ABSTRACT
Objective:To investigate the risk factors of acute Stanford type B aortic dissection (TBAD) complicated with pleural effusion (PE) and the short-term and long-term outcomes of thoracic endovascular aortic repair (TEVAR).Methods:A case-control study. The clinical and imaging data of 1 083 patients with acute TBAD admitted to the General Hospital of Northern Theater Command from April 2002 to December 2020 were retrospectively analyzed, including 211 cases with pleural effusion and 872 cases without pleural effusion. The baseline analysis of the two groups of patients was performed. The risk factors associated with pleural effusion were analyzed by binary logistic regression, and the results were expressed as odds ratio ( OR) and 95% confidence interval ( CI). According to the quantity of pleural effusion, they were simultaneously divided into small pleural effusion group and medium large pleural effusion group, to compare the short-term and long-term effects of TEVAR patients with different amounts of pleural effusion. Results:The incidence of pericardial effusion (17.5% vs. 3.8%, P<0.001), anemia (21.3% vs. 12.5%, P=0.001), aortic spiral tear (49.8% vs. 37.8%, P=0.002), dissection tear over diaphragm (57.8% vs. 48.1%, P=0.011), serum creatinine [85 (69, 111) vs. 81 (67, 100) μmol/L, P=0.011] and white blood cell levels[(11.3±4.2)×10 9/L vs. (10.3±4.2)×10 9/L, P=0.002] in acute TBAD pleural effusion group were significantly higher than those in non-pleural effusion group, and the hemoglobin level was significantly lower than that in non-pleural effusion group [(128±20) vs. (133±17) g/L, P<0.05]. Logistic stepwise regression analysis showed that pericardial effusion ( OR=5.038,95% CI 2.962-8.568, P<0.001), anemia ( OR=2.047,95% CI 1.361-3.079, P=0.001), spiral tear ( OR=1.551,95% CI 1.030-2.336 , P=0.002) and elevated white blood cell ( OR=1.059,95% CI 1.011-1.102, P=0.005) were independent risk factors for TBAD complicated with pleural effusion. The incidences of all-cause death (4/19 vs. 1.5% vs. 0.9%, P<0.001), aortogenic death (4/19 vs. 0.7% vs. 0.7%, P<0.001) and aortic related adverse events (4/19 vs. 1.5% vs. 1.1%, P<0.001) in patients with large pleural effusion during TEVAR operation were significantly higher than those in patients with small pleural effusion and those without pleural effusion, and the differences were statistically significant. At 1 month follow-up after TEVAR, the incidence of all-cause death (4/16 vs. 3.3% vs. 1.6%, P<0.001), aortogenic death (4/16 vs. 0.8% vs.0.7%, P<0.001), aorta related adverse events (4/16 vs. 4.1% vs. 4.7%, P=0.013) and overall clinical adverse events (4/16 vs.9.8% vs. 6.7%, P=0.014) in the medium and large thoracic group were significantly higher than those in the small pleural effusion group and no pleural effusion group, and the differences were statistically significant. At 1 year follow-up after TEVAR, the incidence of all-cause death (4/15 vs. 4.9% vs. 3.9%, P=0.004), aortogenic death (4/15 vs.2.5% vs. 2.1%, P<0.001), aorta related adverse events (5/15 vs. 11.5% vs. 9.4%, P=0.012) and overall clinical adverse events (5/15 vs. 18.9% vs. 13.1%, P=0.029) in the medium and large thoracic group were significantly higher than those in the small pleural effusion group and no pleural effusion group, and the differences were statistically significant. Conclusions:Single center data showed that pericardial effusion, anemia, spiral tear and elevated white blood cell were independent risk factors for acute TBAD complicated with pleural effusion; the early (1 month) and long-term (1 year) rates of all-cause death, aortic mortality, aortic adverse events and overall clinical adverse events were significantly higher in TBAD patients with moderate pleural effusion after TEVAR, and moderate and large pleural effusion was an independent risk factor for near and long-term aortic related adverse events after TEVAR surgery.
ABSTRACT
Objective:To evaluate the clinical efficacy of self-made Tingchan Decoction combined with dopasizin tablets in the treatment of Parkinson disease (PD) in the middle and early stages of yin deficiency and wind movement syndrome.Methods:From January 2020 to March 2021, 84 patients with early-stage PD in Weifang Hospital of Traditional Chinese Medicine in Shandong Province who met the inclusion criteria were divided into 2 groups according to the random number table method, with 42 in each group. The control group was given oral dopasehydrazine tablets, and the observation group and the control group were additionally given the self-made Tingchan Decoction. Both groups were treated for 8 weeks. TCM syndrome scores were performed before and after treatment, and the Unified Parkinson Disease Rating Scale (UPDRS) was used to evaluate the severity of PD. The ELISA was used to determine serum homocysteine (Hcy), high mobility the levels of group protein-1 (HMGB1), IL-6, IL-2, substance P and dopamine (DA). The levels of glutamate (Glu) and γ-aminobutyric acid (GABA) were detected by HPLC. The OD value was determined by photometer, and the relative expression levels of microRNA-124 (miR-124) and microRNA-425 (miR-425) were calculated by the 2 -??Ct method to evaluate the clinical efficacy. Results:The total effective rate was 88.1% (37/42) in the observation group and 73.8% (31/42) in the control group, and the difference between the two groups was statistically significant ( Z=-2.56, P=0.011). after treatment, the action score, tremor score, upper limb coordination score and gait score in the observation group were significantly lower than those in the control group ( t values were 7.23, 5.80, 4.25, 4.17, 15.00,respectively, all Ps<0.01). After treatment, the levels of serum Hcy, HMGB1, IL-6 and IL-2 in the observation group were significantly lower than those in the control group ( t values were 12.16, 10.67, 23.11, 9.95, respectively, all Ps<0.01), serum Glu [(71.28±6.46) μmol/L vs. (56.91±5.87) μmol/L, t=10.67], GABA [(292.39±15.46) μmol/L vs. (248.51±14.38) μmol/L, t=13.47] levels in the observation group were significantly higher than those in he control group ( P<0.01); the level of serum substance P [(3.54±0.43) mg/L vs. (5.61±0.52) mg/L, t=19.88] was significantly lower than that of the control group ( P<0.01). The DA [(79.24±0.52) ng/L vs. (70.15±5.36) ng/L, t=7.93] and miR-124 [(4.57±0.74) vs. (2.81±0.47), t=13.01], miR-425 [(3.94±0.83) vs. (2.73±0.97), t=6.14] expression in the observation group were significantly higher than those in the control group ( P<0.01). Conclusion:Self-made Tingchan Decoction combined with dobasilazine can increase the relative expression of miR-124 and miR-425 in the serum of PD patients, promote the release of dopamine, reduce the oxidative stress in the brain, reduce the level of serum inflammatory cytokines, improve the Symptoms, and protect nerve cells.