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Objective To investigate the genetic risk factors of deep vein thrombosis(DVT)after trauma.Methods In a nested case-control study,50 patients with DVT after traumatic lower extremity fractures and 50 patients without DVT were recruited.The two groups were matched with gender,age and fracture sites.Preoperative venography was performed to diagnose DVT in trauma patients.Genome wide association study(GWAS)was used to investigate the genetic risk factors for preoperative DVT after traumatic lower ex-tremity fractures.Genomic DNA in leukocytes from blood sample was extracted and used for GWAS.Results GWAS was conducted based on 2 662 single nucleotide variants(SNV)which were dispersed in 144 interested genes.Ten genes were found to have signifi-cant association with trauma-related DVT,including cofactors of hemostasis mechanism,i.e.,THBD,F5,SERPIND1 and ITGA2,the factors related to vitamin K-dependent(VKD)carboxylation,i.e.,GGCX and CALU,and the members of cytochrome P450 family,i.e.,CYP1A1,CYP3A4,CYP2C19 and CYP2B6.Conclusion DVT after trauma might be regulated by the cofactors of hemostasis mechanism,the factors related to VKD carboxylation and the members of cytochrome P450 family.The results of our study may provide reference and inspiration for genetic susceptibility of preoperative DVT after trauma.
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Objective:To investigate the iodine nutrition status of key population in Fuzhou City, and to provide scientific basis for adjusting intervention strategies.Methods:From March to October 2021, a survey was conducted on iodine nutrition status of key population in 12 counties (cities, districts) of Fuzhou City. Each county (city, district) was divided into 5 sampling areas according to the east, west, south, north and middle directions. One township (street) was selected from each area, and 40 non-boarding children aged 8 - 10 (age balanced, half male and half female) from one primary school and 20 pregnant women (early, middle and late pregnancy balanced) were selected as survey subjects. Household salt samples and random urine samples were collected, and the salt iodine and urine iodine levels were tested by direct titration and arsenic and cerium catalytic spectrophotometry, respectively. Children's thyroid volume was measured by B-ultrasonography. At the same time, in cooperation with Fuzhou Maternal and Child Health Hospital, the thyroid stimulating hormone (TSH) testing results of heel blood of full-term natural delivery newborns in Fuzhou City in 2021 were collected.Results:A total of 2 400 children were monitored for salt iodine, urine iodine and goiter. The median salt iodine was 24.40 mg/kg, with an iodine salt coverage rate of 93.04% (2 233/2 400), a qualified rate of iodized salt of 97.40% (2 175/2 233), and a consumption rate of qualified iodized salt of 90.62% (2 175/2 400). The median urine iodine was 181.47 μg/L. The rate of goiter was 1.04% (25/2 400). A total of 1 200 pregnant women were monitored for salt iodine and urine iodine. The median salt iodine was 24.10 mg/kg, the coverage rate of iodized salt was 91.08% (1 093/1 200), the qualified rate of iodized salt was 97.90% (1 070/1 093), and the consumption rate of qualified iodized salt was 89.17% (1 070/1 200). The median urine iodine was 128.10 μg/L. The median TSH level in the heel blood of 14 242 newborns was 3.38 mU/L, and the proportion of TSH level > 5 mU/L was 30.96% (4 410/14 242).Conclusions:In 2021, children in Fuzhou City are at an appropriate level of iodine, but pregnant women are insufficient of iodine. We should continue to maintain comprehensive prevention and control measures mainly based on salt iodization, provide health education for pregnant women, and strengthen monitoring of TSH level in newborns.
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Objective:To investigate the safety and effectiveness of Neuroform Atlas stent-assisted coiling in the endovascular treatment of intracranial aneurysms.Methods:This was a retrospective, single-center observational study of 77 patients who underwent endovascular treatment of intracranial aneurysms using the Neuroform Atlas device at the Department of Neurology, People′s Liberation Army General Hospital from July 2020 to May 2022. There were 34 males and 43 females, with a median (range) age of 59 (23-81) years. The degree and effect of aneurysm embolization were evaluated by modified Raymond grading post procedure and after 6 months. Complications occurring during the perioperative period were recorded. Vaso computed tomography was performed immediately after the operation to assess stent opening and adherence. Digital subtraction angiography was performed 6 months after discharge and the aneurysm was classified as cured, stable, or recurrent.Results:A total of 87 Atlases were successfully released in 77 cases. Angiography performed immediately after the embolization revealed 19 (24.7%) modified Raymond grade Ⅰ, 10 (13.0%) grade Ⅱ, and 48 (62.3%) grade Ⅲa cases. Three perioperative complications were observed including thrombotic events in 2 cases and stent migration in 1 case. A follow-up angiogram was available for 47 aneurysms, and showed that modified Raymond grade Ⅰ occlusion was achieved in 38 (80.9%) cases, grade Ⅱ in 2 (4.3%) cases, and grade Ⅲa in 7 (14.9%) cases. At the 6-month follow-up, 38 patients were cured and 7 were stable, whereas 2 patients experienced a recurrence of aneurysm. Stenosis of the parent artery occurred in 3 (6.4%) cases, including 2 at the head and 1 inside the stent.Conclusions:The results of this preliminary study suggest that Neuroform Atlas stent-assisted coiling has a high occlusion rate and low incidence of complications in the endovascular treatment of aneurysms. However, the effectiveness of this procedure for large aneurysms and long-term outcomes require further investigation.
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Objective:To learn about the implementation of various prevention and control measures after achieving the stage goal of eliminating iodine deficiency disorders (IDD) in Fuzhou City, and to evaluate the prevention and control effect.Methods:In September 2020, an assessment and evaluation was conducted on elimination of IDD in 12 counties (cities, districts) under the jurisdiction of Fuzhou City, with specific reference to the "Evaluation Content and Judgment Standards for Elimination of Iodine Deficiency Disorders" (2019 version). Using the target evaluation table for eliminating IDD, 4 management indicators of organizational and leadership, monitoring and prevention measures, iodized salt management and health education in 12 counties (cities, districts) from 2016 to 2020 were evaluated. Using stratified random sampling method, 2 townships/streets were selected from each county (city, district), and 20 pregnant women were sampled from each township/street. At the same time, two villages (neighborhood committees) were randomly selected from each township/street, and 20 children aged 8 - 10 (age balanced, half male and half female) were randomly selected from each village (neighborhood committee). The edible salt samples and instant urine samples of children and pregnant women were collected to detect the contents of salt iodine and urinary iodine; the iodine supplementation status of pregnant women was investigated by iodine supplementation rate questionnaire; the goiter in children was measured by B-ultrasound.Results:The management indicators scores of all 12 counties (cities, districts) were > 85 points, with an average score of 92.75 points. Changle District had the highest score (98 points), and Taijiang District had the lowest score (90 points). A total of 1 457 household salt samples were collected and tested in the city, including 967 samples from children aged 8 - 10 and 490 samples from pregnant women. The median salt iodine was 24.24 mg/kg, and the coverage rate of iodized salt was 93.62% (1 364/1 457). The qualified rate of iodized salt was 97.80% (1 334/1 364), and the coverage rate of qualified iodized salt was 91.56% (1 334/1 457). Except for Gulou District (88.33%, 106/120), Taijiang District (85.00%, 102/120), Mawei District (86.67%, 104/120), Changle District (89.34%, 109/122) and Minqing County (88.43%, 107/121), the coverage rate of qualified iodized salt was < 90%, the coverage rate of qualified iodized salt in the remaining counties (cities, districts) was > 90%. A total of 967 urine samples were collected from children, the median urinary iodine was 187.80 μg/L. The median urinary iodine of children in all counties (cities, districts) ranged from 140.08 to 269.70 μg/L. A total of 967 children were examined, and the goiter rate was 0.72% (7/967). The goiter rate ranged from 0 to 2.44% in all counties (cities, districts). A total of 490 urine samples were collected from pregnant women, with a median urinary iodine of 148.48 μg/L. Among them, the median urinary iodine of pregnant women in Gulou District (184.23 μg/L), Mawei District (262.85 μg/L), Jin'an District (176.80 μg/L), Luoyuan County (166.60 μg/L) and Yongtai County (157.62 μg/L) was > 150 μg/L, the median urinary iodine of pregnant women in other counties (cities, districts) was between 100 and 150 μg/L. A total of 490 pregnant women were investigated for iodine supplementation, the iodine supplementation rate was 94.90% (465/490). Except for Gulou District (85.00%, 34/40), Cangshan District (85.00%, 34/40) and Lianjiang County (87.50%, 35/40), the iodine supplementation rate < 90%, the iodine supplementation rate of pregnant women in other counties (cities, districts) was > 90%.Conclusions:The IDD prevention and control measures in Fuzhou City have been well implemented, and all counties (cities, districts) in Fuzhou City have maintained the state of eliminating IDD, and continued to consolidate the prevention and control achievements.
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Tissue factor pathway inhibitor (TFPI) is a major inhibitor of tissue factor-mediated extrinsic coagulation pathway, mainly derived from microvascular endothelial cells. Recent studies have found that TFPI plays a role in hemophilia, sepsis, antiphospholipid syndrome, venous thromboembolism and other diseases, and participates in the occurrence and development of diseases through anticoagulation mechanism. At present, there are many methods to detect the source, content and function of TFPI, which are helpful for the diagnosis and treatment of clinical diseases.
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Objective:To learn about the changing trend of iodine deficiency disorders (IDD) and the iodine nutrition level of key populations in Fuzhou.Methods:From March 2017 to October 2019, a cross-sectional survey method was used to carry out IDD monitoring among key populations in 12 counties (cities, districts) of Fuzhou. In each county (city, district), one township/street was selected from five directions: East, West, South, North and Middle. Forty non-boarding children aged 8-10 (age balanced, half male and half female) from one primary school and 20 pregnant women in each township/street were selected as the survey subjects. The edible salt samples and instant urine samples of children and pregnant women were collected to detect the contents of salt iodine and urinary iodine; the thyroid volume of children was measured by B-ultrasound, and the goiter rate was calculated.Results:From 2017 to 2019, a total of 7 479 edible salt samples were collected from children's homes, and the median salt iodine was 23.40 mg/kg, the coverage rate of iodized salt was 94.06% (7 035/7 479), the qualified rate of iodized salt was 97.70% (6 873/7 035), and the consumption rate of qualified iodized salt was 91.90% (6 873/7 479). A total of 3 602 edible salt samples were collected from pregnant women's homes, and the median salt iodine was 23.69 mg/kg, the coverage rate of iodized salt was 94.73% (3 412/3 602), the qualified rate of iodized salt was 97.66% (3 332/3 412), and the consumption rate of qualified iodized salt was 92.50% (3 332/3 602). A total of 7 479 urine samples were collected from children, and the median urinary iodine was 172.70 μg/L. A total of 3 602 urine samples were collected from pregnant women, and the median urinary iodine was 131.21 μg/L. A total of 7 479 cases of thyroid gland in children were examined, including 89 cases of goiter, and the goiter rate was 1.19%.Conclusions:The consumption rate of qualified iodized salt ( > 90%) of key populations, urinary iodine (100-< 200 μg/L) and goiter rate ( < 5%) of children in Fuzhou are all in line with the national standard for elimination of IDD, but pregnant women are at risk of iodine deficiency (urinary iodine < 150 μg/L).
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Objective:To evaluate the efficacy of endovascular stenting of various types of venous sinus stenosis in idiopathic intracranial hypertension (IIH).Method:Clinical, radiological, and manometric data before and after stenting in venous sinus stenosis were retrospectively analyzed in 99 IIH patients who were refractory to medical therapy or rapidly progressed between July 2004 to July 2019. The follow-up period was between 2.3 months to 11 years.Results:Our study enrolled 21 men (21.2%)and 78 women (78.8%) with average body mass index (BMI) 19.2-40.6(27.0±4.4) kg/m2 and median age 37 years. Before stent placement, the mean transverse sinus stenosis gradient was 1-59(26±8) mmHg. Patients with extrinsic stenosis were younger than those with intrinsic and mixed stenosis. In all cases, stenting was effective for papilledema. Fifty patients complained of headaches. Pulsatile tinnitus in twenty-eight patients completely alleviated after stenting. In one patient, replacement of stent did not improve symptoms, and a subsequent CSF diversion procedure was performed and effective.Conclusion:Irrespective of the type of stenosis, stenting of venous sinus stenosis is an effective treatment for IIH. Patients with persistent papilledema post-stenting and elevated transverse pressure pre-stenting should be followed closely as high risk of stenting failure may occur and further diversion procedure is needed.
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Objective:To understand the level and distribution of iodine contents in drinking water in Fuzhou City so as to provide evidence for prevention of iodine deficiency disorders and health intervention.Methods:In 2017, a township-level water iodine survey was carried out in 12 counties (cities, districts) under the jurisdiction of Fuzhou City, with a township as a unit, and carry out administrative village-level water iodine survey in township with the median water iodine ≥ 10 μg/L. The water samples of residents' drinking water were collected according to different water supply methods (centralized water supply, mixed water supply and decentralized water supply), and the water iodine content was determined. The water iodine content less than 10 μg/L means iodine deficiency in the external environment. The iodine contents in drinking water of residents in different areas, different water supply methods and different water source types were compared and analyzed.Results:A total of 172 townships in 12 counties (cities, districts) were investigated for water iodine, and 1 630 water samples were collected and tested, the median water iodine was 2.8 μg/L and the range was 0.0 - 130.3 μg/L. At the township-level, the median range of water iodine was 0.4 - 11.2 μg/L. A total of 75 administrative villages were investigated in 4 townships with a median water iodine ≥ 10 μg/L, the median water iodine range was 0.5 - 19.8 μg/L. At the counties (cities, districts) level, the medians of water iodine were all less than 10 μg/L. Among them, the medians of water iodine in inland areas and coastal areas were 2.0 and 4.0 μg/L, respectively, and the difference between different areas was statistically significant ( Z = - 15.70, P <0.01). The medians of water iodine for centralized water supply, mixed water supply and decentralized water supply were 4.1, 2.7, and 3.4 μg/L, respectively, and the difference between different water supply methods was statistically significant ( H = 19.38, P < 0.01). The medians of water iodine in surface water and well water were 2.4 and 3.1 μg/L, respectively, the difference between different water source types was statistically significant ( Z = - 6.23, P<0.01). Conclusions:Iodine deficiency of external environment is common in Fuzhou City, and there is no distribution of high iodine in water source. It is necessary to strengthen the monitoring of iodine deficiency disorders, establish a long-term working mechanism suitable for the level of economic and social development, and consolidate the achievements of prevention and control.
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Objective@#To evaluate the changes of molecular markers of thrombosis in patients with deep venous thrombosis of lower extremities and analyze their value in the detection of venous thrombosis and evaluate the therapeutic effects. @*Methods@#In case-control study, we selected traumatic patients after surgery from Beijing Jishuitan Hospital during December 2018 to May 2019. A total of 64 patients with thrombosis were in DVT group, 39 patients without thrombosis were in non-DVT group, and 28 healthy subjects in the same period were in healthy control group. Venous blood samples were taken from all these people. Coagulation parameters thrombin-antithrombin complexes (TAT), plasmin-α2-plasmin inhibitor complexes (PIC) and tissue-type plasminogen activator-inhibitor complexes (t-PAIC) were detected at first diagnosis and one month after rivaroxaban anticoagulation therapy beginning. The differences of the markers between these groups were compared. @*Results@#The coagulation markers of the patients with lower extremity deep venous thrombosis increased significantly at diagnosis. The levels of plasma TAT, PIC, t-PAIC and sTM in DVT group were significantly higher than those in non-DVT group (P＜0.05). The levels of plasma TAT, PIC and t-PAIC in DVT group were higher than those in healthy control group (P＜0.05). There was no significant difference in sTM level between DVT group and healthy control group (P＞0.05). The results and changes of TAT, PIC, t-PAIC in the patients before and after one month of anticoagulation therapy were statistically different (P＜0.05) in comparison. @*Conclusion@#The molecular markers of thrombosis, TAT, PIC and t-PAIC, could effectively detect deep venous thrombosis of lower extremities and showed significant efficacy in evaluating the efficacy of anticoagulation therapy.
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Objective To study the relationship between hypertensive cerebral hemorrhage and microbleeds by analyzing the characteristics of magetic susceptibility-weighted imaging.Methods Fifty-one patients with mild hypertensive cerebral hemorrhage admitted to Shenzhen Nanshan District No.6 People's Hospital for MRI (T1WI,T2WI and T2FLAIR),susceptibility-weighted imaging,and magnetic resonance angiography from June 2016 to June 2017 were included in this study.Their MRI data were analyzed.Results Multiple foci of microbleeds and small vessel hyperplasia were detected in hemorrhage regions of the 51 patients included in this study,including ＞2 foci of microbleeds in intracranial basal area,thalamus,brain stem and cerebellar area of 40 patients (78.4％),and cerebral small vessel hyperplasia and VR space enlargement in 11 patients (21.6 ％).Magnetic resonance angiography showed cerebral middle artery and basal artery atheroclerosis in 15 patients but no vascular dissection,stenosis,aneurysm and vascular malformation in the other patients.Conclusion MRI can show the pathological changes in cerebral blood vessels of hypertensive hemorrhage patients,including cerebral microbleeds,cerebral small vessel hyperplasia and VR space enlargement.
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Objective To study the characteristics of Chinese ischemic stroke subclassification (CISS) in relation with migration to different climatic zones in autumn and winter.Methods Ninety-six subjects who travelled from northeast China,northwest China and north China to Hainan Province from September 2012 to February 2017 and were admitted to our hospital due to cerebral infarction occurred within 3 weeks after they arrived at Hainan were included in this study.Their demographic data,risk factors for cerebrovascular disease,laboratory blood test and imaging parameters were recorded.The patients were classified according to their medical history,auxiliary examination findings and CISS.The recorded data were statistically analyzed.Results CISS showed that penetrating artery disease,large artery atherosclerosis,cardiogenic stroke,and undetermined etiology accounted for 50.0％,38.5％,4.2％,7.3％ respectively.Hypertension (70.8 ％) and abnormal glucose metabolism (61.5％) were the major risk factors for cerebral in farction.Conclusion The incidence of penetrating artery disease is the highest,followed by that of large artery atherosclerosis in cerebral infarction patients.Alert to cerebral infarction should thus be stressed for those with hypertension and abnormal glucose metabolism who are going to travel in autumn and winter.
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Objective To systematically assess whether cilostazol can delay the progression or decrease the carotid intima-media thickness (clMT).Methods Papers on the effect of cilostazol on cIMT in randomized controlled trials and cohort studies were retrieved from a number of foreign and domestic databases.The data were analyzed by Review Manager 5.3.Results Six randomized controlled trials and two cohort studies were included in this study.A total of 1107 patients were divided into cilostazol therapy group (n=533) and control group (n=574).Meta-analysis showed that cilostazol therapy for 6 months,12 months,≥24 months could reduce the maximum cIMT with a mean difference of-0.04 mm (95％CI:-0.05--0.03,P=0.000),a mean difference of -0.04 mm (95％CI:-0.05--0.03,P=0.000) and a mean difference of-0.08 mm (95％CI:-0.11-0.05,P =0.000) respectively.Conclusion Cilostazol therapy for 6 months,12 months,24 months or more than 24 months can reduce the maximum cIMT,which is needed to be confirmed by studies with a large sample of clinical data.
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BACKGROUND:Three dimensional finite element analysis is widely used in orthopedics, but research in the knee flexion movement is not much. OBJECTIVE:To analyze biomechanical properties of knee flexion using finite element analysis.METHODS:Three dimensional finite element models and models of knee flexion at 30 degrees, 60 degrees and 120 degrees were established. Femoral forward movement, femur inward movement, tibia internal rotation and tibia vara were analyzed at different flexion angles. RESULTS AND CONCLUSION:(1) When knee flexion was at 30 degrees, 60 degrees and 120 degrees, the femur had backward movement. The backward movement value was larger at 60 degrees than at 30 and 120 degrees (P0.05). (2) The femur had outward movement at 30 degrees, and inward movement at 120 degrees. The inward movement value was significantly larger at 120 degrees than at 30 and 60 degrees (P0.05). (3) Tibia internal rotation was not significantly different at 30, 60 and 120 degrees of flexion (P>0.05). (4) Tibia vara was found at 30, 60 and 120 degrees of flexion, but the tibia vara was not obvious at 120 degrees. The tibia vara was maximum at 60 degrees, and significantly higher than that at 120 degrees (P0.05). (5) These findings verify that backward movement was most obvious at 60 degrees. Femur inward movement was most large at 120 degrees. Tibia internal rotation was noticeable at 30 and 120 degrees. Tibia vara was remarkable at 60 degrees.
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Objective To investigate the risk assessment,guiding role,and clinical value of Vaso CT image features for recanalization of vertebrobasilar junction occlusion. Methods From January 2016 to May 2017,14 patients with vertebrobasilar junction occlusion admitted to the Department of Neurology, Chinese PLA General Hospital were analyzed retrospectively. Preoperative cerebral angiography confirmed vertebrobasilar junction occlusion. Vaso CT was used to measure the length of the occluded vessels and vascular direction at both ends. According to these results, the operative risks were evaluated and the recanalization of vertebrobasilar junction occlusion were guided. Results The length of vertebrobasilar junction occlusion was 2. 56-19. 09 mm (mean 4. 5 ± 2. 1 mm) in 14 patients,and 13 of them were treated with the recanalization of vertebrobasilar artery occlusion,the blood vessels of 12 cases were successfully recanalized and stent placement was performed after the recanalization,among them,8 Solitaire stents and 4 Wingspan stents were implanted;One patient did not perform recanalization because of longer length of occlusion (19. 09 mm). All patients operated did not have any perioperative complications, and the neurological symptoms were significantly improved after procedure. Conclusion Vaso CT can accurately determine the surgical risk of the recanalization of vertebrobasilar junction occlusion,and can guide the surgical pathways,reduce the incidence of perioperative complications,and improve the success rate of the operation.
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Objective To investigate the risk assessment,guiding role,and clinical value of Vaso CT image features for recanalization of vertebrobasilar junction occlusion. Methods From January 2016 to May 2017,14 patients with vertebrobasilar junction occlusion admitted to the Department of Neurology, Chinese PLA General Hospital were analyzed retrospectively. Preoperative cerebral angiography confirmed vertebrobasilar junction occlusion. Vaso CT was used to measure the length of the occluded vessels and vascular direction at both ends. According to these results, the operative risks were evaluated and the recanalization of vertebrobasilar junction occlusion were guided. Results The length of vertebrobasilar junction occlusion was 2. 56-19. 09 mm (mean 4. 5 ± 2. 1 mm) in 14 patients,and 13 of them were treated with the recanalization of vertebrobasilar artery occlusion,the blood vessels of 12 cases were successfully recanalized and stent placement was performed after the recanalization,among them,8 Solitaire stents and 4 Wingspan stents were implanted;One patient did not perform recanalization because of longer length of occlusion (19. 09 mm). All patients operated did not have any perioperative complications, and the neurological symptoms were significantly improved after procedure. Conclusion Vaso CT can accurately determine the surgical risk of the recanalization of vertebrobasilar junction occlusion,and can guide the surgical pathways,reduce the incidence of perioperative complications,and improve the success rate of the operation.
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<p><b>OBJECTIVE</b>To evaluate the feasibility, safety, clinical, and angiographic follow-up of only overlapping stents therapy for intracranial vertebral artery dissection aneurysms (VADA).</p><p><b>METHODS</b>Eight consecutive patients (6 men, 2 women; mean age 46.8 years ranging from 34 to 62 years) with intracranial VADA admitted to Department of Neurology, Chinese People's Liberation Army General Hospital from June 2008 to June 2014 were retrospectively reviewed. All patients were diagnosed intracranial VADA by MRI or digital subtraction angiography (DSA). All patients were treated by only overlapping stents therapy under general anesthesia. In the endovascular treatment process 2 to 3 Solitaire, Neuroform or Wingspan self-expandable stents were overlapping implanted in the segment of the aneurysms. All patients received routine antiplatelet therapy before and after endovascular treatment.</p><p><b>RESULTS</b>The operative procedures were succeeded in all patients. Eight patients were implanted 18 stents (2 patients, 3 stents; 6 patients, 2 stents). The stents were located accurately and implanted smoothly, none perioperative complications occurred. All patients lived and worked normally and had no recurrent symptoms on follow-up of 6 to 48 months. All patients performed DSA reexamination on follow-up. The aneurysm blocked in 2 patients, the size lessened in 2 patients, and the size had no change in 3 patients.</p><p><b>CONCLUSIONS</b>Only overlapping stents therapy for treating intracranial VADA is feasible and has good operation safety. Preliminary follow-up results show that it can reduce the probability of thrombosis or hemorrhage and can improve the patients' life quality.</p>
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Adult , Female , Humans , Male , Middle Aged , Intracranial Aneurysm , General Surgery , Retrospective Studies , Stents , Treatment Outcome , Vertebral Artery Dissection , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To investigate the feasibility,safety and follow-up results of multiple stents parallel placement and reconstruction technique for treating giant vertebrobasilar dissecting aneurysms.</p><p><b>METHODS</b>Five consecutive patients with giant fusiform vertebrobasilar dissecting aneurysms in Department of Neurology,Chinese People's Liberation Army General Hospital were retrospectively reviewed from April 2011 to October 2013. All patients were diagnosed vertebrobasilar dissecting aneurysms by MRI and digital subtraction angiography (DSA), the aneurysm size ranged 8.2-15.0 mm. All patients were treated by multiple stents parallel placement and reconstruction technique under general anesthesia. In the endovascular treatment process, 2-3 Solitaire or Neuroform self-expandable stents were parallel implanted in the maximum extension segment of the aneurysms to reconstruct the cavity of the aneurysm and solved the problem that the diameter of the intracranial stent is less than the diameter of the aneurysms. Multiple stents parallel placement can keep the stents stable in the cavity. The parallel stent can close the dissection as well as strengthen the aneurysm walls to alleviate the vessel pulsative compression of the brain stem. Furthermore, one of the parallel stents was selected for the main blood flow channel. Based on the main channel, telescope technique was used to completely covering the dissection. It can not only prevent the progress of dissection to normal regions, but also be helpful for blood flow channel reconstruction to reduce the hemodynamic disorders. All Patients received routine antiplatelet therapy before and after endovascular treatment.</p><p><b>RESULTS</b>The operative procedures were succeeded in all patients. Five patients were implanted 18 stents (3 stents in 3 patients; 4 stents in 1 patient; 5 stents in 1 patient; parallel 3 stents in 2 patients; parallel 2 stents in 3 patients). The signs and symptoms of brain stem and posterior group of cranial nerves improved significantly. All patients lived and worked normally and had no recurrent symptoms on follow-up of 6-24 months. All patients performed DSA reexamination at 6-12 months postoperation. The aneurysm size lessened in 2 patients and had no change in 3 patients.</p><p><b>CONCLUSIONS</b>Multiple stents parallel placement and reconstruction technique for treating giant fusiform vertebrobasilar dissecting aneurysms is feasible and have good operation safety. It may control the dilatation of the aneurysm and reduce the probability of thrombosis or hemorrhage. It can improve the patients' clinical symptoms and quality of life in short term follow-up. The long term result need for further follow-up.</p>
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Humans , Aortic Dissection , General Surgery , Intracranial Aneurysm , General Surgery , Quality of Life , Retrospective Studies , Stents , Treatment OutcomeABSTRACT
Melamine was known as a new risk for kidney stone due to recent incidences of milk powder contamination in China. Here, we performed a retrospective study to investigate whether age, gender, and urinary pH affect melamine-associated kidney stone risk. A retrospective review was performed of 217 children aged less than 3 years old. All children had a history of being fed with Sanlu milk powder contaminated by melamine, and underwent a clinical screening on kidney stone in Shenyang from November 2008 to February 2009. A comparison with the Chi-square was conducted between 83 cases and 125 normal subjects. The difference between children's gender, age, and urinary pH was evaluated. A total of 208 subjects, 136 boys and 72 girls, were included in the study. Significant association was observed between melamine-associated kidney stone risk and gender [odds ratio [OR], 2.03; 95% confidence interval [CI], 1.11-3.74; P=0.02] and urinary pH [OR, 1.78; 95% CI, 1.01-3.11; P=0.04], respectively. Male children were at about twofold increased melamine-associated kidney stone risk compared with female children. Acidic urine showed about 1.78-fold increased melamine-associated kidney stone risk compared with normal urine. Our investigation results showed an association of gender and urinary pH with melamine-associated kidney stone formation risk
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Humans , Female , Male , Kidney Calculi/epidemiology , Hydrogen-Ion Concentration , Urine , Triazines , Gender Identity , Retrospective StudiesABSTRACT
Objective To evaluate the efficacy and safety of the endovascular interventional minimally invasive techniques(IMIT)for treatment of carotid artery iniury. Methods A total of 111 cases of carotid artery injury diagnosed by digital subtraction angiography(DSA)were treated with IMIT.Except for 1 case of extracranial segment injury of internal carotid artery treated with transcatheter stentgraft placement to obturate the rupture of carotid artery,the other 110 cases of intracranial segment injury of internal carotid artery(ICA)were treated with embolization with balloons in 73,embolization with coils in 12,injection of NBCA and PVA in 6,stent-graft placement in 11 and embolization with multiple materials in 8. Results Angiography demonstrated rupture of extracranial segment of internal carotid artery and arteriovenous fistula(AVF)at the neck in 1 case,traumatic carotid cavernous fistula(TCCF)in 83.traumatic pseudoaneurysm at intracranial segment of carotid artery in 14 and both TCCF and pseudoaneurysm in 13.The interventional treatment succeeded in all cases and interual carotid arteries were well protected in 62 cases.Completion angiography documented complete obliteration of the fistulas,with complete disappearance of the clinical symptoms in 110 cases and improvement in 1.Minor complications occurred in 2 cases,without death occurred.During the follow-up for 1-14 months,16 cases reexamined with DSA,which showed that the symptoms of 3 cases reoccurred,2 of whom were cured by re-embolization and 1 was under clinical observation. Conclusions IMIT including transcatheter selective embolization and stent-graft implantation is minimally invasive,safe and effective for treatment of carotid artery injury.
ABSTRACT
BACKGROUND: Functional injury of brain and limb induced by hemorrhage of cerebral arteriovenous malformation could be restored by rehabilitative treatment OBJECTIVE: To investigate the curative effect of rehabilitation on restoration of the functional injury of the brain and limbs induced by bleeding of hemorrhage cerebral arteriovenous malformation (AVM) after embolization.DESIGN: Case analysis.SETTING: Department of Interventional Medicine of General Hospital of Chinese PLA.PARTICIPANTS: From January 1996 to December 2001, a total 56 patients who were diagaosed as cerebral hemorrhage or intraventricle hemorrhage by CT or MRI scanning was selected from General Hospital of Chinese PLA.METHODS: All 56 patients with cerebral arteriovenous malformation were diagnosed by DSA. Rehabilitative treatment was performed with α-butyl cyanoac-rylate or radian surgery. Rehabilitative therapy were as follow: [1] Electric stimulate: S J-Ⅱ type nerve-muscle therapy instrument was used to stimulate the muscles (flexor and extensor) of limbs in the involved side, intensity of which is from weak to strong and frequency of which was from 2 to 3 or 4 per day; [2] Acupuncture: The selected points are:Fengchi, Fengfu, Yintang, Shangxing, Baihui, Quchi, Waiguan, Hegu,Huantiao, Zusanli, Yanglingquan, Sanyinjiao, Taichong, et al. In those who suffered aphasia, lianquan, Jinjin, Yuye were selected. Once a day and a period of treatment was 2 weeks; [3] physical training: the passive movement on the joint in the involved limbs were performed in grade 0 to 1 of muscle strength, the balance training of sitting on bed or standing beside the bed in grade 1 to 2, walking training in grade 2 to 3. The training intensity should be from weak to strong gradually. The items of observation were the improvement in speaking, sense and activity in limbs in the involved side. Evaluation of myodynamia was referenced to 6 grading method of Lovett.MAIN OUTCOME MEASURES: [1] the degree of embolism; [2] the degree of speaking fluency, the sense of limbs and the strength of the muscles of the limbs.RESULTS: Totally 56 cases entered the final analysis without any loss. [1]Degree of embolism: Among 56 cases, 100% focus was eliminated for 77% in 43 cases, 90% was eliminated for 12% in 7 cases and 60%-80% was eliminated for 11% in 6 cases. [2] Fluency of language: Before the treatment of rehabilitation, they suffered different degree impediment of speaking in 14 cases, improvement in 14 cases and obvious improvement in 11 cases. [3] Sense of limb:The sense of limbs was improved in 23 cases and 18 of them improved obviously. [4] Strength of muscles: The strength of muscles in 0 to 1 grade in 3 cases, 1 to 2 grade in 11 cases, 2 to 3 grade in 15 cases. But after the treatment of rehabilitation, speaking ability was improved in 14 cases, and 11 of them improved obviously. The strength of muscles was. resumed to 2 or 3 grade from 0or 1 grade in 2 cases, and to 4 grade in 21 cases and 5 grade in 6 cases.CONCLUSION: Endovascular embolization is a minimal traumatic, the rehabilitative therapy which is secure and effective method for treatment of high risk cerebral AVM, can promote motion function, language function and ability of activity of daily living, and quality of life of patients with cerebral arteriovenous malformation after embolism.