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Objective:To analyze the clinical characteristics and management strategy of carotid web (CW)-related stroke and improve the understanding of CW.Methods:The clinical data of 6 patients with CW-related stroke treated at Xuanwu Hospital, Capital Medical University, from January 2018 to September 2022 were retrospectively analyzed. Relevant data included clinical manifestations, bronchial magnetic resonance imaging (MRI), CT angiography (CTA)/digital subtraction angiography (DSA), carotid ultrasonography, and transcranial color-coded Doppler sonography (TCCD). Treatments and follow-ups were also reported.Results:All 6 patients were middle-aged or young, without traditional risk factors for cerebrovascular disease. The male-to-female ratio was 2∶4. All patients had recurrent strokes, with a score of 2-4 on the National Institutes of Health Stroke Scale at the time of onset. Head MRI showed 5 patients with cerebral infarction in the middle cerebral artery supply area; 1 patient had no intracranial infarction. No significant stenosis of the vessels at the site of the CW was observed in any of the 6 patients. Four patients had ipsilateral stenosis or occlusion of the middle cerebral artery, 1 patient had microembolic signals in the middle cerebral artery, and 1 patient had no significant abnormalities in the intracranial artery. All 6 patients were initially diagnosed by ultrasound. Diagnoses were confirmed by CTA/DSA in 5 cases; the other patient did not show any significant abnormalities. All 6 patients underwent a carotid endarterectomy after a pathological examination to confirm the diagnosis. Postoperatively, regular antiplatelet aggregation and statin lipid-lowering therapies were administered. A follow-up of 0.5 to 5.2 years showed no stroke recurrence in any patient.Conclusions:CW-related stroke is a rare cause of cryptogenic stroke and has a high recurrence rate. For stroke patients who do not have traditional risk factors for cerebrovascular disease while repeatedly experiencing embolic events of the internal carotid artery system, attention should be paid to the combination of the carotid and cerebral arteries, and comprehensive hemodynamic characteristics should be checked for the presence of a CW. Carotid artery ultrasound and TCCD combined with other imaging methods can improve the detection rate of a CW. Simple antiplatelet aggregation therapy cannot effectively prevent stroke recurrence. For patients with confirmed CW-related cerebral infarction, surgical resection can be performed, and the treatment effect can be evaluated using ultrasonography.
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Objective To analyze the correlation of characteristics of carotid artery structure and the incidence of residual stenosis after carotid artery stent (CAS) placement and its influencing factors using color Doppler flow imaging (CDFI).Methods Five hundred and ninety-six cases from January 2013 to December 2015 who underwent CAS (600 pieces of stent) were included in this study.All patients were examined by CDFI within 1 month before and 1 week after carotid artery stenting.The incidence of residual stenosis was analysed.The correlation of residual stenosis and the characteristics of carotid artery lesions and atherosclerotic plaque before stenting were analyzed respectively.Results There was positive correlation between the incidence rates of residual stenosis and irregularly shaped plaque (odd ratios,9.02;95% confidence interval,5.21-15.59,P<0.05),the plaques with calcification in the surface(odd ratios,2.55;95% confidence interval,1.45-4.49,P<0.05),the residual diameter of carotid stenosis less than 1.0 mm(odd ratios,1.61;95% confidence interval,1.06-2.45,P<0.05),which were the independent risk factors for influencing residual stenosis after CAS.Conclusions Choosing a more adaptable stent based on the characteristics of carotid artery lesions and atherosclerotic plaque by CDFI before stenting may be useful for the patients to get best result of revascularization.The rate of residual stenosis may be decreased.
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Objective To investigate the effect of serum lipid level on carotid artery stenosis in patients with ischemic cerebrovascular disease.Methods Using a multi-center cross-sectional study,10 711 consecutive inpatients with transient ischemic attack (TIA) or ischemic stroke diagnosed clearly in 20 stroke screening and prevention project base hospitals from June 2015 to May 2016 were enrolled.According to the results of carotid ultrasonography,1 560 patients with extracranial carotid artery stenosis rate≥50% screened were enrolled in the study.They were divided into a severe stenosis group (70%-99%) and a mild-moderate stenosis group (5.80 mmol/L (7.3%[43/586]vs.0.4%[4/974]) and LDL-C>3.12 mmol/L (26.3%[154/586]vs.10.0%[97/974]) in patients of the severe stenosis group were higher than those in the mild-moderate stenosis group (26.3%[154/586]vs.10.0%[97/974]).Conclusion The high LDL-C and TC levels may increase the incidence of severe carotid artery stenosis or occlusion.
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Objective To investigate the correlation between the stroke-related risk factors and carotid stenosis lesions of ≥40 year′s old Han and minority populations in a community in Beijing as well as the clinical value of carotid ultrasound screening. Methods An investigation of risk factors for stroke and the results of carotid artery ultrasound screening in 510 cases (≥40 years old) Han population and 243 minority population in a community in Minzu University of China in Beijing in April 2014 were analyzed. Results (1)The prevalence of hypertension of the Han population was significantly higher than that of the minority population (53. 5% [n=273] vs. 44. 4% [n=108]; χ2 =5. 43,P=0. 02). (2) The detected rate of carotid intima-media thickness ( IMT ) of the Han population was higher than that of the minority population (77. 5% [n=395] vs. 69. 1% [n=168]; χ2 =6. 03,P=0. 01). There was no significantly difference in the detected rates of carotid plaques and carotid artery stenosis between the two groups (χ2 =0. 56,1. 13 respectively,all P>0. 05). (3) Hypertension and smoking were the independent risk factors for carotid-intima thickening in Han population ( hypertension:OR,1. 851;95% CI 1. 213-2. 825; smoking:OR,2. 311;95% CI 1. 065-5. 016;all P<0. 05). Hyperlipidemia was an independent risk factor for carotid artery intima-media thickening in the minority population (OR,2. 586;95% CI 0. 952-8. 694,P<0. 01). Conclusion To investigate the risk factors for stroke in minority population in China are of particular importance for the prevention of carotid atherosclerotic disease. Carotid ultrasound examination is an important diagnostic technique for early detection of carotid atherosclerotic disease.
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ObjectiveTo retrospectively analyze the distribution of artery involvement above the aortic arch and differences incidence of cerebral ischemic in patients with Takayasu’s arteritis (TA) by color Doppler flow imaging (CDFI).MethodsA total of 84 cases (aged from 11 to 70 years old, median age 39 years old) continuous observed from August 2005 to June 2013 were included in this study. All patients were detected by CDFI and confirmed by digital subtraction angiography (DSA) and clinical examination. The distribution of the involved arteries were analyzed.ResultsA total of 924 vessels (84 patients) was detected, 352 (38.1%) arteries involved inflammatory lesions. The prevalence rate of female was higher than male (92.9% and 7.1%) significantly. The symptoms of cerebral ischemic included dizziness, syncope, TIA, amaurosis etc. The involvement rate of common carotid artery (CCA) was the highest (94.0%), followed by the subclavian arterythe (SA) (82.1%). The detecting rate of bilateral CCA was higher than that of bilateral SA, 75% and 50% (χ2=15.732,P=0.003), respectively. The rate of combined lesions of CCA and SA were higher in left (64.3%) than the right 56% (χ2=12.777,P=0.001). Most patients had multiple vascular (≥ 3 vessels) diseases (69.1%). No significant difference was found in the incidence of cerebral ischemia symptoms in patients with bilateral CCA or SA lesions (74.6% with78.6%) (χ2=0.219,P=0.411). No significant difference was found inthe patients with left or right CCA combined with SA lesions (76.5% with 76.4% ,χ2=1.230, P=0.602) also. The incidence of cerebral ischemia for greater than 3 vessel disease was significantly higher than less vessels (69.1% with 30.9%) (χ2=6.674,P=0.010).ConclusionThe study in the distribution of aortic arch vascular lesion for the patients with Takayasu arteritis by CDFI is valuable for the early detection and treatment of vascular lesions, and decresing the incidence of ischemic cerebrovascular disease.
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Objectives To screen the high-risk population of stroke in China using color Doppler flow imaging (CDFI)and to establish a stroke risk prediction model in Chinese population in order to prevent and treat stroke early. Methods Forty-one base hospitals and 715 286 people in the project areas of the first 6 provinces of China conducted routine physical examinations and investigated the related risk factors for cardiocerebrovascular diseases from July 2011 to April 2012 using a cross-sectional study,among them 61 860 patients underwent carotid CDFI screening,and 49 386 of them were high-risk population (exposed to≥3 risk factors). The bilateral common carotid interma-media thickness (IMT),the number of plaques and the degree of carotid stenosis were screened and documented. And whether carotid IMT thickening or not,with or without carotid plaques,and degree of carotid artery stenotic rate 0-49% and≥50% were performed by multivariate logistic regression analysis with the risk factors for stroke,respectively. Results (1)Logistic regression analysis showed that hypertension,atrial fibrillation,smoking,and lack of physical exercise were the independent risk factors for carotid IMT thickening (hypertension:OR,1. 17;95%CI 1. 12-1. 22;atrial fibrillation:OR,1. 15;95%CI 1. 09-1. 21;smoking:OR,1. 13;95%CI 1. 08-1. 17;and lack of physical exercise:OR,1. 12;95%CI 1.08-1. 16). (2)Hypertension,atrial fibrillation, smoking,and diabetes were the independent risk factors for carotid plaque and carotid artery stenosis rate≥50%(carotid plaque,hypertension:OR,1. 55;95%CI 1. 47-1. 62;atrial fibrillation:OR,1. 13;95%CI 1.06-1. 21;smoking:OR,1. 16;95%CI 1. 11-1. 22;and diabetes:OR,1. 30;95%CI 1. 24-1. 37). Carotid stenosis rate≥50%,hypertension:OR,1. 78;95%CI 1.55-2. 03;atrial fibrillation:OR,1. 59;95%CI 1. 39-1. 81;smoking:OR,1. 33;95%CI 1. 20-1. 48;and diabetes:OR,1. 30;95%CI 1. 17-1. 45. Simple obesity did not increase the incidences of carotid atherosclerotic plaque and carotid artery stenosis ≥50%(OR,0. 78, 0.83;95%CI 0. 75-0. 82 ,0. 75-0. 92,respectively). Conclusions Neck vascular ultrasound can be used as a valuable means for screening high-risk population and detecting risk factors of stroke. It has an important clinical significance for the early diagnosis and treatment of carotid atherosclerosis disease.
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<p><b>OBJECTIVE</b>To investigate the incidence of surgical site infection (SSI) and risk factors in colorectal cancer surgery patients.</p><p><b>METHODS</b>Between October 2003 and October 2013, 1 381 consecutive patients with colorectal cancer managed surgically with primary anastomosis were included in the study. There were 762 male and 619 female patients with mean body mass index (BMI) was (27.7 ± 3.7) kg/m², aged from 20 to 90 years with a median of 67 years. Patients undergoing emergency surgery and requiring stoma creation were excluded. The patients' characteristics, surgical conditions and prognosis were recorded. Univariate and multiple logistic regression analysis were used to identify any variable predictive factors of SSI.</p><p><b>RESULTS</b>One hundred twenty-six (9.12%) cases developed incisional SSI. The occurrence time for SSI was from 2 to 20 days, mean (6.7 ± 2.9) days. According to multivariable logistic regression analysis, BMI (OR = 1.058, P = 0.030), intraoperative contamination (OR = 10.549, P = 0.000) and open operation as compared with a laparoscopic procedure (OR = 2.111, P = 0.001) were significant independent predictors of incisional SSI. There was a significant decrease in incisional SSI in wound protectors group (OR = 1.646, P = 0.012).</p><p><b>CONCLUSION</b>BMI and intraoperative contamination are independent predictors of incisional SSI, and wound protectors and laparoscopic surgery are associated with a lower incidence of incisional SSI following colorectal cancer surgery.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Anastomosis, Surgical , Body Mass Index , Colorectal Neoplasms , General Surgery , Colorectal Surgery , Logistic Models , Prognosis , Retrospective Studies , Risk Factors , Surgical Wound InfectionABSTRACT
5-fluorouracil (5-Fu) as the most common adjuvant chemotherapy has been widely used for patients with colorectal cancer.As reported dihydropyrimidine dehydrogenase (DPD) has been known as an initial rate-limiting enzyme to catalyze approximately 80 ％ of administered dose of 5-Fu.However,patients with a partial or complete DPD deficiency because of the mutation of DPYD gene may suffer from diarrhea,stomatitis,hand-foot syndrome or neurotoxicity and even death.In this article,the application of DPYD gene screening in patients with colorectal cancer of current status and recent clinical application are reviewed.