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Objective:To compare the efficacy of ultrasound combined with endoscopy and ultrasound combined with X-ray guided percutaneous nephrolithotomy(PCNL) in the treatment of complex renal calculi.Methods:The clinical data of 119 patients with complex kidney stones treated by ultrasound combined with endoscopy or ultrasound combined with X-ray guided PCNL in the Second Affiliated Hospital of Anhui Medical University from March 2019 to February 2022 were analyzed retrospectively. According to different guidance methods, they were divided into ultrasound combined with endoscopic guidance group and ultrasound combined with X-ray guidance group.There was no significant difference in age [(53.9±14.2) years vs. (55.6±13.5) years], gender (male/female: 38/21 vs. 30/30), body mass index [(25.0±3.7) kg/m 2 vs. (24.8±3.8)kg/m 2], stone location (left/right: 34/25 vs. 31/29), maximum diameter of renal stones [(31.9±8.3)mm vs. (33.9±13.5)mm], kidney stones maximum cross-sectional area [(601.5±242.5)mm 2 vs. (632.6±278.9)mm 2], number of renal calices involved (3.5±0.9 vs. 3.6±1.3), S. T.O.N.E. scores (9.4±1.0 vs. 9.7±1.4), Guy's grade(Ⅲ/Ⅳ: 45/14 vs. 41/19), preoperative hemoglobin [(125.2±21.5)g/L vs. (125.6±18.4)g/L], serum creatinine[(89.1±33.8) μmol/L vs. (81.9±27.1) μmol/L], urinary tract infection (43/59 vs. 47/60)and positive urinary bacterial culture (12/59 vs.11/60) between the two groups(all P>0.05). The patients in the ultrasound combined with endoscopic guidance group were placed in the modified prone split-leg position. Flexible ureteroscope retrograde into the renal pelvis, combined with ultrasound to determine the best puncture calices. The channels were established and stones were removed under the guidance of ultrasound and endoscopy. In the ultrasound combined with X-ray guidance group, the F5 ureteral catheter was placed retrogradely into the operative side ureter under the lithotomy position. Then the patient changed to prone position and the target calices were punctured under the guidance of ultrasound and X-ray. Through anterograde or retrograde injection of contrast medium, the puncture position was determined to enter in the center of the calicean dome, and the channel establishment process and stone removal are monitored. The operative results and postoperative data were recorded. Results:The average operation time in the ultrasound combined with endoscopic guidance group was significantly shorter than that in the ultrasound combined with X-ray guidance group [(90.2 ± 34.5) min vs. (129.4 ± 43.0) min, P < 0.001]. There was no significant difference in the success rates of initial channel establishment [94.0% (63/67) vs. 87.7% (107/122), P = 0.167], the time of single channel establishment [(7.7 ± 1.9) min vs. (7.7 ± 1.4) min, P =0.765], serum creatinine on the first day after operation[ (89.3±33.6) μmol/L vs. (82.9±27.0) μmol/L, P=0.257] and postoperative hospital stay[(5.3±1.6) d vs.(5.4±1.7) d, P=0.883]. In contrast, patients in ultrasound combined with X-ray guidance group had higher stone free rate [93.3% (56/60) vs. 81.4% (48/59), P=0.049] and lower reoperation rate [3.3% (2/60) vs. 15.3% (9/59), P=0.025]. The mean hemoglobin decrease value of ultrasound combined with endoscopic guidance group was significantly lower than ultrasound combined with X-ray guidance group on the first day after operation [(8.7±6.3) g/L vs. (16.8±6.9) g/L, P<0.001]. The complication rate of ultrasound combined with endoscopic guidance group was significantly lower than that of ultrasound combined with X-ray guidance group [5.1% (3/59) vs. 16.7% (10/60), P = 0.043]. Conclusions:Ultrasound combined with endoscopic guidance PCNL does not need to change body position during operation and has fewer puncture channels, thus saving operation time and reducing complications. It is more suitable for patients with isolated kidney or easy bleeding. Ultrasound combined with X-ray guidance is conducive to the establishment of multi-channel, the stone clearance rate is high and the reoperation rate is low, which is suitable for patients with good health and more renal calices involved with stones.
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Cognitive impairment after infectious meningitis seriously affects the activities of daily living for survivors. There has been lack of systematic researches on the cognitive impact of infectious meningitis so far, it is not clear how to early identify and evaluate the cognitive impairment after meningitis, how to properly carry out early rehabilitative intervention to improve the activities of daily living and to reduce the social and economic burden of patients. This article reviews the characteristics, evaluation methods and rehabilitative interventions of cognitive impairment in patients after infectious meningitis, to provide reference for clinical application.
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The low-frequency oscillation of electroencephalography can reflect the process of brain neuron remodeling. This article reviews the basic principles of neurobiology, measurement and analysis methods of delta (0.5-4 Hz) and theta (4-8 Hz) low-frequency oscillatory activities and their clinical applications in post-stroke motor, cognitive and language functions, and discusses the possibility of their clinical research and conversion application in the field of stroke rehabilitation.
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Objective:To explore the changes in the diffusion tensor imaging (DTI) parameters of the pontocerebellar tract 3 months and one year after ischemic stroke and analyze the data′s potential for predicting long-term motor outcomes.Methods:Thirty patients with middle cerebral artery infarction were prospectively studied using DTI within 3 months and 1 year after the onset. A region of interest-based analysis was performed for the fractional anisotropy (FA) of the middle cerebellar peduncles (MCP) in the pontocerebellar fibers (PCF). Neurological functioning was evaluated using the National Institutes of Health Stroke Scale and the degree of paresis was assessed at the same time using paresis grading. At one year after the onset, balance function, functional prognosis and self-care ability were evaluated using the Brunel Balance Scale, the modified Rankine Scale and the Functional Independence Scale respectively.Results:The average FA on the healthy side 3 months and 1 year after onset was significantly less than on the affected side at each time point. The ratio of the FA of the affected side to that of the unaffected side (rFA) in the PCF correlated significantly with the average paresis scores of the lower and upper extremity and the total paresis score at each time point. Moreover, the rFA of the PCF was significantly correlated with the average functional independence score, the prognosis for the upper and lower extremities as well as motor functioning. The area ratio under the ROC curve of the PCF for predicting lower extremity motor outcome was 0.84, and the optimal threshold was 0.92 (sensitivity 71.4%, specificity 73.9%). The area ratio under the ROC curve was not a significant predictor of upper extremity motor outcome.Conclusion:The DTI parameter rFA of the PCF in patients with subacute middle cerebral artery infarction can help to predict the long-term recovery of motor ability. It can serve as an important reference index for predicting the long-term motor ability of the lower limbs.
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Objective:To discuss the feasibility and clinical efficacy of laparoscopic ureteroplasty with buccal mucosa graft for ureteral stricture.Methods:The clinical data of 10 patients with ureteral stricture admitted to the Second Affiliated Hospital of Anhui Medical University from July 2018 to November 2019 were retrospectively analyzed, including 7 males, 3 females, 5 cases on each side, with an average age of (47.9±7.8)years. All patients had a history of operation related to ureteral calculi. The median value of preoperative serum creatinine was 71(68~610)μmol/L. The status of hydronephrosis and ureteral stricture was evaluated by ultrasonography, CTU and ureteral retrograde angiography.The separation of the renal pelvis on the affected side was (3.1±0.7)cm.There were 7 cases of upper segment stenosis, 2 cases of middle segment stenosis, and 1 case of multiple stenosis. The length of ureteral stenosis was (3.2±0.7)cm. Laparoscopic buccal mucosa ureteroplasty was performed in all 10 cases under general anesthesia. After the stricture ureter segment was separated during the operation, the ureteral stenosis segment was longitudinally cut. According to the stenosis, the buccal mucosa with a length of 3.0-4.5 cm and a width of 1.0-1.5 cm was cut. Buccal mucosa grafts were harvested and placed in the ureter as an anterior onlay with omental wrapping.Results:Ureteral repair was performed laparoscopically in all cases, with no conversion to open and no serious complications. The operative time was (199.2±27.4)min, the blood loss was (101.5±54.7)ml, the median postoperative indwelling time of the drainage tube was 4.5(3.0-7.0)d, and the postoperative hospital stay was (7.9±1.9)days. The patients had clear pronunciation and barrier-free eating one week after the operation.The double J tube was removed one to two months after surgery. The patients were followed up for (11.3±4.2)months after the operation. Follow-up patients underwent imaging and other examinations, which showed significant improvement in hydronephrosis on the affected side, and the median value of renal pelvis separation on the affected side was 1.8(0-2.2)cm. The median value of serum creatinine was 82(66~235)μmol/L. The serum creatinine in 2 patients with renal insufficiency decreased significantly after operation.Conclusions:Laparoscopic buccal mucosa graft ureteroplasty could be a safe and feasible option for the treatment of ureteral stricture with less trauma and rapid recovery. The results of the initial experience are encouraging.
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Objective:To translate the English version and cross-cultural adaptation of Readiness for Return-To-Work Scale (RRTW) into Chinese and tested the reliability and validity of the Chinese version of RRTW in young and middle-aged stroke patients.Methods:RRTW was translated into Chinese with standard translation-retroversion. From August to December 2020, 235 stroke patients in the First Affiliated Hospital, College of Medicine, Zhejiang University were recruited by convenient sampling. The scale was tested by the reliability and validity.Results:The Chinese version of RRTW for stroke was composed of two parts: The first part was divided into four dimensions, with a total of 13 entries; For the unworked stroke population, the second part was divided into two dimensions, with a total of nine entries for the reworked stroke population. The content validity index (CVI) for each item was from 0.875 to 1.000. The total CVI for all items was 0.994. The Pearson correlation coefficient between dimension and scale was from 0.523 to 0.876. Four common factors were obtained from the first part and the cumulative contribution rate was 62.563%. Two common factors were obtained from the second part and the cumulative contribution rate was 49.908%. The Cronbach α coefficient in the first part was 0.760 and in the second part was 0.693.Conclusions:The Chinese version of RRTW for stroke patients has good reliability and validity, which can be used to assess the readiness level of stroke patients to return to work in Chinese society.
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Objective:To explore the application of panoramic teaching in clinical practice.Methods:From October 2017 to October 2018, 40 clinical undergraduate interns were collected into the experimental group (panoramic teaching group, n=20) and the control group (traditional teaching group, n=20). The experimental group received panoramic teaching including case teaching, scenario design, and situational simulation, while the control group adopted traditional teaching mode. After the internship, theoretical and operational examinations, and questionnaire survey were conducted to evaluate the teaching effects of the two teaching modes. The data were collected and analyzed by t test using SPSS 16.0 software. Results:The results showed that theoretical examination [(85.4±3.3) vs. (82.5±2.5)] and clinical operational examination [(31.5±3.5) vs. (27.6±2.2)] scores in the panoramic teaching group were significantly higher than that in the traditional teaching group. The questionnaire survey on the satisfactions with teaching mode showed that the panoramic teaching group was significantly better than the traditional teaching group in theory learning [(7.7±0.9) vs. (6.8±0.7)], clinical practice[(7.8±0.9) vs. (6.7±0.7)], learning interest [(8.1±0.7) vs. (6.9±0.7)], self-learning ability [(7.7±0.7) vs. (7.1±0.6)], teacher-student communication ability [(7.6±0.8) vs. (6.8±0.7)], doctor-patient communication ability [(7.5±0.6) vs. (7.0±0.8)], medical humanistic spirit [(7.9±0.7) vs. (6.8±0.7)], group working [(8.2±0.6) vs. (6.5±0.5)], humanistic concern [(8.4±0.5) vs. (7.4±0.7)], and total satisfactions [(8.4±0.5) vs. (7.4±0.7)].Conclusion:Panoramic teaching can significantly improve the theoretical and operational performance of family practice interns, enhance the effect of clinical teaching of family practice, and increase students’ interest and satisfaction in clinical teaching.
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Objective@#To observe the safety and long-term efficacy of carotid artery stenting(CAS)in octogenarians with carotid stenosis.@*Methods@#Clinical data of patients aged 80 years or older undergoing CAS for carotid stenosis in our hospital between July 2008 and October 2017 were retrospectively analyzed.The perioperative treatment outcomes and mid- and long-term follow-up results were analyzed.@*Results@#A consecutive series of 61 patients(a median age of 81 years, 54 males)were enrolled.Of 61 patients, 23(37.7%)patients had symptomatic carotid artery stenosis.Sixty patients underwent unilateral CAS, one patient underwent bilateral CAS, and 26(42.6%)underwent other cerebrovascular interventional therapy during the same period.The technical success rate was 100.0%.During the perioperative period, the incidence of stroke was 6.6%(4/61), and no patient died.Eight(13.1%)patients had contrast-induced nephropathy, 4(6.6%)patients suffered from cardiac dysfunction, and 30(49.2%)patients had hypotension requiring vasopressor support postoperatively, and all of them recovered well when discharged from hospital.All patients were followed up for a median of 42 months(range 2-108 months, with an interquartile interval of 44 months). The incidence of stroke and death was 8.2%(5/61)within 30 days to 1 year after surgery.The median stroke-free survival was 72 months in patients with symptomatic carotid stenosis, and was 93 months in asymptomatic patients, with the statistically significant difference between the two groups(χ2=4.258, P=0.039).@*Conclusions@#Carotid artery stent implantation in octogenarians with carotid stenosis has a favorable safety and feasibility when performed in experienced centers, and the outcome of a mid- and long-term follow-up is good.
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Objective@#To determine the subcortical areas associated with post-stroke dysphagia and its recovery using diffusion tensor images.@*Methods@#Ten patients with middle cerebral artery lesions and dysphagia were selected into the dysphagia group, while another 10 counterparts without dysphagia were chosen for the non-dysphagia group. The ratios of diffuse anisotropy (rFAs) in eleven regions of interest (ROIs) on both the healthy and affected sides were recorded and compared between the two groups. One and 3 months later, the rFA values of the dysphagia group were again measured and the rFAs were related with dysphagia outcomes and severity using Spearman correlation analysis.@*Results@#Comparing the rFAs of the 11 ROIs between the two groups revealed significant differences between the insulae of the dysphagia group and the non-dysphagia group. Three months later the rFA values of the insulae, cerebral peduncles and superior cerebellar peduncles had increased significantly in the dysphagia group. The average dysphagia outcome and severity score of the dysphagia group was significantly lower one month after the treatment than 3 months later. Moreover, the outcome and severity score was found to be significantly correlated with the rFA values of the insulae and of the superior cerebellar peduncles one month after the treatment, but with that of the cerebral peduncles only after 3 months.@*Conclusion@#Dysphagia within one month of the onset of infarction is related to the insulae, the cerebral peduncles and the superior cerebellar peduncles. After 3 months it is associated with the cerebral peduncles.
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Objective@#To investigate the feasibility and safety of endoscopic combined simultaneous surgery in the modified prone split-leg position for complex renal calculi with ipsilateral ureteral calculi.@*Methods@#The clinical data of 56 cases patients with simultaneous renal and ureteral stones admitted to the Second Affiliated Hospital of Anhui Medical University from January 2016 to March 2019 were retrospectively analyzed. A retrospective analysis was performed on 56 cases of patients with simultaneous renal and ureteral stones who received surgical treatment between January 2016 and March 2019. According to different surgical methods, 56 cases were divided into the modified prone split-leg position group (observation group) and the traditional pre-lithotomy position followed by prone position group (control group). In observation group, the average age of 11 males and 17 females was (54.1±10.2)years. The mean body mass index was (23.8±2.9) kg/m2. The location of stones were left in 14 cases and right in 14 cases. The average kidney involvement calyces number was 2.4±0.7.The mean kidney stones maximum cross-sectional area was (870.9±157.7)m2. According to the Guy′s classification system, there were 3 cases of grade Ⅰ, 11 case of grade Ⅱ and 14 case of grade Ⅲ in the observation group. The kidney stones S. T.O.N.E scores was 8.7±1.3 and ureteral calculi S. T.O.N.E scores were 13.1± 1.6.In the control group, the average age was (57.0±8.3)years old. The mean body mass index was (24.4±2.9)kg/m2. The average kidney involvement calyces number was 2.1±0.7 and the mean kidney stones maximum cross-sectional area was (808.8±189.6)mm2. To the kidney stones Guy′s classification, there were 5 cases of grade Ⅰ, 15 case of grade Ⅱ, 7 case of grade Ⅲ and 1case of grade Ⅳ in the control group. The kidney stones S. T.O.N.E scores were 8.5±0.6 and the ureteral calculi S. T.O.N.E scores were 12.4±1.7. The operation time, calculus clearance rate, postoperative hospitalization days, reoperation rate and severity of complications of Clavien-Dindo were statistically compared between the two groups.@*Results@#The study found that the average operation time in the observation group was significantly shorter than that in the control group [(77.8±27.3)min vs.(94.4±22.8)min](P<0.05). In the observation group, 23 patients had complete removal of renal and ureteral calculi, and 3 patients need reoperation. While in the control group, 16 patients had complete removal and 10 patients had reoperation. There were significant differences between the two groups (P<0.05). According to the complication severity of Clavien-Dindo, there were 4 cases of grade Ⅰ and 1 case of grade Ⅱ in the observation group, 4 cases of grade Ⅰ, 2 case of grade Ⅱ and 2 case of grade Ⅲ in the control group. There were no serious complications of grade Ⅳ and Ⅴ in both groups (P>0.05). In observation group, one case accepted the DSA embolization therapy due to the severe bleeding. One case accepted the puncture drainage due to the perinephric effusion. There was no difference in average postoperative hospital stay between the two groups [(6.5±1.2)d vs.(7.0±2.1)d, P>0.05].@*Conclusions@#It is safe and feasible to treat complex renal calculi with ipsilateral ureteral calculi by endoscopic combined simultaneous surgery in the modified prone split-leg position. One position can solve many problems simultaneously, which can significantly reduce the operation time, increase the stone free rates, reduce the reoperation rate and improve the effectiveness of the operation.
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Objective To investigate the feasibility and safety of endoscopic combined simultaneous surgery in the modified prone split-leg position for complex renal calculi with ipsilateral ureteral calculi.Methods The clinical data of 56 cases patients with simultaneous renal and ureteral stones admitted to the Second Affiliated Hospital of Anhui Medical University from January 2016 to March 2019 were retrospectively analyzed.A retrospective analysis was performed on 56 cases of patients with simultaneous renal and ureteral stones who received surgical treatment between January 2016 and March 2019.According to different surgical methods,56 cases were divided into the modified prone split-leg position group (observation group)and the traditional pre-lithotomy position followed by prone position group (control group).In observation group,the average age of 11 males and 17 females was (54.1 ± 10.2) years.The mean body mass index was (23.8 ± 2.9) kg/m2.The location of stones were left in 14 cases and right in 14 cases.The average kidney involvement calyces number was 2.4 ± 0.7.The mean kidney stones maximum cross-sectional area was (870.9 ± 157.7) m2.According to the Guy's classification system,there were 3 cases of grade Ⅰ,11 case of grade Ⅱ and 14 case of grade Ⅲ in the observation group.The kidney stones S.T.O.N.E scores was 8.7 ± 1.3 and ureteral calculi S.T.O.N.E scores were 13.1 ± 1.6.In the control group,the average age was (57.0 ± 8.3) years old.The mean body mass index was (24.4 ± 2.9) kg/m2.The average kidney involvement calyces number was 2.1 ± 0.7 and the mean kidney stones maximum cross-sectional area was (808.8 ± 189.6)mm2.To the kidney stones Guy's classification,there were 5 cases of grade Ⅰ,15 case of grade Ⅱ,7 case of grade Ⅲ and 1 case of grade Ⅳ in the control group.The kidney stones S.T.O.N.E scores were 8.5 ±0.6 and the ureteral calculi S.T.O.N.E scores were 12.4 ± 1.7.The operation time,calculus clearance rate,postoperative hospitalization days,reoperation rate and severity of complications of Clavien-Dindo were statistically compared between the two groups.Results The study found that the average operation time in the observation group was significantly shorter than that in the control group [(77.8 ± 27.3) min vs.(94.4 ± 22.8) min] (P ＜ 0.05).In the observation group,23 patients had complete removal of renal and ureteral calculi,and 3 patients need reoperation.While in the control group,16 patients had complete removal and 10 patients had reoperation.There were significant differences between the two groups (P ＜ 0.05).According to the complication severity of Clavien-Dindo,there were 4 cases of grade Ⅰ and 1 case of grade Ⅱ in the observation group,4 cases of grade Ⅰ,2 case of grade Ⅱ and 2 case of grade Ⅲ in the control group.There were no serious complications of grade Ⅳ and Ⅴ in both groups (P ＞0.05).In observation group,one case accepted the DSA embolization therapy due to the severe bleeding.One case accepted the puncture drainage due to the perinephric effusion.There was no difference in average postoperative hospital stay between the two groups [(6.5 ± 1.2) d vs.(7.0 ± 2.1) d,P ＞ 0.05].Conclusions It is safe and feasible to treat complex renal calculi with ipsilateral ureteral calculi by endoscopic combined simultaneous surgery in the modified prone split-leg position.One position can solve many problems simultaneously,which can significantly reduce the operation time,increase the stone free rates,reduce the reoperation rate and improve the effectiveness of the operation.
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Objective To determine the subcortical areas associated with post-stroke dysphagia and its re-covery using diffusion tensor images. Methods Ten patients with middle cerebral artery lesions and dysphagia were selected into the dysphagia group, while another 10 counterparts without dysphagia were chosen for the non-dysphagia group. The ratios of diffuse anisotropy ( rFAs) in eleven regions of interest ( ROIs) on both the healthy and affected sides were recorded and compared between the two groups. One and 3 months later, the rFA values of the dysphagia group were again measured and the rFAs were related with dysphagia outcomes and severity using Spearman correla-tion analysis. Results Comparing the rFAs of the 11 ROIs between the two groups revealed significant differences between the insulae of the dysphagia group and the non-dysphagia group. Three months later the rFA values of the in-sulae, cerebral peduncles and superior cerebellar peduncles had increased significantly in the dysphagia group. The average dysphagia outcome and severity score of the dysphagia group was significantly lower one month after the treat-ment than 3 months later. Moreover, the outcome and severity score was found to be significantly correlated with the rFA values of the insulae and of the superior cerebellar peduncles one month after the treatment, but with that of the cerebral peduncles only after3 months. Conclusion Dysphagia within one month of the onset of infarction is related to the insulae,the cerebral peduncles and the superior cerebellar peduncles.After 3 months it is associated with the cerebral peduncles.
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Objective To observe the safety and long-term efficacy of carotid artery stenting (CAS)in octogenarians with carotid stenosis.Methods Clinical data of patients aged 80 years or older undergoing CAS for carotid stenosis in our hospital between July 2008 and October 2017 were retrospectively analyzed.The perioperative treatment outcomes and mid-and long-term follow-up results were analyzed.Results A consecutive series of 61 patients (a median age of 81 years,54 males) were enrolled.Of 61 patients,23 (37.7％)patients had symptomatic carotid artery stenosis.Sixty patients underwent unilateral CAS,one patient underwent bilateral CAS,and 26 (42.6 ％)underwent other cerebrovascular interventional therapy during the same period.The technical success rate was 100.0％.During the perioperative period,the incidence of stroke was 6.6％ (4/61),and no patient died.Eight (13.1％) patients had contrast-induced nephropathy,4 (6.6％) patients suffered from cardiac dysfunction,and 30 (49.2％)patients had hypotension requiring vasopressor support postoperatively,and all of them recovered well when discharged from hospital.All patients were followed up for a median of 42 months(range 2-108 months,with an interquartile interval of 44 months).The incidence of stroke and death was 8.2％ (5/61)within 30 days to 1 year after surgery.The median stroke-free survival was 72 months in patients with symptomatic carotid stenosis,and was 93 months in asymptomatic patients,with the statistically significant difference between the two groups(x2 =4.258,P=0.039).Conclusions Carotid artery stent implantation in octogenarians with carotid stenosis has a favorable safety and feasibility when performed in experienced centers,and the outcome of a mid-and long-term follow-up is good.
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Objective To explore the safety and effectiveness of mechanical thrombectomy in patients ≥80 years old,and to analyze the causes of poor prognosis.Methods The data of twenty consecutive patients ≥ 80 years old with acute ischemic stroke who underwent mechanical thrombectomy in our hospital from January 2017 to June 2018 were retrospectively reviewed.Baseline information,imaging data,thrombectomy procedures,complications,and clinical prognosis were collected.The causes of poor prognosis were analyzed.Results A total of 20 advanced age patients were included,with an average age of (83.3±4.1)years(range 80 to 96 years).All patients underwent mechanical thrombectomy,and the successful recanalization rate(mTICI 2b-3)was 70 ％.The incidence of technical complications was 15％,of which the rate of symptomatic intracranial hemorrhage was 5％.Among the 11 patients with poor prognosis,the causes included the severe diseases and later revascularization in 2 patients,unsuccessful recanalization or complications in 3 cases,and advanced age-related factors in 6 cases,among which there were accompanied multiple severe stenoses,poor collaterals and the rapid progress of stroke in 3 cases and the aggravation of previous comorbidities in 3 cases.Conclusions The advanced age patients ≥80 years old often have more comorbidities,higher prevalence rates of multiple severe vascular stenosis except the occluded vessels,poor collateral compensation and the aggravation of original comorbidities.And all of them may be important factors for the poor prognosis after mechanical thrombectomy.
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Objective@#To explore the safety and short-term efficacy of sole angioplasty with tiny balloon for symptomatic intracranial atherosclerotic stenosis (ICAS) patients with complex lesions refractory.@*Methods@#Consecutive 11 patients with complex ICAS lesions treated by sole angioplasty with tiny balloon (diameter≤2 mm) from September 2016 to November 2017 at Department of Neurosurgery, Beijing Hospital were retrospectively reviewed. Patients′ demographics, lesions characteristics, procedures, complications, and clinical and imaging follow-up data were collected. There were 6 male and 5 female patients with mean age of 63.6 years (range: 45 to 77 years). Clinical manifestations were transient ischemia attack (TIA) in 4 cases, progressive ischemic stroke in 3 cases, recurrent stroke in 3 cases, and 1 case for preparation of scheduled radical resection of colon cancer. ICAS locations were middle cerebral artery M1 segment in 5 cases, M2 segment in 1 case, anterior cerebral artery A1 segment in 2 cases, and intracranial vertebral artery in 3 cases. Mean degree of ICAS stenosis was 92%. Lesion morphology was type A in 3 cases, B in 4 cases and C in 4 cases by Mori classification. Forward flow by modified thrombolysis in cerebral infarction (mTICI) was grade 1 to 2a in 8 cases, 2b in 3 cases. Collateral compensation grading was grade 2 in 5 cases, grade 3 in 6 cases.@*Results@#Technique success rate was 10/11, peri-procedural complication rate was 1/11. Post-procedural forward flow in all cases had been enhanced and 10 cases obtained mTICI 2b to 3. Ten patients got favorable outcomes (modified Rankin score 0 to 2) at discharge. With a mean clinical follow-up time of 5.4 months, 1 patient was found to have TIA recurrence. With a mean clinical follow-up time of 7.4 months, 1 patient was found to have TIA recurrence. Eight in 11 cases obtained imaging follow-up during 3 months, and none restenosis was found.@*Conclusion@#For symptomatic ICAS complex lesions, sole angioplasty with tiny balloon demonstrates relatively high safety with satisfactory short-term clinical and imaging results.
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Objective@#To investigate the value of zTE ASL MRA in the follow-up of interventional treatment of intracranial aneurysm at 1.5 T, using DSA as gold standard.@*Methods@#Patients with intracranial aneurysms who underwent coil embolization with or without stent were enrolled in this study. Both TOF MRA and zTE ASL MRA were performed on a 1.5T whole body scanner (MR360, GE, USA) equipped with an 8 channel head coil, and DSA was performed within one week of the MR examinations. Aneurysmal remnant and intra-stent opacity were analyzed. SE, PE, PPV, NPV of two MRA modalities in aneurysm recanalization detection were calculated. Kappa coefficient was used to determine the inter-reader and intra-reader reproducibility. Paired t test was used to test the visibility of in-stent lumen on two kinds of MRA.@*Results@#A total of 24 patients (27 aneurysms) were included in this study, 23 aneurysms were treated with stent assisted embolization, four coil embolization. Thirteen cases of aneurysm remnant were detected by DSA, 15 by zTE ASL and 11 by TOF MRA. zTE ASL MRA had a relatively higher SE (100%) and NPV(100%) as compared with TOF MRA. The Kappa value in identification of aneurysm remnant was 0.85 between zTE MRA and DSA and 0.70 between TOF MRA and DSA, respectively. The inter-reader reproducibility was good (Kappa 0.70), while the intra-reader reproducibility was excellent(Kappa 0.85). There was statistical significance in the scoring results of the in-stent lumen visibility.@*Conclusion@#zTE ASL MRA proved to be a better imaging modality as compared to TOF MRA to evaluate the endovascular treatment effectiveness of intracranial aneurysms, especially for assessing the aneurysmal recurrence and in-stent lumen visibility.
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Objective To investigate the safety and efficacy of endovascular reconstruction for ruptured and unruptured vertebral artery fusiform aneurysms (VAFAs).Methods The clinical,imaging and follow-up data of 26 consecutive patients with VAFA treated with endovascular reconstruction at the Department of Neurosurgery,Beijing Hospital between October 2009 and September 2017 were analyzed retrospectively.Results (1) Twenty-six patients had 26 VAFAs.Their age ranged from 38 to 69 years old.Nine patients had ruptured aneurysms and 17 had unruptured aneurysms.The diameter of the aneurysms ranged from 5 to 12 mm.The success rate of reconstruction technology was 100％.(2)In 9 patients of the rupture group,8 were embolized by stent-assisted coils,1 was treated with stent-assisted coil embolization alone.Five patients were treated with multiple-stent reconstruction and 4 were treated with stent reconstruction alone.Of the 17 patients in the unrupture group,13 were treated with stent-assisted embolization and 4 were treated with stent implantation alone;7 were treated with multiple-stent reconstruction,and 10 were treated with stent reconstruction alone.No perioperative complications occurred.(3) The patients were followed up for 8.0-97.5 months with a median time of 39.5 months.No new cerebral infarction or cerebral hemorrhage occurred.The patients with good prognosis (the modified Rankin scale scale 0-2) was 100％.Twenty-two patients were followed up for 3.5 to 34.0 months with a median time of 10.3 months.Fourteen patients (63.6％) were cured,4 (18.2％) were stable or improved,and 4 (18.2％) had recurrence;Five of 8 patients were cured in the rupture group;9 of 14 were cured in the unrupture group.There were 2 cases of relapse in each of the two groups.Conclusions Endovascular reconstruction for ruptured and unruptured VAFAs is clinically feasible and the safety is higher.The efficacy of mid-term and long-term follow-up is better.The recurrence rate of ruptured VAFAs has an increasing trend,and close follow-up is required after procedure.
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Objective To establish an animal model suitable for neurosurgeons for the comprehensive training of microvascular anastomosis using rat abdominal aorta and common iliac artery. Methods Twelve adult SD rats were selected,they were generally anesthetized and laparotomized.The abdominal aortas and bilateral common iliac arteries were exposed and fully separated.The lengths and diameters of abdominal aortas and common iliac arteries of each segment were measured.The end-to-end anastomosis were performed choosing the main trunk of the abdominal aorta without a branching artery and longer segment.The unilateral common iliac artery and the sacral median artery were used for end-to-side anastomosis.The bilateral common iliac arteries were used for end-to-side and side-to-side anastomosis.The micro Doppler ultrasound probe was used to detect the blood flow patency of each anastomotic stoma. Results Anatomical separation of the abdominal aortas and the common iliac arteries was successfully performed in 12 SD rats.Each rat could provide 4 vascular anastomosis exercises.The length of abdomen aorta trunk was 15.6 ± 2.5 mm and the diameter was 1.6 ±0.2 mm between the lower left renal artery and right iliolumbar artery.The side-to-side anastomosis was performed.The mean diameter of the median sacral arteries was 0.80 ±0.08 mm.After the fish mouth-like cutting,the end-to-side anastomosis of the right common iliac arteries were conducted.The lenth of left common iliac artery was 9.0 ± 1.5 mm,the diameter was 1.0 ± 0.1 mm,and was cut off at its origin and then the end-to-side anastomosis of the right common iliac arteries were conducted.After end-to-side anastomosis of bilateral common iliac arteries,its distal segment was arranged in parallel with a length of 5.1 ± 0.3 mm,and then the side-to-side anastomosis could be conducted. Conclusions The rat abdominal aorta and iliac artery model can be comprehensively used to simulate the commonly used neurosurgery bypass graft.It is suitable for neurosurgeons with a certain microsurgical basis to conduct a preliminary vascular anastomosis training.
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Walking assessment tools play an important role in assessing walking function,judging prognosis,and providing the basis for rehabilitation treatment for patients with stroke.Understanding the types,methods of use,and clinical significance of the walking function assessment tools are helpful for the assessment of walking function and development of rehabilitation strategies for patients with ischemic stroke.This article reviews the commonly used walking function assessment tools for patients with stroke.
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Objective To compare changes in indexes and analyze their values in prognosis of severe burn patients with sepsis.Methods A retrospective analysis was conducted. The patients with severe burn sepsis admitted to the Third Affiliated Hospital of Soochow University from August 2014 to December 2016 were enrolled. The blood culture was positive in the clinical diagnosis of sepsis. According to the prognosis, the patients were divided into death group and survival group. Their general information, vital signs, blood routine examination, serum sodium (Na+), serum glucose (Glu), C-reactive protein (CRP) and arterial partial pressure of carbon dioxide (PaCO2) at the time of admission and diagnosis of sepsis as well as the level of serum procalcitonin (PCT) at admission, diagnosis of sepsis and 1-8 days of post diagnosis were also compared. Receiver operating characteristic curve (ROC) was used to analyze the prognostic value of each index, and multivariate Cox regression analysis was used to analyze the influence of each index on the survival time, and the survival curve of Kaplan-Meier was analyzed for dead patients.Results There were 25 cases of severe burn patients with sepsis, which were admitted to hospital within 12 hours after injury; the time of diagnosis of burn sepsis was (14±6) days; 8 cases of survival; 17 cases died, the mortality rate was 68.0%, the time from diagnosis of sepsis to death was (28±14) days. The age of the death group was significantly higher than that of the survival group (years: 41±12 vs. 29±9,t = 2.598,P = 0.016), but there was no significant difference in the gender, total burn area,Ⅲ degree area, and the time of diagnosis of sepsis between the two groups. The platelet count (PLT) at the diagnosis of sepsis in death group was significantly lower than that of the survival group (×109/L: 69±43 vs. 180±108,t = -2.773, P = 0.023), and the PCT at 1-8 days of post-diagnosis in the death group was significantly higher than that of survival group [μg/L: 4.4 (2.2, 9.0) vs. 1.6 (0.7, 2.3),Z = -2.521,P = 0.012], but there was no significant difference in body temperature, heart rate, white blood cell count (WBC), percentage of neutrophils (Neu), Na+, Glu, CRP, PCT, PaCO2 at the time of admission and diagnosis of sepsis and PLT at the time of admission between the two groups. ROC curve analysis showed that the area under ROC curve (AUC) of age, PLT at the time of diagnosis and PCT at 1-8 days of post-diagnosis of sepsis was 0.808, 0.779, 0.825, respectively, for predicting the prognosis of patients with severe burn sepsis (allP < 0.05). At the cut-off age of 32, the sensitivity was 73.3% and the specificity was 75.0%. As the cut-off of PLT was 138×109/L at the time of diagnosis, the sensitivity was 92.3% and the specificity was 75.0%. As the cut-off of PCT was 2.39μg/L at 1-8 days of post-diagnosis of sepsis, the sensitivity was 73.3% and the specificity was 87.5%. Multivariate Cox regression analysis showed that age and PLT at the time of diagnosis were the favorable factors for the survival time of patients with severe burn sepsis (β value were -1.834, -0.029, respectively, bothP < 0.05). Kaplan-Meier survival analysis for patients in the death group showed that the median survival time of patients ≥32 years old was longer than that of patients < 32 years old (days: 32 vs. 9); 18-day cumulative survival rate was significantly higher than that of patients < 32 years old [83.3% (10/12) vs. 25.0% (1/4),χ2 = 9.705,P = 0.003].Conclusion Age, PLT at diagnosis of sepsis and PCT at 1-8 days after diagnosis of sepsis could be used as prognostic indexes for severe burn patients with sepsis.