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Brain magnetic resonance imaging (MRI) of the elderly often reveals white matter changes (WMCs) with substantial variability across individuals.Our study was designed to explore MRI features and site-specific factors of ischemic WMCs.Clinical data of consecutive patients diagnosed with ischemic cerebral vascular disease who had undergone brain MRI were collected and analyzed.Multi-logistic regression analysis comparing patients with mild versus severe WMCs was performed to detect independent associations.Analyses of variance (ANOVAs) were used to detect regionally specific differences in lesions.We found that lesion distribution differed significantly across five cerebral areas,with lesions being predominant in the frontal lobe and parieto-occipital area.To explore WMCs risk factors,after adjusting for gender,diabetes mellitus,and hypertension,only age (P＜0.01),creatinine (P=0.01),alkaline phosphatase (ALP) (P=0.01) and low-density lipoprotein cholesterol (LDL-C) (P=0.03) were found to be independently associated with severe WMCs.Age (P＜0.001) was strongly associated with WMCs in the frontal lobe while hypertension was independently related to lesions in the basal ganglia (P=0.048) or infratentorial area (P=0.016).In conclusion,MRI of WMCs showed that ischemic WMCs occurred mostly in the frontal lobe and parieto-occipital area.The infratentorial area was least affected by WMCs.Typically,age-related WMCs were observed in the frontal lobes,while hypertension-related WMCs tended to occur in the basal ganglia and infratentorial area.
ABSTRACT
Brain magnetic resonance imaging (MRI) of the elderly often reveals white matter changes (WMCs) with substantial variability across individuals.Our study was designed to explore MRI features and site-specific factors of ischemic WMCs.Clinical data of consecutive patients diagnosed with ischemic cerebral vascular disease who had undergone brain MRI were collected and analyzed.Multi-logistic regression analysis comparing patients with mild versus severe WMCs was performed to detect independent associations.Analyses of variance (ANOVAs) were used to detect regionally specific differences in lesions.We found that lesion distribution differed significantly across five cerebral areas,with lesions being predominant in the frontal lobe and parieto-occipital area.To explore WMCs risk factors,after adjusting for gender,diabetes mellitus,and hypertension,only age (P＜0.01),creatinine (P=0.01),alkaline phosphatase (ALP) (P=0.01) and low-density lipoprotein cholesterol (LDL-C) (P=0.03) were found to be independently associated with severe WMCs.Age (P＜0.001) was strongly associated with WMCs in the frontal lobe while hypertension was independently related to lesions in the basal ganglia (P=0.048) or infratentorial area (P=0.016).In conclusion,MRI of WMCs showed that ischemic WMCs occurred mostly in the frontal lobe and parieto-occipital area.The infratentorial area was least affected by WMCs.Typically,age-related WMCs were observed in the frontal lobes,while hypertension-related WMCs tended to occur in the basal ganglia and infratentorial area.
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Objective To evaluate the effectiveness of health education approach on the awareness of the diabetes knowledge among diabetic patients and to explore its influencing factors. Methods A total of 130 patients with diabetes mellitus who were hospitalized from 2015 to 2016 were enrolled in this study. Using self-control method, we compared the awareness rates of the diabetes knowledge at pre -hospital admission with pre-discharge from the hospital after the health education, and a logistic model was used to analyze related factors which might influence the awareness of the diabetes knowledge. Results Through health education, awareness rate of overall diabetes knowledge among patients increased from 18.90% to 75.59%. All the awareness rates of diabetes knowledge points increased significantly (all P<0.001) . After health education, the awareness rates of the knowledge on diabetes diagnosis basis and harmfulness of diabetes were still at the lowest level, accounting for 58.27% and 61.42% respectively, while the awareness rates of other diabetic knowledge were higher than 70%. Multivariable logistic regression analysis indicated that the OR value of improvement of overall awareness rate among diabetes patients younger than 50 years old was 0.040, compared to patients older than 50 years. The OR values among diabetes patients with less than 10 years, 10-19 years disease course were only 0.003 and 0.012, compared with patients with more than 20 years disease course. Conclusion Health education can effectively improve the awareness rates of diabetes knowledge in general. However, the intervention effectiveness was unsatisfactory among elder people or patients with short disease course.
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<p><b>BACKGROUND</b>The influence of blood pressure (BP) lowering on intracerebral hemorrhage (ICH) patients is unclear. To assess the safety and efficacy of aggressive antihypertensive therapies in acute ICH patients, we carried out a systematic review and meta-analysis.</p><p><b>METHODS</b>PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and VIP database up to July 2014 were searched. High-quality randomized controlled trials were included. Low-quality trials were excluded. Serious adverse events were defined as the primary outcome. The secondary outcomes were hematoma enlargement (HE) at 24 h after onset, mortality, and favorable clinical outcome at 90 days.</p><p><b>RESULTS</b>Four high-quality trials involving a total of 1427 patients met the inclusion criteria and were analyzed. Odds ratios (ORs) of primary outcome was 0.96 (95% confidence interval [CI ]: 0.82-1.13, P = 0.61). ORs of HE at 24 h after onset, mortality and favorable clinical outcome at 90 days were 0.91 (95% CI: 0.72-1.17, P = 0.47), 0.97 (95% CI: 0.79-1.20, P = 0.81), 1.13 (95% CI: 0.98-1.30, P = 0.09) respectively.</p><p><b>CONCLUSIONS</b>Aggressive BP management policies are safe and might have a potency of reducing HE and improving clinical outcome.</p>
Subject(s)
Humans , Antihypertensive Agents , Therapeutic Uses , Blood Pressure , Cerebral Hemorrhage , Drug Therapy , Hematoma , Drug Therapy , Randomized Controlled Trials as TopicABSTRACT
<p><b>BACKGROUND</b>Endovascular therapy plays an important role in the treatment of brain arteriovenous malformations (BAVMs). Ethylene vinyl alcohol copolymer (Onyx) is a novel liquid embolic material. This study aimed to summarize our experience of using Onyx for embolization of BAVMs with the focus on embolization technique.</p><p><b>METHODS</b>From September 2003 to November 2007, 115 patients (43 women and 72 men, with a mean age of 29 years) with BAVMs were endovascularly treated with Onyx in our department. The following features of all AVMs were evaluated prior to treatment: type of nidus and shunt, draining veins, and feeding arteries. A total of 196 endovascular procedures were performed.</p><p><b>RESULTS</b>The course of endovascular treatment was completed in 88 patients. Additional sessions were planned in 27 patients. Of the 88 patients, total occlusion was obtained in 23 patients (26.1%), near-total (> 80% of the original volume) occlusion was obtained in 35 patients (39.8%) and partial occlusion (< 80% of the original volume) was obtained in 30 patients (34.1%) using embolization as the sole therapeutic technique. Mean volume reduction was 72% (range 30% - 100%) in 115 patients. Thirty four patients (38.6%, 34/88) underwent radiosurgical treatment. Additional embolization sessions were planned in 27 patients. Complications occurred in 19 patients (16.5%, 19/115), leading to death in one patient (mortality 0.9%) and permanent disabling in 3 patients (morbidity 2.6%).</p><p><b>CONCLUSIONS</b>Onyx was shown to be feasible and safe for embolization of BAVMs. Proper use of the Onyx injection technique largely improved the endovascular treatment of BAVMs. Large AVMs can be adequately reduced in size through the use of additional treatment.</p>
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Arteriovenous Malformations , Pathology , Therapeutics , Brain Diseases , Pathology , Therapeutics , Embolization, Therapeutic , Methods , Polyvinyls , Therapeutic Uses , Treatment OutcomeABSTRACT
<p><b>BACKGROUND</b>Aneurysms with wide-necked or a large neck/fundus ratio, especially located on an arterial bifurcation or a small artery, are challenges for interventional neuroradiologist because of the risk of coil migration or coil protrusion into the parent vessels. Our study was designed to improve the efficacy and safety of the "remodeling technique" with the HyperForm balloon for these difficult aneurysms and was confirmed by a follow-up result.</p><p><b>METHODS</b>From June 2004 to September 2006, forty-two patients (20 men, 22 women) with wide-necked or large neck/fundus ratio aneurysms were treated by using the "remodeling technique" with the HyperForm balloon.</p><p><b>RESULTS</b>Forty wide-necked aneurysms were successfully treated with the HyperForm balloon remodeling technique with only two failed cases. Final results consisted of total occlusion in 34 cases (80.9%), subtotal in 4 (9.5%) and incomplete in 2 (4.8%). One aneurysmal rupture occurred, but no clinical consequence was shown. No thromboembolic events were observed during treatment. Final angiographic follow-up time ranged from 3 to 18 months.</p><p><b>CONCLUSIONS</b>The "remodeling technique" with the HyperForm balloon is a very useful tool in the treatment of wide-necked or unfavorable neck/fundus ratio intracranial aneurysms-located on an arterial bifurcation or a small artery and, especially, located on the bifurcation of a large artery and a small one. In our experience, this technique provided a safe and efficient treatment for difficult aneurysms when the standard remodeling technique might have failed.</p>
Subject(s)
Female , Humans , Male , Angioplasty, Balloon , Methods , Intracranial Aneurysm , TherapeuticsABSTRACT
<p><b>OBJECTIVE</b>To evaluate the efficacy of treating severe and chronic vertebral compressive fractures in the elderly with percutaneous vertebroplasty.</p><p><b>METHODS</b>Sixteen patients who suffered from severe back pain and whose daily living was badly affected were retrospectively reviewed. The average age was 72.5 years, the average disease history was 19 months, and the average compressive rate of the affected vertebral bodies was 74.1%.</p><p><b>RESULTS</b>Nineteen affected compressive vertebral bodies in 16 cases were treated with percutaneous vertebroplasty. All the procedures were successful without any complication. After 3.5-7 ml of cement was injected into the lesions, complete relief was achieved in 3 cases, remarkable relief was achieved in 11 cases, and improvement was observed in 2 cases. The scores of 6-point Behavioral Rating Scale and Activity of Daily Living (ADL) declined significantly after the treatment (P < 0.001).</p><p><b>CONCLUSION</b>Percutaneous vertebroplasty can significantly improve the symptoms and quality of life in the elderly patients with severe and chronic vertebral compressive fractures.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Activities of Daily Living , Back Pain , General Surgery , Bone Cements , Therapeutic Uses , Fractures, Spontaneous , General Surgery , Lumbar Vertebrae , General Surgery , Orthopedic Procedures , Methods , Osteoporosis , Quality of Life , Retrospective Studies , Spinal Fractures , General Surgery , Thoracic Vertebrae , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To investigate the efficacy of percutaneous vertebroplasty in the treatment of vertebral hemangioma.</p><p><b>METHODS</b>Seven patients with vertebral hemangiomas were treated by percutaneous vertebroplasty, including one case of cervical, three cases of thoracic, and three cases of lumbar hemangiomas. The average score of the 6-point behavioral pain rating scale was 2.67 +/- 0.41, and the average score of ambulation was 2.83 +/- 0.33. Guilty vertebral bodies were orientated with fluoroscopy. The procedures were performed under local anesthesia. The image features were also analyzed. Unipedicular or bipedicular approaches were used in 6 cases of thoracic and lumbar hemangiomas. The cervical anterior-lateral approach was adopted in one case of cervical hemangioma. 4-7 ml of 15%-20% bone cement was mixed and injected into the vertebral body to form a cast in the lesions. Re-examination of clinical symptoms, plain film, and CT were made for 1, 3, and 9 months of post-procedure follow-up.</p><p><b>RESULTS</b>Good results were achieved in all the seven cases. Pain was completely relieved in 5 cases and partially relieved in 2 cases. Symptom was also recovered in 2 patients with radiculopathy. No recurrence was found after 1-9 months of postoperative follow-up.</p><p><b>CONCLUSION</b>Treatment of vertebral hemangioma with percutaneous vertebroplasty is safe and effective with minimal invasion.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Cervical Vertebrae , General Surgery , Follow-Up Studies , Hemangioma , General Surgery , Lumbar Vertebrae , General Surgery , Orthopedic Procedures , Methods , Pain Measurement , Spinal Neoplasms , General Surgery , Thoracic Vertebrae , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To primarily embolize intracranial aneurysms with new-developed mechanically detachable coils, which is called Detachable Coil System (DCS).</p><p><b>METHODS</b>Five intracranial aneurysms were embolized with DCS, in which 2 were giant aneurysms. DCS with J coils were initially used to make baskets in giant aneurysms, and then other kinds of coils were utilized to pact the aneurysmal cavity. Whereas, spiral coils were mostly used in smaller aneurysms. Coils of DCS were detached by rotating the delivering wire after the coils were satisfactorily positioned in aneurysms.</p><p><b>RESULTS</b>Two of the 5 cases were totally occluded with DCS. Two was sub-totally embolized. Pushing, withdrawal, and adjusting of DCS were safe and efficient. Detachment of DCS was fast. In one case of wide-necked giant aneurysm, coils could not stay inside the aneurysm, which was treated by occlusion of the parent artery.</p><p><b>CONCLUSIONS</b>DCS is a new addition to the interventional radiologist's armamentarium. Detachment is faster. J coils are suitable for giant aneurysms for its unique way of coiling. But more evaluation depends on accumulation of the clinical usage.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Embolization, Therapeutic , Methods , Intracranial Aneurysm , TherapeuticsABSTRACT
We used 4 methods,such as ultrasonic crush(UC),ultrasonic rinse(UR),whorl surge(WS)and rubbing(RU),to isolate epiphytic bacteria from red alga Gracilaria lemaneiformis.Then,we counted bacteria numbers,detected bacterial species,observed bacterial configuration and characteristic of cell wall.Compared with these methods and with different treatments in one method,the results were drawn:the UR and RU were inferior in all methods to isolate bacterial numbers and species,the UC and WS were better,especially,the treatment 30W 30s of UC was the best in experiment,which isolated 12 of 16 bacterial species,and got 1.75 10~6 cells per gram wet weight G.lemaneiformis.