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Objective:To evaluate the safety and feasibility of endovascular recanalization for non-acute internal carotid artery occlusion (NA-ICAO), and to propose a new angiographic classification.Methods:From April 2015 to October 2019, 95 consecutive patients with symptomatic NA-ICAO who received endovascular recanalization were retrospectively analyzed in Beijing Tiantan Hospital, Capital Medical University. All the patients were divided into four groups according to DSA: type Ⅰ, petrous segments were distally reconstituted by collateral vessels; type Ⅱ, cavernous segments were distally reconstituted by collateral vessels; type Ⅲ, ophthalmic segments were distally reconstituted by collateral vessels; type Ⅳ, communicating segments were distally reconstituted by collateral vessels. Study data including clinical characteristics, surgical details, lesion classification, recanalization rate and perioperative complications. For the counting data, the χ 2 test was used to compare between groups. For the quantitative data, the ANOVA was used for the normal distribution data, otherwise the Kruskal-Wallis H test was used. The primary safety outcome was any stroke or death within 30 days. Results:Among the 95 patients, 67 (70.53%) had successful recanalization. The recanalization rates of type Ⅰ－Ⅳ were 92.31% (36/39), 81.82% (18/22), 47.83% (11/23) and 18.18% (2/11) respectively (χ2=29.557, P<0.001). And the complication rates of the four types were 5.13% (2/39), 13.64% (3/22), 21.74% (5/23) and 9.10% (1/11) respectively. The incidence of perioperative ischemic stroke was 2.11% (2/95). No other serious stroke and death occurred. Conclusions:Endovascular recanalization may be feasible and safe for carefully selected patients with NA-ICAO and therefore represents an alternative treatment. The patients with type Ⅰ and Ⅱ lesions had higher recanalization rates, while the patients with type Ⅳ lesions had significantly lower recalculation rate. The new angiographic classification is conducive to the selection of suitable patients and difficulty in grading.
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Objective:To compare the safety and therapeutic effect of bridging therapy versus direct endovascular treatment in patients with acute ischemic stroke(AIS)aged 80 years and over, who received the therapy within 4.5 h of onset.Methods:A total of 89 AIS patients aged 80 years and over receiving the endovascular therapy at our hospital from January 2016 to June 2019 were studied with versus without intravenous thrombolysis before endovascular therapy(the former as bridging therapy group, n=49; the latter as the direct endovascular treatment group, n=40). Baseline information including gender, the modified Rankin scale(mRS)score, medical history, smoking history, preoperative national institute of health stroke scale(NIHSS)score were collected.Clinical data related to the operation including the times from onset to hospital, door-to-puncture and door-to-recanalization, complications(symptomatic cerebral hemorrhage, mortality)and mRS at 90 d after treatment were compared between the two groups.Multiple logistic regression analysis was used to determine whether or not bridging therapy with intravenous thrombolysis was a prognostic factor.Results:There was no significant difference in baseline information between the two groups( P>0.05). The times from onset to hospital, door-to-puncture, door-to-recanalization had no significant difference between the two groups( P>0.05). There was no significant difference in the incidence of symptomatic cerebral hemorrhage and mortality within 90 d between the two groups(26.5% or 13 cases vs. 17.5% or 7 cases, 14.3% or 7 cases vs.7.5% or 3 cases, χ2=1.031 and 1.017, P=0.310 and 0.313). With different clinical outcomes as dependent variables, after adjusting factors such as gender, admission NIHSS and medical history, Logistic regression analysis showed that the bridging therapy with intravenous thrombolysis was not a prognostic factor( OR=0.795, 95% CI: 0.280~2.258, P=0.666). Conclusions:The bridging therapy is as safe and effective as the direct intravascular therapy for AIS patients aged 80 and over within 4.5 hours of onset.The intravenous thrombolysis should be given as soon as possible within time window.
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Objective@#To evaluate the safety and therapeutic efficacy of clinical pathways(CP)for cerebral infarction in patients aged 75 years and above.@*Methods@#A cohort of 363 cerebral infarction patients aged 75 years and above after excluding clinical variants were recruited from January 2016 to June 2018 at the neurology department of Nanyang City Center Hospital.Patients were randomly divided into the CP group(n=184)and the control group(n=179). The day-90 modified Rankin scale score(mRS), mortality, incidences of complications, length of hospital stay, total hospital costs and drug costs were compared between the two groups.@*Results@#The proportion of patients with mRS 0-1 was higher in the CP group than in the control group(77.2% or 142/184 vs.55.3% or 99/179, χ2=19.443, P=0.000). The incidences of pulmonary infection(23.9%, 44/184)and deep venous thrombosis(14.7%, 27/184)were lower in the CP group than in the control group(42.5%, 76/179 & 29.1%, 52/179; χ2=14.101, 11.014, P=0.000, 0.001). There was a significant difference in mortality between the two groups[4.9%(9/184)vs.11.2%(20/179), χ2=4.871, P=0.027]. There was no significant difference in the other incidences of complications between the groups(P>0.05). Hospital stay length(18.3±2.9) d, total cost(2.72±0.42)×104 yuan, and drug cost(0.87±0.29)×104 yuan in the clinical pathway group were lower than those in the control group[(22.8±4.4)d, (3.55±0.81)×104 yuan, (1.42±0.29)×104 yuan](t=11.546, 12.168 and 18.335, all P=0.000).@*Conclusions@#The adoption of clinical pathways can improve medical quality, shorten hospitalization days and reduce hospitalization costs and medical costs in elderly patients with cerebral infarction.
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Objective To evaluate the safety and therapeutic efficacy of clinical pathways(CP) for cerebral infarction in patients aged 75 years and above.Methods A cohort of 363 cerebral infarction patients aged 75 years and above after excluding clinical variants were recruited from January 2016 to June 2018 at the neurology department of Nanyang City Center Hospital.Patients were randomly divided into the CP group(n=184)and the control group(n=179).The day-90 modified Rankin scale score(mRS),mortality,incidences of complications,length of hospital stay,total hospital costs and drug costs were compared between the two groups.Results The proportion of patients with mRS 0-1 was higher in the CP group than in the control group(77.2％ or 142/184 vs.55.3％ or 99/179,x2=19.443,P =0.000).The incidences of pulmonary infection(23.9％,44/184)and deep venous thrombosis(14.7 ％,27/184)were lower in the CP group than in the control group(42.5 ％,76/179 & 29.1％,52/179;x2 =14.101,11.014,P=0.000,0.001).There was a significant difference in mortality between the two groups[4.9％ (9/184)vs.11.2％ (20/179),x2 =4.871,P =0.027].There was no significant difference in the other incidences of complications between the groups(P ＞ 0.05).Hospital stay length (18.3 ± 2.9) d,total cost (2.72 ± 0.42) × 104 yuan,and drug cost (0.87±0.29)× 104yuan in the clinical pathway group were lower than those in the control group [(22.8±4.4)d,(3.55±0.81) × 104 yuan,(1.42±0.29) × 104 yuan](t =11.546,12.168 and 18.335,all P =0.000).Conclusions The adoption of clinical pathways can improve medical quality,shorten hospitalization days and reduce hospitalization costs and medical costs in elderly patients with cerebral infarction.
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Objective To evaluate the safety and therapeutic effects of stent retriever-based thrombectomy (SRT) on acute ischemic stroke (AIS) in patients aged 80 years and older.Methods A cohort of 157 AIS patients hospitalized in Capital Medical University Affiliated Beijing Tiantan Hospital were selected for SRT from January 2016 to May 2017.Based on the age,all patients were divided into two groups:groups aged ＜ 80 years and ≥ 80 years.Baseline information including gender,the Modified Rankin Scale (mRS) score,past medical history,smoking history,preoperative National Institutes of Health Stroke Scale (NIHSS),the Alberta Stroke Program Early CT Scores (ASPECTS),intravenous thrombolysis and clinical outcomes were compared between two groups.The informations related to the operation,including time from onset to hospital,door-to-needle puncture time,door-to-recanalization time,SRT complications (symptomatic cerebral hemorrhage,mortality) and good outcome,were compared between two groups.Logistic regression analysis was used to determine whether the age of 80 years and over was a risk factor for adverse prognosis after SRT.Results There were 130 patients in the group ＜ 80 years of age,and 27 patients in the group ≥80 years.No significant differences were found in baseline information between the two groups (all P＞ 0.05).In addition,there were no significant differences in the proportions of the operative information,complications of SRT and the good outcome (all P＞0.05).Furthermore,advanced age (≥80 years) was not a risk factor for adverse outcome after SRT (OR =0.738,95％ CI:0.300-1.813).Conclusions Stent retriever-based thrombectomy is safe and beneficial for patients with acute ischemic stroke,even in patients aged 80 years and over.
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Objective To evaluate the safety,effectiveness,and middle or long-term efficacy of endovascular stenting of internal carotid artery stenosis at the cavernous segment. Methods Thirty-two patients underwent endovascular stenting at the cavernous segment of internal carotid artery from January 2012 to February 2015 were enrolled retrospectively. Angioplasty and stenting were conducted using Apollo or Winspan stent system. The improvement of internal carotid artery cavernous segment stenosis and perioperative safety and the results of the medium and long-term follow-up of the 2 kinds of stents were observed. Results All the 32 patients achieved technical success. The symptoms of cerebral ischemia of the patients were relieved significantly. The length of the stenosis at cavernous segment of the internal carotid artery was 4 to 13 mm (mean,7. 2 ±2. 9 mm). The stenosis rate from 82 ± 7% before treatment decreased to the 24 ± 7% . One patient had perioperative complication (4. 7%),26 of them were followed up with DSA,and 6 were lost to follow-up. The follow-up period ranged from 7 to 29 months (mean,16 ± 7 months). During the follow-up period,1 patient had intracerebral hemorrhage,1 had cerebral infarction,and none of them died. Four patients had in-stent restenosis,three of them used Winspan stents, and 1 used Apollo stents. Conclusion The patients should be screened strictly,particularly paying attention to the length of lesions. Endovascular stent angioplasty for the treatment of internal carotid artery cavernous segment stenosis is a safe and effective method.
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<p><b>OBJECTIVE</b>To study the effect and possible impact mechanism of salidroside on cognitive ability of Alzheimer's disease (AD) model rats induced by amyloid beta peptide (Abeta1-40).</p><p><b>METHOD</b>Abeta1-40 was injected into bilateral hippocampus to create the AD model. Afterwards, different doses of salidroside (25, 50, 75 mg x kg(-1)) were orally administered for 21 days. Rats' learning and memory abilities were detected by Morris water maze testing system. The levels of the superoxide dismutase (SOD), malondialdehyde (MDA), and the expression of nuclear factor-kappaB (NF-kappaB), inducible nitric oxide synthase (iNOS) and receptor for advanced glycation end products (RAGE) protein in hippocampus were also detected by different methods.</p><p><b>RESULT</b>The place navigation test showed longer escape latency, low frequency of platform quadrant crossing per unit time, damage in learning capacity, significant decrease in SOD acivity in hippocampus, notable increase in MDA content, NF-kappaB, iNOS and RAGE protein expressions in rats. Salidroside (50, 75 mg x kg(-1)) significantly alleviated the impairments of learning and memory ability. The activity of SOD increased in salidroside (50 droside group compared with that of the Alzheimer's disease group (P < 0.01).</p><p><b>CONCLUSION</b>Salidroside may treat Alzheimer's disease by inhibiting the oxidative stress.</p>
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Animals , Male , Rats , Alzheimer Disease , Drug Therapy , Amyloid beta-Peptides , Toxicity , Cognition , Disease Models, Animal , Glucosides , Pharmacology , Therapeutic Uses , Maze Learning , NF-kappa B , Metabolism , Nitric Oxide , Physiology , Phenols , Pharmacology , Therapeutic Uses , Receptor for Advanced Glycation End Products , Receptors, Immunologic , Superoxide Dismutase , MetabolismABSTRACT
By analyzing several aspects of the problem of traditional Chinese medicine injection on basic research, quality standards, production technology and clinical application, put forward content and steps of re-evaluation of traditional Chinese medicine injection.
Subject(s)
Humans , Biomedical Research , Drug Evaluation , Drug-Related Side Effects and Adverse Reactions , Drugs, Chinese Herbal , Therapeutic Uses , Longitudinal Studies , Medicine, Chinese Traditional , Economics , Methods , Public Sector , Research DesignABSTRACT
Objective To elucidate the features of the expression of P53,proliferation and apoptosis in gestational trophoblastic tumor(GTT).Methods Ten cases of normal placenta,10 cases of complete hydatidiform mole(CM),20 cases of invasive hydatidiform mole(IM)and 19 cases of choriocarcinoma(CCA)paraffin-embedded tissues were studied.P53 and PCNA were detected with immunohistochemistry,apoptosis was detected with terminal deoxy-nucleotidyl transferase-mediated dUTP-biotin nick end labeling(TUNEL).Results In NP,CM,IM and CCA,the P53 indexes(P53-Ⅰ)were 4.12%,21.68%,39.61% and 27.39% respectively with significant differences among them(P