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Objective:To explore the risk factors of early infection patients after heart transplantation(HT)and provide references for preventing and treating early infection.Methods:From April 2018 to May 2021, clinical data were retrospectively reviewed for 95 HT recipients treated at Zhengzhou Seventh People's Hospital.They were divided into two groups of infected(n=34)and uninfected(n=61). Gender, age, disease type, preoperative IABP implantation, postoperative intra-aortic balloon pump(IABP)implantation, postoperative extracorporeal membrane oxygenation(ECMO)implantation, preoperative mechanical ventilation, preoperative leukocyte, preoperative lymphocyte, preoperative serum C-reactive protein(CRP), operative approach, APACHEⅡscore, NYHA grade, hemoglobin, cardiopulmonary bypass time, donor heart cold ischemia time, postoperative thoracic drainage tube indwelling time, postoperative gastric tube indwelling time, postoperative urinary tube indwelling time, postoperative acute rejection, postoperative ventilator assisted treatment time and postoperative ICU time.The risk factors of early infection were analyzed by univariate and multivariate Logistic regression analysis.Results:There were 34 cases of early infection after HT and 8 cases died.In infection group, preoperative hemoglobin(female <110 g/L or male <120 g/L), ECMO post-operation, 24-48 h post-operation, APACHE post-operation(>6), postoperative intrathoracic drainage tube indwelling time(≥7 d), postoperative gastric tube indwelling time(≥4 d), postoperative urinary tube indwelling time(≥5 d), postoperative acute rejection(positive), postoperative ventilator assisted treatment time(≥2 d)and postoperative ICU time(≥10 d)were 18 cases(52.94%), 8(23.53%), 30(88.24%), 22(64.71%), 18(52.94%), 20(58.82%), 4(11.76%), 21(61.76%)and 19(55.88%); uninfected group: 16 cases(26.23%), 3(4.92%), 32(52.46%), 24(39.34%), 15(24.59%), 31(34.43%), 1(1.64%), 21(34.43%)and 4(6.56%). Significant inter-group differences existed( χ2=6.778, 5.68, 12.326, 5.623, 7.740, 5.297, 4.489, 6.615, 28.947, P<0.05). Multivariate Logistic regression analysis indicated that 24-48h post-operation, APACHEⅡ score >6(β=1.024, Wald χ2=7.653, OR=2.141, OR95% CI=1.323~4.215), ECMO post-operation(β=1.783, Wald χ2=6.186, OR=5.949, OR95% CI =1.459~24.25), postoperative intrathoracic drainage tube indwelling time ≥7 d(β=0.712, Wald χ2=5.745, OR=1.054, OR95% CI=1.183~6.753), postoperative gastric tube indwelling time(β=0.832, Wald χ2=6.756, OR=1.132, OR95% CI=1.416~8.406), postoperative ventilator assisted treatment time(β=0.745, Wald χ2=6.563, OR=1.212, OR95% CI=1.289~7.346)and postoperative ICU time=1.28(β=1.325, Wald χ2=9.752, OR=2.435, OR95% CI=1.426~6.354)were independent risk factor for early infection after HT( P<0.05). Conclusions:Early infection after HT remains higher.It is significantly correlated with 24-48 h post-operation APACHE II score, ECMO post-operation, postoperative intrathoracic drainage tube indwelling time, postoperative gastric tube indwelling time, postoperative ventilator assisted treatment time and postoperative ICU time.Targeted interventions should be adopted for lowering the incidence of early infection after HT.
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Objective:To investigate the characteristics of cognitive impairment caused by solitary cerebellar infarction.Methods:From January 2017 to January 2019, 76 inpatients with acute cerebellar infarction treated at our hospital were continuously enrolled as the infarction group and 88 outpatients without cerebral infarction at our hospital during the same period were collected as the control group.The patients in the two groups were evaluated by the Montreal Cognitive Assessment Scales(MoCA)and Mini-Mental State Examination(MMSE)Scale at 14 days, 1 month and 3 months after the onset of solitary cerebellar infarction, respectively.Results:The MoCA and MMSE scores were lower in the infarction group than in the control group at 14 days, 1 month and 3 months after the onset of solitary cerebellar infarction(MoCA: 23.9±6.13 vs.28.1±2.51, 22.6±6.07 vs. 28.2±2.28 and 22.5±6.19 vs. 28.2±2.15, t=5.88, 8.03 and 8.09, P<0.001; MMES: 25.7±4.54 vs.28.3±2.25, 24.9±4.63 vs.28.2±2.14 and 24.6±4.43 vs.28.3±2.16, t=4.74, 5.99 and 6.94, all P<0.001). Cognitive function scores showed that three major recognition domains of visual space and executive function, attention and memory had statistically significant difference between the two groups( P<0.05), and the differences in three recognition domain of naming, calculating force, directional force between the two groups were not statistically significant( P<0.05). Conclusions:There is a clear correlation between cerebellar infarction and cognitive impairment, which is mainly manifested in three aspects of visual space and executive function, attention and memory.The great attention should be paid to screening and intervention on the three aspects in clinical work, which is of great significance for improving the quality of life and prognosis of patients.
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Objective:To compare the safety and efficacy of dabigatran and warfarin in the treatment of cerebral venous thrombosis (CVT).Methods:The medical records of patients with CVT admitted to the Department of Neurology, Henan Provincial People's Hospital from January 2017 to December 2018 were analyzed respectively. According to the drug use, they were divided into dabigatran group and warfarin group. The main outcome measure was good functional outcome at 6 months after treatment, defined as the modified Rankin Scale score of 0-2. The secondary outcome measures included the rate of recanalization of the affected venous sinus and the incidence of bleeding.Results:A total of 152 patients with CVT were included, including 34 in the dabigatran group and 118 in the warfarin group. There were no significant differences in demographic and baseline data between the two groups. At 6 months after treatment, the rate of good functional outcomes (94.1% vs. 93.2%; χ2=0.043, P=0.836) and the affected venous sinus recanalization (94.1% vs. 93.2%; χ2=0.043, P=0.836) in the dabigatran group and the warfarin group were not statistically significant. The bleeding rate of the dabigatran group was significantly lower than that of the warfarin group (8.8% vs. 27.1%; χ2=4.985, P=0.026). There was no significant difference in the incidence of minor bleeding between the two groups (8.8% vs. 16.1%; χ2=0.618, P=0.432), but the incidence of severe bleeding in the dabigatran group tended to be lower than that in the warfarin group (0% vs. 11.0%; Fisher's exact test P=0.074). There were no deaths in the dabigatran group and 2 deaths in the warfarin group, of which 1 pregnant woman died of recurrence of CVT at 4 months after treatment, and 1 male patient died of acute myocardial infarction at 2 months after treatment. There was no significant difference in mortality between the two groups (0% vs. 1.7%; Fisher's exact test P=1.000). Conclusions:Dabigatran is as effective as warfarin in the treatment of CVT, and the risk of bleeding complications is lower.
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Objective To investigate the clinical effects of therapeutic hypothermia on the mortality and neurological function recovery in patients with acute large hemispheric infarction (LHI).Methods Seventy-three acute LHI patients (within 24 hours of symptom onset) admitted to our hospital from February 2015 to July 2016 were randomized to the hypothermia group (37 patients)and the control group (36 patients).Patients in the hypothermia group were given standard medical treatment and the surface cooling with a target temperature between 32-35 ℃ lasting for 5-7 days.Patients in the control group were given standard medical treatment and maintained a target temperature of normothermia.All patients were observed the primary end points including mortality and the modified Rankin Scale (mRS) score at 3 months.Results At three months,nine patients of survivors in the hypothermia group had good outcome (mRS score 0-3),whereas only five patients of survivors in the control group,though there was no significant difference (9/17 vs 5/19,x2 =2.676,P＞ 0.05)between the two groups.Twenty patients (54.1％)died in the hypothermia group,while 17 patients(47.2％) in the control group(x2 =0.341,P ＞0.05).Conclusion Therapeutic hypothermia is safe and feasible to patients with acute LHI,but may neither reduce mortality nor improve the neurological outcome in survivors.
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Objective To investigate the characteristics and risk factors of central lymph node metastasis in clinically node negative (cN0) papillary thyroid carcinoma (PTC) (T1 or T2 stage) coexisting with Hashimoto' s thyroiditis (HT).Methods A total of 398 patients undergoing thyroidectomy with central lymph node dissection were enrolled in the study.Patients were divided into the trial group (PTC with HT)and the control group (PTC without HT).The difference of the clinicopathological characteristics between the 2 groups and risk factors for central lymph node metastasis were analyzed.Results Among the total 398 patients,98 (24.6％)had coexistent HT.Central lymph node metastasis rate was similar in the 2 groups (40.8％ vs 41.3％).The number of dissected central lymph nodes was significantly more in the trial group than in the control group (4.9 vs 2.9,P＜0.01) while the number of metastatic lymph nodes had no statistical significance between the 2 groups (1.0 vs 1.0).Univariate analysis showed that tumor size＞1 cm was significantly associated with central lymph node metastasis in the trial group (P＜0.01).Male,＜45 years,tumor size＞1 cm,and tumor located in the middle/lower third of lobe were all significantly associated with central lymph node metastasis in the control group (P＜0.01).Multivariate analysis showed that tumor size＞1 cm was independent predictor for central lymph node metastasis in the trial group,while female,＜45 years,tumor size＞1 cm,and tumor located in the middle/lower third of lobe were all independent predictors for central lymph node metastasis in the control group.Conclusions The number of central lymph nodes was larger in cN0 PTC coexisting with HT patients than that in PTC patients,but there was no statistical difference in the number of metastatic lymph nodes between cN0 PTC with and without HT.Central lymph node dissection is recommended when tumor size 1 cm in cN0 PTC coexisting with HT patients.