ABSTRACT
Objective:To investigate the relationship between wall shear stress (WSS) and the degree of lumen stenosis and plaque characteristics in patients with atherosclerotic stenosis in the middle brain.Methods:Thirty-four patients with moderate to severe unilateral middle cerebral artery stenosis in Nanjing First Hospital from June 2020 to June 2021 were analyzed retrospectively. All patients underwent routine magnetic resonance imaging and vascular wall imaging to obtain plaque parameters such as plaque area, remodeling mode and remodeling index. Based on magnetic resonance angiography, a computational fluid dynamics model was established to simulate the local hemodynamics near the lesion and quantify WSS. The patients were divided into high WSS group and low WSS group according to the median WSS. The differences of clinical baseline data, degree of lumen stenosis and plaque characteristics between the two groups were compared. Pearson correlation analysis was used to calculate the correlation between WSS and lumen stenosis and plaque characteristics.Results:A total of 34 patients were included in this study, 17 in the high WSS group and 17 in the low WSS group. Compared with the low WSS group, the plasma homocysteine level in the high WSS group was lower [(11.10±4.96) μmol/L vs (16.97±6.98) μmol/L, t=-2.83, P=0.010], the degree of stenosis was lower (0.56±0.05 vs 0.66±0.08, t=-4.54, P<0.001), and the proportion of positive lumen remodeling was higher (12/17 vs 4/17, P=0.015). Pearson correlation analysis showed that the degree of lumen stenosis was negatively correlated with WSS ( r=-0.44, P=0.011), and the plaque area was not correlated with WSS. Conclusions:WSS in middle cerebral artery stenosis is related to the degree of lumen stenosis and the mode of vascular remodeling. Higher WSS has poor stability, but lower WSS is more likely to cause lumen stenosis.
ABSTRACT
Objective:To evaluate the safety and efficacy of a novel endoscopic anastomosis clip for the stomach perforation via an animal trial.Methods:Six pigs were used as experimental animals, and two perforation models (10-20 mm in diameter) were created by an endoscopic needle-knife in the stomach of each pig. The perforations were then closed by the novel detachable endoscopic anastomosis clip. The animal survival and healing of the lesions were recorded. All the clips were taken out 30 days after operation through endoscopy. Half of the animals were immediately after clip extraction and the other half of the animals survived for another 30 days owing to observation.Results:All clips were implanted successfully and all lesions healed during 30 days after the operation. All animals survived. The clip natural shedding rate was 33.3%(4/12), and the rest of clips were successfully disassembled and removed. All animals were alive 30 days after clip removal with lesions healed.Conclusion:The novel anastomosis clip is safe and effective in animal experiments with easy to operate. It could be recommended for further clinical research with good clinical prospect.
ABSTRACT
Intracranial atherosclerotic lesions are a common cause of ischemic stroke. Hemodynamics plays an important role in the formation and development of atherosclerosis and the risk assessment of clinical ischemic stroke events. As an evaluation method of cerebral hemodynamics, computational fluid dynamics can intuitively obtain hemodynamic parameters and provide valuable information for clinical diagnosis and treatment. This article reviews the application progress of computational fluid dynamics in evaluating peripheral hemodynamics of intracranial atherosclerotic lesions.
ABSTRACT
Objective:To investigate the correlation between the high-resolution magnetic resonance imaging (MRI) vessel wall characteristics and risk of ischemic stroke in patients with middle cerebral artery (MCA) atherosclerotic stenosis.Methods:Patients with ischemic cerebrovascular disease treated in the Department of Neurology, Nanjing First Hospital, Nanjing Medical University from January 2016 to January 2020 were enrolled prospectively. The patients presented with transient ischemic attack or acute ischemic stroke (AIS). Magnetic resonance angiography showed that the ipsilateral MCA had stenosis of 50%-99%, and it was identified as the responsible lesion. Routine MRI and the vessel wall imaging at the narrowest part of MCA were performed. The characteristics of vessels and plaques at MCA stenosis were compared between the AIS group and the non-AIS group. Multivariate logistic regression analysis was used to determine the independent risk factors for AIS. Receiver operating characteristic (ROC) curve was used to determine the predictive value of vessel wall characteristics for AIS. Results:A total of 65 patients with ischemic cerebrovascular disease and MCA stenosis were enrolled. The age of patients was 68±14 years, 50 were males (76.9%). There were 30 patients (46.2%) in the AIS group and 35 (53.8%) in the non-AIS group. There were no significant differences in demographic data, vascular risk factors and routine laboratory tests between the two groups. Compared with the non-AIS group, the narrowest lumen area in the AIS group (2.36±1.09 mm 2vs. 2.96±1.01 mm 2; t=2.274, P=0.027) was smaller, the plaque area (4.46 ±2.08 mm 2vs. 2.62±1.32 mm 2; t=4.315, P<0.001) was larger, the remodeling index (1.08±0.11 vs. 0.94±0.10; t=5.573, P<0.001) was higher, and the proportion of obvious enhanced plaque (63.3% vs. 11.4%; χ2=19.034, P<0.001) and positive remodeling plaque (80.0% vs. 20.0%; χ2=23.311, P<0.001) were higher. Multivariate logistic regression analysis showed that plaque area (odds ratio [ OR] 2.01, 95% confidence interval[ CI] 1.35-2.98; P=0.001), remodeling pattern ( OR 16.00, 95% CI 4.73-54.15; P=0.001), the narrowest lumen area ( OR 0.568, 95% CI 0.34-0.96; P=0.033) and degree of enhancement ( OR 21.85, 95% CI 5.13-93.00; P<0.001) were the independent risk factors for AIS. ROC curve analysis showed that the combination of plaque area, the narrowest lumen area and the degree of enhancement had the best prediction effect (area under the curve 0.927, 95% CI 0.84-0.96). Conclusion:AIS is more likely to occur when the plaque area at the narrowest part of the MCA is larger, the lumen area is smaller, and there is obvious plaque enhancement.
ABSTRACT
Objective To investigate the relationship between vascular remodeling patterns of atherosclerotic middle cerebral artery (MCA) stenosis and plaque enhancement.Methods From August 2015 to June 2016,patients with unilateral symptomatic atherosclerotic MCA stenosis underwent routine MRI and black blood magnetic resonance inaging examinations.The vessel area and lumen area of MCA at the site of atherosclerotic MCA stenosis were measured,and the degree of MCA stenosis and the remodeling index were calculated.Results A total of 33 patients were included.Eleven had obvious plaque enhancement,including 9 positive remodeling and 2 negative remodeling;22 did not have plaque enhancement,including 5 positive remodeling,5 no remodeling,and 12 negative remodeling.The obvious plaque enhancement group was mainly positive remodeling (81.8％ vs.22.7％),and the no obvious enhancement group was mainly negative remodeling (54.5％ vs.18.2％).The difference was statistically significant (P=0.018).Conclusion Plaque enhancement at the site of atherosclerotic MCA stenosis is mainly positive remodeling,which reflects plaque instability.
ABSTRACT
Objective To explore the difference of coronary artery lesions (CAL) in complete Kawasaki disease (cKD) and incomplete Kawasaki disease (iKD) in children. Methods The clinical data of 1514 hospitalized children with KD from January 2014 to December 2015 were retrospectively analyzed and compared between the children with cKD and those with iKD. The risk factors of CAL were analyzed. Results There were 1094 cases (72.3％) of cKD and 420 cases (27.7％) of iKD in 1514 children with KD. The incidence of CAL in all KD children was 51.9％. And the incidence of CAL in cKD group and iKD group was 57.2％and 37.9％, respectively, and there was statistical difference (P<0.01). The distribution of different degrees of CAL between cKD group and iKD group was statistically different (P<0.01). The incidence of echo enhancement or small coronary artery aneurysm in cKD group (50.4％) was higher, and the incidence of giant coronary artery aneurysm in iKD group (2.4％) was relatively higher. The incidence of thrombosis in iKD group was 3.3％, which was significantly higher than that in cKD group (0.6％) (P<0.001). The time when CAL was found first by clinical ultrasound echocardiography in cKD group and iKD group were 7.842.97 d and 8.472.89 d, respectively, and there was statistical difference (P<0.05). The most frequent involvement was left main trunk in CAL in children with KD. The proportion of simultaneous involvement of the left and right coronary arteries, only right stem involvement, and whole left coronary artery involvement in were significantly higher cKD group than those in iKD group, while the proportion of left main trunk involvement was significantly higher in iKD group than that in cKD group (all P<0.05). Male and iKD were the high risk factors for CAL, and intravenous infusion of immunoglobulin (IVIG) in 5～10 days of the course of disease was the protective factor for CAL. Conclusions CAL, especially giant coronary artery aneurysms and thrombosis, are more common in children with iKD. In iKD, the left coronary artery is mainly involved in CAL, and in cKD, the simultaneous involvement of left and right coronary arteries is the most common in CAL. Standard use of IVIG can reduce the occurrence of CAL.
ABSTRACT
Objective To evaluate the effective dose of dexmedetomidine (DEX) for prevention of emergence agitation (EA) after total intravenous anesthesia or sevoflurane anesthesia for preschool children undergoing a tonsillectomy.Methods 80 preschool children undergoing a selective tonsillectomy were randomly divided into 2 groups:intravenous group (total intravenous anesthesia,n =40) and inhalation group (sevoflurane inhaled anesthesias,n =40).According to the spot-slope method,intravenous group and inhalation group were randomly divided into 5 dose groups and given DEX in a geometric progression after induction.The EA,adverse effects,the pain score and the postoperative behavioral outcomes of each child in the two groups were recorded.Results The ED50s for prevention of EA were 0.28 μg/(kg · h) in intravenous group and 0.34 μg/(kg · h) in inhalation group.The duration of children's staying post-anesthesia care unit (PACU) and the incidence of pain were significantly greater in those with EA than those without (P ＜ 0.05),and the incidence of the postoperative behavioral outcomes were not statically different (P ＞ 0.05).No severe adverse reactions were observed in 95％ confidence limits.Conclusions 0.28 (0.22-0.35) μg/(kg · h) and 0.34 (0.27-0.43) μg/(kg · h) of DEX are safe and reliable for prevention of EA after intravenous anesthesia and sevoflurane anesthesia for preschool children undergoing a tonsillectomy.
ABSTRACT
Objective To investigate mRNA expressions of bcl-2-associated athanogene1 (BAG-1), epithelial growth factor receptor(EGFR)in triple negative breast cancer(TNBC). Methods Polymerase chain reaction (PCR) method was used to detect mRNA expression levels of BAG-1 and EGFR in 51 TNBC cases combined with adjacent tissues in Taihe Hospital of Shiyan City from October 2013 to August 2014, and the relationship between gene expression and the clinicopathologic parameters of TNBC patients was analyzed. Results The relative expressions of BAG-1 mRNA and EGFR mRNA were 0.57±0.25,0.61±0.21 respectively in TNBC. The expression level of mRNA in breast cancer (0.19±0.12, t = 5.12) was higher than that in adjacent tissues (0.21±0.11, t = 7.17), and there was no significant difference (P< 0.001). The difference of expressions of BAG-1 mRNA and EGFR mRNA in TNBC patients with different clinical stage or lymph node metastasis were statistically significant (all P< 0.05), but there was no significant difference in mRNA expression level of the patients with different tumor diameter or age (all P > 0.05). Conclusion BAG-1 mRNA, EGFR mRNA are highly expressed in TNBC, which may be related with the poor prognosis and may be a molecular index for predicting the prognosis of TNBC patients.
ABSTRACT
@#Covalent drugs are a type of inhibitors which exert their biological functions by irreversibly binding to the target through covalent bonds. With the marketing of kinase inhibitor covalent drugs against tumor, covalent drugs have regained the attention for drug discovery and have become a recent hotspot of anti-tumor drugs. In this paper, the action mechanisms, pharmacological advantages and the development strategies of modern covalent drugs are discussed and the recent research progress of anti-tumor covalent inhibitors is summarized, which provides a reference for the design of new anti-tumor covalent drugs.
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of submucosal tunneling endoscopic septum division (STESD) for escophageal diverticulum.</p><p><b>METHODS</b>Clinical data of six consecutive patients with symptomatic esophageal diverticula who received STESD in Endoscopy Center of Zhongshan Hospital, Fudan University from April 2016 to November 2016 were analyzed retrospectively. STESD was performed as following: mucosal entry was made 3 cm from the septum of esophageal diverticulum; submucosal tunnel was created towards the septum; after the satisfactory exposure of the septum, endoscopic division was made down to the bottom of the diverticulum; mucosal closure of the tunnel entry was made. The symptoms were scored using a system modified according to Eckardt score, namely dysphagia, heartburn, regurgitation, weight loss and retrosternal pain with each ranging from 0 to 3 (maximum score 15, minimum score 0, the higher the score, the more severe the symptoms).</p><p><b>RESULTS</b>There were four males and two females with median age of 56.5 (range 50-67) years. Four patients were epiphrenic diverticula, and the other two were Zenker's diverticula. Median duration of disease was 2.5 years (range 5 months-29 years). No previous treatment was attempted. All the patients completed STESD successfully. The median septum division length was 2.5(1-4) cm. The median number of metallic clips for mucosal closure was 5(2-6). The median operation time was 51.5 (33-135) min. No major adverse events, such as perforation or bleeding were found in perioperative period. The median time of hospital stay was 5(3-9) days. All the patients had symptom relief after operation. One patient with Zenker's diverticulum reported foreign body sensation after operation and experienced relief two weeks afterwards. During a median follow-up time of 5(4-10) months, the median symptom score of 6 cases was 4.5 (1-13) before and 0.5 (0-4) after operation. The symptom scores went down to zero in 3 patients (preoperative scores 13, 1, 1, respectively), and down to 1 in 2 patients with main symptom of backflow (preoperative scores 5, 4, respectively). One patient with 29 years history of disease did not report obvious improvement in symptoms (preoperative and postoperative scores 5, 4, respectively).</p><p><b>CONCLUSION</b>Submucosal tunneling endoscopic septum division is efficient and safe to relieve symptomatic esophageal diverticulum in short term.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Diverticulum, Esophageal , General Surgery , Endoscopy, Digestive System , Methods , Length of Stay , Mucous Membrane , Operative Time , Perioperative Period , Retrospective Studies , Surgical Instruments , Treatment Outcome , Video-Assisted Surgery , Methods , Zenker Diverticulum , General SurgeryABSTRACT
Sina 21 century it have seen major leaps in the understanding of the molecular genetic mutations that act as drivers of acute myeloid leukemia (AML). Clinical trials of targeted drugs against specific mutant proteins, such as FLT3-internal tandem duplications (ITD) and isocitrate dehydrogenase mutations (IDH) are ongoing. This review discusses agents in clinical trials that target specific gene mutations and/or epigenetic targets from the 57th American Society of Hematology annual meeting.
ABSTRACT
Great advances have been made in understanding the pathogenesis,diagnosis,risk stratification and treatment of classic bcr-abl-negative myeloproliferative neoplasms (MPN).This article reviews current situation in the treatment of these MPNs presented in the 56th American Society of Hematology (ASH) annual meeting.
ABSTRACT
Acute myeloid leukemia (AML) is a kind of genetic heterogeneous clonal hematopoietic stem cell disorder.Although there were improvements in the outcomes of selected younger patients and those with specific cytogenetic and molecular genetic characteristics,the overall survival for older patients remains dismal.In the last few years,next-generation sequencing technologies have identified recurrent mutations in genes encoding proteins involved in the epigenetic regulation of transcription in most patients with AML.This discovery has led to new insights into the role of the epigenome in AML and opens the possibility of epigenetically targeted therapies.This article will review the most important recurrent mutations in epigenetic regulatory genes and highlight the current and future treatment strategies that attempt to exploit epigenetic targets with the use of hypomethylating agents,which were reported on the 56th American Society of Hematology annual congress in 2014.
ABSTRACT
Primary myelofibrosis is a kind of chronic myeloproliferative neoplasms.The discovery of the JAK2V617F mutation as well as other molecular abnormlities underly the pathogenesis of Philadelphia negative myeloproliferative neoplasms (MPN).The initial description of JAK2V617F mutation in 2005,the reporting of calreticulin (CALR) mutations last year and the clinical application of JAK inhibitors,showed the gradually deepening understanding with regard to the pathogenesis and the development of therapeutic strategies for primary myelofibrosis (PMF).This article reviewed the progress in diagnosis,risk stratification of of PMF,the benefits and potential side effect of JAK inhibitors,which reported on the 2014 European Hematology Association annual congress.
ABSTRACT
The virtual colonoscopy, virtual flattening and virtual splitting method are enhanced by the GPGPU model. The novel virtual eversion method is integrated for fast polyp detection. The experimental result showed that the system and various visualization methods can represent the colon inner-surface clearly and exactly, supporting real-time man-machine interaction. The proposed system is promising in human gastrointestinal cancer and polyp inspection.
Subject(s)
Humans , Colonic Polyps , Diagnosis , Colonography, Computed Tomographic , Methods , Imaging, Three-Dimensional , Software Design , Tomography, X-Ray ComputedABSTRACT
The proposed automatic section method achieves accurate automatic section on colon outer surface centerline and evert the colon, by calculating the centerline windowed average curvature. The method is validated on CT colon datasets, and experimental results show that the sectioned virtual eversion facilitates colon visualization and analysis.
Subject(s)
Humans , Colon , Diagnostic Imaging , Pathology , Colonography, Computed Tomographic , Methods , Imaging, Three-Dimensional , Methods , Phantoms, Imaging , User-Computer InterfaceABSTRACT
Objective To discuss the matching method of irregular device for radiological equipment. Method Related experiences were summed up. Result A set of interventional protective device matching DSA was developed through tripartite corporation. Conclusion The matching method is beneficial to equipment management.