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Objective:To investigate the relationship between hyperuricemia and outcome in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke admitted to Department of Neurology, Putuo Hospital, Shanghai University of Tranditional Chinese Medicine between January 2020 and September 2020 were enrolled retrospectively. The modified Rankin Scale (mRS) score was used to evaluate the clinical outcome 3 months after the onset. ≤2 was considered as good outcome, and >2 was considered as poor outcome. The demography and baseline characteristics were compared between the good outcome group and the poor outcome group. Multivariate logistic regression analysis was used to determine the independent influencing factors of the outcome. Results:A total of 210 patients were included, their age was 69.87±62.62 years. There were 125 males (59.52%) and 85 females (40.48%). The baseline median National Institutes of Health Stroke Scale (NIHSS) score was 4. The serum uric acid level in 169 patients (80.48%) was normal and 41 (19.52%) had hyperuricemia; 120 patients (57.14%) had a good outcome, and 90 (42.86%) had a poor outcome. Blood glucose level, serum uric acid level, baseline NIHSS score and the proportions of diabetes mellitus, history of stroke or transient ischemic attack, hyperuricemia in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that diabetes mellitus (odds ratio [ OR] 2.735, 95% confidence interval [ CI] 1.461-5.121; P=0.002), hyperuricemia ( OR 2.400, 95% CI 1.102-5.228; P=0.027), and higher baseline NIHSS score ( OR 1.233, 95% CI 1.118-1.360; P<0.001) were the independent risk factors for poor outcome in patient with acute ischemic stroke. Conclusion:Hyperuricemia is an independent risk factor for poor outcome in patients with acute ischemic stroke.
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Objective To explore the chronergy of fibrinolysin and its influence on fibrinogen ( FIB ) and thrombus precursor protein (TpP) in treatment of acute cerebral infarction (ACI). Methods The clinical trial adopted the randomized single-blind placebo-controlled design.Totally, 150 patients with ACI (onset time≤12 h) were chosen and randomly divided into experimental group A ( group A receiving treatment of fibrinolysin after 12 h onset of ACI ) , experimental group B ( group B receiving treatment of fibrinolysin after 24 h onset of ACI) and control group ( group C without fibrinolysin treatment) , 50 cases in each group.The patients in experimental group A and B received basic treatment for ACI and fibrinolysin treatment.Patients in group C were given the basic treatment for ACI and placebo.The level of FIB and TpP before and after 7 days treatment, NIHSS scores before and after 14 days treatment, BI scores before and after 90 days treatment, incidence rate of progressive cerebral infarction ( PCI ) , stroke recurrence and mortality rate of the three groups were analyzed to evaluate the clinical effect of fibrinolysin.Hepatic and renal function before and after 7 days treatment, incidence rates of haemorrhage and hypersensitiveness were analyzed to evaluate the security of fibrinolysin. Results The NIHSS score of patients in group A, B and C (4.0±1.6, 6.5±2.2 and 8.0±4.7) was declined significantly after treatment (P0.05).The FIB in group A, B and C after treatment was (2.74±0.75) g?L-1,(2.82±0.83) and (3.67±1.35) g?L-1, respectively.The level of FIB in the three groups did not decrease significantly after treatment (P>0.05).However, the level of FIB in group A and B declined significantly as compared with that in group C.The TpP in group A, B and C after treatment was (3.56±1.26) mg?L-1, (3.43±1.22) and (13.21±6.54) mg?L-1, respectively.The level of TpP in group A and group B decreased significantly after treatment (P<0.05). The level of TpP in group A and B declined even more significantly than that in group C.Fibrinolysin did neither obviously injure liver and kidney nor increase the risk of bleeding, and had low hypersensitiveness incidence rate. Conclusion Treatment with fibrinolysin within 24 h after onset of cerebra infarction benefits the patients. However, dosing after 12 h onset of ACI benefits more than dosing after 24 h.Fibrinolysin plays a role of anti-thrombosis primarily by lowering the TpP level, and its influence on fibrinogen is limited.
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<p><b>OBJECTIVE</b>To explore the mechanism of lumen loss of the left circumflex ostium after main vessel stent implantation.</p><p><b>METHODS</b>Twenty-eight patients undergoing provisional T technique were enrolled in this study. Intravascular ultrasound (IVUS) examination was performed before and after main vessel stenting and kissing balloon post-dilatation to evaluate the geometrical changes of the vessels.</p><p><b>RESULTS</b>The CSA of LCX ostium lumen decreased significantly from 5.9∓2 mm(2) to 4.9∓1.9 mm(2) (P<0.01) after the procedure, and the CSA of LCX ostium P and M increased from 5.4∓2.9 mmmm(2) to 5.7∓2.9 mm(2) (P=0.21) after the main vessel stenting. The changes in LCX ostium lumen CSA was correlated with the changes of LCX ostium EEM CSA but not the LCX ostium P and M CSA. After kissing balloon post-dilatation, the CSA of LCX ostium lumen increased from 4.9∓1.9 mm(2) to 5.5∓1.9 mm(2) (P<0.01) , and the CSA of LCX ostium P and M showed no obvious changes (5.7∓2.9 mmmm(2) vs 5.7∓2.6 mmmm(2), P=0.89). The changes of LCX ostium lumen CSA were correlated with the those of the LCX ostium EEM CSA (R=0.432, P=0.02).</p><p><b>CONCLUSION</b>After stent implantation from the LMCA to the LAD, most of lumen losses of the LCX are due to carina shift, and in occasional cases, plaque shift occurs from the distal LMCA to the ostium of the LCX. Kissing balloon technique can adjust carina shift but can not improve plaque shift.</p>
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Aged , Female , Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , Coronary Artery Disease , Diagnostic Imaging , Therapeutics , Coronary Stenosis , Diagnostic Imaging , Stents , Treatment Outcome , Ultrasonography, InterventionalABSTRACT
<p><b>OBJECTIVE</b>To evaluate the efficacy of atorvastatin in preventing contrast agent-induced nephropathy (CIN) in patients undergoing coronary angiography and explore the mechanism.</p><p><b>METHODS</b>A total of 180 patients undergoing coronary angiography or percutaneous coronary interventions (PCI) were randomized into regular dose and high dose atorvastatin groups (n=90). Serum creatinine (Scr), glomerular filtration rate (GFR), cystatin, peripheral blood levels of myeloperoxidase (MPO), malondialdehyde (MDA), and superoxide dismutase (SOD) before and after the procedure were compared between the two groups.</p><p><b>RESULTS</b>The incidence of CIN was significantly lower in high-dose atorvastatin group than in the regular dose group. At 48-72 h after the surgery, serum Scr and cystatin levels were significantly lower and eGFR was significantly higher in the high-dose group. At 24 h after the surgery, MPO and MDA levels were significantly lower, and SOD activity was significantly higher in high-dose group than in the regular dose group.</p><p><b>CONCLUSION</b>High-dose atorvastatin used before angiography is more effective than the regular dose in attenuating contrast agent-induced renal dysfunction, and its mechanism is related with the inhibition of oxidative stress.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Atorvastatin , Contrast Media , Coronary Angiography , Heptanoic Acids , Pharmacology , Therapeutic Uses , Kidney Diseases , Oxidative Stress , Pyrroles , Pharmacology , Therapeutic UsesABSTRACT
Objective:To study the effect of combined acupuncture and rehabilitation training on early-stage Barthel index of ischemic stroke cases.Method:Fifty ischemic stroke cases were randomized into a treatment group of 24 cases and control group of 26 cases.In addition to routine internal treatment methods,rehabilitation training was applied to cases in the control group,and combined acupuncture and rehabilitation training were applied to cases in the treatment group.Warming and reinforcing manipulations were applied to Jianyu (LI 15),Quchi (LI 11),Hegu (LI 4),Yanglingquan (GB 34),Yinlingquan (SP 9),Zusanli (ST 36),and Sanyinjiao (SP 6),20 min of needle retaining for each point in one treatment.Then the scores of clinical neurological impairment and Barthel index of stroke cases were evaluated before the treatment and 3 weeks after respectively.Results:The significant progress and progress cases in the treatment group were 14 and 12 respectively,whereas that in the control group were 6 and 11 respectively,coupled with 7 cases of no progress.The therapeutic effect in the treatment is substantially better than the control group (P＜0.05).There was no significant difference (P＞0.05) in neurological impairment and scores of Barthel index of the two groups before the treatment,whereas significant difference (P＜0.05) after the treatment.The scores of neurological impairment in the treatment group were significantly reduced after the treatment (P＜0.05),and the scores of Barthel index were significantly increased (P＜0.05).Conclusion:Combined acupuncture and rehabilitation training can produce significantly better effect on early neurological impairment and Barthel index of stroke cases than rehabilitation training alone.
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Objective To investigate the efficacy and safety of tirofiban in acute coronary syndrome(ACS)patients during primary PCI.Methods Sixty two patients with ACS who underwent primary PCI were randomly divided into two groups which were:the tirofiban + PCI group(n=32)and the primary PCI group(n=30).Tirofiban was predominantly initiated in the catheter laboratory before or during the intervention and maintained for a mean of 30 h(10 ?g/kg for bolus,followed by 0.15 ?g/kg?min infusion).Platelet counting,MACE event and periprocedural complication were investigated.Heart function by echo was observed.Results The incidence of the major primary end point(refractory ischemia,new myocardial infarction and death)at 30 days was significantly lower in the tirofiban group than that in the placebo group(9.3% vs 20.0%,P