ABSTRACT
Objective: To investigate the neuroprotective effect of limb remote ischemic preconditioning (rIPC) on patients with ischemic cerebrovascular disease. Methods: A total of 145 patients with previous history of transient ischemic attack (TIA) or cerebral infarction treated regularly by drugs and all the risk factors controlled within the normal range were enrolled. They were diagnosed as multiple extracranial or intracranial stenosis with imaging. They were divided into a limb rIPC group (n = 85) and a control group (n = 60) according to the ratio of 3/2. Both groups were in strict accordance with the medication of U. S. Stroke and transient ischemic attack secondary prevention guidelines 2011 and controlled the risk factors. At the same time, the rIPC group was given limb ischemic preconditioning training, using a dual-arm sphygmomanometer to pressurize both upper limbs to 180-200 mm Hg, maintained for 5 minutes, and deflated and rested for 5 minutes as a cycle. The continuous training was 5 cycles each time, once a day for 6 months. The neurological improvement and re-infarction rate of patients were observed. Thirty-five patients in the rIPC group and 26 in the control group received single photon emission computed tomography (SPECT) examination. The improvement of cerebral blood flow and metabolism was observed. Results: Circled digit oneCompared to the condition before treatment, the neurological deficits were improved in 71 patients (83.5%) in the rIPC group and 40 in the control group after treatment. There was significant difference (P <0.05). Circled digit twoMRI examination showed that 3 patients (3.5%) in the rIPC group and 8 (13.3%) in the control group had recurrent cerebral infarction. There was significant difference (P <0.05). Circled digit threeCompared to the condition before treatment, the SPECT examination showed that cerebral metabolism and cerebral blood flow were improved in 29 patients (82.9%) in the rIPC group and 13 (50.0%) in the control group. There was significant difference between the 2 groups (P <0.01). Circled digit fourAfter rIPC, no patients had heart rate, blood pressure changes, and other discomforts. Conclusion: Limb ischemia preconditioning may obviously improve neurological deficits caused by ischemic stroke, improve the cerebral blood flow and metabolism, and prevent the recurrence of cerebral infarction.
ABSTRACT
Objective To determine the survival rate of HIV/AIDS patients after receiving free antiretroviral treatment in Dehong prefecture, Yunnan province. Methods A retrospective cohort analysis was conducted on all the HIV/AIDS patients aged over 16 years who had started antiretroviral treatment during January 2007 throughout December 2009 in Dehong prefecture.Results A total of 3103 HIV/AIDS patients had received antiretroviral treatment during the study period. Among them, the mean age was (36.0 ± 9.9) years and 62.4% were males. 66.2% of them were infected with HIV through heterosexual transmission, and the mean treatment follow-up time was 21.7 months. Most patients well complied with the treatment, i.e., the average times of not taking the medicine were less than 5 per month. The cumulative survival rate of antiretroviral treatment after 1, 2, 3, 4, and 5 years were 0.95, 0.94, 0.93, 0.92, and 0.92, respectively. Data from the Cox proportional hazard regression model analysis indicated that, after adjustment for age, gender, and marital status, the baseline CD4+T cell counts and transmission route could significantly predicate the rates of survival. Those who were with baseline CD4+T cell counts as 200-350/mm3 were less likely to die of AIDS than those with CD4+T cell counts ＜200/mm3 (Hazard Ratio or HR=0.16, 95%CI:0.09-0.28), and HIV-infected through mother-to-child transmission or routes other than heterosexual transmission were less likely to die of AIDS than through injecting drug use (HR=0.35, 95% CI:0.13-1.00). Conclusion Free antiretroviral treatment had significantly improved the survival of HIV/AIDS patients. Earlier initiation of antiretroviral treatment was likely to have achieved better survival effects.