(RSD=4.3%),respectively.The contents of the related substances were all below 0.7%.CONCLUSION: The established method is reproducible,sensitive and reliable,and applicable for the detection of the related substances in azithromycin tablets.
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BACKGROUND:Leukocytic infiltration induced by release of inflammatory cytotkines and up-regulation of adhesion molecules is closely associated with the formation of cerebral infarcted focus. The related factors have been widely studied.OBJECTIVE: To explore influence of estrogen on inflammatory reaction in rats after focal ischemia/reperfusion injury.DESIGN: Randomized controlled experiment.SETTING: Nanjing General Hospital, Nanjing Military Area Command of Chinese PLA.MATERIALS:The experiment was performed at the Department of Neurology, Department of Pathology, Nanjing General Hospital, Nanjing Military Area Command of Chinese PLA. Adult male SD rats were selected to establish cerebral ischemic models, with the body mass of 280-350 g.METHODS:The rats were assigned into 3 groups: control group,ovariectomized group and estrogen treatment group (estradiol, 200 μg/kg,subcutaneous injection, once a week for 4 weeks). Four weeks later, models with right middle cerebral artery occlusion (MCAO) for 1 hour and 2 hours as well as reperfusion for 0, 1, 3, 6, 22 and 70 hours were established with thread embolism method. Mean number of infiltrative neutrophils in brain tissue was calculated under microscope with 10 high power fields in ischemic hemisphere with hematoxylin and eosin staining. Expression of nuclear factor-κB was determined with immunohistochemical method.MAIN OUTCOME MEASURES:Infiltration of neutrophils and expression of nuclear factor-κB in brain parenchyma.RESULTS: ①Expression of nuclear factor-κB: There was expression of nuclear factor-κB in the ovariectomized group at hour 1 after ischemia.Positive cells appeared at hour 2 after ischemia in the control group and estrogen treatment group. The expression was in the peak at ischemia for 2hours and reperfusion for 3 hours in the three groups, and decreased gradually. There was slight expression at reperfusion for 70 hours in the ovariectomized group, while there was no clear factor-κB positive cell at reperfusion for 22 hours in the control group and estrogen treatment group.②Infiltrative neutrophils in cerebral ischemic region in the ovariectomized group significantly increased at ischemia for 2 hours and reperfusion for 22 hours. Compared with the estrogen treatment group, there was significant difference (P=0.045). At ischemia for 2 hours and reperfusion for 70 hours,infiltrative neutrophils in the ovariectomized group were more than those in the control group and estrogen treatment group, but there were significant differences only between ovariectomized group and control group.CONCLUSION: Estrogen can inhibit inflammatory reaction after cerebral ischemia/reperfusion injury.
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The secondary mental disorder is one of the complications of senile cerebrovascular disease, the medication is different from generic mental disorder. This article summarized the medication of elder patients with secondary mental disorder.
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Objective To study the protective effects of estrogen on function of learning-memory and the neuron of hippocampus in the ovariectomized(OVX) rat model.Methods Estrogen 200 ?g/kg was injected into rats twice a weak followed the OVX rat models were estestablished(OVX+E2 group).The function of learning-memory was tested by Morris water maze;the tau hyperphosphorylation was detected by immunohistochemistry staining;the pathological changes of hippocampus was observed by HE staining and Bielschowski staining.Results Compared with OVX group,the function of learning-memory of Morris water maze in OVX+E2 group were significant improved(all P
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Objective To explore the effect of estrogen on striatal neurons damage in rats induced by quinolinic acid (QA).Methods Ovariectomized rats were divided into two groups:non-replacement treatment group (recievied intrastriatal application of QA alone) and replacement treatment group (received both QA and 17-? estradiol). Striatal neurons injury was evaluated using NADPH-diaphorase histochemistry and the rotation number of rats induced by apomorphine was recorded. Activity of SOD and contents of MDA in striatum was measured by xanthine oxidase and thio-barbital method, respectively.Results Compared with non-replacement treatment group, there was a significant increase in the number of NADPH-diaphorase positive neurons ( P
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In this paper , 2280 strains of suspicious Shigella c culture were detected by the diagnostic typing phage set for Enterobacteriaceae, the routine identification of them were carried oat at the same time . The results showed that 100% of shigella cultures were lysed with 10~3RTD and 99.9% lysed with 1RTD of phage Sh. 12.3% of 65 non-shigeUa cultures agglutinating with typing serum of shigeUa was lysed with 10~3RTD, 4.6% lysed with 1RTD of phage Sh. The determination of lytic-pattern of 2215 shigella culture indicated that only 3 strains of Boyd 5 of lytic-pattern 3 were not reported in literature, the rest strains were consistent to fomer studies. The nonshigella cultures lysed by Sh 10~3RTD could be excluded with 1RTD and its lytic-pattern. 20 strains of Enteroinvasive Escherichia coli possessing shigeUa-related antigens could be differentiated by Sh 10~3RTD. 1RTD and its lytic-pattern.