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Objective To analyze characteristics and clinical significance of affected and unaffected side plaques in patients with symptomatic middle cerebral artery (MCA) atherosclerosis by three dimensional-sampling perfection with application optimized contrasts using different flip angle evolutions (3D-SPACE) of 3.0 T high-resolution magnetic resonance imaging (MRI).Methods During the period from September 2016 to June 2017,31 patients admitted to the Peking University Aerospace School of Clinical Medicine were enrolled in this study.Routine MRI and high-resolution MRI were performed respectively.Patient's affected and unaffected sides were distinguished based on the conventional MRI on the presence or absence of signs of ischemia.The characteristics of bilateral MCA plaques were studied by high-resolution MRI 3D-SPACE sequences.The stenosis rate,plaque load,eccentricity index were quantitatively analyzed,and the degree of plaque enhancement and remodeling were qualitatively analyzed.Results Thirty-one MCAs in affected and unaffected sides were respectively collected,and 124 MCA plaques and reference plane images were obtained.Among all the patients,tihe MCA in unaffected side was larger in lumen area and had atherosclerotic plaques,and some MCAs had varying degrees of thickening of the wall.The stenosis rate,plaque burden and significantly enhanced plaque proportion of MCA in affected side were significantly higher than those in unaffected side (stenosis rate:76.2％ ± 11.5％ vs 51.7％ ± 13.1％,t =7.801,P＜0.01;plaque burden:81.6％ ±8.0％ vs 56.7％ ±13.9％,t =8.614,P＜0.01;significantly enhanced plaque proportion:50.0％ (13/26) vs 0 (0/26),x2 =17.333,P＜ 0.01).There was no statistically significant difference in plaque distribution between the two sides.Positive remodeling blood vessels had more vessel area than negative remodeling blood vessels ((13.8 ± 2.9) mm2 vs (11.3 ± 2.8)mm2,t =2.389,P =0.024).Conclusion The high resolution MRI 3D-SPACE sequence clearly shows the MCA wall and plague,and can analyze the enhancement degree and morphological features of affected and unaffected side atherosclerotic plaques simultaneously,thus it is beneficial for risk stratification assessment and individualized treatment for stroke Patients in clinical practice.
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Objective To study the risk of bloodstream infection in relation with peripherally inserted central venous catheter (PICC) in hospitalized non-cancer patients.Methods Clinical data of 172 non-cancer patients admitted to our hospital for PICC were collected.The risk of PICC-related bloodstream infection (CRBSI) in domestic hospitalized non-cancer patients was analyzed and systematically assessed.Results Of the 183 PICCs placed in 172 patients included in this study,61.7％ were placed in general wards,38.3％ were placed in ICU,87.8％ were placed in combination with indwelling urinary catheter,29.7％ were placed in combination with mechanical ventilation.The median PICC indwelling time was 35 days.CRBSI occurred in 6 patients with an incidence of 0.6/1000 PICCs/day.The risk of CRBSI was centralized in domestic tumor patients after PICC.The reported CRBSI was significantly different in hospitalized non-cancer patients (0.26-33.10/100 PICC).Conclusion The risk of CRBSI is lower in hospitalized patients after PICC placement than after traditional central venous catheter placement.Further studies are needed to assess its value in ICU.
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Objective To investigate the application value of high-resolution magnetic resonance imaging (HR-MRI) as an auxiliary means to evaluate the atherosclerotic stenosis of middle cerebral artery (MCA) before endovascular intervention.Methods Patients with the new infarction or transient ischemic attack in the MCA territories were examined with HR-MRI and digital subtraction angiography (DSA).HR-MRI was used to study the characteristics of atherosclerotic plaques of MCA,qualitatively analyze vascular stenosis rate and plaque load,and qualitatively analyze the plaque location,enhancement degree,and remodeling pattern.The results of HR-MRI examination were used to guide the selection of treatment methods,and the perioperative complications and 3-month outcome of patients treated with intravascular interventional therapy were statistically analyzed.Correlation analysis and consistent evaluation of MCA stenosis rate and stenosis degree measured by DSA and HR-MRI were conducted.Results Atherosclerotic plaques and luminal stenosis in the MCA were found in 25 patients.Among them,13 (52.0％) had positive remodeling,10 (40.0％) had negative remodeling,and 8 (32.0％) had plaques on the sides of perforator arteries.Of the 17 patients who underwent enhanced scan,11 (64.7％) had mild enhancement and 6 (36.3％) had obvious enhancement.Six patients (24％) were treated with endovascular treatment without perioperative complications.Five patients had good outcome and 1 had poor outcome.The stenosis rates of MCA measured by DSA and HR-MRI were 68.05％ ± 21.65％ and 70.9％ ± 20.7％,respectively (t =1.673,P=0.107).The two methods had good correlation (r=0.917,P＜ 0.001).In addition,in the diagnosis of mild (P =0.500),moderate (P =0.063) and severe (P =0.250) stenoses,DSA and HR-MRI also had good consistency.Conclusion HR-MRI can clearly show the characteristics of the middle cerebral artery lumen and plaque.As a preoperative evaluation means for assisted endovascular treatment of atherosclerotic stenosis,it has an important application value.
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Objective To evaluate the effect of different doses of aspirin on the platelet inhibition rate by thremboelastography.Methods One hundred and eighty patients with ischemic stroke or transient cerebral ischemic attack (TIA) were randomly divided into aspirin 100 mg/d group (60 patients),aspirin 200 mg/d group (60 patients) and aspirin 300 mg/d group (60 patients) according to the order of treatment.The platelet inhibition rate which arachidonic acid pathway induced was measured by thromboelastography and compared at different time points (before medication; 7 days,6 months,1 year after medication).Results There were significant differences in the platelet inhibition rate after medication at different time points compared with that before medication in three groups (P ＜ 0.05).After medication at different time points,the platelet inhibition rate of aspirin 100 mg/d group and aspirin 200 mg/d group was gradually decreasing.On the contrary,that of the aspirin 300 mg/d group showed gradually increasing.Cross-sectional comparison of the three groups at different time points showed that there was no significant difference in the platelet inhibition rate among three groups before medication,7 days,6 months after medication (P ＞ 0.05).However,there was significant difference at 1 year after medication (P ＜ 0.05).The platelet inhibition rate inaspirin 300 mg/d group [(93.8 ± 18.6)％] was higher than that in aspirin 200 mg/d group [(83.7 ± 11.2)％]and aspirin 100 mg/d group [(76.6 ± 12.8)％] (P ＜ 0.05).During medication there were 9 patients of less than 50％ platelet inhibition rate in aspirin 100 mg/d group,5 patients in aspirin 200 mg/d group,3 patients in aspirin 300 mg/d group,and 2 patients of peptic ulcer bleeding in aspirin 300 mg/d group.Conclusions The appropriate dose of aspirin (100,200,300 mg/d) can play a very good anti-platelet effect.Increasing the dose on the basis of 100 mg/d,the platelet inhibition rate shows no increase in the short-term (≤6 months),but in the long-term (1 year) there may be differences.It may be associated with less aspirin resistance and the relative increasing bleeding risk.
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To analyze the clinical effects and safety of carotid endarterectomy [CEA] and carotid artery stenting [CA5] in the treatment of high-risk carotid stenosis patients. Total 63 patients who underwent CEA or CAS in our hospitals from January 2007 to December 2012 were selected in this study, and were randomly divided into an observation group and a control group. The patients in the observation group were subjected to CAS and those in the control group were subjected to CEA to compare the primary and secondary endpoints of the treatment. The arrival rates of the primary and secondary endpoints were 7.14% and 10.71% respectively in the observation group, while those were 11.43% and 11.43% respectively in the control group. There were no significant differences in the arrival rates of primary and secondary endpoints between the two groups [P > 0.05]. The efficacies and safety of CAS and CEA are similar in treating high-risk carotid stenosis patients
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@#Objective To observe the effect of low frequency electrical stimulation on dysphagia after stroke. Methods 60 patients with dysphagia after stroke were divided into treatment group and control group with 30 cases in each group. The control group was treated with swallowing exercise, while the treatment group was treated with low frequency electrical stimulation in addition. They were assessed with Fujishima's swallowing evaluation before and after treatment. Results The score increased after treatment in both groups (P<0.05), and increased more in the treatment group than in the control group (P<0.05). Conclusion Low frequency electrical stimulation can improve the effects of swallowing exercise on dysphagia after stroke.
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Many studies have shown that experimental umbilical cord blood stem calls are even more primitive, more self-renewal, differentiation and reproductive potential of ex vivo expansion than bone marrow stem cells and peripheral blood stem calls. The preservation of cord blood stem cells and umbilical cord blood transplantation, and other clinical applications have made significant progress, but blood is also facing many problems. This article reviewed a variety of cord blood stem/progenitor calls of the biological characteristics of liver calls proliferation, differentiation, and the building of umbilical cord blood bank of neurology in clinical application.
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0.05).Conclusions There is a high incidence of the plaque in ECCA in patients with ICVD. The higher-grade stenosis of carotid artery may be related to soft plaque and mixed plaque, the plaque rupture is concerned with in the incidence of ischemic stroke. The diagnostic information about atherosclerotic plaque in one carotid artery can be used to infer information about atherosclerosis severity degree in contralateral artery.Color-Doppler ultrasound examination for ECCA had important reference value for estimating atherosclerosis severity degree in ECCA in patients with ICVD of carotid artery system and the pathogenesis of ischemic stroke.