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Objective To explore the perioperative nursing method and effect of doing minimal invasive occlusion to children with congenital heart disease via subaxillary incision.Methods The data of 86 children patients with congenital heart disease underwent minimally invasive occlusion via right subaxillary incision were retrospectively analyzed and summarized nursing points including preoperative and postoperative mental nursing,postoperative postural care and sedative care,observing whether the occluder moved or detached and mechanical hemolysis,monitoring ECG and blood pressure,and preventing hemorrhage and thrombogenesis.Results One case of infracristal ventricular septal defect with frequent premature ventricular beat after occlusion was converted to thoracotomy surgery;one case of mixed atrial septal defect with heart rate increasing and dyspnea after 12 hours of occlusion was found occluder detached and immediately converted to remove the occluder and fix the atrial septal defect;The other children were successfully recovered and been discharged.Conclusions Full understanding and strengthened perioperative nursing care of complications of children with congenital heart disease after surgical minimally-invasive surgical closure is the key point to avoid the occurrence of fatal complications and ensure the children recover safely and smoothly.
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Objective To assess the risk assessment of stroke associated pneumonia (SAP ) in patients with ischemic stroke using A2DS2 score.Methods A total of 1279 patients with ischemic stroke who were admitted and treated in our department from 2009 to 201 1 were retrospectively analyzed and applicated A2DS2 score.A2DS2 score was calculated as follows:Age ≥75 years=1,atrial fibrillation=1, dysphagia=2,male sex=1;stroke severity:NIHSS score 0-4=0,5-15 =3,≥16=5.The patients were divided into three groups according to A2DS2 score:620 in score 0 group,383 in score 1-9 group,276 in score ≥10 group.The three groups were comparatively analyzed.The diagnostic criteria for SAP were as follows:newly emerging lesions or progressively infiltrating lesions in post-stroke chest images combined with more than two of the following clinical symptoms of infection:(1 )fever ≥38 ℃;(2 )newly occurred cough,productive cough or exacerbation of preexisting respiratory tract symptoms with or without chest pain;(3)signs of pulmonary consolidation and/or moist rales;(4)peripheral white blood cell count≥10 ×109 L -1 or≤4 ×109 L-1 with or without nuclear shift to left,while excluding some diseases with similar clinical manifestations to pneumonia, such as tuberculosis, pulmonary tumors, non-infectious interstitial lung disease,pulmonary edema,pulmonary embolism and atelectasis.Analysis of the incidence and mortality of SAP as well as the correlation with ischemic stroke site were performed in the three groups,respectively. Mean ± standard deviation (x ±s)was used to represent measurement data with normal distribution and t test was used.Percentage was used to represent enumeration data and χ2 test was used.Results The incidence of SAP was significantly higher in A2DS2 score ≥10 group compared with those in score 1-9 and score 0 groups (7 1.7%vs..22.7%,7 1.7%vs..3.7%,respectively),whereas the mortality in score ≥10 group was significantly higher than those in score 1-9 and score 0 groups (16.7%vs.4.96%,16.7%vs.0.3%,respectively).The incidences of cerebral infarction in posterior circulation and cross-MCA, ACA distribution areas were significantly higher in SAP group compared with those in non-SAP group (35.1%vs.10.1%,11.4%vs.7.5%,respectively).The incidence of non-fermentative bacteria infection was significantly increased in score ≥10 group.Conclusions A2DS2 score provides a basis for risk stratification of SAP.The prevention of SAP needs to be strengthened in acute ischemic stroke patients having a A2DS2 score ≥10.
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Objective To investigate the effect of diabetes on short-term prognosis of transient ischemic attack (TIA) in elderly patients.Methods From January 2006 to June 2010,126 patients with TIA aged over 60 years were selected.Patients were divided into diabetic group and non-diabetic group according to past history,blood glucose and glycosylated hemoglobin levels.The cumulative ischemic stroke incidences were analyzed by Kaplan-Meier survival analysis 30 days and 90 days after the first TIA.The risk factors for short-term stroke after TIA were analyzed by Cox regression analysis.Results Among 126 patients with TIA,31 cases (24.6％) had diabetes.The cumulative ischemic stroke incidences were significantly higher in diabetic group than in non-diabetic group 30 days and 90 days after the first TIA (54.8％ vs.22.1％,61.3％ vs.28.4％,both P＜0.01).Cox regression analysis revealed that diabetes and cerebral arterial stenosis were the risk factors for recurrent stroke within 90 days.Conclusions The short-term stroke incidence is significantly higher in elderly diabetic patients than in non-diabetic patients.Diabetes is the independent risk factor for recurrent stroke after TIA.
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Objective To observe senile plaque and iron deposition in cortex and hippocampus of the Alzheimer's disease ( AD ) transgenic mice and investigate their influence on T2 relaxation time.Method All AD transgeic mice were divided into three groups: young group(2,4 months), adult group (6,8,10 months), old group (12,14,16 months), and C57BL/6J mice were as control and were scanned in order by using 4.7 T MR system.Regions of interest (ROI) corresponding to cortex, hippocampus,thalamus, striatum were manually drawn on MR images and T2 MR relaxation times of each ROI were calculated.After MR scan, these mice were decapitated and stained for iron and senile palques.The number of plaque and iron, plaque burden, iron load in cortex and hippocampus were acquired using image pro plus software.Result T2 relaxation times of each group were as following: wild type ( cortex (49.5 ± 2.1 ) ms,hippocampus (51.6 ± 1.1 ) ms ); young ( cortex ( 49.7 ± 0.5 ) ms, hippocampus ( 50.7 ± 0.7 ) ms ); adult (cortex(47.2 ±0.8) ms, hippocampus(47.7 ±0.9) ms) and old (cortex(44.6 ±0.8) ms, hippocampus (45.3 ±0.4)ms).T2 relaxation times in cortex and hippocampus of each group had statistical differences ( cortex F = 18.620, P ＜ 0.01; hippocampus F = 67.925, P ＜ 0.01 ); Compared with young group and wild type mice, T2 relaxation times in corex and hippocampus of adult group mice were decreased significantly.At the same time, T2 relaxation times in old group mice were reduced compared with adult group ( Adult vs young: cortex q =4.284, P ＜0.01, hippocampus q =7.902, P ＜0.01; adult vs wild type: cortex q =4.424, P＜0.05, hippocampus q = 11.450, P ＜0.01; old w adult: cortex q =4.812, P ＜0.01,hippocampus q = 7.034, P ＜ 0.01 ).Histochemical staining for senile plaques found that senile plaques was deposited as early as 4 month.Iron deposition in hippocampus and cortex were detected by perl-DAB as early as 6 months of age, and there was an overall increase in number and load of plaques and iron with age.A positive correlation was observed between plaque burden and iron load ( r = 0.931, P ＜ 0.01 ).At the same time, plaque burden and iron load were negatively correlated with T2 relaxation times ( plaque burden and T2 relaxation times r = - 0.884, P ＜ 0.01; iron load and T2 relaxation times r = - 0.827, P ＜ 0.01 ).Conclusion The changes of T2 relaxation time in AD transgenic mice are attributed to iron and senile plaques.MR T2 relaxation time is a sensitive marker to diagnosis for AD and screen antidementia drugs.
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Objective To explore the value of color Doppler ultrasonography(CDU)as preoperative diagnosing and postoperative monitoring in patients with stenosis of subclavian or innominate artery(SIA)before and after percutaneous transluminal angioplasty and stent(PTAS).Methods A total of 45 patients with stenosis of SIA were selected.Their extracranial vertebral artery and subclavian artery were observed with CDU.In 36 patients with one-sided stenosis of SIA.blood flow direction and spectrum of extracranial vertebraI artery were analyzed.Subclavian steal grade confirmed by spectrum change of vertebral artery was compared with the stenosis grade on quantitative angiography(QA).Among 45 patients with stenosis of SIA,PTAS was performed successfully in 36 patients(36 stents implanted).After stents implanted, hemodynamie parameters such as peak systolic velocity(PSV)in stent, follow-up velocity ratio in stem(VR)were measured.Restenosis in stent were observed.Results In 36 patients with one-sided stenosis of SIA,the ultrasonographic steal grade correlated with the QA stenosis grade significantly(r=0.752,P<0.01).Among 36 patients with stent implanted,follow up 8-12 months, 4 patients with restenosis in stent were found.Compared with the patients without restenosis in stent,PSV and VR in stent increased significantly(P<0.01).Conclusions As a fast and non-invasive imaging technique,CDU could allow diagnosis of stenosis of SIA before PTAS,and detection of restenosis after PTAS.
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Platelet glycoprotein ⅡbⅢa receptor antagonists is a class of novel antiplatelet agents. This article explores the application and prospect of platelet glycoprotein ⅡbⅢa receptor antagonists in ischemic stroke from the aspects of its combination with thrombolytic agents, the application of carotid artery angioplasty and stenting (CAS), and be used alone.
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Objective To investigate the effectiveness,safety of the percutaneous transluminal angioplasty and stenting(PTAS) in the management of the vertebrobasilar stenosis.Methods From April 2003 to June 2004,the PTAS was performed in 28 patients with the vertebrobasilar stenosis.Results Among the 28 patients,the unilateral significant stenosis of the dominant vertebral artery was found in 18 patients,the bilateral stenosis of the vertebral artery in 4 patients,the tandem stenosis of the vertebral artery in 1 patient,the stenosis of the basilar artery in 2 patients.According to Mori's division,the type A occurred in 24 patients,the type B in 3 patients,the type C in 1 patient.The successful rate of stent implantation was 100% without any serious complication.Twenty-eight patients underwent PTAS with a mean pre-procedural vertebrobasilar stenosis of 81.3% and the residual stenosis was less than 10%.Over a mean 6-month follow-up in 17 patients,according to Malek's scale,the scale 1 was in 15 patients,the scale 2 in 2 patients.No restenosis was in 3 patients by the cerebral angiography.Conclusion PTAS in the management of the vertebrobasilar stenosis is a safe and effective method.Meanwhile,PTAS may alleviate the vertebrobasilar ischemia and prevent stroke of the vertebrobasilar system.
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Objective To investigate the clinical value of color doppler ultrasonography(CDU) to extracranial vertebral artery stenosis before and after percutaneous transluminal angioplasty and stent(PTAS) treatment.Methods 61 patients with extracranial vertebral artery stenosis confirmed by digital subtraction angiography(DSA) were detected by CDU on both sides of extracranial vertebral artery before and 3 d,30 d after PTAS.The flow volume(FV),peak systolic velocity(PSV) and resistance index(RI) at the site of C5-C6 segment and stenosis were as analysis targets.Results Before PTAS,80 stenotic extracranial vertebral arteries were found by CDU(mild degree 17 cases,moderate degree 38 cases,severe degree 25 cases).Compared with DSA,coincidence was 86.9%(77.3%,95.0%,83.3%).Among them,the coincidence of moderate extracranial vertebral artery stenosis detected by CDU was excellent(P0.05).Conclusion CDU has the important value in diagnosing extracranial vertebral artery stenosis,and can be used to follow up the blood hemodynamics in the extracranial vertebral artery of patients treated by PTAS.It provided a method for observing the efficacy of PTAS treatment.
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Objective To explore the relationship between the cognitive function and plasma somatostatin(SS) level in the patients with leukoaraiosis(LA).Methods According to the clinical findings and CT imaging,the subjects were divided into three groups:26 patients with LA and dementia, 47 patients with LA but without dementia, and the normal controls for 38 cases. The three groups were determined by means of Hasegawa's Dementia Scale(HDS)and SS levels in plasma.Results As compared with the control group,HDS score and plasma SS level in patients with LA (including dementia group and non dementia group) decreased remarkable(P0.05).Conclusion LA might be the cause of cognitive impairment,the concentrations of plasma SS had declined before dementia did not occur,the cognitive impairment in patients with LA might relate to the decrease of SS levels in the body.
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Objective To study the change of the level of serum cytokines in patients with epilepsy after cerebral infarction.Methods The levels of serum interleukin(IL)-2,IL-6 and tumor necrosis factor-?(TNF-?) in 87 patients with epilepsy after cerebral infarction(epilepsy group) and 75 normal controls(NC group) were measured by radioimmunoassay.Results The levels of TNF-?[(2.5 ?0.57)ng/L],IL-2[(9.0?0.83)ng/L] and IL-6 [(97.5?13.1)ng/L] in epilepsy group were significantly higher than those in the NC group[TNF-?(0.89?0.36)ng/L,IL-2(4.3?1.5)ng/L,IL-6(13.3?11.1)ng/L](all P