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Objective:To investigate blood glucose variability, National Institutes of Health Stroke Scale (NIHSS) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and prognosis in patients with acute and severe cerebrovascular disease, providing a reference for clinical treatment of this disease.Methods:The clinical data of 76 patients with acute and severe cerebrovascular disease who received treatment in Xixi Hospital of Hangzhou between January 2014 and December 2019 were retrospectively analyzed. These patients were divided into a survival group ( n = 51) and a death group ( n = 25) according to the prognosis 28 days after admission. Baseline data, baseline NIHSS score, APACHE II score, standard deviation of blood glucose, mean blood glucose, mean amplitude of glycemic excursions, and blood glucose variability rate were compared between the survival and death groups. The effects of these parameters on the prognosis of acute and severe cerebrovascular disease were analyzed. Results:There were no significant differences in gender, age, history of diabetes, type of disease, and length of hospital stay between the two groups ( χ2 = 1.674, t = 1.048, χ2 = 3.833, 0.263, t = 0.832, all P > 0.05). The proportion of patients with a history of hypertension in the death group was significantly higher than that in the survival group [15.69% (8/51) vs. 52.00% (13/25), χ2 = 11.063, P < 0.05]. There was no significant difference in mean blood glucose between the two groups ( t = 0.118, P > 0.05). The baseline NIHSS score, APACHE II score, standard deviation of blood glucose, mean amplitude of glycemic excursions and blood glucose variability rate in the death group were (24.41 ± 4.14) points, (25.00 ± 6.97) points, (2.72 ± 0.91) mmol/L, (6.27 ± 2.01) mmol/L, (34.83 ± 5.61) %,which were significantly higher than those in the survival group [(17.22 ± 3.63) points, (19.21 ± 5.36) points, (1.69 ± 0.70) mmol/L, (3.72 ± 1.68) mmol/L, (19.54 ± 3.22) %, t = 7.744, 3.999, 5.448, 5.823, 15.095, all P < 0.05]. The proportion of patients with blood glucose variability rate < 20% in the death group was significantly lower than that in the survival group [16.00% (4/25) vs. 74.51% (38/51), χ2= 23.230, P < 0.05]. The proportion of patients with blood glucose variability rate > 30% in the death group was significantly higher than that in the survival group [60.00% (15/25) vs. 13.73% (7/51), χ2 = 17.466, P < 0.05). Logistic regression analysis revealed that baseline NIHSS score, APACHE II score, standard deviation of blood glucose, mean amplitude of glycemic excursions, and blood glucose variability rate were the independent risk factors of death of cerebrovascular disease patients (all P < 0.05). Conclusion:In patients with acute and severe cerebrovascular disease, an obvious blood glucose fluctuation, high baseline NIHSS score, and high APACHE II score help to assess the prognosis of acute and severe cerebrovascular disease and determine the risk of death.
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This article reported 2 cases primary renal Ewing sarcoma (PRES)/primitive neuroectodermal tumor (PNET). By reviewing literature, renal PRES/PNET has a high degree of malignancy, and early symptoms are not typical. It needs to be combined with clinical manifestations, imaging examinations and pathological examination results. At present, surgical treatment is the main treatment, combined with radiotherapy and chemotherapy or targeted treatment might help.
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Objective To evaluate the clinical efficacy of super-selective prostatic arterial embolization(PAE) for the treatment of benign prostatic hyperplasia(BPH).Methods From February 2012to March 2015,a total of 17 patients with BPH who failed in medical treatment,or unwilling to accept surgery were selected for PAE as the study group.The mean age was 73 years (range 61-84 years) and the mean prostatic volume was 64.6 ml (ranging 50-85 ml).The study group underwent super selective arterial embolization.The internal iliac artery angiography was performed and the main blood vessel of prostate was showed.The femoral artery was punctured under local anesthesia and X-ray monitoring,a F4-5 Cobra catheter was inserted,and then the Embosphere microspheres were implanted.A total of 40 patients who underwent transurethral resection of the prostate(TURP) were selected as the control group.The mean age was 70 years (ranging 59-87 years).The mean prostatic volume was 68.7 ml(ranging 55-90 ml).All cases were followed up for 1 year.The changes of prostatic volume (PV),international prostate symptom score(IPSS),quality of life (QOL),pre-and post-treatment peak urinary flow (Qmax) were evaluated.Results For the 17 patients who underwent PAE,the PV decreased from (64.6 ± 10.2) ml to(42.0 ± 7.5) ml,the IPSS decreased from 23.9 ±4.9 to 13.1 ±3.5,QOL decreased from 4.1 ±0.7 to 2.1 ±0.7,and Q increased from (9.5 ± 3.7) ml/s to(21.8 ± 4.2) ml/s,which were statistically significant (P ＜ 0.05) compared with the pre-treatment parameters.The post-operative parameters of the control group were also significantly improved compared with the preoperative parameters (P ＜ 0.05).Conclusions PAE is safe and effective in treating BPH,especially for those failing in medical treatment,or unwilling to accept surgery.
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Objective To review the clinical diagnosis and treatment of acute focal renal infarction. Methods Three cases of focal renal infarction were reported and the literature was reviewed.The patients aged from 45 to 63 years with mean age of 54. Two cases had low back pain, 1 case with abdominal pain. Based on clinical history, B-ultrasonography and CT scan, focal renal infarction was diagnosed in 3 patients. There were 2 cases on left kidney and 1 case right. All cases were applied digital subtraction angiography (DSA) and thrombolytic anticoagulant therapy. Results Two cases received DSA and thrombolytic therapy. The other one case received pethidine 50 mg, progesterone 20 mg treatment, the salvia infusion and low molecular heparin 6000 U anticoagulant therapy. All patients had symtoms relieved after 1 d. A week later CT scan, 3 cases of renal infarction were apparently disappeared. Serum creatinine and urea nitrogen were normal. Three patients were followed, mean follow-up time was 1. 5 (0. 5-2) years. Conclusions The diagnosis of acute focal renal infarction mainly depends on B-ultrasound and CT. Early diagnosis and treatment is important for achieving recovery of the compromised renal function. Renal infarction should be suspected in the presence of abdominal pain of sudden onset.