ABSTRACT
Objective:To investigate the predictors of clinically important stress-related gastrointestinal bleeding (CIS-GIB) after acute stroke and their impact on short-term outcome.Methods:Consecutive acute stroke patients diagnosed as stress ulcer (SU) and admitted to Beijing Friendship Hospital from January 1, 2016 to January 1, 2020 were enrolled retrospectively. The primary outcome event was CIS-GIB and was defined as dominant gastrointestinal bleeding and corresponding clinical manifestations occurred within 24 h after bleeding. The second outcome event was the short-term clinical outcome assessed by the modified Rankin Scale score at 14 d after onset, and ≤2 was defined as a good outcome. Multivariate logistic regression model was used to analyze the independent influencing factors of CIS-GIB and short-term outcome. Results:A total of 96 patients with post-stroke SU were included, accounting for 2.5% (96/3 819) of all patients with acute stroke; among them, 16 patients (16.7%) developed CIS-GIB, accounting for 0.4% (16/3 819) of all patients with acute stroke. Among the included patients, there were 27 women (29.2%), with a median age of 70 years (interquartile range, 62-79 years). The median National Institutes of Health Stroke Scale (NIHSS) score was 8 (interquartile range, 3-17), and a median time interval between SU and the index stroke event was 2 d (interquartile range, 1-5 days). Compared with the non-CIS-GIB group, the baseline NIHSS score and the proportion of patients with supratentorial stroke were higher, the time interval between SU and the index stroke event was longer, the proportion of patients with coagulation dysfunction, using nasogastric tube and ventilator, receiving gastrointestinal invasive hemostasis and erythrocyte component transfusion were higher, and the risks of poor outcome and death were higher in the CIS-GIB group (all P<0.05). Multivariate logistic regression analysis showed that the baseline NIHSS score (odds ratio [ OR] 1.146, 95% confidence interval [ CI] 1.029-1.275; P=0.013), glycosylated hemoglobin ( OR 1.567, 95% CI 1.025-2.395; P=0.038), history of chronic gastric diseases ( OR 24.900, 95% CI 1.446-428.728; P=0.027), supratentorial stroke ( OR 5.701, 95% CI 1.002-32.443; P=0.050) and activated partial thromboplastin time ≥34.0 s ( OR 11.036, 95% CI 1.154-105.560; P=0.037) were the independent risk factors for CIS-GIB; the baseline NIHSS score was an independent influencing factor for poor outcome ( OR 1.366, 95% CI 1.029-1.812; P=0.031). Conclusion:The incidence of CIS-GIB in patients with acute stroke is about 0.4%, which significantly increases the risk of short-term adverse outcome. High glycosylated hemoglobin level, prolonged activated partial thromboplastin time, high baseline NIHSS score, supratentorial stroke and history of chronic gastric diseases are the independent risk factors for CIS-GIB.
ABSTRACT
Heparanase (Hpa) is the only β-D-glucuronidase of degading heparan sulfate proteoglycans in the body of mammalian.Studies have confirmed that Hpa accelerates angiogenesis in multiple physiopathological processes; however there are still a few studies about the expression and role of Hpa after cerebral ischemia.This article mainly introduces the relation between Hpa and angiogenesis after cerebral ischemia.
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<p><b>OBJECTIVE</b>To determine the level of neurohormonal operative stress response-reactive protein (CRP) and rest energy expenditure (REE) after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC).</p><p><b>METHODS</b>Twenty-six consecutive patients with noncomplicated gallstones were randomized for LC (n = 14) and OC (n = 12). Plasma concentrations of somatotropin, insulin, cortisol and CRP were measured. The levels of REE were also measured.</p><p><b>RESULTS</b>On the third postoperative day, the insulin levels were lower than those before operation (P < 0.05). On the first postoperative day, the levels of somatotropin and cortisol were higher in OC than in LC. After operation, the parameters of somatotropin, CRP and cortisol increased compared to the preoperative period in all patients (P < 0.05). On the all-postoperative day, the CRP levels were higher in OC than in LC (P < 0.05). After operation, the REE level increased in OC and LC (P < 0.05). On the all-postoperative day, the REE levels were higher in OC than in LC (P < 0.05).</p><p><b>CONCLUSIONS</b>LC results in less prominent stress response and smaller metabolic interference compared to open surgery. These benefit the restoration of stress hormones, nitrogen balance, and energy metabolism. However, LC can also induce acidemia and pulmonary hypoperfusion because of pneumoperitoneum during surgery.</p>